Prognostic value of serum progesterone and LH values on the day of hCG administration in IUI GnRH antagonist cycles

Objetive: to evaluate the effect of LH surge and progesterone rise in IUI cycles under gonadotropin stimulation with GnRH antagonist coadministration on pregnancy rates (PR). Study Design: The population under study consisted of 152 women prospectively studied and subjected to IUI. Results The higher the progesterone cutoff value, the lower the PR were 26.5% and 10.9% when the cutoff was 1 ng/mL, 26.0% and 8.6% when the cutoff was 1.2 ng/mL, 25.6% and 7.1% when the cutoff was 1.4 ng/mL and 25.3% and 0% when the cutoff was 1.6 ng/mL. Conclusion: In IUI cycles under GnRH antagonist coadministration, serum progesterone levels over 1.0 ng/mL are associated with lower PR, the higher the progesterone levels, the lower the PR.     

Predictive factors for pregnancy during the first four intrauterine insemination cycles using gonadotropin

Abstract

Purpose: Although a variety of factors have been reported as affecting pregnancy rates after intrauterine insemination (IUI), there have been conflicting results on prognostic factors. This study aimed to determine predictive factors for pregnancy in patients undergoing the first four IUI cycles.

Methods: A total of 348 IUI cycles using clomiphene citrate or letrozole combined with gonadotropin, or gonadotropin only were analyzed. Baseline clinical characteristics, variables related to ovulation induction and sperm parameters were compared between pregnant (n?=?54) and non-pregnant groups (n?=?294). Logistic regression analysis was performed to identify factors that could predict a pregnancy.

Results: The overall clinical pregnancy rate was 15.5% (54/348) per cycle and 30.0% (54/180) per couple. During the first four IUI cycles, logistic regression analysis revealed that woman who were 39 years or older (OR: 0.263, 95% CI: 0.076–0.906, p?=?0.034), longer duration of infertility (OR: 0.967, 95% CI: 0.942–0.993, p?=?0.012), endometriosis (versus unexplained infertility; OR: 0.177, 95% CI: 0.040–0.775, p?=?0.022) and endometrial thickness below 7?mm (OR: 0.114, 95% CI: 0.015–0.862, p?=?0.035) were unfavorable factors to predict clinical pregnancy.

Conclusions: Women with old age, longer duration of infertility, the presence of endometriosis or thin endometrium in the preovulatory phase may have unfavorable outcomes during the first four IUI cycles.     

Relationship between oxidative stress and clinical pregnancy in assisted reproductive technology treatment cycles

PurposeTo examine the relationship between serum total oxidant (TOS) and antioxidant (TAS) levels and clinical pregnancy in assisted reproductive technology (ART) cycles.MethodsPrior to and after oocyte pick-up (OPU) and embryo transfer (ET), blood samples were collected from gynecologically normal females (n = 70) who were enrolled for ART solely due to male factor infertility. TAS, TOS levels and oxidative stress indexes (OSI: TOS/TAS) in four phases of treatment cycle (pre and post OPU and ET) between clinically pregnant and non-pregnant patients were compared. Critical cut-off values of significantly different TAS, TOS levels and OSIes for clinical pregnancy were established.ResultsThe TAS levels in patients with clinical pregnancy were significantly higher in all of the four phases of the cycle. Post-OPU and pre-ET TOS levels were significantly higher in clinically pregnant patients. According to OSIes; only the pre-OPU OSI was significantly lower in clinically pregnant patients compared with non-pregnant ones. Moreover, the highest area under the ROC curve (AUC) from the seven different significant measurements [1) pre-OPU OSI, 2) pre-OPU TAS, 3) post-OPU TAS, 4) pre-ET TAS, 5) post-ET TAS, 6) post-OPU TOS, 7) pre-ET TOS] was related to pre-OPU OSI.ConclusionsIn ART cycles, women with a higher total antioxidant status prior to and after OPU and prior to and after ET have an increased probability of clinical pregnancy. Additionally; OSI before OPU was one of the most important determinants for clinical pregnancy, so the oxidant and antioxidant balance is as important as the antioxidant concentration alone.     

The comparision of effect of microdose GnRH-a flare-up,GnRH antagonist/aromatase inhibitor letrozole and GnRH antagonist/clomiphene citrate protocols on IVF outcomes in poor responder patients

Purpose: To compare the effects of microdose GnRH-a flare-up, GnRH antagonist/aromatase inhibitor letrozole and GnRH antagonist/clomiphene citrate protocols on IVF outcomes in poor responder patients.

Methods: Of 225 patients, 83 patients were in microdose flare-up group (Group 1), 70 patients were in GnRH antagonist/letrozole group (Group 2) and 72 patients were in GnRH antagonist/clomiphene citrate group (Group 3). Demographic and endocrine characteristics, the total number of oocytes retrieved, cancellation rate and clinical pregnancy rate were collected

Results: Total dosage of gonadotropins (p?=?0.002) and serum E2 levels on the day of hCG administration (p?=?0.010) were significantly higher and duration of stimulations (p?=?0.03) was significantly longer in group 1. The number of oocytes retrieved was significantly greater in group 1 and 2 when compare to those of group 3 (p?=?0,000). There was a trend towards increasing cycle cancellation rates with GnRH antagonist/clomiphene citrate and GnRH antagonist/letrozole.

Conclusion: Our finding suggest that the results of microdose flare-up protocol are better than other two used treatment protocols, in terms of maximum estradiol levels, number of mature oocytes retrieved, and cancellation rate and it still seems to be superior the ovarian stimulation regime for the poor responder patients.     

Comparison between stimulation with highly purified hMG or recombinant FSH in patients undergoing IVF with GnRH antagonist protocol

Purpose: Highly purified Human Menopausal Gonadotropins (hp-hMG) and recombinant FSH (rFSH) are widely used in assisted reproductive technology (ART). The aim of this study was to compare ART results of the two preparations in GnRH antagonist cycles.

Methods: In this retrospective cohort study, IVF antagonist cycles performed from 2011 through 2013 were reviewed. There were 508 antagonist cycles: 320 stimulated with rFSH and 188 with hp-hMG. For every hp-hMG, two rFSH were matched for patient's age and infertility diagnosis. Subgroup analysis of patients younger and older than 35 was done as well.

Results: Both treatments were resulted in comparable pregnancy and live birth rates. However, cumulative pregnancy rates were higher for the rFSH group. In the matching analysis, the rFSH group had more mature oocytes and more embryos while using lower doses of gonadotropins. Pregnancy, cumulative pregnancy rates, and live birth rates were comparable. In the subgroup analysis, young patients in the rFSH group had better cycle outcomes compared with those in the hp-hMG group.

Conclusion: In antagonist protocol, different gonadotropin products are equally effective. The choice of one or the other should depend on the availability, convenience of use, and cost.     

子宫内膜非典型增生18例保守治疗结局分析

目的探讨孕激素治疗子宫内膜非典型增生的结局及适宜的辅助生育策略。方法回顾性分析2002年1月～2007年4月18例不孕合并子宫内膜非典型增生的患者应用大剂量孕激素保守治疗的结果及妊娠结局。结果①14例患者在应用大剂量孕激素治疗3～36个月后病灶消退，4例病灶持续存在；②3例患者在停止治疗5～15个月后发展为子宫内膜癌。内膜非典型增生病变的再现率为33．3％；③8例患者接受了辅助生育治疗．5例分别经CC＋HMG促排卵治疗3～6周期无优势卵泡发育．1例在第6个促排卵周期获宫内单胎妊娠。4例（包括1例CC＋HMG促排卵未孕者）患者接受了5个周期IVF助孕，1例输卵管妊娠。1例自然流产。另2例冻存胚胎等待移植。结论多数子宫内膜非典型增生的患者对大剂量孕激素治疗有效。对这类患者．一旦内膜病变消退，应积极助孕．可以适当放宽IVF—ET指征。     

Comparison of estradiol and progesterone priming/antagonist/letrozole and microdose flare-up protocols for poor responders undergoing intracytoplasmic sperm injection

Background: To compare the effect of the GnRH antagonist/letrozole/gonadotropin protocol with the microdose GnRH agonist flare-up protocol in poor ovarian responders for intracytoplasmic sperm injection.

Materials and methods: One hundred twenty-one consecutive patients suspected of having or with a history of poor ovarian response between January 2009 and June 2010, who were undergoing ICSI were enrolled. The microdose flareup (MF) protocol was used in 79 patients and the estradiol?+?progesterone/letrozole?+?gonadotropin and GnRH antagonist (EP/ALG) protocol was used in 42 patients.

Results: Age of the patients, duration of infertility, basal FSH, the total gonadotropin consumption, duration of stimulation, E2 level on the day of hCG administration, the number of embryo transferred, the fertilization rate, implantation rate, clinical pregnancy rate and the live birth rate were not statistically different (p?>?0.05). Only the number of oocytes retrieved was significantly higher in the EP/LGA group (1.7?±?0.7 versus 2.6?±?0.6).

Conclusion: The EP/LGA protocol has no significant improvement against the microdose flare-up protocol in poor responder patients.     

麒麟丸联合芬吗通对薄型子宫内膜厚度、血流和妊娠率的影响

目的:观察麒麟丸联合芬吗通对薄型子宫内膜厚度及类型、血流和妊娠率的临床疗效。方法:前瞻性研究76例薄型子宫内膜不孕患者,随机分为对照组和研究组各38例,对照组经阴道给予芬吗通,研究组在对照组的基础上联合口服麒麟丸进行治疗。比较对照组和研究组治疗3个周期后子宫内膜厚度、类型、血流、血雌激素(E2)浓度情况和治疗半年后的自然妊娠率。结果:对照组和研究组治疗3个周期后的子宫内膜厚度、类型、血流、E2浓度情况均有明显改善(P0.05),且研究组子宫内膜厚度和血流优于对照组,差异均有统计学意义(P0.05);治疗半年后自然妊娠率研究组显著高于对照组(52.6%vs 28.9%),差异有统计学意义(P0.05);研究组和对照组中妊娠患者子宫内膜厚度、类型、血流分别与本组中未妊娠患者比较,差异均有统计学意义(P0.05)。结论:麒麟丸联合芬吗通治疗因子宫内膜薄而致的不孕,可有效改善子宫内膜厚度及血流,提高治疗半年后的自然妊娠率。     

Early pregnancy loss rates were different among singleton gestations conceived by ICSI using GnRH agonist and antagonist

This study compared early pregnancy losses (termination of pregnancy before 12 weeks of gestation, EPL) among conceptions achieved by ICSI according to the type of GnRH analogue for ovarian stimulation. Only singleton gestations (2,184) and fresh embryo transfers were included. GnRH agonist was used in 848 gestations out of 2,184 and GnRH antagonist was used in the remaining 1,336 gestations. EPL was found to be significantly higher in GnRH antagonist gestations compared to GnRH agonist (27.2% vs 18.9%). This significant difference persisted when gestations were segregated according to maternal age, especially among women younger than 35 years old. Therefore our results suggest that gestations conceived by ovarian stimulation including GnRH antagonists may have higher propabilty of having EPL.     

Effect of ICSI on subsequent blastocyst development and pregnancy rates

Purpose: To investigate whether ICSI (intracytoplasmic sperm injection)results in decreased blastocyst formation and pregnancy compared to IVF (in vitro fertilization). Methods: We performed a retrospective analysis of blastocyst transfer (BT)offered routinely to patients under age 40 with three 8-cell embryos on day 3 and compared IVF to ICSI cycles. Sequential media were used with P1 until day 3, then Blastocyst Medium until day 5/6. Results: There were 131 IVF and 75 ICSI cycles. There was no difference in age, number of oocytes, zygotes, 8-cell embryos, blastocysts on days 5 and 6, or embryos transferred. Progression to blastocyst was similar (78% for IVF and 73% for ICSI) as was the viable pregnancy rate (51.4% for IVF and 55% for ICSI). No cycles failed to form blastocysts. Conclusions: The progression to blastocyst and the likelihood of conceiving aviable pregnancy were unaltered by ICSI. Thus it seems appropriate for programs to offer BT to patients undergoing ICSI using the same inclusion criteria applied to their IVF patients.     

Ultrasound assessment of endometrial thickness: correlation with ovarian stimulation and pregnancy rates in IVF cycles

PURPOSE: To study the correlation between endometrial thickness and IVF outcome and factors affecting this relation. METHODS: Transvaginal ultrasound evaluation of endometrial thickness on hCG administration day in 112 IVF-ET cycles and comparison to indices of ovarian stimulation. Outcome was considered positive when fetal sac and fetal heart pulse were present at ultrasound. GnRH-agonist and antagonist protocols were also compared. Statistical analysis was performed by the SPSS system, chi-square and t-test. RESULTS: 38 cycles displayed clinical pregnancy. In cases of higher endometrial thickness, pregnancy rates, mean serum estradiol levels, oocyte and mature oocyte numbers as well as mean large follicle numbers were higher, while the mean age was lower. CONCLUSIONS: In 38 cycles resulting in pregnancy, mean endometrial thickness was higher compared to cycles with negative outcomes. Higher serum estradiol is associated with higher endometrial thickness and pregnancy rates. Women achieving pregnancy and pregnant women with endometrium thicker than 9 mm were younger. Follicle stimulation was better with higher endometrial thickness. After adjustments for age, no statistical difference was found in endometrial thickness between agonist and antagonist protocols.     

Expectations for oocyte fertilization and embryo cleavage after whole sperm versus sperm head intracytoplasmic sperm injection

OBJECTIVE: To compare oocyte fertilization and embryo development after intracytoplasmic sperm injection (ICSI) with a whole sperm vs. a sperm head. DESIGN: Retrospective study. SETTING: Hospital-based IVF practice. PATIENT(S): Fifty-three women undergoing 54 IVF-embryo transfer plus ICSI procedures between January 1999 and June 2002. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Oocyte fertilization, zygote cleavage, and embryo stage after 72 hours of culture. RESULT(S): A significantly higher fertilization rate was observed using whole sperm (72.2%) than when using sperm heads (56.4%). Zygote cleavage rates for whole sperm vs. sperm head ICSI were 96.4% and 92.7%, respectively. Embryo cell stage after 72 hours of culture for whole sperm vs. sperm head ICSI was 6.5 +/- 2.1 cells and 5.6 +/- 1.8 cells, respectively. Embryo grade at this same time point was not different (2.3 +/- 1.0 and 2.5 +/- 0.9, respectively). CONCLUSION(S): The ICSI using whole sperm produces superior fertilization rates compared to ICSI using sperm heads, but once oocytes were fertilized, zygote cleavage rates were not different between the two sperm sources. Oocytes injected with a whole sperm produced embryos of higher cell stage but equivalent quality compared to oocytes injected with sperm heads. Therefore, having only sperm heads for use in ICSI should not be a deterrent to using this procedure.     

Live birth rates and birth outcomes by diagnosis using linked cycles from the SART CORS database

Purpose

This study uses linked cycles of assisted reproductive technology (ART) to examine cumulative live birth rates, birthweight, and length of gestation by diagnostic category.

Methods

We studied 145,660 women with 235,985 ART cycles reported to the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System during 2004–2010. ART cycles were linked to individual women by name, date of birth, social security number, partner’s name, and sequence of ART treatments. The study population included the first four autologous oocyte cycles for women with a single diagnosis of male factor, endometriosis, ovulation disorders, diminished ovarian reserve, or unexplained infertility. Live birth rates were calculated per cycle, per cycle number (1–4), and cumulatively. Birthweight and length of gestation were calculated for singleton births.

Results

Within each diagnosis, live birth rates were highest in the first cycle and declined with successive cycles. Women with diminished ovarian reserve had the lowest live birth rate (cumulative rate of 28.3 %); the live birth rate for the other diagnoses were very similar (cumulative rates from 62.1 % to 65.7 %). Singleton birthweights and lengths of gestation did not differ substantially across diagnoses, ranging from 3,112 to 3,286 g and 265 to 270 days, respectively. These outcomes were comparable with national averages for singleton births in the United States (3,296 g and 271 days).

Conclusion

Women with the diagnosis of diminished ovarian reserve had substantially lower live birth rates. However, singleton birthweights and lengths of gestation outcomes were similar across all other diagnoses.     

Male factors in ART outcome prediction

Abstract

Paternal influences on reproduction are significant causing about half of the infertile couples to turn to assisted reproductive techniques. Due to the increasing proportion of infertile couples adopting to conceive by in vitro fertilisation (IVF), predicting outcomes is of ever increasing importance. Since pregnancy rates following IVF are still quite low, prognostic information is very helpful in clinical decisions. Although significant research has been done on the maternal influence, male factor infertility is relatively understudied. To date, potential predictors include: method of fertilisation, age, reactive oxygen species, sperm quality parameters and DNA fragmentation. Predictors under investigation which show promising signs, even though there is no clear cut consensus on the predictive value to date include: folate and homocysteine, anti müllerian hormone measurement, environmental factors, body mass index, smoking, male age, stress, some subsets of antisperm antibodies and epigenetic features.     

Changes in the freezing protocol for human zygotes alter embryonic development and pregnancy rates

OBJECTIVE: To determine the effect of various freezing protocols on postthaw development and pregnancy rates resulting from transfer of human zygotes. DESIGN: Prospective study. SETTING: Tertiary care center. PATIENT(S): Couples undergoing assisted reproductive technology (ART) procedures who wished to have their excess zygotes cryopreserved. INTERVENTION(S): We cryopreserved zygotes with one of three protocols. MAIN OUTCOME MEASURE(S): Post-thaw survival and development of the zygotes as well as pregnancy rate after transfer of these zygotes. RESULT(S): A 3-minute hold time after seeding, followed by a final preplunging temperature of -180 degrees C, resulted in a clinical pregnancy rate of 28.6%. In contrast, a 15-minute postseed hold time and a -30 degrees C final chamber temperature resulted in a 37.3% clinical pregnancy rate. When we combined the protocols to provide a 15-minute postseed holding time and a -180 degrees C before plunging into liquid nitrogen, we achieved a 69.6% clinical pregnancy rate. CONCLUSION(S): By increasing the postseeding hold time and decreasing the temperature of the freezing chamber before plunging the zygotes into liquid nitrogen, significant improvements can be made in postthaw development and pregnancy rates.     

不同精子参数及来源与ICSI结局的相关性研究

目的:探讨不同精子参数及来源与单精子卵胞浆内注射(ICSI)治疗结局的相关性.方法:回顾分析2010年6月至2011年12月在武汉大学人民医院生殖医学中心行ICSI助孕治疗的413个周期,根据精子质量及来源分为4组,非严重少弱的新鲜射出精子组(A1组,244个周期)、严重少弱的新鲜射出精子组(A2组,61个周期)、睾丸精子组(B组,86个周期)、冻融的射出精子组(C组,22个周期).比较4组的ICSI治疗结局.结果:4组患者的受精率、正常受精率、卵裂率、优胚率、临床妊娠率、胚胎种植率和早期流产率均无显著差异(P＞0.05).结论:精子的质量及来源不影响ICSI治疗的受精及早期妊娠结局.     

Rapid decline in ovarian reserve after repeated ART cycles in a 22-year-old IVF patient

Objective The objective was to discuss the rapid decline in ovarian reserve due to repeated assisted reproductive technologies (ART) in a 22-year-old patient.Methods This case report presents an infertile couple admitted to our IVF unit with the diagnosis of recurrent implantation failure and congenital uterine anomaly. Main outcome measures were the number of growing follicles and metaphase II oocytes retrieved.Results After recurrent implantation failure of three in vitro fertilization cycles, the couple underwent three consecutive intracytoplasmic sperm injection cycles in our center. With a high number of oocytes retrieved, first cycle resulted in implantation failure followed by an embryo transfer cancelled cycle. The third cycle was cancelled due to an unexpected poor response even with the highest gonadotrophin dose.Conclusion Rapid decrease in ovarian reserve should be considered when offering repeated ART cycles even if the woman is very young and has a good ovarian reserve.