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Ho VNA, Ho TM, Vuong LN, García-Velasco J. An update on the current indications for in vitro maturation. Curr Opin Obstet Gynecol 2024; 36:173-180. [PMID: 38295060 DOI: 10.1097/gco.0000000000000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
PURPOSE OF REVIEW In vitro maturation has become a significant component of modern assisted reproductive techniques. Published data have been supported for the safety and effectiveness of in vitro maturation treatment. In recent years, potential indications for in vitro maturation (IVM) have been a topic of interest and investigation. RECENT FINDINGS Significant improvements in technique enhancement and data publication for evaluating the efficacy of IVM have been achieved. Recent studies have shown that IVM could offer several advantages over in vitro fertilization. Currently, there are growing indications for IVM beyond the commonly mentioned indication of infertile women with polycystic ovary syndrome. Additionally, some potential candidates might have significant advantages for IVM, such as women diagnosed with gonadotropin resistance ovary syndrome or those seeking fertility preservation. With a better understanding of IVM, from basic science to clinical practice, it can be applied safely, effectively, and affordably to a broader range of patients, making it a more accessible and patient-friendly option. SUMMARY Despite the possibly acknowledged limitations, the potential of in vitro maturation cannot be denied. As this technique becomes increasingly accessible to patients and more continuous efforts are dedicated to advancing this technique, the impact of in vitro maturation is expected.
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Affiliation(s)
- Vu N-A Ho
- IVFMD and HOPE research center, My Duc Hospital
| | - Tuong M Ho
- IVFMD and HOPE research center, My Duc Hospital
| | - Lan N Vuong
- IVFMD and HOPE research center, My Duc Hospital
- Department of obstetrics and gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam
| | - Juan García-Velasco
- IVIRMA Global and IVI Madrid, Madrid
- IVI Foundation, IIS La Fe, Valencia
- Rey Juan Carlos University, Madrid, Spain
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Saucedo-Cuevas L, Ma MPQ, Le AH, Akin N, Pham TD, Ho TM, Pita G, Gonzalez-Neira A, De Vos M, Smitz J, Anckaert E, Vuong LN. Epigenetic variation in neonatal tissues in infants conceived using capacitation-in vitro maturation vs. in vitro fertilization. Fertil Steril 2024; 121:506-518. [PMID: 38052376 DOI: 10.1016/j.fertnstert.2023.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 11/30/2023] [Accepted: 11/30/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE To investigate alterations of the global DNA methylation profile in placenta, cord blood, and neonatal buccal smears in infants conceived using in vitro maturation (IVM) with a prematuration step (capacitation-IVM [CAPA-IVM]) vs. in vitro fertilization (IVF). DESIGN Analysis of data from the offspring of participants in a randomized controlled trial. SETTING Private clinic. PATIENTS Forty-six women with polycystic ovary syndrome and/or high antral follicle count and their offspring (58 newborns). INTERVENTION(S) Women with polycystic ovary syndrome and/or a high antral follicle count participating in the clinical trial were randomized to undergo CAPA-IVM or conventional IVF. MAIN OUTCOME MEASURE(S) At delivery, biological samples including cord blood, placental tissue, and a neonatal buccal smear were collected. Genome-wide DNA methylation was determined using the Illumina Infinium MethylationEPIC BeadChip. Variability in methylation was also considered, and mean variances for the two treatment categories were compared. RESULTS In neonatal buccal smears, there were no significant differences between the CAPA-IVM and conventional IVF groups on the basis of the CpG probe after linear regression analysis using a significant cut-off of false-discovery rate <0.05 and |Δβ|≥0.05. In cord blood, only one CpG site showed a significant gain of methylation in the CAPA-IVM group. In the placenta, CAPA-IVM was significantly associated with changes in methylation at five CpG sites. Significantly more variable DNA methylation was found in five probes in the placenta, 54 in cord blood, and two in buccal smears after IVM of oocytes. In cord blood samples, 20 CpG sites had more variable methylation in the conventional IVF vs. IVM group. Isolated CpG sites showing differences in methylation in cord blood were not associated with changes in gene expression of the overlapping genes. CONCLUSION(S) Capacitation-IVM appeared to be associated with only a small amount of epigenetic variation in cord blood, placental tissue, and neonate buccal smears. CLINICAL TRIAL REGISTRATION NUMBER NCT03405701 (www. CLINICALTRIALS gov).
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Affiliation(s)
- Laura Saucedo-Cuevas
- Follicle Biology Laboratory, UZ Brussel, Vrije Universiteit Brussel, Brussel, Belgium
| | - Mai P Q Ma
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam; HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Anh H Le
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam; HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Nazli Akin
- Follicle Biology Laboratory, UZ Brussel, Vrije Universiteit Brussel, Brussel, Belgium
| | - Toan D Pham
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam; HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Tuong M Ho
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam; HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Guillermo Pita
- Human Genotyping Unit-CeGen, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Anna Gonzalez-Neira
- Human Genotyping Unit-CeGen, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Michel De Vos
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium; Department of Obstetrics, Gynecology, Perinatology, and Reproductology, Institute of Professional Education, Sechenov University, Moscow, Russia
| | - Johan Smitz
- Follicle Biology Laboratory, UZ Brussel, Vrije Universiteit Brussel, Brussel, Belgium
| | - Ellen Anckaert
- Follicle Biology Laboratory, UZ Brussel, Vrije Universiteit Brussel, Brussel, Belgium
| | - Lan N Vuong
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
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Le PTB, Nguyen TTT, Dang TTH, Nguyen TC, Duong TP, Le AH, Ho TM, Vuong LN. Embryological and clinical outcomes in couples with severe male factor infertility versus normozoospermia. Eur J Obstet Gynecol Reprod Biol 2024; 294:123-127. [PMID: 38237310 DOI: 10.1016/j.ejogrb.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 11/07/2023] [Accepted: 01/11/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE This study evaluated embryological and clinical outcomes in couples with severe male factor infertility versus those with normozoospermia undergoing ICSI and in vitro fertilisation. METHODS This multicentre, retrospective cohort study included all couples who had undergone autologous ICSI cycles at My Duc Hospital and My Duc Phu Nhuan Hospital in Vietnam between January 2018 and January 2021 (female age < 35 years and males with severe male factor or normozoospermia based on the World Health Organization 2010 criteria). The primary outcome was the cumulative live birth rate after the first ICSI cycle. RESULTS A total of 1296 couples were included, including 648 with severe male factor infertility and 648 with normozoospermia. The number of two pronuclei zygotes, embryos, and frozen embryos was significantly lower in couples with severe male factor infertility compared with normozoospermia (p < 0.05). In contrast, there were no significant differences between the two groups with respect to cumulative pregnancy outcomes, including the live birth rate, and secondary outcomes including clinical pregnancy rate, ongoing pregnancy rate, and miscarriage rate. CONCLUSION Severe male factor infertility appeared to have an impact on the fertilisation and early developmental potential of embryos, but sperm quality did not affect cumulative clinical fertility outcomes.
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Affiliation(s)
- Phuong T B Le
- IVFMD Phu Nhuan, My Duc Phu Nhuan Hospital, Ho Chi Minh City, Viet Nam; HOPE Research Center, Ho Chi Minh City, Viet Nam.
| | - Trinh T T Nguyen
- IVFMD Phu Nhuan, My Duc Phu Nhuan Hospital, Ho Chi Minh City, Viet Nam; HOPE Research Center, Ho Chi Minh City, Viet Nam
| | - Trang T H Dang
- IVFMD, My Duc Phu Nhuan Hospital, Ho Chi Minh City, Viet Nam; HOPE Research Center, Ho Chi Minh City, Viet Nam
| | - Tri C Nguyen
- IVFMD, My Duc Phu Nhuan Hospital, Ho Chi Minh City, Viet Nam; HOPE Research Center, Ho Chi Minh City, Viet Nam
| | - Toan P Duong
- IVFMD, My Duc Phu Nhuan Hospital, Ho Chi Minh City, Viet Nam; HOPE Research Center, Ho Chi Minh City, Viet Nam
| | - Anh H Le
- IVFMD Phu Nhuan, My Duc Phu Nhuan Hospital, Ho Chi Minh City, Viet Nam; HOPE Research Center, Ho Chi Minh City, Viet Nam
| | - Tuong M Ho
- IVFMD Phu Nhuan, My Duc Phu Nhuan Hospital, Ho Chi Minh City, Viet Nam; IVFMD, My Duc Phu Nhuan Hospital, Ho Chi Minh City, Viet Nam; HOPE Research Center, Ho Chi Minh City, Viet Nam
| | - Lan N Vuong
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
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Hochberg A, Dahan MH, Yarali H, Vuong LN, Esteves SC. Significance of serum AMH and antral follicle count discrepancy for the prediction of ovarian stimulation response in Poseidon criteria patients. J Assist Reprod Genet 2024; 41:717-726. [PMID: 38358433 PMCID: PMC10957796 DOI: 10.1007/s10815-024-03050-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024] Open
Abstract
PURPOSE To determine the risk of not being a poor responder in ovarian stimulation (OS) for in vitro fertilization (IVF) when ovarian reserve markers are discordant-one falling within Poseidon's criteria normal range (e.g., anti-Müllerian hormone (AMH) ≥ 1.2 ng/mL or antral follicle count (AFC) ≥ 5), and the other in the poor ovarian reserve range. METHODS A tri-center retrospective cohort study (2015-2017) involving women with discordant AMH and AFC values undergoing their first IVF/ICSI cycle using conventional OS (cOS, ≥ 150 IU/day of follicle-stimulating hormone). Discordant serum AMH and AFC values were defined according to Poseidon's criteria (AMH < 1.2 ng/mL and AFC ≥ 5 or AMH ≥ 1.2 ng/mL and AFC < 5). Poor ovarian response (POR) was < 4 retrieved oocytes. Receiver operating characteristic (ROC) curves were used to determine AMH and AFC cut-offs for non-POR. Logistic regression analysis evaluated factors associated with non-POR. RESULTS Out of 8797 patients who underwent assessment with both AMH and AFC, 1172 (13.3%) exhibited discordant values. Of these, 854 (72.9%) had ≥ 4 oocytes retrieved. Within this group, 726 (85.0%) had "low" AMH values, whereas 128 (15.0%) had "low" AFCs. An AFC of 6 had 77% sensitivity and 52% specificity (AUC = 0.700), while AMH of 1.19 ng/mL had 31% sensitivity and 85% specificity (AUC = 0.492) for non-POR. AFC and the use of recombinant gonadotropins were positive predictors of non-POR. CONCLUSIONS When serum AMH is < 1.19 ng/mL, but AFC is ≥ 6, there is a moderate likelihood of a non-POR during stimulation. Conversely, if AFC is < 5 but serum AMH is ≥ 1.19 ng/mL, the chances of non-POR are low. Among patients with discordant markers, AFC emerges as the primary predictor of oocyte yield.
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Affiliation(s)
- Alyssa Hochberg
- Department of Obstetrics and Gynecology, McGill University, 845 Rue Sherbrooke, O, Montreal, QC, 3HA 0G4, Canada.
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Michael H Dahan
- Department of Obstetrics and Gynecology, McGill University, 845 Rue Sherbrooke, O, Montreal, QC, 3HA 0G4, Canada
| | - Hakan Yarali
- Anatolia IVF, Ankara, Turkey
- Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Lan N Vuong
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil
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Hochberg A, Dahan MH, Yarali H, Vuong LN, Esteves SC. Clinical factors associated with unexpected poor or suboptimal response in Poseidon criteria patients. Reprod Biomed Online 2024; 49:103852. [PMID: 38657290 DOI: 10.1016/j.rbmo.2024.103852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 04/26/2024]
Abstract
RESEARCH QUESTION What clinical factors are associated with 'unexpected' poor or suboptimal responses to IVF ovarian stimulation per POSEIDON's criteria, and which AMH and AFC threshold values distinguish this population? DESIGN Tri-centre retrospective cohort study (2015-2017) involving first-time IVF and ICSI cycles with conventional ovarian stimulation (≥150 IU/day of FSH). Eligibility criteria included sufficient ovarian reserve markers according to POSEIDON's classification (AMH ≥1.2 ng/ml; AFC ≥5). Ovarian response categories were poor (<4 oocytes), suboptimal (4-9 oocytes) and normal (≥9 oocytes). Primary outcomes included clinical factors associated with an unexpected poor or suboptimal response to conventional ovarian stimulation using logistic regression analyses, and the threshold values of AMH and AFC predicting increased risk of such responses using ROC curves. RESULTS A total of 7625 patients met the inclusion criteria: 204 (9.3%) were poor and 1998 (90.7%) were suboptimal responders. Logistic regression identified significant clinical predictors for a poor or suboptimal response, including AFC, AMH, total gonadotrophin dose, gonadotrophin type and trigger type (P ≤ 0.02). The ROC curves indicated that AMH 2.87 ng/ml (AUC 0.740) and AFC 12 (AUC 0.826) were the threshold values predicting a poor or suboptimal response; AMH 2.17 ng/ml (AUC 0.741) and AFC 9 (AUC 0.835) predicted a poor response; and AMH 2.97 ng/ml (AUC 0.722) and AFC 12 (AUC 0.801) predicted a suboptimal response. CONCLUSIONS The threshold values of AMH and AFC predicting 'unexpected' poor or suboptimal response were higher than expected. These findings have critical implications for tailoring IVF stimulation regimens and dosages.
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Affiliation(s)
- Alyssa Hochberg
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada.; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel..
| | - Michael H Dahan
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
| | - Hakan Yarali
- Anatolia IVF, Ankara, Turkey.; Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Lan N Vuong
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.; IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam.; HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil
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Gilchrist RB, Ho TM, De Vos M, Sanchez F, Romero S, Ledger WL, Anckaert E, Vuong LN, Smitz J. A fresh start for IVM: capacitating the oocyte for development using pre-IVM. Hum Reprod Update 2024; 30:3-25. [PMID: 37639630 DOI: 10.1093/humupd/dmad023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/08/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND While oocyte IVM is practiced sporadically it has not achieved widespread clinical practice globally. However, recently there have been some seminal advances in our understanding of basic aspects of oocyte biology and ovulation from animal studies that have led to novel approaches to IVM. A significant recent advance in IVM technology is the use of biphasic IVM approaches. These involve the collection of immature oocytes from small antral follicles from minimally stimulated patients/animals (without hCG-priming) and an ∼24 h pre-culture of oocytes in an advanced culture system ('pre-IVM') prior to IVM, followed by routine IVF procedures. If safe and efficacious, this novel procedure may stand to make a significant impact on human ART practices. OBJECTIVE AND RATIONALE The objectives of this review are to examine the major scientific advances in ovarian biology with a unique focus on the development of pre-IVM methodologies, to provide an insight into biphasic IVM procedures, and to report on outcomes from animal and clinical human data, including safety data. The potential future impact of biphasic IVM on ART practice is discussed. SEARCH METHODS Peer review original and review articles were selected from PubMed and Web of Science searches for this narrative review. Searches were performed using the following keywords: oocyte IVM, pre-IVM, biphasic IVM, CAPA-IVM, hCG-triggered/primed IVM, natural cycle IVF/M, ex-vivo IVM, OTO-IVM, oocyte maturation, meiotic competence, oocyte developmental competence, oocyte capacitation, follicle size, cumulus cell (CC), granulosa cell, COC, gap-junction communication, trans-zonal process, cAMP and IVM, cGMP and IVM, CNP and IVM, EGF-like peptide and IVM, minimal stimulation ART, PCOS. OUTCOMES Minimizing gonadotrophin use means IVM oocytes will be collected from small antral (pre-dominant) follicles containing oocytes that are still developing. Standard IVM yields suboptimal clinical outcomes using such oocytes, whereas pre-IVM aims to continue the oocyte's development ex vivo, prior to IVM. Pre-IVM achieves this by eliciting profound cellular changes in the oocyte's CCs, which continue to meet the oocyte's developmental needs during the pre-IVM phase. The literature contains 25 years of animal research on various pre-IVM and biphasic IVM procedures, which serves as a large knowledge base for new approaches to human IVM. A pre-IVM procedure based on c-type natriuretic peptide (named 'capacitation-IVM' (CAPA-IVM)) has undergone pre-clinical human safety and efficacy trials and its adoption into clinical practice resulted in healthy live birth rates not different from conventional IVF. WIDER IMPLICATIONS Over many decades, improvements in clinical IVM have been gradual and incremental but there has likely been a turning of the tide in the past few years, with landmark discoveries in animal oocyte biology finally making their way into clinical practice leading to improved outcomes for patients. Demonstration of favorable clinical results with CAPA-IVM, as the first clinically tested biphasic IVM system, has led to renewed interest in IVM as an alternative, low-intervention, low-cost, safe, patient-friendly ART approach, and especially for patients with PCOS. The same new approach is being used as part of fertility preservation in patients with cancer and holds promise for social oocyte freezing.
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Affiliation(s)
- Robert B Gilchrist
- Fertility & Research Centre, Discipline of Women's Health, School of Clinical Medicine, University of New South Wales Sydney, NSW, Australia
| | - Tuong M Ho
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Michel De Vos
- Brussels IVF, UZ Brussel, Brussels, Belgium
- Follicle Biology Laboratory, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Flor Sanchez
- Centro de Estudios e Investigaciones en Biología y Medicina Reproductiva, Lima, Peru
| | - Sergio Romero
- Laboratory of Reproductive Biology and Fertility Preservation, Cayetano Heredia University (UPCH), Lima, Peru
- Centro de Fertilidad y Reproducción Asistida, Lima, Peru
| | - William L Ledger
- Fertility & Research Centre, Discipline of Women's Health, School of Clinical Medicine, University of New South Wales Sydney, NSW, Australia
- City Fertility, Global CHA IVF Partners, Sydney, NSW, Australia
| | - Ellen Anckaert
- Follicle Biology Laboratory, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lan N Vuong
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Johan Smitz
- Follicle Biology Laboratory, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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Tran VTT, Ly LD, Nguyen MHN, Pham TD, Tran LTH, Tran MTN, Ho VNA, Nguyen NT, Hoang HLT, Vuong LN. Thyroid Peroxidase Antibodies in Infertile Women with Polycystic Ovary Syndrome. Reprod Sci 2023; 30:3071-3076. [PMID: 37171775 DOI: 10.1007/s43032-023-01261-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/05/2023] [Indexed: 05/13/2023]
Abstract
To compare the rate of positive thyroid peroxidase antibodies (TPO Ab) between women with different polycystic ovary syndrome (PCOS) phenotypes and women without PCOS. This is a retrospective cohort study. Women with PCOS at My Duc Hospital between June 1, 2020, and March 27, 2021, were matched with non-PCOS women by age. TPO Ab (cut-off: 34 IU/mL) and thyroid-stimulating hormone (TSH) levels were measured as markers of Hashimoto thyroiditis and thyroid function, respectively. One thousand eight hundred eight infertile women were included, 904 with PCOS (mean age 29.0 ± 3.58 years) and 904 without PCOS (29.1 ± 3.4 years; controls). Women with PCOS had a higher body mass index (22.8 ± 3.84 vs. 19.9 ± 2.23 kg/m2, p < 0.001), but most were not overweight/obese. Rates of positive TPO Ab in women with versus without PCOS were 8.2% and 8.4%, respectively (p = 0.932). Rates of positive TPO Ab in patients with PCOS phenotype A, B, C, or D were not statistically different (7.5%, 2.9%, 20.0%, and 7.8%, respectively). Median TSH concentrations were similar in the PCOS and control groups (1.84 mIU/L vs. 1.78 mIU/L, respectively; p = 0.194). Based on a linear regression model, there was no correlation between either BMI or the estradiol to progesterone ratio and TPO Ab status. In a large population of infertile women with PCOS who were mostly lean patients, rates of positive TPO Ab across all four PCOS phenotypes did not differ significantly from those in women without PCOS. These findings did not support the hypothesis that PCOS is a risk factor for Hashimoto thyroiditis.
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Affiliation(s)
- Van T T Tran
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Luong D Ly
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam.
- School of Medicine, Vietnam National University Ho Chi Minh City, Ho Chi Minh City, Vietnam.
- Endocrinology Clinic, My Duc Hospital, Ho Chi Minh City, Vietnam.
| | - Minh H N Nguyen
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Toan D Pham
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Loc T H Tran
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Mai T N Tran
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
- Endocrinology Clinic, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Vu N A Ho
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Nam T Nguyen
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Hieu L T Hoang
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Lan N Vuong
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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Abbara A, Phylactou M, Eng PC, Clarke SA, Pham TD, Ho TM, Ng KY, Mills EG, Purugganan K, Hunjan T, Salim R, Comninos AN, Vuong LN, Dhillo WS. Endocrine Responses to Triptorelin in Healthy Women, Women With Polycystic Ovary Syndrome, and Women With Hypothalamic Amenorrhea. J Clin Endocrinol Metab 2023; 108:1666-1675. [PMID: 36653328 PMCID: PMC10271229 DOI: 10.1210/clinem/dgad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 01/20/2023]
Abstract
CONTEXT Limited data exist regarding whether the endocrine response to the gonadotropin-releasing hormone receptor agonist (GnRHa) triptorelin differs in women with polycystic ovary syndrome (PCOS) compared with healthy women or those with hypothalamic amenorrhea (HA). OBJECTIVE We compared the gonadotropin response to triptorelin in healthy women, women with PCOS, or those with HA without ovarian stimulation, and in women with or without polycystic ovaries undergoing oocyte donation cycles after ovarian stimulation. METHODS The change in serum gonadotropin levels was determined in (1) a prospective single-blinded placebo-controlled study to determine the endocrine profile of triptorelin (0.2 mg) or saline-placebo in healthy women, women with PCOS, and those with HA, without ovarian stimulation; and (2) a retrospective analysis from a dose-finding randomized controlled trial of triptorelin (0.2-0.4 mg) in oocyte donation cycles after ovarian stimulation. RESULTS In Study 1, triptorelin induced an increase in serum luteinizing hormone (LH) of similar amplitude in all women (mean peak LH: healthy, 52.3; PCOS, 46.2; HA, 41.3 IU/L). The AUC of change in serum follicle-stimulating hormone (FSH) was attenuated in women with PCOS compared with healthy women and women with HA (median AUC of change in serum FSH: PCOS, 127.2; healthy, 253.8; HA, 326.7 IU.h/L; P = 0.0005). In Study 2, FSH levels 4 hours after triptorelin were reduced in women with at least one polycystic morphology ovary (n = 60) vs normal morphology ovaries (n = 91) (34.0 vs 42.3 IU/L; P = 0.0003). Serum anti-Müllerian hormone (AMH) was negatively associated with the increase in FSH after triptorelin, both with and without ovarian stimulation. CONCLUSION FSH response to triptorelin was attenuated in women with polycystic ovaries, both with and without ovarian stimulation, and was negatively related to AMH levels.
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Affiliation(s)
- Ali Abbara
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 ONN, UK
- Department of Endocrinology and Diabetes, Imperial College Healthcare NHS Trust, London W12 0NN, UK
| | - Maria Phylactou
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 ONN, UK
- Department of Endocrinology and Diabetes, Imperial College Healthcare NHS Trust, London W12 0NN, UK
| | - Pei Chia Eng
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 ONN, UK
- Department of Endocrinology and Diabetes, Imperial College Healthcare NHS Trust, London W12 0NN, UK
| | - Sophie A Clarke
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 ONN, UK
- Department of Endocrinology and Diabetes, Imperial College Healthcare NHS Trust, London W12 0NN, UK
| | - Toan D Pham
- HOPE Research Centre, My Duc Hospital, Ho Chi Minh City 700000, Vietnam
| | - Tuong M Ho
- HOPE Research Centre, My Duc Hospital, Ho Chi Minh City 700000, Vietnam
| | - Kah Yan Ng
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 ONN, UK
| | - Edouard G Mills
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 ONN, UK
- Department of Endocrinology and Diabetes, Imperial College Healthcare NHS Trust, London W12 0NN, UK
| | - Kate Purugganan
- Department of Endocrinology and Diabetes, Imperial College Healthcare NHS Trust, London W12 0NN, UK
| | - Tia Hunjan
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 ONN, UK
| | - Rehan Salim
- Department of Endocrinology and Diabetes, Imperial College Healthcare NHS Trust, London W12 0NN, UK
| | - Alexander N Comninos
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 ONN, UK
- Department of Endocrinology and Diabetes, Imperial College Healthcare NHS Trust, London W12 0NN, UK
| | - Lan N Vuong
- HOPE Research Centre, My Duc Hospital, Ho Chi Minh City 700000, Vietnam
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam
| | - Waljit S Dhillo
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 ONN, UK
- Department of Endocrinology and Diabetes, Imperial College Healthcare NHS Trust, London W12 0NN, UK
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9
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Pham HH, Le AH, Nguyen AM, Ha UD, Nguyen TC, Pham TD, Le HL, Le TK, Huynh BG, Ho TM, Vuong LN. Cumulative live birth rate after oocyte in vitro maturation with a pre-maturation step in women with polycystic ovary syndrome or high antral follicle count. J Assist Reprod Genet 2023; 40:827-835. [PMID: 36821006 PMCID: PMC10224896 DOI: 10.1007/s10815-023-02752-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 02/13/2023] [Indexed: 02/24/2023] Open
Abstract
PURPOSE This study evaluated the 24-month cumulative live birth rate (CLBR) for women with polycystic ovary syndrome (PCOS) or high antral follicle count (AFC) who underwent oocyte in vitro maturation (IVM) with pre-maturation step (CAPA-IVM). METHODS This multicenter, retrospective study was performed at IVFMD, My Duc Hospital, and IVFMD Phu Nhuan, My Duc Phu Nhuan Hospital from 1 January 2017 to 31 December 2019. All women with PCOS or high AFC treated with a CAPA-IVM cycle were included. Cumulative live birth was defined as at least one live birth resulting from the initiated CAPA-IVM cycle. Where a woman did not return for embryo transfer, outcomes were followed up until 24 months from the day of oocyte aspiration. Logistic regression was performed to identify factors predicting the CLBR. RESULTS Data from 374 women were analyzed, 368 of whom had embryos for transfer (98.4%), and six had no embryos for transfer (1.6%). The oocyte maturation rate was 63.2%. The median number of frozen embryos was 4 [quartile 1, 2; quartile 3, 6]. Cumulative clinical pregnancy and ongoing pregnancy rates were 60.4% and 43.6%, respectively. At 24 months after starting CAPA-IVM treatment, the CLBR was 38.5%. Multivariate analysis showed that patient age and number of frozen embryos were significant predictors of cumulative live birth after CAPA-IVM. CONCLUSIONS CAPA-IVM could be considered as an alternative to in vitro fertilization for the management of infertility in women with PCOS or a high AFC who require assisted reproductive technology.
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Affiliation(s)
- Huy H Pham
- IVMFD Phu Nhuan, My Duc Phu Nhuan Hospital, 43R/2-4 Ho Van Hue, Phu Nhuan District, Ho Chi Minh City, Vietnam.
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam.
| | - Anh H Le
- IVMFD Phu Nhuan, My Duc Phu Nhuan Hospital, 43R/2-4 Ho Van Hue, Phu Nhuan District, Ho Chi Minh City, Vietnam
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Anh M Nguyen
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Uyen D Ha
- IVMFD Phu Nhuan, My Duc Phu Nhuan Hospital, 43R/2-4 Ho Van Hue, Phu Nhuan District, Ho Chi Minh City, Vietnam
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Tri C Nguyen
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Toan D Pham
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Ho L Le
- IVMFD Phu Nhuan, My Duc Phu Nhuan Hospital, 43R/2-4 Ho Van Hue, Phu Nhuan District, Ho Chi Minh City, Vietnam
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Tien K Le
- IVMFD Phu Nhuan, My Duc Phu Nhuan Hospital, 43R/2-4 Ho Van Hue, Phu Nhuan District, Ho Chi Minh City, Vietnam
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Bao G Huynh
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Tuong M Ho
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Lan N Vuong
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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10
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Tran VTT, Nguyen NA, Nguyen NT, Vo TTM, Uong TS, Nguyen HT, Nguyen NT, Pham TD, Nguyen MHN, Vuong LN, Mol BW, Dang VQ. Development of children born to women with twin pregnancies treated with cervical pessary or vaginal progesterone: Follow-up of a randomized controlled trial. Acta Obstet Gynecol Scand 2023; 102:626-634. [PMID: 36905390 PMCID: PMC10072250 DOI: 10.1111/aogs.14545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 01/23/2023] [Accepted: 02/14/2023] [Indexed: 03/12/2023]
Abstract
INTRODUCTION Preterm birth is the most common cause of neonatal morbidity and mortality. Women with twin pregnancies and a short cervical length are at high risk for preterm birth. Vaginal progesterone and cervical pessary have been proposed as potential strategies to reduce preterm birth in this high-risk population. Therefore, we aimed to compare the effectiveness of cervical pessary and vaginal progesterone in improving developmental outcomes of children born to women with twin pregnancies and mid-trimester short cervical length. MATERIAL AND METHODS This was a follow-up study (NCT04295187) of all children at 24 months of age, born from women treated with cervical pessary or progesterone to prevent preterm birth in a randomized controlled trial (NCT02623881). We used a validated Vietnamese version of Ages & Stages Third Edition Questionnaires (ASQ-3) and a red flag questionnaire. In surviving children, we compared the mean ASQ-3 scores, abnormal ASQ-3 scores, the number of children with any abnormal ASQ-3 scores and red flag signs between the two groups. We reported the composite outcome of perinatal death or survival with any abnormal ASQ-3 score in offspring. These outcomes were also calculated in a subgroup of women with a cervical length ≤28 mm (<25th percentile). RESULTS In the original randomized controlled trial, we randomized 300 women to pessary or progesterone. After counting the number of perinatal deaths and lost to follow-up, 82.8% parents in the pessary group and 82.5% parents in progesterone group returned the questionnaire. The mean ASQ-3 scores of the five skills and red flag signs did not differ significantly between the two groups. However, the percentage of children having abnormal ASQ-3 scores in fine motor skills was significantly lower in the progesterone group (6.1% vs 1.3%, P = 0.01). There were no significant differences in the composite outcome of perinatal death or survival with any abnormal ASQ-3 score in unselected women and in those with cervical length ≤28 mm. CONCLUSIONS Cervical pessary and vaginal progesterone may have comparable effects on developmental outcomes in children at ≥24 months of age, born to women with twin pregnancies and short cervical length. However, this finding could be likely due to a lack of study power.
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Affiliation(s)
- Van T T Tran
- My Duc Hospital, Ho Chi Minh City, Vietnam.,HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Nghia A Nguyen
- HOPE Research Center, Ho Chi Minh City, Vietnam.,University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nam T Nguyen
- My Duc Hospital, Ho Chi Minh City, Vietnam.,HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Thu T M Vo
- HOPE Research Center, Ho Chi Minh City, Vietnam.,My Duc Phu Nhuan Hospital, Ho Chi Minh City, Vietnam
| | - Truong S Uong
- HOPE Research Center, Ho Chi Minh City, Vietnam.,My Duc Phu Nhuan Hospital, Ho Chi Minh City, Vietnam
| | - Hau T Nguyen
- My Duc Hospital, Ho Chi Minh City, Vietnam.,HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Ngan T Nguyen
- My Duc Hospital, Ho Chi Minh City, Vietnam.,HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Toan D Pham
- My Duc Hospital, Ho Chi Minh City, Vietnam.,HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Minh H N Nguyen
- My Duc Hospital, Ho Chi Minh City, Vietnam.,HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Lan N Vuong
- HOPE Research Center, Ho Chi Minh City, Vietnam.,University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.,Aberdeen Centre for Women's Health Research, University of Aberdeen, Aberdeen, UK
| | - Vinh Q Dang
- My Duc Hospital, Ho Chi Minh City, Vietnam.,HOPE Research Center, Ho Chi Minh City, Vietnam
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11
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Cluver C, de Groot C, Mol BW, Murphy KE, Norman JE, Pacagnella R, Palmer K, Poon LC, Rolnik DL, Spong CY, Stock SJ, Thangaratinam S, Tong S, Verhoeven C, Vuong LN, Walker SP, Xiaohua L. The need for appropriate language in the debate on medicalisation of pregnancy. Lancet 2023; 401:818-819. [PMID: 36906342 DOI: 10.1016/s0140-6736(23)00125-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/16/2023] [Indexed: 03/11/2023]
Affiliation(s)
- Catherine Cluver
- Department of Obstetrics & Gynecology, Stellenbosch University, Stellenbosch, South Africa
| | - Christianne de Groot
- Department of Obstetrics & Gynecology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Ben W Mol
- Department of Obstetrics and Gynecology, Monash University, Clayton, VIC 3168, Australia; Department of Medical Sciences and Nutrition, School of Medicine, University of Aberdeen, Aberdeen, UK.
| | - Kellie E Murphy
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, ON, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | - Jane E Norman
- Executive Office, University of Nottingham, Nottingham, UK
| | - Rodolfo Pacagnella
- Department of Obstetrics & Gynecology, University of Campinas, Campinas, Brazil
| | - Kirsten Palmer
- Department of Obstetrics and Gynecology, Monash University, Clayton, VIC 3168, Australia
| | - Liona C Poon
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Daniel L Rolnik
- Department of Obstetrics and Gynecology, Monash University, Clayton, VIC 3168, Australia
| | - Catherine Y Spong
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center and Parkland Health, Dallas, TX, USA
| | - Sarah J Stock
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Shakila Thangaratinam
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Stephen Tong
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; Department of Obstetrics & Gynecology, University of Melbourne, Melbourne VIC, Australia
| | - Corine Verhoeven
- Department of Midwifery Science, University of Amsterdam, Amsterdam, Netherlands; Midwifery Academy, Amsterdam Groningen, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, Netherlands; Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands; Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, UK; Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, Netherlands
| | - Lan N Vuong
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy Ho Chi Minh, Ho Chi Minh, Viet Nam
| | - Sue P Walker
- Department of Obstetrics & Gynecology, University of Melbourne, Melbourne VIC, Australia
| | - Liu Xiaohua
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
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12
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Vuong LN, Pham TD, Ho TM, De Vos M. Outcomes of clinical in vitro maturation programs for treating infertility in hyper responders: a systematic review. Fertil Steril 2023; 119:540-549. [PMID: 36754159 DOI: 10.1016/j.fertnstert.2023.01.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/24/2023] [Accepted: 01/31/2023] [Indexed: 02/08/2023]
Abstract
Oocyte in vitro maturation (IVM) has been proposed as an alternative to conventional ovarian stimulation (COS) in subfertile women with polycystic ovary syndrome. To evaluate the effectiveness and safety of IVM compared with COS in women with predicted hyperresponse to gonadotropins, we searched the published literature for relevant studies comparing any IVM protocol with any COS protocol followed by in vitro fertilization or intracytoplasmic sperm injection. A systematic review was undertaken on 3 eligible prospective studies. Live birth rate was not significantly lower after IVM vs. COS (odds ratio [95% confidence interval] of 0.56 [0.32-1.01] overall, 0.83 [0.63-1.10] for human chorionic gonadotropin (hCG)-triggered IVM [hCG-IVM] and 0.45 [0.18-1.13] for non-hCG-triggered IVM [non-hCG-IVM]), irrespective of the stage of transferred embryos. Data from nonrandomized studies generally showed either significantly low or statistically comparable rates of live birth with IVM vs. COS. Most studies have not identified any significant difference between IVM and COS with respect to the rates of obstetric or perinatal complications, apart from a potentially higher rate of hypertensive disorders during pregnancy. The development of offspring from IVM and COS with in vitro fertilization or intracytoplasmic sperm injection appears to be similar. Additional research is needed to identify which patient populations will benefit most from IVM, to define the appropriate clinical protocol, and to develop the optimal culture system.
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Affiliation(s)
- Lan N Vuong
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam; IVF My Duc, My Duc Hospital and HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Toan D Pham
- IVF My Duc, My Duc Hospital and HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Tuong M Ho
- IVF My Duc, My Duc Hospital and HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Michel De Vos
- Brussels IVF, Center for Reproductive Medicine, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium.
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13
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Chong KY, Solangon S, Barnhart K, Causa-Andrieu P, Capmas P, Condous G, de Waard L, Duffy JM, Horne AW, Memtsa M, Mol F, Oza M, Pesce R, Strandell A, van Wely M, Hooft JV', Vuong LN, Zhang J, Jurkovic D, Mol BW. A core outcome set for future research in ectopic pregnancy - an international consensus development study. Fertil Steril 2023; 119:804-812. [PMID: 36736812 DOI: 10.1016/j.fertnstert.2023.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/26/2023] [Accepted: 01/26/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Randomised controlled trials (RCTs) evaluating ectopic pregnancy have different outcomes which are defined and measured in diverse ways, which limits their ability to inform evidence-based clinical practice. OBJECTIVE To address methodological deficiencies in published RCTs and systematic reviews, this study has developed a core outcome set to guide future research in ectopic pregnancy. DESIGN To identify potential outcomes, we performed a comprehensive literature review and interviews with individuals with lived experience in ectopic pregnancy. Potential core outcomes were then entered into a three-round Delphi survey. 154 participants from six continents, comprising healthcare professionals, researchers, and individuals with lived experience in ectopic pregnancy, completed all three rounds of the Delphi survey. Outcomes were prioritised at three consensus development meetings and recommendations were developed on how to report these outcomes where possible. SUBJECTS Healthcare professionals, researchers, and individuals with lived experience in ectopic pregnancy RESULTS: Six outcomes reached full consensus, including treatment success, resolution time, number of additional interventions, adverse events, mortality and severe morbidity, and treatment satisfaction. CONCLUSION The core outcome set with six outcomes for ectopic pregnancy will help standardise reporting of clinical trials, facilitate implementation of findings into clinical practice, and enhance patient centred care.
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Affiliation(s)
- Krystle Y Chong
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia; Monash Women's, Monash Health, Clayton, Australia.
| | - Sarah Solangon
- Institute for Women's Health, University College London, London, UK
| | - Kurt Barnhart
- Department of Obstetrics and Gynecology; Division of Reproductive Endocrinology & Infertility, Penn Medicine/University of Pennsylvania School of Medicine, Philadelphia PA, USA
| | - Pamela Causa-Andrieu
- Department of Radiology. Memorial Sloan Kettering Cancer Center, New York, United States
| | - Perrine Capmas
- Department of Obstetrics and Gynecology, Bicetre University Hospital, Paris Saclay University, Le Kremlin Bicêtre, France
| | - George Condous
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School Nepean, University of Sydney, Nepean Hospital, NSW, Australia
| | - Liesl de Waard
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - James Mn Duffy
- Institute for Women's Health, University College London, London, UK; King's Fertility, Fetal Medicine Research Institute, London, UK
| | - Andrew W Horne
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Maria Memtsa
- Institute for Women's Health, University College London, London, UK
| | - Femke Mol
- Center for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Netherlands
| | | | - Romina Pesce
- Department of Obstetrics and Gynecology; Division of Reproductive Medicine. Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Annika Strandell
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Madelon van Wely
- Center for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Netherlands
| | - Janneke van 't Hooft
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Lan N Vuong
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Jian Zhang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, China
| | - Davor Jurkovic
- Institute for Women's Health, University College London, London, UK
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia; Monash Women's, Monash Health, Clayton, Australia; Aberdeen Centre for Women's Health Research, University of Aberdeen Aberdeen, UK
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14
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Esteves SC, Yarali H, Vuong LN, Conforti A, Humaidan P, Alviggi C. POSEIDON groups and their distinct reproductive outcomes: Effectiveness and cost-effectiveness insights from real-world data research. Best Pract Res Clin Obstet Gynaecol 2022; 85:159-187. [PMID: 35725717 DOI: 10.1016/j.bpobgyn.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 12/14/2022]
Abstract
The Patient-Oriented Strategies Encompassing IndividualizeDOocyte Number (POSEIDON) criteria identify and classify the so-called 'low-prognosis' patients undergoing assisted reproductive technology (ART). Recent large-scale studies using real-world data (RWD) have shown that patients classified under this system have distinct reproductive outcomes. Moreover, these studies also confirm that POSEIDON patients are commonly found in fertility centers. RWD has substantiated the validity of the POSEIDON biomarkers' thresholds (antral follicle count [AFC] and/or anti-Müllerian hormone [AMH]) for patient classification. Lastly, a predictive model has been developed and validated to estimate the POSEIDON metric of success (i.e., number of oocytes needed to achieve at least one euploid blastocyst). Although more evidence is needed in this area, current insights from RWD research indicate that infertility patients can be counseled and managed more effectively under the POSEIDON scope, with potential gains for all parties involved.
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Affiliation(s)
- Sandro C Esteves
- Andrology and Human Reproduction Clinic, Av. Dr. Heitor Penteado, 1464, Campinas, Brazil; Faculty of Health, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Hakan Yarali
- Anatolia IVF and Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Lan N Vuong
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam; IVFMD, My Duc Hospital, Ho Chi Minh City, Viet Nam; HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Viet Nam
| | - Alessandro Conforti
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples, Federico II, Naples, Italy
| | - Peter Humaidan
- Faculty of Health, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Fertility Clinic Skive, Skive Regional Hospital, Skive & Aarhus University, Aarhus, Denmark
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples, Federico II, Naples, Italy
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15
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Tran TD, Vu PM, Pham HT, Au LN, Do HP, Doan HT, Huynh N, Huynh QT, Le BK, Ngo DQ, Nguyen HT, Nguyen KD, Nguyen NA, Nguyen PH, Nguyen TA, Tran TC, Chau HN, Vuong LN, Vu NV. Transforming medical education to strengthen the health professional training in Viet Nam: A case study. Lancet Reg Health West Pac 2022; 27:100543. [PMID: 35874914 PMCID: PMC9301568 DOI: 10.1016/j.lanwpc.2022.100543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
UNLABELLED The competency-based undergraduate curriculum reform at the University of Medicine and Pharmacy at Ho Chi Minh City, Faculty of Medicine (UMP-FM) is detailed and reviewed in reference to the instructional and institutional reforms, and enabling actions recommended by the Lancet 2010 Commission for Health Professional Education. Key objectives are to: revise the overall 6-year curriculum to be more integrated and competency-based; reinforce students' knowledge application, problem-solving, clinical competence, self-directed learning and soft skills; develop a comprehensive and performance-based student assessment programme; and establish a comprehensive quality monitoring programme to facilitate changes and improvements. New features include early introduction to the practice of medicine, family- and community-based medicine, professionalism, interprofessional education, electives experiences, and a scholarly project. Institutional reform introduces a faculty development programme, joint planning mechanism, a "culture of critical inquiry", and a transparent faculty reward system. Lessons learnt from the curriculum reform at UMP-FM could be helpful to medical schools from low- and middle-income countries considering transitioning from a traditional to a competency-based curriculum. FUNDING This work receives no external funding.
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Affiliation(s)
- Tuan D. Tran
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Phuc M. Vu
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Hong T.M. Pham
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Luan N. Au
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Hung P. Do
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Hoa T.T. Doan
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Nghia Huynh
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Quynh T.V. Huynh
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Bao K. Le
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Dat Q. Ngo
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Hanh T.M. Nguyen
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Khanh D. Nguyen
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Nghia A. Nguyen
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Phong H. Nguyen
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Tuan A. Nguyen
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Thang C. Tran
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Hoa N. Chau
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Lan N. Vuong
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Nu V. Vu
- Unit of Development and Research in Medical Education, University of Geneva Faculty of Medicine, Geneva, Switzerland
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16
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Wang R, McLernon DJ, Lai S, Showell MG, Chen ZJ, Wei D, Legro RS, Wang Z, Sun Y, Wu K, Vuong LN, Hardy P, Pinborg A, Stormlund S, Santamaría X, Simón C, Blockeel C, Mol F, Ferraretti AP, Shapiro BS, Garner FC, Li R, Venetis CA, Mol BW, Bhattacharya S, Maheshwari A. Individual participant data meta-analysis of trials comparing fr ozen versus f resh e mbryo transfer strategy (INFORM): a protocol. BMJ Open 2022; 12:e062578. [PMID: 35851030 PMCID: PMC9297209 DOI: 10.1136/bmjopen-2022-062578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Existing randomised controlled trials (RCTs) comparing a freeze-all embryo transfer strategy and a fresh embryo transfer strategy have shown conflicting results. A freeze-all or a fresh transfer policy may be preferable for some couples undergoing in-vitro fertilisation (IVF), but it is unclear which couples would benefit most from each policy, how and under which protocols. Therefore, we plan a systematic review and individual participant data meta-analysis of RCTs comparing a freeze-all and a fresh transfer policy. METHODS AND ANALYSIS We will search electronic databases (Medline, Embase, PsycINFO and CENTRAL) and trial registries (ClinicalTrials.gov and the International Clinical Trials Registry Platform) from their inception to present to identify eligible RCTs. We will also check reference lists of relevant papers. The search was performed on 23 September 2020 and will be updated. We will include RCTs comparing a freeze-all embryo transfer strategy and a fresh embryo transfer strategy in couples undergoing IVF. The primary outcome will be live birth resulting from the first embryo transfer. All outcomes listed in the core outcome set for infertility research will be reported. We will invite the lead investigators of eligible trials to join the Individual participant data meta-analysis of trials comparing frozen versus fresh embryo transfer strategy (INFORM) collaboration and share the deidentified individual participant data (IPD) of their trials. We will harmonise the IPD and perform a two-stage meta-analysis and examine treatment-covariate interactions for important baseline characteristics. ETHICS AND DISSEMINATION The study ethics have been granted by the Monash University Human Research Ethics Committee (Project ID: 30391). The findings will be disseminated via presentations at international conferences and publication in peer-reviewed journals. PROSPERO REGISTRATION NUMBER CRD42021296566.
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Affiliation(s)
- Rui Wang
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - David J McLernon
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Shimona Lai
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Marian G Showell
- Obstetrics and Gynaecology, University of Aukland, Auckland, New Zealand
| | - Zi-Jiang Chen
- Centre for Reproductive Medicine, Shandong University, Jinan, Shandong, China
| | - Daimin Wei
- Centre for Reproductive Medicine, Shandong University, Jinan, Shandong, China
| | - Richard S Legro
- Department of Obstetrics and Gynecology and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Ze Wang
- Centre for Reproductive Medicine, Shandong University, Jinan, Shandong, China
| | - Yun Sun
- Shanghai Key laboratory for Assisted Reproduction and Reproductive Genetics, Center for Reproductive Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Keliang Wu
- Centre for Reproductive Medicine, Shandong University, Jinan, Shandong, China
| | - Lan N Vuong
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Pollyanna Hardy
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Anja Pinborg
- Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Sacha Stormlund
- Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Xavier Santamaría
- Igenomix Foundation, INCLIVA Health Research Institute, Valencia, Spain
| | - Carlos Simón
- Igenomix Foundation, INCLIVA Health Research Institute, Valencia, Spain
| | - Christophe Blockeel
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Femke Mol
- Centre for Reproductive Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Bruce S Shapiro
- Department of Obstetrics and Gynecology, Kirk Kerkorian School of Medicine, Las Vegas, NV, USA
- Fertility Center of Las Vegas, Las Vegas, NV, USA
| | - Forest C Garner
- Department of Obstetrics and Gynecology, Kirk Kerkorian School of Medicine, Las Vegas, NV, USA
- Fertility Center of Las Vegas, Las Vegas, NV, USA
| | - Rong Li
- Centre for Reproductive Medicine, Peking University Third Hospital, Beijing, China
| | - Christos A Venetis
- Centre for Big Data Research in Health & School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Siladitya Bhattacharya
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Abha Maheshwari
- Aberdeen Centre of Reproductive Medicine, NHS Grampian, Aberdeen, UK
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Vuong LN, Chau MN, Nguyen DL, Pham TD, Mol BW, Ho TM. COVID-19 vaccination in pregnancy: Experience in Viet Nam. Eur J Obstet Gynecol Reprod Biol 2022; 274:251-252. [PMID: 35597722 PMCID: PMC9106409 DOI: 10.1016/j.ejogrb.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/11/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Lan N Vuong
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam; HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Viet Nam.
| | - Minh N Chau
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Viet Nam; My Duc Hospital, Ho Chi Minh City, Viet Nam
| | - Duy L Nguyen
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Viet Nam
| | - Toan D Pham
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Viet Nam
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Tuong M Ho
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Viet Nam; My Duc Hospital, Ho Chi Minh City, Viet Nam
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Pham HH, Vu TM, Nguyen CH, Le AH, Nguyen DP, Pham TD, Ho TM, Vuong LN. Effect of post‐warming culture time on the live birth rate after frozen embryo transfer. Reprod Med Biol 2022; 21:e12465. [PMID: 35662890 PMCID: PMC9150497 DOI: 10.1002/rmb2.12465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/10/2022] [Accepted: 04/26/2022] [Indexed: 01/06/2023] Open
Abstract
Purpose Methods Results Conclusions
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Affiliation(s)
- Huy H. Pham
- IVFMD Phu Nhuan My Duc Phu Nhuan Hospital Ho Chi Minh City Vietnam
- HOPE Research Center My Duc Hospital Ho Chi Minh City Vietnam
| | - Trinh M. Vu
- IVFMD Phu Nhuan My Duc Phu Nhuan Hospital Ho Chi Minh City Vietnam
- HOPE Research Center My Duc Hospital Ho Chi Minh City Vietnam
| | - Chau H. Nguyen
- IVFMD Phu Nhuan My Duc Phu Nhuan Hospital Ho Chi Minh City Vietnam
- HOPE Research Center My Duc Hospital Ho Chi Minh City Vietnam
| | - Anh H. Le
- IVFMD Phu Nhuan My Duc Phu Nhuan Hospital Ho Chi Minh City Vietnam
- HOPE Research Center My Duc Hospital Ho Chi Minh City Vietnam
| | - Dung P. Nguyen
- IVFMD Phu Nhuan My Duc Phu Nhuan Hospital Ho Chi Minh City Vietnam
- HOPE Research Center My Duc Hospital Ho Chi Minh City Vietnam
| | - Toan D. Pham
- HOPE Research Center My Duc Hospital Ho Chi Minh City Vietnam
| | - Tuong M. Ho
- HOPE Research Center My Duc Hospital Ho Chi Minh City Vietnam
- IVFMD My Duc Hospital Ho Chi Minh City Vietnam
| | - Lan N. Vuong
- HOPE Research Center My Duc Hospital Ho Chi Minh City Vietnam
- Department of Obstetrics and Gynecology University of Medicine and Pharmacy at Ho Chi Minh City Ho Chi Minh City Vietnam
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Vuong LN, Huynh N, Ngo DQ, Nguyen VN, Duong KD, Tran NN, Le TP, Nguyen NA, Doan TTP, Pham DL, Trinh THK, Vu QTT, Nguyen PH, Tran TD. A Community-Based Model of Care During the Fourth Wave of the COVID-19 Outbreak in Ho Chi Minh City, Vietnam. Front Artif Intell 2022; 5:831841. [PMID: 35481282 PMCID: PMC9037370 DOI: 10.3389/frai.2022.831841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/04/2022] [Indexed: 12/23/2022] Open
Abstract
In response to a call for help during a surge in coronavirus disease-19 (COVID-19) cases in Ho Chi Minh City in July 2021, the University of Medicine and Pharmacy at Ho Chi Minh City developed and implemented a community care model for the management of patients with COVID-19. This was based on three main principles: home care; providing monitoring and care at a distance; and providing timely emergency care if needed. One team supported patients at home with frequent contacts and remote monitoring, while a second team transferred and cared for patients requiring treatment at field emergency care facilities. COVID-19-related mortality rates at the two districts where this approach was implemented (0.43% and 0.57%) were substantially lower than the overall rate in Ho Chi Minh City over the same period (4.95%). Thus, utilization of a community care model can increase the number of patients with COVID-19 who can be effectively managed from home, and use of field emergency care facilities limited the number of patients that had to be referred for tertiary care. Importantly, the community care model also markedly reduced the mortality rate compared with traditional methods of COVID-19 patient management.
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Rimmer MP, Howie RA, Anderson RA, Barratt CLR, Barnhart KT, Beebeejaun Y, Bertolla RP, Bhattacharya S, Björndahl L, Bortoletto P, Brannigan RE, Cantineau AEP, Caroppo E, Collura BL, Coward K, Eisenberg ML, De Geyter C, Goulis DG, Henkel RR, Ho VNA, Hussein AF, Huyser C, Kadijk JH, Kamath MS, Khashaba S, Kobori Y, Kopeika J, Kucuk T, Luján S, Matsaseng TC, Mathur RS, McEleny K, Mitchell RT, Mol BW, Murage AM, Ng EHY, Pacey A, Perheentupa AH, Du Plessis S, Rives N, Sarris I, Schlegel PN, Shabbir M, Śmiechowski M, Subramanian V, Sunkara SK, Tarlarzis BC, Tüttelmann F, Vail A, van Wely M, Vazquez-Levin MH, Vuong LN, Wang AY, Wang R, Zini A, Farquhar CM, Niederberger C, Duffy JMN. Protocol for developing a core outcome set for male infertility research: an international consensus development study. Hum Reprod Open 2022; 2022:hoac014. [PMID: 35402735 PMCID: PMC8990106 DOI: 10.1093/hropen/hoac014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/08/2022] [Indexed: 11/27/2022] Open
Abstract
STUDY QUESTION We aim to develop, disseminate and implement a minimum data set, known as a core outcome set, for future male infertility research. WHAT IS KNOWN ALREADY Research into male infertility can be challenging to design, conduct and report. Evidence from randomized trials can be difficult to interpret and of limited ability to inform clinical practice for numerous reasons. These may include complex issues, such as variation in outcome measures and outcome reporting bias, as well as failure to consider the perspectives of men and their partners with lived experience of fertility problems. Previously, the Core Outcome Measure for Infertility Trials (COMMIT) initiative, an international consortium of researchers, healthcare professionals and people with fertility problems, has developed a core outcome set for general infertility research. Now, a bespoke core outcome set for male infertility is required to address the unique challenges pertinent to male infertility research. STUDY DESIGN SIZE DURATION Stakeholders, including healthcare professionals, allied healthcare professionals, scientists, researchers and people with fertility problems, will be invited to participate. Formal consensus science methods will be used, including the modified Delphi method, modified Nominal Group Technique and the National Institutes of Health's consensus development conference. PARTICIPANTS/MATERIALS SETTING METHODS An international steering group, including the relevant stakeholders outlined above, has been established to guide the development of this core outcome set. Possible core outcomes will be identified by undertaking a systematic review of randomized controlled trials evaluating potential treatments for male factor infertility. These outcomes will be entered into a modified Delphi method. Repeated reflection and re-scoring should promote convergence towards consensus outcomes, which will be prioritized during a consensus development meeting to identify a final core outcome set. We will establish standardized definitions and recommend high-quality measurement instruments for individual core outcomes. STUDY FUNDING/COMPETING INTERESTS This work has been supported by the Urology Foundation small project award, 2021. C.L.R.B. is the recipient of a BMGF grant and received consultancy fees from Exscentia and Exceed sperm testing, paid to the University of Dundee and speaking fees or honoraria paid personally by Ferring, Copper Surgical and RBMO. S.B. received royalties from Cambridge University Press, Speaker honoraria for Obstetrical and Gynaecological Society of Singapore, Merk SMART Masterclass and Merk FERRING Forum, paid to the University of Aberdeen. Payment for leadership roles within NHS Grampian, previously paid to self, now paid to University of Aberdeen. An Honorarium is received as Editor in Chief of Human Reproduction Open. M.L.E. is an advisor to the companies Hannah and Ro. B.W.M. received an investigator grant from the NHMRC, No: GNT1176437 is a paid consultant for ObsEva and has received research funding from Ferring and Merck. R.R.H. received royalties from Elsevier for a book, consultancy fees from Glyciome, and presentation fees from GryNumber Health and Aytu Bioscience. Aytu Bioscience also funded MiOXYS systems and sensors. Attendance at Fertility 2020 and Roadshow South Africa by Ralf Henkel was funded by LogixX Pharma Ltd. R.R.H. is also Editor in Chief of Andrologia and has been an employee of LogixX Pharma Ltd. since 2020. M.S.K. is an associate editor with Human Reproduction Open. K.Mc.E. received an honoraria for lectures from Bayer and Pharmasure in 2019 and payment for an ESHRE grant review in 2019. His attendance at ESHRE 2019 and AUA 2019 was sponsored by Pharmasure and Bayer, respectively. The remaining authors declare no competing interests. TRIAL REGISTRATION NUMBER Core Outcome Measures in Effectiveness Trials (COMET) initiative registration No: 1586. Available at www.comet-initiative.org/Studies/Details/1586. TRIAL REGISTRATION DATE N/A. DATE OF FIRST PATIENT’S ENROLMENT N/A.
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Affiliation(s)
- Michael P Rimmer
- MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Ruth A Howie
- Edinburgh Fertility Centre, Simpsons Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Richard A Anderson
- MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK,Edinburgh Fertility Centre, Simpsons Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Christopher L R Barratt
- Reproductive Medicine Research Group, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Kurt T Barnhart
- Department of Obstetrics and Gynaecology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Yusuf Beebeejaun
- King’s Fertility, The Fetal Medicine Research Unit, King’s College London, London, UK
| | - Ricardo Pimenta Bertolla
- Division of Urology, Department of Surgery, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Lars Björndahl
- ANOVA—Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Pietro Bortoletto
- The Ronald O. Perelman and Claudia Cohen Centre for Reproductive Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Astrid E P Cantineau
- University of Groningen, University Medical Centre, Groningen, Centre of Reproductive Medicine, Groningen, Netherlands
| | - Ettore Caroppo
- Asl Bari, Reproductive Unit and Andrology Clinic, Conversano (Ba), Italy
| | | | - Kevin Coward
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK,Women’s Centre, John Radcliffe Hospital, Headington, Oxford, UK
| | | | - Christian De Geyter
- Reproductive Medicine and Gynaecological Endocrinology (RME), University Hospital, University of Basel, Basel, Switzerland
| | - Dimitrios G Goulis
- Units of Human Reproduction and Reproductive Endocrinology, 1st Department of Obstetrics and Gynaecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ralf R Henkel
- Department of Digestion, Metabolism and Reproduction, Imperial College London, London, UK
| | - Vu N A Ho
- IVFMD, My Duc Hospital, HOPE Research Centre, My Duc Hospital, Ho Chi Minh City, Vietnam
| | | | - Carin Huyser
- Reproductive Biology Laboratory, Department of Obstetrics and Gynaecology, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa
| | - Jozef H Kadijk
- Freya—Dutch Patient Association for Infertility, Gorinchem, The Netherlands
| | | | - Shadi Khashaba
- University of New South Wales, Sydney, Australia,IVF Australia, Sydney, Australia
| | | | | | | | - Saturnino Luján
- Urology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Thabo Christopher Matsaseng
- Stellenbosch University, Stellenbosch, Western Cape, South Africa,Tygerberg Academic Hospital, Cape Town, South Africa
| | - Raj S Mathur
- Manchester University Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Kevin McEleny
- Newcastle Fertility, The Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Rod T Mitchell
- MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Ben W Mol
- University of Aberdeen, Aberdeen, UK,Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | | | - Ernest H Y Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Allan Pacey
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Antti H Perheentupa
- Department of Obstetrics and Gynaecology, University of Turku and Turku University Hospital, Turku, Finland
| | - Stefan Du Plessis
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE,Medical Physiology, Stellenbosch University, Tygerberg, South Africa
| | - Nathalie Rives
- Rouen University Hospital, Biology of Reproduction-CECOS Laboratory, Rouen, France
| | - Ippokratis Sarris
- King’s Fertility, The Fetal Medicine Research Unit, King’s College London, London, UK,Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Peter N Schlegel
- The Ronald O. Perelman and Claudia Cohen Centre for Reproductive Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Maciej Śmiechowski
- Association for Infertility Treatment and Adoption Support “Our Stork”, Warsaw, Poland
| | - Venkatesh Subramanian
- King’s Fertility, The Fetal Medicine Research Unit, King’s College London, London, UK
| | - Sesh K Sunkara
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Basil C Tarlarzis
- Units of Human Reproduction and Reproductive Endocrinology, 1st Department of Obstetrics and Gynaecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Frank Tüttelmann
- Institute of Reproductive Genetics, University of Münster, Münster, Germany
| | - Andy Vail
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Madelon van Wely
- Netherlands Satellite of the Cochrane Gynaecology and Fertility Group, Centre for Reproductive Medicine, Amsterdam, Netherlands,Reproduction & Development Research Institute, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Mónica H Vazquez-Levin
- Laboratorio de Estudios de Interacción Celular en Reproducción y Cáncer, Instituto de Biología y Medicina Experimental (IBYME), Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina (CONICET), Fundación IBYME (FIBYME), Buenos Aires, Argentina
| | - Lan N Vuong
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam,HOPE Research Centre, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Alex Y Wang
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Rui Wang
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Armand Zini
- Division of Urology, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Cindy M Farquhar
- Cochrane Gynaecology and Fertility Group, University of Auckland, Auckland, New Zealand,Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Craig Niederberger
- Correspondence address. Department of Urology, University of Illinois at Chicago, Chicago, IL, USA and Department of Bioengineering, University of Illinois at Chicago College of Engineering, Chicago, IL, USA. E-mail:
| | - James M N Duffy
- King’s Fertility, The Fetal Medicine Research Unit, King’s College London, London, UK
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Vuong LN. Alteration of final maturation and laboratory techniques in low responders. Fertil Steril 2022; 117:675-681. [DOI: 10.1016/j.fertnstert.2022.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 01/25/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022]
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Franasiak JM, Polyzos NP, Neves AR, Yovich JL, Ho TM, Vuong LN, Norman RJ. Intracytoplasmic sperm injection for all or for a few? Fertil Steril 2022; 117:270-284. [DOI: 10.1016/j.fertnstert.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/04/2022]
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Akin N, Le AH, Ha UDT, Romero S, Sanchez F, Pham TD, Nguyen MHN, Anckaert E, Ho TM, Smitz J, Vuong LN. Positive effects of amphiregulin on human oocyte maturation and its molecular drivers in patients with polycystic ovary syndrome. Hum Reprod 2021; 37:30-43. [PMID: 34741172 DOI: 10.1093/humrep/deab237] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/03/2021] [Indexed: 01/19/2023] Open
Abstract
STUDY QUESTION Does use of medium containing amphiregulin improve meiotic maturation efficiency in oocytes of women with polycystic ovary syndrome (PCOS) undergoing in vitro maturation (IVM) preceded by a capacitation culture step capacitation IVM (CAPA-IVM)? SUMMARY ANSWER Use of medium containing amphiregulin significantly increased the maturation rate from oocytes retrieved from follicles with diameters <6 or ≥6 mm pre-cultured in capacitation medium. WHAT IS KNOWN ALREADY Amphiregulin concentration in follicular fluid is correlated with human oocyte developmental competence. Amphiregulin added to the meiotic trigger has been shown to improve outcomes of IVM in a range of mammalian species. STUDY DESIGN, SIZE, DURATION This prospective, randomized cohort study included 30 patients and was conducted at an academic infertility centre in Vietnam from April to December 2019. Patients with PCOS were included. PARTICIPANTS/MATERIALS, SETTING, METHODS In the first stage, sibling oocytes from each patient (671 in total) were allocated in equal numbers to maturation in medium with (CAPA-AREG) or without (CAPA-Control) amphiregulin 100 ng/ml. After a maturation check and fertilization using intracytoplasmic sperm injection (ICSI), all good quality Day 3 embryos were vitrified. Cumulus cells (CCs) from both groups were collected at the moment of ICSI denudation and underwent a molecular analysis to quantify key transcripts of oocyte maturation and to relate these to early embryo development. On return for frozen embryo transfer (second stage), patients were randomized to have either CAPA-AREG or CAPA-Control embryo(s) implanted. Where no embryo(s) from the randomized group were available, embryo(s) from the other group were transferred. The primary endpoint of the study was meiotic maturation efficiency (proportion of metaphase II [MII] oocytes; maturation rate). MAIN RESULTS AND THE ROLE OF CHANCE In the per-patient analysis, the number of MII oocytes was significantly higher in the CAPA-AREG group versus the CAPA-Control group (median [interquartile range] 7.0 [5.3, 8.0] versus 6.0 [4.0, 7.0]; P = 0.01). When each oocyte was evaluated, the maturation rate was also significantly higher in the CAPA-AREG group versus the CAPA-Control group (67.6% versus 55.2%; relative risk [RR] 1.22 [95% confidence interval (CI) 1.08-1.38]; P = 0.001). No other IVM or embryology outcomes differed significantly between the two groups. Rates of clinical pregnancy (66.7% versus 42.9%; RR 1.56 [95% CI 0.77-3.14]), ongoing pregnancy (53.3% versus 28.6%; RR 1.87 [95% CI 0.72-4.85]) and live birth (46.7% versus 28.6%; RR 1.63 [95% CI 0.61-4.39]) were numerically higher in the patients who had CAPA-AREG versus CAPA-Control embryos implanted, but each fertility and obstetric outcome did not differ significantly between the groups. In the CAPA-AREG group, there were significant shifts in CC expression of genes involved in steroidogenesis (STAR, 3BHSD), the ovulatory cascade (DUSP16, EGFR, HAS2, PTGR2, PTGS2, RPS6KA2), redox and glucose metabolism (CAT, GPX1, SOD2, SLC2A1, LDHA) and transcription (NRF2). The expression of three genes (TRPM7, VCAN and JUN) in CCs showed a significant correlation with embryo quality. LIMITATIONS, REASONS FOR CAUTION This study included only Vietnamese women with PCOS, limiting the generalizability. Although 100 ng/ml amphiregulin addition to the maturation culture step significantly improved the MII rate, the sample size in this study was small, meaning that these findings should be considered as exploratory. Therefore, a larger patient cohort is needed to confirm whether the positive effects of amphiregulin translate into improved fertility outcomes in patients undergoing IVM. WIDER IMPLICATIONS OF THE FINDINGS Data from this study confirm the beneficial effects of amphiregulin during IVM with respect to the trigger of oocyte maturation. The gene expression findings in cumulus indicate that multiple pathways might contribute to these beneficial effects and confirm the key role of the epidermal growth factor system in the stepwise acquisition of human oocyte competence. STUDY FUNDING/COMPETING INTEREST(S) This work was funded by the Vietnam National Foundation for Science and Technology Development (NAFOSTED; grant number FWO.106-YS.2017.02) and by the Fund for Research Flanders (FWO; grant number G.OD97.18N). L.N.V. has received speaker and conference fees from Merck, grants, speaker and conference fees from Merck Sharpe and Dohme, and speaker, conference and scientific board fees from Ferring. T.M.H. has received speaker fees from Merck, Merck Sharp and Dohme and Ferring. J.S. reports speaker fees from Ferring Pharmaceuticals and Biomérieux Diagnostics and grants from FWO Flanders, is co-inventor on granted patents on CAPA-IVM methodologies in USA (US10392601B2), Europe (EP3234112B1) and Japan (JP 6806683 registered 08-12-2020) and is a co-shareholder of Lavima Fertility Inc., a spin-off company of the Vrije Universiteit Brussel (VUB, Brussels, Belgium). NA, TDP, AHL, MNHN, SR, FS, EA and UDTH report no financial relationships with any organizations that might have an interest in the submitted work in the previous three years, and no other relationships or activities that could appear to have influenced the submitted work. TRIAL REGISTRATION NUMBER NCT03915054.
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Affiliation(s)
- Nazli Akin
- Follicle Biology Laboratory, UZ Brussel, Vrije Universiteit Brussel, Brussel, Belgium
| | - Anh H Le
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam.,HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Uyen D T Ha
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam.,HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Sergio Romero
- Laboratory of Reproductive Biology and Fertility Preservation, Cayetano Heredia University (UPCH), Lima, Peru
| | - Flor Sanchez
- Laboratory of Reproductive Biology and Fertility Preservation, Cayetano Heredia University (UPCH), Lima, Peru
| | - Toan D Pham
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam.,HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Minh H N Nguyen
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam.,HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Ellen Anckaert
- Follicle Biology Laboratory, UZ Brussel, Vrije Universiteit Brussel, Brussel, Belgium
| | - Tuong M Ho
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam.,HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Johan Smitz
- Follicle Biology Laboratory, UZ Brussel, Vrije Universiteit Brussel, Brussel, Belgium
| | - Lan N Vuong
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam.,HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam.,Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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24
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Nguyen DP, Pham QT, Tran TL, Vuong LN, Ho TM. Blastocyst Prediction of Day-3 Cleavage-Stage Embryos Using Machine Learning. FandR 2021. [DOI: 10.1142/s266131822150016x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Embryo selection plays an important role in the success of in vitro fertilization (IVF). However, morphological embryo assessment has a number of limitations, including the time required, lack of accuracy, and inconsistency. This study determined whether a machine learning-based model could predict blastocyst formation using day-3 embryo images. Methods: Day-3 embryo images from IVF/intracytoplasmic sperm injection (ICSI) cycles performed at My Duc Phu Nhuan Hospital between August 2018 and June 2019 were retrospectively analyzed to inform model development. Day-3 embryo images derived from two-pronuclear (2PN) zygotes with known blastocyst formation data were extracted from the CCM-iBIS time-lapse incubator (Astec, Japan) at 67 hours post ICSI, and labeled as blastocyst/non-blastocyst based on results at 116 hours post ICSI. Images were used as the input dataset to train (85%) and validate (15%) the convolutional neural network (CNN) model, then model accuracy was determined using the training and validation dataset. The performance of 13 experienced embryologists for predicting blastocyst formation based on 100 day-3 embryo images was also evaluated. Results: A total of 1,135 images were allocated into training ([Formula: see text] 967) and validation ([Formula: see text] 168) sets, with an even distribution for blastocyst formation outcome. The accuracy of the final model for blastocyst formation was 97.72% in the training dataset and 76.19% in the validation dataset. The final model predicted blastocyst formation from day-3 embryo images in the validation dataset with an area under the curve of 0.75 (95% confidence interval [CI] 0.69–0.81). Embryologists predicted blastocyst formation with the accuracy of 70.07% (95% CI 68.12%–72.03%), sensitivity of 87.04% (95% CI 82.56%–91.52%), and specificity of 30.93% (95% CI 29.35%–32.51%). Conclusions: The CNN-based machine learning model using day-3 embryo images predicted blastocyst formation more accurately than experienced embryologists. The CNN-based model is a potential tool to predict additional IVF outcomes.
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Affiliation(s)
- Dung P. Nguyen
- IVFMD PN, My Duc Phu Nhuan Hospital, Ho Chi Minh City, Vietnam
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Quan T. Pham
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Thanh L. Tran
- IVFMD PN, My Duc Phu Nhuan Hospital, Ho Chi Minh City, Vietnam
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Lan N. Vuong
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Tuong M. Ho
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
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25
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Ho VN, Pham TD, Hoang HL, Vuong LN. Impact of Polycystic Ovary Syndrome Phenotypes on in Vitro Fertilization Outcomes in Vietnamese Women: A Secondary Analysis of a Randomized Controlled Trial. FandR 2021. [DOI: 10.1142/s2661318221500092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Polycystic ovary syndrome (PCOS) is diagnosed when [Formula: see text]2 of the following symptoms are present: ovulation disorder (OD), hyperandrogenism (HA), and polycystic ovary morphology (PCO). Clinical features of PCOS are heterogeneous and there are four clinical phenotypes: A (OD + HA + PCO); B (HA + OD); C (HA + PCO); and D (OD + PCO). Women with a PCOS phenotype that includes severe HA are at increased risk for pregnancy complications. There are currently no data on impact of PCOS phenotypes on in vitro fertilization (IVF) outcomes in Vietnamese women. This study investigated the association between PCOS phenotypes and IVF outcomes. Methods: This is a secondary analysis of a randomized controlled trial conducted in patients with PCOS undergoing IVF at IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam between January 2018 and April 2019. The primary outcome was live birth rate. Results: A total of 192 patients were included, of whom 33 patients had phenotype A (17.2%) and 159 had phenotype D (82.8%); no patients had phenotype B or C. Body mass index was significantly higher in patients with phenotype A than D (25.36 ± 4.78 versus 22.08 ± 3.21, [Formula: see text] = 0.001). There were no differences in laboratory and pregnancy outcomes between patients with phenotypes A and D. The live birth rate was lower in patients with phenotype A versus D, but the between-group difference did not reach statistical significance (33.3% vs. 42.8%, [Formula: see text] = 0.419). Conclusions: The common PCOS phenotypes in Vietnamese women with infertility were A and D. No impact of PCOS phenotypes on IVF treatment outcomes was detected in this secondary analysis; larger studies are needed
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Affiliation(s)
- Vu N.A. Ho
- IVFMD, My Duc Hospital, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, VietNam
- HOPE Research Center, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, VietNam
| | - Toan D. Pham
- IVFMD, My Duc Hospital, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, VietNam
- HOPE Research Center, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, VietNam
| | - Hieu L.T. Hoang
- IVFMD, My Duc Hospital, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, VietNam
| | - Lan N. Vuong
- IVFMD, My Duc Hospital, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, VietNam
- HOPE Research Center, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, VietNam
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VietNam
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26
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Esteves SC, Yarali H, Vuong LN, Carvalho JF, Özbek İY, Polat M, Le HL, Pham TD, Ho TM, Humaidan P, Alviggi C. Cumulative delivery rate per aspiration IVF/ICSI cycle in POSEIDON patients: a real-world evidence study of 9073 patients. Hum Reprod 2021; 36:2157-2169. [PMID: 34179973 PMCID: PMC8289325 DOI: 10.1093/humrep/deab152] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/16/2021] [Indexed: 12/20/2022] Open
Abstract
STUDY QUESTION What is the cumulative delivery rate (CDR) per aspiration IVF/ICSI cycle in low-prognosis patients as defined by the Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number (POSEIDON) criteria? SUMMARY ANSWER The CDR of POSEIDON patients was on average ∼50% lower than in normal responders and varied across POSEIDON groups; differences were primarily determined by female age, number of embryos obtained, number of embryo transfer (ET) cycles per patient, number of oocytes retrieved, duration of infertility, and BMI. WHAT IS KNOWN ALREADY The POSEIDON criteria aim to underline differences related to a poor or suboptimal treatment outcome in terms of oocyte quality and quantity among patients undergoing IVF/ICSI, and thus, create more homogenous groups for the clinical management of infertility and research. POSEIDON patients are presumed to be at a higher risk of failing to achieve a live birth after IVF/ICSI treatment than normal responders with an adequate ovarian reserve. The CDR per initiated/aspiration cycle after the transfer of all fresh and frozen–thawed/warmed embryos has been suggested to be the critical endpoint that sets these groups apart. However, no multicenter study has yet substantiated the validity of the POSEIDON classification in identifying relevant subpopulations of patients with low-prognosis in IVF/ICSI treatment using real-world data. STUDY DESIGN, SIZE, DURATION Multicenter population-based retrospective cohort study involving 9073 patients treated in three fertility clinics in Brazil, Turkey and Vietnam between 2015 and 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants were women with infertility between 22 and 42 years old in their first IVF/ICSI cycle of standard ovarian stimulation whose fresh and/or frozen embryos were transferred until delivery of a live born or until all embryos were used. Patients were retrospectively classified according to the POSEIDON criteria into four groups based on female age, antral follicle count (AFC), and the number of oocytes retrieved or into a control group of normal responders (non-POSEIDON). POSEIDON patients encompassed younger (<35 years) and older (35 years or above) women with an AFC ≥5 and an unexpected poor (<4 retrieved oocytes) or suboptimal (4–9 retrieved oocytes) response to stimulation, and respective younger and older counterparts with an impaired ovarian reserve (i.e. expected poor responders; AFC <5). Non-POSEIDON patients were those with AFC ≥5 and >9 oocytes retrieved. CDR was computed per one aspirated cycle. Logistic regression analysis was carried out to examine the association between patient classification and CDR. MAIN RESULTS AND ROLE OF CHANCE The CDR was lower in the POSEIDON patients than in the non-POSEIDON patients (33.7% vs 50.6%; P < 0.001) and differed across POSEIDON groups (younger unexpected poor responder [Group 1a; n = 212]: 27.8%, younger unexpected suboptimal responder [Group 1b; n = 1785]: 47.8%, older unexpected poor responder [Group 2a; n = 293]: 14.0%, older unexpected suboptimal responder [Group 2b; n = 1275]: 30.5%, younger expected poor responder [Group 3; n = 245]: 29.4%, and older expected poor responder [Group 4; n = 623]: 12.5%. Among unexpected suboptimal/poor responders (POSEIDON Groups 1 and 2), the CDR was twice as high in suboptimal responders (4–9 oocytes retrieved) as in poor responders (<4 oocytes) (P = 0.0004). Logistic regression analysis revealed that the POSEIDON grouping, number of embryos obtained, number of ET cycles per patient, number of oocytes collected, female age, duration of infertility and BMI were relevant predictors for CDR (P < 0.001). LIMITATIONS, REASONS FOR CAUTION Our study relied on the antral follicle count as the biomarker used for patient classification. Ovarian stimulation protocols varied across study centers, potentially affecting patient classification. WIDER IMPLICATIONS OF THE FINDINGS POSEIDON patients exhibit lower CDR per aspirated IVF/ICSI cycle than normal responders; the differences are mainly determined by female age and number of oocytes retrieved, thereby reflecting the importance of oocyte quality and quantity. Our data substantiate the validity of the POSEIDON criteria in identifying relevant subpopulations of patients with low-prognosis in IVF/ICSI treatment. Efforts in terms of early diagnosis, prevention, and identification of specific interventions that might benefit POSEIDON patients are warranted. STUDY FUNDING/COMPETING INTEREST(S) Unrestricted investigator-sponsored study grant (MS200059_0013) from Merck KGaA, Darmstadt, Germany. The funder had no role in study design, data collection, analysis, decision to publish or manuscript preparation. S.C.E. declares receipt of unrestricted research grants from Merck and lecture fees from Merck and Med.E.A. H.Y. declares receipt of payment for lectures from Merck and Ferring. L.N.V. receives speaker fees and conferences from Merck, Merck Sharp and Dohme (MSD) and Ferring and research grants from MSD and Ferring. J.F.C. declares receipt of statistical services fees from ANDROFERT Clinic. T.M.H. received speaker fees and conferences from Merck, MSD and Ferring. P.H. declares receipt of unrestricted research grants from Merck, Ferring, Gedeon Richter and IBSA and lecture fees from Merck, Gedeon Richter and Med.E.A. C.A. declares receipt of unrestricted research grants from Merck and lecture fees from Merck. The remaining authors have no conflicts of interest to disclose. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil
| | - Hakan Yarali
- Anatolia IVF, Ankara, Turkey.,Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Lan N Vuong
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.,IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam.,HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | | | | | | | - Ho L Le
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.,IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Toan D Pham
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.,IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Tuong M Ho
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.,IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Peter Humaidan
- Fertility Clinic Skive, Skive Regional Hospital, Skive, Denmark
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples, Federico II, Naples, Italy
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27
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Vuong LN, Pham TD, Le KTQ, Ly TT, Le HL, Nguyen DTN, Ho VNA, Dang VQ, Phung TH, Norman RJ, Mol BW, Ho TM. Micronized progesterone plus dydrogesterone versus micronized progesterone alone for luteal phase support in frozen-thawed cycles (MIDRONE): a prospective cohort study. Hum Reprod 2021; 36:1821-1831. [PMID: 33930124 DOI: 10.1093/humrep/deab093] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/16/2021] [Indexed: 12/14/2022] Open
Abstract
STUDY QUESTION Does the addition of oral dydrogesterone to vaginal progesterone as luteal phase support improve pregnancy outcomes during frozen embryo transfer (FET) cycles compared with vaginal progesterone alone? SUMMARY ANSWER Luteal phase support with oral dydrogesterone added to vaginal progesterone had a higher live birth rate and lower miscarriage rate compared with vaginal progesterone alone. WHAT IS KNOWN ALREADY Progesterone is an important hormone that triggers secretory transformation of the endometrium to allow implantation of the embryo. During IVF, exogenous progesterone is administered for luteal phase support. However, there is wide inter-individual variation in absorption of progesterone via the vaginal wall. Oral dydrogesterone is effective and well tolerated when used to provide luteal phase support after fresh embryo transfer. However, there are currently no data on the effectiveness of luteal phase support with the combination of dydrogesterone with vaginal micronized progesterone compared with vaginal micronized progesterone after FET. STUDY DESIGN, SIZE, DURATION Prospective cohort study conducted at an academic infertility center in Vietnam from 26 June 2019 to 30 March 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS We studied 1364 women undergoing IVF with FET. Luteal support was started when endometrial thickness reached ≥8 mm. The luteal support regimen was either vaginal micronized progesterone 400 mg twice daily plus oral dydrogesterone 10 mg twice daily (second part of the study) or vaginal micronized progesterone 400 mg twice daily (first 4 months of the study). In women with a positive pregnancy test, the appropriate luteal phase support regimen was continued until 7 weeks' gestation. The primary endpoint was live birth after the first FET of the started cycle, with miscarriage <12 weeks as one of the secondary endpoints. MAIN RESULTS AND THE ROLE OF CHANCE The vaginal progesterone + dydrogesterone group and vaginal progesterone groups included 732 and 632 participants, respectively. Live birth rates were 46.3% versus 41.3%, respectively (rate ratio [RR] 1.12, 95% CI 0.99-1.27, P = 0.06; multivariate analysis RR 1.30 (95% CI 1.01-1.68), P = 0.042), with a statistically significant lower rate of miscarriage at <12 weeks in the progesterone + dydrogesterone versus progesterone group (3.4% versus 6.6%; RR 0.51, 95% CI 0.32-0.83; P = 0.009). Birth weight of both singletons (2971.0 ± 628.4 versus 3118.8 ± 559.2 g; P = 0.004) and twins (2175.5 ± 494.8 versus 2494.2 ± 584.7; P = 0.002) was significantly lower in the progesterone plus dydrogesterone versus progesterone group. LIMITATIONS, REASONS FOR CAUTION The main limitations of the study were the open-label design and the non-randomized nature of the sequential administration of study treatments. However, our systematic comparison of the two strategies was able to be performed much more rapidly than a conventional randomized controlled trial. In addition, the single ethnicity population limits external generalizability. WIDER IMPLICATIONS OF THE FINDINGS Our findings study suggest a role for oral dydrogesterone in addition to vaginal progesterone as luteal phase support in FET cycles to reduce the miscarriage rate and improve the live birth rate. Carefully planned prospective cohort studies with limited bias could be used as an alternative to randomized controlled clinical trials to inform clinical practice. STUDY FUNDING/COMPETING INTERESTS This study received no external funding. LNV has received speaker and conference fees from Merck, grant, speaker and conference fees from Merck Sharpe and Dohme, and speaker, conference and scientific board fees from Ferring; TMH has received speaker fees from Merck, Merck Sharp and Dohme, and Ferring; R.J.N. has received scientific board fees from Ferring and receives grant funding from the National Health and Medical Research Council (NHMRC) of Australia; BWM has acted as a paid consultant to Merck, ObsEva and Guerbet, and is the recipient of grant money from an NHMRC Investigator Grant. TRIAL REGISTRATION NUMBER NCT0399876.
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Affiliation(s)
- Lan N Vuong
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.,IVFMD, My Duc Hospital and HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Toan D Pham
- IVFMD, My Duc Hospital and HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Khanh T Q Le
- IVFMD, My Duc Hospital and HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Trung T Ly
- IVFMD, My Duc Hospital and HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Ho L Le
- IVFMD, My Duc Hospital and HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Diem T N Nguyen
- IVFMD, My Duc Hospital and HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Vu N A Ho
- IVFMD, My Duc Hospital and HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Vinh Q Dang
- IVFMD, My Duc Hospital and HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Tuan H Phung
- IVFMD, My Duc Hospital and HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Robert J Norman
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Ben W Mol
- Monash University, Melbourne, Australia.,Aberdeen Centre for Women's Health Research, School of Medicine, University of Aberdeen, Aberdeen, UK
| | - Tuong M Ho
- IVFMD, My Duc Hospital and HOPE Research Center, Ho Chi Minh City, Vietnam
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Esteves SC, Yarali H, Vuong LN, Carvalho JF, Özbek İY, Polat M, Le HL, Pham TD, Ho TM. Antral follicle count and anti-Müllerian hormone to classify low-prognosis women under the POSEIDON criteria: a classification agreement study of over 9000 patients. Hum Reprod 2021; 36:1530-1541. [PMID: 33822057 DOI: 10.1093/humrep/deab056] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/24/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What is the agreement between antral follicle count (AFC) and anti-Müllerian hormone (AMH) levels when used to patient classification according to the Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number (POSEIDON) criteria? SUMMARY ANSWER Our study indicates a strong agreement between the AFC and the AMH levels in classifying POSEIDON patients; thus, either can be used for this purpose, although one in four women will have discordant values when both biomarkers are used. WHAT IS KNOWN ALREADY According to the POSEIDON criteria, both AFC and AMH may be used to classify low-prognosis patients. Proposed AFC and AMH thresholds of 5 and 1.2 ng/ml, respectively, have their basis in published literature; however, no study has yet determined the reproducibility of patient classification in comparing one biomarker with the other, nor have their thresholds ever been validated within this patient population. STUDY DESIGN, SIZE, DURATION A population-based cohort study involving 9484 consecutive patients treated in three fertility clinics in Brazil, Turkey and Vietnam between 2015 and 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants were infertile women between 22 and 46 years old in their first in vitro fertilization/intracytoplasmic sperm injection cycle of standard ovarian stimulation with exogenous gonadotropins whose baseline ovarian reserves had been assessed by both AFC and AMH. Details of pre- and post-treatment findings were input into a coded research file. Two indicators of interest were created to classify patients according to the POSEIDON criteria based upon AFC and AMH values. Patients who did not fit any of the four POSEIDON groups were classified as non-POSEIDON. AFC was determined in the early follicular phase using two-dimensional (2D) transvaginal ultrasonography, whereas AMH values were based on the modified Beckman Coulter generation II enzyme-linked immunosorbent assay. Agreement rates were computed between AFC and AMH to classify patients using Cohen's kappa statistics. Logistic regression analyzes were carried out to examine the association between ovarian markers and low (<4) and suboptimal (4-9) oocyte yield. MAIN RESULTS AND THE ROLE OF CHANCE The degree of agreement in classifying patients according to POSEIDON groups was strong overall (kappa = 0.802; 95% CI: 0.792-0.811). A total of 73.8% of individuals were classified under the same group using both biomarkers. The disagreement rates were ∼26% and did not diverge when AFC or AMH was used as the primary biomarker criterion. Significant regression equations were found between ovarian markers and oocyte yield (P < 0.0001). For low oocyte yield, the optimal AFC and AMH cutoff values were 5 and 1.27 ng/ml with sensitivities of 0.61 and 0.66, specificities of 0.81 and 0.72, and AUC receiver operating characteristics of 0.791 and 0.751, respectively. For suboptimal oocyte yield respective AFC and AMH cutoffs were 12 and 2.97 ng/ml with sensitivities of 0.74 and 0.69, specificities of 0.76 and 0.66 and AUCs of 0.81 and 0.80. LIMITATIONS, REASONS FOR CAUTION Our study relied on 2D transvaginal sonography to quantify the AFC and manual Gen II assay for AMH determination and classification of patients. AMH data must be interpreted in an assay-specific manner. Treatment protocols varied across centers potentially affecting patient classification. WIDER IMPLICATIONS OF THE FINDINGS Three of four patients will be classified the same using either AFC or AMH values. Both biomarkers provide acceptable and equivalent accuracy in predicting oocyte yield further supporting their use and proposed thresholds in daily clinical practice for patient classification according to the POSEIDON criteria. However, the sensitivity of POSEIDON thresholds in predicting low oocyte yield is low. Clinicians should adopt the biomarker that may best reflect their clinical setting. STUDY FUNDING/COMPETING INTEREST(S) Unrestricted investigator-sponsored study grant (MS200059_0013) from Merck KGaA, Darmstadt, Germany. The funder had no role in study design, data collection, analysis, decision to publish or manuscript preparation. S.C.E. declares receipt of unrestricted research grants from Merck and lecture fees from Merck and Med.E.A. H.Y. declares receipt of payment for lectures from Merck and Ferring. L.N.V. receives speaker fees and conferences from Merck, Merck Sharp and Dohme (MSD) and Ferring and research grants from MSD and Ferring. T.M.H. received speaker fees and conferences from Merck, MSD and Ferring. The remaining authors have nothing to disclose. TRIAL REGISTRATION NUMBER not applicable.
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Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil
| | - Hakan Yarali
- Anatolia IVF, Ankara, Turkey.,Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Lan N Vuong
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.,IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam.,HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | | | | | | | - Ho L Le
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.,IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Toan D Pham
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.,IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Tuong M Ho
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.,IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
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Vuong LN, Ho VNA, Ho TM, Dang VQ, Phung TH, Giang NH, Le AH, Pham TD, Wang R, Smitz J, Gilchrist RB, Norman RJ, Mol BW. In-vitro maturation of oocytes versus conventional IVF in women with infertility and a high antral follicle count: a randomized non-inferiority controlled trial. Hum Reprod 2021; 35:2537-2547. [PMID: 32974672 DOI: 10.1093/humrep/deaa240] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/14/2020] [Indexed: 01/21/2023] Open
Abstract
STUDY QUESTION Is one cycle of IVM non-inferior to one cycle of conventional in IVF with respect to live birth rates in women with high antral follicle counts (AFCs)? SUMMARY ANSWER We could not demonstrate non-inferiority of IVM compared with IVF. WHAT IS KNOWN ALREADY IVF with ovarian hyperstimulation has limitations in some subgroups of women at high risk of ovarian stimulation, such as those with polycystic ovary syndrome. IVM is an alternative ART for these women. IVM may be a feasible alternative to IVF in women with a high AFC, but there is a lack of data from randomized clinical trials comparing IVM with IVF in women at high risk of ovarian hyperstimulation syndrome. STUDY DESIGN, SIZE, DURATION This single-center, randomized, controlled non-inferiority trial was conducted at an academic infertility center in Vietnam from January 2018 to April 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS In total, 546 women with an indication for ART and a high AFC (≥24 follicles in both ovaries) were randomized to the IVM (n = 273) group or the IVF (n = 273) group; each underwent one cycle of IVM with a prematuration step versus one cycle of IVF using a standard gonadotropin-releasing hormone antagonist protocol with gonadotropin-releasing hormone agonist triggering. The primary endpoint was live birth rate after the first embryo transfer. The non-inferiority margin for IVM versus IVF was -10%. MAIN RESULTS AND THE ROLE OF CHANCE Live birth after the first embryo transfer occurred in 96 women (35.2%) in the IVM group and 118 women (43.2%) in the IVF group (absolute risk difference -8.1%; 95% confidence interval (CI) -16.6%, 0.5%). Cumulative ongoing pregnancy rates at 12 months after randomization were 44.0% in the IVM group and 62.6% in the IVF group (absolute risk difference -18.7%; 95% CI -27.3%, -10.1%). Ovarian hyperstimulation syndrome did not occur in the IVM group, versus two cases in the IVF group. There were no statistically significant differences between the IVM and IVF groups with respect to the occurrence of pregnancy complications, obstetric and perinatal complications, preterm delivery, birth weight and neonatal complications. LIMITATIONS, REASONS FOR CAUTION The main limitation of the study was its open-label design. In addition, the findings are only applicable to IVM conducted using the prematuration step protocol used in this study. Finally, the single ethnicity population limits the external generalizability of the findings. WIDER IMPLICATIONS OF THE FINDINGS Our randomized clinical trial compares live birth rates after IVM and IVF. Although IVM is a viable and safe alternative to IVF that may be suitable for some women seeking a mild ART approach, the current study findings approach inferiority for IVM compared with IVF when cumulative outcomes are considered. Future research should incorporate multiple cycles of IVM in the study design to estimate cumulative fertility outcomes and better inform clinical decision-making. STUDY FUNDING/COMPETING INTEREST(S) This work was partly supported by Ferring grant number 000323 and funded by the Vietnam National Foundation for Science and Technology Development (NAFOSTED) and by the Fund for Research Flanders (FWO). LNV has received speaker and conference fees from Merck, grant, speaker and conference fees from Merck Sharpe and Dohme, and speaker, conference and scientific board fees from Ferring; TMH has received speaker fees from Merck, Merck Sharp and Dohme, and Ferring; RJN has received conference and scientific board fees from Ferring, is a minor shareholder in an IVF company, and receives grant funding from the National Health and Medical Research Council (NHMRC) of Australia; BWM has acted as a paid consultant to Merck, ObsEva and Guerbet, and is the recipient of grant money from an NHMRC Investigator Grant; RBG reports grants and fellowships from the NHMRC of Australia; JS reports lecture fees from Ferring Pharmaceuticals, Biomérieux, Besins Female Healthcare and Merck, grants from Fund for Research Flanders (FWO), and is co-inventor on granted patents on CAPA-IVM methodology in the US (US10392601B2) and Europe (EP3234112B1); TDP, VQD, VNAH, NHG, AHL, THP and RW have no financial relationships with any organizations that might have an interest in the submitted work in the previous three years, and no other relationships or activities that could appear to have influenced the submitted work. TRIAL REGISTRATION NUMBER NCT03405701 (www.clinicaltrials.gov). TRIAL REGISTRATION DATE 16 January 2018. DATE OF FIRST PATENT’S ENROLMENT 25 January 2018.
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Affiliation(s)
- Lan N Vuong
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam.,IVFMD, My Duc Hospital and HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Vu N A Ho
- IVFMD, My Duc Hospital and HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Tuong M Ho
- IVFMD, My Duc Hospital and HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Vinh Q Dang
- IVFMD, My Duc Hospital and HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Tuan H Phung
- IVFMD, My Duc Hospital and HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Nhu H Giang
- IVFMD, My Duc Hospital and HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Anh H Le
- IVFMD, My Duc Hospital and HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Toan D Pham
- IVFMD, My Duc Hospital and HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Rui Wang
- Department of Obstetrics and Gynaecology, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Johan Smitz
- Follicle Biology Laboratory, Free University of Brussels (VUB), Brussels, Belgium
| | - Robert B Gilchrist
- School of Women's and Children's Health, University of New South Wales Sydney, New South Wales, Australia
| | - Robert J Norman
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.,Fertility SA, Adelaide, South Australia, Australia
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
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Vuong LN, Ho TM, Pham TD, Ho VNA, Andersen CY, Humaidan P. The early luteal hormonal profile in IVF patients triggered with hCG. Hum Reprod 2021; 35:157-166. [PMID: 31967304 DOI: 10.1093/humrep/dez235] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/25/2019] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION What is the early luteal phase hormonal profile in patients undergoing ovarian stimulation for IVF/ICSI followed by hCG trigger and a freeze-all strategy without luteal phase support? SUMMARY ANSWER The peak concentration of progesterone occurred 4 days after oocyte pick-up (OPU + 4), with an average 35% fall from OPU + 4 to OPU + 6, and progesterone levels before and 12 h after hCG administration predicted levels during the early luteal phase. WHAT IS KNOWN ALREADY The luteal phase during IVF differs from that during normal cycles, particularly with respect to the serum progesterone level profile. This can cause asynchrony between the embryo and the endometrium, potentially resulting in implantation failure and poor reproductive outcomes. STUDY DESIGN, SIZE, DURATION This prospective study included 161 women with normal ovarian reserve receiving GnRH antagonist co-treatment during ovarian stimulation with FSH who were followed up to 6 days after OPU in a single IVF cycle. PARTICIPANTS/MATERIALS, SETTING, METHODS Women aged 18-42 years undergoing IVF with ovarian stimulation using FSH were included. Ovulation was triggered with recombinant hCG 250 μg. Hormone levels were determined from blood samples taken on the day of trigger, before hCG, at 12, 24 and 36 h after hCG and at 1, 2, 3, 4, 5 and 6 days after OPU. The primary endpoint was early luteal phase serum concentrations of progesterone, LH, estradiol and hCG. MAIN RESULTS AND THE ROLE OF CHANCE One outlier with a pre-hCG serum progesterone level of 11.42 ng/mL was excluded, so all analyses included 160 subjects. Progesterone levels began to increase 1 day after OPU, peaked 4 days after OPU (114 ng/mL), then declined from OPU + 5 onwards. Peak progesterone levels were at OPU + 4, OPU + 5 or OPU + 6 in 38.8, 29.4 and 13.8% of patients, respectively. Approximately two-thirds of patients had a fall in serum progesterone from OPU + 4 to OPU + 6. Pre-hCG progesterone levels correlated significantly with those at 24 h after hCG (r2 = 0.28; P < 0.001), which in turn correlated significantly with progesterone at OPU + 4 (r2 = 0.32; P < 0.001). LH peaked (4.4 IU/L) 12 h after hCG trigger, persisting for 24 h but was barely elevated compared with physiological levels. Serum estradiol peaked twice: at 24 h post-trigger and at OPU + 4. Highest hCG levels (130 mIU/mL) occurred at 24 h post-injection. The best correlations between the number of follicles ≥11 mm and serum progesterone level were seen at 24 and 36 h after hCG and OPU + 1. LIMITATIONS, REASONS FOR CAUTION The influence of different profiles of serum progesterone on reproductive outcomes could not be determined because a freeze-all strategy was used in all patients. In addition, data were not available to relate serum hormone level findings with endometrial histology or endometrial receptivity analysis to clearly identify the relationship between serum hormones and the window of implantation. WIDER IMPLICATIONS OF THE FINDINGS Detailed information about early luteal phase hormone levels could be used to optimize and individualize luteal phase support to improve reproductive outcomes. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by My Duc Hospital, Ho Chi Minh City, Vietnam. All authors state that they have no conflicts of interest to disclose. TRIAL REGISTRATION NUMBER NCT02798146; NCT03174691.
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Affiliation(s)
- Lan N Vuong
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.,IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam.,HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Tuong M Ho
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam.,HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Toan D Pham
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam.,HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Vu N A Ho
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam.,HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Claus Yding Andersen
- Laboratory of Reproductive Biology, Copenhagen University Hospital and Faculty of Health Science, Copenhagen University, Copenhagen, Denmark
| | - Peter Humaidan
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark.,Faculty of Health, Aarhus University, Aarhus, Denmark.,Faculty of Health, University of Southern Denmark, Odense, Denmark
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Dang VQ, Vuong LN, Luu TM, Pham TD, Ho TM, Ha AN, Truong BT, Phan AK, Nguyen DP, Pham TN, Pham QT, Wang R, Norman RJ, Mol BW. Intracytoplasmic sperm injection versus conventional in-vitro fertilisation in couples with infertility in whom the male partner has normal total sperm count and motility: an open-label, randomised controlled trial. Lancet 2021; 397:1554-1563. [PMID: 33894833 DOI: 10.1016/s0140-6736(21)00535-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The use of intracytoplasmic sperm injection has increased substantially worldwide, primarily in couples with non-male factor infertility. However, there is a paucity of evidence from randomised trials supporting this approach compared with conventional in-vitro fertilisation (IVF). We aimed to investigate whether intracytoplasmic sperm injection would result in a higher livebirth rate compared with conventional IVF. METHODS This open-label, multicentre, randomised trial was done at two IVF centres in Ho Chi Minh City, Vietnam (IVFMD, My Duc Hospital and IVFAS, An Sinh Hospital). Eligible couples were aged at least 18 years and the male partner's sperm count and motility (progressive motility) were normal based on WHO 2010 criteria. Couples had to have undergone two or fewer previous conventional IVF or intracytoplasmic sperm injection attempts, have used an antagonist protocol for ovarian stimulation, and agree to have two or fewer embryos transferred. Couples were randomly assigned (1:1) to undergo either intracytoplasmic sperm injection or conventional IVF, using block randomisation with variable block size of 2, 4, or 8 and a telephone-based central randomisation method. The computer-generated randomisation list was prepared by an independent statistician who had no other involvement in the study. Embryologists and couples were not masked to study groups because of the type of interventions and differences in hospital fees, but clinicians performing embryo transfer were unaware of study group allocation. The primary outcome was livebirth after the first embryo transfer from the initiated cycle. Analyses were done on an intention-to-treat basis. The trial is registered with ClinicalTrials.gov, NCT03428919. FINDINGS Between March 16, 2018, and Aug 12, 2019, we randomly assigned 1064 couples to intracytoplasmic sperm injection (n=532) or conventional IVF (n=532). Livebirth after the first embryo transfer from the initiated cycle occurred in 184 (35%) of 532 couples randomly assigned to intracytoplasmic sperm injection and in 166 (31%) of 532 couples randomly assigned to conventional IVF (absolute difference 3·4%, 95% CI -2·4 to 9·2; risk ratio [RR] 1·11, 95% CI 0·93 to 1·32; p=0·27). 29 (5%) couples in the intracytoplasmic sperm injection group and 34 (6%) couples in the conventional IVF group had fertilisation failure (absolute difference -0·9%, -4·0 to 2·1, RR 0·85, 95% CI 0·53 to 1·38; p=0·60). INTERPRETATION In couples with infertility in whom the male partner has a normal total sperm count and motility, intracytoplasmic sperm injection did not improve the livebirth rate compared with conventional IVF. Our results challenge the value of the routine use of intracytoplasmic sperm injection in assisted reproduction techniques for this population. FUNDING My Duc Hospital and Merck Sharp and Dohme.
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Affiliation(s)
- Vinh Q Dang
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam; HOPE Research Center, Ho Chi Minh City, Vietnam.
| | - Lan N Vuong
- HOPE Research Center, Ho Chi Minh City, Vietnam; Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tam M Luu
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Toan D Pham
- HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Tuong M Ho
- HOPE Research Center, Ho Chi Minh City, Vietnam; IVFAS, An Sinh Hospital, Ho Chi Minh City, Vietnam
| | - Anh N Ha
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
| | | | - Anh K Phan
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
| | | | - Thanh N Pham
- IVFAS, An Sinh Hospital, Ho Chi Minh City, Vietnam
| | - Quan T Pham
- HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Rui Wang
- Department of Obstetrics and Gynaecology, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Robert J Norman
- The Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia; Aberdeen Centre for Women's Health Research, University of Aberdeen, Aberdeen, UK
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Tran VTT, Nguyen NA, Nguyen NT, Vo TTM, Uong TS, Nguyen HT, Nguyen NT, Nguyen LMT, Nguyen MHN, Nguyen LK, Vuong LN, Mol B, Dang VQ. 15 Long-term development of children born to women with twin pregnancies treated with pessary or progesterone. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Esteves SC, Yarali H, Vuong LN, Carvalho JF, Özbek İY, Polat M, Le HL, Pham TD, Ho TM. Low Prognosis by the POSEIDON Criteria in Women Undergoing Assisted Reproductive Technology: A Multicenter and Multinational Prevalence Study of Over 13,000 Patients. Front Endocrinol (Lausanne) 2021; 12:630550. [PMID: 33790862 PMCID: PMC8006427 DOI: 10.3389/fendo.2021.630550] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/04/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of low-prognosis patients according to the POSEIDON criteria using real-world data. DESIGN Multicenter population-based cohort study. SETTINGS Fertility clinics in Brazil, Turkey, and Vietnam. PATIENTS Infertile women undergoing assisted reproductive technology using standard ovarian stimulation with exogenous gonadotropins. INTERVENTIONS None. MAIN OUTCOME MEASURES Per-period prevalence rates of POSEIDON patients (overall, stratified by POSEIDON groups and by study center) and the effect of covariates on the probability that a patient be classified as "POSEIDON". RESULTS A total of 13,146 patients were included. POSEIDON patients represented 43.0% (95% confidence interval [CI] 42.0-43.7) of the studied population, and the prevalence rates varied across study centers (range: 38.6-55.7%). The overall prevalence rates by POSEIDON groups were 44.2% (group 1; 95% CI 42.6-45.9), 36.1% (group 2; 95% CI 34.6-37.7), 5.2% (group 3; 95% CI 4.5-6.0), and 14.4% (group 4; 95% CI: 13.3-15.6). In general, POSEIDON patients were older, had a higher body mass index (BMI), lower ovarian reserve markers, and a higher frequency of female factor as the primary treatment indication than non-POSEIDON patients. The former required larger doses of gonadotropin for ovarian stimulation, despite achieving a 2.5 times lower number of retrieved oocytes than non-POSEIDON patients. Logistic regression analyses revealed that female age, BMI, ovarian reserve, and a female infertility factor were relevant predictors of the POSEIDON condition. CONCLUSIONS The estimated prevalence of POSEIDON patients in the general population undergoing ART is significant. These patients differ in clinical characteristics compared with non-POSEIDON patients. The POSEIDON condition is associated with female age, ovarian reserve, BMI, and female infertility. Efforts in terms of diagnosis, counseling, and treatment are needed to reduce the prevalence of low-prognosis patients.
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Affiliation(s)
- Sandro C. Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil
- *Correspondence: Sandro C. Esteves, ; orcid.org/0000-0002-1313-9680
| | - Hakan Yarali
- Anatolia IVF, Ankara, Turkey
- Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Lan N. Vuong
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | | | | | | | - Ho L. Le
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Toan D. Pham
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Tuong M. Ho
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
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Braam SC, Ho VNA, Pham TD, Mol BW, van Wely M, Vuong LN. In-vitro maturation versus IVF: a cost-effectiveness analysis. Reprod Biomed Online 2020; 42:143-149. [PMID: 33132059 DOI: 10.1016/j.rbmo.2020.09.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/30/2020] [Accepted: 09/24/2020] [Indexed: 12/12/2022]
Abstract
RESEARCH QUESTION How do costs and effects of in-vitro maturation (IVM) compare to IVF in women with a high antral follicle count (AFC)? DESIGN This cost-effectiveness analysis (CEA) was based on data of a previous retrospective cohort study at IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam. Between July 2015 and December 2017, 608 women underwent IVM and 311 women IVF. The effectiveness measure for the CEA was cumulative live birth rate (LBR) after one completed cycle including subsequent cryo-cycles within 12 months of inclusion. Data were collected on resource use related to treatment, medication and pregnancy from the case report forms. The mean costs and effects, average cost differences and incremental cost-effectiveness ratios (ICER) were calculated using non-parametric bootstrap resampling to assess the effect of uncertainty in the estimates. RESULTS Cumulative LBR after one completed cycle were 239/608 (39.3%) in the IVM group versus 155/311 (49.8%) in the IVF group (adjusted odds ratio 0.52, 95% confidence interval [CI] 0.30-0.89). Ovarian hyperstimulation syndrome (OHSS) did not occur in the IVM group versus 11/311 (3.5%) in the IVF group. The mean costs per couple were €4300 (95% CI €1371-18,798) for IVM and €6493 (95% CI €2204-20,136) for IVF. The ICER per additional live birth with IVF was €20,144 (95% CI €9116-50,418). Results were robust over a wide range of assumptions. CONCLUSIONS IVM is less expensive than IVF in women with a high AFC undergoing treatment with assisted reproductive technology, while leading to a slightly lower effectiveness in terms of cumulative LBR.
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Affiliation(s)
- Sanne C Braam
- Department of Obstetrics and Gynaecology Amsterdam University Medical Center, University of Amsterdam, Netherlands
| | - Vu N A Ho
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam; HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Toan D Pham
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam; HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Madelon van Wely
- Center for Reproductive Medicine Amsterdam University Medical Center, University of Amsterdam, Netherlands
| | - Lan N Vuong
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam; HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam.
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Ha AN, Pham TD, Vuong LN. Association between Vitamin D Levels and Fertility Outcomes in Patients Undergoing IVF/ICSI. FandR 2020. [DOI: 10.1142/s2661318220500139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Several studies have demonstrated that vitamin D (vitD) might play an important role in the reproductive system due to expression of vitD receptor and vitD-metabolizing enzymes in many reproductive tissues. VitD deficiency has been associated with increased risk of obstetric complications. However, the effect of vitD levels on in vitro fertilization (IVF)/ICSI outcomes is not fully understood. Evidence shows that women with adequate vitD levels might have higher pregnancy rates. This study evaluated the association between serum vitD levels and IVF/ICSI outcomes. Methods: This multicenter, retrospective cohort study was conducted at IVFMD, My Duc Hospital and IVFMDPN, My Duc Phu Nhuan Hospital, Ho Chi Minh City, Vietnam between November 2017 and July 2019. Vietnamese patients aged 18–40 years with serum vitD (25(OH)D) samples collected before starting controlled ovarian stimulation and undergoing embryo transfer were eligible. Patients were divided into four groups based on 25(OH)D levels: <10 ng/mL, 10 to <20 ng/mL, 20 to <30 ng/mL, and [Formula: see text]30 ng/mL. The primary outcome was ongoing pregnancy rate. Results: Of 3779 patients recruited, 25(OH)D levels were <10 ng/mL in 564 (14.9%), 10 to <20 ng/mL in 436 (11.5%), 20 to <30 in 1,142 (30.2%), and [Formula: see text]30 ng/mL in 1,637 (43.3%). Ongoing pregnancy rates were similar across the four subgroups (36%, 40%, 36%, and 36%, respectively; p = 0.409). The number of oocytes retrieved, embryos, clinical pregnancy, implantation, and miscarriage rates did not differ significantly between subgroups. Conclusions: In this analysis, serum vitD levels did not appear to be correlated with pregnancy outcomes in patients undergoing IVF/ICSI.
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Affiliation(s)
- Anh N. Ha
- IVFMD, My Duc Hospital, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, Vietnam
| | - Toan D. Pham
- IVFMD, My Duc Hospital, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, Vietnam
- HOPE Research Center, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, Vietnam
| | - Lan N. Vuong
- IVFMD, My Duc Hospital, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, Vietnam
- HOPE Research Center, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, Vietnam
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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Dang VQ, He YT, Pham HN, Trieu TT, Bui TQ, Vuong NT, Nguyen LM, Nguyen DT, Le TV, Li W, Le CH, Mol BW, Vuong LN. Effectiveness of cervical pessary compared to cervical cerclage with or without vaginal progesterone for the prevention of preterm birth in women with twin pregnancies and a short cervix: study protocol for a two-by-two factorial randomised clinical trial. BMJ Open 2020; 10:e036587. [PMID: 32554744 PMCID: PMC7304826 DOI: 10.1136/bmjopen-2019-036587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Women with twin pregnancies and a short cervix are at increased risk for preterm birth (PTB). Given the burden of prematurity and its attendant risks, the quest for effective interventions in twins has been an area of considerable research. Studies investigating the effectiveness of cervical cerclage, cervical pessary and vaginal progesterone in preventing PTB have yielded conflicting results. The aim of this study is to compare the effectiveness of cervical pessary and cervical cerclage with or without vaginal progesterone to prevent PTB in women with twin pregnancies and a cervical length (CL) ≤ 28 mm. METHODS AND ANALYSIS This multicentre, randomised clinical trial will be conducted at My Duc Hospital and My Duc Phu Nhuan Hospital, Vietnam. Asymptomatic women with twin pregnancies and a CL ≤28 mm, measured at 16-22 weeks' gestation, will be randomised in a 1:1:1:1 ratio to receive a cerclage, pessary, cerclage plus progesterone or pessary plus progesterone. Primary outcome will be PTB <34 weeks. Secondary outcomes will be maternal and neonatal complications. We preplanned a subgroup analysis according to CL from all women after randomisation and divided into four quartiles. Analysis will be conducted on an intention-to-treat basis. The rate of PTB <34 weeks' gestation in women with twin pregnancies and a cervix ≤28 mm and treated with pessary in our previous study at My Duc Hospital was 24.2%. A sample size of 340 women will be required to show or refute that cervical cerclage decreases the rate of PTB <34 weeks by 50% compared with pessary (from 24.2% to 12.1%, α level 0.05, power 80%, 5% lost to follow-up and protocol deviation). This study is not to be powered to assess interactions between interventions. ETHICS AND DISSEMINATION Ethical approval was obtained from the Institutional Ethics Committee of My Duc Hospital and informed patient consent was obtained before study enrolment. Results of the study will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT03863613 (date of registration: 4 March 2019).
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Affiliation(s)
- Vinh Q Dang
- Department of Obstetrics and Gynecology, My Duc Hospital, Ho Chi Minh City, Viet Nam
- HOPE Research Center, Ho Chi Minh City, Viet Nam
| | - Yen Tn He
- HOPE Research Center, Ho Chi Minh City, Viet Nam
- Department of Obstetrics and Gynecology, My Duc Phu Nhuan Hospital, Ho Chi Minh City, Viet Nam
| | - Ha Nh Pham
- Department of Obstetrics and Gynecology, My Duc Hospital, Ho Chi Minh City, Viet Nam
| | - Tuyen Tt Trieu
- Department of Obstetrics and Gynecology, My Duc Phu Nhuan Hospital, Ho Chi Minh City, Viet Nam
| | - Trung Q Bui
- Department of Obstetrics and Gynecology, My Duc Hospital, Ho Chi Minh City, Viet Nam
| | - Nhu T Vuong
- Department of Obstetrics and Gynecology, My Duc Hospital, Ho Chi Minh City, Viet Nam
| | | | | | - Thanh V Le
- Department of Obstetrics and Gynecology, My Duc Hospital, Ho Chi Minh City, Viet Nam
| | - Wentao Li
- Department of Obstetrics and Gynecology, Monash University, Clayton, Victoria, Australia
| | - Cam H Le
- Department of Obstetrics and Gynecology, My Duc Phu Nhuan Hospital, Ho Chi Minh City, Viet Nam
| | - Ben W Mol
- Department of Obstetrics and Gynecology, Monash University, Clayton, Victoria, Australia
| | - Lan N Vuong
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at HCMC, Ho Chi Minh City, Viet Nam
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Alviggi C, Esteves SC, Orvieto R, Conforti A, La Marca A, Fischer R, Andersen CY, Bühler K, Sunkara SK, Polyzos NP, Strina I, Carbone L, Bento FC, Galliano D, Yarali H, Vuong LN, Grynberg M, Drakopoulos P, Xavier P, Llacer J, Neuspiller F, Horton M, Roque M, Papanikolaou E, Banker M, Dahan MH, Foong S, Tournaye H, Blockeel C, Vaiarelli A, Humaidan P, Ubaldi FM. COVID-19 and assisted reproductive technology services: repercussions for patients and proposal for individualized clinical management. Reprod Biol Endocrinol 2020; 18:45. [PMID: 32404170 PMCID: PMC7218705 DOI: 10.1186/s12958-020-00605-z] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/28/2020] [Indexed: 02/06/2023] Open
Abstract
The prolonged lockdown of health services providing high-complexity fertility treatments -as currently recommended by many reproductive medicine entities- is detrimental for society as a whole, and infertility patients in particular. Globally, approximately 0.3% of all infants born every year are conceived using assisted reproductive technology (ART) treatments. By contrast, the total number of COVID-19 deaths reported so far represents approximately 1.0% of the total deaths expected to occur worldwide over the first three months of the current year. It seems, therefore, that the number of infants expected to be conceived and born -but who will not be so due to the lockdown of infertility services- might be as significant as the total number of deaths attributed to the COVID-19 pandemic. We herein propose remedies that include a prognostic-stratification of more vulnerable infertility cases in order to plan a progressive restart of worldwide fertility treatments. At a time when preventing complications and limiting burdens for national health systems represent relevant issues, our viewpoint might help competent authorities and health care providers to identify patients who should be prioritized for the continuation of fertility care in a safe environment.
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Affiliation(s)
- Carlo Alviggi
- grid.4691.a0000 0001 0790 385XDepartment of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Sandro C. Esteves
- grid.489976.d0000 0004 0437 566XANDROFERT, Andrology and Human Reproduction Clinic, Av. Dr. Heitor Penteado, 1463, Campinas, SP 13075-460 Brazil
- grid.411087.b0000 0001 0723 2494Department of Surgery (Division of Urology), University of Campinas (UNICAMP), Campinas, Brazil
- grid.7048.b0000 0001 1956 2722Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Raoul Orvieto
- grid.413795.d0000 0001 2107 2845Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
- grid.12136.370000 0004 1937 0546The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Alessandro Conforti
- grid.4691.a0000 0001 0790 385XDepartment of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Antonio La Marca
- grid.7548.e0000000121697570Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Claus Y. Andersen
- grid.4973.90000 0004 0646 7373Laboratory of Reproductive Biology, University Hospital of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Klaus Bühler
- Center for Gynecology, Endocrinology and Reproductive Medicine, and Stuttgart, Ulm, Germany
- Scientific-Clinical Centre for Endometriosis of the University Hospitals of Saarland, Saarbrücken, Germany
| | - Sesh K. Sunkara
- grid.13097.3c0000 0001 2322 6764Department of Women’s Health, Faculty of Life Sciences, King’s College London, London, UK
| | | | - Ida Strina
- grid.4691.a0000 0001 0790 385XDepartment of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Luigi Carbone
- grid.4691.a0000 0001 0790 385XDepartment of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Fabiola C. Bento
- grid.489976.d0000 0004 0437 566XANDROFERT, Andrology and Human Reproduction Clinic, Av. Dr. Heitor Penteado, 1463, Campinas, SP 13075-460 Brazil
| | | | | | - Lan N. Vuong
- grid.413054.70000 0004 0468 9247Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- grid.490472.cIVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Michael Grynberg
- grid.460789.40000 0004 4910 6535Service de Médecine de la Reproduction et Préservation de la Fertilité, Hôpital Antoine Béclère, Clamart, France, Université Paris Saclay, Saint-Aubin, France
| | - Panagiotis Drakopoulos
- Center for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- grid.8127.c0000 0004 0576 3437Department of Obstetrics and Gynecology, Medical School, University of Crete, 71110, Heraklion, Crete, Greece
| | - Pedro Xavier
- Unit of Reproductive Medicine, Department of Gynecology and Obstetrics, Hospital Center São João, Porto, Portugal
| | - Joaquin Llacer
- grid.476436.40000 0001 0259 6889Instituto Bernabeu, Alicante, Spain
| | | | - Marcos Horton
- Pregna Medicina Reprodutiva, Buenos Aires, Argentina
| | | | - Evangelos Papanikolaou
- grid.492697.7Assisting Nature, Centre of Assisted Reproduction and Genetics, Thessaloniki, Greece
- grid.4793.900000001094570053rd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Michael H. Dahan
- grid.14709.3b0000 0004 1936 8649Department of Obstetrics and Gynecology, McGill University, Montreal, Canada
| | - Shu Foong
- grid.22072.350000 0004 1936 7697Department of Obstetrics & Gynecology, University of Calgary, Calgary, Canada
- Regional Fertility Program, Calgary, Canada
| | - Herman Tournaye
- Center for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Christophe Blockeel
- Center for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Peter Humaidan
- grid.7048.b0000 0001 1956 2722Faculty of Health, Aarhus University, Aarhus, Denmark
- GENERA, Center for Reproductive Medicine, Rome, Italy
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Vuong LN, Le AH, Ho VNA, Pham TD, Sanchez F, Romero S, De Vos M, Ho TM, Gilchrist RB, Smitz J. Live births after oocyte in vitro maturation with a prematuration step in women with polycystic ovary syndrome. J Assist Reprod Genet 2020; 37:347-357. [PMID: 31902102 PMCID: PMC7056678 DOI: 10.1007/s10815-019-01677-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/22/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose Standard oocyte in vitro maturation (IVM) usually results in lower pregnancy rates than in vitro fertilization (IVF). IVM preceded by a prematuration step improves the acquisition of oocyte developmental competence and can enhance embryo quality (EQ). This study evaluated the effectiveness of a biphasic culture system incorporating prematuration and IVM steps (CAPA-IVM) versus standard IVM in women with polycystic ovarian morphology (PCOM). Methods Eighty women (age < 38 years, ≥ 25 follicles of 2–9 mm in both ovaries, no major uterine abnormalities) were randomized to undergo CAPA-IVM (n = 40) or standard IVM (n = 40). CAPA-IVM uses two steps: a 24-h prematuration step with C-type natriuretic peptide-supplemented medium, then 30 h of culture in IVM media supplemented with follicle-stimulating hormone and amphiregulin. Standard IVM was performed using routine protocols. Results A significantly higher proportion of oocytes reached metaphase II at 30 h after CAPA-IVM versus standard IVM (63.6 vs 49.0; p < 0.001) and the number of good quality embryos per cumulus-oocyte complex tended to be higher (18.9 vs 12.7; p = 0.11). Clinical pregnancy rate per embryo transfer was 63.2% in the CAPA-IVM versus 38.5% in the standard IVM group (p = 0.04). Live birth rate per embryo transfer was not statistically different between the CAPA-IVM and standard IVM groups (50.0 vs 33.3% [p = 0.17]). No malformations were reported and birth weight was similar in the two treatment groups. Conclusions Use of the CAPA-IVM system significantly improved maturation and clinical pregnancy rates versus standard IVM in patients with PCOM. Furthermore, live births after CAPA-IVM are reported for the first time.
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Affiliation(s)
- Lan N Vuong
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang Street, District 5, Ho Chi Minh City, Vietnam. .,IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam. .,HOPE Research Center, Ho Chi Minh City, Vietnam.
| | - Anh H Le
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam.,HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Vu N A Ho
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam.,HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Toan D Pham
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam.,HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Flor Sanchez
- Follicle Biology Laboratory, UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussel, Belgium.,Laboratory of Reproductive Biology and Fertility Preservation, Cayetano Heredia University (UPCH), Lima, Peru
| | - Sergio Romero
- Follicle Biology Laboratory, UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussel, Belgium.,Laboratory of Reproductive Biology and Fertility Preservation, Cayetano Heredia University (UPCH), Lima, Peru
| | - Michel De Vos
- Follicle Biology Laboratory, UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussel, Belgium
| | - Tuong M Ho
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam.,HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Robert B Gilchrist
- Fertility and Research Centre, School of Women's and Children's Health, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Johan Smitz
- Follicle Biology Laboratory, UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussel, Belgium
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Vuong LN, Pham TD, Ho VNA, Ho TM, Humaidan P, Andersen CY. Determinants of the hCG Concentration in the Early Luteal Phase After Final Maturation of Follicles With Bolus Trigger of Recombinant hCG. Front Endocrinol (Lausanne) 2020; 11:137. [PMID: 32265836 PMCID: PMC7096548 DOI: 10.3389/fendo.2020.00137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/28/2020] [Indexed: 02/01/2023] Open
Abstract
Introduction: It has recently been shown that late follicular phase progesterone levels correlate well with those in the early luteal phase, and that progesterone levels before and 12 h after human chorionic gonadotropin (hCG) administration predict levels during the early luteal phase. This study investigated determinants of serum hCG levels after a bolus dose of hCG for triggering ovulation in women undergoing in vitro fertilization (IVF). Materials and Methods: This retrospective analysis was performed on data from a prospective study of women aged 18-42 years with normal ovarian reserve receiving gonadotropin-releasing hormone (GnRH) antagonist co-treatment during ovarian stimulation with follicle-stimulating hormone (FSH) who were followed until 6 days after oocyte pick-up (OPU) in a single IVF cycle. The main outcome measures were early luteal phase serum hCG levels, and predictors of those levels. Results: There was wide inter-individual variability in early phase hCG concentrations over the period from 12 h after hCG injection up to 6 days after OPU. Patients with serum hCG values in the bottom 10% had a significantly higher body mass index (BMI; p = 0.038) and a significantly longer duration of stimulation (p = 0.014) than those with higher serum hCG values. Serum progesterone levels up to the first 36 h after hCG injection were significantly higher in the low vs. higher serum hCG group, but were similar at all other time points. There was a significant correlation between serum hCG level after hCG administration and BMI (lower BMI = higher serum hCG). In a cluster analysis, patients with the lowest serum hCG and progesterone levels at 12 h after hCG injection had significantly higher BMI, and significantly lower anti-Müllerian hormone level, duration of stimulation, and number of follicles of ≥11 and ≥14 mm compared with the other three clusters. Conclusion: Predictors of low serum hCG after a trigger bolus were difficult to determine, but BMI seems to be important. More detailed information on the luteal phase hormonal profile and data on predictors of hormone levels during this critical period can facilitate the development of strategies to allow individualization of the luteal phase support regimen, potentially improving IVF outcomes.
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Affiliation(s)
- Lan N. Vuong
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
- *Correspondence: Lan N. Vuong
| | - Toan D. Pham
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Vu N. A. Ho
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Tuong M. Ho
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Peter Humaidan
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark
- Faculty of Health, Aarhus University, Aarhus, Denmark
- Faculty of Health, University of Southern Denmark, Odense, Denmark
| | - Claus Yding Andersen
- Laboratory of Reproductive Biology, Faculty of Health Science, Copenhagen University Hospital, Copenhagen University, Copenhagen, Denmark
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Abbara A, Hunjan T, Ho VNA, Clarke SA, Comninos AN, Izzi-Engbeaya C, Ho TM, Trew GH, Hramyka A, Kelsey T, Salim R, Humaidan P, Vuong LN, Dhillo WS. Endocrine Requirements for Oocyte Maturation Following hCG, GnRH Agonist, and Kisspeptin During IVF Treatment. Front Endocrinol (Lausanne) 2020; 11:537205. [PMID: 33123084 PMCID: PMC7573298 DOI: 10.3389/fendo.2020.537205] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 09/09/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The maturation of oocytes to acquire competence for fertilization is critical to the success of in vitro fertilization (IVF) treatment. It requires LH-like exposure, provided by either human chorionic gonadotropin (hCG), or gonadotropin releasing hormone agonist (GnRHa). More recently, the hypothalamic stimulator, kisspeptin, was used to mature oocytes. Herein, we examine the relationship between the endocrine changes following these agents and oocyte maturation. DESIGN Retrospective cohort study. METHODS Prospectively collected hormonal data from 499 research IVF cycles triggered with either hCG, GnRHa, or kisspeptin were evaluated. RESULTS HCG-levels (121 iU/L) peaked at 24 h following hCG, whereas LH-levels peaked at ~4 h following GnRHa (140 iU/L), or kisspeptin (41 iU/L). HCG-levels were negatively associated with body-weight, whereas LH rises following GnRHa and kisspeptin were positively predicted by pre-trigger LH values. The odds of achieving the median mature oocyte yield for each trigger were increased by hCG/LH level. Progesterone rise during oocyte maturation occurred precipitously following each trigger and strongly predicted the number of mature oocytes retrieved. Progesterone rise was positively associated with the hCG-level following hCG trigger, but negatively with LH rise following all three triggers. The rise in progesterone per mature oocyte at 12 h was greater following GnRHa than following hCG or kisspeptin triggers. CONCLUSION The endocrine response during oocyte maturation significantly differed by each trigger. Counter-intuitively, progesterone rise during oocyte maturation was negatively associated with LH rise, even when accounting for the number of mature oocytes retrieved. These data expand our understanding of the endocrine changes during oocyte maturation and inform the design of future precision-triggering protocols.
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Affiliation(s)
- Ali Abbara
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Tia Hunjan
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Vu N. A. Ho
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Sophie A. Clarke
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Alexander N. Comninos
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Chioma Izzi-Engbeaya
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Tuong M. Ho
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Geoffrey H. Trew
- In vitro Fertilization Unit, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Artsiom Hramyka
- School of Computer Science, University of St Andrews, St Andrews, United Kingdom
| | - Tom Kelsey
- School of Computer Science, University of St Andrews, St Andrews, United Kingdom
| | - Rehan Salim
- In vitro Fertilization Unit, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Peter Humaidan
- The Fertility Clinic, Skive Regional Hospital and Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Lan N. Vuong
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Waljit S. Dhillo
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
- *Correspondence: Waljit S. Dhillo,
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Abstract
Background: Embryo quality is an important predictor of successful outcome in in vitro fertilization (IVF). However, current knowledge on the live birth rate after transfer of poor quality embryos is limited. This study investigated the live birth rate after transfer of only poor quality day-3 embryos in women undergoing IVF. Methods: This retrospective study included 153 couples who underwent IVF at IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam between June 2014 and January 2017 and had only poor quality day-3 embryos available for fresh (n [Formula: see text] 102) or frozen (n [Formula: see text] 51) transfer. The control group included patients who had transfer of one good embryo (n [Formula: see text] 64). Embryos were rated using the Istanbul criteria. Results: In the poor quality embryo group, the mean number of oocytes retrieved and number of embryos were 7.5 ± 4.4 and 1.8 ± 0.9, respectively. Mean number of embryos transferred was 1.6 ± 0.5 in the fresh transfer group and 2.0 ± 0.2 in the freeze-only group. Live births did occur after transfer of poor quality embryos, but the implantation, clinical pregnancy and live birth rates were significantly lower than after fresh or frozen transfer of a single good quality embryo (9.5 vs. 26.6%, p < 0.001; 13.7 vs. 26.6%, p < 0.001; and 7.2 vs. 18.8%, p [Formula: see text] 0.02, respectively). Conclusions: Live birth was achieved after transfer of only poor quality embryos in women undergoing IVF. This suggests that transfer of poor quality embryos could be an option when higher grade embryos are not available, after the chances of live birth have been discussed with the patient.
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Affiliation(s)
- Lan N. Vuong
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Toan D. Pham
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Bao G. Huynh
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
| | | | - Tuong M. Ho
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
| | | | - Ben W. Mol
- Department of Obstetrics and Gynaecology, School of Medicine, Monash University, Melbourne, Australia
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García-Basterra I, García-Ben A, Ríus-Díaz F, González-Gómez A, Hedges TR, Vuong LN, García-Campos JM. Prospective analysis of macular and optic disc changes after non-arteritic anterior ischemic optic neuropathy. J Fr Ophtalmol 2019; 43:35-42. [PMID: 31706462 DOI: 10.1016/j.jfo.2019.03.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 02/16/2019] [Accepted: 03/04/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE To prospectively analyse macular and optic disc changes after the occurrence of non-arteritic anterior ischemic optic neuropathy (NAION) and study possible predictors of final visual outcome. METHODS Patients with NAION underwent a complete ophthalmic examination, including spectral-domain optical coherence tomography of the macula and optic nerve head. The examination was repeated 1, 3, 6, 9 and 12 months after onset. Final visual prognosis was evaluated by visual field (VF) and best-corrected visual acuity (BCVA) at the final visit. Data within the NAION group were analysed over the course of the disease and compared to a disease-free control group at each visit. RESULTS Twenty-two eyes with NAION and 43 eyes from a control group were included. The retinal nerve fiber layer (RNFL) was significantly thicker in NAION eyes than controls at presentation (P=0.00), and significantly decreased during the next 3 months after presentation (P=0.02). The ganglion cell+inner plexiform layer (GCIPL) was thinner in the NAION group throughout the course of the disease (all P<0.05). Although the acute NAION eyes had significantly lower cup/disc ratios and higher neuroretinal and disc sizes (all P=0.00), there were no significant differences between groups from the third month onwards (all P>0.05). The best predictors of BCVA and VF were GCIPL at 3 months of follow-up (r2=0.32; P=0.03) and RNFL at 6 months of follow-up (r2=0.41; P=0.01) respectively. CONCLUSIONS RNFL and optic disc changes occur during the first 3 months after the onset of NAION, whereas GCIPL is affected soon after the onset of symptoms. GCIPL and RNFL are useful predictors of final visual outcome.
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Affiliation(s)
- I García-Basterra
- Department of Ophthalmology, University Hospital Virgen de la Victoria, Málaga, Spain; Department of Ophthalmology, Hospital Costa del Sol, Marbella, Spain.
| | - A García-Ben
- Department of Ophthalmology, University Hospital Santiago de Compostela, Spain
| | - F Ríus-Díaz
- Department of Preventive Medicine, Statistics and Public Health, University of Málaga, Spain
| | - A González-Gómez
- Department of Ophthalmology, University Hospital Virgen de la Victoria, Málaga, Spain
| | - T R Hedges
- The New England Eye Center, Tufts Medical Center, Tufts University, Boston, USA
| | - L N Vuong
- The New England Eye Center, Tufts Medical Center, Tufts University, Boston, USA
| | - J M García-Campos
- Department of Ophthalmology, University Hospital Virgen de la Victoria, Málaga, Spain; Department of Ophthalmology, Centro de Investigaciones Médico-Sanitarias, University of Málaga, Spain
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43
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Ho VN, Mol BW, Vuong LN. Reply: IVM for expected high responders: balancing the effectiveness and safety. Hum Reprod 2019; 34:2081. [PMID: 31560745 DOI: 10.1093/humrep/dez146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/04/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- V N Ho
- IVFMD, My Duc Hospital, HCMC, Vietnam
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - L N Vuong
- IVFMD, My Duc Hospital, HCMC, Vietnam.,Department of Obstetrics/Gynecology, University of Medicine and Pharmacy at HCM City, Vietnam
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44
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Sanchez F, Le AH, Ho VNA, Romero S, Van Ranst H, De Vos M, Gilchrist RB, Ho TM, Vuong LN, Smitz J. Biphasic in vitro maturation (CAPA-IVM) specifically improves the developmental capacity of oocytes from small antral follicles. J Assist Reprod Genet 2019; 36:2135-2144. [PMID: 31399916 DOI: 10.1007/s10815-019-01551-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To investigate the effectiveness of a biphasic IVM culture strategy at improving IVM outcomes in oocytes from small follicles (< 6 mm) compared with routine Standard IVM in patients with polycystic ovaries. METHODS This prospective pilot study was performed in 40 women with polycystic ovaries whose oocytes were randomized to two IVM culture methods. Patients received a total stimulation dose of 450 IU rFSH. Cumulus-oocyte complexes (COCs) from follicles < 6 mm and ≥ 6 mm were retrieved and cultured separately in either a prematuration medium with c-type natriuretic peptide followed by IVM (CAPA-IVM), or STD-IVM. Primary outcomes were maturation rate, embryo quality, and the number of vitrified day 3 embryos per patient. RESULTS Use of the CAPA-IVM system led to a significant improvement in oocyte maturation (p < 0.05), to a doubling in percentage of good and top-quality day 3 embryos per COC, and to an increased number of vitrified day 3 embryos (p < 0.001), compared to STD IVM. Oocytes from follicles < 6 mm benefited most from CAPA-IVM, showing a significant increase in the amount of good and top-quality embryos compared to STD IVM. CAPA-IVM yielded significantly (p < 0.0001) less GV-arrested oocytes and larger oocyte diameters (p < 0.05) than STD IVM. CONCLUSIONS CAPA-IVM brings significant improvements in maturation and embryological outcomes, most notably to oocytes from small antral follicles (< 6 mm), which can be easily retrieved from patients with a minimal ovarian stimulation. The study demonstrates the robustness and transferability of the CAPA-IVM method across laboratories and populations.
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Affiliation(s)
- Flor Sanchez
- Follicle Biology Laboratory, UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussel, Belgium.,Laboratory of Reproductive Biology and Fertility Preservation, Cayetano Heredia University (UPCH), Lima, Peru
| | - Anh H Le
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam.,HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Vu N A Ho
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam.,HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Sergio Romero
- Follicle Biology Laboratory, UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussel, Belgium.,Laboratory of Reproductive Biology and Fertility Preservation, Cayetano Heredia University (UPCH), Lima, Peru
| | - Heidi Van Ranst
- Follicle Biology Laboratory, UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussel, Belgium
| | - Michel De Vos
- Follicle Biology Laboratory, UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussel, Belgium
| | - Robert B Gilchrist
- Fertility and Research Centre, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Tuong M Ho
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam.,HOPE Research Center, Ho Chi Minh City, Vietnam
| | - Lan N Vuong
- IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam.,HOPE Research Center, Ho Chi Minh City, Vietnam.,Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Johan Smitz
- Follicle Biology Laboratory, UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussel, Belgium.
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Ha AN, Pham TD, Dang VQ, Vuong LN, Ho TM. Gonadotropin-Releasing Hormone Agonist Versus Human Chorionic Gonadotropin for Ovulation Induction in Polycystic Ovary Syndrome Patients Undergoing Intrauterine Insemination: A Randomised Controlled Trial. FandR 2019. [DOI: 10.1142/s2661318219500075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Gonadotropins have been recommended to improve ovulation, pregnancy and live birth rates in polycystic ovary syndrome (PCOS) patients with anovulatory infertility and clomiphene citrate (CC) resistance. However, this could increase the risk of ovarian hyperstimulation syndrome (OHSS). Gonadotropin-releasing hormone agonist (GnRHa) triggering could significantly reduce the risk of OHSS in patients undergoing in vitro fertilisation. However, data on the use of GnRHa in intrauterine insemination (IUI) is limited. This study compared the effectiveness of GnRHa and human chorionic gonadotropin (hCG) for ovulation induction in PCOS patients undergoing IUI. Methods: This non-inferiority, single-centre, randomised controlled trial was conducted at IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam between April 2016 and May 2018. PCOS patients aged 18–37 years with CC resistance and [Formula: see text] 3 developing ([Formula: see text] 16 mm) follicles on trigger day after stimulation with gonadotropins were eligible. Those with uterine abnormalities or tubal damage or inseminated with frozen semen were excluded. Triptorelin 0.1 mg or hCG 5000 IU was used when there was [Formula: see text] 1 follicle of [Formula: see text] 17 mm. IUI was performed at 36 hours after triggering. Primary outcome was ongoing pregnancy. Secondary outcomes were clinical pregnancy, multiple pregnancy, miscarriage and OHSS. Results: A total of 380 patients were randomised (190 per group). Treatment groups had similar characteristics at baseline. Ongoing pregnancy rate was 23.7% in the GnRHa group versus 25.3% in the hCG group (Relative risk 0.94; 95% confidence interval, 0.66–1.34; p [Formula: see text] 0.81). Secondary outcome parameters were also not significantly different between the two groups. There were two cases of mild OHSS in the hCG group and none in the GnRHa group. Conclusion: 0.1 mg triptorelin was non-inferior to 5000 IU hCG IU in PCOS patients undergoing ovulation induction by hMG followed by IUI with respect to pregnancy outcomes.
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Affiliation(s)
- Anh N. Ha
- IVFMD, My Duc Hospital, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, Vietnam
| | - Toan D. Pham
- IVFMD, My Duc Hospital, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, Vietnam
- HOPE Research Center, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, Vietnam
| | - Vinh Q. Dang
- IVFMD, My Duc Hospital, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, Vietnam
- HOPE Research Center, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, Vietnam
| | - Lan N. Vuong
- IVFMD, My Duc Hospital, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, Vietnam
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tuong M. Ho
- IVFMD, My Duc Hospital, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, Vietnam
- HOPE Research Center, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, Vietnam
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46
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Giang NH, Vuong LN, Pham TD, Ho TM. Use of Corifollitropin Alfa for Ovarian Stimulation: A Retrospective Analysis of 804 Women Undergoing IVF/ICSI. FandR 2019. [DOI: 10.1142/s2661318219500087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Corifollitropin alfa in GnRH antagonist protocol could provide a friendly treatment for IVF patients. There is limited evidence regarding the outcomes of corifollitropin alfa in ovarian hyperstimulation in Asian population. Methods: This was a retrospective study conducted on IVF women from July 2012 to July 2018. The recruited patients were expected normal responders, expected poor responders and oocyte donors. The patients underwent GnRH antagonist protocol with corifollitropin alfa. Results: There were 804 IVF patients included in the study. The patients were analyzed into: normal ovarian reserve-autologous cycles ([Formula: see text] 36 years and [Formula: see text] 60 kg, n = 33; [Formula: see text] 36 years and [Formula: see text] 60 kg, n [Formula: see text] 9; [Formula: see text] 36 years and [Formula: see text] 50 kg, n [Formula: see text] 204; [Formula: see text] 36 years and [Formula: see text] 50 kg, n [Formula: see text] 52), normal ovarian reserve-donor cycles ([Formula: see text] 60 kg, n [Formula: see text] 234; [Formula: see text] 60 kg, n [Formula: see text] 104) and diminished ovarian reserve cycles (n [Formula: see text] 168). In each group of patients, the pregnancy outcomes of fresh embryo transfer were comparable to those of frozen embryo transfer. Conclusions: Corifollitropin alfa could offer an effective and simple treatment option for all groups of patients without PCOS.
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Affiliation(s)
- Nhu H. Giang
- IVFMD, My Duc Hospital, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, Vietnam
- HOPE Research Center, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, Vietnam
| | - Lan N. Vuong
- HOPE Research Center, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, Vietnam
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang, District 5, Ho Chi Minh City, Vietnam
| | - Toan D. Pham
- IVFMD, My Duc Hospital, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, Vietnam
- HOPE Research Center, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, Vietnam
| | - Tuong M. Ho
- IVFMD, My Duc Hospital, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, Vietnam
- HOPE Research Center, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, Vietnam
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Le KD, Vuong LN, Ho TM, Dang VQ, Pham TD, Pham CT, Norman RJ, Mol BWJ. A cost-effectiveness analysis of freeze-only or fresh embryo transfer in IVF of non-PCOS women. Hum Reprod 2019; 33:1907-1914. [PMID: 30239784 DOI: 10.1093/humrep/dey253] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 06/28/2018] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Is a freeze-only strategy more cost-effective from a patient perspective than fresh embryo transfer (ET) after one completed In Vitro Fertilization/ Intracytoplasmic Sperm Injection (IVF/ICSI) cycle in women without polycystic ovary syndrome (PCOS)? SUMMARY ANSWER There is a low probability of the freeze-only strategy being cost-effective over the fresh ET strategy for non-PCOS women undergoing IVF/ICSI. WHAT IS KNOWN ALREADY Conventionally, IVF embryos are transferred in the same cycle in which oocytes are collected, while any remaining embryos are frozen and stored. We recently evaluated the effectiveness of a freeze-only strategy compared with a fresh ET strategy in a randomized controlled trial (RCT). There was no difference in live birth rate between the two strategies. STUDY DESIGN, SIZE, DURATION A cost-effectiveness analysis (CEA) was performed alongside the RCT to compare a freeze-only strategy with a fresh ET strategy in non-PCOS women undergoing IVF/ICSI. The effectiveness measure for the CEA was the live birth rate. Data on the IVF procedure, pregnancy outcomes and complications were collected from chart review; additional information was obtained using patient questionnaires, by telephone. PARTICIPANTS/MATERIALS, SETTING, METHODS For all patients, we measured the direct medical costs relating to treatment (cryopreservation, pregnancy follow-up, delivery), direct non-medical costs (travel, accommodation) and indirect costs (income lost). The direct cost data were calculated from resources obtained from patient records and prices were applied based on a micro-costing approach. Indirect costs were calculated based on responses to the questionnaire. Patients were followed until all embryos obtained from a single controlled ovarian hyperstimulation cycle were used or a live birth was achieved. The incremental cost-effectiveness ratio (ICER) was based on the incremental cost per couple and the incremental live birth rate of the freeze-only strategy compared with the fresh ET strategy. Probabilistic sensitivity analysis (PSA) and a cost-effectiveness acceptability curve (CEAC) were also performed. MAIN RESULTS AND THE ROLE OF CHANCE Between June 2015 and April 2016, 782 couples were randomized to a freeze-only (n = 391) or a fresh ET strategy (n = 391). Baseline characteristics including mean age, Body Mass Index (BMI), anti-Mullerian hormone, total dose of Follicle Stimulating Hormone (FSH), number of oocytes obtained, good quality Day 3 embryos, fertility outcomes and treatment complications were comparable between the two groups. The live birth rate (48.6% vs. 47.3%, respectively; risk ratio, 1.03; 95% Confidence Interval [CI], 0.89, 1.19; P = 0.78) and the average cost per couple (3906 vs. 3512 EUR, respectively; absolute difference 393.6, 95% CI, -76.2, 863.5; P = 0.1) were similar in the freeze-only group versus fresh ET. Corresponding costs per live birth were 8037 EUR versus 7425 EUR in the freeze-only versus fresh ET group, respectively. The incremental cost for the freeze-only strategy compared with fresh ET was 30 997 EUR per 1% additional live birth rate. The direct non-medical costs and indirect costs of infertility treatment strategies represented ~45-52% of the total cost. PSA shows that the 95% CI of ICERs was -263 901 to 286 681 EUR. Out of 1000 simulations, 44% resulted in negative ICERs, including 13.0% of simulations in which the freeze-only strategy was dominant (more effective and less costly than fresh ET), and 31% of simulations in which the fresh embryo strategy was dominant. In the other 560 simulations with positive ICERs, the 95% CI of ICERs ranged from 2155 to 471 578 EUR. The CEAC shows that at a willingness to pay threshold of 300 000 EUR, the probability of the freeze-only strategy being cost-effective over the fresh ET strategy would be 58%. LIMITATIONS, REASONS FOR CAUTION Data were collected from a single private IVF center study in Vietnam where there is no public or insurance funding of IVF. Unit costs obtained might not be representative of other settings. Data obtained from secondary sources (medical records, financial and activity reports) could lack authenticity, and recall bias may have influenced questionnaire responses on which direct costs were based. WIDER IMPLICATIONS OF THE FINDINGS In non-PCOS women undergoing IVF/ICSI, the results suggested that the freeze-only strategy was not cost-effective compared with fresh ET from a patient perspective. These findings indicate that other factors could be more important in deciding whether to use a freeze-only versus fresh ET strategy in this patient group. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by My Duc Hospital; no external funding was received. Ben Willem J. Mol is supported by an NHMRC Practioner Fellowship (GNT 1082548) and reports consultancy for Merck, ObsEva and Guerbet. Robert J. Norman has shares in an IVF company and has received support from Merck and Ferring. All other authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Khoa D Le
- IVFMD, My Duc Hospital, 4 Nui Thanh Street, Tan Binh District, Ho Chi Minh City, Viet Nam
| | - Lan N Vuong
- IVFMD, My Duc Hospital, 4 Nui Thanh Street, Tan Binh District, Ho Chi Minh City, Viet Nam.,Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tuong M Ho
- IVFMD, My Duc Hospital, 4 Nui Thanh Street, Tan Binh District, Ho Chi Minh City, Viet Nam
| | - Vinh Q Dang
- IVFMD, My Duc Hospital, 4 Nui Thanh Street, Tan Binh District, Ho Chi Minh City, Viet Nam
| | - Toan D Pham
- IVFMD, My Duc Hospital, 4 Nui Thanh Street, Tan Binh District, Ho Chi Minh City, Viet Nam
| | - Clarabelle T Pham
- Faculty of Health and Medical Sciences, School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Robert J Norman
- The Robinson Research Institute, School of Medicine, The University of Adelaide, North Adelaide, South Australia, Australia.,Fertility SA, Level 9 431 King William Street, Adelaide, South Australia, Australia
| | - Ben Willem J Mol
- Department of Obstetrics and Gynecology, Monash University, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, Australia
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48
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Ho VNA, Braam SC, Pham TD, Mol BW, Vuong LN. The effectiveness and safety of in vitro maturation of oocytes versus in vitro fertilization in women with a high antral follicle count. Hum Reprod 2019; 34:1055-1064. [DOI: 10.1093/humrep/dez060] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/29/2019] [Accepted: 04/11/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Vu N A Ho
- IVFMD, My Duc Hospital, Ho Chi Minh, Vietnam
- HOPE Research Center, Ho Chi Minh, Vietnam
| | - Sanne C Braam
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, University of Amsterdam, Netherlands
| | - Toan D Pham
- IVFMD, My Duc Hospital, Ho Chi Minh, Vietnam
- HOPE Research Center, Ho Chi Minh, Vietnam
| | - Ben W Mol
- Department of Obstetrics and Gynecology, Monash University, Melbourne, Australia
| | - Lan N Vuong
- HOPE Research Center, Ho Chi Minh, Vietnam
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, Ho Chi Minh, Vietnam
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Abstract
In vitro maturation (IVM) is an assisted reproductive technology (ART) whereby immature cumulus-oocyte complexes are collected and matured in vitro, without need for controlled ovarian stimulation and ovulation triggering. Advantages of IVM over in vitro fertilization (IVF) include mild or no stimulation, lower medication costs and less patient burden. However, early clinical outcomes with IVM were suboptimal. More recently, clinical studies reported live birth rates after IVM of about 40%. New IVM culture systems are being used to improve the efficacy of IVM. These have been in widespread use for animals for many years and are now showing promise in the clinical setting. Patients more likely to benefit from IVM over IVF include those at risk of OHSS (e.g. women with polycystic ovary syndrome), when the time for ovarian stimulation is limited, or where sustained elevations of estradiol are contraindicated (e.g. oncofertility indications). The main barrier to use of IVM to date was its relative efficacy compared with IVF, and there have also been concerns over the health of infants born following IVM. However, no differences in congenital abnormalities between IVM and other ARTs have been identified. In addition, there is a lack of both experience and standardized protocols. Strategies to overcome barriers to the use of IVM include better training for clinicians, more and better funded research in the field, and improved recognition of IVM by fertility specialists. Overall, IVM offers a valuable alternative for ART in select patient populations. New approaches to IVM appear to have the potential to achieve pregnancy outcomes equivalent to those after IVF. Increasing the use of IVM in the future can be achieved with improved training and education for fertility specialists, and increased funding for IVM research, with the ultimate goal of improving fertility outcomes.
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Affiliation(s)
- Lan N. Vuong
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Tuong M. Ho
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Robert B. Gilchrist
- Fertility and Research Centre, School of Women’s and Children’s Health, University of New South Wales Sydney, Australia
| | - Johan Smitz
- Follicle Biology Laboratory, Vrije Universiteit Brussels, Brussels, Belgium
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50
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Dang VQ, Vuong LN, Ho TM, Ha AN, Nguyen QN, Truong BT, Pham QT, Wang R, Norman RJ, Mol BW. The effectiveness of ICSI versus conventional IVF in couples with non-male factor infertility: study protocol for a randomised controlled trial. Hum Reprod Open 2019; 2019:hoz006. [PMID: 30937394 PMCID: PMC6436611 DOI: 10.1093/hropen/hoz006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 01/23/2019] [Accepted: 02/20/2019] [Indexed: 12/29/2022] Open
Abstract
Study questions Does ICSI result in a higher live birth rate as compared with conventional IVF in couples with non-male factor infertility? What is known already ICSI is primarily indicated for severe male factor infertility. While the use of ICSI for couples with non-male factor infertility has been increasing worldwide, this is not supported by data from randomised controlled trials. Evidence from non-randomised studies suggest no benefit from ICSI compared with conventional IVF in non-male factor infertility, if not a harm. Study design, size, duration This randomised, open-label, multi-centre trial aims to compare the effectiveness of one ICSI cycle and one conventional IVF cycle in infertile couples with non-male factor infertility. A total of 1064 couples will be randomly allocated to an ICSI group and a conventional IVF group. The estimated duration of the study is 30 months. Participants/materials, setting, methods Eligible couples are those whose husbands’ total sperm count and motility are normal, have undergone ≤2 previous IVF/ICSI attempts, use antagonist protocol for ovarian stimulation, agree to have ≤2 embryos transferred and are not participating in another IVF study at the same time. Women undergoing IVM cycles, using frozen semen or having a poor fertilisation (≤25%) in previous cycle will not be eligible. Couples will be randomised to undergo ICSI or conventional IVF (1:1) with ongoing pregnancy resulting in live birth after the first embryo transfer of the started treatment cycle as the primary endpoint. All analyses will be conducted on an intention-to-treat basis. Effect sizes will be summarised as relative risk (RR), with precision evaluated by 95% CIs. STUDY FUNDING/COMPETING INTEREST(S) All authors declare having no conflict of interests with regards to this trial. This work was supported by a grant from MSD [MISP #57508]. Trial registration number NCT03428919. Trial registration date 8 February 2018. DATE OF FIRST PATIENT’S ENROLMENT 16 March 2018.
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Affiliation(s)
- V Q Dang
- IVFMD, My Duc Hospital, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, Vietnam.,HOPE Research Center, My Duc Hospital, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, Vietnam
| | - L N Vuong
- HOPE Research Center, My Duc Hospital, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, Vietnam.,Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang, District 5, Ho Chi Minh City, Vietnam
| | - T M Ho
- HOPE Research Center, My Duc Hospital, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, Vietnam.,IVFAS, An Sinh Hospital, 10 Tran Huy Lieu, Phu Nhuan District, Ho Chi Minh City, Vietnam
| | - A N Ha
- IVFMD, My Duc Hospital, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, Vietnam
| | - Q N Nguyen
- IVFMD, My Duc Hospital, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, Vietnam
| | - B T Truong
- IVFAS, An Sinh Hospital, 10 Tran Huy Lieu, Phu Nhuan District, Ho Chi Minh City, Vietnam
| | - Q T Pham
- IVFMD, My Duc Hospital, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, Vietnam.,HOPE Research Center, My Duc Hospital, 4 Nui Thanh, Tan Binh District, Ho Chi Minh City, Vietnam
| | - R Wang
- Discipline of Obstetrics and Gynaecology, Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Ground Floor, 55 King William Road, North Adelaide SA 5006 Adelaide, Australia
| | - R J Norman
- Discipline of Obstetrics and Gynaecology, Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Ground Floor, 55 King William Road, North Adelaide SA 5006 Adelaide, Australia.,Fertility SA, 431 King William Street, South Australia 5000, Adelaide, Australia
| | - B W Mol
- Department of Obstetrics and Gynaecology, School of Medicine, Monash University, 246 Clayton Road, Clayton 3168, Victoria, Australia
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