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Rivista di Ostetricia e Ginecologia
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Scopus, Emerging Sources Citation Index
Minerva Ginecologica 2016 Jun 08
Longer ovarian stimulation reduces embryo number and clinical pregnancy rate in long GnRH agonist cycles
Caitlin DUNNE 1, 2, Carole LAWRENCE 2, Arianne ALBERT 3, Jon C. HAVELOCK 1, 2 ✉
1 University of British Columbia, Division of Reproductive Endocrinology and Infertility, Vancouver, Canada; 2 Pacific Centre for Reproductive Medicine, Burnaby, Canada; 3 Women’s Health Research Institute, British Columbia Women’s Hospital, Vancouver, Canada
BACKGROUND: To study whether the length of controlled ovarian stimulation affects in vitro fertilization (IVF) cycle outcomes.
METHODS: This retrospective cohort study was performed at a private, university-affiliated fertility centre. We reviewed1522 IVF cycles, comprising 979 long gonadotropin-releasing hormone (GnRH) agonist and 543 GnRH antagonist protocols. All subjects underwent controlled ovarian stimulation followed by fresh embryo transfer. Logistic regression analysis was used to examine the relationship between trigger day and the following cycle outcomes: normal fertilization rate (FR), proportion of mature oocytes, proportion of cycles with embryos for cryopreservation, and clinical pregnancy rate (CPR).
RESULTS: In long agonist cycles, having more days of stimulation was associated with a lower clinical pregnancy rate (OR = 0.87, 95%CI = 0.80-0.96, p = 0.01). Longer stimulation also resulted in fewer cycles with supernumerary embryos for cryopreservation (OR = 0.84, 95%CI = 0.77-0.92, p = 0.0005), despite a having greater number of mature oocytes retreived (OR = 1.05, 95%CI = 1.01- 1.10, p = 0.04). For each additional day of stimulation in a long agonist protocol, the odds of achieving a clinical pregnancy were reduced by 13% and of achieving cryopreservation by 16%. In the antagonist protocol group, the length of ovarian stimulation did not have an effect on the clinical pregnancy and cryopreservation rates.
CONCLUSIONS: Longer duration of ovarian stimulation appears to reduce clinical pregnancy and embryo cryopreservation rates in subjects undergoing long GnRH agonist cycles. The number of days of stimulation does not appear to affect those using the GnRH antagonist protocol.