Mild ovarian stimulation for in vitro fertilization: one perspective from the USA

Baker, Valerie L.

doi:10.1007/s10815-013-9946-8

Cited by 14 publications

(7 citation statements)

References 32 publications

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“…Further studies are warranted including data not available in SART CORS to identify subpopulations who may be at most risk for LBW in autologous fresh transfers, such as women with pre-conception hypertension or women who had a prior delivery of an infant with LBW. We propose that until further analyses are performed, consideration should be given to either milder ovarian stimulation (43, 44), cryopreservation of all embryos with subsequent conception via frozen embryo transfer (45), or single embryo transfer, especially in cases where the risk of LBW based on other maternal factors is high.…”

Section: Discussionmentioning

confidence: 99%

Association of number of retrieved oocytes with live birth rate and birth weight: an analysis of 231,815 cycles of in vitro fertilization

Baker

Brown

Luke

et al. 2015

Fertility and Sterility

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Objective To determine if number of oocytes correlates with live birth rate and incidence of low birthweight (LBW). Design Retrospective cohort. Setting N/A. Patients Women undergoing fresh embryo transfer utilizing either autologous (n=194,627) or donor (n=37,188) oocytes whose cycles were reported to the Society for Assisted Reproductive Technology 2004–2010. Main outcome measures Live birth rate, birthweight, birth weight z-score, LBW. Interventions None. Results For both autologous and donor oocyte cycles, increasing number of oocytes retrieved paralleled live birth rate and embryos available for cryopreservation in most analyses performed with all models adjusted for age and prior births. For cycles achieving singleton pregnancy using autologous oocytes via transfer of 2 embryos, a higher number of oocytes retrieved was associated with lower mean birth weight, lower birthweight z-score, and greater incidence of LBW. In contrast, for cycles using donor oocytes, there was no association of oocyte number retrieved with measures of birthweight. Conclusions A higher number of oocytes retrieved was associated with an increased incidence of LBW in autologous singleton pregnancies resulting from transfer of 2 embryos but not in donor oocyte cycles. Although the effect of high oocyte number on the incidence of LBW in autologous cycles was of modest magnitude, further study is warranted to determine if a subgroup of women may be particularly vulnerable.

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Section: Discussionmentioning

confidence: 99%

Association of number of retrieved oocytes with live birth rate and birth weight: an analysis of 231,815 cycles of in vitro fertilization

Baker

Brown

Luke

et al. 2015

Fertility and Sterility

Self Cite

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“…Furthermore, there is evidence that superovulation may adversely affect embryo quality, possibly through interference with natural selection of the best quality oocytes or other repercussions of ovarian stimulation on oocyte, aneuploidy, or embryo quality (8, 12–15). Given the potential for adverse consequences of ovarian stimulation on the endometrium, oocyte, or embryo, there is increasing interest in mild ovarian stimulation for IVF with the goal of retrieving a limited number of oocytes (15, 16). …”

Section: Introductionmentioning

confidence: 99%

Gonadotropin dose is negatively correlated with live birth rate: analysis of more than 650,000 assisted reproductive technology cycles

Baker

Brown

Luke

et al. 2015

Fertility and Sterility

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135

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Objective To evaluate the correlation between total gonadotropin dose and live birth rate Design Retrospective analysis Setting Clinic-based data Patients 658,519 fresh autologous cycles of in vitro fertilization (IVF) reported to the Society for Assisted Reproductive Technology from 2004 to 2012 Interventions None Main outcome measures Logistic regression models were fitted to live birth rates using categorized values for total follicle stimulating hormone (FSH) dose and number of oocytes retrieved as the primary predictor variables. To reduce the effect of the most significant confounders which may lead physicians to prescribe higher doses of FSH, additional analyses were performed limited to good prognosis patients (<35 years of age, BMI<30, no diagnosis of diminished ovarian reserve, endometriosis, or ovulatory disorder) and including duration of gonadotropin treatment. Results Live birth rate significantly decreased with increasing FSH dose, regardless of the number of oocytes retrieved.. The statistically significant decrease in live birth rate with increasing FSH dose remained in patients with good prognosis, and regardless of female age, except for women aged ≥35 with 1–5 oocytes retrieved. Conclusion This analysis suggests that physicians may wish to avoid prescribing a high dose of FSH.. However, the results of this study do not justify the use of minimal stimulation or natural cycle IVF. Capsule Live birth rate decreased with increasing FSH dose, regardless of number of oocytes retrieved.

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“…At-home use of the MLPT could allow women to increase the frequency and the ease of accessing data regarding their potential pregnancy. Further research could establish a role for the MLPT as a supplement to clinic-based serum lab tests, potentially reducing costs and time burdens for both women and health care systems [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Results of a pilot study in the U.S. and Vietnam to assess the utility and acceptability of a multi-level pregnancy test (MLPT) for home monitoring of hCG trends after assisted reproduction

Shochet

Comstock

Ngoc³

et al. 2017

BMC Women's Health

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BackgroundTo evaluate the utility and acceptability of using multi-level pregnancy tests (MLPTs) at home to monitor hCG trends following assisted reproductive technology (ART).MethodsOne hundred and four women presenting for ART at either Stanford Medicine Fertility and Reproductive Health Clinic (Stanford, CA) or Hung Vuong Hospital (Ho Chi Minh City, Vietnam) participated in this pilot study. Women were asked to perform the MLPT at home, primarily on days when they were also scheduled to receive standard clinic-based serum hCG testing. These tests were administered up to 6 times over the 6-week period following embryo transfer or intrauterine insemination (IUI). Concordance of serial hCG readings for each time point was assessed by comparing trends in urine MLPT results with trends in serum hCG. Stable or increasing hCG level was interpreted as an indication of a progressing pregnancy, while a declining hCG was interpreted as a lack of established or progressing pregnancy. At study end, all participants were asked about the acceptability and convenience of using the MLPT at home for monitoring hCG trends following ART.ResultsData from both urine and serum testing are available for 156 of 179 clinic visits (87.2%). There was high concordance of serial trend results between the two types of tests: among the 156 sets of serum and urine hCG data points, 150 (96.2%) showed a matching trend in hCG pattern and 6 (3.8%) resulted in a discordant trend. Seventy-three percent of women reported being satisfied or very satisfied with using the MLPTs at home. Almost all (96.6%) said that the MLPT was easy or very easy to use.ConclusionThe MLPT offers women and health care providers a client-friendly diagnostic tool to detect very early pregnancy and monitor its progress.Trial registrationThis study was registered on clinicaltrials.gov as NCT01846403 (May 1, 2013), and NCT01919502 (August 5, 2013).

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Mild ovarian stimulation for in vitro fertilization: one perspective from the USA

Cited by 14 publications

References 32 publications

Association of number of retrieved oocytes with live birth rate and birth weight: an analysis of 231,815 cycles of in vitro fertilization

Association of number of retrieved oocytes with live birth rate and birth weight: an analysis of 231,815 cycles of in vitro fertilization

Gonadotropin dose is negatively correlated with live birth rate: analysis of more than 650,000 assisted reproductive technology cycles

Results of a pilot study in the U.S. and Vietnam to assess the utility and acceptability of a multi-level pregnancy test (MLPT) for home monitoring of hCG trends after assisted reproduction

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