Different Methods for Inducing Final Oocyte Maturation When Employing Progesterone-Primed Ovarian Stimulation Protocols

Background Evidently, when undergoing GnRH-antagonist protocols, dual trigger has proven to produce not just better quality and quantity of oocytes but also pregnancy outcome. However, not much comparative studies have been published when PPOS protocol is used for ovarian stimulation. Can the same positive outcomes be expected after the patients have been exposed to the high level of progesterone required for PPOS protocols? Methods In this retrospective cohort study, patients undergoing PPOS protocols were separated into three groups based on the method employed for triggering final follicular maturation, which included: (a) human chorionic gonadotropin (hCG); (b) Gonadotropin-releasing hormone-agonist (GnRH-agonist); or (c)dual trigger (GnRH-agonist + hCG). Either in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) was utilized for fertilization. Assessment comprised of their dynamic hormone profiles, embryonic analysis, and clinical outcomes. Results Of the 344 recruited patients, those fulfilling the Bologna criteria as poor ovarian responders and showing Estradiol (E2)<1000 pg/ml on the day of triggering had higher oocyte maturation rate (82% vs 58%, p<0.05) when triggered with dual trigger (GnRH-agonist + hCG) than hCG alone. For the patients with E2> 6500 pg/ml on the day of triggering, none of the three triggering methods demonstrated a significant advantage regarding the number of oocytes, percentage of matured oocytes, and rate of oocytes at fertilization or cleavage stages. Conclusions Implementing dual trigger for stimulating final follicular maturation in patients undergoing PPOS protocols is debatable. For poor ovarian response (POR) patients, dual trigger appeared to yield higher percentage of matured oocytes. In contrast, for hyper-responders, methods of triggering oocyte maturation did not affect the percentage of matured oocytes or the qualities of the embryos. For this group of patients, therefore, the agent used should be one that would reduce the risks of ovarian hyper-stimulation syndrome (OHSS).

Strong Evidences of the Ovarian Carcinoma Risk in Women after IVF Treatment: A Review Article

Background: In-vitro fertilization (IVF) has been very popular since the birth of the first “test-tube” baby. This method is the last hope and the most serious solution for couples with infertility problems. Although childbearing is a concern of many couples, it must always be noted that any method can also have disadvantages. Thus, many studies have been done on the problems encountered by this method. vantages. Thus, many studies have been done on the problems encountered by this method. Methods: We searched for relevant articles in Pub Med, Springer, Elsevier, and Google Scholar databases, and studied more than 70 papers. Keywords used included ovarian cancer, in vitro fertilization, gonadotropin hormone, clomiphene citrate, and infertility. Results: Due to the large number of studies, high doses of the ovulation-stimulating drugs and their repeated use in this method can increase the risk of the ovarian hyper stimulation syndrome (OHSS), and ovarian cysts, which can lead to ovarian cancer. Also, an increase in the risk of developing ovarian cancer can be due to the increased duration of treatment for up to 12 months and the high doses of medications that are followed by defecation and failure of this treatment. Conclusion: Due to the increase in the rates of infertility treatments and the incidence of gynecological cancers, especially ovarian cancer, this method need to be used with caution. IVF clients and candidates should be informed about potential future risks. People should be evaluated genetically for their history of ovarian cancer and be more aware of the importance of “Personalized medicine”.

New laws ban commercial surrogacy in India

Surrogacy is a controversial issue and most particularly when well-known celebrities have used it. It is a boon for couples where normal pregnancy is not possible but can be used for commercial exploitation. The Government of India passed a law on surrogacy in December 2018, which introduced many changes to the pre-existing rules, in particular, it bans commercial surrogacy and curtails the freedom of foreigners to apply for surrogacy in India. This has dealt a major blow to the agencies who organised surrogacy for foreigners. A key reason for passing this law was the unjust treatment of the women who provided surrogacy services. They had poor living conditions and often failed to receive the money that was paid by the intended parents to the agency. 2 There are some countries where commercial surrogacy is legal, including some states in the United States of America, Poland, Russia and many others. 3 Some surrogate mothers suffer complications from the assisted reproductive technologies used; these mainly include ectopic pregnancy, psychological stress and ovarian hyper stimulation syndrome. 4 Same sex couples, single parents and even infertile women should be encouraged to adopt children.