Biochemical Pregnancy Rate Research Articles

Association between the systemic immune-inflammation index and GnRH antagonist protocol IVF outcomes: a cohort study

Research questionWhat is the relationship between the systemic immune-inflammation index (SII) and IVF outcomes in women undergoing a gonadotrophin-releasing hormone (GnRH) antagonist protocol? DesignThis retrospective cohort study analysed clinical data and blood samples collected before oocyte retrieval from participants undergoing IVF with the GnRH antagonist protocol. Logistic regression and generalized additive models were used to examine the association between SII quartiles and continuous SII values and IVF outcomes. ResultsHigher SII values correlated negatively with biochemical pregnancy, clinical pregnancy, live birth and implantation rates, and positively with early pregnancy loss, independent of age, body mass index, anti-Müllerian hormone and stimulation parameters. The most significant adverse outcomes were observed in the highest SII quartile. A non-linear relationship was identified between log-transformed SII and IVF outcomes, with an inflection point at an SII of approximately 6.72, indicating a threshold effect. ConclusionsElevated SII is associated with poorer IVF outcomes in women after the GnRH antagonist protocol, suggesting its potential as a predictive marker in IVF treatments. Further research is needed to confirm these findings and explore the underlying mechanisms.

Pregnancy Rate In Non-Azoospermia With Normal Or Suboptimal Semen Parameter Versus Azoospermic Male Treated By IVF-ICSI Cycle

Background: Intracytoplasmic sperm injection (ICSI) opens the gate for many cases of male factor infertility to be the biological fathers of their sibling since 1992. Most of cases were non-obstructive azoospermia and different levels of oligoastheno-teratozoospermia. Nowadays many cases of reduced semen parameter or female factor infertility are treated by IVF-ICSI Cycle for better pregnancy rate, biochemical and clinical, and live birth rate. Aim of the study: The study aims to compare biochemical, clinical pregnancy rate and outcome of pregnancies in the group with ejaculated sperm with normal or suboptimal semen parameter and group with non-obstructive azoospermia in whom sperm retrieved by TESE, using ICSI. Method: A retrospective cohort study was conducted between January, 2016 and February, 2023 in the fertility center of Al-Sader Medical City, a total of 372 couple, 90 of the males gave semen sample by masturbation and 282 of the males were non-obstructive azoospermia and their sperms were retrieved by TESE; all are treated by ICSI, all of their female partner were under age of 37 year, the maternal medical condition and obstetric history were not included in this study. Simple random sampling was depended, SPSS version 26 was used to perform the statistical analysis processes. Results: There was a highly significant difference in pregnancy rate by β.HCG between ejaculate group (43.3 %) and azoospermia (26.6 %) with p. value =0.003. A significant difference in clinical pregnancy rate by ultrasound between the ejaculate group (31.1%) and azoospermia (20.9%) with p. value =0.047. There was no statistically significant difference in live birth rate between ejaculate group as (24.4 %) and azoospermia as (17.4 %) with p.value=0.137. Conclusion: Freshly ejaculated sperm with normal or suboptimal semen parameter gave a better biochemical and clinical pregnancy rate than obtained from NOA by TESE, while live birth rate was not largely different in both groups

Comparison of biochemical and clinical pregnancy rate and first outcomes with or without non-invasive preimplantation genetic testing for aneuploidies: a retrospective cohort study.

Evaluation of embryos’ genetic status is an increasingly widespread practice in assisted reproduction clinics. The existence of limitations with PGT-A, such as the invasive nature of the biopsy procedure and the need for the technical ability of embryologists, added with the knowledge that a determinate number of cells in trophectoderm might not be representative of the entire embryo genetics, is leading to increase the use of non-invasive PGT-A (niPGT-A) using spent cultured medium (SMCs) by embryos analyzed. This retrospective cohort study from May 2022 to August 2023 analyzed first experiences with niPGT-A, setting characteristics of patients—first, results obtained comparing pregnancy outcomes with frozen embryo transfer (FET) without niPGT-A. A total of 56 SCMs were collected. The average age of women in the study was 37.4±4.2 in the niPGT-A group and 36.0±5.9 in the FET group (p= 0.2953). The main reasons why couples decided to undergo niPGT-A were women’s age (46.7%), male factor (20.0%), and RIF (16.7%). No significant differences were seen between niPGT-A (n=14) and elective FET (n=18) groups in terms of biochemical pregnancy rate (35.7% vs 38.8%; p=0.4298) and clinical pregnancy rate (35.7% vs 33.3% p=0.4462) (CI 95%). Based on the results obtained, niPGT-A is an excellent alternative to assess the chromosomal status of cultured embryos. Comparing groups, no significant differences were found in biochemical and clinical pregnancy rates. A small number of samples represent a limitation; large-scale randomized studies will be necessary.

The association between systemic immune-inflammation index and in vitro fertilization outcomes in women with polycystic ovary syndrome: a cohort study

BackgroundAs a novel prognostic and inflammatory marker, the systemic immune-inflammation index (SII) has come to the foreground in recent years. SII may be used as an indicator reflecting the progressive inflammatory process in patients with polycystic ovary syndrome (PCOS). This study aimed to evaluate the correlation between SII and assisted reproductive outcomes in PCOS patients.ResultsA total of 966 women undergoing in vitro fertilization (IVF) procedure with PCOS were included in the study. The SII was calculated as platelet count (/L) × neutrophil count (/L)/lymphocyte count (/L). Participants were divided into four groups according to SII quartiles calculated at baseline, and the differences of clinical and laboratory outcomes between these four groups were compared. Moreover, a univariate linear regression model was used to evaluate the associations between SII and the outcomes. Patients in the highest SII quartile (Q4) had lower antral follicle count (AFC), estradiol (E2), and progesterone (P) levels on the day of human chorionic gonadotropin (HCG) start compared with the lower three SII quartiles (Q1-Q3). Moreover, our analysis demonstrated that women in the lower SII quartiles had a higher rate of available embryos and blastocyst formation compared with those in the highest SII quartile. Logarithm of SII correlated negatively with available embryo rate, but not with number of available embryos. Additionally, the results of our multivariate logistic regression analyses indicated that the highest SII quartile was negatively associated with biochemical pregnancy rate (BPR), clinical pregnancy rate (CPR), live birth rate (LBR), and implantation rate (IR). A non-linear relationship between the SII and number of available embryos, with a negative relationship seen to the right of the inflection point was also found.ConclusionsThe interplay among thrombocytosis, inflammation, and immunity could influence assisted reproductive outcomes in PCOS patients. In this regard, SII may serve as a valuable marker for exploring potential correlations.

#53 : Pregnancy Outcome After Hydrosalpinx Aspiration in In-Vitro Fertilization Cycle

Background and Aims: Hydrosalpinx is a severe manifestation of tubal disease-causing infertility in women. It has an adverse effect on the outcome of in vitro fertilization (IVF), reducing live birth rate (LBR) by 50% compared to other tubal factors. Laparoscopic salpingectomy can effectively improve IVF outcome but is contraindicated in some women. It can also be expensive and is not without complications. Ultrasound-guided hydrosalpinx aspiration is a cheaper, less invasive procedure alternative to salpingectomy. It has been shown to improve clinical and ongoing pregnancy rates compared to patients with no aspiration. However, the published literature on the effectiveness of hydrosalpinx aspiration is equivocal. Method: This retrospective study aimed to evaluate the outcome of minimal stimulation (mild) IVF cycles wherein the women underwent hydrosalpinx aspiration prior to embryo transfer at a private fertility clinic in the Philippines. Results: A total of 98 IVF cycles satisfied the inclusion criteria. The average patient age was 35.22 ± 4.57 and average duration of infertility was 5.87 ± 3.70 years. The biochemical pregnancy rate was 48% and the clinical pregnancy rate was 39.8%. Live birth rate was 35.7%, which is comparable to that of mild IVF patients without hydrosalpinx. There was a negative correlation between patient age and biochemical pregnancy rate, clinical pregnancy rate, and LBR, however, the correlations were statistically insignificant (Pearson correlation, P = 0.081, 0.197, and 0.344, respectively). Binary logistic regression analyses showed that age, infertility type, infertility factor, basal hormone levels, and number of eggs retrieved were not predictive of the success of IVF among the women in the study. Conclusion: Our results show that hydrosalpinx aspiration is a safe and effective option in improving pregnancy and live birth rates in women undergoing mild IVF.

#243 : Comparison of IVF Outcome Following Follitropin Alfa and Follitropin Delta Utilization at Melati Clinic, Harapan Kita Women and Children Hospital

Background and Aims: Follitropin delta is the third recombinant FSH (rFSH) preparation developed with an individualized dosing regimen based on patient’s body weight and AMH level. According to the existing report, a daily dose of follitropin delta provides an equivalent ovarian response to that of follitropin alfa. However, the effect of follitropin delta on the resulting embryo and biochemical pregnancy remains to be elucidated. Hence, the present study aims to evaluate the effect of follitropin delta on embryo quality and biochemical pregnancy rates compared with that of follitropin alfa in an in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycle. Methods: A retrospective cohort study was conducted between January and December 2022 at Melati Clinic, Harapan Kita Women and Children Hospital. A total of 59 IVF/ICSI cycles stimulated with follitropin alfa and 26 IVF/ICSI cycles treated with follitropin delta were subsequently analyzed. Results: After analysis, no significant difference was observed regarding the embryo quality of both treatments (P>0.05). The median of the good, moderate, and poor embryos in the follitropin alfa and follitropin delta group was 2 vs. 3, 1 vs. 2, and 2 vs. 2, respectively. Similarly, the biochemical pregnancy rate between the follitropin alfa and follitropin delta group was comparable (25% vs. 15%, P>0.05). Conclusions: In conclusion, our study suggests that stimulation with follitropin delta in IVF/ICSI cycles yields a similar embryo quality and biochemical pregnancy rates to those of follitropin alfa.

#113 : Transdermal Oestrogen (GEL) for Endometrial Preparation in Frozen-Thawed Embryo Transfer

Background and Aims: Frozen-thawed embryo transfer (FET) requires a synchronization between endometrium and embryo. Pregnancy and live birth rates are proven to be significantly higher with FET due to better endometrial receptivity. In this study, we look at effectiveness oftwo oestrogen preparations in hormone replacement therapy (HRT) FET cycle on the pregnancy outcomes. Method: This is a retrospective analysis of 200 HRT FET cycles from 1st Jan 2020-31st December 2021, divided into 2 groups. Group 1 (n=100) received T Progynova 6 mg/day and Group 2 (n=100) received Oestrogel 6 mg/day (17B oestradiol 0.06% gel Besins France) starting on day 1 of menses, without GnRH agonist pituitary downregulation. The oestrogen dose was adjusted accordingly to achieve endometrial thickness (ET) of minimum 8 mm, prior to initiation of vaginal progesterone. The pregnancy outcomes (biochemical pregnancy, clinical pregnancy, ongoing pregnancy, early pregnancy loss and ectopic pregnancy rates), duration of oestrogen usage and endometrial thickness measurement prior to embryo transfer were analysed. Results: The biochemical pregnancy rate in this study was 39%, with a clinical pregnancy rate of 31%. Comparing both preparations, the biochemical pregnancy rate (p=0.562), clinical pregnancy rate (p=0.705), ongoing pregnancy rate (p=0.623), and early pregnancy loss rate (p=0.705) were not statistically significant. The duration required to achieve optimal endometrial thickness (p=0.212), and endometrial thickness measurement prior to vaginal progesterone commencement (p=0.335) were comparable. Conclusion: Oestrogel is a non-inferior option to oestradiol valerate for endometrial preparation in HRT FET cycles, especially for patients with high risk of venous thromboembolism due to its safety profile.

Embryonic, genetic and clinical outcomes of fresh versus vitrified oocyte: A retrospective cohort study

Objective: To compare embryonic development, ploidy status and clinical outcomes between fresh and frozen-thawed oocytes. Methods: This retrospective cohort study evaluated 83 fertilization cycles including both fresh and frozen oocytes from 79 patients at the HP Fertility Center of Hai Phong International Hospital of Obstetrics and Pediatrics in Vietnam. The patient underwent several ovarian stimulation cycles to accumulate a certain number of oocytes that would be vitrified. In the last oocyte retrieval, all patient's oocytes including both frozen and fresh would be fertilized. The outcomes included the rates of oocyte survival, cleavage embryo, blastocyst, ploidy status, pregnancy, biochemical pregnancy and clinical pregnancy. Results: The oocyte survival rate after thawing was 96.5%. No statistically significant difference was found when comparing fresh and frozen oocytes regarding fertilization rate (78.1% vs. 75.5%, P=0.461), usable cleavage embryo rate (86.9% vs. 87.2%, P=0.916) but usable blastocyst rate was found higher statistically in the frozen oocyte group (44.4% vs. 54.0%, P=0.049). The percentages of euploid, aneuploid and mosaic embryos between the fresh group and the vitrified group had no significant differences (33.8% vs. 31.6%, P=0.682; 51.0% vs. 54.2%, P=0.569; 15.2% vs. 12.4%, P=0.787; respectively). The rates of pregnancy, biochemical pregnancy and clinical pregnancy had no statistical difference (68.8% vs. 64.8%, P=0.764; 12.5% vs. 3.6%, P=0.258; 37.5% vs. 46.4%, P=0.565). 17 Mature oocytes are the minimum to have at least one euploid embryo. Conclusions: Oocyte vitrification does not affect embryonic, genetic and clinical results. The number of mature oocytes should be considered for fertilization in some cases.

#276 : Impact of Previous Cesarean Delivery on Pregnancy and Neonatal Outcomes of Subsequent In Vitro Fertilization/Intracytoplasmic Sperm Microinjection and Single Frozen-Thawed Embryo Transfer

Background and Aims: Cesarean delivery (CD) rates continue to rise worldwide. Prior studies have indicated that CD is associated with not only various gynaecological symptoms and obstetric complications but also lower probability of subsequent fertility. However, the recognition about impact of CD on clinical outcomes in subsequent IVF/ICSI-FET is very limited. The purpose was to investigate the effects of previous CD on pregnancy and neonatal outcomes in single frozen-thawed embryo transfer (FET) cycles so that women with a previous cesarean delivery can be given detailed fertility counseling during the ART process. Methods: This is a large retrospective cohort study including a total of 5,750 patients who desired to transfer single vitrified-thawed blastocyst from the same oocyte retrieval cycle as their last live birth between January 2011 and January 2021 in a center for reproductive medicine in Shandong, China, comprising FET cycles of 3,853 previous single CD and 1,897 previous single vaginal delivery (VD). Results: Women with a previous CD had significantly lower rates of biochemical pregnancy (64.52% vs. 71.48% before propensity score matching (PSM), P<0.001; and 65.58% vs. 71.49% after PSM, P<0.001), clinical pregnancy (58.16% vs. 65.79% before PSM, P<0.001; and 59.22% vs. 66.17% after PSM, P<0.001) and live birth (48.17% vs. 55.82% before PSM, P<0.001; and 49.29% vs. 56.10% after PSM, P<0.001) than those with a previous VD. Meanwhile, the CD rate was significantly higher in the CD group (97.85% vs. 18.53% before PSM, P<0.001; and 98.02% vs. 20.51% after PSM, P<0.001). The rates of multiple pregnancy, miscarriage, ectopic pregnancy, multiple live birth, labor complications and preterm and neonatal outcomes were comparable between the two groups. Conclusion: Compared to VD, a previous CD is associated with a significant reduction in the rates of biochemical pregnancy, clinical pregnancy and live birth in patients undergoing subsequent single frozen-thawed blastocyst transfer.

#8 : The Effect of IVF-ET Electro-Ultrasound Therapy on the Outcome of Frozen Embryo Transfer in Patients with Thin Endometrium

Background and Aims: This study are to investigate the clinical indicators of the infertile population of IVF-ET thin endometrium patients after electro-ultrasound treatment, record the observational data and analyze the clinical effectiveness of this treatment method. Method: Patients undergoing IVF-ET freeze-thaw embryo transfer from March 2022 to November 2022 were screened, and those who met the entry criteria were randomly grouped by random number table method. Treatment group (n=32): patients who received electro-ultrasound therapy; patients treated with electro-ultrasound (MLD-C7000) once a day for 30 minutes for 7 days for 1-3 sessions in the context of conventional FET preparation of the endothelium. Control group (n=69): Routine FET preparation of the endometrium without. Results: There were no significant differences in basic data (P > 0.05). The endometrial thickness on the day of conversion 7.75±2.00 mm was significantly higher in the treatment group than the endometrial thickness on the day of conversion 6.39±0.67 mm in the control group (P<0.05). The biochemical pregnancy rate and clinical pregnancy rate in the treatment group were higher than those in the control group, but the differences were not statistically significant (P > 0.05). Conclusion: In IVF-ET patients with thin endometrium, electro-ultrasound therapy device can effectively improve the endometrial thickness of patients with a trend of beneficial effects on clinical outcomes and can be one of the methods to improve the success rate in patients with thin endometrium. However, further increase in sample size is needed in the future to improve the accuracy of the results.

#23 : Correlation of Multinucleated Embryo and Pregnancy Outcome

Background and Aims: Single embryo transfer is increasingly done in practice to avoid multiple pregnancy. Therefore, it is important to ensure the embryo with the best pregnancy outcome is selected. Although new criteria involving genomic, transcriptomic, and proteomic have been developed to predict embryo outcome, morphology of the embryo remains as the main indicator because it is easy to implement and less controversial. To study the correlation of multinucleated embryos and pregnancy outcomes Method: This is a retrospective review of a total of 411 embryos from 225 women undergoing their first IVF or ICSI cycle in University Malaya Medical Centre, Kuala Lumpur between January 2019 and October 2021. Multinucleation was defined as the presence of more than one nucleus within at least one of the blastomeres of a 2-cell embryo and a time-lapse imaging system was used to observe embryo development (Embryoscope; Unisense Fertilitech). Group allocation was based on the presence or absence of multinucleation on day 2 after egg retrieval. Embryos with evidence of one or more blastomere having multinucleation were included in the studied group (n = 67 embryos). Embryos without any blastomere exhibiting multinucleation were included in the control group (n = 344 embryos). Results: The data were based on 225 transfers of 411 embryos consisting of 16.3% (n = 67) from studied group and 83.7% (n = 344) from the control group. The biochemical pregnancy rate and implantation rate is lower in the studied group compared to the control group although not statistically significant (Table 1). Conclusion: Multinucleated embryos reduce the implantation rate and clinical pregnancy rate although not statistically significant.

#20 : Follitropin Delta Can Play a Good Role in Both Patients with High Serum AMH Level and Patients with Low Serum AMH Level in IVF

Background and Aims: To evaluation clinical efficacy of follitropin delta in IVF procedure for Korean. Method: This is a prospective study performed by single physician at primary fertility center. From December 2020 to November 2021, total 82 cycles of IVF were performed. 70% of total cycles was performed using gonadotrophic releasing hormone (GnRH) antagonist protocol, and another 30% of cycles were gonadotrophin releasing hormone agonist (GnRHa) protocol. Results: Average duration of infertility was 2.2± 1.5 years. AMH levels were 2.4± 2.4 ng/ml. The number of obtained oocytes were 8.9± 5.0. Mean daily dose of follitropin delta were 10.3± 2.5 mcg, and total dosage were 121.8± 25.5 mcg. Duration of stimulation were 9.9± 2.0 days. Biochemical pregnancy rate was 38% and clinical pregnancy rate was 27%. No cases of severe ovarian hyperstimulation syndrome were developed. Conclusion: For both patients with good ovarian reserve, and the patients with poor ovarian reserve, follitropin delta can play a good role. With its discriminative fixed dosing protocol, follitropin delta gives more convenient way for both physicians and patients with minimal risk of OHSS, without having detrimental effect on pregnancy rate.

#198 : When to Transfer Day 6 Vitrified Embryos? On Day 5 vs Day 6 of Progesterone, a Retrospective Analysis

Background and Aims: The age of cryopreserved embryos impacts the ART outcome of frozen embryo transfer cycles. The development potential of embryos is not uniform. Though the days of progesterone exposure before transfer of D5 blastocyst is so far standardized, there is lack of standardization on transfer of Slow growing embryo i.e. D6 blastocysts. So, this study aims to compare the clinical outcomes of D6 blastocyst transferred on the 5th day or 6th day of progesterone supplementation. Method: The retrospective data were collected from the central registry of Indira IVF Hospital Private Limited to analyze 62227 frozen cycles from April 2019 to July 2021, divided into two groups: D6-Frozen embryos transferred on P+5 (Group A) vs P+6 (Group B). Results: There were 1212 cycles in Group A, and 189 cycles in the Group B arm in the final analysis). The propensity scores were calculated using binary logistic regression and the nearest neighborhood technique based on the following variables at baseline: Wife Age, Husband Age, Body max Index (BMI), Anti mullerian hormone (AMH), and Endometrial thickness. The clinical pregnancy rate was significantly higher in Group A than in Group B (CPR 70.5% vs. 63.0%, p=0.037). No significant differences were observed in the biochemical pregnancy rate (72.6% vs. 66.1%; p=0.066), biochemical loss rate (3.0% vs. 4.8%; p=0.271), clinical miscarriage rate (15.9% vs. 13.4%; p=0.485), live birth rate (59.2% vs. 54.5%; p=0.218) and multiple live birth rate (16.5% vs. 14.8%; p=0.559). Conclusion: In this study Frozen Embryo Transfer of D-6 blastocysts on the day-5 of progesterone results in better pregnancy outcomes than the day-6 of progesterone.

#270 : Single-Center Retrospective Cohort Analysis: Preimplantation Genetic Testing for Monogenic Disorders (PGT-M) for Monogenic Nephropathy

Background and Aims: Hereditary nephropathy, including monogenic nephropathy, is an important cause of renal insufficiency and end-stage renal disease. Therefore, genetic blockade is necessary for couples with monogenic nephropathy. Following routine application of prenatal diagnosis, preimplantation genetic testing for monogenic disorders (PGT-M) has been applied to the genetic blockade of monogenic disease patients. The purpose of this study is to retrospectively analyze genetic counseling process for patients with nephropathy-related disease and provide clinical overviews of patients with monogenic nephropathy who underwent PGT-M. Method: A single-center retrospective cohort study was conducted at Center for Reproductive Medicine, Shandong University from January 2014 to December 2022. 352 couples with nephropathy-related disease were included in the cohort totally. Statistical analysis was performed using Statistical Package for Social Science software 26.0. Results: Of the 352 couples with nephropathy-related disease, 291 underwent genetic counseling, followed by 180 accepting genetic screening. 104 couples with monogenic nephropathy indications proceeded with PGT-M, including 91 of autosomal dominant inheritance, 9 of autosomal recessive inheritance, 3 of X-linked dominant inheritance, and one of X-linked recessive inheritance. 498 blastocysts were tested by PGT-M combined with preimplantation genetic testing for aneuploidy (PGT-A), making 72 transferable embryos, 249 non-transferable embryos, 72 genetic counseling embryos and 7 amplification failedembryos. Finally, 80 vitrified-thawed single blastocyst transfer cycles were performed. Live births occurred in 38 women, of which 37 transferred embryos with non-pathogenic genotypes. The results of prenatal diagnosis of all newborns were consistent with the testing results for embryos transferred. The cumulative live birth, biochemical pregnancy, clinical pregnancy, ongoing pregnancy and pregnancy loss rates were 36.54%, 56.73%, 49.04%, 7.69%, and 22.03% respectively. Conclusion: PGT-M is an effective means of genetic blockade for couples with monogenic nephropathy. The absence of genetic abnormalities detected by prenatal diagnosis in healthy newborns without monogenic nephropathy also underscore its validity.

Impact of coronavirus disease 2019 vaccination on live birth rates after in vitro fertilization

ObjectiveTo investigate COVID-19 vaccination on live birth rates in patients undergoing in vitro fertilization. DesignRetrospective cohort study SubjectsPatients who underwent fresh or frozen embryo transfer (FET) cycles at an academic center between January 1, 2020 and December 31, 2021. ExposureCOVID-19 vaccination, defined as completing a two-dose regimen (Pfizer or Moderna) or one dose regimen (Johnson & Johnson/Janssen) prior to cycle initiation. Main Outcome MeasuresThe primary outcome was live birth rate per embryo transfer. Secondary outcomes included positive hCG and clinical pregnancy rates per embryo transfer. Outcomes from cycles among vaccinated and unvaccinated patients were compared. Descriptive statistics were used to analyze demographic and cycle characteristics with Student’s t, Wilcoxon rank sum, Pearson Chi-square, and Fisher’s exact tests as appropriate for univariable analysis. Generalized estimating equation models were used to examine the strength of the relationship between vaccination status and pregnancy outcomes. ResultsAmong 709 unvaccinated and 648 vaccinated fresh cycles, there were no statistically significant differences between the number of oocytes retrieved, oocyte maturity, fertilization, and blastocyst utilization rates. In adjusted multivariable analysis, there was no statistically significant difference between fresh cycles among vaccinated patients compared to unvaccinated patients with rates of positive hCG (aOR 1.37, 95% CI 0.84-2.25), clinical pregnancy (aOR 1.22, 95% CI 0.73-2.03), or live birth (aOR 1.37, 95% CI 0.79-2.25) per embryo transfer. Among 264 unvaccinated and 423 vaccinated FET cycles, vaccinated patients had higher odds of positive hCG (aOR 1.54, 95% CI 1.08-2.20), clinical pregnancy (aOR 1.80, 95% CI 1.27-2.56), and live birth (aOR 2.31, 95% CI 1.60-3.32) per embryo transfer compared to unvaccinated patients. ConclusionPatients who were COVID-19 vaccinated prior to FET had higher rates of biochemical pregnancy, clinical pregnancy, and live birth. Vaccination was not associated with pregnancy or live birth rates after fresh cycles. This study contributes to evidence supporting COVID-19 vaccination for patients attempting pregnancy.

Mean number of DNA breakpoints: illuminating sperm DNA integrity and in vitro fertilization outcomes

ObjectiveTo verify the capacity of the mean number of DNA breakpoints (MDB) for evaluating sperm integrity and its relationship with in vitro fertilization (IVF) outcomes. DesignRetrospective cohort study. SettingReproductive center in a tertiary hospital.Patient(s): All men whose female partners underwent IVF from March to October 2022 in the reproductive center. Intervention(s)MDB and DNA fragmentation index (DFI) were used to assess sperm DNA integrity. The patients were stratified into two groups according to MDB and DFI cutoffs: sperm DNA-normal and sperm DNA-impaired. Main outcome measures(1) semen parameters: concentration, progressive motility (PR), MDB and the DFI; (2) IVF outcome measures: two pronuclei (2PN), fertilization rate, fertilization cleavage rate, high-quality embryo rate, biochemical pregnancy rate, clinical pregnancy rate, and implantation rate. ResultsSperm MDB had a higher negative correlation with PR compared to the DFI (r=-0.43, P<0.01; r=-0.37, P<0.01, respectively). Sperm MDB did not have a statistical correlation with sperm concentration, while the DFI correlated significantly with concentration (r=-0.17, P=0.07; r=-0.27, P<0.01, respectively). Logistic regression analysis controlling for age and semen concentration demonstrated that an increase in MDB increased the risk of asthenospermia (OR=1.018, 95% CI 1.003-1.034, P=0.02). An increasing DFI also increased the risk of asthenospermia (OR=1.044, 95% CI 1.002-1.087, P=0.04). MDB showed a stronger clinical relevance with sperm PR than the DFI, as indicated by the area under the curve (AUC) (0.754, 95% CI 0.649-0.859, P<0.01 vs. 0.691, 95% CI 0.556-0.825, P<0.01). A threshold of MDB over 0.37 nM was calculated to define sperm DNA-impaired. Comparison of IVF results showed that the high-quality embryo rate (χ2=13.00, P<0.01) was significantly lower in the DNA-impaired group than in the DNA-normal group stratified by MDB, while there were no significant differences in IVF outcomes in DFI-stratified groups. ConclusionMDB are verified to correlate closely with semen PR and may serve as a predictive parameter for IVF outcomes. Rigorous prospective studies are required to explore MDB performance and to further validate and reinforce the potential application of MDB as a parameter for male infertility.

The influence of male HBV infection on sperm quality, embryonic development, and assisted reproductive outcomes.

What is the impact of male hepatitis B virus (HBV) infection on sperm quality, embryonic development, and assisted reproductive outcomes? Male HBV infection did not affect assisted reproductive outcomes, but HBV is capable of impairing human sperm and embryo formation in the early stages following fertilization. HBV is found in germ cells and early embryos of patients with HBV. HBV may impair human sperm function via increasing reactive oxygen species. We conducted a retrospective cohort study of 1581 infertile couples, including 496 male patients clinically confirmed to have hepatitis B infection, and a laboratory study of effects of HBV proteins on early embryos, using human embryonic stem cells (hESCs), human sperm, and golden hamster oocytes. In total, 1581 infertile couples (24-40 years of age) who were admitted to a reproductive medicine center to undergo ART for the first time from January 2019 to November 2021 were selected as the study subjects. The case group was composed of 469 couples with hepatitis B surface antigen (HBsAg)-seropositive men and seronegative women (368 for IVF and 101 for ICSI treatment). The negative control group was composed of 1112 couples where both men and women were seronegative for hepatitis B antigen. We divided these couples into three comparison groups (IVF/ICSI, IVF, and ICSI). IVF of human sperm and hamster oocytes was used to evaluate the influence of the HBV HBs protein on formation of 2-cell embryos. Mitochondrial membrane potential (MMP) of hESCs was assayed via a fluorescence intensity system. Immunofluorescence staining of the phosphorylated histone H2A.X was applied to identify DNA damage to hESCs caused by the HBV X (HBx) protein. Sperm concentration, total sperm number, and sperm with normal morphology were decreased in the couples with HBV-infected males in couples who were undergoing IVF/ICSI (male HBV(+) vs control: 469 vs 1112 individuals; sperm number, P < 0.01; normal sperm morphology, P < 0.01), IVF (368 vs 792; sperm number, P < 0.01; normal sperm morphology, P ≤ 0.05), and ICSI (101 vs 306; sperm number, P < 0.01; normal sperm morphology, P < 0.001). There was no significant difference in the number of embryo cleavages, blastocyst formation, biochemical pregnancy rate, clinical pregnancy rate, and live-birth rate between case and control groups. The 2PN fertilization rate in IVF/ICSI (P < 0.01) and ICSI (P < 0.05) couples, and the number of 2PN-fertilized oocytes in IVF (P < 0.001) couples were lower in couples with male HBV infection compared to control couples. HBV HBs protein reduced the MMP of human sperm and decreased 2-cell embryo formation in IVF of human sperm and zona-free-hamster oocyte. A reduction in fluorescence intensity and immunofluorescence staining of phosphorylated histone H2A.X indicated that HBx caused MMP impairment and DNA damage in human early embryonic cells, respectively. N/A. HBV can be examined in samples of sperm or discarded IVF early embryos from HBsAg-seropositive men and seronegative women. The hESC model in vitro may not fully mimic the natural embryos in vivo. This study furthers our understanding of the influence of male HBV infection on embryonic development. Our results suggest that a semen-washing process may be necessary for male patients with HBV undergoing ART to minimize the potential negative effects of HBV infection on the early embryo. This work was funded by grants from the National Natural Science Foundation of China, grant numbers 81870432 and 81570567 to X.Z., 81571994 to P.S., and 81950410640, the Natural Science Foundation of Guangdong Province, China (No. 2023A1515010660 to X.Z.), and the Li Ka Shing Shantou University Foundation (Grant No. L11112008). The authors have no conflicts of interest.

Higher live birth rates are associated with a normal body mass index in preimplantation genetic testing for aneuploidy frozen embryo transfer cycles: a Society for Assisted Reproductive Technology Clinic Outcome Reporting System study

To determine whether body mass index (BMI) was associated with live birth in patients undergoing transfer of frozen-thawed preimplantation genetic testing for aneuploidy (PGT-A) embryos. Retrospective cohort study of cycles reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System. All autologous and donor recipient PGT-A-tested cycles reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System from 2014 to2017. Body mass index. The primary outcome measure was the live birth rate, and the secondary outcome measures were the clinical pregnancy and biochemical pregnancy rates. Multivariable generalized additive mixed models and log-binomial models were used to model the relationship between BMI and outcome measures. A total of 77,018 PGT-A cycles from 55,888 patients were analyzed. Of these cycles, 70,752 were autologous, and 6,266 were donor recipient. In autologous cycles, a statistically significant and clear nonlinear relationship was observed between the BMI and live birth rates, with the highest birth rates observed for the BMI range of 23-24.99 kg/m2. When using 23-24.99 kg/m2 as the referent, other BMI ranges demonstrated a lower probability of live birth and clinical pregnancy that continued to decrease as the BMI moved further from the reference value. Patients with a BMI of <18.5 kg/m2 had a 11% lower probability of live birth, whereas those with a BMI of ≥40 kg/m2 had a 27% lower probability than the referent. A normal-weight BMI range of 23-24.99 kg/m2 was associated with the highest probability of clinical pregnancy and live birth after a frozen-thawed PGT-A-tested blastocyst transfer in both autologous and donor recipient cycles. A BMI outside the range of 23-24.99 kg/m2 is likely associated with a malfunction in the implantation process, which is presumed to be related to a uterine factor and not an oocyte factor, as both autologous and donor recipient cycle outcomes were associated similarly with the BMI of the intended parent.

Preconception Non-criteria Antiphospholipid Antibodies and Risk of Subsequent Early Pregnancy Loss: a Retrospective Study

The aim of this study was to investigate the subsequent early pregnancy outcomes in women positive for non-criteria antiphospholipid antibodies (NC-aPLs) before pregnancy. A total of 273 patients who had experienced sporadic or recurrent pregnancy loss and had been screened for 13 NC-aPLs at preconception were recruited in this study from September 2019 to February 2022. Serum levels of NC-aPLs were measured by ELISA using specific kits. The primary outcome was early pregnancy loss, and the secondary outcomes were biochemical pregnancy, clinically confirmed pregnancy loss, and ongoing pregnancy. Among these subjects, 56 patients had one previous pregnancy loss, and 217 had recurrent pregnancy loss (RPL). The NC-aPLs (+) and NC-aPLs (−) groups had similar rates of early pregnancy loss (EPL) after adjustment, regardless of the number of positive NC-aPLs (aOR = 1.054, 95% CI 0.602–1.846). Other outcomes were comparable in both groups, including the rates of biochemical pregnancy (aOR = 1.344, 95% CI 0.427–4.236), clinically confirmed pregnancy loss (aOR = 0.744, 95% CI 0.236–2.344), and ongoing pregnancy (aOR = 0.949, 95% CI 0.542–1.660). Based on sensitivity analysis, the NC-aPLs (+) were not associated with adverse early pregnancy outcomes in women with RPL. Furthermore, the difference in gestational weeks of pregnancy loss between the two groups was also insignificant. This study found no evidence linking preconception NC-aPL positivity to early pregnancy outcomes but offers a reference for future research to clarify NC-aPLs’ potential clinical impact.

The Potential of Theophylline and Pentoxifylline in Sperm Optimization and Its Intracytoplasmic Sperm Injection Outcomes.

Sperm motility is an essentialselection criteria by embryologists at the time of intracytoplasmic sperm injection (ICSI). One method of testing sperm viability is to induce sperm motility by increasing cyclic adenosine monophosphate (cAMP) levels by treating a semen sample with phosphodiesterase inhibitors (PDEIs), such as theophylline and pentoxifylline. It explores the implications of PDEI in medical care, reflecting on its effects in clinical settingsand recognizing potential topics for future exploration. This analysis revealed that by incorporating stimulants that activate movements, the time it took to single out sperms was markedly reduced, and consequently, the sperms were safeguarded from a prolonged period of oxidative stress. Furthermore, theophylline was found to advance sperm motility, consequently resulting in several initially immobile spermatozoa displaying rapid progressive motility. Higher fertilization rate, cleavage rate, good quality embryos (grade I), and higher biochemical and clinical pregnancy rates were found with artificial sperm activation (ASA) using pentoxifylline and theophylline. This review emphasizes the need for more research to evaluate the drug's long-term safety and investigate the effects of theophylline and pentoxifylline on postfertilization parameters, such as embryo development, implantation, and pregnancy outcomes. These areas of investigation are important for understanding the complete impact of these agents and to ensure their safe and effective implementation in clinical practice.