scholarly journals Cumulative live birth rates between GnRH-agonist long and GnRH-antagonist protocol in one ART cycle when all embryos transferred: Real-Word Data of 18853 women from China

2021 ◽  
Author(s):  
Jingwei Yang ◽  
Xiaodong Zhang ◽  
Xiaoyan Ding ◽  
Guoning Huang ◽  
Hong Ye
Keyword(s):  
Live Birth ◽  
Gnrh Agonist ◽  
Gnrh Antagonist ◽  
Live Birth Rate ◽  
Ovarian Response ◽  
Fertilization Rate ◽  
Cumulative Live Birth Rate ◽  
Logistic Analysis ◽  
Cumulative Live Birth ◽  
Significant Difference

Abstract Background: A consensus has been reached on the preferred primary outcome of all infertility treatment trials, which is the cumulative live birth rate (CLBR). Some recent randomized controlled trials (RCTs) and retrospective studies have compared the effectiveness of GnRH-antagonist and GnRH-agonist protocols but showed inconsistent results. Studies commonly used conservative estimates and optimal estimates to described the CLBR of one incomplete ART cycle and there are not many previous studies with data of the complete cycle to compare CLBRs in GnRH-antagonist versus GnRH-agonist protocols.Methods: A total of 18853 patients have completed their first IVF cycle including fresh and subsequent frozen-thawed cycles during 2016-2019, 16827 patients were treated with GnRH-a long and 2026 patients with GnRH-ant protocol. Multivariable logistic analysis was used to evaluate the difference of GnRH-a and GnRH-ant protocol in relation to CLBR.Results: Before PSM, significant differences were observed in baseline characteristics and the CLBR was 50.91% in the GnRH-a and 33.42% in the GnRH-ant (OR: 2.07; 95%CI: 1.88-2.28; P<0.001). Stratified analysis showed the CLBR of GnRH-ant was lower than GnRH-a in suboptimal responders(46.89% vs 27.42%, OR=2.34, 95%CI=1.99-2.74; P<0.001) and no differences of CLBR were observed in other patients between protocols. After adjusting for potential confounders, multivariable logistic analysis found the CLBR of GnRH-ant group was lower than that of GnRH-a group (OR=2.11, 95%CI:1.69-2.63,P<0.001). After PSM to balence the baseline between groups, the CLBR of GnRH-a group was higher than that of GnRH-ant group in suboptimal responders((38.61% vs 28.22%, OR=1.60, 95%CI= 1.28-1.99; P<0.001) and the normal fertilization rate and number of available embryo in GnRH-a were higher than these of GnRH-ant groups in suboptimal responders (77.39% vs 75.22%; 2.86±1.26 vs 2.61±1.22; P<0.05). No significant difference was observed in other patients between different protocols.Conclusions: It is crucial to optimize the utilization of protocols in different ovarian response patients and reconsider the field of application of GnRH-ant protocols in China.

scholarly journals Cumulative live birth rates between GnRH-agonist long and GnRH-antagonist protocol in one ART cycle when all embryos transferred: real-word data of 18,853 women from China

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Jingwei Yang ◽  
Xiaodong Zhang ◽  
Xiaoyan Ding ◽  
Yuting Wang ◽  
Guoning Huang ◽  
...  
Keyword(s):  
Live Birth ◽  
Gnrh Agonist ◽  
Nearest Neighbor ◽  
Gnrh Antagonist ◽  
Live Birth Rate ◽  
Ovarian Response ◽  
Cumulative Live Birth Rate ◽  
Logistic Analysis ◽  
Cumulative Live Birth ◽  
Significant Difference

Abstract Background A consensus has been reached on the preferred primary outcome of all infertility treatment trials, which is the cumulative live birth rate (CLBR). Some recent randomized controlled trials (RCTs) and retrospective studies have compared the effectiveness of GnRH-antagonist and GnRH-agonist protocols but showed inconsistent results. Studies commonly used conservative estimates and optimal estimates to described the CLBR of one incomplete assisted reproductive technology (ART) cycle and there are not many previous studies with data of the complete cycle to compare CLBRs in GnRH-antagonist versus GnRH-agonist protocols. Methods A total of 18,853 patients have completed their first IVF cycle including fresh and subsequent frozen-thawed cycles during 2016–2019, 16,827 patients were treated with GnRH-a long and 2026 patients with GnRH-ant protocol. Multivariable logistic analysis was used to evaluate the difference of GnRH-a and GnRH-ant protocol in relation to CLBR. Utilized Propensity Score Matching(PSM) for sampling by up to 1:1 nearest neighbor matching to adjust the numerical difference and balance the confounders between groups. Results Before PSM, significant differences were observed in baseline characteristics and the CLBR was 50.91% in the GnRH-a and 33.42% in the GnRH-ant (OR = 2.07; 95%CI: 1.88–2.28; P < 0.001). Stratified analysis showed the CLBR of GnRH-ant was lower than GnRH-a in suboptimal responders(46.89 vs 27.42%, OR = 2.34, 95%CI = 1.99–2.74; P < 0.001) and no differences of CLBR were observed in other patients between protocols. After adjusting for potential confounders, multivariable logistic analysis found the CLBR of GnRH-ant group was lower than that of GnRH-a group (OR = 2.11, 95%CI:1.69–2.63, P < 0.001). After PSM balenced the confounders between groups, the CLBR of GnRH-a group was higher than that of GnRH-ant group in suboptimal responders((38.61 vs 28.22%, OR = 1.60, 95%CI = 1.28–1.99; P < 0.001) and the normal fertilization rate and number of available embryo in GnRH-a were higher than these of GnRH-ant groups in suboptimal responders (77.39 vs 75.22%; 2.86 ± 1.26 vs 2.61 ± 1.22; P < 0.05). No significant difference was observed in other patients between different protocols. Conclusions It is crucial to optimize the utilization of protocols in different ovarian response patients and reconsider the field of application of GnRH-ant protocols in China.

The depot GnRH agonist protocol improves the live birth rate per fresh embryo transfer cycle, but not the cumulative live birth rate in normal responders: a randomized controlled trial and molecular mechanism study

2020 ◽  
Vol 35 (6) ◽  
pp. 1306-1318 ◽  
Author(s):  
Bei Xu ◽  
Dirk Geerts ◽  
Shiqiao Hu ◽  
Jing Yue ◽  
Zhou Li ◽  
...  
Keyword(s):  
Live Birth ◽  
Gnrh Agonist ◽  
Birth Rate ◽  
Gnrh Antagonist ◽  
Controlled Trial ◽  
Live Birth Rate ◽  
Ovarian Response ◽  
Endometrial Receptivity ◽  
Cumulative Live Birth Rate ◽  
Cumulative Live Birth

Abstract STUDY QUESTION Do cumulative live birth rates (CLBRs) after one complete ART cycle differ between the three commonly used controlled ovarian stimulation (COS) protocols (GnRH antagonist, depot GnRHa (GnRH agonist) and long GnRHa) in normal responders undergoing IVF/ICSI? SUMMARY ANSWER There were similar CLBRs between the GnRH antagonist, depot GnRHa and long GnRHa protocols. WHAT IS KNOWN ALREADY There is no consensus on which COS protocol is the most optimal in women with normal ovarian response. The CLBR provides the final success rate after one complete ART cycle, including the fresh and all subsequent frozen–thawed embryo transfer (ET) cycles. We suggest that the CLBR measure would allow for better comparisons between the different treatment protocols. STUDY DESIGN, SIZE, DURATION A prospective controlled, randomized, open label trial was performed between May 2016 and May 2017. A total of 819 patients were allocated to the GnRH antagonist, depot GnRHa or long GnRHa protocol in a 1:1:1 ratio. The minimum follow-up time from the first IVF cycle was 2 years. To further investigate the potential effect of COS with the GnRH antagonist, depot GnRHa or long GnRHa protocol on endometrial receptivity, the expression of homeobox A10 (HOXA10), myeloid ecotropic viral integration site 1 (MEIS1) and leukemia inhibitory factor (LIF) endometrial receptivity markers was evaluated in endometrial tissue from patients treated with the different COS protocols. PARTICIPANTS/MATERIALS, SETTING, METHODS Infertile women with normal ovarian response (n = 819) undergoing IVF/ICSI treatment were randomized to the GnRH antagonist, depot GnRHa or long GnRHa protocol. Both IVF and ICSI cycles were included, and the sperm samples used were either fresh or frozen partner ejaculates or frozen donor ejaculates. The primary outcome was the live birth rate (LBR) per fresh ET cycle, and the CLBR after one complete ART cycle, until the birth of a first child (after 28 weeks) or until all frozen embryos were used, whichever occurred first. Pipelle endometrial biopsies from 34 female patients were obtained on Days 7–8 after oocyte retrieval or spontaneous ovulation in natural cycles, respectively, and HOXA10, MEIS1 and LIF mRNA and protein expression levels in the human endometrium was determined by quantitative real-time PCR and western blot, respectively. MAIN RESULTS AND THE ROLE OF CHANCE There were no significant differences in CLBRs between the GnRH antagonist, depot GnRHa or long GnRHa protocol (71.4 versus 75.5 versus 72.2%, respectively). However, there was a significantly higher LBR per fresh ET cycle in the depot GnRHa protocol than in the long GnRHa and GnRH antagonist protocols (62.6 versus 52.1% versus 45.6%, P &lt; 0.05). Furthermore, HOXA10, MEIS1 and LIF mRNA and protein expression in endometrium all showed significantly higher in the depot GnRHa protocol than in the long GnRHa and GnRH antagonist protocols (P &lt; 0.05). LIMITATIONS, REASONS FOR CAUTION A limitation of our study was that both our clinicians and patients were not blinded to the randomization for the randomized controlled trial (RCT). An inclusion criterion for the current retrospective cohort study was based on the ‘actual ovarian response’ during COS treatment, while the included population for the RCT was ‘expected normal responders’ based on maternal age and ovarian reserve test. In addition, the analysis was restricted to patients under 40 years of age undergoing their first IVF cycle. Furthermore, the endometrial tissue was collected from patients who cancelled the fresh ET, which may include some patients at risk for ovarian hyperstimulation syndrome, however only patients with 4–19 oocytes retrieved were included in the molecular study. WIDER IMPLICATIONS OF THE FINDINGS The depot GnRH agonist protocol improves the live birth rate per fresh ET cycle, but not the cumulative live birth rate in normal responders. A possible explanation for the improved LBR after fresh ET in the depot GnRHa protocol could be molecular signalling at the level of endometrial receptivity. STUDY FUNDING/COMPETING INTEREST(S) This project was funded by Grant 81571439 from the National Natural Sciences Foundation of China and Grant 2016YFC1000206-5 from the National Key Research & Development Program of China. The authors declare no conflict of interest. TRIAL REGISTRATION NUMBER The RCT trial was registered at the Chinese Clinical Trial Registry, Study Number: ChiCTR-INR-16008220. TRIAL REGISTRATION DATE 5 April 2016. DATE OF FIRST PATIENT’S ENROLLMENT 12 May 2016

scholarly journals The Effect of Dual Trigger With GnRH Agonist and hCG on Cumulative Live-Birth Rate For Normal Responders in GnRH-Antagonist Cycles

2021 ◽  
Author(s):  
Fumei Gao ◽  
Yanbin Wang ◽  
Min Fu ◽  
Qiuxiang Zhang ◽  
Yumeng Ren ◽  
...  
Keyword(s):  
Live Birth ◽  
Oocyte Maturation ◽  
Gnrh Agonist ◽  
Birth Rate ◽  
Gnrh Antagonist ◽  
Live Birth Rate ◽  
Cumulative Live Birth Rate ◽  
Final Oocyte Maturation ◽  
Cumulative Live Birth ◽  
High Responders

Abstract It has been widely acknowledged that the dual triggering for final oocyte maturation with a combination of gonadotropin-releasing hormone (GnRH) agonist and human chorionic gonadotropin (hCG) improve clinical outcomes in high responders during IVF-ICSI GnRH-antagonist cycles. However, it remains elusive whether this dual trigger is also benifical to the normal responders. The aim of this study was to investigate this issue. In the present study, we retrospectively analysed the data generated from a total of 469 normal responders from 1st January to 31st December 2017 and final oocyte maturation was performed with dual trigger with GnRH agonist combined hCG (n=270) or hCG alone (n=199). All the patients were followed up for three years. Cumulative live birth rate was calculated as the first live birth achieved after all cycles having an embryo transfer (fresh cycles as well as thawing cycles) among both groups. Subjects in the dual trigger group achieved a slightly higher number of oocytes retrieved (11.24 vs. 10.24), higher number of two-pronuclear embryo (2PN) (8.37 vs.7.67) and a higher number of embryos available (4.45 vs.4.03). But the cumulative live birth rate, an all-inclusive success rate for assisted reproductive technology, was similar between the two groups (54.07% vs.59.30%). This study showed that the dual trigger was not superior to only hCG trigger for normal responders in GnRH antagonist cycles in terms of cumulative live birth rate.

scholarly journals Cumulative live birth rate after up to three consecutive embryo transfer cycles in women with poor ovarian response

2020 ◽  
Vol 47 (2) ◽  
pp. 135-139
Author(s):  
Se Jeong Kim ◽  
Dayong Lee ◽  
Seul Ki Kim ◽  
Byung Chul Jee ◽  
Seok Hyun Kim
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Ovarian Response ◽  
Rank Test ◽  
Poor Ovarian Response ◽  
Cumulative Live Birth Rate ◽  
Cumulative Live Birth

Objective: In the present study, we aimed to retrospectively evaluate the cumulative live birth rate (LBR) after up to three consecutive embryo transfer (ET) cycles, either fresh or frozen, in women with expected poor ovarian response (ePOR). Methods: We selected 115 women who entered the first <i>in vitro</i> fertilization (IVF) cycle between August 2013 and July 2016. The women were divided into an ePOR group (37 women) and a non-ePOR group (78 women). All women in the ePOR group were ≥40 years old or had serum anti-Müllerian hormone levels of less than 1.1 ng/mL at the time of the first IVF cycle. Live birth outcomes were monitored until December 2017. The cumulative LBR (with both conservative and optimistic estimates) was calculated according to the serial number of ET cycles. Results: After up to three ET cycles, the overall cumulative LBR was significantly lower in the ePOR group than in the non-ePOR group (conservative estimate, 10.8% vs. 44.9%, respectively; optimistic estimate, 14.7% vs. 56.1%, respectively; log-rank test, <i>p</i>=0.003). Conclusion: Women with ePOR exhibited a lower cumulative LBR than women in the non-ePOR group, and this information should be provided to ePOR women during counseling before starting IVF.

scholarly journals Analysis of IVF/ICSI Outcomes in Endometriosis Patients With Recurrent Implantation Failure: Influence on Cumulative Live Birth Rate

2021 ◽  
Vol 12 ◽  
Author(s):  
Chenyi Zhong ◽  
Liusijie Gao ◽  
Li Shu ◽  
Zhen Hou ◽  
Lingbo Cai ◽  
...  
Keyword(s):  
Live Birth ◽  
Early Treatment ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Treated Group ◽  
Fertilization Rate ◽  
Untreated Group ◽  
Cumulative Live Birth Rate ◽  
Treatment Groups ◽  
Cumulative Live Birth

ObjectiveTo study the influence of endometriosis activity on the pregnancy outcomes of patients with recurrent implantation failure (RIF) in in-vitro fertilization/intra-cytoplasmic sperm injection (IVF/ICSI) cycles. The pregnancy outcomes were compared between RIF patients with endometriosis who received treatment at different occasions to explore the appropriate treatment plan for these patients and to optimize the pregnancy-support strategies.DesignAmbispective cohort study.MethodsA total of 330 patients with endometriosis were enrolled from 2008 to 2018 and included 1043 IVF/ICSI cycles. All patients were diagnosed with RIF after IVF/ICSI. Patients were assigned to three subtypes according to different control states of endometriosis, including the untreated, early-treatment, and late-treatment groups. The clinical pregnancy rate, live birth rate, and cumulative live birth rate of endometriosis patients with RIF were the main outcomes; additionally, the fertilization rate, available embryonic rate, and high-quality embryonic rate were also compared.ResultsThe early-treatment and late-treatment groups showed higher cumulative live birth rate than the untreated group (early-treated 43.6% vs. late-treated 46.3% vs. untreated 27.7%, P&lt;0.001), though patients in the two treatment groups had higher rates of adenomyosis and ovarian surgery. The two treatment group showed a better laboratory result than the untreated and especially, the early-treatment group. The untreated group (46.24%) had a lower IVF fertilization rate than the treated group (early-treated [64.40%] and late-treated [60.27%] (P&lt;0.001). In addition, the rates of available embryos and high-quality embryos in the early-treated group were much higher those that in the untreated group (90.30% vs. 85.20%, 76.50% vs. 64.47%). Kaplan–Meier curve showed that patients in the untreated group needed a mean of 23.126 months to achieve one live birth; whereas those in the treated group needed a comparatively shorter duration (early-treated: 18.479 ± 0.882 months and late-treated: 14.183 ± 1.102 months, respectively).ConclusionEndometriosis has a negative influence on IVF/ICSI outcome. The control of endometriosis activity can result in a higher cumulative live birth rate in patients. It is necessary for endometriosis patients to receive medical treatment to achieve a better prognosis especially for those with RIF.

scholarly journals A Premature Rise of Luteinizing Hormone Is Associated With a Reduced Cumulative Live Birth Rate in Patients ≥37 Years Old Undergoing GnRH Antagonist In Vitro Fertilization Cycles

2021 ◽  
Vol 12 ◽  
Author(s):  
Fumei Gao ◽  
Yanbin Wang ◽  
Dan Wu ◽  
Min Fu ◽  
Qiuxiang Zhang ◽  
...  
Keyword(s):  
Luteinizing Hormone ◽  
Live Birth ◽  
Ovarian Stimulation ◽  
Birth Rate ◽  
Gnrh Antagonist ◽  
Live Birth Rate ◽  
Advanced Age ◽  
Cumulative Live Birth Rate ◽  
Cumulative Live Birth

This is a retrospective cohort study included 1021 patients underwent a flexible GnRH antagonist IVF protocol from January 2017 to December 2017 to explore the effect of a premature rise in luteinizing hormone (LH) level on the cumulative live birth rate. All patients included received the first ovarian stimulation and finished a follow-up for 3 years. A premature rise in LH was defined as an LH level &gt;10 IU/L or &gt;50% rise from baseline during ovarian stimulation. The cumulative live birth rate was calculated as the number of women who achieved a live birth divided by the total number of women who had either delivered a baby or had used up all their embryos received from the first stimulated cycle. In the advanced patients (≥37 years), the cumulative live birth rate was reduced in patients with a premature rise of LH (β: 0.20; 95% CI: 0.05–0.88; p=0.03), compared to patients (≥37 years) without the premature LH rise. The incidence of premature LH rise is associated with decreased rates of cumulative live birth rate in patients of advanced age (≥37 years) and aggravated the reduced potential of embryos produced by the advanced age, not the number of embryos.

O-156 Fertilization rate as a novel indicator for cumulative live birth rate: multicenter retrospective cohort study of 9,394 complete IVF cycles

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
C Zaca’ ◽  
G Scaravelli ◽  
P.E. Levi Setti ◽  
C Livi ◽  
F M Ubaldi ◽  
...  
Keyword(s):  
Live Birth ◽  
Birth Rate ◽  
Performance Indicator ◽  
Positive Association ◽  
Live Birth Rate ◽  
Fertilization Rate ◽  
Key Performance Indicator ◽  
Cumulative Live Birth Rate ◽  
Female Age ◽  
Cumulative Live Birth

Abstract Study question Does fertilization rate (FR) affect cumulative success rates in assisted reproduction cycles? Summary answer These data indicate a positive association between FR with CLBR suggesting the predictive clinical relevance of this parameter and its adoption as Key Performance Indicator(KPI). What is known already Numerous studies have aimed at characterizing outcome predictors. Maternal age is historically and correctly recognized as the single most important factor impacting on the clinical outcome of ART. More recently ovarian response has also gained interest in this respect. However, the quest for novel, more comprehensive predictive factors is not over; new relevant evidence is starting to emerge. FR is a noteworthy parameter because expressing a fundamental aspect of both oocyte and sperm developmental competence. In fact it has been adopted as a key performance indicator of the IVF laboratory, to assess laboratory, operator, and gamete competence. Study design, size, duration Reported data concern a retrospective cohort study carried out between 2015 to 2017 involving 7,968 couples undergoing 9,394 complete ICSI cycles, i.e. whose all embryos were transferred or disposed.All women aged between 18-42 years were included.We excluded from analysis: surgical sperm retrieval cases, cycles resulting in neither fresh or frozen–thawed embryo transfers,cycles in which live birth were not achieved, but with remaining cryopreserved embryos,cycles of PGT, cycle with fertilization failure and standard IVF cycles. Participants/materials, setting, methods The cohort was groupped according to fertilization rate intervals based on recommendations of the Vienna Consensus (&lt;65% - Group 1; 65%-80% - Group 2; &gt;80% - Group 3). Harnessing the large size of the original dataset, further cycle stratifications were carried out based on female age (&lt;34, 35-38, 39-42 years) and number of oocytes retrieved (5-7, 8-10, &gt;10 oocytes). Main results and the role of chance No significant difference in female age was observed between fertilization rate groups (p = 0.640). CLBR was progressively higher in relation fertilization rate in Groups 1, 2 and 3 (20.1%, 34.7%, 41.3%, P &lt; 0.001, respectively). Number of recovered oocytes, embryo number per cycle, cumulative pregnancy rate followed the same trend (p &lt; 0.001). The decrease in CLBR with increasing female age was significantly correlated with fertilization rate and CLBR in all three female age groups (P &lt; 0.001). Finally, to further control for possible patient-specific confounding factors, maternal age, number of retrieved oocytes, percent of inseminated oocytes and fertilization rate were evaluated in a multivariate logistic regression analysis. From this assessment, fertilization rate emerged as a factor independently associated with cumulative live birth rate, to a degree equivalent or higher compared with the number or retrieved oocytes. Limitations, reasons for caution The study design is retrospective and requires further refinement to control for factors that may impact clinical outcome. Wider implications of the findings These data indicate a positive association of FR with CLBR, thereby suggesting that fertilization, in addition to representing an assay for gamete quality and laboratory performance,has an independent clinical significance.Irrespective of the number of retrieved oocytes and female age, we observed that, rates of FR are positively associated with CLBR. Trial registration number None

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