Twenty years’ experience with the Swiss data registry for assisted reproductive medicine: outcomes, key trends and recommendations for improved practice

Geyter, Christian De; Fehr, Peter; Moffat, Rebecca; Gruber, Isabel M.L.; Wolff, Michael von

doi:10.4414/smw.2015.14087

Cited by 24 publications

(16 citation statements)

References 30 publications

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“…retrieving three instead of two oocytes increases the predicted LBR by approximately 25%, relatively, in all age groups. Interestingly, this relative increase in LBR was also reported comparing PORs (< 5 oocytes) with suboptimal responders (5–9 oocytes) in a large retrospective study based on national registry data from 2005 to 2012 in Switzerland [ 27 ].…”

Section: One More Oocyte Matterssupporting

confidence: 56%

“…The reason is most certainly the follicular synchronization obtained after down-regulation, which for the expected POR is of utmost importance as these patients usually have increased late luteal FSH levels during their natural cycle, promoting early recruitment of the leading follicle. As one more oocyte increases the live birth rate by 5% [ 26 , 27 ], the long GnRH agonist down-regulation protocol should be first line treatment for expected POR, unless a double stimulation [ 37 ] is planned for oocyte/embryo accumulation and subsequent frozen thaw embryo transfer.…”

Section: Icos In Expected Poor Responders (Poseidon Groups 3 and 4)mentioning

confidence: 99%

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Individualized controlled ovarian stimulation in expected poor-responders: an update

Haahr

Esteves

Humaıdan

2018

Reprod Biol Endocrinol

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Controlled ovarian stimulation with subsequent multi-follicular development continues to be a keystone in ART. Evidence supports an individualized approach to ovarian stimulation, usually involving combinations of ovarian reserve tests, body mass index and age to tailor the exogenous gonadotropin dose, and potentially adjuvant treatment aiming for high safety and a shortening of time to live birth. While stimulation and trigger concepts have been developed successfully in normo- and hyperresponder patients, the poor responder patient remains difficult to manage. However, recent advances in definition and classification of the expected poor ovarian responder patient might enable a more accurate and clinically useful interpretation of new treatment concepts in a more homogenous study population. In the present review, we discuss the classification of the expected poor ovarian responder patient as well as clinically useful measurements of efficacy for controlled ovarian stimulation, and finally, we discuss the evidence for clinical management of patients with expected poor ovarian response, including adjuvant treatments such as growth hormone, androgens, and LH activity.In conclusion, the best available evidence supports that the treatment of the expected poor ovarian response patient should be individualized in all steps of ART, including the choice of GnRH analogue, the gonadotropin type and dose, ovulation trigger, and the possible use of adjuvant therapies.

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Section: One More Oocyte Matterssupporting

confidence: 56%

Section: Icos In Expected Poor Responders (Poseidon Groups 3 and 4)mentioning

confidence: 99%

Individualized controlled ovarian stimulation in expected poor-responders: an update

Haahr

Esteves

Humaıdan

2018

Reprod Biol Endocrinol

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“…Of note, there were significant difference in the COH protocol and number of oocytes collected. It has been reported that different stimulation protocols (agonist vs. antagonist) (34) and the number of oocytes collected (35,36) may cause bias on the LBR. Hence, duration of infertility, the number of AFC, the number of oocytes collected, and COH protocol were adjusted in logistic regression along with other potential confounding factors.…”

Section: Interpretation Of Datamentioning

confidence: 99%

Growth Hormone Supplementation May Not Improve Live Birth Rate in Poor Responders

et al. 2020

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Backgrounds: Growth hormone (GH) was used for many years to increase ovarian response in poor ovarian responders (PORs). Although meta-analysis suggested that GH therapy improve early clinical outcomes, the benefit of GH usage on chance of live birth was still widely debated. This study was to determine whether or not GH supplementation influences the live birth rate (LBR). Methods: A total of 3,080 expected PORs receiving and not receiving (control) GH adjuvant therapy at Peking University Third Hospital from January 2017 to March 2018 were retrospectively analyzed. The basal characteristics of patients were compared using analysis of variance (continuous variables) and categorical variables were evaluated with a chi-square test. Logistic regression analyses were used to evaluate potential associations of LBR with GH treatment while adjusting other confounding factors. Results: No statistically significant differences existed in miscarriage rate (5.3 vs. 12.5%; p = 0.076) and LBR (37.7 vs. 34.5%; p = 0.426) in young expected PORs (< 35 years of age). Moreover, no significant differences existed in the miscarriage rate (25.6 vs. 23.3%; p = 0.681), and LBR (17.8 vs. 17.9%; p = 0.977) in the old expected PORs (≥35 years of age). Logistic regression suggested that GH adjuvant therapy did not improve the LBR in young (OR, 1.27; 95% CI, 0.88-1.85; p = 0.203) and elderly expected PORs (OR, 1.20; 95% CI, 0.82-1.76; p = 0.342), while GH was not associated with risk of miscarriage in young (OR, 0.37; 95% CI, 0.11-1.24; p = 0.108) and elderly expected PORs (OR, 0.91; 95% CI, 0.43-1.93; p = 0.813). In subgroup analysis, GH treatment significantly increased the day 3 embryos available rate in the subgroup of young PORs with the long down-regulation (63.11 vs. 49.35%; p = 0.004), while significantly reduced the risk of miscarriage in the subgroup of young PORs with GnRH antagonist protocol (0.00 vs. 12. %; p = 0.023). There was no significant difference for LBR in PORs with GnRH antagonist (<35 years [35.19 vs. 28.45%; p = 0.183]; ≥35 years [12.96 vs. 14.03%; p = 0.707]), GnRH-a long (<35 years [33.33 vs. 36.99%; p = 0.597]; ≥35 years [17.44 vs. 20.28%; p = 0.574]) and long down-regulation (<35 years [58.82 vs. 41.90%; p = 0.193]; ≥35 years [43.33 vs. 25.30%; p = 0.065]). Conclusions: Growth hormone treatment may not improve live birth rate in expected poor responders.

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“…ART success has been commonly reported as the delivery of a live birth resulting from one initiated or aspirated ART cycle (7). The most comprehensive studies indicate that there is a positive association between the number of retrieved oocytes and live birth rates (LBR), in particular, cumulative LBR, with higher oocyte thresholds for better outcomes (8)(9)(10). Although the LBR is the preferable endpoint for couples, it depends on a multitude of controlled and uncontrolled factors, thus making it challenging to use this metric for individualized predictions about the number of oocytes needed to achieve the desired outcome.…”

Section: Introductionmentioning

confidence: 99%

Validation of ART Calculator for Predicting the Number of Metaphase II Oocytes Required for Obtaining at Least One Euploid Blastocyst for Transfer in Couples Undergoing in vitro Fertilization/Intracytoplasmic Sperm Injection

Esteves

Yaralı́²,

Ubaldi

et al. 2020

Front. Endocrinol.

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The ART calculator positive predictive values, i.e., the frequency of patients with at least one euploid blastocyst among those who achieved the estimated MIImin, were 84.8%, 87.5%, and 90.0% for 70%, 80%, and 90% predicted probabilities of success, respectively. The ART calculator effectively predicts the MIImin needed to achieve at least one euploid blastocyst in individual patients undergoing IVF/ICSI. The prediction tool might be used for counseling and planning IVF/ICSI treatments.

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Twenty years’ experience with the Swiss data registry for assisted reproductive medicine: outcomes, key trends and recommendations for improved practice

Abstract: Optimal ovarian stimulation should be designed for the retrieval of 10 to 15 oocytes per treatment. Swiss legislation should enable and stimulate a policy of elective single embryo transfer to avoid multiple births.

Cited by 24 publications

References 30 publications

Individualized controlled ovarian stimulation in expected poor-responders: an update

Individualized controlled ovarian stimulation in expected poor-responders: an update

Growth Hormone Supplementation May Not Improve Live Birth Rate in Poor Responders

Validation of ART Calculator for Predicting the Number of Metaphase II Oocytes Required for Obtaining at Least One Euploid Blastocyst for Transfer in Couples Undergoing in vitro Fertilization/Intracytoplasmic Sperm Injection

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