The effect of follicular phase length on cycle outcomes and endometrial development in gonadotrophin ovarian stimulation/intrauterine insemination cycles

Bakkensen, Jennifer B.; Christou, G.; Dimitriadis, Irene; James, Kaitlyn; Souter, Irene

doi:10.1016/j.rbmo.2019.12.007

Cited by 11 publications

(8 citation statements)

References 21 publications

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“…In addition to more skewed XCI and shorter CAG repeats, women with RPL exhibited a shorter stimulation duration than did the controls despite receiving the same antagonist protocol with similar total gonadotropin dosages. Recent studies have reported that a shorter follicular phase length is associated with DOR and poorer oocyte quality [45][46][47] and as such, women with RPL might have undergone a potential decrease in ovarian reserve, although the incidence of DOR, which was defined by AMH and AFC, remained similar compared with the controls. We investigated the relationships between SXCI, CAG repeats, and stimulation duration, and observed that neither SXCI nor XWBM was significantly associated with the duration of stimulation in the RPL group or in the control group.…”

Section: Discussionmentioning

confidence: 96%

Investigation of the role of X chromosome inactivation and androgen receptor CAG repeat polymorphisms in patients with recurrent pregnancy loss: a prospective case–control study

Sui

Zhang

et al. 2022

BMC Pregnancy Childbirth

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Background Previous research has revealed that skewed X chromosome inactivation (SXCI) and androgen receptor (AR) CAG polymorphisms are associated with increased risk of recurrent pregnancy loss (RPL); however, the results are conflicting, and the underlying mechanisms remain unclear. This study investigated the role of SXCI and AR CAG polymorphisms in patients with RPL and explored whether the underlying mechanisms were related to the ovarian reserve and preimplantation embryo aneuploidy. Methods This was a prospective case-control study carried out in a tertiary hospital-based reproductive medicine center. An external validation RPL cohort was recruited during the study period. Data on baseline and cycle characteristics were collected. X-chromosome inactivation (XCI) was measured using a human AR assay. AR polymorphisms were assessed using quantitative fluorescent polymerase chain reactions and direct sequencing. Blastocysts of the patients with RPL were tested by single nucleotide polymorphism microarray based preimplantation genetic testing for aneuploidy. Results In total, 131 patients with idiopathic RPL and 126 controls were included for the case-control study. Patients with RPL exhibited a significantly more skewed XCI distribution pattern (67.71 ± 10.50 vs. 64.22 ± 10.62, p = 0.011), as well as significantly shorter bi-allelic mean (18.56 ± 1.97 vs. 19.34 ± 2.38, p = 0.005) and X-weighted bi-allelic mean (18.46 ± 2.02 vs. 19.38 ± 2.53, p = 0.001) of AR CAG repeats. Multivariate logistic regression models indicated that CAG repeat < 20, SXCI, and duration of stimulation were independently associated with the risk of RPL. However, SXCI and AR CAG polymorphisms were not associated with ovarian reserve or preimplantation embryo aneuploidy in the RPL group, and the same results were attained in a separate validation cohort of 363 patients with RPL. Conclusion SXCI and AR CAG polymorphisms are related to RPL; however, these two factors do not lead to RPL by affecting the ovarian reserve or increasing embryo aneuploidy. The roles of SXCI and AR CAG in RPL may involve other mechanisms that require further investigation. Trial registration: NCT02504281, https://www.clinicaltrials.gov (Date of registration, 21/07/2015; date of enrolment of the first subject, 30/07/2015).

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Section: Discussionmentioning

confidence: 96%

Investigation of the role of X chromosome inactivation and androgen receptor CAG repeat polymorphisms in patients with recurrent pregnancy loss: a prospective case–control study

Sui

Zhang

et al. 2022

BMC Pregnancy Childbirth

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“…Previous publications revealed conflicting results when investigating the relationship between the duration of ovarian stimulation and IVF outcomes. Although some studies support the association between prolonged gonadotropin stimulation and poor pregnancy outcome ( 17 , 20 , 22 ), some argue that there is no connection ( 15 , 24 ), while some have obtained negative correlations ( 23 ). The lack of consensus is likely due to a lack of standardized cut-off points for ovulation duration, a small sample size, or failure to correct for confounding factors other than age.…”

Section: Discussionmentioning

confidence: 99%

“…Clinicians may struggle with the actual trigger time, such as the presence of large lead follicles with numerous small follicles at the same time. Several studies have investigated the effects of ovarian stimulation duration and gonadotropin dose on IVF outcomes, but the results are inconsistent (16)(17)(18)(19)(20)(21)(22)(23)(24)(25). The process of ovarian stimulation is similar to the follicular phase of the menstrual cycle, and the duration of ovarian stimulation is largely dependent on the ovarian response to hormonal stimulation.…”

Section: Introductionmentioning

confidence: 99%

Association Between the Ratio of Ovarian Stimulation Duration to Original Follicular Phase Length and In Vitro Fertilization Outcomes: A Novel Index to Optimise Clinical Trigger Time

Zhao

Zhang

et al. 2022

Front. Endocrinol.

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The duration of ovarian stimulation which is largely dependent on the ovarian response to hormonal stimulation may influence in vitro fertilization (IVF) outcomes. Menstrual cycle length is potentially a good indicator of ovarian reserve and can predict ovarian response. Ovarian stimulation and the follicular phase of the menstrual cycle are both processes of follicular development. There is no published research to predict the duration of ovarian stimulation based on the length of the menstrual cycle. Our retrospective cohort study included 6110 women with regular menstrual cycles who underwent their first IVF treatment between January 2015 and October 2020. Cycles were classified according to quartiles of the ratio of ovarian stimulation duration to original follicular phase length (OS/FP). Multivariate generalized linear models were applied to assess the association between OS/FP and IVF outcomes. The odds ratio (OR) or relative risk (RR) was estimated for each quartile with the lowest quartile as the comparison group. OS/FP of 0.67 to 0.77 had more retrieved and mature oocytes (adjusted RR 1.11, 95% confidence interval [CI] 1.07–1.15, p for trend = 0.001; adjusted RR 1.14, 95% CI 1.09–1.19, p for trend = 0.001). OS/FP of 0.67 to 0.77 showed the highest rate of fertilization (adjusted OR 1.11, 95% CI 1.05–1.17, p for trend = 0.001). OS/FP > 0.77 had the lowest rate of high-quality blastocyst formation (adjusted OR 0.81, 95% CI 0.71–0.93, p for trend = 0.01). No apparent association was noted between OS/FP and clinical pregnancy, live birth, or early miscarriage rate. In conclusion, OS/FP has a significant effect on the number of oocytes, fertilization rate, and high-quality blastocyst formation rate. MCL could be used to predict the duration of ovarian stimulation with an OS/FP of 0.67 to 0.77, which provides a new indicator for the individualized clinical optimization of the trigger time.

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“…In the past, IUI with injectable gonadotropins was used to develop multiple oocytes, but it is no longer acceptable because of its associated conditions such as ovarian hyperstimulation or multiple pregnancy, along with higher cost and stress 2 …”

Section: Introductionmentioning

confidence: 99%

“…1In the past, IUI with injectable gonadotropins was used to develop multiple oocytes, but it is no longer acceptable because of its associated conditions such as ovarian hyperstimulation or multiple pregnancy, along with higher cost and stress. 2 Oral ovarian stimulation medications, including clomiphene citrate and letrozole, are related to lower adverse effects and costs compared with gonadotropins. 3…”

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confidence: 99%

The efficiency of low‐dose letrozole plus clomiphene citrate for ovulation induction in intrauterine insemination cycles: A randomized clinical trial

Asgharnia

Mehrafza

Raoufi

et al. 2021

Intl J Gynecology & Obste

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Objective To investigate if combination therapy with clomiphene citrate (CC) plus letrozole (L) was associated with a higher efficacy than L and CC alone in patients undergoing ovarian induction plus intrauterine insemination. Methods The present multicenter randomized controlled clinical trial was performed between 2018 and 2020. Participants were randomized into three groups: L (n = 167; 5 mg/day), CC (n = 167; 100 mg/day), and L + CC (n = 167) (2.5 mg/day + 50 mg/day) from day 3. Ovarian stimulation was continued with the appropriate dose of gonadotropins daily starting from day 8 and continued until follicular size was 20 mm or more followed by administration of human chorionic gonadotropin (10 000 IU). Semen samples were prepared by direct swim‐up technique. Results In the CC group, gonadotropin dose was significantly higher but endometrial thickness was significantly lower compared with other groups. Number of follicles of 18 mm or more was significantly lower in the L group compared with the other two groups. Number of follicles less than 15 mm was meaningfully higher in the CC group compared with the other groups. In the L + CC group, total and largest follicular size, and the rates of chemical, clinical, and ongoing pregnancy, and live birth were significantly higher compared with other groups. Conclusion Combination therapy with L + CC was superior to either L or CC for achieving pregnancy in women undergoing ovarian induction plus intrauterine insemination.

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The effect of follicular phase length on cycle outcomes and endometrial development in gonadotrophin ovarian stimulation/intrauterine insemination cycles

Cited by 11 publications

References 21 publications

Investigation of the role of X chromosome inactivation and androgen receptor CAG repeat polymorphisms in patients with recurrent pregnancy loss: a prospective case–control study

Investigation of the role of X chromosome inactivation and androgen receptor CAG repeat polymorphisms in patients with recurrent pregnancy loss: a prospective case–control study

Association Between the Ratio of Ovarian Stimulation Duration to Original Follicular Phase Length and In Vitro Fertilization Outcomes: A Novel Index to Optimise Clinical Trigger Time

The efficiency of low‐dose letrozole plus clomiphene citrate for ovulation induction in intrauterine insemination cycles: A randomized clinical trial

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