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Kiran Kumar P, Lava Kumar S, Silambarasan V, Athar M, Kumar EA, Mohanty A, Kumari A, Birajdar P, Kumar A, Sabnam S, Abhilasha S, Sharma GT, Rao HBDP. α-tocopherol deficiency in follicular ovarian cyst (FOCs) follicular fluid (FF) elevates oxidative stress and impairs oocyte maturation. Free Radic Biol Med 2025; 229:415-426. [PMID: 39870224 DOI: 10.1016/j.freeradbiomed.2025.01.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Revised: 01/16/2025] [Accepted: 01/23/2025] [Indexed: 01/29/2025]
Abstract
Follicular ovarian cysts (FOCs) are prevalent reproductive disorders in both humans and animals, especially in livestock, where they cause economic losses by reducing fertility and productivity. FOCs are marked by a dominant follicle that fails to ovulate, disrupting the estrous cycle and reproductive efficiency. Previous studies indicate that the follicular fluid (FF) in cystic ovaries shows oxidative imbalance, affecting oocyte quality by altering glutathione peroxidase (GPX1) and selenium pathways. However, the metabolic profile of FF in cystic ovaries needs further exploration. This study examined oxidative stress and metabolic changes in FOC pathogenesis. Using untargeted metabolomics of goat FF, we found significant differences in 12,741 metabolites between cystic and control FF. Cystic FF had reduced levels of α-tocopherol and 8'-apocaroten-8'-ol, key for oxidative stress management, and increased levels of mycotoxins (e.g., Deoxynivalenol-3-glucoside) and long-chain fatty acids. Adding 200 μM α-tocopherol to FOC FF oocyte cultures doubled oocyte maturation rates and decreased reactive oxygen species (ROS). Metabolomic analysis linked low α-tocopherol to high lipid peroxyl radicals and low glutathione oxidation, emphasizing oxidative stress regulation's importance in the follicular microenvironment. Our findings suggest that α-tocopherol may serve as a biomarker and therapeutic agent to enhance oocyte maturation in FOCs.
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Affiliation(s)
- P Kiran Kumar
- BRIC-National Institute of Animal Biotechnology, Hyderabad, Telangana, 500032, India
| | - S Lava Kumar
- BRIC-National Institute of Animal Biotechnology, Hyderabad, Telangana, 500032, India; Graduate Studies, BRIC-Regional Center for Biotechnology, Faridabad, 121 001, India
| | - V Silambarasan
- BRIC-National Institute of Animal Biotechnology, Hyderabad, Telangana, 500032, India
| | - Mohd Athar
- BRIC-National Institute of Animal Biotechnology, Hyderabad, Telangana, 500032, India; Graduate Studies, BRIC-Regional Center for Biotechnology, Faridabad, 121 001, India
| | - E Ajith Kumar
- BRIC-National Institute of Animal Biotechnology, Hyderabad, Telangana, 500032, India; Graduate Studies, BRIC-Regional Center for Biotechnology, Faridabad, 121 001, India
| | - Aradhana Mohanty
- BRIC-National Institute of Animal Biotechnology, Hyderabad, Telangana, 500032, India; Graduate Studies, BRIC-Regional Center for Biotechnology, Faridabad, 121 001, India
| | - Anjali Kumari
- BRIC-National Institute of Animal Biotechnology, Hyderabad, Telangana, 500032, India; Graduate Studies, BRIC-Regional Center for Biotechnology, Faridabad, 121 001, India
| | - Pravin Birajdar
- BRIC-National Institute of Animal Biotechnology, Hyderabad, Telangana, 500032, India; Graduate Studies, BRIC-Regional Center for Biotechnology, Faridabad, 121 001, India
| | - Akshay Kumar
- BRIC-National Institute of Animal Biotechnology, Hyderabad, Telangana, 500032, India; Graduate Studies, BRIC-Regional Center for Biotechnology, Faridabad, 121 001, India
| | - Sahina Sabnam
- BRIC-National Institute of Animal Biotechnology, Hyderabad, Telangana, 500032, India
| | - S Abhilasha
- BRIC-National Institute of Animal Biotechnology, Hyderabad, Telangana, 500032, India; Graduate Studies, BRIC-Regional Center for Biotechnology, Faridabad, 121 001, India
| | - G Taru Sharma
- BRIC-National Institute of Animal Biotechnology, Hyderabad, Telangana, 500032, India
| | - H B D Prasada Rao
- BRIC-National Institute of Animal Biotechnology, Hyderabad, Telangana, 500032, India.
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Lava Kumar S, Kushawaha B, Mohanty A, Kumari A, Kumar A, Beniwal R, Kiran Kumar P, Athar M, Krishna Rao D, Rao HBDP. Glutathione peroxidase (GPX1) - Selenocysteine metabolism preserves the follicular fluid's (FF) redox homeostasis via IGF-1- NMD cascade in follicular ovarian cysts (FOCs). Biochim Biophys Acta Mol Basis Dis 2024; 1870:167235. [PMID: 38744343 DOI: 10.1016/j.bbadis.2024.167235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 04/18/2024] [Accepted: 05/09/2024] [Indexed: 05/16/2024]
Abstract
Follicular ovarian cysts (FOCs) are characterized by follicles in the ovaries that are >20 mm in diameter and persist for >10 days without the corpus luteum, leading to anovulation, dysregulation of folliculogenesis and subfertility in humans and livestock species. Despite their clinical significance, the precise impact of FOCs on oocyte reserve, maturation, and quality still needs to be explored. While FOCs are observed in both human and livestock populations, they are notably prevalent in livestock species. Consequently, livestock species serve as valuable models for investigating the molecular intricacies of FOCs. Thus, in this study, using goat FOCs, we performed integrated proteomic, metabolomic and functional analyses to demonstrate that oocyte maturation is hampered due to increased reactive oxygen species (ROS) in FOCs follicular fluid (FF) via downregulation of glutathione peroxidase (GPX1), a critical antioxidant seleno enzyme required to negate oxidative stress. Notably, GPX1 reduction was positively correlated with the FF's decline of free selenium and selenocysteine metabolic enzymes, O-phosphoryl-tRNA (Sec) selenium transferase (SEPSECS) and selenocysteine lyase (SCLY) levels. Adding GPX1, selenocysteine, or selenium to the culture media rescued the oocyte maturation abnormalities caused by FOCs FF by down-regulating the ROS. Additionally, we demonstrate that substituting GPX1 regulator, Insulin-like growth factor-I (IGF-1) in the in vitro maturation media improved the oocyte maturation in the cystic FF by down-regulating the ROS activity via suppressing Non-sense-mediated decay (NMD) of GPX1. In contrast, inhibition of IGF-1R and the target of rapamycin complex 1 (mTORC1) hampered the oocyte maturation via NMD up-regulation. These findings imply that the GPX1 regulation via selenocysteine metabolism and the IGF-1-mediated NMD may be critical for the redox homeostasis of FF. We propose that GPX1 enhancers hold promise as therapeutics for enhancing the competence of FOCs oocytes. However, further in vivo studies are necessary to validate these findings observed in vitro.
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Affiliation(s)
- S Lava Kumar
- National Institute of Animal Biotechnology, Hyderabad, Telangana 500032, India; Graduate studies, Regional Center for Biotechnology, Faridabad 121 001, India
| | - Bhawna Kushawaha
- National Institute of Animal Biotechnology, Hyderabad, Telangana 500032, India
| | - Aradhana Mohanty
- National Institute of Animal Biotechnology, Hyderabad, Telangana 500032, India; Graduate studies, Regional Center for Biotechnology, Faridabad 121 001, India
| | - Anjali Kumari
- National Institute of Animal Biotechnology, Hyderabad, Telangana 500032, India; Graduate studies, Regional Center for Biotechnology, Faridabad 121 001, India
| | - Ajith Kumar
- National Institute of Animal Biotechnology, Hyderabad, Telangana 500032, India; Graduate studies, Regional Center for Biotechnology, Faridabad 121 001, India
| | - Rohit Beniwal
- National Institute of Animal Biotechnology, Hyderabad, Telangana 500032, India; Graduate studies, Regional Center for Biotechnology, Faridabad 121 001, India
| | - P Kiran Kumar
- National Institute of Animal Biotechnology, Hyderabad, Telangana 500032, India
| | - Mohd Athar
- National Institute of Animal Biotechnology, Hyderabad, Telangana 500032, India; Graduate studies, Regional Center for Biotechnology, Faridabad 121 001, India
| | - D Krishna Rao
- Tata Institute of Fundamental Research, Hyderabad, Telangana 500032, India
| | - H B D Prasada Rao
- National Institute of Animal Biotechnology, Hyderabad, Telangana 500032, India.
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Li M, Su P, Zhou LM. Live births from in vitro fertilization-embryo transfer following the administration of gonadotropin-releasing hormone agonist without gonadotropins: Two case reports. World J Clin Cases 2023; 11:2067-2073. [PMID: 36998947 PMCID: PMC10044950 DOI: 10.12998/wjcc.v11.i9.2067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/31/2023] [Accepted: 03/01/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND The prevalence of female infertility between the ages of 25 and 44 is 3.5% to 16.7% in developed countries and 6.9% to 9.3% in developing countries. This means that infertility affects one in six couples and is recognized by the World Health Organization as the fifth most serious global disability. The International Committee for Monitoring Assisted Reproductive Technology reported that the global total of babies born as a result of assisted reproductive technology procedures and other advanced fertility treatments is more than 8 million. Advancements in controlled ovarian hyperstimulation procedures led to crucial accomplishments in human fertility treatments. The European Society for Human Reproduction and Embryology guideline on ovarian stimulation gave us valuable evidence-based recommendations to optimize ovarian stimulation in assisted reproductive technology. Conventional ovarian stimulation protocols for in vitro fertilization (IVF)–embryo transfer are based upon the administration of gonadotropins combined with gonadotropin-releasing hormone (GnRH) analogues, either GnRH agonists (GnRHa) or antagonists. The development of ovarian cysts requires the combination of GnRHa and gonadotropins for controlled ovarian hyperstimulation. However, in rare cases patients may develop an ovarian hyper response after administration of GnRHa alone.
CASE SUMMARY Here, two case studies were conducted. In the first case, a 33-year-old female diagnosed with polycystic ovary syndrome presented for her first IVF cycle at our reproductive center. Fourteen days after triptorelin acetate was administrated (day 18 of her menstrual cycle), bilateral ovaries presented polycystic manifestations. The patient was given 5000 IU of human chorionic gonadotropin. Twenty-two oocytes were obtained, and eight embryos formed. Two blastospheres were transferred in the frozen-thawed embryo transfer cycle, and the patient was impregnated. In the second case, a 37-year-old woman presented to the reproductive center for her first donor IVF cycle. Fourteen days after GnRHa administration, the transvaginal ultrasound revealed six follicles measuring 17-26 mm in the bilateral ovaries. The patient was given 10000 IU of human chorionic gonadotropin. Three oocytes were obtained, and three embryos formed. Two high-grade embryos were transferred in the frozen-thawed embryo transfer cycle, and the patient was impregnated.
CONCLUSION These two special cases provide valuable knowledge through our experience. We hypothesize that oocyte retrieval can be an alternative to cycle cancellation in these conditions. Considering the high progesterone level in most cases of this situation, we advocate freezing embryos after oocyte retrieval rather than fresh embryo transfer.
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Affiliation(s)
- Mai Li
- Reproductive Center, Ningbo Women and Children’s Hospital, Ningbo 315000, Zhejiang Province, China
| | - Ping Su
- Reproductive Center, Institution of Reproductive Health, Tongji Medical College, Wuhan 430030, Hubei Province, China
| | - Li-Ming Zhou
- Reproductive Center, Ningbo Women and Children’s Hospital, Ningbo 315000, Zhejiang Province, China
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Zeng H, Zhang C, Zhang L, Liu N. HCG Trigger of GnRH Agonist-Induced Functional Ovarian Cysts Does Not Decrease Clinical Pregnancy Rate in GnRHa Pretreated Frozen Cycles: Evidence From a Retrospective Cohort Study. Front Endocrinol (Lausanne) 2022; 13:876517. [PMID: 35784554 PMCID: PMC9240191 DOI: 10.3389/fendo.2022.876517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND GnRH agonist (GnRHa) pretreatment before the frozen-thawed embryo transfer (FET) was increasingly utilized. However, the incidence of GnRHa-induced functional ovarian cysts (FC) was inevitable. The feasibility and efficacy of HCG triggering GnRHa-induced FC are unknown. OBJECTIVE The aim of the study was to investigate the effect of HCG triggering GnRHa-induced FC on FET outcomes. METHODS A total of 657 HRT-FET cycles with GnRHa pretreatment were retrospectively analyzed. Patients were divided into the FC group and the no functional cysts (NC) group according to whether the patient developed FC (follicular diameter of ≥7 mm and E2 of ≥100 pg/ml). Risk factors associated with the incidence of GnRHa-induced FC were determined by multivariate regression analysis. Pregnancy outcomes were compared between the FC group and the NC group. Propensity score matching (PSM) was performed to reduce the impact of confounding factors. Three multivariate regression models were performed to assess the association between HCG triggering GnRHa-induced FC and clinical pregnancy. Interactive analysis and subgroup analysis were also analyzed. RESULTS The incidence rate of GnRHa-induced FC was 9.74%. Older age (aOR 1.10, 95% CI 1.05-1.15, p-value < 0.001) and lower BMI (aOR 0.81, 95% CI 0.71-0.93, p-value=0.002) are risk factors for GnRHa-induced FC. The implantation rate, clinical pregnancy rate (CPR), and miscarriage rate were not significantly different between the FC group and the NC group before or after PSM (p-value > 0.05). Multivariate logistic models showed that HCG triggering GnRHa-induced FC does not decrease CPR in the general population (p-value > 0.05). The effect of HCG triggering GnRHa-induced FC on clinical pregnancy is interactive with age (p-value for interaction: 0.003); HCG trigger is associated with significantly higher CPR than HRT-FET cycles without FC in patients ≥35 years (aOR 4.40, 95% CI 1.57-12.3, p-value = 0.005). CONCLUSIONS HCG triggering GnRHa-induced FC does not decrease the chance of clinical pregnancy in HRT-FET cycles pretreated with GnRHa.
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Affiliation(s)
- Hong Zeng
- Department of Reproductive Medicine Center, Xiangya Hospital, Central South University, Changsha, China
| | - Chen Zhang
- Department of Reproductive Medicine Center, Xiangya Hospital, Central South University, Changsha, China
- Department of Reproductive Medicine Center, Changsha Maternal and Child Health Care Hospital, Hunan Normal University, Changsha, China
| | - Lei Zhang
- Department of Reproductive Medicine Center, Xiangya Hospital, Central South University, Changsha, China
| | - Nenghui Liu
- Department of Reproductive Medicine Center, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Nenghui Liu,
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Pinto E, Pinelo S, Osório M, Ferreira C, Serra H, Pires I, Barbosa A, Figueiredo H, Felgueira E, Tavares A. Outcomes from ovarian hyperstimulation following the sole administration of gonadotrophin-releasing hormone agonist in the context of in vitro fertilization: report of two cases and review of the literature. Gynecol Endocrinol 2012; 28:545-8. [PMID: 22439899 DOI: 10.3109/09513590.2011.650745] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To report the outcomes from two cases of ovarian stimulation following the sole administration of gonadotrophin-releasing hormone agonist (GnRHa) in the context of in vitro fertilization (IVF). DESIGN A case study was conducted. SETTING National Referral Unit of Reproductive Medicine. PATIENTS Two infertile women undergoing IVF participated in the study. INTERVENTIONS Controlled ovarian hyperstimulation using a long protocol. GnRHa (Buserelin) was started in the luteal phase, in a dose of 600 µg/day, for 12 days. MAIN OUTCOME MEASURES Number of retrieved oocytes, fertilization rate, number of embryos transferred, implantation rate, ongoing pregnancy, and live birth. RESULTS Both women underwent egg retrieval and transfer of good quality embryos. One of them conceived and recently gave birth to a healthy full-term baby. CONCLUSIONS The ovarian hyperstimulation after the sole administration of GnRHa is a rare condition. Oocyte retrieval may be a reasonable treatment under these circumstances instead of cycle cancellation. As far as it is known, this is the third case reported of a live birth following the sole administration of GnRHa in the context of IVF.
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Affiliation(s)
- Evelin Pinto
- Department of Obstetrics and Gynecology, Unit of Reproductive Medicine, Vila Nova de Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal.
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Kumbak B, Kahraman S. Management of prestimulation ovarian cysts during assisted reproductive treatments: impact of aspiration on the outcome. Arch Gynecol Obstet 2008; 279:875-80. [PMID: 19023582 DOI: 10.1007/s00404-008-0837-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Accepted: 10/28/2008] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the effect of basal ovarian cysts and also the impact of aspiration of those cysts at the onset of an assisted reproductive treatment (ART) cycle on stimulation characteristics and treatment outcome. METHODS A retrospective study of 162 normoresponder patients with basal cysts from whom at least five oocytes were retrieved was performed. They all received mid-luteal GnRH-a long protocol. Of 162 patients, 79 with basal cysts of 29.4 +/- 9.0 mm and initial estradiol (E2) of 221.2 +/- 24.3 pg/ml underwent cyst aspiration on day 3 and stimulation was initiated when E2 fell to <70 pg/ml. In the remaining 83 patients with basal cysts of 16.9 +/- 6.4 mm and initial E2 of 39.9 +/- 5.7 pg/ml, the stimulation was started with gonadotropins immediately. The cycle characteristics and the treatment outcomes were compared between those two groups. Further comparison was made between the two groups when initial E2 concentrations were <70 pg/ml. RESULTS No significant differences were found between the two compared groups regarding stimulation parameters and treatment outcomes. Implantation rates (IR) were 27 and 23%, pregnancy rates (PR) were 64 and 54% and live birth rates were 47 and 41% in the cyst positive and cyst aspirated groups, respectively (P > 0.05). CONCLUSION Basal ovarian cysts should not be considered a contraindication to gonadotropin initiation in normoresponder ART patients, provided serum E2 levels indicate down-regulation. Moreover, aspiration of basal cysts does not improve ART outcome when E2 levels are suppressed.
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Affiliation(s)
- Banu Kumbak
- Department of Obstetrics and Gynecology, Yeditepe University, Istanbul, Turkey.
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Ovarian hyperstimulation syndrome following the sole administration of injectable gonadotropin-releasing hormone agonist (triptorelin) for the pituitary down-regulation and in vitro fertilization treatment: report of two cases. Arch Gynecol Obstet 2008; 279:221-3. [DOI: 10.1007/s00404-008-0675-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Accepted: 04/22/2008] [Indexed: 10/22/2022]
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Naifer R, Ajina M, Merdassi G, Bibi M, Ibala S, Saad A. Hyperstimulation ovarienne induite par un agoniste de la GnRH. À propos d'un cas. ACTA ACUST UNITED AC 2005; 33:994-7. [PMID: 16330236 DOI: 10.1016/j.gyobfe.2005.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2004] [Accepted: 06/24/2005] [Indexed: 11/28/2022]
Abstract
We report a case of ovarian hyperstimulation induced by a GnRH agonist (Decapeptyl in a patient aged of 23 years and having 3 years of primary infertility of male origin. Twelve days after agonist administration, several ovarian follicles, great-sized, and with a rate of elevated serum oestradiol have been noted. After triggering of the ovulation by 5000 IU of HCG, oocyte retrieval permitted the collection of 4 oocytes 3 of which were mature. Only one embryo with 4 cells has been transferred 48 hours after intracytoplasmic sperm injection fertilization (ICSI), but there was no pregnancy. Ovarian hyperstimulation induced by GnRH agonist is a rare event and only a few cases have been reported. The development of multiple follicles after the administration of an agonist is a paradoxal answer of the ovary to the pituitary desensitization without a clarified physiopathology. The hypothesis of a direct action of the agonist on the ovary is likeliest. Triggering of ovulation by human chorionic gonadotrophin (HCG) has been achieved by certain authors. Fertilization of oocytes and transfers of embryos have succeeded in certain cases, but only one pregnancy has been reported that led to a living birth.
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Affiliation(s)
- R Naifer
- Service de cytogénétique et biologie de la reproduction, CHU Farhet-Hached, Sousse, Tunisie
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Qublan HS, Amarin Z, Tahat YA, Smadi AZ, Kilani M. Ovarian cyst formation following GnRH agonist administration in IVF cycles: incidence and impact. Hum Reprod 2005; 21:640-4. [PMID: 16253965 DOI: 10.1093/humrep/dei371] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The formation of functional ovarian cysts has been recognized as one of the side effects of GnRH agonist administration. The formation of cysts during IVF treatment may be of no clinical significance or may negatively influence its outcome. The objective of this study was to determine the incidence of ovarian cyst formation following GnRH agonist administration and to examine their effect on IVF outcome. METHODS A prospective study of 1317 IVF patients who developed one or more functional ovarian cysts of >or=15 mm following GnRH agonist treatment was performed. Transvaginal ultrasonographic-guided cyst aspiration was carried out in 76 randomly allocated patients out of 122 patients who were found to have functional ovarian cysts before starting ovarian stimulation with gonadotropins. RESULTS The incidence of follicular cyst formation was 9.3%. Cyst cycles in comparison with non-cyst cycles had significantly elevated day 3 basal FSH (mean+/-SD of 8.3+/-3.2 versus 5.3+/-2.6 mIU/ml, P<0.05) and required more ampoules of gonadotropins (46.3+/-16.5 versus 35+/-14.6, P<0.01). Furthermore, they showed a statistically significant decrease in the quality and number of oocytes retrieved, fertilization rate, number and quality of embryos, implantation and pregnancy rates, with a significant increase in cancellation and abortion rates. Patients with bilateral cysts had a significantly lower number of oocytes and embryos retrieved, with a lower proportion of metaphase II oocytes. They also had a higher proportion of poor quality embryos. Cyst aspiration was not associated with a significant difference in the above parameters. CONCLUSIONS The incidence of cyst formation during GnRH agonist treatment is lower than previously reported. In such cases, the quality of oocytes and embryos were significantly compromised, with a significant increase in the cycle cancellation rate and a decrease in the implantation and pregnancy rates. Neither conservative management nor cyst aspiration improved the IVF outcome.
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Affiliation(s)
- H S Qublan
- Infertility and IVF Center, King Hussein Medical Center, Amman and Infertility and IVF Center, Jordan University of Science and Technology, Irbid, Jordan.
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Owj M, Ashrafi M, Baghestani AR. Ovarian cyst formation and in vitro fertilization outcome. Int J Gynaecol Obstet 2004; 87:258-9. [PMID: 15548404 DOI: 10.1016/j.ijgo.2004.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2004] [Revised: 08/12/2004] [Accepted: 08/18/2004] [Indexed: 10/26/2022]
Affiliation(s)
- M Owj
- Department of Endocrinology and Infertility, Royan Research Center Tehran, Iran.
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Levi R, Ozçakir HT, Adakan S, Göker ENT, Tavmergen E. Effect of ovarian cysts detected on the beginning day of ovulation induction to the success rates in ART cycles. J Obstet Gynaecol Res 2003; 29:257-61. [PMID: 12959149 DOI: 10.1046/j.1341-8076.2003.00110.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM In the present study, we examined the outcome of assisted reproductive technology cycles in patients with or without baseline ovarian cysts following gonadotrophin-releasing hormone analogs administration. MATERIALS AND METHODS Three-hundred and fifty-six patients who had undergone assisted reproductive technology treatment were enrolled in the study. The patients, all of who had undergone cyst aspiration prior to ovarian stimulation, were grouped into two groups according to the absence or presence of ovarian cysts. These two groups were compared on the basis of the clinical pregnancy rates, the baseline E2 levels, the total follicle stimulating hormone ampules used, the total number of days of induction, the maximum E2 levels, the number of oocytes retrieved, the fertilization rates and the number of embryos available for transfer per controlled ovarian hyperstimulation cycle. RESULTS The number of ampules used for induction was significantly higher in the cyst group 37.2 +/- 13.0, 32.1 +/- 11.7, respectively, (P = 0.001). The number of total induction days was also longer in the cyst group 9.7 +/- 2.2, 8.9 +/- 1.6, respectively, (P = 0.001). There was no difference between the mean E2 levels measured on the human chorionic gonadotropin administration days (P = 0.339). There was also no difference in terms of the number of oocyte retrieved (P = 0.846). The number of embryos transferred did not differ statistically between the groups (P = 0.233). Finally, there was no significant difference between the groups according to the clinical pregnancy rates 25.3%, 30.7%, respectively, (P = 0.218). CONCLUSION Baseline ovarian cysts have a negative impact on the quality of ovarian hyperstimulation procedure; however, they have no negative effect on the pregnancy rates in IVF cycles.
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Affiliation(s)
- Rafael Levi
- Ege University Family Planning Infertility Research and Treatment Center, Izmir, Turkey
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Biljan MM, Lapensée L, Mahutte NG, Bissonnette F, Hemmings R, Tan SL. Effects of functional ovarian cysts detected on the 7th day of gonadotropin-releasing hormone analog administration on the outcome of IVF treatment. Fertil Steril 2000; 74:941-5. [PMID: 11056237 DOI: 10.1016/s0015-0282(00)01555-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the impact of functional ovarian cysts on the time required to achieve pituitary suppression, follicular development, embryo quality, and pregnancy rates during IVF treatment. DESIGN Prospective observational study. INTERVENTION(S) Daily treatment with buserelin (sc 500 microg) was initiated on day 2 of menstruation. Ultrasound and hormonal tests were performed on days 1, 7, 11, 14, and weekly thereafter until pituitary suppression was achieved. RESULT(S) 48 patients underwent 51 cycles of IVF treatment. A functional cyst was detected in three cycles (5.8%) with baseline ultrasound scan and in 27 cycles (52.9%) on day 7 of buserelin administration. Patients who developed a cyst required a significantly longer time to achieve pituitary suppression (21 vs. 7 days), had a significantly lower FSH level at the time of initiation of gonadotropins, required more ampules of gonadotropin (45 vs. 41 ampules), developed less follicles (13 vs. 17.5), and had lower embryo quality. However, there were no differences in the implantation (23.5% vs. 17.2%) and pregnancy rates (37.2% vs. 29.2%) between two groups. CONCLUSION(S) Functional cysts prolong the period to achieving pituitary suppression, increase gonadotropin requirements, and decrease follicular recruitment and embryo quality. They have, however, no negative effect on pregnancy rates.
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Affiliation(s)
- M M Biljan
- McGill Reproductive Center, Department of Obstetrics and Gynecology, Royal Victoria Hospital, McGill University, Montreal, Québec, Canada.
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Mehta RH, Anand Kumar TC. Can GnRH agonists act directly on the ovary and contribute to cyst formation? Hum Reprod 2000; 15:505-7. [PMID: 10686187 DOI: 10.1093/humrep/15.3.505] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R H Mehta
- Hope Infertility Clinic, Reproductive Health Clinic And Research Centre, 12 Aga Abbas Ali Road, Bangalore 560 042, India
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Session DR, Saad AH, Salmansohn DD, Kelly AC. Ovarian activity during follicular-phase down regulation in in vitro fertilization is associated with advanced maternal age and a high recurrence rate in subsequent cycles. J Assist Reprod Genet 1995; 12:301-4. [PMID: 8520192 DOI: 10.1007/bf02213708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE Previous reports have suggested that the ovarian response to leuprolide acetate is predictive of in vitro fertilization pregnancy rates. This study evaluated the outcome of in vitro fertilization cycles complicated by elevated estradiol levels during leuprolide acetate down regulation and the outcome of subsequent cycles in the same patients. METHODS Two hundred fifty-two in vitro fertilization cycles were initiated utilizing leuprolide acetate down regulation beginning on cycle day 1. RESULTS Seventy-four of these cycles had an elevated estradiol level at the time of the baseline scan (28%). This group of patients had a higher maternal age, a higher cycle cancellation rate (27.5 vs 16.3%), and a high rate of recurrence on subsequent cycles (63%). CONCLUSIONS The pregnancy rate per retrieval was equivalent in the two groups. This suggests that patients with advanced maternal age or a history of failure to suppress in a previous cycle may benefit from alternate regimens of superovulation.
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Affiliation(s)
- D R Session
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York, USA
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