Autologous Assisted Reproductive Technology Research Articles

Age-Related Increase in Live-Birth Rates of First Frozen Thaw Embryo Compared With First Fresh Transfer in Initial Assisted Reproductive Technology Cycles Without Preimplantation Genetic Testing [ID 2683417

INTRODUCTION: Compare live-birth outcomes stratified by age between primary frozen (FET) and fresh transfers in initial autologous assisted reproductive technology (ART) cycles without preimplantation genetic testing (PGT). METHODS: This was a retrospective cohort study of autologous first ART cycles without PGT comparing success rates of primary embryo transfer (frozen thaw versus fresh) from the 2014–2020 SARTCORS database. We compared live-birth rate (LBR) stratified by age and cumulative live-birth rate (CLBR) for first FET versus first fresh cycles in first ART cycle. Primary transfer (FET or fresh) was the first transfer for an index retrieval. LBR was number of live births from first embryo transfer associated with first retrieval. CLBR was defined as at least one live birth from all linked embryo transfers within 1 year from initial retrieval. Multivariate logistic regression (MLR) determined association between live-birth outcomes and method of transfer. RESULTS: 228,171 first ART cycles resulted in primary embryo transfer. 62,100 initial FETs and 166,071 fresh transfers were compared. LBR was 48.3% for initial FETs versus 39.8% for initial fresh transfers (P<.001). CLBR was 71.8% for initial FETs versus 59.2% for initial fresh transfers (P<.001). MLR demonstrated that initial FETs had a greater chance of live birth across all age groups, with adjusted odds ratio of live birth incrementally increasing with advancing age groups. CONCLUSION: Overall, LBR and CLBR were greater for first FET than fresh transfers with incremental increases in odds of live birth with advancing age, suggesting the presence of a more favorable age-related change in endometrial receptivity present in frozen–thawed cycles.

Age-related increase in live-birth rates of first frozen thaw embryo versus first fresh transfer in initial assisted reproductive technology cycles without PGT

BackgroundThe landscape of assisted reproductive technology (ART) has seen a significant shift towards frozen-thawed embryo transfers (FET) over fresh transfers, driven by technological advancements and clinical considerations. This study aimed to compare live birth outcomes between primary FET and fresh transfers, focusing on cycles without preimplantation genetic testing (PGT), using United States national data from the SART CORS database spanning from 2014 to 2020.MethodsWe performed a retrospective cohort study of autologous first ART cycles without PGT comparing primary embryo transfer (frozen thaw vs. fresh) success rates from the 2014–2020 SARTCORS database. Live-birth rates (LBR) and cumulative live-birth rates (CLBR) were compared between first FET versus first fresh embryo transfer from an index retrieval. Multivariate logistic regression (MLR) determined association between live birth outcomes and method of transfer. In a subsequent sub-analysis, we compared these two embryo transfer methods among patients with either diminished ovarian reserve (DOR) or male factor infertility.Results228,171 first ART cycles resulted in primary embryo transfer. 62,100 initial FETs and 166,071 fresh transfers were compared. Initial FETs demonstrated higher LBR and CLBR compared to fresh transfers (LBR 48.3% vs. 39.8%, p < 0.001; CLBR 74.0% vs. 60.0%, p < 0.0001). MLR indicated greater chances of live birth with FET across all age groups, with adjusted odds ratio (aOR) of live-birth incrementally increasing with advancing age groups. For DOR cycles, LBR and CLBR were significantly higher for FET compared to fresh (33.9% vs. 26.0%, p < 0.001, 44.5% vs. 37.6%, p < 0.0001), respectively. MF cycles also demonstrated higher LBR and CLBR with FET (52.3% vs. 44.2%, p < 0.001, 81.2% vs. 68.9%, p < 0.0001), respectively. MLR demonstrated that in DOR cycles, initial FET was associated with greater chance of live birth in age groups ≥ 35yo (p < 0.01), with aOR of live birth increasingly considerably for those > 42yo (aOR 2.63, p < 0.0001).ConclusionsOverall LBR and CLBR were greater for first FET than fresh transfers with incremental increases in odds of live birth with advancing age, suggesting the presence of a more favorable age-related change in endometrial receptivity present in frozen-thawed cycles. For both DOR and MF cycles, LBR and CLBR after primary transfer were greater for first FET than fresh. However, this was particularly evident in older ages for DOR cycles. This suggests that supraphysiologic stimulation in older DOR cycles may be detrimental to endometrial receptivity, which is in part corrected for in FET cycles.

Impact of Indication for Oocyte and Embryo Reception on Reproductive and Obstetric Outcomes

Objectives: This study aimed to assess if the indication for oocyte reception (OR) or embryo reception (ER) impacts the reproductive and obstetric outcomes by evaluating our experience at a tertiary fertility centre and by performing a literature review on this subject. Several previous studies have reported that, in contrast to other types of fertility treatment, the indication for OR/ER seems to have little impact on the outcomes. However, the compared indication groups vary considerably between these studies, and some data indicates worse outcomes in patients who developed premature ovarian insufficiency (POI) due to Turner syndrome or treatment with chemotherapy/radiotherapy. Design: A retrospective analysis of all cases of OR/ER at a tertiary fertility centre from 2001 until 2020 was conducted. We analysed 584 cycles from 194 individual patients. A literature review on the impact of indication on reproductive or obstetric outcomes of OR/ER was performed using the following databases: PubMed/MEDLINE, Embase, and the Cochrane Library. A total of 27 studies were included and analysed. Participants, Setting, Methods: For the retrospective analysis, patients were divided into three major indication groups: failure of autologous assisted reproductive technology, POI, and genetic disease carrier. To assess reproductive outcomes, we determined pregnancy rate, implantation rate, miscarriage rate, and live birth rate. For comparing obstetric outcomes, we reviewed the term of birth, mode of delivery, and birthweight. Outcomes were compared using Fisher’s exact test, χ² test, and one-way ANOVA utilizing the GraphPad tool. Results: There were no significant differences in reproductive and obstetric outcomes between the three major indication groups in our population, in line with the findings reported by existing literature. Data on impaired reproductive outcomes in patients with POI after chemotherapy/radiotherapy are conflicting. Obstetrically, these patients are at higher risk of preterm birth and possibly also low birthweight, especially after abdomino-pelvic or total body irradiation. For patients with POI due to Turner syndrome, most data suggest similar pregnancy rates but a higher rate of pregnancy loss, and obstetrically an increased risk of hypertensive disorders and caesarean section. Limitations: The small number of patients in the retrospective analysis resulted in low statistical power when evaluating differences between smaller subgroups. There were some missing data on the occurrence of complications during pregnancy. Our analysis covers a period of 20 years, during which several technological innovations have also been made. Conclusions: Our study shows that the important heterogeneity in couples treated with OR/ER does not significantly impact their reproductive or obstetric outcomes, except for POI due to Turner syndrome or treatment with chemotherapy/radiotherapy, where there seems to be an important uterine/endometrial component that cannot be entirely overcome by providing a healthy oocyte.

Low anti-mullerian hormone decreased clinical pregnancy and increased risk of poor ovarian response in women over 35 years of age.

Low anti-mullerian hormone decreased clinical pregnancy and increased risk of poor ovarian response in women over 35 years of age.

Association of state insurance coverage mandates with assisted reproductive technology care discontinuation

Insurance coverage for fertility services may reduce the financial burden of high-cost fertility care such as assisted reproductive technology and improve its utilization. Patients who exit care after failing to reach their reproductive goals report higher rates of mental health problems and a lower sense of well-being. It is important to understand the relationship between state-mandated insurance coverage for fertility services and assisted reproductive technology care discontinuation. This study aimed to assess whether state-mandated insurance coverage for fertility services is associated with lower rates of care discontinuation after an initial assisted reproductive technology cycle that did not result in a live birth. This is a retrospective, population-based cohort study using data from United States fertility clinics reporting to the National Assisted Reproductive Technology Surveillance System during 2016 and 2018. Patients who began their first autologous assisted reproductive technology cycle during 2016 and 2017 and did not have a live birth were included. We describe the rate of assisted reproductive technology care discontinuation (no additional cycle within 12 months of the previous cycle's date of failure). Multivariable analyses were conducted to evaluate factors independently associated with care discontinuation, including the scope of fertility services included in state coverage mandate at assisted reproductive technology cycle initiation that were as follows: comprehensive (≥3 assisted reproductive technology cycles), limited (1, 2, or an unspecified number of assisted reproductive technology cycles), mandate not including assisted reproductive technology, and no mandate. Among 91,324 patients who underwent their first autologous assisted reproductive technology cycle that did not result in live birth, 24,072 (26.4%) discontinued care. Compared with patients who lived in states with mandates for comprehensive assisted reproductive technology coverage, those in states with mandates for fertility services coverage that did not include assisted reproductive technology or states with no mandate were 46% (adjusted relative risk, 1.46; 95% confidence interval, 1.31-1.63) and 26% (adjusted relative risk, 1.26; 95% confidence interval, 1.15-1.39) more likely to discontinue care, respectively, after controlling for patient and cycle characteristics. Increasing patient age, distance from clinic ≥50 miles, previous live birth, fewer oocytes retrieved, and not having embryos cryopreserved were also associated with higher rates of discontinuation. Non-Hispanic Black, non-Hispanic Asian, and Hispanic patients had higher rates of care discontinuation than non-Hispanic White patients regardless of the existence or scope of state-mandated assisted reproductive technology coverage. Comprehensive state-mandated insurance coverage for assisted reproductive technology is associated with lower rates of assisted reproductive technology care discontinuation.

Which assisted reproductive technology (ART) treatment strategy is the most clinically and cost-effective for women of advanced maternal age: a Markov model

ObjectiveTo evaluate the clinical and cost-effectiveness of preimplantation genetic testing for aneuploidy, social freezing, donor and autologous assisted reproductive technology (ART) treatment strategies for women aged 35–45 following 6–12 months of infertility.MethodsFour Markov decision-analytic models comprising: (i) Preimplantation genetic testing for aneuploidy (PGT-A); (ii) autologous ART from age 40 using oocytes cryopreserved at age 32 (social freezing); (iii) ART using donated oocytes (donor ART); (iv) standard autologous ART treatment (standard care) were developed for a hypothetical cohort of 35 to 45 years old ART naïve women with 6–12 months of infertility. Input probabilities for key parameters including live birth rates were obtained from the available literature. Deterministic and probabilistic sensitivity analyses were conducted to address uncertainty in estimating the parameters and around the model’s assumptions. Cost effectiveness was assessed from both societal and patient perspectives .Result(s)For infertile women at age 40 and above, social freezing is the most cost-saving strategy with the highest chance of a cumulative live birth at a lowest cost from a societal perspective. PGT-A and donor ART were associated with higher treatment costs and cumulative live-birth rates compared with the autologous ART. Among the four ART strategies, standard autologous ART has the lowest cumulative live birth rate of 45% at age 35 and decreasing to 1.6% by age 45 years. At a willingness-to-pay threshold of Australian dollars (A$)50,000, our model shows all alternative treatment strategies –PGT-A, social freezing and donor ART have a higher probability of being cost-effective compared to the standard autologous ART treatment. However, higher out-of-pocket expenditure may impede their access to these alternate strategies.ConclusionGiven current evidence, all alternate strategies have a higher probability of being cost-effective compared to the standard autologous ART treatment. Whether this represents value for money depends on societal and individual’s willingness-to-pay for children conceived with ART treatment.

Impact of Thyroid Autoimmunity on Assisted Reproductive Technology Outcomes and Ovarian Reserve Markers: An Updated Systematic Review and Meta-Analysis

Background: Thyroid autoimmunity (TAI) has a high prevalence among women of reproductive age. Investigating its possible impact on ovarian function and fertility is, thus, of utmost relevance. The aim of this systematic review and meta-analysis was to elucidate the effect of TAI on both assisted reproductive technology (ART) outcomes and ovarian reserve. Methods: This systematic review and meta-analysis was restricted to two groups of research articles investigating the association between TAI and: (1) autologous ART outcomes (i.e., fertilization rate [FR], implantation rate, clinical pregnancy rate [CPR], miscarriage rate, and live birth rate), (2) markers of ovarian reserve (i.e., anti-Müllerian hormone, basal follicle stimulating hormone, antral follicle count, and number of oocytes retrieved). Studies including women affected by overt hypo/hyperthyroidism were excluded. Relevant studies were identified by a systematic search in PubMed, MEDLINE, ClinicalTrials.gov, Embase, and Scopus, from database inception to May 1, 2022. Results: From a total of 432 identified publications, 22 studies were included in Group 1 and 26 studies in Group 2. The presence of TAI was associated with a higher risk of miscarriage (7606 participants, odds ratio [OR] 1.52, confidence interval [CI 1.14-2.01], p = 0.004, I2 = 53%), lower chance of embryo implantation (7118 participants, OR 0.72, [CI 0.59-0.88], p = 0.001, I2 = 36%), and live birth (11417 participants, OR 0.73, [CI 0.56-0.94], p = 0.02, I2 = 71%). These associations were no longer observed in a subgroup analysis of patients who exclusively underwent intracytoplasmic sperm injection (ICSI). The FR and CPR as well as the mean values of surrogate markers of oocyte quantity appeared not to be affected by TAI. Conclusions: This data synthesis suggest a higher risk of adverse ART outcomes in women with positive TAI. However, the reliability of these findings is hampered by the relatively low quality of the evidence and significant heterogeneity in many of the meta-analyses. The possible protective effect of ICSI is promising but should be confirmed in controlled prospective clinical trials. PROSPERO Registration ID: CRD42021236529.

The impact of insurance mandates on donor oocyte utilization: an analysis of 39,338 donor oocyte cycles from the Society for Assisted Reproductive Technology registry

A total of 19 states passed legislation mandating insurance coverage of assisted reproductive technology, and out-of-pocket costs associated with invitro fertilization vary significantly depending on the region. Consequently, it has been observed that assisted reproductive technology utilization differs regionally and is associated with the presence of an insurance mandate. However, it is unknown whether regional differences exist among patients using donor oocytes. This study aimed to determine the patient and cycle-specific parameters associated with the use of donor oocytes according to the insurance mandate status of the Society for Assisted Reproductive Technology clinic in which the assisted reproductive technology cycle was performed. This study was a retrospective cohort study using national data collected from the Society for Assisted Reproductive Technology registry for 39,338 donor oocyte cycles and 242,555 autologous oocyte cycles performed in the United States from January 1, 2014, to December 31, 2016. Cycles were stratified by insurance mandate of the state in which the assisted reproductive technology cycle was performed: comprehensive (coverage for at least 4 cycles of assisted reproductive technology), limited (coverage limited to 1-3 assisted reproductive technology cycles), offer (insurance mandates exist but exclude assisted reproductive technology treatment), and no mandate. The primary outcome was the number of previous autologous assisted reproductive technology cycles of the recipient. The secondary outcomes included age, serum follicle stimulating hormone level, frozen donor oocyte utilization, day of embryo transfer, number of embryos transferred, clinical pregnancy rate, and live birth rate. Analyses were adjusted for day of transfer, number of embryos transferred, and age of the recipient. Patients in no mandate states underwent fewer autologous assisted reproductive technology cycles (mean, 1.1; standard deviation, 1.6) before using donor oocytes than patients in offer (mean, 1.7; standard deviation, 2.5; P<.01), limited (mean, 1.5; standard deviation, 2.5; P<.01), and comprehensive (mean, 1.7; standard deviation, 2.0; P<.01) states. Patients in no mandate states were more likely to use frozen oocytes than patients in offer (relative risk, 0.54; 95% confidence interval, 0.52-0.57), limited (relative risk, 0.50; 95% confidence interval, 0.46-0.54), and comprehensive (relative risk, 0.94; 95% confidence interval, 0.89-0.99) states. Clinical pregnancy and live birth rates were similar among recipients of donor oocytes, regardless of insurance mandate. Despite similar ages and ovarian reserve parameters, patients without state-mandated insurance coverage of assisted reproductive technology were more likely to use frozen donor oocytes and undergo fewer autologous invitro fertilization cycles than their counterparts in partial or comprehensive insurance coverage states. These differences in donor oocyte utilization highlight the financial barriers associated with pursuing assisted reproductive technology in uninsured states.

The impact of single-step and sequential embryo culture systems on obstetric and perinatal outcomes in singleton pregnancies: the Massachusetts Outcomes Study of Assisted Reproductive Technology

To compare the obstetric and perinatal outcomes of deliveries conceived with embryos from single-step vs. sequential culture media systems. Historical cohort of Massachusetts vital records linked to assisted reproductive technology clinic data from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System and laboratory embryology data from two large academic hospital fertility centers. Not applicable. Patients with singleton live birth deliveries between 2004 and 2017 conceived with autologous assisted reproductive technology cycles with fresh blastocyst transfer using either single-step (n = 1,058) or sequential (n = 474) culture media systems. None. Associations of single-step vs. sequential culture with obstetric outcomes (mode of delivery, placental abnormalities, pregnancy-induced hypertension, and gestational diabetes) and perinatal outcomes (preterm birth, low birthweight, small-for-gestational-age, and large-for-gestational-age [LGA]) were assessed with multivariate logistic modeling, adjusted for maternal age, race/ethnicity, education, parity, insurance type, protein supplementation, oxygen concentration, fertilization method, and number of transferred embryos. Compared with sequential culture, single-step culture was associated with increased odds of LGA (adjusted odds ratio 2.1, 95% confidence interval 1.04-4.22). There were no statistically significant differences between single-step and sequential culture media systems in the odds of placental abnormalities, pregnancy-induced hypertension, gestational diabetes, prematurity, small-for-gestational-age, or low birthweight. Single-step culture is associated with increased odds of LGA, indicating that embryo culture media systems may affect perinatal outcomes.

Progression of depression and anxiety symptoms in pregnancies conceived by assisted reproductive technology in the United States

Purpose Women who utilize assisted-reproductive technology (ART) to achieve pregnancy experience unique circumstances before and during their pregnancy. This study aims to examine the progression of mental health in pregnant women who conceived via various methods of ART to understand gestational time periods of emotional stability or risk specific to these populations. Methods Secondary analysis of the Yale Pink and Blue Study – a prospective cohort involving women from 137 obstetrical practices in the northeastern United States between 2005–2009. Depressive and anxiety symptoms among spontaneous, planned pregnancies were compared to ART pregnancies using the Edinburgh Postnatal Depression Scale (EPDS) and its anxiety subscale (EPDS-3A), respectively. Generalized Estimating Equations were used to compare group changes (EPDS and EPDS-3A score threshold ≥10) at timepoints of <17 weeks (T1), 28(±2) weeks (T2), and 8(±4) weeks postpartum (T3). Results 1,466 spontaneous, planned pregnancies were compared to 191 pregnancies conceived via ART. Prevalence of depressive symptoms were similar between conception groups. Change in prevalence over time differed significantly between those groups (from T1 to T3 (β 0.59), as well as between spontaneous pregnancies compared to autologous gamete ART pregnancies (from T1 to T2 (β 0.48) and T1 to T3 (β 0.65). Course of anxiety did not differ between conception groups. Conclusions Women who conceive via ART have different rates of change in depressive symptoms throughout gestation compared to women with spontaneous pregnancies.

ENDOMETRIAL THICKNESS AND OBSTETRICAL OUTCOME IN ASSISTED REPRODUCTIVE TECHNOLOGY

Mounting evidence suggests that assisted reproductive technology (ART) alters certain obstetrical parameters as compared to natural pregnancies. Endometrial thickness (EMT) is one possible parameter which could impact on the depth of placentation – either too shallow, or too deep. While the impact of EMT on actual pregnancy rates has been studied in ART, little is known on whether EMT affects the quality of placentation. Therefore, we studied the impact of EMT on obstetrical outcomes following fresh and frozen embryo transfers (ET). Retrospective cohort study including patients who obtained a live birth (LB) after autologous ART in our center, between January 2017 and December 2019. Single and double blastocyst transfers were included. Fresh and frozen ET with singleton and twin pregnancies were analyzed separately. We divided them into 4 groups according to the last measured EMT before ET : <7mm,7 to 9 mm; 9 to 12 mm; ≥ 12 mm. Primary outcome was pregnancy duration in days. Secondary outcomes were the birth weight, obstetrical complications and the delivery mode. Associations between the 4 EMT groups were assessed using ANOVA and Fisher tests. 120 patients obtained single LB after fresh ET and 19 patients obtained twin LB. After frozen ET 571 patients had single LB and 75 patients had twin LB. No significant difference was reported between the 4 EMT groups when compared for pregnancy duration in fresh or frozen ET, and in singleton or twin pregnancies. In fresh ET with singleton pregnancies, more obstetrical complications and medically induced deliveries before 41 gestational weeks (GW) were reported in the groups<7 mm and >12mm.Table 1Results for singleton pregnancies<7 mm7-9 mm9-12 mm≥12 mmpvalueFresh ETN=5N=25N=68N=22Pregnancy Duration256.7±20.3262.7±13.4260.7±18.5263.3±10.20.78Birth Weight3153±744.73263.7±407.13196.1±509.23128.2±507.70.83SpontaneousInduced<41GWInduced≥41GW1 (20)2 (40)2 (40)19 (76)5 (20)1 (4)49 (72)14 (21)5 (7)9 (41)10 (45)3 (14)0.01Complications4 (80)4 (16)20 (29)7 (32)0.04Frozen ETN=19N=324N=202N=26Pregnancy Duration256.7±20.3262.7±13.4260.7±18.5263.3±10.20.23Birth Weight3139.2±777.03326.7±535.73271.3±635.23422.7±469.50.29SpontaneousInduced<41GWInduced≥41GW9 (47)7 (37)3 (16)147 (45)126 (39)51 (16)89 (44)78 (39)35 (17)12 (46)10 (38)4 (15)0.99Complications4 (21)87 (27)49 (24)7 (27)0.88 Open table in a new tab Our findings report no difference in the pregnancy duration (in days) or in birth weight related to endometrial thickness at the time of fresh or frozen ET. This suggests that EMT does not impact the quality of placentation.

Personal exposure to particulate matter air pollution and outcomes of ovarian stimulation: a pilot study in Massachusetts, US

BACKGROUND AND AIM: Higher exposure to ambient air pollution has been associated with lower fertility in women including specific adverse effects on ovarian steroidogenesis and folliculogenesis; however, no previous studies have measured personal exposure to air pollution which quantifies a woman’s real exposure levels. METHODS: We enrolled nine women undergoing a fresh, autologous assisted reproductive technology (ART) cycle at the Massachusetts General Hospital Fertility Center 2018-2019. At the woman’s baseline ultrasound appointment (cycle day 3), they were given an AirBeam2 monitor, which measures three size fractions of particulate matter (PM1, PM₂.₅, and PM10), a smartphone, and a 3-day activity diary. Women collected exposure data for the following 72 hours. Between cycle day 11 and 16, women underwent oocyte retrieval and information was collected on number of total and mature oocytes retrieved. Multivariable generalized linear models were used to evaluate associations between personal PM exposures and ovarian stimulation outcomes. RESULTS:Women collected PM data for an average (minimum, maximum) of 33.7 (8.4, 64.4) hours during ovarian stimulation. Their median (interquartile range [IQR]) exposure to PM1, PM₂.₅, and PM10 was 0.4 (4.1), 2.3 (5.5), 3.7 (8.3) μg/m³, respectively. After adjusting for age, stimulation protocol, infertility diagnosis, and average temperature exposure, an IQR increase in average exposure to PM1, PM₂.₅, and PM10 during cycle days 3 to 5 was associated with -26.8% (95% CI -37.6, -14.2%), -47.9% (95% CI -61.6, -29.1%), and -43.8% (95% CI -57.3, -26.0%) fewer oocytes retrieved, respectively. An IQR increase in PM1, PM₂.₅, and PM10 exposure was also associated with -18.4% (95% CI -33.9, 0.6%), -38.2% (95% CI -58.5 -8.1%), and -34.0% (95% CI -53.8, -5.6%) fewer mature oocytes retrieved, respectively. CONCLUSIONS:In this small pilot study of women undergoing ART in Massachusetts, higher personal exposure to PM during ovarian stimulation was associated with poorer oocyte yield. KEYWORDS: Air pollution, Particulate matter, Reproductive Outcomes, Short-term exposure, Environmental epidemiology

Female age is associated with the optimal number of oocytes to maximize fresh live birth rates: an analysis of 256,643 fresh ART cycles

Research questionWhat is the optimal number of oocytes retrieved at which maximum live birth rate is observed after fresh autologous assisted reproductive technology (ART) cycles for women of different ages? DesignRetrospective cohort study of all fresh autologous ART aspiration cycles (n = 256,643) undertaken in Australia and New Zealand between 2009 and 2015. Primary outcome measure was live birth rate (LBR) (delivery of at least one liveborn baby at 20 weeks’ gestation or over per fresh aspiration cycle). Cycles were grouped according to female age (<30, 30–34, 35–49, 40–44 and ≥45 years) and ovarian response (one to three, four to nine, 10–14, 15–19, 20–25 and ≥25 oocytes). Secondary outcome was incidence of ovarian hyperstimulation syndrome (OHSS) requiring hospitalization. ResultsAt different oocyte yields, LBR per fresh aspiration cycle peaked and then declined at, depending on female age: <30 years: six to 11 oocytes (LBR 31–34%); 30–34 years: 11–16 oocytes (LBR 29–30%); 35–39 years: nine to 17 oocytes (LBR 21–24%); and 40–44 years: 15–17 oocytes (LBR 11–12%). The incidence of OHSS increased significantly with the number of oocytes retrieved, from 1.2% with 15 oocytes retrieved to 9.3% with 30 or more oocytes retrieved (P < 0.001). ConclusionThe optimal number of oocytes at which maximum LBR was observed in a fresh aspiration cycle was highly dependent on age. Because of the observational nature of the results, a cause–effect relationship between the number of oocytes retrieved and LBR should not be assumed; evidence from well-designed randomized control trials is required before clinical advice can be suggested.

The effect of donor and recipient race on outcomes of assisted reproduction

A growing literature suggests that minority races, particularly Black women, have a lower probability of live birth and higher risk of perinatal complications after autologous assisted reproductive technology. However, questions still remain as to whether these racial disparities have arisen because of associations between race and oocyte/embryo quality, the uterine environment, or a combination of the two. Oocyte donation assisted reproductive technology represents a unique approach to examine this question. This study aimed to evaluate the associations between the race of female oocyte donors and recipients and live birth rates following vitrified donor oocyte assisted reproductive technologies. This was a retrospective study conducted at a single, private fertility clinic that included 327 oocyte donors and 899 recipients who underwent 1601 embryo transfer cycles (2008-2015). Self-reported race of the donor and recipient were abstracted from medical records. Live birth was defined as the delivery of at least 1 live-born neonate. We used multivariable cluster weighted generalized estimating equations with binomial distribution and log link function to estimate the adjusted risk ratios of live birth, adjusting for donor age and body mass index, recipient age and body mass index, tubal and uterine factor infertility, and year of oocyte retrieval. The racial profile of our donors and recipients were similar: 73% white, 13% Black, 4% Hispanic, 8% Asian, and 2% other. Women who received oocytes from Hispanic donors had a significantly higher probability of live birth (adjusted risk ratio, 1.20; 95% confidence interval, 1.05-1.36) than women who received oocytes from white donors. Among Hispanic recipients, however, there was no significant difference in probability of live birth compared with white recipients (adjusted risk ratio, 1.07; 95% confidence interval, 0.90-1.26). Embryo transfer cycles using oocytes from Black donors (adjusted risk ratio, 0.86; 95% confidence interval, 0.72-1.03) and Black recipients (adjusted risk ratio, 0.84; 95% confidence interval, 0.71-0.99) had a lower probability of live birth than white donors and white recipients, respectively. There were no significant differences in the probability of live birth among Hispanic, Asian, and other race recipients compared with white recipients. Black female recipients had a lower probability of live birth following assisted reproductive technology, even when using vitrified oocytes from healthy donors. Female recipients who used vitrified oocytes from Hispanic donors had a higher probability of live birth regardless of their own race.

THE EFFECT OF DONOR AND RECIPIENT RACE ON OUTCOMES OF ASSISTED REPRODUCTION USING DATA FROM A VITRIFIED DONOR OOCYTE BANK

A growing literature suggest that minority races, particularly Black women, have a lower probability of live birth and a higher risk of perinatal complications after autologous assisted reproductive technology (ART); however, questions still remain as to whether racial disparities are associated with differences in oocyte/embryo quality, an impaired uterine environment, or a combination of the two. To investigate this question further, we evaluated how oocyte donor and recipient race is associated with ART outcomes using data from a large, racially diverse vitrified donor oocyte bank.

Assisted reproductive technology in Africa: a 5-year trend analysis from the African Network and Registry for ART

Research questionWhat were the trends in utilization, outcomes and practices in assisted reproductive technology (ART) in Africa between 2013 and 2017? DesignCycle-based data and retrospective summary data were collected cross-sectionally from voluntarily participating ART centres. ResultsDuring the 5-year period, 153,917 ART procedures were reported from 73 centres in 18 countries. ART utilization remained low in all countries and years. Autologous fresh ART was by far the most common intervention, with little change in the clinical pregnancy rate (CPR) per aspiration (34.9% in 2013; 31.7% in 2017) and a consistent preponderance of young women. Oocyte donation represented less than 10% of reported procedures. Although the transfer of multiple embryos prevailed, elective single-embryo transfer (eSET) resulted in a CPR of 43.2% per transfer in fresh autologous cycles, which was notably higher compared with non-elective SET cycles (16.6%) and all dual embryo transfers (DET; 37.3%). Compared with eSET, elective DET further increased the CPR by less than 5% while raising the multiple delivery rate by 33.4%. The majority of multiples were born preterm. Many pregnancies were, however, lost to follow-up, compromising the delivery and birth outcome data. ConclusionART monitoring has been successfully established in Africa although progress must continue. Although data are not yet representative, best evidence indicates low access to ART. Perinatal outcome supports eSET, but other social determinants responsible for multiple embryo transfers are important factors to consider. Efforts must be directed at improving pregnancy follow-up. Registry data are integral to the widening of access to high-quality ART in Africa.

Risk of Lower Birth Weight and Shorter Gestation in Oocyte Donation Pregnancies Compared With Other Assisted Reproductive Technology Methods: Systematic Review.

Oocyte donation (OD) is associated with an increased risk of pregnancy-induced hypertension, but the evidence of an association between OD and infant outcomes, including birth weight and gestational age, is conflicting. This study sought to determine the associations between oocyte donation and birth weight or gestational age compared with other forms of autologous oocyte assisted reproductive technology (ART). Medline, Embase, and the CENTRAL Trials Registry of the Cochrane Collaboration were searched using a comprehensive search strategy. Studies of women over 24 weeks gestation compared infant outcomes among OD pregnancies versus other ART. Study quality was assessed, and a meta-analysis of mean birth weight and gestational age was conducted using a random effects model. Nineteen studies were included. Four studies showed a significant association between OD and lower birth weights, and five studies found significant differences in gestational age between OD and autologous oocyte ART. The pooled difference in birth weight means between OD and autologous ART was -42 (-88, 4) . The pooled difference in gestational age was -0.4 weeks (-0.8, 0.0 weeks). A high degree of interstudy heterogeneity exists, and the association between OD and infant outcomes remains unclear.

Delivery and feto-neonatal outcomes of diamniotic twin pregnancies in women with no chronic disease or gestational complications: impact of mode of conception

Introduction: Autologous and heterologous assisted reproductive technology (ART) conceptions have been on the rise for the last few decades and alongside with that have the rate of multiple pregnancies. Multiple gestations are associated with high odds of gestational complications and, in turn, adverse delivery and feto-neonatal outcomes. Whether ART-conception further increases such elevated risk is still debated. ART is more commonly accessed by older women with chronic diseases, which relate to heightened likelihood of complications. We decided to investigate the influence of autologous and heterologous ART conception compared to spontaneous conception on delivery and feto-neonatal outcomes of diamniotic twin pregnancies in a cohort of healthy women with no chronic conditions or gestational complications.Materials and methods: Retrospective cohort study among diamniotic twin pregnancies in mothers without pregestational or gestational disease. Delivery and feto-neonatal outcomes were compared among three groups according to mode of conception: (1) spontaneous conception (SC, referent group, n = 251 pregnancies), (2) autologous ART-conception (A-ART, n = 87), and (3) heterologous ART-conception (H-ART, n = 22).Results: At adjusted analyses, twin pregnancies conceived by A-ART showed a twofold heightened risk of delivery by urgent/emergent cesarean section, as well as four and sevenfold increase in odds of blood loss >1000 and >1500 mL, respectively. H-ART pregnancies were at fivefold higher risk of undergoing prelabor cesarean section compared to SC, whereas no differences were identified for odds of severe post-partum hemorrhage. Also, A-ART and H-ART gestations displayed fetal and neonatal outcomes similar to SC pregnancies when analysis was adjusted for relevant confounding factors.Conclusion: Our results suggest that both A-ART and H-ART conception associate with increased odds of operative delivery among diamniotic twin pregnancies in healthy mothers with no chronic diseases or gestational complications. Also, a higher risk of severe postpartum hemorrhage appears to relate to A-ART independent of mode of delivery and maternal age. Further studies with larger series of uncomplicated twin pregnancies are warranted to improve our understanding of the relationship of ART to adverse delivery outcomes.

The impact of using donor sperm in assisted reproductive technology cycles on perinatal outcomes

To assess the impact of using donor sperm in assisted reproductive technology (ART) cycles on perinatal outcomes. Historical cohort study. US national database from the Society of Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) from 2012 to2013. Patients undergoing the first fresh autologous ART cycle using either donor or partner sperm. None. Miscarriage, preterm birth, low birthweight rates. A total of 134,710 fresh autologous ART cycles were evaluated from the SART CORS database. Following exclusion criteria and after restricting to the first cycle, 2,123 donor sperm and 42,799 partner sperm ART cycles were included in the final analyses. After adjusting for all confounding variables (including maternal age, race, body mass index, smoking status, gravidity, history of preterm birth, highest follicle stimulating hormone count, blastocyst transfer percentage, total embryo transferred, and etiology of infertility), no statistically significant differences in miscarriage rates, preterm births, very preterm births, low birthweight, and very low birthweight were observed. Birthweight was significantly lower in the partner sperm group than in the donor sperm group (3,292 ± 601 and 3,233 ± 592g in donor and partner sperm groups, respectively, adjusted P value 0.003); however, this small absolute difference (adjusted effect estimate 42g, 95% CI 14.7-70.9) does not carry clinical significance. The use of donor sperm in fresh autologous ART cycles was not associated with increased miscarriage, preterm births, or low birthweights, as compared to cycles using partner sperm. This information can be used in patient counseling to reassure patients using donor sperm in ART cycles.

Assisted Reproductive Technology, Comorbidities, and Cardiovascular Risk: The Experience of an Italian Center.

A growing number of infertile women undergo assisted reproductive technology (ART). Older maternal age and the presence of comorbidities may affect cardiovascular (CV) women health. Safety aspects are central in risk assessment; we report the experience of internal medicine clinical setting at the ART center. we investigated 243 infertile women (110 autologous and 133 oocyte donation [OD]); cardiometabolic parameters and CV risk factors were investigated during the clinical evaluation. We observed high prevalence of dyslipidemia (62.9%), smoking habit (27.5%), and body mass index (26.7%). Waist ≥80 cm was present in 65%, and waist to hip ratio (WHR) value >0.80 in 60.5% of women. The prevalence of migraine with aura, hypertension, and diabetes was 5.3%, 4.9%, and 4.5%, respectively. By evaluating variables according to autologous or OD ART, we observed that OD women were older than autologous, p < 0.0001. Overweight and obesity prevalence was higher in OD group; waist and WHR were significantly higher in autologous than in OD group (75% vs. 57%, p = 0.005, and 91.8% vs. 34.6%, p = 0.01, respectively). We observed a statistically significant unfavorable risk profile in OD in comparison to autologous women (p = 0.003); in particular, 60% of OD women carried 3-5 CV risk factors, and 8.3% carried at least six CV risk factors. The experience of an internal medicine clinic at the ART center strongly underlies the relevance of a careful medical evaluation before attempting ART, and suggests the opportuneness of a structured internal medicine clinic in every gynecology setting to better frame risk profile.