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The worldwide prevalence of primary and secondary infertility is estimated at
2% and 10.5%, respectively, among women aged 20-44 years and attempting to conceive. Poor ovarian responders (PORs) involve 9-24% of patients undergoing in-vitro fertilization (IVF). proper tailoring of the ovarian stimulation protocol in order to maximize the number of oocytes collected represents a crucial step for them to eventually conceive.
Recent evidence indicates that in the same menstrual cycle, there are multiple follicular recruitment waves. This coincides with the theory that folliculogenesis occurs in a wave-like fashion. Thus, within a single menstrual cycle, there can theoretically be multiple opportunities for a clinician to collect oocytes, as opposed to the conventional single cohort of antral follicles during the follicular phase.
Utilizing this concept, clinicians have been attempting to retrieve oocytes from poor responders using both the follicular-phase stimulation (FPS) and the luteal-phase stimulation (LPS) protocols to increase the number of oocytes collected shorter within shorter period of time. By increasing the number of the retrieved oocytes collected, a better clinical can be assured since there is a clear relationship between the number of oocytes collected and live birth rates across all female age groups.
which protocol is the most effective remains controversial and the efficacy of PPOS in POR compared with that of conventional protocols is unclear.

Start Date01 Sep 2020

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Literatures (Medical) associated with Merional

31 Dec 2024·Česká gynekologie

Comparing highly purified human menopausal gonadotropin and recombinant follicle stimulating hormone in poor ovarian reserve patients undergoing intracytoplasmic sperm injection

Article

Author: Tutar, Mahmut Sami ; Akgun, Humeyra ; Gunenc, Oguzhan ; Dogru, Sukran ; Korucu, Dilay Gok

Objective: We aimed to compare highly purified human menopausal gonadotropin (hp-hMG) and recombinant follicle stimulating hormone (rFSH) in short antagonist in vitro fertilization (IVF) cycles of patients with poor ovarian reserve (POR). Limited research exists on this comparison in short antagonist cycles for this patient group. Materials and methods: This retrospective cohort study involved 165 POR patients aged 18–45 years who underwent IVF between 2018 and 2022. Patients were divided into two groups based on their GnRH antagonist protocol: hp-hMG (group 1 = 72) and rFSH (group 2 = 93). We compared pregnancy outcomes, number of oocytes collected, mature oocytes retrieved, mean fertilized oocytes, top quality embryos transferred, and serum estradiol (E2) and progesterone (P) levels on human chorionic gonadotropin (hCG) administration day. Results: No significant differences were found in E2 and P levels on hCG trigger day, endometrial thickness on transfer day, stimulation duration, total oocyte number, and mature oocyte number (P > 0.05). The total gonadotropin dose was significantly higher in the rFSH group (P < 0.001). The number of top-quality embryos transferred and clinical pregnancy and live birth rates did not diff er significantly between groups (P = 0.320; P = 0.310; P = 0.652; and P = 0.662, resp.). Conclusion: Neither hp-hMG nor rFSH showed superiority in patients with POR, indicating similar effectiveness in this population. Key words: highly purified human menopausal gonadotropin – in vitro fertilization – live birth – poor ovarian reserve – recombinant follicle stimulating hormone

01 Dec 2024·Iranian biomedical journal

25th National and 11th International Annual Congress on Research and Technology of Iranian Medical Sciences Students, Urmia, Iran, 5-7 September, 2024

Article

Author: Khadem Ghaebi, Nayyereh ; Joghatayi, Farzaneh ; Morovatdar, Negar ; Pousti, Navid ; Afiat, Maliheh ; Afzaljavan, Fahimeh

IntroductionInfertility is a severe challenge for most health systems. One of the medications recently used for ovulation induction is letrozole, applied either alone or in combination with gonadotropin. The present study was conducted to compare ovulation induction in infertile polycystic ovarian syndrome (PCOS) women candidates of intrauterine insemination (IUI) who were resistant to letrozole by two regimens: single-drug stair step letrozole vs. combined letrozole plus human menopausal gonadotropin.Methods and MaterialsIn this parallel randomized clinical trial, 60 infertile women with PCOS, candidates for intrauterine insemination, admitted to Milad Infertility Center at Imam Reza Hospital, Mashhad, Iran, were randomly assigned into two groups. The intervention group received 5 mg of letrozole for five days from menstruation day 3 and 7.5 mg of letrozole for another five days if dominant follicles were not observed on days 14-19. Control cases received letrozole (5 mg) from day 3 of the cycle for five days plus Cinnal-f® (75 international units subcutaneously daily) on days 8 and 9. They received another dose of Cinnal-f® if the dominant follicle was not observed on days 10-12 of the cycle. In the case of detecting dominant follicles, 5000 units of intramuscular hCG were prescribed, and 36 hours later, the patients underwent IUI. The outcomes were considered, and data were analyzed using SPSS.ResultsAlmost 70% of the stair-step letrozole group and 53.2% in the combined medication had a dominant follicle (p = 0.12), mainly observed after day 14 in the stair-step letrozole group and during days 10-14 in the letrozole/gonadotropin group (p = 0.001). The positive beta-hCG level was significantly higher in the stair-step letrozole group (23.3%) than in the letrozole/gonadotropin group (13.3%). The clinical pregnancy and gestations of 20 weeks or beyond (ongoing pregnancy) were 16.66% and 10% in the stair-step letrozole and letrozole/gonadotropin groups, respectively (p = 0.03).Conclusion and DiscussionOur study found similar frequencies of dominant follicles between the stair-step letrozole and letrozole/ gonadotropin groups and a significantly higher frequency of chemical pregnancy (positive beta-hCG) and clinical and ongoing pregnancy in the stair-step letrozole group. As an easy and acceptable method for patients, this protocol can be a suitable alternative for ovulation induction.

01 Oct 2024·Journal of Human Reproductive Sciences

Evaluation of Predictors of Response to Ovulation Induction Using Letrozole in Women with Polycystic Ovary Syndrome: A Prospective Cohort Study

Article

Author: Kumari, Archana ; Sati, Hem Chandra ; Sharma, Mona ; Tholiya, Shanti ; Mahey, Reeta ; Kalaivani, Mani ; Malhotra, Neena ; Jayraj, Aarthi K.

ABSTRACTBackground:Ovulation induction (OI) in patients with polycystic ovary syndrome (PCOS) remains challenging, and several biomarkers have been evaluated for their ability to predict ovulation. The predictive ability of candidate biomarkers, particularly with letrozole-based therapy in infertile PCOS women, remains inconclusive as it is yet to be evaluated in a prospective study.Aim:To assess the role of anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), luteinising hormone (LH)/FSH ratio, testosterone and free androgen index (FAI) as predictors of ovarian response to letrozole-based OI therapy during OI cycles in infertile women with PCOS from North India.Settings and Design:A prospective cohort study was conducted in a tertiary care hospital in north India.Materials and Methods:The study enrolled 80 infertile women with PCOS, diagnosed according to the Rotterdam criteria. OI was conducted using letrozole with or without human menopausal gonadotropin. Baseline endocrine and metabolic parameters, including serum AMH, FSH, LH, testosterone and FAI levels, were measured using ELISA or chemiluminescence methods on day 2 of the menstrual cycle. Follicular response to OI was monitored by transvaginal ultrasonography.Statistical Analysis Used:Descriptive and inferential statistical analyses were conducted, including Mann–Whitney, Kruskal–Wallis, Independent t-test, analysis of variance, Fisher’s exact test and receiver operating characteristic curve analysis. Data were processed using Microsoft Excel and analysed with SPSS software, version 25.0. P < 0.05 was considered statistically significant.Results:Of 80 women enrolled, 74 responded to letrozole-based OI, while six were non-responders. Body mass index (BMI), serum testosterone and pre-treatment AMH levels significantly correlated with follicular response, with higher values linked to reduced responsiveness. The likelihood ratio+ (95% confidence interval) was 3.32 (2.45–5.06) for AMH, 1.97 (1.03–3.78) for BMI and 1.93 (1.22–3.08) for testosterone. The odds ratio for AMH was 2.88 (1.01–8.21) and 1.25 (1.02–1.53) for BMI. An AMH cut-off of ≤16.43 ng/mL predicted ovarian response with an AUC of 0.88.Conclusions:Pre-treatment AMH levels, along with BMI and serum testosterone, are significant predictors of ovarian response to letrozole-based OI in infertile women with PCOS.

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Indication	Country/Location	Organization	Date
Anovulation	-	Ibsa Farmaceutici Italia Srl	02 Mar 2009

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Indication	Highest Phase	Country/Location	Organization	Date
Polycystic Ovary Syndrome	Discovery	Saudi Arabia	Saudi German Hospitals Group	01 Apr 2019

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Study	Phase	Population	Analyzed Enrollment	Group	Results	Evaluation	Publication Date


ESPE2022	Not Applicable	Cartilage-Hair Hypoplasia	72	gonadotropin	idhzkunpth(hztoyhrqtj) = oqkfewiiwz lvusjvcksb (egqnylfwkp, 48) View more	-	15 Sep 2022
				gonadotropin	idhzkunpth(hztoyhrqtj) = nctnceseqk lvusjvcksb (egqnylfwkp, 54) View more
NCT04537078 (CTgov)	Phase 3	Infertility, Female	90	Combined Oral Contraceptive+Decapeptyl+Cyclo-Progynova+progesterone+Gonadotropin+Duphaston (the Progestin Primed Double Stimulation Group)	rbrpppuryc(yxscoeemtu) = fmagczmpei aevpqdnajj (itynphcwnu, ldpreouili - mgzqgxdfgj) View more	-	17 Feb 2022
				Combined Oral Contraceptive+Cetrotide Injectable Product+Decapeptyl+Cyclo-Progynova+progesterone+Chorionic Gonadotropin+Gonadotropin (the Flexible GnRh Antagonist)	mmohqesjlf(epokgmqevj) = nnfwjvlsvj iwazkpclov (tirwrtbrgc, oiuvdeyegz - plechuxxlk) View more

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