Browse

You are looking at 1 - 10 of 186 items for

Francesca Hearn-Yeates F Hearn-Yeates, Centre for Reproductive Health, The University of Edinburgh, Edinburgh, United Kingdom of Great Britain and Northern Ireland

Search for other papers by Francesca Hearn-Yeates in
Google Scholar
PubMed
Close
,
Andrew W Horne A Horne, Centre for Reproductive Health, The University of Edinburgh, Edinburgh, United Kingdom of Great Britain and Northern Ireland

Search for other papers by Andrew W Horne in
Google Scholar
PubMed
Close
,
Siobhain O’Mahony S O’Mahony, Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland

Search for other papers by Siobhain O’Mahony in
Google Scholar
PubMed
Close
, and
Philippa T K Saunders P Saunders, Centre for Reproductive Health, The University of Edinburgh, Edinburgh, United Kingdom of Great Britain and Northern Ireland

Search for other papers by Philippa T K Saunders in
Google Scholar
PubMed
Close

Endometriosis is a chronic inflammatory condition affecting one in 10 women and those assigned female at birth, defined by the presence of endometrial-like tissue outside the uterus. It is commonly associated with pain, infertility, and mood disorders, and often comorbid with other chronic pain conditions, such as irritable bowel syndrome. Recent research has identified a key role for the microbiota-gut-brain axis in health and a range of inflammatory and neurological disorders, prompting an exploration of its potential mechanistic role in endometriosis. Increased awareness of the impact of the gut microbiota within the patient community, combined with the often-detrimental side effects of current therapies, has motivated many to utilise self-management strategies, such as dietary modification and supplements, despite a lack of robust clinical evidence. Current research has characterised the gut microbiota in endometriosis patients and animal models. However, small cohorts and differing methodology has resulted in little consensus in the data. In this narrative review, we summarise research studies that have investigated the role of gut microbiota and their metabolic products in the development and progression of endometriosis lesions, before summarising insights from research into co-morbid conditions and discussing the reported impact of self-management strategies on symptoms of endometriosis. Finally, we suggest ways in which this promising field of research could be expanded to explore the role of specific bacteria, improve access to ‘microbial’ phenotyping, and to develop personalised patient advice for reduction of symptoms such as chronic pain and bloating.

Open access
Kaltrina Krasniqi K Krasniqi, University of Warwick, Coventry, CV4 7AL, United Kingdom of Great Britain and Northern Ireland

Search for other papers by Kaltrina Krasniqi in
Google Scholar
PubMed
Close
,
Naomi Black N Black, University of Warwick, Coventry, United Kingdom of Great Britain and Northern Ireland

Search for other papers by Naomi Black in
Google Scholar
PubMed
Close
,
Erin Williams E Williams, R(D)SVS, The University of Edinburgh College of Medicine and Veterinary Medicine, Midlothian, EH25 9RG, United Kingdom of Great Britain and Northern Ireland

Search for other papers by Erin Williams in
Google Scholar
PubMed
Close
,
Osvaldo Bogado Pascottini O Bogado Pascottini, Ghent University, Merelbeke, B-9820, Belgium

Search for other papers by Osvaldo Bogado Pascottini in
Google Scholar
PubMed
Close
,
Sarah Thornton S Thornton, Hook Norton Veterinary Group, White Hill Surgery, Hook Norton, OX15 5DG, Hook Norton, United Kingdom of Great Britain and Northern Ireland

Search for other papers by Sarah Thornton in
Google Scholar
PubMed
Close
,
Siobhan Quenby S Quenby, Reproductive Health, University of Warwick , coventry, United Kingdom of Great Britain and Northern Ireland

Search for other papers by Siobhan Quenby in
Google Scholar
PubMed
Close
, and
Joshua Odendaal J Odendaal, University of Warwick, Coventry, United Kingdom of Great Britain and Northern Ireland

Search for other papers by Joshua Odendaal in
Google Scholar
PubMed
Close

Chronic endometritis (CE) in humans is asymptomatic inflammation of the endometrium, associated with poor reproductive outcomes. Similarly asymptomatic endometrial inflammation in cows, termed subclinical endometritis (SCE), is associated with adverse reproductive outcomes. While the pathophysiology and treatment options for CE in humans remains poorly defined, the financial implications of SCE in dairy cows mean it has been intensively researched. We performed a systematic review with an emergent theme thematic analysis of studies of SCE in cows, to determine potential areas of interest in human CE research. A literature search for studies of subclinical endometritis in cows published between 1990 and November 2021 was performed across Embase, Medline, Scopus and CINAHL. Studies of symptomatic or clinical endometritis were excluded. Thematic analysis across two broad themes were explored: diagnostic methods and pathophysiology of SCE. In total, 44 bovine studies were included. 12 studies reported on diagnostic methodology. The primary emergent theme was the use of cytology for the diagnosis of SCE. This method has a lower sensitivity than histopathology but is less invasive and more specific than alternative techniques of ultrasound, vaginoscopy, or metabolic markers. The subthemes related to pathophysiology were identified as type of endometritis, metabolic stress, artificial insemination, infective causes, and altered cellular pathways. Despite the lack of symptoms, cellular pathways of inflammation including NFkB, MAPK, and inflammasomes were found to be activated. The key themes related to the diagnosis and pathophysiology of SCE in cows identified in this systematic review highlight potential areas for future research into human CE.

Open access
R de Koning Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
Nederlandse Endometriose Kliniek, Reinier de Graaf Gasthuis, Delft, The Netherlands

Search for other papers by R de Koning in
Google Scholar
PubMed
Close
,
A E P Cantineau Department of Obstetrics and Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands

Search for other papers by A E P Cantineau in
Google Scholar
PubMed
Close
,
K van der Tuuk Department of Obstetrics and Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands

Search for other papers by K van der Tuuk in
Google Scholar
PubMed
Close
,
B De Bie Endometriosis Foundation of the Netherlands (Endometriose Stichting), Sittard, The Netherlands

Search for other papers by B De Bie in
Google Scholar
PubMed
Close
,
H Groen Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands

Search for other papers by H Groen in
Google Scholar
PubMed
Close
,
M E van den Akker-van Marle Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands

Search for other papers by M E van den Akker-van Marle in
Google Scholar
PubMed
Close
,
A W Nap Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands

Search for other papers by A W Nap in
Google Scholar
PubMed
Close
,
J W M Maas Department of Gynaecology and Grow-school of Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands

Search for other papers by J W M Maas in
Google Scholar
PubMed
Close
,
F W Jansen Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands

Search for other papers by F W Jansen in
Google Scholar
PubMed
Close
,
A R H Twijnstra Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands

Search for other papers by A R H Twijnstra in
Google Scholar
PubMed
Close
, and
M D Blikkendaal Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
Nederlandse Endometriose Kliniek, Reinier de Graaf Gasthuis, Delft, The Netherlands

Search for other papers by M D Blikkendaal in
Google Scholar
PubMed
Close

Currently, the optimal treatment to increase the chance of pregnancy and live births in patients with colorectal endometriosis and subfertility is unknown. Evidence suggests that that both surgery and in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) are effective in improving the live birth rate (LBR) among these women. However, the available evidence is of low quality, reports highly heterogeneous results, lacks direct comparison between both treatment options, and does not assess whether a combination strategy results in a higher LBR compared to IVF/ICSI-only treatment. Additionally, the optimal timing of surgery within the treatment trajectory remains unclear. The primary objective of the TOSCA study is to assess the effectiveness of surgical treatment (potentially combined with IVF/ICSI) compared to IVF-/ICSI-only treatment to increase the chance of an ongoing pregnancy resulting in a live birth in patients with colorectal endometriosis and subfertility, measured by cumulative LBR. Secondary objectives are to assess and compare quality of life and cost-effectiveness in both groups. Patients will be followed for 40 months after inclusion or until live birth. The TOSCA study is expected to be completed in 6 years.

Trial registration number

The TOSCA trial is registered as ‘Cost-Effectiveness of Surgical Excision of Colorectal Endometriosis Compared to ART Treatment Trajectory (TOSCA)’ in the Clinical Trials Register (NCT No. NCT05677269, https://clinicaltrials.gov/ct2/show/NCT05677269)

Date of first patient enrolment

The first patient was included in February 2023.

Lay summary

Treating bowel endometriosis in people with fertility problems is difficult, and at the moment, there is no consensus on the best way to increase the chances of pregnancy. This makes it hard for gynaecologists to advise people when to have either IVF/ICSI or surgery, particularly in patients with fewer pain symptoms, as the benefits of surgery to enhance fertility have to be balanced against the potential risk of side effects. Surgery can improve fertility and pain symptoms, but it may delay people trying to conceive which means the reserve of eggs in the ovaries will reduce with time. IVF/ICSI also seems a viable option, but having the surgery first may increase the chances of conception (both naturally and/or after IVF/ICSI). The TOSCA study aims to determine whether surgery for bowel endometriosis leads to an increased birth rate and better patient reported outcome measures compared to IVF/ICSI alone.

Open access
Maria Handzhiyska M Handzhiyska, Research Department, Nadezhda Women's Health Hospital, Sofia, Bulgaria

Search for other papers by Maria Handzhiyska in
Google Scholar
PubMed
Close
,
Rumiana Ganeva R Ganeva, Research Department, Nadezhda Women's Health Hospital, Sofia, Bulgaria

Search for other papers by Rumiana Ganeva in
Google Scholar
PubMed
Close
,
Dimitar Parvanov D Parvanov, Research and development, Nadezhda Women's Health Hospital, Sofia, Bulgaria

Search for other papers by Dimitar Parvanov in
Google Scholar
PubMed
Close
,
Margarita Ruseva M Ruseva, Research Department, Nadezhda Women's Health Hospital, Sofia, Bulgaria

Search for other papers by Margarita Ruseva in
Google Scholar
PubMed
Close
,
Petar Eftimov P Eftimov, Department of Cell and Developmental Biology, Sofia University St Kliment Ohridski, Sofia, Bulgaria

Search for other papers by Petar Eftimov in
Google Scholar
PubMed
Close
,
Vilyana Georgieva V Georgieva, Andrology Department, Nadezhda Women's Health Hospital, Sofia, Bulgaria

Search for other papers by Vilyana Georgieva in
Google Scholar
PubMed
Close
,
Denitsa Velikova D Velikova, Andrology Department, Nadezhda Women's Health Hospital, Sofia, Bulgaria

Search for other papers by Denitsa Velikova in
Google Scholar
PubMed
Close
, and
Georgi Stamenov G Stamenov, Obsterics and Gynecology Department, Nadezhda Women's Health Hospital, Sofia, Bulgaria

Search for other papers by Georgi Stamenov in
Google Scholar
PubMed
Close

The objective of this study was to compare the motility, morphology, and levels of DNA fragmentation of spermatozoa subjected to conventional swim-up or cumulus matrix (CM) sperm selection. Semen samples were collected from 60 normozoospermic men at a private hospital between December 2021 and March 2022. After liquefaction, semen samples were separated into two portions – one part was subjected to conventional swim-up preparation and the remaining spermatozoa were subjected to CM selection. The CM was obtained by mechanical isolation from healthy donor oocytes. Semen analysis and evaluation of sperm were performed according to WHO 6th Edition Laboratory Manual and Kruger’s strict criteria, respectively. Sperm DNA fragmentation (SDF, %) of the two preparations was evaluated using Halosperm G2 detection kit (Halotech, Madrid, Spain). Wilcoxon rank-sum test was used to compare the characteristics of spermatozoa obtained by the two preparations. Spermatozoa selected by CM showed significantly better rapidly progressive motility (43.5% vs. 30.6%, respectively, p<0.001), higher percentage of morphologically normal forms (14.0% vs. 9.0%, respectively, p<0.05), and lower levels of SDF (26.0% vs. 45.0%, p<0.05) in comparison to those prepared by conventional swim-up. Moreover, the incidence of multiple sperm defects was considerably lower in the samples that underwent CM selection compared to those that did not (30.0% vs. 49.0%, respectively, p<0.05).The selection by CM significantly increases sperm motility and reduces morphologically abnormal spermatozoa and DNA fragmentation rates in comparison to the conventional swim-up preparation. The application of this selection technique may increase chances of successful IVF outcomes.

Open access
Caitriona Brennan Department of Pediatrics, University of California San Diego, La Jolla, California, USA
Division of Biological Sciences, University of California San Diego, La Jolla, California, USA

Search for other papers by Caitriona Brennan in
Google Scholar
PubMed
Close
,
Kristina Chan Department of Pediatrics, University of California San Diego, La Jolla, California, USA
Department of Bioengineering, University of California, San Diego, La Jolla, California, USA

Search for other papers by Kristina Chan in
Google Scholar
PubMed
Close
,
Tanya Kumar Medical Scientist Training Program, University of California San Diego, La Jolla, California, USA

Search for other papers by Tanya Kumar in
Google Scholar
PubMed
Close
,
Erica Maissy Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
Biomedical Sciences Graduate Program, University of California San Diego, La Jolla, California, USA

Search for other papers by Erica Maissy in
Google Scholar
PubMed
Close
,
Linda Brubaker Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, California, USA

Search for other papers by Linda Brubaker in
Google Scholar
PubMed
Close
,
Marisol I Dothard Department of Pediatrics, University of California San Diego, La Jolla, California, USA
Biomedical Sciences Graduate Program, University of California San Diego, La Jolla, California, USA

Search for other papers by Marisol I Dothard in
Google Scholar
PubMed
Close
,
Jack A Gilbert Department of Pediatrics, University of California San Diego, La Jolla, California, USA
Center for Microbiome Innovation, University of California San Diego, La Jolla, California, USA

Search for other papers by Jack A Gilbert in
Google Scholar
PubMed
Close
,
Katharine E Gilbert Department of Pediatrics, University of California San Diego, La Jolla, California, USA

Search for other papers by Katharine E Gilbert in
Google Scholar
PubMed
Close
,
Amanda L Lewis Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, California, USA

Search for other papers by Amanda L Lewis in
Google Scholar
PubMed
Close
,
Varykina G Thackray Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, California, USA
Center for Microbiome Innovation, University of California San Diego, La Jolla, California, USA

Search for other papers by Varykina G Thackray in
Google Scholar
PubMed
Close
,
Amir Zarrinpar Department of Bioengineering, University of California, San Diego, La Jolla, California, USA
Medical Scientist Training Program, University of California San Diego, La Jolla, California, USA
Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, California, USA
Center for Microbiome Innovation, University of California San Diego, La Jolla, California, USA
Jennifer Moreno Department of Veterans Affairs Medical Center, La Jolla, California, USA
Institute of Diabetes and Metabolic Health, University of California San Diego, La Jolla, California, USA

Search for other papers by Amir Zarrinpar in
Google Scholar
PubMed
Close
, and
Rob Knight Department of Pediatrics, University of California San Diego, La Jolla, California, USA
Department of Bioengineering, University of California, San Diego, La Jolla, California, USA
Center for Microbiome Innovation, University of California San Diego, La Jolla, California, USA
Department of Computer Science and Engineering, University of California, San Diego, La Jolla, California, USA
Halıcıoğlu Data Science Institute, University of California San Diego, La Jolla, California, USA

Search for other papers by Rob Knight in
Google Scholar
PubMed
Close

Graphical abstract

Abstract

Although numerous studies have demonstrated the impact of microbiome manipulation on human health, research on the microbiome’s influence on female health remains relatively limited despite substantial disease burden. In light of this, we present a selected review of clinical trials and preclinical studies targeting both the vaginal and gut microbiomes for the prevention or treatment of various gynecologic conditions. Specifically, we explore studies that leverage microbiota transplants, probiotics, prebiotics, diet modifications, and engineered microbial strains. A healthy vaginal microbiome for females of reproductive age consists of lactic acid-producing bacteria predominantly of the Lactobacillus genus, which serves as a protective barrier against pathogens and maintains a balanced ecosystem. The gut microbiota’s production of short-chain fatty acids, metabolism of primary bile acids, and modulation of sex steroid levels have significant implications for the interplay between host and microbes throughout the body, ultimately impacting reproductive health. By harnessing interventions that modulate both the vaginal and gut microbiomes, it becomes possible to not only maintain homeostasis but also mitigate pathological conditions. While the field is still working toward making broad clinical recommendations, the current studies demonstrate that manipulating the microbiome holds great potential for addressing diverse gynecologic conditions.

Lay summary

Manipulating the microbiome has recently entered popular culture, with various diets thought to aid the microbes that live within us. These microbes live in different locations of our body and accordingly help us digest food, modulate our immune system, and influence reproductive health. The role of the microbes living in and influencing the female reproductive tract remains understudied despite known roles in common conditions such as vulvovaginal candidiasis (affecting 75% of females in their lifetime), bacterial vaginosis (25% of females in their lifetime), cervical HPV infection (80% of females in their lifetime), endometriosis (6–10% of females of reproductive age), and polycystic ovary syndrome (10–12% of females of reproductive age). Here, we review four different approaches used to manipulate the female reproductive tract and gastrointestinal system microbiomes: microbiota transplants, probiotics, prebiotics, and dietary interventions, and the use of engineered microbial strains. In doing so, we aim to stimulate discussion on new ways to understand and treat female reproductive health conditions.

Open access
Michael L Power Center for Species Survival, Smithsonian’s National Zoo and Conservation Biology Institute, Washington, District of Columbia, USA

Search for other papers by Michael L Power in
Google Scholar
PubMed
Close
,
Carly R Muletz-Wolz Center for Conservation Genomics, Smithsonian’s National Zoo and Conservation Biology Institute, Washington, District of Columbia, USA

Search for other papers by Carly R Muletz-Wolz in
Google Scholar
PubMed
Close
, and
Sally L Bornbusch Center for Conservation Genomics, Smithsonian’s National Zoo and Conservation Biology Institute, Washington, District of Columbia, USA
Department of Nutrition Science, Smithsonian’s National Zoo and Conservation Biology Institute, Washington, District of Columbia, USA

Search for other papers by Sally L Bornbusch in
Google Scholar
PubMed
Close

Graphical abstract

Abstract

Milk is an ancient, fundamental mammalian adaptation that provides nutrition and biochemical communication to offspring. Microbiomes have been detected in milk of all species studied to date. In this review, we discuss: (a) routes by which microbes may enter milk; (b) evidence for proposed milk microbiome adaptive functions; (c) variation in milk microbiomes across mammals; and (d) future research directions, including suggestions for how to address outstanding questions on the viability and functionality of milk microbiomes. Milk microbes may be sourced from the maternal gastrointestinal tract, oral, skin, and mammary gland microbiomes and from neonatal oral and skin microbiomes. Given the variety of microbial sources, stochastic processes strongly influence milk microbiome assembly, but milk microbiomes appear to be influenced by maternal evolutionary history, diet, environment, and milk nutrients. Milk microbes have been proposed to colonize the neonatal intestinal tract and produce gene and metabolic products that influence physiology, metabolism, and immune system development. Limited epidemiological data indicate that early-life exposure to milk microbes can result in positive, long-term health outcomes. Milk microbiomes can be modified by dietary changes including providing the mother with probiotics and prebiotics. Milk replacers (i.e. infant formula) may benefit from supplementation with probiotics and prebiotics, but data are lacking on probiotics’ usefulness, and supplementation should be evidence based. Overall, milk microbiome literature outside of human and model systems is scarce. We highlight the need for mechanistic studies in model species paired with comparative studies across mammals to further our understanding of mammalian milk microbiome evolution. A broader study of milk microbiomes has the potential to inform animal care with relevance to ex situ endangered species.

Lay summary

Milk is an ancient adaptation that supports the growth and development of mammalian neonates and infants. Beyond its fundamental nutritional function, milk influences all aspects of neonatal development, especially immune function. All kinds of milks so far studied have contained a milk microbiome. In this review, we focus on what is known about the collection of bacterial members found in milk microbiomes. Milk microbiomes include members sourced from maternal and infant microbiomes and they appear to be influenced by maternal evolutionary history, diet, milk nutrients, and environment, as well as by random chance. Once a neonate begins nursing, microbes from milk colonize their gut and produce byproducts that influence their physiology, metabolism, and immune development. Empirical data on milk microbiomes outside of humans and model systems are sparse. Greater study of milk microbiomes across mammals will expand our understanding of mammalian evolution and improve the health of animals under human care.

Open access

Oogonial stem cells: the unexpected superheroes

The time has come for stem cell technologies to be used in fertility studies

Rita L Sousa Gamete Research Centre, Department of Veterinary Sciences, University of Antwerp, Antwerp, Belgium

Search for other papers by Rita L Sousa in
Google Scholar
PubMed
Close
Open access
Shiuli Bhattacharyya UCL, Department of Medical School, London, UK

Search for other papers by Shiuli Bhattacharyya in
Google Scholar
PubMed
Close

The rights of transgender and intersex people have become a contentious issue in our current political climate. Whether it be the rights of intersex athletes such as Caster Semenya (who identifies as a woman) to compete in elite sport, or the rights of transgender women to use women’s only spaces, there is an increasingly fierce debate as to the legitimacy of people’s gender and sexual identities and what parameters should be used to define them. A common argument accepted by most in our society is that while gender may be a spectrum, sex is an inalienable binary.

Open access
Free access
Irene Gazzo Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI Department), University of Genoa, Genova, Italy
IRCCS Ospedale Policlinico San Martino, Genova, Italy

Search for other papers by Irene Gazzo in
Google Scholar
PubMed
Close
,
Francesca Bovis Department of Health Sciences, University of Genoa, Genova, Italy

Search for other papers by Francesca Bovis in
Google Scholar
PubMed
Close
,
Denise Colia Reproductive Medicine Unit, Ospedale Evangelico Internazionale, Genova, Italy

Search for other papers by Denise Colia in
Google Scholar
PubMed
Close
,
Fausta Sozzi Physiopathology of Human Reproduction Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy

Search for other papers by Fausta Sozzi in
Google Scholar
PubMed
Close
,
Mauro Costa Reproductive Medicine Unit, Ospedale Evangelico Internazionale, Genova, Italy

Search for other papers by Mauro Costa in
Google Scholar
PubMed
Close
,
Paola Anserini Physiopathology of Human Reproduction Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy

Search for other papers by Paola Anserini in
Google Scholar
PubMed
Close
, and
Claudia Massarotti Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI Department), University of Genoa, Genova, Italy
IRCCS Ospedale Policlinico San Martino, Genova, Italy

Search for other papers by Claudia Massarotti in
Google Scholar
PubMed
Close

In the registration trials, follitropin delta was compared with a fixed dose of 150 UI of follitropin alpha/beta, finding higher chances to reach a target response of 8–14 oocytes compared to controls. For this reason, follitropin delta is marketed as particularly useful in expected hyper-responder patients. The main outcome of this study is to report if comparable results are reached in a real-life scenario with follitropin alpha/beta doses chosen by the physician, based on patients’ characteristics. This is a retrospective study performed in two public fertility centres. All first cycles from January 2020 to June 2022 with either follitropin delta (cases) or alpha/beta (controls) in patients with anti-Müllerian hormone >2.5 ng/mL were compared by an inverse probability weighting approach based on propensity score. The follitropin total dose was higher in controls (1179.06 ± 344.93 vs 1668.67 ± 555.22 IU, P < 0.001). The target response of 8–14 oocytes was reached by 40.2% of cases and 40.7% of controls (odds ratio (OR): 0.99, 95% confidence interval (CI): 0.65–1.53, P = 0.98). Fewer than 8 oocytes were collected in 24.1% of cases and 22% of controls (OR: 1.10, 95% CI: 0.71–1.69, P = 0.67); more than 14 oocytes in 35.7% of cases and 37.3% of controls (OR: 0.83, 95% CI: 0.54–1.28, P = 0.40). Our experience did not find worse results in term of proportion of patients who reached the target response with an algorithm-chosen dose of follitropin delta compared to a personalised starting dose of follitropin alpha/beta, with follitropin delta having the advantage of objectivity. However, larger numbers are needed to confirm these results.

Lay summary

The starting dose of the drugs used to stimulate the ovaries in IVF (gonadotropins) is usually decided by the doctor, using their clinical experience and expertise and tailored to the individual patient. Recently one type of stimulating drug (follitropin delta) was marketed with an algorithm for deciding the starting dose based on the patient’s anti-Müllerian hormone (AMH) levels and weight. In the initial trials, it was compared with a fixed dose of standard follitropins (alpha/beta), and it was found to reduce the likelihood of an excessive response in patients at risk of ovarian hyperstimulation syndrome. We report on these results, in terms of number of eggs obtained, in patients with an expected high ovarian response, compared to doses of standard follitropins that were not fixed, but personalised, to see if this did not make a difference. We found similar results in the two groups, suggesting that using the algorithm to decide the dose of follitropin delta does not work less well than a personalised starting dose of follitropin alpha/beta, but has the advantage of being objective.

Open access