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1.
Reprod Health ; 18(1): 141, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34215261

RESUMO

BACKGROUND: The fear of infertility or delayed return to fertility is a common barrier to contraceptive use in sub-Saharan Africa, particularly among young or nulliparous women. Global evidence on return to pregnancy after method discontinuation suggests these fears may be misplaced; yet the topic has not been widely studied in sub-Saharan Africa nor by age and parity group. METHODS: Reproductive calendar data from recent Demographic and Health Surveys of 15 sub-Saharan African countries were used to analyze time-to-pregnancy following discontinuation of a contraceptive method with the reason to become pregnant. The probability of pregnancy at 12 months was estimated using single-decrement life tables run by type of method discontinued, age and parity. Results are presented by region: francophone West Africa, anglophone West Africa and East Africa. RESULTS: The 12-month probability of pregnancy after discontinuation of contraception to become pregnant was 73.0% in francophone West Africa, 78.8% in anglophone West Africa, and 82.0% in East Africa. Our results showed significant regional differences in return to pregnancy by 12 months, with probabilities in francophone West Africa being significantly lower than in anglophone West Africa or East Africa. A lower return to pregnancy by 12 months was seen among women ages 35-49 years and was lowest after discontinuation of a hormonal method for all age groups. Differences by parity group were only evident after discontinuation of hormonal methods in francophone West Africa. CONCLUSIONS: Sustainable gains in increasing contraceptive uptake, especially among youth, may be difficult to achieve without information and counseling that address concerns about infertility and potential delays in return to pregnancy following use of hormonal methods.


Assuntos
Comportamento Contraceptivo , Anticoncepcionais , Dispositivos Anticoncepcionais , Tomada de Decisões , Taxa de Gravidez , Adolescente , Adulto , África Oriental , África Ocidental , Criança , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez
2.
Trop Anim Health Prod ; 53(3): 397, 2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34250554

RESUMO

Ovsynch is a widely accepted estrus synchronization protocol for improving the reproductive performance of water buffaloes who manifest low reproductive efficiency. Recently, some modified protocols based on Ovsynch such as 2 injections of prostaglandin 14 days apart following the Ovsynch are also introduced to enhance the reproductive potential of this species. In the present study, a meta-analytical assessment was performed with the objective to evaluate the reproductive performance of water buffaloes synchronized with Ovsynch or modified Ovsynch programs. Meta-analysis of the fixed or random effects model was determined by the heterogeneity among the studies. Reproductive outcome of interest was pregnancy per artificial insemination (P/AI) measured on day 25 (25-100). A total of 32 articles including 4003 buffaloes using either Ovsynch or modified Ovsynch protocol were reviewed. In the random effects model for buffaloes, the overall proportion of P/AI was 42.55% [95% confidence interval (CI): 37.48-47.70; n = 3,089] and 46.44% (95% CI: 39.63-53.31; n = 914) on day 25 after AI for Ovsynch and modified Ovsynch, respectively. Results for P/AI were then categorized by ovarian activity, where P/AI was available for 3575 cyclic buffaloes and 320 non-cyclic buffaloes. For cyclic buffaloes, the overall proportion of P/AI was 47.54% (95% CI: 42.72-52.38; n = 2911) and 57.97% (95% CI: 54.12-61.77; n = 664) on day 25 after AI for Ovsynch and modified Ovsynch, respectively. In the fixed effects model for non-cyclic buffaloes, the overall proportion of P/AI was 19.68% (95% CI: 13.48-26.58; n = 167) and 33.01% (95% CI: 25.50-40.94; n = 153) on day 25 after AI for Ovsynch and modified Ovsynch, respectively. In conclusion, a benefit for P/AI is detected in buffaloes with the modified Ovsynch protocol. Besides, whichever estrus synchronization protocols (Ovsynch or modified Ovsynch), cyclic buffaloes have higher P/AI compared with non-cyclic buffaloes.


Assuntos
Búfalos , Dinoprosta , Animais , Sincronização do Estro , Feminino , Hormônio Liberador de Gonadotropina , Inseminação Artificial/veterinária , Lactação , Gravidez , Taxa de Gravidez , Progesterona
3.
Int J Mol Sci ; 22(10)2021 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-34065597

RESUMO

Progestogens are frequently administered during early pregnancy to patients undergoing assisted reproductive techniques (ART) to overcome progesterone deficits following ART procedures. Orally administered dydrogesterone (DG) shows equal efficacy to other progestogens with a higher level of patient compliance. However, potential harmful effects of DG on critical pregnancy processes and on the health of the progeny are not yet completely ruled out. We treated pregnant mice with DG in the mode, duration, and doses comparable to ART patients. Subsequently, we studied DG effects on embryo implantation, placental and fetal growth, fetal-maternal circulation, fetal survival, and the uterine immune status. After birth of in utero DG-exposed progeny, we assessed their sex ratios, weight gain, and reproductive performance. Early-pregnancy DG administration did not interfere with placental and fetal development, fetal-maternal circulation, or fetal survival, and provoked only minor changes in the uterine immune compartment. DG-exposed offspring grew normally, were fertile, and showed no reproductive abnormalities with the exception of an altered spermiogram in male progeny. Notably, DG shifted the sex ratio in favor of female progeny. Even though our data may be reassuring for the use of DG in ART patients, the detrimental effects on spermatogenesis in mice warrants further investigations and may be a reason for caution for routine DG supplementation in early pregnancy.


Assuntos
Didrogesterona/administração & dosagem , Fase Luteal/efeitos dos fármacos , Reprodução/efeitos dos fármacos , Animais , Suplementos Nutricionais , Implantação do Embrião/efeitos dos fármacos , Feminino , Fertilização In Vitro/métodos , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Parto/efeitos dos fármacos , Placenta/efeitos dos fármacos , Gravidez , Taxa de Gravidez , Progesterona/administração & dosagem , Progestinas/administração & dosagem , Técnicas de Reprodução Assistida
4.
Hum Reprod ; 36(7): 1932-1940, 2021 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-34128044

RESUMO

STUDY QUESTION: Do the length of follicular phase estradiol exposure and the total length of the follicular phase affect pregnancy and live birth outcomes in natural frozen embryo transfer (FET) cycles? SUMMARY ANSWER: An estradiol level >100 pg/ml for ≤4 days including the LH surge day is associated with worse pregnancy and live birth outcomes; however, the total length of the follicular phase is not associated with pregnancy and live birth outcomes. WHAT IS KNOWN ALREADY: An estradiol level that increases above 100 pg/ml and continues to increase is indicative of the selection and development of a dominant follicle. In programmed FET cycles, a limited duration of follicular phase estradiol of <9 days results in worse pregnancy rates, but a prolonged exposure to follicular phase estradiol for up to 4 weeks does not affect pregnancy outcomes. It is unknown how follicular phase characteristics affect pregnancy outcomes in natural FET cycles. STUDY DESIGN, SIZE, DURATION: This retrospective cohort study included infertile patients in an academic hospital setting who underwent their first natural frozen autologous Day-5 embryo transfer cycle in our IVF clinic between 01 January 2013 and 31 December 2018. Donor oocyte and gestational carrier cycles were excluded. PARTICIPANTS/MATERIALS, SETTING, METHODS: The primary outcomes of this study were pregnancy and live birth rates. Patients were stratified into two groups based on the cohorts' median number of days from the estradiol level of >100 pg/ml before the LH surge: Group 1 (≤4 days; n = 1052 patients) and Group 2 (>4 days; n = 839 patients). Additionally, patients were stratified into two groups based on the cohorts' median cycle day of LH surge: Group 1 (follicular length ≤15 days; n = 1287 patients) and Group 2 (follicular length >15 days; n = 1071 patients). A subgroup analysis of preimplantation genetic testing for aneuploidies (PGT-A) embryo transfer cycles was performed. Logistic regression analysis, adjusted a priori for patient age, number of embryos transferred, and use of PGT-A, was used to estimate the odds ratio (OR) with a 95% CI. MAIN RESULTS AND THE ROLE OF CHANCE: In the length of elevated estradiol analysis, the pregnancy rate per embryo transfer was statistically significantly lower in patients with an elevated estradiol to surge of ≤4 days (65.6%) compared to patients with an elevated estradiol to surge of >4 days (70.9%; OR 1.30 (95% CI 1.06-1.58)). The live birth rate per embryo transfer was also statistically significantly lower in patients with an elevated estradiol to surge of ≤4 days (46.6%) compared to patients with an elevated estradiol to surge of >4 days (52.0%; OR 1.23 (95% CI 1.02-1.48)). In the follicular phase length analysis, the pregnancy rate per embryo transfer was similar between patients with a follicular length of ≤15 days (65.4%) and patients with a follicular length of >15 days (69.0%; OR 1.12 (95% CI 0.94-1.33)): the live birth rate was also similar between groups (45.5% vs 51.5%, respectively; OR 1.14 (95% CI 0.97-1.35)). In all analyses, once a pregnancy was achieved, the length of the follicular phase or the length of elevated oestradiol >100 pg/ml no longer affected the pregnancy outcomes. LIMITATIONS, REASONS FOR CAUTION: The retrospective design of this study is subject to possible selection bias in regard to which patients at our clinic were recommended to undergo a natural FET compared to a fresh embryo transfer or programmed FET. To decrease the heterogeneity of our study population, we only included patients who had blastocyst embryo transfers; therefore, it is unknown whether similar results would be observed in patients with cleavage-stage embryo transfers. The retrospective nature of the study design did not allow randomized to a specific ovarian stimulation or ovulation trigger protocol. However, all patients were managed with the standardized protocols at a single center, which strengthens the external validity of our results when compared to a study that only evaluates one specific stimulation protocol. WIDER IMPLICATIONS OF THE FINDINGS: Our observations provide cycle-level characteristics that can be applied during a natural FET cycle to help optimize embryo transfer success rates. Physicians should consider the parameter of number of days that oestradiol is >100 pg/ml prior to the LH surge when determining whether to proceed with embryo transfer in a natural cycle. This cycle-specific characteristic may also help to provide an explanation for some failed transfer cycles. Importantly, our findings should not be used to determine whether to recommend a natural or a programmed FET cycle for a patient, but rather, to identify natural FET cycles that are not optimal to proceed with embryo transfer. STUDY FUNDING/COMPETING INTEREST(S): No financial support, funding, or services were obtained for this study. The authors do not report any potential conflicts of interest. TRIAL REGISTRATION NUMBER: N/A.


Assuntos
Fase Folicular , Resultado da Gravidez , Transferência Embrionária , Estradiol , Feminino , Humanos , Nascido Vivo , Indução da Ovulação , Gravidez , Taxa de Gravidez , Estudos Retrospectivos
5.
BMJ Open ; 11(6): e051058, 2021 06 24.
Artigo em Inglês | MEDLINE | ID: mdl-34168037

RESUMO

INTRODUCTION: Over the last decades, the use of intracytoplasmic sperm injection (ICSI) has increased, even among patients without male factor infertility. The increase has happened even though there is no evidence to support that ICSI results in higher live birth rates compared with conventional in vitro fertilisation (IVF) in cases with nonmale factor infertility. The lack of robust evidence on an advantage of using ICSI over conventional IVF in these patients is problematic since ICSI is more invasive, complex and requires additional resources, time and effort. Therefore, the primary objective of the IVF versus ICSI (INVICSI) study is to determine whether ICSI is superior to standard IVF in patients without severe male factor infertility. The primary outcome measure is first live birth from fresh and frozen-thawed transfers after one stimulated cycle. Secondary outcomes include fertilisation rate, ongoing pregnancy rate, birth weight and congenital anomalies. METHODS AND ANALYSIS: This is a two-armed, multicentre, randomised, controlled trial. In total, 824 couples/women with infertility without severe male factor will be recruited and allocated randomly into two groups (IVF or ICSI) in a 1:1 ratio. Participants will be randomised in variable block sizes and stratified by trial site and age. The main inclusion criteria are (1) no prior IVF/ICSI treatment, (2) male partner sperm with an expected count of minimum 2 million progressive motile spermatozoa following density gradient purification on the day of oocyte pick up and (3) age of the woman between 18 and 42 years. ETHICS AND DISSEMINATION: The study will be performed in accordance with the ethical principles in the Helsinki Declaration. The study is approved by the Scientific Ethical Committee of the Capital Region of Denmark. Study findings will be presented, irrespectively of results at international conferences and submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT04128904. Pre-results.


Assuntos
Infertilidade Masculina , Injeções de Esperma Intracitoplásmicas , Adolescente , Adulto , Coeficiente de Natalidade , Feminino , Fertilização In Vitro , Humanos , Infertilidade Masculina/terapia , Masculino , Estudos Multicêntricos como Assunto , Gravidez , Taxa de Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto Jovem
6.
FASEB J ; 35(7): e21696, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34085322

RESUMO

During the in vitro fertilization treatment, human chorionic gonadotrophin (hCG) is routinely used as a substitute for the natural endogenous LH surge during the final stage of oocyte maturation. However, it does not provide the FSH surge observed in the mid-cycle of the natural cycle. To date, whether the FSH surge can improve oocyte quality and pregnancy outcomes remains unknown. Randomized controlled trials comparing the following four trigger methods to conventional hCG were examined: GnRH agonist (GnRHa), kisspeptin, GnRHa plus hCG (dual trigger), and FSH plus hCG (FSH co-trigger). The results showed that the use of dual triggers was associated with a significantly higher number of retrieved cumulus-oocyte complexes (COCs) (weighted mean difference [WMD] 1.625, 95% CI 0.684-2.565), retrieved mature oocytes (WMD 0.986, 95% CI 0.426-1.545) and fertilized (2PN) oocytes (WMD 0.792, 95% CI 0.083-1.501), compared with the use of hCG. However, there was no significant difference between the two groups in terms of pregnancy rate. The FSH co-trigger resulted in significantly higher rates of 2PN oocytes retrieved than the hCG trigger (WMD 0.077, 95% CI 0.028-0.126). Notably, the risk of OHSS did not differ among the three treatment groups compared to that of the hCG group. This review protocol was registered with PROSPERO (CRD 42020194201).


Assuntos
Fertilização In Vitro/métodos , Técnicas de Maturação in Vitro de Oócitos/métodos , Oócitos/fisiologia , Injeções de Esperma Intracitoplásmicas/métodos , Feminino , Humanos , Oócitos/citologia , Gravidez , Resultado da Gravidez , Taxa de Gravidez
7.
BMC Med Inform Decis Mak ; 21(1): 176, 2021 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-34082727

RESUMO

BACKGROUND: Different endometrial patterns have an important effect on the relationship between endometrial thickness (EMT) and clinical pregnancy rate. There is a significant difference in age, selection of cycle protocols, and clinical pregnancy rates among four groups with diverse endometrial patterns. METHODS: This retrospective study aimed to assess the association between EMT on human chorionic gonadotropin (HCG) administration day and the clinical outcome of fresh in vitro fertilization (IVF). The 5th, 50th, and 95th percentiles for EMT were determined as 8, 11, and 14 mm, respectively. Patients were sub-divided into four groups based on their EMT in different endometrial patterns (Group 1: < 8 mm; Group 2: ≥ 8 and ≤ 11 mm; Group 3: > 11 and ≤ 14 mm; Group 4: > 14 mm). We divided patients into three groups based on their endometrial pattern and evaluated the correlation between EMT and clinical pregnancy rate. RESULTS: We found a positive correlation between pregnancy rates and EMT in all endometrial patterns. Multiple logistic regression analysis proved age, duration of infertility, cycle protocols, number of embryos transferred, progesterone on HCG day, endometrial patterns, and EMT have significant effects on clinical pregnancy rates. Meanwhile, there was a significant difference in age, selection of cycle protocols, and clinical pregnancy rates among four groups with diverse endometrial patterns. CONCLUSIONS: Different endometrial patterns have an important effect on the relationship between EMT and clinical pregnancy rate.


Assuntos
Fertilização In Vitro , Resultado da Gravidez , Gonadotropina Coriônica , Feminino , Humanos , Gravidez , Resultado da Gravidez/epidemiologia , Taxa de Gravidez , Estudos Retrospectivos
8.
Afr J Reprod Health ; 25(1): 122-128, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34077118

RESUMO

This study evaluated pregnancy results after fresh and frozen embryo transfer in males with infertility due to non-obstructive azoospermia and oligoasthenoteratozoospermia. In this retrospective study, a total of 801 embryo transfer cycles were followed up, including 423 fresh embryo transfers and 378 frozen embryo transfers in which intracytoplasmic sperm injection (ICSI) was performed because of male infertility. This study included females aged 28-38 years without uterine, endometrial, ovarian and tubal abnormalities and with regular menstrual cycles (n=801), and males aged 28-38 years with non-obstructive azoospermia and oligoasthenoteratozoospermia. Descriptive statistical methods and the independent t-test were used in the comparison of two groups with normal distribution, the Mann-Whitney U test was used in the comparison of two groups without normal distribution, and the Chi-square test was used to compare categorical variables. There were no statistically significant differences between the fresh embryo transfer group and frozen embryo transfer group in terms of rates of pregnancy, biochemical pregnancy, clinical pregnancy, live birth rate, and abortion rate. There was no difference between fresh embryo transfer and frozen embryo transfer in terms of pregnancy results in couples with non-obstructive azoospermia and oligoasthenoteratozoospermia as male infertility factor.


Assuntos
Astenozoospermia/complicações , Azoospermia/complicações , Transferência Embrionária , Infertilidade Masculina/etiologia , Oligospermia/complicações , Taxa de Gravidez , Injeções de Esperma Intracitoplásmicas/métodos , Adulto , Feminino , Humanos , Masculino , Gravidez , Estudos Retrospectivos , Injeções de Esperma Intracitoplásmicas/efeitos adversos
9.
J Pak Med Assoc ; 71(4): 1270-1272, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34125788

RESUMO

Ovarian cancer is the second biggest cause of gynaecological cancer related death in elderly women which is uncommon during reproductive age. We, herein present a thought-provoking case of an infertile woman who was diagnosed with stage IVA ovarian cancer just one year after the In Vitro Fertilisation cycles. A 37-year-old woman with secondary infertility who underwent three cycles of ovarian stimulation, had two grade II cleavage-stage embryos transferred, though they did not result in pregnancy in two years. During the IVF treatment, ovarian cyst puncture was performed and no malignant cells were observed. The following year, she suffered from abdominal pain with extremely elevated tumour markers and stage IVA ovarian carcinoma was confirmed by transabdominal operation. The patient underwent cytoreductive surgery and chemotherapy; however, she was insensitive to postoperative chemotherapy with poor CA 125. The case aroused high attention regarding safety of IVF including standardisation and close long-term follow-up.


Assuntos
Infertilidade Feminina , Neoplasias Ovarianas , Adulto , Idoso , Feminino , Fertilização In Vitro , Humanos , Infertilidade Feminina/etiologia , Indução da Ovulação , Gravidez , Taxa de Gravidez
10.
Chin Med J (Engl) ; 134(12): 1405-1415, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34091521

RESUMO

BACKGROUND: More and more scholars have called for the cumulative live birth rate (CLBR) of a complete ovarian stimulation cycle as a key indicator for assisted reproductive technology. This research aims to study the CLBR of the first ovarian hyperstimulation cycles and analyze the related prognosis factors that might affect the CLBR. METHODS: Our retrospective study included first in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) cycles performed between January 2013 to December 2014. A total of 17,978 couples of first ovarian hyperstimulation IVF/ICSI cycles were included. The study was followed up for 4 years to observe the CLBR. The multivariable logistic regression model was used to analyze the prognosis factor, P value of <0.05 was considered statistically significant. RESULTS: The cumulative pregnancy rate was 58.14% (10,452/17,978), and the CLBR was 49.66% (8928/17,978). The female age was younger in the live birth group when compared with the non-live birth group (30.81 ±â€Š4.05 vs. 33.09 ±â€Š5.13, P < 0.001). The average duration of infertility was shorter than the non-live birth cohort (4.22 ±â€Š3.11 vs. 5.06 ±â€Š4.08, P < 0.001). The preliminary gonadotropin used and the total number of gonadotropin used were lower in the live birth group when compared with the non-live birth group (both P < 0.001). Meanwhile, the number of oocytes retrieved and transferrable embryos were both significantly higher in the live birth group (15.35 ±â€Š7.98 vs. 11.35 ±â€Š7.60, P < 0.001; 6.66 ±â€Š5.19 vs. 3.62 ±â€Š3.51, P < 0.001, respectively). CONCLUSIONS: The women's age, body mass index, duration of infertility years, infertility factors, controlled ovarian hyperstimulation protocol, the number of acquired oocytes, and number of transferrable embryos are the prognosis factors that significantly affected the CLBR.


Assuntos
Coeficiente de Natalidade , Injeções de Esperma Intracitoplásmicas , China , Feminino , Fertilização In Vitro , Humanos , Nascido Vivo , Indução da Ovulação , Gravidez , Taxa de Gravidez , Estudos Retrospectivos
11.
Eur J Obstet Gynecol Reprod Biol ; 262: 216-220, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34062308

RESUMO

OBJECTIVE: To study the feasibility of a randomized controlled trial (RCT) comparing intrauterine insemination (IUI) with and without letrozole in couples with unexplained or mild male factor infertility STUDY DESIGN: We performed a randomized pilot study including 100 couples with unexplained or mild male factor infertility in the Reproductive Medicine Centre of Peking University Third Hospital in China. The couples scheduled for IUI were randomized to IUI with or without ovarian stimulation (letrozole) for up to 3 cycles within a time horizon of 4 months. Women in the letrozole group received 5 mg oral letrozole daily starting from cycle day 3-5 for 5 days. Women in the natural cycle IUI group did not receive any ovarian stimulation before IUI. The primary outcome is ongoing pregnancy leading to live birth. The study was registered under trial number NCT03455426 RESULTS: Between March 2018 and January 2019, 158 couples were eligible to participate after initial screening and 100 (63.3 %) couples agreed to participate. Of the 100 recruited couples, 50 were randomly allocated to IUI with letrozole and 50 to natural cycle IUI. Live birth occurred in 12 women (24.0 %) in the letrozole group and 10 women (20.0 %) in the natural cycle group (RR 1.20 (95 % CI 0.57-2.52)). Clinical pregnancy rates were 28 % and 26 % in the letrozole group and natural cycle group respectively (RR 1.08 (95 % CI 0.56-2.05). There were no multiple pregnancies in both groups. Patients were willing to be randomized and useful information was gained to plan a definitive trial. CONCLUSIONS: We showed that an RCT comparing IUI with letrozole versus natural cycle IUI in couples with unexplained or mild male factor infertility is feasible and acceptable.


Assuntos
Infertilidade Masculina , Infertilidade , China , Feminino , Humanos , Inseminação , Inseminação Artificial , Letrozol , Masculino , Indução da Ovulação , Projetos Piloto , Gravidez , Taxa de Gravidez
12.
Hum Reprod ; 36(7): 1841-1853, 2021 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-34050362

RESUMO

STUDY QUESTION: What is the clinical-effectiveness and safety of the endometrial scratch (ES) procedure compared to no ES, prior to usual first time in vitro fertilisation (IVF) treatment? SUMMARY ANSWER: ES was safe but did not improve pregnancy outcomes when performed in the mid-luteal phase prior to the first IVF cycle, with or without intracytoplasmic sperm injection (ICSI). WHAT IS KNOWN ALREADY: ES is an 'add-on' treatment that is available to women undergoing a first cycle of IVF, with or without ICSI, despite a lack of evidence to support its use. STUDY DESIGN, SIZE, DURATION: This pragmatic, superiority, open-label, multi-centre, parallel-group randomised controlled trial involving 1048 women assessed the clinical effectiveness and safety of the ES procedure prior to first time IVF, with or without ICSI, between July 2016 and October 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS: Participants aged 18-37 years undergoing their first cycle of IVF, with or without ICSI, were recruited from 16 UK fertility clinics and randomised (1:1) by a web-based system with restricted access rights that concealed allocation. Stratified block randomisation was used to allocate participants to TAU or ES in the mid-luteal phase followed by usual IVF with or without ICSI treatment. The primary outcome was live birth after completing 24 weeks gestation within 10.5 months of egg collection. MAIN RESULTS AND THE ROLE OF CHANCE: In total, 1048 women randomised to TAU (n = 525) and ES (n = 523) were available for intention to treat analysis. In the ES group, 453 (86.6%) received the ES procedure. IVF, with or without ICSI, was received in 494 (94.1%) and 497 (95.0%) of ES and TAU participants respectively. Live birth rate was 37.1% (195/525) in the TAU and 38.6% (202/523) in the ES: an unadjusted absolute difference of 1.5% (95% CI -4.4% to 7.4%, P = 0.621). There were no statistical differences in secondary outcomes. Adverse events were comparable across groups. LIMITATIONS, REASONS FOR CAUTION: A sham ES procedure was not undertaken in the control group, however, we do not believe this would have influenced the results as objective fertility outcomes were used. WIDER IMPLICATIONS OF THE FINDINGS: This is the largest trial that is adequately powered to assess the impact of ES on women undergoing their first cycle of IVF. ES was safe, but did not significantly improve pregnancy outcomes when performed in the mid-luteal phase prior to the first IVF or ICSI cycle. We recommend that ES is not undertaken in this population. STUDY FUNDING/COMPETING INTEREST(S): Funded by the National Institute of Health Research. Stephen Walters is an National Institute for Health Research (NIHR) Senior Investigator (2018 to present) and was a member of the following during the project: National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Clinical Trials and Evaluation Committee (2011-2017), NIHR HTA Commissioning Strategy Group (2012 to 2017); NIHR Programme Grants for Applied Research Committee (2020 to present); NIHR Pre doctoral Fellowship Committee (2019 to present). Dr. Martins da Silva reports grants from AstraZeneca, during the conduct of the study; and is Associate editor of Human Reproduction and Editorial Board member of Reproduction and Fertility. Dr. Bhide reports grants from Bart's Charity and grants and non-financial support from Pharmasure Pharmaceuticals outside the submitted work. TRIAL REGISTRATION NUMBER: ISRCTN number: ISRCTN23800982. TRIAL REGISTRATION DATE: 31 May 2016. DATE OF FIRST PATIENT'S ENROLMENT: 04 July 2016.


Assuntos
Fertilização In Vitro , Injeções de Esperma Intracitoplásmicas , Coeficiente de Natalidade , Feminino , Humanos , Fase Luteal , Gravidez , Taxa de Gravidez , Resultado do Tratamento
13.
BMC Pregnancy Childbirth ; 21(1): 348, 2021 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-33934703

RESUMO

BACKGROUND: No previous study directly compares the fixed day-5 initiation versus the flexible initiation of GnRH antagonist administration in IVF/ICSI for those patients who are predicted as high ovarian responders without PCOS. To evaluate whether the number of oocytes retrieved is different by using the two GnRH antagonist protocols in Chinese women with predicted high ovarian response except PCOS. METHODS: A randomized controlled trial of 201 infertile women with predicted high ovarian response except PCOS undergoing in vitro fertilization. Ovary stimulation was performed using recombinant FSH and GnRH antagonists. GnRH antagonist ganirelix (0.25 mg/d) was started either on day 5 of stimulation (fixed group) or when LH was > 10 IU/L, and/or a follicle with mean diameter > 12 mm was present, and/or serum E2 was > 600 pg/ml. Patient monitoring was initiated on day 3 of stimulation in flexible group. RESULT(S): No significant difference was observed between the fixed and flexible groups regarding the number of oocytes retrieved (16.72 ± 7.25 vs. 17.47 ± 5.88, P = 0.421), the Gonadotropin treatment duration (9.53 ± 1.07 vs. 9.67 ± 1.03, P = 0.346) and total Gonadotropin dose (1427.75 ± 210.6 vs. 1455.94 ± 243.44, P = 0.381). GnRH antagonist treatment duration in fixed protocol was statistically longer than the flexible protocol (6.57 ± 1.17 vs 6.04 ± 1.03, P = 0.001). There was no premature LH surge in either protocol. CONCLUSION(S): Fixed GnRH antagonist administration on day 5 of stimulation appear to achieve a comparable oocyte retrieved compared with flexible antagonist administration. TRIAL REGISTRATION: NCT02635607 posted on December 16, 2015 in clinicaltrials.gov.


Assuntos
Infertilidade Feminina/terapia , Ovário/efeitos dos fármacos , Indução da Ovulação/métodos , Síndrome do Ovário Policístico/fisiopatologia , Adulto , Gonadotropina Coriônica/administração & dosagem , Feminino , Fertilização In Vitro/métodos , Hormônio Foliculoestimulante Humano/administração & dosagem , Hormônio Liberador de Gonadotropina/administração & dosagem , Hormônio Liberador de Gonadotropina/análogos & derivados , Humanos , Infertilidade Feminina/fisiopatologia , Ovário/metabolismo , Ovário/fisiopatologia , Síndrome do Ovário Policístico/complicações , Gravidez , Taxa de Gravidez , Proteínas Recombinantes/administração & dosagem , Resultado do Tratamento , Pamoato de Triptorrelina/administração & dosagem , Adulto Jovem
14.
Andrologia ; 53(7): e14096, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33982319

RESUMO

An electronic-based search was performed with MEDLINE bases through PubMed, Cochrane through Central, and Embase until August 2020 for the purpose of evaluating the impact of the aetiology of obstructive azoospermia on ICSI cycles. In the final analysis, there were 15 cohort studies included, comparing a group of patients with acquired azoospermia and others due to congenital bilateral absence of the vas deferens submitted to ICSI. Those 15 articles within 4,480 couples were analysed, and similar fertilisation rate (65.1% vs. 65.3%; p = .38), pregnancy rate per cycle (40.0% vs. 43.1%; p = .06) and live birth rate (29.6% vs. 30.0%;p = .76) were found between groups. Comparing specifically post-vasectomy azoospermia and congenital groups, both presented a similar fertilisation rate (62.4% vs. 53.4%, respectively; OR 1.10; 95% CI, 0.79, 1.54; p = .56; I2  = 89%) and pregnancy rate per cycle (39.4% vs. 35.6%, respectively; OR 1.26; 95% CI, 0.96, 1.66; p = .09; I2  = 0%). However, a higher live birth rate was identified in the congenital group compared to vasectomy group (28.4% × 19.5%; OR 1.54; 95% CI, 1.11, 2.15; p = .01; I2  = 0%). The reasons for that are unclear and factors such as couple age and sperm DNA fragmentation should be considered.


Assuntos
Azoospermia , Azoospermia/terapia , Feminino , Humanos , Masculino , Gravidez , Taxa de Gravidez , Estudos Retrospectivos , Injeções de Esperma Intracitoplásmicas , Ducto Deferente
15.
Ceska Gynekol ; 86(2): 86-92, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34020554

RESUMO

: Objective: The aim of the study CERES (CzEch REkovelle real life Study) was to gather experience with the use of a novel gonadotrophine, to evaluate the efficacy of follitropin delta in Czech clinical settings and to compare our results with the clinical trial ESTHER-1. METHODS: Individualized follitropin delta daily dose in µg based on the patient's anti-Müllerian hormone (AMH) level and body weight (AMH < 15 pmol/ L: 12 µg/ d; AMH > 15 pmol/ L: 0.10­0.19 µg/ kg/ d; max. 2 µg/ d). RESULTS: A total of 85 women (aged 24-42 years) was included in the study. The average patients age was 32.9 years, the average body weight was 67.8 kg, and the mean level of AMH was 23.2 pmol/ L. There were initiated 85 controlled ovarian stimulations with follitropin delta and 84 egg collections. Forty patients (47%) had optimal number of retrieved eggs (8-14), 75 patients (88%) had embryotransfer, 10 patients (12%) had no embryo suitable for transfer, 65 patients had single embryo transfer and 10 patients had 2 embryos for transfer. There were reported 37 clinical pregnancies (43.5% cPR - clinical pregnancy rate), 30 live births (35.3% LBR - live birth rate), 3 (3.5%) early moderate ovarian hyperstimulation syndroms (OHSS) and no hospitalization due to the treatment. CONCLUSION: Individualized ovarian stimulation optimizes ovarian response, maintains treatment efficacy and improves safety by reducing OHSS incidence. The results of the Czech population study are fully comparable with the international, randomized, assessor-blinded trial ESTHER-1.


Assuntos
Fertilização In Vitro , Síndrome de Hiperestimulação Ovariana , Adulto , Hormônio Antimülleriano , Feminino , Hormônio Foliculoestimulante Humano , Gonadotropinas , Humanos , Indução da Ovulação , Gravidez , Taxa de Gravidez , Proteínas Recombinantes , Adulto Jovem
16.
J Int Med Res ; 49(5): 3000605211018600, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34038202

RESUMO

OBJECTIVE: To evaluate the effects of body mass index (BMI) in patients with polycystic ovary syndrome (PCOS) undergoing controlled ovarian stimulation (COS) with intrauterine insemination (IUI). METHODS: This retrospective study evaluated couples with PCOS undergoing COS and IUI. The relationship between cumulative IUI pregnancy outcomes and BMI, treatment cycles, treatment schemes, number of dominant follicles, endometrial thickness, infertility duration and type of infertility was analysed. RESULTS: The study evaluated 831 IUI cycles in 451 couples with PCOS. Compared with normoweight women, overweight and obese women required more human menopausal gonadotropin (hMG) doses and more days of COS. Gestational diabetes mellitus occurred more frequently in the obese group than in the other BMI groups. The clinical pregnancy and live birth rates in the hMG, clomiphene citrate (CC) + hMG and letrozole (LE) + hMG groups were significantly higher than those in the CC and LE groups. The clinical pregnancy rate was higher in the secondary infertility group compared with the primary infertility group. CONCLUSION: Obese women might require more hMG doses and more days of COS to overcome the effects of weight. As BMI increases, the incidence of gestational diabetes might also increase. The number of cycles and type of infertility may have a predictive value for pregnancy outcomes.


Assuntos
Infertilidade Feminina , Síndrome do Ovário Policístico , Feminino , Fármacos para a Fertilidade Feminina , Humanos , Inseminação , Indução da Ovulação , Síndrome do Ovário Policístico/complicações , Gravidez , Taxa de Gravidez , Estudos Retrospectivos
17.
AIDS ; 35(7): 1073-1081, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33946086

RESUMO

OBJECTIVE: The aim of this study was to evaluate the cumulative live birth rate in women undergoing in-vitro fertilization/intracytoplasmic-sperm-injection (IVF/ICSI) according to the type of chronic viral infection [HIV, hepatitis-B virus (HBV) and hepatitis-C virus (HCV)]. DESIGN: A cohort study. SETTING: A tertiary-care university hospital. PARTICIPANTS: Women with a chronic viral illness HIV, HBV or HCV- were followed until four IVF/ICSI cycles had been completed, until delivery or until discontinuation of the treatment before the completion of four cycles. MAIN OUTCOME MEASURES: The primary outcome was the cumulative live birth rate after up to four IVF/ICSI cycles. RESULTS: A total of 235 women were allocated to the HIV-infected group (n = 101), the HBV-infected group (n = 114) and the HCV-infected group (n = 20). The cumulative live birth rate after four cycles was significantly lower in the HIV-infected women than in those with HBV [39.1%, 95% confidence interval (95% CI): 17.7-60.9 versus 52.8%, 95% CI: 41.6-65.5, respectively; P = 0.004]. Regarding the obstetrical outcomes, the mean birth weight was lower in the HIV-infected women than in those with HBV or HCV. Multivariate analysis indicated that the age, the anti-Müllerian hormone and the number of cycles performed were significantly associated with the chances of a live birth. CONCLUSION: HIV-infected women had lower cumulative live birth rate than women with chronic hepatitis, and this was due to less favourable ovarian reserve parameters. These findings underscore the need to better inform practitioners and patients regarding fertility issues and the importance of early fertility assessment. However, larger studies are necessary to gain more in-depth knowledge of the direct impact of HIV on live birth rates.


Assuntos
Infecções por HIV , Estudos de Coortes , Feminino , Fertilização In Vitro , Infecções por HIV/complicações , Humanos , Gravidez , Taxa de Gravidez , Injeções de Esperma Intracitoplásmicas
18.
Medicine (Baltimore) ; 100(21): e26075, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34032737

RESUMO

ABSTRACT: We aimed to determine clinical factors predicting successful pregnancy by comparing pregnancy failure and success groups after adenomyomectomy. Additionally, we analyzed fertility outcomes after adenomyomectomy.The medical records of 43 patients who had undergone adenomyomectomy and received in vitro fertilization treatment from 2017 to 2020 were retrospectively reviewed. Patients were divided into pregnancy failure (n = 28) and pregnancy success (n = 15) groups. Patients' demographic factors were evaluated and compared between the groups.The age of patients was higher (39.0 [32.0-45.0] vs. 37.0 [33.0-42.0] years, P = .006) whereas the level of anti-Müllerian hormone (anti-Müllerian hormone [AMH]; 0.54 [0.01-8.54] vs. 2.91 [0.34-7.92] ng/mL, P = .002) lower in the pregnancy failure group compared to the pregnancy success group. The operative time was longer (220.0 [68.0-440.0] vs. 175.0 [65.0-305.0] min, P = .048) while the estimated blood loss higher (750 [100-2500] vs. 500 [50-2000] mL, P = .016) in the pregnancy failure group compared to the pregnancy success group. No significant difference was observed in body mass index, symptoms, cancer antigen 125, preoperative uterine volume, or type of adenomyosis. In the multivariate analysis, age and AMH were significant predictive factors for successful pregnancy.Ovarian reserve (age and AMH) and disease severity might be predictive factors for successful pregnancy in patients who have undergone adenomyomectomy. Adenomyomectomy should be considered for women desiring pregnancy and having appropriate ovarian reserve. Our results would be beneficial for patients and clinicians before deciding on adenomyomectomy. Larger prospective studies are required to confirm our findings.


Assuntos
Adenomiose/cirurgia , Hormônio Antimülleriano/sangue , Fertilização In Vitro/estatística & dados numéricos , Infertilidade Feminina/terapia , Adenomiose/sangue , Adenomiose/complicações , Adenomiose/patologia , Adulto , Endométrio/patologia , Endométrio/cirurgia , Feminino , Humanos , Infertilidade Feminina/sangue , Infertilidade Feminina/etiologia , Miométrio/patologia , Miométrio/cirurgia , Reserva Ovariana , Gravidez , Taxa de Gravidez , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
19.
J Coll Physicians Surg Pak ; 30(5): 523-527, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34027862

RESUMO

OBJECTIVE: To compare the IVF outcome of patients assumed to be poor responders before their first cycle treated by microdose flare-up or GnRH antagonist protocols with patients who had a poor ovarian response after their first cycle stimulated with long GnRH protocol. STUDY DESIGN: Observational cohort study. PLACE AND DURATION OF STUDY: Department of Obstetrics and Gynecology, IVF Unit of Gazi University Faculty of Medicine, from September 2014 to February 2019. METHODOLOGY: Patients treated with the first cycle of IVF and diagnosed as poor responders after ovarian stimulation were evaluated according to the treatment protocol, including microdose flare-up (Group 1: 136 patients), GnRH antagonist (Group 2: 105 patients), and long GnRH agonist (Group 3: 77 patients). RESULTS: Basal FSH level was significantly lower in group 3 compared to other groups (p<0.05). The number of oocytes retrieved, the number of metaphase II oocytes were similar between groups, although the mean AFC was significantly higher in group 3 than in group1 and 2 (p<0.05). Clinical pregnancy rates per patient were higher in group 3 (20.8%) than in group 1 (12.5%) and group 2 (13.3%), but the difference was not statistically significant (p=0.230). The live birth rate per patient was statistically higher in group 3 (19.5%) as compared to other groups (8.8%, 9.5%, respectively; p<0.05). CONCLUSION: Long protocol may be an option in poor responders undergoing IVF. Ovarian reserve markers are essential factors with stimulation protocol for the success of IVF in poor responder patients. Key Words:  Infertility, Ovulation induction, Ovarian reserve, Fertilisation in-vitro, Oocyte retrieval, Pregnancy outcome, Reproductive techniques, Assisted.


Assuntos
Nascido Vivo , Indução da Ovulação , Feminino , Fertilização In Vitro , Hormônio Liberador de Gonadotropina , Antagonistas de Hormônios , Humanos , Estudos Observacionais como Assunto , Gravidez , Taxa de Gravidez
20.
Theriogenology ; 171: 64-71, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34029785

RESUMO

Non-steroidal anti-inflammatory drugs (NSAIDs) at the time of embryo transfer (ET) are commonly used to improve pregnancy rates in cows. A meta-analysis was conducted on 16 trials from 9 publications involving control (n = 2335) and NSAID-treated (n = 2849) cows. The meta-analysis explained the relative risk (RR) with its 95% confidence interval (CI) for pregnancy per embryo transfer (P/ET) after NSAID treatment under various circumstances. NSAID treatment with was associated on average with a 15% higher P/ET compared to no treatment (RR = 1.15, 95% CI = 1.07 to 1.2). The results also highlight that the use of NSAIDs at the time of ET was particularly effective in cows with difficulty in passing the catheter from the cervix during ET, with 71% more likely P/ET (RR = 1.71, 95% CI = 1.07 to 2.74) with the use of NSAIDs for these cows compared to other cows. The data were too limited to analyse the influence of NSAID molecules (flunixin meglumine [FM] and meloxicam), cyclooxygenase (COX) inhibitor type (non-selective COX inhibitor [both COX-1 and COX-2] and selective COX inhibitor [only COX-2]), embryo processing (embryo production, embryo conservation and embryo quality), stress, synchronization, breed and parity on the relationship between NSAIDs and P/ET.


Assuntos
Anti-Inflamatórios não Esteroides , Preparações Farmacêuticas , Animais , Bovinos , Transferência Embrionária/veterinária , Feminino , Meloxicam , Gravidez , Taxa de Gravidez
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