scholarly journals Co-Administration of Clomiphene Citrate and Letrozole in Mild Ovarian Stimulation Versus Conventional Controlled Ovarian Stimulation Among POSEIDON Group 4 Patients

2022 ◽  
Vol 12 ◽  
Author(s):  
Hsin-Ta Lin ◽  
Meng-Hsing Wu ◽  
Li-Chung Tsai ◽  
Ta-Sheng Chen ◽  
Huang-Tz Ou
Keyword(s):  
Pregnancy Outcomes ◽  
Ovarian Stimulation ◽  
Clomiphene Citrate ◽  
Fertilization Rate ◽  
Control Group ◽  
Study Group ◽  
Output Rate ◽  
Mild Ovarian Stimulation ◽  
Group 4 ◽  
Mild Stimulation

This retrospective study assessed the effect of the co-administration of clomiphene citrate (CC) and letrozole in mild ovarian stimulation, compared to conventional regimens, among Patient-Oriented Strategies Encompassing Individualized Oocyte Number (POSEIDON) Group 4 patients. There were 114 POSEIDON Group 4 patients undergoing in vitro fertilization treatments with 216 stimulation cycles recruited from a Taiwan’s reproductive center during 2016-2020. Main outcomes were the numbers, quality of retrieved oocytes and embryo development. Pregnancy outcomes were assessed after embryo transfers. Per stimulation cycle, patients receiving mild stimulation with a combination of CC and letrozole (study group) versus those with COS (control group) had lower numbers of pre-ovulatory follicles (2.00 ± 1.23 vs. 2.37 ± 1.23, p=0.0066) and oocytes retrieved (1.83 ± 1.17 vs. 2.37 ± 1.23, p=0.0017), and lower follicular output rate (58.6% vs. 68.38%, p=0.0093) and mature oocyte output rate (44.29% vs. 52.88%, p=0.0386) but a higher top-quality metaphase II oocyte ratio (66.7% vs. 54.59%, p=0.0444) and a similar fertilization rate (91.67% vs. 89.04%, p=0.4660). With adjustment for significant between-group baseline differences using multivariable logistic generalized estimating equation model analyses, there was no statistical difference in oocytes retrieved and embryo development between the study and control groups, and insignificant increases in successful pregnancies in the study group were found compared to the control group (i.e., odds ratios [95% CIs]: 1.13 [0.55, 232] and 1.50 [0.65, 3.49] for ongoing pregnancy and live birth, respectively). For POSEIDON Group 4 patients, cotreatment of CC and letrozole in mild stimulation may increase the high-quality oocyte ratio and yield comparable fertilization rate and pregnancy outcomes.

scholarly journals Clomiphene Citrate Priming Increases Sensitivity During Ovarian Stimulation in Poor Ovarian Responders Undergoing In Vitro Fertilization Treatment: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Shan Liu ◽  
Xinyu Liu ◽  
Huanhuan Li ◽  
Minghui Liu ◽  
Yasu Lv ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Ovarian Stimulation ◽  
Retrospective Cohort ◽  
Clomiphene Citrate ◽  
Control Group ◽  
Study Group ◽  
Poor Ovarian Responders ◽  
Gonadotropin Dosage ◽  
Antagonist Protocol

Abstract Background: Since ovarian stimulation was introduced as an assisted reproductive technology, poor ovarian response (POR) management has challenged clinicians. Guidance on optimally managing patients with poor response and/or low sensitivity to ovarian stimulation is still lacking. We aimed to investigate whether a clomiphene citrate (CC) priming protocol could increase ovarian sensitivity in poor ovarian responders. Methods: This single-center retrospective cohort study included 294 patients (374 ovarian stimulation cycles). Of these, 193 cycles were treated by a CC priming antagonist protocol (study group) and 181 by the classical flexible gonadotropin-releasing hormone antagonist protocol (control group). Stimulation data and laboratory and clinical outcomes were compared between the groups. Results: Total gonadotropin dosage and dosage per follicle were considerably lower, the follicle-to-oocyte index was significantly higher, and the gonadotropin duration was shorter in the study group. After adjusting for potential confounders, multivariate regression analysis showed that cumulative ongoing pregnancy remained comparable between the groups (adjusted odds ratio: 0.761, 95% confidence interval: 0.300-1.933, P = 0.566). Age, body mass index, gonadotropin dosage per follicle, and the follicle-to-oocyte index were directly associated with the reproductive outcomes. The result of the sensitivity analysis showed that patients stimulated by the CC priming antagonist protocol were administered less gonadotropin (1,739.09 ± 719.39 vs. 3,114.77 ± 1,171.23, P < 0.001) at a lower gonadotropin dosage per follicle (637.36 ± 373.05 vs. 1286.26 ± 976.66, P < 0.001) and for a shorter duration (6.58 ± 2.23 vs. 9.80 ± 1.90, P < 0.001). Conclusions: The CC priming antagonist protocol offered a convenient and patient-friendly way to increase ovarian sensitivity during ovarian stimulation in poor ovarian responders.

scholarly journals Correlation of Endometrial Glycodelin Expression and Pregnancy Outcome in Cases with Polycystic Ovary Syndrome Treated with Clomiphene Citrate Plus Metformin: A Controlled Study

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Selda Uysal ◽  
Ahmet Zeki Isik ◽  
Serenat Eris ◽  
Seyran Yigit ◽  
Yakup Yalcin ◽  
...  
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Pregnancy Outcomes ◽  
Pap Smear ◽  
Polycystic Ovary ◽  
Clomiphene Citrate ◽  
Controlled Study ◽  
Control Group ◽  
Study Group ◽  
Metformin Treatment ◽  
Ovary Syndrome

Objective. The purpose of this study was to evaluate the relationship between clomiphene citrate (CC) plus metformin treatment and endometrial glycodelin expression and to then correlate this relationship with pregnancy outcomes.Material and Methods. A total of 30 patients diagnosed with polycystic ovary syndrome (PCOS) according to the Rotterdam criteria constituted our study group. All had been admitted to the gynecology outpatient clinic between June 1, 2011, and January 1, 2012, for infertility treatment. Our control group consisted of 20 patients admitted for routine Pap smear control. They had no history of infertility and were not using contraceptives and they were actively attempting pregnancy. Midluteal progesterone measurement and pipelle endometrial biopsies were performed with both groups. For PCOS patients, metformin treatment was initiated right after the biopsy and CC was added in the second menstrual cycle. Pipelle endometrial biopsies were repeated. Histological dating and immunohistochemistry for glycodelin were performed by a single pathologist who was blinded to the patients’ clinical data.Result(s). The posttreatment ovulation rate in the study group was 93.3%. No pregnancies were achieved in either group when glycodelin expression was not present, even in the presence of ovulation. When glycodelin expression was high in PCOS group, the pregnancy rate was 60% and all pregnancies ended in live births. In weak expression group, however, three out of four pregnancies ended as early pregnancy losses.Conclusion(s). Endometrial glycodelin expression is an important predictor of pregnancy outcomes in both PCOS and fertile groups.

PS02.208: THE SHIELDING METHOD WITH POLYGLYCOLIC ACID SHEETS AND FIBRIN GLUE FOR PREVENTING ESOPHAGEAL STRICTURE AFTER ENDOSCOPIC SUBMUCOSAL DISSECTION: A HISTORICAL CONTROL STUDY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 181-181
Author(s):  
Toshiro Iizuka ◽  
Daisuke Kikuchi ◽  
Yugo Suzuki ◽  
Shu Hoteya
Keyword(s):  
Fibrin Glue ◽  
Esophageal Stricture ◽  
Steroid Injection ◽  
Polyglycolic Acid ◽  
Control Group ◽  
Study Group ◽  
Group 4 ◽  
Stricture Rate ◽  
Intralesional Steroid ◽  
Intralesional Steroid Injection

Abstract Background There have been several reports that steroid administration are effective at preventing strictures after ESD. However, adverse events after steroid use are of great concern. We have reported that shielding with polyglycolic acid (PGA) sheets and fibrin glue can be useful for prevention of stricture after ESD. We conducted a retrospective analysis of efficiency of shielding with PGA sheets and fibrin glue for prevention of esophageal stricture compared with intralesional steroid injection. Methods ESD was performed on a total of 608 lesions in 553 patients for superficial esophageal cancer from January 2012 to March 2017. Of these, 45 lesions were enrolled in the study group (PGA sheets and fibrin glue) and 40 lesions were enrolled in the control group (intralesional steroid injection). The incidence of postoperative stricture at 6 weeks and the number of sessions of endoscopic balloon dilatation (EBD) required to resolve any strictures were evaluated. Among them, patients with additional surgery were excluded in both groups when investing the outcome. Results The post-ESD stricture rate was 10.5% in the study group (4/38 patients), which was not significantly lower than the stricture rate of 10.8% in the historical control group (4/37 patients; P = 0.63). The mean number of EBD was 1.2 ± 4.2 in the study group and 0.68 ± 2.2 in the control group, which was not significant (P = 0.47). Conclusion PGA sheets and fibrin glue appear to be a promising option for the prevention of esophageal stricture similar to the effect of intralesional steroid injection. Disclosure All authors have declared no conflicts of interest.

SAY NO to mild ovarian stimulation for all poor responders: it is time to realize that not all poor responders are the same

2020 ◽  
Vol 35 (9) ◽  
pp. 1964-1971 ◽  
Author(s):  
N P Polyzos ◽  
B Popovic-Todorovic
Keyword(s):  
Ovarian Stimulation ◽  
Ovarian Response ◽  
Poor Responder ◽  
Treatment Modalities ◽  
Poor Responders ◽  
Mild Ovarian Stimulation ◽  
Mild Stimulation ◽  
Current Article ◽  
Poor Ovarian Responders ◽  
Intense Stimulation

ABSTRACT Over the last 25 years, a vast body of literature has been published evaluating different treatment modalities for the management of poor ovarian responders. Despite the evidence that maximizing ovarian response can improve the chances of live born babies in poor responders, there are still voices suggesting that all poor responders are the same, irrespective of their age and their actual ovarian reserve. This has resulted in the suggestion of adopting a mild ovarian stimulation approach for all poor responders, based on the results of several trials which failed to identity differences when comparing mild and more intense stimulation in predicted poor responders. The current article analyzes in detail these studies and discusses the shortcomings in terms of type of population included, outcomes and settings performed, which may actually be responsible for the belief that only mild stimulation should be used. In the era of individualization in medicine, it must be realized that there are subgroups of predicted poor responders who will benefit from an individual rather than ‘one fits all’ mild stimulation approach and thus we should provide the same standard of treatment for all our poor responder patients.

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.

scholarly journals P-065. High fertilization rate after ovarian stimulation with clomiphene citrate for ICSI

1997 ◽  
Vol 12 (Suppl_2) ◽  
pp. 150-151
Author(s):  
R. Felberbaum ◽  
P. Montzka ◽  
W. Küpker ◽  
S. Al-Hasani ◽  
M. Ludwig ◽  
...  
Keyword(s):  
Ovarian Stimulation ◽  
Clomiphene Citrate ◽  
Fertilization Rate ◽  
High Fertilization

STUDY ON THE EFFECT OF ADVANCED MATERNAL AGE AT OBSTETRIC AND PERINATAL LEVEL

2021 ◽  
pp. 60-62
Author(s):  
Juliya John ◽  
Aswath Kumar ◽  
Saley Daniel
Keyword(s):  
Caesarean Section ◽  
Pregnancy Outcomes ◽  
Maternal Age ◽  
Gestational Hypertension ◽  
Preterm Labour ◽  
Perinatal Outcomes ◽  
Advanced Maternal Age ◽  
Control Group ◽  
Study Group ◽  
Adverse Perinatal Outcomes

INTRODUCTION: Advanced maternal age is commonly considered to be 35 years or older. The association between adverse perinatal outcomes and advanced maternal age has been a matter of controversy in several studies. While some researchers have noted an increased rate of adverse pregnancy outcomes in women older than 35 years, others have failed to nd any association between advanced maternal age and adverse perinatal outcomes. This discordance in conclusions could be attributed to the heterogeneity of study populations, differences in the denition of pregnancy outcomes, and failure to adjust for potential confounders. Therefore, we aimed to investigate the impact of advanced maternal age on obstetric and perinatal outcomes in this study. MATERIALS AND METHODS: The study was carried out among the patients who presented to the labour ward. This is a prospective observational study. The demographic data of these women, gestational age at time of delivery and complication during pregnancy are noted. They will be followed up till discharge and mode of delivery, perinatal outcome and any intrapartum and postpartum complications will be recorded in the research proforma. Sample Size: 252. RESULTS: Though there were higher incidence of Gestational hypertension, PROM, Preterm labour, placenta previa, Malpresentation, Multiple Pregnancy, FGR and treatment taken for infertility among the study group when compared to control group, their statistical signicance could not be established. There was also higher incidence of caesarean section (50.8%) and Operative vaginal delivery (2.6%) in the study group. There was no statistically signicant weight difference among the babies born to mothers in case and control group. CONCLUSION: Pregnant women of Advanced Maternal Age is thought about with great concern among the doctors as well as patients. In this study, there is an increased incidence of antenatal complications like Gestational Diabetes Mellitus, Gestational Hypertension, Caesarean Section and Preterm labour in women aged more than 35 years compared to the women of age 20 to 35 years.

Pregnancy outcomes among patients with recurrent pregnancy loss and chromosomal aberration (CA) without PGD

2018 ◽  
Vol 46 (7) ◽  
pp. 764-770 ◽  
Author(s):  
Maor Kabessa ◽  
Avi Harlev ◽  
Michael Friger ◽  
Ruslan Sergienko ◽  
Baila Litwak ◽  
...  
Keyword(s):  
Live Birth ◽  
Pregnancy Outcomes ◽  
Pregnancy Loss ◽  
Recurrent Pregnancy Loss ◽  
Control Group ◽  
Study Group ◽  
Birth Rates ◽  
Live Birth Rates ◽  
Index Pregnancy ◽  
Significant Difference

Abstract Background: Recurrent pregnancy loss (RPL) is defined by two or more failed clinical pregnancies. Three to four percent of the couples with RPL have chromosomal aberrations (CA) in at least one partner. The parent’s structural chromosomal abnormalities may cause an unbalanced karyotype in the conceptus which could lead to implantation failure, early or late pregnancy loss, or delivery of a child with severe physical and/or mental disabilities. Objective: To compare live birth rates of couples with CA to couples with normal karyotypes and to investigate medical and obstetric characteristics and pregnancy outcomes of couples with CA and RPL who attend an RPL clinic at a tertiary hospital. Methods: A retrospective cohort study, including 349 patients with two or more consecutive pregnancy losses. The study group consisted of 52 patients with CA, and the control group consisted of 297 couples with normal karyotype. All patients were evaluated and treated in the RPL clinic at Soroka University Medical Center and had at least one subsequent spontaneous pregnancy. Results: The demographic and clinical characteristics were not found to be statistically different between the two groups. The group of carriers of CA had 28/52 (53.8%) live births in their index pregnancy vs. the normal 202/297 (68%) (P=0.067, CI 95%) in the control group. No statistically significant etiology was found between the study group and the control group. A statistically significant difference in live birth rates was found when comparing the total amount of pregnancies [index pregnancy (IP)+post index pregnancy (PIP)] between the study group and the control group (54.16% vs. 67.82%, respectively, P=0.0328). Conclusion: Patients with RPL and CA who have spontaneous pregnancies, have a good prognosis (63.4%) of a successful pregnancy with at least one of the pregnancies (index or post index) resulting in a live birth.

scholarly journals Pregnancy outcomes in women with severe hypothyroidism

2013 ◽  
Vol 169 (3) ◽  
pp. 313-320 ◽  
Author(s):  
Dania Hirsch ◽  
Sigal Levy ◽  
Varda Nadler ◽  
Vered Kopel ◽  
Bracha Shainberg ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Control Group ◽  
Study Group ◽  
Maximum Serum ◽  
Health Maintenance ◽  
Median Serum ◽  
The Impact ◽  
Serum Tsh ◽  
Tsh Levels

ObjectiveHypothyroidism during pregnancy has been associated with adverse obstetrical outcomes. Most studies have focused on subjects with a mild or subclinical disorder. The aims of the present study were to determine the relative rate of severe thyroid dysfunction among pregnant women with hypothyroidism, identify related factors and analyse the impact on pregnancy outcomes.DesignA retrospective case series design was employed.MethodsThe study group included 101 pregnant women (103 pregnancies) with an antenatal serum TSH level >20.0 mIU/l identified from the 2009–2010 computerised database of a health maintenance organisation. Data were collected from the medical records. Pregnancy outcomes were compared with those of a control group of 205 euthyroid pregnant women during the same period.ResultsThe study group accounted for 1.04% of all insured pregnant women with recorded hypothyroidism during the study period. Most cases had an autoimmune aetiology. All women were treated with levothyroxine (l-T4) during pregnancy. Maximum serum TSH level measured was 20.11–150 mIU/l (median 32.95 mIU/l) and median serum TSH level 0.36–75.17 mIU/l (median 7.44 mIU/l). The mean duration of hypothyroidism during pregnancy was 21.2±13.2 weeks (median 18.5 weeks); in 36 cases (34.9%), all TSH levels during pregnancy were elevated. Adverse pregnancy outcomes included abortions in 7.8% of the cases, premature deliveries in 2.9% and other complications in 14.6%, with no statistically significant differences from the control group. Median serum TSH level during pregnancy was positively correlated with the rate of abortions+premature deliveries and rate of all pregnancy-related complications (P<0.05).ConclusionsAbortions and premature deliveries occur infrequently in women with severe hypothyroidism. Intense follow-up and l-T4 treatment may improve pregnancy outcomes even when target TSH levels are not reached.

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