Importance of a 5- versus 7-day pill-free interval in a GnRH antagonist protocol using corifollitropin alfa: a prospective cohort study in oocyte donors.

In this prospective cohort study, oocyte donors were recruited prospectively and assigned to receive corifollitropin alfa: 5 days after pill discontinuation (group D5; 42 donors), or 7 days after pill discontinuation (group D7; 50 donors) in a gonadotrophin-releasing hormone antagonist protocol. Fixed additional daily doses of 200 IU recombinent FSH (rFSH) were started after 7 days of corifollitropinalfa, until triggering. No significant differences in basal characteristics were observed between both groups. In group D5, mean (SD) total additional rFSH dose was 659 (452) IU; in group D7, total rFSH dose was 459 (356) IU (P = 0.022). Duration of stimulation was significantly longer in group D5 compared with group D7 (P = 0.002). No differences were found in total number of oocytes obtained. Total number of injections was significantly lower in group D7 compared with group D5 (9.8 [3.2] versus 11.9 [3.9], respectively; P = 0.004). Total cost of medication used for donor treatment was significantly higher in group D5 than in group D7 (P = 0.015). After more than 22 days of pill-taking, extending the pill-free interval to 7 days significantly reduces the total dose of gonadotrophins, duration of stimulation, total cost of medication and total number of injections.

Is AMH useful to reduce low ovarian response to GnRH antagonist protocol in oocyte donors?

We aimed to establish the reference values of Anti-Müllerian hormone (AMH) in our oocyte donor population and correlate them with the ovarian response to an antagonist stimulation protocol and to study the predictive capacity of AMH for poor response (PR). Normal AMH curves were obtained for 172 candidates. AMH levels decreased with age although they showed great heterogeneity and spread in absolute values at any age range. AMH levels showed a positive correlation, statistically significant, with the Antral Follicle Count (r = 0,705), and number of oocytes retrieved (r = 0,356). In receiver operating characteristic curve analysis a threshold value of AMH = 2.31 ng/ml predictive for retrieval <6 MII (area under the curve (AUC) 0.675) was identified. This cut-off predicted PR with a sensitivity of 70.4% and a specificity of 61.8%, (PPV = 39.6%; NPV = 85.5%, p = 0.004). When performing a multiple logistic regression analysis including age, AFC and FSH, an AUC = 0.668 for PR was obtained whereas if AMH was added to the model it resulted in an AUC = 0.713. In oocyte donors aged 18 to 35 with an AFC ≥ 10 and basal FSH <10 mIU/ml, measuring AMH levels improved just slightly the prediction for PR.

Vitrified blastocysts from Preimplantation Genetic Diagnosis (PGD) as a source for human Embryonic Stem Cell (hESC) derivation.

Embryos diagnosed as abnormal in Preimplantation Genetic Diagnosis (PGD) cycles are useful for the establishment of human Embryonic Stem Cells (hESC) lines with genetic disorders. These lines can be helpful for drug screening and for the development of new treatments. Vitrification has proved to be an efficient method to preserve human blastocysts. One hundred and three abnormal or undiagnosed vitrified blastocysts from the PGD programme at Institut Universitari Dexeus were donated for human embryonic stem cell derivation. The overall survival rate after warming was 70.6 %. Our results showed better survival rates when blastocysts have not started the hatching process (initial/expanded 87.8 %, hatching 68.3 % and hatched 27.3 %). Thirty-five blastocysts and 12 partially surviving embryos were seeded. One hESC line with the multiple exostoses type 2 paternal mutation was obtained.