Fertilization Cycles Research Articles

Reproductive Outcomes of Conventional In Vitro Fertilization and Intracytoplasmic Sperm Injection in Patients with Non-Severe Male Infertility Across Poor and Different Sub-Optimal Ovarian Response Categories: A Cohort Study Based on 30,352 Fresh Cycles from 2009–2019

Due to the influence of economic, social and many other factors, there are more and more reproductive problems. Originally introduced for managing male factor infertility, intracytoplasmic sperm injection had become the most commonly used fertilization treatment in the world, with broadened indications including low oocyte yield, prior fertilization failure with conventional in vitro fertilization etc. However, academic evidence for better live-birth outcomes of intracytoplasmic sperm injection over conventional in vitro fertilization is limited. Thus, we aimed to compare the reproductive outcomes of conventional in vitro fertilization and intracytoplasmic sperm injection in patients with non-severe male factor infertility across poor and different sub-optimal ovarian response categories. The fertility rate, implantation rate, clinical pregnancy rate, live birth rate and other obstetric outcomes were mainly compared. Our results showed that independent of the number of oocytes retrieved, intracytoplasmic sperm injection significantly increased the fertilization rate, while conventional in vitro fertilization cycles showed a higher implantation rate, clinical pregnancy rate, and live birth rate. No differences were observed in most obstetric outcomes. Our study indicates that poor ovarian response is not an indication for intracytoplasmic sperm injection in couples with non-severe male infertility.

Comparison of outcomes between intracytoplasmic sperm injection and in vitro fertilization inseminations with preimplantation genetic testing for aneuploidy, analysis of Society for Assisted Reproductive Technology Clinic Outcome Reporting System data

To evaluate whether insemination via intracytoplasmic sperm injection provides any benefit over in vitro fertilization for non-male factor infertility with respect to pre-implantation genetic testing results and pregnancy outcome. Retrospective Cohort Study of the Society for Assisted Reproductive Technology database. Patients undergoing in vitro fertilization or intracytoplasmic sperm injection in non-male factor pre-implantation genetic testing for aneuploidy cycles. In vitro fertilization vs. intracytoplasmic sperm injection MAIN OUTCOME MEASURES: Primary outcomes were percentage of embryos suitable for transfer and live birth rates. Secondary outcomes included subgroup analysis for embryos suitable for transfer on cycles from patients ≥ 35 y/o vs. < 35 y/o, ≤ 6 oocytes retrieved vs. > 6 oocytes retrieved, and unexplained infertility. Additionally, gestational age at delivery and birthweight between in vitro fertilization and intracytoplasmic sperm injection were evaluated. A total of 30,446 non-male factor preimplantation genetic diagnosis for aneuploidy cycles were evaluated, of which 4867 were in vitro fertilization and 25,579 were intracytoplasmic sperm injection. Following exclusion criteria and adjustment for any necessary confounding variables, no significant differences existed in embryos suitable for transfer between in vitro fertilization and intracytoplasmic sperm injection cycles, 41.6% (40.6%, 42.6%) vs. 42.5% (42.0%, 42.9%), respectively or live birth rates, 50.1% (37.8, 62.4%) vs. 50.8% (38.5%, 62.9%), respectively. There were no significant differences in the rates of embryos suitable for transfer and live birth rates between in vitro fertilization and intracytoplasmic sperm injection in non-male factor cycles undergoing pre-implantation genetic testing for aneuploidy.

Outcomes of BRCA pre-implantation genetic testing according to the parental mutation origin: a cohort study

BackgroundThe process of gamete formation and early embryonic development involves rapid DNA replication, chromosome segregation and cell division. These processes may be affected by mutations in the BRCA1/2 genes. The aim of this study was to evaluate BRCA mutation inheritance and its effect on early embryonic development according to the parental origin of the mutation. The study question was approached by analyzing in vitro fertilization cycles (IVF) that included pre-implantation testing (PGT-M) for a BRCA gene mutation.MethodsThis retrospective cohort study compared cycles of pre-implantation genetic testing for mutations (PGT-M) between male and female patients diagnosed with BRCA 1/2 mutations (cases), to a control group of two other mutations with dominant inheritance (myotonic dystrophy (MD) and polycystic kidney disease (PKD)). Results were compared according to mutation type and through a generalized linear model analysis.ResultsThe cohort included 88 PGT-M cycles (47 BRCA and 41 non-BRCA) among 50 patients. Maternal and paternal ages at oocyte retrieval were comparable between groups. When tested per cycle, FSH dose, maximum estradiol level, oocytes retrieved, number of zygotes, and number of embryos available for biopsy and affected embryos, were not significantly different among mutation types. All together 444 embryos were biopsied: the rate of affected embryos was comparable between groups. Among BRCA patients, the proportion of affected embryos was similar between maternal and paternal mutation origin (p = 0.24). In a generalized linear model analysis, the relative oocyte yield in maternal BRCA patients was significantly lower (0.7, as related to the non BRCA group)(p < 0.001). Zygote formation and blastulation were not affected by the BRCA gene among paternal cases (P = 0.176 and P = 0.293 respectively), nor by paternal versus maternal BRCA carriage (P = 0.904 and P = 0.149, respectively).ConclusionsBRCA PGT-M cycles performed similarly compared to non-BRCA cycles. Inheritance rate and cycle parameters were not affected by the parental origin of the mutation.

Follitropin delta combined with menotropin in patients at risk for poor ovarian response during in vitro fertilization cycles: a prospective controlled clinical study

BackgroundThe maximum daily dose of follitropin delta for ovarian stimulation in the first in vitro fertilization cycle is 12 μg (180 IU), according to the algorithm developed by the manufacturer, and based on patient’s ovarian reserve and weight. This study aimed to assess whether 150 IU of menotropin combined with follitropin delta improves the response to stimulation in women with serum antimullerian hormone levels less than 2.1 ng/mL.MethodsThis study involved a prospective intervention group of 44 women who received 12 μg of follitropin delta combined with 150 IU of menotropin from the beginning of stimulation and a retrospective control group of 297 women who received 12 μg of follitropin delta alone during the phase 3 study of this drug. The inclusion and exclusion criteria and other treatment and follow-up protocols in the two groups were similar. The pituitary suppression was achieved by administering a gonadotropin-releasing hormone (GnRH) antagonist. Ovulation triggering with human chorionic gonadotropin or GnRH agonist and the option of transferring fresh embryos or using freeze-all strategy were made according to the risk of developing ovarian hyperstimulation syndrome.ResultsWomen who received follitropin delta combined with menotropin had higher estradiol levels on trigger day (2150 pg/mL vs. 1373 pg/mL, p < 0.001), more blastocysts (3.1 vs. 2.4, p = 0.003) and more top-quality blastocysts (1.8 vs. 1.3, p = 0.017). No difference was observed in pregnancy, implantation, miscarriage, and live birth rates after the first embryo transfer. The incidence of ovarian hyperstimulation syndrome did not differ between the groups. However, preventive measures for the syndrome were more frequent in the group using both drugs than in the control group (13.6% vs. 0.6%, p < 0.001).ConclusionsIn women with serum antimullerian hormone levels less than 2.1 ng/mL, the administration of 150 IU of menotropin combined with 12 μg of follitropin delta improved the ovarian response, making it a valid therapeutic option in situations where ovulation triggering with a GnRH agonist and freeze-all embryos strategy can be used routinely.Trial registrationU1111-1247-3260 (Brazilian Register of Clinical Trials, available at https://ensaiosclinicos.gov.br/rg/RBR-2kmyfm).

Restorative Reproductive Medicine

While mainstream secular medicine tends toward treating a woman’s fertility cycle as something outside the realm of her general health, Restorative Reproductive Medicine aims to do just the opposite. RRM embraces a wholistic view of women’s health, viewing individual’s experience as part of the full tapestry of her health. The reproductive system is a vital component of understanding each specific woman’s medical status and RRM is designed to use the study of women’s cycles to reveal the bigger picture of women’s health rather than interfere with it, as mainstream medicine tends to do far too quickly.

Detecting partial premature ovulation during follicular aspiration compromises the quantity, but not the quality, of the oocytes retrieved in stimulated in vitro fertilization (IVF) cycles.

To analyze if partial premature ovulation (PPO) detection during oocyte pick-up (OPU) impairs the quality of the retrieved oocyte cohort. The PPO concept refers to the situation when premature ovulation happens only in some of the follicles and it is detected during OPU. This study constitutes a retrospective analysis performed in an infertility clinic (Spain) during 2016-2021 with patients undergoing OPU after controlled ovarian hyperstimulation for an in vitro fertilization (IVF) treatment. Study code: 2110-VLC-091- VG, registered on December 9 2021. Data from women with PPO (n=111) were compared to a matched control sample of cycles without PPO (n=333) at a proportion of 1:3. Cycles were matched for age, body mass index (BMI), treatment year, embryo genetic analysis and stimulation protocol type. The mean numbers of oocytes (6.1 vs. 11.2), mature oocytes (4.7 vs. 8.8), correctly fertilized oocytes (3.6 vs. 6.6) and top-quality blastocysts (0.9 vs. 1.8) were significantly lower in the PPO group than the nonPPO group (p<0.05). However, maturation, fertilization, top-quality blastocyst and pregnancy rates were statistically comparable among groups (p>0.05). Cycles with PPO have fewer available oocytes and, thus, fewer available embryos for transfer, al though their quality is intact, and still offer chances of pregnancy in these cases. Hence cycle cancellation may not be worth associated money, time and morale losses once PPO is detected.

Vitamin D and follicular recruitment in the in vitro fertilization cycle.

Vitamin D (VD) is a fat-soluble steroid hormone, synthesized by the skin, most known for its role in bone mineral balance. Vitamin D receptors (VDR) are also found in the female reproductive system, but their role remains unclear. The objective of this study was to analyze the relationship between serum vitamin D levels and the number of oocytes retrieved after ovarian stimulation. This is a retrospective study involving 267 patients undergoing in vitro fertilization (IVF) carried out in the Fertipraxis clinic, a private practice facility. The patients were initially divided into two groups according to their VD levels. Group 1 included 152 patients with VD levels < 30 ng/mL and group 2 had 115 patients with VD levels > 30 ng/mL. They were further analyzed and separated considering their age, anthropometric data, ovarian reserve, amount of gonadotropin used, and follicles obtained until trigger day. In our analysis, there were no difference in the number of follicles and oocytes retrieved, nor in the number of mature oocytes obtained from patients with both vitamin D deficiency and sufficiency. The results of our study show no difference among number of follicles, oocytes retrieved and mature oocytes obtained after ovarian stimulation according to their vitamin D serum levels. Further higher-quality studies are needed to evaluate the possible roles of serum vitamin D levels in other stages of human fertilization process.

Summer versus winter: the impact of the seasons on oocyte quality in in vitro fertilization cycles.

The aim of this study was to determine the effects of seasons (winter vs. summer) on oocyte quality in infertile women undergoing ovulation induction for in vitro fertilization. This retrospective cross-sectional study assessed 155 cycles of in vitro fertilization-induced ovulation in women, with 71 and 84 cycles occurring in the summer and winter, respectively. Oocytes were evaluated for quality, with 788 and 713 assessed during summer and winter, and classified according to Nikiforov's categories: (a) category I, good quality; (b) category 2, medium quality; and (c) category 3, low quality. Thickened zona pellucida (p<0.001), increased perivitelline space (p<0.001), oocyte shape abnormalities (p=0.01), and the presence of refractile bodies (p<0.0001) were more frequent in the summer cycles, whereas cytoplasmic granularity (p<0.001) was more frequent in the winter cycles. In winter, we observed a higher frequency of category 3 (p<0.001) and category 2 (p<0.001) oocytes and a lower frequency of category 1 (p<0.001) oocytes. Oocyte dysmorphisms were found in 70-80% of cases and were more common in winter. The main features include a thickened zona pellucida, enlarged perivitelline space, irregular shape, and cytoplasmic granularity. This implies better-quality oocytes in the summer than in the winter. However, retrospective studies have limitations due to data collection biases and potential confounding variables such as diet and exercise. Future research is needed to confirm these findings and explore the underlying mechanisms.

Follicular fluid concentration of soluble Human-G Leukocytic Antigen (sHLA-G) in in vitro fertilization cycles of women with and without peritoneal endometriosis.

The objective of this research is to investigate the association between the concentrations of soluble human leukocyte G antigen (sHLA-G) in the follicular fluid (FF) in infertile patients with peritoneal endometriosis submitted to in vitro fertilization. We performed a cross-sectional study, including ninety-six women undergoing in vitro fertilization (IVF) ageing ≤ 40 years. Infertile patients were classified into two groups: with endometriosis diagnosed by laparoscopy and without endometriosis due to tubal factor. ELISA measured soluble HLA-G in the FF of a pool of punctured (more than 17mm) follicles from women with endometriosis and without endometriosis who were subjected to ovulation induction for IVF. Embryos obtained after fertilization were classified according to the graduated embryo score (GES). Groups were comparables in terms of age, the number of follicles, AMH, FSH and all included reproductive outcomes. There was no association between sHLA-G concentrations and the average score of the generated embryos (p>0.05). Measurement of sHLA-G in the follicle fluid in women with endometriosis and without endometriosis (tubal factor) showed no significant difference (p>0.05). We also compared sHLA-G per follicle and per embryo, which were not different between both groups (p>0.05). Patients with peritoneal endometriosis submitted to IVF did not demonstrate an altered sHLA-G in the follicular fluid compared to the follicular fluid sHLA-G concentration in tubal factor patients. Also, this molecule was not linked to any other reproductive outcome.

The use of combined hormonal contraceptive for in-vitro fertilization cycle priming is not associated with decreased pregnancy rate in frozen embryo transfer cycles: a cohort study.

The objectives of this study are to evaluate the cycle outcomes from IVF treatment preceded by oral contraceptive pills (OCP) priming compared to estradiol pretreatment and to determine if there is a role for OCP priming for those undergoing frozen embryo transfers. The study took place at a university-affiliated fertility center in Canada. The study included in-vitro fertilization (IVF) antagonist cycles from Jan 2016 to Jun 2019. Those with protocol deviation or treatment cancellation were excluded. There were 2237 cycles by 1958 patients; 27% of cycles utilized OCP priming. The average age in the OCP group was 34 years old compared to 36.5 in the estradiol group (P<0.01). AMH was reported in 43% of patients and was 3.7ng/mL in the OCP group versus 2.2 ng/mL in the estradiol group (P<0.01). The number of oocytes (15.2 vs. 12.5) and number of blastocysts (4.6 vs. 3.3) were higher in the OCP group (P all <0.01). After adjusting for age and AMH with linear regression for the 978 cycles with recorded AMH (24% with OCP prime), a significantly higher number of oocytes (13.8 vs. 11.9, P=0.002) was still noted in the OCP group. There were 866 euploid embryo transfer cycles (28% with OCP prime). There were no significant differences in implantation (77% vs. 76%) or ongoing pregnancy rates (56% vs. 54%) between those who had a frozen embryo transfer after OCP primed compared to estradiol primed stimulation cycles (P all >0.6). There were no differences in pregnancy outcomes from euploid frozen blastocyst transfers after OCP primed antagonist cycles compared to estradiol pretreatment. In fact, the use of OCP pretreatment was associated with increased oocyte yield, keeping in mind demographic differences with the OCP pretreatment group being younger with higher anti-Müllerian hormone and a higher prevalence of PCOS. Thus, OCP priming should still be considered in specific populations, such as those with oligo-ovulation or adequate ovarian reserve.

Assisted reproductive technology in Japan: A summary report for 2021 by the Ethics Committee of the Japan Society of Obstetrics and Gynecology.

The Japan Society of Obstetrics and Gynecology (JSOG) registry gathers comprehensive data from registered assisted reproductive technology (ART) facilities in Japan. Herein, we report 2021 ART cycle characteristics and outcomes. Descriptive statistics were used to summarize and analyze 2021 data. In 2021, 625 ART facilities participated in the registry; 27 facilities did not conduct ART cycles and 598 registered treatment cycles. In total, 498 140 cycles were registered, and there were 69 797 neonates (increases of 10.7% and 15.5%, respectively, from the previous year). The number of freeze-all invitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycles decreased in 2021; the number of neonates born was 2268 for IVF-embryo transfer (ET) cycles and 2850 for ICSI cycles. Frozen-thawed ET (FET) cycles increased markedly from 2020 (11.2% increase). In 2021, 239 428 FET cycles were conducted, resulting in 87 174 pregnancies and 64 679 neonates. For fresh transfers, the total single ET, singleton pregnancy rate, and singleton live birth rates were 82.7%, 97.0%, and 97.3%; for FET, these rates were 84.9%, 96.9%, and 97.1%. The 2021 Japanese ART registry analysis showed marked increases in both total treatment cycles and live births from the previous year.

Sperm Donors’ Identity Disclosure: Is It REALLY Crucial? For Whom?

ObjectiveTo study the preference of sperm donors with identity disclosure (ID) versus anonymous donors (AD) and to understand if this selection affects clinical outcomes in an Israeli population. MethodsThis retrospective study included patients who chose imported sperm donation during 2017–2021. Of these, 526 used their own (autologous) oocytes and 43 patients used donated oocytes (DO). The primary endpoint was the type of chosen donor with ID versus AD. We examined the tendency toward ID according to demographic parameters and the theoretical impact of donor-type selection on reproductive outcome and compared patients who performed cycles with autologous oocytes with those using DO. ResultsSingle women had a significantly higher probability of choosing sperm donors with ID than heterosexual couples (55.6% vs. 33.3%, OR 2.5, CI 95% 1.52–4.11, P < 0.001). Although not significant, same-sex couples were more likely to choose sperm donors with ID than heterosexual couples (49.1% vs. 33.3%, OR 1.93, CI 95% 0.97–3.85, P = 0.06). Sperm donor samples, 2501 vials, were imported. It was performed 698 intra-uterine insemination and 812 in vitro fertilization cycles were performed, respectively, resulting in 283 pregnancies without differences between patients who chose sperm donors with ID versus AD sperm. No significant differences were observed regarding the option for sperm donors with ID between patients using DO (44.2%) and those using autologous oocytes (51.3%). ConclusionWhile ID is important for a certain section (mainly single) of recipients, it is far from the only dominant factor during donor selection. Sperm donation type does not impact clinical outcomes.

Ovarian response determines the luteinizing hormone suppression threshold for patients following the gonadotrophin releasing hormone antagonist protocol: A retrospective cohort study

BackgroundOvarian reactivity to gonadotrophin stimulation varies, and individual adjustments to the timing and dose of gonadotrophin-releasing hormone (GnRH) antagonist administration are necessary to prevent excessive increases and decreases in luteinizing hormone (LH) levels in patients with different ovarian response following the GnRH antagonist (GnRH-A) protocol. The present study aims to investigate optimal LH suppression thresholds for patients with normal ovarian response (NOR), high ovarian response (HOR), and poor ovarian response (POR) following the GnRH-A protocol respectively. MethodsA total of 865 in vitro fertilization (IVF) cycles using a flexible or fixed GnRH-A protocol were included. Patients were categorized into the HOR, NOR, or POR group according to their anti-Müllerian hormone (AMH) levels. Then, patients in each group were stratified into one of four subgroups according to the quartile (Q1-Q4) of the basal LH level to LH on triggering day ratio (bLH/hLH). The primary outcomes were the clinical pregnancy and live birth rates, and the secondary outcomes were the number of oocytes retrieved, MII oocytes, two pronucleus (2PN) embryos, and good-quality embryos. ResultsThere were 526 patients with NOR, 180 with HOR, and 159 with POR. Basal LH level, LH on triggering day and bLH/hLH were identified as independent predictors of clinical pregnancy rate and live birth rate by logistics regression analysis. Compared to those with NOR, patients with POR had the lowest embryo implantation rate (22.6% vs. 32.8%, P < 0.05), clinical pregnancy rate (32.3% vs. 47.3%, P < 0.05) and live birth rate (22.6 vs. 37.8%, P < 0.05) of fresh embryo transfer (ET). The embryo implantation, clinical pregnancy and live birth rates of frozen embryo transfer (FET) were not significantly different among the three groups. In the subgroup analysis, patients with HOR had the highest embryo implantation rate (51.6%, P < 0.05), clinical pregnancy rate (68.4%, P < 0.05) and live birth rate (52.6%, P < 0.05) of ET in Q3, with a bLH/hLH ratio of 2.40–3.69. In the NOR group, the embryo implantation rate (41.9%, P < 0.05), clinical pregnancy rate (61.5%, P < 0.05) and live birth rate (50.8%, P < 0.05) of ET and live birth rate (53.1%, P < 0.05) of FET were highest in Q2, with a bLH/hLH ratio of 1.29–2.05. Patients with POR had the highest clinical pregnancy rate (57.1%, P < 0.05) and live birth rate (42.9%, P < 0.05) of ET in Q2, with a bLH/hLH ratio of 0.86–1.35. ConclusionsIn the present study, the bLH/hLH ratio represented the LH suppression threshold. The subgroup analysis of HOR, NOR and POR showed that, the LH suppression threshold varies according to ovarian response. We recommend LH suppression thresholds of 2.40–3.69 for HOR, 1.29–2.05 for NOR, and 0.86–1.35 for POR to obtain the highest clinical pregnancy rate and live birth rate. This study provides comprehensive and precise references for clinicians to monitor LH levels individually during controlled ovarian stimulation (COS) according to the patient’s ovarian response following the GnRH-A protocol.

Interdisciplinary study of the medium-term fertility trend in Latvia (1970-2022)

The article aims at identifying the medium-term fertility trend in Latvia. The main research question is whether it is possible in the near future to increase fertility in Latvia, as planned in the “Strategy for the Reproduction of the Nation FAMILY - LATVIA - 2030 (2050)”. The authors conducted the mathematical analysis of fertility in Latvia for the medium-term period of 1970-2022 (53 years), which includes two decades of the so-called “Soviet era” and the period of independence after the collapse of the USSR. The study is based on the available data of the official Latvian statistics on the total fertility rate. The novelty of this interdisciplinary - demographic, economic and sociological - study is determined by the use of mathematical analysis to identify demographic trends, which is not typical for the publications of Latvian and foreign researchers. The study is also based on the theory of economic cycles to identify demographic fertility cycles and their phases in Latvia and to predict fertility rates in Latvia for the near future. Furthermore, the analysis of the sociological surveys data allowed to understand the main reason for the steady - in the medium-term perspective - linear decline in fertility in Latvia. This reason is value changes in the society, in which children are no longer at the center of the life value system of men and especially women in Latvia, i.e., are no longer considered necessary for the realization of their life goals and ambitions. Based on the results of the mathematical analysis of the medium-term fertility trend in Latvia, the authors believe that the decline in fertility in Latvia will continue for several more years before the bottom of the next demographic fertility cycle will be reached (and this bottom will be lower than the previous one, i.e., below 1.22 -1.25), and there will be an upturn in a linearly declining fertility trend. However, even this expected rise will not reach the previous peak; the next peak is likely to be below 1.74. Thus, the desired and even expected by the creators of the “Strategy for the Reproduction of the Nation” increase in fertility in Latvia to the level of 1.77 by 2027 is considered by the authors unattainable.

The assessment of educational and supportive care to the infertile females undergoes In Vitro Fertilization procedure by clinical pharmacist: a randomized clinical trial

Background Infertility affects approximately 10-15% of married individuals, and may trigger various emotional reactions. Females undergoing in vitro fertilization (IVF) are more susceptible to experiencing depression. This study aims to assess the influence of pharmacist counseling on quality of life, depression scores, and pregnancy rates among infertile females undergoing IVF treatment. Method The research examined women who visited the infertility clinic at Kamal Al-Samaraie Hospital in Baghdad, Iraq to achieve pregnancy. These individuals were separated into a control group and an intervention group. The intervention group received an educational program consisting of five visits, while the control group got a conventional hospital procedure. The present research evaluated the quality of life-related to fertility using the FertiQoL (Fertility Quality of Life) questionnaire. It examined the participants’ depression levels using the CES-D (Center for Epidemiologic Studies Depression) scale. These assessments were conducted at the commencement and conclusion of the in vitro fertilization (IVF) cycle. Results The present research included 150 women diagnosed with infertility, whose average age was 30.32 ± 5.64 years. The participants had a mean body mass index (BMI) of 27.12 ± 3.57. No statistically significant difference was seen in the FertiQoL evaluation scores between the control and intervention groups at the beginning of the study. The FertiQoL, assessed at the end of the trial, exhibited a statistically significant increase in the interventional group, with a P-value of 0.025. The prevalence of Depression risk patients decreased from 83% to 69%, and the interventional group exhibited a substantially greater proportion of favorable pregnancy outcomes (48%) compared to the control group (29.3%). Conclusion Infertile women who undergo IVF operations have higher rates of depression. Depression may be reduced, and quality of life improved with education and supportive counseling. Pregnancy rates rise as a result of clinical pharmacist counseling. Trial registration This study was registered on Clinical Trials.gov (NCT06022640).

The effect of laparoscopic ovarian drilling on pregnancy outcomes in polycystic ovary syndrome women with more than 2 in-vitro fertilization cycle failures: A pilot RCT.

Background: The effect of laparoscopic ovarian drilling (LOD) before in vitro fertilization/ intracytoplasmic sperm injection (IVF/ICSI) cycles on pregnancy outcomes is an unclear and challenging subject. Objective: To evaluate the impact of LOD before IVF/ICSI cycles on controlled ovarian stimulation and pregnancy outcomes in polycystic ovary syndrome (PCOS) women with a history of more than 2 IVF failures. Materials and Methods: In this randomized clinical trial, women with PCOS diagnosis who referred to Arash Women's hospital, Tehran, Iran for IVF/ICSI cycle from August 2015-January 2018 were evaluated. Eligible participants were allocated into 2 groups randomly (n = 17/each group). The participants in the LOD group (intervention) were treated with laparoscopic couture, and after one month, they underwent IVF/ICSI cycles using the gonadotropin-releasing hormone antagonist protocol. The control group had no intervention. The oocyte and embryo qualities, ovarian hyperstimulation syndrome rate, the rates of chemical and clinical pregnancy and early miscarriage, live birth, and pregnancy complications, were compared between groups. Results: Finally, 34 participants were evaluated. The controlled ovarian stimulation outcomes were similar between groups. The ovarian hyperstimulation syndrome rate in the LOD group was significantly lower than in the control group (p = 0.04). One case of spontaneous pregnancy was reported in the LOD group. No significant difference was observed between groups in clinical pregnancy, miscarriage, and live birth rates. The rates of pregnancy complications (gestational diabetes mellitus, preeclampsia, and preterm birth) were similar between groups. Conclusion: Performing LOD before IVF/ICSI cycles did not improve the pregnancy outcomes in PCOS women, a clinical trial with a larger sample size is needed to prove these results.

Human Chorionic Gonadotropin Trigger Day Progesterone to Oocyte Ratio Predicts Pregnancy Outcomes of In Vitro Fertilization Cycles: A Retrospective Cohort Study and Literature Review

Human Chorionic Gonadotropin Trigger Day Progesterone to Oocyte Ratio Predicts Pregnancy Outcomes of In Vitro Fertilization Cycles: A Retrospective Cohort Study and Literature Review

#104 : Live Birth Rate After Preimplantation Genetic Testing for Monogenic Disorders (PGT-M) for Thalassemia in Vietnamese Patients

Background and Aims: Thalassemia is a hereditary blood disorder with diverse clinical manifestation inherited by autosomal recessive manner which affected 1.5% of the population. Clinically, there are two major forms: [Formula: see text]-thalassemia and [Formula: see text]-thalassemia. Palliative treatment of the severe forms by blood transfusion is eventually compromised by the concomitant problems of iron overload, alloimmunization, and bloodborne infections. In Vietnam, there are approximately 13.8% cases of thalassemia carriers in the entire population. PGT-M aims to characterize the genetic status of embryos resulting from in vitro fertilization (IVF) cycles. Herein, we report the clinical outcome of using PGT-M in couples who are thalassemia carriers. Methods: This was a case series report conducted at IVFMD, My Duc Hospital, Vietnam between April 2019 and April 2022. A total of 38 couples who underwent IVF cycle in combination with PGT-M were enrolled in this study. Trophectoderm biopsy samples undergone whole-genome amplification, followed by next-generation sequencing (NGS) via the MiSeq platform for aneuploidy screening. Specific-targeted genes were performed for thalassemia detection in the next step. Results: PGT-M was performed on a total of 128 blastocysts from 38 couples. Among 128 blastocysts, 92 (71.9%) were euploid. The rate of unaffected blastocysts was 38.0% and heterozygous blastocysts was 27.2% among euploid blastocysts. Single blastocyst transfer was performed in 30 couples and underwent 34 cycles. The clinical pregnancy rate was 50.0% and the overall live birth rate was 41.2%. Conclusion: Data from this study showed a favorable live birth rate after PGT-M for thalassemia. We should encourage carrier couples to undergo PGT-M to eliminate the transfer of this disorder through the next generation.

#40 : Correlation Between Pre-Trigger Estradiol Levels and the Number of Mature Oocytes in Patients Who Underwent In Vitro Fertilization

Background and Aims: Strong association between pre-trigger estradiol levels on the day of human Chorionic Gonadotropin (hCG) administration and the number of mature oocytes retrieved was widely reported. Consequently, higher estradiol levels measured might give a prediction of the higher number of mature oocytes retrieved on Ovum Pick Up (OPU) procedure. This study was done to investigate the correlation between pre-trigger estradiol levels and number of mature oocytes retrieved in patients who underwent In Vitro Fertilization (IVF) cycles in Indonesian population. Method: A cross sectional study was done at Mbrio IVF Clinic, Mitra Keluarga Hospital Kelapa Gading, Jakarta, Indonesia. Data was collected from the medical records of 77 patients who underwent IVF cycles between September 2021 and March 2023. The level of estradiol on the hCG administration day and the number of mature oocytes retrieved were analysed to find any correlation between both variables using the Spearman Test. Results: There were 77 women who underwent IVF procedures with the age range between 27 and 45-year-old (mean 35,5 ± 4,52). Most of them (83%) had primary infertility and had infertility between 1 to 14 years (mean 5,5 ± 3,48). These subjects came to the clinic mostly due to both male and female factors (49,4%), followed by male factor only (27,3%). E2 on hCG day ranged between 194 to 13.000 pg/ml with the median 2.709 pg/ml, and the mature oocytes retrieved ranged between 0 and 31 with a median of 8 oocytes. A statistically significant correlation (r = 0.827; p&lt;0.01) was found between the estradiol level and mature oocytes retrieved. Conclusion: Pre-trigger Estradiol level can be used as a predictor for the number of mature oocytes retrieved in IVF cycle as these two variables are strongly correlated to each other. A multi-centre study with larger sample size is needed to validate current data.

#167 : Role of Endometrial Receptivity Using 3D Doppler Ultrasound on Pregnancy Outcome of IVF-FET Cycles

Background: The success of in vitro fertilization and embryo transfer (IVF-ET) cycles depends primarily on the quality of the embryo and the receptivity of the uterus. In addition to embryo quality the receptivity of the endometrium plays a role in the implantation process. Uterine receptivity is widely accepted as one of the main limiting factors in IVF outcomes. Endometrial thickness and endometrial pattern have been regarded as indicators for endometrial receptivity. Objective: To compare the ultra-sonographic endometrial characteristic in relation to blood flow on Doppler between pregnant and non-pregnant groups of FET patients in IVF/ ICSI cycles. Methods: This cross-sectional study is approved by the Institutional Ethical Committee (IEC) of Hameed Latif Hospital. Our study consists of 200 women who have come for FET cycle. On 18th day of period cycle, endometrial thickness, resistance index was obtained by transvaginal sonography. In the combined analysis, endometrial thickness groups (group 1: &lt;9 mm; group 2: [Formula: see text]9 mm) were subdivided into two endometrial patterns (triple-line and diffused). The women were divided into the [Formula: see text]-HCG positive and [Formula: see text]-HCG negative groups. For statistical analysis chi-square and Fisher’s exact tests was used. Multiple logistic regression analysis and the receiver operating characteristic (ROC) curve analysis were applied to determine the best predictive variables. Results: The women in [Formula: see text]-HCG positive group were significantly younger as compared to [Formula: see text]-HCG negative group. Endometrial thickness was ¿ 9mm and RI was lower in group 1. A significant association was found between endometrial pattern and pregnancy outcome. (p-value = 0.01. ROC curve revealed that for ultrasound parameters the area under the curve was around 0.5. Conclusion: Endometrium pattern and thickness and resistive index on Doppler may better predictor for pregnancy; combined endometrial characteristics do not predict outcomes.