IFS Catalyst Cochrane

Question: Are ovarian stimulation protocols combining oral medications like Clomiphene citrate or Letrozole with gonadotropins effective and safe compared to gonadotropins alone in women undergoing In-vitro fertilization (IVF)?

Focus : Regimens using oral ovulogens and gonadotropins versus gonadotropins alone for women undergoing IVF.

Population Of Interest : Unselected IVF population of subfertile women undergoing controlled ovarian stimulation for IVF and ‘poor’ responders.

Intervention Under Investigation : Clomiphene citrate (CC) or Letrozole (Ltz) with gonadotropins for controlled ovarian hyperstimulation (COH).

What Was The Comparison?: Gonadotropins alone for COH

What Were The Main Outcomes?: Live birth rate (LBR), ovarian hyperstimulation syndrome (OHSS) rate and cycle cancellation rate.

Results In Short

• Twenty-two trials including 3599 women undergoing IVF

• Live birth rate: No difference in live birth rate following ovarian stimulation with CC or Ltz with gonadotropins versus gonadotropins alone (Risk Ratio (RR) 0.92, 95% confidence interval (CI) 0.66 to 1.27; 4 RCTs, 493 women, low-quality evidence) in the general IVF population1. No difference in live birth rate following ovarian stimulation with CC or Ltz and gonadotropins versus gonadotropins alone (RR 1.16, 95% CI 0.49 to 2.79, 2 RCTs, 357 women, low-quality evidence) among poor responders.

• OHSS rate: Significantly lower incidence of OHSS following stimulation protocols using CC or Ltz with gonadotropins versus gonadotropins alone (Peto OR 0.21, 95% CI 0.11 to 0.41, 5 RCTs, 1067 women, low-quality evidence) in the general IVF population.

• Cycle cancellation rate: Significantly higher cycle cancellation rate with CC or Ltz and gonadotropins versus gonadotropins alone (RR 1.87, 95% CI 1.43 to 2.45, 9 RCTs, 1784 women, low-quality evidence) in the general IVF population.

• Number of gonadotropin ampoules and number of oocytes retrieved: Decrease in number of gonadotropin ampoules used and mean number of oocytes collected when CC or Ltz with gonadotropins was used compared with gonadotropin-only regimens (moderate quality evidence) in the general IVF population and poor responders.

Limitation

• Only six among 22 included studiesreported live birth rates as primary outcome, necessitating cautious interpretation of overall results.

• Studies included only fresh stimulated IVF cycles. None of the trials addressed surplus frozen embryos available for subsequent transfer; thereby data for cumulative live birth was not available. Currently, cumulative live birth rate is a more preferred outcome to evaluate effectiveness of IVF treatment.

• Studies that assessed poor responders used varied criteria for inclusion thereby introducing clinical heterogeneity.

• Lack of blinding in most included trials, poor reporting of methodology, differences in protocol and cycle cancellation policy impacted the overall quality of evidence.

Evidence Based Practice Points

• Current weight of evidence suggests comparable live birth rates between CC or Ltz and gonadotropins versus gonadotropins alone,in both the routine IVF population and among poor responders. It is a viable alternative protocol in certain clinical scenarios like poor responders.

• Addition of CC or Ltz reduces gonadotrophin requirement and incidence of ovarian hyperstimulation syndrome. Reduced gonadotrophin requirement could reduce initial treatment cost.

• Higher cancellation rates and lower oocyte yield following use of CC or Ltz with gonadotrophin is a drawback. Cancellation of cycles can be psychologically distressing for the couples.

• There has been a shift of contemporary practice towards maximizing oocyte yield in single retrieval cycle and “freeze all policy” due to higher cumulative live birth rate2. In light of these developments, studies evaluating cumulative live birth following milder stimulation protocols using CC or Ltz with gonadotrophins are needed along with cost effectiveness in order to establish their role in current IVF practice.

Reference

1. Kamath MS, Maheshwari A, Bhattacharya S, Lor KY, Gibreel A. Oral medications including clomiphene citrate or aromatase inhibitors with gonadotropins for controlled ovarian stimulation in women undergoing in vitro fertilisation. Cochrane Database Syst Rev. 2017;11(11):CD008528.

2. Drakopoulos P, Blockeel C, Stoop D, Camus M, De Vos M, Tournaye H, Polyzos NP. Conventional ovarian stimulation and single embryo transfer for IVF/ICSI. How many oocytes do we need to maximize?

Source: 

https://www.indianfertilitysociety.org/ifs-catalyst-cochrane-vol-6/

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More Post: The psychological impact of infertility and it’s treatment

IVF is the Way to Motherhood in Tubal Blockage

One of the major reasons for not being able to conceive women who want to become a mother is the blockage of Fallopian tubes. Most women do not know that they are unable to conceive due to problem in their fallopian tube. If the fallopian tube is obstructed then the egg and sperm will not be able to fuse, which will cause failure of fertilization process. The problem of blockage can occur in any one or both the tubes. About 30-40% of cases of infertility in women are caused Fallopian tube blockage.

Symptoms of blockage in Fallopian tubes

There is no decisive symptom which shows that there is problem of tubal blockage in women, but when women try to get pregnant during this period, experience pain during urination, pain during periods and pain can occur during sexual activity too. If any of those symptoms exists then it is advised to consult a doctor. A type of fallopian tube block called as Hydrosalpinx, which causes inflammation and fluid in the tubes due to which stomach ache, pelvic pain and unusual vaginal discharge can occur.

Causes of blockage in tube

·   

• Pelvic disease- Infection to scar tissue causes swelling in the pelvic region, which can cause the Hydrosalpinx and block the tube.

• STD - Infectious diseases caused by Chlamydia, Gonorrhea can block tubes.

• Endometriosis - During the menstruation, the lining of the uterus is formed every month, which flows during the period. For women suffering from endometriosis, the lining of the uterus is formed outside the uterus, and in extreme cases can develop in fallopian tubes, vagina. Unfortunately, the trouble increases further when the uterus lining in the period does not disappear and it gets accumulated. This condition causes blockage in Fallopian tubes.

• Surgery - The prevalence of any type of surgery that has the Fallopian tube attached can get block. A previous operation of ectopic pregnancy can also be a cause of blockage.

• Tuberculosis - It affects the possibility of fallopian tubes and pregnancy.

• Fibroids - The growth of fibroids attached to the uterus can cause blockage of Fallopian tube.

Treatment for tube blockage

There is no reason to lose hope for the women with Fallopian tube Blockage. It only requires choosing the right treatment at the right time.

Treatment of blocked tube depends on where blockage is present, it can be one side or both tubes are close. The blockage can be removed by laparoscopy surgery after a detailed diagnosis of the location and cause of the blockage. Surgeries are done to repair damaged tubes. 

If the damage to the tube is severe and no scope of surgical correction is observed then it certainly

cause fertility problems. The specialists advise to proceed with IVF technology for its treatment. There are strong possibilities for pregnancy. Poor patients with block tubes should consider IVF in time, without wasting further time and money.

What is In-vitro Fertilization (IVF)

In-vitro Fertilization is a process of artificial fertilization, that normally occur in the fallopian tube, done in the lab, and the embryo is later implanted in the woman's uterus, which results in pregnancy, so when the tube is blocked, this technique is most beneficial. Thus pregnancy with blocked fallopian tubes is difficult but not impossible.

Care womens centre - Best ivf centre in indore is well known one of the Best fertility hospital in Indore provides affordable ivf cost in indore as compared to others. If you are looking for infertility treatment in indore then you are at right place.At our test tube baby centre indore, have a high sucess story providing smiles to thousant of childless couple. visit our website and book an appointment https://www.carewomenscentre.com/

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To More Post: Complications of High-Risk Pregnancy and how to avoid that.

Complications of High-Risk Pregnancy and how to avoid that.

If your gynaecologist suggests that there is a risk in the pregnancy, there must be several questions arise in your mind, like whether the baby is OK or not? How will be the health of the baby or the mother? How much prenatal care to be needed? Etc.

In general we suggest that the case is of high risk pregnancy if there is a complicated disease or disorder that is affecting the health of either mother or foetus or both.

The risk factors:

• Age of pregnancy- mothers at the age less than 19 or more than 35 are at the higher risk of pregnancy.

• Lifestyle habits- habits of smoking cigarettes, regular high intake of alcohol or any other drug abuse may leads to the high risk during pregnancy.

• Physical health- height and weight of the lady also contributes to this, Short stature of <145cms and weight lacking or leading the range of 40-80kg.

• Medical history- Mother with the history of uncontrolled Asthama, infections, chronic hypertension, diabetes, breathing problems, etc are generally considered as at high risk of pregnancy.

• Multiple pregnancy with twin or higher multiples and pregnancy complications like placenta position, Rh sensitization, etc.

Need to detect high risk pregnancy:

• To assess the treatment plan and reduce the chances of emergencies.

• It the diagnosis is done properly, during treatment we can avoid the risk to life of mother and the baby.

• Early diagnosis helps to reduce the drug requirements and hence can be cost effective.

Symptoms:

• Breathlessness

• Excertion

• Headache and pain in abdomen

• Per vaginal bleeding or leaking

• Vision problems

Steps to be taken:

• Preconception appointment are highly recommended to the patients having any of the known risk factors and planning to become pregnant. Physical assesment is very important before concieving. Also discuss about the genetic condition in relation to baby.

• Visit your consultant to get regular prenatal check-ups. This will help your doctor to assess your and your baby’s health.

• Avoid getting habits of smoking, drinking, etc. If you already have the habits then quit them immediately.

• During pregnancy your basic body requirements increases thus you need to have proper dietary intake and food that fulfill the nutritional needs.

High risk pregnancy might make you nervous or anxious about the risk factors Associated with the baby or the mother but you must take these steps and keep the positive attitude to have a healthy pregnancy.

Care womens centre is one of the Best IVF Center and provide the best infertility and test tube baby treatment in Indore. if you are looking for fertility Hospital in Indore you should visit care womens centre in Indore. Book your appointment now : https://www.carewomenscentre.com/about-us/why-care-womens-centre/

More Post : Possible causes for irregular periods