Oocyte Retrieval Research Articles

Comparison of success rates in early stages of in vitro fertilization (IVF) in women with and without endometriosis

Endometriosis remains a significant challenge for reproductive-aged women and is frequently associated with infertility. Although in vitro fertilization (IVF) is used to address infertility in women with endometriosis, its effectiveness in this context is still debated, particularly in developing countries such as Indonesia, where IVF remains a major challenge. The aim of this study was to investigate the success rates of early stages of IVF in women with and without endometriosis. A retrospective cohort study was conducted at the Graha Amerta Fertility Clinic, located within Dr. Soetomo Academic General Hospital in Surabaya, Indonesia. The quantity and quality of oocytes (the number of oocytes obtained by ovum pick-up (OPU) and the number of metaphase II (MII) oocytes), fertilization quality (the number of two-pronuclei oocytes and fertilization rate), embryo development quality (cleavage rate and blastocyst rate), biochemical pregnancy, clinical pregnancy, and live birth rate were collected from IVF patients between 2017−2022. Independent Student’s t-test or Mann-Whitney test was used accordingly for comparison analysis. A total of 410 IVF patients were included in the study; 93 had endometriosis, while 317 had no endometriosis. Oocyte quantity obtained by OPU (p=0.016) and oocyte quality (p=0.045), as measured by the number of MII oocytes, were significantly lower in the endometriosis group compared to the non-endometriosis group. However, there were no significant differences between the two groups in terms of the number of two-pronuclei oocytes (p=0.105), fertilization rate (p=0.987), cleavage rate (p=0.467), blastocyst rate (p=0.128), biological pregnancy rates (OR: 0.98; 95%CI: 0.60–1.60; p=0.940), clinical pregnancy rate (OR: 0.69; 95%CI: 0.39–1.24, p=0.219), or live birth rate (p=0.609). These findings suggest that while endometriosis may reduce oocyte quantity and quality, it does not significantly impact the success rates of IVF.

Safety and effectiveness of controlled ovarian stimulation and oocyte retrieval during prepubertal and peripubertal period

Safety and effectiveness of controlled ovarian stimulation and oocyte retrieval during prepubertal and peripubertal period

The efficacy of orally administered L-carnitine in alleviating ovarian dysfunctions has laid the foundation for targeted in vivo use: a study employing self-control and propensity score matching.

This study aimed to evaluate the effectiveness of oral L-carnitine administration in patients after treatment failure to lay the groundwork for targeted in vivo use. A total of 515 In Vitro Fertilization (IVF) patients undergoing subsequent cycles were included after applying exclusion criteria. They were divided into a control group of 362 patients and a study group of 153 patients who received oral L-carnitine until oocyte retrieval.140 patients were matched according to maternal age, infertility duration, body mass index (BMI), day three top-quality embryos rate, by propensity score matching (PSM). The study investigated the relationship between L-carnitine treatment and in vivo oocyte maturation, normal fertilization, and subsequent embryo development. Following PSM, initial differences in BMI and Day3 top-quality embryo rate between groups were nullified, we created two comparable cohorts with highly similar characteristics. In the subsequent cycles, the study group showed significant improvements in in vivo oocyte maturation rate at retrieval (p=0.002), normal in vitro fertilization rate (p=0.003), blastocyst formation rate (p=0.003), and usable blastocyst rate compared to controls. Although there was no significant difference in the top-quality embryo rate on Day 3, the study group showed a 10% increase in the upper quartile (55.35% vs. 66.67%). The cumulative clinical pregnancy and live birth rates showed a significant improvement (59.82% vs. 68.42%,p=0.004, 47.41% vs. 59.80%, p=0.002). Furthermore, self-control analysis revealed substantial enhancements (p<0.001) in all outcome measures following L-carnitine administration, resulting in the birth of 74 healthy neonates without congenital anomalies. We theorized that daily oral intake of L-carnitine before oocyte retrieval could boost oocyte quality and embryonic development, thus improving IVF outcomes. Ongoing investigations hold the potential to offer valuable insights into the applications and mechanisms underlying the therapeutic effectiveness of L-carnitine.

Cumulative live birth rate of a blastocyst versus cleavage stage embryo transfer policy during in vitro fertilisation in women with a good prognosis: multicentre randomised controlled trial

ObjectivesTo evaluate whether embryo transfers at blastocyst stage improve the cumulative live birth rate after oocyte retrieval, including both fresh and frozen-thawed transfers, and whether the risk of obstetric and...

Does it affect the live birth rates to have a maximum endometrial thickness of 7, 8, or 9 mm in in-vitro fertilization-embryo transfer cycles?

To assess the effect of endometrial thickness (EMT) on live birth rates (LBR) in women with endometrial lining between 7.0-9.9 mm. This retrospective cohort study included women who underwent fresh and frozen embryo transfers between 2008 and 2018, grouped according to their maximum EMT; group 1, 7.0-7.9 mm; group 2, 8.0-8.9 mm; and group 3, 9.0-9.9 mm and underwent blastocyst transfer. The study included 7,091 in-vitro fertilization cycles: 1,385 in group 1, 3,000 in group 2, and 2,706 in group 3. The combined LBR was 22.2%. The mean age of women at oocyte retrieval day was 36.7±4.5 years. There was no difference in female age at oocyte retrieval or in the quality of embryos transferred between the three groups. Group 1 had more diagnoses of diminished ovarian reserve (25.8% vs. 19.5% and 19.1%; p<0.001) and less male factor infertility compared with group 2 and 3, respectively (25.0% vs. 28.8% and 28.5%; P=0.024). LBR was higher with increasing endometrial thickness, group 2 vs. group 1 (22.0% vs. 17.4%; P=0.0004), group 3 vs. group 1 (25.0% vs. 17.2%; p<0.001), and group 3 vs. group 2 (25.0% vs. 22.0%; P=0.008). After controlling for confounding factors, these three groups did not differ in LBR (group 1 vs. group 2, odds ratio [OR], 1.08; 95% confidence interval [CI], 0.83-1.4; P=0.54 and group 1 vs. group 3, OR, 1.16; 95% CI, 0.90-1.51; P=0.24). Live birth rates in women with endometrial thickness between 7.0-9.9 mm were not affected by different cut-offs when blastocyst transfer was performed.

Utilization of Assisted Reproductive Technologies in Breeding Auliekol Cattle: A Comparative Study.

This study evaluates the utilization of in vitro embryo production (IVEP) technology for the conservation and breeding of the Auliekol cattle breed, a primary beef breed in Kazakhstan facing population decline due to the cessation of breeding programs and the incursion of transboundary diseases. We assessed the effect of consecutive ovum pick-up (OPU) procedures on oocyte yield and embryo production in Auliekol and Aberdeen Angus cows. A total of 2232 and 3659 oocytes were aspirated from Auliekol and Aberdeen Angus donors, respectively, with significantly higher yields and embryo production observed in Aberdeen Angus cows. The application of a meiotic block using Butyrolactone I (BLI) and subsequent in vitro fertilization (IVF) protocols was employed, with embryo development monitored up to the morula/blastocyst stage. Results indicated that Auliekol cows exhibited lower oocyte recovery, cleavage, and blastocyst rates compared to Aberdeen Angus cows, likely due to genetic characteristics. Despite the challenges, IVEP presents a valuable tool for the preservation and future propagation of the Auliekol breed, highlighting the need for further research to enhance reproductive outcomes and conservation strategies.

Letrozole co-treatment in an antagonist protocol for overweight women undergoing IVF treatment: a retrospective study

BackgroundOverweight women undergoing IVF treatment have lower success rates. Letrozole, an aromatase inhibitor, has been used as an adjunct for IVF treatment, but its specific effects in overweight women have not been investigated. This study was to explore the effects of letrozole co-treatment in an antagonist protocol for overweight infertile women undergoing IVF treatment.MethodsThis retrospective cohort study included overweight infertile women who underwent IVF/ICSI treatment and fresh embryo transfer (ET), with or without letrozole co-treatment in an antagonist protocol, from 2007 to 2021 at Shanghai Ninth People’s Hospital (Shanghai, China). A total of 704 overweight infertile women were included: 585 women were in the antagonist group, and 119 women were in the letrozole co-treatment group. The primary outcome was the live birth rate after fresh ET. Propensity score-based patient-matching was employed to balance the covariates between the groups. Multivariate logistic regression analysis was also performed to estimate odds ratio (OR) and 95% confidence interval (CI) for association of letrozole co-treatment and the live birth outcome.ResultsLetrozole co-treatment induced significant changes in hormonal profile on the trigger day. The letrozole group exhibited a decrease in the total number of follicles compared to the antagonist group, but a higher proportion of large follicles at oocyte retrieval (P < 0.05). The quantity and quality of embryos were comparable between the two groups (P > 0.05). The letrozole co-treatment group had a significantly higher live birth rate than the control group (38.7% vs. 22.6%, P = 0.026). With multivariate logistic regression analysis, letrozole co-treatment was associated with higher odds of live birth after adjusting for potential confounding factors (adjusted OR = 2.00, 95% CI = 1.17–3.39, P = 0.011). Letrozole presented no significant associations with obstetrical or neonatal complications (P > 0.05).ConclusionLetrozole co-treatment in an antagonist protocol may offer potential benefits for overweight infertile women undergoing IVF treatment. Further research is warranted to validate these findings and explore the broader implications for letrozole co-treatment.

Shining a Light on the Specimen Room: Enhancing Global Research on Bird Eggs through Standardized Digital Archives

Bird egg collections in natural history museums are valuable resources for studies such as how birds’ eggs may evolve under different environmental conditions, providing information that is critical in our changing world and of great interest to scientists. However, the millions of bird egg specimens, many collected over 100 years ago, are often not prioritized in digitized archives. To assess the current status of digitized egg specimens, we examined data available on open-source platforms such as iDigBio, based on the Marini et al. (2020) review of egg collections. Millions of bird egg specimens are preserved in museums worldwide, but only about 21% have been digitally cataloged and made accessible on global platforms, mostly from Western countries. While the technology used for extracting features from digital objects has greatly advanced for studying the size, color and spottiness of eggs (e.g., SpotEgg), the digitized specimens may not be formatted to meet the needs for research, thereby limiting their application. For example, among eight museums with digitized collections, images from six include a scale, but only the Yale Peabody Museum also incorporates a color chart with standardized gray patches for calibration (e.g., Calibrite Color Checker). Furthermore, coordinates obtained through georeferencing are essential for studying environmental influences on egg traits. Yet, fewer than half of the specimens (49%) have been georeferenced. Here we demonstrate how properly digitized specimens—using a dark background, adding a scale, and incorporating a standard color chart in the photo—can be utilized to study the evolution of egg color in birds. We urge the adoption of a standard digitization protocol for bird egg collections, the enhancement of georeferencing for the specimens, and the integration of local databases into global platforms to increase accessibility for the scientific community. These procedures should also be implemented at the early stage of the digitization process to maximize the value of digitized specimens.

Outcomes of IVF treatments in women with antiphospholipid antibodies or antiphospholipid syndrome

BackgroundOvulation induction for in vitro fertilization (IVF) may increase intravascular thromboses among patients with antiphospholipid autoantibodies (aPLs) or antiphospholipid syndrome (APS) due to the high estrogen levels. While natural or modified natural IVF treatment cycles (MNC) are sometimes used instead of stimulated cycles with empiric anticoagulant treatment among these infertile patients, their efficacy is unclear. Materials and methodsA retrospective cohort study including all IVF cycles of patients diagnosed with aPLs or APS in a tertiary, university-affiliated hospital between 2012 and 2022. The outcomes of stimulated cycles with anticoagulants and MNC and natural IVF cycle attempts were compared. Results121 oocyte retrievals from 38 women were analyzed: 93 stimulated and 28 MNC or natural IVF cycles. The rates of cycle cancellation (0 % vs. 17.9 %, p < 0.001) and cycles in which no oocytes were retrieved (0 % vs. 43.5 %, p < 0.001) were significantly lower following stimulated cycles vs. natural and MNC. In parallel, positive β-hCG (31.9 % vs. 10.9 %, p = 0.03), clinical pregnancy rate (23.6 % and 3.6 %, p < 0.001) and live birth rates (18.1 % vs. 3.6 %, p = 0.01) were significantly higher following stimulated cycles. No thrombotic events or bleeding occurred in any cycle. ConclusionOvarian stimulation for IVF is more effective for successful pregnancy and delivery than natural cycles and MNC and can be safely undertaken in aPLs or APS women undergoing IVF. Rates of complication from hormonal treatment are not increased when treated with LMWH during ovarian stimulation.

Hormone-free versus FSH-primed infertility treatment of women with polycystic ovary syndrome using biphasic in vitro maturation: a randomized controlled trial

To compare oocyte maturation rates and pregnancy outcomes in women with polycystic ovary syndrome (PCOS) undergoing biphasic in vitro maturation (capacitation [CAPA]-IVM) with versus without follicle-stimulating hormone (FSH) priming. Randomized, controlled, assessor-blinded trial SUBJECTS: Women aged 18-37 years with PCOS and an indication for CAPA-IVM. Participants were randomized (1:1) to undergo CAPA-IVM with or without FSH priming. The FSH priming group had two days of FSH injections before oocyte pick-up; no FSH was given in the non-FSH group. After CAPA-IVM, day-5 embryos were vitrified for transfer in a subsequent cycle. The primary endpoint was number of matured oocytes. Secondary outcomes included rates of live birth, implantation, clinical pregnancy, ongoing pregnancy, pregnancy complications, obstetric and perinatal complications, and neonatal complications. The number [interquartile range] of matured oocytes did not differ significantly in the non-FSH versus FSH group (13 [9-18] vs. 14 [7-8]; absolute difference -1 [95% confidence interval (CI) -5, 4]); other oocyte and embryology outcomes did not differ between groups. Rates of ongoing pregnancy and live birth were both 38.3% in the non-FSH group and both 31.7% in the FSH group (risk ratio for both outcomes: 1.21, 95% CI 0.74-1.98). Maternal complications were infrequent and occurred at a similar rate in the two groups; there were no preterm deliveries before 32 weeks' gestation. These findings open the possibility of a new, hormone-free approach to infertility treatment of women with PCOS.

Study on the Technology of Laparoscopic Ovum Pick-Up and In Vitro Embryo Production in Chongming Goats.

The application of laparoscopic ovum pick-up (LOPU) and in vitro production of embryos (IVEP) technologies has opened up a new path for purebred breeding and breed improvement in goats. However, due to the complexity of the procedures and multiple influencing factors, these technologies have not been widely adopted in goat production. This study explores factors affecting the efficiency of LOPU in goats by comparing the use of controlled internal drug release (CIDR) for estrus synchronization, conventional FSH versus long-acting recombinant ovine FSH (R-FSH) for superovulation, and the timing of LOPU at 48 h, 60 h, and 72 h of follicular development. The metrics evaluated included the recovery rate of cumulus-oocyte complexes (COCs), the average number of ovarian follicles, the average number of COCs, and the average number of available COCs. The results demonstrated that the efficiency of LOPU was significantly higher with two doses of R-FSH compared to the conventional FSH superovulation protocol and the control group (p < 0.05), with two doses of R-FSH providing a higher LOPU efficiency than one dose (p < 0.05). Using CIDR for estrus synchronization showed no significant difference in LOPU efficiency compared to the non-CIDR group. Similarly, the efficiency of LOPU showed no significant difference between the hormone treatments at 48 h, 60 h, and 72 h. By exploring and optimizing the factors influencing LOPU, we ultimately established a LOPU technology system for goats that meets the production needs of small ruminants.

Recipients' and Environmental Factors Affecting the Pregnancy Rates of a Large, Fresh In Vitro Fertilization-Embryo Transfer Program for Dairy Cows in a Commercial Herd in China.

The main objective of this study was to determine the influence of the recipient dairy cows' breed, lactation number, estrus condition, the type, location and volume of the corpus luteum (CL) and the time of year that the embryo transfer (ET) was performed on the pregnancy rates of a large, fresh in vitro fertilization-embryo transfer program for dairy cows in a commercial herd in China. The recipients were from a herd of dairy cows in Ningxia, a province in northwest China, and we statistically analyzed the data of 495 cows from 2021 to 2023. Cumulus oocyte complexes (COCS) were isolated from follicular fluid obtained through ovum pick-up (OPU) and oocytes were incubated 20-22 h for in vitro maturation (IVM). Embryos were obtained after 10-12 h of in vitro fertilization (IVF) and six days of in vitro culture (IVC). Embryos at the morula or blastocyst stage were transferred to randomly chosen recipients (n = 495). The influence of recipients' breed (Holstein or other), recipients' lactation number (heifers or cows), estrus type (natural or synchronized), CL type (homogeneous, CLhom or cavitary, CLcav), CL side (left or right), volume of the CL and season of transfer (spring, autumn or winter) on pregnancy rates were determined. The pregnancy rates were analyzed by binomial logistic regression with IBM SPSS statistics software, version 26. Pregnancy rates after ET to Holstein cows and other breeds were 43.49% and 42.68%, respectively (p > 0.05). Regarding age, pregnancy rates were 45.56% for heifers and 30.77% for cows (p < 0.05). Pregnancy rates following ET during natural and synchronized estrus were 44.41% and 41.5%, respectively (p > 0.05). Pregnancy rates with a left- or right-side CL were 40.18% and 45.65%, respectively (p > 0.05). The pregnancy rates achieved with a CLhom and CLcav were 44.44% and 39.68%, respectively (p < 0.05). The rates obtained in spring, autumn and winter were 49.26%, 46.02% and 34.64%, respectively (p < 0.05). Moreover, it was found that pregnancy rates were higher in recipients with a CL volume measuring greater than 10 cm3 compared with those with a CL volume measuring less than 10 cm3 (p < 0.05). The comparisons showed that recipients' breed, estrus type or side of the CL had no effect, but the recipients' lactation number, ET season and the type and volume of the CL have significant effects on pregnancy rates during ET.

BCORL1, POF1B, and USP9X copy number variation in women withidiopathic diminished ovarian reserve.

To analyze the copy number variation (CNV) in the X-linked genes BCORL1, POF1B, and USP9X in idiopathic diminished ovarian reserve (DOR). This case-control study included 47 women, 26 with DOR and 21 in the control group. Age, weight, height, BMI, and FSH level were evaluated, as well as antral follicle count (AFC), oocyte retrieval after controlled ovarian stimulation, and metaphase II (MII) oocytes. The CNVs of BCORL1, USP9X, and POF1B genes were measured by quantitative real time PCR (qPCR) using two reference genes, the HPRT1 (X-linked) and MFN2 (autosomal). Protein-protein interaction network and functional enrichment analysis were performed using the STRING database. The mean age was 36.52 ± 4.75 in DOR women and 35.38 ± 4.14 in control. Anthropometric measures did not differ between the DOR and control groups. DOR women presented higher FSH (p = 0.0025) and lower AFC (p < .0001), oocyte retrieval after COS (p = 0.0004), and MII oocytes (p < .0001) when compared to the control group. BCORL1 and POF1B did not differ in copy number between DOR and control. However, DOR women had more copies of USP9X than the control group (p = 0.028). The increase in the number of copies of the USP9X gene may lead to overexpression in idiopathic DOR and contribute to altered folliculogenesis and oocyte retrieval.

Combined removal of ovarian teratoma and oocyte retrieval by laparoscopic surgery under regional anesthesia

To describe the simultaneous laparoscopic approach for teratoma removal and oocyte retrieval performed under regional anesthesia in a woman, desiring to preserve fertility. The patient included in this video gave consent for publication of the video and posting of the video online including social media, the journal website, scientific literature websites, and other applicable sites. Video case report demonstrating the clinical management and laparoscopicteratoma removal combined with oocyte retrievalaccomplished underregional anesthesia. University tertiary care hospital. We present a case of a 31-year-old woman who referred to our Fertility Center with a previous history of right salpingo-oophorectomy for mucinous ovarian cystadenoma and the presence of a large ovarian teratoma of ten centimeters of the contralateral ovary. The ovarian stimulation started in the early follicular phase. Not being able to visualize follicular growth during the ovarian stimulation, it was decided to adopt fixed protocol with antagonist on the 5th day and to proceed, on 15th day, with a laparoscopic pick-up and simultaneous removal of the cyst. Laparoscopic surgery was performed: the left ovary appeared larger in size for the presence of the suspicious mature dermoid cyst and multiple follicles, previously not identified at ultrasound imaging. The follicles contained oocytes that were aspirated with an aspiration needle of 17 G connected to a craft suction pump. Then, practicing the stripping technique, an enucleation of the ovarian cyst was performed. Surprisingly, the removal of the cyst revealed other follicles that were readily aspirated. The patient remained awake during the entire procedure and a low pressure of 10 mmHg was maintained at 15° of Trendelenburg position. A total of seven follicles were aspirated, seven oocytes were retrieved, and six mature oocytes were cryopreserved. The cyst was totally removed and no intracavitary spillage was caused. Simultaneous laparoscopic approach for teratoma removal and oocyte cryopreservation should be considered an effective fertility preservation strategy in patients in whom the presence of an ovarian neoformation does not allow visualization of growing follicles by ultrasound. Laparoscopic oocyte retrieval under regional anesthesia is a safe and well-tolerated technique and should be considered for patients where the transvaginal approach could not be performed.

Evaluation of conical 9 well dish on bovine oocyte maturation and subsequent embryonic development.

The Conical 9 well dish (C9 well dish) is characterized by a decreasing cross-sectional area towards the base. This design was hypothesized to enhance embryonic development by emulating the in vivo physical environment through density modulation. Comparative analyses revealed no significant difference in nuclear maturation rates between the C9 well dish and the 5-well dish. Reactive oxygen species (ROS) generation was lower in the C9 well dish compared to the 5-well dish; however, this difference was not statistically significant. On the second day of in vitro culture, the cleavage rate in the C9 well dish was 4.66% higher, although not statistically significant, and the rates of blastocyst development were similar across both dishes. No significant differences were observed in the intracellular levels of glutathione (GSH) and ROS, as well as in the total cell number within the blastocysts between the dish types. The expression of mitogen-related factors, TGFα and IGF-1, in the blastocysts was consistent between the dishes. However, PDGFβ expression was significantly lower in the C9 well dish compared to the 35 mm petri dish. Similarly, the expression of the apoptosis factor Bax/Bcl2l2 showed no significant differences between the two dishes. Despite the marked difference in PDGFβ expression, its impact on blastocyst formation appeared negligible. The study also confirmed the feasibility of culturing a small number of oocytes per donor, collected via Ovum Pick-Up (OPU), with reduced volumes of culture medium and mineral oil, thus offering economic advantages. In conclusion, the present study indicates that the C9 well dish is effective for in vitro development of a small quantity of oocytes and embryos, presenting it as a viable alternative to traditional cell culture dishes.

How to Define In-Vitro Fertilization Success: A Delphi Consensus among China Experts

Background: A Delphi consensus was conducted to formulate an expert opinion on the definition of in-vitro fertilization (IVF) success, to provide a reference basis for clinical practice. Methods: Chinese experts in assisted reproductive technology (ART) were surveyed using the Delphi method. Based on the literature related to IVF success, eight experts developed a framework of statements and items. A questionnaire was then distributed to 23 experts to canvas their opinions on these statements. If consensus was not achieved, the statement was revised and revoted upon until a consensus was reached. Results: Consensus was reached for 19 statements related to the definition of IVF success, the most relevant of which are summarized as follows: (1) Goal of IVF treatment ([Formula: see text] statement): to attain a healthy live birth in the shortest possible time and with the lowest possible risks; (2) Definition of IVF success ([Formula: see text] statements): effectiveness, safety, and efficiency of IVF treatment should be included in the definition of success, with the cumulative live birth rate per ovarian stimulation cycle within 2 years being a performance indicator (PI) of success, and IVF success should be measured from a patient-centered perspective, including the patient’s burden and satisfaction. (3) Assurance of IVF success ([Formula: see text] statements): to provide evidence-based treatment and avoid the introduction of IVF add-ons into routine clinical practice without any clear evidence of benefit, optimize treatment quality by establishing and monitoring key PIs, and improving quality control systems. (4) Hurdles of IVF success ([Formula: see text] statements): cycle cancellation before oocyte pickup and treatment discontinuation after failed cycles are hurdles of success to IVF. Conclusions: Based on the Delphi method, the expert opinion on the definition of IVF success has been formed, which could complement guidelines and may help improve treatment outcomes.

Cost-Effectiveness of Clomiphene Citrate-Based Minimal Stimulation Compared with Controlled Ovarian Stimulation Protocol in Women with Diminished Ovarian Reserve

Background: In Japan, where infertility treatment is now covered by insurance, appropriate protocols for patients with diminished ovarian reserve (DOR) based on treatment outcomes and cost-effectiveness must be selected. Therefore, this study aims to provide information on the outcomes and cost-effectiveness of conventional ovarian stimulation and mild stimulation for patients with DOR in Japan. Methods: Data from 66 women who underwent first oocyte retrieval at Showa University Hospital between May 2019 and November 2023 were analyzed. Results: The clomiphene citrate (CC) group used significantly fewer gonadotropins and incurred lower costs than the conventional ovarian stimulation group while achieving comparable clinical outcomes, including cumulative live birth rates. Conclusions: CC-based minimal stimulation is a cost-effective alternative to conventional ovarian stimulation for patients with low ovarian reserve without compromising clinical efficacy. Further randomized controlled trials are required to confirm these findings and optimize protocols for this population.

Incidence and timing of pregnancy loss following timed artificial insemination or timed embryo transfer with a fresh or frozen in vitro-produced embryo

The aim of this study was to characterize the incidence and timing of pregnancy loss from service event (timed artificial insemination or timed embryo transfer) to parturition. Lactating Holstein-Friesian cows were randomly assigned to receive either artificial insemination (AI, n = 243) or embryo transfer (ET, n = 863) with a fresh or frozen in vitro-produced blastocyst derived from oocytes collected from the ovaries of elite dairy donors (n = 14 Holstein Friesian and n = 8 Jersey) and elite beef donors (n = 21 Angus) using transvaginal ovum pick-up. In addition, oocytes were collected from the ovaries of beef heifers of known pedigree following slaughter at a commercial abattoir (n = 119). Blood samples were collected on d 7 from all cows to determine progesterone concentration and from subsets of cows on d 18 (n = 524) and d 25 (n = 378) to determine mRNA abundance of interferon-stimulated gene-15 and pregnancy-specific protein B concentration, respectively, to provide an early pregnancy diagnosis. Transrectal ultrasonography was conducted to determine pregnancy status on d 32, d 62 and d 125 after synchronized ovulation. Parturition date was recorded for all cows that reached a term delivery. The predicted probability of pregnancy (%) varied at each time point (d7, 18, 25, 32, 62, 125, parturition) depending on treatment (AI: 77.0, 60.2, 52.3, 48.8, 47.0, 44.6, 44.0; fresh ET: 100.0, 69.5, 60.3, 56.1, 48.4, 46.8, 45.5; frozen ET: 100.0, 61.7, 52.2, 41.6, 32.9, 31.8, 30.2). Irrespective of treatment, the largest proportion of pregnancy loss occurred in the period from service event (AI on d 0 or ET on d 7) to d 18, with minimal loss occurring between d 62 and parturition (AI: 1.8%, fresh ET: 1.9%, frozen ET: 3.5%). Treatment differences in the predicted probability of pregnancy per service event were detected between fresh ET vs frozen ET on d 32 and both AI and fresh ET vs frozen ET on d 62, 125 and at parturition. There was greater probability of pregnancy loss between d 32 and 62 following ET (Fresh: 11.3%, Frozen: 18.0%) than AI (4.0%). The percentage of cows that calved following transfer of a fresh embryo (45.5%) was similar to AI (44.0%), but less when a frozen embryo was transferred (30.2%). In conclusion, AI and fresh ET led to a greater probability of a cow becoming pregnant and maintaining the pregnancy to term than frozen ET. Cows that were still pregnant on d 62 had a very strong likelihood of maintaining the pregnancy to full-term parturition, irrespective of treatment. Further work is required to improve the likelihood of pregnancy establishment and reduce embryonic and fetal mortality following transfer of a cryopreserved in vitro-produced embryo.

Laparoscopic salpingostomy for two types of hydrosalpinx: a step-by-step video tutorial

This study aims to illustrate our laparoscopic salpingostomy approach for two types of hydrosalpinx, emphasizing various reproductive surgical techniques. A step-by-step demonstration of the technique is provided alongside narrated video footage. University hospital. Infertile patients with hydrosalpinx seeking natural conception. Laparoscopic salpingostomy for clubbed hydrosalpinx is demonstrated with video and includes the following steps: 1) creating an opening into the tube at the terminal end for hydrosalpingeal fluid drainage; 2) dissecting and removing peritubal and periovarian adhesions; 3) excising redundant fimbrial tissues to restore fimbrial mobility; 4) evert the mucosa using an intussusception method until endothelial folds are visible; 5) confirming tubal patency with a dye test; 6) heating the serosal surface of the tube to evert the edges; 7) suturing the edges using 6-0 vicryl to the proximal serosa of the tube circumferentially with an inverting suture technique; 8) thoroughly irrigating with Ringer's solution to remove blood clots and debris; and 9) applying auto-crosslinked hyaluronan gel to the exposed raw surface. Salpingostomy for the cystic type differs, notably in carefully shaving the adhesive tubal end from the ovary until the tubo-ovarian ligament is completely exposed. The primary aim of salpingostomy is to reduce the likelihood of distal tube re-obstruction. If hydrosalpinx recurs after salpingostomy, there remains a possibility of requiring additional surgery, such as salpingectomy, prior to IVF. (s): Extensive adhesions were meticulously dissected and removed from the peritoneal cavity. Fimbrial mobility was restored to establish a patent fallopian tube capable of ovum pickup. Electrocoagulation and suturing techniques were employed to evert the tube edges, effectively reducing the risk of re-obstruction. The utilization of an inverting suture technique aided in inwardly turning the cut edges, minimizing the risk of adhesion formation. Laparoscopic salpingostomy, when performed by surgeons proficient in reproductive surgical techniques, provides a significant option for patients with hydrosalpinx seeking natural conception. The decision to preform salpingostomy or salpingectomy is usually made intraoperatively on the basis of the severity of tubal disease. Clinical history is also an important factor in decision to perform salpingostomy.

A comparison of ondansetron in preventing postoperative nausea and vomiting for patients with or without preoperative anxiety with painless egg retrieval: a prospective, randomized, controlled trial.

Patients undergoing painless egg retrieval are prone to preoperative anxiety, and whether preoperative anxiety induces postoperative nausea and vomiting (PONV) is debated. The primary objective of this prospective, randomized, controlled study was to compare the clinical effect of ondansetron in preventing PONV for patients with and without preoperative anxiety. The secondary objective was to investigate whether preoperative anxiety was associated with PONV. The self-rating anxiety scale (SAS) was used to assess the anxiety patients undergoing painless egg retrieval. Patients with a SAS standard score of 50-60 were selected to the anxiety group (n=105); and patients with a SAS standard score of 25-35 were assigned to the non-anxiety group (n=104). Venous blood samples of both groups of patients were obtained during admission and 1 hour after surgery, and all serotonin (5-HT) levels were tested using an enzyme-linked immunosorbent assay. The anxiety group was then randomly assigned into two subgroups: ondansetron (AO group, n=53) and placebo saline (AS group, n=52). Similarly, patients in the non-anxiety group were also randomly assigned to one of two subgroups: ondansetron (NO group, n=51) and placebo saline (NS group, n=53). The AO and NO groups received 8 mg (4 mL) of intravenous ondansetron 15 minutes before surgery, while the AS and NS groups received an equivalent volume (4 mL) of normal saline. We then analyzed the vital signs, risk factors for nausea and vomiting, intraoperative anesthetic doses, incidences of nausea and vomiting in 24 hours after surgery, serum 5-HT level before and after surgery, other adverse responses, pain scores, and satisfaction. A total of 200 patients eventually completed this study. The serum 5-HT values in the anxiety group were higher before and after surgery than in the non-anxiety group (P<0.05), but there was no significant difference in serum 5-HT before and after surgery in the same group (P>0.05). The incidence of PONV was more significant in the AS group than in the NS group (P<0.05). The incidence of PONV was also higher in the AS group than in the AO group (P<0.05). Still, there was no statistically significant difference between the NO and NS groups (P>0.05). There were no significant differences between the four groups in vital signs, risk factors for nausea and vomiting, intraoperative anesthetic doses, other adverse responses and pain scores (P>0.05). Patients in the AS group had lower satisfaction scores than those in the other three groups (P<0.05). Patients experiencing preoperative anxiety have a greater risk of PONV following painless egg retrieval compared to those without preoperative anxiety. Ondansetron can reduce the occurrence of PONV in patients with preoperative anxiety, but it has no discernible preventative effect in non-anxious patients. Chinese Clinical Trial Registry ChiCTR2400079504.