Researcher:
Shakerian, Bahar

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Doctor

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Bahar

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Shakerian

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Shakerian, Bahar

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2021 - 20224

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    Effectiveness of the flexible progestin primed ovarian stimulation protocol compared to the flexible gnrh antagonist protocol in women with decreased ovarian reserve
    (Taylor & Francis Ltd, 2022) Türkgeldi, Engin; Yıldız, Şule; Çekiç, Sebile Güler; Shakerian, Bahar; Keleş, İpek; Ata, Mustafa Barış; Faculty Member; Faculty Member; Doctor; Doctor; Doctor; Faculty Member; School of Medicine; School of Medicine; N/A; N/A; N/A; School of Medicine; Koç University Hospital; 329649; 134205; N/A; N/A; N/A; 182910
    The aim of this retrospective cohort study was to compare the effectiveness of the new flexible progestin primed ovarian stimulation (fPPOS) protocol with the flexible gonadotropin-releasing-hormone antagonist (GnRH-ant) protocol in women with decreased ovarian reserve (DOR). Twenty-seven women who underwent fPPOS and 54 age-matched women who received GnRH-ant for pituitary suppression were included in the study. All women had DOR and underwent oocyte cryopreservation. Three-hundred IU/day FSH was started on cycle day 2-3 and 0.25 mg/day GnRH-ant or 10 mg/day medroxyprogesterone acetate was started when the leading follicle reached 14 mm or serum oestradiol level was >= 200 ng/mL. The median duration of stimulation, day of commencing pituitary suppression and duration of suppression were similar in both groups, with 8, 5, and 5 days, respectively. The median number of cumulus-oophorous complexes (4.0 vs 5.5), metaphase-two oocytes (3 vs 4), the total number of oocytes cryopreserved (3.0 vs 4.5), and oocyte maturation rates (0.67 vs 0.70) were similar between the fPPOS and GnRH-ant groups, respectively. There was one case of premature ovulation in the fPPOS group and none in the GnRH-ant group (p = 0.91). In conclusion, fPPOS may be used in women with DOR without compromising the number of oocytes retrieved and seems a viable alternative to the flexible GnRH-ant protocol.
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    How predictive is endometrial thickness for live birth after fresh and frozen-thawed embryo transfer when no cut-off is employed?
    (Oxford Univ Press, 2021) Türkgeldi, Engin; Shakerian, Bahar; Yıldız, Şule; Keleş, İpek; Ata, Mustafa Barış; Faculty Member; Doctor; Faculty Member; Doctor; Faculty Member; School of Medicine; N/A; School of Medicine; N/A; School of Medicine; Koç University Hospital; 329649; N/A; 134205; N/A; 182910
    Study Question: Does endometrial thickness (EMT) predict live birth (LB) after fresh and frozen-thawed embryo transfer (ET) and is there a lower EMT cut-off for ET? Summary Answer: Once intracavitary pathology and inadvertent progesterone exposure is excluded, EMT is not predictive for LB. EMT is not linearly associated with probability of LB. What is Known Already: EMT is commonly used as a marker of endometrial receptivity and in turn, assisted reproductive technology treatment success. ET is often cancelled or postponed if EMT is below an arbitrary cut-off. However, the available evidence on the relationship between EMT and LB rates is conflicting and too dubious to hold such strong stance. An overwhelming majority of the studies on the subject are retrospective, they use different arbitrary cut off values ranging between 6 to 9 mm with heterogeneous stimulation and transfer protocols. Study Design, Size, Duration: Records of all women who underwent fresh or frozen-thawed ET in Koc University Hospital Assisted Reproduction Unit between October 2016 - August 2019 were retrospectively screened. All women who underwent fresh or frozen-thawed blastocyst transfer during the study period were included. Every woman contributed to the study with only one transfer cycle for each category, i.e., fresh ET and frozen-thawed ET. Participants/Materials, Setting, Methods: After ruling out endometrial pathology, EMT was measured on the day of ovulation trigger for fresh ET cycles, and on the day of progesterone commencement for frozen-thawed ET. ET was carried out, regardless of EMT, if there was no suspicion of inadvertent progesterone exposure, i.e., due to follicular phase progesterone elevation in fresh or premature ovulation in frozen ET cycles. Main Results and the Role of Chance: 560 ET cycles, 273 fresh and 287 frozen-thawed, were analyzed. EMT varied from 4mm to 18mm. EMT were similar between women who achieved a LB and who did not after fresh ET [10.5 (9.2 – 12.2) mm and 9 (8 – 11) mm, respectively, p = 0.11]. Ovarian stimulation characteristics and proportion of women who received a single embryo were similar (69% vs 68.3%, respectively, p = 0.91). Women who achieved a LB was significantly younger than those who did not [35 (32–38) and 37 (33–41), respectively, p < 0.01]. Women who had a LB and who did not after frozen-thawed ET had similar EMT of 8.4 (7.4 – 9.7) mm and 9 (8 – 10) mm, respectively (p = 0.38). Women who achieved a LB were significantly younger than those who did not [32 (29–35) vs 34 (30–38) years, p = 0.04]. The proportion of women who received a single ET was similar between women who achieved a LB and who did not after a FET [86/95 (90.5%) vs 181/192 (94.3%), respectively, p = 0.26]. Area under curve values of EMT for predicting LB in fresh, frozen-thawed and all ET were 0.56, 0.47 and 0.52, respectively. EMT and LB rate were not linearly correlated in fresh or frozen-thawed ET cycles. Limitations, Reasons for Caution: Although our study is retrospective, no women was denied ET due to EMT in our center. Only patients undergoing ET were included in the analysis, which may introduce bias due to the selection of couples who were competent enough to produce at least one blastocyst fit for transfer. Wider Implications of the Findings: Since women with thin endometrium had reasonable chance for LB even in the absence of a cut-off for EMT in this unique dataset, delaying or denying ET for any given EMT value alone does not seem justified. Further studies in which ET is carried out regardless of EMT are needed.
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    Endometrial thickness is not predictive for live birth after embryo transfer, even without a cutoff
    (Elsevier, 2021) Shakerian, Bahar; Türkgeldi, Engin; Yıldız, Şule; Keleş, İpek; Ata, Mustafa Barış; Doctor; Faculty Member; Faculty Member; Doctor; Faculty Member; N/A; School of Medicine; School of Medicine; N/A; School of Medicine; Koç University Hospital; Koç University Hospital; Koç University Hospital; Koç University Hospital; Koç University Hospital; N/A; 329649; 134205; N/A; 182910
    Objective: To investigate the predictive value of endometrial thickness (EMT) for live birth when a lower threshold of EMT is not employed for embryo transfer (ET). Design: Retrospective study Setting: Academic assisted reproduction center Patient(s): All women who underwent fresh or frozen-thawed ET at the Koc & cedil; University Hospital Assisted Reproduction Unit between October 2016 and August 2019 Intervention(s): After ruling out endometrial pathology, blastocyst transfer was planned regardless of the EMT in the absence of increased serum progesterone level on the trigger day in fresh embryo transfer cycles or before commencing progesterone treatment in artificially prepared frozen-thawed ET cycles. Main Outcome Measure(s): The primary outcome was live birth. Live birth and miscarriage rates per ET were stratified according to fresh and frozen-thawed ET cycles for each millimeter of endometrial thickness. Receiver operator characteristic curve analyses were performed to evaluate the predictive value of EMT for live birth. Result(s): A total of 560 ET cycles, 273 fresh and 287 frozen-thawed, were included in the study. Relevant patient characteristics as well as EMTs were similar between women who achieved a live birth and those who did not after fresh or frozen-thawed ET. There was no linear association between EMT and live birth or miscarriage rates. Area under the curve values for EMT to predict live birth after fresh, frozen-thawed, and all ETs were 0.56, 0.47, and 0.52, respectively. Conclusion(s): Our results showed that the EMT was not predictive for live birth in either fresh or frozen-thawed ET cycles. Once intracavitary pathology and inadvertent progesterone exposure were excluded, women with thinner EMTs should not be denied their potential for live birth because it is comparable to that of those with thicker EMT.& nbsp;
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    PublicationOpen Access
    Dual trigger compared with human chorionic gonadotropin alone and effects on clinical outcome of intracytoplasmic sperm injection
    (Royan Institute of Iran, 2021) Shakerian, Bahar; Türkgeldi, Engin; Çekiç, Sebile Güler; Yıldız, Şule; Keleş, İpek; Ata, Mustafa Barış; Doctor; Faculty Member; Doctor; Doctor; Faculty Member; School of Medicine; Koç University Hospital; N/A; 329649; N/A; N/A; N/A; 182910
    Background: this study compared outcomes of the standard 6000 IU human chorionic gonadotropin (hCG) trigger with a dual trigger comprised of 6000 IU hCG and 1 mg lcuprolide acetate for final oocytc maturation in an intracytoplasmic sperm injection (ICSI) cycle. By convention, ICSI was performed in most cases at the clinic. Materials and Methods: in this retrospective study, a total of 50 women were included in each arm. Participants were matched for age, indication and number of prior assisted reproduction technology (ART) cycles. Women at risk for ovarian hyperstimulation syndrome (OHSS) were excluded. A flexible gonadotropin releasing honnone (GnRH) antagonist protocol was used and final oocyte maturation was triggered when two leading follicles were >17 mm. Distribution of variables was evaluated visually with histograms. Continuous variables were defined by mean (standard deviation) or median (25th-75th percentile) depending on distribution characteristics. Categorical variables were defined by numbers and percentages. Continuous variables were compared between the groups with the t test or Mann-Whitney U test as appropriate. Categorical variables were compared by the chi-square test and its derivatives as appropriate. A two-sided P<0.05 indicated statistical significance. Results: both groups had similar antral follicle counts, median parity (0) and number of previous failed cycles (0). The median number of oocytes (8 vs. 7), metaphase-two oocytes (6 vs. 5.5), blastocysts (1 vs. 1), clinical pregnancy rates (CPR) (28% vs. 22%), ongoing pregnancy rates (OPR) (22% vs. 20%) and pregnancy rate per transfer (53.3% vs 53.8%) were similar between the dual trigger and hCG only groups, respectively. Conclusion: dual trigger for oocyte maturation stimulation failed to improve the ICSI outcome.