Lower Clinical Pregnancy Rate Research Articles

The impact of adenomyosis on the outcome of IVF–embryo transfer

Our study examined the impact of adenomyosis on the chance of clinical pregnancy after IVF and embryo transfer (IVF–ET). This was a prospective multicentre study from April 2013 to October 2015. We included 375 women with history of infertility who attended for a 3D scan prior to IVF–ET. A total of 150/375 (40.0%, 95% confidence interval [CI] 35.2–45.0) women had clinical pregnancy. Women with any feature of adenomyosis had a lower clinical pregnancy rate (21/72 [29.2%, 95% CI 18.6–39.6] versus 129/303 [42.6%, 95% CI 37.1–48.2], P = 0.044, relative risk (RR) 0.68 [95% CI 0.47–1.00]). Logistic regression selected an adenomyosis score of 4 or higher as an independent predictor of clinical pregnancy (odds ratio [OR] 0.35 [95% CI 0.15–0.82]). Estimated probability of clinical pregnancy decreased from 42.7% (95% CI 37.1–48.3) for women with no adenomyosis features to 22.9% (95% CI 13.4–32.6) for those with four and 13.0% (95% CI 2.2–23.9) for those with all seven. Women with adenomyosis have lower clinical pregnancy rate after IVF–ET. Condition severity expressed as a number of morphological features on ultrasound scan increases the magnitude of the effect.

Progesterone, progesterone/estradiol and ART outcomes in day-5 transfer cycles

The objective of this study was to assess the effects of elevated luteal-phase progesterone levels (PE) and high progesterone/estradiol ratio (‘P/E2’ ratio) on IVF outcomes, exclusively in GnRH-antagonist cycles with day-5 embryo transfer. PE was not found to have a significant effect on implantation or clinical pregnancy rate (CPR) (OR 0.56, 95% CI 0.25–1.25, p = .16). Elevated ‘P/E2’ ratio (≥0.55) on trigger day was associated with a poorer response to stimulation and lower clinical pregnancy rates (OR 0.58, 95% CI 0.34–1.00, p = .05). Patients with PE and low ‘P/E2’ ratio yielded significantly more oocytes than patients with PE and high ‘P/E2’ ratio. The mean implantation rate per patient decreased by 60% in the group with PE and high ‘P/E2’ ratio in comparison to the group with PE and low ‘P/E2’ ratio (17.9%±36.6 vs. 45.5%±47.2, p = .06), although no statistical significance was observed. The detrimental effect of PE may be mitigated by culturing embryos to day-5 before embryo transfer. Combined assessment of serum progesterone and ‘P/E2’ ratio may predict pregnancy outcome better than progesterone levels alone.

Coasting (withholding gonadotrophins) for preventing ovarian hyperstimulation syndrome.

Coasting (withholding gonadotrophins) for preventing ovarian hyperstimulation syndrome.

The Impact of Progesterone Level on Day Of hCG Injection in IVF Cycles on Clinical Pregnancy Rate.

Background:Premature progesterone rise (PPR) has long been implicated as contributing to implantation failure. Despite the use of gonadotropin-releasing hormone (GnRH) analogues, subtle increases in serum progesterone (P4) levels beyond a threshold progesterone concentration were observed on the day of trigger in controlled ovarian hyperstimulation cycles.Aims:The purpose of the study was to evaluate the incidence of PPR on the day of trigger in conventional IVF/ICSI cycles and its impact on clinical pregnancy rate.Settings and Design:A total of 235 patients undergoing conventional IVF/IVF–ICSI by fresh embryo transfer cycles from January 2016 to December 2016 at the infertility unit of a tertiary care hospital were prospectively analyzed.Material and Methods:Patients included in the study were subjected to GnRH agonist long/antagonist protocol. Ovulation induction was given with rFSH and/or HMG in both the protocols. The cutoff for defining PPR was P4≥ 1.5 ng/ml, and an analysis of the role of P4on clinical pregnancy rate was performed. Statistical analysis was performed with the Statistical Package for the Social Sciences trial version 23.0 software for Windows and Primer software.Results and Conclusion:The overall clinical pregnancy rate per embryo transfer was 30.6%. The clinical pregnancy rate in the patients with P4 <1.5 ng/ml was significantly higher than those with elevated levels, P4≥ 1.5 ng/ml (33.3% vs. 12.9%; P = 0.037). Premature progesterone elevation in ART cycles is possibly associated with lower clinical pregnancy rates.

The Relationship Between the MTHFR C677T Genotypes to Serum Anti-Müllerian Hormone Concentrations and In Vitro Fertilization/Intracytoplasmic Sperm Injection Outcome.

The expression of the 5,10-methylentetrahydrofolate reductase (MTHFR) gene in human oocytes and preimplantation embryos suggests that the MTHFR gene is involved in folliculogenesis and female reproduction. Considering the importance of the MTHFR gene on female reproduction, the aim of this study was to evalu- ate the influence of MTHFR C677T polymorphism on ovarian marker reserve, particularly serum anti-Müllerian hormone (AMH) levels, and ovarian response as well as clinical pregnancy rates after in vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI). A total of 137 women who underwent ART treatment due to male factor infertility enrolled in this study. Genotyping of MTHFR C677T polymorphism and serum AMH concentrations were performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique and an ultrasensitive enzymelinked immunosorbent assay (ELISA). Women with the TT genotype showed significantly higher AMH levels (4.5 ± 3.2 ng/mL) compared to carriers of other genotypes after ovarian stimulation. We observed a nonsignificant trend towards lower clinical pregnancy rates in patients with the TT (23.1%) versus CT (48.4%) genotypes (p = 0.2). No significant differences existed in terms of miscarriage and live birth rates among the groups. Multivariable logistic regression revealed that the duration of infertility and AFC were important predictive variables for the live birth rate. Our results confirmed that the presence of the T mutant allele of the 677 polymorphism in the MTHFR gene led to an increased trend in AMH levels. Interestingly, we observed that the numbers of oocytes retrieved decreased in the mutated genotypes. We have not observed this trend in relation to oocyte maturity. The influence of the MTHFR C677T polymorphism on embryo quality and pregnancy rate after ART cycles remains unclear.

Effect of pretreatment with oral contraceptives and progestins on IVF outcomes in women with polycystic ovary syndrome.

Do oral contraceptives (OCs) and progestins impact live birth rate ofIVF when used for cycle scheduling in women with polycystic ovary syndrome (PCOS)? OCs used for scheduling IVF cycle were associated with lowered rates of pregnancy and live birth after fresh embryo transfer, whereas progestins used for this purpose yield higher rates of pregnancy and live birth than OCs. Due to oligo-menorrhea in PCOS, OCs and progestin are extensively used to schedule the start of an IVF cycle in women with PCOS. Little is known about the effect of such pretreatments on outcomes, especially, the rate of live birth. This was a nested cohort study and secondary analysis of a multicenter randomized trial, which was designed to compare live birth rate after fresh embryo transfer vs frozen embryo transfer (FET) in women with PCOS (Frefro-PCOS). A total of 1508 women were enrolled from 14 centers between June 2013 and May 2014. At the discretion of local investigators, subjects were instructed to wait for spontaneous menses (Control group, n = 323), or were prescribed progestins (P group, n = 283) or OCs (OCs group, n = 902) to induce menstruation prior to the start of ovarian stimulation. GnRH antagonist protocol was initiated at Day 2 or 3 of induced or spontaneous menses cycle. The rates of pregnancy, pregnancy loss and live birth after either fresh embryo transfer or FET were compared among these three groups. With fresh embryo transfer, women with OC-induced menses had lower rates of clinical pregnancy (48.8% vs 63.6%, relative rate (RR): 0.77, 95% CI: 0.66-0.89) and live birth (36.1% vs 48.1%, RR: 0.75, 95% CI: 0.61-0.92) than women with spontaneous menses. With freeze-all and deferred FET, women with OC-induced menses had a similar pregnancy rate but a higher pregnancy loss rate (27.7% vs 13.0%, RR: 2.13, 95% CI: 1.28-3.52) after FET than women with spontaneous menses. The live birth rate after FET in women with OC-induced menses, progestin-induced menses and spontaneous menses was 49.4%, 50.7% and 60.2%, respectively (P = 0.06). Progestin-induced menses was associated with similar rates of pregnancy, pregnancy loss and live birth after transfer of either fresh or frozen embryos compared with spontaneous menses. Multivariate logistic regression analysis showed that OCs used for menses induction was associated with lower rate of live birth. The methods for menses induction were not assigned randomly, thus selection bias was highly likely because of the study design and significant differences that were observed in the baseline characteristics of the women in the different groups. The mean BMI in this study population was relatively normal; the applicability of this result to obese PCOS women needs to be evaluated in further study. Our results suggest that either waiting for a spontaneous menses or using progestin is a better option than using OCs to induce menses in women with PCOS prior to ovarian stimulation using GnRH antagonist protocol for IVF. Further randomized controlled studies are needed to confirm our findings. This study was funded by National Basic Research Program of China (973 Program) (2012CB944700), the State Key Program of National Natural Science Foundation of China (81430029), National Natural Science Foundation of China (81471428) and Thousand Talents Program (Drs Legro and Zhang H). Dr Legro reports receiving consulting fees from Euroscreen, Kindex, Bayer and Millendo Pharmaceuticals and research funding from Ferring. Others report no disclosures. Frefro-PCOS was registered at Clinicaltrials.gov: NCT01841528.

Longer ovarian stimulation reduces embryo number and clinical pregnancy rate in long GnRH agonist cycles.

The aim of this study was to analyze whether the length of controlled ovarian stimulation affects in vitro fertilization (IVF) cycle outcomes. This retrospective cohort study was performed at a private, university-affiliated fertility centre. We reviewed 1522 IVF cycles, comprising 979 long gonadotropin-releasing hormone (GnRH) agonist and 543 GnRH antagonist protocols. All subjects underwent controlled ovarian stimulation followed by fresh embryo transfer. Logistic regression analysis was used to examine the relationship between trigger day and the following cycle outcomes: normal fertilization rate (FR), proportion of mature oocytes, proportion of cycles with embryos for cryopreservation, and clinical pregnancy rate (CPR). In long agonist cycles, having more days of stimulation was associated with a lower clinical pregnancy rate (OR=0.87, 95% CI=0.80-0.96, P=0.01). Longer stimulation also resulted in fewer cycles with supernumerary embryos for cryopreservation (OR=0.84, 95% CI=0.77-0.92, P=0.0005), despite a having greater number of mature oocytes retreived (OR=1.05, 95% CI=1.01-1.10, P=0.04). For each additional day of stimulation in a long agonist protocol, the odds of achieving a clinical pregnancy were reduced by 13% and of achieving cryopreservation by 16%. In the antagonist protocol group, the length of ovarian stimulation did not have an effect on the clinical pregnancy and cryopreservation rates. Longer duration of ovarian stimulation appears to reduce clinical pregnancy and embryo cryopreservation rates in subjects undergoing long GnRH agonist cycles. The number of days of stimulation does not appear to affect those using the GnRH antagonist protocol.

Effects of cystectomy for ovary benign cyst on ovarian reserve and pregnancy outcome of in vitro fertilization-embryo transfer cycle

To investigate the impact of previous cystectomy for ovary benign cyst on ovarian reserve and pregnancy outcome in in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) cycles. Totally 622 infertility patients were retrospectively investigated who underwent first IVF/ICSI-ET cycle in Reproductive Hospital Affiliated to Shandong University from January 2013 to June 2014. There were 153 cases who had been removed ovarian cyst by cystectomy surgeries recruited as study group, in which 44 cases of ovarian endometriosis cyst, 35 cases of benign ovarian teratomas, 67 cases of simple ovarian cyst and 7 cases of ovarian mucinous cystadenoma. In contrast, 469 infertility patients with tubal-factor infertility or male factor were included as control group. The age-matched women in the control group had no ovarian surgery previously. The indicators of ovarian reserve and pregnancy outcome were analyzed between two groups. The influence of different types of ovarian cysts on ovarian reserve and pregnancy outcome in IVF/ICSI-ET cycles were also studied, ovarian endometriosis cyst was studied as Group A, and Group B consisted of benign ovarian teratomas, simple ovarian cyst and mucinous cystadenoma. (1) The significantly lower serum antimullerian hormone (AMH) level (median: 1.92 versus 2.90 mg/L), antral follicle count (AFC; median: 12.0 versus 13.0), retrieved oocytes (12±5 versus 13±6) and the number of embryo cryopreserved (median: 1.0 versus 3.0) were found in study group compared with control group (all P<0.05). There was no statistical difference between two group for the following parameters, such as basal FSH level, the total dosage of gonadotropin duration and the total dosage of gonadotropin (all P>0.05). A better clinical pregnancy rate was achieved in control group (61.6%, 241/391) than that in study group (61.4%, 81/132), but no significant difference was existed (P=0.96). (2) Compared to Group B, Group A had fewer AFC, lower serum AMH level, retrieved oocytes and the number of embryo cryopreserved (11±4 versus 13±5; 1.65 versus 2.15 mg/L; 9±4 versus 13±5; 0 versus 2.0; all P< 0.01). There was a lower clinical pregnancy rate in Group A than that in Group B [50.0% (19/38) versus 66.0% (62/94)], accompanying with higher abortion rate [3/19 versus 9.7% (6/62)], but no differences were observed (all P>0.05). Ovarian reserve declines after the cystectomy for ovarian benign cysts and the cystectomy has a negative impact on IVF/ICSI-ET cycle, resulting in a decrease of the number of retrieved oocytes and the number of embryo cryopreserved, but do not influence clinical pregnancy outcome. Ovarian reserve is impaired more seriously by cystectomy for ovarian endometriosis cyst than other ovarian benign cyst.

Do serum anti-Mullerian hormone levels correlate with pregnancy outcomes in patients with diminished ovarian reserve undergoing in vitro fertilization?

Previous studies have suggested that patients with serum markers of diminished ovarian reserve (DOR) have higher rates of embryonic aneuploidy and lower rates of clinical pregnancy. To test this hypothesis, we investigate the correlation between pregnancy outcomes in patients < 35 years of age with good quality embryos and serum anti-mullerian hormone (AMH) levels as a marker for DOR.

The impact of LH, E2, and P level of HCG administration day on outcomes of in vitro fertilization in controlled ovarian hyperstimulation

The objective of this study was to evaluate the impact of luteinizing hormone (LH), estradiol (E2) and progesterone (P) levels on the day of human chorionic gonadotropin (HCG) administration on outcomes of in vitro fertilization (IVF) in controlled ovarian hyperstimulation (COH).In this retrospective study, 129 infertile women undergoing IVF/intracytoplasmic sperm injection (ICSI) treatments were included; these cycles were stratified according to LH levels of ≥ 1.12 IU/L or < 1.12 U/L and according to E2 levels of ≥ 1,005.89 pmol/L or < 1,005.89 pmol/L. The main outcome measure was the clinical pregnancy rate.The clinical pregnancy rate was significantly higher in the group with LH ≥ 1.12 IU/L than in the group with LH < 1.12 U/L (43.28% vs. 30.65%, p < 0.05). The clinical pregnancy rate was also higher in the group with E2 ≥ 1,005.89 pmol/L than in the group with average E2 < 1,005.89 pmol/L (42.86% vs. 30.51%, p < 0.05). Among the LH, E2, and P levels on the day of HCG administration, LH level was the most important predictor of outcomes of IVF in COH. The present data showed an adverse effect of low serum LH level (LH < 1.12 IU/L) on the day of HCG administration on clinical pregnancy rate. E2 level can also predict the outcomes of IVF in COH.Low serum LH level (LH < 1.12 IU/L) and low serum E2 level (average E2 < 1,005.89 pmol/L) on the day of HCG administration led to low clinical pregnancy rates, while the P level on the day of HCG administration may have had little effect on clinical pregnancy.

Vitamin D deficiency and pregnancy rates in women undergoing single embryo, blastocyst stage, transfer (SET) for IVF/ICSI

What is the influence of vitamin D deficiency on pregnancy rates among women undergoing IVF/ICSI and Day 5 (blastocyst stage) single embryo transfer (SET)? Vitamin D deficiency results in significantly lower pregnancy rates in women undergoing single blastocyst transfer. Preliminary experiments have identified the presence of vitamin D receptors in the female reproductive system. However, results regarding the effect of vitamin D deficiency on clinical outcomes are conflicting. None of the previous studies adopted a SET strategy. Serum vitamin D concentration was measured retrospectively in patients who underwent SET on Day 5. Overall 368 consecutive infertile women treated within a period of 15 months were included in the study. All patients underwent ovarian stimulation for IVF/ICSI and Day 5 SET. Serum samples were obtained 7 days prior to embryo transfer and stored frozen at -20°C. Samples were collectively analyzed for their 25-OH vitamin D content. Vitamin D deficiency was defined as serum 25-OH vitamin D levels <20 ng/ml in accordance with the Institute of Medicine and the Endocrine Society clinical practice guidelines. Clinical pregnancy rates were significantly lower in women with vitamin D deficiency compared with those with higher vitamin D values (41 versus 54%, P = 0.015).Logistic regression analysis was performed to identify whether vitamin D deficiency is independently associated with clinical pregnancy rates after controlling for 16 potential confounding factors. According to our results vitamin D deficiency was independently associated with lower clinical pregnancy rates, odds ratios [ORs (95% confidence interval (CI) 0.61 (0.39-0.95)] for vitamin D deficiency (deficient versus non-deficient women), P = 0.030. Finally, even when restricting our analysis to women undergoing elective SET (274 patients), vitamin D deficiency was again independently associated with pregnancy rates [OR (95% CI) 0.56 (0.33-0.93), P = 0.024]. Our results refer only to patients undergoing Day 5 SET. Although vitamin D deficiency appears to compromise pregnancy rates in this population, no guidance can be provided regarding a potential relationship between vitamin D deficiency and ovarian reserve or response to ovarian stimulation. Vitamin D deficiency impairs pregnancy rates in women undergoing single blastocyst transfer. Future prospective confirmatory studies are needed to validate our results and examine the exact underlying mechanism by which vitamin D levels may impair pregnancy rates in infertile women undergoing IVF/ICSI. None declared.

A comparison of implantation, miscarriage and pregnancy rates of single and double day 3 embryo transfer between fresh and frozen thawed transfer cycles: a retrospective study

Background Reduced endometrial receptivity in hyperstimulated cycles may lead to a lower implantation rate and a lower clinical pregnancy rate, but it is unclear if it is also associated with an increase in pregnancy loss rate. The aim of this study was to compare the implantation, miscarriage, and pregnancy rates between fresh and frozen thawed transfer of one or two day-3 embryos, with a view to understanding whether or not reduced endometrial receptivity encountered in hyperstimulated cycles is associated with an increase in miscarriage rate. Methods This study involved a consecutive series of 1 551 single day-3 embryo transfer cycles and consecutive 5 919 double day-3 embryo transfer cycles in the Assisted Reproductive Unit of the Sir Run Run Shaw Hospital, Hangzhou, China, between January 2010 and December 2012. Results The implantation and clinical pregnancy rates (single embryo 30.7% and double embryos 33.4% and 51.4%) using fresh cycle were both significantly lower than that of frozen-thawed cycles (single embryo 35.8% and double embryos 38.1% and 57.8%). There was no difference in biochemical loss or clinical miscarriage rates between the two groups. Conclusions Impairment of endometrial receptivity associated with ovarian hyperstimulation leads to implantation failure at a very early stage, resulting in an increased number of non-pregnancy. It does not lead to increase in biochemical or clinical losses. The significantly reduced ongoing pregnancy rates in both fresh single and double embryo transfer are therefore due to failure to achieve a pregnancy, rather than pregnancy loss after conception.

Effect of Adenomyosis on In Vitro Fertilization/Intracytoplasmic Sperm Injection Outcomes in Infertile Women: A Retrospective Cohort Study

Aims: To study the effect of adenomyosis on in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes in infertile patients. Methods: We performed a retrospective, database-searched cohort study based on 10,268 patients undergoing controlled ovarian hyperstimulation and IVF/ICSI between 2009 and 2011 in our unit. Adenomyosis was diagnosed by transvaginal ultrasound. A high-quality matched cohort study with strict inclusion criteria was conducted. We compared the basic characteristics and main IVF/ICSI outcomes between the two groups. Results: We identified 83 patients with adenomyosis, of whom we included 77, and strictly matched them to 77 patients without adenomyosis. Higher day 3 estrogen levels and a longer duration of gonadotropin stimulation days were found in women with adenomyosis compared to control subjects. Patients with adenomyosis had a nonsignificant trend toward a lower clinical pregnancy rate and a higher miscarriage rate (p = 0.103 and 0.09, respectively). The delivery rate was significantly lower in the adenomyosis group in comparison to the matched controls (p = 0.022). Conclusions: Within the limitations of a retrospective study (albeit with a remarkably large number of observations), our results suggest that transvaginal ultrasound-diagnosed adenomyosis could have a negative impact on the main IVF/ICSI outcomes. Improving the diagnostic validity and scoring of disease severity in patients with adenomyosis is suggested.

Follicular flushing and in vitro fertilization outcomes in the poorest responders: a randomized controlled trial

Does follicular flushing during oocyte retrieval improve the number of oocytes retrieved in the poorest responders? Follicular flushing in the poorest responders does not increase the number of oocytes retrieved and may result in lower implantation and clinical pregnancy rates. Although previous studies have shown no beneficial effect of follicular flushing in normal responders, no study has demonstrated a detrimental effect and many IVF centers continue to perform this technique in poor responders. Data on follicular flushing in this patient group are limited, with no randomized trial to date assessing its utility in the poorest responders. This randomized controlled trial compared the effects of follicular flushing and direct aspiration on IVF outcomes in the poorest responders, defined as having four or fewer follicles ≥12 mm on the day of hCG administration. Fifty patients were randomized during the 12-month enrollment period. The patients were treated at an academic fertility center at Weill Cornell Medical College, New York. Fifty women were randomized to follicular flushing (n = 25) or direct aspiration (n = 25). One patient in the direct aspiration group was canceled prior to oocyte retrieval for premature ovulation and was included in the intent-to-treat analysis. There was no difference in the number of oocytes retrieved with a median (IQR) of 4 (2-6) in the aspiration group versus 3 (2-5) in the flushing group (95% CI: -0.78, 1.98; P = 0.41). Patients who underwent follicular flushing had significantly fewer embryos transferred {1.7 [standard deviation (SD) 0.6] versus 2.5 (SD 1.2), P = 0.03}, a lower implantation rate (5.3 versus 34.2%, P = 0.006) and a lower clinical pregnancy rate (4 versus 36%, P = 0.01). The difference in pregnancy rates remained significant after adjusting for embryos transferred. Findings, including results for secondary outcome measures, may not be generalizable to natural IVF cycles as these were excluded from the study. This is the first randomized trial to evaluate the utility of follicular flushing in the poorest responders, and the first to demonstrate a potentially detrimental effect of flushing on IVF outcomes. None. NCT 01558141.

Turner syndrome patients undergoing anonymous egg donation cycles have low clinical and ongoing pregnancy rates after single blastocyt transfer

Turner syndrome (TS) often leads to premature ovarian failure and infertility. Although anonymous egg donation (AED) may enable TS patients to achieve pregnancy, some studies have demonstrated lower pregnancy rates. These patients are also at higher risk for cardiovascular complications in pregnancy, including death. The aim of this study was to assess pregnancy outcomes in patients with TS undergoing AED compared with non-TS patients undergoing AED.

Genetic polymorphisms of serotonin transporter and receptor 1A could influence success during embryo implantation and maintenance of pregnancy

To explore whether serotonin-related gene polymorphisms influence clinical outcomes of IVF treatment in recipients using donated oocytes. Nested case-control study. University-affiliated infertility clinic. Two hundred forty-five women undergoing IVF treatment with donated oocytes. None. Genotype and haplotype analysis of the serotonin transporter-linked polymorphic region (5-HTTLPR), rs1800532, rs6295, rs6313, and rs3813929, between recipients grouped according to the results of the oocyte donation for IVF treatment. No differences were found between genotype distribution of the tryptophan hydroxylase 1, serotonin receptor 2A, and serotonin receptor 2C polymorphisms. Recipients carrying the LL genotype for 5-HTTLPR had lower clinical pregnancy rates (PR) and higher biochemical pregnancy loss (BPL) events. Lower implantation rates were found in CC carriers for 5-HT1A.rs6295 who also presented higher BPL rates. A lower incidence of clinical pregnancy was observed for LC haplotypes, corresponding to an increase in BPL rates. A strong association was found between early pregnancy loss and recipients carrying the 5-HTTLPR and rs6295 genetic variants. Identifying biological processes involving serotonin and embryo implantation may help to understand the dynamics of the maternal-embryo dialogue.

Effect of laser assisted hatching on outcome of assisted reproductive technology

Objective: To determine whether laser-assisted hatching can improve clinical outcome of assisted reproductive techniques in both unselected patients and patients with advanced female age, with recurrent implantation failure, or who are using frozen-thawed embryos. Study design: Prospective randomized study. Patients and methods: 179 consecutive women scheduled for intracytoplasmic sperm injection (ICSI) were randomised to either laser assisted hatching (LAH) or non LAH group. Patients were divided into 94 test and 85 control groups. On the day of embryo transfer, the zona pellucida of the selected embryos in the test group was thinned by using an infrared optical laser system, whereas in the control group they were left intact. Clinical pregnancy rates (CPR) and implantation rates (IR) were estimated. Result(s): Patients that underwent LAH (n = 94) had CPR, and IR of 35.1% and 50%, respectively. Patients that did not undergo LAH (n = 85) had lower CPR (28.2%, P = 0.324) and IR (33%, P = 230), with no statistically significant difference P Conclusion: The current study suggested that there is no need for the routine use of laser assisted hatching. However, there is evidence of laser assisted hatching benefit in selected patients

Overweight men with nonobstructive azoospermia have worse pregnancy outcomes after microdissection testicular sperm extraction

To evaluate the effect of obesity on the outcome of testicular sperm extraction (TESE) and assisted reproductive technology. Clinical retrospective study. Center for reproductive medicine at a tertiary-care university hospital. Nine hundred seventy patients with nonobstructive azoospermia. Microdissection TESE followed by intracytoplasmic sperm injection (ICSI). Sperm retrieval rate and clinical pregnancy rate. Testicular sperm were successfully retrieved in 55% of men overall. Of those with sperm found, clinical pregnancy rate was 51% and live birth rate 40%. Sperm retrieval rates were similar in men with body mass index (BMI) <25 kg/m(2), 25-30 kg/m(2), and >30 kg/m(2) (59%, 57%, and 54%, respectively). Mean BMI of men who contributed to pregnancy (27.3 ± 4.9 kg/m(2)) was lower than for men whose sperm did not contribute to a pregnancy (28.2 ± 5.4 kg/m(2)). No man with BMI >43 kg/m(2) (n = 11) contributed to a successful pregnancy, even though sperm were found in men with BMI up to 57 kg/m(2). On multivariable logistic regression analysis, male BMI was the only predictor of successful pregnancy among the variables analyzed, including male age, female age, and female BMI. Overweight men have lower clinical pregnancy rate after microdissection TESE and ICSI compared with men with normal BMI. Men with BMI >43 kg/m(2) did not contribute to any pregnancies, despite successful sperm retrieval.

Intramuscular progesterone versus 8% Crinone vaginal gel for luteal phase support for day 3 cryopreserved embryo transfer

To compare outcomes after intramuscular progesterone (IMP) or 8% Crinone vaginal gel for luteal support for day 3 cryopreserved embryo transfer (CET). Retrospective cohort study with multivariable analysis. Academic medical center. All autologous and donor egg invitro fertilization and intracytoplasmic sperm injection patients who had a day 3 CET from January 1, 2008, to April 30, 2011, with luteal support using 25-50 mg/d IMP or 8% Crinone twice daily, initiated 3 days before the CET. None. Implantation rate, clinical pregnancy, and live birth rates per CET. IMP (n = 440) and Crinone (n = 298) recipients were similar for all demographic characteristics and cycle parameters assessed. Although implantation rates did not differ significantly between the two groups (Crinone vs. IMP: 19.6% vs. 30.4%), women supplemented with Crinone had significantly lower rates of clinical pregnancy (36.9% vs. 51.1%) and live birth (24.4% vs. 39.1%) compared with those on IMP. We observed that day 3 CET cycles with 8% Crinone luteal support had a 44% and 49% lower odds of clinical pregnancy and live birth, respectively, compared with those with IMP support. Further studies are required to identify the optimal timing and dose of 8% Crinone vaginal gel for use in CET cycles.

Endometrial gene expression in the early luteal phase is impacted by mode of triggering final oocyte maturation in recFSH stimulated and GnRH antagonist co-treated IVF cycles

Do differences in endometrial gene expression exist after ovarian stimulation with four different regimens of triggering final oocyte maturation and luteal phase support in the same patient? Significant differences in the expression of genes involved in receptivity and early implantation were seen between the four protocols. GnRH agonist triggering is an alternative to hCG triggering in GnRH antagonist co-treated cycles, resulting in an elimination of early ovarian hyperstimulation syndrome. Whereas previous studies have revealed a low ongoing clinical pregnancy rate after GnRH agonist trigger due to a high early pregnancy loss rate, despite supplementation with the standard luteal phase support, more recent studies, employing a 'modified' luteal phase support including a bolus of 1500 IU hCG on the day of oocyte aspiration, have reported ongoing pregnancy rates similar to those seen after hCG triggering. A prospective randomized study was performed in four oocyte donors recruited from an oocyte donation program during the period 2010-2011. Four oocyte donors in a university IVF center each prospectively underwent four consecutive stimulation protocols, with different modes of triggering final oocyte maturation and a different luteal phase support, followed by endometrial biopsy on Day 5 after oocyte retrieval. The following protocols were used: (A) 10 000 IU hCG and standard luteal phase support, (B) GnRH agonist (triptorelin 0.2 mg), followed by 1500 IU hCG 35 h after triggering final oocyte maturation, and standard luteal phase support, (C) GnRH agonist (triptorelin 0.2 mg) and standard luteal phase support and (D) GnRH agonist (triptorelin 0.2 mg) without luteal phase support. Microarray data analysis was performed with GeneSpring GX 11.5 (RMA algorithm). Pathway and network analysis was performed with the gene ontology software Ingenuity Pathways Analysis (Ingenuity® Systems, www.ingenuity.com, Redwood City, CA, USA). Samples were grouped and background intensity values were removed (cutoff at the lowest 20th percentile). A one-way ANOVA test (P< 0.05) was performed with Benjamini-Hochberg multiple testing correction. Significant differences were seen in endometrial gene expression, related to the type of ovulation trigger and luteal phase support. However, the endometrial gene expression after the GnRH agonist trigger and a modified luteal phase support (B) was similar to the pattern seen after the hCG trigger (A). The study was performed in four oocyte donors only; however, it is a strength of the study that the same donor underwent four consecutive stimulation protocols within 1 year to avoid inter-individual variations. These endometrial gene-expression findings support the clinical reports of a non-significant difference in live birth rates between the GnRH agonist trigger and the hCG trigger, when the GnRH agonist trigger is followed by a bolus of 1500 IU hCG at 35 h post trigger in addition to the standard luteal phase support. This study was supported by an un-restricted research grant by MSD Belgium. EudraCT number 2009-009429-26, protocol number 997 (P06034).