本案因懷孕至32周, 因引發母體妊娠高血壓 提早引產
J Hum Reprod Sci. 2015 Jul-Sep;8(3):178-81. doi: 10.4103/0974-1208.165149.
2015年11月28日
IVF後若正常胚胎與葡萄胎同時並存下, 仍可繼續懷孕
本案因懷孕至32周, 因引發母體妊娠高血壓 提早引產
J Hum Reprod Sci. 2015 Jul-Sep;8(3):178-81. doi: 10.4103/0974-1208.165149.
Partial/complete hydatidiform mole with coexisting fetus is a rare condition. Optimal management is a challenge that remains a dilemma since these pregnancies are associated with maternal as well as fetal complications including hemorrhage, preeclampsia, thromboembolic disease, intra uterine demise and increased risk of persistent trophoblastic disease. Here we report 2 cases of partial mole with live fetus after ICSI and a case of complete mole with coexisting fetus after ICSI in a turner mosaic that resulted in a live birth.
本案因懷孕至32周, 因引發母體妊娠高血壓 提早引產
J Hum Reprod Sci. 2015 Jul-Sep;8(3):178-81. doi: 10.4103/0974-1208.165149.
子宮腺肌症adenomyosis, 一種常見子宮良性疾病
IVF病患若合併子宮腺肌症, 可能會下降懷孕率達28%
Is adenomyosis associated with IVF/ICSI outcome in terms of clinical pregnancy rate?
In a meta-analysis of published data, women with adenomyosis had a 28% reduction in the likelihood of clinical pregnancy at IVF/ICSI compared with women without adenomyosis.
Estimates of the effect of adenomyosis on IVF/ICSI outcome are inconsistent.
A systematic literature review and meta-analysis were conducted. A Medline search was performed to identify all the comparative studies published from January 1998 to June 2013 in the English language literature on IVF/ICSI outcome in women with and without adenomyosis. Two authors independently performed the literature screening, scrutinized articles of potential interest, selected relevant studies and extracted data. Studies were categorized based on research design.
Of the 17 articles assessed in detail, 9 were finally selected based on diagnosis of adenomyosis at magnetic resonance imaging or transvaginal ultrasonography. The quality of studies was evaluated by means of the Newcastle-Ottawa scale. A total of 1865 women were enrolled in the 9 selected studies, 665 of whom in 4 prospective observational studies, and 1200 in 5 retrospective studies. The dichotomous data for clinical pregnancy and secondary outcomes were expressed as risk ratios (RR) with 95% confidence intervals (CIs) and were combined in a meta-analysis using the random-effects model. The heterogeneity Cochrane's Q and the I(2) statistics were calculated. Egger's approach to testing the significance of funnel plot asymmetry was also used.
The clinical pregnancy rate achieved after IVF/ICSI was 123/304 (40.5%) women with adenomyosis versus 628/1262 (49.8%) in those without adenomyosis. The RR of clinical pregnancy ranged from 0.37 (95% CI, 0.15-0.92) to 1.20 (95% CI, 0.58-2.45), with a significant heterogeneity among studies (I(2) = 56.8%, P = 0.023). Pooling of the results yielded a common RR of 0.72 (95% CI, 0.55-0.95). A funnel plot showed no indication of asymmetry among studies (Egger's test, P = 0.696). In a meta-regression model, no association was observed between prevalence of endometriosis and the likelihood of clinical pregnancy. Three studies reported the pregnancy rate per cycle. The common RR was 0.71 (95% CI, 0.51-0.98; I(2) = 78.1%, P = 0.010). The RR observed in a study with donated oocytes was 0.90 (95% CI, 0.75-1.08). The number of miscarriages per clinical pregnancy was reported in seven studies. A miscarriage was observed in 77/241 women with adenomyosis (31.9%) and in 97/687 in those without adenomyosis (14.1%). The RR of miscarriage ranged from 0.57 (95% CI, 0.15-2.17) to 18.00 (95% CI, 4.08-79.47) (I(2) = 67.7%, P = 0.005). Pooling of the results yielded a common RR of 2.12 (95% CI, 1.20-3.75).
Qualitative and quantitative heterogeneity among studies was high. At sensitivity analysis, I(2) statistic regarding the main outcome was reduced under the 50% threshold removing one trial, but the resulting confidence interval crossed unity. Also the confidence interval of the common RR of the four studies reporting only one IVF/ICSI cycle included unity. Only part of the studies could be included in the assessment of secondary outcomes.
Adenomyosis appears to impact negatively on IVF/ICSI outcome owing to reduced likelihood of clinical pregnancy and implantation, and increased risk of early pregnancy loss. Screening for adenomyosis before embarking on medically assisted reproductive procedures should be encouraged. The potentially protective role of long down-regulation protocols needs further evaluation. In future studies on the association between adenomyosis and IVF/ICSI outcome, a matched case-control design should be adopted, live birth should be the default primary outcome and only the results regarding the first cycle should be considered.
IVF病患若合併子宮腺肌症, 可能會下降懷孕率達28%
Hum Reprod. 2014 May;29(5):964-77. doi: 10.1093/humrep/deu041. Epub 2014 Mar 12.
Uterine adenomyosis and in vitro fertilization outcome: a systematic review and meta-analysis.
Abstract
STUDY QUESTION:
SUMMARY ANSWER:
WHAT IS KNOWN ALREADY:
STUDY DESIGN, SIZE, DURATION:
PARTICIPANTS, SETTING, METHODS:
MAIN RESULTS AND THE ROLE OF CHANCE:
LIMITATIONS, REASONS FOR CAUTION:
WIDER IMPLICATIONS OF THE FINDINGS:
研究顯示, 未成熟卵子MI縱使施行顯微注射rescue ICSI, 結果仍是徒勞無益(未受精, 未分裂, 染色體異常)
精蟲DNA異常(fragment)仍無法藉由型態有效篩選
Hum Reprod Update. 2015 Nov 18. pii: dmv050. [Epub ahead of print]
ICSI is currently the most commonly used assisted reproductive technology, accounting for 70-80% of the cycles performed. This extensive use, even excessive, is partly due to the high level of standardization reached by the procedure. There are, however, some aspects that deserve attention and can still be ameliorated. The aim of this systematic review was to evaluate the results of available publications dealing with the management of specific situations during ICSI in order to support embryologists in trying to offer the best laboratory individualized treatment.
This systematic review is based on material obtained by searching PUBMED between January 1996 and March 2015. We included peer-reviewed, English-language journal articles that have evaluated ICSI outcomes in the case of (i) immature oocytes, (ii) oocyte degeneration, (iii) timing of the various phases, (iv) polar body position during injection, (v) zona-free oocytes, (vi) fertilization deficiency, (vii) round-headed sperm, (viii) immotile sperm and (ix) semen samples with high DNA fragmentation.
More than 1770 articles were obtained, from which only 90 were specifically related to the issues developed for female gametes and 55 for the issues developed for male gametes. The studies selected for this review were organized in order to provide a guide to overcome roadblocks. According to these studies, the injection of rescue metaphase I oocytes should be discouraged due to poor clinical outcomes and a high aneuploidy rates; laser-assisted ICSI represents an efficient method to solve the high oocyte degeneration rate; the optimal ICSI timing and the best polar body position during the injection have not been clarified; injected zona-free oocytes, if handled carefully, can develop up to blastocyst stage and implant; efficient options can be offered to patients who suffered fertilization failure in previous conventional ICSI cycles. Most controversial and inconclusive are data on the best method to select a viable spermatozoa when only immotile spermatozoa are available for ICSI and, to date, there is no reliable approach to completely filter out spermatozoa with fragmented DNA from an ejaculate. However, most of the studies do not report essential clinical outcomes, such as live birth, miscarriage and fetal abnormality rate, which are essential to establish the safety of a procedure.
This review provides the current knowledge on some controversial technical aspects of the ICSI procedures in order to improve its efficacy in specific contexts. Notwithstanding that embryologists might benefit from the approaches presented herein in order to improve ICSI outcomes, this area of expertise still demands a greater number of well-designed studies, especially in order to solve open issues about the safety of these procedures.
精蟲DNA異常(fragment)仍無法藉由型態有效篩選
Hum Reprod Update. 2015 Nov 18. pii: dmv050. [Epub ahead of print]
The ICSI procedure from past to future: a systematic review of the more controversial aspects.
Abstract
BACKGROUND:
METHODS:
RESULTS:
CONCLUSIONS:
2015年11月22日
生育要趁早
中國「一胎化」政策施行了36年(起於1979年)，如今，好不容易盼到了全面開放「生二孩」，內心裡五味雜陳。一般而言，婦女35歲以上受孕機率就會下降，40歲以上就算是高齡產婦，「奔五」(屆齡50歲)的婦女，根本就生不出小孩來。男性到了60歲以後，生育能力也會逐漸下降，「奔七」(屆齡70歲)就甭說了。看著自己垂垂老矣的身軀，便知道政府的美意終究不能在自己身上實現，因此大嘆：
老二行時不讓生老二，老二不行時讓你生老二。
老二行的不想生老二，老二不行的想生老二。
老二不行的希望老二行的生老二，老二行的不聽老二不行的偏不生老二，氣得老二不行的很想自己生老二，偏偏老二不行生不了老二。
2015年11月21日
冷凍液配方trehalose功能類似 sucrose
傳統人類冷凍液配方
trehalose海藻糖 功能類似 sucrose
ethylene glycol and propylene glycol (EG + PG=1:1)or EG+PG+DMSO(1:1:1)優於EG and dimethyl sulfoxide (EG + DMSO=1:1)
ES: 7.5% EG+7.5%DMSO
VS: 15% EG+15%DMSO+0.5 M sucrose
傳統人類解凍液配方
TS: 1M
sucrose
DS: 0.5 M
sucrose
-----------------------------------------------------------------------------------------------------
本豬卵實驗顯示trehalose海藻糖 功能類似 sucrose
ethylene glycol and propylene glycol (EG + PG=1:1)or EG+PG+DMSO(1:1:1)優於EG and dimethyl sulfoxide (EG + DMSO=1:1)
空包卵Empty zona pellucida與病患卵子數量較少卵巢功能低下呈現正相關
臨床有時會遇到空包卵Empty zona pellucida (EZP)
本篇顯示EZP 與病患卵子數量較少, 卵巢功能低下, 卵子品質較差, 卵子受孕率較低, 高齡有正相關性
The factors behind the empty zona pellucida (EZP) formation and its relationship with in vitro fertilization (IVF) outcomes were analyzed. A total of 104 patients who underwent IVF treatment and collected oocytes including EZP were enrolled in this study. EZP index (EZPI = the ratio of number of EZP to number of cumulus-oocyte complex (COC)) was used for the statistical analysis. Patients were grouped as Group 1 when EZPI ≤ 0.17 (n = 57) and Group 2 when EZPI > 0.17 (n = 47). Type-2 EZP, a variation or an advanced type of oocyte degeneration, is tested. Woman age, basal hormone levels, and total gonadotropin dose were significantly higher in Group 2 compared to Group 1. Total antral follicle count was significantly low in Group 2. Total number of mature oocytes, oocyte quality index, the number of fertilized oocytes, and the numbers of Grade 1 embryos were significantly low in Group 2. On the linear regression analysis, using gonadotropin releasing hormone antagonist protocol (B = 0.086, p = 0.030), the number of ≥17 mm follicle (B = 0.015, p = 0.047), peak serum level of estradiol (B = -3.625; p = 0.014), number of fertilized oocytes (B = -0.02, p = 0.0001) and the day-2 embryo score (B = -0,044, p = 0.001) significantly affected EZPI. An increment of the EZPI may be revealed decreased oocyte quality, and it is also related to the poor ovarian response.
本篇顯示EZP 與病患卵子數量較少, 卵巢功能低下, 卵子品質較差, 卵子受孕率較低, 高齡有正相關性
Gynecol Endocrinol. 2012 May;28(5):341-4. doi: 10.3109/09513590.2011.631632. Epub 2011 Dec 1.
Does empty zona pellucida indicate poor ovarian response on intra cytoplasmic sperm injection cycles?
Abstract
本篇質疑於破卵日當天測P4之必要性
P4數值與懷孕率無明顯關聯
P4值與E2值, 卵數量呈現正相關
Fertil Steril. 2015 Oct 9. pii: S0015-0282(15)01925-1. doi: 10.1016/j.fertnstert.2015.09.008. [Epub ahead of print]
To evaluate in our setting whether there is currently a level of P on the hCG day (P-hCG) predictive of no pregnancy.
Observational study of prospectively collected data of the P-hCG levels of stimulated IVF cycles.
In vitro fertilization unit.
All cycles of IVF/intracytoplasmic sperm injection with fresh embryo transfer performed between January 2009 and March 2014.
None.
Pregnancy rate.
Clinical pregnancy rate per ET was 38.7% and live birth rate was 29.1%. The P-hCG concentration was positively correlated to E2 on the hCG day, and the number of oocytes was negatively correlated to age. Progesterone on hCG day was higher among agonist- compared with antagonist-treated patients (mean ± SD: 1.13 ± 0.69 ng/mL vs. 0.97 ± 0.50 ng/mL) and among recombinant FSH compared with recombinant FSH + hMG stimulation (mean ± SD: 1.11 ± 0.58 ng/mL vs. 0.94 ± 0.50 ng/mL). Pregnancy rate was positively associated with the number of oocytes. There was no correlation between P-hCG value and pregnancy rate, overall or according to the type of treatment.
In our setting there is no P-hCG value differentiating a good from a poor cycle success rate.
P4數值與懷孕率無明顯關聯
P4值與E2值, 卵數量呈現正相關
Fertil Steril. 2015 Oct 9. pii: S0015-0282(15)01925-1. doi: 10.1016/j.fertnstert.2015.09.008. [Epub ahead of print]
Should progesterone on the human chorionic gonadotropin day still be measured?
Abstract
OBJECTIVE:
DESIGN:
SETTING:
PATIENT(S):
INTERVENTION(S):
MAIN OUTCOME MEASURE(S):
RESULT(S):
CONCLUSION(S):
decapetetyl 0.2-0.4mg 均可用於誘導排卵
GnRHa (decapetetyl triptorelin) 0.2-0.4mg (2-4支)均可用於誘導排卵
卵數量, 胚胎數量, 胚胎品質並無差異
LH, P4, 數值, 0.4mg>0.3, 0.2mg
2015年11月8日
近4成囊胚期胚胎呈現染色體異常
近4成囊胚期胚胎呈現染色體異常
這足以說明囊胚期植入後懷孕率只有4-5成
To examine the prevalence of aneuploidy in human blastocysts resulting from donated eggs and embryo implantation after transfer of normal euploid embryos. Also, to assess the necessity of preimplantation genetic screening (PGS) for embryos produced with donor eggs.
Blastocysts from donor-recipient cycles were biopsied for PGS (PGS group) and the samples were analyzed with DNA microarray. Euploid blastocysts were transferred to the recipients, and both clinical pregnancy and embryo implantation were examined and compared with embryos without PGS (control group).
After PGS, 39.1 % of blastocysts were abnormal, including aneuploidy and euploid with partial chromosome deletion and/or duplication. Transfer of normal euploid blastocysts brought about 72.4 % of clinical pregnancy, 65.5 % of ongoing/delivery and 54.9 % of embryo implantation rates; these rates were slightly higher than those in the control group (66.7, 54.0 and 47.8 %, respectively), but there was no statistical difference between the two groups. By contrast, the miscarriage rate was higher in the control group (19.2 %) than in the PGS group (9.5 %), but no statistical difference was observed. Transfer of two or more embryos did not significantly increase the ongoing/delivery rates in both groups, but significantly increased the twin pregnancy rates (50.0 % in the PGS group and 43.8 % in the control group).
High proportions of human blastocysts derived from donor eggs are aneuploid. Although pregnancy and embryo implantation rates were increased, and miscarriage rates were reduced by transfer of embryos selected by PGS, the efficiency was not significantly different as compared to the control, suggesting that PGS may be necessary only in some specific situations, such as single embryo transfer.
這足以說明囊胚期植入後懷孕率只有4-5成
J Assist Reprod Genet. 2015 Jun;32(6):999-1006. doi: 10.1007/s10815-015-0492-4. Epub 2015 May 9.
Assessment of aneuploidy formation in human blastocysts resulting from donated eggs and the necessity of the embryos for aneuploidy screening.
Abstract
PURPOSE:
METHODS:
RESULTS:
CONCLUSION(S):
玻璃化冷凍胚胎優於慢速冷凍保存
Hum Reprod. 2014 Dec;29(12):2794-801. doi: 10.1093/humrep/deu246. Epub 2014 Oct 14.
Clinical outcomes following cryopreservation of blastocysts by vitrification or slow freezing: a population-based cohort study.
Abstract
STUDY QUESTION:
SUMMARY ANSWER:
WHAT IS KNOWN ALREADY:
STUDY DESIGN, SIZE, DURATION:
PARTICIPANTS/MATERIALS, SETTING, METHODS:
MAIN RESULTS AND THE ROLE OF CHANCE:
自體卵子冷凍後解凍試管嬰兒與一般試管嬰兒無差異
自體卵子冷凍儲存後再解凍懷孕生產嬰兒狀況與一般試管嬰兒無差異
The study aims to describe the newborn health parameters of the 50 first children conceived after autologous oocyte vitrification in France.
The 50 children born after autologous oocyte vitrification/warming cycle (VAO children) have been retrospectively compared with 364 children conceived by micromanipulation using freshly recovered non-vitrified oocytes (ICSI children). Children included in the study were born between 2011 and 2015. Maternal characteristics (age, body mass index, smoking habits), obstetric outcomes (diabetes, hypertension, placenta previa, parity, mode of delivery), and perinatal outcome (twinning, sex, birth weight, macrosomia, birth defects) were analyzed. The generalized estimating equation for correlated data was performed to evaluate perinatal outcomes and caesarean section.
No statistically significant difference was found between VAO children and ICSI children, even after adjusting confounding factors (low birth weigh odds ratio (OR) 0.8, 95 % confident interval (CI) 0.3-2.2, adjusted (AOR) 0.5, 95 % CI 0.2-1.7; large for gestational age OR 1.5, 95 % CI 0.3-7.0, AOR 1.6, 95 % CI 0.3-7.5; birth defects OR 0.4, 95 % CI 0.1-3.2, AOR 0.5, 95 % CI 0.1-3.7; caesarean section OR 1.8, 95 % CI 0.9-3.4, AOR 1.8, 95 % CI 0.9-3.7).
According to our results, newborn health parameters of children conceived in our center by micromanipulation using vitrified/warmed autologous oocytes seem not to be different from children born after micromanipulation on freshly recovered oocytes.
J Assist Reprod Genet. 2015 Oct 30. [Epub ahead of print]
The first 50 live births after autologous oocyte vitrification in France.
Abstract
PURPOSE:
METHODS:
RESULTS:
CONCLUSIONS:
使用FSH+LH或使用HMG誘導排卵懷孕率類似
使用FSH+LH誘導排卵 vs 使用HMG誘導排卵
二者懷孕率類似
Is the treatment with recombinant FSH (rFSH) plus recombinant LH (rLH) more effective than highly purified (HP)-hMG in terms of ongoing pregnancy rate (PR) in women ≥35 years of age undergoing intrauterine insemination (IUI) cycles?
The ongoing PR was not significantly different in women treated with rFSH plus rLH or with HP-hMG.
Although previous studies have shown beneficial effects of the addition of LH activity to FSH, in terms of PR in patients aged over 34 years having ovulation induction, no studies have compared two different gonadotrophin preparations containing LH activity in women ≥35 years of age in IUI cycles.
A single-centre RCT was performed between May 2012 and September 2013 with 579 women ≥35 years of age undergoing IUI cycles. The patients were randomly assigned to one of the two groups, rFSH in combination with rLH group or HP-hMG (Meropur) group, by giving them a code number from a computer generated randomization list, in order of enrolment. The randomization visit took place on the first day of ovarian stimulation.
Five hundred and seventy-nine patients with unexplained infertility or mild male factor undergoing IUI cycles were recruited in a university hospital setting. All women were enrolled in this study only for one cycle of treatment. Five hundred and seventy-nine cycles were included in the final analysis. Two hundred and ninety patients were treated with rFSH in combination with rLH and 289 patients were treated with HP-hMG. The ovarian stimulation cycle started on the third day of the menstrual cycle and the starting gonadotrophin doses used were 150 IU/day of rFSH plus 150 IU/day of rLH or 150 IU/day of HP-hMG. The drug dose was adjusted according to the individual follicular response. A single IUI per cycle was performed 34-36 h after hCG injection.
The main outcome measures were ongoing PR and number of interrupted cycles for high risk of ovarian hyperstimulation syndrome (OHSS). Ongoing pregnancy rates were 48/290 (17.3%) in the recombinant group versus 35/289 (12.2%) in the HP-hMG group [(odds ratio (OR) 1.50, 95% CI 0.94-2.41, P = 0.09]. The number of interrupted cycles for high risk of OHSS was 13/290 (4.5%) in the rFSH plus rLH group and 2/289 (0.7%) in the HP-hMG group (OR 6.73, 95% CI 1.51-30.12, P = 0.013).
二者懷孕率類似
Hum Reprod. 2015 Jan;30(1):179-85. doi: 10.1093/humrep/deu302. Epub 2014 Nov 14.
Highly purified hMG versus recombinant FSH plus recombinant LH in intrauterine insemination cycles in women ≥35 years: a RCT.
Moro F1, Scarinci E2, Palla C2, Romani F2, Familiari A2, Tropea A2, Leoncini E3, Lanzone A2, Apa R2.
Abstract
STUDY QUESTION:
SUMMARY ANSWER:
WHAT IS KNOWN ALREADY:
STUDY DESIGN, SIZE, DURATION:
PARTICIPANTS/MATERIALS, SETTING, METHODS:
MAIN RESULTS AND THE ROLE OF CHANCE:
自發性排卵反應隔一天即應施行人工受孕
自發性排卵反應隔一天即應施行人工受孕
隔2天施行人工受孕懷孕率會下降
What is the impact on pregnancy rates when intrauterine insemination (IUI) is performed 1 or 2 days after the spontaneous LH rise?
IUI 1 day after the spontaneous LH rise results in significantly higher clinical pregnancy rates compared with IUI performed 2 days after the LH rise.
IUI is scheduled within a limited time interval during which successful conception can be expected. Data about the optimal timing of IUI are based on inseminations following ovarian stimulation. There is no available evidence regarding the correct timing of IUI in a natural menstrual cycle following the occurrence of a spontaneous LH rise.
A prospective RCT, including patients undergoing IUI with donor sperm in a natural menstrual cycle. IUI cycles (n = 435) were randomized between October 2010 and April 2013, of which 23 were excluded owing to protocol deviation and 412 received the allocated intervention.
Serial serum LH concentrations were analysed in samples taken between 07:00 and 09:00 h to detect an LH rise from Day 11 of the cycle onwards. The subjects were randomized to receive insemination either 1 or 2 days after the observed LH rise. In the final analysis, there were 213 cycles in the group receiving IUI 1 day after the LH rise and 199 cycles in the group receiving IUI 2 days after the LH rise.
Significantly higher clinical pregnancy rates per IUI cycle were observed in patients undergoing IUI 1 day after the LH rise when compared with patients undergoing IUI 2 days after the LH rise [19.7 (42/213) versus 11.1% (22/199), P = 0.02]. In view of the timing of sampling for LH, the inseminations were performed at 27 h (±2 h) and 51 h (±2 h) after detection of the LH rise. The risk ratio of achieving a clinical pregnancy if IUI was scheduled 1 day after the LH rise compared with 2 days was 1.78 [95% confidence interval (CI), 1.11-2.88]. This points towards a gain of one additional clinical pregnancy for every 12 cycles performed 1 day instead of 2 days after the LH rise. When analysing the results per patient, including only women who underwent their first treatment cycle of insemination, the outcome was in line with the per cycle analysis, demonstrating an 8% difference in pregnancy rate in favour of the early group (20.5 versus 12.2%), however, this difference was not significant.
隔2天施行人工受孕懷孕率會下降
Hum Reprod. 2014 Apr;29(4):697-703. doi: 10.1093/humrep/deu022. Epub 2014 Feb 18.
Should an intrauterine insemination with donor semen be performed 1 or 2 days after the spontaneous LH rise? A prospective RCT.
Abstract
STUDY QUESTION:
SUMMARY ANSWER:
WHAT IS KNOWN ALREADY:
STUDY DESIGN, SIZE, DURATION:
PARTICIPANTS/MATERIALS, SETTING, METHODS:
MAIN RESULTS AND THE ROLE OF CHANCE:
2015年11月7日
施打hCG當天 P4/E2>0.35 ET後懷孕率會下降
施打hCG當天 P4>1.2或 P4/E2>0.35 ET後懷孕率會下降
The effect of elevated levels of serum progesterone (P4) and estradiol (E2) on the day of human chorionic gonadotropin and their cut-off value on in vitro fertilization (IVF) outcomes is still not clear.
The aim was to evaluate the association between serum P4, E2 and progesterone/estradiol ratio (P4/E2) on pregnancy outcome in IVF/intracytoplasmic sperm injection (ICSI) cycles with long agonist protocol.
Retrospective, single center, cohort study.
A review of complete data of 544 women undergoing fresh IVF/ICSI cycles (539 cycles) with long agonist protocol from January 2012 to February 2014 was done. Data were stratified into Three groups according to the number of oocytes retrieved: low (≤4 oocytes obtained), intermediate (5-19 oocytes obtained), and high ovarian response (≥20 oocytes obtained).
Fishers exact test/Chi-square was carried for comparing categorical data. Receiver operating characteristics analysis was performed to determine the cut-off value for P4 and P4/E2 detrimental for pregnancy.
A negative association was observed between pregnancy rate (PR) and serum P4 and P4/E2 levels with no effect on fertilization and cleavage rate. The overall cut-off value of serum P4 and P4/E2 ratio detrimental for pregnancy was found to be 1.075 and ≥0.35, respectively. Different P4 threshold according to the ovarian responders were calculated, 1.075 for intermediate and 1.275 for high responders. Serum E2 levels were not found to be significantly associated with PR.
Serum P4 levels and P4/E2 ratio are a significant predictor for pregnancy outcome without affecting cleavage and fertilization rate while serum estradiol levels do not seem to affect PR.
J Hum Reprod Sci. 2015 Apr-Jun;8(2):80-5. doi: 10.4103/0974-1208.158606.
Do increased levels of progesterone and progesterone/estradiol ratio on the day of human chorionic gonadotropin affects pregnancy outcome in long agonist protocol in fresh in vitro fertilization/intracytoplasmic sperm injection cycles?
Abstract
BACKGROUND:
AIMS:
SETTING AND DESIGN:
MATERIALS AND METHODS:
STATISTICAL ANALYSIS:
RESULTS:
CONCLUSION:
子宮內膜異位瘤手術處理不會明顯提高IVF懷孕率
子宮內膜異位瘤手術處理不會明顯提高IVF懷孕率
Endometriosis is a disease known to be detrimental to fertility. Women with endometriosis, and the presence of endometrioma, may require artificial reproductive techniques (ART) to achieve a pregnancy. The specific impact of endometrioma alone and the impact of surgical intervention for endometrioma on the reproductive outcome of women undergoing IVF/ICSI are areas that require further clarification. The objectives of this review were as follows: (i) to determine the impact of endometrioma on IVF/ICSI outcomes, (ii) to determine the impact of surgery for endometrioma on IVF/ICSI outcome and (iii) to determine the effect of different surgical techniques on IVF/ICSI outcomes.
We performed a systematic review and meta-analysis examining subfertile women who have endometrioma and are undergoing IVF/ICSI, and who have or have not had any surgical management for endometrioma before IVF/ICSI. The primary outcome was live birth rate (LBR). Our secondary outcomes were clinical pregnancy rate (CPR), mean number of oocyte retrieved (MNOR), miscarriage rate (MR), fertilization rate, implantation rate, antral follicle count (AFC), total stimulating hormone dose, and any rates of adverse effects such as cancellation and associated complications during the IVF/ICSI treatment.
We included 33 studies for the meta-analysis. The majority of the studies were retrospective (30/33), and three were RCTs. Compared with women with no endometrioma undergoing IVF/ICSI, women with endometrioma had a similar LBR (odds ratio [OR] 0.98; 95% CI [0.71, 1.36], 5 studies, 928 women, I(2) = 0%) and a similar CPR (OR 1.17; 95% CI [0.87, 1.58], 5 studies, 928 women, I(2) = 0%), a lower mean number of oocytes retrieved (SMD -0.23; 95% CI [-0.37, -0.10], 5 studies, 941 cycles, I(2) = 37%) and a higher cycle cancellation rate compared with those without the disease (OR 2.83; 95% CI [1.32, 6.06], 3 studies, 491 women, I(2) = 0%). Compared with women with no surgical treatment, women who had their endometrioma surgically treated before IVF/ICSI had a similar LBR (OR 0.90; 95% CI [0.63, 1.28], 5 studies, 655 women, I(2) = 32%), a similar CPR (OR 0.97; 95% CI [0.78, 1.20], 11 studies, 1512 women, I(2) = 0%) and a similar mean number of oocytes retrieved (SMD -0.17; 95% CI [-0.38, 0.05], 9 studies, 810 cycles, I(2) = 63%).
Women with endometrioma undergoing IVF/ICSI had similar reproductive outcomes compared with those without the disease, although their cycle cancellation rate was significantly higher. Surgical treatment of endometrioma did not alter the outcome of IVF/ICSI treatment compared with those who did not receive surgical intervention. Considering that the reduced ovarian reserve may be attributed to the presence of endometrioma per se, and the potential detrimental impact from surgical intervention, individualization of care for women with endometrioma prior to IVF/ICSI may help optimize their IVF/ICSI results.
Hum Reprod Update. 2015 Nov;21(6):809-25. doi: 10.1093/humupd/dmv035. Epub 2015 Jul 12.
The impact of endometrioma on IVF/ICSI outcomes: a systematic review and meta-analysis.
Abstract
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黃體期使用低劑量hCG可取代傳統黃體針補充療法
黃體期使用低劑量hCG (125iu/d)可取代傳統黃體針補充療法
http://www.ncbi.nlm.nih.gov/pubmed/26209535
Can the luteal phase support be improved in terms of efficacy, hormonal profiles and convenience as compared with today's standard care?
Daily low-dose rhCG supplementation in GnRHa triggered IVF cycles can replace the traditional used luteal phase support with exogenous progesterone.
A bolus of hCG for final maturation of follicles in connection with COS may induce the risk of OHSS and the luteal phase progesterone levels rise very abruptly in the early luteal phase.
This is a proof-of-concept study conducted as a three arm RCT with a total of 93 patients. First patient enrolled in January 2012 and the study finished in January 2014.
Normal responder women undergoing IVF/ICSI treatment in a university hospital. One arm served as control, where women followed a standard antagonist protocol. Two study arms were included both having 125 IU hCG daily for luteal phase support without exogenous progesterone after using a GnRHa trigger for ovulation induction. In both study arms exogenous FSH was stopped on stimulation day 6 and replaced by exogenous hCG that was initiated on either stimulation day 2 or day 6. Blood samples were obtained on the day of ovulation induction, on the day of oocyte pickup (OPU) and day OPU + 7.
The mean serum levels of hCG did not exceeded the normal physiological range of LH activity in any samples. Mid-luteal progesterone levels were significantly higher in the two study groups receiving daily low-dose hCG for luteal phase support as compared with the control group (control group: 177 ± 27 nmol/l; study group 1: 334 ± 42 nmol/l; study group 2: 277 ± 27 nmol/l; (mean ± SEM). No differences in reproductive outcome were seen between groups.
http://www.ncbi.nlm.nih.gov/pubmed/26209535
Hum Reprod. 2015 Oct;30(10):2387-95. doi: 10.1093/humrep/dev184. Epub 2015 Jul 23.
Daily low-dose hCG stimulation during the luteal phase combined with GnRHa triggered IVF cycles without exogenous progesterone: a proof of concept trial.
Abstract
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