Recent fertility research projects

DHEA Research Study

DHEA Trial

This research study looks at whether pregnancy rates are improved after IVF in poor responders when given dehydroepiandrosterone (DHEA), a naturally occurring hormone that is thought to increase the number of eggs produced by these women when given before and during their IVF treatment. It will also look at the number of eggs they produce, the quality of their embryos as well as how many of their pregnancies result in a live birth or miscarriage.
 
One factor that determines the success of IVF is how many eggs are produced, as this will affect how many embryos are created. Some women tend either not to respond to the drugs that cause egg production during IVF or produce very few eggs and are termed poor responders.
 
Women who met an internationally agreed consensus definition of poor responders took part in the study. The women will had any two of the following:

1. Advanced maternal age (≥40 years) or any other risk factor for poor ovarian response (POR)
2. Previous poor ovarian response
3. An abnormal ovarian reserve test
 
Two groups of poor responders going through IVF (200 in each group) were studied. One group was given 75 mg DHEA daily and the other a placebo (dummy tablet) to take for 10 weeks before their IVF. Patients were assigned to the groups at random and neither they nor the researchers knew which medication they were taking. We followed their treatment and compared the number of women in each group who get pregnant.
 
The main benefit of the study was to provide a definitive answer whether DHEA makes a difference in IVF outcome in this group of women. If the claims about the effects of DHEA are true, then those in the group taking it, and in the broader context many poor responder women, will benefit by getting pregnant. If the claims are not proven then again many poor responder women will be spared the financial and emotional cost of using an ineffective drug. As far as we can tell from our reading, DHEA is safe at the dose and duration that we will be using it. Several women have used it with no reported significant risk.
 
Results are not available yet.

E-freeze

Patients at Complete Fertility were asked to take part in a research study to find out which method of embryo transfer results in a higher healthy baby rate. IVF involves hormone injections to stimulate a woman’s ovaries to produce eggs which are then removed by a minor operation and mixed with sperm to create embryos in the laboratory. Usually these embryos are replaced within the uterus in 3 to 5 days. This is called fresh embryo transfer. Any remaining embryos are usually frozen so that they can be thawed and transferred at a later date if required – a process known as thawed frozen embryo transfer. Both forms of embryo transfer are commonly used as part of routine IVF treatment.

There have been some small studies, which suggest that using thawed frozen embryos may lead to improved pregnancy rates. This is because when frozen embryos are used, there is a delay in embryo transfer of between one and three months, allowing the excess of hormones of ovarian stimulation to wear off, giving the uterus time to return to its natural state. Only a few, small studies have been done so we don’t know which procedure is better. The E-Freeze study will compare these two procedures of embryo transfer in 1086 couples from IVF centres throughout the UK. 

Results are coming soon.

Endometrial scratch trial

This research study was conducted to find out if performing an endometrial scratch is beneficial for women undergoing IVF/ICSI for the first time.

An endometrial scratch is a simple routine outpatient procedure that involves taking a small amount of tissue from the lining of the womb (endometrium). It is thought that the process of scratching the lining of the womb may release certain chemicals that are important in helping the fertilised egg (embryo) to stick to the lining of the womb (implantation). Similar trials have used the same technique in women undergoing IVF/ICSI for the second or subsequent time with beneficial results.

The endometrial scratch trial recruited 1044 women from ten IVF units in the UK. Each woman taking part in the trial will be randomly allocated to receive (intervention group) or not receive (control group) the endometrial scratch procedure. If you have the endometrial scratch you’ll require one additional visit to your IVF clinic for the procedure.

Cheong, Y., Pye, C., Chatters, R., Cohen, J., Walters, S., Young, T., ... Metwally, M. (2018). Induced Endometrial Trauma (endometrial scratch) in the mid-luteal menstrual cycle phase preceding first cycle IVF/ICSI versus usual IVF/ICSI therapy: study protocol for a randomised controlled trial. BMJ Open.

Trial to examine the quality of embryos cultured in two different incubators

Patients have been taking part in a trial in order for us to understand whether there is any difference between the growth and development of embryos cultured in two different incubators; the standard benchtop ‘MINC’ incubator and an Embryoscope™.

The Embryoscope™ is a new type of incubator which may improve IVF outcomes, but this has not yet been demonstrated. We wish to compare this incubator with our standard incubator. Both have been shown to be safe and effective in clinical practice.

Results are coming soon.

Recent publications

Book:

Cheong, Y., Tulandi, T., & Li, T-C. (Eds.) (2018). Practical problems in assisted conception. Cambridge: Cambridge University Press.

Articles:

Ng, K., Wellstead, S., Cheong, Y., & Macklon, N. (2018). A randomised controlled trial of a personalised lifestyle coaching application in modifying periconceptional behaviours in women suffering from reproductive failures (iPLAN trial). BMC Women’s Health, 196. DOI: 10.1186/s12905-018-0689-7

Cheong, Y., Saran, M., Hounslow, J. W., & Reading, I. C. (2018). Are pelvic adhesions associated with pain, physical, emotional and functional characteristics of women presenting with chronic pelvic pain? A cluster analysis. BMC Women’s Health, 18(1), 11. DOI: 10.1186/s12905-017-0509-5, 10.1186/s12905-017-0509-5

Kandavel, V., & Cheong, Y. (2018). Does intra-uterine insemination have a place in modern ART practice? Best Practice and Research: Clinical Obstetrics and Gynaecology, 53, 3-10. DOI: 10.1016/j.bpobgyn.2018.08.003

Vincent, K., Baranowski, A., Bhattacharya, S., Birch, J., Cheong, Y., Cregg, R., ... Horne, A. W. (2018). GaPP2: A multi-centre randomised controlled trial of the efficacy of gabapentin for the management of chronic pelvic pain in women: study protocol. BMJ Open, 8(1), 1-8. [e014924]. DOI: 10.1136/bmjopen-2016-014924

Cheong, Y., Pye, C., Chatters, R., Cohen, J., Walters, S., Young, T., ... Metwally, M. (2018). Induced Endometrial Trauma (endometrial scratch) in the mid-luteal menstrual cycle phase preceding first cycle IVF/ICSI versus usual IVF/ICSI therapy: study protocol for a randomised controlled trial. BMJ Open.

Manousopoulou, A., Hamdan, M., Fotopoulos, M., Garay Baquero, D., Teng, J., Garbis, S., & Cheong, Y. (2018). Integrated eutopic endometrium and non-depleted serum quantitative proteomic analysis identifies candidate serological markers of endometriosis. Proteomics Clinical Applications.

Ng, K. Y. B., Mingels, R., Morgan, H., Macklon, N., & Cheong, Y. (2018). In-vivo oxygen, temperature and pH dynamics in the reproductive tract and their importance in human conception. Human Reproduction Update, 24(1), 15-34. DOI: 10.1093/humupd/dmx028

Eapen, A., Joing, M., Kwon, P., Tong, J., Maneta, E., De Santo, C., ... for the RESPONSE study group (2018). Recombinant human granulocyte - colony stimulating factor in women with unexplained recurrent pregnancy losses: a randomised clinical trial. Human Reproduction.