In Vitro Fertilization Treatment Cycles Research Articles

P-597 Pain intensity of oocyte retrieval of low and moderate number of oocytes is only mild, questioning the need of anesthesia and analgesia

Abstract Study question What is the pain intensity of oocyte retrieval (oocyte pick-up, OPU) without anesthesia and analgesia in women with low or medium number of follicles? Summary answer Pain intensity is only mild and is only slightly different in cycles with up to 5 aspirated oocytes and in repeated In-Vitro-Fertilisation (IVF) cycles. What is known already OPU is usually performed with anesthesia. However, OPU with anesthesia requires more treatment time and is more expensive. Previous studies have assessed the pain of OPUs without anesthesia in conventionally stimulated IVF using 15 to 19 gauge (G) aspiration needles and found high pain scores. Therefore, anesthesia is usually used in such IVF treatments. In contrast, in Natural cycle IVF (NC-IVF) OPU is commonly performed without anesthesia. The pain intensity of such OPUs and of OPUs of medium number of follicles has never been systematically analysed. Study design, size, duration A prospective, cross-sectional, multi-center observational study analyzing IVF cycles without anesthesia and analgesia was performed in seven IVF centers in Germany and Switzerland between January 2022 and March 2023. Women who performed one to ten NC-IVF or minimal stimulation IVF treatment cycles were enrolled. 518 aspirations were performed with 17G needles and 1772 with 19G or 20G needles. In total, 2290 cycles from 1039 patients were recorded. Participants/materials, setting, methods Pain score was assessed using a Visual Analogue Scale (VAS), graded 0 to 10 (0 = no pain; 10 = worst pain possible). Information about ovarian stimulation, number of collected oocytes, needle size, aspiration pressure and complications were recorded. A descriptive analysis was performed first, followed by a statistical evaluation using a linear mixed model to analyze the effect of the number of oocytes retrieved and of the number of cycles on the pain score. Main results and the role of chance The number of oocytes retrieved varied from 0 to 16 (interquartile range 1-2). The pain score varied from 0 to 10 with a median pain score of 3.0 (interquartile range 2-4), defined as “mild” pain. Compared to a reference value of aspirations with 1 oocyte, the pain score increased slightly by 0.5 points if no oocyte was retrieved, by 0.42 points if 2-5 oocytes were retrieved and by 1.14 points if ≥ 6 oocytes were retrieved (p < 0.001). Pain decreased slightly with repeated aspirations (-0.05 points per cycle) (p = 0.028). Needle size did not affect the pain scores. Seventeen vaginal and abdominal bleedings were recorded, two requiring hospitalization (<0.1%). Limitations, reasons for caution As only NC-IVF and minimal stimulation IVF cycles were analysed using mainly 19G and 20G needles, the results cannot be extrapolated to cycles with a high ovarian response and to aspirations using larger volume needles. Wider implications of the findings In case of one or few follicles OPU can be offered without anesthesia and analgesia to reduce aspiration time and cost. Trial registration number NCT05125497

Reducing radicality in fertility-sparing surgery is associated with improved in vitro fertilization outcome in early-stage cervical cancer: A national retrospective study

ObjectiveFertility-sparing surgery (FSS) aims to achieve oncological outcomes that are non-inferior to radical treatment while preserving fertility and optimizing reproductive results. This study assesses in vitro fertilization (IVF) outcomes in early-stage cervical cancer survivors following FSS, comparing radical and non-radical approaches. MethodsThis retrospective analysis used data from Hungary's National Health Insurance Fund (2004–2022) on patients who underwent IVF treatment following FSS for early-stage cervical cancer at ten Hungarian fertility clinics. Patients were classified into radical and non-radical surgical groups, with the uterine arteries being spared in the non-radical procedures. RStudio (R software version: 4.2.2) was used for statistical analysis. Student's t-test was used to compare group means, and Fisher's exact test was applied to assess independence and distributions between categorical variables, and to estimate odds. ResultsThe study analyzed data from 122 IVF treatment cycles involving 36 patients. The non-radical group had a significantly higher live birth rate (83%, 5/6 compared to the radical group (17%, 5/30). Additionally, the non-radical group had a significantly higher implantation rate and cumulative live birth rate per oocyte retrieval (37%, 7/19 and 55%, 6/11 respectively) compared to the radical group (8%, 12/148 and 6%, 5/80 respectively). ConclusionThis is the largest study to evaluate IVF outcomes in young cervical cancer survivors who have undergone FSS. The findings suggest that less radical procedures are associated with significantly better IVF outcomes. These results emphasize the importance of considering oncological safety and reproductive outcomes together when choosing FSS for early-stage cervical cancer patients. It also highlights the reproductive benefits of performing less radical surgery.

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.

The Prediction of IVF Outcomes with Autologous Oocytes and the Optimal MII Oocyte/Embryo Number for Live Birth at Advanced Maternal Age.

Background and Objectives: Delayed childbearing in advanced age might be associated with a low prognosis for achieving pregnancy. Therefore, it is important to establish a predictive tool that will optimize the likelihood of a live birth at advanced age. Material and Methods: The retrospective study was conducted at the Ferona Fertility Clinic in Novi Sad (Republic of Serbia), between January 2020 and May 2021. The survey included 491 women aged ≥35 who met the inclusion criteria and who were subjected to an IVF (in vitro fertilization) treatment cycle. Results: The average number of retrieved oocytes, MII (metaphase II) oocytes, and developed embryos significantly decreased in advanced age. Age was also found to have a significant adverse effect on pregnancy and live birth rates. In women aged ≥35, 10/12 MII oocytes or 10/11 embryos are required for reaching an optimal live birth rate/cumulative live birth rate. Optimal CLBR (cumulative live birth rate) per one oocyte was achieved when 9 MII oocyte were retrieved. Conclusions: The study indicates that the cut-off for increased risk is ≥42 year. However, despite low live birth rates, autologous IVF for these women is not futile. An increase in the number of retrieved mature oocytes and a generation of surplus cryopreserved embryos could reinforce LBR (live birth rate) and CLBR. Clinicians should be very cautious in counseling, as autologous IVF may only be applicable to women with good ovarian reserve.

P-510 Low neighbourhood socioeconomic status is associated with lower cumulative ongoing pregnancy rate after in vitro fertilization treatment

Abstract Study question Is there an association between neighbourhood socioeconomic status (SES) and cumulative ongoing pregnancy after 2.5 years of in vitro fertilization (IVF) treatment? Summary answer Low and middle neighbourhood SES is associated with lower odds of an ongoing pregnancy within 2.5 years of IVF treatment than high neighbourhood SES. What is known already Low SES is known to have a negative impact on general health and a variety of medical conditions, including perinatal health. However, not much data is available on the impact of SES on IVF treatment outcome. Study design, size, duration This is a retrospective observational study of 3720 couples undergoing IVF or IVF-ICSI treatment between 2006 and 2020. Participants/materials, setting, methods Neighbourhood SES was assigned to each couple based on the postal code of residence. Subsequently, SES was categorized into low (<p20), medium (p20-p80), and high (>p80). Multivariable logistic regression analyses were performed with cumulative ongoing pregnancy within 2.5 years as outcome variable, SES category, female age, BMI, smoking status (yes/no), and interaction terms for age*SES and BMI*SES were used as covariates. Main results and the role of chance There was no difference in ongoing pregnancy rates between SES groups after the first fresh embryo transfer or in the average number of IVF treatment cycles performed. However, the cumulative ongoing pregnancy rates differ significantly between SES groups (Low; 43.6%, medium; 50.9%, high; 54.1%). Low SES had significantly lower odds for achieving an ongoing pregnancy within 2.5 years (OR = 0.06 (95%CI 0.02-0.22)). The interaction terms age*SES and BMI*SES showed attenuation of this association with increasing age and BMI (OR = 1.07 (95%CI 1.022 – 1.12) and OR = 1.61 (95%CI 1.25 – 2.09), respectively). The associations with medium SES were similar, but less pronounced (OR = 0.16 (95%CI 0.05 – 0.50) with OR = 1.04 (95%Cl 1.00 – 1.09) and OR = 1.41 (1.12 – 1.77) for the interaction terms with female age and BMI respectively. Limitations, reasons for caution We were not able to perform additional analysis on individual characteristics like educational level, ethnicity or language proficiency due to lack of data. Wider implications of the findings In the Netherlands, health insurance is mandatory. Our study showed that even with equal access to fertility care, patients living in a low SES neighbourhood are disadvantaged. This underlines the importance of taking the whole wellbeing of the patient into account, before starting an IVF treatment. Trial registration number not applicable

Prediction model of gonadotropin starting dose and its clinical application in controlled ovarian stimulation

BackgroundSelecting an appropriate and personalized Gn starting dose (GSD) is an essential procedure for determining the quality and quantity of oocytes in the controlled ovarian stimulation (COS) process of the in-vitro fertilization (IVF) treatment cycle. The current approach for determining the GSD is mainly based on the experience of a clinician, lacking unified and scientific standards. This study aims to establish a prediction model of GSD, based on which good COS outcomes can be achieved with the influencing factors comprehensively evaluated quantitatively.Material and methodsWe collected a total of 1555 patients undergoing the first oocytes retrieving cycle and conducted correlation analysis to find the significant factors related to the GSD. Two GSD models are built based on two popular machine learning approaches, and the one with better model performance is selected as the final model. Finally, clinical application and validation were conducted to verify the effectiveness of the proposed model.Results(1) Age, duration of infertility, type of infertility, body mass index (BMI), antral follicle count (AFC), basal follicle stimulating hormone (bFSH), estradiol (E2), luteinizing hormone (LH), anti-Müllerian hormone (AMH) and COS treatment regimen were closely related to the GSD (P < 0.05). (2) The selected model has good modeling performance in terms of both root mean square error (RMSE) (29.87 ~ 34.21) and regression coefficient R (0.947 ~ 0.953). (3) A comprehensive evaluation of influencing factors for GSD is conducted and shows that the top four most significant factors are age, AMH, AFC, and BMI. (4) The proposed GSD can approximate the actual value well in the clinical application, with the mean absolute error of only 11.26 units, and the recommended results can prompt the number of oocytes retrieved (NOR) close to the optimal number.ConclusionModeling the GSD value with machine learning approaches is feasible and effective, and the proposed model has good clinical application for determining the GSD in the IVF treatment cycle.

Live-Birth Outcomes Among Women With Infertility and Anti-Müllerian Hormone Levels of 0.3 ng/mL or Lower.

To estimate the live-birth rate per in vitro fertilization (IVF) cycle and after cumulative infertility treatment among patients with anti-müllerian hormone (AMH) levels of 0.3 ng/mL or lower. We conducted a retrospective cohort study at a single academic center of patients with infertility and AMH levels of 0.3 ng/mL or lower who initiated one or more IVF cycles (2013-2019). Exclusion criteria included prior chemotherapy, hormonal contraceptive use within 3 months of AMH level measurement, and severe male factor infertility. Patients were stratified by Society for Assisted Reproductive Technology (SART) age group. The primary outcome was live-birth rate per IVF cycle. Live-birth outcomes were compared with the 2018 SART National Summary Report for live births per single intended oocyte retrieval, with proportion difference (PD) and 95% CI reported. A total of 978 patients were included. The median (interquartile range) number of cycles initiated was 2 (1-3). With the first initiated cycle, the live-birth rate for those with AMH levels of 0.3 ng/mL or lower was significantly lower in each age category compared with the SART live-birth rate per single initiated cycle (younger than 35 years: 26.2% vs 55.6%, PD 29.4%, 95% CI 20.9-37.9%; 35-37 years: 15.9% vs 40.8%, PD 24.9%, 95% CI 19.0-30.9%; 38-40 years: 12.6% vs 26.8%, PD 14.3%, 95% CI 10.2-18.3%; 41-42 years: 4.7% vs 13.4%, PD 8.7%, 95% CI 5.9-11.6%; older than 42 years: 1.2% vs 4.1%, PD 2.9%, 95% CI 1.5-4.3%). In patients aged 35-37, 38-40, 41-42, and older than 42 years, the cumulative live-birth rate after up to three initiated cycles was comparable with the SART live-birth rate per single initiated cycle but remained significantly lower in patients younger than age 35 years (PD 16.8%, 95% CI 7.3-26.2%). After all treatments were included (cumulative IVF, ovulation induction, and unassisted cycles), live-birth rates were similar to SART live-birth rates per single initiated cycle in all age groups. Compared with national outcomes, patients with AMH levels of 0.3 ng/mL or lower had a significantly lower chance of live birth after their first initiated cycle. However, the cumulative live-birth rate after up to three initiated cycles was comparable with national live-birth outcomes per single initiated cycle in patients aged 35 years or older. In patients younger than age 35 years, only when all IVF and non-IVF treatment cycles were included did the cumulative live-birth rate become comparable with the national rate per single IVF cycle.

O-200 Women’s understanding of their personal chance of success with IVF

Abstract Study question How well informed are Australian women who undergo In Vitro Fertilisation (IVF) about their treatment and their chances of having a baby? Summary answer Only one in four women accurately estimated their individual chance of success with IVF and most women overestimated their chance. What is known already IVF is the cornerstone of infertility treatment, and high quality, transparent and reliable treatment information is essential for patient-centred care. A recent review into IVF practice in Victoria, Australia has highlighted deficiencies in information-provision. Similar findings have also been reported internationally. An assessment of women’s understanding of various aspects of the treatment is needed to identify information gaps that should be addressed by clinicians. While limited knowledge about infertility and infertility treatment in the general population is well-documented, little is known about the level of knowledge about infertility treatment among women undergoing IVF treatment. Study design, size, duration We conducted an anonymous online survey of women who had started IVF since 2018 in Australia. The survey aimed to assess how well-informed women feel about their treatment, and was advertised on social media, enabling women from across Australia to participate. Responses were collected from 3 to 21 June 2021. Participants/materials, setting, methods The survey included questions on demographic characteristics and IVF history. It also asked how well-informed participants felt about their treatment, what they 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’ beliefs about chance of success were compared with their chance as calculated by the Society for Assisted Reproductive Technology’s (SART) online calculator. Main results and the role of chance The survey was completed by 225 women. Only about a quarter (25.8%) of participants accurately estimated their chance of success within 20% relative to their SART calculated chance, and more than half (52.4%) overestimated their chance. Among women who rated their understanding of their chance of success as ‘high’ (7-10/10), less than one third (31.6%) accurately estimated their chance of success. Older age and having undergone several cycles were associated with women being more likely to overestimate their chance of success (odds ratios of 3.2 and 2.5, respectively). Ninety percent of women indicated that their preferred source of treatment information was a consultation with their doctor, despite many women reporting that doctors only explained the probability of having a baby with IVF moderately well (mean 5.9/10). Women also reported that they wished they had been given more realistic information about IVF and their chance of success. 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. Limitations, reasons for caution The dissemination method precludes calculation of response rate, and it is not possible to know if participants are representative of all women undergoing IVF. There is inherent imprecision in the way understanding of chance of success was estimated. The potential impact of recall bias could neither be quantified nor excluded. Wider implications of the findings The poor understanding of personal chance of success amongst women undergoing IVF in Australia, highlights the need for systematic and evidence-based improvement in the way clinics inform patients about the probability of having a baby with IVF. Further research into how information-provision in IVF can be improved is needed. Trial registration number Not applicable

P-710 COVID-19 Vaccination and Infertility Treatment Outcomes

Study questionIs there an influence of mRNA COVID-19 vaccine on ovarian response and in vitro fertilization (IVF) treatment outcomes?Summary answerCOVID-19 mRNA vaccine did not affect the ovarian response nor pregnancy rates in IVF treatmentWhat is known alreadyStudies demonstrated that infection with COVID-19 during pregnancy increased the risk of the development of severe disease and pregnancy complications.A recent meta-analysis of international data showed a declining tendency to be vaccinated, possibly influenced by public concerns over safety of the vaccines. Specifically, concerns were raised about a possible detrimental effect on fertility and pregnancy outcomes due to similarity between syncytin-1, a human placental fusion protein, and the SARS-CoV-2 spike protein expressed after administration of the COVID-19 vaccine.To date, only one retrospective analysis on 36 infertility patients has assessed the influence of COVID-19 vaccination on IVF treatment outcomes.Study design, size, durationA retrospective cohort study . The study included a total of 400 patients, 200 vaccinated women and 200 age matched non-vaccinated women, undergoing IVF treatments during January-April 2021.Participants/materials, setting, methodsAll vaccinated women aged 20-42 that underwent IVF treatment cycles between January 1, 2021 and April 31 2021 were included. All participants completed two doses of the BNT162b2 (Pfizer-BioNTech) vaccine at least two weeks before starting ovarian stimulation. The study group was matched by age to non-vaccinated patients that underwent IVF treatments during the same period. Patients with a positive COVID 19 test in the past were excluded.Main results and the role of chanceTwo hundred patients underwent oocyte retrieval 14-68 days after receiving COVID-19 vaccination. No difference was found between vaccinated and non-vaccinated patients in mean number of oocytes retrieved per cycle (10.63 vs 10.72, p = 0.93). Among 128 vaccinated patients and 133 non-vaccinated patients that underwent fresh embryos transfers, no difference was demonstrated in clinical pregnancy rates (32.8% vs. 33.1%, p-value=0.96), 42 and 44 pregnancies respectively. The fertilization rates and mean number of cryopreserved embryos were similar between the two groups in freeze all cycles (55.43% vs. 54.29%, p-value=0.73), (3.59 vs. 3.28, p-value=0.80). Among vaccinated patients and non-vaccinated patients that underwent fresh embryos transfers, no difference was demonstrated in the fertilization rate (64.81% vs. 61.98%, p = 0.51), and transferred embryos quality. Regression models applied demonstrated no effect of the vaccine on oocyte yields and pregnancy rates.Limitations, reasons for cautionLimitations include retrospective nature and different treatment protocols.Additional limitation is the lack of information about vaccination status of the partners. One would assume that if unbalanced, the proportion of vaccinated males would be higher in the study group as partners tend to choose similarly in regard to vaccine administration.Wider implications of the findingsWomen should consider vaccination prior to their attempts to conceive via IVF treatments.Trial registration numberASF-0094-21

Diagnostic laparoscopy prior to IVF cycle improves outcome in patients with unilateral distal tubal occlusion

ObjectiveTo assess the impact of laparoscopy before in vitro fertilization (IVF) treatment on live birth rates in patients with distal unilateral tubal obstruction (UTO). MethodsRetrospective cohort study which was conducted in tertiary ART center in Ankara University Hospital between January 2008- January 2019. Inclusion criteria were distal UTO at HSG, patients who were 18–40 years age and baseline serum FSH levels between 3 and 15 IU/ml. Exclusion criteria were patients who had previous tubal surgery and, hormonal dysfunction such as hyperprolactinemia or hypothyroidism at the time of the IVF cycle. Results49 patients who underwent 117 IVF treatment cycles were included in the final analysis. Among those 17 patients (34 IVF cycles) in the study group who underwent laparoscopy prior to IVF cycles, and 32 patients (83 IVF cycles) in the control group who directly underwent IVF cycle with no prior laparoscopy. Eleven pathologies (64.7%) were detected and treated at laparoscopies of 17 patients with distal UTO. Both the clinical pregnancy and the live birth rates were also significantly higher in the study group when compared to the control group (29.4% vs. 12%, P=.031; 26.5% vs. 9.6%, respectively; P=.039). ConclusionsPatients with distal UTO generally have a pelvic pathology and laparoscopy prior to IVF cycles can improve the treatment outcome.

Prediction of poor ovarian response during In vitro fertilization in Nigerian women: A comparison of basal antral follicle count and follicle-stimulating hormone

Background: Poor ovarian reserve has been shown to be associated with poor outcomes of in-vitro fertilization (IVF) treatment. Women who can be reliably identified as expected poor responders can be advised on chances of poor outcomes that may dissuade them from wasting resources on IVF using their own eggs; and offered donor eggs, especially in a resource-poor country like Nigeria. Many centres routinely perform basal follicle-stimulating hormone (FSH) assay before IVF; however, basal antral follicle count (AFC) has emerged as a more reliable test of ovarian reserve that can be provided at a reduced cost compared to FSH in an IVF clinic setting. The determined predictive values of basal AFC compared to FSH in Nigerian women can be used to predict poor ovarian response during IVF treatment; and also to influence local clinical practice in IVF by offering a more reliable and affordable test, thereby avoiding wastage due to duplicate and unnecessary investigations. Aim: The aim is to determine the diagnostic accuracy of basal AFC compared to basal FSH for the prediction of ovarian response during the IVF cycle in Nigerian women. Patients, Materials and Methods: This was a hospital-based prospective comparative study in two private fertility centres in Abuja. Consecutive 166 women that underwent IVF treatment cycles who met the inclusion criteria were recruited. On day 2 to day 4 of a normal cycle, FSH assay and AFC using the Broekmans’ systematic process were done. They had controlled ovarian hyperstimulation by antagonist or agonist and occasionally long protocols. The poor response was defined as <4 follicles of >17 mm on the day of human chorionic gonadotropin trigger or ≤3 oocytes retrieved. Receiver operating characteristics (ROC) analysis was done to determine the level of the area under the curve (AUC) and optimum cut-off values of FSH and AFC in predicting poor ovarian response. Results: Twenty-eight (16.9%) had poor responses. ROC analysis demonstrated that AFC had the largest (AUC = 0.707, P = 0.001) relative to FSH (AUC = 0.591, P = 0.128). The ROC analysis showed that the optimum cut-off value for the prediction of poor response for AFC was ≤10, which had a higher accuracy of 67.5%, while for FSH was ≥8.15 mIU/ml with a lower accuracy of 61.5%. They both had the same sensitivity of 60.7%; however, AFC had better specificity, negative and positive predictive value, and higher odds ratio for the prediction of poor ovarian response. The positive and negative likelihood ratios of both cut-off values suggest that they may not be useful as diagnostic tests. Conclusion: ROC analysis estimated that AFC more accurately predicts poor ovarian response by its larger and more significant AUC compared to FSH in our population of women.

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

Is social support related to better mental health, treatment continuation and success rates among individuals undergoing in-vitro fertilization? Systematic review and meta-analysis protocol.

Infertility and its treatment via in-vitro fertilization (IVF) represent a global health area of increasing importance. However, the physical and psychological burden of IVF can negatively impact psychological wellbeing, as well as treatment retention and success. Social support has been found to have positive health effects among populations facing health-related stressors worldwide, and its potential protective role for IVF patients merits further attention. We present a protocol for a systematic review of peer-reviewed published studies quantitatively investigating associations between social support and i) mental health; ii) the decision to (dis)continue with IVF treatment cycles and; iii) IVF success (pregnancy and birth rates); among individuals who are undertaking or have undertaken IVF cycles. Studies will be included if they work with human subjects, provide correlation coefficients between measures of social support and at least one of the outcomes of interest, and are in the English language. Social support may derive from both naturally occurring networks and more formalized sources or interventions. The protocol for this systematic review was developed according to the PRISMA-P guidelines. Ten health-, psychology- and sociology-related databases will be searched using composite search terms that include keywords for ‘IVF’ and ‘social support’. To assess methodological quality, the authors will use a modified version of the Newcastle-Ottawa Scale. Should three or more moderate or good quality studies be identified for any one outcome of interest, correlation meta-analyses, using the Hedges-Olkin method, will be conducted to pool effect sizes and heterogeneity will be assessed. Should the number, quality and characteristics of eligible studies not allow for reliable quantitative synthesis, the authors will limit the analysis to qualitative synthesis, with a focus on implications of findings for future research and programming.

The association between prior cesarean delivery and subsequent in vitro fertilization outcomes in women undergoing autologous, frozen-thawed single euploid embryo transfer

The rates of cesarean deliveries continue to increase worldwide. Previous work suggests an association between a previous cesarean delivery and reduced fertility in natural conception and invitro fertilization treatment cycles. To our knowledge, there is no published research that explored the relationship between a previous cesarean delivery and the clinical outcomes after invitro fertilization and the subsequent transfer of a single frozen-thawed euploid embryo. This study aimed to investigate the relationship between the previous mode of delivery and subsequent pregnancy outcomes in patients undergoing a single frozen-thawed euploid embryo transfer after invitro fertilization. A retrospective cohort study was performed at a single academic fertility center from January 2012 to April 2020. All women with a history of a live birth undergoing autologous, frozen-thawed single euploid embryo transfers were identified. Cases included patients with a single previous cesarean delivery; controls included patients with a single previous vaginal delivery. Only the first embryo transfer cycle was included. The primary outcome was the implantation rate. Secondary outcomes included ongoing pregnancy and live birth rates, biochemical pregnancy rate, and clinical miscarriage rate. A total of 525 patients met the inclusion criteria and were included in the analysis. Patients with a previous cesarean delivery had a higher body mass index (24.5±4.5 vs 23.4±4.1; P=.004) than those in the vaginal delivery cohort; the rest of the demographic data were otherwise similar. In a univariate analysis, the implantation rate was significantly lower in patients with a previous cesarean delivery (111/200 [55.5%] vs 221/325 [68.0%]; P=.004). After adjusting for the relevant covariates, a previous cesarean delivery was associated with a 48% reduction in the odds of implantation (adjusted odds ratio, 0.52; 95% confidence interval, 0.34-0.78; P=.002). In addition, after adjusting for the same covariates, a previous cesarean delivery was significantly associated with a 39% reduction in the odds of an ongoing pregnancy and live birth (adjusted odds ratio, 0.61; 95% confidence interval, 0.41-0.90; P=.01). There were no differences in the biochemical pregnancy rates or clinical miscarriage rates. This study demonstrated a marked reduction in implantation and ongoing pregnancy and live birth associated with a previous cesarean delivery in patients undergoing a single euploid embryo transfer. Our work stresses the importance of reducing the primary cesarean delivery rates at a national level and elucidating the mechanisms behind the substantially lower implantation rates after a cesarean delivery.

Abstract PR05: Utilizing electronic fertility clinic records and registry linkage to establish a retrospective population-based cohort study to evaluate the association between in vitro fertilization (IVF) and subsequent cancer risk in women

Abstract Background: Since the introduction of in vitro fertilization (IVF) in 1978, the use of assisted reproduction technology (ART) has increased annually with an estimated 240,000 ART-conceived children born each year worldwide. Despite its widespread use, the impact on subsequent maternal and child health is not well understood. Specifically, cancer risk in women receiving IVF treatment has not been adequately evaluated, in part due to the complex nature of the research question and the need for large numbers of exposed women with long follow-up to evaluate rare cancer outcomes. Methods: To address this research question, we designed a country-wide retrospective medical record linkage study that utilizes electronic records from all IVF units in operation in Israel between 1997 and 2014. Linkage to cancer registry is facilitated via unique national identification numbers. We selected Israel for this study because it has the highest rate of ART/IVF exposure in the world, with 24 IVF units in the country that perform more than 45,000 ART cycles annually. Fertility treatment is fully covered by national health insurance with no restriction on the number of cycles or type of procedure, thus reducing potential selection issues related to access to care that may exist in other populations. We are currently collecting medically documented and detailed exposure information from the IVF units, including causes of infertility, hormonal treatments, procedures (e.g., IVF), and important covariates (e.g., parity, body mass index, etc.). To date we have collected exposure and covariate information from 18,470 women receiving treatment at 9 IVF clinics and conducted an interim linkage with the cancer registry through December 2014, providing on average 15 years of follow-up. We calculated standardized incidence ratios (SIRs) for all cancers combined and separately for breast cancer and further evaluated breast cancer risk with number of treatment cycles using Cox proportional hazards regression. Results: Based on interim registry linkage we identified 611 invasive cancers including 272 breast cancers among 18,470 women with more than 236,000 woman-years of follow-up. The incidence of cancer [SIR (95% confidence interval (CI)): 0.96 (0.88-1.04)] or breast cancer [0.98 (0.87-1.11)] was not elevated compared to the general population. Further, breast cancer risk was not associated with increased number of IVF treatment cycles [adjusted hazard rate ratio (RR) (95% CI) per IVF cycle: 1.01 (0.96-1.09)]. Conclusions: With this data we have demonstrated the feasibility of linking IVF clinic data with the nationwide cancer registry to evaluate cancer risk. In our preliminary analyses, IVF treatment was not associated with risk of incident invasive cancer or breast cancer. Given that continued linkage with the cancer registry is feasible, we will be able to monitor long-term cancer risks associated with IVF treatment using the enumerated data. This abstract is also being presented as Poster A15. Citation Format: Britton Trabert, Galit Hirsh-Yechezkel, Adel Farhi, Inna Zaslavsky, Shai E. Elizur, Arik Kahana, Raoul Orvieto, Hananel Holzer, Ilan Calderon, Shevach Friedler, Einat Shalom-Paz, Raphael Ron-El, Arie Raziel, Louise A. Brinton, Liat Lerner-Geva. Utilizing electronic fertility clinic records and registry linkage to establish a retrospective population-based cohort study to evaluate the association between in vitro fertilization (IVF) and subsequent cancer risk in women [abstract]. In: Proceedings of the AACR Special Conference on Modernizing Population Sciences in the Digital Age; 2019 Feb 19-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(9 Suppl):Abstract nr PR05.

Maternal C-reactive protein and in vitro fertilization (IVF) cycles.

Embryo implantation is accompanied by a potent inflammatory response, and a gradient of cytokines and chemokines produced by endometrial cells supports the embryo-endometrial interaction. C-reactive protein (CRP) serves as an early marker of inflammation and recent studies have illustrated that controlled ovarian hyperstimulation (COH) could increase its levels. Interestingly, a high chance of pregnancy has been reported in women who had an elevated CRP level on the day of embryo transfer. It seems an elevated systemic inflammation in the in vitro fertilization (IVF) cycle can increase the implantation and pregnancy rates. However, the results regarding the association of CRP with ART outcomes are controversial. Therefore, in this review, we aimed to describe how CRP levels change during a cycle of IVF treatment and which factors can potentially affect this pattern of change. Furthermore, the association of CRP with ART outcomes has been discussed.

Hysteroscopy Findings in Women with Thin Endometrium Scheduled for In Vitro fertilization in Niger Delta Region, Nigeria.

The effect of endometrial thickness on in vitro fertilization (IVF) outcome is still a subject of debate. It is unclear why a thin endometrium reduces IVF success rates. Our objective was to analyze the hysteroscopic findings in women scheduled for IVF who had an endometrial thickness less than 7 mm. Relevant data of patients scheduled for IVF cycles and found to have an endometrial thickness (ET) of <7 mm on transvaginal ultrasound scan (TVS) between April 1, 2010 and March 31, 2017, at a private fertility and minimal access surgery unit in the Niger-Delta region of Nigeria, were retrieved and documented. A total of 41 patients had ET <7 mm during the study period. These patients accounted for 2.8% of the 1487 IVF cycles performed during the same period. All 41 patients had office hysteroscopies performed, constituting 4.1% of the 1,002 hysteroscopies performed during the study period. The age range of the patients was 23 - 50 years with a mean of 39.9 ± 6.9 years, and the duration of infertility ranged from 3 to 13 years with a mean of 7.2 ± 2.5 years. Most of the patients (32, 78.1%) had secondary infertility. Sixteen patients (39.0%) had intrauterine adhesions. A thin endometrium, though infrequent during IVF treatment cycles, might be associated with undiagnosed intrauterine adhesions.

A prospective, cross-sectional study of the protective and risk psychological factors of successful in vitro fertilisation outcome: preliminary results in a Greek sample

The aim of this prospective, cross-sectional study was to examine the protective and risk psychological factors associated with the successful outcome of In vitro fertilisation (IVF). Various psychological factors that may affect the IVF outcome were measured to a sample of 61 infertile women (mean age 37.2 ± 4.4), who started their first or consecutive IVF treatment cycle in an IVF Unit in Greece. Over half of the participants (50.8%) became pregnant. A binary logistic regression analysis (stepwise) was conducted on pregnancy as the outcome, with various variables as predictors. The model was statistically significant (Omnibus Chi-square = 27.324, df = 5, p < .001), explained 54.7% of the variance, and correctly classified 84.6% of the cases. Life purpose (odds ratio [OR] = 1.35, 95% CI = 1.02–1.78) and negative emotions (e.g. discontent, sorrow) (OR = 1.76, 95% CI = 1.19–2.60) were associated with increased pregnancy rates, whereas autonomy (OR = 0.57, 95% CI = 0.39–0.82), and stress (OR = 0.69, 95% CI = 0.55–0.88) were associated with decreased pregnancy rates. It has been concluded that the relationship between psychological factors and successful IVF outcome is more complex than commonly believed. The identification of the risk and protective psychological factors could contribute to increased pregnancy rates and foster the implementation of tailored therapeutic interventions.Impact statementWhat is already known on this subject? High levels of infertility stress and/or depression have been associated with lower pregnancy rates. However, little is known on the impact of emotions, personality characteristics and other psychological variables on in vitro fertilisation (IVF) outcome.What the results of this study add? A combination of commonly believed ‘negative’ factors (e.g. stress) and ‘positive’ ones (e.g. well-being) may diversely affect the IVF outcome. Otherwise believed to be positive aspects of human life (i.e. autonomy) may decrease the likelihood of pregnancy, and other factors believed to be ‘negative’ (e.g. negative emotions) may increase pregnancy rates.What the implications of these findings are for clinical practice and/or further research? The findings invite researchers to further examine the role of the psychological factors which could potentially affect pregnancy rates. Modifiable factors, such as well-being, stress and emotions, should guide tailored interventions aimed at increasing the pregnancy rates in infertile women.

Investigating the effect of lifestyle risk factors upon number of aspirated and mature oocytes in in vitro fertilization cycles: Interaction with antral follicle count.

IntroductionThere is evidence demonstrating that certain lifestyle factors have a detrimental effect on fertility. Since such factors often coexist, possible synergistic effects merit further investigation. Thus we aimed to examine the cumulative impact of lifestyle factors on in vitro fertilization (IVF) early reproductive treatment outcomes and their interaction with measures of ovarian reserve.Materials and methodsBy following women who were starting their first fresh IVF cycle in 2 cohorts, the “Lifestyle study cohort” (hypothesis generating cohort, n = 242) and the “UppSTART study” (validation cohort, n = 432) in Sweden, we identified two significant risk factors acting independently, smoking and BMI, and then further assessed their cumulative effects.ResultsWomen with both these risk factors had an Incidence Rate Ratio (IRR) of 0.75 [(95% CI 0.61–0.94)] regarding the number of aspirated oocytes compared to women without these risk factors. Concerning the proportion of mature oocytes in relation to the total number of aspirated oocytes, the interaction between BMI and Antral Follicle Count (AFC) was significant (p-value 0.045): the lower the value of AFC, the more harmful the effect of BMI with the outcome.ConclusionsData shows that there is an individual as well as a cumulative effect of smoking and BMI on the number of aspirated and mature oocytes in fresh IVF treatment cycles. AFC might modify associations between BMI and the proportion of mature oocytes in relation to the total number of aspirated oocytes. These results highlight the importance of lifestyle factors on IVF early reproductive outcomes and provide additional evidence for the importance of preconception guidance for the optimization of IVF cycle outcome.