2015年11月8日

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

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:

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?

SUMMARY ANSWER:

The ongoing PR was not significantly different in women treated with rFSH plus rLH or with HP-hMG.

WHAT IS KNOWN ALREADY:

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.

STUDY DESIGN, SIZE, DURATION:

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.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

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.

MAIN RESULTS AND THE ROLE OF CHANCE:

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).

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

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.

Blockeel C1, Knez J, Polyzos NP, De Vos M, Camus M, Tournaye H.

Author information

Abstract

STUDY QUESTION:

What is the impact on pregnancy rates when intrauterine insemination (IUI) is performed 1 or 2 days after the spontaneous LH rise?

SUMMARY ANSWER:

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.

WHAT IS KNOWN ALREADY:

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.

STUDY DESIGN, SIZE, DURATION:

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.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

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.

MAIN RESULTS AND THE ROLE OF CHANCE:

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.

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

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?

Singh N1, Kaur SD1, Malik N1, Malhotra N1, Vanamail P1.

Author information

Abstract

BACKGROUND:

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.

AIMS:

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.

SETTING AND DESIGN:

Retrospective, single center, cohort study.

MATERIALS AND METHODS:

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).

STATISTICAL ANALYSIS:

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.

RESULTS:

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.

CONCLUSION:

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.

子宮內膜異位瘤手術處理不會明顯提高IVF懷孕率

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.

Hamdan M1, Dunselman G2, Li TC3, Cheong Y4.

Author information

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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%).

CONCLUSIONS:

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.

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

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.

Andersen CY1, Elbaek HO2, Alsbjerg B3, Laursen RJ2, Povlsen BB2, Thomsen L3, Humaidan P3.

Author information

Abstract

STUDY QUESTION:

Can the luteal phase support be improved in terms of efficacy, hormonal profiles and convenience as compared with today's standard care?

SUMMARY ANSWER:

Daily low-dose rhCG supplementation in GnRHa triggered IVF cycles can replace the traditional used luteal phase support with exogenous progesterone.

WHAT IS KNOWN ALREADY:

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.

STUDY DESIGN, SIZE, DURATION:

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.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

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.

MAIN RESULTS AND THE ROLE OF CHANCE:

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.

冷凍胚胎植入前不需誘導排卵即可達到類似懷孕率

冷凍胚胎植入前不需誘導排卵, 使用自然週期配合少量荷爾蒙藥劑即可達到類似懷孕率

2015 Nov;30(11):2552-62. doi: 10.1093/humrep/dev224. Epub 2015 Sep 12.

Frozen-thawed embryo transfer in a natural or mildly hormonally stimulated cycle in women with regular ovulatory cycles: a RCT.

Peeraer K1, Couck I2, Debrock S2, De Neubourg D2, De Loecker P2, Tomassetti C2, Laenen A3, Welkenhuysen M2, Meeuwis L2, Pelckmans S2, Meuleman C2, D'Hooghe T2.

Author information

Abstract

STUDY QUESTION:

Can ovarian stimulation with low dose hMG improve the implantation rate (IR) per frozen-thawed embryo transferred (FET) when compared with natural cycle in an FET programme in women with a regular ovulatory cycle?

SUMMARY ANSWER:

Both IR and live birth rate (LBR) per FET were similar in the group with mild ovarian stimulation and the natural cycle group.

WHAT IS KNOWN ALREADY:

Different cycle regimens for endometrial preparation are used prior to FET: spontaneous ovulatory cycles, cycles with artificial endometrial preparation using estrogen and progesterone hormones, and cycles stimulated with gonadotrophins or clomiphene citrate. At present, it is not clear which regimen results in the highest IR or LBR. More specifically, there are no RCTs in ovulatory women comparing reproductive outcome after FET during a natural cycle and during a hormonally stimulated cycle.

STUDY DESIGN, SIZE, DURATION:

A total of 410 women scheduled for FET during 579 cycles (December 2003-September 2013) were enrolled in an open-label RCT to natural cycle (NC FET group, n = 291) or to a cycle hormonally stimulated with s.c. gonadotrophins (hMG FET group, 37.5-75 IU per day, n = 288). A total of 672 embryos were transferred during 434 cycles (332 embryos and 213 cycles in the NC FET group; 340 embryos and 221 cycles in the hMG FET group). Assuming a = 0.05 and 80% power, it was calculated that 219 frozen-thawed embryos were required for transfer in each group to demonstrate a difference of 10% in IR.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

Women were eligible according to the following inclusion criteria: regular ovulatory cycle, female age ≥21 years and ≤45 years, informed consent. FET cycles with preimplantation genetic screening were excluded. The primary outcome was IR per embryo transferred. Secondary outcomes included IR with fetal heart beat (FHB), LBR per embryo transferred and endometrial thickness on the day of hCG administration. Statistical analysis was by intention to treat and controlled for the presence of multiple measures, as eligible women could be randomized in more than one cycle. Chi-square and independent t-test were used to compare categorical and continuous variables. The relative risk (RR) was estimated using a Poisson model with log link. Hierarchical models with random intercepts for patient and cycle were considered to account for clustering of cycles within patients and of embryos within cycles.

MAIN RESULTS AND THE ROLE OF CHANCE:

The primary outcome, IR per embryo transferred, was not statistically different between the NC FET group (41/332 (12.35%)) and in the hMG FET group (55/340 (16.18%)) (RR 1.3 (95% confidence interval (CI) 0.9-2.0), P = 0.19). Similarly, the secondary outcome, IR with FHB per embryo transferred, was 34/332 (10.24%) in the NC FET group and 48/340 (14.12%) in the hMG FET group (RR 1.4 (95% CI 0.9-2.1), P = 0.15). The LBR per embryo transferred was 32/332 (9.64%) in the NC FET group and 45/340 (13.24%) in the hMG FET group (RR 1.4 (95% CI 0.9-2.2), P = 0.17). Endometrial thickness was also similar in both groups [8.9 (95% CI 8.7-9.1) in the NC FET group and 8.9 (95% CI 8.7-9.1) in the hMG FET group]. The duration of the follicular phase was significantly shorter (P < 0.001) in the hMG FET group [13.7 days (95% CI 13.2-14.2)] than in the NC FET group [15.4 days (95% CI 14.8-15.9)].

LIMITATIONS, REASONS FOR CAUTION:

Randomization of cycles instead of patients; open-label design; relatively long period of recruitment.

WIDER IMPLICATIONS OF THE FINDINGS:

Our observation that the IR per embryo transferred is not significantly increased after FET during natural or gonadotrophin stimulated cycle, suggests that the effect of mild hormonal stimulation with gonadotrophins is smaller than what was considered clinically relevant with respect to reproductive outcome after FET. These data suggest that endometrial receptivity is not relevantly improved, but also not impaired after hormonal stimulation with gonadotrophins. Since FET during a natural cycle is cheaper and more patient-friendly, we recommend this regimen as the treatment of choice for women with regular cycles undergoing FET.

STUDY FUNDING/COMPETING INTERESTS:

The authors have no conflict of interest to declare. T.D. and K.P. were supported by the Clinical Research Foundation of UZ Leuven, Belgium. This study was also supported by the Ferring company (Copenhagen, Denmark), which provided free medication (Menopur) required for the group of patients who were randomized in the hMG FET group. The Ferring company was not involved in the study design, data analysis, writing and submission of the paper.

20-25%受孕卵子呈現染色體異常

IVF失敗主因為胚胎染色體異常
胚胎染色體異常主因為受孕過程減數分裂異常

20-25%受孕卵子呈現染色體異常

http://www.ncbi.nlm.nih.gov/pubmed/26255654

Genotype un-diagnosed	28 (10%)
Amplification failure	14 (5%)
Allele drop-out	14 (5%)

網頁

2015年11月8日

Highly purified hMG versus recombinant FSH plus recombinant LH in intrauterine insemination cycles in women ≥35 years: a 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:

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

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:

The impact of endometrioma on IVF/ICSI outcomes: a systematic review and meta-analysis.

Abstract

BACKGROUND:

METHODS:

RESULTS:

CONCLUSIONS:

Daily low-dose hCG stimulation during the luteal phase combined with GnRHa triggered IVF cycles without exogenous progesterone: a proof of concept trial.

Abstract

STUDY QUESTION:

SUMMARY ANSWER:

WHAT IS KNOWN ALREADY:

STUDY DESIGN, SIZE, DURATION:

PARTICIPANTS/MATERIALS, SETTING, METHODS:

MAIN RESULTS AND THE ROLE OF CHANCE:

Frozen-thawed embryo transfer in a natural or mildly hormonally stimulated cycle in women with regular ovulatory cycles: a 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:

LIMITATIONS, REASONS FOR CAUTION:

WIDER IMPLICATIONS OF THE FINDINGS:

STUDY FUNDING/COMPETING INTERESTS:

Clomiphene based ovarian stimulation in a commercial donor program.

Abstract

OBJECTIVE:

MATERIALS AND METHODS:

RESULTS:

CONCLUSION:

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Embryo selection versus natural selection: how do outcomes of comprehensive chromosome screening of blastocysts compare with the analysis of products of conception from early pregnancy loss (dilation and curettage) among an assisted reproductive technology population?

Abstract

OBJECTIVE:

DESIGN:

SETTING:

PATIENT(S):

INTERVENTION(S):

MAIN OUTCOME MEASURE(S):

RESULT(S):

CONCLUSION(S):

450 IU versus 600 IU gonadotropin for controlled ovarian stimulation in poor responders: a randomized controlled trial.

Abstract

OBJECTIVE:

DESIGN: