Infertility patient clinical journey outcome depends on initial treatment, starting with ovulation induction (OI) vs in vitro fertilization (IVF): results from a large real-world database

Mahony, M.C.; Mottla, Gilbert L.; Richter, K.S.; Ball, G.D.; Ansari, Saleem; Hayward, Brooke

doi:10.1016/j.fertnstert.2019.07.1130

Cited by 2 publications

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“…For example, cycle cancellation due to the risk of OHSS may necessitate discontinuation of the ongoing ART treatment and/or subsequent OS cycles, which increases both the emotional and financial burden on patients ( 7 ). Evidence suggests that the discontinuation rate is higher amongst patients undergoing subsequent treatment cycles after a failed ART treatment in previous attempts ( 44 ). Dose adjustment during gonadotropin stimulation based on ovarian response to treatment measured by ultrasound assessment of follicular development and hormonal monitoring is a common strategy to limit the risk of OHSS and reduce the occurrence of cycle cancellations ( 18 , 38 , 45 ).…”

Section: Discussionmentioning

confidence: 99%

Recombinant Human Follicle-Stimulating Hormone Alfa Dose Adjustment in US Clinical Practice: An Observational, Retrospective Analysis of a Real-World Electronic Medical Records Database

Mahony¹,

Hayward²,

Mottla³

et al. 2021

Front. Endocrinol.

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PurposeTo determine the pattern of dose adjustment of recombinant human follicle-stimulating hormone alfa (r-hFSH-alfa) during ovarian stimulation (OS) for assisted reproductive technology (ART) in a real-world setting.MethodsThis was an observational, retrospective analysis of data from an electronic de-identified medical records database including 39 clinics in the USA. Women undergoing OS for ART (initiated 2009–2016) with r-hFSH-alfa (Gonal-f® or Gonal-f RFF Redi-ject®) were included. Assessed outcomes were patients’ baseline characteristics and dosing characteristics/cycle.ResultsOf 33,962 ART cycles, 13,823 (40.7%) underwent dose adjustments: 23.4% with ≥1 dose increase, 25.4% with ≥1 dose decrease, and 8.1% with ≥1 increase and ≥1 decrease. Patients who received dose adjustments were younger (mean [SD] age 34.8 [4.58] years versus 35.9 [4.60] years, p<0.0001) and had lower BMI (25.1 [5.45] kg/m2 versus 25.5 [5.45] kg/m2, p<0.0001) than those who received a constant dose. The proportion of patients with non-normal ovarian reserve was 38.4% for those receiving dose adjustment versus 51.9% for those with a constant dose. The mean (SD) number of dose changes/cycle was 1.61 (0.92) for cycles with any dose adjustment, 1.72 (1.03) for cycles with ≥1 dose increase, 2.77 (1.00) for cycles with ≥1 dose increase and ≥1 decrease (n=2,755), and 1.88 (1.03) for cycles with ≥1 dose decrease.ConclusionsDose adjustment during OS is common in clinical practice in the USA and occurred more often in younger versus older patients, those with a high versus non-normal ovarian reserve or those with ovulation disorders/polycystic ovary syndrome versus other primary diagnoses of infertility.

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Section: Discussionmentioning

confidence: 99%

Recombinant Human Follicle-Stimulating Hormone Alfa Dose Adjustment in US Clinical Practice: An Observational, Retrospective Analysis of a Real-World Electronic Medical Records Database

Mahony¹,

Hayward²,

Mottla³

et al. 2021

Front. Endocrinol.

Self Cite

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“…The barriers to achieving this patient goal are several: medical conditions in the female and/or male, the patient's age, financial barriers and psychological stress. Based on numerous clinicians' experience, approximately 50-60% of patients seen in a tertiary care center will have a baby [22]. About 10% will decide not to pursue treatment because the prognosis is very poor, while about 30% will not achieve their goal because of financial and/or psychological barriers: 10% financial reasons alone, 10% psychological reasons alone and 10% a combination of the two.…”

Section: Overview Of Infertilitymentioning

confidence: 99%

Fertility Counseling: Clinical Guide

2022

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The second edition of the essential guide for reproductive professionals is now available in a Clinical Guide and a Case Studies Guide, presenting the most current knowledge on counseling diverse patients amidst rapidly advancing modern technology. Follow an in-depth presentation of clinical concepts in this Clinical Guide for a foundational understanding of the medical and psychosocial experience of fertility treatment. Explore the areas of reproductive psychology, therapeutic approaches, assessment and preparation in assisted reproduction, addressing the needs of diverse populations, and clinical practice issues. Featuring new topics such as transgender ART, recurrent pregnancy loss, post-partum adjustment, and the pregnant therapist. Then in Case Studies, discover the accessible, real-world experiences and perspectives as leading international practitioners share their stories applying clinical concepts to treatment practice. An essential aid for medical and mental health professionals, this comprehensive guide allows clinicians to develop and refine the skills required to address the increasingly complex psychosocial needs of fertility patients.

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Infertility patient clinical journey outcome depends on initial treatment, starting with ovulation induction (OI) vs in vitro fertilization (IVF): results from a large real-world database

Cited by 2 publications

References 0 publications

Recombinant Human Follicle-Stimulating Hormone Alfa Dose Adjustment in US Clinical Practice: An Observational, Retrospective Analysis of a Real-World Electronic Medical Records Database

Recombinant Human Follicle-Stimulating Hormone Alfa Dose Adjustment in US Clinical Practice: An Observational, Retrospective Analysis of a Real-World Electronic Medical Records Database

Fertility Counseling: Clinical Guide

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