ABSTRACT
Background: Microdose flare-up GnRH agonist and GnRH antagonist have becomemore popular in the management of poor ovarian responders [POR] in recent years;however, the optimal protocol for POR patients undergoing in vitro fertilization hasstill been a challenge
Methods: In this observational study design, two hundred forty four poor ovarian responderswere retrospectively evaluated for their response to GnRH agonist protocol[group-1, n=135] or GnRH antagonist protocol [group-2, n=109]. Clinical pregnancyrate was the primary end point and was compared between the groups. Student t-test,Mann Whitney U test and 2-test were used to compare the groups. The p<0.05 wasconsidered to show a statistically significant result
Results: The mean total gonadotropin doses were 3814 +/- 891 IU in group 1 and3539 +/- 877 IU in group 2 [p=0.02]. The number of metaphase-II oocytes [3.6 +/- 2.4 vs.2.8 +/- 1.9, p=0.005] and implantation rates [27.8% vs. 18.8%, p=0.04] in group 1 andgroup 2, respectively were significantly different. The fertilization rate in group 1and group 2 was 73% vs. 68%, respectively [p=0.5] and clinical pregnancy rate was19.8% vs. 14.4%, respectively [p=0.13]
Conclusion: The GnRH agonist microdose flare-up protocol has favorable outcomeswith respect to the number of oocytes retrieved and implantation rate; nevertheless,the clinical pregnancy rate was found to be similar in comparison to GnRH antagonistprotocol in poor ovarian responders. GnRH antagonist protocol appears to bepromising with significantly lower gonadotropin requirement and lower treatmentcost in poor ovarian responders
ABSTRACT
OBJECTIVE: To study the effect of body composition on reproduction in women with unexplained infertility treated with a controlled ovarian hyperstimulation and intrauterine insemination programme. METHODS: This prospective observational study was conducted on 308 unexplained infertile women who were scheduled for a controlled ovarian hyperstimulation and intrauterine insemination programme and were grouped as pregnant and non-pregnant. Anthropometric measurements were performed using TANITA-420MA before the treatment cycle. Body composition was determined using a bioelectrical impedance analysis system. RESULTS: Body fat mass was significantly lower in pregnant women than in non-pregnant women (15.61+/-3.65 vs.18.78+/-5.97, respectively) (p=0.01). In a multiple regression analysis, body fat mass proved to have a stronger association with fecundity than the percentage of body fat, body mass index, or the waist/hip ratio (standardized regression coefficient> or =0.277, t-value> or =2.537; p<0.05). The cut-off value of fat mass, which was evaluated using the receiver operating characteristics curve, was 16.65 with a sensitivity of 61.8% and a specificity of 70.2%. Below this cut-off value, the odds of the pregnancy occurrence was found to be 2.5 times more likely. CONCLUSION: Body fat mass can be predictive for pregnancy in patients with unexplained infertility scheduled for a controlled ovarian hyperstimulation and intrauterine insemination programme.
Subject(s)
Female , Humans , Pregnancy , Adipose Tissue , Body Composition , Body Mass Index , Electric Impedance , Fertility , Infertility , Insemination , Observational Study , Pregnant Women , Prospective Studies , Reproduction , ROC Curve , Sensitivity and SpecificityABSTRACT
The aim of the study was to investigate whether the use of low molecular weight heparin [LMWH] improve live birth rates when compared with control group in patients with unexplained recurrent miscarriages [URM]. In this prospective observational study 150 women with a history of two or more previous unexplained first trimester pregnancy loss who received LMWH; either enoxaparin [n=50], tinzaparin [n=50] or nothing [n=50] were followed for the pregnancy outcome measures. Only the patients who have used standardized dosage of LMWH [4000 IU/day enoxaparin or 3500 IU/day tinzaparin] were included to the study. The primary end point was the live birth rate and secondary end points were the side effects, late pregnancy complications and neonatal outcome in the study cohorts. Live birth was achieved 85% of the LMWH group and 66% of the control group [p=0.007]. According to the subgroup analysis; live birth rates did not differ significantly between the enoxaparin and tinzaparin group [84% and 86%, respectively]. Maternal and neonatal side effects were not statistically significant among the study participants. Thromboprophylaxis with LMWH resulted in a improved live-birth rate in patient with 2 or more consecutive unexplained recurrent pregnancy loss. Nevertheless these findings need to be confirmed in larger randomized trials