8 results on '"Broekmans, F. J."'
Search Results
2. The poor responder in IVF: is the prognosis always poor?: a systematic review.
- Author
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Oudendijk JF, Yarde F, Eijkemans MJ, Broekmans FJ, and Broer SL
- Subjects
- Adult, Age Factors, Female, Humans, Oocytes, Ovulation Induction, Pregnancy, Prognosis, Fertilization in Vitro, Pregnancy Rate
- Abstract
BACKGROUND In IVF treatment a considerable proportion of women are faced with a low number of oocytes retrieved. These poor responders have reduced pregnancy rates compared with normal responders. However, this may not be applicable to all poor responders. This review aims at identifying patient characteristics and ovarian reserve tests (ORT) that will determine prognosis for pregnancy in poor responders. METHODS A systematic search was conducted in PubMed, Embase, Cochrane and SCOPUS databases in April 2010. Studies regarding patient characteristics or ORT in poor responders and their pregnancy prospects were included. All included papers were summarized in descriptive tables. RESULTS Nineteen studies were included. Pooled data of six studies comparing poor and normal responders demonstrated clearly lower pregnancy rates in poor responders (14.8 versus 34.5%). Ten studies indicated that older poor responders have a lower range of pregnancy rates compared with younger (1.5-12.7 versus 13.0-35%, respectively). Four studies showed that pregnancy prospects become reduced when fewer oocytes are retrieved (0-7% with 1 oocyte versus 11.5-18.6% with 4 oocytes). Five studies concerning pregnancy rates in subsequent cycles suggested a more favourable outcome in unexpected poor responders, and if ≥2 oocytes were retrieved. CONCLUSIONS Poor responders are not a homogeneous group of women with regards to pregnancy prospects. Female age and number of oocytes retrieved in particular will modulate the chances for pregnancy in current and subsequent cycles. Applying these criteria will allow the identification of couples with a reasonable prognosis and balanced decision-making on the management of poor responders. more...
- Published
- 2012
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3. Clinical outcomes in relation to the daily dose of recombinant follicle-stimulating hormone for ovarian stimulation in in vitro fertilization in presumed normal responders younger than 39 years: a meta-analysis.
- Author
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Sterrenburg MD, Veltman-Verhulst SM, Eijkemans MJ, Hughes EG, Macklon NS, Broekmans FJ, and Fauser BC
- Subjects
- Adult, Female, Follicle Stimulating Hormone adverse effects, Follicle Stimulating Hormone pharmacology, Humans, Pregnancy, Pregnancy Rate, Recombinant Proteins, Risk Assessment, Treatment Outcome, Fertilization in Vitro, Follicle Stimulating Hormone administration & dosage, Ovulation Induction methods
- Abstract
Background: The optimal ovarian stimulation dose to obtain the best balance between the probability of pregnancy and the risk of complications, while maximizing cost-effectiveness of in vitro fertilization (IVF) treatment, is yet to be established., Methods: A systematic search of the electronic databases PubMed, EMBASE and Cochrane library, from 1984 until October 2009 for randomized controlled trials comparing different doses of recombinant FSH in IVF, was performed., Results: Ten studies (totaling 1952 IVF cycles) were included in the present meta-analysis, comprising patients younger than 39 years with regular menstrual cycle, normal basal FSH levels and two normal ovaries. Comparison was made between studies using a daily dose of 100 versus 200 IU recFSH, and between 150 versus 200 IU recFSH or higher. Although oocyte yield was greater in the >200 IU/day dose group, pregnancy rates were similar compared with lower dose groups. The risk of insufficient response to ovarian stimulation was greatest in the 100 IU/day dose group. The risk of developing ovarian hyperstimulation syndrome was greater in the >200 IU/day dose group. The number of embryos available for cryopreservation was lowest in the 100 IU/day group, but similar comparing the 150 IU/day and the >200 IU/day dose groups., Conclusions: This meta-analysis suggests that the optimal daily recFSH stimulation dose is 150 IU/day in presumed normal responders younger than 39 years undergoing IVF. Compared with higher doses, this dose is associated with a slightly lower oocyte yield, but similar pregnancy and embryo cryopreservation rates. Furthermore, the wide spread adherence to this optimal dose will allow for a considerable reduction in IVF costs and complications. more...
- Published
- 2011
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4. AMH and AFC as predictors of excessive response in controlled ovarian hyperstimulation: a meta-analysis.
- Author
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Broer SL, Dólleman M, Opmeer BC, Fauser BC, Mol BW, and Broekmans FJ
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- Female, Fertilization in Vitro, Follicle Stimulating Hormone adverse effects, Follicle Stimulating Hormone pharmacology, Humans, Ovarian Hyperstimulation Syndrome chemically induced, Predictive Value of Tests, Prognosis, Sensitivity and Specificity, Anti-Mullerian Hormone analysis, Ovarian Follicle cytology, Ovarian Hyperstimulation Syndrome diagnosis, Ovulation Induction adverse effects
- Abstract
Background: Anti-Mullerian hormone (AMH) is a marker of ovarian reserve status and represents a good predictor of ovarian response to ovarian hyperstimulation. The aim of this study was to assess the accuracy of AMH and antral follicle count (AFC) as predictors of an excessive response in IVF/ICSI treatment., Methods: A systematic review and meta-analysis of the existing literature was performed. Studies were included if 2 × 2 tables for the outcome excessive response in IVF patients in relation to AMH/AFC could be constructed. Using a bivariate meta-analytic model, both summary point estimates for sensitivity and specificity were calculated, as well as summary ROC curves. Clinical value was analysed by calculating post-test probabilities of excessive response at optimal cut-off levels, as well as the corresponding abnormal test rates., Results: Nine studies reporting on AMH and five reporting on AFC were found. Summary estimates of sensitivity and specificity for AMH were 82 and 76%, respectively, and 82 and 80%, respectively, for AFC. Comparison of the summary estimates and ROC curves for AMH and AFC showed no statistical difference. Abnormal test rates for AMH and AFC amounted to ∼14 and 16%, respectively, at cut-off levels where test performance is optimal [likelihood ratio for a positive result (LR + ) > 8], with a post-test probability of ± 70%., Conclusions: Both AMH and AFC are accurate predictors of excessive response to ovarian hyperstimulation. Moreover, both tests appear to have clinical value. This opens ways to explore the potential of individualized FSH dose regimens based on ovarian reserve testing. more...
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- 2011
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5. The clinical significance of the retrieval of a low number of oocytes following mild ovarian stimulation for IVF: a meta-analysis.
- Author
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Verberg MF, Eijkemans MJ, Macklon NS, Heijnen EM, Baart EB, Hohmann FP, Fauser BC, and Broekmans FJ
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- Adult, Embryo Transfer, Female, Follicle Stimulating Hormone administration & dosage, Follicle Stimulating Hormone therapeutic use, Humans, Pregnancy, Pregnancy Rate, Randomized Controlled Trials as Topic, Sperm Injections, Intracytoplasmic, Fertilization in Vitro, Oocyte Retrieval, Ovulation Induction methods
- Abstract
Background: Milder ovarian stimulation protocols for in vitro fertilization (IVF) are being developed to minimize adverse effects. Mild stimulation regimens result in a decreased number of oocytes at retrieval. After conventional ovarian stimulation for IVF, a low number of oocytes are believed to represent poor ovarian reserve resulting in reduced success rates. Recent studies suggest that a similar response following mild stimulation is associated with better outcomes., Methods: This review investigates whether the retrieval of a low number of oocytes following mild ovarian stimulation is associated with impaired implantation rates. Three randomized controlled trials comparing the efficacy of the mild ovarian stimulation regimen (involving midfollicular phase initiation of FSH and GnRH co-treatment) for IVF with a conventional long GnRH agonist co-treatment stimulation protocol could be identified by means of a systematic literature search., Results: These studies comprised a total of 592 first treatment cycles. Individual patient data analysis showed that the mild stimulation protocol results in a significant reduction of retrieved oocytes compared with conventional ovarian stimulation (median 6 versus 9, respectively, P < 0.001). Optimal embryo implantation rates were observed with 5 oocytes retrieved following mild stimulation (31%) versus 10 oocytes following conventional stimulation (29%) (P = 0.045)., Conclusions: The optimal number of retrieved oocytes depends on the ovarian stimulation regimen. After mild ovarian stimulation, a modest number of oocytes is associated with optimal implantation rates and does not reflect a poor ovarian response. Therefore, the fear of reducing the number of oocytes retrieved following mild ovarian stimulation appears to be unjustified. more...
- Published
- 2009
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6. Mild ovarian stimulation for IVF.
- Author
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Verberg MF, Macklon NS, Nargund G, Frydman R, Devroey P, Broekmans FJ, and Fauser BC
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- Birth Rate, Clinical Protocols, Embryo Implantation, Female, Follicle Stimulating Hormone administration & dosage, Follicle Stimulating Hormone pharmacology, Follicle Stimulating Hormone therapeutic use, Humans, Ovarian Follicle drug effects, Ovarian Follicle growth & development, Ovulation Induction trends, Pregnancy, Pregnancy Rate, Randomized Controlled Trials as Topic, Fertilization in Vitro, Ovulation Induction methods
- Abstract
Background: Mild ovarian stimulation for in vitro fertilization (IVF) aims to achieve cost-effective, patient-friendly regimens which optimize the balance between outcomes and risks of treatment., Methods: Pubmed and Medline were searched up to end of January 2008 for papers on ovarian stimulation protocols for IVF. Additionally, references to related studies were selected wherever possible., Results: Studies show that mild interference with the decrease in follicle-stimulating hormone levels in the mid-follicular phase was sufficient to override the selection of a single dominant follicle. Gonadotrophin-releasing hormone antagonists compared with agonists reduce length and dosage of gonadotrophin treatment without a significant reduction in the probability of live birth (OR 0.86, 95% CI 0.72-1.02). Mild ovarian stimulation may be achieved with limited gonadotrophins or with alternatives such as anti-estrogens or aromatase inhibitors. Another option is luteinizing hormone or human chorionic gonadotrophin administration during the late follicular phase. Studies regarding these approaches are discussed individually; small sample size of single studies along with heterogeneity in patient inclusion criteria as well as outcomes analysed does not allow a meta-analysis to be performed. Additionally, the implications of mild ovarian stimulation for embryo quality, endometrial receptivity, cost and the psychological impact of IVF treatment are discussed., Conclusions: Evidence in favour of mild ovarian stimulation for IVF is accumulating in recent literature. However, further, sufficiently powered prospective studies applying novel mild treatment regimens are required and structured reporting of the incidence and severity of complications, the number of treatment days, medication used, cost, patient discomfort and number of patient drop-outs in studies on IVF is encouraged. more...
- Published
- 2009
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7. The accuracy of multivariate models predicting ovarian reserve and pregnancy after in vitro fertilization: a meta-analysis.
- Author
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Verhagen TE, Hendriks DJ, Bancsi LF, Mol BW, and Broekmans FJ
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- Cell Count, Female, Humans, Multivariate Analysis, Ovary cytology, Pregnancy, Fertilization in Vitro, Models, Biological, Ovarian Follicle cytology, Ovary physiology, Pregnancy Outcome
- Abstract
BACKGROUND To review the accuracy of multivariate models for the prediction of ovarian reserve and pregnancy in women undergoing IVF compared with the antral follicle count (AFC) as single test. METHODS We performed a computerized MEDLINE and EMBASE search to identify articles published on multivariate models for ovarian reserve testing in patients undergoing IVF. In order to be selected, articles had to contain data on the outcome of IVF in terms of either pregnancy and/or poor response and on the prediction of these events based on a multivariate model. For the selected studies, sensitivity and specificity of the test in the prediction of poor ovarian response and non-pregnancy were calculated. Overall performance was assessed by estimating a summary receiver operating characteristic (ROC) curve, which was compared with the ROC curve for the AFC as the current best single test. RESULTS We identified 11 studies reporting on the predictive capacity of multivariate models in ovarian reserve testing. All studies reported on the prediction of poor ovarian response, whereas none reported on the occurrence of pregnancy. The sensitivity for prediction of poor ovarian response varied between 39% and 97% and the specificity between 50% and 96%. Logistic regression analysis indicated that cohort studies provided a significantly better discriminative performance than case-control studies. As cohort studies are superior to case-control studies, further analysis was limited to the cohort studies. For the cohort studies, a summary ROC curve could be estimated, which had a shape similar to that previously made for the AFC. CONCLUSIONS The accuracy of multivariate models for the prediction of ovarian response in women undergoing IVF is similar to the accuracy of AFC. No data are available on the capacity of these models to predict pregnancy, let alone live birth. On the basis of these findings, the use of more than one single test for the assessment of ovarian reserve cannot currently be supported. more...
- Published
- 2008
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8. A systematic review of tests predicting ovarian reserve and IVF outcome.
- Author
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Broekmans FJ, Kwee J, Hendriks DJ, Mol BW, and Lambalk CB
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- Anti-Mullerian Hormone, Biopsy, Cell Count, Estradiol metabolism, Female, Follicle Stimulating Hormone analysis, Follicle Stimulating Hormone metabolism, Glycoproteins analysis, Glycoproteins metabolism, Humans, Inhibins analysis, Inhibins metabolism, Ovarian Follicle cytology, Predictive Value of Tests, Pregnancy, Testicular Hormones analysis, Testicular Hormones metabolism, Ovarian Function Tests methods, Ovary physiology
- Abstract
The age-related decline of the success in IVF is largely attributable to a progressive decline of ovarian oocyte quality and quantity. Over the past two decades, a number of so-called ovarian reserve tests (ORTs) have been designed to determine oocyte reserve and quality and have been evaluated for their ability to predict the outcome of IVF in terms of oocyte yield and occurrence of pregnancy. Many of these tests have become part of the routine diagnostic procedure for infertility patients who undergo assisted reproductive techniques. The unifying goals are traditionally to find out how a patient will respond to stimulation and what are their chances of pregnancy. Evidence-based medicine has progressively developed as the standard approach for many diagnostic procedures and treatment options in the field of reproductive medicine. We here provide the first comprehensive systematic literature review, including an a priori protocolized information retrieval on all currently available and applied tests, namely early-follicular-phase blood values of FSH, estradiol, inhibin B and anti-Müllerian hormone (AMH), the antral follicle count (AFC), the ovarian volume (OVVOL) and the ovarian blood flow, and furthermore the Clomiphene Citrate Challenge Test (CCCT), the exogenous FSH ORT (EFORT) and the gonadotrophin agonist stimulation test (GAST), all as measures to predict ovarian response and chance of pregnancy. We provide, where possible, an integrated receiver operating characteristic (ROC) analysis and curve of all individual evaluated published papers of each test, as well as a formal judgement upon the clinical value. Our analysis shows that the ORTs known to date have only modest-to-poor predictive properties and are therefore far from suitable for relevant clinical use. Accuracy of testing for the occurrence of poor ovarian response to hyperstimulation appears to be modest. Whether the a priori identification of actual poor responders in the first IVF cycle has any prognostic value for their chances of conception in the course of a series of IVF cycles remains to be established. The accuracy of predicting the occurrence of pregnancy is very limited. If a high threshold is used, to prevent couples from wrongly being refused IVF, a very small minority of IVF-indicated cases (approximately 3%) are identified as having unfavourable prospects in an IVF treatment cycle. Although mostly inexpensive and not very demanding, the use of any ORT for outcome prediction cannot be supported. As poor ovarian response will provide some information on OR status, especially if the stimulation is maximal, entering the first cycle of IVF without any prior testing seems to be the preferable strategy. more...
- Published
- 2006
- Full Text
- View/download PDF
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