Ovulatory Women Research Articles

P-490 Impact of follicular phase characteristics on mid-luteal progesterone and ongoing pregnancy rates: Lessons learned from true natural cycle frozen embryo transfer

Abstract Study question Is there an association between follicular phase endocrine and ultrasonographic characteristics and ongoing pregnancy rates (OPRs) in true-natural cycle (t-NC) frozen embryo transfers (FETs)? Summary answer Endometrial thickness one day before ovulation is the only independent predictor of ongoing pregnancy (OP) in t-NC FET cycles. What is known already In ovulatory women, NC FET is currently being proposed instead of the hormonal replacement treatment (HRT) protocol since HRT is associated with increased maternal and obstetric risk factors, most probably due to the absence of a corpus luteum. However, the presence of ovulation in regularly cycling women does not guarantee a receptive endometrium. Currently, there is a lack of data regarding the impact of follicular phase endocrine and ultrasonographic parameters on mid-luteal progesterone (P4) levels and OPRs in t-NC FET cycles. Study design, size, duration A cohort study of 229 women who underwent warmed blastocyst transfer employing t-NC. Three strategies were adopted. During January 2017-June 2017, serum P4 was not monitored. During July 2017-June 2020, serum P4 was routinely monitored on the FET-1 day. During July 2020-August 2022, a rescue strategy with daily 25-mg subcutaneous progesterone was adopted for patients with P4 levels between 7-10 ng/mL. In patients with serum P4<7 ng/mL FET was cancelled. Participants/materials, setting, methods Staying in-town and having regular menstrual cycles, permitting intensive endocrine and ultrasonographic monitoring (daily serum estradiol [E2], luteinizing hormone [LH], P4, and transvaginal ultrasonography), starting mid-cycle until confirmation of ovulation was the only inclusion criteria. Only the first FET cycle per patient was included. The primary outcome measure was OPR. The impact of follicular phase endocrine and ultrasonographic parameters on serum P4 levels on the FET-1 day and OPRs were evaluated using regression analysis. Main results and the role of chance Follicular phase parameters, including follicular phase length, late follicular phase E2, LH, P4 levels, and maximal follicle diameter before ovulation, were not significant predictors of ongoing pregnancy (OP) in t-NC FET. In contrast, the endometrial thickness one day prior to ovulation was a significant independent predictor of OP (adjusted OR = 1.29, 95% CI:1.06-1.56). When endometrial thickness before ovulation was assessed in quartiles, univariate OPRs in the 25th (<9.1 mm), 25-50th (9.1-10.1mm), 51-75th (10.2-11.6 mm) and >75th (>11.6 mm) percentiles were 43.3%, 47.3%, 71.7%, and 54.7%, respectively (p=0.016). Following logistic regression analysis, the adjusted ORs for OPR of the 51-75th (3.69, 95% CI:1.42-9.56) and >75th (2.86, 95% CI: 1.06-7.73) percentiles were significantly higher when compared with that of < 25th. The three strategies for monitoring/acting (rescue if needed) based on serum P4 levels on the FET-1 day were associated with similar adjusted ORs for OP. Notably, cancellation of cycles with serum P4 <7 ng/mL and adopting a rescue policy for those with 7-10 ng/mL did not increase OPRs. After multivariate linear regression analysis, late follicular E2 levels (ß-coefficient: 0.399 ng/mL, 95% CI:0.007;0.021) and BMI (ß-coefficient: −0.292 ng/mL, 95% CI: −0.730;-0.222) were the only significant predictors of P4 levels on the FET-1 day. Limitations, reasons for caution Limitations include the cohort study design evaluating three different policies, the single point serum P4 assessment, and adopting an arbitrary lower cut-off of < 7 ng/mL for cycle cancellation and 7-10 ng/mL for a rescue strategy. Wider implications of the findings Endometrial thickness one day before ovulation was the only significant predictor of OP in t-NC FET cycles. Apart from endometrial thickness, none of the follicular phase parameters were significant predictors of OP. Single-point assessment of serum P4 may not be reliable when assessing reproductive outcomes in t-NC FET. Trial registration number Not applicable

Menses and Positive Partner Interactions Increase Mate Guarding Behaviors in Established Romantic Couples

Mate Guarding (Alberts et al., 1996), behaviors intended to decrease a romantic partner’s sexual access to potential extradyadic partners (e.g., touching partner around others, not attending gatherings), are thought to change throughout the menstrual cycle. Rooted in theories suggesting ovulating women’s sexual interest/behaviors increase during times of fertility, couples increase their mate guarding behaviors to limit reproductive costs (Gangestad et al., 2006). Yet, much of the research fails to examine mate guarding behaviors and fertility in established, committed couples. Using an ecological momentary assessment, romantically committed, heterosexual couples (n = 42 pairs) completed daily surveys tracking relationship dynamics for one menstrual cycle (e.g., 28 days; all naturally cycling). Dependent t-tests showed mate guarding behaviors increased during menses compared to ovulation (women, t = 4.5, p <.001; men, t = 3.5, p<.001), but positive couple interactions were unchanged. We tested actor-partner effects between positive daily partner interactions and mate guarding during menses and ovulation. Positive actor effects were found for both (menses women ß = 3.276, p <.001, men ß = 3.049, p =.002; ovulation women ß = 1.637, p =.041, men ß = 3.089, p =.011); whereas partner effects were only observed for men during ovulation (ß = 2.806, p =.006). Results demonstrate evolutionary psychological theories suggesting mate guarding increases during ovulation may not be predictive in established couples. For committed couples, times when female partners are unlikely to conceive are opportunities when couples demonstrate their fidelity.

Interplay of Cortisol, Testosterone, and Abdominal Fat Mass in Normal-weight Women With Polycystic Ovary Syndrome.

Ovarian and adrenal steroidogenesis underlie endocrine-metabolic dysfunction in polycystic ovary syndrome (PCOS). Adipocytes express aldo-keto reductase 1C3 and type 1 11β-hydroxysteroid dehydrogenase, which modulate peripheral androgen and cortisol production. To compare serum adrenal steroids, including 11-oxygenated androgens (11-oxyandrogens), cortisol, and cortisone between normal-weight women with PCOS and body mass index- and age-matched ovulatory women with normal-androgenic profiles (controls), and assess whether adrenal steroids associate with abdominal adipose deposition. Prospective, cross-sectional, cohort study. Academic medical center. Twenty normal-weight women with PCOS and 20 body mass index-/age-matched controls. Blood sampling, IV glucose tolerance testing, and total-body dual-energy x-ray absorptiometry. Clinical characteristics, hormonal concentrations, and body fat distribution. Women with PCOS had higher serum total/free testosterone (T) and androstenedione (A4) levels and a greater android/gynoid fat mass than controls (androgens P < .001; android/gynoid fat mass ratio, P = .026). Serum total/free T and A4 levels correlated positively with android/gynoid fat mass ratio in all women combined (P < .025, all values). Serum 11ß-hydroxyA4, 11-ketoA4, 11ß-hydroxyT, 11-ketoT, cortisol, and cortisone levels were comparable between female types and unrelated to body fat distribution. Serum 11-oxyandrogens correlated negatively with % total body fat, but lost significance adjusting for cortisol. Serum cortisol levels, however, correlated inversely with android fat mass (P = .021), with a trend toward reduced serum cortisol to cortisone ratio in women with PCOS vs controls (P = .075), suggesting diminished 11β-hydroxysteroid dehydrogenase activity. Reduced cortisol may protect against preferential abdominal fat mass in normal-weight PCOS women with normal serum 11-oxyandrogens.

Diagnostic Performance of Anti-Müllerian Hormone, Luteinizing Hormone to Follicle-Stimulating Hormone Ratio, Testosterone, and Prolactin to Predict Polycystic Ovary Syndrome Among Sudanese Women.

Polycystic ovary syndrome (PCOS) is one of the most important contributing factors to infertility. The diagnosis of PCOS is not an easy procedure, as the signs and symptoms are heterogeneous and of undefined etiology. There are only a few published studies that address the diagnostic performance of anti-Müllerian hormone in diagnosis of PCOS in sub-Saharan Africa including Sudan. This study aims to assess anti-Müllerian hormone (AMH), luteinizing to follicle-stimulating hormone ratio (LH: FSH), total testosterone (TT), and prolactin (PRL) levels among PCOS. In addition, we determine if AMH can be used as a predictor of PCOS among Sudanese women. There were 600 women enrolled in this observational cross-sectional study, 300 of whom had PCOS, and 300 of whom healthy women; PCOS was diagnosed using the Rotterdam criteria. On days 2-4 of the menstrual cycle, serum LH, FSH, AMH, TT, and PRL levels were measured for all participants. Diagnostic performance of these parameters for PCOS was determined by receiver operating characteristic (ROC) curve. Significantly higher means among PCOS regarding their BMI, AMH; LH: FSH ratio; TT; PRL, whereas significantly inverse in FSH compared with normal ovulatory women. On ROC analysis, AMH had the largest operating characteristic curve at cut-off >3.95 ng/mL; AUC = 0.999 with Youden's index 0.99%, followed by LH: FSH ratio at cut-off 0.749; AUC=0.932; Youden's index 0.813%, TT cut-off 0.82 mIU/L, AUC=0.852 with Youden's index 0.58, while PRL showed the lowest AUC=0.627 with cut-off 15.3 ng/mL, Youden's index was 0.18%, P. value<0.001. Sudanese women with PCOS had higher serum AMH level, LH:FSH ratio, and TT level. Moreover, AMH level has better discriminative power and good diagnostic potency for the diagnosis of PCOS among Sudanese.

The likelihood of a healthy live birth after frozen embryo transfer with endometrium prepared by natural ovulation regimen vs programmed regimen: a propensity-score matching study

The number of frozen embryo transfer cycles is increasing, but the optimal method of endometrial preparation for frozen embryo transfer remains controversial. Few studies have investigated the healthy live birth outcome after the natural ovulation regimen vs the programmed regimen. This study aimed to explore whether the likelihood of a healthy live birth after frozen embryo transfer differs between the natural ovulation regimen and the programmed regimen. We conducted a retrospective cohort study including 7824 ovulatory women who underwent the first frozen embryo transfer cycle of single-blastocyst transfer with endometrial preparation by natural ovulation regimen vs programmed regimen, between June 2017 and June 2021. Propensity score matching was used to control for confounding variables in a 1:1 ratio. The primary outcome was healthy live birth, defined as birth of a live, singleton infant born at term, with an appropriate birthweight for gestational age. The natural ovulation regimen resulted in a higher probability of achieving healthy live birth compared with the programmed regimen (35.8% vs 30.6%; P<.0001). In addition, a higher rate of singleton live birth was observed after the natural ovulation regimen relative to the programmed regimen (49.6% vs 45.7%; P=.003). Women with the natural ovulation regimen were also less likely to experience clinical pregnancy loss (16.0% vs 19.7%; P=.005) and hypertensive disorders of pregnancy (3.9% vs 6.0%; P=.004) compared with women with the programmed regimen. Singletons born after the programmed regimen had greater mean birthweight (3441.50±539.97 vs 3394.96±503.87; P=.020) and higher risk of being large for gestational age (23.3% vs 18.7%; P=.003) than those conceived after the natural ovulation regimen. The natural ovulation regimen may be superior to the programmed regimen with regard to higher likelihood of healthy live birth and lower risk of pregnancy loss and maternal hypertensive disorders of pregnancy.

Overview Of Polycystic Ovary Syndrome (PCOS)

PCOS, commonly known as hyperandrogenic anovulation, is a condition that affects women's ovaries. A frequent endocrine system illness that affects women of reproductive age is polycystic ovarian syndrome (PCOS), also known as hyperandrogenic anovulation (HA), or Stein-Leventhal syndrome (Evans and Riley, 1958). According to Stein and Leventhal (1935), it is a condition that develops on one or both ovaries when an estimated 10 tiny cysts with a diameter ranging from 2 to 9 mm and/or an ovarian volume greater than 10 ml are present. According to a systematic examination of women using National Institutes of Health (NIH) diagnostic criteria, 4–10% of women of reproductive age have PCOS. Recent research reveals that PCOS is a lifelong syndrome that first manifests during pregnancy, despite the fact that it was traditionally thought to be a disorder that only affected adult women. It is a syndrome that can be avoided by raising awareness among patients and healthcare professionals. Starting with its diagnosis, pathophysiology, repercussions, and treatment options, there are numerous areas of disagreement(1).

12-months of increased dietary intake does not exacerbate disordered eating-related attitudes, stress, or depressive symptoms in women with exercise-associated menstrual disturbances: The REFUEL randomized controlled trial

Disordered eating-related attitudes are a leading cause of energy deficiency and menstrual disturbances in exercising women. Although treatment recommendations include psychological counseling with increases in dietary intake, a key concern is whether increased dietary intake may exacerbate negative eating behaviors. ObjectiveTo determine the effects of a 12-month nutritional intervention on eating-related attitudes and psychological characteristics in exercising women with oligomenorrhea/amenorrhea (Oligo/Amen). MethodsIntent-to-treat analysis of the REFUEL randomized controlled trial (#NCT00392873) in 113 exercising women (age [mean±SEM]:] 21.9 ± 0.4 yrs; BMI: 20.9 ± 0.2 kg/m2). Women were randomized to increase energy intake 20–40% above baseline energy needs (Oligo/Amen+Cal, n = 40) or maintain energy intake (Oligo/Amen Control, n = 36) while maintaining their exercise behaviors. A reference group of ovulatory women (OVref, n = 37) maintained diet and exercise behaviors. Body composition, eating attitudes, stress, and depressive symptoms were assessed at baseline and every 3 months. ResultsAt baseline, the Oligo/Amen groups had higher drive for thinness, cognitive restraint, and eating disorder risk than OVref group (p < 0.001). Increased energy intake led to increases in percent body fat and fat mass (p < 0.010), but not psychobehavioral outcomes, in the Oligo/Amen+Cal compared to Oligo/Amen Control group. Independent of group, cognitive restraint decreased (p < 0.001) and resilient coping increased (p < 0.007) over 12-months, while perceived stress (p = 0.143) and depressive symptoms (p = 0.344) were unchanged. DiscussionLong-term nutritional intervention consisting of modest increases in dietary intake with guidance from a registered dietician and a psychologist increases body and fat mass without increasing disordered eating-related attitudes, stress, or depressive symptoms in exercising women with Oligo/Amen.

Premature timing of progesterone luteal phase support initiation did not negatively impact live birth rates in modified natural frozen thawed embryo transfer cycles

Study questionIn a modified natural cycle frozen-thawed embryo transfer (mNC-FET), does the premature timing of progesterone luteal phase support (LPS) initiation 24 h following human chorionic gonadotropin (hCG) trigger impact live birth? Summary answerPremature LPS initiation did not negatively affect the live birth rate (LBR) in mNC-FET cycles compared with conventional LPS initiation 48 h after hCG triggering. What is known alreadyDuring natural cycle FET, human chorionic gonadotropin is routinely used to mimic endogenous luteinizing hormone (LH) surge to induce ovulation, which allows more flexibility in embryo transfer scheduling, thus relieving the burden of multiple visits by patients and laboratory workloads, which is also known as mNC-FET. Moreover, recent data demonstrates that ovulatory women undergoing natural cycle FETs have a lower risk of maternal and fetal complications due to the essential role of the corpus luteum in implantation, placentation and pregnancy maintenance. While several studies have confirmed the positive effects of LPS in mNC-FETs, the timing of progesterone LPS initiation is still unclear, as compared with fresh cycles where robust research has been conducted. To the best of our knowledge, no clinical studies comparing different beginning days in mNC-FET cycles have been published. Study design, size, durationThis retrospective cohort study involved 756 mNC-FET cycles performed at a university-affiliated reproductive center between January 2019 and August 2021. The primary outcome measured was the LBR. Participants/materials, setting, methodsOvulatory women ≤42 years of age who were referred for their autologous mNC-FET cycles were included in the study. According to the timing of progesterone LPS initiation following the hCG trigger, patients were assigned into two categories: premature LPS group (progesterone initiation 24 h after hCG trigger, n = 182) versus conventional LPS group (progesterone initiation 48 h after hCG trigger, n = 574). Multivariate logistic regression analysis was used to control for confounding variables. Main results and the role of chanceThere were no differences in background characteristics between the two study groups, except for the proportion of assisted hatching (53.8% in premature LPS group versus 42.3% in conventional LPS group, p = 0.007). In the premature LPS group, 56 of 182 patients (30.8%) had a live birth, compared to 179 of 574 patients (31.2%) in the conventional LPS group, with no significant difference observed between groups (adjusted odds ratio [aOR] 0.98, 95% confidence interval [CI] 0.67–1.43, p = 0.913). In addition, there was no significant difference between the two groups in other secondary outcomes. A sensitivity analysis for LBR according to the serum LH and progesterone levels on hCG trigger day also confirmed the aforementioned findings. Limitations, reasons for cautionIn this study, retrospective analysis was conducted in a single center and was therefore prone to bias. Additionally, we did not anticipate monitoring the patient's follicle rupture and ovulation after hCG triggering. Future prospective clinical trials remain necessary to confirm our results. Wider implications of the findingsWhile exogenous progesterone LPS was added 24 h after hCG triggering, embryo-endometrium synchrony would not be adversely affected so long as sufficient time was allowed for endometrial exposure to exogenous progesterone. Our data support promising clinical outcomes following this event. As a result of our findings, clinicians and patients will be able to make better informed decisions. Study funding/competing interest(s)No specific funding was available for this study. The authors have no personal conflicting interests to declare. Trial registration numberN/A.

Elevated baseline LH/FSH ratio is associated with poor ovulatory response but better clinical pregnancy and live birth in Chinese women with PCOS after ovulation induction

BackgroundWhat is the association between elevated baseline LH/FSH ratio and reproductive outcomes, especially ovulatory response, among Chinese women with polycystic ovary syndrome (PCOS) after ovulation induction. MethodsThis was a secondary analysis of a multicenter randomized trial in 1000 women with PCOS from 21 sites (27 hospitals) in Mainland China. LH and FSH levels before ovulation induction and the main outcomes including ovulation, biochemical pregnancy, clinical pregnancy, miscarriage, and live birth were measured. A linear regression model, logistic regression models and Cox proportional hazard regression model were used to estimate the association between LH/FSH ratios and reproductive outcomes in PCOS. ResultsLH/FSH ratio was significantly associated with age, body mass index (BMI), total testosterone (TT), estradiol (E2), free testosterone (FT), and antimullerian hormone (AMH). Anovulatory women had significantly higher LH/FSH ratio than ovulatory women (P = 0.003), especially in women with young age (P = 0.023), high BMI (P = 0.002), low E2 (P = 0.002), FT (P = 0.010), TT (P < 0.001) and AMH(P = 0.032). Women with elevated LH/FSH ratio were associated with lower ovulation (LH/FSH≥1 OR = 0.42, 95% CI, 0.26–0.68; LH/FSH≥2 OR = 0.32, 95% CI, 0.20–0.54; LH/FSH≥3 OR = 0.40, 95% CI 0.21–0.74) when compared with LH/FSH<1. The association was held after adjustment for treatment with or without the confounding factors. Although no association between LH/FSH ratio and biochemical pregnancy, women with 1 ≤ LH/FSH<2 were associated with higher clinical pregnancy (OR = 1.71; 95% CI, 1.09–2.67) and live birth (OR = 1.73; 95% CI, 1.09–2.75) compared to women with LH/FSH<1. Women with 2 ≤ LH/FSH<3 were associated with lower miscarriage rate (OR = 0.38; 95% CI, 0.16–0.93). ConclusionsElevated baseline LH/FSH ratio in women with PCOS was associated with poor ovulatory response, but women were more likely to achieve clinical pregnancy and live birth than women with normal LH/FSH. It suggests LH and FSH in women with PCOS may play a role in successful pregnancy despite of negative impact in ovulation.

Early detection of liver disorders using hybrid soft computing techniques for optimal feature selection and classification

SummaryHuman liver disease is a sort of illness that starts in the ovaries and is particularly dangerous for women. As a consequence, aberrant cells develop that have the potential to spread to other parts of the body. Liver disease is a serious disorder that affects women's ovaries and is difficult to identify early on, which is why it is still one of the leading causes of mortality. The significance of unequivocal confirmation of intrinsic and typical components in establishing new frameworks to detect and eliminate danger is substantial. In this study, we present a hybrid soft computing approach for early diagnosis of liver problems (EDLD‐HS). For high and low level feature extraction models, we first employ an improved ant swarm optimization (IASO) approach. Then, for optimum feature selection, we develop a modified whale search optimization (MWSO) technique that combines features that may reflect both texture patterns and semantic backdrop scattered in the data. After that, we employed a hybrid swallow swarm intelligent‐deep neural network (HSSI‐DNN) classifier to determine the stage of liver illness. Finally, we used MATLAB R2014a to test our proposed EDLD‐HS method using well‐known benchmark datasets including BUPA, ILPD, and MPRLPD. The simulation findings are compared to existing state‐of‐the‐art methodologies in terms of accuracy, specificity, sensitivity, precision, recall, F1‐score, G‐mean, and area under curve (AUC). The detection accuracy of the proposed HSSI‐DNN classifier is 83.26% (BUPA), 84.26% (ILPD), and 91.23% (ILPD) (MPRLPD).

Bibliometric analysis and visualization of literature on assisted reproduction technology.

Assisted reproductive technology (ART) is a method that uses various techniques to process sperm or ova. Assisted reproductive technology involves removing ova from a woman's ovaries, combining them with sperm in the laboratory, and returning them to the woman's body or donating them to another woman. Based on the web of science core collection database, we firstly analyzed the quantity and quality of publications in the field of ART, secondly profiled the publishing groups in terms of country, institution, author's publication and cooperation network, and finally sorted out and summarized the hot topics of research. In total, 6,288 articles on ART were published between 2001 and 2022 in 1,013 journals. Most of these published articles represent the global research status, potential hotspots and future research directions. Publications and citations of research on assisted reproductive technology have steadily increased over the past few decades. Academic institutions in Europe and the United States have been leading in assisted reproductive technology research. The countries, institutions, journals, and authors with the most published articles were the United States (1864), Harvard Univ (108), Fertility and Sterility (819), and Stern, Judy E. (64). The most commonly used keywords are Assisted reproductive technology (3303) and in-vitro Fertilization (2139), Ivf (1140), Pregnancy (1140), Women (769), Intracytoplasmic Sperm injection (644), In Fertilization (632), Risk (545), and Outcome (423). Frozen embryo transfer, intracytoplasmic sperm injection, and in vitro fertilization are the main research topics and hotspots in the field of assisted reproductive technology.

Ova Retrieval for IVF in the Light of Islamic Sharī'ah Laws in Pakistan.

The technique of in vitro fertilization is the cornerstone of all assisted reproductive techniques. Other sophisticated procedures springing from it can differ in the method of assisted fertilization; for example, the site of deposition of gametes or embryos in the uterus or Fallopian tube, the use of fresh or frozen gametes and embryos, assistance from donor sperms or oocytes, and whether gestation is carried out in the same woman or another woman. IVF itself depends on the retrieval of ova from a woman's ovaries. This pivotal stage of IVF has not been deliberated upon by Muslim jurists, who largely focus on the overall legal status of IVF, whereas the legal position of this particular step in IVF impacts the whole procedure. This research paper focuses specifically on the retrieval of ova for IVF in the light of Islamic Sharī'ah.

Loci on chromosome 12q13.2 encompassing ERBB3, PA2G4 and RAB5B are associated with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenemia of ovarian theca cell origin. We report significant association of androgen production with 15 single nucleotide variants (SNVs) identified by exome sequencing of theca cells from women with PCOS and normal ovulatory women. Ten SNVs are located within a 150 kbp region on 12q13.2 which encompasses loci identified in PCOS genome-wide association studies (GWAS) and contains PCOS candidate genes ERBB3 and RAB5B. The region also contains PA2G4 which encodes a transcriptional corepressor of androgen receptor and androgen receptor-regulated genes. PA2G4 has not previously been recognized as related to PCOS in published GWAS studies. Two of the SNVs are predicted to have functional consequences (ERBB3 missense SNV, PA2G4 promoter SNV). PA2G4 interacts with the ERBB3 cytoplasmic domain containing the missense variant, suggesting a potential signaling pathway disruption that could lead to the PCOS ovarian phenotype. Single cell RNA sequencing of theca cells showed significantly less expression of PA2G4 after forskolin treatment in PCOS cells compared to normal cells (padj = 3.82E-30) and in cells heterozygous for the PA2G4 promoter SNV compared to those without the SNV (padj = 2.16E-11). This is consistent with a functional effect of the PA2G4 promoter SNV. No individual SNV was significantly associated with PCOS in an independent family cohort, but a haplotype with minor alleles of three SNVs was found preferentially in women with PCOS. These findings suggest a functional role for 12q13.2 variants in PCOS and implicate variants in ERBB3 and PA2G4 in the pathophysiology of PCOS.

Frozen-thawed embryo transfer in modified natural cycles: a retrospective analysis of pregnancy outcomes in ovulatory women with vs. without spontaneous luteinizing hormone surge

BackgroundTiming of frozen embryo transfer (FET) in natural endometrial preparation cycles is often based on luteinizing hormone (LH) surge. However, some patients do not show spontaneous LH surge despite follicular maturation. The objective of this study was to evaluate the impact of spontaneous LH surge on pregnancy outcomes in modified natural cycles (mNC).MethodsThis retrospective analysis included 1897 FET cycles with modified natural endometrial preparation in normo-ovulatory women between January 1, 2015, to December 31, 2019, at our center: 920 cycles with spontaneous LH surge (≥ 20 IU/L) and 977 without. For cleavage embryos, FET was conducted 4 and 5 days after hCG injection in women with and without LH surge, respectively. For blastocysts, FET was conducted 6 and 7 days after hCG injection in women with and without LH surge, respectively. Multivariate regression was conducted to examine the factors associated with live birth.ResultsLive birth rate was 43.7% in patients with spontaneous LH surge vs. 43.8% in women without LH surge (P = 0.961). The two groups also had similar implantation rate (36.2% vs. 36.7%, P = 0.772), biochemical pregnancy rate (54.8% vs. 55.4%, P = 0.796) and clinical pregnancy rate (50.9% vs. 51.7%, P = 0.721). In multivariate regression, live birth was not associated with LH surge (aOR, 0.947, 95% CI, 0.769, 1.166).ConclusionPregnancy outcomes were similar in mNC-FET in cycles with vs. without spontaneous LH surge if FET timing is adjusted.

LBMON235 Impact Of A Hypocaloric Dietary Weight-loss Intervention On Antral Follicle Dynamics In Women With Obesity And Regular Ovulatory Cycles

Abstract We recently showed that eumenorrheic, ovulatory women with obesity experience suppressed antral follicle dynamics, as evidenced by fewer recruitment events, selectable follicles and dominant follicles. Ovulatory follicles were selected for preferential growth at smaller diameters and lower luteal progesterone production was also observed. Weight loss is posited to improve reproductive function in women with obesity. However, the mechanisms underlying these improvements are unclear. The objective of this study was to contrast ovarian follicular growth and endocrine dynamics in eumenorrheic women with obesity, before and after a weight-loss intervention. | Twelve reproductive age females with obesity (total percent body fat ≥35%) and regular menstrual cycles (21-35 days) were evaluated by serial ovarian transvaginal ultrasonography and venipuncture every-other-day for one complete inter-ovulatory interval (IOI) (pre-intervention) and after a 6-month hypocaloric dietary intervention (post-intervention). The number and diameters of all follicles ≥2mm at each visit were documented offline using the Grid Method. Growth profiles of individual follicles which grew to &amp;gt;7mm were recorded using the Identity Method to document antral follicle recruitment events, selection, and ovulation. Clinical, morphologic, and endocrine features were compared pre- and post-intervention using paired t-tests and mixed models. | Participants lost an average of 9.5±3.8% total body weight (IQR: 7.7-12.6%). Antral follicle counts (AFC) across the IOI were lower post-intervention versus pre-intervention (PINTERVENTION=0. 002), driven by fewer 2-5mm follicles (PINTERVENTION=0. 001). Participants tended to exhibit more recruitment events (Pre: 1. 0±0.7 vs. Post: 2. 0±0.9, P=0. 09) and more selectable (6-9mm) follicles before and after weight loss (4±3 vs. 6±4 respectively, P=0. 07). A greater number of selectable follicles achieved a diameter of &amp;gt;10mm across the IOI post-intervention (PINTERVENTION=0. 001). Ovulatory follicles were also selected at larger diameters after the intervention (Pre: 7.3±2.9mm vs. Post: 10.9±2.6, P=0. 01). Dominant and ovulatory follicle growth kinetics were similar before and after the intervention (All, P&amp;gt;0. 05). Luteal progesterone concentrations were higher in women after the intervention (Pre: 5.3±3.7 vs. Post: 6.3±4.7ng/mL, P&amp;lt;0. 0001). | Eumenorrheic women with obesity demonstrate changes in follicle dynamics with weight loss following a hypocaloric dietary intervention. Development of more dominant follicles, a larger diameter at selection, and increased luteal progesterone production suggests increased responsiveness to gonadotropins with weight loss. Further studies are needed to elucidate the metabolic mechanisms driving any transient or sustained changes in ovarian physiology with hypocaloric dietary interventions aimed at weight loss. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

Administration of depot GnRH agonist prior to programmed frozen-thawed embryo transfer does not improve the live birth rate in ovulatory women: A large, multi-center retrospective study.

Despite that gonadotropin-releasing hormone (GnRH) agonist pretreatment has been widely used before programmed frozen-thawed transfer (FET), its impact on live birth rates in ovulatory women remains uncertain. In the present study, we aim to determine if GnRH agonists pretreatment before FET improves live birth rates in women undergoing in vitro fertilization with FET. Programmed FET cycles conducted in four infertility centers were retrospectively collected and reviewed for eligibility from January 2016 and December 2017. Patient’s demographics, ovarian stimulation parameters, and pregnancy outcomes were compared between those given GnRH agonist pretreatment versus no pretreatment in ovulatory women undergoing FET cycles. A total of 6397 programmed cycles were screened for eligibility, of which 5049 cycles were included in the study for analysis. Compared with the group of no GnRH agonist pretreatment (n = 4143), women in the GnRH agonist group (n = 906) were older (33.0 vs 34.0, P < .001), had a higher proportion of subjects with previous transfer attempts and had a higher number of embryos transferred. After controlling for confounders, the logistic regression results showed that GnRH agonist pretreatment did not increase the odds of both clinical pregnancy (OR 0.92, 95% CI [0.70–1.20]), ongoing pregnancy (OR 0.91, 95% CI [0.69–1.19]) and live birth rates (OR 0.84, 95% CI [0.64–1.10]). However, when restricted to women who had no previous transfer attempts, women in the GnRH pretreatment group had lower odds of achieving live birth (OR 0.49, 95% CI [0.30–0.79]). Sensitivity analysis performed in patients with male factor infertility causes showed GnRH agonist pretreated group had lower live birth rates compared to no GnRH agonist pretreatment group (OR = 0.65, 95% CI [0.43–0.97]). Our findings suggested that GnRH agonist pretreatment does not bring additional benefits in live birth rate improvements for ovulatory women undergoing FET cycles. Therefore, the pros of using GnRH agonist to reduce premature ovulation should be weighed against the cons of prolonged time to pregnancy, discomforts resulting from pituitary suppression, and increased medical costs associated with GnRH agonist use.

IS HOME-BASED MONITORING OF OVULATION TO TIME FROZEN EMBRYO TRANSFER AN EFFECTIVE ALTERNATIVE FOR HOSPITAL-BASED MONITORING OF OVULATION?

Among women who are undergoing in vitro fertilization (IVF), transfer of frozen embryo’s (FET) in the natural cycle (NC) is an effective alternative to FET in the artificial or supplemented cycle in terms of pregnancy outcomes. As NC-FET results in a lower perinatal complication rate that artificial FET, it is a preferred method to transfer frozen embryos in ovulatory women. The standard in NC-FET is modified or hospital-based NC-FET, which involves repeated ultrasounds and triggering the ovulation. From the woman’s point of view, a more natural approach to time FET using LH urine tests to allow a natural ovulation, i.e. true NC or home-based monitoring, may be desired. It is not known whether FET in the true NC results in similar ongoing pregnancy rates compared to modified NC-FET.

Comparison of endometrial preparation protocols (natural cycle versus hormone replacement cycle) for frozen embryo transfer (COMPETE): a study protocol for a randomised controlled trial

IntroductionNatural cycle (NC) and hormone replacement treatment (HT) are frequently used endometrial preparation protocols prior to frozen-thawed embryo transfer in ovulatory women. It is not clear which protocol results in...

THE ASSOCIATIONS BETWEEN BODY MASS INDEX AND LIVE BIRTH OUTCOMES AMONG PATIENTS WITH AND WITHOUT OVULATORY DYSFUNCTION UNDERGOING INTRAUTERINE INSEMINATION CYCLES

To determine whether body mass index (BMI) affects intrauterine insemination (IUI) treatment success in anovulatory versus ovulatory women, particularly with BMI ≥ 30 kg/m2.

Programmed frozen embryo transfer cycle increased risk of hypertensive disorders of pregnancy: a multicenter cohort study in ovulatory women

Although live birth rates were comparable between programmed and natural frozen-thawed embryo transfer cycles, recent data showed that pregnancies after programmed cycle were associated with an increased risk of adverse perinatal outcomes, such as hypertensive disorders of pregnancy. Such a difference might be attributed to selection bias because patients with ovulation disorders are more likely to receive programmed endometrial preparation protocol than natural cycle. This study aimed to analyze whether programmed endometrial preparation protocol is associated with an increased risk of adverse perinatal outcomes compared with natural cycle during frozen embryo transfer in ovulatory women. This regional multicenter retrospective cohort study was conducted in 5 reproductive medical centers in Southeast China. Patients with regular cycles (21-35 days), who underwent either programmed or natural cycle blastocyst frozen embryo transfer and delivered singleton live birth babies after 28 weeks of gestation between 2016 and 2019 were analyzed. Each patient only contributed 1 cycle per cohort. The patients' frozen embryo transfer treatment cycles were linked to their obstetrical medication record, and a comprehensive medical record review was conducted to compare the maternal and neonatal outcomes between natural cycle and programmed cycle. Crude and adjusted odds ratios with 95% confidence intervals were calculated, and adjustment was made for relevant confounders. Study samples included 499 natural cycle frozen embryo transfer cases and 900 programmed frozen embryo transfer cases. Pregnancies after programmed cycle were associated with increased odds of hypertensive disorders of pregnancy (adjusted odds ratio, 2.71; 95% confidence interval, 1.59-4.91) and preeclampsia (adjusted odds ratio, 2.71; 95% confidence interval, 1.17-6.23) compared with pregnancies after natural cycle. No significant difference was detected regarding other adverse perinatal outcomes between the 2 endometrial protocols. In subgroup analysis, both the subgroups of hormone replacement therapy and hormone replacement therapy with gonadotrophin-releasing hormone analogue pretreatment had increased odds of developing hypertensive disorders of pregnancy than the natural cycle group. The risk of developing preeclampsia was higher in the hormone replacement therapy with gonadotrophin-releasing hormone analogue pretreatment subgroup than in the other 2 groups (adjusted odds ratio, 4.99; 95% confidence interval, 1.94-12.82) (aOR, 2.47; 95% CI, 1.17-5.18). Pregnancies after programmed frozen embryo transfer were associated with higher risks of hypertensive disorders of pregnancy in ovulatory women. The hormone replacement therapy with gonadotrophin-releasing hormone analogue pretreatment cycle led to the highest risk of preeclampsia among the 3 protocols.