Outcome Of Assisted Reproductive Technology Treatment Research Articles

Lifestyle and fertility-specific quality of life affect reproductive outcomes in couples undergoing in vitro fertilization.

A Mediterranean dietary pattern, sleeping habits, physical activity, and lifestyle appear to affect reproductive health. There are few reports about whether fertility-specific quality of life (QOL) is linked to infertility treatment outcomes. The aim of this study is to investigate when lifestyle factors and fertility-specific QOL are comprehensively considered, which factors influence assisted reproductive technology (ART) outcomes. This prospective cohort includes 291 women undergoing a first ART treatment at multiple centers in Japan and was designed to evaluate the influence of diet, physical activity, sleeping pattern, computer use duration, and fertility-specific quality of life tool (FertiQoL) score on ART treatment outcomes using a questionnaire. The primary endpoint was the good-quality blastocyst rate per oocyte retrieval and the secondary endpoints were a positive pregnancy test and gestational sac (GS) detection. The good-quality blastocyst rate per oocyte retrieval tended to be negatively associated with frequent fish consumption. After all embryo transfer (ET) cycles, a positive pregnancy test tended to be positively associated with longer sleep and longer computer use (OR = 1.6, 95% CI = 0.9-2.7 and OR = 1.7, CI = 1.0-2.8, respectively) and negatively associated with a smoking partner (OR= 0.6, CI = 0.3-1.0). GS detection was positively and significantly associated with frequent olive oil intake and longer computer use (OR = 1.7, CI = 1.0-3.0 and OR = 1.7, CI = 1.0-3.0, respectively). After ET cycles with a single blastocyst, a positive pregnancy test was positively and significantly associated with longer computer use (OR = 2.0, CI = 1.1-3.7), while GS detection was significantly more likely in women with longer computer use (OR = 2.1, CI = 1.1-3.8) and tended to be more likely in women with a higher FertiQoL Total scaled treatment score (OR= 1.8, CI = 1.0-3.3). p < 0.05 was considered statistically significant and 0.05≤ p <0.01 as tendency. Olive oil may be an important factor in dietary habits. Fertility-specific QOL and smoking cessation guidance for partners are important for infertile couples.

Vertical transmission of microbiomes into embryo culture media and its association with assisted reproductive outcomes

Research Question: Can microbes vertically transmit from semen and follicular fluids to embryo culture media during assisted reproductive technology (ART) treatments?Design: Spent embryo culture media (SECM) were collected along with seminal fluid and follicular fluid samples from 61 infertility couples undergoing ART treatment at the Prince of Wales Hospital, Hong Kong SAR, China. Metagenomic analysis was conducted to identify the source of microbes in SECM, the correlation between semen microbiomes and male infertility, and the correlation between follicular fluid microbiome and female infertility.Results: Microbial vertical transmission into SECM was reported in 82.5% of the cases, and semen was the main source of contamination in c-IVF cases. The increased abundances of Staphylococcus and Streptococcus anginosus in semen showed statistically negative impacts on sperm count and total motility, respectively (p <0.001). We observed significant increases in the abundances of Prophyromonas, Neisseria, and Facklamia in follicular fluid in women with anovulation, uterine factor infertility, and unexplained infertility, respectively (p <0.01). Finally, there was no significant correlation between the bacteria identified in all sample types with ART outcomes including fertilization rates, embryo development, the number of available embryos, and clinical pregnancy rates.Conclusion: Embryo culture media can be contaminated during ART treatment, not only by seminal microbes but also by follicular fluid and other sources of microbes. There were strong correlations between specific microbial taxa in semen and sperm quality as well as between follicular fluid microbiomes and the etiology of female infertility. However, the microbiome of SECM, semen, and follicular fluid showed no significant association with ART treatment outcomes.

Multiple Imputation of Missing Race/Ethnicity Information in the National Assisted Reproductive Technology Surveillance System.

Background: Missing race/ethnicity data are common in many surveillance systems and registries, which may limit complete and accurate assessments of racial and ethnic disparities. Centers for Disease Control and Prevention's National Assisted Reproductive Technology (ART) Surveillance System (NASS) has a congressional mandate to collect data on all ART cycles performed by fertility clinics in the United States and provides valuable information on ART utilization and treatment outcomes. However, race/ethnicity data are missing for many ART cycles in NASS. Materials and Methods: We multiply imputed missing race/ethnicity data using variables from NASS and additional zip code-level race/ethnicity information in U.S. Census data. To evaluate imputed data quality, we generated training data by imposing missing values on known race/ethnicity under missing at random assumption, imputed, and examined the relationship between race/ethnicity and the rate of stillbirth per pregnancy. Results: The distribution of imputed race/ethnicity was comparable to the reported one with the largest difference of 0.53% for non-Hispanic Asian. Our imputation procedure was well calibrated and correctly identified that 89.91% (standard error = 0.18) of known race/ethnicity values on average in training data. Compared to complete-case analysis, using multiply imputed data reduced bias of parameter estimates (the range of bias for stillbirth per pregnancy across race/ethnicity groups is 0.02%-0.18% for imputed data analysis, versus 0.04%-0.66% for complete-case analysis) and yielded narrower confidence intervals. Conclusions: Our results underscore the importance of collecting complete race/ethnicity information for ART surveillance. However, when the missingness exists, multiply imputed race/ethnicity can improve the accuracy and precision of health outcomes estimated across racial/ethnic groups.

A novel variant in CFAP69 causes asthenoteratozoospermia with treatable ART outcomes and a literature review.

Multiple morphological abnormalities of the sperm flagella (MMAF) are a severe form of sperm defect causing male infertility. Previous studies identified the variants in the CFAP69 gene as a MMAF-associated factor, but few cases have been reported. This study was performed to identify additional variants in CFAP69 and describe the semen characteristics and outcomes of assisted reproductive technology (ART) in CFAP69-affected couples. Genetic testing with next-generation sequencing (NGS) panel of 22 MMAF-associated genes and Sanger sequencing was performed in a cohort of 35 infertile males with MMAF to identify pathogenic variants. Morphological, ultrastructural, and immunostaining analyses were performed to investigate the characteristics of probands' spermatozoa. ART with intracytoplasmic sperm injection (ICSI) was carried out for the affected couples to get their own progenies. We identified a novel frameshift variant in CFAP69 (c.2061dup, p. Pro688Thrfs*5) from a MMAF-affected infertile male with low sperm motility and malformed morphology of sperm. Furthermore, transmission electron microscopy and immunofluorescence staining revealed that the variant induced the aberrant ultrastructure and reduction of CFAP69 expression in the proband's spermatozoa. Moreover, the partner of the proband birthed a healthy girl through ICSI. This study expanded the variant spectrum of CFAP69 and described the good outcome of ART treatment with ICSI, which is beneficial to the molecular diagnosis, genetic counseling, and treatment of infertile males with MMAF in the future.

Assisted Reproductive Technology Treatment Outcomes in Women With Liver Disease.

There is a need for evidence-based counseling for women with chronic liver disease (LD) who may experience impaired fertility. Currently, the literature on assisted reproductive technology (ART) treatment in women with LD has been limited to a single European case series. We evaluated ART treatment outcomes in patients with LD and compared with controls. The retrospective study evaluated women with and without LD who had normal ovarian reserve and underwent ART treatment in a high-volume fertility practice from 2002 to 2021. We identified 295 women with LD (mean age 37.8 ± 5.2 years) who underwent 1,033 ART treatment cycles; of these women, 115 underwent 186 in vitro fertilization (IVF) cycles. Six women (2.0%) had cirrhosis, 8 (2.7%) were postliver transplantation, and 281 (95.3%) had chronic LD, with viral hepatitis (B and C) being the most prevalent. In the subgroup who underwent IVF and embryo biopsy, the median fibrosis-4 score was 0.81 (0.58-1.03), and there were no statistically significant differences in response to controlled ovarian stimulation, embryo fertilization rate, or ploidy outcome in patients with LD compared with controls. In those who subsequently underwent a single thawed euploid embryo transfer to achieve pregnancy, there were no statistically significant differences in rates of clinical pregnancy, clinical pregnancy loss, or live birth in patients with LD compared with controls. To the best of our knowledge, this study is the largest to date to evaluate IVF efficacy in women with LD. Our study demonstrates that patients with LD have similar ART treatment outcomes compared with those without LD.

Evaluation of assisted reproductive technology treatment outcomes based on stimulation dosages and anti-Mullerian hormone levels

Background: Serum levels of anti-Müllerian hormone (AMH) have a significant association with ovarian response in the event of assisted reproductive technology (ART) treatment cycles. The present study was performed to evaluate the ovarian stimulation protocols selection with respect to serum AMH levels in patients and its impact on ART outcome. Methods: Based on the serum AMH, 191 women were classified as low, normal and high responders. Follicle Stimulating Hormone (FSH) and Human Menopausal Gonadotropin (HMG) dosages in controlled ovarian stimulation were determined. Retrieval, maturation, fertilization and utilization rates were measured. Subgroup analysis was done using one-way ANOVA followed by post hoc analysis. The relationship between AMH levels and fertilization was determined using Pearson’s correlation analysis. A p-value &lt;0.05 was considered as statistically significant. Results: According to AMH levels, the majority of the patients were normal responders (52.4%) followed by high responders (29.8%) and low responders (17.8%). The average FSH, HMG per day and number of days HMG required was found to be significant among the different responders. Further, retrieval rate and blastulation rate was found to be significant among the different responders. A positive correlation was found between AMH and the number of oocytes retrieved and number of oocytes successfully fertilized, which was found to be significant. In addition, there was a significant inverse relationship between AMH levels and age. Conclusions: The study outcomes revealed that the rates of retrieval, maturation, fertilization, embryo utilization and blastulation were higher among the high responders compared with the low responders. Thus, proper increase in dosages of ovarian stimulation protocol is required among the low responders to achieve quality embryos.

Association of ABO blood groups and ART outcomes among subfertile South Asian women: a retrospective cohort study

BackgroundBlood groups are expressed on the surface of the red cells, and their association with the ovarian reserve and pregnancy outcomes has been an area of interest. The aim of the current study is to study the association of blood groups with live birth rates among South Asian women undergoing assisted reproductive technology treatment. It is a retrospective cohort analysis of women undergoing assisted reproductive technology (ART) at Christian Medical College and Hospital, India, between January 2007 and June 2017. All women ≤ 40 years undergoing the first ART cycle with fresh embryo transfer were included and stratified into four groups (A, B, AB, and O) based on the blood group type. The ART outcomes were analyzed among the groups.ResultsA total of 2524 women underwent fresh embryo transfer cycles during the study period, among whom 2079 women were analyzed. There was no statistically significant difference in the live birth rates for women with blood group B (odds ratio, OR 0.96, confidence interval, CI, 95% 0.74–1.24), blood group AB (OR 0.89, 95% CI 0.58–1.35), and blood group O (OR 0.87, 95% CI 0.68–1.12) with blood group A as the reference. After adjusting for important confounders, there was no statistically significant difference in the live birth rates for women with blood group B, AB, and O in comparison with blood group A.ConclusionThe current study showed no association of blood groups with the ART treatment outcomes in South Asian women.

Anorexigenic peptide (leptin, obestatin, nesfatin-1) levels and their impact on assisted reproductive technology treatment outcomes in patients with polycystic ovary syndrome.

ObjectiveIn this study we aimed to assess anorexigenic peptide levels in patients with or without polycystic ovary syndrome (PCOS) and their effects on assisted reproductive treatment (ART) outcomes.MethodsA prospective case-control study was conducted in a tertiary care university-based ART clinic. Eighty-three patients were included in the study. The PCOS group included 41 patients, and the non-PCOS group included 42 controls. The 2003 Rotterdam criteria were used for PCOS patient selection. The ART indications in the non-PCOS group were tubal factor or unexplained infertility. Venous blood samples were taken on the third day of the menstrual cycle to determine the serum anorexigenic peptide levels. The enzyme-linked immunosorbent assay method was used for laboratory analyses.ResultsIn the PCOS group, serum obestatin levels were significantly lower than in the control group, but serum anorexigenic peptide levels were similar in PCOS patients with or without clinical pregnancy. Ovarian hyperstimulation syndrome (OHSS) was diagnosed only in PCOS patients, and the obestatin levels of OHSS patients were significantly lower than those of other PCOS patients.ConclusionsBaseline anorexigenic peptide levels did not affect the clinical pregnancy rate in ART cycles. Obestatin may play a role in the pathophysiology of OHSS. This possibility should be confirmed in further research.

Stress, anxiety, and depression in infertile couples are not associated with a first IVF or ICSI treatment outcome

BackgroundPsychological distress may exert a negative influence on reproductive function of couples at reproductive age. Couples seeking assisted reproductive technology (ART) treatment may have a higher prevalence of psychological distress than fertile couples. However, whether psychological distress is associated with the outcome of ART treatment remains unknown. We aimed to investigate the association of pre-treatment psychological distress and clinical pregnancy rate among infertility couples undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment.MethodsThis nested case-control study was conducted based on women who underwent their first fresh IVF or ICSI cycle in the Jiangsu Birth Cohort Study (JBC) between November 2015 and January 2019. A total of 150 women who did not obtain clinical pregnancy after first IVF or ICSI fresh embryo transfer were identified as cases, and a total of 300 age matched women who obtained clinical pregnancy were identified as controls. Conditional logistic regression analyses were used to investigate the association between psychological distress and the outcome of first IVF or ICSI treatment, adjusting for multiple potential confounders.ResultsNo statistically significant association was observed between score of maternal symptoms of psychological distress and clinical pregnancy. Adjusted ORs of logistic regression were 1.00 (95% CI 0.97-1.03) for anxiety, 0.98 (95% CI 0.95-1.02) for depression, and 0.98 (95% CI 0.95-1.01) for perceived stress, respectively. When treat depression and anxiety as categorical variables, 62 (13.8%) were classified as clinical depression, 11 (2.4%) were classified as clinical anxiety, among 450 women in the present study. Psychological distress symptoms were also not associated with clinical pregnancy rate. Adjusted ORs of logistic regression were 0.27 (95% CI 0.03-2.33) for anxiety, 0.88 (95% CI 0.46-1.68) for depression, respectively.ConclusionsOur findings firstly indicated that psychological distress experienced prior to IVF/ICSI treatment was not associated with clinical pregnancy.

What can we learn from a decade of promoting safe embryo transfer practices? A comparative analysis of policies and outcomes in the UK and Australia, 2001-2010

Given similar socio-demographic profiles and costs of healthcare, why has Australia been significantly more successful than the UK in reducing the assisted reproductive technology (ART) multiple birth rate? The Australian model of supportive public ART funding, permissive clinical guidelines and an absence of published clinic league tables has enabled Australian fertility specialists to act collectively to achieve rapid and widespread adoption of single embryo transfer (SET). There are striking differences in ART utilization and clinical practice between Australia and the UK. The ART multiple birth rate in Australia is <8% compared with slightly <20% in the UK. The role played by public funding, clinical guidelines, league tables and educational campaigns deserves further evaluation. Parallel time-series analysis was performed on ART treatment and outcome data sourced from the Human Fertilisation and Embryology Authority (HFEA) ART Registry and the Australian and New Zealand Assisted Reproduction Database (ANZARD). Funding arrangements, clinical practice guidelines and key professional and public education campaigns were mapped to trends in clinical practice and ART treatment outcomes between 2001 and 2010. A total of 425 360 and 422 003 autologous treatment cycles undertaken between 2001 and 2010 in the UK and Australia were analysed. From 2001 to 2010, the most striking difference in clinical practice was the increase in SET cycles in Australia from 21 to 70% of cycles, compared with an increase from 8.4 to 31% in the UK. In 2004-2005, both countries introduced clinical guidelines encouraging safe embryo practices, however, Australia has a history of supportive funding for ART, while the National Health Service has a more restrictive and fragmented approach. While clinical guidelines and education campaigns have an important role to play, funding remains a key element in the promotion of SET. This is a descriptive population study and therefore quantifying the independent effect of differential levels of public funding was not possible. With demand for ART continuing to increase worldwide, it is imperative that we remove barriers that impede safe embryo transfer practices. This analysis highlights the importance of supportive public funding in achieving this goal.

Psychiatric disorders among women and men in assisted reproductive technology (ART) treatment. The Danish National ART-Couple (DANAC) cohort: protocol for a longitudinal, national register-based cohort study

IntroductionThere are complex causal associations between mental disorders, fertility treatment, fertility treatment outcome and infertility per se. Eating disorders cause endocrine disturbances, anovulation and thereby infertility, and research has shown...

A national study of the effect of increasing obesity on the response to and outcome of assisted reproductive technology (ART)

OBJECTIVE: To evaluate the effect of increasing female obesity on the response to and outcome of ART treatment.DESIGN: Retrospective cohort study.MATERIALS AND METHODS: The study population included 158,385 ART cycles from the Society for Assisted Reproductive Technology Clinical Online Reporting System for 2007-08 and was limited to women with both height and weight recorded. Women were categorized by their body mass index (BMI, weight/height2) as underweight (<18.5), normal weight (18.5-24.9), overweight (25.0-29.9), and obese (30.0-34.9, 35.0-39.9, 40.0-44.9, 45.0-49.9, and ≥50.0). Logistic regression was used to model the odds of cycle cancellation overall, cycle cancellation due to low response, not pregnant as the treatment outcome, and fetal loss or stillbirth as the pregnancy outcome, as adjusted odds ratios and 95% confidence intervals, with normal weight women as the reference group. Models were adjusted for maternal age, race and ethnicity, height, infertility diagnoses; treatment and pregnancy models were additionally adjusted for oocyte source and state, and number of embryos transferred.RESULTS: Compared to normal weight women, the odds of both cycle cancellation overall and cancellation due to low response significantly paralleled increasing obesity, despite higher dosages of follicle stimulating hormone. These odds rose from 1.05 and 1.11 for overweight women to 1.92 and 2.18 for women with BMIs ≥50.0, respectively. The odds of treatment failure (not pregnant) and pregnancy failure (fetal loss or stillbirth) also increased significantly with rising BMI, from 1.04 and 1.12 for overweight women to 1.50 and 2.23 for women with BMIs ≥50.0, respectively.CONCLUSION: These results indicate significantly higher odds of cycle cancellation, and treatment and pregnancy failures with increasing obesity. These effects are greatest among the heaviest women, but are also significantly higher even among overweight women. OBJECTIVE: To evaluate the effect of increasing female obesity on the response to and outcome of ART treatment. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: The study population included 158,385 ART cycles from the Society for Assisted Reproductive Technology Clinical Online Reporting System for 2007-08 and was limited to women with both height and weight recorded. Women were categorized by their body mass index (BMI, weight/height2) as underweight (<18.5), normal weight (18.5-24.9), overweight (25.0-29.9), and obese (30.0-34.9, 35.0-39.9, 40.0-44.9, 45.0-49.9, and ≥50.0). Logistic regression was used to model the odds of cycle cancellation overall, cycle cancellation due to low response, not pregnant as the treatment outcome, and fetal loss or stillbirth as the pregnancy outcome, as adjusted odds ratios and 95% confidence intervals, with normal weight women as the reference group. Models were adjusted for maternal age, race and ethnicity, height, infertility diagnoses; treatment and pregnancy models were additionally adjusted for oocyte source and state, and number of embryos transferred. RESULTS: Compared to normal weight women, the odds of both cycle cancellation overall and cancellation due to low response significantly paralleled increasing obesity, despite higher dosages of follicle stimulating hormone. These odds rose from 1.05 and 1.11 for overweight women to 1.92 and 2.18 for women with BMIs ≥50.0, respectively. The odds of treatment failure (not pregnant) and pregnancy failure (fetal loss or stillbirth) also increased significantly with rising BMI, from 1.04 and 1.12 for overweight women to 1.50 and 2.23 for women with BMIs ≥50.0, respectively. CONCLUSION: These results indicate significantly higher odds of cycle cancellation, and treatment and pregnancy failures with increasing obesity. These effects are greatest among the heaviest women, but are also significantly higher even among overweight women.

Success rate in icsi (intracytoplasmic sperm injection) treatment of men with non-obstructive azoospermia (NOA): a comparative study between tese (testicular sperm extraction) and microdissection-tese

OBJECTIVE: Compare the results from men with NOA who were submitted to either conventional TESE or to Microdissection-TESE and underwent assisted reproductive technology (ART) treatment in an ICSI protocol. DESIGN: Prospective observational and retrospective comparative study. MATERIALS AND METHODS: Sixty five couples, where men had been diagnosed with NOA, were submitted to Microdissection-TESE procedures for sperm retrieval (group 1). All procedures were scheduled one day prior to ICSI. Seminiferous tubuli were selected under 40x microscopic control and evaluated in the lab for the presence of sperm. Same setting contralateral testicular exploration was carried out as needed. In successful cases, the remaining specimens were cryopreserved for future use. For comparative purposes, we conducted a retrospective analysis of 471 patients with a diagnosis of NOA who underwent ART treatment and had been submitted to conventional TESE in our center (group 2). In all cases, a testicular equatorial incision with the excision of significant testicular samples was used for unilateral or bilateral testicular exploration. Sperm retrieval rate (SRR) and ART treatment outcomes in men who had positive sperm retrieval were studied. RESULTS: Mean male and female partner age in groups 1 and 2 were 38.5 ± 7.5 vs. 38.1 ± 8.0 (p=0.665) and 32.7 ± 4.9 vs. 33.4 ± 6.0 years (p=0.362), respectively. Including the cases where frozen sperm were used in subsequent ART treatment attempts, 78 ICSI cycles were performed in group 1 and 429 in group 2. The SSR was significantly higher in group 1 (55.4 vs. 26.9%; p<0.01). Mean injected oocytes per case and fertilization rate in groups 1 and 2 were 7.6 ± 2.4 vs. 7.6 ± 3.0 (p=0.87) and 57.1 vs. 57.9% (p=0.79), respectively. Mean “excellent” (Type A) embryos transferred per case in groups 1 and 2 were 1.7 ± 1.1 vs. 1.8 ± 1.6, (p=0.94), respectively. Implantation, clinical pregnancy and miscarriage rates in groups 1 and 2 were 13.0 vs. 13.3%, (p=0.93), 31.0 vs. 30.4%, (p=0.95) and 15.4 vs. 15.4%, (p=0.46), respectively. Cumulative pregnancy rate per positive sperm retrieval biopsy in groups 1 and 2 were 36.1 vs. 31.3%, (p=0.59), respectively. CONCLUSIONS: Men with NOA have a higher SRR using Microdissection-TESE when compared to TESE. Nevertheless, similar results in ART treatments that use ICSI should be expected when sperm are retrieved. Clinical pregnancy rates of around 30% should be anticipated in this setting, with a cumulative pregnancy rate per positive biopsy of approximately 36%.

IVF with antisperm antibodies the way forward?

We set to establish the influence of Antisperm Antibodies (ASAB) presence on outcome of Assisted Reproductive Technology (ART), in particular if the laboratory technique used in males with ASAB can impact on outcome. Our null hypothesis was that the outcome of ART treatment is independent of the laboratory technique used when more than 50% but less than 100% ASAB are present.