ICSI Cycles Research Articles

The relationship of serum and follicular fluid pregnancy-associated plasma protein (PAPP-A) levels with endometrial thickness in PCOS and non-PCOS women undergoing ICSI-cycles

Pregnancy-associated plasma protein (PAPP-A) is a metalloproteinase that binds and cleaves insulin-like growth factor-binding protein 4 (IGFBP4), then releases IGF-1 from the IGFBP4/IGF-1 complex, activating the IGF pathway. As a result, in the IGF system, PAPP-A is regarded as a bioactive IGF-1 enhancing enzyme. IGFs and IGF receptors are thought to play a role in endometrium receptivity. A critical endometrium receptivity biomarker was up-regulated by PAPP-A. The present study aimed to assess the relationship of PAPP-A levels in serum and follicular fluid with endometrial thickness in PCOS and non PCOS women enrolled in the ICSI cycle. Forty-five infertile Iraqi women with PCOS and non-PCOS criteria were nominated from those who were attending the Higher Institute for Infertility Diagnosis and Assisted Reproductive Technologies clinic. The age of the included women ranged between 20-45 years. PAPP-A level measures in serum (at pick-up day and embryo transfer day) and follicular fluid. In non-PCOS patients, PAPP-A has higher level in serum and follicular fluid but without statistically significant difference comparing with PCOS patients. Level of PAPP-A and endometrial thickness increased significantly at the day of embryo transfer in contract with pick up day. The result did not show any correlation between PAPPA levels and endometrial thickness in both days. While, there was insignificant increase in endometrial thickness at both pick up and transfer days between pregnant and non-pregnant women. In conclusion, level of PAPP-A (in serum and follicular fluid) and endometrial thickness at the time of embryo transfer were significantly higher than pick-up day, this study did not establish a statistical significant relationship between serum and follicular fluid in PAPP-A levels and endometrial thickness.

DOES LOOKS MATTER? EFFECT OF ISOLATED TERATOZOOSPERMIA ON FERTILIZATION AND EMBRYO OUTCOME IN ICSI CYCLES

This retrospective study aimed to re-evaluate the clinical value of a 4% cut-off threshold of sperm morphology in Intra Cytoplasmic Sperm Injection - ICSI cycles.

CLINICAL FACTORS ASSOCIATED WITH SUBOPTIMAL BLASTULATION RATE IN ICSI CYCLES: A PARAMETRIC MODELING APPROACH

Blastulation rate is an important performance marker for assisted reproduction laboratories. Special interest groups suggested competency metrics for blastulation rate and we investigated factors associated with suboptimal blastulation rate in ICSI cycles.

ANTAGONIST VERSUS SHORT AGONIST PROTOCOL IN POSEIDON-4 CATEGORY UNDERGOING FRESH ICSI CYCLES

Recently POSEIDON (Patient-Oriented Strategies Encompassing IndividulaizeD Oocyte Number) classification was proposed to categorize patients with expected poor response to conventional stimulation (1). Searching for the ideal management of poor responders in IVF is still an active research area. The study objective is to compare GnRH-antagonist and GnRH-agonist short protocols in ICSI cycles for the POSEIDON-4 group.

SINGLE DOSE TRIPTORELIN 0 .1 MG AS A LUTEAL PHASE SUPPORT IN ANTAGONIST INTRACYTOPLASMIC SPERM INJECTION (ICSI) CYCLES

To compare the effect of luteal phase support using progesterone and triptorelin versus progesterone alone on the reproductive outcomes of antagonist ICSI cycles.

Effectiveness of Low Dose Aspirin or Vaginal Sildenafil on Perifollicular Blood Flow Using Doppler ultrasound and EG-VEGF and their Impacts on ICSI Cycle Outcome

Effectiveness of Low Dose Aspirin or Vaginal Sildenafil on Perifollicular Blood Flow Using Doppler ultrasound and EG-VEGF and their Impacts on ICSI Cycle Outcome

Live Birth Rates in Women Under 38 Years Old with AMH Level < 1.2ng/ml in the First In Vitro Fertilization + / - Intracytoplasmic Sperm Injection: Retrospective Study and Arguments for Care.

Many studies failed to show a predictive impact of AMH levels on the chances of pregnancy; however, acceptable pregnancy rates for young women with low AMH levels were observed in IVF + / - ICSI. The objectives of this retrospective study were to evaluate the clinical pregnancy and live birth rates in the first IVF + / - ICSI cycle in women under 38years old with AMH level < 1.2ng/ml and to determine the arguments for care. We classified the women into three groups: group A: AMH < 0.4ng/ml (n: 86); group B: AMH: 0.4 to 0.8ng/ml (n: 90); and group C: AMH > 0.8 to < 1.2ng/ml (n: 92). We recorded data on the patients' characteristics, stimulation cycles, embryo cultures, and ongoing pregnancies. No difference was observed between the three groups for the number of embryos transferred, the clinical pregnancy, and the live birth rates (LBR) per embryo transfer (LBR/transfer: 24.1% in group A, 25.9% in group B, and 28.1% in group C). The young age of the women reassures about the oocyte quality, but a low level of AMH may raise concerns about a lower quantitative oocyte yield, leading to accelerated management of the couple in IVF + / - ICSI.

Mental health and behavioural problems in adolescents conceived after ART.

Mental health and behavioural problems in adolescents conceived after ART.

Association between ICSI cycle outcome and response in women with infertility

Background: Infertility is the inability to achieve a clinical pregnancy after 12 months of regular and unprotected sexual activity. Increases in child-bearing delay and maternal age at first pregnancy significantly impact the rise of age-related infertility and the demand for treatment using assisted reproduction techniques (ART). As a result, many women with a low ovarian reserve and a poor ovarian response (POR) to conventional stimulation seek medical assistance at infertility clinics. Aim: The study aimed to evaluate the quality of oocytes and embryos, as well as the rates of conception, in infertile women who were candidates for fresh intracytoplasmic sperm injection between good and poor-responder women (ICSI). Patients and methods: The study was conducted on 45 infertile women undergoing ICSI at the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies/ Al-Nahrain University/ Baghdad/ Iraq from October 2021 to April 2022, regardless of whether they had previously undergone ICSI. The morphology of the oocytes and the quality of the resulting embryos were assessed. The patients' ages ranged from 20 to 42 years old. There was primary and secondary infertility ranging from one to 20 years. Every couple had a basic reproductive assessment. The antagonist protocol was used for all infertile females. All females had their serum levels of AMH, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and oestradiol (E2) measured on the second or third day of their cycle. The serum oestradiol (E2) level was re-measured on the day of the hCG injection. Results: The participants in the study were 32.6 ± 5.3 years old. The findings showed that 57.8% of the patients had a well response, and 24.4% of the women were pregnant. In those who became pregnant, anti-müllerian hormone (AMH) levels were significantly higher, and follicle-stimulating hormone (FSH) levels were noticeably lower (p&gt; 0.05). The E2, LH, prolactin, and progesterone levels were not statistically different (P&gt; 0.05). Conclusion: In conclusion, the findings revealed a positive relationship between response and ICSI outcomes in infertile women.

Evaluation of Origio IVM medium quality in in vitro maturation of human germinal vesicle oocytes gained during intra cytoplasmic sperm injection cycles

Different medium has been introducing in last two decays for IVM of human oocytes germinal vesicles but they are very expensive and gained by order with different qualification, and different maturation rates. Objective: the aim of study to evaluate the efficacy of Origio IVM medium used in in vitro maturation of germinal vesicles gained during ICSI cycles. Patients and methods: 81 oocytes in germinal vesicle stage involved in in vitro maturation (IVM) program with Origio medium, they represent 35 cases (couples) that underwent IVF-ICSI operation, gained from them, (18) of them excluded because they are morphologically abnormal, the rest (63) GV introduced in program, they incubated for 24 hours and reassessed again to evaluate their maturation, the study done in the High institute for infertility diagnosis and assisted reproductive technologies, Al- Nahrain University from the period December 2018 to February 2020 .

Evaluation of fertilization medium quality in in vitro maturation of human germinal vesicle oocytes gained during intra cytoplasmic sperm injection cycles

Background: in vitro maturation of human germinal oocytes is a promising technique in assisted reproductive technologies, different medium has been introducing in last two decays for this purpose but they are very expensive and gained by order with different qualification Objective: the aim of study to evaluate the efficacy of fertilization medium used in in vitro maturation of germinal vesicles gained during ICSI cycles. Patients and methods: 42 oocytes in germinal vesicle stage involved in in vitro maturation (IVM) program with fertilization medium, they represent 22 cases (couples) that underwent IVF-ICSI operation, gained from them, (9) of them excluded because they are morphologically abnormal, the rest (33) GV introduced in program, they incubated for 24 hours and reassessed again to evaluate their maturation, the study done in the High institute for infertility diagnosis and assisted reproductive technologies, Al- Nahrain University from the period December 2018 to February 2020 . Results: out of (33) Gv incubation for 24 hours (6) of them remain in GV stage, (8) of them pass to M1 maturation stage, and another (8) passes to M2 stage of maturation, the rest 11 they were atretic.

Are Clinical Outcomes of Microdissection Testicular Sperm Extraction in Non-Obstructive Azoospermic Men Affected by the Use of Fresh or Frozen Gametes?

Background: Non-obstructive azoospermia (NOA) is a severe form of male factor infertility, evident in approximately 5% of infertile couples seeking fertility treatment. The combination of microsurgical testicular sperm extraction (mTESE) and ICSI has become one of the treatment options, with sperm motility positively associated with outcome success rates. Few studies have investigated whether use of fresh or thawed gamete combinations affect clinical outcomes. Aim: To determine the clinical outcomes of ICSI cycles using mTESE recovered testicular sperm of NOA patients and whether these are affected by the use of fresh or thawed gametes. Method: A retrospective study of NOA patients who underwent mTESE between March 2017 and September 2020. Clinical outcomes investigated included successful surgical sperm retrieval (SSR), sperm motility, fertilisation, embryo utilisation and live-birth/ongoing pregnancy rates. Results: A total of 105 NOA patients underwent mTESE, with a 65.7% successful SSR. In total 58 patients contributed to 72 ICSI cycles, with a 37.5% 2PN fertilisation rate and 29.4% live-birth/ongoing pregnancy rate. Cycles using only motile sperm had a greater fertilisation rate than those using a motile/non-motile sperm combination (51.7% vs 31.1%, p[Formula: see text]0.05). Compared with fresh, thawed testicular spermatozoa didn’t affect clinical outcomes, including live-birth/ongoing pregnancy rates (Fresh 18.2%; Thawed 17.9%; Odds ratio (OR) 1.02 (0.34-2.86) p=0.98). In contrast, use of thawed oocytes decreased fertilisation rate [Fresh-oocytes: 45.0%; Vitrified-oocytes: 35.5%; OR 1.47(1.03-2.10), p=0.03] but had no differences for other clinical outcomes, including live-birth/ongoing pregnancy rate (p=0.74). Importantly, injection of exclusively non-motile-spermatozoa (n=26 cycles) resulted in a very low fertilisation rate (2.7%) and no live-birth/ongoing pregnancies were recorded. Conclusion: Microdissection TESE is an effective treatment for NOA patients, with no clear negative effects of using thawed spermatozoa, however, the use of vitrified oocytes requires further investigation. The use of non-motile spermatozoa in mTESE ICSI cycles is discouraged.

Demographics and Cycle Outcomes of Transgender Patients Accessing Gamete Services at Monash IVF Victoria

Background: Since 2003 an increasing number of transgender patients are electing to store gametes prior to transitioning and/or utilising ART services at Monash IVF Victoria. Aim: The aim of this study was to determine the number of transgender patients accessing gamete storage and utilisation services, as well as their cycle outcomes. Methodology: A retrospective study of frozen gamete usage of 48 patients collected between 2003-2021 was undertaken. Results: Trans-female patients were the most common cohort, with 37 patients (16-49yrs, mean age 25.9± 7.7) undertaking semen freezing and two (13yrs and 17yrs) surgical sperm retrieval prior to transitioning. Between 2003-2010 and 2011-2021 six (15.4%) and 33 (84.6%) patients respectively used this treatment. On average 2.3± 2.0 ejaculates/patient were frozen. At freezing 13 (35.1%) patients had &gt;1 ejaculate with a low sperm count and 23 patients (62%) low sperm motility compared to WHO criteria; data were unavailable if patients had already commenced hormonal therapy. Four patients (10.8%) elected to register as sperm donors and their sperm used, while only four (10.8%) trans -female patients have returned, 2-7 years later (mean 5.3± 2.2 years) with a cis -female partner to utilise their gametes; two achieving a live birth. In contrast, nine trans -male patients (20-29yrs, mean age 23.9± 2.6yrs) undertook oocyte collection; one (11.1%) had treatment in 2003-2010 and eight (88.9%) between 2011-2021. On average 1.4± 0.7 egg freezing cycles/patient were conducted, with 4-30 eggs frozen/collection (mean 14.4± 7.1). One patient donated their oocytes to their cis- female partner in an ICSI cycle 7 years after freezing and achieved one live birth. Conclusion: Gamete cryopreservation is a valuable service for transitioning patients wishing to preserve fertility; numbers are increasing, with low utilisation to date and successful outcomes recorded. Exploring transgender patient experiences and ART service uptake will provide vital feedback to tailor an inclusive fertility journey at our clinics.

Debate: Are We Limiting the Potential of Oocytes by Not Using ICSI for All? - ICSI Should be Used for Most IVF Cycles

Background: Following earlier studies introducing an IVF-ICSI Split model on couples with unexplained infertility to avoid the scenario of unexplained failed or poor fertilization, PIVET has adopted a high ICSI rate approaching 90%, whereas the general rate among Australian facilities is around 60%. Aim: To compare the embryology and clinical outcomes in an IVF program where ICSI is applied beyond male-factor reasons and applies an IVF-ICSI Split protocol for IVF-naïve women with unexplained infertility. Method: This observational study with retrospective data analysis reports on autologous IVF± ICSI procedures conducted over the period 2011 to 2019 with follow-up of ensuing pregnancies through 2020. Results: Using autologous oocytes, 2343 women had 3434 IVF± ICSI cycles with 84.5% of women had 88.9% of initiated treatment cycles using ICSI and only 5.3% of women had 4.0% of cycles by IVF. The remaining 10.1% of women utilised the IVF-ICSI Split model for the remaining 7.2% of cycles. It was shown that oocyte fertilisation rates were significantly higher for ICSI (p&lt;0.0001), but not significant for women &gt;40 years. The utilisation rates of the ensuing embryos were [Formula: see text]45% across all ages with no significant differences across the ages, except for those small numbers of women [Formula: see text] 45 years who had a higher rate from IVF-generated embryos (p&lt;0.0002). Pregnancy outcomes were higher from ICSI-generated embryos across the age groups, being especially marked among the younger women &lt;40 years (p&lt;0.0001). Miscarriage rates were lowest for the IVF-generated pregnancies (overall 6.7% vs 22.8%, p&lt;0.0001) but nevertheless the final live birth productivity rates per initiated treatment cycle remained higher from the ICSI-generated pregnancies (56.5% vs 46.3%; p&lt;0.0001). Conclusion: Although this study does not meet the highest standards for EBM, it emanates from a pioneer facility with &gt;40 years of published activity and which practices 90% blastocyst transfers in &gt;90% SET cycles. The study supports a high ICSI rate of 90% and an IVF-ICSI Split rate of 10%.

Is There an Increased Incidence of Aneuploid Embryos in Cases of Obstructive and Non-Obstructive Azoospermia?

Background: Current evidence supports that males with low spermatozoa concentrations, as well as obstructive azoospermia (OA) or non-obstructive azoospermia (NOA), present with high rates of aneuploid spermatozoa. This issue could potentially lead to an increased number of aneuploid embryos in subsequent ICSI cycles using surgically retrieved spermatozoa, however, azoospermia is not routinely considered to be a clinical indication for pre-implantation genetic testing for aneuploidies (PGT-A). Aim: To identify the incidence of aneuploid embryos in PGT-A cycles that used testicular spermatozoa extracted through surgical sperm retrieval (SSR). In addition, whether aneuploidy rates differed between embryos fertilised with SSR compared with ejaculated spermatozoa. Method: A retrospective study of OA and NOA patients who underwent SSR between March 2017 and September 2020 and had PGT-A cycles. Next-generation sequencing was employed to detect embryo aneuploidies. Data were compared and analysed using a chi-square test with PGT-A cycles using ejaculated spermatozoa within the same time-period. Results: A total of 57 males underwent SSR, leading to 68 cycles that included the use of PGT-A. A total of 152 embryos with conclusive results identified there to be 57.2% euploid embryos (87/152) and 38.2% aneuploid embryos (58/152) in the SSR group. In comparison, the ejaculated spermatozoa group resulted in 59.2% (2115/3677) euploid embryos and 35.7% (1312/3677) aneuploid embryos. The incidence of aneuploid embryos (38.2%) in the SSR group was not statistically significant [Odds ratio: 1.11 (0.79-1.56) p=0.53]. Importantly, there were no differences for mean maternal age for both study groups (SSR female partners: 36.7 years; ejaculated spermatozoa female partners: 37.1 years; p&gt;0.1). Conclusion: The current outcomes indicate there is not an increased incidence of aneuploid embryos in PGT-A cycles of men who underwent to SSR compared with men using ejaculated spermatozoa.

The role of FSH to AMH ratio in poor prognosis patients undergoing ICSI cycle

Objective:The objective of this study was to estimate the number of oocyte retrieval and cycle cancellation using follicle stimulating hormone (FSH) to anti-Mullerian hormone (AMH) ratio in poor prognosis patients undergoing intracytoplasmic sperm injection treatment.Material and Methods:This retrospective study including fresh cycles was conducted in Zekai Tahir Burak Women’s Health Training and Research Hospital, between January 2015 and October 2018. Women aged between 24 and 44 years were recruited and the baseline serum hormone levels, FSH/AMH ratio, and the antral follicle count were recorded. Number of retrieved oocytes, metaphase-II oocytes, fertilised oocytes, and the number and grade of the embryos were also recorded.Results:A total of 108 cycles, corresponding to 92 women with poor prognosis were eligible for analysis. The use of FSH/AMH ratio performed well in predicting retrieved oocyte count <5 with an area under the curve (AUC) of 0.82 [95% confidence interval (CI): 0.71-0.92]. A FSH/AMH ratio cut-off of 11.36 was set for the retrieval of <5 oocyte at oocyte pick-up (OPU) with 80% sensitivity and 87% specificity. The FSH/AMH cut-off value was 14.22 to differentiate cycle cancellation and no oocyte retrieval at OPU, with a sensitivity of 91% and a specificity of 44% (AUC of 0.71; 95% CI: 0.59-0.83). There was no correlation between FSH/AMH ratio and clinical pregnancy.Conclusion:The assessment of this simple ratio at the beginning of the cycle may help clinicians better anticipate gonadotropin stimulation treatment and better counsel patients about cycle cancellation and the expected oocyte yield.

Investigation of the Predictive Factors of Diminished Ovarian Reserve in Women Aged Less Than 40 Years and Undergoing ICSI Cycle.

Diminished ovarian reserve (DOR) is one of the primary causes of poor ICSI outcomes. Therefore, this study was performed to speculate which of the following parameters: AMH, AFC, and women's age can be used as a predictor factor of the DOR in women aged < 40years. This prospective study enrolled 500 women suffering from idiopathic infertility problems and who underwent GnRH antagonist multiple-dose stimulation protocol. The women were divided into two groups: normal fertility (FSH ≤ 10 mIU/mL, n = 300) and DOR (FSH > 10 mIU/mL, n = 200). At the time of the study, the average of women age was 29.3 ± 5.7years. A significant reduction was found in AMH level, AFC, number of mature, immature oocytes, fertilized oocytes, embryos transferred, and β-hCG level in the DOR group compared to the normal fertility group (P < 0.001). Conversely, a significant increase was shown in the age of the DOR group compared to the normal fertility group (30.8 ± 5.8 vs. 28.2 ± 5.4, respectively; P < 0.001). A significant negative association was found between the AFC, the number of mature oocytes, fertilized oocytes, embryos transferred, and the basal level of FSH in the DOR group (P < 0.01). The receiver operating characteristics (ROC) demonstrated that AMH level and AFC had the highest accuracy, followed by age in the prediction of DOR (P < 0.001) with a cut-off value of ≤ 1.2ng/mL, ≤ 4.5, and > 29.5years, respectively. This study exhibited that the levels of AMH and AFC are the best biomarkers, followed by age for the prediction of DOR in women < 40years old. Furthermore, AMH is the only independent factor that is significantly related to DOR in women.

Impact of Reactive Oxygen Species Level in Serum and Culture Media on Pregnancy Rate after Day 3 and Day 5 Embryo Transfer in Iraqi Infertile Females Undergoing ICSI

Reactive oxygen species (ROS) are active chemical compounds created by the body's metabolic process and are crucial in human reproduction. Excessive ROS can contribute to oxidative stress, which has been linked to poor fertility. Embryo culture medium plays an essential role in IVF/ICSI cycles. Eighty participants underwent ovarian stimulation and ICSI cycles; ROS levels were measured in blood samples on the ovum pickup (OPU) day and in each embryo culture dish on ET day using enzyme-linked immunosorbent assay (ELISA). These values were associated with the quality of generated embryos. Women were divided into two groups, the first had day 3 embryo transfers, whereas the second received blastocyst transfers on day 5. Grades I embryos count was shown to be inversely related to the serum and culture medium ROS levels. Pregnant women had significantly greater levels of GI embryos (p=0.011) and lower levels of GIII embryos (p=0.024). Pregnancy rates for the third- and fifth-days of the embryo transfers were 24% and 50%, respectively, with (p=0.045). Pregnancy success rates were increased after ET day 5, and were strongly influenced by transfer day. Blastocyst-stage embryos with high serum ROS levels were found to be underdeveloped. Culture medium ROS levels can be used as an adjuvant criterion for embryo selection and metabolic marker for developing embryos.

Impact of Reactive Oxygen Species Level in Serum and Culture Media on Pregnancy Rate after Day 3 and Day 5 Embryo Transfer in Iraqi Infertile Females Undergoing ICSI

Reactive oxygen species (ROS) are active chemical compounds created by the body's metabolic process and are crucial in human reproduction. Excessive ROS can contribute to oxidative stress, which has been linked to poor fertility. Embryo culture medium plays an essential role in IVF/ICSI cycles. Eighty participants underwent ovarian stimulation and ICSI cycles; ROS levels were measured in blood samples on the ovum pickup (OPU) day and in each embryo culture dish on ET day using enzyme-linked immunosorbent assay (ELISA). These values were associated with the quality of generated embryos. Women were divided into two groups, the first had day 3 embryo transfers, whereas the second received blastocyst transfers on day 5. Grades I embryos count was shown to be inversely related to the serum and culture medium ROS levels. Pregnant women had significantly greater levels of GI embryos (p=0.011) and lower levels of GIII embryos (p=0.024). Pregnancy rates for the third- and fifth-days of the embryo transfers were 24% and 50%, respectively, with (p=0.045). Pregnancy success rates were increased after ET day 5, and were strongly influenced by transfer day. Blastocyst-stage embryos with high serum ROS levels were found to be underdeveloped. Culture medium ROS levels can be used as an adjuvant criterion for embryo selection and metabolic marker for developing embryos.

Endometrial polyps and their insinuation in the pregnancy rates of patients undergoing ICSI-FET cycles: A retrospective cohort study

To study the effect of endometrial polyps in infertility patients and their insinuation in pregnancy rates in patients undergoing ICSI-FET cycles following polypectomy.This is a retrospective study in 345 infertility patients attending Reproductive center of Sudha Hospital, Erode. Infertile women with endometrial polyps diagnosed by transvaginal ultrasound were subjected to hysteroscopic polypectomy. Vitrified embryo transfer was done one to three months following polypectomy and the clinical pregnancy rates were analysed. The age, body mass index, the type of infertility (primary or secondary), duration of infertility, pattern of menstruation, were precisely evaluated. An endometrial polyp based on their location inside the uterine cavity is assessed by hysteroscopy and the significance of the polyp location with pregnancy rates is evaluated.Of the 345 women who underwent hysteroscopic polypectomy 229 became pregnant and 116 women were non pregnant in ICSI-FET cycles. There is a strong positive association between endometrial polypectomy and pregnancy rate in ICSI-FET cycles. The incidence of Endometrial Polyps in pregnant and non-pregnant group was not related to the age, gravida and parity. Pregnancy rate after polypectomy based on polyp location is statistically insignificant. Multiple polyps are common compared to solitary polyp. Polyps are more common in posterior uterine wall than anterior, lateral walls and uterotubal junction.Hysteroscopic polypectomy gives promising results in infertility patients undergoing ICSI cycles prior to vitrified embryo transfer and location of polyps does not determine the pregnancy outcomes.