O-186 The implementation of a novel algorithm for monitoring ovulation in an IVF mixed protocol may simplify stimulation monitoring
Notice bibliographique
Résumé
Abstract Study question Which patients are eligible to skip ovulation monitoring before day 10 in In Vitro Fertilization (IVF) and what are the financial implications? Summary answer Thanks to our innovative gonadotropin prescription algorithm, patients with low ovarian reserve and maximum ovarian stimulation may not require monitoring until day 10 of IVF. What is known already In most fertility clinics, the standard procedure for IVF is early monitoring on day 6 of ovarian stimulation. Our focus is on personalizing the stimulation protocol by identifying the optimal dose of gonadotropin. With the aid of our unique algorithm, we aim to streamline monitoring. Frequent ultrasound examinations required for IVF can impose restrictions and create a burden for patients, resulting in increased costs for both patients and physicians. Study design, size, duration In a retrospective study conducted from April 2021 to August 2022 at the OVO clinic in Montreal (Canada), participants included all patients over 18 years old who underwent an IVF stimulation cycle utilizing an antagonist protocol and a customized mixed protocol prescription consisting of follitrophin delta and human menopausal gonadotropin, based on the patient's weight and anti-Mullerian hormone level. The sudy was approved by Veritas IRB, an independent ethic committee. Tracking number of study :2023-3189-13659-2 Participants/materials, setting, methods In the study, gonadotropin dosages were assigned either based on our algorithm (group 1) or at the physician's discretion (group 2). Ultrasound and hormonal analysis were performed on day 6. Following the physician's evaluation, adjustments to the gonadotropin dosage were made if necessary. The common trigger criteria was the presence of at least three follicles measuring between 16 and 22mm. Main results and the role of chance The study included 714 patients meeting the inclusion criteria. In group 1, there was a high percentage of patients stimulated with the maximum doses (80.3% compared to 22.5% in group 2). No dosage modifications or incidents of ovarian hyperstimulation syndrome were observed in group 1. Only 4.5% of patients (n = 16) triggered ovulation before day 10 (on day 9). In the non-maximal dose population, patients treated according to the algorithm (group A) experienced significantly fewer changes to the gonadotropin dosage at day 6 compared to patients treated based on the physician's discretion only (group B) (24.6% vs 46.9%, p < 0.001). The dosage of gonadotropins was notably more frequent adjusted in group B (46.9% vs 24.6%, p < 0.001). A higher risk of ovarian hyperstimulation syndrome was significantly more frequent in the non-maximal dose population compared to the maximal dose population (64.6% vs 27.5%, p < 0.01). These findings suggest that ovulation monitoring may not be necessary in the population stimulated to the maximum dose. This could result in 478 ultrasound and blood tests being avoided in the context of this study. Limitations, reasons for caution The data was obtained through a retrospective analysis. However, not monitoring before day 10 could pose a risk of delaying the cancellation of the IVF cycle, resulting in unnecessary treatment continuation. Wider implications of the findings This significant study indicates that, thanks to our algorithm, monitoring only on day 10 would be adequate for patients with low ovarian reserve who are stimulated to the maximum dose. Further validation of this strategy can be conducted through a randomized prospective study or with the use of different gonadotropins. Trial registration number non applicable
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,010 | 0,017 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,010 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».