Study question Which patients are eligible to skip ovulation monitoring before day 10 in In Vitro... more 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 patient...
Study question Following a failed IVF cycle, does adding letrozole for the first 5 days of a repe... more Study question Following a failed IVF cycle, does adding letrozole for the first 5 days of a repeated cycle have any advantage versus repeating the same protocol? Summary answer Following a failed IVF cycle, letrozole supplementation during ovarian stimulation for IVF results in a similar cumulative live birth rate (CLBR) with 22% less gonadotropins. What is known already Letrozole results in an increase of intraovarian androgen concentration, which augments follicular stimulating hormone (FSH) receptor expression on granulosa cells and follicular responsiveness to exogenous gonadotropins. Letrozole co-treatment with gonadotropins during controlled ovarian stimulation (COH) for IVF has been investigated mainly in poor and normo-responders with conflicting clinical outcomes. This is the first and largest study that investigates the effects of adding letrozole for the first five days of COH for IVF, in GnRH antagonist cycles, to a category of patients who had a prior failed stimulated...
Journal de Gynécologie Obstétrique et Biologie de la Reproduction
Intérêt de la fécondation in vitro en cycle naturel (FIVn) dans les échecs de l'implantation D'ap... more Intérêt de la fécondation in vitro en cycle naturel (FIVn) dans les échecs de l'implantation D'après la communication de I.
Miscarriage rates were 16.9% 95%CI(14.8-18.2) in control group and 14.6% 95%CI(9.3-19.9) in PCS g... more Miscarriage rates were 16.9% 95%CI(14.8-18.2) in control group and 14.6% 95%CI(9.3-19.9) in PCS group. The role of chance is very limited, given the elevated number of treatments included in our research. CONCLUSIONS: Apart from diminishing the risk for the offspring, implementing PCS provides a clear trend to have ongoing pregnancy rates improved and miscarriage rates decreased on the cases where PCS has been performed.
OBJECTIVE: To examine recent trends and associations in intracytoplasmic sperm injection (ICSI) u... more OBJECTIVE: To examine recent trends and associations in intracytoplasmic sperm injection (ICSI) use among states with and without an insurance mandate for coverage of in vitro fertilization (IVF) services. DESIGN: Population-based cross-sectional study. MATERIALS AND METHODS: Data from the 2000-2014 National Assisted Reproductive Technology Surveillance System were analyzed. We used linear regression to assess trends in ICSI use among fresh IVF cycles performed in 8 states with insurance mandates for IVF, and 43 states without mandates (including the District of Columbia), stratified by male factor infertility. For the most recent 5-year period (2010-2014), we compared ICSI use by mandate status, and used log-binomial regression to calculate adjusted rate ratios (aRR) for associations between ICSI use and insurance mandates, accounting for clustered clinic outcomes with generalized estimating equations. We also compared ICSI use in non-male factor infertility cycles by mandate status for selected characteristics (unexplained infertility, low oocyte yield, maternal age greater than or equal to 38 years, greater than or equal to 2 prior cycles and no live births, and use of preimplantation genetic diagnosis (PGD)). P-values less than 0.05 were considered statistically significant. RESULTS: ICSI use increased overall during 2000-2014, but for nonmale factor infertility cycles, the increase was greater among nonmandate states (34.6% vs 71.4%, a 36.8% change, P<.0001) versus mandate states (39.5% vs 62.3%, a 22.8% change, P<.0001). From 2010-2014, ICSI use was higher in non-mandate vs. mandate states, for cycles with (94.5% vs. 90.9%, aRR 0.97; 95% CI, 0.94-0.996, P¼.03), and without (68.4% vs. 59.6%, aRR 0.86; 95% CI, 0.74-0.99, P¼.04) male factor infertility. ICSI use was statistically significantly higher in non-mandate states than in mandate states for the selected characteristics assessed except for PGD; this difference was the greatest among cycles with unexplained infertility (66.7% vs. 53.5%) and low oocyte yield (71.8% vs. 61.1%). CONCLUSIONS: Mandates were associated with decreased ICSI use for non-male factor infertility cycles, especially for cycles with unexplained infertility and low oocyte yield.
Journal de gynécologie, obstétrique et biologie de la reproduction, 2004
Since the introduction of IVF treatments, natural cycle IVF (nIVF) has been largely replaced by I... more Since the introduction of IVF treatments, natural cycle IVF (nIVF) has been largely replaced by IVF with ovarian stimulation to obtain multiple oocytes. Failure to anticipate the retrieval of more than two oocytes often results in cancellation of the cycle. However, nIVF has several advantages. It is associated with a close to zero multiple pregnancy rate, and a zero risk of ovarian hyperstimulation syndrome. Per cycle, nIVF is less time consuming, physically and emotionally less demanding for patients, and cheaper than stimulated IVF, but also less effective. GnRH antagonists have improved the outcome of nIVF cycles. They avoid unexpected ovulation and frequent cancellations. In selected cases, especially in women with implantation failure or with poor ovarian response, favorable results can be obtained from nIVF cycles, despite the replacement of a single embryo. Poor results are obtained in women over 38 years.
Journal de gynécologie, obstétrique et biologie de la reproduction, 2002
Introduction. The TVT procedure has been changed the surgical treatment of stress urinary inconti... more Introduction. The TVT procedure has been changed the surgical treatment of stress urinary incontinence (SUI). The aim of this study was to collect the patient's point of view. and The TVT procedure was performed to treat SUI on 144 consecutive women in our institution between May 1998 and December 2000. We have sent a postal questionnaire to all patients in order to determine subjective results on SUI and post-operative voiding difficulties. We have obtained 124 responses (86.1% of patients). The median follow-up was 20 months +/- 12 (range 8 to 38 months). The patients were "very satisfied" in 56.5% (n=70), "satisfied" in 34.6% (n=43) and "unsatisfied" in 8.9% of cases (n=11). The functional discomfort about SUI was, on a 0 to 10 visual analog scale, 7.5 +/- 2 preoperatively and 2.2 +/- 2.8 post-operatively. Only 13.7% of patients have SUI postoperatively, and then 86.3% are considered cured. Nevertheless, voiding difficulties are common after this...
Objective: To report results of analysis of in vitro fertilization (IVF) users' choices regarding... more Objective: To report results of analysis of in vitro fertilization (IVF) users' choices regarding the potential use of their surplus cryopreserved embryos for posthumous assisted reproduction (PAR). Design: Examination of signed consent forms. Setting: Public IVF clinic. Patient(s): A total of 498 individuals who had signed consent forms for cryopreservation of surplus embryos. Intervention(s): Content analysis of consent form. Main Outcome Measure(s): Agreement to PAR; importance of appropriate counseling within the consent process. Result(s): Approximately 68% of individuals consented to the use of surplus embryos for embryologist training and improvement of assisted reproductive techniques, and 56% consented to the use of surplus embryos in a research project; 73.5% of men and 61.8% of women agreed to leave their cryopreserved embryos to their partners for reproductive use in the event of their death. Conclusion(s): Our results demonstrate that a majority of both men and women agree to leave their frozen embryos to their partners for PAR in a ''real life'' context, i.e., in which they were required to provide consent for this prospective option. PAR involves complex issues, including the psychologic aspects of initiating a pregnancy while mourning the loss of a loved one or the effect on the prospective child. We argue that in light of the acceptability of PAR-as demonstrated by our results-further research is required regarding how to best counsel and inform IVF users about the choices they are making in this context, to ensure that their consent for PAR is in fact well informed. (Fertil Steril Ò 2014;102:1410-5. Ó2014 by American Society for Reproductive Medicine.
In August 2010, the provincial government of Québec, Canada introduced funding of assisted reprod... more In August 2010, the provincial government of Québec, Canada introduced funding of assisted reproduction treatment through the provincial health programme. Alongside this benefit, legislation was introduced to control assisted reproduction treatment activities in the province, including restrictions on the number of embryos that could be transferred in any one cycle. The aim of the programme was to transfer a single embryo in every cycle; multiple embryos could be transferred under suboptimal conditions but required physician justification. In the first 3 months of this programme, 1353 cycles of IVF were performed in five Québec assisted reproduction centres, with an overall clinical pregnancy rate of 32% per embryo transfer and 50% of transfers used elective single-embryo transfer (eSET). The multiple-pregnancy rate was only 3.7% per clinical pregnancy. In 2009, prior to the introduction of the programme, eSET was used in only 1.6% of embryo transfers, resulting in a multiple-pregnancy rate of 25.6%. These data demonstrate that providing provincially funded assisted reproduction treatment created an environment in which the aggressive use of eSET was not only possible, but also rapidly implemented. The result was a dramatic drop in multiple-pregnancy rates, approaching those for natural pregnancies. RBMOnline
Study question Which patients are eligible to skip ovulation monitoring before day 10 in In Vitro... more 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 patient...
Study question Following a failed IVF cycle, does adding letrozole for the first 5 days of a repe... more Study question Following a failed IVF cycle, does adding letrozole for the first 5 days of a repeated cycle have any advantage versus repeating the same protocol? Summary answer Following a failed IVF cycle, letrozole supplementation during ovarian stimulation for IVF results in a similar cumulative live birth rate (CLBR) with 22% less gonadotropins. What is known already Letrozole results in an increase of intraovarian androgen concentration, which augments follicular stimulating hormone (FSH) receptor expression on granulosa cells and follicular responsiveness to exogenous gonadotropins. Letrozole co-treatment with gonadotropins during controlled ovarian stimulation (COH) for IVF has been investigated mainly in poor and normo-responders with conflicting clinical outcomes. This is the first and largest study that investigates the effects of adding letrozole for the first five days of COH for IVF, in GnRH antagonist cycles, to a category of patients who had a prior failed stimulated...
Journal de Gynécologie Obstétrique et Biologie de la Reproduction
Intérêt de la fécondation in vitro en cycle naturel (FIVn) dans les échecs de l'implantation D'ap... more Intérêt de la fécondation in vitro en cycle naturel (FIVn) dans les échecs de l'implantation D'après la communication de I.
Miscarriage rates were 16.9% 95%CI(14.8-18.2) in control group and 14.6% 95%CI(9.3-19.9) in PCS g... more Miscarriage rates were 16.9% 95%CI(14.8-18.2) in control group and 14.6% 95%CI(9.3-19.9) in PCS group. The role of chance is very limited, given the elevated number of treatments included in our research. CONCLUSIONS: Apart from diminishing the risk for the offspring, implementing PCS provides a clear trend to have ongoing pregnancy rates improved and miscarriage rates decreased on the cases where PCS has been performed.
OBJECTIVE: To examine recent trends and associations in intracytoplasmic sperm injection (ICSI) u... more OBJECTIVE: To examine recent trends and associations in intracytoplasmic sperm injection (ICSI) use among states with and without an insurance mandate for coverage of in vitro fertilization (IVF) services. DESIGN: Population-based cross-sectional study. MATERIALS AND METHODS: Data from the 2000-2014 National Assisted Reproductive Technology Surveillance System were analyzed. We used linear regression to assess trends in ICSI use among fresh IVF cycles performed in 8 states with insurance mandates for IVF, and 43 states without mandates (including the District of Columbia), stratified by male factor infertility. For the most recent 5-year period (2010-2014), we compared ICSI use by mandate status, and used log-binomial regression to calculate adjusted rate ratios (aRR) for associations between ICSI use and insurance mandates, accounting for clustered clinic outcomes with generalized estimating equations. We also compared ICSI use in non-male factor infertility cycles by mandate status for selected characteristics (unexplained infertility, low oocyte yield, maternal age greater than or equal to 38 years, greater than or equal to 2 prior cycles and no live births, and use of preimplantation genetic diagnosis (PGD)). P-values less than 0.05 were considered statistically significant. RESULTS: ICSI use increased overall during 2000-2014, but for nonmale factor infertility cycles, the increase was greater among nonmandate states (34.6% vs 71.4%, a 36.8% change, P<.0001) versus mandate states (39.5% vs 62.3%, a 22.8% change, P<.0001). From 2010-2014, ICSI use was higher in non-mandate vs. mandate states, for cycles with (94.5% vs. 90.9%, aRR 0.97; 95% CI, 0.94-0.996, P¼.03), and without (68.4% vs. 59.6%, aRR 0.86; 95% CI, 0.74-0.99, P¼.04) male factor infertility. ICSI use was statistically significantly higher in non-mandate states than in mandate states for the selected characteristics assessed except for PGD; this difference was the greatest among cycles with unexplained infertility (66.7% vs. 53.5%) and low oocyte yield (71.8% vs. 61.1%). CONCLUSIONS: Mandates were associated with decreased ICSI use for non-male factor infertility cycles, especially for cycles with unexplained infertility and low oocyte yield.
Journal de gynécologie, obstétrique et biologie de la reproduction, 2004
Since the introduction of IVF treatments, natural cycle IVF (nIVF) has been largely replaced by I... more Since the introduction of IVF treatments, natural cycle IVF (nIVF) has been largely replaced by IVF with ovarian stimulation to obtain multiple oocytes. Failure to anticipate the retrieval of more than two oocytes often results in cancellation of the cycle. However, nIVF has several advantages. It is associated with a close to zero multiple pregnancy rate, and a zero risk of ovarian hyperstimulation syndrome. Per cycle, nIVF is less time consuming, physically and emotionally less demanding for patients, and cheaper than stimulated IVF, but also less effective. GnRH antagonists have improved the outcome of nIVF cycles. They avoid unexpected ovulation and frequent cancellations. In selected cases, especially in women with implantation failure or with poor ovarian response, favorable results can be obtained from nIVF cycles, despite the replacement of a single embryo. Poor results are obtained in women over 38 years.
Journal de gynécologie, obstétrique et biologie de la reproduction, 2002
Introduction. The TVT procedure has been changed the surgical treatment of stress urinary inconti... more Introduction. The TVT procedure has been changed the surgical treatment of stress urinary incontinence (SUI). The aim of this study was to collect the patient's point of view. and The TVT procedure was performed to treat SUI on 144 consecutive women in our institution between May 1998 and December 2000. We have sent a postal questionnaire to all patients in order to determine subjective results on SUI and post-operative voiding difficulties. We have obtained 124 responses (86.1% of patients). The median follow-up was 20 months +/- 12 (range 8 to 38 months). The patients were "very satisfied" in 56.5% (n=70), "satisfied" in 34.6% (n=43) and "unsatisfied" in 8.9% of cases (n=11). The functional discomfort about SUI was, on a 0 to 10 visual analog scale, 7.5 +/- 2 preoperatively and 2.2 +/- 2.8 post-operatively. Only 13.7% of patients have SUI postoperatively, and then 86.3% are considered cured. Nevertheless, voiding difficulties are common after this...
Objective: To report results of analysis of in vitro fertilization (IVF) users' choices regarding... more Objective: To report results of analysis of in vitro fertilization (IVF) users' choices regarding the potential use of their surplus cryopreserved embryos for posthumous assisted reproduction (PAR). Design: Examination of signed consent forms. Setting: Public IVF clinic. Patient(s): A total of 498 individuals who had signed consent forms for cryopreservation of surplus embryos. Intervention(s): Content analysis of consent form. Main Outcome Measure(s): Agreement to PAR; importance of appropriate counseling within the consent process. Result(s): Approximately 68% of individuals consented to the use of surplus embryos for embryologist training and improvement of assisted reproductive techniques, and 56% consented to the use of surplus embryos in a research project; 73.5% of men and 61.8% of women agreed to leave their cryopreserved embryos to their partners for reproductive use in the event of their death. Conclusion(s): Our results demonstrate that a majority of both men and women agree to leave their frozen embryos to their partners for PAR in a ''real life'' context, i.e., in which they were required to provide consent for this prospective option. PAR involves complex issues, including the psychologic aspects of initiating a pregnancy while mourning the loss of a loved one or the effect on the prospective child. We argue that in light of the acceptability of PAR-as demonstrated by our results-further research is required regarding how to best counsel and inform IVF users about the choices they are making in this context, to ensure that their consent for PAR is in fact well informed. (Fertil Steril Ò 2014;102:1410-5. Ó2014 by American Society for Reproductive Medicine.
In August 2010, the provincial government of Québec, Canada introduced funding of assisted reprod... more In August 2010, the provincial government of Québec, Canada introduced funding of assisted reproduction treatment through the provincial health programme. Alongside this benefit, legislation was introduced to control assisted reproduction treatment activities in the province, including restrictions on the number of embryos that could be transferred in any one cycle. The aim of the programme was to transfer a single embryo in every cycle; multiple embryos could be transferred under suboptimal conditions but required physician justification. In the first 3 months of this programme, 1353 cycles of IVF were performed in five Québec assisted reproduction centres, with an overall clinical pregnancy rate of 32% per embryo transfer and 50% of transfers used elective single-embryo transfer (eSET). The multiple-pregnancy rate was only 3.7% per clinical pregnancy. In 2009, prior to the introduction of the programme, eSET was used in only 1.6% of embryo transfers, resulting in a multiple-pregnancy rate of 25.6%. These data demonstrate that providing provincially funded assisted reproduction treatment created an environment in which the aggressive use of eSET was not only possible, but also rapidly implemented. The result was a dramatic drop in multiple-pregnancy rates, approaching those for natural pregnancies. RBMOnline
Uploads
Papers by I. Kadoch