Luteal Phase Ovarian Stimulation May Improve Oocyte Retrieval and Oocyte Quality in Poor Ovarian Responders Undergoing In Vitro Fertilization: Preliminary Results from a Single-Center Prospective Pilot Study

2018 ◽  
Vol 35 (6) ◽  
pp. 847-856 ◽  
Author(s):  
Li-Te Lin ◽  
Salvatore Giovanni Vitale ◽  
San-Nung Chen ◽  
Zhi-Hong Wen ◽  
Hsiao-Wen Tsai ◽  
...  
Keyword(s):  
Pilot Study ◽  
Luteal Phase ◽  
Oocyte Retrieval ◽  
Oocyte Quality ◽  
Single Center ◽  
Vitro Fertilization ◽  
Prospective Pilot Study ◽  
Poor Ovarian Responders ◽  
Luteal Phase Ovarian Stimulation

scholarly journals The Presence of Immature GV− Stage Oocytes during IVF/ICSI Is a Marker of Poor Oocyte Quality: A Pilot Study

2020 ◽  
Vol 8 (1) ◽  
pp. 4
Author(s):  
Pia Astbury ◽  
Goutham N. Subramanian ◽  
Jessica Greaney ◽  
Chris Roling ◽  
Jacqui Irving ◽  
...  
Keyword(s):  
Dna Damage ◽  
Pilot Study ◽  
Germinal Vesicle ◽  
Oocyte Retrieval ◽  
Oocyte Quality ◽  
Outcome Data ◽  
Developmental Competence ◽  
Success Rates ◽  
Vitro Fertilization

Here we investigate whether the presence of germinal vesicle-stage oocytes (GV− oocytes) reflects poor oocyte developmental competence (or quality). This was a prospective, non-randomised, cohort pilot-study involving 60 patients undergoing in vitro fertilization/ intracytoplasmic sperm injection for whom complete pregnancy outcome data were available. Patients in whom GV− oocytes were retrieved (GV+) at transvaginal oocyte retrieval (TVOR) were compared with those from whom no GVs were retrieved (GV−). We found that GV+ (n = 29) and GV− (n = 31) patients were similarly aged (35.4 vs. 36.4 years; p = 0.446). GV+ patients had a mean of 2.41 ± 2.03 GVs and comparable yields of MII oocytes to GV− patients (11 ± 6.88 vs. 8.26 ± 4.84; p = 0.077). Compared with GV− patients, GV+ patients had markedly lower implantation rates (11.8% vs. 30.2%; p = 0.022) as well as oocyte utilisation rates for clinical pregnancy (2.3% vs. 6.8%; p = 0.018) and live-birth (1.9% vs. 5.7%; p = 0.029). DNA damage levels measured using γH2AX immunostaining were not different in oocytes from women <36 years versus those ≥36 years (p = 0.606). Thus, patients who have GV− stage oocytes at TVOR exhibit poor oocyte quality reflected in reduced per-oocyte pregnancy success rates and uniformly high levels of oocyte DNA damage.

scholarly journals Luteal phase support for in vitro fertilization/intracytoplasmic sperm injection fresh cycles: a systematic review and network meta-analysis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Hanglin Wu ◽  
Songying Zhang ◽  
Xiaona Lin ◽  
Shasha Wang ◽  
Ping Zhou
Keyword(s):  
Live Birth ◽  
Pregnancy Outcomes ◽  
Luteal Phase ◽  
Meta Analysis ◽  
Oocyte Retrieval ◽  
Gnrh Agonists ◽  
Ongoing Pregnancy ◽  
Vitro Fertilization ◽  
Lps Treatment

Abstract Background Various luteal phase supports (LPSs) have been proven to increase the pregnancy rate in fresh cycles of in vitro fertilization or intracytoplasmic sperm injection; however, there is still significant debate regarding the optimal use of LPS. Methods A systematic review with the use of a network meta-analysis was performed via electronic searching of Ovid MEDLINE, the Cochrane Library, Embase, Web of Science, ClinicalTrials.gov and Google Scholar (up to January 2021) to compare the effectiveness and safety of various LPSs, as well as to evaluate the effects of different initiations of LPSs on pregnancy outcomes. The primary outcomes included live birth and ongoing pregnancy, with the results presented as odds ratios (ORs) with 95% confidence intervals (CIs). Results Eighty-nine randomized controlled trials with 29,625 women comparing 14 interventions or placebo/no LPS treatments were included in the meta-analyses. No significant differences were found in terms of the pregnancy outcomes when LPS was started within 48 h after oocyte retrieval versus a delayed initiation between 48 h and 96 h after oocyte retrieval. The addition of gonadotropin-releasing hormone (GnRH) agonists to progesterone vaginal pessaries showed a significant benefit in terms of live birth (OR 1.39, 95% CI 1.08 to 1.78). Only human chorionic gonadotropin (HCG) was found to be more efficacious than the placebo/no LPS treatment in terms of live birth (OR 15.43, 95% CI 2.03 to 117.12, low evidence). Any active LPSs (except for rectal or subcutaneous progesterone) was significantly more efficacious than the placebo/no LPS treatment in terms of ongoing pregnancy, with ORs ranging between 1.77 (95% CI 1.08 to 2.90) for the vaginal progesterone pessary and 2.14 (1.23 to 3.70) for the intramuscular progesterone treatment. Among the comparisons of efficacy and tolerability between the active treatments, the differences were small and very uncertain. Conclusion Delays in progesterone supplementation until 96 h after oocyte retrieval does not affect pregnancy outcomes. The safety of GnRH agonists during the luteal phase needs to be evaluated in future studies before the applications of these agonists in clinical practice. With comparable efficacy and acceptability, there may be several viable clinical options for LPS.

scholarly journals Oxidative Stress Reduction by Midazolam Premedication during Oocyte Retrieval Procedure: Pilot Study

2021 ◽  
Vol 10 (4) ◽  
pp. 855
Author(s):  
Maja Pešić ◽  
Katarina Kličan-Jaić ◽  
Marinko Vučić ◽  
Krunoslav Kuna ◽  
Andro Košec ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Pilot Study ◽  
In Vitro Fertilization ◽  
Stress Reduction ◽  
Catalase Activity ◽  
Oocyte Retrieval ◽  
Control Group ◽  
Medical Problems ◽  
Vitro Fertilization

Infertility is one of the major medical problems nowadays. Couples who opt for In Vitro Fertilization (IVF) face a great deal of stress which certainly affects the outcome of the procedure. Therefore, we aimed to reduce the stress during the oocyte retrieval procedure by applying midazolam. Total oxidant (TOC) and antioxidant (TAC) capacities of serum, as well as glutathione (GSH) content and catalase activity, were measured in both control and midazolam groups. Follicular fluid was also tested for oxidant capacity and IL1β. Results implied that the midazolam group increased TAC at the end of the procedure. At the same time, the control group decreased GSH at the beginning of the procedure, and both groups decreased catalase activity at the end of the procedure. The results imply that stress during the procedure affects oxidative and antioxidative parameters of the patients, but did not affect the frequency of the pregnancy at the end of this pilot study. Yet, the results imply that oxidative and antioxidative mechanisms during IVF should be investigated in detail as they could affect the outcome of IVF.

scholarly journals Double or dual stimulation in poor ovarian responders: where do we stand?

2021 ◽  
Vol 15 ◽  
pp. 263349412110241
Author(s):  
Mehtap Polat ◽  
Sezcan Mumusoglu ◽  
Irem Yarali Ozbek ◽  
Gurkan Bozdag ◽  
Hakan Yarali
Keyword(s):  
Menstrual Cycle ◽  
In Vitro Fertilization ◽  
Live Birth ◽  
Ovarian Stimulation ◽  
Luteal Phase ◽  
Follicular Phase ◽  
Vitro Fertilization ◽  
Poor Ovarian Responders ◽  
Double Stimulation

Recent advances in our recognition of two to three follicular waves of development in a single menstrual cycle has challenged the dogmatic approach of ovarian stimulation for in vitro fertilization starting in the early follicular phase. First shown in veterinary medicine and thereafter in women, luteal phase stimulation–derived oocytes are at least as competent as those retrieved following follicular phase stimulation. Poor ovarian responders still remain a challenge for many decades simply because they do not respond to ovarian stimulation. Performing follicular phase stimulation and luteal phase stimulation in the same menstrual cycle, named as double stimulation/dual stimulation, clearly increases the number of oocytes, which is a robust surrogate marker of live birth rate in in vitro fertilization across all female ages. Of interest, apart from one study, the bulk of evidence reports significantly higher number of oocytes following luteal phase stimulation when compared with follicular phase stimulation; hence, performing double stimulation/dual stimulation doubles the number of oocytes leading to a marked decrease in patient drop-out rate which is one of the major factors limiting cumulative live birth rates in such poor prognosis patients. The limited data with double stimulation/dual stimulation-derived embryos is reassuring for obstetric and neonatal outcome. The mandatory requirement of freeze-all and lack of cost-effectiveness data are limitations of this novel approach. Double stimulation/dual stimulation is an effective strategy when the need to obtain oocytes is urgent, including patients with malignant diseases undergoing oocyte cryopreservation and patients of advanced maternal age or with reduced ovarian reserve.

scholarly journals Age-related decline in the expression of GDF9 and BMP15 genes in follicle fluid and granulosa cells derived from poor ovarian responders

2020 ◽  
Author(s):  
Yan Gong ◽  
Jesse Li-Ling ◽  
Dongsheng Xiong ◽  
Jiajing Wei ◽  
Taiqing Zhong ◽  
...  
Keyword(s):  
Granulosa Cells ◽  
Oocyte Retrieval ◽  
Ovarian Response ◽  
Oocyte Quality ◽  
Enzyme Linked Immunosorbent Assay ◽  
Altered Expression ◽  
Age Related ◽  
Tertiary Teaching ◽  
Poor Ovarian Responders

Abstract Background: Growth differentiation factor 9 (GDF9) and bone morphogenetic protein 15 (BMP15) genes play important roles in folliculogenesis. Altered expression of the two have been found among patients with poor ovarian response (POR). In this prospective cohort study, we have determined the expression of the GDF9 and BMP15 genes in follicle fluid (FF) and granulosa cells (GCs) derived from poor ovarian responders grouped by age, and explored its correlation with the outcome of in vitro fertilization and embryo transfer (IVF-ET) treatment.Methods: A total of 196 patients with POR were enrolled from a tertiary teaching hospital. The patients were diagnosed by the Bologna criteria and sub-divided into group A (< 35 year old), group B (35-40 year old), and group C (> 40 year old). A GnRH antagonist protocol was conducted for all patients, and FF and GCs were collected after oocyte retrieval. Expression of the GDF9 and BMP15 genes in the FF and GCs was determined with enzyme-linked immunosorbent assay (ELISA), quantitative real-time polymerase chain reaction (qRT-PCR) and Western blotting.Results: Compared with group C, groups A and B had significantly more two pronuclei (2PN) oocytes and transplantable embryos, in addition with higher rates of implantation and clinical pregnancy (P < 0.05). The expression level of GDF9 and BMP15 genes in the FF and GCs differed significantly among the three groups (P < 0.05), showing a trend of decline along with age. Conclusions: For poor ovarian responders, in particular those over 40, the expression of GDF9 and BMP15 is declined with increased age and in accompany with poorer oocyte quality and IVF outcome.

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