Difference In Live Birth Rate Research Articles

Comparison between oral dydrogesterone versus micronized vaginal progesterone gel in clinical outcome within the first HRT-FET cycle: a retrospective analysis.

The purpose of this study is to compare the clinical efficacy of oral dydrogesterone and micronized vaginal progesterone (MVP) gel during the first HRT-FET cycle. A retrospective cohort study based on a total of 344 women undergoing their first HRT-FET cycles without Gonadotropin-Releasing Hormone agonist (GnRH-a) pretreatment was conducted. All the cycles were allocated to two groups in the reproductive medical center at the University of Hong Kong-Shenzhen Hospital. One group (n = 193) received oral dydrogesterone 30mg/d before embryo transfer, while the other group (n = 151) received MVP gel 180mg/d. The demographics and baseline characteristics of two groups were comparable. We found no statistically significant difference in live birth rate (24.35% vs. 31.13%, P = 0.16), clinical pregnancy rate (34.72% vs. 36.42%, P = 0.74), embryo implantation rate (25.09% vs. 28.36%, P = 0.43), positive pregnancy rate (42.49% vs 38.41%, P = 0.45), miscarriage rate (9.33% vs 3.97%, P = 0.05), or ectopic pregnancy rate (0.52% vs. 0.66%, P = 0.86) between the oral dydrogesterone group and MVP gel group. In the multivariate logistic regression analysis for covariates, medication used for luteal support was not associated with live birth rate (OR = 0.73, 95% CI: 0.32-1.57, P = 0.45). And the different luteal support medication did not have a significant positive association with the live birth rate in the cycles with day 2 embryo transferred (OR = 1.39, 95% CI:0.66-2.39, P = 0.39) and blastocyst transferred (OR = 1.31 95% CI:0.64-2.69, P = 0.46). 30mg/d oral dydrogesterone and 180mg/d MVP gel revealed similar reproductive outcomes in HRT-FET cycles in the study.

Metformin and progestins in women with atypical hyperplasia or endometrial cancer: systematic review and meta-analysis.

To assess metformin's effectiveness in adding it to progestin-based hormone therapy for treating atypical endometrial hyperplasia (AEH) and early endometrial cancer (EEC). We conducted a systematic review and meta-analysis following PRISMA guidelines (registration number CRD42023399094). We searched databases for studies up to March 2023, including randomized and non-randomized clinical trials in English. Out of 280 studies, 9 studies (1104 patients) were eligible. A total of 408 patients were allocated to receive metformin, and 696 patients entered the control group. Primary analysis focused on evaluating the CR showed a significant difference in patients with AEH treated with metformin (RR = 1.10, 95% CI 1.02-1.20, p = 0.02). Relapse rate (RR = 0.62, 95% CI 0.33-1.17, p = 0.14) was also evaluated. Secondary analysis indicated higher pregnancy rates (RR = 1.28, 95% CI 1.04-1.57, p = 0.02) with no significant difference in live birth rates (RR = 0.56, 95% CI 0.29-1.10, p = 0.09). Combined therapy is effective. Metformin shows superiority to the standard regimen in achieving better CR rate in patients with AEH and benefits pregnancy rates but not recurrence or live birth rates. Therefore, the ideal fertility-sparing treatment for EC has not yet been determined and further clinical trials are needed.

Live birth outcomes following single-step blastocyst warming technique - optimizing efficiency without impacting live birth rates.

To evaluate the impact of a single-step (SS) warming versus standard warming (SW) protocol on the survival/expansion of vitrified blastocysts and their clinical outcomes post-frozen embryo transfer (FET). Retrospective analysis was performed on 200 vitrified/warmed research blastocysts equally divided amongst two thawing protocols utilizing the Fujifilm Warming NX kits (Fujifilm, CA). SW utilized the standard 14-minute manufacturer's guidelines. SS protocol required only a one-minute immersion in thaw solution (TS) before the embryos were transferred to culture media. A time-interrupted study was performed evaluating 752 FETs (SW: 376 FETs, SS 376 FETs) between April 2021-December 2022 at a single academic fertility clinic in Boston, Massachusetts. Embryologic, clinical pregnancy, and live birth outcomes were assessed using generalized estimated equation (GEE) models, which accounted for potential confounders. There was 100% survival for all blastocysts (n = 952 embryos) with no differences in blastocyst re-expansion regardless of PGT status. Adjusted analysis showed no differences in implantation, clinical pregnancy, spontaneous abortion, or biochemical pregnancy rate. A higher odds of multiple gestation [AdjOR(95%CI) 1.06 (1.01, 1.11), p = 0.019] were noted, even when adjusting for number of embryos transferred [AdjOR(95%CI) 1.05 (1.01, 1.10)]. Live birth outcomes showed no differences in live birth rates or birthweight at delivery. The study found equivalent outcomes for SS and SW in all parameters except for a slight rise in the rate of multiple gestations. The results suggest that SS warming is an efficient, viable alternative to SW, reducing thaw times without adverse effects on live birth rates or neonatal birth weights.

Efficacy and safety of follitropin delta versus follitropin alpha/beta in infertility treatment: A systematic review and meta-analysis.

Follitropin δ may be an alternative to conventional follitropin α/β for controlled ovarian stimulation (COS) within assisted reproductive treatment (ART), but its efficacy and safety remain unknown. We performed a random-effects meta-analysis to compare the efficacy and safety of follitropin δ and follitropin α/β. We searched randomized controlled trials comparing follitropin δ and follitropin α/β using MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, and WHO-ITCRP on December 14, 2022. The primary outcomes were the live birth rate and the incidence of moderate or severe ovarian hyperstimulation syndrome (OHSS). The certainty of the evidence was assessed using the grading of recommendations assessment, development, and evaluation approach. The protocol was registered on the Open Science Framework. Three studies involving 2682 participants were included in our meta-analysis. The results indicated that follitropin δ may result in little to no difference in live birth rates (risk ratio [RR], 1.12; 95% confidence interval [CI], 0.91-1.38; low certainty) and the incidence of moderate or severe OHSS (RR, 0.78; 95% CI, 0.48-1.26; low certainty) compared with follitropin α/β. Follitropin δ may result in little to no difference in COS compared with follitropin α/β, especially in terms of live births and safety.

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

Utility of Repeat Uterine Cavity Evaluation in the Infertility Workup.

Background: Uterine cavity abnormalities contribute to infertility. The purpose of this study was to evaluate the incidence, recurrence rates, and risk factors for uterine cavity abnormalities in women undergoing infertility workup and treatment, focusing on the utility of routinely repeated imaging. Methods: Retrospective cohort study at single academic medical center of 833 infertile women who had uterine cavity evaluations performed at least 9 months apart. Results: Of 833 eligible patients, 664 (79.7%) had normal initial imaging and 169 (20.3%) had abnormal initial imaging. Among the former, 10% had abnormal uterine cavity on repeat saline infusion sonohysterography (SIS); among the latter, 32% had abnormal repeat SIS [Chi-square p < 0.0001, risk ratio 2.30 (95% confidence interval 1.85-2.86)]. On average, 23.1 ± 13.6 months passed between studies. Regardless of initial imaging findings, women with abnormal repeat SIS were older than those with normal repeat SIS, with no difference in time elapsed between studies. There were no associations between repeat imaging outcomes and body mass index, uterine instrumentation, number of treatment cycles, or maximum peak estradiol levels in a single cycle between studies. There was no difference in live birth rate among cycles started within 1 year after repeat SIS across groups. Conclusions: Uterine cavity abnormalities were found in 10% of patients on repeat imaging despite initially normal testing. No risk factors for cavity abnormality on repeat imaging were identified besides age and prior abnormality. It would be prudent to continue performing routine repeat uterine cavity evaluation for women undergoing fertility treatment, particularly if corrective measures had been taken in the past.

A retrospective analysis of the effect of latent tuberculosis infection on clinical pregnancy outcomes of in vitro fertilization–fresh embryo transferred in infertile women

Abstract In areas with high incidence of tuberculosis (TB), there are more infertile women who underwent in vitro fertilization (IVF) and have latent TB infection (LTBI), and thus, their potential risks should be paid enough attention. The purpose of our study aimed to analyze the relationship between LTBI and clinical pregnancy outcomes of IVF and fresh embryo transfer (IVF–FET). This was a retrospective study of 628 infertile women who had undergone IVF–FET in the Fourth Affiliated Hospital of Hebei Medical University from January 2019 to December 2021. The women experienced no clinical symptoms, negative imaging, and T-SPOT.TB-positive diagnosis of LTBI. We divided the study population into the LTBI group and the non-LTBI group. The clinical pregnancy rate in the LTBI group was significantly lower than that in the non-LTBI group (40.54% vs 49.51%, P = 0.031), and there was no significant difference in live birth rate and miscarriage rate between the two groups. Logistic regression analysis showed that LTBI was an independent risk factor for decreased clinical pregnancy rate in infertile women undergoing IVF–FET. In conclusion, LTBI affects clinical pregnancy rate of IVF–FET in infertile women, and therefore, clinicians (especially in countries with a high TB burden) need to pay attention to LTBI before IVF and embryo transfer.

Clinical study of modified Shirodkar transvaginal cervical cerclage during pregnancy in the treatment of cervical insufficiency

Objective: To investigate the clinical efficacy of modified Shirodkar transvaginal cervical cerclage (TVCC) in the treatment of cervical insufficiency (CI) and its impact on maternal and fetal outcomes. Methods: The clinical data of 218 pregnant women with CI admitted to Fu Xing Hospital, Capital Medical University from January 1, 2015 to August 31, 2021 was retrospectively analyzed. According to different surgical approaches, they were divided into modified Shirodkar TVCC treatment during pregnancy (TVCC group, 108 cases) and non-pregnant women underwent laparoscopic cervical cerclage (LACC) treatment (LACC group, 110 cases). The clinical data and pregnancy outcomes of the two groups were compared. Furthermore, the two groups of pregnant women were stratified according to cervical length (CL) to explore the effects of the two surgical methods on the pregnancy outcomes of CI women with different CL. Results: (1) Related indicators before and during cerclage: there were no complications such as massive hemorrhage, bladder injury and anesthesia accident in the two groups of pregnant women during cerclage. Compared with the LACC group, TVCC group had longer preoperative CL [(2.3±0.6) vs (2.7±0.6) cm], more intraoperative blood loss [(7.5±0.5) vs (14.4±1.4) ml] and longer hospital stay [(6.0±0.1) vs (7.3±0.4) day]. However, the operation time was shorter [(42.9±1.6) vs (25.9±1.4) minute] and the hospitalization cost was less [(9 912±120) vs (5 598±140) yuan], and the differences were statistically significant (all P<0.05). (2) Pregnancy outcomes: live birth rates were 95.4% (103/108) in the TVCC group and 96.4% (106/110) in the LACC group, showing no significant difference between the two groups (χ2=2.211, P=0.232). The preterm birth rate (12.0%, 13/108) in the TVCC group was higher than that in the LACC group (7.3%, 8/110), the neonatal birth weight was lower than that in the LACC group [(3 006±96) vs (3 225±42) g], and the proportion of low birth weight infants was higher than that in the LACC group [15.5% (16/103) vs 1.9% (2/106)], and the differences were statistically significant (all P<0.05). (3) Stratified analysis of CL: for pregnant women with CL<2.0 cm, the miscarriage rate of the TVCC group was higher than that of the LACC group (2/9 vs 3.0%), and the live birth rate was lower than that of the LACC group (7/9 vs 97.0%), and the differences were statistically significant (all P<0.05). For CL 2.0-<2.5 cm, 2.5-<3.0 cm, CL≥3.0 cm, there were no statistically significant differences in preterm birth rate and live birth rate between the two groups (all P>0.05). Conclusions: Modified Shirodkar TVCC is simple and easy to operate, which significantly reduces the cesarean section rate and medical cost compared with LACC, and there is no significant difference in the live birth rate. When there is inevitable late abortion, laparoscopic cerclage removal does not need to be performed again, which could reduce the second operation and is worthy of clinical application.

Live birth rates in in vitro fertilization cycles with five or fewer follicles.

To evaluate live birth rates (LBRs) for in vitro fertilization (IVF) cycles with ≤5 follicles at trigger, with the goal of helping patients with low follicle counts decide whether to proceed to retrieval. This is a retrospective cohort study from an urban, university-affiliated fertility center. All IVF cycles that yielded <10 oocytes between 2016 and 2020 were reviewed. Cycles were included if <5 follicles measuring >14 mm were verified on trigger day. The primary outcome was LBR per retrieval after fresh or frozen transfer. Secondary outcomes were number of oocytes, mature oocytes, 2-pronuclear zygotes (2-PNs), blastocysts for transfer/biopsy, and euploid blastocysts (if preimplantation genetic testing for aneuploidy (PGT-A) was used). 1502 cycles (900 with PGT-A) from 972 patients were included. Mean number of oocytes, mature oocytes, 2-PNs, blastocysts for transfer/biopsy, and euploid blastocysts differed by follicle number (p < 0.001). Across all age groups, there were differences in LBR associated with follicle number (p < 0.001). However, within age groups, not all results were significant. For example, for patients <35 years, LBR did not differ by follicle number and among patients 35-37 years; LBR with two or three follicles was lower than with five (p < 0.02). LBR for patients 35-40 years was <20% with 1-3 follicles and 25-40% with 4-5 follicles. LBR for patients >41 years was <5% with 1-3 follicles and <15% with 4-5 follicles. As expected, LBR is higher with more follicles. Providing patients with <5 follicles with specific data can help them weigh the emotional, physical, and financial costs of retrieval.

Effect of female body mass index on intrauterine insemination outcomes: a systematic review and meta-analysis

The prevalence of women with a raised body mass index (BMI) seeking assisted conception treatment is increasing. Findings of existing studies evaluating the effect of female BMI on intrauterine insemination (IUI) treatment outcomes remain inconsistent. This systematic review and meta-analysis evaluate the effect of female BMI on IUI treatment outcomes. Two authors independently conducted data extraction and assessed study quality. Risk ratios (RR) and 95% confidence intervals were calculated using the Mantel-Haenszel approach for dichotomous outcomes. 11 studies involving 23,145 IUI treatment events, comprising 21,211 cycles from 8 studies, and 1,934 participants in three studies, met the inclusion criteria for the meta-analysis. Two cohorts of women undergoing IUI treatment were compared - women with normal BMI < 25 kg/m2 were compared with a second cohort of women with a BMI category ≥ 25 kg/m2. There was no statistically significant difference in live birth rate (LBR) (RR 1.06, 95% CI 0.86–1.307); clinical pregnancy rate (CPR) (RR 0.94, 95% CI 0.78–1.13); miscarriage (RR 0.92, 95% CI 0.31–2.74) or ectopic pregnancy rate (RR 2.20, 95% CI 0.78–6.23). Our meta-analysis showed that a raised female BMI did not affect IUI treatment outcomes. Nevertheless, weight loss counselling should be offered to women with a raised BMI undergoing IUI, to reduce the associated obstetric morbidity.

Obstetric and Neonatal Outcomes After Transferring More Than One Embryo in Patients With Preimplantation Genetic Testing.

To compare obstetric and neonatal outcomes after single embryo transfer (SET) compared with multiple embryo transfer (MET) from frozen-thawed transfer cycles of embryos that underwent preimplantation genetic testing for aneuploidies (PGT-A). We conducted a retrospective cohort study from the SART CORS (Society for Assisted Reproductive Technology Clinic Outcome Reporting System) national database. Clinical and demographic data were obtained from the SART CORS database for all autologous and donor egg frozen-thawed transfer cycles of embryos that underwent PGT-A between 2014 and 2016, after excluding cycles that used frozen oocytes, fresh embryo transfer, and transfers of embryos from more than one stimulation cycle. Multivariable linear and log-binomial regression models were used to estimate the relative and absolute difference in live-birth rate, multiple pregnancy rate, gestational age at delivery, and birth weight between SET compared with MET. In total, 15,638 autologous egg transfer cycles and 944 donor egg transfer cycles were analyzed. Although the live-birth rate was higher with MET compared with SET in the autologous oocyte cycles (64.7% vs 53.2%, relative risk [RR] 1.24, 95% CI, 1.20-1.28), the multiple pregnancy rate was markedly greater (46.2% vs 1.4%, RR 32.56, 95% CI, 26.55-39.92). Donor oocyte cycles showed similar trends with an increased live-birth rate (62.0% vs 49.7%, RR 1.26, 95% CI, 1.11-1.46) and multiple pregnancy rate (54.0% vs 0.8%) seen with MET compared with SET. Preterm delivery rates and rates of low birth weight were significantly higher in MET compared with SET in both autologous and donor oocyte cycles and were also higher in the subanalysis of singleton deliveries that resulted from MET compared with SET. Despite some improvement in live-birth rate, nearly half of the pregnancies that resulted from MET of embryos that underwent PGT-A were multiples. Compared with SET, MET is associated with significantly higher rates of neonatal morbidity, including preterm delivery and low birth weight. The transfer of more than one embryo that underwent PGT-A should continue to be strongly discouraged, and patients should be counseled on the significant potential for adverse outcomes.

Different doses of recombinant FSH and determining parameters of oxidative stress.

This study aimed to examine if there is a connection between recombinant FSH dose and OS parameters in serum and the impact on IVF outcome. This study consisted of 101 participants that went through IVF procedures. Parameter that were tested are SOD, SH groups and MDA. Serum samples were drawn before stimulation and on the last day of ovarian stimulation. Two groups were formed according to the dose of gonadotropins (rFSH). In both groups there were no significant differences in live-birth rate and miscarriage. In both groups mean serum MDA and SH-groups were significantly higher after ovarian stimulation, but mean serum SOD was significantly lower when compared to values before stimulation. There were less patients without OS before stimulation. Our results suggest that there is a difference in serum concentration in groups SOD, SH groups and MDA at the beginning and at the end ovarian stimulation. On the other hand, dose of rFSH is not related with change of parameters for oxidative stress, quality of oocytes, embryos, fertilization, pregnancies, and miscarriage rate. Patients without oxidative stress before the IVF procedure needed lower doses of gonadotropins during stimulation.

The effects of male anxiety and depression on IVF outcomes.

What are the effects of male anxiety and depression on IVF outcomes? Men with anxiety had lower final total motile sperm counts (fTMSC) during IVF compared to men without anxiety; however, there were no differences in live birth rates (LBRs). Studies have shown that male anxiety causes low sperm motility, worse sperm morphology, and increased DNA fragmentation, which are known to be influential factors on fertilization rates and embryo quality during IVF. However, data are lacking on whether there is a direct association between male anxiety and/or depression and IVF outcomes. This was a survey-based, retrospective cohort study completed at a single, large hospital-affiliated fertility center with 222 respondents who underwent IVF with or without ICSI. The study was conducted between 6 September 2018 and 27 December 2022. Male partners of couples who underwent IVF or IVF/ICSI completed a Hospital Anxiety and Depression Scale (HADS) questionnaire. They were separated into two groups for both anxiety (HADS-A ≥ 8 or HADS-A < 8) and depression (HADS-D ≥ 8 or HADS-D < 8). Men with an elevated HADS-A or HADS-D score ≥8 were considered to have anxiety or depression, respectively. The primary outcome was LBR. Secondary outcomes included semen parameters at the time of IVF, cycle outcomes, pregnancy outcomes, and prevalence of erectile dysfunction and low libido. There were a total of 222 respondents, of whom 22.5% had a HADS-A ≥ 8 and 6.5% had a HADS-D ≥ 8. The average age of respondents was 37.38 ± 4.90 years old. Antidepressant use was higher in the respondents with a HADS-A or HADS-D ≥ 8 (P < 0.05). Smoking use was similar between groups for both HADS-A and HADS-D (P > 0.05). When adjusted for male BMI, antidepressant use and smoking, men with a HADS-A or HADS-D ≥ 8 had similar rates of erectile dysfunction (adjusted relative risk (aRR) = 1.12 (95% CI 0.60, 2.06)) and low libido (aRR = 1.70 (95% CI 0.91, 3.15)) compared to those with a HADS-A or HADS-D ≤ 8. Men with a HADS-A ≥ 8 were more likely to have a lower fTMSC on the day of oocyte retrieval (11.8 ≥ 8 vs 20.1 < 8, adjusted ß = -0.66 (95% CI -1.22, -0.10)). However, the LBR per embryo transfer (ET) was similar between the HADS-A groups (43.2% ≥8 vs 45.1% <8, adjusted relative risk = 0.90 (95% CI 0.65, 1.06)). Although depression was uncommon in the entire cohort, the HADS-D groups were clinically similar for fTMSC (18.7 ≥ 8 vs 16.0 < 8) and LBR per ET (46.7% ≥8 vs 45.4% <8). Limitations of our study are the survey-based design, the lack of sperm morphology assessment at the time of IVF, our inability to fully assess the HADS-D ≥ 8 cohort due to the small sample size and the large Caucasian demographic. Couples undergoing IVF have an increased likelihood of suffering from anxiety and/or depression. There is currently a debate on whether or not men should be treated with antidepressants while attempting to conceive due to potential detrimental effects on sperm quality. Our study shows that, regardless of antidepressant use, couples with men who did or did not report anxiety and/or depression have similar LBRs when undergoing IVF. Therefore, it is important to assess both partners for mental health and to not withhold treatment due to a concern about a potential impact of antidepressants or anxiety/depression on sperm quality. There was no funding to report for this study. Z.W. is a contributing author for UptoDate. S.S.S. is on the advisory board for Ferring Pharmaceuticals. E.G. was a medical consultant for Hall-Matson Esq, Teladoc, and CRICO and is a contributing author for UptoDate. The remaining authors have nothing to report. N/A.

Comparison of dydrogesterone plus progesterone gel with subcutaneous aqueous progesterone plus progesterone gel for luteal phase supplementation of subsequent in vitro cycle in women after previous cycle failure.

The luteal phase supplementation (LPS) of the in vitro fertilization (IVF) cycle is crucial to increase the chance of a live birth. There is no preferred progestogen for use in the general population. The optimal progestogen regimen in the event of prior IVF failure is unknown. The aim was to compare the live birth rate for dydrogesterone plus progesterone gel versus aqueous progesterone plus progesterone gel in LPS of the IVF cycle in women with at least one previous IVF failure. A prospective randomized single-center study enrolled women with at least one previous IVF failure undergoing another IVF cycle. Women were randomly assigned in a 1:1 ratio to 2 arms depending on LPS protocol: dydrogesterone (Duphaston®) + progesterone in vaginal gel (Crinone®) vs aqueous progesterone solution in subcutaneous injection (Prolutex®) + progesterone in vaginal gel (Crinone®). All women underwent fresh embryo transfer. The live birth rate with one prior IVF failure was 26.9% for D + PG vs 21.2% for AP + PG (p = 0.54), and with at least two IVF failures: 16% for D + PG vs 31.1% for AP + PG (p = 0.16). There were no significant differences in live birth rates between protocols, regardless of the number of prior IVF failures. In light of the evidence from this study that neither of the two LPS protocols is more effective in women with prior IVF failure, other factors, such as potential side effects, dosing convenience and patient preference, should be considered when choosing a treatment.

Moderate and increased physical activity is not detrimental to live birth rates among women with unexplained infertility and obesity

To determine if moderate physical activity is associated with live birth rates in women with unexplained infertility and obesity. Secondary analysis of the Improving Reproductive Fitness through Pretreatment with Lifestyle Modification in Obese Women with Unexplained Infertility trial. US fertility centers, 2015-2019. A total of 379 women participated in Improving Reproductive Fitness through Pretreatment with Lifestyle Modification in Obese Women with Unexplained Infertility trial, a lifestyle modification program with increased physical activity (phase I, 16 weeks) and up to three cycles of clomiphene citrate treatment and intrauterine insemination (phase II). Participants were instructed to add 500 steps/day weekly until a maximum of 10,000 steps/day was reached and maintained. Participants were stratified as active (top third, N = 125) and less active (lower third, N = 125) on the basis of the average number of steps per day recorded using a FitBit activity tracker. Live birth rate. Active participants were more physically active at the time of enrollment than less active participants (average baseline steps per day, 8,708 [7,079-10,000] vs. 4,695 [3,844-5,811]; P ≤ 0.001) and were more likely to reach 10,000 steps/day than less active participants (average steps per day, 10,526 [9,481-11,810] vs. 6,442 [4,644-7,747]; P ≤ 0.001), although both groups increased their average steps per day by a similar amount (1,818 vs.1,747; P = 0.57). There was no difference in live birth rates (24/125 [19.2%] vs. 25/125 [20%]; P = 0.87) between active and less active participants nor were there differences in clinical pregnancy rates (P = 0.45) or miscarriage rates (P = 0.49) between the two groups. Active participants were more likely to achieve the physical activity goal, although this was not associated with benefit or harm with respect to live birth. ClinicalTrials.gov (NCT02432209), first posted: May 4,2015.

Storage time does not influence pregnancy and neonatal outcomes for first single vitrified high-quality blastocyst transfer cycle

Does blastocyst storage time have an impact on pregnancy and neonatal outcomes following the first single vitrified/warmed high-quality blastocyst transfer cycle for young women? Retrospective cohort study in a university-affiliated reproductive medical centre. A total of 2938 patients undergoing their first frozen embryo transfer (FET) cycle with a single high-quality blastocyst (Day 5: 3BB and above; Day 6: 4BB and above) transferred were divided into five groups: Group A with storage time ≤3 months (n = 1621), Group B with storage time of 4-6 months (n = 657), Group C with storage time of 7-12 months (n = 225), Group D with storage time of 13-24 months (n = 104), and Group E with storage time of 25-98 months (n = 331). After adjusting for confounding factors by multivariate logistic regression, there were no significant differences in live birth rate [Group A as reference; Group B: adjusted odds ratio (aOR) 0.954 (95% CI 0.791- 1.151); Group C: aOR 0.905 (95% CI 0.674-1.214); Group D: aOR 0.727 (95% CI 0.474-1.114); Group E: aOR 1.185 (955 CI 0.873-1.608)], β-human-chorionic-gonadotropin-positive rate, clinical pregnancy rate and miscarriage rate between Group A and the other groups. Among all singletons born after FET, there were no significant differences with regards to gestational age, preterm birth, birthweight, low birthweight, high birthweight and macrosomia. Long-term cryostorage of human vitrified high-quality blastocysts does not affect pregnancy or neonatal outcomes.

P-534 Serum progesterone levels on the day of embryo transfer do not affect pregnancy outcomes after euploid blastocyst transfer: data from artificial cycles with intramuscular progesterone

Abstract Study question Do serum progesterone levels on the day of embryo transfer (ET) have an impact on implantation and pregnancy outcomes? Summary answer Serum luteal progesterone levels were not associated with pregnancy outcomes under the condition of utilizing 60mg intramuscular progesterone for luteal support in artificial cycles. What is known already It was recognized that circulating progesterone level might be associated with frozen-thawed embryo transfer (FET) success, and a serum progesterone level above a certain threshold at the time of blastocyst transfer improved live birth rates (LBR) and reduced risk of miscarriage in artificial FET cycles. However, this hypothesis is controversial as the previous findings were based on data using vaginal progesterone as luteal phase support with various doses and timing of administration. Studies evaluating euploid-only FET cycles with intramuscular progesterone were lacking. Study design, size, duration The study incorporated infertile couples undergoing (preimplantation genetic testing, PGT) from 1st January 2018 to 31st July 2021. It is a retrospective cohort study including 771 patients who underwent single frozen-thawed euploid blastocyst transfer after an artificial endometrial preparation cycle with 60mg intramuscular progesterone daily for luteal support. Each patient only contributed one cycle per cohort. Participants/materials, setting, methods Patients with recurrent implantation failure, endometrium 7.0 mm and cycles with gonadotrophin releasing hormone analogue down regulation were excluded. Serum progesterone measurements were taken on the day of ET, approximately 20±2 hours after the last injection of progesterone. The primary outcome was LBR based on serum progesterone levels. Secondary outcomes were the relationship between serum progesterone levels and clinical pregnancy rate, miscarriage rate as well as obstetrical and neonatal outcomes. Main results and the role of chance The median of serum progesterone levels was 11.80 ng/ml [9.95, 14.60] (median/IQR) and the overall LBR, clinical pregnancy rate and miscarriage rate were 55.6%, 64.33% and 10.69% respectively. Patients with the lowest centile of serum progesterone level (≤P10, ≤8.2ng/ml) had a similar clinical pregnancy rate (62.0% vs 64.6%), live birth rate (50.6% vs 56.2%) and miscarriage rate (12.2% vs 10.5%) compared with the rest of patients. After dividing patients in deciles according to serum progesterone levels, no differences in LBR were observed among groups and no correlations were found between progesterone levels and the other pregnancy outcomes. Multivariate regression analysis confirmed that serum progesterone levels did not affect the LBR after adjusting for possible confounders (age, body mass index, PGT indication, primary infertility, history of miscarriage, endometrium thickness, day of blastocyst and embryo quality) with adjusted (OR) 0.99, 95%CI 0.96-1.03), while the day of blastocyst (D6 vs. D5: aOR 0.47, 95%CI 0.33-0.65) as well embryo quality (good quality embryo vs. available embryo: aOR 1.88, 95%CI 1.38-2.58) were associated with LBR independently. Similarly, serum progesterone in their lowest levels did not negatively impact other pregnancy outcomes (ex. clinical pregnancy rates, miscarriage rates) and the perinatal outcomes. Limitations, reasons for caution This is a retrospective cohort study and the results only apply for patients under artificial cycles with intramuscular progesterone. Moreover, the time interval between the last administration of progesterone and the blood test was not controlled in the present study. Wider implications of the findings Serum progesterone level may not influence the FET outcomes independently in an artificial cycle with intramuscular progesterone. A daily dose of 60mg progesterone intramuscularly for luteal support is sufficient and the measurement of serum progesterone does not need to be performed in advance for most of the patients. Trial registration number not applicable

P-667 The attenuated response to elevated serum progesterone levels on pregnancy outcomes of fresh IVF/ICSI cycles in older patients

Abstract Study question Whether there are different impacts of serum progesterone (P) levels on the day of trigger on pregnancy outcomes in patients of different age groups. Summary answer Our results suggest that the pregnancy outcome was less sensitive to progesterone elevation in older patients. What is known already It is now generally believed that the P elevation at the late follicular phase reduces the pregnancy rate by opening the implantation window prematurely and disrupt the embryo-endometrial synchrony. Previous studies further investigated the effect of developmental stages of embryo, number of oocytes retrieved, cause of infertility and different stimulation regimens on the association of P level and the likelihood of pregnancy. However, the study of maternal age on such association is scarce. A previous study found that LH receptor (LHCGR) and progesterone receptor (PGR) were up regulated in advanced age group. Study design, size, duration This was a non-interventional, retrospective cohort study of patients undergoing routine practice in a university-based fertility center between 2015 and 2021. One thousand five hundred and seventeen IVF/ICSI cycles among 1305 patients were included in the analysis. Participants/materials, setting, methods Fresh ET using autologous oocytes with serum P level measured on the day of hCG administration were included. Exclusion criteria include cycles without P measurement, using frozen oocytes, PGT cycles, freeze-all cycles, oocyte donation and no embryo transfer cycles. The patient age was divided into 3 groups: group 1 included patients at age 35 or below, group 2 included patients at age 36 to 39, group 3 included those at 40 years old or above. Main results and the role of chance We performed logistic regression analysis for each group to determine the contributing factors to the live birth outcome. In group 1, age, serum P level, number of usable embryos, embryo grading and endometrial thickness were found to be significantly associated with live birth. In group 2, age and number of usable embryos were significantly associated with live birth. However, total dose of gonadotropin was found to be the sole contributing factor to live birth in group 3. We also divided the P levels into low (≤0.50 ng/mL), median (0.51-1.00 ng/mL) and high (&amp;gt;1.00 ng/mL) and compared the live birth rate in each age groups. The live birth rate was found to be significantly reduced with increasing P levels (40.3% vs. 35.5% vs. 23.6%, p = 0.005). No significant difference in live birth rate between different P levels was found in age group 2 and 3. Limitations, reasons for caution The limitation of the study is its retrospective nature which may have led to bias in the interpretation of the data. There were also significantly higher proportion of cleavage-stage embryo to blastocyst transfer in the older group. Wider implications of the findings The negative association of premature progesterone rise at pre-ovulatory phase to the IVF fresh ET outcome was more prominent for younger patients. This may be one of the contributing factors that accounts for the great heterogeneity in the cut-off of P and its predicting power in different studies. Trial registration number Not applicable

P-614 Endometrial preparation: effect of estrogen levels before the embryo transfer on the live birth rate from 14825 freezing-all cycles

Abstract Study question Is there a difference in live birth rate during discrepant estrogen levels before the embryo transfer following either hormone replacement therapy (HRT) or natural cycle(NC)? Summary answer The higher estrogen level on the day before embryo transfer may reduce the live birth rate in either HRT or NC. What is known already The endometrial preparation of frozen embryo transfer cycle is to synchronize of endometrium and embryo under the condition of exogenous estrogen and progesterone drugs in HRT or follicle monitoring in NC. Estrogen is crucial and different estrogen levels could imply variations on endometrial preparation. Information on the effect of discrepant estrogen levels before the embryo transfer on reproductive outcomes of women undergoing freezing-all cycles is scarce. Study design, size, duration Retrospective cohort study including 14825 first frozen embryo transfers following IVF/ICSI undergoing freezing-all cycles from January 2016 to December 2020. A total of 12305 (83.0%) patients received NC while 2520 (17.0%) received HRT. Participants/materials, setting, methods Effect of estrogen levels on live birth rates, stratifified by deciles and ROC to determine the cutoff values for estrogen level on the day before embryo transfer.Multivariable logistic regression analysis was performed to adjust for confounders. Main results and the role of chance The live birth rate was 44.7% and 52.4% in HRT and NC respectively. The live birth rate of HRT began to decline when the estrogen level was P60 in the deciles which the cut-off values of ROC was closed with the estrogen level was 891.6 pg/ml. The lower level of estrogen on the day before embryo transfer in HRT corresponds to a higher live birth rate（51.4% vs 32.9%）.The cut-off values of ROC in NC was statistically different with the estrogen level was 194.4 pg/ml. The lower level of estrogen on the day before embryo transfer in NC corresponds to a higher live rate（53.0% vs 48.6%）.After adjusting the possible confounding factors by multivariate logistic regression, it was found that the estrogen level on the day before embryo transfer in HRT and NC was the independent influencing factor of live birth rate with the OR of 0.57 (0.47,0.68) and 0.82 (0.74,0.90), respectively. Limitations, reasons for caution The greatest limitation of this study is its retrospective study. On the other hand, this study was performed using non-PGT cycle, although this is unlikely to affect the results,we cannot exclude the possibility that euploid embryo responds differently to endometrial state in comparison to aneuploid embryo. Wider implications of the findings In freezing-all cycles, the higher estrogen level on the day before embryo transfer may reduce the live birth rate in either HRT or NC. Clinicians should pay attention to the control of estrogen level in luteal phase. Trial registration number Nona

P-444 The use of socioeconomic deprivation as an explanation of variation in IVF success rates between clinics

Abstract Study question Can differences in the live birth rate (LBR) between clinics with similar standard operating procedures (SOPs) be explained by variations in socioeconomic deprivation? Summary answer Socioeconomic deprivation does not appear to explain differences in LBR between clinics with similar SOPs in this cohort What is known already IVF success rates vary markedly between clinics. Numerous factors determine whether an IVF cycle is likely to be successful. It has been suggested that more socioeconomically deprived women are significantly less likely to achieve a live birth per cycle than less deprived women. In the UK, there is considerable variation in the levels of socioeconomic deprivation between different cities. Study design, size, duration We undertook a multi-center, retrospective review of prospectively collected data. We included all women undergoing their first IVF/ICSI cycle between January 2016 and December 2020 in eight different clinics belonging to the same IVF group. Clinics were located across England: three were situated in ‘very deprived’ cities, two in ‘predominantly affluent’ cities and the remaining cities were ‘neither very deprived nor very affluent’ i.e. their distribution was not skewed. Participants/materials, setting, methods We included all women undergoing their first IVF/ICSI cycle involving transfer of a single, fresh embryo. SOPs for medical and laboratory aspects of treatment were similar across all eight clinics. Socioeconomic deprivation was assessed using the Index of Multiple Deprivation (IMD) determined by the residential postcode of each woman undergoing treatment. Patients were categorized into quintiles according to IMD score. Live birth rates across IMD quintiles were calculated. Statistical analysis was performed using SPSS 22. Main results and the role of chance In total, across the 8 clinics, 17171 women underwent an IVF/ICSI cycle. The LBR ranged from 17.9 - 35.7% (p &amp;lt; 0.001) with both upper and lower extremes in clinics in cities classified as ‘neither very deprived nor very affluent’. The overall LBR ranged from 23.7-26.0% across the IMD quintiles. This difference was neither linear nor statistically significant. Similar trends were noted whether the treatment was NHS (n = 4992) or self-funded (n = 12179). The proportion of women in each IMD quintile varied significantly (p &amp;lt; 0.001) across the different clinics: in the most deprived quintile this ranged from 3.2 - 22.8% and in the least deprived quintile this ranged from 19.1 - 30.8%. The LBR in each IMD quintile also varied significantly (p &amp;lt; 0.001) across the different clinics. The LBR in the most deprived quintile ranged from 7.1 - 46.1% and in the least deprived quintile ranged from 19.4 - 22.9%. Limitations, reasons for caution Our results require caution as the distribution of deprivation amongst women undergoing IVF was not representative of the cities in which clinics were located with a skew towards greater affluence seen. Further unknown variables appear responsible for the significant variation in LBRs between clinics rather than IMD categorization alone. Wider implications of the findings The distribution of deprivation amongst women undergoing IVF was not representative of the cities in which clinics were located. Whilst not unexpected due to the cost of IVF, ethical questions regarding access to fertility care are highlighted and efforts to promote inclusion should be prioritized. Trial registration number Not applicable