scholarly journals The effects of low-dose human chorionic gonadotropin for luteal phase support on pregnancy outcomes in poor ovarian responders: a randomized clinical trial

2021 ◽  
Author(s):  
Tahereh Madani ◽  
Arezoo Arabipoor ◽  
Fariba Ramezanali ◽  
Shabnam Khodabakhshi ◽  
Zahra Zolfaghari
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Live Birth ◽  
Pregnancy Outcomes ◽  
Luteal Phase ◽  
Clinical Pregnancy ◽  
Birth Rates ◽  
Luteal Phase Support ◽  
Live Birth Rates ◽  
Significant Difference

Abstract Purpose: The question that remains is, does changing the type of luteal phase support (LPS) improve the pregnancy outcomes in patients with poor ovarian response (POR) diagnosis?. Therefore, this study was designed to investigate and compare the efficiency of different methods of luteal phase support (progesterone alone or hCG alone and the combination of progesterone with hCG) in these patients.Methods: This randomized clinical trial evaluated three hundred seventy five patients who were diagnosed as POR on the basis of Bologna criteria undergoing intracytoplasmic sperm injection- embryo transfer (ICSI-ET) cycles at Royan institute from November 2015 to June 2019. The patients were allocated randomly into three different LPS groups on the day of oocyte pickup. In first group, 1500 IU of hCG IM on the ET day, as well as 4 days after that were administrated. In the second group, the patients received 1500 IU of hCG IM on the ET day, as well as 3 and 6 days after the ET along with vaginal suppositories 400 mg twice daily. For the third group, only vaginal suppositories twice daily was administrated from the day of oocyte pick up until the pregnancy test day.The clinical pregnancy, miscarriage and live birth rates were the main outcomes. Results: The data analysis showed that the three groups were comparable. In the following, there is no significant difference in terms of implantation, clinical pregnancy, and miscarriage and live birth rates among groups. The twin pregnancy rate in the hCG-only group was higher than those of in the other two groups, although this difference was not statistically significant (P=0.06).Conclusion: The type of LPS does not improve the pregnancy and live birth rates in POR patients. A multi-center clinical trial is warranted to confirm or refute these findings.Trial registration: The study was registered in the clinicaltrial.gov site on 14 June 2015. (NCT02798653 at www. clinicaltrials.gov, registered prospectively).

P–671 Dual Trigger(low adjuvant HCG4h after GnRHagonist trigger)have positive impact of overall embryo’s quality, implantation ,clinical pregnancy and live birth rates in high-risk patients for OHSS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
E Petanovsk. Kostova
Keyword(s):  
High Risk ◽  
Live Birth ◽  
Clinical Pregnancy ◽  
Birth Rates ◽  
High Risk Patients ◽  
Live Birth Rates ◽  
Significant Difference ◽  
Risk Patients ◽  
Group A ◽  
Group B

Abstract Study question Study aim is to compare implantation,clinical pregnancy and livebirth rates between giving1500IU of hCG4hours after GnRHagonist,on trigger day or GnRHagonist as alone trigger with luteal support withHCG1500IU.35h later on OPUday. Summary answer Adjuvant doze of1500IUhCG4h after bolus of GnRHagonist on trigger day significantly improve quality of blastocyst,implantation,clinical pregnancy and live birth rates without increasing the risk ofOHSS. What is known already The use of GnRHagonist for final oocyte maturation in antagonist cycle significantly decrease the incidence of OHSS,but there have been studies showing lower pregnancy rates in patients triggered with GnRHagonist compared with hCG in autologous cycles,attributed to a defective luteal phase, especially in high–risk patients despite intensive luteal phase support.To improve the results of IVF,an alternative approach is adding a small bolus dose of hCG(1500IU)35h later,on the OPU day after GnRHagonist trigger which provides more sustained support for the corpus luteum.The question is does low doses of hCGgiven on the same day with GnRHagonist trigger is making better quality oocytes. Study design, size, duration Single center prospective longitudinal cohort study fromJanuary2017 to Decembar2019.The initial inclusion criteria were:women age≥18and≤39years,AMH≥3,3ng/ml and ≥12 antral follicles on basal ultrasound.Patients with history of OHSS and PCO are also included in the study.Patients with applied “freeze-all” technique with peak estradiol≥4000pg/ml on trigger day>18oocytes on the OPU day,and recognized significant risk for developing OHSS were also included.The cumulative implantation,clinical pregnancy and live birth rates were analyzed,only in embryos from the same COS protocol in every patient. Participants/materials, setting, methods A total of 231 patients were entered for final analysis,who underwent a flexible antagonist protocol,ICSI and fresh or thawed ET on 3th(38.53%) or 5th( 61.47%)day in women’s autologous cycles.Patients were randomized in one of two groups: GroupA-Dual trigger group 1500IUof hCG 4h after GnRH agonist application on trigger day and GroupB –1500IU of HCG 35h later,on the OPU day.We used nonparametric and parametric statistical tests.Significant differences were considered all values ​​of p < 0.05 Main results and the role of chance Both groups are homogenous regarding several variables:age,BMI,type of sterility,smoking status,AMH,PCO, spermogram.There is no significant difference between the two(AvsB)groups according to average number of retrieved oocytes(13.6 vs 14.6 p > 0,05),M II oocytes(11.03 vs 11.99 p > 0.05).The dual trigger group(A)had a higher fertility rate(69.99% vs 64.11% p < 0,05)compared with GnRHagonist trigger group(B).There are no significant difference between groups(AvsB)according to cumulative average number of:transferred embryos(2.4vs2.5 p > 0.05)TQE transfered on 3th day(1.5.vs 1.3.p>0.05);transferred blastocyst(2.6 vs2.7 >0.05);cryo embryos(2.5vs1.9 p > 0.05),but there are significant difference according to cumulative implantation rate of transferred blastocyst in favor of group A(48.18% vs 33.89%p<0.05).Analyzes of morphological characteristics of transferred blastocyst depicted in the order of degree of blastocyst expansion,inner cellular mass(ICM)and trofoectoderm(TE) and ranking overall blastocysts quality from“excellent”,“good”,“average” and “pore” ,shows that there are significantly more percentage of patient with embryo transfer of “excellent” or even one “excellent” blastocyst in group A (30.56%,31.94% vs 21.54%,23.08% p < 0.05) in opposite of percentage of patients with embryo transfer with “poore “” blastocyst in group B (37.5% vs 46.15.%p<0.05). Clinical pregnanacy rate (71.68% vs 50.84% p < 0.05) , and live birth rate (60,18% vs 42,58% ), were significantly higher in group A. There were no cases of moderate or severe OHSS in both groups. Limitations, reasons for caution Dual trigger in GnRH antagonist protocols should be advocated as a safe approach but undetected high risk patients are reasons for caution for developing clinically significant OHSS. Wider implications of the findings: Adjuvant low dose of hCG on GnRHagonist trigger day improve clinical pregnancy and live birth rates without increasing the risk of clinically significant OHSS.Protocol of dual trigger and freezing all oocytes or embryos in patients with high risk of developing OHSS is promising technique in everyday practice. Trial registration number 8698

Pregnancy outcomes among patients with recurrent pregnancy loss and chromosomal aberration (CA) without PGD

2018 ◽  
Vol 46 (7) ◽  
pp. 764-770 ◽  
Author(s):  
Maor Kabessa ◽  
Avi Harlev ◽  
Michael Friger ◽  
Ruslan Sergienko ◽  
Baila Litwak ◽  
...  
Keyword(s):  
Live Birth ◽  
Pregnancy Outcomes ◽  
Pregnancy Loss ◽  
Recurrent Pregnancy Loss ◽  
Control Group ◽  
Study Group ◽  
Birth Rates ◽  
Live Birth Rates ◽  
Index Pregnancy ◽  
Significant Difference

Abstract Background: Recurrent pregnancy loss (RPL) is defined by two or more failed clinical pregnancies. Three to four percent of the couples with RPL have chromosomal aberrations (CA) in at least one partner. The parent’s structural chromosomal abnormalities may cause an unbalanced karyotype in the conceptus which could lead to implantation failure, early or late pregnancy loss, or delivery of a child with severe physical and/or mental disabilities. Objective: To compare live birth rates of couples with CA to couples with normal karyotypes and to investigate medical and obstetric characteristics and pregnancy outcomes of couples with CA and RPL who attend an RPL clinic at a tertiary hospital. Methods: A retrospective cohort study, including 349 patients with two or more consecutive pregnancy losses. The study group consisted of 52 patients with CA, and the control group consisted of 297 couples with normal karyotype. All patients were evaluated and treated in the RPL clinic at Soroka University Medical Center and had at least one subsequent spontaneous pregnancy. Results: The demographic and clinical characteristics were not found to be statistically different between the two groups. The group of carriers of CA had 28/52 (53.8%) live births in their index pregnancy vs. the normal 202/297 (68%) (P=0.067, CI 95%) in the control group. No statistically significant etiology was found between the study group and the control group. A statistically significant difference in live birth rates was found when comparing the total amount of pregnancies [index pregnancy (IP)+post index pregnancy (PIP)] between the study group and the control group (54.16% vs. 67.82%, respectively, P=0.0328). Conclusion: Patients with RPL and CA who have spontaneous pregnancies, have a good prognosis (63.4%) of a successful pregnancy with at least one of the pregnancies (index or post index) resulting in a live birth.

scholarly journals Possibility of live birth in patients with low serum β-hCG 14 days after blastocyst transfer

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Yixuan Wu ◽  
Haiying Liu
Keyword(s):  
Live Birth ◽  
Roc Curve ◽  
Pregnancy Outcomes ◽  
Luteal Phase ◽  
Clinical Pregnancy ◽  
Blastocyst Transfer ◽  
Luteal Phase Support ◽  
Live Births ◽  
Β Hcg ◽  
Low Serum

Abstract Background Although prior work has attempted to predict pregnancy outcomes by assaying serum β-hCG levels after blastocyst transfer, no study has focused on pregnancy outcomes in those with initially low serum β-hCG levels. This study sought to investigate pregnancy outcomes of patients with low serum β-hCG levels 14 days after blastocyst transfer. Methods A retrospective study was conducted at the Third Affiliated Hospital of Guangzhou Medical University to study patients whose serum β-hCG levels were at 5–299 mIU/ml 14 days after frozen blastocyst transfer. Rates of live birth, early miscarriage, biochemical pregnancy loss and ectopic pregnancy were analyzed according to the female patients’ age by Chi-squared analysis. Receiver operating characteristic (ROC) curves were plotted to explore the threshold of predicting clinical pregnancy and live births. Results 312 patients had serum β-hCG levels < 300 mIU/ml at 14 days after frozen blastocyst transfer, among which, 18.6% were live births, 47.4% were early miscarriages, 22.8% were biochemical pregnancies and 9.6% were ectopic pregnancies. ROC curve analysis showed that a predicted value of β-hCG for clinical pregnancy was 58.8 mIU/ml with an area under the ROC curve (AUC) of 0.752, a sensitivity of 95.0% and specificity of 53.5%. The threshold for live births was 108.6 mIU/ml with an AUC of 0.649, a sensitivity of 93.1% and a specificity of 37.0%. For the β-hCG fold increase over 48 h, the cut-off for clinical pregnancy was 1.4 with an AUC of 0.899, a sensitivity of 90.3% and a specificity of 77.8%. The threshold for live birth was 1.9 with an AUC of 0.808, a sensitivity of 88.5% and specificity of 64.5%. Conclusions Initially low serum β-hCG levels 14 days after frozen blastocyst transfer indicated minimal chances of live birth. For patients having an initial β-hCG > 58.8 mIU/ml, luteal phase support should continue. Another serum β-hCG test and ultrasound should be performed one week later. When an initial serum β-hCG is < 58.8 mIU/ml, luteal phase support should be discontinued and serum β-hCG measured with ultrasound one week later.

scholarly journals Fresh Versus Frozen Testicular Sperm Samples in Microdissection Testicular Sperm Extraction Intracytoplasmic Sperm Injection Treatment

2017 ◽  
pp. 1
Author(s):  
Şafak Hatırnaz ◽  
Serdar Başaranoğlu ◽  
Ebru Hatırnaz ◽  
Mine Kanat Pektaş
Keyword(s):  
Clinical Outcomes ◽  
Live Birth ◽  
Intracytoplasmic Sperm Injection ◽  
Clinical Pregnancy ◽  
Testicular Sperm Extraction ◽  
Obstructive Azoospermia ◽  
Testicular Sperm ◽  
Birth Rates ◽  
Live Birth Rates ◽  
Significant Difference

<p><strong>Objective:</strong> The present study aims to compare the clinical outcomes of fresh versus frozen testicular samples in patients with non-obstructive azoospermia who would undergo intracytoplasmic sperm injection procedure.<br /><strong>Study Design:</strong> This is a retrospective review of 541 patients with non-obstructive azoospermia who consecutively underwent microdissection testicular sperm injection and intracytoplasmic sperm injection between January 2010 and October 2014.<br /><strong>Results:</strong> A total of 4896 mature oocytes were collected from the partners of azoospermic men and 1894 sperms were retrieved by microdissection testicular sperm procedures. About 1036 fresh sperms were used to perform intracytoplasmic sperm injection in 296 men with non-obstructive azoospermia whereas 858 in 245 azoospermic men. Approximately 1228 embryos were obtained after intracytoplasmic sperm injection and 1080 embryos were transferred. After embryo transfer, 146 clinical pregnancies occurred and 125 pregnancies ended up with live birth. The fertilization, implantation, clinical pregnancy and live birth rates were respectively 44.6%, 33.4%, 28.0% and 24.7% for 296 fresh microdissection testicular sperm cycles. On the other hand, the fertilization, implantation, clinical pregnancy and live birth rates were respectively 46.5%, 32.7%, 25.7% and 21.2% for 245 frozen microdissection testicular sperm cycles. There was no statistically significant difference between the fresh and frozen microdissection testicular sperm injection cycles in aspect of fertilization, implantation, clinical pregnancy and liver birth rates (p=0.125, p=0.194, p=0.196 and p=0.182).<br /><strong>Conclusion:</strong> The utilization of fresh and frozen sperms in microdissection testicular sperm - intracytoplasmic sperm injection cycles has similar clinical outcomes. The use of frozen sperms obtained by testicular sperm can be considered as an efficient and safe approach for avoiding unnecessary ovarian hyperstimulation and repetitious interventions on testicular tissues.</p>

scholarly journals Possibility of Live Birth in Patients with Low Serum β-hCG 14 Days After Blastocyst Transfer

2020 ◽  
Author(s):  
Yixuan Wu ◽  
Haiying Liu
Keyword(s):  
Live Birth ◽  
Roc Curve ◽  
Pregnancy Outcomes ◽  
Luteal Phase ◽  
Clinical Pregnancy ◽  
Blastocyst Transfer ◽  
Luteal Phase Support ◽  
Live Births ◽  
Β Hcg ◽  
Low Serum

Abstract Background: Although prior work has attempted to predict pregnancy outcomes by assaying serum β-hCG levels after blastocyst transfer, no study has focused on pregnancy outcomes in those with initially low serum β-hCG levels. This study sought to investigate pregnancy outcomes of patients with low serum β-hCG levels 14 days after blastocyst transfer.Methods: A retrospective study was conducted at the Third Affiliated Hospital of Guangzhou Medical University to study patients whose serum β-hCG levels were at 5-299 mIU/ml 14 days after frozen blastocyst transfer. Rates of live birth, early miscarriage, biochemical pregnancy loss and ectopic pregnancy were analyzed according to the female patients’ age by Chi-squared analysis. Receiver operating characteristic (ROC) curves were plotted to explore the threshold of predicting clinical pregnancy and live births. Results: 312 patients had serum β-hCG levels <300 mIU/ml at 14 days after frozen blastocyst transfer, among which, 18.6% were live births, 47.4% were early miscarriages, 22.8% were biochemical pregnancies and 9.6% were ectopic pregnancies. Live birth rates were higher in the <38 years of age group as compared those > 38 years (19.0% vs.16.6%; P=0.045). ROC curve analysis showed that a predicted value of β-hCG for clinical pregnancy was 58.8 mIU/ml with an area under the ROC curve (AUC) of 0.752, a sensitivity of 95.0% and specificity of 53.5%. The threshold for live births was 108.6 mIU/ml with an AUC of 0.649, a sensitivity of 93.1% and a specificity of 37.0%. For the β-hCG fold increase over 48 hours, the cut-off for clinical pregnancy was 1.4 with an AUC of 0.899, a sensitivity of 90.3% and a specificity of 77.8%. The threshold for live birth was 1.9 with an AUC of 0.808, a sensitivity of 88.5% and specificity of 64.5%.Conclusions: Initially low serum β-hCG levels 14 days after frozen blastocyst transfer indicated minimal chances of live birth. For patients having an initial β-hCG >58.8 mIU/ml, luteal phase support should continue. Another serum β-hCG test and ultrasound should be performed one week later. When an initial serum β-hCG is < 58.8 mIU/ml, luteal phase support should be discontinued and serum β-hCG measured with ultrasound one week later.

scholarly journals Possibility of Live Birth in Patients with Low Serum β -hCG 14 Days After Blastocyst Transfer

2020 ◽  
Author(s):  
Yixuan Wu ◽  
Haiying Liu
Keyword(s):  
Live Birth ◽  
Roc Curve ◽  
Pregnancy Outcomes ◽  
Luteal Phase ◽  
Clinical Pregnancy ◽  
Blastocyst Transfer ◽  
Luteal Phase Support ◽  
Live Births ◽  
Β Hcg ◽  
Low Serum

Abstract Background: Although prior work has attempted to predict pregnancy outcomes by assaying serum β-hCG levels after blastocyst transfer, no study has focused on pregnancy outcomes in those with initially low serum β-hCG levels. This study sought to investigate pregnancy outcomes of patients with low serum β-hCG levels 14 days after blastocyst transfer.Methods: A retrospective study was conducted at the Third Affiliated Hospital of Guangzhou Medical University to study patients whose serum β-hCG levels were at 5-299 mIU/ml 14 days after frozen blastocyst transfer. Rates of live birth, early miscarriage, biochemical pregnancy loss and ectopic pregnancy were analyzed according to the female patients’ age by Chi-squared analysis. Receiver operating characteristic (ROC) curves were plotted to explore the threshold of predicting clinical pregnancy and live births. Results: 312 patients had serum β-hCG levels <300 mIU/ml at 14 days after frozen blastocyst transfer, among which, 18.6% were live births, 47.4% were early miscarriages, 22.8% were biochemical pregnancies and 9.6% were ectopic pregnancies. ROC curve analysis showed that a predicted value of β-hCG for clinical pregnancy was 58.8 mIU/ml with an area under the ROC curve (AUC) of 0.752, a sensitivity of 95.0% and specificity of 53.5%. The threshold for live births was 108.6 mIU/ml with an AUC of 0.649, a sensitivity of 93.1% and a specificity of 37.0%. For the β-hCG fold increase over 48 hours, the cut-off for clinical pregnancy was 1.4 with an AUC of 0.899, a sensitivity of 90.3% and a specificity of 77.8%. The threshold for live birth was 1.9 with an AUC of 0.808, a sensitivity of 88.5% and specificity of 64.5%.Conclusions: Initially low serum β-hCG levels 14 days after frozen blastocyst transfer indicated minimal chances of live birth. For patients having an initial β-hCG >58.8 mIU/ml, luteal phase support should continue. Another serum β-hCG test and ultrasound should be performed one week later. When an initial serum β-hCG is < 58.8 mIU/ml, luteal phase support should be discontinued and serum β-hCG measured with ultrasound one week later.

scholarly journals Progesterone levels predict pregnancy outcomes in individuals with fallopian tube associated infertility

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wenjia Bo ◽  
Ning Zhang ◽  
Ling Wang ◽  
Ying Guo ◽  
Haicui Wu
Keyword(s):  
Luteinizing Hormone ◽  
Fallopian Tube ◽  
Live Birth ◽  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Pregnancy Outcomes ◽  
Clinical Pregnancy ◽  
Birth Rates ◽  
Live Birth Rates

Abstract Background This study aimed at determining the predictive value of human chorionic gonadotropin and progesterone levels on pregnancy outcomes in patients receiving in vitro fertilization due to fallopian tube associated infertility. Methods We retrospectively analyzed the clinical data of 854 cycles due to fallopian tube associated infertility in vitro fertilization fresh embryo transfer. The clinical data had been collected from January 2010 to December 2018 and was divided into 7 groups depending on the progesterone level on human chorionic gonadotropin administration day. Live birth rates and observation trends were calculated. The receiver operating characteristic curve was established to determine the optimal cutoff value for progesterone, which was used to further divide the data into 3 groups; Group 1 (progesterone ≦ 1.0 ng/ml), Group 2 (1.0 ng/ml ≤ progesterone ≤ 1.25 ng/ml), and Group 3 (progesterone ≥ 1.25 ng/ml). We then compared the ovulation results and clinical outcomes among the 3 groups. Results There were no significant differences in age, infertility years, gonadotropin dosage, gonadotropin days, Luteinizing hormone level on human chorionic gonadotropin day, 2 pronuclear fertilization rates, clinical pregnancy rates, live birth rates, full-term birth rate, and preterm birth rates among the three groups. However body mass index (p = 0.001), basal luteinizing hormone (p = 0.034), estrogen peak (p < 0.001), number of oocytes obtained (P < 0.001) were significantly different. Conclusions Progesterone level on human chorionic gonadotropin day does not affect the clinical pregnancy rate and live birth rates after in vitro fertilization. However, progesterone levels between 1.0 and 1.25 ng/ml may lead to good clinical pregnancy outcomes.

Sign in / Sign up

Export Citation Format

Share Document