scholarly journals Procriação Medicamente Assistida em Ciclo Natural: Avaliação dos Resultados de um Departamento de Medicina da Reprodução

2019 ◽  
Vol 32 (1) ◽  
pp. 25
Author(s):  
Mariana Carlos Alves ◽  
Andreia Leitão Marques ◽  
Helena Barros Leite ◽  
Ana Paula Sousa ◽  
Teresa Almeida-Santos
Keyword(s):  
Embryo Transfer ◽  
Assisted Reproduction ◽  
Ovarian Stimulation ◽  
Lower Cost ◽  
Oocyte Retrieval ◽  
Clinical Pregnancy ◽  
Poor Responders ◽  
Natural Cycle ◽  
Medically Assisted Reproduction ◽  
The Mean

Introduction: Medically assisted reproduction in natural cycle has been investigated, especially in women with poor response to conventional ovarian stimulation, with endometrial receptivity improvement, lower cost and possibility of successive cycles. The disadvantages are: lower profitability per treatment cycle and higher cancellation rate. The aim of this study was to determine the rate of clinical pregnancy in infertile women subjected to medically assisted reproduction in natural cycle.Material and Methods: Retrospective study of 149 medically assisted reproduction without ovarian stimulation of 50 infertile women, between January/2011 and October/2014.Results: The mean age of women undergoing medically assisted reproduction in natural cycle was 36.1 years. Approximately half (46.0%) of the cycles were performed in poor responders. On the day of ovulation trigger, the mean diameter of the follicle was 17.5 mm. Twenty-three cycles (15.4%) were canceled prior to ovulation trigger. In 8 cycles (5.3%), ovulation occurred between ovulation trigger and oocyte retrieval. In the majority of cycles (n = 118; 79.2%) oocyte retrieval was executed, a medically assisted reproduction technique was performed in 71 (47.6%), mostly intracytoplasmic injection. The overall fertilization rate was 77.5%. In 40 cycles (26.8%) there was embryo transfer. The implantation rate and the clinical pregnancy rate by embryo transfer was 35.0% and 25.0%, respectively. Most pregnancies occurred in poor responders, according to Bologna criteria.Discussion: Although the pregnancy rate per cycle started was 6.7%, the rate of clinical pregnancy per embryo transfer is quite satisfactory, being a group of women with unfavorable responses in previous treatments. The relatively high rates of cycle cancellation are mitigated by the greater simplicity and lower cost of these cycles.Conclusion: The results obtained in this study demonstrate that Medically Assisted Reproduction in natural cycle may be an alternative treatment for ovarian stimulation in patients with poor prognosis, whose only alternative would be oocyte donation.

P–694 Natural cycle vs Accumulation of oocytes. Which strategy is better for women with the poor ovarian response (POR)?

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
K Bekzatova ◽  
M Shishimorova
Keyword(s):  
Embryo Transfer ◽  
Ovarian Stimulation ◽  
Ovarian Response ◽  
Clinical Pregnancy ◽  
Successful Outcome ◽  
Poor Responders ◽  
Poor Ovarian Response ◽  
Average Amount ◽  
Number Of Patients ◽  
Natural Cycles

Abstract Study question The aim of this study is to determine whether repetitive natural cycles (Strategy A) or oocyte accumulation (Strategy B) is a more effective strategy. Summary answer There was no statistical difference between the strategies however, the number of attempts for successful outcome with strategy A was lower than in strategy B. What is known already For populations with poor ovarian response natural cycles (NC) or modified natural cycles (mNC) with minimal stimulation have been implemented as a preferable option as opposed to conventional ovarian stimulation. Due to the development of advanced vitrification techniques, the accumulation of oocytes has become available. Previous studies (2011, 2013, 2019) suggest that accumulation of oocytes could be a successful alternative to repetitive natural cycles for poor responders aged ≥35 years, showing higher clinical pregnancy rates. Moreover, the embryo-transfer cancellation and miscarriage rate were significantly lower in the oocyte accumulation strategy. Study design, size, duration Present retrospective cohort study included a selection of patients with POR treated from 2019–2020, which were divided into 2 strategies. Strategy A included 324 natural cycles or modified natural cycles with successful oocyte retrievals (Female mean age: 36.3 years). The strategy B consisted of 46 cycles with thawed oocytes that were accumulated through cryopreservation in several attempts (average n = 2,3) prior in NC or mNC (Female mean age: 37.6 years). Participants/materials, setting, methods POR was defined by following criteria: 1) advanced maternal age (≥35 years) or; 2) previous POR (≤3 oocytes with a conventional ovarian stimulation protocol); 3) abnormal ovarian reserve test; The vitrification of the oocytes was performed using Kuwayama method (Cryotech®, Japan), while thawing was performed using Cryotop method (Kitazato®, Japan). Prior to fertilization, oocytes were cultured for 2 hours in IVF medium (Origio®, Denmark). The unsuccessful transvaginal oocyte retrievals (TVOR) were excluded from both strategies. Main results and the role of chance The clinical pregnancy rate per started cycle and per transfer in Strategy A vs Strategy B were 15,4% vs 15,2% and 28.08% vs 20%, respectively. Strategy A seemed to achieve higher rates; however, the difference was not statistically significant (Student’s t-test, p < 0.05). Throughout all TVORs the rate of successful retrieval was 71.7%. The embryo-transfer cancellation rates in Strategy A vs Strategy B were 38,2% vs 8,69%, respectively. With strategy A the average amount of attempts for successful clinical pregnancy was 1.86. With strategy B the average amount of cryopreservations for oocyte accumulation was 2.3. Limitations, reasons for caution The number of patients in strategy B was significantly lower than in strategy A. Larger study with an increased number of samples is necessary to confirm the results. In addition calculation of cost-effectiveness in each strategy. The unsuccessful TVORs were excluded from both strategies, which significantly affects the statistical rates. Wider implications of the findings: This study might help in developing and selecting more appropriate strategies for women with POR. The findings might help to determine the amount of time and attempts required for a successful outcome for patients aged ≥35. It can also be helpful in regulating the financial part of artificial reproductive technology. Trial registration number N/A

scholarly journals Natural Cycle Results in Lower Implantation Failure than Ovarian Stimulation in Advanced-Age Poor Responders Undergoing IVF: Fertility Outcomes from 585 Patients

2021 ◽  
Author(s):  
Maria Paola De Marco ◽  
Giulia Montanari ◽  
Ilary Ruscito ◽  
Annalise Giallonardo ◽  
Filippo Maria Ubaldi ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Ovarian Stimulation ◽  
Embryo Implantation ◽  
Implantation Rate ◽  
Poor Responder ◽  
Advanced Age ◽  
Poor Responders ◽  
Natural Cycle ◽  
Significant Difference ◽  
Over 40 Years

AbstractTo compare pregnancy rate and implantation rate in poor responder women, aged over 40 years, who underwent natural cycle versus conventional ovarian stimulation. This is a retrospective single-center cohort study conducted at the GENERA IVF program, Rome, Italy, between September 2012 and December 2018, including only poor responder patients, according to Bologna criteria, of advanced age, who underwent IVF treatment through Natural Cycle or conventional ovarian stimulation. Between September 2012 and December 2018, 585 patients were included within the study. Two hundred thirty patients underwent natural cycle and 355 underwent conventional ovarian stimulation. In natural cycle group, both pregnancy rate per cycle (6.25 vs 12.89%, respectively, p = 0.0001) and pregnancy rate per patient101 with at least one embryo-transfer (18.85 vs 28.11% respectively, p = 0.025) resulted significant reduced. Pregnancy rate per patient managed with conventional ovarian stimulation resulted not significantly different compared with natural cycle (19.72 vs 15.65% respectively, p = 0.228), but embryo implantation rate was significantly higher in patients who underwent natural cycle rather than patient subjected to conventional ovarian stimulation (13 vs 8.28% respectively, p = 0.0468). No significant difference could be detected among the two groups in terms of abortion rate (p = 0.2915) or live birth pregnancy (p = 0.2281). Natural cycle seems to be a valid treatment in patients over 40 years and with a low ovarian reserve, as an alternative to conventional ovarian stimulation.

scholarly journals Relative Potencies of Anastrozole and Letrozole to Suppress Estradiol in Breast Cancer Patients Undergoing Ovarian Stimulation before in Vitro Fertilization

2007 ◽  
Vol 92 (6) ◽  
pp. 2197-2200 ◽  
Author(s):  
Amr A. Azim ◽  
Maria Costantini-Ferrando ◽  
K. Lostritto ◽  
Kutluk Oktay
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Ovarian Stimulation ◽  
Area Under The Curve ◽  
Oocyte Retrieval ◽  
Embryo Cryopreservation ◽  
Breast Cancer Patients ◽  
Vitro Fertilization ◽  
The Mean

Abstract Context: Breast cancer patients undergoing controlled ovarian hyperstimulation (COH) for embryo or oocyte cryopreservation should be induced by the method that leads to the least increase in estradiol (E2) levels. Objective: The aim of the study was to determine the potency of anastrozole to suppress serum E2 levels in breast cancer patients undergoing COH. Design and Setting: A prospective sequential cohort study was conducted in an academic center for reproductive medicine between May 2003 and November 2005 for letrozole and between December 2005 and April 2006 for anastrozole. Patients: Breast cancer patients presenting for fertility preservation participated in the study. Intervention: COH using FSH and letrozole (n = 47) or anastrozole (n = 7) was followed by oocyte retrieval and embryo cryopreservation. Main Outcome Measures: Serum E2 levels, area under the curve for E2, and outcomes of COH cycles were measured. Results: There were no significant differences between the two groups regarding length of stimulation, total gonadotropin dose, number of follicles larger than 17 mm, and the lead follicle size on human chorionic gonadotropin (hCG) day and number of embryos cryopreserved. The mean E2 levels on the day of hCG and post-hCG days were higher in the anastrozole group compared to the letrozole group (1325.89 ± 833.17 and 2515.07 ± 1368.52 vs. 427.78 ± 278.24 and 714.38 ± 440.83 pg·d/ml; P ≤ 0.01), respectively, even when anastrozole dose was increased up to 10 mg/d. The mean area under the curve was significantly higher in the anastrozole group compared to the letrozole group (4402.93 ± 1526.7 vs. 1287.48 ± 732.17 pg·d/ml; P <0.004). Conclusions: Breast cancer patients who underwent ovarian stimulation with anastrozole had a significantly higher exposure to E2 than those who were stimulated with letrozole.

scholarly journals 2017–2018 Assisted Reproduction Cost Analysis Performance Indexes: Lombardy County Case Study

2021 ◽  
Vol 3 ◽  
Author(s):  
Paolo Emanuele Levi-Setti ◽  
Andrea Busnelli ◽  
Annalisa Bodina ◽  
Roberto De Luca ◽  
Giulia Scaravelli
Keyword(s):  
Embryo Transfer ◽  
Multiple Pregnancy ◽  
Economic Cost ◽  
Oocyte Retrieval ◽  
Delivery Rate ◽  
Success Rates ◽  
Performance Indexes ◽  
Significant Difference ◽  
The Mean ◽  
Lost To Follow Up

Objective: The aim of the present study was to analyze the IVF success rates and the economic cost per delivery in all the public funded IVF Units in Lombardy in the 2017–2018 period and to assess any significant difference in ART outcomes among the enrolled centers.Methods: Analysis of costs for the 2017 and 2018 fresh transfer delivery rate (DR) and Cumulative delivery rate (CDR) considering both fresh and frozen cycles were extracted from the ART Italian Registry on oocytes retrievals, fresh and frozen embryos and oocytes embryo transfer performed in 22 Lombardy IVF Units.Results: In 2017, 29,718 procedures were performed, resulting in 4,543 pregnancies and 3,253 deliveries. In 2018, there were 29,708 procedures, 4,665 pregnancies and 3,348 deliveries. Pregnancies lost to follow up were 5.0% with a (range of 0–67.68%) in 2017 and 3.4% (range of 0–45.1%) in 2018. The cost reimbursement for the cycles were €2,232 ($2,611) for oocyte retrieval and €2,194 ($2,567) for embryo transfer, excluding ovarian stimulation therapy and luteal phase support. 19.33 (5.80). The DR was 13.23 ± 5.69% (range 2.86–29.11%) in 2017 and 19.33 ± 5.80% in 2018 (range 11.82–34.98 %) and the CDR was 19.86 ± 9.38% (range 4.43–37.88%) in 2017 and 21.32 ± 8.84% (range 4.24–37.11%). The mean multiple pregnancy delivery rate (MDR) was 11.08 ± 5.55% (range 0.00–22.73%) in 2017 and 10.41 ± 4.99% (range 1.33–22.22%) in 2018. The mean CDR cost in euros was 26,227 ± 14,737 in 2017 and 25,018 ± 16,039 in 2018. The mean CDR cost among centers was 12,480 to 76,725 in 2017 and 12,973 to 86,203 in 2018.Conclusions: Our findings show impressive differences in the DR and CDR among centers and the importance of cryopreservation in patients' safety and economic cost reduction suggesting the formulation of specific KPI's (Key performance indexes) and minimal performance indexes (PI) as a basis for the allocation of public or insurance resources. In particular, the reduction of multiple pregnancy rates costs, may lead to a more widespread use of ART even in lower resources countries.

scholarly journals The Association between changes in C reactive protein and pregnancy rate in IVF/ICSI

2021 ◽  
Vol 4 (2) ◽  
pp. 01-08
Author(s):  
Bahaa Aldin
Keyword(s):  
Pregnancy Rate ◽  
Embryo Transfer ◽  
Oocyte Retrieval ◽  
Maternity Hospital ◽  
Clinical Pregnancy ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Study Results ◽  
Written Informed Consent ◽  
High Chance

Objectives: The aim of this study is to evaluate the association between changes in C reactive protein and pregnancy rate in IVF/ICSI. Patients and methods: A prospective cohort study that was conducted in Ain Shams University Maternity Hospital, Infertility Clinic during period time from September 2018 to September 2020. A total of 100 infertile women who were candidate for IVF/ICSI, over a period of 2 years, beginning in September 2018 were recruited to the study after they met the inclusion and exclusion criteria. The participants gave written informed consent and approval for the ethical aspects of the study. Results: This study showed no statistically significant differences according to clinical pregnancy regarding the sociodemographic data as BMI, duration of infertility and type of infertility and regarding Oocyte retrieval and embryo transfer, also no significant differences according to clinical pregnancy regarding CRP at baseline and at Oocyte pickup as well as CRP change at oocyte pickup. But age was significantly lower in cases with clinical pregnancy and CRP at embryo transfer and CRP change at embryo transfer were significantly higher in cases with positive pregnancy. Conclusion: Finally, we concluded that patients whose CRP level decreased on transfer day, had lower chance of pregnancy, whereas patients whose CRP level elevated on embryo transfer day had high chance of pregnancy

scholarly journals Does daily co administration of gonadotropins and letrozole during the ovarian stimulation improve IVF outcome for poor and sub optimal responders?

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Moran Shapira ◽  
Raoul Orvieto ◽  
Oshrit Lebovitz ◽  
Ravit Nahum ◽  
Adva Aizer ◽  
...  
Keyword(s):  
Ovarian Stimulation ◽  
Multiple Dose ◽  
Paired Comparison ◽  
Ovarian Response ◽  
Clinical Pregnancy ◽  
Poor Responders ◽  
Ivf Outcomes ◽  
Oocyte Yield ◽  
Subsequent Cycle ◽  
Estradiol Levels

Abstract Background Co-administration of letrozole during the first 5 days of ovarian stimulation was suggested to improve IVF outcomes in poor responders. We aimed to determine whether poor/sub-optimal responders might benefit from Letrozole co-treatment throughout the entire stimulation course. Methods We retrospectively reviewed the medical files of women who demonstrated poor (oocyte yield ≤3) and sub-optimal (4 ≤ oocyte yield ≤9) ovarian response during conventional multiple-dose antagonist stimulation protocols and were co-treated in a subsequent cycle with 5 mg Letrozole from the first day of stimulation until trigger day. A self-paired comparison between gonadotropins-only and gonadotropins-letrozole cycles was performed. Results Twenty-four patients were included. Mean patients’ age was 39.83 ± 4.60 and mean day-3-FSH was 12.77 ± 4.49 IU/m. Duration of stimulation and total gonadotropins dose were comparable between the two cycle groups. Peak estradiol levels were significantly lower in gonadotropins-letrozole cycles (2786.74 ± 2118.53 vs 1200.13 ± 535.98, p < 0.05). Number of retrieved oocytes (3.29 ± 2.15 vs 6.46 ± 3.20, p < 0.05), MII-oocytes (2.47 ± 1.65 vs 5.59 ± 3.20, p < 0.05), 2PN-embryos (1.78 ± 1.50, 4.04 ± 2.74, p < 0.05) and top-quality embryos (0.91 ± 0.97 vs. 2.35 ± 1.66, p < 0.05) were significantly higher in the gonadotropins-letrozole cycles. Clinical pregnancy rate in gonadotropins-letrozole cycles was 31.5%. Conclusion Letrozole co-treatment during the entire stimulation course improves ovarian response and IVF outcomes in poor/sub-optimal responders.

P–609 The chances of one live birth rates after first ART cycle in minimal stimulation cycle IVF with letrozole only and natural cycle IVF

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Y Takahashi ◽  
N Hisa ◽  
R Kotake ◽  
Y Suzuki ◽  
S Akimoto ◽  
...  
Keyword(s):  
Cohort Study ◽  
Gnrh Antagonist ◽  
Oocyte Retrieval ◽  
Clinical Pregnancy ◽  
Natural Cycle ◽  
Live Birth Rates ◽  
Significant Difference ◽  
Natural Cycle Ivf ◽  
Clinical Pregnancy Rates ◽  
Minimal Stimulation

Abstract Study question Are one live birth rates (LBRs) similar in minimal stimulation cycle IVF with letrozole only and natural cycle IVF for the first ART cycle? Summary answer LBRs after first ART cycle in minimal stimulation cycle IVF with letrozole only are superior to natural cycle IVF. What is known already The addition of letrozole to gonadotropins in ovarian stimulation (OS) may reduce the risk of OHSS, but there is no significant difference were reported in ongoing pregnancy rate or number of oocytes retrieved in the letrozole + FSH group compared to the FSH only. No differences were also reported in clinical pregnancy rates or number of mature oocytes in the additional of letrozole in an GnRH antagonist protocol group compared to the GnRH antagonist group. There are no previous study comparing LBRs after first ART cycle in minimal stimulation cycle IVF with letrozole and natural cycle IVF. Study design, size, duration Data for this retrospective cohort study were obtained 643 women, 30–39 years of age started their first ART cycle at one private fertility clinic between January 2016- December 2019. Participants/materials, setting, methods A total of 643 women were scheduled their first oocyte retrieval cycle. 118 women started with letrozole (LE) and 525 women started natural cycle (NC). The main strategy for OS in our center is minimal stimulation and natural cycle IVF. Patients consulted with gynecologists to determine their treatment plan based on patients’ preference or their menstrual cycle. All pregnancies generated from oocyte retrieval during the first IVF cycle including fresh and frozen-thaw cycles were registered. Main results and the role of chance The number of retrieved oocytes and the normal fertilization rates were significantly higher in the LE than NC (4.4 vs 3.4, 77.6% vs 71.1%), p &lt; 0.05 respectively). There was no significant difference in the clinical pregnancy rates (CPRs) per embryo transfer (ET) (fresh cleavage stage ET: 32.9% vs 28.0%, frozen-thaw blastocyst ET: 39.4% vs 44.9% ns). However, the CPRs and LBRs per oocyte retrieval (OR) were significantly higher in the LE group (39.0% vs 28.6, 33.9% vs 21.9%, p &lt; 0.05 respectively). In a subsequent regression analyses, LBRs per OR of LE was significantly higher than NC as well. (adjusted OR = 1.63 (95% CI: 1.02–2.58, p = 0.041). Limitations, reasons for caution The strength of the present study was the use of a large cohort of women who underwent minimal stimulation IVF with letrozole only. Although our results are promising, limited by retrospective cohort study. These interpretations prompted the need for a perspective cohort study to evaluate the efficacy of letrozole. Wider implications of the findings: When comparing minimal stimulation IVF with letrozole only and natural cycle IVF, we found significantly higher LBRs per OR in minimal stimulation IVF with letrozole only, despite similar CPRs per ET. Trial registration number none

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