scholarly journals Predictive Factors for Live Birth in Fresh In Vitro Fertilization/Intracytoplasmic Sperm Injection Treatment in Poor Ovarian Reserve Patients Classified by the POSEIDON Criteria

2021 ◽  
Vol 12 ◽  
Author(s):  
Fei Li ◽  
Tian Ye ◽  
Huijuan Kong ◽  
Jing Li ◽  
Linli Hu ◽  
...  
Keyword(s):  
Live Birth ◽  
Predictive Factors ◽  
Ovarian Reserve ◽  
Inflection Point ◽  
Multivariate Logistic Regression Analysis ◽  
Threshold Effect ◽  
Poor Responders ◽  
Female Age ◽  
Live Births ◽  
Poor Ovarian Reserve

The mechanisms underlying poor ovarian response (POR) in assisted reproductive technology remain unclear, there is no consensus on the management of poor responders, the POSEIDON stratification classifies infertility patients into “expected” or “unexpected” groups to provide a more nuanced picture of POR, but few researchers have discussed the independent predictive factors (smoothed plots and the threshold effect) for live birth in POR patients classified by the new criteria. We conducted a retrospective cohort study using clinical data from 6,580 POR patients classified by the POSEIDON criteria in the First Affiliated Hospital of Zhengzhou University, and explored the live birth based on the results before and after the threshold inflection point of each independent influencing factor. Among 6,580 poor ovarian reserve patients classified by the POSEIDON criteria, 1,549 (23.54%) had live births, and 5,031 (76.46%) did not have live births. Multivariate logistic regression analysis showed that female age (OR 0.901; 95% CI 0.887~0.916; P < 0.001), body mass index (OR 0.963; 95% CI 0.951~0.982; P < 0.001), antral follicle counting (OR 1.049; 95% CI 1.009~1.042; P < 0.001) and controlled ovarian hyperstimulation protocol were independent factors predicting live birth in patients with POR. The threshold effect analysis found that the inflection point of female age was 34 years old, and when age was > 34 years old, the probability of live birth in POR patients dropped sharply (OR 0.7; 95% CI 0.7~0.8; P < 0.001). The inflection point of BMI was 23.4 kg/m2, and BMI had a negative correlation with live birth (OR 0.963; 95% CI 0.951~0.982; P < 0.001). The threshold inflection point of AFC was 8n. Female age, BMI, AFC and COH protocol were independent predictive factors associated with live birth in POR patients classified by the POSEIDON criteria. The smooth curve fit and threshold effect analyses provide clinical management strategies for these patients. In addition, the early-follicular-phase long-acting GnRH-agonist long protocol seems to have a higher live birth rates than other protocols. It is worth highlighting that BMI should be considered as well in the POSEIDON criteria.

scholarly journals Comparison of IVF Outcomes between Minimal Stimulation and High-Dose Stimulation for Patients with Poor Ovarian Reserve

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Tal Lazer ◽  
Shir Dar ◽  
Ekaterina Shlush ◽  
Basheer S. Al Kudmani ◽  
Kevin Quach ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Live Birth ◽  
Ovarian Reserve ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Poor Responders ◽  
High Dose ◽  
Poor Ovarian Reserve

We examined whether treatment with minimum-dose stimulation (MS) protocol enhances clinical pregnancy rates compared to high-dose stimulation (HS) protocol. A retrospective cohort study was performed comparing IVF and pregnancy outcomes between MS and HS gonadotropin-antagonist protocol for patients with poor ovarian reserve (POR). Inclusion criteria included patients with an anti-Müllerian hormone (AMH) ≤8 pmol/L and/or antral follicle count (AFC) ≤5 on days 2-3 of the cycle. Patients from 2008 exclusively had a HS protocol treatment, while patients in 2010 had treatment with a MS protocol exclusively. The MS protocol involved letrozole at 2.5 mg over 5 days, starting from day 2, overlapping with gonadotropins, starting from the third day of letrozole at 150 units daily. GnRH antagonist was introduced once one or more follicles reached 14 mm or larger. The HS group received gonadotropins (≥300 IU/day) throughout their antagonist cycle. Clinical pregnancy rate was significantly higher in the MS protocol compared to the HS protocol (P=0.007). Furthermore, the live birth rate was significantly higher in the MS group compare to the HS group (P=0.034). In conclusion, the MS IVF protocol is less expensive (lower gonadotropin dosage) and resulted in a higher clinical pregnancy rate and live birth rate than a HS protocol for poor responders.

scholarly journals Applying growth hormone as an adjuvant to correct poor prognosis outcomes in IVF: Study 2 compares dehydroepiandrosterone

2021 ◽  
Vol 16 (3) ◽  
pp. 164-190
Author(s):  
John Lui Yovich ◽  
Shanthi Srinivasan ◽  
Mark Sillender ◽  
Shipra Gaur ◽  
Philip Rowlands ◽  
...  
Keyword(s):  
Live Birth ◽  
Ovarian Reserve ◽  
Poor Prognosis ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Utilization Rate ◽  
Recurrent Implantation Failure ◽  
Birth Rates ◽  
Live Births ◽  
Live Birth Rates

This retrospective study examines the influence of recombinant growth hormone (rGH) and dehydroepiandrosterone (DHEA) adjuvants on oocyte numbers, embryo utilization and live births arising from 3637 autologous IVF±ICSI treatment cycles undertaken on 2376 women across ten years (2011-2020) within a pioneer Australian facility. Despite using an FSH-dosing algorithm enabling maximal doses up to 450 IU for women with reduced ovarian reserve, younger women had significantly higher mean numbers of oocytes recovered than older women ranging from 11.1 for women <35 years to 9.4 for women aged 35-39 years reducing to 6.5 for women aged 40-44 years and 4.1 for those aged ≥45 years (p<0.0001). Overall, the embryo utilization rate was 48.5% and live birth productivity rate was 35.4 % across all ages and neither rGH nor DHEA showed any benefit on these rates, in fact, those women with nil adjuvants showed the highest live birth rate per initiated cycle (44.94% overall: p<0.0001, and 55.2% for the youngest group: p<0.001). Embryo utilization was increased by rGH in those women aged 40-44 years who had low ovarian reserve (p<0.0001), but this benefit did not translate into any improvement in the live birth rate, in fact those women who did not use adjuvants had the highest overall birth rate (p<0.0001). Similarly, other factors known to cause a poor prognosis, including low IGF-1 profile, recurrent implantation failure, and low oocyte numbers at OPU, showed no improvement in embryo utilization nor in live births from the adjuvants. The relevance of embryo quality was examined on 1135 women whose residual embryos after a single fresh-embryo transfer failed to develop to a suitable grade for cryopreservation. From 1727 cycles such women often displayed an improved embryo utilization rate with both rGH, and with DHEA or combined rGH+DHEA. Even so, live birth rates were not improved by either of the adjuvants excepting young women <35 years using rGH without DHEA (p<0.05). Examining poor prognosis sub-groups, indicated both rGH and DHEA or combined rGH+DHEA consistently improved embryo utilization in those women with low ovarian reserve (p<0.0001), or those with low IGF-1 levels (p<0.0001) or with recurrent implantation failure (p<0.02). All the poor-prognosis sub-groups showed low live birth rates and, notwithstanding the improvements in embryo utilization, the live birth rates were not significantly improved by the adjuvants, albeit the rates were closer to the nil adjuvant groups (not significantly different).

scholarly journals Predictive Factors for Pregnancy after Intrauterine Insemination: A Retrospective Study of Factors Affecting Outcome

2016 ◽  
Vol 8 (2) ◽  
pp. 140-144
Author(s):  
Azadeh Pravin Patel ◽  
Megha Snehal Patel ◽  
Sushma Rakesh Shah ◽  
Shashwat Kamal Jani
Keyword(s):  
Retrospective Study ◽  
Pregnancy Rate ◽  
Live Birth ◽  
Predictive Factors ◽  
Intrauterine Insemination ◽  
Multiple Pregnancy ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Female Age ◽  
Factors Affecting

ABSTRACT Objectives To determine the predictive factors for pregnancy after stimulated intrauterine insemination (IUI). Materials and methods A retrospective analysis of 136 patients undergoing 443 stimulated IUI cycles was done in an attempt to identify significant variables predictive of treatment success. The primary outcome measures were clinical pregnancy and live birth rates. Predictive factors evaluated were female age, duration of infertility, indication for IUI, number of preovulatory follicles, and postwash total motile fraction (TMF). Results The overall clinical pregnancy rate and live birth rate were 7.2% and 5.1 per cycle respectively. The mean number of IUI cycles per patient was 3.2, the miscarriage rate was 15%, and the multiple pregnancy rate was 3.1%. Among the predictive factors evaluated, female age (age > 37 years; p = 0.039), the duration of infertility (5.36 vs 6.71 years, p = 0.032), and the TMF (between 10 and 20 million, p = 0.003) significantly influenced the clinical pregnancy rate. Conclusion The clinical management of the selected infertile couple should be performed in an expedited manner taking into consideration the age of the woman, etiology, and duration of infertility and motile fraction of sperms. How to cite this article Patel AP, Patel MS, Shah SR, Jani SK. Predictive Factors for Pregnancy after Intrauterine Insemination: A Retrospective Study of Factors Affecting Outcome. J South Asian Feder Obst Gynae 2016;8(2):140-144.

scholarly journals Applying growth hormone as an adjuvant to correct poor prognosis outcomes in IVF: Study 1 compares melatonin

2021 ◽  
Vol 16 (1) ◽  
pp. 219-238
Author(s):  
John L Yovich ◽  
Shanthi Srinivasan ◽  
Mark Sillender ◽  
Shipra Gaur ◽  
Philip Rowlands ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Live Birth ◽  
Ovarian Reserve ◽  
Poor Prognosis ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Utilization Rate ◽  
Fresh Embryo Transfer ◽  
Recombinant Growth Hormone ◽  
Live Births

This retrospective study examines the influence of recombinant growth hormone (rGH) and melatonin adjuvants on oocyte numbers, embryo utilization and live births arising from 3637 autologous IVF±ICSI treatment cycles undertaken on 2376 women across ten years (2011-2020) within a pioneer Australian facility. Despite using an FSH-dosing algorithm enabling maximal doses up to 450 IU for women with reduced ovarian reserve, younger women had significantly higher mean numbers of oocytes recovered than older women ranging from 11.1 for women <35 years to 9.4 for women aged 35-39 years reducing to 6.5 for women aged 40-44 years and 4.0 for those aged ≥45 years (p<0.0001). Overall, the embryo utilization rate was 48.5% and live birth productivity rate was 35.4 % across all ages and neither rGH nor melatonin showed any benefit on these rates, in fact, those women with nil adjuvants showed the highest live birth rate per initiated cycle (42.0% overall: p<0.0001, and 55.3% for the youngest group: p<0.001). Embryo utilization was increased marginally by rGH in those women aged 40-44 years who had high ovarian reserve (p<0.05), but this benefit did not translate into any improvement in the live birth rate. Similarly, other factors known to cause a poor prognosis, including low IGF-1 profile, recurrent implantation failure, and low oocyte numbers at OPU, showed no improvement in embryo utilization nor in live births from the adjuvants. The relevance of embryo quality was examined on 1135 women whose residual embryos after a single fresh-embryo transfer failed to develop to a suitable grade for cryopreservation. From 1727 cycles such women often displayed an improved embryo utilization rate with rGH, but not with melatonin. Even so, live birth rates were not improved by either of the adjuvants.

scholarly journals How Can We Predict Success in Poor Responders?

2021 ◽  
Vol 28 (4) ◽  
pp. 361-366
Author(s):  
Alina Elena BORDEA ◽  
◽  
Elvira BRATILA ◽  
Diana MIHAI ◽  
Marina ANTONOVICI ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Live Birth ◽  
Ovarian Reserve ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Poor Responder ◽  
Poor Responders ◽  
The Poor ◽  
Laboratory Techniques ◽  
Reproductive Techniques

Objectives: The aim of this study was to evaluate how can we predict success in poor responder patients in terms of pregnancy rate and live birth rate. Material and method: This study is a review of the newest papers that have in the center the poor responders undergoing treatment involving assisted reproductive techniques (ART). Outcomes: The results show that the most reliable factors when counseling a poor responder patient are age and Anti-Müllerian hormone (AMH) level. Conclusions: The most important factors that influence pregnancy rate are age and ovarian reserve, but other factors such as male pathology and laboratory techniques must be studied deeper.

scholarly journals Live birth rates in different subgroups of poor ovarian responders according to Bologna and POSEIDON group classification criteria

2020 ◽  
Author(s):  
Mehri Mashayekhy ◽  
Arezoo Arabipoor ◽  
Forouzan Barabi ◽  
Zahra Zolfaghari
Keyword(s):  
Live Birth ◽  
Predictive Factors ◽  
Treatment Cycle ◽  
Group Analysis ◽  
Group Classification ◽  
Birth Rates ◽  
Live Births ◽  
Bologna Criteria ◽  
Live Birth Rates ◽  
Group 3

Abstract Background: Live birth rates (LBRs) have been separately evaluated in two poor ovarian responder (POR) classification methods. We designed the present study to compare the LBRs according to Bologna criteria or Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number (POSEIDON) group classifications to determine the important predictive factors for LBR in patients with POR. Methods: In this cross-sectional study, we evaluated a database that contained clinical and laboratory information on infertility treatment cycles of all patients with at least one POR after standard controlled ovarian stimulation (COH) during in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles from December 2015 to December 2017. The eligible data were collected and the subjects divided into five groups according to Bologna criteria and four groups according to POSEIDON group classification. Results: We assessed 812 patients diagnosed with POR; overall, 517 underwent embryo transfer (ET) during the last treatment cycle (63.6%). The results indicated a total clinical pregnancy rate of 19.3% (100 cases) and LBR of 16.1% (86 cases). According to Bologna criteria, 41 patients were not included in any group. Analysis of treatment cycle outcome showed that patients classified as Bologna group II had a higher LBR than the other groups. In terms of POSEIDON classification, all of the patients could be classified into groups. Patients in POSEIDON group 3 had the highest LBR. According to multivariable regression analysis, the significant independent variables that remained in the model as important predictive factors for live births were the number and quality (good and excellent) of the embryos transferred, and POSEIDON group 3 classification. Conclusion: The results indicated that the POSEIDON group classification could be more comprehensive and practical than Bologna criteria for diagnosing and categorizing POR patients. In addition, we noted that the number and quality of transferred embryos were the most important prognostic factors for live births in POR patients. Therefore, we suggest that clinicians consider COH protocols that have a freezing embryo strategy and the collection of more good quality embryos to improve the probability of a live birth.

scholarly journals Obesity and adverse pregnancy outcomes in older patients with decreased ovarian reserve: a retrospective single-centre study

2021 ◽  
Author(s):  
Fangxu Lin ◽  
Hao Shi ◽  
Qiongyao Shi ◽  
Yingchun Su ◽  
Shanjun Dai ◽  
...  
Keyword(s):  
Older Women ◽  
Live Birth ◽  
Ovarian Reserve ◽  
Pregnancy Outcomes ◽  
Older Patients ◽  
Normal Weight ◽  
Adverse Pregnancy Outcomes ◽  
Live Births ◽  
Live Birth Rates ◽  
Adverse Pregnancy

Abstract BackgroundIn recent years, infertility has increased in older women with decreased ovarian reserve (DOR). Studies have shown that women with DOR have fewer oocytes, which are poorer in quality, and have an increased risk of adverse pregnancy outcomes. Pre-pregnancy BMI is significantly correlated with many adverse pregnancy outcomes. Therefore, we conducted this study to explore the correlation between body mass index (BMI) and abortion and live birth in older patients with DOR. MethodsThe clinical data of 2052 older women with infertility and DOR admitted to the Reproductive Medicine Center of the First Affiliated Hospital of Zhengzhou University from August 2009 to May 2018 were analysed retrospectively. Patients were divided into underweight (BMI < 18.5 kg/m 2 ; n = 56), normal weight (18.5 kg/m 2 ≤ BMI < 24 kg/m 2 ; n = 1389), overweight (24 kg/m 2 ≤ BMI < 28 kg/m 2 ; n = 527) and obese (BMI ≥ 28 kg/m 2 ; n = 80). We compared the pregnancy outcomes of patients in each group. ResultsLogistic regression analysis showed that being overweight or obese were independent risk factors for miscarriage (P < 0.05) and protection factors for live births (P<0.05). Being underweight was a protective factor for live births (P < 0.05). ConclusionsThe abortion and live birth rates in older infertile women with DOR are correlated with BMI. Higher BMI was associated with higher abortion rates and lower live birth rates. Being underweight also correlated with the live birth rate. Therefore, to improve pregnancy outcomes, we suggest that older patients with DOR may benefit from maintaining a normal weight before seeking fertility treatments.

scholarly journals Follicular Fluid Perfluoroalkyl and Polyfluoroalkyl Substances Are Associated With Adverse ART Outcomes in Women With Poor Ovarian Reserve

2021 ◽  
Author(s):  
Yunying Cai ◽  
LanPing Zhong ◽  
Ze Wu ◽  
Min Wang ◽  
Heng Su
Keyword(s):  
Live Birth ◽  
Follicular Fluid ◽  
Ovarian Reserve ◽  
Ovarian Function ◽  
Ultra Performance Liquid Chromatography ◽  
Reproductive Technology ◽  
Female Fecundity ◽  
Polyfluoroalkyl Substances ◽  
Perfluoroalkyl And Polyfluoroalkyl Substances ◽  
Poor Ovarian Reserve

Abstract BackgroundPrevious evidence suggests that perfluoroalkyl and polyfluoroalkyl substances (PFASs) adversely affect ovarian function and female fecundity. However, the evidence remains insufficient to infer a direct relationship between PFAS exposure and adverse assisted reproductive technology (ART) outcomes. To fill this gap, we examined follicular fluid PFAS exposure and ART outcomes in patients with poor ovarian reserve (POR) in a prospective study.MethodsIn total, 147 women with POR were included. Eight PFASs were measured in follicular fluid (n=104) samples using simultaneous analysis by ultra-performance liquid chromatography coupled to triple quadrupole tandem mass spectrometry. The PFAS contamination status of the patients’ follicular fluid and the association between characteristics and ART outcomes were investigated by logistic regression.ResultsAfter adjustment for age and BMI, PFOA, PFNA, PFHxS and ∑PFAS were strongly associated with a decreased probability of pregnancy (PFOA highest vs. lowest tertile: OR=1.95, 95% CI: 1.61, 2.38; PFNA highest vs. lowest tertile: OR= 3.0, 95% CI: 2.46, 3.68; PFHxS highest vs. lowest tertile: OR= 1.95, 95% CI: 1.61, 2.35; ∑PFAS second vs. lowest tertile: OR=3.31, 95% CI: 2.74, 3.89). PFOS and PFUnDA were inversely associated with failed implantation. No relationships were noted between failed implantation and other PFAS analytes. The same result was obtained when using live birth as an outcome measure.ConclusionsIn women with POR, follicular fluid PFAS exposure may decrease the probability of clinical pregnancy and live birth.

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