Live Delivery Rate Research Articles

The Impact of State Mandated Financial Coverage for Donor Egg In Vitro Fertilization (IVF) Cycles on Choosing Fresh Eggs from Infertile Donor vs. Paid Donors vs. Frozen Egg Banks

We sought to determine if using infertile oocyte donors donating only half of the eggs collected to recipients, had comparable live delivery rates following fresh and frozen embryo transfer (ET) when compared to oocytes obtained from compensated donors with a single recipient, compensated donors split between two recipients, or an oocyte bank. A retrospective review of 1,361 in vitro fertilization-embryo transfer (IVF-ET) cycles comparing live delivery rates after fresh ET and live delivery rates per retrieval by donor oocyte source was performed. Live delivery rates per fresh ET showed no significant difference between the four-oocyte sources. However, using an infertile donor had a statistically significant increase in live delivery rate per retrieval when compared to using a compensated donor split between two recipients or an oocyte bank. There was a 15% decrease in live delivery rate per retrieval when using an infertile donor compared to a compensated donor with a single recipient. Financial burden of infertility services has been a long-standing barrier to infertility treatment access. Sharing oocytes with an infertile donor can have financial advantage without significant sacrifice of success rates. It is especially cost saving for recipients in mandated states who actually are financially reimbursed for the majority of the cost of the IVF cycle.

Neonatal Outcomes of Embryos Cultured in a Time-Lapse Incubation System: an Analysis of More Than 15,000 Fresh Transfer Cycles.

In the past 5years, the time-lapse culture system (TLS) has gradually been applied to the field of assisted reproduction. However, there are few reports on the comparison between this system and the conventional culture system (CS) on the outcome of newborns. As a new model in embryo culture, we should pay attention to its neonatal outcomes. We examined 15,252 fresh transfer cycles processed between January 2016 and December 2019. After propensity score matching, embryos in two groups, TLS and CS, had similar rates of miscarriages, ectopic pregnancy, and live delivery (P > 0.05). Embryos in the TLS group achieved higher clinical pregnancy and implantation rates (P < 0.05). Of the perinatal and neonatal outcomes, singletons and twins were analyzed separately. No significant differences were observed in gestational age, preterm deliveries, birth weight, and sex ratio (P > 0.05). Incidences of malformations of babies delivered from CS and TLS groups were also similar between the two groups. Embryos cultured in a TLS are as safe as CS with regard to neonatal outcomes, including congenital malformations.

P–093 The use of donor sperm improves post-ICSI live birth rates in advanced maternal age women

Abstract Study question Can the use of donor sperm improve post-ICSI live birth rate in advanced maternal age (AMA) patients? Summary answer The use of donor sperm increases post-ICSI live birth rate while substantially reducing abortion occurrence in AMA patients. What is known already Oocyte DNA repair capacity decreases with maternal age, when sperm DNA integrity is particularly important to avoid the transfer of gene truncations and de novo mutations to the zygote. Optimal DNA repair activity in the zygote requires paternal inheritance of 8-oxoguanine DNA glycosylase (OGG1), a rate-limiting enzyme in the base excision repair pathway. However, the involvement of paternal aging and sperm quality in the severe drop in fertility observed in AMA patients has not been addressed. While strategies to mitigate the impact of AMA on fertility have exclusively targeted oocyte quality, the sperm contribution in this scenario remains somehow neglected. Study design, size, duration Retrospective, multicentric, international study including 755 first ICSI cycles with patients’ own oocytes achieving a fresh ET between 2015 and 2019, 337 of which using normozoospermic partner semen and 418 using donor sperm. The association of sperm origin (partner vs. donor) with live birth was assessed by univariate/multivariate analysis in non-AMA (&amp;lt;37 years, n = 278) and AMA (≥37 years, n = 477) patients. ICSI outcomes were compared between partner and donor sperm in non-AMA and AMA patients. Participants/materials, setting, methods The study was conducted in 3 fertility clinics including 755 Caucasian patients aged 24 to 42 years. Univariate/multivariate analyses were performed to test the association of sperm origin with live birth; infertility factor, maternal age, oocyte yield and number of embryos transferred were included in the model as confounding variables. In addition, ICSI outcomes were compared between donor and partner sperm groups with the Chi-square (percentages) or with the Wilcoxon sum rank (continuous variables) tests. Main results and the role of chance The multivariate analysis revealed that the use of donor sperm was positively and independently associated with live birth occurrence in AMA [1.82 OR (1.08–3.07) 95% IC; p = 0.024], but not in non-AMA patients [1.53 (0.94–2.51); p = 0.090]. Maternal age [0.75 (0.64–0.87); p &amp;lt; 0.001], number of MII oocytes recovered [1.14 (1.05–1.23); p = 0.001] and number of embryos transferred [1.90 (1.27–2.86); p = 0.002] were also independently associated with live birth in AMA patients. Live birth and delivery rates were 70–75% higher, while miscarriage rate was less than half in donor sperm compared to partner sperm AMA cycles (LBR: 25.4% vs. 14.5%, p = 0.003; DR: 22.5% vs. 13.5%, p = 0.008; MR: 18.0% vs. 39.5%; p = 0.009). Implantation (17.4% vs. 13.5%; p = 0.075) and clinical pregnancy rates (27.5% vs. 22.3%; p = 0.121) did not significantly differ between sperm donation and partner sperm AMA cycles. Male age was substantially lower (23.6 ± 5.2 vs. 41.4 ± 5.0; p &amp;lt; 0.0001) and oocyte yield was higher (5.1 ± 3.1 vs. 4.3 ± 2.6; p &amp;lt; 0.0001) in sperm donation compared to partner sperm AMA cycles, while maternal age did not vary (39.8 ± 1.6 vs. 39.6 ± 1.7; p = 0.348). Limitations, reasons for caution This study is limited by its retrospective nature and by differences in patients’ profiles between sperm donation and homologous cycles, although this variation has been controlled for in the statistical analysis. Wider implications of the findings: The findings suggest that donor sperm can improve live birth rates by drastically reducing miscarriage occurrence in AMA patients. Therefore, the present results may influence AMA treatment decisions and, above all, contribute for AMA patients to achieve a healthy birth. Trial registration number Not applicable

Sperm donation: an alternative to improve post-ICSI live birth rates in advanced maternal age patients.

Can sperm donation increase live birth rates following ICSI in advanced maternal age (AMA) patients? Sperm donation increases the live birth rate in AMA ICSI cycles. In ICSI practice, sperm donation has been predominantly applied to overcome male infertility. The involvement of paternal age and lower sperm quality in the severe reduction in fertility observed in AMA patients remains to be clarified. Retrospective multicenter cohort study including data generated between 2015 and 2019 from 755 ICSI cycles achieving a fresh embryo transfer, of which 337 were first homologous cycles (normozoospermic partner sperm and homologous oocytes) and 418 were first sperm donation cycles (donor sperm and homologous oocytes). The association of sperm origin (partner vs donor) with live birth was assessed by multivariate analysis in non-AMA (<37 years, n = 278) and AMA (≥37 years, n = 477) patients, separately, including in the model all variables previously found to be associated with live birth in a univariate analysis (number of MII oocytes recovered, number of embryos transferred, and maternal age). ICSI outcomes were compared between sperm donation and homologous cycles in overall, non-AMA and AMA patients. The study was conducted in three fertility clinics and included 755 Caucasian patients aged 24-42 years undergoing their first homologous or sperm donation ICSI cycle achieving a fresh embryo transfer. The multivariate analysis revealed that sperm donation was positively associated with the likelihood of a live birth independently of all other variables tested in AMA (P = 0.02), but not in non-AMA patients. Live birth, delivery, and miscarriage rates differed substantially between sperm donation and homologous AMA cycles; live birth and delivery rates were 70-75% higher (25.4% vs 14.5% and 22.5% vs 13.5%, respectively; P < 0.01), while miscarriage occurrence was less than half (18.0% vs 39.5%; P < 0.01) in sperm donation compared to homologous AMA cycles. This study is limited by its retrospective nature, differences in patients profiles between sperm donation and homologous-control groups and varying proportion of donor cycles between fertility centers, although these variations have been controlled for in the statistical analysis. The findings suggest that sperm donation increases live birth rates while reducing miscarriage occurrence in AMA patients, and thus may be a valid strategy to improve ICSI outcomes in this growing and challenging patient group. N/A. N/A.

Laser-assisted hatching on clinical and neonatal outcomes in patients undergoing single vitrified Blastocyst transfer: A propensity score-matched study.

PurposeThis study determined the effect of laser‐assisted hatching on the clinical and neonatal outcomes of single vitrified blastocyst transfer.MethodsFrom June 2014 to March 2018, 289 matched pairs after propensity score matching were analyzed. During the blastocyst warming procedure, a small section of the zona pellucida area in the empty perivitelline space was sliced off using multiple laser beams. The clinical and neonatal outcomes of the laser‐treated group and non‐treatment control were analyzed.ResultsIn the laser‐assisted hatching group, significantly higher rates of clinical pregnancy (40.8% vs 29.4%, P < .01) and live delivery (34.3% vs 22.5%, P < .01) were observed compared to the control group. Other variables such as the average gestational weeks, the sex of the baby, birthweight, or congenital malformations were found to have no significant differences in neonatal outcomes. Moreover, all babies were singleton live births.ConclusionsSingle vitrified blastocyst transfer treated with laser‐assisted hatching increases the live birth rate and has no adverse effects on neonatal outcomes.

SPERM WITH VERY LOW MOTILE DENSITY (MD) MAY BE A CAUSE OF REDUCED CHANCE OF LIVE DELIVERY DESPITE TRANSFER OF NORMAL MORPHOLOGIC EMBRYOS

To determine if a male factor, specifically low MD, can reduce the chance of a live baby despite normal fertilization and the production of embryos with good morphology. Prospective comparison study. To eliminate an oocyte factor as a confounding variable, the study selected pairs of patients sharing donor oocytes. The only couples selected were those where the male partners of 1 couple had a MD below <10x106/mL and the other male partner ≥10x106/mL. The low MD group when evaluating outcome was further divided into very low MD of <5x106/mL and 5-9.9x106/mL. Only cycles where both couples had a fresh embryo transfer (ET) on day 3 were included. Intracytoplasmic sperm injection (ICSI) was used for couples where MD was <10x106/mL unless strict morphology was ≤4% when ICSI was used even with normal MD. There were 242 ETs in low MD groups and 245 in normal MD group.Tabled 1Comparison of in vitro fertilization (IVF) outcome according to MD in pairs sharing oocytesMotile Density (10x106/mL)<55-9.9≥10# transfers14399245% fertilized72.1%70.9%70.9%% 6-8 cell day 357.3%60.2%62.4%% clinical preg./transfer47.6%49.5%56.3%% miscarriage/clinical preg. live20.6%8.2%16.7%% delivered37.8%45.5%46.9%% implantation26.5%26.7%30.9%Chi-square = NS. Power analysis showed one would need to triple the number of subjects to show that the difference in live delivery rates comparing very low MD vs. normal MD was significant. Evaluating a subset with normal morphology using strict criteria, the live delivered pregnancy rate for very low MD was 36.1% (26/72) vs. 48.3% and miscarriage rate was 29.7% vs. 13.3%. Thus, low strict morphology was not a confounding variable. Since both low MD groups had ICSI performed, and the less severe group did as well as the normal MD group, ICSI did not seem to be a confounding variable. There was an average of 1.8 embryos transferred in the very low MD group vs. 1.9 in the normal MD group. Open table in a new tab Chi-square = NS. Power analysis showed one would need to triple the number of subjects to show that the difference in live delivery rates comparing very low MD vs. normal MD was significant. Evaluating a subset with normal morphology using strict criteria, the live delivered pregnancy rate for very low MD was 36.1% (26/72) vs. 48.3% and miscarriage rate was 29.7% vs. 13.3%. Thus, low strict morphology was not a confounding variable. Since both low MD groups had ICSI performed, and the less severe group did as well as the normal MD group, ICSI did not seem to be a confounding variable. There was an average of 1.8 embryos transferred in the very low MD group vs. 1.9 in the normal MD group. Though the differences were not significant, possibly the results could suggest that even using the best quality oocytes, males with very low MD may be responsible for unexplained failure to achieve a live birth even with the transfer of normal quality embryos by morphologic criteria. Since good oocytes can sometimes correct sperm defects, it may be that these differences may be even greater if the oocytes retrieved are of less quality. Thus, in cases of repeated failure to achieve live deliveries in couples where the sperm has very low MD, instead of switching to donor oocytes, one could consider first trying donor sperm. A larger possibly multicenter study is needed to support or refute this suggested cause of unexplained infertility.

Pregnancy and birth outcomes of single versus multiple embryo transfer in gestational surrogacy arrangements: a systematic review and meta-analysis

Multiple embryo transfer (MET) is associated with both an increased risk of multiple pregnancy and of live birth. In recent years, MET has become standard practice for most surrogacy arrangements. There is limited review of the use of MET versus single embryo transfer (SET) in surrogacy practice. The present review systematically evaluated the pregnancy outcomes of surrogacy arrangements between MET versus SET among gestational carriers. A systematic search of five computerized databases without restriction to the English language or study type was conducted to evaluate the primary outcomes: (i) clinical pregnancy; (ii) live delivery; and (iii) multiple delivery rates. The search returned 97 articles, five of which met the inclusion criteria. The results showed that clinical pregnancy (RR = 1.21, 95% CI: 1.06–1.39, n = 5, I2 = 41%), live delivery (RR = 1.29, 95% CI: 1.10–1.51, n = 4, I2 = 35%) and multiple delivery rates (RR = 1.42, 95% CI: 6.58–69.73, n = 4, I2 = 54%) were statistically significantly different in MET compared to SET. Adverse events including miscarriage, preterm birth and low birthweight were found following MET. Our findings support the existing evidence that MET results in multiple pregnancy and subsequently more adverse outcomes compared to SET. From a public health perspective, SET should be advocated as the preferred treatment for gestational carriers.

Neonatal outcome of children born after ICSI with epididymal or testicular sperm: A 10-year study in China

Some studies show that children born after ICSI with non-ejaculated sperm are at increased risk of birth defects, other studies hold the opposite view. Does neonatal outcome including congenital malformations in children born after ICSI with percutaneous epididymal sperm aspiration (PESA) and testicular sperm aspiration (TESA) differ from neonatal outcome in children born after ICSI with ejaculated sperm? In this study, we examined the data from our IVF center from 2006 to 2016, to compare neonatal outcomes and rates of congenital malformations in children born after ICSI with different sperm origin. The results showed the clinical pregnancy rate and implantation rate of non-ejaculated sperm group were significantly higher (P < 0.001) than ejaculated sperm group. There were 775 clinical pregnancies from non-ejaculated sperm group and 2,486 clinical pregnancies from ejaculated sperm group. Most of the clinical pregnancy outcomes were comparable between non-ejaculated sperm group and ejaculated sperm group (p > 0.05): the miscarriage rate per transfer, ectopic pregnancy rate per clinical pregnancy, induced abortion rate per clinical pregnancy and fetal deaths per clinical pregnancy. However, the live delivery rate per transfer of non-ejaculated sperm group was significantly higher than that of ejaculated sperm group (45.4% vs 36.7%, P < 0.001). Moreover, the comparison between the epididymal sperm, testicular sperm and ejaculated sperm groups showed there were no difference in the incidence of congenital malformations of babies live birth. Among singleton gestation live births, there were more girls than boys in both non-ejaculated sperm and ejaculated sperm group. In conclusion, the present study clearly showed no statistical increased risk in neonatal outcomes of newborns were found in the ICSI treatment with epididymal or testicular sperm. It may provide information for consultation for ICSI treatment in PESA or TESA patients.

Ideal embryo transfer position and endometrial thickness in IVF embryo transfer treatment.

To establish an ideal transfer strategy by investigating the relationships among embryo transfer (ET) depth, endometrial thickness, and subsequent in vitro fertilization treatment clinical pregnancy outcomes. In the present retrospective analysis, data from in vitro fertilization-ET treatment cycles conducted at a fertility center in Shanghai, China, between October 2014 and March 2015 were analyzed. Women were divided into groups 1-4 according to transfer depth (<10; 10-15, 15-20, and >20mm, respectively), as measured by air bubbles. Additionally, 391 women were divided into groups A-C according to endometrial thickness (<7, 1-12, and >12mm, respectively). Clinical pregnancy outcomes were assessed by group. Data from 501 cycles were included. Clinical pregnancy and live delivery rates were significantly higher in group 2 (P=0.009 and P=0.002, respectively) and group 3 (P=0.008 and P=0.001, respectively) than in group 4. Among the 394 patients with endometrial thickness data available, clinical pregnancy and live delivery rates were higher in group B (P=0.028 and P=0.015, respectively) and group (P=0.013 and P=0.013, respectively) than in group A. Correct transfer depth and endometrial thickness can increase the rates of clinical pregnancy, implantation, and live delivery. Placing the embryos at 10-20mm from the fundus and at an endometrial thickness of more than 7mm is recommended for optimal clinical pregnancy outcomes.

Adenomyosis

The usual treatment for severe adenomyosis has been hysterectomy, because its removal is complicated by infiltrative tissue destruction of normal uterine myometrium.. Yet many women wish to retain their uterus to preserve their ability to become pregnant and carry babies. Our objective was to see if it is possible to remove very large, symptomatic adenoymas with a technique that allows safe future childbearing. Complete excision of adenomyotic tissue and reconstruction of the uterine wall by a triple-flap method to prevent uterine rupture in subsequent pregnancies. From June 1998 to August 2017, 113 women with very severe adenomyosis who desired pregnancy, and all of whom had severe and debilitating symptoms were enrolled and followed for relief of symptoms and successful pregnancy and live birth. A dramatic reduction of menstrual symptoms occurred immediately and 69.5% of women delivered a healthy baby at term without any incidence of uterine rupture. Adenomyosis is a disabling disease in women that until recently had been treated by hysterectomy. However, many patients wish to preserve their uterus for childbearing, necessitating the need for a more effective conservative approach in treating this disease. The “triple-flap method” described here has not only significantly decreased the symptoms of adenomyosis but has also increased fertility in these patients with no incidence of uterine rupture. A successful live baby delivery rate of 69.5% has been achieved in these women who otherwise would have undergone hysterectomy.

Application of testicular spermatozoa cryopreservation in assisted reproduction.

To evaluate the efficiency of spermatozoa cryopreservation and to compare the clinical pregnancy outcomes in intracytoplasmic sperm injection (ICSI) using fresh versus cryopreserved spermatozoa collected by testicular sperm aspiration (TESA). A retrospective study was performed to compare the outcomes of men who accepted frozen-spermatozoa-based TESA-ICSI with those of men who underwent TESA-ICSI using fresh spermatozoa between January 1, 2015, and December 30, 2016. The groups were matched for age. The rates of fertilization, good-quality embryos, blastocyst formation, and clinical pregnancy outcomes were obtained from clinical records and were compared between the groups. There were no significant differences between the frozen TESA group (n=79) and the fresh TESA group (n=194) in the rates of fertilization (71.4% vs 73.4%), good-quality embryos (55.3% vs 54.5%), blastocyst formation (60.9% vs 60.1%), clinical pregnancy (61.7% vs 55.1%), and live delivery (51.1% vs 45.7%) (P>0.05 for allcomparisons). Freezing low-count sperm collected by TESA with a cryoprotectant was an efficient method in the treatment of male factor infertility.

Effects of body mass index on the outcomes of in vitro fertilization in Chinese patients with polycystic ovary syndrome: a retrospective cohort study

To investigate the effects of body mass index (BMI) on the outcomes of in vitro fertilization (IVF) in Chinese patients with polycystic ovary syndrome (PCOS). In the retrospective cohort study, a total of 1074 patients with PCOS undergoing IVF between April 2010 and May 2017 in two reproductive medicine centers, respectively in eastern China (Women’s Hospital, School of Medicine, Zhejiang University, Zhejiang Province) and in southern China (Maternal and Child Health Care Hospital of Liuzhou, Guangxi Province), were included. The patients were divided into four groups according to the recommended Chinese BMI cut-off points: underweight (BMI< 18.5 kg/m2), normal weight (18.5 kg/m2≤BMI<24.0 kg/m2), overweight (24.0 kg/m2≤BMI<28.0 kg/m2), and obese (BMI≥ 28.0 kg/m2). The basic characteristics of the PCOS patients, the details of IVF treatment, and the pregnancy outcomes were collected. There were no significant differences among the normal weight, overweight, and obese PCOS patients undergoing IVF on the biochemical pregnancy rate, clinical pregnancy rate, miscarriage rate, live birth rate, or term delivery rate (P>0.05), although the overweight and obese PCOS patients required more gonadotropin (Gn) (P<0.001) as well as longer stimulation period (P<0.001), and got less retrieved oocytes (P<0.05) and fertilized oocytes (P<0.05). The underweight PCOS patients required less Gn (P<0.05) and achieved higher live birth rate and term delivery rate (P<0.05), compared with the normal weight PCOS patients. High BMI had no negative effects on the outcomes of IVF in Chinese patients with PCOS; however, the conclusion may seem a little limited due to the retrospective design and the potential bias.

Reporting on longitudinal live birth rates and cumulative delivery rates are more realistic outcome measures than sperm retrieval rates in couples undergoing mTESE–ICSI

The live birth rates (LBRs) in men with non-obstructive azoospermia (NOA) undergoing microdissection TESE (mTESE) are under reported, with surgical sperm retrieval rate often used as the primary outcome measure. We analysed longitudinal and cumulative delivery rates following mTESE– intracytoplasmic sperm injection (ICSI) in NOA. Sperm was retrieved in 45% of patients undergoing mTESE. Median male and female age were 42 years (IQR 37–47) and 35 years (IQR 31–38) respectively. A total of 141 ICSI cycles and 23 frozen embryo transfers resulted in 62 pregnancies and 37 LBRs. The longitudinal LBR, crude and expected cumulative delivery rates after five cycles were 15.5%, 48.7% and 71.1%, respectively. Reassuringly, there was no significant difference in pregnancy rate (PR) (p = 0.37) or LBR (p = 0.68) using fresh or frozen sperm or embryo (p = 0.74). Sperm retrieval was significantly correlated with Johnsen score (JS) (p = 0.006) and hypospermatogenesis (HS) (p = 0.04), whilst LBR only significantly correlated with female age (p = 0.04). The longitudinal LBR for a couple embarking on mTESE for azoospermia is only 15.5%, although the cumulative delivery rates are promising. Reassuringly, the outcomes using fresh versus frozen embryos or sperm are comparable. Reporting on delivery rates from a single mTESE procedure are more objective and realistic measures of treatment success in men with NOA.

Association between induced abortion history and later in vitro fertilization outcomes.

To establish an effective and safe clinical fertility strategy by investigating the relationship between abortion history and pregnancy outcomes of in vitro fertilization (IVF) treatment. In the present retrospective cohort study, data from IVF treatment cycles performed at a reproductive center in China between October 1, 2014, and October 31, 2015, were assessed. Outcomes were compared between women with a history of induced abortion and those without. There were 1532 IVF treatment cycles included; 454 patients had a history of induced abortion and 1078 did not. The spontaneous abortion rate was significantly higher (30/170 [17.6%] vs 41/420 [9.8%]; P=0.002) and the endometrium was significantly thinner (8.8±1.8 vs 9.7±1.8cm; P=0.001) among patients with a history of induced abortion compared with those without. In a subgroup analysis of patients with a history of induced abortion, women who had undergone surgical abortions had a lower live delivery rate compared with medical abortions (29/76 [38%] vs 101/378 [27%]; P=0.039). Further, women who had a history of more than two surgical abortions had lower live delivery and clinical pregnancy rates (both P<0.05). A history of induced abortion was associated with worse IVF outcomes, especially a history of more than two surgical abortions.

The impact of an increased progesterone-to-follicle number ratio on live delivery rates in women with normal ovarian reserve.

To explore the relationship between progesterone-follicle number (P/F) ratio and live delivery rate in patients with normal ovarian reserve undergoing cleavage-stage embryo transfer with a long gonadotropin-releasing hormone agonist cycle. The present retrospective study included data from patients younger than 38years with normal ovarian reserve who were undergoing in vitro fertilization/intracytoplasmic sperm injection and embryo transfer at Zhongnan Hospital, Wuhan University, China, between January 1, 2009 and December 31, 2015. Patients underwent cleavage-stage fresh embryo transfer with a long gonadotropin-releasing hormone agonist cycle, and associations between P/F ratios and fertility/pregnancy outcomes were analyzed. Patients with a P/F ratio of 0.11 or above had higher serum progesterone levels (P<0.001) and lower serum estradiol levels (P<0.001) on the day of human chorionic gonadotropin administration in comparison with patients with lower P/F ratios; elevated P/F ratios were also associated with fewer follicles at least 14mm in size (P<0.001) and lower live delivery rates (P<0.001). Multiple logistic regression confirmed that P/F ratio was an independent predictor of live delivery rate (P=0.001). A P/F ratio of at least 0.11 was associated with lower live delivery rates in women with normal ovarian reserve undergoing cleavage-stage embryo transfer with a long gonadotropin-releasing hormone agonist cycle.

Comparison of perinatal outcomes following fresh and frozen-thawed blastocyst transfer

ObjectiveTo investigate the effect of ovarian stimulation on endometrial receptivity by comparing singleton pregnancy and perinatal outcomes following fresh or frozen-thawed blastocyst transfers. MethodsA retrospective cohort study enrolled patients undergoing fresh or frozen-thawed blastocyst transfers that resulted in live deliveries between January 1, 2010 and September 30, 2013 at a single academic center. Implantation, clinical pregnancy, spontaneous abortion, and live delivery rates were calculated. The incidence of term delivery, preterm delivery, low birth weight, term low birth weight, and very low birth weight were also recorded. To detect a 10% difference in the implantation rate, a minimum sample size of at least 415 transfer cycles in each group was estimated. ResultsThe study included data from 918 fresh and 1273 frozen-thawed cycles. Patients in both groups were of similar age and there was no difference in the grading of blastocysts. No differences were observed in the implantation (37.3% vs 37.7%), clinical pregnancy (50.2% vs 49.4%), spontaneous abortion (7.3% vs 9.3%), and live delivery (42.9% vs 40.6%) rates of the two groups. A sub-analysis of all live singleton and twin deliveries revealed no difference in perinatal outcomes between the two techniques. ConclusionsThe present study demonstrated equivalent singleton pregnancy and perinatal outcomes when comparing frozen-thawed and fresh blastocyst transfer procedures.

Gestational surrogacy in Australia 2004-2011: treatment, pregnancy and birth outcomes.

Information on gestational surrogacy arrangement and outcomes is limited in Australia. This national population study investigates the epidemiology of gestational surrogacy arrangement in Australia: treatment procedures, pregnancy and birth outcomes. A retrospective study was conducted of 169 intended parents cycles and 388 gestational carrier cycles in Australia in 2004-2011. Demographics were compared between intended parents and gestational carrier cycles. Pregnancy and birth outcomes were compared by number of embryos transferred. Over half (54%) intended parents cycles were in women aged <35 years compared to 38% of gestational carrier cycles. About 77% of intended parents cycles were of nulliparous women compared to 29% of gestational carrier cycles. Of the 360 embryo transfer cycles, 91% had cryopreserved embryos transferred and 69% were single-embryo transfer (SET) cycles. The rates of clinical pregnancy and live delivery were 26% and 19%, respectively. There were no differences in rates of clinical pregnancy and live delivery between SET cycles (27% and 19%) and double-embryo transfer (DET) cycles (25% and 19%). Five of 22 deliveries following DET were twin deliveries compared to none of 48 deliveries following SET. There were 73 liveborn babies following gestational surrogacy treatment, including 9 liveborn twins. Of these, 22% (16) were preterm and 14% (10) were low birthweight. Preterm birth was 13% for liveborn babies following SET, lower than the 31% or liveborn babies following DET. To avoid adverse outcomes for both carriers and babies, SET should be advocated in all gestational surrogacy arrangements.

Application of FISH method for preimplantation genetic diagnostics of reciprocal and Robertsonian translocations.

Carriers of reciprocal (RCP) and Robertsonian (RT) translocations are known to be at risk for reproductive difficulties. Preimplantation genetic diagnosis (PGD) is one of the options these carriers have to try to fulfill their desire to have a child. The FISH technique is one of the best method to detect RCPs, and, together with the Next Generation Sequencing, to diagnose RTs. The aim of the present study was to assess the usefulness of the FISH method for rapid diagnosis of translocations in our center to improve the reproductive counseling. From 2008 to 2012 one hundred and twenty seven fresh cycles of the in vitro fertilization (IVF; without freezing embryos) were performed in 42 couples with an RCP and 35 couples with an RT translocations. The patients were diagnosed before IVF as translocation carriers and therefore they opted for PGD. The classical FISH protocol has been applied with specific oligonucleotide probes. In total 521 blastomeres were tested in order to determine the presence or absence of genetic anomalies resulting from one of the parents being a translocation carrier. Despite the large number of abnormal embryos (407 embryos - 78.1% of all examined embryos), 19.4% of blastomeres appeared to come from a normal or balanced embryos that may have been transferred to the uterus. In 63 of the 127 cycles embryo transfer (ET) was feasible and 24 women had a successful singleton or twin pregnancy. Thus, a live delivery rate of 18.9% per started cycles and 38.1% per cycle with ET was obtained. FISH should be regarded as an optimal preimplantation genetic diagnosis method for specific RCP and RT translocation carriers to increase the chance of successful IVF procedure.

Live delivery outcome after tubal sterilization reversal: a population-based study

To determine the cumulative incidence of live delivery in women who underwent reversal of tubal sterilization. Population-based retrospective cohort study. Hospitals in Western Australia. All women aged 20-44 years, with a history of hospital admission for tubal sterilization, who subsequently underwent reversal of sterilization during the period 1985 to 2009 in Western Australia (n = 1,898). Data regarding reversal of sterilization and prior tubal sterilization were extracted from routinely collected administrative hospital separation records, until commencement of IVF treatment. First live-delivery rates. There were 969 first live deliveries observed during the study period. The overall cumulative live-delivery rate was 20% (95% confidence interval [CI] 18-23) within the first year after reversal, 40% (95% CI 38-42) at 2 years, 51% (95% CI 48-53) at 5 years, and 52% (95% CI 50-55) at 10 years. The 5-year cumulative live-delivery rate was significantly lower in women who were aged 40-44 years (26%) compared with younger women (aged 20-29, 30-34, and 35-39 years) (50%, 56%, and 51%, respectively). Women undergoing reversal of sterilization before they reach age 40 years have at least a 50% chance of delivering a live baby within the next 5 years. Up to that age, there is no significant difference in live deliveries. The live-delivery rate halves after the age of 40 years.

Perinatal outcomes in singleton and twin ICSI pregnancies following hysteroscopic correction of partial intrauterine septa.

To investigate the perinatal outcomes of patients with clinical pregnancies from ICSI treatments who had previously undergone hysteroscopic surgery to correct partial intrauterine septa and compare them to outcomes of patients with no intrauterine anomalies. A retrospective observational analysis of 2024 ultrasound confirmed pregnancies from ICSI treatments performed between January 2005 and June 2012. The patients were grouped according to their intrauterine status, and sub-grouped according to the number of fetal hearts observed; singleton control (n=1128), twin control (n=566), singleton septum (n=217) and twin septum (n=113). The primary outcomes analyzed were miscarriage, preterm, very preterm, stillbirth, vanishing twin and live delivery rates, as well as low birth weight and very low birth weight rates. The live birth rate (89,9 %) in the singleton control subgroup was non-significantly higher than the live birth rate (85,3 %) in the septum subgroup, with a RR of 1,05 (p=0,0583, 95 % CI 0,9943-1,1182) for live birth. In contrast the live birth rate (91,3 %) in twin control subgroup was significantly higher than the live birth rate (84,1 %) in the septum subgroup, with a RR 1,09 (p=0,0282, 95 % CI 0,9988-1,1819). Non-significantly, higher miscarriage and stillbirth rates were the main contributors to the reduced live birth rates. The singleton and twin septum subgroups also had higher rates of premature and very premature delivery and LBWs and vLBW, especially in the singleton septum subgroup. The hysteroscopic correction of intrauterine septa may not eliminate all risks for premature delivery.