Mauvaises répondeuses : peut-on améliorer nos résultats ?

Percier, M. Duport; Anahory, T.; Ranisavljevic, Noémie; Bringer-Deutsch, S.

doi:10.1016/j.gofs.2016.12.023

Cited by 6 publications

(3 citation statements)

References 71 publications

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“…Preimplantation genetic testing for aneuploidies (PGT-A) are also beneficial for advanced women to select an euploid embryo to transfer (21). An optimal ovarian stimulation regimen to improve the quality of oocytes (22, 23) could be an alternative option. Supplements such as dehydroepiandrosterone were tried to improve follicle development (24), though there is insufficient evidence to support their use in these patients.…”

Section: Discussionmentioning

confidence: 99%

Cumulative Live Birth Rates of Good and Low Prognosis Patients According to POSEIDON Criteria: A Single Center Analysis of 18,455 Treatment Cycles

et al. 2019

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Objective: To investigate the characteristics and outcomes of low prognosis patients defined by POSEIDON criteria undergoing IVF treatment. Design: Retrospective cohort analysis. Setting: An IVF clinic in a public hospital. Patients: 18,455 fresh aspirated IVF cycles with subsequently frozen embryo transfer from Jan 2014 to Jan 2017 in a single IVF clinic were included in the analysis. The low prognosis patients were categorized into 4 groups based on POSEIDON criteria: group 1: age < 35, antral follicle count (AFC) ≥ 5, number of oocytes retrieved ≤ 9 in the previous cycle; group 2: age ≥ 35, AFC≥5, number of oocytes retrieved ≤ 9 in the previous cycle; group 3: age < 35, AFC < 5; group 4: age ≥ 35, AFC < 5. The non-low prognosis patients: group 5: AFC ≥ 5, previous number of oocytes retrieved > 9 oocytes; group 6: AFC ≥ 5, no previous ovarian stimulation. Intervention(s): None. Main Outcome Measure: The primary outcome was cumulative live birth rate (CLBR). Result(s): Taking group 1 as reference, the CLBR from young women in group 3 (35.5%, OR 0.9, 95% CI 0.7–1.2) was slightly lower than that in group 1 (44.6%, p = 0.615). The CLBR in group 2 (24.5%, OR 0.6, 95% CI 0.4–0.8, p = 0.004) and group 4 (12.7%, OR 0.4, 95% CI 0.3–0.6, p < 0.001) was significant lower than that in group 1. In non-poor prognosis patients, the CLBR from young women in group 5 (53.5% OR 1.3 95% CI 0.9, 1.7, p = 0.111) was a slight higher than the reference group 1 while the highest CLBR was originated from the first IVF patients with good ovarian reserve in group 6 (66.9%, OR 2.0, 95% CI 1.6, 2.4). Conclusion(s): The CLBRs and implantation rates in the young women (group 3) with diminished ovarian reserve was similar in those young women (group 1), and was significantly higher than in advanced age women with a fair ovarian reserve (group 2). Though patients in group 2 had better ovarian reserve, more oocytes and more embryos, the pregnancy outcome was inferior to that of group 3 patients with poorer ovarian reserve, fewer oocytes and fewer embryos.

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Section: Discussionmentioning

confidence: 99%

Cumulative Live Birth Rates of Good and Low Prognosis Patients According to POSEIDON Criteria: A Single Center Analysis of 18,455 Treatment Cycles

et al. 2019

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“…The pathophysiology of preeclampsia associates a defect in trophoblastic invasion, placental hypoxia, oxidative stress as well as dysfunction of the maternal endothelium linked to various substances released by the placenta in the maternal circulation [15]. It is possible to hypothesise that these condition simply suggest the involvement of multiple risk factors in this process including the quality of the embryo which is strongly correlated with patient's age [16] [17].…”

Section: Discussionmentioning

confidence: 99%

The Impact of Extreme Maternal Ages on Hypertensive Disorders of Pregnancy: A Retrospective Cohort Study in Dakar, Senegal

Ndiaye¹,

Gueye²,

Diallo³

et al. 2020

OJOG

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Background: Hypertensive disorders of pregnancy are a frequent situation and involve about 8%-10% of pregnancies. Extremes maternal ages have been associated to hypertensive disorders of pregnancy. In Africa, even if motherhood in teens is common, pregnancy at advanced age is getting more and more frequent. Objectives: To investigate the relation between maternal age and hypertensive disorders of pregnancy. Methods: A retrospective cohort study over 8 years was conducted in a suburb setting in Dakar, Senegal. The participants were divided into two groups based on the occurrence of hypertensive disorders of pregnancy (HDP). Data were extracted from E-Perinatal, our electronic medical recording system and analyzed using SPSS 20.0 and R Studio software version 1.1.383.51. Maternal and perinatal outcomes were assessed over 3 age groups: <19 years, >34 years and 19-34 years old. Results: The study included 2226 cases of HDP out of 36,499 deliveries leading to an incidence of 6.1%. The proportions of nulliparous, multiple pregnancies and maternal diabetes were higher in women with HDP. The risk of high blood pressure among mothers aged 35 years and over was 1.6 times as high as the risk among those aged 19-34 years at a significant level before and after adjusting for third factors i.e. parity, multiple pregnancy and diabetes. However, adolescents were found to have the same risk compared to their counterparts aged 19-34 years. Risk of eclampsia was 4 times greater among adolescent girls. Conclusion: Advanced maternal age greater than or equal to 35 years is a risk factor for high blood pressure. There is no extra risk in adolescent girls with regard to high blood pressure; however, risk of eclampsia was higher in this group.

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“…Patients identified as “poor responders” are an increasing population representing 10 to 24% of women involved in ART ( 4 ). The optimal treatment suited for poor responders is not clearly established yet ( 5 , 6 ). Gonadotropin releasing hormone (GnRH) antagonists and GnRH agonists (GnRH-a) are equally recommended for predicted poor responders ( 7 ), according to ESHRE recommendations (Ovarian stimulation for IVF/ICSI, Guideline of the ESHRE, 2019).…”

Section: Introductionmentioning

confidence: 99%

“Short agonist stop” protocol, an ovarian stimulation for poor responders in in vitro fertilization (IVF): A pilot study

et al. 2022

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IntroductionPoor responder patients remain a challenge in assisted reproductive technologies. The “short agonist stop” (SAS) stimulation protocol uses a double stimulation (flare up effect with the gonadotropin-releasing hormone (GnRH) agonist (GnRH-a) then gonadotropins) associated with a less strenuous blockage (discontinuation of GnRH-a) to favor follicular recruitment in order to obtain a better ovarian response. This study aims to compare the number of oocytes obtained after a SAS stimulation protocol with those obtained after the previous stimulation protocol, in the same women, with poor ovarian response (POR) diagnosed according to the POSEIDON criteria.DesignThis therapeutic observational retrospective cohort from 2018 to 2022, with a case-control evaluation compared with the same patients’ previous performance, included women with POR undergoing IVF with SAS stimulation protocol. The primary outcome was the number of total oocytes recovered and secondary outcomes were the numbers of mature oocytes, total embryos observed at day 2 and usable cleaved embryos and blastocysts (day 5/6).Results63 patients with SAS and previous cycles were included. In the SAS group, the mean number of oocytes was significantly higher: 7.3 vs 5.7, p=0.018 in comparison with the previous attempt. So was the number of mature oocytes (5.8 vs 4.1, p=0.032) and the total mean number of embryos obtained at day 2 (4.1 versus 2.7, p=0.016). The SAS stimulation generated 84 usable embryos: 57 cleaved embryos and 27 blastocysts. The mean number of usable embryos was similar in both groups (1.64 vs 1.31, respectively, p=0.178). In total, out of 63 patients, after the SAS protocol, and subsequent embryo transfers (fresh and frozen, n=54), 9 patients had ongoing pregnancies and no miscarriage occurred. The cumulative ongoing pregnancy rate (cOPR) after the SAS protocol was 14.3% (9/63) per oocyte pick-up and 16.7% (9/54) per transfer.ConclusionSAS stimulation is a short and original protocol strengthening the therapeutic arsenal of poor responders, that may offer promising results for those patients with low prognosis and previous failed IVF. Results must be confirmed with a randomized controlled trial.

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Mauvaises répondeuses : peut-on améliorer nos résultats ?

Cited by 6 publications

References 71 publications

Cumulative Live Birth Rates of Good and Low Prognosis Patients According to POSEIDON Criteria: A Single Center Analysis of 18,455 Treatment Cycles

Cumulative Live Birth Rates of Good and Low Prognosis Patients According to POSEIDON Criteria: A Single Center Analysis of 18,455 Treatment Cycles

The Impact of Extreme Maternal Ages on Hypertensive Disorders of Pregnancy: A Retrospective Cohort Study in Dakar, Senegal

“Short agonist stop” protocol, an ovarian stimulation for poor responders in in vitro fertilization (IVF): A pilot study

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