Day Of hCG Trigger Research Articles

Does the controlled ovarian stimulation increase the weight of women undergoing IVF treatment?

ObjectiveWomen undergoing assisted reproductive treatment are usually concerned about the side effects caused by high doses of gonadotropin. A common inquiry of patients is concerning the weight gain as a consequence. The aim of this study was to evaluate if controlled ovarian stimulation increase the weight of women undergoing IVF treatment.Study designThis retrospective cohort study included 734 women undergoing IVF treatment between January 2017 and May 2018 and had body weight measured on the day of ovarian stimulation starting (basal-weight) and on the hCG trigger day (hCG-weight). The difference of hCG-weight and basal-weight was calculated and correlated to number of oocytes retrieved and ovarian stimulation protocol. For 358 women, two international validated questionnaires to evaluate the anxiety and binge eating were applied at the end of ovarian stimulation and also associated to the body weight gain. ResultsThe basal-weight and hCG-weight were paired compared and demonstrate a statistically significant weight gain from basal to hCG-weight of a mean of 387.7 ± 720.4 g (p < 0.001). The weight gain had a positive correlation with the number of oocytes retrieved (Pearson correlation, r = 0.181; p < 0.001) but no correlation with the ovarian stimulation protocol. Regarding the questionnaires answered by patients, neither anxiety score (Pearson: r = -0,031; p = 0,561) nor binge eating score (Pearson: r = 0,069; p = 0,199) were correlated with weight gain from basal-weight to hCG- weight. However, patients who felt eating more during the treatment had a higher weight gain (p < 0.001) independently of the number of oocytes retrieved. ConclusionsThe weight gain is possibly a result from edema and is clinically irrelevant despite of the statistical significance and will probably be resolved in some days after oocytes retrieval. A small “weight gain” was observed and associated to the number of oocytes retrieved regardless of protocol and medication used in the ovarian stimulation.

Supraphysiological estradiol levels on the hCG trigger day are associated with SGA for singletons born from fresh embryo transfer.

The effects of supraphysiological estradiol (E2) on neonatal outcomes and the significance of specific E2 concentrations remain unclear. The purpose of this study was to investigate whether supraphysiological E2 levels on the human chorionic gonadotropin (hCG) trigger day are associated with small size for gestational age (SGA) in singletons born from fresh embryo transfer (ET) cycles. Patients with singleton pregnancies who delivered after the transfer of fresh embryos, during the period from July 2012 to December 2017, at our center were included. We excluded cycles involving a vanishing twin, maternal age >35 years, basal follicle-stimulating hormone ≥10 mIU/ml, or anti-Müllerian hormone ≤1 ng/ml. We then divided all cycles into five groups by E2 level on trigger day: group A, <2000 pg/ml (reference group); group B, 2000 pg/ml≤E2<2999 pg/ml; group C, 3000 pg/ml≤E2<3999 pg/ml; group D, 4000 pg/ml≤E2<4999 pg/ml; and group E, ≥5000 pg/ml. The prevalence of SGA among singletons from fresh ET was the primary outcome. The SGA rate significantly increased when the E2 level was ≥4000 pg/ml, as observed by comparing groups D (odds ratio [OR]: 1·79, 95% confidence interval [CI]: 1·16-2·76, P = 0·01) and E (OR: 1·68, 95% CI: 1·10-2·56, P = 0·02) with the reference group. Multivariate logistic regression indicated that a serum E2 level of at least 4000 pg/ml on the hCG trigger day was associated with increased SGA and with significant differences for groups D (adjusted OR [AOR]: 1·65, 95% CI: 1·05-2·59, P = 0·03) and E (AOR: 1·60, 95% CI: 1·03-2·53, P = 0·04) relative to the reference group. In conclusion, in fresh ET cycles, the supraphysiological E2 ≥4000 pg/ml on the hCG trigger day increases the risk of SGA.

Thicker endometrium on hCG trigger day improves the live birth rate of fresh cleavage embryo transfer in GnRH-agonist regimen of normogonadotrophic women.

BackgroundLuteinizing hormone (LH) and progesterone (PROG) on human chorionic gonadotropin (hCG) trigger day are significantly correlated with assisted reproductive technology (ART) outcome. Moreover, LH and PROG are also involved in the functional preparation of the endometrium during the implantation window; however, whether they are related to endometrial thickness (EMT) is still unknown. The aim of the present study was to assess whether EMT has a positive correlation on the live birth rate following fresh embryo transfer (ET), and whether LH and PROG have an impact on EMT.MethodsA total of 2,260 normogonadotrophic women were treated with a GnRH agonist for in vitro fertilization (IVF)/intracytoplasmic sperm injection. Patients with advanced age and poor ovarian reserve were excluded. The levels of LH, PROG, and EMT on the hCG trigger day were divided into binary variables, respectively, by the cutoff values, and which were obtained based on receiver operating characteristic curve analysis of live birth among LH, PROG and EMT levels on the hCG trigger day, respectively. Multivariate binary logistic regression was used to confirm the role of LH, PROG, and EMT on the live birth, and stratified analysis was used to determine whether LH and PROG have an impact on EMT.ResultsEMT and LH were protective factors for live births, with odds ratios (OR) of 1.11 [95% confidence interval (CI): 1.066–1.157] and 1.696 (95% CI: 1.345–2.139), respectively. However, PROG was a risk factor for live birth, with an OR of 0.635 (95% CI: 0.526–0.766). The hierarchical cross-table analysis indicated that EMT had no significant difference for live birth in the combination of low LH and high PROG group. In the other subgroups, thick EMT was associated with a higher live birth rate (P<0.05).ConclusionsOn hCG trigger day, EMT, LH, and PROG all were independent factors that affected the live birth of fresh ETs. Thick EMT can significantly increase the live birth rate. However, multivariate logistic regression analysis showed that EMT does not affect the live birth rate in combination of low LH and high PROG environment.

Timing of HMG supplementation and clinical outcomes of advanced-age patients with diminished ovarian reserve receiving gonadotropin-releasing hormone antagonist protocol

To assess the effect and timing of human menopausal gonadotropin (HMG) supplementation in advancedage patients with diminished ovarian reserve (DOR) receiving gonadotropin-releasing hormone antagonist protocol. A total of 682 patients with DOR aged over 35 years undergoing IVF-ET treatment were included in this study. All the patients underwent a GnRH antagonist protocol, and controlled ovarian stimulation was initiated on day 2-3 of the menstrual cycle with follicle stimulation hormone (FSH). According to the timing of HMG supplementation, the patients were divided into no supplementation group (n=371) without HMG supplementation; early supplementation group (n=139), in which daily HMG supplementation started on the first day till the trigger day; and late supplementation group (n=172), in which HMG supplementation started when the leading follicle reached 10-14 mm in diameter and lasted until the trigger day. The pregnancy outcomes of the patients were compared among the 3 groups. The 3 groups showed no significant difference in hCG trigger day E2 and P levels, endometrial thickness, or the number of follicles with comparable fertilization rate and cleavage rate (P>0.05). Gn dose used was the lowest in no supplementation group, and the average number of oocytes retrieved was significantly smaller in early supplementation group than in late supplementation group (P < 0.05). The mean number of mature oocytes and embryos available were significantly higher in late supplementation group than in early supplementation group (P < 0.05). The clinical pregnancy rate of fresh embryo transfer cycle was significantly higher in late supplementation group than in no supplementation group (27.7% vs 45.1%, P < 0.05), but the implantation rate, early miscarriage rate, heterotopic pregnancy rate and live birth rate were comparable among the 3 groups (P>0.05). No significant differences were found among the 3 groups in the implantation rate, clinical pregnancy rate, early miscarriage rate, heterotopic pregnancy rate or live birth rate of the first frozen-thawed embryo transfer cycle with a freeze-all strategy (P>0.05). HMG supplementation in the middle and late follicular phase can improve the outcomes of controlled ovarian hyperstimulation and increase the clinical pregnancy rate of fresh embryo transfer cycle in advanced-age patients with DOR undergoing GnRH antagonist protocol.

Impact of Premature Progesterone Rise on Intracytoplasmic Sperm Injection Outcomes Using Gonadotropin-Releasing Hormone Antagonist Protocol

Background: Premature progesterone rise (PPR) refers to an increase in serum progesterone (P4) levels on or before the human chorionic gonadotropin (hCG) trigger day. This work aimed to evaluate the impact of serum P4 levels on the day of hCG trigger on the outcomes of intracytoplasmic sperm injection (ICSI) cycles using the gonadotropin-releasing hormone (GnRH) antagonist protocol. Methods: The prospective cohort study was conducted at the Cytogenetics and Endoscopy unit, Obstetrics & Gynaecology Department, Zagazig University, including 150 women having ICSI/fresh-embryo transfer (ET). Each patient had one trial of ICSI/fresh ET cycle. In the study, patients were subjected to controlled ovarian stimulation (COS) using a GnRH antagonist protocol. P4 levels were measured on the hCG trigger day (hCG-P4), and the results were correlated to the outcomes of the ICSI cycle. Results: There was a statistically significant negative correlation between hCG-P4 and the top-quality embryo (TQE) rate. No significant association was found between hCG-P4 level and clinical pregnancy, ongoing pregnancy, or miscarriage. The cutoff for hCG-P4 predicting unsuccessful achievement of clinical pregnancy was ≥ 0.925 (p>0.05). Patients with hCG-P4 level ≥0.925 ng/ml had a significantly lower TQE rate than patients with hCG-P4

Optimal Candidates to Do Fresh Embryo Transfer in Those Using Oral Contraceptive Pretreatment in IVF Cycles.

ObjectiveConcern regarding the adverse impact of pretreatment of oral contraceptives (OC) prior to ovarian stimulation for in vitro fertilization (IVF) on pregnancy outcome has been debated. We investigated factors that may be associated with live birth rate (LBR) in fresh embryo transfer cycles after OC pretreatment.MethodsA retrospective study was conducted at the Reproductive Center of Ren Ji Hospital, Shanghai, China. 814 women aged 20–35 years undergoing their first autologous IVF cycle and fresh embryo transfer after OC pretreatment were included. Long gonadotropin releasing hormone (GnRH) agonist (a) or GnRH antagonist (ant) protocol was used for ovarian stimulation. Predictive factors for LBR were identified using multivariate logistic regression analysis.ResultsMultivariate logistic regression analysis demonstrated that using GnRH-ant protocol for ovarian stimulation was associated with significantly lower LBR (OR 0.70, 95% CI 0.52–0.93), while endometrial thickness on day of hCG trigger was associated with increased LBR (OR 1.16, 95% CI 1.06–1.27). Despite comparable patients’ age, duration of infertility, BMI and basal FSH between GnRH-a and GnRH-ant groups, those using GnRH-ant resulted in significantly lower LBR compared to the GnRH-a group (37.4 vs. 48.5%, p = 0.002). Using ROC analysis and a cut-off endometrial thickness of < and ≥ 9.5 mm, those < 9.5 mm using GnRH-ant resulted in significantly lower LBR (28.5 vs. 43.4%, p = 0.004), while no differences were noted with an endometrial thickness ≥9.5 mm (49.6 vs. 51.1%, p = 0.78).ConclusionsLive birth was significantly impacted in OC pre-treated GnRH-ant cycles with an endometrial thickness of <9.5 mm on day of hCG trigger. Cryopreservation of all embryos in these cycles should be considered.

TO COMPARE THE COMBINED EFFECT OF ORAL SILDENAFIL AND ESTRADIOL VALERATE TO ESTRADIOL VALERATE ALONE IN PATIENTS WITH CLOMIPHENE INDUCED CYCLES IN INFERTILE WOMEN ON ENDOMETRIAL THICKNESS.

Objective- Endometrial thickness &lt;7 mm accepted as a reliable sign of suboptimal implantation potential. Clomiphene citrate (CC) has some negative effects on the endometrium. We evaluated the effect of concomitant administration of oral sildenal and estradiol valerate on endometrial thickness Aim- To compare the combined effect of oral sildenal and estradiol valerate to estradiol valerate alone in patients with clomiphene induced cycles in infertile women on endometrial thickness. Material And Method- This randomized study was conducted on infertile women attending infertility OPD in SN Medical College, Agra over a period of 2 years from January 2019 to December 2020. Infertile patients were randomly divided into two equal groups. In control group, 50 patients were given clomiphene citrate 50 mg daily from D2 to D6 along with estradiol valerate 2 mg thrice daily from 2nd day of the cycle till the day of trigger of ovulation. In study group, 50 patients were given clomiphene citrate 50 mg daily from D2 to D6 along with estradiol valerate 2mg 12 thrice daily plus oral sildenal citrate 25mg every 8 h from 2nd day of the cycle till the day of hCG trigger. Results- The results in this study conrm the superiority of using oral sildenal with estradiol for improving endometrial thickness, vascularity and pregnancy rates. Conclusion- Addition of oral sildenal citrate to estradiol valerate in ovulation induction cycles has better results in improving endometrial thickness, endometrial blood ow and pregnancy outcome as compared to estradiol valerate alone in women with anovulatory infertility

Association between estradiol levels and clinical outcomes of IVF cycles with single blastocyst embryo transfer

Objective: To determine the correlation of different serum estradiol levels on the trigger day with the clinical and laboratory outcomes of in-vitro fertilization (IVF) cycles comprising a single fresh top-quality blastocyst transfer. Methods: This was a retrospective observational study performed in Morula IVF Clinic Jakarta. Five hundred forty-two women were recruited and grouped according to their serum estradiol levels on the trigger day of follicular maturation as follows: &lt;2 000 pg/mL, 2 000-2 999 pg/mL, 3 000-3 999 pg/mL, and ≥ 4 000 pg/mL. Clinical pregnancy and miscarriage rates were evaluated as the primary outcomes and embryology laboratory results as the secondary outcomes which consisted of the number of retrieved, mature, and fertilized oocytes, the total sum of derived embryos, and top-quality embryos at cleavage and blastocyst stage. Results: Clinical pregnancy and miscarriage rates did not differ among the groups (P&gt;0.05). Nonetheless, the study demonstrated a positive correlation of the serum estradiol levels with the overall laboratory outcomes including the number of retrieved, mature, and fertilized oocytes, the total sum of derived embryos, and top-quality embryos at cleavage and blastocyst stage (P&lt;0.001). The subject group with estradiol level of ≥4 000 pg/mL was superior to the other groups in its respective median number of retrieved, mature, fertilized oocytes, total derived embryos, and top-quality cleavage- and blastocyst-stage embryos. Conclusions: Although an apparent positive correlation is observed between estradiol levels and laboratory outcomes, serum estradiol level on hCG trigger day is not associated with the clinical outcomes of IVF.

Oral Vitamin D supplementation impacts gene expression in granulosa cells in women undergoing IVF.

Oral Vitamin D supplementation impacts gene expression in granulosa cells in women undergoing IVF.

Significance of endometrial thickness change after human chorionic gonadotrophin triggering in modified natural cycles for frozen-thawed embryo transfer.

BackgroundPeak endometrial thickness (EMT), measured on the end of follicular phase or early luteal phase, is the most widely used marker for endometrial receptivity during infertility treatment. However, the clinical significance of follicular-to-luteal EMT change remains unclear. We aimed to study whether the change of EMT between the day of human chorionic gonadotrophin (hCG) triggering and the day of frozen-thawed embryo transfer (FET) has any influence on pregnancy outcomes in modified natural cycles (mNCs).MethodsThis was a retrospective cohort study of 2,768 regular ovulatory women who underwent their first mNC-FET cycles from January 2011 to June 2015. Patients were divided into three groups according to the percentage change of EMT from the hCG triggering day to the FET day: >5% decrease (n=405), ±5% plateau (n=1,259) and >5% increase (n=1,104). The main outcome measure was live birth rate.ResultsLive birth rates were 41.9%, 39.8% [crude odds ratio (cOR) 0.91, 95% CI, 0.73–1.15) and 42.4% (cOR 1.02, 95% CI, 0.87–1.20) in the EMT plateau, decrease and increase groups, respectively (P=0.649). Multiple regression analysis did not alter the finding after controlling for a variety of confounders. Compared with the post-trigger EMT plateau group, the adjusted OR of live birth was 0.88 (95% CI, 0.69–1.12) in the decrease group and 1.05 (95% CI, 0.88–1.25) in the increase group. Similarly, no significant associations were observed before or after adjustment between EMT change and other pregnancy outcomes including positive hCG test, clinical pregnancy, early miscarriage and ongoing pregnancy.ConclusionsEMT change from hCG triggering to embryo transfer was not associated with pregnancy chances in mNC-FET cycles. This reassuring finding should provide guidance for physicians and patients when confronted with EMT decrease on the transfer day.

Predictor for supraphysiologic serum estradiol elevation on hCG triggering day of controlled ovarian stimulation using letrozole and gonadotropins in women with estrogen-dependent cancers.

The objective of this study was to evaluate predicting factors for supraphysiologic serum estradiol elevation during controlled ovarian stimulation (COS) with administration of letrozole and gonadotropins in patients with estrogen-dependent cancer. Use of aromatase inhibitors is recommended to prevent the potential effects of elevated serum estradiol levels and recurrence of tumor in patients with estrogen-dependent cancers during COS. Although previous studies reported that letrozole have shown an effective lowering of peak estrogen levels, a part of patients shows supraphysiologic levels of estrogen associated with ovarian stimulation despite the administration of letrozole. From January 2009 to December 2019, patients with estrogen-dependent cancer who underwent COS with antagonist protocol using a letrozole (5 mg/ day) to keep estrogen levels low were included in this study. Early monitoring serum estradiol was measured in all patients on the 4-6th day of stimulation. Subjects were classified into two groups according to the serum estradiol level on hCG triggering day, physiologic estradiol group (≤400 pg/mL) and supraphysiologic estradiol group (>400 pg/mL). A total of 96 COS cycles were retrospectively analyzed. Supraphysiologic level of serum estradiol was found in 21.9% of the patients. Mean age, AMH, duration of stimulation, total dose of gonadotropins administered were not different between the two groups. However, early monitoring serum estradiol level was significantly higher in the supraphysiologic estradiol group (67.1±47.9 vs. 115.6±78.1, p = 0.001) and was associated with the occurrence of supraphysiologic elevation of serum estradiol on hCG triggering day. Patients with early monitoring serum estradiol ≥84.5 pg/mL had an odds ratio of 5.376 [95% CI, 1.613–17.913] for supraphysiologic elevation of serum estradiol compared to those with early monitoring serum estradiol below 84.5 pg/mL. In conclusion, early monitoring serum estradiol is an independent predicting factor for supraphysiologic level of serum estradiol on hCG triggering day in the COS cycles using letrozole and gonadotropins.

Factors related to follicular oxidative stress in intracytoplasmic sperm injection cycles and its effects on granulosa cells

The aim of the present study was to investigate several common conditions that may potentially be correlated with follicular oxidative status during an intracytoplasmic sperm injection (ICSI) cycle and that include the serum oestrogen level on the day of oocyte pick-up, maternal age and pregnancy outcome. Patients that were enrolled in the study were classified randomly into three groups using their numerical order. The first group were classified based on maternal age (<35 and ≥35 years) (n = 398), the second group on the serum oestradiol (E2) level on the day of human chorionic gonadotropin (hCG) administration (levels >90th percentile and ≤ 90th percentile) (n = 491) and the third group on pregnancy outcome (positive/negative) (n = 376). The groups were matched for the other variables (stimulation protocol, dose of gonadotropin, duration of stimulation, antral follicle count, body mass index, basal follicle stimulating hormone (FSH), and E2 levels and day of hCG trigger) to prevent the possible contribution of those parameters to the results. Each group was matched for other variables (stimulation protocol, dose of gonadotrophin, duration of stimulation, antral follicle count, body mass index, basal FSH and E2 levels and day of hCG trigger) that may have affected the outcome, except for the parameter under investigation. Maternal age (P = 0.044,168 r = 0.418), oestrogen level on day of hCG administration (P = 0.001, r = 0.436) and pregnancy outcome (AUC = 0.65, P = 0.071) were found to be correlated with follicular oxidative status. The results obtained will help us to shield patients from possible situations that may cause oxidative stress and therefore adverse outcomes of an ICSI cycle.

Pregnancy Outcomes of Women With Polycystic Ovary Syndrome for the First In Vitro Fertilization Treatment: A Retrospective Cohort Study With 7678 Patients.

BackgroundThe risk of adverse pregnancy outcomes is increased by having a polycystic ovary syndrome (PCOS) diagnosis. However, the confounders in previous studies preclude firm conclusions, and further studies are warranted.ObjectivesTo investigate whether PCOS affects pregnancy outcomes and complications in infertile women undergoing their first in vitro fertilization (IVF) treatment, taking into account important confounders.MethodsWe performed a retrospective cohort study of 7,678 infertile women, including 666 women with PCOS and 7,012 controls undergoing their first IVF treatment at a private fertility center from January 2010 to December 2017. Our main outcome was the impact of PCOS on adverse pregnancy outcomes (miscarriage, preterm delivery, pregnancy-induced hypertension) and pregnancy outcomes (live birth rate, clinical pregnancy rate, implantation rate). PCOS effects were summarized by adjusted odds ratios (aORs) with 95% confidence intervals (CIs) after controlling for maternal characteristics.ResultsAfter adjusting for differences in maternal age, BMI, infertility duration, total dose of gonadotropin, serum E2 and endometrial thickness on the day of hCG trigger, number of fertilized occytes, number of embryos transferred, embryo type (cleavage-stage embryo or blastocyst) and quality, women with PCOS had an increased risk of developing unfavorable pregnancy complications, including miscarriage (aOR 1.629, 95% CI 1.240–2.141), very preterm delivery (< 32 weeks) (aOR 2.072, 95% CI 1.133–3.791). For pregnancy outcomes, PCOS was associated with higher clinical pregnancy rate (aOR 1.248, 95% CI 1.038–1.501) and implantation rate (aOR 1.238, 95% CI 1.030–1.489) after adjusting for the above-mentioned confounders.ConclusionsWomen with PCOS are at increased risk of adverse pregnancy outcomes after adjusting for differences in maternal characteristics. These women may need more frequent medical consultants and management during pregnancy and parturition.

THE ASSOCIATION OF AMH WITH ENDOMETRIAL THICKNESS IN GONADOTROPIN STIMULATION/INTRAUTERINE INSEMINATION CYCLES

The role of anti-Müllerian hormone (AMH) and its receptor (AMH-R) on endometrial function and development is not well known. However, endometrial production of AMH has been reported, and endometrial expression of both AMH and AMH-R has shown cyclic variation with unclear significance. Our objective was to evaluate the association, if any, between AMH and pre-ovulatory endometrial thickness (ET) in gonadotropin induction (Gn)/intrauterine insemination (IUI) cycles. Retrospective cohort study. All Gn/IUI cycles (n=11,383) taking place at a large academic fertility center between 11/2007 and 12/2019, were retrospectively reviewed. 1,856 Gn/IUI cycles (from 912 patients) with a recorded pre-treatment serum AMH level and information available on endometrial thickness (ET) (measured by transvaginal ultrasound on either the day of or the day prior to HCG-trigger) were identified and included in the current analysis. Uterine factor infertility patients were excluded. Statistical analysis: Parametric and non-parametric tests were used as appropriate. Linear regression models, adjusted for potential confounders, were used to evaluate the effect of AMH on ET (bAMH stands for the regression coefficient of AMH). P < 0.05 was considered significant. Mean (SD) age, BMI, and AMH were: 35.9 (4.0) years, 25.1 (5.1) kg/m2, and 3.5 (4.2) ng/ml, respectively. Idiopathic infertility was the most common diagnosis (32.0%), and PCOS accounted for 8.7% of the population. Mean (SD) and median (IQR) ET (mm) were: 9.1 (2.3) and 9.0 (7.5, 10.4), respectively, when measured on HCG-trigger day, and 8.4 (2.3) and 8.0 (7.0, 10.0), respectively, when measured the day prior to it. Unadjusted regression models, showed a positive, albeit weak, correlation between AMH and ET (as measured on both HCG-trigger day and day prior to it) [r: 0.1, bAMH (95%CI): 0.03 (-0.003, 0.06), p: 0.08, and r: 0.1, bAMH (95%CI): 0.04 (0.01, 0.08), p: 0.02, respectively]. When models were adjusted for BMI, prior parity, and peak estradiol (E2) levels, the positive correlation between AMH and ET became stronger, [r: 0.2, bAMH (95%CI): 0.04 (0.03, 0.11), p: 0.009; r: 0.3, bAMH (95%CI): 0.07 (0.03, 0.11), p<0.001, for HCG-trigger day and day prior to HCG, respectively]. When models were further adjusted for PCOs diagnosis, the results remained significant [r: 0.2, bAMH (95%CI): 0.04 (0.001, 0.08), p: 0.045; r: 0.3, bAMH (95%CI): 0.05 (0.01, 0.10), p:0.03; for HCG-trigger day and day prior to HCG, respectively]. Pre-treatment, circulating serum AMH levels correlated positively with endometrial thickness in the pre-ovulatory phase of Gn/IUI cycles. Our data suggests a possible independent effect of AMH on endometrial development among patients undergoing Gn/IUI treatments.

COST EFFECTIVE PROTOCOL WITH LETROZOLE AND 3 DOSES OF GONADOTROPIN COMBINATION AS AN ALTERNATIVE TO CONTINUOUS GONADOTROPIN FOR OVULATION INDUCTION FOR IUI IN CLOMIPHENE CITRATE RESISTANT PCOS PATIENTS - A RCT

Clomiphene citrate (CC) is the primary drug of choice for ovulation induction in PCOS but resistance to ovarian stimulation or stunted follicular growth is a frequent observation with CC. Inappropriate pregnancy rate & inadequate pregnancy outcomes are also observed with CC. The next approach of ovulation induction in CC resistance cases is using continuous Gonadotropin but it has many disadvantages such as high treatment cost, multi follicular development leading to multiple pregnancy, OHSS and frequent shifting of cycle to IVF-ET treatment. Letrozole induces folliculogenesis by releasing H-P axis from tonic inhibitory effect of estrogen & by augmenting gonadotropin secretion. It helps in follicular development without any adverse effect on the peripheral estrogen sensitive tissues. Adding few ampoules of gonadotropin at interval along with letrozole increases FSH at follicular receptor level & produces good quality oocyte. The purpose of the study was: -To evaluate the efficacy of combined Letrozole & 3 doses of gonadotropin in CC resistant IUI cases. -To compare the efficacy and cost effectivity of this protocol with continuous gonadotropin therapy. This RCT was conducted in a tertiary infertility care centre from July 2017 to January 2019. Total 108 anovulatory PCO women in the age group 20 to 36 years who had previous ≥3 failed treatment cycles with CC were randomly divided into Group A (Letrozole plus 3 doses gonadotropin group) & Group B (Continuous gonadotropin group) comprising 54 patients in each group. 2 blood samples from all the patients on Day2 of cycle and on the Day of hCG triggering were analyzed for endocrine profile. Patients in gr A were studied for total 96 cycles (n = 96) who received tab Letrozole 5 mg daily from D2 to D6 and injection U-FSH- HP (75 IU) on D2, D5 and D8 of cycle. Patients in gr B were studied for total 84 cycles (n = 84) & received continuous gonadotropin (U-FSH- HP, 75 IU) starting from D2 of cycle. Folliculometry was started from D9 of cycle & ovulation triggering was done by hCG when dominant follicle reached ≥ 18 mm. Single IUI was performed with documented ovulation. Both groups were evaluated in respect of terminal endocrinological profile, number of follicles, ovulation rate, pregnancy rate & outcome, adverse effects & cost effectivity. Demographic & baseline endocrine profile was comparable. In Gr A & B, mean no of follicles and average terminal estradiol level were 1.8 ±0.6 Vs 4.2 ± 0.8 (p< 0.05) and 266 ± 46 Vs 756 ± 84 pg (p< 0.001) respectively. Ovulation rate and pregnancy rate in both groups were 83.3% Vs 90.5% (p = 0.157) and 18.8% Vs 20.2% (p = 0.774) in Gr A & B respectively. In Gr B, 3 patients (3.6%) developed OHSS and 4 patients (4.8%) needed shifting of cycle to IVF-ET whereas no such incidents happened in Gr A. The average cost per cycle was significantly less in Gr A than Gr B. The combined therapy with Letrozole and 3 doses of gonadotropin is a cost effective treatment protocol in CC resistant PCOS patient before proceeding to costly continuous gonadotropin therapy without any significant difference in ovulation and pregnancy rate.

Systematic oxidative stress is not associated with live birth rate in young non-obese patients with polycystic ovarian syndrome undergoing assisted reproduction cycles: A prospective cohort study

ObjectiveOxidative stress may be associated with polycystic ovary syndrome (PCOS) and poor outcomes after assisted reproduction treatment. It is unclear if systematic oxidative stress is correlated with live birth rate in patients with PCOS after controlled ovarian stimulation. This study aimed to investigate the serum oxidative stress markers on the day of trigger hCG and its relationship with live birth rate in young non-obese women with or without PCOS undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment. Study designIn this prospective cohort study, 50 patients with PCOS and 50 patients without PCOS aged less than 35 years and undergoing IVF/ICSI between February 2017 and January 2018 were studied. The body mass index (BMI) of all participants was less than 28 kg/m2. Serum malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GPx) levels on the day of hCG were measured. Demographic and cycle characteristics, embryo laboratory data and pregnancy outcomes after fresh embryo transfer were analyzed. Univariate analysis and logistic regression analysis were used to analyze independent variables predicting the live birth rate. ResultsAfter conventional ovarian stimulation, the patients with PCOS had higher serum MDA and GPx concentrations (P < 0.03) and lower serum SOD levels (P < 0.03) on the hCG trigger day than the controls. Further, the serum MDA and GPx levels on the trigger day were also positively correlated with the number of good quality embryos (R = 0.26, P = 0.01; R = 0.21, P = 0.04; respectively). However, cycle characteristics, IVF/ICSI outcomes and pregnancy outcomes were comparable between the two groups. Multivariate logistic regression analysis showed that the rate of good quality embryos (OR 1.04, 95 %CI 1.01–1.06, P = 0.005) and the duration of infertility (OR 0.74, 95 %CI 0.56−0.98, P = 0.04) were predictive factors of live birth rate. The ROC curve analysis showed the AUC for the model was 0.76 (95 %CI: 0.67−0.86, P < 0.001). ConclusionThe data suggest that moderate systemic oxidative stress on the hCG trigger day had no detrimental effects on live birth rate in young and non-obese patients with PCOS after IVF/ICSI treatment.

Do spontaneously decreasing estradiol levels prior to triggering of ovulation adversely impact in vitro fertilization outcomes?

ObjectiveThe aim of this study was to explore the potential adverse effect of spontaneously decreasing serum estradiol (SE) levels on in vitro fertilization (IVF) outcomes.MethodsThis retrospective single-subject study analyzed IVF cycles conducted at a hospital IVF unit between 2010 and 2017. Overall, 2,417 cycles were analyzed. Only cycles with spontaneously decreasing SE before human chorionic gonadotropin (hCG) triggering were included. Each patient served as her own control, and subsequent cycles were analyzed for recurrent SE decreases. The main outcome was the number of oocytes retrieved.ResultsCycle characteristics were similar between the study (SE decrease) and control groups, with the exception of the median SE on the day of hCG triggering (899.7 pg/mL; interquartile range [IQR], 193–2,116 pg/mL vs. 1,566.8 pg/mL; IQR, 249–2,970 pg/mL; p < 0.001). The study group, relative to the control group, had significantly fewer total oocytes (5 [IQR, 2–9] vs. 7 [IQR, 3–11]; p = 0.002) and significantly fewer metaphase II (MII) oocytes (3 [IQR, 1–6] vs. 4 [IQR, 2–8]; p = 0.001) retrieved. The study group had fewer cleavage-stage embryos than the control cycles (3 [IQR, 1–6] vs. 4 [IQR, 2–7]; p = 0.012). Compared to cycles with a ≤ 20% SE decrease, cycles with a > 20% decrease had significantly fewer total and MII oocytes retrieved. SE decrease recurred in 12% of patients.ConclusionA spontaneous decrease in SE levels adversely affected IVF outcomes, with a linear correlation between the percentage decrease and the number of oocytes retrieved. SE decrease can repeat in later cycles.

Evidence from three cohort studies on the expression of MUC16 around the time of implantation suggests it is an inhibitor of implantation.

To examine the expression of MUC16 in the endometrium peri-implantation period in three different cohort studies. This was a retrospective observational cohort study. A total of 245 participants were recruited in three separate cohort studies: (1) women with recurrent miscarriage (n = 50) and fertile controls (n = 29); (2) women who had high (n = 20) or normal (n = 20) progesterone on the day of hCG trigger in ovarian stimulation cycle for IVF; and (3) women who did (n = 95) or did not (n = 31) conceive following frozen embryo transfer in HRT cycles. All subjects had archived endometrial samples precisely taken on LH+7 in natural cycles, or hCG+6 in ovarian stimulation cycles, or P+5 in HRT cycles. The H-score (median, range) of MUC16 in the luminal epithelium and glandular epithelium was determined by using immunohistochemistry. The median (range) of H-score of MUC16 in the luminal epithelium (1) in women with recurrent pregnancy loss was 23.7 (0-300), which was significantly (P < 0.05) lower than that of 118.4 (7.7-300) in fertile controls; (2) in women with elevated progesterone on the day of hCG administration (147.8, 18.0-230.1), significantly (P < 0.05) higher than that of women with normal progesterone (61.0, 2.3-205.3); (3) in women who conceived (23.1, 0-250.3), significantly (P < 0.001) lower than that in women who did not conceive (58.4, 0-300). The expression of MUC16 in all three cohort studies is consistent with it being an inhibitor of implantation.

The Level of Serum Progesterone on the day of HCG Administration in Assisted Reproduction Cycles

Introduction: During stimulated IVF- ET cycle spontaneous LH surge occur in about 20 – 50 % of cycle stimulated with gonadotropin without the pituitary suppression of GnRH agonist. This has been related to maturation and recovery of oocyte together decrease fertilization and implantation rate, this spontaneous LH surge is associated with increase in serum progesterone , so without pituitary suppression with GnRH , the rise of serum progesterone in the per ovulatory period may indicate the occurrence of spontaneous of LH surge, the aim of study is to indicate cutoff point of progesterone in the day of HCG administration. Method: This was a retrospective, non-interventional cohort study of patients undergoing ICSI at Tiba infertility center in Babylon, from period 2015 - 2019, all patient age from 20 – 45 years old under long protocol, had at least one grade I embryo transferred, total amount of patients was 1457. At second day of menstrual cycle we stimulate by used recombinant FSH, measured on second day of menstruation serum FSH, LH and estrogen levels, transvaginal ultrasound used to monitored the follicles. when follicle became 14 mm in size we used antagonist. 3 or more follicles gotten 18 mm in diameter. Activation gave either hCG alone or mixture of hCG and agonist. After 14 days from embryo transfer we checked HCG and after that after 10 days transvaginal ultrasound was done. Results: In our study showed the significant association between positive pregnancy outcome and progesterone level at day of HCG trigger were 79.2 % of female with positive pregnancy at progesterone level 2.5, There is a significant differences of LH at day of HCG activate rendering to progesterone level day of HCG activate, progesterone level ( < 1.5) had more chief level at day of HCG activate with mean and SD (5.38 ± 2.52), and reduction when the level progesterone rise. Conclusion: pregnancy cannot depend on progesterone level at day when HCG administration for assisted reproduction cycles treated with GnRH agonists and gonadotrophins. So cutoff point of progesterone can reach to above 1.5 ng/ ml and expected of pregnancy at this level.

The Level of Serum Progesterone on the day of HCG Administration in Assisted Reproduction Cycles

Introduction: During stimulated IVF- ET cycle spontaneous LH surge occur in about 20 – 50 % of cycle stimulated with gonadotropin without the pituitary suppression of GnRH agonist. This has been related to maturation and recovery of oocyte together decrease fertilization and implantation rate, this spontaneous LH surge is associated with increase in serum progesterone , so without pituitary suppression with GnRH , the rise of serum progesterone in the per ovulatory period may indicate the occurrence of spontaneous of LH surge, the aim of study is to indicate cutoff point of progesterone in the day of HCG administration. Method: This was a retrospective, non-interventional cohort study of patients undergoing ICSI at Tiba infertility center in Babylon, from period 2015 - 2019, all patient age from 20 – 45 years old under long protocol, had at least one grade I embryo transferred, total amount of patients was 1457. At second day of menstrual cycle we stimulate by used recombinant FSH, measured on second day of menstruation serum FSH, LH and estrogen levels, transvaginal ultrasound used to monitored the follicles. when follicle became 14 mm in size we used antagonist. 3 or more follicles gotten 18 mm in diameter. Activation gave either hCG alone or mixture of hCG and agonist. After 14 days from embryo transfer we checked HCG and after that after 10 days transvaginal ultrasound was done. Results: In our study showed the significant association between positive pregnancy outcome and progesterone level at day of HCG trigger were 79.2 % of female with positive pregnancy at progesterone level 2.5, There is a significant differences of LH at day of HCG activate rendering to progesterone level day of HCG activate, progesterone level ( < 1.5) had more chief level at day of HCG activate with mean and SD (5.38 ± 2.52), and reduction when the level progesterone rise. Conclusion: pregnancy cannot depend on progesterone level at day when HCG administration for assisted reproduction cycles treated with GnRH agonists and gonadotrophins. So cutoff point of progesterone can reach to above 1.5 ng/ ml and expected of pregnancy at this level.