Difference In Live Birth Rate Research Articles

Effect of time since vasectomy on live birth rate of TESE‒ICSI egg donation cycles and male-related prognostic factors.

Vasectomy is a widely used method of contraception. However, some men may have the desire to become biological fathers again after a period. To explore the effect of time since vasectomy and different male comorbidities on live birth rates from intracytoplasmic sperm injection cycles using donated oocytes by using testicular spermatozoa obtained by testicular sperm extraction. This was a retrospective study of 123 couples who underwent a testicular sperm extraction‒intracytoplasmic sperm injection cycle after vasectomy using donated oocytes. Subjects were divided into groups according to time since vasectomy and the male risk factor evaluated. The main outcomes measured were live birth rate per embryo transfer, per oocyte donation cycle, and per couple. We assessed the cumulative live birth rate according to the time since vasectomy and considered male comorbidities: body mass index, hypertension, diabetes mellitus, dyslipidemia, and smoking. The overall live birth rate per couple was 59.3% (50.6-68.0). Considering the number of embryo transfer and oocyte donation cycle, the live birth rates were 34.1% (27.8-40.4) and 44.5% (36.9-52.1), respectively. The live birth rate according to time since vasectomy was not statistically different between groups. Consequently, the cumulative live birth rate was similar between the different interval times when considering one to eight embryo transfers (p=0.74). No statistical differences in live birth rate and cumulative live birth rate were found between groups clustered according to male body mass index, smoking, hypertension, and dyslipidemia. However, diabetic male patients had a significantly lower rate of live birth rate per couple (22.2% [4.94-49.4]) than non-diabetic patients did (62.7% [53.7-71.8]) (p=0.03), but not in their cumulative live birth rate. The time since vasectomy seems to have no detrimental effects on the live birth rate and cumulative live birth rate in testicular sperm extraction‒intracytoplasmic sperm injection cycles with donated oocytes. Male diabetes negatively affects the overall live birth rate per couple, but not the cumulative live birth rate. These results could be useful for multidisciplinary patient-tailored counseling, regarding the chance of having a pregnancy and facilitating the decision-making process of the fertility specialists.

P-579 Is the use of donated oocytes effective to reestablish live birth rates? Reproductive outcomes of 5313 euploid embryo transfers in autologous versus egg donation cycles

Abstract Study question Is live birth rate of autologous versus donor cycles similar after a euploid embryo transfer? Summary answer The live birth rate was significantly higher in autologous cycles after a euploid embryo transfer. What is known already Advanced maternal age (AMA) is a detrimental factor for patients to achieve a successful outcome in ART. Physiological ovarian aging negatively affects oocyte quality and quantity. Thus, the number of cycles with donated oocytes is increasing for AMA patients worldwide, with the perspective of surpass the oocyte factor and achieve a live birth in similar rates as younger patients. The goal of this study was to compare the live birth rates of autologous versus donor cycles after a euploid embryo transfer. Study design, size, duration Observational cohort study including all patients of IVF cycles with a euploid embryo transfer after PGT-A (NGS technology), according to medical referral between Jan/2016 and Dec/2020 (n = 3623 patients and 4025 cycles) in a private ART center. Participants/materials, setting, methods Reproductive outcomes between autologous and egg donation cycles were compared and data were analyzed in the follow subgroups: cycles with a fresh oocyte and fresh embryo transfer (FRESH), frozen embryo transfer (FET) and fresh embryo transfer from frozen oocytes (FOT). Positive pregnancy test (PPT), clinical pregnancy (CP), clinical miscarriage (CM) and live birth (LB) rates were compared. Kruskal-Wallis and Fisher test were applied for statistical analysis, significance was considered if p < 0,05. Main results and the role of chance In total, 3623 patients – 88.9% autologous and 11.1% with donated oocytes – were included. They performed 4025 ETs (3591/434) with 5313 biopsied blastocysts (4736/577) in a mean of 1,32/1,33 blastocysts per transfer in autologous/donated cycles respectively. The majority of patients using autologous and donated oocytes underwent a FET (97,2% and 63,1%), followed by FOT (1,5% and 34,7%) and FRESH (1,3% and 2,2%, respectively). Mean maternal age in autologous and donor cycles was 37,76±3,9yo and 43,47±4,26yo and oocyte donors were 24,99±3,86yo. In subgroups, autologous patients in FRESH were 38,33±2,69 yo, similar in FET (37,73±3,93 yo) and older in FOT, 39,25±3,93 yo (p = 0,03). Patients in donor cycles showed no difference in age. PPT and CP were similar in autologous and donated cycles (PPT: 59,2% vs 54,8%, p = 0.08; CP: 52,2% vs 48,2%, p = 0.11). In subgroup analysis, PPT and CP were higher in donated cycles vs autologous cycles for FOT (PPT: 50,7% vs 33,3%, p = 0.004; CP: 40,7% vs 20,8%, p = 0.01). Overall, CM were higher in donated cycles (15,5% vs 10,6%, p = 0.03), especially after FET (16,8% vs 10,6%, p = 0.025). LB rates were higher in autologous compared to donated cycles (37,8% vs 29,5%, p = 0.0007). There was no significant difference in LB rates in subgroup analysis. Limitations, reasons for caution This is a large cohort study; however, we cannot exclude potential bias due its retrospective nature. Including only euploid embryos, we excluded bias on ploidy status when comparing autologous versus donated oocytes cycles, yet the potential harmful of embryo biopsy may not be neglect. Wider implications of the findings Live birth rate was significantly higher in autologous cycles after a euploid embryo transfer, regardless of subgroups. AMA patients that choose to undergo an IVF treatment with donated oocytes should be aware that there are other important factors related to a successful reproductive outcome, including immunological adaptation and endometrial aging. Trial registration number Not applicable.

P-212 Balancing success and safety in assisted reproductive technologies cycles: the outcomes of transferring poor-quality blastocyst or day 5 slow-growing embryos with good-quality blastocyst

Abstract Study question Does transferring two mixed-quality embryos improve the live birth rate (LBR) without increasing the multiple gestation rate compared to the single good-quality blastocyst (GQB) transfers? Summary answer The transfers of single GQB and two mixed-quality embryos show similar LBRs, however, the multiple gestation rate was significantly higher in double embryo transfer groups. What is known already Due to higher LBR after blastocyst transfer, the single embryo transfer (SET) strategy has gained popularity worldwide. Despite that double-embryos transfers (DET) demonstrate higher LBR than SET, multiple gestation rates (MGRs) are higher in DET. To reduce MGR but still accomplish high LBR, DETs could be performed using embryos of mixed-quality. It has been suggested that the transfer of GQB with poor-quality blastocyst (PQB) could increase LBR without increasing MGR. Alternatively, when the embryo transfer is scheduled in a fresh cycle, the DET could be performed with GQB and day 5 slow-growing embryo (SGE) – early blastocyst or morula. Study design, size, duration This study included assisted reproductive technologies (ART) cycles with fresh embryo transfer on day 5, between 2015 and 2021, for patients under 34 years. Selected ART cycles were assigned into five groups: SET with GQB (SET-GQB, n = 754); DET with two GQBs (DET-GQB, n = 306); DET with one GQB and one PQB (DET-GP, n = 75); DET with one GQB and one day 5 SGE (DET-GS, n = 386), DET with two day 5 SGE (DET-SGE, n = 209). Participants/materials, setting, methods According to Gardner and Schoolcraft’s grading system, blastocyst morphological assessment was performed on day 5. Blastocysts graded as AA, AB, BA, and BB with a degree of expansion ≥3 were classified as GQBs, whereas blastocysts graded ВС, СВ, СС with a degree of expansion ≥3 were classified as PQBs. Day 5 morulas and blastocysts with degree of expansion 1 were classified as slow-growing embryos. The cycles with donor gametes, preimplantation genetic testing were excluded. Main results and the role of chance The LBR was significantly higher in DET-GQB than in SET-GQB [53,59% (164/306) vs 40,58% (306/754); P < 0,001]. There were no significant differences in implantation rate (IR) and miscarriage rate (MR) between SET-GQB and DET-GQB [47,88% (361/754) vs. 44,12% (270/612) P = 0,165], [12,19% (44/361) vs. 10,00% (27/270) P = 0,389]. However, the MGR was significantly higher in DET-GQB compared to SET-GQB [36,59% (60/164) vs 1,31% (4/306) P < 0,001]. When SET-GQB was compared with DET-GS, DET-GP there were no significant differences in LBR: [40,58% (306/754) vs. 39,64% (153/386) P = 0,757; vs. 41,33% (31/75) P = 0,899]. The IR was significantly higher in SET-GQB than in DET-GS and DET-GP [47,88% (361/754) vs. 30,70% (237/772) P < 0,001; vs. 30,00% (45/150) P < 0,001]. There were no significant differences in MR between SET-GQB and DET-GS, DET-GP [12,19% (44/361) vs. 17,30% (41/237) P = 0,079; vs. 11,11% (5/45) P = 0,834]. However, the MGR was significantly lower in SET-GQB compared to DET-GS, DET-GP [1,31% (4/306) vs. 18,95% (29/153) P < 0,001; vs. 22,58% (7/31) P < 0,001]. The IR and LBR were significantly higher in SET-GQB compared to DET-SGE [47,88% (361/754) vs 16,99% (71/418) P < 0,001], [40,58% (306/754)vs 19,14% (40/209) P < 0,001]. The MR and MGR were significantly lower in SET-GQB than in DET-SGE [12,19% (44/361) vs 32,39% (23/71) P < 0,001], [1,31% (4/306) vs 15,00% (6/40) P < 0,001]. Limitations, reasons for caution The study is limited due to the uneven distribution and a low number of participants in group DET-GP. Blastocyst morphological assessment remains subjected to a human factor. It was impossible to form a group where two PQBs were transferred, as there were only a few cases of such transfers. Wider implications of the findings Transferring an additional poor-quality embryo (poor-quality blastocyst or day 5 slow-growing embryo) does not increase the live birth rates. However, it significantly raises the multiple gestation rate. Despite the low live birth rate when two day 5 slow-growing embryos are transferred, the multiple gestation rate significantly increases, compared to SET. Trial registration number Not applicable

O-201 Antinuclear antibodies in women with recurrent early pregnancy loss: prevalence and impact on subsequent pregnancy outcome

Abstract Study question What is the prevalence of antinuclear antibodies (ANAs) in women with recurrent early pregnancy loss (REPL) and do they affect subsequent pregnancy outcome? Summary answer The prevalence of ANAs in women with REPL was 13.0%, and their presence did not negatively impact subsequent pregnancy outcomes, including EPL and livebirth rates. What is known already An etiological factor cannot be identified in more than half of the couples experiencing REPL. Immunologic mechanisms could be involved, with the presence of autoimmune disease (AD) associated to lower reproductive outcomes. For the mere presence of ANAs, in the absence of AD, the evidence on the association with REPL is controversial, with most studies having a small sample size with important clinical and methodological heterogeneity. Study design, size, duration This is a single-centre, retrospective cohort study from a tertiary referral hospital including 960 women referred for REPL between January 2014 and December 2019. During the entire study period, maternal serum ANA detection was part of the routine diagnostic REPL work-up, defined as two or more pregnancy losses before the 10th week of gestation, including previous spontaneous conceptions and pregnancies following autologous IVF/ICSI treatment. Participants/materials, setting, methods Women under the age of 40 at ANA analysis were eligible for inclusion. Confirmed AD, uterine anomalies, parental chromosomal abnormalities and uncontrolled endocrine disorders were exclusion criteria. The prevalence of positive ANA titers and the impact of ANA positivity on the outcome of a subsequent pregnancy were investigated with EPL rate as the main outcome parameter and biochemical pregnancy rate, clinical miscarriage rate and live birth rate as secondary outcome measures. Main results and the role of chance Positive ANA screening at a titer of ≥ 1/80 was observed in 125/940 women (13.0%), a prevalence in line with previously published data in the general population not experiencing REPL. There were no statistically significant differences in maternal age, body mass index, ethnicity, or conception method between ANA-positive and -negative women. No higher number of previous EPLs was observed in ANA-positive compared to ANA-negative women (respectively 2.7 versus 2.8, p = 0.06). Women with ANAs had significantly more thyroid antibodies (21.6% versus 10.2%, p < 0.001). For a subsequent pregnancy, no association was observed between ANA positivity and reproductive outcome with an unadjusted EPL rate of 30/86 (34.9%, ANA-positive) versus 206/509 (40.5%, ANA-negative, p = 0.32). Logistic regression analysis did not identify ANAs as an independent predictive risk factor for additional EPL (OR 0.73, 95%CI 0.45-1.20, p = 0.22). Similarly, there was no significant difference in live birth rates between both groups (p = 0.5), with 54/86 (62.8%) in ANA-positive and 300/509 (58.9%) in ANA-negative patients. Limitations, reasons for caution The current data are limited by the absence of a formal control group without REPL, the retrospective nature of the study and potential bias due to unmeasured confounders. Wider implications of the findings These findings further questions systematic ANA measurement in the diagnostic work-up of REPL without AD. Furthermore, when ANAs are detected, patient counselling and treatment adaptations should be considered with caution, given our inability to eventually detect any significant differences in the pregnancy outcomes between ANA-positive and -negative REPL patients. Trial registration number not applicable

P-695 Optimizing oocyte donor stimulation: A revelation from 2,666 cases emphasizing the sole efficacy of exogenous FSH

Abstract Study question Does the administration of human menopausal gonadotrophin in controlled ovarian stimulation improve clinical outcomes in the oocyte donation program? Summary answer The addition of hMG (human menopausal gonadotropin) reduces the number of retrieved oocytes without improving embryo development or clinical outcomes in oocyte donation program. What is known already In controlled ovarian stimulation for assisted reproduction treatments, follicle stimulating hormone(FSH) is essential, but the importance of LH supplementation from menopausal origin is controversial. It is a common practice to use hMG to provide the LH effect. The standard preparation contains FSH and LH effects in a 1:1 ratio.The FSH component would recruit ovarian follicles and stimulate their growth, while the LH component would facilitate their maturation. Our aim was to compare the outcomes of intracytoplasmic sperm injection (ICSI) treatments using a gonadotropin-releasing hormone GnRH) antagonist protocol with recombinant FSH(FSHr) alone and supplemented with hMG in the oocyte donation program. Study design, size, duration This is a retrospective cohort study of 2,666 patients enrolled in the oocyte donation program at a single center over four consecutive years. Donor stimulation commenced with daily FSHr injections. The FSHr group (n = 2,078) continued FSHr, while the FSHr+hMG group (n = 588) received hMG. Participants/materials, setting, methods Donors received GnRH agonist via i.m. injection until a mean diameter >18 mm in at least eight follicles. Transvaginal oocyte retrieval was scheduled 36h later, followed by ICSI for all retrieved oocytes. Embryos were cultured in time-lapse systems and evaluated using an artificial intelligence-based model (iDAScore v2). Recipients underwent hormone replacement therapy for endometrial preparation. Our comparative study examined oocytes retrieved, embryo score, implantation, and live birth outcomes in fresh and frozen embryo transfers (ETs). Main results and the role of chance The number of retrieved oocytes was higher in the FSHr group than in the FSHr+hMG group: 24.9±10.6 vs. 18.2±8.8 (p < 0.001). In addition, embryos from the FSHr+hMG group exhibited slower early development, with significantly lower division times to two, three, four and five cells in the FSHr group (p < 0.005). However, late parameters of embryo development showed no differences. Automatic scoring by the deep learning algorithm was identical for blastocysts in the FSHr (4.8±2.8) and FSHr+hMG groups (4.8±2.8); p = 1. Implantation rates showed no significant differences for fresh ET (FSHr: 58.6% vs. FSHr+hMG: 61.9%; n = 2,073; p = 1) or frozen ET (FSHr: 49.3% vs. FSHr+hMG: 46%; n = 2,687; p = 1). Similarly, there were no differences in live birth rates for fresh ET (FSHr: 45.6% vs. FSHr+hMG: 50.3%; n = 1,993; p = 1) or frozen ET (FSHr: 31.8% vs. FSHr+hMG: 33.8%; n = 2,508; p = 1). Limitations, reasons for caution The retrospective and single-center nature of the study would be its main limitations. It is essential to emphasize that these results are only applicable within the oocyte donation program. Wider implications of the findings Based on our findings, the use of exogenous FSHr alone is likely adequate in the GnRH antagonist protocol for optimal ovarian stimulation of donors, leading to the production of high-quality embryos and successful clinical outcomes. Trial registration number Not Applicable

P-198 Time to maximum blastocyst expansion (tmBE) may represent a novel metric for assessing embryo competence

Abstract Study question Can the time to achieve maximum blastocyst expansion (tmBE) and the frequency of spontaneous collapses serve as useful indicators of embryo competence? Summary answer Compared to the frequency of spontaneous collapses, tmBE was a better indicator of embryo competence, potentially serving as a valuable metric for embryo selection. What is known already Identifying the most viable blastocyst for transfer is essential for success in assisted reproduction. In scenarios with good prognosis, such as oocyte donation, blastocyst selection may require a more nuanced approach, given the high number of available good quality embryos. Exploring indicators of embryo competence beyond traditional morphology-based criteria may be beneficial, however an in-depth understanding is still lacking. Blastocyst expansion and contraction dynamics have been suggested to play a role in developmental and chromosomal fitness. However, their predictive value has not been investigated across a wide range of patient populations. Study design, size, duration This is a single-center retrospective study of 287 blastocysts transferred in autologous (n = 88) and heterologous (n = 199) cycles, performed between September 2019 and September 2022. Only fresh single embryo transfers were considered. We compared blastocysts across two groups: advanced maternal age (AMA) patients (>35 years old, n = 88) and oocyte donors (<35 years old, n = 199). We evaluated well-established indicators of embryo quality, as well as novel metrics, including tmBE and the frequency of spontaneous collapses. Participants/materials, setting, methods Conventional indicators of embryo quality included blastocyst grade and morphokinetic timings (tPNf, t2, t3, t4, t5, t8, tSB and tB). tMBE was defined as the maximum time (hpi) required for the blastocyst to reach its largest diameter, extending beyond tB. Blastocyst contractions were measured as a decrease and subsequent recovery of the blastocoel area over time. ImageJ was employed for size measurements. p<0.05 was considered statistically significant after Two-tailed Student’s t-test or Chi-square test. Main results and the role of chance We observed a significant difference in live birth rates between oocyte donors and AMA patients (40% vs 18%, p=0.0004). Nevertheless, there were no differences across blastocyst expansion scores between oocyte donors and AMA patients (5= 58% vs 65%; 4= 38% vs 30% and 3= 4% vs 5%, p > 0.05), nor in their morphology score (Excellent= 57% vs 61%; Good= 24% vs 18%; Average= 15% vs 16% and Poor= 4% vs 5%). In terms of morphokinetics, when comparing oocyte donor and AMA embryos, the only significant difference was observed at tPNF (22.0±2.4 vs 22.6±2.3; p= 0.04). No differences were found at t2, t3, t4, t5, t8, tSB and tB. Additionally, the frequency of spontaneous collapses showed no significant differences between the oocyte donor and AMA group (1.4±1.2 vs 1.5±1.0, p=0.66). However, blastocysts from oocyte donors reached tmBE significantly faster than AMA embryos (115.0±4.8 vs 117.2±3.4; p = 0.0003). When these variables were further correlated to clinical outcomes, the frequency of spontaneous collapses did not appear to influence live birth in either group. Notably, however, tmBE was significantly shorter for embryos resulting in a live birth, across both the oocyte donor (113.5 vs 115.4, p = 0.04) and AMA group (115.6 vs 117.6, p = 0.04). Limitations, reasons for caution This is a single center retrospective study with a relatively small sample size, especially in the AMA group. Caution should be made when generalizing results to other patient populations, as confounding were not taken into consideration. No data on the chromosomal status of embryos was available. Wider implications of the findings Our results suggest that tMBE may serve as a reliable indicator of embryo potential, allowing a more nuanced embryo selection, particularly in cases with a high number of good quality embryos. This study opens avenues for further research into novel metrics for assessing embryo competence Trial registration number not applicable

O-291 Sonographic Symphony: a systematic review and network meta-analysis of the use of 2D, 3D, 4D ultrasound’s influence on embryo transfer outcomes

Abstract Study question To comprehensively evaluate and compare pregnancy and live birth rates following clinical touch, 2D, 3D or 4D ultrasound guided embryo transfer of a blastocyst. Summary answer The use of 3D and 4D ultrasound is not superior to 2D transabdominal ultrasound, but all forms of ultrasound are superior to clinical touch alone. What is known already While several factors contribute to the overall success of embryo transfer, the accurate placement of the embryo within the uterine cavity remains a critical determinant of implantation and subsequent pregnancy. While two-dimensional (2D) ultrasound provides basic imaging during embryo transfer, assisting with catheter placement, three-dimensional (3D) ultrasound adds volume and spatial information, aiding in assessing the endometrial cavity and embryo positioning. Meanwhile, four-dimensional (4D) ultrasound introduces real-time visualisation, offering dynamic insights into embryo movement and potential implantation. Although 2D remains a standard for most transfers, there is a growing interest in leveraging advanced imaging technologies to improve assisted reproductive outcomes. Study design, size, duration We searched bibliographical databases, including the Cochrane Central Register of Controlled Trials, EMBASE and Medline, from inception until August 2023. Randomised controlled trials that compared 2D transabdominal (2D TAUS), 2D transvaginal (2D TVUS), 3D and 4D ultrasound guided embryo transfer with one another or with clinical touch were included. The primary outcome was live birth rate (LBR), and the secondary outcome was clinical pregnancy rate (CPR) per transfer. Participants/materials, setting, methods Two reviewers independently screened selected studies and extracted the data. Pairwise and network meta-analyses (NMA) were conducted according to the technique used. Effect estimates were odds ratio (OR) with 95% confidence interval (CI) for each outcome respectively. Summary estimates were calculated using random-effects methods and quality assessment was performed using GRADE. Main results and the role of chance Twenty-eight trials, reporting data from 10,521 embryo transfer procedures, were included. Four different ultrasound modalities were evaluated: 2D transabdominal guided embryo transfer (2D TAUS) (21 trials), 2D transvaginal guided embryo transfer (2D TVUS) (four trials), 3D transabdominal guided embryo transfer (one trial) and 4D transabdominal guided embryo transfer (one trial). Compared to 2D TAUS, there was no difference in LBR in the network meta-analysis when using 2D TVUS (OR 1.14; 95% CI: 0.75-1.74), 3D ultrasound (OR 0.98; 95% CI: 0.49-1.97) or 4D ultrasound modality (OR 1.28; 95% CI: 0.56- 2.94). The use of clinical touch was associated with lower LBR (OR 0.71; 95% CI: 0.49-1.03). Compared to 2D TAUS, there was no difference in clinical pregnancy rate in the network meta-analysis when using 2D TVUS (OR 1.17; 95% CI: 0.86-1.58), 3D ultrasound (OR 0.97; 95% CI: 0.57-1.63) or 4D ultrasound modality (OR 1.30; 95% CI: 0.71- 2.38). The use of clinical touch was associated with lower CPR (OR 0.74; 95% CI: 0.64-0.85). Limitations, reasons for caution Variability in study designs, methodologies, and participant characteristics across primary studies can complicate the synthesis of results. There was only one study directly comparing 3D and 4D interventions which resulted in sparse data, affecting the precision and reliability of estimates. Wider implications of the findings Published evidence supports the continued use of 2D transabdominal ultrasound guided embryo transfer in routine clinical practice. There is insufficient evidence to support the introduction of 3D and 4D ultrasound when performing embryo transfers. Larger randomised controlled trials specifically assessing the superiority of these modalities are recommended. Trial registration number not applicable

O-163 The effect of ambient exposure to air pollutants on live birth rates in frozen embryo transfer cycles

Abstract Study question Do air pollutants during oocyte retrieval (OPU) and frozen embryo transfer (FET) affect in vitro fertilization (IVF) outcomes? Summary answer Environmental exposure to increased concentrations of CO either on oocyte retrieval or embryo transfer day negatively influences clinical outcomes in FET cycles. What is known already Exposure to air pollution is linked to adverse perinatal outcomes and reduced fecundity, yet its effect on fertility and IVF cycles is inconclusive. Previous studies explored associations between air pollutant concentrations and IVF outcomes with conflicting results. Nevertheless, few assessed different pollutants’ effects either on oocyte retrieval or embryo transfer days on live birth rates. While Asian and American studies suggest that pollutants affect pregnancy rates, from European studies failed to show meaningful differences in live birth rates. Considering varying pollutant levels globally, we aimed to evaluate their impact on a European population’s fertility outcomes. Study design, size, duration A retrospective cohort study analysed 1960 FET cycles conducted by a university affiliated fertility center in Europe between January 2017 to December 2022. Participants/materials, setting, methods Daily average ambient concentrations of five air pollutants (PM2.5, NO, SO2, CO, and O3) were obtained from an urban air quality monitoring station on the day of oocyte retrieval and the day of FET. Tertiles (T1, T2, T3) of each pollutant served as cut-off levels. Multiple logistic regression analysis assessed associations between pollutant exposure and pregnancy outcomes, adjusted for confounders. Main results and the role of chance Overall pregnancy and live birth rates following FET were 52.55% and 40.71%, respectively. When analysis the results according to air pollutants on the day of FET, ambient exposure to CO was significantly associated with up to 36% lower live birth (T2, OR: 0.64, 95% CI: 0.49—0.84; T3, OR: 0.67, 95% CI: 0.51—0.88; both compared to T1). Higher CO concentrations on the FET day were positively associated with increased miscarriage rates of up to 75% (T2, OR: 1.75, 95% CI: 1.12—2.75; T3, OR: 1.63, 95% CI: 1.04—2.56; both compared to T1). Limitations, reasons for caution The retrospective nature of the study and the omission of various potential covariates including environmental and patient factors that could affect IVF outcomes, limit our findings. Exposure assessment exclusively considered specific IVF days, and reliance on data from one air quality station reduces accuracy. Caution advised when interpreting the results. Wider implications of the findings This study highlights the potential impact of air quality on IVF cycle outcomes. Further investigations are needed to determine vulnerable IVF cycle phases and clarify mechanisms underlying fertility impairment. Trial registration number not applicable

In vitro fertilization and perinatal outcomes of patients with advanced maternal age after single frozen euploid embryo transfer: a propensity score-matched analysis of autologous and donor cycles

ObjectiveTo evaluate in vitro fertilization (IVF) and perinatal outcomes of donor egg and autologous cycles in advanced reproductive-aged patients after undergoing single, frozen euploid embryo transfer (SET/FET). DesignA retrospective, multicenter cohort study. SettingUniversity-affiliated and private IVF centers. Patient(s)Patients between 39-46 years old undergoing IVF with intracytoplasmic sperm injection (ICSI) and preimplantation genetic testing for aneuploidy (PGT-A) using whole-chromosome sequencing with donor (n=278) or autologous (n=278) oocytes between October 2017 and October 2021. Intervention(s)SET/FET with donor or autologous euploid embryo Main outcome measure(s)The live birth rate after the first embryo transfer, calculated per embryo transfer. Secondary outcomes included implantation rate, ectopic pregnancy rate, miscarriage rate, and gestational age and birthweight at the time of delivery. Result(s)Patients using donor or autologous oocytes had a similar likelihood of implantation57.91% (51.87-63.78) versus 57.19% (51.15-63.09), p=0.93 and live birth rate 41.01% (95% CI:35.17-47.04) versus 42.45% (95% CI:36.56-48.49), p=0.86. Furthermore, there were no significant differences in ectopic pregnancy rate [0.72% (0.09-2.57) versus 0.36% (0.01-1.99), p=1] or miscarriage rate [16.19% (12.06-21.05) versus 14.39% (95% CI:10.48-19.08), p=0.98], gestational age [38.50 weeks (38.08-38.92) versus 39.16 weeks (38.25-40.07), p=0.19], or birthweight of infants [2982.25 kg (2606.69-3357.81) versus 3128.24 kg (2962.30-3294.17), p=0.95]. The univariate analysis showed no association of advanced maternal age on the live birth rate [risk relative (RR) 1.03 (IC95%: 0.84-1.25); p=0.79]. Multivariate analysis using putative confounders for embryo competency found no associations with live birth rate [adjusted risk relative (aRR) 1.22 (IC95%: 0.75-1.98); p=0.42] Conclusion(s)Patients with euploid blastocysts derived from donor or autologous oocytes did not reveal statistically significant differences in live birth rate, implantation rate, ectopic pregnancy rate, miscarriage rate, duration of gestation, or infant birthweight. These findings suggest that age-related reproductive decline and/or poor IVF outcomes associated with advanced reproductive-aged women undergoing IVF are heavily driven by embryonic aneuploidy.

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.

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.

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.