In Vitro Fertilization Patients Research Articles

Emerging post-Dobbs liability concerns for providers handling embryos.

This review outlines novel, emerging legal risks for in-vitro fertilization (IVF) providers and patients. This article reviews recent antiabortion legal developments that create novel legal risks to IVF. This article examines new potential liability for the handling or managing of embryos, and threats to safe, efficient, standard-of-care practice of IVF. It reviews established US and international judicial and regulatory frameworks based on scientifically grounded recognition of IVF embryos as deserving of 'special respect', and finds this approach to be an alternative for law and policy makers. Defining life as 'beginning at fertilization' (or 'conception') or otherwise embracing 'embryonic personhood' creates emerging legal vulnerabilities and concerns for IVF patients and professionals who handle embryos and threatens standard-of-care IVF. Internationally and domestically established, scientifically grounded understandings of IVF embryos, rather than religious beliefs, should be the basis for legal frameworks that accord appropriate - but not unlimited - protections to IVF embryos. This article presents this framework as an alternative to the current path being embraced by some US policymakers and courts, as a means of protecting the rights of patients, providers and the families they create.

Regulatory safeguards needed if preimplantation genetic testing for polygenic risk scores (PGT-P) is permitted in Singapore

Singapore, a highly affluent island city-state located in Southeast Asia, has increasingly leveraged new assisted reproductive technologies (ART) to overcome its dismal fertility rates in recent years. A new frontier...

Exploring gonadotropin dosing effects on MII oocyte retrieval in ovarian stimulation.

Ovarian stimulation with gonadotropins is crucial for obtaining mature oocytes for in vitro fertilization (IVF). Determining the optimal gonadotropin dosage is essential for maximizing its effectiveness. Our study aimed to develop a machine learning (ML)model to predict oocyte counts in IVF patients and retrospectively analyze whether higher gonadotropin doses improve ovarian stimulation outcomes. We analyzed the data from 9598 ovarian stimulations. An ML model was employed to predict the number of mature metaphase II (MII) oocytes based on clinical parameters. These predictions were compared with the actual counts of retrieved MII oocytes at different gonadotropin dosages. The ML model provided precise predictions of MII counts, with the AMH and AFC being the most important, and the previous stimulation outcome and age, the less important features for the prediction. Our findings revealed that increasing gonadotropin dosage did not result in a higher number of retrieved MII oocytes. Specifically, for patients predicted to produce 4-8 MII oocytes, a decline in oocyte count was observed as gonadotropin dosage increased. Patients with low (1-3) and high (9-12) MII predictions achieved the best results when administered a daily dose of 225IU; lower and higher doses proved to be less effective. Our study suggests that high gonadotropin doses do not enhance MII oocyte retrieval. Our ML model can offer clinicians a novel tool for the precise prediction of MII to guide gonadotropin dosing.

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

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

Development of a Novel Endometrial Signature Based on Endometrial microRNA for Determining the Optimal Timing for Embryo Transfer.

Though tremendous advances have been made in the field of in vitro fertilization (IVF), a portion of patients are still affected by embryo implantation failure issues. One of the most significant factors contributing to implantation failure is a uterine condition called displaced window of implantation (WOI), which refers to an unsynchronized endometrium and embryo transfer time for IVF patients. Previous studies have shown that microRNAs (miRNAs) can be important biomarkers in the reproductive process. In this study, we aim to develop a miRNA-based classifier to identify the WOI for optimal time for embryo transfer. A reproductive-related PanelChip® was used to obtain the miRNA expression profiles from the 200 patients who underwent IVF treatment. In total, 143 out of the 167 miRNAs with amplification signals across 90% of the expression profiles were utilized to build a miRNA-based classifier. The microRNA-based classifier identified the optimal timing for embryo transfer with an accuracy of 93.9%, a sensitivity of 85.3%, and a specificity of 92.4% in the training set, and an accuracy of 88.5% in the testing set, showing high promise in accurately identifying the WOI for the optimal timing for embryo transfer.

Overcoming poor ovarian response in assisted reproductive technology programs in patients of late reproductive age

Objective: to increase the effectiveness of in vitro fertilization in patients of late reproductive age by optimizing prepregnancy preparation for the IVF program.Materials and methods: The study included 67 patients of late reproductive age with a history of unsuccessful IVF attempts, divided into two groups at the second stage of the study, depending on the volume of prepregnancy preparation: group 1 (33 patients), group 2 (34 patients). The control group (50 patients) were healthy women of reproductive age. Immunohistochemical examination of the endometrium and microbiological examination of the uterine cavity, hormonal status of peripheral blood, study of the concentration of melatonin in peripheral blood and follicular fluid, antioxidant status of follicular fluid, expression of leukemia inhibitory factor (LIF) in the cervical secretion were performed.Results: in patients with age-related dysregulation of the hypothalamic-pituitary-ovarian axis and impaired fertile function, a systemic and local (in follicles) decrease in melatonin levels was revealed. The studied effects of melatonin suggested that its use in patients of late reproductive age with reduced follicular reserve and a "poor" response to ovarian stimulation may increase the effectiveness of in vitro fertilization (IVF).Conclusions: The inclusion in the pre-gravidar preparation of a complex of water-soluble polypeptide fractions of the epiphysis, stimulating the production of endogenous melatonin, made it possible to increase the effectiveness of IVF in patients by an average of 3.1 times according to the criterion of "clinical pregnancy" and 4.1 times according to the criterion of "live birth".

Patient interest in and clinician reservations on polygenic embryo screening: a qualitative study of stakeholder perspectives.

We explored and compared perspectives of reproductive endocrinology and infertility specialists (REIs) and in vitro fertilization (IVF) patients regarding polygenic embryo screening (PES), a new type of preimplantation screening that estimates the genetic chances of developing polygenic conditions and traits in the future. Qualitative thematic analysis of semi-structured interviews with US-based REIs and IVF patients. Clinicians and patients often held favorable views of screening embryos for physical or psychiatric conditions, though clinicians tended to temper their positive attitudes with specific caveats. Clinicians also expressed negative views about screening embryos for traits more frequently than patients, who generally held more positive views. Most clinicians were either unwilling to discuss or offer PES to patients or were willing to do so only under certain circumstances, while many patients expressed interest in PES. Both stakeholder groups envisioned multiple potential benefits or uses of PES and raised multiple potential, interrelated concerns about PES. A gap exists between clinician and patient attitudes toward PES; clinicians generally maintained reservations about such screening and patients indicated interest in it. Clinicians and patients sometimes imagined using PES to prepare for the birth of a predisposed or "affected" individual-a rationale that is often associated with prenatal testing. Many clinicians and patients held different attitudes depending on what is specifically screened, despite the sometimes blurry distinction between conditions and traits. Considerations raised by clinicians and patients may help guide professional societies in developing guidelines to navigate the uncertain terrain of PES.

Ten years of invitro fertilization in Indonesia: Access to infertility care in a developing country.

This research was conducted to assess access to assisted reproductive technologies (ART) and the current status of the invitro fertilization (IVF) program that have been implemented in Indonesia over the last 10 years. We established a retrospective cohort study and descriptive analysis of the current state of access to infertility care in Indonesia. The data were collected from all IVF centers, clinics, and hospitals in Indonesia from 2011 to 2020, including the number of IVF clinics, total ART cycles, retrieved fresh and frozen embryos, average age of IVF patients, IVF pregnancy rate, and causes of infertility. The number of reported fertility clinics in Indonesia has increased from 14 clinics in 2011 to 41 clinics by 2020. As many as 69 569 ART cycles were conducted over the past 10 years, of which 51 892 cycles used fresh embryos and 17 677 cycles used frozen embryos. The leading cause of consecutive infertility diagnosis was male infertility. Nearly half of the women who underwent IVF procedures (48.9%) were under 35 years old. The pregnancy rate outcome of women who underwent IVF ranged from 24.6% to 37.3%. Developments in ART in Indonesia have led to improvements in the ART cycles performed throughout the 10 year period. The identification of key areas that require improvement can provide an opportunity to enhance access to infertility care.

Effect of health education program on knowledge, stress, and satisfaction among infertile women undergoing in vitro fertilization injection

Abstract Background Stress and dissatisfaction are common issues among patients undergoing in vitro fertilization (IVF). The process of IVF can be emotionally and psychologically challenging, leading to stress, anxiety, and depression in patients. This can be exacerbated by factors such as the length of infertility, the uncertainty of the outcome, and the financial burden of treatment. Additionally, the physical demands of the treatment, the side effects of medication, and the fear of failure can contribute to dissatisfaction and emotional strain in IVF patients. This pre-post intervention study design aimed to evaluate the effect of a health education program on knowledge, stress, and satisfaction among 100 infertile women undergoing IVF attending the Woman’s Health Hospital’s infertility outpatient clinic and IVF unit at Assiut University. Knowledge and stress were measured by women’s knowledge about IVF and the perceived stress scale, respectively. The satisfaction was measured using the Scale of Patient Satisfaction about IVF. Results There is a marked improvement in the knowledge of infertile women, with a significant reduction in their stress levels after the health education program. Furthermore, the satisfaction scores of the women who participated in the program improved significantly. Conclusion The health education program demonstrated a positive impact on knowledge, stress levels, and satisfaction among infertile women undergoing IVF. These findings highlight the positive impact of the program on the participants and emphasize the importance of continuous educational programs regarding IVF to improve knowledge, decrease stress levels, and increase their overall satisfaction with the treatment.

Hybrid of Smart System Model to Support the Service of Fertility Doctors in Handling In-Vitro Fertilization Patient Complaints

The majority of In-Vitro Fertilization (IVF) patients immediately call a fertility doctor when they experience different symptoms than usual. However, the high workload makes fertility doctors unable to immediately provide recommendations to handle complaints of IVF patients, while the longer wait for recommendations from fertility doctors will increase the anxiety of IVF patients and high levels of anxiety affect the success rate of IVF programs. The Case-Based Reasoning (CBR) model has lower performance than the modified CBR model, and the CBR model adds to the workload of fertility doctors, namely having to handle the revision stage. To overcome these problems, the CBR model was modified by applying the Chris Case-Based Reasoning (CCBR) similarity formula and combining it with the Rule-Based Reasoning model. The results of performance measurements showed that the accuracy score increased to 47\% and the precision score remained 100\%, so the results of this modification of the CBR model are worthy of being recommended for application to a smart system for handling complaints of IVF patients.

#184 : Dual Triggers of Ovidrel and Buserelin Improves the Outcome of In Vitro Fertilization in Yasmin Fertility Clinic

Introduction: Controlled ovarian stimulation (COS) is a technique used in in vitro fertilization (IVF) to stimulate multiple ovarian follicles at the same time before oocyte retrieval. “Dual triggering” for final oocyte maturation using a gonadotropin-releasing hormone agonist (GnRHa) and human chorionic gonadotropin (hCG) can improve clinical outcomes during in vitro fertilization. We thought that further investigation regarding the efficacy of dual triggers was warranted. In this study, we aim to investigate the outcome of dual triggering in IVF with a combination of a single dose of a GnRH agonist (Buserelin) and rhCG (Ovidrel). Methods: This retrospective study subjected 22 women who underwent IVF with dual triggers of Ovidrel and Buserelin in Yasmin IVF Center, Dr. Cipto Mangunkusumo General Hospital in Jakarta. Demographic data was gathered from paper-based patient treatment medical records. Result: Patients who received dual triggers therapy, the average oocyte obtained in the study sample was 11.83 in women under 35 years old (group 1) and 8.27 in women above 35 years old (group 2). The average of embryo day 3 was (7.29 vs 4.40). The average BMI in our study sample was (21.54 vs 24.60), the duration of infertility average was (6.14 vs 8). For the average blastocyst, fertilization rate, cleavage rate, and blastocyst rate consecutively (4.86 vs 3.07, 66.76 vs 66.18, 101.78 vs 87.83, 83.57 vs 73.90). We found the pregnancy rate was 34,28% (14,28% vs 20,0%) which we assessed based on a positive bHCG result and a P4 value after fresh embryo transfer. No cases of ovarian hyperstimulation syndrome were reported in either group. Conclusion: Dual triggering of Ovidrel and Buserelin may be a useful maturation treatment to maximize the outcome of mature oocytes in IVF patients. However, further investigation will be needed.

#53 : Pregnancy Outcome After Hydrosalpinx Aspiration in In-Vitro Fertilization Cycle

Background and Aims: Hydrosalpinx is a severe manifestation of tubal disease-causing infertility in women. It has an adverse effect on the outcome of in vitro fertilization (IVF), reducing live birth rate (LBR) by 50% compared to other tubal factors. Laparoscopic salpingectomy can effectively improve IVF outcome but is contraindicated in some women. It can also be expensive and is not without complications. Ultrasound-guided hydrosalpinx aspiration is a cheaper, less invasive procedure alternative to salpingectomy. It has been shown to improve clinical and ongoing pregnancy rates compared to patients with no aspiration. However, the published literature on the effectiveness of hydrosalpinx aspiration is equivocal. Method: This retrospective study aimed to evaluate the outcome of minimal stimulation (mild) IVF cycles wherein the women underwent hydrosalpinx aspiration prior to embryo transfer at a private fertility clinic in the Philippines. Results: A total of 98 IVF cycles satisfied the inclusion criteria. The average patient age was 35.22 ± 4.57 and average duration of infertility was 5.87 ± 3.70 years. The biochemical pregnancy rate was 48% and the clinical pregnancy rate was 39.8%. Live birth rate was 35.7%, which is comparable to that of mild IVF patients without hydrosalpinx. There was a negative correlation between patient age and biochemical pregnancy rate, clinical pregnancy rate, and LBR, however, the correlations were statistically insignificant (Pearson correlation, P = 0.081, 0.197, and 0.344, respectively). Binary logistic regression analyses showed that age, infertility type, infertility factor, basal hormone levels, and number of eggs retrieved were not predictive of the success of IVF among the women in the study. Conclusion: Our results show that hydrosalpinx aspiration is a safe and effective option in improving pregnancy and live birth rates in women undergoing mild IVF.

Autologous Platelet-Rich Plasma (PRP) in Infertility-Infusion versus Injectable PRP.

(1) Background: During IVF (in vitro fertilization) procedures, endometrial thickness has a significant role in the success of pregnancy outcomes for embryo transfers. Endometrial thickness, a crucial component of endometrial receptivity, is a contentious issue. The regenerative properties of PRP have been shown in recent research to have positive effects on the endometrium. PRP increases the pregnancy rate in IVF patients with thin endometrium and recurrent implantation failure. In order to demonstrate the efficacy of PRP therapies, this work compares the administration of injectable and infusible PRP during endometrial preparation. (2) Methods: This prospective single-arm control study was conducted at an IVF center in Oradea, Romania. This study included 50 patients; 27 were included in the group with Injectable PRP and 23 in the group with Infusible PRP. The outcome was compared between the two groups, with the primary outcome being the endometrial thickness after the PRP infusion or injection and the secondary outcome being the pregnancy rate in both groups. (3) Results: Patients who were treated with Injectable PRP had a higher pregnancy rate. An improvement in the quality of the endometrium, in terms of thickness, was also observed in the patients who were injected with PRP. (4) Conclusions: Compared to PRP infusions inside the uterus, sub-endometrial PRP injections in frozen embryo transfer methods have a greater pregnancy rate.

What do women undergoing in vitro fertilization (IVF) understand about their chance of IVF success?

How well informed are Australian women who undergo IVF about their chances of having a baby? Only one in four women estimated their individual chance of success with IVF accurately, with most women overestimating their chance. Limited knowledge about infertility and infertility treatment in the general population is well-documented. The few studies that have investigated patients' knowledge about the chance of IVF success suggest that while IVF patients are aware of average success rates, they tend to be unrealistic about their own chance of success. We conducted an anonymous online survey of 217 women who had started IVF since 2018 in Australia. The survey was advertised on social media, enabling women from across Australia to participate. Responses were collected in June 2021. The survey included questions on demographic characteristics and IVF history. It asked what participants thought their chance of having a baby from one IVF treatment cycle was, how they rated their knowledge about chance of success, and about their experience of receiving IVF-related information. Participants' estimations of their chance of success were compared with their chance as calculated by the Society for Assisted Reproductive Technology's (SART) online calculator. Responses to a free-text question about what information women wished they had been given when they started treatment were analysed thematically. Only about a quarter (58/217, 27%) of participants accurately estimated their chance of having a baby within 20% relative to their SART calculated chance, with more than half (118/217, 54%) overestimating their chance. Ninety percent of women indicated that their preferred source of treatment information was a consultation with their doctor, despite less than half (44%) reporting that doctors explained the probability of having a baby with IVF well (mean 5.9/10). In free-text responses, many women also reported that they wished they had been given more realistic information about IVF and their chance of success. The dissemination method precludes calculation of response rate, and it is not possible to know if participants are representative of all women undergoing IVF. Additionally, we only surveyed women undergoing IVF, while those who decided not to have IVF were not included. Therefore, women who overestimated their chance may have been overrepresented. There is also inherent imprecision in the way understanding of chance of success was estimated. The potential impact of recall bias could neither be quantified nor excluded. It is difficult to determine to what extent women's lack of understanding of what is possible with IVF is due to poor information-provision by clinicians and the clinic, and how much can be explained by optimism bias. The finding of poor understanding of personal chance of success amongst women undergoing IVF in Australia requires further investigation to determine potential reasons for this. The findings can be used by clinics to develop strategies for improvement in the information-provision process to ensure that women can make informed decisions about their fertility treatment. This study received no external funding. S.L. is supported by a NHMRC Investigator Grant (APP1195189). R.W. is supported by a NHMRC Investigator Grant (APP2009767). B.W.M. is supported by a NHMRC Investigator Grant (GNT1176437). B.W.M. reports consultancy for Merck and ObsEva and has received research funding and travel funding from Merck. The other authors have no conflicts of interest. N/A.

Efficacy of intracytoplasmic sperm injection in women with non-male factor infertility: A systematic review and meta-analysis.

The use of intracytoplasmic sperm injection (ICSI) has dramatically increased in patients with non-male factor infertility during the last decades. However, whether ICSI provides a significant benefit over invitro fertilization (IVF) in these patients is still controversial. In this study, we aimed to investigate the efficacy of ICSI on reproductive outcomes with non-male factor infertility and to provide updated evidence for clinical practice. We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials from inception to March 2023. Randomized controlled trials (RCTs) comparing the efficacy between ICSI and IVF in patients with non-male factor infertility were included. The main outcomes were the live birth rate (LBR), fertilization rate (FR), and total fertilization failure (TFF). The pooled estimates were calculated using the random-effects models as relative risk (RR) with 95% confidence intervals (CIs). This systematic review and meta-analysis was registered in PROSPERO (CRD42023427004). We included 18 RCTs with 3249 cycles and 30 994 oocytes. The results demonstrated that ICSI reduced the risk of TFF (RR = 0.26, 95% CI: 0.13-0.50, I2 = 58%) and increased FR per oocyte inseminated/injected (RR = 1.14, 95% CI: 1.08-1.20, I2 = 69%), but it did not improve LBR (RR = 1.11, 95% CI: 0.94-1.30, I2 = 0%) or other outcomes compared with IVF. However, the difference in fertilization failure reduction between ICSI and IVF may be explained by different randomization methods (randomization based on patients vs. sibling oocytes). When considering only studies with randomization based on patients, we found no evidence of the difference between the groups (RR = 0.72, 95% CI: 0.48-1.06, I2 = 0%). Furthermore, no differences were observed in subgroup analyses based on other factors, including female age, study period, and controlled ovarian stimulation protocols. Our findings suggest that ICSI leads to no difference in reproductive outcomes compared to IVF in patients with non-male factor infertility. Considering the cost and safety of ICSI, we have no evidence to support the routine use of ICSI in these populations. High-quality RCTs with large sample sizes will be needed to confirm our results and explore clinical and neonatal outcomes.

Pro- and anti-inflammatory cytokines and growth factors in patients undergoing in vitro fertilization procedure treated with prednisone.

Embryo implantation is a key moment in pregnancy. Abnormal production of pro- and anti-inflammatory cytokines, their receptors and other immune factors may result in embryo implantation failure and pregnancy loss. The aim of this study was to determine the profile of selected pro- and anti-inflammatory factors in the blood plasma of patients undergoing in vitro fertilization (IVF) and control women who achieved pregnancy after natural conception. The examined patients were administered steroid prednisone. We present results concern the plasma levels of IFN-ɣ, BDNF, LIF, VEGF-A, sTNFR1 and IL-10. We found that IVF patients receiving steroids differed significantly from patients who were not administered such treatment in terms of IFN-γ and IL-10 levels. Moreover, IVF patients differed in secretion of all tested factors with the fertile controls. Our results indicated that women who secrete at least 1409 pg/ml of sTNFR1 have a chance to become pregnant naturally and give birth to a child, while patients after IVF must achieve a concentration of 962.3 pg/ml sTNFR1 in blood plasma for successful pregnancy. In addition, IVF patients secreting VEGF-A above 43.28 pg/ml have a greater risk of miscarriage or a failed transfer in comparison to women secreting below this value. In conclusion, fertile women present a different profile of pro- and anti-inflammatory cytokines, and growth factors compared to patients with recurrent implantation failure (RIF).

Factors Associated with the Efficacy of Mature Oocyte Production after Dual-Trigger Controlled Ovarian Stimulation using A GnRH Antagonist Protocol.

The number of mature oocytes retrieved plays a significant role in determining embryo development and pregnancy outcomes of in-vitro fertilization (IVF). However, studies investigating factors predictive of the efficacy of mature oocyte production (EMOP) after dual-trigger controlled ovarian stimulation (COS) are rare. This study aims to identify key predictors of EMOP during dual-trigger COS with a GnRH antagonist protocol for IVF. This retrospective cohort study included 359 first-time IVF patients undergoing dual-trigger COS with a GnRH antagonist protocol. EMOP was defined as the ratio of MII oocyte count to antral follicle count (AFC). Based on EMOP results, patients were divided into two groups: Group A (EMOP < 70%; n = 232) and Group B (EMOP ≥ 70%; n = 127). Multivariate logistic regression analysis revealed that day-2 follicle-stimulating hormone (FSH), stimulation duration, and total oocyte count were the most significant predictors of EMOP (p < 0.05; odds ratios: 1.637, 3.400, and 1.530, respectively). Receiver operating characteristic analysis demonstrated that total oocyte count < 9.5 (AUC, 0.782; sensitivity, 76.2%; specificity, 69.2%; p < 0.001), and stimulation duration < 9.5 days (AUC, 0.725; sensitivity, 63.5%; specificity, 66.7%; p < 0.001) significantly predicted EMOP < 70%. Stimulation duration combined with total oocyte count exhibited the highest power in predicting EMOP < 70% (AUC, 0.767; sensitivity, 92.3%; specificity, 42.4%). Stimulation duration combined with total oocyte count was identified as the most important factor associated with the efficacy of mature oocyte production during dual-trigger COS in IVF using a GnRH antagonist protocol.

Progesterone Serum Level on HCG Trigger Day among Frozen Embryo Transfer IVF Patients and Pregnancy Outcomes: A Systematic Review and Meta-Analysis

Abstract: The association between progesterone serum levels on the day of hCG administration and IVF pregnancy outcomes has been the subject of numerous studies and clinical investigations. We aim to conduct a systematic review and meta-analysis to explore the influence of progesterone serum levels on hCG trigger day on pregnancy outcomes in vitro fertilization (IVF) cycles. Through a comprehensive search of the PubMed and Embase databases, eight studies were identified for inclusion. The analysis revealed a risk ratio for live birth rate of 0.91 (95% CI 0.79-1.06), clinical pregnancy rate of 1.01 (95% CI 0.89-1.15), miscarriage rate: 0.98 (95% CI 0.80-1.21), implantation rate 0.81 (95% CI 0.49-1.35), and mean difference for endometrial thickness -0.01 (95% CI -0.16, 0.14). This study showed insignificant progesterone serum levels on the day of hCG administration and IVF pregnancy outcomes. However, the heterogeneity across studies emphasizes the need for larger, standardized investigations to elucidate the nuanced associations between progesterone levels and IVF success. This study contributes to our understanding of the role of progesterone in IVF outcomes and provides a basis for future research to optimize fertility treatment protocols.

Estradiol serum level on progesterone support day among frozen embryo transfer IVF patients and pregnancy outcomes a systematic review and meta-analysis

Introduction: The relationship between estradiol serum levels on the day of progesterone injection and the outcomes of in vitro fertilization (IVF) pregnancies has been extensively explored in various studies and clinical inquiries. This study aims to conduct a systematic review and meta-analysis to investigate the influence of estradiol serum levels on the day of progesterone injection on pregnancy outcomes in IVF cycles. Method: By conducting a thorough search of the PubMed and Embase databases, a total of eight studies were selected for inclusion in the analysis. The results indicated a risk ratio of 1.34 (95% CI 0.85-2.11) for live birth rate, 0.94 (95% CI 0.90-0.99) for biochemical pregnancy rate, 1.02 (95% CI 0.79-1.31) for clinical pregnancy rate, 0.84 (95% CI 0.51-1.41) for miscarriage rate, 0.81 (95% CI 0.49-1.35) for implantation rate, and a mean difference of -0.01 (95% CI -0.35 to 0.33) for endometrial thickness. Results: The study indicates that there is no significant association between progesterone serum levels on the day of hCG administration and IVF pregnancy outcomes. However, the substantial heterogeneity observed across the included studies underscores the necessity for more comprehensive and standardized investigations to uncover the intricate associations between estradiol levels and IVF success. Conclusion: This research enhances our comprehension of the role of estradiol serum levels in IVF outcomes and lays the groundwork for future studies aimed at refining fertility treatment protocols.

Progestin Primed Ovarian Stimulation (PPOS) protocol yields lower euploidy rate in older patients undergoing IVF

BackgroundTo explore if exogenous progestin required for progestin primed ovarian stimulation (PPOS) protocol compromises the euploidy rate of patients who underwent preimplantation genetic testing cycles when compared to those who received the conventional gonadotropin-releasing hormone (GnRH) antagonist protocol.MethodsThis retrospective cohort study analyzed 128 preimplantation genetic testing for aneuploidy (PGT-A) cycles performed from January 2018 to December 2021 in a single university hospital-affiliated fertility center. Infertile women aged 27 to 45 years old requiring PGT-A underwent either PPOS protocol or GnRH-antagonist protocol with in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) for fertilization. Frozen embryo transfers were performed following each PGT-A cycle. Data regarding the two groups were analyzed using the Statistical Package for Social Sciences (SPSS) version 22.0 (SPSS Inc., Chicago, IL).ResultsPatients who underwent PPOS treatment had significantly reduced blastocyst formation rate and euploidy rate compared to those who received the GnRH antagonist protocol. Subgroup-analysis was performed by stratifying patients’ age into elder and young subgroups (elder: ≥ 38-year-old, young: < 38-year-old). In the elder sub-population, the blastocyst formation rate of the PPOS group was significantly lower than that of the GnRH-antagonist group (45.8 ± 6.1% vs. 59.9 ± 3.8%, p = 0.036). Moreover, the euploidy rate of the PPOS group was only about 20% of that of the GnRH-antagonist group (5.4% and 26.7%, p = 0.006). In contrast, no significant differences in blastocyst formation rate (63.5 ± 5.7% vs. 67.1 ± 3.2%, p = 0.45) or euploidy rate (30.1% vs. 38.5%, p = 0.221) were observed in the young sub-population. Secondary outcomes, which included implantation rate, biochemical pregnancy rate, clinical pregnancy rate, live birth rate, and miscarriage rate, were comparable between the two treatment groups, regardless of age.ConclusionWhen compared to the conventional GnRH-antagonist approach, PPOS protocol could potentially reduce the euploidy rate in aging IVF patients. However, due to the retrospective nature of this study, the results are to be interpreted with caution. Before the PPOS protocol is widely implemented, further studies exploring its efficacy in larger populations are needed to define the optimal patient selection suitable for this method.Trial registrationHuman Investigation and Ethical Committee of Chang Gung Medical Foundation (202200194B0).