Increased endometrial thickness is associated with improved treatment outcome for selected patients undergoing in vitro fertilization embryo transfer
|
|
- Lynne Miles
- 5 years ago
- Views:
Transcription
1 Increased endometrial thickness is associated with improved treatment outcome for selected patients undergoing in vitro fertilization embryo transfer Xingqi Zhang, Ph.D., a Chi-Huang Chen, M.D., b Edmond Confino, M.D., a Randall Barnes, M.D., a Magdy Milad, M.D., a and Ralph R. Kazer, M.D. a a Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Feinberg School of Medicine of Northwestern University, Chicago, Illinois; and b Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan Objective: To examine possible relationships between endometrial thickness and treatment outcome after IVF and embryo transfer, and to explore the role of potential confounding factors that may influence such relationships. Design: Retrospective study. Setting: A university-affiliated clinical IVF center. Patient(s): Patients undergoing IVF embryo transfer with their own oocytes. Intervention(s): None. Main Outcome Measure(s): Endometrial thickness was determined on the day of hcg administration, 2 days before oocyte retrieval. Clinical pregnancy was confirmed by ultrasound observation of fetal heart activity. Result(s): The study analyzed 897 IVF embryo transfer cycles. Treatment outcome (clinical pregnancy) after IVF embryo transfer was positively associated with increased endometrial thickness and peak E 2 concentrations in serum, and negatively associated with advanced age. Endometrial thickness was dependent on peak E 2 concentrations in serum, but was independent of patient age or duration of ovarian stimulation. Thin endometrium reduced PRs in relatively young patients ( 38 years old), in patients who required more than 10 days of gonadotropin stimulation, or in patients whose embryo transfers consisted of poor quality embryos. Conclusion(s): Increased endometrial thickness was associated with improved treatment outcome, but this association was dependant on patient age, duration of ovarian stimulation, and embryo quality. (Fertil Steril 2005;83: by American Society for Reproductive Medicine.) Key Words: Endometrial thickness, pregnancy rates, patient age, embryo quality Endometrial receptivity refers to a physiological state of the endometrium that is optimal for embryo implantation. Endometrial receptivity is brought about primarily by ovarian steroid hormones, and is synchronized with fertilization and embryo development (1). However, the molecular mechanism underlying endometrial receptivity is poorly understood and a reliable molecular indicator of endometrial receptivity remains elusive. Correlating molecular events in the endometrium with its receptivity is even more difficult in the human for both technical and ethical reasons. Measurement of the endometrial thickness under ultrasound is both atraumatic and simple, and has been studied as a possible indicator for endometrial receptivity and predictor for treatment outcome after IVF embryo transfer procedures (2 5). However, the findings from these studies were inconclusive largely due to limited sample sizes. The aims of this study were to examine possible relationships between endometrial thickness and treatment outcome after IVF embryo transfer with a relatively large sample size, and to determine what factors affect such relationships. Received October 6, 2003; revised and accepted September 17, Reprints requests: Xingqi Zhang, Ph.D., 675 N. Saint Clair Street, Room , Chicago, IL (FAX: ; x-zhang3@ northwestern.edu). MATERIALS AND METHODS This study included 897 IVF embryo transfer cycles performed between January 1999 and June 2002 at the IVF Program of the Feinberg School of Medicine of Northwestern University. Cycles using donor oocytes or cryopreserved embryos were excluded from this study. For patients who underwent more than one IVF embryo transfer cycle during the period of the study, only the first cycle was included. Endometrial thickness was not used as a criterion for cancellation of oocyte retrieval or embryo transfer. An exempt for patient consent was approved by the Institutional Review Board of Northwestern University. Procedures for controlled ovarian hyperstimulation, oocyte retrieval, IVF, embryo culture, and embryo transfer have been described elsewhere (6). Embryo transfer was usually performed on day 3, and postponed to day 5 only if more than four good quality embryos (8-cell, little or no fragmentation) were present on day 3. To assess treatment outcome, serum -hcg levels were measured 13 days after retrieval in all patients and repeated 2 days later if the first result was positive. Clinical pregnancy was confirmed by ultrasound observation of fetal cardiac activity 2 3 weeks after positive hcg tests. 336 Fertility and Sterility Vol. 83, No. 2, February /05/$30.00 Copyright 2005 American Society for Reproductive Medicine, Published by Elsevier Inc. doi: /j.fertnstert
2 Endometrial thickness was defined as the maximal distance between the echogenic interfaces of the myometrium and the endometrium measured in the plane through the central longitudinal axis of the uterus. The measurement recorded on the day of hcg injection was used for the analysis in this study. Peak serum E 2 concentration was defined as the value measured on the day of hcg injection. A step-wise multiple logistical regression analysis was used to assess the impact of age, endometrial thickness, peak E 2 level, and days of stimulation on treatment outcome. The possible dependence of endometrial thickness on patient age, peak serum E 2 concentration, or the number of days of ovarian stimulation before hcg injection was then assessed using a stepwise multiple linear regression analysis. Finally, study cycles were divided into two groups according to patient age at the beginning of the IVF cycle, days of gonadotropin stimulation, the quality of embryos for transfer, or the day of transfer. Each group was subdivided into three endometrial thickness groups ( 9 mm, 9 14 mm, and 14 mm), as in earlier studies (5, 7). A 2 test was used to compare differences in pregnancy rates (PR) between the three endometrial thickness groups separately for young ( 38 years old) or old patients ( 38 years old), short or long duration of gonadotropin stimulation ( 11 days or 11 days), transfers consisting of zero or at least one good quality embryo (8-cell stage without fragmentation on day 3, or blastocyst stage with well-defined inner cell mass and trophectoderm on day 5), and transfers performed on day 3 or day 5. The level of statistical significance was defined as P.05. In addition, the relationship between endometrial thickness and treatment outcome in each of the subgroups was also analyzed by a receiver operator characteristic (ROC) curve, using computer software from Analyse-It Ltd (Leeds, UK). RESULTS The age of the patients in this study ranged from 23 to 44 years, averaging 35.6 years. The overall PR per transfer was 43% (Table 1). Other demographic data in this study, including pregnancy history, length of infertility, and diagnosis were comparable to the latest national summary data published by the Centers for Disease Control. TABLE 1 Summary of demographic data. Total number of IVF embryo 897 transfer cycles Age (years) 35.6 / 3.7 Months of infertility 30 / 24 Diagnosis (%)* Male factor 26 Endometriosis/uterine 11 factor Ovarian factor 21 Tubal factor 15 Unexplained/other 36 No. of embryos transferred 2.6 / 0.9 Clinical pregnancy rates (%) 43.1 *The sum is greater than 100 because some patients have more than one diagnosis. Association of Cycle Characteristics with Treatment Outcome The relationships between treatment outcome (clinical pregnancy) and patient age, endometrial thickness, peak E 2 levels, and number of days of gonadotropin stimulation are presented in Table 2. Stepwise multiple logistical regression analyses showed that patient age is negatively correlated with treatment outcome, and that increasing endometrial thickness and peak serum E 2 levels are associated with improved PRs. Treatment outcome is independent of the number of days of stimulation. Factors Influencing Endometrial Thickness and its Effect on Treatment Outcome Endometrial thickness is positively correlated with peak E 2 concentrations in serum (Fig. 1), but is independent of patient age and the number of days of ovarian stimulation. When the IVF embryo transfer cycles were divided according to patient age, cycles with thin endometrium had lower PRs than the medium or thick groups only for the TABLE 2 Multiple logistical regression analyses. Independent variables Patient age Endometrial thickness Peak E 2 level Days of stimulation R P R Regression coefficient; R is considered statistically significant if P.05. Fertility and Sterility 337
3 FIGURE 1 peak estradiol concentration in serum. Correlation coefficient 0.06, P.04. FIGURE 3 treatment outcome: effect of duration ovarian stimulation. Value on top of each histogram represents number of clinical pregnancies/number IVF embryo transfer cycles. a vs. b, and a vs. c : P.001. relatively young patients (Fig. 2). Pregnancy rates were lower in older patients regardless of their endometrial thickness. Thin endometrium led to reduced PRs if the number of days of ovarian stimulation was 11 days (Fig. 3). Similarly, PRs were negatively affected by thin endometrium if the embryos available for transfer were of poor quality, or if embryo transfers were performed on day 3 (Table 3). The areas under the ROC curve of endometrial thickness vs. treatment outcome ranged from 0.51 to 0.54 (95% confidence interval, ) for each of the subgroups by patient age, duration of stimulation, embryo quality, and day of embryo transfer. This suggests that the data analyzed in this study cannot establish a true endometrial thickness cutoff value below which pregnancy would not occur. FIGURE 2 treatment outcome: effect of patient age. Value on top of each histogram represents number of clinical pregnancies/number IVF embryo transfer cycles. a vs. b, a vs. c, and b vs. c : P.001. DISCUSSION Many characteristics of the human endometrium, including thickness, structure, and vascularization, can be studied noninvasively by ultrasound. Among these characteristics, endometrial thickness is probably the easiest and most reproducible measurement of endometrial development (8, 9). Conflicting reports exist concerning possible relationships between endometrial thickness and treatment outcome after IVF embryo transfer presumably because of the multiple confounding factors that may affect such a relationship (2 5). This study examined the possible association of endometrial thickness with treatment outcome, as well as factors that may affect endometrial thickness and its relationship with treatment outcome. Most studies in the literature compared the mean endometrial thickness between IVF embryo transfer cycles that resulted in a pregnancy and those that did not result in pregnancy, and very few of the reported studies analyzed more than 200 cycles (2). In a recent study of 1,186 IVF cycles using an ovarian stimulation protocol similar to the current study, the odds ratio for achieving a pregnancy was reduced if the endometrium was thin (4). This is supported by the findings of the current study. Studies that failed to find an association between endometrial thickness and treatment outcome either had a much smaller sample size (e.g., 10, 11) or used different ovarian stimulation protocols, such as the clomiphene citrate hmg ovarian stimulation protocol (e.g., 12, 13). An endometrial thickness 14 mm was found to be detrimental for successful pregnancy after IVF (3). However, data from a more recent study (5) and those from this study do not support this finding. 338 Zhang et al. Endometrial thickness and IVF outcome Vol. 83, No. 2, February 2005
4 TABLE 3 treatment outcome: effect of embryo quality or day of embryo transfer. Endometrial thickness (mm) Number of good-quality embryos in each transfer Day of embryo transfer At least one None Day 3 Day /93 (44) 6/40 (15) a 36/134 (27) a 39/98 (40) /469 (47) 36/118 (31) b 132/357 (37) b 91/156 (58) 14 62/117 (53) 23/60 (38) c 52/114 (46) c 32/58 (55) Treatment outcome is presented as clinical pregnancies/embryo transfers (%); within the same column, a vs. b, and a vs. c : P.05 ( 2 test). The possible associations of PRs with ovarian responses were analyzed in more detail in an earlier study (6). The present study, with a substantially larger sample size, confirmed our previous findings in that PRs are positively associated with peak E 2 levels but are independent of the length of ovarian stimulation (Table 2), the number of large follicles, or the number of oocytes retrieved (data not shown). An increase in endometrial thickness has been associated with younger patients and patients who have high peak serum E 2 levels (7). However, it is difficult to discern from that study whether age and E 2 levels can independently affect the endometrial thickness. If a correlation between endometrial thickness and patient age exits, the association of increased endometrial thickness with improved PRs could well be attributed to an age effect. Using a stepwise regression analysis, the present study found that endometrial thickness was dependent on serum E 2 levels, but not on patient age (Fig. 1). Because endometrial thickness is independent of patient age, it is probably not a proxy for any age-related effect on treatment outcome. The length of ovarian stimulation may presumably affect the endometrial thickness because a longer period of ovarian stimulation may allow additional time for the endometrium to develop. However, this assumption was not supported by the stepwise multiple regression analysis that failed to demonstrate a statistically significant relationship between the number of days of ovarian stimulation and endometrial thickness. Maternal age is a well-known determinant of fertility and treatment outcome after IVF embryo transfer (14 16). When the possible impact of endometrial thickness on treatment outcome was examined separately according to patient age, endometrial thickness was found to be positively associated with treatment outcome only for younger patients ( 38 years old). However, PRs were low in the older patients group regardless of their endometrial thickness. This finding suggests that the poor prognostic factors associated with advanced reproductive age cannot be compensated for by optimal endometrial development. Conversely, high quality embryos may be able to compensate for poor endometrial development. Although the duration of ovarian stimulation did not appear to influence endometrial thickness, the length of ovarian stimulation was a confounding factor influencing the impact of endometrial thickness on treatment outcome. Thus, the current results indicate that a thin endometrial strip predicts poor treatment outcome only if the length of ovarian stimulation is greater than the median duration. It is possible that a shorter period of gonadotropin administration reflects better ovarian function and therefore better oocyte quality, which in turn can compensate for less optimal endometrial development. When examined separately by the day of embryo transfer, treatment outcome is negatively affected by thin endometrium only for day 3 transfers but not for day 5 transfers. Furthermore, thin endometrium is associated with reduced PRs only for transfers in the absence of good quality embryos, but not for transfers with at least one good quality embryo. Taken together, our findings suggest that the requirement for optimal endometrial environment is less stringent when high quality embryos are available for transfer. Alternatively, the additional 2-day delay may provide an inadequate endometrium with additional time to develop. In conclusion, these data suggest that endometrial thickness has predictive value for treatment outcome in younger patients, in patients who require prolonged gonadotropin stimulation, or in those who have poor quality embryos. However, this study failed to establish a cutoff value for endometrial thickness below which pregnancy would not occur. With the exception of the age parameter, these results, taken together, suggest that inadequate endometrial thickness is primarily a problem in patients with relatively poor oocyte/embryo quality. The absence of an association be- Fertility and Sterility 339
5 tween endometrial thickness and PRs in the older patients might be due to the dominant impact of age per se on PRs. Acknowledgments: The authors wish to acknowledge the diligent technical assistance of the Embryology Laboratory staff: Karen Horan, Kathleen Kallmann, Yelena Pasman, Melanie Scott, and Gabriel Levine. REFERENCES 1. Psychoyos A. Hormonal control of ovoimplantation. Vitamins & Hormones 1973;31: Freidler S, Schenker JG, Herman A, Lewin A. The role of ultrasonography in the evaluation of endometrial receptivity following assisted reproductive treatments: a critical review. Hum Reprod Update 1996; 2: Weissman A, Gotileb L, Casper RF. The detrimental effect of increased endometrial thickness on implantation and pregnancy rates and outcome in an in vitro fertilization program. Fertil Steril 1999;71: De Geyter C, Schmitter M, De Geyter M, Nieschlag E, Holzgreve W, Schneider HP. Prospective evaluation of the ultrasound appearance of the endometrium in a cohort of 1,186 infertile women. Fertil Steril 2000;73: Dietterich C, Check JH, Choe JK, Nazari A, Lurie D. Increased endometrial thickness on the day of human chorionic gonadotropin (hcg) injection does not adversely effect pregnancy or implantation rates following in vitro fertilization-embryo transfer (IVF-ET). Fertil Steril 2002;77: Chen C-H, Zhang X, Barnes R, Confino E, Milad M, Puscheck E, et al. Relationship between peak serum estradiol levels and treatment outcome in in vitro fertilization cycles after embryo transfer on day 3 or day 5. Fertil Steril 2003;80: Noyes N, Liu HC, Sultan K, Schattman G, Rosenwaks Z. Endometrial thickness appears to be a significant factor in embryo implantation in in-vitro fertilization. Hum Reprod 1995;10: Delisle MF, Villeneuve M, Boulvain M. Measurement of endometrial thickness with transvaginal ultrasonography: is it reproducible? J Ultrasound Med 1998;17: Spandorfer SD, Arrendondo-Soberon F, Loret de Mola JR, Feinberg RF. Reliability of intraobserver and interobserver sonographic endometrial stripe thickness measurements. Fertil Steril 1998;70: Coulam CB, Bustillo M, Soensken DM, Britten S. Ultrasonographic predictors of implantation after assisted reproduction. Fertil Steril 1994; 62: Serafini P, Batzofin J, Nelson J, Olive D. Sonographic uterine predictors of pregnancy in women undergoing ovulation induction for assisted reproductive treatments. Fertil Steril 1994;62: Oliveira JB, Baruffi RL, Mauri AL, Petersen CG, Campos MS, Franco JG Jr. Endometrial ultrasonography as a predictor of pregnancy in an in-vitro fertilization programme. Hum Reprod 1993;8: Strohmer H, Obruca A, Radner KM, Feichtinger W. Relationship of the individual uterine size and the endometrial thickness in stimulated cycles. Fertil Steril 1994;61: Van Kooij RJ, Looman CW, Habbema JD, Dorland M, te Velde ER. Age-dependent decrease in embryo implantation rate after IVF. Fertil Steril 1996;66: Yaron Y, Botchan A, Amit A, Kogosowski A, Yovel I, Lessing JB. Endometrial receptivity: the age-related decline in pregnancy rates and the effect of ovarian function. Fertil Steril 1993;60: Dew JE, Don RA, Hughes GJ, Johnson TC, Steigrad SJ. The influence of advanced age on the outcome of assisted reproduction. J Assist Reprod Genet 1998;15: Zhang et al. Endometrial thickness and IVF outcome Vol. 83, No. 2, February 2005
DSJUOG ABSTRACT INTRODUCTION /jp-journals
Firoozeh Ahmadi et al ORIGINAL ARTICLE 10.5005/jp-journals-10009-1491 A Two-year Cross-sectional Prospective Study for Assessment of Endometrial Thickness and Volume using Three-dimensional Transvaginal
More informationChanges in measured endometrial thickness predict in vitro fertilization success
Changes in measured endometrial thickness predict in vitro fertilization success Grant D. E. McWilliams, D.O., a and John L. Frattarelli, M.D. b a Tripler Army Medical Center, Honolulu, Hawaii; and b Reproductive
More informationCarole Dietterich, R.T., R.D.M.S., Jerome H. Check, M.D., Ph.D., Jung K. Choe, M.D., Ahmad Nazari, M.D., and Deborah Lurie, Ph.D.
FERTILITY AND STERILITY VOL. 77, NO. 4, APRIL 2002 Copyright 2002 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A. Increased endometrial
More informationOriginal Article. KEY WORDS: Doppler, endometrial thickness, in-vitro fertilization
Original Article Predictive value of endometrial thickness, pattern and sub-endometrial blood flows on the day of hcg by 2D Doppler in in-vitro fertilization cycles: A prospective clinical study from a
More informationPredicting factors for endometrial thickness during treatment with assisted reproductive technology
Predicting factors for endometrial thickness during treatment with assisted reproductive technology Wiser Amir, M.D., a Baum Micha, M.D., a Hourwitz Ariel, M.D., a Lerner-Geva Liat, M.D., Ph.D., b Dor
More informationThe effect of endometrial thickness on IVF/ICSI outcome
Human Reproduction Vol.18, No.11 pp. 2337±2341, 2003 DOI: 10.1093/humrep/deg461 The effect of endometrial thickness on IVF/ICSI outcome P.Kovacs 1,3, Sz.Matyas 1, K.Boda 2 and S.G.Kaali 1 1 Kaali Institute
More informationA Tale of Three Hormones: hcg, Progesterone and AMH
A Tale of Three Hormones: hcg, Progesterone and AMH Download the Ferring AR ipad/iphone app from the Apple Store: http://bit.ly/1okk74m Interpreting Follicular Phase Progesterone Ernesto Bosch IVI Valencia,
More informationThe association between anti-müllerian hormone and IVF pregnancy outcomes is influenced by age
Reproductive BioMedicine Online (2010) 21, 757 761 www.sciencedirect.com www.rbmonline.com ARTICLE The association between anti-müllerian hormone and IVF pregnancy outcomes is influenced by age Jeff G
More informationInterpreting follicular Progesterone: Late follicular Progesterone to Estradiol ratio is not influenced by protocols or gonadotropins used
Interpreting follicular Progesterone: Late follicular Progesterone to Estradiol ratio is not influenced by protocols or gonadotropins used Ellenbogen A., M.D., Shalom-Paz E., M.D, Asalih N., M.D, Samara
More informationMedicine. Wei Yang, MMed, Tao Zhang, MMed, Zhou Li, PhD, Xinling Ren, PhD, Bo Huang, PhD, Guijin Zhu, MMed, Lei Jin, PhD. Observational Study
Observational Study Medicine Combined analysis of endometrial thickness and pattern in predicting clinical outcomes of frozen embryo transfer cycles with morphological good-quality blastocyst A retrospective
More informationIVF treatment should not be postponed for patients with high basal FSH concentrations
Reproductive BioMedicine Online (2010) 21, 631 635 www.sciencedirect.com www.rbmonline.com SHORT COMMUNICATION IVF treatment should not be postponed for patients with high basal FSH concentrations Ettie
More informationN.A.Bersinger 1, A.Brandenberger, E.Berger, C.K.Baumann and M.H.Birkhäuser
Human Reproduction vol.13 no.7 pp.1962 1967, 1998 Serum pregnancy-specific β 1 -glycoprotein before embryo transfer is related to endometrial thickness and to outcome prognosis in women undergoing in-vitro
More informationObjective: To study the role of sildenafil on the echogenic pattern of endometrium in infertile patients with bad endometrium.
The effect of Sildenafil on endometrial characters in patients with infertility Ali F. Al-Assadi, F.I.C.O.G.,C.A.B.O.G.1. Sajeda A. Al-Rubaye, F.I.C.O.G.1 Zainab Laaiby, M.B.Ch.B.2 (1- Assist. Prof./Basra
More informationEvaluation of cycle-to-cycle variation of endometrial. responsiveness using transvaginal sonography in women undergoing assisted reproduction
Ultrasound Obstet Gynecol 2002; 19: 484 489 Evaluation of cycle-to-cycle variation of endometrial Blackwell Science, Ltd responsiveness using transvaginal sonography in women undergoing assisted reproduction
More informationEndometrial Preparation for Frozen Embryo Transfer (FET) Zitao Liu, MD, PhD New Hope Fertility Center, NY
Endometrial Preparation for Frozen Embryo Transfer (FET) Zitao Liu, MD, PhD New Hope Fertility Center, NY Natural Cycle FET Protocol for endometrial preparation N FET, including modified N FET HRT FET:
More informationRelation between the Number and Size of Follicles in Ovulation Induction and the Rate of Pregnancy
Relation between the Number and Size of Follicles in Ovulation Induction and the Rate of Pregnancy Aseel Mosa Jabber M.SC.G.O. The department of Obstetrics and Gynecology, Faculty of Medicine Thi-qar university
More informationPower Doppler Endometrial Evaluation as a Method for the Prognosis of Embryo Implantation in an ICSI Program
CLINICAL ASSISTED REPRODUCTION Power Doppler Endometrial Evaluation as a Method for the Prognosis of Embryo Implantation in an ICSI Program PAULA CONTART, 1 RICARDO LUIZ RAZERA BARUFFI, 1 JOAQUIM COELHO,
More informationElena H. Yanushpolsky, M.D., a Shelley Hurwitz, Ph.D., b Eugene Tikh, B.S., c and Catherine Racowsky, Ph.D. a
FERTILITY AND STERILITY VOL. 80, NO. 1, JULY 2003 Copyright 2003 American Society for Reproductive Medicine Published by Elsevier Inc. Printed on acid-free paper in U.S.A. Predictive usefulness of cycle
More informationIN VITRO FERTILIZATION
FERTILITY AND STERILITY VOL. 79, NO. 1, JANUARY 2003 Copyright 2003 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A. IN VITRO FERTILIZATION
More informationPredictive factors of successful pregnancy after assisted reproductive technology in women aged 40 years and older
Reprod Med Biol (2009) 8:145 149 DOI 10.1007/s12522-009-0023-z ORIGINAL ARTICLE Predictive factors of successful pregnancy after assisted reproductive technology in women aged 40 years and older Akihisa
More informationAssisted Reproduction. Rajeevi Madankumar, 1,2 James Tsang, 1 Martin L. Lesser, 1 Daniel Kenigsberg, 1 and Steven Brenner 1 INTRODUCTION
( C 2005) DOI: 10.1007/s10815-005-4912-8 Assisted Reproduction Clomiphene citrate induced ovulation and intrauterine insemination: effect of timing of human chorionic gonadotropin injection in relation
More informationin vitro fertilization
FERTILITY AND STERILITY VOL 69, NO. 6, JUNE 1998 Copyright (#1998 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A. Elevated levels of basal
More informationOvarian response in three consecutive in vitro fertilization cycles
FERTILITY AND STERILITY VOL. 77, NO. 4, APRIL 2002 Copyright 2002 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A. Ovarian response in
More informationAnalysis of factors affecting embryo implantation
Analysis of factors affecting embryo implantation Andrew L.Speirst, H.W.G.Baker and Nusratudin Abdullah The Royal Women's Hospital, Melbourne, Australia ITo whom correspondence should be addressed Introduction
More informationTimur Giirgan, M.D.* Bulent Urman, M.D. Hakan Yarali, M.D. Hakan E. Duran, M.D.
FERTILITY AND STEFULI~ Vol. 68, No. 3, September 1997 Copyright 1997 American Society for Reproductive Medicine Printed on acid-free paper in U. S. A. Published by Elsevier Science Inc. Follicle-stimulating
More informationProgesterone and clinical outcomes
Synchronization of Slowly Developing Embryos Restores Implantation Success Richard T. Scott, Jr, MD, HCLD Clinical and Scientific Director, Reproductive Medicine Associates of New Jersey Professor and
More informationSonographic determination of a possible adverse effect of domiphene citrate on endometrial growth
Human Reproduction vol.5 no.6 pp.670-674, 1990 Sonographic determination of a possible adverse effect of domiphene citrate on endometrial growth Yael Gonen 1 and Robert F.Casper Division of Reproductive
More informationIs it the seed or the soil? Arthur Leader, MD, FRCSC
The Physiological Limits of Ovarian Stimulation Is it the seed or the soil? Arthur Leader, MD, FRCSC Objectives 1. To consider how ovarian stimulation protocols work in IVF 2. To review the key events
More informationOvarian age-based stimulation of young women with diminished ovarian reserve results in excellent pregnancy rates with in vitro fertilization
Ovarian age-based stimulation of young women with diminished ovarian reserve results in excellent pregnancy rates with in vitro fertilization Norbert Gleicher, M.D., and David Barad, M.D. Center for Human
More informationto find a more reliable scoring system to associate embryo morphology and pregnancy outcome.
Embryo quality is more important for younger women whereas age is more important for older women with regard to in vitro fertilization outcome and multiple pregnancy Tsung-Hsien Lee, M.D., M.Sc., a,b,c
More informationORIGINAL ARTICLE ENDOMETRIAL THICKNESS AND PREGNANCY OUTCOME IN IUI CYCLES
ENDOMETRIAL THICKNESS AND PREGNANCY OUTCOME IN IUI CYCLES Asha Verma 1, Rekha Mulchandani 2, Nupur Lauria 3, Kusum Verma 4, Sunita Himani 5 HOW TO CITE THIS ARTICLE: Asha Verma, Rekha Mulchandani, Nupur
More informationIN VITRO FERTILIZATION
FERTILITY AND STERILITY VOL. 82, NO. 4, OCTOBER 2004 Copyright 2004 American Society for Reproductive Medicine Published by Elsevier Inc. Printed on acid-free paper in U.S.A. IN VITRO FERTILIZATION Prognostic
More informationAntral follicle count as a predictor of ovarian response
Original article Antral follicle count as a predictor of ovarian response N. Lonegro a, N. Napoli a,*, R. Pesce b and C. Chacón a a Imaging Department, Hospital Italiano de Buenos Aires, Ciudad Autónoma
More informationThree-dimensional ultrasonographic ovarian measurements and in vitro fertilization outcome are related to age
FERTILITY AND STERILITY VOL. 79, NO. 1, JANUARY 2003 Copyright 2003 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A. Three-dimensional
More informationArticle Prediction of pituitary down-regulation by evaluation of endometrial thickness in an IVF programme
RBMOnline - Vol 8. No 5. 2004 595-599 Reproductive BioMedicine Online; www.rbmonline.com/article/1065 on web 17 March 2004 Article Prediction of pituitary down-regulation by evaluation of endometrial thickness
More informationAre all-freeze cycles & frozen-thawed embryo transfers improving IVF outcomes?
Are all-freeze cycles & frozen-thawed embryo transfers improving IVF outcomes? Andrea Weghofer Foundation for Reproductive Medicine 2017 New York, November 16-19 Conflict of interest No relevant financial
More informationEndometrial thickness affects the outcome of in vitro fertilization and embryo transfer in normal responders after GnRH antagonist administration
Wu et al. Reproductive Biology and Endocrinology 2014, 12:96 RESEARCH Open Access Endometrial thickness affects the outcome of in vitro fertilization and embryo transfer in normal responders after GnRH
More informationEstradiol Level on Day 2 and Day of Trigger: A Potential Predictor of the IVF-ET Success
DOI 10.1007/s13224-014-0515-6 ORIGINAL ARTICLE Estradiol Level on Day 2 and Day of Trigger: A Potential Predictor of the IVF-ET Success Prasad Sudha Kumar Yogesh Singhal Megha Sharma Shashi Received: 27
More informationDoes a woman s educational attainment influence in vitro fertilization outcomes?
Does a woman s educational attainment influence in vitro fertilization outcomes? The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters.
More informationPrognostic factors of ovarian response and IVF outcome in patients with deep infiltrating endometriosis Claire GAUCHE-CAZALIS, Chadi YAZBECK
Prognostic factors of ovarian response and IVF outcome in patients with deep infiltrating endometriosis Claire GAUCHE-CAZALIS, Chadi YAZBECK Obstetrics Gynecology and Reproductive Medicine Department Bichat
More informationLOW RESPONDERS. Poor Ovarian Response, Por
LOW RESPONDERS Poor Ovarian Response, Por Patients with a low number of retrieved oocytes despite adequate ovarian stimulation during fertility treatment. Diagnosis Female About Low responders In patients
More informationSupraphysiological estradiol levels do not affect oocyte and embryo quality in oocyte donation cycles
Human Reproduction Vol.17, No.1 pp. 83 87, 2002 Supraphysiological estradiol levels do not affect oocyte and embryo quality in oocyte donation cycles Joseph E.Peña, Peter L.Chang 1, Lai-King Chan, Khaled
More informationComparison of tamoxifen and clomiphene citrate for induction of ovulation in cases with thin endometrium
Original Article Comparison of tamoxifen and clomiphene citrate for induction of ovulation in cases with thin endometrium Department of Obstetrics and Gynecology, Faculty of Medicine, Suez Canal University
More informationSubject: Infertility Policy Effective Date: 01/07 Revision Date: 01/2018
Subject: Infertility Policy Effective Date: 01/07 Revision Date: 01/2018 DESCRIPTION Infertility is the condition of an individual who has been unable to conceive or produce conception during a period
More informationAntral follicle count in clinical practice: analyzing clinical relevance
CONTROVERSY I Antral follicle count in clinical practice: analyzing clinical relevance Albert Hsu, M.D., Margaret Arny, Ph.D., Alexander B. Knee, M.S., Carrie Bell, M.D., Elizabeth Cook, Ph.D., Amy L.
More informationSuperovulation with human menopausal gonadotropins is associated with endometrial gland-stroma dyssynchrony*
aes FERTILITY AND STERILITY Vol. 61, No.4, April 1994 Copyright ee) 1994 The American Fertility Society Printed on acid-free paper in U. S. A. r I Superovulation with human menopausal gonadotropins is
More informationIVF Protocols: Hyper & Hypo-Responders, Implantation
IVF Protocols: Hyper & Hypo-Responders, Implantation Midwest Reproductive Symposium June 4-5, 4 2010 Subset : Hyper-Responders Mark R. Bush, MD, FACOG, FACS OBJECTIVE: Important goals for the PCOS patient
More informationFreeze-All Policy: Is It Right for Everyone?
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/online-education/non-certified-non-accredited/freeze-all-policy-it-righteveryone/9879/
More informationInfertility treatment
In the name of God Infertility treatment Treatment options The optimal treatment is one that provide an acceptable success rate, has minimal risk and is costeffective. The treatment options are: 1- Ovulation
More informationNeil Goodman, MD, FACE
Initial Workup of Infertile Couple: Female Neil Goodman, MD, FACE Professor of Medicine Voluntary Faculty University of Miami Miller School of Medicine Scope of Infertility in the United States Affects
More informationIn Vitro Fertilization and Embryo Transfer
Acta Medica et Biologica Vol. 41, No.4, 171-176, 1993 The Influence of Low Ovarian Response on the Results of In Vitro Fertilization and Embryo Transfer Hirofumi HIRASAWA Department of Obstetrics and Gynecology,
More informationOriginal Article. Fauzia HaqNawaz 1*, Saadia Virk 2, Tasleem Qadir 3, Saadia Imam 3, Javed Rizvi 2
Original Article Comparison of Letrozole and Clomiphene Citrate Efficacy along with Gonadotrophins in Controlled Ovarian Hyperstimulation for Intrauterine Insemination Cycles Fauzia HaqNawaz 1*, Saadia
More informationSynchronization between embryo development and endometrium is a contributing factor for rescue ICSI outcome
Reproductive BioMedicine Online (2012) 24, 527 531 www.sciencedirect.com www.rbmonline.com ARTICLE Synchronization between embryo development and endometrium is a contributing factor for rescue ICSI outcome
More informationObesity does not impact implantation rates or pregnancy outcome in women attempting conception through oocyte donation
IN VITRO FERTILIZATION Obesity does not impact implantation rates or pregnancy outcome in women attempting conception through oocyte donation Allison Styne-Gross, M.D., a Karen Elkind-Hirsch, Ph.D., b
More informationIn Vitro Fertilization in Clomiphene-Resistant Women with Polycystic Ovary Syndrome
Original Article Effect of Laparoscopic Ovarian Drilling on Outcomes of In Vitro Fertilization in Clomiphene-Resistant Women with Polycystic Ovary Syndrome Maryam Eftekhar, M.D. 1, Razieh Deghani Firoozabadi,
More informationStudy on Several Factors Involved in IVF-ET of Human Beings
Study on Several Factors Involved in IVF-ET of Human Beings Lei X 1, Zhuoran W 1, Bin L 1, Huiming L 1, Hongxiu Z 1, Yajuan Z 1, Yingbo Q 1, Guixue Z 2 1 The First Clinical College of Harbin Medical University,
More informationThe effects of prior gravidity on the outcomes of ovum donor and own oocyte cycles
FERTILITY AND STERILITY Vol. 65, No.3, March 1996 Copyright t';, 1996 American Society for Reproductive Medicine Printed on acid-free paper in U. s. A. The effects of prior gravidity on the outcomes of
More informationlbt lab tests t Conrolled Ovarian Hyperstimulation Dr Soheila Ansaripour
lbt lab tests t and Conrolled Ovarian Hyperstimulation Dr Soheila Ansaripour Research Instituteof Avicenna 4/23/2012 Why good prediction of poor response good prediction i of OHSS application appropriate
More informationMenstruation-free interval and ongoing pregnancy in IVF using GnRH antagonists
Human Reproduction Vol.21, No.4 pp. 1012 1017, 2006 Advance Access publication December 8, 2005. doi:10.1093/humrep/dei415 Menstruation-free interval and ongoing pregnancy in IVF using GnRH antagonists
More informationResearch Article Serum hcg Levels following the Ovulatory Injection: Associations with Patient Weight and Implantation Time
Obstetrics and Gynecology International Volume 215, Article ID 52714, 6 pages http://dx.doi.org/1.1155/215/52714 Research Article Serum hcg Levels following the Ovulatory Injection: Associations with Patient
More informationOriginal Article Impact of estrogen-to-oocyte ratio on live birth rate in women undergoing in vitro fertilization and embryo transfer
Int J Clin Exp Med 2015;8(7):11327-11331 www.ijcem.com /ISSN:1940-5901/IJCEM0008838 Original Article Impact of estrogen-to-oocyte ratio on live birth rate in women undergoing in vitro fertilization and
More informationComparison of single versus double intra uterine insemination
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Pathak B. Int J Reprod Contracept Obstet Gynecol. 2017 Dec;6(12):5277-5281 www.ijrcog.org DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20175091
More informationIVM in PCOS patients. Introduction (1) Introduction (2) Michael Grynberg René Frydman
IVM in PCOS patients Michael Grynberg René Frydman Department of Obstetrics and Gynecology A. Beclere Hospital, Clamart, France Maribor, Slovenia, 27-28 February 2009 Introduction (1) IVM could be a major
More informationDoes previous response to clomifene citrate influence the selection of gonadotropin dosage given in subsequent superovulation treatment cycles?
J Assist Reprod Genet (26) 23:427 431 DOI 1.17/s1815-6-965-x ASSISTED REPRODUCTION Does previous response to clomifene citrate influence the selection of gonadotropin dosage given in subsequent superovulation
More informationINDICATIONS OF IVF/ICSI
PROCESS OF IVF/ICSI INDICATIONS OF IVF/ICSI IVF is most clearly indicated when infertility results from one or more causes having no other effective treatment; Tubal disease. In women with blocked fallopian
More informationSerial uterine artery Doppler velocity parameters and human uterine receptivity in IVF/ICSI cycles
Ultrasound Obstet Gynecol 2008; 31: 432 438 Published online 4 February 2008 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/uog.5179 Serial uterine artery Doppler velocity parameters
More informationLuteal phase rescue after GnRHa triggering Progesterone and Estradiol
Luteal phase rescue after GnRHa triggering Progesterone and Estradiol L. Engmann University of Connecticut Disclaimer Fertility Speaker Bureau Merck Pharmaceuticals Introduction GnRH agonist is effective
More informationOptimizing Fertility and Wellness After Cancer. Kat Lin, MD, MSCE
Optimizing Fertility and Wellness After Cancer Kat Lin, MD, MSCE University Reproductive Care University of Washington Nov. 6, 2010 Optimism in Numbers 5-year survival rate 78% for all childhood cancers
More informationAgonist versus antagonist in ICSI cycles: a randomized trial and cost effectiveness analysis Badrawi A, Zaki S, Al-Inany H, Ramzy A M, Hussein M
Agonist versus antagonist in ICSI cycles: a randomized trial and cost effectiveness analysis Badrawi A, Zaki S, Al-Inany H, Ramzy A M, Hussein M Record Status This is a critical abstract of an economic
More informationIN VITRO FERTILIZATION
IN VITRO FERTILIZATION FERTILITY AND STERILITY VOL. 74, NO. 2, AUGUST 2000 Copyright 2000 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A.
More informationUnderstanding Infertility, Evaluations, and Treatment Options
Understanding Infertility, Evaluations, and Treatment Options Arlene J. Morales, M.D., F.A.C.O.G. Fertility Specialists Medical Group, Inc. What We Will Cover Introduction What is infertility? Briefly
More informationPatricia T Jimenez 1*, Samantha B Schon 2, Randall R Odem 2, Valerie S Ratts 2 and Emily S Jungheim 2
Jimenez et al. Reproductive Biology and Endocrinology 2013, 11:35 RESEARCH Open Access A retrospective cross-sectional study: fresh cycle endometrial thickness is a sensitive predictor of inadequate endometrial
More informationOvarian Response to Gonadotrophin Stimulation in Patients with Previous Endometriotic Cystectomy
Ovarian Response to Gonadotrophin Stimulation in Patients with Previous Endometriotic Cystectomy M.E. Coccia, F. Cammilli, L. Ginocchini, F. Borruto* and F. Rizzello Dept Gynaecology Perinatology and Human
More informationMilder is better? Advantages and disadvantages of "mild" ovarian stimulation for human in vitro fertilization
Milder is better? Advantages and disadvantages of "mild" ovarian stimulation for human in vitro fertilization Revelli et al. Reproductive Biology and Endocrinology 2011, 9:25 Presenter: R2 孫怡虹 Background
More informationThe Comparison of Clinical Outcomes between GnRH Agonist Long Protocol and GnRH Antagonist Short Protocol in Oocyte Donation Cycles
: 30 1 2003 Kor J Fertil Steril, Vol 30, No 1, 2003, 3 The Comparison of Clinical Outcomes between GnRH Agonist Long Protocol and GnRH Antagonist Short Protocol in Oocyte Donation Cycles Jeong Ho Rhee,
More informationreach levels up to 10 times or more those found during spontaneous cycles (2, 3).
Estradiol production during controlled ovarian hyperstimulation correlates with treatment outcome in women undergoing in vitro fertilization embryo transfer Mohamed F. M. Mitwally, M.D., a,c Helmata S.
More informationPrognosticating ovarian reserve by the new ovarian response prediction index
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Tak A et al. Int J Reprod Contracept Obstet Gynecol. 2018 Mar;7(3):1196-1200 www.ijrcog.org DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20180917
More informationKisspeptin: A Potential Factor for Unexplained Infertility and Impaired Embryo Implantation
Original Article Kisspeptin: A Potential Factor for Unexplained Infertility and Impaired Embryo Implantation Aaida Mumtaz, MBBS. 1#, Aqsa Khalid, MBBS. 1#, Zehra Jamil, M.Phil. 2, Syeda Sadia Fatima, Ph.D.
More informationConception rate after in vitro fertilization in patients who conceived in a previous cycle
FERTILITY AND STERILITY Copyright
More informationMilan Reljič, Ph.D., Veljko Vlaisavljević, Ph.D., Vida Gavrić, M.Sc., Borut Kovačič, Ph.D.,
FERTILITY AND STERILITY VOL. 75, NO. 3, MARCH 2001 Copyright 2001 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A. Value of the serum estradiol
More informationAn Overview of Uterine Factors That Influence Implantation
An Overview of Uterine Factors That Influence Implantation Bulent Urman, M.D. Dept. of Obstetrics and Gynecology Koc University School of Medicine Assisted Reproduction Unit, American Hospital, ISTANBUL
More informationPremature progesterone elevation impairs implantation and live birth rates in GnRH-agonist IVF/ICSI cycles
Arch Gynecol Obstet (2010) 281:747 752 DOI 10.1007/s00404-009-1248-0 REPRODUCTIVE MEDICINE Premature progesterone elevation impairs implantation and live birth rates in GnRH-agonist IVF/ICSI cycles Esra
More informationERA. Endometrial Receptivity Analysis. Patented since
Endometrial Receptivity Analysis Patented since 2009 www.igenomix.com ERA ERA analyzes by NGS the expression of 236 genes in order to determine the personalized window of implantation for each patient.
More informationCURRICULUM VITAE. Guttenberg, NJ th Ave New York, NY B.S. Degree, Trinity College, Hartford, Ct.
Page 1 CURRICULUM VITAE ALTHEA M. O'SHAUGHNESSY, M.D., FACOG PLACE OF BIRTH: CITIZENSHIP: New York, N.Y. U.S.A. PERSONAL: Married: John Children: Sean Alison HOME ADDRESS: BUSINESS ADDRESS: 32 Lydia Drive
More informationSample size a Main finding b Main limitations
1 Table 1. Available studies on the relation between endometriosis and miscarriage (1995-2015). Study (citation) Country Study period Study design Sample size a Main finding b Main limitations Matoras
More informationPDF hosted at the Radboud Repository of the Radboud University Nijmegen
PDF hosted at the Radboud Repository of the Radboud University Nijmegen The following full text is a publisher's version. For additional information about this publication click this link. http://hdl.handle.net/2066/22797
More informationAssociation of estradiol levels on the day of hcg administration and pregnancy achievement in IVF: a systematic review
Human Reproduction Vol.19, No.11 pp. 2446 2453, 2004 Advance Access publication October 7, 2004 doi:10.1093/humrep/deh473 Association of estradiol levels on the day of hcg administration and pregnancy
More informationFollicle-stimulating hormone/luteinizing hormone ratio as an independent predictor of response to controlled ovarian stimulation
Follicle-stimulating hormone/luteinizing hormone ratio as an independent predictor of response to controlled ovarian stimulation Aim: To determine whether a follicle-stimulating hormone (FSH)/luteinizing
More informationPerformance of patients with a ''frozen pelvis" in an in vitro fertilization program
FERTILITY AND STERILITY Copyright 1987 The American Fertility Society Printed in U.8A. Performance of patients with a ''frozen pelvis" in an in vitro fertilization program David Molloy, F.R.A.C.O.G.*t
More information(BMI)=18.0~24.9 kg/m 2 ;
33 10 Vol.33 No.10 2013 10 Oct. 2013 Reproduction & Contraception doi: 10.7669/j.issn.0253-357X.2013.10.0672 E-mail: randc_journal@163.com - ( 400013) : () GnRH-a - () : IVF- ET 233 A (I~II 102 ) B (III~IV
More informationInfertility in Women over 35. Alison Jacoby, MD Dept. of Ob/Gyn UCSF
Infertility in Women over 35 Alison Jacoby, MD Dept. of Ob/Gyn UCSF Learning Objectives Review the effect of age on fertility Fertility counseling for the patient >35 - timing - lifestyle - workup Fertility
More informationMinimal stimulation achieves pregnancy rates comparable to human menopausal gonadotropins in the treatment of infertility*
FERTILITY AND STERILITY Copyright :Q' 1996 American Society for Reproductive Medicine Printed on acid-free paper in U. S. A. Minimal stimulation achieves pregnancy rates comparable to human menopausal
More informationJMSCR Vol 06 Issue 09 Page September 2018
www.jmscr.igmpublication.org Impact Factor (SJIF): 6.379 Index Copernicus Value: 79.54 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v6i9.53 Role of Anti-Mullerian Hormone
More informationNew York Science Journal 2014;7(4)
The Minimal Stimulation Protocol for ICSI: An Alternative Protocol for Ovarian Stimulation Adel Elsayed Ibrahim, MD Assisted Reproductive Unit Azhar University Adel.sayed29@gmail.com Abstract: Background:
More informationProstaglandin therapy during the proliferative phase improves pregnancy rates following frozen embryo transfer in a hormone replacement cycle
bs_bs_banner doi:10.1111/jog.12328 J. Obstet. Gynaecol. Res. Vol. 40, No. 5: 1331 1337, May 2014 Prostaglandin therapy during the proliferative phase improves pregnancy rates following frozen embryo transfer
More informationProspective evaluation of automated follicle monitoring in 58 in vitro fertilization cycles: follicular volume as a new indicator of oocyte maturity
Prospective evaluation of automated follicle monitoring in 58 in vitro fertilization cycles: follicular volume as a new indicator of oocyte maturity Adela Rodrıguez-Fuentes, M.D., a Jairo Hernandez, Ph.D.,
More informationOVULATION INDUCTION. Hsiang, Kaohsiung, Taiwan (FAX: ; adm.cgmh.org.tw).
OVULATION INDUCTION Significantly superior response in the right ovary compared with the left ovary after stimulation with follicle-stimulating hormone in a pituitary down-regulation regimen Kuo-Chung
More informationFertility assessment and assisted conception
Fertility assessment and assisted conception Dr Geetha Venkat MD FRCOG Director Pulse Learning Women s health 14 September 2016 Disclosure statement Dr Venkat is a director of Harley Street Fertility Clinic.
More informationA prospective randomised study comparing a GnRH-antagonist versus a GnRH-agonist short protocol for ovarian stimulation in patients referred for IVF
FVV IN OBGYN, 2012, 4 (2): 82-87 Original paper A prospective randomised study comparing a GnRH-antagonist versus a GnRH-agonist short protocol for ovarian stimulation in patients referred for IVF S. GORDTS,
More information