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Levi Setti P.E.,Humanitas Fertility Center | Alviggi C.,University of Naples Federico II | Colombo G.L.,University of Pavia | Pisanelli C.,Hospital Pharmacist | And 4 more authors.
Journal of Endocrinological Investigation | Year: 2015

Background: Gonadotropins are protein hormones which are central to the complex endocrine system that regulates normal growth, sexual development, and reproductive function. There is still a lively debate on which type of gonadotropin medication should be used, either human menopausal gonadotropin or recombinant follicle-stimulating hormone. The objective of the study was to perform a systematic review of the recent literature to compare recombinant follicle-stimulating hormone to human menopausal gonadotropin with the aim to assess any differences in terms of efficacy and to provide a cost evaluation based on findings of this systematic review. Methods: The review was conducted selecting prospective, randomized, controlled trials comparing the two gonadotropin medications from a literature search of several databases. The outcome measure used to evaluate efficacy was the number of oocytes retrieved per cycle. In addition, a cost evaluation was performed based on retrieved efficacy data. Results: The number of oocytes retrieved appeared to be higher for human menopausal gonadotropin in only 2 studies while 10 out of 13 studies showed a higher mean number of oocytes retrieved per cycle for recombinant follicle-stimulating hormone. The results of the cost evaluation provided a similar cost per oocyte for both hormones. Conclusions: Recombinant follicle-stimulating hormone treatment resulted in a higher oocytes yield per cycle than human menopausal gonadotropin at similar cost per oocyte. © 2014 The Author(s).

Levi Setti P.E.,Humanitas Fertility Center | Porcu E.,S. Orsola Malpighi University Hospital | Patrizio P.,Yale University | Vigiliano V.,National Health Institute | And 4 more authors.
Fertility and Sterility | Year: 2014

Objective To compare mature human oocytes cryopreservation with slow freezing (SF) and vitrification (VT) in infertile couples. Design Retrospective study of national Italian data submitted during the period 2007-2011. Setting National ART registry. Patient(s) Infertile patients with supernumerary oocytes. Intervention(s) Thawing or warming of cryopreserved oocytes and ICSI. Main Outcome Measure(s) oocyte survival, fertilization, implantation and clinical pregnancy rate between SF and VT. Result(s) A total of 14,328 cycles with 11,599 transfers, 1,850 pregnancies, 1,168 deliveries and 1,342 babies born were analyzed from 146 reporting centers (range of cycles 1-1,255 per center). The SF oocytes' survival rate was lower than in VT (51.1% vs. 63.1%). Fertilization rate was significantly higher in SF than in VT (SF 71.6% vs. VT 70.1%). VT showed a significantly higher pregnancy rate, both per started cycle (14.4% vs. 12.0%) and per transfer (18.0% vs. 14.8%), and implantation rate (9.5% vs. 8.1%) than SF. However, the range and median pregnancy rate per started cycle were, respectively, 0%-50% and 7.7% in SF and 0%-100% and 6.7% in VT. Conclusion(s) VT showed a statistically significant higher performance than SF. As with other ART procedures, the results are not homogeneous among clinics and protocols, but the confirm the clinical value of oocyte cryopreservation in infertile patients. © 2014 by American Society for Reproductive Medicine.

Levi-Setti P.E.P.E.,Humanitas Fertility Center | Borini A.,Tecnobios Procreazione | Patrizio P.,Yale University | Bolli S.,National Health Institute | And 3 more authors.
Journal of Assisted Reproduction and Genetics | Year: 2016

Purpose: This study is a retrospective collection of aggregated data from all the Italian ART centers reporting to the Italian National Register from cycles started between January 2005 and December 2013. Methods: Data from both slow freezing (SF) and vitrification (V) were assessed for the period 2007–2013, while during the years 2005–2006 cryopreservation was exclusively performed by SF. Results: In the study period, a total of 2,526,024 oocytes were retrieved (from 378,543 retrievals), of which 1,346,061 (53.3 %) were inseminated in fresh cycles and 214,481 (8.5 %) were cryopreserved. Cryopreserved oocytes were used in 24,173 cycles yielding 19,453 transfer cycles (80.5 % of the thawing/warming cycles) and 3043 clinical pregnancies (15.6 % per transfer). A significant difference in implantation (8.7 vs 12.9 % OR 1.30 CI 1.20–1.40) and pregnancy rates per transfer (12.2 vs 14.9 % OR 1.34 CI 1.23–1.46) was found between SF and V. Complete outcome data was available for 2708 pregnancies (89.8 %), leading to 1882 deliveries and 2152 live births. Neonatal major congenital anomalies were 0.9 % (20/2152). Conclusions: A wide variation in pregnancy rates were found among different centers and lower rates were reported in donor cycles and in centers with more experience. © 2015, Springer Science+Business Media New York.

Levi Setti P.E.,Humanitas Fertility Center | Moioli M.,Humanitas Fertility Center | Smeraldi A.,Humanitas Fertility Center | Cesaratto E.,Humanitas Fertility Center | And 4 more authors.
Journal of Assisted Reproduction and Genetics | Year: 2016

Purpose: The aim of this study was to provide a comprehensive follow-up of fetal and perinatal outcome and the incidence of congenital anomalies in babies born after fresh embryo transfers compared to those conceived spontaneously in infertile couples. Methods: Retrospective comparative analysis of all clinical pregnancies from fresh cleavage-stage embryo transfer cycles (IVF and ICSI) compared with infertile patients who conceived spontaneously in the same time period (control). Congenital anomalies were classified following the European Surveillance of Congenital Anomalies (EUROCAT) classification. Results: A total of 2414 assisted reproductive technology (ART) pregnancies were compared to 582 spontaneous conceptions in the control infertile group representing 2306 deliveries. No significant differences were found in pregnancy outcome between the two groups (delivery rate, abortion rate, ectopic pregnancies, medical abortions for fetal anomalies, single and twins mean gestational age, and weight at delivery). A significant difference (p < 0.001) was found in the twin (21.3 vs 2.3 %) and triplet rates (2.3 vs 0 %). A total of 2351 babies were delivered in the ART group and 449 in the control group. A total of 90 babies (3.8 %) were diagnosed with a major congenital anomaly in the ART group and 15 (3.3 %) in the control group (p = ns). The overall rate of major congenital anomalies (105/2800) in ART and spontaneous pregnancies in infertile couples was significantly higher when compared to the EUROCAT 2.0 versus 3.75 % (p = 0.0002). Discussion: Babies born after ART treatments and from spontaneous conception in infertile couples had rates of congenital anomalies higher than those recorded by the EUROCAT. However, the rates of anomalies were not different within the infertile population whether conceived by ART or spontaneously. These data suggest that the diagnosis of infertility in itself is the common denominator for the increase in the rates of anomalies seen in both ART and spontaneous conceptions. © 2016, Springer Science+Business Media New York.

Levi-Setti P.E.,Humanitas Fertility Center | Menduni F.,Humanitas Fertility Center | Smeraldi A.,Humanitas Fertility Center | Patrizio P.,Yale University | And 2 more authors.
Journal of Assisted Reproduction and Genetics | Year: 2016

Purpose: This study aims to compare implantation, pregnancy, and delivery rates in frozen transfer cycles with blastocysts that were vitrified either with artificial shrinking (AS group) or without (NAS group). Methods: Retrospective comparative study of artificial shrinking of blastocysts prior to vitrification and frozen embryo transfer cycles in infertile patients undergoing frozen embryo transfer (FET) was done at the Humanitas Fertility Center between October 2009 and December 2013. Main outcome measure(s) were implantation (IR), pregnancy (PR), and delivery rates (DR) between the two groups. Results: A total of 1028 consecutive warming blastocyst transfer cycles were considered. In 580 cycles (total of 822 blastocysts), artificial shrinking was performed prior to vitrification (AS group), while in the remaining 448 cycles (total of 625 blastocysts), the artificial shrinking was not performed (NAS group). There were no differences in patient age (36.4 ± 3.7 vs. 36.3 ± 3.9) and number of embryos transferred (1.41 ± 0.49 vs. 1.38 ± 0.50) between groups. The IR, PR, and DR in the AS group were significantly higher (p < 0.05) than in the NAS group (29.9 vs. 23.0 %, 36.3 vs. 27.9 %, and 26.5 vs. 18.1 %, respectively). Conclusions: Performing AS of blastocysts prior to vitrification appears to improve implantation, pregnancy, and delivery rates probably related to a decreased risk of ultrastructural cryodamages, plausible when cryopreserving expanded blastocysts. © 2016 Springer Science+Business Media New York

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