Transcript The Effect of Bromocriptine Rebound Method on Ongoing

The Effect of Bromocriptine-Rebound Method on Ongoing Pregnancy and Live Birth
after Intracytoplasmic Sperm Injection Cycles: a Randomized Clinical Trial
Ashraf Aleyasin, Ramak Esmaeeliazad R, Marzie Aghahosseini , Leili Safdarian, Fatemeh Sarvi Abbas Ali Kokab
Department of Infertility, Shariati Hospital, Tehran University of Medical Sciences
Objectives:
Table 2; Cycle characteristics of patients in long protocol and BRM groups
Assisted reproductive technology (ART) has found a significant role to
treat infertility among couples with broad range of causes. Despite
advances in ART, the success of individual cycle to a live birth is still low.
This can be related to poor response to ovulation induction. Different
protocols have been recommended to optimize follicular development;
however the best protocol to improve ovarian stimulation has yet to be
recognized. To assess whether Bromocriptine rebound method (BRM) can
improve pregnancy outcomes after ICSI cycles.
Long protocol group
Number of patients
59
58
Total dose of gonadotropins ( IU )a
( NO. of 75 IU ampoules )
33 ( 3–104 )
33 ( 16–104 )
1686.5 ( 22-26600 )
1844 ( 174-17690 )
0.477
No. of oocytes retrieved a
11 ( 3-34 )
11 ( 2-25 )
0.895
No. of metaphase II oocytesa
7 ( 2-18 )
7 ( 1-18 )
0.986
6 ( 1–14 )
5.5 ( 1–15 )
0.621
Fertilization rate ( % )
76.7
79.4
0.325
Total of embryo transfer
3 ( 0-5 )
4 ( 0-5 )
0.233
No. of top-quality embryo transfer
4 ( 1-14 )
4 ( 1-11 )
0.310
Freezed embryo
0 ( 0-14 )
0 ( 0-8 )
0.701
Implantation rates ( % )
16.3
11.5
0.196
OHSS ( % )
7
3.5
0.679
No. of pronucleus
a
a
values are mean ± SD
Pregnancy outcomes of patients in long protocol and BRM groups
Number of patients
Method and long protocol groups with respect to mean age and BMI (body
mass index), infertility duration, primary or secondary infertility and basic
laboratory tests. There were no significant differences in the numbers of
developed follicles, total retrieval oocytes, embryo transfer and embryos
with superior morphologic between two groups. The values of chemical,
clinical and ongoing pregnancies and live births were not significantly
differences between two groups (37%, 35%, 28.1%, 28.1% in group 1 and
44%, 38.6%, 21.1% and 19.3% in group 2 respectively); ongoing
pregnancy and live birth were significantly higher in chemical pregnant on
BRM. The miscarriage rates were higher in long protocol group.
0.880
E2 day of hCG ( pg/ml )a
BR group
Results
P value
Conclusion
The results of this prospective study revealed that BRM
might lead to higher ongoing pregnancy and live birth rates
compared to Long protocol in women undergoing ICSI
cycles.
Key Words: Bromocriptine, ICSI, Live birth, Prolactin
Material $ Method
This study was prospective controlled randomized clinical trial involving
117 volunteer patients attended outpatient clinic, infertility centre, Shariati
teaching hospital, Tehran, Iran. The patients were recruited between
March 2009 and August 2010. Institutional review board ethical approval
for this study was obtained from the Tehran University Ethics Committee.
The patients received written information about the study and potential
complications of assisted reproductive technology (ART), followed by oral
discussion and formal consent. All patients underwent intracytoplasmic
sperm injection. Ovulatory women with normal serum prolactin levels
were assigned to either Bromocriptine rebound method (n=59 cycles) or
long protocol (n=58 cycles). Both procedures were carried out in a similar
way; however a group of patients have been given Bromocriptine daily
from day 4th of the preceding cycle until the 7 days before gonadotropin
stimulation (BRM). The outcomes of ICSI and hormonal data were
compared between patients on long standard protocol, and patients on
the BR method.
BR group
Parameter
Long protocol group
P value
59
58
Chemical pregnancy rate ( % )
21 ( 36.8 )
25 ( 43.9 )
0.445
Clinical pregnancy rate ( % )
20 (35.1 )
22 (38.6)
0.698
Ongoing pregnancy rate ( % )
16 (28.1 )
12 (21.1)
0.384
Miscarriage ( % )
5 (23.8)
13 (52.0)
0.051
Multiple pregnancy ( % )
5 ( 31.3 )
2 ( 16.7 )
0.661
Live birth rate ( % )
16 (28.1)
11 (19.3)
References:
1- Masao Jinno, Yuuko Katsumata, Toshihisa Hoshiai, et
al: a novel method of ovarian stimulation for in vitro
fertilization ( bromocriptine rebound method ) increases
developmental potential of oocytes and pregnancy rate :
Nippon Sanka Fujinka Gakkai Zasshi 1995 Dec. ;47
(12) : 1337-44
2- Kyorin University, Tokyo, Japan: a novel method of
ovarian stimulation for in vitro fertilization: bromocriptine
rebound method: Fertil steril. 1996 Aug ; 66 (2) : 271-4
3- Jinno M, Katsumata Y, Hoshiai T, Nakamura : A
therapeutic
role
of
prolactin
supplementation
bromocriptine rebound method : J clin Endocrinol Metab
1997 Nov ; 82 (11) : 3603-11