In Vitro Fertilization Outcomes Research Articles

The use of frozen embryos and frozen sperm have complementary IVF outcomes: a retrospective analysis in couples experiencing IVF/Donor and IVF/Husband

BackgroundThe cryopreservation of sperm or embryos has been an important strategy in the treatment of infertility. Recently studies have revealed the outcomes after IVF (in vitro fertilization) treatment for single-factor exposure either to frozen sperm or embryos.MethodsThis retrospective study was to uncover the exposure to both frozen sperm and embryo effects using IVF/H (in vitro fertilization using husbands’ fresh sperm) or IVF/D (in vitro fertilization using donors’ frozen sperm) treatment.ResultsThe results showed the clinical pregnancy rate (CPR), live birth rate (LBR) and low birth weight rate (LBW) increased to 63.2% (or 68.1%), 61.1% (or 66.4%) and 15.8% (or 16.2%) after using frozen embryo transfer within Group IVF/H (or Group IVF/D). After using frozen sperm, the high-quality embryo rate (HER) increased to 52% and baby with birth defect rate (BDR) reduced to 0% in subgroup D/ET comparing to subgroup H/ET. While the fertilization rate (FER), cleavage rate (CLR), HER and multiple pregnancy rate (MUR) reduced to 75%, 71%, 45% and 9.2% in subgroup D/FET comparing to subgroup H/FET. Finally, our study found accumulative frozen gamete effects, including both sperm and embryos, led to the significantly increasing in the HER (p < 0.05), CPR (p < 0.001), LBR (p < 0.001) and LBW (p < 0.05) in subgroup D/FET comparing to subgroup H/ET.ConclusionThe use of frozen embryos and frozen sperm have complementary IVF outcomes. Our findings highlighted the parent’s distinguished frozen effect not only for clinical studies but also for basic research on the mechanism of cellular response adaptations to cryopreservation.

Effect of thyroid function on assisted reproduction outcomes in euthyroid infertile women: A single center retrospective data analysis and a systematic review and meta-analysis.

BackgroundThe influence of thyroid-stimulating hormone (TSH) on gestational outcomes have been studied and checked whether differing TSH levels are relevant on human reproduction outcomes. International guidelines recommend TSH values <2.5 mIU/L in women trying to conceive, since values above this level are related to a higher frequency of adverse reproductive outcomes. This study aimed to evaluate whether TSH values correlate with different gestational outcomes in euthyroid infertile women without autoimmune thyroid disease.MethodsA retrospective cohort study was conducted involving 256 women who underwent in vitro fertilization (IVF) treatment. The participants were divided into two groups: TSH 0.5-2.49 mIU/L (n=211) and TSH 2.5-4.5 mIU/L (n=45). The clinical data, hormonal profiles and reproductive outcomes were compared between groups. Additionally, a systematic review with meta-analysis following the PRISMA protocol was carried out in PubMed/MEDLINE, EMBASE, and SciELO, with no time or language restrictions, for articles comparing TSH groups named “low TSH” (<2,5 mIU/L) and “high TSH” (≥2.5 mIU/L). A meta-analysis of proportions was performed with pooled estimates expressed as relative risk (RR) of events and a random effects model.ResultsAge, BMI, free thyroxine levels (FT4) hormonal profile and IVF outcomes were not different between groups, neither gestational outcomes (p=0.982). Also, no difference was observed when the TSH and FT4 levels were compared between patients with positive or negative gestational outcomes (p=0.27 and p=0.376). Regarding the systematic review with meta-analysis, 17 studies from 2006 to 2022 were included, and added by this original retrospective research comprising 13.247 women undergoing IVF. When comparing the proportions of clinical pregnancy between the TSH groups, no significant difference was found (RR 0.93, 95% CI 0.80–1.08), with high between studies heterogeneity (I²: 87%; τ2: 0.0544; p<0.01). The number of deliveries was not significantly different between groups, despite a trend towards higher frequency in the high-TSH group (RR 0.96, 95% CI 0.90–1.02).ConclusionVariation in TSH levels within the normal range was not associated with pregnancy and delivery rates in women, without autoimmune thyroid disease, who underwent IVF treatment.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD 42022306967.

Specific lifestyle factors and in vitro fertilization outcomes in Romanian women: a pilot study.

BackgroundInfertility is an important health concern worldwide. Although lifestyle habits and behaviors have been widely reported as predictors of IVF outcomes by previous studies, they have not been reported for Romanian women undergoing IVF. In this regard, our pilot study aimed to begin to address the data gap by assessing lifestyle predictors of in vitro fertilization (IVF) outcomes in Romanian women.Study designOur pilot study included 35 participants who completed a first IVF cycle at a single infertility center. We evaluated individual self-reported lifestyle habits and behaviors as predictors of IVF outcomes, and employed principal component analysis (PCA) to characterize multiple lifestyle habits and behaviors into personal care product (PCP) use, and healthy diet and physical activity patterns as predictors of IVF outcomes.ResultsOur PCA analysis showed that greater use of PCPs was associated with lower probabilities of pregnancy (RR: 0.92, 95% CI [0.87–0.98]) and live birth (RR: 0.94, 95% CI [0.88–1.01]) while, the healthy dietary habits and physical activity were associated with a higher likelihood of pregnancy, although without statistical significance (RR: 1.10, 95% CI [0.93–1.30]).ConclusionsIn this pilot study we identified associations between IVF outcomes among Romanian women and certain lifestyle habits and behaviors including stress, diet and physical activity, and certain PCP use. We also estimated the joint effects of multiple lifestyle factors using PCA and found that PCP use, healthy dietary habits and physical activity were associated with IVF outcomes.

Analysis of anti-apoptotic protein (Bcl-xl) levels and mRNA expression in infertile patients.

In assisted reproductive technology (ART), researchers have tried to predict in vitro fertilization (IVF) outcomes depending on follicular cells apoptosis. Previous reports suggested the B-cell lymphoma-extra-large (BCL-XL) as an apoptosis inhibitor in mammalian ovaries. Therefore, the present research aimed to correlate BCL-XL expression in blood and concentration in follicular fluid (FF) with some outcomes of IVF. A prospective case-control study on infertile women (n=80, mean age= 31.18± 6.04 years) who underwent an IVF program at Kamal Al-Samarai Hospital (Baghdad/Iraq), July 2021- January 2022. All women were split based on pregnancy outcome into two groups: the non-pregnant group (n=40) and the pregnant group (n=40). Samples of FF and blood were assembled at oocyte retrieval time. The BCL-XL mRNA expression was assessed with the Real-Time Quantitative Reverse Transcription-polymerase chain reaction (Real-Time qRT-PCR) technique, whereas the BCL-XL concentration in FF was investigated by sandwich enzyme-linked immunosorbent assay (ELISA). The BCL-XL concentration in FF from pregnant group (3.90 ng/ml ±1.16) raised significantly (P = 0.00) compared with non-pregnant group (1.90 ng/ml ± 0.63). Similarly, the BCL-XL mRNA expression in blood from pregnant group (0.73 ±0.31) raised significantly (P = 0.00) compared with non-pregnant group (0.34± 0.12). In addition, FF BCL-XL concentration associated significantly with fertilization rate (r= 0.399, P=0.048). The research proposed that the elevation of anti-apoptotic BCL-XL might assist in diminished apoptosis in pregnant women who underwent IVF treatment.

NEIGHBORHOOD DEPRIVATION AND BLACK-WHITE DIFFERENCES IN IN VITRO FERTILIZATION OUTCOMES

There are significant Black-White racial disparities in in vitro fertilization (IVF) outcomes that are poorly explained by individual-level factors. Therefore, we sought to explore whether neighborhood characteristics may contribute to the racial disparities in IVF outcomes.

UNHEALTHY AIR QUALITY SECONDARY TO WILDFIRES IS ASSOCIATED WITH LOWER BLASTOCYST YIELD FROM IN VITRO FERTILIZATION

Air pollution exposure is associated with adverse reproductive outcomes, however, the impact of an acute episode of unhealthy air quality on in vitro fertilization (IVF) outcomes has not been studied. The historic September 2020 Oregon wildfires caused an unprecedented air quality crisis with an increase in average air quality index from 26 (Good) in the preceding 2 months to 336 (Hazardous) over a 10-day period. To evaluate the relationship between unhealthy air quality and IVF outcomes, we compared IVF cycle outcomes during a 10-day period of unhealthy air quality to IVF cycles from 2 months prior.

IN VITRO FERTILIZATION OUTCOMES AMONG WOMEN WITH RECURRENT PREGNANCY LOSS IN THE UNITED STATES

There is controversy surrounding the utility of in vitro fertilization (IVF) and preimplantation genetic testing for aneuploidy (PGT-A) as a treatment for women with recurrent pregnancy loss (RPL). We hypothesized that in women with RPL, the addition of PGT-A would improve the probability of live birth per cycle start in the first embryo transfer following retrieval. This study aims to evaluate the impact of PGT-A on IVF outcomes among women with RPL in the United States (US).

BNT162b2 Covid-19 vaccine does not affect fertility as explored in a pilot study of women undergoing IVF treatment.

The COVID-19 pandemic spreads worldwide, causing devastating consequences. BioNTech and Pfizer's BNT162b2 vaccine was one of the first vaccines to receive emergency-use authorization. However, its impact on women's fertility has not been primarily assessed leading to spread of unfounded rumors, causing vaccine hesitancy. We investigate the possible impact of BNT162b2 COVID-19 vaccine on in vitro fertilization (IVF) outcomes. We compared data from 42 women undergoing their first IVF following 2 doses of BNT162b2 vaccination to 42 unvaccinated women undergoing their first IVF. The first outcome consisted of the pregnancy based on first hCG value; secondary outcomes were IVF cycle outcomes. A second analysis was done on 29 paired patients from both groups based on age, FSH, and the indication for IVF. We report different levels of the pregnancy formation; oocyte's development: numbers of oocytes retrieved (9.3±6.8 vs. 11.5 ± 7.9, p=0.19) and matured (6.9±4.8 vs. 9.1 ± 6.6, p=0.14), and embryonal stage: fertilization rates (64.1±26.6 vs. 66.3±23.3, p=0.14), the quantity (4.3 ± 3.2 vs. 5.7±4.4, p=0.23) and qualities of embryos (good/fair/poor) at day 3 were comparable. The analysis showed no significant difference between the groups, and the odds for pregnancy were similar (OR=0.9, 95% CL[0.3-2.8] p.value 0.833). From our results, this vaccine does not affect IVF performance and outcomes from the early stage of oocyte development through to the early beginning of pregnancy; therefore, it seems that the BNT162b2 vaccine does not compromise women's fertility.

Granulosa Cell Conditioned Medium Enhances The Rate of Mouse Oocyte In Vitro Maturation and Embryo Formation.

In vitro maturation (IVM) and cryopreservation of oocytes are two important parts of assisted reproductive technology (ART), but their efficacy is low. This study aimed to improve the quality of in vitro vitrified-warmed maturated oocytes using granulosa cell conditioned medium (GCCM). In the experimental study, fresh/non-vitrified and vitrified-warmed mouse germinal vesicle (GV) oocytes (as F and V) were In vitro maturated using basal medium (BM) and also BM supplemented with 50% GCCM as treated groups (GM), and categorized as FBM, FGM, VBM and VGM groups, respectively. The rate of successful IVM (MII oocyte formation), mitochondrial membrane potential and the viability of MII oocytes were determined using inverted microscopy, JC-1 and trypan blue staining. Then, the rate of In vitro fertilization (IVF) and subsequent two-cell embryo formation was calculated. Finally, the expression levels of Oct4, Sox2, Cdk-2, Gdf9, Integrin beta1 and Igf2 were analyzed using real-time polymerase chain reaction (PCR) in MII oocytes and two-cell embryos. These analyses showed that GCCM significantly increased the IVM rate, oocyte meiotic resumption and mitochondrial membrane potential (P<0.05). In addition, the rate of IVF and two-cell embryo formation was significantly higher in FGM and VGM compared to FBM and VBM (P<0.05). Interestingly, GCCM significantly affected the expression of the studied genes. Our findings suggest that GCCM might be useful for improving the efficiency of IVM and the subsequent IVF outcomes.

IMPACT OF COVID-19 VACCINATION ON ART OUTCOME

To determine if COVID-19 vaccination has a significant influence on parameters considered important for Assisted reproductive technology (ART) in women. Retrospective analysis of 106 female patients, investigating BMI, donor age, TSH, AMH, LH post trigger, P4 pre trigger, eggs retrieved, number of mature eggs, fertilized eggs and E2 before HCG respectively with respect to COVID-19 vaccination status. All In vitro fertilization (IVF)/Preimplantation Genetic Testing for Aneuploidies (PGT-A) cycles resulting in embryo biopsy over a course of 12 months at a large, multicenter, private practice were included in analysis. A total of 106 patients were included in the analysis. Patients were stratified into two groups based on the COVID-19 vaccination such that 58 patients had received at least a single dose of vaccine and 48 had not received any dose of vaccine. Data recorded included BMI, donor age, TSH, AMH, LH post trigger, P4 pre trigger, eggs retrieved, number of matured eggs, fertilized eggs, and E2 before HCG respectively. Statistical analysis included two-tailed Student’s t-test for continuous variables, Chi-squared test for categorical variables, Pearson correlation for correlation matrix analysis, with p<0.05 defining statistical significance. GraphPad Prism (GraphPad Software) was used for statistical analysis. We compared BMI, donor age, TSH, AMH, HCG post trigger, LH post trigger, P4 pre trigger, eggs retrieved, number of mature eggs, fertilized eggs, and E2 before HCG respectively between the vaccinated (n=58) and non-vaccinated (n=48) groups. Results showed that there was no significant difference between the two groups for the considered parameters (p>0.05). Our findings suggest that COVID-19 vaccination does not influence the BMI, donor age, TSH, AMH, HCG post trigger, LH post trigger, P4 pre trigger, eggs retrieved, number of matured eggs, fertilized eggs and E2 before HCG. Further studies are required to find If additional parameters, such as Aneuploidy rates, antibody booster trigger, suppression and trigger type medication could influence the pregnancy in the women undergoing ART with respect to COVID-19 vaccination. Together these studies will help to overcome vaccine hesitance and establish a clear understanding about vaccines in the context of clinical variables that are considered relevant to ART for successful IVF outcomes.

Embryo production by in vitro fertilization in wild ungulates: progress and perspectives – A Review

Abstract Wild ungulates are of fundamental importance for balancing ecosystems, as well as being the species of economic interest. Increasing concern over the accelerated population reduction of these species has resulted in the development of assisted reproduction techniques, such as in vitro fertilization (IVF), as a tool for conservation and multiplication. In the present scenario, IVF protocols were developed based on the methodologies used for domestic ungulates. Nevertheless, owing to the physiological and reproductive differences among the species, several factors associated with IVF and its relationship with the characteristics of the species of interest require clarification. In vitro conditions for the collection and selection of female and male gametes, oocyte maturation, sperm capacitation, co-incubation of gametes, and embryonic development can influence IVF results. Therefore, the present review considers the main advances in the methodologies already used for wild ungulates, emphasizing the strategies for improving the protocols to obtain better efficiency rates. Additionally, we discuss the conditions of each IVF stage, with emphasis on aspects related to in vitro manipulation and comparability with the protocols for domestic ungulates.

The Comparison the Impact of Flare-up GnRH Agonist with Delayed-Start GnRH Antagonist Protocols on the IVF Outcome of Poor Responder Patients: A Randomized Controlled Trial

Objectives: The current research was established to make a comparison between the delayed-start GnRH antagonist and flare-up GnRH agonist protocols in poor response patients. Methods: The present study is a randomized, prospective, controlled trial that was performed on 150 women who referred to two distinct in vitro fertilization (IVF) centers in Iran. Patients were randomly assigned to two experimental groups, as one group was treated with the delayed-start GnRH antagonist protocol (delayed-start group), while another group was treated with the flare-up protocol (flare-up group). Results: The serum concentrations of estradiol and progesterone, along with the thickness of endometrial tissue and the number of follicles ≥13 mm was significantly increased in the delayed-start group compared with the flare-up group. Also, the number of total oocytes, retrieved mature oocytes, total embryos, fertilized oocytes, as well as the quality of embryos were markedly higher in the delayed-start group when compared with the flare-up group. No statistically significant difference was found in the rates of fertilization, implantation, and pregnancy between the two experimental groups. Conclusions: According to the above evidence, it seems that the effect of delayed-start protocol on ovarian responsiveness was more pronounced during controlled ovarian stimulation in comparison with the flare-up protocol and the delayed start protocol probably lead to better implantation and pregnancy rates in comparison with the flare up agonist protocol cycle in poor responders.

Clinical significance of serum and follicular fluid ceramide levels in women with low ovarian reserve.

Objective:Ceramide (CER) is a bioactive component of the mitochondrial membrane. In this study, we will investigate the clinical importance of serum CER (sCER) and follicular fluid CER (ffCER) levels in the lipid synthesis pathway and their effect on poor oocyte quality and in vitro fertilization (IVF) outcome.Materials and Methods:This cross-sectional, case-control study was conducted in the IVF unit of a maternity hospital in the capital of Turkey, Ankara. A total of 88 women undergoing their first IVF cycle were included in this study patients were divided into 2 groups according to current diagnostic criteria for their ovarian reserves. Baseline sCER levels, and ffCER concentrations retrieved on the oocyte pickup day were measured.Results:The mean age, body mass index, and infertility duration of the patients was similar between the groups (all p>0.05). There was also no significant difference in the clinical pregnancy rates (38.6% vs. 47.7%, p=0.127). sCER (15.6±6.5 vs. 23.5±8.9) and ffCER (82.5±34.3 vs. 116.4±46.5) levels were statistically significantly lower in the low ovarian reserve (LOR) group (both p<0.001). The performed receiver operating characteristic curve analysis revealed that sCER and ffCER levels could predict both LOR and pregnancy.Conclusion:This is the first study evaluating the sCER and ffCER levels of patients undergoing IVF treatment. CER may be used as an ovarian reserve markers and a biomarker capable of predicting IVF outcomes.

Chronic Endometritis in Infertile Women: Impact of Untreated Disease, Plasma Cell Count and Antibiotic Therapy on IVF Outcome-A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis aims to evaluate the impact of chronic endometritis (CE) and its therapy on in vitro fertilization (IVF) outcome. Additionally, we aim to investigate whether various degrees of CE severity may exert a different effect on IVF outcome. Ongoing-pregnancy rate/live-birth-rate (OPR/LBR), clinical-pregnancy rate (CPR), and miscarriage rate (MR) were calculated. A total number of 4145 patients (from ten studies) were included. Women with CE had lower OPR/LBR (OR 1.97, p = 0.02) and CPR (OR 2.28, p = 0.002) compared to those without CE. CE cure increased OPR/LBR (OR 5.33, p < 0.0001) and CPR (OR 3.64, p = 0.0001). IVF outcome was comparable between women with cured CE and those without CE (OPR/LBR, CPR and MR: p = ns). Women with severe CE had lower OPR/LBR (OR 0.43, p = 0.003) and CPR (OR 0.40, p = 0.0007) compared to those mild CE. Mild CE showed no influence on the IVF outcome as compared to women without CE (OPR/LBR, CPR and MR: p = ns). Based on this data analysis, CE significantly reduces OPR/LBR and CPR in women undergoing IVF. Importantly, CE resolution after antibiotic therapy may improves IVF outcome, leading to similar OPR/LBR and CPR as compared to unaffected patients. The negative effects of CE on IVF outcome may be restricted to severe disease, whereas mild CE may have no influence on IVF success.

Associations between internal concentrations of fluorinated and organochlorinated chemicals in women and in vitro fertilization outcomes: A multi-pollutant study

The impact of persistent organic pollutants (POPs) on reproductive health is still poorly understood, even though infertility management has high associated societal and economical costs. The aims of this study were to characterize the internal levels of polychlorinated biphenyls (PCBs), organochlorine pesticides (OCPs) and perfluoroalkylated substances (PFAS) in women undergoing in vitro fertilization (IVF); and evaluate their association with IVF outcomes, individually and as mixtures in a combined multipollutant approach. Thus, 136 women undergoing IVF treatment at Nantes University Hospital (France) were prospectively recruited between 2019 and 2020. Serum samples were analyzed using liquid chromatography with tandem-mass spectrometry for 14 PFAS. Follicular fluid was analyzed with gas chromatography coupled to high resolution mass spectrometry for 14 PCBs and 25 OCPs. Intermediate and clinical IVF outcomes were ascertained by embryologists and clinicians using standardized protocols. Multivariate Poisson regression models and Bayesian Kernel Machine Regressions (BKMR) were used to identify individual and joint associations between POPs and IVF outcomes adjusting for age, body mass index (BMI) and anti-Müllerian hormone. The results showed that most POPs were widely present in women, and globally not associated with clinically relevant IVF outcomes, like live birth rates. Nonetheless, negative associations between PCB138 and trans-nonachlor with useable blastocysts were identified, β −0.28 (95%CI [-0.52; −0.04] p = 0.02) and β −0.22 (95%CI [-0.40; −0.03] p = 0.02). Conversely, PCB28 showed positive associations with the number of useable blastocysts, pregnancy rate and live birth rate. The BKMR analysis suggested the lack of association of the mixture with intermediate and clinical outcomes. The study supports the need of conducting further studies in a larger population sample in order to ensure sufficient statistical power to identify modest effects and a robust stratification analysis to account for the large underlying disease heterogeneity.

Activated protein C resistance impact on Syrian candidates for in vitro fertilisation and the benefit of anticoagulation therapy: a retrospective cohort study

Activated protein C resistance (APCR) is a common thrombophilia, caused mainly by a mutation. The impact of APCR on the efficacy of In Vitro Fertilization (IVF) are still unclear, and no solid recommendations for its management were published. To investigate the effect of APCR on IVF outcomes and assess the efficacy of our management protocol, we retrospectively scanned the medical records of women who were tested with APCR assay in 2019 at our fertility centre. The 66 women (12%) positive for APCR had lower odds of reaching clinical pregnancies after IVF 0.18 [95% CI: 0.07–0.47] and fewer live births. The administration of low-molecular-weight heparin and aspirin associated with more implantation in treated compared to untreated APCR-positive women with an odds ratio of 43.2 [7.51–248.6]. In conclusion, APCR negatively affects the number of clinical pregnancies after IVF, but anticoagulation therapy can mitigate this effect and significantly increase clinical pregnancies. Impact Statement What is already known on this subject? The evidence about the impact of APCR on IVF outcomes is still inconclusive. According to the Canadian guideline, routine screening for thrombophilia in patients with recurrent pregnancy loss is not recommended. No clear recommendations regarding the management of APCR in the planning for IVF are yet available. What do the results of this study add? APCR significantly increases implantation failure among infertile women who conduct IVF. Management of APCR using LMWH and aspirin was effective in mitigating this effect and increasing successful implantation. What are the implications of these findings for clinical practice and/or further research? Our findings can support the recommendation to include APCR assay in the routine tests for infertile women conducting IVF, and suggest the combination between LMWH and aspirin as an effective therapy to increase successful implantation in APCR positive candidates. However, more controlled clinical trials are still needed to confirm our results.

The Impact of Lifestyle on Sperm Function, Telomere Length, and IVF Outcomes.

Many risk factors can potentially influence sperm quality. Telomeres confer stability on the chromosome and their dysfunction has been implicated in conditions such as cancer, aging, and lifestyle. The impact of lifestyle on sperm cell telomeres is unclear. The objectives of this study were to evaluate the impact of lifestyle behaviors on telomere length in sperm and to follow the correlation with pregnancy outcomes in patients undergoing in vitro fertilization (IVF). In this prospective observational study, sperm was analyzed for telomere length (TL). Men were asked to report lifestyle behaviors including occupation (physical or sedentary), smoking duration and amount, physical activity, dietary habits, and where they keep their cellular phone (bag, pants, or shirt pocket). Correlations among semen analysis, TL, men’s habits, and embryo quality and pregnancy outcomes were evaluated. Among 34 patients recruited, 12 had longer TL and 13 shorter TL. Sperm motility was negatively correlated with TL (Pearson correlation = −.588, p = .002). Smoking adversely affected native sperm motility (53% motility in nonsmokers vs. 37% in smokers; p = .006). However, there was no significant impact on TL. The group with longer telomeres demonstrated significant association with healthy diet (10/12 vs. 6/13; p = .05) and a trend toward more sports activity, weekly (16/84 vs. 7/91; p = .04) compared with the shorter telomeres group. This study suggests that lifestyle, healthy diet, and sports activity are associated with long telomeres in sperm. Sperm quality is also influenced by patients’ habits. The study strongly recommends maintaining a healthy lifestyle to preserve general health and fertility.

Factors in infertility score on referral and non-referral cases who underwent In Vitro Fertilization (IVF) treatment at a fertility clinic in Surabaya, Indonesia

HIGHLIGHTS 1. Infertility score should be identified to obtain successful outcome of In Vitro Fertilization (IVF).2. Factors considered in determining the infertility score were examined.3. Each factor in infertility score (e.g, age, duration of infertility, menstrual cycle, pelvic pain etc.) has its own different degrees of severity that influence the outcome of IVF. ABSTRACT Objectives: To examine the factors used in infertility score on referral and non-referral cases who underwent IVF treatment at Fertility Clinic of Graha Amerta, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, in 2014-2016 Materials and Methods: This research was a descriptive analytic retrospective study using secondary data from medical records at Fertility Clinic of Graha Amerta in 2014-2016. With a total sampling technique, a total of 342 referral and non-referral infertility cases were obtained. The variables in this study were the factors considered in infertility score. Results: From a total of 342 cases, 44% had the wife's age in the range of 30-35 years, 80.1% had an infertile duration of &gt; 3 years, and 54.7% had one type of pelvic pain, 68.4% still had regular menstrual cycles, and about 76% did not have a history of pelvic infection. On sperm analysis factor, there were 27.5% of men who fell into the severe category according to infertility score. There was a significant difference in the duration of infertility and sperm morphology in referral and non-referral cases. Conclusion: Infertility score can be useful because each case has its own infertility factors with different degrees of severity, which leads to infertility.

Development of a Model Predicting the Outcome of In Vitro Fertilization Cycles by a Robust Decision Tree Method.

IntroductionInfertility is a worldwide problem. To evaluate the outcome of in vitro fertilization (IVF) treatment for infertility, many indicators need to be considered and the relation among indicators need to be studied.ObjectivesTo construct an IVF predicting model by a robust decision tree method and find important factors and their interrelation.MethodsIVF and intracytoplasmic sperm injection (ICSI) cycles between January 2010 and December 2020 in a women’s hospital were collected. Comprehensive evaluation and examination of patients, specific therapy strategy and the outcome of treatment were recorded. Variables were selected through the significance of 1-way analysis between the clinical pregnant group and the nonpregnant group and then were discretized. Then, gradient boosting decision tree (GBDT) was used to construct the model to compute the score for predicting the rate of clinical pregnancy.ResultThirty-eight variables with significant difference were selected for binning and thirty of them in which the pregnancy rate varied in different categories were chosen to construct the model. The final score computed by model predicted the clinical pregnancy rate well with the Area Under Curve (AUC) value achieving 0.704 and the consistency reaching 98.1%. Number of two-pronuclear embryo (2PN), age of women, AMH level, number of oocytes retrieved and endometrial thickness were important factors related to IVF outcome. Moreover, some interrelations among factors were found from model, which may assist clinicians in making decisions.ConclusionThis study constructed a model predicting the outcome of IVF cycles through a robust decision tree method and achieved satisfactory prediction performance. Important factors related to IVF outcome and some interrelations among factors were found.

Pregnancy outcomes following in vitro fertilization treatment in women with previous recurrent ectopic pregnancy.

ObjectivesThe aim of this study was to investigate the impact of a history of recurrent ectopic pregnancy (EP) on pregnancy outcomes of subsequent in vitro fertilization (IVF) treatment.MethodsA retrospective cohort study involving 457 women with a history of recurrent EP (REP group), 912 women with a history of single EP (SEP group), and 1169 women with a history of intrauterine pregnancy (IUP group) as the control group, was conducted. IVF outcomes were compared for each cohort.ResultsThe incidence of EP in the REP group after IVF treatment was significantly lower than those in the SEP group (2.4% vs. 6.8%, P = 0.011), and similar to those in the IUP group (2.4% vs. 2.1%, P = 0.830). No significant differences were observed in the clinical pregnancy rate, miscarriage rate, and live birth rate among the three groups. There was no statistically significant difference in the recurrent EP rate between the salpingectomy and salpingostomy treatments. Adjusting for maternal and treatment factors did not influence live birth rates for women with previous REP compared with women with previous SEP and those with IUP. The odds of EP were 82.2% lower (OR 0.178, 95% CI 0.042–0.762; P = 0.020) in women who had blastocyst transfer compared with cleavage embryo transfer in the SEP group. The odds of EP were over six times (OR 6.260, 95% CI 1.255–31.220; P = 0.025) in women who underwent double embryo transfer as opposed to single embryo transfer in the IUP group.ConclusionOur results indicate that women with previous recurrent EP have a lower risk of EP after IVF in comparison with women with previous single EP. Previous EP has no significant adverse effect on the main IVF outcomes. The salpingostomy and salpingectomy treatments of EP do not significantly affect the incidence of recurrent EP after IVF.