Minimal ovarian stimulation for IVF: appraisal of potential benefits and drawbacks

Fauser, Bart C.J.M.; Devroey, Paul; Yen, S. S. C.; Gosden, Roger G.; Crowley, William F.; Baird, D. T.; Bouchard, Philippe

doi:10.1093/humrep/14.11.2681

Cited by 206 publications

(92 citation statements)

References 59 publications

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“…The data suggest that impaired endometrial receptivity in patients with high levels of E 2 can be improved by decreasing E 2 levels, albeit in the next cycle (8). Also, the application of minimal stimulation protocols, in which gentle manipulation of the FSH window is applied, may result in a reduced degree of stimulation of the ovaries (18). However, in these minimal stimulation protocols still a large number of oocytes can be collected at retrieval and the E 2 levels at day of hCG still can be high, while the risk of poor response seems to be increased (19).…”

Section: Discussionmentioning

confidence: 97%

Use of Stimulated Serum Estradiol Measurements for the Prediction of Hyperresponse to Ovarian Stimulation in in Vitro Fertilization (IVF)

Hendriks

Klinkert

Bancsi

et al. 2004

J Assist Reprod Genet

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Purpose : In ovarian stimulation an exaggerated ovarian response is often seen and is related to medical complications, such as ovarian hyperstimulation syndrome (OHSS), and increased patient discomfort. If it were possible to identify hyperresponders at an early stage of the stimulation phase, adaptation of the stimulation protocol would become feasible to minimize potential complications. Therefore, we studied the usefulness of measuring stimulated serum estradiol (E 2 ) levels in predicting ovarian hyperresponse. Methods : A total of 109 patients undergoing their first IVF treatment cycle using a long protocol with GnRH agonist was prospectively included. The E 2 level was evaluated on day 3 and 5 of the stimulation phase. Two outcome measures were defined. The first was ovarian hyperresponse (collection of ≥15 oocytes at retrieval and/or peak E 2 > 10000 pmol/L, or cancellation due to ≥30 follicles growing and/or peak E 2 > 15000 pmol/L, or OHSS developed). The second outcome measure comprised a subgroup representing the more severe hyperresponders, named extreme-response (cancellation or OHSS developed). Results : The data of 108 patients were analyzed. The predictive accuracy of E 2 measured on stimulation day 3 towards ovarian hyperresponse was clearly lower than that of E 2 measured on stimulation day 5 (area under the receiver operating characteristic curve (ROC AUC ) 0.75 and 0.81, respectively). For extreme-response the predictive accuracy of E 2 measured on stimulation day 3 or 5 was comparable (ROC AUC 0.81 and 0.82, respectively). For both outcome measures the stimulated E 2 tests yielded only acceptable specificity with moderate sensitivity at higher cutoff levels. Prediction of extreme-response seemed slightly more effective due to a lower error rate. Conclusions : There is a significant predictive association between E 2 levels measured on stimulation day 3 and 5 and both ovarian hyperresponse and extreme-response in IVF. However, the clinical value of stimulated E 2 levels for the prediction of hyperresponse is low because of the modest sensitivity and the high false positive rate. For the prediction of extreme-response the clinical value of stimulated E 2 levels is moderate.

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Section: Discussionmentioning

confidence: 97%

Use of Stimulated Serum Estradiol Measurements for the Prediction of Hyperresponse to Ovarian Stimulation in in Vitro Fertilization (IVF)

Hendriks

Klinkert

Bancsi

et al. 2004

J Assist Reprod Genet

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“…Fourth, we can consider modifying our protocols of ovarian stimulation to avoid the production of too many oocytes, which, as demonstrated here and in previous studies, may not lead to more live births, but to increased BEmbryo Wastages.M inimal stimulation or natural IVF cycles have been associated with improved egg quality and reduced aneuploidy rates [37][38][39]. Additionally, a reduction in the amount of medication used for stimulation would reduce the risk of ovarian hyperstimulation syndrome for high responders, and possibly be a more cost-effective strategy for poor responders [40,41] and reduce the rates of oocyte aneuploidy [42]. Fifth, more studies are needed to address endometrial receptivity in fresh transfer versus deferred frozen embryo transfer cycles [43].…”

Section: Discussionmentioning

confidence: 99%

Embryo wastage rates remain high in assisted reproductive technology (ART): a look at the trends from 2004–2013 in the USA

Ghazal¹,

Patrizio²

2016

J Assist Reprod Genet

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This work examined the trend in Bembryo wastager ates after ART in USA and its relationship to the number of embryos transferred, live born infants delivered across patient age, and the yearly percentage of embryos wasted. The data were obtained from the US-clinics SART databank for the years 2004-2013. A total of 1,808,082 non-donor embryos were transferred in 748,394 fresh cycles resulting in 358,214 liveborn. During the years of analysis, the mean number of embryos transferred has progressively decreased leading to an overall significant decrease in Embryo Wastage rates (83.2 to 76.5%, p < 0.001) while the percentage of transfers leading to a live born increased (24.8 to 27.8%, p = 0.002). Embryo Wastage negatively correlated with percentage of transfers resulting in live birth (p = 0.001), and the average number of embryos transferred positively correlated with the percentage of embryos wasted (p < 0.001). The overwhelming majority of embryos transferred still do not result into a live birth confirming that only few embryos per ART cycle are competent. The overall BEmbryo Wastage^rates have consistently decreased from a high of 90% in 1995 to a rate of 76.5% in 2013. Transferring fewer embryos particularly at the blastocyst-stage and improved methods of embryo selection may further decrease BEmbryo Wastage^rates.

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“…In our previous research, it has been demonstrated that the risk of OHSS increases with rising number of harvested oocytes and the risk is significantly higher in patients with more than ten collected oocytes (Reljič et al, 1999). Severe OHSS is a serious and potentially life-threatening complication of MAR treatment and has a mean incidence of 1-3% in MAR programmes involving standard ovarian stimulation protocols (Fauser et al, 1999). However, to date, there are no reliable predictors of its occurrence.…”

Section: Ovarian Hyperstimulation Syndromementioning

confidence: 99%

“…In current practice, long acting gonadotrophin-releasing hormone (GnRH) agonist pituitary suppression combined with recombinant or purified urinary exogenous follicle stimulating hormone (FSH) is the most frequently used stimulation protocol . However, in light of making MAR more "patient friendly", there is a recent trend toward milder stimulation protocols in order to reduce the chances of complications and not lastly, to lower the costs of MAR treatment (Fauser et al, 1999). With the availability of GnRH antagonists in ovarian stimulation protocols, administration of FSH can be delayed to midfollicular phase, thus reducing the amount of gonadotrophins used for stimulation and minimizing exogenous hormonal interferences that are present in conventional hormonal stimulation (Fauser & van Heusden, 1997).…”

Section: Ovarian Stimulation Strategiesmentioning

confidence: 99%

Does the Number of Retrieved Oocytes Influence Pregnancy Rate After Day 3 and Day 5 Embryo Transfer?

Vlaisavljević¹,

Knez²,

Kovačič³

2012

Advances in Embryo Transfer

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Minimal ovarian stimulation for IVF: appraisal of potential benefits and drawbacks

Cited by 206 publications

References 59 publications

Use of Stimulated Serum Estradiol Measurements for the Prediction of Hyperresponse to Ovarian Stimulation in in Vitro Fertilization (IVF)

Use of Stimulated Serum Estradiol Measurements for the Prediction of Hyperresponse to Ovarian Stimulation in in Vitro Fertilization (IVF)

Embryo wastage rates remain high in assisted reproductive technology (ART): a look at the trends from 2004–2013 in the USA

Does the Number of Retrieved Oocytes Influence Pregnancy Rate After Day 3 and Day 5 Embryo Transfer?

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