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Xiuxian Zhu - One of the best experts on this subject based on the ideXlab platform.

  • duphaston and human menopausal gonadotropin protocol in normally ovulatory women undergoing Controlled Ovarian Hyperstimulation during in vitro fertilization intracytoplasmic sperm injection treatments in combination with embryo cryopreservation
    Fertility and Sterility, 2017
    Co-Authors: Xiuxian Zhu
    Abstract:

    Objective To evaluate endocrine characteristics and clinical outcomes in normal ovulatory patients undergoing Controlled Ovarian Hyperstimulation (COH) with the use of a Duphaston and hMG protocol during in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatments in combination with frozen-thawed embryo transfer (FET) compared with the characteristics and outcomes of patients undergoing an Utrogestan and hMG protocol. Design Prospective Controlled study. Setting Tertiary care academic medical center. Patient(s) A total of 250 infertile patients undergoing IVF/ICSI treatments. Intervention(s) Duphaston (20 mg/d) or Utrogestan (100 mg/d) was taken orally from cycle day 3 until the trigger day, with hMG (150–225 IU) administered when appropriate. When the dominant follicles reached maturity, 0.1 mg GnRH agonist was used as the trigger. Viable embryos were cryopreserved in both protocols for transfer at a later time. Main Outcome Measure(s) The primary outcome was the number of oocytes retrieved. Secondary outcomes included the incidence of premature LH surge, the number of viable embryos, and clinical pregnancy outcomes from FET cycles. Result(s) Consistent LH suppression was achieved during COH. None of the participants experienced a premature LH surge. The number of oocytes retrieved (8.22 ± 5.46 vs. 8.8 ± 5.62) was similar between the two groups. No between-group significant differences were observed in the number of mature oocytes (7.2 ± 4.72 vs. 6.98 ± 4.68), fertilized oocytes (6.16 ± 4.34 vs. 6.32 ± 4.23), and viable embryos (2.96 ± 2.22 vs. 3.4 ± 2.54). Furthermore, the clinical pregnancy rates (53.04% vs. 51.7%), early miscarriage rates (8.2% vs. 11.84%), implantation rates (38.68% vs. 35.71%), and cumulative pregnancy rates per woman (66.67% vs. 69.47%) were also similar. Conclusion(s) Duphaston administration during COH was similar to Utrogestan in the prevention of LH surge, embryonic characteristics, and pregnancy outcomes. Clinical Trial Registration Number ChiCTR-IOR-15007265.

  • the utrogestan and hmg protocol in patients with polycystic Ovarian syndrome undergoing Controlled Ovarian Hyperstimulation during ivf icsi treatments
    Medicine, 2016
    Co-Authors: Xiuxian Zhu
    Abstract:

    Poor oocyte quality is a main concern for decreased reproductive outcomes in women with polycystic Ovarian syndrome (PCOS) during Controlled Ovarian Hyperstimulation (COH). A primary way to improve oocyte quality is to optimize the COH protocol. It was demonstrated that the viable embryo rate per oocyte retrieved in the Utrogestan and hMG protocol, a novel regimen based on frozen-thawed embryo transfer (FET), is statistically higher than that in the short protocol. Thus, a retrospective study was conducted to evaluate the endocrine characteristics and clinical outcomes in PCOS patients subjected to the Utrogestan and hMG protocol compared with those subjected to the short protocol.One hundred twenty three PCOS patients enrolled in the study group and were simultaneously administered Utrogestan and human menopausal gonadotropin (hMG) from cycle day 3 until the trigger day. When the dominant follicles matured, gonadotropin-releasing hormone agonist (GnRH-a) 0.1 mg was used as the trigger. A short protocol was applied in the control group including 77 PCOS women. Viable embryos were cryopreserved for later transfer in both groups. The primary outcome was the viable embryo rate per oocyte retrieved. The secondary outcomes included the number of oocytes retrieved, fertilization rate, and clinical pregnancy outcomes from FET cycles.The pituitary luteinizing hormone (LH) level was suppressed in most patients; however, the LH level in 13 women, whose basic LH level was more than 10 IU/L, surpassed 10 IU/L on menstruation cycle day (MC)9-11 and decreased subsequently. No significant between-group differences were observed in the number of oocytes retrieved (13.27 ± 7.46 vs 13.1 ± 7.98), number of viable embryos (5.57 ± 3.27 vs 5 ± 2.79), mature oocyte rate (90.14 ± 11.81% vs 93.02 ± 8.95%), and cleavage rate (97.69 ± 6.22% vs 95.89 ± 9.57%). The fertilization rate (76.11 ± 19.04% vs 69.34 ± 21.81%; P < 0.05), viable embryo rate per oocyte retrieved (39.85% vs 34.68%; P < 0.05), biochemical pregnancy rate (71.72% vs 56.67%; P < 0.05), clinical pregnancy rate (64.65% vs 51.65%; P < 0.05), and implantation rate (46.46% vs 31.35%; P < 0.05) in the study group were significant higher than those in the control group.This study shows that the Utrogestan and hMG protocol was feasible to improve the oocyte quality, possibly providing a new choice for PCOS patients undergoing IVF/ICSI treatments in combination with embryo cryopreservation.

  • utrogestan as an effective oral alternative for preventing premature luteinizing hormone surges in women undergoing Controlled Ovarian Hyperstimulation for in vitro fertilization
    Medicine, 2015
    Co-Authors: Xiuxian Zhu, Xiaole Zhang
    Abstract:

    A major cause of cycle cancellation during Controlled Ovarian Hyperstimulation (COH) in women undergoing in vitro fertilization (IVF) is the occurrence of premature luteinizing hormone (LH) surges. Steroidal preparations can modulate the secretion of gonadotropins (Gn); however, few studies using progesterone to inhibit the premature LH surges in COH have been published. The purpose of the study was to evaluate the oral delivery of progesterone soft capsules (Utrogestan) to prevent LH surges from the follicular phase and to compare cycle characteristics as well as to evaluate pregnancy outcomes in subsequent frozen-thawed embryo transfer (FET) cycles. A total of 374 patients were enrolled in this retrospective study, among which 187 patients were simultaneously administered Utrogestan and human menopausal gonadotrophin (hMG) from cycle day 3 until the trigger day. A short protocol including 187 controls with comparable age, body mass index (BMI), infertility duration, and antral follicle count was also used. GnRH agonist (0.1 mg) or hCG (3000 IU) was used for a trigger when the dominant follicles matured. Viable embryos were cryopreserved for later transfer in both groups. The primary outcome was the number of oocytes retrieved. The secondary outcomes included the number of mature oocytes, incidence of premature LH surge, and clinical pregnancy outcomes from FET cycles. Consistent LH suppression was achieved during COH, with a range of 0.07 to 8.9 IU/L, and no premature LH surge was detected. The number of oocytes retrieved in the Utrogestan and hMG protocol was comparable with that in the short protocol (10.92 ± 5.74 vs 10.6 ± 6.22, P > 0.05), and the dose of hMG was higher than that used in the short protocol (1884.22 ± 439.47 IU vs 1446.26 ± 550.48 IU, P < 0.05). No significant between-group difference was observed in the mature oocyte rate (88.88% vs 90.12%), cleavage rate (96.58% vs 96.58%), clinical pregnancy rate (54.27% vs 51.65%), or implantation rate (33.59% vs 34.02%). The study shows that Utrogestan is an effective oral alternative for preventing premature LH surges in women undergoing COH, which will help to establish a convenient user regimen in combination with FET.

Jacob Ashkenazi - One of the best experts on this subject based on the ideXlab platform.

Frank J M Broekmans - One of the best experts on this subject based on the ideXlab platform.

  • prevention of multiple pregnancies in couples with unexplained or mild male subfertility randomised Controlled trial of in vitro fertilisation with single embryo transfer or in vitro fertilisation in modified natural cycle compared with intrauterine
    BMJ, 2015
    Co-Authors: A J Bensdorp, Annemieke Hoek, Frank J M Broekmans, R I Tjonkonfat, Patrick M M Bossuyt, C A M Koks, G J E Oosterhuis, H R Verhoeve, J P De Bruin
    Abstract:

    Objectives To compare the effectiveness of in vitro fertilisation with single embryo transfer or in vitro fertilisation in a modified natural cycle with that of intrauterine insemination with Controlled Ovarian Hyperstimulation in terms of a healthy child. Design Multicentre, open label, three arm, parallel group, randomised

  • the role of anti mullerian hormone assessment in assisted reproductive technology outcome
    Current Opinion in Obstetrics & Gynecology, 2010
    Co-Authors: Simone L Broer, Ben Willem J Mol, Madeleine Dolleman, Bart C J M Fauser, Frank J M Broekmans
    Abstract:

    Purpose of reviewThe purpose of this study is to summarize the role of anti-Mullerian hormone (AMH) in assisted reproductive technology (ART) treatment.Recent findingsAMH is a good marker in the prediction of Ovarian response to Controlled Ovarian Hyperstimulation. In clinical practice, this means t

  • the role of anti mullerian hormone assessment in assisted reproductive technology outcome
    Current Opinion in Obstetrics & Gynecology, 2010
    Co-Authors: Simone L Broer, Madeleine Dolleman, Bart C J M Fauser, Frank J M Broekmans
    Abstract:

    PURPOSE OF REVIEW: The purpose of this study is to summarize the role of anti-Mullerian hormone (AMH) in assisted reproductive technology (ART) treatment. RECENT FINDINGS: AMH is a good marker in the prediction of Ovarian response to Controlled Ovarian Hyperstimulation. In clinical practice, this means that AMH may be used for identifying poor or excessive responders. So far, studies show that AMH is not a good predictor for the occurrence of pregnancy after ART treatment. Therefore, routine screening for a poor Ovarian reserve status using AMH is not to be advocated. Still, Ovarian response prediction using AMH may open ways for patient-tailored stimulation protocols in order to reduce cancellations for excessive response, possibly improve pregnancy prospects and reduce costs. SUMMARY: AMH is able to predict extremes in Ovarian response to Controlled Ovarian Hyperstimulation but cannot predict pregnancy after ART treatment. Its future clinical role may be in the individualization of ART stimulation protocols

  • intrauterine insemination with Controlled Ovarian Hyperstimulation versus expectant management for couples with unexplained subfertility and an intermediate prognosis a randomised clinical trial
    The Lancet, 2006
    Co-Authors: Frank J M Broekmans, Pieternel Steures, Marinus J C Eijkemans, Dik J F Habbema, Peter G A Hompes, H R Verhoeve, Jan Willem Van Der Steeg, Patrick M M Bossuyt
    Abstract:

    Summary Background Intrauterine insemination with Controlled Ovarian Hyperstimulation is commonly used as first-line treatment for couples with unexplained subfertility. Since such treatment increases the risk of multiple pregnancy, a couple's chances of achieving an ongoing pregnancy without it should be considered to identify those most likely to benefit from treatment. We aimed to assess the incremental effectiveness of intrauterine insemination with Controlled Ovarian Hyperstimulation compared with expectant management in couples with unexplained subfertility and an intermediate prognosis of a spontaneous ongoing pregnancy. Methods 253 couples with unexplained subfertility and a 30–40% probability of a spontaneous ongoing pregnancy within 12 months were randomly assigned either intrauterine insemination with Controlled Ovarian Hyperstimulation for 6 months or expectant management for 6 months. The primary endpoint of this hospital-based study was ongoing pregnancy within 6 months. Analysis was by intention to treat. This trial is registered with the Dutch Trial Register and as an International Standard Randomised Clinical Trial, number ISRCTN72675518. Findings Of the 253 couples enrolled, 127 were assigned intrauterine insemination with Controlled Ovarian Hyperstimulation and 126 expectant management. In the intervention group, 42 (33%) women conceived and 29 (23%) pregnancies were ongoing. In the expectant management group, 40 (32%) women conceived and 34 (27%) pregnancies were ongoing (relative risk 0·85, 95% CI 0·63–1·1). There was one twin pregnancy in each study group, and one woman in the intervention group conceived triplets. Interpretation A large beneficial effect of intrauterine insemination with Controlled Ovarian Hyperstimulation in couples with unexplained subfertility and an intermediate prognosis can be excluded. Expectant management for 6 months is therefore justified in these couples.

Renato Fanchin - One of the best experts on this subject based on the ideXlab platform.

  • dynamics of serum anti mullerian hormone levels during the luteal phase of Controlled Ovarian Hyperstimulation
    Human Reproduction, 2005
    Co-Authors: Renato Fanchin, Daniel Mendez H Lozano, Nabil Louafi, Nelly Achourfrydman, Rene Frydman, Joelle Taieb
    Abstract:

    BACKGROUND: To investigate the dynamics of serum anti-Mullerian hormone (AMH) levels during the luteal phase of Controlled Ovarian Hyperstimulation (COH) and its possible association with follicle development. METHODS: We prospectively studied 34 women undergoing COH with GnRH agonist and FSH. On the day of hCG (dhCG), serum AMH, estradiol (E2), progesterone and hCG levels were measured, and Ovarian follicles were sorted into three size classes: <12, 12 -15 and 16- 22 mm. Hormonal measurements were repeated 4 days (hCG 1 4) and 7 days (hCG 1 7) after hCG. RESULTS: From dhCG to hCG 1 4, we observed a decline in serum AMH levels (264 6 3%; P< 0.0001), which paralleled that of E2 levels. From hCG 1 4 to hCG 1 7, an increase in AMH levels occurred (82 6 28%; P< 0.02), whose magnitude was correlated with the number of < 12 mm fol- licles (r 5 0.68; P< 0.0001) but not with other follicle size classes nor with the remaining hormone levels. CON- CLUSIONS: After hCG, AMH levels initially decline, presumably as an effect of follicle luteinization, then increase during the mid-luteal phase. Although the mechanisms implicated in the mid-luteal AMH increase are unclear, its positive association with small follicle count, but not with luteal progesterone and E2 levels, supports the hypothesis that AMH levels might reflect luteal follicle development.

  • premenstrual administration of gonadotropin releasing hormone antagonist coordinates early antral follicle sizes and sets up the basis for an innovative concept of Controlled Ovarian Hyperstimulation
    Fertility and Sterility, 2004
    Co-Authors: Renato Fanchin, Altina Castelo Branco, Isaac Jacques Kadoch, Ghada Hosny, Mira Bagirova, Rene Frydman
    Abstract:

    Abstract Objective To investigate whether premenstrual administration of a GnRH antagonist coordinates early antral follicle sizes during the subsequent follicular phase. Design Prospective, longitudinal study. Setting University Hospital in France Patient(s) Twenty-five women, 50 cycles. Intervention(s) On cycle day 2 (control/day 2), women underwent measurements of early antral follicles by ultrasound and serum FSH and Ovarian hormones. On day 25, they received a single cetrorelix acetate administration, 3 mg. On the subsequent day 2 (premenstrual GnRH antagonist/day 2), participants were re-evaluated as on control/day 2. Main outcome measure(s) Magnitude of follicular size discrepancies. Result(s) Follicular diameters (4.1 ± 0.9 vs. 5.5 ± 1.0 mm) and follicle-to-follicle size differences decreased on premenstrual GnRH antagonist/day 2 as compared with control/day 2. Consistently, FSH (4.5 ± 1.9 vs. 6.7 ± 2.4 mIU/mL), E 2 (23 ± 13 vs. 46 ± 26 pg/mL), and inhibin B (52 ± 30 vs. 76 ± 33 pg/mL) were lower on GnRH antagonist/day 2 than on control/day 2. Conclusion(s) Premenstrual GnRH antagonist administration reduces diameters and size disparities of early antral follicles on day 2, likely through the prevention of luteal FSH elevation and early follicular development. This simple, original approach may be used to coordinate multifollicular development in Controlled Ovarian Hyperstimulation.

Siladitya Bhattacharya - One of the best experts on this subject based on the ideXlab platform.

  • Recombinant follitropin alfa/lutropin alfa in fertility treatment
    Biologics: Targets & Therapy, 2010
    Co-Authors: Ahmed Gibreel, Siladitya Bhattacharya
    Abstract:

    Recombinant human follicle stimulating hormone (rFSH) and luteinizing hormone (LH), also known as follitropin alpha and lutropin alpha, are manufactured by genetic engineering techniques which ensure high quality and batch to batch consistency. Follitropin alpha can be used for Controlled Ovarian Hyperstimulation in assisted reproduction, ovulation induction for WHO group I and II anovulatory infertility and in men with hypogonadotrophic hypogonadism (HH) or idiopathic oligo-asthenospermia. Current evidence suggests superiority of urinary human menopausal gonadotropin (HMG) over follitropin alpha in Controlled Ovarian Hyperstimulation for IVF in terms of live birth rate per couple. Addition of lutropin to follitropin alpha in an unselected IVF population does not appear to confer any benefit; however, it may have a role in ovulation induction in women with hypothalamic hypogonadism. Urinary HMG preparations (especially currently available highly purified preparations) are more cost effective than rFSH in terms of cost per ongoing pregnancy. However, women using rFSH injection pen devices have higher levels of satisfaction as compared to those using urinary HMG by means of conventional syringes.

  • recombinant follitropin alfa lutropin alfa in fertility treatment
    Biologics: Targets & Therapy, 2009
    Co-Authors: Ahmed Gibreel, Siladitya Bhattacharya
    Abstract:

    Recombinant human follicle stimulating hormone (rFSH) and luteinizing hormone (LH), also known as follitropin alpha and lutropin alpha, are manufactured by genetic engineering techniques which ensure high quality and batch to batch consistency. Follitropin alpha can be used for Controlled Ovarian Hyperstimulation in assisted reproduction, ovulation induction for WHO group I and II anovulatory infertility and in men with hypogonadotrophic hypogonadism (HH) or idiopathic oligo-asthenospermia. Current evidence suggests superiority of urinary human menopausal gonadotropin (HMG) over follitropin alpha in Controlled Ovarian Hyperstimulation for IVF in terms of live birth rate per couple. Addition of lutropin to follitropin alpha in an unselected IVF population does not appear to confer any benefit; however, it may have a role in ovulation induction in women with hypothalamic hypogonadism. Urinary HMG preparations (especially currently available highly purified preparations) are more cost effective than rFSH in terms of cost per ongoing pregnancy. However, women using rFSH injection pen devices have higher levels of satisfaction as compared to those using urinary HMG by means of conventional syringes.