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Article ; Online: GnRH agonist trigger in poor prognosis patients undergoing a multicycle approach through DuoStim or consecutive stimulations: a SWOT analysis.

Vaiarelli, Alberto / Ruffa, Alessandro / Cerrillo, María / García-Velasco, Juan Antonio

Current opinion in obstetrics & gynecology

2024 Volume 36, Issue 3, Page(s) 124–133

Abstract: Purpose of review: Identify the most recent and significant evidence regarding the ovulation trigger within the framework of a multicycle approach through DuoStim, providing valuable insights for improving treatment strategies in patients with a poor ... ...

Abstract	Purpose of review: Identify the most recent and significant evidence regarding the ovulation trigger within the framework of a multicycle approach through DuoStim, providing valuable insights for improving treatment strategies in patients with a poor prognosis. Recent findings: The trigger method plays a pivotal role in optimizing in-vitro fertilization (IVF) stimulation, influencing oocyte retrieval and maturation rates, as well as follicle recruitment in consecutive ovarian stimulations such as double stimulation. Decision-making involves multiple factors and, while guidelines exist for conventional stimulation, specific recommendations for the multicycle approach are not well established. Summary: The different methods for inducing oocyte maturation underscore the need for personalization of IVF protocols. The GnRH agonist trigger induces rapid luteolysis and establishes favorable hormonal conditions that do not adversely affect the recruitment of consecutive follicular waves in the context of DuoStim. It serves as a valid alternative to hCG in freeze-all cycles. This strategy might enhance the safety and flexibility of ovarian stimulations with no impact on oocyte competence and IVF efficacy.
MeSH term(s)	Humans ; Ovulation Induction/methods ; Female ; Gonadotropin-Releasing Hormone/agonists ; Fertilization in Vitro/methods ; Oocyte Retrieval/methods ; Pregnancy ; Fertility Agents, Female/therapeutic use ; Prognosis ; Triptorelin Pamoate/therapeutic use ; Pregnancy Rate ; Chorionic Gonadotropin/therapeutic use
Chemical Substances	Gonadotropin-Releasing Hormone (33515-09-2) ; Fertility Agents, Female ; Triptorelin Pamoate (08AN7WA2G0) ; Chorionic Gonadotropin
Language	English
Publishing date	2024-03-26
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1049382-7
ISSN	1473-656X ; 1040-872X
ISSN (online)	1473-656X
ISSN	1040-872X
DOI	10.1097/GCO.0000000000000947
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Article ; Online: Double stimulation for the management of poor-prognosis patients: where are we going?

Petrone, Pasquale / Vaiarelli, Alberto / Blockeel, Christophe

Current opinion in obstetrics & gynecology

2023 Volume 35, Issue 3, Page(s) 246–253

Abstract: Purpose of review: The technical improvements in IVF allowed the implementation of nonconventional ovarian stimulation protocols for some specific patients. Where time is crucial, such as with oncologic patients, poor-prognosis patients, patients with ... ...

Abstract	Purpose of review: The technical improvements in IVF allowed the implementation of nonconventional ovarian stimulation protocols for some specific patients. Where time is crucial, such as with oncologic patients, poor-prognosis patients, patients with low ovarian reserve, and those with advanced maternal age, access to IVF treatment is even more critical. Some of these protocols might start in the late follicular phase, luteal phase, or involve both stimulations within the same ovarian cycle. Recent findings: Until now, published evidence showed that oocytes retrieved from unconventional protocol seem to be developmentally, genetically, and reproductively competent. Second stimulation in the same ovarian cycle after the conventional approach may represent a sound alternative to oocyte accumulation. This can be proposed in progress after careful counselling focused on the patients' chances of finding at least one euploid embryo on account of their age and of the number of blastocysts obtained after the conventional approach. Summary: The adoption of these new strategies, known as double stimulation protocol, can be conceived as a real full-personalization of ovarian stimulation. Multicentre prospective RCTs are urgently needed to evaluate the efficacy, efficiency, and costs of double stimulation versus two consecutive conventional approaches with standard or mild stimulation and in a different IVF setting.
MeSH term(s)	Female ; Humans ; Pregnancy ; Fertilization in Vitro/methods ; Prospective Studies ; Menstrual Cycle/physiology ; Luteal Phase ; Ovulation Induction/methods ; Prognosis ; Pregnancy Rate
Language	English
Publishing date	2023-03-06
Publishing country	England
Document type	Review ; Journal Article
ZDB-ID	1049382-7
ISSN	1473-656X ; 1040-872X
ISSN (online)	1473-656X
ISSN	1040-872X
DOI	10.1097/GCO.0000000000000869
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Article ; Online: The metrics maze in science: navigating academic evaluation without journalistic pressures.

Alviggi, Carlo / Nappi, Rossella E / La Marca, Antonio / Ubaldi, Filippo Maria / Vaiarelli, Alberto

Reproductive biomedicine online

2024 , Page(s) 103935

Abstract: In recent years a troubling trend has emerged in the medical research field, notably in reproductive medicine, manifesting an increased emphasis on quantity over quality in articles published. The pressure to collect copious publication records risks ... ...

Abstract	In recent years a troubling trend has emerged in the medical research field, notably in reproductive medicine, manifesting an increased emphasis on quantity over quality in articles published. The pressure to collect copious publication records risks compromising meticulous expertise and impactful contributions. This tendency is exemplified by the rise of 'hyper-prolific researchers' publishing at an extraordinary rate (i.e. every 5 days), prompting a deeper analysis of the reasons underlying this behaviour. Prioritizing rapid publication over Galileo Galilei's systematic scientific principles may lead to a superficial approach driven by quantitative targets. Thus, the overreliance on metrics to facilitate academic careers has shifted the focus to numerical quantification rather than the real scientific contribution, raising concerns about the effectiveness of the evaluation systems. The Hamletian question is: are we scientist or journalist? Addressing these issues could necessitate a crucial re-evaluation of the assessment criteria, emphasizing a balance between quantity and quality to foster an academic environment that values meaningful contributions and innovation.
Language	English
Publishing date	2024-03-05
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2113823-0
ISSN	1472-6491 ; 1472-6483
ISSN (online)	1472-6491
ISSN	1472-6483
DOI	10.1016/j.rbmo.2024.103935
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Article ; Online: DuoStim reduces time to pregnancy, minimizes treatment discontinuation, and is potentially cost-effective.

Garcia-Velasco, Juan A / Cimadomo, Danilo / Cerrillo, Maria / Vaiarelli, Alberto / Ubaldi, Filippo Maria

Human reproduction (Oxford, England)

2023 Volume 38, Issue 8, Page(s) 1643–1644

MeSH term(s)	Pregnancy ; Female ; Humans ; Time-to-Pregnancy ; Cost-Benefit Analysis ; Menstrual Cycle ; Fertilization in Vitro
Language	English
Publishing date	2023-06-12
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	632776-x
ISSN	1460-2350 ; 0268-1161 ; 1477-741X
ISSN (online)	1460-2350
ISSN	0268-1161 ; 1477-741X
DOI	10.1093/humrep/dead113
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Article ; Online: Low-quality evidence from a randomized controlled trial due to an inappropriate IVF setting to challenge Dual Stimulation strategy.

Ubaldi, Filippo Maria / Vaiarelli, Alberto / Cimadomo, Danilo / Cerrillo, Maria / Rienzi, Laura / Garcia-Velasco, Juan A

Human reproduction (Oxford, England)

2023 Volume 38, Issue 8, Page(s) 1645–1647

MeSH term(s)	Humans ; Pregnancy ; Female ; Fertilization in Vitro ; Pregnancy Rate ; Ovulation Induction
Language	English
Publishing date	2023-06-21
Publishing country	England
Document type	Randomized Controlled Trial ; Letter ; Comment
ZDB-ID	632776-x
ISSN	1460-2350 ; 0268-1161 ; 1477-741X
ISSN (online)	1460-2350
ISSN	0268-1161 ; 1477-741X
DOI	10.1093/humrep/dead108
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Article ; Online: Is a randomized controlled design sufficient for a trial to be valuable?

Ubaldi, Filippo Maria / Cimadomo, Danilo / Vaiarelli, Alberto / Rienzi, Laura

Human reproduction (Oxford, England)

2021 Volume 36, Issue 8, Page(s) 2416–2417

MeSH term(s)	Humans ; Research Design
Language	English
Publishing date	2021-05-13
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	632776-x
ISSN	1460-2350 ; 0268-1161 ; 1477-741X
ISSN (online)	1460-2350
ISSN	0268-1161 ; 1477-741X
DOI	10.1093/humrep/deab114
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Article ; Online: Reply: 'Second stimulation in the same ovarian cycle', probably a terminology more appropriate than 'luteal phase stimulation' in the DuoStim protocol.

Vaiarelli, Alberto / Cimadomo, Danilo / Rienzi, Laura / Ubaldi, Filippo Maria

Human reproduction (Oxford, England)

2021 Volume 36, Issue 6, Page(s) 1723–1724

MeSH term(s)	Blastocyst ; Female ; Follicular Phase ; Humans ; Luteal Phase ; Menstrual Cycle ; Pregnancy
Language	English
Publishing date	2021-02-03
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	632776-x
ISSN	1460-2350 ; 0268-1161 ; 1477-741X
ISSN (online)	1460-2350
ISSN	0268-1161 ; 1477-741X
DOI	10.1093/humrep/deab018
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Article ; Online: How should the best human embryo in vitro be? Current and future challenges for embryo selection.

Cimadomo, Danilo / Innocenti, Federica / Taggi, Marilena / Saturno, Gaia / Campitiello, Maria R / Guido, Maurizio / Vaiarelli, Alberto / Ubaldi, Filippo M / Rienzi, Laura

Minerva obstetrics and gynecology

2023 Volume 76, Issue 2, Page(s) 159–173

Abstract: In-vitro fertilization (IVF) aims at overcoming the causes of infertility and lead to a healthy live birth. To maximize IVF efficiency, it is critical to identify and transfer the most competent embryo within a cohort produced by a couple during a cycle. ...

Abstract	In-vitro fertilization (IVF) aims at overcoming the causes of infertility and lead to a healthy live birth. To maximize IVF efficiency, it is critical to identify and transfer the most competent embryo within a cohort produced by a couple during a cycle. Conventional static embryo morphological assessment involves sequential observations under a light microscope at specific timepoints. The introduction of time-lapse technology enhanced morphological evaluation via the continuous monitoring of embryo preimplantation in vitro development, thereby unveiling features otherwise undetectable via multiple static assessments. Although an association exists, blastocyst morphology poorly predicts chromosomal competence. In fact, the only reliable approach currently available to diagnose the embryonic karyotype is trophectoderm biopsy and comprehensive chromosome testing to assess non-mosaic aneuploidies, namely preimplantation genetic testing for aneuploidies (PGT-A). Lately, the focus is shifting towards the fine-tuning of non-invasive technologies, such as "omic" analyses of waste products of IVF (e.g., spent culture media) and/or artificial intelligence-powered morphologic/morphodynamic evaluations. This review summarizes the main tools currently available to assess (or predict) embryo developmental, chromosomal, and reproductive competence, their strengths, the limitations, and the most probable future challenges.
MeSH term(s)	Humans ; Artificial Intelligence ; Blastocyst/pathology ; Genetic Testing ; Fertilization in Vitro ; Aneuploidy
Language	English
Publishing date	2023-06-16
Publishing country	Italy
Document type	Review ; Journal Article
ZDB-ID	3062815-5
ISSN	2724-6450
ISSN (online)	2724-6450
DOI	10.23736/S2724-606X.23.05296-X
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Article ; Online: Cryostorage management of reproductive cells and tissues in ART: status, needs, opportunities and potential new challenges.

Canosa, Stefano / Maggiulli, Roberta / Cimadomo, Danilo / Innocenti, Federica / Fabozzi, Gemma / Gennarelli, Gianluca / Revelli, Alberto / Bongioanni, Francesca / Vaiarelli, Alberto / Ubaldi, Flippo M / Rienzi, Laura / Palmer, Giles A / Nijs, Martine

Reproductive biomedicine online

2023 Volume 47, Issue 3, Page(s) 103252

Abstract: Among the wide range of procedures performed by clinical embryologists, the cryopreservation of reproductive cells and tissues represents a fundamental task in the daily routine. Indeed, cryopreservation procedures can be considered a subspecialty of ... ...

Abstract	Among the wide range of procedures performed by clinical embryologists, the cryopreservation of reproductive cells and tissues represents a fundamental task in the daily routine. Indeed, cryopreservation procedures can be considered a subspecialty of medically assisted reproductive technology (ART), having the same relevance as sperm injection or embryo biopsy for preimplantation genetic testing. However, although a great deal of care has been devoted to optimizing cryopreservation protocols, the same energy has only recently been spent on developing and implementing strategies for the safe and reliable storage and transport of reproductive specimens. Herein, we have summarized the content of the available guidelines, the risks, the needs and the future perspectives regarding the management of cryopreservation biorepositories used in ART.
MeSH term(s)	Humans ; Male ; Semen ; Reproductive Techniques, Assisted ; Germ Cells ; Cryopreservation/methods ; Spermatozoa
Language	English
Publishing date	2023-06-22
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	2113823-0
ISSN	1472-6491 ; 1472-6483
ISSN (online)	1472-6491
ISSN	1472-6483
DOI	10.1016/j.rbmo.2023.06.007
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Article ; Online: Does recurrent implantation failure exist? Prevalence and outcomes of five consecutive euploid blastocyst transfers in 123 987 patients.

Gill, Pavan / Ata, Baris / Arnanz, Ana / Cimadomo, Danilo / Vaiarelli, Alberto / Fatemi, Human M / Ubaldi, Filippo Maria / Garcia-Velasco, Juan A / Seli, Emre

Human reproduction (Oxford, England)

2024

Abstract: Study question: What are the clinical pregnancy and live birth rates in women who underwent up to two more euploid blastocyst transfers after three failures in the absence of another known factor that affects implantation?: Summary answer: The fourth ...

Abstract	Study question: What are the clinical pregnancy and live birth rates in women who underwent up to two more euploid blastocyst transfers after three failures in the absence of another known factor that affects implantation? Summary answer: The fourth and fifth euploid blastocyst transfers resulted in similar live birth rates of 40% and 53.3%, respectively, culminating in a cumulative live birth rate of 98.1% (95% CI = 96.5-99.6%) after five euploid blastocyst transfers. What is known already: The first three euploid blastocysts have similar implantation and live birth rates and provide a cumulative live birth rate of 92.6%. Study design, size, duration: An international multi-center retrospective study was conducted at 25 individual clinics. The study period spanned between January 2012 and December 2022. A total of 123 987 patients with a total of 64 572 euploid blastocyst transfers were screened for inclusion. Participants/materials, setting, methods: Patients with a history of any embryo transfer at another clinic, history of any unscreened embryo transfer at participating clinics, parental karyotype abnormalities, the use of donor oocytes or a gestational carrier, untreated intracavitary uterine pathology (e.g. polyp, leiomyoma), congenital uterine anomalies, adenomyosis, communicating hydrosalpinx, endometrial thickness <6 mm prior to initiating of progesterone, use of testicular sperm due to non-obstructive azoospermia in the male partner, transfer of an embryo with a reported intermediate chromosome copy number (i.e. mosaic), preimplantation genetic testing cycles for monogenic disorders, or structural chromosome rearrangements were excluded. Ovarian stimulation protocols and embryology laboratory procedures including trophectoderm biopsy followed the usual practice of each center. The ploidy status of blastocysts was determined with comprehensive chromosome screening. Endometrial preparation protocols followed the usual practice of participating centers and included programmed cycles, natural or modified natural cycles. Main results and the role of chance: A total of 105 (0.085% of the total population) patients met the criteria and underwent at least one additional euploid blastocyst transfer after failing to achieve a positive pregnancy test with three consecutive euploid blastocyst transfers. Outcomes of the fourth and fifth euploid blastocyst transfers were similar across participating centers. Overall, the live birth rate was similar with the fourth and fifth euploid blastocysts (40% vs 53.3%, relative risk = 1.33, 95% CI = 0.93-1.9, P value = 0.14). Sensitivity analyses excluding blastocysts biopsied on Day 7 postfertilization, women with a BMI >30 kg/m2, cycles using non-ejaculate or donor sperm, double-embryo transfer cycles, and cycles in which the day of embryo transfer was modified due to endometrial receptivity assay test result yielded similar results. Where data were available, the fourth euploid blastocyst had similar live birth rate with the first one (relative risk = 0.84, 95% CI = 0.58-1.21, P = 0.29). The cumulative live birth rate after five euploid blastocyst transfers was 98.1% (95% CI = 96.5-99.6%). Limitations, reasons for caution: Retrospective design has its own inherent limitations. Patients continuing with a further euploid embryo transfer and patients dropping out from treatment after three failed euploid transfers can be systematically different, perhaps with regard to ovarian reserve or economic status. Wider implication of the findings: Implantation failure seems to be mainly due to embryonic factors. Given the stable and high live birth rates up to five euploid blastocysts, unexplained recurrent implantation failure should have a prevalence of <2%. Proceeding with another embryo transfer can be the best next step once a known etiology for implantation failure is ruled out. Study funding/competing interest(s): None. Trial registration number: N/A.
Language	English
Publishing date	2024-03-07
Publishing country	England
Document type	Journal Article
ZDB-ID	632776-x
ISSN	1460-2350 ; 0268-1161 ; 1477-741X
ISSN (online)	1460-2350
ISSN	0268-1161 ; 1477-741X
DOI	10.1093/humrep/deae040
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