PubMed | c Toronto West Fertility Center and a ee Fertility Center
Type: Journal Article | Journal: Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology | Year: 2016
The objective of this study is to compare the combination of dehydroepiandrosterone (DHEA) and coenzyme Q10 (CoQ10) (D+C) with DHEA alone (D) in intrauterine insemination (IUI) and in vitro fertilization (IVF) cycles among patients with decreased ovarian reserve.We retrospectively extracted data from patients charts treated by DHEA with/without CoQ10 during IUI or IVF between February 2006 and June 2014. Prestimulation parameters included age, BMI, day 3 FSH and antral follicular count (AFC). Ovarian response parameters included total gonadotropins dosage, peak serum estradiol, number of follicles>16mm and fertilization rate. Clinical outcomes included clinical and ongoing pregnancy rates.Three hundred and thirty IUI cycles involved D+C compared with 467 cycles of D; 78 IVF cycles involved D+C and 175 D. In both IUI and IVF, AFC was higher with D+C compared with D (7.45.7 versus 5.94.7, 8.26.3 versus 5.25, respectively, p<0.05). D+C resulted in a more follicles>16mm during IUI cycles (3.32.3 versus 2.92.2, respectively, p=0.01), while lower mean total gonadotropin dosage was administered after D+C supplementation compared with D (34141141 IUs versus 38771143 IUs respectively, p=0.032) in IVF cycles. Pregnancy and delivery rates were similar for both IUI and IVF.D+C significantly increases AFC and improves ovarian responsiveness during IUI and IVF without a difference in clinical outcome.
PubMed | a ee Fertility Center
Type: Journal Article | Journal: Systems biology in reproductive medicine | Year: 2015
Ovarian follicular responsiveness to controlled ovarian hyperstimulation (COH) with gonadotropins is extremely variable between individual patients, and even from cycle to cycle for the same patient. High responder patients are characterized by an exaggerated response to gonadotropin administration, accompanied by a higher risk for ovarian hyperstimulation syndrome (OHSS). In spite of its importance, the literature regarding high responders is characterized by heterogeneous classification methodologies. A clear separation should be drawn between risk factors for a high ovarian response and the actual response exhibited by a patient to stimulation. Similarly, it is important to distinguish between high ovarian response and development of clinically significant OHSS. In this article we: (1) review recent publications pertaining to the identification and clinical management of high responders, (2) propose an integrated clinical model to differentiate sub-groups within this population based on this review, and (3) suggest specific protocols for each sub-group. The model is based on a chronological patient assessment in an effort to target treatment based on the specific clinical circumstances. It is our hope that the algorithm we have developed will assist clinicians to supply targeted and precise treatments in order to achieve a favorable reproductive outcome with minimum complications for each patient.