High responders and patients with a good prognosis are not immune to the negative impact on live birth rate of elevated P on the day of triggering

2015 ◽  
Vol 103 (6) ◽  
pp. 1423 ◽  
Author(s):  
Ernesto Bosch
Keyword(s):  
Live Birth ◽  
Birth Rate ◽  
Negative Impact ◽  
Live Birth Rate ◽  
Good Prognosis ◽  
High Responders

P–728 Can in couples with unexplained infertility the use of a prediction model to triage assisted reproduction technology save costs?

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
D K Nguyen ◽  
S OLeary ◽  
M A Gadalla ◽  
R Wang ◽  
W Li ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Prediction Model ◽  
Live Birth ◽  
Birth Rate ◽  
Prognostic Model ◽  
Live Birth Rate ◽  
Good Prognosis ◽  
Unexplained Infertility ◽  
Usual Model ◽  
Natural Conception

Abstract Study question Can in couples with unexplained infertility a prognosis-tailored management strategy, that delays treatment if natural conception prospects are good, reduce costs without affecting live-birth rate? Summary answer In couples with unexplained infertility, use of a prognostic tool for natural conception followed by expectant management in good-prognosis couples is cost-effective. What is known already Few countries have guidelines for the assessment of the likelihood of natural conception to determine access to publicly funded ART. In the Netherlands and New-Zealand, couples with unexplained infertility who have a good prognosis for natural conception are encouraged to delay starting ART. However, the cost-effectiveness of this prognosis-tailored treatment strategy has not been determined. Study design, size, duration We studied couples with unexplained infertility to compare a prognosis-tailored strategy to care-as-usual. In the prognosis-tailored strategy, couples were assessed using Hunault’s prediction model. In good-prognosis couples (12-months natural conception >40%), outcomes without ART were modelled by censoring observations after start of ART. We then assumed that poor-prognosis couples (<40% natural conception) were treated, while good-prognosis couples delayed the start of treatment for 12 months. Data for the care-as-usual model were based on real observations. Participants/materials, setting, methods We studied 272 couples with unexplained infertility. Costs of in vitro fertilisation (IVF) and intra-uterine insemination (IUI) were calculated based on the out-of-pocket costs and Australian Medicare costs. In a cost-effectiveness model, we compared costs and effects of both strategies. Main results and the role of chance The prognostic model classified 272 couples with unexplained infertility as favourable (N = 107 (39.3%) or unfavourable prognosis (N = 165 (60.7%)) for natural conception. In the prognosis-tailored strategy, the cumulative live-birth rate was 71.1% (95% CI 64.7% - 76.4%) while the number of ART cycles was 393 (353 IVF; 40 IUI). In care-as-usual strategy, the cumulative conception rate leading to live-birth for the cohort of 272 couples, who underwent a total of 398 IVF cycles and 48 IUI cycles, was 72.1% (95% CI 65.7% - 77.4%). Mean time to conception leading to live birth was 388 days in the prognosis-tailored strategy and 419 days in the care-as-usual strategy. This translated for the 272 couples into potential savings of 45 IVF cycles and eight IUI cycles, which cost a total of AUD$ 125,817 for out-of-pocket and AUD$ 264,497 for Australian Medicare. The average cost savings per couple was AUD$ 1,435 (out-of-pocket AUD$ 463 per couple and Australian Medicare AUD$ 962 per couple). The incremental cost-effectiveness ratio, which was calculated as the total costs per additional live-births, was AUD$ 143,497 per additional live birth. Limitations, reasons for caution This study was limited to couples at a single IVF clinic. The modelling was also based on several key assumptions, particularly the number of fresh and frozen embryo transfer cycles for each couple. Wider implications of the findings: Our results show that in couples with unexplained infertility the use of a prognostic model guiding the start of an IVF-treatment reduces costs without compromising live birth rates. Trial registration number Not applicable

scholarly journals Determining Diagnostic Criteria of Unexplained Recurrent Implantation Failure: A Retrospective Study of Two vs Three or More Implantation Failure

2021 ◽  
Vol 12 ◽  
Author(s):  
Yingying Sun ◽  
Yile Zhang ◽  
Xueshan Ma ◽  
Weitong Jia ◽  
Yingchun Su
Keyword(s):  
Pregnancy Rate ◽  
Diagnostic Criteria ◽  
Live Birth ◽  
Birth Rate ◽  
Negative Impact ◽  
Live Birth Rate ◽  
Implantation Failure ◽  
Recurrent Implantation Failure ◽  
Significant Difference ◽  
Definition Of

BackgroundThe definition of recurrent implantation failure (RIF) differs clinically, one of the most controversial diagnostic criteria is the number of failed treatment cycles. We tried to investigate whether the two implantation failure could be included in the diagnostic criteria of RIF.MethodsA retrospective analysis of the clinical data of patients (N=1518) aged under 40 years with two or more implantation failure, recruited from the Center for Reproductive Medicine of the First Affiliated Hospital of Zhengzhou University from January 2016 to June 2019.ResultsAfter adjusting for confounding factors by using binary logistic regression, the results showed that partial general information and: distribution of associated factors were significant differences such as maternal age (aOR=1.054, P=0.001), type of cycle (aOR=2.040, P<0.001), stage of embryos development (aOR=0.287, P<0.001), number of embryos transferred (aOR=0.184, P<0.001), female factor (tubal pathology) (aOR=0.432, P=0.031) and male factor (aOR=1.734, P=0.002) between the groups with two and three or more unexplained implantation failure. And further explored whether these differential factors had a significant negative impact on pregnancy outcome, the results showed that: for patients who had three unexplained implantation failure, in the fourth cycle of ET, the live birth rate decreased significantly with age (aOR=0.921, P<0.001), and the live birth rate of blastocyst transfer was significantly higher than that of cleavage embryo transfer (aOR=1.826, P=0.007). At their first assisted pregnancy treatment after the diagnosis of RIF according to these two different definitions, there were no significant difference in the biochemical pregnancy rate, clinical pregnancy rate, ectopic pregnancy rate and abortion rate (P>0.05), but the live birth rate (35.64% vs 42.95%, P=0.004) was significantly different. According to the definition of ‘two or more failed treatment cycles’, the live birth rate of the first ET treatment after RIF diagnosis was significantly lower than that of patients according to the definition of ‘three or more failed treatment cycles’.ConclusionFor patients with unexplained recurrent implantation failure, two implantation failure cannot be included in the diagnostic criteria of RIF. This study supports the generally accepted definition of three or more failed treatment cycles for RIF.

scholarly journals The interaction of female age and active male smoking has negative influence on success rates of the in vitro fertilization treatments

2020 ◽  
Vol 23 (1) ◽  
pp. 57-62
Author(s):  
E Petanovska Kostova
Keyword(s):  
Pregnancy Rate ◽  
Live Birth ◽  
Birth Rate ◽  
Negative Impact ◽  
Live Birth Rate ◽  
Negative Influence ◽  
Binary Logistic Regression Analysis ◽  
Assisted Reproduction Technique ◽  
Ongoing Pregnancy Rate

AbstractThis study monitors the effect of male smoking and age of the woman on the success of the intracytoplasmic sperm injection (ICSI) fertilization process as part of the assisted reproduction technique (ART). A total of 703 couples in the in vitro fertilization (IVF) program were included. Binary logistic regression analysis was used to study the effect of male smoking on clinical pregnancy rate and live birth rate. The results from the study showed that interaction of male smoking and women’s age (>35 years) have significant negative impact on ongoing pregnancy rate and live birth rate.

O-114 Improved safety and efficiency of individualised versus conventional gonadotropin dosing for ovarian stimulation in IVF/ICSI: an individual patient meta-analysis (IPD-MA)

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
F Janse ◽  
M Eijkemans ◽  
B Fauser
Keyword(s):  
Live Birth ◽  
Ovarian Stimulation ◽  
Birth Rate ◽  
Meta Analysis ◽  
Live Birth Rate ◽  
Mean Difference ◽  
Icsi Cycle ◽  
Subgroup Analyses ◽  
Individualised Dosing ◽  
High Responders

Abstract Study question Does an individualised, weight- and AMH-based dosing approach with follitropin delta improve live birth rate, safety, and efficiency, compared to conventional dosing in IVF/ICSI? Summary answer Individualised ovarian stimulation performs similarly for live birth rate (increased in normal-high AMH), and reduces the incidence of OHSS and total FSH dosage. What is known already Previous studies investigated the effect of individualized gonadotropin dosing in IVF/ICSI using ovarian reserve tests such as anti-Müllerian hormone (AMH) and antral follicle count (AFC). A Cochrane Review concluded that individualised dosing in IVF is associated with a reduction of ovarian hyperstimulation syndrome (OHSS), but no effect on live birth rate. It is hypothesized that an individualised dosing approach is predominantly beneficial in the patients who are potentially normal or high responders. This study addresses the performance of a new human recombinant FSH (follitropin delta) with individualised dosing based on AMH and body weight. Study design, size, duration This is an individual participant data meta-analysis (IPD-MA) of three follitropin delta phase 3 trials, executed in Europe and North- and South America, South-East Asia, and Japan. All trials were randomized, controlled, assessor-blinded, multicenter studies in which individualised follitropin delta vs. conventional follitropin alpha or beta were compared. Women were followed from inclusion, at start of their first fresh IVF/ICSI cycle, until 4 weeks after live birth. Participants/materials, setting, methods Women aged 20-40 yrs, undergoing their first IVF/ICSI cycle, were randomly assigned to follitropin delta (AMH < 15 pmol/L: 12 µg/day; AMH ≥ 15 pmol/L: 0.10-0.19 µg/kg/day: maximum 12 µg/day) or conventional follitropin alpha or beta (150 IU/day for 5 days, possible subsequent dose adjustments). The IPD-MA was performed using logistic regression analysis. Planned subgroup analyses were performed for expected normal/high responders (serum AMH ≥15 pmol/L), and expected low responders (serum AMH <15 pmol/L). Main results and the role of chance Nearly 2,700 women were randomised and exposed: n = 1,348 for conventional dosing regimen with follitropin alpha or beta, and n = 1,334 for individualised dosing with follitropin delta. Live birth rate was similar for both groups (29.5% in follitropin delta vs. 26.9% in follitropin alpha/beta; OR 1.14 (0.96-1.35)). However, in expected normal to high responders live birth rate was significantly increased for those receiving individualised follitropin delta (31.4% vs. 25.9%; OR 1.31 (1.06 - 1.62)). Mean number of transferred embryos/blastocysts was comparable (0.95 vs. 0.94, respectively; mean difference 0.0076; NS), and did not differ when subgroup analyses were performed for normal/high AMH and low AMH. The occurrence of early OHSS was significantly reduced in individualised follitropin delta (4.0% vs. 6.4%; OR 0.62 (95% CI 0.43-0.88)), in subgroup analyses a similar reduction was identified. Total dosage of FSH was significantly lower in individualized follitropin delta (84.5 vs. 112.1 µg; mean difference -27.5 µg (95% CI -30.0 - -25.1)), with a more pronounced effect in normal to high AMH (mean difference -36.5 µg (95% CI -39.2 - -33.7)). Gestational age and birth weight were similar. The IPD-MA identified similar findings among women from the three studies with their different ethnic backgrounds. Limitations, reasons for caution For individualised dosing with follitropin delta, it was observed that the number of cryopreserved embryos was significantly lower (2.4 vs. 3.0, mean difference -0.67 (p < 0.05)), and it remains unclear whether this affects cumulative live birth rate. Wider implications of the findings Individualised dosing with gonadotropin delta is similarly successful in terms of live birth (increased for normal-high AMH women), reduces safety risks, and is more effective with regard to gonadotropin dosage, compared with conventional dosing in IVF/ICSI. Treatment costs are reduced by prescription of lower gonadotropin doses and OHSS reduction. Trial registration number NCT01956110, NCT03228680, NCT03296527

P–291 Searching for a suitable serum progesterone range at triggering day to achieve optimal cumulative live birth rate in high responders – Which range is better?

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
M J Chen ◽  
C Ya-Fang ◽  
G Hwa-Fen ◽  
Y Yu-Chiao ◽  
K Hsioa-Fan ◽  
...  
Keyword(s):  
Pregnancy Outcome ◽  
Live Birth ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Blastocyst Formation ◽  
Cumulative Live Birth Rate ◽  
Cumulative Live Birth ◽  
Group A ◽  
Group B ◽  
High Responders

Abstract Study question Is there a suitable range of serum progestereone level at triggering day to optimize the cumulative live birth rate (LBR) in high responders? Summary answer Fom the point of view of cLBR, the optimal P4 range for triggering is between 1.5 to 2.5 ng/ml generally and in the high responders. What is known already It is well established that premature progesterone rise (PPR) affect adversely the pregnancy outcome in fresh embryo transfer cycle. It is inferred that PPR alters synchrony between endometrium and the embryos. However, detailed study of the effect of PPR on efficiency of oocyte retrieval , embryo quality and the subsequent cumulative pregnancy outcome is still lacking. Hence we sort to analyze the effect of PPR on the final cumulative LBR in our program especially focused on high responders. Study design, size, duration ART Database in our center was retrospectively reviewed. Total 1523 cycles between 20160101 and 20191231 were recruited under the condition of GnRH antagonist cycle with duration of ovulation induction for more than 5 days and available serum P4 level data on triggering day for data analysis for the relationship between serum P4 value and final cumulative LBRs. Participants/materials, setting, methods Cycles with serum P4 level < 1.5 ng/ml were defined as without PPR (Group A: n = 1383). Cycles with serum P4 level >1.5 were defined as with PPR: P4 between 1.5 and 2.5 as Group B (n = 113), P4 > 2.5 as Group C (n = 27). Those high responding cycles (n = 404) were analyzed similarly and separately as Group A’ (n = 304), B’ (n = 81) and C’(n = 19). The statistics were carried out by SPSS-PC ver. 22.0 with p < 0.05 as statistical significance. Main results and the role of chance Group A had significantly lower number of oocytes (9.8 + 8.0) retrieved as compared to Group B (19.3 + 11.2) and Group C (18.2 + 9.9). However there were no differences in fertilization rate, good embryo rates and BC formation rates between groups. The cumulative LBR (cLBR) were significantly higher in Group B (65.1%) as compared to Group A (40.9%, p < 0.001) and Group C (37.0%, p = 0.008). For the high responding cycles, Group B’ also had marginally significant higher cLBR (75.3%) as compared to group A’(63.8% ; p=0.051) and Group C’ (52.6%; p = 0.050). Comparisons between Group A’ and C revealed significantly less oocytes retrieved but significantly higher blastocyst formation rates in Group A’ and the resultant cLBR were comparable between these two groups. Comparisons between Groups B’ and C’ revealed comparable oocytes retrieved but significant lower blastocyst formation rates and cLBRs in Group C’. The baseline of the first part analysis revealed higher age and lower AMH in Group A, but comparable age and AMH between groups B and C.The lower cLBR in group A could be due to selection bias.The second part (high responders) showed comparable baselines between three groups. However, the case numbers are too few in group C’ which might also result in uncertainty. Limitations, reasons for caution Although the data revealed interesting, significantly different results between groups, this is only a retrospective analysis from our ART patient series. Selection bias could not be precluded. Analysis restricted to high responders could have a more balanced population for comparisons. However, more cases are needed to affirm the findings. Wider implications of the findings: We still do not know the tolerable ceiling of serum P4 at the triggering day in high responders if future FET already planned. Pushing P4 value too high not only could not increase mature oocyte yields and possibly may decrease the number of available good blastocysts for optimizing final cLBRs. Trial registration number Not applicable

P–761 Can modified luteal support in fresh cycle after agonist trigger “rescue” the cumulative live birth rate (CLBR) in high responders

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
D Chowdhury ◽  
Y Kopeika
Keyword(s):  
Live Birth ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Cumulative Live Birth Rate ◽  
Luteal Support ◽  
Cumulative Live Birth ◽  
Multiple Variables ◽  
High Responders ◽  
Agonist Trigger ◽  
Fresh Transfer

Abstract Study question Can modified luteal support in fresh cycle “rescue” the cumulative live birth rate (CLBR) in high responders who receive agonist trigger? Summary answer Live birth rate in high responders who had agonist trigger in fresh cycle was significantly reduced despite modified luteal support. What is known already Previous studies, including small randomised controlled trials, claimed that good live birth rate could be achieved at fresh transfer in “high responders” who had GnRHa trigger with modified luteal phase support. However, majority of these studies exclude the true high responders (patients with 20 and above oocytes) and average number of collected eggs reported in many of these studies in the range of 9 to 12. The data on outcome of fresh transfer in true high responders is very limited. Study design, size, duration A prospective observational study was conducted in 407 patients, aged 23–42 years who were expected to be at risk of high response (AFC>18, AMH>20 pmol/l) undergoing controlled ovarian stimulation between 2014–2019 triggered either with HCG or GnRH agonist. Live birth rate (LBR) in a fresh and subsequent 3 frozen transfers were compared in groups with different triggers and freeze all. Participants/materials, setting, methods Patients were stimulated in short antagonist protocol. The trigger was chosen based on the background characteristics, peak oestradiol and clinician discretion. Triggering was achieved either with 0.5 mg buserelin (GnRHa) 0.5mgin 230 patients (A) or with 250 mcg of hCG(H) in 177 patients. Modified luteal support included vaginal progesterone, oral oestrogen and 1500 iu of hCG on the day of egg retrieval. The later was omitted with more than 20 oocytes. Main results and the role of chance The mean age, AFC, number of previous cycles, number of embryos transferred were 33.3, 22.4, 0.26 and 1.2 respectively and did not have significant difference between different triggers. Whereas AMH (53 pmol/l (A) vs 43.1 pmol/l (H), P = 0.003), peak oestradiol (15140.74 (A) vs 9738.59 (H), P = 5.59X10–14), and number of oocytes collected (21 vs.17, P = 5.63X10–7) were significantly higher in GnRHa group. Seventeen patients in buserelin group had elective freeze all. Ovarian Hyperstimulation Syndrome (OHSS) rate was 3.9% in buserelin group (more then half of these cases had a bolus of hCG at egg collection; most were mild/moderate). On the other hand, hCG group had 2.5% of OHSS (all severe). Live birth rate in fresh cycle was 31% in hCG and 21% in GnRHa groups. If freeze all was undertaken in fresh cycle after GnRHa trigger, then LBR in the first frozen cycle of this group was 53% (P = 0.003, fresh vs frozen GnRHa group). CLBR was not different between GnRHa and hCG groups (51%). However, this was significantly lower than CLBR in GnRHa trigger freeze all group 76% (P = 0.03) Limitations, reasons for caution The limitation of this study is its non-randomised nature. However, since it is one of the biggest studies for high responders it has a power to minimise bias by adjusting for multiple variables. Wider implications of the findings: Proceeding with fresh transfer in high responders after GnRHa trigger with modified luteal support not only maintains the risk of OHSS (equivalent to hCG group) but also significantly impairs the LBR not compensated even after 3 subsequent frozen embryo transfers. Therefore, freeze-all approach should be preferred in this group. Trial registration number NA

scholarly journals Effect of a “Dual Trigger” Using a GnRH Agonist and hCG on the Cumulative Live-Birth Rate for Normal Responders in GnRH-Antagonist Cycles

2021 ◽  
Vol 8 ◽  
Author(s):  
Fumei Gao ◽  
Yanbin Wang ◽  
Min Fu ◽  
Qiuxiang Zhang ◽  
Yumeng Ren ◽  
...  
Keyword(s):  
Live Birth ◽  
Oocyte Maturation ◽  
Birth Rate ◽  
Gnrh Antagonist ◽  
Live Birth Rate ◽  
Cumulative Live Birth Rate ◽  
Final Oocyte Maturation ◽  
Cumulative Live Birth ◽  
High Responders

“Dual triggering” for final oocyte maturation using a combination of a gonadotropin-releasing hormone agonist (GnRHa) and human chorionic gonadotropin (hCG) can improve clinical outcomes in high responders during in vitro fertilization–intracytoplasmic sperm injection (IVF–ICSI) GnRH-antagonist cycles. However, whether this dual trigger is also beneficial to normal responders is not known. We retrospectively analyzed the data generated from 469 normal responders from 1 January to 31 December 2017. The final oocyte maturation was undertaken with a dual trigger with a GnRHa combined with hCG (n = 270) or hCG alone (n = 199). Patients were followed up for 3 years. The cumulative live-birth rate was calculated as the first live birth achieved after all cycles having an embryo transfer (cycles using fresh embryos and frozen–thawed embryos) among both groups. Women in the dual-trigger group achieved a slightly higher number of oocytes retrieved (11.24 vs. 10.24), higher number of two-pronuclear (2PN) embryos (8.37 vs. 7.67) and a higher number of embryos available (4.45 vs. 4.03). However, the cumulative live-birth rate and the all-inclusive success rate for assisted reproductive technology was similar between the two groups (54.07 vs. 59.30%). We showed that a dual trigger was not superior to a hCG-alone trigger for normal responders in GnRH-antagonist cycles in terms of the cumulative live-birth rate.

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