Ovarian Stimulation Research Articles

Are assisted reproductive technology pregnancies more likely to be exposed to teratogenic medication? A whole-population study.

Assisted reproductive technology (ART) pregnancies are at greater risk of birth defects than non-ART pregnancies. Teratogenic medication exposure is a potential cause of birth defects that has not been compared between ART and non-ART pregnancies. To determine whether the prevalence of exposure to teratogenic medicines during pregnancy varies by conception method (ART and three non-ART groups: ovulation induction (OI), subfertile untreated, and fertile naturally conceiving). We linked state and commonwealth datasets for all live and stillbirths (≥20 weeks) in Western Australia with a conception date ≥1 July 2012 and date of birth ≤31 December 2014. We calculated the prevalence of exposure to teratogenic medicines (Therapeutic Goods Association Category D/X) across conception groups for the: (i) first trimester, and (ii) second and third trimesters. We identified 2041 ART, 590 OI, 2063 subfertile and 52 987 fertile pregnancies (57 681). The overall prevalence of exposure to Category D/X medicines was 0.8% in the first trimester, and 0.7% in the second and third trimesters. Category X medicines exposure was <0.5% for all conception groups and trimesters. The first trimesters of ART and OI pregnancies were more often exposed to Category D medicines than subfertile and fertile pregnancies, (ART = 4.9%, OI = 2.0% vs subfertile = 1.3%, fertile = 0.6%) as were later trimesters (ART = 3.4%, OI = 1.4% vs subfertile = 0.9%, fertile = 0.6%). The overall prevalence of exposure to teratogenic medicines is low; however, exposure was greatest in pregnancies arising from ART and may be a modest contributing factor to the higher rate of birth defects observed among ART babies.

Luteinizing hormone profiles during ovarian stimulation in assisted reproductive treatment

IntroductionFew data is available on the natural course of luteinizing hormone (LH) during ovarian stimulation, but it has been suggested that ‘oversuppressed’ LH could decrease fertility outcomes. Our aim with this study is to evaluate the changes in LH depending on the used stimulation protocol to better define LH oversuppressioin.MethodsPatients undergoing oocyte retrieval in a tertiary fertility center between 01-01-2015 and 30-09-2020 after stimulation with a short-agonist (SA) or antagonist (A) protocol were included. Data were retrospectively retrieved from 858 electronic patient records, of which 338 SA cycles and 783 A cycles. A continuous profile was set out to evaluate the pooled measurements of the mean LH in time during ovarian stimulation and linear mixed modeling was used to compare the change of LH between 4 time points: the day prior to start of gonadotrophins (T1), stimulation day 5 (T2), stimulation day 6 (T3) and on the day of oocyte maturation trigger (T4). Oversuppression of LH was defined as a decrease of LH &amp;gt; 50% after initiation of GnRH antagonist and LH levels &amp;lt; 1.2 IU/l after GnRH antagonist. A subanalysis was performed for type of gonadotrophin (recFSH vs hp-hMG).ResultsIn the SA protocol, an initial LH peak was followed by a slow decrease of LH until triggering. In the A protocol, LH decreased after gonadotrophin initiation with a further rapid decrease after initiation of the antagonist and remained low until trigger. LH levels dropped &amp;gt; 50% in 26.2% of the antagonist cycles and LH levels were &amp;lt; 1.2 IU/l in 45.3% of cycles after initiation of GnRH-antagonist.ConclusionThe course of LH in the SA protocol differs from the A protocol where low mean LH levels are seen. Oversuppression of LH, or iatrogenic LH deficiency as described in earlier studies, may be a rather pervasive phenomenon during stimulation with an antagonist protocol and warrants further investigation to elucidate the clinical relevance of low LH levels during ovarian stimulation.

Could the use of agonist protocols benefit patients who do not respond well to human reproduction treatment?

The primary goal of this article is to analyze whether there is still room for ovarian stimulation in poor responders prescribed the long protocol. This retrospective cohort study analyzed the medical charts of patients seen at the Vida Centro de Fertilidade, a private fertility clinic in Rio de Janeiro, Brazil, from January 2018 to June 2023. It included poor responders described based on the Bologna criteria who were first prescribed conventional treatment with an antagonist protocol, without success, and then the long agonist protocol. Statistical analysis was performed on the Statistical Package for the Social Sciences (version 20). Comparisons of continuous variables between groups were performed with the Mann-Whitney U test or Student's t-test, as appropriate. The chi-square test was used to compare categorical variables. Statistical significance was achieved when p<0.05. We found a better response among patients on the agonist than on the antagonist protocol in terms of number of follicles larger than 14 mm on the day of trigger (3.17 versus 2.1; p<0.05), number of eggs on the day of retrieval (3.5 versus 1.37; p<0.05), number of mature eggs (2.67 versus 1.37; p<0.05), and number of embryos after fertilization on the first day of development (1.87 versus 0.8; p<0.05). This protocol's cancellation rate was slightly lower (0.03 versus 0.43; p<0.05). The long protocol still yields positive results in poor responders who were previously prescribed the antagonist protocol.

Effect of basal luteinizing hormone/follicle-stimulating hormone ratio on clinical outcome of In Vitro fertilization in patients with polycystic ovarian syndrome: a retrospective cohort study.

The basal luteinizing hormone (LH) and the prior LH to follicle-stimulating hormone (FSH) ratio (LH/FSH) in polycystic ovarian syndrome (PCOS) are generally higher than those in non-PCOS patients and the general population. The potential negative effects of elevated LH on human reproductive function are highly controversial, as are the effects of down-regulation of LH on reproductive function. The purpose of this study was to evaluate the effect of the basal LH/FSH ratio on the live birth rate of PCOS patients undergoing in vitro fertilization (IVF) cycles. A retrospective analysis was conducted on 698 patients with polycystic ovary syndrome undergoing IVF treatments with a mild stimulation protocol (n = 95) and a gonadotropin-releasing hormone (GnRH) agonist protocol (n = 603). The basal LH/FSH ratio of 2 was used as the cut-off value for further subgroup analysis. The demographic properties, controlled ovarian hyperstimulation (COH) processes, and clinical pregnancy outcomes were compared between groups under each ovulation stimulation protocol. The live birth rate for patients with a LH/FSH ratio ≥ 2 group (56.38%, n = 149) was not statistically different from that of the ones with a ratio < 2 (53.74%, n = 454) in the GnRH agonist protocol (P = 0.576). Correspondingly, the live birth rate for the LH/FSH ratio ≥ 2 group (43.48%, n = 23) also showed no statistical difference from the ratio < 2 group (48.61%, n = 72) in the mild stimulation protocol (P = 0.668). Additionally, LH/FSH ratios had no significant effect on the live birth rate after adjusting for confounders both in the GnRH agonist protocol (adjusted OR: 1.111; 95% CI [0.467-2.642], P = 0.812) and in the mild stimulation protocol (adjusted OR: 4.057; 95% CI [0.431-38.195], P = 0.221). Furthermore, there was no significant difference in the live birth rate between different ovulation stimulation protocols in PCOS patients with the LH/FSH ratio ≥ 2. The live birth rate in IVF outcomes was not affected by an elevated basal LH/FSH ratio in patients with polycystic ovary syndrome. The choice of the GnRH agonist protocol or mild stimulation protocol for ovulation stimulation does not affect the final clinical outcomes either for PCOS patients with a basal LH/FSH ratio ≥ 2.

The impact of age and number of oocytes retrieved on the cumulative live birth rate in women with poor ovarian response: A 15-year study

BackgroundApproximately 15 % of women undergoing assisted reproductive treatment (ART) fall in the category of poor ovarian reserve defined as the retrieval of three or fewer oocytes following conventional ovarian stimulation with a daily gonadotrophin dose of 150–450 international units, according to the Bologna criteria. Low number of oocytes collected is, therefore, likely to translate to low chance of successful ART treatment. ObjectivesThe objective of the study was to assess if age and number of oocytes retrieved influence the cumulative live birth rate (LBR) in women with poor ovarian response (POR) to controlled ovarian hyperstimulation. Study designWe have used anonymised, prospectively collected data spanning July 2004 until June 2019 on consecutive in vitro fertilisation (IVF) and intra-cytoplasmic sperm injection (ICSI) cycles performed at a tertiary fertility treatment unit. Women who underwent conventional ovarian stimulation with a starting daily gonadotrophin dose of 150–450 IU in their first or second IVF cycle where 1–3 oocytes were retrieved were included in the study, with women where four oocytes were retrieved formed a comparative control group. Only one cycle per patient was included. ResultsA total of 2,516 fresh IVF or ICSI cycles were analyzed. The overall clinical pregnancy and LBR in the cohort of included women were 16.4 % and 12.6 % respectively. The cumulative LBR per patient included was 13.1 %. When adjusting for age, treatment type, FSH at baseline, and daily gonadotrophin dose, a significant increase in cumulative LBR was observed for two (OR 2.63, 95 % CI 1.43–4.81), three (OR 3.74, 95 % CI 2.09–6.68) and four (OR 5.3, 95 %CI- 3.01–9.35) oocytes collected, compared to one oocyte only. A significantly lower chance of successful outcome was noted in women 43–45 years old versus younger age groups, irrespective of number of oocytes collected. ConclusionsIn this large cohort of women with POR, both age and number of oocytes retrieved are independent factors influencing the cumulative LBR after IVF treatment. Irrespective of age, retrieval of one additional oocyte is associated with an increase in the cumulative LBR per oocyte retrieval.

Clinical and anamnestic characteristics of patients with functional ovarian cysts (Retrospective study)

Ovarian cysts are common in young women of reproductive age. It is estimated that around 7% of women worldwide experience a symptomatic cyst during their lifetime. Functional ovarian cysts (FOCs) occupy one of the leading places in the structure of gynecological diseases (45-55%) in women of reproductive age. Functional cysts are not true neoplasms and are considered as a variant of a normal physiological process.Ovarian retention formations are found in 7.8% of clinically healthy women and in every second (52.3%) patient with lower abdominal pain or menstrual cycle disorders. Studies of FOCs have mainly concerned cysts that arose after ovulation induction, studies of spontaneous follicular cysts are limited, the question of the effect of FOCs on fertility and ovarian reserve is debated.The objective: to analyze the management of patients with FOCs in real clinical practice.Materials and methods. A retrospective case-control cohort study was conducted with the participation of 350 women aged 19 to 39 years who were diagnosed with ovarian neoplasms between 2020 and 2022. Complaints, anamnesis data, applied methods of diagnosis and treatment of neoplasms were analyzed. Results. According to clinical data, the cases were divided into 3 groups. The I group included 122 (34.9%) women in whom, in the absence of symptoms and complaints, ovarian neoplasms were detected for the first time during pelvic ultrasound.The II group consisted of 116 (33.1%) female patients, who for the first time applied for an examination due to complaints of periodic unilateral pain of various nature, a feeling of discomfort in the lower abdomen.The III group included 112 (32.0%) women who were urgently hospitalized with complaints of acute pain and pressure in the lower abdomen, bloating, weakness, dizziness. Among the patients of this group, 53 (47.3%) women had ovarian neoplasms diagnosed earlier (within 2.6±0.7 years).Among the studied cohort, according to ultrasound data, functional (follicular cysts and corpus luteum cysts) ovarian cysts were verified among the detected neoplasms in 253 (72.3%) women.Conclusions. The prevalence of functional ovarian cysts in women that do not have clinical manifestations as ultrasound findings is 78.7%, among them follicular cysts predominate (66.4%). Infertility occurs in 23.8% of asymptomatic women with functional ovarian cysts. In 34.5% of women with functional ovarian cysts who have clinical symptoms, menstrual cycle disorders prevail.

Successful application of preimplantation genetic testing combined with thirdgeneration sequencing for blocking hereditary spastic paraplegia

We report a case of application of third-generation sequencing (TGS) combined with preimplantation genetic testing (PGT) for successful prevention of hereditary spastic paraplegia (HSP) caused by SPAST gene mutations and assess the value of PGT-M and TGS in managing hereditary spastic paraplegia. A family affected by HSP underwent whole exon sequencing (WES), and a c.1699G>T mutation in the SPAST gene was identified. The mutation site in the proband was confirmed through Sanger sequencing. A single nucleotide polymorphism (SNP) site flanking the SPAST gene mutation was selected as the genetic linkage marker, and a SNP haplotype carrying the mutated gene was constructed. Ovarian stimulation using an antagonist regimen was performed for oocyte retrieval, followed by intracytoplasmic sperm injection (ICSI) and embryo culture. Blastocyst trophectoderm cells were biopsied for preimplantation genetic testing for monogenic disorders (PGT-M) to allow the selection of disease-free embryos for transfer. In this cycle, a total of 20 oocytes were retrieved, among which 18 were successfully fertilized to result in 12 blastocysts eligible for biopsy. Genetic testing revealed that all the 12 blastocysts were successfully amplified and confirmed as euploidy. Among them, 8 blastocysts did not carry paternal mutations, and a high-quality euploid embryo was selected for frozen embryo transfer (FET). Subsequent amniotic fluid testing during pregnancy confirmed the absence of paternal mutations in the fetus, resulting in the birth of a healthy baby girl. For cases of genetic diseases with missing pedigree data, the application of third-generation sequencing and PGT-M technique can effectively block vertical transmission of SPAST gene mutation to the offspring, avoid pregnancy with an aneuploid embryo, and help families with autosomal dominant HSP obtain healthy offsprings.

Available Oocytes rate as a predictor of clinical pregnancy outcomes in controlled ovarian stimulation: A retrospective analysis of 7933 Cycles.

Controlled ovarian stimulation (COS) and embryo culture may affect the development and maturation of oocytes obtained by assisted reproduction technologies (ART). This study used the concept of available oocytes rate (AOR) to evaluate the effect of COS and to identify factors that influence oocyte development and clinical pregnancy (CP). Medical data of 7933 patients who underwent oocyte retrieval and ART treatments was retrospectively reviewed at Fujian Provincial Maternity and Children's Hospital from January 2013 to December 2019. Baseline characteristics of patients, concentrations of hormones, as well as endometrial thickness, number of aspirated follicles, retrieved and available oocytes, and CP rates, were analyzed. Univariate and multivariate analyses showed that basal estradiol (E2) (OR=0.98, p=0.04), endometrial thickness on human chorionic gonadotropin (hCG)-day (OR=1.25, p<0.01), number of follicles aspirated (OR=1.58, p<0.01), oocytes retrieved (OR=0.80, p=0.04), available oocytes (OR=0.48, p=0.04) and AOR (OR=1.18, p<0.01) contributed to CP. The receiver operating characteristic (ROC) curve for the CP rates showed a possible cutoff for the AOR (area under the curve (AUC)=0.788, cut off=34.13%). All 103 cycles with an AOR less than 34% were then selected as Group-A, and 103 cycles were selected as Group-C by 1:1 case-control matching. The human menopausal gonadotropin (HMG) dose was significantly different between Group-A and Group-C (1064.00±1042.01 U vs. 675.00±691.67 U, respectively, p=0.006). The duration of HMG usage was 7.88±4.73 days in Group-A and 5.79±3.59 days in Group-C (p=0.014). The AOR is an important indicator of oocyte function and is correlated with clinical pregnancy outcomes of fresh cycles. The AOR could objectively predict HMG as a clinically related factor that affected the number and maturation of oocytes for insemination.

Characterization of the gut microbiota in patients with SARS-CoV-2 infection during controlled ovarian stimulation

BackgroundThe Coronavirus disease 2019 (COVID-19) pandemic has emerged as a global health crisis, with clinical manifestations including those suggesting injury to various organs such as the ovaries, which implies that it extends beyond respiratory infections. Changes in gut microbiota may exhibit correlations with the mechanisms and stages of severity in COVID-19, as well as a link with sex hormones, embryo development, and pregnancy. Controlled ovarian stimulation (COS) is used to induce the development of multiple high-quality follicles during in vitro fertilization (IVF). Our research aimed to investigate whether patients infected with COVID-19 have altered gut microbiota compositions that would affect the outcomes of COS.MethodsTwenty-one healthy females and seventeen patients with COVID-19 were enrolled. Samples were sequenced for gut microbiota identification through 16 S rRNA V3-V4 region, including species annotation, community diversity, and community functions.ResultsNo significant differences were found between the groups in terms of in IVF cycle outcomes and laboratory parameters. Patients with COVID-19 and healthy women showed no significant difference in the total number of available blastocyst embryos. Furthermore, the gut microbiota alpha diversity index in the COVID-19 group were markedly reduced compared to those of healthy females. Comparing the COVID-19 group to the controls, the gut microbiota dysbiosis decreased levels of Ruminococcus, and Agathobater, and elevated levels of Achromobacter and Raistonia. Finally, we identified a series of microbial functional characteristics, including membrane transport and carbohydrate metabolism, that exhibited significant disparities between the two groups.ConclusionsPatients in the COVID-19 group exhibited significant disparities in the gut microbiota composition compared to the healthy women during COS. However, the IVF outcomes did not show any significant differences between the two groups. Collectively, our speculation suggests that SARS-COV-2 infection may alter the gut microbiota without impacting IVF outcomes.

Successful Live Birth Outcome in A Patient with Empty Follicle Syndrome: A Case Report and Literature Review.

Here, we report on a rare case of a successful live birth in a patient with empty follicle syndrome. A 35-year-old woman with ovulatory disorder and a 4-year history of primary infertility conducted in vitro fertilization-embryo transfer (IVF-ET) treatment in our hospital. The patient experienced six controlled ovarian stimulation cycles. In the first two cycles, despite adequate ovarian response, normal development of multiple follicles, and normal serum estradiol (E2) levels, no oocytes were retrieved from these mature follicles during the aspiration procedure. The patient was diagnosed with "empty follicle syndrome". Whole exome sequencing (WES) identified a missense mutation in the luteinizing hormone/chorionic gonadotropin receptor (LHCGR). In subsequent cycles, we try to increase the trigger dosage, combine gonadotropin-releasing hormone agonists (GnRH agonist) with human chorionic gonadotropin (HCG) for a dual trigger, supplement with luteinizing hormone (LH)-like active substances during the stimulation process, and extend the time between triggering and oocyte retrieval. In the end, successful oocyte retrieval and pregnancy were achieved.

A cost-effectiveness analysis of gonadotropins used for ovarian stimulation during assisted reproductive technology based on data from the French nationwide claims database (SNDS).

Various gonadotropins are used for ovarian stimulation (OS). This study investigated the cost-effectiveness of different gonadotropins based on real-world data from the French National Health Database (SNDS) over a 7-year follow-up of assisted reproductive technology (ART) treatments. Cost-effectiveness analysis of different gonadotropins based on real-world data from the French National Health Database (SNDS). Women from SNDS undergoing OS leading to oocyte pick-up registered between 31 Jan 2013 and 31 Dec 2018 (N=245,534 stimulations) and receiving either r-hFSH alfa originator (110,439), its biosimilars (12,287), or urinaries (mainly HP-hMG[65,654] and marginally u-hFSH-HP[7,821]) were included (follow-up:31 Dec 2019). Clinical inputs for this model, including live birth (LB) and cumulative LB (CLB) were calculated from data as published in Grynberg et al. 2022. A decision-tree model was developed comprising pregnancy and live birth rate (LBR) states for a complete ART cycle, including one fresh and ≤4 frozen/thawed embryo transfers and related costs. Cost inputs included those of drugs, ART procedure, pregnancy and delivery, and adverse events. Cost per LB and CLB, and incremental cost-effectiveness ratio (ICER) were assessed. Robustness of results was determined by comprehensive sensitivity analyses. Overall, r-hFSH alfa originator was found to be associated with a lower cost per LB and per CLB (cost per LB: €26,010; CLB: €22,278) versus its biosimilars (cost per LB: €28,037; CLB: €23,807) and versus urinaries (cost per LB: €26,636; CLB: €23,335). Calculated ICERs with r-hFSH alfa for LB were €5,538 and €14,090, whereas for CLB were €1,945 and €13,742 versus biosimilars and urinaries, respectively. Cost-effectiveness acceptability curve showed that in a majority of iterations r-hFSH alfa originator had a probability of being cost-effective at a hypothetical threshold of €20,000/live birth. Sensitivity analyses showed that the most important variable impacting the outcome in fresh transfers was the probability of birth for biosimilars and the probability of pregnancy for urinaries, while for cumulative transfers it was the probability of pregnancy for biosimilars and the probability of birth for urinaries. As the clinical data were obtained from a non-interventional study and not a randomised controlled trial, the results may still be susceptible to residual confounding or other biases Conclusions: r-hFSH alfa originator is cost-effective compared to its biosimilars and to urinaries (mainly HP-hMG) and is associated with a lower cost per LB compared to these gonadotropins, where the main driver is the higher live birth efficacy rate achieved with it.

Ovarian Stimulation Effects on Ghrelin Secretion and Reproductive Potential

ABSTRACTObjectiveFinely regulated Ghrelin (Ghrl) secretion is essential during early pregnancy, as infra or supraphysiologic levels can be detrimental. Since oestrogens stimulate Ghrl synthesis, ovarian stimulation (OS) might increase ghrelinemia, thus being detrimental for fertility. The aim of this work was to evaluate whether OS increases ghrelinemia and associates with maternal endocrine and immune biomarkers and reproductive success.DesignThe 97 women undergoing assisted reproduction were grouped as follows: OS: undergoing OS and fresh embryo transfer (n = 35); FET: undergoing frozen embryo transfer in a cycle different from that of OS (n = 25) and, OD: undergoing embryo transfer in oocyte donation cycles (n = 37). At embryo transfer day, several endocrine and immune biomarkers were assessed.ResultsOS patients showed significantly higher serum estradiol, progesterone and Ghrl, than those not stimulated. Patients that suffered miscarriage showed significantly lower concentrations of sex‐hormones, with a similar trend for Ghrl, that deserves further investigation. Moreover, OS patients showed decreased frequencies of circulating T cells and reduced ratios of uNK/NK cells, which significantly associated with serum levels of sex‐hormones. Besides, ROC curves identified cut‐off values predictive of clinical pregnancy and/or miscarriage for peripheral counts of uNK cells, T cells, and uNK/NK cells ratio.ConclusionsAs hypothesised, OS significantly increased serum Ghrl in correlation with sex‐hormone levels. These last, significantly associated with maternal immune response and reproductive outcome. Although Ghrl exhibited a similar profile, it did not reach statistical significance, indicating the need for further investigation. Additionally, the identification of maternal immunological cut‐off values holds significant clinical relevance.

Analysis of single-cell RNA sequencing in human oocytes with diminished ovarian reserve uncovers mitochondrial dysregulation and translation deficiency

BackgroundDiminished ovarian reserve (DOR) is clinically characterized by a decrease in the number of available ovarian follicles and a decline in the quality of oocytes, accompanied by hormonal changes. Low quality of DOR oocyte leads to impaired embryo development, an increased risk of aneuploid pregnancies and miscarriages. However, the specific pathogenic mechanism remains unclear, posing a significant challenge for assisted reproductive technology.MethodsFor the first time, our study employed single-cell RNA sequencing to reveal the altered transcriptomic landscape of DOR oocytes at GV stage after ovarian stimulation. Differentially expressed genes analysis (DEGs), functional enrichment analysis, weighted gene co-expression network analysis (WGCNA) and protein-protein interactions network analysis were performed.ResultsWe found 132 up-regulated genes and 466 down-regulated genes in DOR oocytes, with the down-regulated genes primarily enriched in mitochondrial function and translation. Hub genes, identified through integrated analysis of WGCNA and DEGs, were further validated in DOR and control oocytes using RT-qPCR. By utilizing hub genes and employing transcription factor enrichment tools, it had been predicted that pleomorphic adenoma gene 1 (PLAG1) played a crucial role as a transcriptional regulatory factor in DOR oocytes. Additionally, we conformed the PLAG1-IGF2 axis was dysregulated in DOR oocytes.ConclusionsTranscriptome analysis revealed that DOR oocytes exhibited mitochondrial dysfunction and translational defects, and the PLAG1-IGF2 axis might be a potential contributor for the low quality of DOR oocytes.

Clinical efficacy of Crinone on pregnancy outcomes in frozen embryo transfer: A retrospective study in the Chinese population.

The aim of this study was to retrospectively investigate the effect of Crinone vaginal gel on pregnancy outcomes in women undergoing natural cycle (NC) frozen embryo transfer (FET) and to obtain the most suitable population for its routine application. The 1613 women who underwent FET in the NC regimen [including the controlled ovulation stimulation protocol for the natural cycle, or the controlled ovulation stimulation protocol for the natural cycle (NC-COS)] from 2017 to 2021 were included. All patients were divided into 2 groups including Control group and Crinone group, which administered with or without Crinone vaginal gel. The key clinical information and between the 2 groups was recorded in detail. The results indicated that there were no statistical differences in blood β human chorionic gonadotropin (HCG) positive rate, clinical pregnancy, live birth, abortion (spontaneous and induced) and stillbirth between Control group and Crinone group. Moreover, Crinone could prevent spontaneous abortion. The spontaneous abortion rate in the Crinone group was 5.93% while this in control group was 8.32%. In the cohort exposed to Femoston, the preventive result was more significant (0/32 vs 5/15, P = .001). Furthermore, Crinone exhibited a significant protective effect on spontaneous abortion in 1520 patients who received no human menopausal gonadotropin (HMG) treatment. This study demonstrated that the Crinone could protect women against spontaneous abortion, especially in patients who do not need HMG or in combination with Femoston.

Oocyte maturity rate is an age-independent predictor of blastocyst development and euploidy rates: a multicenter retrospective study

Research Question Can oocyte maturity rate predict blastocyst development and euploidy rates independently of patient age? Design A multicenter retrospective study including 1547 consecutive women undergoing first in-vitro fertilization cycle of oocyte retrieval-intracytoplasmic sperm injection with preimplantation genetic testing for aneuploidy (IVF/ICSI/PGT-A). Both centers used the same PGT lab for PGT-A testing. Oocyte maturity rate as a predictor for cycle outcomes of blastocyst development and euploidy rates was analyzed by Poisson regression model, after controlling for other known confounders. Results Oocyte maturity rate is positively correlated with blastocyst development rate and euploidy rate after controlling for patient age at cycle start, BMI, AMH levels, total FSH dosage, number of days of ovarian stimulation, and peak estradiol level (p&lt;0.01). Conclusion This study demonstrated that oocyte maturity rate can predict blastocyst development and euploidy rates independently of other confounding factors including patient age. This finding suggests that oocyte maturity rate may serve as an important biomarker for oocyte quality. This can be used by physicians to evaluate and improve the efficacy of ovarian stimulation regimens for IVF. This may further enhance artificial intelligence (AI) capabilities in optimizing ovarian stimulation protocols and outcomes of Assisted Reproductive Technologies (ART).

A multicycle approach through DuoStim with a progestin-primed ovarian stimulation (PPOS) protocol: a valuable option in poor prognosis patients undergoing PGT-A.

This study is to evaluate the effectiveness of a PPOS protocol in poor prognosis patients undergoing IVF with DuoStim and PGT-A versus the conventional protocol with GnRH antagonist. Retrospective cohort study encompassing 444 couples obtained matching one PPOS-DuoStim with two antagonist-DuoStim cycles at a private IVF center between 2020 and 2023 (averagematernal age: 40years, averagecumulus-oocyte complexes collected after the first stimulation: 5). The study was powered to exclude a two-sided different euploid blastocyst rate per MII oocytes (EBR per MII) in the two groups (alpha = 0.05, power = 0.9, effect size = 0.3). All cycles involved ICSI, blastocyst stage PGT-A, and single vitrified-warmed euploid transfers. We compared all embryological and clinical outcomes within each group (first vs. second stimulations), and among the two study arms (first stimulation vs. first stimulation; second stimulations vs. second stimulation; overall). The overall EBR per MII was the primary study outcome. The cumulative-live-birth-rate per concluded cycles (CLBR) was the main secondary outcome. In the second stimulations, we obtained a greater number of COCs and MIIs in both antagonist- and PPOS-DuoStim groups. No difference was observed for all embryological and clinical outcomes when comparing the two stimulations within each group. All embryological and clinical outcomes were comparable also between the two groups, including the EBR per MII. To date, 285 and 121 antagonist- and PPOS-DuoStim cycles were concluded. The CLBR was comparable between the groups: 26% vs. 29%. PPOS-DuoStim holds potential for being an efficient, patient-friendly, and possibly cost-effective approach that does not compromise treatment efficacy. Future investigations must explore PPOS effect on follicular recruitment, neonatal, and long-term outcomes.

Abnormalities of Oocyte Maturation: Mechanisms and Implications.

The elucidation of oocyte maturation mechanisms is paramount for advancing embryo development within the scope of assisted reproductive technologies (ART). Both cytoplasmic and nuclear maturation represent intricate processes governed by tightly regulated cellular pathways, which are essential for ensuring the oocyte's competence for fertilization and subsequent embryogenesis. A comprehensive grasp of these mechanisms is vital, as the maturation stage of the oocyte significantly influences chromosomal integrity, spindle formation, and its ability to support the initial stages of embryonic development. By leveraging this knowledge, we can enhance in vitro fertilization (IVF) protocols, refining ovarian stimulation regimens and culture conditions to improve oocyte quality. This, in turn, has the potential to boost pregnancy rates and outcomes. Further research in this area will contribute to the development of novel interventions that aim to increase the efficacy of preimplantation embryonic development, offering new opportunities for individuals undergoing fertility treatments.

Trends in Anti-Mullerian Hormone levels among Women attending Fertility Clinic in the UAE.

Background: Anti-Müllerian hormone (AMH) is widely recognised as the gold standard for assessing ovarian reserve. It is also utilised to predict ovarian response during controlled ovarian stimulation in assisted reproductive technology (ART) and is key indicator of oocyte yield, embryo quality, embryo euploidy, and live birth rates.

Anti-Müllerian hormone as a predictor of oocyte yield following controlled ovarian stimulation in the rhesus macaque.

Anti-Müllerian hormone (AMH) is widely used in the clinic as a biomarker for ovarian reserve and to predict ovarian response to gonadotropin stimulation. Patients with higher AMH levels tend to yield more oocytes and have better outcomes from assisted reproductive technology (ART) procedures. The goal of this study is to determine if AMH can be used to predict the outcome of controlled ovarian stimulation in rhesus macaques, which are commonly used in biomedical research, to refine animal use while maximizing oocyte yield. We hypothesized that pre-stimulation AMH values can be used to predict oocyte yield and quality. Regularly cycling adult macaques underwent controlled ovarian stimulation and baseline (pre-stimulation) plasma AMH levels were determined using an AMH-specific enzyme-linked immunoassay. Oocytes were collected by laparoscopic or ultrasound-guided aspiration, then counted and evaluated for quality and stage of meiosis. Sperm from established fertile males were used to inseminate the oocytes in vitro with fertilization success checked 14 - 16 hours later. Females were grouped by oocyte yield: low ≤ 17; mid = 18 - 41; high ≥ 42. We found that high and mid yielders had significantly higher AMH than low yielders (p<0.0001) and the percent of mature oocytes was greater in the high and mid yielders. There were no significant differences in oocyte quality or ova fertilization rate. These data suggest that AMH is a useful measure for controlled ovarian stimulation success in rhesus macaques and can be used to identify suitable animals for oocyte donation before entering them into a stimulation protocol.

Predictive values of cervix length measurement based on transvaginal ultrasonography

BACKGROUND: Pregnancy is an important process in women’s life, which is widely concerned by women. In recent years, the incidence of premature delivery (PTD) becomes more and more higher due to the development of auxiliary reproduction and ovulation induction technologies and the changes of pregnant women’s lifestyle and physical quality. PTD not only affects postpartum recovery and causes great physical pains, but it also has adverse effects on the birth state of neonates and even leads to neonatal death OBJECTIVE: The predictive values of cervix length (CL) measurement based on transvaginal ultrasonography (TVUS) and pathological examination of placenta for premature delivery (PTD) were investigated and the correlation between PTD and infection was analyzed. METHODS: 120 pregnant women with PTD or high-risk factors for PTD admitted to The Affiliated Hospital of Southwest Medical University between February 2020 and March 2022 were included as the subjects and underwent pathological examination of placenta and TVUS for CL measurement. The final gestational age was set as the standard for the evaluation on the predictive values of pathological examination of placenta and TVUS. What’s more, 36 subjects in PTD group and 84 in normal delivery group (control group) underwent pathological examination of placenta for the analysis of the correlation between PTD and infection. RESULTS: The joint inspection method showed significantly better sensitivity, specificity, PPV, and NPV compared to single CL or pathological examination of the placenta (P&lt; 0.05). Among pregnant women, those with CL ⩽ 30 mm and positive placental pathology had a higher proportion compared to those with CL &gt; 30 mm and negative placental pathology (P&lt; 0.05). Furthermore, the incidence of Ureaplasma Urealyticum (UU), Chlamydia Trachomatis (CT), and Chorioamnionitis (CA) in vaginal discharge of the preterm delivery (PTD) group was significantly higher than that of the control group (P&lt; 0.05). CONCLUSION: The combination of CL ⩽ 30 mm and positive placental pathology could effectively predict PTD and placental infection was notably correlated with the occurrence of PTD.