In Vitro Fertilization-embryo Transfer Cycles Research Articles

Effectiveness of double ABCX-based psychotherapy for psychological distress among women undergoing in vitro fertilization-embryo transfer: a three-arm randomized controlled trial

ObjectiveThis study aimed to evaluate the effectiveness of double ABCX-based psychotherapy for psychological distress during in vitro fertilization-embryo transfer (IVF-ET) among a female group (FG), couple group (CoG) and control group (CG).MethodsA total of 201 women undergoing their first IVF-ET cycle were randomized into three groups. The 6-session intervention was delivered at each visit to the IVF clinic. The primary outcomes were depression and anxiety, and the secondary outcomes included sleep quality, serum cortisol (nmol/L) levels and the clinical pregnancy rate, which were assessed before and after the intervention.ResultsThe group-by-time effects were significant for depression, anxiety, sleep quality and serum cortisol levels, with larger effect sizes in the FG than in the CoG. There was no significant difference in the pregnancy rate among the three groups.ConclusionPsychotherapy effectively mitigated psychological distress, suggesting greater effectiveness for couples undergoing IVF couples than for women only. It is structured and easy to use during the IVF treatment cycle.Trial registration numberhttps://register.clinicaltrials.gov (NCT03931187, retrospectively registered on April 23, 2019)

Effect of Elevated Progesterone Levels on hCG Trigger Day on Clinical Pregnancy Outcome in Short-Acting GnRHa Downregulated Cycles.

Previous studies suggested higher serum progesterone (P) levels were strongly associated with a lower clinical pregnancy rate (CPR) for in vitro fertilization-embryo transfer (IVF-ET). However, the effect of increased serum P levels on the day of human chorionic gonadotropin (hCG) administration on clinical outcomes in short-acting gonadotropin-releasing hormone agonist (GnRHa) downregulated IVF-ET cycles remains unclear. We conducted a retrospective cohort study from January 2017 to December 2021, which included a total of 1664 patients receiving their first short-acting GnRHa IVF-ET cycles at our reproductive medicine centre of Nanjing Drum Tower Hospital. The smooth curve fitting and interaction analysis were employed to analyse the association between the CPR and the serum P levels with different embryo types (cleavage-stage embryo or blastocyst). In addition, total cycles were grouped according to different P levels on the trigger day of hCG administration for further analysis. The CPR of patients with increased serum P level (higher than 1.5 ng/mL) on the hCG day did not decrease. A smoothing curve fitting showed that the CPR did not change obviously with the increase in serum P levels. Subgroup analysis of different types of embryos transferred showed that no correlation was observed between the CPR and serum P levels on the day of hCG administration in cleavage-stage embryo transfer cycles. However, the CPR of patients receiving blastocyst transfer showed a downward trend with the increase in serum P levels. At the same time, an interaction analysis also confirmed that the CPR of blastocyst transfer was more likely to be affected by elevated serum P levels on the hCG day. In the luteal phase short-acting GnRHa downregulated IVF-ET cycles, the elevated serum P levels on the hCG day did not affect the CPR of cleavage-stage embryo transfer but reduced the CPR of blastocyst transfer.

#139 : Outcomes of IVF-ET in Overweight/Obese and Normal-Weight Women with PCOS

Background and Aims: Overweight/obese women with polycystic ovary syndrome (PCOS) have poorer pregnancy outcomes, compared to normal-weight women. Body mass index (BMI) is a risk factor of in vitro fertilization-embryo transfer (IVF-ET). This study is to compare the outcomes of IVF-ET between the overweight/obese and normal-weight women with PCOS. Method: We performed a retrospective cohort study in a large reproductive center of a university hospital. The participants were the women with PCOS who underwent IVF-ET. We compared live birth, miscarriage and other clinical outcomes between the women with BMI ≥25 (overweight/obese group) and 18≤BMI<25 (normal-weight group). Results: We included 3733 women with PCOS who underwent the first IVF-ET cycle from Jan 2016 to Dec 2020. 1693 of them were overweight/obese and had longer stimulation days and more doses of gonadotropins, while less numbers of oocytes retrieved and good quality embryos. Live birth rates were significantly lower in overweight/obese women, compared with normal-weight women (29.8% vs. 36.2%, OR 0.8 (0.7, 0.9)). Clinical pregnancy rates were significantly lower (38.5% vs. 43.0%, OR 0.8 (0.7, 0.9)). Miscarriage rates were significantly higher in overweight/obese women, compared with normal-weight women (21.5% vs. 14.6%, OR 1.6 (1.2, 2.1)). Multivariate logistic regression analysis showed BMI was an independent risk factor. Conclusion: Overweight/obese women with PCOS had poorer outcomes of IVF-ET, compared to normal-weight women with PCOS.

#132 : Outcomes and Related Risk Factors of Heterotopic Pregnancy in IVF-ET Cycles

Background and Aims: In vitro fertilization-embryo transfer (IVF-ET) has demonstrated significant success in treating infertility, but it can also introduce complications and risks such as heterotopic pregnancy (HP), which can lead to ectopic pregnancy rupture and bleeding, potentially endangering the patient’s life and fertility. This study aims to investigate the outcomes and associated risk factors of HP following IVF-ET, providing clinical insights for HP treatment. Methods: A retrospective analysis was conducted on the clinical data, treatment, and pregnancy outcomes of patients with HP after IVF-ET admitted to First Hospital of Lanzhou University from Jan. 2012 to Dec. 2022. Statistically significant risk factors were identified and subjected to logistic regression analysis. Results: Our data revealed a HP incidence of 1.27%. Among the 66 patients with HP, 5 underwent conservative treatment (7.58%, 5/66) with a live birth rate of 25.00% (1/5). Laparoscopic surgery was performed on 61 cases (92.42%, 61/66), with a live birth rate of 77.05% (47/61). Among patients receiving laparoscopic surgery, 49.18% (30/61) had a history of pelvic surgery, 39.34% (24/61) underwent a fresh IVF cycle, and 60.66% (37/61) had a freeze-thaw cycle. The live birth rate was 83.67% (41/49) for those with a visible fetal germ and 85.37% (35/41) for those with a visible fetal heartbeat prior to surgery. Further logistic regression analysis revealed that the average diameter of the intrauterine gestational sac prior to laparoscopic surgery, the absence of a fetal germ and fetal heartbeat within the intrauterine gestational sac, and an extended duration of laparoscopic surgery were risk factors affecting pregnancy outcomes (P<0.05). Conclusion: The incidence of HP in IVF-ET is much higher than in natural conception. Laparoscopic surgery is an effective treatment for HP, which does not seem to impact the ongoing pregnancy and live birth rates of the intrauterine gestational sac. However, the patient’s pregnancy outcome can be influenced by several factors, such as the average diameter and development of the intrauterine gestational sac prior to surgery, as well as the duration of the surgery.

Adverse impact of elevated progesterone levels on human chorionic gonadotropin trigger day on blastocyst transfer outcomes in gonadotropin-releasing hormone agonist cycles

ObjectiveDose an elevated serum progesterone (P) level on the human chorionic gonadotropin (hCG) trigger day have a negative effect on clinical pregnancy outcomes for embryos transferred at different stages of development in long-acting gonadotropin-releasing hormone agonist (GnRHa) in vitro fertilization-embryo transfer (IVF-ET) cycles? Study designThis was a noninterventional, retrospective, observational, single-centre cohort study. A total of 1951 patients received long-acting GnRHa for pituitary downregulation in IVF-ET cycles at Nanjing Drum Tower Hospital from January 2018 to December 2020. The serum P levels on the day of hCG administration were measured, together with other cycle parameters, to explore the relationship between P levels and the clinical pregnancy rate (CPR) of different embryos transferred. ResultsWhen the serum P level on the hCG day was higher than 1.5 ng/mL, the CPR did not decrease significantly. There was no correlation between the CPR of cleavage-stage embryo transfer and the serum P level on the hCG day. In addition, the interaction analysis suggested that the CPR of patients undergoing blastocyst transfer decreased as serum P levels on the hCG day increased. Progesterone levels on the day of hCG administration were closely related to the CPR of blastocyst transfer rather than cleavage-stage embryo transfer. ConclusionAn increased serum P level on the day of hCG administration did not affect the CPR of cleavage-stage embryo transfer, but it reduced the CPR of blastocyst transfer cycles.

Development and Validation of Prediction Model for High Ovarian Response in In Vitro Fertilization-Embryo Transfer: A Longitudinal Study.

Objective To develop and validate a prediction model for high ovarian response in in vitro fertilization-embryo transfer (IVF-ET) cycles. Methods Totally, 480 eligible outpatients with infertility who underwent IVF-ET were selected and randomly divided into the training set for developing the prediction model and the testing set for validating the model. Univariate and multivariate logistic regressions were carried out to explore the predictive factors of high ovarian response, and then, the prediction model was constructed. Nomogram was plotted for visualizing the model. Area under the receiver-operating characteristic (ROC) curve, Hosmer-Lemeshow test and calibration curve were used to evaluate the performance of the prediction model. Results Antral follicle count (AFC), anti-Müllerian hormone (AMH) at menstrual cycle day 3 (MC3), and progesterone (P) level on human chorionic gonadotropin (HCG) day were identified as the independent predictors of high ovarian response. The value of area under the curve (AUC) for our multivariate model reached 0.958 (95% CI: 0.936-0.981) with the sensitivity of 0.916 (95% CI: 0.863-0.953) and the specificity of 0.911 (95% CI: 0.858-0.949), suggesting the good discrimination of the prediction model. The Hosmer-Lemeshow test and the calibration curve both suggested model's good calibration. Conclusion The developed prediction model had good discrimination and accuracy via internal validation, which could help clinicians efficiently identify patients with high ovarian response, thereby improving the pregnancy rates and clinical outcomes in IVF-ET cycles. However, the conclusion needs to be confirmed by more related studies.

Analysis of the levels of hope and influencing factors in infertile women with first-time and repeated IVF-ET cycles

PurposeTo explore the hope levels and influencing factors in infertile women undergoing first-time and repeated in vitro fertilization-embryo transfer (IVF-ET) cycles.MethodsThis study was a cross-sectional and convenient sampling study conducted among patients undergoing IVF-ET from January to June 2019. Patients were divided into first-time and repeated groups by the number of IVF-ET cycles, and then a questionnaire survey was administered. The questionnaire included demographic information, Herth hope index (HHI) scale, Locke-Wallace short marital-adjustment test scale and social support rating scale. Multiple linear regression was used to analyse the influencing factors associated with hope levels.ResultsA total of 298 IVF-ET patients were recruited for the study, including 150 (50.3%) in the first-time cycle group and 148 (49.7%) in the repeated cycle group. The HHI score of the repeated cycle group was significantly lower than that of the first-time cycle group (34.4 ± 3.5 vs. 37.5 ± 3.7, P < 0.001). Multiple linear regression analysis indicated that repeated IVF-ET and age were independently negatively correlated with HHI, with standardized coefficient β values of − 0.895 and − 0.223, respectively (both P < 0.001). High education level (P = 0.002), high monthly income (P = 0.020), high degree of short marital-adjustment test (P < 0.001) and social support rating (P < 0.001) were independently positively correlated with HHI.ConclusionInfertile women undergoing repeated IVF-ET have low hope levels. Maintaining a good marriage adjustment and establishing a good social support and relationship network could effectively improve their hope levels.

THE CORRELATION BETWEEN OBESITY AND THE PREGNANCY OUTCOMES IN FRESH EMBRYO TRANSFER CYCLE

To evaluate the effect of obesity on in vitro fertilization (IVF) outcomes in fresh embryo transfer (ET) cycles, and further investigate the effect of obesity on IVF outcomes in women with polycystic ovarian syndrome (PCOS) undergoing fresh ET. A total of 7663 fresh IVF or Intracytoplasmic sperm injection (ICSI）ET cycles and 760 fresh ET cycles in PCOS patients from January 2010 to December 2019 in the reproductive medicine center of the Sixth Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed. Patients were divided into four groups according to Asian body mass index (BMI) classification: underweight (BMI <18.5kg/㎡), normal weight (BMI 18.5-22.9kg/㎡),overweight (BMI 23-27.4kg/㎡), and obese ( BMI ≥27.5kg/㎡). Patients’ characteristics and pregnancy outcomes were compared among these groups, and multivariate analyses were conducted to determine the effects of BMI on the live birth rate and perinatal outcomes. Compared with overweight women, significantly higher clinical pregnancy rate (CPR), live birth rate (LBR) and small for gestational age (SGA) rate, and lower large for gestational age (LGA) rate were associated with normal weight women (P< 0.05). Multivariate logistic regression analysis showed that whether or not the patients are obese had no correlation with the chance of live birth (OR=0.994,95% CI:0.770-1.283,P=0.962), while the female age was an independent risk factor for LBR（OR=0.920,95% CI:0.905-0.935,P=0.000）. Underweight women had a significantly higher likelihood of SGA (OR=0.497,95% CI: 285-0.869,P=0.014), while overweight women were more likely to give birth to LGA（OR=4.346, 95%CI: 1.330-14.204, P=0.015). There were no correlation between obesity and the LBR, SGA rate and LGA rate in PCOS patients. Female obesity did not correlate with the chance of live birth in fresh ET cycle. A higher chance of SGA was associated with underweight, and obese patients were more likely to give birth to LGA infants. In PCOS patients, the degree of obesity had no effect on the LBR, SGA rate and LGA rate.

Immediate versus delayed frozen embryo transfer in women following a failed IVF-ET attempt: a multicenter randomized controlled trial

BackgroundThe optimal time at which to perform a frozen-thawed embryo transfer (FET) following a failed in-vitro fertilization-embryo transfer (IVF-ET) attempt remains elusive to most reproductive experts. Physicians often delay the introduction of FET due to concerns related to potential residual effects of ovarian hyperstimulation which may interfere with the regular menstrual cycle. Moreover, given that most of the published studies on the topic are retrospective and have inconsistent findings, it is crucial to develop evidence-based randomized control guides for clinical practice. Therefore, this well-designed randomized controlled trial (RCT) was conducted to determine whether it is necessary to delay FET for at least one menstrual cycle after the failure of fresh embryo transfer.MethodsInfertile women eligible for IVF-ET were invited to participate in this multicenter, randomized, non-inferiority, parallel-group, unblinded, controlled trial at the academic fertility centers of four public hospitals in Chinese Mainland. Infertile women scheduled to receive their first FET cycle after a failed IVF-ET attempt were randomly assigned to either (a) the immediate FET group in which FET was performed in the first menstrual cycle following the failed IVF-ET cycle (n = 366) or (b) the delayed FET group in which FET was performed in the second or subsequent menstrual cycle following the failed IVF-ET cycle (n = 366). All FET cycles were performed during hormone replacement cycles for endometrial preparation. The primary outcome was the ongoing pregnancy, defined as a detectable fetal heart beat beyond twelve weeks of gestation. Secondary outcomes were other pregnancy-related outcomes, maternal and neonatal complications. Analysis was performed by both intention-to-treat and per-protocol principles.ResultsA total of 646 FETs were completed. The frequency of moderate to severe depression and high stress level prior to FET in delayed FET group were significantly higher than that in immediate FET group (10.6% vs 6.1%, p = 0.039; 30.3% vs 22.4%, p = 0.022, respectively). Immediate FET resulted in a higher frequency of clinical pregnancy than did delayed FET (41.7% vs 34.1%), for a relative risk (RR) of 1.23 (95% confidence interval [CI], 1.00–1.50; p = 0.045). Women who underwent immediate FET also had a lower frequency of biochemical pregnancy loss (11.7% vs. 30.6%), with a RR of 0.28 (95% CI 0.23–0.63, p < 0.001), and a higher frequency of embryo implantation (25.2% vs. 20.2%), with a RR of 1.25 (95% CI 1.01–1.53; p = 0.038). Although the ongoing pregnancy and live birth rates did not differ significantly between the immediate FET and delayed FET groups (37.1% vs 30.3%, RR 1.22, 95% CI 0.99–1.52, p = 0.067; 36.5% vs 30.0%, RR 1.22, 95% CI 0.98–1.52, p = 0.079, respectively), a multivariate logistic regression analysis adjusted for potential confounders such as depression and stress levels revealed that the immediate FET group had a significantly higher ongoing pregnancy and live birth rates than the delayed FET group (odds ratio 0.68, 95% CI 0.47–0.99, p = 0.041; odds ratio 0.67, 95% CI 0.46–0.96, p = 0.031). The risks of maternal and neonatal complications were comparable between the two groups.ConclusionsIn women with a previous failed IVF-ET attempt, immediate FET resulted in higher ongoing pregnancy and live birth rates than delayed FET. These findings warrant caution in the indiscriminate application of a delayed FET strategy when apparent risk of high stress level is perceived.Trial registrationChiCTR2000033313.

Association between serum oestradiol level on the hCG administration day and neonatal birthweight after IVF-ET among 3659 singleton live births

Oestradiol, an important hormone in follicular development and endometrial receptivity, is closely related to clinical outcomes of fresh in vitro fertilization-embryo transfer (IVF-ET) cycles. A supraphysiologic E2 level is inevitable during controlled ovarian hyper-stimulation (COH), and its effect on the outcome of IVF-ET is controversial. The aim of this retrospective study is to evaluate the association between elevated serum oestradiol (E2) levels on the day of human chorionic gonadotrophin (hCG) administration and neonatal birthweight after IVF-ET cycles. The data of 3659 infertile patients with fresh IVF-ET cycles were analysed retrospectively between August 2009 and February 2017 in First Hospital of Zhengzhou University. Patients were categorized by serum E2 levels on the day of hCG administration into six groups: group 1 (serum E2 levels ≤ 1000 pg/mL, n = 230), group 2 (serum E2 levels between 1001 and 2000 pg/mL, n = 524), group 3 (serum E2 levels between 2001 and 3000 pg/mL, n = 783), group 4 (serum E2 levels between 3001 and 4000 pg/mL, n = 721), group 5 (serum E2 levels between 4001 and 5000 pg/mL, n = 548 ), and group 6 (serum E2 levels > 5000 pg/mL, n = 852). Univariate linear regression was used to evaluate the independent correlation between each factor and outcome index. Multiple logistic regression was used to adjust for confounding factors. The LBW rates were as follows: 3.0% (group 1), 2.9% (group 2), 1.9% (group 3), 2.9% (group 4), 2.9% (group 5), and 2.0% (group 6) (P = 0.629), respectively. There were no statistically significant differences in the incidences of neonatal LBW among the six groups. We did not detect an association between peak serum E2 level during ovarian stimulation and neonatal birthweight after IVF-ET. The results of this retrospective cohort study showed that serum E2 peak levels during ovarian stimulation were not associated with birth weight during IVF cycles. In addition, no association was found between higher E2 levels and increased LBW risk. Our observations suggest that the hyper-oestrogenic milieu during COS does not seem to have adverse effects on the birthweight of offspring after IVF. Although this study provides some reference, the obstetric-related factors were not included due to historical reasons. The impact of the high estrogen environment during COS on the birth weight of IVF offspring still needs future research.

Effect of evaporation-induced osmotic changes in culture media in a dry-type incubator on clinical outcomes in in vitro fertilization-embryo transfer cycles.

ObjectiveThis study investigated whether adding outer-well medium to inhibit osmotic changes in culture media in a dry-type incubator improved the clinical outcomes of in vitro fertilization-embryo transfer (IVF-ET) cycles.MethodsIn culture dishes, the osmotic changes in media (20 µL)-covered oil with or without outer-well medium (humid or dry culture conditions, respectively) were compared after 3 days of incubation in a dry-type incubator. One-step (Origio) and G1/G2 (Vitrolife) media were used.ResultsThe osmotic changes in the dry culture condition (308 mOsm) were higher than in the humid culture conditions (285–290 mOsm) after 3 days of incubation. In day 3 IVF-ET cycles, although the pregnancy rate did not significantly differ between the dry (46.2%) and humid culture (51.0%) groups, the rates of abortion and ongoing pregnancy were significantly better in the humid culture group (1.5% and 49.5%, respectively) than in the dry culture group (8.3% and 37.8%, respectively, p<0.05). In day 5 IVF-ET cycles, the abortion rate was significantly lower in the humid culture group (2.2%) than in the dry culture group (25.0%, p<0.01), but no statistically significant difference was observed in the rates of clinical and ongoing pregnancy between the dry (50.0% and 25.0%, respectively) and humid culture groups (59.5% and 57.3%, respectively) because of the small number of cycles.ConclusionHyperosmotic changes in media occurred in a dry-type incubator by evaporation, although the medium was covered with oil. These osmotic changes were efficiently inhibited by supplementation of outer-well medium, which resulted in improved pregnancy outcomes.

Differential impact of controlled ovarian hyperstimulation on live birth rate in fresh versus frozen embryo transfer cycles: a Society for Assisted Reproductive Technology Clinic Outcome System study

To study the impact of both controlled ovarian hyperstimulation (COH) length and total gonadotropin (GN) dose individually and in concert on live birth rates (LBR) in both fresh and freeze-all invitro fertilization embryo transfer (IVF-ET) cycles. Historical cohort study. Not applicable. The U.S. national database from the Society of Assisted Reproductive Technology Clinic Outcome Reporting System from 2014 to 2015 was used to identify patients undergoing autologous GN stimulation IVF cycles with the use of GnRH antagonist-based suppression protocols where a single embryo transfer was performed as part of a fresh IVF-ET cycle (fresh, n = 14,866) or the first frozen embryo transfer after a freeze-all cycle (frozen, n = 2,964), and not including preimplantation genetic testing cycles. The patients' demographic and cycle characteristics, duration of COH, total GN dose, and pregnancy outcomes were extracted. Binomial regression models estimated trend and relative risk of live birth with respect to days of stimulation and total GN dose singularly, and after adjustment for a priori confounders including age, parity, body mass index, diagnosis, and maximum follicle-stimulating hormone in both fresh and frozen embryo transfer cycles. Both days of stimulation and total GN dose were then added to the multivariate model to show whether they were independently associated with LBR. Not applicable. Live birth rate. In both fresh and frozen cycles, length of COH was significantly associated with total GN dose. On univariate analysis, LBR decreased significantly with increasing length of stimulation and increasing total GN dose in both fresh and frozen cycles. On multivariable analysis including both days of stimulation and total GN dose, days of stimulation was no longer significantly correlated with LBR, whereas total GN dose remained significantly correlated with LBR in fresh cycles only. When total GN doses ranging from <2,000 IU through 5,000 IU to >5,000 IU were compared, a significant improvement in live birth rate was noted with lower total GN doses. Specifically, GN doses <2,000 IU had a 27% higher rate of live birth compared with GN dose >5,000 IU. For GN dose groups up to 4,000 IU, the estimated effect on LBR was similar. There was a marginal improvement (13%) in LBR with GN doses of 4,000 IU to 5,000 IU compared with >5,000 IU. When the multivariate model was applied to the frozen cycles, neither total GN dose nor days of stimulation was significantly associated with LBR. High total GN dose but not prolonged COH is associated with decreasing LBRs in fresh cycles, whereas neither factor significantly affects LBR in frozen cycles. Consideration should be given to minimizing the total GN dose when possible in fresh autologous cycles, either by decreasing the daily dose or by limiting the length of stimulation to improve LBRs. In freeze-all cycles, the use of higher GN doses does not seem to adversely affect the LBR of the first frozen embryo transfer. High total GN dose likely exerts a negative impact on the endometrium and/or oocyte/embryo unrelated to the length of stimulation. The differential effect of total GN dose on LBR in fresh and frozen cycles may imply a greater impact exerted on the endometrium rather than the oocyte.

Association between serum estradiol level on the human chorionic gonadotrophin administration day and clinical outcome.

Background:Estradiol, as an important hormone in follicular development and endometrial receptivity, is closely related to clinical outcomes of fresh in vitro fertilization embryo transfer (IVF-ET) cycles. The aim of this retrospective study was to evaluate the association between elevated serum estradiol (E2) levels on the day of human chorionic gonadotrophin (hCG) administration and IVF-ET pregnancy and birth outcomes.Methods:A total of 1771 infertile patients with their first fresh IVF-ET cycles were analyzed retrospectively between January 2011 and January 2016 in Peking University First Hospital. Patients were categorized by serum E2 levels on the day of hCG administration into six groups: group 1 (serum E2 levels ≤ 1000 pg/mL, n = 205), group 2 (serum E2 levels 1001–2000 pg/mL, n = 457), group 3 (serum E2 levels 2001–3000 pg/mL, n = 425), group 4 (serum E2 levels 3001–4000 pg/mL, n = 310), group 5 (serum E2 levels 4001–5000 pg/mL, n = 237), and group 6 (serum E2 levels > 5000 pg/mL, n = 137). The retrieved oocyte and MII oocyte numbers and implantation and clinical pregnancy rates of the groups were compared as the first objective of the study. For the 360 women with singleton births among all patients, the area under the corresponding receiver operating characteristic curve (ROC curve) was calculated to assess the predictive value of the E2 change for the probability of low birth weight (LBW) infants as the second objective.Results:The retrieved oocyte and MII oocyte numbers and implantation and clinical pregnancy rates gradually increased from groups 1 to 5 but decreased in group 6. The parameters of group 1 were statistically worse than those of the other groups, from group 2 to group 6 (the number of retrieved oocytes, t = 13.096, t = 23.307, t = 23.086, t = 26.376, t = 19.636, P < 0.003; the number of retrieved MII oocytes, t = 10.856, t = 20.868, t = 21.874, t = 23.374, t = 19.092, P < 0.003; the implantation rate, χ2 = 12.179, χ2 = 22.239, χ2 = 23.993, χ2 = 23.344, χ2 = 16.758, P < 0.003; the clinical pregnancy rate, χ2 = 16.415, χ2 = 28.074, χ2 = 35.387, χ2 = 37.025, χ2 = 24.590, P < 0.003). ROC analysis revealed that when a serum peak E2 of 3148 pg/mL was used to predict LBW.Conclusions:The results indicate that serum E2 levels have a concentration-dependent effect on clinical outcomes. The optimal range of the E2 level during a fresh IVF-ET cycle is 1000 to 3148 pg/mL.

Influence of GnRH antagonist in reproductive women on in vitro fertilization and embryo transfer in fresh cycles.

The aim of the present study was to evaluate the influence of a gonadotropin-releasing hormone (GnRH) antagonist compared with a GnRH agonist on in vitro fertilization (IVF) cycle outcome in reproductive women. The characteristics of treatment and outcomes of pregnancy were retrospectively compared between the antagonist (GnRH-A, antagonist group) and agonist (GnRH-a, agonist group) regimens. The area under the curve (AUC) of receiver operating characteristic (ROC) curves was also used to evaluate whether the endometrial thickness (cm), progesterone (P) level (ng/ml) and estradiol (E2) level (pg/ml) on the day of human chorionic gonadotropin (hCG) administration (hCG day) had the ideal sensitivity and specificity for predicting clinical pregnancy. There were no significant differences in the baseline profiles of luteinizing hormone, E2 and P between the GnRH-A and GnRH-a groups (P=0.646, 0.224 and 0.119, respectively). However age, body mass index and follicle stimulating hormone (FSH) level significantly differed between the two groups (P<0.001, =0.025 and <0.001, respectively). Regarding treatment, there were significant differences in the stimulation duration (recombinant FSH days of usage), dose of gonadotrophins, E2, and P levels on hCG day, endometrial thickness on hCG day, mean number of total oocytes retrieved, mean number of two pronuclei oocytes, mean number of embryos available and mean number of embryos transferred (all P<0.001). The rate of clinical pregnancy was lower with the GnRH antagonist than with the GnRH agonist (P<0.001). Additionally, the live birth rate in the GnRH-A group was significantly lower than that in the GnRH-a group (P<0.001). The rate of ectopic pregnancy did not differ significantly between the treatment groups (P=0.840). However, the rate of ovarian hyperstimulation syndrome (OHSS) in group GnRH-A was significantly lower than that in group GnRH-a (P=0.039). Therefore, in the present series of patients who underwent IVF embryo transfer cycles, a GnRH antagonist protocol was associated with significantly lower rates of clinical pregnancy and live birth compared with a GnRH agonist protocol; however, the rate of OHSS was significantly lower with GnRH antagonist compared with GnRH agonist. Furthermore, the results of the influence of endometrial thickness on clinical pregnancy, based on the ROC curve (AUC), demonstrated that the AUC was 0.553 [95% confidence interval (CI): 0.521-0.585], and with a cutoff of 9.25 cm, the Youden index [sensitivity-(1-specificity)] was 0.085. The results of the influence of E2 level on hCG day on the clinical pregnancy rate revealed an AUC of 0.613 (95% CI: 0.581-0.644), and with a cutoff of 1,520 pg/ml, the Youden index was 0.184. The results of the influence of P level on hCG day (ng/ml) on the clinical pregnancy rate revealed an AUC of 0.526 (95% CI: 0.494-0.558), and with a cutoff of 0.415 ng/ml, the Youden index was 0.061. These results of the ROC curve analyses demonstrated that neither the endometrial thickness nor the E2 and P levels on hCG day had the ideal sensitivity or specificity for predicting clinical pregnancy.

Serum oxytocin profiles in patients with repeated implantation failure during IVF cycles

Objective: The objective of this study is to investigate the association between oxytocin (OT) levels and repeated implantation failure (RIF) during in vitro fertilization-embryo transfer (IVF-ET) cycles. Methods: Blood samples were collected from 108 women undergoing IVF-ET treatment at the following time points: gonadotrophin (Gn) administration day (Gn Day 0), hCG administration day (hCG Day 0), ET administration day (ET Day 0), and 5 d after ET (ET Day 5). Serum OT and steroid profiles were measured and compared among three groups: Group A included 38 women with a history of RIF, Group B included 41 women who became pregnant following the first fresh ET, and Group C included 29 women who did not become pregnant following the first fresh ET. Results: The OT levels of the three groups at different time points were not significantly different. Serum OT levels were significantly higher on hCG Day 0, ET Day 0, and ET Day 5 than on Gn Day 0, and they were significantly correlated with the estradiol concentration on ET Day 0. Conclusions: RIF patients do not have elevated serum OT levels during IVF-ET cycles.

The application of superb micro-vascular imaging in predicting pregnancy outcome in patients with in vitro fertilization-embryo transfer

Objective To investigate the role of endometrial thickness, uterine artery and spiral artery blood flow parameters, endometrial and subendometrial blood flow on pregnancy outcome in vitro fertilization-embryo transfer (IVF-ET) cycle, compare the difference of the endometrial and subendometrial blood flow typing between the superb micro-vascular imaging (SMI) and power doppler ultrasound (PDUS). Methods Forty-one patients undergoing IVF-ET cycles in our hospital were recruited in this study. Transvaginal color Doppler ultrasound was performed to determine and record endometrial thickness, peak systolic velocity(PSV), end diastolic velocity(EDV), pulse index(PI), resistance index(RI), systolic diastolic ratio(S/D) of uterine artery and spiral artery, and degree endometrial and subendometrial blood flow signals were showed under the two blood flow modes of PDUS and SMI respectively on the day of human chorionic gonadotropin(HCG) injection. The degree of the endometrial and subendometrial blood flow was scored using Applehau classification method. According to the pregnancy outcome, patients were divided into pregnancy group and nonpregnancy group, the difference of the above indicators between the two groups were compared, and the degree of endometrial and subendometrial blood flow under two kinds of blood flow mode were observed. Results ①On the day of HCG injection, patients in pregnancy group had lower RI, PI, S/D of spiral artery than those in the nonpregnancy group (P 0.05). ②On the day of HCG injection, there was significant difference between the pregnant group and nonpregnant group in endometrial and subendometrial blood flow degree with SMI mode (P=0.005). The patients with type Ⅲ in pregnancy group were most (50%). ③The endometrial and subendometrial blood flow typing (β=1.085, OR=1.085, 95% CI=1.040-8.421, P=0.042) of pregnancy group under SMI mode have an independent predictive value. With increased blood flow typing under endometrial and subendometrial blood flow, the higher the possibility of pregnancy in patients. The ROC curve analysis showed that the area under ROC endometrial and subendometrial blood flow typing SMI mode on the HCG day was 0.746(P=0.008). Conclusions SMI is a new and effective type of Doppler ultrasound technique to evaluate the endometrial and subendometrial blood flow in IVF-ET cycle. On the day of HCG injection, the endometrial and subendometrial blood flow typing in SMI mode may predict pregnancy outcomes in IVF-ET cycles, and guide to choose the best embryo transfer time. Key words: Superb micro-vascular imaging; Endometrial receptive; Embryo transfer; Pregnancy outcome

Evaluation of Laparoscopic Intervention versus Ultrasound Guided Aspiration of Bilateral Hydrosalpinges on Endometrial LIF mRNA Expression Level and Pregnancy Outcome after IVF-ET Cycle

Background : Hydrosalpinx is a common gynecological dis­ease. 30% of infertile women undergoing in vitro fertilization-embryo transfer (IVF-ET) have hydrosalpin­x. Leukemia inhibitory factor (LIF) mRNA expression level is lower in the endometrium during the implantation window in the presence of bilateral hydrosalpinges. If the hydrosalpinx is removed, LIF mRNA expression returns to normal values. Objectives: This study was designed to evaluate laparoscopic intervention of bilateral hydrosalpinges versus transvaginal ultrasound guided aspiration on LIF mRNA expression level during implantation window and pregnancy outcome after IVF-ET cycle. Methodology : Sixty patients who had bilateral hydrosalpinges were classified into two groups; 30 women underwent laparoscopic salpingectomy or proximal tubal occlusion and 30 women underwent transvaginal ultrasound guided aspiration. Determination of LIF mRNA expression level in endometrial samples was performed preoperatively and in the 3 rd postoperative cycle. In addition, pregnancy outcome was evaluated in the first IVF-ET cycle. Results: Endometrial LIF mRNA expression level in laparoscopic group significantly increased postoperatively than transvaginal ultrasound guided aspiration group with a significant difference (P=0.03). In addition, there is increased levels in patients undergoing laparoscopic and ultrasound guided aspiration groups after treatment than before with a significant difference (P=0.005) and (P =0.04); respectively. As regards pregnancy outcome, it is more favorable in laparoscopic group than ultrasound guided aspiration with statistically significant difference (P=0.013). Conclusion: Our findings showed that endometrial LIF mRNA expression level was increased and pregnancy outcome was more favorable after laparoscopic inter­vention versus transvaginal ultrasound guided aspiration for treatment of bilateral hydrosalpinges patients. , Egypt

Retrospective analysis of outcomes of selectively or spontaneously reduced multiple pregnancies out of 6 917 in vitro fertilization-embryo transfer pregnancy cycles

Objective: To analyze the effects of fetal reduction in early pregnancy on obstetric and neonatal outcomes of spontaneously or selectively reduced multiple pregnancies produced by in vitro fertilization-embryo transfer (IVF-ET). Methods: Retrospective study of 6 917 clinical pregnancies from IVF-ET cycles, including 754 multiple pregnancies divided into two groups according to the remaining fetus number: reduced singleton group (n=599) and reduced twin group (n=155); and maternal and neonatal outcomes of two groups were compared to primary singleton group (n=3 589) and primary twin group (n=2 574). Results: The rate of pregnancy complication [9.85%(59/599) versus 6.21%(223/3 589)], preterm birth [19.37%(116/599) versus 10.73%(385/3 589)], low birth weight [9.71%(56/577) versus 4.57% (152/3 324)], perinatal death [0.69%(4/577) versus 0.12%(4/3 324)] and malformation [2.95%(17/577) versus 1.02%(34/3 324)] in reduced singleton group were significantly higher than those in primary singleton group (all P<0.01). There were no significant differences between reduced twin group and primary twin group (all P>0.05). In reduced singleton group, birth defect rate was 2.95%, which was higher than those of the other three groups (P<0.05), in this group spontaneous pregnancy reduction accounted for 89.3% (535/599). Conclusions: (1) The rate of pregnancy complication, preterm birth, low birth weight, perinatal death and malformation in reduced singleton group are still higher than primary singletons, suggesting embryo reduction only is a compensated method in multiple pregnancies. Limiting the number of embryos transferred is the essential solution. (2) The rate of birth defect in spontaneous pregnancy reduction group is higher, so prenatal examination should be reinforced in this group.

Urinary triclosan concentrations and early outcomes of in vitro fertilization-embryo transfer.

Triclosan (TCS) exists ubiquitously in the environment. Several in vitro and in vivo studies have demonstrated that TCS exerts endocrine disruptive effects on reproduction, but data from human populations are limited and conflicting. The objective of our study was to investigate whether high urinary TCS concentration is adversely associated with early reproductive outcomes in women undergoing in vitro fertilization-embryo transfer (IVF-ET). This prospective cohort study was conducted from September 2015 to June 2016, including 156 infertile women undergoing their first IVF-ET cycle. Two spot urine samples were collected prior to oocyte retrieval for TCS detection using solid-phase extraction (SPE) and liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS). Linear regression model and binary logistic regression model were used to evaluate the association between urinary TCS concentrations and IVF outcomes. The intake of aquaculture food may have positive influences on urinary TCS concentrations. After adjustment for age, body mass index (BMI), baseline follicle-stimulating hormone (FSH), antral follicle count (AFC) and smoking status, a significant decrease of top quality embryo formation and implantation rate was observed in patients with urinary TCS concentration greater than or equal to the median level (0.045 μmol/mol Cr). We concluded that TCS exposure may exert negative effects during early stages of human reproduction.

GnRH Antagonist Protocol: Is It Effective for Expected Poor Ovarian Responders with Tubal Factor Undergoing IVF?

Background: This study aimed to determine if the gonadotropin releasing hormone (GnRH) antagonist protocol is optimal for expected poor ovarian responders with tubal factor undergoing in vitro fertilization-embryo transfer (IVF-ET). Methods: A total of 341 IVF-ET cycles were retrospectively identified. The following inclusion criteria were applied: age ≥ 40 years and patients with tubal factors. The cycles were divided into two groups: a GnRH antagonist group (157 cycles) and a GnRH agonist group (184 cycles). Results: The duration of stimulation and the total doses of gonadotropin in the GnRH agonist group were significantly more than those in the GnRH antagonist group (P < 0.05). There were significant differences in LH and P values on the hCG measurement days between the two groups (0.91 ± 1.17 vs. 4.82 ± 4.69 U/L and 0.69 ± 0.42 vs. 1.03 ± 0.50 ng/mL, P < 0.05). The implantation rate of the GnRH antagonist group was 12.24%, which was slightly higher than that of the GnRH agonist group (10.10%, P = 0.437). The clinical pregnancy rate of the two groups showed no statistical differences (23.36% vs. 23.03%, P = 1.000). Conclusion: For expected poor ovarian responders, the GnRH antagonist protocol was, to some extent, superior to the GnRH agonist protocol in terms of the implantation and clinical pregnancy rates.