Subtle perturbations of ovarian steroidogenesis in patients classified as Poseidon Group 3. Which consequences for therapeutic strategy?

The optimal strategy for stimulation of young women with a low ovarian reserve is still a challenging issue because the physio-pathogeny of this disorder is often unknown. As androgen production by the ovary plays a crucial role in folliculogenesis, it was tempting to speculate that subtle perturbations in ovarian steroidogenesis might participate to the low responsiveness to gonadotrophins. Indeed, analysis of human luteinized granulosa cells has recently provided evidence for some enzymatic deficits in steroidogenesis and altered response to gonadotrophins.

Non-inferiority of progestin-primed ovarian stimulation versus GnRH antagonist protocol: A propensity score-weighted analysis.

Purpose: To evaluate the effectiveness of the progestin-primed ovarian stimulation (PPOS) protocol versus the gonadotropin-releasing hormone antagonist (GnRH-ant) protocol in ovarian stimulation.

Methods: In this retrospective cohort study, we included 804 patients who were treated between January 1, 2022, and July 1, 2023. Outcomes of ovarian stimulation were compared between the PPOS (n = 206) and GnRH-ant (n = 598).

Management of Etonogestrel implant migration into the pulmonary artery.

Objectives: To evaluate the relationship between time since contraceptive implant placement and retrieval outcomes in patients with implant migration into the pulmonary artery.

Study Design: We reviewed all cases of pulmonary artery implant migration referred to the Marie Lannelongue hospital from 2015 through 2020. Using our hospital database, we collected patients' clinical data and removal information to assess the success of therapeutic management according to the delay between implant insertion and removal.

Comparative Effectiveness of Mild or Conventional GnRH-Antagonist Protocols for Ovarian Stimulation in Poor Responders (Poseidon Group 4).

A panel of experts (the Poseidon Group) introduced a new and more detailed stratification for poor ovarian responders in order to predict the prognosis of IVF outcome according to the sensitivity to FSH. However, various arguments about the management strategy of these patients still remain, including the convenience and the cost. Therefore, this study was conducted to compare the efficacy of mild and conventional GnRH antagonist ovarian stimulation prescribed in patients classified in Poseidon Group 4.

Second live birth after undergoing assisted reproductive technology in women operated on for endometriosis.

Objective: To determine prognostic factors for a second live birth, after a first child obtained through assisted reproductive techniques (ART).

Design: Observational study from January 2004 to December 2014.

Setting: Tertiary care university hospital and ART center.

External validation of the Endometriosis Fertility Index in a French population.

Objective: To show an external validation of the Endometriosis Fertility Index (EFI) and to observe cumulated pregnancy rates after infertility management combining surgery and assisted reproductive technologies (ART).

Design: Observational study from January 2004 to December 2012.

Setting: Tertiary-care university hospital and ART center.

Clinical predictive criteria associated with live birth following elective single embryo transfer.

Objective: We aimed to define clinical criteria from the patients related to the occurrence of live birth in case of elective single embryo transfer (eSET).

Study Design: We analyzed retrospectively 409 eSET at day 2/3 between March 2005 and July 2012, proposed in case of (i) woman's age <37 years, (ii) first/second IVF0 cycle, (iii) ≥2 good quality embryos obtained (3-5/6-10 blastomeres at day 2/3 and <20% fragmentation), including one top embryo (4/8 cells). In all, 124/409 live births (30.

Could sperm grade under high magnification condition predict IMSI clinical outcome?

Objective: The aim of this study was to examine whether injection of first-best morphology grade selected spermatozoa improves live birth rate (LBR) compared to intracytoplasmic morphologically selected sperm injection (IMSI) using second-best grade sperm.

Study Design: In this prospective observational study, 132 patients were enrolled. Inclusion criteria were the presence of severe male factor (normal spermatozoa <10% in fresh ejaculated semen and <10% in selected sperm according to David's classification) associated with ≤2 previous ICSI failure.

Phase IV, open-label, randomized study of low-dose recombinant human follicle-stimulating hormone protocols for ovulation induction.

Background: This Phase IV, open-label, multicentre, randomized study (MEnTOR) compared two low-dose recombinant human follicle-stimulating hormone (r-hFSH) protocols for ovulation induction.

Methods: This study was conducted in six Middle Eastern countries between March 2009 and March 2011. Eligible women (18-37 years), with World Health Organization Group II anovulatory infertility, were randomized to receive r-hFSH (starting daily dose: 75 IU) as a chronic low-dose (CLD) (37.

Impact of high serum progesterone during the late follicular phase on IVF outcome.

With ovarian stimulation for IVF, serum progesterone concentration may increase during the last few days of stimulation. Several factors, mainly the intensity of the ovarian response to gonadotrophins, have been identified to explain progesterone elevation but many other issues remain uncertain. The aim of this narrative, nonsystematic review is to address the nonconsensual issues of the reasons and consequences of premature progesterone elevation during ovarian stimulation.

Is intracytoplasmic morphologically selected sperm injection effective in patients with infertility related to teratozoospermia or repeated implantation failure?

Objective: To evaluate the potential benefit of intracytoplasmic morphologically selected sperm injection (IMSI) in patients selected for either severe teratozoospermia or repeated implantation failure after conventional intracytoplasmic sperm injection (ICSI).

Design: Prospective nonrandomized observational study.

Setting: University hospital assisted reproduction unit.

Assessment of theca cell function: a prerequisite to androgen or luteinizing hormone supplementation in poor responders.

Poor responders are a heterogeneous population, with some patients displaying a diminished ovarian reserve and others a poor ovarian reserve with preserved granulosa cell function. Androgen and LH/hCG supplementation has been advocated for poor responders, mainly those >40 years old. Although androgens synergistically act with FSH to support folliculogenesis, and ovarian androgen secretion declines with age, there is still no evidence that androgen therapy is actually effective to improve ovarian FSH sensitivity.

Pretreatment with estrogen does not affect IVF-ICSI cycle outcome compared with no pretreatment in GnRH antagonist protocol: a prospective randomized trial.

Objective: To assess effects of estrogen pretreatment in GnRH antagonist protocol.

Design: Prospective, randomized multicenter study.

Setting: Ten private or university-based centers.

Impact of endogenous luteinizing hormone serum levels on progesterone elevation on the day of human chorionic gonadotropin administration.

Objective: To assess the relationship between endogenous LH serum levels after GnRH analogue administration and serum P elevation on the day of hCG administration (P hCG).

Design: Retrospective study.

Setting: Reproductive medicine center in a university hospital.

Hydrosalpinx and infertility: what about conservative surgical management?

Objective: The aim of this study was to assess and validate a management protocol for infertile patients affected by at least one hydrosalpinx.

Study Design: Eighty-one consecutive infertile normo-ovulatory patients with uni or bilateral hydrosalpinx planed to be surgically managed were included in the protocol from November 2003 to May 2007. During laparoscopy, a systematic evaluation of the tubes was firstly conducted and the local management protocol based on validated tubal prognostic scores was applied.

Conventional ovarian stimulation no longer exists: welcome to the age of individualized ovarian stimulation.

The prediction of extremes of ovarian response to stimulation and the irreversibility of reduced ovarian reserve remain important clinical and basic science research issues of IVF treatment. Recommending commencement of ovarian stimulation using any of the available exogenous compounds without knowledge of individual ovarian potentials is simplistic and dangerous because of the possible adverse consequences for the woman. The identification of groups of patients likely to benefit from one protocol than another is central to the workup process of IVF.

Efficacy of transient abdominal ovariopexy in patients with severe endometriosis.

Objective: To assess adhesion formation and fertility outcome after transient abdominal ovariopexy performed in patients with severe endometriosis.

Study Design: Retrospective study including 218 patients who underwent surgery for severe endometriosis from 1997 to 2009. One hundred and thirty-nine (64%) patients were infertile.

Biological predictive criteria for clinical pregnancy after elective single embryo transfer.

In this prospective observational study, the onset of a clinical pregnancy after elective single embryo transfer (eSET) was significantly associated with: 1) the woman's age as well as the number of good- and top-quality embryos; and 2) the day of the embryo transfer (day 3>day 2). Good-quality embryos had the same ability to implant, regardless of the zygotic score, the day 1 early cleavage rate, the fragmentation degree, and the top-quality assessment, specifying the eligibility criteria for eSET.

Should all embryos from day 1 rescue intracytoplasmic sperm injection be transferred during frozen-thawed cycles?

A retrospective analysis of a 5-year rescue intracytoplasmic sperm injection (ICSI) experience performed in 17 cases of complete IVF fertilization failure showed that the ongoing pregnancy rate per embryo transfer (ET) is much higher in a subsequent frozen-thawed cycles (40%, 2/5) than following a fresh ET (6.7%, 1/15). These results suggest that cryopreservation of all embryos, subsequently used in frozen-thawed cycles, might improve rescue ICSI outcome throughout a better synchronization of the embryo development with the endometrium.

Assessment of theca cell function prior to controlled ovarian stimulation: the predictive value of serum basal/stimulated steroid levels.

Background: Serum androgen levels correlate with ovarian sensitivity to follicle-stimulating hormone (FSH) but in practice, standard baseline serum testosterone (T) levels prior to in-vitro fertilization (IVF) may not be the most appropriate marker for determination.

Methods: Infertile women enrolled in an IVF programme were included in this study. Serum T and Delta4-androstenedione (A), and the androgen precursor 17-hydroxyprogesterone (17-OHP) were measured before and 24 h after a gonadotrophin-releasing hormone agonist stimulation test (GAST).

[Impact of overweight on the outcome of ovarian stimulation].

Overweight and obesity have a negative impact on the efficacy of agents used to induce ovulation, and especially on the dose of clomiphene citrate or gonadotrophins required to achieve ovulation. BMI is a major predictor of the ovarian response. In IVF-ICSI cycles, overweight is associated with a decrease in the number of oocytes.

"Empty follicle syndrome" after human error: pregnancy obtained after repeated oocyte retrieval in a gonadotropin-releasing hormone antagonist cycle.

Objective: To report a case of empty follicle syndrome (EFS) after human error occurring in hCG administration and discuss the specific management of this event in a GnRH antagonist cycle.

Design: Case report.

Setting: A university hospital.

Day 3 compared with day 2 cryopreservation does not affect embryo survival but improves the outcome of frozen-thawed embryo transfers.

A retrospective study was performed to determine the differences in embryo survival and frozen-thawed embryo transfers outcome between cryopreservation performed on day 3 versus day 2. We conclude that freezing supernumerary embryos on day 3 provides similar thawing survival parameters, better implantation, pregnancy, and live-birth rates compared with day 2 cryopreservation.