Tekrarlayan ART Ba şarısızlıklarının Yönetimi. Dr. Ayd ı n Ar ı c ı Kadın Sağlığı Bölümü Anadolu Sağlık Merkezi Department of Obstetrics, Gynecology & Reproductive Sciences Yale University School of Medicine. Live-Birth Rate per patient started in cohort. Cycle Number
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Tekrarlayan ART Başarısızlıklarının Yönetimi
Dr. Aydın Arıcı
Kadın Sağlığı Bölümü
Anadolu Sağlık Merkezi
Department of Obstetrics, Gynecology & Reproductive Sciences
Yale University School of Medicine
No. of patients started = 750
Witsenburg et al. 2005
Live Births per transfer using a woman’s own or donor eggs
2002 Assisted Reproductive Technology Success Rates: National Summary and Fertility Clinic Report. CDC
Patients with repeated IVF failure
cycles AgePGD Controls
Study 1: 3 3215%8% (N.S.)
Study 2: 3 30 no controls
Study 3: 2 3814%12% (N.S.)
Study 4: 3 3620%24% (N.S.)
Study 5: 2 n.a.20%0% (N.S.)
1: Gianaroli et al. 1999, 2: Kahraman et al. 2000, 3: Munné et al., RBO 2003, 4: Pehlivan et al. 2003, 5: Werlin et al. 2003
Patients with recurrent IVF failure are defined as younger than 37 years and who have had at least 3 consecutive unsuccessful IVF/ICSI cycles with good-quality embryos.
Platteau et al. 2006
In a systematic review of adjuvant GH treatment on IVF outcomes, in women without a history of poor response, there was no evidence to support the use of GH (Harper K, 2003).
There was, however, a small but significant improvement in pregnancy rates in poor responders, although cost is a limiting factor (Harper K, 2003).
Tesarik et al. evaluated adjuvant GH in women >40-year-old undergoing IVF. Women co-treated with GH had more pregnancy (26 vs 6%) and delivery rates (22 vs 4%).
Metformin treatment increased the number of oocytes in insulin-resistant women with PCOS,(Fedorcsák, 2003). This finding, however, was not supported in otherRCT’s
Duration of FSH stimulation→
The number of oocytes retrieved→
Fertilization rates →
Embryo quality →
Pregnancy and live birth rates →
Fertilization rate, →
Oocytes retrieved and placebo→
Pregnancy or miscarriage rates →
A 28-day course of metformin during the IVF cycle improved pregnancy outcome and reduced the risk of OHSS. Pregnancy rate per ET was 44.4% vs 19% and live birth rate per ET was 37.8% vs 14.3%(Tang, 2006).
Meta-analysis demonstrated that metformin use in ART does not improve pregnancy (OR=3.46; CI=0.98-12.2) or live birth rates (Costello, 2006).
Higher # oocytes 4.4 vs 3.4
Better fertilization rates3.0 vs 1.4
Cumulative embryo score16.1 vs 8.4
Lower cancellation rate 4% vs 32%
Transferred embryos 2.4 vs 1.4
Barad & Gleicher. Hum Reprod 2006
- Levi et al., Fertil Steril, 01
EMB on 7 days after hCG
Normal menstrual cycle
Basir et al. 01
IVF candidate with a normal HSG
Shamma et al. Fertil Steril 1992
Eldar-Geva et al., Fertil Steril 1998
Reinhold et al. Hum Reprod Update 1998
IVF PREGNANCY RATES
Barnhart et al, Fertil Steril 2002
Sallam, Garcia-Velasco, Dias, and Arici, Cochrane Database 2006
Rai et al . Hum Reprod. 1995; Oshiro et al. Obstet Gynecol. 1996; Simpson et al. FertilSteril. 1998
Roque et al., Thromb Haemost. 2004
A randomized, placebo controlled trial