scholarly journals Comparison of Luteal Phase Estradiol Priming Stimulation Protocol and the Standard Antagonist Protocol in Patients With Diminished Ovarian Reserve Undergoing ICSI

2021 ◽  
Author(s):  
Sezin Erturk Aksakal ◽  
Oya Aldemir ◽  
İnci Kahyaoglu ◽  
İskender Kaplanoğlu ◽  
Serdar Dilbaz
Keyword(s):  
Embryo Transfer ◽  
Ovarian Reserve ◽  
Ovarian Stimulation ◽  
Luteal Phase ◽  
Clinical Pregnancy ◽  
Diminished Ovarian Reserve ◽  
Live Birth Rates ◽  
Protocol Group ◽  
Significant Difference ◽  
Antagonist Protocol

Abstract ObjectiveThis study aimed to compare the IVF outcomes in patients with diminished ovarian reserve stimulated with luteal phase estradiol (E2) priming protocol versus the standard antagonist protocol.MethodsThe study included 603 patients undergoing intracytoplasmic sperm injection cycles (ICSI) with the diagnosis of diminished ovarian reserve (DOR) who were stimulated with the luteal E2 priming protocol (n=181) and the standard antagonist protocol (n=422). Groups were compared in terms of demographic characteristics, ovarian stimulation results, ICSI cycle outcomes, clinical pregnancy, and live birth rates per embryo transfer. ResultsThe duration of ovarian stimulation was longer, and the total gonadotropin dose used was significantly higher (p=0.001) in the E2 priming protocol group than the antagonist protocol group. The number of embryos transferred was higher in the antagonist protocol group compared with the luteal E2 priming protocol group (0.87±0.75 vs. 0.64±0.49; p=001), but there was no statistically significant difference in terms of embryo quality (p>0.05). The cycle cancellation rate and the clinical pregnancy and live birth rates per embryo transfer were similar in both groups.ConclusionsThere was no significant difference between the ICSI outcomes of the patients diagnosed with diminished ovarian reserve stimulated with the antagonist protocol and the luteal E2 priming protocol. The antagonist protocol might be considered more advantageous because of the shorter treatment duration and lower doses of gonadotropin, and it allows more embryos to be transferred. Additional randomized controlled trials are needed to verify these findings.

scholarly journals Evaluation of Presepsin as a Predictive Marker in Women Undergoing ICSI

2020 ◽  
Vol 1 (6) ◽  
Author(s):  
Bushra Rasheed Al-Azawea ◽  
Hayder A. L. Mossa ◽  
Liqaa R. Altamimi ◽  
Lubna Amer Al-Anbary
Keyword(s):  
Follicular Fluid ◽  
Intracytoplasmic Sperm Injection ◽  
Ovarian Stimulation ◽  
Predictive Marker ◽  
Clinical Findings ◽  
Clinical Pregnancy ◽  
Infertile Women ◽  
Poor Predictor ◽  
Significant Difference ◽  
Antagonist Protocol

Purpose: The purpose of this study was to determine the ability of using Presepsin as a biomarker to evaluate the clinical pregnancy rate in a cohort of couples undergoing ICSI in a sample of Iraqi population. Patients and Methods: Sixty infertile women selected for undergoing intracytoplasmic sperm injection, the patient’s ovarian stimulation were by antagonist protocol accordingly to their clinical findings. Results: The results of the study shows there was no significant difference in the serum Presepsin between pregnant and non-pregnant ladies, 421.57 (1534.65) versus 878.64 (1322.23), respectively (P = 0.875), Furthermore, there was no significant difference in follicular fluid Presepsin between pregnant and non-pregnant ladies, 1286.73 (1232.00) versus 0.00 484.15 (1467.00), respectively (P = 0.296). Conclusions :We conclude that serum or follicular fluid Presepsin as a biomarker is a poor predictor of fertility outcome with no significant difference between pregnant and non-pregnant ladies

O-230 RCT comparing Recombinant-hcg trigger with Dual-trigger (GnRH-agonist and recombinant-hcg ) in improving clinical outcome in ICSI cycles in women with Diminished Ovarian Reserve

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
A Jindal ◽  
M Singh
Keyword(s):  
Clinical Outcome ◽  
Embryo Transfer ◽  
Gnrh Agonist ◽  
Ovarian Reserve ◽  
Gnrh Antagonist ◽  
Clinical Pregnancy ◽  
Diminished Ovarian Reserve ◽  
Study Group ◽  
Cancellation Rate ◽  
Hcg Trigger

Abstract Study question Does use of Dual-trigger (GnRH-agonist with recombinant-hcg) improve the clinical outcome in women with diminished ovarian reserve as compared to Recombinant-hcg trigger? Summary answer Yes, the use of Dual-trigger (GnRH-agonist with recombinant-hcg) improve the clinical outcome in women with diminished ovarian reserve as compared to Recombinant-hcg trigger. What is known already The population of poor responders has grown exponentially over the years and their management of ovarian stimulation remains one of the most challenging aspects. In GnRH antagonist down-regulated IVF-ICSI cycles, dual triggering for the final oocyte maturation with GnRH-a and a reduced dose of hCG improves the rate of fertilization and clinical pregnancy in women with diminished ovarian reserve. Further more, the benefit of lowered cycle cancellation rate would also enable greater percentage of patients with diminished ovarian reserve to reach the final stage of their ART treatment, thereby enhancing their chances of achieving a successful pregnancy . Study design, size, duration This RCT included GnRH antagonist ICSI cycles from 2018-2019. 82 women with diminished ovarian reserve (AMH ≤ 1.1 ng/ml and AFC ≤5) were included. The primary outcome measured was the oocyte fertilization rate, implantation rate and clinical pregnancy rate per oocyte retrieval cycle. Secondary outcome measured was embryo transfer cancellation rate and abortion rate per oocyte retrieval cycle. Participants/materials, setting, methods 82 women with diminished ovarian reserve undergoing fresh embryo transfer were included and randomly divided in two groups - Group-A (hCG trigger/control group: n = 41); and Group-B (dual trigger/study group: n = 41). Both patient groups underwent controlled ovarian stimulation using antagonist. The final oocyte maturation was triggered either by recombinant hCG (Group-A) or by a combination of recombinant hCG and GnRH-agonist (Dual trigger) (Group-B). Main results and the role of chance The dual-trigger group had significantly higher fertilization rate (62.8 vs. 37.6%), higher clinical pregnancy rate (31.4% vs. 18.1%) as compared to the recombinant-hCG trigger group. In addition, the abortion rate(12.1% vs. 21.3%) and embryo transfer cancellation rate (8.3% vs. 16.1%) were both significantly lower in the dual trigger group. The baseline characteristics for the control and the study group were similar and there was no significant difference in the patient age, serum AMH level, and cause of infertility. The total r-FSH dose, duration of stimulation, endometrial thickness, and serum hormone profile on the day of trigger were also similar between the control and the study group. The main advantage of triggering with GnRH-a is that it induces a mid-cycle FSH surge which resembles the natural ovulatory cycle hormonal changes. Study shows that in GnRH antagonist ART cycles, dual triggering with GnRH-a and hCG could significantly improve the rate of fertilization and clinical pregnancy in diminished ovarian reserve women. Furthermore, the benefit of lowered cycle cancellation rate would also enable greater percentage of patients with diminished ovarian reserve to reach the final stage of their ART treatment thereby enhancing their chance of achieving a successful pregnancy as well as reducing their mental stress. Limitations, reasons for caution The main limitation of our study is the low patient number. Triggering with GnRH-a has become a significant part of contemporary ART practice, especially in high responders, oocytes donors and oncology patients. However, more RCTs are required in order to justify the use of GnRH-agonists in poor responders in ART cycles. Wider implications of the findings Results of our study concurred with other studies of dual triggering, calls for a possible paradigm shift in ovulation-triggering agent for GnRH-antagonist cycles. Diminished ovarian reserve patients are constituting a large part of clinical ART practice and for such patients, obtaining maximum mature oocytes and good embryos is vitally important. Trial registration number not applicable

O-112 Outcomes of random-start ovarian stimulation protocols as a possible evidence of the theory of antral follicles continuous recruitment

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Y Martirosyan ◽  
T Nazarenko ◽  
A Birukova ◽  
I Dmitrieva
Keyword(s):  
Menstrual Cycle ◽  
Ovarian Reserve ◽  
Ovarian Stimulation ◽  
Luteal Phase ◽  
Young Patients ◽  
Serum Levels ◽  
Prospective Clinical Study ◽  
Antral Follicles ◽  
Informed Consent Form ◽  
Significant Difference

Abstract Study question We tried to validate the possibility and efficiency of ovarian stimulation (OS) started on any day of the menstrual cycle, based on a theory of continuous recruitment of antral follicles. Summary answer Formation of a pool of follicles with higher sensitivity to gonadotropic stimulation occurs several times during the menstrual cycle (MC). What is known already According to classical concepts and fundamental positions formulated in the middle of the last century, follicular recruitment occurs only once during the menstrual cycle - in the early follicular phase. Nowadays there is increasing evidence to suggest that there are multiple (two or three) antral follicular waves of recruitment during the MC. Also some researchers state that the process of follicle recruitment is continuous. Study design, size, duration This prospective clinical study was conducted at the V.I. Kulakov NMRC for OG&Pof Russia. The study included female cancer patients seeking retrieval and cryopreservation of oocytes and/or embryos before cancer treatment. 240 patients were selected for the study. The patients were divided into 5 groups depending on the cycle day on the moment when ovarian stimulation was initiated. All patients signed an informed consent form approved by the Ethics Committee. Participants/materials, setting, methods The 1st group consisted of patients who started standart OS from 1 to 5 days of the cycle (n = 65); the 2nd - from 6 to 10 (n = 36), the 3rd - from 11 to 15 (n = 45), the 4th - from 16 to 22 (n = 44), the 5th - from 23 to 28 (n = 50). In the late follicular and luteal phase we performed OS without a pituitary modulator. The comparative analysis included features of oo-, embryogenesis and steroidogenesis. Main results and the role of chance The mean age, BMI and AMH were not different among groups. There were no LH rise or OHSS signs noticed in any groups, despite that OS in late follicular and luteal phase of the MC was performed with no GnRH antagonist addition.There was no statistically significant difference in the duration of stimulation, starting doses, total dose of FSH and HMG. The largest number of oocyte cumulus complexes was obtained in the 5th group (11 (9–21) vs 7 (3,5–15,5) in the 1st group, p = 0,030). The greatest number of mature oocytes was obtained in the 4th and 1st groups. In the 2nd group the largest number of immature oocytes was obtained (37 (9.1%)). A smaller number of mature oocytes (165 (61.8%) vs 492 (72.9%) and 314 (77.5%), p = 0.001) was obtained in group 2 (compared with the 1st and the 4th groups), when stimulation was started in the presence of a dominant follicle . These periods coincided with higher estradiol and lower FSH serum levels. Based on our data the optimal moment for effective OS initiation starts with the decrease in serum estradiol which is approximately 48 hours before the menstrual bleeding. Limitations, reasons for caution The presented results could be applied mainly to young patients with high and normal ovarian reserve, who were in the main study group. In patients with low ovarian reserve, short menstrual cycle and early ovulation an issue of favorable time points for the initiation of OS should be resolved individually. Wider implications of the findings The data collected during our research could possibly contribute to future personification of OS protocols. Tailoring the ovarian stimulation protocols to the needs of the patients could decrease time needed for completing the protocol without affecting oocyte yield or their maturity. Trial registration number none

scholarly journals Comparison of modified agonist, mild-stimulation and antagonist protocols for in vitro fertilization in patients with diminished ovarian reserve

2018 ◽  
Vol 46 (6) ◽  
pp. 2327-2337 ◽  
Author(s):  
Rong Yu ◽  
Hao Jin ◽  
Xuefeng Huang ◽  
Jinju Lin ◽  
Peiyu Wang
Keyword(s):  
Ovarian Reserve ◽  
Diminished Ovarian Reserve ◽  
Vitro Fertilization ◽  
Protocol Group ◽  
Mild Stimulation ◽  
Group A ◽  
Group B ◽  
Early Abortion ◽  
Antagonist Protocol

Objective To compare the efficacy of three protocols for ovarian stimulation in patients with diminished ovarian reserve during in vitro fertilization (IVF) treatment. Methods This prospective randomized study enrolled patients with diminished ovarian reserve who underwent cycles of IVF or intracytoplasmic sperm injection. The patients were randomly divided into three groups: a modified gonadotrophin releasing hormone (GnRH) agonist protocol (group A); (ii) a mild stimulation protocol (group B); or (iii) an antagonist protocol (group C). Demographic characteristics, clinical variables and pregnancy outcomes were compared between the groups. Results A total of 116 patients were enrolled in the study: 54 in group A, 52 in group B and 60 in group C. Group B (32.69%) had a significantly higher cycle cancellation rate compared with groups A (11.11%) and C (16.67%). The early abortion rate of group C (44.44%) was significantly higher than group A (12.50%), but not significantly different from group B (16.67%). There were no significant differences in the clinical pregnancy rates and live birth rates among the three groups. Conclusion A modified GnRH agonist protocol achieved a comparable pregnancy rate to those of the mild stimulation protocol and antagonist protocol, whilst having lower cycle cancellation and early abortion rates.

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).

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