In Vitro Fertilization In Women Research Articles

Fixed versus flexible gonadotropin releasing hormone antagonist protocol in women with polycystic ovary syndrome undergoing in vitro fertilization: An RCT.

Despite the extensive use of the gonadotropin-releasing hormone (GnRH) antagonist protocol in treating infertile women, particularly those with polycystic ovary syndrome (PCOS), there have not been sufficient evidence to compare the flexible and fixed variants in in vitro fertilization (IVF) cycles. This study aims to assess the treatment outcomes of flexible and fixed types of GnRH-antagonist protocol for IVF in women with PCOS. In this randomized clinical trial, 150 infertile women with PCOS, who were candidates for IVF, and referred to the Yazd Research and Clinical Center for Infertility, Yazd, Iran between October 2023 and February 2024 were included. Participants were divided into 2 groups (n = 75/each) based on the type of antagonist protocol (fixed or flexible). GnRH antagonist administration started on the 5 day of gonadotropin treatment in the fixed group. In the flexible group when there was at least one follicle 12-14 mm, GnRH antagonist was started. Finally, the number of metaphase II oocyte, the quality of embryos, the duration of the stimulation cycle, the dose of gonadotropin, the number of GnRH-antagonist, and the rate of ovarian hyperstimulation syndrome were evaluated. No statistically significant difference was observed in terms of cycle length and the total dose of gonadotropin between groups. Nevertheless, a notable distinction was observed in the total number of oocytes (17.84 vs. 15.5, p = 0.023) and mature oocytes (13.64 vs. 11.83, p = 0.019) in the flexible group compared to the fixed group. In conclusion, the IVF outcomes are more favorable in women with PCOS undergoing the flexible GnRH-antagonist protocol compared to the fixed protocol.

Comparison of success rates in early stages of in vitro fertilization (IVF) in women with and without endometriosis

Endometriosis remains a significant challenge for reproductive-aged women and is frequently associated with infertility. Although in vitro fertilization (IVF) is used to address infertility in women with endometriosis, its effectiveness in this context is still debated, particularly in developing countries such as Indonesia, where IVF remains a major challenge. The aim of this study was to investigate the success rates of early stages of IVF in women with and without endometriosis. A retrospective cohort study was conducted at the Graha Amerta Fertility Clinic, located within Dr. Soetomo Academic General Hospital in Surabaya, Indonesia. The quantity and quality of oocytes (the number of oocytes obtained by ovum pick-up (OPU) and the number of metaphase II (MII) oocytes), fertilization quality (the number of two-pronuclei oocytes and fertilization rate), embryo development quality (cleavage rate and blastocyst rate), biochemical pregnancy, clinical pregnancy, and live birth rate were collected from IVF patients between 2017−2022. Independent Student’s t-test or Mann-Whitney test was used accordingly for comparison analysis. A total of 410 IVF patients were included in the study; 93 had endometriosis, while 317 had no endometriosis. Oocyte quantity obtained by OPU (p=0.016) and oocyte quality (p=0.045), as measured by the number of MII oocytes, were significantly lower in the endometriosis group compared to the non-endometriosis group. However, there were no significant differences between the two groups in terms of the number of two-pronuclei oocytes (p=0.105), fertilization rate (p=0.987), cleavage rate (p=0.467), blastocyst rate (p=0.128), biological pregnancy rates (OR: 0.98; 95%CI: 0.60–1.60; p=0.940), clinical pregnancy rate (OR: 0.69; 95%CI: 0.39–1.24, p=0.219), or live birth rate (p=0.609). These findings suggest that while endometriosis may reduce oocyte quantity and quality, it does not significantly impact the success rates of IVF.

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

Effect of weight loss before in vitro fertilization in women with obesity or overweight and infertility: a systematic review and meta-analysis

The effect of weight loss before in vitro fertilization (IVF) procedures on pregnancy outcomes in women with overweight or obesity and infertility remains controversial. In this systematic review and meta-analysis, we investigated whether weight loss before IVF in these women affected the IVF results and reproductive outcomes. PubMed, Embase, and the Cochrane Library databases were searched from the inception dates until December 2022, using combinations of relevant keywords. Only six randomized controlled trials, including 1627 women with obesity or overweight, were analyzed. The weight change in the intensive care group, compared to the control group who underwent IVF without weight loss was – 4.62 kg (mean difference; 95% confidence interval [CI] − 8.10, − 1.14). Weight loss before IVF did not significantly increase the live birth rate in women with obesity or overweight and infertility (odds ratio, 1.38; 95% CI 0.88, 2.10). The clinical pregnancy, miscarriage, ongoing pregnancy, and ectopic pregnancy rates did not differ between the weight loss and control groups before IVF. This meta-analysis demonstrated that even significant weight loss before IVF in women with obesity or overweight and infertility did not improve the live birth, clinical pregnancy, ongoing pregnancy, or ectopic pregnancy rates. PROSPERO Registration Number: CRD42023455800.

Conventional in vitro fertilisation rather than intracytoplasmic sperm injection when only one oocyte is retrieved: Time to overcome irrational fears.

The use of intracytoplasmic sperm injection (ICSI) currently extends beyond male factor infertility, notably replacing conventional in vitro fertilisation (IVF) in scenarios like limited oocyte availability, where it is used as a precaution against complete fertilisation failure. While existing studies on the use of conventional IVF in such situations provide some reassurance, the available evidence is somewhat insufficient and ICSI is commonly used. To evaluate whether conventional IVF can be a feasible option when only one oocyte is retrieved. A retrospective study was performed to evaluate the fertilisation rate with conventional IVF in women retrieving only one oocyte and whose partner had normal semen. The study aimed at evaluating whether the fertilisation rate was aligned with the threshold indicated by recognized IVF laboratory performance indicators (Vienna Consensus). Clinical pregnancy and live birth rates were secondary outcomes. Out of 304 cycles with a single oocyte inseminated with conventional IVF, 209 achieved normal fertilisation and 82 did not. Thirteen had no mature oocytes. The fertilisation rate was 69% (95% CI: 63-74%) and increased to 72% (95% CI: 66-77%) when immature oocytes were excluded. The fertilisation rate surpassed the minimum competency threshold of the Vienna Consensus (60%), even if below the benchmark value (75%). Clinical pregnancy and live birth rates per oocyte retrieval were 10% and 8%, respectively. Univariate and multivariate analyses failed to identify any predictive factor of fertilisation. Conventional IVF with one oocyte met Vienna Consensus standards even if it fell short of higher benchmarks.

Elevated Anti-Müllerian Hormone as a Prognostic Factor for Poor Outcomes of In Vitro Fertilization in Women with Polycystic Ovary Syndrome.

Women with polycystic ovary syndrome (PCOS) tend to have elevated anti-Müllerian hormone (AMH) levels, which appear to correlate with disease severity and pregnancy outcomes. This was a retrospective observational study designed to assess the relationship between circulating AMH levels and in vitro fertilization (IVF) outcomes. The study involved 150 women with PCOS who underwent IVF treatments. The women's IVF cycles were allocated into three subgroups according to AMH levels: 'low' (AMH < 3.7 ng/mL; n = 49), 'middle' (AMH 3.7-7.4 ng/mL; n = 94), and 'high' (AMH > 7.4 ng/mL; n = 56). All pregnancy-related outcomes (positive beta human chorionic gonadotropin (βHCG), clinical pregnancy rate, live birth rate, and cumulative live birth rate) were greater in women's IVF cycles with 'low' AMH when compared to those with 'middle' or 'high' AMH (p < 0.05). AMH levels below 3.7 ng/mL were found to be associated with lower oocyte immaturity rate and better pregnancy outcomes, although baseline AMH was not shown to have any significant predictive power for live birth and cumulative live birth in the multivariable logistic regression analysis after adjusting for possible confounders nor in the ROC analyses. In summary, the current study lays the groundwork to validate high AMH levels as a poor prognostic factor for pregnancy outcomes after IVF in women with PCOS.

Relationship between serum vitamin D levels and pregnancy rate of women with recurrent implantation failure undergoing IVF

Objective: Vitamin D deficiency has been shown to be associated with pregnancy complications due to the effect on implantation. However, the effect of vitamin D on the clinical outcomes of IVF in women with recurrent implantation failure is unclear. Present study aimed to investigate the effect of vitamin D status in recurrent implantation failure (RIF) patients undergoing in vitro fertilization (IVF) cycles. Methods: A cross-sectional study was carried out on 52 women with RIF undergoing IVF treatments from 2018 to 2019. Blood samples were collected from participant after 2 weeks of embryo transfer and then serum 25-OH vitamin D levels were measured using enzyme-linked immunosorbent assay (ELISA) method. Clinical pregnancy and patients’ characteristics were evaluated. Results: The incidence of vitamin D deficiency, insufficiency and sufficiency among the studied population were 7.7%, 73.1% and 19.2%, respectively. Vitamin D levels were significantly associated with clinical pregnancy in patients with ≥30 years old, being overweight, duration of marriage and infertility duration ≥5 years and having history of abortion. By adjusting confounding factors in the multivariate analysis, we found a significant association between vitamin D levels and clinical pregnancy in RIF patients (p=0.007). Conclusion: There is a significant correlation between vitamin D levels and clinical pregnancy rate in RIF woman undergoing IVF. However, more randomized, controlled trials are suggested.

Assessing the Risk of Relapse Requiring Corticosteroids After In Vitro Fertilization in Women With Multiple Sclerosis.

Several studies have shown an increased risk of relapse after in vitro fertilization (IVF) in women with multiple sclerosis (MS), especially when a gonadotrophin-releasing hormone (GnRH) agonist stimulation protocol was used. Our objective was to investigate the risk of relapse after IVF in women with MS, overall and according to stimulation protocol (GnRH agonists vs antagonists), using data from the French national health insurance database. This retrospective cohort study included all women with MS who have benefited from IVF between January 1, 2010, and December 31, 2015, in France. Three-month exposed periods after IVF were compared with unexposed periods before IVF, each woman being her own control. Four outcomes were considered: annualized relapse rate (ARR), proportion of IVF with relapse, difference in the number of relapses "after-before," and the delay from IVF to the first relapse. Relapses were identified by an algorithm based on MS-related hospital admissions and the use of corticosteroid therapy. Stimulation protocols and disease-modifying therapies (DMTs) were identified using drug claims. Zero-inflated Poisson regression models adjusted for age at IVF and the presence of DMT were used. A random effect on women was included because women may undergo multiple IVF procedures. Subgroup analyses by stimulation protocol and IVF outcome (pregnancy or failure) were conducted. A total of 225 women accounting for 338 IVF procedures were included (the mean age at the first IVF 34.6 ± 4.5 years; 36% of women underwent at least 2 IVF procedures during the period). No increase in the risk of relapse after IVF was found overall (before vs after IVF: 0.20 vs 0.18 relapse per patient-year; 7.7% vs 7.1% of IVF with women having at least one relapse) and in subgroups. A lower ARR before and after IVF was observed among women who remained treated until IVF. The maintenance of DMT until IVF seemed to be a determining factor in reducing the risk of relapse. Women with MS should be reassured because we did not show an increased risk of relapse requiring the use of corticosteroid therapy after IVF neither with GnRH agonists nor with GnRH antagonists.

Live Birth Rate in Women with Recurrent Pregnancy Loss after In Vitro Fertilization with Concomitant Intravenous Immunoglobulin and Prednisone.

Pregnancy loss after in vitro fertilization (IVF) is at least as common as after spontaneous conception. Recurrent pregnancy loss (RPL) may often have an immunological background, and it is therefore relevant to test immune-based interventions in these patients. The objective was to investigate the effect of immunotherapy with intravenous immunoglobulin (IvIg) and prednisone (PRS) as concomitant therapy to IVF in women with RPL after earlier IVF treatments. In a cohort study conducted at The Danish RPL Clinic, 41 women with three or more consecutive pregnancy losses after IVF underwent at least one further IVF cycle with concomitant immunotherapy from 2012 to 2017. The immunotherapy with IvIg and PRS was given before embryo transfer and repeatedly in the first trimester when pregnancy was achieved. Fourteen women (34.2%) achieved a live birth after the first embryo transfer with immunotherapy, and a total of 32/41 (78%) achieved a live birth after up to 4 embryo transfers. Baseline characteristics and the presence of autoantibodies were not significantly different among women achieving live birth or not. The observed 34% birth rate in women with RPL after IVF receiving immunotherapy appears higher than the expected 16–19% birth rate without immunotherapy and is similar to findings in a previous cohort from our clinic. Concomitant immunotherapy as described may be a promising intervention for women with RPL after IVF; however, the effect must be tested in a randomized controlled trial.

The Impact of High Circulating Anti-Müllerian Hormone on Endometrial Thickness and Outcome of Assisted Reproductive Technology in Women with Polycystic Ovarian Syndrome: A Cohort Study.

Elevated circulating anti-Müllerian hormone (AMH) in women with the polycystic ovarian syndrome (PCOS) has been found to have a detrimental effect on endometrial function. This may adversely affect the outcome of in vitro fertilisation (IVF) in PCOS women. To investigate the impact of high serum AMH concentrations on endometrial thickness (ET) and the outcome of IVF in women with PCOS. This retrospective cohort study included all PCOS women who underwent fresh IVF\intracytoplasmic sperm injection cycles between January 2016 and December 2021 in one major IVF centre. PCOS diagnosis was based on Rotterdam criteria, and participants were identified from centre database. All women received antagonist protocol. Primary outcomes were trigger-day ET and live birth rate (LBR). Circulating AMH was correlated with ET and ovarian response. AMH levels were compared between women with and without live birth. ET and LBRs were compared between women with AMH <7.0 ng/ml versus those with AMH ≥7.0 ng/ml. The study included 102 PCOS women, of which six were excluded due to poor response (n = 4), hyperresponse (n = 1) or fertilisation failure (n = 1). Of the remaining 96 women, 42 (43.8%) achieved a live birth. There was no statistically significant (P > 0.05) correlation between AMH and ET. Mean ± standard deviation AMH concentration was not significantly (P > 0.05) different between women with live birth (6.5 ± 3.4 ng/ml) and those without (6.5 ± 2.4 ng/ml). High AMH positively correlated with the number of oocytes retrieved, metaphase II oocytes and embryos (P = 0.003, 0.006 and 0.006, respectively). There was no statistically significant (P > 0.05) difference in ET or LBR between women with AMH <7.0 ng/ml (n = 72; ET, 10.7 ± 1.8 mm; LBR, 45.8% [33/72] versus those with AMH ≥7.0 ng/ml (n = 24; ET, 10.8 ± 1.7 mm; LBR, 37.5% [9/24]). High circulating AMH in PCOS women does not seem to negatively affect ET or LBRs during assisted reproductive technology.

BLASTOCYST CULTURE IN IN-VITRO FERTILIZATION IN WOMEN WITH POLYCYSTIC OVARY SYNDROME

Objective: This study aimed to evaluation of formation and development of blastocyst in in-vitro fertilization in women with polycystic ovary syndrome. Methods: Retrospective study on 53 women with PCOS and 52 women with non-PCOS, who underwent in-vitro fertilization with blastocyst culture at Center for Reproductive Endocrinology and Infertility, Hue University of Medicine and Pharmacy Hospital since January 2019 until December 2020. Results: In women with PCOS, ovarian stimulation resulted in a greater number of retrieved oocyte and blastocyst embryos. Study group with PCOS had a statistically significant lower fertilization rate and day-5 embryo rate of 74.8% and 54% compared with those in the control group (84% and 61.2%, respectively). No statistically significant differences were observed in the mature oocyte rate, the good cleavage embryo rate and the pregnancy rate in the group with PCOS compared with the control group. Conclusion: Women with PCOS have higher number of retrieved oocytes after stimulation. The ability to fertilization and quality of blastocyst was lower in the group with PCOS but the potential for implantation and pregnancy rate were similar to the control group after vitrified-warmed embryo transfer. Key words: Polycystic Ovary Syndrome (PCOS), blastocyst, in vitro fertilization, infertility

P–295 Does endometriosis affect oocyte quality? An analysis of 13 627 donor oocyte recipient and autologous IVF cycles

Abstract Study question Does endometriosis affect live birth following donor oocyte recipient versus autologous in vitro fertilisation (IVF) cycle. Summary answer There was no significant difference in the live birth rate (LBR) in women with endometriosis undergoing donor oocyte recipient versus autologous IVF cycle. What is known already For infertile women with endometriosis, IVF is often considered as a treatment option. Lower implantation and pregnancy rates have been observed following IVF in women with endometriosis when compared to tubal factor infertility. It has been debated that lower pregnancy rates following IVF in endometriosis is due to both oocyte quality and the endometrium. To delineate whether endometriosis affects oocyte quality or the endometrium, we planned a study using donor oocyte recipient model where the recipient were women with endometriosis. We compared the LBR after oocyte recipient cycle with autologous IVF in women with endometriosis Study design, size, duration We obtained anonymised dataset of all the IVF cycles performed in the UK since 19991 from the Human Fertilization and Embryology Authority (HFEA). Data from 1996 to 2016 comprising a total of 13 627 donor oocyte recipient and autologous IVF cycles with endometriosis and no other cause of infertility were analysed. Participants/materials, setting, methods Data on all women with endometriosis undergoing fresh or frozen IVF treatment cycles were analysed to compare the LBR between donor oocyte recipient and autologous treatment cycles. Logistic regression analysis was performed adjusting for number of previous IVF cycles, previous live birth, period of treatment, day of embryo transfer, number of embryo transferred, fresh and frozen cycle. Main results and the role of chance There was no significant difference in the LBR in women with endometriosis undergoing donor oocyte recipient fresh cycles compared to women undergoing fresh autologous IVF cycles (31.6% vs. 31.0%; odds ratio, OR 1.03, 99% CI 0.79 – 1.35). After adjusting for confounders listed above, there was no significant difference in LBR in women undergoing donor oocyte recipient fresh cycles versus fresh autologous ART cycles (aOR 1.06, 99% CI 0.79 – 1.42). There was no significant difference in the LBR in women with endometriosis undergoing frozen donor oocyte recipient cycles compared to women undergoing autologous frozen embryo transfer cycles (19.6% vs. 24.0%; OR 0.77, 99% CI 0.47 - 1.25). After adjusting for potential confounders, there was no significant difference in the LBR in women undergoing frozen donor oocyte recipient cycles compared with autologous frozen embryo transfer cycles (aOR 0.84, 99% CI 0.50 - 1.41). Limitations, reasons for caution Although the analysis was adjusted for several potential confounders, there was no information on classification of endometriosis to allow adjustment. Wider implications of the findings: The current study design does not indicate endometriosis has an impact on oocyte quality given that the outcomes in donor oocyte recipient cycles are comparable with autologous IVF cycles. These findings need to be further studied and validated. Trial registration number Not applicable

P-295 Does endometriosis affect oocyte quality? An analysis of 13 627 donor oocyte recipient and autologous IVF cycles

Abstract Study question Does endometriosis affect live birth following donor oocyte recipient versus autologous in vitro fertilisation (IVF) cycle. Summary answer There was no significant difference in the live birth rate (LBR) in women with endometriosis undergoing donor oocyte recipient versus autologous IVF cycle. What is known already For infertile women with endometriosis, IVF is often considered as a treatment option. Lower implantation and pregnancy rates have been observed following IVF in women with endometriosis when compared to tubal factor infertility. It has been debated that lower pregnancy rates following IVF in endometriosis is due to both oocyte quality and the endometrium. To delineate whether endometriosis affects oocyte quality or the endometrium, we planned a study using donor oocyte recipient model where the recipient were women with endometriosis. We compared the LBR after oocyte recipient cycle with autologous IVF in women with endometriosis Study design, size, duration We obtained anonymised dataset of all the IVF cycles performed in the UK since 19991 from the Human Fertilization and Embryology Authority (HFEA). Data from 1996 to 2016 comprising a total of 13 627 donor oocyte recipient and autologous IVF cycles with endometriosis and no other cause of infertility were analysed. Participants/materials, setting, methods Data on all women with endometriosis undergoing fresh or frozen IVF treatment cycles were analysed to compare the LBR between donor oocyte recipient and autologous treatment cycles. Logistic regression analysis was performed adjusting for number of previous IVF cycles, previous live birth, period of treatment, day of embryo transfer, number of embryo transferred, fresh and frozen cycle. Main results and the role of chance There was no significant difference in the LBR in women with endometriosis undergoing donor oocyte recipient fresh cycles compared to women undergoing fresh autologous IVF cycles (31.6% vs. 31.0%; odds ratio, OR 1.03, 99% CI 0.79 – 1.35). After adjusting for confounders listed above, there was no significant difference in LBR in women undergoing donor oocyte recipient fresh cycles versus fresh autologous ART cycles (aOR 1.06, 99% CI 0.79 – 1.42). There was no significant difference in the LBR in women with endometriosis undergoing frozen donor oocyte recipient cycles compared to women undergoing autologous frozen embryo transfer cycles (19.6% vs. 24.0%; OR 0.77, 99% CI 0.47 - 1.25). After adjusting for potential confounders, there was no significant difference in the LBR in women undergoing frozen donor oocyte recipient cycles compared with autologous frozen embryo transfer cycles (aOR 0.84, 99% CI 0.50 - 1.41). Limitations, reasons for caution Although the analysis was adjusted for several potential confounders, there was no information on classification of endometriosis to allow adjustment. Wider implications of the findings The current study design does not indicate endometriosis has an impact on oocyte quality given that the outcomes in donor oocyte recipient cycles are comparable with autologous IVF cycles. These findings need to be further studied and validated. Trial registration number Not applicable

P–633 lifestyle intervention prior to IVF does not improve embryo utilization rate and cumulative live birth rate in women with obesity

Abstract Study question Does lifestyle intervention prior to in vitro fertilization (IVF) improve embryo utilization rate (EUR) and cumulative live birth rate (CLBR) in women with obesity? Summary answer A six-month lifestyle intervention preceding IVF improved neither EUR, nor CLBR in women with obesity. What is known already A randomized controlled trial (RCT) evaluating the efficacy of a low caloric liquid formula diet (LCD) preceding IVF in women with obesity was unable to demonstrate an effect of LCD on embryo quality and live birth rate. In that study, only one fresh embryo transfer (ET) or, in case of freeze-all strategy, the first transfer with frozen-thawed embryos was reported. We hypothesized that any effect on embryo quality of a lifestyle intervention in women with obesity undergoing IVF treatment is better revealed by EUR and CLBR after transfer of fresh and frozen-thawed embryos. Study design, size, duration This is a nested cohort study within an RCT. The LIFEstyle study examined whether a six-month lifestyle intervention prior to assisted reproductive technology (ART) in women with obesity improved live birth rate, compared to prompt ART within 24 months after randomization. In the original study, 577 women with obesity and infertility were assigned to a lifestyle intervention followed by ART (N = 290) or to prompt ART (N = 287) between 2009 and 2012. Participants/materials, setting, methods The first IVF cycle with successful oocyte retrieval was included, resulting in 51 participants in the intervention group and 72 in the control group. EUR was defined as the proportion of inseminated/injected oocytes that could be transferred or cryopreserved as an embryo. Analysis was performed per cycle and per oocyte/embryo. CLBR was defined as the percentage of participants with at least one live birth from the first fresh and subsequent frozen-thawed ET(s). Main results and the role of chance The overall mean age was 31.64 years, and the mean BMI was 35.40 ± 3.21 kg/m2 in the intervention group, and 34.86 ± 2.86 kg/m2 in the control group (P = 0.33). The mean difference of weight change at six months between the two groups was in favor of the intervention group (mean difference in kg: –3.14, 95% CI: –5.73 – –0.56). The median (Q25; Q75) of EUR was 33.3% (12.5; 60.0) in the intervention group and 33.3% (16.7; 50.0) in the control group in the per cycle analysis (adjusted B: 2.7%, 95% CI: –8.6 – 14.0). In the per oocyte/embryo analysis, in total 280 oocytes were injected or inseminated in the intervention group, 113 were utilized (transferred or cryopreserved embryos, EUR = 40.4%); in the control group EUR was 30.8% (142/461). The lifestyle intervention did not significantly improve EUR (adjusted OR: 1.36, 95% CI: 0.94 – 1.98) in the per oocyte/embryo analysis taking into account the interdependency of the oocytes per participant. CLBR was not significantly different between the intervention group and the control group after adjusting for type of infertility (male factor and unexplained) and smoking (27.5% vs 22.2%, adjusted OR: 1.03, 95% CI: 0.43 – 2.47). Limitations, reasons for caution This study is a nested cohort study within an RCT, and no power calculation was performed. The randomization was not stratified for indicated treatment. The limited absolute weight loss and the short duration of the lifestyle intervention might be insufficient to affect EUR and CLBR. Wider implications of the findings: Our data do not support the hypothesis of a beneficial effect of lifestyle intervention on embryo quality and CLBR after IVF in women with obesity. Trial registration number NTR 1530

Бинарная логистическая регрессия как модель прогноза наступления беременности методом экстракорпорального оплодотворения у женщин с трубно-перитонеальном бесплодием

Predicting the onset of pregnancy by in vitro fertilization (IVF) in women with tuboperitoneal infertility is a pressing challenge of modern medicine. Aim: to develop a method for determining the chance of pregnancy by IVF in women with tuboperitoneal infertility, based on the analysis of physiological parameters, using the binary logistic regression. Materials and methods. The object of the study is clinically healthy women before pregnancy and in the first trimester after conception, women with tuboperitoneal infertility before entering the IVF and in the first trimester of gestation, and women with tuboperitoneal infertility and an unsuccessful IVF trial. We analyzed the state of the cardiovascular system and autonomic regulation, adaptive capabilities and height-weight indicators at the first stage of the study. The data were statistically processed using the Microsoft Office and Statistica10 software package. We used the binary logistic regression method to create a model for predicting pregnancy in the second stage. Results. Based on the physiological indicators obtained using logistic regression analysis a mathematical model was built – a formula for assessing the probability of non-pregnancy. Conclusion. The quality of prognosis of the binary logistic regression model was 97.2%. The model can serve as a method for predicting the onset of pregnancy by IVF in women with tuboperitoneal infertility. We recommend this method for use in the work of a practicing physician.

Safety and efficacy of in vitro fertilisation in patients with chronic liver disease and liver transplantation recipients

Chronic liver disease and liver transplantation (LT) can delay both timing and ability of women to conceive. With increased awareness and availability of invitro fertilisation (IVF), the need for accurate counselling is paramount. To date, minimal data exist on outcomes of IVF in patients with chronic liver disease, cirrhosis, or post-LT. We report the largest experience of IVF in women with liver-related subfertility (LRSF). A retrospective analysis was performed on 42 women with LRSF who had undergone 57 IVF cycles between 1990 and2019. Forty-two women with LRSF received IVF; 9 cycles in 6 women with cirrhosis, 14 cycles in 11 women post-LT, and 34 cycles in 25 women without cirrhosis. The main aetiologies of liver disease included HBV, HCV, and autoimmune hepatitis (AIH). Of 57 IVF cycles evaluated, 43 (75%) resulted in successful implantation. Eight (2 post-LT, 3 with cirrhosis, 4 without cirrhosis) resulted in miscarriage. The live birth rate (LBR) was 74% (32/43). Two of 9 (22%) patients with cirrhosis, 4/14 (29%) patients who were post-LT, and 6/34 (18%) patients without cirrhosis had unsuccessful IVF attempts. Nine of 57 (16%) IVF cycles resulted in new liver enzyme derangement during therapy, which improved after treatment completion. Six pregnancies (2 in patients who were post-LT, 4 without cirrhosis) were complicated by obstetric cholestasis (OC). Ovarian hyperstimulation syndrome (OHSS) was rare (n= 3, 7%). One patient with AIH-related cirrhosis decompensated after initiating IVF, warranting discontinuation of therapy. There were no maternal deaths. Three women developed a hypertensive disorder of pregnancy. Half the pregnancies resulted in premature deliveries (range 27-36 weeks). In selected cases, IVF in women with LRSF can be successful. However, patients should be counselled on the potential increased risks of OHSS, OC, and prematurity. Women with liver disease or those who have had a liver transplant can experience difficulties getting pregnant. In this study, we look at whether alternative approaches to achieve pregnancy are harmful in these women. Overall, there were no significant issues with the use of invitro fertilisation in women with liver disease, but they need to be aware of potential risks, such as early delivery of the baby.

Взаимосвязь между уровнями адипокинов, их соотношением в фолликулярной жидкости и результативностью экстракорпорального оплодотворения у женщин с нормальной и повышенной массой тела

Adipokines produced by adipose tissue are involved in the regulation of steroidogenesis and folliculogenesis and affect embryo implantation and endometrial receptivity. As a result, the adipokine levels and their ratio in the follicular fluid can be used to evaluate the effectiveness of the in vitro fertilization (IVF). The aim was to study the effect of the leptin, adiponectin and ghrelin levels and their ratios in the follicular fluid of women with the normal and increased body weight on the effectiveness and outcome of IVF. We studied women with normal body weight who became pregnant (PN, n = 7) or who did not become pregnant (nPN, n = 14) as a result of IVF, and overweight women (BMI > 25 kg/m2), who became pregnant (PO, n = 5) and not pregnant (nPO, n = 19) after IVF. In the PN group, the level of leptin in the follicular fluid was higher than in the nPN group (p < 0.05). In the PO and nPO groups, it did not differ, but was higher than in the groups with normal body weight. In the PN group, the ghrelin level was lower than in the nPN group (p < 0.05), while in the PO and nPO groups it was comparable. The leptin/adiponectin ratio in the PN group was higher than in the nPN group (7.05±0.84 versus 2.97±0.44, p < 0.05), but lower than in the PO (13.80±2.28) and nPO (11.28±1.03) groups. The leptin/ghrelin ratio in the PN group was also higher than in the nPN group (18.46±4.20 vs. 4.07±0.68, p < 0.05), but lower than in the PO (37.46±21.59) and nPO (25.17±3.97) groups. The prognostic significance of the leptin/ghrelin ratio was 25.13 (CI 1.24-509.15, p = 0.035). The adiponectin levels and the adiponectin/ghrelin ratio in the investigated groups did not differ. Thus, the prognostic significance of the leptin and ghrelin levels and the leptin/ghrelin and leptin/adiponectin ratios in the follicular fluid is due to the patient’s body weight and metabolic status. The concentration of leptin and the ratio of leptin/ghrelin in the follicular fluid can be considered as valuable markers for assessing the success of IVF in women with normal body weight.

Effectiveness and safety of in vitro maturation of oocytes versus in vitro fertilisation in women with high antral follicle count: study protocol for a randomised controlled trial

IntroductionIn vitro maturation (IVM) is a potential alternative to conventional in vitro fertilisation (IVF) to avoid ovarian hyperstimulation syndrome (OHSS). This is particularly relevant in women with a high antral...

Oral Health Status and Fertility Treatment Including IVF.

Oral health is extremely important for the general wellbeing of the individual. From a number of research articles, it is established that there is a definitive connection between periodontal health and many systemic diseases, like type II diabetes, cardiovascular diseases and even preterm labor and low birth weight of babies. The significant rate of failure in the treatment of infertility and IVF (in vitro fertilization) even with multiple advancements in the last decade has made scientist take interest in newer parameters of health, an important one among them being periodontal health. From the limited number of studies available on the relationship between periodontitis and reproductive health, it can be inferred that periodontitis can act as a focus of infection leading to bacteremia which can lead to complications in conceiving naturally or through IVF in women. A limited number of studies have also reported an association between male factor infertility (MFI) and dental health status of men. Although more research is needed to understand and explore this connection, this article reviews the current literature available linking poor oral health to infertility and poor outcomes of IVF.

Correlation of fetuin-B concentrations in serum and follicular fluid with outcomes of in vitro fertilization

To investigate the relationship between serum/follicular fluid fetuin B levels and outcome of in vitro fertilization (IVF). Infertility women (28 with low fertilization rates, 44 with normal fertilization rates) receiving IVF in Women's Hospital of Zhejiang University School of Medicine during June and December 2016 were enrolled in the study. Serum/follicular fluid fetuin B levels were measured with ELISA method. Correlations of serum and follicular fetuin B level with fertilization outcome of IVF were analyzed with Pearson correlation coefficient and receiver operating characteristic (ROC) curve. A positive correlation between serum fetuin B and follicular fluid fetuin B levels was observed (r=0.675, P<0.01). Both serum and follicular fluid fetuin B levels in women with low fertilization rates of IVF were lower than those in women with normal fertilization rates[(6.09±1.31) μg/mL vs. (7.13±1.47) μg/mL, t=3.050, P<0.05; (5.13±0.96)μg/mL vs. (6.22±1.33) μg/mL, t=3.755, P<0.01]. ROC analysis showed that the area under curve (AUC) of serum fetuin B level in predicting fertilization rate was 0.832 (95% CI:0.729-0.934, P<0.01), and 6.08 μg/mL could be used as cut-off value. Serum fetuin B level is correlated with follicular fluid fetuin B level, and it may be used for predicting the fertilization outcome of IVF.