scholarly journals CC-Human Menopausal Gonadotropin Combined with Growth Hormone in Mini-stimulation Protocol could Improve Clinical Outcome in Poor Ovarian Responders

2016 ◽  
Author(s):  
Arie A Polim ◽  
Ivan R Sini ◽  
Indra NC Anwar ◽  
Aryando Pradana ◽  
Kurniawati Kurniawati ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Pregnancy Rate ◽  
Group Versus ◽  
Poor Responders ◽  
Human Menopausal Gonadotropin ◽  
Ongoing Pregnancy ◽  
Stimulation Protocol ◽  
Ongoing Pregnancy Rate ◽  
Significant Difference ◽  
Poor Ovarian Responders

Objective: To investigate the role of CC-highly purified Human Menopausal Gonadotropin (hpHMG) and Growth Hormone (GH) in mini-stimulation protocol to improve outcome in poor ovarian responders (POR). Method: All patients were given clomiphene citrate 150 mg from day 3 to day 7 of menstrual cycle followed by 150 IU hpHMG daily from day 8 until ovulation trigger. Two groups were observed where one group received GH and the other arm did not. In the GH group, 8 IU of GH were given from day 1 of stimulation until stimulation was stopped. GnRH antagonist was used to suppress ovulation. Result: Among 51 eligible women, 29 patients with GH and 22 patients without GH, no difference was observed in the number of oocytes retrieved (2.21 versus 2.64) and the number of embryos transferred (1.24 versus 1.68) in the GH group versus the group without GH, respectively. Total clinical pregnancy rate was 17.6%. No significant difference in pregnancy and ongoing pregnancy rate in both groups (17.2% versus 18.2%) and (13.8% versus 13.6%), respectively. In patients older than 40 years old, GH showed a 4-fold likelihood in producing top quality embryos (44.8% vs 13.6%, OR=3.6, p=0.05). Conclusion: CC-HMG regimen in mini-stimulation protocol is an effective option in poor responders. Additional GH in ministimulation program provided a higher number of top quality embryos in women older than 40 years old, although there were no difference in clinical or ongoing pregnancy rate. Keywords: CC-HMG, growth hormone, IVF, mini-stimulation protocol, poor ovarian responders

scholarly journals Sequential Use of Testosterone Gel and Growth Hormone in Expected Poor Responders and those with Previous Poor Assisted Reproductive Technology Outcomes: A Pilot Study

2017 ◽  
Vol 8 (1) ◽  
pp. 1-4
Author(s):  
Sathya Balasubramanyam
Keyword(s):  
Growth Hormone ◽  
Pregnancy Rate ◽  
Assisted Reproductive Technology ◽  
Case Series ◽  
Reproductive Technology ◽  
Poor Responders ◽  
Ongoing Pregnancy ◽  
Ongoing Pregnancy Rate ◽  
Testosterone Gel ◽  
The Mean

ABSTRACT Introduction Poor responders have suboptimal outcomes following conventional in vitro fertilization/intracytoplasmic sperm injection treatment. There is some evidence that transdermal testosterone and growth hormone may help in improving live birth rates in this group. Aim To present a case series of women who had sequential transdermal testosterone and growth hormone treatment in view of their being expected poor responders or with a history of previous poor oocyte or embryo quality. Setting Private assisted reproduction clinic. Materials and methods A total of 24 women underwent 30 cycles of controlled ovarian stimulation. Ten patients out of 24 had previous poor assisted reproductive technology outcomes, of which 4 were poor responders. Fourteen were expected poor responders. The women used approximately 1.2 gm of transdermal testosterone from day 5 to 25 along with a standard oral contraceptive pill. Growth hormone was given at 8 units/day subcutaneously from day 2 along with the gonadotropins in the antagonist protocol. Results The mean age of the women was 34.92 years (±3.6). The average duration of subfertility was 7.54 (±4.005) years. The mean antral follicle count was 9 (±3.28) and the mean anti-Mullerian hormone level was 1.2 ng/mL (±0.56). The mean number of eggs collected was 8 (±5.45). Number of mature (M2) eggs was 6.6 (±4.5) Mean number of eggs fertilized was 5.04 (±4.03); clinical pregnancy rate was 8/24 (33.3%) and ongoing pregnancy rate was 4/24 (16.6%). Conclusion This case series shows an encouraging clinical pregnancy rate. The reduced ongoing pregnancy rate probably reflects the suboptimal gamete quality. Further randomized controlled trials (RCTs) are needed to assess the efficacy of sequential transdermal testosterone and growth hormone therapy in poor responders. Clinical significance The ongoing pregnancy rate in this group with poor prognosis seems encouraging, and further well-designed RCTs would help in assessing the merits of this sequential therapy. How to cite this article Balasubramanyam S. Sequential Use of Testosterone Gel and Growth Hormone in Expected Poor Responders and those with Previous Poor Assisted Reproductive Technology Outcomes: A Pilot Study. Int J Infertil Fetal Med 2017;8(1):1-4.

scholarly journals The relationship between cannabis use and IVF outcome—a cohort study

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Eden Har-Gil ◽  
Ayala Heled ◽  
Marjorie Dixon ◽  
Abdul Munaf Sultan Ahamed ◽  
Yaakov Bentov
Keyword(s):  
Cohort Study ◽  
Pregnancy Rate ◽  
Implantation Rate ◽  
Fertilization Rate ◽  
Cannabis Use ◽  
Ongoing Pregnancy ◽  
Female Reproduction ◽  
Ongoing Pregnancy Rate ◽  
Ivf Outcomes ◽  
Significant Difference

Abstract Background The effects of cannabis use on male and female reproduction have been the focus of scientific research for decades. Although initial studies raised concerns, more recent studies were reassuring. Considering the recent legalization of recreational use of cannabis in Canada, we sought to analyze IVF outcomes among users and non-users in a single IVF center. Methods This is a retrospective cohort study from a single IVF center assessing IVF outcomes among male-female, non-donor IVF patients that are either cannabis users or non-users. We analyzed the ongoing pregnancy rate as well as oocyte yield, fertilization rate, peak serum estradiol, sperm, and embryo quality. We used the Mann-Whitney test, chi-square test, and Kruskal-Wallis tests where appropriate. Results Overall, the study included 722 patients of which 68 (9.4%) were cannabis users, most defined as light users. The results of the study show similar implantation rate (40.74% vs. 41.13%) and ongoing pregnancy rate (35.2% vs. 29.1%) between the users and non-users, respectively. No significant difference between users and non-users in any of the other analyzed outcomes could be detected. Conclusions The results may provide some reassurance for the lack of any demonstrable detrimental effects of cannabis consumption on IVF outcomes. This study was limited by its retrospective nature, self-reporting of cannabis use, and a small user sample size. A larger prospective study is needed to validate its findings.

scholarly journals Comparison of Highly Purified HMG versus Recombinant FSH with Antagonist Protocol in Poor Responder Patients

2020 ◽  
Vol 02 (01) ◽  
pp. 14-20
Author(s):  
Arie A. Polim ◽  
Nining Handayani ◽  
Adinda Pratiwi ◽  
Caroline Hutomo ◽  
Arief Boediono ◽  
...  
Keyword(s):  
Treatment Group ◽  
Pregnancy Rate ◽  
Follicle Stimulating Hormone ◽  
Progesterone Level ◽  
P Value ◽  
Poor Responders ◽  
Human Menopausal Gonadotropin ◽  
Significant Difference ◽  
Antagonist Protocol ◽  
Stimulating Hormone

Background:Luteinizing hormone (LH) supplementation may have beneficial effect on the maturity and fertilizability of oocytes in poor ovarian reserve (POR) and may influence the progesterone level, thus increasing the pregnancy rate. However, previous studies on the effect of LH activity supplementation on poor responders have shown conflicting results. This study aimed to compare the clinical effectiveness of two different forms of gonadotropin (highly purified human menopausal gonadotropin (HP-HMG) vs. recombinant human follicle-stimulating hormone (r-hFSH)-only) in Indonesian population. Methods: Women diagnosed with poor ovarian response who received gonadotropin-releasing hormone (GnRH) antagonist protocol with either HP-HMG or r-hFSH-only were investigated. Women who underwent freeze all cycles, mini stimulation, and natural stimulation were excluded. Multiple logistic regression was performed to assess the effect of follicle-stimulating hormone (FSH) + human chorionic gonadotropin (HCG)-driven LH activity combination in HP-HMG to pregnancy event adjusting for progesterone level, demographic variables, and clinical characteristic variables. Results: A total of 101 subjects in the HP-HMG treatment group and 89 subjects in r-hFSH-only treatment group were involved in the study. There was no significant difference of clinical pregnancy rate between HP-HMG group and r-hFSH-only group (adjusted OR: 0.94, 95% CI: 0.39–2.25; p-value: 0.890). Conclusion: Compared to r-hFSH-only group, combination of FSH + HCG-driven LH activity in HP-HMG group had similar effectiveness in poor responders undergoing in vitro fertilization (IVF) using the antagonist protocol.

P–211 Double warming and double vitrification for euploid embryos does not affect implantation nor ongoing pregnancy rate

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
B A Hashimi
Keyword(s):  
Statistical Analysis ◽  
Pregnancy Rate ◽  
Small Sample ◽  
Trophectoderm Biopsy ◽  
Ongoing Pregnancy ◽  
Ongoing Pregnancy Rate ◽  
Patient Counselling ◽  
Significant Difference ◽  
Group A ◽  
The Mean

Abstract Study question Does exposure of embryos to double vitrification and double warming affect the chances of ongoing pregnancy for patients undergoing PGT-A and transfer euploid embryos? Summary answer Our analysis shows that there is no statistically significant difference in implantation or ongoing pregnancy rate between single or double vitrification/warming cycles. What is known already The use of PGT-A is increasing in the last years and progressively more patients opting in for this, in order to reduce time to pregnancy. Implantation failures prior to genetic testing or the incidence of no-result embryos post PGT-A are some of the scenarios that expose the embryos to multiple rounds of vitrification/warming cycles. The exact effect that such exposure has on embryos is still to be investigated and confirmed as to whether it affects the outcome (i.e. implantation/ongoing pregnancy rate) or the future health of the child. Study design, size, duration Our analysis is a retrospective observation study of data collected from 151 consecutive frozen euploid embryo transfers (FET). These were performed at a single centre between January-December 2020. Two groups were created for this study. The first group includes euploid embryos that were transferred post being exposed to single vitrification/warming (n = 126). In the second group euploid embryos were exposed twice to vitrification/warming (n = 25). Statistical analysis using chi-square test and statistical significance was calculated when p ≤ 0.05. Participants/materials, setting, methods Blastocysts from 151 patients were split into two groups based on the number of vitrification/warming cycles that they underwent prior to FET. The first group includes embryos that were subjected to trophectoderm biopsy and were then vitrified (n = 126). The second group includes embryos that were initially vitrified without undergoing PGT-A analysis. Following implantation failures, their remaining embryos were warmed, biopsied and re-vitrified. Post PGT-A analysis euploid embryos were then re-warmed and transferred (n = 25). Main results and the role of chance For the first group (A), 450 blastocysts (day 5–7) were subjected to trophectoderm biopsy, where 5-cells taken, and embryos were then vitrified. Post PGT-A analysis 260 euploid embryos identified. From them 126 embryos transferred in frozen replacement cycles, where the mean embryo age for the group was 36.1±4.2. The grade of embryos transferred were of 4BC or better based on Gardner’s grading system. The implantation and ongoing pregnancy rate for this group was 62%. For the second group (B), 101 blastocysts (day 5–7) warmed, in order to undergo trophectoderm biopsy and were then re-vitrified. Post PGT-A analysis 49 euploid embryos identified. From them, 25 embryos transferred in frozen replacement cycles, where the mean maternal age for the group was 35.05±5.2. The grade of embryos transferred were of similar quality to group A. The implantation and ongoing pregnancy rate for this group was 64%. Statistical analysis confirmed that there is no statistical difference between the groups (p = 0.74). In addition, 60% of patients (n = 5) who had double vitrification, double biopsy and double warming have ongoing pregnancy. In conclusion, for transferrable quality euploid blastocysts, double vitrification has comparable reproductive outcomes as in single vitrification, thereby supporting the efficacy of double vitrification/warming when necessary. Limitations, reasons for caution This study uses a small sample size of patients. The data are observational and were retrospectively analysed so unknown confounders could not be assessed. The addition of more cycles and further multivariate analysis, including the child’s health is essential for confirmation of the findings. However, initial results are very reassuring. Wider implications of the findings: Our study has implications for clinical practice and patient counselling. Especially in patients that they choose to undergo PGT-A with pre-vitrified embryos post implantation failures with non PGT-A tested embryos. Trial registration number N/A

scholarly journals Comparison of clinical outcome of frozen embryo transfer after embryo selection based on morphokinetic versus morphologic criteria for freezing

2018 ◽  
Vol 5 (12) ◽  
pp. 2910-2917
Author(s):  
Le Nhat Quang ◽  
Le Thi Bich Tram ◽  
Nguyen Huyen Minh Thuy ◽  
Pham Duong Toan ◽  
Dang Quang Vinh ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Clinical Outcomes ◽  
Embryo Transfer ◽  
Obstructive Azoospermia ◽  
Ongoing Pregnancy ◽  
Ongoing Pregnancy Rate ◽  
Vitro Fertilization ◽  
Significant Difference ◽  
Frozen Embryos

Background: Results from the latest meta-analysis, in fresh cycles, showed that the application of time-lapse monitoring (TLM) together with an embryo-evaluating algorithm was associated with a significantly higher rate of ongoing pregnancy and a lower rate of early pregnancy loss. The aim of this study was to compare the clinical outcomes of frozen embryos classified according to morphokinetic versus morphologic criteria. Methods: This was a retrospective cohort study, conducted at IVFAS, An Sinh Hospital, Vietnam, from July 2014 to July 2017. Patients undergoing in vitro fertilization (IVF) treatment with antagonist protocol and having freeze-only on day 5 were included. Exclusion criteria were patients (i) treated with in-vitro maturation, (ii) having obstructive azoospermia, or (iii) having uterine abnormalities. Embryos were cultured up to day 5 in TLM system (Primo Vision, Vitrolife, Sweden) or in benchtop (G185, K System, Denmark). The quality of frozen embryos was evaluated based on morphokinetic or morphologic criteria. In the subsequent cycle, endometrial preparation was done by using exogenous estradiol and progesterone. Embryos were thawed and up to 2 embryos were transferred to the uterus. The primary outcome was ongoing pregnancy. The rate of post-thaw survival, post-thawed good/moderate embryo, clinical pregnancy, implantation, miscarriage and ectopic pregnancy were used as secondary endpoints. Results: A total of 276 patients were recruited, with 138 patients in the morphokinetic group and 138 patients in the morphologic group. Baseline characteristics were comparable between the two groups. There was no significant difference in ongoing pregnancy rate in morphokinetic versus morphologic group (57.2% vs. 60.1%, p=0.71). All secondary outcomes were comparable between the two groups. Conclusion: In frozen day-5 embryo transfer, the clinical outcomes were similar when embryos were classified according to morphokinetic versus morphologic criteria for freezing. Using morphokinetic criteria to select embryos for freezing did not improve the ongoing pregnancy rate, as compared to morphologic criteria.  

scholarly journals Comparative effectiveness of recombinant human follicle-stimulating hormone alfa (r-hFSH-alfa) versus highly purified urinary human menopausal gonadotropin (hMG HP) in assisted reproductive technology (ART) treatments: a non-interventional study in Germany

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Klaus F. Bühler ◽  
Robert Fischer ◽  
Patrice Verpillat ◽  
Arthur Allignol ◽  
Sandra Guedes ◽  
...  
Keyword(s):  
Assisted Reproductive Technology ◽  
Live Birth ◽  
Pregnancy Loss ◽  
Follicle Stimulating Hormone ◽  
Reproductive Technology ◽  
Clinical Pregnancy ◽  
Human Menopausal Gonadotropin ◽  
Ongoing Pregnancy ◽  
Complete Cycle ◽  
Significant Difference

Abstract Background This study compared the effectiveness of recombinant human follicle-stimulating hormone alfa (r-hFSH-alfa; GONAL-f®) with urinary highly purified human menopausal gonadotropin (hMG HP; Menogon HP®), during assisted reproductive technology (ART) treatments in Germany. Methods Data were collected from 71 German fertility centres between 01 January 2007 and 31 December 2012, for women undergoing a first stimulation cycle of ART treatment with r-hFSH-alfa or hMG HP. Primary outcomes were live birth, ongoing pregnancy and clinical pregnancy, based on cumulative data (fresh and frozen-thawed embryo transfers), analysed per patient (pP), per complete cycle (pCC) and per first complete cycle (pFC). Secondary outcomes were pregnancy loss (analysed per clinical pregnancy), cancelled cycles (analysed pCC), total drug usage per oocyte retrieved and time-to-live birth (TTLB; per calendar week and per cycle). Results Twenty-eight thousand six hundred forty-one women initiated a first treatment cycle (r-hFSH-alfa: 17,725 [61.9%]; hMG HP: 10,916 [38.1%]). After adjustment for confounding variables, treatment with r-hFSH-alfa versus hMG HP was associated with a significantly higher probability of live birth (hazard ratio [HR]-pP [95% confidence interval (CI)]: 1.10 [1.04, 1.16]; HR-pCC [95% CI]: 1.13 [1.08, 1.19]; relative risk [RR]-pFC [95% CI]: 1.09 [1.05, 1.15], ongoing pregnancy (HR-pP [95% CI]: 1.10 [1.04, 1.16]; HR-pCC [95% CI]: 1.13 [1.08, 1.19]; RR-pFC [95% CI]: 1.10 [1.05, 1.15]) and clinical pregnancy (HR-pP [95% CI]: 1.10 [1.05, 1.14]; HR-pCC [95% CI]: 1.14 [1.10, 1.19]; RR-pFC [95% CI]: 1.10 [1.06, 1.14]). Women treated with r-hFSH-alfa versus hMG HP had no statistically significant difference in pregnancy loss (HR [95% CI]: 1.07 [0.98, 1.17], were less likely to have a cycle cancellation (HR [95% CI]: 0.91 [0.84, 0.99]) and had no statistically significant difference in TTLB when measured in weeks (HR [95% CI]: 1.02 [0.97, 1.07]; p = 0.548); however, r-hFSH-alfa was associated with a significantly shorter TTLB when measured in cycles versus hMG HP (HR [95% CI]: 1.07 [1.02, 1.13]; p = 0.003). There was an average of 47% less drug used per oocyte retrieved with r-hFSH-alfa versus hMG HP. Conclusions This large (> 28,000 women), real-world study demonstrated significantly higher rates of cumulative live birth, cumulative ongoing pregnancy and cumulative clinical pregnancy with r-hFSH-alfa versus hMG HP.

scholarly journals Natural Cycle Results in Lower Implantation Failure than Ovarian Stimulation in Advanced-Age Poor Responders Undergoing IVF: Fertility Outcomes from 585 Patients

2021 ◽  
Author(s):  
Maria Paola De Marco ◽  
Giulia Montanari ◽  
Ilary Ruscito ◽  
Annalise Giallonardo ◽  
Filippo Maria Ubaldi ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Ovarian Stimulation ◽  
Embryo Implantation ◽  
Implantation Rate ◽  
Poor Responder ◽  
Advanced Age ◽  
Poor Responders ◽  
Natural Cycle ◽  
Significant Difference ◽  
Over 40 Years

AbstractTo compare pregnancy rate and implantation rate in poor responder women, aged over 40 years, who underwent natural cycle versus conventional ovarian stimulation. This is a retrospective single-center cohort study conducted at the GENERA IVF program, Rome, Italy, between September 2012 and December 2018, including only poor responder patients, according to Bologna criteria, of advanced age, who underwent IVF treatment through Natural Cycle or conventional ovarian stimulation. Between September 2012 and December 2018, 585 patients were included within the study. Two hundred thirty patients underwent natural cycle and 355 underwent conventional ovarian stimulation. In natural cycle group, both pregnancy rate per cycle (6.25 vs 12.89%, respectively, p = 0.0001) and pregnancy rate per patient101 with at least one embryo-transfer (18.85 vs 28.11% respectively, p = 0.025) resulted significant reduced. Pregnancy rate per patient managed with conventional ovarian stimulation resulted not significantly different compared with natural cycle (19.72 vs 15.65% respectively, p = 0.228), but embryo implantation rate was significantly higher in patients who underwent natural cycle rather than patient subjected to conventional ovarian stimulation (13 vs 8.28% respectively, p = 0.0468). No significant difference could be detected among the two groups in terms of abortion rate (p = 0.2915) or live birth pregnancy (p = 0.2281). Natural cycle seems to be a valid treatment in patients over 40 years and with a low ovarian reserve, as an alternative to conventional ovarian stimulation.

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