Ovarian Stimulation In Women Research Articles

Pharmacoeconomic analysis of the application of follitropin alfa in combination with assisted reproductive technologies

Objective: to evaluate clinical-economic feasibility and impact of follitropin alfa on the state healthcare budget of the Russian Federation in the population of women with diagnosed infertility and poor ovarian response, who undergo treatment with assisted reproductive technologies (ART).Material and methods. A cost minimization analysis to evaluate clinical-economic feasibility of follitropin alfa in women with infertility and poor ovarian response who underwent ART was performed. The model of the budget impact analysis included the costs required for the ovarian stimulation of patients distributed by various variants of their management. The current practice involved the application only of fixed dose combinations (FDC) of follitropin alfa + lutropin alfa. The expected practice suggested a change in the approach by shifting 25% of patients with poor ovarian response from FDC of follitropin alfa + lutropin alfa to follitropin alfa. A time horizon of modeling was 1 year.Results. The cost minimization analysis demonstrated that the application of drug with international nonproprietary name follitropin alfa is characterized by the cost cut of 12,020 rubles (–21.56%) per patient compared with FDС of follitropin alpha + lutropin alpha. The results of budget impact analysis showed that a shift of 25% of population from FDC of follitropin alfa + lutropin alfa to follitropin alfa could cut direct medical costs by 7.96 million rubles per year (–5.39%).Conclusion. Evaluation of clinical-economic feasibility and budget impact analysis showed that the application of follitropin alfa during ovarian stimulation in women with infertility and poor ovarian response leads to a decrease in budget expenses.

Flexible Antagonist versus Agonist Flare Protocol in Women above 40 Undergoing IVF, A retrospective Cohort Study.

Several strategies have been proposed for ovarian stimulation in older women, such as using an increased daily dose of gonadotropins (300-450 IU per day) with GnRH agonist (long or micro dose flare protocols), or using GnRH antagonist protocols. The objective of this study is to compare the efficacy of flexible GnRH antagonist protocol and GnRH agonist flare - pituitary block protocols for ovarian stimulation in women above 40 years old undergoing IVF. This study was performed between January 2016 and February 2019. One hundred and fourteen women aged between 40 and 42 years who underwent IVF were divided into two groups; group I were treated by Flexible GnRH antagonist protocol (Antagonist group, n=68); and group II were treated by Flare GnRH agonist protocol (Flare group, n=46). Patients treated with the antagonist protocol had a significantly lower cancellation rate when compared with patients treated with flare agonist protocol (10.3% vs. 21.7%, p value 0.049). The other parameters evaluated did not show statistically significant differences. Our finding showed that both Flexible antagonist and Flare agonist protocols had comparable outcomes, with lower cycle cancellation rates for older patients treated with the antagonist protocol.

Proliferation in cervical epithelium during ovarian stimulation in women with cervical intraepithelial neoplasia

<h3></h3> Отказ от применения хирургических методов лечения у женщин с цервикальной интраэпителиальной неоплазией легкой степени (CIN1), инфицированных вирусом папилломы человека (ВПЧ), перед программами экстракорпорального оплодотворения (ЭКО) уменьшает риск невынашивания и преждевременных родов в случае наступления беременности. Данный подход был бы оправдан в отсутствие прогрессирования диспластического процесса при стимуляции суперовуляции. <h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Изучить пролиферативную активность эпителия шейки матки у пациенток с CIN1 в ответ на стимуляцию суперовуляции (ССО) препаратами гонадотропинов в программах ЭКО. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> <i></i> Проведено исследование гистопрепаратов с применением стандартной окраски гематоксилином и эозином, выполнен иммуногистохимический анализ (экспрессия Ki-67 и p161NK4a) эпителия шейки матки у 40 ВПЧ-инфицированных пациенток с CIN1 (основная группа), а также у 38 неинфицированных женщин без явлений цервикальной дисплазии (группа сравнения) в процессе ССО в программах ЭКО. <h3>РЕЗУЛЬТАТЫ</h3> У всех пациенток основной группы как до, так и после ССО выявлены явления акантоза, у женщин группы сравнения — лишь в 2 (5,26%) случаях (<i>p</i>=0,001), что свидетельствует о роли ВПЧ-инфекции в процессах пролиферации в пораженных участках. У пациенток основной группы с исходно низкой или умеренной степенью экспрессии Ki-67 и p161NK4a статистически значимого увеличения их активности после ССО не было (<i>p</i>&gt;0,05). <h3>ЗАКЛЮЧЕНИЕ</h3> <i></i> По данным морфологического, в том числе иммуногистохимического, анализа эпителия шейки матки в процессе стимуляции суперовуляции у пациенток с цервикальной интраэпителиальной неоплазией легкой степени — носителей вируса папилломы человека в программе экстракорпорального оплодотворения не определяется прогрессирование диспластического процесса.

P–635 Standard versus mild ovarian stimulation in women with polycystic ovaries (PCO): Impact on outcomes in subsequent frozen embryo treatment cycles (FET)

Abstract Study question Does mild ovarian stimulation in women with PCO result in higher live birth rates during subsequent FET cycles? Summary answer Mild ovarian stimulation with FSH doses &amp;lt;150IU did not result in higher clinical pregnancy or livebirth rates in subsequent FET. What is known already Ovarian stimulation during IVF in women with PCO is associated with an exaggerated response, ovarian hyperstimulation syndrome, poor egg to follicle ratio, low fertilisation rates and poor blastocyst conversion. Mild ovarian stimulation, often referred to as protocols with FSH doses under 150IU, is often employed to overcome these challenges. One of the perceived benefits of this approach is improved oocyte and embryo quality reflected in lower aneuploidy rates. Study design, size, duration This was a retrospective observational study looking at 99 FET between January 2011 and Jan 2021 that followed a fresh cycle in women with a pre-treatment antral follicle count of 12 + 12 or greater. Patients were identified through the antral follicle count at the pre-treatment investigation ultrasound scan. Ultrasound findings, treatment cycle details and clinical outcomes were entered prospectively into a dedicated clinic database. Data was retrieved and analysed using SPSS V25. Participants/materials, setting, methods The study was conducted in a large IVF centre. Data on women with an AFC of 12 + 12 or above, undergoing an autologous FET cycle following a fresh cycle were collected. Women were split into those receiving &amp;lt;150IU of FSH (Group1, n = 51) and those receiving FSH ³150 IU (Group 2, n = 48). Binary logistic regression analysis was performed to control for confounders. Live birth was the primary outcome, with biochemical and clinical pregnancy being secondary outcomes. Main results and the role of chance Women in Group 1 were younger (30.8±3.6 v 33.8±3.65, p &amp;lt; 0.005) but had a similar antral follicle count (38.2±11.7 v 34.2±9.1, p = 0.07). The total number of eggs collected (24.1±13.8 v 25.9±8.8, p = 0.45) and fertilisation rate (0.59±0.2 v 0.58±0.18, p = 0.77) during their fresh cycle were comparable. Women in Group 2 had a larger number of embryos suitable for cryopreservation (7.36±4.2 v 4.8±3.5, p = 0.001) In the subsequent frozen embryo replacement cycle, there was no difference in the number or quality of embryos transferred with most women having a single embryo transfer (63% v 48%, p = 0.14) and at least one top quality embryo transferred (68.6% v 81%, p = 0.15). There was a higher biochemical pregnancy rate in Group 1 (84% v 66%, p = 0.035) but with no difference in clinical pregnancy rate (53% v 44%, p = 0.37) or live birth rate (49% v 42%, p = 0.76). Live birth rates remained comparable even after controlling for age, and number and quality of embryos transferred (OR: 1.21 (95% CI 0.50–2.94). Limitations, reasons for caution This was a retrospective analysis raising the risk of allocation bias. This study was also at risk of information bias as it relied on accurate documentation of the AFC at the pre-treatment scan. Wider implications of the findings: Patients can be reassured that both stimulation protocols result in similar live birth rates in subsequent frozen embryo replacement cycles. Prospective trials using PGT-A are required to assess whether aneuploidy could account for the discrepancy in biochemical pregnancy rates in the two groups considering the subsequent comparable clinical pregnancy rates. Trial registration number Not applicable

Effect of Dexamethasone Co-Treatment During Ovarian Stimulation in Women of Different Reproductive Age With Elevated Early Follicular Phase Progesterone Level: a Prospective Longitudinal Study.

The aim of this paper was to estimate the effect of dexamethasone during ovarian stimulation in women of different reproductive age with elevated early follicular phase progesterone level undergoing fresh IVF cycle. This study is a prospective longitudinal analysis of consecutive women who underwent fresh IVF cycles at a single center, between January 2012 to December 2013. Women with early follicular phase progesterone above 0.50 ng/ml, assessed in day 0 or day 5 of stimulation, were included. Study group (n = 113) included women who underwent dexamethasone supplementation until the day of triggering. Women who did not undergo dexamethasone treatment formed the control group (n = 109). We further stratified our study population according to age ranges: (1) ≤ 34 years, (2) between 35 and 39 years, and (3) ≥ 40 years. Significantly lower progesterone levels were observed in study than in control group (0.59 ± 0.21 vs 0.94 ± 0.42, p < 0.001). Such difference is not observed in women above 39 years old. Higher, albeit not significant, live birth rate was detected in the study versus control group, considering the overall population. In women ≤ 34 years old, a significantly higher live birth rate was observed in women who underwent dexametasone treatment than in the control group (67.5% vs 47.2%, p = 0.04). Conversely, live birth rates were similar between groups in women above 34 years old. Our data suggest that dexamethasone helps to modulate progesterone levels during the follicular phase and might improve live birth rate of women below 34 years old.

Growth hormone supplementation during ovarian stimulation improves oocyte and embryo outcomes in IVF/PGT-A cycles of women who are not poor responders.

To determine the effect of human growth hormone (GH) supplementation during ovarian stimulation in women undergoing IVF/PGT-A cycles, who do not meet the Bologna criteria for poor ovarian response (POR). This is a retrospective cohort study of 41 women with suboptimal outcomes in their first cycle of IVF/PGT-A including lower than expected number of MII oocytes, poor blastulation rate, and/or lower than expected number of euploid embryos for their age, who underwent a subsequent IVF/PGT-A cycle with the same fixed dose gonadotropin protocol and adjuvant GH treatment. Daily cotreatment with GH started with first gonadotrophin injection. The IVF cycle outcomes were compared between the control and GH cycle using the Wilcoxon-Signed Rank test. The total number of biopsied blastocysts (mean ± SD; 2.0 ± 1.6 vs 3.5 ± 3.2, p = 0.009) and euploid embryos (0.8 ± 1.0 vs 2.0 ± 2.8, p = 0.004) were significantly increased in the adjuvant GH cycle compared to the control cycle. The total number of MII oocytes also trended to be higher in the GH cycle (10.2 ± 6.3 vs 12.1 ± 8.3, p = 0.061). The overall blastulation and euploidy rate did not differ between the control and treatment cycle. Our study uniquely investigated the use of adjuvant GH in IVF/PGT-A cycles in women without POR and without a priori suspicion for poor outcome based on their clinical parameters. Our study presents preliminary evidence that GH supplementation in these women is beneficial and is associated with an increased number of blastocysts for biopsy and greater number of euploid embryos for transfer.

INTRA- AND INTER-CYCLE VARIABILITY OF ANTI-MÜLLERIAN HORMONE (AMH) LEVELS IN HEALTHY WOMEN MEASURED WITH ELECSYS AMH PLUS IMMUNOASSAY: THE BICYCLE STUDY

To determine variability of anti-Müllerian hormone (AMH) serum levels during the natural menstrual cycle between different women (inter-subject), between separate menstrual cycles within a woman (inter-cycle), and within a menstrual cycle (intra-cycle). Understanding variation in AMH levels may aid with assessment of ovarian reserve and provide a reliable prediction of response to ovarian stimulation in women undergoing assisted reproduction.

The role of diet in unexpected poor response to ovarian stimulation: a cross-sectional study

Is there an association between diet and poor ovarian response to ovarian stimulation in women with normal biomarkers of ovarian reserve? Women eligible for IVF at an Academic Fertility Center were invited to participate in this prospective cross-sectional study. The main inclusion criteria were age 18-39 years, body mass index 18-25kg/m2, preserved ovarian reserve (antral follicle count 10-22 or anti-Müllerian hormone concentration 2-5ng/ml) and a starting dose of gonadotrophins of 150-225IU/day. Information on diet was obtained using a validated food frequency questionnaire. 'Unexpected poor ovarian response' was defined as the retrieval of three or fewer suitable oocytes. A logistic regression model was used to adjust for confounders. Out of the 303 women enrolled in the study, 48 (16%) showed an unexpected poor ovarian response. The frequency of poor responders increased with increasing glycaemic load, carbohydrate intake and fibre intake. When comparing the third with the first tertile (reference), the adjusted odds ratios for these were 3.91 (95% confidence interval [CI] 1.11-13.83, P = 0.04), 4.78 (95% CI 1.23-18.51, P = 0.02) and 6.03 (95% CI 1.18-30.77, P = 0.07), respectively. Elevated dietary glycaemic load as well as carbohydrate intake and fibre intake is significantly associated with unexpected poor ovarian response. Future interventional studies should clarify whether dietary modification might restore normal response.

What are the effects of glucocorticoid supplementation during ovarian stimulation for women undergoing in vitro fertilization (IVF)?

What are the effects of glucocorticoid supplementation during ovarian stimulation for women undergoing in vitro fertilization (IVF)?

Influence of age on response to controlled ovarian stimulation in women with low levels of serum anti-Müllerian hormone

This study aims at detecting and evaluating differences in quantitative response to controlled ovarian stimulation (COS) with high doses of gonadotropins in women with low serum anti-Müllerian hormone (AMH). About 369 first cycles in a real-life scenario in women between 21 and 43 years old and with AMH ≤0.9 ng/ml were analyzed. Older women had a significantly worse outcome with respect to young women, not only qualitatively, but also in terms of quantitative ovarian response to COS [odd ratio (OR) to obtain at least three MII oocytes with each increasing year of female age: 0.89, 95% CI: 0.85 − 0.94; p < .001]. This study endorses that age is a significant factor when counseling patients with low AMH. AMH levels per se are not a reason to exclude patients from a COS treatment, since pregnancy and live birth can be achieved, especially in younger patients. However, with an AMH equally low, the ovarian response worsens with age, making questionable the effectiveness of a stimulation with high-dose gonadotropins in the older subgroup.

Gonadotropins versus oral ovarian stimulation agents for unexplained infertility: a systematic review and meta-analysis

To compare live birth and multiple gestation in patients diagnosed with unexplained infertility undergoing intrauterine insemination after ovarian stimulation (OS-IUI) with oral medications versus gonadotropins. Systemic review and meta-analysis. Not applicable. Patients undergoing OS-IUI for treatment of unexplained infertility. Clomiphene, letrozole, or gonadotropins for OS-IUI. Live birth and multiple gestation. Eight total trials were identified that met the inclusion criteria and comprised 2,989 patients undergoing 6,590 cycles. One study reported a significant increase in both live births and multiple gestations with the use of gonadotropins, two studies found an increased likelihood of live birth with the use of gonadotropins, and two studies found an increased risk of twins with gonadotropins. The relative risk of live birth in subjects receiving gonadotropins was 1.09. The relative risk of multiple gestation in subjects receiving gonadotropins was 1.06. Clinical pregnancy was higher in protocols with lax cancellation policies or higher gonadotropin doses, with subsequent increased relative risks of multiple gestations of 1.20 and 1.15, respectively. Singleton births per subject were similar between the two groups. The results did not change in per-protocol, per cycle, or fixed-effect model sensitivity analyses. For every birth gained with the use of gonadotropins, a similar increased risk of multiple gestation occurs. The randomized data do not support the use of gonadotropin for OS-IUI in women with unexplained infertility. Prospero CRD4201911998.

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.

Efficacy of Follitropin-A (Gonal-F) Versus Follitropin-B (Puregon) for Controlled Ovarian Stimulation in Women Undergoing IVF

The purpose of this study was to compare the efficacy of two recombinant FSH on pregnancy rates in infertile patients. Material and Methods: between 2015-2017, 387 females intended to have in vitro fertilization (IVF) for infertility treatment (226 patients use Gonal-F and 161 using Puregon. Results: Serum E2 concentration at hCG time was higher with Follitropin-a treated patients, and a larger number of retrieved oocyte result in a large number of the transferred embryo, and high pregnancy rate than Follitropin-b treated patients. Conclusions: Gonal-F (Follitropin-a) is associated with a potential stimulatory effect on ovaries. Puregon (Follitropin-b) was associated with a lower clinical pregnancy rate (PR). E2 level 5-7 days after stimulation can be used as an indicator of the success of IVF.

Особливості контрольованої стимуляції яєчників у поганих відповідачів

The objective: search for an optimal protocol for ovarian stimulation in women with a reduced ovarian response with investigation of its effectiveness by studying the number of oocytes obtained, embryo quality, as well as pregnancy and implantation rate. Materials and methods. The study of the effectiveness of the controlled ovarian stimulation regimen in poor responders women using long acting FSH in the protocol with GnRH antagonists compared with the modified protocol combining the use of aromatase inhibitors (letrozole) and gonadotropins was conducted. Results. The stimulation of the ovaries with Coriophiolotropin alfa and the aromatase inhibitor has been shown to be effective in the treatment of patients with a poor response to stimulation. Patient perceptions of corifolotropin-alpha protocols show better tolerability than traditional protocols due to fewer injections, which reduces the likelihood of early termination of treatment. Modified protocols with the use of aromatase inhibitors should be used in cases of optimization of financial expenses during the CSR protocol with a similar result. Conclusion. The results of the study prove the effectiveness of the stimulation regimens used in controlled ovarian stimulation for poor responders. The use of coriophyllotropin alfa and aromatase inhibitor letrozole in combination with additional FSH doses and gonadotropin-rilising hormone antagonists simplifies the design of the stimulation regimen, minimizes the number of injections with shorter stimulation and optimizes patient financial costs. Key words: controlled ovarian stimulation, poor responders, coriophyllotropin alpha, aromatase inhibitors.

Modulation of Gonadotropins Activity by Antibodies.

Gonadotropins are essential for reproduction control in humans as well as in animals. They are widely used all over the world for ovarian stimulation in women, spermatogenesis stimulation in men, and ovulation induction and superovulation in animals. Despite the availability of many different preparations, all are made of the native hormones. Having different ligands with a wide activity range for a given receptor helps better understand its molecular and cellular signaling mechanisms as well as its physiological functions, and thus helps the development of more specific and adapted medicines. One way to control the gonadotropins' activity could be the use of modulating antibodies. Antibodies are powerful tools that were largely used to decipher gonadotropins' actions and they have shown their utility as therapeutics in several other indications such as cancer. In this review, we summarize the inhibitory and potentiating antibodies to gonadotropins, and their potential therapeutic applications.

Random start versus conventional start controlled ovarian stimulation in women with cancer: comparing oocyte yield among fertility preservation cycles

To determine if random start controlled ovarian stimulation provides similar oocyte yields compared to conventional ovarian stimulation in women with cancer. Retrospective cohort study. All stimulation cycles for patients undergoing oocyte cryopreservation for fertility preservation due to recent cancer diagnoses and upcoming chemotherapy or radiation were reviewed from 2012-2018. Of the 180 oocyte cryopreservation cycles, 42 cycles (40 unique patients) met inclusion criteria. Patients were grouped into either random start or non-random cycle start. Conventional start was defined as scheduled early follicular phase (prior to cycle day six) initiation of gonadotropins. A two-sample t test was used to compare the primary outcome (number of mature oocytes cryopreserved) between the random and conventional starts. The mean number of mature oocytes cryopreserved were similar in random (n=22) and conventional start controlled ovarian stimulation cycles (n=20) (12.3 versus 10.8, p=0.58). There were no differences in cancellation rate, patient age, patient body mass index (BMI), days of stimulation, peak estradiol, or total cycle gonadotropin use. Mean BMI was 27.4. The addition of letrozole to the stimulation cycles in women with breast cancer (18 cycles) did not change the mean number of oocytes retrieved (17.5 vs 15.2, p = 0.52) or the mean number of mature oocytes cryopreserved (12.8 vs 9.7, p =0.25) compared to non-letrozole stimulation cycles. Fertility preservation is of great interest for women with cancer preparing to undergo potentially gonadotoxic cancer treatments. Random cycle start controlled ovarian stimulation reduces the time delay for initiation of cancer treatment and provides similar oocyte yields in comparison to conventional cycle start. Minimizing cancer treatment delays will expand fertility preservation options for women with cancer.Table 1Oocyte yield comparing random start versus conventional start ovarian stimulation cyclesRandom-start (n=20)Conventional Start (n=22)p-valueAge (years)28.2 (23.9-32.5)30.6 (27.1-34.2)0.37Baseline E2 (pg/mL)151 (21-280) n=16 (some data missing)66.56 (39.9-80.4) n=19 (some data missing)0.12Days of Stimulation10.5 (9.5-11.5)11.0 (10.2-11.8)0.40Peak E2 (pg/mL)1910 (1204-2617)1658 (1080-2237)0.56Total gonadotropin dose (IU)3758 (2813-4703)4643 (3833-5453)0.14Total number of oocytes aspirated (Mean and 95% CI)18.3 (13.0-23.5)14.9 (10.1-19.7)0.33Number of mature oocytes cryopreserved (Mean and 95% CI)12.3 (8.8-15.7)10.8 (6.6-15.0)0.58DiagnosisAML-2 Breast- 8 Cervix-2 Hodgkins Lymphoma-3 Neuroendocrine-1 Polycythemia-1 Sarcoma-2ALL- 1 Breast- 10 Brain- 4 Hodgkins Lymphoma-3 MDS-1 Sarcoma- 1 Open table in a new tab

Myo-inositol supplementation reduces the amount of gonadotropins and length of ovarian stimulation in women undergoing IVF: a systematic review and meta-analysis of randomized controlled trials.

To evaluate whether oral myo-inositol supplementation (MI) is able to reduce the amount of gonadotropins (GA) and the length of controlled ovarian hyperstimulation (SL) in both Polycystic Ovarian Syndrome (PCOS) and non-PCOS women undergoing in vitro fertilization (IVF). We performed a systematic review (PROSPERO ID: CRD42017069439) of randomized controlled trials (RCTs). We searched articles published in English between January 1985 to August 2017, using the combination of the Medical Subject Headings "Inositol" with "Ovulation Induction", "follicle-stimulating hormone, human, with HCG C-terminal peptide", "Reproductive Techniques, Assisted", and "Fertilization in Vitro". We collected data about GA and SL comparing MI to no treatment or D-Chiro-Inositol (DCI) supplementation (controls). A subgroup analysis was performed to evaluate selected outcomes in PCOS and non-PCOS women. We included 8 studies embedding 812 participants. We found a reduction in GA (p < 0.00001) and SL (p = 0.0007) in patients receiving MI with respect to controls. MI was effective in both PCOS (p < 0.00001) and non-PCOS women (p = 0.02) in reducing GA; conversely, MI supplementation decreased the SL only in PCOS women (p < 0.00001). During IVF, MI is effective in both PCOS and non-PCOS women in saving gonadotropins, but reduces efficiently SL only in PCOS women.

Vitamin D Deficiency Is Associated With Poor Ovarian Stimulation Outcome in PCOS but Not Unexplained Infertility.

The impact of vitamin D deficiency on the success of ovarian stimulation according to underlying infertility diagnosis has not been investigated. To evaluate the relationship between vitamin D deficiency and reproductive outcomes after ovarian stimulation in women with either polycystic ovary syndrome (PCOS) or unexplained infertility. Retrospective cohort study. Analysis of randomized controlled trial (RCT) data. Participants from the Pregnancy in Polycystic Ovary Syndrome II (PPCOS II) RCT (n = 607); participants from the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS) RCT of unexplained infertility (n = 647). Serum 25(OH)D levels measured in banked sera. Primary: live birth; secondary: ovulation (PPCOS II), pregnancy, and early pregnancy loss. In PPCOS II, subjects with vitamin D deficiency [25(OH)D < 20 ng/mL or 50 nmol/L] were less likely to ovulate (adjusted OR, 0.82; 95% CI, 0.68 to 0.99; P = 0.04) and experienced a 40% lower chance of live birth (adjusted OR, 0.63; 95% CI, 0.41 to 0.98; P = 0.04) than those not deficient. In AMIGOS, no significant association between vitamin D deficiency and live birth was noted. In pregnant subjects from both studies, vitamin D deficiency was associated with elevated risk of early pregnancy loss (OR, 1.6; 95% CI, 1.0 to 2.6; P = 0.05). In this investigation of women pursuing ovarian stimulation, the association between vitamin D deficiency and diminished live birth relied on carrying the diagnosis of PCOS and was not observed in unexplained infertility. Given the generally modest success of ovarian stimulation, addressing vitamin D deficiency may prove an important treatment adjunct for many infertile women.

Ovarian reserve and response to stimulation in women undergoing fertility preservation according to malignancy type.

Does ovarian reserve and ovarian response to ovarian stimulation in women with cancer undergoing oocyte vitrification for fertility preservation vary according to the type of malignancy? Retrospective cohort study including 105 women aged between 18 and 40 years, who were referred for fertility preservation (oocyte vitrification) between 2013 and 2016. The women were divided into three groups: breast cancer, lymphoma or other cancer. All of them had been recently diagnosed with cancer, with gonadotoxic treatment scheduled, and had oocyte vitrification after ovarian stimulation with antagonist protocol. Baseline antral follicle count and anti-Müllerian hormone were no different between women with breast cancer, lymphoma or other cancer. The number of cancelled cycles for poor ovarian response was similar between the groups. The number of FSH units per mature oocyte, the number of mature oocytes (metaphase II) retrieved, and the oocyte maturity rate were not significantly different between the three groups. As the type of cancer does not seem to significantly affect ovarian reserve and ovarian response to ovarian stimulation, our results do not support the relevance of integrating this parameter when establishing ovarian stimulation protocol for oocyte vitrification cycle in women with cancer.

Effects of dehydroepiandrosterone on the ovarian reserve and pregnancy outcomes in perimenopausal rats (DHEA and fertility in perimenopausal rats)

BackgroundDehydroepiandrosterone (DHEA) is a weak androgen and a crucial precursor of sex steroids. Exogenous supplementation of DHEA is now being commonly used to augment ovarian stimulation in women with diminished ovarian reserve. However, the effects of DHEA are controversial. AimsThis study verifies the effects of pharmacologic doses of DHEA on the ovarian reserve variables, follicular development, reproductive function, and pregnancy outcomes of perimenopausal rats. Main methodsThe reproductive function was studied by monitoring the estrous cycle and hormones. The ovarian reserve was studied by testing the anti-mullerian hormone and ovarian histology. The follicular development was studied histologically and immunohistochemically. Key findingsDHEA supplementation at a dose of at 50 mg/kg improved the ovarian reserve and pregnancy outcomes. Higher doses of DHEA caused PCOs-like symptoms manifested by the development of cystic follicles and low ovarian reserve and pregnancy outcomes. SignificanceDHEA is a promising treatment that improves the ovarian reserve parameters and pregnancy outcomes. Further studies are needed to determine the optimal dose and duration.