scholarly journals Effect of oocyte donor stimulation on recipient outcomes: data from a US national donor oocyte bank

2020 ◽  
Vol 35 (4) ◽  
pp. 847-858 ◽  
Author(s):  
H S Hipp ◽  
A J Gaskins ◽  
Z P Nagy ◽  
S M Capelouto ◽  
D B Shapiro ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Study Design ◽  
Ovarian Stimulation ◽  
Obstetric Outcomes ◽  
Lower Odds ◽  
Oocyte Donor ◽  
Donor Oocyte ◽  
Oocyte Yield ◽  
Oocyte Donors

Abstract STUDY QUESTION How does ovarian stimulation in an oocyte donor affect the IVF cycle and obstetric outcomes in recipients? SUMMARY ANSWER Higher donor oocyte yields may affect the proportion of usable embryos but do not affect live birth delivery rate or obstetric outcomes in oocyte recipients. WHAT IS KNOWN ALREADY In autologous oocyte fresh IVF cycles, the highest live birth delivery rates occur when ~15–25 oocytes are retrieved, with a decline thereafter, perhaps due to the hormone milieu, with super-physiologic estrogen levels. There are scant data in donor oocyte cycles, wherein the oocyte environment is separated from the uterine environment. STUDY DESIGN, SIZE, DURATION This was a retrospective cohort study from 2008 to 2015 of 350 oocyte donors who underwent a total of 553 ovarian stimulations and oocyte retrievals. The oocytes were vitrified and then distributed to 989 recipients who had 1745 embryo transfers. The primary outcome was live birth delivery rate, defined as the number of deliveries that resulted in at least one live birth per embryo transfer cycle. PARTICIPANTS/MATERIALS, SETTING, METHODS The study included oocyte donors and recipients at a donor oocyte bank, in collaboration with an academic reproductive endocrinology division. Donors with polycystic ovary syndrome and recipients who used gestational carriers were excluded. The donors all underwent conventional ovarian stimulation using antagonist protocols. None of the embryos underwent pre-implantation genetic testing. The average (mean) number of embryos transferred to recipients was 1.4 (range 1–3). MAIN RESULTS AND THE ROLE OF CHANCE Per ovarian stimulation cycle, the median number of oocytes retrieved was 30 (range: 9–95). Among the 1745 embryo transfer cycles, 856 of the cycles resulted in a live birth (49.1%). There were no associations between donor oocyte yield and probability of live birth, adjusting for donor age, BMI, race/ethnicity and retrieval year. The results were similar when analyzing by mature oocytes. Although donors with more oocytes retrieved had a higher number of developed embryos overall, there was a relatively lower percentage of usable embryos per oocyte warmed following fertilization and culture. In our model for the average donor in the data set, holding all variables constant, for each additional five oocytes retrieved, there was a 4% (95% CI 1%, 7%) lower odds of fertilization and 5% (95% CI 2%, 7%) lower odds of having a usable embryo per oocyte warmed. There were no associations between donor oocyte yield and risk of preterm delivery (<37 weeks gestation) and low birthweight (<2500 g) among singleton infants. LIMITATIONS, REASONS FOR CAUTION Ovarian stimulation was exclusively performed in oocyte donors. This was a retrospective study design, and we were therefore unable to ensure proportional exposure groups. These findings may not generalizable to older or less healthy women who may be vitrifying oocytes for planned fertility delay. There remain significant risks to aggressive ovarian stimulation, including ovarian hyperstimulation. In addition, long-term health outcomes of extreme ovarian stimulation are lacking. Lastly, we did not collect progesterone levels and are unable to evaluate the impact of rising progesterone on outcomes. WIDER IMPLICATIONS OF THE FINDINGS Live birth delivery rates remain high with varying amounts of oocytes retrieved in this donor oocyte model. In a vitrified oocyte bank setting, where oocytes are typically sent as a limited number cohort, recipients are not affected by oocyte yields. STUDY FUNDING/COMPETING INTEREST(S) Additional REDCap grant support at Emory was provided through UL1 TR000424. Dr. Audrey Gaskins was supported in part by a career development award from the NIEHS (R00ES026648).

P–295 Does endometriosis affect oocyte quality? An analysis of 13 627 donor oocyte recipient and autologous IVF cycles

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
M S Kamath ◽  
B Antonisamy ◽  
S K Sunkara
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Study Design ◽  
Oocyte Quality ◽  
Pregnancy Rates ◽  
Frozen Embryo Transfer ◽  
In Vitro Fertilisation ◽  
Donor Oocyte ◽  
Human Fertilization ◽  
Significant Difference

Abstract Study question Does endometriosis affect live birth following donor oocyte recipient versus autologous in vitro fertilisation (IVF) cycle. Summary answer There was no significant difference in the live birth rate (LBR) in women with endometriosis undergoing donor oocyte recipient versus autologous IVF cycle. What is known already For infertile women with endometriosis, IVF is often considered as a treatment option. Lower implantation and pregnancy rates have been observed following IVF in women with endometriosis when compared to tubal factor infertility. It has been debated that lower pregnancy rates following IVF in endometriosis is due to both oocyte quality and the endometrium. To delineate whether endometriosis affects oocyte quality or the endometrium, we planned a study using donor oocyte recipient model where the recipient were women with endometriosis. We compared the LBR after oocyte recipient cycle with autologous IVF in women with endometriosis Study design, size, duration We obtained anonymised dataset of all the IVF cycles performed in the UK since 19991 from the Human Fertilization and Embryology Authority (HFEA). Data from 1996 to 2016 comprising a total of 13 627 donor oocyte recipient and autologous IVF cycles with endometriosis and no other cause of infertility were analysed. Participants/materials, setting, methods Data on all women with endometriosis undergoing fresh or frozen IVF treatment cycles were analysed to compare the LBR between donor oocyte recipient and autologous treatment cycles. Logistic regression analysis was performed adjusting for number of previous IVF cycles, previous live birth, period of treatment, day of embryo transfer, number of embryo transferred, fresh and frozen cycle. Main results and the role of chance There was no significant difference in the LBR in women with endometriosis undergoing donor oocyte recipient fresh cycles compared to women undergoing fresh autologous IVF cycles (31.6% vs. 31.0%; odds ratio, OR 1.03, 99% CI 0.79 – 1.35). After adjusting for confounders listed above, there was no significant difference in LBR in women undergoing donor oocyte recipient fresh cycles versus fresh autologous ART cycles (aOR 1.06, 99% CI 0.79 – 1.42). There was no significant difference in the LBR in women with endometriosis undergoing frozen donor oocyte recipient cycles compared to women undergoing autologous frozen embryo transfer cycles (19.6% vs. 24.0%; OR 0.77, 99% CI 0.47 - 1.25). After adjusting for potential confounders, there was no significant difference in the LBR in women undergoing frozen donor oocyte recipient cycles compared with autologous frozen embryo transfer cycles (aOR 0.84, 99% CI 0.50 - 1.41). Limitations, reasons for caution Although the analysis was adjusted for several potential confounders, there was no information on classification of endometriosis to allow adjustment. Wider implications of the findings: The current study design does not indicate endometriosis has an impact on oocyte quality given that the outcomes in donor oocyte recipient cycles are comparable with autologous IVF cycles. These findings need to be further studied and validated. Trial registration number Not applicable

P-295 Does endometriosis affect oocyte quality? An analysis of 13 627 donor oocyte recipient and autologous IVF cycles

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
M S Kamath ◽  
B Antonisamy ◽  
S K Sunkara
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Study Design ◽  
Oocyte Quality ◽  
Pregnancy Rates ◽  
Frozen Embryo Transfer ◽  
In Vitro Fertilisation ◽  
Donor Oocyte ◽  
Human Fertilization ◽  
Significant Difference

Abstract Study question Does endometriosis affect live birth following donor oocyte recipient versus autologous in vitro fertilisation (IVF) cycle. Summary answer There was no significant difference in the live birth rate (LBR) in women with endometriosis undergoing donor oocyte recipient versus autologous IVF cycle. What is known already For infertile women with endometriosis, IVF is often considered as a treatment option. Lower implantation and pregnancy rates have been observed following IVF in women with endometriosis when compared to tubal factor infertility. It has been debated that lower pregnancy rates following IVF in endometriosis is due to both oocyte quality and the endometrium. To delineate whether endometriosis affects oocyte quality or the endometrium, we planned a study using donor oocyte recipient model where the recipient were women with endometriosis. We compared the LBR after oocyte recipient cycle with autologous IVF in women with endometriosis Study design, size, duration We obtained anonymised dataset of all the IVF cycles performed in the UK since 19991 from the Human Fertilization and Embryology Authority (HFEA). Data from 1996 to 2016 comprising a total of 13 627 donor oocyte recipient and autologous IVF cycles with endometriosis and no other cause of infertility were analysed. Participants/materials, setting, methods Data on all women with endometriosis undergoing fresh or frozen IVF treatment cycles were analysed to compare the LBR between donor oocyte recipient and autologous treatment cycles. Logistic regression analysis was performed adjusting for number of previous IVF cycles, previous live birth, period of treatment, day of embryo transfer, number of embryo transferred, fresh and frozen cycle. Main results and the role of chance There was no significant difference in the LBR in women with endometriosis undergoing donor oocyte recipient fresh cycles compared to women undergoing fresh autologous IVF cycles (31.6% vs. 31.0%; odds ratio, OR 1.03, 99% CI 0.79 – 1.35). After adjusting for confounders listed above, there was no significant difference in LBR in women undergoing donor oocyte recipient fresh cycles versus fresh autologous ART cycles (aOR 1.06, 99% CI 0.79 – 1.42). There was no significant difference in the LBR in women with endometriosis undergoing frozen donor oocyte recipient cycles compared to women undergoing autologous frozen embryo transfer cycles (19.6% vs. 24.0%; OR 0.77, 99% CI 0.47 - 1.25). After adjusting for potential confounders, there was no significant difference in the LBR in women undergoing frozen donor oocyte recipient cycles compared with autologous frozen embryo transfer cycles (aOR 0.84, 99% CI 0.50 - 1.41). Limitations, reasons for caution Although the analysis was adjusted for several potential confounders, there was no information on classification of endometriosis to allow adjustment. Wider implications of the findings The current study design does not indicate endometriosis has an impact on oocyte quality given that the outcomes in donor oocyte recipient cycles are comparable with autologous IVF cycles. These findings need to be further studied and validated. Trial registration number Not applicable

The euploid blastocysts obtained after luteal phase stimulation show the same clinical, obstetric and perinatal outcomes as follicular phase stimulation-derived ones: a multicenter study

2020 ◽  
Vol 35 (11) ◽  
pp. 2598-2608
Author(s):  
Alberto Vaiarelli ◽  
Danilo Cimadomo ◽  
Erminia Alviggi ◽  
Anna Sansone ◽  
Elisabetta Trabucco ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Multicenter Study ◽  
Gestational Age ◽  
Ovarian Stimulation ◽  
Luteal Phase ◽  
Perinatal Outcomes ◽  
Follicular Phase ◽  
Blastocyst Transfer ◽  
Large For Gestational Age

Abstract STUDY QUESTION Are the reproductive outcomes (clinical, obstetric and perinatal) different between follicular phase stimulation (FPS)- and luteal phase stimulation (LPS)-derived euploid blastocysts? SUMMARY ANSWER No difference was observed between FPS- and LPS-derived euploid blastocysts after vitrified-warmed single embryo transfer (SET). WHAT IS KNOWN ALREADY Technical improvements in IVF allow the implementation non-conventional controlled ovarian stimulation (COS) protocols for oncologic and poor prognosis patients. One of these protocols begins LPS 5 days after FPS is ended (DuoStim). Although, several studies have reported similar embryological outcomes (e.g. fertilization, blastulation, euploidy) between FPS- and LPS-derived cohort of oocytes, information on the reproductive (clinical, obstetric and perinatal) outcomes of LPS-derived blastocysts is limited to small and retrospective studies. STUDY DESIGN, SIZE, DURATION Multicenter study conducted between October 2015 and March 2019 including all vitrified-warmed euploid single blastocyst transfers after DuoStim. Only first transfers of good quality blastocysts (≥BB according to Gardner and Schoolcraft’s classification) were included. If euploid blastocysts obtained after both FPS and LPS were available the embryo to transfer was chosen blindly. The primary outcome was the live birth rate (LBR) per vitrified-warmed single euploid blastocyst transfer in the two groups. To achieve 80% power (α = 0.05) to rule-out a 15% difference in the LBR, a total of 366 first transfers were required. Every other clinical, as well as obstetric and perinatal outcomes, were recorded. PARTICIPANTS/MATERIALS, SETTING, METHODS Throughout the study period, 827 patients concluded a DuoStim cycle and among them, 339 did not identify any transferable blastocyst, 145 had an euploid blastocyst after FPS, 186 after LPS and 157 after both FPS and LPS. Fifty transfers of poor quality euploid blastocysts were excluded and 49 patients did not undergo an embryo transfer during the study period. Thus, 389 patients had a vitrified-warmed SET of a good quality euploid blastocyst (182 after FPS and 207 after LPS). For 126 cases (32%) where both FPS- and LPS-derived good quality blastocysts were available, the embryo transferred was chosen blindly with a ‘True Random Number Generator’ function where ‘0’ stood for FPS-derived euploid blastocysts and ‘1’ for LPS-derived ones (n = 70 and 56, respectively) on the website random.org. All embryos were obtained with the same ovarian stimulation protocol in FPS and LPS (GnRH antagonist protocol with fixed dose of rec-FSH plus rec-LH and GnRH-agonist trigger), culture conditions (continuous culture in a humidified atmosphere with 37°C, 6% CO2 and 5% O2) and laboratory protocols (ICSI, trophectoderm biopsy in Day 5–7 without assisted hatching in Day 3, vitrification and comprehensive chromosome testing). The women whose embryos were included had similar age (FPS: 38.5 ± 3.1 and LPS: 38.5 ± 3.2 years), prevalence of male factor, antral follicle count, basal hormonal characteristics, main cause of infertility and previous reproductive history (i.e. previous live births, miscarriages and implantation failures) whether the embryo came from FPS or LPS. All transfers were conducted after warming in an artificial cycle. The blastocysts transferred after FPS and LPS were similar in terms of day of full-development and morphological quality. MAIN RESULTS AND THE ROLE OF CHANCE The positive pregnancy test rates for FPS- and LPS-derived euploid blastocysts were 57% and 62%, biochemical pregnancy loss rates were 10% and 8%, miscarriage rates were 15% and 14% and LBRs were 44% (n = 80/182, 95% CI 37–51%) and 49% (n = 102/207, 95% CI 42–56%; P = 0.3), respectively. The overall odds ratio for live birth (LPS vs FPS (reference)) adjusted for day of blastocyst development and quality, was 1.3, 95% CI 0.8–2.0, P = 0.2. Among patients with euploid blastocysts obtained following both FPS and LPS, the LBRs were also similar (53% (n = 37/70, 95% CI 41–65%) and 48% (n = 27/56, 95% CI 35–62%) respectively; P = 0.7). Gestational issues were experienced by 7.5% of pregnant women after FPS- and 10% of women following LPS-derived euploid single blastocyst transfer. Perinatal issues were reported in 5% and 0% of the FPS- and LPS-derived newborns, respectively. The gestational weeks and birthweight were similar in the two groups. A 5% pre-term delivery rate was reported in both groups. A low birthweight was registered in 2.5% and 5% of the newborns, while 4% and 7% showed high birthweight, in FPS- and LPS-derived euploid blastocyst, respectively. Encompassing the 81 FPS-derived newborns, a total of 9% were small and 11% large for gestational age. Among the 102 LPS-derived newborns, 8% were small and 6% large for gestational age. No significant difference was reported for all these comparisons. LIMITATIONS, REASONS FOR CAUTION The LPS-derived blastocysts were all obtained after FPS in a DuoStim protocol. Therefore, studies are required with LPS-only, late-FPS and random start approaches. The study is powered to assess differences in the LBR per embryo transfer, therefore obstetric and perinatal outcomes should be considered observational. Although prospective, the study was not registered. WIDER IMPLICATIONS OF THE FINDINGS This study represents a further backing of the safety of non-conventional COS protocols. Therefore, LPS after FPS (DuoStim protocol) is confirmed a feasible and efficient approach also from clinical, obstetric and perinatal perspectives, targeted at patients who need to reach the transfer of an euploid blastocyst in the shortest timeframe possible due to reasons such as cancer, advanced maternal age and/or reduced ovarian reserve and poor ovarian response. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER N/A.

Oocyte donor anti-mullerian hormone (AMH) and antral follicle count (AFC) predict donor oocyte yield and recipient implantation

2013 ◽  
Vol 100 (3) ◽  
pp. S140
Author(s):  
K.N. Fru ◽  
M.J. Hill ◽  
E.R. Bertone-Johnson ◽  
A.H. DeCherney ◽  
E.D. Levens ◽  
...  
Keyword(s):  
Antral Follicle ◽  
Antral Follicle Count ◽  
Oocyte Donor ◽  
Donor Oocyte ◽  
Oocyte Yield

scholarly journals Comparison of Cumulative Live Birth Rates Per Aspiration IVF/ICSI Cycle Between GnRH Antagonist Protocol and Progesterone-Primed Ovarian Stimulation Protocol for Infertility With Normal Ovarian Reserve: A Randomised Controlled Trial

2021 ◽  
Author(s):  
Hongjuan Ye ◽  
Xue Xue ◽  
Liya Shi ◽  
Ying Qian ◽  
Hui Wang ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Ovarian Reserve ◽  
Ovarian Stimulation ◽  
Gnrh Antagonist ◽  
Controlled Trial ◽  
In Vitro Fertilisation ◽  
Gnrh Antagonists ◽  
Lh Surge ◽  
Cumulative Live Birth

Abstract Background: Oral progestin has been used to prevent premature ovulation during follicle stimulation protocols performed in combination with a freeze-only strategy. However, no studies have determined how oral progestin clinically compares to gonadotropin-releasing hormone (GnRH) antagonists in women with normal ovulation. This study aimed to compare the efficacy and safety of controlled ovarian stimulation between progestin-primed ovarian stimulation (PPOS) protocol and GnRH antagonist (GnRH-ant) protocol.Methods: Young women with infertility and normal ovarian reserve who underwent in vitro fertilisation (IVF) treatments were screened and randomly allocated to the PPOS or GnRH-ant group. Women in the PPOS group underwent freeze-all and delayed embryo transfer, whilst fresh embryo transfer was preferred for those in the GnRH-ant group. The primary endpoint was the cumulative live birth rate (CLBR). Secondary endpoints included the incidence of premature luteinising hormone (LH) surge and the number of viable embryos.Results: CLBRs were similar in the PPOS and GnRH-ant group (55.75% vs. 52.87%, respectively, P > 0.05). No premature LH surge was observed during ovarian stimulation in the PPOS group, although six (3.45%) cases were observed in the GnRH-ant group. On the trigger day, LH level was lower in the PPOS group than in the GnRH-ant group (2.30 ± 1.78 mIU/ml vs. 3.66 ± 3.52 mIU/ml, P < 0.01). There were no differences in the number of retrieved oocytes, mature oocytes, or viable embryos between the two groups. Other clinical outcomes including implantation rates (37.27% vs. 36.77%), clinical pregnancy rates (55.75% vs. 55.89%), and miscarriage rates (12.28% vs. 13.76%) were comparable between the PPOS group and GnRH-ant group (P > 0.05). There was also no significant differences in newborn weights for singleton or twin births between the two groups (P > 0.05).Conclusion: Live birth outcomes are similar for PPOS and GnRH antagonist protocols in women with normal ovarian reserve. PPOS is likely to play a promising role in the freeze-only strategy given its simplicity and convenience for the patient. Trial registration: This trial was registered in the China Clinical Trial Registry on September 6, 2018 (number: ChiCTR1800018246).

scholarly journals The Effect of Supraphysiological Estradiol on Pregnancy Outcomes Differs Between Women With PCOS and Ovulatory Women

2018 ◽  
Vol 103 (7) ◽  
pp. 2735-2742 ◽  
Author(s):  
Daimin Wei ◽  
Yunhai Yu ◽  
Mei Sun ◽  
Yuhua Shi ◽  
Yun Sun ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Pregnancy Outcomes ◽  
Ovarian Stimulation ◽  
Birth Rate ◽  
Polycystic Ovary ◽  
Embryo Implantation ◽  
Live Birth Rate ◽  
Estradiol Level ◽  
Fresh Embryo Transfer

Abstract Context Supraphysiological estradiol exposure after ovarian stimulation may disrupt embryo implantation after fresh embryo transfer. Women with polycystic ovary syndrome (PCOS), who usually overrespond to ovarian stimulation, have a better live birth rate after frozen embryo transfer (FET) than after fresh embryo transfer; however, ovulatory women do not. Objective To evaluate whether the discrepancy in live birth rate after fresh embryo transfer vs FET between these two populations is due to the variation in ovarian response (i.e., peak estradiol level or oocyte number). Design, Setting, Patients, Intervention(s), and Main Outcome Measure(s) This was a secondary analysis of data from two multicenter randomized trials with similar study designs. A total of 1508 women with PCOS and 2157 ovulatory women were randomly assigned to undergo fresh or FET. The primary outcome was live birth. Results Compared with fresh embryo transfer, FET resulted in a higher live birth rate (51.9% vs 40.7%; OR, 1.57; 95% CI, 1.22 to 2.03) in PCOS women with peak estradiol level &gt;3000pg/mL but not in those with estradiol level ≤3000 pg/mL. In women with PCOS who have ≥16 oocytes, FET yielded a higher live birth rate (54.8% vs 42.1%; OR, 1.67; 95% CI, 1.20 to 2.31), but this was not seen in those with &lt;16 oocytes. In ovulatory women, pregnancy outcomes were similar after fresh embryo transfer and FET in all subgroups. Conclusions Supraphysiological estradiol after ovarian stimulation may adversely affect pregnancy outcomes in women with PCOS but not in ovulatory women.

First live birth following IVF–embryo transfer and use of GnRHa alone for ovarian stimulation

2009 ◽  
Vol 19 (2) ◽  
pp. 162-164 ◽  
Author(s):  
Foad Azem ◽  
Beni Almog ◽  
Dalit Ben-Yosef ◽  
Rita Kapustiansky ◽  
Israel Wagman ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Ovarian Stimulation
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