Higher live birth rate following transdermal testosterone pretreatment in poor responders: a systematic review and meta-analysis

A systematic review and meta-analysis was performed aiming to identify good-quality randomized controlled trials (RCT) evaluating testosterone pretreatment in poor responders. Eight RCTs were analysed, evaluating 797 women. Transdermal testosterone gel was used in all studies, with a dose ranging from 10 to 12.5 mg/day for 10–56 days. The main outcome measure was achievement of pregnancy, expressed as clinical pregnancy or live birth. Testosterone pretreatment was associated with a significantly higher live birth (risk ratio [RR] 2.07, 95% confidence interval [CI] 1.09–3.92) and clinical pregnancy rate (RR 2.25, 95% CI 1.54–3.30), as well as a significant increase in the number of cumulus–oocyte complexes retrieved. Significantly fewer days to complete ovarian stimulation, a lower total dose of gonadotrophins, a lower cancellation rate due to poor ovarian response and a thicker endometrium on the day of triggering of final oocyte maturation were observed. No significant differences were observed in oestradiol concentration, the numbers of follicles ≥17 mm, metaphase II oocytes, two-pronuclear oocytes and embryos transferred, and the proportion of patients with embryo transfer. The current study suggests that the probability of pregnancy is increased in poor responders pretreated with transdermal testosterone who are undergoing ovarian stimulation for IVF.     

Estrogen or anti-estrogen for Bologna poor responders?

Abstract

The current study aims to compare cycle outcomes of two ovarian stimulation protocols in poor responders according to the Bologna criteria; luteal estrogen priming (LE) or letrozole (LZ) co-treatment in antagonist protocol. Following retrospective chart review of a single center, 162 cycles were found eligible for the comparison of two ovarian stimulation protocols. After interpreting data, significantly higher serum estradiol levels, longer duration of cycle, higher number of fertilized oocytes and good quality embryos were detected in patients who received LE. Despite any statistical significance, higher clinical pregnancy rate (CPR) and ongoing pregnancy rate (OPR) per embryo transfer (ET) were detected with LE protocol compared with LZ (12.3% versus 18.2% and 9.6% versus 12.7%, respectively). Younger patients (<40 years) revealed higher CPR and OPR per started cycle compared with older patients (≥40 years) where only OPR was statistically significant. Multivariable analysis demonstrated that basal antral follicle count, peak serum estradiol levels and number of fertilized oocytes were independent variables significantly associated with clinical pregnancies (p < 0.05). In the current analysis, LE or LZ protocols revealed comparable but quite low pregnancy rates in poor responders according to the Bologna criteria. Younger patients were more likely to achieve pregnancy compared to older patients with both protocols.     

Do poor responders have poor perinatal outcomes? A retrospective analysis of 1386 assisted reproductive technology cycles

Objective

The purpose of this study was to evaluate whether poor responder women have adverse perinatal outcomes compared to normo responders following assisted reproductive technology (ART).

Quantification of ovarian stromal Doppler signals in poor responders undergoing in vitro fertilization with three-dimensional power Doppler ultrasonography

OBJECTIVE: This was a prospective comparative clinical study to test the hypothesis that the decreased ovarian sensitivity to gonadotropins observed in women embarking on an in vitro fertilization (IVF) treatment may be due to changes in ovarian stromal blood flow. STUDY DESIGN: Three-dimensional (3D) power Doppler ultrasonographic indexes were used to quantify ovarian stromal blood flow and vascularization in poor responders. Forty patients undergoing an IVF cycle were collected and divided into two groups, a poor responder group (n=17) (estradiol <600 pg/mL or < or =3 oocytes retrieved) and normal responder group (n=23), based on their response to a standard down-regulation protocol for controlled ovarian stimulation. During ovarian stimulation, on the day of administration of human chorionic gonadotropin (HCG), patients underwent hormonal (serum E2), ultrasonographic (follicular number and diameter), and 3D power Doppler (ovarian stromal blood flow) evaluation. RESULTS: Compared with poor responders, the serum estradiol levels on the day of administration of HCG, the number of follicles more than 14 mm, the number of oocytes retrieved, the number of embryos transferred, and the pregnancy rate were significantly higher in normal responders. The Vascularization Index, Flow Index, and Vascularization Flow Index were significantly lower (P<.05) in the poor responder (0.13+/-0.11, 30.89+/-10.35, and 0.05+/-0.04, respectively) compared with the women with a normal response (1.20+/-1.10, 43.88+/-7.77, and 0.61+/-0.57, respectively). CONCLUSION: The 3D power Doppler indexes of ovarian stromal blood flow in poor responders was significantly lower than normoresponders. This may help to explain the poor response during HCG administration in controlled ovarian stimulation.     

Serum luteinizing hormone level on the third day after ovarian stimulation in GnRH agonist short protocol is predictive of outcome in poor responders but not in normal responders

Objectives: To identify whether prognostic value of LH measurement in normal responders (NR) is different from poor responders (POR).

Methods: A retrospective, single-center study was conducted among patients who underwent ovarian stimulation with short protocol, with 300 NR and 101 POR, according to Bologna Consensus criteria. LH was measured on 3rd and 5th day after stimulation and HCG administration day.

Results: There was significant difference in the clinical pregnancy rate per cycle initiated among those with LH level on the third day after stimulation (a) below the 25 centile (b) between the 25 and 75 centile and (c) above the 75 centile in women with POR (7.7%, 15.1% vs. 36.4%, p?=?0.02) but not in NR. There was significant correlation between LH ranks and clinical pregnancy rate in POR (p?=?0.02) but not in NR. Factors associated with clinical pregnancy rate in POR were age and LH on the third of stimulation, while factors in NR were age, AFC and FSH.

Conclusion: LH level on the 3rd day of stimulation was predictive of clinical pregnancy in POR but not in NR.     

体外受精-胚胎移植治疗中高反应人群卵母细胞利用率的影响因素分析

目的探索影响体外受精(IVF)-胚胎移植治疗中高反应人群卵母细胞利用率(OUR)的临床因素。方法OUR的定义为可移植和(或)可冻存的卵裂期胚胎和(或)囊胚的数量与当个周期获卵数的比值。选取中国医学科学院北京协和医院2013年1月至2019年12月期间获卵数≥15个的周期,将OUR位于最高与最低10%的周期分为高OUR组和低OUR组,比较两组患者的一般情况、促排卵治疗的相关参数和妊娠结局,采用多因素logistic回归分析影响高反应人群OUR的临床因素。结果高OUR组纳入了43例患者,低OUR组纳入了47例患者,两组的OUR分别为77.4%(601/776)和11.9%(104/874)。既往IVF或卵母细胞胞质内单精子注射(IVF/ICSI)史(OR=0.10,95%CI为0.01~0.81)、不孕因素为子宫内膜异位症(OR=0.16,95%CI为0.03~0.84)以及卵巢刺激期间雌二醇水平下降(OR=0.16,95%CI为0.04~0.64)是OUR的不利因素(P<0.05);在促排卵方面,双重降调节方案(OR=3.74,95%CI为1.06~26.86)和相对长的促排卵时间(OR=3.24,95%CI为1.25~8.42)是获得较高OUR的保护性因素(P<0.05)。虽然两组患者的获卵数及第二次减数分裂中期的卵母细胞(MⅡ)数相似,但高OUR组的累积临床妊娠率和累积活产率[分别为95.3%(41/43)、90.7%(39/43)]均显著高于低OUR组[分别为40.4%%(19/47)、31.9%(15/47)],两组分别比较,差异均有统计学意义(P均<0.01)。结论在高反应人群中,既往IVF/ICSI治疗史不利于OUR,促排卵时,可尽量选择双重降调节方案和适当延长促排卵时间并避免雌激素水平的下降,以保证更佳的OUR。     

Outcome of assisted reproductive technology in different subgroups of poor ovarian responders fulfilling the POSEIDON criteria

Purpose

Low success rates are common in women undergoing in vitro fertilization who respond poorly to ovarian hyperstimulation. Due to the heterogeneity of the populations, expressing a unique and shared definition is necessary in order to individualize infertility treatment. The main goal of this study was to evaluate the assisted reproductive technology outcome among various subgroups of poor responders defined by the POSEIDON (Patients-Oriented Strategies Encompassing IndividualizeD Oocyte Number) stratification.

Effects of transdermal testosterone in poor responders undergoing IVF: systematic review and meta-analysis

A systematic review and meta-analysis was performed to evaluate the effect of transdermal testosterone preceding ovarian stimulation in women with poor ovarian response undergoing IVF. Studies comparing pretreatment with transdermal testosterone versus standard ovarian stimulation among poor responders were included. The main outcome assessed was live birth. Three trials were included (113 women in the testosterone group, 112 in the control group). Testosterone-treated women achieved significantly higher live birth rate (risk ratio, RR, 1.91, 95% CI 1.01 to 3.63), clinical pregnancy rate (RR 2.07, 95% CI 1.13 to 3.78) and required significantly lower doses of FSH (RR ?461.96, 95% CI ?611.82 to ?312.09). However, differences observed in clinical pregnancy per embryo transferred were not statistically significant (RR 1.72, 95% CI 0.91 to 3.26). No differences were observed regarding number and quality of the oocytes retrieved. In conclusion, transdermal testosterone significantly increases live birth and reduces the doses of FSH required. These findings support the theoretical synergistic role of androgens and FSH on folliculogenesis. The present data should be interpreted with caution because of the small number of trials and clinical heterogeneity. The identification of poor responders that could especially benefit from testosterone treatment should be addressed in further studies.The poor response to ovarian stimulation among women undergoing IVF is of great concern in reproductive medicine. Certain modalities have been tested to improve this response to gonadotrophin stimulation, although results from some studies have shown conflicting results. Hence, a systematic review and meta-analysis was performed in order to evaluate the effect of transdermal testosterone prior to ovarian stimulation among these women with poor ovarian response. The main outcome assessed was live birth rate. In all, three trials were included, which comprehended 113 women in the testosterone group and 112 in the control group. Women that were pretreated with transdermal testosterone achieved significantly higher live birth rate and clinical pregnancy rate and required significantly lower doses of exogenous FSH as compared with controls. However, when clinical pregnancy rate was adjusted per embryo transferred differences observed were not statistically significant. No differences were observed in the number and quality of the oocytes retrieved. In conclusion, transdermal testosterone prior to ovarian stimulation significantly increases live birth and reduces the doses of FSH required among poor responders. In addition, the identification of poor responders that could especially benefit from testosterone treatment should be addressed in further studies.     

Freeze-all embryo strategy in poor ovarian responders undergoing ovarian stimulation for in vitro fertilization

This retrospective study determined the efficacy of the ‘freeze-all’ embryo strategy in poor ovarian responders undergoing ovarian stimulation for in vitro fertilization (IVF). A total of 559 poor responders who met Bologna criteria between January 2012 and December 2014 were included in this study: 256 in the fresh embryo transfer group and 303 in the freeze-all group. Vitrification and warming of day 3 embryos were performed using the Cryotop method. The poor responders treated with fresh embryo transfer and those treated with freeze-all strategy showed similar live birth rates per cycle (12.1% vs. 16.2%, p?=?.172) and per transfer (15.9% vs. 20.9%, p?=?.182). Multivariate logistic regression analysis showed that maternal age at retrieval (odds ratio, 0.919; 95% confidence interval, 0.865–0.977; p?=?.006) and number of good-quality embryos transferred (odds ratio, 1.953; 95% confidence interval, 1.346–2.835; p?相似文献   

微刺激全部胚胎冷冻方案在常规体外受精-胚胎移植失败的卵巢低反应患者中的应用

目的探讨微刺激全部胚胎冷冻方案在常规体外受精/卵胞质内单精子显微注射-胚胎移植(IVF/ICSI-ET)方案失败的卵巢低反应(POR)患者中的应用价值。方法对196例IVF/ICSI-ET应用常规促排卵方案因POR放弃周期或移植失败后改用微刺激方案的402个周期进行回顾性分析,比较前、后2次不同促排卵方案的临床和实验室指标。结果 402个微刺激周期中32个周期取消,周期取消率为7.96%,370个周期获得卵母细胞,平均获卵数(2.2±1.5)个,共233个周期有胚胎冷冻,胚胎冷冻率为57.96%,共194个周期进行了ET,临床妊娠74例,早期自然流产6例,起始周期累积妊娠率为37.75%(74/196),冻融胚胎移植(FET)周期临床妊娠率为38.14%(74/194),其中≤37岁组FET周期的临床妊娠率(50.89%)明显高于37岁组(20.73%)(P0.05)。微刺激方案的临床和实验室指标均显著优于常规长方案。结论微刺激全部胚胎冷冻方案对常规方案IVF/ICSI-ET治疗失败的POR患者具有疗程短、刺激剂量小,获卵率高、可利用胚胎率高、周期取消率低等特点,对于该类患者再次助孕可考虑微刺激方案。     

Modified natural cycle IVF versus conventional stimulation in advanced-age Bologna poor responders

Research questionDo ongoing pregnancy rates (OPR) differ between modified natural cycle IVF (MNC-IVF) and conventional high-dose ovarian stimulation (HDOS) in advanced-age Bologna poor responders?DesignThis was a retrospective cohort study including patients with poor ovarian response (POR) attending a tertiary referral university hospital from 1 January 2011 to 1 March 2017. All women who fulfilled the Bologna criteria for POR and aged ≥40 years who underwent their first intracytoplasmic sperm injection (ICSI) cycle in the study centre were included.ResultsIn total, 476 advanced-age Bologna poor responder patients were included in the study: 189 in the MNC-IVF group and 287 in the HDOS group. OPR per patient were significantly lower in the MNC-IVF group (5/189, 2.6%) compared with the HDOS group (29/287, 10.1%) (P = 0.002). However, after adjustment for relevant confounders (number of oocytes and presence of at least one top-quality embryo), the multivariate logistic regression analysis showed that the type of treatment strategy (HDOS versus MNC-IVF) was not significantly associated with OPR (odds ratio 2.56, 95% confidence interval 0.9–7.6).ConclusionsIn advanced-age Bologna poor responders, MNC-IVF, which is a more patient-friendly approach, could be a reasonable alternative in this difficult-to-treat group of women.     

Comparison of clinical outcomes between conventional in vitro fertilization and intracytoplasmic sperm injection in poor responders with only single oocyte retrieved

ObjectiveTo compare the clinical outcomes between conventional insemination (IVF) and intracytoplasmic sperm injection (ICSI) in poor responders with only a single oocyte retrieved.Materials and methodsThis is a retrospective case–control study. Couples who were treated with assisted reproductive technology (ART) with a single oocyte retrieved in Mackay Memorial Hospital from 1996 to 2016 were recruited. All data were categorized into three groups, according to their fertilization method and semen quality: group A, conventional insemination with non-male factor (IVF-NMF, n = 115), group B, ICSI with male factor (ICSI-MF, n = 30), and group C, ICSI with non-male factor (ICSI-NMF, n = 49).ResultsNo statistically significant difference was observed between IVF and ICSI groups in pregnancy outcomes, including the chemical or clinical pregnancy rate, miscarriage rate, and live birth rate. Similar fertilization rates per oocyte obtained were observed in IVF and ICSI patients, but significantly lower per mature oocyte in the ICSI group (IVF: 91.5%, ICSI-MF: 75.0%, ICSI-NMF: 77.8%). Although there is no statistical significance, the lower live birth rate is observed in group C than others (A:11.5%, B:25%, C:5%, p = 0.187).ConclusionIn this study, pregnancy outcomes of conventional in vitro fertilization and ICSI in poor responders with only a single oocyte retrieved were similar. However, the fertilization rate of matured oocytes in ICSI groups is significantly lower than that in the IVF group, indicating that ICSI procedures might cause oocyte damage. Therefore, the choice of fertilization method should be based on semen quality. A randomized controlled trial should be performed to confirm our findings.     

Pregnancies and births achieved from in vitro matured oocytes retrieved from poor responders undergoing stimulation in in vitro fertilization cycles

OBJECTIVE: To describe pregnancies that resulted from in vitro matured oocytes derived from stimulated IVF cycles before cancellation owing to poor response of gonadotropins. DESIGN: Case report.University hospital. PATIENT(S): Eight patients who underwent in vitro maturation.Immature oocyte retrieval, in vitro maturation of immature oocytes, fertilization, and ET. Luteal support with progesterone and plvyeron was given. MAIN OUTCOME MEASURE(S): Pregnancy and live birth. RESULT(S): Three pregnancies (two live births and another ongoing) were achieved after immature oocyte retrieval, in vitro maturation, fertilization with ICSI, and ET. CONCLUSION(S): Immature oocyte retrieval from poor responders during stimulation, followed by in vitro maturation, may be an alternative before the cycle is canceled.     

Conversion of ICSI cycles to IUI in poor responders to controlled ovarian hyperstimulation

AimComparison between the results of the oocyte retrieval technique and the conversion to the intra-uterine insemination (IUI) technique in cases with poor ovarian response to the controlled ovarian hyperstimulation (COH) procedure.Patients and methodsIt is a retrospective observational study in women with poor ovarian response to COH which is defined as estradiol (E2) peak level <1000 pg/mL or with ?4 follicles which are ?14 mm in diameter. Four hundred and sixteen cases were reported as poor responders in 2 IVF centers since December 2007 to July 2010. One hundred and fifty two cases of them proceeded to the oocyte retrieval procedure. These cases were assigned as group (A). Sixty eight cases converted to IUI and were assigned as group (B). One hundred and ninety six cases canceled their cycles. These cases were not included in the current study. Our data were collected from the databases of two In Vitro Fertilization (IVF) centers and analyzed retrospectively to compare the results of the different applied techniques in the studied groups. The main measured outcome parameters were the clinical pregnancy rate and the live birth rate.ResultsThe group of cases proceeded to the oocyte retrieval procedure had a higher basal Follicle Stimulating Hormone (FSH) level, needed a longer duration of stimulation with higher Human Menopausal Gonadotropin (HMG) doses and had higher E2 peak levels. The clinical pregnancy rates and the live birth rates were higher in the group proceeded to the oocyte retrieval than the group converted to IUI but the difference was not statistically significant.ConclusionAs the pregnancy rates difference between both groups was not statistically significant the conversion to IUI could be considered a useful substitute to the oocyte retrieval procedure in the poor responder cases. However, to adopt this conclusion, further confirmation in other prospective studies with larger sample size is a must.     

Expression of genes that regulate follicle development and maturation during ovarian stimulation in poor responders

Research questionSex hormone-binding globulin (SHBG), androgen receptor (AR), LH beta polypeptide (LHB), progesterone receptor membrane component 1 (PGRMC1) and progesterone receptor membrane component 2 (PGRMC2) regulate follicle development and maturation. Their mRNA expression was assessed in peripheral blood mononuclear cells (PBMC) of normal and poor responders, during ovarian stimulation.DesignFifty-two normal responders and 15 poor responders according to the Bologna criteria were enrolled for IVF and intracytoplasmic sperm injection and stimulated with 200 IU of follitrophin alpha and gonadotrophin-releasing hormone antagonist. HCG was administered for final oocyte maturation. On days 1, 6 and 10 of stimulation, blood samples were obtained, serum hormone levels were measured, RNA was extracted from PBMC and real-time polymerase chain reaction was carried out to identify the mRNA levels. Relative mRNA expression of each gene was calculated by the comparative 2^?DDCt method.ResultsDifferences between mRNA levels of each gene on the same time point between the two groups were not significant. PGRMC1 and PGRMC2 mRNA levels were downregulated, adjusted for ovarian response and age. Positive correlations between PGRMC1 and AR (standardized beta = 0.890, P < 0.001) from day 1 to 6 and PGRMC1 and LHB (standardized beta = 0.806, P < 0.001) from day 1 to 10 were found in poor responders. PGRMC1 and PGRMC2 were positively correlated on days 6 and 10 in normal responders.ConclusionsPGRMC1 and PGRMC2 mRNA are significantly decreased during ovarian stimulation, with some potential differences between normal and poor responders.     

Hypothalamic-pituitary suppression with oral contraceptive pills does not improve outcome in poor responder patients undergoing in vitro fertilization-embryo transfer cycles

Purpose: To evaluate and compare the use of OCP with GnRHa for hypothalamic-pituitary suppression in poor responder IVF patients. Methods: Retrospective analysis of IVF-ET cycles of poor responders. Hypothalamic-pituitary suppression with OCP (Group I, n = 29) or GnRHa (Group II, n = 52), followed by stimulation with gonadotropin, oocyte retrieval, and embryo transfer. Baseline characteristics and cycle outcomes were compared. Results: 73 women underwent 81 cycles from 1/1/1999 to 1/1/2000. Baseline characteristics were similar. 31/81 (38%) cycles were cancelled (Group I, 14/29 (48%) vs. Group II, 17/52 (33%), NS). Cycle outcomes including amount of gonadotropin, number of eggs retrieved, number of embryos transferred, and embryo quality were similar. Patients in Group I required fewer days of stimulation to reach oocyte retrieval. Pregnancy outcomes were similar in the two groups. Conclusion: Our retrospective analysis revealed no improvement in IVF cycle outcomes in poor responders who received OCPs to achieve hypothalamic-pituitary suppression instead of GnRHa.     

Effects of luteal estradiol pre-treatment on the outcome of IVF in poor ovarian responders

Background: In view of the discrepancies about the luteal estradiol treatment before stimulation protocols having some potential advantages compared with the standard protocols in poor ovarian responders undergoing IVF, a meta-analysis of the published data was performed to compare the efficacy of the luteal estradiol pre-treatment protocols in IVF poor response patients. Methods: We searched for all published articles. The searches yielded 32 articles, from which seven studies met the inclusion criteria. We performed this meta-analysis involving 450 IVF patients in luteal estradiol pre-treatment protocol group and 606 patients in standard protocol group. Results: The luteal estradiol protocol resulted in a significantly higher duration of stimulation compared with the standard protocol. In addition, the number of oocytes retrieved and mature oocytes retrieved were significantly higher in the luteal estradiol protocols than those in the standard protocols. The cycle cancellation rate (CCR) in the luteal estradiol protocols was lower than the standard protocols. Moreover, no significant difference was found in the clinical pregnancy rate (CPR). Conclusions: The addition of the estradiol in the luteal phase preceding IVF in poor responders improved IVF cycle outcomes, including increasing the number of oocytes retrieved and mature oocytes retrieved and decreasing the CCR.     

Comparison of different stimulation protocols efficacy in poor responders undergoing IVF: A retrospective study

Purpose: To compare the efficacy of different stimulation protocols on pregnancy outcomes in poor responders undergoing in vitro fertilization (IVF). Materials and methods: This was a retrospective study to compare the efficacy of four different protocols including gonadotropin-releasing hormone (GnRH) agonist (long, short and miniflare) and GnRH antagonist on pregnancy outcomes in poor responders. This investigation was performed on 566 poor respond patients who were candidates for IVF. Main outcome measures included the total number of oocytes and mature oocytes retrieved, pregnancy rates, implantation and overall cancellation rates which were compared between four mentioned groups. Results: Number of follicles >18?mm on hCG day were significantly higher in GnRH-a long versus GnRH antagonist, GnRH-a short and GnRH-a miniflare protocols. The mean number of oocytes and mature oocytes retrieved were significantly higher in GnRH-a long versus miniflare (4.7?±?3.05 versus 3.26?±?2.9 and 3.69?±?3.1 versus 2.65?±?2.2, respectively). There were no significant differences in implantation, pregnancy and overall cancellation rates between four groups. Conclusion: The present study suggests that the application of four different protocols in poor respond patients seem to have similar efficacy in improving clinical outcomes such as implantation, pregnancy rates and cancellation rate even though GnRH-a long protocol yielded more retrieved oocytes and mature oocytes compared to GnRH-a miniflare protocol.     

The decline in serum estradiol on the second day after oocyte retrieval affects the outcome of IVF/ICSI-ET treatment in high ovarian responders

Objective: To investigate the predictive value of the decline in serum estradiol on the second day after oocyte retrieval on the outcomes of in vitro fertilization (IVF) or intra-cytoplasmic sperm injection and embryo transfer (ICSI-ET) among high ovarian responders.

Design: Retrospective single-center cohort study.

Setting: Tertiary-care, university-affiliated teaching hospital.

Patients Women aged 20–45 years undergoing assisted reproduction treatment from June 2014 to December 2015.

Interventions: A total of 980 cycles were included; 395 high responders (Group 1) and 256 normal responders (Group 3) underwent embryo transfer (ET) in fresh ET cycles. A total of 329 high ovarian responders who underwent cryopreservation of all embryos (Group 2) were recruited as controls. The cases were divided into the following five subgroups according to the rate of serum estradiol decline on the second day after oocyte retrieval: 50.00–59.99% (Subgroup A), 60.00–69.99% (Subgroup B), 70.00–79.99% (Subgroup C), 80.00–89.99% (Subgroup D) and?≥?90.00% (Subgroup E). The clinical outcomes were analyzed.

Main outcome measures: Clinical pregnancy rate, implantation rate.

Results: In Group 1, the pregnancy rate decreased from 51.33 to 36.72% and the implantation rate decreased from 30.93 to 21.70% when the level of serum estradiol on the second day after oocyte retrieval decreased by more than 80%, which was a statistically significant decline (p?2) value and implantation rate were also significantly different (p?2 on the second day after oocyte retrieval had no significant effect on the clinical pregnancy rate or the implantation rate. The trend was similar in Group 3.

Conclusions: A decline in the E₂ level of >?80% after oocyte retrieval may play an important role in unsatisfactory IVF/ICSI-ET outcomes among high ovarian responders.     

Obstetric risk factors for poor neonatal adaptation at birth

Purpose: To identify obstetric risk factors of delivering a neonate with poor neonatal adaptation at birth.

Material and methods: Nested case–control study. Poor neonatal adaptation was defined for presence of at least: umbilical cord artery pH <7.10, base deficit ≥12?mmol/L, Apgar score at 1′ ≤5. Controls were selected from the same population and matched with cases. The association between clinical parameters and poor neonatal adaptation was analyzed by logistic regression.

Results: One hundred and thirty three women (2.1% of all live births) with a neonate presenting a poor neonatal adaptation were matched with 133 subsequent controls. Significant contributions for the prediction of poor neonatal adaptation were provided by maternal age ≥35 years (p?≤?.001, odds ratio (OR) 3.9 [95%CI: 2.3–6.8]), nulliparity (p?≤?.001, OR 3.3 [95%CI: 1.8–6]), complications during pregnancy (p?=?.032, OR 2.2 [95%CI: 1.1–4.4]), gestational age at delivery <37 weeks (p?=?.008, OR 5.2 [95%CI: 1.5–17.8]) and cardiotocography category II or III (p?≤?.001, OR 36.3 [95%CI: 16.5–80.1]). The receiver operative characteristic curve was 0.91 [95%CI: 0.87–0.95], and detection rates 82.7% and 89.5% at 10% and 20% of false positive rates, respectively.

Conclusions: Several obstetric risk factors before and during labor can identify a subgroup of newborns at higher risk of a poor neonatal adaptation at birth.