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Lab Attendance

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Test Student 2015

Lab 1 Assessment

Article 1 PMID 6241855

The aim of this study was to look at in vitro Maturation (IVM) in women with Polycycsitc Ovarian Syndrome (PCOS) undergoing in vitro fertilization (IVF) compared to women who do not have PCOS. To do this the authors of the article wanted too analyse past studies regarding IVM and PCOS so created an algorithm to aid in their search, with the end of the search date being October 15th 2013. Studies deemed eligible for use in this research compared the rates of various outcomes such as live births and cycle cancellations between people with PCOS, PCO and control women undergoing IVM. Animal studies, case reports and trials on ovum recipients were excluded. An excel spreadsheet was created by 3 of the authors to record and sort their data.

The extent of publication bias was not assessed as it was deemed not necessary due to the small study pool per outcome. To evaluate the quality of the data used in this study, the authors used the nine-item Newcastle Ottawa Quality scale. The main outcome measured was live births per women and per cycle. Other measures included clinical pregnancy per woman, miscarriage rate and fertilization rate. Based on the frequencies of the outcomes between the 3 groups, 95% confidence intervals (CI's) were calculated. Two additional analyses were conducted with regards to clinical pregnancy and live births, namely one based on women and the other on cycles. Statistical analysis was done using STATA Software/SE 13.

268 PCOS, 100 PCO and 440 control patients were included in the analysis. The authors found that live birth rates did not differ between PCOS and non-PCOS women was seen in the cycle-based analysis but in the women-based analysis, a slightly higher birth rate was seen for PCOS women. According to both the woman and cycle based approaches, higher rates of clinical pregnancy were seen for PCOS women compared to non-PCOS women. The same trend was seen for implantation rates in women with PCOS compared to women without PCOS. Cancellation rates were lower in women with PCOS in both subgroups however maturation and miscarriage rates did not differ between the 3 groups assessed. Fertilization rates were minimally lower between women with PCOS compared to non-PCOS women.

A higher rate of clinical pregnancy rates were seen in women with PCOS who have undergone stimulation with FSH and hCG priming during both women and cycle based analysis. No pattern between the 3 groups was seen when there was a lack of priming with hCG. When rating the quality of the studies,the scores ranged between 5 and 9, with older studies receiving a lower score compared to newer studies. To conclude, it was found that IVM appears to be a good approach when it comes to treating women with PCOS during IVF as opposed to women without PCOS. It is an efficient treatment option in terms of implantation, clinical pregnancy and cycle cancellation rates.

Article 2 PMID 26238449

The aim of this article was to evaluate the effects of progesterone elevation as a result of human chorionic gonadotropin (hCG) administration on the outcome of IVF with transferred embryos at various stages of development. The study looked at an excess of 10,000 women undergoing day 3 cleavage-stage embryo transfer and an additional 1146 women undergoing day 5 blastocyst-stage embryo transfer. Both groups of women underwent controlled ovarian stimulation using gonadotropin and GnRH agonist. Certain exclusion criteria were set for participants in the study, including the exclusion of couples in which either member had chromosomal abnormalities. Various patient characteristics were evaluated, such as BMI, cause of infertility and basal FSH levels. Ovarian stimulation was controlled by patients doctor on a case by case basis, assigning them either standard long GnRH agonist or modified prolonged GnRH agonist protocol. Serum levels of FSH and LH were suppressed using triptorelin acetate. Doses were adjusted after 4 days depending on how the ovary had responded and when more than 3 follicles had reached 17mm, GnRH was injected into the patient and after ~36 hours, oocytes were retrieved. The cleavage-stage embryos were graded against a criteria for quality and women with 3 or more quality embryos were selected to go onto blastocyst stage development. A grading criteria was also used for the blastocyst-stage embryos.

2-4 days prior to IVF, basal FSH levels were measured. Throughout the ovarian stimulation, the levels of hormones such as LH and progesterone were assessed while fasting. A clinical pregnancy (CP) was considered to be present is if, upon ultrasound, cardiac pulsations were heard and a intrauterine gestational sac is present, 35-45 days post embryo transfer. Patients in both groups were divided into subgroups based on their serum progesterone levels due to the fact that the relationship between pregnancy rate and serum progesterone levels was thought to be non-linear. Various statistical analyses were then carried out to establish results for the aims. These included Mantel-Haenszel test for trend analysis and 95% confidence intervals.

The results were logged based on a variety of criteria including patients characteristics. They found the average basal FSH levels of patients to be 7.16 with the majority of patients being in their first IVF cycles. Advanced age and PCOS were two of several causes of infertility found. In the 3 day ET group, an inverse relationship between serum progesterone levels (SPL) and CP's was seen, however, a decrease in CP's was seen when the SPL reached >1.0ng/ml, indicating a detrimental affect on the likelihood of pregnancy when the progesterone reaches a certain threshold and exponentially worsens with increasing levels of progesterone. A similar pattern was seen in the 5 day ET group which showed an inverse relationship between SPL and CP's until SPL's reached >1.75ng/ml

Various factors were shown to be significantly associated with CP's through a multivariate logistic regression analysis. For example, in the 3 day ET group, a negative relationship was seen between CP's and serum progesterone levels where as a positive one was seen between CP's and the transfer of top-quality embryos. A similar trend was seen for the 5 day ET, however, female age was negatively associated with CP. The conclusion of this study showed that administration of progesterone on the day oh hCG administration decreased the rate of clinical pregnancies in both cleavage and blastocyst embryo stages whilst the woman underwent controlled ovarian stimulation.

References

PMID 26244658

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