Days Of Ovarian Stimulation Research Articles

The unique opportunities and obstacles when integrating personal air pollution monitoring into studies of human fertility

BACKGROUND AND AIM: Exposure to air pollution has been associated with increased risk of infertility and pregnancy loss; however, the majority of research to date has relied on indirect measurements of air pollution which may have significant limitations due to the temporal and spatial variability of outdoor air pollution and the limited time that people spend outdoors. Directly measuring personal exposure to air pollution is a growing topic of interest, particularly in reproductive epidemiology, given the relatively short time windows of exposure susceptibility. METHODS: The Air Pollution, In Vitro Fertilization (IVF), and Reproductive Outcomes (AIR) Study recruited women undergoing a fresh, autogulous IVF cycle at the Massachusetts General Hospital Fertility Center. On the first day of ovarian stimulation, women were instructed to wear a personal particulate matter (PM) air pollution monitor (AirBeam2©), which measures three size fractions of particulate matter (PM1, PM2.5, and PM10), temperature, humidity, and GPS location, and complete a time-activity diary for the following 72-hour period. RESULTS:Between September 2018 and November 2019, 14 (out of 31 eligible) women enrolled in the AIR Study. The majority (71%) of women who did not enroll began ovarian stimulation on the weekend, when study staff were not regularly in clinic. 10 women successfully collected air pollution data for a median (minimum, maximum) of 41.5 (8.4, 64.5) hours during ovarian stimulation. The median (interquartile range) exposure to PM1, PM2.5, and PM10 was 0.7 (4.1), 2.1 (5.5), 3.2 (8.3) μg/m3, respectively. During this 72-hour window, women spent the majority of their time (72%) inside at home. Among the 4 women who were unsuccessful with the air monitors, limited battery life and frequent connection issues were cited as the main issues. CONCLUSIONS:Personal air pollution monitors can be utilized to characterize short-term exposure and, when applied appropriately, may greatly enhance our understanding of how air pollution affects human reproduction. KEYWORDS: air pollution, particulate matter, reproductive outcomes, short-term exposure, exposure assessment

Corifollitropin alfa in different variants of ovarian response in assisted reproductive technology programmes: literature review

This literature review focuses on the use of corifollitropin alfa for ovarian stimulation in assisted reproductive technology (ART) programmes in different groups of patients. Corifollitropin alfa is a gonadotropin drug with prolonged FSH activity. The main difference between corifollitropin alfa and other gonadotropins is the higher level of peak FSH, which leads to the recruitment of more follicles. Another feature is the inability to adjust the gonadotropin dose during the first days of ovarian stimulation. In contrast to traditional indications/contraindications for gonadotropins, the use of cortifollitropin is not recommended in combination with GnRH agonists or in patients with polycystic ovary syndrome.Evidence for the feasibility and efficacy of using corifollitropin alfa in patients with various ovarian response variants in ART programmes has been analysed. Most researchers agree that the use of corifollitropin alfa can be recommended for patients with a presumed poor or normal ovarian response. The use of corifollitropin alfa in patients with a presumed excessive response to ovarian timulation is possible when embryo transfer is not expected: in oocyte donation/oocyte vitrification cycles or in "freeze-all" cycles.A significant advantage of using corifollitropin alfa for oocyte donor patients is the single administration of the drug, which can be done in a medical facility, which reduces the risk of prescription non-compliance.The use of corifollitropin alfa in protocols with GnRH agonists requires further research: firstly, corifollitropin alfa has no LH component and secondly, there is no possibility of ovulation trigger replacement in this protocol if there is a high risk of early ovarian hyperstimulation syndrome.

Trajectories and predictors of anxiety and depression amongst infertile women during their first IVF/ICSI treatment cycle

PurposeThis study aimed to identify anxiety and depression trajectories of infertile women during first IVF treatment cycle and to examine whether the identified trajectories were associated with baseline psychological predictors, namely fertility-related stress, resilience, and illness perception. MethodsA longitudinal prospective study was conducted to assess anxiety and depression using the Chinese version of Self-Rating Anxiety Scale (SAS) and Self-Rating depression Scale (SDS) at four different time points: the day of first IVF/ICSI appointment (baseline/T1), the first day of ovarian stimulation (T2), the one day before oocyte retrieval (T3), and the day of fresh embryo transfer (T4). Final analysis was done on data obtained from 202 infertile women. Latent class growth mixed modeling was carried out to identify anxiety and depression trajectories. Multinomial logistic regressions were conducted to investigate predictors of trajectory membership. ResultsThree different adjustment trajectories were identified amongst infertile women during their first IVF/ICSI treatment cycle. A total of 40.1 and 37.6% of women showed normal levels of anxiety and depression (resilient trajectories), respectively, 45.0 and 43.1% of women had recovery trajectories, and 14.9 and 19.3% of women had chronic anxiety and depression trajectories. Non-resilient trajectories were associated with relatively shorter duration of infertility, higher fertility-related stress, and lower resilience. ConclusionThe results imply that it is possible to identify women in chronic or recovery trajectories on the day of first IVF/ICSI appointment, so that tailored prevention strategies integrated components that attenuate stress appraisal and strengthen resilience should be implemented to target those individuals.

THE USE OF DYDROGESTERONE TO PREVENT LH PEAK IN RANDOM-START OVARIAN STIMULATION FOR FERTILITY PRESERVATION

Compare the efficacy of oral dydrogesterone to prevent LH peak during ovarian stimulation versus usual antagonist protocol in fertility preservation cases with oocyte vitrification. Randomized prospective study from August 2019 to March 2020 at the Gynecology, Obstetric and Reproductive Medicine department of the Aziza Othmana University Hospital. Inclusion criteria: All patients underwent controlled ovarian stimulation for fertility preservation via oocyte vitrification. Exclusion criteria: Patients with hormone-dependent diseases (breast cancer, systemic lupus). Random-start ovarian stimulation was conducted with 300 IU of recombinant FSH for all patients. Patients were randomized into 2 groups on the day of the onset of ovarian stimulation: Group 1: prevention of LH peak using Dydrogesterone orally: 10 mg three times a day; beginning the first day of ovarian stimulation. Group 2: Prevention of LH peak by subcutaneous injection of Cetrotelix 0.25 mg per day from the first day of ovarian stimulation. Ovulation was triggered with 0.2 mg triptoreline. Oocyte pickup took place 37 hours later, either vaginally or per urethral transvesical route (for virgin patients). χ2 test was used to compare qualitative variables. Student’s t-test was used to compare quantitative variables. P-value < 0.05 was considered as statistically significant. Forty-seven patients were included in our study: 22 in Group 1 and 25 in Group 2. There was no significant difference regarding the clinical characteristics of the 2 groups (Group 1 vs Group 2) in terms of age (23.14 ± 5.07 vs 23.8 ± 5.7 , p: 0.7), BMI (21.63 ± 3.6 vs 22.48 ± 4.03 , p: 0.5), AMH levels (2.04 ± 1.24 vs 3.3 ± 1.93, p: 0.06), the duration of ovarian stimulation ( 9.14 ± 1.55 vs 9.33 ± 1.79 , p: 0.5), the number of follicles with a diameter > 15 mm on the day of triggering ( 7.62 ± 4.1 vs 7.5 ± 3.3, p: 0.6) and plasma oestrogen levels on the day of triggering ovulation (2587 ± 1601 vs 2083 ± 1163, p: 0.1) Moreover, pickup results were similar (goupe 1 vs group 2) for the number of CCOS( 12.71 ± 7.7 vs 12.29 ± 7.6 , p: 0.3) and the number of mature oocytes ( 9.85 ± 5.9 vs 9 ± 6.7 , p: 0.9). It should be noted that LH monitoring was performed in all patients and the difference was not significant either. Prevention of premature LH peak during COS is possible using dydrogesterone in Random-start protocols for fertility preservation, excluding cases of hormone-dependant diseases.

The association of embryo quality with the number of days of ovarian stimulation in women undergoing IVF/ICSI-ET cycle- a prospective observational study

Objective: An attempt was made to evaluate the impact of the length of ovarian stimulation on the embryo quality, with recommended strength of gonadotropin doses in women who underwent IVF/ICSI-ET cycles. Setting: Women, who underwent oocyte retrieval and fresh embryo transfer between August 2019 and November 2019, were evaluated. Design: Prospective observational study. Method: Women with primary and secondary infertility were recruited from the OPD. Ovarian stimulation was started with gonadotropins according to our center’s protocol (Antagonist protocol). Oocyte retrieval was performed approximately 36 hours after the hCG administration (trigger) followed by IVF/ICSI. Fertilization analysis was performed approximately 16 to 18 hours postinsemination. After fertilization, embryo scoring was carried out on the day of embryo transfer procedure. The primary outcome was the development of good quality embryos in relation to the days of ovarian stimulation. Statistical Analysis: Data were analyzed by Statistical Package for Social Studies (SPSS) 21.0 software package (IBM Corporation, USA): Chi-square test for categorical variables, nonparametric Kruskal Wallis test, ANOVA test, and Pearson correlation for continuous variables were applied. These tests were applied as appropriate and statistically significant level calculated at P < 0.05. Results: The length of ovarian stimulation has little impact on the quality of embryo and pregnancy outcome. Conclusion: The length of ovarian stimulation has little impact on the quality of embryo and pregnancy outcome. Future studies on large number with proper randomization are invited to be conducted to confirm the finding of present study.

Randomized, Controlled Pilot Study of Low-Dose Human Chorionic Gonadotropin Administration Beginning From the Early Follicular Phase for Women With Polycystic Ovarian Syndrome Undergoing Ovarian Stimulation Using the Progesterone Protocol.

Purpose: To illustrate whether low-dose human chorionic gonadotropin (hCG) administration during the early follicular phase could reduce the number of large preovulatory follicles in women with polycystic ovarian syndrome (PCOS) undergoing ovarian stimulation using the progesterone protocol.Methods: We performed a randomized, controlled pilot trial at a university-affiliated tertiary hospital. A total of 40 infertile women undergoing their first in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment with the freeze-all strategy were included. Human menopausal gonadotropin (hMG) and progesterone soft capsule 100 mg/d were added simultaneously beginning from menstrual cycle day 3 for all participants. Low-dose hCG (200 IU) was injected every 3 days in the study group from the first day of ovarian stimulation until trigger. The primary outcome was the number of large preovulatory follicles. Secondary outcomes included the incidence of ovarian hyperstimulation syndrome (OHSS); the number of oocytes retrieved, mature oocytes, and good-quality embryos; and clinical results after frozen-thawed embryo transfer (FET) cycles.Results: The study group had slightly more large preovulatory follicles than the control group (17.75 ± 10 vs. 13.2 ± 5.34; P > 0.05). None of the participants experienced severe OHSS. There were no statistically significant differences in the number of oocytes retrieved (15.9 ± 8.46 vs. 15.75 ± 6.96), mature oocytes (13.55 ± 6.56 vs. 13.4 ± 6.34), and good-quality embryos (5.5 ± 3.41 vs. 4.9 ± 2.99) between the two groups (P > 0.05). Clinical pregnancy rates (65.52 vs. 41.94%; P = 0.067) and live birth rates (48.28 vs. 35.48%; P = 0.315) per transfer following FET of the study group were higher than those of the control group, but without statistical significance.Conclusions: Administration of low-dose hCG from the early follicular phase for PCOS patients undergoing ovarian stimulation with progesterone protocol may lead to slightly more early preovulatory follicles and marginally, but not significantly, higher clinical pregnancy rates. A continuous trial should be performed to explore the effects of supplementation with different doses of hCG from the start of ovarian stimulation in PCOS patients using the progesterone protocol.Clinical Trial Registration: Chictr.org.cn, identifier: ChiCTR-IOR-15007165

The effect of intra-ovarian androgen priming on ovarian reserve parameters in Bologna poor responders

What are the effects of long-term androgen priming in Bologna criteria poor ovarian reserve (POR) patients undergoing IVF? This open-label pilot study was conducted at IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam. It included consecutive patients aged 18-41 years who fulfilled Bologna criteria for POR undergoing intra-ovarian androgen priming and ultra-long down-regulation with a gonadotrophin-releasing hormone agonist (GnRHa), followed by stimulation with gonadotrophins and GnRH antagonist co-treatment for IVF (n = 30). Priming consisted of low-dose recombinant human chorionic gonadotrophin (rHCG) 260 IU every second day plus letrozole 2.5 mg/day, both for 8 weeks; priming stopped on the first day of ovarian stimulation. The primary endpoint was serum anti-Müllerian hormone (AMH) concentration 8 weeks after priming. Secondary endpoints included antral follicle count (AFC) (2-10 mm), serum human chorionic gonadotrophin (HCG), testosterone and progesterone levels. Circulating testosterone, progesterone, oestradiol and HCG levels remained unchanged during androgen priming; the mean AMH level decreased steadily from 0.49 ng/ml (baseline) to 0.33 ng/ml (8 weeks). AFC was 4-5 throughout the study. A mean of 1.1 ± 0.9 good transferable embryos were obtained; embryo transfer was performed in 15 patients; no ongoing pregnancies were obtained. Long-term intra-ovarian androgen priming in the current set-up had no significant effect on hormone levels, AFC and recruitable follicles after ovarian stimulation in Bologna POR patients undergoing IVF. Further studies are needed to explore other androgen priming protocols and the clinical value of priming regimens in IVF.

Evidence-based evaluation of repeated cycles of oocyte donation by the same woman: treatment outcomes are not adversely affected by multiple prior donations

To evaluate the quality of oocyte cohorts retrieved from healthy young women undergoing repeated cycles of oocyte donation. Retrospective cohort study. Records of oocyte donation cycles performed at a single ART center from November 2011 through April 2019 were reviewed. The associations between oocyte donation cycle number and pre-treatment antral follicle count (AFC), total dosage of follicle-stimulating hormone (FSH) administered during ovarian stimulation, days of ovarian stimulation, follicles > 14 mm at trigger, retrieved oocyte number, mature (MII) oocyte number, the number of good quality blastocysts, and the percentage of euploid blastocysts among cycles undergoing PGT-A analysis by NGS were evaluated by linear regression analysis. A total of 91 oocyte donation cycles among 18 oocyte donors (3 to 6 cycles each) were available for analysis. The total dosage of FSH administered per cycle remained constant across treatment cycle numbers. However, a higher number of prior oocyte donation cycles was associated with significantly increasing numbers of antral follicles, mature follicles (>14mm) at trigger, and mature (MII) oocytes retrieved. Our investigative efforts focus on providing more couples the opportunity to have healthy children. One such group is egg donor recipients. There are limited available data on repeated ovulation stimulation cycles. It has been suggested that FSH stimulation may hasten ovarian aging by increasing recruitment of small growing follicles, thereby accelerating the depletion of follicle reserve. It has not been reported if repetitive oocyte donation affects average follicles recruited, oocyte maturity, blastocyst rate or ploidy status.

Clinically significant intra-day variability of serum progesterone levels during the final day of oocyte maturation: a prospective study with repeated measurements

Is there significant variability in progesterone levels during the final day of oocyte maturation in women undergoing ovarian stimulation? Progesterone levels drop from the basal level up to 44% during the final day of oocyte maturation in women undergoing ovarian stimulation. It has been suggested that elevated progesterone levels on the final day of ovarian stimulation may be related to poorer outcomes in in vitro fertilization fresh cycles due to a negative impact on the endometrium. However, despite conflicting results regarding the actual effect of progesterone on pregnancy rates and the lack of a well-established cut off, currently many IVF patients have their embryo transfer deferred when progesterone values surpass a threshold of 1.5ng/ml on the day of ovulation triggering. This was a prospective cohort study conducted in 22 oocyte donors of a university-affiliated fertility centre between November 2017 and January 2018. We calculated the sample size to detect a difference of 15% between the first and last progesterone measurements with a 5% false-positive rate in a two-sided test with 80% statistical power and a 95% confidence interval (CI). Progesterone circulating levels were evaluated at four different times during the final day of oocyte maturation (08:00, 12:00, 16:00 and 20:00) before ovulation triggering in healthy oocyte donors. A flexible antagonist protocol was used, and ovarian stimulation was achieved with recombinant follicle-stimulating hormone (FSH) in all cases. The pairwise percentage differences in progesterone levels for each patient were calculated. Univariate linear regression analysis was adopted in order to evaluate variables associated with progesterone levels on the first measurement. The intra-day variability of progesterone was analysed using mixed models. Mean serum progesterone values at 08:00, 12:00, 16:00 and 20:00 were 1.75ng/ml, 1.40ng/ml, 1.06ng/ml and 0.97ng/ml. The progesterone difference between 08:00 and 20:00 was 0.77 (95% CI, 0.56-0.99), which is equivalent to a 44% decline in the mean progesterone values between the first (08:00) and the last determination (20:00; P< 0.001). Among those patients with basal (08:00) progesterone levels >1.5ng/ml (n= 10), 70% (n= 7) showed levels reduced to <1.5ng/ml on the last determination of the day (20:00). A mixed model analysis revealed that the progesterone reduction during the day was significantly associated with time and total recombinant FSH dose administered. Only young healthy oocyte donors stimulated with an antagonist protocol using recombinant FSH were included. Extrapolation to the general IVF population, with different stimulation protocols and gonadotropins, needs to be confirmed. This study suggests that a single progesterone determination on the final day of oocyte maturation is not reliable enough to make clinical decisions due to the enormous variation in progesterone during the day. Further studies are needed to better define the impact of the follicular progesterone rise on the endometrium of IVF cycles. Funding was granted from Fundació Santiago Dexeus Font. N.P.P. received unrestricted grants and/or lectures fees from Roche Diagnostics, MSD, Merck, Ferring Pharmaceuticals, IBSA, Theramex and BESINS International, not associated with the current study. The remaining authors have no competing interests. Clinicaltrials.gov NCT03366025.

Amyloid-like substance in mice and human oocytes and embryos.

To identify and characterize amyloid-like substance (ALS) in human and mouse oocytes and preimplantation embryos. An experimental prospective pilot study. A total of 252 mouse oocytes and preimplantation embryos and 50 immature and in vitro matured human oocytes and parthenogenetic human embryos, from 11 consenting fertility patients, ages 18-45. Fluorescence intensity from immunofluorescent staining and data from confocal microscopy were quantified. Data were compared by one-way analysis of variance, with the least square-MEANS post-test, Pearson correlation coefficients (r), and bivariate analyses (t tests). ALS morphology was verified using transmission electron microscopy. Immunostaining for ALS appears throughout the zona pellucida, as well as in the cytoplasm and nucleus of mouse and human oocytes, polar bodies, and parthenogenetic embryos, and mouse preimplantation embryos. In mouse, 2-cell embryos exhibited the highest level of ALS (69000187.4 ± 6733098.07). Electron microscopy confirmed the presence of ALS. In humans, fresh germinal vesicle stage oocytes exhibited the highest level of ALS (4164.74088 ± 1573.46) followed by metaphase I and II stages (p = 0.008). There was a significant negative association between levels of ALS and patient body mass index, number of days of ovarian stimulation, dose of gonadotropin used, time between retrieval and fixation, and time after the hCG trigger. Significantly higher levels of ALS were found in patients with AMH between 1 and 3ng/ml compared to < 1ng/ml. We demonstrate for the first time the presence, distribution, and change in ALS throughout some stages of mouse and human oocyte maturation and embryonic development. We also determine associations between ALS in human oocytes with clinical characteristics.

Correlation between Ovarian Reserve and Incidence of Ectopic Pregnancy after In Vitro Fertilization and Embryo Transfer.

PurposeTo elucidate the correlation between ovarian reserve and the incidence of ectopic pregnancy (EP) following in vitro fertilization and embryo transfer (IVF/ET) cycles.Materials and MethodsIn this observational study, 430 fresh IVF/ET cycles were examined from patient data of two university hospital infertility clinics. All included patients were positive for β-human chorionic gonadotropin (hCG) at 2 weeks after oocyte retrieval via controlled ovarian stimulation. For each cycle, information on age, duration of infertility, basal follicle stimulating hormone (FSH), anti-Müllerian hormone (AMH), days of ovarian stimulation, numbers of retrieved oocytes and transferred embryos, and pregnancy outcomes was collected. Patients with AMH lower than 1.0 ng/dL or basal FSH higher than 10 mIU/mL were classified into the decreased ovarian reserve (DOR) group, and the remaining patients were classified into the normal ovarian reserve (NOR) group.ResultsIn total, 355 cycles showed NOR, and 75 cycles DOR. There were no significant differences between the DOR and NOR groups regarding intrauterine (74.7% vs. 83.4%, respectively) or chemical (14.7% vs. 14.1%, respectively) pregnancies. The DOR group had a higher EP than that of NOR group [10.7% (8/75) vs. 2.5% (9/355), p=0.004]. In both univariate [odds ratio (OR) 5.6, 95% confidence interval (CI) 1.4–9.6, p=0.011] and multivariate (adjusted OR 5.1, 95 % CI 1.1–18.7, p=0.012) analysis, DOR was associated with a higher risk of EP.ConclusionDOR may be associated with a higher risk of EP in IVF/ET cycles with controlled ovarian stimulation. More careful monitoring may be necessary for pregnant women with DOR.

Specific protocols of controlled ovarian stimulation for oocyte cryopreservation in breast cancer patients.

Fertility preservation is an important concern in breast cancer patients. In the present investigation, we set out to create a specific protocol of controlled ovarian stimulation (cos) for oocyte cryopreservation in breast cancer patients. From November 2014 to December 2016, 109 patients were studied. The patients were assigned to a specific random-start ovarian stimulation protocol for oocyte cryopreservation. The endpoints were the numbers of oocytes retrieved and of mature oocytes cryopreserved, the total number of days of ovarian stimulation, the total dose of gonadotropin administered, and the estradiol level on the day of the trigger. Mean age in this cohort was 31.27 ± 4.23 years. The average duration of cos was 10.0 ± 1.39 days. The mean number of oocytes collected was 11.62 ± 7.96 and the mean number of vitrified oocytes was 9.60 ± 6.87. The mean estradiol concentration on triggering day was 706.30 ± 450.48 pg/mL, and the mean dose of gonadotropins administered was 2610.00 ± 716.51 IU. When comparing outcomes by phase of the cycle in which cos was commenced, we observed no significant differences in the numbers of oocytes collected and vitrified, the length of ovarian stimulation, and the estradiol level on trigger day. The total dose of follicle-stimulating hormone and human menopausal gonadotropin administered was statistically greater in the group starting cos in the luteal phase than in the group starting in the late follicular phase. Our results suggest that using a specific protocol with random-start ovarian stimulation for oocyte cryopreservation in breast cancer patients is effective and could be offered to young women undergoing oncologic treatment.

PIH7 - LONG-ACTING RECOMBINANT FSH (CORIFOLLITROPIN ALFA) VERSUS RECOMBINANT FSH AS ASSISTED REPRODUCTION TECHNIQUES IN THE MANAGEMENT OF INFERTILITY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Assisted reproductive technologies (ARTs) are well-established treatments for many types of subfertility. Current treatment regimens prescribe daily injections of FSH (urinary FSH or recombinant FSH (rFSH)). Corifollitropin alfa (CRFa) is a new long-acting FSH which can replace seven daily FSH injections during the first week of controlled ovarian stimulation. This study was aimed to compare the effectiveness of CRFa versus rFSH in terms of pregnancy and safety outcomes in women undergoing ARTs. A systematic review was conducted in major databases including PubMed, Cochrane, Embase, Google scholar, and Web of Science up to June 2018 with limitation to English full-text published articles. Data extraction and assessment of risk of bias was independently done by two review authors. Mantel-Henszel odds ratios (OR) and standardized mean differences (SMD) were calculated for outcomes. The primary outcomes were live birth rate, ovarian hyperstimulation syndrome (OHSS) rate, the number of oocytes retrieved, and the number of embryos transferred. Meta-analysis was performed using RevMan 5.3 software. The study examined nine RCTs including 2407 patients receiving CRFa and 2056 women receiving daily rFSH. Although women receiving CRFa had a significantly higher number of oocyte retrieved (SMD: +0.25 , 95%CI: 0.11-0.39 ), number of metaphase II oocytes (SMD: +0.28 , 95%CI: 0.11-0.44 ), and number of embryos obtained (SMD: +0.27 , 95%CI: 0.13-0.41), in comparison to rFSH; there was a significant differences in the rate of embryos transferred in favor of rFSH (OR: 0.68, 95%CI: 0.55–0.85). However, no significant differences between CRFa and rFSH was found with respect to the majority of clinical effectiveness and safety parameters considered including live birth rate, ongoing pregnancy rate, clinical pregnancy rate, miscarriage rate, and OHSS rate. A single dose of CRFa for the first 7 days of ovarian stimulation is a generally well-tolerated and equally effective treatment compared with rFSH.

Serum estradiol level on the fifth day of ovarian stimulation in a GnRH antagonist protocol can predict pregnancy outcomes in IVF/ICSI

Serum estradiol level on the fifth day of ovarian stimulation in a GnRH antagonist protocol can predict pregnancy outcomes in IVF/ICSI

The Impact of Antithyroid Antibodies on Pregnancy Outcome following Intracytoplasmic Sperm Injection (ICSI) cycle

Background: the presence of antithyroid antibodies (ATA) are frequently encountered in general population and approximately 1/5 of childbearing age women are positive for the antithyroid peroxidase antibody (TPO-Ab) or antithyroglobulin antibody (TG-Ab). Autoimmune thyroid diseases are rather frequent in women in the childbearing age, affecting 5-20% of them. They are characterized by the presence of antithyroglobulin and antithyroperoxidase antibodies, grouped under the definition of ATA. ATA are often detected in subjects complaining of hypo- or hyperthyroidism, but are no rarely found in patients without any sign of thyroid dysfunction. Aim of the Work: to investigate the impact of antithyroid antibodies on pregnancy outcome in cases of one or two failure of Intracytoplasmic Sperm Injection (ICSI) cycle. Patients and Methods: the present study is a prospective study. This study was conducted at Ahmed Oraby IVF center (private center), and was approved by the Medical Ethical Committee of Al-Azhar University. Informed consent was obtained from every patient according to Hospital Ethics Committee. Age of patients, diseases status and previous treatments were recorded. This study was done on 50 patients complaining of infertility with history of one or two failure of ICSI cycle and patients divided into two groups, in the ATA positive group, 25 women were positive for TG-Ab and/or TPO-Ab, 25 women negative for TG-Ab and/or TPO-Ab served as controls. All patients did not receive any adjuvant treatment, such as glucocorticoids, anticoagulants, or other adjuvants. Patients with other autoimmune diseases, or positive for anticardiolipin antibody, antinuclear antibody, lupus anticoagulant, or rheumatoid factor were excluded from this study. Results: there were no significant differences in age, BMI, basal LH, FSH levels, cause of infertility and duration of infertility between two main groups. No significant differences in terms of the days of ovarian stimulation, estradiol level, total gonadotropins dose, number of oocytes retrieved, available embryos and blactocysts number neither of embryos transferred nor in rates of fertilization, implantation and clinical pregnancy between two main groups were found. The only statistically significant among the ATA positive group increase the abortion rate was found p value 0.02. Conclusion: patients with anti-TPO antibodies showed no significant differences in fertilization, implantation, pregnancy rates, live birth rates but higher risk for miscarriage following intracytoplasmatic sperm injection-ICSI and embryo transfer when compared with those negative for anti-thyroid antibodies.

The Impact of Antithyroid Antibodies on Pregnancy Outcome following Intracytoplasmic Sperm Injection (ICSI) cycle

Background: the presence of antithyroid antibodies (ATA) are frequently encountered in general population and approximately 1/5 of childbearing age women are positive for the antithyroid peroxidase antibody (TPO-Ab) or antithyroglobulin antibody (TG-Ab). Autoimmune thyroid diseases are rather frequent in women in the childbearing age, affecting 5-20% of them. They are characterized by the presence of antithyroglobulin and antithyroperoxidase antibodies, grouped under the definition of ATA. ATA are often detected in subjects complaining of hypo- or hyperthyroidism, but are no rarely found in patients without any sign of thyroid dysfunction. Aim of the Work: to investigate the impact of antithyroid antibodies on pregnancy outcome in cases of one or two failure of Intracytoplasmic Sperm Injection (ICSI) cycle. Patients and Methods: the present study is a prospective study. This study was conducted at Ahmed Oraby IVF center (private center), and was approved by the Medical Ethical Committee of Al-Azhar University. Informed consent was obtained from every patient according to Hospital Ethics Committee. Age of patients, diseases status and previous treatments were recorded. This study was done on 50 patients complaining of infertility with history of one or two failure of ICSI cycle and patients divided into two groups, in the ATA positive group, 25 women were positive for TG-Ab and/or TPO-Ab, 25 women negative for TG-Ab and/or TPO-Ab served as controls. All patients did not receive any adjuvant treatment, such as glucocorticoids, anticoagulants, or other adjuvants. Patients with other autoimmune diseases, or positive for anticardiolipin antibody, antinuclear antibody, lupus anticoagulant, or rheumatoid factor were excluded from this study. Results: there were no significant differences in age, BMI, basal LH, FSH levels, cause of infertility and duration of infertility between two main groups. No significant differences in terms of the days of ovarian stimulation, estradiol level, total gonadotropins dose, number of oocytes retrieved, available embryos and blactocysts number neither of embryos transferred nor in rates of fertilization, implantation and clinical pregnancy between two main groups were found. The only statistically significant among the ATA positive group increase the abortion rate was found p value 0.02. Conclusion: patients with anti-TPO antibodies showed no significant differences in fertilization, implantation, pregnancy rates, live birth rates but higher risk for miscarriage following intracytoplasmatic sperm injection-ICSI and embryo transfer when compared with those negative for anti-thyroid antibodies.

Comparison of two different dosage of GnRH agonist as ovulation trigger in oocyte donors: a randomized controled trial.

To compare the results obtained with two different GnRH agonist dosages: 0.3mg versus 0.4mg to trigger ovulation in oocyte donor cycles. Experimental controlled randomized trial including 40 patients from a private practice center. The patients were randomized into two groups. Group A received a single dose of Triptorelin 0.3mg (Decapeptyl®) 36hours before pick-up. Group B patients received Triptorelin 0.4mg (Decapeptyl®) before pick-up to final oocyte maturation. We evaluated the total number of oocytes collected, the number of mature oocytes and total days of ovarian stimulation. The average of total collected oocytes were 16 (Group A) versus 15 (Group B), and the mean number of mature oocytes were 13 versus 12 respectively. The only variable showing a difference was the percentage of mature oocytes, which was greater in Group A, resulting in 84.6%, in contrast with those treated with 0.4mg of Triptorelin (78.6%), although these differences were not statistical significant (p=0.35). Days of stimulation did not differ between groups. No cases of empty follicle syndrome were reported. We found that an increase from 0.3 to 0.4mg of triptorelin in an oocyte donation program might not improve outcomes. Nevertheless, more studies might be necessary, not only in oocyte donors but in sterile women as well, to evaluate how GnRH agonist dosage could affect the results among other factors.

Comparison of ultrasound-guided endometrial polypectomy carried out on the oocyte retrieval day and the first day of ovarian stimulation in IVF–ICSI cycles

In this retrospective cohort study, the effect of endometrial polypectomy carried out on the day of oocyte retrieval and on the first day of ovarian stimulation in patients with a large (≥10 mm) endometrial polyp undergoing IVF and intractyoplasmic sperm injection (ICSI) was investigated and compared. A total of 74 eligible IVF–ICSI cycles in 74 women who underwent endometrial polypectomy on either the day of oocyte pick-up (late polypectomy group, 39 cycles) or the first day of ovarian stimulation (early polypectomy group, 35 cycles) between January 2007 and July 2012 were included in this study. Patient characteristics between early and late polypectomy groups were similar. Total dose and days of recombinant human FSH administered, numbers of retrieved oocytes, mature oocytes, fertilized oocytes, grade 1 or 2 embryos and embryos transferred between the two groups were also similar, as was clinical pregnancy rate per cycle, embryo implantation rate and spontaneous abortion rate between the two groups. Therefore, endometrial polypectomy on the day of oocyte retrieval could be a more patient-friendly option for patients with a large endometrial polyp undergoing IVF–ICSI.

Corifollitropin alfa versus recombinant follicle-stimulating hormone: an individual patient data meta-analysis

A meta-analysis was conducted of individual patient data (n = 3292) from three randomized controlled trials of corifollitropin alfa versus rFSH: Engage (150 µg corifollitropin alfa n = 756; 200 IU rFSH n = 750), Ensure (100 µg corifollitropin alfa n = 268; 150 IU rFSH n = 128), and Pursue (150 µg corifollitropin alfa n = 694; 300 IU rFSH n = 696). Women with regular menstrual cycles aged 18–36 and body weight >60 kg (Engage) or ≤60 kg (Ensure), or women aged 35–42 years and body weight ≥50 kg (Pursue), received a single injection (100 µg or 150 µg) of corifollitropin alfa (based on body weight and age) or daily rFSH. The difference (corifollitropin alfa minus rFSH) in the number of oocytes retrieved was +1.0 (95% CI: 0.5–1.5); vital pregnancy rate: −2.2% (95% CI: −5.3%–0.9%); ongoing pregnancy rate: −1.7% (95% CI: −4.7%–1.4%); and live birth rate: −2.0% (95% CI: −5.0%–1.1%). The odds ratio for overall OHSS was 1.15 (95% CI: 0.82–1.61), and for moderate-to-severe OHSS: 1.29 (95% CI: 0.81–2.05). A single dose of corifollitropin alfa for the first 7 days of ovarian stimulation is a generally well-tolerated and similarly effective treatment compared with daily rFSH.

Timing of ovarian stimulation in patients prior to gonadotoxic therapy: an analysis of 684 stimulations

ObjectiveTime to therapy initiation in patients requiring gonadotoxic therapy is crucial. This article evaluates the efficiency of random start ovarian stimulation in affected women. Study designRetrospective anonymous registry data analysis from 85 university and non-university fertility centres participating in the international network FertiPROTEKT. The study comprised 684 women undergoing ovarian stimulation for fertility preservation from 2007 to 2013. According to the time of stimulation initiation, days of ovarian stimulation, total dose of gonadotropins used, gonadotropin dose used per day, number of oocytes retrieved and incidence of ovarian hyperstimulation syndrome were analysed. Statistical analysis was performed using analysis of variance in case of continuous outcome variables and chi-square tests in case of categorical variables. ResultsAmong 684 women who underwent ovarian stimulation prior to gonadotoxic therapy 472 (69.0%) started ovarian stimulation between menstrual cycle day 1–5 (group A), 109 (15.9%) between day 6–14 (group B) and 103 (15.1%) after day 14 (group C). The days of stimulation (A: 10.8±2.4, B: 10.6±2.7, C: 11.5±2.2) and total dose of gonadotropins (A: 2496IU±980, B: 2529IU±940, C: 2970IU±1145) were significantly increased in group C. Numbers of obtained oocytes (Group A: 11.6±7.7, B: 13.9±9.1, C: 13.6±7.9) were significantly increased in group B and C, while the overall incidence of ovarian hyperstimulation syndrome III° was 0.15%. ConclusionThe outcome of ovarian stimulation is similar after stimulation initiation during any phase of the menstrual cycles, supporting the concept of random-start ovarian stimulation before gonadotoxic therapy without disadvantage for the patient concerning later fertility preservation.