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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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
2002 Assisted Reproductive Technology Success Rates: National Summary and Fertility Clinic Report. CDC
cycles Age PGD Controls
Study 1: 3 32 15% 8% (N.S.)
Study 2: 3 30 no controls
Study 3: 2 38 14% 12% (N.S.)
Study 4: 3 36 20% 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%).
Growth Hormone benefit from PGD for aneuploidy screening?
M benefit from PGD for aneuploidy screening?etformin 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 rates 3.0 vs 1.4
Cumulative embryo score 16.1 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
ADENOMYOSIS benefit from PGD for aneuploidy screening?
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