In Vitro Fertilization Cycles Research Articles

The effect of depression on the outcome of infertile females underwent the first In Vitro Fertilization procedure

Background: Infertility affects married adults, and In Vitro Fertilization (IVF) is an Assisted Reproductive Technology (ART) that can treat it. Women undergoing IVF are more likely to experience depression. There is a need to reduce depression by supporting and advising sufferers. The aim of this study is to evaluate the effect of depression on pregnancy rates among infertile females underwent IVF treatment. Materials and Methods: This observational study analyzed 149 patients attending the infertility center at Kamal Al-Samaraie hospital seeking a chance of a conception. The participants received a traditional hospital protocol. The study assessed depression status using the CES-D (Center for Epidemiologic Studies Depression) scale at the beginning of the IVF cycle. Results: Conclusion: Our findings show that the pregnancy rate was not related to baseline depression of women underwent the first IVF procedure. .

The effect of male factors on embryo morphokinetics: a retrospective analysis of 2726 blastocysts.

Male infertility may influence fertilization rates, embryo morphology, and implantation rates in in vitro fertilization (IVF) cycles. Oocyte competence plays a major role in embryo development, but there is a limited understanding of the connection between sperm quality, embryo development, and morphokinetic parameters using donor oocytes. The study evaluated if sperm quality may influence the morphokinetic parameters in IVF cycles. A retrospective multicentric observational cohort study included 747 ICSI cycles using donor oocytes with fresh or frozen sperm. Embryos were cultured in time-lapse incubators until the blastocyst stage. The population was divided into three groups according to sperm concentration, as control group (> 16 mill/mL), severe oligospermia (0-5 mill/mL), and moderate oligospermia group (5-16 mill/mL). Morphokinetic analysis showed no difference in the time from the 2-cell to 6-cell stage of embryo development. A significant difference was observed on day 3 of embryo development, specifically at the 7-cell stage (t7), severe oligospermia 53.37 ± 9.81, moderate oligospermia 56.95 ± 9.78, and control 55.1 ± 8.85h post-insemination (hpi) (p = 0.024), and 8-cell stage (t8), severe oligospermia 55.41 ± 10.83, moderate oligospermia 61.86 ± 12.38 hpi (p < 0.001), and control 58.61 ± 11.33. Accordingly, the synchrony of the four cleavages going from 4 to 8 cells (s3) was found statistically different among the groups in the severe oligospermia 8.05 ± 9.99, moderate oligospermia 11.66 ± 11.04 hpi, and control 8.55 ± 8.58 (p = 0.009). Morphokinetic time ranges were obtained for t6, t7, t8, and s3 in order to identify the good-quality blastocysts. Poor sperm quality is associated with alterations in morphokinetic parameters on day 3 in IVF cycles with donor oocytes, underlining the important role of spermatozoa during embryo development.

External validation of a fully automated evaluation tool: a retrospective analysis on 68,471 scored embryos.

To externally validate a fully automated embryo classification in in vitro fertilization (IVF) treatments. Retrospective cohort study SUBJECTS: A total of 6,434 patients undergoing 7,352 IVF treatments contributed 70,456 embryos. Embryos were evaluated by conventional morphology and retrospectively scored using a fully automated deep learning-based algorithm across conventional IVF, oocyte donation, and PGT-A cycles. The primary outcomes were implantation and live birth including odds ratios (ORs) from generalized estimating equation (GEE) models. Secondary outcomes were embryo morphology, euploidy and miscarriage. Exploratory outcomes included comparison between conventional methodology and artificial intelligence (AI) algorithm with areas under the ROC curves (AUCs), agreement degree between AI and embryologists, Cohen's Kappa coefficient and relative risk (RR). Implantation and live birth rates increased as the automatic embryo score rose. The GEE model, controlling for confounders, showed the automatic score was associated with an OR of 1.31 (95%CI[1.25-1.36]) for implantation in treatments using oocytes from patients, and an OR of 1.17 (95%CI[1.14-1.20]) in the oocyte donation program, with no significant association in PGT-A treatments. For live birth, the ORs were 1.27 (95%CI[1.21-1.33]) for patients, 1.16 (95%CI[1.13-1.19]) for donors, and 1.05 (95%CI[1-1.10]) for PGT-A cycles. The average score was higher in embryos with better morphology, in euploid embryos compared to aneuploid embryos, and in embryos that resulted in a full-term pregnancy compared to those that miscarried. Concordance between the highest-scoring embryo and the embryo with the best conventional morphology was 71.4%(95%CI[67.7%-75.0%]) in treatments with patient oocytes and 61.0%(95%CI[58.6%-63.4%]) in the oocyte donation program. Overall, the Cohen's Kappa coefficient was 0.63. The automatic embryo score showed similar AUCs to conventional morphology, although implantation was higher when the transferred embryo matched the highest-scoring embryo from each cohort (57.36% vs. 49.98%). RR indicated a 1.14-fold increase in implantation likelihood when the top-ranked embryo was transferred. Fully automated embryo scoring effectively ranked embryos based on their potential for implantation and live birth. The performance of the conventional methodology was comparable to that of the artificial intelligence-based technology; however, better clinical outcomes were observed when the highest-scoring embryo in the cohort was transferred.

Increased miscarriage rate is associated with at least four components of metabolic syndrome in women with polycystic ovary syndrome undergoing in vitro fertilization or intracytoplasmic sperm injection embryo transfer cycle.

This study aimed to investigate the association between the components of metabolic syndrome (MetS) and reproductive outcomes in women with polycystic ovary syndrome (PCOS) undergoing their first in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) embryo transfer cycle. This is a retrospective study that included 720 women with PCOS from January 2018 to December 2021. Anthropometric, biochemical, and reproductive data of the study subjects were collected from electronic medical record. Women with PCOS met <3, 3, and >3 criteria of MetS were classified in group 1, 2, and 3, respectively. The miscarriage rate in women with MetS was significantly higher than that in non-MetS group (23.2% vs. 14.2%, p = 0.03). There was a significant increasing trend in miscarriage rate from group 1 to group 3 (p for trend <0.05). The miscarriage rate in group 3 was significantly higher than that in group 1 (29.3% vs. 14.2%, p < 0.05). Logistic regression analyses showed that women with at least four components of MetS (group 3) were independently associated with a high risk of miscarriage, with the odds ratios and 95% confidence intervals for group 2 and 3 versus group 1 were 1.38 (0.67-2.82) and 2.46 (1.06-5.74), respectively (p for trend = 0.04). PCOS women accompanied with at least four diagnostic criteria of MetS is independently associated with increased miscarriage rate when undergoing their first IVF or ICSI cycle.

Detoxification as a potential intervention for improving in vitro fertilization outcomes: a comparative analysis of failed cycles before and after detox

Objectives: In vitro fertilization (IVF) success rates vary, posing challenges for patients with repeated failed cycles. Environmental toxins, including endocrine-disrupting chemicals, may contribute to IVF failure. Detoxification has emerged as a potential intervention to improve outcomes, but its efficacy remains uncertain. Methods: We conducted a retrospective analysis of data from 65 IVF patients undergoing detoxification at a private fertility clinic in Lagos, Nigeria, between 2020 and 2022. Demographic data, IVF history, and detoxification details were collected. Logistic regression assessed the impact of age and failed IVF cycles on live birth outcomes, with odds ratios calculated. Results: Of 65 patients, 33 achieved a positive pregnancy outcome after detoxification. A significant reduction in failed IVF cycles postdetoxification was observed (P &lt; 0.0001). Logistic regression indicated that older age and more failed IVF cycles were associated with decreased odds of live birth. However, detoxification mitigated this effect, reducing the odds of failed IVF cycles, although not significantly. Conclusion: Detoxification shows promise as an intervention to improve IVF outcomes in patients with repeated failed cycles. By reducing failed IVF cycles and enhancing live birth rates, detoxification may optimize reproductive success. Further research with larger sample sizes is needed to confirm these findings and elucidate underlying mechanisms. Nonetheless, our study highlights the importance of considering environmental factors and adopting holistic approaches to enhance IVF success.

In vitro fertilization-induced extreme hypertriglyceridemia with secondary acute pancreatitis in emergency department: A case report and literature review

Abstract Acute pancreatitis is one of the severe complications of hypertriglyceridemia, which needs to be recognized early to provide appropriate treatment. Hypertriglyceridemia-induced pancreatitis has several causes, in which in vitro fertilization (IVF) is a rare etiology that is becoming increasingly popular. We report a 33-year-old female patient with a history of hypertension who has failed an IVF cycle and started a new IVF procedure 1 month before admission. She was diagnosed with severe triglyceridemia-induced acute pancreatitis with extremely high serum triglycerides (TGs) levels (18,547 mg/dL). We combined plasmapheresis and intravenous (IV) insulin and significantly reduced blood TG over a short time. She was discharged with a TG level of 366.7 mg/dL on the 10th day. It is essential to monitor serum TG levels in plasma before, during, and after this therapy, especially in the 1st month after initiating IVF. Although plasmapheresis combined with IV insulin is not officially recommended for acute triglyceridemia-induced pancreatitis, the therapy can be considered in cases with extremely high serum TG levels.

In-vitro fertilization experience with follitropin-delta in poor responders identified by POSEIDON Classification.

Controlled ovarian stimulation during in-vitro fertilization (IVF) is personalized based on anticipated hyper, normal, poor response. With respect to poor responders, who are often treated using higher gonadotropin dosing and combination of urinary and recombinant gonadotropins (rFSH) with marginal benefit, we report our experience with a newer, more potent rFSH (Follitropin-δ) undergoing IVF. Retrospective analysis of all IVF cycles in which follitropin-δ was used alone or combined with urinary gonadotropins over a 3-year period. Patients were grouped according to the POSEIDON Classification as expected low responders (POSEIDON 3-4; AMH<1.2; N.=45), unexpected low responders (POSEIDON 1-2; retrieval of ≤9 oocytes; N.=67) and those with a normal response (N.=93). Demographic, stimulation (including target number of retrieved oocytes [8 to14]), embryology and clinical outcome parameters (clinical pregnancy rate [CPR], live birth rate [LBR], cumulative live birth rate [cLBR]) were compared. Those categorized as POSEIDON patients were older, had lower ovarian reserve, were more likely to use a mixed protocol, less likely to reach the target oocytes retrieved (35.7% vs. 51.6%, P<0.001), and had a lower cLBR per patient (29.5% vs. 38.7%, P=0.006) when compared to non-POSEIDON patients. Expected low responders (POSEIDON 3-4) were older and had lower AMH when compared to unexpected low responders (POSEIDON 1-2), but no differences in the target of oocytes retrieved (33.3% vs. 37.3%, P=0.66) and cLBR (28.9% vs. 37.3%, P=0.06) were noted. In expected low responders, follitropin-δ can be used to optimize oocyte collection and clinical outcome though one may need to deviate from the algorithm-suggested dose. Future studies should explore stimulation modifications in unexpected low responders.

Pre- and Procedural Factors Influencing the Success of In Vitro Fertilization: Evaluating Embryo Quality and Clinical Pregnancy in Cases of Tubal Factor Infertility.

Introduction: While tubal occlusion is a prevalent cause of infertility, accounting for 11-35% of infertility cases among women, there remains a limited understanding of the factors influencing clinical pregnancy following in vitro fertilization (IVF). Methods: In our retrospective, cross-sectional cohort study conducted at a single tertiary center, medical records of women aged 19 to 43 years were analyzed. Logistic regression models were employed to identify the prognostic factors associated with clinical pregnancy after IVF in patients with tubal factor infertility, excluding cases with hydrosalpinx. Results: Data from 219 women diagnosed with tubal occlusion were compared to 1140 cases with non-tubal indication, covering a total of 1359 IVF cycles. A lower maternal age (adjusted odds ratio [AOR]: 0.89, p = 0.001) and a higher embryo quality (AOR: 1.26, p = 0.01) emerged as important factors in clinical pregnancy in the tubal infertility group. Moreover, a lower maternal (AOR:0.91, p < 0.01) and paternal age (p = 0.001), and favorable semen quality (AOR: 1.32, p = 0.03) were critical determinants in the non-tubal infertility group. BMI was generally higher in tubal infertility patients (p = 0.01). Furthermore, FSH level (AOR: 0.93, p = 0.004), AMH level (p < 0.04), number of embryos transferred (AOR: 2.04, p < 0.001), and embryo quality (AOR: 1.26, p < 0.001) came into prominence only in the non-tubal infertility group. The clinical pregnancy rate (34.2%) of women with tubal occlusion did not differ significantly from those in other forms of infertility undergoing IVF (35.4%). Conclusions: Although tubal infertility is typically anticipated to yield the highest clinical pregnancy rates following IVF, it is crucial to acknowledge that both maternal and paternal characteristics can also significantly impact the outcomes.

The role of microenvironmental factors in the pre-ovulatory oocyte in the pathogenesis of “poor” ovarian response to in vitro fertilization (IVF) programs

Background. The “poor” response to ovarian stimulation during IVF (in vitro fertilization) cycles depends on various factors, including the biochemical composition of the follicle microenvironment. Recent studies have focused on the relationship between vascular tone regulators, angiogenic factors, oxidative stress, and the quality of oocytes. Despite this, there is still no consensus on the exact effect of these factors on folliculogenesis or their role in “poor” responses.Objective. To evaluate the content of biochemical factors and regulators of vascular tone and angiogenesis in follicular fluid in patients with a “poor” ovarian response to stimulation in IVF programs, compared to similar indicators in women with a normal ovarian response.Materials and methods. An open prospective cohort study was conducted, including 56 patients who were part of the IVF program. The criterion for separating the cohort of women was their response to controlled ovarian stimulation during the IVF cycle. Women with a “poor” response (n=32) were placed in the main group, while those with a normal response (n=24) were in the comparison group. Follicular fluid samples from women with a “poor” response were divided into two subgroups based on the presence or absence of an oocyte-cumulus complex in the follicle. The biochemical and soluble regulatory factors in follicular fluid were analyzed in both groups after controlled ovarian stimulation was completed. Statistical analysis of the data was done using methods from variation statistics. A critical level of significance for the differences was set at p ≤0.05.Result. The levels of urea, glucose, high-density lipoprotein, and total antioxidant status (TAOS) in follicular fluid (FF) from patients with a “poor” ovarian response were statistically significantly higher compared to those in the control group. The levels of bilirubin, low-density lipoprotein, and uric acid were also significantly lower in VF from patients in the main group compared to the control group, p&lt;0.05. The indices of vascular endothelial growth factor (VEGF-A) and vascular endothelial growth receptor-2 (VEGFR-2) in FF from women with a “poor” response were significantly lower than those from patients with a normal response, while the levels of endogenous nitric oxide were significantly higher in the former group compared to the latter, p&lt;0.05.Conclusion. The absence of an oocyte-cumulus complex in the pre-ovulatory follicle, which is associated with a “poor” response of the ovary to stimulation, is likely due to a disruption in vascularization processes. This is supported by a decrease in the levels of pro- and anti-angiogenic factors, such as VEGF-A and VEGFR-2.

Outcomes of IVF treatments in women with antiphospholipid antibodies or antiphospholipid syndrome

BackgroundOvulation induction for in vitro fertilization (IVF) may increase intravascular thromboses among patients with antiphospholipid autoantibodies (aPLs) or antiphospholipid syndrome (APS) due to the high estrogen levels. While natural or modified natural IVF treatment cycles (MNC) are sometimes used instead of stimulated cycles with empiric anticoagulant treatment among these infertile patients, their efficacy is unclear. Materials and methodsA retrospective cohort study including all IVF cycles of patients diagnosed with aPLs or APS in a tertiary, university-affiliated hospital between 2012 and 2022. The outcomes of stimulated cycles with anticoagulants and MNC and natural IVF cycle attempts were compared. Results121 oocyte retrievals from 38 women were analyzed: 93 stimulated and 28 MNC or natural IVF cycles. The rates of cycle cancellation (0 % vs. 17.9 %, p < 0.001) and cycles in which no oocytes were retrieved (0 % vs. 43.5 %, p < 0.001) were significantly lower following stimulated cycles vs. natural and MNC. In parallel, positive β-hCG (31.9 % vs. 10.9 %, p = 0.03), clinical pregnancy rate (23.6 % and 3.6 %, p < 0.001) and live birth rates (18.1 % vs. 3.6 %, p = 0.01) were significantly higher following stimulated cycles. No thrombotic events or bleeding occurred in any cycle. ConclusionOvarian stimulation for IVF is more effective for successful pregnancy and delivery than natural cycles and MNC and can be safely undertaken in aPLs or APS women undergoing IVF. Rates of complication from hormonal treatment are not increased when treated with LMWH during ovarian stimulation.

True empty follicle syndrome is a subtype of oocyte maturation abnormalities.

To review the outcomes of in vitro maturation (IVM) and in vitro fertilization (IVF) in women with empty follicle syndrome (EFS). The study evaluated the genetic underpinnings of EFS by analyzing mutations. This retrospective case series involving 17 women with EFS over at least 2 IVF cycles was conducted. The study also employed whole-exome sequencing to analyze the genetic mutations. The treatment approaches included letrozole-primed IVM, follicle-stimulating hormone (FSH)-human chorionic gonadotrophin (hCG)-primed IVM, and conventional IVF. The average female age was 31.5±4.6 years, and the duration of infertility was 7.3±3.5 years. Four patients underwent IVF. IVM oocyte collections yielded oocytes in 12 of 13 subjects. Of these, 75% (9/12) yielded MII oocytes after 48 h of IVM media incubation. Six subjects had fertilized embryos, resulting in a 40.9% intracytoplasmic sperm injection (ICSI) fertilization rate (9 embryos/22 MII oocytes). Genetic analysis revealed mutations in seven patients. This study demonstrated the partial efficacy of letrozole-primed IVM plus growth hormone and FSH-hCG primed IVM protocols. No pregnancies or live births were recorded after IVM. One ongoing pregnancy post-IVF and one spontaneous live birth were observed. Inter-cycle variabilities were observed in women with oocyte maturation abnormalities (OMAs). Almost all patients with EFS had oocytes collected during IVM following IVF. These oocytes have limited potential for maturation, fertilization, and live birth, as demonstrated by the low rates observed after IVM culture and ICSI. These conditions are observed in OMAs due to defects in the oocyte machinery. The proposed flowchart provides a comprehensive classification approach for various forms of EFS.

Decoupling Implantation Prediction and Embryo Ranking in Machine Learning: The Impact of Clinical Data and Discarded Embryos

Automated live embryo imaging has transformed in vitro fertilization (IVF) into a data‐intensive field. Unlike clinicians who rank embryos from the same IVF cycle cohort based on the embryos visual quality and determine how many embryos to transfer based on clinical factors, machine learning solutions usually combine these steps by optimizing for implantation prediction and using the same model for ranking the embryos within a cohort. Herein, it is established that this strategy can lead to suboptimal selection of embryos. It is revealed that despite enhancing implantation prediction, inclusion of clinical properties hampers ranking. Moreover, it is found that ambiguous labels of failed implantations, due to either low‐quality embryos or poor clinical factors, confound both the optimal ranking and even implantation prediction. To overcome these limitations, conceptual and practical steps are proposed to enhance machine learning‐driven IVF solutions. These consist of separating the optimizing of implantation from ranking by focusing on visual properties for ranking and reducing label ambiguity.

Rescue ICSI Improved Cumulative Live Birth Rate for Cycles with Second Polar Body Extrusion Rate

ObjectiveTo determine the indications for early rescue intracytoplasmic sperm injection (ICSI) application. DesignA retrospective cohort study SubjectsThe study included 19,808 patients who underwent conventional in vitro fertilization (IVF) or rescue ICSI for their first cycles between February 2017 and December 2021. ExposureRescue ICSI cycles constituted the study group, where oocytes that had not extruded the second polar body 4-6 hours after insemination were rescued by ICSI. The control group consisted of conventional IVF cycles with no interventions to rescue oocytes without the second polar body. Generalized additive models (GAMs) were constructed to describe the relationship between the second polar body extrusion rate and cumulative live birth rate in conventional IVF and rescue ICSI cycles, respectively. The cutoff value of the second polar body extrusion rate guiding rescue ICSI application was determined from the intersection point of GAMs. Maternal age range applicable to rescue ICSI was further analyzed using the same method. Clinical outcomes were compared between conventional IVF and rescue ICSI cycles across different second polar body extrusion rate and maternal age subgroups. Main outcome measuresThe second polar body extrusion rate and maternal age range for rescue ICSI application, normal fertilization rate, and cumulative live birth rate. ResultsGAMs showed that the cutoff value for the second polar body extrusion rate about rescue ICSI application was 50%. When the rate <50%, normal fertilization rate and cumulative live birth rate (63.7% vs. 46.1%, OR: 1.609, 95% CI: 1.276-2.030) were significantly higher in rescue ICSI cycles than conventional IVF cycles. When the rate ≥50%, rescue ICSI cycles had similar normal fertilization rate and cumulative live birth rate compared to conventional IVF cycles. Further analysis on maternal age in cycles with second polar body extrusion rate <50% released that rescue ICSI cycles showed a higher cumulative live birth rate (67.7% vs. 48.3%, OR: 1.732, 95% CI: 1.361-2.202) than conventional IVF cycles for women aged < 38 years. ConclusionIVF cycles with second polar body extrusion rate <50% in women aged < 38 years was applicable to early rescue ICSI.

Is there any difference in Lactobacillus abundance between age groups during ovarian stimulation in fresh in vitro fertilization (IVF) cycles?

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Aim&amp;lt;/strong&amp;gt; To investigate an influence of age and body mass index (BMI) as determinants of infertility treatment success in vitro fertilization (IVF) procedures confirmed so far, on the amount of &amp;lt;em&amp;gt;Lactobacillus&amp;lt;/em&amp;gt; spp. (LS) and &amp;lt;em&amp;gt;Gardnerella vaginalis&amp;lt;/em&amp;gt; (GV) in the endometrium in fresh IVF cycles at the time of embryo transfer.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Methods&amp;lt;/strong&amp;gt; This a prospective single-centre study included patients who underwent fresh embryo transfer (ET) in a private IVF Centre. A catheter tip for embryo transfer was used for collecting samples from the endometrial cavity. Real time polymerase chain reaction (RT PCR) was used to determine LS and GV quantity. Patients were divided into two age groups: &amp;amp;lt;35 years and &amp;amp;ge;35 years. Normal BMI group included patients with 18.-24.9 kg/m&amp;lt;sup&amp;gt;2&amp;lt;/sup&amp;gt;, and the in-creased BMI group patients with BMI &amp;amp;ge; 25kg/m&amp;lt;sup&amp;gt;2&amp;lt;/sup&amp;gt;.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Results&amp;lt;/strong&amp;gt; Tips for embryo transfer catheters were positive on LS in 55 (96.4%) patients. The median of quantification cycle of RT-PCR (Cq RT-PCR) for LS was 33, and 31 for the younger and older groups, respectively. Twenty-one (36.8%) patients tested positive for GV. The median of Cq RT-PCR for GV was 33 and 34 for the younger and older groups, respectively. There were 36 patients with normal and 18 with increased BMI. BMI showed no correlation with LS amount in the endometrial cavity.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Conclusion&amp;lt;/strong&amp;gt; Aging affects the endome-trial microbiome resulting in an increase of &amp;lt;em&amp;gt;Lactobacillus&amp;lt;/em&amp;gt; number, but not the number of GV.&amp;lt;/p&amp;gt;

Live birth after transmyometrial embryo transfer in a patient with radical trachelectomy

ObjectiveTo report the successful utilization of transmyometrial embryo transfer (TMET) in a patient with a history of radical trachelectomy. DesignVideo article. SettingAcademic fertility center. Subject(s)A 39-year-old, para 1, woman with a history of radical trachelectomy and abdominal cerclage presented with secondary infertility. Her prior pregnancy was conceived naturally. Her first in vitro fertilization (IVF) cycle yielded only one day-7 euploid blastocyst. All attempts at performing mock embryo transfers, cervical dilatation and hysteroscopy were unsuccessful due to absence of clinically identifiable cervical tissue. The euploid embryo was transferred into a gestational carrier; however, this resulted in a biochemical pregnancy. She underwent a second IVF cycle that yielded one day-5 euploid blastocyst. Given her history, TMET was planned. The patient included in this video gave consent for publication of the video and posting of the video online including social media, the journal website, scientific literature websites (such as PubMed, ScienceDirect, Scopus, etc.) and other applicable sites. InterventionTMET using the Towako® catheter. Main Outcome MeasuresImplantation, clinical pregnancy and live birth. ResultsFollowing institutional and Health Canada approval of the Towako® catheter, a transvaginal-ultrasound guided TMET was performed under sedation with intravenous midazolam and fentanyl. The day-5 euploid blastocyst from the second IVF cycle was transferred and the patient’s β-human chorionic gonadotropin (β-hCG) levels 9 and 11 days after TMET were 86 IU/L and 262 IU/L, respectively. A single intrauterine pregnancy with cardiac activity of 119 beats/min was noted at a gestational age of 7 weeks and 2 days. The patient delivered a live singleton at 35 weeks and 2 days weighing 2182 grams. ConclusionTMET is a useful clinical technique for transferring embryos in patients with acquired or congenital cervical issues in whom trans-cervical embryo transfer is either very difficult or impossible.

Twenty-year oncology sperm banking experience at a Canadian academic fertility centre: a retrospective study examining the usage and reproductive outcomes from oncology patients

BackgroundMany cancer treatments pose a threat to fertility for patients. Semen cryopreservation before cancer treatment is an effective method to preserve fertility. There are sparse long-term data on the usage...

Association between pre-gravid body mass index and clinical outcomes in in vitro fertilization: a multicentered retrospective cohort study

BackgroundWith the increasing incidence of obesity and the childbearing-age delay among women, a debate over obesity’s impacts on pregnancy and neonatal outcomes becomes hot. The potential negative effects of obesity and aging on fertility lead to an idea, whether an obese female pursuing IVF treatment can benefit from an ideal BMI achieved over a long-time weight loss process at the cost of aging? We aimed to assess the association between body mass index (BMI) and clinical or neonatal outcomes in patients undergoing in vitro fertilization (IVF) treatment, for answering whether it is necessary to lose weight first for obese patients, particularly those at advanced age.MethodsA retrospective cohort study was performed using multicentered data from China. The women were stratified into 5 groups in terms of pre-gravid BMI (kg/m2) with the WHO obesity standard (group 1: BMI < 18.5; group 2: 18.5 ≤ BMI < 23.0; group 3: 23.0 ≤ BMI < 25.0; group 4: 25.0 ≤ BMI < 30.0; group 5: BMI ≥ 30.0). The primary outcome was cumulative live birth rate (CLBR), and other clinical and neonatal outcomes were weighed as secondary outcomes. Multivariate logistic regression analyses were carried to evaluate the association between BMI and the CLBR, or between BMI and some neonatal outcomes. Furthermore, we implemented a machine-learning algorithm to predict the CLBR based on age and BMI.ResultsA total of 115,287 women who underwent first IVF cycles with autologous oocytes from January 2013 to December 2017 were included in our study. The difference in the CLBR among the five groups was statistically significant (P < 0.001). The multivariate logistic regression analysis showed that BMI had no significant impact on the CLBR, while women’s age associated with the CLBR negatively. Further, the calculation of the CLBR in different age stratifications among the five groups revealed that the CLBR lowered with age increasing, quantitatively, it decreased by approximately 2% for each one-year increment after 35 years old, while little difference observed in the CLBR corresponding to the five groups at the same age stratification. The machine-learning algorithm derived model showed that BMI’s effect on the CLBR in each age stratification was negligible, but age’s impact on the CLBR was overwhelming. The multivariate logistic regression analysis showed that BMI did not affect preterm birth, low birth weight infant, small for gestational age (SGA) and large for gestational age (LGA), while BMI was an independent risk factor for fetal macrosomia, which was positively associated with BMI.ConclusionsMaternal pre-gravid BMI had no association with the CLBR and neonatal outcomes, except for fetal macrosomia. While the CLBR was lowered with age increasing. For the IVF-pursuing women with obesity plus advanced age, rather than losing weight first, the sooner the treatment starts, the better. A multicentered prospective study with a large size of samples is needed to confirm this conclusion in the future.

Clinical data-based modeling of IVF live birth outcome and its application

BackgroundThe low live birth rate and difficult decision-making of the in vitro fertilization (IVF) treatment regimen bring great trouble to patients and clinicians. Based on the retrospective clinical data of patients undergoing the IVF cycle, this study aims to establish classification models for predicting live birth outcome (LBO) with machine learning methods.MethodsThe historical data of a total of 1405 patients undergoing IVF cycle were first collected and then analyzed by univariate and multivariate analysis. The statistically significant factors were identified and taken as input to build the artificial neural network (ANN) model and supporting vector machine (SVM) model for predicting the LBO. By comparing the model performance, the one with better results was selected as the final prediction model and applied in real clinical applications.ResultsUnivariate and multivariate analysis shows that 7 factors were closely related to the LBO (with P < 0.05): Age, ovarian sensitivity index (OSI), controlled ovarian stimulation (COS) treatment regimen, Gn starting dose, endometrial thickness on human chorionic gonadotrophin (HCG) day, Progesterone (P) value on HCG day, and embryo transfer strategy. By taking the 7 factors as input, the ANN-based and SVM-based LBO models were established, yielding good prediction performance. Compared with the ANN model, the SVM model performs much better and was selected as the final model for the LBO prediction. In real clinical applications, the proposed ANN-based LBO model can predict the LBO with good performance and recommend the embryo transfer strategy of potential good LBO.ConclusionsThe proposed model involving all essential IVF treatment factors can accurately predict LBO. It can provide objective and scientific assistance to clinicians for customizing the IVF treatment strategy like the embryo transfer strategy.

P-793 New approaches for treating diminished ovarian reserve: MSC-derived extracellular vesicles and autologous platelet rich plasma

Abstract Study question Does intraovarian injection of MSC-Derived Extracellular Vesicles (EVs) and autologous platelet rich plasma (PRP) improves the outcome of IVF in women with Diminished Ovarian reserve? Summary answer EVs and PRP therapies increse Antral follicle count (AFC), lower FSH level and result in higher amount of mature oocytes and blastocysts What is known already Diminished ovarian reserve (DOR) and premature ovarian insufficiency (POI) are significant impediments to the success of in vitro fertilization (IVF). Current strategies for ovarian stimulation primarily affects only the growth of antral follicles. Even in scenarios where ovarian ovulatory function is compromised, a reservoir of dormant follicles persists, which could potentially be activated by stem cells. Mesenchymal stem cells (MSCs), owing to their multipotent differentiation capabilities and paracrine signaling properties, have emerged as leading candidates for innovative therapeutic approaches. Recent scientific inquiries have highlighted the paracrine impact of EVs secreted by stem cells, underscoring their prospective therapeutic relevance. Study design, size, duration This prospective interventional study was conducted at the V.I. Kulakov Scientific Research Center for Obstetrics, Gynecology, and Perinatology in Russia. It involved 60 infertile female participants aged 20 to 38 years, each with DOR and a history of at least two unsuccessful IVF cycles. These participants were enrolled in the study during their subsequent IVF cycle. Prior to inclusion, all patients provided written informed consent. Participants/materials, setting, methods Patients in group 1 (n = 30) received treatment with exosomes derived from human umbilical cord mesenchymal stem cells (HUC-MSCs-Exos) prior to initiating their in vitro fertilization (IVF) cycle. In contrast, participants in group 2 (n = 30) underwent intraovarian therapy with autologous platelet-rich plasma (PRP) in preparation for their IVF cycle. The comparative analysis encompassed antral follicle count (AFC), anti-Müllerian hormone (AMH) levels, follicle-stimulating hormone (FSH) levels, ovarian stimulation outcomes, and the primary characteristics of oogenesis and embryogenesis. Main results and the role of chance After transplantation of EVs and PRP the ovarian function-related hormone levels and the AFC returned to nearly normal parameteres.Meanwhile, after exosomal treatment the improvement in reproductive outcomes was more significant. FSH concentration was significantly different before and 30 days after the procedure in both groups. In group 1 FSH values were less than the initial data In 95% of cases, in group 2 – in 72% of cases. AMH levels did not change significantly in both groups. The AFC increased in group 1 compared to group 2. All Patients underwent an IVF antagonist cycle after 3 months from the treatment. The number of obtained oocytes in group 1 ranged from 2 to 8, MII from 1 to 6; in group 2: from 0-5, MII – 0-5. The number of blastocysts in group 1 ranged from 1 to 5, in group 2 – from 0 to 3. In group 1, pregnancy occurred in 9 patients (30%): 1 women ( 3,3%) conceived spontaneously in the cycle of procedures, 8 (26,7%) attempted IVF, in group 2 pregnancy occurred in 4 patients (13,3%): 4 attempted IVF. EVs and PRP injections improve outcomes of IVF results in women with low ovarian reserve. Limitations, reasons for caution Limitations may include the fact that the study is single-center and has a rather small amount of patients enrolled in the study. Fundamental approaches to further research in this area are also required to better understand the obtained results. Wider implications of the findings EVs and PRP therapies appear to enhance ovarian reserve metrics and the success rates of IVF programs in patients with DOR. The clinical implementation of these interventions may offer improved reproductive prospects for patients whose sole option was previously oocyte donation. Trial registration number 121040600410-7

P-573 Reframing reproductive odds: live birth rate in women with undetectable or negligible anti-mullerian hormone (AMH) levels

Abstract Study question what is the Live birth rate in women with undetectable or negligible AMH levels ? Summary answer Based on our findings, we suggest considering IVF for twith undetectable or negligible AMH levels. What is known already The reproductive outcomes of women with undetectable or negligible AMH levels have not been well studied. Nevertheless, it is widely believed that females with extremely low AMH levels may have difficulty conceiving and may experience early menopause. An undetectable AMH value is indicative of an ovarian reserve similar to that of a 44-year-old woman. It is important to note that fertility is not solely determined by AMH levels and that other variables, such as age, can also have an impact. Study design, size, duration This study was a retrospective cohort design. Data were collected from October 2009 to April 2022, and included 81 consecutive female participants aged 24 to 43 years with undetectable or negligible levels of AMH who had previously experienced a failed in vitro fertilization (IVF) cycle due to poor ovarian response. The participants were given DHEA after at least one failed IVF cycle, The primary outcome measure was live birth rate (LBR). Participants/materials, setting, methods The study participants were divided into two groups based on AMH levels. Group A had undetectable AMH equivalent to &amp;lt; 0.14 ng/ml (For SI units &amp;lt;1 pmol/L), and group B had negligible AMH levels between 0.14 ng/ml and 0.5 ng/ml (For SI units; 1 pmol/L to 3.6 pmol/L) as defined by Tocci et al. (2009). Both groups underwent IVF, and if the cycle failed, women received DHEA before next IVF cycle. The Primary outcome was LBR. Main results and the role of chance The study, which was conducted from October 2009 to April 2022, analysed a total of 81 cycles, with 41 in Group A and 40 in Group B. There were no significant differences in patient characteristics between the two groups. The overall spontaneous pregnancy rate was 17% (7/41) for women in Group A and 7.5% (3/40) for women in Group B, who received DHEA while waiting to start their next IVF cycle. All pregnancies resulted in live births. Additionally, one case in Group A converted from IVF to IUI and also resulted in a live birth. The overall LBR per woman and per embryo transfer (ET) were 53% (43/81) and 62.3% (43/69) respectively. The LBR per started cycle for Group A and Group B was 51.2% (21/41) and 55% (22/40) (p = 0.12), respectively. The LBR per ET for Groups A and B were 60% (21/35) and 64.7% (22/34) (p = 0.16), respectively. The rate of first trimester miscarriages was similar in both groups. The sub-analysis of patient age showed that the overall LBR for women under 37 years old was 44.4% (36/81) and 55.5% (45/81) for women aged 37 years old and above. The cycle cancellation rate was 14.81% (12/81). Limitations, reasons for caution The small sample size and the study’s retrospective design may introduce bias. Additionally, during the 12 years of the study period, AMH measurement techniques have changed. These limitations should be taken into account when interpreting the results. Further research is needed to establish the cost-effectiveness of these findings. Wider implications of the findings The presence of undetectable or negligible AMH levels should not automatically exclude the use of assisted reproductive technology. Supplementation with DHEA and a tailored ovarian stimulation protocol may improve reproductive outcomes in these cases and should be considered before resorting to oocyte donation. Trial registration number Not Applicable