scholarly journals Comparison of the predictive value of progesterone-related indicators for pregnancy outcomes of women undergoing the short-acting GnRH agonist long protocol: a retrospective study

2020 ◽  
Author(s):  
Yangyang Zhang ◽  
Yang Xu ◽  
Yuqiong Wang ◽  
Qing Xue ◽  
Jing Shang ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Gnrh Agonist ◽  
Pregnancy Outcomes ◽  
Predictive Value ◽  
Ovarian Response ◽  
Clinical Pregnancy ◽  
Short Acting ◽  
Good Quality Embryo ◽  
Response Group ◽  
Long Protocol

Abstract Background There are many progesterone (P) elevation-related indicators for predicting pregnancy outcomes, including serum P, P-to-oestradiol ratio (P/E2), P-to-follicle index (PFI), and P-to-mature oocyte index (PMOI); however, due to inconsistencies in study populations and controlled ovarian hyperstimulation (COH) protocols among studies, these indicators are controversial. Moreover, no researchers have included these four commonly used indicators in one study to compare their predictive efficacies. The objective of this study was to compare the predictive value of P-related indicators for pregnancy outcome of women undergoing the short-acting GnRH agonist long protocol. Methods A total of 612 infertile women undergoing IVF/ICSI were recruited for this study. Serum samples were obtained on the morning of HCG injection for serum P and E2 measurements. Transvaginal ultrasound was performed to determine the follicle count (≥ 14 mm). The number of mature oocytes was observed in the embryo laboratory after oocyte retrieval. Results In cases of P < 2.5 ng/ml, there was no significant difference in the serum P level or P/E2 between the pregnant group and the non-pregnant group. The PFI and PMOI of the pregnant group were significantly lower than those of the non-pregnant group. According to the stratified analysis of the ovarian response, only the PMI and PMOI of the pregnant women in the normal ovarian response group were lower than those of the non-pregnant women. In order to compare the predictive value of the PFI and PMOI in IVF/ICSI outcomes, patients were divided into four groups. The good-quality embryo rate and clinical pregnancy rate were highest in Group A (low PFI and low PMOI) and lowest in Group D (high PFI and high PMOI). In the two groups with discordant PFI and PMOI, namely, Group B (low PFI and high PMOI) and Group C (high PFI and low PMOI), the good-quality embryo rate and clinical pregnancy rate were not significantly different. Conclusions PFI and PMOI had equal value in predicting clinical pregnancy outcomes in the normal ovarian response group undergoing the short-acting GnRH agonist long protocol. Each clinical centre can choose one of the indicators according to their actual situation in clinical practice.

scholarly journals Comparison of the predictive value of progesterone‐related indicators for pregnancy outcomes of women undergoing the short‐acting GnRH agonist long protocol: a retrospective study

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Yangyang Zhang ◽  
Yang Xu ◽  
Yuqiong Wang ◽  
Qing Xue ◽  
Jing Shang ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Gnrh Agonist ◽  
Pregnancy Outcomes ◽  
Predictive Value ◽  
Ovarian Response ◽  
Clinical Pregnancy ◽  
Short Acting ◽  
Good Quality Embryo ◽  
Response Group ◽  
Long Protocol

Abstract Background There are many progesterone (P) elevation-related indicators for predicting pregnancy outcomes, including the serum P, P-to-oestradiol ratio (P/E2), P-to-follicle index (PFI), and P-to-mature oocyte index (PMOI); however, due to inconsistencies in study populations and controlled ovarian hyperstimulation (COH) protocols among studies, these indicators are controversial. Moreover, no researchers have included these four commonly used indicators in one study to compare their predictive efficacies. The objective of this study was to compare the predictive value of P-related indicators for pregnancy outcomes of women undergoing the short-acting GnRH agonist long protocol. Methods A total of 612 infertile women undergoing IVF/ICSI were recruited for this study. Serum samples were obtained on the morning of HCG injection for serum P and E2 measurements. Transvaginal ultrasound was performed to determine the follicle count (≥ 14 mm in diameter). The number of mature oocytes was observed in the embryo laboratory after oocyte retrieval. Results In cases of P < 2.5 ng/ml, there was no significant difference in the serum P level or P/E2 between the pregnant group and the non-pregnant group. The PFI and PMOI of the pregnant group were significantly lower than those of the non-pregnant group. According to the stratified analysis of the ovarian response, only the PMI and PMOI of the pregnant women in the normal ovarian response group were lower than those of the non-pregnant women. To compare the predictive value of the PFI and PMOI in IVF/ICSI outcomes, the patients were divided into four groups. The good-quality embryo rate and clinical pregnancy rate were highest in Group A (low PFI and low PMOI) and lowest in Group D (high PFI and high PMOI). In the two groups with discordant PFI and PMOI, namely Group B (low PFI and high PMOI) and Group C (high PFI and low PMOI), the good-quality embryo rate and clinical pregnancy rate were not significantly different. Conclusions The PFI and PMOI had equal value in predicting clinical pregnancy outcomes in the normal ovarian response group undergoing the short-acting GnRH agonist long protocol. Each clinical centre can choose one of the indicators according to their actual situation in clinical practice and establish individual cut-off values for PFI and PMOI based on their own hormonal measurements.

scholarly journals Comparison of the predictive value of progesterone-related indicators for pregnancy outcomes of women undergoing the short-acting GnRH agonist long protocol: a retrospective study

2021 ◽  
Author(s):  
Yangyang Zhang ◽  
Yang Xu ◽  
Yuqiong Wang ◽  
Qing Xue ◽  
Jing Shang ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Gnrh Agonist ◽  
Pregnancy Outcomes ◽  
Predictive Value ◽  
Ovarian Response ◽  
Clinical Pregnancy ◽  
Short Acting ◽  
Good Quality Embryo ◽  
Response Group ◽  
Long Protocol

Abstract Background: There are many progesterone (P) elevation-related indicators for predicting pregnancy outcomes, including the serum P, P-to-oestradiol ratio (P/E2), P-to-follicle index (PFI), and P-to-mature oocyte index (PMOI); however, due to inconsistencies in study populations and controlled ovarian hyperstimulation (COH) protocols among studies, these indicators are controversial. Moreover, no researchers have included these four commonly used indicators in one study to compare their predictive efficacies. The objective of this study was to compare the predictive value of P-related indicators for pregnancy outcomes of women undergoing the short-acting GnRH agonist long protocol. Methods: A total of 612 infertile women undergoing IVF/ICSI were recruited for this study. Serum samples were obtained on the morning of HCG injection for serum P and E2 measurements. Transvaginal ultrasound was performed to determine the follicle count (≥ 14 mm in diameter). The number of mature oocytes was observed in the embryo laboratory after oocyte retrieval.Results: In cases of P<2.5 ng/ml, there was no significant difference in the serum P level or P/E2 between the pregnant group and the non-pregnant group. The PFI and PMOI of the pregnant group were significantly lower than those of the non-pregnant group. According to the stratified analysis of the ovarian response, only the PMI and PMOI of the pregnant women in the normal ovarian response group were lower than those of the non-pregnant women. To compare the predictive value of the PFI and PMOI in IVF/ICSI outcomes, the patients were divided into four groups. The good-quality embryo rate and clinical pregnancy rate were highest in Group A (low PFI and low PMOI) and lowest in Group D (high PFI and high PMOI). In the two groups with discordant PFI and PMOI, namely Group B (low PFI and high PMOI) and Group C (high PFI and low PMOI), the good-quality embryo rate and clinical pregnancy rate were not significantly different.Conclusions: The PFI and PMOI had equal value in predicting clinical pregnancy outcomes in the normal ovarian response group undergoing the short-acting GnRH agonist long protocol. Each clinical centre can choose one of the indicators according to their actual situation in clinical practice and establish individual cut-off values for PFI and PMOI based on their own hormonal measurements.

Effect of the Timing of Frozen Embryo Transfer on Pregnancy Outcomes in High Ovarian Response Patients Undergoing Freeze-All Strategy

2020 ◽  
Author(s):  
Na Zuo ◽  
Yingzhuo Gao ◽  
Ningning Zhang ◽  
Da Li ◽  
Xiuxia Wang
Keyword(s):  
Propensity Score ◽  
Embryo Transfer ◽  
Subgroup Analysis ◽  
Pregnancy Outcomes ◽  
Ovarian Response ◽  
Frozen Embryo Transfer ◽  
Matched Cohort ◽  
Entire Cohort ◽  
Long Acting ◽  
Long Protocol

Abstract Background: Frozen embryo transfer (FET) can greatly improve the pregnancy outcomes for high ovarian response (HOR) population. However, it is not known whether the impaired endometrial receptivity derived from controlled ovarian hyperstimulation (COH) can be fully recovered in the first menstrual cycle after oocyte retrieval, and whether the timing of FET is a risk factor on pregnancy outcomes in HOR population undergoing freeze-all strategy.Methods: A retrospective cohort study to compare the pregnancy outcomes of the immediate and delayed FET groups in HOR population undergoing freeze-all strategy. Propensity score matching was used to make the potential risk factors of the immediate and delayed FET groups comparable. Multivariable regression analysis was used to study the effect of the timing of FET on pregnancy outcomes in the entire cohort and propensity score-matched cohort, even in different COH protocol cohorts as subgroup analysis.Results: We showed that the immediate FET group were no worse than delayed FET group in the entire cohort [clinical pregnancy rate (CPR), adjusted odd ratio (OR), 0.942, 95% confidence interval (CI), 0.784-1.133; spontaneous abortion rate (SAR), adjusted OR, 1.118, 95% Cl (0.771-1.623); live birth rate (LBR), adjusted OR, 1.060, 95% Cl (0.886-1.267)]. The same results were obtained by χ2 test in the propensity score-matched cohort (CPR, 60.5% versus 63.5%; SAR, 11.6% versus 12.3%; LBR, 48% versus 49.3%) (P > 0.05). Subgroup analysis indicated that pregnancy outcomes of immediate FET were non-inferior to delayed FET in short-acting gonadotropin-releasing hormone agonist (GnRH-a) long protocol (P > 0.05). The SAR of the immediate FET group were lower than that of the delayed FET group in GnRH antagonist protocol (adjusted OR, 0.646, 95% CI, 0.432-0.966) and long-acting GnRH-a long protocol (adjusted OR, 0.375, 95% CI, 0.142-0.990) (P < 0.05), no differences were observed in CPR and LBR (P > 0.05).Conclusions: These findings indicate that immediate FET might not affect pregnancy outcomes in HOR patients undergoing freeze-all strategy. Delaying FET could increase the SAR in GnRH-ant and long-acting GnRH-a long protocols.

scholarly journals Uterus Size May Affect Reproductive Outcome in Women with Adenomyosis After Gnrh- Agonist Pretreatment Undergoing Frozen Embryo Transfer Cycles: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Wei Xiong ◽  
Ruiyi Tang ◽  
Peng Wu ◽  
Zhengyi Sun ◽  
jingran zhen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Pregnancy Rate ◽  
Embryo Transfer ◽  
Live Birth ◽  
Gnrh Agonist ◽  
Retrospective Cohort Study ◽  
Pregnancy Outcomes ◽  
Retrospective Cohort ◽  
Clinical Pregnancy ◽  
Frozen Embryo Transfer

Abstract Background: GnRH-agonist is used to treat adenomyosis, but its efficacy in adenomyosis patients with uterine enlargement undergoing frozen embryo transfer (FET) is unclear. Methods：The retrospective cohort study comprised 112 adenomyosis patients with uterine enlargement undergoing the first FET circle. A long-term GnRH-a pretreatment was administered to 112 patients with uterine enlargement. These patients were divided into two groups according to the therapeutic effect: patients with a normal-size uterus after GnRH-a treatment (GN group) and patients with an enlarged uterus after GnRH-a treatment (GL group). Results：Not all patients can shrink their uterus to a satisfactory level. After receiving GnRH-a pretreatment, the uterus returned to normal size in 77% of patients (GN group), and 23% of patients had a persistently enlarged uterus (GL group). The pregnancy rate, clinical pregnancy rate, ongoing pregnancy rate, and live birth rate were significantly higher in the GN group than in the GL group. Controlling for the confounding factors, normal uterus size (odds ratio [OR] 4.50; P=0.03) and low body mass index (OR 3.13; P=0.03) affected the odds of achieving live birth. The cut-off value selected on the ROC curve of uterus volume after GnRH-a treatment for detecting live birth was 144.7Conclusions：GnRH-a pretreatment was associated with the regression of adenomyosis lesions and improved clinical pregnancy outcomes in the adenomyosis patients with uterine enlargement whose lesion are GnRH-a susceptible on FET cycles. However, about a quarter of patients may not be less responsive to GnRH-a and have poorer pregnancy outcomes, especially in overweight women.

scholarly journals Association analysis of body mass index on ovarian response and pregnancy outcomes during IVF / ICSI treatment: a retrospective study in Southern Han Chinese Women

2020 ◽  
Author(s):  
Li Li ◽  
Yanhong Chen ◽  
Chengli Zeng ◽  
Weilin Ou ◽  
Zhifeng Lin ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Pregnancy Rate ◽  
Spontaneous Abortion ◽  
Pregnancy Outcomes ◽  
Birth Rate ◽  
Chinese Women ◽  
Ovarian Response ◽  
Normal Weight ◽  
Abortion Rate ◽  
Clinical Pregnancy

Abstract Background: The purpose of the present study is to evaluate the effect of body mass index (BMI) on cycle characteristics and in vitro fertilization / intracytoplasmic sperm injection (IVF / ICSI) outcomes of a long down-regulation protocol in Southern Han Chinese women. Methods : This retrospective, observational study included 5279 infertile women undergoing IVF / ICSI cycle with a long down-regulation protocol. All the patients were divided into four subgroups by the recommended Chinese BMI cut-off points: underweight, BMI < 18.5 kg/m 2 ; normal-weight, 18.5 kg/m 2 ≤ BMI < 24.0 kg/m 2 ; overweight, 24.0 kg/m 2 ≤ BMI < 28.0 kg/m 2 ; obese, BMI ≥ 28.0 kg/m 2 . The demographic data and biochemical tests of patients, the parameters related to the ovarian responsiveness to gonadotrophin stimulation, IVF / ICSI treatment characteristics and pregnancy outcomes (clinical pregnancy rate, spontaneous abortion rate and lived birth rate) were compared among BMI categories. Results: The overweight patients had lower ovarian sensitivity index (OSI) ( P < 0.05) and higher spontaneous abortion rate than women in the normal-weight (13.59% vs. 10.28%, OR = 2.37, 95% CI: 1.35 – 4.16, P = 0.003 ). The overweight and obese patients seemed to have lower clinical pregnancy rate and live birth rate, but the difference was not statistically significant ( P > 0.05). Conclusion: This study provides new epidemiological clues that the elevated BMI might increase the risk of spontaneous abortion and impair ovarian response to gonadotropin stimulation during IVF / ICSI treatment.

The effect of repeated controlled ovarian stimulation cycles on the gamete and embryo development

Zygote ◽  
2019 ◽  
Vol 27 (05) ◽  
pp. 347-349 ◽  
Author(s):  
L.T. Paul ◽  
O. Atilan ◽  
P. Tulay
Keyword(s):  
Adverse Effect ◽  
Pregnancy Outcomes ◽  
Ovarian Stimulation ◽  
Ovarian Response ◽  
Fertilization Rate ◽  
Pregnancy Rates ◽  
Clinical Pregnancy ◽  
Controlled Ovarian Stimulation ◽  
Developmental Potential ◽  
Clinical Pregnancy Rates

SummaryThe aim of this study was to investigate if there is an adverse effect of multiple controlled ovarian stimulation (COS) on the maturity of oocytes (MI and MII), fertilization rate, embryo developmental qualities and clinical pregnancy rates in donation cycles. In total, 65 patients undergoing oocyte donation cycles multiple times were included in this study. Patients were grouped as group A that consisted of donors with ≤2 stimulation cycles while B consisted of donors with ≥3 stimulation cycles; and group C included donors who had ≤15 oocytes, while group D had donors with ≥16 oocytes. Numbers of oocytes obtained, MI and MII oocytes, fertilization, embryo quality and clinical pregnancy outcomes were compared. Significant statistical differences were observed in total number of oocytes obtained, maturity of oocytes (MI and MII), fertilization rate, embryo qualities and clinical pregnancy outcomes of donors in groups A–D. Donors with ≤2 ovarian stimulation cycles had lower numbers of immature oocytes than donors with three or more stimulation cycles. However, donors with ≥3 stimulation cycles had higher numbers of mature oocytes, zygotes, with better day 3 embryo qualities and higher clinical pregnancy rates than donors with ≤2 stimulation cycles. Repeated COS does not seem to have any adverse effect on ovarian response to higher dose of artificial gonadotropin, as quality of oocytes collected and their embryological developmental potential were not affected by the number of successive stimulation cycles. The effect of multiple COS on the health of the oocyte donor needs to be assessed for future purpose.

Endometrial but not Ovarian Response is Associated With Clinical Outcomes and can be Improved by Prolonged Pituitary Downregulation in Patients With Thin and Medium Endometrium

2018 ◽  
Vol 26 (11) ◽  
pp. 1409-1416 ◽  
Author(s):  
Jianyuan Song ◽  
Xuejiao Sun ◽  
Kun Qian
Keyword(s):  
Clinical Outcomes ◽  
Endometrial Thickness ◽  
Ovarian Response ◽  
Endometrial Receptivity ◽  
Clinical Pregnancy ◽  
Thin Endometrium ◽  
Implantation Rates ◽  
Clinical Pregnancy Rates ◽  
Long Protocol ◽  
Pituitary Downregulation

The aim of this study is to investigate the effect of ovarian and endometrial response on live birth rates (LBRs) in young normal and high responders and prolonged pituitary downregulation on endometrial receptivity and clinical outcomes in patients with different endometrial thickness. Between January 2013 and December 2017, 9511 patients underwent first in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles with age ≤35 years, follicle stimulating hormone < 10 IU/l, and ≥4 retrieved oocytes were conducted. The estradiol (E2) levels on the human chorionic gonadotropin (HCG) day were classified into 4 groups: group 1 (<3000 pg/mL); group 2 (3000-5000 pg/mL); group 3 (5000-7000 pg/mL), and group 4 (≥7000 pg/mL). Logistic regression analysis was performed to predict the independent variables for live birth. Clinical outcomes between gonadotropin-releasing hormone agonist (GnRH-a) long protocol and GnRH-a prolonged protocol in patients with different endometrial thickness (EMT) were compared. There were no significant differences among the 4 groups in implantation rates, clinical pregnancy rates, and LBRs ( P > .05). Binary logistic regression analysis suggested that EMT but not E2 levels was one of the independent predictive factors of LBRs (odds ratio 0.889, 95% confidence interval, 0.865-0.914, P < .001). The prolonged protocol had significantly higher implantation rates and clinical pregnancy rates in patients with medium (7 < EMT < 14 mm), especially thin endometrium (≤7 mm) compared to short GnRH-a long protocol. Our study showed that endometrial response but not ovarian response was associated with LBRs in young normal and hyper responders. Prolonged pituitary downregulation was an effective treatment to improve endometrial receptivity in patients with medium, especially thin endometrium.

scholarly journals Prediction and management model of preterm birth

2019 ◽  
Vol 74 (4) ◽  
pp. 221-228 ◽  
Author(s):  
Yuriy A. Semenov ◽  
Valentina F. Dolgushina ◽  
Marina G. Moskvicheva ◽  
Vasiliy S. Chulkov
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Predictive Value ◽  
Diagnostic Value ◽  
Adverse Pregnancy Outcomes ◽  
History Of ◽  
Group 2 ◽  
Adverse Pregnancy ◽  
Group 1

Background: It seems relevant to study the contribution of socio-demographic, somatic and obstetric-gynecological factors in the implementation of preterm birth. Aims: Assessment of the prognostic significance of socio-demographic, obstetric-gynecological and somatic factors in the prediction of preterm birth and associated adverse pregnancy outcomes with subsequent validation of the prognostic model. Materials and methods: Cohort study with a mixed cohort. A retrospective assessment of socio-demographic factors, harmful habits, obstetric and gynecological pathology, somatic diseases, course and outcomes of pregnancy was carried out with the assessment of the status of newborns in 1246 women with subsequent construction of a predictive model of preterm birth and adverse outcomes of pregnancy using Regression with Optimal Scaling and its prospective validation in 100 women. Results: The most significant predictors, that increase the chance of preterm birth and adverse pregnancy outcomes, were history of premature birth, irregular monitoring during pregnancy, history of pelvic inflammatory disease, smoking, obesity, the onset of sexual activity up to 16 years, cardiovascular and endocrine diseases. Intellectual job reduced the chance of preterm birth and adverse pregnancy outcomes This multivariate predictive model has a diagnostic value. The score of risk factors 25 points had a sensitivity of 73%, a specificity of 71%, the area under the ROC curve (AUC) 0.76 (good quality), p0.001. After stratification of high-risk groups by maternal and perinatal pathology the following list of diagnostic and therapeutic measures is introduced and actively implemented in antenatal clinics. To stratificate this model, we prospectively analyze the course and pregnancy outcomes of 100 women divided into 2 groups: group 1 ― 50 women with preterm delivery, group 2 ― 50 women with term delivery. A total score of 25 and above had 44% of women in group 1 and only 10% of women in group 2 (sensitivity 81.4%, specificity 61.6%, positive predictive value 44%, negative predictive value 90%, positive likelihood ratio 2.2 [1.53.0], negative likelihood ratio 0.3 [0.130.68]). Conclusions: We have proposed a model for predicting preterm birth and delivery and perinatal losses using the available characteristics of pregnant women from early pregnancy with moderate indicators of diagnostic value. Further validation of the model in the general population of pregnant women is required.

scholarly journals Effectiveness of HP-hMG vs r-FSH in Patients undergoing IVF/ICSI Cycles with Moderate Male Factor Infertility

2012 ◽  
Vol 3 (2) ◽  
pp. 51-56
Author(s):  
Rutvij Jay Dalal
Keyword(s):  
Gnrh Agonist ◽  
Pregnancy Outcomes ◽  
Embryo Quality ◽  
Study Groups ◽  
Fertilization Rate ◽  
Clinical Pregnancy ◽  
Human Menopausal Gonadotropin ◽  
Male Factor Infertility ◽  
Male Factor ◽  
Control Study

ABSTRACT Aim The aim of this case-control study was to compare the efficacy of highly purified human menopausal gonadotropin (HPhMG) vs recombinant follicle stimulating hormone (r-FSH) treatments following GnRH agonist suppression in patients undergoing intracytoplasmic sperm injection (ICSI) with moderate male factor infertility in terms of oocyte and embryo quality and clinical pregnancy outcomes. Materials and methods A total of 240 infertile women were treated with HP-hMG group (n: 120 patients) or (r-FSH group, n: 120 patients) following GnRH agonist suppression (long regimen). Inclusion criteria for the study groups were infertility due to moderate oligoastheno-teratospermia with no associated female infertility factor, previous ART cycles <2, female patients aged 19 to 35 years with normal basal FSH, regular ovulatory cycles and BMI <30 kg/m2. Results Treatment durations and gonadotropin doses were similar in both groups. Cycle cancellation rates, clinical pregnancy and miscarriage rates, total and metaphase II oocytes retrieved, fertilization rate, number of embryos transferred were all similar in both groups. The clinical pregnancy rates were 45.9% (n: 50/109) in the r-FSH group and 40.4% (n: 44/109) in the HP-hMG group. Conclusion HP-hMG is effective as r-FSH in terms of oocyte and embryo quality and clinical pregnancy outcomes in patients undergoing ICSI with moderate male factor infertility. How to cite this article Dalal RJ, Pai H, Palshetkar N. Effectiveness of HP-hMG vs r-FSH in Patients undergoing IVF/ICSI Cycles with Moderate Male Factor Infertility. Int J Infertility Fetal Med 2012;3(2):51-56.

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