Oocyte Retrieval Cycles Research Articles

Association of the Cumulative Live Birth Rate with the Factors in Assisted Reproductive Technology: A Retrospective Study of 16,583 Women.

The cumulative live birth rate (CLBR) can better reflect the overall treatment effect by successive treatments, and continuous rather than categorical variables as exposure variables can increase the statistical power in detecting the potential correlation. Therefore, the dose-response relationships might find an optimal dose for the better CLBR, offering evidence-based references for clinicians. To determine the dose-response relationships of the factors and the optimal ranges of the factors in assisted reproductive technology (ART) associated with a higher CLBR, this study retrospectively analyzed 16,583 patients undergoing the first in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) from January 2017 to January 2019. Our study demonstrated the optimal ranges of age with a higher CLBR were under 32.10 years. We estimated the CLBR tends to increase with increased levels of AMH at AMH levels below 1.482 ng/mL, and the CLBR reaches a slightly high level at AMH levels in the range from 2.58-4.18 ng/mL. The optimal ranges of basal FSH with a higher CLBR were less than 9.13 IU. When the number of cryopreserved embryos was above 1.055 and the number of total transferred embryos was 2, the CLBR was significantly higher. In conclusion, there is a non-linear dose-response relationship between the CLBR with age, AMH, basal FSH, and the number of cryopreserved embryos and total transferred embryos. We proposed the optimal ranges of the five factors that were correlated with a higher CLBR in the first oocyte retrieval cycle, which may help consultation at IVF clinics.

The effectiveness of controlled ovarian stimulation with tamoxifen for patients with estrogen-sensitive breast cancer: A systematic review and meta-analysis.

Tamoxifen is used for the suppression of estrogen-sensitive tumor recurrence in oocyte retrieval cycles. This meta-analysis aimed to evaluate the quality of controlled ovarian stimulation (COS) with co-administration of gonadotropins and tamoxifen (COS with tamoxifen). PubMed, Embase, and Cochrane Library were searched for articles on October 30, 2022. The authors included studies comparing COS with tamoxifen and COS with gonadotropins and letrozole (COS with letrozole) or gonadotropin only (COS with gonadotropin only) for fertility preservation in patients with breast cancer. The main outcome measures were the COS quality, total number of retrieved oocytes (TOR), total number of mature oocytes (TMO), and peak estradiol levels (PEL). Four studies (348 patients, two randomized controlled trials, and two cohort studies) were included in our meta-analysis. There was no significant difference in TOR (95% CI, [-3.84, 2.90]) and TMO (95% CI, [-2.20, 2.64]) between COS with tamoxifen and COS with letrozole. There was also no difference in TOR (95% CI, [-6.14, 1.86]) between COS with tamoxifen and COS with gonadotropin only. Statistically significant decrease was observed in PEL during COS with letrozole compared with tamoxifen (95% CI, [1414.4, 4953.7]). The quality did not differ between COS with tamoxifen and COS with letrozole or gonadotropin only.

Outcomes of Fertility Preservation for Female Cancer Patients in a Single Tertiary Center.

To report our experience of fertility preservation (FP) in female cancer patients. We retrospectively analyzed the medical records of female who underwent elective oocyte or embryo cryopreservation before cancer treatment between January 2015 and December 2020 at Asan Medical Center. We analyzed the type of cancer, the rate of reuse of cryopreserved oocytes or embryos, and fertility outcomes such as the resumption of menstruation or pregnancy. A total of 174 patients underwent 182 oocyte retrieval cycles after controlled ovarian stimulation for oocyte or embryo cryopreservation. The median age of patients was 33.0 (range 19-46) years, and the patients were most unmarried female (65.52%). The majority of patients were diagnosed with breast cancer (78.16%), and the remaining were diagnosed with gastrointestinal (6.33%) and hematologic malignancies (5.75%). The maturation rate of oocyte cryopreservation was 83.33%, and the fertilization rate of embryo cryopreservation was 72.07%. Of the 57 patients currently not undergoing cancer treatment, 34 resumed menstruating and 19 (33.33%, 19/57) returned to attempt a pregnancy. Among them, five patients succeeded in natural pregnancy. Eleven patients received frozen-thawed embryo transfer, and four patients succeeded in becoming pregnant (36.36%, 4/11). Only 6.3% of patients returned to use their gametes, and 93.7% of gametes are still in storage. FP in cancer patients should be considered before cancer treatment. Through continuous research on oncofertility, it is necessary to consider how to increase the return rate and provide appropriate information to cancer patients of reproductive age.

Correlation of IVF outcomes and number of oocytes retrieved: a UK retrospective longitudinal observational study of 172 341 non-donor cycles

ObjectiveHow do numbers of oocytes retrieved per In vitro fertilisation (IVF) cycle impact on the live birth rate (LBR) and multiple gestation pregnancy (MGP) rates?DesignRetrospective observational longitudinal study.SettingUK IVF clinics.PopulationNon-donor...

Preimplantation genetic testing for aneuploidy: helpful but not a first choice.

This retrospective cohort study aimed to assess and compare the outcomes between cumulative live birth of patients with and without PGT-A and also between prior unsuccessful IVF cycles and PGT-A cycles among patients who experienced IVF but without live birth delivery, and to clarify the effective usage of PGT-A as an in vitro fertilization (IVF) add-on. A total of 2113 females undergoing IVF with at least one blastocyst were reviewed. Patients in the PGT-A and non-PGT-A groups were further categorized into first-time IVF and prior unsuccessful IVF groups (previous IVF experience but without live birth delivery). In the PGT-A group, there were additional oocyte retrieval cycles, fewer transfer cycles per patient, higher clinical pregnancy rates per embryo transfer, and lower miscarriage rates per clinical pregnancy as compared to the non-PGT-A group, all showing significant differences. However, the first-time IVF group with PGT-A had a significantly longer duration from the first oocyte retrieval to the first live birth delivery (LBD) and a significantly lower LBD rate per patient than the non-PGT-A group. The cumulative probability for a first LBD with PGT-A was inferior in the first-time IVF group for women < 35years, marginally superior in the prior unsuccessful IVF group of women aged 38-40years, and similar for other groups. PGT-A should not be recommended to all patients; however, if the first IVF treatment failed, PGT-A may reduce the patient's burden regardless of age.

Pregnancy and neonatal outcomes after long-term vitrification of blastocysts among 6,900 patients after their last live birth

To evaluate whether prolonged storage of vitrified blastocysts negatively impacts pregnancy and neonatal outcomes. A retrospective cohort study. University hospital. A total of 6,900 patients who desired to transfer vitrified blastocysts from the same oocyte retrieval cycle as their last live birth met the inclusion criteria and were grouped according to the storage duration (1,890 patients in group 1 with storage duration < 3 years, 2,693 patients in group 2 with storage duration between 3 and 4 years, 1,344 patients in group 3 with storage duration between 4 and 5 years, 578 patients in group 4 with storage duration between 5 and 6 years and 395 patients in group 5 with storage duration ≥ 6 years but ≤ 10.5 years). None. Rates of blastocyst survival, biochemical pregnancy, clinical pregnancy, miscarriage, ectopic pregnancy, and live birth and neonatal outcomes. The survival rates of the vitrified blastocysts significantly decreased with prolonged storage from group 1 to the subsequent groups 2, 3, 4, and 5. After adjusting for potential confounding factors, the rates of biochemical pregnancy, clinical pregnancy, and live birth were significantly decreased when the vitrified blastocysts were stored for more than 6 years (group 5) compared with these for less than 3 years (group 1) but no distinct differences were found in these above-mentioned indicators among group 1, 2, 3, and group 4 (group 1 as reference). However, no significant differences were noted in the rates of miscarriage and ectopic pregnancy and neonatal outcomes on prolonged storage of vitrified blastocysts. Long-term blastocyst vitrification for more than 6 years can negatively affect the rates of biochemical pregnancy, clinical pregnancy, and live birth but does not impact neonatal outcomes.

Status of maternal serum B vitamins and pregnancy outcomes: New insights from in vitro fertilization and embryo transfer (IVF-ET) treatment.

The influence of B vitamins on human fertility and infertility treatments remains elusive. Therefore, this study investigated the association of most B vitamins with IVF-ET outcomes. A total of 216 subjects aged <35 year in their first oocyte retrieval cycle were recruited. Blood samples from the participants were collected before the oocyte pick-up procedure, and serum levels of riboflavin, niacin, pantothenic acid, vitamin B6 (including PA and PLP), folate, and methylmalonic acid (MMA) were detected using high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Endpoints were classified into three groups according to tertiles (lower, middle, and upper) of each vitamin index, and the association of the serum vitamin status with intermediate and clinical outcomes was analyzed using a generalized estimating equation model. Higher riboflavin levels were associated with elevated probabilities of high-quality embryos, as well as clinical pregnancy after embryo transfer. A greater likelihood of transferable embryos was found in the middle tertile of serum folate. Similarly, a negative correlation of serum MMA, a marker of vitamin B12 deficiency, with high-quality embryos was identified. No significance was observed for other vitamins in terms of all endpoints. Therefore, sufficient levels of pre-conception riboflavin, folate, and vitamin B12 are recommended for successful infertility treatment and pregnancy planning; further evidence is needed to confirm our conclusion.

The cytokine profiles in follicular fluid and reproductive outcomes in women with endometriosis.

Endometriosis patients undergoing in vitro fertilization-embryo transfer (IVF-ET) treatment suffer from poor oocyte quality, a reduced likelihood of the fertilization rate, and low embryo quality. The dysregulation of immune cells and cytokine profiles in the follicular fluid (FF) may play an important role in the competence of the oocyte and the development of the embryo, but the mechanism remains largely unknown. A total of 40 proved advanced staged endometriosis patients were enrolled in this study. The pregnancy results were followed until all the embryos collected by the first oocyte retrieval cycle were used up. The immune cells subtypes in FF and serum collected on the day of oocyte retrieval were detected by flow cytometry and 27 cytokines were determined using the Bio-Plex Pro Human Cytokine 27-Plex Immunoassay. The specific effect of cytokine on the gene expression of human granulosa cells was determined by RT-qPCR. The fertilization rate and the cumulative live birth rate were significantly lower in the endometriosis group. The ratio of CD4+ /CD8+ T cells in FF was significantly lower, while the level of IP-10, RANTES and G-CSF were statistically higher in the endometriosis group. The level of IP-10 correlated with the IVF outcome. Moreover, treated by IP-10, the mRNA level of FSHR and CYP19A1 the human granulosa cells were downregulated in vitro. These results suggest that alterations of the lymphocyte subsets and cytokines in women with advanced endometriosis may have an impact on the oocyte development and resulting in poorer IVF outcomes.

Oocyte Cryopreservation: A 9-Year Single-Centre Experience

ObjectiveOocyte cryopreservation (OC) has increased in recent years; however, there is a paucity of published data on the use of cryopreserved oocytes and associated outcomes. MethodsA retrospective review of 748 OC cycles between 2013 and 2022 at a private fertility centre was performed. Outcome parameters for oocyte retrieval cycles were reviewed. For patients who returned for oocyte disposition, outcomes subsequent to oocyte re-warming, fertilization, and transfer were analyzed. ResultsThere were 748 OC cycles (653 elective and 95 non-elective) in 646 patients (556 elective and 90 non-elective). Patients were older at the time of freezing in the elective oocyte group compared with the non-elective group (36.5 vs. 28.8 y; P < 0.001). Sixty-five patients returned to warm and fertilize their oocytes (50 in the elective group and 15 in the non-elective group). The survival rate for warmed oocytes was 76.1% (541/711), and 66.2% of surviving oocytes were successfully fertilized, and 39.1% reached blastulation. Twenty-three patients underwent embryo transfers (10 after preimplantation genetic testing for aneuploidy), with 15 patients having at least 1 delivery or ongoing pregnancy. ConclusionsTo date, this is the largest published experience with OC in Canada. OC can lead to successful live births but does not guarantee a viable outcome for all patients. In this study, most patients with vitrified oocytes had not returned for disposition, so long-term follow-up is still required to verify the efficacy of OC.

Audit and Accreditation of ART Facilities in Japan; JISART’s Commitment Focusing on Quality Management Systems (QMS) and Patient Satisfaction

In Japan in 2018, 247,402 cycles of oocyte retrieval were performed at 592 facilities and 56,979 ART babies were born. 1 in 16 new births were as a result of ART. There is presently no law regulating ART and each facility operates under a system of self-regulation based on the requirements of the Japan Society of Obstetrics and Gynaecology. In 2000, systems for staffing, quality and safety management were not clearly structured. JISART (The Japanese Institution for Standardizing Assisted Reproductive Technology) was set up in 2003 with a view to improving quality of treatment and patient satisfaction. It is comprised of 31 private clinics with over 500 annual oocyte retrievals and all members are ISO9001 certified. With the Reproductive Technology Accreditation Committee playing a central role, a Code of Practice, guidelines for quality and safety management in ART, and audit checklists have been created. Specialist physicians, embryologists, nurses, administration staff and a patient support group conduct audits triennially, covering some 245 points. With respect to physicians, the audits look at whether there are systems in place for patient examinations and professional development, and at treatment outcomes and risk management. For embryologists and nurses, they examine qualifications, knowledge and technique along with records of equipment inspections and consent forms. Further, patients are interviewed to ascertain their satisfaction with and suggested areas for improvement to facilities and personnel. In Japan, the situation regarding ART is undergoing great changes, with audits having changed from on-site to online due to the COVID-19 pandemic and the government considering whether ART should be covered by national health insurance. In the conference, I will talk about the current situation regarding audits and suggest issues for further consideration.

Usage and cost-effectiveness of elective oocyte freezing: a retrospective observational study

BackgroundThe previous model-based cost-effectiveness analyses regarding elective oocyte cryopreservation remained debatable, while the usage rate may influence the cost per live birth. The aim of this study is to disclose the usage and cost-effectiveness of the planned cryopreserved oocytes after oocyte thawing in real-world situations.MethodsThis was a retrospective single-center observational study. Women who electively cryopreserved oocytes and returned to thaw the oocytes were categorized as thawed group. The oocytes were fertilized at our center and the sperm samples for each individual was retrieved from their respective husbands. Clinical outcomes were traced and the cumulative live birth rate per thawed case was calculated. The costs from oocyte freezing cycles to oocyte thawing, and embryo transfer cycles were accordingly estimated. The cumulative cost per live birth was defined by the cumulative cost divided by the live births per thawed case.ResultsWe recruited 645 women with 840 oocyte retrieval cycles for elective oocyte freezing from November 2002 to December 2020. The overall usage rate was 8.4% (54/645). After the storage duration exceeded ten years, the probabilities of thawing oocytes were 10.6%, 26.6%, and 12.7% from women who cryopreserved their oocytes at the age ≤ 35 years, 36–39 years, and ≥ 40 years, respectively (P = 0.304). Among women who thawed their oocytes, 31.5% (17/54) of women achieved at least one live birth. For the age groups of ≤ 35 years, 36–39 years, and ≥ 40 years, the cumulative live birth rates per thawed case were 63.6%, 42.3%, and 17.6%, respectively (P = 0.045), and the cumulative costs for one live birth were $11,704, $17,189, and $35,642, respectively (P < 0.001).ConclusionsThe overall usage rate was 8.4% in our cohort. The cumulative live birth rate was greatest in the youngest group and the cumulative cost per live birth was highest in the oldest group, which was threefold greater than that in the group aged ≤ 35 years. The findings added to the limited evidence of the usage rate in real-world situations, which could hopefully aid future analysis and decision-making in public health policy and for women willing to preserve fertility.Trial registrationNone.

Intracytoplasmic sperm injection vs. conventional in vitro fertilization in patients with non-male factor infertility

To compare the cumulative live birth rates (CLBRs) and cost effectiveness of intracytoplasmic sperm injection (ICSI) and conventional invitro fertilization (cIVF) for non-male factor infertility. A retrospective cohort study. Society for Assisted Reproductive Technology clinics. A total of 46,967 patients with non-male factor infertility with the first autologous oocyte retrieval cycle between January 2014 and December2015. None. The primary outcomes were CLBR, defined as up to 1 live birth from an autologous retrieval cycle between 2014 and 2015, and linked fresh and frozen embryo transfers through 2016. The secondary outcomes included miscarriage rate, 2 pronuclei per oocyte retrieved, and the total number of transferred and frozen embryos. Analyses were performed on subsamples with and without preimplantation genetic testing for aneuploidy (PGT-A). A cost analysis was performed to determine the costs accrued by ICSI. Among cycles without PGT-A in patients with non-male factor infertility, the CLBR was 60.9% for ICSI cycles vs. 64.3% for cIVF cycles, a difference that was not significantly different after adjustment for covariates (adjusted risk ratio, 0.99; 95% confidence interval, 0.99-1.00). With PGT-A, no difference in CLBR was found between ICSI and cIVF cases after adjustment (64.7% vs. 69.0%, respectively; adjusted risk ratio, 0.97; 95% confidence interval, 0.93-1.01). The patients were charged an estimated additional amount of $37,476,000 for ICSI without genetic testing and an additional amount of $7,213,500 for ICSI with PGT-A over 2 years by Society for Assisted Reproductive Technology clinics. In patients with non-male factor infertility, ICSI did not improve CLBR. Given the additional cost and the lack of CLBR benefit, our data show that the routine use of ICSI in patients with non-male factor infertility is not warranted.

P-583 PCOS patients got better IVF/ICSI outcomes with “higher” progesterone level on hCG day: a retrospective study of Ten years data

Abstract Study question We aimed to investigate whether serum Progesterone (P) on the day of hCG trigger can be used as a biomarker to predict the IVF/ICSI outcomes in PCOS patients. Summary answer PCOS patients got better IVF/ICSI outcomes with “higher” progesterone level (2.7-5.9mmol/L). What is known already There were several studies suggesting serum Progesterone (P) on the day of hCG trigger can be used as a biomarker to predict IVF outcomes, and to decide fresh cycle embryo transfer or frozen all. But there was few study focus on PCOS patients. Study design, size, duration This is a single-center retrospective cohort study in PCOS women undergoing the first transfer of an IVF cycle between January 1st 2010 and December 31th 2019. There were 141,539 oocyte retrieval cycles during the study period, and 97,189 cycles were their first IVF cycle. PCOS was diagnosed according to the Rotterdam criteria. Among them, 3,146 cycles full filled the inclusion and exclusion criteria, and all with two embryos transferred on Day 3. Participants/materials, setting, methods We compared the live birth rate of fresh embryo transfer, stratified for serum P level. We looked for interaction between serum P level and live birth rate of fresh cycles. The serum P level within normal range (&amp;lt; 6nmol/L) on the day of hCG trigger day was divided into 4 quartiles. The four quartiles were defined as ≤ 1.35 nmol/L (Q1), &amp;gt;1.35-1.93 nmol/L (Q2), &amp;gt;1.93-2.7 nmol/L (Q3), &amp;gt;2.7 nmol/L (Q4). Main results and the role of chance The baseline characteristics with no different between groups, except BMI. The patients in Q4 group with lowest BMI, significantly higher number of oocytes retrieved and live birth rate (P &amp;lt; 0.05) . The Logistic regression analysis of the relative factors on live birth rate including BMI, basal LH and number of oocytes retrieved [P = 0.003, 0.030, 0.037 respectively, 95%CI (1.022, 1.111), (1.004, 1.076), (1.002, 1.082)]. Limitations, reasons for caution Due to the retrospective nature of this study, a well-designed and matched large sample prospective study is needed. The definition of elevated P level and the method of hormonal assessments were different between studies, this limiting the comprehensive analysis of researches and the further verification of existing results. Wider implications of the findings PCOS patients who with normal range P level on hCG day, got better IVF/ICSI outcomes with “higher” progesterone level (2.7-5.9mmol/L). Weight control is important for PCOS patients accepting IVF treatment. Trial registration number NOT APPLICABLE

Noninvasive Chromosome Screening for Evaluating the Clinical Outcomes of Patients With Recurrent Pregnancy Loss or Repeated Implantation Failure.

This retrospective cohort study explores whether noninvasive chromosome screening (NICS) for aneuploidy can improve the clinical outcomes of patients with recurrent pregnancy loss (RPL) or repeated implantation failure (RIF) in assisted reproductive technology. A total of 273 women with a history of RPL or RIF between 2018 and 2021 were included in this study. We collected data of all oocyte retrieval cycles and single blastocyst resuscitation transfer cycles. For the patients experiencing RPL, NICS reduced the miscarriages rate per frozen embryo transfer (FET), improved the ongoing pregnancies rate and live birth rate: 17.9% vs 42.6%, adjusted OR 0.39, 95% CI 0.16–0.95; 40.7% vs 25.0%, adjusted OR 2.00, 95% CI 1.04–3.82; 38.9% vs 20.6%, adjusted OR 2.53, 95% CI 1.28–5.02, respectively. For the patients experiencing RIF, the pregnancy rates per FET in the NICS group were significantly higher than those in the non-NICS group (46.9% vs. 28.7%, adjusted OR 2.82, 95% CI 1.20–6.66). This study demonstrated that the selection of euploid embryos through NICS can reduce the miscarriage rate of patients experiencing RPL and improve the clinical pregnancy rate of patients experiencing RIF. Our data suggested NICS could be considered as a possibly useful screening test in clinical practice.

Effect of dominant follicle status at the time of retrieval on the clinical outcomes in natural cycle IVF combined with immature oocyte treatment.

Objective: It is commonly believed that the oocytes from small follicles are unhealthy when a dominant follicle (DF) is recruited in the ovaries, especially when the DF is ovulated. This study aims to confirm whether the presence or ovulation of DF at the time of retrieval affects the clinical outcome of the natural cycle IVF with in vitro maturation (NC-IVF/M) treatment.Methods: Data were collected from 446 women with regular menstrual cycle and 536 retrieval cycles using NC-IVF/M treatment. The cycles were divided into three groups based on the results of the oocyte retrieval cycle. Group A covers the collection of oocytes from the DF and small follicles; Group B incorporates failed oocyte retrieval from DF and then the oocytes are retrieved only from small follicles; and Group C includes the retrieval of oocytes only from small follicles accompanied with an ovulated DF. Furthermore, Group B and C have subgroups to include whether in vivo matured oocytes were obtained from small follicles. Following aspiration of DF and small follicles, mature oocytes were inseminated on the date of retrieval by intracytoplasmic sperm injection (ICSI) and the immature oocytes were matured in vitro. If the immature oocytes were matured in vitro, they were inseminated using ICSI, and then the embryos obtained from in vivo and in vitro matured oocytes were transferred accordingly.Results: The oocytes from DF were successfully retrieved in 445 cycles (83.0%), failed to be retrieved in 54 cycles (10.1%) and ovulated in 37 cycles (6.9%). In Group A, an average of 2.0 ± 1.7 mature oocytes were retrieved, which was significantly higher than the average of Group B, with 1.3 ± 1.3 matured oocytes and Group C, with an average of 1.1 ± 1.5 matured oocytes (P < 0.01). However, the average number of immature oocytes retrieved from each group show no difference among the three groups. There was no significant difference in maturation rates of immature oocytes, fertilization rates among the three groups. The clinical pregnancy rate per transfer cycle is 34.5%, 34.6% and 25.7% in Group A, B and C, respectively. No significant differences were observed in embryonic development and implantation capacity in Group B and C in comparison to Group A. And there was no significant difference in clinical pregnancy, implantation, live birth and miscarriage rates among the three groups. No significant differences were observed in the developmental and implantation capacity according to with or without in vivo matured oocytes were retrieved in Group B and Group C.Conclusion: The presence or ovulation of the dominant follicle from the ovaries does not significantly influence the developmental and implantation capacity of immature oocytes retrieved from small follicles, suggesting that NC-IVF/M is a promising treatment option for women without ovarian stimulation.

The Reproductive Outcome of Women with Hypogonadotropic Hypogonadism in IVF.

ObjectiveThe purpose of this study was to evaluate the reproductive outcome of patients with hypogonadotropic hypogonadism (HH) receiving in vitro fertilization and embryo transfer (IVF-ET).MethodsThe reproductive outcome of 81 HH patients and 112 controls who underwent oocyte retrieval was evaluated retrospectively in the Center for Reproductive Medicine of Peking University Third Hospital from 2010 to 2019.ResultsThe basic levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), androstenedione (A) and prolactin (PRL) were significantly lower in the HH group than the control group. Although the HH patients required a significantly longer stimulation and higher gonadotropin (Gn) doses than the control patients, the total number of oocytes retrieved, fertilized embryos, two pronuclear (2PN) embryos, transferable embryos, fertilization and 2PN rates were comparable between the two groups. Although the live birth rate (LBR) of the first fresh cycle was higher in the control group than the HH group, there was no statistical significance. Then we further divided HH patients into two subgroups according to the etiology. Forty-one cases were termed as congenital HH (CHH), while the other 40 cases were termed as acquired HH (AHH), the latter includes functional hypothalamic amenorrhea (FHA) and pituitary HH (PHH). Our results showed that there were no significant differences in basic clinical characteristics and IVF parameters between the two groups. In the HH group, a total of 119 oocyte retrieval cycles were carried out and they responded adequately to ovulation induction. Urinary human menopausal gonadotropin (HMG) was used alone in 90 cycles while combination of HMG and recombinant human follicle stimulating hormone (rFSH) in the other 29 cycles. There were no significant differences in IVF-related parameters between the two groups. The conservative cumulative live birth rates (CLBRs) after the first, the second and ≥third cycles were 43.21%, 58.02% and 60.49%, respectively, while the corresponding optimal CLBRs were 43.21%, 68.45% and 74.19%. The preterm birth (PTB) rates of singletons and twin pregnancy in HH patients were 8.33% (3/36) and 30.77% (4/13), respectively.ConclusionIVF-ET is an effective treatment for HH patients with infertility and patients can get satisfactory pregnancy outcomes.

The Utility of Preimplantation Genetic Test in Couples with History of Infertility and Pregnancy Loss

Preimplantation genetic test (PGT) is cutting-edge technology for early detection of genetic abnormalities in embryos prior to their implantation in the uterus. PGT prevents the transfer of affected embryos during in vitro fertilization (IVF) procedures and termination of pregnancy. In our study we report the results from 185 couples with history of infertility and pregnancy loss that had undergone IVF procedures with PGT. Trophectoderm biopsy was carried out on 497 blastocyst stage embryos originating from 231 oocyte retrieval cycles. Array-based comparative genomic hybridization (aCGH) and next-generation sequencing (NGS) were subsequently performed. One hundred and ninety-six embryos had balanced profile (40.16%) and 292 embryos showed unbalanced profile (59.84%). Embryo transfer was performed in 109 cases (58.92%) and biochemical pregnancy was reported in 33.03%. Live birth rate was 29.36% and pregnancy loss occurred in 3.67% of cases. Our results show that PGT reduces the number of meaningless transfers, eliminates the trauma of termination of desired pregnancy and possible medical complications. In couples with reproductive failure PGT decreases the risk for pregnancy loss, increases the chance of conceiving with a chromosomally balanced embryo and live birth of a healthy offspring per transfer.

Cumulative live birth rates for low-prognosis women over 5\u2009years or 9 frozen-thawed embryo transfer cycles

BackgroundFor heterogeneous populations of low-prognosis women, it remains unclear as to how long individuals should continue undergoing ART when attempting to have a baby, as there have been insufficient studies to date tracking the cumulative live birth rates (CLBRs) for these women over the entire course of their ART treatment, particularly over extended time periods.MethodsThis was a retrospective analysis of 17,698 women at a tertiary care academic medical center who had begun undergoing IVI/ICSI cycles using a progestin-primed ovarian stimulation (PPOS) approach between January 2013 and January 2019. Low-prognosis patients were stratified into four groups based upon POSEIDON criteria, with patients exhibiting normal or high ovarian reserves and response to stimulation (defined as AFC ≥5, > 9 oocytes retrieved) being included as controls (group 5). The CLBR within 5 years or 9 FET cycles from the ovum pick-up (OPU) day of the first cycle was the primary endpoint for this study, including all repetitive oocyte retrieval cycles and subsequent FET cycles. Optimistic and conservative approaches were used for the analysis of CLBRs and the depiction of cumulative incidence curves.ResultsUnder both optimistic and conservative model analyses, normal and good responders exhibited the highest CLBR within 5 years or 9 FET cycles, followed by younger unexpected poor responders, younger expected poor responders, older unexpected poor responders, and older expected poor responders. Upward trends in CLBRs were evident across the five groups with the prolongation of time or an increase in FET cycle counts. Within the first 2 years or 3 FET cycles, the CLBRs rose rapidly, followed by more moderate increases over the following 2–3.5 years or 4–6 cycles, with expected poor responders exhibiting the most obvious improvements. All Patients reached a CLBR plateau after 3.5 years or 6 FET cycles.ConclusionsAll low-prognosis women should undergo ART treatment for a minimum of 2 years or 3 FET cycles, and exhibit better outcomes when extending ART treatment to 3.5 years or 6 FET cycles (particularly for POSEIDON groups 3 and 4), but should consider ceasing further treatment thereafter due to a lack of apparent benefit.

Recurrent implantation failure: a plea for a widely adopted rational definition

Most proposed definitions of recurrent implantation failure (RIF) are based on clinical judgement, probably affected by patients' demands. They are not based on robust statistical considerations. As a result, a diagnosis of RIF is commonly made too early, exposing couples to the risk of overdiagnosis and overtreatment. However, the situation is changing, and three statistical approaches have recently been proposed. The first is a probability model based on the chances of success per cycle and suggests for the definition three failed oocyte retrieval cycles with all embryos being transferred in women younger than 40 years of age. The second approach suggests an individualized diagnosis that takes into consideration multiple factors, while the third is also based on individualization but mainly relies on anticipated euploidy rates across the female age range. All these approaches have their pros and cons. Regardless of the specific peculiarities, they represent steps in the right direction, with the intent of providing a statistically sound definition. However, these attempts will not be useful unless endorsed by the scientific community in general. There is a pressing need for a rigorous and shared definition of RIF that will be widely accepted by researchers, scientific societies and other stakeholders, including patients.

Optimal individualization of patient-oriented ovarian stimulation in Japanese assisted reproductive technology clinics, a review for unique setting with advanced-age patients.

Ovarian stimulation is a key issue in assisted reproductive technology (ART) treatment. ART practice in Japan is unique with various types of ovarian stimulation protocols, which may contribute to lower pregnancy rates compared to other countries. This review aims to clarify optimal individualized ovarian stimulation for improving the pregnancy rate per one oocyte retrieval cycle in Japan. We performed a literature review to describe ovarian stimulation, classification of infertile women depending on ovarian reserve and response, and Japanese ART data and discussed optimal conventional and mild ovarian stimulation protocols in Japan. According to Japanese ART registry data, the live birth rate of 30-35-year-old women was 32%-37% per ET cycle; therefore, four to five embryos are calculatedly needed when aiming a cumulative live birth rate of ≥80%. Mild stimulation aimed at collecting 5-10 oocytes can be alternative choice as an optimal ovarian stimulation protocol in young women. In 40-year-old women, the live birth rate is 18.8%, resulting in eight or more embryos as necessary. Conventional stimulation must be required in women with advanced age. In poor responders, however, mild stimulation may be sufficient for maximumly extracting their ovarian function. In Japan, mild ovarian stimulation can be selected in patients with a good prognosis and poor responders; however, conventional ovarian stimulation is necessary for women in advanced age.