RESUMO
OBJECTIVE: To determine whether elective frozen embryo transfer (eFET), or the 'freeze-all' strategy, associated with better cumulative clinical outcomes compared with fresh embryo transfer (ET). METHODS: A total of 7,236 IVF cycles that were followed by a fresh ET or eFET between 2013 and 2017. The patients were subjected to controlled ovarian stimulation (COS) with a gonadotropin-releasing hormone (GnRH) antagonist protocol and cleavage-stage ET. Embryo cryopreservation was performed on day 3 by vitrification using an open system. A comparison of cumulative outcomes between the eFET (n=4,065cycles) and the fresh ET groups (n=3,171cycles) were performed. The analysis was performed in four groups of patients based on the number of retrieved oocytes: Group 1: poor responders (1-3 oocytes); Group 2: suboptimal responders (4-9 oocytes); Group 3: normal responders (10-15 oocytes); and Group 4: hyper-responders (>15 oocytes). The primary outcome was the cumulative live birth rate (CLBR) per stimulated cycle. RESULTS: There were a total of 10,283 ETs (n=5,639 eFET group; n=4,644 fresh group). The freeze-all strategy is associated with improved CLBRs in normal and hyper-responders, but not in suboptimal and poor responders. In Group 1, there were 351 IVF cycles and 387 ETs in total, and the CLBR was 14.3% and 17.7% (p=0.584) for the eFET and fresh group, respectively. In Group 2, there were 2,074 IVF cycles and 2,465 ET in total, and the CLBR was 25.1% and 23.3% (p=0.083) in the eFET and fresh group, respectively. There was a significant difference in the CLBR in Groups 3 and 4, favouring the eFET strategy. In Group 3, 2226 IVF cycles and 3243 ET were performed. The CLBR was 40.5% in the eFET and 36.6% in the fresh group (p<0.001). In Group 4, there were 2547 IVF cycles and 3,188 ET in total, and the CLBR was 52.2% and 47.7% (p<0.001) in the eFET and fresh group, respectively. The number needed to treat to achieve one additional live birth was 25.9 in Group 3 and 22.3 in Group 4. CONCLUSIONS: The implementation of the freeze-all strategy should be individualized. The freeze-all strategy is associated with improved CLBRs in normal and hyper-responders, but not in suboptimal and poor responders.
Assuntos
Coeficiente de Natalidade , Transferência Embrionária , Criopreservação/métodos , Transferência Embrionária/métodos , Feminino , Fertilização in vitro/métodos , Antagonistas de Hormônios/uso terapêutico , Humanos , Nascido Vivo/epidemiologia , Indução da Ovulação/métodos , Gravidez , Estudos RetrospectivosRESUMO
OBJECTIVE: To identify low prognosis in-vitro fertilization (IVF) patients treated at Centro de Fertilidad y Ginecología del Sur (CFGS) based on the POSEIDON criteria. METHODS: This retrospective study included 412 IVF patients and assessed them based on the POSEIDON criteria to describe the cumulative live birth rates seen in each group. RESULTS: 13.1% of patients met the POSEIDON criteria, and the proportion of cases in POSEIDON groups 1, 2, 3 and 4 were 20.4%, 31.5%, 14.8%, and 33.3%, respectively. The cumulative live birth rate for the individuals meeting the POSEIDON criteria was 25.9%, while for patients in POSEIDON groups 1, 2, 3, and 4 the rates were 45.5%, 29.4%, 25.0%, and 11%, respectively. The differences were not statistically significant due to the small number of cases. CONCLUSIONS: Patients belonging to the four POSEIDON groups were described at CFGS. Age and number of retrieved mature oocytes were determining parameters in the prognosis of pregnancy in IVF/ICSI patients.
Assuntos
Coeficiente de Natalidade , Fertilização in vitro , Feminino , Humanos , Nascido Vivo/epidemiologia , Indução da Ovulação , Peru/epidemiologia , Gravidez , Prognóstico , Estudos RetrospectivosRESUMO
RESEARCH QUESTION: Does the type of pituitary suppression protocol influence cumulative live birth rate (LBR) in Bologna poor responders treated with corifollitropin alfa (CFA)? DESIGN: Retrospective cohort analysis including poor responder patients fulfilling the Bologna criteria who underwent their first intracytoplasmic sperm injection cycle using a CFA-based ovarian stimulation protocol between 2011 and 2017. The starting dose of CFA was 150 µg. The primary outcome was cumulative LBR, defined as the first delivery of a live born resulting from the fresh and all the subsequent frozen embryo transfers. RESULTS: A total of 717 cycles were divided into three groups: A (gonadotrophin-releasing hormone [GnRH] antagonist protocol, n = 407), B (long GnRH agonist protocol, n = 224) and C (short GnRH agonist protocol, n = 86). Cumulative LBR did not significantly differ between groups (20.1% versus 17.4% versus 14.0%; Pâ¯=â¯0.35). Significantly more patients in Group A had supernumerary embryos cryopreserved (28.3% versus 18.4% versus 11.6%; P < 0.001). Days of additional highly purified human menopausal gonadotrophin 300 IU injections following CFA were significantly different between Groups A, B and C (3 versus 5 versus 3 days; P < 0.001). Multivariate logistic regression analysis showed that the number of oocytes retrieved remained an independent predictive factor (odds ratio 1.23, 95% confidence interval 1.16-1.31) for cumulative LBR. CONCLUSIONS: Poor responders according to the Bologna criteria in whom CFA is used for ovarian stimulation had comparable cumulative LBR, irrespective of the type of pituitary suppression. An increase in number of oocytes retrieved is an independent variable related to cumulative LBR.