Search

Research question: Urine LH testing may be useful to confirm an LH surge after the GnRH agonist (GnRHa) trigger prior to oocyte retrieval in IVF. Design: A prospective cohort study, including oocyte donors undergoing ovarian stimulation, treated with a GnRHa trigger for final oocyte maturation. Urine LH testing was performed at home, 12 h after the GnRHa trigger. In the case of a negative result, serum LH and progesterone measurements were done that same day. Donors with no serum LH peak after trigger were re-scheduled using a dual trigger, with GnRHa and hCG. Results: Three hundred and fifty nine oocyte donors were included in the analysis. Three hundred and fifty six donors had positive urine LH tests, followed by oocyte retrieval. In one case, the LH test was positive, however, no oocytes were retrieved (false positive 1/356). Three LH tests were negative in urine: in one of these three cases, LH was tested again in blood, confirming an LH rise, consistent with an optimal response to the GnRHa trigger; in the other two cases, serum LH was <15 mUI/mL, after which the oocyte retrieval was re-scheduled for 36 h after an being re-triggered, resulting in the retrieval of 19 and 22 MII oocytes, respectively. Considering the cost analysis, it would be a significantly cost-saving strategy, as blood testing would have costed 14,840€ vs. only 185.5€ in urine LH kits. Conclusions: Urinary testing of the LH surge after GnRHa trigger is easy, safe, reliable, and convenient. In addition, LH urine testing allows identifying donors and patients who could benefit from a rescue hCG trigger after an unsuccessful GnRHa trigger., (Copyright © 2020 Cozzolino, Matey, Alvarez, Toribio, López, Perona, Henzenn, Piró, Humaidan and Garcia-Velasco.)

Purpose: To evaluate whether ICSI offers any benefit compared with IVF in different ovarian response categories in case of non-male factor infertility., Methods: This is a retrospective multicenter analysis using individual patient data, conducted in 15 tertiary referral hospitals in Europe (1 center in Belgium and 14 in Spain). The study included the first cycle of all patients undergoing ovarian stimulation for IVF or ICSI in a GnRH antagonist protocol. Only patients having either IVF or ICSI for non-male factor infertility were included. Patients were divided into 4 groups based on their ovarian response as follows: group A, poor responders (1-3 oocytes); group B, suboptimal responders (4-9 oocytes); group C, normal responders (10-15 oocytes); group D, high responders (> 15 oocytes)., Results: In total, 4891 patients were analyzed, of whom 4227 underwent ICSI and 664 IVF. There was no significant difference for the insemination method (ICSI vs. IVF) used among the different ovarian response categories: 87% vs. 13%, 87% vs. 13%, 86% vs. 14%, 84% vs. 16%, for groups A, B, C, and D, respectively, p value = 0.35. Mean fertilization rates and embryo utilization rates were comparable between IVF and ICSI in the whole cohort. Fresh and cumulative LBR did not differ significantly for IVF and ICSI in poor, suboptimal, normal, and high responders., Conclusion: There is no advantage of ICSI over IVF as insemination method for non-male factor infertility, irrespective of the ovarian response. The number of oocytes retrieved has no value for the selection of the insemination procedure in case of non-male infertility.

Objective: To evaluate the association between the number of oocytes retrieved and cumulative live birth rates., Design: Retrospective multicenter analysis using individual patient data., Setting: Tertiary referral hospitals., Patient(s): In total, 14,469 patients were analyzed. The study included the first cycle of patients stimulated for IVF/intracytoplasmic sperm injection (ICSI) from 2009 to 2014. All patients included in the analysis had either delivered a baby or had used all their embryos after their first stimulated cycle. All patients had vitrification as cryopreservation method. All women were followed up for at least 2 years., Intervention(s): Ovarian stimulation with GnRH antagonist protocol for IVF/ICSI., Main Outcome Measure(s): The primary outcome was the cumulative live birth rate defined as the delivery of at least one live-born infant (>24 weeks of gestation) in the fresh or in the subsequent frozen-thawed cycles in relation to the number of oocytes retrieved. Only the first delivery was considered in the analysis. The secondary outcome was live birth after the fresh IVF/ICSI cycle only., Result(s): Cumulative live birth rates steadily increased with the number of oocytes, reaching 70% when ≥25 oocytes were retrieved. Interestingly, no plateau in cumulative live birth rates was observed, but a moderate increase of 5.1% on average was detected beyond 27 oocytes. Regarding the fresh cycle outcome, live birth probability increased up to seven oocytes retrieved and remained relatively unchanged (increase or decrease of ≤5%) between seven and 20 oocytes retrieved. However, a drop in fresh live birth rates was identified thereafter, which could be attributed to the progressive increase in "freeze-all" cycle rate with the number of oocytes retrieved, exceeding 20% in patients with >20 oocytes retrieved., Conclusion(s): This is the largest multicenter study evaluating for the first time the impact of ovarian response on cumulative live birth rate. The significant progressive increase of cumulative live birth rate with the number of oocytes in our study suggests that ovarian stimulation may not have a detrimental effect on oocyte/embryo quality in good-prognosis women less than 40 year old. Nevertheless, although very high ovarian response may further increase cumulative live birth rates, ovarian stimulation should be rational and avoid extreme response in terms of oocytes retrieved to preserve patients' convenience and safety and avoid ovarian hyperstimulation syndrome or other iatrogenic complications., (Copyright © 2018 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To compare the efficacy of oocyte vitrification (OV) with that of ovarian cortex cryopreservation and transplantation (OCT) in women undergoing gonadotoxic treatments., Design: Prospective observational cohort study., Setting: Not applicable., Patient(s): Candidates for chemo-/radiotherapy who joined our fertility preservation (FP) program were included in this study between 2005 and 2015. One cohort included 1,024 patients undergoing OV; the other cohort included 800 patients undergoing OCT., Intervention(s): OV using the cryotop device and OCT using a slow freezing protocol., Main Outcome Measure(s): Live-birth rate (LBR) and clinical pregnancy rate (CPR)., Result(s): Basal antimüllerian hormone levels of the patients revealed no differences in ovarian reserve before FP (OV, 11.6 pM [5.4-24.7]; OCT, 11.8 pM [6.4-21.9]). In the OV cohort, 49 patients used the vitrified oocytes after a mean storage time of 3.9 years. In the OCT cohort, 44 sought pregnancy after a mean storage time of 5.5 years. A trend toward higher CPR and LBR (per patient) was observed in the OV group (risk ratio [RR CPR ], 1.31 [95% confidence interval, 0.90-1.92]; RR LBR 1.39 [95% confidence interval, 0.95-2.03]), although differences were not statistically significant. In the OCT group, 46.7% of pregnancies occurred spontaneously and no pregnancy was achieved when the tissue was harvested beyond the age of 36 years. All patients except three undergoing OCT resumed or improved endocrine ovarian function., Conclusion(s): Although we observed a trend toward higher LBR after OV, OCT is a very effective method to preserve fertility, allows for natural pregnancy, and restores ovarian function. In clinical scenarios where OV is not feasible, OCT remains the FP technique of choice and should no longer be considered experimental., (Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose of Review: It is necessary to clarify the fertility preservation-related points of concern that often frighten patients or physicians when it comes to deciding about oocyte cryopreservation for fertility preservation, which are often perceived as procedure limitations, are sometimes real and often theoretical and may make the prognosis worse., Recent Findings: Letrozole added to gonadotrophins for controlled ovarian stimulation is safe when applied to hormone-sensitive cancer patients as it avoids associated high estradiol levels. This benefit is only for estrogens, but not for progesterone. Triggering ovulation with gonadotropin releasing hormone agonist bolus and adding the gonadotropin releasing hormone antagonist after oocyte retrieval help minimize its effect. A random start is currently widespread as neither results nor offspring are compromised, and it avoids waiting for menstruation and, therefore, delaying treatment., Summary: The cumulative live birth rate is conditioned by the number of available oocytes and patient's age. Assisted reproductive technologies may help cancer patients to achieve pregnancy with good obstetric outcomes and apparent oncological safety. Although counseling should be provided on an individual basis, fertility preservation in cancer patients and later pregnancy in survivors after adequate treatment and follow-up should not be discouraged.

Obstetric outcome of first pregnancies achieved after vitrification and warming oocytes from women being treated for cancer was evaluated. Of a total of 493 women who consulted for fertility preservation, 357 had their oocytes cryopreserved after being diagnosed with cancer, and 11 returned after being cured for assisted reproduction treatments (eight had breast cancer, one Hodgkin lymphoma, one endometrial adenocarcinoma, and one thyroid cancer). The oocyte survival rate was 92.3%, the fertilization rate was 76.6%, and the mean number of embryos transferred was 1.8 ± 0.7. Beta-human chorionic gonadotropin was detected in seven out of the 11 embryo transfers carried out. Four ongoing pregnancies were achieved and delivered at term with normal fetal weight and no major or minor malformations. Women diagnosed with cancer who have their eggs cryopreserved before anti-cancer treatment have good assisted reproductive technology performance and good perinatal outcomes. Cryopreservation of oocytes seems to be a good alternative for fertility preservation in these women., (Copyright © 2014 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

The aim of this observational prospective study was to compare multiple embryological and pregnancy outcomes for vitrified oocytes against the same outcomes using vitrified embryos in patients at risk for ovarian hyperstimulation syndrome. Ninety-six patients were included and allocated to vitrification of oocytes (Group 1) or embryos (Group 2). No statistical differences in baseline characteristics between groups were detected. Implantation rate was 30.6% versus 33.1%, and clinical pregnancy rate was 41.9% versus 7.1% in groups 1 and 2, respectively. A higher clinical spontaneous abortion rate occurred in group 2 (9.7% versus 21.9% for groups 1 and 2, respectively), but the same cumulative clinical pregnancy rate was observed after three embryo transfers (62.0% in group 1 and 69.6% in group 2). The ongoing pregnancy rate per patient was similar in both groups (56.0% and 54.3% in groups 1 and 2, respectively). Also, live birth rate per stimulation was similar (72.0% and 69.6% in groups 1 and 2, respectively). No differences were observed in outcomes according to vitrification timing. Oocyte vitrification achieved the same live birth rate as embryo vitrification., (Copyright © 2014 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

Objective: To use microarray technology to analyze endometrial gene expression after gonadotropin-releasing hormone agonist (GnRH-a) triggering with four different protocols of luteal support in comparison with results obtained after a human chorionic gonadotropin (hCG) trigger., Design: Prospective, randomized, controlled trial., Setting: University-affiliated private assisted-reproduction center., Patient(s): 25 healthy oocyte donors undergoing controlled ovarian stimulation., Intervention(s): On day of final oocyte maturation, randomization to [1] GnRH-agonist triggering and luteal support with oral estradiol (2 mg/8 hours) and vaginal progesterone (200 mg/12 hours), [2] GnRH-a and a daily dose of 150 IU of recombinant LH from oocyte pickup, [3] GnRH-a and a single bolus of 60 μg of recombinant hCG on oocyte pickup, [4] GnRH-a and three doses of 20 μg of recombinant hCG separated by 48 hours, or [5] 250 μg of recombinant hCG for trigger and standard luteal support; with endometrial biopsy samples collected 7 days after triggering., Main Outcome Measure(s): Gene expression using the Endometrial Receptivity Array (ERA) and pathway and network analysis of study groups 1-4 compared with controls (group 5)., Result(s): The 56 genes in group 1 (25 up-regulated and 31 down-regulated) exhibited altered expression compared with the 36 genes from group 2 (13 up-regulated and 23 down-regulated), 44 from group 3 (28 up-regulated and 16 down-regulated), and 30 (20 up-regulated and 10 down-regulated) from group 4., Conclusion(s): Differences were seen in endometrial gene expression related to the type of ovulation trigger and luteal support. However, gene expression after the GnRH-a trigger and modified luteal support adding LH/hCG activity more closely resembles the pattern seen in the hCG group., Clinical Trial Registration Number: EudraCT 2011-003250-34., (Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

The aim of this review is to provide current knowledge on oocyte cryopreservation, with special emphasis on vitrification as a means to preserve fertility in different indications. Major advancements achieved in the past few years in the cryolaboratory have facilitated major changes in our practice. Areas such as fertility preservation for social or oncologic reasons, the possibility to create oocyte banks for egg donation programs, the opportunity to avoid ovarian hyperstimulation syndrome, or to accumulate oocytes in low-yield patients, or even to offer treatment segmentation by stimulating the ovaries, vitrifying, and then transferring in a natural cycle are some of the options that are now available with the development of cryopreservation. We present general experience from our group and others on fertility preservation for age-related fertility decline as well as in oncologic patients, confirming that oocyte vitrification is a standardized, simple, reproducible, and efficient option., (Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the results of controlled ovarian stimulation before chemotherapy for oocyte vitrification to preserve fertility in women diagnosed with cancer and compare them with a historical control group., Design: A retrospective, multicenter, observational study performed between March 2007 and January 2011., Setting: University-affiliated infertility clinics., Patient(s): Of 272 patients affected by cancer in our Fertility Preservation Program, 223 women underwent a stimulated cycle for oocyte vitrification according to our protocols before cancer treatment. Their results were compared with a historical control group of 98 patients diagnosed with male factor infertility who were stimulated for a conventional IVF cycle., Intervention(s): Controlled ovarian stimulation and oocyte retrieval., Main Outcome Measure(s): Days of stimulation, total dose of gonadotropins, estrogen levels, and number of oocytes retrieved and vitrified., Result(s): No differences were found in days of stimulation, but significant differences in E(2) levels and the number of retrieved oocytes were measured, especially in the hormone-dependent cancer group., Conclusion(s): Patients with hormone-dependent cancer had a weaker response to controlled ovarian stimulation compared with patients with non-hormone-dependent cancer. Whether the oncological disease already affects the ovaries before chemo-/radiotherapy remains to be elucidated., (Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Agonist triggering combined with oocyte vitrification and ET in a subsequent natural cycle avoids ovarian hyperstimulation syndrome in patients at risk and shows excellent cycle outcome., (Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose of Review: To summarize recent advances in oocyte and embryo cryopreservation techniques and outcomes., Recent Findings: Vitrification is gradually replacing slow freezing due to a better survival rate after thawing. Most units use vitrification for both oocyte and blastocyst cryopreservation, as these two biological structures did not perform very well with slow freezing technique. Basic experiments show that cellular damage seems lower after vitrification. Taken all together, this is helping vitirification to be expanding rapidly, and new clinical indications are being incorporated as well (i.e., fertility preservation)., Summary: Cryopreservation has been used as a complement to IVF, and recent publications indicate that pregnancy rates achieved with frozen oocytes and embryos are comparable with those achieved in fresh cycles. Multiple publications studying oocyte and embryo physiology during cryopreservation have been published recently; however, larger studies are needed to verify the efficacy of new cryopreservation techniques. Vitrification is a simple and robust technique that is being incorporated into the majority of IVF units, mainly for oocyte and blastocyst cryopreservation.

In this observational trial, we compared the impact on two different strategies, egg vitrification (n = 152) obtained after triggering final oocyte maturation with GnRH agonists and transferring the embryos at a later stage, with classical coasting (n = 96) to avoid OHSS in patients at risk due to high response to COH. Our results show that oocyte vitrification after GnRH agonists triggering is a highly attractive, safe, and efficient alternative to postpone embryo transfer in patients at high risk of OHSS, resulting in decreased risk for the patient and a better cycle outcome (pregnancy rate 50% vs 29.5%)., (Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

To assess possible effects on subcellular organization after cryopreservation, we compared vitrified and slowly frozen oocytes in terms of their post-warm/thaw morphology, meiotic spindle configuration, and DNA integrity. DNA integrity of cryopreserved oocytes was not altered after the procedures, but vitrification was more effective than slow cooling, as shown by higher survival rate and spindle assessment despite a higher misalignment between meiotic spindle and polar body., (Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To compare the hormonal profile when using triptorelin vs. human chorionic gonadotropin (hCG) to trigger ovulation in intrauterine insemination (IUI) cycles., Study Design: Twenty-five patients who underwent 48 cycles were enrolled in a prospective, randomized, crossover study. After ovulation induction with recombinant follicle-stimulating hormone (FSH), couples were randomly allocated to a first cycle with a single dose of 0.2 mg of triptorelin or 5,000 IU of urinary hCG to trigger ovulation; if pregnancy did not occur, a second cycle was carried out, and the patient was crossed over to the other treatment group. Blood was collected the day of hCG/triptorelin administration and both days after IUI., Results: Patients treated with triptorelin showed a significantly higher FSH and luteinizing hormone (LH) rise 24 hours after the injection when compared to hCG. Serum progesterone was significantly increased 48 hours after hCG administration, although estradiol levels were comparable between the groups., Conclusion: A higher LH and FSH peak than that induced by hCG was observed. Considering that serum progesterone levels were suboptimal in both protocols and taking into account the lower progesterone production in gonadotropin releasing hormone analogue cycles, corpus luteum supplementation in the luteal phase should be recommended for these patients.

Objective: To investigate the factors that may be related to pregnancy in oocyte recipients who shared oocytes from the same donor and showed discordant pregnancy outcome., Design: Matched pair analysis., Setting: IVF academic center., Patient(s): Five hundred forty-two oocyte donation cycles that shared oocytes from 197 donors with discordant outcome., Intervention(s): Egg donation and embryo transfer., Main Outcome Measure(s): Pregnancy rate and implantation rate., Result(s): Three hundred sixty-five matched-paired discordant outcome oocyte recipients were analyzed. Pregnant and nonpregnant recipients were similar in terms of age, serum E(2) levels, endometrial thickness, indications for oocyte donation, and abnormal sperm parameters. No differences were found in the number of oocytes received per patient, fertilization rate, IVF/intracytoplasmic sperm injection (ICSI) distribution, embryo quality, or on embryo transfer difficulty., Conclusion(s): Discordant pregnancy outcome could not be explained by the different egg recipients and cycle factors studied. In addition to chance, other factors must be investigated that could explain discordant outcome in egg recipients sharing oocytes from single donors.

Pancreatic Autoimmunity is defined as the presence of autoantibodies and more frequent need for insulin treatment. Affected women presenting recurrent implantation failure (RIF) or recurrent miscarriage (RM) are often misdiagnosed. The objective of thestudy was to describe clinical and metabolic profiles suggestive of Pancreatic Autoimmunity and therapeutic strategy in patients with RIF/RM. We analyzed retrospectively 735 patients, and have identified a subset (N = 20) with similar metabolic characteristics. At the same time, we included a control group (n = 39), with similar demographic characteristics and negative for pancreatic, thyroid or celiac disease autoimmunity. The patients identified with autoimmune metabolic problem (N = 20) had relatives with diabetes mellitus. At 120 minutes after Oral Glucose Tolerance Test (OGTT) low level of insulin secretion (<2 IU/ml) was found in 70% of patients. Glutamic acid decarboxylase 65 (GAD 65) antibodies, with or without other autoantibodies, were positive in80% of patients and anti-IA2 alone were positive I the rest. Since pregestational period, insulin administration was recommended for 10 patients, metformin for 4 patients and exclusively diet control in 5 of them. Significantly increased live bith rates (LBR) per cycle were observed after metabolic control (52%) compared with live birth rate (LBR) after cycles without control (7.5%) (p<0.0001). We noticed 2 cases of pre-eclampsia and 6 low-birth weights. Insulin administration was needed during the pregnancy in 68% of patients and after childbirth in 31.57% of them. In our control group, all of patients (n = 39) underwent ART (53.8% SET and 46.1% DET) with a 50% (SET) and 61.9% (DET) live birth rate (LBR) per cycle. Patients with RIF/RM, normal BMI, low insulin levels after OGTT could benefit from additional metabolic immune testing. A correct diagnosis and treatment could have a positive impact on their reproductive results and live birth rate. [ABSTRACT FROM AUTHOR]

Several infertile patients, who may even represent around 40% of the infertile cohort, may respond “suboptimally” (4–9 oocytes retrieved) following IVF, despite being predicted as normal responders. The aim of our longitudinal study was to evaluate the ovarian response of suboptimal responders in terms of the number of oocytes retrieved, following their second IVF cycle, evaluating exclusively patients who had the same stimulation protocol and used the same or higher initial dose of the same type of gonadotropin compared to their previous failed IVF attempt. Overall, our analysis included 160 patients treated with a fixed antagonist protocol in their second cycle with the same [53 (33.1%)] or higher [107 (66.9%)] starting dose of rFSH. The number of oocytes retrieved was significantly higher in the second IVF cycle [6 (5–8) vs. 9 (6–12), p < 0.001]. According to our results, a dose increment of rFSH remained the only significant predictor of the number of oocytes retrieved in the subsequent IVF cycle (coefficient 0.02, p-value = 0.007) after conducting GEE multivariate regression, while adjusting for relevant confounders. A regression coefficient of 0.02 for the starting dose implies that an increase of 50 IU of the initial rFSH dose would lead to 1 more oocyte. [ABSTRACT FROM AUTHOR]