Frozen Embryo Transfer Research Articles

Detecting defects: low initial serum human chorionic gonadotropin (hCG) level may predict future fetal anomalies following frozen embryo transfer (FET).

To investigate the relationship between early serum hCG levels after frozen embryo transfer and fetal anomalies. This was acase-control study at a single academic fertility center between 1/2010 and 12/2021, including all patients who underwent euploid frozen embryo transfers resulting in any fetal anomaly confirmed at the time of induced abortion > 10weeks or any anomaly reported at delivery. Controls included patients with healthy live births matched for age and day/grade of embryo after euploid FET. The primary outcome was fetal anomaly, with comparisons made using serum hCG levels from cycle day 28 to cycle day 35 and percent change between days 28 and 35. Both cycle day 28 serum hCG levels and day 35 serum hCG levels were significantly lower in the anomalous group (day 28: 152 vs 177.5 mIU/mL, p < 0.04; day 35: 3033 vs 3744 mIU/mL, p < 0.05). Patients with anomalous outcomes had a significantly lower hCG to start with 5/78 (6.4%) < 50mIU/mL, 16/78 (20.5%) 51-100mIU/mL, and 57/78 (73.1%) > 101mIU/mL, compared to controls 3/78 (3.8%) < 50mIU/mL, 8/77 (10.3%) 51-100mIU/mL, and 66/77 (85.7%) > 101mIU/mL (p < 0.02). However, the rate of rise between day 28 and day 35 was not statistically different (1758.0% vs 2097.0%, p = 0.23). Patients with anomalous fetal outcomes following frozen embryo transfer had lower early serum hCG levels than controls with healthy live births, highlighting the potential utility of this serum marker to identify high-risk pregnancies in the first trimester and expedite treatment as appropriate for this rare but devastating outcome.

Optimal duration of progesterone before cryopreserved embryo transfer in hormone replacement therapy cycles: A prospective pilot study.

This prospective pilot cohort study aimed to ascertain the optimal duration of progesterone supplementation prior to frozen embryo transfer (FET) in women undergoing hormone replacement therapy (HRT) cycles. A total of 127 participants were enrolled and divided into 2 cohorts. The first cohort, comprising of 39 women, was used to determine the peak period of endometrial receptivity. These participants underwent serial assessments of integrin alphavbeta3, homeobox gene A10, and leukemia inhibitory expression levels from days 3 to 7 (P + 3 to P + 7) during the mock HRT cycles. The second cohort included 88 women who embarked on their inaugural HRT-FET cycle and were monitored for pregnancy outcomes after the transfer of D3 embryos after 3 or 4 days of progesterone administration. The results indicated a significant enhancement in biochemical pregnancy and embryo implantation rates in the P + 3 group (87.18% and 74.36%, respectively) compared to those in the P + 4 group (68.42% and 65.79%; P = .047 and P = .044, respectively). These data suggest that a 3-day progesterone regimen prior to D3 embryo transfer may be more beneficial. Notably, the maximal expression of endometrial receptivity markers was observed on day P + 6 within the HRT cycles, which is consistent with previous research that correlated day 6 embryos with peak endometrial receptivity. Therefore, a 3-day progesterone lead-in may enhance synchrony between D3 embryos and the endometrium. Our findings suggest that initiating D3 embryo transfer after 3 days of progesterone administration may optimize embryo-endometrial synchronization, thereby potentially enhancing clinical outcomes in FET cycles.

Impact of corpus luteum number on maternal pregnancy and birth outcomes: the Rotterdam Periconception Cohort.

To investigate associations between assisted reproductive technology (ART) -induced alterations in corpus luteum (CL) number during implantation, and maternal pregnancy and birth outcomes. Pregnancies conceived through ART are associated with increased risks of adverse obstetric and perinatal outcomes, with discrepancies in outcomes between different ART treatment protocols. We hypothesize this is due to the periconceptional hormonal environment regulated by the CL. ART protocols affect CL quantity at conception resulting in CL absence or a supraphysiological number of CL. This study is embedded in the Rotterdam Periconceptional Cohort, an ongoing tertiary center prospective cohort at the Erasmus University Medical Center in Rotterdam, the Netherlands. Women with a singleton pregnancy with data on CL. The number of CL, based on mode of conception: 0 CL (artificial cycle frozen embryo transfer (AC-FET), n=72); >1 CL (ovarian stimulated fresh embryo transfer, n=462) and 1 CL (natural cycle frozen embryo transfer (NC-FET) and natural conceptions, n=1327). Hypertensive disorders of pregnancy, gestational diabetes, gestational age at birth and birthweight, derived from medical records. We included 1,861 pregnancies. The results were adjusted for maternal age, maternal body mass index, nulliparity and obstetric history. In comparison with natural conceptions (1 CL), a pregnancy with CL absence (0 CL) was associated with a higher risk of gestational diabetes (aOR 2.59 [95% CI 1.31;5.15]), and a higher risk of preeclampsia, albeit non-significantly (aOR 2.02 [95% CI 0.91;4.51]). In comparison with pregnancies with >1 CL the risk of preeclampsia was significantly lower (aOR 0.36 [95% CI 0.18;0.72]). Post hoc analyses revealed that in male neonates, >1 CL was associated with a lower birthweight percentile (aβ -6.18 [95% CI -11.16;-1.20]). In contrast, female neonates showed no association with >1 CL, whereas CL absence was associated with a higher birthweight percentile (aβ 12.93 [95% CI 2.52;23.34]). Risks of hypertensive disorders of pregnancy, gestational diabetes and relative birthweight differ between CL groups. These findings support the hypothesis that an aberrant number of CL impacts maternal pregnancy and or birth outcomes. Additional studies need to be conducted to investigate causes and underlying pathophysiology.

Development of a Novel Nomogram Based on Ultrasonic Radiomics for Predicting Intrauterine Pregnancy After Frozen Embryo Transfer Cycle.

This study aimed to develop a nomogram for predicting intrauterine pregnancy after an in vitro frozen embryo transfer cycle using endometrial ultrasound radiomics. A total of 211 patients who underwent ultrasound examination on the day of endometrial transformation before the frozen embryo transfer cycle were enrolled. The patients were divided into an intrauterine pregnancy group and a pregnancy failure group based on ultrasound results. Clinical characteristics and radiomic features were analyzed using univariate and multivariate logistic regression analyses. A nomogram prediction model was established based on radiomic signatures and significant clinical factors. The model's robustness was assessed in training and external validation cohorts. Nine radiomic features were selected using least absolute shrinkage and selection operator (LASSO), and the radiomics score (Rad-score) was calculated as the sum of each feature multiplied by the nonzero coefficient from LASSO. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve based on the Rad-score was 0.72, 0.65, and 0.69 in the training, validation, and combined cohorts, respectively. To improve diagnostic efficiency, the Rad-score was further integrated with clinical factors to form a novel predictive nomogram. The results indicated that the AUC increased to 0.81, 0.67, and 0.77 in the training, validation, and combined cohorts, respectively. Decision curve analysis showed that the radiomics nomogram was clinically useful. The radiomics and clinical predictive nomogram can effectively predict intrauterine pregnancy after in vitro frozen embryo transfer and can be further applied in clinical strategy.

Sequential Transfer of Blastocysts on Day 5 and Day 6 in Patients with Repeated Implantation Failure in Frozen Embryo Transfer Cycle.

The aim of this study was to evaluate which frozen embryo transfer (FET) strategy benefits the recurrent implantation failure (RIF) population. A retrospective study of 336 women with RIF was performed from July 2020 to October 2023. The patients were divided into three groups according to the FET protocol. The three FET protocols included transferring a blastocyst on both days 5 and 6 (Group 1, n = 138); transferring a cleavage-stage embryo on day 3 and a blastocyst on day 5 (Group 2, n = 55); and transferring double blastocysts on day 5 (Group 3, n = 143).The sequential day 5 and day 6 blastocyst ET strategy significantly improved in vitro fertilization success rates compared with those of both the traditional double-blastocyst day 5 transfer strategy and the strategy involving one cleavage-stage embryo transfer on day 3 and one blastocyst transfer on day 5 in RIF patients. Compared with those observed in Day 5 double-blastocyst transfer, the rates of clinical pregnancy and implantation increased (51.75% vs. 64.49%, P < 0.001 and 37.06% vs. 41.3%, P = 0.005, respectively), while the rates of biochemical pregnancy and multiple gestation decreased (18.18% vs. 12.32%, P = 0.006 and 43.24% vs. 28.09%, P = 0.044, respectively) with the new protocol.Blastocysts from sequential embryo transfer on day 5 and day 6 were more effective than those from the traditional FET protocol at improving pregnancy outcomes and lowering the multiple pregnancy rate in RIF patients. When only one or zero good-quality blastocysts are available, sequential blastocyst ET on days 5 and 6 should be considered.

Successful application of preimplantation genetic testing combined with thirdgeneration sequencing for blocking hereditary spastic paraplegia

We report a case of application of third-generation sequencing (TGS) combined with preimplantation genetic testing (PGT) for successful prevention of hereditary spastic paraplegia (HSP) caused by SPAST gene mutations and assess the value of PGT-M and TGS in managing hereditary spastic paraplegia. A family affected by HSP underwent whole exon sequencing (WES), and a c.1699G>T mutation in the SPAST gene was identified. The mutation site in the proband was confirmed through Sanger sequencing. A single nucleotide polymorphism (SNP) site flanking the SPAST gene mutation was selected as the genetic linkage marker, and a SNP haplotype carrying the mutated gene was constructed. Ovarian stimulation using an antagonist regimen was performed for oocyte retrieval, followed by intracytoplasmic sperm injection (ICSI) and embryo culture. Blastocyst trophectoderm cells were biopsied for preimplantation genetic testing for monogenic disorders (PGT-M) to allow the selection of disease-free embryos for transfer. In this cycle, a total of 20 oocytes were retrieved, among which 18 were successfully fertilized to result in 12 blastocysts eligible for biopsy. Genetic testing revealed that all the 12 blastocysts were successfully amplified and confirmed as euploidy. Among them, 8 blastocysts did not carry paternal mutations, and a high-quality euploid embryo was selected for frozen embryo transfer (FET). Subsequent amniotic fluid testing during pregnancy confirmed the absence of paternal mutations in the fetus, resulting in the birth of a healthy baby girl. For cases of genetic diseases with missing pedigree data, the application of third-generation sequencing and PGT-M technique can effectively block vertical transmission of SPAST gene mutation to the offspring, avoid pregnancy with an aneuploid embryo, and help families with autosomal dominant HSP obtain healthy offsprings.

Ovarian Stimulation Effects on Ghrelin Secretion and Reproductive Potential

ABSTRACTObjectiveFinely regulated Ghrelin (Ghrl) secretion is essential during early pregnancy, as infra or supraphysiologic levels can be detrimental. Since oestrogens stimulate Ghrl synthesis, ovarian stimulation (OS) might increase ghrelinemia, thus being detrimental for fertility. The aim of this work was to evaluate whether OS increases ghrelinemia and associates with maternal endocrine and immune biomarkers and reproductive success.DesignThe 97 women undergoing assisted reproduction were grouped as follows: OS: undergoing OS and fresh embryo transfer (n = 35); FET: undergoing frozen embryo transfer in a cycle different from that of OS (n = 25) and, OD: undergoing embryo transfer in oocyte donation cycles (n = 37). At embryo transfer day, several endocrine and immune biomarkers were assessed.ResultsOS patients showed significantly higher serum estradiol, progesterone and Ghrl, than those not stimulated. Patients that suffered miscarriage showed significantly lower concentrations of sex‐hormones, with a similar trend for Ghrl, that deserves further investigation. Moreover, OS patients showed decreased frequencies of circulating T cells and reduced ratios of uNK/NK cells, which significantly associated with serum levels of sex‐hormones. Besides, ROC curves identified cut‐off values predictive of clinical pregnancy and/or miscarriage for peripheral counts of uNK cells, T cells, and uNK/NK cells ratio.ConclusionsAs hypothesised, OS significantly increased serum Ghrl in correlation with sex‐hormone levels. These last, significantly associated with maternal immune response and reproductive outcome. Although Ghrl exhibited a similar profile, it did not reach statistical significance, indicating the need for further investigation. Additionally, the identification of maternal immunological cut‐off values holds significant clinical relevance.

Clinical efficacy of Crinone on pregnancy outcomes in frozen embryo transfer: A retrospective study in the Chinese population.

The aim of this study was to retrospectively investigate the effect of Crinone vaginal gel on pregnancy outcomes in women undergoing natural cycle (NC) frozen embryo transfer (FET) and to obtain the most suitable population for its routine application. The 1613 women who underwent FET in the NC regimen [including the controlled ovulation stimulation protocol for the natural cycle, or the controlled ovulation stimulation protocol for the natural cycle (NC-COS)] from 2017 to 2021 were included. All patients were divided into 2 groups including Control group and Crinone group, which administered with or without Crinone vaginal gel. The key clinical information and between the 2 groups was recorded in detail. The results indicated that there were no statistical differences in blood β human chorionic gonadotropin (HCG) positive rate, clinical pregnancy, live birth, abortion (spontaneous and induced) and stillbirth between Control group and Crinone group. Moreover, Crinone could prevent spontaneous abortion. The spontaneous abortion rate in the Crinone group was 5.93% while this in control group was 8.32%. In the cohort exposed to Femoston, the preventive result was more significant (0/32 vs 5/15, P = .001). Furthermore, Crinone exhibited a significant protective effect on spontaneous abortion in 1520 patients who received no human menopausal gonadotropin (HMG) treatment. This study demonstrated that the Crinone could protect women against spontaneous abortion, especially in patients who do not need HMG or in combination with Femoston.

Correlation Between Luteal Phase Serum Progesterone Levels and Pregnancy Outcome in Frozen Embryo Transfer Cycles: A Prospective Cohort Study

Objectives To study the correlation between luteal phase serum progesterone (P4) levels and pregnancy outcome in frozen embryo transfer (FET) cycles and to find out the cut-off level of luteal phase serum P4 which favours successful pregnancy outcome in FET cycles. Material and Methods This prospective cohort study included 100 women undergoing hormone replacement therapy (HRT)-FET cycle at Akanksha IVF Centre from December 2023 to June 2024, fulfilling the inclusion and exclusion criteria. Serum P4 levels were measured for all the patients in the luteal phase (days 21–23) after FET with intramuscular P4 as luteal phase support. Pregnancy outcome was assessed in terms of implantation rate, biochemical pregnancy rate, clinical pregnancy rate (CPR), first-trimester miscarriage rate and ongoing pregnancy rate. Results The most favourable pregnancy outcomes were observed at serum P4 levels 25.1-35 ng/mL. A statistically significant association was seen between the luteal phase serum P4 levels and implantation rate (36.08%), biochemical pregnancy rate (4%), CPR (52%) and ongoing pregnancy rate (42%). According to the receiver operating characteristic (ROC) curve analysis, the optimal cut-off value for favourable outcomes was determined to be 22.3 ng/mL. However, the analysis also indicated that the luteal phase serum P4 levels did not reliably predict clinical or ongoing pregnancy. Conclusion Larger studies are needed to establish a threshold level of serum P4 in the luteal phase that can differentiate between successful and unsuccessful implantation. However, it is still uncertain whether the issue of unsuccessful implantation can be resolved once it is detected on days 21–23 of the HRT-FET cycle.

Perinatal and obstetric-neonatal outcomes following frozen embryo transfer cycles with a thinner endometrium: a retrospective study

ObjectiveThe purpose of this study was to evaluate the relationship of thin endometrial thickness (EMT) on the maternal and child health outcome of frozen-thawed embryo transfer (FET) cycles with singletons.MethodsThe retrospective cohort study included 1,771 live singleton deliveries, with 273 in the thin endometrium group (EMT ≤ 7.5 mm) and 1,498 in the control group (EMT > 7.5 mm). Pregnancy, perinatal complications and neonatal outcomes were compared between the two groups.ResultsWomen in the thinner endometrium group had higher rates of preeclampsia (7.69% vs. 7.00%), placenta previa (4.39% vs. 2.43%), postpartum haemorrhage (15.38% vs. 11.42%) than the control groups, although they were not significantly different. Significant difference was observed in the rates of placental abruption (1.09% vs. 0.07%, P = 0.001), abnormal placental cord insertion (3.66% vs. 1.74%, P = 0.011), placental adherence (15.38% vs. 7.14%, P < 0.001) between the two groups. No significant difference could be found regarding preterm labour, macrosomia, Apgar ≤ 7, large for gestational age (LGA) and appropriate for gestational age (AGA), and singletons from the thinner endometrium group had a significantly lower birthweight than those from the controls. Then after adjusting for confounders, thinner endometrium was still statistically significantly associated with placental adherence, postpartum haemorrhage and low birthweight (LBW).ConclusionThese findings highlight the important role of endometrial thickness in influencing perinatal and obstetric-neonatal outcomes in FET cycles. The study contributes to the growing body of evidence supporting the clinical relevance of endometrial thickness in FET cycles and underscores the need for close monitoring and management of pregnancies in women with a thin endometrium. Future research should focus on elucidating the underlying mechanisms and identifying effective interventions to improve endometrial thickness and pregnancy outcomes in this patient population.

Excess Weight Impairs Oocyte Quality, as Reflected by mtDNA and BMP-15.

This prospective, case-control study evaluated the impact of obesity on oocyte quality based on mtDNA expression in cumulus cells (CC), and on bone morphogenetic protein 15 (BMP-15) and heparan sulfate proteoglycan 2 (HSPG2) in follicular fluid (FF). It included women 18 to <40 years of age, divided according to BMI < 24.9 (Group 1, n = 28) and BMI > 25 (Group 2, n = 22). Demographics, treatment, and pregnancy outcomes were compared. The mtDNA in CC, BMP-15, HSPG2, the lipid profile, the hormonal profile, and C-reactive protein were evaluated in FF and in blood samples. The BMP-15 levels in FF and the mitochondrial DNA in CC were higher in Group 1 (38.8 ± 32.5 vs. 14.3 ± 10.8 ng/mL; p = 0.001 and 1.10 ± 0.3 vs. 0.87 ± 0.18-fold change; p = 0.016, respectively) than in Group 2. High-density lipoprotein levels in blood and FF were higher in Group 1 (62 ± 18 vs. 50 ± 12 mg/dL; p = 0.015 and 34 ± 26 vs. 20.9 ± 7.2 mg/dL; p = 0.05, respectively). Group 2 had higher blood C-reactive protein (7.1 ± 5.4 vs. 3.4 ± 4.3 mg/L; p = 0.015), FF (5.2 ± 3.8 vs. 1.5 ± 1.6 mg/L; p = 0.002) and low-density lipoprotein levels (91 ± 27 vs. 71 ± 22 mg/dL; p = 0.008) vs. Group 1. Group 1 demonstrated a trend toward a better clinical pregnancy rate (47.8% vs. 28.6%: p = 0.31) and frozen embryo transfer rate (69.2% vs. 53.8; p = 0.69). Higher BMI resulted in lower BMP-15 levels and reduced mtDNA expression, which reflect decreased oocyte quality in overweight women.

Exogenous progesterone rescue in patients with low mid-luteal serum progesterone levels undergoing true natural vitrified-warmed blastocyst transfer.

To explore whether a 25mg subcutaneous progesterone daily rescue daily improves the reproductive outcomes in patients with low serum progesterone (P4) levels (7-10ng/mL), measured one day before true natural cycle (t-NC) frozen embryo transfer (FET). A cohort study of 192 women undergoing t-NC warmed blastocyst transfer. Patients were stratified into three different groups based on serum P4 levels on the FET-1day: patients who had serum P4 levels of 7-10ng/mL and underwent rescue progesterone administration (rescue group), patients with serum P4 levels of 7-10ng/mL without progesterone administration (non-rescue group), and patients with serum P4 > 10ng/mL on FET-1day (control group). The primary outcome was possible differences in live birth rate (LBR) between groups. The LBRs for the serum P4 7-10ng/mL without rescue, 7-10ng/mL with rescue, and > 10ng/mL (control) groups were 41%, 46%, and 52%, respectively (p = 0.61). The estimated adjusted probability of live birth for serum P4 7-10ng/mL without rescue, 7-10ng/mL with rescue, and > 10ng/mL (control) groups were also comparable: 43.5% (95% CI, 20.0-70.4%), 49.8% (95% CI, 28.1-71.6%), and 57.4% (95% CI, 44.0-69.8%), respectively. Serum P4 levels higher than 7ng/mL seem to secure LBRs in patients undergoing t-NC FET. A rescue policy consisting of a daily subcutaneous 25mg progesterone dose in patients with serum P4 levels 7-10ng/mL does not further enhance LBRs when compared to those patients with similar serum P4 levels without rescue.

Elevated luteinizing hormone levels during the artificial endometrial preparation cycle do not impact pregnancy outcomes in patients undergoing single vitrified-warmed blastocyst transfer

The effect of an increase in luteinizing hormone levels on pregnancy outcomes in patients undergoing artificial endometrial preparation for frozen embryo transfer has not been definitively elucidated. We aimed to investigate the effect of elevated luteinizing hormone levels, measured prior to progesterone administration, on the ongoing pregnancy rate in patients undergoing artificial endometrial preparation for single vitrified-warmed blastocyst transfer. Patients began taking oral oestradiol valerate on menstrual day 2–3. When the endometrial thickness reached ≥7 mm, they were tested for oestradiol, progesterone, and luteinizing hormone, and luteal phase support was started. The participants were divided into four groups based on luteinizing hormone percentiles, and differences in pregnancy outcomes were examined. No significant differences were observed for on-going pregnancy rate and the other pregnancy outcomes between the groups. In multivariate logistic regression analysis, not the luteinizing hormone levels but the quality of embryo had a significant influence on ongoing pregnancy (p = 0.004; adjusted odds ratio, 1.8; 95% confidence interval, 1.213–2.675). The elevation of luteinizing hormone levels during artificial endometrial preparation did not have an impact on the ongoing pregnancy or the other pregnancy outcomes.

An explainable machine learning model based on ultrasound for predicting reproductive outcomes after frozen embryo transfer

Research questionCan an optimal machine learning (ML) model be developed to predict reproductive outcomes following frozen embryo transfer (FET)༟ Design787 infertile females who received FET were included in this prospective study. The participants were split into a training cohort (n=550) and a testing cohort (n=237) at a ratio of seven to three. Radiomics features were extracted from ultrasound images of the endometrium and junctional zone. A radiomics model was developed to generate the rad-score. Logistic regression was applied to process the clinical data and create a clinical model. A fusion ML model A was developed by integrating the rad-score with independent clinical data via XGboost algorithm. The performance of the models was compared by the area under the receiver operating characteristic curve (AUC). The SHapley Additive exPlanations (SHAP) method was employed to interpret and visualize the contribution of features to the outcomes. ResultsThe fusion model A demonstrated superior performance, as indicated by an AUC of 0.861 (95% CI: 0.829-0.890) in the training cohort, surpassing both the clinical model (AUC: 0.680, 95% CI: 0.635-0.722; P<0.001) and the radiomics model (AUC: 0.814, 95% CI: 0.777-0.848; P<0.001). Additionally, the SHAP summary plot reveals the impacts of each feature on the predictive model, and the rad-score was found to be the top feature.SHAP force plots provided explanations at the individual level. ConclusionAn explainable ML model was established utilizing clinical data and ultrasound images to forecast outcomes of FET. Utilizing the SHAP method, clinicians may better comprehend the outcomes.

Comparison of Fresh vs Frozen Embryo Transfer in Terms of successful Pregnancy Outcome in Pakistan

Comparison of Fresh vs Frozen Embryo Transfer in Terms of successful Pregnancy Outcome in Pakistan

Does Inclusion of Gnrh Agonist in Luteal Phase Support Improve Pregnancy Rates in Frozen Embryo Transfer Cycles?

Does Inclusion of Gnrh Agonist in Luteal Phase Support Improve Pregnancy Rates in Frozen Embryo Transfer Cycles?

Determining Factors Influencing The Successful Embryo Transfer and Pregnancy during The Frozen Cycle of In Vitro Fertilization: A Retrospective Cohort Study.

Frozen embryo transfer (FET) has been increasingly used due to advancements in cryopreservation techniques and the safety advantages. This study aims to determine various factors influencing the successful FET. Retrospective cohort analysis included 1112 women who underwent programmed FET between January 2012 and October 2022, at King Chulalongkorn Memorial Hospital, Thailand. Patient characteristics, embryo characteristics, endometrial preparation protocol, endometrial characteristics (thickness, pattern), embryo transfer procedure (tip and flow during transfer, embryo placement location, the difficulty of the procedure, presence of blood and mucous at catheter), and operator factor were analyzed. Multiple logistic regression analysis was used to assess the relationship between collected variables and successful embryo transfer which is defined by clinical pregnancy. The overall clinical pregnancy rate was 34.2%. Women aged 35-40 years and >40 years were less likely to have a clinical pregnancy compared to those aged <35 years [adjusted odds ratio (aOR): 0.523; 95% confidence intervals (CI): 0.360-0.757, P<0.001 and aOR: 0.260; 95% CI: 0.152-0.434, P<0.001, respectively]. Obese women with body mass index (BMI) ≥25 kg/m2 were significantly associated with decreased clinical pregnancy (aOR: 0.632; 95% CI: 0.403-0.978, P=0.042) compared to those with normal BMI. Day-3 and day-4 embryo transfer showed a significant decrease in clinical pregnancy compared to blastocyst transfer (aOR: 0.294; 95% CI: 0.173-0.485, P<0.001 and aOR: 0.497; 95% CI: 0.265-0.900, P=0.024). Double embryo transfer (DET) was 1.78 times more likely to have a clinical pregnancy than women with single embryo transfer (SET) (aOR: 1.779; 95% CI: 1.293-2.458, P<0.001). The cycles with endometrial thickness <8 mm were associated with a decrease in clinical pregnancy compared with those with a thickness ≥8 mm (aOR: 0.443; 95% CI: 0.225-0.823, P=0.013). Older age, obesity, non-blastocyst transfer, single embryo transfer, and endometrial thickness of <8 mm were significantly associated with a decreased clinical pregnancy in programmed FET.

Global research trends in endometrial receptivity from 2000 to 2024: bibliometric analysis.

In recent years, extensive research has been conducted on endometrial receptivity (ER), with rapidly evolving research hotspots and trends. Our study aimed to explore the development of ER research from 2000 to the present and provide insights for future endeavors. Relevant research publications on ER from 2000 to 2024 were retrieved from the Web of Science Core Collection (WOSCC) database. CiteSpace, VOSviewer and Excel tools were employed to conduct the bibliometric analysis. A total of 3,354 articles were analyzed, revealing an overall upward trend in annual publication numbers, signifying the increasing attractiveness and research value of this field. Globally, China led with a notable advantage of 1,030 publications, followed by the United States (650) and Spain (251), constituting the first tier of international research. Valencia University topped the list of institutions with 108 publications, closely followed by Shanghai Jiao Tong University with 87. Fertility and Sterility (IF6.6, Q1) is the one with the largest number of publications, accounting for 7.96% of the total publications. The three most co-cited journals were Fertility and Sterility, Biology of Reproduction, and Human Reproduction. A co-citation reference analysis revealed that ER research can be categorized into ten major subfields, including embryo implantation, frozen embryo transfer, integrins, recurrent implantation failure, intrauterine adhesions, etc. Since 2020, the keywords with the strongest citation bursts include repeated implantation failure and frozen. This study employs bibliometric analysis to offer researchers in the field of ER a comprehensive perspective. Since 2000, there has been a remarkable surge in the number of publications in the ER research field. These studies primarily concentrate on delving into the pathophysiological mechanisms of ER, with the primary objective of enhancing clinical pregnancy rates and live birth rates, benefiting more infertile patients. Currently, addressing the ER issues in patients with recurrent implantation failure represents the forefront of research. The primary treatment approaches currently in use involve optimizing embryo transfer timing and employing innovative strategies such as immunotherapy. These cutting-edge analyses not only provide new insights into the treatment of ER but also offer researchers fresh research directions, and staying abreast of the latest trends and advancements in the field.

Intrauterine infusion of autologous platelet rich plasma can be an efficient treatment for patients with unexplained recurrent implantation failure

The studies posits that there is not sufficient evidence to support the use of intrauterine platelet-rich plasma (PRP) infusion in patients with recurrent implantation failure (RIF). This study aims to investigate the effects of infusion of PRP on patients with unexplained-RIF in fresh and frozen embryo transfer (ET) cycles. A total of 80 participants were included in this study. The participants were randomly assigned to one of two groups with and without PRP infusion. Each of the PRP and control groups were also divided into fresh and frozen ET subgroups. ET outcomes were compared between groups. Clinical pregnancy rate was significantly higher in Frozen ET in PRP group than other subgroups (p < 0.0001). Miscarriage rate were significantly lower in PRP group than control group. Pregnancy complications and preterm labor were significantly higher in PRP group than control group (p < 0.0001). Live birth and healthy baby rate were significantly higher in PRP group than control group (p < 0.0001). The intrauterine infusion of 0.8-1 ml of PRP 48 h before blastocyst ET at fresh and frozen cycles can be an efficient treatment option for u-RIF patients. Also, results indicated that the clinical pregnancy rate was equal to the live birth rate at fresh ET cycles, whereas the live birth rate was lower than the clinical pregnancy rate at frozen ET cycles. Therefore, considering the superiority of fresh cycles over freeze cycles, the infusion of PRP into the uterus of patients with RIF is recommended to be done at fresh ET cycles.Trial registration: NCT, NCT03996837. Registered 25/06/2019. Retrospectively registered, http://www.clinicaltrial.gov/ NCT03996837.

Non-genetic risk factors for preeclampsia: an updated umbrella review

Abstract Background Preeclampsia (PE) is a common pregnancy disorder with complex mechanisms, and multiple risk factors may contribute to its development. Our objective is to update our literature search from our previous umbrella review, summarizing recent evidence on non-genetic risk factors associated with PE and assessing their credibility to identify those supported by robust epidemiological evidence. Methods We searched PubMed, EMBASE, Scopus, and ISI Web of Science up to June 2023. For each meta-analysis, we computed summary effect estimates, 95% confidence intervals, 95% prediction intervals, and assessed heterogeneity using I², while also examining small-study effects and excess significance bias. Quality assessment was conducted using the AMSTAR-2 tool. Results 89 meta-analyses were identified, providing data on 219 associations. Of these, 151 (69%) showed statistically significant findings at P &amp;lt; 0.05, with 52 (24%) remaining significant at P &amp;lt; 10-6. Large or very large heterogeneity was observed in 121 (55%) associations. Evidence for small-study effects and excess significance bias was found in 27 (12%) and 29 (13%) associations, respectively. Only 16 (7%) presented convincing evidence: Polycystic Ovary Syndrome (PCOS), PCOS (adjusted), Obstructive Sleep Apnea (OSA), Obesity (adjusted), Chronic Kidney Disease (CKD), Pregnancy Intrahepatic Cholestasis, SARS-CoV-2 infection (adjusted), Oocyte donation (OD) vs. In vitro fertilization (IVF), Fresh embryo transfer vs. spontaneous conception (SC) (singleton), Frozen embryo transfer vs. SC, OD vs. SC (singleton), IVF-OD vs. IVF-AO, IVF-OD fresh ET vs. IVF-AO fresh ET, NC frozen embryo transfer vs. AC frozen embryo transfer, Fetal sex (term), and Smoking. Conclusions Maternal health conditions like PCOS, along with reproductive interventions such as OD and IVF, as well as lifestyle factors like obesity and smoking, showed convincing associations with PE. Key messages • Maternal health conditions, reproductive interventions, and lifestyle factors showed compelling evidence of association with preeclampsia. • Our findings emphasize the multifactorial nature of preeclampsia and suggest potential avenues for further research and clinical intervention.