Assisted Reproductive Technology In Women Research Articles

Association between follicular fluid bacteria with inflammatory markers of the complete blood count and the outcomes of assisted reproductive technology in women with endometriosis: A case-control study.

Endometriosis is a common reason for infertility and poor outcomes of assisted reproductive technology (ART). Inflammation is involved in the pathogenesis of this disease. The presence of microorganisms in women with endometriosis may increase levels of inflammatory markers. The purpose of this study is to determine the relationship between the presence of bacteria in the follicular fluid with the inflammatory markers of the complete blood count (CBC) and the outcomes of in vitro fertilization(IVF) in women with endometriosis. This case-control study was conducted on 74 patients undergoing IVF, referred to Al-Zahra Hospital in Rasht (Iran) in 2021. The patients were divided into two case groups including 37 women with endometrioma and the control group, including 37 infertile women with a male factor and normal ultrasound. In total, 74 follicular fluids were collected from the case and control groups and were cultured in the laboratory. The relationship between culture results with IVF outcomes and the levels of CBC inflammatory markers including the number of white blood cells (WBCs), lymphocytes, neutrophils, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR), erythrocyte sedimentation rate (ESR), and c-reactive protein (CRP) was analyzed. There was no significant statistical difference between the frequency of bacteria present in the follicular fluid (p = 0.861), the mean rate of fertilization (p = 0.363), the frequency of CRP (p = 0.999), and the mean WBCs, lymphocytes, neutrophils, NLR, LMR, and PLR in the two groups. There was a significant statistical difference between the mean number of oocytes of metaphase II (p = 0.034) and the mean ESR (p = 0.018) in the two groups. It seems necessary to evaluate follicular fluid as a biological substance that is considered an optimal factor for predicting oocyte quality, fertilization rate, embryo quality, and the success rate of ART.

Evaluation of the efficacy of ivf programs in women with infertility who have surgical interventions on the pelvic organs

Aim . To evaluate the effectiveness of assisted reproductive technologies in women with infertility after surgical interventions on the pelvic organs. Material and methods : We analyzed the data of 90 women who approached the Nasl Medical Center due to infertility for IVF in 2017-2020, to whom different approaches in surgical treatment and without surgical interventions on the pelvic organs in the anamnesis were applied at the first stage. Results . “A differentiated approach during the surgical stage and a complex of rehabilitation anti-adhesion measures in the postoperative period, as preparation for the IVF program, ensured a frequency of clinical pregnancy occurrence in 69% of cases, and a cumulative frequency coefficient of live births (CLBR) of 44.8% in the main group.” Conclusions . Decreased fertility of women who underwent abdominal surgery without observing organ-sparing principles and rehabilitation anti-adhesion measures justifies the wider introduction of endoscopic organ-sparing interventions on the pelvic organs with a mandatory postoperative complex of restorative measures in adolescent girls and women of reproductive age to preserve their fertility.

Effectiveness of endometrial scratching in infertility treatment with assisted reproductive technologies

Embryo implantation is a key factor limiting the effectiveness of assisted reproductive technologies, and depends on the quality of the blastocyst and the susceptibility of the endometrium. Various methods of treatment aimed at improving the receptivity of the uterine mucosa, including endometrial scratching, have been proposed. At the same time, the main mechanisms underlying this intervention remain unclear. Moreover, the optimal duration of exposure to the uterine mucosa and the groups of patients in which it can have a positive effect have not been determined. The study aims to investigate the main mechanisms and evaluate the effectiveness of local endometrial damage performed at various times before embryo transfer in the program of assisted reproductive technologies in women with and without a history of implantation failures based on the analysis of scientific literature. Clinical studies, systematic reviews and meta-analyses were studied in PubMed, Embase, Cochrane Library, Web of Science databases, Elsevier, Springer, Wiley publishers, on eLibrary, Research Gate platforms, in open sources of the scientific and educational segment of the Internet. The literature search was conducted by keywords: endometrial scratching, local endometrial damage, implantation failures, endometrial receptivity, assisted reproductive technologies, infertility. The search depth is 20 years. The main mechanisms of the effect of scratching on increasing endometrial receptivity include decidualization, the development of a local inflammatory reaction, as well as improved synchronization between the uterine mucosa and the transferred embryo by preventing premature maturation of the endometrium. Studies that showed a positive effect of local damage to the uterine mucosa were mainly conducted in patients with repeated implantation failures and with intervention in the luteal phase of the cycle preceding stimulation. At the same time, the work performed in a non-selective population of women and non-standardized by exposure time, in most cases, did not reveal the advantages of endometrial scratching. In this regard, additional qualitative randomized controlled trials with a large sample size and a clear identification of groups of patients for whom this intervention may benefit are required.

Thyroid autoimmunity and its negative impact on female fertility and maternal pregnancy outcomes.

Thyroid autoimmunity (TAI) is commonly defined as the presence of thyroperoxidase antibodies (TPOAbs) and/or thyroglobulin antibodies (TgAbs), which predisposes an individual to hypothyroidism. TAI affects nearly 10% of women of reproductive age and evokes great interest from clinicians because of its potentially negative impact on female fertility and pregnancy course. In this mini-review, we review the current literature concerning the influence of TPOAb or TPOAb/TgAb positivity without thyroid dysfunction on reproduction. TAI may negatively affect female fertility; several studies have found an increased prevalence of TAI in infertile women, especially in those with unexplained infertility and polycystic ovary syndrome. According to some observations, TAI might also be connected with premature ovarian insufficiency and endometriosis. The relationship between TAI and an increased risk of pregnancy loss is well documented. The pathophysiological background of these observations remains unclear, and researchers hypothesize on the direct infiltration of reproductive organs by thyroid antibodies, co-existence of TAI with other autoimmune diseases (either organ specific or systemic), immunological dysfunction leading to inhibition of immune tolerance, and relative thyroid hormone deficiency. Interestingly, in the current literature, better outcomes of assisted reproductive technology in women with TAI have been reported compared with those reported in earlier publications. One plausible explanation is the more widespread use of the intracytoplasmic sperm injection method. The results of randomized clinical trials have shown that levothyroxine supplementation is ineffective in preventing adverse pregnancy outcomes in women with TAI, and future research should probably be directed toward immunotherapy.

Outcomes after assisted reproductive technology in women with cancer: a systematic review and meta-analysis.

What are the associations between a history of cancer and outcomes after ART? Compared to women without cancer, on average, women with cancer had a lower return for embryo transfer and a lower likelihood of clinical pregnancy and live birth after ART. Small, single-institution studies have suggested that cancer and its treatment may negatively affect ART outcomes. We conducted a systematic review with meta-analysis of studies comparing ART outcomes between women with and without cancer. PubMed, Embase and Scopus were searched for original, English-language studies published up to June 2021. Inclusion criteria required reporting of ART outcomes after controlled ovarian stimulation (COS) among women with a history of cancer compared to women without cancer who used ART for any indication. Outcomes of interest ranged from duration of COS to likelihood of live birth after embryo transfer. Random-effects meta-analysis was used to calculate mean differences and odds ratios (ORs) with 95% CIs and 95% prediction intervals (PIs). We assessed heterogeneity by age-adjustment, referent group indication for ART, study location and among women with breast cancer and women who initiated ART before cancer treatment. We used visual inspection, Egger's test and the trim-and-fill method to assess funnel plot asymmetry. Of 6094 unique records identified, 42 studies met inclusion criteria, representing a median per study of 58 women with cancer (interquartile range (IQR) = 159) and 114 women without cancer (IQR = 348). Compared to women without cancer, on average, women with cancer had a lower return for embryo transfer (OR: 0.22; 95% CI: 0.07, 0.74; 95% PI: 0.00, 64.98); lower likelihood of clinical pregnancy (OR: 0.51; 95% CI: 0.35, 0.73; 95% PI: 0.19, 1.35); and lower likelihood of live birth (OR: 0.56; 95% CI: 0.38, 0.83; 95% PI: 0.19, 1.69). Substantial among-study heterogeneity was observed for COS duration, gonadotropin dose, cycle cancellation, total oocytes and mature oocytes. Fertilization percentage showed less heterogeneity, but study-specific estimates were imprecise. Similarly, number of embryos showed less heterogeneity, and most studies estimated minimal differences by cancer history. Funnel plot asymmetry was observed for estradiol peak and oocyte maturation percentage. Appreciable confounding is possible in 11 studies that lacked adequate control for group differences in age, and among-study heterogeneity was observed for most outcomes. Lack of data limited our ability to assess how cancer clinical factors (e.g. cancers other than breast, cancer stage and treatment) and ART cycle characteristics (e.g. fresh versus frozen embryo transfers and use of gestational carriers) may affect outcomes. Women with cancer may be less likely to achieve pregnancy and live birth after embryo transfer. Further examination of reproductive outcomes and sources of heterogeneity among studies is warranted to improve evidence of the expected success of ART after a cancer diagnosis. This research was supported in part by R01 CA211093 and P30 ES010126. C.M. was supported by the University of North Carolina Lineberger Cancer Control Education Program (T32 CA057726) and the National Cancer Institute (F31 CA260787). J.A.R.-H. was supported by the National Cancer Institute (K08 CA234333, P30 CA016672). J.A.R.-H. reports receiving consulting fees from Schlesinger Group and Guidepoint. The remaining authors declare no competing interests. N/A.

Эффективность программ вспомогательных репродуктивных технологий с проведением преимплантационного генетического тестирования на анеуплоидии у женщин с синдромом поли­кистозных яичников

Эффективность программ вспомогательных репродуктивных технологий с проведением преимплантационного генетического тестирования на анеуплоидии у женщин с синдромом поли­кистозных яичников

The Ultra-Long Study: A Randomized Controlled Trial Evaluating Long-Term GnRH Downregulation Prior to ART in Women With Endometriosis

(Abstracted from Hum Reprod 2021;36:2676–2686) Although the adverse effect of endometriosis on pregnancy rate is well established, the impact of endometriosis on pregnancy rate after treatment with assisted reproductive technology (ART) remains unclear. There is evidence that the use of prolonged pituitary downregulation before ART in women with any degree of endometriosis increases the odds of clinical pregnancy significantly (up to 4-fold); however, this evidence is limited by potential methodology and publication bias.

Innovative Protocol of ART in Women with LNG-Ius for Fertility-Sparing Treatment of Endometrial Intraepithelial Neoplasia

<h3>Study Objective</h3> to evaluate the safety and efficacy of an Assisted Reproductive Technology (ART) program based on controlled ovarian stimulation with Levonorgestrel Intrauterine System (LNG-IUS) <i>in situ</i> in women affected by endometrial intraepithelial neoplasia<i>.</i> <h3>Design</h3> prospective observational study. <h3>Setting</h3> young women conservatively treated for FIGO IA G1 early endometrial cancer (EEC) and atypical endometrial hyperplasia (AEH) who underwent ART program with LNG-IUS <i>in situ</i>. <h3>Patients or Participants</h3> 6 patients undergoing conservative treatment for EEC (n=1) or AEH (n=5), from January 2019 to March 2021. <h3>Interventions</h3> patients with focal EEC were treated by hysteroscopic resection of the lesion according to Mazzon's technique; patients with AEH were treated by superficial endometrial resection preserving the basal layer of the endometrium. LNG-IUD was inserted in all patients after surgery. Patients were followed with histological evaluation at 3 months by endometrial biopsy, until two subsequent negative biopsies were obtained. At this time, controlled ovarian stimulation was started, oocytes retrieval was performed, and mature oocytes were cryopreserved. After removal of LNG-IUS, embryo transfer procedure was performed. Rates of oocytes retrieved, mature frozen oocytes and pregnancies were assessed. Rates of response and recurrence were also evaluated <h3>Measurements and Main Results</h3> out of 6 patients, 100% had a complete response and no subsequent relapse. Oocytes retrieved were 9.33±2.28 (mean±SD); mature oocytes were 7.5±1.89 (mean±SD). Embryo transfer was performed three months after the LNG-IUS removal. 4 pregnancies were obtained (66.67%),2(50%) of whom resulted in live birth, 1(25%) is still ongoing, 1(25%) resulted in a miscarriage in the first trimester. 2 patients (33.33%) experimented implantation failure and they are waiting for a further attempt <h3>Conclusion</h3> the presence of LNG-IUS during controlled ovarian stimulation has no detrimental effects on ovarian quality, while allowing to balance the potentially dangerous effect of hyperestrogenism on the endometrium of patients affected by AEH or EEC, with promising results about pregnancy outcomes.

The value of transvaginal 4-dimensional hysterosalpingo-contrast sonography in predicting the necessity of assisted reproductive technology for women with tubal factor infertility.

More than 50 million women suffer from infertility worldwide, among whom 30% have associated fallopian tube pathology. Fortunately, the diagnostic accuracy of tubal patency has been enhanced with the consistent development of ultrasound imaging technology, especially the invention of transvaginal 4-dimensional hysterosalpingo-contrast sonography (TV 4D HyCoSy). However, detailed imaging data for evaluating the tubal condition for spontaneous conception and assessing the necessity of assisted reproductive technology (ART) have yet to be amassed. Patients with tubal factor infertility (TFI) who received TV 4D HyCoSy were recruited for this study. They were divided into two groups according to the method of conception: the natural pregnancy group (patients who naturally conceived within 3 months after TV 4D HyCoSy) and the assisted reproduction group (patients who failed to conceive naturally within the 3 months but successfully conceived through ART). Logistic regression analysis was performed to examine the data obtained from participants' medical history and TV 4D HyCoSy investigation. Of the initial 1,433 women, 348 were excluded due to exclusion criteria or lack of follow-up. A total of 1,085 TFI patients were finally included, with individuals in the natural pregnancy group accounting for 27.74% (n=301), and those in the ART group accounting for 37.33% (n=405). The age was younger and the duration of infertility was shorter in the group of women who conceive spontaneously after TV 4D HyCoSy (P<0.05). In terms of imaging data, their endometrial thickness was thinner, right fallopian tube wall was more intact, morphology of the right fallopian tube was smoother, and their ovarian motility (bilateral), fallopian tube visualization (bilateral) and overflow condition of the contrast agent from the fimbriae of fallopian tube (bilateral) were better. In addition, the resistance of the contrast agent injection was less likely to be persistent, reflux was less likely to happen and 0/1 dispersion of the contrast agent around the ovary (bilateral) were more likely to be annular (P<0.05). The imaging data gathered from TV 4D HyCoSy in TFI patients were comprehensive, which suggested that TV 4D HyCoSy could have potential to be used to assess the necessity of post-HyCoSy ART intervention in patients with TFI. This could be of benefit in reducing the incidence of overtreatment and potential complications of ART.

Oocyte ability to repair sperm DNA fragmentation: the impact of maternal age on intracytoplasmic sperm injection outcomes

To study the impact of sperm DNA fragmentation (SDF) on clinical outcomes of assisted reproductive technology in women with different age ranges. Historical cohort study. Private university-affiliated invitro fertilization center. Five hundred forty couples undergoing intracytoplasmic sperm injection cycles. Cycles were split into three groups according to maternal age: ≤36 years old (n = 285), 37-40 years old (n = 147), and >40 years old (n = 108). Semen samples were evaluated for SDF using the Sperm Chromatin Dispersion test and, for each age group, the cycles were subdivided according to SDF index: low fragmentation index (<30% SDF) and high fragmentation index (≥30% SDF). Implantation, pregnancy, and miscarriage rates. For younger patients (≤36 years old) and those between 37 and 40 years of age, no significant differences were noted in laboratory and clinical outcomes for cycles with <30% SDF or ≥30% SDF. When maternal age was >40 years of age, significantly lower high-quality day-3 embryos (54.4% vs. 33.1% and blastocyst development rates (49.6% vs. 30.2%), lower pregnancy (20.0% vs. 7.7%) and implantation rates (19.7% vs. 11.9%), and increased miscarriage rate (12.5% vs. 100.0%) were observed for cycles with ≥30% SDF compared with <30% SDF, respectively. Older oocytes, when injected with sperm derived from samples with high SDF index, develop into embryos of poor quality that lead consequently to lower implantation and pregnancy rates and higher miscarriage rates, in intracytoplasmic sperm injection cycles from women with advanced maternal age.

Perinatal and maternal outcomes after frozen versus fresh embryo transfer cycles in women of advanced maternal age

ObjectiveThe delay of childbearing in women has become a worldwide issue in recent decades. The application of assisted reproductive technology in women of advanced maternal age (AMA) is increasing. Evidence on the safety and outcomes of frozen embryo transfer (FET) compared with fresh embryo transfer (ET) in AMA women is still lacking. Therefore, the objective of the present study was to compare perinatal and maternal outcomes after autologous FET and fresh ET cycles in women of AMA. Study designA retrospective study of 1663 FET and 3964 fresh ET cycles in reproductive medical centers from 2009 to 2014. Women who aged ≥35 years and had clinical pregnancies after autologous frozen or fresh ET were included. The main perinatal outcomes included birth weight, gestational age, rates of preterm birth, macrosomia, low birth weight (LBW), and very low birth weight. The main maternal outcomes included rates of hypertensive disorders of pregnancy, gestational diabetes mellitus, and preterm premature rupture of the membranes. ResultsWomen who underwent FET had an increased risk of hypertensive disorders of pregnancy [1.1 % vs. 0.4 %, adjusted OR (95 % CI): 2.76 (1.39−5.51); p = 0.004]. Singletons born after FET had significantly higher mean birth weight (3388.78 ± 538.47 vs. 3316.19 ± 549.08; p = 0.001). Furthermore, increased risk of macrosomia [13.5 % vs. 10.4 %, adjusted OR (95 % CI): 1.35 (1.07−1.71); p = 0.013] and decreased risk of LBW [3.6 % vs. 5.3 %, adjusted OR (95 % CI): 0.67 (0.45−1.00); p = 0.048] were found in singletons born after FET. ConclusionsPerinatal risks of AMA patients are higher in FET than in fresh ET, including higher birth weight, risks of macrosomia in singleton births, and hypertensive disorders of pregnancy.

PERINATAL AND MATERNAL OUTCOMES AFTER FROZEN VERSUS FRESH EMBRYO TRANSFER CYCLES IN WOMEN OF ADVANCED MATERNAL AGE

The delay of childbearing age in women has become a worldwide issue in recent decades. The application of assisted reproductive technology in women of advanced maternal age (AMA) is increasing. There is still lacking evidence on the safety and outcomes of frozen embryo transfer (FET) compared with fresh embryo transfer (ET) in women of AMA. Therefore, the objective of the present study is to compare perinatal and maternal outcomes after autologous FET and fresh ET cycles in women of AMA.

Restoration of reproductive health in women who recover from COVID-19. Several aspects

<h3></h3> В данном обзоре литературы представлена актуальная информация о восстановлении репродуктивного здоровья женщин после перенесенной новой коронавирусной инфекции (COVID-19). Рассмотрены такие вопросы, как ведение беременности и аспекты профилактики осложнений у родильниц после перенесенного COVID-19, рекомендации по прегравидарной подготовке, подбору методов контрацепции и проведению вспомогательных репродуктивных технологий после перенесенного COVID-19. В обзоре отражены клинические рекомендации международных профессиональных сообществ, включая RCOG (Королевский колледж акушеров и гинекологов Великобритании) и ESHRE (Европейское общество репродукции человека и эмбриологии). Рассмотрены вопросы взаимосвязи психологического состояния женщин после перенесенного COVID-19 и репродуктивного здоровья.

Effect of pretreatment with combined oral contraceptives on outcomes of assisted reproductive technology for women with polycystic ovary syndrome: a meta-analysis.

To evaluate the effect of pretreatment with combined oral contraceptives (COC) on outcomes in women with polycystic ovary syndrome (PCOS) who underwent assisted reproductive technology for subfertility. Two authors independently searched MEDLINE, EMBASE, and the Cochran Library to identify and review articles published from October 1995 until December 2018 according to selection criteria. Outcomes are expressed as mean difference and odds ratio (OR) in a meta-analysis model. A total of seven studies were included in this meta-analysis: one randomized controlled study and two prospective and four retrospective cohort studies. Meta-analysis showed that the COC pretreatment did not affect rate of clinical pregnancy (OR = 0.93, 95% confidence interval CI 0.65-1.34, I2 = 76%) or ovarian hyperstimulation syndrome (OR = 0.90, 95% CI 0.57-1.44, I2 = 0%). However, the rate of miscarriage in the COC group was significantly higher (OR = 1.33, 95% CI 1.02-1.72, I2 = 9%) and the rate of cumulative live birth was significantly lower compared with the control group (OR = 0.72, 95% CI 0.54-0.98, I2 = 55%). Subgroup analysis showed higher rates of miscarriage and lower rates of cumulative live birth in studies with a gonadotropin-releasing hormone (GnRH) antagonist protocol (OR = 1.69, 95% CI 1.17-2.44, I2 = 0% and OR = 0.38, 95% CI 0.29-0.50, respectively). Pretreatment with COC in women with PCOS before assisted reproductive technology may have an adverse effect on clinical outcomes, especially with a GnRH antagonist protocol.

An observational multicentre study on the efficacy and safety of assisted reproductive technologies in women with rheumatic diseases.

ObjectivesThe aim was to determine whether assisted reproductive technologies (ARTs) confer additional risk in rheumatic patients (in terms of disease flare and fetal–maternal complications) and whether, if performed, their efficacy is affected by maternal disease.MethodsSixty infertile rheumatic women undergoing 111 ART cycles were included. Clinical pregnancy rate, live birth rate, maternal disease flares and maternal–fetal complications were recorded.ResultsOne hundred and eleven ART cycles in 60 women were analysed. We reported 46 pregnancies (41.4%), 3 (3.1%) cases of ovarian hyperstimulation syndrome and no cases of thrombosis during stimulation, pregnancy and puerperium. One or more maternal complication was reported in 13 (30.2%) pregnancies, and fetal complications occurred in 11 fetuses (21.1%). The live birth rate was 98%, but we reported three (6%) perinatal deaths in the first days of life. During puerperium, we recorded one (2.5%) post-partum haemorrhage and one (2.5%) articular flare.ConclusionThe safety and efficacy of the ARTs, demonstrated in the general population, seems to be confirmed also in rheumatic patients. No evidence was found to advise against their application, and the choice of therapy should be made depending on the patient’s risk profile, irrespective of whether the pregnancy is natural or artificial induced.

PROTHROMBOTIC STATES IN WOMEN WITH INFERTILITY AND PSYCHOSOMATIC DISORDERS

Failures of in vitro fertilization (IVF) may be associated with prothrombotic states, the circulation of antiphospholipid antibodies (APA).The aim of the study was to establish the value of antiphospholipid antibodies in the effectiveness of infertility treatment by assisted reproductive technologies in women with psychosomatic disorders.Material and methods. 93 women with infertility were screened: 1 group - 32 women without severe psychosomatic disorders; group 2 - 61 women with psychosomatic disorders. The control group consisted of 30 fertile women.Results. Definition in the blood serum of the level of AFA to membrane phospholipids (phosphatidylethanolamine, phosphatidylserine, cardiolipinum), hemostasis (platelet count, ADP-induced platelet aggregation index, fibrinogen concentration, prothrombin index, activated partial thromboplastin time - APTT, D-dimer), homocysteine, molecular genetic study of polymorphous variants for β-fibrinogen (C148T, -455GA) genes. The frequency of significant AFA titres in the group of women without psychosomatic disorders was 18.9%, and if they were present - 44.3%, respectively. Only in 11.5% of women in 2 groups, elevated levels of APA were associated with one or more clinical criteria for antiphospholipid syndrome (APS). In patients with infertility and psychosomatic disorders, increased platelet aggregation in the context of relative thrombocytopenia, higher fibrinogen levels, soluble fibrin-monomeric complexes, and prolonged APTT with elevated D-dimer levels. Some patients have hyperhomocysteinemia. In patients with psychosomatic disorders, the frequency of the minor alleles of the locus C148T and -455GA of the β-fibrinogen gene was greater than 40% (25-30% in group 1).Conclusions. Allocated factors that adversely affect the efficiency of IVF at the patients with psychosomatic disorders: elevation of APA; reduction in the number of platelets; growth of the ADP-induced aggregation index; extension of APTT; increase of fibrinogen, D-dimer; homocysteine; the presence of the minor allele of the T polymorphic locus C148T of the β-fibrinogen gene. The presence of prothrombotic states associated with APS should be taken into account when preparing for IVF and make the appropriate correction for them.

Stimulation of ovulation in program of auxiliary reproductive technologies in women over 40 years (review of literature)

The article presents modern literature data on the stimulation of ovulation in programs of assisted reproductive technologies in women over 40, the advantages and disadvantages of conventional ovarian induction schemes, the clinical and economic effectiveness of the use of coryphollitropine-a for folliculogenesis.

Role of preimplantation genetic screening in effectiveness of programs of assisted reproductive technologies in women with recurrent miscarriage (a review)

Role of preimplantation genetic screening in effectiveness of programs of assisted reproductive technologies in women with recurrent miscarriage (a review)

Prognostic factors for assisted reproductive technology in women with endometriosis-related infertility

Assisted reproductive technology is one of the therapeutic options offered for managing endometriosis-associated infertility. Yet, published data on assisted reproductive technology outcome in women affected by endometriosis are conflicting and the determinant factors for pregnancy chances unclear. We sought to evaluate assisted reproductive technology outcomes in a series of 359 endometriosis patients, to identify prognostic factors and determine if there is an impact of the endometriosis phenotype. This was a retrospective observational cohort study, including 359 consecutive endometriosis patients undergoing invitro fertilization or intracytoplasmic sperm injection, from June 2005 through February 2013 at a university hospital. Endometriotic lesions were classified into 3 phenotypes-superficial peritoneal endometriosis, endometrioma, or deep infiltrating endometriosis-based on imaging criteria (transvaginal ultrasound, magnetic resonance imaging); histological proof confirmed the diagnosis in women with a history of surgery for endometriosis. Main outcome measures were clinical pregnancy rates and live birth rates per cycle and per embryo transfer. Prognostic factors of assisted reproductive technology outcome were identified by comparing women who became pregnant and those who did not, using univariate and adjusted multiple logistic regression models. In all, 359 endometriosis patients underwent 720 assisted reproductive technology cycles. In all, 158 (44%) patients became pregnant, and 114 (31.8%) had a live birth. The clinical pregnancy rate and the live birth rate per embryo transfer were 36.4% and 22.8%, respectively. The endometriosis phenotype (superficial endometriosis, endometrioma, or deep infiltrating endometriosis) had no impact on assisted reproductive technology outcomes. After multivariate analysis, history of surgery for endometriosis (odds ratio, 0.14; 95% confidence ratio, 0.06-0.38) or past surgery for endometrioma (odds ratio, 0.39; 95% confidence ratio, 0.18-0.84) were independent factors associated with lower pregnancy rates. Anti-müllerian hormone levels <2 ng/mL (odds ratio, 0.51; 95% confidence ratio, 0.28-0.91) and antral follicle count <10 (odds ratio, 0.27; 95% confidence ratio, 0.14-0.53) were also associated with negative assisted reproductive technology outcomes. The endometriosis phenotype seems to have no impact on assisted reproductive technology results. An altered ovarian reserve and a previous surgery for endometriosis and/or endometrioma are associated with decreased pregnancy rates.

Прогнозування неефективності допоміжних репродуктивних технологій у жінок з безплідністю та патологією печінки

Прогнозування неефективності допоміжних репродуктивних технологій у жінок з безплідністю та патологією печінки