Embryo Transfer Procedures Research Articles

P-522 Embryo transfer procedural parameters do not predict IVF cycle outcome

Abstract Study question Do embryo transfer (ET) procedural parameters affect the clinical outcome, in terms of positive human chorionic gonadotropin (hCG), clinical pregnancy and live-birth? Summary answer Observation of ET procedural parameters, either as single parameters or combined in a model, does not seem to have a predictive value on cycle outcome. What is known already It has been reported that several ET procedural parameters of technical nature may influence IVF outcome. Observational studies on variables during and post ET from mucus presence to catheter reload, have been published and data hitherto is conflicting leaving practitioners confounded. It is essential to evaluate the effect of the reported ET performance parameters, clarifying the degree of effect on a singular or combinatorial level. This will assist practitioners in recording and analysing strictly factors that hold high-significance predictive value, instead of redundantly recording moot parameters that may be unfit to serve as key performance indicators post ET. Study design, size, duration A prospective observational study was performed between 3/2018 and 9/2022 in a single IVF center. ET procedures for a total of 1417 women were assessed. The performance parameters studied and associated with clinical outcomes were the following: time of ET, presence of cervical mucus in the catheter, presence of blood, catheter reload, employment of tenaculum and stylet, resistance during transfer, ease of transfer according to the practitioner and discomfort as experienced by the patient. Participants/materials, setting, methods Only women of normal endometrial and uterine anatomy and function were included. Genetic and endocrine abnormalities, azoospermia and PGT cycles were excluded. Embryo grading was performed according to Veeck’s and Gardner’s system depending on developmental stage. All ETs were performed employing the same type of soft catheter. The clinical outcomes evaluated were positive hCG, clinical pregnancy, and live-birth. Associations were evaluated on a singular or combinatorial level between the ET performance parameters and clinical outcomes. Main results and the role of chance A univariate logistic regression was employed to evaluate the possible effect of each of the ET procedural parameters. None of the ET parameters presented with statistical significance. The employment of ultrasound, the number, and the quality of transferred embryos, maternal age as well as the physician and embryologist performing the transfer were evaluated as covariates in a univariate regression model. Number (p = 0.01) and quality of transferred embryos (p = 0.003), as well as maternal age (p = 0.004) presented with statistical significance. The multivariate approach yielded similar results. To evaluate the possibility that interactions between the ET procedural parameters could affect cycle outcome a model was created evaluating all possible interactions and combination of the ET parameters. To adjust for possible multiple comparison bias, the Bonferroni correction was employed. Only the presence of mucus along with significant resistance seemed to present with statistical significance (p < 0.0001). However, when adjusting for the covariates the combination of cervical mucus and significant resistance did not provide a statistically significant effect on clinical outcomes and thus cannot be considered as an independent predictor. When subgrouping only for women below the age of 35 with at least one top quality embryo, no statistically significant association was observed. Limitations, reasons for caution The sample size could be a reason for caution when interpreting the results of the present study as a larger number of women presenting with each combination may be required to reach the threshold of statistical significance. The single-center nature of the study may present as another limitation. Wider implications of the findings Data indicates that ET procedural parameters hold no predictive value singularly or combinatorially. The only robust predictive factors are embryo quality, number, and maternal age. While further studies are required to cement this finding, it may be the case that the time-consuming recording and analysis of such parameters is redundant. Trial registration number Not applicable

P-501 Live birth rates (LBR) are not influenced by a change in embryo quality imposed by embryo cryopreservation and thawing in single euploid frozen embryo transfers.

Abstract Study question Is a change of embryo quality through vitrification and thawing associated with a reduced LBR when a single euploid frozen embryo transfer is performed? Summary answer Live birth rates are not influenced by a change in embryo quality through embryo cryopreservation and thawing in single euploid frozen embryo transfer. What is known already Embryo aneuploidy is the most significant single factor and accounts for about 50% of implantation failure and miscarriage in human reproduction. Preimplantation genetic test for aneuploidy (PGT-A) presents a mean to identify euploid embryos, thereby improving pregnancy rates and reducing early pregnancy losses. However, after PGT-A on trophectoderm cells at blastocyst stage, embryos have to be cryopreserved and warmed later for the embryo transfer procedure. Embryo quality is known to impact implantation and ongoing pregnancy rates, therefore, the aim of this analysis was to evaluate the impact of a change in embryo quality between pre-vitrification and post-thaw on the outcome. Study design, size, duration This retrospective observational study included a total of 611 pregnant patients after frozen-thawed euploid single embryo transfer (FET) at a tertiary IVF centre between April 2017 and December 2020. All embryos transferred were cryopreserved after trophectoderm biopsy for PGT-A, performed either on day 5 or day 6. Each patient was only included once into the analysis. Endometrial preparation for FET was performed either in a natural cycle (NC) or as a hormonal replacement cycle (HRT). Participants/materials, setting, methods Patients with infertility, undergoing ovarian stimulation and FET in either a HRT or a NC as endometrial preparation approach, and who achieved a pregnancy, were included. Embryos were morphologically graded pre-vitrification and post-thaw based on inner cell mass and trophectoderm morphology on the day of cryopreservation. Four groups were initially established (top, good, fair, poor), hence for the analysis, fair and poor qualities were combined. Main results and the role of chance A total of 591 patient were analysed after exclusion of 20 patients due to the occurrence of late miscarriage and ectopic pregnancy. Patients’ characteristics are as follows (mean±SD (min-max)): age 33.87±5.55(20-47) years; AMH 3.20±3.28ng/mL(0.01-35.72); BMI(body mass index) 26.61±4.86kg/m2(14.84-40.31) and AFC 14.00±7.33(1-35). The changes in the embryo quality pre-vitrification and post-thaw were categorized in “no change”, “improved” or “degraded”. All groups were compared to top-quality-no change group. A binary logistic analysis evaluated the following groups regarding their combined impact on LB: top quality-degraded (odds ratio (OR)0.702; 95% confidence interval (CI)0.302-1.635, p = 0.413); good quality-no change (OR 1.022; CI:0.457-2.287; p = 0.958); good quality-degraded (OR 0.787; CI:0.330-1.880; P = 0.590); good quality-improved (OR 0.301; 0.056-1.628; P = 0.163); fair+poor quality-no change(OR 0.521; 0.203-1.340; P = 0.176); fair+poor quality-degraded (OR 0.283; 0.056-1.438; P = 0.128) and fair+poor quality-improved (OR 1.917; 0.431-8.534; P = 0.393). No impact on the probability of LB was seen in any combined group of change in embryo quality with its pre-grades. Furthermore, no association was found for age, BMI, AMH, pre-vitrification and post-thaw quality. Embryos biopsied on day 6 instead day 5 had a decreased chance of a LB (OR 0.516; 0.305-0.875, p = 0.014). Further on, NC was associated with significantly higher chance of LB compared to HRT cycle (OR 2.629; 1.606-4.305, p = <0.001). Limitations, reasons for caution Limitation is the retrospective design of the study and the grading of the embryos, which might be subjective and bearing interobserver variability. Wider implications of the findings Whereas a change in the embryo quality does not impact the chance of LB after single euploid FET, a NC approach increases the odds for LB. This fact should be considered for a personalized treatment approach and in the choice of the endometrial preparation protocol. Trial registration number not applicable

Identification of pregnancies and their outcomes in healthcare claims data, 2008-2019: An algorithm.

Pregnancy is a condition of broad interest across many medical and health services research domains, but one not easily identified in healthcare claims data. Our objective was to establish an algorithm to identify pregnant women and their pregnancies in claims data. We identified pregnancy-related diagnosis, procedure, and diagnosis-related group codes, accounting for the transition to International Statistical Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) diagnosis and procedure codes, in health encounter reporting on 10/1/2015. We selected women in Merative MarketScan commercial databases aged 15-49 years with pregnancy-related claims, and their infants, during 2008-2019. Pregnancies, pregnancy outcomes, and gestational ages were assigned using the constellation of service dates, code types, pregnancy outcomes, and linkage to infant records. We describe pregnancy outcomes and gestational ages, as well as maternal age, census region, and health plan type. In a sensitivity analysis, we compared our algorithm-assigned date of last menstrual period (LMP) to fertility procedure-based LMP (date of procedure + 14 days) among women with embryo transfer or insemination procedures. Among 5,812,699 identified pregnancies, most (77.9%) were livebirths, followed by spontaneous abortions (16.2%); 3,274,353 (72.2%) livebirths could be linked to infants. Most pregnancies were among women 25-34 years (59.1%), living in the South (39.1%) and Midwest (22.4%), with large employer-sponsored insurance (52.0%). Outcome distributions were similar across ICD-9 and ICD-10 eras, with some variation in gestational age distribution observed. Sensitivity analyses supported our algorithm's framework; algorithm- and fertility procedure-derived LMP estimates were within a week of each other (mean difference: -4 days [IQR: -13 to 6 days]; n = 107,870). We have developed an algorithm to identify pregnancies, their gestational age, and outcomes, across ICD-9 and ICD-10 eras using administrative data. This algorithm may be useful to reproductive health researchers investigating a broad range of pregnancy and infant outcomes.

An Observational Study of IVF Outcomes with The Inference of Bacterial Vaginosis (BV) Infection

Objective: The purpose of this study is to investigate the effect of bacterial vaginosis on females who are undergoing IVF treatment. Background: It is a fascinating process that enables infertile couples who are having difficulty conceiving naturally to achieve pregnancy through ART. The most common procedure in ART is IVF, where embryo transfer is one of the crucial steps in achieving a successful pregnancy. IVF is a complex series of procedures used to enhance fertility, address genetic problems, and aid in the conception of a child. During IVF, mature eggs are retrieved from the ovaries and fertilized with sperm, and further culture the embryos in an IVF laboratory. In assisted reproduction, embryos are transferred into a female's uterus in order to establish a pregnancy. It should be noted that there is still a wide range of indications and associated risks that affect embryo transfer procedures. Bacterial infection is one of the most common complications. Infection due to bacteria in the vagina known as bacterial vaginosis occurs when some normal microflora grows too large, resulting in bacterial imbalances. Symptoms include off-white or grey vaginal discharge that smells fishy. Increasing evidence suggests that bacterial vaginosis may not only cause disease in the lower genital tract. In-vitro fertilization (IVF) patients were examined for potential associations with infertility and effects on fertilization and implantation. Methodology: A total of 135 infertile couples were counseled for this study, however only 100 agreed to participate. In this observational study, we examined the effect of bacterial infection on IVF outcomes among infertile females (n=100) receiving IVF treatment at Aashakiran IVF, Kharar, Punjab, between July 2020 to December 2022. Informed consent was obtained from all patients prior to the procedure. For all females in this study, unexplained categories of patients were enrolled who had normal tubal patency, regular ovulation, and no male factors. A swab sample (n=100) was taken from the patient before embryo transfer. There are still many indications and associated risks that affect the embryo transfer procedure. The sample was cultured on a blood agar plate and isolated from the sample for up to 48 hours. They first checked after 24 hours, if the growth was not present then incubated for up to 48 hours. Then we compared their IVF outcomes in the samples in which we found bacterial growth. Result: 34 samples with bacterial growth showed 15(44.11%) patients get positive IVF results and 19 (55.88%) patients get negative IVF results. Whereas overall 66 samples without any bacterial growth showed 32 (48.48%) positive IVF results and 34 (51.51%) negative IVF outcomes out of 100 patients. The difference in IVF outcome between bacterial growth and no growth of BV is 4.37% only. Thus, this study does not support the hypothesis that BV adversely affects embryo implantation and outcome. Conclusion: The present study concluded that somewhere BV affects IVF outcomes. For more understanding of BV infection how much effect IVF results then need to study higher patient data.

Odds and Predictors of Monozygotic Twinning in a Multicentre Cohort of 25,794 IVF Cycles

The rate of monozygotic twinning (MZT) has seen a gradual increase in recent years. Numerous parameters involved in ART procedures are blamed for this surge, even though the exact explanation is as yet unknown. Our study's objectives were to determine the risk variables for monozygotic twinning after ART and to estimate their prevalence. We examined 25,794 IVF cycles for the incidence of monozygotic twinning in this observational analysis. Our study, which was carried out across seven tertiary IVF centres over the course of four years, found an overall MZT rate of 0.37% per embryo transfer procedure and 0.88% of all pregnancies. Monozygotic twinning was more commonly seen in fresh single-embryo transfer (SET) and blastocyst transfer cycles. Larger multicentre studies are needed to explore the potential risk variables.

Human Uterine Lavage: First Live Births from In Vivo Conceived Genetically Screened Blastocysts.

We wish to report the first live births from genetically screened human euploid blastocysts obtained by uterine lavage. The embryos transferred to infertile women were previously obtained using a novel fully automated uterine lavage catheter and fluid recovery device developed for this indication. The objective of this portion of the research was to confirm embryo implantation and live births with these unique in vivo conceived blastocysts obtained by uterine lavage. In vivo conceived embryos recovered by uterine lavage 5days after intrauterine insemination were available for embryo donation. In vivo embryos were the result of prior controlled ovarian stimulation cycles in oocyte donors and intrauterine insemination with donor sperm. An observational case series of nine embryo transfer procedures was performed at an outpatient fertility center. One to two embryos were transferred to eight infertile women since one woman had two separate embryo transfer procedures. Nine embryo transfer procedures were performed with 14 blastocysts in eight women resulting in a blastocyst implantation rate of 36% (5/14) and live birth rate of 44% (4/9). Five infants have been born from the four delivered pregnancies with one set of twins. This is the first report of live births from genetically screened human euploid blastocysts obtained by uterine lavage. The nonsurgical uterine lavage office procedure represents the only current approach to obtain in vivo conceived embryos and can provide a benchmark for comparison to standard in vitro cultured blastocysts. Live births of in vivo conceived blastocysts represent the validation that the nonsurgical uterine lavage procedure allows simplified access to naturally conceived embryos without performing the surgical procedure of an oocyte aspiration. Owing to its simplicity, uterine lavage may be useful in screening embryos for preimplantation genetic testing for aneuploidy in fertile and infertile couples. ClinicalTrials.gov (Identifier NCT03426007).

A new insight into the impact of systemic lupus erythematosus on oocyte and embryo development as well as female fertility.

Systemic lupus erythematosus (SLE) is often associated with adverse reproductive outcomes. But it's currently unclear regarding the role of SLE in oocyte and embryonic development. Also, it's controversial whether SLE has an adverse effect on fertility. There is a lack of comprehensive understanding and assessment of fertility in patients with SLE. This study was aim to investigate oocyte and embryonic development as well as ovarian reserve, and clinical outcomes in SLE patients during in vitro fertilization (IVF) treatment. By combining data on embryonic and gamete development in SLE patients, we hope to provide new insights into a comprehensive assessment of fertility in SLE patients. In this study, we collected data from 34 SLE patients who were previously diagnosed and in remission for a total of 44 IVF cycles and matched 102 infertile women with a total of 148 IVF cycles by Propensity Score Matching (PSM) of 1:3 ratio. We then evaluated baseline characteristics, ovarian reserve, IVF laboratory outcomes, and clinical outcomes between the two groups. After PSM matching, baseline characteristics including age, infertility types, and duration, as well as infertility causes overall coincided between the two groups. Anti-müllerian hormone (AMH) was significantly lower in the SLE group vs comparison (1.9 vs. 3.3 ng/mL, P=0.001). The SLE group performed a significant reduction in available embryo rate (76.6% vs. 86.0%, P=0.001), good-quality blastocyst formation rate (35.1% vs. 47.0%, P=0.003), and blastocyst formation rate (51.0% vs. 67.7%, P=0.001) compared to the comparison. As for clinical outcomes, the implantation rate in the SLE group was notably lower (37.9% vs. 54.9%, P=0.022). The CLBR following every embryo-transfer procedure was distinctly lower (41.2% vs 64.7%, P=0.016) in the SLE group vs comparison. Also, the conservative and optimal CLBRs following every complete cycle procedure were significantly reduced in the SLE group vs the comparison (P=0.001, both). Patients with SLE present worse outcomes in oocyte and embryonic development, thus yielding compromised female fertility and clinical pregnancy. Individualized fertility assessment and early fertility guidance are necessary for these special groups.

Aging-Related Ovarian Failure and Infertility: Melatonin to the Rescue

Aging has a major detrimental effect on the optimal function of the ovary with changes in this organ preceding the age-related deterioration in other tissues, with the middle-aged shutdown leading to infertility. Reduced fertility and consequent inability to conceive by women in present-day societies who choose to have children later in life leads to increased frustration. Melatonin is known to have anti-aging properties related to its antioxidant and anti-inflammatory actions. Its higher follicular fluid levels relative to blood concentrations and its likely synthesis in the oocyte, granulosa, and luteal cells suggest that it is optimally positioned to interfere with age-associated deterioration of the ovary. Additionally, the end of the female reproductive span coincides with a significant reduction in endogenous melatonin levels. Thus, the aims are to review the literature indicating melatonin production in mitochondria of oocytes, granulosa cells, and luteal cells, identify the multiple processes underlying changes in the ovary, especially late in the cessation of the reproductive life span, summarize the physiological and molecular actions of melatonin in the maintenance of normal ovaries and in the aging ovaries, and integrate the acquired information into an explanation for considering melatonin in the treatment of age-related infertility. Use of supplemental melatonin may help preserve fertility later in life and alleviate frustration in women delaying childbearing age, reduce the necessity of in vitro fertilization-embryo transfer (IVF-ET) procedures, and help solve the progressively increasing problem of non-aging-related infertility in women throughout their reproductive life span. While additional research is needed to fully understand the effects of melatonin supplementation on potentially enhancing fertility, studies published to date suggest it may be a promising option for those struggling with infertility.

Effect of administration of atosiban at day of embryo transfer on in-vitro fertilization out come

Background: The most crucial step of assisted reproduction is embryo implantation, which is impacted by a variety of factors, including the patient's age, embryo quality, and endometrial receptivity. The embryo transfer (ET) procedure, which induces uterine contractions, may hinder embryo implantation. Objectives: On the day of embryo transfer, examine the effects of Atosiban administration on implantation, clinical pregnancy, miscarriage, and live birth rates. Material and Methods: The study included 60 individuals with a diagnosis of primary or secondary infertility due to male or female factor, tubal factors, moderate endometriosis, or other unknown reasons. Two groups of patients were selected at random. The first group received 6.75 milligrammes of atosiban intravenously 30 minutes before ET, whereas the second group received no medication. Pregnancy outcomes in both groups were compared. Results: Significantly higher clinical pregnancy and implantation rates were observed (60% versus 30%) and (37.8% versus 17.8%) respectively, with non-significantly higher live birth rates (94.4% versus 66.7%), while the miscarriage rate was lower in the Atosiban group but not significantly (5.6% versus 33.3%). Conclusion: These findings imply that atosiban therapy prior to embryo transfer improves embryo implantation.

Obstetric and perinatal outcomes following frozen and fresh embryo transfer in patients with endometrial hyperplasia and carcinoma: a retrospective study in a high-volume reproductive center

BackgroundThere is ongoing debate regarding which embryo transfer procedure can achieve a higher live birth rate. Research has suggested that frozen ET might be beneficial for certain populations, such as hyper-responders. This study aimed to compare outcomes of pregnancies between frozen and fresh embryo transfer cycles in patients with endometrial hyperplasia and carcinoma.MethodsThis retrospective cohort study was conducted at a high-volume reproductive center from January 2010 to January 2022. Patients who were diagnosed with endometrial hyperplasia with atypia and endometrial carcinoma were included. They all underwent in vitro fertilization after conservative treatment. The primary outcome was live birth after frozen and fresh embryo transfer cycles, and secondary outcomes included perinatal complications and other pregnancy outcomes.ResultsOverall, 259 ET cycles (130 fresh and 129 frozen) were included. The rate of live births per embryo transfer cycle of the whole cohort was 20.8% (54/259), and no significant between-group difference was found after adjusting for potential confounding factors (23.8% vs. 17.8%; adjusted OR, 0.47; 95% CI, 0.21-1.06; p=0.068). Compared to fresh embryo transfer group, the incidence of total maternal complications in the frozen embryo transfer group was significantly higher (30.4% vs. 6.5%, p=0.019). Analyzing each complication as a separate entity, patients in the frozen embryo transfer group had a higher incidence of hypertensive disorders of pregnancy (p=0.028). Multiple logistic regression analysis showed that frozen embryo transfer was related with an increased occurrence of maternal complications (OR, 6.68, 95% CI, 1.01-44.19, p=0.040).ConclusionsAmong patients with endometrial hyperplasia and carcinoma, the rate of live births was comparable between both embryo transfer procedures, while frozen embryo transfer might be associated with a higher risk of maternal complications compared to that with fresh embryo transfer.

How Could One Sperm and One Oocyte Proceed To Molar Pregnancy? Prevalence of Molar Pregnancy during ICSI Procedure in Over 25,000 Fresh Embryo Transfers: A Retrospective Cross-Sectional Study.

Gestational trophoblastic disease (GTD) is a heterogeneous group of diseases characterized by excessive proliferating trophoblastic tissue. The prevalence of GTD has a varied geographical distribution. However, its frequency following intracytoplasmic sperm injection (ICSI) cycles has not yet been reported. This study aimed to estimate GTD frequency and prevalence after ICSI cycles. This retrospective cross-sectional study included all patients diagnosed with GTD subsequent to ICSI and segmental embryo transfer procedure during 2011-2019 at Royan Institute. GTD diagnosis was established for patients who met all three criteria: beta-human chorionic gonadotropin (β-hCG) levels greater than 100,000 mIU/mL, vesicular ultrasonographic pattern, and presence of pathologic features of hydatidiform mole. Although we assessed the GTD frequency in all ICSI cycles, GTD cases were only observed following fresh embryo transfer ICSI procedures. We evaluated 25,667 fresh embryo transfer ICSI procedures out of 41,540 ICSI cycles. This study identified a total of 10 GTDs confirmed by all criteria which were mentioned previously. Of these 10 GTDs, nine cases had hydatidiform mole, and one had gestational trophoblastic neoplasia. The frequency of GTD was calculated 10 cases in 41,540 (0.240 per 1000) ICSI procedures and 10 in 25,667 (0.389 per 1000) fresh embryo transfers following ICSI cycles. Also, we detected 10 GTD cases in 8,196 (1.220 per 1000) clinical pregnancies. We discuss that the possibility of GTD after ICSI procedure is not as low as expected. Thus, the previous theses are insufficient to explain all aspects of molar pregnancy, and more research is required.

Inteligenţa artificială în tehnicile de reproducere asistată

Artificial intelligence (AI) represents a continuously expanding technique, recording real progress in multiple medical specialties. The improvement of calculation algorithms, the appearance of more and more powerful computers, the training of doctors to use this equipment, and data processing techniques have contributed to the increased performance of assisted reproduction technology. Currently, implementing AI algorithms in the clinical activity of assisted reproductive technology (ART) represents a challenge. There are a series of limitations of the deep learning and decision tree processes due to the risks regarding the validation of the results, the ethical aspects, the responsibility for the correctness of the information, the doctors’ reluctance to use AI, and the lack of empathy for patients. However, the continuous research on the AI algorithms is essential in clinical embryology and in assisted human reproduction techniques. The early diagnosis of infertility, the personalization of treatment schemes, and the prediction of ART success are just a few directions for promoting AI applications in reproductive medicine, without being able to replace the current clinical model. The possibility of making predictions regarding the quality of embryo transfer procedures and the normal pregnancy rate are factors that show the future direction of the development of in vitro fertilization techniques.

What should be the strategy in case of a big follicle at the start of the cycle? Shall we start the stimulation or postpone it to the next cycle?

This study facilitates decision-making when an antral follicle diameter >15 mm is detected at the beginning of the menstrual cycle in poor responder (POR) patients. Eighty-three POR patients with at least one leading follicle with a diameter of 15 to 24 mm on the 2nd-4th days of the menstrual cycle were assessed. The mean age of females was 40.1±4.8 (26-45), and the mean partners' age was 42.1±7.8 (26-65). Fifty-one (61.4%) women underwent an oocyte pick-up procedure 36 h after the first ultrasonographic examination on the 2nd-4th days of the menstrual cycle. Gonadotrophin stimulation was initiated in 32 (38.6%) patients. Among women in whom oocyte retrieval was performed, an oocyte was obtained in 49 (59.75%) patients. In 13 of 49 patients (26.5%), no mature oocytes were obtained. Fertilized 2pn embryos were obtained in 18 of 33 patients (54.5%). Among the fertilized embryos, 12 were good, six were moderate, and two were of poor quality. Following the frozen embryo transfer procedure, one of the two patients experienced a clinical pregnancy. Patients with POR are still difficult to manage both clinically and therapeutically. Since every oocyte is valuable and important, patients should be carefully followed up. Our research will be directed by the need to rule out a physiological ovarian cyst when large antral follicles appear at the beginning of the cycle. The clinician should give them a chance.

Ectopic pregnancy risk factors in infertile patients: a 10-year single center experience

The present retrospective study included both intrauterine insemination and in vitro assisted reproductive technologies (ART) procedures performed from January 2009 to December 2018 at a tertiary-care Fertility Centre. The purpose was to assess the incidence of ectopic pregnancy (EP) in infertile population who undergoes ART and to identify any risk factor impacting the occurrence of EP after ART. Among 27,376 cycles, 7352 pregnancies were achieved, of which 132 were EPs, the 1.80% (95% CI 1.5–2.1) of all pregnancies. In fresh embryo transfer cycles, a history of prior pelvic adhesions showed the greatest impact on the incidence of EP (aOR 2.49 95% CI 1.53–4.07 p < 0.001). Other factors associated with EP incidence were also identified, such as female age, basal FSH, the transfer of blastocyst embryos and difficulties during the embryo transfer procedure. In frozen embryo transfer cycles, the only factor influencing the incidence of EP was anti Müllerian hormone (AMH) serum concentration (aOR 0.81 95% CI 0.65–1.00, p = 0.048). To conclude, the incidence of EP observed was comparable to that reported after natural conception. On the other hand, pre-existing risk factors, traditionally more common in infertile population, appeared to influence the incidence of EP and should thus be modified if possible.

Effects of Repeated Cryopreservation of Cleavage-Stage Embryos on Pregnancy and Perinatal Outcomes of Single Embryo Transfer

Background: Embryo cryopreservation is an important part of assisted reproductive technologies to increase cumulative pregnancy rate in clients. However, in clinical settings, embryos can be subjected to repeated cryopreservation-warming cycles due to certain clinical circumstances. There are limited data on the effect such cycles may have on the success of embryo transfer procedures. In this study, we investigated the effect of repeated cryopreservation of cleavage-stage embryos on the pregnancy and perinatal outcomes of frozen embryo transfer (FET). Methods: We retrospectively collected data on single cleavage-stage embryo transfer (ET) cycles performed in our center from January 2017 to August 2021 and identified 98 cycles of repeated cryopreservation-warming in cleavage-stage ET cycles. Propensity score matching was conducted according to the age of the patients, body mass index, endometrial thickness, type of oocyte retrial cycle, and quality of the transplanted embryos to match once-cryopreserved cleavage-stage ET cycles in our center at a ratio of 1:3 (caliper value 0.01). Finally, 294 once-cryopreserved cleavage-stage ET cycles were set as controls. Clinical pregnancy, early miscarriage, live birth rates, and other pregnancy and perinatal outcomes were compared between the two groups. Results: Similar success rates were obtained with twice-cryopreserved embryo transfers (n = 98) and with once-cryopreserved embryo transfers (n = 294). Importantly, there was no significant difference in the clinical pregnancy, early miscarriage, and live birth rates as well as perinatal outcomes such as preterm birth and pregnancy complication rates between the two groups. There were no birth defects in the two groups. Conclusions: Repeated cryopreservation may not negatively affect pregnancy and perinatal outcomes of single cleavage-stage ET and may present a safe option for resuscitated cleavage-stage embryos that have been canceled for transfer.

A NON-COMMERCIAL WITNESSING SYSTEM A JOURNEY TO CREATE A BAR CODE SYSTEM FROM DISH LABELS TO MICROSCOPIC BAR CODES NEXT TO THE EMBRYO

The complexity of the procedures in the IVF laboratory requires a witnessing system to decrease the risk of human errors. Current quality control practices include a second person in a double witnessing protocol in gamete collection, insemination, and embryo transfer procedures. Commercial electronic witnessing systems have provided an alternative option for increasing the security level of matching samples in the laboratory; however, blastocyst biopsies, cell loading, and individual embryo freezing have not been covered entirely due to the complexity of the microscopic level.

DIAGNOSIS OF DIMINISHED OVARIAN RESERVE AND PREIMPLANTATION GENETIC TESTING IMPACT FROZEN EMBRYO TRANSFER LABORATORY AND CLINICAL OUTCOMES: TRACKING FAILED THAW CYCLES AS A KEY PERFORMANCE INDICATOR

Blastocysts from patients with diminished ovarian reserve (DOR) are less likely to be euploid, independent of age, suggesting reduction in oocyte quality/quantity.1 However, after euploid single-embryo transfer, live birth rates (LBRs) between women with and without DOR remain similar.1 We evaluated the proportion of failed thaw cycle (FThC) in the presence of DOR, with and without preimplantation genetic testing (PGT), as a key performance indicator (KPI) for frozen embryo transfer (FET) procedures in this patient population.

Ефективність програм екстракорпорального запліднення (IVF/ICSI) у пацієнток із прогнозованою слабкою відповіддю яєчників

Purpose - to show the effectiveness of in vitro fertilization (IVF) programs in infertile women with a predicted poor ovarian response to stimulation with various gonadotropins and to study the course of pregnancy, childbirth and the condition of their newborns. Materials and methods. The Group І is 75 women, the controlled stimulation of superovulation in which by urinary gonadotropins was performed in the protocol with the use of gonadotropin-releasing hormone antagonist. The Group ІІ (comparison) is 65 women, the stimulation of superovulation in which was carried out according to an analogical scheme with recombinant gonadotropins. Confirmation or exclusion of biochemical pregnancy was carried out by determining the level of total human chorionic gonadotropin in blood serum 14 days after embryo transfer. Data processing was carried out using the Stat Soft Statistica 8.0 software package. Results. The frequency of cancellation of IVF cycle (IVF/ICSI) in the patients of the Group І was reliably lower than among the patients of the Group ІІ: in the Group І it was 2 (2.7%) cases against 8 (12.3%) cases in the Group ІІ (p&lt;0.05). IVF cycle cancellations among the patients of the Group І was reliably lower than among the women of the Group ІІ (OR=0.205; 95% СІ: 0.048-0.87; p&lt;0.05). Embryo transfer procedure was performed for 73 women of the Group І and 57 patients of the Group ІІ. The frequency of pregnancy on the IVF protocol and embryo transfer was 41.1% (30/73) and 36.8% (21/57), respectively. Absence of the further embryo development after implantation (biochemical pregnancy) was registered in 1 (3.3%) woman of the Group І and 1 (4.8%) patient of the Group ІІ. Non-developing pregnancy up to 12 weeks was diagnosed in 2 (6.6%) women of the Group І and 3 (14.2%) patients of the Group ІІ. Pregnancy that occurred after the IVF/ICSI program resulted in childbirth in 24 (32.9%) women out of 73 of the Group І and 13 patients out of 57 (22.8%) of the Group ІІ. Conclusions. In women who underwent the controlled stimulation of superovulation by urinary gonadotropins in the protocol using gonadotropin-releasing hormone antagonist compared to women who underwent the stimulation of superovulation with recombinant gonadotropins according to an analogical scheme, the frequency of pregnancy and completion of pregnancy by childbirth was reliably higher. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the author.

Evidence and consensus on technical aspects of embryo transfer.

BACKGROUNDUltrasound-guided embryo transfer (US-GET) is a widely performed procedure, but standards for the best practice are not available.OBJECTIVE AND RATIONALEThis document aims to provide an overview of technical aspects of US-GET after considering the published data and including the preparation for the embryo transfer (ET) procedure, the actual procedure, the post-procedure care, associated pathologies, complications and risks, quality assurance and practitioners’ performance.SEARCH METHODSA literature search for evidence on key aspects of the ET procedure was carried out from database inception to November 2021. Selected papers (n = 359) relevant to the topic were analysed by the authors. The following key points were considered in the papers: whether ultrasound (US) practice standards were explained, to what extent the ET technique was described and whether complications or incidents and how to prevent such events were reported. In the end, 89 papers could be used to support the recommendations in this document, which focused on transabdominal US-GET.OUTCOMESThe relevant papers found in the literature search were included in the current document and described according to the topic in three main sections: requirements and preparations prior to ET, the ET procedure and training and competence for ET. Recommendations are provided on preparations prior to ET, equipment and materials, ET technique, possible risks and complications, training and competence. Specific aspects of the laboratory procedures are covered, in particular the different loading techniques and their potential impact on the final outcomes. Potential future developments and research priorities regarding the ET technique are also outlined.LIMITATIONS, REASONS FOR CAUTIONMany topics were not covered in the literature review and some recommendations were based on expert opinions and are not necessarily evidence based.WIDER IMPLICATIONSET is the last procedural step in an ART treatment and is a crucial step towards achieving a pregnancy and live birth. The current paper set out to bring together the recent developments considering all aspects of ET, especially emphasizing US quality imaging. There are still many questions needing answers, and these can be subject of future research.STUDY FUNDING/COMPETING INTEREST(S)No funding. A.D.A. has received royalties from CRC Press and personal honorarium from Cook, Ferring and Cooper Surgical. The other co-authors have no conflicts of interest to declare that are relevant to the content of this article.

Effects of COVID-19 Quarantine Period on Fertility Patients and IVF Clinic Management Worldwide

Background: The initial months of 2020 experienced a rapid spread of a new Coronavirus named SARS-2. The World Health Organisation declared a global pandemic on 11th March 2020. Due to the new strain of the virus, little was known regarding COVID-19 and its effects on fertility and pregnancy. Aim: To explore how fertility clinics and ART treatments proceeded post COVID-19 lockdowns and how this affected fertility patients. Method: We surveyed fertility clinics world-wide with an online questionnaire through the platform RedCap. The questionnaire contained 33 questions focusing on the differences of country responses to guidelines and regulations. Scientific directors, medical directors and lab managers were contacted via email with the questionnaire link. The questionnaire was approved by Monash Health Human Research Ethics Committee and focused on the initial COVID-19 lockdown. Results: There were 34 individual country responses, Asia (11), Europe (10), Africa (3), North America (3), Oceania (2) and South America (5). Of the 34 countries, 7 countries did not experience a complete cessation of all procedures. Most countries followed their government health recommendations and clinic policies. IVF/ICSI and frozen embryo transfer (FET) procedures proved to be the most delayed treatments. Sixteen countries reported to have an increase in freeze-all cycles compared to fresh transfers. Patients had to undergo a SARS-CoV-2 test in 50% of countries. Additional counselling for patients during the pandemic was implemented in 22 countries. Conclusion: During the COVID-19 pandemic most fertility services were suspended, allowing insight into the implications of a shutdown. In conclusion, a protocol for scenarios of this nature would benefit future events. A protocol including increased phycological support, continuation of care, including telehealth and guidelines for prioritizing couples who need treatment most urgently.