A mild ovarian stimulation strategy in women with poor ovarian reserve undergoing IVF: a multicenter randomized non-inferiority trial

Youssef, Mohamed; Wely, Madelon van; Al-Inany, Hesham; Madani, Tahereh; Jahangiri, Nadia; Khodabakhshi, Shabnam; Alhalabi, Marwan; Akhondi, Mohammad Mehdi; Ansaripour, Soheila; Tokhmechy, Reihaneh; Zarandi, L; Rizk, Ahmed; El-Mohamedy, M; Shaeer, Eman; Khattab, Mahmoud M.; Mochtar, Monique H.; Veen, Fulco van der

doi:10.1093/humrep/dew282

Cited by 55 publications

(62 citation statements)

References 30 publications

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“…None of our cases that developed OHSS had a GnRHa-trigger, consistent with the studies by Decleer et al 20 and Humaidan et al 21 and Kol et al 22 . Griesinger et al 23 obtained a reduced incidence of mild and moderate OHSS using a GnRHa-trigger, and only one cases out of 1924 women had an OHSS event.…”

Section: Discussionsupporting

confidence: 92%

Using Anti-Müllerian Hormone and Serum Estradiol to Predict Ovarian Hyperstimulation Syndrome in Patients Using Antagonist Protocol During IVF/ICSI Cycles

2017

Evidence Based Women's Health Journal

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Objectives: To investigate the ability of Anti-Müllerian hormone (AMH) and estradiol (E2) to predict OHSS in women using the GnRH antagonist protocol while undergoing invitro-fertilization (IVF) or intra-cytoplasmic sperm injection (ICSI). Study design: Retrospective analysis of women who had performed IVF/ICSI at assisted conception unit of Kasr Alainy university hospital over a period of 3 years. Patients and Methods: Basal serum AMH, estradiol (E2) level on the day of ovulation trigger and OHSS, among various other parameters were recorded and analyzed. Results: Thirty cases of OHSS (8.54%) were identified. There was no statistical difference in incidence of OHSS among age (p=0.976), FSH (p=0.286), LH (p=0.932), TSH (p=0.277), and prolactin (p=0.283), however, AMH (p=0.04), BMI (p=0.012), AFC (p< 0.001), and E2 before trigger (p<0.001) were significant. The overall clinical pregnancy rate was 27.35 % (n=96). The receiver operator analysis curve had a cut-off value of 4.45ng/ml (80%, sensitivity & 56% specificity). The area under the curve (AUC) was 0.661 with 95% confidence interval (CI) (0.548-0.775) (p=0.003). While for E2 the cut-off value was 4459 pg/ml with 76.7% sensitivity and 55.7% specificity), AUC 0.673 95% (CI) (0.554-0.791) (p=0.002). Combining both AMH ≥ 4.45ng/ml and E2 ≥4459 pg/ml had odds ratio 4.302 (95% CI) (1.795-10.304), relative risk (RR) 0.891 with 95%CI (0.832-0.954) (p<0.001). Conclusion: AMH and serum E2 before trigger are not highly accurate tests alone for the prediction of OHSS. When basal serum AMH was ≥4.45ng/ml and E2 ≥ 4459 pg/ml, the patient was at 4 fold increased risk of developing OHSS.

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Section: Discussionsupporting

confidence: 92%

Using Anti-Müllerian Hormone and Serum Estradiol to Predict Ovarian Hyperstimulation Syndrome in Patients Using Antagonist Protocol During IVF/ICSI Cycles

2017

Evidence Based Women's Health Journal

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“…So far, several papers attempting mild ovarian stimulation protocols in women with low ovarian reserve have been published from some clinical facilities . Taking these currently widely practiced methods into consideration, we basically left the choice of an ovarian stimulation protocol to the request of the patients after fully explaining the pros and cons of each protocol.…”

Section: Methodsmentioning

confidence: 99%

Different anti‐Műllerian hormone (AMH) levels respond to distinct ovarian stimulation methods in assisted reproductive technology (ART): Clues to better ART outcomes

Ishii¹,

Tachibana²,

Okawa³

et al. 2019

Reprod Medicine & Biology

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Purpose We asked whether the relationship between anti‐Műllerian hormone (AMH) value and the response to ovarian stimulation (OS) might be AMH value‐related and differ for each regimen, aiming at getting clues as to how to choose OS protocols according to AMH levels. We further addressed how AMH value connects with ART outcome. Methods A total of 1112 women undergoing egg retrieval in ART were included. We adopted four OS protocols, that is, clomiphene, clomiphene + low‐dose gonadotropins (Gns), GnRH (Gn‐releasing hormone) + Gns (short), and GnRH antagonist. Results Anti‐Műllerian hormone showed a stronger correlation with egg number compared with age over a wide age range. When patients were stratified into four groups by AMH value (<1, 1‐2, 2‐3, and 3≦ ng/mL), the relationship between AMH and egg number differed among differential OS regimes. The number of eggs rose as AMH and total doses of Gn increased. When analyzed for each AMH group, egg number, but not AMH, was associated with pregnancy rate. Conclusion Different AMH levels exhibit characteristic responses to distinct OS regimens. To improve ART outcomes, personalized OS should be selected so as to maximize egg number, which seems to be a more precise variable than AMH for predicting pregnancy.

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“…Progressive improvements in embryology now allow for good pregnancy outcomes after using milder stimulation regimes with deliberately lower oocyte yields. Three randomised controlled trials in women considered to be poor responders to ovarian stimulation have shown similar pregnancy rates with mild ovarian stimulation versus the standard high-dose stimulation regimens, [27][28][29] contradicting the concept that high FSH doses might improve the outcome for such patients. Similarly, a recent randomised controlled trial assessing women with predicted hyper-response undergoing IVF/ICSI with a reduced FSH dose (100 IU/ day) compared with standard dose (150 IU/day), resulted in similar cumulative live birth rates and, importantly, lower rates of OHSS, although not of severe OHSS.…”

Section: Mild Stimulation Regimesmentioning

confidence: 99%

In vitro fertilisation/intracytoplasmic sperm injection beyond 2020

Crawford

Ledger

2018

BJOG

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Over 8 million babies have been born following IVF (in vitro fertilisation) and other artificial reproductive technology (ART) procedures since Louise Brown's birth 40 years ago. New innovations have added much complexity to both clinical and laboratory procedures over the last four decades. Translation of novel approaches from basic science into clinical practice continues unabated, widening the applicability of ART to new groups of people and helping improve both chances of healthy live birth and patient acceptability. However, the impact of ART on the health of both patients and their offspring continues to cause concern, and many ethical challenges created by new scientific developments in this field attract widely differing opinions. What is undeniable is that there will be a sustained global growth in utilisation of ART and that reproductive tourism will allow many people to access the treatment they desire notwithstanding national regulations that may forbid some approaches. The greatest challenge is to expand access to ART to those living in the less wealthy nations who are equally deserving of its benefits.

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A mild ovarian stimulation strategy in women with poor ovarian reserve undergoing IVF: a multicenter randomized non-inferiority trial

Abstract: May 2011.

Cited by 55 publications

References 30 publications

Using Anti-Müllerian Hormone and Serum Estradiol to Predict Ovarian Hyperstimulation Syndrome in Patients Using Antagonist Protocol During IVF/ICSI Cycles

Using Anti-Müllerian Hormone and Serum Estradiol to Predict Ovarian Hyperstimulation Syndrome in Patients Using Antagonist Protocol During IVF/ICSI Cycles

Different anti‐Műllerian hormone (AMH) levels respond to distinct ovarian stimulation methods in assisted reproductive technology (ART): Clues to better ART outcomes

In vitro fertilisation/intracytoplasmic sperm injection beyond 2020

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