scholarly journals “When All Seems Lost”: The Ultralong Estrogen Priming (ULEP) Cycle Offers Good Pregnancy Outcomes in Poor Responder Patients

2020 ◽  
Vol 02 (01) ◽  
pp. 27-31
Author(s):  
Robert Lahoud
Keyword(s):  
Pregnancy Outcomes ◽  
Follicle Stimulating Hormone ◽  
Ovarian Response ◽  
Poor Responder ◽  
Controlled Ovarian Hyperstimulation ◽  
Ongoing Pregnancy ◽  
Poor Ovarian Response ◽  
Vitro Fertilization ◽  
History Of

Background: Treating patients with a history of poor ovarian response (POR) presents many challenges for the clinician. Poor in vitro fertilization (IVF) outcomes are a common end result. The aim of this article is to provide a detailed description of an ultralong estrogen priming (ULEP) cycle in the treatment of patients with a history of POR and to compare the outcomes to matched controls which were treated with other IVF protocols. Methods: In a retrospective study, 50 patients who meet the Bologna criteria for POR were treated with 50 ULEP cycles. The results of these cycles were compared to 50 matched controls, who were treated with other IVF protocols. Results: Patients who underwent the ULEP cycles required 3.2 more days of controlled ovarian hyperstimulation (COH) and required an extra 579 IU of follicle-stimulating hormone (FSH). The ongoing pregnancy rates per transfer were significantly greater in the ULEP group (35.1% vs. 9.1%, OR 5.4, 95% CI 1.4-21.2, p = 0.005) and per cycle started (26% vs. 6%, OR 5.5, 95% CI 1.5-20.8, p = 0.003). Conclusions: Even though the ULEP cycle is long and demanding for the patients, the outcomes suggest that this treatment regime offers a viable alternative in patients with a history of POR.

scholarly journals Stage 2 Acupuncture for Poor Ovarian Response: A Randomized Controlled Trial

2021 ◽  
Vol 10 (10) ◽  
pp. 2182
Author(s):  
Jihyun Kim ◽  
Hoyoung Lee ◽  
Tae-Young Choi ◽  
Joong Il Kim ◽  
Byoung-Kab Kang ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Ovarian Response ◽  
Controlled Ovarian Hyperstimulation ◽  
University Hospital ◽  
Ovarian Hyperstimulation ◽  
Poor Ovarian Response ◽  
Vitro Fertilization ◽  
Randomized Controlled

Acupuncture is believed to improve ovarian reserve and reproductive outcomes in women undergoing in vitro fertilization (IVF). This study was conducted to evaluate the effect of network-optimized acupuncture followed by IVF on the oocyte yield in women showing a poor ovarian response. This study was an exploratory randomized controlled trial conducted from June 2017 to January 2020 at the Pusan National University Hospital. Women diagnosed with poor ovarian response were enrolled and randomly divided into two groups: IVF alone and Ac + IVF groups (16 acupuncture sessions before IVF treatment). Eight acupoints with high degree centrality and betweenness centrality were selected using network analysis. Among the participants, compared with the IVF treatment alone, the acupuncture + IVF treatment significantly increased the number of retrieved mature oocytes in women aged more than 37 years and in those undergoing more than one controlled ovarian hyperstimulation cycle. The negative correlation between the number of retrieved mature oocytes and consecutive controlled ovarian hyperstimulation cycles was not observed in the Ac + IVF group irrespective of the maternal age. These findings suggest that physicians can consider acupuncture for the treatment of women with poor ovarian response and aged > 37 years or undergoing multiple IVF cycles.

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.

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