Positive Beta-human Chorionic Gonadotropin Research Articles

A Study to Determine the Reason for Lower Pregnancy Rates in Younger Women with Diminished Oocyte Reserve-less Chance of Implanting vs. Fetal Demise

Most studies find lower live-delivered pregnancy rates (LDPRs) following in vitro fertilization-embryo transfer (IVF-ET) in women with diminished oocyte reserve (DOR) vs. normal oocyte reserve (NOR) even in a younger population. How much of a discrepancy may depend on the degree of oocyte depletion in the DOR group and the follicular stimulation protocol. Some fertility specialists favor an FSH receptor up-regulation technique as the protocol to attain the maximum LDPRs in women with DOR. The objective of this study was to compare chemical, clinical, and LDPRs following IVF-ET to determine if the main time of embryo loss is very early, as evidenced by the largest discrepancy occurring in attaining even a chemical pregnancy, and/ or a large discrepancy between a chemical pregnancy and attaining a clinical pregnancy (ultrasound evidence of a gestational sac) or later losses as evidenced by showing a greater loss rate from clinical evidence of pregnancy to live delivery in those with DOR compared to NOR. Overall, the DOR group, with a mean serum anti-Mullerian hormone (AMH) level of 0.42 ng/mL, had 50% as much chance to have an LDPR/transfer as women with NOR (AMH of 4.66) despite the same number of day 3 embryos transferred. The main reduction in LDPRs occurred from embryo transfer failing to attain a positive clinical pregnancy in the DOR group. The least discrepancy was from attaining a clinical pregnancy to live delivery. Thus, for NOR from positive pregnancy test 59% of this younger age group will have a live delivery vs. 50% for DOR. Thus, the reduction in LDPRS/transfer in young women with DOR vs. NOR seems mostly very early so the DOR group does not even attain a positive serum beta human chorionic gonadotropin level. This suggests that this inferiority in attaining a live delivery may be related to aneuploidy involving large chromosomes or a marked decrease in the mitochondrial DNA of the embryo.

Semaphorin 3A Increases in the Plasma of Women with Diminished Ovarian Reserve Who Respond Better to Controlled Ovarian Stimulation.

Semaphorin 3A (SEMA3A) plays a crucial role in the development, differentiation, and plasticity of specific types of neurons that secrete Gonadotropin-Releasing Hormone (GnRH) and regulates the acquisition and maintenance of reproductive competence in humans and mice. Its insufficient expression has been linked to reproductive disorders in humans, which are characterized by reduced or failed sexual competence. Various mutations, polymorphisms, and alternatively spliced variants of SEMA3A have been associated with infertility. One of the common causes of infertility in women of reproductive age is diminished ovarian reserve (DOR), characterized by a reduced ovarian follicular pool. Despite its clinical significance, there are no universally accepted diagnostic criteria or therapeutic interventions for DOR. In this study, we analyzed the SEMA3A plasma levels in 77 women and investigated their potential role in influencing fertility in patients with DOR. The results revealed that the SEMA3A levels were significantly higher in patients with DOR than in healthy volunteers. Furthermore, the SEMA3A levels were increased in patients who underwent fertility treatment and had positive Beta-Human Chorionic Gonadotropin (βHCG) values (β+) after controlled ovarian stimulation (COS) compared to those who had negative βHCG values (β-). These findings may serve as the basis for future investigations into the diagnosis of infertility and emphasize new possibilities for the SEMA3A-related treatment of sexual hormonal dysfunction that leads to infertility.

Elevated Anti-Müllerian Hormone as a Prognostic Factor for Poor Outcomes of In Vitro Fertilization in Women with Polycystic Ovary Syndrome.

Women with polycystic ovary syndrome (PCOS) tend to have elevated anti-Müllerian hormone (AMH) levels, which appear to correlate with disease severity and pregnancy outcomes. This was a retrospective observational study designed to assess the relationship between circulating AMH levels and in vitro fertilization (IVF) outcomes. The study involved 150 women with PCOS who underwent IVF treatments. The women's IVF cycles were allocated into three subgroups according to AMH levels: 'low' (AMH < 3.7 ng/mL; n = 49), 'middle' (AMH 3.7-7.4 ng/mL; n = 94), and 'high' (AMH > 7.4 ng/mL; n = 56). All pregnancy-related outcomes (positive beta human chorionic gonadotropin (βHCG), clinical pregnancy rate, live birth rate, and cumulative live birth rate) were greater in women's IVF cycles with 'low' AMH when compared to those with 'middle' or 'high' AMH (p < 0.05). AMH levels below 3.7 ng/mL were found to be associated with lower oocyte immaturity rate and better pregnancy outcomes, although baseline AMH was not shown to have any significant predictive power for live birth and cumulative live birth in the multivariable logistic regression analysis after adjusting for possible confounders nor in the ROC analyses. In summary, the current study lays the groundwork to validate high AMH levels as a poor prognostic factor for pregnancy outcomes after IVF in women with PCOS.

Case Report: Breaking barriers - Pregnancy achieved by intracytoplasmic sperm injection of a zona-free oocyte

The zona pellucida is a protective layer surrounding the oocytes and early-stage embryos. It is said to be essential for the process of fertilisation and protecting the pre-implantation embryo. Absence of zona pellucida can pose great problems during in vitro fertilisation (IVF), like impaired fertilisation, polyspermy and hindered embryo development, thus leading to a low implantation rate and unsuccessful pregnancy outcome. This case report demonstrates the successful treatment of primary infertility in a 35-year-old female with significantly low anti-Mullerian hormone (AMH) levels and limited ovarian reserve. Her husband (41 years) had oligoasthenozoospermia. The couple had been trying to conceive for two years before seeking medical assistance. Following an unsuccessful intrauterine insemination (IUI) attempt, the decision was made to pursue IVF with ovarian stimulation. Two oocytes were retrieved after ovum pickup, one of which was at the germinal vesicle (GV) stage and later degenerated, while the other was without the zona pellucida. In this case, the intracytoplasmic sperm injection (ICSI) of zona-free oocyte was chosen to prevent polyspermy, resulting in successful fertilization. The embryo progressed to the eight-cell stage and was transferred on day three. A positive beta-human chorionic gonadotropin (β-hCG) test confirmed pregnancy fourteen days later. In assisted reproductive techniques (ART), zona-free oocytes are a common occurrence, but fertilizing those oocytes is not common; they are usually considered to be of no use and rejected. In the present case, we realized that zona-free gametes are not only capable of getting fertilized and developing into good-quality embryos, but also give successful pregnancy outcomes.

Correlation between clinical and laboratory parameters and early pregnancy loss in assisted reproductive technology cycles: A cross-sectional study.

BackgroundThe miscarriage rate after pregnancy resulting from assisted reproductive technology (ART) is about 20%, roughly half of which is biochemical. The correlations between the number and quality of oocytes, estradiol level and early pregnancy loss have not been fully clarified.Objective This study aimed to examine the clinical and laboratory parameter effects on early abortion in ART cycles.Materials and MethodsIn this cross-sectional study, 408 women who were ART candidates and were referred to the Yazd Infertility and Research Center, Yazd, Iran during March 2017 to March 2020 participated. Women who had a fresh embryo transferred and who had a positive beta human chorionic gonadotropin serum test were included in the study. The Anti-Müllerian hormone (AMH) level, embryo quality, oocyte number, progesterone level, estradiol level, and maternal age were extracted from the medical records.ResultsNo significant difference was observed in the age, mean estradiol and progesterone levels on trigger day, number of MII oocytes, and embryo quality between the groups (p = 0.19, 0.42, 0.07, 0.34 and 0.20, respectively). No statistically significant difference was found between the 3 groups of AMH level (p = 0.20). After evaluation using logistic regression, the rate of negative clinical pregnancies was higher in the group with AMH 1 ng/ml. However, this was not found to be statistically significant.ConclusionWe did not find any correlation between early abortion and AMH levels, embryo quality, oocyte number, progesterone level, estradiol level, or maternal age.

Potential of Plasma Rich in Growth Factors (PRGF-Endoret) to Enhance the Efficacy of Assisted Reproductive Techniques in Refractory Cases.

Aim: Nowadays, infertility problems affect a high percentage of couples. This study aimed to evaluate the effect of plasma rich in growth factors (PRGF-Endoret, hereafter PRGF) as a promising coadjuvant therapy in assisted reproductive techniques and its possible role in implantation and pregnancy rates. This retrospective study included 36 PRGF cycles in 27 women with one of the following reproductive disorders: recurrent implantation failure (n = 16), repeated abortion (n = 8), and thin endometrium (n = 3).Methods: PRGF was obtained from each patient and administered as three consecutive intrauterine instillations. The endometrial thickness was measured after each PRGF infusion and a good-quality embryo transfer was performed for every patient. Endometrial thickness, biochemical pregnancy, and miscarriage rate were the primary measured outcomes.Results: PRGF increased the endometrial growth respecting the initial thickness in all cases. The biochemical pregnancy rate determined as positive beta-human chorionic gonadotropin (β-hCG) was 59%, considering the total number of patients; the ongoing pregnancy percentage was 48%. PRGF application day was relevant with a significant probability of achieving pregnancy (p < 0.01) when the first PRGF infusion was carried out beyond 6.5 days after the first day of the woman's cycle and the second one beyond 9.5 days of the menstrual cycle.Conclusions: Intrauterine autologous PRGF infusion is a safe, easily accessible, and inexpensive therapy that could collaborate in fertility treatments by optimizing the endometrium for implantation and thus favoring the crosstalk between the embryo and the uterus improving the embryo-maternal dialogue.

P-557 Fresh Transfer with Supernumerary PGT-A Biopsy: The Best of Both Worlds

Abstract Study question What is difference in time to pregnancy for patients between 35-40 years who undergo fresh versus frozen-thawed embryo transfers with or without PGT-A? Summary answer Patients undergoing fresh embryo transfer (ET) had a shorter time to pregnancy within the same cycle compared to patients electing for freeze-all cycles. What is known already When comparing clinical pregnancy rates following fresh versus frozen-thawed embryo transfers, multiple studies have shown a higher clinical pregnancy rate among frozen-thawed embryo transfers compared to fresh embryo transfers. Particularly for patients over 35 years, there has been a growing national trend towards elective freeze-all cycles, for reasons such as to pursue preimplantation genetic testing for aneuploidy (PGT-A). While PGT-A testing can be effective in reducing miscarriage in patients age 38-40, there is limited studies evaluating time to pregnancy within this population, especially in the context of each passing month’s effect on fertility. Study design, size, duration Retrospective review was performed for 697 IVF cycles and 881 transfers from January 2016 – December 2021 at a single academic fertility center in Boston, Massachusetts. Two-tailed t-tests and analysis of variance (ANOVA) were used to compare differences, with p-value less than 0.05 set for statistical significance. All PGT-A testing as performed using a modified FAST-SeqS next generation sequencing method (Invitae, San Francisco, CA). Participants/materials, setting, methods Cycle characteristic of patients between 35-40 were categorized to four groups: Fresh ET with PGT-A of supernumerary embryos (82 transfers), Fresh ET without PGT-A (526 transfers), Freeze-all cycle with PGT-A (223 transfers), and Freeze-all cycle without PGT-A (50 transfers). All averages were calculated within one IVF cycle with a single cohort of embryos. Time to pregnancy was calculated in days from day of retrieval to positive serum beta-human chorionic gonadotropin (bHCG). Main results and the role of chance Among the 881 transfers, 478 had fresh ETs and 403 had frozen-thawed ETs with or without PGT-A respectively. When comparing fresh and freeze-all cycles, there was no difference in average numbers of transfers performed to achieve a clinical pregnancy (1.27 fresh vs 1.25 freeze-all, p = 0.56). For patients who didn’t elect for PGT-A, there was no difference in number of embryos transferred (1.86 for fresh versus 2.06 for freeze-all, p = 0.54). For patients who elected for PGT-A, the average number of embryos transferred was higher for patients that opted for fresh transfer over freeze-all (1.67 for fresh ET with PGT-A of supernumerary embryos versus 1.24 for freeze-all PGT-A, p = 0.0025). Average days from oocyte retrieval to pregnancy was significantly lower for all fresh ETs (28.8 days for fresh ET without biopsy, 26.6 days for fresh ET with biopsy of supernumerary embryos, p &amp;lt; 0.0001) compared to all freeze-all transfers (110.9 days for freeze-all ET without biopsy, 119.5 days for freeze-all ET with biopsy, p &amp;lt; 0.0001). This delay in time to pregnancy is partially attributed to pending genetic testing results, however, these results usually return in 2-3 weeks, which does not account for the near 3-month delay in time to pregnancy among freeze-all cycles. Limitations, reasons for caution These retrospective findings were of all women who achieved pregnancy from one retrieval. These results are not reflective of the patients who needed to undergo multiple cycles to achieve pregnancy, or patients who never achieved pregnancy. Wider implications of the findings These findings suggest that PGT-A may be offered to patients &amp;gt; 35 to minimize the number of embryos for transfer. Patients opting for a fresh transfer of an untested embryo and biopsy of supernumerary embryos had a nearly 3-month shorter time to pregnancy than those electing for a freeze-all cycle Trial registration number not applicable

Pregnancy rate in intrauterine insemination, is uterine biophysical profile of predictive value? A prospective study.

This study aimed at evaluating the value of uterine biophysical profile (UBP) scoring to predict the pregnancy rate after IUI. This prospective study was carried out on 85 women who were referred to our tertiary teaching center with infertility of male factor or unknown etiology infertility in 2018. To measure the uterine biophysical criteria, transvaginal ultrasonography (TVS) was performed on the day of beta-human chorionic gonadotropin (B-hCG) injection, and the results were evaluated based on positive B-hCG. 85 patients were included with a mean age of 30years; of those 12 (14.1%) were able to conceive. UBP (p = 0.151) and it's parameters (including endometrial thickness, number of endometrial layers, myometrial echogenicity, uterine artery pulsatility index, myometrial blood flow internal to arcuate vessels, endometrial blood flow in the third zone of endometrium, myometrial contraction frequency, and ovarian follicle (OF) size [p = 0.05, 0.89, 0.59, 0.79, 1, 1, 0.59, and 0.77, respectively]) were not significantly associated with pregnancy rate. 91.7% of the cases with positive pregnancy test results, had a UBP score of > 13; however, UBP score was not meaningfully associated with IUI treatment success rate (p = 0.15). UBP scoring system seems to need more data for external validation, or it might require modifications before implementation, as it may cause false reassurance.

P–264 Clinical relevance of re-expansion after blastocyst thawing

Abstract Study question Are there any differences in clinical outcomes after SET of re-expanded versus non-re-expanded blastocysts? Summary answer The transfer of re-expanded thawed blastocysts is associated with improved clinical outcomes. What is known already Improvements in embryo culture conditions, endometrial receptivity protocols and vitrification as a revolutionary cryopreservation technique have allowed the expansion of blastocyst stage transfers (Lieberman and Tucker, 2006; Stanger et al., 2012; Rienzi et al., 2017), increasing clinical pregnancy and implantation rates in IVF cycles. The re-expansion of thawed blastocyst at the time of transfer has been considered as a good prognosis factor, but not always thawed embryos re-expand. To evaluate the relevance of this event, we compared the clinical results of the re-expanded embryos versus the collapsed ones after their thawing and transfer. Study design, size, duration A total number of 1.125 frozen-thawed blastocyst transfers were included in this retrospective observational study between January 2018 and December 2020. Seven hundred and eighty-six thawed blastocyst were fully expanded at the time of the transfer and 339 thawed blastocysts were non-re-expanded when they were transferred. Participants/materials, setting, methods 1.125 single frozen-thawed blastocyst embryo transfer (SET) cycles (802 from donated and 319 from autologous oocytes) were divided in two groups (re-expanded vs non-re-expanded). Positive beta human chorionic gonadotrophin (bHCG), pregnancy rate (PR), early miscarriage rate (EMR) and live birth rate (LBR) were compared between the two groups. Blastocysts were thawed using an Irvine Scientific® Thaw kit, Irvine Scientific® and were transferring in culture medium (Global® Total® LP, CooperSurgical®). Main results and the role of chance During 2018, 190 re-expanded blastocyst and 94 non-re-expanded were transferred. Statistical significant differences were found in the percentage of positive bHCG (48.4% vs 30.9%, p &amp;lt; 0,0048) and PR (39.5% vs 25.5%, p &amp;lt; 0,0203), respectively. In 2019, statistical differences were found in the LBR between 307 re-expanded blastocyst and 124 non-re-expanded (30.6% vs 12.9%; p &amp;lt; 0,00001). Differences were also found in positive bHCG (50.2% vs 21.8%, p &amp;lt; 0,00001) and PR (40.7% vs 15.3%, p &amp;lt; 0,00001), respectively. Finally, in 2020, 289 re-expanded blastocyst and 121 non-re-expanded were transferred, and significant differences were obtained in the percentage of positive bHCG (46.8% vs 22.3%, p &amp;lt; 0,00001) and PR (32.9% vs 15.7%, p &amp;lt; 0,00001), respectively. Globally, all the variables analysed were statistically significant in favour of the re-expanded embryo group: positive bHCG (48.7% vs 24.5%; p &amp;lt; 0,00001), PR (37.5% vs 18.3%; p &amp;lt; 0,00001) and LBR (20.1% vs 9.5%; p &amp;lt; 0,00001), except for EMR. Limitations, reasons for caution The inherent limitations to a retrospective design. Larger studies are warranted in order to reach robust conclusions on the subject. Wider implications of the findings: Transfer of re-expand blastocyst could be a positive indicator of clinical outcomes. In case of non-re-expand embryos, transfer of two could be reasonable. Trial registration number NONE

Pregnancy of unknown location.

Patients presenting with a positive pregnancy test and vaginal bleeding or pelvic pain routinely undergo transvaginal ultrasound as the standard diagnostic assessment. Pregnancy of unknown location is a classification that describes patients with a positive beta-human chorionic gonadotropin (β-hCG

Pregnancy rates after slow-release insemination (SRI) and standard bolus intrauterine insemination (IUI) \u2013 A multicentre randomised, controlled trial

This multicentre, randomised, controlled cross-over trial was designed to investigate the effect of intra-uterine slow-release insemination (SRI) on pregnancy rates in women with confirmed infertility or the need for semen donation who were eligible for standard bolus intra-uterine insemination (IUI). Data for a total of 182 women were analysed after randomisation to receive IUI (n = 96) or SRI (n = 86) first. The primary outcome was serological pregnancy defined by a positive beta human chorionic gonadotropin test, two weeks after insemination. Patients who did not conceive after the first cycle switched to the alternative technique for the second cycle: 44 women switched to IUI and 58 switched to SRI. In total, there were 284 treatment cycles (IUI: n = 140; SRI: n = 144). Pregnancy rates following SRI and IUI were 13.2% and 10.0%, respectively, which was not statistically significant (p = 0.202). A statistically significant difference in pregnancy rates for SRI versus IUI was detected in women aged under 35 years. In this subgroup, the pregnancy rate with SRI was 17% compared to 7% with IUI (relative risk 2.33; p = 0.032) across both cycles. These results support the hypothesis that the pregnancy rate might be improved with SRI compared to standard bolus IUI, especially in women aged under 35 years.

A pilot study on effect of autologous platelet-rich plasma on refractory thin endometrium in frozen embryo transfer cycle

Background: During assisted reproductive technology (ART) treatments, one of the most common reasons for cancellation of the cycle is thin endometrium. Refractory endometrium which doesn’t respond to standard medical therapies can be the aetiology of recurrent implantation failure. Thin endometrium remains an unsolved problem in the treatment of infertile women. Autologous PRP is known to help tissue regeneration. Aims: To evaluate the effect of intrauterine infusion of platelet-rich plasma in case of thin endometrium and its impact on endometrial thickness and clinical pregnancy rate. Materials and Methods: Our study was prospective randomised controlled trial done from 1st October 2018 to 1st April 2019 at Reproductive Biology & IVF Centre, Maulana Azad Medical College, New Delhi, India. Twenty- four women undergoing frozen embryo transfer with history of thin endometrium (less than 7 mm) with normal hysteroscopic examination were enrolled. Patients with uncorrected asherman syndrome, submucosal polyp, fibroid or congenital uterine anomaly were excluded from study. From day 2 of menses Tab estradiol valerate (tablet Estrabet, Abott India) was started in a dose of 6–8 mg/day. It was increased up to 12 mg/day gradually after reviewing endometrial thickness serially. Patients with thin endometrium on day 10/11 received PRP on day 11 and repeat dose after 48 hours if endometrial thickness was less than 7 mm. Frozen embryo transfer was done in patients who achieved endometrial thickness 7 mm or more. Results: The mean pre-treatment endometrial thickness was 4.68±0.96 mm, which significantly increased to 6.65±0.52 mm, post treatment (P < 0.05). Four patients out of 24 in our study could not achieve an optimal pattern of endometrium after treatment and embryo transfer was postponed. The positive beta human chorionic gonadotropin rate was 55%, and clinical pregnancy rate was 45% among them. Conclusion: PRP was found to play an effective role in thin endometrium.

Unusual Presentation of Metastatic Cervical Squamous Cell Carcinoma with Serum Positive Beta Human Chorionic Gonadotropin.

Abstract We present a case of a 30-year-old female who presented with one month of worsening dyspnea. On admission she was having pleuritic chest pain with associated cough and worsening dyspnea. CTA showed a moderate sized pleural effusion with two hypodensities noted in the liver. Patient received several thoracenteses and had abdominal distension that required paracentesis, which showed transudative fluid initially. There was a noted supraclavicular lymph node, however the patient refused lymph node biopsy. Retroperitoneal lymph node, which was seen on CT abdomen, was eventually biopsied which showed metastatic carcinoma with squamoid differentiation with unknown primary. Beta subunit of human chorionic gonadotropin (b-HCG) was rechecked for the biopsy and was mildly elevated to 33. The patient refused gynecological evaluation, pelvic ultrasound revealed a distended endometrial cavity with heterogeneous contents and a complex left adnexal cyst. Pelvic MRI noted a large cervical mass (4.6x4.5x3.8cm) with parametrial invasion. Subsequently her status declined, and she was intubated for hypoxic respiratory failure. Patient unfortunately passed away. Autopsy confirmed metastatic cervical cancer with significant tumor burden as evidence of &gt;80% of the liver with tumor. Although the patient’s pap smear previously did not culture for HPV, the lymph node biopsy stained positive with Pap stain and shown that the carcinoid cells were most affected by HPV. Later is was found that 3.5 years prior the patient had a Pap smear positive for low-grade squamous intraepithelial lesion however was lost to follow up. Although there have been studies that have examined cervical cancer and the intracellular expression of b-hCG, serum b-hCG is not known to be elevated in squamous cell carcinoma of the cervix. For women presenting with wide spread disease, gynecological malignancies should be ruled out regardless of age.

The Relationship Between Endometrial Thickness and Endometrial Pattern With Pregnancy Rate Based on Positive Serum Beta-Human Chorionic Gonadotropin

Objectives: Infertility is defined as the lack of pregnancy after one year of sexual contact without using any contraception. The aim of this study was to investigate the association between endometrial thickness (ET) and endometrial pattern with beta-human chorionic gonadotropin (B-HCG) test in women undergoing the induction of ovulation who referred to the infertility clinic of Ali ibn-e Abitalib hospital in Zahedan. Materials and Methods: This cross-sectional study was conducted at Ali ibn-e Abitaleb hospital in Zahedan (Iran) in 2017. The ET and endometrial pattern were estimated using transvaginal sonography and the pregnancy rate was determined based on B-HCG test. Finally, the data were analyzed by SPSS using the Chi-square test and independent t-test. Results: A total of 200 individuals with a mean age of 29.6 ± 5.6 years were evaluated in this study. The negative or positive B-HCG distribution was significantly different in terms of the endometrial pattern (P=0.001) so that 35.3% of women had B-HCG positive cases in the three-line pattern of ET while in the homogenous pattern, 3.3% had B-HCG positive cases. In addition, the pregnancy rate in women with ET greater than 7 mm was significantly higher compared to those women with ET less than 7 mm thickness (35.1% vs. 12.8%, P&lt;0.001). Conclusions: Overall, the results of this study showed a significant correlation between the endometrial pattern and ET and pregnancy rate based on positive B-HCG test.

Miscarriage history association with euploid embryo transfer outcomes.

Is a history of miscarriage (including recurrent pregnancy loss) associated with euploid cryopreserved embryo transfer outcomes? Retrospective cohort study from 2014 to 2018 of patients at an academic medical centre, undergoing their first cycle of IVF with 24-chromosome Day 5/6 preimplantation genetic testing for aneuploidies (IVF-PGT-A). Multivariate logistic regression was used to investigate the relationship between history of miscarriage and euploid single cryopreserved embryo transfer outcomes (ongoing pregnancy, miscarriage), adjusting for an extensive list of patient and cycle confounders. In the study cohort of 283 patients, the overall unadjusted positive beta human chorionic gonadotrophin (bHCG) rate was 70.0%, ongoing pregnancy rate was 52.3%, and the total pregnancy loss (biochemical and clinical pregnancy loss) rate per positive bHCG cycle was 24.7%. While 35.3% of patients had a history of at least one previous miscarriage, 14.5% of patients had a history of recurrent pregnancy loss (RPL). For patients with a history of miscarriage, it was found that the adjusted odds ratios (OR) and 95% confidence intervals (CI) for positive bHCG were 1.30 (0.51-3.27), for ongoing pregnancy were 0.88 (0.38-2.03) and for total pregnancy loss were 1.41 (0.49-4.05), when compared with patients without a history of miscarriage. For RPL patients, OR for positive bHCG, ongoing pregnancy and total pregnancy loss also did not significantly differ when compared with patients with no history of miscarriage. In this cohort, there was no significant association between miscarriage history and euploid cryopreserved embryo transfer outcomes (ongoing pregnancy, total pregnancy loss) after adjustment for potential confounders. Further study in larger data sets is warranted.

Anti-Müllerian hormone in association with euploid embryo transfer outcomes.

To investigate the association between anti-Müllerian hormone (AMH) concentration and maternal age with single euploid cryopreserved embryo transfer. Retrospective cohort study from 2014 to 2018 at an academic medical centre, including 389 cycles of IVF with 24-chromosome Day 5/6 preimplantation genetic testing for aneuploidies (PGT-A). Multivariate logistic regression was used to study AMH and age in relation to IVF outcomes (positive beta human chorionic gonadotrophin [bHCG], ongoing pregnancy and pregnancy loss rates) for patients with at least one euploid embryo for transfer, controlling for patient and cycle confounders. In this cohort the overall unadjusted positive bHCG rate was 69.2% and ongoing pregnancy rate was 52.7% per transfer, while the pregnancy loss rate was 23.4% per cycle with positive bHCG. Multivariate analysis found that compared with the reference group of AMH 1 to <5 ng/ml, AMH <1 and 5+ did not have any significant difference in positive bHCG (odds ratio, OR 0.65 [0.30-1.44] and 1.27 [0.61-2.65] for AMH <1 and AMH 5+, respectively) or ongoing pregnancy (OR 0.80 [0.43-1.50] and 1.41 [0.68-2.90]). However, AMH <1 had statistically significant lower euploid miscarriage rates compared with the reference group with OR 0.32 (0.12-0.85, P = 0.022); AMH 5+ did not have any statistical difference in miscarriage rate. Neither age at retrieval nor age at transfer were significantly associated with transfer outcomes. AMH concentration was not associated with positive bHCG or ongoing pregnancy for euploid embryo transfers after adjustment for potential confounders. Maternal age was not associated with euploid transfer outcomes. Further study is warranted in larger cohorts.

Association of IL-1 and TNF-α Levels in Endometrial Secretion and Success of Embryo Transfer in IVF/ICSI Cycles.

BackgroundIn this work, we have determined the levels of interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-α), which function as cytokines in endometrial receptivity, through the endometrial secretion within the eligible individuals and thus studied their relationships with the success or failure of pregnancy in in vitro fertilization/intra cytoplasmic sperm injection (IVF/ICSI) cycles.Materials and MethodsIn this prospective study, 76 women were selected for their first IVF/ICSI and met the study inclusion criteria. All of the patients have undergone the endometrial secretion aspiration prior to performing the oocyte collection. The levels of IL-1and TNF-α were analyzed by the means of enzyme-linked immunosorbent assay method, using special standard kits. The patients were requested to undergo the serum human chorionic gonadotropin measurements and ultrasound evaluation for the purpose of detecting successful implantations and pregnancies.ResultsAmong the 76 subjects of the study, 33 (43.4%) patients had a positive beta-human chorionic gonadotropin (β-hCG) and 44 (56.6%) resulted in a negative β-hCG. It should be also noted that through the patients with positive β-hCG, 23 (30.3%) of them displayed fetal heart rate in their transvaginal sonography (TVS). Compared to the group with failed pregnancies and their cytokine levels, we perceived a higher concentration of IL-1 in the group containing successful chemical pregnancies (P=0.00). However, there was no significant difference in terms of clinical pregnancy in the IL-1 levels between the two groups (P=0.06). In addition, there was not any notable difference in the levels of TNF-α between the two groups, neither in terms of chemical nor clinical pregnancy (P=0.8 and P=0.6, respectively).ConclusionThe current study suggests that higher concentrations of IL-1 in endometrial secretions could be as- sociated with improved endometrial receptivity and IVF outcome. With regards to TNF-α, no statistically significant difference was observed between the groups of with and without successful pregnancies.

Miscarriage history association with euploid embryo transfer outcomes

Abstract Research question Is a history of miscarriage (including recurrent pregnancy loss) associated with euploid cryopreserved embryo transfer outcomes? Design Retrospective cohort study from 2014 to 2018 of patients at an academic medical centre, undergoing their first cycle of IVF with 24-chromosome Day 5/6 preimplantation genetic testing for aneuploidies (IVF-PGT-A). Multivariate logistic regression was used to investigate the relationship between history of miscarriage and euploid single cryopreserved embryo transfer outcomes (ongoing pregnancy, miscarriage), adjusting for an extensive list of patient and cycle confounders. Results In the study cohort of 283 patients, the overall unadjusted positive beta human chorionic gonadotrophin (bHCG) rate was 70.0%, ongoing pregnancy rate was 52.3%, and the total pregnancy loss (biochemical and clinical pregnancy loss) rate per positive bHCG cycle was 24.7%. While 35.3% of patients had a history of at least one previous miscarriage, 14.5% of patients had a history of recurrent pregnancy loss (RPL). For patients with a history of miscarriage, it was found that the adjusted odds ratios (OR) and 95% confidence intervals (CI) for positive bHCG were 1.30 (0.51–3.27), for ongoing pregnancy were 0.88 (0.38–2.03) and for total pregnancy loss were 1.41 (0.49–4.05), when compared with patients without a history of miscarriage. For RPL patients, OR for positive bHCG, ongoing pregnancy and total pregnancy loss also did not significantly differ when compared with patients with no history of miscarriage. Conclusions In this cohort, there was no significant association between miscarriage history and euploid cryopreserved embryo transfer outcomes (ongoing pregnancy, total pregnancy loss) after adjustment for potential confounders. Further study in larger data sets is warranted.

Inner cell mass and trophectoderm morphology impact the likelihood of achieving sustained implantation among expanded, euploid blastocysts

Preimplantation for genetic testing for aneuploidy (PGT-A) has been prospectively demonstrated to increase implantation rates over morphologic assessment alone. However, it is unclear whether morphology retains additional predictive power once an embryo is diagnosed as euploid with PGT-A. We sought to evaluate the influence of morphologic assessment by comparing pregnancy outcomes among expanded, euploid blastocysts (blasts). Retrospective cohort. All autologous IVF cycles between 2012-2016 were reviewed for inclusion. Only transfer of expanded blasts were performed during this time period (at least Grade 4 by Gardner criteria) and only single embryo transfers were included. The subjects were separated into 3 groups (good, fair, poor) based on the morphology of the inner cell mass (ICM) and trophectoderm (TE). Good quality blasts were defined as having any combination of A or B grades for both ICM and TE. Fair quality blasts were those with only 1 C grade assigned to either ICM or TE grade. Blasts with C grades in both ICM and TE were categorized as poor. The primary outcome was sustained implantation rate (SIR), defined as presence of fetal cardiac activity at 8 weeks. Logistic regression was performed to control for female age, size of the blast cohort, and day of transfer (5 or 6). Secondary outcome included pregnancy loss rate following a positive serum beta human chorionic gonadotropin (bHCG). A total of 2949 transfers were included. Blasts graded as good, fair, and poor quality demonstrated SIR of 70.5%, 56.9%, and 47.5%, respectively. Compared to the good quality cohort, and after controlling for age, cohort size, and day of transfer, the adjusted odds of sustained implantation were significantly reduced for the fair (aOR 0.56, 95% CI 0.44-0.71, p<0.001) and the poor-quality group (aOR 0.35, 95% 0.22-0.55) (p<0.001). Pregnancy loss rate was significantly lower among good quality blasts (p<0.001). Even among fully expanded, euploid blasts, ICM and TE morphology influence the likelihood of achieving a sustained implantation. The letter C grade in either or both ICM and TE is also associated with an increased risk of miscarriage. These data indicate that morphologic assessments should be considered when counseling patients on anticipated success - even among euploid blasts. This information may be particularly useful to patients who are planning to bank multiple euploid embryos to achieve their desired family size.Tabled 1Study CharacteristicsGoodFairPoorP-valueN251235780Age35.8 +/- 2.436.7 +/- 2.936.7 +/- 2.80.14AMH3.4 (2.1-5.7)2.6 (1.8-5.3)2.4 (0.9-4.1)<0.01Initial serum beta-HCG179.5 (140-202)117.4 (103-186)100.2 (93-163)<0.001% Serum Positive beta-HCG83.4% (2094/2512)79% (282/357)70% (56/80)<0.01Sustained Implantation Rate70.5% (1772/2512)56.9% (203/557)47.5% (38/80)<0.001Pregnancy Loss Rate after Positive beta-HCG15.4% (322/2094)38.9% (79/203)32.1% (18/56)<0.001 Open table in a new tab

Delaying Thyroxine Until Positive Beta-Human Chorionic Gonadotropin is Safe for Patients Receiving Fertility Therapy: Applying New ATA Guidelines to Subclinical Hypothyroidism.

This study sought to examine the effect of changing TSH threshold recommendations from 2.5 to 4 mIU/L before fertility therapy on the prevalence of early gestational subclinical hypothyroidism (SCH) (TSH2 >2.5 mIU/L) and to evaluate implications on progression to clinical pregnancy (defined as detection of cardiac activity on ultrasound). A retrospective chart review was performed in an academic fertility clinic on all patients with a measured pre-treatment TSH (TSH1) and positive beta-human chorionic gonadotropin following fertility treatment. The study assessed the effect of TSH2 on ongoing pregnancy, both in patients newly diagnosed with SCH and in patients previously receiving LT4, stratified by initial TSH. Of 482 women included in the study, baseline TSH (TSH1) was <2.5 mIU/L in 333 women (69%) and 2.5-4 mIU/L in 64 women (13.2%). Eighty-five women were taking LT4 at baseline (17.6%). Among women with a TSH1 between 2.5 and 4 mIU/L, the corresponding TSH in early pregnancy (TSH2) was <2.5 mIU/L in 35 women (55%). Overall, there was no difference in progression to clinical pregnancy between women with a TSH2 of 2.5-4 mIU/L compared with women with a TSH2 <2.5 mIU/L (OR 0.70; 95% CI 0.44-1.09). Similarly, when excluding women taking LT4 at baseline, there was no difference in progression to clinical pregnancy (OR 0.90; 95% CI 0.28-2.86). Rate of progression to clinical pregnancy was equivalent between women with an early pregnancy TSH (TSH2) <2.5 and women with a TSH2 of 2.5-4.0 mIU/L. Our findings support initiating LT4 in early pregnancy, as opposed to pre-pregnancy if the TSH remains above cut-off because there does not appear to be a difference in in early pregnancy outcomes if treatment is delayed.