Annick Delvigne - Academia.edu (original) (raw)

Papers by Annick Delvigne

Research paper thumbnail of Laser zona thinning improves implantation rates in patients with repeated IVF failures

International journal of fertility and women's medicine, 2008

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Research paper thumbnail of Les fausses couches à répétition: consensus du GGOLFB

info:eu-repo/semantics/publishe

Research paper thumbnail of Ce que dit la loi

Research paper thumbnail of Prise en charge de première intention du couple infertile

info:eu-repo/semantics/publishe

Research paper thumbnail of In vitro fertilization when men, women, or both partners are positive for HIV: a case–control study

Archives of Gynecology and Obstetrics, 2017

The aim of this study was to compare the outcomes of in vitro fertilization (IVF) for couples whe... more The aim of this study was to compare the outcomes of in vitro fertilization (IVF) for couples where one or both partners were positive for the human immunodeficiency virus (HIV) to matched control couples. Methods A matched case-control retrospective study was performed. Data for 104 couples where the woman was HIV-positive; for 90 couples where the man was HIVpositive; and for 33 couples where both partners were HIVpositive were prospectively analyzed in comparison to matched controls treated in our center during the same period. The main outcomes were clinical pregnancy and live birth rates. Results For couples involving an HIV-positive man, clinical outcomes were comparable to controls and resulted in the birth of 18 healthy babies after 90 cycles. When the woman was affected, cycle cancelation, number of retrieved oocytes, and ongoing clinical pregnancy rates per transfer were statistically reduced. Implantation rates were comparable to those of non-affected controls. Seven healthy babies for 104 cycles were obtained. For a couple in which both partners were HIV-positive, only one healthy birth occurred after 33 cycles. Pregnancy rates were systematically reduced though not significantly probably due to sample size. Conclusions Our data suggest that IVF outcomes were similar to controls when men were HIV-positive and remain acceptable when women were HIV-positive. IVF outcomes were severely reduced in our sero-concordant couples; however, many patients had severe HIV disease previously, and therefore, these results should be reassessed in patients treated early in their disease. Keywords Assisted reproductive technology Á In vitro fertilization Á Human immunodeficiency virus Á Casematched study Á Infertility Pauline Vankerkem and Yannick Manigart shared first authorship.

Research paper thumbnail of Fertilization failure in IVF: why and what next?

Human Reproduction, 1990

Among 297 couples who underwent 587 oocyte collection procedures, 95 (16%) total fertilization fa... more Among 297 couples who underwent 587 oocyte collection procedures, 95 (16%) total fertilization failures (FT) were observed. This frequency is similar in couples with either normal or only mildly deficient spermatozoa (16.2 and 13.7% respectively) but is almost doubled in cases of moderately and severely defective sperm (26.5%). However, this latter group accounts for only 19% of FF events. The fertilization rate per oocyte (FR) follows an inverse trend. FR was correlated with the final (i.e. after swim-up) sperm count and with initial and Final motility of the sperm sample. If the final count and motility were <2 x 10 6 /ml and 40% respectively, the FF frequency in the group with partner's spermatozoa was significantly higher and FR significantly lower. FR was inversely correlated with the number of oocytes recovered but FF was found significantly more frequently only when fewer than three eggs were retrieved. No correlation was found between FF and either female causes of infertility, age or dosage of stimulation treatment. However, in the group with donor spermatozoa the FR was significantly lower amongst tubal, endocrinopathic and endometriotic patients (67.6, 67.2 and 56.6 respectively versus 79.7% in harvests from idiopathic cases). FR was decreased and FF increased when ovulation induction resulted from a spontaneous LH peak supplemented with human chorionic gonadotropin (HCG), as compared to induction by HCG alone. In the group using normal or mildly defective spermatozoa, if FF occurs at the first attempt, the frequency of recurrence in further trials is high (29%) and the probability of pregnancy after completed trials is low (12.5%). In the group with donor spermatozoa this recurrence rate is lower (14.3%) and the pregnancy rate remains unmodified (31.2%) as compared to cases without any FF amongst other trials.

Research paper thumbnail of Predictive value of classical and automated sperm analysis for in-vitro fertilization

Human Reproduction, 1991

The fertilization rates observed in 122 attempts at in-vitro fertilization were examined in relat... more The fertilization rates observed in 122 attempts at in-vitro fertilization were examined in relation to sperm characteristics assessed by visual and automated screening. Using linear regression analysis, a significant correlation was found between the fertilization rate and (i) evaluations in fresh semen sperm concentration, percentages of sperm motility, vitality and normal morphology and velocity, (ii) measurements in swim-up preparations of percentages of sperm motility, vitality and morphology, velocity and amplitude of lateral head displacement. No significant correlation was found between the fertilization rate and any of the parameters studied in 24-h-old swim-up suspensions. Analysis by multiple variable stepwise linear regression showed an optimal correlation (R6 = 0.62) between the observed fertilization rate and theoretical calculation obtained from the following predictive function: fertilization rate = -0.3 + (0.008 x swim-up motility) + (0.004 x normal sperm morphology in fresh semen). Introduction of kinematic characteristics studied by automated screening improved the multiple correlation between the calculated and observed fertilization rate in cases of normal or mildly defective semen. Because of the limited availability of motile spermatozoa, automated analysis could not supersede classical sperm analysis in cases of more severe sperm defects.

Research paper thumbnail of How do cumulative live birth rates and cumulative multiple live birth rates over complete courses of assisted reproductive technology treatment per woman compare among registries?

Human Reproduction, 2015

How do the national cumulative (multiple) live birth rates over complete assisted reproduction te... more How do the national cumulative (multiple) live birth rates over complete assisted reproduction technology (ART) courses of treatment per woman in Belgium compare to those in other registries? summary answer: Cumulative live birth rates (CLBRs) remain high with a low cumulative multiple live birth rate when compared with other registries and publications. what is known already: In ART, a reduction in the multiple live birth rate could be achieved by reducing the number of embryos transferred. It has been shown that by doing so, live birth rates per cycle were maintained, particularly when the augmentation effect of attached frozen-thawed cycles was considered. study design, size, duration: A retrospective cohort study included all patients with a Belgian national insurance number who were registered in the national ART registry (Belrap) and who started a first fresh ART cycle between 1 July 2009 until 31 December 2011 with follow up until 31 December 2012. We analysed 12 869 patients and 38 008 cycles (both fresh and attached frozen cycles). participants, materials, settings, methods: CLBRs per patient who started a first ART cycle including fresh and consecutive frozen cycles leading to a live birth. Conservative estimates of cumulative live birth assumed that patients who did not return for treatment had no chance of achieving an ART-related live birth, whereas optimal estimates assumed that women discontinuing treatment would have the same chance of achieving a live birth as those continuing treatment. A maximum of six fresh ART cycles with corresponding frozen cycles was investigated and compared with other registries and publications. main results and role of chance: The CLBR was age dependent and declined from 62.9% for women ,35 years, to 51.4% for women 35-37 years, to 34.1% for women 38-40 years and 17.7% for women 41-42 years in the conservative analysis after six cycles. In the optimal estimate, the CLBR declined from 85.9% for women ,35 years, to 72.0% for women 35-37 years, to 50.4% for women 38-40 years and 36.4% for women 41-42 years. The cumulative multiple live birth rates for the whole population were 5.1 and 8.6% for the conservative and optimal estimate, respectively. limitations, reasons for caution: Conservative and optimal estimates use assumptions for the whole ART population and do not take the individual patient into account.

Research paper thumbnail of Eiceldonatie: medische en psychologische evaluatie van eiceldonor en gevolgen voor haar gezondheid

Research paper thumbnail of A qualitative systematic review of coasting, a procedure to avoid ovarian hyperstimulation syndrome in IVF patients

Human Reproduction Update, 2002

Coasting', a method which consists of stopping exogenous gonadotrophins and postponing HCG admini... more Coasting', a method which consists of stopping exogenous gonadotrophins and postponing HCG administration until the patient's serum estradiol (E 2) level decreases, is often used to prevent ovarian hyperstimulation syndrome (OHSS). We conducted a systematic review to analyse whether there is suf®cient evidence to justify the general acceptance of coasting. The studies, which involved 493 patients in 12 studies, are very heterogeneous in the characteristics and number of patients in the ovulation stimulation schemes. The study designs, control groups, selection criteria for coasting and the OHSS classi®cations were variable. In most studies a threshold value of E 2 was used (often 3000 pg/ml) and/or the number of follicles were considered. The fertilization rates (36.7±71%) and the pregnancy rates (20±57%) were acceptable in terms of IVF results in comparison with those of other large IVF databanks. In 16% of the cycles, ascites was described and 2.5% of the patients required hospitalization. In conclusion, while coasting does not avoid totally the risk of OHSS, it decreases its incidence in high-risk patients. Many questions remain unanswered about how coasting should be managed, and we suggest that a randomized prospective multicentre study is required.

Research paper thumbnail of Review of clinical course and treatment of ovarian hyperstimulation syndrome (OHSS)

Human Reproduction Update, 2003

The ovarian hyperstimulation syndrome (OHSS) is a rare iatrogenic complication of ovarian stimula... more The ovarian hyperstimulation syndrome (OHSS) is a rare iatrogenic complication of ovarian stimulation occurring during the luteal phase or during early pregnancy. This complication is unusual as it is not the consequence of a treatment which is vital or mandatory for the patient's health. Nevertheless, it can be accompanied by severe morbidity and may even be fatal. Data pertaining to the clinical course and consequences of OHSS in women and its treatment were searched using Medline, Current Contents and PubMed. To date, only a few studies have collected a large number of cases of OHSS. The clinical course of OHSS may involve, according to its severity and the occurrence of pregnancy, electrolytic imbalance, neurohormonal and haemodynamic changes, pulmonary manifestations, liver dysfunction, hypoglobulinaemia, febrile morbidity, thromboembolic phenomena, neurological manifestations and adnexal torsion. Treatment of the acute phase relies only on an empirical and symptomatic approach. The general approach will be adapted to the levels of severity. Speci®c approaches such as paracentesis, pleural puncture, surgical approach of OHSS and speci®c medication during OHSS were evaluated sporadically. More adequate treatment methods would require a better understanding of the underlying pathophysiological mechanisms, to promote an aetiological therapeutic approach. Properly conducted studies, including large numbers of patients are required in order to determine the best method of prevention and management.

Research paper thumbnail of Metabolic characteristics of women who developed ovarian hyperstimulation syndrome

Human Reproduction, 2002

BACKGROUND: The aim of this study was to investigate whether a higher incidence of hyperinsulinis... more BACKGROUND: The aim of this study was to investigate whether a higher incidence of hyperinsulinism is found in women who have suffered from ovarian hyperstimulation syndrome (OHSS) as compared with other IVF patients. Additionally, we also assessed whether any abnormalities in the haemostatic system were more frequent in women with a past history of OHSS. METHODS: A pilot study was carried out involving OHSS patients and matched IVF patients. Homeostasis model assessment (HOMA) of insulin sensitivity was calculated. The main outcome measures were: insulin sensitivity, coagulation anomalies, factor V Leiden mutations, methylene tetrahydrofolate reductase (MTHFR) polymorphism and prothrombin gene mutation, protein C and protein S deficiency. RESULTS: No increased incidence in hyperinsulism nor in abnormalities of the haemostatic system were observed. CONCLUSIONS: This pilot study does not provide evidence for an increased prevalence of hyperinsulinism among women who have developed OHSS in the past.

Research paper thumbnail of Acceptance by Belgian physicians of in-vitro fertilization treatment in women with HIV infection

AIDS, 2002

SCOPUS: le.jinfo:eu-repo/semantics/publishe

Research paper thumbnail of Outcome of conventional IVF and ICSI on sibling oocytes in mild male factor infertility

Human Reproduction, 2002

BACKGROUND: Decisions concerning the treatment choice for assisted reproduction (IVF or ICSI) are... more BACKGROUND: Decisions concerning the treatment choice for assisted reproduction (IVF or ICSI) are usually made after the evaluation of male fertility factors, or after taking into account the results of previous IVF attempts. There are no widely accepted criteria, so decisions for couples with male subfertility are often empirical and may lead to complete fertilization failure after IVF, or to the unnecessary use of ICSI. METHODS: A study was conducted in which half the oocytes from each of 58 couples with moderate oligo ⍨ astheno ⍨ teratozoospermia were inseminated (conventional IVF) and the other half microinjected (ICSI). The technique used for subsequent cycles depended on the results of the first cycle. RESULTS: Nineteen of the 58 IVF/ICSI attempts resulted in fertilization after ICSI only (32.8%) and 39 in fertilization after IVF and ICSI (67.2%). For patients with oocyte fertilization only after ICSI, 61.5% of the oocytes microinjected were fertilized. A mean of 2.2 embryos per patient were transferred, leading to eight clinical pregnancies (42.1%).The implantation rate was 21.4%. All subsequent cycles were carried out with ICSI. Couples with oocyte fertilization after both IVF and ICSI had slightly better semen characteristics than those with oocyte fertilization only after ICSI, but this difference was not significant. Overall, no statistically significant difference was observed between IVF and ICSI in sibling oocytes for any of the variables studied: fertilization rate, embryo morphology and rates of development, pregnancy and implantation. Although only small numbers of oocytes or embryos were available for each couple, six couples had lower fertilization rates after IVF and eight had lower embryo quality after IVF. Eight patients had lower sperm quality in the second cycle, and only seven couples underwent subsequent IVF cycles. CONCLUSIONS: This strategy enabled us to avoid 32.8% of complete fertilization failures after IVF, but not to decrease significantly the number of ICSI attempts in subsequent cycles. However, the uncertainties concerning the safety of ICSI suggest that ICSI should be used cautiously and judiciously.

Research paper thumbnail of Impact of luteal phase support with vaginal progesterone on the clinical pregnancy rate in intrauterine insemination cycles stimulated with gonadotropins: a randomized multicenter study

Fertility and Sterility, 2016

Objective: To evaluate the effect of luteal phase support (LPS) in intrauterine insemination (IUI... more Objective: To evaluate the effect of luteal phase support (LPS) in intrauterine insemination (IUI) cycles stimulated with gonadotropins. Design: Randomized multicenter trial. Setting: Academic tertiary care centers and affiliated secondary care centers. Patient(s): Three hundred and ninety-three normo-ovulatory patients, <43 years, with body mass index %30 kg/m 2 , in their first IUI cycle, with at least one patent tube, a normal uterine cavity, and a male partner with total motile sperm count R5 million after capacitation. Intervention(s): Gonadotropin stimulation, IUI, randomization to LPS using vaginal progesterone gel (n ¼ 202) or no LPS (n ¼ 191). Main Outcome Measure(s): Clinical pregnancy rate, live-birth rate, miscarriage rate, and duration of the luteal phase. Result(s): The primary outcome, the clinical pregnancy rate, was not statistically different between the treatment group (16.8%) and the control group (11%) (relative risk [RR] 1.54; 95% confidence interval [CI], 0.89-2.67). Similarly, the secondary outcome, the livebirth rate, was 14.9% in the treatment group and 9.4% in the control group (RR 1.60; 95% CI, 0.89-2.87). The mean duration of the luteal phase was about 2 days longer in the treatment group (16.6 AE 2.2 days) compared with the control group (14.6 AE 2.5 days) (mean difference 2.07; 95% CI, 1.58-2.56). Conclusion(s): Although a trend toward a higher clinical pregnancy rate as well as live-birth rate was observed in the treatment group, the difference with the control group was not statistically significant.

Research paper thumbnail of Are there predictive criteria of complicated ovarian hyperstimulation in IVF?

Human Reproduction, 1991

Among 599 trials of in-vitro fertilization (TVF) treatment, complicated ovarian hyperstimulation ... more Among 599 trials of in-vitro fertilization (TVF) treatment, complicated ovarian hyperstimulation (OHSS) was diagnosed in 14 cases (2.5%) on the basis of heavy abdominal discomfort and echographic findings (ascites, ovarian enlargement with cysts). Among eight hospitalized patients, four presented with a haemoconcentration and/or electrolytic disturbances. OHSS cases were compared with two control groups for a series of criteria: age, aetiology of infertility, total dose of human menopausal gonadotrophin (HMG), day of oocyte collection, oestradiol (E2) peak level, rate of E2 increase, number of oocytes, number of embryos transferred and embryonic vitality scores. Comparison with a random group of normal IVF trials showed a significant difference for the following parameters: E2 peak level and rate of increase, E^/dose of HMG, EVday of egg collection and number of oocytes. When OHSS cases were compared to another control group consisting only of high E2 responders (peak E2 > 2700 pg/ml), no significant difference was found for any of the above-mentioned criteria. In view of this lack of predictive power of individual criteria, stepwise discriminant analysis was applied, showing that this method might provide a predictive mathematical function for evaluating the risk of OHSS before human chorionic gonadotrophin (HCG) administration. Such a formula, however, should be validated by a multicentric study in which a greater number of OHSS cases would be tested.

Research paper thumbnail of Fertility treatment in HIV needs multidisciplinary team

Research paper thumbnail of Oocyte quality and IVF outcome after coasting to prevent ovarian hyperstimulation syndrome

International journal of fertility and women's medicine

To evaluate, in a large cohort of patients, oocyte quality and IVF outcome after coasting used to... more To evaluate, in a large cohort of patients, oocyte quality and IVF outcome after coasting used to prevent ovarian hyperstimulation. Retrospective study. IVF cycles which had reached estradiol serum levels of at least 4,000 pg/mL without being coasted (control group, n = 208), or where coasting was applied (coasted group, n = 157). IVF data of coasted cycles were compared with the control group. Within the group of coasted cycles, we also analyzed whether indirect parameters related to coasting had an effect on IVF results. Coasted patients showed higher maximum estradiol levels and greater numbers of large follicles than the control group, but lower oocyte recovery rates. There were no other significant differences between the two groups of patients. Within the group of coasted patients, no significant relation was found between the number of days of coasting, the estradiol level on the day of hCG, or the fall in estradiol and the outcome, whether measured in terms of oocyte quality...

Research paper thumbnail of Systematic review of data concerning etiopathology of ovarian hyperstimulation syndrome

International journal of fertility and women's medicine

The ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of ovarian stimulation... more The ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of ovarian stimulation occurring during the luteal phase or early pregnancy. It has been observed over the last 60 years, since gonadotropins were first used to induce ovulation. The prevalence varies, according to study, from 0.5% to 5%. The pathogenesis of OHSS is, apparently, complex. It involves a vasoactive mediator, secreted by the ovaries (in overabundance) after artificial stimulation. Estradiol, which is a marker of ovarian response, is not the mediator. The candidate mediators reviewed are prolactin and prostaglandins; the ovarian prorenin-renin-angiotensin system; cytokines (including allergy-cytokines-histamine as a system); VEGF; angiogenin; the Kinin-Kallikrein system; VCAM and ICAM; selectins; von Willebrand factor; and endothelin. The main conclusion is that OHSS is the result of disturbance of the basically inflammation-like normal ovulation process, and has as its main feature capillary leak...

Research paper thumbnail of Unpredictable cases of complicated ovarian hyperstimulation in IVF

International journal of fertility and women's medicine

To characterize a subpopulation of complicated cases of ovarian hyperstimulation syndrome (OHSS).... more To characterize a subpopulation of complicated cases of ovarian hyperstimulation syndrome (OHSS). Descriptive retrospective study. 0.75% of our IVF-ET population suffered from OHSS. Among this group, 33% did not exhibit any recognized risk criteria of OHSS in terms of infertility characteristics and ovarian response to exogenous gonadotrophins. Only severe (ascites) OHSS cases were considered (n = 5) in this study. Previous IVF-ET attempts had been uneventful and during the complicated trial, estradiol peak levels and numbers of oocytes retrieved remained below 2,500 pg/mL (conversion factor to SI unit, 3.671) and 10, respectively. In all cases, the luteal phase was supplemented by hCG and all patients became pregnant. A threshold level of exogenous and/or endogenous hCG seems to be responsible for the occurrence of OHSS. One-third of the patients developing an ovarian hyperstimulation syndrome after IVF-ET had not previously shown risk criteria. A causal role of exogenous and/or en...

Research paper thumbnail of Laser zona thinning improves implantation rates in patients with repeated IVF failures

International journal of fertility and women's medicine, 2008

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Research paper thumbnail of Les fausses couches à répétition: consensus du GGOLFB

info:eu-repo/semantics/publishe

Research paper thumbnail of Ce que dit la loi

Research paper thumbnail of Prise en charge de première intention du couple infertile

info:eu-repo/semantics/publishe

Research paper thumbnail of In vitro fertilization when men, women, or both partners are positive for HIV: a case–control study

Archives of Gynecology and Obstetrics, 2017

The aim of this study was to compare the outcomes of in vitro fertilization (IVF) for couples whe... more The aim of this study was to compare the outcomes of in vitro fertilization (IVF) for couples where one or both partners were positive for the human immunodeficiency virus (HIV) to matched control couples. Methods A matched case-control retrospective study was performed. Data for 104 couples where the woman was HIV-positive; for 90 couples where the man was HIVpositive; and for 33 couples where both partners were HIVpositive were prospectively analyzed in comparison to matched controls treated in our center during the same period. The main outcomes were clinical pregnancy and live birth rates. Results For couples involving an HIV-positive man, clinical outcomes were comparable to controls and resulted in the birth of 18 healthy babies after 90 cycles. When the woman was affected, cycle cancelation, number of retrieved oocytes, and ongoing clinical pregnancy rates per transfer were statistically reduced. Implantation rates were comparable to those of non-affected controls. Seven healthy babies for 104 cycles were obtained. For a couple in which both partners were HIV-positive, only one healthy birth occurred after 33 cycles. Pregnancy rates were systematically reduced though not significantly probably due to sample size. Conclusions Our data suggest that IVF outcomes were similar to controls when men were HIV-positive and remain acceptable when women were HIV-positive. IVF outcomes were severely reduced in our sero-concordant couples; however, many patients had severe HIV disease previously, and therefore, these results should be reassessed in patients treated early in their disease. Keywords Assisted reproductive technology Á In vitro fertilization Á Human immunodeficiency virus Á Casematched study Á Infertility Pauline Vankerkem and Yannick Manigart shared first authorship.

Research paper thumbnail of Fertilization failure in IVF: why and what next?

Human Reproduction, 1990

Among 297 couples who underwent 587 oocyte collection procedures, 95 (16%) total fertilization fa... more Among 297 couples who underwent 587 oocyte collection procedures, 95 (16%) total fertilization failures (FT) were observed. This frequency is similar in couples with either normal or only mildly deficient spermatozoa (16.2 and 13.7% respectively) but is almost doubled in cases of moderately and severely defective sperm (26.5%). However, this latter group accounts for only 19% of FF events. The fertilization rate per oocyte (FR) follows an inverse trend. FR was correlated with the final (i.e. after swim-up) sperm count and with initial and Final motility of the sperm sample. If the final count and motility were <2 x 10 6 /ml and 40% respectively, the FF frequency in the group with partner's spermatozoa was significantly higher and FR significantly lower. FR was inversely correlated with the number of oocytes recovered but FF was found significantly more frequently only when fewer than three eggs were retrieved. No correlation was found between FF and either female causes of infertility, age or dosage of stimulation treatment. However, in the group with donor spermatozoa the FR was significantly lower amongst tubal, endocrinopathic and endometriotic patients (67.6, 67.2 and 56.6 respectively versus 79.7% in harvests from idiopathic cases). FR was decreased and FF increased when ovulation induction resulted from a spontaneous LH peak supplemented with human chorionic gonadotropin (HCG), as compared to induction by HCG alone. In the group using normal or mildly defective spermatozoa, if FF occurs at the first attempt, the frequency of recurrence in further trials is high (29%) and the probability of pregnancy after completed trials is low (12.5%). In the group with donor spermatozoa this recurrence rate is lower (14.3%) and the pregnancy rate remains unmodified (31.2%) as compared to cases without any FF amongst other trials.

Research paper thumbnail of Predictive value of classical and automated sperm analysis for in-vitro fertilization

Human Reproduction, 1991

The fertilization rates observed in 122 attempts at in-vitro fertilization were examined in relat... more The fertilization rates observed in 122 attempts at in-vitro fertilization were examined in relation to sperm characteristics assessed by visual and automated screening. Using linear regression analysis, a significant correlation was found between the fertilization rate and (i) evaluations in fresh semen sperm concentration, percentages of sperm motility, vitality and normal morphology and velocity, (ii) measurements in swim-up preparations of percentages of sperm motility, vitality and morphology, velocity and amplitude of lateral head displacement. No significant correlation was found between the fertilization rate and any of the parameters studied in 24-h-old swim-up suspensions. Analysis by multiple variable stepwise linear regression showed an optimal correlation (R6 = 0.62) between the observed fertilization rate and theoretical calculation obtained from the following predictive function: fertilization rate = -0.3 + (0.008 x swim-up motility) + (0.004 x normal sperm morphology in fresh semen). Introduction of kinematic characteristics studied by automated screening improved the multiple correlation between the calculated and observed fertilization rate in cases of normal or mildly defective semen. Because of the limited availability of motile spermatozoa, automated analysis could not supersede classical sperm analysis in cases of more severe sperm defects.

Research paper thumbnail of How do cumulative live birth rates and cumulative multiple live birth rates over complete courses of assisted reproductive technology treatment per woman compare among registries?

Human Reproduction, 2015

How do the national cumulative (multiple) live birth rates over complete assisted reproduction te... more How do the national cumulative (multiple) live birth rates over complete assisted reproduction technology (ART) courses of treatment per woman in Belgium compare to those in other registries? summary answer: Cumulative live birth rates (CLBRs) remain high with a low cumulative multiple live birth rate when compared with other registries and publications. what is known already: In ART, a reduction in the multiple live birth rate could be achieved by reducing the number of embryos transferred. It has been shown that by doing so, live birth rates per cycle were maintained, particularly when the augmentation effect of attached frozen-thawed cycles was considered. study design, size, duration: A retrospective cohort study included all patients with a Belgian national insurance number who were registered in the national ART registry (Belrap) and who started a first fresh ART cycle between 1 July 2009 until 31 December 2011 with follow up until 31 December 2012. We analysed 12 869 patients and 38 008 cycles (both fresh and attached frozen cycles). participants, materials, settings, methods: CLBRs per patient who started a first ART cycle including fresh and consecutive frozen cycles leading to a live birth. Conservative estimates of cumulative live birth assumed that patients who did not return for treatment had no chance of achieving an ART-related live birth, whereas optimal estimates assumed that women discontinuing treatment would have the same chance of achieving a live birth as those continuing treatment. A maximum of six fresh ART cycles with corresponding frozen cycles was investigated and compared with other registries and publications. main results and role of chance: The CLBR was age dependent and declined from 62.9% for women ,35 years, to 51.4% for women 35-37 years, to 34.1% for women 38-40 years and 17.7% for women 41-42 years in the conservative analysis after six cycles. In the optimal estimate, the CLBR declined from 85.9% for women ,35 years, to 72.0% for women 35-37 years, to 50.4% for women 38-40 years and 36.4% for women 41-42 years. The cumulative multiple live birth rates for the whole population were 5.1 and 8.6% for the conservative and optimal estimate, respectively. limitations, reasons for caution: Conservative and optimal estimates use assumptions for the whole ART population and do not take the individual patient into account.

Research paper thumbnail of Eiceldonatie: medische en psychologische evaluatie van eiceldonor en gevolgen voor haar gezondheid

Research paper thumbnail of A qualitative systematic review of coasting, a procedure to avoid ovarian hyperstimulation syndrome in IVF patients

Human Reproduction Update, 2002

Coasting', a method which consists of stopping exogenous gonadotrophins and postponing HCG admini... more Coasting', a method which consists of stopping exogenous gonadotrophins and postponing HCG administration until the patient's serum estradiol (E 2) level decreases, is often used to prevent ovarian hyperstimulation syndrome (OHSS). We conducted a systematic review to analyse whether there is suf®cient evidence to justify the general acceptance of coasting. The studies, which involved 493 patients in 12 studies, are very heterogeneous in the characteristics and number of patients in the ovulation stimulation schemes. The study designs, control groups, selection criteria for coasting and the OHSS classi®cations were variable. In most studies a threshold value of E 2 was used (often 3000 pg/ml) and/or the number of follicles were considered. The fertilization rates (36.7±71%) and the pregnancy rates (20±57%) were acceptable in terms of IVF results in comparison with those of other large IVF databanks. In 16% of the cycles, ascites was described and 2.5% of the patients required hospitalization. In conclusion, while coasting does not avoid totally the risk of OHSS, it decreases its incidence in high-risk patients. Many questions remain unanswered about how coasting should be managed, and we suggest that a randomized prospective multicentre study is required.

Research paper thumbnail of Review of clinical course and treatment of ovarian hyperstimulation syndrome (OHSS)

Human Reproduction Update, 2003

The ovarian hyperstimulation syndrome (OHSS) is a rare iatrogenic complication of ovarian stimula... more The ovarian hyperstimulation syndrome (OHSS) is a rare iatrogenic complication of ovarian stimulation occurring during the luteal phase or during early pregnancy. This complication is unusual as it is not the consequence of a treatment which is vital or mandatory for the patient's health. Nevertheless, it can be accompanied by severe morbidity and may even be fatal. Data pertaining to the clinical course and consequences of OHSS in women and its treatment were searched using Medline, Current Contents and PubMed. To date, only a few studies have collected a large number of cases of OHSS. The clinical course of OHSS may involve, according to its severity and the occurrence of pregnancy, electrolytic imbalance, neurohormonal and haemodynamic changes, pulmonary manifestations, liver dysfunction, hypoglobulinaemia, febrile morbidity, thromboembolic phenomena, neurological manifestations and adnexal torsion. Treatment of the acute phase relies only on an empirical and symptomatic approach. The general approach will be adapted to the levels of severity. Speci®c approaches such as paracentesis, pleural puncture, surgical approach of OHSS and speci®c medication during OHSS were evaluated sporadically. More adequate treatment methods would require a better understanding of the underlying pathophysiological mechanisms, to promote an aetiological therapeutic approach. Properly conducted studies, including large numbers of patients are required in order to determine the best method of prevention and management.

Research paper thumbnail of Metabolic characteristics of women who developed ovarian hyperstimulation syndrome

Human Reproduction, 2002

BACKGROUND: The aim of this study was to investigate whether a higher incidence of hyperinsulinis... more BACKGROUND: The aim of this study was to investigate whether a higher incidence of hyperinsulinism is found in women who have suffered from ovarian hyperstimulation syndrome (OHSS) as compared with other IVF patients. Additionally, we also assessed whether any abnormalities in the haemostatic system were more frequent in women with a past history of OHSS. METHODS: A pilot study was carried out involving OHSS patients and matched IVF patients. Homeostasis model assessment (HOMA) of insulin sensitivity was calculated. The main outcome measures were: insulin sensitivity, coagulation anomalies, factor V Leiden mutations, methylene tetrahydrofolate reductase (MTHFR) polymorphism and prothrombin gene mutation, protein C and protein S deficiency. RESULTS: No increased incidence in hyperinsulism nor in abnormalities of the haemostatic system were observed. CONCLUSIONS: This pilot study does not provide evidence for an increased prevalence of hyperinsulinism among women who have developed OHSS in the past.

Research paper thumbnail of Acceptance by Belgian physicians of in-vitro fertilization treatment in women with HIV infection

AIDS, 2002

SCOPUS: le.jinfo:eu-repo/semantics/publishe

Research paper thumbnail of Outcome of conventional IVF and ICSI on sibling oocytes in mild male factor infertility

Human Reproduction, 2002

BACKGROUND: Decisions concerning the treatment choice for assisted reproduction (IVF or ICSI) are... more BACKGROUND: Decisions concerning the treatment choice for assisted reproduction (IVF or ICSI) are usually made after the evaluation of male fertility factors, or after taking into account the results of previous IVF attempts. There are no widely accepted criteria, so decisions for couples with male subfertility are often empirical and may lead to complete fertilization failure after IVF, or to the unnecessary use of ICSI. METHODS: A study was conducted in which half the oocytes from each of 58 couples with moderate oligo ⍨ astheno ⍨ teratozoospermia were inseminated (conventional IVF) and the other half microinjected (ICSI). The technique used for subsequent cycles depended on the results of the first cycle. RESULTS: Nineteen of the 58 IVF/ICSI attempts resulted in fertilization after ICSI only (32.8%) and 39 in fertilization after IVF and ICSI (67.2%). For patients with oocyte fertilization only after ICSI, 61.5% of the oocytes microinjected were fertilized. A mean of 2.2 embryos per patient were transferred, leading to eight clinical pregnancies (42.1%).The implantation rate was 21.4%. All subsequent cycles were carried out with ICSI. Couples with oocyte fertilization after both IVF and ICSI had slightly better semen characteristics than those with oocyte fertilization only after ICSI, but this difference was not significant. Overall, no statistically significant difference was observed between IVF and ICSI in sibling oocytes for any of the variables studied: fertilization rate, embryo morphology and rates of development, pregnancy and implantation. Although only small numbers of oocytes or embryos were available for each couple, six couples had lower fertilization rates after IVF and eight had lower embryo quality after IVF. Eight patients had lower sperm quality in the second cycle, and only seven couples underwent subsequent IVF cycles. CONCLUSIONS: This strategy enabled us to avoid 32.8% of complete fertilization failures after IVF, but not to decrease significantly the number of ICSI attempts in subsequent cycles. However, the uncertainties concerning the safety of ICSI suggest that ICSI should be used cautiously and judiciously.

Research paper thumbnail of Impact of luteal phase support with vaginal progesterone on the clinical pregnancy rate in intrauterine insemination cycles stimulated with gonadotropins: a randomized multicenter study

Fertility and Sterility, 2016

Objective: To evaluate the effect of luteal phase support (LPS) in intrauterine insemination (IUI... more Objective: To evaluate the effect of luteal phase support (LPS) in intrauterine insemination (IUI) cycles stimulated with gonadotropins. Design: Randomized multicenter trial. Setting: Academic tertiary care centers and affiliated secondary care centers. Patient(s): Three hundred and ninety-three normo-ovulatory patients, <43 years, with body mass index %30 kg/m 2 , in their first IUI cycle, with at least one patent tube, a normal uterine cavity, and a male partner with total motile sperm count R5 million after capacitation. Intervention(s): Gonadotropin stimulation, IUI, randomization to LPS using vaginal progesterone gel (n ¼ 202) or no LPS (n ¼ 191). Main Outcome Measure(s): Clinical pregnancy rate, live-birth rate, miscarriage rate, and duration of the luteal phase. Result(s): The primary outcome, the clinical pregnancy rate, was not statistically different between the treatment group (16.8%) and the control group (11%) (relative risk [RR] 1.54; 95% confidence interval [CI], 0.89-2.67). Similarly, the secondary outcome, the livebirth rate, was 14.9% in the treatment group and 9.4% in the control group (RR 1.60; 95% CI, 0.89-2.87). The mean duration of the luteal phase was about 2 days longer in the treatment group (16.6 AE 2.2 days) compared with the control group (14.6 AE 2.5 days) (mean difference 2.07; 95% CI, 1.58-2.56). Conclusion(s): Although a trend toward a higher clinical pregnancy rate as well as live-birth rate was observed in the treatment group, the difference with the control group was not statistically significant.

Research paper thumbnail of Are there predictive criteria of complicated ovarian hyperstimulation in IVF?

Human Reproduction, 1991

Among 599 trials of in-vitro fertilization (TVF) treatment, complicated ovarian hyperstimulation ... more Among 599 trials of in-vitro fertilization (TVF) treatment, complicated ovarian hyperstimulation (OHSS) was diagnosed in 14 cases (2.5%) on the basis of heavy abdominal discomfort and echographic findings (ascites, ovarian enlargement with cysts). Among eight hospitalized patients, four presented with a haemoconcentration and/or electrolytic disturbances. OHSS cases were compared with two control groups for a series of criteria: age, aetiology of infertility, total dose of human menopausal gonadotrophin (HMG), day of oocyte collection, oestradiol (E2) peak level, rate of E2 increase, number of oocytes, number of embryos transferred and embryonic vitality scores. Comparison with a random group of normal IVF trials showed a significant difference for the following parameters: E2 peak level and rate of increase, E^/dose of HMG, EVday of egg collection and number of oocytes. When OHSS cases were compared to another control group consisting only of high E2 responders (peak E2 > 2700 pg/ml), no significant difference was found for any of the above-mentioned criteria. In view of this lack of predictive power of individual criteria, stepwise discriminant analysis was applied, showing that this method might provide a predictive mathematical function for evaluating the risk of OHSS before human chorionic gonadotrophin (HCG) administration. Such a formula, however, should be validated by a multicentric study in which a greater number of OHSS cases would be tested.

Research paper thumbnail of Fertility treatment in HIV needs multidisciplinary team

Research paper thumbnail of Oocyte quality and IVF outcome after coasting to prevent ovarian hyperstimulation syndrome

International journal of fertility and women's medicine

To evaluate, in a large cohort of patients, oocyte quality and IVF outcome after coasting used to... more To evaluate, in a large cohort of patients, oocyte quality and IVF outcome after coasting used to prevent ovarian hyperstimulation. Retrospective study. IVF cycles which had reached estradiol serum levels of at least 4,000 pg/mL without being coasted (control group, n = 208), or where coasting was applied (coasted group, n = 157). IVF data of coasted cycles were compared with the control group. Within the group of coasted cycles, we also analyzed whether indirect parameters related to coasting had an effect on IVF results. Coasted patients showed higher maximum estradiol levels and greater numbers of large follicles than the control group, but lower oocyte recovery rates. There were no other significant differences between the two groups of patients. Within the group of coasted patients, no significant relation was found between the number of days of coasting, the estradiol level on the day of hCG, or the fall in estradiol and the outcome, whether measured in terms of oocyte quality...

Research paper thumbnail of Systematic review of data concerning etiopathology of ovarian hyperstimulation syndrome

International journal of fertility and women's medicine

The ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of ovarian stimulation... more The ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of ovarian stimulation occurring during the luteal phase or early pregnancy. It has been observed over the last 60 years, since gonadotropins were first used to induce ovulation. The prevalence varies, according to study, from 0.5% to 5%. The pathogenesis of OHSS is, apparently, complex. It involves a vasoactive mediator, secreted by the ovaries (in overabundance) after artificial stimulation. Estradiol, which is a marker of ovarian response, is not the mediator. The candidate mediators reviewed are prolactin and prostaglandins; the ovarian prorenin-renin-angiotensin system; cytokines (including allergy-cytokines-histamine as a system); VEGF; angiogenin; the Kinin-Kallikrein system; VCAM and ICAM; selectins; von Willebrand factor; and endothelin. The main conclusion is that OHSS is the result of disturbance of the basically inflammation-like normal ovulation process, and has as its main feature capillary leak...

Research paper thumbnail of Unpredictable cases of complicated ovarian hyperstimulation in IVF

International journal of fertility and women's medicine

To characterize a subpopulation of complicated cases of ovarian hyperstimulation syndrome (OHSS).... more To characterize a subpopulation of complicated cases of ovarian hyperstimulation syndrome (OHSS). Descriptive retrospective study. 0.75% of our IVF-ET population suffered from OHSS. Among this group, 33% did not exhibit any recognized risk criteria of OHSS in terms of infertility characteristics and ovarian response to exogenous gonadotrophins. Only severe (ascites) OHSS cases were considered (n = 5) in this study. Previous IVF-ET attempts had been uneventful and during the complicated trial, estradiol peak levels and numbers of oocytes retrieved remained below 2,500 pg/mL (conversion factor to SI unit, 3.671) and 10, respectively. In all cases, the luteal phase was supplemented by hCG and all patients became pregnant. A threshold level of exogenous and/or endogenous hCG seems to be responsible for the occurrence of OHSS. One-third of the patients developing an ovarian hyperstimulation syndrome after IVF-ET had not previously shown risk criteria. A causal role of exogenous and/or en...