Clinical Outcomes Of Assisted Reproductive Technology Research Articles

Can endometrial compaction predict live birth rates in assisted reproductive technology cycles? A systematic review and meta-analysis.

Endometrial compaction (EC) is defined as the difference in endometrial thickness from the end of the follicular phase to the day of embryo transfer (ET). We aimed to determine the role of EC in predicting assisted reproductive technology (ART) success by conducting a meta-analysis of studies reporting the association between EC and clinical outcomes of ART. MEDLINE via PubMed, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from the date of inception to May 19, 2023. The primary outcome was live birth rate (LBR) per ET. Secondary outcomes were live birth or ongoing pregnancy per ET, ongoing pregnancy per ET, clinical pregnancy per ET, and miscarriage per clinical pregnancy. Fifteen studies were included. When data from all studies reporting live birth were pooled, overall LBR rates were comparable in cycles showing EC or not [RR = 0.97, 95%CI = 0.92 to 1.02; 10 studies, 11,710 transfer cycles]. In a subgroup of studies that included euploid ET cycles, a similar LBR for patients with and without EC was noted [RR = 0.99, 95%CI = 0.86 to 1.13, 4 studies, 1172 cycles]. The miscarriage rate did not seem to be affected by the presence or absence of EC [RR = 1.06, 95%CI = 0.90 to 1.24; 12 studies]. The predictive value of EC in determining LBR is limited, and assessment of EC may no longer be necessary, given these findings. PROSPERO CRD42023410389.

O-220 Artificial intelligence for embryo selection: ethical, social and regulatory issues

Abstract Study question What are the key ethical, social and regulatory issues raised by artificial intelligence technologies (AI) for embryo selection, and how might these be best managed? Summary answer Key issues with AI for embryo selection include deskilling, transparency, accountability, and fairness. These require attention to improve psychosocial and clinical outcomes in ART. What is known already Artificial intelligence (AI) technologies play a growing role in the assisted reproductive technology (ART) sector. Machine learning holds enormous promise for improving the selection of human embryos for transfer after IVF. Time-lapse imaging in conjunction with machine learning has the potential to standardise and automate embryo selection, improving clinical outcomes. Promising results have recently been published, and AI tools have reached the market. However, ethical and regulatory analysis has not kept pace with the technology. There has been negligible research on the ethical, social, and regulatory issues raised by the use of machine learning methods for embryo selection. Study design, size, duration A terrain-mapping review of the academic literature was performed to identify the key social, ethical and regulatory issues raised by AI for embryo selection. This is part of a multi-method study, collecting qualitative and quantitative data alongside ethical and regulatory analysis.The study is expected to take 1 year. Participants/materials, setting, methods A systematic review of the extant literature on the ethical, social, and regulatory issues raised by machine learning for embryo selection, combined with a narrative review of the broader literature on the use of AI in healthcare was undertaken. This review of ethical and regulatory issues will ultimately combine with data from semi-structured interviews and an online survey of ART patients and practitioners, including fertility specialists and embryologists, and ART regulators in Australia. Main results and the role of chance This paper reports on ethical and regulatory analysis of key issues that emerge from the use of AI for embryo selection. The use of AI in healthcare generally has raised serious concerns about deskilling and ‘dehumanization’(as roles traditionally performed by humans are displaced by technology), transparency, accountability, and fairness. This paper examines these issues in the ART context, to begin to develop guidance on how to best implement this technology in ways that balances the interests of all stakeholders and is consistent with maintaining public trust in the field of ART. Limitations, reasons for caution It is anticipated that much of the analysis of the social, ethical and regulatory issues will be generalisable internationally. However, the study prioritises one context - that of Australia. Some features of the Australian context may limit generalisability. Wider implications of the findings There is a need to address the ethical, social and regulatory issues that arise with the emergence of innovative technologies within ART to maintain public trust and ensure that psychosocial and clinical outcomes are improved. Further data collection on stakeholder views of machine learning for embryo selection will be required. Trial registration number Not applicable

Associations of Sperm mtDNA Copy Number, DNA Fragmentation Index, and Reactive Oxygen Species With Clinical Outcomes in ART Treatments

Recent studies have suggested that sperm mitochondrial DNA copy number (mtDNA-CN), DNA fragmentation index (DFI), and reactive oxygen species (ROS) content are crucial to sperm function. However, the associations between these measurements and embryo development and pregnancy outcomes in assisted reproductive technology (ART) remain unclear. Semen samples were collected from 401 participants, and seminal quality, parameters of sperm concentration, motility, and morphology were analyzed by a computer-assisted sperm analysis system. DFI, mtDNA-CN, and ROS levels were measured using sperm chromatin structure assay, real-time quantitative polymerase chain reaction, and ROS assay, respectively. Among the participants, 126 couples underwent ART treatments, including in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), and 79 of the couples had embryos transferred. In 401 semen samples, elevated mtDNA-CN and DFI were associated with poor seminal quality. In 126 ART couples, only mtDNA-CN was negatively correlated with the fertilization rate, but this correlation was not significant after adjusting for male age, female age, seminal quality, ART strategy, number of retrieved oocytes, controlled stimulation protocols, and cycle rank. Regarding pregnancy outcomes, sperm mtDNA-CN, ROS, and DFI were not associated with the clinical pregnancy rate or live birth rate in 79 transferred cases. In conclusion, increased mtDNA-CN and DFI in sperm jointly contributed to poor seminal quality, but sperm mtDNA-CN, ROS, and DFI were not associated with clinical outcomes in ART.

Effects of leukocytospermia on the outcomes of assisted reproductive technology.

Leukocytospermia is one of the common causes of male infertility, and its effects on the clinical outcomes of assisted reproduction are controversial. There are no recommendations for the management of leukocytospermia in cases of assisted reproductive technology (ART). To investigate the impact of leukocytospermia on ART, we retrospectively compared the clinical outcomes in ART couples with or without leukocytospermia and further analysed the impact of the insemination method itself by split insemination treatment in ART couples with leukocytospermia. In this study, leukocytospermia was detected in 133 patients, namely 63 in the conventional in vitro fertilization (IVF) group, 38 in the intracytoplasmic sperm injection (ICSI) group and 32 in the split insemination group. Leukocytospermia has a negative influence on the parameters of semen samples; however, leukocytospermia did not affect the clinical outcomes of IVF or ICSI. Different insemination methods did not affect the fertilization, clinical pregnancy or live birth rates. In the split insemination study, no significant differences in clinical pregnancy and live birth rates between the IVF and ICSI groups were found; however, the numbers of two pronuclei (2PN), available embryos and good‐quality embryos in the ICSI group were higher than those in the IVF group. Leukocytospermia may be a risk factor affecting semen parameters, and more attention should be given to IVF insemination. Leukocytospermia has no significant negative effect on the outcomes of ART. ICSI may obtain better embryos than IVF, but it cannot improve the clinical pregnancy and live birth rates.

Investigating the impact of asymptomatic or mild SARS-CoV-2 infection on female fertility and in vitro fertilization outcomes: A retrospective cohort study.

Background: The current study aimed to investigate the impact of asymptomatic or mild severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on female fertility and laboratory and clinical outcomes in assisted reproductive technology (ART) treatments.Methods: Patients undergoing ART treatments in the Reproductive Medicine Center, Tongji Hospital, Wuhan, from May 2020 to February 2021 were enrolled. Seventy of them were positive for serum SARS-CoV-2 antibodies (IgG and/or IgM), and 3973 patients had negative results. Propensity score matching with a ratio of 1:3 was performed, and there were 65 females in the case group and 195 females in the control group.Findings: The ovarian reserves and ovarian responses between groups after matching were similar. The proportions of mature oocytes, damaged oocytes, fertilized oocytes, cleavage embryos, high-quality embryos, and available blastocysts were also similar, despite a slight decrease in the blastocyst formation rate in the case group. In addition, there were no significant differences in terms of the biochemical pregnancy rate, clinical pregnancy rate, early miscarriage rate, or implantation rate.Interpretation: There is no evidence that a history of asymptomatic or mild SARS-CoV-2 infection in females may negatively affect female fertility, embryo laboratory outcomes, or clinical outcomes in ART treatments.

Effect of serum 25-hydroxyvitamin D levels on sperm quality and assisted reproductive technology outcomes for men of infertile Chinese couples.

Vitamin D insufficiency/deficiency is highly prevalent in China, but its effect on sperm quality and outcomes of assisted reproductive technology (ART) in men from infertile couples is not clear. This study aimed to explore the association of serum 25-hydroxyvitamin D (25OHD) levels and semen parameters, as well as ART outcomes for men from infertile couples. This study recruited 1308 men from infertile couples who attended the Reproductive Medicine Center of Peking University Third Hospital for first time from February to August 2019 (NCT03804294). Reproductive hormones levels, semen parameters, and clinical outcomes of ART were compared between vitamin D-deficient group (serum 25OHD≤10ng/mL), insufficient group (serum 25OHD 10-20ng/mL), and sufficient group (serum 25OHD≥20ng/mL). We found 27.7% of participants were vitamin D sufficient, suggesting high prevalence of vitamin D insufficiency/deficiency in China. Reproductive hormone levels were similar between the three groups. The total number of morphologically normal spermatozoa was significantly different between the three groups in all participants, impaired semen quality subgroup, and normozoospermia subgroup (P<.05) with the adjustment of confounders (age, BMI, alcohol consumption, cigarette smoking, and physical exercise). The percentage of normal sperm morphology significantly increased with elevated serum 25OHD levels in all participants and the participants with impaired semen quality (P<.05), and the total sperm count showed significant difference in participants with impaired semen quality (P=.026). For routine in vitro fertilization and intracytoplasmic sperm injection cycles, there were no differences in fertilization rate, top-quality embryo rate, biochemical pregnancy rate, and clinical pregnancy rate between serum 25OHD<20ng/mL and serum 25OHD≥20ng/mL groups. Males of infertile couples with higher serum 25OHD levels exhibit better results in sperm morphology, and serum 25OHD levels may contribute to total sperm number in participants with impaired semen quality, but show no effects on the ART outcomes.

Clinical outcome of assisted reproductive technologies in advanced aged men

Abstract Objective The purpose was to establish whether the advanced male age may influence the outcomes in a controlled assisted reproductive technology (ART) program. Design This is an experimental study. Setting Research and Clinical Center for Infertility of Yazd. Sample A total of 63 men undergoing ART cycles. Material In a retrospective study, the outcome of intracytoplasmic sperm injection (ICSI) in ART cycles in two groups of patients was studied. Patients regarding etiology of infertility were divided into two groups: (A) male factor infertility (n = 47), and (B) female factor infertility (n = 16). Sperm parameters, ART cycle characteristics and clinical outcomes were assessed between two groups. Main outcome measures Clinical outcomes of ART in advanced aged men. Results There were no significant differences in rates of sperm count and morphology between two groups, but the rate of spermatozoa with progressive motility were higher in group B in comparison with A ( P = 0.002). The rates of high quality embryos, pregnancy and live birth showed no significant differences between the groups ( P = 0.4, P = 0.4, P = 0.2, respectively). Conclusion It appears that the clinical outcome of ART in male and female factor infertility was not influenced by advanced paternal age.