Why more is less and less is more when it comes to ovarian stimulation

Blumenfeld, Zeev

doi:10.1007/s10815-015-0599-7

Cited by 20 publications

(21 citation statements)

References 65 publications

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“…This was observed in several studies, who found the lower implantation rate in high estradiol level condition during IVF ET cycle [10] [14] [15]. However, the difference in pregnancy results was not the primary goal of this study.…”

Section: Discussionsupporting

confidence: 50%

The Comparison of Area under the Curve of Serum Estradiol during Controlled Ovarian Stimulation between Long Gonadotrophin Releasing Hormone Agonist Protocol and Short Gonadotrophin Antagonist Protocol in Invitro Fertilization

Bayuaji¹,

Permadi²,

Sastramihardja³

et al. 2017

OALib

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Background: during stimulation, estradiol levels represent the dynamic hormonal interaction of follicle development. Some studies have been done to evaluate the influence of day-hCG estradiol assay and IVF outcome. However, this assay does not reflect the total exposure of estradiol throughout stimulation. Hence the concept of calculating the area under the curve (AUC) of estradiol during ovarian stimulation is thought to be a better parameter to evaluate total exposure of estradiol to the entire process of IVF. Methods: a retrospective analysis of data from a fertility center in a tertiary hospital. Between 2011-2016, there were long GnRH agonist cycles and short GnRH antagonist cycles eligible for analysis. Data including subject's characteristics, the level of estradiol on day-2, day-6, and day-hCG during controlled ovarian stimulation were obtained. Those data were plotted, and area under the curve of each subject was calculated. Statistical analysis was done using student t-test while p < 0.05 was considered significant. Results: there were no significant differences in subject's age (33.4 vs. 34.2 years, p = 0.12), day-3 of menstrual cycle FSH level (7.1 vs. 7.3 mIU/mL, p = 0.64), and day-3 estradiol level (35.1 vs. 36.5 pg/mL, p = 0.61). The estradiol level on day-5 of COS was How to cite this paper: Bayuaji, H., Permadi, W., Sastramihardja, H.S. and Nataprawira, H.M.N. (2017)

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Section: Discussionsupporting

confidence: 50%

The Comparison of Area under the Curve of Serum Estradiol during Controlled Ovarian Stimulation between Long Gonadotrophin Releasing Hormone Agonist Protocol and Short Gonadotrophin Antagonist Protocol in Invitro Fertilization

Bayuaji¹,

Permadi²,

Sastramihardja³

et al. 2017

OALib

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“…More "mild" ovarian stimulation during IVF cycles has several benefits, including decreased incidence of ovarian hyperstimulation syndrome (OHSS), decreased frequency of multiple gestations, decreased rates of aneuploidy, lower cost, and improved access to IVF treatment [19]. Milder stimulation protocols have been associated with better implantation and pregnancy rates despite a lower number of oocytes retrieved [19]. Multiple mechanisms to explain this paradox that less oocytes may yield improved IVF outcomes have been proposed.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple mechanisms to explain this paradox that less oocytes may yield improved IVF outcomes have been proposed. Elevated E2 and P4 levels seen with conventional IVF protocols may be associated with direct embryo toxicity and diminished endometrial receptivity, and as such have poorer IVF outcomes [19]. It has been suggested that elevated E2 may disrupt folliculogenesis and oocyte maturation.…”

Section: Discussionmentioning

confidence: 99%

Patient and in vitro fertilization (IVF) cycle characteristics associated with variable blastulation rates: a retrospective study from the Duke Fertility Center (2013–2017)

Jones

Acharya

et al. 2019

Middle East Fertil Soc J

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Background: To evaluate the association of patient and IVF cycle characteristics with blastulation rate and formation of high-quality blastocysts Results: We analyzed autologous blastocyst cycles from 2013 to 2017. Cycles were subdivided into low (< 33%), intermediate (33-66%), and high (> 66%) blastulation rates. Embryo quality was assigned by embryologists using Gardner Criteria. R statistical package was used, and the blastulation groups were compared using analysis of variance (ANOVA) for continuous variables and chi-squared tests for categorical variables. The Bonferroni correction was used to adjust for multiple comparisons. One hundred seventeen IVF cycles met our inclusion criteria. Of these, 20 (17.1%) had low, 74 (63.2%) had intermediate, and 23 (19.7%) had high blastulation rates. Low blastulation rate was associated with a lower number of blastocysts, including fewer high-quality blastocysts. The mean number of oocytes retrieved was highest (18.1) in the group with the lowest blastulation rate, and lowest (13.4) in those with the highest blastulation rate, although this did not reach statistical significance. There were no significant differences between blastulation rates and age, gravidity, prior live birth, anti-mullerian hormone, estradiol and progesterone levels on the day of ovulation trigger, follicle-stimulating hormone dose, or fertility diagnosis. Conclusions: High blastulation rate is associated with a greater number of blastocysts, including a greater number of high-quality blastocysts. Higher oocyte yield, however, is not associated with improved blastulation rates. Blastulation rates, blastocyst number, and quality remain difficult to predict based on cycle characteristics alone, and oocyte yield may not be an accurate predictor of either outcome. Precis High oocyte yield may be associated with a lower blastulation rate and a lower number of high-quality blastocysts.

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“…This would result in embryo transfer only being performed if the endometrium has not been exposed to ovarian stimulation and is in developmental synchrony with the embryo. As a compromise approach to this problem, low-dose stimulation regimens have been developed in an attempt to minimize the adverse effects of more aggressive conventional controlled ovarian hyperstimulation [104].…”

Section: Suboptimal Endometrial Function As a Results Of Controlled Ovmentioning

confidence: 99%

What is the contribution of embryo-endometrial asynchrony to implantation failure?

Teh

McBain

Rogers

2016

J Assist Reprod Genet

162

122

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Why more is less and less is more when it comes to ovarian stimulation

Cited by 20 publications

References 65 publications

The Comparison of Area under the Curve of Serum Estradiol during Controlled Ovarian Stimulation between Long Gonadotrophin Releasing Hormone Agonist Protocol and Short Gonadotrophin Antagonist Protocol in Invitro Fertilization

The Comparison of Area under the Curve of Serum Estradiol during Controlled Ovarian Stimulation between Long Gonadotrophin Releasing Hormone Agonist Protocol and Short Gonadotrophin Antagonist Protocol in Invitro Fertilization

Patient and in vitro fertilization (IVF) cycle characteristics associated with variable blastulation rates: a retrospective study from the Duke Fertility Center (2013–2017)

What is the contribution of embryo-endometrial asynchrony to implantation failure?

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