Alberto Vaiarelli1, Danilo Cimadomo2, Gianluca Gennarelli3, Maurizio Guido4, Carlo Alviggi5, Alessandro Conforti5, Claudia Livi6, Alberto Revelli3,7, Silvia Colamaria2, Cindy Argento2, Maddalena Giuliani2, Carlo De Angelis8, Maria Matteo9, Stefano Canosa3, Angela D'Alfonso4, Valentino Cimadomo10, Laura Rienzi2, Filippo Maria Ubaldi2. 1. GeneraLife IVF, Clinica Valle Giulia, via G. De Notaris, 2b, 00197, Rome, Italy. alberto.vaiarelli@gmail.com. 2. GeneraLife IVF, Clinica Valle Giulia, via G. De Notaris, 2b, 00197, Rome, Italy. 3. GeneraLife IVF, Livet, Turin, Italy. 4. MeSVA Department, University of L'Aquila, L'Aquila, Italy. 5. Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy. 6. GeneraLife IVF, Centro Demetra, Florence, Italy. 7. Obstetrics and Gynaecology SCDU1, Physiopathology of Reproduction and IVF Unit, Sant'Anna Hospital, University of Turin, Turin, Italy. 8. Department of Gynecological, Obstetrical, and Urological Sciences, "Sapienza" University of Rome, Operative Unit of Obstetrics, Fabia Mater Clinic, Rome, Italy. 9. Department of Medical and Surgical Sciences, University of Foggia, Physiopathology and Reproductive Unit, University Hospital of Foggia, Foggia, Italy. 10. BNY Mellon, Krakow, Poland.
Abstract
PURPOSE: Our primary objective was to assess whether immediately undergoing a second stimulation in the same ovarian cycle (DuoStim) for advanced-maternal-age and/or poor-ovarian-reserve (AMA/POR) patients obtaining ≤ 3 blastocysts for preimplantation-genetic-testing-for-aneuploidies (PGT-A) is more efficient than the conventional-approach. METHODS: All AMA/POR patients obtaining ≤ 3 blastocysts after conventional-stimulation between 2017 and 2019 were proposed DuoStim, and 143 couples accepted (DuoStim-group) and were matched for the main confounders to 143 couples who did not accept (conventional-group). GnRH-antagonist protocol with recombinant-gonadotrophins and agonist trigger, intra-cytoplasmatic-sperm-injection (ICSI) with ejaculated sperm, PGT-A and vitrified-warmed euploid single-blastocyst-transfer(s) were performed. The primary outcome was the cumulative-live-birth-delivery-rate per intention-to-treat (CLBdR per ITT) within 1 year. If not delivering, the conventional-group had 1 year to undergo another conventional-stimulation. A cost-effectiveness analysis was also conducted. RESULTS: The CLBdR was 10.5% in the conventional-group after the first attempt. Only 12 of the 128 non-pregnant patients returned (165 ± 95 days later; drop-out = 116/128,90.6%), and 3 delivered. Thus, the 1-year CLBdR was 12.6% (N = 18/143). In the DuoStim-group, the CLBdR was 24.5% (N = 35/143; p = 0.01), 2 women delivered twice and 13 patients have other euploid blastocysts after a LB (0 and 2 in the conventional-group). DuoStim resulted in an incremental-cost-effectiveness-ratio of 23,303€. DuoStim was costlier and more effective in 98.7% of the 1000 pseudo-replicates generated through bootstrapping, and the cost-effectiveness acceptability curves unveiled that DuoStim would be more cost-effective than the conventional-approach at a willingness-to-pay threshold of 23,100€. CONCLUSIONS: During PGT-A treatments in AMA/POR women, DuoStim can be suggested in progress to rescue poor blastocyst yields after conventional-stimulation. It might indeed prevent drop-out or further aging between attempts.
PURPOSE: Our primary objective was to assess whether immediately undergoing a second stimulation in the same ovarian cycle (DuoStim) for advanced-maternal-age and/or poor-ovarian-reserve (AMA/POR) patients obtaining ≤ 3 blastocysts for preimplantation-genetic-testing-for-aneuploidies (PGT-A) is more efficient than the conventional-approach. METHODS: All AMA/POR patients obtaining ≤ 3 blastocysts after conventional-stimulation between 2017 and 2019 were proposed DuoStim, and 143 couples accepted (DuoStim-group) and were matched for the main confounders to 143 couples who did not accept (conventional-group). GnRH-antagonist protocol with recombinant-gonadotrophins and agonist trigger, intra-cytoplasmatic-sperm-injection (ICSI) with ejaculated sperm, PGT-A and vitrified-warmed euploid single-blastocyst-transfer(s) were performed. The primary outcome was the cumulative-live-birth-delivery-rate per intention-to-treat (CLBdR per ITT) within 1 year. If not delivering, the conventional-group had 1 year to undergo another conventional-stimulation. A cost-effectiveness analysis was also conducted. RESULTS: The CLBdR was 10.5% in the conventional-group after the first attempt. Only 12 of the 128 non-pregnant patients returned (165 ± 95 days later; drop-out = 116/128,90.6%), and 3 delivered. Thus, the 1-year CLBdR was 12.6% (N = 18/143). In the DuoStim-group, the CLBdR was 24.5% (N = 35/143; p = 0.01), 2 women delivered twice and 13 patients have other euploid blastocysts after a LB (0 and 2 in the conventional-group). DuoStim resulted in an incremental-cost-effectiveness-ratio of 23,303€. DuoStim was costlier and more effective in 98.7% of the 1000 pseudo-replicates generated through bootstrapping, and the cost-effectiveness acceptability curves unveiled that DuoStim would be more cost-effective than the conventional-approach at a willingness-to-pay threshold of 23,100€. CONCLUSIONS: During PGT-A treatments in AMA/POR women, DuoStim can be suggested in progress to rescue poor blastocyst yields after conventional-stimulation. It might indeed prevent drop-out or further aging between attempts.
Authors: Danilo Cimadomo; Antonio Capalbo; Paolo Emanuele Levi-Setti; Daria Soscia; Giovanna Orlando; Elena Albani; Valentina Parini; Marta Stoppa; Lisa Dovere; Luisa Tacconi; Elena Ievoli; Roberta Maggiulli; Filippo Maria Ubaldi; Laura Rienzi Journal: Hum Reprod Date: 2018-11-01 Impact factor: 6.918
Authors: Anna M Modest; Lauren A Wise; Matthew P Fox; Jennifer Weuve; Alan S Penzias; Michele R Hacker Journal: Hum Reprod Date: 2018-12-01 Impact factor: 6.918
Authors: Antonio Capalbo; Nathan R Treff; Danilo Cimadomo; Xin Tao; Kathleen Upham; Filippo Maria Ubaldi; Laura Rienzi; Richard T Scott Journal: Eur J Hum Genet Date: 2014-10-29 Impact factor: 4.246
Authors: Sandro C Esteves; Carlo Alviggi; Peter Humaidan; Robert Fischer; Claus Y Andersen; Alessandro Conforti; Klaus Bühler; Sesh K Sunkara; Nikolaos P Polyzos; Daniela Galliano; Michael Grynberg; Hakan Yarali; Irem Y Özbek; Matheus Roque; Lan N Vuong; Manish Banker; Laura Rienzi; Alberto Vaiarelli; Danilo Cimadomo; Filippo M Ubaldi Journal: Front Endocrinol (Lausanne) Date: 2019-11-20 Impact factor: 5.555