Assisted Reproductive Technology Research Articles

Vaginal Progesterone Gel versus Intramuscular Progesterone for Luteal Phase Support in Suboptimal Responders Undergoing Assisted Reproductive Cycles

Background: The purpose of this research is to compare the efficacy of 8% micronized vaginal progesterone gel (VAG) at 180 mg daily versus intramuscular progesterone (IMP) in oil at 100 mg daily for luteal phase support (LPS) after fresh single embryo transfer (SET) in Patient-Oriented Strategies Encompassing Individualized Oocyte Number (POSEIDON) Group 1b patients, and to ascertain whether the type of LPS predicts live birth in these patients. Methods: A total of 2420 assisted reproductive technology (ART) cycles performed in Ondokuz Mayıs University IVF Unit were analysed retrospectively. The data of POSEIDON Group 1b (unexpected suboptimal responders) who underwent antagonist in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles were included. All patients were categorized into groups according to the form of LPS, specifically VAG and IMP. Pregnancy, clinical pregnancy rate (CPR), live birth rate (LBR), spontaneous abortion rate and predictors of live birth (age, infertility duration, body mass index (BMI), type of progesterone used for luteal support, serum day 3 estradiol, serum progesterone on the day of human coryonic gonadotrophin (HCG), total duration of induction, serum estradiol on the day of HCG, the total number of oocytes retrieved, number of mature oocytes obtained, average gonadotropin dose per day, total gonadotropin dose administered and total number of embryos retrieved) were analyzed. Results: There was no statistically significant difference between the micronized VAG and IMP groups in terms of age (31 (23–35) vs. 27 (23–35), p = 0.319). There were no statistically significant differences in pregnancy outcomes between the two groups concerning CPR per transfer (70.6% vs. 75.6%; p = 0.364), ongoing pregnancy per cycle (36.2% vs. 39.5%; p = 0.577), and LBR per cycle (34.4% vs. 36.1%; p = 0.785). The spontaneous abortion rates (36.2% vs. 36.8%; p = 0.921) were similar between VAG and IMP groups. The type of LPS did not emerge as a parameter predicting pregnancy (odds ratio (OR): 0.718, 95% confidence interval (95% CI): 0.652–1.313, p = 0.451), clinical pregnancy (OR: 0.598, 95% CI: 0.592–1.289, p = 0.562) and live birth (OR: 0.802, 95% CI: 0.661–1.202, p = 0.580). The logistic regression analysis aimed at assessing the influence of confounding factors, namely age, BMI, and duration of infertility on pregnancy rate, CPR and LBR, did not reveal statistically significant results (p > 0.05). Conclusions: VAG 180 mg daily provide similar pregnancy outcomes compared to 100 mg daily IMP in POSEIDON Group 1b patients undergoing antagonist fresh IVF/ICSI cycles.

Dichorionic triamniotic triplets after two blastocysts transfer underwent multifetal pregnancy reduction: two case reports and literature review

BackgroundThe increase in the rate of multiple pregnancies in clinical practice is associated with assisted reproductive technology (ART). Given the high risk of dichorionic triamniotic (DCTA) triplet pregnancies, reducing DCTA triplet pregnancies to twin or singleton pregnancies is often beneficial.Case presentationThis article reports on two cases of DCTA triplet pregnancies resulting from two blastocyst transfers. Given the high risk of complications such as twin-to-twin transfusion syndrome (TTTS) in monochorionic diamniotic (MCDA) twin pregnancies, patients have a strong desire to preserve the dichorionic diamniotic (DCDA) twins. Multifetal pregnancy reduction (MFPR) was performed in both cases to continue the pregnancy with DCDA twins by reducing one of the MCDA twins. Both of the pregnant women in this report eventually gave birth to healthy twins at 37 weeks.ConclusionsFor infertile couples with multiple pregnancies but with a strong desire to remain the DCDA twins, our report suggests that reducing DCTA triplets to DCDA twin pregnancies may be an option based on clinical operability and assessment of surgical difficulty.

Improved surrogate eggshell incubation system for assisted reproductive technologies such as cloning, genome modification, and de-extinction efforts

A germinal disc located on the egg yolk surface drives genetic modification. Windowed and surrogate eggshell incubation methods have been developed, but these exhibit limited abilities to generate transgenic chickens. In the present study, we investigated the frequency of observing the germinal disc according to the preincubation positioning direction and time and found that it depended on those conditions, but only a few chicks (2.8–5.6%) hatched using the windowed method. Then, we attempted to improve surrogate method via one- or two-step procedures. All eggs, including surrogates that were 10 g heavier than the donor eggs, were obtained from a poultry flock of the same age. With the one-step surrogate method, where the donor egg was transferred only once through a 3.5 cm hole on the point end, at the first day of preincubation, into the surrogate egg, the survival rate at day 4 was 30.8%, and the hatching rate was 11.8%. With the two-step surrogate method (transfer was on the 1st and 4th day of incubation), the survival rate at day 4 was improved to 90.7%, and a hatching rate of 70.0% was achieved. Therefore, this method can be effective for in ovo artificial incubation.

Legal regulation of surrogacy: International experience, status and prospects for development in Ukraine

The use of assisted reproductive technologies in Ukraine is insufficiently regulated at the legislative level, which necessitates a study of one of the types of assisted reproductive technologies – surrogacy – and the legal basis for the use of this phenomenon in Ukraine. The purpose of this study was to clarify the status and identify the shortcomings of legal regulation of surrogacy under the national legislation of Ukraine, and to investigate the world practices of its development. To fulfil the stated purpose, the study employed general scientific and special methods of scientific cognition, specifically, the formal legal method, the comparative legal method, and the method of functional forecasting. The study focused on the specific features of consolidating the institution of surrogacy in European legislation. The study found no unified international regulation of surrogacy relations, which leads to the existence of different approaches to their regulation in legislation. The study analysed the current state of national legislation on the use of assisted reproductive technologies through surrogacy and highlighted the existing gaps and shortcomings that need to be addressed. It was found that Ukraine lacks comprehensive legal regulation of surrogacy relations, which leads to contradictory opinions on the problem of using this type of assisted reproductive technologies. Based on the study conducted, conclusions were drawn on the need to amend the legislation of Ukraine regarding the use of surrogacy as a type of assisted reproductive technology. An analysis of the regulations of Ukraine suggests the need for a unified legal regulation of the surrogacy process. This analysis of the regulatory framework is of practical significance for further legislative regulation of legal relations in surrogacy matters

Clinical characteristics analysis of heterotopic cervical pregnancy

Objective: To investigate the clinical characteristics of heterotopic cervical pregnancy (HCP). Methods: A retrospective analysis was conducted based on the general clinical data, assisted reproductive technology (ART) data, diagnosis and treatment data, and pregnancy outcomes of 17 patients diagnosed with HCP who received ART at the Reproductive Medicine Center of Peking University Third Hospital from January 2011 to April 2022. Results: The age of 17 HCP patients was (34.2±1.5) years, all of whom occurred after the application of ART; Among them, 11 cases had a history of uterine cavity operation. All 17 patients had vaginal bleeding, with only 1 case accompanied by abdominal pain. The gestational age at the diagnosis of HCP was [6+2 (5+2-6+4)] weeks. Two patients underwent conservative observation and were closely followed up. Both of them had intrauterine pregnancy until full-term and underwent cesarean section; One patient underwent ultrasound-guided cervical pregnancy reduction surgery, resulting in miscarriage due to premature rupture of membranes at 18+1 weeks of intrauterine pregnancy; One patient underwent ultrasound-guided cervical pregnancy reduction surgery, followed by uterine artery embolization, hysteroscopy, removal of cervical pregnancy lesions, and curettage due to excessive bleeding; One patient underwent uterine artery embolization, hysteroscopy, cervical pregnancy lesion clearance, and curettage due to excessive vaginal bleeding; One patient underwent hysteroscopy examination, cervical pregnancy lesion removal surgery, and uterine curettage due to embryo arrest during intrauterine pregnancy; 11 cases underwent ultrasound-guided cervical pregnancy lesion clearance surgery, all of which resulted in live births. Among the 13 delivery patients, 4 cases were premature and 9 cases were full-term; 5 cases of vaginal delivery and 8 cases of cesarean section. Conclusions: The most common clinical manifestation of HCP is vaginal bleeding. Ultrasound guided cervical pregnancy lesion clearance surgery is safe and feasible, and with good pregnancy outcomes.

The Effect of COVID-19 and COVID-19 Vaccination on Assisted Human Reproduction Outcomes: A Systematic Review and Meta-Analysis.

The most discussed infectious disease is coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Many research endeavors have focused on the effects of the virus on reproductive organs, as these have also been shown to carry the receptors to which the virus attaches. The results of assisted reproductive technology (ART) have been significantly affected by the pandemic, with some in vitro fertilization (IVF) centers being closed due to the risk of further spread of the disease. According to World Health Organization statistics, 17.5% of adults worldwide suffered from fertility problems in 2023; in other words, one in six people in the world have reproductive health problems. As infertility is a growing problem in the modern world and new developments in assisted reproduction are always a topic of profound interest, it is important to understand the impact of SARS-CoV-2 on reproductive health. This systematic review aimed to examine studies describing patients undergoing ART procedures with a COVID-19-positive history and to shed light on the recent evidence on the safety of COVID-19 vaccination in the ART context. A meta-analysis was conducted to confirm the results of the systematic review. The results showed a significant difference in clinical pregnancy rates between the vaccinated and unvaccinated groups and an increased miscarriage rate in those with a COVID-19-positive history. However, no significant difference in clinical pregnancy and birth rates was found in participants with a previous COVID-19 infection. The results show that further studies and research are needed, even though the spread and impact of the virus have decreased. Evidence-based information for individuals and couples undergoing infertility treatment is vital to enable informed decision-making.

Significance of FSHR and LHCGR gene polymorphisms on clinical outcomes in gonadotropin-releasing hormone antagonist protocol with freeze-all strategy: A case-control study.

Follicle-stimulating hormone receptor (FSHR) and luteinizing hormone/choriogonadotropin receptor (LHCGR) are integral to ovarian function, facilitating follicle development and maturation through their respective hormonal interactions. The influence of receptor polymorphisms on the outcomes of freeze-all cycles remains unclear. This study investigates the impact of FSHR N680S and LHCGR N312S polymorphisms on clinical outcomes in freeze-all cycles. Women undergoing controlled ovarian stimulation for assisted reproductive technology participated in this study. They were administered a gonadotropin-releasing hormone antagonist protocol, with recombinant follicle-stimulating hormone (rFSH) dosages adjusted according to age, body mass index, antral follicle count, and individual hormonal responses. Additionally, human menopausal gonadotropin dosages were tailored based on the LHCGR N312S genetic variant. Analysis revealed no significant differences in age, body mass index, antral follicle count, or marital status across the genotypes of FSHR N680S and LHCGR N312S. However, notable differences were observed in the rFSH dosage required daily and in total among the FSHR polymorphism genotypes. Genotypes of the LHCGR polymorphism correlated with fewer stimulation days. A significant interaction was observed between the 2 polymorphisms concerning total rFSH dosage. The presence of serine in the FSHR polymorphism was associated with higher rFSH dosage requirements. Both FSHR N680S and LHCGR N312S polymorphisms significantly influenced clinical pregnancy and live birth outcomes in freeze-all cycles, underscoring the potential of a pharmacogenomic approach to optimize hormone supplementation in controlled ovarian stimulation protocols during assisted reproductive technology treatments.

Identify Affecting Factors on Total Fertility Rate: A Systematic Review

Background: The total fertility rate (TFR) is a key indicator of population dynamics and health. It shows the average number of children a woman would have in her lifetime, based on the current fertility rates for different age groups. Various factors affect the TFR, such as social, economic, political, technological, environmental, and health factors. By analyzing these factors and how they influence the TFR, policymakers and planners can design and implement interventions to achieve optimal population and health outcomes. Methods: We searched PubMed, Scopus, ISI Web of Science, and ProQuest databases, as well as the Google Scholar search engine systematically. We searched for studies from 13 December 2021 - 20 May 2022, without time limits. We included studies that described at least one driver of TFR. We applied the STEEPH framework (social, technology, environmental, economic, political, and health) method to analyze the qualitative data. Results: We included 64 studies from 26 countries. We identified 410 drivers of TFR, and classified 181 drivers into six main categories: Social, technological, environmental, economic, political, and health. The main factors that lower the fertility rate are education, aging, poverty, postponing marriage (social), exposure of women to mass media (technology), type of residence and living in urban areas, road accidents (environmental), income and economic situation (recession and inflation), unemployment, debt, women’s employment (economic), government policies (political), use of anti-fertility drugs (health). The main drivers that raise the fertility rate are having first child girls, women’s proximity to their workplace (social), use of assisted reproductive technology (technology), living in rural areas and natural and unnatural disasters (environmental), improvement in men’s labor market conditions, employment opportunities (economic), increased parental leave (political), high infant mortality (health). Conclusions: We identified a comprehensive list of effective drivers that have increased or decreased TFR in different parts of the world. It is necessary to review these drivers considering the specific conditions and social, cultural, economic, and political coordinates of each country. This review should inform policymakers' actions in this area.

Good deeds or exploitation?: Queer parents working for private assisted reproductive technologies companies in urban China

This article examines the interplay of queer reproduction and private assisted reproductive technologies (ART) companies in urban China. While same-sex marriage has not gained legal recognition in mainland China and childbirth outside heterosexual marriage has been restricted, queer parents who have children through ART have gradually become visible. ART has emerged as an ideal way for Chinese queer citizens to have children, though they are not legally permitted to use ART services in domestic hospitals. Consequently, an increasing number of queer intended parents turned to underground ART businesses, with some of them becoming salespeople or business owners themselves. My ethnographic analysis comes from fieldworks conducted in Guangdong province, China, from 2018 to 2021. This paper shows that the legal and moral debates brought by queer people’s use of ART are perceived differently among diverse gender and sexual groups in Chinese society. It founds that queer parents’ participation in the ART industry has demonstrated the potential for queer forms of parenthood and family, while reinforcing stratified reproduction and gender inequalities. The tendency to reduce IVF/surrogacy to “womb-for-rent” business among Chinese ART businesses continues to impact queer people’s reproductive and parenting rights. This paper hopes to offer insights into queer reproductive justice and reproductive technologies across the globe.

Parenting strategies and child behavior at preschool age in families using assisted reproductive technologies

Introduction. Certain parenting strategies have a significant impact on the appearance of behavioral problems in children. Due to the continuous increase in the number of children conceived with the help of assisted reproductive technologies (ART), and the availability of limited, disparate and contradictory data on the development of such children and influencing family factors, the purpose of this study is to identify the characteristics and relationship of maternal and paternal parenting strategies and child behavior in preschool age in families with ART. Materials and methods. The sample consisted of 90 families who used ART and 155 families with natural conception. To identify the features of the child's parenting strategies, the "Interaction with the child" questionnaire was used, and the "Behavior of your child" questionnaire was used to assess the child's behavior. Nonparametric Mann–Whitney U test. Results. The general trends (regardless of the type of conception) are the dominance of manifestations of sensitivity to the child, emotionality, responsiveness, positive constructive regulation of discipline on the part of both parents, but with a predominance of severity in mothers compared with fathers (p≤0.05). There is no specificity associated with the type of conception (p>0.05) in the characteristics of a child's behavior at the age of 5 years. On the one hand, the stronger emotionality towards the child on the part of both parents is specific for families who have used ART (3684.5 < U < 5154.0; p≤0.05), but on the other hand, there are trends towards less consistency and the risk of contradictions in the upbringing of a child compared with families with natural conception of a child, the lack of direct links between paternal strategies and child behavior indicators (p>0.05), stronger interrelations of different manifestations of dysfunctional behavior in a child. The types of ART families with different types of severity and relationship of parental parenting strategies and behavioral characteristics of children (p≤0.05) are identified. Conclusion. The results of the study show the need to develop and conduct personalized training programs for parents and build individual trajectories of psychological support for families who have used ART at the age stages of child development.

Assessment of embryologist sufficiency and associated regional disparities in Japanese assisted reproduction facilities using nationwide survey data (IZANAMI project).

This study aims to comprehensively examine the employment and practices of embryologists in Japan's assisted reproductive technology (ART) laboratories, focusing on the impact of various factors such as ART cycle numbers, add-ons, and regional differences. Additionally, it seeks to assess the extent to which Japanese ART facilities meet international minimum standards set by the American Society for Reproductive Medicine (ASRM). A survey was conducted from December 2021 to February 2022 among 621 ART facilities in Japan. The study categorized facilities into five ART cycle groups and compared the number of embryologists across these groups. It also examined the correlation between the number of embryologists, ART cycles, add-ons, and regional differences. Data were analyzed using linear regression and multiple linear regression analyses. The study's findings revealed a significant correlation between the total number of embryologists at each facility and the ART cycles. Notably, there were significant differences in the number of embryologists across all ART cycle categories. Of the 435 facilities, only 44.6% met the ASRM minimum embryologist staffing requirement. The regression analysis further highlighted the significance of ART cycles and preimplantation genetic testing for aneuploidies as factors. Moreover, the number of embryologists stationed at urban facilities was significantly higher than at nonurban facilities, indicating a potential regional disparity. In Japan, it was first found that more than 50% of ART facilities do not have sufficient embryologists in place relative to the number of ART cycles. Furthermore, the add-ons and regional differences affect the placement of embryologists.

The Impact of Endometriosis on Reproductive Outcomes in ART Cycles.

Endometriosis is defined as the existence of endometrial glands and stroma outside the uterine cavity. This disease is responsible for about 15% of the indications for assisted reproductive technologies (ART). This study is a retrospective cross-sectional study on 1382 women aged 18-42 who underwent ART in Yazd Reproductive Sciences Institute during 2018-2022. Women were divided into two groups: women with endometriosis (N = 173) and women with a tubal factor or unexplained infertility as the control group (N = 1209). Chemical and clinical pregnancy rates and live birth rates were compared. Women with endometriosis had significantly (P < 0.001) lower retrieved oocytes (7.73 ± 5.52 vs 11.53 ± 7.46), metaphase II oocytes (6.27 ± 4.72 vs 9.37 ± 6.62), and the total number of obtained embryos (3.95 ± 3.52 vs 6.13 ± 5.02). Chemical (P = 0.001) and clinical (P = 0.028) pregnancy rates were lower in women with endometriosis, while live birth rates showed no difference between the two groups (P = 0.069). The findings of this study showed that endometriosis can disturb reproductive outcomes after ART.

Use and understanding of AI in the ART laboratory: an international survey

Research questionArtificial intelligence (AI) may have the potential to transform assisted reproductive technology (ART), yet adoption remains limited. This study aimed to evaluate awareness, adoption and comprehension of AI among ART laboratory professionals. DesignA cross-sectional survey consisting of 32 questions was conducted among clinical embryologists worldwide using an online questionnaire and was held from July 17th to August 31st, 2023. It assessed familiarity with AI technology, current knowledge within laboratories, understanding of AI principles and limitations, and views on ethical concerns, job impacts, and scientist-patient relationships. ResultsThe study included answers from 702 respondents. Results revealed a high degree of awareness of AI concepts. Participants recognised AI's potential benefits in embryology but acknowledged known limitations. While open to adoption, they expressed reservations surrounding ethics, effects on jobs, and maintaining positive patient relationships. The study uncovered differences in embryologists' opinions based on their years of experience. Most embryologists independent of age were positive regarding AI but workplace concerns diminished with age. ConclusionsIn conclusion, ART professionals are broadly receptive to AI, and yet ethical and practical uncertainties are raised. Further engagement between developers and end-users can align AI innovation with the values and needs of human practitioners.

Prehypertension in male affects both semen quality and pregnancy outcomes in their first single blastocyst frozen-thawed embryo transfer cycles

To investigate whether prehypertension (pre-HTN) in male affects semen quality and assisted reproductive technology (ART) outcomes. Retrospective cohort study. University-affiliated reproductive medicine center. Clinical data were collected from 1,043 couples undergoing their first single blastocyst frozen-thawed embryo transfer cycles. According to the blood pressure (1 mm Hg = 0.133 kPa) in male, including systolic blood pressure (SBP) and diastolic blood pressure (DBP), the subjects were divided into the control group (90 ≤ SBP < 120 mm Hg and 60 ≤ DBP < 80 mm Hg, n = 611) and the pre-HTN group (120 ≤ SBP < 140 mm Hg and/or 80 ≤ DBP < 90 mm Hg, n = 432). The association between pre-HTN and semen quality, and ART outcomes was then evaluated. Primary outcome: live birth rate. semen quality, laboratory embryo outcomes, clinical pregnancy rate, biochemical pregnancy rate, miscarriage rate, and other pregnancy outcomes. Compared with the control group, the pre-HTN group showed lower total sperm motility, total sperm count, sperm progressive motility, progressive sperm count , and higher prevalence of oligozoospermia (17.6% vs. 13.1%), and asthenozoospermia (37.7% vs. 19.8%). Meanwhile, compared with the control group, the pre-HTN group had a lower clinical pregnancy rate (42.8% vs. 57.6%) and a lower live birth rate (32.9% vs. 47.3%). There were no differences in the remaining parameters of semen quality, laboratory embryo outcomes (except for the proportion of intracytoplasmic sperm injection), and pregnancy outcomes between the two groups. Additionally, regression analysis showed that pre-HTN in male was an independent risk factor for clinical pregnancy (adjusted odds ratio, 0.57; 95% confidence interval, 0.44-0.74) and live birth (adjusted odds ratio, 0.58; 95% confidence interval, 0.44-0.75). Prehypertension in male not only results in lower semen quality, but also has negative consequences on the success of ART. It is an independent risk factor for clinical pregnancy and live birth in the first single blastocyst frozen-thawed embryo transfer cycles.

Effects of Embryo Microbial Contamination on ART and Neonatal Outcomes.

This study investigated the incidence and microbial etiology of embryo contamination in assisted reproductive technology (ART), and its influence on embryo development, pregnancy and neonatal outcomes. A retrospective analysis was conducted on embryo contamination at the Reproductive Centre of the Third Affiliated Hospital of Guangzhou Medical University, between 2018 and 2021. In the period from 2018 to 2021, the average incidence of embryo contamination was 0.12%. Bacterial growth was observed in 39 cases, with a preponderance of Escherichia coli (20, 51.28%), Streptococcus agalactiae (7, 17.95%). The fertilization rate of contaminated embryos was 18.18% (Klebsiella pneumoniae) to 94.79% (S. agalactiae), the cleavage rate was 9.09% (Enterobacter cloacae) to 98.90% (S. agalactiae), and the available embryo rate of Day 3 was 0 (Klebsiella pneumoniae, Enterobacter cloacae) to 63.33% (S. agalactiae). Blastocyst formation rate was 3.23% (Proteus mirabilis) to 64.29% (Streptococcus mitis). E. coli contamination occurred mostly on Day 1, and S. agalactiae on Days 3 and 5. After rinsing and rescuing treatment, six healthy male babies were born. E. coli and S. agalactiae were the most common bacterial embryo contaminants. Most microbial contamination can significantly decrease the fertilization rate. Embryo transfer after rinsing and continuing culture had no negative effect on neonatal outcomes, but there was an increased risk of early abortion due to E. coli contamination.

How to Define In-Vitro Fertilization Success: A Delphi Consensus among China Experts

Background: A Delphi consensus was conducted to formulate an expert opinion on the definition of in-vitro fertilization (IVF) success, to provide a reference basis for clinical practice. Methods: Chinese experts in assisted reproductive technology (ART) were surveyed using the Delphi method. Based on the literature related to IVF success, eight experts developed a framework of statements and items. A questionnaire was then distributed to 23 experts to canvas their opinions on these statements. If consensus was not achieved, the statement was revised and revoted upon until a consensus was reached. Results: Consensus was reached for 19 statements related to the definition of IVF success, the most relevant of which are summarized as follows: (1) Goal of IVF treatment ([Formula: see text] statement): to attain a healthy live birth in the shortest possible time and with the lowest possible risks; (2) Definition of IVF success ([Formula: see text] statements): effectiveness, safety, and efficiency of IVF treatment should be included in the definition of success, with the cumulative live birth rate per ovarian stimulation cycle within 2 years being a performance indicator (PI) of success, and IVF success should be measured from a patient-centered perspective, including the patient’s burden and satisfaction. (3) Assurance of IVF success ([Formula: see text] statements): to provide evidence-based treatment and avoid the introduction of IVF add-ons into routine clinical practice without any clear evidence of benefit, optimize treatment quality by establishing and monitoring key PIs, and improving quality control systems. (4) Hurdles of IVF success ([Formula: see text] statements): cycle cancellation before oocyte pickup and treatment discontinuation after failed cycles are hurdles of success to IVF. Conclusions: Based on the Delphi method, the expert opinion on the definition of IVF success has been formed, which could complement guidelines and may help improve treatment outcomes.

Programming the onset of ovarian stimulation: from early follicular phase start to oral contraceptive pill, to luteal phase E2, Duostim, and random start oral contraceptive protocols

Ovarian stimulation has been the single most efficient measure ever taken in assisted reproductive technology for improving outcomes by harvesting multiple oocytes and ultimately, embryos. Today, ovarian stimulation protocols consist of administrating exogenous gonadotropins to override the natural mechanisms that control the ovulatory quota to one in humans. For practicality issues, there have been numerous attempts to control, or "program," when ovarian stimulation is initiated to improve functionality and in turn efficacy for assisted reproductive technology programs. The different options for controlling the onset of ovarian stimulation currently available are discussed here, as well as the novel possibility of using progestins for blocking premature ovulation.

Human Umbilical Cord Mesenchymal Stem Cells Derived Exosomes Improved The Aged Mouse IVM Oocytes Quality.

During assisted reproductive technology (ART) treatment, the aged women, especially those over 35years old, have fewer mature oocytes and poorer quality of the oocytes comparing with the young women. In vitro maturation (IVM) technology facilitates the usage of immature oocytes, which is clinically important for the aged women. However, the maturation rate is low for the oocytes from the aged women. Human umbilical cord mesenchymal stem cells derived exosomes (HUCMSCs-exosomes), as important mediators of intercellular communication, have been widely used to restore ovarian function and improve female fertility. In this study, we isolated HUCMSCs-exosomes and collected the immature germinal vesicle oocytes from the naturally aged mouse model. And we added these HUCMSCs-exosomes to the conventional IVM culture system. The effects of HUCMSCs-exosomes on IVM oocytes were observed and analyzed from multiple aspects including maturation rate, spindle morphology, mitochondria function, and development potential. We found the quality of oocytes was improved by HUCMSCs-exosomes. Based on the results, we propose that HUCMSCs-exosomes may provide a novel and cell free strategy in the improvement of the IVM in elderly infertile women in the future.

Single Nucleotide Polymorphism array analysis for fetuses from balanced translocation carriers at the second trimester

Prenatal diagnosis is crucial for pregnancies from couples with a carrier of a balanced translocation. We retrospectively reviewed 195 pregnancies from 189 couples with a balanced translocation carrier. Of these, 126 were from natural conception, while 69 were conceived through assisted reproductive technology (ART) with preimplantation genetic diagnosis (PGD). Both single nucleotide polymorphism (SNP) array analysis and conventional karyotyping were conducted on all pregnancies, and karyotype-visible imbalances and pathogenic/likely pathogenic copy number variations (CNVs) were categorized as clinically significant abnormalities. In natural conception group, couples with a female carrier experiencing more than two miscarriages accounted for 30.2%, significantly higher than the 14.0% in male carrier couples (p<0.05). In the PGD group, similar difference was observed between female and male carrier couples (p<0.05). In the natural pregnancies, SNP array analysis yielded additional 12 cases of CNVs, including two cases of pathogenic (P)/likely pathogenic (LP) aberrations, four variants with uncertain significance (VUS), and six likely benign variants. Only two CNVs were found to be associated with translocation breakpoints, which were finally confirmed to be of parental inheritance. In the PGD pregnancies, two cases of VUS unrelated to the translocation breakpoints were revealed. Taken together, repeated miscarriage was more frequently observed in couples where the carrier was female than male. Conventional SNP array analysis in prenatal diagnosis indicated insufficient evidence to support the notion that balanced translocations increase the likelihood of fetuses having clinically significant CNVs.

Predictors of gamete donation: a cross sectional survey study.

In 2015, assisted reproductive technology (ART) accounted for 1.7% of all U.S. births, donor eggs accounted for over 17,000 started cycles in 2015, and donor sperm accounting for 6.2% of all cycles started in 2014. With increasing utilization of donor gametes as a method of assisting patients with infertility, the number of babies born each year utilizing gamete donation will also continue to increase. This study aimed to elucidate factors impacting decision to donate, amongst a representative national population. A survey was distributed via the internet utilizing SurveyMonkey Enterprise with HIPAA compliance. Univariate regressions and frequencies were conducted between each demographic and personal characteristic and the willingness to donate. Log Binomial and linear regression was used categorical and continuous variables, and Risk ratios were calculated. In this large survey study, 64% of men and 50% of women reported they would be willing to donate gametes, with the majority desiring monetary compensation. Men with a high Consumer Financial Protection Bureau score were less likely to report that they would consider donating sperm compared to a medium high CFPB score. No other financial indicators were associated with considering donating sperm. There were no associations between CFPB score and egg donation outcomes. Black or African American women were less likely to consider donating their eggs compared to other groups, and more likely to desire > $5000 in compensation. In this large survey study, a small minority of participants reported they would be willing to donate to an unknown infertility patient for reproductive purposes. High and very high CFPB scores were associated with willingness to donate games, but not with desire for monetary compensation or amount.