Day Of hCG Administration Research Articles

GnRH agonis short protocol versus GnRH antagonist flexible protocols in poor responder undergoing in vitro fertilization treatment.

Objective: To compare the short agonist and flexible antagonist protocols in the management of poor responders to standerd long down regulation protocol. Design: Randomized prospective comparative study. Setting: private IVF center(Engab). Patient(s): One hundred poor-responder (IVF)(ICSI), who responded poorly to the standerd long down- regulation protocol in their first treatment cycle. Intervention(s): Peak serum E2 was assayed on the day of hCG administration. Main Outcome Measure(s): primary outcome: number of HMG ampoules used, peak E2 at the triggering day, number of oocytes retrieved, number of metaphase II oocytes, fertilization rate, embryo quality and number of embryos transferred.cycle cancellation. secondary outcome: pregnancy rate , miscarriage rate . Result(s): GnRH-antagonist protocol shows increased – non significant- pregnancy rate and decreased - non significant - miscarriage rate than agonist short protocol, however agonist short protocol appears to be more effective than the GnRH-antagonist protocol in terms of number of FSH ampules, peak E2 level, fertilization rate, and top-quality embryos transferred in poor-responder. Conclusion(s): The probability of pregnancy might be better with the use of the antagonist protocol, also flexible antagonist protocol is a simpler and more patient friendly method of ovarian stimulation compared with the short agonist protocol.

The Level of Serum Progesterone on the day of HCG Administration in Assisted Reproduction Cycles

Introduction: During stimulated IVF- ET cycle spontaneous LH surge occur in about 20 – 50 % of cycle stimulated with gonadotropin without the pituitary suppression of GnRH agonist. This has been related to maturation and recovery of oocyte together decrease fertilization and implantation rate, this spontaneous LH surge is associated with increase in serum progesterone , so without pituitary suppression with GnRH , the rise of serum progesterone in the per ovulatory period may indicate the occurrence of spontaneous of LH surge, the aim of study is to indicate cutoff point of progesterone in the day of HCG administration. Method: This was a retrospective, non-interventional cohort study of patients undergoing ICSI at Tiba infertility center in Babylon, from period 2015 - 2019, all patient age from 20 – 45 years old under long protocol, had at least one grade I embryo transferred, total amount of patients was 1457. At second day of menstrual cycle we stimulate by used recombinant FSH, measured on second day of menstruation serum FSH, LH and estrogen levels, transvaginal ultrasound used to monitored the follicles. when follicle became 14 mm in size we used antagonist. 3 or more follicles gotten 18 mm in diameter. Activation gave either hCG alone or mixture of hCG and agonist. After 14 days from embryo transfer we checked HCG and after that after 10 days transvaginal ultrasound was done. Results: In our study showed the significant association between positive pregnancy outcome and progesterone level at day of HCG trigger were 79.2 % of female with positive pregnancy at progesterone level 2.5, There is a significant differences of LH at day of HCG activate rendering to progesterone level day of HCG activate, progesterone level ( < 1.5) had more chief level at day of HCG activate with mean and SD (5.38 ± 2.52), and reduction when the level progesterone rise. Conclusion: pregnancy cannot depend on progesterone level at day when HCG administration for assisted reproduction cycles treated with GnRH agonists and gonadotrophins. So cutoff point of progesterone can reach to above 1.5 ng/ ml and expected of pregnancy at this level.

The Level of Serum Progesterone on the day of HCG Administration in Assisted Reproduction Cycles

Introduction: During stimulated IVF- ET cycle spontaneous LH surge occur in about 20 – 50 % of cycle stimulated with gonadotropin without the pituitary suppression of GnRH agonist. This has been related to maturation and recovery of oocyte together decrease fertilization and implantation rate, this spontaneous LH surge is associated with increase in serum progesterone , so without pituitary suppression with GnRH , the rise of serum progesterone in the per ovulatory period may indicate the occurrence of spontaneous of LH surge, the aim of study is to indicate cutoff point of progesterone in the day of HCG administration. Method: This was a retrospective, non-interventional cohort study of patients undergoing ICSI at Tiba infertility center in Babylon, from period 2015 - 2019, all patient age from 20 – 45 years old under long protocol, had at least one grade I embryo transferred, total amount of patients was 1457. At second day of menstrual cycle we stimulate by used recombinant FSH, measured on second day of menstruation serum FSH, LH and estrogen levels, transvaginal ultrasound used to monitored the follicles. when follicle became 14 mm in size we used antagonist. 3 or more follicles gotten 18 mm in diameter. Activation gave either hCG alone or mixture of hCG and agonist. After 14 days from embryo transfer we checked HCG and after that after 10 days transvaginal ultrasound was done. Results: In our study showed the significant association between positive pregnancy outcome and progesterone level at day of HCG trigger were 79.2 % of female with positive pregnancy at progesterone level 2.5, There is a significant differences of LH at day of HCG activate rendering to progesterone level day of HCG activate, progesterone level ( < 1.5) had more chief level at day of HCG activate with mean and SD (5.38 ± 2.52), and reduction when the level progesterone rise. Conclusion: pregnancy cannot depend on progesterone level at day when HCG administration for assisted reproduction cycles treated with GnRH agonists and gonadotrophins. So cutoff point of progesterone can reach to above 1.5 ng/ ml and expected of pregnancy at this level.

Follicular flushing versus direct aspiration in poor responder IVF patients: a randomized prospective study

ObjectiveTo compare follicular flushing with a double-lumen needle with direct aspiration on the number of oocytes collected in a poor responder population in IVF. Study designWe conducted a randomized controlled prospective single-center study between March 2011 and June 2016 at the ART center in the Medico-Surgical and Obstetric Center in Schiltigheim, France. Patients undergoing IVF who had ≤ 4 follicles ≥ 14 mm on the day of HCG administration were recruited and then randomized to one of two groups : simple aspiration group (= NO FLUSH) with a single-lumen 17-gauge needle or follicular flushing group (= FLUSH) which underwent oocyte puncture with aspiration and follicular flushing with a double-lumen 17-gauge needle.The primary end-point was the number of oocytes collected. Secondary assessment criteria were the fertilization rate, the number of transferable embryos, the number of clinical pregnancies and their outcome. Results252 patients were included: 127 in the Flush group and 125 in the No flushThe number of oocytes retrieved per patient was significantly lower in the FLUSH group: 2.41 than in the NO FLUSH group: 3.42 (p < 0.001).The number of transferable embryos, fertilization rate (68.8 % in the FLUSH group versus 75 % p = 0.682), or pregnancy rate weren't different but (15 versus 13).However the number of failed punctures was significantly higher in the FLUSH group (11 % versus 3.2 % p = 0.016) and the duration of oocyte retrieval was significantly longer in the FLUSH group where the median time was 10 min whereas it was only 7 min in the NO FLUSH group, p < 0.001 ConclusionFollicular flushing in poor responders is not beneficial and could be detrimental with an increasing procedure time and less oocytes retrieved.

Pre-Mature Raise of Progesterone and its Effect on Clinical Pregnancy Rate and Live Birth Rate in Intra-Cytoplasmic Sperm Injection (ICSI) Cycles

Background: During controlled ovarian hyper-stimulation COH, level of Progesterone on a day of human chorionic gonadotrophin (hCG) trigger for a final ovum maturation has a precious role for implantation of the embryos. Aims: This study aims to investigate the incidence and the effect of Premature Progesteron Rise (PPR) on pregnancy rates PR as well as live birth rate LBR in ICSI cycle. Material and Methods: A total of 710 patients undergoing ICSI cycles with fresh embryo transfer at Misurata National Infertility Centre were retrospectively involved. Patients included in the study who are <40 years with good ovarian response and had long agonist/antagonist ICSI protocols with fresh embryo transfer. Results: The average age of patients was (32.26 years ± 4.924). The cut-off value found in this study to define PPR is (1.064 ng/ml). The overall incidence of serum PPR on hCG administration was 31.32%. The average serum PPR on a day of hCG administration was (1.1 ±1.8) ng/ml. PPR had a negative significant effect on PR (P-value 0.03). Conclusion: In order to improve ICSI outcome, the PR is significantly negatively correlated with PPR. So, when serum P4 level is approaching the cutoff value (1.064 ng/ml) during COH, modification of the clinical treatment might be considered to improve the ICSI outcomes.

Correlation between Serum Levels of Progesterone on HCG Administration Day and Clinical Pregnancy Rate in ICSI cycles

Abstract Background Infertility is an illness clinically defined as failure to achieve a clinical conception after 12 months of regular and unprotected normal sexual intercourse. It affects around 8 -12% of child bearing-aged couples globally. Premature progesterone elevation is considered for a long time a cornerstone factor to endometrial implantation failure. Although the extensive usage of GnRH analogues for down-regulation of pituitary, rise in progesterone serum levels, still occur at various levels on the day of administration of hCG for ultimate oocyte maturity in fresh IVF management cycles. Aim to investigate and evaluate the correlation between serum progesterone level on the day of HCG administration and the clinical pregnancy rate as a primary outcome, quality of embryo, quality of oocyte, fertilization rate and chemical pregnancy assessed by B-HCG level 2 weeks after embryo transfer as secondary outcomes. Methodology This prospective non interventional study was conducted at Assisted Reproduction Unit, Ain Shams University Maternity Hospital, Cairo, Egypt, starting from December 2015 till March 2017. The study included 240 women scheduled for ICSI presented with primary or secondary infertility, the causes of infertility in this study were male factor, tubal factor and unexplained infertility. Results the current research study displayed that there was unfavorable statistical correlation between serum progesterone elevation at the day of HCG trigger and the clinical pregnancy rates which was 34.2%, the cut off value of serum progesterone was 1.09 ng/ml; above this value the serum pregnancy rates were negatively influenced. Additionally premature rise of serum progesterone levels reduced the embryonic quality, oocyte quality and fertilization rate. Conclusion serum progesterone level equal to or above 1.09 ng/ml at the day of HCG trigger unfavorably influences on the clinical pregnancy rates in ICSI cycles. Recommendations All embryos should be cryopreserved when serum progesterone on the day of HCG trigger equals to or above 1.09 ng/ml during ICSI cycle to be transferred in subsequent cycle to avoid implantation failure.

Factors associated with extremely high progesterone concentrations on the day of HCG administration

ObjectiveProgesterone elevation on the day of human chorionic gonadotropin (hCG) administration remains one of the most controversial topics in reproductive endocrinology. Factors associated with these increases have not been fully determined. The purpose of our study is to investigate factors associated with extreme progesterone elevation on the day of human chorionic gonadotropin (hCG) administration. Materials and methodsThis retrospective observational, single-center cohort study recruited 2000 fresh in vitro fertilization (IVF) and/or intracytoplasmic sperm injection(ICSI)-embryo transfer cycles from January 2000 to December 2014 in our institution. ResultsWhen cycles were divided into those with progesterone <1.94 ng/mL (n = 1791) and ≧1.94 ng/mL (n = 209) on the day of hCG administration, five factors were positively associated with highly elevated progesterone concentration: protocol (GnRH agonist versus antagonist; odds ratio [OR = 2.786]), number of dominant follicles (OR = 1.098), total dose of follicle stimulating hormone (FSH) used (OR = 1.023), elevated luteinizing hormone (LH) (OR = 1.085) and estradiol (E2; OR = 1.001) concentrations on the day of hCG administration (p < 0.001 each). After omitting the protocol effect, the remaining factors showed limited contributions to highly elevated progesterone (ORs = 0.95–1.2). ConclusionsThe factor showing the greatest association with extreme progesterone elevation was use of the GnRH agonist protocol.

Moderate-to-severe ovarian hyperstimulation syndrome: A retrospective multivariate logistic regression analysis in Chinese patients.

Ovarian hyperstimulation syndrome (OHSS), a life-threatening complication occurring in stimulated ovarian cycles, arises from treatment with gonadotropin for inducing follicular maturation. The aim of this study was to compare the risk factors between patients with severe OHSS and those without OHSS after in vitro fertilization by intracytoplasmatic sperm injection/embryo transfer (IVF-ICSI/ET). Identifying the associated risk factors may provide guidance for clinicians on how to prevent OHSS. The retrospective study involved patients who had completed IVF-ICSI/ET cycles. The difference in markers for predicting the occurrence of OHSS between groups was compared. The potential protective and risk factors, as well as the predictive markers, were identified. Patients with OHSS were younger (p = 0.015), had higher basal antral follicle counts (AFC) (p < 0.001) and lower total dosages of gonadotropin (Gn) (p = 0.011). On the day of human chorionic gonadotropin (hCG) administration, significantly higher total numbers of follicles (p < 0.001), serum estradiol (E2) (p < 0.001) and progestrone (Pg) (p = 0.001) levels, numbers of oocytes (p < 0.001) and metaphase II (MII) oocytes (p < 0.001) were also observed in the OHSS group when compared to the non-OHSS group. A univariate regression analysis revealed that age (OR = 0.898, 95% CI = 0.822-0.981) and total dosage of Gn (OR = 0.999, 95% CI = 0.999-1.000) were protective factors, whereas AFC (OR = 1.090, 95% CI = 1.051-1.131) and, on the day of hCG injection, the number of follicles (OR = 1.185, 95% CI = 1.027-1.230), serum E2 (OR = 1.000, 95% CI = 1.000-1.000) and Pg (OR = 2.773, 95% CI = 0.510-3.370) levels, the number of oocytes (OR = 1.254, 95% CI = 0.894-1.472) and MII oocytes (OR = 1.238, 95% CI = 0.747-1.217) were risk factors for OHSS. However, a multivariate regression analysis showed that the total number of follicles (OR = 1.124, 95% CI = 1.027-1.230) was the only predictive factor for the occurrence of OHSS. The study demonstrated that the follicle count measured on the day of hCG administration was the only predictive factor for the occurrence of OHSS. This provides basic guidance to clinicians on the prevention of the complication when using assisted reproductive technologies (ART).

Endometriozisli hastalarda ovulasyon indüksiyonu ajanı olarak letrozol ve gonedotropinlerin karşılaştırılması: prospektif randomize çalışma

Purpose: This study aimed to compare the effects of letrozole and gonadotropins for ovulation induction in infertile patients with stage 1-2 endometriosis. Materials and methods: Twenty patients who underwent diagnostic laparoscopy and histologically diagnosed stage 1-2 endometriosis were included in this prospective randomized study. Patients who planned to continue with timed sexual intercourse were randomized into two treatment groups including letrozole (n=10) or gonadotropins (n=10) for minimum three and maximum five treatment cycles. Results: Ovulation occurred in 37/45 cycles (82.2%) in the letrozole group and 32/37 cycles (86.4%) in the gonadotropin group, without statistically significant difference ( p =0.590). Total number of follicles was significantly higher in gonadotropin group on the day of hCG administration (2.33±0.71 vs. 3.05±0.91, p < 0.001). Clinical pregnancy rates both per completed cycles and per patients were similar between two groups (8.1% vs. 9.4%, p =0.850 and 30% vs. 30%, p =1.000; respectively). Conclusions: Letrozole is well tolerated and cost effective ovulation induction agent in patients with endometriosis and effects of letrozole for ovulation induction were comparable to gonadotropins.

Evaluation of growth hormone co-treatment in in vitro fertilization in patients responding better to the GnRH antagonist short protocol.

ObjectiveThe present study aims at evaluating the results obtained after in vitro fertilization in bad responders, using controlled ovarian hyperstimulation together with the use of gonadotrophin releasing hormone (GnRH) antagonist (cetrorelix acetate) in a short protocol.MethodsThis is an analytical, longitudinal, retrospective and controlled study involving patients who underwent in vitro fertilization (IVF) procedures in the assisted reproduction program of the Reproferty clinic, in the municipality of São José dos Campos/SP, from January 2012 to December 2016. We collected the data obtained from the medical records of patients considered to have undergone controlled ovarian hyperstimulation using GnRH antagonist (cetrorelix acetate) and Growth Hormone (GH) in a short cycle protocol. The patients considered controls were those submitted to the same hyperstimulation process, without using GH.ResultsThere were significant differences in the following analyzed parameters: gonadotrophin regimen dose, stimulation duration, and estradiol levels on the day of HCG administration, number of follicles, number of retrieved oocytes, number of mature oocytes and number of good-quality embryos. On the other hand, the GH administration was not significant in the number of cycles that achieved transfer, the number of embryos transferred and the number of frozen cycles. In the case group, there was no increase in the number of cycles that reached pregnancy rate βhCG+; however, the clinical pregnancy rates and live birth rates were significant.ConclusionThe present investigation demonstrated that GH administration as a supplement in poor responders improves the majority of the parameters to achieve a full term pregnancy in these patients.

Pre-Mature Raise of Progesterone and its Effect on Clinical Pregnancy Rate and Live Birth Rate in Intra-Cytoplasmic Sperm Injection (ICSI) Cycles

Background: During controlled ovarian hyper-stimulation COH, level of Progesterone on a day of human chorionic gonadotrophin (hCG) trigger for a final ovum maturation has a precious role for implantation of the embryos. Aims: This study aims to investigate the incidence and the effect of Premature Progesteron Rise (PPR) on pregnancy rates PR as well as live birth rate LBR in ICSI cycle. Material and Methods: A total of 710 patients undergoing ICSI cycles with fresh embryo transfer at Misurata National Infertility Centre were retrospectively involved. Patients included in the study who are <40 years with good ovarian response and had long agonist/antagonist ICSI protocols with fresh embryo transfer. Results: The average age of patients was (32.26 years ± 4.924). The cut-off value found in this study to define PPR is (1.064 ng/ml). The overall incidence of serum PPR on hCG administration was 31.32%. The average serum PPR on a day of hCG administration was (1.1 ±1.8) ng/ml. PPR had a negative significant effect on PR (P-value 0.03). Conclusion: In order to improve ICSI outcome, the PR is significantly negatively correlated with PPR. So, when serum P4 level is approaching the cutoff value (1.064 ng/ml) during COH, modification of the clinical treatment might be considered to improve the ICSI outcomes.

Peripheral Estrogens in Women with Endometriosis Undergoing IVF.

A consistent body of in vitro evidence supports a detrimental effect of endometriosis on ovarian steroidogenesis, in particular the synthesis of estrogens. However, clinical evidence is scanty and methodologically weak. This study aimed at clarifying whether peripheral 17-β-estradiol during IVF are influenced by the presence of endometriosis. Women undergoing IVF were retrospectively reviewed. Cases were women with a diagnosis of endometriosis. Controls were matched to cases in a 1:1 ratio by study period, age, total number of developed follicles on the day of hCG administration, protocol of hyperstimulation, gonadotropin used, and starting dose. The primary outcome was the ratio between serum levels of 17-β-estradiol and the total number of developed follicles. Fifty-three women with endometriosis and 53 controls were selected. The median ratio (interquartile range) between serum 17-β-estradiol and the total number of developed follicles in the two groups was 207 (164-282) and 201 (144-268) pg/ml, respectively (p = 0.46). Sensitivity analyses on the magnitude of the follicular response, the history of surgery for endometriomas, and the presence of endometriomas did not show any subgroup at increased risk of peripheral estrogens impairment. Endometriosis does not influence peripheral levels of 17-β-estradiol during IVF. Our findings argue against a biologically relevant effect of the disease on ovarian estrogen-synthesis.

The correlation between endometrial thickness and pregnancy outcomes in fresh ART cycles with different age groups: a retrospective study

BackgroundIn assisted reproductive technology (ART) cycles in addition to embryo quality, the receptivity of the endometrium plays the main role in clinical outcomes. Endometrial receptivity is necessary to implantation of an embryo, and ultrasound has been established as an appreciated, simple, and non-invasive technique in the evaluation of the endometrial preparation before embryo transfer in fresh in vitro fertilization (IVF) cycles. Debate on the predictive value measuring endometrial thickness before administering human chorionic gonadotropin (HCG) for ovulation triggering in ART is ongoing. In order to explore the impact of endometrial thickness on triggering day on ongoing pregnancy rate (OPR) in ART cycles, we retrospectively analyzed data from 1000 patients undergoing IVF/ICSI cycles.ResultsThe data showed pregnancy rate was increased in the endometrial thickness of 8 mm to 11 mm then decreased, and in endometrial thickness (Ent) > 14 mm, pregnancy rate was zero. There were significant differences in endometrial thickness and pregnancy outcomes between different age groups. The pregnancy rate was higher (32%) in 23–30 years old women, and the range of Ent in this group was 6–12 mm. Also, the data showed a positive correlation between Ent with AMH and estradiol levels and the number of COC and MII oocytes and a negative correlation between female age with Ent.ConclusionThe result showed that Ent on hCG administration day is associated with pregnancy outcomes in fresh IVF/ICSI cycles with different age groups, although some of the clinical parameters may have an effect on Ent. Large studies are needed to make a definitive conclusion.

Increased Progesterone on the Day of Administration of hCG in Controlled Ovarian Hyperstimulation Affects the Expression of HOXA10 in Primates' Endometrial Receptivity.

The increase in progesterone (P4) levels on the day of human chorionic gonadotropin (hCG) administration have a negative effect on endometrial receptivity. There are few reports regarding the expression of homeobox A10 (HOXA10) as one of many biomolecular factors of endometrial receptivity. To evaluate the effect of increased P4 concentration on the day of hCG administration on HOXA10, a total of 16 Macaca nemestrina were divided into three dose groups of recombinant-follicle stimulating hormone (rFSH) (30IU, 50IU, and 70IU) and one control group. Injection of rFSH combined with gonadotropin release hormone (GnRH) at 160 ug/day was given subcutaneously using a long protocol technique. Blood samples for estradiol (E2) and (P4) concentration measurements were taken on the day of injecting hCG in the final follicular phase, while the collection of endometrial tissue for HOXA10 measurement was carried out 8 to 10 days after hCG administration. E2 and P4 were measured by ELISA, whereas HOXA10 expression was measured with immunohistochemical (IHC) techniques. The concentration of E2 and P4 was found to be higher in dose groups compared with the natural group, but no significant differences were found within the group. For the Hscore for HOXA10 expression, no significant differences within dose groups were found. In addition, no significant differences for the Hscore for HOXA10 were found when compared to E2 groups. Significantly, the Hscore of HOXA10 was found to be >1 ng/mL in the P4 group compared with the Hscore HOXA10 in the P4 natural group (p = 0.022). The high concentration of P4 caused by ovarian hyperstimulation in the follicular phase stimulates the expression of HOXA10 in the secretion phase.

Value of endometrial echo pattern transformation after hCG trigger in predicting IVF pregnancy outcome: a prospective cohort study

BackgroundThere is much value in identifying non-invasive ways of measuring endometrial receptivity, as it has the potential to improve outcomes following in vitro fertilization (IVF). It has been suggested that endometrial echogenicity on the day of hCG administration was a good marker of endometrial receptivity. In the daily practice, we notice that patients with non-homogeneous hyperechoic endometrium on the embryo transfer day usually have lower pregnancy rates. We therefore extended the research onward transformation of echo pattern after hCG trigger to analyze the relationship between endometrial echogenicity transformation and IVF outcomes.MethodsA total of 146 infertile women undergoing their first IVF cycle were recruited in the prospective cohort study from August 2017 through August 2018. A series of endometrial echo pattern monitoring was carried out in these patients after hCG trigger: hCG day, from 1 through 3 days after ovum pick-up (OPU + 1, OPU + 2, OPU + 3).ResultsThe endometrial echogenicity value was calculated as the ratio of the hyperechogenic endometrial area over the whole endometrial area. Clinical pregnancy rate and embryo implantation rate had positive relationship with echogenicity value. The ROC curve analysis of endometrial echogenicity showed the area under curve was greatest on the second day after oocyte retrieval (OPU + 1, 2, 3 were 0.738, 0.765, 0.714 respectively) versus pregnancy. Endometrial echogenicity value on OPU + 2 had a higher predictive efficiency, and the cutoff value was 76.5%. The sensitivity was 61.3% and specificity was 82.0%. When putting the cut-off at <60%, the sensitivity was 93.8% and the specificity was 23.1%.ConclusionsThe endometrial echogenicity value on OPU + 2 was recommended to evaluate endometrial receptivity. It seemed appropriate for clinicians to provide a ‘freeze all’ IVF cycle and transfer in a subsequent frozen-thawed embryos cycle when echogenicity value <60% on OPU + 2.Trial registrationThe registration number was ChiCTR-OOC-17012214 and the registration date was August 1st, 2017.

Shorter telomere length of white blood cells is associated with higher rates of aneuploidy in women undergoing in vitro fertilization

Telomeres are tandem repeats of the sequence TTAGGG located at the ends of chromosomes. Telomere shortening is a key mechanism of cell senescence and aging. Telomere shortening has been associated with decreased oocyte quality through disruption of chromosome alignment and spindle structure. In this study, we sought to evaluate whether the telomere length of cumulus cells (CC) or white blood cells (WBC) in an infertile population is associated with reproductive aging. Prospective cohort study. Women undergoing IVF between July 2017 and December 2018 were recruited for the study under Institutional Review Board approval. Blood and CC were collected at the time of oocyte retrieval. Genomic DNA was isolated and stored at -80°C. Telomere DNA length was measured by quantitative real-time PCR and normalized to AluYa5 sequence as an endogenous control for each sample. Linear regression was applied to determine if telomere length (TL) of WBC or CC was associated with patient age, number of oocytes retrieved, number of mature (M2) oocytes retrieved, blastulation rate, aneuploidy rate, serum anti-mullerian hormone (AMH), and serum estrogen (E2) level on day of hCG or GnRHa administration. TL data was available for WBC samples from 156 individuals and for CC samples from 142 patients. Data was available for both tissue types in 139 patients (age range 25.7 to 45.0 years, mean 35.0 ± 4.0 years). As expected, WBC telomere length declined with increasing age (p=0.006). In contrast, CC TL was equivalent in patients of all ages and failed to show anticipated age-related shortening. As such, CC TL was unrelated to any index of ovarian performance including number of oocytes retrieved (p=0.95), M2 oocytes retrieved (p=0.81), blastulation rate (p=0.98), aneuploidy rate (p=0.30), AMH level (p=0.32), or mid-cycle E2 level (p=0.77). Consistent with these data, CC TL was not associated with patient age (p=0.99). While WBC TL declined with increasing maternal age, it was a poor predictor of quantitative ovarian performance [total oocytes retrieved (p=0.47), number of M2 oocytes retrieved (p=0.30), AMH level (p=0.13), E2 level (p=0.36), and blastulation rate (p=0.48)]. However, TL of WBC samples was associated with embryonic competence as evidenced by aneuploidy rate (p=0.02), with shorter TL associated with higher aneuploidy. The TL of CC was not associated with patient age or any index of ovarian or embryonic performance. Declining WBC TL was associated with increasing maternal age and increasing rates of embryonic aneuploidy. Further studies are necessary to determine if changes in peripheral somatic cell TL are truly prognostic for aneuploidy rate within a given maternal age group or if this finding is simply reflective of a simultaneous change which occurs with age.

Factors affecting pregnancy outcomes following the surgical removal of intrauterine adhesions and subsequent in vitro fertilization and embryo transfer.

This study aimed to investigate the clinical factors affecting pregnancy rates following the surgical removal of intrauterine adhesions (IUAs) and subsequent in vitro fertilization and embryo transfer (IVF-ET). We retrospectively evaluated case data from patients who had undergone hysteroscopic surgery to remove varying degrees of IUAs and who had subsequently received assisted reproductive treatments with IVF-ET (in all 140 cycles) at our hospital between January, 2011 and January, 2015. The patient data were divided into either the pregnancy or non-pregnancy groups based on the pregnancy outcomes, and a number of clinicopathological variables were compared these two groups, such as age, infertility (type and duration), the number of prior surgical treatments for and severity of IUAs, the baseline follicle-stimulating hormone/luteinizing hormone (FSH/LH) ratio and estradiol level, endometrial thickness on the day of human chorionic gonadotropin (hCG) administration, etc. We selected the variables with statistically significant differences to generate multivariate logistic regression and linear correlation analyses. We found that i) the mean endometrial thickness on the day of hCG administration was greater in the pregnancy group, and that the average gestational age was younger than that in the non-pregnancy group. The different age groups had significantly different pregnancy rates. The mean baseline FSH/LH ratio of the women in the pregnancy group was lower than that in the women in the non-pregnancy group. The number of embryos transferred in the pregnancy group was higher than that in the non-pregnancy group. However, the other variables exhibited similar values between these two groups. ii) Our multivariate logistic regression analyses revealed that age and endometrial thickness on the day of hCG administration had significant effects on the pregnancy outcome. The baseline FSH/LH ratio and the number of embryos transferred were similar between the groups. On the whole, age and endometrial thickness on the day of hCG administration are the most important predictors of pregnancy outcome in the patients undergoing IVF-ET following the surgical removal of IUAs. Importantly however, the identification of effective methods with which to improve the endometrial thickness and the ovarian response in patients with diminished ovarian reserves warrants further investigation in future research.

17. DO PROGESTERONE VALUES AFFECT THE EUPLOID RATE OF EMBRYOS IN PGT-A PATIENTS?

Introduction In about 35% of cases undergoing ovarian stimulation may occur a rise in serum progesterone in the late follicular phase. This could produce premature luteinization and affect the endometrial receptivity. However, some studies suggest that the elevated progesterone could generate damage to the oocyte affecting the embryo quality and therefore increasing the rate of aneuploidy in the generated embryos which contributes decrease the implantation and newborn live rate. Materials and Methods A total of 2509 patients undergoing preimplantation genetic testing for aneuploidy screening (PGT-A) were included in this retrospective study performed between 2016 and 2018. The age of patients ranged from 22 to 49 years. Laser assisted blastocyst biopsies were done in all cases by either pulling or flicking method. Antagonist protocol was used in the majority of the cases and P4 levels were measured the day of hCG administration. Poisson regression model was used as statistical analysis where progesterone was considered as a continuous variable. Other variables such age, body mass index (BMI), estradiol and ovarian sensitivity index were included in the model. P values Results The increase of ovarian sensitivity index in one unit predicted the increase of euploid embryos in 1.67 times when controlling for the rest of variables. The increase in age had a negative influence decreasing the mean number of euploid embryos by 10%. On the other hand the increase of P4 values predicted an increase in the number of euploid embryos by 7%. Conclusions The increasing values of progesterone does not decrease the availability of euploid embryos for transfer therefore, based in this initial approach P4 seems a surrogate marker of higher ovarian response which is also positively associated with embryo euploidy.

Do young women with unexplained infertility show manifestations of decreased ovarian reserve?

To investigate whether unexplained infertility at a young age demonstrates manifestations of decreased ovarian reserve. A total of 100 women were divided into two equally sized groups. The study group comprised women aged ≤ 37years diagnosed with unexplained infertility, and the control group included age-matched women with either mechanical factor or severe male factor infertility. Both groups were comparable in their basic characteristics. Overall, women with unexplained infertility presented with inferior ovarian reserve results set against women of the control group. The number of ≥ 14-mm follicles on the day of hCG administration was significantly lower in the study compared with the control group (7.0 ± 4.5 vs. 10.4 ± 4.1 follicles, respectively, P < 0.001). Likewise, basal serum FSH was higher in the study compared with the control group (8.4 ± 5.5 vs. 6.4 ± 1.7IU/L, respectively, P = 0.015), while antral follicle count was lower (10.9 ± 6.6 vs. 16.2 ± 6.6 follicles, respectively, P < 0.001). Furthermore, women with unexplained infertility required a higher total dose of FSH for ovarian stimulation (2,923 ± 1,701 vs. 2,196 ± 941IU/L, respectively, P = 0.010), but exhibited a lower number of retrieved oocytes (9.3 ± 6.3 vs. 15.6 ± 7.9 oocytes, respectively, P < 0.001), alongside a lower number of achieved embryos (5.3 ± 4.0 vs. 8.0 ± 4.7 embryos, respectively, P = 0.002). Interestingly, the cumulative clinical pregnancy rate was not significantly different between the two groups (44% vs. 58%, respectively, P = 0.163). Young women ≤ 37years of age with unexplained infertility have clear manifestations of sub-optimal ovarian reserve set against controls. Our findings suggest that unexplained infertility at a young age may be a risk factor for developing poor ovarian response, specifically as a quantitative, rather than a qualitative, risk factor.

Association between serum estradiol level on the human chorionic gonadotrophin administration day and clinical outcome.

Background:Estradiol, as an important hormone in follicular development and endometrial receptivity, is closely related to clinical outcomes of fresh in vitro fertilization embryo transfer (IVF-ET) cycles. The aim of this retrospective study was to evaluate the association between elevated serum estradiol (E2) levels on the day of human chorionic gonadotrophin (hCG) administration and IVF-ET pregnancy and birth outcomes.Methods:A total of 1771 infertile patients with their first fresh IVF-ET cycles were analyzed retrospectively between January 2011 and January 2016 in Peking University First Hospital. Patients were categorized by serum E2 levels on the day of hCG administration into six groups: group 1 (serum E2 levels ≤ 1000 pg/mL, n = 205), group 2 (serum E2 levels 1001–2000 pg/mL, n = 457), group 3 (serum E2 levels 2001–3000 pg/mL, n = 425), group 4 (serum E2 levels 3001–4000 pg/mL, n = 310), group 5 (serum E2 levels 4001–5000 pg/mL, n = 237), and group 6 (serum E2 levels > 5000 pg/mL, n = 137). The retrieved oocyte and MII oocyte numbers and implantation and clinical pregnancy rates of the groups were compared as the first objective of the study. For the 360 women with singleton births among all patients, the area under the corresponding receiver operating characteristic curve (ROC curve) was calculated to assess the predictive value of the E2 change for the probability of low birth weight (LBW) infants as the second objective.Results:The retrieved oocyte and MII oocyte numbers and implantation and clinical pregnancy rates gradually increased from groups 1 to 5 but decreased in group 6. The parameters of group 1 were statistically worse than those of the other groups, from group 2 to group 6 (the number of retrieved oocytes, t = 13.096, t = 23.307, t = 23.086, t = 26.376, t = 19.636, P < 0.003; the number of retrieved MII oocytes, t = 10.856, t = 20.868, t = 21.874, t = 23.374, t = 19.092, P < 0.003; the implantation rate, χ2 = 12.179, χ2 = 22.239, χ2 = 23.993, χ2 = 23.344, χ2 = 16.758, P < 0.003; the clinical pregnancy rate, χ2 = 16.415, χ2 = 28.074, χ2 = 35.387, χ2 = 37.025, χ2 = 24.590, P < 0.003). ROC analysis revealed that when a serum peak E2 of 3148 pg/mL was used to predict LBW.Conclusions:The results indicate that serum E2 levels have a concentration-dependent effect on clinical outcomes. The optimal range of the E2 level during a fresh IVF-ET cycle is 1000 to 3148 pg/mL.