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ABSTRACT: OBJECTIVE: To identify predictors of ovarian response in women undergoing ovarian stimulation with corifollitropin alfa in a GnRH antagonist protocol and determine specific thresholds for the prediction of low and excessive responders. DESIGN: Retrospective cohort study. SETTING: University-based tertiary care center. PATIENT(S): Infertile women undergoing ovarian stimulation for in vitro fertilization/intracytoplasmic sperm injection. INTERVENTION(S): Controlled ovarian hyperstimulation with corifollitropin alfa in a GnRH antagonist protocol. MAIN OUTCOME MEASURE(S): Relationship between ovarian reserve tests and ovarian response. RESULT(S): Antimüllerian hormone (AMH) and antral follicle count (AFC) were the only independent predictors for low and excessive ovarian response. In prediction of excessive response, the area under the receiver operating characteristic curve [AUC (95% CI)] for AMH was 0.890 (0.832-0.947) and 0.897 (0.829-0.964) for AFC. The optimal thresholds for identifying excessive responders were 3.52 ng/mL for AMH (sensitivity 89.5, specificity 83.8) and 16 for AFC (sensitivity 80.0, specificity 84.5). AMH and AFC also predicted low ovarian response: AUCs AMH 0.836 (0.783-0.889) and AFC 0.830 (0.767-0.894). The optimal thresholds for predicting low response were 1.37 ng/mL for AMH (sensitivity 74.1, specificity 77.5) and 8 for AFC (sensitivity 72.2, specificity 84.6). For both excessive and low ovarian responses, a logistic regression model combining the biomarkers was associated with improved discrimination. CONCLUSION(S): AMH and AFC are the best predictors for low and excessive response in women treated with corifollitropin alfa in an antagonist protocol. Using AMH and AFC to select suitable candidates for treatment with corifollitropin alfa may result in a safe and convenient stimulation.
Fertility and sterility 05/2013; · 3.97 Impact Factor
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ABSTRACT: The effect of age on outcome is one of the most intriguing areas in the assisted reproduction field. In older patients using donor spermatozoa to reproduce, it remains undefined as to which is the treatment of choice: intrauterine insemination (IUI) or IVF/intracytoplasmic sperm injection (ICSI). Since life-table analysis provides data that are easy to use for patient counselling, this study analysed cumulative delivery rates (CDR) in patients using donor spermatozoa undergoing either primarily IUI or IVF/ICSI and patients who eventually switched from IUI to IVF/ICSI. Crude and expected CDR after six IUI cycles and three primary ICSI cycles (no previous IUI) were similar in both groups (24% versus 26% and 29% versus 35%, respectively). Since time-to pregnancy is an important factor in these older patients, ICSI treatment is advised to be started immediately, since a single cycle of ICSI will achieve the same success rate as a much longer period with at least six IUI cycles. If patients switch to ICSI after failed IUI, this only adds marginal benefit in CDR. Nearly all deliveries in the primary ICSI group were achieved in the first cycle. The effect of age on assisted reproduction outcome is one of the most intriguing areas in fertility. In older patients using donor spermatozoa to reproduce, it remains undefined as to which is the treatment of choice: intrauterine insemination (IUI) or IVF/intracytoplasmic sperm injection (ICSI). Since life-table analysis provides data that are easy to use for patient counselling, our study aimed at analysing cumulative success rates in patients using donor spermatozoa performing either primarily IUI or IVF/ICSI and in patients who eventually switched from IUI to IVF/ICSI. We analysed data on 150 women aged 40years or more undergoing primarily 764IUI cycles with donor spermatozoa and data on 175 IVF/ICSI cycles in 86 patients, including 63 switchers from IUI to IVF/ICSI. Any delivery after 25weeks of gestation after a maximum of 12IUI cycles and seven ICSI cycles was taken as the primary endpoint. Crude and expected cumulative delivery rates (CDR) were calculated. Previous failed IUI cycles were taken into account. Crude and expected CDR after six IUI cycles and three primary ICSI cycles (no previous IUI) were similar in both groups. Most deliveries in the primary ICSI group were achieved in the first cycle. Since time-to pregnancy is an important factor for older patients, we may advise to start immediate ICSI treatment since a single cycle of ICSI will achieve the same success rate as a much longer period with at least six IUI cycles. If patients switch to ICSI after failed IUI, this only adds marginal benefit in CDR.
Reproductive biomedicine online 02/2013; · 2.04 Impact Factor
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ABSTRACT: BACKGROUND: To investigate the obstetrical and perinatal impact of oocyte donation, a cohort of women who conceived after OD was compared with a matched control group of women who became pregnant through in vitro fertilisation with autologous oocytes (AO). METHODS: A matched-pair analysis has been performed at the Centre for Reproductive Medicine of the UZ Brussel, Dutch speaking Free University of Brussel. A total of 410 pregnancies resulted in birth beyond 20 weeks of gestation occurring over a period of 10 years, including 205 oocyte donation pregnancies and 205 ICSI pregnancies with autologous oocytes (AO). Patients in the OD group were matched on a one-to-one basis with the AO group in terms of age, ethnicity, parity and plurality. Matched groups were compared using paired t-tests for continuous variables and McNemar test for categorical variables. A conditional logistic regression analyses was performed adjusting for paternal age, age of the oocyte donor, number of embryos transferred, and singleton/twin pregnancy. RESULTS: Oocyte donation was associated with an increased risk of pregnancy induced hypertension (PIH) (matched OR: 1.502 CI: 1.024-2.204), and first trimester bleeding (matched OR: 1.493 CI: 1.036-2.15). No differences were observed between the two matched groups with regard to gestational age, mean birth weight and length, head circumference and Apgar scores. CONCLUSIONS: Oocyte donation is associated with an increased risk for PIH and first trimester bleeding independent of the recipients¿ age, parity and plurality, and independent of the age of the donor or the partner. However, oocyte donation has no impact on the overall perinatal outcome.
Reproductive Biology and Endocrinology 06/2012; 10(1):42. · 2.05 Impact Factor
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ABSTRACT: The objective of this prospective randomized study was to assess whether spontaneous triggering of ovulation by detecting LH rise with serial serum testing, results in higher pregnancy rates as compared with administration of human chorionic gonadotrophin (HCG) in patients undergoing intrauterine insemination (IUI) in natural cycles. The trial was registered in clinicaltrials.gov as NCT01414673. Three hundred patients treated by IUI in natural cycles at the Centre of Reproductive Medicine of the Dutch-Speaking Brussels Free University were randomized to either spontaneous triggering of ovulation (spontaneous LH group) (n=150) or administration of HCG (n=150). Donor spermatozoa was used in 197/300 patients (65.67%). The duration of the follicular phase was significantly higher in the spontaneous LH group as compared with the HCG group (P=0.004). However, the ongoing pregnancy rate was significantly higher in the spontaneous LH group as compared with the HCG group (34/150 versus 16/150, P=0.008; difference 12.0%, 95% CI - 3.6 to 20.4). The use of LH for timing ovulation in natural cycles might be the best way to maximize the probability of pregnancy for patients undergoing IUI. It remains unclear whether the probability of pregnancy is associated with the mode of ovulation triggering in intrauterine insemination (IUI) natural cycles. The aim of this study was to assess prospectively whether spontaneous triggering of ovulation by detecting LH rise results in higher pregnancy rates as compared to administration of human chorionic gonadotrophin (HCG) in patients undergoing IUI. Based on our results, spontaneous triggering of ovulation is associated with significantly higher ongoing pregnancy rates compared with administration of HCG in patients undergoing IUI. Therefore, the use of LH for timing ovulation in natural cycles might be the best way to maximize the probability of pregnancy for patients undergoing IUI.
Reproductive biomedicine online 05/2012; 25(3):278-83. · 2.04 Impact Factor
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ABSTRACT: This randomized controlled trial analyses the ability to control the oocyte retrieval schedule of gonadotrophin-releasing hormone antagonist cycles through the administration of oestradiol valerate during the luteo-follicular transition period prior to the initiation of ovarian stimulation. Eighty-six women undergoing ovarian stimulation for IVF/intracytoplasmic sperm injection were enrolled in the study. The control group (n = 42) received a standard ovarian stimulation protocol. In the pretreatment group (n = 44), patients were administered oestradiol valerate at a daily dose of 2 · 2 mg from day 25 of the preceding cycle onwards, during 6–10 consecutive days, depending on the day of the week. The primary endpoint was the proportion of patients undergoing oocyte retrieval during a weekend day (i.e. Saturday or Sunday), which was significantly lower in the pretreatment group (1/37, 2.7%) compared with the control group (8/39, 20.5%; P value = 0.029). The clinical pregnancy rates per started cycle were similar in the pretreatment group (38.6%) compared with the control group (38.1%). Pretreatment with oestradiol valerate results in a significantly lower proportion of patients undergoing oocyte retrieval during a weekend day and can be a valuable tool for the organization of an assisted reproduction centre.
Reproductive biomedicine online 03/2012; 24(3):272-80. · 2.04 Impact Factor
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ABSTRACT: To investigate the association between the probability of pregnancy and hormone exposure between the end of menstruation and the day of triggering final oocyte maturation (menstruation-free interval).
Prospective study.
University.
One hundred women (aged ≤ 39 years) stimulated with a fixed dose of recombinant follicle-stimulating hormone (200 IU).
Daily gonadotropin-releasing hormone antagonist (GnRH, 0.25 mg) used from day 6 of stimulation onward, final oocyte maturation triggered by administration of 10,000 IU of human chorionic gonadotropin (hCG) as soon as ≥ 3 follicles ≥ 17 mm were present, and hormone assessment performed at initiation of stimulation, on the first day after menstruation had stopped, on the day of antagonist initiation, and on the day of hCG administration.
The association between hormone exposure during the menstruation-free interval and the probability of ongoing pregnancy.
The exposure to progesterone during the menstruation-free interval was statistically significantly higher in patients who did not become pregnant compared with those who did (4.20 ± 2.54 vs. 3.13 ± 1.14, respectively). Binary logistic regression confirmed the adverse effect of the increased exposure to progesterone for the achievement of pregnancy.
In recombinant follicle-stimulating hormone/gonadotropin-releasing hormone antagonist in vitro fertilization/intracytoplasmic sperm injection cycles, a lower probability of pregnancy is associated with a higher exposure to progesterone during the menstruation-free interval.
Fertility and sterility 08/2011; 96(4):884-8. · 3.97 Impact Factor
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ABSTRACT: Single blastocyst transfer has the advantage of maximizing the fresh single pregnancy rate. However, in patients with a low number of good quality embryos on day 3, it remains unclear whether immediate embryo transfer or further embryo culture with blastocyst transfer is the most preferable option.
A retrospective cohort study was carried out in which the outcome of 590 fresh in vitro fertilization (IVF) cycles over a 15 months period and their cryo cycles were analyzed. A total of 341 patients cycles had an elective day 5 strategy independent of intermediate embryo evaluation while another 249 patients underwent a day 5 embryo transfer only if at least four embryos were available on day 3. Blastocyst vitrification was performed using a closed high security system.
Demographics, stimulation parameters and embryological data were comparable in the two groups. Patients in the elective day 5 group had a lower fresh transfer rate (90.62% vs. 95.18%, p < 0.05) as compared to patients with a day 3 or day 5 embryo transfer policy. No difference was observed in the fresh live birth rate and multiple pregnancy rate per initiated cycle (32.84% vs. 28.92%; 1.17% vs 0%) The projected cumulative ongoing pregnancy rate compensating for double counting in case subjects have more than one pregnancy is not different (42.58% vs. 39.84%).
Despite lower fresh transfer rates, elective single blastocyst transfer yields a similar projected cumulative ongoing pregnancy rate as in a policy with cleavage stage or blastocyst transfer depending on a good quality embryo count on day 3.
Reproductive Biology and Endocrinology 01/2011; 9:60. · 2.05 Impact Factor
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ABSTRACT: In a prospective randomized controlled trial, 119 patients were randomized to receive either recombinant hCG (250 μg) or urinary-derived hCG (10,000 IU) for final oocyte maturation in an antagonist protocol with a fixed dose of recombinant FSH (187.5 IU) and predefined single blastocyst transfer. The delivery rate was improved in the recombinant hCG group compared with the urinary-derived hCG group (44.1 vs. 25.7, respectively); however, adequately powered randomized controlled trials are justified to ascertain whether this difference is true.
Fertility and sterility 12/2010; 94(7):2902-4. · 3.97 Impact Factor
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ABSTRACT: The purpose of this study is to assess the effect of luteal phase supplementation (LPS) on pregnancy rates in human chorionic gonadotropin (hCG)-induced natural frozen-thawed (FET) cycles.
All performed hCG-induced natural FET cycles from January 2006 until August 2007 were retrospectively identified. The study group consisted of 452 cycles: 243 supplemented with progesterone administration (600 mg natural micronized progesterone in three separate doses) and 209 without progesterone. Analysis was limited to cycles where embryos were cryopreserved on day 3. Final oocyte maturation was achieved by hCG when endometrial thickness of >or=7 mm and a follicle of 17 mm were present on ultrasound.
No statistically significant differences were observed in ongoing pregnancy rate between the two groups (22% versus 21%, p=0.8; difference +1%; 95% confidence interval (CI): -6.5 to +8.7). The non-significant effect of the presence or not of luteal support on pregnancy rate was confirmed by logistic regression (odds ratio (OR): 0.9, 95% CI: 0.54-1.47, P=0.64). A previous pregnancy following fresh embryo transfer (OR: 6.04, 95% CI: 3.63-10.02, P=0.001) and increased endometrial thickness (OR: 1.25, 95% CI: 1.11-1.41, P=0.001) significantly affected the achievement of ongoing pregnancy, whereas the association between embryo score and achievement of pregnancy was marginally significant (OR:0.28, 95% CI: 0.08-0.97, P=0.05).
There is no convincing evidence to support the use of LPS in hCG-induced natural FET cycles, since there is no luteal phase defect. Further prospective randomized studies are necessary to confirm these findings.
European journal of obstetrics, gynecology, and reproductive biology 03/2010; 150(2):175-9. · 1.97 Impact Factor
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ABSTRACT: The proportion of twins resulting from multifetal pregnancy reduction of higher-order multiples is increased in pregnancies resulting from hormone stimulation when compared with twins following in vitro fertilization/intracytoplasmic sperm injection treatment. These reduced twin pregnancies may carry a higher perinatal risk compared with other twin pregnancies, which should be taken into account when assessing the perinatal outcome of twin pregnancies after assisted reproduction.
Fertility and sterility 11/2007; 88(4):997-9. · 3.97 Impact Factor
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ABSTRACT: To evaluate the effect of different human chorionic gonadotropin (hCG) doses on the ongoing pregnancy rates in patients with polycystic ovary syndrome (PCOS).
Prospective, randomized, controlled trial.
Tertiary university referral center.
Eighty PCOS patients.
Patients were randomized to receive 10,000 IU (n = 28), 5000 IU (n = 26), or 2500 IU (n = 26) of hCG for triggering final oocyte maturation as soon as >or=3 or more follicles of 17 mm or larger were present at ultrasound. Patients were stimulated with recombinant follicle stimulating hormone (FSH) and daily gonadotropin-releasing hormone (GnRH) antagonist, starting on day 6 of stimulation.
Ongoing pregnancy, fertilization rates.
The median fertilization rates were 52.8%, 65.4%, and 55.6% after administration of 10,000 IU, 5000 IU and 2500 IU, respectively. The ongoing pregnancy rates per PCOS patient receiving hCG were 26.9% (7 of 26), 30.8% (8 of 26) and 34.8% (8 of 23), respectively.
A decrease in the dose of hCG used to trigger final oocyte maturation does not appear to affect adversely the probability of pregnancy in PCOS patients treated by IVF using GnRH antagonists and recombinant FSH, and further testing in future larger-scale trials is recommended.
Fertility and sterility 11/2007; 88(5):1382-8. · 3.97 Impact Factor
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ABSTRACT: To explore luteal phase hormone profiles in patients stimulated with recombinant FSH and GnRH antagonist for IVF under two different modes of luteal support: P and P with E(2).
Prospective randomized study.
Patients in an academic reproductive medicine unit.
One hundred and three patients undergoing ovarian stimulation with a fixed dose of 200 IU recombinant FSH and GnRH antagonist.
Patients were randomized to receive luteal phase supplementation, either P vaginally (n = 49) or P and 4 mg E(2) orally (n = 54).
Hormonal assessment during the luteal phase on days 1, 4, 7, and 10 after the administration of hCG.
Hormone levels did not differ during the luteal phase between the two groups with the exception of E(2) concentration on day 10 after hCG, which was significantly higher in the E(2)-supplemented group compared with the P group (median 760 pg/mL, range 2,496 vs. median 589.50 pg/mL, range 2,098).
Addition of 4 mg E(2) for luteal support after stimulation with recombinant FSH and GnRH antagonist does not alter significantly the endocrine profile of the luteal phase until day 7 after hCG. At day 10 after hCG, the E(2) levels are significantly higher in the E(2)-supplemented group.
Fertility and sterility 04/2007; 87(3):504-8. · 3.97 Impact Factor
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ABSTRACT: The purpose of this study was to evaluate prospectively the association between the achievement of ongoing pregnancy and the time interval from the end of menstruation until the administration of HCG (menstruation-free interval) in patients treated by IVF.
A fixed dose of 200 IU of recombinant FSH (rFSH) was started in 90 patients on day 2 of the menstrual cycle and daily GnRH antagonist was initiated on day 6 of stimulation. Triggering of final oocyte maturation was performed with 10,000 IU of HCG as soon as three follicles of > or =17 mm were present at ultrasound.
Single embryo transfer was performed in 64.6% of the patients who reached embryo transfer (53/82). Ongoing pregnancy rate per embryo transfer was 18.3% (95% CI 11.4-28.0%). The menstruation-free interval significantly predicted the probability of ongoing pregnancy in a logistic regression analysis, controlling for female age and LH on day 1 of stimulation (odds ratio for the menstruation-free interval: 0.70; 95% CI: 0.54-0.92).
The longer the interval from the end of menstruation until the administration of HCG, the lower the probability of ongoing pregnancy in patients stimulated with recombinant FSH and GnRH antagonist for IVF.
Human Reproduction 05/2006; 21(4):1012-7. · 4.47 Impact Factor
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ABSTRACT: Single-embryo transfer has been recommended to reduce the incidence of multiple gestations when in vitro fertilization is performed in women under 36 years of age. We designed a prospective, randomized, controlled trial to determine whether there were any differences in the rates of pregnancy and delivery between women undergoing transfer of a single cleavage-stage (day 3) embryo and those undergoing transfer of a single blastocyst-stage (day 5) embryo.
We studied 351 infertile women under 36 years of age who were randomly assigned to undergo transfer of either a single cleavage-stage embryo (176 patients) or a single blastocyst-stage embryo (175 patients). Multifollicular ovarian stimulation was performed with a gonadotropin-releasing hormone antagonist and recombinant follicle-stimulating hormone.
The study was terminated early after a prespecified interim analysis (which included 50 percent of the planned number of patients) found a higher rate of pregnancy among women undergoing transfer of a single blastocyst-stage embryo (P=0.02). The rate of delivery was also significantly higher in this group than in the group undergoing transfer of a single cleavage-stage embryo (32.0 percent vs. 21.6 percent; relative risk, 1.48; 95 percent confidence interval, 1.04 to 2.11). Two multiple births occurred, both of monozygotic twins, both of which were in the group undergoing transfer of a single cleavage-stage embryo.
These findings support the transfer of a single blastocyst-stage (day 5) embryo in infertile women under 36 years of age.
New England Journal of Medicine 04/2006; 354(11):1139-46. · 53.30 Impact Factor
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ABSTRACT: The objective of this randomized controlled trial was to assess the effect of oral contraceptive pill (OCP) pretreatment on the probability of ongoing pregnancy in patients treated with a GnRH antagonist for IVF.
A fixed dose of 200 IU recombinant FSH (rFSH) was started in 425 patients either on day 2 of the menstrual cycle (non-OCP group: n = 211) or 5 days after discontinuing the OCP (OCP group: n = 214). GnRH-antagonist was initiated on day 6 of stimulation, and triggering of final oocyte maturation was performed with 10,000 IU of HCG.
Ongoing pregnancy rates per started cycle in the non-OCP and OCP group were 27.5% and 22.9%, respectively [95% confidence interval (CI) of the difference: -3.7 to +12.8]. Pregnancy loss was significantly increased in the OCP (36.4%) compared with the non-OCP group (21.6%) (95% CI of the difference: -28.4 to -2.3).
Pretreatment with OCP, as compared with initiation of stimulation on day 2 of the cycle in patients treated with GnRH antagonist and recombinant FSH, appears to be associated with a not significant difference in ongoing pregnancy rates per started cycle and results in a significantly higher early pregnancy loss.
Human Reproduction 03/2006; 21(2):352-7. · 4.47 Impact Factor
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ABSTRACT: To determine the incidence of ovarian hyperstimulation syndrome (OHSS) in a large series of GnRH antagonist-stimulated cycles and to assess the predictive value of E2 and the number of follicles on the day of hCG administration.
Prospective cohort study of women undergoing IVF treatment with a GnRH antagonist protocol over a 2-year period.
Tertiary university hospital.
One thousand eight hundred one patients who underwent 2,524 cycles.
Multifollicular ovarian stimulation with recombinant FSH and GnRH antagonist for IVF-ICSI treatment.
Incidence of OHSS in GnRH antagonist cycles, predictive value of E2, and number of follicles on the day of hCG for OHSS occurrence.
Fifty-three patients were hospitalized because of OHSS (2.1%; 95% confidence interval [CI]:1.6-2.8). Early OHSS presented in 31 patients (1.2%; 95% CI: 0.9-1.8), whereas the late type was a complication in 22 patients (0.9%; 95% CI: 0.5-1.3). Late OHSS cases compared with the early OHSS cases always occurred in a pregnancy cycle (100% vs. 40%); had higher probability of being severe (72.7% vs. 42%), and more often were related to a multiple pregnancy (40% vs. 0). Receiver operating characteristic curve analysis for several E2 concentrations and number of follicles with a diameter of > or =11 mm revealed that the predictive value of the optimal threshold of > or =13 follicles (85.5% sensitivity; 69% specificity) was statistically significantly superior to the optimal threshold of 2,560 ng/L for E2 concentrations (53% sensitivity, 77% specificity) in identifying patients at risk for OHSS. Considering that severe OHSS represents the most clinically significant pattern, the combination of a threshold of > or =18 follicles and/or E2 of > or =5,000 ng/L yields a 83% sensitivity rate with a specificity as high as 84% for the severe OHSS cases.
Clinically significant OHSS still remains a limitation of multifollicular ovarian stimulation for IVF even with the use of GnRH antagonist protocols. The number of follicles can discriminate the patients who are at risk for developing OHSS, whereas E2 concentrations are less reliable for the purpose of prediction. There is more than ever an urgent need for alternative final oocyte maturation-triggering medication.
Fertility and sterility 02/2006; 85(1):112-20. · 3.97 Impact Factor
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ABSTRACT: To optimize blastocyst cryopreservation, the prerequisite is to develop a better understanding of factors that influence their survival and implantation potential. Therefore, the aim of the present work was to evaluate, retrospectively, the outcome of blastocyst cryopreservation in a day 2/3 fresh embryo transfer programme.
Two different freezing strategies were compared: a first strategy (strategy A: 3007 blastocysts frozen) consisted of freezing those blastocysts that had at least a cavity; a second strategy (strategy B: 3831 blastocysts frozen) consisted of freezing only more advanced stage blastocysts with a good quality inner cell mass and trophectoderm. The outcome of cryopreservation, as related to the two different freezing strategies, was analysed. In addition, after freezing and thawing, we evaluated the influence of blastocyst developmental characteristics on immediate morphological survival and further development in vitro.
The immediate morphological survival after thawing was higher for early blastocysts as compared to advanced and hatching blastocysts. The further developmental potential in vitro of thawed blastocysts was higher for advanced and hatching blastocysts as compared to early blastocysts. As a result, the percentage of deliveries, calculated as a percentage of started thawing cycle, and the percentage of children born, calculated as a percentage of embryos transferred, was not different for strategies A and B.
The results clearly indicate that culture conditions and cryopreservation procedures of blastocysts need to be further improved.
Human Reproduction 11/2005; 20(10):2939-45. · 4.47 Impact Factor
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ABSTRACT: Prolongation of follicular phase by delaying hCG administration has been reported to result in a significantly lower ongoing pregnancy rate that did not seem to be due to an embryonic factor. The aim of this prospective randomized study was to assess the effect of delaying hCG administration on endometrial histology.
Ten oocyte donors underwent endometrial biopsy on the day of oocyte retrieval and endometrial histology was assessed by Noyes' criteria. Ovarian stimulation was performed with recombinant (r)FSH and daily GnRH antagonist starting on day 6 of stimulation. Patients were randomized by a computer-generated list to receive 10 000 IU of hCG either as soon as > or =3 follicles > or =17 mm were present on ultrasound (early-hCG group, n = 5) or 2 days after this criterion was met (late-hCG group, n = 5).
When hCG was delayed, endometrial advancement was present in all samples examined (median advancement 3 days, range 2-3 days). On the contrary, no secretory changes were observed when the follicular phase was not prolonged (difference in the proportion of patients with advancement between the early-hCG and the late-hCG group: 100%, 95% CI: 38-100).
Prolongation of follicular phase by delaying hCG administration results in a higher incidence of endometrial advancement on the day of oocyte retrieval in GnRH antagonist cycles.
Human Reproduction 10/2005; 20(9):2453-6. · 4.47 Impact Factor
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ABSTRACT: Ovarian hyperstimulation syndrome (OHSS) in IVF/ICSI cycles may occur either as an early (early onset) or a late pattern (late onset). This observational study was designed to identify whether the onset pattern of OHSS is associated with the occurrence of pregnancy and the early pregnancy outcome.
Among 4376 consecutive IVF/ICSI cycles, 113 patients were hospitalized for OHSS after IVF/ICSI treatment and were included in the study. The setting was the Dutch-speaking Brussels Free University Hospital, between June 2000 and September 2002.
Early OHSS occurred in 53 patients, and late OHSS complicated 60 patients. A total of 96.7% of the late OHSS cases occurred in a pregnancy cycle and were more likely to be severe than the early cases (P < 0.05). Although in the early group there initially was a 41.5% positive HCG rate per cycle, the clinical pregnancy rate fell to 28.3% as a result of a significantly (P < 0.05) increased preclinical pregnancy loss rate compared with the non-OHSS patients (31.8 versus 88.3%, respectively). The ongoing pregnancy rate per cycle was 14.4% in the early and 26.4% in the late group. Multiple pregnancy rates were high in both groups (40 and 45.5%, respectively), but only in the late group did the incidence reach significance compared with the non-OHSS population (45.5 versus 29.1%, P = 0.02). Estradiol levels and number of follicles on the day of HCG were significantly higher in the early OHSS group. However, there was no difference in estradiol values on the day of hospital admittance between the two groups. In addition, the number of follicles on the day of HCG administration appears to be a better prognostic indicator for the occurrence of severe OHSS than the estradiol values (87% of the severe cases had > or = 14 or follicles of a diameter > or = 11 mm, whereas only 50% of them had an estradiol value > or = 3000 ng/l).
The early OHSS pattern is associated with exogenously administered HCG and a higher risk of preclinical miscarriage, whereas late OHSS may be closely associated with the conception cycles, especially multiple pregnancies, and is more likely to be severe. Further clarification of these two different clinical entities could have implications for research protocols as well as for preventive and management strategies for OHSS.
Human Reproduction 04/2005; 20(3):636-41. · 4.47 Impact Factor
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ABSTRACT: It is generally accepted that the age-related increased aneuploidy rate is correlated with reduced implantation and a higher abortion rate. Therefore, advanced maternal age (AMA) couples are a good target group to assess the possible benefit of preimplantation genetic diagnosis for aneuploidy screening (PGD-AS) on the outcome after assisted reproductive technology (ART).
A prospective randomized controlled clinical trial (RCT) was carried out comparing the outcome after blastocyst transfer combined with PGD-AS using fluorescence in situ hybridization (FISH) for the chromosomes X, Y, 13, 16, 18, 21 and 22 in AMA couples (aged > or =37 years) with a control group without PGD-AS. From the 400 (200 for PGD-AS and 200 controls) couples that were allocated to the trial, an oocyte pick-up was performed effectively in 289 cycles (148 PGD-AS cycles and 141 control cycles).
Positive serum HCG rates per transfer and per cycle were the same for PGD-AS and controls: 35.8% (19.6%) [%/per embryo transfer (per cycle)] and 32.2% (27.7%), respectively (NS). Significantly fewer embryos were transferred in the PGD-AS group than in the control group (P<0.001). The implantation rate (with fetal heart beat) was 17.1% in the PGD-AS group versus 11.5% in the control group (not significant; P=0.09). We observed a normal diploid status in 36.8% of the embryos.
This RCT provides no arguments in favour of PGD-AS for improving clinical outcome per initiated cycle in patients with AMA when there are no restrictions in the number of embryos to be transferred.
Human Reproduction 12/2004; 19(12):2849-58. · 4.47 Impact Factor
