ABSTRACT
Resumen OBJETIVO: Evaluar los desenlaces de una estrategia combinada para fertilización in vitro: mínima estimulación ovárica, diagnóstico genético preimplantación para aneuploidias y transferencia de un solo embrión. MATERIALES Y MÉTODOS: Estudio de cohorte, retrospectivo, efectuado en dos centros de reproducción de México, en un periodo de tres años. Se incluyeron pacientes entre 25 y 45 años, en protocolo de fertilización in vitro, con mínima estimulación, diagnóstico genético preimplantación para aneuploidias (PGT-A) y transferencia de embrión único. El diagnóstico genético preimplantación se estableció mediante microarreglos y secuenciación de nueva generación (NGS). Para el análisis estadístico se integraron 5 grupos, según la edad de las pacientes: menores de 35 años; 35 a 37 años; 38 a 40 años; 41 a 42 años; y mayores de 42 años. Mediante estadística descriptiva se analizaron las variables numéricas y categóricas. RESULTADOS: Se analizaron 175 ciclos, en 125 pacientes (edad promedio: 39 años ± 5). Se obtuvieron, en promedio, 5 óvulos por ciclo. La tasa de fertilización fue de 86.5% y la de blastocisto por óvulo fertilizado de 50.7%. Se tomó biopsia para diagnóstico genético preimplantación para aneuploidias a 404 embriones. La tasa general de euploidia fue de 33%. Se efectuaron 69 transferencias de embrión único, con una tasa de embarazo por transferencia de 71%. La tasa de nacimiento por transferencia fue de 60.8% (42 nacimientos). CONCLUSIONES: La combinación de mínima estimulación, diagnóstico genético preimplantación para aneuploidias y transferencia de embrión único, es un procedimiento adecuado para alcanzar una tasa de nacimiento alta.
Abstract OBJECTIVE: To evaluate results of a combined approach in IVF, using minimal stimulation, preimplantation genetic testing for aneuploidy, and single blastocyst transfer. MATERIALS AND METHODS: Retrospective cohort study over a three years' period in two fertility centers in Mexico. A total of 125 patients were included, between 25 and 45 years old, with minimal stimulation IVF, preimplantation genetic testing for aneuploidy (PGT-A) and single euploid embryo transfer. PGT was performed using microarrays and next generation sequencing (NGS). RESULTS: A total of 175 cycles (mean age: 39 years old) were analyzed in 125 patients. On average, five eggs were collected per cycle; fertilization rate was 86.57%; blastocyst rate was 50.7% per fertilized egg. Only 33% of embryos were euploid. Pregnancy rate per transferred embryo was 71%. Live birth rate was 60.8% (42 births). CONCLUSIONS: A combination of minimal stimulation, PGT-A and single blastocyst embryo transfer can yield a high live birth rate.
ABSTRACT
PURPOSE: To evaluate the efficacy of minimal stimulation using discretely administered gonadotropin combined with clomiphene citrate (CC) or letrozole (LTZ) for intrauterine insemination (IUI) cycles. MATERIALS AND METHODS: Total 257 IUI cycles from 158 infertile couples were assessed. A CC dose of 100 mg/day (n=126 cycles) or a LTZ dose of 5 mg/day (n=131 cycles) was administered on days 3-5 of the menstrual cycle for 5 days. Each group received human menopausal gonadotropin at a dose of 150 IU by two or three alternative day: CC combined with alternate-day regimen for 2 or 3 days (CC+300, n=37; CC+450, n=89) and LTZ combined with alternate-day regimen for 2 or 3 days (LTZ+300, n=36; LTZ+450, n=95). RESULTS: The clinical pregnancy rate was comparable between the CC and LTZ groups (18.3% vs. 13.0%, p=0.243). The clinical pregnancy rate also showed no significant difference among the 4 groups (21.6% vs. 16.9% vs. 11.1% vs. 12.6%, p=0.507). The multiple pregnancy rate was significantly higher in LTZ compared to CC group (37.5% vs. 8.7%, p=0.028) and in the LTZ+450 compared to CC+450 group (50% vs. 13.3%, p=0.038). Overall, there were 15 cases of ovarian hyperstimulation syndrome (OHSS), with the prevalence being significantly lower in the LTZ compared to CC group (1.5% vs. 10.3%, p=0.003). OHSS was more prevalent in the CC+450 compared to the LTZ+450 group (12.4% vs. 1.1%, p=0.002). CONCLUSION: Our findings suggest that minimal stimulation using two alternate-day gonadotropin with LTZ decreases the development of OHSS and multiple pregnancies, while maintaining comparable pregnancy rates in IUI cycles.
Subject(s)
Adult , Female , Humans , Pregnancy , Aromatase Inhibitors/administration & dosage , Clomiphene/administration & dosage , Drug Administration Schedule , Drug Combinations , Fertility Agents, Female/administration & dosage , Fertilization in Vitro , Gonadotropins/administration & dosage , Infertility, Female/drug therapy , Insemination, Artificial/statistics & numerical data , Nitriles/administration & dosage , Ovulation Induction/methods , Pregnancy Rate , Treatment Outcome , Triazoles/administration & dosageABSTRACT
PURPOSE: To evaluate the efficacy of minimal stimulation using discretely administered gonadotropin combined with clomiphene citrate (CC) or letrozole (LTZ) for intrauterine insemination (IUI) cycles. MATERIALS AND METHODS: Total 257 IUI cycles from 158 infertile couples were assessed. A CC dose of 100 mg/day (n=126 cycles) or a LTZ dose of 5 mg/day (n=131 cycles) was administered on days 3-5 of the menstrual cycle for 5 days. Each group received human menopausal gonadotropin at a dose of 150 IU by two or three alternative day: CC combined with alternate-day regimen for 2 or 3 days (CC+300, n=37; CC+450, n=89) and LTZ combined with alternate-day regimen for 2 or 3 days (LTZ+300, n=36; LTZ+450, n=95). RESULTS: The clinical pregnancy rate was comparable between the CC and LTZ groups (18.3% vs. 13.0%, p=0.243). The clinical pregnancy rate also showed no significant difference among the 4 groups (21.6% vs. 16.9% vs. 11.1% vs. 12.6%, p=0.507). The multiple pregnancy rate was significantly higher in LTZ compared to CC group (37.5% vs. 8.7%, p=0.028) and in the LTZ+450 compared to CC+450 group (50% vs. 13.3%, p=0.038). Overall, there were 15 cases of ovarian hyperstimulation syndrome (OHSS), with the prevalence being significantly lower in the LTZ compared to CC group (1.5% vs. 10.3%, p=0.003). OHSS was more prevalent in the CC+450 compared to the LTZ+450 group (12.4% vs. 1.1%, p=0.002). CONCLUSION: Our findings suggest that minimal stimulation using two alternate-day gonadotropin with LTZ decreases the development of OHSS and multiple pregnancies, while maintaining comparable pregnancy rates in IUI cycles.
Subject(s)
Adult , Female , Humans , Pregnancy , Aromatase Inhibitors/administration & dosage , Clomiphene/administration & dosage , Drug Administration Schedule , Drug Combinations , Fertility Agents, Female/administration & dosage , Fertilization in Vitro , Gonadotropins/administration & dosage , Infertility, Female/drug therapy , Insemination, Artificial/statistics & numerical data , Nitriles/administration & dosage , Ovulation Induction/methods , Pregnancy Rate , Treatment Outcome , Triazoles/administration & dosageABSTRACT
OBJECTIVE: The aim of this study was to evaluate the outcomes of the GnRH antagonist (Cetrorelix) minimal stimulation protocol comparing with GnRH agonist combined with long stimulation protocol in male infertility patients. METHODS: From Jan 2002 to Jun 2003, 65 patients (65 cycles) were performed in controlled ovarian hyperstimulation by using GnRH antagonist and GnRH agonist for male infertility patients. GnRH antagonist combined with minimal stimulation protocol was administered in 30 patients (30 cycles, Study Group) and GnRH agonist long stimulation protocol was administered in 35 patients (35 cycles, Control Group). We compared the pregnancy rate/cycle, total hMG(A)/cycle, retrieved oocyte/cycle, and the incidence of ovarian hyperstimulation syndrome between the two groups. Student-t test was used to determine statistical significance. Statistical significance was defined as p<0.05. RESULTS: The mean number of oocytes retrieved per cycle was 4.7 +/- 0.6 in the GnRH antagonist group and 8.4 +/- 1.8 in the GnRH agonist group. Fertilization rates were 82.5 +/- 17.7% and 79.4 +/- 20.2% in the GnRH antagonist and agonist group, respectively. The GnRH antagonist group used a lower dose of hMG (8.5 +/- 1.2 vs 39.4 +/- 10.7 ample/cycle) and none of them developed OHSS. Clinical pregnancy rates per cycle were 23.3% in GnRH antagonist group and 31.4% GnRH agonist group. CONCLUSION: GnRH antagonist protocol may be presented as a new controlled ovarian hyperstimulation protocol which has been applied to male-factor infertility undergoing ICSI.
Subject(s)
Female , Humans , Male , Pregnancy , Fertilization , Gonadotropin-Releasing Hormone , Incidence , Infertility , Infertility, Male , Oocytes , Ovarian Hyperstimulation Syndrome , Pregnancy Rate , Reproductive Techniques, Assisted , Sperm Injections, IntracytoplasmicABSTRACT
OBJECTIVE: The Aim of this study to compare the clinical outcomes of GnRH antagonist (Cetrorelix) in minimal stimulation protocol for assisted reproductive technologies to that of GnRH agonist combined with long protocol. METHODS: This study considered of 38 cycles was applied to 32 patients from Mar. 2001 to Feb. 2002. They were normoovulation patients and normal sperm. We excluded the poor responder for severe endometriosis women. The study group consisting of 16 patients was applied with 18 cycles of minimal protocol using GnRH antagonist. The control group consisting of 16 patients was applied with 20 cycles of long protocol using GnRH agonist. RESULTS: The age and infertility duration of the study group were 34.2 +/- 2.8 years and 5.2 +/- 0.4 years each, whereas those of the control group were 33.8 +/- 3.2 years and 4.3 +/- 0.5 years respectively, thus showing insignificant difference between the two groups. E2 (pg/ml)/LH (mIU/ml)/FSH (mIU/ml), tested on the 3rd day of menstrual period as a baseline, of the study group were 18.4 +/- 3.4/8.4 +/- 1.2/6.3 +/- 0.8 respectively. Those of the control group were 19.2 +/- 2.5/7.8 +/- 0.7/6.8 +/- 0.6, which also were insignificantly difference from those of the study group. As for the hMG dosage, 24.5 +/- 3.5 amples were injected to the control group and a significant less dosage of 12.3 +/- 2.3 amples were injected to the study group (p<0.05). E2 level of the study on the hCG injection day was 864.3 +/- 34.5 (pg/ml) which was significantly less than 184.0 +/- 89.4 of the control group (p<0.05). The numbers of ovarian follicles on the ovum pick-up day were 4.2 +/- 1.2 and 8.6 +/- 2.4 for the study and control groups respectively. The number of embryo transferred in the study group was 3.8 +/- 0.5, which was less than 5.3 +/- 0.6 in the control group (p<0.05). However, there were no significant differences in the fertility and pregnancy rates. There were no premature LH surges in both groups. One case of abortion in 5 pregnancies of study group and one in 6 pregnancies of control group, whereas none of them were in the study group. CONCLUSION: The minimal stimulation protocol using GnRH antagonist might be a simple, safe and effective method in the controlled ovarian hyperstimulation compared with GnRH agonist combined long protocol. The use of GnRH antagonist ended with less amples of gonadotropin, less complication even with similar clinical outcomes and efficacy, which was caused by long protocol using GnRH agonist.