Application and pregnancy outcomes analysis of hysteroscopy combined with hysterosalpingo-contrast sonography in intrauterine insemination

Editorial group: Cochrane Gynaecology and Fertility Group. Publication status and date: New search for studies and content updated (no change to conclusions), published in Issue 11, 2015.

Oocyte retrieval versus conversion to intrauterine insemination in patients with poor response to gonadotropin therapy

Cetrorelix lowers premature luteinization rate in gonadotropin ovulation induction–intrauterine insemination cycles: a randomized-controlled clinical trial

Predictive Value of Teratospermia During Initial Sperm Analysis on the Success of Intrauterine Insemination Cycles

This study aimed to investigate the associations between the post-wash total progressively motile sperm count (TPMSC) in the first intrauterine insemination (IUI) cycle and pregnancy outcomes of the second IUI cycle. Data were retrieved from the clinical database at the Reproductive Center of Peking University Third Hospital (Beijing, China) between January 2011 and December 2022. Couples were included in this retrospective cohort study if they had unexplained or mild male factor infertility and were treated with IUI for two consecutive cycles using the same protocol. A total of 8290 couples were included in the analysis. The mean ± standard deviation (s.d.) age of women was 32.0 ± 3.5 years. We categorized groups based on the post-wash TPMSC (×106) levels in the first IUI cycle: group 1 (0 < TPMSC < 1, n = 1290), group 2 (1 ≤ TPMSC < 2, n = 863), group 3 (2 ≤ TPMSC < 3, n = 800), group 4 (3 ≤ TPMSC < 4, n = 783), group 5 (4 ≤ TPMSC < 5, n = 1541), group 6 (5 ≤ TPMSC < 6, n = 522), group 7 (6 ≤ TPMSC < 7, n = 547), group 8 (7 ≤ TPMSC < 8, n = 175), group 9 (8 ≤ TPMSC < 9, n = 556), group 10 (9 ≤ TPMSC < 10, n = 192), and group 11 (TPMSC ≥ 10), n = 1021). The primary outcome was live birth rate of the second IUI cycle. Live birth rates were 7.9%, 5.8%, 7.6%, 7.4%, 7.3%, 8.4%, 7.5%, 7.4%, 8.8%, 8.9%, and 7.6% in each group, respectively. There were no statistically significant differences in clinical pregnancy rates or live birth rates between any groups and those with the post-wash TPMSC <1 × 106. In an IUI program for unexplained and mild male factor infertility, the post-wash TPMSC in the first IUI cycle was not significantly associated with the live birth rate in the second IUI cycle.

Recombinant FSH increases live birth rates as compared to clomiphene citrate in intrauterine insemination cycles in couples with subfertility: a prospective randomized study

Day 2 embryo transfer (ET) and day 3 ET afford similar reproductive outcomes in the poor responder

Objective: To investigate the influence of season on live birth and clinical pregnancy rates, as well as assisted reproductive technology (ART) outcomes, in the Hainan region. Methods: Patients were categorized into four groups based on the dates of artificial insemination and transplantation: spring, summer, autumn, or winter. The main outcome measures were clinical pregnancy rates and live birth rates. Secondary outcomes included body mass index (BMI), oocyte number, two pronuclei (2PN) cleavage rate, total gonadotropin (Gn) dosage and days, age, 2PN fertilization rate, sperm concentration, sperm PR rate, anti-Müllerian hormone (AMH), and endometrial thickness. Outpatient semen quality indicators included sperm PR rate, total sperm count, sperm concentration, and total sperm motility. Results: This retrospective cohort study analyzed 2,016 artificial insemination cycles and 1,783 ovarian retrieval cycles from January 2017 to October 2022, and assessed the semen quality of 6,651 outpatients from May 2017 to October 2022. In artificial insemination cycles, sperm PR rate and clinical pregnancy rate were highest in winter, with a statistically significant difference between groups (P &lt; 0.05). Clinical pregnancy rate was influenced by both age and sperm PR rate (P &lt; 0.05). In ovarian retrieval cycles, the winter group had significantly higher clinical pregnancy, 2PN fertilization, and 2PN cleavage rates than the other groups. The autumn group had higher live birth rates, though not significantly different. Additionally, winter months showed higher total sperm concentration and total sperm number compared to other seasons. Conclusion: Seasonality affected clinical pregnancy and live birth rates in artificial insemination cycles but not in ovarian retrieval cycles in the Hainan region. These findings suggest that while there is no need to choose a specific season for ovarian retrieval cycles, artificial insemination in winter may be preferable for patients.

The impact of different sperm preparation methods on clinical pregnancy and live birth rates in intrauterine insemination cycles: a retrospective single-center cohort study

Assisted reproductive technologies (ART) in Canada: 2004 results from the Canadian ART Register

Luteal phase deficiency as a result of multifollicular development which produces supraphysiological progesterone and estradiol levels and benefit of luteal phase support have been proven in assisted reproductive technique (ART) treatment. But, there were some controversial results in intrauterine insemination (IUI) cycles whether luteal phase support (LPS) with progesterone have an impact on pregnancy outcome. To assess the efficacy of vaginal progesterone gel in the gonadotropin-induced IUI cycles, this retrospective data analysis compared the luteal phase support and control group in terms of clinical pregnancy (CPR) and live birth rates (LBR). In subgroup analysis, multifollicular and monofollicular growth were analyzed separately. In total, after exclusion criteria, 380 IUI cycles were analyzed, cycles were grouped as LPS(+) and LPS(-) with 190 and 190 cycles, respectively. CPR and LBR were comparable between groups (11.6% vs. 10.5, p = .74 and 8.9% vs. 8.4%, p = .75 respectively). Although multifollicular growth demonstrated higher pregnancy outcomes than monofollicular growth, intermediate follicles (14–16 mm) had a positive impact on pregnancy outcome in monofollicular growth like multifollicular subgroup. We found no difference in CPR and LBR according to the luteal phase vaginal progesterone gel. Nevertheless, multifollicular cycles and also monofollicular growth cycles with two and more intermediate follicles may have benefit LPS in gonadotropin-induced IUI cycles.

Do infectious diseases (hepatitis B virus [HBV], hepatitis C virus [HCV], and syphilis) impact embryo quality, pregnancy, and neonatal outcomes following a complete IVF cycle? Infections with HBV, HCV, or syphilis do not have detrimental impacts on live birth rates or neonatal outcomes in couples following a complete IVF cycle. Maternal or paternal infections with HBV, HCV, or syphilis may decrease the clinical pregnancy rate, result in poorer embryo outcomes, and lower offspring birth weight. However, there is significant controversy regarding these effects across existing studies, highlighting the need for further research. This is a retrospective matched cohort study. Data were obtained from the clinical database of couples who underwent IVF treatment at a single academically affiliated fertility clinic from January 2011 to December 2019, with follow-up extending to December 2020. Out of 180666 complete cycles recorded, 2443 cycles fulfilled our inclusion criteria. In cycles that fulfilled our inclusion criteria, there were 1997 cycles in the HBV study group, 154 cycles in the HCV study group, and 292 cycles in the syphilis study group. Each study cycle was paired with four controls based on participant age and the timing of IVF treatment, resulting in 7988 controls for the HBV group, 616 controls for the HCV group, and 1169 controls for the syphilis group. Infections could be either single-parent or biparental. The primary outcome was live birth per complete cycle (i.e. fresh cycle plus subsequent frozen-thawed cycles). Subgroup analyses were conducted dividing cycles into maternal infection and paternal infection. In the HBV group, pregnancy outcomes (clinical pregnancy, miscarriage, and live birth rates) and neonatal birth weight were similar to that of the controls. In the HCV group, no significant differences from the controls were observed except for a lower clinical pregnancy rate in the study group (36.4% vs 42.2%, adjusted β and 95% CI: 0.62 [0.39-0.96]). Similarly, no significant differences were found in pregnancy or neonatal outcomes between the syphilis group and the control group. As for subgroup analyses, the male-only HBV infection subgroup showed a higher miscarriage rate in the study group than in the control group (22.5% vs 17.7%, adjusted β and 95% CI: 1.56 [1.07-2.28]). For the HCV and syphilis subgroups, none of the outcomes showed significant differences between either the female-only infection or male-only infection subgroups and the controls. Although potential confounders were considered and adjusted for, residual bias may still exist due to the study design. The inclusion of participants solely from a single center limited the generalizability of our findings to a broader context. We presented a comprehensive overview of the impact of prevalent infectious diseases on IVF outcomes, hoping to address uncertainties surrounding the decisions of couples infected with these diseases and to assist in preventing adverse reproductive outcomes in clinical practice. This study was supported by the National Natural Science Foundation of China (82204052), the National Key R&D Program of China (2022YFC2705305), and the Clinical key project of Peking University Third Hospital (BYSYZD2023007). The authors declare no competing interests. N/A.

Endometrial thickness: How thin is too thin?

Study question Does PGT-A, with or without an ERA, enhance pregnancy outcomes in patients with recurrent implantation failure undergoing IVF when compared to traditional morphological assessments? Summary answer PGT-A improves implantation, clinical pregnancy and live birth rates in RIF patients, while adding ERA does not significantly enhance outcomes. What is known already Recurrent implantation failure (RIF) is a major challenge in assisted reproductive technology (ART). Preimplantation genetic testing for aneuploidy (PGT-A) is commonly used to improve implantation by selecting euploid embryos. Endometrial receptivity assay (ERA) aims to optimise embryo transfer timing. However, the effectiveness of PGT-A and ERA in improving pregnancy outcome to RIF patients remains debated, with inconsistent findings across studies. Study design, size, duration Relevant studies published between January 2004 and January 2025 were systematically retrieved from PubMed, Embase, and the Cochrane Library databases. A total of 17 studies involving 7,240 cases met the inclusion criteria. Using a random-effects model, odds ratios (ORs) were calculated to assess key outcomes, including implantation, clinical pregnancy, ongoing pregnancy, live birth, and miscarriage rates. Participants/materials, setting, methods The analysis evaluated 7,240 recurrent implantation failure (RIF) cases across 17 studies. A random-effects model was employed to determine odds ratios (ORs) for implantation, clinical pregnancy, ongoing pregnancy, live births, and miscarriage rates. The study compared patients who underwent preimplantation genetic testing for aneuploidy (PGT-A) only against those who received PGT-A along with the endometrial receptivity assay (ERA), in contrast to traditional morphological assessment of embryos alone. Main results and the role of chance The findings revealed that PGT-A significantly increased implantation rates (OR = 1.75, 95% CI: 1.27-2.40, p = 0.00), clinical pregnancy rates (OR = 1.67, 95% CI: 1.17-2.37, p = 0.00), and live birth rate rates (OR = 1.74, 95% CI: 1.30-2.31, p = 0.00). However, the procedure did not significantly decrease miscarriage rates (OR = 1.30, 95% CI: 0.79-2.14, p = 0.30). Furthermore, incorporating ERA into PGT-A protocols did not yield any significant improvement in outcomes for RIF patients (implantation rates OR = 3.94, 95% CI: 0.70-22.15, p = 0.12; clinical pregnancy rates OR = 2.42, 95% CI: 0.56-10.33, p = 0.23; live birth rates OR = 1.15, 95% CI: 0.35-3.77, p = 0.82; miscarriage rates OR = 0.34, 95% CI: 0.11-1.05, p = 0.06). Notable heterogeneity was present across studies (I2 = 45%-92%). Limitations, reasons for caution Significant heterogeneity across studies (I² = 45%-92%) may affect result reliability. Differences in study design, patient characteristics, and PGT-A/ERA protocols could introduce bias. Wider implications of the findings PGT-A improves implantation, clinical pregnancy, and live birth rates in RIF patients, supporting its role in embryo selection. However, adding ERA does not enhance outcomes, suggesting limited benefit in routine use. These findings may guide clinical decision-making in ART, emphasising the need for individualized treatment approaches. Trial registration number No

P-461: IUI results are not affected by the test of tubal patency used