Laparoscopic Ablation of Endometriosis in Infertile Patients: A Retrospective Study

2011 ◽  
Vol 3 (1) ◽  
pp. 53-57
Author(s):  
Fortunato Genovese ◽  
Maria Cristina Teodoro ◽  
Gabriella Rubbino ◽  
Marco Antonio Palumbo ◽  
Giuseppe Zarbo
Keyword(s):  
Pregnancy Rate ◽  
Live Birth ◽  
Birth Rate ◽  
Early Stage ◽  
Live Birth Rate ◽  
Fertility Rate ◽  
Cumulative Live Birth Rate ◽  
Cumulative Live Birth ◽  
Group A ◽  
Group B

Purpose Even at the early stage endometriosis, may be associated with infertility, whose treatment, which is not always straightforward, is often controversial. This study intends to determine the effectiveness of laparoscopic ablation of lesions at an early stage. Methods The charts of 250 women suffering from infertility, admitted from July 1998 to December 2008 to the obstetric and gynecologic departments of Vittorio Emanuele and Santo Bambino hospitals in Catania were reviewed. Among these women, 97 patients (38.8%) affected by stage 1 and 2 endometriosis were found and divided into 2 groups of 53 (A) and 44 (B) patients. According to the approach of the surgeon, group A patients underwent laparoscopic ablation of endometriotic lesions with or without adesiolysis, while group B patients only had diagnostic laparoscopy. Cumulative pregnancy rate, cumulative live birth rate, monthly fertility rate and outcome of pregnancies (miscarriages and live birth), developed within the first year soon after laparoscopy, were determined in each group. Results This study shows that, according to the literature, laparoscopic systematic destruction of minimal and mild stage endometriotic lesions, improves the cumulative pregnancy rate (49.1% in group A versus 22.7% in group B) and cumulative live birth rate (39.6% in group A versus 18.2% in group B) in selected patients. However, this type of intervention, by itself, does not normalize the monthly fertility rate that remains low in both groups (4.1% in group A and 1.9% in group B). Conclusions This study suggests that laparoscopic treatment of minimal-mild endometriotic lesions is a valid therapeutic option because it improves the fertility rate, even if it does not completely resolve the reduced fertility.

scholarly journals The key factors affecting cumulative live birth rate after single oocyte retrieved in women during IVF/ICSI-ET: a retrospective analysis of 1380 PCOS patients

2021 ◽  
Author(s):  
You Li ◽  
Leizhen Xia ◽  
Jun Tan ◽  
Qiongfang Wu ◽  
Ziyu Zhang
Keyword(s):  
Live Birth ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Cumulative Live Birth Rate ◽  
Factors Affecting ◽  
Live Births ◽  
Cumulative Live Birth ◽  
Starting Dose ◽  
Group A ◽  
Group B

Abstract Background: The factors affecting the cumulative live birth rate (CLBR) of PCOS patients who received in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) are unknown.Methods: Here we carried out a retrospective analysis of 1380 PCOS patients who received IVF/ICSI-ET for the first time from January 2014 to December 2016. According to the cumulative live births of PCOS patients after single oocyte collection, they were divided into cumulative live births group (group A) and non-cumulative live births group (group B).Results: The conservative cumulative live birth rate was 63.48%. There were 876 cumulative live births (group A) and 504 non-cumulative live births (group B) according to whether the patients had live births or not. Competition analysis showed that duration of infertility, primary/secondary type of infertility, stimulation protocols, starting dose of gonadotrophins and oocyte retrieved numbers were significantly correlated with CLBR. The Cox proportional risk regression model of PCOS patients showed that stimulation protocols had a significant impact on CLBR. Patients in the GnRH-antagonist protocol group and the mild stimulation protocol had lower CLBR than those in the Prolonged GnRH-agonist protocol, which was statistically significant. PCOS patients with the starting dose of gonadotrophins greater than 112.5u had lower CLBR than those with less than 100u, which was statistically significant. Women with 11-15 oocytes and 16-20 oocytes had higher CLBR than women with 1-9 oocytes, which was statistically significant.Conclusions: According to our statistical results, patients with PCOS represent a challenge for reproductive medicine.

P–291 Searching for a suitable serum progesterone range at triggering day to achieve optimal cumulative live birth rate in high responders – Which range is better?

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
M J Chen ◽  
C Ya-Fang ◽  
G Hwa-Fen ◽  
Y Yu-Chiao ◽  
K Hsioa-Fan ◽  
...  
Keyword(s):  
Pregnancy Outcome ◽  
Live Birth ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Blastocyst Formation ◽  
Cumulative Live Birth Rate ◽  
Cumulative Live Birth ◽  
Group A ◽  
Group B ◽  
High Responders

Abstract Study question Is there a suitable range of serum progestereone level at triggering day to optimize the cumulative live birth rate (LBR) in high responders? Summary answer Fom the point of view of cLBR, the optimal P4 range for triggering is between 1.5 to 2.5 ng/ml generally and in the high responders. What is known already It is well established that premature progesterone rise (PPR) affect adversely the pregnancy outcome in fresh embryo transfer cycle. It is inferred that PPR alters synchrony between endometrium and the embryos. However, detailed study of the effect of PPR on efficiency of oocyte retrieval , embryo quality and the subsequent cumulative pregnancy outcome is still lacking. Hence we sort to analyze the effect of PPR on the final cumulative LBR in our program especially focused on high responders. Study design, size, duration ART Database in our center was retrospectively reviewed. Total 1523 cycles between 20160101 and 20191231 were recruited under the condition of GnRH antagonist cycle with duration of ovulation induction for more than 5 days and available serum P4 level data on triggering day for data analysis for the relationship between serum P4 value and final cumulative LBRs. Participants/materials, setting, methods Cycles with serum P4 level < 1.5 ng/ml were defined as without PPR (Group A: n = 1383). Cycles with serum P4 level >1.5 were defined as with PPR: P4 between 1.5 and 2.5 as Group B (n = 113), P4 > 2.5 as Group C (n = 27). Those high responding cycles (n = 404) were analyzed similarly and separately as Group A’ (n = 304), B’ (n = 81) and C’(n = 19). The statistics were carried out by SPSS-PC ver. 22.0 with p < 0.05 as statistical significance. Main results and the role of chance Group A had significantly lower number of oocytes (9.8 + 8.0) retrieved as compared to Group B (19.3 + 11.2) and Group C (18.2 + 9.9). However there were no differences in fertilization rate, good embryo rates and BC formation rates between groups. The cumulative LBR (cLBR) were significantly higher in Group B (65.1%) as compared to Group A (40.9%, p < 0.001) and Group C (37.0%, p = 0.008). For the high responding cycles, Group B’ also had marginally significant higher cLBR (75.3%) as compared to group A’(63.8% ; p=0.051) and Group C’ (52.6%; p = 0.050). Comparisons between Group A’ and C revealed significantly less oocytes retrieved but significantly higher blastocyst formation rates in Group A’ and the resultant cLBR were comparable between these two groups. Comparisons between Groups B’ and C’ revealed comparable oocytes retrieved but significant lower blastocyst formation rates and cLBRs in Group C’. The baseline of the first part analysis revealed higher age and lower AMH in Group A, but comparable age and AMH between groups B and C.The lower cLBR in group A could be due to selection bias.The second part (high responders) showed comparable baselines between three groups. However, the case numbers are too few in group C’ which might also result in uncertainty. Limitations, reasons for caution Although the data revealed interesting, significantly different results between groups, this is only a retrospective analysis from our ART patient series. Selection bias could not be precluded. Analysis restricted to high responders could have a more balanced population for comparisons. However, more cases are needed to affirm the findings. Wider implications of the findings: We still do not know the tolerable ceiling of serum P4 at the triggering day in high responders if future FET already planned. Pushing P4 value too high not only could not increase mature oocyte yields and possibly may decrease the number of available good blastocysts for optimizing final cLBRs. Trial registration number Not applicable

scholarly journals rLH/rFSH Combination Improved Cumulative Live Birth Rate in Patients With LH Over-Suppression Following GnRH Agonist Pituitary Down-Regulation Compared to rFSH or hMG Alone: A Retrospective Cohort Study With Propensity Score Matching

2021 ◽  
Author(s):  
Ansu Tu ◽  
Lihong Geng ◽  
Ying Zhong
Keyword(s):  
Propensity Score ◽  
Pregnancy Rate ◽  
Propensity Score Matching ◽  
Live Birth ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Cumulative Live Birth Rate ◽  
Down Regulation ◽  
Cumulative Live Birth ◽  
Secondary Endpoints

Abstract PurposeThe suppression of luteinizing hormone (LH) in patients undergoing gonadotropin-releasing hormone agonist (GnRH-a) pituitary down-regulation may cause LH deficiency which may impact follicular development. However, little is known about effect of LH adding in patients with LH over-suppression. This study to investigate the effects of different gonadotropins on the cumulative live birth rate (CLBR) in the patients with LH over-suppression after GnRH-a pituitary down-regulation. MethodsThis retrospective study used propensity score-matching methodology to compare CLBR, as the primary endpoint, in the patients with LH over-suppression after different GnRH-a pituitary down-regulation regimens, including recombinant follicle stimulating hormone (rFSH) combined with recombinant LH (rLH), or using rFSH alone, or human menopausal gonadotropin (hMG) alone. The secondary endpoints included biochemical pregnancy rate, clinical pregnancy rate, and live birth rate in fresh embryo transfer cycles. ResultsA total of 88 patients were enrolled after matching: 22 patients in the rFSH+rLH group, 44 in the rFSH group, and 22 in the hMG group. The CLBR of the rFSH+rLH group was significantly higher than that of the rFSH and hMG groups (19/22, 86.4% vs. 25/44, 56.8%, P = 0.014; vs. 7/22, 31.8%, P < 0.001). Moreover, the rFSH group had a higher CLBR than the hMG group (P = 0.048). There were no significant differences in any of the secondary endpoints (all P > 0.05). ConclusionExogenous rLH supplementation achieved a higher CLBR than rFSH or hMG alone among patients with LH over-suppression; furthermore, rFSH alone was superior to hMG alone for CLBR.

scholarly journals Effect of GnRH Agonist Alone or Combined With Different Low-dose hCG on Cumulative Live Birth Rate for High Responders in GnRH Antagonist Cycles: a Retrospective Study

2021 ◽  
Author(s):  
Yuxia He ◽  
Yan Tang ◽  
Shiping Chen ◽  
Jianqiao Liu ◽  
Haiying Liu
Keyword(s):  
Live Birth ◽  
Oocyte Maturation ◽  
Low Dose ◽  
Live Birth Rate ◽  
Cumulative Live Birth Rate ◽  
Oocyte Maturity ◽  
Cumulative Live Birth ◽  
Group A ◽  
Group B ◽  
High Responders

Abstract Background: There is insufficient evidence regarding the impact of dual trigger on oocyte maturity and reproductive outcomes in high responders. Thus, we aimed to explore the effect of gonadotropin-releasing hormone agonist (GnRHa) trigger alone or in combination with different low-dose human chorionic gonadotropin (hCG) regimens on rates of oocyte maturation and cumulative live birth in high responders who underwent a freeze-all strategy in GnRH antagonist cycles.Methods: A total of 1343 cycles were divided into three groups according to different trigger protocols: group A received GnRHa 0.2 mg (n=577), group B received GnRHa 0.2 mg and hCG 1000 IU (n=403), and group C received GnRHa 0.2 mg and hCG 2000 IU (n=363). Results: There were no significant differences in age, body mass index, and rates of oocyte maturation, fertilization, available embryo, and top-quality embryo between the groups. However, the incidence of moderate to severe ovarian hyperstimulation syndrome (OHSS) was significantly different between the three groups (0% in group A, 1.49% in group B, and 1.38% in group C). For the first frozen embryo transfer (FET) cycle, there were no significant differences in the number of transferred embryos and rates of implantation, clinical pregnancy, live birth, and early miscarriage between the three groups. Additionally, the cumulative ongoing pregnancy rate and cumulative live birth rate were not significantly different between the three groups. Similarly, there were no significant differences in gestational age, birth weight, birth height, and the proportion of low birth weight among subgroups stratified by singleton or twin.Conclusions: GnRHa trigger combined with low-dose hCG (1000 IU or 2000 IU) did not improve oocyte maturity and embryo quality and was still associated with an increased risk of moderate to severe OHSS. Therefore, for high responders treated with the freeze-all strategy, the GnRHa single trigger is recommended for final oocyte maturation, which can prevent the occurrence of moderate to severe OHSS and obtain satisfactory pregnancy and neonatal outcomes in subsequent FET cycles.

scholarly journals Dual Trigger for Final Follicular Maturation Improves Cumulative Live-Birth Rate in Ovarian Stimulation for Freeze-All In Vitro Fertilization/Intracytoplasmic Sperm Injection Cycles

2021 ◽  
Vol 12 ◽  
Author(s):  
Haiyan Zhu ◽  
Chenqiong Zhao ◽  
Yibin Pan ◽  
Hanjing Zhou ◽  
Xiaoying Jin ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Live Birth ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Cumulative Live Birth Rate ◽  
Cumulative Live Birth ◽  
Hcg Trigger

Study QuestionDoes dual trigger in freeze-all in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles improve the cumulative live-birth outcome compared with human chorionic gonadotropin (hCG) trigger?Summary AnswerDual trigger for final follicular maturation improves the cumulative pregnancy and live-birth rates compared with hCG trigger in freeze-all IVF/ICSI cycles.What Is Known AlreadyDual trigger could increase the numbers of oocytes and mature oocytes and improve pregnancy rates.Study Design, Size, DurationThis retrospective cohort analysis included data from 4438 freeze-all IVF/ICSI cycles between January 2012 and December 2017.Participants/Materials, Setting, MethodsWomen aged 20−49 years who underwent ovarian stimulation and oocyte retrieval for autologous IVF/ICSI with a freeze-all policy in our centre were enrolled. Data on number of oocytes retrieved, number of mature oocytes, clinical pregnancy rate, live-birth rate, cumulative pregnancy rate, and cumulative live-birth rate (CLBR) were assessed and compared between patients who underwent a dual trigger and hCG trigger. Multivariate logistic regression was performed to identify and adjust for factors known to independently affect the CLBR.Main Results and the Role of ChanceA total of 4438 IVF/ICSI cycles were analyzed, including 1445 cycles with single hCG trigger and 2993 cycles with dual trigger. The cumulative biochemical pregnancy rate (60.8% vs. 68.1%, P&lt;0.001; odds ratio (OR): 0.727; 95% confidence interval (CI): 0.638–0.828), cumulative clinical pregnancy rate (52.9% vs. 58.5%, P&lt;0.001; OR: 0.796; 95%CI: 0.701–0.903), and CLBR (44.3% vs. 50.5%, P&lt;0.001; OR: 0.781; 95%CI: 0.688–10.886) were all significantly lower in the hCG-trigger group compared with the dual-trigger group. The clinical pregnancy rate (48.2% vs. 58.2%, P=0.002; OR: 0.829; 95%CI: 0.737–0.934) and embryo implantation rate (34.4% vs. 38.9%, P&lt;0.001; OR: 0.823; 95%CI: 0.750–0.903) in each transfer cycle were also significantly lower in the hCG-trigger group compared with the dual-trigger group. After controlling for all potential confounding variables, the trigger method was identified as an independent factor affecting the CLBR. The OR and 95%CI for hCG trigger were 0.780 and 0.641–0.949 (P=0.013).Limitations, Reasons for CautionThe data used to analyse the effect of dual trigger on cumulative pregnancy and live-birth outcomes were retrospective, and the results may thus have been subject to inherent biases. Further prospective randomized controlled trials are required to verify the beneficial effects of dual trigger.Wider Implications of the FindingsDual trigger had a positive effect on CLBRs, suggesting that it could be used as a routine trigger method in freeze-all cycles.Study Funding/Competing Interest(s)This study was supported by grants from National Key Research and Development Program of China (2018YFC1004800), the Natural Science Program of Zhejiang (LY19H040009), the National Natural Science Foundation of China (No. 81601236). No authors have competing interests to declare.

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