DOI: 10.7860/JCDR/2019/42579.13278 Original Article Characteristics and Pregnancy Rate of IVF-ICSI Patients with Short Antagonist Protocols: A Section 4-Year Single Center Retrospective Study Obstetrics and Gynaecology IDA BAGUS KARTHA1, I MADE MAHADINATA2, IDA AYU INDIRA3, I KETUT TUNAS4, NGURAH OKA PUTRAWA5 ABSTRACT the study population was 33.06±4.529 (22-45) years, the mean Introduction: In-vitro Fertilisation-Intracytoplasmic Sperm maternal BMI was 24.49±4.193 (15.8-43.5) kg/m2, and the mean Injection (IVF-ICSI) is a modern technology where a sperm duration of infertility was 6.03±3.594 (0-20) years. The number is injected into an ovum. IVF-ICSI is a solution to overcome of oocytes obtained Ovum Pick Up (OPU) was 6.74±3.726 (1-22) infertility when all other assisted reproductive technique is not and mean number of Embryo Transfer (ET) was 2.58±0.946 (1-4). successful. The short antagonist protocol is the most commonly The clinical pregnancy rates significantly increased with the performed ovarian stimulation and the preference in many IVF maternal age below 35 years (p=0.017), normal BMI (p=0.016), clinics. The pregnancy rate for IVF-ICSI program in each clinic infertility period less than six years (p=0.005), oocytes more is influenced by variety of factors. than five obtained during OPU (p=0.001), and three embryos transferred during ET (p=0.003). Aim: To study the success rates and patients characteristics that would increase the pregnancy rate in the IVF-ICSI patients Conclusion: The pregnancy rate of IVF-ICSI patients with a short with short antagonist protocols for ovarian stimulation. antagonist protocol and fresh ET was 44.6%. The number of oocytes more than five obtained during OPU and three embryos Materials and Methods: Medical records of patients who transferred during ET significantly increase the pregnancy rates, participated in IVF-ICSI program in IVF clinic, from January 2014 while the characteristics of patients who are more likely to be to December 2017 were studied. The data were then analysed pregnant stastistically are maternal age less than 35 years, a using Chi-square test. normal BMI, and infertility period of less than six years. Results: A total of 428 IVF-ICSI patients met the inclusion criteria; 191 (44.6%) had clinical pregnancies. The mean age of Keywords: Infertility, In-vitro fertilisation, Intracytoplasmic sperm injection, Ovarian stimulation antagonist INTRODUCTION Indonesia. The data were generated within the period of four years, IVF-ICSI is a modern technology in which an ovum is injected with that is, from January 2014 to December 2017. The Institutional sperm outside the body. IVF-ICSI is a solution to overcome infertility Ethical Committee approval was obtained for the study (035/RSPM/ when all other assisted reproductive methods are unsuccessful. DIR/III/2018). IVF-ICSI is a complex and expensive procedure. Therefore, not all The data for the following patients were included for the study- levels of people in the society can undertake such process [1]. The patients that followed the first IVF program, underwent all IVF short antagonist protocol is the most commonly performed ovarian processes through antagonist ovarian stimulation protocol, stimulation and the preference of many IVF clinics because it is Intracytoplasmic Sperm Injection (ICSI), and fresh ET. Patients safer, more convenient and more affordable [2,3]. who postponed the above IVF procedures were categorised within Typically, IVF has a success rate of 35-42% in various IVF centers exclusion criteria. globally [4]. Among 32 IVF centers in Indonesia, the pregnancy Ovarian stimulation: On day 2 of menstrual period, a basic rate is 28.57% [5]. The variation in the success rate of pregnancy evaluation was conducted by ultrasound examination and hormonal in each clinic is also influenced by various factors other than the assay (LH, FSH, Estradiol and Prolactin). Ovarian stimulation methods of ovarian stimulation e.g., age, maternal weight, infertility began with the administration of recombinant FSH (Gonal-F, Merck period, IVF history, pregnancy records, number of eggs, quantity, Serono) injections on day 3, where younger patients (<35 years) and quality of the transferred embryo [6]. By understanding these were given two ampoules (150 IU) of Gonal-F every day, and factors that could influence the pregnancy success rate in the elderly patients (≥35 years) were arranged for administration short antagonist protocol, infertile couples who will undertake of a three-ampoule injection (225 IU) of Gonal-F every day. The the IVF-ICSI procedure could be informed regarding the actions same dose was maintained for the first 4 days of stimulation. that need to be taken into account prior to undergoing such On day 7, estradiol serum (E2) and transvaginal ultrasonography mechanisms [7]. examinations were performed to monitor follicular development. The FSH dose was adjusted optimally based on the results of MATERIALS AND METHODS transvaginal ultrasonography for the number and size of developing This study used retrospective analysis through Cohort method. follicles. The GnRH antagonist, cetrorelix, was then given daily by Using consecutive sampling method, the samples in this study were s.c. injection (0.25 mg/day) at night (6:00-8:00 PM) from day 7 of taken from the medical records of infertile couples who undertook the stimulation cycle to the day of Human Chorionic Gonadotropin IVF program, IVF Clinic Prima Medika Hospital, Denpasar, Bali, (hCG) administration (permanent antagonist). Additional transvaginal Journal of Clinical and Diagnostic Research. 2019 Nov, Vol-13(11): QC01-QC04 1 Ida Bagus Kartha et al., Characteristics and Pregnancy Rate of IVF-ICSI Patients with Short Antagonist Protocols www.jcdr.net ultrasound examinations were also performed after days 9 and 11 BMI (Kg/m2) Pregnant n (%) Not Pregnant n (%) total n (%) of treatment. Underweight (<18.5) 18 (4.2) 9 (2.1) 27 (6.3) Procedures for oocyte retrieval: rFSH (Gonal-F, MerckSerono) and Normal (18.5-24.9) 116 (27.1) 132 (30.8) 248 (57.9) cetrorelix (Cetrorelix, MerckSerono) were administered continuously Overweight (25-30) 40 (9.3) 75 (17.6) 115 (26.9) until three follicles reached ≥16 mm. The serum concentrations for Estradiol (E2) was tested and HCG (Ovidrel, MerckSerono) was Obese (>30) 17 (4.0) 21 (4.9) 38 (8.9) then administered. Oocytes were retrieved 34-36 hour after HCG Total 191 (44.6) 237 (55.4) 428 (100) injection and were fertilised in vitro (ICSI) according to the standard [Table/Fig-3]: Maternal Body mass index (BMI) and pregnancy success. procedures. (p=0.016); n: number of cycles Embryo transfer: Embryo transfer was performed 72 hours after A total of 342 (79.9%) primary infertile patients and 86 (20.1%) oocyte collection (embryo 3 days). A maximum of three embryos were secondary infertile patients were included in this study. There transferred to each patient, except in special patient circumstances was no significant difference between primary and secondary where four embryos could be tranferred. Progesterone (suppossitaria) infertility to the success of pregnancy as shown in [Table/Fig-4] was given every day vaginally; (90 mg/day) from the first day after (p>0.05). oocyte retrieval to maintain luteal function. Clinical pregnancy was defined as an increase in serum β-HCG 12 days after ET and the Type of Infertility Pregnant n (%) Not Pregnant n (%) total n (%) presence of a gestational sac by ultrasonography within 2 weeks Primary infertility 152 (35.5) 190 (44.4) 342 (79.9) after β-HCG examination. Secondary infertility 39 (9.1) 47 (11.0) 86 (20.1) STATISTICAL ANALYSIS Total 191 (44.6) 237 (55.4) 428 (100) [Table/Fig-4]: Type of infertility and pregnancy success. Statistical analysis was done using the SPSS 17.0. The maternal (p=0.88); n: number of cycles age, maternal BMI, duration of infertility, history of previous pregnancy were collected as part of the patients characteristics. Ninety eight couples (22.9%) took IVF programs with infertility The relationship of characteristics with the success of pregnancy duration less than three years; 161 couples (37.6%) with infertility was tested by Chi-square (p<0.05). duration of three to six years; and 169 couples (39.5%) with infertility duration above six years. The relationship between infertility duration RESULTS and pregnancy success showed a significant difference as shown in Based on the analysis, there were 569 records of married couples [Table/Fig-5] (p<0.05). who took part in the IVF program at IVF Clinic Prima Medika Hospital, with antagonist protocols and 60 cycles were cancelled. Infertility duration (year) Pregnant n (%) Not Pregnant n (%) Sum n (%) There were 428 cycles which met the inclusion criteria (first IVF, <3 39 (9.1) 59 (13.8) 98 (22.9) short antagonist protocol, ICSI, and fresh ET). It was found that 3-6 88 (20.6) 73 (17.1) 161 (37.6) there were 245 chemical pregnancies, consisting of 191 clinical >6 64 (14.9) 105 (24.5) 169 (39.5) pregnancies and 54 miscarriages [Table/Fig-1]. Hence, it could be Total 191 (44.6) 237 (55.4) 428 (100) inferred that during the four years, the pregnancy rate was 44.6%. [Table/Fig-5]: Infertility duration and pregnancy success. The mean of maternal age was 33.06±4.529 (22-45) years, BMI (p=0.005) n: number of cycles was 24.49±4.193 (15.8-43.5) kg/m2, and the mean infertile duration was 6.03±3.594 (0-20) years. The mean IVF cycle that the patients In this study, the number of oocytes obtained during OPU had undertook was 1.22±0.564 (1-5); number of oocytes obtained a significant difference in pregnancy success as displayed in through OPU was 6.74±3.726 (1-22), and the mean number of [Table/Fig-6] (p<0.005).