scholarly journals Progesterone- primed ovarian stimulation in polycystic ovarian syndrome: An RCT

2019 ◽  
Author(s):  
Maryam Eftekhar ◽  
Masrooreh Hoseini ◽  
Lida Saeed
Keyword(s):  
Pregnancy Rate ◽  
Ovarian Stimulation ◽  
Polycystic Ovarian Syndrome ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Control Group ◽  
Miscarriage Rate ◽  
Antagonist Group ◽  
Ovarian Syndrome ◽  
Antagonist Protocol

Background: In vitro fertilization is an important therapy for women with polycystic ovarian syndrome (PCOS). The use of new ways of improving clinical results is yet required. Objective: This study was aimed to investigate the efficacy of progesterone primed ovarian stimulation (PPOS) and compare with conventional antagonist protocol in PCOS. Materials and Methods: A total of 120 PCOS women who were candidates for assisted reproductive technology treatment from August to January 2019 were enrolled in this RCT and were placed into two groups, randomly (n = 60/each). The PPOS group received 20 mg/day Dydrogesterone orally since the second day of the cycle and the control group received antagonist protocol. The pregnancy outcomes including the chemical and clinical pregnancy, the miscarriage rate, and the percent of gestational sacs/transferred embryos was compared in two groups. Results: Number of MII oocyte, maturity rate, Number of 2 pronuclei (2PN) and serum estradiol levels on trigger day were statistically lower in PPOS group (p = 0.019, p = 0.035, p = 0.032, p = 0.030), respectively. Serum LH level on trigger day in PPOS group was higher than antagonist group (p = 0.005). Although there wasn’t sever ovarian hyper simulation syndrome in any participants, mild and moderate ovarian hyper simulation syndrome was less in PPOS group (p = 0.001). Also, the chemical and clinical pregnancy rate were higher in the antagonist group, althoughit was not statistically significant (p = 0.136, p = 0.093 respectively). Conclusion: Our study demonstrate that PPOS does not improve chemical and clinical pregnancy rate of the infertile women with PCOS. Key words: Progesterone, Polycystic ovarian syndrome, Controlled ovarian stimulation, Frozen-thawed embryo transfer, Pregnancy rate.

scholarly journals Can Serum Anti-Mullerian Hormone Level and LH / FSH Ratio Be Predictive of Clinical Pregnancy Through Intracytoplasmic Sperm Injection - Embryo Transfer?

2019 ◽  
pp. 1
Author(s):  
Tugba Elgun ◽  
Meric Karacan ◽  
Asiye Izem Sandal ◽  
Tulay Irez
Keyword(s):  
Pregnant Women ◽  
Pregnancy Rate ◽  
Ovulation Induction ◽  
Polycystic Ovarian Syndrome ◽  
Hormone Level ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Control Group ◽  
Clinical Parameters ◽  
Ovarian Syndrome

<p><strong>Objective:</strong> To compare clinical pregnancy rate through ICSI-ET between polycystic ovarian syndrome patients and women with normal ovaries (control group). We also investigated whether serum Anti-Müllerian hormone level or LH/FSH ratio may predict clinical pregnancy rate in both groups.</p><p><strong>Study Design:</strong> In this retrospective study, endocrine/ clinical parameters and cycle characteristics of women with polycystic ovarian syndrome (n=32) and women with normal ovaries (n=115) aged &lt;40 years were evaluated.</p><p><strong>Results:</strong> Clinical pregnancy rate in polycystic ovarian syndrome group did not differ from that in the control group (31.3% vs. 32.2%, p&gt;0.05, respectively). The LH/FSH ratio was significantly higher in women who conceived compared to women who did not in the polycystic ovarian syndrome group (0.9 vs. 0.6, respectively, p=0.4). The cut-off value of 0.6 in the LH/FSH ratio predicted clinical pregnancy with a specificity of 76% and a sensitivity of 65% in the polycystic ovarian syndrome group. Anti-Müllerian hormone was significantly higher in women who conceived compared to women who did not in the control group (4.0 ng/mL vs. 2.1 ng/mL, respectively, p=0.4).</p><p><strong>Conclusion:</strong> Polycystic ovarian syndrome patients have a similar clinical pregnancy rate with women having normal ovaries through ICSI-ET. The LH/FSH ratio assessed prior to ovulation induction was significantly higher in pregnant polycystic ovarian syndrome patients compared to polycystic ovarian syndrome patients who did not conceive. Anti-Müllerian hormone level was significantly higher in pregnant women compared to non-pregnant women with normal ovaries.</p>

scholarly journals IVF and ICSI outcomes of female patients with X chromosome mosaicism: A 5-year retrospective cohort study

2020 ◽  
Author(s):  
Shanshan Liang ◽  
Jianzhi Yang ◽  
Haixia Wu ◽  
Shiyi Xiong ◽  
Ming Guo ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Embryo Transfer ◽  
X Chromosome ◽  
Oocyte Retrieval ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Control Group ◽  
Miscarriage Rate ◽  
Fresh Embryo Transfer ◽  
Chromosome Mosaicism

Abstract BackgroundThis study focused on the assisted reproductive treatment (ART) outcomes of female patients with X chromosome mosaicism (XM), who underwent their first IVF/ICSI and day 2 or day3 fresh embryo transfer, and the possible impacts of the different mosaic types.Results78 couples with XM female and normal male were included as the X group. 78 couples with normal karyotype were included as the control group. Subgroup X1 included 41 45,X/46,XX cases, Subgroup X2 included 23 47,XXX/46,XX cases, and Subgroup X3 included 13 45,X/47,XXX/46,XX cases. With similar female age and similar body mass index (BMI), the X group had higher total gonadotropin (Gn) dosage than the control group (1800 IU VS 1612 IU). In subgroup analysis, the follical number during oocyte retrieval was less in subgroup X1 than that in X2 or X3. The fertilization rate was lower in subgroup X1 than that in subgroup X2. The utilization rate was higher in subgroup X2 than that in subgroup X3. The implantation rate, clinical pregnancy rate, and miscarriage rate before 12 weeks' gestation were similar in all groups.ConclusionsFemale with 45,X cell line may face higher Gn dosage, less follical number during oocyte retrieval and fewer embryos. But female with X chromosome mosaicism may have similar clinical pregnancy rate and miscarriage rate after fresh embryo transfer.

scholarly journals Impact of Body Mass Index on Outcomes of In Vitro Fertilization/Intracytoplasmic Sperm Injection Among Polycystic Ovarian Syndrome Patients

2016 ◽  
Vol 39 (5) ◽  
pp. 1723-1734 ◽  
Author(s):  
Na Cui ◽  
Huixia Wang ◽  
Wei Wang ◽  
Jie Zhang ◽  
Yueming Xu ◽  
...  
Keyword(s):  
Body Mass Index ◽  
In Vitro Fertilization ◽  
Pregnancy Rate ◽  
Intracytoplasmic Sperm Injection ◽  
Polycystic Ovarian Syndrome ◽  
Clinical Pregnancy ◽  
Miscarriage Rate ◽  
Vitro Fertilization ◽  
Ovarian Syndrome

Background: The aim of this study is to assess the effect of body mass index (BMI) on outcomes of in vitro fertilization (IVF) / intracytoplasmic sperm injection (ICSI) among polycystic ovarian syndrome (PCOS) and non-PCOS patients. Methods: This was a retrospective cohort study that was performed in the Second Hospital of Hebei Medical University. Patients who were under 35 years old were included in the study and were divided into four groups based on their BMI. The number of retrieved oocytes, implantation rate, clinical pregnancy rate, miscarriage rate and live births among PCOS and non-PCOS patients were compared between different BMIs. Results: IVF/ICSI pregnancies in obese PCOS women had a considerably higher risk of miscarriage and low rate of clinical pregnancy than in non-obese PCOS pregnancies. However, in non-PCOS patient, obesity significantly elevated miscarriage rate but did not affect clinical pregnancy rate. Conclusion: Obesity in PCOS patients led to poor outcomes of IVF/ICSI.

scholarly journals Using Letrozole Cotreatment With Progestin-Primed Ovarian Stimulation In Women With Polycystic Ovary Syndrome Treated For IVF

2021 ◽  
Author(s):  
Yali Liu ◽  
Jiaying Lin ◽  
Li Chen ◽  
Xiaoyan Mao ◽  
Li Wang ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Ovarian Stimulation ◽  
Polycystic Ovary ◽  
Implantation Rate ◽  
Clinical Pregnancy ◽  
Control Group ◽  
Miscarriage Rate ◽  
Ovary Syndrome ◽  
Premature Lh Surge ◽  
Pituitary Suppression

Abstract Background: Women with polycystic ovary syndrome (PCOS) often experience poor oocyte quality and a high risk of ovarian hyperstimulation syndrome (OHSS) when treated with controlled ovarian stimulation (COS) in vitro fertilization (IVF). Progestin-primed ovarian stimulation (PPOS) shows good potential to compete with conventional protocols in women with PCOS. However, it always accompanied by increased pituitary suppression and gonadotropin consumption. Letrozole (LE) has the ability to increase luteinizing hormone (LH) levels and appears to have the potential to alleviate pituitary inhibition during COS in women with PCOS. A retrospective cohort trial was performed to evaluate the efficacy of PPOS with or without letrozole in infertile women with PCOS.Methods: This retrospective cohort study included 448 women with PCOS who underwent COS with human menopausal gonadotropin (hMG) and medroxyprogesterone acetate (MPA) (n=224) or hMG and MPA cotreatment with LE (n=224) from January 2018 to March 2021. Baseline characteristics of the two groups were balanced with propensity score matching using the nearest neighbour random matching algorithm at a ratio of 1:1. The primary outcome measure was the implantation rate. The secondary outcomes were the endocrinological profiles, gonadotropin dose and duration, number of oocytes retrieved and viable embryos, clinical pregnancy rate, miscarriage rate and ectopic pregnancy rates.Result(s): The implantation rate was significantly higher in the study group than that in the control group (42.22% vs. 34.69%, P < 0.05). Compared with the control group，the study group had a higher LH concentration on the trigger day (3.85±3.6 mIU/ml vs. 2.44±1.71 mIU/ml, P < 0.01), but there was no case of premature LH surge or OHSS in both groups. The consumption of gonadotropin, the number of oocytes retrieved and viable embryos were similar between the two groups. Additionally, no difference was found in the clinical pregnancy rate, miscarriage rate or ectopic pregnancy rate.Conclusion(s): This study shows that LE administration in the PPOS protocol was feasible to improve the implantation rate and alleviate profound pituitary suppression from progestin administration without interfering with its premature LH surge blockade effect but with a non-significant reduction in gonadotropin consumption in women with PCOS undergoing IVF treatment.

scholarly journals Outcome of Laparoscopic Ovarian Drilling in Patients of Clomiphene Resistant Polycystic Ovarian Syndrome in a Tertiary Care Center

2013 ◽  
Vol 4 (2) ◽  
pp. 39-44 ◽  
Author(s):  
T Shashikala ◽  
Mandeep Kaur ◽  
Gautham Pranesh ◽  
Anjali Gahlan ◽  
K Deepika
Keyword(s):  
Pregnancy Rate ◽  
Live Birth ◽  
Birth Rate ◽  
Polycystic Ovarian Syndrome ◽  
Multiple Pregnancy ◽  
Live Birth Rate ◽  
Clinical Pregnancy ◽  
Miscarriage Rate ◽  
Laparoscopic Ovarian Drilling ◽  
Ovarian Syndrome

ABSTRACT Background Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women and its prevalence is rising. Management of the disease is usually medical and some resistant cases may require surgical treatment in the form of laparoscopic ovarian drilling (LOD). Medical management exposes the patient to increased risk of multiple pregnancy and hyperstimulation. LOD avoids the need of medical therapy or makes the ovaries more responsive to treatment. Aim The objective of this descriptive study was to study the outcome of LOD in patients of PCOS with clomiphene resistance in the form of clinical pregnancy and live birth rate. Setting Tertiary assisted conception center. Design Observational study. Materials and methods 100 patients of clomiphene resistant PCOS who underwent LOD. Outcome measure Primary outcome was clinical pregnancy rate and secondary outcome was ovarian hyperstimulation syndrome (OHSS) rate, multiple pregnancy rate, miscarriage rate, prevalence of hypothyroidism and live birth rate in PCOS patients. Results Clinical pregnancy rate—47.3%, OHSS rate—2.7%, multiple pregnancy rate—4%, miscarriage rate—6.7%, prevalence of hypothyroidism—48% and live birth rate—40.5%. Conclusion Patients with irregular cycles, high LH/FSH ratio usually have CC resistance. PCO patients have high prevalence of hypothyroidism and it should be specifically screened and treated. Low incidence of miscarriage rate, OHSS rate and multiple pregnancy rates is seen after LOD with 47.3% clinical pregnancy and 40.5% live birth rates. Patients with high values of LH/FSH ratio are the candidates who stay nonpregnant in spite of LOD and this information is very useful in prognosticating the patients. How to cite this article Kaur M, Pranesh G, Mittal M, Gahlan A, Deepika K, Shashikala T, Rao KA. Outcome of Laparoscopic Ovarian Drilling in Patients of Clomiphene Resistant Polycystic Ovarian Syndrome in a Tertiary Care Center. Int J Infertility Fetal Med 2013;4(2):39-44.

Effect of Sildenafil in Endometrial Ripening with Induction of Ovulation by Clomiphene Citrate in Polycystic Ovarian Syndrome; Double Blinded; Randomized Controlled Trial

2019 ◽  
Vol 2 (3) ◽  
pp. 01-10
Author(s):  
Dalia Mohammed Mohammed El-Khaldy ◽  
Mohamed Saeed Khallaf ◽  
Ahmed Mohamed Nour Eldin Hashad ◽  
Ibrahim Shazly Mohamed Amen Elshazly
Keyword(s):  
Randomized Controlled Trial ◽  
Polycystic Ovarian Syndrome ◽  
Controlled Trial ◽  
Clomiphene Citrate ◽  
Clinical Pregnancy ◽  
Sildenafil Citrate ◽  
Control Group ◽  
Induction Of Ovulation ◽  
Randomized Controlled ◽  
Ovarian Syndrome

Back ground: World Health Organization (WHO) defines infertility as a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Worldwide, 8 to 12 percent of couples experience fertility problems. Causes of infertility in women were as follows: menstrual disorders (disorders of cycle length and flow) 62.6%, diseases (obesity, thyroid diseases, diabetes) 58.7%, impaired ovulation (hormonal disorders, oligoovulation and anovulation) 50.3%, uterine causes 16.7%, tubal factor 15.4%, and cervical causes 7.9%. In the male factor fertility there was semen abnormalities (44.6%), genetic factors (29.8%), anti-spermatogenesis agents (11%), and vascular disorders (17.2%). Aim of the Study: The purpose of this study is to evaluate the effect of sildenafil in endometrial ripening with induction of ovulation by clomiphene citrate in polycystic ovarian syndrome. Patients and methods: It is a randomized controlled trial on 65 infertile women with polycystic ovarian syndrome; patients were randomly divided into two equal groups. In control group, 31 patients were given oral sildenafil, one tablet every 12 hrs. From 2nd day of the cycle till 12th day and clomiphene citrate, one tablet every 12 hours, for 5 days from 3rd day of the menstrual cycle. In study group, 34 patients were given oral placebo, one tablet every 12 hrs. From 2nd day of the cycle till 12th day and clomiphene citrate, one tablet every 12 hours, for 5 days from 3rd day of the menstrual cycle. A transvaginal ultrasound was performed to evaluated the endometrial thickness before and after treatment, the follicularometeric was measured on day 11 and day13. Uterine artery Doppler was then measured. Qualitative serum B-hCG level was checked 14 days after ovulation to assess clinical pregnancy rate. Design: Prospective, Double blinded randomized controlled trial. Setting: Obstetrics & Gynecology outpatient clinic, Ain Shams University Hospital. Study duration: 3 months. Results: The present study was a double-blind, randomized, controlled study that was conducted on 65 women with PCOS who underwent induction of ovulation by Clomiphene citrate in outpatient clinic of Ain Shams University hospital. Conclusion: Our systematic review and meta-analysis showed that follicular supplementation of sildenafil citrate (oral or vaginal), alone or adjuvant therapy can be used for improving the EM and clinical pregnancy rate in women undergoing assisted reproduction. However, given the methodological limitations the current evidence does not support its use in clinical practice yet. Future high-quality RCT with large sample size to evaluate the sildenafil citrate effect in women undergoing assisted reproduction are needed. Future RCTs should focus on type of processing, stage of embryo, embryo quality, dosage, time of administration, type of control group, in order to identify the groups of patients who would benefit the most from this intervention and the most appropriate dosage, time, and type of sildenafil citrate which would have the most positive effect and the less possible side effects.

scholarly journals INFLUENCE ON THE OUTCOME OF ART PROGRAMS OF FROZEN-THAWED BLASTOCYSTS EXPANDED ON FIVE OR SIX DAY

2021 ◽  
pp. 68-75
Author(s):  
A.O. Polumiskova ◽  
S.I. Tevkin ◽  
T.M. Jussubaliyeva ◽  
M.S. Shishimorova
Keyword(s):  
Pregnancy Rate ◽  
Assisted Reproductive Technologies ◽  
Reproductive Technologies ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Miscarriage Rate ◽  
Art Programs ◽  
Group A ◽  
The Difference ◽  
Group B

In order to increase the effectiveness of assisted reproductive technologies (ART) programs, it is essential to improve and develop conditions of embryo culture prior its transfer or cryopreservation of expanded blastocysts on the day 5 or 6. The aim of the study was to assess the effect of human blastocysts’ expansion timing on clinical pregnancy rate (CPR), miscarriage rate (MR) and take-home baby rate (THBR) in frozen-thawed cycles during ART programs. The study involved 2275 frozen embryo transfers (FET) of blastocysts expanded on the day 5 (group A) and 170 FET of blastocysts expanded on the day 6 (group B). The pregnancy rates in both groups were 50.8% and 46.5% respectively. There were no statistically significant differences in clinical pregnancy rate 37.4% and 37.0%, miscarriage rate 26.0% and 21.5% in both groups, respectively. THBR, as the main indicator of efficiency in the programs with transfer of post thawed expanded blastocysts on the day 5 (group A) or 6 (group B) were 36.5% and 35.2%, respectively (the difference is insignificant). In conclusion, in cryoprotocols the day of blastocyst expansion (day 5 or 6 of development) does not statistically affect PR, MR and THBR. In FET programs the quality of blastocyst (excellent and good) should be prioritized regardless of the day of cryopreservation.

scholarly journals Comparative Analysis of Effectiveness of Clomiphene Citrate and Letrozole Combined with Low Dose Human Menopausal Gonadotropin for Controlled Ovarian Stimulation in Intrauterine Insemination Cycles

2021 ◽  
Vol 73 (3) ◽  
pp. 198-203
Author(s):  
Padmalaya Thakur ◽  
Sujata Pradhan
Keyword(s):  
Pregnancy Rate ◽  
Ovarian Stimulation ◽  
Low Dose ◽  
Intrauterine Insemination ◽  
Clomiphene Citrate ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Controlled Ovarian Stimulation ◽  
Human Menopausal Gonadotropin ◽  
Group B

Objective: To compare the efficacy of clomiphene citrate and letrozole in combination with low dose human menopausal gonadotropin for controlled ovarian stimulation in intrauterine insemination (IUI) cycles.Methods: During January-2018 to December-2019 for intending 496 IUI cycles, controlled ovarian stimulation was performed with either clomiphene or letrozole combined with human menopausal gonadotropin (hMG), in two arms:  subjects in one arm (Group A) were with clomiphene and hMG in 222 cycles; those in the second arm (Group B) were with letrozole and hMG in 274 cycles. Pregnancy rate and clinical pregnancy rate of both groups were considered as the primary outcomes.Results: Patient characteristics like female age, indications for IUI, type of IUI, endometrial thickness and total motile fraction (TMF) of spermatozoa of male partners were seen similar in both groups. The letrozole-hMG group (Group B) had significantly higher numbers of cycles with single dominant follicle (P=0.01) and human chorionic gonadotropin (hCG) was more frequently used as the ovulation trigger (P=0.03). Pregnancy rate (18.5% vs. 15.3%, P=0.35) and clinical pregnancy rate (18.5% vs. 15.3%, P=0.35) were similar in groups A and B, respectively.Conclusion: Clomiphene citrate and letrozole combined with low dose human menopausal gonadotropin were equally effective for controlled ovarian stimulation in IUI cycles.

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