Intrauterine Pregnancy Rate Research Articles

Personalized embryo transfer guided by rsERT with hourly precision improves pregnancy outcomes in patients with a receptive window of implantation: a pilot study.

To investigate whether personalized embryo transfer (pET) predicted by a modified RNA-sequencing-based endometrial receptivity test (rsERT) model can improve intrauterine pregnancy rate (IPR) in patients with a receptive window of implantation (WOI). A retrospective pilot study was conducted in the Center for Reproductive Medicine, Central South University, from January 2018 to December 2023. A total of 524 patients with receptive WOI results from rsERT were assigned into two groups based on whether they underwent conventional embryo transfer (conventional ET) or pET. Patients in the conventional ET were matched with those in the pET group at a 1:1 ratio using propensity score matching (PSM). Before PSM, the IPR (55.73% vs. 46.19%, P = 0.032) and implantation rate (IR) (47.51% vs. 34.03%, P = 0.000) in the pET group were significantly higher than that in the conventional ET group. However, the number and types of transferred embryos differed significantly between the two groups. After adjusting for confounding factors, IPR (57.38% vs. 44.81, P = 0.016) and IR (46.81% vs. 33.10%, P = 0.001) remained significantly higher in the pET group compared to the conventional ET group. The implantation failure rate was significantly lower in the pET group compared to controls (42.62% vs. 55.19%, P = 0.016). Additionally, the multiple-pregnancy rate was significantly higher in the pET group compared to the conventional ET group (10.29% vs. 1.68%, P = 0.001). Women with receptive WOI results could benefit from the receptivity-timed pET predicted by the newly refined rsERT. These findings provide a basis for future research in precision medicine for embryo transfer.

Embryonic Parameters Associated With Outcomes of Single Blastocyst Frozen Transfer [ID 2683440

INTRODUCTION: It is unclear how various in vitro fertilization cycle characteristics may ultimately influence the fertility outcomes of patients utilizing assisted reproductive technology. This study investigates embryo characteristics to determine which features are most associated with clinical intrauterine pregnancy after frozen embryo transfer. METHODS: This retrospective study evaluates 535 single blastocyst frozen embryo transfers (FETs) in 2022 and received IRB approval from the University of Kansas. Logistic regression analyses were used to evaluate embryo characteristics and likelihood of clinical intrauterine pregnancy (IUP), defined as positive fetal cardiac activity on ultrasound after 12 weeks of gestation. Blastocyst survival (percentage of live cells), blastocoele re-expansion, and morphological grade were evaluated prior to embryo transfer. Significant embryonic parameters included blastocyst developmental stage and blastocyst grade before cryopreservation, usage of preimplantation genetic testing for aneuploidy (PGT-A), post-warm blastocyst survival (percentage of live cells), degree of blastocoele re-expansion, blastocyst grading before transfer, and presence of zona pellucida. RESULTS: Among 535 FET cycles, 257 (48.0%) resulted in clinical IUP. Multivariate logistic regression analysis showed a significant independent influence of blastocyst development time (day 5/6) (odds ratio [OR] 0.571; P=.003), morphological grade before cryopreservation (day 5/6) (OR 0.648; P=.013), usage of PGT-A (OR 1.704; P=.010), and percentage of post-thaw live cells (OR 0.322; P=.001) on embryo transfer success rates. While fully expanded blastocysts showed a significantly higher rate of clinical IUP, the degree of blastocoele re-expansion did not appear to be independently related to ongoing pregnancy when multivariate logistic regression analysis was employed (OR 2.886; 95% CI: 0.824–10.105; P=.097). CONCLUSION: In addition to blastocyst quality prior to cryopreservation, post-thaw blastocyst survival is an independent predictor of embryo recovery and further development potential. Additional understanding of the potential contributors to failed FETs can inform strategies for improvement. Further investigation is needed to determine how to minimize embryonic cell damage during the vitrification and warming process.

Effect of different starting doses of FSH on laboratory and clinical outcomes in patients with moderate AMH level.

IVF and ICSI-ET are widely used ART for addressing infertility which have been developed and improved over the last four decades. COS is a crucial step in IVF/ICSI-ET, whereby medications stimulate the ovaries to produce multiple eggs. The success of the procedure depends on the number of eggs retrieved, and individualized ovarian stimulation protocols based on factors like age and ovarian reserve can optimize the chances of obtaining mature oocytes. The optimal starting dose of FSH at moderate AMH levels remains a topic of debate., tThis study aims to compare different starting doses of FSH in clinical outcomes by analyzing data from a single center. This retrospective study collected clinical material from patients with moderate AMH levels at 1.2 ~ 4.5ng/mL who received IVF/ICSI-ET under a follicular phase long protocol from July 2018 to December 2021 at Guiyang Maternal and Child Health Care Hospital, China. The patients' clinical data were retrieved from the hospital's software database and divided into two groups based on FSH starting dose, as follows: lower starting dose group: FSH ≤ 150IU; and higher starting dose group: FSH > 150IU. Multiple laboratory and clinical outcomes were compared between the two groups. A total of 1784 patients with moderate serum AMH levels who received IVF/ICSI-ET under a follicular phase long protocol were enrolled based on eligibility criteria. In the population with moderate AMH levels, a lower starting dose of FSH might have more benefit than a higher starting dose in numbers of follicles with diameters ≥ 14mm and < 16mm, ≥ 16mm and < 18mm, and ≥ 18mm; numbers of retrieved oocytes, 2PNs, transferable embryos, high-quality embryos, and cleavage stage embryos transferred; and clinical pregnancy rate, intrauterine pregnancy rate, and parturition rate. Moreover, rFSH had a statistically significantly higher number of oocytes retrieved, number of 2PNs, and number of transferable embryos than that of patients who received uFSH. The starting dose of FSH in the moderate AMH population remains controversial and a higher starting dose may not lead to more benefit in laboratory and clinical outcomes.

#238 : rsERT Guided Personalized Embryo Transfer Improves Clinical Outcomes in RIF Patients

Background and Aims: Narrowed or shifted window of implantation (WOI) is acknowledged to be one of the endometrial origins of embryo implantation failure, especially in patients with repeated implantation failure (RIF). RNA-Seq-based endometrial receptivity test (rsERT) was developed to assess the endometrial receptivity (ER) and guide the personalized embryo transfer (pET). Clinical studies were conducted to evaluate the clinical utility of rsERT in RIF patients. Method: 566 RIF patients with rsERT and pET in multi-centers from 2019-2022 were included in this retrospective study, which was defined as rsERT-pET group. RIF patients without rsERT and pET in the same period was used as control for comparison. rsERT-pET group was further divided into normal WOI (nWOI) and shifted WOI (sWOI) groups. Clinical pregnancy rate and ongoing pregnancy rate were therefore compared among these groups by nonparametric statistical approaches. Results: The intrauterine pregnancy and ongoing pregnancy rates of rsERT-pET group were receptively 55.0% and 46.2%, which were significantly higher than those of the control group (55.0% vs 35.1%, OR = 2.26, p-value = 2.33×10[Formula: see text]; 46.2% vs 19.8%, OR = 3.45, p-value = 4.08×10[Formula: see text] ). We further evaluated the intrauterine pregnancy rates of sWOI and nWOI and found remarkably better pregnancy outcomes in patients from nWOI group compared to those in sWOI group patients (62.4% vs 50.4%, OR = 1.64, p-value = 0.005). Conclusion: The pET guided by the result of rsERT significantly improved the clinical outcomes in patients with RIF based on the intrauterine pregnancy rate and the ongoing pregnancy rate, indicating the clinical potential of rsERT method.

Treatment outcomes of tubal pregnancy with tubal preservation: A meta-analysis.

Ectopic pregnancy is a common gynecological emergency that poses a significant risk of maternal mortality during the first trimester. It also increases the incidence of infertility and repeated ectopic pregnancy. The aim of this study was to evaluate whether there is a difference in the degree of tubal patency between salpingostomy and systemic treatment with methotrexate (MTX), as well as the odds of intrauterine pregnancy and repeat ectopic pregnancy, and the degree of tubal patency in salpingectomy with or without tubal suturing. We searched PubMed, EMBASE, and the Cochrane Library up to April 2023. Four randomized controlled trials were included in the review. We analyzed the combined data using Review Manager 5.3 software and Stata 12.0 software, utilizing a random effects model. When comparing salpingostomy and systemic treatment with MTX, there was no significant difference in the degree of tubal patency (OR = 1.09, 95% CI (0.54-2.38), P = .83). For salpingostomy with or without tubal suturing, there were no significant differences in the rates of intrauterine pregnancy, repeat ectopic pregnancy, and tubal patency degree [(OR = 1.05, 95% CI (0.41-2.68), P = .92), (OR = 0.68, 95% CI (0.19-2.42), P = .92), (OR = 1.68, 95% CI (0.14-20.33), P = .68)]. This meta-analysis demonstrates that systemic treatment with MTX is an effective treatment for patients who wish to preserve their fallopian tubes without undergoing surgery. This form of treatment can help avoid surgical procedures that may damage the fallopian tubes and improve fertility prospects. If choosing surgery, we believe that opting for salpingostomy without tubal suturing could reduce the operation time and minimize damage.

Hyperbaric oxygen therapy: a possible choice for patients with resistant thin endometrium during frozen embryo transfer treatments

BackgroundThin endometrium is considered suboptimal for embryo implantation, leading to compromised pregnancy rates without effective therapies. While some studies have reported promoted endometrial growth after a period of hyperbaric oxygen therapy (HBOT) in patients with intrauterine adhesion, there have been no reports in patients with resistant thin endometrium. The purpose of this study was to investigate the impact of HBOT on endometrium growth and pregnancy outcomes in patients with resistant thin endometrium during frozen embryo transfer (FET) treatments.MethodsThis prospective pre-post cohort study was conducted at a university-affiliated assisted reproductive medical center between October 2021 and December 2022. Patients who had experienced at least one canceled transfer cycle due to a thin endometrium(< 7 mm) on the endometrium transformation day, despite the use of standard therapies as well as adjuvant therapies, were enrolled in the study. Patients were assigned voluntarily to either the HBOT group or the concurrent control group. The HBOT group received daily HBOT for at least 10 days during the proliferative phase, in addition to the routine endometrium preparation methods and the concurrent control group underwent cycles without HBOT. Propensity score matching (PSM) was used to ensure comparability between the groups. Both self-control and case-control comparisons were conducted. The primary outcome measured was endometrial thickness (ET) on the day of endometrium transformation. Secondary outcomes included intrauterine pregnancy rate (IPR), embryo implantation rate (IR), miscarriage rate, and others.ResultsPatients in the HBOT group demonstrated a significantly thicker endometrial thickness on the day of endometrium transformation after undergoing therapy (5.76 ± 1.66 vs. 6.57 ± 1.23, P = 0.002). This improvement was accompanied by a decreased rate of cycle cancellations. Baseline parameters and endometrial thickness were comparable between the HBOT group and the concurrent control group during the cycle. The IPR was similar in patients who received cleavage-stage embryos (0.0% vs. 6.7%, P = 1.00), but significantly higher in patients in the HBOT group who received blastocysts (53.8% vs. 18.2%, P = 0.017).ConclusionsA period of HBOT prior to endometrium transformation contributes to increased endometrial thickness and facilitates blastocyst implantation in patients with resistant thin endometrium during FET treatments.Trial registrationThe trial was registered on the Chinese Clinical Trial Registry (registration no. ChiCTR2300072831, retrospectively registered).

Treatment strategies for intrauterine adhesion: focus on the exosomes and hydrogels.

Intrauterine adhesion (IUA), also referred to as Asherman Syndrome (AS), results from uterine trauma in both pregnant and nonpregnant women. The IUA damages the endometrial bottom layer, causing partial or complete occlusion of the uterine cavity. This leads to irregular menstruation, infertility, or repeated abortions. Transcervical adhesion electroreception (TCRA) is frequently used to treat IUA, which greatly lowers the prevalence of adhesions and increases pregnancy rates. Although surgery aims to disentangle the adhesive tissue, it can exacerbate the development of IUA when the degree of adhesion is severer. Therefore, it is critical to develop innovative therapeutic approaches for the prevention of IUA. Endometrial fibrosis is the essence of IUA, and studies have found that the use of different types of mesenchymal stem cells (MSCs) can reduce the risk of endometrial fibrosis and increase the possibility of pregnancy. Recent research has suggested that exosomes derived from MSCs can overcome the limitations of MSCs, such as immunogenicity and tumorigenicity risks, thereby providing new directions for IUA treatment. Moreover, the hydrogel drug delivery system can significantly ameliorate the recurrence rate of adhesions and the intrauterine pregnancy rate of patients, and its potential mechanism in the treatment of IUA has also been studied. It has been shown that the combination of two or more therapeutic schemes has broader application prospects; therefore, this article reviews the pathophysiology of IUA and current treatment strategies, focusing on exosomes combined with hydrogels in the treatment of IUA. Although the use of exosomes and hydrogels has certain challenges in treating IUA, they still provide new promising directions in this field.

Intracytoplasmic sperm injection versus conventional in vitro fertilisation in couples with males presenting with normal total sperm count and motility.

Starting over 40 years ago, in vitro fertilisation (IVF) has become the cornerstone for fertility treatment. Since then, in 1992, Palermo and colleagues successfully applied the technique intracytoplasmic sperm injection (ICSI) to benefit couples where conventional in vitro fertilisation (c-IVF) and sub-zonal insemination (SUZI) proved unsuccessful. After this case report, ICSI has become the treatment of choice for couples with severe male factor subfertility. Over time, ICSI has been used in the treatment of couples with mild male and even unexplained infertility. This review is an update of the review, first published in 1999, comparing ICSI with c-IVF for couples with males presenting with normal total sperm count and motility. To evaluate the effectiveness and safety of ICSI relative to c-IVF in couples with males presenting with normal total sperm count and motility. We searched the following databases and trial registers: Cochrane Central Register of Controlled Trials (CENTRAL), Embase (excerpta Medica Database), MEDLINE (Medical Literature Analysis and Retrieval System Online) and PsycINFO (Psychological literature database) for articles between January 2010 and 22 February 2023. We included randomised controlled trials (RCTs) that compared ICSI with c-IVF in couples with males presenting with normal total sperm count and motility. We used standard methodical procedures recommended by Cochrane. The primary review outcomes were live birth and adverse events. Secondary outcomes included clinical pregnancy, viable intrauterine pregnancy and miscarriage. The original review published in 2003 included one RCT. In this 2023 update, we identified an additional two RCTs totalling a cohort of 1539 couples, comparing ICSI with c-IVF techniques. Two studies reported on live birth. Using the GRADE method, we assessed the certainty of evidence and reported evidence as low-certainty for live birth. We are uncertain of the effect of ICSI versus c-IVF for live birth rates (risk ratio (RR) 1.11, 95% confidence interval (CI 0.94 to 1.30, I2 = 0%, 2 studies, n = 1124, low-certainty evidence). The evidence suggests that if the chance of live birth following c-IVF is assumed to be 32%, the chance of live birth with ICSI would be between 30% and 41%. For adverse events; multiple pregnancy, ectopic pregnancy, pre-eclampsia and prematurity, there was probably little or no difference between the two techniques. No study reported the primary outcome stillbirth. For secondary outcomes, we are uncertain of the effect of ICSI versus c-IVF for clinical pregnancy rates (RR 1.00, 95% CI 0.88 to 1.13, I2 = 45%, 3 studies, n = 1539, low-certainty evidence). Comparison of viable intrauterine pregnancy rates showed probably little or no difference between ICSI and c-IVF (RR 1.00, 95% CI 0.86 to 1.16, I2=75%, 2 studies, n = 1479 couples, moderate-certainty evidence). The high heterogeneity may have been caused by one older study conducted when protocols were less rigorous. The evidence suggests that if the chance of viable intrauterine pregnancy following c-IVF is assumed to be 33%, the chance of viable intrauterine pregnancy with ICSI would be between 28% and 38%. Miscarriage rates also showed probably little or no difference between the two techniques. The current available studies that compare ICSI and c-IVF in couples with males presenting with normal total sperm count and motility, show neither method was superior to the other, in achieving live birth, adverse events (multiple pregnancy, ectopic pregnancy, pre-eclampsia and prematurity), also alongside secondary outcomes, clinical pregnancy, viable intrauterine pregnancy or miscarriage.

P-483 Application of RNA-sequencing based predictive model for endometrial WOI in patients with recurrent implantation failure: a prospective cohort study

Abstract Study question Is intrauterine pregnancy rate following a FET timed by the rsERT with hour precision higher than the conventional FET among patients with recurrent implantation failure? Summary answer Personalized embryo transfer (pET) guided by this newly optimized rsERT significantly improved pregnancy outcomes of patients with recurrent implantation failure (RIF). What is known already Asynchrony between blastocyst and endometrium is responsible for implantation failures. Hence, accurate prediction for endometrial window of implantation (WOI) would maximize the effectiveness of assisted reproductive technology (ART). Previously, we have established a predictive model for endometrial WOI (rsERT) by three-time points sampling from the same patient at 48-hour intervals during one menstrual cycle. To avoid multiple sampling and build a more efficient WOI prediction tool, estimation method with hour precision by single time point sampling is urgently needed. Study design, size, duration This was a two-phase strategy involving model optimization and benefit evaluation with a prospective controlled trial. The study was performed in a tertiary hospital setting between September 2018 and December 2021. In the first phase (September 2018-June 2020), 91 participants were recruited to optimize the rsERT. In the second phase (June 2020-December 2021), 176 patients with RIF were enrolled to valida the clinical efficacy of this newly optimized rsERT. Participants/materials, setting, methods First phase: endometrium samples were obtained from sampling on LH + 5, +7, +9 or P + 3, +5, +7 respectively. Samples were predicted by the rsERT. Only those in agreement with theoretical WOI timing and from whom successfully obtained intrauterine clinical pregnancy after subsequent FET were eligible. Second phase: 88 patients in the experimental group underwent pET timed by rsERT after sampling at LH + 7 or P + 5. 88 patients in the control group performed standard embryo transfer without sampling. Main results and the role of chance This newly optimized predictive model could provide hour-based results of endometrial WOI and have an average accuracy of 94.51% by using 10-fold cross validation. In the second phase, a total of 88 NGS were constructed for RNA-sequencing by using endometrial biopsy samples from RIF patients in the experimental group (n = 88). The results indicated WOI displacement in 40 of 88 (45.45%). Among them, advanced WOI occurred in two patients (2/40, 5.00%), and delayed WOI occurred in 38 patients (38/40, 95.00%). The baseline clinical parameters, including age, BMI, infertility duration, types of infertility, number of previous failed cycles, main aetiology of infertility, the prevalence of pre-implantation genetic screening/diagnosis (PGS/PGD), endometrial thickness, endometrial types, the percentage of transferred blastocysts, good-quality embryo transferred rate and number of transferred embryos were all comparable between the two groups (P &amp;gt; 0.05). The intrauterine pregnancy rate (IPR) and implantation rate (IR) of the experimental group were significantly improved compared to those of the control group (for IPR: 61.36% vs. 31.82%, RR 3.630, 95%CI 1.958-6.732, P = 0.000; for IR: 42.86% vs. 24.66%, RR 2.292, 95%CI 1.392-3.772, P = 0.001). Moreover, in the experimental group, pregnancy outcomes did not exhibit remarkable differences between the natural cycle and hormone replacement (HRT) cycle. Limitations, reasons for caution Caution is warranted due to the non-randomized design and limited sample size of the study. Besides, embryonic factors should be taken into consideration as well. Hence, a multi-center randomized controlled trial of rsERT combined with PGT is needed to further validate its clinical efficacy. Wider implications of the findings These data add a new alternative of predictive model for endometrial WOI among Chinese women. Trial registration number the National Key Research and Development Program of China

The Effect of Probiotic Supplementation in Intrauterine Sperm Insemination Pregnancy Rate

Background: By using probiotic products, such as Lactovag, which contain high amounts of a safe and beneficial bacterial strain, the vaginal microbiome can be near healthy in infertile women, and as a consequence, the reproductive outcomes are improved. Objectives: The present study was done to assess the effect of Lactovag on pregnancy outcomes in IUI cycles. Methods: This single-blind clinical trial was conducted on 194 infertile women who underwent IUI in the infertility clinic of Yas Hospital between December 2021 and March 2022. In the intervention group, two weeks before IUI, Lactovage suppository was prescribed once per night, while in the control group, no extra interventions were done. All the patients underwent IUI in the same way. The primary outcomes of the study were biochemical and clinical pregnancy rates. Results: The average age of women was 30.51 ± 4.6 years, ranging from 22 to 43 years. The average age of the women’s partner was 34.89 ± 4.41 years, ranging from 24 to 49 years. There were no significant differences regards the basic information of the two study groups. The most common infertility cause was polycystic ovary syndrome (40.7%). The biochemical and clinical pregnancy rate was 12.4% in the Lactovage group and 10.3% in the control group. Although the pregnancy rate improved with a Lactovage prescription, this difference was insignificant (P-value = 0.651). Conclusions: While the pregnancy rate in women with probiotic therapy was higher, it was insignificant. Future randomized studies are needed to definitively examine probiotic therapy and establish its benefit in women candidates for IUI.

Evaluation of Early Frozen Blastocyst Transfer in A True Natural Cycle Protocol in Comparison to A Hormone Replacement Protocol: A Single-Center Cohort Study.

Timing of frozen embryo transfer (FET) within a purported window of implantation is of increasing interest, and there is a paucity of evidence surrounding the transfer of frozen embryos early within these frozen embryo transfer protocols. This study aimed to evaluate whether live birth rates were equivalent after FET of blastocysts 4 days after luteinizing hormone (LH) surge in a true natural cycle protocol, compared to a hormone replacement (HR) protocol. Single-centre, retrospective cohort study involving patients undergoing autologous frozen blastocyst transfer from January 1st, 2013, to December 31st, 2016. Cycles were grouped according to their protocol: true natural cycle (hormonal detection of LH surge with FET scheduled four days later) versus HR cycle (luteal phase gonadotropin-releasing hormone agonist suppression, oral or vaginal estradiol and intramuscular progesterone starting five days before FET). A total of 850 cycles were included, 501 true natural cycles and 349 HR cycles. The primary outcome was the live birth rate, secondary outcomes included clinical pregnancy rate and miscarriage. Logbinomial regression models were performed adjusting for a priori selected variables. Adjusted resulted in live birth rates of 38.7 and 40.4%, [adjusted risk ratio (aRR): 0.96, 95% confidence interval (CI): 0.76-1.22, P=0.729] in the natural cycle and HR groups, respectively. The secondary outcome analyses did not demonstrate any statistically significant difference in the rate of positive human chorionic gonadotropin (hCG), clinical intrauterine pregnancy rate, or miscarriage rate. The timing of the FET four days after LH surge in a true natural cycle protocol results in equivalent live birth rates compared to a HR protocol. Results of this study suggest that the window of implantation within the natural cycle may be less finite than currently believed and further prospective studies evaluating the timing of frozen embryo transfer are warranted.

A comparison of special intrauterine balloons and intrauterine contraceptive devices in the treatment of intrauterine adhesions

PurposeThis study aimed to compare the efficacy of a special kind of intrauterine balloon (IUB) and that of an intrauterine contraception device (IUD) for patients with intrauterine adhesions (IUAs) after transcervical resection of adhesion (TCRA).MethodsIn this retrospective cohort study, after TCRA, 31 patients received a special IUB, and 38 patients received an IUD. The Fisher exact test, logistic regression method, Kaplan–Meier method and Cox proportional hazards regression model were used for statistical analysis. A two-sided value of P < 0.05 was considered statistically significant.ResultsThe readhesion rate significantly differed between the IUB group and IUD group, at 15.39% and 54.06%, respectively (P = 0.002). For recurrent moderate IUA, patients in the IUB group had lower scores than patients in the IUD group (P = 0.035). There was a significant difference in the intrauterine pregnancy rate of IUA patients in the IUB group and IUD group after treatment, with rates of 55.56% and 14.29%, respectively (P = 0.015).ConclusionPatients in the special IUB group had better outcomes than those in the IUD group, which has a certain guiding significance for clinical work.

Which patients with hydrosalpinx will benefit more from reproductive surgery to improve natural pregnancy outcomes?: A systematic review and meta-analysis.

The most common tubal disease leading to infertility occurs in the distal region, manifesting as hydrosalpinx. Tubal surgery is an effective alternative treatment. However, subpopulations that benefit the most from tubal repair surgery remain unclear. The objective of this study was to investigate the natural pregnancy outcomes of patients with hydrosalpinx after reproductive surgery and those with different grades of hydrosalpinx. We searched the major online databases (PubMed, Embase, Cochrane Library, Web of Science, and Clinical Trials) to collect observational studies on patients with hydrosalpinx who underwent surgeries to preserve natural fertility from January 2000 to August 2022. The outcome indicators were natural intrauterine pregnancy (IUP) and ectopic pregnancy (EP) rates. Studies on patients with hydrosalpinx who underwent laparoscopic surgeries and those who intended to be conceived naturally were included. Studies on patients with non-hydrosalpinx diseases, those who underwent open surgery, and those who intended to undergo assisted conception were excluded. The Newcastle-Ottawa scale for observational studies was used for quality evaluation. Meta-analysis of a single rate was performed using RevMan5.3 software. A total of 10 articles were included in this study, including 1317 patients with hydrosalpinx. Seven studies were retrospective and 3 were prospective. It was found that after surgery for preserving natural fertility function, the IUP and EP rates of patients with hydrosalpinx were 27% (95% confidence interval [CI]: 22-32%) and 4.8% (95% CI: 2.91-8.26%), respectively. In addition, the IUP and EP rates in patients with mild (n = 254), moderate (n = 252), and severe (n = 473) hydrosalpinx were 50.5% (95% CI: 38.65-61.97%), 32.9% (95% CI: 21.88-46.24%), 10.7% (95% CI: 4.76-21.88%), and 7.4% (95% CI: 2.91-19.35%), 9.09% (95% CI: 6.54-13.79%), 8.3%, 8.26% (95% CI: 3.85-18.03%), respectively. Patients with mild to moderate hydrosalpinx will benefit more from reproductive surgery to improve natural pregnancy outcomes. However, the small sample size in our study needs to be further expanded, and the grouping needs to be more refined, such as grouping based on age. This may provide more guidance in clinical practice.

Endoscopic Tubal Restorative Surgeries for Tubal Factor Infertility at a Teaching Hospital in North Central Nigeria: A Preliminary Report of a Prospective Longitudinal Study

Abstract Background: Tubal surgery is an acceptable treatment option for infertility due to tubal factors. However, in the era of assisted reproductive technology, the use of restorative tubal surgery for the treatment of tubal factor infertility has been reduced. Objectives: This study was conducted to determine the incidence of endoscopic tubal surgery, tubal factor infertility, fertility outcomes, and factors that influence successful or favorable outcomes among women with gynecological endoscopic surgeries for tubal factor infertility. Materials and Methods: This is a preliminary report of a prospective longitudinal study of women with endoscopic tubal restorative surgery for tubal factor infertility at a Federal Teaching Hospital in North Central Nigeria between November 9, 2016, and February 12, 2020. Thirty-four women aged 26–42 years who had bilateral tubal blockage before surgeries were analyzed. The primary outcome measure was clinical pregnancy, whereas secondary outcomes were tubal patency, live birth, miscarriage, and ectopic pregnancy rates. Data were analyzed using Statistical Package for the Social Sciences version 26. Data analysis was descriptive and inferential at a 95% confidence interval, P &lt; 0.05 was considered statistically significant. Logistic regression was carried out to determine independent factors for successful fertility outcomes after endoscopic tubal surgery. Results: There were 1534 gynecological admissions among whom 159 (10.4%) had endoscopy surgeries for infertility. Of the 159 women, 37 (23.3%) had confirmed tubal infertility with bilateral tubal blockage on hysterosalpingography and laparoscopy with a dye test. Thirty-four (women who met the inclusion criteria were analyzed and three women who had salpingectomy and bilateral tubal disconnection and those with AMH of &lt;1.0ng/mL were excluded from the study. The mean age was 34.0 ± 5.2 years, and the majority (67.6%) were nulliparous. Peritubal adhesions were the most common tubal pathology seen on laparoscopy. Hysteroscopic tubal cannulation with selective salpingography (41%), salpingolysis (29%), salpingostomy (21%), and fimbrioplasty (9%) were the interventions performed. Bilateral and unilateral tubal patencies were achieved in 58.8% and 32.5%, respectively. The overall cumulative clinical pregnancy rate was 38.2%, out of which 35.3% conceived spontaneously. Live births (LBs) and miscarriage rates are 20.6% and 17.6%, respectively. There was no ectopic pregnancy. Regression estimates showed that lower age (P = 0.029), lesser duration of infertility (P = 0.038), and treatment of other etiological factors at the same setting (P = 0.019) are independent factors for successful fertility outcome after endoscopic restorative tubal surgery. Conclusions: The high rate of spontaneous intrauterine pregnancy and LBs in this study rekindles the hope of natural conception at a low cost among women with tubal factor infertility.

Therapeutic effect of laparoscopic salpingotomy vs. salpingectomy on patients with ectopic pregnancy: A systematic review and meta-analysis.

Background and aimLaparoscopic treatment of ectopic pregnancy mainly includes laparoscopic salpingotomy and salpingectomy. We aimed to assess the therapeutic effect of laparoscopic salpingotomy and salpingectomy on patients with tubal pregnancy.MethodsFrom January 2000 through June 2022, the Cochrane Library, Medline, PubMed, Web of Science, EMBASE, and the Chinese Biomedicine Database were searched for studies that compared the therapeutic effect of laparoscopic salpingotomy vs. salpingectomy in the treatment of tubal pregnancy.ResultsTwenty-four randomized clinical trials (RCTs) studies were incorporated into this analysis. No statistical differences were found between the two groups in terms of operation duration and postoperative hospitalize length, but the volume of intraoperative blood loss in patients with laparoscopic salpingotomy was less than that in salpingectomy. Importantly, the natural intrauterine pregnancy rate after laparoscopic salpingotomy was significantly higher than those who underwent salpingectomy. In addition, laparoscopic salpingotomy can better protect the ovarian reserve function and endocrine function and provide favorable conditions for the second pregnancy.ConclusionPatients with ectopic tubal pregnancy should give priority to laparoscopic salpingotomy for embryo extraction.

Tubal ectopic pregnancy: a retrospective cohort study on clinical characteristics, treatment options and reproductive outcomes within 5years.

To investigate the association between different treatments of tubal ectopic pregnancy (EP) -expectant management, methotrexate (MTX), selected or recommended laparoscopic surgery-and the subsequent reproductive outcomes. We conducted a retrospective cohort study including 228 EPs. The patients were divided into four treatment groups: 28 (12.3%) with expectant management successfully, 60 (26.3%) with MTX successfully, 140 patients with laparoscopic salpingectomy, of which 47 (20.6%) were assigned to selected surgery group because they opted for surgical treatment versus MTX, 93 (40.8%) were assigned to recommended surgery group as recommended by the attending physician. The recommended surgery group had the lowest rate of intrauterine pregnancy (IUP) (77.42%) and live birth (LB) (72.04%), while the incidence of recurrent EP (REP) (20.43%) was the highest, but the statistical differences were not significant. We did not observe significant differences of the EP-IUP time interval, rates of LB and miscarriage (MIS) between the four groups. Compared to the MTX group, recommended surgery was negatively associated with IUP (adjusted OR, 95%CI: 0.34, 0.11-1.03) and LB (0.35, 0.14-0.92), while it had higher risk for REP (3.48, 1.03-11.74) in the subsequent pregnancy. Further, compared to selective surgery group, recommended surgery was negatively associated with IUP (0.15, 0.03-0.68) and LB (0.23, 0.07-0.74), while it had higher risk for REP (6.83, 1.43-32.67) in the subsequent pregnancy. Expectant treatment was negatively associated with assisted reproductive technology (ART) (0.08, 0.02-0.40) compared with MTX. Of the185 patients who had LBs, all adverse outcomes were not statistically different between the four groups. Patients with recommended laparoscopic salpingectomy had worse reproductive outcomes than the other treatment groups. The disease status of EP may play an important role in the association rather than the surgery alone.

Comparisons of Fertility Outcomes Following a Salpingectomy and a Salpingotomy with or Without Suturing for a Tubal Ectopic Pregnancy.

ObjectiveThis study aimed to compare fertility outcomes in patients who underwent different laparoscopic surgeries and to determine the most beneficial surgical treatment for tubal ectopic pregnancy (EP) patients who wished to become pregnant in the future.MethodsIn this retrospective study, patients aged 18–36 years, who had been diagnosed with a tubal EP in our hospital, were enrolled. Based on the treatment methods, the patients were divided into three groups, ie a salpingectomy group, a salpingotomy with suturing group and a salpingotomy without suturing group. The follow-up time for the enrolled patients was more than three years. Serum beta (β)-human chorionic gonadotropin (β-HCG) levels were monitored after surgery. The intrauterine pregnancy (IUP) rate at 12, 24 and 36 months postoperatively, and recurrent EP rate were compared.ResultsThe median time for β-HCG level returning to normal in the salpingectomy group was much shorter than in the salpingotomy with suturing or salpingotomy without suturing groups (P < 0.001). The 12, 24 and 36-month IUP rates among the three groups were not significantly different. A recurrent EP was found in only one patient in the salpingotomy with suturing group and two patients in the salpingotomy without suturing group.ConclusionIn this study, we found that salpingectomy and salpingotomy with or without suturing methods reflected no significant differences in fertility outcomes for tubal EP patients.

P-187 Post-thaw embryo quality is not predictive of live birth rates in frozen embryo transfer cycles: a retrospective cohort study

Abstract Study question To determine whether post-thaw change in embryo quality is associated with live birth outcomes. Summary answer Post-thaw embryo morphology is not predictive of live birth rates in single frozen embryo transfer cycles. What is known already Embryo quality is typically evaluated via morphological assessment of embryos based on the Gardner criteria. For medical or elective reasons, embryos are commonly frozen for future use through the vitrification process. Research has shown that embryo quality pre-vitrification correlates highly with freeze-thaw survival, implantation, pregnancy, and subsequent live birth rates. Good-quality embryos are therefore more likely to be selected for vitrification. However, it is not unusual to find a decline in the quality of these vitrified embryos upon thawing them for embryo transfer. Study design, size, duration We retrospectively identified a patient cohort based out of the Ottawa Fertility Centre in Ottawa, Ontario, Canada, between 2016 and 2020. Participants/materials, setting, methods Frozen single embryo transfer (FET) cycles involving good-quality expanded blastocysts deriving from autologous oocytes were selected for inclusion. We compared FET cycles involving good post-thaw embryo quality to those with worsened/poor post-thaw embryo quality. The primary outcome was live birth after FET. Secondary outcomes included rates of positive serum human chorionic gonadotropin, clinical intrauterine pregnancy, miscarriage, and ectopic pregnancy. We fit a multivariate logistic regression model, adjusting for patient and cycle characteristics. Main results and the role of chance A total of 962 single FET cycles were analyzed. There were 826 embryos that preserved their pre-vitrification quality post-thaw and 136 embryos that exhibited poorer quality on post-thaw assessment. Baseline characteristics were mostly comparable between the two groups under study. In the multivariate regression model, the adjusted odds of live birth was not significantly different in the group with good post-thaw embryo quality compared to that in the group with worse/poor post-thaw embryo quality (odds ratio [OR] 1.30, 95% confidence interval [CI] 0.86-1.96, p = 0.21). Similarly, no significant associations were found between post-thaw embryo quality and the secondary outcomes of positive BhCG (OR 1.19, 95% CI 0.81-1.75), clinical intrauterine pregnancy (OR 1.29, 95% CI 0.87-1.87), miscarriage (OR 0.97, 95% CI 0.53-1.77), and ectopic pregnancy rates (OR 0.41, 95% CI 0.14-1.24). Limitations, reasons for caution Although a multivariate regression model was used to adjust for clinically relevant confounders, there remains the possibility for residual confounding given the observational nature of our study. Wider implications of the findings The results of our study suggest that, after adjusting for patient and cycle characteristics, post-thaw embryo quality does not impact live birth outcomes. Trial registration number Not applicable

Dose-Effect Relationship of Chitosan and Danshen Combined Injection for Fallopian Tube Recanalization.

Objectives: This study examined the dose-effect relationship of chitosan and danshen combined injections on the long-term prevention of fallopian tube re-obstructions, with increased pregnancy rates in infertile women. Methods: High-performance liquid chromatography was used to determine the content changes of combined chitosan and danshen injection. Two hundred and eighty patients with fallopian tube obstructions were randomly assigned to four groups. Group A (control group, saline), Group B (2 ml chitosan, 4 ml danshen), Group C (2 ml chitosan, 10 ml danshen), and Group D (1 ml chitosan, 10 ml danshen). Injections were administered after tubal recanalization. Results: The effective constituent of chitosan and danshen injection was stable. Tubal patency rate was 94.2% and 87.3% in Group C after 1 and 3 years, respectively, which was significantly higher than Groups A (38.6%, 31.5%), B (73.5%, 64.1%), and D (68.5%, 50.7%). Intrauterine pregnancy rates were 61.8% and 79.4% in Group C after 1 and 3 years, respectively, and were significantly higher than Groups A (31.8%, 34.8%), B (40.1%, 62.5%), and D (38.5%, 58.5%) (p < 0.05). Conclusion: Combined Chitosan and danshen injections prevented tubal obstruction and increased pregnancy rates for long periods using an optimal ratio of 1 part chitosan and 5 parts danshen.

Should expectant management of heterotopic pregnancy be considered?

Both expectant and interventional managements are acceptable in selected cases, when heterotopic pregnancy is diagnosed, with high ongoing intra-uterine pregnancy rate and term deliveries. Heterotopic pregnancy, though relatively rare, is potentially a life-threatening condition. The aim of the study is to compare expectant versus interventional management of heterotopic pregnancies. This is a retrospective cohort study including all women diagnosed with heterotopic pregnancy on ultrasound from March 2011 to December 2020 in a single medical center. Expectant and interventional management outcomes were compared. Primary outcome was defined as live birth. Forty-one women were diagnosed with heterotopic pregnancy during the study period. Management was expectant in 10 (24.4%) and interventional in 31 (75.6%) of the women. Expectant management was considered when the patient was stable, and the attending physician decided that the ectopic pregnancy did not continue to develop. Interventions included laparoscopic salpingectomy (n = 26), laparoscopic cornual resection (n = 2), laparotomic cornual resection (n = 1) and gestational sac aspiration (n = 2). The intra-uterine pregnancy continued to develop in 6 (60.0%) and 22 (81.5%) of the women in the expectant and interventional groups, respectively (p = 0.52). All women managed expectantly reached term delivery, as opposed to 17/22 (77.3%) in the intervention management group (p = 0.60). Multivariate analysis found serum β-hCG level as the only independent parameter associated with ongoing pregnancy rate (B = 0.001, p = 0.04). Both expectant and interventional management were found to be acceptable when heterotopic pregnancy was diagnosed, with high ongoing intra-uterine pregnancy rate and term deliveries.