results: Studies show that mild interference with the decrease in follicle-stimulating hormone levels in the mid-follicular phase was suffi- cient to override the selection of a single dominant follicle. Gonadotrophin-releasing hormone antagonists compared with agonists reduce length and dosage of gonadotrophin treatment without a significant reduction in the probability of live birth (OR 0.86, 95% CI 0.72- 1.02). Mild ovarian stimulation may be achieved with limited gonadotrophins or with alternatives such as anti-estrogens or aromatase inhibitors. Another option is luteinizing hormone or human chorionic gonadotrophin administration during the late follicular phase. Studies regarding these approaches are discussed individually; small sample size of single studies along with heterogeneity in patient inclusion criteria as well as outcomes analysed does not allow a meta-analysis to be performed. Additionally, the implications of mild ovarian stimulation for embryo quality, endometrial receptivity, cost and the psychological impact of IVF treatment are discussed. conclusions: Evidence in favour of mild ovarian stimulation for IVF is accumulating in recent literature. However, further, sufficiently powered prospective studies applying novel mild treatment regimens are required and structured reporting of the incidence and severity of com- plications, the number of treatment days, medication used, cost, patient discomfort and number of patient drop-outs in studies on IVF is encouraged.

/pdf/mild-ovarian-stimulation-for-ivf-11vt3bz2xu.pdf

Mild ovarian stimulation for IVF

BACKGROUND: The formation of functional ovarian cysts has been recognized as one of the side effects of GnRH agonist administration. The formation of cysts during IVF treatment may be of no clinical significance or may negatively influence its outcome. The objective of this study was to determine the incidence of ovarian cyst formation following GnRH agonist administration and to examine their effect on IVF outcome. METHODS: A prospective study of 1317 IVF patients who developed one or more functional ovarian cysts of 15 mm following GnRH agonist treatment was performed. Transvaginal ultrasonographic-guided cyst aspiration was carried out in 76 randomly allocated patients out of 122 patients who were found to have functional ovarian cysts before starting ovarian stimulation with gonadotropins. RESULTS: The incidence of follicular cyst formation was 9.3%. Cyst cycles in comparison with noncyst cycles had significantly elevated day 3 basal FSH (mean ± SD of 8.3 ± 3.2 versus 5.3 ± 2.6 mIU/ml, P < 0.05) and required more ampoules of gonadotropins (46.3 ± 16.5 versus 35 ± 14.6, P <0.01). Furthermore, they showed a statistically significant decrease in the quality and number of oocytes retrieved, fertilization rate, number and quality of embryos, implantation and pregnancy rates, with a significant increase in cancellation and abortion rates. Patients with bilateral cysts had a significantly lower number of oocytes and embryos retrieved, with a lower proportion of metaphase II oocytes. They also had a higher proportion of poor quality embryos. Cyst aspiration was not associated with a significant difference in the above parameters. CONCLUSIONS: The incidence of cyst formation during GnRH agonist treatment is lower than previously reported. In such cases, the quality of oocytes and embryos were significantly compromised, with a significant increase in the cycle cancellation rate and a decrease in the implantation and pregnancy rates. Neither conservative management nor cyst aspiration improved the IVF outcome.

/pdf/ovarian-cyst-formation-following-gnrh-agonist-administration-1uk32b6mta.pdf

Ovarian cyst formation following GnRH agonist administration in IVF cycles: incidence and impact

https://www.fertstert.org/article/S0015-0282(10)02148-5/pdf

Anti-Müllerian hormone serum levels predict response to controlled ovarian hyperstimulation but not embryo quality or pregnancy outcome in oocyte donation.

Advances in oocyte and embryo cryopreservation for assisted reproduction prompted new approaches to ovarian stimulation. Attention has been paid to progesterone and its derivatives to block the LH surge, as oocyte vitrification removes possible harmful effects of progestins on endometrial receptivity. This review summarizes the current status of progestin use to inhibit ovulation during ovarian stimulation compared with conventional ovarian stimulation. Progestin-primed ovarian stimulation is shown to effectively inhibit spontaneous ovulation, without affecting the number of retrieved oocytes and embryo quality. Reproductive outcomes from ovarian stimulation with progestins appear similar to those from conventional ovarian stimulation, although large trials are needed to confirm this. Use of progestins allows better control of LH concentrations, lower costs and easier (oral) administration. Therefore, progestin-primed ovarian stimulation could be the first choice for ovarian stimulation in fertility preservation, oocyte donation and preimplantation genetic testing cycles. So-called ‘non-conventional’ ovarian stimulation protocols (luteal and random-start, double ovarian stimulation), which always require oocyte or embryo cryopreservation, may also use progestins to inhibit the endogenous LH surge. Since the ‘freeze-all’ strategy with delayed transfer is mandatory, high responders undergoing IVF could benefit more from this approach. Economic advantage remains to be demonstrated, as do pregnancy and neonatal outcomes.

Use of progestins to inhibit spontaneous ovulation during ovarian stimulation: the beginning of a new era?

Despite the development of in vitro fertilization (IVF) more than 30 years ago, the cost of treatment remains high. Furthermore, over the years, more sophisticated technologies and expensive medications have been introduced, making IVF increasingly inaccessible despite the increasing need. Globally, the option to undergo IVF is only available to a privileged few. In recent years, there has been growing interest in exploring strategies to reduce the cost of IVF treatment, which would allow the service to be provided in low-resource settings. In this review, we explore the various ways in which the cost of this treatment can be reduced.

/pdf/low-cost-in-vitro-fertilization-current-insights-xxrh3h5vlf.pdf

Low-cost in vitro fertilization: current insights.

Purpose: To compare the efficiency of transvaginal ultrasound-guided functional ovarian cyst aspiration, withconservative management, in the outcome of patientsundergoing assisted reproductive technique (ART) (in vitrofertilization or intracytoplasmic sperm injection). Thesecysts were identified before ovarian stimulation begun andafter administration of a midluteal GnRH agonist.

Methods: Fifty nine patients undergoing ART from January1, 1997 to February 28, 1999, who developed functionalovarian cysts were included. Aspirations of these cysts(n = 14) versus conservative management(n = 45) were compared. Total number of ovarian folliclesdeveloped, number of oocytes retrieved, estradiol levels onthe day of human chorionic gonadotropin, fertilization rate,number of good quality embryos transferred, implantation,and clinical pregnancy rate per cycle were evaluated.

Results: No statistical differences were observed betweenthe two groups in any of the selected parameters.

Conclusions: Cyst aspiration and conservative managementshowed similar implantation and pregnancy rates, in patientswho develop functional ovarian cysts after pituitarydown-regulation following luteal phase gonadotropin-releasinghormone agonist administration. Prospective studies areneeded to confirm this trend.

Conservative management versus aspiration of functional ovarian cysts before ovarian stimulation for assisted reproduction.

Preliminary experience with a low-cost stimulation protocol that includes letrozole and human menopausal gonadotropins in normal responders for assisted reproductive technologies

Is it worth testing for AMH in young oocyte donors

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Conservative management versus aspiration of functional ovarian cysts before ovarian stimulation for assisted reproduction.

Preliminary experience with a low-cost stimulation protocol that includes letrozole and human menopausal gonadotropins in normal responders for assisted reproductive technologies

Is it worth testing for AMH in young oocyte donors