Very interested in this publication, I would like to precise that it is always so difficult to evaluate the degree of ovarian insufficiency. Surgery disrupts the hippo signaling pathway causing probably resumption of ovarian function. In all cases, this is only possible on the assumption that there are still few recruitable follicles in the ovarian cortex. Hence difficulties in interpreting the results of such surgery
I agree with everything that is mentioned in this reflection and I would like to stress the high probability of the epigenetic origin of endometriosis. The presence of endometriosis in the male and the fetus suggests that the epigenetic origin is well established, on the basis of numerous studies determining many candidate genes (CALD1, FN1, FASN, IL6, etc ...) The methylation status of these genes seems to be decisive for understanding the prognosis and the evolution of the endometriotic disease. These genes are accessible by the study of free DNA fragments in circulating blood and their methylation status, studied by our team (patent pending) has enabled us to establish not only early diagnosis but also a prognosis. as to the scalability of endometriosis foci. A therapeutic argument is at the end of validation and the results on pain and comfort of life seem promising
In France GH must be order by a pediatrician only for growth disorder in children. GH is accused of mutagenic risks and therefore gynecologists prefer do not prescribe it even for twelve days, because of the medico forensic risk. Stupid but true!
I totally confirm the work and the conclusion of the authors. We have already shown the positive effect of GH in polycystic ovaries supplying many dysmorphic oocytes but also in older women (Tesarik, J., A. Hazout, and Mendoza, C. ICSI in women aged> 40 years by ovarian co-stimulation with growth hormone Hum Reprod 2005; 20: 2536-2541) The question is, based on these results, why clinicians do not use GH as adjunct to stimulation in the cases evoked ?
I have red with interest the Paper of the Gianarolli team. I don't contest the results but the value of the free DNA assay into the blastocele and the results of the TE biopsy can not be compared. Even if there is a coincidence between the viability of blastocysts viability and the absence of DNA in their blastocele and euploid blastocyst viability. Moreover Few centers can practice both explorations despite high cost
Thank you for the comment Andre! As you point out, your group and others have been looking at this question for over 10 years and the preponderance of data now clearly points to a negative effect of elevated P on the day of hCG. I agree that if a program is a "freeze all" program, then there is little utility in regularly measuring progesterone levels. I don't believe the current evidence suggests that elevated P levels effect oocyte quality. We have demonstrated this be showing that FET cycles are not effected by the P level in the initial fresh cycles, donor oocyte cycles are also not effected, and the paper currently in F&S that shows that donors on progestins do not have their oocytes negatively affected.
Thank you Micah for your prompt answer
I do not think that high progesterone level may affect the oocyte quality. I was only referring to the immuno-inflammatory state of a stimulated endometrium.
One of the most common questions reviewers and readers ask us is "at what P threshold do you recommend a freeze only cycle?". This turned out to be a more complex question than can be answered without a dedicated study. In this paper, we address this specific question and offer a range of data that we hope provides the clinician and the patient with information to make an informed and individualized decision. We welcome any questions and critiques from the readers of F&S.
Dear Micah Do not you think that after ovarian stimulation putting a relatively "out of phase" endometrium (2 to 3 days in advance), there is reason to wonder about the value of progesterone before HcG? We have treated this subject with Pr Frydman and R.Fanchin more than 10 years ago. We had the same conclusions as you, but the recent notions acquired in terms of endometrial transformation in the course of an ovarian stimulation make us think, at the time of "Freeze All" , that the problem is other than the progesterone level. Best regards
The conclusions of this meta-analysis are not surprising. Despite the heterogeneity of so-called randomized studies, it is not clear why an endometrial biopsy performed before an IVF cycle should, after menstruation, retain the ability to change the terms of the embryo-uterine dialog during a stimulated cycle.
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Recent Comments
Very interested in this publication, I would like to precise that it is always so difficult to evaluate the degree of ovarian insufficiency. Surgery disrupts the hippo signaling pathway causing probably resumption of ovarian function. In all cases, this is only possible on the assumption that there are still few recruitable follicles in the ovarian cortex. Hence difficulties in interpreting the results of such surgery
I agree with everything that is mentioned in this reflection and I would like to stress the high probability of the epigenetic origin of endometriosis. The presence of endometriosis in the male and the fetus suggests that the epigenetic origin is well established, on the basis of numerous studies determining many candidate genes (CALD1, FN1, FASN, IL6, etc ...) The methylation status of these genes seems to be decisive for understanding the prognosis and the evolution of the endometriotic disease. These genes are accessible by the study of free DNA fragments in circulating blood and their methylation status, studied by our team (patent pending) has enabled us to establish not only early diagnosis but also a prognosis. as to the scalability of endometriosis foci. A therapeutic argument is at the end of validation and the results on pain and comfort of life seem promising
In France GH must be order by a pediatrician only for growth disorder in children. GH is accused of mutagenic risks and therefore gynecologists prefer do not prescribe it even for twelve days, because of the medico forensic risk. Stupid but true!
I totally confirm the work and the conclusion of the authors. We have already shown the positive effect of GH in polycystic ovaries supplying many dysmorphic oocytes but also in older women (Tesarik, J., A. Hazout, and Mendoza, C. ICSI in women aged> 40 years by ovarian co-stimulation with growth hormone Hum Reprod 2005; 20: 2536-2541) The question is, based on these results, why clinicians do not use GH as adjunct to stimulation in the cases evoked ?
I have red with interest the Paper of the Gianarolli team. I don't contest the results but the value of the free DNA assay into the blastocele and the results of the TE biopsy can not be compared. Even if there is a coincidence between the viability of blastocysts viability and the absence of DNA in their blastocele and euploid blastocyst viability. Moreover Few centers can practice both explorations despite high cost
Thank you for the comment Andre! As you point out, your group and others have been looking at this question for over 10 years and the preponderance of data now clearly points to a negative effect of elevated P on the day of hCG. I agree that if a program is a "freeze all" program, then there is little utility in regularly measuring progesterone levels. I don't believe the current evidence suggests that elevated P levels effect oocyte quality. We have demonstrated this be showing that FET cycles are not effected by the P level in the initial fresh cycles, donor oocyte cycles are also not effected, and the paper currently in F&S that shows that donors on progestins do not have their oocytes negatively affected.
Thank you Micah for your prompt answer
I do not think that high progesterone level may affect the oocyte quality. I was only referring to the immuno-inflammatory state of a stimulated endometrium.
Congratulations for your paper
Warmest regards
One of the most common questions reviewers and readers ask us is "at what P threshold do you recommend a freeze only cycle?". This turned out to be a more complex question than can be answered without a dedicated study. In this paper, we address this specific question and offer a range of data that we hope provides the clinician and the patient with information to make an informed and individualized decision. We welcome any questions and critiques from the readers of F&S.
Dear Micah
Do not you think that after ovarian stimulation putting a relatively "out of phase" endometrium (2 to 3 days in advance), there is reason to wonder about the value of progesterone before HcG?
We have treated this subject with Pr Frydman and R.Fanchin more than 10 years ago. We had the same conclusions as you, but the recent notions acquired in terms of endometrial transformation in the course of an ovarian stimulation make us think, at the time of "Freeze All" , that the problem is other than the progesterone level.
Best regards
The conclusions of this meta-analysis are not surprising. Despite the heterogeneity of so-called randomized studies, it is not clear why an endometrial biopsy performed before an IVF cycle should, after menstruation, retain the ability to change the terms of the embryo-uterine dialog during a stimulated cycle.