1,721,040 research outputs found
Reproductive biology and IVF: ovarian stimulation and endometrial receptivity
No full textThe influence of ovarian stimulation on endometrium receptivity has been inadequately addressed in medical literature. Hormonal effects of ovarian stimulation on endometrial changes as compared with the natural cycle should be elucidated and correlated with the potential of the embryo to implant. It is important to distinguish between the endometrial effect of induction of ovulation in anovulatory women and those of ovarian (super)ovulation in ovulatory women. Induction of ovulation leads to in vivo conception whereas ovarian stimulation results in in vitro fertilization. The available data in the field indicate that endometrial changes have an impressive negative influence on the potential of embryonic implantation. The aim of this review is to analyse the effects of gonadotropin, GnRH-agonist and GnRH-antagonist administration on endometrial behaviour, to highlight the gaps in current knowledge and to propose areas in which research is needed
The science behind 25 years of ovarian stimulation for in vitro fertilization
No full textTo allow selection of embryos for transfer after in vitro fertilization, ovarian stimulation is usually carried out with exogenous gonadotropins. To compensate for changes induced by stimulation, GnRH analog cotreatment, oral contraceptive pretreatment, late follicular phase human chorionic gonadotropin, and luteal phase progesterone supplementation are usually added. These approaches render ovarian stimulation complex and costly. The stimulation of multiple follicular development disrupts the physiology of follicular development, with consequences for the oocyte, embryo, and endometrium. In recent years, recombinant gonadotropin preparations have become available, and novel stimulation protocols with less detrimental effects have been developed. In this article, the scientific background to current approaches to ovarian stimulation for in vitro fertilization is reviewed. After a brief discussion of the relevant aspect of ovarian physiology, the development, application, and consequences of ovarian stimulation strategies are reviewed in detail
Pregnancy complications in women with polycystic ovary syndrome
No full textBackground: The great majority of studies performed so far concerning women diagnosed with polycystic ovary syndrome (PCOS) have focused on diagnosis, menstrual cycle abnormalities, hirsutism and infertility. Although progress has been made in developing methods for achieving a pregnancy and reducing multiple gestations in women with PCOS, little attention has been paid to pregnancy complications and subsequent child outcomes. This review aims to summarize current knowledge regarding the clinical and pathophysiological features of pregnancy and children in women with PCOS. Methods: A literature search up to April 2015 was performed in PubMed, Medline, the Cochrane Library andWeb of Science without language restriction. All articles were initially screened for title and abstract and full texts of eligible articles were subsequently selected. Systematic reviewswith meta-analysis were initially included for each specific subject. Recent randomised controlled trials (RCTs), which were not included in the systematic reviews, were also included. In addition to evidence from meta-analyses or RCTs, we used non-randomized prospective, uncontrolled prospective, retrospective andexperimental studies.Whenspecific data for patientswithPCOSwere lacking, results fromgeneral populationstudieswere reported. Results: Women withPCOSexhibit a clinically significant increased risk of pregnancycomplicationscompared with controls.Data whichwere not adjusted for BMI or otherconfounders demonstrated inPCOSa 3-4-fold increased risk of pregnancy-induced hypertension and pre-eclampsia, a 3-fold increased risk of gestational diabetes and 2-fold higher chance for premature delivery. Features characteristic of PCOS, such as hyperandrogenism, obesity, insulin resistance and metabolic abnormalities, may contribute to the increased risk of obstetric and neonatal complications. Limited available data suggest that offspring ofwomen with PCOS have an increased risk for futuremetabolic and reproductive dysfunction. Underlying pathophysiological mechanisms of pregnancy complications along with its association with health of offspring remain uncertain. To date, the strategies for prevention and management of pregnancy complications in women with PCOS, and whether long-term health of these women is influenced, and to what extent, by pregnancy and/or pregnancy complications, remain to be elucidated. Conclusions: Women with PCOS show an increased risk of pregnancy complications. Heterogeneous aetiological factors involved in PCOS and associated co-morbidities may all be involved in compromised pregnancy and child outcomes. In women with PCOS, a possible relationship with genetic, environmental, clinical and biochemical factors involved in this complex condition, as well as with pregnancy complications and long-term health for both mother and child, remains to be established
The early luteal phase administration of estrogen and progesterone does not induce premature luteolysis in normo-ovulatory women
No full textObjective: The luteal phase after ovarian hyperstimulation for in vitro fertilization (IVF) is insufficient.Therefore, luteal phase supplementation is routinely applied in IVF. It may be postulated thatpremature luteolysis after ovarian hyperstimulation is due to supraphysiological steroid levels in theearly luteal phase. In the present study, high doses of steroids are administered after the LH surge innormo-ovulatory volunteers in order to investigate whether this intervention gives rise to endocrinechanges and a shortening of the luteal phase.Design: Randomized controlled trial.Methods: Forty non-smoking, normal weight women, between 18 and 37 years of age, with a regularmenstrual cycle (24–35 days), received either high dosages of estradiol (E2), progesterone (P), E2CPorno medication. Blood sampling was performed every other day from the day of the LH surge until LHC14. Duration of the luteal phase and endocrine profiles were the main study outcomes.Results: Early luteal phase steroid concentrations achieved by exogenous administration werecomparable with levels observed following ovarian hyperstimulation for IVF. No difference in the lutealphase length was observed comparing all groups. However, a significant decrease in LH levels could beobserved 6 days after the mid-cycle LH surge (P!0.001) in women receiving P, resulting in accelerateddecrease of inhibin A production by the corpus luteum (PZ0.001).Conclusion: The present intervention of high-dose steroid administration shortly after the LH surgefailed to induce a premature luteolysis regularly in cyclic women. It seems that the induced transientsuppression in LH allowed for a timely recovery of corpus luteum function. Other additional factorsmay be held responsible for the distinct reduction in luteal phase length observed after ovarianhyperstimulation for IVF
Reply: Polycystic ovary syndromeand pregnancy
No full textSir,
We thank Dr Galazis for his interest in our review (Palomba et al., 2015)
and for the issues raised about the increased risk of pregnancy complications
in women with polycystic ovary syndrome (PCOS). Our comprehensive
review demonstrated that women with PCOS have a 2-fold
increased risk of gestational diabetes mellitus (GDM) and a 3–4-fold
increased risk of pregnancy-induced hypertension (PIH) and preeclampsia
(PE) when compared with non-PCOS controls (Palomba
et al., 2015)
Harbin Consensus Conference Workshop Group; Conference Chairs: Improving the Reporting of Clinical Trials of Infertility Treatments (IMPRINT): modifying the CONSORT statement
No full textClinical trials testing infertility treatments often do not report on the major outcomes of interest to patients and clinicians and the public (such as live birth) nor on the harms, including maternal risks during pregnancy and fetal anomalies. This is complicated by the multiple participants in infertility trials which may include a woman (mother), a man (father), and result in a third individual if successful, their offspring (child), who is also the desired outcome of treatment. The primary outcome of interest and many adverse events occur after cessation of infertility treatment and during pregnancy and the puerperium, which create a unique burden of follow-up for clinical trial investigators and participants. In 2013, because of the inconsistencies in trial reporting and the unique aspects of infertility trials not adequately addressed by existing Consolidated Standards of Reporting Trials (CONSORT) statements, we convened a consensus conference in Harbin, China, with the aim of planning modifications to the CONSORT checklist to improve the quality of reporting of clinical trials testing infertility treatment. The consensus group recommended that the preferred primary outcome of all infertility trials is live birth (defined as any delivery of a live infant ?20 weeks gestations) or cumulative live birth, defined as the live birth per women over a defined time period (or number of treatment cycles). In addition, harms to all participants should be systematically collected and reported, including during the intervention, any resulting pregnancy, and during the neonatal period. Routine information should be collected and reported on both male and female participants in the trial. We propose to track the change in quality that these guidelines may produce in published trials testing infertility treatments. Our ultimate goal is to increase the transparency of benefits and risks of infertility treatments to provide better medical care to affected individuals and couples. ? The Author 2014. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: [email protected]
The case for mild stimulation for IVF: recommendations from The International Society for Mild Approaches in Assisted Reproduction.
Full text linkThe practice of ovarian stimulation for IVF is undergoing a fundamental re-evaluation as recent data begin to successfully challenge the traditional paradigm that ovarian stimulation should be aimed at the retrieval of as many oocytes as possible, in the belief that this will increase pregnancy rates. An opposing view is that live birth rate should not be the only end-point in evaluating the success of IVF treatment and that equal emphasis should be placed on safety and affordability. The International Society for Mild Approaches in Assisted Reproduction (ISMAAR) committee has carried out an up-to-date literature search, with the evidence being graded according to the University of Oxford's Centre for Evidence-Based Medicine. The recommendations were formulated taking into account the quality of evidence on the efficacy, risk and cost of each intervention. ISMAAR recommends adopting a mild approach to ovarian stimulation in all clinical settings as an increasing body of evidence suggests that mild stimulation is as effective as conventional stimulation, while being safer and less expensive. Mild ovarian stimulation could replace conventional stimulation, thus making IVF safer and more accessible worldwide
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