Art outcome in combined group of women with premature ovarian failure and menopausal women
Keywords:Premature ovarian failure, Menopause, Antral follicle count, Infertility, Ovum donation, Embryo donation
Background: It is to present an overview of the study of the ART cycles in combined group of women with premature ovarian failure (POF) and menopausal women in 1 year period. Purpose of the study was to know the pregnancy outcome in this combined group. Since majority of the patients who entered our tertiary hospital had already received various treatment methods such as gonadotropins, long protocols and ultra-short protocols in previous hospitals with no positive result, we had to take them directly to the ovum donation (OD) or embryo donation (ED).
Methods: A simple study was performed from 1st January, 2015 to 31st December, 2015. Women with POF and menopause were enrolled and complete follow up of them was done from their first visit till stable pregnancy of 14 weeks was achieved. While doing this, we considered various parameters which can affect the ART outcome, for e.g. endometrial evaluation, hysteroscopy findings, proliferative phase preparation, leuteal support, semen analysis etc. The study outcome results included pregnancy rate and miscarriage rate.
Results: In spite of good efforts, ultimately, stable pregnancy rate (beyond 14 weeks gestation) of these women was only 35% that was almost one third of the total study population that too with the help of OD and ED. Pregnancy rate was actually 42%, out of which 7% had miscarriage. With all the cost, efforts and time involved, 65% (2/3rd) of women could not achieve successful pregnancy.
Conclusions: Since the possibility of pregnancy gradually declines after the age of 30 and a steep fall in fertility after the age of 35, women should be advised not to postpone marriages and should be encouraged to have children earlier.
Kokcu A. Premature Ovarian Failure from current perspective. J Gyn Endocrinology. 2010;26(8):555-62.
Akman MA, Erden HF, Tosun SB, Beyazit N. Comparison of agonistic flare up protocol and antagonistic multiple dose protocol in poor responders. J Human Reprod. 2001;16(5):868-70.
Keay SD, Mathur RS, Jemkims JM. Assisted conception following poor ovarian response to gonadotrophin stimulation. BJOG. 1997;104(5):521-7.
Sadeghi MR. New hopes for the treatment of POF. J. Reprod and fertility. 2013;14(1):1-2.
Mirkin S, Arslon M, Churikov D. Age as a prognostic factor in POF and human endometrium during the window of implantation. Human Reprod. 2003;20:2104-17.
Vegetti W, Alogna F. Study in human reproduction on idiopathic form of POF and early menopause. J. of Human Reprod. 1998;14(11):2731-34.
ESHRE premature ovarian insufficiency guidelines development group. Management of women with premature ovarian insufficiency; December 2015. Page 33.
Goldberg DJ, Carmel J, Cohen, James Holland. FSH as a factor in diagnosis of POF. New England J Med. 1973;145(8):955-67.
Noyas N, Hampton B.S, Benkeley A. Factors useful in predicting the success of oocyte donation, a 3 year retrospective analysis. Fertil Steril. 2001;76(1):92-7.
Del Prato, Borani. J. FSH levels in POF.Human Repod. 2006; 24;(12);3082 -89.
La Marca A, Sighinolfi G, Radi D. AMH as a predictive marker in ART. Hum Reprod. 2009;16:113-30.
Ohlenbusch A, Henneke M, Brockman K, George M, Henfield F. J Comparison of FSH v/s AFC in the diagnosis of POF. Human Mutation, variation, information and disease. 2013;25(4):411.
Broakmans FJ, Schiffer GJ, Bancsi LF. Ovarian reserve tests in infertility practice and normal fertile women. Maturitas. 2004;30:205-14.
Satwik R, Kochhar M, Gupta SM, Majumdar A. AMH in predicting ovarian response. J Human Reprod Sci. 2012;5(2):206-12.
Remohi J, Gartner B, Gallardo E, Yalil. Oocyte donation in women with recurrent pregnancy loss. Hum Reprod. 1997;67:717-23.
Soares S, Troncoss C, Bosch E. Age and uterine receptiveness, predictive outcome of oocyte donor cycles. J Clin Endocrinl Metab. 2005;90:4399-04.
Borini A, Bafaro G, Violini F. Oocyte donation programme. J Fertil Steril. 2003;63:258-61.
Tibiletti M, Testa G, de Lauretis Y, Alogna F, Castoldi E. Prog nostic factors in POF. J. Human Reprod. 2003;13(7):1796-800.
Desselle L. Endometrial thickness for IVF success. Human Reprod. 2009;24:3082-9.
Saadat. Hormonal profile of leuteal phase with GnRH. Human Reprod. 2004;19:1719-24.
Simon C, Bellver J, Vidal C. Similar endometrial development in oocyte donors treated with high or low dose GnRH antagonist compared to GnRH agonist treatment in natural cycles. Human Reprod. 2005;12:3318-27.
Check. The future trends of induction of ovulation. Minerva Endocrinol. 1995;35:227-46.
Dilwigi AJ, Engman L, Schwidt DW, Beradiva CA, Nelson JC. Lupride acetate microdose protocol v/s leuteal phase Ginerelix protocol for poor responders. J Fertil Steril. 2007;95:2531-33.
Jiao X, Qin C, Li J, Qin Y, Gao X, Zhang B, et al. Cytogenetic analysis of 531 Chinese women with POF; Human Reprod. 2012;27(7):2201-7.
Kolanlari, Venetis CA, Diedrich K, Tarlatzis BC, Griesinger G. Karyotype study in POF women. J Assist Reprod Genet 2013;25:429-30.
Hock, Schoemaker T, Drexhage H.A. POF and autoimmunity. Endocr Rev. 1997;18:107-34.
Welt CK. Autoimmune oophoritis in adolescents. Am J Y Y Acod Sci. 2008;68:499-509.
Badway S, Sharara FI, Scott RT. Assessment of endometrium in poor responders. Infertility Reprod Med Clinics North Amer. 2007;56:415.
Tartagni M, Cicinelli E, De Prgola G, De Salvia M A, Levopa C, Loverro G. Effects of pre treatment with estrogens on ovarian stimulation with gonadotrophins in women with POF. A randomized placebo controlled trial. Fertil Steril. 2007;87:858-61.
Schiender T, Gee M, Stevens. Poor responders and IVF outcome. Fertil Steril.1997;67(1):93-7.
Dixit H, Rao L, Padmalatha V, Raseswari T. Genes governing POF. Elsevier J. 2010;20(6):724-40.
Lutjen PJ, Trounson AO, Luton JF, Findley JK, Wood EC, Renou PM. The establishment and maintenance of pregnancy using IVF, ovum donation and embryo donation in IVF. Nature. 1984;307:174-5.
Sauer MV. 300 cycles of oocyte donation at University of South California; assessing the effect of age and infertility diagnosis on pregnancy and implantation rates. J Assist Reprod Genet. 1994;11(2):92-6.
Templeton, Sauer MV. Principles of oocyte and embryo donation. Edited by Mark V. Sauer Reprod. Biomed Online. 2006;12(2):153-62.
Amerathunga D, Weston G, Osianlis T. IVF with donor eggs in POF and postmenopausal women. J Assist Reprod Genet. 2009;26(9-10):511- 4.
Shilling A. Pregnancy outcome with donor eggs and embryo donation in women with POF. J. of Reproduction and Sterility. 2010;140:633-41.
Galbeya TA, Kyrgiore M, Lii TC, Stern C, Nardo L C. Incidence of miscarriage in POF women and role of aspirin. Human Reproduction update. 2006;13:357-64.
Alagana L, Nardo ML, Wakim R. Pregnancy outcome in POF women using donor eggs. Arch. Gyneco Obstet. 2004;298:77-8.