Outcomes In Infertile Women Research Articles

Effect of body mass index on ovarian reserve and ART outcomes in infertile women: a large retrospective study

BackgroundObesity poses a significant global health challenge, with profound implications for women’s reproductive health. The relationship between ovarian reserve and body mass index (BMI) remains a subject of debate. While obesity is generally associated with poorer outcomes in assisted reproductive technology (ART), the evidence remains inconclusive. This study aimed to investigate the effect of pre-pregnancy BMI on ovarian reserve and ART outcomes in infertile patients.MethodsWe conducted a retrospective cohort study involving women who underwent in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) procedures at Tongji Hospital between 2016 and 2023. The study included 30,746 initial fresh cycles and 5,721 singleton deliveries. Patients were stratified by age and further categorized into four BMI groups: lean (< 18.5 kg/m²), normal weight (18.5–24.9 kg/m²), overweight (25.0–29.9 kg/m²), and obese (≥ 30.0 kg/m²). The primary endpoints of the study were pregnancy and perinatal outcomes. To explore the association between BMI and these outcomes, we adjusted for relevant confounding factors and utilized multivariate linear regression models, complemented by multifactorial logistic regression analyses.ResultsAnti-Müllerian hormone (AMH) levels were significantly lower in the overweight and obese groups compared to the normal weight group. After adjusting for age, a negative correlation was found between AMH and BMI in the age subgroups of 20–30 and 30–35 years. Among women aged 20–35 years, those in the overweight and obese groups had significantly fewer retrieved oocytes, mature oocytes, and two-pronuclear (2PN) embryos than their normal weight counterparts. Despite these differences, pregnancy outcomes in the overweight and obese groups were comparable to those in the normal weight group across all age categories. Additionally, obesity was linked to an increased risk of gestational diabetes mellitus, hypertensive disorders of pregnancy, and macrosomia.ConclusionsAn age-related decrease in AMH levels was evident with increasing BMI. Although being overweight or obese is associated with poorer embryo and perinatal outcomes, it does not seem to have a substantial impact on fertility.

O-281 Characterization of Vaginal microbiota and reproductive outcomes associated with assisted reproductive technologies through next-generation sequencing, from Indian population

Abstract Study question Is there any association between the composition of the vaginal microbiota and the reproductive outcomes in infertile women’s undergoing for assisted reproductive treatments (ART)? Summary answer Higher microbial abundance in non-pregnant patients compared to pregnant patients. These pathogens could be used as a possible marker for a higher IVF failure rate. What is known already Various next- generation sequencing methods have been used to study bacterial populations in infertile Women. Vaginal microbiota could have an influence on success rates of fertility treatments. The bacterial microbiota varies by the population. There is no direct evidence on this subject to guide clinical decision making or its influence on the hierarchy of fertility treatments. While the presence of pathogenic bacteria non-Lactobacilli dominated microbiota is associated with poor reproductive outcomes in assisted reproductive treatments (ART). Additional studies, particularly those using metagenomics approaches, may be useful. Study design, size, duration A total of 240 infertile women’s were included in the study. The study population consists of patients attending to the ART unit of a tertiary medical center Udaipur, India, between November 2021 to October 2023. Depending on the biochemical pregnancy results, they were divided into two groups. Group 1 (n = 128) was pregnancy (P), and Group 2 (n = 112) non- pregnancy (NP) group, Patients were aged between (20-45 years). The ethical approval was obtained from the institute. Participants/materials, setting, methods DNA was extracted from vaginal swab samples collected at the time of oocyte pick up using the commercially available ( DNeasy Power Soil kit). The Vaginal microbiota of samples were analyzed using 16S ribosomal RNA gene amplification (MinION) Oxford Nanopore Ltd. Bioinformatics analysis was performed using QIIME2 and Microbiome Analyst packages. Alpha, beta diversity and taxonomic characterization were compared for microbial composition. The findings of the principle coordinate analysis were shown using R version 4.0. Main results and the role of chance Our results show that higher Shannon and Simpson index were obtained in the non- pregnancy (NP) group compared to the pregnancy (P) group. In addition, the partial least squares discriminant analysis (PLS-DA) revealed a difference in microbial composition between pregnancies (P) and non- pregnancy (NP) groups, as well as a higher microbial abundance in non-pregnant patients compared to pregnant patients. At the phylum level Firmicutes, Actinobacteria, Proteobacteria, Fusobacteria, and Bacteroidetes are the most common predominant in the pregnancy (P) group (80.77, 9.52, 9.18, 0.04, and 0.40%, respectively) and the non- pregnancy (NP) group (72, 61, 12.41, 8.01, and 3.75%). A higher abundance of Firmicutes (80.77 vs. 72.61%) and Proteobacteria (9.18 vs. 8.01%), and a lower abundance of Actinobacteria (9.52 vs. 12.41%, p = 0.03), Fusobacteria (0.04 vs. 8.01%, p = 0.02), and Bacteroidetes (0.40 vs. 3.75%, p = 0.03) were observed in pregnancy (P) group. At the genus level, pregnancy group (P) increased the abundance of probiotics lactic acid bacteria (74.61 vs 63.09%) and decreased the abundance of the pathogen Gardnerella (6.03 vs 7.24%, p = 0.03), Atopobium (0.84 vs 4.14%, p = 0.02), Sneathia (0.03 vs. 3.75%, p = 0.02), and Prevotella (0.38 vs. 3, 02%, p = 0.04). Limitations, reasons for caution The limited sample size is the primary constraint of this study. Larger studies with a larger sample size are needed to confirm the distinct microbiome patterns identified in female reproductive tracts samples in connection to infertility and live birth rate (LBR) outcomes. Wider implications of the findings Vaginal microbiota composition associated to different clinical outcomes in patients undergoing ART might have profound implications. This may lead to failed fertility treatments and reduced live birth rate (LBR). More studies are needed to clarify the relative effectiveness of treatments for infertility. Trial registration number NA

Association Between Dietary Behaviors and Assisted Reproduction Outcomes in Infertile Women: Region of Anhui Province, China

Association Between Dietary Behaviors and Assisted Reproduction Outcomes in Infertile Women: Region of Anhui Province, China

Dydrogesterone-primed ovarian stimulation versus gnrh antagonist protocol in in-vitro fertilization for poor responders: A pilot study

PPOS (Progestin-Primed Ovarian Stimulation) has shown efficacy in preventing early luteinization and improving outcomes in infertile women. However, data among those with poor ovarian response (POR) are limited. This study aimed to evaluate the effect of PPOS protocol on the chance of success throughout the IVF process in patients with POR (POSEIDON group III &amp; IV) undergoing IVF/ICSI in Vietnam. This was a randomized controlled trial involving 120 infertile women with POR. PPOS or GnRH-ant protocol was randomly applied to the participants of either group (n = 60 in each group). The primary outcome measures the chances of achieving oocyte maturation and retrieval, fertilization, and embryo formation. The effect of PPOS compared to GnRH-ant protocol was estimated as marginal risk-ratio (RR) from binomial regression analysis. We found that the chance of success in achieving MII oocytes, fertilization, and high-quality D3 and D5 embryos were equivalent between the two protocols; (RR (95% CI) were 0.97 (0.88-1.07), 1.00 (0.89-1.14), 1.04 (0.96-1.14), 1.14 (0.74-1.73), respectively). In conclusion, PPOS protocol using DYG slightly improves the IVF funnel in women with POR undergoing IVF/ICSI; however, these differences were not significant. Therefore, we concluded that the efficacy of the PPOS protocol is equivalent to that of the GnRH-ant stimulation protocol. Clinical Trial Registration Number: NCT06191809. Method: A randomized controlled trial involving 120 infertile women with POR was conducted. PPOS or GnRH-ant protocol were randomly applied to the participants of either group (n = 60 in each group). The primary outcome measures the chances of achieving oocyte maturation and retrieval, fertilization, and embryo formation. The effect of PPOS compared to GnRH-ant protocol was estimated as marginal risk-ratio (RR) from binomial regression analysis. Results: The chance of success in achieving MII oocytes, fertilization, and high-quality D3 and D5 embryos were equivalent between the two protocols (RR (95% CI) were 0.97 (0.88-1.07), 1.00 (0.89-1.14), 1.04 (0.96-1.14), 1.14 (0.74-1.73), respectively). Conclusion: PPOS protocol using DYG slightly improves the IVF funnel in women with POR undergoing IVF/ICSI; however, these differences were not significant. Therefore, we concluded that the efficacy of the PPOS protocol is equivalent to that of the GnRH-ant stimulation protocol.

Early GnRH-agonist therapy does not negatively impact the endometrial repair process or live birth rate.

To investigate whether different timings of GnRH-a downregulation affected assisted reproductive outcomes in infertile women with moderate-to-severe intrauterine adhesions (IUAs) accompanied by adenomyosis. A retrospective case series. An assisted reproductive technology center. The study reviewed 123 infertile women with moderate-to-severe IUAs accompanied by adenomyosis undergoing their first frozen-thawed embryo transfer (FET) cycles between January 2019 and December 2021. The majority of patients had moderate IUA (n=116, 94.31%). The average Basal uterine volume was 73.58 ± 36.50 cm3. The mean interval from operation to the first downregulation was 21.07 ± 18.02 days (range, 1-79 days). The mean duration of hormone replacement therapy (HRT) was 16.93 ± 6.29 days. The average endometrial thickness on the day before transfer was 10.83 ± 1.75 mm. A total of 70 women achieved clinical pregnancy (56.91%). Perinatal outcomes included live birth (n=47, 67.14%), early miscarriage (n=18, 25.71%), and late miscarriage (n=5, 7.14%). The time interval between uterine operation and the first downregulation was not a significant variable affecting live birth. Maternal age was the only risk factor associated with live birth (OR:0.89; 95% CI: 0.79-0.99, P=0.041). The earlier initiation of GnRH-a to suppress adenomyosis prior to endometrial preparation for frozen embryo transfer did not negatively impact repair of the endometrium after resection.

Effect of endometrial injury on pregnancy outcomes in infertile women undergoing intrauterine insemination.

One of the most common treatments for infertility is intrauterine insemination (II). The objective of this study was to determine the effect of endometrial injury on pregnancy outcomes in unexplained infertility in women undergoing II. In this randomized clinical trial, 122 women with unexplained infertility who were referred to Shariati Hospital from 2018 to 2020 were enrolled. They underwent ovulation induction using letrozole and gonadotropins. On day 9 of stimulation, they were randomly assigned to two similar groups of the same size. The first group underwent endometrial local injury by pipelle endometrial sampling, and the second group (control group) received no intervention. Only 1 II cycle was performed for each patient. Patients with negative pregnancy outcomes were followed up for 3 months. Endometrial thickness, dominant follicle count, chemical and clinical pregnancy rate, miscarriage rate, and spontaneous pregnancy rate after the II cycle were compared between the two groups. Endometrial thickness, dominant follicle count, chemical and clinical pregnancy rate, and miscarriage rate in the same II cycle were not different between the two groups (p>0.05). However, the spontaneous pregnancy rate after the II cycle was significantly higher in the endometrial injury group (p=0.02). Endometrial injury increases pregnancy rates in later cycles but not in the same II cycle.

The Relationship Between Serum Growth Differentiation Factor-15 (GDF-15) Levels and Clinical Outcomes in Infertile Women Receiving In-vitro Fertilization Treatment

Objective: It has been reported in many studies that Growth Differentiation Factor-15 (GDF-15) has an important role in physiological or pathological processes. As there is no study in the current scientific literature examining the status of GDF-15 in infertility and its treatment outcomes, we aimed to investigate this.&#x0D; Material and methods: According to their ovarian reserve characteristics, 88 infertile women were divided into three groups: normal ovarian reserve (NOR), diminished ovarian reserve (DOR), and polycystic ovary syndrome (PCOS). Estradiol (E2), follicle-stimulating hormone (FSH), luteinizing hormone (LH), anti-mullerian hormone (AMH), and GDF-15 levels were measured in their serum. The antagonist protocol patients' total oocyte, meiosis II (MII) oocytes, embryo count, and clinical pregnancy rates were documented.&#x0D; Results: In terms of serum GDF-15 concentrations, there was no statistically significant difference among the mean values of the three study groups. The mean FSH level at baseline was substantially higher in the DOR group compared to the PCOS group. The median serum AMH levels of all three groups were found to be statistically different. The antagonist protocol patients' total oocytes, meiosis II (MII) oocytes, embryo count, and clinical pregnancy rates were documented.&#x0D; Conclusion: In the present study, a significant and strong correlation between serum GDF-15 level and consequent embryo number was detected. Thereby, serum GDF-15 level may be considered to be a biomarker for predicting IVF clinical outcomes.

Does autoimmune disease affect in vitro fertilization results in normo-responder cases?

Aims: This study aimed to assess the effects of autoimmune disorders on pregnancy outcomes in infertile women undergoing in vitro fertilization (IVF) treatment. Methods: This retrospective cohort study was conducted between March 2022 and September 2023, involving 90 infertile women without autoimmune diseases as a control group and 96 infertile women with autoimmune diseases as a case group. The study investigated the impact of autoimmune diseases on IVF treatment outcomes. Single embryo transfer (ET) was performed on the fifth day in all patients. Autoimmune diseases included in this study as Hashimoto's disease, Rheumatoid Arthritis, Sjogren's syndrome, Systemic lupus erythematosus (SLE), Ulcerative Colitis, and Behcet's disease. Results: There was no statistically significant association between the case and control groups regarding live birth rate (p&gt;0.05). Similarly, no statistically significant association was found between the case and control groups concerning the clinical pregnancy rate (p&gt;0.05). Our results revealed that total oocyte, pronuclear (PN), and metaphase II (MII) oocyte rates were statistically significantly higher in healthy infertile women (p&lt;0.05). The number of attempts, anti mullerian (AMH) levels, total gonadotropin dose, and total days were similar between the groups (p&gt;0.05). Conclusion: Autoimmune diseases do not significantly affect pregnancy outcomes in women undergoing IVF. However, several factors, such as total oocyte, PN, and MII oocytes, clinical pregnancy rate (CPR), and live birth rate (LBR) levels, support the association between autoimmune diseases and IVF outcomes.

Association of fat distribution differences in infertile women with assisted reproductive outcomes: A prospective cohort study.

To investigate the impacts of fat distribution on assisted reproductive outcomes in infertile women. The study randomly recruited 576 infertile women who underwent assisted reproductive technology treatment at the Reproductive Medicine Center of the First Affiliated Hospital of Anhui Medical University between July and October 2022. Questionnaires and body composition measurements were administered to assess baseline information and fat distribution. The numbers of oocytes, zygotes presenting with two pronuclei (2PN), and available embryos were tracked at the end of the cycle. Multifactorial logistic regression models and restricted cubic spline (RCS) curve models were used to explore the relationships between fat distribution and reproductive outcomes while controlling for confounding factors. The study found that the participants had a mean age of 30.82 years. The analysis showed that there was a significant difference between the amount of leg body fat mass (LBFM) and the distribution of reproductive outcomes. However, there was no significant correlation between the level of visceral fat and reproductive outcomes. After taking confounding factors into account, the multifactorial regression analysis showed that the total body fat mass and the number of oocytes (odds ratio (OR) 0.92, 95% confidence interval (CI) 0.84-0.99), 2PN (OR 0.92, 95% CI 0.84-0.99), and embryos available for transfer (OR 0.90, 95% CI 0.82-0.99) were negatively correlated. RCS modeling revealed a linear dose-response relationship between LBFM and assisted reproductive outcomes. Fat distribution varies among infertile women, and higher amounts of fat are associated with poorer assisted reproductive outcomes.

#186 : Ultra-Long Protocol During IVF Outcome in Infertile Women with Endometriosis

Background and Aim: Endometriosis issue with infertility may require ART and long-term GnRH agonist therapy prior to frozen embryo transfer was associated with a greater rate of clinical pregnancy. The aim of the study is to assess pregnancy outcomes in endometriosis patients who have received GnRH-a ultra-long protocol prior to IVF. Method: A retrospective cohort study was conducted at the Yasmin IVF Center, Dr. Cipto Mangunkusumo General Hospital in Jakarta. The study included all Patients diagnosed with endometriosis and underwent IVF procedure with GnRH-a ultra-long protocol was used for ovarian stimulation from July 2021 to January 2023. Parameters observed were maternal age, body mass index, oocytes retrieved, fertilization rate, blastocyst rate, and pregnancy rate. Result: There were 12 patients who underwent IVF and received ovarian stimulation with ultra long protocol. The average oocyte retrieved in this study was 12 ± 5,3 with the average fertilization rate was 66,2 ± 18,2. We found a pregnancy rate was 58,3% and total live born child was 3 out of 7 patients (42,8%). We assessed based on the presence of intrauterine gestational sac with fetal heartbeat at ultrasound examination. Conclusion: Ultra long protocol for stimulations in patients with endometriosis have a chance to improve oocytes retrieval, fertilization rate, and pregnancy rate.

Clinical evidence of growth hormone for infertile women with diminished ovarian reserve undergoing IVF: a systematic review and meta-analysis.

To appraise the current randomized clinical trials (RCTs) for evidence of the association of growth hormone (GH) with improved outcomes in infertile women with diminished ovarian reserve (DOR) undergoing in vitro fertilization (IVF). Relevant RCTs published in Chinese or English were identified through a comprehensive search of nine databases from the period of database inception to April 20, 2023. We included trials investigating adjuvant GH during ovarian stimulation and reported the subsequent outcomes. The group with adjuvant GH treatment and the group without adjuvant GH treatment were set up as the trial and control groups, respectively. The quality of RCTs was measured according to the Cochrane Collaboration Handbook. Of the 579 studies initially identified, 10 RCTs comprising 852 infertile women with DOR were included. The GH dose of individual trials ranged between 3 and 5 IU/day. Overall, we judged the trials to be at high risk of bias in the blinding domain. Pooled results showed that GH was associated with an increased clinical pregnancy rate (RR = 1.63, 95%CI [1.31, 2.03], p < 0.0001) and a greater number of oocytes retrieved (MD = 0.91, 95%CI [0.47, 1.35], p < 0.0001). Favorable associations were also observed when ovarian stimulation was combined with GH therapy for improving the optimal embryos rate (RR = 1.84, 95%CI [1.30, 2.59], p = 0.0005) and the number of optimal embryos (MD = 0.28, 95%CI [0.08, 0.48], p = 0.005) along with reducing the cycle cancellation rate (RR = 0.46, 95%CI [0.24, 0.89], p = 0.02). Moreover, GH resulted in an increase in the fertilization rate (RR = 1.33, 95%CI [1.18, 1.50], p < 0.00001) and the embryo implantation rate (RR = 1.56, 95%CI [1.21, 2.01], p = 0.0006). In addition, there was a significant enhancement in estradiol levels (SMD = 1.18, 95%CI [0.46, 1.91], p = 0.001) and endometrial thickness (MD = 0.75, 95%CI [0.41, 1.09], p < 0.0001) on the day of hCG. With regard to the total number of days and total dose of gonadotrophins used, GH treatment was correlated with shorter days (MD = -0.26, 95%CI [-0.46, -0.06], p = 0.01) and lower dose (MD = -460.97, 95%CI [-617.20, -304.73], p < 0.00001) of gonadotrophins applied during ovarian stimulation. Furthermore, GH in conjunction with the GnRH antagonist protocol was more conducive to improving the number of oocytes retrieved when compared with the GnRH agonist protocol (p < 0.0001). Moreover, a notable association was also seen in IVF combined with GH more than or equal to 4.5 IU/day to increase the number of optimal embryos and estradiol levels on the day of hCG (p < 0.05). For infertile women with DOR undergoing IVF, adjuvant treatment with GH during ovarian stimulation protocols showed better clinical outcomes, shorter days and lower dosages of gonadotrophin required. Furthermore, well-designed RCTs are needed to verify our results in the future. https://www.crd.york.ac.uk PROSPERO (CRD42023421739).

The Effect of Non-Pharmacological Interventions on Quality of Life, Depression, and Pregnancy Outcomes in Infertile Women: A Meta-Analysis of Randomized Controlled Studies

The Effect of Non-Pharmacological Interventions on Quality of Life, Depression, and Pregnancy Outcomes in Infertile Women: A Meta-Analysis of Randomized Controlled Studies

Effects of antituberculosis treatment on pregnancy outcomes in infertile women with genital tuberculosis: a systematic review

ObjectivesTo evaluate the efficacy of antituberculosis therapy on pregnancy outcomes in infertile women with genital tuberculosis.DesignSystematic review.Data sourcesWe searched in PubMed/MEDLINE, CENTRAL and EMBASE up to 15 January 2023. Additionally,...

Endometrial polyps effect on pregnancy outcomes in infertile women with minimal/mild endometriosis: A retrospective study.

To assess the pregnancy outcomes and associated influencing factors of pregnancy after hysteroscopy combined with laparoscopy treatment in infertile patients with minimal/mild endometriosis. A retrospective study. West China Second University Hospital of Sichuan University. We enrolled 898 infertile women who had their minimal/mild endometriosis lesions removed by laparoscopy, including 271 patients additionally diagnosed with endometrial polyps who also underwent hysteroscopic polypectomy. Based on the existence of endometrial polyps, patients with minimal/mild endometriosis were enrolled and divided into polyps group and non-polyps group. Pregnancy outcomes. A total of 271 women with minimal/mild endometriosis were included in polyps group while 491 women with minimal/mild endometriosis were included in non-polyps group. The pregnancy rate of polyps group was not statistically significant compared with non-polyp group (60.15% vs. 58.25%). The pregnancy rate was higher among patients with polyps ≥1 cm (76.06%, 54/71) than patients with polyps <1 cm (54.50%, 109/200) or patients without polyps (58.25%, 286/491) (p = 0.006). The pregnancy rate was higher for patients with multiple polyps (67.86%, 95/140) than for patients with single polyp (51.91%, 68/131) or without polyps (p = 0.025). Among women with minimal/mild endometriosis, hysteroscopic polypectomy did significantly increase fertility in infertile patients with multiple polyps or size of polyp ≥1 cm compared with those without endometrial polyps, single polyp, and size of polyp <1 cm. The size and number of polyps were independently associated with the reproductive ability of women with minimal/mild endometriosis.

Application of specific ELISAs for BMP15 and GDF9 to cumulus cell extracts from infertile women

Bone morphogenetic protein 15 (BMP15) and growth differentiation factor 9 (GDF9) are oocyte-specific paracrine factors which regulate ovarian cumulus cell (CC) functions. This study aimed to investigate if BMP15 and GDF9 bound to CCs can be characterized, quantified, and show an association with IVF outcomes in infertile women. BMP15 and GDF9 ELISAs were validated and applied to discarded CC extracts. Pooled CCs from individual patients were collected from 120 (cohort 1; BMP15 only) and 81 infertility patients (cohort 2; BMP15 and GDF9) undergoing superovulation. BMP15 and GDF9 levels expressed per CC DNA were correlated with maternal age, clinical and embryology data. Total BMP15 and GDF9 were highly correlated with each other (r = 0.9, p < 0.001). The GDF9:BMP15 ratio was unrelated to oocyte number or age. BMP15/CC DNA and GDF9/CC DNA were unaffected by the type of superovulation and were not related to oocyte/embryo outcomes.

Adenomyosis and Infertility: A Literature Review.

Background and Objectives: Adenomyosis (the presence of ectopic endometrial glands and stroma below the endometrial-myometrial junction) is a benign condition which is increasingly diagnosed in younger women suffering from infertility. The aim of this narrative review was to study the pathophysiology and prevalence of adenomyosis, the mechanisms causing infertility, treatment options, and reproductive outcomes in infertile women suffering from adenomyosis. Materials and Methods: A literature search for suitable articles published in the English language was performed using PubMed from January 1970 to July 2022. Results: The literature search retrieved 50 articles that met the purpose of this review and summarized the most recent findings regarding the accuracy of diagnostic methods, pathophysiology, and the prevalence of adenomyosis and optimal strategies for the treatment of infertile women with adenomyosis. Conclusions: Adenomyosis is a common gynecological disorder, affecting women of reproductive age. It negatively affects in vitro fertilization, pregnancy and the live birth rate, as well as increases the risk of miscarriage. With the advent of non-invasive diagnoses with MRI and TVUS, the role of adenomyosis in infertility has been better recognized. Overall, more randomized controlled trials (RCTs) are needed to provide strong data on the accuracy of diagnostic methods, the pathophysiology and the prevalence of adenomyosis, the fertility outcomes of patients and the optimal strategy for the treatment.

Effects of ovarian stimulation protocols on outcomes of assisted reproductive technology in adenomyosis women: a retrospective cohort study.

To evaluate the effects of different ovarian stimulation protocols on in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes in infertile women with adenomyosis. We carried out a retrospective cohort study among infertile women with adenomyosis receiving IVF/ICSI treatment, including 257 fresh embryo transfer (ET) cycles and 305 frozen embryo transfer (FET) cycles. In fresh ET cycles, ultra-long, long, short, and antagonist protocols were adopted. In FET cycles, patients received long-acting GnRH agonist (GnRHa) pretreatment or not. The primary outcome was clinical pregnancy rate (CPR), and the secondary outcomes included implantation rate (IR), miscarriage rate (MR), and live birth rate (LBR). In fresh ET cycles, compared with ultra-long and long protocols, IR (49.7%, 52.1% versus 28.2%, P=0.001) and CPR (64.3%, 57.4% versus 35.6%, P=0.004) significantly decreased in the short protocol. Similarly, compared with ultra-long and long protocols, a decreased inclination of IR (49.7%, 52.1% versus 33.3%) and CPR (57.4%, 64.3% versus 38.2%) existed in the antagonist protocol, although no statistical significance was detected because of strict P adjustment of Bonferroni method (Padj=0.008). Compared with long protocol, LBR in short protocol decreased obviously (48.2% versus 20.3%, P<0.001). In FET cycles, no matter which origin of embryos, there were no statistical differences in IR, CPR, and LBR. For women ≥35 years receiving fresh ET, CPR was higher in ultra-long and long protocols (52.1%, 50.0% versus 20.0%, 27.5%, P=0.031) compared to antagonist and short protocols. For women ≥35 years receiving FET, compared with ultra-long and antagonist protocols, cycles with embryos originating from long and short protocols had higher proportions of long-acting GnRHa pretreatment (30.4%,30.00 versus 63.9%, 51.4%, P=0.009). IR (61.1%, 48.6% versus 32.6%, 25.0%, P=0.020) and CPR (58.3%, 48.6% versus 30.4%, 25.0%, P=0.024) in long and short protocols were higher than rates of ultra-long and antagonist protocols, but no statistical differences were supported because of strict Bonferroni method (Padj=0.008). In infertile women with adenomyosis, if a fresh embryo was planned for transfer, an ultra-long or long protocol might be beneficial. If antagonist and short protocols were used, whole embryos frozen followed by FET was recommended. In FET cycles, embryos derived from different protocols had no impact on pregnancy outcomes.

Effectiveness of laparoscopic niche resection versus expectant management in patients with unexplained infertility and a large uterine caesarean scar defect (uterine niche): protocol for a randomised controlled trial (the LAPRES study)

IntroductionA uterine niche is a defect at the site of the uterine caesarean scar that is associated with gynaecological symptoms and infertility. Promising results are reported in cohort studies after...

Food & Fertility Study: study protocol for a Danish multicentre prospective cohort study investigating the association between food intake and semen quality, pregnancy and birth outcomes in infertile women and men

IntroductionWorldwide infertility is highly prevalent, and lifestyle factors, such as food intake, could have an essential role in the success of a fertility treatment. The literature is not consistent and...

Establishment of hysteroscopic scoring system of chronic endometritis and correlative analysis with pregnancy outcomes of in vitro fertilization-embryo transfer in infertile patients

Objective: To establish a hysteroscopic chronic endometritis (hCE) scoring system for patients with chronic endometritis, and observe the correlation of hCE score with in vitro fertilization-embryo transfer (IVF-ET) pregnancy outcomes in infertile women. Methods: The study retrospectively investigated the correlation of morphologic features and hCE score with pregnancy outcomes during IVF-ET in infertile women with CE (n=429) at Yantai Yuhuangding Hospital between January 2017 and September 2018. The clinical pregnancy rate and live birth rate with different score levels (1-3,4-7 and 8-14) after IVF-ET treatment were analyzed. Multivariate regression analysis was performed to adjust for confounding factors. The correlation and regression between hCE score and pregnancy outcomes was analyzed by curve fitting. Results: The age of 429 patients [M(Q1, Q3)] was 31 (29, 35) years. There were 50.6% (217 cases), 35.4% (152 cases), and 14.0% (60 cases) of patients with hCE score of 1-3, 4-7, and 8-14, respectively. The pregnancy rates of the three groups were 60.8% (132 cases), 44.7% (68 cases) and 16.7% (10 cases), P<0.001; The live birth rates were 51.2% (111 cases), 36.8% (56 cases) and 13.3% (8 cases), respectively (P<0.001). Compared with patients with hCE of 1-3, pregnancy rates in those with hCE of 4-7 and 8-14 were lower, and the OR values were 0.521 (0.342-0.793) and 0.129 (0.062-0.268). The live birth rates in patients with hCE of 4-7 and 8-14 were lower than that in patients with hCE of 1-3, and the OR values were 0.570 (0.372-0.873) and 0.162 (0.073-0.360), all P<0.05. Quadratic curve fitting results showed that clinical pregnancy rate and live birth rate decreased with the increase of hCE score. Conclusions: With the increase of hCE score, the clinical pregnancy rate and live birth rate of patients gradually decrease. hCE 4 is an important cut-off threshold significantly affecting the pregnancy outcome.