GnRHa for trigger and luteal phase support in natural cycle frozen embryo transfer - A proof of concept study.

We aimed to explore whether ovulation induced by a GnRH analogue (GnRHa), followed by daily GnRHa luteal support provides an efficient platform for natural cycle frozen embryo transfer (NC-FET). In this cohort study, included were normo-ovulatory women who underwent NC-FET cycles, under the age of 40, with an antral follicle count > eight. Ovulation was triggered with triptorelin (0.2 mg Decapeptyl; Ferring), and luteal support was initiated two days later, using a Nafarelin inhaler (Synarel, Pfizer), 200 µg twice daily. Main outcome measures were luteal estradiol and progesterone levels (three to five days following ovulation), implantation rate, ongoing pregnancy rate, early pregnancy loss rate, and live birth rate. Fifty-one patients treated between 2017 and 2018 were included. Mid luteal progesterone levels among study patients, were non-significantly different between patients who achieved pregnancy and those who did not, but differed significantly on day 14 following ovulation (86.0 ± 31.3 vs. 9.8 ± 9.5 nmol/L, respectively, p < 0.001). Twenty-three patients achieved a clinical pregnancy (45.1 %); interestingly, there were no chemical pregnancies. Three pregnancies ended in an early abortion at 6-7 weeks gestation, and 20 pregnancies continued as ongoing pregnancies (39.2 %). One patient had a late abortion at 16 weeks gestation, and 14 had a live birth. In conclusion, in this proof of concept study, inducing ovulation with a bolus of GnRHa in NC-FET, followed by repeated daily GnRHa administration, resulted in satisfactory luteal phase steroid levels and high ongoing pregnancy and live birth rates.

Gonadotropin-releasing hormone analogue as sole luteal support in antagonist-based assisted reproductive technology cycles.

OBJECTIVE: To evaluate the efficacy of GnRH agonists (GnRH-a) as sole luteal phase support in patients undergoing IVF in antagonist-based cycles compared with standard vaginal P preparations. DESIGN: Retrospective cohort. SETTING: Private fertility clinic. PATIENT(S): Patients who underwent antagonist-based cycles performed at our clinic between 2009 and 2015. INTERVENTION(S): Intranasal GnRH-a or vaginal P as luteal support. MAIN OUTCOME MEASURE(S): Live birth rates. RESULT(S): A total of 2,529 antagonist-based cycles from 1,479 women were available for analysis, in which GnRH-a were used in 1,436 cycles (56.7%) and P supplementation in 1,093 cycles (43.2%). Significantly higher live birth rates were demonstrated for the entire GnRH-a group compared with the P group. This result was even more prominent when women older than 35 years were considered separately. Furthermore, after adjustment for age, body mass index (BMI), past obstetric history, number of IVF cycles, oocyte retrieved and embryos transferred, GnRH-a was still associated with a higher rate of live birth (odds ratio 1.46, 95% confidence interval 1.10-1.94). Once a positive ß-hCG was achieved, chemical pregnancy rates (PRs) and miscarriage rates were not statistically different between the GnRH-a and the P supplementation group, and GnRH-a was associated with a higher rate of live births (odds ratio 1.59, 95% confidence interval 1.07-2.36). CONCLUSION(S): This large retrospective study suggests that repeated intranasal GnRH-a for luteal phase support is associated with a higher live birth rate compared with standard P supplementations.

Intranasal gonadotropin-releasing hormone agonist (GnRHa) for luteal-phase support following GnRHa triggering, a novel approach to avoid ovarian hyperstimulation syndrome in high responders.

OBJECTIVE: To study whether intranasal GnRH agonist (GnRHa) can be effectively used for luteal support in high-responder patients undergoing fresh-embryo transfer after ovulation induction with the use of GnRHa. DESIGN: Retrospective cohort study. SETTING: Private fertility clinic. PATIENT(S): Forty-six high-responder patients were administered a GnRHa ovulation trigger to avoid ovarian hyperstimulation syndrome (OHSS), followed by 2 weeks of daily intranasal GnRHa (nafarelin) for luteal-phase support. No additional progesterone supplementation was administrated. INTERVENTION(S): Intranasal GnRHa for luteal-phase support. MAIN OUTCOME MEASURE(S): The primary outcome was ongoing clinical pregnancy rate. RESULT(S): High median progesterone levels were measured at midluteal phase and on the day of the first positive pregnancy test (190 nmol/L on both measures). We obtained 24 (52.1%) ongoing clinical pregnancies. None of the patients developed OHSS. CONCLUSION(S): Intranasal GnRHa is effective in achieving luteal-phase support in high-responder patients triggered with GnRHa and avoiding OHSS.

Does gravidity influence the success of in vitro fertilization-embryo transfer cycles?

OBJECTIVE: To evaluate the influence of gravidity on the results of in vitro fertilization (IVF)-embryo transfer (ET) cycles. PATIENTS AND METHODS: All consecutive women aged <35 years admitted to our IVF unit from January 2002 to December 2004 were enrolled in the study. Only patients undergoing one of their first three IVF cycle attempts were included. Gravidity, ovarian stimulation characteristics, number of oocytes retrieved, number of embryo transferred and clinical pregnancy rate were assessed. RESULTS: Three hundred and forty-two consecutive IVF cycles were evaluated. One hundred and sixty-one cycles were from nulligravidas and 181 from women with a history of at least one previous clinical pregnancy. Forty-eight (29.8%) clinical pregnancies were observed in the nulligravida group and 56 (30.9%) in the gravida group. There were no differences between nulligravidas and gravidas in causes of infertility, length of ovarian stimulation, peak estradiol and progesterone levels, number of oocytes retrieved, fertilization rate and number of embryos transferred. Gravidas were significantly older (30.4 vs. 27.6 years, p < 0.001) and used more gonadotropin ampoules (36.1 vs. 31.8, p < 0.004) compared with the nulligravidas. CONCLUSIONS: Patient gravidity has no influence on the likelihood of achieving pregnancy in IVF-ET cycles.

Hysteroscopy combined with hysterosalpingo contrast sonography (HyCoSy): a new modality for comprehensive evaluation of the female pelvic organs.

AIM: Hysterolaparoscopy is the gold-standard procedure for mechanical evaluation of the female pelvic organs. However, it is invasive and potentially life-threatening. The purpose of the present study was to assess the value of an alternative, minimally invasive technique. METHOD: All consenting women who reached the stage of mechanical evaluation in their infertility work-up were invited to participate in the study. All underwent diagnostic hysteroscopy followed by hysterosalpingo contrast sonography (HyCoSy) performed in a single session on an outpatient basis. Patient clinical data were collected prospectively. RESULTS: Twenty women participated in the study, 6 with primary infertility and 14 with secondary infertility. All procedures yielded satisfactory evaluation of the uterine cavity and uterine and ovarian structures, fallopian tube patency, and relationship between the fallopian tube fimbrial edges and the ovaries. All patients were discharged within 2 h; there were no complications during or after the procedure. CONCLUSION: The combination of hysteroscopy and hysterosalpingo contrast sonography (HyCoSy) can provide a comprehensive, functional and relatively non-invasive evaluation of the female pelvic organs.

Does intravaginal probiotic supplementation increase the pregnancy rate in IVF-embryo transfer cycles?

This study investigated the effect of intravaginal administration of probiotics immediately after oocyte retrieval on vaginal colonization and outcome of the IVF-embryo transfer cycle. One hundred and seventeen women who underwent ovarian stimulation and IVF were randomized immediately after oocyte retrieval into two groups: those who received intravaginal probiotics (study group, n = 50) and those who did not (control group, n = 67). Vaginal colonization with lactobacilli and pregnancy rate were compared between the two groups. No significant between-group differences were observed in patient age, oestrogen and progesterone concentrations on day of human chorionic gonadotrophin administration, number of oocytes retrieved, fertilization rate, number of embryos transferred, or pregnancy rate. The presence of lactobacilli in the vagina during oocyte retrieval or embryo transfer did not improve the pregnancy rate. Furthermore, intravaginal administration of lactobacilli following oocyte retrieval did not affect the prevalence of lactobacilli during embryo transfer, or the pregnancy rate. Intravaginal probiotic supplementation immediately after oocyte retrieval has no effect on vaginal colonization or pregnancy rate in IVF cycles.

Immediate ambulation after embryo transfer: a prospective study.

OBJECTIVE: To assess whether bed rest following the embryo transfer (ET) procedure contributes to the implantation process and pregnancy rate. DESIGN: A prospective (patient-influenced) study. SETTING: An in vitro fertilization (IVF) unit of an academic medical center. PATIENT(S): Four hundred six patients undergoing controlled ovarian hyperstimulation and IVF. INTERVENTION(S): All women undergoing in vitro fertilization-embryo transfer (IVF-ET) cycles in our unit were given a special individual counseling session before the ET procedure in which they were informed that our previous experience showed no advantage for bed rest over immediate ambulation after ET. The women were allowed to select the practice of their choice, and they were assured that their decision would have no influence on their further treatment. MAIN OUTCOME MEASURE(S): The stimulation pattern and cycle outcome were compared between the two groups (bed rest and immediate ambulation). RESULT(S): Of the 406 patients counseled during the study period, 167 preferred immediate ambulation and 239 opted to stay in the unit for 1 hour's bed rest. There were no significant differences between the groups in mean patient age, number of embryos transferred, and other variables of the assisted reproductive technique cycles. Pregnancy rates did not differ between the groups: 41 out of 167 (24.55%) in the immediate-ambulation group and 51 out of 239 (21.34%) in the bed-rest group. CONCLUSION(S): Immediate ambulation following the ET procedure has no adverse influence on the ability to conceive.

Significance of increased endometrial thickness in assisted reproduction technology treatments.

PURPOSE: The purpose of this study was to evaluate the relationship between thick endometrium and both implantation and pregnancy rates in ART treatments. METHODS: The study group was composed of consecutive women undergoing ultrasonographic evaluation on the day of hCG administration in our ART unit. Endometrial thickness was measured at the thickest part of the midsagittal plane. On the basis of the findings, patients were divided into two groups: A--endometrial thickness >14 mm (above the 95th percentile) and B--endometrial thickness 7-14 mm (between the 5th and 95th percentiles). Patients with a thickness of less than 7 mm were excluded from the study. RESULTS: In all, 1218 cycles were included in the study (50 in Group A and 1168 in Group B). There was no significant difference between the groups in mean patient or mean number of embryos transferred. Similar pregnancy and implantation rates were noted in Group A (24 and 11.3%, respectively) and Group B (27.7 and 14.7%, respectively). Endometrial thickness was found to have a significant positive correlation with the duration of follicular stimulation, and an inverse correlation with woman's age. CONCLUSIONS: Increased endometrial thickness (>14 mm) is not associated with decreased implantation or pregnancy rates in assisted reproduction.

Comparison of leuprolide acetate and triptorelin in assisted reproductive technology cycles: a prospective, randomized study.

OBJECTIVE: To compare the use of two depot GnRH-a, leuprolide and triptorelin, in long-suppression GnRH-a protocols. DESIGN: Prospective, randomized study. SETTING: An IVF unit of an academic medical center.Fifty-two women who underwent controlled ovarian hyperstimulation and IVF. INTERVENTION(S): Patients were prospectively randomized to receive 3.75 mg depot formulations of either leuprolide or triptorelin on days 21-23 of the menstrual cycle. Stimulation with gonadotropins was initiated after pituitary desensitization was achieved. MAIN OUTCOME MEASURE(S): The stimulation pattern and cycle outcomes were compared between the two groups. RESULT(S): Twenty-six patients were included in each group. No significant differences were observed in the patient age, estrogen, and P levels on day of hCG administration, gonadotropin dosage, number of oocytes retrieved, fertilization rate, percentage of high-quality embryos, and number of embryos transferred. However, significantly higher clinical implantation and pregnancy rates were found in the leuprolide group compared with the triptorelin group. CONCLUSION(S): A depot preparation of leuprolide is associated with higher implantation and pregnancy rates than a depot preparation of triptorelin when it is used in the midluteal phase as part of the long-suppression GnRH-a protocol in IVF.

Mode of delivery following successful external cephalic version.

Mode of delivery of pregnancies following successful external cephalic version (ECV) was evaluated in a retrospective case-controlled study. Successful ECV was performed in 105 of 223 (47%) attempts. Data were obtained in 96 of 105 (91.4%) pregnancies that were matched 1:2 fashion to the next consecutive singleton deliveries for maternal age, gravidity, parity, and ethnic origin. The groups were compared for mode of delivery, indications for cesarean section (CS) and instrumental delivery, gestational age at delivery, birth weight and Apgar score. There was no significant difference between the groups in maternal age or the rates of low 5-minute Apgar score (