SafakHatirnaz premature ovarianinsufficiency Dualoocyte and retrieval inthesame embryo transfer cycle with for women Clinical Article Article Type: This article isThis article by protected copyright. All rights reserved. 10.1002/ijgo.12768 differences thisbetween andVersion version the ofRecord.c Please the through copyediting, typesetting, pagination and proofreading process, to whichmay lead This article acceptedhas been for publication andundergone fullpeer review buthasnotbeen stimulationimprove might reproductiveou phasebeforecommencinggrowing earlyinthefollicular ovarianfollicles ovarian Synopsis: Email: SafakHatirnaz,Yenimahalle, BirinciCanik, Şehit Mesut 85,Samsun, No. CadTurkey * Correspondence 4 Duzce,Turkey 3 University,Turkey Istanbul, 2 InternationalTurkey Hospital,Canik, Samsun, 1 AcceptedInstitute, McGillMontreal,ResearchHealth University CareCenter, Canada ObstetricsDepartment of andGynecology, Article Department Obstetrics of andSchoolIVF Center, Gynecology, Medicine, of Koç IVF Center, [email protected] For womenwithprematureovarianrescuing insufficiency, spontaneously Department ofObstetrics &Gynecology,Samsun Medicana
1,* , Baris, Ata
2 , Ebru, Hatırnaz
tcomes. tcomes. Faculty of Medicine, Duzce University, Faculty Medicine, of Duzce University, 1 ,
Alper Basbug
3 , Samer Tannus, ite ite this as doi: article
4
among women withovarianpremature among women insufficiency (POI). transferinembryo the menstrual same Objective: Abstract ovarian Random insufficiency; start Keywords: This article isThis article by protected copyright. All rights reserved. Accepted retrieval reproductive outcomes. fewer oocyte cycles andmightpotentially improve ovarian in embryo transfer stimulationthesubsequent in and samecycleresulted Conclusion: duallive inthe vs 8%, birthrates group (28% trigger higher and numb total group 1( Results: s underwent who conventionalstimulation n=37).Both received ovarian (group2, groups 1,n=14)werewithimmediate cyclethose ovarianstimulation(group compared of Articleretrievalearly inthefollicularwhounderwentoocytean phase followedor larger by folliclecenter inTurkeybetween2015.12 2013Womenwithanovarian of and Methods: - quality embryos ( quality P
The groups had similar baseline parameters. baselineThe groupshadsimilarparameters.
<0.001); total<0.001); retrievals oocytegroup2( higher numberof in was A retrospective study of 51womenwithPOIattendingreproductive studyof A retrospective a
To compare dual oocyte retrievalTo comparedualoocyte withminimal and ovarianstimulation Dual oocyteretrieval; Follicularwaves;Ovarian stimulation;Premature ubsequent ovarian fortransfer. stimulationubsequent obtaintwoembryos cyclesto Rescuing growing follicles early er of oocyteser of retrieved wassimilar ( P =0.031). There was
cycle versusconventional ovarian stimulation in follicular the with combined phase a
non P -
=0.192). Group 1 had more Group=0.192). 1hadmore significanttrend toward higher P =0.08). =0.08). Serum estradiol washigherin
P <0.001); <0.001);
mm
diminished ovarian reserves, such asinthecaseovarianprematurediminished ofovarian reserves, insufficiency cycle, considers folliclesrecruited that are particular,technology(ART). In theof developing theorywhich follicularwaves, onovariana considerablein stimulation influence assistedreproductive protocols A clearerunderstandingthe of 1 INTRODUCTION This article isThis article by protected copyright. All rights reserved. Acceptedoncology patients[6]. was Theof thepresentstudy assess the aim to effectiveness random st experience earlyfollicular obtained from oocyte retrievalphase and studiesfrom [7] protocol The institutea hasdeveloped dual study of oocyteretrieval based on success.treatment these follicularwaves canr rescued fromatresiaby commencingstimulationTaking ovarian[6]. advantage of continuouswavesdeveloping cyclecanbe of themenstrual that follicles during disorder[5]. S womenaffected bythis no consensusonhowtostimulatefolliculargrowthfor Unfortunately,multi ART,In Article respond ovarianstimulationoften poorlyto [3]. affectssex It 1% steroids. amenorrhea,oligomenorrhea or elevatedlevels,a deficiency of and gonadotropin [1,(POI) 2]
might promoteespeciallywomen individualized stimulationfor protocols, with the main goal ovarianstimulation develop of multiple isto follicles [4] art ovarianstimulation emergency used for preservation fertility protocol in . POIsevere is a form of trategiesrandom suchas start ovarian stimulationbasedthe areon
- follicular obtainedgrowth israrely – 3% of women under the ageof40 women3% of the under esultinhigher whichfactorfor a isakey yieldoocytes, of dynamicshave ofhumanfolliculogenesismay ovarian ovarian characterizedby dysfunction continuously in throughoutthe menstrual cohorts
in cases of POI, and casesofPOI, in there is
years . These. women . womenreproductive outcomesfor withPOI. oocytes,of hence dual retrievalwouldhigherimproving in oocyte numbers result in folliclesThe which aspiratedlatefollicular are hypothesisth inthe phase. was compareto “dual withcollection”traditional this approach ovarianstimulation oocyte sti early follicularlargerfolliclesof ofinitiation aspiration minimal andovarian phase of This article isThis article by protected copyright. All rights reserved. women,efforts weremade obtainatleasttwoembryosthebest chanceof to for including c whounderwentgroup 1,whereaswomen a dualretrieval includedin oocyte protocolmenstrual were cycleandunderwenta present who For the POI study, women12 hadof with follicles (<0.30 oligomenorrhea/amenorrhea, folliclestwo ovarian (2 follicleelevated serum All women obtained all participants. from ClinArt International000298/2015). no. Hospital(study local of wasapprovedbythe December31, 2015.Thestudy ethical committee ARTthe at womendata were a retrospectivestudy, In from reviewed withPOIwho underwent 2 MATERIALS ANDMETHODS
Accepted Article oocyte recruitmulationand to multiple collection forwomen after withPOI, oocytes
pg/mL). clomiphene citrate clomiphene included in the study were diagnosed with POI by following werediagnosed the included inthestudy withPOI criteria: Clinart IVF Clinart cent
– - stimulating hormone (FSH)higher levels than40 9
mm) at mm) thepresence of pelvic baseline scan, er
and gonadotropins,wereFor included group 2. all in ,
andanti low of levels Trabzon
, Turkey between January1,Turkey between , 2013,and
lassical stimulation protocol, ovarian - Müllerian hormone
Written informedWritten consentwas
mm earlyinthe
IU/L, upto at withleastoneat follicle12 of transvagin underwent retrieval For dualstimulation withcycle, oocyte minimal inthesame obtained, oneembryo only however, wastransferred. ovarian as stimulation cycleswereperformed twoembryos needed.werenot If anyclinicalas aresult, w embryos pregnancy; available This article isThis article by protected copyright. All rights reserved. pick obtained. dual The oocyte vitrifiedeithera fresh or fertilized,then bothfresh and retrieved wassuccessfulsecond collection the mature oocyte was oocyte and collection 35 wasperformed andasecondoocyte administered, observed,a and2 cycle), every letrozolecollectionon day5of werecarriedout(i.e.,day8 the administration of cycle for administered at a dose of Novartis (Femara, Pharmaceuticals, The oocyteswerefertilized andthe collected Letrozole vitrifiedatcleavagestage. retrievalOocyte 35 performed was 10 followedrecombinant chorionicadministered, by gonadotropin (hCG; human gonadotropinrecombinant (225 estrogenserum least was150 level at
Accepted Article 000
IU;
minimal stimulationcycle. inthesame ovarian Follow
Pregnyl,
single225 of dose – Schering 3
al ultrasound on day 2 or 3 ofor 3 al ultrasoundthe onday2 menstrual cycle,and those days thereafter. Whenafolliclemeasuring 16 days thereafter. - warmed embryo waswarmed embryo transferred,dependingwas onwhenit 2.5
-
mg/day twice daily starting on day 3 of the menstrual twicemg/day the daily onday3of starting mmlargerwere or oocyte offered collection iftheir Plough, Kenilworth, NJ, Kenilworth, USA Plough, vitrified -
IU Gonal of up cycle in Box issummarized 1. IU ; Gonal ;
hoursafterhCG injection. Schaffhabserstrasse/Tein - warmed embryos embryos were Otherwise,warmed transferred.
pg/mL.In thisasingle doseof case, - f, Merck, f, - f andsecondf a were injection hCG Mo
dugno ere vitrifiedandsubsequent ) the same evening. the same ) ,
- , Switzerland) , BA up scans after oocyte after up scans
hours later. Ifhourslater. the , Italy) ,
women mm or mm was more
was was obtained. untilovarian twoembryos immediately stimulationwere after, cyclewasinitiated If the and firstcollection fertilized. failedtwoembryos, achieveanotherleast to at whenadministered follicles the reached17 with150 3 ofthemenstrualon day2orandultrasound cycle, classicalFor the stimulation protocol, ovarian This article isThis article by protected copyright. All rights reserved. Acceptedprogesterone inoil (Progestan 50 Nordisk, supportedThephase with lutealwas two embryos wereavailable. transferred as eitherfresh, vitrified andfewuneven noor[8].Embryos fragments cytoplasmic blastomeres were blastomeres andminorcytoplasmicblebs; fragments orgrade3,those with and those witheven fra blastomeres nocytoplasmic injection.were 3andclassifiedasgrade1, after until Embryoscultured day was bythetwo pronuclei confirmed presenceof two polarbodies 18 and cytoplasmicinjection Intra sperm was (ICSI) us adverseeffects.sedation possible and ArticleQueenborough,Queenborough, UK). All received information women aboutthe PropofolGermany) and (FreseniusBad Kabi,Homberg, Sevofluorane (Aesica collectionOocyte was performed under mildgeneral sedation – Bagsværd,
225
IU of GonalIU of
Denmark) and - f was absence anovariancyst.hCGwas f begun of inthe
mg; Koçakmg; Istanbul, Farma, Serum Turkey). - warmed, freshor bothandvitrifie twice 8
mg/day of oral estrogen of mg/day Novo (Estrafem, daily
mm insize,mm andoocytes
w intramuscular intramuscular ed to fertilize the oocytes. Fertilizationfertilize oocytes. ed tothe omen underwenttransvaginal
gments; grade2,those witheven clomiphene citrate injections of (no intubation) using(no intubation) d were collected - warmed when
combined – 5 24 0
mg of mg hours - hCG distribution of continuousof distribution variableswasassessedbyShapiro Datawereby using18(IBM,Armonk,NY, analyzed SPSSversion USA). The 24 or after as apregnancy beyond12 an intrathe presence of was measured 12 This article isThis article by protected copyright. All rights reserved. AcceptedAs expected, function tests. basal was dual estrogen significantlythe higher oocyte in luteinizinghormon age,duration ofinfertility,basal bodymass follicle index,basal count, antral summarizedthe analysisincluded are two groupsweresimilar inTablein in The 1. characteristicsandbaselineDemographic hormonalthe values51 women of achieve oocytesor retrieve embryos. viable respectively)were(7 and13, a excludedthefailure finalanalysisto from to owing oocyte retriev 12 of 21 hadafollicle these, During period,71 womenwithwere thestudy POItreatedthe studycenter.Of at 3 RESULTS than 0.05wasconsideredstatistically significant. Articleand Fisherexact were test compare usedto categoricvariables.A Mann weremean presentedas – Whitney
weeksgestation. of
al, and 50 underwent classicalal, and50underwent ovarianstimulation.Overall, 20women U
test weretest compare usedto continuousvariables.Pearson e, anti e, days after embryotransfer. Clinical as considered pregnancy was - uterine gestational sac. Anuterine gestational ongoing was sac. pregnancy defined -
Müllerian hormone, progesterone, prolactin,andMüllerian hormone, thyroid ±
weeks of gestation.weeks of SD
mm early menstrual perioddual inthe underwent and
or medianappropriate. (range)asStudent
Livedeliveryat wasdefinedas birth
– Wilk test andthe test data Wilk P
valueless of t
and 2
test amount of gonadotropinsamount of ( 4, vs (2 group classical stimulation ovarian dual oocyte alower of retrieval number retrievals grouphad compared withthe as The ofthe characteristics stimulation TableThe ovarian cyclesarepresented in 2. the menstrual cyc presencebeginning growing the folliclesretrieval of the groupowingto at ovarian of This article isThis article by protected copyright. All rights reserved. was rescuegrowing phase. approach to alreadyintheearly follicular ovarianfollicles embry ovarianobtainby minimal oocytes to provided more stimulationand stimulation was were byICSI,were fertilized embryos vitrifiedatthecleavageand stage, subsequent diagnos withresult ingoodoutcomesascompared classical women for stimulation ovarian followedretrieval,phase follicularoocyteretrievalbe convenient bylate mightand was Theof thepresentstudy examine aim to whether phaseoocyte earlyfollicular 4 DISCUSSION statistical significancevs 8%, (29% differencelive inthe the toward higher birthrate dualdidreach not retrievalgroup, The aresummarized reproductive outcomes inTableAlthough 3. therewasatrend 2). thebetterHowever,retrieval embryosof dualmore quality grouphad oocyte (Table embryosof similar totalcycle. of asimilar oocytesretrieved number per number and
Accepted Article os in order toleastos inorderat transfer two embryossame cycle. inthe Theof this aim ed with POI. InwithPOI. study,ed the oocytesobtained early follicular follicles from phase
le.
450
±
75 vs2730 P =0.08). P
± <0.001),and usedasignificantly lower
720, P
<0.001).Both groupshada
POI), and other women with diminished ovarian reserve who did not meet the POI meet thePOI andwomen reservewhodidnot POI), otherwithdiminished ovarian whowith folliclesaminorityPOI presentedwithgrowing (i.e., women of ovarian with size.Howe wasnotsignificant,the difference probablyretrievalthe small group,owingtosample quality. towardinembryo wasatrend higher Althoughrate there live birthdual the ovarian s study showed neededThe womeninthedualretrieval present that groupfewer This article isThis article by protected copyright. All rights reserved. surprising more Thus,it isnot that onefollicle the than to canreachowing dominancy calledthroughoutthe menstrual aprocess in folliculardevelopment. cycle, wave However,undergo folliclesrecruited incohort atresia [2]. are a normalIn menstrual cycle, usually dominantandothers one the becomes follicle embryos if young canbeobtained age, [11]. ar women have these ovarianreserve, oocyte retrievalDespite diminished their severely cycles. of oocytesgood numberwithfeweralready canachievea developingfollicles ovarian present stu early follicular usinggonadotropinsphaseAs foundin highdosesof and the [10]. ovarianclinicians of stimulation,starting aclassicalapproach use stimulation inthe importan cardiovascular ofInfertility and[9]. osteoporosis risk increased disease is an becausethe differenthealth of aspectsexperienced affected women,suchas by P criteria wereexclud
Accepted Article ovarianremature insufficiency t issue andmany theset for women, themseek of treatments. fertility Many timulationgonadotropins, cycles,usedlowerof amountsand hadbetter ver, it should it ver, studygroup beemphasized the comprised that only women dy, however, flexibilityhowever, dy, approach treatment inthe byattempting rescue to easonableachievingmainly of pregnancy, becauseoftheir chance ed. ed.
shoulda multidisciplinarymanner in beevaluated
s continuously folliclesthe larger from atresia,resulting of ofnextemergence inthe cohort The high levels oocytes retrieved early byperforming phaseretrieval. follicular of phenomenonfertility treatments, canbeusedtoincreasethetotalnumber this andthosewithamong botholderdiminishedreserves[12].Duringwomen ovarian FSHof circulatingfollicularhigh inthe This levels early phase. hasb This article isThis article by protected copyright. All rights reserved. AcceptedwithPOI. were aspirat addition, theretrieval dual groupincluded follicles withleading oocyte that women It shouldthe diagnosisisnothowever, that POI each benoted, common. group. of In The curre embryofresh This abeperformedinretrieval. the enables transferto cycle. same aftershifted tothe andthewindowofimplantationsuppressed issecond oocyte star on hasminimal endometrium.by priming, progesterone effects the Furthermore, probablytheduration ofestradiolWithoutestradiol becauseof[14]. short exposure seem retrievalimpairEarlyphaseendometrial toreceptivity, follicularoocyte doesnot thatresulted inlivetransfer birth[7]. ArticlePOIcase ofwithdual oocyteretrieval andsame this stageWe containcompetentoocytes. previously may a observed reported at canbea follicularphase during inter the ting letrozole the first oocyteretrieval, after estradiol immediately priming is
nt study has limitations, the main one being the small number of womenstudy haslimitations,theof smallnt being number main in the one ed inearlyfollicular uncommonamongphase, women the which isalso -
of FSH observed among these women may prevent the 2 FSHprevent the of among observed thesewomenmay ovulatoryinterval [13].Although inearly estradiol elevated the
signsubtle of insufficiency,functional ovarian cysts
- cycle vitrified
-
warmed embryo een observed – 5 - mm
inmight result improved reproductiveoutcomes. those are toclassicalyields that comparableof embryo ovarianstimulation,and inperformed s conventional untilin cycle ovarianshould laterthe or stimulation bedeferred and detected bysonography, particular,follicles developingwhen berescued should treatingconclusion, withPOIshouldthe approachto In women in beflexible; This article isThis article by protected copyright. All rights reserved. cycle:areview. 2012;18(1):73 reproductionthe humanmenstrual update. Human 2. 2013;30(2):213 andgenetics. reproduction andimplicationsfolliculogenesis in its ofassisted assistedreproduction.Journal 1. References Thehave authorsnoconflictsof Conflicts ofinterest finalAllthe the manuscript. version authorsapproved offorpublication. manuscript manuscript. manuscript. acquired,and thestudy;data; theperformed interpreted the drafted analyzed,and manuscript. SH Author contributions
Accepted Article
conceived,and planned, performedthe s Baerwald AR, Adams GP, Baerwald AdamsGP, AR, YangProgressLi Y,He DZ,Yangovarian Z. in W, understanding human ST AB BA
ubsequent cycles.This mayresultand approach in oocyte good
planned thestudy;and performed andrevised drafted the performed thestudy;carriedout themanuscript. anddrafteddesigned andrevised thestudy,
interest Pierson RA.Ovarian folliculogenesis during antral
- 9. tudy; analyzedandtudy; data; draftedthe the
statistical anddrafted the analysis;
EH - 91.
Idiopathic premature ovarianwhatsuitableis theIdiopathic stimulation failure: most premature ovarian 5. update.2014;20(1):124 practice.from theoryto reservemarkers: IVF using ovarian Humanreproduction 4. journal medicine. of 2009;360(6):606 3. This article isThis article by protected copyright. All rights reserved. England).(Oxford, 2017;32(1):112 amulticenter IVF: undergoing non randomized al. Amildet ovarianstimulationreserve inwomen withpoorovarian strategy 10. endocrinological investigation.2015;38(6):597 ovarianpathogenesis fromJournal insufficiency: clinical to management. of 9. Fertilityand sterilit cleavageimpact of morphologyembryos andof status, transferred. number grade, fertilizationinjection:Embryo implantation invitro in intracytoplasmic and sperm 8. biomedicine2015;31(6):819 online. vitrified collection and 7. cancer. Current 6. experimental &gynecology.protocol? Clinical obstetrics and 2013;40(3):327
Accepted Article
Youssef vanWelyM, MA, LuisiReginiPizzo S,OrlandiniC,Vellucci A,Petraglia F, Premature F. MayerAronshonHsuJ, MI, Lanzendorf KolmP,etal. M, S, Muasher HatirnazAta B. S,E, Livebirthfollowing oocyte earlyfollicular phase CakmakH, RosenRandom MP. AwwadHannounJ, FarraC, Abou A, Sunkaracontrolled A, SK.IndividualizationovarianLa Marca stimulation of in ovarianNelsonLM. ClinicalPrimary insufficiency.TheNew practice. England opinion inobstetrics2015;27(3):215 &gynecology. y. 1999;72(4):679y. - warmed embryo transfer 8 daystransferwarmed embryoReproductive later. - 40.
Al - - 8. - - Inany H, MadaniJahangiriInany H, T,Khodabakhshi N,S, 22. 85. -
14. -
start ovarianstart stimulation inpatientswith
- Abdallah M, Isaacson K, Ghazeeri IsaacsonK, Abdallah M, - - 603. inferioritytrial. Human reproduction
- 21.
- 30. G.
doublestimulation.2018.Reproductive biomedicine online. basedovarian conceptof onthe follicular Fromrandomand waves: conventionalto 12. England).(Oxford, 2018. butnotold:qualitativea quantitative reductioninperformance. Human reproduction Diminishedandstimulation ovarianreserveto poorresponse patients<38 years in 11. This article isThis article by protected copyright. All rights reserved. Accepted Contraception. age 2015;91(5):360 women. histologic effects Article14. 2013;20(12):1243(New NY). York, ovarian wavedynamicsduringMenopause humanmenstrual follicular cycle. the 13.
Dinh A, Sriprasert I,WilliamsDinhAR,Archer DF. endometrial A,Sriprasert review Athe of Chizen H, VandenBrink Hale D, SunkaraSK,SighinolfiLa MarcaNewovarian G, A.strategiesof stimulation Mo rin SJ, Patounakis G, Juneaurin SJ,PatounakisG, CR,Neal RT, Seli SA,Scott Jr., E. of progestinsinof modulators progesteronereceptor reproductive and
- 54.
G, BaerwaldG, Age A. - 7.
- related changes in major related changesinmajor This article isThis article by protected copyright. All rights reserved. subcutaneous; TVUS, transvaginal ultrasound. Abbreviations: Gn, gonadotropin; hCG, human chorionic gonadotropin; i.m., intramuscular; Box Accepted ArticleTreatment cycle Stage of step Protocol 1
Cycle management in dualoocyte pick
Gn+ hCGGn+ 2 Day observation Follicle – 3
daily for 5 days 2.5 mg twice Letrozole Day 3
- up with minimal stimulation and same
35 h 4 Day OPU1st – 5
TVUS 6 Day – 7
TVUS 8 Day – 9
- cycle embryo transfer. TVUS Gn+ hCGGn+ 10 Day – 11
LMWH, low molecular weight heparin;
2nd OPU 35 h 12 Day – 13
Vitrified warmed; Fresh/vitrified Fresh; 15 Day Embryo transfer – 16
- warmed
- OPU, oocyte pick
daily LMWH 4000 mg 1 progesterone in oil, 50 Estrogen 8 16 Day Luteal phase support – 17 onward
2 i.m.; -
mg daily; up; s.c.,
IU s.c.
Abbreviations: AFC, antral follicle count; AMH, anti Thyroxine hormone, ng/dL Prolactin, ng/mL Estrogen, pg/mL Progesterone, ng/mL Basal FSH, mIU/mL AMH, Basal LH, mIU/mL Basal AFC BMI Duration of infertility, y Age, y Variable Table 1 This article isThis article by protected copyright. All rights reserved. d c b a Abbreviations: Fresh ET Frozen ET Fresh +frozen ET Endometrial thickness at ET, mm Embryo grade Number of formed embryos Number of oocytes fertilized Number of MII oocytes Number of collected oocytes Total gonadotropin dose, IU Number of OPUs Variable Table 2 e d c b a hormone; LH, luteinizing hormone. kilograms divided by the square of height in meters);
By Measured on cycle start day. AcceptedBy By Values ArticleBy independent samples t test. By Measured on patient referral. Values :
III II I Fisher Mann Mann
2
ng/mL
test.
Results of oocyte pick Demographic characteristics and basal hormonal parameters of the study women are are
– –
exact test. b Whitney Whitney
given meanas given meanas
CC, CC,
c
clomiphene citrate;
U U
test. test.
± ±
SD, SD,
-
up, endometrial thickness, embryo transfer, and embryoquality
median (range), or number (percentage) unless stated otherwise. median (range), or number (percentage) unless stated otherwise. Dual Dual oocyteretrieval
Dual Dual oocyteretrieval 258.43 92.50 ET, embryo transfer; MII, metaphase II; OPU, oocyte pick 23.05 41.38 17.44 28.18 28.86 1.00 0.13 10.79 2 (1 (n=14) 450 14 (64) 2 (1 2 (1 2 (1 3 (2 (n=14)
3 (21) 3 (21) 8 (57) 6 (27) 0 ± ± ±
2 (9) ± ± ± ± ± ± –
12.67 0.22 0.04
2
7) 4.61 3.68 3.85 3.91 4.75 84.92
± ± – – – –
2) 3) 3) 3) 1.12 75
-
Mü
CC,
llerian hormone;llerian BMI,
clomiphene citrate; FSH, follicle
CC CC + gonadotropin
CC+ gonadotropin 98.82 25.59 25.89 44.99 16.93 27.78 30.32 1.06 0.13 9.91 2730 1 (1 4 (1 (n=37) 27 (73) 10 (27) 19 (33) 20 (34) 20 (34) 2 2 (1 2 (1 2 (2 (n=37) 4 (3
(1 ± ± ±
± ± ± ± ± ± 0 ±
– –
± – – – – - 0.21 0.05 13.09
2) 7) 5.92 9.54 6.44 3.92 3.97 4.64 1.20
4) 2) 2) 3) 3) 720
(calculated as weight in
<0.001 < P 0.001 0.024 0.899 0.534 0.192 0.017 0.057 0.031 0.583 0.001 <0.001 value P 0.128 0.123 0.392 0.032 0.445 0.724 0.758 0.081 0.242 -
stimulating a
value .
–
d b b b b c c
b b
a
d d e d e d e d d
. d
-
up.
b a Abbreviations: Live birth Clinical pregnancy Spontaneous abortion Positive Outcome Table 3 This article isThis article by protected copyright. All rights reserved.
Accepted ArticleBy Values
Fisher exactFisher test.
Clinical outcomes among thestudy women are
- hCG test given as CC, CC,
clomiphene citrate;
number (percentage) unless stated otherwise
Dual Dual oocyteretrieval hCG, hCG, human chorionic gonadotropin. (n=14) 4 (29) 4 (29) 6 (43) 0 (0)
a .
CC CC + gonadotropin
.
11 (30) (n=37) 3 (8) 3 (8) 3 (8)
P 0.080 0.080 0.552 0.510 value
b