ObjectiveTo evaluate different starting doses of recombinant human follicle-stimulating hormone (rhFSH) on pregnancy outcomes for patients with normal ovarian reserve during gonadotropin- releasing hormone antagonist (GnRH-ant) protocol-controlled ovarian stimulation of in vitro fertilization (IVF) cycles.MethodsIn this retrospective study, a total of 1138 patients undergoing IVF cycles following the GnRH-ant protocol were enrolled. Patients were divided into two groups according to the starting dose of rhFSH. 617 patients received a starting dose of rhFSH of 150 IU, and 521 patients received a starting dose of rhFSH of 225 IU. We compared demographic characteristics, ovarian stimulation and embryological characteristics, and pregnancy and birth outcomes between the two groups. Multivariate logistic regression analysis was performed to examine the possible effects of the known potential confounding factors on pregnancy outcomes.ResultsThe number of oocytes retrieved in the 150 IU rhFSH group was significantly lower than those in the 225 IU rhFSH group. There was no significant difference between the two groups referring to embryological characteristics. The proportion of fresh embryo transfer in the 150 IU rhFSH group was significantly higher than that in the 225 IU rhFSH group (48.30% vs. 40.90%), and there was no difference in the risk of ovarian hyperstimulation syndrome and pregnancy outcomes between the two groups.ConclusionsIn conclusion, the starting dose of rhFSH of 150 IU for ovarian stimulation has a similar pregnancy outcome as starting dose of rhFSH of 225 IU in GnRH-ant protocol for patients with normal ovarian reserve. Considering the potential cost-effectiveness and shorter time to live birth, the starting dose of rhFSH of 150 IU may be more suitable than 225 IU.
Research question: This study investigates the difference in reproductive outcomes with the late addition of vaginal oestradiol to oral oestradiol in artificially cycled frozen embryo transfer (AC-FET) cycles. Design: This retrospective cohort study was conducted at a university-affiliated tertiary care hospital. We divided 806 infertility patients who underwent programmed pre-FET endometrial preparation from January 2018 to July 2021 into two independent groups: Group A (591 with oral estradiol valerate only) and group B (215 with late oral estradiol valerate plus vaginal 17 β-estradiol). The primary outcome was the live birth rate (LBR), and the secondary outcome was other pregnancy-related outcomes. Propensity score matching (PSM) and multivariate logistic regression were applied to analyze all pregnancy outcomes, with a subgroup analysis based on vaginal oestradiol dose for group B. A subanalysis of cycles with endometrial thickness < 8 mm on the day prior to progesterone was also performed to assess the effect of adding vaginal oestradiol late in the thin endometrial transplantation cycle on reproductive outcomes.Results: Before and after PSM analysis, the live birth rates in group A were 41.1% and 42.2%, significantly higher than 31.2% and 30.8% in group B (P=0.015), respectively. Multiple logistic regression analysis demonstrates that group B was less likely to have a live birth than group A (OR 0.643, 95% Cl 0.453-0.913, P=0.014). Subgroup analysis of group B according to vaginal oestradiol dose demonstrated an insignificant difference in live birth rates between the subgroups (42.6% vs. 26.8% vs. 34.6%, P=0.118). In thin endometrial transplant cycles with an endometrial thickness < 8 mm on the day prior to progesterone, live birth rates were similar in both groups (36.9% vs. 26.8%, P=0.234).Conclusion: The addition of vaginal oestradiol as part of an artificial endometrial preparation (AEP) at a late stage of oral oestradiol significantly reduced LBR in autologous frozen-thawed embryo transfer, is independent of the dose of vaginal oestradiol, and does not improve the reproductive outcome in thin endometrial transfer cycles. However, more well-designed randomized clinical trials merit further investigation to confirm this conclusion.
Research question This study investigates the difference in reproductive outcomes with the late addition of vaginal oestradiol to oral oestradiol in artificially cycled frozen embryo transfer (AC-FET) cycles. Design This retrospective cohort study was conducted at a university-affiliated tertiary care hospital. We divided 806 infertility patients who underwent programmed pre-FET endometrial preparation from January 2018 to July 2021 into two independent groups: Group A (591 with oral estradiol valerate only) and group B (215 with late oral estradiol valerate plus vaginal 17 β-estradiol). The primary outcome was the live birth rate (LBR), and the secondary outcome was other pregnancy-related outcomes. Propensity score matching (PSM) and multivariate logistic regression were applied to analyze all pregnancy outcomes, with a subgroup analysis based on vaginal oestradiol dose for group B. A subanalysis of cycles with endometrial thickness < 8 mm on the day prior to progesterone was also performed to assess the effect of adding vaginal oestradiol late in the thin endometrial transplantation cycle on reproductive outcomes. Results Before and after PSM analysis, the live birth rates in group A were 41.1% and 42.2%, significantly higher than 31.2% and 30.8% in group B (P = 0.015), respectively. Multiple logistic regression analysis demonstrates that group B was less likely to have a live birth than group A (OR 0.643, 95% Cl 0.453–0.913, P = 0.014). Subgroup analysis of group B according to vaginal oestradiol dose demonstrated an insignificant difference in live birth rates between the subgroups (42.6% vs. 26.8% vs. 34.6%, P = 0.118). In thin endometrial transplant cycles with an endometrial thickness < 8 mm on the day prior to progesterone, live birth rates were similar in both groups (36.9% vs. 26.8%, P = 0.234). Conclusion The addition of vaginal oestradiol as part of an artificial endometrial preparation (AEP) at a late stage of oral oestradiol significantly reduced LBR in autologous frozen-thawed embryo transfer, is independent of the dose of vaginal oestradiol, and does not improve the reproductive outcome in thin endometrial transfer cycles. However, more well-designed randomized clinical trials merit further investigation to confirm this conclusion.
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