Dataset Information

Fresh embryo transfer versus freeze-only after in vitro maturation with a pre-maturation step in women with high antral follicle count: a randomized controlled pilot study.

ABSTRACT:

Purpose

In vitro maturation (IVM) is an alternative to in vitro fertilization (IVF) for women at high risk of developing ovarian hyperstimulation syndrome (OHSS). This study determined the effectiveness and safety of a freeze-only strategy versus fresh embryo transfer (ET) after IVM with a pre-maturation step (CAPA-IVM) in women with a high antral follicle count (AFC).

Methods

This randomized, controlled pilot study (NCT04297553) was conducted between March and November 2020. Forty women aged 18-37 years with a high AFC (≥24 follicles in both ovaries) undergoing one cycle of CAPA-IVM were randomized to a freeze-only strategy with subsequent frozen ET (n = 20) or to fresh ET (n = 20). The primary endpoint was ongoing pregnancy resulting in live birth after the first ET of the started treatment cycle.

Results

The ongoing pregnancy rate in the freeze-only group (65%) was significantly higher than that in the fresh ET group (25%; p = 0.03), as was the live birth rate (60% versus 20%; p = 0.02). Clinical pregnancy rate was numerically, but not significantly, higher after frozen versus fresh ET (70% versus 35%; p = 0.06), while the number of day 3 or good quality embryos, endometrial thickness on the day of oocyte pick-up, implantation rate, and positive pregnancy test rate did not differ significantly between groups. No cases of OHSS were observed, and miscarriage and multiple pregnancy rates were similar in the two groups.

Conclusions

These findings suggest that the effectiveness of CAPA-IVM could be improved considerably by using a freeze-only strategy followed by frozen ET in subsequent cycles.

Trial registration number

NCT04297553 ( www.clinicaltrials.gov ).

SUBMITTER: Vuong LN

PROVIDER: S-EPMC8266980 | biostudies-literature | 2021 Jun

REPOSITORIES: biostudies-literature

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Publications

Fresh embryo transfer versus freeze-only after in vitro maturation with a pre-maturation step in women with high antral follicle count: a randomized controlled pilot study.

Vuong Lan N LN Nguyen Linh K LK Le Anh H AH Pham Huy H HH Ho Vu Na VN Le Ho L HL Pham Toan D TD Dang Vinh Q VQ Phung Tuan H TH Smitz Johan J Ho Tuong M TM

Journal of assisted reproduction and genetics 20210406 6

<h4>Purpose</h4>In vitro maturation (IVM) is an alternative to in vitro fertilization (IVF) for women at high risk of developing ovarian hyperstimulation syndrome (OHSS). This study determined the effectiveness and safety of a freeze-only strategy versus fresh embryo transfer (ET) after IVM with a pre-maturation step (CAPA-IVM) in women with a high antral follicle count (AFC).<h4>Methods</h4>This randomized, controlled pilot study (NCT04297553) was conducted between March and November 2020. Fort ...[more]

PMID: 33825118

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Project description:BackgroundPhthalates are ubiquitously used in a variety of products and have an adverse effect on folliculogenesis. However, previous epidemiological studies on the associations between phthalate exposure and antral follicle count (AFC) produced conflicting results. The present study aimed to evaluate the associations between urinary phthalate metabolite concentrations and AFC among women undergoing in vitro fertilization (IVF).MethodsWe collected 525 urine samples and measured 8 phthalate metabolites from IVF patients. Poisson regression models were conducted to evaluate the associations between phthalate metabolite concentrations and AFC. In addition, participants were stratified into a younger group (< 35 years) and an older group (≥ 35 years) to explore the potential effect modification by age. We also performed sensitivity analyses by restricting our analyses to only infertile women diagnosed with tubal factor infertility to test the robustness of the results.ResultsSignificant positive associations were observed among urinary MBP, MEOHP and ∑PAEs concentrations and AFC after adjusting for age, BMI, year of study and infertility diagnosis. Compared with women in the first tertile, women in the third tertile of MBP and MEOHP had 7.02% (95% CI: 1.18%, 12.9%) and 8.84% (95% CI: 2.83%, 14.9%) higher AFC, respectively, and women in the second and third tertiles of ∑PAEs had 6.19% (95% CI: 0.37%, 12.0%) and 9.09% (95% CI: 3.22%, 15.0%) higher AFC, respectively. In addition, MBP, MEOHP and ∑PAEs also had significant positive associations with AFC in trend tests for dose-response. In the age-stratified analysis, we found a stronger relationship between phthalate metabolite concentrations and AFC among older women and an inverse association among younger women. We observed similar results in the sensitivity analyses.ConclusionWe found positive associations between phthalate exposure and AFC, which support the idea that phthalate exposure may accelerate primordial follicle recruitment and lead to higher AFC in women undergoing IVF. More studies are needed to better understand their relationships.

Project description:Objective The aim of this study is to investigate whether the follicle-to-oocyte index [FOI: (number of retrieved oocytes/antral follicle count) × 100] was associated with clinical pregnancy after fresh cleavage transfer. Design The framework used to organize this study is retrospective cohort analysis. Setting The study was performed in a single in vitro fertilization center in a public hospital. Patients In total, 4,323 fresh embryo transfer cycles from 1 August 2011 to 31 January 2022 were retrospectively analyzed. Data were designated into three groups according to FOI tertile values. Interventions There are no interventions in this study. Main outcome measure The primary outcome measure is the clinical pregnancy rate (CPR). Results A total of 4,323 patients were included in the study. According to their FOI, patients were divided into low (FOI ≤ 0.70, n = 1,434), medium (FOI = 0.71–0.95, n = 1,070), and high (FOI = 0.96–1.00, n = 1,819) tertile groups. A significant statistical increase in the CPR from the lowest to the highest tertile FOI group was detected (47.28%, 51.78%, and 51.57%; P =0.026). After adjusted for potential confounders, multivariate logistic regression analysis revealed a positive association between FOI and CPR [odds ratio (OR) = 1.57; 95% confidence interval (CI): 1.18–2.11]. Each standard deviation increments in FOI (SD = 0.24) corresponded to a 20% increase in the CPR. Trend analysis also showed that FOI tertile groups were positively associated with CPR (P for trend = 0.010). Smooth curve fitting indicated the existence of a linear relationship across the entire range of FOI. No optimal cutoff value of FOI for prognosing CPR was found in smooth curve fitting analysis. Moreover, subgroup analyses suggested that the association was significantly stronger in the single cleavage transfer cycle (OR = 2.04; 95% CI: 1.14–3.65). Conclusions FOI is an independent variable in prediction for CPR in fresh embryo transfer cycle, especially in the single cleavage transfer cycle.

Dataset Information

Fresh embryo transfer versus freeze-only after in vitro maturation with a pre-maturation step in women with high antral follicle count: a randomized controlled pilot study.

Purpose

Methods

Results

Conclusions

Trial registration number

Publications

Fresh embryo transfer versus freeze-only after in vitro maturation with a pre-maturation step in women with high antral follicle count: a randomized controlled pilot study.

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