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Natural IVF/ET - treatment success

Natural IVF/ET - treatment success. Neda Smiljan Severinski Marko Gospić. Terminology. Natural IVF/ET cycle : Monitoring of natural cycle - ultrasound No any medication Modified natural cycle Monitoring of natural cycle Only medication is hCG injection for final oocyte maturation.

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Natural IVF/ET - treatment success

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  1. Natural IVF/ET - treatment success Neda Smiljan Severinski Marko Gospić

  2. Terminology • Natural IVF/ET cycle: • Monitoring of natural cycle - ultrasound • No any medication • Modified natural cycle • Monitoring of natural cycle • Only medication is hCG injection for final oocyte maturation

  3. Success of assisted reproduction ?

  4. How to define or calculate IVF/ET cycle success ? • CLINICAL PREGNANCY RATE (CPR): (positive heart beat in intrauterine embryo): • In relation to started cycle • In relation to number of oocyteaspirations • In relation to number of embryo transfers

  5. How to define or calculate IVF/ET cyclesucess ? • LIVEBIRTH RATE: • In relation to started cycle • In relation to number of oocytes aspirations • In relation to number of embryo transfers

  6. What is failed cycle of assisted reproduction ? • Cycle cancelation before ovum pick up ? • Cycle with bad quality oocytes or without oocytes ? • Oocytes fertilisation failure or irregular fertilisation ? • Cycle without embryo transfer or bad quality embryos ? • Cycle with implantation failure ? • Cycle with positive hCG, without clinical pregnancy ? • Cycle with vital clinical pregnancy but spontaneus abortion in first trimester? • . . . . .

  7. Absentfoliculogenesisandoogenesis • Patients category ? • Young reproductive age with diminished ovarian reserve or premature ovarian failure • Older reproductive age (> 35 – 40) • Old reproductive age ( > 40 ) • Treatment options: • Natural cycle IVF/ET • „Patient friendly IVF/ET” • Conventional ovarian stimulation • Agressive ovarian stimulation – „fight for every egg” • Adjuvant drugs – androgens DHEA

  8. Cyclewithoutembryo transfer • Bad quality of oocytes, sperm or embryos • Growth retarded embryos • Disturbance in endometrium development • Other complication • Treatmentoptions: • DHEA, corticosteroids, LH • Estrogen, progesteron, sildenafil

  9. Interpretation of treatment success? • Institutions with excellent succes of treatment : inclusion - exclusion criterias to starting treatment • Some institution have „cut off” values: age, FSH, AMH or AFC • Results of donation treatment programme: represent the real success of some institutions in conventional IVF/ET treatment • Who are patients in thecenter for infertility treatment?

  10. Natural fecundability 5 months 50 Nulliparous 2.7 months Parous

  11. Patients and methods • Period 1.1.2010 – 31.12.2011 ( two years ) • 89 patients (couples) • Age: mean = 34,2 (min. = 24, max. = 45) • 181 modified natural IVF/ET cycles • mean = 2,03 cycle/patient • only one patient had 8 natural IVF/ET cycles

  12. Legal aspects of treatment • VII/2009 – VII/2012 “Restrictive” law • Health ensurance guarantee: • No age limitation for treatment • Number of IVF/ET in natural cycle was unlimited

  13. Age structureonly 36% < 33 year

  14. Results of treatment • No oocyte • No fertilisation • No developed embryo • Growth retarded embryo • Polyploidy

  15. Period of treatment = 8 months = 8 modified natural cycle n = 89 n = 1 Treatment months

  16. Pregnancy n = 15/89 couples (16,8%) Max 8 Min 1 Treatmentmonths

  17. Completed cycles (n=65/181 – 35,9%) Treatment months

  18. Pregnancy per cycle, overview Max 15,4% Min 4,2% Month of treatment

  19. Pregnancy per embryotransfer, overview Max 40% Min 14,3%

  20. Failed cycles

  21. Cummulative results Chance for concieving in natural IVF/ET is 8-9% in each month of treatment. After six months of treatment chance to concive would be 54 % !!!!

  22. Theoretical calculation of success: pregnancy rate

  23. Treatment problems 100% 45/89 = 50,6% 24/45 = 53,3% 13/24 = 54,2% 7/13 = 53,8%

  24. Conclusion • Monthly cummulative cuccess (PR/cycle) in modified natural cycles was about 9% in each month • Significant amount of couples cancel their treatment after only three months. Why? • Continuation and repeating of monthly treatment in modified natural cycle may have positive influence on PR

  25. Legal aspects of treatment • VII/2012 – today “Liberal” law • Health ensurance guarantee: • age limitation for treatment – 42 year • Number of IVF/ET in natural cycle is only two • Chance to concive in modified natural cycle is 18% for each patient

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