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Kadioglu N, Kahyaoğlu İ, Kaplanoğlu İ, Dilbaz S, Engin Üstün Y. Evaluation of Clinical Outcomes after Poor-Quality Embryo Transfer and Prognostic Parameters. J Clin Med 2023; 12:6236. [PMID: 37834880 PMCID: PMC10573848 DOI: 10.3390/jcm12196236] [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: 08/12/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
We aimed to investigate the clinical results following poor-quality embryo transfer and the parameters to foresee the prognosis. In this study, 2123 cycles that had day 3 and day 5 single-fresh embryo with poor-quality embryo transfers and good-quality embryo transfers were compared. The cycles according to transfer day were evaluated by conducting a subgroup analysis. The correlation between all the obtained demographic characteristics, controlled ovarian stimulation parameters, and cycle results were analysed. Clinical pregnancy was established in 53 patients that underwent transfer in the poor-quality embryo group (14.9%). Of these patients, 36 had live birth (live birth rate per clinical pregnancy 67.9%). In cleavage-stage embryos, live birth rates per clinical pregnancy were higher in poor-quality blastocyst transfer. When analysing the factors affecting live births in the poor-quality embryo group, as the total gonadotropin dose increases, the probability of live birth decreases, as in the probability of hCG positivity. In conclusion, although the probability of pregnancy is low, when clinical pregnancy is established, there is a high chance of having a live birth after poor-quality embryo transfers. This could be regarded as an acceptable option in cycles when only poor-quality embryos are available.
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Affiliation(s)
- Nezaket Kadioglu
- Department of Obstetrics and Gynecology, University of Yuksek Ihtisas, Ankara 06530, Turkey
| | - İnci Kahyaoğlu
- Department of Assisted Reproductive Technology, Etlik City Hospital, University of Health Sciences, Ankara 06620, Turkey; (İ.K.); (İ.K.)
| | - İskender Kaplanoğlu
- Department of Assisted Reproductive Technology, Etlik City Hospital, University of Health Sciences, Ankara 06620, Turkey; (İ.K.); (İ.K.)
| | - Serdar Dilbaz
- Department of Assisted Reproductive Technology, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, University of Health Sciences, Ankara 06620, Turkey; (S.D.); (Y.E.Ü.)
| | - Yaprak Engin Üstün
- Department of Assisted Reproductive Technology, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, University of Health Sciences, Ankara 06620, Turkey; (S.D.); (Y.E.Ü.)
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Boudry L, Racca A, Tournaye H, Blockeel C. Type and dose of gonadotropins in poor ovarian responders: does it matter? Ther Adv Reprod Health 2021; 15:26334941211024203. [PMID: 34263173 PMCID: PMC8243085 DOI: 10.1177/26334941211024203] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/07/2021] [Indexed: 12/15/2022] Open
Abstract
Infertile patients with a diminished ovarian reserve, also referred to as
poor ovarian responders, constitute a substantial and increasing
population of patients undergoing in vitro
fertilization. The management of patients with poor ovarian response
is still a controversial issue. Almost a century has passed since the
introduction of the first gonadotropin. A broad collection of urinary
and recombinant gonadotropins, including biosimilars, is commercially
available now. Despite great advances in assisted reproductive
technology, there remains uncertainty about the optimal treatment
regimen for ovarian stimulation in poor ovarian responders. Although
oocyte donation is the most successful and ultimate remedy for poor
ovarian responders, most patients persist on using their own oocytes
in several attempts, to achieve the desired pregnancy. The aim of this
review is twofold: first, to provide an overview of the commercially
available gonadotropins and summarize the available evidence
supporting the use of one or another for ovarian stimulation in poor
ovarian responders, and second, to address the controversies on the
dosage of gonadotropins for this specific in vitro
fertilization population.
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Affiliation(s)
- Liese Boudry
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, 1090, Brussels, Belgium
| | - Annalisa Racca
- Department of Obstetrics, Gynecology and Reproduction, Hospital Universitari Dexeus, Barcelona, Spain
| | - Herman Tournaye
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium; Department of Obstetrics, Gynecology, Perinatology and Reproduction, Institute of Professional Education, Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Christophe Blockeel
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium; Department of Obstetrics and Gynaecology, University of Zagreb, Zagreb, Croatia
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Gerber RS, Fazzari M, Kappy M, Cohen A, Galperin S, Lieman H, Jindal S, Buyuk E. Differential impact of controlled ovarian hyperstimulation on live birth rate in fresh versus frozen embryo transfer cycles: a Society for Assisted Reproductive Technology Clinic Outcome System study. Fertil Steril 2020; 114:1225-1231. [PMID: 33012553 DOI: 10.1016/j.fertnstert.2020.06.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 04/09/2020] [Revised: 05/29/2020] [Accepted: 06/10/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study the impact of both controlled ovarian hyperstimulation (COH) length and total gonadotropin (GN) dose individually and in concert on live birth rates (LBR) in both fresh and freeze-all in vitro fertilization embryo transfer (IVF-ET) cycles. DESIGN Historical cohort study. SETTING Not applicable. PATIENT(S) The U.S. national database from the Society of Assisted Reproductive Technology Clinic Outcome Reporting System from 2014 to 2015 was used to identify patients undergoing autologous GN stimulation IVF cycles with the use of GnRH antagonist-based suppression protocols where a single embryo transfer was performed as part of a fresh IVF-ET cycle (fresh, n = 14,866) or the first frozen embryo transfer after a freeze-all cycle (frozen, n = 2,964), and not including preimplantation genetic testing cycles. The patients' demographic and cycle characteristics, duration of COH, total GN dose, and pregnancy outcomes were extracted. Binomial regression models estimated trend and relative risk of live birth with respect to days of stimulation and total GN dose singularly, and after adjustment for a priori confounders including age, parity, body mass index, diagnosis, and maximum follicle-stimulating hormone in both fresh and frozen embryo transfer cycles. Both days of stimulation and total GN dose were then added to the multivariate model to show whether they were independently associated with LBR. INTERVENTION(S) Not applicable. MAIN OUTCOME MEASURE(S) Live birth rate. RESULTS In both fresh and frozen cycles, length of COH was significantly associated with total GN dose. On univariate analysis, LBR decreased significantly with increasing length of stimulation and increasing total GN dose in both fresh and frozen cycles. On multivariable analysis including both days of stimulation and total GN dose, days of stimulation was no longer significantly correlated with LBR, whereas total GN dose remained significantly correlated with LBR in fresh cycles only. When total GN doses ranging from <2,000 IU through 5,000 IU to >5,000 IU were compared, a significant improvement in live birth rate was noted with lower total GN doses. Specifically, GN doses <2,000 IU had a 27% higher rate of live birth compared with GN dose >5,000 IU. For GN dose groups up to 4,000 IU, the estimated effect on LBR was similar. There was a marginal improvement (13%) in LBR with GN doses of 4,000 IU to 5,000 IU compared with >5,000 IU. When the multivariate model was applied to the frozen cycles, neither total GN dose nor days of stimulation was significantly associated with LBR. CONCLUSIONS High total GN dose but not prolonged COH is associated with decreasing LBRs in fresh cycles, whereas neither factor significantly affects LBR in frozen cycles. Consideration should be given to minimizing the total GN dose when possible in fresh autologous cycles, either by decreasing the daily dose or by limiting the length of stimulation to improve LBRs. In freeze-all cycles, the use of higher GN doses does not seem to adversely affect the LBR of the first frozen embryo transfer. High total GN dose likely exerts a negative impact on the endometrium and/or oocyte/embryo unrelated to the length of stimulation. The differential effect of total GN dose on LBR in fresh and frozen cycles may imply a greater impact exerted on the endometrium rather than the oocyte.
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Affiliation(s)
- Rachel S Gerber
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York.
| | - Melissa Fazzari
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Michelle Kappy
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Alexa Cohen
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Sharon Galperin
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Harry Lieman
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Sangita Jindal
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Erkan Buyuk
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York; Reproductive Medicine Associates of New York, Icahn School of Medicine at Mount Sinai, New York, New York
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Abstract
AIM As no upper limit of the daily dose of gonadotropins (DD GN) used for controlled ovarian hyperstimulation (COH) in patients undergoing assisted reproductive technology (ART) has been established, we aimed to evaluate the efficacy of using different DD GN in terms of live-birth achievement. METHODS Data of patients treated at a single university medical center during the same period was analyzed retrospectively. Four groups were analyzed according to the DD GN administered: group I ("high dose"): >225- ≤ 375 IU; Group II ("Very high dose"): 376-450 IU; group III ("extremely high dose"): 451-600 IU. Normo-responders treated with DD GN ≤250 IU served as control (C). Variables included were DD GN, total GN dose/cycle, age, FSH, BMI, gravidity, parity, cycle number, IVF/ICSI, infertility diagnosis treatment protocol and outcome parameters. RESULTS The analysis of 1394 treatment cycles of 943 patients indicated that DD and total dose of GN correlated negatively with the number of oocytes, implantation, clinical pregnancy and live-birth rate (25.9%, 14.6%, 11.4% and 4.7% in groups C, I, II and III, respectively) The logistic regression analysis indicated that the adjusted odds ratios for LBR correlated inversely with the DD administered - independently from age, baseline FSH, BMI and previous failed cycles. CONCLUSIONS Increasing the daily dose of GN to doses higher than 450 IU or a total dose of 3000 IU/cycle is at least questionable if not harmful.
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Affiliation(s)
- S Friedler
- a Infertility and IVF Unit, Barzilai University Medical Center, Ashkelon, Faculty of Health Sciences, Ben Gurion University of the Negev , Beersheba , Israel
| | - S Meltzer
- a Infertility and IVF Unit, Barzilai University Medical Center, Ashkelon, Faculty of Health Sciences, Ben Gurion University of the Negev , Beersheba , Israel
| | - B Saar-Ryss
- a Infertility and IVF Unit, Barzilai University Medical Center, Ashkelon, Faculty of Health Sciences, Ben Gurion University of the Negev , Beersheba , Israel
| | - J Rabinson
- a Infertility and IVF Unit, Barzilai University Medical Center, Ashkelon, Faculty of Health Sciences, Ben Gurion University of the Negev , Beersheba , Israel
| | - T Lazer
- a Infertility and IVF Unit, Barzilai University Medical Center, Ashkelon, Faculty of Health Sciences, Ben Gurion University of the Negev , Beersheba , Israel
| | - G Liberty
- a Infertility and IVF Unit, Barzilai University Medical Center, Ashkelon, Faculty of Health Sciences, Ben Gurion University of the Negev , Beersheba , Israel
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Baker VL, Brown MB, Luke B, Smith GW, Ireland JJ. Gonadotropin dose is negatively correlated with live birth rate: analysis of more than 650,000 assisted reproductive technology cycles. Fertil Steril 2015; 104:1145-52.e1-5. [PMID: 26297646 DOI: 10.1016/j.fertnstert.2015.07.1151] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [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: 05/16/2015] [Revised: 07/17/2015] [Accepted: 07/22/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the correlation between total gonadotropin dose and live birth rate. DESIGN Retrospective analysis. SETTING Not applicable. PATIENT(S) A total of 658,519 fresh autologous cycles of in vitro fertilization (IVF) reported to the Society for Assisted Reproductive Technology from 2004 to 2012. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Logistic regression models were fitted to live birth rates with the use of categorized values for total FSH dose and number of oocytes retrieved as the primary predictor variables. To reduce the effect of the most significant confounders that may lead physicians to prescribe higher doses of FSH, additional analyses were performed limited to good-prognosis patients (<35 years of age, body mass index <30 kg/m(2), and no diagnosis of diminished ovarian reserve, endometriosis, or ovulatory disorder) and including duration of gonadotropin treatment. RESULT(S) Live birth rate significantly decreased with increasing FSH dose, regardless of the number of oocytes retrieved. The statistically significant decrease in live birth rate with increasing FSH dose remained in patients with good prognosis, and regardless of female age, except for women aged ≥ 35 years with 1-5 oocytes retrieved. CONCLUSION(S) This analysis suggests that physicians may wish to avoid prescribing a high dose of FSH. However, the results of this study do not justify the use of minimal-stimulation or natural-cycle IVF.
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Affiliation(s)
- Valerie L Baker
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California.
| | - Morton B Brown
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Barbara Luke
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, Michigan
| | - George W Smith
- Laboratory of Mammalian Reproductive Biology and Genomics, Department of Animal Science, Michigan State University, East Lansing, Michigan
| | - James J Ireland
- Molecular Reproductive Endocrinology Laboratory, Department of Animal Science, Michigan State University, East Lansing, Michigan
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Lashen H, Ledger W, López Bernal A, Evans B, Barlow D. Superovulation with a high gonadotropin dose for in vitro fertilization: is it effective? J Assist Reprod Genet 1998; 15:438-43. [PMID: 9717120 PMCID: PMC3454804 DOI: 10.1007/bf02744938] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [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: 01/20/1998] [Accepted: 03/19/1998] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Our purpose was to investigate the effect on the ovarian response of increasing the gonadotropin dose. METHODS We analyzed retrospectively the in vitro fertilization data for patients who had two cycles of treatment, with a higher dose in cycle 2. The patients were stratified according to age, ovarian response, and gonadotropin dose in the first cycle. The main outcome measure was the number of follicles, eggs, and embryos and the peak estradiol (E2) level. RESULTS The study included 244 patients. Patients in both age groups (n = 118, < or = 33 years; n = 126, > 33 years), low (n = 66) and intermediate (n = 145) responders, and patients who received < 225 IU follicle-stimulating hormone (n = 175) in cycle 1 had a better response in cycle 2. However, the high responders (n = 33) and those who received 225 or 300 IU follicle-stimulating hormone (n = 69) in cycle 1 showed a similar response in both cycles, except for a significantly higher E2 level in cycle 2. CONCLUSIONS Our results indicate that exceeding a daily dose of 300 IU is unrewarding.
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Affiliation(s)
- H Lashen
- Academic Department, Birmingham University, Birmingham Women's Hospital, Edgbaston, U.K
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