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Effects of controlled ovarian stimulation regimens on top-quality blastocyst development and perinatal outcomes with the freeze-all strategy: A retrospective comparative study

  • 투고 : 2022.10.12
  • 심사 : 2023.01.20
  • 발행 : 2023.06.30

초록

Objective: This study aimed to determine the effect of ovarian stimulation regimens on the top-quality blastocyst development rate and perinatal outcomes with the freeze-all strategy. Methods: A retrospective comparative cohort analysis of 149 in vitro fertilization (IVF) cycles using the freeze-all strategy was conducted. The IVF cycles were stimulated with either a gonadotropin-releasing hormone antagonist or clomiphene citrate along with gonadotropin based on the patient's serum anti-Müllerian hormone level. Oocyte retrieval, fertilization, and embryo culture were performed following standard procedures. All good-quality blastocysts were cryopreserved and used for frozen-thawed embryo transfer (FET) in subsequent cycles. The fertilization, blastulation, and top-quality blastocyst development rates were calculated. The perinatal outcomes of FET cycles, gestational period, and birth weight were assessed. Results: The main outcome of this study was the top-quality blastocyst development rate, and the secondary outcomes were perinatal parameters (e.g., gestational period and birth weight) between the stimulation regimens. Despite the higher number of usable-quality embryos in the antagonist group, the blastocyst development rate remained comparable (p=0.105). Similarly, perinatal outcomes were comparable in subsequent FET cycles (p=0.538). Conclusion: These findings suggest that the choice between antagonist and clomiphene citrate with gonadotropin as stimulation in controlled ovarian stimulation regimens may not affect the top-quality blastocyst development rate. The IVF outcomes (e.g., clinical pregnancy, miscarriage, and live birth rates) remained unaffected in subsequent FET cycles. Unlike fresh embryo transfer, the birth weight and gestational length were not associated with prior controlled ovarian stimulation regimens when the freeze-all strategy was used.

키워드

과제정보

The authors acknowledge the Kinoshita Ladies Clinic staff and patients for their assistance in this project. The anonymous reviewers are greatly acknowledged.

참고문헌

  1. Macklon NS, Stouffer RL, Giudice LC, Fauser BC. The science behind 25 years of ovarian stimulation for in vitro fertilization. Endocr Rev 2006;27:170-207. https://doi.org/10.1210/er.2005-0015
  2. Segawa T, Kato K, Miyauchi O, Kawachiya S, Takehara Y, Kato O. Evaluation of minimal stimulation IVF with clomiphene citrate and hMG. Fertil Steril 2007;88(Suppl 1):S286.
  3. Bhandari S, Ganguly I, Chittawar PB, Agarwal P, Singh A, Gupta N. Use of clomiphene to prevent premature luteinizing hormone surge during controlled ovarian hyper stimulation. Int J Reprod Contracept Obstet Gynecol 2016;5:1944-8. https://doi.org/10.18203/2320-1770.ijrcog20161695
  4. Gnoth C, Maxrath B, Skonieczny T, Friol K, Godehardt E, Tigges J. Final ART success rates: a 10 years survey. Hum Reprod 2011;26:2239-46. https://doi.org/10.1093/humrep/der178
  5. Pelinck MJ, Vogel NE, Hoek A, Simons AH, Arts EG, Mochtar MH, et al. Cumulative pregnancy rates after three cycles of minimal stimulation IVF and results according to subfertility diagnosis: a multicentre cohort study. Hum Reprod 2006;21:2375-83. https://doi.org/10.1093/humrep/del192
  6. Santos MA, Kuijk EW, Macklon NS. The impact of ovarian stimulation for IVF on the developing embryo. Reproduction 2010;139:23-34. https://doi.org/10.1530/REP-09-0187
  7. Verberg MF, Eijkemans MJ, Macklon NS, Heijnen EM, Baart EB, Hohmann FP, et al. The clinical significance of the retrieval of a low number of oocytes following mild ovarian stimulation for IVF: a meta-analysis. Hum Reprod Update 2009;15:5-12. https://doi.org/10.1093/humupd/dmn053
  8. Engel JB, Ludwig M, Felberbaum R, Albano C, Devroey P, Diedrich K. Use of cetrorelix in combination with clomiphene citrate and gonadotrophins: a suitable approach to 'friendly IVF'? Hum Reprod 2002;17:2022-6. https://doi.org/10.1093/humrep/17.8.2022
  9. Singh A, Bhandari S, Agrawal P, Gupta N, Munaganuru N. Use of clomiphene-based stimulation protocol in oocyte donors: a comparative study. J Hum Reprod Sci 2016;9:159-63. https://doi.org/10.4103/0974-1208.192054
  10. Weiss JM, Ludwig M, Ortmann O, Diedrich K. GnRH antagonists in the treatment of infertility. Ann Med 2003;35:512-22. https://doi.org/10.1080/07853890310001302
  11. Olivennes F, Belaisch-Allart J, Emperaire JC, Dechaud H, Alvarez S, Moreau L, et al. Prospective, randomized, controlled study of in vitro fertilization-embryo transfer with a single dose of a luteinizing hormone-releasing hormone (LH-RH) antagonist (cetrorelix) or a depot formula of an LH-RH agonist (triptorelin). Fertil Steril 2000;73:314-20. https://doi.org/10.1016/S0015-0282(99)00524-5
  12. Jwa SC, Nakashima A, Kuwahara A, Saito K, Irahara M, Sakumoto T, et al. Neonatal outcomes following different ovarian stimulation protocols in fresh single embryo transfer. Sci Rep 2019;9:3076.
  13. Van Steirteghem AC, Nagy Z, Joris H, Liu J, Staessen C, Smitz J, et al. High fertilization and implantation rates after intracytoplasmic sperm injection. Hum Reprod 1993;8:1061-6. https://doi.org/10.1093/oxfordjournals.humrep.a138192
  14. Veeck LL. Oocyte assessment and biological performance. Ann N Y Acad Sci 1988;541:259-74. https://doi.org/10.1111/j.1749-6632.1988.tb22263.x
  15. Gardner DK, Surrey E, Minjarez D, Leitz A, Stevens J, Schoolcraft WB. Single blastocyst transfer: a prospective randomized trial. Fertil Steril 2004;81:551-5. https://doi.org/10.1016/j.fertnstert.2003.07.023
  16. Kanda Y. Statistical analysis using freely-available "EZR (Easy R)" software. Rinsho Ketsueki 2015;56:2258-66.
  17. Check JH. Mild ovarian stimulation. J Assist Reprod Genet 2007;24:621-7. https://doi.org/10.1007/s10815-007-9179-9
  18. Kol S, Lightman A, Hillensjo T, Devroey P, Fauser B, Tarlatzis B, et al. High doses of gonadotrophin-releasing hormone antagonist in in-vitro fertilization cycles do not adversely affect the outcome of subsequent freeze-thaw cycles. Hum Reprod 1999;14:2242-4. https://doi.org/10.1093/humrep/14.9.2242
  19. Hernandez-Nieto C, Lee JA, Alkon-Meadows T, Luna-Rojas M, Mukherjee T, Copperman AB, et al. Late follicular phase progesterone elevation during ovarian stimulation is not associated with decreased implantation of chromosomally screened embryos in thaw cycles. Hum Reprod 2020;35:1889-99. https://doi.org/10.1093/humrep/deaa123
  20. Vanni VS, Somigliana E, Reschini M, Pagliardini L, Marotta E, Faulisi S, et al. Top quality blastocyst formation rates in relation to progesterone levels on the day of oocyte maturation in GnRH antagonist IVF/ICSI cycles. PLoS One 2017;12:e0176482.
  21. Huang B, Ren X, Wu L, Zhu L, Xu B, Li Y, et al. Elevated progesterone levels on the day of oocyte maturation may affect top quality embryo IVF cycles. PLoS One 2016;11:e0145895.
  22. Baldini D, Savoia MV, Sciancalepore AG, Malvasi A, Vizziello D, Beck R, et al. High progesterone levels on the day of HCG administration do not affect the embryo quality and the reproductive outcomes of frozen embryo transfers. Clin Ter 2018;169:e91-5.
  23. Pardinas ML, Nohales M, Labarta E, De Los Santos JM, Mercader A, Remohi J, et al. Elevated serum progesterone does not impact euploidy rates in PGT-A patients. J Assist Reprod Genet 2021;38:1819-26. https://doi.org/10.1007/s10815-021-02197-y
  24. Kyrou D, Popovic-Todorovic B, Fatemi HM, Bourgain C, Haentjens P, Van Landuyt L, et al. Does the estradiol level on the day of human chorionic gonadotrophin administration have an impact on pregnancy rates in patients treated with rec-FSH/GnRH antagonist? Hum Reprod 2009;24:2902-9. https://doi.org/10.1093/humrep/dep290
  25. Jones CA, Acharya KS, Acharya CR, Raburn D, Muasher SJ. Patient and in vitro fertilization (IVF) cycle characteristics associated with variable blastulation rates: a retrospective study from the Duke Fertility Center (2013-2017). Middle East Fertil Soc J 2020;24:4.
  26. Kolibianakis EM, Collins J, Tarlatzis BC, Devroey P, Diedrich K, Griesinger G. Among patients treated for IVF with gonadotrophins and GnRH analogues, is the probability of live birth dependent on the type of analogue used?: a systematic review and meta-analysis. Hum Reprod Update 2006;12:651-71. https://doi.org/10.1093/humupd/dml038
  27. Al-Inany HG, Abou-Setta AM, Aboulghar M. Gonadotrophin-releasing hormone antagonists for assisted conception. Cochrane Database Syst Rev 2006;3:CD001750.
  28. Karimzadeh MA, Ahmadi S, Oskouian H, Rahmani E. Comparison of mild stimulation and conventional stimulation in ART outcome. Arch Gynecol Obstet 2010;281:741-6. https://doi.org/10.1007/s00404-009-1252-4
  29. Kato K, Ezoe K, Yabuuchi A, Fukuda J, Kuroda T, Ueno S, et al. Comparison of pregnancy outcomes following fresh and electively frozen single blastocyst transfer in natural cycle and clomiphene-stimulated IVF cycles. Hum Reprod Open 2018;2018:hoy006.
  30. Bourgain C, Devroey P. The endometrium in stimulated cycles for IVF. Hum Reprod Update 2003;9:515-22. https://doi.org/10.1093/humupd/dmg045