In Vitro Fertilization Cycles Research Articles

Effect of Platelet-Rich Plasma (PRP) in Combination with Endometrial Scratching for Patients Undergoing Assisted Reproductive Technology Treatment

ABSTRACT Endometrium scratching is a process of intentionally injuring the endometrium, and after scratching the endometrium, platelet-rich plasma (PRP) is inserted into the endometrial wall to improve pregnancy outcome. This case report revolves around a 33-year-old woman and her 38-year-old husband, who have been married for 3 years and were seeking treatment for their secondary infertility. The female had a history of hypothyroidism, and after the investigation, she was diagnosed with hyperprolactinemia. She also had a history of failure in vitro fertilization (IVF) cycles and two recurrent miscarriages upon investigation. The husband was found to have asthanozoospermia. After diagnosis of the female, we started treatment of cabergoline for hyperprolactinemia, a history of unsuccessful IVF cycles, and two recurrent miscarriages upon investigation. After the treatment of hyperprolactinemia in our clinic, we scheduled ovum pick-up and started the stimulation and performed intra-cytoplasmic sperm injection. After 1 month, we scheduled embryo transfer. On day 1, the progesterone scratched the endometrium wall and loaded the PRP to enhance the endometrial wall, and after an interval of 14 days, we checked the β-hCG level in the blood, and the result was positive, that is, the level was 1020 mIU/mL. The successful result of endometrial scratching with PRP improves pregnancy outcomes.

SARS-CoV-2 infection, vaccination and in vitro fertilization treatment: A prospective cohort study

BackgroundThe impact of COVID-19 on reproductive health is controversial. The association between female SARS-CoV-2 infection and laboratory and pregnancy outcomes following subsequent in vitro fertilization (IVF) treatment remains unclear. This study aimed to investigate the relationship between IVF treatment at different time intervals after SARS-CoV-2 infection and reproductive outcomes. MethodsA prospective cohort study of 920 IVF cycles post-SARS-CoV-2 infection was conducted. Modified Poisson regression and logistic regression models were utilized to evaluate oocyte- and embryo-related outcomes as well as clinical outcomes. Stratified analyses were also performed based on the vaccination status of the female participants. ResultsSARS-CoV-2 infection within three months was associated with reduced available [Adjusted RR (aRR): 0.96, 95 %CI: 0.91–1.00] and top-quality embryos (aRR: 0.90, 95 %CI: 0.83–0.98) in subsequent IVF treatment. Among patients failing to finish the three-dose vaccination, the interval between SARS-CoV-2 infection and cycle initiation of less than 90 days was associated with a lower number of oocytes retrieval (aRR: 8.81, 95 %CI: 8.24–9.41 vs aRR: 9.64, 95 %CI: 9.06–10.25), available embryos (aRR: 0.93, 95 %CI: 0.88–0.99), and top-quality embryos (aRR: 0.81, 95 %CI: 0.72–0.91) rather than among fully vaccinated women. Moreover, COVID-19 infection was not associated with biochemical pregnancy, clinical pregnancy, embryo implantation, and early abortion either in fresh embryo transfer (ET) or frozen ET. ConclusionsThis study indicated that initiating IVF treatment within 90 days of SARS-CoV-2 infection might reduce the likelihood of obtaining available and top-quality embryos, especially among those who had not completed the three-dose vaccination. Nevertheless, female COVID-19 infection did not affect pregnancy or early abortion. Further rigorously designed studies are required to support these findings.

Does growth hormone supplementation of in vitro fertilization/intracytoplasmic sperm injection improve cumulative live birth rates in women with poor embryonic development in the previous cycle?

BackgroundGrowth hormone (GH) has been proposed as an adjunct in in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles, especially in women with poor ovarian response. However, it is unclear whether GH supplementation is effective in women with poor embryonic development in the previous IVF cycle. The aim of this study was to evaluate the effectiveness of GH supplementation in IVF/ICSI cycles in women with poor embryonic development in the previous cycle.MethodsThis is a retrospective cohort study from a public fertility center in China, in which we performed propensity score-matching (PSM) for female age and AFC in a ratio of 1:1. We compared the cumulative live birth rate per started cycle, as well as a series of secondary outcomes. We included 3,043 women with poor embryonic development in the previous IVF/ICSI cycle, of which 1,326 had GH as adjuvant therapy and 1,717 had not. After PSM, there were 694 women in each group.ResultsAfter PSM, multivariate analyses showed the cumulative live birth rate to be significantly higher in the GH group than the control group [N = 694, 34.7% vs. N = 694, 27.5%, risk ratio (RR): 1.4 (95%CI: 1.1–1.8)]. Endometrial thickness, number of oocytes retrieved, number of embryos available, and number of good-quality embryos were significantly higher in the GH group compared to controls. Pregnancy outcomes in terms of birth weight, gestational age, fetal sex, preterm birth rate, and type of delivery were comparable. When we evaluated the impact of GH on different categories of female age, the observed benefit in the GH group did not appear to be significant. When we assessed the effect of GH in different AFC categories, the effect of GH was strongest in women with an AFC5-6 (32.2% versus 19.5%; RR 2.0; 95% CI 1.2–3.3).ConclusionsWomen with poor embryonic quality in the previous IVF/ICSI cycles have higher rates of cumulative live birth with GH supplementation.

Ethnicity and In Vitro Fertilization Outcomes in an Equal Access to Care Setting [ID 2683634

INTRODUCTION: Many studies report racial disparities in assisted reproductive technology (ART) outcomes, specifically, lower pregnancy rates and higher miscarriage rates in Black women. In an equal access to care setting, we wanted to delineate causes of this ongoing racial disparity. METHODS: This is a retrospective review of ART cycles at Brooke Army Medical Center (BAMC) from 2013 to 2021 via the Society for Assisted Reproductive Technology database. This study received a nonresearch designation from the BAMC IRB. RESULTS: A total of 1,211 in vitro fertilization (IVF) cycles were reviewed, comparing outcomes by race from first-time embryo transfers, fresh or frozen after “freeze-all” IVF cycles. Black women (19% of all cycles) experienced a lower live birth rate (27.3% versus 34.6%; risk ratio [RR] 0.75; 95% CI 0.6–0.94), but did not experience a statistically significant increase in pregnancy loss (36.8% versus 30.6%; RR 1.26; 95% CI, 0.94–1.68] compared to all other patients. Black women were found to have a higher prevalence of uterine factor infertility (RR 2.87; 95% CI, 2.24–3.66) and tubal factor infertility (RR 1.79; 95% CI, 1.51–2.12). When controlling for uterine factor infertility, Black racial identity was no longer a risk factor for decreased live birth rate (adjusted RR 0.85; 95% CI, 0.69–1.07). CONCLUSION: Recent literature demonstrates poorer ART outcomes for Black women. Our study suggests that this may be attributable to uterine fibroids, and an increased research focus on uterine fibroid treatment in patients desiring fertility may improve ART outcomes in Black women.

Immediate versus delayed single blastocyst transfer following the first stimulated IVF cycle in the freeze-all strategy: a study protocol for a randomised controlled trial

IntroductionIn recent years, the use of frozen embryo transfers (FET) has rapidly increased following the freeze-all strategy due to the advantages of increased maternal safety, improved pregnancy rates, lower ectopic...

IVF and obstetrics outcomes among women of very advanced maternal age (45+) using donor egg

Research QuestionDoes very advanced maternal age (VAMA, aged 45+) influence obstetric outcomes among women using donor oocytes in in vitro fertilization (IVF)? DesignThis retrospective cohort study analysed data from a nationwide IVF registry in Taiwan, focusing on IVF cycles involving women aged 45 or older using donated oocytes between 2007 and 2016. The study assessed cumulative live birth rates (CLBR) and secondary outcomes such as clinical pregnancy, miscarriage, live birth, and twin pregnancy rates, alongside perinatal outcomes like caesarean section rates, preeclampsia, gestational diabetes, and birth weight. ResultsThe study included 1,718 embryo transfer cycles from 745 women, with a stable live birth rate of about 40% across the study period. The CLBR was slightly lower in women over 50 (54.2%) compared to those aged 45-46 (58.0%), but these differences were not statistically significant (p=0.647). Secondary outcomes and perinatal outcomes did not significantly differ across age groups. Regression analysis suggested a non-significant decrease in live birth rates and birth weight with increasing maternal age. The study also found that single embryo transfer (SET) minimized the risk of twin pregnancies without significantly affecting live birth rates. ConclusionsIVF with donor oocytes remains a viable option for women of VAMA, with consistent live birth rates across age groups. However, the study underscores the importance of elective SET to reduce the risk of twin pregnancies and associated adverse outcomes. Further research is needed to explore the impact of other factors such as paternal age and embryo development stage on IVF success in this population.

ОТНОШЕНИЕ НАСЕЛЕНИЯ РЕСПУБЛИКИ БЕЛАРУСЬ К ПРИМЕНЕНИЮ ЭКСТРАКОРПОРАЛЬНОГО ОПЛОДОТВОРЕНИЯ

Purpose. To identify the attitude and stereotypical perception of the population about the use of in vitro fertilization (IVF) in the Republic of Belarus. Material and methods. A sociological survey of a representative republican sample, which consisted of 1805 respondents (851 (47%) men, 954 (53%) women) aged 18 to 65 years, was performed. Results. In general, there is a positive attitude on the part of society towards reproductive technologies (21.6% of respondents claimed absolutely positive attitude and 30.2% had rather positive attitude to IVF; a neutral attitude was revealed in 37.1% of respondents). Some of the population retain stereotypes associated with varying degrees of influence of reproductive technologies on the psychophysical health of children (about 34%). Conclusion. A system of measures is needed to improve the preparation of married couples with an established diagnosis of infertility and the ineffectiveness of other treatment methods for artificial conception. This approach will minimize the number of failed IVF cycles and reduce the risk of complications for the mother and child. The effective use of assisted reproductive technologies (ART) with positive outcomes in overcoming infertility will contribute to the formation of a positive attitude towards reproductive technologies on the part of society.

Leukocytospermia does not negatively impact outcomes in in vitro fertilization cycles with intracytoplasmic sperm injection and preimplantation genetic testing for aneuploidy: findings from 5435 cycles.

To investigate whether leukocytospermia (defined as the presence of ≥ 1 × 106 white blood cells/mL) affects clinical and embryologic outcomes in in vitro fertilization (IVF) cycles with intracytoplasmic sperm injection (ICSI) and preimplantation genetic testing for aneuploidy (PGT-A). This was a retrospective cohort study including 5425 cycles between January 2012 to December 2021 at a single large university-affiliated fertility clinic. The primary outcome was live birth rate (LBR). The prevalence of leukocytospermia was 33.9% (n = 1843). Baseline characteristics including female age, BMI, AMH, Day 3 FSH, and male partner's age were similar in cycles with and without leukocytospermia. The LBR after the first euploid embryo transfer was similar in those with and without leukocytospermia (62.3% vs. 63% p = 0.625). Secondary outcomes including clinical pregnancy rate (CPR), sustained implantation rate (SIR), fertilization (2PN) rate, blastulation rate, and aneuploidy rate were also evaluated. The CPR (73.3% vs 74.9%, p = 0.213) and SIR (64.6% vs. 66%, p = 0.305) were similar in both groups. The 2PN rate was also similar in both groups (85.7% vs. 85.8%, p = 0.791), as was the blastulation rate per 2PN (56.7% vs. 57.5%, p = 0.116). The aneuploidy rate was not significantly different between groups (25.7% vs 24.4%, p = 0.053). A generalized estimation equation with logistic regression demonstrated that the presence leukocytospermia did not influence the LBR (adjusted OR 0.878; 95% CI, 0.680-1.138). Leukocytospermia diagnosed just prior to an IVF cycle with PGT-A does not negatively impact clinical or embryologic outcomes.

Comparison of progestin-primed ovarian stimulation regimen and antagonist regimen in women aged 35 years or older with diminished ovarian reserve: A propensity score-matched study.

Diminished ovarian reserve (DOR) has been a major challenge in infertility treatment. The present study aimed to compare the efficacy of progestin-primed ovarian stimulation (PPOS) regimen and antagonist regimen in infertile patients aged 35 years or older with DOR. A retrospective study of 289 invitro fertilization (IVF) cycles from April 2016 to June 2022 was performed. Propensity score matching (PSM) was used to balance the baseline characteristics between the two groups at a ratio of 1:1. After matching, there were 87 cycles in the PPOS group and 87 cycles in the antagonist group. The primary outcome measures included the incidence of premature LH surge, the number of retrieved oocytes, and the number of mature oocytes, which were comparable between the two groups (all P values >0.05). There were no significant differences in laboratory indicators and final clinical outcomes between the two groups (all P values >0.05). For DOR patients aged 35 years or older, the number of retrieved oocytes and the number of mature oocytes were comparable between the PPOS and antagonist groups. Moreover, the two regimens showed no difference in the inhibition of premature LH surge.

Clinical utility of office hysteroscopy following failed invitro fertilization-embryo transfer: A retrospective cohort study.

Despite its widespread use, invitro fertilization (IVF) outcomes are challenged by implantation failure, largely due to factors such as embryo quality and endometrial receptivity. In this study, we investigated the clinical effect of office hysteroscopy (OH) on the subsequent frozen-thawed embryo transfer (FET) in infertile women who experienced a failed IVF-embryo transfer (IVF-ET) cycle. We included 577 infertile women who underwent OH because of a history of failed ET between October 2019 and September 2021. During OH, visible endometrial polyps (EPs) were diagnosed and removed by curette or biopsy forceps; chronic endometritis (CE) was diagnosed by histopathology and immunohistochemistry and treated with oral doxycycline (0.2 g/d) for 14 days. According to the hysteroscopic findings and endometrial pathology with immunohistochemistry, patients were divided into three groups: group A (n = 161) had CE with or without EPs, group B (n = 156) had EPs only, and group C (n = 260) had no CE or EPs. In the following FET cycle, the implantation rates were 47%, 51%, and 45% (P = 0.411); the clinical pregnancy rates were 56%, 62%, and 55% (P = 0.436); the live birth rates were 45%, 51%, and 42% (P = 0.205); and the miscarriage rates were 18%, 16%, and 22% (P = 0.497) in groups A, B, and C, respectively. There were no significant differences among groups (P > 0.05). OH is helpful for diagnosis and treatment of abnormal intrauterine environment in women with a failed IVF cycle and further improves their pregnancy outcome in the following FET.

Can the endometrioma be an obstacle to complete oocyte retrieval in IVF cycles? A retrospective study.

The study aimed to evaluate the utility and safety of ancillary maneuvers during oocyte retrieval for patients with endometrioma that makes ovum pick-up hard due to poor ovarian surgical accessibility. Cases of 251 women with ovarian endometriomas undergoing in vitro fertilization (IVF) in our infertility unit were retrospectively analyzed to evaluate the clinical IVF cycle outcomes after oocyte retrieval. Controls (n = 251) were age-matched women without endometriomas who underwent an uncomplicated oocyte retrieval. No statistically significant differences were observed between groups except for the number of oocytes retrieved, which was higher in the control group than in the group of women with endometrioma. On the contrary, there were no differences between the experimental groups in the fertilization rate and number of embryos, and neither were there in the pregnancy and live birth rate. Moreover, the surgical complications were infrequent and similar between the two analyzed groups. Accidental or voluntary endometrioma punctures were not accompanied by increases in the risk of a pelvic infection. In conclusion, patients with endometrioma can undergo high-performance oocyte recovery procedures thanks to safe accessory maneuvers during the ovum pick-up.

Assessment of the implantation window and embryonic factor impact to the treatment of recurrent implantation failure (RIF). A prospective study

The aim: to study of the prognostic value of endometrial receptivity and preimplantation genetic diagnosis of embryos, and their influence on the effectiveness of in vitro fertilization (IVF) programs. We also evaluate the importance of this factor in comparison with other potential causes of infertility. Materials and methods: This prospective cohort study included 123 infertile women who underwent in vitro fertilization (IVF) treatment. 93 patients had repeated unsuccessful implantation attempts and were divided into three groups: group 1 - patients who were treated using genetically untested embryos according to a standard fixed stimulation protocol, group 2 - patients who were treated using euploid embryos after preimplantation genetic screening according to standard fixed protocol; group 3 - patients who underwent treatment using euploid embryos after pre-implantation genetic screening and determination of the implantation window with subsequent modification of the stimulation protocol, according to the endometrial examination result. 30 patients had a first attempt at IVF, which was carried out using genetically untested embryos, according to a standard fixed protocol, and made up the control group (CG). Determination of the window of implantation was carried out by triple aspiration biopsy of the endometrium during the luteal phase of the menstrual cycle since the endometrium is most susceptible to implantation during this period. Samples were analyzed using scanning electron microscopy. Based on the results obtained, the endometrial preparation protocol was individualized for the next attempt. preimplantation genetic testing (PGT) of embryos was carried out by the next generation (NGS) method. Statistical analysis was performed using IBM SPSS V25.0 for Windows software. Results: According to the obtained results, patient characteristics, screening rates, IVF cycle characteristics, and the number, quality, and stage of transferred embryos were compared between groups. The rate of clinical pregnancy was 46.7 % among patients of group 1.70 % among patients of group 2, 82.8 % among patients of group 3 and 50.0 % of the control group and statistically significantly different between groups (χ2=10.955, p= 0.012). The rate of live birth was 43.3 % among patients of group 1, 53.3 % among patients of group 2, 72.4 % among patients of group 3 and 43.3 % - of the control group, however, it did not differ statistically significantly between groups (χ2=6,639, р=0,084) Conclusions: The unique window of implantation and the embryonic factor are among the main reasons for multiple failed implantation attempts. Personalization of the endometrial preparation protocol and preimplantation embryo diagnosis are effective methods to improve IVF outcomes

A case report of a family with developmental arrest of human prokaryotic stage zygote.

To study the genetic variation leading to the arrest phenotype of pronuclear (PN) zygotes. We recruited a family characterized by recurrent PN arrest during in vitro fertilization (IVF) and intracytoplasmic sperm injection cycles (ICSI) and performed whole-exome sequencing for 2 individuals. The transcriptome profiles of PN-arrest zygotes were assessed by single-cell RNA sequencing analysis. The variants were then validated by PCR amplification and Sanger sequencing in the affected individuals and other family members. A family characterized by recurrent PN arrest during IVF and ICSI cycles were enrolled after giving written informed consent. Peripheral blood samples were taken for DNA extraction. Three PN-arrest zygotes from patient III-3 were used for single-cell RNA-seq as described. This phenotype was reproduced after multiple cycles of egg retrieval and after trying different fertilization methods and multiple ovulation regimens. The mutant genes of whole exon sequencing were screened and verified. The missense variant c. C1630T (p.R544W) in RGS12 was responsible for a phenotype characterized by paternal transmission. RGS12 controls Ca2+ oscillation, which is required for oocyte activation after fertilization. Single-cell transcriptome profiling of PN-arrest zygotes revealed defective established translation, RNA processing and cell cycle, which explained the failure of complete oocyte activation. Furthermore, we identified proximal genes involved in Ca2+ oscillation-cytostatic factor-anaphase-promoting complex (Ca2+ oscillation-CSF-APC) signaling, including upregulated CaMKII, ORAI1, CDC20, and CDH1 and downregulated EMI1 and BUB3. The findings indicate abnormal spontaneous Ca2+ oscillations leading to oocytes with prolonged low CSF level and high APC level, which resulted in defective nuclear envelope breakdown and DNA replication. We have identified an RGS12 variant as the potential cause of female infertility characterized by arrest at the PN stage during multiple IVF and ICSI.

IVF outcomes pre- and post-anti-COVID-19 vaccination – Are there any differences?

Since the beginning of the SARS-CoV-2 pandemic, there have been rising concerns about the virus's possible ability to affect male and female fertility. Although effective vaccines were introduced and the vaccination rate of the general population is high, some reproductive-age individuals are still hesitant to receive the vaccine, because of an unestablished belief that the vaccine might impair fertility. In this single-center retrospective study, encompassing data from 387 medical files of in-vitro fertilization (IVF) patients we compared IVF cycle outcomes and sperm characteristics in vaccinated couples before and after vaccination, as well as between vaccinated patients and a control group of individuals who were neither vaccinated nor infected with COVID-19 before or during the cycles. We found no significant differences between vaccinated and non-vaccinated patients concerning the number of retrieved oocytes and the total motile sperm count (TMC). The mean number of retrieved oocytes showed a slight increase in the vaccinated group compared to the non-vaccinated control group (10.8 vs. 9.18, p = 0.14). Additionally, within the vaccinated group, no significant difference was observed in the mean number of oocytes before and after vaccination (9.7 and 10.8, p = 0.14). Other similar cycle outcomes between the groups were the rates of implantation, pregnancy, and ovarian hyperstimulation syndrome. This study emphasized that the mRNA anti-COVID-19 vaccination doesn’t adversely affect ovarian response or sperm quality in IVF patients. These findings contribute valuable insights to the safety profile of anti-COVID-19 vaccines in the context of reproductive-aged populations, aiding decision-making during ongoing virus outbreaks and potential future scenarios.

Premature luteinization and pregnancy outcomes in depot goserelin-downregulated assisted reproductive technology cycles: A cross-sectional study from Ethiopia.

To compare the rate of premature luteinization in depot goserelin-downregulated invitro fertilization (IVF) cycles with other IVF protocols at a teaching hospital in Ethiopia. We conducted a cross-sectional study on the effects of premature luteinization on IVF outcomes at St. Paul's Hospital Millennium Medical College, a tertiary teaching hospital in Ethiopia. Patients who had IVF at this hospital between 2019 and 2020 were included in the study. Patient records were reviewed and collected on Open Data Kit. We used Stata release 15 to analyze the data. A simple descriptive analysis and bivariate analysis were performed as appropriate. A P-value less than 0.05 was considered asstatistically significant. A total of 305 patients (40 cases with premature luteinization and 265 without premature luteinization) were included. There was no difference in the rate of premature luteinization in the depot goserelin long protocol cycles (6.4%), compared to minimal stimulation (14.1%) and antagonist protocols (16.7%), P = 0.19. Embryo transfer was carried out in 27 (67.5%) patients in the premature luteinization group, which was lower than the 86.0% (228/265) in the non-premature luteinization group, P = 0.003. There was no difference in the median number of oocytes retrieved (8.5 [interquartile range 5.0, 13.0] per cycle in the premature luteinization group vs 5.0 [interquartile range 3.0, 10.0] in those without premature luteinization, P = 0.10). A depot goserelin-downregulated long protocol for IVF is a cost-effective and convenient option for controlled ovarian hyperstimulation without increased risk of having premature luteinization compared to antagonist and minimal stimulation protocols.

Ghanaian women’s experiences of unsuccessful in-vitro fertilisation treatment, unravelling their meanings: a Heideggerian hermeneutic phenomenological study

BackgroundWomen having experienced infertility over a period usually decide on an option for an invitro fertilisation treatment (IVF). However, in the quest to seek help and to be part of motherhood, they sometimes become unsuccessful in their fertility journey. The researchers aimed to explore the meanings and emotions attached to infertility and unsuccessful invitro fertilisation (IVF) treatment among Ghanaian women, as this area of inquiry is less explored in Africa and specifically in the Ghanaian context.MethodsThe study followed a qualitative approach and drew inspiration from the Heideggerian phenomenological philosophy and design. Six (6) women, aged between 29 and 40 years, who had experienced at least one unsuccessful IVF cycle, were purposefully selected from a private specialist fertility hospital in Kumasi, Ghana. One-on-one interviews were conducted with the participants, and the interviews were transcribed verbatim. The collected data was analyzed using Van Manen six-step framework, which helped to uncover the existential meanings and interpretations these women ascribed to their experiences.ResultsThe results of the study revealed four main themes that were deemed essential aspects of meaning for the participants. These themes were: (1) Experiencing an Existential Faith and Hope. The participants described their journey through infertility and invitro fertilisation (IVF) treatment as a profound test of their existential faith and hope finding strength in maintaining a positive outlook despite the challenges and setbacks they faced., (2) Facing up to the Angst: This theme highlights the participants' courage in confronting the emotional dimensions of their struggles. The women acknowledged and confronted their anxieties, fears, and emotional distress associated with their infertility and unsuccessful IVF treatment., (3). Non-disclosedness: This theme refers to the participants' experiences of keeping their struggles with IVF treatment private, often due to societal and cultural factors. (4). Endured feelings of inadequacy of being-in-the-world-of-motherless: Participants expressed feelings of inadequacy, self-doubt, and a sense of being incomplete due to their inability to conceive and fulfill the societal role of motherhood. Their narratives revealed the profound impact of societal expectations on their self-perception and identity.ConclusionThe study's findings reveal insights into the experiences and interpretations of infertility and unsuccessful IVF treatment among Ghanaian women. Employing Heideggerian hermeneutics, the research elucidates the diverse existential, emotional, and societal aspects inherent in the struggles of infertility. The multifaceted nature of these women's journeys underscores the significance of a comprehensive approach to infertility care that recognizes the cultural, social, emotional, and existential dimensions of the IVF process. Additionally, the study emphasizes the necessity for culturally sensitive support systems and interventions to address the unique challenges faced by this population.

Novel PLCZ1 mutation caused polyspermy during in vitro fertilization.

Failure of oocyte activation, including polyspermy and defects in pronuclear (PN) formation, triggers early embryonic developmental arrest. Many studies have shown that phospholipase C zeta 1 (PLCZ1) mutations cause failure of PN formation following intracytoplasmic sperm injection (ICSI); however, whether PLCZ1 mutation is associated with polyspermy during in vitro fertilization (IVF) remains unknown. Whole-exome sequencing (WES) was performed to identify candidate mutations in couples with primary infertility. Sanger sequencing was used to validate the mutations. Multiple PLCZ1-mutated sperm were injected into human and mouse oocytes to explore whether PN formation was induced. Assisted oocyte activation (AOA) after ICSI was performed to overcome the failure of oocyte activation. We identified three PLCZ1 mutations in three patients who experienced polyspermy during IVF cycles, including a novel missense mutation c.1154C>T, p.R385Q. PN formation failure was observed during the ICSI cycle. However, injection of multiple PLCZ1-mutated sperm induced PN formation, suggesting that the Ca2+ oscillations induced by the sperm exceeded the necessary threshold for PN formation. AOA after ICSI enabled normal fertilization, and all patients achieved successful pregnancies. These findings expand the mutational spectrum of PLCZ1 and suggest an important role for PLCZ1 in terms of blocking polyspermy. Furthermore, this study may benefit genetic diagnoses in cases of abnormal fertilization and provide potential appropriate therapeutic measures for these patients with sperm-derived polyspermy.

Predictive Role of Progesterone Levels for IVF Outcome in Different Phases of Controlled Ovarian Stimulation for Patients With and Without Endometriosis: Expert View.

The study aimed to review the role of basal, trigger, and aspiration day progesterone levels (PLs) as predictors of in vitro fertilization (IVF) success for patients with and without endometriosis. A non-systematic review was conducted by searching papers published in English during the period of 1990-2023 in MEDLINE and PubMed, Embase, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register), and Web of Science. The most widely used IVF predictor success was the trigger day progesterone serum level. Many studies utilize the threshold level of 1.5-2.0ng/ml. However, the predictive power of only progesterone level failed to show high sensitivity and specificity. Contrary, progesterone level on the trigger day combined with the number of mature retrieved oocytes had the highest predictive power. High baseline progesterone level was associated with poor IVF outcomes. Research on progesterone and IVF success in patients with endometriosis is limited but indicates that endometriosis patients seem to benefit from higher progesterone concentrations (≥ 37.1ng/ml) in IVF cycles. Currently, there is limited data for a definitive insight into the mportance of progesterone in the estimation of IVF success. Nonetheless, this summarized evidence could serve as up-to-date guidance for the role of progesterone in the prediction of IVF outcomes, both in patients with and without endometriosis.

Hashimoto’s Thyroiditis Negatively Influences Intracytoplasmic Sperm Injection Outcome in Euthyroid Women on T4 Substitution Therapy: A Retrospective Study

Objective: The objective of this study was to analyze the impact of thyroid autoimmunity (TAI) on reproductive outcome parameters of intracytoplasmic sperm injection (ICSI) cycles as compared to TAI-negative ICSI cycles. Design: In this single in vitro fertilization (IVF) center retrospective study, 86 infertile women with elevated thyroid peroxidase or TGAb levels, but euthyroid after thyroxine replacement (study group), were compared to 69 female patients with no thyroid abnormalities (controls). Following ICSI treatment fertilization rate (FR), clinical pregnancy rate (CPR), miscarriage rate (MR), and live birth rate (LBR) were analyzed. Materials, Setting, Methods: All subjects with various infertility factors were treated with ICSI in university-based IVF center. Patients in the study group received thyroxine replacement and were euthyroid at IVF treatment. Before the IVF cycles, endocrinological parameters were uniformly assessed: thyroid function and antibodies, reproductive hormones (anti-Müllerian hormone [AMH], follicular stimulating hormone [FSH], luteinizing hormone, E2, PRL, testosterone, DHEAS, 17-OHP, AD) and OGTT (0–60–120 min glucose and insulin). Following descriptive comparison of laboratory parameters, age-adjusted analyses of FR, CPR, MR, and LBR were performed. Results: TAI-positive women were older (mean age 35.31 ± 4.95 vs. 32.15 ± 4.87 years; p = 0.002), had higher FSH (8.4 ± 3.4 vs. 7.4 ± 2.32 U/L; p = 0.024), higher E2 (53.94 ± 47.61 vs. 42.93 ± 18.92 pg/mL; p = 0.025) levels, while AMH (2.88 ± 2.62 vs. 3.61 ± 1.69 ng/mL; p = 0.0002) was lower. There were no differences in TSH levels (1.64 ± 0.96 vs. 1.66 ± 0.65 µIU/mL; p = 0.652) between the two groups. FT3 (2.63 ± 0.58 vs. 2.98 ± 0.55 pg/mL; p = 0.002) was lower and FT4 (1.3 ± 0.29 vs. 1.13 ± 0.21 ng/dL; p = 0.0002) was higher in the TAI-positive group, reflecting clinically irrelevant differences. Egg cell counts (6 ± 3.8 vs. 7.5 ± 3.95; p = 0.015) were lower in TAI and remained so following age adjustment. Although the overall ICSI FR did not differ (62.9% vs. 69.1%, p = 0.12), it was lower for patients under 35 with TAI showing decreasing differences in line with age. The CPR (36.04% vs. 69.56%; p p p = 0.024) was higher in the TAI group, and these differences remained after age adjustment. Limitations: Since the higher age of the study group may interfere with the effect of TAI, age adjustment calculations were necessary to perform to eliminate this confounding factor. Conclusion: Despite optimal thyroid supplementation in clinical or subclinical hypothyroidism, the presence of TAI negatively influences CPR and is connected to a higher MR, thus resulting in a lower LBR after ICSI. Decreased FR with ICSI in TAI patients may also contribute to poorer outcomes, especially in younger women.

Cumulative live birth rate of in vitro fertilization cycle via progestin-primed ovarian stimulation versus gonadotropin-releasing hormone antagonist protocol in infertile women with normal ovarian reserve: an open-label, randomized controlled trial

This study aimed to evaluate the cumulative live birth rate (cLBR) of progestin-primed ovarian stimulation (PPOS) protocol versus gonadotropin-releasing hormone antagonist (GnRH-ant) protocol for in vitro fertilization (IVF) cycle in infertile women with normal ovarian reserve (NOR). Infertile women with NOR who underwent their first IVF cycle were enrolled in an open-label randomized controlled trial. Patients were randomly assigned 1:1 to receive a freeze-all strategy with delayed embryo transfer (PPOS group, n = 174) and fresh embryo transfer first (GnRH-ant group, n = 174). The primary outcome was the cLBR per aspiration. The cLBR between the PPOS group and GnRH-ant group were comparable (55.75% vs. 52.87%, p = 0.591). A premature luteinizing hormone surge was not observed in the PPOS group, while there were six cases (3.45%) in the GnRH-ant group, but no premature ovulation in either of the groups. The pregnancy outcomes, including implantation rate, clinical pregnancy rate and miscarriage rate, were all comparable. In addition, the number of retrieved oocytes, mature oocytes and viable embryos were similar (all p > 0.05) between the two groups.