In Vitro Fertilization Cycles Research Articles

Clomiphene citrate throughout the duration of ovarian stimulation in patients with diminished ovarian reserve: an approach to decrease costs, reduce injection burden, and prevent premature ovulation.

Clomiphene citrate (CC) is often utilized as an adjunct in in vitro fertilization (IVF) protocols during the first 5days of stimulation for endogenous FSH release. However, due to its antiestrogenic mechanism of action, CC may also effectively prevent the LH surge, and hence premature ovulation, if continued until the day of trigger. The objective of this study was to evaluate a "long CC" protocol, in which CC is continued throughout the entire cycle in-lieu of GnRH antagonist, and to compare IVF outcomes with a standard 5-day CC + GnRH antagonist protocol in patients with diminished ovarian reserve (DOR) undergoing IVF with high-dose gonadotropins. This is a retrospective cohort study of all CC-based IVF cycles at a single institution between 9/2020 and 9/2022. Mild stimulation protocols were excluded. The long CC group received CC throughout the entire cycle without GnRH antagonist. The CC + GnRH antagonist group received CC for the first 5days of stimulation followed by GnRH antagonist when the lead follicle reached 14mm. The primary outcome was mature oocyte yield. There were 361 cycles (77%) in the long CC group and 108 (23%) in the 5-day CC + GnRH antagonist group. Age and AMH levels were similar between the two groups. There was no significant difference in mature oocyte yield between the long CC and 5-day CC + GnRH antagonist groups (median 5 (IQR 5) vs. 4.5 (IQR 5), respectively, (P = 0.922)). MII oocytes/AFC did not differ (0.69 vs. 0.56, respectively, P = 0.16). Premature ovulation occurred in 0.3% of cycles in the long CC group vs. 3.0% of cycles in the 5-day CC + GnRH antagonist group (P = 0.019). In DOR patients undergoing IVF, a long CC protocol is an effective and patient-friendly approach associated with non-inferior oocyte yield.

How to estimate the probability of a live birth after one or more complete IVF cycles? the development of a novel model in a single-center.

To develop a predictive tool in the form of a Nomogram based on the Cox regression model, which incorporates the impact of the length of treatment cycles on the outcome of live birth, to evaluate the probability of infertile couples having a live birth after one or more complete cycles of In Vitro Fertilization (IVF), and to provide patients with a risk assessment that is easy to understand and visualize. A retrospective study for establishing a prediction model was conducted in the reproductive center of Shenzhen Zhongshan Obstetrics & Gynecology Hospital (formerly Shenzhen Zhongshan Urology Hospital). A total of 4413 patients who completed ovarian stimulation treatment and reached the trigger were involved. 70% of the patients were randomly placed into the training set (n = 3089) and the remaining 30% of the patients were placed into the validation set (n = 1324) randomly. Live birth rate (LBR) and cumulative LBR (CLBR) were calculated for one retrieval cycle and the subsequent five frozen embryo transfer (FET) cycles. Proportional Hazards (PH) Assumption test was used for selecting the parameter in the predictive model. A Cox regression model was built based on the basis of training set, and ROC curves were used to test the specificity and sensitivity of the prediction model. Subsequently, the validation set was applied to verify the validity of the model. Finally, for a more intuitive assessment of the CLBR more intuitively for clinicians and patients, a Nomogram model was established based on predictive model. By calculating the scores of the model, the clinicians could more effectively predict the probability for an individual patient to obtain at least one live birth. In the fresh embryo transfer cycle, the LBR was 38.7%. In the first to fifth FET cycle, the optimal estimate and conservative estimate CLBRs were 59.95%, 65.41%, 66.35%, 66.58%, 66.61% and 56.81%, 60.84%, 61.50%, 61.66%, 61.68%, respectively. Based on PH test results, the potential predictive factors for live birth were insemination method, infertility factors, serum progesterone level (R = 0.043, p = 0.059), and luteinizing hormone level (R = 0.015, p = 0.499) on the day initiated with gonadotropin, basal follicle-stimulating hormone (R = -0.042, p = 0.069) and BMI (R = -0.035, p = 0.123). We used ROC curve to test the predictive power of the model. The AUC was 0.782 (p < 0.01, 95% CI: 0.764-0.801). Then the model was verified using the validation data. The AUC was 0.801 (p < 0.01, 95% CI: 0.774-0.828). A Nomogram model was built based on potential predictive factors that might influence the event of a live birth. The Cox regression and Nomogram prediction models effectively predicted the probability of infertile couples having a live birth. Therefore, this model could assist clinicians with making clinical decisions and providing guidance for patients. N/A.

Breaking Barriers: A Triumph over Infertility in Swyer’s Syndrome

This case study examines the comprehensive fertility treatment and eventual successful conception of a patient with Swyer’s syndrome. It emphasizes the impact of suitable luteal support on reproductive outcomes. The patient underwent a thorough evaluation including karyotyping, laparoscopy, and gonadectomy. She then pursued donor oocytes in vitro fertilization (IVF) cycles, which were preceded by an estradiol challenge to evaluate endometrial receptivity. Human chorionic gonadotropin (hCG) was used for luteal phase support in the third IVF attempt after two previous unsuccessful cycles. The third IVF cycle, which included injection hCG for luteal support, led to successful implantation and conception. The pregnancy was uneventful, and the patient delivered a healthy baby via caesarean section at 37 weeks gestation. This case underscores the intricate management required for infertility in patients with gonadal dysgenesis. The positive outcome with hCG luteal support suggests its potential role in enhancing endometrial receptivity and implantation success in IVF treatments.

Association between snoring and in vitro fertilization outcomes among infertile women.

To explore the association between snoring and in vitro fertilization (IVF) outcomes in infertile women, focusing on embryological parameters and pregnancy outcomes. This study represents a secondary analysis of the PKU-ERC study (NCT05373290). We included a cohort of 632 infertile women, aged 24-45 years, undergoing their first IVF treatment from the Reproductive Center of Peking University People's Hospital between January 2018 and November 2021. All patients with the assistance of their husbands completed a questionnaire including snoring status and frequency before ovulation induction (OI). Embryology parameters were evaluated during the first IVF cycle, and pregnancy outcomes were assessed through follow-up. Among 579 subjects, 33.5% reported occasional snoring, and 8.8% reported frequent snoring. After adjusting for confounding factors, multiple linear regression model showed that frequent snorers had higher β-coefficients for the number of blastocysts and available embryos compared to non-snorers (both P<0.05). Among 551 subjects who completed the first embryo transfer, 6.2% suffered biochemical pregnancy loss. Frequent snorers were more likely to experience biochemical pregnancy loss compared to non-snorers and occasional snorers (5.7% vs. 14.6%, P=0.033; 4.8% vs. 14.6%, P=0.026). Multivariable analysis revealed that frequent snoring was a risk factor for biochemical pregnancy loss (adjusted odds ratio, aOR: 2.95, 95% confidence interval, CI: 1.06-8.24, P=0.039), while high-density lipoprotein cholesterol (HDL-C) level was a protective factor after IVF (aOR: 0.21, 95% CI: 0.05-0.92, P=0.038). Frequent snoring is associated with a decreased number of available oocytes and an increased risk of biochemical pregnancy loss following IVF. However, the potential influence of undiagnosed obstructive sleep apnea (OSA) should be considered when interpreting these results.

Association of anti-phosphatidylserine/prothrombin antibodies with adverse in vitro fertilization outcomes.

Anti-phosphatidylserine/prothrombin antibodies (aPS/PT) are classified as non-criteria antiphospholipid antibodies (aPL), and are strongly associated with thrombosis and pregnancy complications linked to antiphospholipid syndrome (APS). This study aimed to investigate whether aPS/PT positivity is associated with adverse outcomes in vitro fertilization (IVF). The study included infertile women who tested positive aPS/PT and underwent IVF cycles, as well as infertile controls with pure tubal etiology. We compared the impact of aPS/PT on baseline and clinical characteristics, immune-related indicators, IVF laboratory metrics, and pregnancy outcomes. Women with aPS/PT exhibited lower numbers of retrieved oocytes, embryos, and both perfect and available embryos, as well as reduced rates of blastocyst formation. Furthermore, an imbalanced Th17/Treg ratio and significantly elevated serum IL-17A levels were observed in women with aPS/PT compared to controls. In conclusion, the presence of aPS/PT is associated with adverse IVF and pregnancy outcomes. Early screening for aPS/PT and appropriate consultation for couples undergoing IVF-ET should be considered. Additionally, specific immune and inflammatory mechanisms related to aPS/PT warrant further investigation.

Dual Trigger in IVF—A SWOT Analysis

The typical agent used for final oocyte maturation and resumption of meiosis in in-vitro fertilisation (IVF) has been human chorionic gonadotropin (hCG). This acts as a surrogate for the physiological spontaneous luteinising hormone (LH) surge. Gonadotropin-releasing hormone agonist (GnRH-a) has been used as an alternative trigger in cycles where endogenous LH control is achieved using GnRH-antagonist and has been shown to be an effective method of reducing the risk of OHSS. However, GnRHa trigger is associated with poor corpus luteum function, leading to impaired endometrial receptivity. A combination of a GnRHa and hCG (dual trigger) was proposed to improve IVF cycle outcomes, especially in poor and normo-responder patients. Dual trigger aims to provide a more physiological alternative to HCG-only trigger while obviating some of the problems associated with GnRHa alone. Clinical evidence now supports the value of dual trigger where there has been a previous low proportion of mature eggs or where there is a suboptimal LH response to GnRHa alone. In poor responders, dual triggers could be considered as an effective first line. Dual trigger allows for comparable outcomes in normal and high responders, allowing the possibility of fresh embryo transfer with good clinical pregnancy and live birth rates while minimising OHSS risk.

Prolonged Ovarian Stimulation Does Not Worsen Neonatal Outcomes After Fresh Embryo Transfers.

To investigate the relationship between prolonged ovarian stimulation and neonatal outcomes after autologous fresh embryo transfer (fET). A retrospective cohort study. University-affiliated centres. 3529 patients underwent autologous invitro fertilisation (IVF) cycles between August 1, 2016 and December 31, 2022, with a live singleton birth after fET. Univariate and multivariate regression analyses were used to determine the relationship between prolonged ovarian stimulation and neonatal outcomes. Propensity score matching (PSM) was applied to evaluate independent effects. Neonatal outcomes. Multivariate regression showed no significant association between simulation duration and birthweight (adjusted β: 4.19, 95% confidence interval [CI]: -13.86 to 22.23; p = 0.6494) or gestational age (GA) (adjusted β: -0.01, 95% [CI]: -0.09 to 0.06; p = 0.7403) Categorical analysis of neonatal outcomes, including low birthweight (LBW) (adjusted Odds Ratio [OR]: 0.94, 95% [CI]: 0.70 to 1.25; p = 0.6501), macrosomia (adjusted OR: 0.95, 95% [CI]: 0.78 to 1.16; p = 0.6294), small for gestational age (SGA) (adjusted OR: 0.95, 95% [CI]: 0.75 to 1.19; p = 0.6465), large for gestational age (LGA) (adjusted OR: 1.02, 95% [CI]: 0.85 to 1.21; p = 0.8542) and preterm (adjusted OR: 0.93, 95% [CI]: 0.77 to 1.11; p = 0.4191), revealed no associations with stimulation duration. PSM analysis confirmed these findings. Prolonged ovarian stimulation does not appear to increase adverse neonatal outcomes in singleton newborns after autologous fET.

Assessing Willingness to Pay for IVF Among Infertile Women in Greece: A Single-Center Case Study.

In recent years, In Vitro fertilization (IVF) science has grown by leaps and bounds in the field of assisted reproduction, helping millions of couples worldwide. The aim of this study is to examine the extent to which infertile women are willing to pay for IVF services in Greece. Through the distribution of questionnaires, willingness to pay (WTP) is recorded according to IVF success rates, and the relationship between WTP and the respondents' demographic characteristics is analyzed. Subjects were divided into two groups according to age and were given a hypothetical scenario, according to the contingent valuation approach. The majority of women were reluctant to pay the amount of money corresponding to the average cost of an IVF cycle in Greece. In particular, participants replied that the amount they would be willing to pay is only one-third of the indicative amount of €6000. Moreover, WTP is not influenced by the professional status or educational level of the participating women. This study highlights the financial barriers many couples face when pursuing assisted reproduction. If the average cost of IVF were lower, infertile women would be willing to undergo more IVF cycles if necessary. This finding has important implications for the valuation of IVF services and the development of pricing policies to enhance affordability and accessibility. Policymakers must consider reforms that balance the cost of IVF with its societal benefits. By incorporating this aspect into pricing and policy decisions, Greece can improve the accessibility of IVF services and ensure equitable treatment opportunities for all concerned individuals.

Polycystic ovary syndrome and morphokinetic embryonic development: A case-control study evaluating 791 embryos.

To investigate the association between Polycystic Ovary Syndrome (PCOS) and the rate of embryo development, using time-lapse monitoring systems (TLM), compared to a control group of women with mechanical (tubal) factor infertility. A retrospective case-control study conducted in a university affiliated IVF unit. Women with PCOS undergoing in-vitro fertilization (IVF) treatments and those with non-PCOS controls with tubal factor infertility only. Development morphokinetic milestones were compared and analysis of covariance for time to distinct cell number as well as logistic mixed models to determine predictors for embryos over the 75th percentile was performed. Not applicable. Embryo development morphokinetic parameters in women with and without PCOS undergoing IVF treatments. The study included 791 embryos from 115 women, 364 embryos from 52 women with PCOS and 427 embryos from 63 women with non-PCOS controls with tubal factor infertility. The PCOS group was 4 years younger (30.07±6.03 vs. 34.08±4.84 years, p=0.002) and had higher number of oocytes retrieved (16.00 vs. 11.00, p<0.001), mature oocytes (11.00 vs. 7.00,<0.001) and fertilized oocytes (8.00 vs. 5.00, p<0.001). The PCOS and control groups demonstrated comparable clinical pregnancy rates (55.8% vs. 32.1%,p=0.053), miscarriage rate (12.5% vs. 11.8%, p=0.994) and live birth rate (48,8% vs. 31.2%, p=0.089). Morphokinetic parameters were comparable between the groups. While age was associated with later time to 5 and 8 discrete cells and start of blastulation (tSB), PCOS was only associated with later tSB, including tSB>75th percentile. This study demonstrated comparable IVF outcomes in women with PCOS and non-PCOS controls. An analysis of TLM data from these patients showed no evidence that PCOS negatively affects embryonic development rate in women undergoing IVF cycles.

An additive opinion to the committee opinion of ASRM and SART on the use of preimplantation genetic testing for aneuploidy (PGT-A).

After over 20years of progressively increasing clinical utilization of PGT-A (and its precursors), the American Society for Reproductive Medicine (ASRM) and its daughter society, the Society for Assisted Reproduction (SART), for the first time published a committee opinion clearly acknowledging that "the value of PGT-A as a routine screening test for patients undergoing in vitro fertilization (IVF) has not been demonstrated." This statement is timely and welcome but requires some additions and raises some new questions, among those why, if PGT-A in a general population does not improve IVF cycle outcomes, the routine clinical utilization of PGT-A should continue.

Protecting Future Generations From Hereditary Genetic Disorders Using Preimplantation Genetic Diagnosis: A Narrative Review Article.

Preimplantation genetic diagnosis (PGD) is provided by majority of reproductive clinics in the United States (US), and PGD is used in many in vitro fertilization (IVF) procedures every year. PGD is extensively used to screen for certain genetic abnormalities and aneuploidy in individuals undergoing IVF. Genetic disorders are very prevalent in Saudi Arabia. The high prevalence of consanguinity in the population explains, to a great extent, the incidence of genetic disorders being relatively higher in the Kingdom of Saudi Arabia (KSA) compared to many other countries. Estimates range from 6% to 10% among all live births, and at least one study estimated that up to 30% of the population couldbe affected by a genetic disorder at any time in their lifetime.Therefore, a preventive measure such as PGDis useful for detecting genetic disorders before implantation. In KSA,genetic disorders are prevalent with a high psychological and financial burden. A diagnostic procedure like PGD is useful for detecting genetic disorders. It is used to analyze embryos under the IVF cycle. Then, a biopsy is taken from the embryos and analyzed using techniques such as polymerase chain reaction (PCR) and fluorescence in situ hybridization (FISH). Only healthy embryos are transferred to the uterus, thus eliminating the need for a parental diagnostic test that comes with substantial risk to the mother and the fetus. PGD is used for the detection of genetic abnormalities such as sex-linked diseases and chromosomal abnormalities, helping parents with genetic disorders to conceive a healthy child. Some of the limitations of PGD are its unavailability and the high cost, which limitthe access for parents of low socioeconomic status. It creates many decision-making problems for the facilities and parents. Our objectives include giving an overview of PGD history, demonstrating indications for this procedure, explaining its techniques, and discussing the ethical issues surrounding it. PGD offers improved IVF results and reduced genetic disorder prevalence but also has disadvantages like high costs, limited access, and ethical concerns.

Value of PGT-A when only one or two blastocysts are obtained: propensity-score matching and cost-effectiveness study.

To compare the effectiveness and cost of in-vitro fertilization (IVF) with or without preimplantation genetic testing for aneuploidy (PGT-A) when only one or two blastocysts are obtained. A dataset was gathered from 1829 patients including 368 non-PGT-A and 1461 PGT-A cycles with one or two blastocysts obtained, between April 2013 and July 2022. Patients were matched 1:1 by propensity-score matching for maternal age, number of metaphase-II oocytes inseminated and number of blastocysts obtained, achieving a database of 242 patients per group. The non-PGT-A and PGT-A groups were compared for differences in live birth rate (LBR) per embryo transfer (ET), cumulative LBR per patient, miscarriage rate (MR) per clinical pregnancy, number of days between oocyte retrieval and conclusion of the IVF cycle (primary outcome), mean expenses incurred at the clinic and incremental cost-effectiveness ratio (ICER). More than twice as many ETs were conducted in the non-PGT-A group compared with the PGT-A group, yet the cumulative LBR per patient was similar between groups (23.6% (95% CI, 18.5-29.5%) vs 27.3% (95% CI, 21.9-33.4%)). This outcome was achieved with a higher LBR per ET (16.2% (95% CI, 12.6-20.5%) vs 41.5% (95% CI, 33.9-49.4%)) and lower MR per clinical pregnancy (30.1% (95% CI, 21.8-42.6%) vs 13.9% (95% CI, 7.5-24.0%)) in the PGT-A group. The MR per patient was also lower in the PGT-A group (9.5% (95% CI, 6.2-14.1%) vs 4.5% (95% CI, 2.4-8.2%)). The mean duration between oocyte retrieval and IVF cycle conclusion was 131 (95% CI, 113-150) days in the non-PGT-A group vs 74 (95% CI, 61-87) days in the PGT-A group (P < 0.001; power = 99.8%). The ICER of PGT-A for the months saved between oocyte retrieval and conclusion of the IVF cycle was €499 overall, ranging between €170 and €2065 according to the number of blastocysts obtained and/or maternal age. The ICER of PGT-A for prevented miscarriages was €18 968, decreasing to €3525 when calculated among patients aged ≥ 35 years with two blastocysts obtained. When conducted in expert IVF clinics for patients indicated for the procedure, PGT-A is clinically valuable even when only one or two blastocysts are obtained. PGT-A reduces the number of ETs and miscarriages while the cumulative LBR per patient remains unaffected, and allows these outcomes to be achieved in a shorter timeframe. The ICER of PGT-A vs non PGT-A decreased as maternal age increased. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Using national invitro fertilization registries to validate clinical outcomes after invitro fertilization covered by health insurance.

To evaluate invitro fertilization (IVF) cycles covered by health insurance using a national commercial claims database and validate key clinical events against national IVF registries. Retrospective cohort study. US women aged 20-44 years who underwent IVF from 2005-2020 in Optum's deidentified Clinformatics Data Mart Database (CDM). Undergoing IVF. Invitro fertilization cycles and rates of pregnancies (inclusive of losses and terminations), live births, and live birth types (e.g., singleton, twin, and triplet or higher-order). We identified more than 3,000 IVF cycles in each year from 2005-2020 within CDM. When comparing our rates of clinical outcomes with external benchmark data, the results were similar across all the years of our study. For example, in 2020, the percentages of pregnancies after first embryo transfer were 62.03% (95% confidence interval [CI], 59.48-64.47) in CDM and 64.96% in data from the Society for Assisted Reproductive Technology (SART). The rates of live birth after first embryo transfer were 44.58% (95% CI, 41.90-47.21) in CDM in 2020 and 46.95% in SART in 2020. The rate of singleton births was 94.17% (95% CI, 92.24-96.10) in CDM in 2020, and this rate was 94.37% in SART in 2020. For twin births, the rates were 5.48% (95% CI, 3.60-7.35) in CDM in 2020 and 5.46% in SART in 2020. The rates of triplet or higher-order births were 0.35% (95% CI, 0.00-0.84) in CDM in 2020 and 0.17% in SART in2020. We found that CDM can be used to accurately identify IVF cycles covered by insurance and key clinical outcomes such as rates of pregnancies, live births, and live birth types, and our reported rates were similar to national IVF clinical registry data. Our findings support that CDM is a robust data source to conduct research about IVF insurance coverage and can accurately evaluate clinical outcomes resulting from IVF. Policymakers who are considering insurance coverage for IVF can use CDM to model and measure the impact of new or existing policies for IVF insurance coverage.

Tips and Tricks for Robotic Management of Diffuse Adenomyosis

To demonstrate a step-by-step approach in two cases of diffuse adenomyosis using different surgical techniques depending on the disease's extent. The video also highlights surgical tips to minimize blood loss and maximize the excision of the adenomyotic disease. Description of technique and narrated surgical video footage. An endometriosis and adenomyosis referral center. The patients included in this video gave consent for the publication of the video and posting of the video online, including social media, the journal website, scientific literature websites (e.g., PubMed, ScienceDirect, and Scopus), and other applicable sites. A 38-year-old nulligravid patient with a history of chronic pelvic pain, dysmenorrhea, and infertility for 2 years had previously undergone two unsuccessful invitro fertilization (IVF) cycles. During her first IVF cycle, five embryos were produced; one embryo was transferred, and the remaining embryos were frozen. In the second attempt, one frozen embryo was transferred after endometrial preparation as per protocol. However, both cycles were unsuccessful, resulting in implantation failure. Preoperative magnetic resonance imaging revealed diffuse adenomyosis in the posterior wall of the uterus, measuring 8.7 × 6.0 cm, with a thickened junctional zone (>12 mm). A 36-year-old G2P1 patient with a history of cesarean section and secondary infertility had two IVF cycles: the first resulted in early pregnancy loss at 6 weeks, and in the second cycle, she was premedicated with gonadotropin-releasing hormone for 3 months; however, it was unsuccessful. Preoperative magnetic resonance imaging identified diffuse adenomyosis involving both the anterior and posterior uterine walls, with a thickened junctional zone (>12 mm). In the first case, a classic excisional technique was performed to remove the adenomyosis from the posterior uterine wall. In the second case, a double flap approach was used to excise adenomyosis from both the anterior and posterior uterine walls. Intracavitary diluted indocyanine green dye was used to maximize the precise excision of adenomyosis tissue while maintaining an adequate myometrial residual around the cavity. Robotic-assisted excision of adenomyosis tissue while sparing adequate myometrium and reconstructing uterine walls. Both procedures were completed without complications, and patients were discharged on the same day of surgery. Patients were seen at 6 weeks for postoperative follow-up with no complaints. The plan is to obtain imaging before resuming IVF treatment. Patients were advised to wait 6 months after surgery before attempting conception to allow for recovery. Uterus-sparing surgical techniques for diffuse adenomyosis are advisable in selected cases where medical management and/or repeated IVF cycles fail. Preoperative imaging is crucial for precisely mapping the disease and applying the appropriate surgical technique. Different techniques have been proposed using an open or a minimally invasive approach. The use of a robotic platform, in conjunction with indocyanine green dye, can facilitate these surgical techniques and potentially improve outcomes.

The impact of age and number of oocytes retrieved on the cumulative live birth rate in women with poor ovarian response: A 15-year study

BackgroundApproximately 15 % of women undergoing assisted reproductive treatment (ART) fall in the category of poor ovarian reserve defined as the retrieval of three or fewer oocytes following conventional ovarian stimulation with a daily gonadotrophin dose of 150–450 international units, according to the Bologna criteria. Low number of oocytes collected is, therefore, likely to translate to low chance of successful ART treatment. ObjectivesThe objective of the study was to assess if age and number of oocytes retrieved influence the cumulative live birth rate (LBR) in women with poor ovarian response (POR) to controlled ovarian hyperstimulation. Study designWe have used anonymised, prospectively collected data spanning July 2004 until June 2019 on consecutive in vitro fertilisation (IVF) and intra-cytoplasmic sperm injection (ICSI) cycles performed at a tertiary fertility treatment unit. Women who underwent conventional ovarian stimulation with a starting daily gonadotrophin dose of 150–450 IU in their first or second IVF cycle where 1–3 oocytes were retrieved were included in the study, with women where four oocytes were retrieved formed a comparative control group. Only one cycle per patient was included. ResultsA total of 2,516 fresh IVF or ICSI cycles were analyzed. The overall clinical pregnancy and LBR in the cohort of included women were 16.4 % and 12.6 % respectively. The cumulative LBR per patient included was 13.1 %. When adjusting for age, treatment type, FSH at baseline, and daily gonadotrophin dose, a significant increase in cumulative LBR was observed for two (OR 2.63, 95 % CI 1.43–4.81), three (OR 3.74, 95 % CI 2.09–6.68) and four (OR 5.3, 95 %CI- 3.01–9.35) oocytes collected, compared to one oocyte only. A significantly lower chance of successful outcome was noted in women 43–45 years old versus younger age groups, irrespective of number of oocytes collected. ConclusionsIn this large cohort of women with POR, both age and number of oocytes retrieved are independent factors influencing the cumulative LBR after IVF treatment. Irrespective of age, retrieval of one additional oocyte is associated with an increase in the cumulative LBR per oocyte retrieval.

The Efficacy of Multiwavelength Red and Near-Infrared Transdermal Photobiomodulation Light Therapy in Enhancing Female Fertility Outcomes and Improving Reproductive Health: A Prospective Case Series with 9-Month Follow-Up.

Background/Objectives: Female infertility due to unexpected causes exhibits a great challenge for both clinicians and women who are trying to conceive. The present clinical case series study aimed to evaluate the efficacy of multiple wavelengths of red and near-infrared (NIR) laser photobiomodulation (PBM) for increasing the potential of fertility in women and improving reproductive health in unexplained infertility issues. The objectives were to assess the following: (1) any adverse effects; (2) the possibility of producing an effective PBM protocol; (3) and healthy live birth. The inclusion criteria were to related to females who failed to conceive naturally beyond two years, multiple miscarriages, molar pregnancy, non-viable embryos from in vitro fertilisation (IVF) cycles, and failure to complete successful implantation of viable pre-implantation genetic tested (PGT-A) embryos. Methods: Case series of three female subjects with unexplained age-related infertility issues, which included a failure to conceive naturally beyond two years, multiple miscarriages, molar pregnancy, non-viable embryos from IVF cycles, and failure to complete successful implantation of viable pre-implantation genetic tested (PGT-A) embryos. In each case, previous conditions were recorded and then compared with outcomes after the patient received a course of PBM treatments. In every case, fertility outcomes improved. Three cases resulted in a full-term pregnancy and the birth of a healthy baby. PBM treatments were given at weekly and/or at two-week intervals using IR and NIR wavelengths between 600 nm and 1000 nm in the lead up to natural conception, IVF oocyte retrieval, blastocyst/embryo implantation, and/or the production of viable embryos. Results: In every case, fertility outcomes improved. Improvements in reproductive health outcomes in each case give reason to suggest that PBM may help to improve unexplained age-related infertility. Conclusions: Our study demonstrated that multiwavelength of red and NIR PBM with either an LED or laser, or a combination, improved female fertility and reproductive health and contributed to healthy live births in females diagnosed with unexplained age-related infertility. Extensive studies with robust data are warranted to validate our PBM dosimetry and treatment protocols. Moreover, understanding the genetic and phenotype biomarkers is important to standardise a range of PBM light dosimetry.

Characterization of the gut microbiota in patients with SARS-CoV-2 infection during controlled ovarian stimulation

BackgroundThe Coronavirus disease 2019 (COVID-19) pandemic has emerged as a global health crisis, with clinical manifestations including those suggesting injury to various organs such as the ovaries, which implies that it extends beyond respiratory infections. Changes in gut microbiota may exhibit correlations with the mechanisms and stages of severity in COVID-19, as well as a link with sex hormones, embryo development, and pregnancy. Controlled ovarian stimulation (COS) is used to induce the development of multiple high-quality follicles during in vitro fertilization (IVF). Our research aimed to investigate whether patients infected with COVID-19 have altered gut microbiota compositions that would affect the outcomes of COS.MethodsTwenty-one healthy females and seventeen patients with COVID-19 were enrolled. Samples were sequenced for gut microbiota identification through 16 S rRNA V3-V4 region, including species annotation, community diversity, and community functions.ResultsNo significant differences were found between the groups in terms of in IVF cycle outcomes and laboratory parameters. Patients with COVID-19 and healthy women showed no significant difference in the total number of available blastocyst embryos. Furthermore, the gut microbiota alpha diversity index in the COVID-19 group were markedly reduced compared to those of healthy females. Comparing the COVID-19 group to the controls, the gut microbiota dysbiosis decreased levels of Ruminococcus, and Agathobater, and elevated levels of Achromobacter and Raistonia. Finally, we identified a series of microbial functional characteristics, including membrane transport and carbohydrate metabolism, that exhibited significant disparities between the two groups.ConclusionsPatients in the COVID-19 group exhibited significant disparities in the gut microbiota composition compared to the healthy women during COS. However, the IVF outcomes did not show any significant differences between the two groups. Collectively, our speculation suggests that SARS-COV-2 infection may alter the gut microbiota without impacting IVF outcomes.

Support of the luteal phase in programs for transferring thawed embryos into the uterine cavity in patients with overweight and obesity

Introduction. Progesterone levels are a critical factor for embryo implantation in in vitro fertilization (IVF) programs, including thawed embryo transfer programs. Overweight/obese patients often have lower blood progesterone concentrations in the luteal phase during IVF cycles, which requires an individual approach to planning luteal support in this category of patients.Aim. To compare the pregnancy ratе and miscarriage rates up to 12 weeks of pregnancy in overweight/obese patients who underwent a program of transfer of thawed embryos into the uterine cavity, depending on the type and route of administration of gestagens.Materials and methods. The study included 76 overweight or obese patients. All patients were treated for infertility using a program for transferring a thawed embryo into the uterine cavity; luteal phase support was carried out either using micronized progesterone, identical to natural, – the drug Utrogestan in a daily dose of 800 mg intravaginally (40 patients), or combination therapy was prescribed – vaginal gel with progesterone 90 mg in combination with the synthetic progestin dydrogesterone in a daily dose of 30 mg, taken orally (36 patients).Results. The rates of pregnancy and miscarriage in the first trimester were comparable in both groups and did not depend on differences in luteal support.Conclusions. The formation of the luteal phase of the cycle in patients with overweight/obesity is equally effective using various forms of gestagens. The use of micronized progesterone may be preferable in patients with overweight/obesity in terms of the ability to monitor blood progesterone levels, a more favorable metabolic profile when used vaginally, and the possibility of switching to oral administration of the drug in the event of the development of adverse local events.

Predictions of live birth in IVF programs of patients with recurrent implantation failure

BackgroundWhen a high-quality embryo is implanted into the uterus, but the pregnancy is not established as shown by the ultrasound visualization of an intrauterine gestational sac, this is known as “implantation failure.” Cases when more than two times implantation failure occurred was defined as recurrent implantation failure (RIF). Additional testing is done at this stage of infertility treatment to avoid a repeat of the same result with a future in vitro fertilization (IVF) effort. Aim of the studyThe study aimed to evaluate predictive value of using embryo transfer personalization because of the implantation window study in combination with preimplantation genetic testing in patients with recurrent implantation attempts. MethodsBriefly describe the main methods or treatments applied: Ninety-three infertile women make up the sample for this prospective cohort study. In regard to treatment results, the study intends to assess the predictive importance of patient characteristics, screening indicators, and several features of IVF cycles, such as the quantity, quality, and developmental stage of the transferred embryos. Statistical methods employed include the calculation of the median (Me) and interquartile range (IQR) for continuous variables. The Mann-Whitney U test was used to discern differences between unrelated samples, while categorical variables were presented as absolute and percentage values. The Pearson’s Chi-squared test assessed differences between groups. Logistic regression, utilizing both enter and backward Wald methods, was applied to establish associations with binary outcomes. ResultsThe integration of individualized embryo transfer and preimplantation genetic testing (PGT) significantly enhanced the likelihood of live births by 3.4 times in patients experiencing recurrent implantation failure (RIF), with a statistical significance of p = 0.026. In contrast, employing PGT alone increased the probability of live births by 1.5 times; however, this result was not statistically significant (p = 0.439). The predictive model for live birth in patients with RIF, based on our study findings, is defined as follows: the probability of live birth = 1.936 + [1.014 if PGT-A embryos are utilized for transfer] + [1.742 if endometrial preparation is tailored according to the Wellbeing Index (WI)] − [1.860 in cases of secondary infertility] − [1.891 when a male factor is involved]. ConclusionsThe determination of the implantation window (IW) and PGT of the embryo are efficient methods of live birth achievement for patients with RIF.

The Impact of Laparoscopic Treatment on Fertility Outcomes in Patients with Severe Endometriosis

Background: Endometriosis, a prevalent gynecological disorder affecting women of reproductive age, is a significant cause of infertility, especially in severe cases involving extensive adhesions, endometriomas, and deep infiltrating lesions. In Bangladesh, the delay in diagnosis and limited access to advanced treatments, including laparoscopic surgery, poses challenges to improving fertility outcomes for women with severe endometriosis. Objective: This study aimed to assess the impact of laparoscopic treatment on fertility outcomes in patients with severe endometriosis, particularly in a resource-limited healthcare setting in Bangladesh. Methods: This retrospective cohort study included 78 women with severe endometriosis from tertiary hospitals in Dhaka and Khulna, Bangladesh. All participants had previously experienced unsuccessful in vitro fertilization (IVF) attempts and subsequently underwent laparoscopic surgery between 2015 and 2024. Data collection involved reviewing primary and secondary data from these tertiary hospitals, including medical records and operative reports, and was supplemented by follow-up interviews for comprehensive analysis. Variables such as patient age, infertility duration, previous IVF cycles, operative findings, and postoperative fertility outcomes were analyzed using SPSS, with statistical significance set at P &lt; .05. Results: The mean age of patients was 34.3 years, and the average duration of infertility was 52.9 months. Post-laparoscopic surgery, 42.3% (33/78) of women successfully delivered, with 7% achieving spontaneous conception. Younger age, fewer prior IVF cycles, and a normal uterine appearance on transvaginal ultrasound were significantly associated with improved fertility outcomes. Salpingectomy was more common among those who delivered (70%), though the removal of ovarian endometriomas did not significantly impact fertility success. Conclusion: Laparoscopic treatment significantly improves fertility outcomes in Bangladeshi women with severe endometriosis, even in a resource-limited setting. Age, normal ovarian function, and uterine appearance were key factors influencing reproductive success. These findings underscore the importance of timely surgical intervention for endometriosis-related infertility, highlighting the need for improved access to laparoscopic surgery in low-resource healthcare systems.