In vitro maturation in subfertile women with polycystic ovarian syndrome undergoing assisted reproduction

Siristatidis, Charalampos; Maheshwari, Abha; Vaidakis, Dennis; Bhattacharya, Siladitya

doi:10.1002/14651858.cd006606.pub4

Cited by 18 publications

(14 citation statements)

References 83 publications

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“…In the latest EIM data collection including 776 556 cycles, complications were reported in 1471 out of 918 159 (0.160%) cycles, including 983 bleedings, 117 infections, and 361 other complications ( The European IVF-monitoring Consortium for the European Society of Human Reproduction and Embryology et al , 2020 ). In a large observational study analyzing 23 827 OPUs from a single centre, the overall incidence of complications was 0.4% ( Levi-Setti et al , 2018 ), while a Cochrane meta-analysis reported an overall incidence of 0.72% of complications ( Siristatidis et al , 2018 ). Overall, the incidence of complications of OPU is small ( ESHRE Working Group on Ultrasound in ART et al , 2019 ).…”

Section: Resultsmentioning

confidence: 99%

The Maribor consensus: report of an expert meeting on the development of performance indicators for clinical practice in ART

Vlaisavljević¹,

Apter

Capalbo

et al. 2021

Human Reproduction Open

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STUDY QUESTION Is it possible to define a set of performance indicators (PIs) for clinical work in ART, which can create competency profiles for clinicians and for specific clinical process steps? SUMMARY ANSWER The current paper recommends six PIs to be used for monitoring clinical work in ovarian stimulation for ART, embryo transfer, and pregnancy achievement: cycle cancellation rate (before oocyte pick-up (OPU)) (%CCR), rate of cycles with moderate/severe ovarian hyperstimulation syndrome (OHSS) (%mosOHSS), the proportion of mature (MII) oocytes at ICSI (%MII), complication rate after OPU (%CoOPU), clinical pregnancy rate (%CPR), and multiple pregnancy rate (%MPR). WHAT IS KNOWN ALREADY PIs are objective measures for evaluating critical healthcare domains. In 2017, ART laboratory key PIs (KPIs) were defined. STUDY DESIGN, SIZE, DURATION A list of possible indicators was defined by a working group. The value and limitations of each indicator were confirmed through assessing published data and acceptability was evaluated through an online survey among members of ESHRE, mostly clinicians, of the special interest group Reproductive Endocrinology. PARTICIPANTS/MATERIALS, SETTING, METHODS The online survey was open for 5 weeks and 222 replies were received. Statements (indicators, indicator definitions, or general statements) were considered accepted when ≥70% of the responders agreed (agreed or strongly agreed). There was only one round to seek levels of agreement between the stakeholders. Indicators that were accepted by the survey responders were included in the final list of indicators. Statements reaching less than 70% were not included in the final list but were discussed in the paper. MAIN RESULTS AND THE ROLE OF CHANCE Cycle cancellation rate (before OPU) and the rate of cycles with moderate/severe OHSS, calculated on the number of started cycles, were defined as relevant PIs for monitoring ovarian stimulation. For monitoring ovarian response, trigger and OPU, the proportion of MII oocytes at ICSI and complication rate after OPU were listed as PIs: the latter PI was defined as the number of complications (any) that require an (additional) medical intervention or hospital admission (apart from OHSS) over the number of OPUs performed. Finally, clinical pregnancy rate and multiple pregnancy rate were considered relevant PIs for embryo transfer and pregnancy. The defined PIs should be calculated every 6 months or per 100 cycles, whichever comes first. Clinical pregnancy rate and multiple pregnancy rate should be monitored more frequently (every 3 months or per 50 cycles). Live birth rate (LBR) is a generally accepted and an important parameter for measuring ART success. However, LBR is affected by many factors, even apart from ART, and it cannot be adequately used to monitor clinical practice. In addition to monitoring performance in general, PIs are essential for managing the performance of staff over time, and more specifically the gap between expected performance and actual performance measured. Individual clinics should determine which indicators are key to the success in their organisation based on their patient population, protocols, and procedures, and as such, which are their KPIs. LIMITATIONS, REASONS FOR CAUTION The consensus values are based on data found in the literature and suggestions of experts. When calculated and compared to the competence/benchmark limits, prudent interpretation is necessary taking into account the specific clinical practice of each individual centre. WIDER IMPLICATIONS OF THE FINDINGS The defined PIs complement the earlier defined indicators for the ART laboratory. Together, both sets of indicators aim to enhance the overall quality of the ART practice and are an essential part of the total quality management. PIs are important for education and can be applied during clinical subspecialty. STUDY FUNDING/COMPETING INTEREST(S) This paper was developed and funded by ESHRE, covering expenses associated with meetings, literature searches, and dissemination. The writing group members did not receive payment. Dr G.G. reports personal fees from Merck, MSD, Ferring, Theramex, Finox, Gedeon-Richter, Abbott, Biosilu, ReprodWissen, Obseva, PregLem, and Guerbet, outside the submitted work. Dr A.D. reports personal fees from Cook, outside the submitted work; Dr S.A. reports starting a new employment in May 2020 at Vitrolife. Previously, she has been part of the Nordic Embryology Academic Team, with meetings were sponsored by Gedeon Richter. The other authors have no conflicts of interest to declare. DISCLAIMER This document represents the views of ESHRE, which are the result of consensus between the relevant ESHRE stakeholders and where relevant based on the scientific evidence available at the time of preparation. The recommendations should be used for informational and educational purposes. They should not be interpreted as setting a standard of care, or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. They do not replace the need for application of clinical judgment to each individual presentation, nor variations based on locality and facility type. Furthermore, ESHREs recommendations do not constitute or imply the endorsement, recommendation, or favouring of any of the included technologies by ESHRE.

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Section: Resultsmentioning

confidence: 99%

The Maribor consensus: report of an expert meeting on the development of performance indicators for clinical practice in ART

Vlaisavljević¹,

Apter

Capalbo

et al. 2021

Human Reproduction Open

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“…Regarding the comparison of antagonist vs agonist protocols: the first published review found no significant difference 104 , while the following reviews observed no significant differences in rates of clinical pregnancy and miscarriage, but reduced OHSS rates with antagonist 105 -107 , which is in agreement with the results from the present review. Regarding the comparison of IVM vs conventional IVF, the previously published reviews were inconclusive because no RCTs were identified 12,108 .…”

Section: Comparison With Other Systematic Reviewsmentioning

confidence: 99%

Strategies for improving outcome of assisted reproduction in women with polycystic ovary syndrome: systematic review and meta‐analysis

Kollmann

Martins

Lima

et al. 2016

Ultrasound in Obstet & Gyne

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“…IVM was initially introduced in clinical practice as a safer alternative for conventional ovarian stimulation to avoid ovarian hyperstimulation syndrome (OHSS) and ovarian torsion [12,13]. Thus, IVM constitutes a promising alternative to in vitro fertilization of in vivo-matured oocytes conventional in predicted or expected high responders, such as polycystic ovary syndrome (PCOS) patients [9,[13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

In Vitro Maturation of Oocytes Retrieved from Ovarian Tissue: Outcomes from Current Approaches and Future Perspectives

Roo

Tilleman

2021

JCM

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In vitro maturation (IVM) of transvaginally aspirated immature oocytes is an effective and safe assisted reproductive treatment for predicted or high responder patients. Currently, immature oocytes are also being collected from the contralateral ovary during laparoscopy/laparotomy and even ex vivo from the excised ovary or the spent media during ovarian tissue preparation prior to ovarian cortex cryopreservation. The first live births from in vitro-matured ovarian tissue oocytes (OTO-IVM) were reported after monophasic OTO-IVM, showing the ability to achieve mature OTO-IVM oocytes. However, fertilisations rates and further embryological developmental capacity appeared impaired. The introduction of a biphasic IVM, also called capacitation (CAPA)-IVM, has been a significant improvement of the oocytes maturation protocol. However, evidence on OTO-IVM is still scarce and validation of the first results is of utmost importance to confirm reproducibility, including the follow-up of OTO-IVM children. Differences between IVM and OTO-IVM should be well understood to provide realistic expectations to patients.

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In vitro maturation in subfertile women with polycystic ovarian syndrome undergoing assisted reproduction

Abstract: In vitro maturation in subfertile women with polycystic ovarian syndrome undergoing assisted reproduction.

Cited by 18 publications

References 83 publications

The Maribor consensus: report of an expert meeting on the development of performance indicators for clinical practice in ART

The Maribor consensus: report of an expert meeting on the development of performance indicators for clinical practice in ART

Strategies for improving outcome of assisted reproduction in women with polycystic ovary syndrome: systematic review and meta‐analysis

In Vitro Maturation of Oocytes Retrieved from Ovarian Tissue: Outcomes from Current Approaches and Future Perspectives

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