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Best fertility hospital in india | Test tube baby center in indore | Mohak infertility center

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Mohak IVF Center, one of the Best test tube baby center and Best fertility hospital in india. Provides you International Standard Infertility Treatment along with assisted reproductive technologies like IUI, IVF, ICSI ,etc at affordable IVF treatment / Test tube Baby Treatment cost along with the satisfaction of being consulted by the most renowned IVF specialist in Indore,M.P. Come join best centre for IVF treatment cost in indore in our voyage towards better healthcare facilities for infertile couples and experience the Best Infertility Treatment in Indore. Book an appointment Call now 7898047572 For more information, visit – PowerPoint PPT presentation

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Title: Best fertility hospital in india | Test tube baby center in indore | Mohak infertility center


1
  • Mohak Laparoscopy and Infertility Center

Cochrane Review Series
2

Cochrane Review Series
Question Are ovarian stimulation protocols
combining oral medications like Clomiphene
citrate or Letrozole with gonadotropins effective
and safe compared to gonadotropins alone in women
undergoing In-vitro fertilization
(IVF)? Focus Regimens using oral ovulogens and
gonadotropins versus gonadotropins alone for
women undergoing IVF. Population Of
Interest Unselected IVF population of subfertile
women undergoing controlled ovarian stimulation
for IVF and poor responders Intervention
Under Investigation Clomiphene citrate (CC) or
Letrozole (Ltz) with gonadotropins for controlled
ovarian hyperstimulation (COH).
3
What Was The Comparison?  Gonadotropins alone
for COH What Were The Main Outcomes? Live birth
rate (LBR), ovarian hyperstimulation syndrome
(OHSS) rate and cycle cancellation rate.

4

Results In Short 
  • Twenty-two trials including 3599 women
    undergoing IVF.
  • Live birth rate No difference in live birth
    rate following ovarian stimulation with CC or
    Ltz with gonadotropins versus gonadotropins alone
    (Risk Ratio (RR) 0.92, 95 confidence interval
    (CI) 0.66 to 1.27 4 RCTs, 493 women, low-quality
    evidence) in the general IVF population1. No
    difference in live birth rate following ovarian
    stimulation with CC or Ltz and gonadotropins versu
    s gonadotropins alone (RR 1.16, 95 CI 0.49 to
    2.79, 2 RCTs, 357 women, low-quality evidence)
    among poor responders.
  • OHSS rate Significantly lower incidence of OHSS
    following stimulation protocols using CC or Ltz
    with gonadotropins versus gonadotropins alone
    (Peto OR 0.21, 95 CI 0.11 to 0.41, 5 RCTs, 1067
    women, low-quality evidence) in the general IVF
    population.
  • Cycle cancellation rate Significantly higher
    cycle cancellation rate with CC or Ltz and
    gonadotropins versus gonadotropins alone (RR
    1.87, 95 CI 1.43 to 2.45, 9 RCTs, 1784 women,
    low-quality evidence) in the general IVF
    population.


5
  • Number of gonadotropin ampoules and number of
    oocytes retrieved Decrease in number of
    gonadotropin ampoules used and mean number of
    oocytes collected when CC or Ltz with
    gonadotropins was used compared with
    gonadotropin-only regimens (moderate quality
    evidence) in the general IVF population and poor
    responders.

6
Limitation 
  • Only six among 22 included studiesreported live
    birth rates as primary outcome, necessitating
    cautious interpretation of overall results.
  • Studies included only fresh stimulated IVF
    cycles. None of the trials addressed surplus
    frozen embryos available for subsequent transfer
    thereby data for cumulative live birth was not
    available. Currently, cumulative live birth rate
    is a more preferred outcome to evaluate
    effectiveness of IVF treatment.
  • Studies that assessed poor responders used
    varied criteria for inclusion thereby introducing
    clinical heterogeneity.
  • Lack of blinding in most included trials, poor
    reporting of methodology, differences in protocol
    and cycle cancellation policy impacted the
    overall quality of evidence.

7
Evidence Based Practice Points
  • Current weight of evidence suggests comparable
    live birth rates between CC or Ltz and
    gonadotropins versus gonadotropins alone,in both
    the routine IVF population and among poor
    responders. It is a viable alternative protocol
    in certain clinical scenarios like poor
    responders.
  • Addition of CC or Ltz reduces gonadotrophin
    requirement and incidence of ovarian
    hyperstimulation syndrome. Reduced gonadotrophin
    requirement could reduce initial treatment cost.
  • Higher cancellation rates and lower oocyte yield
    following use of CC or Ltz with gonadotrophin is
    a drawback. Cancellation of cycles can be
    psychologically distressing for the couples.
  • There has been a shift of contemporary practice
    towards maximizing oocyte yield in single
    retrieval cycle and freeze all policy due to
    higher cumulative live birth rate2. In light of
    these developments, studies evaluating cumulative
    live birth following milder stimulation protocols
    using CC or Ltz with gonadotrophins are needed
    along with cost effectiveness in order to
    establish their role in current IVF practice.

8
Reference 1.Kamath MS, Maheshwari A,
Bhattacharya S, Lor KY, Gibreel A. Oral
medications including clomiphene citrate or
aromatase inhibitors with gonadotropins for
controlled ovarian stimulation in women
undergoing in vitro fertilisation. Cochrane
Database Syst Rev. 201711(11)CD008528. 2.
Drakopoulos P, Blockeel C, Stoop D, Camus M, De
Vos M, Tournaye H, Polyzos NP. Conventional
ovarian stimulation and single embryo transfer
for IVF/ICSI. How many oocytes do we need to
maximize? Source https//www.indianfertilitysoc
iety.org/ifs-catalyst-cochrane-vol-6/
9
Mohak IVF Center, one of the Best test tube baby
center and Best fertility hospital in india.
Provides you International Standard Infertility
Treatment along with assisted reproductive
technologies like IUI, IVF, ICSI ,etc at
affordable IVF treatment / Test tube Baby
Treatment cost along with the satisfaction of
being consulted by the most renowned IVF
specialist in Indore,M.P. Come join best centre
for IVF treatment cost in indore in our voyage
towards better healthcare facilities for
infertile couples and experience the Best
Infertility Treatment in Indore. Book an
appointment Call now 7898047572 For more
information, visit https//www.mohakivf.com Pleas
e go through our social media like our page to
no more about ivf Facebook
https//www.facebook.com/MOHAK-IVF-116714780678528
7/ Please do follow on Instagram Instagram
https//www.instagram.com/mohak_ivf/ To More
Post Fallopian Tube And Its Function
10
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