Implantation Rates In Patients Research Articles

Serum anti-endometrial antibodies as a biomarker for implantation rate in patients with endometriosis who had recurrent implantation failure and prepared for Intracytoplasmic Sperm Injection

Serum anti-endometrial antibodies as a biomarker for implantation rate in patients with endometriosis who had recurrent implantation failure and prepared for Intracytoplasmic Sperm Injection

Women undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) might benefit from maintaining serum luteinizing hormone levels: A retrospective analysis.

We aimed to evaluate the effect of serum luteinizing hormone (LH) levels on human chorionic gonadotropin (HCG) injection day (LHHCG) on outcomes of in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) patients. It is a retrospective cohort study involving 620 women who had an IVF cycle in Taizhou Hospital Affiliated to Wenzhou Medical University between 2018-2020. The participants were divided into different groups according to LHHCG level and age. The clinical data and outcomes were compared between groups. The numbers of follicles (≥ 14 mm) on HCG day, retrieved oocytes, mature oocytes, and two pronuclei (2PN) embryos in women with LHHCG < 2 IU/L were more than those with LHHCG ≥ 2 IU/L. Women with LHHCG < 2 IU/L had lower high-quality embryo rate (42.2% vs. 46.5%, p = 0.002) and implantation rate (40.0% vs. 58.8%, p = 0.044) compared to those with LHHCG ≥ 2 IU/L. When LHHCG < 2 IU/L, there was no significant difference in implantation rates in patients < 35 years compared to those ≥ 35 years. When LHHCG ≥ 2 IU/L, patients < 35 years old had higher implantation rates (71.7% vs. 41.2%, p < 0.001) compared to those ≥ 35 years old. The success rates of IVF fertilization and ICSI fertilization and biochemical and clinical pregnancy rates were not significantly different between groups. Our results demonstrated that women undergoing IVF/ICSI-ET might benefit from maintaining LHHCG levels at ≥ 2 IU/L. In addition, age might associate with LHHCG levels and be a better determining factor of the transfer outcome than serum LHHCG levels for IVF/ICSI-ET.

Subtle changes in perivascular endometrial mesenchymal stem cells after local endometrial injury in recurrent implantation failure

Improvements in reproductive techniques have resulted in the live birth rates from IVF procedures increasing from 5% to approximately 30% in recent decades but has plateaued since. Emerging preclinical and clinical data implicates endometrial receptivity deficiencies in patients with recurrent implantation failure (RIF) as the predominant factor hindering successful implantation. Mechanisms on how local endometrial injury (LEI) improves implantation rates in patients with RIF are currently unknown. We hypothesized that LEI may influence perivascular endometrial mesenchymal stem/progenitor cells (eMSCs) which are thought to regenerate the stromal vascular component of the functional layer every month. Here, we assessed the effect of LEI on the proportion and function of eMSCs present in consecutive LEI biopsies. Consecutive paired mid-luteal phase endometrial biopsies obtained from patients with RIF were digested to single cells and the proportion of SUSD2-expressing cells determined. Growth kinetics and decidualization were compared between the consecutive LEI samples. A mid-luteal LEI altered the decidualization capacity of SUSD2+ eMSCs in women with RIF, but not their proportion or clonogenicity. With the potential of LEI to improve IVF outcomes in women with RIF, additional investigations are needed to understand the impact of the altered decidualization response in eMSCs.

Abstract 14604: Arrhythmia Burden With Right-Heart Catheterization: A Systematic Review and Meta-Analysis

Background: Current guidelines cite complete heart block as a complication of invasive hemodynamic monitoring. This was described to be higher in those with existing intraventricular conduction delays. The objective of this meta-analysis was to evaluate the true risk of arrhythmias and pacemaker implantation rates in patients undergoing right-heart catheterization or with pulmonary artery catheter use. Methods: A literature search was performed from inception until May 2022. Studies that reported incidence rates of arrhythmias in those undergoing right-heart catherization or with pulmonary catheter use, including right- (RBBB) and left-bundle branch (LBBB), were included. Some studies described the development of complete heart block (CHB) and need for pacing. Results: Six single-center studies were included in our analysis with a total of 8, 077 right-heart catheter insertions. All patients had continuous ECG monitoring. Most frequently reported arrhythmia was premature ventricular ectopy (56.4%). No fatal ventricular arrhythmias were described and when noted, RBBB was transient in nature (0.2%, n=12/7577). The risk of CHB was 12.8% (n=24) in those with pre-existing LBBB (n=187). Pacing needs were infrequently described, but when reported was 6.3% (n=10) of concordant CHB and LBBB (n=160), and this was 0.2% of all described LBBB patients (n=6292) ( Figure ). Conclusion: Most arrhythmias were benign and transient in nature. The risk of CHB requiring pacing needs was only 0.2%. This begs the question of true burden of the theoretical complication of CHB with invasive hemodynamic monitoring, and most evidence is from decades ago.

Three-Dimensional Visualization of Mouse Endometrial Remodeling After Superovulation.

Uterine status determines pregnancy success. Although it is well known that superovulation operations can disrupt uterine function, our understanding of the morphological changes in the uterine endometrium at the three-dimensional (3D) level is limited. Here, combining the tissue clearing with 3D deep imaging, we reveal an increase in epithelial density and angiogenesis after ovarian stimulation, which is accompanied by a circulating surge in P4 levels. Using an ovariectomized mouse model, we further detected the separate regulatory effects of P4 and E2 on the uterine endometrium, with P4 promoting endothelial cell growth and E2 inducing epithelial proliferation. Additionally, we observed that the effects of E2 can be partially neutralized by P4, and vice versa. By analyzing the 3D uterine imaging, we discovered an interesting phenomenon in which the growing blood vessels closely surround the remodeling uterine epithelium, indicating a close relationship between angiogenesis and epithelial growth. These findings provide new insight into the uterine epithelial changes and angiogenesis at the 3D level, and explain a potential reason for endometrial changes due to the low implantation rate in patients undergoing clinic super-ovulation.

Epicardial fat volume is associated with preexisting atrioventricular conduction abnormalities and increased pacemaker implantation rate in patients undergoing transcatheter aortic valve implantation

Epicardial fat tissue (EFT) is a highly metabolically active fat depot surrounding the heart and coronary arteries that is related to early atherosclerosis and adverse cardiac events. We aimed to investigate the relationship between the amount of EFT and preexisting cardiac conduction abnormalities (CCAs) and the need for new postinterventional pacemaker in patients with severe aortic stenosis planned for transcatheter aortic valve implantation (TAVI). A total of 560 consecutive patients (54% female) scheduled for TAVI were included in this retrospective study. EFT volume was measured via a fully automated artificial intelligence software (QFAT) using computed tomography (CT) performed before TAVI. Baseline CCAs [first-degree atrioventricular (AV) block, right bundle branch block (RBBB), and left bundle branch block (LBBB)] were diagnosed according to 12-lead ECG before TAVI. Aortic valve calcification was determined by the Agatston score assessed in the pre-TAVI CT. The median EFT volume was 129.5 ml [IQR 94–170]. Baseline first-degree AV block was present in 17%, RBBB in 10.4%, and LBBB in 10.2% of the overall cohort. In adjusted logistic regression analysis, higher EFT volume was associated with first-degree AV block (OR 1.006 [95% CI 1.002–1.010]; p = 0.006) and the need for new pacemaker implantation after TAVI (OR 1.005 [95% CI 1.0–1.01]; p = 0.035) but not with the presence of RBBB or LBBB. EFT volume did not correlate with the Agatston score of the aortic valve. Greater EFT volume is associated independently with preexisting first-degree AV block and new pacemaker implantation in patients undergoing TAVI. It may play a causative role in degenerative processes and the susceptibility of the AV conduction system.

P–313 Endometrial receptivity analysis for personalized embryo transfer in patients with recurrent implantation failure: a retrospective analysis of a Chinese cohort

Abstract Study question To quantify the effectiveness of endometrial receptivity analysis (ERA)-guided personalized embryo transfer (pET) in Chinese women. Summary answer ERA-guided pET may remarkably improve pregnancy and implantation rates among Chinese women with Recurrent implantation failure (RIF). What is known already RIF is a major cause of infertility, and endometrial receptivity is widely accepted to impact implantation failure. Precision prediction of the WOI, the time when the endometrium is most receptive to the implantation of the embryo, is, therefore, of great significance to improve implantation prospects. Previous studies have shown the effectiveness of ERA for the prediction of the WOI, and how pET, timed by ERA, improves implantation and pregnancy rates; however, the efficacy of ERA-guided pET remains unknown for Chinese women. Study design, size, duration Patients in Chengdu Xi’nan Gynecology Hospital (Chengdu, China) who were undergoing frozen embryo transfer (FET) at the blastocyst stage on day five or day six during the period from November 2019 through September 2020 were recruited for this study. A total of 145 eligible patients were included in the study and assigned to the ERA group (n = 67) or the control group (n = 78). Clinical pregnancy outcomes were compared between the two groups. Participants/materials, setting, methods Endometrial specimens were collected the from ERA group. Total RNA was extracted from endometrial specimens, the transcriptomic sequencing data were processed using RNA-Seq and the endometrial receptivity status was assessed by the ERA predictor. The endometrium was classified as receptive or non-receptive according to the ERA assessment, and pET was done at the time determined by ERA in the ERA group. Subjects in the control group did not receive ERA and underwent blastocyst transfer normally. Main results and the role of chance The demographic and clinical characteristics were comparable between the ERA and control groups (P &amp;gt; 0.05). The ERA test identified 10.45% of samples as receptive and 89.55% of samples as non-receptive in the ERA group, with 70.15% of samples presenting a pre-receptive profile. We observed higher cumulative pregnancy (74.63% vs. 64.10%) and cumulative implantation rate (47.32% vs. 21.68%) rates, and a lower biochemical pregnancy rate (18.00% vs. 34.00%) in the ERA group when compared to the control group (P &amp;lt; 0.05). Additionally, we found higher pregnancy (67.16% vs. 39.74%) and implantation (46.54% vs. 16.94%) rates as well as a lower biochemical pregnancy rate (17.78% vs. 45.16%) after the first ERA test in the ERA group when compared to the control group (P &amp;lt; 0.01). Limitations, reasons for caution First, this is a retrospective analysis, which is relatively more biased than prospective clinical trials. Second, the study sample is considerably small. Third, only 10.45% of the subjects were identified as presenting a receptive profile, which limits the comparisons of clinical outcomes between patients with receptive and non-receptive endometria. Wider implications of the findings: This study demonstrates that the ERA test helps to determine the optimal timing for embryo transfer, improve pregnancy and implantation rates in patients with RIF, and guides the clinical application of the ERA test. Trial registration number approval No. 2020–018

P–329 Müllerian anomalies and embryo implantation in oocyte donation

Abstract Study question Do patients with Mullerian anomalies (MA) who receive donated oocytes have different embryo implantation rate than patients with normal uterus? Summary answer In oocyte donation, patients with MA had lower implantation rate than patients with normal uterus. What is known already MA are associated with infertility and miscarriage but the mechanisms to explain this relation are not known. Some studies describe both oocyte and/or uterine factor. All studies describing the outcome in patients with MA, so far, are with own oocytes but none in oocyte donation. Study design, size, duration A multicentre restrospective cohort study from January 2000 to December 2019. Patients receiving donated oocytes were divided between those with MA (n = 473) according ESHRE classification and other group with normal uterus (n = 57 869). The primary outcome was implantation rate at fresh embryo transfer. Secondary aims were biochemical pregnancy rate, clinical pregnancy rate, ongoing pregnancy rate, miscarriage rate and live pregnancy rate. Participants/materials, setting, methods We considered the first oocyte donation cycle, without severe male factor, myomas, hydrosalpinx, Asherman syndrome, polyps or indication for preimplantational genetic diagnosis divided in two groups; patients with MA and no malformed uterus. MA group includes cycles of complete bicorporeal uterus (162), partial bicorporeal (30), bicorporeal septate (15), T shaped uterus (26), infantilis uterus (8), complete septate uterus (110), partial septate uterus (94) and hemi-uterus without rudimentary cavity (29). Main results and the role of chance We registered 58 342 patients from our oocyte donation program. Results are shown as mean and 95%CI and differences in pregnancy rates were expressed as relative risks (RR) with 95% CI being reference patients with normal uterus. In patients with MA, the implantation rate was different according the categories being significantly lower in patients with unicornuate uterus (0.29 95%CI: 0.14–0.43. p = 0.03). Biochemical pregnancy rate was significantly higher in patients with septate uterus (RR 1.51 (95%CI 1.02–2.22, p = 0.03) and significantly lower in unicornuate uterus (RR 0.49 (95%CI 0.27–0.90). No differences were found in clinical pregnancy rate among groups, but ongoing pregnancy rate and live birth rate were lower in unicornuate uterus ( RR 0.28 (95%CI 0.13–0.63, p = 0.002), (RR 0.32 (95%CI 0.14–0.73, p = 0.007) respectively. Miscarriage rate was significantly higher in patients with septate uterus (RR 1.78 (95%CI 1.18–2.68, p = 0.006) Limitations, reasons for caution As this was a retrospective cohort study, we were unable to study differences due to modifications in medical or laboratory protocols during this long period time. Different size of sample in some groups of MA makes impossible to translate conclusions to general population. Wider implications of the findings: Our results indicate that there might be a defect in the embryo implantation rate in patients with MA depending on uterine factor. Different sample size among groups and some groups with scarce number of cases make less precise results. More studies controlling biases are needed to confirm our results. Trial registration number NCT04571671

Implantation Rates with Adding Vaginal Lactobacilli to Luteal Phase Support in Patients Undergoing Fresh Embryo Transfer in IVF/ICSI Cycles

Bu prospektif çalışmanın amacı IVF/ICSI sikluslarında taze embriyo transferi uygulanan infertil hastalarda luteal fazda vajinal laktobasil desteğinin implantasyon oranlarına etkisini araştırmaktır. Vajinal mikrobiyota ve infertilite ilişkisi günümüzde oldukça popüler bir araştırma konusudur ve yapılan çalışmalarda bozulmuş vajinal mikrobiyotanın infertil hastalarda gebelik sonuçlarını olumsuz olarak etkilediği bilinmektedir. Biz de bu sebeple çalışmamızda 88 infertil hastaya kontrollü ovaryan hiperstimülasyon sonrası oosit toplandığı gün vajinal 1x4 tablet vajinal laktobasil desteği sağlayarak, gebelik sonuçlarını laktobasil desteği uygulanmayan 88 kontrol hastası ile karşılaştırdık. Sonuçlarda grupların demografik verileri birbirine benzerdi. Ve çalışmanın birincil sonucu olan implantasyon oranları çalışma grubunda %38,6 kontrol grubunda %32,9 olarak bulundu. Sonuçlar kontrol grubunda daha yüksek olmasına rağmen istatistiksel olarak benzerdi. Çalışmanın sonucu olarak taze embriyo transferi yapılan infertil hastalarda luteal fazda laktobasil desteği sağlanmasının gebelik sonuçlarına etkisi gözlenmedi.

Tacrolimus Improves the Implantation Rate in Patients with Elevated Th1/2 Helper Cell Ratio and Repeated Implantation Failure (RIF).

Introduction An abnormal endometrial immune response is involved in the pathogenesis of repeated implantation failure (RIF), so we investigated the effectiveness of tacrolimus treatment on the endometrium of RIF patients. Materials and Methods Ten RIF patients with elevated T-helper 1/T-helper 2 (Th1/Th2) cell ratios were recruited into a clinical study. The expression of p53, leukemia inhibitory factor (LIF), interleukin (IL)-4, IL-10, IL-17, and interferon gamma (IFN-γ) in the endometrium of patients with and without tacrolimus treatment and the association of these factors with assisted reproductive technology (ART) outcomes were investigated. Results Tacrolimus significantly increased the expression of LIF, IL-10, and IL-17 and decreased the expression of IL-4, IFN-γ, and the IFN-γ/IL-10 ratio in RIF patients. Tacrolimus treatment resulted in an implantation rate of 40%, a clinical pregnancy rate of 50%, and a live birth rate of 35% in RIF patients with elevated Th1/Th2 ratios who had previously failed to become pregnant despite at least three transfers of embryos. We also found a significant positive correlation between IL-10 levels and the implantation rate. Conclusions Our findings suggest that RIF patients with a higher Th1/Th2 ratio could be candidates for tacrolimus therapy and that this immunosuppressive drug could be acting through upregulation of LIF, IL-10, and IL-17.

Study the Role of Trichomoniasis in In Vitro Fertilization (IVF) Failure

Trichomoniasis is a sexual transmitted disease that affects human fertility. In women, trichomoniasis has been related to infertility due to pelvic inflammatory disease that compromises tubal patency, while in men, trichomoniasis may contributed to infertility by deficit of sperm cell quality and function due to physical damage. In this article, asymptomatic fifty couples with unexplained infertility, undergoing In Vitro Fertilization (IVF) were examined for Trichomonas vaginalis (T.V.) infection. In 70% of couples, embryo implantation failed and pregnancy was not achieved, probably as a consequence of trichomoniasis. The result indicates that T. vaginalis pathogenicity, adverse reproductive health outcomes, in time diagnosis, and treatment may improve implantation rate in patients with unexplained infertility undergoing Assisted reproductive technology ( ART).

Bu Shen Zhu Yun Decoction Improves Endometrial Receptivity via VEGFR-2-Mediated Angiogenesis.

Vascular endothelial growth factor receptor-2 (VEGFR-2) regulates the mitogen-activated protein kinase (MAPK) signaling pathway and plays an important role in angiogenesis. Bu Shen Zhu Yun decoction (BSZYD) can improve endometrial receptivity and embryo implantation rates in patients undergoing in vitro fertilization. However, whether BSZYD improves endometrial receptivity via angiogenesis remains unclear. Here, we investigated the effects of BSZYD on the proliferation, migration, and angiogenesis of human endometrial microvascular endothelial cells (HEMECs) and found that BSZYD upregulated the expression of cyclin D1, matrix metalloproteinase 9 (MMP9), and proliferating cell nuclear antigen (PCNA) in HEMECs. Cell Counting Kit 8 assay, scratch-wound assay, and Tube Formation Assay results showed that BSZYD promoted the proliferation, migration, and angiogenesis of HEMECs. Western blot analysis results revealed the activation of the MAPK signaling pathway by BSZYD through the upregulation of VEGF and VEGFR-2 expression. Together, these findings highlight the novel mechanism underlying BSZYD-mediated improvement in endometrial receptivity through the MAPK signaling pathway.

Endometrial CD138 count appears to be a negative prognostic indicator for patients who have experienced previous embryo transfer failure

To explore the predictive value of endometrial CD138 expression in the natural cycle preceding frozen embryo transfer in patients with normal endometrial dating and histopathologic features, who previously failed the transfer of two high-quality fresh embryos. Retrospective analysis. University-affiliated hospital. Women with normal endometrial dating and histopathologic features who previously failed the transfer of two high-quality fresh embryos, and who then underwent an endometrial scratching operation preceding a natural cycle. Paraffin-embedded endometrial samples cut into sections for immunohistochemistry staining of CD138 (syndecan-1) expression, then clinical information for these patients reviewed and analyzed. Clinical rates of pregnancy and implantation. A total of 141 women met the inclusion criteria. Of these patients, about 31.2% (44 of 141) were positive for CD138 expression, with CD138 counts ranging from 0 to 33. Receiver operating characteristic (ROC) curves were analyzed to determine whether the number of cells expressing CD138 (CD138+ cells) predicted a successful pregnancy. The areas under the ROC curves based on CD138+ cell density and CD138+ cell count were 0.660 and 0.658, respectively. The clinical pregnancy and embryo implantation rates in patients not expressing CD138 (80.04% and 64.9%, respectively) were statistically significantly higher than rates in CD138+ patients (52.7% and 46.8%, respectively). In addition, the higher the number of cells expressing CD138, the worse the outcome of the pregnancy. Finally, clinical data showed that free pelvic fluid on the day of endometrial sampling (identified using transvaginal ultrasound) might be a risk factor for CD138 expression. Endometrial CD138+ count might be a valuable marker predicting pregnancy outcomes after frozen embryo transfer in patients with normal endometrial dating and histopathologic features who previously failed the transfer of two high-quality fresh embryos.

El uso de la tecnología Time-Lapse y algoritmo predictivo KIDScore 5 ayudan a mejorar la selección de embriones euploides para la transferencia

Objetivos. Evaluar si el uso del algoritmo KIDScore 5 (known implantation data) puede ayudar a seleccionar entre los embriones euploides, para mejorar las tasas de embarazo e implantación en pacientes sometidas a procedimientos de reproducción asistida. Métodos. Estudio de cohorte retrospectivo en una clínica de fertilidad, desde octubre 2016 a diciembre 2018. Se estudió 1 049 embriones provenientes de 328 pacientes. Todos los embriones fueron cultivados en la incubadora Time-Lapse, Embryoscope® (Vitrolife®, Canadá) durante 5 a 6 días. De estos, 896 embriones (85,4%) fueron biopsiados y analizados mediante NGS y recibieron una valoración otorgada por el algoritmo predictivo KIDScore 5 (Vitrolife®, Canadá). Los 153 embriones restantes (14,6%) únicamente recibieron la valoración mediante el algoritmo predictivo KIDScore 5. Se realizó 256 transferencias únicas de embriones euploides en parejas sometidas a tratamientos de FIV en el laboratorio de reproducción asistida de la Clínica Inmater, Lima – Perú. Resultados. La tasa de implantación de los embriones euploides transferidos con valores de KIDScore = 6 versus los transferidos con valores de KIDScore = 1 tuvo diferencia estadísticamente signficativa (73,5% vs. 50,8%; p=0,030). Al evaluar la relación entre la tasa de euploidia embrionaria versus el resultado del valor de KIDScore 5, se obtuvo diferencias altamente significativas en las tasas de euploidia en los embriones con resultados de KIDScore 6 y 5 versus los de KIDScore 0 y 1 (60,5% vs. 45,7%; p=0,0004). Conclusiones. La selección embrionaria con ayuda del algoritmo KIDScore 5 ofrece ventaja en las tasas de implantación y embarazo únicamente cuando se transfieren embriones euploides. Su uso como criterio adicional a la selección embrionaria debiera ser considerado siempre que se acompañe estudio genético a los embriones a transferir. Los embriones euploides con valor más alto en la escala del algoritmo KIDScore 5, tienen mejores tasas de implantación y euploidía que los embriones con el valor mínimo de dicho algoritmo.

ADministration of Clotrimazole prior to Frozen Embryo Transfer (FET) Cycles May Improve Implantation Rate

Introduction We hypothesized 2 years ago that the presence of candidiasis whether clinical or sub- clinical may impact negatively on implantation and pregnancy rates. On this basis, we decided to put our patients prophylactically on clotrimazole (Canestan) one week prior to the embryo transfer. We found a trend to higher pregnancy and implantation rate in patients administered with Canestan as opposed to those who were not ( Lee et al., PGDIS, 2017 ). It is of interest that vaginal candidiasis has been associated with a reduced number of lactobacilli ( Hillier et al., 1992 ). Moreover, Moreno et al. (2016) also reported a significantly reduced implantation rate in IVF patients with a non-Lactobacillus- dominant endometrial microbiota. In this retrospective study, we review the effect of Canesten in the clinical outcome of FET patients. Material and Methods A total of 342 patients (age range=23-44) with blastocysts screened using Preimplantation Genetic Screening (PGS) underwent FET cycles in Alpha Fertility Centre, Malaysia, between July 2016 and October 2017. Oocyte donors were excluded from the study. These patients were divided into 2 groups: 290 patients with 362 euploid blastocysts transferred in the treatment group (Group A), and 52 patients with 64 euploid blastocysts transferred in the control group (Group B). All patients were administered with oestrogen (Progynova) and progesterone (Cyclogest or Crinone 8%) for endometrium preparation. In Group A, patients were given Canesten 500 mg pessary 7 days prior to embryo transfer. The mean age of patients in Group A was 34.3 while the mean age of patients in Group B was 35.3 (p>0.05). All thawed blastocysts survived with morphologically intact inner cell masses and trophectoderm cells. The mean number of blastocysts transferred was 1.2 each for Group A and B. Clinical pregnancy and number of gestational sacs were determined by ultrasound. Results The implantation rate was significantly higher in patients treated with Canesten (67.0%) compared to those who were not (53.1%) with a p value of 0.05). Conclusion Based on our preliminary result and this study with a larger sample size, it is suggestive that the use of Canesten pessaries in FET cycles is promising in improving implantation rate and this appears to apply to all age groups. Nevertheless, further studies which are controlled needs to be undertaken to confirm the above.

The impact of intramural fibroids on reproductive outcome in patients undergoing IVF procedures

Uterine fibroids are benign tumors which may alter the implantation process. The present study aims to examine the impact of medium-sized (3-5 cm) intramural fibroids without contact with the endometrial cavity on implantation rates in patients following in vitro fertilization (IVF) protocols. Materials and method. Thirty-one patients with intramural fibroids and 65 patients with normal uterine cavity undergoing IVF were recruited for the study groups and retrospectively evaluated. Results. Statistically significant differences were observed only regarding endometrial thickness between the two groups, and not regarding pregnancy rates. Conclusions. Intramural fibroids do not seem to decrease pregnancy rates in patients undergoing IVF with the long protocol.

Hysteroscopic Resection of Endometrial Polyps and Assisted Reproductive Technology Pregnancy Outcomes Compared with No Treatment: A Systematic Review

Endometrial polyps are frequently encountered in the uterine cavity of infertile women. There is much debate regarding the treatment of endometrial polyps in patients who are undergoing assisted reproductive technology (ART). A systematic review was performed by searching PubMed, Embase, and the Cochrane Library for retrospective or prospective studies that compared the effect of hysteroscopic resection of polyps with no treatment on pregnancy outcomes of patients who underwent ART. The primary outcomes were clinical pregnancy, live birth, miscarriage, and implantation rates after ART. Eight studies with a total of 2267 patients were included. The results showed that hysteroscopic resection of endometrial polyps (mean size <2 cm) was associated with an increased rate of clinical pregnancy in patients who underwent intrauterine insemination. No clear benefit was observed for clinical pregnancy, live birth, miscarriage, or implantation rates in patients who underwent in vitro fertilization/intracytoplasmic sperm injection cycles. In conclusion, the effect of hysteroscopic polypectomy on pregnancy outcomes of patients who have undergone ART remains unclear. More prospective, randomized controlled trials are warranted to determine appropriate treatment.

Empiric antibiotic treatment of suspected chronic endometritis does not improve sustained implantation rates following failed euploid frozen embryo transfer (FET)

Chronic endometritis (CE) is associated with lower implantation rates in patients with recurrent implantation failure1. Some studies have demonstrated an improvement in pregnancy outcomes following antibiotic treatment for CE. Diagnosis of CE requires a procedure, typically an endometrial biopsy or dilation and curettage, in order to obtain a histologic specimen2. Some clinicians have moved towards empiric antibiotic treatment of suspected chronic endometritis for patients with a prior implantation failure.

Effect of endometrial injury on implantation and pregnancy rates: a randomised controlled trial

Objective: To study the effect of induced endometrial injury on the pregnancy and implantation rates in patients undergoing intracytoplasmic sperm injection (ICSI) cycles. Study Design: Randomised case control study. Setting: University hospital's fertility clinic. Materials and Methods: A total of 240 women undergoing ICSI cycles were randomly divided into three equal groups, Group A underwent endometrial scratching by pipelle, group B underwent hysteroscopic endometrial injury, and group C were controls. Results: No difference was seen between the groups in terms of age, BMI, endometrial thickness, number of oocytes retrieved, or number of embryos transferred. Pregnancy rate was similar in groups A and B, which was higher than group C, but the difference was not statistically significant. Implantation rate was significantly higher in both groups A and B than controls, and significantly in group B compared to group A. Conclusions: Endometrial injury, especially if induced by hysteroscopy, might be helpful to increase the implantation rate in cases undergoing ICSI-embryo transfer (ICSI-ET). Pregnancy rate however did not change.

Intrauterine autologous platelet-rich plasma therapy to improve implantation rates in patients undergoing frozen embryo transfer: A pilot study

Background: Successful implantation is a well-orchestrated event requiring the presence of a healthy embryo, a receptive endometrium, appropriate embryo endometrial cross-talk, and adequate maternal immune protection. Despite advances in assisted reproductive technology, there are insignificant improvements in the implantation and pregnancy rates. Intrauterine infusion of platelet-rich plasma (PRP) might improve implantation rates through its paracrine effects by recruiting growth factors and cytokines that favor decidualization and implantation. Objectives: The objective of the study is to study whether intrauterine PRP improves implantation rates in patients undergoing frozen embryo transfer (FET). Subjects and Methods: In this retrospective study, we collected data of patients who underwent FET in Mother and Child Hospital for 11 months from January 2018 to November 2018. We screened data of 98 patients who had at least one previous failed FET and underwent subsequent FET. The patients were divided into a study and control group. The study group received Intrauterine PRP before FET, while the control group did not. All patients underwent the same hormone replacement therapy regimen for endometrial preparation. Main Outcome Measure: The main outcomes studied were the implantation rates and clinical pregnancy rates (CPR) after embryo transfer. Results: Patient demographics such as mean age, body mass index, and anti-mullerian hormone of both groups were comparable. Overall, the CPR was 42.8% in the control group and 47.6% in the intervention group, and the difference was not statistically significant. Conclusion: Intrauterine PRP does not increase the implantation rates/CPR significantly in patients who have had one previous FET failure.