Objective: To investigate whether luteal E 2 administration reduces size discrepancies of early a... more Objective: To investigate whether luteal E 2 administration reduces size discrepancies of early antral follicles. Design: Prospective, crossover study. Setting: ART unit, Clamart, France. Patient(s): Sixty women and 120 cycles. Intervention(s): On cycle day 3 (baseline day 3), all women underwent measurements of early antral follicles by ultrasound and serum FSH and ovarian hormones. From day 20 until the next cycle day 2, 30 of them received oral 17-E 2 , whereas the remaining women served as controls. The day after E 2 discontinuation (E 2 day 3) or on subsequent cycle day 3 (control day 3), participants were reevaluated as on baseline day 3. Main Outcome Measure(s): Magnitude of follicular size discrepancies. Result(s): Follicular size discrepancies and follicular diameters were significantly attenuated on E 2 day 3 (3.7 Ϯ 0.5 mm) as compared with baseline day 3 (4.9 Ϯ 1.0 mm), but not in controls (5.0 Ϯ 0.8 vs. 4.9 Ϯ 0.8 mm). FSH (4.3 Ϯ 1.9 vs. 7.3 Ϯ 3.3 mIU/mL) and inhibin B (34 Ϯ 28 vs. 71 Ϯ 32 pg/mL) levels were consistently lower on E 2 day 3 than on baseline day 3 but remained unchanged in controls. Conclusion(s): Luteal E 2 administration reduces the size and improves the homogeneity of early antral follicles on day 3. This approach may be instrumental in synchronizing follicular development during controlled ovarian hyperstimulation.
, NY). Samples were categorized based on the individuals' reported weekly alcohol consumption. A ... more , NY). Samples were categorized based on the individuals' reported weekly alcohol consumption. A two-tailed t-test was performed to test for significant differences between alcohol consuming and non-consuming groups. RESULTS: Despite a relatively high degree of inter-individual variability in sperm DNA 5-hmC levels (CV¼43.36), we found that global 5-hmC levels in sperm DNA are approximately 2-fold in individuals who consume alcohol (n¼23) compared with those who do not (n¼27; p¼0.008). CONCLUSION: We recently reported that global sperm DNA 5-hmC levels are significantly lower than levels in blood. This is in support of the hypothesis that 5-hmC facilitates transcription, as mature sperm are transcriptionally quiescent and have very low levels of 5-hmC. Here we demonstrate that on average global sperm 5-hmC is significantly increased in individuals who consume alcohol. These data comport with recent findings suggesting that alcohol intake leads to sperm DNA hypomethylation, and may provide insight into the mechanism by which this hypomethylation occurs.
Objective: To investigate whether seminatural cycle is a reasonable management for ovarian aging ... more Objective: To investigate whether seminatural cycle is a reasonable management for ovarian aging patients. Design: Prospective study.
Objective: To investigate whether premenstrual administration of a GnRH antagonist coordinates ea... more Objective: To investigate whether premenstrual administration of a GnRH antagonist coordinates early antral follicle sizes during the subsequent follicular phase. Design: Prospective, longitudinal study. Setting: University Hospital in France Patient(s): Twenty-five women, 50 cycles. Intervention(s): On cycle day 2 (control/day 2), women underwent measurements of early antral follicles by ultrasound and serum FSH and ovarian hormones. On day 25, they received a single cetrorelix acetate administration, 3 mg. On the subsequent day 2 (premenstrual GnRH antagonist/day 2), participants were re-evaluated as on control/day 2. Main Outcome Measure(s): Magnitude of follicular size discrepancies. Result(s): Follicular diameters (4.1 Ϯ 0.9 vs. 5.5 Ϯ 1.0 mm) and follicle-to-follicle size differences decreased on premenstrual GnRH antagonist/day 2 as compared with control/day 2. Consistently, FSH (4.5 Ϯ 1.9 vs. 6.7 Ϯ 2.4 mIU/mL), E 2 (23 Ϯ 13 vs. 46 Ϯ 26 pg/mL), and inhibin B (52 Ϯ 30 vs. 76 Ϯ 33 pg/mL) were lower on GnRH antagonist/day 2 than on control/day 2. Conclusion(s): Premenstrual GnRH antagonist administration reduces diameters and size disparities of early antral follicles on day 2, likely through the prevention of luteal FSH elevation and early follicular development. This simple, original approach may be used to coordinate multifollicular development in controlled ovarian hyperstimulation.
and E2 Յ 80 pg/mL on day 2 of their menstrual cycle began stimulation with recombinant FSH or hum... more and E2 Յ 80 pg/mL on day 2 of their menstrual cycle began stimulation with recombinant FSH or human menopausal gonadotropins. GnRH antagonists were given when the lead follicles were Ն 14mm or E2 Ն 400 pg/mL. HCG was administered when a minimum of 3 follicles were Ͼ 18 mm and E2 levels Ͼ 600 pg/mL, followed by oocyte retrieval 35 hours later. Cycles were cancelled if there were Ͻ 3 follicles with E2 Ͻ 500 pg/mL after 8 days of stimulation. Embryo transfer (ET) was performed on day 3. Serum samples collected at the time of baseline evaluation and after 4 days of gonadotropin stimulation were assayed in duplicate using an inhibin-B ELISA (Serotec, UK). Assay results were used to divide patients into four groups based on median inhibin values (baseline Յ 55 pg/mL vs. Ͼ 55 pg/mL, and day 5 Յ 300 pg/mL vs. Ͼ 300 pg/mL). Groups were then compared by age, baseline FSH and E2, oocyte number retrieved, number and quality of embryos transferred, and cycle pregnancy result. Statistical analysis was performed using Student's t-test to compare means Ϯ SEM between groups. Results: Of 103 cycles, 64 (62.1%) were retrieved, and 39 (37.9%) were cancelled due to poor response. The overall clinical pregnancy rate per ET was 21.3% (13/61), with an ongoing pregnancy rate of 13.1% (8/61). Baseline inhibin and cycle day 5 levels ranged from 15 to 256 pg/mL, and 15 to 2500 pg/mL, respectively. Baseline inhibin levels Յ 55 pg/mL and day 5 inhibin levels Յ 300 pg/mL were associated with significantly higher cancellation rates, and extremely low pregnancy rates (see table). There was no statistical difference detected amongst groups in age, baseline E2, number of oocytes, and embryo number and quality. Cycle results according to inhibin-B levels. * P Ͻ.05 Conclusion: Both baseline and cycle day 5 inhibin-B levels are useful additions to traditional ovarian reserve measurements in predicting ovarian response and cycle outcome in women over 39, and may be helpful in counseling patients regarding opportunity for IVF success.
Design: Longitudinal. Materials/Methods: Women with 2 normal ovaries, undergoing IVF and consider... more Design: Longitudinal. Materials/Methods: Women with 2 normal ovaries, undergoing IVF and considered to be at an increased risk of OHSS because of the presence of Ͼ 20 follicles (n ϭ 81) were investigated with pre-hCG U/S, colour Doppler imaging (CDI) and serial pre-and post hCG pVEGF. Those with a past history of ovarian disease (including PCO or PCOS) or surgery were excluded. Colour Doppler blood flow imaging was performed with an Acuson 128 XP10 computerised imaging system. A sandwich enzyme immuno-assay (Quantikine™, ELISA) was used to assay free VEGF 165. Those who were admitted to hospital with the moderate or severe forms of OHSS, but did not conceive [Group II; n ϭ 9] were compared with matched controls [Group I; n ϭ 27]. The VEGF data was not normally distributed and, therefore, required log e transformation. VEGF data are therefore presented as detransformed log e (geometric) means (95%CI). Simple 2-sample t-test was used to compare (geometric) means and analysis of variance was also performed with age, number of follicles; and embryos transferred as co-variates. Results: The peak systolic and time-averaged maximal velocity, pulsatility index, resistance index and S/D ratio of intrafollicular blood flow and pVEGF were similar (p0.05); but the degree of intrafollicular vascularity (FVI) was higher before hCG in the OHSS group (0.38 ϩ 0.18 vs. 0.69 ϩ 0.12; p Ͻ 0.001). There was no statistically significant difference in pVEGF between the two groups before hCG and oocyte recovery (OR) (p ϭ 0.39 and 0.93 respectively). However, following the hCG trigger and oocyte recovery; serial log e mean (95%CI) pVEGF (pg/ml) increased significantly on the days of embryo transfer (DET) [10.00 (4.80,25.30) vs 67.50 (3.14,149.20); p Ͻ 0.01] and DETϩ4 [4.70 (1.90,17.20) vs. 186.10 (70.80,294.70); p Ͻ 0.001] respectively in the OHSS group. Analysis of variance also confirmed that there was no significant increase from day of hCG to OR (p ϭ 0.76) but significant increases occurred in the OHSS group on DET (p ϭ 0.010) and DETϩ4 (p ϭ 0.002) respectively. Conclusions: These results demonstrate that despite higher pre-hCG intrafollicular vascularity, the pVEGF levels are similar to controls before; but increase significantly after hCG in the OHSS group. This may indicate a pre-hCG paracrine effect; genetic differences in VEGF receptivity in the OHSS group; or that other putative angiogenic modulators are involved in the development of pre-hCG intrafollicular vascularity in OHSS.
Study question Following a failed IVF cycle, does adding letrozole for the first 5 days of a repe... more Study question Following a failed IVF cycle, does adding letrozole for the first 5 days of a repeated cycle have any advantage versus repeating the same protocol? Summary answer Following a failed IVF cycle, letrozole supplementation during ovarian stimulation for IVF results in a similar cumulative live birth rate (CLBR) with 22% less gonadotropins. What is known already Letrozole results in an increase of intraovarian androgen concentration, which augments follicular stimulating hormone (FSH) receptor expression on granulosa cells and follicular responsiveness to exogenous gonadotropins. Letrozole co-treatment with gonadotropins during controlled ovarian stimulation (COH) for IVF has been investigated mainly in poor and normo-responders with conflicting clinical outcomes. This is the first and largest study that investigates the effects of adding letrozole for the first five days of COH for IVF, in GnRH antagonist cycles, to a category of patients who had a prior failed stimulated...
RESEARCH QUESTION Do live birth rates (LBR) following modified natural IVF (mnIVF) differ accordi... more RESEARCH QUESTION Do live birth rates (LBR) following modified natural IVF (mnIVF) differ according to serum anti-Müllerian hormone (AMH) concentration? DESIGN Retrospective cohort study including 638 women aged ≤39 years starting their first mnIVF cycle at a university-affiliated private IVF centre. Patients were divided into three groups, by concentration of AMH: ≤0.5 ng/ml (25th percentile), 0.51-2.03 ng/ml (25-75th percentile, reference) and 2.04-6.56 ng/ml (75th percentile). Analyses were stratified by AMH percentile and the age of patients (<35, 35-39 years). Logistic regression assessed the impact of age and AMH percentile on outcomes. LBR was the primary outcome measure. RESULTS LBR per started cycle were comparable across AMH percentiles (11.6%, 12.4% and 17.0% for the 25th, 25-75th and 75th percentile, respectively). No statistically significant difference was found between the three AMH groups with respect to cancellation, successful egg retrieval, embryo transfer, or biochemical and clinical pregnancy rates. Logistic regression analysis did not identify AMH percentile as a significant predictor of live birth. Compared with the reference group, the odds ratios (OR [95% confidence interval, CI]) for live birth in the <25th and >75th AMH percentile groups were 0.97 (0.54-1.76) and 1.41 (0.82-2.41), respectively. The results were the same regardless of age group (<35 years, 35-39 years). CONCLUSIONS Serum AMH cannot be used to predict mnIVF outcomes. Patients in lower/upper AMH percentiles showed pregnancy and LBR comparable to patients with normal AMH.
Aim: To compare clomiphene citrate (CC) and letrozole for ovarian stimulation (OS) in therapeutic... more Aim: To compare clomiphene citrate (CC) and letrozole for ovarian stimulation (OS) in therapeutic donor sperm insemination (TDI) cycles. Methods: Retrospective cohort study between January 2011 and June 2014 at a University-affiliated private IVF clinic in Montreal, Canada. 257 normo-ovulatory women ≤40 years of age with no history of infertility undergoing 590 TDI cycles in the absence of a male partner (single women and same-sex couples) or azoospermia were included. Patients received 100 mg CC daily (145 women, 321 cycles) or letrozole 5 mg daily (112 women, 269 cycles), from days 3 to 7. Only the first 3 cycles were included per patient. Our main outcome measure was cumulative live birth rates (LBR). Results: Baseline characteristics were comparable between the 2 groups. There were no differences in LBR per cycle (16.5% (53/321) vs. 11.5% (31/269), p = 0.08) and cumulative LBR (36.6% (53/145) vs. 27.7% (31/112), p = 0.13), between CC and letrozole, respectively. Multiple pregnancy rate (11.6% (8/69) vs. 8.7% (4/46), p = 0.6) and miscarriage rate (21.7 vs. 21.7%, p = 1) were also comparable between CC and letrozole, respectively. Conclusion: In normo-ovulatory women undergoing TDI, OS with CC or letrozole resulted in similar live birth and twin pregnancy rates.
Journal of Obstetrics and Gynaecology Canada, 2009
U ne nullipare de 25 ans a subi une hystérosalpingographie dans le cadre d'une évaluation visant ... more U ne nullipare de 25 ans a subi une hystérosalpingographie dans le cadre d'une évaluation visant l'infertilité primaire à la suite de 16 semaines d'aménorrhée. Une analyse d'urine visant la grossesse menée huit semaines plus tôt avait généré des résultats négatifs.
Objective: To determine the prevalence of chronic endometritis (CE) in patients with recurrent im... more Objective: To determine the prevalence of chronic endometritis (CE) in patients with recurrent implantation failure (RIF) after IVF and unexplained recurrent pregnancy loss (RPL). Design: Prospective observational study between November 2012 and March 2015. Setting: University-affiliated private IVF clinic. Patient(s): Women with RIF after IVF (group 1) and unexplained RPL (group 2). Intervention(s): Office hysteroscopy followed by an endometrial biopsy was performed as part of the workup for RIF and RPL. The diagnosis of CE was histologically confirmed using immunohistochemistry stains for syndecan-1 (CD138). Main Outcome Measure(s): The prevalence of CE in each group and the sensitivity/specificity of office hysteroscopy in the diagnosis of CE. Result(s): Ninety-nine patients were included (46 in group 1 and 53 in group 2). The mean age was 36.3 AE 4.9 years in group 1 and 34.5 AE 4.9 years in group 2. Five biopsies were uninterpretable (three in group 1 and two in group 2) because of insufficient specimen. The prevalence of CE was 14% (6/43) in group 1 and 27% (14/51) in group 2. The sensitivity and specificity of office hysteroscopy in the diagnosis of CE were 40% (8/20) and 80% (59/74), respectively. Conclusion(s): We found a high prevalence of immunohistochemically confirmed CE in women with RIF and RPL. Office hysteroscopy is a useful diagnostic tool but should be complemented by an endometrial biopsy for the diagnosis of CE.
Objective: To investigate whether luteal E 2 administration reduces size discrepancies of early a... more Objective: To investigate whether luteal E 2 administration reduces size discrepancies of early antral follicles. Design: Prospective, crossover study. Setting: ART unit, Clamart, France. Patient(s): Sixty women and 120 cycles. Intervention(s): On cycle day 3 (baseline day 3), all women underwent measurements of early antral follicles by ultrasound and serum FSH and ovarian hormones. From day 20 until the next cycle day 2, 30 of them received oral 17-E 2 , whereas the remaining women served as controls. The day after E 2 discontinuation (E 2 day 3) or on subsequent cycle day 3 (control day 3), participants were reevaluated as on baseline day 3. Main Outcome Measure(s): Magnitude of follicular size discrepancies. Result(s): Follicular size discrepancies and follicular diameters were significantly attenuated on E 2 day 3 (3.7 Ϯ 0.5 mm) as compared with baseline day 3 (4.9 Ϯ 1.0 mm), but not in controls (5.0 Ϯ 0.8 vs. 4.9 Ϯ 0.8 mm). FSH (4.3 Ϯ 1.9 vs. 7.3 Ϯ 3.3 mIU/mL) and inhibin B (34 Ϯ 28 vs. 71 Ϯ 32 pg/mL) levels were consistently lower on E 2 day 3 than on baseline day 3 but remained unchanged in controls. Conclusion(s): Luteal E 2 administration reduces the size and improves the homogeneity of early antral follicles on day 3. This approach may be instrumental in synchronizing follicular development during controlled ovarian hyperstimulation.
, NY). Samples were categorized based on the individuals' reported weekly alcohol consumption. A ... more , NY). Samples were categorized based on the individuals' reported weekly alcohol consumption. A two-tailed t-test was performed to test for significant differences between alcohol consuming and non-consuming groups. RESULTS: Despite a relatively high degree of inter-individual variability in sperm DNA 5-hmC levels (CV¼43.36), we found that global 5-hmC levels in sperm DNA are approximately 2-fold in individuals who consume alcohol (n¼23) compared with those who do not (n¼27; p¼0.008). CONCLUSION: We recently reported that global sperm DNA 5-hmC levels are significantly lower than levels in blood. This is in support of the hypothesis that 5-hmC facilitates transcription, as mature sperm are transcriptionally quiescent and have very low levels of 5-hmC. Here we demonstrate that on average global sperm 5-hmC is significantly increased in individuals who consume alcohol. These data comport with recent findings suggesting that alcohol intake leads to sperm DNA hypomethylation, and may provide insight into the mechanism by which this hypomethylation occurs.
Objective: To investigate whether seminatural cycle is a reasonable management for ovarian aging ... more Objective: To investigate whether seminatural cycle is a reasonable management for ovarian aging patients. Design: Prospective study.
Objective: To investigate whether premenstrual administration of a GnRH antagonist coordinates ea... more Objective: To investigate whether premenstrual administration of a GnRH antagonist coordinates early antral follicle sizes during the subsequent follicular phase. Design: Prospective, longitudinal study. Setting: University Hospital in France Patient(s): Twenty-five women, 50 cycles. Intervention(s): On cycle day 2 (control/day 2), women underwent measurements of early antral follicles by ultrasound and serum FSH and ovarian hormones. On day 25, they received a single cetrorelix acetate administration, 3 mg. On the subsequent day 2 (premenstrual GnRH antagonist/day 2), participants were re-evaluated as on control/day 2. Main Outcome Measure(s): Magnitude of follicular size discrepancies. Result(s): Follicular diameters (4.1 Ϯ 0.9 vs. 5.5 Ϯ 1.0 mm) and follicle-to-follicle size differences decreased on premenstrual GnRH antagonist/day 2 as compared with control/day 2. Consistently, FSH (4.5 Ϯ 1.9 vs. 6.7 Ϯ 2.4 mIU/mL), E 2 (23 Ϯ 13 vs. 46 Ϯ 26 pg/mL), and inhibin B (52 Ϯ 30 vs. 76 Ϯ 33 pg/mL) were lower on GnRH antagonist/day 2 than on control/day 2. Conclusion(s): Premenstrual GnRH antagonist administration reduces diameters and size disparities of early antral follicles on day 2, likely through the prevention of luteal FSH elevation and early follicular development. This simple, original approach may be used to coordinate multifollicular development in controlled ovarian hyperstimulation.
and E2 Յ 80 pg/mL on day 2 of their menstrual cycle began stimulation with recombinant FSH or hum... more and E2 Յ 80 pg/mL on day 2 of their menstrual cycle began stimulation with recombinant FSH or human menopausal gonadotropins. GnRH antagonists were given when the lead follicles were Ն 14mm or E2 Ն 400 pg/mL. HCG was administered when a minimum of 3 follicles were Ͼ 18 mm and E2 levels Ͼ 600 pg/mL, followed by oocyte retrieval 35 hours later. Cycles were cancelled if there were Ͻ 3 follicles with E2 Ͻ 500 pg/mL after 8 days of stimulation. Embryo transfer (ET) was performed on day 3. Serum samples collected at the time of baseline evaluation and after 4 days of gonadotropin stimulation were assayed in duplicate using an inhibin-B ELISA (Serotec, UK). Assay results were used to divide patients into four groups based on median inhibin values (baseline Յ 55 pg/mL vs. Ͼ 55 pg/mL, and day 5 Յ 300 pg/mL vs. Ͼ 300 pg/mL). Groups were then compared by age, baseline FSH and E2, oocyte number retrieved, number and quality of embryos transferred, and cycle pregnancy result. Statistical analysis was performed using Student's t-test to compare means Ϯ SEM between groups. Results: Of 103 cycles, 64 (62.1%) were retrieved, and 39 (37.9%) were cancelled due to poor response. The overall clinical pregnancy rate per ET was 21.3% (13/61), with an ongoing pregnancy rate of 13.1% (8/61). Baseline inhibin and cycle day 5 levels ranged from 15 to 256 pg/mL, and 15 to 2500 pg/mL, respectively. Baseline inhibin levels Յ 55 pg/mL and day 5 inhibin levels Յ 300 pg/mL were associated with significantly higher cancellation rates, and extremely low pregnancy rates (see table). There was no statistical difference detected amongst groups in age, baseline E2, number of oocytes, and embryo number and quality. Cycle results according to inhibin-B levels. * P Ͻ.05 Conclusion: Both baseline and cycle day 5 inhibin-B levels are useful additions to traditional ovarian reserve measurements in predicting ovarian response and cycle outcome in women over 39, and may be helpful in counseling patients regarding opportunity for IVF success.
Design: Longitudinal. Materials/Methods: Women with 2 normal ovaries, undergoing IVF and consider... more Design: Longitudinal. Materials/Methods: Women with 2 normal ovaries, undergoing IVF and considered to be at an increased risk of OHSS because of the presence of Ͼ 20 follicles (n ϭ 81) were investigated with pre-hCG U/S, colour Doppler imaging (CDI) and serial pre-and post hCG pVEGF. Those with a past history of ovarian disease (including PCO or PCOS) or surgery were excluded. Colour Doppler blood flow imaging was performed with an Acuson 128 XP10 computerised imaging system. A sandwich enzyme immuno-assay (Quantikine™, ELISA) was used to assay free VEGF 165. Those who were admitted to hospital with the moderate or severe forms of OHSS, but did not conceive [Group II; n ϭ 9] were compared with matched controls [Group I; n ϭ 27]. The VEGF data was not normally distributed and, therefore, required log e transformation. VEGF data are therefore presented as detransformed log e (geometric) means (95%CI). Simple 2-sample t-test was used to compare (geometric) means and analysis of variance was also performed with age, number of follicles; and embryos transferred as co-variates. Results: The peak systolic and time-averaged maximal velocity, pulsatility index, resistance index and S/D ratio of intrafollicular blood flow and pVEGF were similar (p0.05); but the degree of intrafollicular vascularity (FVI) was higher before hCG in the OHSS group (0.38 ϩ 0.18 vs. 0.69 ϩ 0.12; p Ͻ 0.001). There was no statistically significant difference in pVEGF between the two groups before hCG and oocyte recovery (OR) (p ϭ 0.39 and 0.93 respectively). However, following the hCG trigger and oocyte recovery; serial log e mean (95%CI) pVEGF (pg/ml) increased significantly on the days of embryo transfer (DET) [10.00 (4.80,25.30) vs 67.50 (3.14,149.20); p Ͻ 0.01] and DETϩ4 [4.70 (1.90,17.20) vs. 186.10 (70.80,294.70); p Ͻ 0.001] respectively in the OHSS group. Analysis of variance also confirmed that there was no significant increase from day of hCG to OR (p ϭ 0.76) but significant increases occurred in the OHSS group on DET (p ϭ 0.010) and DETϩ4 (p ϭ 0.002) respectively. Conclusions: These results demonstrate that despite higher pre-hCG intrafollicular vascularity, the pVEGF levels are similar to controls before; but increase significantly after hCG in the OHSS group. This may indicate a pre-hCG paracrine effect; genetic differences in VEGF receptivity in the OHSS group; or that other putative angiogenic modulators are involved in the development of pre-hCG intrafollicular vascularity in OHSS.
Study question Following a failed IVF cycle, does adding letrozole for the first 5 days of a repe... more Study question Following a failed IVF cycle, does adding letrozole for the first 5 days of a repeated cycle have any advantage versus repeating the same protocol? Summary answer Following a failed IVF cycle, letrozole supplementation during ovarian stimulation for IVF results in a similar cumulative live birth rate (CLBR) with 22% less gonadotropins. What is known already Letrozole results in an increase of intraovarian androgen concentration, which augments follicular stimulating hormone (FSH) receptor expression on granulosa cells and follicular responsiveness to exogenous gonadotropins. Letrozole co-treatment with gonadotropins during controlled ovarian stimulation (COH) for IVF has been investigated mainly in poor and normo-responders with conflicting clinical outcomes. This is the first and largest study that investigates the effects of adding letrozole for the first five days of COH for IVF, in GnRH antagonist cycles, to a category of patients who had a prior failed stimulated...
RESEARCH QUESTION Do live birth rates (LBR) following modified natural IVF (mnIVF) differ accordi... more RESEARCH QUESTION Do live birth rates (LBR) following modified natural IVF (mnIVF) differ according to serum anti-Müllerian hormone (AMH) concentration? DESIGN Retrospective cohort study including 638 women aged ≤39 years starting their first mnIVF cycle at a university-affiliated private IVF centre. Patients were divided into three groups, by concentration of AMH: ≤0.5 ng/ml (25th percentile), 0.51-2.03 ng/ml (25-75th percentile, reference) and 2.04-6.56 ng/ml (75th percentile). Analyses were stratified by AMH percentile and the age of patients (<35, 35-39 years). Logistic regression assessed the impact of age and AMH percentile on outcomes. LBR was the primary outcome measure. RESULTS LBR per started cycle were comparable across AMH percentiles (11.6%, 12.4% and 17.0% for the 25th, 25-75th and 75th percentile, respectively). No statistically significant difference was found between the three AMH groups with respect to cancellation, successful egg retrieval, embryo transfer, or biochemical and clinical pregnancy rates. Logistic regression analysis did not identify AMH percentile as a significant predictor of live birth. Compared with the reference group, the odds ratios (OR [95% confidence interval, CI]) for live birth in the <25th and >75th AMH percentile groups were 0.97 (0.54-1.76) and 1.41 (0.82-2.41), respectively. The results were the same regardless of age group (<35 years, 35-39 years). CONCLUSIONS Serum AMH cannot be used to predict mnIVF outcomes. Patients in lower/upper AMH percentiles showed pregnancy and LBR comparable to patients with normal AMH.
Aim: To compare clomiphene citrate (CC) and letrozole for ovarian stimulation (OS) in therapeutic... more Aim: To compare clomiphene citrate (CC) and letrozole for ovarian stimulation (OS) in therapeutic donor sperm insemination (TDI) cycles. Methods: Retrospective cohort study between January 2011 and June 2014 at a University-affiliated private IVF clinic in Montreal, Canada. 257 normo-ovulatory women ≤40 years of age with no history of infertility undergoing 590 TDI cycles in the absence of a male partner (single women and same-sex couples) or azoospermia were included. Patients received 100 mg CC daily (145 women, 321 cycles) or letrozole 5 mg daily (112 women, 269 cycles), from days 3 to 7. Only the first 3 cycles were included per patient. Our main outcome measure was cumulative live birth rates (LBR). Results: Baseline characteristics were comparable between the 2 groups. There were no differences in LBR per cycle (16.5% (53/321) vs. 11.5% (31/269), p = 0.08) and cumulative LBR (36.6% (53/145) vs. 27.7% (31/112), p = 0.13), between CC and letrozole, respectively. Multiple pregnancy rate (11.6% (8/69) vs. 8.7% (4/46), p = 0.6) and miscarriage rate (21.7 vs. 21.7%, p = 1) were also comparable between CC and letrozole, respectively. Conclusion: In normo-ovulatory women undergoing TDI, OS with CC or letrozole resulted in similar live birth and twin pregnancy rates.
Journal of Obstetrics and Gynaecology Canada, 2009
U ne nullipare de 25 ans a subi une hystérosalpingographie dans le cadre d'une évaluation visant ... more U ne nullipare de 25 ans a subi une hystérosalpingographie dans le cadre d'une évaluation visant l'infertilité primaire à la suite de 16 semaines d'aménorrhée. Une analyse d'urine visant la grossesse menée huit semaines plus tôt avait généré des résultats négatifs.
Objective: To determine the prevalence of chronic endometritis (CE) in patients with recurrent im... more Objective: To determine the prevalence of chronic endometritis (CE) in patients with recurrent implantation failure (RIF) after IVF and unexplained recurrent pregnancy loss (RPL). Design: Prospective observational study between November 2012 and March 2015. Setting: University-affiliated private IVF clinic. Patient(s): Women with RIF after IVF (group 1) and unexplained RPL (group 2). Intervention(s): Office hysteroscopy followed by an endometrial biopsy was performed as part of the workup for RIF and RPL. The diagnosis of CE was histologically confirmed using immunohistochemistry stains for syndecan-1 (CD138). Main Outcome Measure(s): The prevalence of CE in each group and the sensitivity/specificity of office hysteroscopy in the diagnosis of CE. Result(s): Ninety-nine patients were included (46 in group 1 and 53 in group 2). The mean age was 36.3 AE 4.9 years in group 1 and 34.5 AE 4.9 years in group 2. Five biopsies were uninterpretable (three in group 1 and two in group 2) because of insufficient specimen. The prevalence of CE was 14% (6/43) in group 1 and 27% (14/51) in group 2. The sensitivity and specificity of office hysteroscopy in the diagnosis of CE were 40% (8/20) and 80% (59/74), respectively. Conclusion(s): We found a high prevalence of immunohistochemically confirmed CE in women with RIF and RPL. Office hysteroscopy is a useful diagnostic tool but should be complemented by an endometrial biopsy for the diagnosis of CE.
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Papers by Isaac Kadoch