Clinical adjuncts in in vitro fertilization: a growing list

Kamath, Mohan S; Mascarenhas, Mariano; Franik, Sebastian; Liu, Emily; Sunkara, Sesh Kamal

doi:10.1016/j.fertnstert.2019.09.019

Cited by 45 publications

(36 citation statements)

References 64 publications

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“…Several studies have since been published with inconsistent results [15][16][17][18][19]. Because of the inconsistencies in study ndings, both ASRM and ESHRE have failed to support the universal use of GH in the ovarian stimulation protocol of poor responder patients [20,21]. The purpose of this study is to evaluate the role of GH as an adjuvant treatment in women with a history of a poor IVF outcome.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Growth Hormone on In Vitro Fertilization Outcomes During Ovarian Stimulation: A Matched Cohort Study

Kurtz¹,

Clements²,

Bloom³

et al. 2021

Preprint

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Background. While growth hormone (GH) is commonly used as an adjuvant treatment to controlled ovarian stimulation (COS) for in vitro fertilization (IVF) cycles, the data regarding its efficacy is inconsistent. Design. A retrospective matched cohort study of poor responder patients who underwent COS without the use of GH (COS-GH) subsequently followed by COS cycles that included adjuvant GH (COS+GH) treatment. Materials and Methods. A list of all patients having filled a prescription for GH from January 2018 – March 2020 was obtained. GH was administered daily at 3mg (9IU) starting on the first day of stimulation and ending on the day of trigger. Only women who had documentation of a previous cycle without the use of GH were included in the study. Results. 182 cycles (91 patients) were included in the study, and COS-GH cycles were compared to COS+GH cycles. The total dose of gonadotropins used (5757 vs 4252 mIU, p=0.002), duration of stimulation (10.4 vs 10.1 days, p=-.045), maximum Estradiol (E2) (2411 vs 1932 pg/ml, p=0.010), endometrial thickness (11.2 vs 10.6 mm, p=0.010), number of oocytes retrieved (14.2 vs 11.8, p=0.001), number of mature oocytes (11.1 vs 9.7, p=0.028), number of blastocysts (3.98 vs 2.56, p=<0.001) and number of usable blastocysts (2.5 vs 1.6, p=<0.001) were all significantly greater in the GH group. Conclusions. Adding GH to the COS protocol in poor responder patients may lead to improvements in the number of oocytes retrieved, number of mature oocytes, endometrial thickness, number of blastocysts, the number of usable blastocysts.

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Section: Introductionmentioning

confidence: 99%

The Effect of Growth Hormone on In Vitro Fertilization Outcomes During Ovarian Stimulation: A Matched Cohort Study

Kurtz¹,

Clements²,

Bloom³

et al. 2021

Preprint

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“…[ 2 ] However, in spite of various advances in the clinical and laboratory techniques and the introduction of several adjuncts aimed at improving ART outcomes, the live birth rate (LBR) remains at 22%–25%. [ 2 3 4 ] The success of the ART program is considered multifactorial and is determined by clinical characteristics, controlled ovarian hyperstimulation protocols, in vitro gamete handling, culture conditions, and environmental factors. [ 5 6 ]…”

Section: Introductionmentioning

confidence: 99%

Seasonal Influence on Assisted Reproductive Technology Outcomes

Singh

Joseph

Karuppusami

et al. 2021

Journal of Human Reproductive Sciences

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Background: It is well known that seasonal variations influence natural conception and birth rates variably in different populations. It has been hypothesised that similar seasonal influences may affect treatment outcomes following assisted reproductive technology (ART). However, most studies report conflicting results. Aim: The aim of the study is to elucidate whether seasonality had any impact on the treatment success of the ART program. Study Setting and Design: We conducted a retrospective cohort study at a university-level tertiary care hospital in South India. Materials and Methods: All couples who underwent ART between January 2012 and December 2016 were included in the study. We divided the study population into three groups based on the seasonal differences experienced in our region. The primary outcome was live birth rate (LBR). Statistical Analysis: Univariate and multiple logistic regression models were used to compare outcomes and results reported as odds ratio (OR) and 95% confidence interval (CI). Results: Univariate analysis revealed no significant difference in LBR in monsoon season (174/651, 26.7% vs. 83/319, 26.0%; OR 1.04, 95% CI 0.77,1.41; P = 0.81) as compared to summer. However, LBR was significantly higher in winter season (114/341, 33.4% vs. 83/319, 26.0%; OR 1.43; 95% CI: 1.02, 2.00; P = 0.04). Further, multivariate analysis following adjustment for various confounding factors revealed no significant statistical difference in LBR in monsoon (adjusted odds ratio [aOR], 0.92; 95% CI: 0.66, 1.26; P = 0.59) or winter (aOR 1.32; 95% CI: 0.92, 1.88; P = 0.13) as compared to summer season. Conclusion: The current study found no significant effect of seasonal variation on LBR following ART.

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“…Over the years, despite advances in ovarian stimulation protocols, in vitro laboratory techniques and cryopreservation methods, the live birth rate (LBR) per cycle following ART remains between 22% and 25% ( De Geyter et al , 2020 ). Many clinical adjuncts have been introduced in ART practice in order to improve the treatment outcomes despite a lack of conclusive evidence ( Kamath et al , 2019 ). Empirical use of antioxidants for treating male factor subfertility or its use as an adjunct prior to ART is common in contemporary practice ( Eskenazi et al , 2005 ; Agarwal and Majzoub, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

“…Earlier studies have used multiple semen parameters as surrogate markers to indicate the effectiveness of antioxidants, such as improvement in sperm motility ( Omu et al , 2008 ; Balercia et al , 2009 ) or DNA fragmentation index ( Greco et al , 2005 ). Owing to the perceived benefits, antioxidant use prior to ART for male factor subfertility has been promoted in order to improve LBR ( Sigman et al , 2006 ; Tremellen et al , 2007 ; Kamath et al , 2019 ). The results of studies evaluating the effectiveness of antioxidant pretreatment prior to ART are conflicting ( Kessopoulou et al , 1995 ; Sigman et al., 2006 ; Tremellen et al , 2007 ).…”

Section: Introductionmentioning

confidence: 99%

Antioxidant pretreatment for male partner before ART for male factor subfertility: a randomized controlled trial

Joseph

Mascarenhas

Karuppusami

et al. 2020

Human Reproduction Open

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STUDY QUESTION Does oral antioxidant pretreatment for the male partner improve clinical pregnancy rate in couples undergoing ART for male factor subfertility? SUMMARY ANSWER There was no significant difference in clinical pregnancy rate following oral antioxidant pretreatment for male partner in couples undergoing ART for male factor subfertility compared to no pretreatment. WHAT IS KNOWN ALREADY Damage to sperm mediated by reactive oxygen species (ROS) contributes significantly to male factor infertility. The ROS-related injury reduces fertilization potential and adversely affects the sperm DNA integrity. Antioxidants act as free radical scavengers to protect spermatozoa against ROS induced damage. During ART, use of sperms which have been exposed to ROS-mediated damage may affect the treatment outcome. Pretreatment with antioxidants may reduce the ROS-mediated sperm DNA damage. Currently, antioxidants are commonly prescribed to men who require ART for male factor subfertility but there is ambiguity regarding their role. STUDY DESIGN, SIZE, DURATION This was an open label, randomized controlled trial conducted at a tertiary level infertility clinic between February 2013 and October 2019. The trial included 200 subfertile couples who were undergoing ART treatment for male factor subfertility. PARTICIPANTS/MATERIALS, SETTING, METHODS Couples were randomized into treatment arm (n = 100) and control arm (n = 100). In the treatment arm, the male partner received oral antioxidants (Vitamin C, Vitamin E and Zinc) for 3 months just prior to the ART cycle. In the control arm, no antioxidant was given to the male partner. The primary outcome was clinical pregnancy rate, while live birth rate (LBR), miscarriage rate and changes in semen parameters were the secondary outcomes. MAIN RESULTS AND THE ROLE OF CHANCE Out of 200 women randomized, 135 underwent embryo transfer as per protocol. Following intention to treat analysis, no significant difference was noted in clinical pregnancy (36/100, 36% vs 26/100, 26%; odds ratio (OR) 1.60, 95% CI 0.87 to 2.93) and LBR (25/100, 25% vs 22/100, 22%; OR 1.18, 95% CI 0.61 to 2.27) between antioxidant and no pretreatment arms. The clinical pregnancy rate per embryo transfer was significantly higher following antioxidant pretreatment (35/64, 54.7% vs 26/71, 36.6%; OR 2.09, 95% CI 1.05 to 4.16) compared to no pretreatment. There was no significant difference in LBR per embryo transfer (25/64, 39.1%, vs 22/71, 31.0%; OR 1.43, 95% CI 0.70 to 2.91) after antioxidant pretreatment versus no pretreatment. The semen parameters of sperm concentration (median, interquartile range, IQR) (18.2, 8.6 to 37.5 vs 20.5, 8.0 to 52.5, million/ml; P = 0.97), motility (median, IQR) (34, 20 to 45 vs 31, 18 to 45%; P = 0.38) and morphology (mean ± SD) (2....

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Clinical adjuncts in in vitro fertilization: a growing list

Cited by 45 publications

References 64 publications

The Effect of Growth Hormone on In Vitro Fertilization Outcomes During Ovarian Stimulation: A Matched Cohort Study

The Effect of Growth Hormone on In Vitro Fertilization Outcomes During Ovarian Stimulation: A Matched Cohort Study

Seasonal Influence on Assisted Reproductive Technology Outcomes

Antioxidant pretreatment for male partner before ART for male factor subfertility: a randomized controlled trial

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