First Cycle Of In Vitro Fertilization Research Articles

A Controversial Old Topic Revisited: Should Diagnostic Hysteroscopy Be Routinely Performed prior to the First IVF Cycle? A Systematic Review and Updated Meta-analysis

This systematic review and meta-analysis aimed to analyze the impact of performing diagnostic hysteroscopy before the first in vitro fertilization (IVF) cycle on the clinical pregnancy rate and live birth. PubMed-MEDLINE, Embase, Web of Science, The Cochrane Library, Gynecology and Fertility Specialized Register of Controlled Trials, and Google Scholar were consulted from inception to June 2022 using combinations of the relevant Medical Subject Headings terms and keywords. The search included major clinical trial registries such as ClinicalTrials.gov and the European EudraCT registry without language restrictions. In addition, manual cross-reference searches were also performed. All randomized and controlled clinical trials, prospective and retrospective cohort studies, and case-control studies comparing the probability of pregnancy and live birth among patients who underwent diagnostic hysteroscopy with possible treatment of any abnormal findings before the IVF cycle and patients who underwent the IVF cycle directly have been considered for inclusion. Studies with insufficient information on the results of interest or without the necessary information to perform the pooled analysis, those without a control group or with end points considered different than those of interest, were excluded. The review protocol was registered in PROSPERO (CRD42022354764). A total of 12 studies were included in the quantitative synthesis, reporting the reproductive outcomes of 5056 patients undergoing ART treatment for the first time. Selected studies included 6 randomized controlled trials, 1 prospective cohort study, 3 retrospective cohort studies, and 2 case-control studies. The likelihood of clinical pregnancy of patients undergoing hysteroscopy before IVF was significantly higher than those without hysteroscopy (odds ratio [OR], 1.49; 95% confidence CI 1.16-1.91; I2 = 69%). (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.22-1.88; I2 59%). Eight studies included live birth rate; no statistically significant differences were found between the 2 groups for this outcome (OR,1.24; 95% CI, 0.94-1.64; I2 = 62%). Subsequently, a sensitivity analysis was performed, including only randomized clinical trials. Clinical pregnancy OR of patients undergoing hysteroscopy before starting the IVF cycle remained significantly higher than the control group (OR,1.62, 95% CI, 1.15-2.29; I2 = 62%). Risk of bias assessment was performed using the Grading of Recommendations Assessment, Development, and Evaluation. The available scientific evidence suggests that performing routine hysteroscopy before the first IVF attempt improves the clinical pregnancy rate; however, the live birth rate is unaffected.

Antimüllerian hormone is not associated with embryo ploidy in patients with and without infertility undergoing in vitro fertilization with preimplantation genetic testing

To assess the association between antimüllerian hormone (AMH) and embryo ploidy rates in 2 cohorts of patients undergoing invitro fertilization (IVF) with trophectoderm biopsy for preimplantation genetic testing for aneuploidy (PGT-A): the general population of women pursuing IVF with PGT-A (Infertile cohort) and women pursuing IVF with preimplantation genetic testing for monogenic disorders (PGT-M) owing to the risk of hereditary monogenic diseases (Non-infertile cohort). Retrospective cohort study. Academic center. Patients undergoing their first cycle of IVF with trophectoderm biopsy and PGT-A or PGT-A and PGT-M in our center between March 2012 and June 2020. Patients of advanced maternal age according to the Bologna criteria (age ≥40 years) and patients who underwent fresh embryo transfers were excluded. None. Proportion of euploid, mosaic, and aneuploid embryos per cycle. "Infertile" (n = 926) and "Non-infertile" (n = 214) patients were stratified on the basis of AMH levels, with low-AMH defined as <1.1 ng/mL in accordance with the Bologna criteria. Age-adjusted regression models showed no relationship between AMH classification and proportion of euploid, mosaic, and aneuploid embryos in the Infertile or Non-infertile cohorts. In the Infertile cohort, no association between AMH classification and embryo ploidy rates was identified in a subgroup analysis of patients aged <35 years, 35-37 years, and 38-39 years. These findings persisted in a sensitivity analysis of infertile patients stratified into AMH (ng/mL) quartile categories. No association was found between AMH and the proportion of euploid, mosaic, or aneuploid embryos in 2 large cohorts of patients undergoing IVF with PGT-A (Infertile patients) or PGT-A and PGT-M (Non-infertile patients), suggesting that a quantitative depletion of ovarian reserve does not predict the ploidy status of the embryo cohort.

The Essential Role of Body Weight in Adjusting Gn Dosage to Prevent High Ovarian Response for Women With PCOS During IVF: A Retrospective Study.

Polycystic ovarian syndrome (PCOS) is the major cause of anovulatory infertility. Since women with PCOS are often accompanied by increased body weight and hyper response to controlled ovarian stimulation, individualized gonadotropin (Gn) dose is required to achieve a therapeutic effect while minimizing the risk of ovarian hyperstimulation simultaneously. We aimed to investigate the essential role of body weight in optimizing initial Gn dosage for PCOS patients during in vitro fertilization (IVF). We retrospectively included 409 infertile PCOS patients who used gonadotropin-releasing hormone (GnRH)-antagonist fixed protocol and underwent their first cycle of IVF in West China Second University Hospital from January 2019 to June 2021. Baseline characteristics controlled ovarian stimulation parameters, and reproductive outcomes were compared between patients with different body weights and different ovarian responses. Multivariable linear regression analyses were adopted to investigate the relationship between body weight and initial Gn dosage. Receiver operating characteristic (ROC) curves were drawn to find the optimal cut-off value of body weight in predicting the starting Gn dosage so as to prevent high ovarian response (HOR). We found that luteinizing hormone (LH) level and Anti-Mullerian hormone (AMH) level were lowest in the group with body weight over 70 kg and was highest in the group with body weight less than 50 kg. Increased body weight was significantly correlated to the rise of initial Gn dosage (Beta = 0.399, t = 8.921, p < 0.001). Normal ovarian response (NOR) patients had significantly less fresh cycle cancel rate and ovarian hyperstimulation syndrome (OHSS) rate which outweighed the fewer embryos compared with HOR patients. Using ROC curves, 53.25 kg (sensitivity, 84.2%; specificity, 53.8%) and 70.5 kg (sensitivity, 58.8%; specificity, 93.0%) were identified as the optimal cut-off values to predict the initial Gn dosage of no more than 150 IU and 225 IU, respectively. In conclusion, adjusting the initial Gn dosage based on body weight is crucial to preventing ovarian hyperstimulation while not influencing reproductive outcomes for PCOS patients during IVF.

P-523 rs2277698 Single nucleotides polymorphisms in tissue inhibitors of metalloproteinases 2 (TIMP2) affected clinical outcomes of women undergoing in vitro fertilization

Abstract Study question Is there any association between clinical outcomes of women undergoing in vitro fertilization (IVF) and the polymorphic variants of matrix metalloproteinases (MMPs) or tissue inhibitors of metalloproteinases (TIMPs)? Summary answer Our findings suggested that clinical outcomes of women undergoing IVF were associated with rs2277698 SNPs in TIMP2. What is known already The extracellular matrix proteolytic machinery is one of the most important mechanisms for regulating trophoblast invasion. Matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs), which are involved in the extracellular matrix proteolysis process, have the ability to regulate the degradation of the extracellular matrix and play a critical role in trophoblast invasion. Study design, size, duration A prospective study was composed of 1014 women undergoing their first fresh IVF cycle with non-donor from January 2014 to December 2015. Participants/materials, setting, methods The present study was carried out in Lee Women’s Hospital, Taiwan. DNA was extracted from the peripheral blood of all participants, and the SNPs were genotyped by real-time polymerase chain reaction. The effects of the following three single nucleotide polymorphisms (SNPs) on IVF outcomes were explored: TIMP1 (rs4898 C/T), TIMP2 (rs2277698 C/T) and MMP2 (rs243865 C/T). The SNP genotype, correlation with clinical pregnancy, embryo implantation, abortion and live birth rates of IVF were analyzed. Main results and the role of chance In the analysis of 1014 patients attempting their first cycle of IVF, the genotypes frequencies of the study population showed a statistically significant association between TIMP2 (rs2277698 C/T) and clinical outcome. For TIMP2 polymorphisms, women with wild genotype (CC) hadhigher clinical pregnancy rate (34.8% v.s 28.0%; p = 0.032), embryo implantation rate (19.4% v.s 15.4%; p = 0.009), live birth rate (29.8% v.s 22.1%; p = 0.006), and lower abortion rate (7.0% v.s 17.1%; p = 0.005) compared women with CT/TT genotype. On the other hand, the clinical outcomes in different TIMP1 or MMP2 gene polymorphisms groups were no statistically significant difference. Limitations, reasons for caution The size number of the study samples. Wider implications of the findings This study showed that the TIMP2 SNP polymorphisms CT/TT was associated with low trend of clinical outcomes. The mechanism of TIMP2 gene T allele affected the outcomes of IVF remains to be determined. Further studies should focus on the mechanism of these associations in a larger, more heterogeneous cohort. Trial registration number CS13194

Subsequent IVF outcomes following antibiotic therapy for chronic endometritis in patients with recurrent implantation failure.

The aim is to identify the chronic endometritis (CE) incidence in recurrent implantation failure (RIF) patients undergoing in vitro fertilization (IVF) treatment and compare the IVF outcomes of RIF patients with CE following antibiotic therapy with RIF patients without CE. Another purpose is to compare the IVF outcomes of described RIF patients with patients undergoing the first cycle of IVF. In this retrospective cohort study, CE was diagnosed with CD-138 immunohistochemical staining. Among RIF patients, two groups were formed as group 1, including patients diagnosed with CE and treated by antibiotics (n=129), and group 2, including patients without CE (n=103). Patients with the first IVF cycle having similar infertility etiologies with RIF patients were reviewed as group 3 (n=932). CE was diagnosed in 55.6% of RIF patients. The number of oocytes retrieved was not different between groups. Implantation rates (IR) were similar after antibiotic treatment in RIF patients with or without CE. However, Group 3 had a higher IR (41.1%) than group 1 and 2 (23.1% and 30.1%, respectively) (p < 0.001). Clinical pregnancy (CPR) and live birth rates (LBR) were comparable between RIF groups. However, CPR and LBR were significantly higher in group 3 (48.6% and 40.5%) than group 1 (36.4% and 27.9%), and group 2 (37.9% and 30.1%) (p=0.007 and p=0.005, respectively). Unidentified endometrial factors except CE may also affect the implantation process, although CE is a frequent finding in patients with RIF. Reproductive outcomes may not be improved only with antibiotics in RIF patients with CE.

Issues des transferts cumulés d’embryons frais et congelés en fécondation in vitro chez les femmes infectées par le virus de l’hépatite B

ObjectiveTo assess the impact of hepatitis B virus (HBV) infection in women on in vitro fertilization (IVF) outcomes. MethodsAn observational monocentric case-control cohort study conducted between 2012 and 2019 compared the outcomes of the first cycle of IVF between 64 woman infected with HBV and 128 seronegative controls. Frozen embryos transfers made within 18 months of the puncture were included. The exclusion criteria were severe infections, viral co-infection in women, any viral infection in their spouse, or lack of fresh embryo transfer. The matching was performed according to age, primary infertility or secondary, conventional or intracytoplasmic injection IVF technique and date of attempt. The main analysis focused on cumulative live births rates (LBR). ResultsThe clinical and ovarian stimulation characteristics were comparable except for a longer period of infertility in the HBV group. The LBR in the HBV group, when compared to controls, was not different after transfer of fresh (14.06 vs. 25.00% P=0.08) or frozen embryos (4.17 vs. 18.92% P=0.08), but significantly decreased in cumulative analysis (15.63 vs. 35.94% P=0.003). HBV infection was negatively associated with LBR in multivariate analysis OR=0.38 (95% CI 0.14–0.92) P<0.05. The implantation rate was lower in the HBV group versus controls, in fresh (14.89 vs. 27.72% P=0.02) and frozen (3.03 vs. 21.65% P=0.01) embryo transfers. ConclusionThis study suggests a negative impact of HBV infection in women on the cumulative LBR after IVF.

An investigation of the effects on follicular-embryonal development and pregnancy outcomes of serum and follicular fluid ischemia-modified albumin in cases of unexplained infertility receiving in vitro fertilization treatment

Objective: To show the effect of the oxidative stress index (OSI) of serum and follicular fluid and ischemia-modified albumin (IMA) levels on embryonic development and pregnancy in cases of unexplained infertility applied with in-vitro fertilization (IVF). Materials and Methods: A total of 80 patients were treated with antagonist protocol in the first cycle of IVF for a diagnosis of unexplained infertility. We recorded demographic data, blood and follicular fluid levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), anti-Müllerian hormone (AMH), OSI and IMA. Using ROC analysis for follicular fluid OSI and IMA, patients were grouped according to the cutoff values determined (11.15 and 0.509, respectively). Results: No correlation was detected between serum OSI and IMA values and the implantation rate. In the follicular fluid OSI ≤ 11.15 group (n = 32), beta HCG positivity was seen in 65.6% of patients and live births in 50%. In the IMA ≤ 0.509 group (n = 24), beta HCG positivity was seen in 66.6% and live births in 50%. With respect to follicular fluid OSI and IMA values, the difference in terms of both beta HCG positivity and live birth rates was statistically significant (p = 0.003, p = 0.007, and p = 0.044, p = 0.028, respectively). The BMI value was significantly high in the IMA &gt; 0.509 group (p &lt; 0.05). Conclusions: In cases of unexplained infertility with high BMI, increased IMA but not OSI in follicular fluid during IVF treatment could be related to decreased implantation and live birth rates. Follicular fluid IMA levels below the cutoff value may predict pregnancy success.

Interleukin-3 Polymorphism is Associated with Miscarriage of Fresh in Vitro Fertilization Cycles.

The aim of this study was to examine the association between interleukin (IL) genes polymorphisms and in vitro fertilization (IVF) outcome. A prospective cohort analysis was performed at a Women’s Hospital IVF centre of 1015 female patients undergoing fresh non-donor IVF cycles. The effects of the following six single nucleotide polymorphisms (SNPs) in five IL genes on IVF outcomes were explored: IL-1α (rs1800587 C/T), IL-3 (rs40401 C/T), IL-6 (rs1800795 C/G), IL-15 (rs3806798 A/T), IL-18 (rs187238 C/G) and IL-18 (rs1946518 G/T). The main outcome measures included clinical pregnancy, embryo implantation, abortion and live birth rates. There were no statistically significant differences in clinical pregnancy, embryo implantation and live birth rates in the analysis of 1015 patients attempting their first cycle of IVF. Infertile women with IL-3 homozygous major genotype had a higher abortion rate than those with heterozygous and homozygous minor genotype (16.5% vs. 7.9%, P = 0.025). In conclusion, our results indicated that the IL-3 rs40401 polymorphism is associated with increased risk of abortion of IVF patients. Future studies with inclusion of other ethnic populations must be conducted to confirm the findings of this study.

Factors beyond insurance coverage that are associated with in vitro fertilization dropout

Lack of insurance coverage for in vitro fertilization (IVF) is associated with dropout after a failed cycle. However, some women with IVF insurance dropout of care, and the reasons for this are less clear. Our objective was to determine factors associated with dropout after a failed cycle in women with IVF insurance coverage. Retrospective cohort study. In our tertiary care IVF center, we queried an insurance database and included all women with IVF coverage who underwent a first cycle of IVF in our center between 2001 and 2010. On average about half of our patients have an infertility benefit. Women who conceived during their first cycle and women using gestational carriers or donor oocytes were excluded. This yielded a total of 408 women with IVF coverage that did not conceive with an initial fresh cycle. Of this cohort, 41% had IVF insurance coverage through an Illinois mandate, and 59% had employer-sponsored IVF insurance coverage. Demographic data included age, BMI, race, antral follicle count, obstetrical history, and distance from the clinic. Initial IVF cycle data included total gonadotropin used, peak estradiol, number of oocytes retrieved, and whether excess embryos were cryopreserved. Standard univariate statistics were used to determine differences in baseline characteristics between women with and without IVF coverage. Probabilities of returning for an additional IVF cycle were calculated with Students t-test and chi-square analysis. Logistic regression was used to control for potential confounders. Statistical analyses were performed in SPSS. There was a trend toward higher dropout in women with a prior live birth, but this did not reach statistical significance (RR 0.88, CI 0.76-1.00, p=0.06). Black women were significantly less likely to return for another cycle than women who were not black, with a RR of 0.71 (CI 0.51-0.99, p=0.04). Women who froze excess embryos were more likely to return for another cycle, with a RR of 1.21 (CI 1.08-1.35, p=0.0008). Black race and cryopreservation of embryos remained significant after controlling for prior live birth, total gonadotropin dose, and number of oocytes retrieved (RR 0.4, CI 0.14-0.97; RR 2.5, CI 1.3-5.1, respectively). In a cohort of women with insurance coverage for IVF, black women and women without cryopreserved embryos were more likely to dropout of care after an initial failed cycle. For women who did not freeze embryos, the prognosis for future IVF cycles may have been poor or they may have been unwilling to undergo another invasive and time consuming fresh cycle despite having coverage. It is unclear from our data why black patients dropout of care more frequently, but there are likely disparities in access to care that go beyond insurance coverage and should be investigated in future studies.

The sex ratio of singleton and twin delivery offspring in assisted reproductive technology in China

In order to evaluate the impact of assisted reproductive technology (ART) procedure and individual factors on the sex ratio of singletons and twins at birth after in vitro fertilization (IVF) and intra-cytoplasmic sperm injection (ICSI) treatment in China. We conducted a retrospective cohort study including patients undergoing their first cycle of IVF or ICSI with autologous oocytes from 2001 to 2015. A total of 7410 babies were born from 5832 women with 7410 live birth. The secondary sex ratio (SSR) in singletons was significantly higher than twins (53.97% vs. 50.89%, P = 0.009). The largest disparity was observed in ‘thawed blastocyst embryos ICSI’ subgroup that SSR was 59.84% in singletons and 42.45% in twins (P = 0.013). Blastocyst transfer was positively associated with elevated SSR when compared to cleavage stage embryos in singletons (Odds Ratio [OR] = 1.17, P < 0.001). In addition, paternal age was significantly associated with SSR (OR = 0.75, P = 0.014). While the decrease of SSR was significantly associated with ICSI when compared to IVF (OR = 0.61, P = 0.046) in twins. Blastocyst transfer increases SSR in comparing with cleavage stage embryos in singletons, while the use of ICSI reduces SSR in twins. Our findings offered important complement for better understanding the underlying determinant of SSR in ART offspring.

Live birth after fresh versus frozen single blastocyst transfer (Frefro-blastocyst): study protocol for a randomized controlled trial

BackgroundMultiple pregnancies are one of the major safety concerns of in vitro fertilization (IVF) due to the increased risk of maternal and neonatal complications. Single embryo transfer is the most effective way to reduce the risk of multiple pregnancies. Selection of the embryo and optimization of the implantation environment are crucial to retain the success rate when the number of transferred embryos is diminished. Fresh embryo transfer with supra-physiological levels of hormones has been suggested to have an adverse effect on implantation. Elective frozen embryo transfer has been suggested to result in a higher rate of live birth than fresh embryo transfer. However, there is still a lack of evidence from randomized clinical trials comparing the efficacy and safety between frozen and fresh single blastocyst transfers.Methods/designWe are conducting a randomized controlled trial in women aged 20–35 undergoing their first cycle of IVF with or without intracytoplasmic sperm injection. After ovarian stimulation with a gonadotropin-releasing hormone antagonist protocol, women who obtain four or more embryos on day 3 of the embryo culture are randomized into two parallel groups: a single fresh blastocyst transfer group and a single frozen blastocyst transfer group (all blastocysts vitrified and a deferred frozen blastocyst transfer). The primary outcome is singleton live birth.DiscussionThe results of this study will provide evidence for the efficacy and safety of the strategy of elective frozen single blastocyst transfer in women with a good prognosis.Trial registrationChinese Clinical Trial Registry, ChiCTR-IOR-14005405. Registered on 30 Oct 2014.

Multiple thrombophilic single nucleotide polymorphisms lack a significant effect on outcomes in fresh IVF cycles: an analysis of 1717 patients.

The aim of the study is to determine if thrombophilic single nucleotide polymorphisms (SNPs) affect outcomes in fresh in vitro fertilization (IVF) cycles in a large general infertility population. A prospective cohort analysis was performed at a university-affiliated private IVF center of female patients undergoing fresh non-donor IVF cycles. The effect of the following thrombophilic SNPs on IVF outcomes were explored: factor V (Leiden and H1299R), prothrombin (G20210A), factor XIII (V34L), β-fibrinogen (-455G → A), plasminogen activator inhibitor-1 (4G/5G), human platelet antigen-1 (a/b9L33P), and methylenetetrahydrofolate reductase (C677T and A1298C). The main outcome measures included positive pregnancy test, clinical pregnancy, embryo implantation, live birth, and pregnancy loss. Patients (1717) were enrolled in the study, and a total of 4169 embryos were transferred. There were no statistically significant differences in positive pregnancy test, clinical pregnancy, embryo implantation, live birth, or pregnancy loss in the analysis of 1717 patients attempting their first cycle of IVF. Receiver operator characteristics and logistic regression analyses showed that outcomes cannot be predicted by the cumulative number of thrombophilic mutations present in the patient. Individual and cumulative thrombophilic SNPs do not affect IVF outcomes. Therefore, initial screening for these SNPs is not indicated.

In Vitro Fertilization in Women With Inflammatory Bowel Disease Is as Successful as in Women From the General Infertility Population

Inflammatory bowel disease (IBD) affects women of reproductive age, so there are concerns about its effects on fertility. We investigated the success of invitro fertilization (IVF) in patients with IBD compared with the general (non-IBD) IVF population. We conducted a matched retrospective cohort study of female patients with IBD who underwent IVF from 1998 through 2011 at 2 tertiary care centers. Patients were matched 4:1 to those without IBD (controls). The primary outcome was the cumulative rate of live births after up to 6 cycles of IVF. Secondary outcomes included the proportion of patients who became pregnant and the rate of live births for each cycle. Forty-nine patients with Crohn's disease (CD), 71 patients with ulcerative colitis (UC), 1 patient with IBD-unclassified, and 470 controls underwent IVF during the study period. The cumulative rate of live births was 53% for controls, 69% for patients with UC (P= .08 compared with controls), and 57% for patients with CD (P= .87 compared with controls). The incidence of pregnancy after the first cycle of IVF was similar among controls (40.9%), patients with UC (49.3%; P= .18), and patients with CD (42.9%; P= .79). Similarly, the incidence of live births after the first cycle of IVF was similar among controls (30.2%), patients with UC (33.8%; P= .54), and patients with CD (30.6%; P= .95). Based on a matched cohort study, infertile women with IBD achieve a rate of live births after IVF that is comparable with those of infertile women without IBD.

Antimullerian hormone versus the clomiphene citrate challenge test for evaluation of ovarian reserve prior to in vitro fertilization

Antimullerian hormone versus the clomiphene citrate challenge test for evaluation of ovarian reserve prior to in vitro fertilization

Prevalence of Common Thrombophilia and Antiphospholipid Antibodies in Unexplained Infertility Women Undergoing in Vitro Fertilization (IVF)

AbstractAbstract 628Assisted reproductive technology (ART) is extensively used as a tool for pregnancy achievement in subfertile couples. Congenital and acquired thrombophilia have been suggested by some investigators to play a role in abnormal embryos implantation and placentation. The objective of this study was to assess the role of common thrombophilia in women with unexplained infertility undergoing in vitro fertilization (IVF). We enrolled five hundred ninety-four women from a large healthcare maintenance organization going through IVF and who had a thrombophilia workup, and compared them for prevalence of thrombophilia to two reference groups consisting of 637 fertile women from previous work and 17,337 women members of the same healthcare organization with no history of venous thromboembolisms. The mean age of the women at the first cycle of IVF was 30.9 years (SD: ±4.1).The mean number of IVF cycles was 7.3 (SD: 5.0), and the mean fertility success rate per woman was 14.6% (SD: 19.0).None of the common thrombophilia tested was found to be significantly associated with the number of IVF cycles or with lower fertility success rate. Rather, women who had APCR and/or factor V Leiden and lupus anticoagulant had significantly higher live birth rates (12.25% and 12.64%, respectively) in comparison to women who were tested negative (8.98% and 9.7%, respectively). Thus, hypercoagulability is not associated with failure to achieve pregnancy. These data suggest that neither screening for thrombophilia nor anticoagulant treatment is indicated in cases with unexplained reproductive failure. Disclosures:No relevant conflicts of interest to declare.

Does obesity compromise ovarian reserve markers? A clinician’s perspective

The aim of the study was to ascertain if increasing body mass index (BMI) adversely affects ovarian reserve among infertile women of Asian origin undergoing in vitro fertilization (IVF). This prospective study on 183 women was carried out in the infertility clinic of All India Institute of Medical Sciences, New Delhi, India. Blood hormonal assay in all patients including follicle-stimulating hormone (FSH), luteinizing hormone (LH) and inhibin B was performed on day 2/3 of a spontaneous cycle. A transvaginal ultrasonographic examination on day 2-5 of the menstrual cycle was done for antral follicle count (AFC) and ovarian volume. A correlation between BMI and ovarian reserve parameters like FSH, LH, inhibin B, antral follicle count and ovarian volume was noted. Age was comparable in the three BMI groups. The mean duration of infertility was 8.38 years. Compared to the normal weight, the overweight and obese women had a statistically significantly low inhibin B (p < 0.0259). The AFC when taken together on both sides was not statistically significant between the groups; however, the overweight and obese women had a significantly low AFC (p < 0.0129) on the right side. Incorporating anti-mullerian hormone, a newer marker for ovarian reserve, may benefit these obese infertile women. Further work is required to elucidate the mechanisms underlying the effect of obesity on inhibin B as a marker of ovarian reserve in infertile women. The best marker to check the ovarian reserve is perhaps the woman's performance during an IVF cycle. However, considering the psychological and financial stress of the procedure, it may seem wise to consider counseling of obese women on their expected performance in the first cycle of IVF through such studies.

Comparison of an interactive web-based teaching tool and traditional didactic learning for IVF patients: a randomized controlled trial

To compare an interactive web-based teaching tool with traditional didactic learning in a classroom format to educate in vitro fertilization (IVF) patients. Randomized controlled trial This study recruited 50 women undergoing their first cycle of IVF at the Ottawa Fertility Centre (Ontario Canada). Patients completed a baseline knowledge questionnaire and stress survey and were then randomized to one of two conditions: (a) an interactive web-based teaching tool or (b) a nurse-led teaching session. After completion of the education, patients began their IVF cycle. All subjects completed a post-intervention knowledge questionnaire, stress survey, satisfaction survey and demographic questionnaire prior to starting IVF. A second satisfaction survey was completed at embryo transfer. The primary outcome measure was the level of knowledge after the intervention. Using an independent t-test, pre and post intervention knowledge scores were compared, which revealed no significant differences between groups prior to the intervention [t(37) = -0.823, P>.05]. A paired samples t-test indicated that both groups showed significant improvement between their pre and post intervention scores [Web-based: t(20) = -5.379, P=0.00; Classroom-based: t(20) = -4.826, P=0.00]. The independent-t test showed no significant difference between groups for post-knowledge scores [t (37) = -0.475, P>.05]. This is the first known study to examine interactive web-based learning as an option for IVF patients. The present study supports the use of web-based learning as an equally effective tool for medical education in IVF patients. This approach provides several advantages, including information accessibility, flexibility of delivery and cost. Further analyses will examine level of satisfaction with both formats, as well as stress levels before and after the intervention.

Effects of Caffeine Consumption by Women and Men on the Outcome of In Vitro Fertilization.

The objective of this study was to estimate the association between caffeine consumption and in vitro fertilization (IVF) outcomes. A total of 2474 couples were prospectively enrolled prior to undergoing their first cycle of IVF, contributing a total of 4716 IVF cycles. Discrete survival analysis adjusting for observed confounders was applied to quantify the relation between caffeine consumption and livebirth. Secondary outcomes of interest were oocyte retrieval, peak estradiol level, implantation rate, and fertilization rate. Overall, caffeine consumption by women was not significantly associated with livebirth (ptrend=0.74). Compared with women who do not drink caffeine, the likelihood of livebirth was not significantly different for women who drank low (>0-800 mg/week; odds ratio [OR]=1.00, 95% confidence interval [CI])=0.83-1.21), moderate (>800-1400 mg/week; OR=0.89, 95% CI=0.71-1.12), or high levels of caffeine (>1400 mg/week; OR=1.07, 95% CI=0.85-1.34). Greater caffeine intake by women was associated with a significantly lower peak estradiol level (ptrend=0.03), but was not associated with the number of oocytes retrieved (ptrend=0.75), fertilization rate (ptrend=0.10), or implantation rate (ptrend=0.23). There was no significant association between caffeine intake by men and livebirth (ptrend=0.27), fertilization (ptrend=0.72), or implantation (ptrend=0.24). The individual effects of consumption of coffee, tea, or soda by women or men were not related to livebirth. Caffeine consumption by women or men was not associated with IVF outcomes.

Can quantitative three‐dimensional power Doppler angiography be used to predict ovarian hyperstimulation syndrome?

To test the hypothesis that ovarian vascularity is increased in women developing ovarian hyperstimulation syndrome (OHSS) and to assess its value as a predictor of OHSS during in-vitro fertilization (IVF). 118 subjects undergoing their first cycle of IVF had a three-dimensional (3D) transvaginal ultrasound scan in the early follicular phase of the menstrual cycle preceding IVF treatment. 18 of them developed moderate or severe OHSS and 100 subjects had normal ovarian response. Antral follicle count, ovarian volume, and ovarian vascularity (vascularization index (VI), flow index (FI) and vascularization flow index (VFI)) were compared between OHSS and control groups. Multiple regression analysis was used to assess the predictive value of these variables against age, body mass index and basal follicle-stimulating hormone level for the development of OHSS. The ovarian blood flow indices VI (11.1 +/- 11.6 vs. 8.6 +/- 7.3%; P = 0.23), FI (38.0 +/- 4.8 vs. 38.0 +/- 5.5; P = 0.95) and VFI (4.2 +/- 3.3 vs. 3.5 +/- 3.1; P = 0.40) were similar in the OHSS group and the normal responders. While antral follicle count was significantly higher in women developing OHSS (33.0 +/- 15.1) than in the control group (19.2 +/- 9.9, P < 0.001), ovarian volume did not differ between the two groups (10.6 +/- 3.8 vs. 8.9 +/- 4.8 cm(3), respectively, P = 0.11). On multiple regression analysis, antral follicle count was the only significant predictor of OHSS (P < 0.01). Women developing OHSS during IVF do not demonstrate an increased ovarian blood flow as measured by 3D ultrasound but do have a significantly higher antral follicle count, which is the only significant predictor of OHSS.

Evaluation of age, basal FSH, LH, FSH/LH ratio and E2 levels in 800 patients as predictors of in vitro fertilization (IVF) outcome

OBJECTIVE: To analyze to what extent age and the basal FSH, LH, FSH/LH ratio and E2 levels affect the results of ovarian stimulation and IVF outcome. Design: Retrospective cohort study. Setting: University hospital infertility centre. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: Eight hundred patients undergoing their first cycle of IVF with ovarian stimulation after pituitary desensitization were included in the study. The patients were divided in different study groups according to their age and their basal FSH, LH, FSH/LH ratio and E2 levels. The biological and clinical parameters of the IVF outcome, cancellation rate, implantation rate, and pregnancy rate were evaluated in each group. RESULTS: Both increasing age and basal FSH were associated considerably with reduced numbers of oocytes collected and embryos available for transfer and degreased pregnancy rate. The combined use of age and basal FSH significantly improves the predictive power for these parameters. Increasing basal LH was significantly linked with degreased numbers of mature oocytes. A significant negative correlation was demonstrated between serum FSH concentration and cancellation and pregnancy rate. Elevated FSH/LH ratio was associated with fewer mature oocytes. CONCLUSIONS: Both basal FSH and woman's age are essential predictive factors of the outcome of IVF treatment, mainly for the achievement or not of pregnancy and for miscarriage rate. However FSH is a more important predictive factor. High levels of E2 (>75pg/ml) together with advanced age has great specificity. Elevated FSH/LH ratio in the beginning of the cycle may be vital for the quality of the oocytes and predicts a poor outcome in patients undergoing controlled ovarian stimulation for IVF.