Intrauterine Pregnancy Rate Research Articles

Does the ultrasound appearance of the endometrium during treatment with assisted reproductivetechnologies influence pregnancy outcomes?

We evaluated endometrial pattern, defined as the relative echogenicity of the endometrium on a longitudinal uterine ultrasonic section, as a surrogate for endometrial receptivity in an attempt to evaluate the association between endometrial pattern and pregnancy outcome in women who underwent ART treatment. The primary outcome was live birth and secondary outcomes were clinical intrauterine pregnancy and miscarriage. Potential associations were evaluated using cluster-weighted generalized estimating equations to account for within-couple correlation among repeated ART cycles while adjusting for potentially confounding variables. There were 1034 ART cycles with embryo transfer (778 fresh, 256 frozen) among 695 women (median age: 31.0 (6.0) years). The average number of embryos transferred per cycle was 2.1. The clinical intrauterine pregnancy rate per transfer was 56.0% for fresh and 54.3% for frozen cycles. The overall live birth rate per embryo transfer was 48.4%. Live birth rates were unchanged when the endometrium was semi-trilinear (RR:0.91 CI:0.74,1.12) or unilinear (RR:1.15 CI:0.89,1.49) in comparison to trilinear endometrium after controlling for potentially confounding variables. Results were similar when analysed separately for fresh and frozen cycles and when evaluating associations with clinical intrauterine pregnancy and miscarriage rates. It appears that endometrial pattern does not significantly affect live birth in ART and our data do not support cancelling an ART cycle if the endometrium is less than trilinear.

Reproductive outcomes following a ruptured ectopic pregnancy

Purpose: To determine the effect of ruptured ectopic pregnancies on the rate of future intrauterine pregnancies.Materials and Methods: This was a retrospective study of patients at a University-affiliated hospital with a history of an ectopic pregnancy between January 1991 to December 2016. All patients that underwent a salpingectomy for a tubal ectopic pregnancy were considered for this study. Intrauterine pregnancy rates for patients with a history of a ruptured ectopic pregnancy were compared to those with non-ruptured ectopic pregnancies. Fisher’s exact test was used for analysis.Results: During the study period, 77 patients met the inclusion criteria. In this cohort, 14 patients with a history of a tubal ruptured ectopic pregnancy had achieved pregnancy within 12 months, compared to 24 patients in the non-ruptured group (52% vs 48%, p = 0.81). The rate of intrauterine pregnancies, compared to repeat ectopic pregnancy, in both the ruptured and non-ruptured group, was 71% (p > 0.99).Conclusion(s): Ruptured ectopic pregnancies did not adversely affect the rate of intrauterine pregnancy within 12 months of rupture when compared to non-ruptured ectopic pregnancies.

Observation on the clinical effect of laparoscopic surgery in the treatment of ectopic pregnancy

Objective To investigate the effect of laparoscopic surgery in the treatment of ectopic pregnancy and its influence on pregnancy and complications. Methods From January 2014 to January 2018, 130 cases of ectopic pregnancy patients admitted to the Fourth People's Hospital of Tongxiang were selected.Among them, 93 cases with fertility requirements were selected as the study subjects.According to different surgical method, they were divided into observation group (46 cases) and control group (47 cases). The observation group was treated by laparoscopic surgery, while the control group was treated by open surgery.The operative indicators and complications were compared between the two groups.The pregnancy was followed up at 12 months after operation. Results The bleeding volume in the observation group was (43.24±8.98)mL, which was less than that in the control group[(87.94±15.46)mL], the anal exhaust time[(14.96±3.24)h] and the time of getting out of bed activity[(10.13±2.41)h]in the observation group were shorter than that in the control group[(26.53±2.89)h and (18.65±2.76)h], the hospitalization time[(5.41±1.23)d] and the operation time[(65.89±13.21)min] in the observation group were shorter than that in the control group[(7.87±1.54)d and (81.32±14.25)min], the differences between the two groups were statistically significant(t=17.002, 18.183, 15.844, 8.501, 5.405, all P<0.05). The incidence of postoperative complications in the observation group (6.52%) was lower than that in the control group (25.53%) (χ2=6.211, P<0.05). The intrauterine pregnancy rate in the observation group (78.26%) was higher than that in the control group (51.06%) (χ2=7.482, P<0.05). Conclusion Laparoscopic surgery is effective in the treatment of ectopic pregnancy.It can improve the rate of intrauterine pregnancy, reduce postoperative complications and shorten hospitalization time. Key words: Pregnancy, ectopic; Laparoscopic; Effect; Pregnancy; Complications

Autologous Platelet Rich Plasma (A-PRP) in Unexplained Infertility: A Revolution in Reproductive Medicine

Background: Any treatment for unknown infertility is empiric by default, and the broad range of treatment, including expectant management, superovulation, IUI, IVF and IVF–intracytoplasmic sperm injection, reflects the uncertainty with this diagnosis. There are limited data to support the efficacy of many of these treatments, and no uniform protocol exists in clinical practice. Autologous platelet rich plasma (A-PRP) can be a novel technique which has never been explored before much in this field. Objective: To compare autologous platelet rich plasma with expectant management in cases of unexplained infertility. Materials and methods: All cases (50) of primary unexplained infertility were treated with either A-PRP or by expectant management on the basis of their endometrial thickness (7 mm). All cases of thin endometrium (<7 mm) were subjected to A-PRP (25 cases). Whereas rest of the cases (25 in number) was monitored as per expectant management protocol for a maximum of three cycles after which they were switched over to being treated with PRP. The main outcomes measured were number of follicles, endometrial thickness, pregnancy rate and miscarriage rates. The statistical analysis was evaluated with IBM SPSS Statistics for Windows, Version 24.0, IBM Corp, and Chicago, IL. Results: Out of 46 patients, 25 patients (54.35%) got conceived with a single dose of intra-uterine autologous platelet rich plasma injection, which was found to be statistically highly significant. The correlation analysis with Spearman’s Rank correlation coefficient (rho ρ) was 0.891 which show highly positive correlation between intrauterine autologous platelet rich plasma injection and pregnancy rate and 0.247 which show weakly positive correlation between expectant management and pregnancy rate. Conclusion: Autologous platelet rich plasma (A-PRP) is a novel technique than can treat unexplained infertility with favorable outcomes.

Transvaginal Natural Orifice Transluminal Endoscopic Surgery Tubal Reanastomosis: A Novel Route for Tubal Surgery

Video Objective To demonstrate how a transvaginal natural orifice transluminal endoscopic surgery (NOTES) tubal reanastomosis is a novel route for tubal surgery. The surgical technique is a combination of traditional vaginal surgery with single-site surgical skills. Design The surgical technique is explained in a stepwise fashion with the use of surgical video footage. The video uses a surgical case to demonstrate the specific techniques necessary to perform a NOTES tubal reanastomosis. Setting Teaching university. Patients A 42-year-old female G2P2 with a history of tubal ligation 11 years before presentation requesting a tubal recanalization. Interventions Transvaginal NOTES tubal reanastomosis was initiated with a posterior colpotomy. A single-site gelport was placed. The fallopian tubes were hydrodissected, the blocked portion of each tube was removed, an epidural catheter was threaded through each lumen, and the two remaining segments of each tube were sutured together in an end-to-end fashion using single-site suturing skills. Conclusion Transvaginal NOTES tubal reanastomosis as an alternative route for tubal reanastomosis. The current preferred technique for reversal of a tubal sterilization is to perform a minimally invasive surgery with an end-to-end anastomosis. This gives the patient a 60%-90% intrauterine pregnancy rate postoperatively. NOTES has the benefits of a fast recovery, no abdominal incisional pain, and an extremely cosmetic outcome. Current research has shown a 0%-3.1% range for the risk of pelvic infection in transvaginal NOTES if prophylactic antibiotics are administered during the surgery. The NOTES tubal reanastomosis combines the traditional vaginal surgery technique of creating a posterior colpotomy with single-site surgical skills like suturing and knot tying. The surgery is completed through a single transvaginal port without an abdominal incision. In the hands of a skilled minimally invasive surgeon, transvaginal NOTES tubal reanastomosis is a feasible and alternative route for this procedure.

Assessing the impact of delayed blastulation using time lapse morphokinetics and preimplantation genetic testing in an IVF patient population.

There is clinical evidence that early cleavage timing parameters predictive of blastocyst development also correlate with embryo implantation potential. The aim of this study is to determine the developmental competency of embryos with delayed blastulation. Retrospective study performed from 2015 to 2016 at the Division of Reproductive Endocrinology and Infertility at Northwestern University. A total of 2,292 embryos from 524 patients were included. Day 6 blastocysts had statistically significant longer times for every time point analyzed than day 5 blastocysts (p < 0.001). We found no statistically significant difference in euploidy rates between day 5 (44%) and day 6 (41%) embryos (p = 0.573). t7 and t8 time points were independent predictors of euploidy after controlling for day of biopsy (p < 0.015 and p < 0.014, respectively). Intrauterine pregnancy (IUP) and live birth (LB) were less likely to occur after transferring day 6 embryos (p = 0.0033 and p = 0.0359) without previous genetic testing. However, in embryos that undergo preimplantation genetic testing for aneuploidy (PGT-A), there were no significant differences in IUP or LB rates. Early time-lapse points can be used to predict embryo development. Day of blastulation may be an independent predictor IUP, with day 6 blastocysts having lower pregnancy and live birth rates. Our data suggests that day 5 and day 6 PGT-A tested embryos show similar rates of euploidy, suggesting that differences in PR seen in the non-PGT-A tested group may be caused by factors other than aneuploidy. Genetic testing technologies in combination with time-lapse microscopy may provide further information to improve IVF outcomes.

Associations between ambient air pollution and pregnancy rate in women who underwent in vitro fertilization in Shenyang, China

To assess the associations between air pollution and the pregnancy rate of IVF, we performed a retrospective cohort study on 1455 women who underwent the first fresh IVF cycle at a fertility center from January 2014 to April 2018 and lived in Shenyang during treatment. Binary logistic regression models were used to evaluate the effect of an interquartile range increase in each pollutant on the intrauterine pregnancy rate. Both average chronic and daily acute exposure to air pollution were considered. Increased O3 (adjusted OR = 0.87, 95% CI: 0.81, 0.98) during the period from gonadotropins starting to oocyte retrieval was associated with decreased probability of intrauterine pregnancy, especially the day before oocyte retrieval (adjusted OR = 0.86, 95% CI: 0.78, 0.95). Our results suggest that exposure to O3 before oocyte retrieval has an adverse effect on intrauterine pregnancy. Future studies should be performed in order to confirm our findings.

Effect of laparoscopic salpingotomy on ovarian reserve function in patients with tubal pregnancy

Objective To investigate the effect of laparoscopic salpingotomy and salpingectomy on ovarian reserve function in patients with tubal pregnancy. Methods From October 2014 to March 2017, 201 cases of tubal pregnancy in Jizhong energy Fengfeng Group Hospital were selected and divided into observation group (112 cases) and control group (89 cases) according to different treatment methods.The observation group was treated with laparoscopic salpingectomy, while the control group was treated with laparoscopic salpingectomy.The number of sinus follicles and ovarian volume were measured by color Doppler ultrasound at third days of menstruation on first, third, sixth months after the operation respectively and the ovulation was detected in 6 months after the operation.The intrauterine pregnancy of the two groups was observed one year after operation. Results There was no significant difference in the number and volume of healthy ovarian antral follicles between the two groups in 1, 3 and 6 months after operation respectively (all P>0.05). The number of sinus follicles in the 1, 3 and 6 months after the operation were (7.71 ± 3.12), (7.86 ± 2.03) and (7.65 ± 1.89) in observation group respectively, while that in the control group were (4.06 ± 1.05), (3.91 ± 1.14) and (4.89±2.03)respectively.There was no significant difference in the number of sinus follicles in different time groups (Fintra-group=0.573, P>0.05). The difference between the groups was statistically significant (F inter-grouP=634.306, P 0.05). The difference between the groups was statistically significant (Finter-group=449.106, P< 0.01), F interaction=261.017, P< 0.01). The ovulation rate at 6 months (82.1%, 92/112) and intrauterine pregnancy rate at 1 year (71.8%, 79/110) in the observation group were higher than those in the control group (56.2%, 50/89) and (31.0%, 27/87). There were significant differences between the two groups(χ2=12.601, 28.753, all P<0.05). Conclusion Laparoscopic salpingotomy is better than salpingectomy in the treatment of tubal pregnancy.The ovulation rate and intrauterine pregnancy rate are also superior to salpingectomy.It shows that laparoscopic fenestration can protect the ovarian reserve reserve function and reproductive function of patients. Key words: Tubal pregnancy; Laparoscopy; Oviduct fenestration; Salpingectomy; Number of sinus follicles; Ovarian volume

Combined chitosan and Dan-shen injection for long-term tubal patency in fallopian tube recanalization for infertility

To prospectively study the efficacy of different anti-adhesion agents for the prevention of tubal obstruction after recanalization, this trial was approved by our hospital ethics committee. Four hundred patients with fallopian tube obstruction were randomly assigned to four groups. The control group underwent recanalization alone, whereas the other groups were injected with chitosan, Dan-shen, or combined chitosan and Dan-shen after recanalization. The tubal patency rate in all four groups was recorded after 12 day, 3 months, and 12 months. The pregnancy rates were noted after 12 months. The recanalization rates after 1 day in the control, chitosan, Dan-shen, and combined chitosan and Dan-shen groups were 94.1, 97.1, 96.5, and 98.2%, respectively (p = 0.18, p > 0.05). The rates of tubal patency after 3 months were significantly higher in the combined chitosan and Dan-shen (96.5%), chitosan (88%), and Dan-shen (85.2%) groups compared with the control group (73.9%) (p = 0.0001, p < 0.05). The recanalization rate and intrauterine pregnancy rate after 12 months was significantly higher in the combined chitosan and Dan-shen group (93.8 and 63.9%, respectively) compared with the other groups (control 39 and 30.6%, chitosan 78.4 and 46.9%, and Dan-shen 77.3 and 43.3%) (p = 0.0029 and p = 0.0001, p < 0.05). Chitosan, Dan-shen, or a combination of the two compounds could be effective for preventing tubal obstruction after interventional recanalization, possibly increasing the rate of pregnancy in affected women. The combined chitosan and Dan-shen injection has unique advantages in the interventional recanalization of obstructed fallopian tubes.

Factors Predicting Persistent Ectopic Pregnancy After Laparoscopic Salpingostomy or Salpingotomy for Tubal Pregnancy: A Retrospective Cohort Study

To identify factors predictive of persistent ectopic pregnancy (PEP) in women who have undergone laparoscopic salpingostomy or salpingotomy for tubal pregnancy. Retrospective cohort study (Canadian Task Force classification II-2). Tertiary referral center. Ninety-nine women who underwent laparoscopic tubal preservation surgery for ectopic pregnancy. Seventy women underwent laparoscopic salpingostomy, and the remaining 29 women underwent laparoscopic salpingotomy. Factors predicting PEP were evaluated. The change in serum beta human chorionic gonadotropin (β-hCG) levels from baseline observed between postoperative days 5 and 10 (ChCGD5-10) was a predictor of PEP (odds ratio [OR], 0.80; p = .01). Based on receiver operating characteristic (ROC) curve analysis, a cutoff value of 93.1% was determined, with an area under the ROC curve of 0.95 (sensitivity, 85.7%; specificity, 100%). Nonetheless, when considering perioperative variables only, body mass index (BMI) was identified as a predictor of PEP (OR, 0.71; p = .03). Based on the ROC analysis, a BMI cutoff value of ≤22 kg/m2 was determined, with an ROC area of 0.73 (sensitivity, 43.2%; specificity, 100%). In addition, a higher baseline β-hCG level (hazard ratio [HR], 1.0002; p = .009) and left tubal pregnancy (HR, 6.46; p = .03) were predictive of recurrent ectopic pregnancy. There were no differences in the perioperative outcomes, PEP rates, or subsequent intrauterine pregnancy rates between the salpingostomy and salpingotomy groups. In addition, surgical method was not a predictor of recurrent ectopic pregnancy. ChCGD5-10 was identified as a predictor for PEP, suggesting that it might be more clinically useful for the follow-up of PEP. When considering perioperative variables only, BMI was a predictor for PEP. In addition, there was no significant difference in clinical outcomes between the salpingostomy and salpingotomy groups.

A clinical study of Guizhi-Fuling pill combined with conventional therapy for the patients with oviduct obstructive infertility

Objective In order to evaluate the clinical curative effect of Guizhi-Fuling pill combined with conventional therapy for the patients with oviduct obstructive infertility. Methods In this study, 102 patients with oviduct obstructive infertility (OOI) that accorded with the inclusion criteria were randomly divided into two groups according to the order of treatment. During the study, a total of 5 patients were lost in the two groups, and so 49 in the treatment group and 48 in the control group completed the protocol. The control group was given fallopian tube recanalization under the hysteroscopy, and the treatment group was given oral Guizhi-Fuling pill at day 2 after surgery on the basis of the control group treatment. Both groups were observed for 6 months. Before and after treatment, TCM symptom score was conducted, and IL-6 level was determined by radioimmunoassay; the uterine fallopian tube was examined after the 6th month of treatment, and pregnancy rate was observed and recorded. Results After treatment, abdominal pain degree (0.6 ± 0.1 vs. 1.3 ± 0.1, t=3.612), the low back pain (0.9 ± 0.2 vs. 1.6 ± 0.2, t=2.553), abdominal distension (0.5 ± 0.0 vs. 1.0 ± 0.8, t=2.364), menstrual blood clots (0.5 ± 0.1 vs. 1.0 ± 0.1, t=2.331) in the treatment group were significantly lower than those in the control group (Ps<0.05). After treatment, the rate of oviduct patency was 75.5% (37/49) in thetreatment group, 50.0% (24/48) in the control group, and the comparison difference between the two groups was statistically significant (χ2=8.075, P=0.044). After 6 months of treatment, the pregnancy rate of the treatment group was 63.3% (31/49), and that of the control group was 37.5% (18/48), the difference of pregnancy rate between the two groups was statistically significant (χ2=6.724, P=0.035). After treatment, serum IL-6 (31.04 ± 2.47 ng/ml vs. 42.71 ± 2.52 ng/ml, t=7.593) in the treatment group was signicantly lower than the control group (P<0.05). Conclusions Guizhi-Fuling pill combined with conventional therapy can reduce IL-6 level, promote fallopian tube recanalization, improve the intrauterine pregnancy rate, and improve the clinical symptoms of OOI patients. Key words: Infertility, female; Fallopian tube obstruction; Gui Zhi Fu Ling Wan; Hysteroscopes; Interventional

Comparison of Vaginal Gel and Intramuscular Progesterone for In vitro Fertilization and Embryo Transfer with Gonadotropin-Releasing Hormone Antagonist Protocol.

Background:Luteal support is a key to patients undergoing in vitro fertilization and embryo transfer (IVF-ET) with gonadotropin-releasing hormone (GnRH)-antagonist protocol. This study aimed to compare the effect between vaginal progesterone (VP) and intramuscular progesterone (IMP) with GnRH-antagonist protocol after IVF-ET.Methods:A total of 1760 patients (18 years ≤ age ≤35 years) undergoing IVF-ET with GnRH-antagonist protocol were studied retrospectively between September 2014 and August 2015 in Peking University Third Hospital. In the patients, 1341 patients received VP (VP group) and 419 patients received IMP (IMP group) as luteal support. We compared clinical outcomes between these two groups. The primary objective of the study was the live birth rate. Measurement data between the two groups were conducted using independent samples t-test. The variables in line with non-normal distribution were expressed as median (p25 and p75) and were compared using nonparametric Mann–Whitney U-test.Results:Live birth rate in VP group was 38.55%, significantly higher than that in the IMP group, which was 30.79% (χ2 = 8.287, P = 0.004). The clinical intrauterine pregnancy rate and implantation rate in VP group were also significantly higher than those in the IMP group (clinical intrauterine pregnancy rate 47.35% vs. 41.29%, χ2 = 4.727, P = 0.030; implantation rate 30.99% vs. 25.26%, χ2 = 14.546, P < 0.001). Any statistically significant differences in ectopic pregnancy and abortion rates between two groups were not observed.ConclusionLuteal support with VP had better clinical outcomes for young women undergoing IVF-ET with GnRH-antagonist protocol.

Transvaginal natural orifice transluminal endoscopic surgery tubal reanastomosis: a novel route for tubal surgery

To demonstrate how a transvaginal natural orifice transluminal endoscopic surgery (NOTES) tubal reanastomosis is a novel route for tubal surgery. The surgical technique is a combination of traditional vaginal surgery with single-site surgical skills. The surgical technique is explained in a stepwise fashion with the use of surgical video footage. The video uses a surgical case to demonstrate the specific techniques necessary to perform a NOTES tubal reanastomosis. Teaching university. A 42-year-old female G2P2 with a history of tubal ligation 11years before presentation requesting a tubal recanalization. Transvaginal NOTES tubal reanastomosis was initiated with a posterior colpotomy. A single-site gelport was placed. The fallopian tubes were hydrodissected, the blocked portion of each tube was removed, an epidural catheter was threaded through each lumen, and the two remaining segments of each tube were sutured together in an end-to-end fashion using single-site suturing skills. Transvaginal NOTES tubal reanastomosis as an alternative route for tubal reanastomosis. The bilateral fallopian tubes were recanalized with bilateral tubal patency. This was confirmed 8weeks postoperatively with a three-dimensional sonohystogram, which showed patency of the bilateral fallopian tubes. The current preferred technique for reversal of a tubal sterilization is to perform a minimally invasive surgery with an end-to-end anastomosis. This gives the patient a 60%-90% intrauterine pregnancy rate postoperatively. NOTES has the benefits of a fast recovery, no abdominal incisional pain, and an extremely cosmetic outcome. Current research has shown a 0%-3.1% range for the risk of pelvic infection in transvaginal NOTES if prophylactic antibiotics are administered during the surgery. The NOTES tubal reanastomosis combines the traditional vaginal surgery technique of creating a posterior colpotomy with single-site surgical skills like suturing and knot tying. The surgery is completed through a single transvaginal port without an abdominal incision. In the hands of a skilled minimally invasive surgeon, transvaginal NOTES tubal reanastomosis is a feasible and alternative route for this procedure.

Association between ambient air pollution and pregnancy rate in women who underwent IVF.

Are the concentrations of five criteria air pollutants associated with probabilities of biochemical pregnancy loss and intrauterine pregnancy in women? Increased concentrations of ambient particulate matter (PM10), nitrogen dioxide (NO2), carbon monoxide (CO) during controlled ovarian stimulation (COS) and after embryo transfer were associated with a decreased probability of intrauterine pregnancy. Exposure to high ambient air pollution was suggested to be associated with low fertility and high early pregnancy loss in women. Using a retrospective cohort study design, we analysed 6621 cycles of 4581 patients who underwent one or more fresh IVF cycles at a fertility centre from January 2006 to December 2014, and lived in Seoul at the time of IVF treatment. To estimate patients' individual exposure to air pollution, we computed averages of hourly concentrations of five air pollutants including PM10, NO2, CO, sulphur dioxide (SO2) and ozone (O3) measured at 40 regulatory monitoring sites in Seoul for each of the four exposure periods: period 1 (start of COS to oocyte retrieval), period 2 (oocyte retrieval to embryo transfer), period 3 (embryo transfer to hCG test), and period 4 (start of COS to hCG test). Hazard ratios (HRs) from the time-varying Cox-proportional hazards model were used to estimate probabilities of biochemical pregnancy loss and intrauterine pregnancy for an interquartile range (IQR) increase in each air pollutant concentration during each period, after adjusting for individual characteristics. We tested the robustness of the result using generalised linear mixed model, accounting for within-woman correlation. Mean age of the women was 35 years. Average BMI was 20.9 kg/m2 and the study population underwent 1.4 IVF cycles on average. Cumulative pregnancy rate in multiple IVF cycles was 51.3% per person. Survival analysis showed that air pollution during periods 1 and 3 was generally associated with IVF outcomes. Increased NO2 (adjusted HR = 0.93, 95% CI: 0.87, 0.99) and CO (0.94, 95% CI: 0.89, 1.00) during period 1 were associated with decreased probability of intrauterine pregnancy. PM10 (0.92, 95% CI: 0.85, 0.99), NO2 (0.93, 95% CI = 0.86, 1.00) and CO (0.93, 95% CI: 0.87, 1.00) levels during period 3 were also inversely associated with intrauterine pregnancy. Both PM10 (1.17, 95% CI: 1.04 1.33) and NO2 (1.18, 95% CI: 1.03, 1.34) during period 3 showed positive associations with biochemical pregnancy loss. The district-specific ambient air pollution treated as an individual exposure may not represent the actual level of each woman's exposure to air pollution. Smoking, working status, parity or gravidity of women, and semen analysis data were not included in the analysis. This study provided evidence of an association between increased ambient concentrations of PM10, NO2 and CO and reduced probabilities for achieving intrauterine pregnancy using multiple IVF cycle data. Specifically, our results indicated that lower intrauterine pregnancy rates in IVF cycles may be linked to ambient air pollution during COS and the post-transfer period. This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (2013 R1A6A3A04059017, 2016 R1D1A1B03933410 and 2018 R1A2B6004608) and the National Cancer Center of Korea (NCC-1810220-01). The authors report no conflicts of interest. N/A.

The prognostic capacity of transvaginal hydrolaparoscopy to predict non-IVF conception

Transvaginal hydrolaparoscopy (THL) is performed to investigate tubal pathology in subfertile women. This retrospective multicentre cohort study investigated the results of THL and subsequent pregnancy rates. Between 2000 and 2011, 1033 subfertile women participated in the study. The primary outcome measure was intrauterine pregnancy, either after natural conception or after treatment with intrauterine insemination or ovulation induction. Cumulative intrauterine pregnancy rates were calculated using Kaplan-Meier analysis and fecundity rate ratios (FRR) were established. THL showed bilateral patent tubes in 83%, one-sided tubal occlusion in 12.4% and bilateral tubal occlusion in 4.6% of women. Cumulative intrauterine pregnancy rates after 36 months were 52% for women with bilateral patent tubes, 44% for one-sided tubal occlusion (FRR 1.04; 95% confidence interval [CI], 0.78 to 1.39) and 7% for bilateral tubal occlusion (FRR 0.13; 95% CI, 0.04 to 0.43). Endometriosis was diagnosed in 6.4%, and adhesions in 9.1%, while 3.9% of women had both. Corresponding FRR were 0.73 (95% CI, 0.49 to 1.09), 0.68 (95% CI, 0.46 to 1.02) and 0.42 (95% CI, 0.20 to 0.84). In conclusion, women with bilateral tubal occlusion or a combination of endometriosis and adhesions found on THL significantly reduced chances of natural conception.

Effect of air bubbles localization and migration after embryo transfer on assisted reproductive technology outcome

To evaluate the effect of embryo flash position and movement of the air bubbles at 1 and 60minutes after ET on clinical pregnancy rates (PRs). Prospective clinical trial. University fertility clinic. A total of 230 fresh ultrasound-guided ETs performed by a single physician (C.F.) at the IVF center of Yeditepe University Hospital between September 2016 and February 2017 were included. Transabdominal ultrasonographic guidance at ET. Clinical PRs. There was no significant difference in terms of clinical PRs between women with embryo flash located >15mm and <15mm from the fundus at 1 or 60minutes (P=.6 and P=.7, respectively). The PRs in women with embryo flash located <15mm and >15mm from the fundus were 47% and 60%, respectively (P=.6). The clinical intrauterine PRs were 69.5%, 38.5%, and 19.1% in fundal, static, and cervical, respectively. The highest PR was in fundal when compared with others (P<.01). The clinical PR appears to be associated with the embryo flash movement/migration and the PR was dramatically reduced when the embryo migrated from its original position toward the cervix at 60minutes. We concluded that clinical PR appears to be associated with the embryo flash movement/migration at 60minutes after ET and embryo flash movement toward the fundus is associated with higher clinical PRs. Further well-designed randomized controlled trials are required to optimize ET technique in the future.

Effect of Levothyroxine on Miscarriage Among Women With Normal Thyroid Function and Thyroid Autoimmunity Undergoing In Vitro Fertilization and Embryo Transfer

Presence of thyroid autoantibodies in women with normal thyroid function is associated with increased risk of miscarriage. Whether levothyroxine treatment improves pregnancy outcomes among women undergoing in vitro fertilization and embryo transfer (IVF-ET) is unknown. To determine the effect of levothyroxine on miscarriage among women undergoing IVF-ET who had normal thyroid function and tested positive for thyroid autoantibodies. An open-label, randomized clinical trial involving 600 women who tested positive for the antithyroperoxidase antibody and were being treated for infertility at Peking University Third Hospital from September 2012 to March 2017. The intervention group (n = 300) received either a 25-μg/d or 50-μg/d dose of levothyroxine at study initiation that was titrated according to the level of thyroid-stimulating hormone during pregnancy. The women in the control group (n = 300) did not receive levothyroxine. All participants received the same IVF-ET and follow-up protocols. The primary outcome was the miscarriage rate (pregnancy loss before 28 weeks of gestation, which was calculated among women who became pregnant). The secondary outcomes were clinical intrauterine pregnancy rate (fetal cardiac activity seen at sonography observation on the 30th day after the embryo transfer), and live-birth rate (at least 1 live birth after 28 weeks of gestation). Among the 600 women (mean [SD] age, 31.6 [3.8] years) randomized in this trial, 567 women (94.5%) underwent IVF-ET and 565 (94.2%) completed the study. Miscarriage rates were 10.3% (11 of 107) in the intervention group and 10.6% (12 of 113) in the control group, with the absolute rate difference (RD) of -0.34% (95% CI, -8.65% to 8.12%) over the 4.5-year study period. Clinical intrauterine pregnancy rates were 35.7% (107 of 300) in the intervention group and 37.7% (113 of 300) in the control group, with an absolute RD of -2.00% (95% CI, -9.65% to 5.69%). Live-birth rates were 31.7% (95 of 300) in the intervention group and 32.3% (97 of 300) in the control group, with an absolute RD of -0.67% (95% CI, -8.09% to 6.77%). Among women in China who had intact thyroid function and tested positive for antithyroperoxidase antibodies and were undergoing IVF-ET, treatment with levothyroxine, compared with no levothyroxine treatment, did not reduce miscarriage rates or increase live-birth rates. Chinese Clinical Trial Registry: ChiCTR-TRC-13004097.

New Evidence to Guide Ectopic Pregnancy Diagnosis and Management.

Ectopic pregnancy is a leading source of morbidity and mortality in pregnancy, accounting for 1% to 2% of all pregnancies. Timely diagnosis and management of these abnormal gestations are vital to patient safety. The objective of this study was to describe recent evidence in the risk factors, diagnosis, and management of ectopic pregnancy. Comprehensive review of the published literature. Recent literature describes newly identified risk factors for ectopic pregnancy, particularly those specific to assisted reproduction. Furthermore, evidence mounts for the utility of endometrial sampling for the diagnosis of pregnancy location, allowing a significant proportion of women to avoid methotrexate by diagnosing failing intrauterine pregnancies instead. Finally, recent, high-level evidence supports (in women with normal contralateral fallopian tubes) the equivalence of salpingectomy and salpingostomy regarding rates of subsequent intrauterine pregnancy and recurrent ectopic pregnancy. While serial serum human chorionic gonadotropin levels and transvaginal ultrasound are the mainstays of ectopic pregnancy diagnosis, recent publications revisit the utility of endometrial sampling in diagnosing pregnancy location, using manual vacuum aspiration instead of the criterion-standard dilation and curettage. Expectant management of ectopic pregnancies is the subject of ongoing research, and in the meantime, treatment remains medical or surgical (dependent on clinical parameters and patient preference); salpingostomy and salpingectomy provide equivalent subsequent pregnancy outcomes in women with contralateral fallopian tubes in place.

Pregnancy outcome of laparoscopic tubal reanastomosis: retrospective results from a single clinical centre.

ObjectiveTubal sterilization is a widespread method of contraception. Post-sterilization regret is encountered, despite careful consideration prior to the procedure. Two treatment options are available for women after having had tubal sterilization: microsurgical reversal and IVF treatment. Recent improvements in laparoscopy have allowed tubal reanastomosis to be performed. This study aimed to evaluate the reproductive outcome after laparoscopic tubal reanastomosis and surgical features of the patients.MethodsFrom June 2007 to January 2010, 27 patients with bilateral tubal ligation who underwent laparoscopic tubal reanastomosis were evaluated retrospectively. Tubal sterilization was performed by Pomeroy’s technique during caesarean section in all of the patients. Before surgery, all of the patients were evaluated for possible other causes of infertility and the results of the evaluation were normal.ResultsThe mean age of the patients was 31.8 years (range, 27–38 years). The mean interval between sterilization and reversal was 5.1 years (range, 1–14 years). Bilateral reversal was achieved in 24 patients. The operation time ranged from 85 to 140 minutes with a mean time of 105 minutes. All of the patients were discharged on the next day. There were no postoperative complications. Overall pregnancy, intrauterine pregnancy, and ectopic pregnancy rates were 55.5% (15/27), 51.8% (14/27), and 3.7% (1/27), respectively. Of the 14 intrauterine pregnancies, one ended with abortion at 6 weeks’ gestation (1/14). The mean interval from surgery to pregnancy was 270 days (range, 147–420 days).ConclusionLaparoscopic tubal reanastomosis has the advantages of fewer complications, less postoperative discomfort, a smaller incisional scar, a shorter recovery time, and earlier resumption of normal activities. This technique has a satisfactory pregnancy rate in selected patients who desire reversal of tubal sterilization.

Hysterosalpingography prior to the gonadotropin stimulated intrauterine insemination improvesclinical pregnancy rates in women with unexplained infertility

Gonadotropin stimulated intrauterine insemination (IUI) cycles performed following one month after hysterosalpingography (HSG) are associated with improvement in clinical pregnancy rates in unexplained infertile couples. A retrospective cohort study was performed between 2008 and 2014. A total of 92 unexplained infertile couples undergoing their first cycle IUI stimulated by gonadotropins were included in the analysis. Participants were classified into two groups according to IUI cycles performed one month (Group A, n = 25 cycles) or longer than one month (Group B, n = 67 cycles) after the HSG procedure. The overall clinical pregnancy rate was found as 25% (23 clinical pregnancies / 92 cycles). Clinical pregnancy rate was 44 % (11/25) for Group A and 17.9 % (12/67) for Group B. In Group A, there were significantly higher clinical pregnancy rates compared to Group B (OR: 3.6, 95% CI, 1.3-9.8; p = 0.012). It has been demonstrated that fertility improving effect of HSG was most prominent in the first six months after procedure. Likewise, in gonadotropin stimulated IUI cycles performed following one month after HSG, there seems to be an improvement in pregnancy rates in unexplained couples. In unexplained cases, it may be a reasonable approach to plan IUI cycles in the first month after HSG in clinical practice.