Mild approaches in assisted reproduction Better for the future

Authors:
René Frydman, M.D., Ph.D., Geeta Nargund, M.D.

Volume 102, Issue 6, Pages 1540–1541

Abstract:
Current approaches for in vitro fertilization (IVF) in the majority of assisted conception units throughout the world are aggressive, unphysiological, and expensive. Is this really necessary? There is a widespread belief among practitioners that for a woman the only consideration is a high success rate, and that the current practice of down-regulation, high-dose stimulation, and retrieval of a large number of oocytes yields a higher success rate per cycle and better outcomes. Incidentally, it also results in a higher income for the clinic, so surely, the argument goes, this is a win-win situation for both patient and practitioner.

Fluorescent in situ hybridization of human sperm Diagnostics indications and therapeutic implications

Capsule:
This article presents a review of the diagnostic and therapeutic indications of sperm fluorescent in situ hybridization and how its use affects treatment of patients with infertility and unfavorable pregnancy outcomes.

Authors:
Ranjith Ramasamy, M.D., Stefan Besada, B.S., Dolores J. Lamb, Ph.D.

Volume 102, Issue 6, Pages 1534-1539

Abstract:

Male factor infertility is a relatively common condition, affecting at least 6% of men of reproductive age. Typically, men with unknown genetic abnormalities resort to using assisted reproductive techniques (ART) to achieve their reproductive goals. Infertile men who father biological children using ART could have a higher incidence of aneuploidy, which is a deviation from the normal haploid or diploid chromosomal state. Aneuploidy can be evaluated using fluorescent in situ hybridization (FISH), a cytogenetic assay that gives an estimate of the frequencies of chromosomal abnormalities. The chromosomes that are generally analyzed in FISH (13, 18, 21, X, and Y) are associated with aneuploidies that are compatible with life. The technique is indicated for various reasons but primarily in [1] men who despite normal semen parameters suffer recurrent pregnancy loss, and [2] men with normal semen parameters, who are undergoing in vitro fertilization but still experiencing recurrent implantation failure. As a screening tool, the technique can help in reproductive and genetic counseling of affected couples, or those who have previously experienced failure of ART. A qualitative analysis of FISH study results allows couples to make informed reproductive choices. Given the increasing clinical use of FISH in various infertility diagnoses, and the development of novel adjunct technologies, one can expect much progress in the areas of preimplantation genetic screening, diagnostics, and therapeutics.

Ovarian response to recombinant human follicle stimulating hormone A randomized antiMüllerian hormone stratified dose response trial in women undergoing in vitro fertilization intracytoplasmic sperm injection

Capsule:
Increasing rhFSH doses results in a linear increase in number of oocytes retrieved in an AMH-dependent manner.

Authors:
Joan-Carles Arce, M.D., Ph.D., Anders Nyboe Andersen, M.D., Ph.D., Manuel Fernández-Sánchez, M.D., Ph.D., Hana Visnova, M.D., Ph.D., Ernesto Bosch, M.D., Ph.D., Juan Antonio García-Velasco, M.D., Ph.D., Pedro Barri, M.D., Ph.D., Petra de Sutter, M.D., Ph.D., Bjarke M. Klein, Ph.D., Bart C.J.M. Fauser, M.D., Ph.D.

Volume 102, Issue 6, Pages 1633-1640

Abstract:

Objective:
To evaluate the dose–response relationship of a novel recombinant human FSH (rhFSH; FE 999049) with respect to ovarian response in patients undergoing IVF/intracytoplasmic sperm injection treatment; and prospectively study the influence of initial anti-Müllerian hormone (AMH) concentrations.

Design:
Randomized, controlled, assessor-blinded, AMH-stratified (low: 5.0–14.9 pmol/L [0.7–

Setting:
Seven infertility centers in four countries.

Patient(s):
Two hundred sixty-five women aged ≤37 years.

Intervention(s):
Controlled ovarian stimulation with either 5.2, 6.9, 8.6, 10.3, or 12.1 μg of rhFSH, or 11 μg (150 IU) of follitropin alfa in a GnRH antagonist cycle.

Main Outcome Measure(s):
Number of oocytes retrieved.

Result(s):
The number of oocytes retrieved increased in an rhFSH dose–dependent manner, from 5.2 ± 3.3 oocytes with 5.2 μg/d to 12.2 ± 5.9 with 12.1 μg/d. The slopes of the rhFSH dose–response curves differed significantly between the two AMH strata, demonstrating that a 10% increase in dose resulted in 0.5 (95% confidence interval 0.2–0.7) and 1.0 (95% confidence interval 0.7–1.3) more oocytes in the low and high AMH stratum, respectively. Fertilization rate and blastocyst/oocyte ratio decreased significantly with increasing rhFSH doses in both AMH strata. No linear relationship was observed between rhFSH dose and number of blastocysts overall or by AMH strata. Five cases of ovarian hyperstimulation syndrome were reported for the three highest rhFSH doses and in the high AMH stratum.

Conclusion(s):
Increasing rhFSH doses results in a linear increase in number of oocytes retrieved in an AMH-dependent manner. The availability of blastocysts is less influenced by the rhFSH dose and AMH level.

Clinical Trial Registration Number
NCT01426386.

Articles of Special Interest

Mild approaches in assisted reproduction Better for the future

Tuesday, November 25, 2014
Current approaches for in vitro fertilization (IVF) in the majority of assisted conception units throughout the world are aggressive, unphysiological, and expensive. Is this really necessary?

Fluorescent in situ hybridization of human sperm Diagnostics indications and therapeutic implications

Tuesday, November 25, 2014
This article presents a review of the diagnostic and therapeutic indications of sperm fluorescent in situ hybridization and how its use affects treatment of patients with infertility and unfavorable pregnancy outcomes.

Ovarian response to recombinant human follicle stimulating hormone A randomized antiMüllerian hormone stratified dose response trial in women undergoing in vitro fertilization intracytoplasmic sperm injection

Tuesday, November 25, 2014
Increasing rhFSH doses results in a linear increase in number of oocytes retrieved in an AMH-dependent manner.

Developmental potential of zona pellucida free oocytes obtained following mild in vitro fertilization

Tuesday, November 25, 2014
Zona pellucia–free eggs could be cultured until the blastocyst stage with efficacy similar to zona intact control eggs, without adversely affecting pregnancy rates and the neonatal outcome of resulting offspring.
Translate »