LH 注射適用於高齡及卵巢反應不佳之IVF病患

Fertil Steril. 2018 Apr;109(4):644-664. doi: 10.1016/j.fertnstert.2018.01.003.

Recombinant luteinizing hormone supplementation in assisted reproductive technology: a systematic review.

Alviggi C1, Conforti A2, Esteves SC3, Andersen CY4, Bosch E5, Bühler K6, Ferraretti AP7, De Placido G2, Mollo A2, Fischer R8, Humaidan P9; International Collaborative Group for the Study of r-hLH (iCOS-LH).

Author information

Abstract

OBJECTIVE:

To assess the role of recombinant human LH (r-hLH) supplementation in ovarian stimulation for ART in specific subgroups of patients.

DESIGN:

Systematic review.

SETTING:

Centers for reproductive care.

PATIENT(S):

Six populations were investigated: 1) women with a hyporesponse to recombinant human FSH (r-hFSH) monotherapy; 2) women at an advanced reproductive age; 3) women cotreated with the use of a GnRH antagonist; 4) women with profoundly suppressed LH levels after the administration of GnRH agonists; 5) normoresponder women to prevent ovarian hyperstimulation syndrome; and 6) women with a "poor response" to ovarian stimulation, including those who met the European Society for Human Reproduction and Embryology Bologna criteria.

INTERVENTION(S):

Systematic review.

MAIN OUTCOME MEASURE(S):

Implantation rate, number of oocytes retrieved, live birth rate, ongoing pregnancy rate, fertilization rate, and number of metaphase II oocytes.

RESULT(S):

Recombinant hLH supplementation appears to be beneficial in two subgroups of patients: 1) women with adequate prestimulation ovarian reserve parameters and an unexpected hyporesponse to r-hFSH monotherapy; and 2) women 36-39 years of age. Indeed, there is no evidence that r-hLH is beneficial in young (<35 y) normoresponders cotreated with the use of a GnRH antagonist. The use of r-hLH supplementation in women with suppressed endogenous LH levels caused by GnRH analogues and in poor responders remains controversial, whereas the use of r-hLH supplementation to prevent the development of ovarian hyperstimulation syndrome warrants further investigation.

CONCLUSION(S):

Recombinant hLH can be proposed for hyporesponders and women 36-39 years of age.

弓形子宮對胚胎植入後著床率無明顯不良影響

Fertil Steril. 2018 Mar 30. pii: S0015-0282(17)32117-9. doi: 10.1016/j.fertnstert.2017.12.001. [Epub ahead of print]

The arcuate uterus: is there an impact on in vitro fertilization outcomes after euploid embryo transfer?

Surrey ES1, Katz-Jaffe M2, Surrey RL3, Small AS2, Gustofson RL2, Schoolcraft WB2.

Author information

Abstract

OBJECTIVE:

To study the impact of the arcuate uterus on euploid blastocyst-stage embryo transfer outcomes after comprehensive chromosomal screening (CCS).

DESIGN:

Controlled retrospective trial.

SETTING:

Tertiary care assisted reproduction technology (ART) center.

PATIENT(S):

Consecutive patients undergoing in vitro fertilization and euploid embryo transfer after CCS during 2014.

INTERVENTION(S):

Ultrasound examinations and office hysteroscopy; array comparative genomic hybridization to perform CCS after a trophectoderm biopsy.

MAIN OUTCOME MEASURE(S):

Implantation and live-birth rates.

RESULT(S):

Patients were divided into two groups based on the presence (group 1) or absence (group 2) of arcuate uterus. Exclusion criteria were donor oocytes, evidence of other endometrial cavitary abnormalities, prior uterine surgery, and arcuate uterus <4 mm. Group 1 included 78 patients with arcuate uterus of mean depth 5.43 ± 1.81 mm (range: 4-9.5 mm) undergoing 83 transfer cycles. Group 2 included 354 controls undergoing 378 transfer cycles. There were no differences between the groups in baseline characteristics or mean number of euploid embryos transferred. Cycle outcomes were similar between the two groups: rates of implantation (63.7% vs. 65.4%), live birth (68.67% vs. 67.81%), biochemical pregnancy (8.4% vs. 7.65%), and spontaneous abortion (4.8% vs. 4.27%).

CONCLUSION(S):

Arcuate uterus has no impact on ART outcomes after euploid embryo transfer subsequent to CCS, so arcuate uterus should be considered an incidental finding without an indication for surgical resection.

GRHantagonist使用最佳時機為最大濾泡1.4cm  & E2 300-1100pg/ml
屆時E2 過高或過低均會下降PR

Send to

Fertil Steril. 2018 Mar 28. pii: S0015-0282(17)32162-3. doi: 10.1016/j.fertnstert.2017.12.021. [Epub ahead of print]

Cycle day, estrogen level, and lead follicle size: analysis of 27,790 in vitro fertilization cycles to determine optimal start criteria for gonadotropin-releasing hormone antagonist.

Schumacher BML1, Mersereau JE2, Steiner AZ2.

Author information

Abstract

OBJECTIVE:

To determine the optimal criteria at which to start GnRH antagonists during controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF).

DESIGN:

Retrospective clinical cohort.

SETTING:

IVF clinics.

PATIENT(S):

Women undergoing fresh autologous IVF using GnRH antagonist for ovulation suppression during COH.

INTERVENTION(S):

Measurement of lead follicle size, E2 level, and cycle day of stimulation on day of antagonist initiation.

MAIN OUTCOME MEASURE(S):

Clinical pregnancy rate (PR).

RESULT(S):

The highest clinical PR was achieved when the antagonist was started when a lead follicle reached 14-15.9 mm in size (mean clinical PR 21.3; 95% confidence interval [CI] 19.3, 23.6) on cycle day 6 (mean clinical PR 22.2; 95% CI 17, 28.4), or when the E2 level was between 500 and 599 pg/mL (mean clinical PR 25.4; 95% CI 19.5, 32.4). Starting antagonists when the E2 level was <300 or >1,100 pg/mL reduced the odds of clinical pregnancy by 40% (odds ratio 0.60, 95% CI 0.5, 0.7).

CONCLUSION(S):

Cycle day, E2 level, and follicle size at time of antagonist start are all independent predictors of a clinical pregnancy after IVF. Initiating antagonists when the E2 level is extremely low (<300 pg/mL) or extremely high (>1,100 pg/mL) significantly reduces the odds of pregnancy.

ICSI 對於高齡及非男性不孕症支應用並無特別助益

Hum Reprod. 2017 Jan;32(1):119-124. Epub 2016 Nov 16.

The role of intracytoplasmic sperm injection in non-male factor infertility in advanced maternal age.

Tannus S1, Son WY2, Gilman A2, Younes G2, Shavit T2, Dahan MH2.

Author information

Abstract

STUDY QUESTION:

Does ICSI improve reproductive outcomes compared with conventional IVF when used for non-male factor infertility in women aged 40 years and over?

SUMMARY ANSWER:

There is no advantage of ICSI over conventional IVF in women aged 40 years and over when used for non-male factor infertility.

WHAT IS KNOWN ALREADY:

The use of ICSI has increased dramatically in recent years and is being applied for indications other than male factor infertility. Currently, ICSI is used in 65% of IVF cycles in Europe and in 76% of cycles in the USA. Despite its increase use, there is no clear evidence of a benefit in using ICSI over conventional IVF. Older women undergoing infertility treatments are at an increased risk of having diminished ovarian reserve and lower oocyte quality, which could make ICSI the preferred insemination method in this group. However, studies that have examined the benefits of ICSI in this age group are lacking.

STUDY DESIGN, SIZE, DURATION:

A retrospective, single center study included women, aged 40-43 years, who underwent IVF treatments for non-male factor infertility between January 2012 until June 2015.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

A total of 745 women were included in the study. Of these, 490 women underwent ICSI and 255 women underwent conventional IVF. In order to be included in the study, women had to be at least 40 years of age at the beginning of ovarian stimulation and their male partner had to have normal sperm parameters according to World Health Organisation (WHO) fifth edition. Exclusion criteria included: more than three previous IVF cycles, a history of fertilization failure or low fertilization (<50%), the use of donor or frozen oocytes and the use of donor or frozen sperm samples. The primary outcome was the live birth rate. Secondary outcomes included fertilization rates, fertilization failure and embryo quality.

MAIN RESULTS AND THE ROLE OF CHANCE:

Baseline characteristics were similar between the two groups, except for the number of previous IVF cycles, which was higher in the ICSI group (1.0 vs. 0.6, P = 0.0001). Despite similar numbers of oocytes retrieved (7.2 vs. 6.5), when examining oocytes maturity (performed 2 h after oocyte retrieval in the ICSI group and after 18 h in the conventional IVF group), the conventional IVF group had a higher number of Metaphase II (MII) oocytes (6.1 vs. 4.7, P < 0.0001). The conventional IVF group also had higher numbers of zygotes formed (4.48 vs. 3.66, P = 0.001), more cycles with embryos transferred at the blastocyst stage (36 vs. 26%, P = 0.005) and more cycles where embryos were available for cryopreservation (26.4 vs. 19.7%, P = 0.048), compared with the ICSI group. The fertilization rates (64 vs. 67%) and fertilization failure (9.0 vs. 9.7%) were similar. After logistic regression analysis controlling for confounders, the live birth rates were similar between the groups (11.9 vs. 9.6%). Subgroup analyses of women undergoing their first IVF cycle and women with ≤3 oocytes retrieved did not show an advantage of ICSI over conventional IVF.