Cumulative Clinical Pregnancy Rate Research Articles

Cetrorelix lowers premature luteinization rate in gonadotropin ovulation induction–intrauterine insemination cycles: a randomized-controlled clinical trial

Attempting to compare the rates of premature luteinization (PL), clinical pregnancy, and cycle cancellation in ovulation induction-intrauterine insemination (OI-IUI) cycles with and without the GnRH antagonist, cetrorelix, a randomized-controlled trial was undertaken in which patients were randomized to one of two OI-IUI protocols. Those in the cetrorelix arm showed a significantly reduced rate of PL and no change in clinical pregnancy or cycle cancellation rate, leading to the conclusion that GnRH antagonists can decrease the rate of PL, but appear to have no effect on pregnancy or cycle cancellation in gonadotropin OI-IUI cycles.

Effect of urinary versus recombinant FSH on clinical outcomes after frozen–thawed embryo transfers: a systematic review

Recent randomized trials, systematic reviews and cost-effectiveness analyses have demonstrated the relative efficacy,and in some cases superiority, of urinary gonadotrophins (uFSH, human menopausal gonadotrophin) compared with recombinant FSH (rFSH). However, the effectiveness of frozen-embryo transfers (FET) following ovarian stimulation with uFSH versus rFSH in the fresh cycle has not been well investigated. The objective of this study was to determine whether there are differences in clinical outcomes in women undergoing FET according to the type of gonadotrophin used during ovarian stimulation. Following a meticulous search, all published comparative studies of FET using ovarian stimulation were reviewed. Data on clinical outcomes were extracted and systematically presented. Using the agonist long protocol for down-regulation, five trials provided extractable data for live-birth and ongoing pregnancy rates following FET, as well as the cumulative live-birth, ongoing pregnancy and clinical pregnancy rates following fresh-embryo transfer and FET from the same cycle. There was no evidence of significant effect difference between the uses of uFSH versus rFSH regarding any of the outcomes. In conclusion there is insufficient evidence to determine whether the use of a certain type of gonadotrophin during ovarian stimulation affects the clinical outcomes in subsequent FET.

Cumulative ongoing pregnancy rate achieved with oocyte vitrification and cleavage stage transfer without embryo selection in a standard infertility program

BACKGROUNDRecent advancement of minimum volume vitrification methods has resulted in a dramatic increase in the efficiency of the process. The aim of this study was to estimate the cumulative reproductive outcome of a cohort of infertile couples undergoing ICSI and oocyte vitrification in restrictive legal conditions, where only a limited number of oocytes could be inseminated per cycle and embryo selection and cryopreservation were forbidden.METHODSIn this prospective longitudinal cohort study, the cumulative ongoing pregnancy rates obtained by the insemination of fresh and vitrified oocytes from the same cohort were calculated as primary outcome measures. Moreover, the effect of basal and cycle characteristics on clinical outcomes were assessed.RESULTSBetween September 2008 and May 2009, 182 ICSI cycles were performed where oocyte vitrification was possible. A total of 104 first and 11 second oocyte warming cycles were then performed in non-pregnant patients of the same cohort. The overall ongoing pregnancy rates obtained in the fresh, and first and second warming cycles were 37.4, 25.0 and 27.3%, respectively. The overall cumulative ongoing clinical pregnancy rate observed per stimulation cycle was 53.3%. Maternal age was the only characteristic found to influence the reproductive outcome, with an inverse correlation between the age >40 and the ongoing pregnancy rates (P = 0.04, by Cox regression analysis).CONCLUSIONSHigh cumulative ongoing pregnancy rates can be obtained with transfers of embryos derived from fresh and cryopreserved oocytes in a typical infertile population. Female age significantly affects outcomes in this system.

Cumulative clinical pregnancy rates after COH and IUI in subfertile couples

To evaluate the influence of female age and cause of infertility on the outcome of controlled ovarian hyperstimulation (COH) and intrauterine insemination (IUI), we studied 2717 COH cycles in 1035 subfertile couples. The cumulative clinical pregnancy rates were 39% and 58% after three and six COH cycles, respectively. The cumulative pregnancy rate significantly decreased with maternal age and differed by cause of infertility. The cumulative pregnancy rate continued to increase with an increase in COH cycle number up to the third, or forth cycle, in patients with mechanical and combined infertility, respectively, and in up to the second cycle in patients aged 40 years or more. These findings provide treatment guidelines for clinicians in determining the likelihood of treatment success and the point at which to proceed to the next treatment strategy.

Effective blastocyst cryopreservation markedly increases cumulative pregnancy rates per ova retrieval in donor ova and non-donor cycles independent of patient age

OBJECTIVE: To compare the pregnancy rates of 990 fresh IVF/ICSI with 212 FET blastocyst transfers as a function of patient age. DESIGN: Ongoing longitudinal review. MATERIALS AND METHODS: From Jan. 2007 to Dec. 2008, an extended culture with triple gas system was used for 990 fresh IVF/ICSI cycles. After transfer the left blastocysts were cryopreserved by slow rate method. At the same time, 212 blastocyst FET cycles were completed. Main outcome measures: clinical pregnancy rate (CPR) (defined as viable delivery and/or ongoing pregnancy). RESULTS: The pregnancy rates of different patient age groups are shown in table 1 for donor and non-donor cycles. Table 1: Pregnancy results by age group in 990 fresh IVF/ICSI cycles and 212 blastocyst FET cycles.Table 1Pregnancy results by age group in 990 fresh IVF/ICSI cycles and 212 blastocyst FET cycles.Donor<35 yrs35-37 yrs38-40yrs≥41 yrsTotalFresh Cycle #187273164162204990Fresh Cycle Pregnancy rate142 (76%)178 (65.2%)89 (54.3%)76 (46.9%)58 (28.4%)543 (54.8%)Fresh Cycle CPR129 (69%)148 (54.2%)66 (40.2%)58 (35.8%)40 (19.6%)441 (44.5%)FET Cycle #5289271810212Blastocysts thawed147267734737571Survived # (rate)137 (93.2%)242(90.6%)67(91.8%)38(80.9%)36(97.3%)520(91.1%)Average ET#2.52.62.523.62.4FET Pregnancy rate34 (65.4%)64 (71.9%)18 (66.7%)10 (55.6%)3 (30%)129 (60.8%)FET CPR31 (59.6%)55 (61.8%)14 (51.9%)9 (50%)2 (20%)111 (52.4%) Open table in a new tab CONCLUSIONS: Fresh CPR was similar to FET CPR in the Donor group (69% vs. 59.6%, P =0.6536). No significant differences in CPR were found in all age groups between fresh and cryopreserved embryo transfer cycles. Effective blastocyst cryopreservation is a highly effective method to increase the cumulative clinical pregnancy rate per ova retrieval.

Is the surgical approach beneficial to subfertile women with symptomatic extensive adenomyosis?

Our aim was to assess the role of surgical intervention for symptom control and reproductive performance improvement in the management of subfertile women with symptomatic extensive uterine adenomyosis. Sixty-five subfertile women with pathology-proven extensive uterine adenomyosis, who were treated with conservative surgery or medical treatment with 6-month gonadotrophin-releasing hormone (GnRH) agonist or combination therapy, were retrospectively reviewed and their data analyzed. Twenty-eight women received conservative surgery with/without GnRH agonist (group A), and 37 received 6-month GnRH agonist therapy only (group B). Follow-up evaluations, including subjective symptoms (a self-reported 6-point verbal numeric rating scale and an analgesic usage score for dysmenorrhea) and objective parameters (serum CA125 level, and uterine size), and clinical pregnancy and successful delivery rates were made semi-annually over the ensuing 3 or more years. The women in group A had higher serum CA125 levels, more infertile years, and a larger uterine size. Subjective symptom control and objective parameters were better in group A during the entire 36-month follow up compared with those in group B. Cumulative 3-year clinical pregnancy and successful delivery rates were significantly higher in group A, compared with those in group B (46.4% [13/28] versus 10.8% [4/37], P = 0.002, and 32.1% [9/28] versus 8.1% [3/37], P = 0.022, respectively). Conservative surgery or combination therapy provides more effective and longer durable symptom control in the management of symptomatic women with extensive uterine adenomyosis, compared with GnRH agonist alone. Reproductive performance was also better in patients treated with conservative surgery with/without GnRH agonist.

Cryoaugmentation-clinical pregnancy rates per oocyte retrieval procedure including all subsequent frozen embryo transfers

OBJECTIVE: Cryopreservation of surplus embryos maximizes an ART programme's efficiency. However, not all couples go on to use all frozen embryos. The theoretical cumulative clinical pregnancy rate from a single IVF(in vitro fertilisation) cycle may be higher than that observed. The aim of the study was to calculate the observed and theoretical benefit of freezing supernumerary embryos.

Optimization of the Donor Insemination Program: A Variation on the Theme

Optimization of the Donor Insemination Program: A Variation on the Theme

Cumulative pregnancy rate after ICSI with cryopreserved testicular tissue in non-obstructive azoospermia

The aim of the present study was to describe a simplified and inexpensive method of testicular tissue freezing, to assess the cumulative clinical pregnancy rate (CPR) by this technique, and to provide useful information for counselling couples with non-obstructive azoospermia. One hundred and sixty-five couples with non-obstructive azoospermic males pursuing assisted conception, from December 1995 to December 2002, were included. In all cases, the testicular tissue retrieved by open multiple-biopsy (both sides, by testicular sperm extraction) was frozen using a simple liquid nitrogen vapour freezing technique and was stored in liquid nitrogen thereafter. Only mature spermatozoa were used for intracytoplasmic sperm injection (ICSI) after thawing. Expected CPR were calculated using the Kaplan–Meier survival analysis. A total of 281 cycles were performed resulting in 53 clinical pregnancies. Crude and expected CPR (95% confidence intervals) after three cycles were 32.1 (25.7–40.1) and 55.7% (37.0–74.4) respectively. In conclusion, this simplified method for freezing testicular tissue resulted in a satisfactory outcome after ICSI in cases of non-obstructive azoospermia.

Cumulative pregnancy rates after transfer of fresh and thawed embryos

Frozen-thawed embryo transfer is an effective procedure that allows further possibilities of pregnancy in addition to those obtained after the fresh in vitro fertilization (IVF). In our follow-up study we analysed all fresh embryo transfer procedures and every frozen-thawed embryo transfer performed from January 2000 to December 2001 evaluating the cumulative pregnancy rates. The study population was divided into two groups according to the female age: <38 years (group I) and >38 years (group II). All the best embryos were chosen for transfer and all the supernumerary good quality embryos were cryopreserved on the day of transfer. The embryos were then thawed and manipulated using a new technique. In group I, 527 patients (619 cycles) underwent fresh embryo transfer and in 232 of them (238 cycles) the embryos were frozen (44% per patients and 38.4% per cycle). In group II, 156 patients (193 cycles) underwent fresh embryo transfer and in 14 of them (15 cycles) the embryos were frozen (9% per patient and 7.8% per cycle). The pregnancy rate of group I patients that had their supernumerary embryos frozen (232 patients and 238 cycles) was 47.4% per cycle and 48.7% per patient whereas in the same population of group II patients (14 patients and 15 cycles) the clinical pregnancy rate was 35.7% per cycle and 38.5% per patients. The cumulative clinical pregnancy rate after transfer of fresh and thawed embryos was: group I, 74% per cycle and 76% per patients; group II, 42.8% per cycle and 46.1% per patient. Frozen-thawed embryo transfer is a cost-effective practice.

Blastocyst versus day-3 embryo transfers: A comparison of fresh and thaw cycle cumulative outcomes

Objective: A number of strategies have been designed to reduce multiple gestation rates while enhancing pregnancy and delivery rates. One method is to transfer two day-3 embryos and utilize supernumerary embryos in subsequent thaw cycles. An alternative strategy is to transfer two blastocyst stage embryos after extended culture to day 6 in vitro. The goal of the present study is to examine the cumulative pregnancy outcomes of fresh plus thaw cycles derived from a single oocyte retrieval in patients in whom two day-3 embryos were transferred and compare this data to cumulative outcomes when two blastocyst-stage embryos were transferred. Design: Retrospective analysis. Materials/Methods: Cycles in patients aged less than 35 years who underwent oocyte retrieval and day 3 transfer (D3T) or blastocyst transfer (BT) of two embryos between May 1, 1999 and October 31, 2001 were included in the study. Clinical pregnancy, live birth, singleton delivery, and multiple delivery rates were calculated for D3T and BT cycles. Cumulative pregnancy outcomes were determined by combining the outcomes of fresh cycles with outcomes of subsequent thaw cycles derived from the same ovulation induction/oocyte retrieval cycle. Data was examined by chi-square analysis. Results: During the study period, there were 527 fresh D3T cycles in which two embryos were transferred and patient age was less than 35 years. In fresh cycles only, the clinical pregnancy rate was 44.8% (236/527) and the live birth delivery rate was 31.1% (164/527). In 318 cycles (60.3%) at least one day-3 embryo was cryopreserved. 168 (31.8%) subsequent thaw cycles were performed. Combining fresh and thaw cycle outcomes revealed a cumulative pregnancy rate per oocyte retrieval of 50.5% (266/527). The cumulative live birth rate was 32.8% (173/527). 30 of 266 pregnancies (11.3%) were the result of thaw cycles. In the 188 fresh BT cycles examined, the pregnancy rate was 34.0 % (64/188) and the live birth rate was 29.8% (56/188). 23 (12.2%) subsequent thaw cycles were performed. The cumulative clinical pregnancy rate was 36.2% (68/188) and the cumulative live birth rate was 30.3 % (57/188). 4 clinical pregnancies and 1 live birth were the result of thaw BT cycles. Comparison of cumulative D3T and BT pregnancy, delivery, and multiple pregnancy rates are summarized in Table 1. Table 1Cumulative Pregnancy OutcomesAverage age, yearsPregnancy rate, %Live birth rate, %Singleton, %Twin, %Triplet, %Day-331.350.5 (266/527)∗p < 0.00132.8 (173/527)69.4 (120/173)28.3 (49/173)1.2 (1/173)Blastocyst31.836.2 (68/188)30.3 (57/188)68.4 (39/57)31.6 (18/57)0∗ p < 0.001 Open table in a new tab Conclusions: Among patients younger than 35 years of age, the cumulative live birth rate achieved by transfer by two fresh day-3 embryos combined with subsequent thaw cycles is comparable to cumulative cycle outcomes when two blastocyst-stage embryos are transferred. Additionally, the multiple gestation rates are similar. The significantly higher pregnancy rate of cumulative day-3 cycles is minimized by an increased rate of miscarriage in day 3 transfers. These data indicate that day-3 and blastocyst transfer of two embryos are expected to yield similar cumulative live birth rates with similarly low multiple gestation rates in this population.

A 3 year retrospective review of intrauterine insemination, using cryopreserved donor spermatozoa and cycle monitoring by urinary or serum luteinizing hormone measurements

Insemination with donor spermatozoa is an integral part of infertility treatment. For the last 3 years in our unit, intrauterine insemination with donor spermatozoa (IUID) has been used in preference to vaginal insemination. In this retrospective study, patients were offered an initial course of five single intrauterine inseminations with cryopreserved donor spermatozoa and treatment was then reviewed. A total of 389 patients received 1465 inseminations. In all, 1119 cycles were monitored using luteinizing hormone serum analyses and 346 cycles using the urine home test kits. The clinical pregnancy rate per insemination for the cycles monitored by the serum assay was 18.0% (202/1119) compared with the urine cycles (13.7%, 46/346) (P <05). The pregnancy loss rate was not significantly different (14.4%, 29/202 and 21.7%, 10/46) (serum and urine cycles respectively). The viable clinical pregnancy rate was significantly higher (P <03) for the serum cycles than for the cycles using the urinary monitoring (15.5%, 173/1119 and 10.4%, 36/346 respectively). The cycles monitored by serum assay had a significantly higher cumulative viable clinical pregnancy rate (P <0001) of 70.2% after nine inseminations compared with the urine monitored cycles of 54.8%. The majority of patients opted for the serum cycles, with a minority self-selecting the urine cycles mainly for travelling convenience. The explanation for the significant differences between the viable clinical pregnancy rates per insemination and the cumulative viable clinical pregnancy rates may be due to the sensitivity of the urine home test kit or the patients' interpretation of the result.

Results of laparoscopic treatments of ovarian endometriomas: laparoscopic ovarian fenestration and coagulation

Objective: To determine the long-term results of laparoscopic fenestration and coagulation of ovarian endometriomas and to compare them with the results of ovarian cystectomy performed by either laparotomy or laparoscopy. Design: Case-control study. Setting: Two university-affiliated hospitals. Patient(s): One hundred fifty-six premenopausal women with ovarian endometriomas of at least 3 cm in diameter (stage 3 and 4 endometriosis, revised American Fertility Society classification). Intervention(s): Laparoscopic ovarian fenestration and coagulation (group 1, 80 patients); laparoscopic ovarian cystectomy (group 2, 23 patients); and ovarian cystectomy by laparotomy and microsurgical technique (group 3, 53 patients). Main Outcome Measure(s): Operative findings, recurrence rate, and cumulative clinical pregnancy rate (PR) over a 36-month follow-up period. Result(s): The mean (± SD) time to first pregnancy was significantly shorter in group 1 (1.4 ± 0.2 years) than in group 2 (2.2 ± 0.5 years) or group 3 (2.4 ± 0.5 years). The difference between the cumulative clinical PR between the three groups was not statistically significant after 36 months of follow-up. The difference in the recurrence rate among groups 1, 2, and 3 was not statistically significant. Conclusion(s): Laparoscopic ovarian fenestration and coagulation of endometriomas leads to faster conception than ovarian cystectomy by laparotomy. Laparoscopic ovarian fenestration and coagulation of endometriomas is associated with cumulative clinical PRs and recurrence rates over 36 months that are similar to those associated with ovarian cystectomy.

Intracytoplasmic injection of fresh and cryopreserved testicular spermatozoa in patients with nonobstructive azoospermia—a comparative study

Objective: To compare the outcome of intracytoplasmic sperm injection (ICSI) with fresh and frozen-thawed testicular spermatozoa in patients with nonobstructive azoospermia. Design: Retrospective analysis of consecutive ICSI cycles. Setting: In Vitro Fertilization Unit, Assaf Harofeh Medical Center. Patient(s): Eighteen with nonobstructive azoospermia in whom testicular sperm was found after testicular sperm extraction. Intervention(s): Testicular sperm retrieval, cryopreservation, and ICSI with fresh or frozenthawed testicular spermatozoa. Main Outcome Measure(s): Two-pronuclear fertilization; embryo cleavage rates, mean number of embryos transferred per cycle, and their relative quality, embryo implantation, clinical pregnancy, and ongoing pregnancy rates (PRs) per ET. Result(s): No statistically significant differences were noted in all parameters examined between ICSI cycles with fresh or cryopreserved testicular spermatozoa from the same nine patients and comparing all ICSI cycles performed; with fresh (25 cycles) and thawed (14 cycles) testicular spermatozoa, respectively: two-pronuclear fertilization, 47% versus 44%; embryo cleavage rates, 94% versus 89%; implantation rates, 9% versus 11%; and clinical PR, 26% versus 27%. The delivery or ongoing PR using fresh sperm was better (21% versus 9%), but the difference did not reach statistical significance. The cumulative clinical PRs and ongoing PRs per testicular sperm extraction procedure were 36% and 24%, respectively. Conclusion(s): Testicular sperm cryopreservation using a simple freezing protocol is promising in patients with nonobstructive azoospermia augmenting the overall success achieved after surgical sperm retrieval. (Fertility Sterility 1997;68:892-7. C 1997 by American Society for Reproductive Medicine.)

The results of in vitro fertilization-embryo transfer in couples with unexplained infertility failing to conceive with superovulation and intrauterine insemination

To determine the results of IVF-ET in couples with long-standing unexplained infertility who had failed to conceive with four to six cycles of superovulation and IUI. Retrospective case control series. University IVF-ET center. One hundred seventeen couples with unexplained infertility who had failed to conceive with superovulation and IUI underwent 157 cycles of IVF-ET. Results were compared with 194 tubal factor couples subjected to 250 IVF-ET cycles within the same time period. Total fertilization failure events were more common (20.4% versus 7.6%) and tended to be repetitive in couples with unexplained infertility. When total fertilization failure events were excluded, fertilization rates (57.8% versus 60.9%) and cumulative clinical pregnancy rates over three cycles (55.4% versus 46.5%) were similar in unexplained infertility and tubal disease groups. Couples with unexplained infertility failing to conceive with superovulation and IUI have a favorable outcome when treated subsequently with IVF-ET. Conception rates similar to couples with tubal disease may be expected despite a higher incidence of total fertilization failure events.

Reproductive potential after treatment for persistent ectopic pregnancy

We examined the success rate and reproductive outcome of 50 patients who had been treated for persistent EP after initial unsuccessful salpingostomy. All who underwent salpingectomy had successful treatment of their persistent EP. One treatment failure occurred after MTX. Of 50 women, 32 (61.5%) attempted conception after treatment for persistent EP. The cumulative clinical pregnancy rate after treatment for persistent EP was 59% at 36 months. There was a significant association between clinical pregnancy rate after persistent EP and those with normal contralateral fallopian tubes (P < 0.005). The relative risk of having a clinical pregnancy among those who attempted conception was 2.3 for those having a normal contralateral fallopian tube compared with those with a contralateral fallopian tube with obvious pathology. Intrauterine pregnancy rates after treatment of persistent EP were similar to those reported for primary treatment of EP.