Start Of Ovarian Stimulation Research Articles

Influence of short-term ovarian stimulation on bone metabolism in women undergoing fertility treatment

Abstract Objectives Hormonal disturbances during menopause are an established influencing factor on bone health, but the role of controlled ovarian hyperstimulation for fertility treatment remains unclear. To evaluate the influence of ovarian stimulation on bone metabolism with particular regard to serum follicle-stimulating hormone (FSH) levels this prospective observational study was conducted. Methods A total of 71 women underwent controlled ovarian hyperstimulation with recombinant FSH (rFSH) or human menopausal gonadotropin (HMG) (FSH + LH) administered in individual doses, with gonadotropin-releasing hormone (GnRH) agonist down-regulation initiated in the luteal phase of the previous cycle. At four time points (start of down-regulation [T1], start of ovarian stimulation [T2], oocyte retrieval [T3] and luteal phase of the stimulation cycle [T4]), luteinizing hormone (LH), FSH, estradiol (E2), osteocalcin (OC), bone-specific alkaline phosphatase (BAP), as well as the bone resorption markers β-isomerized C-terminal telopeptide of type I collagen (β-CTX) and tartrate-resistant acid phosphatase (TRACP) were measured. Results The cyclic variations in FSH levels had a positive effect on the concentration profile of the bone resorption marker β-CTX (p=0.0001). Supraphysiologic estradiol levels showed a negative association with osteocalcin concentrations (p=0.017), and significantly lower OC and TRACP levels were observed at T4 compared to T1. By group comparison, women treated with rFSH presented with a higher bone turnover than the HMG group at the end of a stimulation cycle (T4). Conclusions Our results show that FSH is a significant influencing factor of bone metabolism. Overall, there was no evidence of enhanced bone resorption under short-term ovarian stimulation therapy. Further studies with bigger sample sizes are warranted to validate these results.

Fertility Preservation for the Transgender Individual

This review aims to update readers on recent evidence in order to counsel and guide clinical management of individuals with gender dysphoria seeking fertility preservation (FP). Relevant topics include a discussion of the consistent desire for children in transgender people despite a low utilization rate of FP services, animal models, and human histology depicting the effect of gender-affirming treatment (GAT) on the gonads, varied time for resumption of menses, and start of ovarian stimulation upon discontinuing testosterone (T) in transmen, feasible clinical and experimental options for FP in transgender males and females, worsening dysphoria, and recommended methods to mitigate symptoms, and lastly a short discussion of changes in legislation providing increased insurance coverage of medically indicated FP for transpatients. FP is an important option for transgender patients who desire to retain the ability to become genetic parents. While controlled ovarian stimulation for oocyte or embryo cryopreservation is the standard-of-care for transmen, unique considerations must be made in this population. Recent literature has highlighted the ability of transmen to have viable oocytes and pregnancies despite a history of T use, suggesting that the window of genetic parentage does not close with the start of GAT. FP for transwomen requires ejaculation or extraction with sperm cryopreservation; options for prepubertal transwomen are only in nascent phases. Research is rapidly evolving though many questions remain unanswered. The harmonization of advances in assisted reproduction with legislation advocating for transgender rights will continue to reach new peaks in the coming years.

Comparison of antral follicle count and serum anti Müllerian hormone level for determination of gonadotropin dosing in in-vitro fertilization: randomized trial.

To compare the proportion of women achieving a desired ovarian response following ovarian stimulation when gonadotropin dosing was determined based on antral follicle count (AFC) vs serum anti-Müllerian hormone (AMH) level, in women undergoing in-vitro fertilization (IVF) using the gonadotropin-releasing hormone (GnRH) antagonist protocol. This was a randomized double-blind trial carried out in a university-affiliated assisted reproduction unit. A total of 200 women undergoing their first IVF cycle using the GnRH-antagonist protocol between April 2016 and February 2018 were randomized to determination of gonadotropin dosing based on either AFC or serum AMH level measured in the pretreatment cycle 1 month before the IVF cycle. Patients underwent IVF as per our center's standard protocol. The proportion of subjects achieving a desired ovarian response, defined as retrieval of six to 14 oocytes, was compared between the two study arms. Subgroup analysis of patients with baseline AFC > 5 and those with baseline AFC ≤ 5 was performed. Concordance in AFC and AMH categorization between the pretreatment cycle and the ovarian-stimulation cycle was assessed using Cohen's kappa (κ). There was no significant difference in the proportion of patients achieving a desired ovarian response between the AFC (54%) and AMH (49%) groups (P = 0.479). The median number of oocytes retrieved was nine vs seven (P = 0.070), and the median follicular output rate was 0.54 vs 0.55 (P = 0.764) in the AFC and AMH groups, respectively. Similar findings were observed on subgroup analysis of subjects with AFC ≤ 5 and AFC > 5 at the start of ovarian stimulation (P > 0.05 for all comparisons). There was moderate concordance between AFC and AMH measured in the pretreatment cycle and the stimulation cycle (κ = 0.478 and 0.587, respectively). The proportion of women achieving a desired ovarian response following ovarian stimulation using the GnRH-antagonist protocol is similar when the gonadotropin-dosing algorithm used is based on AFC or serum AMH level. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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

Predicting suboptimal oocyte yield following GnRH agonist trigger by measuring serum LH at the start of ovarian stimulation.

Are the LH levels at the start of ovarian stimulation predictive of suboptimal oocyte yield from GnRH agonist triggering in GnRH antagonist down-regulated cycles? LH levels at the start of ovarian stimulation are an independent predictor of suboptimal oocyte yield following a GnRH agonist trigger. A GnRH agonist ovulation trigger may result in an inadequate oocyte yield in a small subset of patients. This failure can range from empty follicle syndrome to the retrieval of much fewer oocytes than expected. Suboptimal response to a GnRH agonist trigger has been defined as the presence of circulating LH levels <15IU/l 12h after triggering. It has been shown that patients with immeasurable LH levels on trigger day have an up to 25% risk of suboptimal response. In this retrospective cohort study, all patients (n= 3334) who received GnRH agonist triggering (using Triptoreline 0.2mg) for final oocyte maturation undergoing a GnRH antagonist cycle in our centre from 2011 to 2017 were included. The primary outcome of the study was oocyte yield, defined as the ratio between the total number of collected oocytes and the number of follicles with a mean diameter >10mm prior to GnRH agonist trigger. The endocrine profile of all patients was studied at initiation as well as at the end of ovarian stimulation. In order to evaluate whether LH levels, not only at the end but also at the start, of ovarian stimulation predicted oocyte yield, we performed multivariable regression analysis adjusting for the following confounding factors: female age, body mass index, oral contraceptives before treatment, basal and trigger day estradiol levels, starting FSH levels, use of highly purified human menopausal gonadotrophin and total gonadotropin dose. Suboptimal response to GnRH agonist trigger was defined as <10th percentile of oocyte yield. The average age was 31.9years, and the mean oocyte yield was 89%. The suboptimal response to GnRH agonist trigger cut-off (<10th percentile) was 45%, which was exhibited by 340 patients. Following confounder adjustment, multivariable regression analysis showed that LH levels at the initiation of ovarian stimulation remained an independent predictor of suboptimal response even in the multivariable model (adjusted OR 0.920, 95% CI 0.871-0.971). Patients with immeasurable LH levels at the start of stimulation (<0.1IU/l) had a 45.2% risk of suboptimal response, while the risk decreased with increasing basal LH levels; baseline circulating LH <0.5IU/L, <2IU/L and <5IU/L were associated with a 39.1%, 25.2% and 13.6% risk, respectively. The main limitation of the study is its retrospective design. This is the largest study of GnRH agonist trigger cycles only, since most of the previous research on the predictive value of basal LH levels was performed in dual trigger cycles. LH values should be measured prior to start of ovarian stimulation. In cases where they are immeasurable, suboptimal response to GnRH agonist trigger can be anticipated, and an individualized approach is warranted. There was no funding and no competing interests. Not applicable.

Ovarian stimulation in cancer patients: random versus conventional start

To determine if random start ovarian stimulation in cancer patients provides similar results compared to conventional stimulation starting in follicular phase. Retrospective data analysis at a single center (CEGYR). All patients undergoing oocyte cryopreservation for fertility preservation due to recent cancer diagnosis were rewied from 2012 to 2018. Patients were grouped according to random start or conventional start of the ovarian stimulation. Conventional start was defined as scheduled in early follicular phase initiation of gonadotrophins; random start was initiated at any other moment of the menstrual cycle. The analyzed variables were: number of oocytes, number of matured oocytes (metaphase II), and cycle length. 71 cycles met inclusion criteria. Oocytes were collected of 23 (33%) patients on the random start group and 48 (67%) from the conventional one. Mean age was 33.8 years old in the conventional and 33.25 years old in the random start groups. (p:0.65 IC95%, 2.04-3.23). The mean number of oocytes collected were similar 11.9 (conventional) versus 10.4 (random) (p:0.47 IC95%, 2.65-5.66) and mean number of mature oocytes vitrified was also similar (metaphase II): 9.30 (conventional) vs 7.6 (random) (p:0.34 IC95%, 1.81-5.13). The cycle duration was different, being the conventional shorter (9.7 days) than the random group (11.3 days) (p:0.0019 IC95%, 0.61-2.58). Random start stimulation cycles for cancer patients has comparable results and allows patients to start gonadotrophin stimulation irrespective of menstrual cycle phase, with no impairment of oocyte yield and only a small increase of cycle duration.

Random Start Ovarian Stimulation for Oocyte or Embryo Cryopreservation in Women Desiring Fertility Preservation Prior to Gonadotoxic Cancer Therapy.

Women of reproductive age diagnosed with cancer are often interested in preserving gametes or reproductive tissue that would allow for future genetic parenthood. Preservation of fertility is often accomplished in young cancer patients via ovarian stimulation followed by oocyte or embryo cryopreservation. Conventional stimulation protocols, however, require 2-4 weeks to complete ovarian stimulation, oocyte retrieval and possible fertilization. Such a strategy may not be feasible in patients requiring urgent cancer treatment. Recent studies have highlighted that random start ovarian stimulation can be initiated irrespective of the phase of the menstrual cycle and is an attractive alternative to conventional ovarian stimulation. The primary aim of the current review is to discuss the feasibility and success of random start ovarian stimulation for oocyte or embryo cryopreservation in women desiring fertility preservation prior to gonadotoxic cancer therapy. We performed a systematic review of medical literature published between January 2000 to June 2017 reporting the utility of random start ovarian stimulation for fertility preservation. Search terms included "fertility preservation," "cancer," "ovarian stimulation," "random-start ovarian stimulation," "embryo cryopreservation, and" "oocyte cryopreservation." Publications were included in this review only if patients underwent random start ovarian stimulation prior to cancer therapy. Nineteen publications were identified and perused by the authors. Most publications described the utility of random start ovarian stimulation in the setting of breast cancer. Radom-start stimulation was associated with a reduced time interval between ovarian stimulation initiation and oocyte or embryo cryopreservation. The yield of mature oocytes and their developmental potential into embryos was comparable between conventional and random-start protocols, albeit with higher gonadotropin doses in the latter. The current review suggests that random start ovarian stimulation can shorten the interval between ovarian stimulation and oocyte retrieval, with the yield of oocytes and embryos being comparable to conventional stimulation protocols. Thus, random start ovarian stimulation may serve as a better option for fertility preservation in patients requiring urgent cancer treatment.

Random start ovarian stimulation for fertility preservation appears unlikely to delay initiation of neoadjuvant chemotherapy for breast cancer.

Is random start ovarian stimulation associated with delays in initiation of neoadjuvant chemotherapy for breast cancer? Among women who complete fertility preservation (FP) consultation, random start ovarian stimulation is unlikely to delay time to initiation of neoadjuvant chemotherapy start. Neoadjuvant chemotherapy is now a widely accepted treatment modality for operable breast cancer and random start ovarian stimulation is an increasingly-utilized modality for FP. While conventional ovarian stimulation does not appear to delay starting adjuvant chemotherapy, the relationship between random start ovarian stimulation and neoadjuvant chemotherapy start is not well-understood. Cross-sectional study of all women seen between from January 2011 to April 2017 for FP consultation prior to starting neoadjuvant chemotherapy for breast cancer. A chart-review was performed. Study inclusion criteria were female sex; age 18-45; non-metastatic breast cancer diagnosis; underwent FP consultation; underwent neoadjuvant chemotherapy. Referrals for FP evaluation came from a regional referral base of oncology clinics. Various time-points related to cancer diagnosis, FP or chemotherapy were obtained from medical record review. We compared time-points between those who underwent ovarian stimulation for FP versus those who did not using T-tests and linear modeling. A total of 89 women who had FP consultation prior to neoadjuvant chemotherapy were identified. Sixty-seven percent underwent ovarian stimulation prior to cancer treatment and 33% did not. Women who underwent ovarian stimulation were similar in parity and clinical cancer stage to those who did not. Overall, the average time from cancer diagnosis to chemotherapy start was similar between the group that did undergo ovarian stimulation and those who did not (38.1 ± 11.3 versus 39.4 ± 18.5 days, P = 0.672). Those that underwent ovarian stimulation were referred 9.4 ± 6.8 days after diagnosis versus 17.9 ± 15.3 days for those who did not undergo ovarian stimulation (P < 0.001). Retrospective study with potential for selection bias among those who underwent ovarian stimulation versus those who did not. Reasons for caution include the possibility of unmeasured differences among those who did and did not undergo ovarian stimulation, including: patients' and providers' perceptions of the urgency to start chemotherapy, ongoing oncology work-up and treatment planning, FP decision-making, and the pursuit of second and third opinions. The difference in time from referral to FP consultation may have also influenced patients' decisions about whether to undergo ovarian stimulation. In this study, FP with random start ovarian stimulation was not associated with a delay cancer treatment in the neoadjuvant setting, so long as there was a prompt FP referral. Patients undergoing neoadjuvant chemotherapy should be informed of these findings to avoid unnecessary anxiety due to concern for delays. This study was supported by departmental research funding within the University of California, San Francisco Department of Obstetrics, Gynecology and Reproductive Sciences. There are no conflicts of interest to declare.

Back-to-back random start ovarian stimulation prior to chemotherapy results in a doubling of oocyte yield

Back-to-back random start ovarian stimulation prior to chemotherapy results in a doubling of oocyte yield

A specific controlled ovarian stimulation (COS) protocol for fertility preservation in women with breast cancer undergoing neoadjuvant chemotherapy.

Aim of the studyThe authors present a novel and specific controlled ovarian stimulation protocol for fertility preservation in women with estrogen-positive receptor breast cancer undergoing neoadjuvant chemotherapy. The protocol foresees random start ovarian stimulation and the use of letrozole associated to tamoxifen.Material and methodsForty breast cancer patients were included in the study. COS was performed either with recombinant FSH or hMG. Concomitantly with COS, letrozole in a dose of 5 mg and tamoxifen in a dose of 20 mg were given orally on a daily basis. The trigger was performed with 0.2 mg of triptorelin, in the presence of follicles ≥ 19 mm. Oocyte retrieval was scheduled 35–36 hours after triptorelin injection. Our main outcome measures were the number of oocytes collected and number of oocytes vitrified, the length of ovarian stimulation, total dose of gonadotropins administered, and levels of estradiol on the day of the trigger.ResultsThe mean age of patients was 30.43 ±4.25 years. Nineteen women commenced COS in the luteal phase, eleven in the early follicular phase and ten in the late follicular phase. The mean number of collected oocytes was 11.78 ±9.12 and the mean number of vitrified oocytes was 9.72 ±7.36. The mean duration of COS was 10.03 ±1.33 days. The mean estradiol concentrations on the triggering day was 623.10 ±441.27, and the mean dose of gonadotropins administered was 2540 ±713.10.ConclusionsThe authors suggest that the protocol is efficient and may be a safe option for oocyte vitrification in these patients.

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.

Initiation of Ovarian Stimulation with Recombinant FSH in a GnRH An-tagonist Cycle: Day 2 versus Day 5?

Recent approaches in IVF are trending towards more physiological and patient friendly stimulation cycles, with reduction in cost and stress associated with ovarian stimulation. Delaying onset of stimulation from day 2 to day 5 in a GnRH antagonist protocol is a novel approach which helps maintain a more physiological hormonal milieu. The present review compares the follicular growth patterns and endocrine profiles in women undergoing delayed onset versus the conventional day 2 start of ovarian stimulation.

Predetermined day 6 embryo transfer does not decrease clinical pregnancy rates

To compare clinical pregnancy rates when embryo transfer is determined by embryo development versus a predetermined day 6 transfer. Retrospective clinical study. Fresh blastocyst transfers performed at a private ART center between January 2009 and December 2013 were categorized as follows:• Day 5 (D5): women were transferred 5 days after oocyte retrieval if they had expanded blastocysts on that day.• Day 6 (D6): women were transferred 6 days after oocyte retrieval because they did not have expanded blastocysts on D5.• Predetermined Day 6 (pD6): women were transferred 6 days after oocyte retrieval regardless of embryo development on D5. The predetermination was made at the start of ovarian stimulation and based on physician and/or patient availability. Women undergoing PGD/PGS were excluded from the analysis. Patient characteristics were compared using ANOVA. Clinical pregnancy, implantation and monozygotic twinning rates were compared with chi-square analysis. A total of 1717 blastocyst transfers were included in the analysis. There were 1268 transfers in the D5 group, 388 transfers in the D6 group and 61 transfers in the pD6 group. Mean age, number of oocytes retrieved, and number of blastocysts transferred did not statistically differ between the groups. Women whose embryo transfer date was arbitrarily determined at stimulation start (pD6) had similar clinical pregnancy rates to patients transferred on D5 (60.7% vs 53.9%, NS). Both D5 and pD6 patients had clinical pregnancy rates that were significantly higher than D6 patients (43.6%, p<0.001 and p<0.01, respectively). Implantation rates were also similar with pD6 patients having an implantation rate of 46.1%, compared with 40.6% in D5 patients (NS). Both D5 and pD6 patients had higher implantation rates than D6 patients (31.1%, p<0.0001 and p<0.01 respectively). Rates of monozygotic twinning was similar between groups. Previous studies have suggested that when embryo transfer date is determined by embryo development, women receiving D6 transfers have lower pregnancy rates than those receiving D5 transfers. Our data confirms this observation, however, women undergoing predetermined D6 embryo transfer have similar clinical pregnancy rates compared with those having a transfer as soon as expanded blastocysts are available, allowing for more predictable scheduling of embryo transfers. The deliberate extension of blastocyst culture does not appear to increase the risk of monozygotic twinning.

Is it possible to reduce the incidence of weekend oocyte retrievals in GnRH antagonist protocols?

A retrospective analysis of a large, randomized clinical trial (Engage) assessed whether adjusting the start day of ovarian stimulation and/or day of human chorionic gonadotrophin (HCG) trigger could minimize oocyte retrieval during weekends without adverse effects on clinical outcome. Patients received recombinant FSH/gonadotrophin-releasing hormone (GnRH) antagonist regimens, with stimulation starting on day 2 or 3 of menses. HCG was administered when at least three follicles of ⩾ 17mm were present on ultrasound scan or 1day later. The frequency distribution of the day of reaching the HCG criterion relative to stimulation initiation was analysed to determine the optimal stimulation start day (cycle day 2 or 3) depending on the weekday at which menses started, to minimize weekend retrieval. The number of oocytes retrieved and pregnancy rates were not affected by start day and/or delay in HCG administration in regularly ovulating women aged 18–36years with bodyweight 60–90kg, body mass index 18–32kg/m2 and menstrual cycle length 24–35days. In recombinant FSH/GnRH antagonist regimens, it appears possible to minimize weekend oocyte retrieval by selecting the cycle day to initiate stimulation, day 2 when menses starts Friday–Tuesday, otherwise day 3 and if necessary in combination with a 1-day HCG delay.A retrospective analysis of the data collected from a large, randomized clinical trial (Engage) was conducted to assess whether adjusting the start day of ovarian stimulation and/or the day of human chorionic gonadotrophin (HCG) trigger could minimize the possibility of retrieving the mature egg cells during weekends, without an adverse effect on the clinical outcome. Patients were administered recombinant FSH/gonadotrophin-releasing hormone (GnRH) antagonist on either day 2 or 3 of menses in order to start ovarian stimulation. Ultrasound monitoring was subsequently performed to determine when at least three follicles of ⩾17mm or more in diameter were present, and final maturation was induced by HCG administration either on that day or 1day later, if necessary. The frequency distribution of day of reaching HCG criterion relative to ovarian stimulation initiation on cycle day 2 or 3 was analysed to determine the optimal ovarian stimulation day (day 2 or 3) depending on the weekday at which the menses started to minimize the possibility of weekend egg retrieval. Number of eggs retrieved and pregnancy rates were not found to be affected by day of stimulation and/or a 1-day delay in HCG administration. In a recombinant FSH/GnRH antagonist protocol, weekend egg retrieval can be minimized by selecting the appropriate cycle day to initiate ovarian stimulation (cycle day 2 when menses starts Friday to Tuesday, otherwise cycle day 3), and if necessary in combination with a 1-day HCG delay.

Corifollitropin alfa in a long GnRH agonist protocol: proof of concept trial

Fifty healthy women, aged 18-39 years with no known risk of ovarian hyperstimulation were treated with 100 or 150 μg corifollitropin alfa (dependent on body weight) in a long GnRH agonist protocol. At these doses, corifollitropin alfa initiated and supported growth of a large cohort of follicles during the first week of ovarian stimulation.

Recombinant follicle-stimulating hormone (rFSH) supplemented with low-dose human chorionic gonadotropin compared with rFSH alone for ovarian stimulation for in vitro fertilization

Low-dose hCG supplementation was administered at the start of ovarian stimulation, concomitantly with recombinant FSH (rFSH) in GnRH antagonist cycles, and these were compared with GnRH-a cycles that used rFSH alone. The low-dose hCG group had similar implantation and pregnancy rates but had significantly reduced rFSH requirements, allowing for an average cost savings of $600 per cycle.

Effect of halving the daily dose of triptorelin at the start of ovarian stimulation on hormone serum levels and the outcome of in vitro fertilization

Halving the standard daily dose of triptorelin at the start of ovarian stimulation in down-regulated women stimulated with recombinant FSH is enough for pituitary suppression and was associated with higher LH serum concentrations in the follicular phase. However, this did not translate into higher serum concentrations of androstenedione and E2 and had no significant effect on ovarian response and the outcome of IVF/intracytoplasmic sperm injection.

Use of serum inhibin B levels at the start of ovarian stimulation and at oocyte pickup in the prediction of assisted reproduction treatment outcome

To assess whether serum inhibin B levels before gonadotropin administration and at oocyte pickup (OPU) are associated with pregnancy. Retrospective case-control study. University-based IVF program. Fifty-five IVF pregnancies and 55 control cycles matched by age, type of infertility, E(2) at ovulation induction, number of oocytes retrieved, and number of embryos replaced. None. Association between serum inhibin B at stimulation day 1 (SD1) and OPU and pregnancy; correlation between inhibin B with clinical and endocrine parameters; predictive accuracy of inhibin B measurements at OPU. Inhibin B on SD1 was similar between pregnant and nonpregnant subjects, whereas it was significantly higher at OPU in pregnant cycles, but did not allow differentiation between pregnancy outcomes. Inhibin B on SD1 was positively correlated with same-day E(2) in both groups and inversely with age in pregnant cycles. In both groups, inhibin B at OPU correlated positively with number of oocytes collected and with E(2) at ovulation induction. Higher inhibin B concentrations at OPU are predictive of clinical pregnancy, independently of age, peak E(2), number of oocytes retrieved and number of embryos replaced. Inhibin B on stimulation day 1 did not prove to be a useful predictor.

Endometrial wave direction switch and the outcome of in vitro fertilization

Objective: To describe endometrial wavelike activity, endometrial thickness and texture in IVF cycles, and to relate them to IVF outcome. To evaluate wave patterns on the day of hCG administration as a predictor of IVF outcome. Design: Ultrasound study. Setting: University hospital-based infertility clinic. Patient(s): Twenty-eight women undergoing IVF. Intervention(s): Ultrasound examinations were performed at five fixed moments (start ovarian stimulation, hCG administration, ovum pickup (OPU), ET, and 7 days after hCG administration) and at three variable moments in the stimulation period in the cycle. The OPU was performed 2 days after hCG administration; ET was performed 2 or 3 days after that. Main Outcome Measure(s): Endometrial wave pattern, thickness, texture, IVF outcome. Result(s): Embryo transfer was performed in 22 cycles. In 73% of the cycles a wave direction switch (WDS) from fundus to cervix (FC) to cervix to fundus (CF) occurred before OPU. Eleven (50%) patients became pregnant. Significantly more FC waves persisted until hCG administration in the cycles in which the patients conceived. Endometrial thickness and texture were unrelated to IVF outcome. Conclusion(s): Endometrial wave pattern is associated with pregnancy in IVF. The persisting presence of FC waves until hCG administration (a late WDS) predicts a favorable IVF outcome.

Endometrial wavelike activity, endometrial thickness, and ultrasound texture in controlled ovarian hyperstimulation cycles

Objective: To describe endometrial wavelike activity, endometrial thickness, and texture in controlled ovarian hyperstimulation (COH) cycles. Design: Prospective observational ultrasound study. Setting: University hospital-based infertility clinic. Patient(s): Thirty-five COH cycles in 19 women with unexplained infertility. Intervention(s): Transvaginal ultrasound examination was performed throughout COH cycles. Intrauterine insemination was performed after hCG administration. Main Outcome Measure(s): Endometrial wavelike activity, wave frequency, wave velocity, endometrial thickness, and endometrial texture. Result(s): Endometrial wavelike activity increased from menstruation to ovulation and decreased in the luteal phase. On day hCG+2, endometrial wave-like activity was observed in all cycles. Waves from cervix to fundus prevailed in the periovulatory phase. Endometrial wavelike activity was related significantly to endometrial thickness at the start of ovarian stimulation and in the luteal phase. Endometrial thickness increased throughout the cycle. Endometrial texture showed periovulatory a triple-line aspect. Conclusion(s): In COH cycles, endometrial wavelike activity is more pronounced than in spontaneous cycles. The number of follicles and endometrial wavelike activity were not correlated significantly. This is the first prospective study to provide longitudinal observational evidence that endometrial thickness increases throughout the COH cycle and that a triple line pattern develops.