Is single ovary a detrimental factor for live-birth rate in IVF?

Is single ovary a detrimental factor for live-birth rate in IVF? Sir, I read with great interest the detailed study of Lind et al. (2017), in which they found reduced live-birth rates after IVF/ICSI in women with previous unilateral oophorectomy. These are important results with far reaching implications to patients, however, they are in sharp contrast to findings in the majority of studies we (Lass et al., 1997) and others published over the last 30 years, summarised by Khan et al. (2014). There has been wide consensus that women with a single ovary have a poorer response to stimulation, require more gonadotrophins, and yield fewer oocytes and embryos. However, by mechanisms which are not fully understood, the clinical pregnancy rate and much less reported live pregnancy rate were not reduced and are similar to the reference group (Lass, 1999; Khan et al., 2014). The weakness of all these studies, including the current one of Lind et al., is that all were retrospective historic observational studies with their inherent biases. None of them were prospective randomised control studies. I believe that such prospective study is long overdue. I suggest also performing a systematic literature review and meta-analysis of the dozen or so published observational studies to try to understand the real clinical effect of unilateral oophorectomy on life birth rate in IVF/ICSI. References Khan Z, Gada RP, Tabbaa ZM, Laughlin-Tommaso SK, Jensen JR, Coddington CC III, Stewart EA. Unilateral oophorectomy results in compensatory follicular recruitment in the remaining ovary at time of ovarian stimulation for in vitro fertilization. Fertil Steril  2014; 101: 722– 727. Google Scholar CrossRef Search ADS PubMed  Lass A. The fertility potential of women with a single ovary. Hum Reprod Update  1999; 5: 546– 550. Google Scholar CrossRef Search ADS PubMed  Lass A, Paul M, Margara R, Winston RM. Women with one ovary have decreased response to GnRHa/HMG ovulation protocol in IVF but the same pregnancy rate as women with two ovaries. Hum Reprod  1997; 12: 298– 300. Google Scholar CrossRef Search ADS PubMed  Lind T, Holte J, Olofsson I, Hadziosmanovic N, Gudmundsson J, Nedstrand E, Lood M, Berglund I, and Rodriguez-Wallberg K. Reduced live-birth rates after IVF/ICSI in women with previous unilateral oophorectomy: results of a multicentre cohort study. Hum Reprod, pp. 1--10, 2017. doi:10.1093/humrep/dex358. © The Author(s) 2018. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Human Reproduction Oxford University Press

Is single ovary a detrimental factor for live-birth rate in IVF?

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Publisher
Oxford University Press
Copyright
© The Author(s) 2018. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com
ISSN
0268-1161
eISSN
1460-2350
D.O.I.
10.1093/humrep/dey007
Publisher site
See Article on Publisher Site

Abstract

Sir, I read with great interest the detailed study of Lind et al. (2017), in which they found reduced live-birth rates after IVF/ICSI in women with previous unilateral oophorectomy. These are important results with far reaching implications to patients, however, they are in sharp contrast to findings in the majority of studies we (Lass et al., 1997) and others published over the last 30 years, summarised by Khan et al. (2014). There has been wide consensus that women with a single ovary have a poorer response to stimulation, require more gonadotrophins, and yield fewer oocytes and embryos. However, by mechanisms which are not fully understood, the clinical pregnancy rate and much less reported live pregnancy rate were not reduced and are similar to the reference group (Lass, 1999; Khan et al., 2014). The weakness of all these studies, including the current one of Lind et al., is that all were retrospective historic observational studies with their inherent biases. None of them were prospective randomised control studies. I believe that such prospective study is long overdue. I suggest also performing a systematic literature review and meta-analysis of the dozen or so published observational studies to try to understand the real clinical effect of unilateral oophorectomy on life birth rate in IVF/ICSI. References Khan Z, Gada RP, Tabbaa ZM, Laughlin-Tommaso SK, Jensen JR, Coddington CC III, Stewart EA. Unilateral oophorectomy results in compensatory follicular recruitment in the remaining ovary at time of ovarian stimulation for in vitro fertilization. Fertil Steril  2014; 101: 722– 727. Google Scholar CrossRef Search ADS PubMed  Lass A. The fertility potential of women with a single ovary. Hum Reprod Update  1999; 5: 546– 550. Google Scholar CrossRef Search ADS PubMed  Lass A, Paul M, Margara R, Winston RM. Women with one ovary have decreased response to GnRHa/HMG ovulation protocol in IVF but the same pregnancy rate as women with two ovaries. Hum Reprod  1997; 12: 298– 300. Google Scholar CrossRef Search ADS PubMed  Lind T, Holte J, Olofsson I, Hadziosmanovic N, Gudmundsson J, Nedstrand E, Lood M, Berglund I, and Rodriguez-Wallberg K. Reduced live-birth rates after IVF/ICSI in women with previous unilateral oophorectomy: results of a multicentre cohort study. Hum Reprod, pp. 1--10, 2017. doi:10.1093/humrep/dex358. © The Author(s) 2018. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

Journal

Human ReproductionOxford University Press

Published: Mar 1, 2018

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