Comment on “Progesterone elevation does not compromise pregnancy rates in high responders: a pooled analysis of in vitro fertilization patients treated with recombinant follicle-stimulating hormone/releasing hormone antagonist in six trials”

24 10 2013

To the Editor:

I read with great interest and attention the original article published recently by Griesinger et al. (1) entitled “Progesterone elevation does not compromise pregnancy rates in high responders: a pooled analysis of in vitro fertilization patients treated with recombinant follicle-stimulating hormone/releasing hormone antagonist in six trials.” In this article, Griesinger et al. conclude that a progesterone (P) elevation > 1.5 ng/mL on the day of hCG administration is associated with a lower ongoing pregnancy rate (OPR) in the general population, but not in patients with a high ovarian response, defined as an oocyte yield > 18 oocytes.

These authors performed excellent statistical work, pooling data from six multicenter randomized controlled trials relatively similar in their design, and presented the results as if all came from one single study. However, the study deserves several comments that question the unequivocal conclusion that is presented even in the title of the manuscript. Read the rest of this entry »





Concerning “The use of recombinant luteinizing hormone in patients undergoing assisted reproductive techniques with advanced reproductive age: a systematic review and meta-analysis”

30 04 2012

To the Editor:

With great interest we read the article by Hill et al. (1) on the use of recombinant luteinizing hormone (r-LH) in patients of 35 years and older undergoing assisted reproductive techniques. The use of r-LH supplementation during ovarian stimulation as part of assisted reproduction treatment is controversial and literature shows conflicting results in women of 35 years and older. The available evidence does not support the hypothesis that the addition of r-LH increases the pregnancy rate in unselected patients treated in an IVF/ICSI protocol with recombinant FSH and a GnRH agonist or antagonist. But there might be a potential benefit of the use of r-LH supplementation during ovarian stimulation in women with a poor response and women of advanced age (2). An update and systematic review and meta-analysis focused on women of 35 years and older is therefore timely and of great value with regard to possibilities to individualize treatments to improve outcomes. Read the rest of this entry »





Ovarian hyperstimulation syndrome or massive intraperitoneal hemorrhage?

21 06 2011

To the Editor:

I read with interest a recent paper by Griesinger et al. (1) describing, for the first time in the English literature, a case of severe ovarian hyperstimulation syndrome (OHSS) post-GnRH agonist trigger of ovulation. However, the clinical details of the case cast serious shadow on the correct diagnosis.

The hallmark of severe OHSS is elevated hematocrit (>45%, or >30% increment over baseline values) secondary to hemoconcentration (2). However, the described patient experienced severe intraperitoneal hemorrhage leading to decreasing hematocrit (41% on day of trigger, 37% on day of oocyte retrieval). Blood transfusion was given (no details on amount) due to “drastic decrease of hemoglobin levels to 4.9 mmol/L,” with hematocrit “15,000, oliguria, elevated creatinine, liver dysfunction, anasarca) were not given. Read the rest of this entry »





IVM media are designed specifically to support immature cumulus-oocyte complexes not denuded oocytes that have failed to respond to hyperstimulation

2 06 2011

To the Editor:

We wish to express concern about the design, analysis and conclusions reported in the article by Moschini et al. (1). This study compares the efficiency of an oocyte IVM medium (Medicult) to a cleavage-stage embryo culture medium (Sage IVF), for the in vitro maturation (IVM) of denuded oocytes that have failed to respond to gonadotropins in a standard IVF cycle (rescue IVM). We have a number of objections to this study: Read the rest of this entry »