In Vitro Fertilization-embryo Transfer Research Articles

Predictive value of C-reactive protein level and pregnancy rate in intracytoplasmic sperm injection cycle

Objective The aim was to determine the possible relation between the maternal serum C-reactive protein (CRP) level and outcome of controlled ovarian stimulation and pregnancy rate in patients undergoing in-vitro fertilization (IVF) or intracytoplasmic sperm injection. Background Controlled ovarian hyperstimulation is apparently a key factor in the success of IVF embryo transfer. CRP is a sensitive marker in the inflammatory process rises following hormonal stimulation and does not have diurnal alterations but administration of exogenous estrogen increases its level. Materials and methods This prospective cohort study was conducted at the outpatient clinic in a Private Infertility Unit, Menoufia, Egypt, from November 2018 to August 2019. This study included 100 infertile patients who were candidates for IVF/intracytoplasmic sperm injection and fulfilled the inclusion and exclusion criteria. Full history was taken. Participants underwent CRP measuring at three times, at the day of beginning of ovarian stimulation, ovum pickup, and the day of transfer. Two groups were identified for those who get pregnant and those who did not get pregnant. Results Patients whose CRP level decreased on transfer day (19 cases) 14 got pregnant (73.7%), whereas only five failed to get pregnant (26.3%). Patients whose CRP level increased on transfer day (81 cases) 52 got pregnant (64%), whereas 29 failed to get pregnant (36%). Conclusion Ovulation induction is an inflammatory process leading to increased levels of CRP but with different patterns. These patterns of changes failed to be used as markers of successful outcome of IVF treatment.

A comparison of in vitro fertilization-embryo transfer outcome by two types of soft embryo transfer catheters

Introduction: One of the remaining challenges in assisted reproductive procedures, especially in vitro fertilization (IVF), is proper embryo transfer. The aim of this clinical trial was to compare IVFembryo transfer outcome by two types of soft embryo transfer catheters in Hamadan Endometrics and Endometriosis Research Center (Iran).
 Methods: In this clinical trial study, 100 patients who were candidates for IVF were evaluated. Patients were randomly assigned into two groups (A=50 and B=50). The IVF was identical for both groups until the embryo transfer stage. For group A, soft catheter CH3 PM TRANS SET MINI was used and in group B, KITAZATO soft catheter was used for embryo transfer. All transfers were performed by one person. Patients were recruited using checklists, demographic information, infertility history, beta-human chorionic gonadotropin (ß-hCG) serum levels at day 14 post-transfer, and pregnancy bag 28 days after transfer. The results were analyzed by SPSS software version 16 and using descriptive statistics, chi-square and t-test. The significance level was < 0.05.
 Results: The mean age of group A and group B was 30.12 and 29.24 years, respectively (p=0.341). The mean duration of infertility in both groups was not statistically significant, and in groups A and B were 4.89 and 4 years, respectively. Ninety % of group A experienced their first IVF experience, while in group B it was slightly lower than 86%, which was not statistically significant. The mean number of eggs obtained in group A was 9.84 and in the group B was 9.88 (p=0.962). The mean number of embryos formed in group A was 6.24 and in group B was 5.72 (p=0.405). There was no statistically significant difference between the two groups in using of Tenaculum, the quality of transmission, and the contamination of the catheter head into the blood or mucus.
 Conclusion: According to the findings of the present study, the use of KITAZATO catheter compared to PM TRANS SET MINI CH3 catheter for fetal transfer in IVF patients showed no significant difference in pregnancy success rate. However, patients who received the KITAZATO catheter had a slightly higher chance of pregnancy that could be clinically valuable.

The risk of twin pregnancies should be minimized in patients with a unicornuate uterus undergoing IVF-ET

Unicornuate uteri are associated with infertility, miscarriage, preterm delivery and even uterine rupture. The aim of this research was to investigate the effects of unicornuate uterine anomaly on twin pregnancies after in vitro fertilization-embryo transfer (IVF-ET). A total of 206 women with unicornuate uteri (A singleton, B selective reduction (SR) of twins to a singleton, C twins) and 314 women with normal uteri (D SR of twins to a singleton, E twins) who delivered at ≥22 weeks were included. C was associated with a significantly lower live birth rate (adjusted odds ratio (aOR) 0.08, 95% confidence interval (CI), 0.01–0.69) and higher risks of preterm delivery (aOR 11.63, 95% CI, 4.85–27.92), perinatal mortality (aOR 11.43, 95% CI, 1.44–90.57) and low birth weight (aOR 5.92, 95% CI 1.94–18.06) than A, a 15-fold greater risk of preterm delivery (aOR 15.54, 95% CI 3.09–78.28) than B and a greater risk of preterm delivery (aOR 2.76, 95% CI 1.33–5.73) than E. After SR to a singleton, the perinatal outcomes were statistically similar between B and D. These results showed that the risk of twin pregnancies should be minimized in patients with unicornuate uterine anomaly undergoing IVF-ET.

The Impact of Assisted Reproductive Technology in Twin Pregnancies Complicated by Intrahepatic Cholestasis of Pregnancy: a Retrospective Cohort Study.

Our study aims to evaluate the perinatal outcomes in twin pregnancies diagnosed with intrahepatic cholestasis of pregnancy (ICP) and to compare these with normal healthy twin pregnancies for perinatal outcomes. The second outcome of the study was to determine whether in vitro fertilization-embryo transfer (IVF-ET) affects the perinatal outcome in ICP patients. In this study, 59 ICP and 641 healthy twin pregnancies were compared for perinatal outcomes retrospectively. According to the mode of conception, the twin pregnancies with ICP were divided into 2 groups. The twin pregnancies with ICP who were conceived with IVF were referred to as the IVF-ET group. The twin pregnancies with ICP who were conceived spontaneously or by ovulation induction and intrauterine insemination (IUI) were referred to as the non-IVF-ET group. Twin pregnancies with ICP give birth significantly earlier than normal twin pregnancies (p ˂ 0.001). The diagnosis of ICP occurred significantly earlier in the IVF-ET pregnancy with ICP than in the non-IVF-ET group. In twin pregnancies with IVF-ET, patients delivered significantly earlier than in the non-IVF-ET group (p=0.002). Twin pregnancies with ICP were found to have significantly higher rates of meconium-stained amniotic fluid, postnatal intubation, and admission to the neonatal intensive care unit (NICU) than healthy twin pregnancies. ICP is a risk factor for preterm delivery in twin pregnancies. In addition, ICP develops earlier and more frequently in twin pregnancies from IVF-ET than in those from non-IVF twin pregnancies, and the disease may be more serious.

Pregnancy outcomes of dichorionic triamniotic triplet pregnancies after in vitro fertilization-embryo transfer: multifoetal pregnancy reduction versus expectant management

BackgroundTrichorionic triplet pregnancy reduction to twin pregnancy is associated with a lower risk of preterm delivery but not with a lower risk of miscarriage. However, data on dichorionic triamniotic (DCTA) triplet pregnancy outcomes are lacking. This study aimed to compare the pregnancy outcomes of DCTA triplets conceived via in vitro fertilization-embryo transfer (IVF-ET) managed expectantly or reduced to a monochorionic (MC) singleton or monochorionic diamniotic (MCDA) twins at 11–13+ 6 gestational weeks.MethodsTwo hundred ninety-eight patients with DCTA triplets conceived via IVF-ET between 2012 and 2016 were retrospectively analysed. DCTA triplets with three live foetuses were reduced to a MC singleton (group A) or MCDA twins (group B) or underwent expectant management (group C). Each multifoetal pregnancy reduction (MFPR) was performed at 11–13+ 6 gestational weeks. Pregnancy outcomes in the 3 groups were compared.ResultsEighty-four DCTA pregnancies were reduced to MC singleton pregnancies, 149 were reduced to MCDA pregnancies, and 65 were managed expectantly.There were no significant differences among groups A, B, and C in miscarriage rate (8.3 vs. 7.4 vs. 10.8%, respectively) and live birth rate (90.5 vs. 85.2 vs. 83.1%, respectively) (P > 0.05).Group A had significantly lower rates of preterm birth (8.3 vs. 84.6%; odds ratio (OR) 0.017, 95% confidence interval (CI) 0.006–0.046) and low birth weight (LBW; 9.2 vs. 93.2%; OR 0.007, 95% CI 0.003–0.020) than group C (P < 0.001).Group B had significantly lower preterm birth (47.0 vs. 84.6%; OR 0.161, 95% CI 0.076–0.340) and LBW rates (58.7 vs. 93.2%; OR 0.103, 95% CI 0.053–0.200) than group C (P < 0.001).Group A had significantly lower preterm birth (8.3 vs. 47.0%; OR 0.103, 95% CI 0.044–0.237; P < 0.001), LBW (9.2 vs. 58.7%; OR 0.071, 95% CI 0.032–0.162; P < 0.001) and perinatal death rates (1.3 vs. 9.1%; OR 0.132, 95% CI 0.018–0.991; P = 0.021) than group B.ConclusionThe MFPR of DCTA triplets to singleton or MCDA pregnancies was associated with better pregnancy outcomes compared to expectant management. DCTA triplets reduced to singleton pregnancies had better perinatal outcomes than DCTA triplets reduced to MCDA pregnancies.

Outcomes of in vitro fertilization–embryo transfer in women with diminished ovarian reserve after growth hormone pretreatment

The study was to evaluate the in vitro fertilization–embryo transfer (IVF-ET) outcomes in women with diminished ovarian reserve (DOR) after pretreatment with growth hormone (GH). Retrospective propensity score matching study, which included 92 women received GH over 4 weeks pretreatment before their subsequent IVF cycles and 92 matched controls who underwent IVF cycles between July 2017 and August 2018. The evaluation parameters included ovarian response, embryological parameters, and pregnancy outcomes after embryo transfer (ET). The mean number of retrieved oocytes and transferable day-3 embryos were significantly higher after GH pretreatment. The implantation rate, clinical pregnancy rate, and ongoing pregnancy rate per fresh ET cycle were similar between the GH group and control group. In women who either achieved pregnancy or utilized all the embryos resulting from the index stimulation cycle, the cumulative clinical pregnancy rate was significantly higher in women with GH compared to the control group. 4 weeks pretreatment with GH could increase ovarian response to stimulation and then improved IVF-ET outcomes in women with DOR.

Three patients with 46,X,inv(Y)(p11.2q11.2)pat/45,X and their pedigree analysis.

The present study aimed to perform chromosome examination and pedigree analysis on three patients with semen abnormality who had undergone in vitro fertilization–embryo transfer (IVF‐ET). Peripheral blood cell culture and chromosome karyotyping were performed on 4,200 individuals who had undergone chromosome examination. Among them, 155 pregnant women who had successfully conceived were subjected to amniotic cell culture and chromosome karyotyping and those with abnormal chromosome karyotype were further subjected to C‐banding and whole‐genome sequencing. Mosaicism for a 46,X,inv(Y)(p11.2q11.2)pat/45,X karyotype was identified in the probands and immediate adult male relatives. The incidence of this mosaicism in the study population was only 0.07% (3/4,200), which is reported for the first time. For the proband of pedigree A, the results of whole‐genome sequencing and other tests were normal, and the chromosome karyotype of IVF fetuses was 46,X,inv(Y)(p11.2q11.2)pat. All the male members of three pedigrees have normal phenotypes, with no features of Turner's syndrome (45,X) or hermaphroditism (45,X/46,XY), suggesting that the inverted Y chromosome is extremely unstable and particularly susceptible to loss in somatic cells. So we speculate this karyotype may be a unique type of inverted Y chromosome in somatic cells.

The effectiveness of different down-regulating protocols on in vitro fertilization-embryo transfer in endometriosis: a meta-analysis

BackgroundTo investigate the effectiveness of the GnRH-a ultra-long protocol, GnRH-a long protocol, and GnRH-a short protocol used in in vitro fertilization-embryo transfer (IVF-ET) in infertile women with endometriosis.MethodsWe searched PubMed, Embase, Web of Science, Cochrane Library, Elsevier Science Direct, OA Library, Google Scholar, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, China Science and Technology Journal database, and the China Biology Medicine disc for randomized controlled trials (RCTs) and observational studies (non-RCTs) to evaluate the efficacy of the GnRH-a ultra-long protocol, GnRH-a long protocol, and GnRH-a short protocol in IVF-ET in infertile patients with endometriosis.ResultsA total of 21 studies in compliance with the standard literature were included, and RCT and non-RCT studies were analyzed separately. This meta-analysis showed that the GnRH-a ultra-long protocol could improve the clinical pregnancy rate of infertile patients in RCT studies, especially in patients with stages III–IV endometriosis (RR = 2.04, 95% CI: 1.37~3.04, P < 0.05). However, subgroup analysis found the different down-regulation protocols provided no significant difference in improving clinical outcomes in patients with endometriosis in the non-RCT studies.ConclusionThis study suggests that the GnRH-a ultra-long protocol can improve the clinical pregnancy rate of the patients with stages III–IV endometriosis in RCT studies. Although it is generally believed that the results of RCT are more reliable, the conclusions of the non-RCT studies cannot be easily neglect, which let us draw conclusions more cautious.

Live birth rate comparison of three controlled ovarian stimulation protocols for in vitro fertilization-embryo transfer in patients with diminished ovarian reserve after endometrioma cystectomy: a retrospective study

BackgroundWomen with endometriosis and previous cystectomy may respond less well to gonadotropin stimulation, which results in fewer oocytes retrieved and poor pregnancy outcomes. Choosing an appropriate protocol for such populations is essential. This study involved an analysis of the effect of different controlled ovarian stimulation (COS) protocols on the clinical outcomes of in vitro fertilization-embryo transfer (IVF-ET) in women with diminished ovarian reserve (DOR) who underwent ovarian endometrioma cystectomy.MethodsA total of 342 patients that underwent IVF-ET treatment at the Beijing Obstetrics and Gynecology Hospital from January 1, 2013 to April 30, 2018 were included in this retrospective study. The patients were distributed into three groups according to the COS protocols, namely prolonged GnRH-agonist (Group A, n = 113), GnRH-antagonist (Group B, n = 121), and long GnRH-agonist (Group C, n = 108). The clinical and laboratory parameters of the three protocols were analyzed and a logistic regression of clinical pregnancy and live births was conducted.ResultsThere were no significant differences in the age, infertility duration, basic follicle stimulation hormone (FSH), luteinizing hormone (LH), or estradiol (E2) levels as well as other baseline characteristics among groups (P > 0.05). The total gonadotrophin (Gn) dosage and duration tended to be less in the GnRH-antagonist group than in the others (P < 0.05). No significant differences were found in the implantation rate and clinical pregnancy rate among the groups, but the prolonged GnRH-agonist group showed the highest rates. In addition, no significant differences were present in the number of retrieved oocytes, oocyte fertilization rate, embryo utilization rate, live birth rate, abortion rate, ectopic pregnancy rate, or multiple pregnancy rate in the three groups (P > 0.05). Age had a significant effect on both clinical pregnancy and live birth.ConclusionFor those DOR patients who had undergone ovarian endometriosis cystectomy, the prolonged GnRH-agonist protocol may achieve better clinical IVF-ET outcomes, but there were no significant differences from the other groups. The GnRH-antagonist protocol may reduce the cost and time of drug treatment. Age should be considered for its influence on pregnancy outcome. However, a larger sample size may be needed for further study.

The Surgical Benefit of Hysterolaparoscopy in Endometriosis-Related Infertility: A Single Centre Retrospective Study with a Minimum 2-Year Follow-Up.

Aim: This study examined the fertility performance of women after combined hysterolaparoscopic surgical management of endometriosis. Design: This study is a hospital-based retrospective review. Materials and Methods: Data collected from the records of all patients presented with endometriosis-related infertility using a checklist designed for the purpose. Result: A total of 81.3% (370/455) of women who have had the desire to have children became pregnant during the study period after the surgery. Of those who became pregnant, all three-hundred-forty-seven patients were followed to the end of their pregnancies. A successful live birth occurred in 94.2% (327/347) of individuals, and pregnancy loss occurred in 5.8% (20/347). The mean patient age was 34.1 ± 4.1 years, and the average duration of infertility was 3.4 ± 3.3 years. Pregnancy occurred spontaneously in 39.5% (146/370) of patients, after artificial insemination (AIH) in 3.8% (14/370) of women, and after in vitro fertilization-embryo transfer (IVF-ET) in 56.8% (210/370) of cases. Patients aged ≤ 35 years had a higher chance of conception post-surgery—84% versus 77%, respectively (p = 0.039). Based on the modes of pregnancy, the timely introduction of an assisted reproductive technique (ART) demonstrated a significant effect on fertility performance postsurgery. Comparatively, this effect was 91.3% vs. 74.1% among the ≤35- and >35-year-old age groups, respectively. There was no significant difference in reproductive performance based on stages of endometriosis, nor in the other parameters evaluated. Conclusion: Our data are consistent with previous clinical studies regarding the management options of endometriosis-related infertility. Overall, the combined hysterolaparoscopy treatment is a very effective and reliable procedure, and is even more effective when combined with ART. It enhances women’s wellbeing and quality of life, and significantly improves reproductive performance.

Effect of wheat-grain moxibustion at Yinbai (SP 1) on the menstrual period prolongation after IVF-ET down-regulation treatment

To compare the clinical effect between wheat-grain moxibustion at Yinbai (SP 1) and oral administration of dydrogesterone tablet for menstrual period prolongation after down-regulation treatment of in vitro fertilization embryo transfer (IVF-ET). A total of 54 patients with prolonged menstrual period after down-regulation treatment of IVF-ET were randomly divided into an observation group and a control group, 27 cases in each one. In the observation group, when the menstrual period delayed more than 7 days, the wheat-grain moxibustion at Yinbai (SP 1) was performed, once a day, with an interval of 1 day between two 3-day treatments; when the menstrual blood was cleaned, the ovulation was continued and the eggs were taken. In the control group, when the menstrual period delayed more than 7 days, the oral administration of dydrogesterone tablet was provided, 10 mg each time, twice a day; when the menstrual blood was cleaned, the ovulation was continued and the eggs were taken. The number of days for menstrual blood to be cleaned, the area change of uterine cavity hemorrhage, the morphology of endometrium, the blood supply of endometrium, the number of oocytes obtained, the grade of frozen embryo and the clinical effect were observed between the two groups after treatment. Compared with the control group, the number of days for menstrual blood to be cleaned was shorter in the observation group after treatment (P<0.05); the area of uterine cavity hemorrhage in the observation group was smaller than that in the control group (P<0.05); the morphology of endometrium and the supply of blood flow in the observation group were superior to those in the control group (P<0.05). However, there was no significant difference in the number of oocytes obtained and available frozen embryo between the two groups (P>0.05). The cured rate in the observation group was 100.0% (27/27), higher than 33.3% (9/27) in the control group (P<0.05). The wheat-grain moxibustion at Yinbai (SP 1) could more effectively treat prolonged menstrual period after IVF-ET down-regulation treatment, which is beneficial to the preparation of the endometrium, and has no effect on the oocyte collection and embryo culture.

Frequent and mild scrotal heat stress impairs embryo development, implantation and offspring sex ratio in mice.

Frequent and mild scrotal heat stress (fmSHS) often occurs in humans. The aim of this study was to determine the impact of fmSHS on natural fertility, the IVF-embryo transfer (IVF-ET) process and the offspring sex ratio. Male mice were randomly divided into four groups: no scrotal heat stress (SHS) (controls) and those subjected to SHS at 37°C, 39°C or 41°C for 30min once a week for 5 consecutive weeks. The testis, epididymis and sperm quality were assessed to evaluate the effects of different degrees of SHS, to establish an fmSHS model. Then, natural fertility, IVF-embryo transfer (IVF-ET) results, embryo development, offspring sex ratio and the X/Y chromosome-bearing sperm ratio were examined. SHS at 39°C and 41°C caused mild impairment to spermatozoa, leading to a phenotype similar to oligoasthenozoospermia in humans. Given that most SHS conditions in humans are close to body temperature, SHS of 39°C was adopted to build the fmSHS model. fmSHS reduced the fertilization rate, impaired on-time development and reduced the implantation rate of the embryos in the IVF-ET process, but it did not affect the development or function of blastocysts. The fmSHS mice produced more Y chromosome-bearing spermatozoa and propagated more male offspring. fmSHS not only reduced the fertilization ability of spermatozoa but also influenced their function beyond fertilization, in addition to changing the offspring sex ratio. These results may help to shed new light on the infertility treatment of males with scrotal heat risk and the health concerns of offspring propagated from these fathers.

Up-regulation of miR-145 may contribute to repeated implantation failure after IVF-embryo transfer by targeting PAI-1.

Repeated implantation failure (RIF) is a major limiting factor in assisted reproductive technology. As miR-145 (also known as MIR145) is up-regulated in patients with RIF, this study asked, what is the molecular mechanism underlying the affect of miR-145 on embryo implantation in RIF? Ishikawa cells were infected with lentivirus containing miR-145 and miR-145 NC. Massive transcriptome data analyses and bioinformatics analysis were used to search for a potential candidate target of miR-145. The expression of the potential candidate target was detected using quantitative reverse transcription PCR (qRT-PCR) and western blotting in the Ishikawa cells infected with lentivirus containing miR-145 or miR-145 NC. Subsequently, a dual luciferase reporter assay was performed to verify whether the potential candidate target was a novel direct target of miR-145. In addition, expression of PAI-1 (plasminogen activator inhibitor 1, also known as SERPINE1) in endometrial tissue from women with RIF and in control endometrial tissue was examined using qRT-PCR and immunohistochemistry. Based on massive transcriptome data analyses and bioinformatics analysis, PAI-1 was regarded as a potential candidate target of miR-145. miR-145 overexpression was achieved in Ishikawa cells. PAI-1 was confirmed as a direct target of miR-145 by bioinformatic analysis, qRT-PCR, western blotting and dual luciferase reporter assay. Further, results from the clinical sample indicated that at both the mRNA and protein levels, PAI-1 expression was down-regulated in endometrial tissues from women with RIF compared with control group women, and this was negatively related to miR-145 expression. The study results suggests that miR-145 may target and down-regulate PAI-1 expression and influence embryo implantation in women with RIF who are undergoing IVF.

Psychology and adaptation of couples during in vitro fertilization-embryo transfer: a qualitative study

Objective To understand the psychology and inter-adaptation of patients with in vitro fertilization-embryo transfer (IVF-ET) and their spouses. Methods From August to November 2017, this study selected 13 females with IVF-ET and 13 spouses in Reproduction Center of a ClassⅢ Grade A hospital in Anhui Province as subjects by purposive sampling. In-depth semi-structured and individualized interview was carried out for those subjects with the phenomenology study of qualitative research. Colaizzi 7-step analysis was used to sort out and analyze interview data. Results Psychological pressure was common in patients with IVF-ET and their spouses and interacted with each other. Totals of four themes were extracted separately, in patients: (1) being worried about IVF-ET and marital status; (2) bearing stress from family, social and themselves; (3) changes of life style and relationship between husband and wife; (4) coping with stress and adjustment mode solely; in spouses: (1) being worried about IVF-ET and physical condition of their wives; (2) bearing stress from family, work and economy; (3) changes of life style and relationship between husband and wife, (4) lack of coping with stress and adjustment mode. Conclusions We should pay attention to psychological pressure and interaction of IVF-ET patients and their spouses, influence of spouse support and coping style on psychology of IVF-ET patients. Take professional measures to improve the pregnancy outcome by providing targeted health guide and psychological intervention for couples. Key words: Infertility; Sterility; Fertilization in vitro-embryo transfer; Psychological pressure; Spouses; Qualitative research

Three-Dimensional Automated Volume Calculation (Sonography-Based Automated Volume Count) versus Two-Dimensional Manual Ultrasonography for Follicular Tracking and Oocyte Retrieval in Women Undergoing in vitro Fertilization-Embryo Transfer: A Randomized Controlled Trial.

Aim:To compare the oocyte yield using three-dimensional (3D) automated and two-dimensional (2D) ultrasound-based follicle tracking in women undergoing in vitro fertilization-embryo transfer (IVF-ET).Settings and Design:A randomized controlled trial was conducted in the Reproductive Medicine Unit of a teaching medical institute from January 2017 to December 2018.Materials and Methods:A total of 130 patients undergoing IVF-ET were enrolled and randomized into two groups (65 patients in each group). In Group A, follicular tracking during controlled ovarian stimulation (COS) was done using 3D Sonography- based Automated Volume Count (SonoAVC), whereas in Group B, follicular tracking was done by manual ultrasonography (2D USG). The primary outcome measures were the number of oocytes retrieved (the total number and the number of mature oocytes). Secondary outcomes were fertilization rate, cleavage rate, total number of embryos and time taken to perform scans. Other outcome measures were clinical pregnancy rate, miscarriage rate and live birth rate (LBR).Statistical Analysis Used:Chi-square test, Student's t-test, Z-test, Wilcoxon rank-sum test, Bland–Altman's plot.Results:The two groups were comparable with regard to assisted reproductive technology (ART) outcomes. Group B required more time for performing the scan (P < 0.01).Conclusion:Automated SonoAVC ultrasound can be used interchangeably with manual 2D USG for follicle tracking during COS giving comparable ART outcomes with the added advantage of saving time. Our study implies the promising results of applying artificial intelligence in follicular tracking during COS.

Management strategies of heterotopic pregnancy following in vitro fertilization-embryo transfer

ObjectiveThe purpose of this study was to evaluate the efficiency and safety of different treatment modalities for heterotopic pregnancy (HP) in vitro fertilization-embryo transfer (IVF-ET) cycles to avoid influence on intrauterine pregnancy (IUP). Materials and methodsCases of HP (n = 90) were from the IVF/ICSI registry database at the Reproductive Hospital Affiliated to Shandong University. An additional 360 women were randomly selected as controls. The primary outcome to examine the risk factors, diagnostic modalities and the impact of different treatment modalities for HP. ResultsOur results showed that surgical treatment had a certain effect on improving the live-birth rate, although the effect was not statistically significant (87.9% vs. 70.8%, P = 0.055). The risk factors for HP included previous tubal surgery and hydrosalpinx. Fourteen days after embryo transfer, the serum levels of β-human chorionic gonadotropin (β-hCG) and estradiol (E2) were lower in the HP group than in the IUP group (P < 0.05). Furthermore, age and endometrial thickness showed a significant difference between the early abortion and the live-birth groups of HP. ConclusionsIn our retrospective study, we supported early surgical laparoscopic intervention to minimize the incidence of abortion of IUP, which resulted in a better live-birth rate. A history of ectopic pregnancy and previous tubal surgery may increase the risk of HP. Low levels of serum β-hCG and E2 on the 14th day after embryo transfer could indicate the incidence of HP.

General Issues in Clinical Research of Acupuncture and In Vitro Fertilization.

In vitro fertilization-embryo transfer (IVF-ET), a well-developed technology, provides the last possibility or hope for infertile women. However, the live birth rate per IVF cycle is still not satisfactory. Acupuncture is a frequently used adjunctive therapy drawing wide attention on improvement of IVF. Although so many randomized controlled trials have been evaluating the effect of acupuncture on IVF in the past 20 years, the exact efficacy of acupuncture on IVF is still controversy mainly because of no consensus on placebo control and acupuncture scheme. This paper focused on the general issues in clinical research of acupuncture and IVF and gave some suggestions for future directions.

Chromosome abnormality rate and related factors of spontaneous abortion in early pregnancy

Objective: To investigate chromosome abnormality rate and related factors of spontaneous abortion in early pregnancy. Methods: A total of 831 tissue samples of spontaneous abortion in early pregnancy were collected from June 2015 to August 2018 in the First Affiliated Hospital of Nanjing Medical University. Chromosomal copy number was analyzed by next generation sequencing (NGS). The relationships between chromosome abnormality and maternal age, in vitro fertilization-embryo transfer (IVF-ET) pregnancy, number of previous spontaneous abortions, history of live birth were analyzed by statistical methods. Results: Among 831 tissue samples of spontaneous abortion in early pregnancy, 461 (55.5%, 461/831) were found to have chromosome abnormalities. Maternal age (OR=1.107, 95%CI: 1.070- 1.145) and history of live birth (OR=1.909, 95%CI: 1.182-3.083) were the positive correlative factors of chromosome abnormality. Times of previous spontaneous abortion (OR=0.807, 95%CI: 0.702-0.928) and IVF-ET pregnancy (OR=0.554, 95%CI: 0.404-0.760) were the negative correlative factors of chromosome abnormality. Conclusions: Chromosome abnormality is an important cause of spontaneous abortion in early pregnancy. The rate of chromosome abnormality increases with the increase of maternal age and the history of live birth, and decreases with the increase of number of previous spontaneous abortion and IVF-ET pregnancy.

Prediction of clinical outcomes of patients with surplus cleavage-stage embryos for blastocyst culture after D3 embryo transfer

Objective: To find the best strategy of embryo transfer, so as to provide theoretical basis for improving the clinical outcomes of in vitro fertilization-Embryo transfer (IVF-ET), we investigate the blastocyst culture of surplus cleavage-stage embryos after D3 embryo transfer and the prediction of clinical outcomes with or without blastocyst formation. Methods: A retrospective study was conducted on 3 568 patients who underwent IVF-ET in the Reproductive Medicine Center of the First Affiliated Hospital of Zhengzhou University from January 2016 to May 2018, whotransplanted two embryos in D3 with blastocyst culture of surplus cleavage-stage embryos, according to their age, they were divided into three groups: <35 years old group, 35-38 years old group, and>38 years old group.And according to the presence or absence of blastocyst formation, they were also divided into two subgroups: blastocyst formation group and non-blastocyst formation group. The embryo development and clinical outcomes in each group were compared. Results: (1) Comparisons of the embryo development in the three age groups with the first cycle. The total fertilization rate, cleavage rate and high quality embryo rate of the blastocyst formation group in the three groups were higher than those in the non-blastocyst formation group, P<0.05; In<35 years old group, the embryo utilization rate (75.0% vs 70.6%), pregnancy rate (74.9% vs 70.3%), planting rate (53.6% vs 48.6%), delivery rate (66.7% vs 61.1%) and live birth rate (66.5% vs 61.0%) of the blastocyst formation group were higher than those in the non-blastocyst formation group, P<0.05. (2) Comparisons of embryo development in the three age groups with multiple cycles (≥2 cycles). In<35 years old group, the total fertilization rate (75.0% vs 70.6%),delivery rate (62.7% vs 43.8%) and live birth rate (62.7% vs 43.8%) of the blastocyst formation group were significantly higher than those in the non-blastocyst formation group, P<0.05; In>38 years old group, the pregnancy rate (56.3% vs 25.8%), implantation rate (34.4% vs 14.5%), delivery rate (43.8% vs 11.3%), live birth rate (43.8% vs 11.3%) of the blastocyst formation group were higher than those in the non-blastocyst formation group, P<0.05. Conclusions: The results of blastocyst culture in different groups can predict the outcomes of embryo transfer in D3. For patients<35 years old with the first cycle, the clinical outcomes of the blastocyst formation group after D3 embryo transfer is better than that of the non-blastocyst formation group. For Patients with multiple cycles (≥2 cycles),the clinical outcomes of the embryo formation group is superior to that of the non-blastocyst formation group<35 years old or>38 years old.

51 Bovine embryos with distinct early morphokinetic pathways present different post-embryonic genome activation transcriptomic patterns and different cryotolerance

We recently developed and validated a methodology based on early morphokinetics to predict 6 categories of bovine embryos, including 4 categories of blastocysts: early hatching blastocysts (EHB), hatching blastocysts (HB), low hatching blastocysts (LHB), and arrhythmic blastocysts (AB) (Reis et al. 2018 Anim. Reprod. 15, 601). We hypothesised that different early morphokinetic pathways could (1) be accompanied by different biological patterns (EGA, etc.) and (2) influence interaction with environmental constraints (cryopreservation, etc.). The objective of this study was (1) to investigate whether transcriptomic differences between the predicted EHB, HB, LHB, or AB could be observed immediately after the fourth embryonic cycle (just after EGA); (2) to assess cryotolerance of these morphokinetic categories. Time lapses were produced during 4 days post invitro insemination (dpi) (Reis et al. 2018). Study 1: 128 embryos having finished the fourth embryonic cycle were individually dry frozen at 4.7 dpi, classified as EHB, HB, LHB, or AB, and pooled into four batches of eight embryos/category (total 16 samples). Total RNA was extracted, amplified using the SMARTseq V4 ultralow input kit (Clontech), libraries were prepared using the Nextera XT Illumina library preparation kit, and sequenced (paired-end 50-34bp) on an Illumina NextSEqn 500 instrument. Identification of differentially expressed genes was achieved using Limma package (R). The P-values were adjusted using the Benjamini and Hochberg false discovery rate (Saenz-de-Juano et al. 2014). Fold change &amp;gt;2 or &amp;lt;0.5 and adjusted P&amp;lt;0.05 were considered significant. Enrichment analysis was performed using the Web server enrichR. Study 2: 90 embryos showing signs of expansion (diameter &amp;gt;135µm and −2µm at zona pellucida) were slow frozen at 6.2 or 7 dpi, classified as EHB (n=8), HB (n=29), LHB (n=32), or AB (n=21), and further thawed and cultured invitro for 72h. Cryotolerance was evaluated at 24 and 72h post-thawing. Statistical analysis was performed using chi-square or Fisher test. Study 1: the AB category presented 258, 699, and 899 upregulated genes and 40, 62, and 60 downregulated in comparison to LHB, HB, and EHB, respectively. The functional comparison of the two extremes (EHB vs. AB), at 4.7 dpi, showed that AB embryos present intense transcription regulation activity. The monocarboxylic acid binding pathway was upregulated in EHB. Study 2: the post-thawing invitro survival was similar between EHB, HB, LHB, and AB (50%, 34.5%, 31.3%, and 42.9%, respectively). The hatching/alive ratio in EHB category tended to be lower than AB (1/4 vs. 8/9; P=0.052). Frozen/thawed EHB and HB presented reduced hatching rates, whereas LHB and AB significantly increased the hatching potential after thawing compared with their not-frozen counterparts of the learning database (25% vs. 100%; 50% vs. 100%; 70% vs. 11%; 88.9% vs. 18%, respectively). Morphokinetic prediction highlighted a new classification of bovine embryos with different biological features. This could contribute to improve practice on IVF embryo transfer taking into account these differences.