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1.
Reprod Biomed Online ; 41(3): 361-364, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32660814

RESUMO

The COVID-19 pandemic has significantly increased mortality in many countries, with the number of infected cases increasing exponentially worldwide. One of the main determining factors of the poor prognosis in these patients is the development of coagulopathy. Moreover, it is well known that assisted reproductive technology procedures confer a risk of thromboembolic complications. This commentary analyses specific aspects coexisting between the thrombotic risk described during virus infection and that reported in the context of assisted reproduction treatments. Based on known pathophysiological aspects of virus infection and of ovarian stimulation, there are common elements that deserve to be taken into account. In the present context, any risk of hyperstimulation should be avoided. Gonadotrophin-releasing hormone agonist triggering should be mandatory in high-responder patients and/or those with COVID-19 infection. In both cases, the cycle should be segmented. A proposal is made for the use of prophylactic low molecular weight heparin not only in those cases in which oocyte retrieval has been performed, but also in those in which cancellation has been decided. In addition, endometrial preparation for frozen-thawed embryo transfers should use the transdermal route in order to minimize the higher thrombotic risk associated with the oral route.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Técnicas de Reprodução Assistida/efeitos adversos , Tromboembolia/epidemiologia , Tromboembolia/virologia , Transferência Embrionária/métodos , Feminino , Heparina de Baixo Peso Molecular/administração & dosagem , Humanos , Recuperação de Oócitos , Síndrome de Hiperestimulação Ovariana/complicações , Síndrome de Hiperestimulação Ovariana/prevenção & controle , Síndrome de Hiperestimulação Ovariana/virologia , Indução da Ovulação/efeitos adversos , Pandemias , Gravidez , Fatores de Risco , Tromboembolia/prevenção & controle
2.
Zhonghua Fu Chan Ke Za Zhi ; 55(1): 9-14, 2020 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-32074767

RESUMO

Objective: To explore and compare the preventive effect of using letrozole and gonadotropin-releasing hormone (GnRH) antagonist during luteal phase of patients at high risk for ovarian hyperstimulation syndrome (OHSS). Methods: A total of 99 infertile women undergoing in vitro fertilization and embryo transfer or intracytoplasmic sperm injection with high risk for OHSS were enrolled in this randomized controlled trial.The letrozole group (n=51) received letrozole of 7.5 mg daily for 3 days;the GnRH antagonist group (n=48) were given cetrorelix of 0.25 mg subcutaneously daily for 3 days. Both groups received support therapy combined with embryo cryopreservation. The incidence of OHSS was surveyed. And the serum concentration of estradiol, LH and progesterone on days 3, 5 and 8 after oocytes retrieval were measured. Results: There were no statistical differences in terms of baseline characteristics of patients and outcomes of controlled ovarian hyperstimulation between the two groups.The incidence of moderate and severe OHSS was found no significantly difference between letrozole group [11.8%(6/51)] and GnRH antagonist group [10.4%(5/48);P>0.05]. The estradiol concentration of the indicated days on days 3,5 and 8 after oocytes retrieval in letrozole group and GnRH antagonist group were (1 417±3 543) versus (15 210±9 921) pmol/L, (1 692±4 330) versus (18 680±11 567) pmol/L, (239±336) versus (3 582±5 427) pmol/L, respectively;compared with GnRH antagonist group, the estradiol level was significantly lower in the letrozole group (all P<0.01). The luteinizing hormone level in the letrozole group were (0.46±0.40), (0.56±0.55)and (0.67±0.58) U/L on days 3,5 and 8 after oocytes retrieval, which were significantly higher than those of GnRH antagonist group [(0.28±0.28), (0.30±0.19) and (0.45±0.37) U/L, respectively; all P<0.05]. There was no obvious differences on progesterone levels between letrozole group and GnRH antagonist group (all P>0.05),and on days 8 after oocytes retrieval,the level of progesterone in each group were significantly lower than those on day 3 and 5 after oocytes retrieval (P<0.05). Conclusion: Letrozole has the same efficiency as GnRH antagonist for the prevention of OHSS, faster and cheaper to use, but its efficacy seems not to be related to the suppression of steroidogenic during the luteal phase.


Assuntos
Hormônio Liberador de Gonadotropina/antagonistas & inibidores , Infertilidade Feminina/terapia , Letrozol/uso terapêutico , Síndrome de Hiperestimulação Ovariana/prevenção & controle , Indução da Ovulação , Estradiol/sangue , Feminino , Fertilização In Vitro , Humanos , Fase Luteal , Hormônio Luteinizante/sangue , Progesterona/sangue
3.
Int J Gynaecol Obstet ; 149(2): 166-170, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31925779

RESUMO

OBJECTIVE: To evaluate the effect of oral diosmin on the incidence and severity of ovarian hyperstimulation syndrome (OHSS) and explore the value of diosmin in preventing and treating OHSS. METHOD: A retrospective study of women attending a reproductive center in Guangzhou, China, between September and December 2016. The inclusion criterion was previous cancellation of embryo transfer after oocyte retrieval during IVF owing to a high risk of OHSS. The women were divided into two groups depending on whether they received oral diosmin (1000 mg twice daily for 10 days) after oocyte retrieval (diosmin group) or not (control group). Apart from diosmin, both groups underwent the same treatment. Baseline information and data related to OHSS were compared. RESULTS: Overall, 146 women were included: 74 in the diosmin group and 72 in the control group. The incidence of moderate-to-severe OHSS in the diosmin and control groups was 5/74 (6.2%) and 14/72 (13.4%), respectively (P=0.027). The control group included four cases of paracentesis due to ascites; there were no cases of paracentesis or severe OHSS in the diosmin group. CONCLUSION: Oral administration of diosmin effectively reduced both the incidence of moderate-to-severe OHSS and the severity of OHSS among high-risk women.


Assuntos
Diosmina/administração & dosagem , Recuperação de Oócitos/estatística & dados numéricos , Síndrome de Hiperestimulação Ovariana/prevenção & controle , Administração Oral , Adulto , Estudos de Casos e Controles , China/epidemiologia , Feminino , Humanos , Incidência , Recuperação de Oócitos/métodos , Síndrome de Hiperestimulação Ovariana/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença
4.
J Pak Med Assoc ; 69(Suppl 3)(8): S4-S8, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31603867

RESUMO

Objectives: To evaluate the effect of acupuncture at follicular phase of menstrual cycle on anti-mullerian hormone levels in patients with polycystic ovary syndrome undergoing in-vitro fertilisation and to see its impact on assisted reproduction outcome. Methods: The prospective, randomised, controlled trial was conducted from March 2011 to July 2012 at the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. In the center, the patients randomly chose odd or pair number, the patients with odd numbers classified as an interventional group and the patients with paired numbers as non-interventional group. Infertile polycystic ovary syndrome patients aged 20-40 years were enrolled from the hospital's Assisted Reproduction Centre from March 2011 to July 2012. The patients were randomised into two groups, with one receiving follicular phase acupuncture for 30-40 minutes according to the principles of traditional Chinese medicine, and the other group not getting subjected to acupuncture. Serum and follicular anti-mullerian hormone concentration were determined. Results: Of the 102 patients, 33(32.4%) were in the intervention group, while 69(67.6%) were in the control group. There was no significant effect of acupuncture on serum and follicular fluid anti-mullerian hormone levels in the intervention group compared to the control group (p>0.05). Serum progesterone and estradiol levels on the day of giving human chorionic gonadotrophin, as well as serum progesterone and estradiol levels on the day of oocytes pick-up were significantly lower in the intervention group (p<0.05). Number of embryos transferred, clinical and ongoing pregnancy rates were significantly higher in the intervention group (p<0.05) with a significant decrease of ovarian hyper-stimulation syndrome rate in the intervention group (p<0.05). Conclusions: Follicular phase acupuncture was found to have a positive effect for polycystic ovary syndrome patients undergoing in-vitro fertilisation, but it had no effect on anti mullerian hormone concentrations.


Assuntos
Terapia por Acupuntura , Hormônio Antimülleriano/análise , Fertilização In Vitro , Infertilidade Feminina/terapia , Síndrome de Hiperestimulação Ovariana/prevenção & controle , Síndrome do Ovário Policístico/sangue , Hormônio Antimülleriano/sangue , Gonadotropina Coriônica/efeitos adversos , Gonadotropina Coriônica/uso terapêutico , Estradiol/sangue , Feminino , Líquido Folicular/química , Humanos , Infertilidade Feminina/etiologia , Síndrome de Hiperestimulação Ovariana/etiologia , Síndrome do Ovário Policístico/complicações , Gravidez , Taxa de Gravidez , Progesterona/sangue , Estudos Prospectivos
5.
Curr Med Sci ; 39(3): 431-436, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31209815

RESUMO

Polycystic ovary syndrome (PCOS) is one of the most common causes of infertility in women. Progestin-primed ovarian stimulation (PPOS) protocol, which used oral progestin to prevent premature luteinizing hormone (LH) surges in ovarian stimulation, has been proved to be effective and safe in patients with PCOS. The aim of the present study was to compare the efficacy of PPOS protocol with that of the traditional gonadotropin-releasing hormone (GnRH) antagonist protocol in patients with PCOS. A total of 157 patients undergoing in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) were recruited into this study. The patients were divided into two groups by the stimulation protocols: the GnRH antagonist protocol group and the PPOS protocol group. There was no significant difference in the clinical characteristics between the two groups. Dose and duration of gonadotropin were higher in the PPOS protocol group. Estradiol levels on the day of human chorionic gonadotropin (hCG) administration were significantly lower in the PPOS protocol group. Fertilization rates and the number of good quality embryos were similar between the two groups. Remarkably, we found 6 patients with moderate ovarian hyperstimulation syndrome (OHSS) in the GnRH antagonist protocol group but 0 in the PPOS protocol group. A total of 127 women completed their frozen embryo transfer (FET) cycles. There were no significant differences between the two groups in terms of clinical pregnancy rate per transfer, implantation rate, first-trimester miscarriage rate and on-going pregnancy rate per transfer. To conclude, PPOS protocol decreased the incidence of OHSS without adversely affecting clinical outcomes in patients with PCOS.


Assuntos
Fármacos para a Fertilidade Feminina/uso terapêutico , Hormônio Liberador de Gonadotropina/análogos & derivados , Antagonistas de Hormônios/uso terapêutico , Infertilidade Feminina/terapia , Indução da Ovulação/métodos , Síndrome do Ovário Policístico/fisiopatologia , Progestinas/administração & dosagem , Adulto , Gonadotropina Coriônica/administração & dosagem , Transferência Embrionária/métodos , Estradiol/sangue , Feminino , Fertilização In Vitro/métodos , Expressão Gênica , Hormônio Liberador de Gonadotropina/antagonistas & inibidores , Hormônio Liberador de Gonadotropina/genética , Hormônio Liberador de Gonadotropina/metabolismo , Hormônio Liberador de Gonadotropina/uso terapêutico , Humanos , Infertilidade Feminina/complicações , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/fisiopatologia , Masculino , Síndrome de Hiperestimulação Ovariana/induzido quimicamente , Síndrome de Hiperestimulação Ovariana/diagnóstico , Síndrome de Hiperestimulação Ovariana/prevenção & controle , Ovário/efeitos dos fármacos , Ovário/metabolismo , Ovário/fisiopatologia , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/diagnóstico , Gravidez , Taxa de Gravidez , Progestinas/efeitos adversos , Estudos Prospectivos , Injeções de Esperma Intracitoplásmicas/métodos , Resultado do Tratamento
6.
Reprod Health ; 16(1): 81, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196113

RESUMO

BACKGROUND: Infertility affects one in seven couples; many of these need in vitro fertilisation (IVF). IVF involves external hormones to stimulate a woman's ovaries to produce eggs which are harvested surgically. Embryos, created in the laboratory by mixing eggs with sperm, are grown in culture for a few days before being replaced within the uterus (fresh embryo transfer). Spare embryos are usually frozen with a view to transfer at a later point in time - especially if the initial fresh transfer does not result in a pregnancy. Despite improvements in technology, IVF success rates remain low with an overall live birth rate of 25-30% per treatment. Additionally, there are concerns about health outcomes for mothers and babies conceived through IVF, particularly after fresh embryo transfer, including maternal ovarian hyperstimulation syndrome (OHSS) and preterm delivery. It is believed that high levels of hormones during ovarian stimulation could create a relatively hostile environment for embryo implantation whilst increasing the risk of OHSS. It has been suggested that freezing all embryos with the intention of thawing and replacing them within the uterus at a later stage (thawed frozen embryo transfer) instead of fresh embryo transfer, may lead to improved pregnancy rates and fewer complications. We aim to compare the clinical and cost effectiveness of fresh and thawed frozen embryo transfer, with the primary aim of identifying any difference in the chance of having a healthy baby. METHODS: E-Freeze is a pragmatic, multicentre two-arm parallel group randomised controlled trial where women aged ≥18 and < 42 years, with at least three good quality embryos are randomly allocated to receive either a fresh or thawed frozen embryo transfer. The primary outcome is a healthy baby, defined as a term, singleton, live birth with appropriate weight for gestation. Cost effectiveness will be calculated from a healthcare and societal perspective. DISCUSSION: E-Freeze will determine the relative benefits of fresh and thawed frozen embryo transfer in terms of improving the chance of having a healthy baby. The results of this pragmatic study have the potential to be directly transferred to clinical practice. TRIAL REGISTRATION: ISRCTN registry: ISRCTN61225414 . Date assigned 29/12/2015.


Assuntos
Criopreservação/economia , Transferência Embrionária/métodos , Fertilização In Vitro/métodos , Congelamento , Infertilidade Feminina/terapia , Nascimento Vivo/epidemiologia , Adolescente , Adulto , Análise Custo-Benefício , Criopreservação/métodos , Implantação do Embrião , Embrião de Mamíferos , Feminino , Fertilização In Vitro/legislação & jurisprudência , Humanos , Síndrome de Hiperestimulação Ovariana/epidemiologia , Síndrome de Hiperestimulação Ovariana/prevenção & controle , Indução da Ovulação , Gravidez , Complicações na Gravidez/epidemiologia , Resultado da Gravidez , Taxa de Gravidez , Adulto Jovem
7.
Eur J Obstet Gynecol Reprod Biol ; 237: 42-47, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31009858

RESUMO

The study assessed the impact of an AMH algorithm for FSH dosing in 589 patients to maintain pregnancy rates while minimizing OHSS rates in 1st antagonist cycles for IVF. Patients with low AMH < 12 pmol/L (n = 203) had maximal stimulation with corifollitropin, patients with AMH 12-32 pmol/L (n = 256) had standard stimulation with 150 IU/day of rFSH and patients with AMH > 32 pmol/L (n = 130) had minimal stimulation with 112 IU/day of HP-hMG. The proportion of patients with targeted (5-14) number of oocytes at retrieval was: Low AMH 42%, intermediate AMH 76% and high AMH 67% (p < 0.001). Low responses (≤ 4 oocytes) was found in 55%, 16% and 26% (p < 0.001) in the low, intermediate and high AMH group, respectively. Excessive responses (≥15 oocytes) was found in 2.5%, 6.2% and 6.1% in the low, intermediate and high AMH groups, respectively. Despite the high proportion of low responses, the ongoing pregnancy rates in the high AMH group was 41% per started cycle. A total of 14 patients had OHSS preventive actions like agonist triggering (n = 12) and/or cryopreservation of all embryos (n = 4) and all avoided OHSS. Three (0.5%) patients were admitted to hospital with severe OHSS, and all occurred after hCG triggering and all cases were late OHSS in relation to pregnancy. All were in the high AMH group after aspiration of 10-15 follicles. The conclusion is that among high AMH patients, low dose HP-hMG will limit the mean number of oocytes, without compromising pregnancy rates. The OHSS risk will be low, but as long as transfer after hCG triggering is used OHSS will occur unless a cut-off for OHSS preventive actions as low as 10-15 follicles is used.


Assuntos
Hormônio Antimülleriano/sangue , Fertilização In Vitro/métodos , Hormônio Foliculoestimulante/administração & dosagem , Síndrome de Hiperestimulação Ovariana/prevenção & controle , Indução da Ovulação/métodos , Injeções de Esperma Intracitoplásmicas/métodos , Adulto , Algoritmos , Esquema de Medicação , Feminino , Humanos , Síndrome de Hiperestimulação Ovariana/etiologia , Indução da Ovulação/efeitos adversos , Gravidez , Taxa de Gravidez , Comportamento de Redução do Risco
8.
Curr Med Sci ; 39(2): 278-284, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31016522

RESUMO

This observational study included 21 patients at remarkably high risk of ovarian hyperstimulation syndrome (OHSS), characterized by more than 30 follicles measuring ≥11 mm in diameter on trigger day and/or pre-trigger peak estradiol exceeding 10 000 pg/mL, which was also the feature of women with established severe early OHSS followed by gonadotrophin-releasing hormone agonist (GnRHa) trigger and freeze-all policy that previously have been reported. All patients received a second dose of GnRHa 12 h after the first GnRHa trigger combined with administration of GnRH antagonist at 0.25 mg/day for a period of 3 days from the day of oocyte retrieval onwards. The in vitro fertilization (IVF) outcomes may be preferable compared with a bolus of GnRHa trigger and none of the included patients developed moderate-to-severe OHSS. Moreover, patients' symptoms, reproductive hormone levels and ultrasound findings were improved significantly. This new strategy seems to be efficacious and could be a further supplement of GnRHa trigger with or without applying freeze-all strategy to completely prevent early-onset moderate to severe OHSS, especially for the patients characterized by ≤30 follicles measuring ≥11 mm in diameter on trigger day and/or pre-trigger peak estradiol exceeding 10 000 pg/mL. Further studies should be performed to compare this regimen with conventional methods of OHSS prevention.


Assuntos
Estradiol/metabolismo , Fármacos para a Fertilidade Feminina/administração & dosagem , Hormônio Liberador de Gonadotropina/análogos & derivados , Hormônio Liberador de Gonadotropina/agonistas , Folículo Ovariano/efeitos dos fármacos , Síndrome de Hiperestimulação Ovariana/prevenção & controle , Adulto , Feminino , Fertilização In Vitro/métodos , Hormônio Liberador de Gonadotropina/administração & dosagem , Humanos , Infertilidade Feminina/tratamento farmacológico , Infertilidade Feminina/metabolismo , Recuperação de Oócitos/métodos , Indução da Ovulação/métodos , Gravidez , Taxa de Gravidez
9.
Taiwan J Obstet Gynecol ; 58(2): 255-260, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30910149

RESUMO

OBJECTIVE: Ovarian hyperstimulation syndrome (OHSS) is a major complication of assisted reproductive technologies (ART). Polycystic ovary syndrome (PCOS) is a risk factor for OHSS. The aim of this randomized clinical trial (RCT) was to study the effect of low-dose aspirin (LDA) on the development of OHSS and ART outcomes in PCOS during ART. MATERIALS AND METHODS: This double-blinded placebo controlled RCT was performed on 232 PCOS infertile women in their first ART cycles during 2010-2016. LDA and placebo capsules were prepared, packed and specified by code numbers in similar shapes. One package was given to every woman and asked to take one capsule/day since the 21st day of her cycle prior to the gonadotropin stimulation. Gonadotropin releasing hormone agonist long protocol and triggering by human chorionic gonadotropin were used. Development of moderate to severe OHSS and their ART outcomes were documented then the codes were broken and data analyzed. Chi-square and Mann-Whitney U tests were used for the statistical analyses. RESULTS: Eighteen cases that did not follow the study design were excluded. 214 cycles remained for the final analyses with 109 cases in LDA and 105 in the placebo group. Rate of the moderate to severe OHSS in LDA group was 34.9% compared to 30.5% in placebo group (P = 0.494). Fertilization rate was 71.8% vs 65.1% (P = <0.001) and the mean number of grade III embryos were 3.28 ± 3.53 vs 1.46 ± 1.42 (P = 0.014) in LDA and placebo groups, respectively. The mean number of the oocytes in different grades, total and frozen embryos also implantation and clinical pregnancy rates were not different between the groups. CONCLUSION: Moderate to Severe OHSS was not decreased but fertilization rate and the mean number of poor quality embryos were increased in LDA arm. REGISTRATION NUMBER: IRCT 201105216541N1.


Assuntos
Aspirina/administração & dosagem , Hormônio Liberador de Gonadotropina/uso terapêutico , Oócitos/efeitos dos fármacos , Síndrome de Hiperestimulação Ovariana/prevenção & controle , Indução da Ovulação/efeitos adversos , Adulto , Aspirina/efeitos adversos , Método Duplo-Cego , Feminino , Fertilização In Vitro/efeitos adversos , Fertilização In Vitro/métodos , Hormônio Liberador de Gonadotropina/efeitos adversos , Hormônio Liberador de Gonadotropina/agonistas , Humanos , Infertilidade Feminina/etiologia , Recuperação de Oócitos/estatística & dados numéricos , Síndrome de Hiperestimulação Ovariana/diagnóstico , Síndrome do Ovário Policístico/complicações , Gravidez , Resultado do Tratamento , Adulto Jovem
10.
Gynecol Endocrinol ; 35(8): 695-700, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30880505

RESUMO

The purpose of this study was to evaluate the effect of two doses of D-chiro-inositol (DCI) in combination with Myo-inositol (MYO) in women with PCOS undergoing ICSI. This was a multicenter controlled, randomized, double-blind parallel group study with two MYO-DCI formulations for 12 weeks. The study group (SG) was administered 550 mg of MYO + 150 mg of DCI twice daily; the control group (CG) was administered 550 mg of MYO + 13.8 mg of DCI twice daily. The participants comprised 60 women with PCOS undergoing ICSI. At baseline, no differences were found between the two groups regarding age, BMI, HOMA-IR or testosterone levels. The pregnancy and live birth rates were significantly higher in the SG than in the CG (65.5 vs. 25.9 and 55.2 vs. 14.8, respectively) [risk ratio (RR) = 0.4; 95%CI (0.2, 0.79); p = .003 and RR = 0.27; 95%CI (0.10, 0.70); p = .002 respectively]. The risk of ovarian hyperstimulation syndrome (OHSS) was lower in the SG (3.44 vs. 18.5%, p = .07). The combination of MYO-DCI at high doses of DCI improves the pregnancy rates and reduces the risk of OHSS in women with PCOS undergoing ICSI.


Assuntos
Fertilização In Vitro/métodos , Infertilidade Feminina/terapia , Inositol/administração & dosagem , Síndrome do Ovário Policístico/terapia , Injeções de Esperma Intracitoplásmicas , Adolescente , Adulto , Coeficiente de Natalidade , Relação Dose-Resposta a Droga , Método Duplo-Cego , Composição de Medicamentos , Feminino , Humanos , Recém-Nascido , Síndrome de Hiperestimulação Ovariana/prevenção & controle , Gravidez , Taxa de Gravidez , Injeções de Esperma Intracitoplásmicas/métodos , Adulto Jovem
11.
Panminerva Med ; 61(1): 42-51, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30674181

RESUMO

Ovulation trigger (OT) strategy is a cornerstone in modern patient-tailored in-vitro fertilization treatment, securing the optimal number of mature oocytes retrieved without compromising fertilization, embryo development and euploidy rates. Moreover, the OT strategy is taken into consideration before selecting fresh or frozen embryo transfer (freeze-all) to obtain optimal reproductive outcomes while maintaining a low risk of ovarian hyperstimulation syndrome. Several OT agents have been proposed, however, the most common agents used in modern IVF are human chorionic gonadotropin and gonadotropin-releasing hormone agonist. As no OT agent can be generally recommended for universal use, this review evaluates different OT strategies in different clinical scenarios, discussing both the biological plausibility and the clinical evidence.


Assuntos
Síndrome de Hiperestimulação Ovariana/prevenção & controle , Indução da Ovulação/métodos , Ovulação/fisiologia , Gonadotropina Coriônica/uso terapêutico , Criopreservação , Transferência Embrionária , Endométrio , Feminino , Fármacos para a Fertilidade Feminina/uso terapêutico , Fertilização In Vitro , Humanos , Kisspeptinas/química , Oócitos/metabolismo , Técnicas de Reprodução Assistida
13.
Gynecol Endocrinol ; 35(5): 368-369, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30614333

RESUMO

This study aims to report a case of early, severe ovarian hyperstimulation syndrome (OHSS) following GnRH agonist trigger for final oocyte maturation despite luteal support with a GnRH agonist. Contrary to the claim that luteal support using a GnRH agonist eliminates the risk for OHSS in high-risk patients, this report alerts practitioners to the risk of severe OHSS development despite GnRH agonist luteal support in patients receiving GnRH antagonist protocol with GnRH agonist triggering and cautions the practitioners to consider other measures of OHSS prevention.


Assuntos
Hormônio Liberador de Gonadotropina/agonistas , Fase Luteal , Síndrome de Hiperestimulação Ovariana/prevenção & controle , Indução da Ovulação/efeitos adversos , Adulto , Transferência Embrionária , Feminino , Fertilização In Vitro/métodos , Hormônio Liberador de Gonadotropina/antagonistas & inibidores , Humanos , Síndrome de Hiperestimulação Ovariana/etiologia , Indução da Ovulação/métodos , Gravidez , Resultado do Tratamento
14.
BMJ Open ; 8(12): e023413, 2018 12 09.
Artigo em Inglês | MEDLINE | ID: mdl-30530584

RESUMO

INTRODUCTION: In vitro maturation (IVM) is a potential alternative to conventional in vitro fertilisation (IVF) to avoid ovarian hyperstimulation syndrome (OHSS). This is particularly relevant in women with a high antral follicle count (AFC) and/or polycystic ovary syndrome (PCOS), who are at increased risk for OHSS. However, no randomised controlled trials of IVM versus IVF in women with high AFC have reported both pregnancy and OHSS rates. The aim of this study is to compare the effectiveness and safety of one IVM cycle and one IVF with segmentation cycle within women with PCOS or high AFC-related subfertility. METHODS AND ANALYSIS: This randomised controlled trial will be conducted at a specialist IVF centre in Vietnam. Eligible subfertile women with PCOS and/or high AFC will be randomised to undergo either IVM or IVF. The primary outcome is live birth after the first embryo transfer of the started treatment cycle. Cycles in which no embryo is available for transfer will be considered as failures. The study has a non-inferiority design, with a maximal acceptable between-group difference of 5%. Rates of OHSS will also be reported. ETHICS AND DISSEMINATION: Ethical approval was obtained from the participating centre, and informed patient consent was obtained before study enrolment. Results of the study will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT03405701; Pre-results.


Assuntos
Fertilização In Vitro , Técnicas de Maturação in Vitro de Oócitos , Folículo Ovariano , Adulto , Transferência Embrionária , Feminino , Humanos , Recém-Nascido , Síndrome de Hiperestimulação Ovariana/prevenção & controle , Síndrome do Ovário Policístico/complicações , Gravidez , Fatores de Risco , Resultado do Tratamento , Vietnã
15.
Prog. obstet. ginecol. (Ed. impr.) ; 61(5): 438-443, sept.-oct. 2018. tab, graf
Artigo em Inglês | IBECS | ID: ibc-175077

RESUMO

Objective: To compare the clinical outcomes of an elective vitrification program with those of a fresh embryo transfer program including vitrification of the remaining embryos. Material and methods: Retrospective study of 99 cycles from the elective vitrification program (Group A) and 150 cycles from the nonelective vitrification program (Group B) carried out from January 2014 to December 2015 in Instituto Bernabeu, Alicante, Spain. In both groups, the embryos were from the patient’s own oocytes. The variables evaluated in group A were clinical indication, endometrial preparation protocols for frozen embryo transfer, percentage of embryo survival after thawing, and day of embryo vitrification. The main clinical indication (54.5% of cases) in Group A was to avoid ovarian hyperstimulation syndrome. Outcomes: The percentage of embryo implantation (35.2% vs. 27%), the percentage of positive pregnancies with beta-hCG (58.5% vs. 42.9%), and the percentage of clinical pregnancy (41.5% vs. 32.5%) were superior in Group A when we transferred embryos of types A and/or B according to the ASEBIR classification, although no statistically significant differences were found (p = 0.230, p = 0.082, and p = 0.360, respectively). Conclusions: A "freeze-all" strategy is the procedure of choice for avoiding ovarian hyperstimulation syndrome or possible embryo-endometrium asynchrony at the time of the transfer. It also provides clinical results that are at least comparable to those obtained with fresh embryo transfer


Objetivo: Comprobar los resultados clínicos del programa de vitrificación electiva de embriones frente al de transferencia en fresco y congelación de los embriones restantes. Material y métodos: Se han estudiado de forma retrospectiva 99 ciclos de vitrificación electiva (Grupo A) y 150 ciclos de vitrificación no electiva (Grupo B) realizados entre enero de 2014 y diciembre de 2015 en el Instituto Bernabeu de Alicante. En ambos grupos los embriones obtenidos provenían de ovocito propio. En el grupo A se valoraron las indicaciones clínicas, los protocolos de preparación endometrial para la criotransferencia (CT), el porcentaje de supervivencia embrionaria a la descongelación y el día de vitrificación embrionaria. La indicación clínica mayoritaria (54.5% de los casos) en el grupo A fue evitar el Síndrome de Hiperestimulación Ovárica (SHO). Resultados: El porcentaje de implantación embrionaria (35,2% vs. 27%), el de embarazo positivo con beta (58.5% vs. 42,9%) y el de embarazo clínico (41,5% vs. 32,5%) fue superior en el grupo A cuando se transfirieron embriones de categoría A y/o B según los criterios de la Asociación Española para el Estudio de la Biología de la Reproducción (ASEBIR), aunque no se alcanzaron diferencias estadísticamente significativas (p = 0,230, p = 0,082 y p = 0,360, respectivamente). Conclusiones: La vitrificación electiva de embriones nos ha permitido por un lado evitar complicaciones como el SHO y por otro, obtener resultados clínicos cuanto menos comparables a los ofrecidos con transferencia embrionaria en fresco


Assuntos
Humanos , Feminino , Fertilização In Vitro/métodos , Técnicas de Reprodução Assistida , Transferência Embrionária/métodos , Estudos Retrospectivos , Vitrificação , Preservação de Tecido/métodos , Síndrome de Hiperestimulação Ovariana/prevenção & controle , Resultado do Tratamento , Destinação do Embrião
16.
Ginekol Pol ; 89(8): 407-413, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30215458

RESUMO

OBJECTIVE: This study aimed to investigate and compare the pregnancy and live birth rates in IVF cycles of frozen-thawed embryo transfers and fresh embryo transfers in a group of women with a high risk of Ovarian hyperstimulation syndrome (OHSS). MATERIAL AND METHODS: The study group consisted of 254 women with a high level of response to controlled ovarian hyperstimulation. The patients who received fresh cycle embryo transfers with calcium infusions are referred to as the Fresh Ca+ group, and those without the calcium therapy are called the Fresh Ca- group; and we used correspondingly similar terminology for the Frozen group. RESULTS: We observed no statistically significant differences between the cycles of fresh and frozen-thawed embryo transfers in patients with a high risk of OHSS in terms of implantation, clinical pregnancy, and live birth rates. Furthermore, these implantation, clinical pregnancy and live birth rates were not different in the cycles with or without calcium treatment. There was no statistical difference in the OHSS rates between the fresh and frozen-thawed cycles; although, the OHSS rates were less in the two calcium infusion groups (Fresh Ca+ and Frozen-thawed Ca+) than in the without-calcium group. There was no OHSS development in the subjects of the Frozen-thawed Ca+ group. CONCLUSION: Our study results suggest that fresh and frozen-thawed embryo transfers have similar IVF results in patients with a high risk of OHSS. Calcium infusion is beneficial in preventing OHSS without altering pregnancy rates. Both IVF protocols with calcium infusion can safely be applied in high-responder patients without lowering success rates.


Assuntos
Blastocisto , Gluconato de Cálcio/administração & dosagem , Criopreservação , Transferência Embrionária , Fármacos para a Fertilidade Feminina/administração & dosagem , Fertilidade/efeitos dos fármacos , Infertilidade/terapia , Indução da Ovulação , Injeções de Esperma Intracitoplásmicas , Adulto , Gluconato de Cálcio/efeitos adversos , Técnicas de Cultura Embrionária , Transferência Embrionária/efeitos adversos , Feminino , Fármacos para a Fertilidade Feminina/efeitos adversos , Humanos , Infertilidade/diagnóstico , Infertilidade/fisiopatologia , Infusões Intravenosas , Nascimento Vivo , Síndrome de Hiperestimulação Ovariana/etiologia , Síndrome de Hiperestimulação Ovariana/fisiopatologia , Síndrome de Hiperestimulação Ovariana/prevenção & controle , Indução da Ovulação/efeitos adversos , Gravidez , Taxa de Gravidez , Estudos Retrospectivos , Fatores de Risco , Injeções de Esperma Intracitoplásmicas/efeitos adversos , Resultado do Tratamento , Adulto Jovem
17.
JBRA Assist Reprod ; 22(4): 301-306, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-30106541

RESUMO

OBJECTIVE: Coasting is a well-known strategy to decrease severity of Ovarian Hyperstimulation Syndrome (OHSS). The purpose of this study is to assess the effect of Coasting on blastocyst development and subsequent clinical outcome following exclusive blastocyst transfer. METHODS: We conducted an observational cohort study of patients having blastocyst transfer following IVF/ICSI treatment. Patients undergoing IVF/ICSI cycles were included in the study. Patients at risk of OHSS were coasted. Outcome following exclusive blastocyst transfer was compared between coasted and non-coasted groups. The main outcome measures were the rate of blastocyst development and live birth rates in coasted and non-coasted cycles. Within coasted cycles, outcome was further analysed based on coasting duration and serum estradiol (E2) drop (difference between peak E2 and E2 on day of HCG). RESULTS: A total of 166 coasted cycles and 656 non-coasted cycles had blastocyst transfer. Blastocyst development (45.97% vs. 48.6%) and live birth rates (45.18% vs. 43.44%) were not significantly different between coasted and non-coasted cycles. The overall clinical pregnancy (54.21% vs. 49.08%) and implantation rates (43.95% vs. 39.54%) following blastocyst transfer in coasted cycles were not significantly different from those of non-coasted cycles. CONCLUSION: Coasting duration up to 6 days and drop in serum E2 levels did not compromise blastocyst development, implantation, clinical pregnancy or live birth rates. We conclude that coasting with subsequent blastocyst transfer can be used as an effective strategy in patients at risk of OHSS with no detrimental effects on blastocyst development or live birth outcome.


Assuntos
Desenvolvimento Embrionário , Síndrome de Hiperestimulação Ovariana/prevenção & controle , Indução da Ovulação/métodos , Adulto , Estudos de Coortes , Feminino , Fertilização In Vitro , Humanos , Gravidez , Resultado da Gravidez , Injeções de Esperma Intracitoplásmicas
19.
Acta Obstet Gynecol Scand ; 97(10): 1162-1167, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29889977

RESUMO

The objective of this narrative review was to suggest a rational order of treatment choices in anovulatory women with polycystic ovary syndrome (PCOS), for whom a multitude of treatment options exist. In obese/overweight women with PCOS the importance of weight reduction should be stressed. Inositol, a dietary supplement with a documented effect on ovulation and without adverse effects in the doses recommended, may be suggested. Additional first-line medical alternatives include insulin sensitizers, selective estrogen receptor modulators, and aromatase inhibitors. Of these, the aromatase inhibitor letrozole and the combination of clomiphene citrate and metformin have the highest rates of ovulation and live birth. Second-line treatments are ovarian electrocautery and low-dose follicle-stimulating hormone stimulation. Controlled ovarian stimulation with in vitro fertilization, should be considered the last option as it carries a significant risk of ovarian hyperstimulation syndrome in patients with PCOS.


Assuntos
Infertilidade Feminina/prevenção & controle , Indução da Ovulação/métodos , Síndrome do Ovário Policístico/terapia , Feminino , Fármacos para a Fertilidade Feminina/uso terapêutico , Humanos , Síndrome de Hiperestimulação Ovariana/prevenção & controle , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
20.
Taiwan J Obstet Gynecol ; 57(3): 383-388, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29880170

RESUMO

OBJECTIVE: The aim of the present study was to investigate effects of resveratrol (RSV) over ovarian hyperstimulation syndrome (OHSS) in rat model. MATERIALS AND METHODS: 24 female Wistar rats (22 days old) were divided into four groups. Group 1 (control group; n = 6) received 0.1 ml intraperitoneal (IP) saline from days 22-26; group 2 (mild-stimulated group; n = 6) received 10 IU pregnant mare serum gonadotropin (PMSG) on day 24 and 10 IU of hCG 48 h later (day 26); group 3 (OHSS group; n = 6) was given 10 IU of PMSG for 4 consecutive days from day 22 and 30 IU hCG on the fifth day to induce OHSS; group 4 (OHSS + RSV group; n = 6) was treated the same as group 3, but received 60 mg/kg RSV 2 h before PMSG injection for 4 consecutive days and 2 h before the hCG injection on the fifth day. RESULTS: Weight gain was highest in the OHSS group. Ovarian weights were lower in the treatment group than OHSS group. Peritoneal fluid VEGF levels were lower for RSV group compared to group 2 and 3. Total VEGF immunoreactivity was higher in OHSS group than group 1, 2 and 4. CONCLUSION: These results indicate that RSV is beneficial for prevention of OHSS by reducing the increases in body and ovarian weight and VEGF activity. These effects may be mediated by anti-inflammatory, anti-oxidant and anti-angiogenic capacity of RSV.


Assuntos
Antioxidantes/administração & dosagem , Síndrome de Hiperestimulação Ovariana/prevenção & controle , Ovário/efeitos dos fármacos , Estilbenos/administração & dosagem , Fator A de Crescimento do Endotélio Vascular/efeitos dos fármacos , Animais , Peso Corporal , Modelos Animais de Doenças , Feminino , Gonadotropinas Equinas/administração & dosagem , Humanos , Ovário/patologia , Ratos , Ratos Wistar , Resveratrol , Estatísticas não Paramétricas , Fator A de Crescimento do Endotélio Vascular/metabolismo
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