scholarly journals Whether poor responses have worse perinatal prognosis (retrospective analysis of assisted reproductive technologies cycle)

2018 ◽  
Vol 22 (3) ◽  
pp. 503-508
Author(s):  
G.V. Strelko
Keyword(s):  
Gestational Diabetes ◽  
Ovarian Stimulation ◽  
Preterm Labor ◽  
Perinatal Outcomes ◽  
Ovarian Response ◽  
Control Group ◽  
Poor Responders ◽  
Poor Ovarian Response ◽  
Normal Response ◽  
Significant Difference

The prevalence of poor ovarian response is 5.6–35.1% in women undergoing controlled ovarian stimulation in ART cycles. The frequency of delivery of poor responders after ART is on average from 9.9% to 23.8%. In clinical practice, the vast majority of poor responders are older women, which may have an effect on perinatal outcomes, respectively. Although numerous studies have reported that the fertility rate after ART in women of this age group is quite low, data on perinatal outcomes in this group of women is limited. Therefore, the aim of our study was to retrospectively analyze and compare perinatal outcomes in women with poor ovarian response to stimulation compared to control group (normal response to stimulation) in assisted reproductive technology programs. 278 women with infertility with a reduced response to stimulation (poor responders), who were the main group, were screened. Indications for the inclusion of women in the main group were the presence of at least two of the following criteria for a poor ovarian response according to the 2011 Bologna criteria and 93 infertile patients with a normal ovarian response to stimulation of the control group. Subsequently, retrospective study of perinatal effects such as preterm labor, low birth weight, gestational diabetes, preeclampsia in 50 women with infertility with reduced response to stimulation and 37 controls with normal response to stimulation in which pregnancy was diagnosed was performed. Variational-statistical processing of the results of the study was performed using the program “Statistica 6.0”. The study demonstrated a significantly lower pregnancy rate in poor responders compared with women from the control group — 50 (17.9%) vs. 37 (39.8%), respectively. Perinatal outcome were similar only to the statistically significant difference in the percentage of spontaneous abortions before 12 weeks of gestation — 9 (18%) vs. 4 (10.8%), respectively, in groups with no significant difference in the preterm labor frequency — 10 (20.8%) and 6 (18.1%) of the low weight of the child at birth — 9 (18.7%) versus 5 (15.1%), respectively, in poor responders patients and in women with normal ovarian response. The frequency of complications such as gestational diabetes and high blood pressure were not significantly different in both clinical groups — 3 (6.25%) versus 2 (6.1%) and 5 (10.4%) versus 3 (9.1%) respectively. Thus, he poor responders in ART programs have a significantly lower pregnancy rate and a higher incidence of pregnancy loss up to 12 weeks compared with women who had a normal response to ovarian stimulation without a significant difference in the rates of various complications of pregnancy and perinatal outcomes. Wide randomized multicentric trials are needed to find out the causal relationships with regard to the effect on pregnancy, miscarriage, perinatal effects of controlled ovarian stimulation regimens, embryotransfers in fresh or cryo cycles etc.

P–789 Obstetric and perinatal outcomes in poor ovarian responders and normal responders flowing fresh embryo transfer: a prospective, monocentric, observational study

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
J Deng
Keyword(s):  
Observational Study ◽  
Controlled Trial ◽  
Perinatal Outcomes ◽  
Ovarian Response ◽  
Poor Responders ◽  
Perinatal Complications ◽  
Poor Ovarian Response ◽  
Fresh Embryo Transfer ◽  
Significant Difference ◽  
Complications Rate

Abstract Study question Whether women pregnant after a poor response in IVF have obstetric and perinatal complications more frequently than women with pregnancies after a normal response in IVF? Summary answer There were no statistically significant differences in obstetric and perinatal complications rate between poor responders and normal responders in Chinese women. What is known already Poor ovarian response usually indicates a reduction in follicular response, resulting in a reduced number of retrieved oocytes. Patients are less likely to conceive and have a higher risk of cycle cancellation and low clinical pregnancy rate. Whether poor ovarian response is associated with obstetric and perinatal complications is however debated. Study design, size, duration Design: Prospective, monocentric, observational study. Size: 1664 women with poor ovarian response and 1061 women with normal ovarian response duration : July 1, 2017 to Aug 15, 2019.Participants/materials, setting, methods: 1664 women with poor ovarian response and 1061 women with normal ovarian response undergoing IVF or ICSI were enrolled in this study. The primary outcome was obstetric and perinatal complications rate. Main results and the role of chance 1664 women with POR and 1061 women with NOR were enrolled in this study.Poor and normal responders did not have significantly different incidences in obstetric and perinatal complications(25.42% vs 25.45%), nor were there a significant difference in preeclampsia, gestational diabetes mellitus, postpartum hemorrhage or abruptio placentae. But POR group have a lower frequency of twin pregnancies(8.47% vs 28.66%,P<0.01),low birth weight(5.08% vs 14.23%,P<0.01)and prematurity (9.32% vs 17.03%,P<0.01). Limitations, reasons for caution Despite its size, an observational study such as this has a number of inherent limitations, and the best way to confirm its findings will be to compare obstetric and perinatal outcomes in different subgroup of pregnancies following ART in an adequately powered randomized, controlled trial. Wider implications of the findings: This prospective, monocentric, observational study suggests that women with poor ovarian response did not have higher perinatal complication rate than women with normal ovarian response. Oocyte quality and quantity may not affect the rate of perinatal complications. Trial registration number Not applicable

P–694 Natural cycle vs Accumulation of oocytes. Which strategy is better for women with the poor ovarian response (POR)?

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
K Bekzatova ◽  
M Shishimorova
Keyword(s):  
Embryo Transfer ◽  
Ovarian Stimulation ◽  
Ovarian Response ◽  
Clinical Pregnancy ◽  
Successful Outcome ◽  
Poor Responders ◽  
Poor Ovarian Response ◽  
Average Amount ◽  
Number Of Patients ◽  
Natural Cycles

Abstract Study question The aim of this study is to determine whether repetitive natural cycles (Strategy A) or oocyte accumulation (Strategy B) is a more effective strategy. Summary answer There was no statistical difference between the strategies however, the number of attempts for successful outcome with strategy A was lower than in strategy B. What is known already For populations with poor ovarian response natural cycles (NC) or modified natural cycles (mNC) with minimal stimulation have been implemented as a preferable option as opposed to conventional ovarian stimulation. Due to the development of advanced vitrification techniques, the accumulation of oocytes has become available. Previous studies (2011, 2013, 2019) suggest that accumulation of oocytes could be a successful alternative to repetitive natural cycles for poor responders aged ≥35 years, showing higher clinical pregnancy rates. Moreover, the embryo-transfer cancellation and miscarriage rate were significantly lower in the oocyte accumulation strategy. Study design, size, duration Present retrospective cohort study included a selection of patients with POR treated from 2019–2020, which were divided into 2 strategies. Strategy A included 324 natural cycles or modified natural cycles with successful oocyte retrievals (Female mean age: 36.3 years). The strategy B consisted of 46 cycles with thawed oocytes that were accumulated through cryopreservation in several attempts (average n = 2,3) prior in NC or mNC (Female mean age: 37.6 years). Participants/materials, setting, methods POR was defined by following criteria: 1) advanced maternal age (≥35 years) or; 2) previous POR (≤3 oocytes with a conventional ovarian stimulation protocol); 3) abnormal ovarian reserve test; The vitrification of the oocytes was performed using Kuwayama method (Cryotech®, Japan), while thawing was performed using Cryotop method (Kitazato®, Japan). Prior to fertilization, oocytes were cultured for 2 hours in IVF medium (Origio®, Denmark). The unsuccessful transvaginal oocyte retrievals (TVOR) were excluded from both strategies. Main results and the role of chance The clinical pregnancy rate per started cycle and per transfer in Strategy A vs Strategy B were 15,4% vs 15,2% and 28.08% vs 20%, respectively. Strategy A seemed to achieve higher rates; however, the difference was not statistically significant (Student’s t-test, p < 0.05). Throughout all TVORs the rate of successful retrieval was 71.7%. The embryo-transfer cancellation rates in Strategy A vs Strategy B were 38,2% vs 8,69%, respectively. With strategy A the average amount of attempts for successful clinical pregnancy was 1.86. With strategy B the average amount of cryopreservations for oocyte accumulation was 2.3. Limitations, reasons for caution The number of patients in strategy B was significantly lower than in strategy A. Larger study with an increased number of samples is necessary to confirm the results. In addition calculation of cost-effectiveness in each strategy. The unsuccessful TVORs were excluded from both strategies, which significantly affects the statistical rates. Wider implications of the findings: This study might help in developing and selecting more appropriate strategies for women with POR. The findings might help to determine the amount of time and attempts required for a successful outcome for patients aged ≥35. It can also be helpful in regulating the financial part of artificial reproductive technology. Trial registration number N/A

scholarly journals Aromatase inhibitors in “poor” ovarian responders undergoing in vitro fertilization

2017 ◽  
Vol 66 (3) ◽  
pp. 169-175
Author(s):  
Alexandra I. Merkulova
Keyword(s):  
Aromatase Inhibitors ◽  
Ovarian Stimulation ◽  
Treatment Protocol ◽  
Ovarian Response ◽  
Controlled Ovarian Stimulation ◽  
Poor Responders ◽  
Poor Ovarian Response ◽  
Vitro Fertilization ◽  
The Ideal

Since the IVF treatment expands worldwide, it has become apparent that a proportion of women responds suboptimally to controlled ovarian stimulation with exogenous gonadotrophins. There is still no consensus on the ideal controlled ovarian stimulation protocol for patients with “poor” ovarian response. Many strategies have been studied. However, no compelling advantage for one treatment protocol over another has been identified. The addition of aromatase inhibitors in “poor” responders stimulation protocols is described in this article.

Thyroid Dysfunction in Pregnant Women with Gestational Diabetes Mellitus

2020 ◽  
Vol 16 (8) ◽  
pp. 895-899 ◽  
Author(s):  
Shahin Safian ◽  
Farzaneh Esna-Ashari ◽  
Shiva Borzouei
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Thyroid Dysfunction ◽  
Control Group ◽  
Thyroid Peroxidase ◽  
Free T4 ◽  
Significant Difference ◽  
Experimental Group

Aims: Investigation thyroid dysfunction and autoimmunity in pregnant women with gestational diabetes mellitus. Background: This article was written to evaluate the thyroid function and anti-thyroid peroxidase (anti- TPO) antibodies in pregnant women with gestational diabetes mellitus (GDM). Method: A total of 252 women with GDM and 252 healthy pregnant women were enrolled. Thyroid tests, including TSH, FreeT3, Free T4, and anti-TPO were performed for all women at 24–28 weeks of gestation. Data analysis was then carried out using SPSS ver. 22. Result: There was a significant difference between the experimental group (38.4%) and the control group (14.06%) in terms of the prevalence of subclinical hypothyroidism (p= 0.016). The frequency of anti-TPO was higher in the experimental group than the control group and positive anti-TPO was observed in 18.6% of women with GDM and 10.3% of healthy pregnant women (P= 0.008). Conclusion: Thyroid disorders are observed in pregnant women with GDM more frequently than healthy individuals and it may be thus reasonable to perform thyroid tests routinely.

scholarly journals The effect of oat bran consumption on gestational diabetes: a randomized controlled clinical trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zahra Barati ◽  
Mina Iravani ◽  
Majid Karandish ◽  
Mohammad Hosein Haghighizadeh ◽  
Sara Masihi
Keyword(s):  
Clinical Trial ◽  
Blood Glucose ◽  
Gestational Diabetes ◽  
Fasting Blood Glucose ◽  
Intervention Group ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Standard Diet ◽  
Oat Bran ◽  
Significant Difference

Abstract Background Gestational diabetes is the most common medical complication in pregnancy, and it has many side effects for the mother and the fetus. The aim of this study was to evaluate the effect of oat bran consumption on gestational diabetes. Methods This study is a randomized clinical trial that was performed on 112 women with gestational diabetes treated with diet. Participants were randomly divided into two groups of 56. Participants in both groups were given a diet for gestational diabetes. In addition to the diet, the intervention group received 30 g of oat bran daily for 4 weeks at lunch and dinner. Tests of fasting blood glucose and two-hour postprandial (2hpp) glucose were taken from both groups: before the intervention, and 2 and 4 weeks after the start of the intervention. Data analysis was performed using SPSS statistical software (version 22) using independent t-test, as well as Chi-square and Mann-Whitney tests. P values less than 0.05 were considered statistically significant. Results There was no statistically significant difference between the two groups in terms of mean blood glucose before the intervention, while 2 and 4 weeks after the intervention, mean fasting blood glucose and two-hour postprandial (2hpp) glucose decreased significantly in the intervention group compared with the control group (P < 0.001). Conclusion Based on the results of this study, the addition of oat bran to the standard diet for pregnant women with gestational diabetes reduced fasting blood glucose and two-hour postprandial (2hpp) glucose. More detailed studies with higher sample sizes are recommended to prove the effectiveness of this valuable dietary supplement. Trial registration IRCT registration number:IRCT20191220045828N1. Registration date: 2020-04-18. Registered while recruiting.

Comparison of hematological parameters and perinatal outcomes between COVID-19 pregnancies and healthy pregnancy cohort

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Esin Merve Erol Koç ◽  
Rahime Bedir Fındık ◽  
Hatice Akkaya ◽  
Işılay Karadağ ◽  
Eda Özden Tokalıoğlu ◽  
...  
Keyword(s):  
Complete Blood Count ◽  
Perinatal Outcomes ◽  
Control Group ◽  
Strong Positive Correlation ◽  
Monocyte Count ◽  
Distribution Width ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Significant Difference ◽  
Adverse Perinatal Outcomes

AbstractObjectivesTo evaluate the relationship between Coronavirus Disease 2019 (COVID-19) in pregnancy and adverse perinatal outcomes. The secondary aim is to analyze the diagnostic value of hematologic parameters in COVID-19 complicated pregnancies.MethodsThe current study is conducted in a high volume tertiary obstetrics center burdened by COVID-19 pandemics, in Turkey. In this cohort study, perinatal outcomes and complete blood count indices performed at the time of admission of 39 pregnancies (Study group) complicated by COVID-19 were compared with 69 uncomplicated pregnancies (Control group).ResultsThere was no significant difference between the obstetric and neonatal outcomes of pregnancies with COVID-19 compared to data of healthy pregnancies, except the increased C-section rate (p=0.026). Monocyte count, red cell distribution width (RDW), neutrophil/lymphocyte ratio (NLR), and monocyte/lymphocyte ratio (MLR) were significantly increased (p<0.0001, p=0.009, p=0.043, p<0.0001, respectively) whereas the MPV and plateletcrit were significantly decreased (p=0.001, p=0.008) in pregnants with COVID-19. ROC analysis revealed that the optimal cut-off value for MLR was 0.354 which indicated 96.7% specificity and 59.5% sensitivity in diagnosis of pregnant women with COVID-19. A strong positive correlation was found between the MLR and the presence of cough symptom (r=41.4, p=<0.0001).ConclusionsThe study revealed that, pregnancies complicated by COVID-19 is not related with adverse perinatal outcomes. MLR may serve as a supportive diagnostic parameter together with the Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) in assessment of COVID-19 in pregnant cohort.

scholarly journals Natural Cycle Results in Lower Implantation Failure than Ovarian Stimulation in Advanced-Age Poor Responders Undergoing IVF: Fertility Outcomes from 585 Patients

2021 ◽  
Author(s):  
Maria Paola De Marco ◽  
Giulia Montanari ◽  
Ilary Ruscito ◽  
Annalise Giallonardo ◽  
Filippo Maria Ubaldi ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Ovarian Stimulation ◽  
Embryo Implantation ◽  
Implantation Rate ◽  
Poor Responder ◽  
Advanced Age ◽  
Poor Responders ◽  
Natural Cycle ◽  
Significant Difference ◽  
Over 40 Years

AbstractTo compare pregnancy rate and implantation rate in poor responder women, aged over 40 years, who underwent natural cycle versus conventional ovarian stimulation. This is a retrospective single-center cohort study conducted at the GENERA IVF program, Rome, Italy, between September 2012 and December 2018, including only poor responder patients, according to Bologna criteria, of advanced age, who underwent IVF treatment through Natural Cycle or conventional ovarian stimulation. Between September 2012 and December 2018, 585 patients were included within the study. Two hundred thirty patients underwent natural cycle and 355 underwent conventional ovarian stimulation. In natural cycle group, both pregnancy rate per cycle (6.25 vs 12.89%, respectively, p = 0.0001) and pregnancy rate per patient101 with at least one embryo-transfer (18.85 vs 28.11% respectively, p = 0.025) resulted significant reduced. Pregnancy rate per patient managed with conventional ovarian stimulation resulted not significantly different compared with natural cycle (19.72 vs 15.65% respectively, p = 0.228), but embryo implantation rate was significantly higher in patients who underwent natural cycle rather than patient subjected to conventional ovarian stimulation (13 vs 8.28% respectively, p = 0.0468). No significant difference could be detected among the two groups in terms of abortion rate (p = 0.2915) or live birth pregnancy (p = 0.2281). Natural cycle seems to be a valid treatment in patients over 40 years and with a low ovarian reserve, as an alternative to conventional ovarian stimulation.

scholarly journals Association of single-nucleotide polymorphisms in the ESR2 and FSHR genes with poor ovarian response in infertile Jordanian women

2021 ◽  
Vol 48 (1) ◽  
pp. 69-79
Author(s):  
Amer Mahmoud Sindiani ◽  
Osamah Batiha ◽  
Esra’a Al-zoubi ◽  
Sara Khadrawi ◽  
Ghadeer Alsoukhni ◽  
...  
Keyword(s):  
Single Nucleotide Polymorphisms ◽  
Statistical Significance ◽  
Ovarian Response ◽  
Control Group ◽  
P Value ◽  
Case Group ◽  
Nucleotide Polymorphisms ◽  
Poor Ovarian Response ◽  
Single Nucleotide ◽  
Number Of Patients

Objective: Poor ovarian response (POR) refers to a subnormal follicular response that leads to a decrease in the quality and quantity of the eggs retrieved after ovarian stimulation during assisted reproductive treatment (ART). The present study investigated the associations of multiple variants of the estrogen receptor 2 (ESR2) and follicle-stimulating hormone receptor (FSHR) genes with POR in infertile Jordanian women undergoing ART.Methods: Four polymorphisms, namely ESR2 rs1256049, ESR2 rs4986938, FSHR rs6165, and FSHR rs6166, were investigated in 60 infertile Jordanian women undergoing ART (the case group) and 60 age-matched fertile women (the control group), with a mean age of 33.60±6.34 years. Single-nucleotide polymorphisms (SNPs) were detected by restriction fragment length polymorphism and then validated using Sanger sequencing.Results: The p-value of the difference between the case and control groups regarding FSHR rs6166 was very close to 0.05 (p=0.054). However, no significant differences were observed between the two groups in terms of the other three SNPs, namely ESR2 rs1256049, ESR2 rs4986938, and FSHR rs6165 (p=0.561, p=0.433, and p=0.696, respectively).Conclusion: The association between FSHR rs6166 and POR was not statistically meaningful in the present study, but the near-significant result of this experiment suggests that statistical significance might be found in a future study with a larger number of patients.

scholarly journals Effectiveness of Nursing Intervention on Health Locus of Control and Self-Efficacy in Women with Gestational Diabetes

2021 ◽  
Vol 3 (1) ◽  
pp. 12
Author(s):  
Sabah R. H. Ahmed ◽  
Safaa G. Salem ◽  
Nahed M. Saber ◽  
Reda T. A. Abou Elazab ◽  
Merfat M. Atia
Keyword(s):  
Locus Of Control ◽  
Gestational Diabetes ◽  
Self Efficacy ◽  
Health Locus Of Control ◽  
Intervention Group ◽  
Nursing Intervention ◽  
Outpatient Clinics ◽  
Control Group ◽  
Significant Difference ◽  
And Control

the offspring in prenatal and postnatal periods and later life.  Lack of self-care is the most important reason for mortality in diabetic patients. Self-efficacy has a significant role in enhancing successful adherence to healthy behaviors, lifestyle modifications, and diabetes control among gestational diabetes pregnant women. Aim:  The current study aimed to evaluate the nursing intervention (NI) effectiveness on health locus of control (HELOC) and self-efficacy in women with gestational diabetes (GD). Methods: A quasi-experimental design (study and control group) was used. The researchers conducted this study at the Antenatal Outpatient Clinics of Shebin El-Kom Teaching Hospital, Menoufia Governorate, Egypt. A purposive sample of 120 women with GD was carefully chosen from the nominated setting and dispersed accidentally into two identical groups (study and control group). Three tools were used for collecting the study data: A structured self-administered questionnaire, the Multidimensional Health Locus of Control Scale-C Form, and the General Self-efficacy Scale. Results: There is a statistically significant difference between the intervention and control groups in their internal health locus of control (HELOC) scores after the intervention, with a mean difference of 4.70 at CI 95% for the intervention group p<0.001. A non-statistically significant difference was found between the intervention group and the control group in the external health locus of control (HELOC) mean scores before and after the intervention, although there was a significant difference between the change in both groups p=0.032. Also, there is a highly statistically significant difference between the intervention group and the control group in the self-efficacy scores after the intervention in the intervention group, where p<0.001 compared to a non-significant difference between them before the intervention group intervention (p=0.555). Conclusion: The study concluded that the women with GD who attended NI sessions obtained higher HELOC scores (internal and external) and higher self-efficacy scores than those who do not. Educational nursing intervention should become a fundamental part of the total management of gestational diabetes in antenatal outpatient clinics.

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