Optimal individualization of patient‐oriented ovarian stimulation in Japanese assisted reproductive technology clinics, a review for unique setting with advanced‐age patients

2022 ◽  
Author(s):  
Keiji Kuroda ◽  
Yukiko Katagiri ◽  
Osamu Ishihara
Keyword(s):  
Assisted Reproductive Technology ◽  
Ovarian Stimulation ◽  
Reproductive Technology ◽  
Advanced Age

scholarly journals Endometrial morphology and modulation of hormone receptors during ovarian stimulation for assisted reproductive technology cycles

2011 ◽  
Vol 95 (3) ◽  
pp. 1037-1041 ◽  
Author(s):  
Laura Detti ◽  
Ghassan M. Saed ◽  
Nicole M. Fletcher ◽  
Michael L. Kruger ◽  
Michelle Brossoit ◽  
...  
Keyword(s):  
Assisted Reproductive Technology ◽  
Ovarian Stimulation ◽  
Hormone Receptors ◽  
Reproductive Technology ◽  
Technology Cycles

scholarly journals Outcomes and Recommendations of an Indian Expert Panel for Improved Practice in Controlled Ovarian Stimulation for Assisted Reproductive Technology

2017 ◽  
Vol 2017 ◽  
pp. 1-14 ◽  
Author(s):  
Baiju Ahemmed ◽  
Vani Sundarapandian ◽  
Rohit Gutgutia ◽  
Sathya Balasubramanyam ◽  
Richa Jagtap ◽  
...  
Keyword(s):  
Assisted Reproductive Technology ◽  
Ovarian Stimulation ◽  
Strong Association ◽  
Reproductive Technology ◽  
Data Availability ◽  
Controlled Ovarian Stimulation ◽  
Cohort Size ◽  
Serum Progesterone ◽  
Vitro Fertilization

Purpose.To improve success of in vitro fertilization (IVF), assisted reproductive technology (ART) experts addressed four questions. What is optimum oocytes number leading to highest live birth rate (LBR)? Are cohort size and embryo quality correlated? Does gonadotropin type affect oocyte yield? Should “freeze-all” policy be adopted in cycles with progesterone >1.5 ng/mL on day of human chorionic gonadotropin (hCG) administration?Methods.Electronic database search included ten studies on which panel gave opinions for improving current practice in controlled ovarian stimulation for ART.Results.Strong association existed between retrieved oocytes number (RON) and LBRs. RON impacted likelihood of ovarian hyperstimulation syndrome (OHSS). Embryo euploidy decreased with age, not with cohort size. Progesterone > 1.5 ng/dL did not impair cycle outcomes in patients with high cohorts and showed disparate results on day of hCG administration.Conclusions.Ovarian stimulation should be designed to retrieve 10–15 oocytes/treatment. Accurate dosage, gonadotropin type, should be selected as per prediction markers of ovarian response. Gonadotropin-releasing hormone (GnRH) antagonist based protocols are advised to avoid OHSS. Cumulative pregnancy rate was most relevant pregnancy endpoint in ART. Cycles with serum progesterone ≥1.5 ng/dL on day of hCG administration should not adopt “freeze-all” policy. Further research is needed due to lack of data availability on progesterone threshold or index.

scholarly journals Analysis of the clinical efficiency of human menopausal gonadotropins in the assisted reproductive technology program

2021 ◽  
pp. 34-41
Author(s):  
Yu. A. Drapkina ◽  
N. P. Makarova ◽  
V. Yu. Smolnikova
Keyword(s):  
Assisted Reproductive Technology ◽  
Ovarian Stimulation ◽  
Ovarian Function ◽  
Laboratory Data ◽  
Reproductive Technology ◽  
Gonadotropin Releasing Hormone ◽  
Human Menopausal Gonadotropin ◽  
Technology Program ◽  
Releasing Hormone ◽  
Technology Programs

Introduction. Comparative analysis of urinary and recombinant gonadotropins is ongoing to improve the efficiency of assisted reproductive technology programs. Particular interest focused on the identification of individual groups of patients with maximal efficacy of using certain ovarian stimulation drugs in an assisted reproductive technology program.Objective. To review the application of Menopur Multidose 1200 IU for ovarian stimulation in assisted reproductive technology protocols with gonadotropin-releasing hormone agonists (GnRH) or gonadotropin-releasing hormone antagonists (GnRH antagonists) in the current clinical practice.Materials and methods. The study retrospectively enrolled 4,080 women aged 20-43 years. Ovarian stimulation in the Assisted Reproductive Technology program was performed using the GnRH antagonist protocol in 65.8% of patients and the GnRH agonist protocol with Menopur Multidose 1200 IU with or without the additional Menopur 75 IU in 34.2% of women.Results. Clinical and laboratory data of the patients, stimulated cycle parameters, characteristics of the embryological stage, and results of the assisted reproductive technology program were analyzed. The frequency of obtaining degenerated oocytes did not exceed 5%. The relative number of blastocysts of good quality was 59.9%, while for patients in the older age group, the figure was 54.6. The average pregnancy rate in patients in the “Menopur Multidose 1200 IU p/k” group was 39.3%, which corresponds to high-performance indicators of the assisted reproductive technology program.Conclusions. Administration of highly purified human menopausal gonadotropin (hMG) (Menopur Multidose 1200 IU) to stimulate ovarian function in patients of different ages is accompanied by an adequate number of mature oocytes, good quality blastocysts, and satisfactory clinical pregnancy rates. Thus, highly purified human menopausal gonadotropin is not inferior to recombinant follicle-stimulating hormone(r-FSH) concerning the efficacy of assisted reproductive technology programs.

scholarly journals Low Prognosis by the POSEIDON Criteria in Women Undergoing Assisted Reproductive Technology: A Multicenter and Multinational Prevalence Study of Over 13,000 Patients

2021 ◽  
Vol 12 ◽  
Author(s):  
Sandro C. Esteves ◽  
Hakan Yarali ◽  
Lan N. Vuong ◽  
José F. Carvalho ◽  
İrem Y. Özbek ◽  
...  
Keyword(s):  
Assisted Reproductive Technology ◽  
Ovarian Reserve ◽  
Ovarian Stimulation ◽  
Primary Treatment ◽  
Population Based ◽  
Reproductive Technology ◽  
Female Infertility ◽  
Prevalence Rates ◽  
Real World Data ◽  
Female Age

ObjectiveTo estimate the prevalence of low-prognosis patients according to the POSEIDON criteria using real-world data.DesignMulticenter population-based cohort study.SettingsFertility clinics in Brazil, Turkey, and Vietnam.PatientsInfertile women undergoing assisted reproductive technology using standard ovarian stimulation with exogenous gonadotropins.InterventionsNone.Main outcome measuresPer-period prevalence rates of POSEIDON patients (overall, stratified by POSEIDON groups and by study center) and the effect of covariates on the probability that a patient be classified as “POSEIDON”.ResultsA total of 13,146 patients were included. POSEIDON patients represented 43.0% (95% confidence interval [CI] 42.0–43.7) of the studied population, and the prevalence rates varied across study centers (range: 38.6–55.7%). The overall prevalence rates by POSEIDON groups were 44.2% (group 1; 95% CI 42.6–45.9), 36.1% (group 2; 95% CI 34.6–37.7), 5.2% (group 3; 95% CI 4.5–6.0), and 14.4% (group 4; 95% CI: 13.3–15.6). In general, POSEIDON patients were older, had a higher body mass index (BMI), lower ovarian reserve markers, and a higher frequency of female factor as the primary treatment indication than non-POSEIDON patients. The former required larger doses of gonadotropin for ovarian stimulation, despite achieving a 2.5 times lower number of retrieved oocytes than non-POSEIDON patients. Logistic regression analyses revealed that female age, BMI, ovarian reserve, and a female infertility factor were relevant predictors of the POSEIDON condition.ConclusionsThe estimated prevalence of POSEIDON patients in the general population undergoing ART is significant. These patients differ in clinical characteristics compared with non-POSEIDON patients. The POSEIDON condition is associated with female age, ovarian reserve, BMI, and female infertility. Efforts in terms of diagnosis, counseling, and treatment are needed to reduce the prevalence of low-prognosis patients.

scholarly journals The Place of In Vitro Maturation in Assisted Reproductive Technology

2019 ◽  
Vol 01 (01) ◽  
pp. 11-15 ◽  
Author(s):  
Lan N. Vuong ◽  
Tuong M. Ho ◽  
Robert B. Gilchrist ◽  
Johan Smitz
Keyword(s):  
Assisted Reproductive Technology ◽  
Ovarian Stimulation ◽  
In Vitro Maturation ◽  
Polycystic Ovary ◽  
Reproductive Technology ◽  
Vitro Fertilization ◽  
Medication Costs ◽  
Main Barrier ◽  
Patient Burden

In vitro maturation (IVM) is an assisted reproductive technology (ART) whereby immature cumulus-oocyte complexes are collected and matured in vitro, without need for controlled ovarian stimulation and ovulation triggering. Advantages of IVM over in vitro fertilization (IVF) include mild or no stimulation, lower medication costs and less patient burden. However, early clinical outcomes with IVM were suboptimal. More recently, clinical studies reported live birth rates after IVM of about 40%. New IVM culture systems are being used to improve the efficacy of IVM. These have been in widespread use for animals for many years and are now showing promise in the clinical setting. Patients more likely to benefit from IVM over IVF include those at risk of OHSS (e.g. women with polycystic ovary syndrome), when the time for ovarian stimulation is limited, or where sustained elevations of estradiol are contraindicated (e.g. oncofertility indications). The main barrier to use of IVM to date was its relative efficacy compared with IVF, and there have also been concerns over the health of infants born following IVM. However, no differences in congenital abnormalities between IVM and other ARTs have been identified. In addition, there is a lack of both experience and standardized protocols. Strategies to overcome barriers to the use of IVM include better training for clinicians, more and better funded research in the field, and improved recognition of IVM by fertility specialists. Overall, IVM offers a valuable alternative for ART in select patient populations. New approaches to IVM appear to have the potential to achieve pregnancy outcomes equivalent to those after IVF. Increasing the use of IVM in the future can be achieved with improved training and education for fertility specialists, and increased funding for IVM research, with the ultimate goal of improving fertility outcomes.

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