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

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.

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The Place of In Vitro Maturation in Assisted Reproductive Technology

Fertility & Reproduction ◽

10.1142/s2661318219300022 ◽

2019 ◽

Vol 01 (01) ◽

pp. 11-15 ◽

Cited By ~ 3

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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Follicular fluid and assisted reproductive technology programs outcomes (literature review)

GYNECOLOGY ◽

10.26442/20795696.2019.6.190663 ◽

2020 ◽

Vol 21 (6) ◽

pp. 36-40

Author(s):

Anna G. Burduli ◽

Natalia A. Kitsilovskaya ◽

Yuliya V. Sukhova ◽

Irina A. Vedikhina ◽

Tatiana Y. Ivanets ◽

...

Keyword(s):

Clinical Practice ◽

Assisted Reproductive Technology ◽

Follicular Fluid ◽

Economic Cost ◽

Reproductive Technology ◽

Art Programs ◽

Vitro Fertilization ◽

Non Invasive ◽

Established Fact

The review presents data on metabolites in the follicular fluid (FF) from the perspective of reproductive medicine and their use in order to predict outcomes of assisted reproductive technology (ART) programs. It considers various components of this biological medium (hormones, lipids, melatonin, etc.) with an assessment of their predictive value in prognosis of the effectiveness of in vitro fertilization (IVF) programs. The data on experimental directions in this field and the prospects for their use in clinical practice are presented. The article emphasizes that the growing clinical need and the unsolved problem of increasing the effectiveness of ART programs determine the need for further studies of the FF composition. Materials and methods. The review includes data related to this topic from foreign and Russian articles found in PubMed which were published in recent years. Results. Given the established fact of a direct effect of FF composition on growth and maturation of oocytes, and further, on the fertilization process, various FF metabolites are actively investigated as non-invasive markers of quality of oocytes/embryos. The article provides data on the experimental directions in this field and the prospects for their use in clinical practice. However, clinical studies of a relation between various FF metabolites levels and outcomes of IVF programs are contradictory. Conclusion. Owing large economic cost for treatment of infertility with IVF, there is need for expansion and intensification of studies to identify and use reliable predictors in prognosis of ART programs outcomes.

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Faculty Opinions recommendation of Clomiphene citrate in combination with gonadotropins for controlled ovarian stimulation in women undergoing in vitro fertilization.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717964658.793468288 ◽

2013 ◽

Author(s):

Fatma F Verit

Keyword(s):

In Vitro Fertilization ◽

Ovarian Stimulation ◽

Clomiphene Citrate ◽

Controlled Ovarian Stimulation ◽

Vitro Fertilization

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The expression of human testis‐specific actin capping protein predicts in vitro fertilization outcomes: A novel biomarker of sperm function for assisted reproductive technology

Reproductive Medicine and Biology ◽

10.1002/rmb2.12407 ◽

2021 ◽

Author(s):

Yusuke Inagaki ◽

Shinichiro Fukuhara ◽

Sohei Kuribayashi ◽

Koichi Okada ◽

Yosuke Sekii ◽

...

Keyword(s):

In Vitro Fertilization ◽

Assisted Reproductive Technology ◽

Reproductive Technology ◽

Human Testis ◽

Sperm Function ◽

Vitro Fertilization ◽

Capping Protein ◽

Actin Capping Protein ◽

Actin Capping

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A randomized controlled dose–response pilot study of addition of hCG to recombinant FSH during controlled ovarian stimulation for in vitro fertilization

Human Reproduction ◽

10.1093/humrep/des256 ◽

2012 ◽

Vol 27 (10) ◽

pp. 3074-3084 ◽

Cited By ~ 28

Author(s):

L.L. Thuesen ◽

A. Loft ◽

A.N. Egeberg ◽

J. Smitz ◽

J.H. Petersen ◽

...

Keyword(s):

Pilot Study ◽

In Vitro Fertilization ◽

Dose Response ◽

Ovarian Stimulation ◽

Controlled Ovarian Stimulation ◽

Recombinant Fsh ◽

Vitro Fertilization ◽

Randomized Controlled

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Pregnancy Outcomes Using Assisted Reproductive Technology After Fertility-Preserving Therapy in Patients With Endometrial Adenocarcinoma or Atypical Complex Hyperplasia

International Journal of Gynecological Cancer ◽

10.1111/igc.0b013e31819960ba ◽

2009 ◽

Vol 19 (1) ◽

pp. 147-151 ◽

Cited By ~ 23

Author(s):

Aera R. Han ◽

Yong-Soon Kwon ◽

D. Y. Kim ◽

J. H. Kim ◽

Y. M. Kim ◽

...

Keyword(s):

Endometrial Cancer ◽

Assisted Reproductive Technology ◽

Intrauterine Insemination ◽

Medical Center ◽

Endometrial Adenocarcinoma ◽

Controlled Ovarian Hyperstimulation ◽

Reproductive Technology ◽

Vitro Fertilization ◽

Asan Medical

Objectives:To evaluate the outcomes of pregnancy in young women (<40 years old) with early endometrial cancer or atypical complex hyperplasia who were treated by conservative management followed by assisted reproductive technology (ART).Materials and Methods:Medical charts of 11 patients treated from January 1997 to October 2007 at Asan Medical Center were retrospectively reviewed. These patients had all been treated with progestin and serial dilatation and curettage as primary fertility-preserving therapies.Results:After pathological remission of disease, 10 patients tried to become pregnant by ART, 4 by in vitro fertilization and embryo transfer, and 6 by controlled ovarian hyperstimulation, with or without intrauterine insemination. Eight women had intrauterine pregnancies, and 6 patients had live births. Patients have been followed up for 9 to 51 months (mean, 21 months) after delivery, with no evidence of tumor recurrence.Conclusions:Fertility-preserving therapy followed by ART can be a good option in well-selected patients with early endometrial cancer who want to become pregnant.

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