Day Of hCG Research Articles

Chronic hepatitis B virus infection in women is not associated with IVF/ICSI outcomes

This study was to evaluate whether chronic HBV (Hepatitis B virus) infection in women is associated with poor performance following IVF/ICSI (in vitro fertilization/intracytoplasmic sperm injection) treatments. 123 cycles with female chronic HBV infection were compared with 246 cycles with no-infected couples, matched for female age, D3 serum FSH (follicles stimulation hormone) levels, body mass index and assisted reproductive technology approach used (IVF or ICSI), in a ratio of 1:2. The details in IVF/ICSI cycles, including the dosage of gonadotrophin used, the serum estradiol levels and the endometrial thickness on the day of hCG (human chorionic gonadotrophin) injection, the mean number of oocytes retrieved, and the embryology data, were similar among seropositive and seronegative women. And there was no significant differences in implantation rates and live birth rates between seropositive women group and matched control (30.52 versus 28.34% per transfer; 42.28 versus 40.65%). The results indicated that women with chronic HBV infection is not associated with outcomes of IVF/ICSI treatments.

Controlled Ovarian Stimulation Using a Long Gonadotropin-Releasing Hormone Antagonist Protocol: A Proof of Concept and Feasibility Study

Background/Aims: To evaluate the feasibility of a long protocol of controlled ovarian stimulation prior to in vitro fertilization (IVF) and embryo transfer with a gonadotropin-releasing hormone (GnRH) antagonist used for pituitary and ovarian suppression. Methods: Thirty patients undergoing IVF/intracytoplasmic sperm injection were randomized into two groups. The control group (n = 16) received a standard flexible GnRH antagonist protocol. Ovarian stimulation consisted of 225 IU/day of recombinant follicle-stimulating hormone for 5 days, followed by 225 IU/day of human menopausal gonadotropin until human chorionic gonadotropin (hCG) administration. The study group (n = 14) received 0.25 mg of GnRH antagonist daily for 7 days, thereafter, upon confirmation of pituitary and ovarian suppression, ovarian stimulation was commenced with the same protocol as used in the control group. Hormone and follicle dynamics, as well as laboratory characteristics and cycle outcome, were compared for both groups. Results: Both groups were comparable in baseline characteristics. Pituitary and ovarian suppression were effectively achieved in 12/14 patients in the study group. The duration of ovarian stimulation and gonadotropin consumption were similar in both groups, as was also the number and size of follicles on hCG day. Conclusion: The results of our study confirm the feasibility of a long GnRH antagonist protocol. This regimen could become another option to optimize GnRH antagonist protocols, and should thus be further explored.

Cryopréservation de la cohorte embryonnaire en cas de risque d’hyperstimulation : prévention et efficacité

ObjectiveTo evaluate the benefits, regarding prevention and clinical pregnancy rates, of embryos cryopreservation in patients at high risk of ovarian hyper-stimulation. Patients and methodsRetrospective study with 66 patients divided into two groups. Group 1 (n=24), cryopreservation of all the embryos due to high risk of OHSS. Group 2 (n=42), fresh embryo transfer despite of ovarian hyper-response (E2>4000/mL, hCG day). We performed a comparative analysis for group 1 and 2 regarding implantation, pregnancy, live birth and spontaneous abortion rates. ResultsNo case of OHSS was observed in group 1 and 40.5 % in group 2. Fresh embryo transfer in group 2 gave the following results: 12.9 % implantation rate, 21.4 % pregnancy rate per transfer and 22.2 % spontaneous abortion. Identical implantation and pregnancy rates after frozen ET cycles were observed in both groups. Whereas live birth rates were significantly better in group 1 (15.4 % vs. 67 %, P=0.04) with a significant lower rate of spontaneous abortion (27 % vs. 11.4 %, P<0,01). Discussion and conclusionThe negative impact of hyperestrogenic state seems to be limited to endometrial receptivity with no effect on oocyte or embryo quality. In situation of ovarian hyper-response, cryopreservation of all embryos with subsequent transfer of thawed embryos is an efficient strategy to avoid OHSS without decreasing pregnancy and live birth rates.

Comparison of GnRH agonist and antagonist protocols in normoresponder patients who had IVF-ICSI

To measure the estradiol (E2) and progesterone levels on day of human chorionic gonadotropin (hCG) and to assess follicular development, pregnancy rates and IVF-ICSI outcomes comparing gonadotropin releasing hormone (GnRH) agonist and antagonist protocols. A total 195 women were included in the study. The patients were treated with agonist or antagonist protocol according to the clinician's and patient's preference. GnRH agonist and antagonists were administered to 77 and 118 patients, respectively. Retrieved oocyte number (RON), metaphase two oocyte number (MON), E2 and progesteron levels on day of hCG, and fertilization rate were significantly higher in agonist group than antagonist group (p < 0.05). Implantation rate (IR), clinical pregnancy rate (CPR), and ongoing pregnancy rate (OPR) were significantly higher in antagonist group than agonist group (p < 0.05). However, there was no significant difference between both groups in relation with total follicle stimulating hormone (FSH). GnRH agonist treatment seems to be associated with higher serum E2 and progesterone levels and resulted in lower pregnancy rates than antagonist treatment.

Preventing ovarian hyperstimulation syndrome: cabergoline versus coasting

The use of cabergoline and coasting are both effective in reducing the risk of ovarian hyperstimulation syndrome (OHSS). Our aim was to compare the effectiveness of cabergoline with coasting to prevent moderate-severe OHSS. Fifty-seven consecutive infertile patients (81 cycles) at risk of developing OHSS were enrolled through our computerized IVF database system. Inclusion criteria were: (i) E2 level on the day of human chorionic gonadotrophin (hCG) greater than 3,500 pg/ml; (ii) patients who underwent luteal long GnRH agonist cycle; (iii) patients who used cabergoline for OHSS prevention; (iv) patients who underwent coasting for OHSS prevention. The cabergoline group constituted 17 patients (26 cycles) who started using 0.5 mg oral cabergoline daily for 8 days on the day of hCG, whereas the coasting group constituted 40 patients (55 cycles) who underwent coasting. Both groups were comparable regarding the women's mean age, body mass index and duration of infertility. Implantation rate, clinical pregnancy per embryo transfer and miscarriage rates were not different between the two groups. There was no OHSS in the cabergoline group (0 %), whereas there were two OHSS (3.6 %) in the coasting group; however, this difference was not significant. In conclusion, 0.5 mg daily use of cabergoline for 8 days beginning from hCG administration is a very effective way to reduce moderate-severe OHSS without sacrificing pregnancy rates in patients at risk of developing OHSS.

Transforming growth factor-β1 and its receptor soluble endoglin are altered in polycystic ovary syndrome during controlled ovarian stimulation

To evaluate the relationship between transforming growth factor (TGF)-β1 and its receptor, soluble endoglin (sENG), in the serum and follicular fluid of women with polycystic ovarian syndrome (PCOS) compared with that of non-PCOS normal ovulating women during controlled ovarian stimulation (COS). Prospective case-control study. Academic-affiliated assisted reproductive technology unit. Fourteen PCOS and 14 matched non-PCOS control women undergoing COS. Serum was collected on day 3 (baseline), day of hCG, and day of retrieval. Follicular fluid (FF) was collected on day of oocyte retrieval. ELISA was performed to determine TGF-β1 and sENG protein levels. Serum and FF levels of TGF-β1 and sENG. Serum TGF-β1 did not change significantly during COS but was increased in PCOS compared with non-PCOS women on day 3 and days of hCG administration and oocyte retrieval. Serum sENG increased after hCG administration only in the non-PCOS control group. In addition, serum sENG was decreased in PCOS compared with non-PCOS control women on the days of hCG and retrieval. Accordingly, the bioavailability of TGF-β1 (TGF-β1/sENG ratio) was increased in women with PCOS compared with non-PCOS controls at all three time points. No differences in either factor were noted in FF between groups. The increased TGF-β1 bioavailability in PCOS is not only due to increased TGF-β1 levels but also to decreased levels of its receptor, sENG. These data suggest that increased TGF-β1 bioavailability may contribute to the pathogenesis of PCOS and its increased risk for ovarian hyperstimulation.

Outcome of cryotransfer of embryos developed from vitrified oocytes: double vitrification has no impact on delivery rates

Evaluate the outcome of cryotransfer of embryos developed from vitrified oocytes. Retrospective cohort study. Private university-affiliated IVF center. Women undergoing warming cycles in which vitrified embryos were developed from vitrified or fresh oocytes. Vitrification by the Cryotop open device. Delivery rate (DR) per warming cycle. A total of 471 warming cycles of 796 vitrified embryos developed from vitrified oocytes (group 1) and 2,629 warming cycles of 4,394 vitrified embryos derived from fresh oocytes (group 2) were evaluated. Overall survival rates were 97.2% [95% confidence interval [CI] 95.9%-98.6%] vs. 95.7% [95% CI 94.9-96.4], respectively. DRs per warming cycle were 33.8% (group 1) and 30.9% (group 2). Double vitrification had no effect on DR (odds ratio [OR] 0.877, 95% CI 0.712-1.080). Confounding factors (ovum donation or autologous cycles; day-3 or blastocyst embryo transfer [ET]; natural or hormonal replacement therapy for ET; single or double ET; previous cycles, number of oocytes, doses of gonadotropins and E2 levels on the day of hCG) did not modify the effect of double vitrification on DR (OR 0.872, 95% CI 0.702-1.084). Vitrification at early cleavage or blastocyst stage of embryos obtained from previously vitrified oocytes has no effect on DR/warming cycle.

The effectiveness of earlier oocyte retrieval in the case of a premature luteinizing hormone surge on hCG day inin vitrofertilization-embryo transfer cycles

ObjectiveTo evaluate the efficacy of earlier oocyte retrieval in IVF patients with a premature LH surge on hCG day.MethodsOne hundred forty IVF patients (164 cycles) with premature LH surge on hCG day were included, retrospectively. We divided them into 2 study groups: LH surge with timed ovum pick-up (OPU) 36 hours after hCG injection (group B, 129 premature cycles), and LH surge with earlier OPU within 36 hours after hCG injection (group C, 35 cycles). Control groups were tubal factor infertility without premature LH surge (group A, 143 cycles).ResultsThe mean age (year) was statistically higher in group C than in groups A or B (38.2±5.4 vs. 36.2±4.2 vs. 36.8±4.9, respectively; p=0.012). The serum LH levels (mIU/mL) on hCG day were significantly higher in group B and C than in group A (22.7±14.9 vs. 30.3±15.9 vs. 3.2±2.9, respectively; p>0.001). Among groups A, B, and C, 4.9%, 31.7%, and 51.4% of the cycles, respectively, had no oocytes, and the overall rates of cycle cancellation (OPU cancellation, no oocyte, or no embryos transferrable) were 15.4%, 65.9%, and 74.3%, respectively. The fertilization rate (%) was significantly higher in group B than in group C (73.2±38.9 vs. 47.8±42.9, p=0.024). The clinical pregnancy rate was significantly higher in group C than in groups A and B (44.4% vs. 27.3% vs. 9.1%, respectively, p=0.021). However, the miscarriage rate was also higher in group C than in group B (22% vs. 0%, respectively, p=0.026).ConclusionEarlier OPU may not be effective in reducing the risk of cycle cancellation in patients with premature LH surge on hCG day. A larger scale study will be required to reveal the effectiveness of earlier ovum retrieval with premature LH surge.

Endometriosis fertility index score maybe more accurate for predicting the outcomes of in vitro fertilisation than r-AFS classification in women with endometriosis.

BackgroundEndometriosis is a common disease. The most widely used staging system of endometriosis is the revised American Fertility Society classification (r-AFS classification) which has limited predictive ability for pregnancy after surgery. The endometriosis fertility index (EFI) is used to predict fecundity after endometriosis surgery. This diagnostic accuracy study was designed to compare the predictive value of the EFI with that of the r-AFS classification for IVF outcomes in patients with endometriosis.Methods199 women with endometriosis receiving IVF treatment after surgery were analysis. The EFI score and r-AFS classification in their ability to predict these IVF outcomes were compared in the same population. ROC curves were used to analyse the predictive values of the EFI and r-AFS indices for clinical pregnancy, and their accuracies were evaluated by sensitivity, specificity, and the Youden’s index.ResultsThe Area Under the Curve (AUC) of the EFI score (AUC = 0.641, Standard Error(SE) = 0.039, P = 0.001, 95% CI = 0.564-0.717, cut-off score = 6) was significantly larger than that of the r-AFS classification (AUC = 0.445, SE = 0.041, P = 0.184, and 95% CI = 0.364-0.526). The antral follicle count, oestradiol level on day of hCG, number of oocytes retrieved, number of oocytes fertilised, and number of cleaved embryos in the greater than or equal to 6 EFI score group was greater than that of the lower than or equal to 5 EFI score group, and the dose of gonadotropin of the greater than or equal to 6 EFI score group were less than that in the lower than or equal to 5 EFI score group. Implantation rate, clinical pregnancy rate, and cumulative pregnancy rate in the greater than or equal to 6 EFI score group were higher than in the lower than or equal to 5 EFI score group.ConclusionsIt suggests that the EFI has more predictive power for IVF outcomes in endometriosis patients than the r-AFS classification. The clinical pregnancy rate was higher in patients with EFI greater than or equal to 6 score than with EFI lower than or equal to 5 score.

Clomiphene Citrate plus Modified GnRH Antagonist Protocol for Women with Poor Ovarian Response Undergoing ICSI Treatment Cycles: Randomized Controlled Trial

Objective: To compare Clomiphene Citrate (CC) and lower dose of Human chorionic Gonadotropins (HMG) plus Gonadotropins Releasing Hormone (GnRH) antagonist with conventional mid-luteal long agonist GnRH with higher dose of HMG in women with poor ovarian response, undergoing Intracytoplasmic Sperm Injection (ICSI). Poor ovarian response was defined as the development of less than 3 follicles ≥ 17 mm on HCG day in a previous midluteal GnRH agonist-IVF/ICSI cycle or women with age >35 years old. Method: Pilot non blind two arms parallel randomised controlled. Seventy women with a history of previous poor ovarian response undergoing controlled ovarian hyperstimulation (COH) for ICSI. Interventions: The control group (n=35) received a conventional mid-luteal long GnRH agonist treatment with daily injections of HP HMG, starting on day 2 of the cycle at a dose of 300 IU /day. In the study group (n=35), pre-treatment with luteal E2 supplementation was administrated followed by clomiphene citrate for 5 days, starting on day 2 of the cycle followed by daily injections of 225 IU HP HMG and GnRH antagonist from cycle day 6 onward. Results: There was no evidence of statistically significant difference between both groups regarding the clinical pregnancy rate per women randomized (5/35 (14%) versus 3/35 (9%); 95% CI: 0.39-8.09, p=0.43). The cost of ovarian stimulation per cycle worked out to be USD 208, 8 and 557.3 for CC ovarian stimulation group and conventional ovarian stimulation group respectively. Conclusion: CC and a lower dose of HMG plus GnRH antagonist preceded by mid-luteal E2 supplementation is as effective as the conventional ovarian stimulation in producing similar ICSI outcomes at lower cost in women with poor ovarian response.

Minimal stimulation protocol using letrozole versus microdose flare up GnRH agonist protocol in women with poor ovarian response undergoing ICSI

Background: To compare the IVF outcomes of letrozole/antagonist and microdose GnRH agonist flare up protocols in poor ovarian responders undergoing intracytoplasmic sperm injection. Materials and methods: A randomized controlled trial was performed in patients with one or more previous failed IVF cycles in which four or less oocytes were retrieved when the gonadotrophin starting dose was at least 300 IU/day. Sixty patients were randomized by computer-generated list to receive either letrozole/antagonist (mild stimulation) n = 30 or GnRH-a protocol (microdose flare) n = 30. Results: Both groups were similar with respect to background and hormonal characteristics (age, duration of infertility, BMI, FSH, LH and E2). The clinical pregnancy rate per cycle was similar in both groups (13.3 vs. 16.6%; OR = 0.769; 95% CI = 0.185, 3.198). The doses of used gonadotropins and the number of stimulation days were significantly lower in the letrozole/antagonist protocol. The peak E2 level on the day of hCG, the endometrial thickness, the retrieved oocytes, the number of fertilized oocytes, the number of transferred embryos and the cancellation rate were statistically similar in both groups. Conclusions: The letrozole/antagonist protocol is a cost-effective and patient-friendly protocol that may be used in poor ovarian responders for IVF/ICSI.

High ovarian response does not jeopardize ongoing pregnancy rates and increases cumulative pregnancy rates in a GnRH-antagonist protocol

Is the ovarian response to controlled ovarian stimulation (COS) related to the ongoing pregnancy rate when taking into account the main covariates affecting the probabilities of pregnancy following fresh embryo transfer? In patients treated with corifollitropin alfa or daily recombinant FSH (rFSH) in a GnRH-antagonist protocol, a high ovarian response did not compromise ongoing pregnancy rates and increased cumulative pregnancy rates following fresh and frozen-thawed embryo transfer. A strong association between the number of oocytes and pregnancy rates has been described but this is the first comprehensive analysis assessing important confounders that might affect pregnancy rates. In a large, prospective, double-blind, randomized trial (Engage; n = 1506), patients were treated with either a single dose of 150 μg corifollitropin alfa or daily 200 IU rFSH for the first 7 days of COS in a GnRH-antagonist (ganirelix) protocol. In this retrospective analysis, patients were categorized into five groups according to the number of oocytes retrieved (0-5, 6-9, 10-13, 14-18 and >18 oocytes). The number of good-quality embryos obtained and transferred, as well as the ongoing pregnancy rates, live birth rates and cumulative ongoing pregnancy rates per started cycle by group were evaluated. Univariate analysis was performed to identify factors that predict the chance of ongoing pregnancy. Logistic regression analysis on the dependent variables ongoing pregnancy and cumulative ongoing pregnancy, respectively, including oocyte category as an independent factor in the model, was performed by treatment group (corifollitropin alfa and rFSH) and overall. The likelihood of ongoing pregnancy and cumulative ongoing pregnancy was then evaluated taking into account ovarian response as well as other identified significant predictors of success. In total, 1506 patients had been randomized in a ratio of 1:1 to either of the treatment groups. Patients were aged ≤ 36 years and had a body weight >60 kg. The ongoing pregnancy rates per started cycle increased in the corifollitropin alfa and rFSH groups from 31.9 and 31.3%, respectively, in the lowest response group (0-5 oocytes) to 41.9 and 43.4% in the highest response group (>18 oocytes) with a significant linear trend (P = 0.04). The cumulative pregnancy rates taking frozen-thawed embryo transfers into account increased from 33.0 and 31.3% to 60.8 and 55.9% in the corifollitropin alfa and rFSH groups, respectively. Univariate logistic regression analyses of ongoing pregnancy showed significant effects for the following factors: embryo transfer (double or single, P < 0.01), region of treatment (North America or Europe, P < 0.01), progesterone level on the day of hCG (>1.5 or ≤ 1.5 ng/ml, P < 0.01), start day of the stimulation (cycle day 2 or 3, P = 0.02) and age (P = 0.04). Logistic regression analysis of ongoing pregnancy using 10-13 oocytes as the reference category, per treatment group and overall revealed estimated odds ratios (OR) close to 1.0 versus the reference, without statistically significant differences with and without adjustment for significant predictive factors affecting pregnancy rates. Unadjusted OR for cumulative pregnancy reflected significantly lower odds of pregnancy for the lowest response group and significantly higher odds of pregnancy for the highest response group in comparison with the reference. When adjusted for the predictive factors, the cumulative ongoing pregnancy OR (95% confidence interval) of the highest response group versus the reference group was 1.87 (1.34-2.59) when the data of both treatment groups were pooled. The number of covariates included in the final model was limited to five major factors and not all other potentially significant predictive factors were available for evaluation. This analysis is limited to IVF patients with a regular menstrual cycle up to 36 years of age and a body weight >60 and ≤ 90 kg treated with a GnRH-antagonist protocol and cannot be extrapolated to other patient populations or treatment regimens.

The significance of progesterone/estradiol ratio on the day of HCG on the ICSI outcome in both obese and non-obese patients

Abstract Aim To study the significance of progesterone/estradiol ( P / E 2 ) ratio on the outcome of ICSI cycles and if this relation would differ in obese vs. non-obese patients. Method Retrospective analysis of the results of 143 patients undergoing their first ICSI cycles at kaser-elaini ART unit. All the included patients had long protocol for ovarian stimulation. P / E 2 ratio was correlated to the pregnancy rate in all the included patients then they were classified into two groups according to their BMI into two groups. Group 1: with BMI > 30 and group 2: with BMI P / E 2 ratio in addition to the number of retrieved oocytes, their maturity, fertilization rate and the pregnancy rate. Results Although elevated levels of peak estradiol in non-obese patients 4.43 ± 5.02 compared to obese patients 3.27 ± 2.24 and the difference is statistically significant ( p value = 0.017) in addition to significant difference in levels of peak progesterone which is elevated in non-obese patients 1.64 ± 1.38 compared to obese patients 1.41 ± 1.1 ( p value = 0.038). However, no significant difference was detected between the two groups regarding the progesterone/estradiol ratio ( p value = 0.989), also no statistical difference was found regarding the number of retrieved oocytes, number of mature oocytes and the rate of fertilization in each group. The pregnancy rate showed near values in each group 36.9% in non-obese patients’ vs. 29.4% in obese patients which was not found to be statistically significant between the two groups. Conclusion P / E 2 ratio cannot be used as a reliable predictor for pregnancy rate, and this is not different between obese and non-obese patients. No significant difference was found between obese and non-obese patients regarding peak progesterone, estradiol level on day of neither HCG nor other ICSI outcomes including number of retrieved oocytes, fertilization rate or the pregnancy rate.

The Effect of Local Injury to the Endometrium for Implantation and Pregnancy Rates in ICSI –ET Cycles with Implantation Failure: a randomised controlled study

To assess the effect of local injury to the endometrium for implantation, pregnancy and live birth rates in ICSI –ET cycles with recurrent implantation failure. The study was prospectively designed and performed in a university hospital. A group of 100 women, who failed to conceive during one or more cycles of IVF and embryo transfer (ET), was treated with a long protocol for controlled ovarian hyperstimulation. The IVF treatment and ET were preceded by repeated endometrial biopsies, in a randomly selected 50 of a total of 100 women. Age of the women, days of stimulation, total dose of gonadotropins, E2 concentrations and endometrial thickness on hCG day, total MII stage oocytes, the total number of high quality embryos for transfer, the day of transfer and the number of embryos transferred were similar for both groups. Transfer of a similar number of embryos (138 and 141 in the experimental and control patients, respectively) resulted in rates of implantation (34.67 % vs. 30.88 %; p= 0,1384) clinical pregnancy (60 % vs. 34 %; p= 0.009), and live births per ET (44 % vs. 24 %; p= 0.03), which were higher in the experimental group as compared to controls. These results suggest that IVF treatment that is preceded by local injury to the endometrium improved the rates of embryo implantation, clinical pregnancy, and live births in asiste reproductive technique.

Estradiol supplementation in intracytoplasmic sperm injection cycles with thin endometrium

Objective: To evaluate the efficacy of estradiol supplementation starting on the day of human chorionic gonadotrophin (hCG) in patients with thin endometrium in intracytoplasmic sperm injection (ICSI) cycles. Methods: A total of 117 consecutive patients with the endometrial thickness on the hCG day ≤8 mm were rewieved. Estradiol supplementation was given in 57 patients and the remaining 60 patients were accepted as control group. Estradiol supplemented (ES) group received estradiol hemihydrate 4 mg/day started on the day of hCG. Luteal phase was supported using the vaginal progesterone gel in both groups. Clinical pregnancy rate, implantation rate, miscarriage rate, endometrial thickness on the day of oocyte pick-up and on the day of embryo transferred were accepted as main outcome measures. Results: There were no statistical differences in terms of clinical pregnancy rate (28.1% vs. 23.3%), implantation rate (16% vs. 10.4%), miscarriage rate (21% vs. 31.6%), endometrial thickness on the oocyte pick-up day (8.5 ± 1.8 vs. 8.4 ± 1.4, mm) and embryo transferred day (9.6 ± 2.9 vs. 10.3 ± 2.4, mm) in the ES group vs. control group. Conclusion: Estradiol supplementation starting on the hCG day for the patients with thin endometrium does not provide any benefit on the pregnancy outcome in ICSI cycles.

The effect of transvaginal endometrial perfusion with granulocyte colony-stimulating factor (G-CSF)

The effect of transvaginal endometrial perfusion with granulocyte colony-stimulating factor (G-CSF)

Leading follicle size in modified natural cycle IVF- predictor of successful outcome?

ObjectiveTo determine whether a threshold size of the leading follicle in a modified natural cycle IVF protocol prior to triggering ovulation will impact clinical outcomes.DesignSingle-centre retrospective cohort study.Materials and MethodsAll modified natural cycle IVF leading to successful oocyte retrieval performed in our institution between July 2005 and December 2011 were included. Only first cycle attempts were included. In this protocol, patients are started on gonadotropin (Repronex 150 IU), antagonist (Orgalutran 0.25 mg TID) and anti-inflammatory (Indocid 50 mg TID) when the leading follicle reaches 15 mm until the day of hcG trigger. Results were stratified according to leading follicle size (17 mm, 18 mm, 19 mm, 20 mm) on the day of hCG.ResultsA total of 624 patients underwent egg retrieval during the study period. Mean patient age was 32.5 years. Leading follicle size was 17mm in 25.6%, 18 mm in 42.6%, 19 mm in 19.7% and 20 mm or greater in 12% of cases. Mean rate of successful egg retrieval was 90% in all cases. Clinical pregnancy rates were 32.6% (17 mm), 30.4% (18 mm), 44.1% (19 mm) and 34.2% (20 mm). Although there seems to be a trend towards bigger follicular size, there was no statistically significant difference in clinical pregnancy rates in the 4 groups compared.ConclusionModified natural cycle IVF offers a minimally invasive approach in Assisted Reproductive Technology. One can be confident in inducing ovulation at 17mm up until 20mm in a modified natural cycle IVF protocol with equally successful clinical outcomes. ObjectiveTo determine whether a threshold size of the leading follicle in a modified natural cycle IVF protocol prior to triggering ovulation will impact clinical outcomes. To determine whether a threshold size of the leading follicle in a modified natural cycle IVF protocol prior to triggering ovulation will impact clinical outcomes. DesignSingle-centre retrospective cohort study. Single-centre retrospective cohort study. Materials and MethodsAll modified natural cycle IVF leading to successful oocyte retrieval performed in our institution between July 2005 and December 2011 were included. Only first cycle attempts were included. In this protocol, patients are started on gonadotropin (Repronex 150 IU), antagonist (Orgalutran 0.25 mg TID) and anti-inflammatory (Indocid 50 mg TID) when the leading follicle reaches 15 mm until the day of hcG trigger. Results were stratified according to leading follicle size (17 mm, 18 mm, 19 mm, 20 mm) on the day of hCG. All modified natural cycle IVF leading to successful oocyte retrieval performed in our institution between July 2005 and December 2011 were included. Only first cycle attempts were included. In this protocol, patients are started on gonadotropin (Repronex 150 IU), antagonist (Orgalutran 0.25 mg TID) and anti-inflammatory (Indocid 50 mg TID) when the leading follicle reaches 15 mm until the day of hcG trigger. Results were stratified according to leading follicle size (17 mm, 18 mm, 19 mm, 20 mm) on the day of hCG. ResultsA total of 624 patients underwent egg retrieval during the study period. Mean patient age was 32.5 years. Leading follicle size was 17mm in 25.6%, 18 mm in 42.6%, 19 mm in 19.7% and 20 mm or greater in 12% of cases. Mean rate of successful egg retrieval was 90% in all cases. Clinical pregnancy rates were 32.6% (17 mm), 30.4% (18 mm), 44.1% (19 mm) and 34.2% (20 mm). Although there seems to be a trend towards bigger follicular size, there was no statistically significant difference in clinical pregnancy rates in the 4 groups compared. A total of 624 patients underwent egg retrieval during the study period. Mean patient age was 32.5 years. Leading follicle size was 17mm in 25.6%, 18 mm in 42.6%, 19 mm in 19.7% and 20 mm or greater in 12% of cases. Mean rate of successful egg retrieval was 90% in all cases. Clinical pregnancy rates were 32.6% (17 mm), 30.4% (18 mm), 44.1% (19 mm) and 34.2% (20 mm). Although there seems to be a trend towards bigger follicular size, there was no statistically significant difference in clinical pregnancy rates in the 4 groups compared. ConclusionModified natural cycle IVF offers a minimally invasive approach in Assisted Reproductive Technology. One can be confident in inducing ovulation at 17mm up until 20mm in a modified natural cycle IVF protocol with equally successful clinical outcomes. Modified natural cycle IVF offers a minimally invasive approach in Assisted Reproductive Technology. One can be confident in inducing ovulation at 17mm up until 20mm in a modified natural cycle IVF protocol with equally successful clinical outcomes.

Sequential letrozole and HMG: a successful novel super ovulation protocol significantly improves pregnancy rate in PCOS patients undergoing ICSI. randomized controlled trial

Sequential letrozole and HMG: a successful novel super ovulation protocol significantly improves pregnancy rate in PCOS patients undergoing ICSI. randomized controlled trial

Despite the addition of recombinant LH, recombinant FSH leads to higher progesterone (P4) levels of the day of hCG than FSH-hCG preparations but this phenomenon does not alter IVF-ET outcome

Recent data showed that, in controlled ovarian hyperstimulation, FSH-hCG (HP-hMG) increases P4 levels on the day of hCG administration (dhCG) less than recombinant FSH (rFSH) and, when using HP-hMG, premature P4 elevation does not lead to poorer IVF-ET outcome. We aimed at clarifying if addition of recombinant LH (rLH) to rFSH might: 1. attenuate P4 levels on dhCG as HP-hMG, after controlling for the number of growing follicles; 2. modulate the possible effects of premature P4 elevation on IVF-ET results.

Serum estradiol levels in egg donors on the day of hCG do not correlate with pregnancy rates and outcomes

Serum estradiol levels in egg donors on the day of hCG do not correlate with pregnancy rates and outcomes