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Gan R, Huang X, Zhao J, Zhang Q, Huang C, Li Y. Time interval between hCG administration and oocyte retrieval and ART outcomes: an updated systematic review and meta-analysis. Reprod Biol Endocrinol 2023; 21:61. [PMID: 37400840 DOI: 10.1186/s12958-023-01110-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/14/2023] [Indexed: 07/05/2023] Open
Abstract
RESEARCH QUESTION To explore whether prolonged hCG-ovum pickup interval improves assisted reproductive technology outcomes. DESIGN CENTRAL, CNKI, Cochrane Systematic Reviews, EMBASE, MEDLINE, PUBMED, and Web of Science up to May 13 2023 were searched for studies reporting associations between hCG-ovum pickup intervals and assisted reproductive technology outcomes. Intervention types included short (≤ 36 h) and long (> 36 h) hCG-ovum pickup intervals in assisted reproductive technology cycles. All outcomes were based upon only fresh embryo transfers. Primary outcome is defined as the clinical pregnancy rate. Data were pooled using random-effects models. Heterogeneity was assessed using the I 2 statistics. RESULTS Twelve studies were included in the meta-analysis, including five retrospective cohort studies, one prospective cohort study, and six randomized or quasi-randomized controlled trials. The short and long interval groups had similar oocyte maturation rates, fertilization rate and high-quality embryo rate (OR, 0.69; 95% CI, 0.45-1.06; I 2 = 91.1%, OR, 0.88; 95% CI, 0.77-1.0; I 2 = 44.4% and OR, 1.05; 95% CI, 0.95-1.17; I 2 = 8.6%, respectively). The clinical pregnancy rates in the long retrieval group were significantly higher than in the short retrieval group (OR, 0.66; 95% CI, 0.45-0.95; I 2 = 35.4%). The groups had similar miscarriage and live birth rates (OR, 1.92; 95% CI, 0.66-5.60; I 2 = 0.0% and OR, 0.50; 95% CI, 0.24-1.04; I 2 = 0.0%, respectively). CONCLUSIONS The clinical pregnancy rates can be increased by prolonging the hCG-ovum pickup interval, which would help us develop more reasonable time schedules for fertility centers and patients. META-ANALYSIS REGISTRATION PROSPERO CRD42022310006 (28 Apr 2022).
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Affiliation(s)
- Runxin Gan
- Reproductive Medicine Center, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, P.R. China
- Clinical Research Center for Women's, Reproductive Health in Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan, P.R. China
| | - Xi Huang
- Reproductive Medicine Center, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, P.R. China
- Clinical Research Center for Women's, Reproductive Health in Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan, P.R. China
| | - Jing Zhao
- Reproductive Medicine Center, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, P.R. China
- Clinical Research Center for Women's, Reproductive Health in Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan, P.R. China
| | - Qiong Zhang
- Reproductive Medicine Center, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, P.R. China
- Clinical Research Center for Women's, Reproductive Health in Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan, P.R. China
| | - Chuan Huang
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, 410000, China
| | - Yanping Li
- Reproductive Medicine Center, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, P.R. China.
- Clinical Research Center for Women's, Reproductive Health in Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan, P.R. China.
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Cao XL, Sun ZG. Borderline form of empty follicle syndrome treated with a novel dual trigger method combined with delayed oocyte retrieval: A case report. World J Clin Cases 2020; 8:825-830. [PMID: 32149067 PMCID: PMC7052558 DOI: 10.12998/wjcc.v8.i4.825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/10/2020] [Accepted: 01/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Borderline form of empty follicle syndrome is a condition in which only a few mature or immature oocytes are recovered after meticulous follicular aspiration, despite adequate ovarian response to stimulation. It is a rare phenomenon with an unclear cause. Currently, the condition still lacks effective treatment.
CASE SUMMARY A patient with secondary infertility who had undergone three cycles of assisted reproductive technique (ART) is described. With regard to good follicular response, two oocytes were obtained in the first two ART cycles, but no embryo was formed. In the third ART cycle, which is the subject of this study, ovulation was induced by dual trigger of a supernormal dose of human chorionic gonadotropin (HCG) combined with a delayed oocyte retrieval approach. The method involved administration of gonadotropin-releasing hormone agonist, recombinant HCG, and urinary HCG 39 h before ovum pick-up. Ten oocytes were recovered, two out of three mature eggs were fertilized after intracytoplasmic sperm injection, resulting in two embryos that were subsequently cryopreserved. The case report guidelines have been used herein to present the first case of this novel dual trigger method.
CONCLUSION This approach provides a new treatment option for patients with a similar condition in the future. This study can also inspire further investigation on the effects of various β-HCG serum levels 36 h after intramuscular HCG administration.
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Affiliation(s)
- Xian-Ling Cao
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan 250011, Shandong Province, China
- Integrative Medicine Research Centre of Reproduction and Heredity, the Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250011, Shandong Province, China
| | - Zhen-Gao Sun
- Integrative Medicine Research Centre of Reproduction and Heredity, the Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250011, Shandong Province, China
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Dias S, McNamee R, Vail A. Evidence of improving quality of reporting of randomized controlled trials in subfertility. Hum Reprod 2006; 21:2617-27. [PMID: 16793995 DOI: 10.1093/humrep/del236] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The quality of randomized controlled trials (RCTs) in subfertility and their suitability for inclusion in meta-analyses have been assessed in the past and found to be insufficient. Our aim was to assess whether this quality has improved over time, particularly since the publication of the Consolidated Standards of Reporting Trials (CONSORT) statement, and to assess what proportion of trials could be included in the meta-analyses of pregnancy outcomes such as those included in Cochrane Reviews. METHODS A selection of subfertility trials published in 1990, 1996 and 2002 was collected from the Cochrane Menstrual Disorder and Subfertility Group (MDSG) database. Only trials published in English as full journal articles, claiming to be randomized and reporting on pregnancy outcomes, were included. RESULTS One hundred and sixty-four trials met our inclusion criteria. Twenty-four (15%) were found not to be randomized, despite claims, and only 10 trials (6%) provided adequate details on the methods of randomization and allocation concealment. Of these, only three had sufficient details extractable to allow for an intention-to-treat analysis of the outcome 'live birth'. CONCLUSIONS Although an improvement in some subfertility-specific issues was observed, the quality of reporting of RCTs still needs to improve to make them suitable for inclusion in meta-analyses such as those in the Cochrane Library.
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Affiliation(s)
- Sofia Dias
- Biostatistics Group, University of Manchester, Manchester, UK.
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Bustillo M. Unsuccessful oocyte retrieval: technical artefact or genuine 'empty follicle syndrome'? Reprod Biomed Online 2004; 8:59-67. [PMID: 14759289 DOI: 10.1016/s1472-6483(10)60498-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Unsuccessful oocyte retrieval after apparently successful ovarian stimulation (also referred to as 'empty follicle syndrome') occurs in 1-7% of women undergoing assisted reproductive techniques. A literature review was performed, as individual studies have reached differing conclusions on the aetiology and treatment or management of the phenomenon. The aetiology is not clear, but probably multifactorial, and occurs in natural and stimulated cycles. In many cases, technical problems such as errors in human chorionic gonadotrophin (HCG) administration or defects in HCG batches can be identified, but this is not sufficient to account for all reported cases. The term empty follicle syndrome is inappropriate in cases in which such procedural factors can be identified. In many patients, however, unsuccessful oocyte retrieval appears to be due to an underlying ovarian dysfunction, and some may have a genuine empty follicle syndrome. Appropriate measures, such as monitoring of serum beta-HCG, should be taken to minimize the risk of unsuccessful oocyte retrieval. This review discusses the potential causes of unsuccessful oocyte retrieval, its clinical implications, and potential solutions to this clinical problem.
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Affiliation(s)
- María Bustillo
- South Florida Institute for Reproductive Medicine, 7300 SW 62nd Place, 4th Floor, Miami, Florida, USA.
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Vandekerckhove P, O'Donovan PA, Lilford RJ, Harada TW. Infertility treatment: from cookery to science. The epidemiology of randomised controlled trials. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1993; 100:1005-36. [PMID: 8251450 DOI: 10.1111/j.1471-0528.1993.tb15142.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To review the epidemiology of published randomised controlled trials in infertility treatment over the last 25 years, with special emphasis on the number and quality of trials. DESIGN Computer literature review by MEDLINE backed up by a manual search of 41 journals. Each trial was classified according to the methodology described and quality criteria. The results were recorded in a computer database. Odds ratios (OR) and confidence intervals (CI) were calculated where the data were sufficient. SUBJECTS Couples suffering from primary or secondary infertility. The trials studied 33,761 patients overall. SETTING Institute of Epidemiology and Health Services Research, Leeds. RESULTS Five hundred and one randomised trials in male and female infertility treatment were identified between 1966 and 1990. Pregnancy was an outcome in 291 (58%) and these were the subject of detailed analysis. Two hundred and twenty-four (77%) and 67 (23%) 'pregnancy trials' were concerned, respectively, with female and male infertility. Four per cent of the trials were preceded by a sample size calculation, and the average sample size was 96 patients (range 5-933); 700 patients per group would be required to demonstrate plausible success rates for most treatments. The method of randomisation was unstated or pseudo-randomised in 206 (71%) of trials where pregnancy was an outcome. Only 29 (5.8%) of studies were multicentre. The method of confirmation of pregnancy was omitted for 70% of papers. Cross-over design was used in 103 (21%) of cases. Meta-analysis is possible for selected topics such as the use of anti-oestrogens in idiopathic oligospermia and unexplained female infertility. Eight cases of double reporting were identified. CONCLUSIONS Trials using randomised methodology were relatively few in comparison with other branches of medicine, although their use is important in the evaluation of treatment for infertility as treatment-independent pregnancy is common. It was encouraging to note that an exponential increase in the use of this methodology occurred during the last three years, especially in association with assisted conception techniques, and meta-analysis has become possible for selected topics. However, many trials suffer from an unrealistically small sample size, inappropriate use of cross-over design or pseudo-randomisation. The trend towards properly controlled studies should be encouraged but these studies should be of improved quality and organised on a multicentre or even international basis.
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Affiliation(s)
- P Vandekerckhove
- Institute of Epidemiology and Health Services Research, University of Leeds, UK
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