P–608 The new standard for ovulation triggering should be GnRH agonist rather than hCG during controlled ovarian stimulation for IVF/ICSI: a systematic review and meta-analysis

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
M Bourdon ◽  
M Peigné ◽  
C Solignac ◽  
B Darné ◽  
S Languille ◽  
...  
Keyword(s):  
Ovarian Stimulation ◽  
Pregnancy Loss ◽  
Birth Rate ◽  
Meta Analysis ◽  
Live Birth Rate ◽  
Clinical Pregnancy ◽  
Controlled Ovarian Stimulation ◽  
Early Pregnancy Loss ◽  
Randomised Controlled ◽  
Antagonist Protocol

Abstract Study question Do Gonadotropin-releasing hormone agonists (GnRHa) triggering improves oocyte maturation, clinical outcomes, and safety compared to human chorionic gonadotropin (hCG) triggering during controlled ovarian stimulation with an antagonist protocol? Summary answer The final triggering using GnRHa allows a higher number of retrieved and mature oocytes to be obtained with comparable clinical outcomes and lower OHSS risk. What is known already GnRHa represent an alternative to hCG for ovulation triggering after controlled ovarian stimulation with an antagonist protocol for IVF/ICSI. GnRHa triggering is thought to be more physiological due to the endogenous surges in LH and FSH levels. However, the benefit of GnRHa over hCG triggering on oocyte maturation remains controversial. Study design, size, duration A systematic review and meta-analysis of randomised controlled clinical trials. Searches were conducted from 01 January 1990 to 15 April 2020 on MEDLINE, EMBASE, the Cochrane Library, ClinicalTrials.gov and EudraCT, using the following search terms: ‘GnRH agonist’, ‘hCG’, ‘triggering’. Two independent reviewers carried out the study selection, the bias assessment using the RoB2 tool, and the data extraction according to Cochrane methods. Participants/materials, setting, methods The primary outcomes were the total number of retrieved oocytes and the number of mature oocytes. The main secondary outcomes were the number of embryos obtained, the clinical pregnancy rate, the early pregnancy loss rate, the live birth rate, and the incidence of ovarian hyperstimulation syndrome (OHSS). Random-effects meta-analysis was performed followed by prespecified sensitivity and subgroup analyses. Main results and the role of chance A total of 29 randomised controlled trials were included. The mean number of retrieved oocytes [difference in means (95% CI) 0.99 (0.21, 1.78); p = 0.01; n = 26] and of mature oocytes [0.68 (0.04, 1.33); p = 0.04; n = 12] were statistically significantly higher after GnRHa than after hCG triggering. A similar difference was observed for the number of embryos [0.94 (0.19, 1.68); p = 0.01; n = 10]. No differences in the clinical pregnancy rate [risk ratio 1.01 (0.90, 1.14); p = 0.83; n = 23], early pregnancy loss [1.27 (0.94, 1.71); p = 0.13; n = 16], and live birth rate [1.00 (0.77, 1.29); p = 0.97; n = 6] were noted. GnRHa was associated with a lower incidence of OHSS [odds ratio 0.25 (0.08, 0.74); p = 0.012; n = 20]. Limitations, reasons for caution The validity of meta-analysis results depends mainly on the quality and the number of the published studies available. Wider implications of the findings: In light of its safety and effectiveness, GnRHa should be the new standard for triggering in antagonist cycles, with dual triggering with hCG when the risk of OHSS is low and a fresh embryo transfer approach is used. Trial registration number NA

scholarly journals Live Birth Rate of Fresh Embryo Transfer with GnRH Agonist Long Protocol is Higher Than Frozen Embryo Transfer

2020 ◽  
Author(s):  
Xiaoyan Ding ◽  
Jingwei Yang ◽  
Lan Li ◽  
Na Yang ◽  
Ling Lan ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Embryo Transfer ◽  
Live Birth ◽  
Pregnancy Loss ◽  
Birth Rate ◽  
Implantation Rate ◽  
Live Birth Rate ◽  
Clinical Pregnancy ◽  
Fresh Embryo Transfer ◽  
Long Protocol

Abstract Background: Along with progress in embryo cryopreservation, especially in vitrification has made freeze all strategy more acceptable. Some studies found comparable or higher live birth rate with frozen embryo transfer (FET) than with fresh embryo transfer（ET）in gonadotropin releasing hormone antagonist (GnRH-ant) protocol. But there were no reports about live birth rate differences between fresh ET and FET with gonadotropin releasing hormone agonist (GnRH-a) long protocol. The aim of this study is to analyze whether patients benefit from freeze all strategy in GnRH-a protocol from real-world data.Methods: This is a retrospective cohort study, in which women undergoing fresh ET or FET with GnRH-a long protocol at Chongqing Reproductive and Genetics Institute from January 2016 to December 2018 were evaluated. The primary outcome was live birth rate. The secondary outcomes were implantation rate, clinical pregnancy rate, pregnancy loss and ectopic pregnancy rate.Results: A total of 7,814 patients met inclusion criteria, implementing 5,216 fresh ET cycles and 2,598 FET cycles, respectively. The demographic characteristics of the patients were significantly different between two groups, except BMI. After controlling for a broad range of potential confounders (including age, infertility duration, BMI, AMH, no. of oocytes retrieved and no. of available embryos), multivariate logistic regression analysis demonstrated that there was no significant difference in terms of clinical pregnancy rate, ectopic pregnancy rate and pregnancy loss rate between two groups (all P>0.05). However, the implantation rate and live birth rate of fresh ET group were significantly higher than FET group (P<0.001 and P=0.012, respectively).Conclusion: Compared to FET, fresh ET following GnRH-a long protocol could lead to higher implantation rate and live birth rate in infertile patients underwent in vitro fertilization (IVF). The freeze all strategy should be individualized and made with caution especially with GnRH-a long protocol.

scholarly journals Controlled Ovarian Stimulation Should Not Be Recommended for Male Infertility Treated With IUI

2020 ◽  
Author(s):  
Yan Tang ◽  
Qian-Dong He ◽  
Ting-Ting Zhang ◽  
Jing-Jing Wang ◽  
Si-Chong Huang ◽  
...  
Keyword(s):  
Male Infertility ◽  
Pregnancy Rate ◽  
Ovarian Stimulation ◽  
Birth Rate ◽  
Multiple Pregnancy ◽  
Live Birth Rate ◽  
Abortion Rate ◽  
Clinical Pregnancy ◽  
Ovulatory Follicles ◽  
Multiple Pregnancy Rate

Abstract Background: Some studies stated that intra-uterine insemination (IUI) with controlled ovarian stimulation (COS) might increase the chance of pregnancy, while others suggested that IUI in natural cycle (NC) should be the treatment of first choice. Whether it is necessary to use COS at the same time, when IUI is applied to treat male infertility solely? There is still no consensus.Objective: To investigate the efficacy of IUI with COS in male infertility solely?Methods: 544 IUI cycles from 280 couples who sought medical care for male infertility from January 2010 to February 2019 were divided into two groups: group NC-IUI and group COS-IUI. Besides, the COS-IUI group was further divided into two subgroups according to the number of pre-ovulatory follicles on the day of HCG: cycles with monofollicular development (1 follicle group) and cycles with at least two pre-ovulatory follicles (≥ 2 follicles group). The outcome of IUI, including clinical pregnancy rate, live birth rate, spontaneous abortion rate, ectopic pregnancy rate and multiple pregnancy rate were compared.Results: The clinical pregnancy rate, live birth rate, early spontaneous abortion rate, and ectopic pregnancy rate were comparable between NC-IUI group and COS-IUI group. Similar results were observed among NC-IUI group, 1 follicle group and ≥ 2 follicles group. However, when it comes to the multiple pregnancy rate, a trend toward higher multiple pregnancy rate was observed in the COS-IUI group compared that in the NC-IUI group (10.5% (2/19) vs. 0 (0/42), P=0.093), furthermore, a significant difference was found between NC-IUI group and ≥ 2 follicles group (0 vs. 20%, P =0.034).Conclusion: For male infertility, since in cycles with COS, especially in those with at least two pre-ovulatory follicles cycles, the multiple pregnancy rate increased without substantial gain in overall pregnancy rate, COS in IUI should not be recommended. If COS is required, one stimulated follicle and one health baby should be the goal considering the safety both for mothers and fetuses.

scholarly journals Systematic meta-analysis of subsequent pregnancy outcomes in recurrent pregnancy loss couples with parental abnormal chromosomal karyotype

2021 ◽  
Author(s):  
Peng-Sheng Zheng ◽  
Shan Li ◽  
Jing Jing He
Keyword(s):  
Live Birth ◽  
Pregnancy Outcomes ◽  
Pregnancy Loss ◽  
Birth Rate ◽  
Recurrent Pregnancy Loss ◽  
Meta Analysis ◽  
Live Birth Rate ◽  
Sufficient Evidence ◽  
Current Evidence ◽  
Miscarriage Rate

Background Parental abnormal chromosomal karyotypes are considered as reasons for recurrent pregnancy loss. Objective This systematic meta-analysis evaluated the current evidence on pregnancy outcomes amongst couples with abnormal versus normal chromosomal karyotypes. Search strategy Two independent reviewers screened titles and abstracts identified in EMBASE and PubMed from inception to January 2021. Selection criteria Studies were included if they provided a description of pregnancy outcomes of parental chromosomal abnormality. Data collection and analysis Random effects meta-analysis was used to compare odds of pregnancy outcomes associated with noncarriers and carriers. Main results A significantly lower first pregnancy live birth rate (FPLBR) was found in carriers than in noncarriers with RPL (OR: 0.55; 95% CI: 0.46-0.65; p<0.00001). Regarding FPLBR between translocation or inversion carriers and noncarriers, a markedly decreased FPLBR was found in translocation (OR: 0.44; 95% CI: 0.31–0.61; p<0.00001) but not inversion carriers. The accumulated live birth rate (ALBR) (OR: 0.96; 95% CI: 0.90–1.03; p=0.26) was similar, while the miscarriage rate (MR) of accumulated pregnancies (OR: 2.21; 95% CI: 1.69–2.89; p<0.00001) was significantly higher in the carriers than in noncarriers with RPL. The ALBR was not significant (OR: 1.82; 95% CI: 0.38–8.71; p=0.45) but the MR (OR: 5.75; 95% CI: 2.57–12.86; p<0.0001) was markedly lower for carriers who choose PGD than natural conception. Conclusions Carriers with RPL had higher risk of miscarriage but obtained a satisfying pregnancy outcome through multiple attempts. No sufficient evidence was found PGD could enhance the ALBR but it was an alternative to decrease the MR.

O-093 Male translocations in recurrent pregnancy loss: Natural conception versus PGD treatment: what is the right option?: A systematic review and meta-analysis

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
D Cardenas Armas ◽  
M Duran-Retamal ◽  
R Odia ◽  
S Cawood ◽  
E Drew ◽  
...  
Keyword(s):  
Systematic Review ◽  
Live Birth ◽  
Pregnancy Loss ◽  
Birth Rate ◽  
Meta Analysis ◽  
Live Birth Rate ◽  
Miscarriage Rate ◽  
History Of ◽  
Natural Conception ◽  
The Difference

Abstract Study question Does PGD treatment in couples with a history of RPL due to male translocations improve the outcome, increasing LBR and reducing miscarriage rate and time taken to live birth? Summary answer Live birth rate is significantly increased, miscarriage rate is significantly reduced using PGD. Time taken to achieve live birth rate is shorter in PGD treatment. What is known already Reciprocal translocation are the most common structural rearrangement in infertile men. The specific chromosomes and breakpoints involved might play an important role, often expressed as abnormal semen parameters or repeated pregnancy loss (RPL). The genetic counselling of these men remains challenging. Previous studies and meta-analysis performed showed no difference in live birth rate when comparing natural conception versus PGD treatment. However, the difference in miscarriage rate and time to live birth between PGD and natural conception has not been reported before in the medical literature. Study design, size, duration A systematic review of the literature was ­conducted through MEDLINE, EMBASE, and the Cochrane database up until December 2020. A comprehensive search yield 287 articles, 25 of which were included for abstract reading, finally, six were included in the meta-analysis. Participants/materials, setting, methods The six selected articles, reported on Live birth rate (LBR), miscarriage rate and time to live birth (TTLB) for natural conception compared to PGD for the same cohort of patients. All of the included articles were of retrospective design. The primary outcome was the comparison in LBR and the second outcome was the analysis in miscarriage rate and TTLB in the PGD group versus natural conception. Main results and the role of chance A total of 1438 couples that conceived naturally, had a LBR of 22.46%, compared with 43,17% among 681 couples that underwent PGD (0.53 95% CI (0.43-0.65) p o &lt; 0,00001). The six articles included in this meta-analysis had significant homogeneity (I2 = 96%). Comparison of miscarriage rates, natural conception represented 1339 miscarriages out of 1836 pregnancies, in comparison with 44 miscarriages out of 558 pregnancies achieved through PGD. The OR showed a 10 fold increase risk of miscarriage when conceiving naturally in couples with a male translocation (10.18; 95% CI (2.88-36.04) p = 0.0003). Regarding TTLB, the difference was not statistically significant, however it did reflect that PGD patients will have a shorter TTLB (3.56 95% CI (-0.88-8.00)p = 0.12). One of the studies included, took into account the waiting list to access PGD funding, prolonging therefore the TTLB in the PGD group. Limitations, reasons for caution The main limitation of this study is the low number of studies. TTLB should be interpreted with caution given that one of the articles included the time of the waiting lists. More studies could demonstrate a shorter time period for these couples to conceive and have a successful ongoing pregnancy. Wider implications of the findings First study to demonstrate the value of PGD in decreasing miscarriage rates in couples with RPL. Specially when counselling couples with history of RPL with male translocations. PGD should be offered in these couples to improve the outcome, and to diminish the physical, emotional and sequelae of RPL and TOP. Trial registration number not applicable

scholarly journals Cumulative Live Birth Rates in Patients with Polycystic Ovary Syndrome: Comparing Progestin Primed Ovarian Stimulation Protocol and GnRH-Antagonist Protocol

2020 ◽  
Author(s):  
Jingjuan Ji ◽  
Lihua Luo ◽  
Lingli Huang
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Ovarian Stimulation ◽  
Birth Rate ◽  
Gnrh Antagonist ◽  
Polycystic Ovary ◽  
Live Birth Rate ◽  
Cumulative Live Birth ◽  
Gnrh Antagonist Protocol ◽  
Antagonist Protocol

Abstract Background: Cumulative live birth rate (CLBR) becomes a comprehensive and meaningful indictor of the success of IVF nowadays. Frozen-embryo transfer (FET) was associated with a higher rate of live birth and a lower risk of the ovarian hyperstimulation syndrome (OHSS) in polycystic ovary syndrome (PCOS) patients. Progestin-primed ovarian stimulation (PPOS) is a new ovarian stimulation protocol in which oral progestin been used to prevent premature luteinizing hormone (LH) surges during ovarian stimulation. The purpose of the current study is to investigate the CLBR of an in vitro fertilization (IVF) cycle in women with PCOS following PPOS protocol compared with gonadotropin releasing hormone (GnRH) antagonist protocol.Methods: It is a retrospective study. The first IVF cycle of 666 PCOS women were included. Ovarian stimulations were performed with PPOS or GnRH antagonist protocol. All patients included in the analysis had either delivered a baby or had used all their embryos of their first stimulated cycle. The patients were followed for 2–7 years until February 2020.Result(s): The CLBR were similar in the PPOS and GnRH antagonist group (64% vs 60.1%, P = 0.748). Logistic regression analyses showed treatment protocol (PPOS vs GnRH antagonist) did not show any significant correlation with the CLBR (adjusted OR: 0.898; 95% CI: 0.583-1.384, P=0.627). No statistically significant differences were found in the live birth rates per embryo transfer (41.3% vs. 38.4%) in the study group and controls.Conclusion(s): The results of this study showed that both the live birth rate per embryo transfer and the cumulative live birth rate were similar between PPOS and GnRH antagonist group. PPOS protocol is efficient in the controlled ovarian stimulation of patients with PCOS.

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 &lt; 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 &lt;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 &lt; 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

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