Higher Clinical Pregnancy Rate Research Articles

Diverse impacts of female chromosomal polymorphisms on assisted reproduction outcomes: a retrospective cohort study

BackgroundThe effects of female chromosomal polymorphisms (FCPs) on various aspects of reproductive health have been investigated, yet the findings are frequently inconsistent. This study aims to clarify the role of FCPs on the outcomes of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).MethodsThis retrospective cohort study comprised 951 couples with FCPs and 10,788 couples with normal karyotypes who underwent IVF/ICSI treatment at Peking University Third Hospital between 2015 and 2021. The exposure was FCPs. The embryological outcomes and clinical outcomes were compared.ResultsThe FCPs, as a whole, compromised the oocyte maturation rate (76.0% vs. 78.8%, P = 0.008), while they did not adversely affect other IVF/ICSI outcomes. Further detailed analyses showed that every type of FCPs contributed to the lower oocyte maturation rate, particularly the rare FCPs (69.0% vs. 78.8%, P = 0.008). The female qh + was associated with a higher normal fertilization rate (63.0% vs. 59.2%, adjusted P = 0.022), a higher clinical pregnancy rate (37.0% vs. 30.7%, adjusted P = 0.048), and a higher live birth rate (27.0% vs.19.0%, adjusted P = 0.003) in couples undergoing IVF. Conversely, in couples undergoing ICSI, female qh + was found to be related to a lower normal fertilization rate (58.8% vs. 63.8%, P = 0.032), a comparable clinical pregnancy rate (25.7% vs. 30.9%, P = 0.289), and a comparable live birth rate (19.8% vs. 19.2%, P = 0.880) compared to the control group. Additionally, an increased risk of preterm birth was observed in women undergoing IVF with multiple polymorphisms (62.5% vs. 16.9%, adjusted P < 0.001) and in women undergoing ICSI with pstk+ (36.4% vs. 15.4%, P = 0.036).ConclusionsOur research unravels the diverse impacts of various FCPs on IVF/ICSI outcomes, highlighting the detrimental effects of FCPs on oocyte maturation and the risk of preterm birth.

Effect of the time interval between denudation and ICSI on fresh embryo transfer reproductive outcomes: a retrospective study.

This study aims to determine if the incubation after oocyte denudation before Intra-cytoplasmic sperm injection (ICSI) affects the clinical pregnancy rate. This was a retrospective, consecutive data analysis of 1370 patients who underwent ICSI cycles at the Department of Reproductive Medicine of West China Second University of Sichuan University (Chengdu, Sichuan) between January 2020 and July 2022. The primary outcome was the clinical pregnancy rate. The second outcome included fertilization rate, biochemical pregnancy rate, and miscarriage rates. A total of 1370 continuous fresh transferred ICSI cycles were analyzed. Multivariate linear regression and logistic regression analysis of factors related to clinical pregnancy rates revealed that clinical pregnancy rates were significantly associated with denudation (DEN)-ICSI time interval. Long DEN-ICSI intervals are associated with a higher clinical pregnancy rate during fresh embryo transfer. The DEN-ICSI time interval is an independent factor for clinical outcomes in fresh ICSI transfer cycles.

Impact of vaginal microecological differences on pregnancy outcomes and endometrial microbiota in frozen embryo transfer cycles.

This prospective study investigates the correlation between vaginal microecology and pregnancy outcomes and explores their impact on endometrial microbiota composition during frozen embryo transfer (FET) cycles. Additionally, the impact of transvaginal Lactobacillus supplementation on reproductive outcomes in patients with previous failed cycles was assessed. A total of 379 patients undergoing FET at a reproductive medicine center were categorized into clinical pregnancy (CP), miscarriage (MISC), and non-pregnant (NP) groups. Vaginal specimens were collected for microecological evaluation prior to embryo transfer. Endometrial microbiota samples were obtained during embryo transfer for 16S rRNA gene sequencing analysis to assess endometrial microbiota composition. Vaginal microecological indicators, including pH, Lactobacillus dominance, and leukocyte esterase activity, were measured. Transvaginal Lactobacillus supplementation was investigated in 60 patients with previous failed cycles. Vaginal microecology significantly correlated with pregnancy outcomes, with normal microecology associated with a higher clinical pregnancy rate. Vaginal pH and leukocyte esterase activity were significantly associated with clinical pregnancy. Furthermore, vaginal microecological differences significantly impacted endometrial microbiota composition. However, no significant differences were observed in endometrial microbiota composition among the CP, MISC, and NP groups. Notably, transvaginal Lactobacillus supplementation increased the clinical pregnancy rate without affecting the miscarriage rate. This study highlights that normal vaginal microecology, characterized by lower pH and leukocyte esterase negativity, is associated with a higher likelihood of clinical pregnancy following FET. Importantly, vaginal microecological differences influence endometrial microbiota composition. Moreover, transvaginal Lactobacillus supplementation appears promising in improving clinical pregnancy rates in patients with previous failed cycles. These findings contribute to a better understanding of the interplay between vaginal and endometrial microbiota and offer potential interventions to enhance reproductive success in assisted reproductive technologies.

Impact of oil-based contrast agents in hysterosalpingography on fertility outcomes in endometriosis: a retrospective cohort study

BackgroundPrevious studies have suggested that oil-based contrast agents used during hysterosalpingography (HSG) in infertile patients can enhance fertility. However, limited research has investigated the effect of oil-based contrast medium specifically in individuals with endometriosis-related infertility.ObjectiveThis study aims to explore the impact of oil-based contrast medium on fertility outcomes in women with endometriosis-related infertility.MethodsConducted at the First Affiliated Hospital of Guangxi Medical University (January 2020 to June 2022), the study included 512 patients undergoing HSG. Patients were categorized into oil-based and non-oil-based groups, and after propensity score matching, demographic characteristics were compared. Main outcomes included clinical pregnancy rates, live birth rates, early miscarriage rates, and ectopic pregnancy rates.ResultsIn our analysis, the Oil-based group showed significantly better outcomes compared to the Non-oil-based group. Specifically, the Oil-based group had higher clinical pregnancy rates (51.39% vs. 27.36%) and increased live birth rates (31.48% vs. 19.93%). This trend held true for expectant treatment, IUI, and IVF/ICSI, except for surgical treatment where no significant difference was observed. After adjusting for various factors using propensity score matching, the Non-oil-based group consistently exhibited lower clinical pregnancy rates compared to the Oil-based group. The Odds Ratio (OR) was 0.38 (95%CI: 0.27–0.55) without adjustment, 0.34 (0.22–0.51) in multivariable analysis, 0.39 (0.27–0.57) using inverse probability of treatment weighting (IPTW), and 0.22 (0.14–0.35) in propensity score matching.ConclusionOil-based contrast medium used in HSG for women with endometriosis-related infertility is associated with higher clinical pregnancy rates and live birth rates compared to Non-oil-based contrast medium.

Higher pre-pregnancy body mass index was associated with adverse pregnancy and perinatal outcomes in women with polycystic ovary syndrome after a freeze-all strategy: Ahistorical cohort study.

Previous studies have demonstrated that abnormal body mass index (BMI) is associated with adverse pregnancy outcomes in frozen-thawed embryo transfer cycles. However, the relationship between BMI and pregnancy and perinatal outcomes in patients with polycystic ovary syndrome (PCOS) remains unclear. Furthermore, whether a diagnosis of PCOS could result in adverse pregnancy and perinatal outcomes in women with different BMIs remains unknown. A historical cohort study included 1667 women with PCOS and 12 256 women without PCOS after a freeze-all policy between January 2016 and December 2020. The outcomes encompassed both pregnancy and perinatal outcomes. Multivariate logistic regression analysis and restricted cubic spline models were performed to eliminate confounding factors when investigating the relationship between BMI and different outcomes. After controlling for covariates, pregnancy outcomes were comparable between underweight women with PCOS and normal weight women with PCOS. However, overweight patients had a lower clinical pregnancy rate and an overall live birth rate. Furthermore, patients with obesity had a lower rate of multiple pregnancies but a higher rate of biochemical pregnancy than in the normal BMI group. Additionally, the restricted cubic spline models showed that as maternal BMI increased to 32 kg/m2, the clinical pregnancy rate and live birth rate after blastocyst transfer decreased, but the risks of preterm birth, gestational diabetes mellitus, macrosomia, large-for-gestational age (LGA) and very LGA increased in patients with PCOS after a freeze-all strategy. Moreover, a diagnosis of PCOS resulted in a higher clinical pregnancy rate and live birth rate and a higher risk of small-for-gestational age in the normal weight group. However, women with PCOS in the overweight group exhibited higher risks of very preterm birth and gestational diabetes mellitus compared with women without PCOS. This study showed that a higher BMI had a detrimental impact on the pregnancy and perinatal outcomes of PCOS patients undergoing a freeze-all strategy. However, it was only statistically significant in the overweight group. A diagnosis of PCOS had a higher clinical pregnancy rate and live birth rate in normal weight women but higher risks of perinatal complications in normal weight and overweight women.

HMG addition affects the change in progesterone level during IVF stimulation and LBR: a retrospective cohort study

BackgroundPremature progesterone (P) rise during IVF stimulation reduces endometrial receptivity and is associated with lower pregnancy rates following embryo transfer (ET), which can influence provider recommendation for fresh or frozen ET. This study aimed to determine whether change in P level between in IVF baseline and trigger (\U0001d6abP) is predictive of pregnancy outcome following fresh ET, and whether the ratio of gonadotropins influences P rise and, as a result, clinical pregnancy outcomes: clinical pregnancy rate (CPR) and live birth rates (LBR).MethodsRetrospective cohort study at a single fertility center at an academic institution. The peak P level and \U0001d6abP were modeled in relation to prediction of CPR and LBR, and the ratios of hMG:rFSH were also modeled in relation to prediction of peak P level on day of trigger, \U0001d6abP, and CPR/LBR in a total of 291 patients undergoing fresh embryo transfer after controlled ovarian hyperstimulation-IVF (COH-IVF).Results\U0001d6abP correlates with CPR, with the most predictive range for success as \U0001d6abP 0.7–0.85 ng/mL (p = 0.005, 95% CI 0.635, 3.636; predicting CPR of 88.9%). The optimal range for peak P in regard to pregnancy outcome was 0.15–1.349 ng/mL (p = 0.01; 95% CI for coefficient in model 0.48–3.570). A multivariable logistic model for prediction of CPR and LBR using either peak or \U0001d6abP supported a stronger association between \U0001d6abP and CPR/LBR as compared to peak P. Furthermore, an hMG:rFSH ratio of > 0.6 was predictive of lowest peak P (p = 0.010, 95% CI 0.035, 0.256) and smallest \U0001d6abP (p = 0.012, 95% CI 0.030, 0.243) during COH-IVF cycles. Highest CPRs were observed within hMG:rFSH ratios of 0.3–0.4 [75.6% vs. 62.5% within and outside of the range, respectively, (p = 0.023, 95% CI 0.119, 1.618)]. Highest LBRs were seen within the range of 0.3–0.6 hMG:rFSH, [LBR of 55.4% vs. 41.4% (p = 0.010, 95% CI 0.176, 1.311)].ConclusionsOur data supports use of \U0001d6abP to best predict pregnancy rates and therefore can improve clinical decision making as to when fresh ET is most appropriate. Furthermore, we found optimal gonadotropin ratios can be considered to minimize P rise and to optimize CPR/LBR, emphasizing the importance of luteinizing hormone (LH) activity in COH-IVF cycles.

#304 : Comparing GnRH Agonist and GnRH Antagonist Protocols for IVF-ET Outcomes in Patients with Endometriosis: A Meta-Analysis

Background and Aims: Endometriosis is known to have detrimental effects on fertility, but there is no consensus on the optimal stimulation protocol for IVF-ET in patients with endometriosis. The study aimed to compare the IVF outcomes of gonadotropin-releasing hormone (GnRH) agonist protocols versus antagonist protocols in patients diagnosed with endometriosis. Method: We performed a meta-analysis of studies that compared IVF outcomes of GnRH agonist versus antagonist protocols in patients with endometriosis. Through literature search, we retrieved 222 articles, and the last search date was April 7, 2023. Among them, six studies which met inclusion criteria were eligible for final analysis. The primary outcome was clinical pregnancy. Random effects and fixed effects models were applied according to I2 statistics. Results: The use of GnRH agonist was associated with higher clinical pregnancy rate (Odds ratio (OR) 1.61, 95% CI 1.35–1.93, 6 studies, [Formula: see text]&lt;0.00001, I2=16%), higher live birth rate (OR 1.75, 95% CI 1.32–2.33, 3 studies, [Formula: see text]&lt;0.0001, I2=12%), and similar miscarriage rate. The total dose of gonadotropin did not differ between the two methods, but the GnRH agonist protocol had a longer duration of stimulation (WMD 1.34, 95% CI 0.44–2.24, 5 studies, I2=98%), retrieved more oocytes (WMD 2.23, 95% CI 0.58–3.88, 3 studies, [Formula: see text]=0.0008, I2=97%), more MII oocytes (WMD 2.81, 95% CI 2.34–3.28, 3 studies, [Formula: see text]&lt;0.00001, I2=0), and more embryos (WMD 1.90, 95%CI 1.13–2.67, 3 studies, [Formula: see text]&lt;0.00001, I2=68%). Conclusion: Patients with endometriosis may benefit from using GnRH agonist protocol in the IVF-ET cycle, as it may be associated with a higher clinical pregnancy rate and live birth rate. Even though the stimulation duration is longer, more oocytes, mature oocytes, and embryos may be expected. Although the findings of this study may be potentially beneficial for clinicians, it is crucial to conduct additional randomized prospective trials with larger cohorts to further validate the results.

IVF Stimulation - personalized, optimized, and simplified using an advanced decision-support tool: A randomized trial

We assessed the effectiveness of a clinical decision support tool to reduce total cumulative follicle-stimulating hormone dosage used, to eliminate the need for ultrasound exams after day 5 of an individual superovulation cycle, and to improve the number of high-quality embryos obtained. The design we used was a Randomized Control Trial in a private fertility center. This study included 93 women aged 25–45 years undergoing IVF. 48 Test and 45 Control participants included normal and poor responders and patients with polycystic ovarian syndrome. A clinical decision support tool was used to forecast stimulatory hormone dosing for an individual cycle based on follicle size distribution on day 1 and day 5. Cumulative stimulatory hormone doses, oocytes retrieved, number of Mii oocytes, total embryos, high-quality embryos obtained during the cycle, and clinical pregnancy rates was the main outcome measures. Test participants required significantly lower cumulative FSH doses during superovulation cycles (average 1883 IU test, 2530 IU control, p &lt;0.01), with significantly higher numbers of total embryos (average 5.4 test, 3.5 control, p&lt;0.01), and high-quality embryos (average 3.1 test, 1.2 control, p&lt;0.01). Test participants had higher Mii follicles, although the difference was not statistically significant. The clinical pregnancy rate reported was significantly higher for test participants than control participants (52% test, 26% control, p&lt;0.05). The test group had more poor responders and PCOS patients than the control group. In conclusion, the clinical decision support tool eliminated the need for ultrasound exams after day 5, reduced the doses of stimulatory hormone required, yielded significantly higher numbers of high-quality embryos, and resulted in higher clinical pregnancy rates.

Improved Pregnancy Outcomes and Endometrial Receptivity by Thawed Frozen Embryo Transfer in Mildly Stimulated Cycles with Letrozole Combined with Estrogen in Women with Unresponsive Thin Endometrium Compared to Standard Endometrial Preparation with Estrogen Alone: A Retrospective Study.

Infertile women undergoing frozen embryo transfer (FET) cycles may not show optimal endometrial growth with estrogens alone. To evaluate clinical effect of mild stimulation with letrozole and estrogens on endometrial growth in comparison to standard endometrial preparation with oral and topical estrogens in infertile women with unresponsive thin endometrium undergoing FET. Retrospective observational case-control study. Forty women unresponsive to first AC-FET cycle were given mild stimulation with letrozole and estrogens as second LE-FET cycle for endometrial preparation (LE-FET study group) and compared with 40 historical controls who had received two cycles of AC-FET (AC-FET control group). Responses were assessed by optimal endometrial thickness (≥ 7mm) and clinical pregnancy. Descriptive statistics were elaborated by mean ± SD and percentages. Results were expressed by mean ± SD, unpaired t test for difference in endometrial thickness, chi square and Fisher exact test to compare the difference in pregnancy among both groups. Mean endometrial thickness was significantly increased in LE-FET study group (6.68 ± 2.09mm) versus AC-FET control group (5.35 ± 1.90mm). Higher clinical pregnancy rate was noted in study group as compared to control group (35% versus 12.5%). This study suggests that letrozole with estradiol (LE-FET) compared to estradiol alone (AC-FET) for second cycle significantly increased endometrial thickness and improved clinical pregnancy rates in women with unresponsive thin endometrium after first AC-FET cycle with estradiol alone. Addition of letrozole to estrogen upfront for FET cycles may enhance endometrial receptivity and might improve pregnancy outcomes.

Suitable endometrial thickness on embryo transfer day may reduce ectopic pregnancy rate and improve clinical pregnancy rate

BackgroundThis retrospective study aimed to investigate the most suitable endometrial thickness (EMT) on the day of embryo transfer that could reduce ectopic pregnancy rate (EPR) and improve clinical pregnancy rate (CPR) in fresh embryo transfer patients with early follicular phase long-acting regimen.MethodsA total of 11,738 IVF/ICSI cycles, comprising 4,489 non-clinical pregnancies, 7,121 intrauterine pregnancies, and 128 ectopic pregnancy cycles after fresh embryo transfer, recorded between September 2017 and December 2020. Clinical pregnancy (CP) and ectopic pregnancy (EP) were the primary outcomes. Multivariate logistic regression was used to calculate the adjusted odds ratio (aOR) and 95% confidence interval (CI) for EP and CP. Patients were divided into three groups based on the EMT (6–10 mm, 11–15 mm, and 16–20 mm). CPR and EPR per millimeter of EMT were drawn into a line chart, and three groups were analyzed by Chi-square test.ResultsAfter controlling for potential confounders, EMT had a significant effect on CP (aOR = 1.07; 95% CI, 1.05–1.08; P = 0.00) and EP (aOR = 0.88; 95% CI, 0.82–0.94; P = 0.00). With the increase of EMT, CPR increased and EPR decreased. Pearson correlation coefficients were r = 0.708 (P = 0.00) and r =-0.558 (P = 0.03), respectively. Significant differenceswere detected in the CPRs and EPRs (all P = 0.00). The CPR in the 6–10 mm group (54.88%) was significantly lower than that in the 11–15 mm group (64.23%) and the 16–20 mm group (64.40%) (P = 0.00). The EPR in the 6–10 mm group (2.72%) was significantly higher than that in the other two groups (1.60% and 0.97%, P = 0.00). The difference in CPR and EPR between the 11–15 mm group and the 16–20 mm group was not statistically significant, which indicated that EMT ≥ 11 mm simultaneously reduced the EPR and increased the CPR.ConclusionsEMT was inversely proportional to EPR and directly proportional to CPR in fresh embryo transfer cycles. The EMT ≥ 11 mm on the day of embryo transfer could simultaneously achieve lower EPR and higher CPR. Accordingly, more attention should be given to the EMT of women who underwent ART treatment.

P-265 The inner cell mass (ICM) hatching levels of blastocyst before vitrification associated with clinical pregnancy rates after single embryo transfer in PGT-A cycles

Abstract Study question Is there an association between ICM hatching levels and clinical pregnancy rate after single blastocyst transfer (SET) in preimplantation genetic testing for aneuploidy (PGT-A) cycles? Summary answer A blastocyst with ICM hatching level ≤ 50% has a better clinical pregnancy rate than that in a blastocyst with ICM hatching level &amp;gt; 50%. What is known already The zona pellucida (ZP) breaching and trophectoderm (TE) herniating by laser assisted hatching before blastocyst stage is commonly used in blastocyst biopsy. The degree of hatching levels of ICM and TE is different between blastocysts before vitrification. However, completely hatched embryos may be more fragile due to the biopsy and vitrification/ warming processes and thus more susceptible to potential cellular damage prior to transfer. For the moment, no published studies have explored the entire set of information on morphological evaluation of biopsied blastocyst before vitrification including TE, ICM hatching levels, and clinical outcomes. Study design, size, duration A retrospective study including 578 PGT-A cycles with SET was conducted at Lee Women's Hospital between January 2020 and May 2022 (CS1-21156). The women age &amp;lt;20 or &amp;gt; 45 years were excluded in this study. The vitrification of expanded blastocysts on day 5 or day 6 was performed after TE biopsy. The hatching levels before vitrification were classified according the degree of TE or ICM hatching out from ZP. Participants/materials, setting, methods The groups of TE hatching levels were divided into (1) without hatching, (2) ≤25% hatching, (3) &amp;gt;25% &amp;lt;100% hatching and (4) hatching out. The groups of ICM hatching levels were divided into (1) ≤50% and (2) &amp;gt;50% hatching. The primary outcome measure was the clinical pregnancy rate. Statistical analysis was performed using the generalized estimating equations (GEE), Spearman’s correlation, Kruskal-Wallis test, Fisher's exact test and c2 test. Main results and the role of chance The average of women age was 36.8 ± 4.4 (24-45) years. The overall clinical pregnancy, miscarriage and ongoing rates after SET were 65.4% (378/578), 10.3% (39/378) and 58.5% (338/578), respectively. Spearman's correlation analysis indicated that the TE hatching levels, the ICM hatching levels and the ICM grade were associated with the clinical pregnancy rate (p &amp;lt; 0.01). According to multivariate regression analysis, the ICM hatching level ≤ 50% (OR: 1.863, 95% CI: 1.034-3.358, p = 0.038) and ICM grade A (OR: 1.662, 95% CI: 1.037-2.667, p = 0.035) were positively associated with clinical pregnancy probability. No significantly associations were found between women age, embryo day, TE hatching levels and clinical pregnancy rate (P &amp;gt; 0.05) after multivariate regression analysis. The clinical pregnancy rate in the blastocyst with ≤ 50% hatching (68.7% (328/477) ) was significantly higher than that in the blastocyst with &amp;gt; 50% hatching (49.5%, 50/101; p &amp;lt; 0.001). Furthermore, the blastocyst with grade A and ≤ 50% hatching had a highest clinical pregnancy rate (76.9% (93/121)) and the blastocyst with grade B and &amp;gt; 50% hatching had a lowest clinical pregnancy rate (46.3%, 38/82; p &amp;lt; 0.001). The abortion rates between all groups were no significantly difference. Limitations, reasons for caution A smaller sample size in the group of ICM hatching &amp;gt; 50% and further study with a larger sample size was needed to investigate putative impacts on clinical outcomes after SET. Wider implications of the findings These results demonstrate that a blastocyst with high degree of ICM herniating after biopsy and vitrification protocols decreased the clinical pregnancy probability. Selecting a biopsied blastocyst with either low ICM hatching level and grade A morphology for SET has a best pregnancy outcomes. Trial registration number not applicable

O-068 Transdermal testosterone gel (TTG) pre-treatment duration in improving ivf outcome in patients with poor prognosis (poseidon group 3 and 4): A randomised controlled trial.

Abstract Study question To compare the most effective duration of pre-treatment with transdermal testosterone gel in improving IVF outcomes using GnRH antagonist protocol in poor prognosis patients. Summary answer Pre-treatment with testosterone gel for 28 days had higher clinical pregnancy rate, more mature oocytes in lesser days and lower total dose of gonadotropins. What is known already Poor prognosis patients undergoing IVF exhibits subnormal ovarian response resulting in higher IVF cycle cancellation and lower clinical pregnancy. Amongst various adjuvants regimens use of androgen supplementation improves clinical pregnancy and probability of live birth in such patients. Androgen stimulates early stages of follicular growth, increase the number of primary, pre-antral and antral follicles. It increases FSH receptor expression in granulosa cells, in turn leading to better oocyte yield and pregnancy rate. We aim to compare the most effective duration of pre-treatment with transdermal testosterone gel in improving IVF outcomes using GnRH antagonist protocol in poor prognosis patients. Study design, size, duration A prospective, randomised controlled trial was carried out from 1st September 2021 to 31st August 2022 at a tertiary infertility centre in India. 100 poor prognosis patients POSEIDON group 3 and 4 (age 21-40 years, AFC &amp;lt;5 and AMH ≤1.2 ng/ml) were enrolled. They were randomized into 4 groups of 25 each by computer based program. Participants/materials, setting, methods Group 1, control received no pretreatment, Group 2, Group 3 and Group 4 received 1% TTG one actuation (12.5mg testosterone daily) for 2, 3 and 4 weeks respectively before start of ovarian stimulation. Patients received a starting dose of HP HMG dose 300 IU and dose was adjusted. Inj. Cetrorelix 0.25 mg started when lead follicle was 14 mm and Oocyte retrievals were performed 35 hours after 250 mcg r-HCG trigger. Main results and the role of chance All groups were comparable with regards to baseline FSH, AFC and AMH levels. Only one cycle was cancelled in control group because of lack of response to gonadotropins till day 5 of stimulation. Requirement of total days (9.68 Vz 8.95 days) and total dose of gonadotropins was significantly lower in group 4 as compared to control group 1. This showed that cases with pre-treatment of transdermal testosterone gel for longer duration, required less amount of gonadotropin (2826 IU Gp 1 Vz 2329 IU Gp 4) treatment (p &amp;lt; 0.01) and also the mean number of mature oocytes retrieved (0.80 Gp 1 Vz 3.38 Gp 4) were significantly higher (p &amp;lt; 0.01). Day 3 fresh embryo transfers were performed for all. Incidence of clinical pregnancy rate was 4.2%, 8%, 12% in group 1, 2, and 3 respectively which increased to 20% in group 4 (p-0.33). Miscarriage rate was 4.2% , 4%, 12% and 4% in group 1 ,2, 3 and 4 respectively (p-0.71). Ongoing pregnancy rate was 4% in group 1, while it was 7.7 %, 10.6 % and 19.2% in group 2,3 and 4 respectively (p-0.33). Limitations, reasons for caution The study was done at a single centre with small sample size, replication with more subjects and in different centers is needed. The long term effects of testosterone pretreatment requires further studies. Wider implications of the findings Pre-treatment with testosterone gel in poor prognosis patients improves response to gonadotrophin, reducing amount and days to complete stimulation and results in higher number of mature oocytes and improved clinical pregnancy rates. Transdermal testosterone treatment is advantageous as it is not first metabolized in the liver, convenient to the patient. Trial registration number CTRI/2022/03/040793

P-238 Non-interventional study comparing the effectiveness and safety of r-hFSH:r-hLH versus r-hFSH in women aged 35-42 years with normal ovarian reserve undergoing GnRH antagonist ART treatment

Abstract Study question Is ovarian stimulation (OS) with r-hFSH:r-hLH more effective than OS with r-hFSH alone in women aged 35-42 with normal ovarian reserve treated with ART? Summary answer Compared to r-hFSH alone, OS with r-hFSH:r-hLH for ART treatment was associated with a significant increase in clinical pregnancy and live birth per initiated cycle. What is known already Meta-analyses and secondary analyses of clinical data provide evidence that OS during ART treatment with r-hFSH:r-hLH is associated with improved reproductive outcomes when compared to r-hFSH alone in various patient groups with: a) advanced maternal age , b) low ovarian reserve or , c) hypo response to OS. Other subgroups of patients might also benefit of the use of r-hFSH:r-hLH during OS for ART treatment. We aimed to determine if, in a real-world setting, OS with r-hFSH:r-hLH is associated with improved clinical benefit when compared to r-hFSH alone in patients aged 35-42 years with normal ovarian reserve. Study design, size, duration A non-interventional study including women aged 35-42 years with normal ovarian reserve biomarkers (menstrual cycle day 2 or 3 FSH&amp;lt;12IU/L or 9&amp;lt;AFC&amp;lt;20 with a 2&amp;lt;diameter&amp;lt;10 mm, or AMH ≥1.2ng/ml) undergoing OS for ART treatment (fresh transfer only; GnRH antagonist protocol) in 12 French centers between 1/1/2008 and 31/12/2016, with a follow-up period up to 31/12/2017. The analysis included two cohorts: a) 4,323 OS cycles with r-hFSH alone, and b) 1,070 OS cycles with r-hFSH:r-hLH. Participants/materials, setting, methods Anonymized data were extracted from the Retrospective Multicenter Statistical database, including 12 French centers. A generalized linear model was used to address lack of randomization. The fixed effect part included age, an ovarian reserve estimator and stimulation; the random effect included age, AMH, AFC, FSH, cause of infertility and number of attempts, center and patient effect. Clusters (matched subsets) were built based on the propensity score by using a two-stage algorithm. Main results and the role of chance We included in our analysis 4,472 women receiving ART treatment after OS with r-hFSH (mean age: 37.8 years; 4,323 cycles) or with r-hFSH:r-hLH (mean age: 38.1 years; 1,070 cycles). In the r-hFSH cohort the mean AMH level was 2.81 ng/ml and mean AFC was 12.0, in the r-hFSH:r-hLH cohort they were 2.14 ng/ml and 10.0, respectively. The mean total r-hFSH dose were 2,275 IU (r-hFSH cohort) and 3,002 IU (r-hFSH:r-hLH cohort). Mean ± SD number of oocytes were 8.1 ± 5.7 (r-hFSH cohort) and 6.1 ± 4.3 (r-hFSH:r-hLH cohort); mean ± SD number of embryos were 4.0 ± 3.4 (r-hFSH cohort) and 3.3 ± 3.2 (r-hFSH:r-hLH cohort). The unadjusted ongoing pregnancy rate reached 17.1% in the r-hFSH cohort and 20.4% in the r-hFSH:r-hLH cohort, whilst the unadjusted live birth rate reached 17.0% and 20.2%, respectively. Unadjusted pregnancy failure rate was 6.6% and 3.7%, respectively. After adjusting for confounders, when compared to OS with r-hFSH, OS with rhFSH:rhLH was associated with a higher clinical pregnancy rate (Risk ratio,RR 1.232; 95% CI 1.058 to 1.436; p-value = 0.007) and a higher live birth rate (RR 1.452; 95% CI 1.227-1.1719, p-value &amp;lt;0.001) per initiated cycle. Limitations, reasons for caution Since this was a real-world data study, no random assignment of stimulation was performed, and some residual confounding is possible due to unmeasured confounders. Live births resulting from further transfers of frozen embryos were not included in the analysis. Wider implications of the findings This study demonstrated that OS with r-hFSH:r-hLH improves live birth rate in women &amp;gt; 35 years old with a normal ovarian reserve, compared to r-hFSH only. Sound RWE studies can be combined with RCTs to guide clinical and payer’s decision making, paving the way to precision medicine. Trial registration number Not applicable

Role of luteinizing hormone elevation in outcomes of ovulation induction with letrozole for polycystic ovary syndrome.

The effect of elevated luteinizing hormone (LH) on the clinical outcomes of ovulation induction (OI) in infertile anovulatory patients with polycystic ovary syndrome (PCOS) remains controversial. This retrospective study included PCOS patients undergoing intrauterine insemination (IUI) following letrozole (LE) stimulation without OC pretreatment. A retrospective cohort analysis was conducted in a single, academic ART center from January 2013 to May 2019. In total, 835 IUI cycles of PCOS patients treated with letrozole were collected for the analysis. Cohorts were separated based on the level of basal LH (bLH) and LH level after letrozole administration (LHle) during OI. OI response and reproductive outcomes were evaluated for each cohort. No adverse effects of dysregulated levels of either bLH or LHle on ovulation rate or reproductive outcomes were observed. Furthermore, the cohort of individuals with normal bLH and high LHle levels, exclusive of LH surge, exhibited significantly higher rates of clinical pregnancy (30.3% vs. 17.3%, p = 0.002) and live birth (24.2% vs. 15.2%, p = 0.024) than those with normal bLH and normal LHle. These results indicated that high LH levels in PCOS are not solid evidence of poor prognosis of letrozole-induced ovulation, while elevated LHle may be a prospective predictor for better OI outcomes. It seems that preinhibition of LH secretion is not needed.

Efficacy of atosiban for repeated embryo implantation failure: A systematic review and meta-analysis.

Repeated embryo implantation failure (RIF) posed a significant challenge in assisted reproduction. Evidence of its therapeutic effectiveness including atosiban used around embryo transfer to improve pregnancy outcomes in RIF patients undergoing in vitro fertilization-embryo transfer (IVF-ET) remained inconsistent. This study aimed to explore the efficacy of atosiban on pregnancy outcomes of patients with RIF who received IVF-ET. The research was designed using the PICOS format. A systematic search of four English databases, PubMed, EMBASE, Web of Science, Cochrane Library, and one Chinse database, China National Knowledge Infrastructure (CNKI) was conducted. The time range was from inception to December 10, 2022. Then trials comparing the efficacy of atosiban and control group on pregnancy outcomes in RIF patients who receive IVF-ET were included. Subgroup analysis and sensitivity analysis were performed to reduce the influence of heterogeneity between included studies. Risk ratio (RR) and 95% confidence interval (CI) were calculated. The main outcome measure was clinical pregnancy rate (CPR). For the analyses, StataMP 17.0 (Stata Corporation, USA) was used. Two prospective randomized controlled trials (RCTs), one prospective cohort study and four retrospective cohort studies were included. Our results showed that atosiban was associated with higher clinical pregnancy rate (RR=1.54, 95% CI: 1.365-1.735, P < 0.001, I2 = 0.0%). The results of subgroup analysis based on study types (prospective randomized controlled clinical trial, retrospective cohort study and prospective cohort study) showed that in all types of studies, CPR of atosiban group was significantly higher than controlled group. The results of subgroup analysis based upon the diagnostic criteria of number of previous embryo transfer failures showed that the intervention of atosiban improved the CPR whether in participants with 2 previous ET failures or in participants with 3 previous ET failures. Nevertheless, the incidence of ectopic pregnancy, multiple pregnancy, and miscarriages were not significantly different between the case and control groups. For women who are undergoing IVF-ET and have experienced repeated embryo implantation failure, atosiban may be an important factor in enhancing pregnancy outcomes. To confirm this conclusion, more thorough, prospective randomized controlled studies of sizable sample sizes with well design are required.

Supplementary dydrogesterone is beneficial as luteal phase support in artificial frozen-thawed embryo transfer cycles compared to micronized progesterone alone.

The number of frozen embryo transfers increased substantially in recent years. To increase the chances of implantation, endometrial receptivity and embryo competency must be synchronized. Maturation of the endometrium is facilitated by sequential administration of estrogens, followed by administration of progesterone prior to embryo transfer. The use of progesterone is crucial for pregnancy outcomes. This study compares the reproductive outcomes and tolerability of five different regimens of hormonal luteal phase support in artificial frozen embryo transfer cycles, with the objective of determining the best progesterone luteal phase support in this context. This is a single-center retrospective cohort study of all women undergoing frozen embryo transfers between 2013 and 2019. After sufficient endometrial thickness was achieved by estradiol, luteal phase support was initiated. The following five different progesterone applications were compared: 1) oral dydrogesterone (30 mg/day), 2) vaginal micronized progesterone gel (90 mg/day), 3) dydrogesterone (20 mg/day) plus micronized progesterone gel (90 mg/day) (dydrogesterone + micronized progesterone gel), 4) micronized progesterone capsules (600 mg/day), and (5) subcutaneous injection of progesterone 25 mg/day (subcutan-P4). The vaginal micronized progesterone gel application served as the reference group. Ultrasound was performed after 12-15 days of oral estrogen (≥4 mg/day) administration. If the endometrial thickness was ≥7 mm, luteal phase support was started, up to six days before frozen embryo transfer, depending on the development of the frozen embryo. The primary outcome was the clinical pregnancy rate. Secondary outcomes included live birth rate, ongoing pregnancy, and miscarriage and biochemical pregnancy rate. In total, 391 cycles were included in the study (median age of study participants 35 years; IQR 32-38 years, range 26-46 years). The proportions of blastocysts and single transferred embryos were lower in the micronized progesterone gel group. Differences among the five groups in other baseline characteristics were not significant. Multiple logistic regression analysis, adjusting for pre-defined covariates, showed that the clinical pregnancy rates were higher in the oral dydrogesterone only group (OR = 2.87, 95% CI 1.38-6.00, p=0.005) and in the dydrogesterone + micronized progesterone gel group (OR = 5.19, 95% CI 1.76-15.36, p = 0.003) compared to micronized progesterone gel alone. The live birth rate was higher in the oral dydrogesterone-only group (OR = 2.58; 95% CI 1.11-6.00; p=0.028) and showed no difference in the smaller dydrogesterone + micronized progesterone gel group (OR = 2.49; 95% CI 0.74-8.38; p=0.14) compared with the reference group. The application of dydrogesterone in addition to micronized progesterone gel was associated with higher clinical pregnancy rate and live birth rate and then the use of micronized progesterone gel alone. DYD should be evaluated as a promising LPS option in FET Cycles.

Impact of sexual intercourse on frozen-thawed embryo transfer outcomes: a randomized controlled trial

BackgroundExposure of the female reproductive tract to either seminal plasma or fluid component of the ejaculate is beneficial to achieving successful embryo implantation and normal embryo development. But whether the “physical” component of sexual intercourse during the peri-transfer period have any influence on frozen-thawed embryo transfer (FET) pregnancy outcomes is not clear.MethodsWe conducted a randomized trial that included 223 patients undergoing in vitro fertilization (IVF) treatment at a university-affiliated reproductive center from 19 July 2018 to 24 February 2019. Enrolled patients undergoing IVF treatment were randomized either to engage sexual intercourse using the barrier contraception (Group A, n = 116) or to abstain (Group B, n = 107) one night before FET. The primary outcome was clinical pregnancy rate.ResultsPatients having intercourse had higher clinical pregnancy rate (51.72% vs. 37.07%, P = 0.045) and implantation rate (38.31% vs. 24.77%, P = 0.005) compared to those did not engage intercourse. However, there was no significant difference of the spontaneous abortion rate between two groups (11.67% 33 vs. 14.63%, P = 0.662).ConclusionsSexual intercourse before embryo transfer may improve the clinical pregnancy and implantation rates during FET cycles. However, it should be noted that patients choose only one time for sexual intercourse, that is, the night before embryo transfer.Trial registrationThe present study was registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn/, ChiCTR1800017209).

Reproductive outcomes after expectant and surgical management for tubal pregnancy: a retrospective study

Background: The management of ectopic pregnancy is widely debated. Salpingectomy, salpingostomy, and expectant management are widely performed, but the best approach in terms of keeping good future spontaneous fertility chances is yet to be determined. Material and methods: We performed a retrospective analysis (Clinical Trial ID: NCT05479786) of the medical records of patients with an ultrasonographic or surgical diagnosis of tubal ectopic pregnancy that were admitted to the University of Debrecen Clinical Centre between 2012 and 2020. Results: A total of 312 patients were included in the analysis. Patients managed expectantly and patients treated with salpingostomy had significantly higher rates of clinical pregnancy than patients treated with salpingectomy. Pregnancy outcomes and recurrence rates were comparable between the study groups. Salpingectomy was found to decrease the likelihood of conceiving spontaneously by 65%. A stratified analysis based on serum β-HCG levels demonstrated that all treatment modalities carry the same reproductive opportunities for patients presenting with β-HCG levels ≤ 1745 IU/L. Conclusion: Salpingectomy was found to decrease the patient’s chance of achieving a natural conception. Conservative approaches should be considered with caution only when the patient’s clinical condition permits, and the patient is appropriately counseled.

Evaluation of Dysfunctional HDL by Myeloperoxidase/Paraoxonase Ratio in Unexplained Infertility Patients Undergoing IVF/ICSI

Patients with UEI (study group, n = 40) and male factor infertility (control group, n = 36) were included in this prospective study. Demographics and laboratory assessments were analyzed. Total dosages of gonadotropin were higher in UEI when compared to the control group (p = 0.033). Number of Grade 1 embryos and the quality of blastocysts were lower in UEI than in the control group (p = 0.024, p = 0.020, respectively), whereas serum MPO/PON ratio was higher in UEI (p = 0.042). Stepwise linear regression analysis revealed that serum MPO/PON ratio levels could significantly predict the duration of infertility (p = 0.012). Serum MPO/PON ratio increased in patients with UEI, whereas the number of Grade 1 embryos and the quality of blastocysts decreased. Similar clinical pregnacy rates were found in both groups but the ET on day five is associated with higher clinical pregnancy rate in the male factor infertility.

Assisted reproductive technologies in Africa: The African Network and Registry for ART, 2018 and 2019

Research questionWhat were the utilization, practices and outcomes of assisted reproductive technology (ART) in Africa in 2018 and 2019? DesignCycle-based data (CBD) and retrospective summary data were collected cross-sectionally from voluntarily participating ART centres. ResultsDuring 2018, 43,958 ART procedures were reported by 67 centres in 16 countries, increasing to 45,185 procedures reported by 70 centres in 18 countries in 2019. Autologous fresh procedures predominated at 70%, whereas autologous frozen embryo transfers (FET) increased from 21.2% to 23.1% and oocyte donation cycles remained below 10%. In 2019, the mean age of women undergoing autologous fresh embryo transfer was 33.9 years and received a mean number of 2.4 embryos per transfer. The clinical pregnancy rate (CPR) per fresh embryo transfer was 42.8% in 2018 and 38.4% in 2019, with corresponding rates of 38.3% and 31.8% after FET. In both years, most ART procedures, excluding single embryo transfer (SET), were associated with a multiple delivery rate above 20%, reaching over 30% after elective dual embryo transfer in autologous cycles and after fresh oocyte donation. Multiples were predominantly born preterm with a substantially increased perinatal mortality rate. The CBD for both years showed that elective SET (eSET) achieved a high CPR without compromising safety. ConclusionThis third report of The African Network and Registry for Assisted Reproductive Technology documents the prevailing practice of multiple embryo transfers in a cohort of relatively young women while highlighting the importance of disaggregating eSET, non-eSET and double embryo transfer. The high CPR after eSET and the increase in cryopreservation cycles are encouraging trends towards decreasing the number of embryos transferred without compromising effectiveness. Improved follow-up of ART pregnancies is required.