Biochemical Pregnancy Loss Rate Research Articles

Is biochemical pregnancy loss associated with embryo or endometrium? A retrospective cohort study in frozen single embryo transfer of own and donated oocytes.

Does the use of preimplantation genetic testing for aneuploidies (PGT-A), personalized embryo transfer with endometrial receptivity assay (pET-ERA), or the use of donated oocytes modify the incidence of biochemical pregnancy loss (BPL) in frozen single embryo transfer (FSET)? Following FSET, BPL incidence does not differ between own and donated oocytes, and the use of PGT-A with euploid embryo transfer or pET-ERA results in a similar incidence of BPL compared to cycles without embryo or endometrial analysis. BPL occurs frequently after IVF, and many factors have been associated with its incidence. The etiology of BPL is not well known, but the most probable cause seems to be either a low-quality embryo or impaired endometrial maintenance. The impact of techniques diagnosing embryonic ploidy or endometrial receptivity on BPL incidence and the BPL incidence between own and donated oocytes have not been analyzed. This is a retrospective cohort study analyzing the incidence of BPL over 3741 cycles of FSET derived from own (2399 cycles) and donated (1342 cycles) oocytes between January 2013 and January 2022 in 1736 of which PGT-A, pET-ERA, or both were applied. We defined BPL as a pregnancy diagnosed only by serum β-hCG > 10 UI/l followed by a decrease that does not result in a clinical pregnancy. Clinical pregnancy was defined as the presence of gestational sac on transvaginal ultrasound. We compared BPL rates among patients undergoing 2399 FSETs from own oocytes, which comprised 1310 cycles of embryos analyzed by PGT-A, 950 cycles of untested embryos, 30 cycles of untested embryos with pET-ERA, and a subgroup of 109 cycles analyzed by both PGT-A and pET-ERA. We also included a total of 1342 FSET cycles from donated oocytes comprising 132, 1055, 140, and 15 cycles in the same groups, respectively. In FSET from own oocytes, the overall BPL rate per embryo transfer was 8.2% (95% CI [7.09-9.33]). In untested embryo transfers, the BPL rate was 7.5% [5.91-9.37]. In the PGT-A group, the BPL rate was 8.8% [7.32-10.47]. In the pET-ERA group, the rate was 6.7% [0.82-22.07]. In the PGT-A+ERA group, the rate was 6.5% [2.65-12.90]. No significant differences were found (P = 0.626). A multivariate analysis considering clinically meaningful variables that were significantly different among groups, taking the untested embryos/endometrium group as a reference, showed comparable incidences among groups. For PGT-A, the adjusted odds ratio (AdjOR) was 1.154 [0.768-1.735] (P = 0.49) and for PGT-A+ERA 0.885 [0.330-2.375] (P = 0.808). Because of a low number of registered cases in the pET-ERA group, and to prevent statistical errors and convergence issues, this group was excluded from further analysis. In FSET of donated oocytes, the overall BPL rate per embryo transfer was 4.9% [3.76-6.14]. In the PGT-A group, the BPL rate was 6.8% [3.16-12.55]. In the pET-ERA group, the rate was 5.0% [2.03-10.03]. In untested embryo transfers, the rate was 4.7% [3.46-6.10]. No cases occurred in the PGT-A+ERA group, and no significant differences were found (P = 0.578). The multivariate analysis showed comparable incidences among groups. For PGT-A the AdjOR was 1.669 [0.702-3.972] (P = 0.247) and for pET-ERA 1.189 [0.433-3.265] (P = 0.737). The PGT-A+ERA group was eliminated from the model to prevent statistical errors and convergence issues because no BPL cases were registered in this group. In the multivariate analysis, when the sources of oocytes were compared, own versus donated, no significant differences were found in the incidence of BPL. This was a retrospective cohort study with potential biases. In addition, we were unable to control differences among groups due to modifications in medical or laboratory protocols during this long time period, which may modify the relationships being addressed. Factors previously associated with BPL, such as immunological conditions other than thyroid autoimmunity, were not considered in this study. Limited sample sizes of some groups may limit the statistical power for finding differences that can be present in the general population. BPL may be related to a mechanism not associated with the chromosomal constitution of the embryo or the transcriptome of the endometrium. More studies are needed to explore the factors associated with this reproductive issue. No specific funding was available for this study. None of the authors have a conflict of interest to declare with regard to this study. This trial was registered at clinicaltrials.gov (NCT04549909).

SARS-CoV-2 infection in pregnant patients on TNFα inhibitor: Real-life data with a review of literature

Tumor necrosis factor alpha (TNFα) is involved in the occurrence of negative pregnancy outcomes. The study aimed to evaluate the safety and efficacy of the immunosuppressive TNFα inhibitors (TNFαi) in the treatment of patients with a history of recurrent reproductive failure in the context of COVID-19 pandemics. We reviewed 85 patients who received TNFαi (certolizumab pegol) during Mainland China’s first wave of COVID-19 pandemic, from 21st Nov 2022–11 th Jan 2023. We also collected corresponding data from 130 pregnant patients who never used TNFαi for comparison. There were no significant differences in the history of previous pregnancy loss, miscarriage, embryo implantation failure, comorbidities and doses of COVID-19 vaccination. 82.2% and 87.7% pregnant patients contracted primary COVID-19 with symptoms in TNFαi group and no-TNFαi group. Duration of symptoms was significantly longer in TNFαi group and the incidences of cough and lethargy was significantly higher in TNFαi group. Both groups reported similar severity to same-aged close contacts, similar rates of other symptoms and hospitalization. No deaths were reported. In the in vitro fertilization (IVF) subgroup, we achieved a biochemical pregnancy loss rate of 17.4%, miscarriage rate of 21.7%, ongoing pregnancy rate and live birth rate of 34.2%. COVID-19 did not influence the live birth rate. We concluded that TNFαi administration in pregnancy was not associated with increased susceptivity to and severity of COVID-19. However, TNFαi users showed more prominent symptoms and longer recovery time. The pregnancy outcomes with TNFαi in such high-risk group for pregnancy loss was satisfactory.

Preimplantation Genetic Testing for Aneuploidy Could Not Improve Cumulative Live Birth Rate Among 705 Couples with Unexplained Recurrent Implantation Failure.

We evaluate whether next-generation sequencing (NGS)-based preimplantation genetic testing for aneuploidy (PGT-A) improves the cumulative pregnancy outcomes of patients with unexplained recurrent implantation failure (uRIF) as compared to conventional in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI). This was a retrospective cohort study (2015-2022). A total of 705 couples diagnosed with uRIF were included in the study. 229 women transferred blastocysts based on morphological grading (IVF/ICSI) and 476 couples opted for PGT-A to screen blastocysts by NGS. Women were further stratified according to age at retrieval (<38 years and ≥38 years). The primary outcome was the cumulative live-birth rate after all the embryos were transferred in a single oocyte retrieval or until achieving a live birth. Confounders were adjusted using binary logistic regression models. Cumulative live-birth rate was similar between the IVF/ICSI group and the PGT-A group after stratified by age: IVF/ICSI vs PGT-A in the <38 years subgroup (49.7% vs 57.7%, adjusted OR (95% CI) = 1.25 (0.84-1.84), P = 0.270) and in the ≥38 years subgroup (14.0% vs 19.5%, adjusted OR (95% CI) = 1.09 (0.41-2.92), P = 0.866), respectively. Nonetheless, the PGT group had a lower first-time biochemical pregnancy loss rate (17.0% vs 8.7%, P = 0.034) and a higher cumulative good birth outcome rate (35.2% vs 46.4%, P = 0.014) than the IVF/ICSI group in the <38 years subgroup. Other pregnancy outcomes after the initial embryo transfer and multiple transfers following a single oocyte retrieval were all similar between groups. Our results showed no evidence of favorable effects of PGT-A treatment on improving the cumulative live birth rate in uRIF couples regardless of maternal age. Use of PGT-A in the <38 years uRIF patients would help to decrease the first-time biochemical pregnancy loss and increase the cumulative good birth outcome.

Male Hyperuricemia Is Associated with Poor Reproductive Outcomes of IVF-ET

Objective. To investigate the effect of male hyperuricemia on reproductive outcome of in vitro fertilization-embryo transfer (IVF-ET). Methods. Clinical data of 412 couples who underwent their first cycle of IVF-ET were analyzed. According to the serum uric acid (SUA) level of the male, they were divided into control group (SUA ≤ 416 μmol/L) and hyperuricemia group (SUA &gt; 416 μmol/L). The primary and secondary observation indices were pregnancy outcome after quality fresh embryo transfer and embryo outcome after IVF. Binary logistic regression was used to analyze the relationship between male SUA and related pregnancy outcomes. The ROC curve of the effect of male SUA on biochemical pregnancy loss rate (BPLR) after fresh embryo transplantation was drawn. Results. BPLR in hyperuricemia group increased significantly than that in control group (4.7% vs. 31.6%, P=0.012), and the clinical pregnancy rate and live birth rate were significantly lower (61.5% vs. 39.4%, P=0.038) (56.9% vs. 33.3%, P=0.027). Binary logistic regression analysis showed that BPLR after fresh embryo transfer was positively correlated with male SUA (B = 0.010, P=0.019, OR = 1.010, 95% CI (1.002, 1.018)). The area under receiver operating characteristic curve was 0.784, the specificity was 53.7%, and the sensitivity was 100.0%, P=0.010. Moreover, the total fertilization rate and 2PN fertilization rate in hyperuricemia group were significantly lower than those in control group (86.0% vs. 81.6%, P=0.001) (75.0% vs. 69.6%, P &lt;0.001). Conclusion. Male hyperuricemia is an independent risk factor for increasing BPLR after fresh embryo transfer and can also reduce the total fertilization rate and 2PN fertilization rate of IVF.

P-481 Additional sub-cutaneous progesterone: a putative strategy to counteract poor clinical outcomes after vitrified-warmed euploid blastocyst transfer?

Abstract Study question Is there an association between additional subcutaneous progesterone (a-sP) during luteal phase support for vitrified-warmed euploid blastocyst transfers and the clinical outcomes? Summary answer a-sP was mainly administered to worse-prognosis patients:positive-pregnancy-test (PPT), but also biochemical-pregnancy-loss (BPL) rates were lower than control, thereby involvingsimilar live-birth-rate (LBR) per transfer. What is known already Frozen-embryo-transfer (FET) implementation is increasing worldwide, and luteal-phase-support is a hot-topic. Serum/uterine progesterone levels are key in eliciting immunological tolerance and uterine quiescence, while supporting the processes underlying embryo implantation. Yet, a consensus is missing on progesterone administration (formulation, route, dosage, and duration). Endometrial biopsy studies showed increased progesteroneconcentration after vaginal administration, while sP has excellent pharmacokinetics with faster peak serum concentration.Combining both administration routes might compensate cases ofpoor vaginal absorption and contribute to reaching adequate systemic/uterine levels. This synergy might be beneficial especially in RIF-patients, subject to lower LBRs also in the context of euploid ET. Study design, size, duration Retrospective analysis of 775 vitrified-warmed euploid blastocysttransfers conducted January2020-March2021. Three of 12 gynecologists administrated a-sP as luteal phase support mostly to patients with a worse reproductive history (i.e., longer duration of infertility and/or higher number of previous failed IVF). We assessed the clinical outcomes (PPT, BPL, miscarriage and LBR) in the group of patients who used a-SP (N = 128) versus the control(N = 647), adjusting for confounders in logistic regression analyses. Participants/materials, setting, methods Only euploid non-mosaic blastocysts were transferred. All patients had normal uterine cavities and thyroid function. Endometrial preparation was performed with either hormone-replacement-therapy (estradiol valerate 6mg/die plus vaginal micronized progesterone 800mg/die) or modified-natural-cycle (hCG administration plus vaginal micronized progesterone 400mg/die). In the a-sP group, the supplementation was started 3 days before FET. In case of pregnancy, the therapy was continued until the 8thweek. Main results and the role of chance The patients in the control and a-sP groups were similar for oocyte age (37.6±2.7yr versus 37.5±2.7yr), age at ET (37.7±3.2yr versus 37.7±3.4yr), and body-mass-index (22.2±2.4 versus 22.0±2.8yr). Conversely, the patients in the a-SP group experienced longer duration of infertility (3.5±1.9yr in the control versus 4.1±2.6yr, p = 0.05), and had already undergone ≥1 previous IVF cycle (37%) and ≥2 failed ETs (22%) more frequently than the control (27% and 12%, respectively;p=0.05). The endometrial preparation protocol was similar in the two groups (76% hormone-replacement-therapy and 24% modified-natural-cycle). Also, blastocyst quality and day of transfer were similar. In the study period, the prevalence of a-sP administration increased from first to second-third ETs (13% to 29%). The confounders identified on the clinical outcomes were blastocyst quality, day of transfer and consecutive number of ET. Therefore, these features were included in multivariate logistic regressions. PPT rates were 61.1% (N = 395/647) and 49.2% (N = 63/128, p = 0.01) in the control and a-SP groups, respectively (multivariate-OR:0.65, 95%CI 0.44-0.97;adjusted-p=0.04). BPL rates were 9.1% (N = 36/395) and 1.6% (N = 1/63, p = 0.04), respectively (multivariate-OR:0.14, 95%CI 0.02-0.99;adjusted-p=0.05). Miscarriage rates were 14.2% (N = 51/359) and 6.5% (N = 4/62;p=0.1), respectively (multivariate-OR:0.4, 95%CI 0.14-1.16;adjusted-p=0.1). Lastly, LBRs were 47.6% (N = 308/647) and 45.3% (N = 58/128), respectively (multivariate-OR:1.04, 95% 0.7-1.55;adjusted-p=0.8). Limitations, reasons for caution Retrospective analysis. Progesterone levels are not routinely assessed in our clinical practice. A larger prospective study only in poor prognosis patients is required to assess the putative benefit of a-sP. Wider implications of the findings About 30% of patients undergoing FET suffer from inadequate progesterone levels, possibly impacting the clinical outcomes, yetscarcely detectable through its serum levels. In these women, vaginal progesterone could be insufficient, and a-sP can act as a rescue strategy against reduced endometrial receptivity via lower BPL. Trial registration number Not applicable

Progesterone levels on the day of embryo transfer using a single pessary of 400mg of vaginal progesterone vs. 200mg x2 pessaries in hormonal replacement cycles.

Does the use of 400mg pessaries of micronized progesterone provide comparable results as pessaries of 200mg x2, in terms of progesterone levels in hormonal replacement cycles for embryo transfer?. Retrospective cohort study based on 299 embryo transfer treatments under artificial endometrial preparation carried out at Instituto Bernabeu. 131 patients received 1 pessary of 400 mg b.i.d. (group A) and 168 received 2 pessaries of 200 mg b.i.d. (group B). Mean serum progesterone levels were similar between groups (A: 13.64±4.47ng/mL vs. B: 13.88±7.17ng/mL). There were no differences in suboptimal progesterone levels between groups (A: 11.5% vs. B: 16.8%). In terms of patients receiving additional progesterone supplementation, there were no differences between groups (A: 26% vs. B: 35.3%.). No differences between groups were observed in clinical outcomes: pregnancy rate (PR) (A: 55% vs. B: 54.8%), biochemical pregnancy loss rate (BPLR) (A: 13.4% vs. B: 17.6%), miscarriage rate (MR) (A: 17.9% vs. B: 19.8%) and ongoing pregnancy rate (OPR) (A: 36.5% vs. B: 34.1%). One progesterone pessary of 400mg (Cyclogest®) twice daily appears to be non-inferior to the use of two-200mg pessaries twice daily in terms of progesterone levels in HRT cycles.

P-396 Is biochemical pregnancy loss (BPL) associated with embryo or endometrium? A multicentre retrospective study with +7000 cases

Abstract Study question Is biochemical pregnancy loss rate (BPLR) associated with alterations within the embryo or the endometrium? Summary answer The BPLR was similar in frozen embryo transfers among groups: euploid embryo (PGT-A group), adjusted by endometrial receptivity assay (ERA group), ERA+ PGT-A group, and controls. What is known already The etiology of BPL is not well known, but the most likely causes hypothesized seem to be either a low-quality embryo or impaired endometrial receptivity. Different studies showed that factors such as age, ovarian stimulation, the oocyte and embryo quality and endometrium receptivity may have something to do with the occurrence of biochemical pregnancy loss post-assisted reproduction treatments. However, other studies have shown that BPLR does not increase as a function of age or seems independent of embryo’s development stage or embryonic chromosomal constitution. No studies have evaluated nor controlled specifically the uterine factor with tools as ERA. Study design, size, duration Retrospective cohort study between January 2013 and January 2021, on patients undergoing 7491 frozen embryo transfers, comparing BPLR per pregnancy among groups of patients with optimized embryo and endometrial quality (ERA+ PGT-A, n = 169), optimized embryo quality (PGT-A, n = 2670), optimized endometrium quality (ERA=61), and controls (neither ERA nor PGT-A, n = 4591) from own oocytes, from two University-affiliated centers. We defined BPL as a pregnancy diagnosed only by serum beta-hCG&amp;gt;10UI/L without resulting in a clinical pregnancy. Participants/materials, setting, methods BPLR and other variables including age, body mass index, number of previous IVF, days of endometrial preparation, type of cycle (natural or with hormonal replacement), endometrial thickness, fresh sperm concentration and fresh sperm volume were evaluated among groups using chi-squared test, for univariate analysis. Main results and the role of chance Mean women’s age was 35.95 years 95%CI (35.86 ,36.04), BMI 22.52kg/m2 95%CI (22.45, 22.59), endometrial preparation length 17.96 days 95%CI (17.78, 18.14), 29.8% of them on natural cycle, and 70.25% with hormonal therapy replacement. Donor sperm was used on 7.8% of the treatments, and embryo quality was comparable between groups of study, with an overall A rating of the embryos 24.9%, B 50.95%, C 23.37% based on Spanish ASEBIR society criteria. Mean sperm characteristics were: volume 2.79 ml 95%CI (2.74-2.85), concentration 38.78 mill/ml 95%CI (33.77-39.39), on the raw ejaculate, and after preparation, concentration varied to 7.80mill/ml 95%CI(6.76-7.39) On the univariate analysis, overall BPLR was 8.06% 95%CI (7.45-8.70). Control group presented 7.65% 95%CI (6.89-8.46), with ERA group (optimized endometrial factor) showing 8.33% 95%CI (2.76-18.39), PGT-A group (optimized embryonic factor) 8.82% 95%CI (7.77-8.96), and PGT-A+ERA 7.14% 95%CI (3.75-12.14) without statistically significant differences. Limitations, reasons for caution As this was a retrospective cohort study, we are exposed to several biases that have been tried to control by means of inclusion/exclusion criteria and proper statistical adjustment. Subsequently, results should be interpreted with caution, and a clear cause-effect relationship cannot be assumed. Wider implications of the findings Our results indicate that with PGT-A, ERA test or both it is not possible to modify the BPLR. A different mechanism no associated with chromosomal structure or transcriptomic expression of the endometrium could be studied as cause of BPL. More studies are needed for explore this reproductive issue. Trial registration number not applicable

P-389 Elevated BMI in oocyte donors or recipients is associated with a higher risk of miscarriage after blastocyst transfer: a multicenter analysis of 1544 procedures

Abstract Study question Is an elevated BMI in either oocyte donors or recipients associated with a higher risk of miscarriage after blastocyst transfer? Summary answer Overweight in oocyte donors and/or obesity in recipients are associated with a 2X-higher risk of miscarriage in egg donation cycles. What is known already Several basic-science, clinical and epidemiological studies revealed an association between BMI and infertility, suggesting a J-shaped relationship: both underweight and especially overweight/obese women can suffer from reproductive impairments. In particular, overweight-obese women are more prone to suffer from a miscarriage even when euploid blastocysts are transferred. Yet, it is still unclear whether this is the consequence of an altered oocyte (and then embryonic) competence and/or an impaired endometrial receptivity. In this context, oocyte donation cycles represent the ideal clinical setting to shed some light on an issue with numerous social, clinical, and logistic implications. Study design, size, duration Retrospective study including 1544 blastocyst single embryo transfers (SETs) conducted in oocyte donation cycles (Jan2019-May2021). All oocytes were vitrified at 2 egg banks in Spain and warmed at 8 clinics part of the same network. The primary outcome was the miscarriage rate (&amp;lt;22nd gestational weeks) per clinical pregnancy according to donors’ and/or recipients’ BMI. Four BMI clusters were defined (underweight: &amp;lt;18.5; normal-weight: 18.5-24.9; over-weight: 25-30; obese: &amp;gt;30). Participants/materials, setting, methods 66.1%,4.9%,20.3% and 8.7% of SETs were conducted in normal-weight, underweight, overweight, and obese recipients. 81.4%,4.5% and 14.1% of SETs with oocytes derived from normal-weight, underweight, and overweight donors. The putative confounders investigated were egg bank, IVF center, fresh/vitrified-warmed SET, blastocyst quality/day, recipient/donor age, endometrial preparation protocol, number of consecutive SET. Before SET, we requested blood test for infections and TORCH, thyroid function, coagulation and immunological assessment, cardiological, gynecologic and breast evaluation. Main results and the role of chance Overweight-obese recipients were slightly older (43.0±4.0yr) than normal-weight ones (42.2±3.8yr; p &amp;lt; 0.01). Similarly, overweight donors were slightly older (27.5±4.5yr) than normal-weight ones (26.4±4.3yr; p &amp;lt; 0.01). Therefore, all outcomes were adjusted for recipients’/donors’ age. The overall positive pregnancy rate per blastocyst SET and biochemical pregnancy loss rate were 51.8% and 12.6%. No association was reported between either recipients’ or donors’ BMI and both these secondary outcomes. Conversely, higher recipients’ and donors’ BMI were significantly associated with a higher risk of miscarriage after blastocyst SET (multivariate-OR 1.05, 95%CI 1.01-1.1, adjusted-p=0.05; multivariate-OR 1.1, 95%CI 1.04-1.2, adjusted-p&amp;lt;0.01). The most significant differences were reported for obese versus normal-weight recipients (N = 18/64,28.1% versus N = 73/448,16.3%; p = 0.03, power=60%; multivariate-OR 1.8, 95%CI 1.01-3.4, adjusted-p=0.05) and for overweight versus normo-weight donors (N = 31/111,27.9% versus N = 94/561,16.8%; p &amp;lt; 0.01, power=73%; multivariate-OR 1.9, 95%CI 1.16-3.0, adjusted-p=0.01). In the 14 clinical pregnancies where the oocytes derived from overweight donors and the blastocysts were transferred to obese women the miscarriage rate was 50%; the same outcome in normal-weight recipients using oocytes from normal-weight donors was 15% (N = 55/366; p &amp;lt; 0.01, power=85%; OR 5.6, 95%CI 1.8-16.8, p &amp;lt; 0.01). The data were similar across both egg banks and all IVF centers. All other parameters assessed were not associated with the primary outcome under investigation. Limitations, reasons for caution The study is retrospective, and the sample size in each sub-group shall be increased. Moreover, BMI is a gross marker of an individual’s metabolic status. Future studies on more accurate markers like percentage and localization of adipose tissue assessed through techniques like bioelectrical impedance analyses are desirable. Wider implications of the findings Both oocyte competence and endometrial receptivity might be impaired from unbalanced nutritional intakes. More studies on this topic are certainly required. Whenever possible, nutritional/lifestyle adjustments should be encouraged in obese patients because of their higher risk of miscarriage, and a BMI limit should be considered also when recruiting egg donors. Trial registration number Not applicable

Elevated Body Mass Index in Donor Oocyte Recipients Does Not Affect Implantation of Euploid Embryos.

Background: Obesity is a worldwide epidemic that has been shown to have serious implications on health outcomes. Regarding reproductive health, increased body mass index (BMI) reduces fertility and increases the time to conceive. It is unclear how excess weight in females affects the development of oocytes and embryos or the impact of implantation. Materials and Methods: This retrospective single-center study aimed to determine if overweight and obese oocyte recipients had similar pregnancy outcomes compared with healthy weight controls after the transfer of a single euploid frozen-thawed embryo transfer (FET). Five hundred twenty-eight patients who underwent a transfer from 2016 to 2021 were included. The primary outcome studied was the clinical pregnancy (CP) rate. Secondary outcomes included live birth (LB) rate, biochemical pregnancy loss (BPL) rate, and clinical pregnancy loss (CPL) rate. Results: The overall CP rate was 54.9% and did not differ significantly among normal weight (n = 318), overweight (n = 129), and obese (n = 81) BMI categories (0.56 vs. 0.56 vs. 0.49, p = 0.56). There were no significant differences in LB rate (0.47 vs. 0.43 vs. 0.38, p = 0.33), BPL rate (0.14 vs. 0.09 vs. 0.11, p = 0.59), and CPL rate (0.15 vs. 0.21 vs. 0.18, p = 0.38) among BMI groups. Conclusions: Our findings provide support that BMI alone does not adversely alter endometrial receptivity and is not the cause of poor in vitro fertilization (IVF) outcomes in patients with increased BMI. These deleterious IVF outcomes might be to the result of diminished oocyte and/or embryo quality or other factors that have not yet been elucidated.

The euploid blastocysts obtained after luteal phase stimulation show the same clinical, obstetric and perinatal outcomes as follicular phase stimulation-derived ones: a multicenter study.

The euploid blastocysts obtained after luteal phase stimulation show the same clinical, obstetric and perinatal outcomes as follicular phase stimulation-derived ones: a multicenter study.

The biochemical pregnancy loss rate remains stable up irrespective of age and differs in pattern from clinical miscarriages

Introduction As women age, the increasing rate of aneuploidy lead to an augmentation in the incidence of clinical miscarriages. It was anticipated that biochemical pregnancy rates would also rise with maternal age. However, no study has previously evaluated the effect of maternal age on biochemical pregnancy rates. Material and methods A retrospective cohort study of 2177 subjects who underwent single embryo transfer (SET) as part of a fresh or thawed IVF cycle were recruited from 2008 through 2012, resulting in 952 pregnancies. Data was stratified for age and compared using analysis of variance (continuous data) and chi-squared tests (categorical data). Results The likelihood of a clinical miscarriage increased with age (p < .001). Surprisingly, advancing age had no effect on the biochemical pregnancy loss rate (p = .72) (Age 21–30 y: 10.7%, Age 31–35 y:9.8%, Age 36–40y:11.5%, Age 41–42 y:13.6%). Conclusions Biochemical pregnancy loss rate did not increase as a function of age in women 21 to 42 years of age.

Biochemical pregnancy loss after frozen embryo transfer seems independent of embryo developmental stage and chromosomal status.

Biochemical pregnancy loss (BPL), defined as serum beta-human chorionic gonadotropin levels ≥50IU/l in at least two pregnancy tests, not associated with any ultrasonographical evidence of pregnancy, is often attributed to chromosomal abnormalities; however, no hard evidence exists to support this hypothesis. Are any IVF cycle parameters associated with the occurrence of a BPL? Retrospective study aimed at evaluating the effect of embryo developmental stage at transfer and chromosomal assessment on the BPL rate in IVF after frozen embryo transfer (FET). Specifically, 641 FET of 1179 cleavage stage untested embryos (Group A), 1021 FET of 1259 untested blastocyst stage embryos (Group B), and 789 blastocyst stage FET of 803 euploid embryos (Group C) were performed in a 6-year period. Only FET were evaluated to avoid a potential effect of ovarian stimulation on endometrial receptivity. The BPL rates were similar (n = 30/217, 13.8% in Group A; n = 37/412, 9.0% in Group B; n = 42/433, 9.7% in Group C). Neither embryo developmental stage at FET nor chromosomal assessment showed a correlation with BPL. Furthermore, logistic regression analyses did not show any association between BPL and patient, cycle and/or transfer characteristics. BPL seems independent of the embryo's developmental stage, the use of trophectoderm biopsy and the chromosomal constitution at FET. Similar BPL rates after transferring euploid blastocysts compared with both untested cleavage and blastocyst stage embryos suggest investigating the role of endometrial and other embryonic factors putatively involved in the process of implantation.

Pregnancy loss in pregnancies conceived after in vitro oocyte maturation, conventional in vitro fertilization, and intracytoplasmic sperm injection

To compare rates of pregnancy loss after oocyte maturation in vitro (IVM), after IVF, and after intracytoplasmic sperm injection (ICSI). Retrospective comparative study. University tertiary-care center for infertility. Women undergoing assisted reproductive technology in a single center. Oocyte maturation in vitro, IVF, or ICSI, as indicated. Biochemical pregnancy, clinical miscarriage, ectopic pregnancy, and late fetal loss. There were 1,581 positive pregnancy tests (120 IVM, 849 IVF, and 612 ICSI). The biochemical pregnancy loss rate did not statistically significantly differ among the groups: 17.5% (21/120) after IVM, 17.0% (144/849) after IVF, and 18.0% (110/612) after ICSI. The clinical miscarriage rate after IVM was 25.3% (25/99), which was statistically significantly different compared with 15.7% (111/705) after IVF and 12.6% (63/502) after ICSI. However, the clinical miscarriage rates in women with polycystic ovary syndrome were statistically similar, at 24.5% (24/98) after IVM and 22.2% (18/81) after IVF. The ectopic pregnancy rates also were statistically similar: 1.0% (1/99) after IVM, 2.3% (16/705) after IVF, and 1.8% (9/502) after ICSI. The late fetal loss rates were similar as well: 1.0% (1/99) after IVM, 2.7% (19/705) after IVF, and 2.9% (14/502) after ICSI. There were no chromosomal abnormalities in the IVM group. There is a higher rate of clinical miscarriage after IVM when compared with IVF and ICSI. This appears to be related to polycystic ovary syndrome rather than to the IVM procedure.