Embryo transfer based on previous uterine length measurement enhance ICSI outcomes when compared with standard ultrasonographic-guided embryo transfer

Purpose: To evaluate an embryo transfer method based on the transabdominal ultrasound associated with the previous uterine length measurement performed though vaginal ultrasound, which consists of the distance from the external cervical os to the fundal endometrial surface plus the half of the distance of the endometrial lumen. The pregnancy and implantation rates in patients undergoing assisted reproduction treatment were evaluated. Methods: The study evaluated 200 patients undergoing intracytoplasmic sperm injection (ICSI) cycles, in which the pituitary blockage was achieved though GnRH agonist or antagonist and FSH and hCG were used for follicular growth and final maturation respectively The patients were split into two groups based on embryo transfer method used. Every patient in which the embryo transfer was based on previous uterine length measurement (ULM group, n=50) was matched with three cycles in which embryo transfer was performed though standard ultrasonographicguidance (US group, n=150). The outcomes of the studied groups were evaluated. Results: Experimental groups were similar for the female age; the number of aspirated follicles, the number of MII retrieved oocytes, number of transferred embryos, endometrium thickness and the causes of infertility. The groups were also equal regarding the easiness of transfer (95.5% vs 95.6% for US and ULM groups respectively, p=1.000). However, both the implantation (11.9% vs 30.6% for US and ULM groups respectively, p<.0001) and the pregnancy rates (26.0% vs 54.0% for US and ULM groups respectively, p=.001) were significantly higher in the ULM group. Conclusion: Our findings demonstrated that the embryo transfer method based on the transabdominal ultrasound associated with the previous uterine length measurement should be performed routinely in assisted reproduction centers, since it is able to significantly improve pregnancy and implantation rates.Objetivos: avaliar um método adicional a transferência embrionária guiada por ultra-sonografia transabdominal, realizando uma medida uterina (Histerossonometria prévia), através de ultra-sonografia transvaginal tomando como base os resultados das taxas de gestação e de implantação em pacientes submetidas a tratamento de reprodução assistida de alta complexidade de transferência de embriões. Métodos: foram estudados 200 ciclos de injeção intracitoplasmática de espermatozóides (ICSI) submetidos a protocolos longos com Agonista do GnRH e com Antagonista do GnRH para o bloqueio dos ciclos sendo utilizados para indução e “Trigger” , FSH e LH recombinantes respectivamente. As pacientes foram subdivididas em 2 grupos, o grupo estudo de estudo foi representado por 50 pacientes onde foram realizadas Histerossonometria prévia em Transferências embrionárias guiadas por US transabdominal e os resultados destes ciclos foram comparados ao grupo controle que consistia em 150 ciclos onde se utilizou o protocolo padrão de transferência embrionária guiada por US transabdominal. Resultados: os grupos não apresentaram diferença estatística com relação a idade, causa de infertilidade, espessura endometrial, tipo de protocolo de indução, oócitos recuperados na punção ovariana,oócitos maduros obtidos e número de embriões transferidos. Com relação à transferência fácil também não houve diferença estatística quando comparado o grupo estudo com o controle (92 por cento x 92 por cento).No entanto quando avaliamos as taxas de gestação e implantação entre os grupos podemos observar um aumento estatisticamente significante para o grupo de estudo x controle, 54 por cento x 26 por cento (p=0,001) e 30,67 por cento x 11,93 por cento (p<0,0001) respectivamente. Conclusões: os achados demonstram que a realização da transferência embrionária guiada por US transabdominal auxiliada pela Histerossonometria Prévia do local adequado para a transferência deve ser utilizada de rotina nas clínicas de fertilização assistida, pois as taxas de gestação e de implantação apresentam um aumento estatisticamente significante, trazendo grande benefício para os resultados de ciclos de ICSI.TEDEBV UNIFESP: Teses e dissertaçõe

Cost-effectiveness comparison between pituitary down-regulation with a gonadotropin-releasing hormone agonist short regimen on alternate days and an antagonist protocol for assisted fertilization treatments

Objective: To compare cost-effectiveness between pituitary down-regulation with a GnRH agonist (GnRHa) short regimen on alternate days and GnRH antagonist (GnRHant) multidose protocol on in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) outcome. Design: Prospective, randomized. Setting: A private center. Patient(s): Patients were randomized into GnRHa (n = 48) and GnRHant (n = 48) groups. Intervention(s): GnRHa stimulation protocol: administration of triptorelin on alternate days starting on the first day of the cycle, recombinant FSH (rFSH), and recombinant hCG (rhCG) microdose. GnRHant protocol: administration of a daily dose of rFSH, cetrorelix, and rhCG microdose. Main Outcome Measure(s): ICSI outcomes and treatment costs. Result(s): A significantly lower number of patients underwent embryo transfer in the GnRHa group. Clinical pregnancy rate was significantly lower and miscarriage rate was significantly higher in the GnRHa group. It was observed a significant lower cost per cycle in the GnRHa group compared with the GnRHant group ($5,327.80 ± 387.30 vs.$5,900.40 ± 472.50). However, mean cost per pregnancy in the GnRHa was higher than in the GnRHant group ($19,671.80 ± 1,430.00 vs.$11,328.70 ± 907.20). Conclusion(s): Although the short controlled ovarian stimulation protocol with GnRHa on alternate days, rFSH, and rhCG microdose may lower the cost of an individual IVF cycle, it requires more cycles to achieve pregnancy. Clinical Trial Registration Number: NCT01468441. © 2013 by American Society for Reproductive Medicine