Fertilization Cycles Research Articles

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<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: <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.

#201 : Comparison of the Sensitivity of Detecting Cervical Bacteria with Next Generation Sequencing and Third Generation Sequencing Technologies

Background and Aims: In in vitro fertilization (IVF) cycles, some patients suffering with vaginosis showed poor reproductive outcome even transferring with good quality embryos. The aim of this pilot study was to evaluate whether the species of Lactobacillus could be detected by next generation sequencing (NGS) and Third generation sequencing (TGS). Method: 18 Patients aged 32–48 years-old who visited our fertility center from February 2021 to June 2022 with previous failure of transfer cycle were included. Exclusion criteria was antibiotic treatment within 3 months prior to enrolment. Genomic DNA of cervical microbiota taken from Cervico vaginal swabs in all patients were extracted and amplified. NGS was performed following the protocol of Ion 16S Metagenomics Kit by detecting V2–4–8 and V3–6, 7–9 regions of 16S. Amplicons were sequenced with Ion GeneStudio S5 Prime System. For TGS, full length of 16S was sequenced with Single Molecule, Real-Time (SMRT) Sequencing (Pacific Biosciences) and analyzed. Results: All of the 18 cervical samples could be amplified with V2–4–8 and V3–6, 7–9 primers and the genus could be 100% identified by NGS. However, most of the Lactobacillus includes L. crispatus, L. jensenii. and L. gasseri showed indistinguishable except of L. iners. On the other hand, TGS clearly identified all Lactobacillus. For Gardnerella, Atopobium and Prevotella, TGS and NGS showed equivalent sensitivity in genus level. However, due to the sequence similarity, Escherichia/Shigella could not be identified from the Lactobacillus. Conclusion: In this report, we aim to compare the sensitivity of detecting bacteria by 16S amplification method. Preliminary results suggest that NGS can distinguish bacterium causes vaginosis in genus level, but there might be misleading if the existence of pathogen such as Escherichia/Shigella. Till now, TGS still exhibits the best sensitivity for distinguish Lactobacillus in species level.

#244 : Reproductive Outcomes of Conventional In Vitro Fertilization and Intracytoplasmic Sperm Injection in Patients with Non-Severe Male Infertility Across Poor and Different Suboptimal Ovarian Response Categories

Background and Aims: For non-severe male factor infertility patients with poor and sub-optimal ovarian response, are there any differences in reproduction outcomes between IVF (in vitro fertilization) and ICSI (intracytoplasmic sperm injection) methods? Methods: Retrospective cohort study. Patients with non-severe male infertility and poor ovarian response who underwent in vitro fertilization or intracytoplasmic sperm injection at the Center for Reproductive Medicine, Peking University Third Hospital between 2009 and 2019 were included in this study (n = 30,352). Results: In all groups, intracytoplasmic sperm injection cycles involved older patients and a longer duration of infertility, while body mass index, AMH, and bFSH levels were similar. Independent of the number of oocytes retrieved, intracytoplasmic sperm injection significantly increased the fertilization rate, while in vitro fertilization cycles showed a higher implantation rate, clinical pregnancy rate, and live birth rate. No differences were observed in most obstetric outcomes, including abortion, early abortion, multiple fetus, cesarean delivery, gestational age, and congenital malformations rates. However, in vitro fertilization cycles showed higher preterm delivery rates and lower birth weights in groups with 4-6, and 7-9 oocytes retrieved. A higher female/male infant ratio was observed in intracytoplasmic sperm injection cycles when 4-6 oocytes were retrieved. Conclusions: In patients with non-severe male infertility and poor or suboptimal ovarian response, even if intracytoplasmic sperm injection increased the fertilization rate, in vitro fertilization exhibited significant advantages in implantation, clinical pregnancy, and live birth rates. Our study indicates that poor ovarian response is not an indication for intracytoplasmic sperm injection in couples with non-severe male infertility.

Embryonic, genetic and clinical outcomes of fresh versus vitrified oocyte: A retrospective cohort study

Objective: To compare embryonic development, ploidy status and clinical outcomes between fresh and frozen-thawed oocytes. Methods: This retrospective cohort study evaluated 83 fertilization cycles including both fresh and frozen oocytes from 79 patients at the HP Fertility Center of Hai Phong International Hospital of Obstetrics and Pediatrics in Vietnam. The patient underwent several ovarian stimulation cycles to accumulate a certain number of oocytes that would be vitrified. In the last oocyte retrieval, all patient's oocytes including both frozen and fresh would be fertilized. The outcomes included the rates of oocyte survival, cleavage embryo, blastocyst, ploidy status, pregnancy, biochemical pregnancy and clinical pregnancy. Results: The oocyte survival rate after thawing was 96.5%. No statistically significant difference was found when comparing fresh and frozen oocytes regarding fertilization rate (78.1% vs. 75.5%, P=0.461), usable cleavage embryo rate (86.9% vs. 87.2%, P=0.916) but usable blastocyst rate was found higher statistically in the frozen oocyte group (44.4% vs. 54.0%, P=0.049). The percentages of euploid, aneuploid and mosaic embryos between the fresh group and the vitrified group had no significant differences (33.8% vs. 31.6%, P=0.682; 51.0% vs. 54.2%, P=0.569; 15.2% vs. 12.4%, P=0.787; respectively). The rates of pregnancy, biochemical pregnancy and clinical pregnancy had no statistical difference (68.8% vs. 64.8%, P=0.764; 12.5% vs. 3.6%, P=0.258; 37.5% vs. 46.4%, P=0.565). 17 Mature oocytes are the minimum to have at least one euploid embryo. Conclusions: Oocyte vitrification does not affect embryonic, genetic and clinical results. The number of mature oocytes should be considered for fertilization in some cases.

The Impact of Endometriosis on Intracellular Calcium Levels, Cyclic Dependent Kinase 1 (Cdk1) Expression, and Cyclin B Expression in Post-Ovulation Oocytes of Mice Model.

Since endometriosis causes a decrease in oocyte quality, the success rate of in vitro fertilization cycles decreases. The purpose of the current study was to analyze the effect of endometriosis on intracellular calcium levels, Cdk1 expression, and cyclin B expression in oocytes. Thirty-two mice (Mus musculus) were divided into control and endometriosis groups. The cumulus oocyte complex (COC) were obtained in all groups. Denudated cells were assessed for calcium levels by calorimetric examinations. Complex oocytes were examined for Cdk1 and cyclin B expression by immune-cytochemistry and were read under a microscope. Intercellular calcium levels, Cdk1, and cyclin B expression were significantly lower in the endometriosis group than in the control group. There was a significant relationship between calcium levels and Cdk1 expression (p<0.05, r=0.659), a significant relationship between calcium levels and cyclin B expression (p<0.05, r=0.885), and also a significant correlation between Cdk1 and cyclin B expression (p<0.05, r=0.537). The data presented in this study suggested that the intracellular oocyte calcium level, Cdk1 expression, and cyclin B expression were lower in mice with endometriosis. A positive correlation was observed between calcium levels and the expression of Cdk1 and cyclin B. Furthermore, a positive correlation was also found between Cdk1 and cyclin B expression.

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

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

Neighborhood deprivation and racial differences in in vitro fertilization outcomes

BACKGROUNDThere are significant racial disparities in in vitro fertilization outcomes, which are poorly explained by individual-level characteristics. Environmental factors such as neighborhood-level socioeconomic factors may contribute to disparities in in vitro fertilization outcomes; however, few studies have directly addressed this research question in a large, racially diverse cohort. OBJECTIVETo investigate whether neighborhood deprivation is associated with differences in in vitro fertilization outcomes. STUDY DESIGNOur retrospective cohort study included 1110 patients who underwent 2254 autologous in vitro fertilization cycles between 2014 and 2019 at an academic fertility center in the Southeastern United States. Neighborhood deprivation was estimated using the neighborhood deprivation index, a composite variable measuring community levels of material capital based off poverty, occupation, housing, and education domains. Using multivariable log-binomial generalized estimating equations with cluster weighting, risk ratios (RR) and 95% confidence intervals (CI) were estimated for cycle cancellation, miscarriage (defined as spontaneous pregnancy loss before twenty weeks after a confirmed intrauterine gestation), and live birth according to patient neighborhood deprivation index. RESULTSThere were positive associations between increasing neighborhood deprivation index (indicating worsening neighborhood deprivation) and body mass index, as well as increasing prevalence of tubal and uterine factor infertility diagnoses. The crude probability of live birth per cycle was lower in Black (24%) versus White patients (32%) and the crude probability of miscarriage per clinical pregnancy was elevated in Black (22%) as compared to White patients (12%). After adjustment, neighborhood deprivation index was not significantly associated with risk of cycle cancellation or live birth. Results were consistent when analyses were stratified by race. CONCLUSIONOur research demonstrates racial disparities between Black and White women in the incidence of miscarriage and live birth following in vitro fertilization. While level of neighborhood deprivation was closely related to race, it did not have strong associations with in vitro fertilization outcomes in our population as a whole or within strata of race.

What moral weight should patient-led demand have in clinical decisions about assisted reproductive technologies?

Evidence suggests that one reason doctors provide certain interventions in assisted reproductive technologies (ART) is because of patient demand. This is particularly the case when it comes to unproven interventions such as 'add-ons' to in vitro fertilisation (IVF) cycles, or providing IVF cycles that are highly unlikely to succeed. Doctors tend to accede to demands for such interventions because patients are willing to do and pay 'whatever it takes' to have a baby. However, there is uncertainty as to what moral weight should be placed on patient-led demands in ART, including whether it is acceptable for such demands to be invoked as a justification for intervention. We address this issue in this paper. We start by elucidating what we mean by 'patient-led demand' and synthesise some of the evidence for this phenomenon. We then argue that a doctor's professional role morality (PRM) yields special responsibilities, particularly in commercialised healthcare settings such as ART, because of the nature of professions as social institutions that are distinct from markets. We argue on this basis that, while there may be reasons (consistent with PRM) for doctors to accede to patient demand, this is not always the case. There is often a gap in justification between acceding to patient-led demands and providing contested interventions, particularly in commercial settings. As a result, acceding to demand in such settings needs a strong justification to be consistent with PRM.

The relationship between microbial contaminations of embryo transfer catheters with pregnancy outcome after embryo transfer.

Different stages of assisted reproductive technologies are susceptible to contamination by various microorganisms. The aim of the study was to investigate the relationship between microbial contamination of embryo transfer catheters and the pregnancy outcome after embryo transfer. This cohort study was conducted on 60 patients candied for in vitro fertilization and embryo transfer cycles from 2021 to 2022. All embryos were transferred using a sterile syringe. The catheter contamination was checked by the microbial culture method, and in the case of microbial culture that were negative, polymerase chain reaction was done to confirm the result. The data analyzed using STATA 17 to determine the impact of catheter contamination on the clinical pregnancy rate. The average age of peoples whose microbial culture was positive was lower than that of people whose microbial culture was negative (P<0.05). Also the results showed that people who live in villages have more positive microbial cultures than people who live in cities (P<0.05). Also there is no difference between the number of successful implantations and the pregnancy outcome between people whose microbial culture results were positive or negative. The results of the current study showed that the contamination of the embryo transfer catheter with microorganisms under our investigation did not affect the pregnancy outcome.

Effect of extra-low dose levothyroxine supplementation on pregnancy outcomes in women with subclinical hypothyroidism undergoing in vitro fertilization and embryo transfer

ObjectiveThis study was undertaken to test the therapeutic effect of extra-low dose of levothyroxine (LT4; 25 mcg/day) to preconception and pregnant women with subclinical hypothyroidism (SCH). Materials and methodsThis is a retrospective study, SCH women who succeeded in their first in vitro fertilization (IVF) cycle between January 1, 2018, to December 31, 2020 were included. SCH is defined as normal serum free thyroxine (T4) level and an elevated serum thyroid stimulating hormone (TSH) level >4 mIU/L. Extra-low dose of levothyroxine (LT4; 25 mcg/day) was prescribed to the SCH women from the establish of diagnosis of SCH to the end of pregnancy. The pregnancy outcomes (miscarriage, live birth, preterm birth, and small for gestational age baby) were compared to the euthyroid pregnant women. ResultsTotally, 589 women were screened, and 317 cases received their first time IVF treatment. 167 women were clinically pregnant after IVF treatment, 155 of them were euthyroid and 12 of these women were diagnosed to have SCH. The average age of the participants was 35 years old. There were no significant differences in age, body mass index (BMI), anti-müllerian hormone (AMH), types of embryo transfer, number of embryos to transfer, or embryo stage during transfer between two groups. The live birth rate, miscarriage rate, and preterm birth rate in women with SCH supplemented with extra-low dose of LT4 were non-inferior to euthyroid patients (miscarriage rate: P = 0.7112; live birth rate: P = 0.7028; preterm delivery: P = 0.2419; small for gestational age: P = 0.2419). ConclusionOur result demonstrated that supplementation with extra-low dose of levothyroxine at 25 mcg/day to SCH women can produce the comparable obstetrical and neonatal outcome as that in euthyroid pregnant women. Accordingly, we suggest extra-low-dose of levothyroxine may be considered as a safe and effective alternative for those SCH pregnant women who were not tolerated to the standard dose of levothyroxine.

Compared With Conventional Insemination, Intracytoplasmic Sperm Injection Provides No Benefit in Cases of Nonmale Factor Infertility as Evidenced by Comparable Euploidy Rate

(Abstracted from Fertil Steril 2023;120(2)) Intracytoplasmic sperm injection (ICSI) has dramatically improved fertilization rates for couples with male factor infertility and those with prior failed in vitro fertilization (IVF) cycles. Although several international academic organizations and the cumulative evidence do not suggest the routine use of ICSI for nonmale factor infertility, it is now used frequently for all cases of IVF regardless of the indication.

The relationship between basal serum dehydroepiandrosterone sulfate (DHEAS) levels and the response to ovarian stimulation in in-vitro fertilization cycles

The relationship between basal serum dehydroepiandrosterone sulfate (DHEAS) levels and the response to ovarian stimulation in in-vitro fertilization cycles

Artificial intelligence in time-lapse system: advances, applications, and future perspectives in reproductive medicine.

With the rising demand for in vitro fertilization (IVF) cycles, there is a growing need for innovative techniques to optimize procedure outcomes. One such technique is time-lapse system (TLS) for embryo incubation, which minimizes environmental changes in the embryo culture process. TLS also significantly advances predicting embryo quality, a crucial determinant of IVF cycle success. However, the current subjective nature of embryo assessments is due to inter- and intra-observer subjectivity, resulting in highly variable results. To address this challenge, reproductive medicine has gradually turned to artificial intelligence (AI) to establish a standardized and objective approach, aiming to achieve higher success rates. Extensive research is underway investigating the utilization of AI in TLS to predict multiple outcomes. These studies explore the application of popular AI algorithms, their specific implementations, and the achieved advancements in TLS. This review aims to provide an overview of the advances in AI algorithms and their particular applications within the context of TLS and the potential challenges and opportunities for further advancements in reproductive medicine.

Number of Available Embryos: A Prediction Tool for Analyzing the Effect of Sperm DNA Fragmentation on Pregnancy Outcome of Patients Undergoing IVF Cycles from Embryology

Sperm DNA fragmentation (SDF) can affect the pregnancy outcome of assisted reproduction technology. The cumulative live birth rate (CLBR), a new parameter of pregnancy outcome, attracts the attention of researchers to study the effect of SDF on CLBR. This study will focus on whether the number of available embryos (AEN) can be used as a predictor to investigate the effect of SDF on CLBR of in vitro fertilization (IVF) cycles. Our study included 1,347 couples who underwent IVF cycles and detected their SDF results by the sperm chromatin structure assay. Subsequently, CLBR and AEN on Day 3 were examined and compared between the SDF ≤ 30% and SDF &gt; 30% group. The finding by the correlation analysis showed a strong correlation in CLBR and AEN, suggesting that AEN can be used as a predictor of CLBR. When comparing the two groups, significant differences were noticed in CLBR (81.1% vs. 71.5%, P = 0.009 ) and AEN (8.10 ± 4.43 vs. 7.21 ± 4.27, P = 0.021 ), revealing that SDF has an influence on both indicators. The results of the covariance analysis suggested that the available embryo rate per maturity oocyte was higher in the SDF ≤ 30% group, and the embryologic parameters showed a significant difference in the available embryo formation rate on Day 3, but not in the fertilization and cleavage rates, suggesting that SDF reduced the quality of embryos, which did not reach the morphological standard of the available embryos, and further reduced AEN and CLBR in the IVF cycles.

High-DNA Stainability Is Not Related to Embryonic Development and Clinical Outcomes on In Vitro Fertilization Cycles: A Retrospective Study Using a Propensity Score-Matching Analysis

The high-DNA stainability (HDS) might be an indicator for the detection of sperm chromatin decondensation structure resulting from the incomplete histone-to-protamine exchange. The aim of our study was to investigate the association of HDS with embryonic development and clinical outcomes after in vitro fertilization (IVF) treatment. Couples underwent IVF cycles from January 2016 to December 2020 were retrospectively studied, including a total of 2,604 target couples undergoing IVF treatment and 628 couples undergoing fresh IVF-embryo transplantation (IVF-ET) treatment. Couples were divided into HDS &gt; 15% group and HDS ≤ 15% group according to HDS levels. After controlling the bias between groups using the propensity score-matching method, data of embryonic development, and clinical outcomes were analyzed. No significant differences were observed between HDS &gt; 15% group and HDS ≤ 15% group regarding fertilization rate (83.33% vs. 84.62%,P=0.349), two pronuclei rate (81.82% vs. 83.33%,P=0.613), cleavage rate (100.00% vs. 100.00%,P=0.172), and high-quality embryo rate (60.00% vs. 60.00%,P=0.961). Linear regression analysis showed that HDS was negatively associated with fertilization rate (B value = −0.094, 95% CI: −0.184 to −0.005,P=0.039), whereas no correlation (adjusted B value = −0.081, 95% CI: −0.170 to 0.008,P=0.074) was observed after adjusting potential confounding factors. The clinical pregnancy rate (62.11% vs. 60.39%,P=0.699), ongoing pregnancy rate (52.17% vs. 53.10%,P=0.838), early miscarriage rate (9.94% vs. 7.28%,P=0.283), late miscarriage rate (0.62% vs. 2.14%,P=0.305), and live birth rate (51.55% vs. 50.96%,P=0.838) were not significantly different between groups. Binary logistic regression analysis showed that HDS levels did not affect clinical outcomes after fresh IVF-ET treatments. HDS was not significantly associated with embryonic development and clinical outcomes of IVF. Our findings suggested that HDS evaluation before IVF treatment might be with limited potential to predict embryo development and clinical outcomes.

Oocyte in-vitro maturation primed with letrozole-HCG versus FSH-HCG in women with oocyte maturation abnormalities: a retrospective study

Research QuestionThe objective of this study was to compare letrozole-hCG primed IVM with FSH-hCG primed IVM in women with oocyte maturation abnormalities (OMAs) defined as at least two failed in vitro fertilization (IVF) cycles where immature oocytes were retrieved. DesignThis retrospective study was conducted at a private fertility clinic from January 2009 to April 2023. The final analysis included 75 women in Group 1 (FSH-hCG primed IVM) and 52 women in Group 2 (letrozole-hCG IVM). Result(s)Group 1 demonstrated a significantly higher median number of oocytes obtained [9, (IQR: 1-5) vs. 5 (IQR: 1-18)] (p<0.001). However, the groups had no differences in oocyte maturation stages at collection (p>0.05). At the end of IVM, group 1 had 73/666 mature oocytes, while group 2 had 106/322 mature oocytes, and the median MII oocyte rate per patient was higher in group 2 [33.3%, (IQR: 66.7-100.0%) vs. 0.0%, (IQR: 0.0-22.2%)] (p<0.001). Moreover, Group 2 demonstrated a higher median fertilization rate [66.7%, (IQR: 50.0-100.0%) vs. 50.0%, (IQR: 0.0-66.7%)] (p=0.027). The group 2 had a higher proportion of Grade 1 (17.1% vs. 0%) and Grade 2 (58.5% vs. 6.3%) embryos (p<0.001). Notably, all pregnancies obtained in the study were in Group 2 (5 vs. 0; p=0.042). Conclusion(s)IVM with Letrozole-hCG priming in women with prior failed IVF cycles due to OMAs may result in mature oocytes, clinical pregnancies, and live births. The effectiveness of letrozole priming IVM on the subtypes of OMAs need further investigation with studies including higher number of cases.

Ozone sauna therapy and pulsed electromagnetic field therapy could potentially improve outcome in women with diminished ovarian reserve undergoing assisted reproductive technology.

There are limited treatment options for women with severely diminished ovarian reserve (DOR) who experience repeatedly failed in vitro fertilization (IVF) cycles and with persistently thin endometrial lining thickness (EMT) during frozen embryo transfer cycles. Therefore, a large majority of patients resort to using donor oocytes and gestational carriers. Data from existing animal and human studies suggest that ozone sauna therapy (OST) and pulsed electromagnetic field therapy (PEMF) are emerging as potential therapeutic adjuncts for female reproduction. This study was conducted to assess the fertility outcome of OST + PEMF in vivo in patients undergoing IVF/frozen embryo transfe and the effects of OST in vitro on human granulosa cell (GC) function. Forty-four women with DOR underwent their 1st IVF cycle (Cycle 1), and then were administered transdermal and intravaginal OST + PEMF, twice a week for 3 weeks, followed by a 2nd IVF cycle (Cycle 2) using the same protocol as in Cycle 1. GCs collected from another six women who underwent egg retrieval were equally split and cultured with OST (test) or placed in room temperature (control) outside the OST chamber in the same room. The results demonstrated that Cycles 1 and 2 had no significant difference in the number of days of stimulation, baseline hormones measured, number of oocytes retrieved or peak estradiol levels. However, the number of embryos formed after OST + PEMF in Cycle 2 was significantly higher than the Cycle 1. Furthermore, EMT measured in Cycle 2 demonstrated a significant increase compared to Cycle 1 and all patients reached a satisfactory EMT of approximately 7 mm. In vitro studies demonstrated that OST led to a 5-fold significant increase in the aromatase enzyme while a significant 50% reduction was noted in the side-chain cleavage enzyme in GCs. Both OST + PEMF are known for their vasodilatory, anti-inflammatory, and antioxidant actions, which could enhance endometrial receptivity and increase the number of formed embryos without increasing the number of oocytes retrieved, suggesting an improvement in oocyte quality. Finally, ozone can alter genes involved in steroidogenesis suggesting that it could improve ovarian function.