In Vitro Fertilization Pregnancy Outcomes Research Articles

Paternal Age Is Not Associated With Pregnancy Outcomes After Single Thawed Euploid Blastocyst Transfer.

Although controversial, increasing paternal age has been shown to negatively affect assisted reproductive technology (ART) outcomes and success rates. Most studies investigating the effect of paternal age on ART outcomes use a donor oocyte model to minimize maternal aneuploidy contribution. This study sought to determine whether increasing paternal age is associated with adverse in vitro fertilization (IVF) outcomes when aneuploidy is minimized using preimplantation genetic screening. There were 573 single thawed euploid embryo transfers from 473 patients undergoing oocyte donor and autologous IVF cycles. Cycles were categorized according to paternal age at oocyte retrieval, and an age adjustment was performed for maternal age in order to evaluate for an isolated paternal age effect. Fertilization rate was found to decrease significantly with increasing paternal age ( P = .04). After controlling for oocyte age, there was no significant difference in pregnancy outcomes across all paternal age categories after euploid embryo transfer, including implantation rate ( P = .23), clinical pregnancy rate ( P = .51), and spontaneous abortion rate ( P = .55). Therefore, if a couple is able to produce and transfer a single thawed euploid embryo, no difference in IVF pregnancy outcomes is identified with increasing paternal age.

Live Birth Pregnancy Outcome after First In Vitro Fertilization Treatment in a Patient with Systemic Lupus Erythematosus and Isolated High Positive IgA Anti-β2glycoprotein I Antibodies: A Case Report.

IgA anti-β2glycoprotein I antibodies (IgA-anti-β2GPI) seems to be the most prevalent isotype in patients with Systemic Lupus Erythematosus (SLE) with a significant association to thrombotic events. Both SLE and antiphospholipid syndrome (APS) can be associated with implantation failure, fetal loss and obstetric complications. Recent reports highlight the clinical value of IgA-anti-β2GPI determination in supporting in vitro fertilization (IVF) treatment and IVF pregnancy outcomes. We report a 36-year-old female diagnosed with SLE, endometriosis and unexplained infertility. Conventional APS markers were consistently negative: anti-cardiolipin (aCL) and anti-β2GPI: IgG/IgM. She was then tested with reports of repeatedly high IgA-anti-β2GPI and tested positive from 2014 after IgA (aCL; anti-β2GPI) were established in our APS diagnostic panel. She underwent successful first IVF procedure with a 30 week live birth pregnancy outcome. During the follow up no lupus flare, thrombosis or ovarian hyperstimulation syndrome were registered. Serum IgA anti-β2GPI and anti-dsDNA levels declined statistically significant during the second and third trimester. Titres of IgA-anti-β2GPI remained lower postpartum as well. This case highlights the clinical importance of IgA-anti-β2GPI testing for family planning, assisted reproduction and pregnancy in women with SLE and/or APS.

Predictive value of follicular fluid insulin like growth factor-1 in IVF outcome of normo-ovulatory women

Abstract Introduction Insulin like growth factor-1 (IGF-1) has been found to stimulate follicular development, estrogen and progesterone production and oocyte maturation. This study aims to detect the changes in the follicular fluid IGF-1 levels in normo-ovulatory women undergoing in vitro fertilization (IVF) cycle and evaluate the possibility of IGF-1 to be a predictive marker for IVF outcome in normo-ovulatory women. Materials and methods This prospective cross-sectional study was performed among 88 IVF normo-ovulatory women who were categorized according to IVF pregnancy outcome (clinical pregnancy) into two groups: 55 pregnant women and 33 non-pregnant women. Follicular fluid IGF-1 levels have been measured at the time of oocyte retrieval by utilizing enzyme linked immune-sorbent assay (IGF-1 ELISA kit, Diametra, Inc, Italy). The relationship between follicular fluid IGF-1 (FF IGF-1) levels and the number of oocytes retrieved, number of mature oocytes, number of embryos, fertilization and clinical pregnancy rate were assessed. The demographic data were similar between two groups as regards age and BMI. Results FF IGF-1 levels were significantly higher in pregnant women than in non-pregnant women (90.11 ± 44.31 ng/ml, 69.07 ± 30.55 ng/ml) respectively (p Conclusion Our study demonstrated that higher FF IGF-1 levels predict higher pregnancy rates in normo-ovulatory women undergoing IVF cycles.

Effect of elevated estradiol levels on the hCG administration day on IVF pregnancy and birth outcomes in the long GnRH-agonist protocol: analysis of 3393 cycles.

This retrospective study aimed to evaluate the association between elevated serum estradiol (E 2) levels on the human chorionic gonadotrophin (hCG) administration day and in vitro fertilization (IVF) pregnancy and birth outcomes in the long GnRH-agonist protocol. This study analyzed the data of 3393 infertile women who underwent initial fresh IVF. The patients were categorized into high and low E 2 groups based on their serum E 2 levels on the hCG day. Pregnancy and birth outcomes were compared. The implantation rate, clinical pregnancy rate, and live birth rate were all significantly higher in the high E 2 group than in the low E 2 group (p<0.05). The good-quality embryo rate and abortion rate did not significantly differ between the two groups. There were no significant differences in the mode of delivery, gestational age, birth weight, and fetal gender between the two groups. Furthermore, there were no differences in the risk of preterm birth, low birth weight, and fetal malformation between the two groups in 860 single live births. Subgroup analysis of singleton pregnancies in the high E 2 (E 2≥3757pg/mL) group revealed a significant increase in abortion rate in the age group of ≥37years. Elevated serum E 2 levels associated with controlled ovarian stimulation did not increase the risks of preterm birth, low birth weight, and fetal malformation. High E 2 on the hCG day had no detrimental effect on the implantation rate, clinical pregnancy rate, and live birth rate.

Accuracy of a Direct Progesterone Immunoassay.

Beyond the established role of serum progesterone measurement in the luteal phase of menstrual cycle to confirm recent ovulation, it is also increasingly used to detect premature luteinization during in vitro fertilization (IVF) hyperstimulation, where late follicular phase increase in serum progesterone is reportedly associated with adverse pregnancy outcomes. Virtually all serum progesterone measurements in clinical and IVF practice use direct, nonextraction immunoassays, often in multiplex, high-throughput platform assays optimized for high, postovulatory, midluteal phase serum progesterone concentrations. However, the performance of direct progesterone immunoassays for smaller increases is not established. We studied 254 women undergoing IVF hyperstimulation with serum progesterone around the time of human chorionic gonadotropin (hCG) administration, measured in each sample by a direct progesterone immunoassay (Beckman Coulter Access) and by LC-MS. Immunoassay overestimated serum progesterone in almost every sample with an increasingly high variability and deviation at lower concentrations (immunoassay <5 nmol/L, equivalent to LC-MS <2 nmol/L). Immunoassay consistently overestimates serum progesterone levels so that low measurements (immunoassay <5 nmol/L) are too inaccurate to be used quantitatively. The utility of higher serum progesterone measurements by immunoassay and serum progesterone and other steroids measured by multiplex LC-MS profiling in predicting IVF pregnancy outcomes warrants further investigation. There is a need for caution in clinical diagnosis of premature luteinization based on increased late follicular phase serum progesterone measurements using direct progesterone immunoassay that consistently overestimates low serum progesterone concentrations.

Pregnancy Outcomes of In Vitro Fertilization with or without Ovarian Hyperstimulation Syndrome: A Retrospective Cohort Study in Chinese Patients.

Background:The effect of ovarian hyperstimulation syndrome (OHSS) on pregnancy outcomes of in vitro fertilization (IVF) patients is still ambiguous. This study aimed to analyze pregnancy outcomes of IVF with or without OHSS in Chinese patients.Methods:A retrospective cohort study was undertaken to compare pregnancy outcomes between 190 women with OHSS and 197 women without OHSS. We examined the rates of clinical pregnancy, multiple pregnancies, miscarriage, live birth, preterm delivery, preterm birth before 34 weeks’ gestation, cesarean delivery, low birth weight (LBW), and small-for-gestational age (SGA) between the two groups. Odds ratios (ORs) and 95% confidence intervals (CIs) of measure of clinical pregnancy were also analyzed.Results:The clinical pregnancy rate of OHSS patients was significantly higher than that of non-OHSS patients (91.8% vs. 43.5%, P < 0.001). After controlling for drug protocol and causes of infertility, the adjusted ORs of moderate OHSS and severe/critical OHSS for clinical pregnancy were 4.65 (95% CI, 1.86–11.61) and 5.83 (95% CI, 3.45–9.86), respectively. There were no significant differences in rates of multiple pregnancy (4.0% vs. 3.7%) and miscarriage (16.1% vs. 17.5%) between the two groups. With regard to ongoing clinical pregnancy, we also found no significant differences in the rates of live birth (82.1% vs. 78.8%), preterm delivery (20.9% vs. 17.5%), preterm birth before 34 weeks’ gestation (8.6% vs. 7.9%), cesarean delivery (84.9% vs. 66.3%), LBW (30.2% vs. 23.5%), and SGA (21.9% vs. 17.6%) between the two groups.Conclusion:OHSS, which occurs in the luteal phase or early pregnancy in IVF patients and represents abnormal transient hemodynamics, does not exert any obviously adverse effect on the subsequent pregnancy.

PRM33 - Methodology Using Pharmacy And Medical Claims Data To Evaluate Real-World Outcomes And Costs Of Ivf Treatment In The Us

To describe the methodology used to identify treatment cycles and determine real-world outcomes associated with the in vitro fertilization (IVF) treatments, follicle-stimulating hormone (FSH) versus FSH+human menopausal gonadotropin (hMG), using administrative claims data. This retrospective study used the Truven Healthcare MarketScan® Claims Database to identify and compare IVF treatment protocols, pregnancy and birth outcomes among women aged 18–<35 undergoing IVF between January 2009 and December 2012. Patients with ≥1 claim for a gonadotropin-releasing hormone agonist (GnRHAg) or antagonist (GnRHAnt) (first claim being the index date), ≥1 claim for FSH and ≥1 claim for human chorionic gonadotropin (hCG), using National Drug Codes, were selected. Patients were included on identification of a prescription for FSH in the 7 days pre-index through 60 days post-index, hCG in the 60 days post-index and ≥1 embryo transfer (ET) code (using current procedural terminology) ≤60 days post-index. The FSH+hMG cohort also required identification of ≥1 claim for hMG ≤60 days post-index. Patient eligibility was defined as continuous enrollment for 12 months prior and 18 months post-index. ICD-9-CM codes were used to identify live birth outcomes within 42 weeks of ET. Inclusion/exclusion criteria identified 627 and 852 patients in the FSH and FSH+hMG cohorts, respectively. The 18-month post-index eligibility criteria accounted for a large number of patients removed (n=7366). No differences in first-cycle outcomes were seen between FSH and FSH+hMG for: live birth per ET (38.1% vs 38.5%; OR 1.02 [95%CI: 0.82–1.26], p=0.871) and live birth per pregnancy (54.44% vs 54.37%; OR 1.00 [95%CI: 0.78–1.28], p=0.98), respectively. Most published analyses of fertility treatment outcomes are derived from single fertility center datasets. This methodology successfully identified two distinct IVF treatment protocols and allowed comparison of outcomes using real-world healthcare claims data sourced from a variety of fertility centers.

Sexual function and fertility quality of life in women using in vitro fertilization.

Women undergoing fertility treatment are likely to report negative changes in sexual function. With the rapid increase in the number of women pursuing in vitro fertilization (IVF), there is a need to better understand how IVF impacts a woman's sexual experiences and quality of life. This study has three purposes: (i) test the psychometric properties of the Sexual Functioning Questionnaire (SFQ) in a sample of U.S. women undergoing IVF; (ii) compare sexual function of women undergoing IVF with a nonclinical sample of U.S. women; and (iii) identify the aspects of sexual function most related to fertility quality of life (FertiQoL). A total of 136 women who had recently undergone or who were currently undergoing IVF completed a web-based, cross-sectional survey about sexual experiences and quality of life. Data were collected on infertility diagnosis, length of infertility, number of IVF cycles, pregnancy, and birth outcomes. Six domains of sexual function as well as the medical impact of IVF were assessed using the SFQ. A validated instrument was used to measure FertiQoL. Reliability analyses for the SFQ indicate sufficiently strong fit (Cronbach's alpha = 0.79 to 0.89). Compared with a nonclinical sample, women undergoing IVF scored significantly lower in sexual interest, desire, orgasm, satisfaction, sexual activity, and overall sexual function (P < 0.05). A stepwise linear regression indicated that sexual problems predicted FertiQoL scores (Beta = 4.61, P < 0.01). The most common sexual problems included lack of sexual interest or desire (30%), difficulty with orgasm (15%), vaginal dryness (14%), and vaginal tightness (13%). Women undergoing IVF may be at particular risk for sexual problems. Sexual function issues may markedly impact overall quality of life during fertility treatment and should be addressed as an important component of comprehensive care.

Basal serum testosterone levels correlate with ovarian response but do not predict pregnancy outcome in non-PCOS women undergoing IVF.

To evaluate basal testosterone (T) levels in women undergoing in vitro fertilization (IVF) cycles and examine the association between basal T levels and ovarian response or IVF pregnancy outcome. We retrospectively analyzed 1413 infertile Chinese women undergoing their first IVF treatment at our institution's reproductive center from March 2011 to May 2013. The basal testosterone (T) levels in women undergoing in vitro fertilization (IVF) and the relationship between basal T levels and ovarian response or IVF pregnancy outcome were determined. These patients did not have polycystic ovary syndrome (PCOS) or endometriosis, and were treated with a long luteal down-regulation protocol. Subjects were divided into 2 groups according to basal testosterone (T) levels: Group 1, basal T values <20 ng/dl (n = 473), and Group 2, basal T values >20 ng/dl (n = 940). We evaluated the association of basal T levels with ovarian response and IVF outcome in the two groups. In this study, BMI, basal follicle-stimulating hormone (FSH) levels, basal luteinizing hormone (LH) levels, antral follicle count (AFC), days of stimulation, total gonadotrophin dose, basal FSH/LH ratio, and the number of follicles >14 mm were significantly different (P < 0.05) between the two groups. Basal T level positively correlated with ovarian reserve function, number of follicles >14 mm on human chorionic gonadotrophin (HCG) day, and total gonadotropin dose. However, basal T levels play no role in predicting IVF pregnancy outcome. Basal T level can be used as a good predictor for ovarian response and the number of large follicles on HCG day. Additionally, we may use basal T level as a marker to predict FSH dosage. In general women, lower level of T might relate with potential poor ovarian response. However, based on our data, basal T levels do not predict pregnancy outcome.

Low testosterone levels in women with diminished ovarian reserve impair embryo implantation rate: a retrospective case-control study

To investigate the association of basal testosterone (T) levels with the outcome of in vitro fertilization (IVF) in women with diminished ovarian reserve (DOR). Complete clinical data on the first 223 IVF cycles in women with DOR were retrospectively analyzed. The associations of basal follicle stimulating hormone, luteinizing hormone, estradiol, and T levels with ovarian response and IVF outcome were studied. Basal T levels were significantly different between pregnant and non-pregnant women. However, basal T levels showed no correlation with controlled ovarian hyperstimulation parameters after adjusting for age. The association of basal T levels with pregnancy rate was significant after adjusting for other impact factors. Using receiver operating characteristic (ROC) analysis, the basal T level of 1.115 nmol/L for predicting pregnancy outcome had a sensitivity of 82.80 % and specificity of 58.09 %. The women were divided into two groups based on this value; although the clinical characteristics and ovarian stimulation parameters were similar, the clinical pregnancy (16.18 % (11/68) vs. 40.15 % (53/132), respectively, p = 0.000) and implantation rates (10.07 % (15/149) vs. 22.41 % (65/290), respectively, p = 0.002) were significantly different in the low and high T level groups. In women with DOR, the basal T level presented a positive association with pregnancy outcome in IVF. The poor reproductive outcome observed in women with lower basal T levels may be due to the decreased implantation rate.

Single euploid embryo transfer improves IVF pregnancy, miscarriage, and multiple gestation outcomes compared to national society for assisted reproductive technology database (SART) outcomes

The objective of our study was to determine if trophectoderm biopsy, vitrification, array-comparative genomic hybridization and single thawed euploid embryo transfer (STEET) can reduce multiple gestations and yield high pregnancy and low miscarriage rates compared to our routine fresh in vitro-fertilization (IVF) and national IVF outcomes.

Pilot study on molecular quantitation and sequencing of endometrial cytokines gene expression and their effect on the outcome of in vitro fertilization (IVF) cycle

Human trophoblast invasion and differentiation are essential for successful pregnancy outcome. The molecular mechanisms, however, are poorly understood. Interleukin (IL)-11, a cytokine, regulates endometrial epithelial cell adhesion. Leukemia inhibitory factor (LIF) is one of the key cytokines in the embryo implantation regulation. The present study aimed to assess the levels of LIF, IL-11, and IL-11 α receptor gene expression in the endometrium of women undergoing IVF and correlate their levels with the IVF pregnancy outcome. Also, the study aimed to detect any mutation in these three genes among IVF pregnant and non-pregnant women versus control menstrual blood of fertile women. Endometrial tissue biopsies were taken from 15 women undergoing IVF on the day of oocyte retrieval. The quantitative expression of IL-11, IL-11Rα, and LIF genes was assessed by real-time PCR and PCR products were sequenced. Menstrual blood from 10 fertile women was used as control to compare the DNA sequence versus DNA sequence of the studied genes in endometrial biopsies. LH, FSH, and E2 were assessed for enrolled patients by ELISA. Endometrial thickness was also assessed by pelvic ultrasonography. No significant difference was detected between quantitative expression of the three studied genes and pregnancy IVF outcome. Although DNA sequence changes were found in IL-11 and LIF genes of women with negative pregnancy IVF outcome compared to women with positive pregnancy IVF outcome, no DNA sequence changes were detected for IL-11Rα. Other studied parameters (e.g., age, LH, FSH, E2, and endometrial thickness) showed no significant differences or correlation of quantitative expression of the three studied involved genes. Data suggested that there were no significant differences between quantitative expression of IL-11, IL-11Rα, and LIF genes and the IVF pregnancy outcome. The present study may reveal that changes in IL-11 and LIF genes sequence may contribute in pregnancy IVF outcome.

The effect of ketorolac on pregnancy rates when used immediately after oocyte retrieval

To study the effect of ketorolac, a potent anti-inflammatory medication, on in vitro fertilization (IVF) pregnancy outcomes when used at the time of oocyte retrieval. Retrospective review of 454 patients from 2003-2009. Tertiary hospital-affiliated fertility center. Consecutive subfertile women undergoing their first IVF cycle. Ketorolac administration immediately after oocyte retrieval. Pregnancy, implantation, live-birth, and miscarriage rates, and postsurgical visual analog pain score. Of the 454 patients undergoing their first IVF cycle for all indications, 103 received intravenous ketorolac immediately after oocyte retrieval, based on anesthesiologist preference. Patient and procedural characteristics were similar between both groups. The use of ketorolac had no effect on the rates of implantation, miscarriage, pregnancy, live birth, or multiple pregnancy. The patients receiving ketorolac experienced statistically significantly less pain. This study suggests ketorolac has no apparent detrimental effect on IVF pregnancy outcomes when administered immediately after oocyte retrieval. Ketorolac appears to be a safe and effective analgesic to use at the time of oocyte retrieval.

Microorganisms within Human Follicular Fluid: Effects on IVF

Our previous study reported microorganisms in human follicular fluid. The objective of this study was to test human follicular fluid for the presence of microorganisms and to correlate these findings with the in vitro fertilization (IVF) outcomes. In this study, 263 paired follicular fluids and vaginal swabs were collected from women undergoing IVF cycles, with various causes for infertility, and were cultured to detect microorganisms. The cause of infertility and the IVF outcomes for each woman were correlated with the microorganisms detected within follicular fluid collected at the time of trans-vaginal oocyte retrieval. Microorganisms isolated from follicular fluids were classified as: (1) ‘colonizers’ if microorganisms were detected within the follicular fluid, but not within the vaginal swab (at the time of oocyte retrieval); or (2) ‘contaminants’ if microorganisms detected in the vagina at the time of oocyte retrieval were also detected within the follicular fluid. The presence of Lactobacillus spp. in ovarian follicular fluids was associated with embryo maturation and transfer. This study revealed microorganisms in follicular fluid itself and that the presence of particular microorganisms has an adverse affect on IVF outcomes as seen by an overall decrease in embryo transfer rates and pregnancy rates in both fertile and infertile women, and live birth rates in women with idiopathic infertility. Follicular fluid microorganisms are a potential cause of adverse pregnancy outcomes in IVF in both infertile women and in fertile women with infertile male partners.

Single thawed euploid embryo transfer improves IVF pregnancy, miscarriage, and multiple gestation outcomes and has similar implantation rates as egg donation

The objective of our study was to determine if trophectoderm biopsy, vitrification, array-comparative genomic hybridization and single thawed euploid embryo transfer (STEET) can reduce multiple gestations and yield high pregnancy and low miscarriage rates. We performed a retrospective observational study comparing single thawed euploid embryo to routine age matched in vitro fertilization (IVF) patients that underwent blastocyst transfer from 2008 to 2011 and to our best prognosis group donor oocyte recipients (Donor). Our main outcome measures were implantation rate, clinical pregnancy rate, spontaneous abortion rate and multiple gestation rate. The STEET group had a significantly higher implantation rate (58%, 53/91) than the routine IVF group (39%, 237/613) while the Donor group (57%, 387/684) had a similar implantation rate. The clinical pregnancy rates were not statistically different between the STEET and IVF groups. However, the multiple gestation rate was significantly lower in the STEET group (STEET 2% versus IVF 34%, Donor 47%). STEET results in a high pregnancy rate, low multiple gestation rate and miscarriage rates. Despite the older age of STEET patients and transfer of twice as many embryos, the implantation rate for STEET was indistinguishable from that for egg donation. STEET offers an improvement to IVF, lowering risks without compromising pregnancy rate.

The effect of time interval between hysteroscopic submucous fibroid resection (SMR) and subsequent in vitro fertilization (IVF) cycle on pregnancy outcomes

Traditionally, many physicians have advised their patients to delay starting IVF for at least two menstrual cycles after an extensive SMR, in order to allow for thorough healing of the endometrium prior to embryo transfer. The purpose of this study was to determine whether the time interval between SMR and subsequent IVF cycle significantly affects pregnancy outcomes. Retrospective cohort study. IVF cycle characteristics and pregnancy outcomes were compared between women who had undergone a single SMR less than 90 days prior to starting an IVF cycle, and women who waited between 91 and 365 days before starting IVF. Volumes of fibroid pathology specimens for each SMR were recorded. Mann-Whitney and Fisher's exact tests were used for statistical analysis. The mean number of days between having surgery and starting IVF was 52.6 days in the shorter time interval group, and 188.3 days in the longer time interval group. No significant differences in demographics, volume of removed fibroid, endometrial stripe on the day of HCG, implantation rate (IR), total pregnancy rate (TPR), live birth rate (LBR) or miscarriage rate (MR) were seen between women who had an IVF cycle within 90 days of their SMR and those who waited between 91 and 365 days.Tabled 1IVF Outcome byTime Interval After SMR≤90 days (52.6±22.0)91-365 days (188.3±75.3)P valueN=4066Age (yrs)39.9±2.539.1±3.10.14Fibroid volume (cm3)6.3±11.24.8±9.00.82Protocol (% Luteal suppression)73820.33# Prior IVF Cycles1.4±2.51.1±1.50.94Endometrial stripe on day of HCG9.77±2.099.67±2.090.76# Mature Oocytes9.8±8.28.3±4.10.63# embryos transferred3.72±1.202.95±1.470.20IR0.12±0.20.16±0.30.31TPR (%)37.545.40.54LBR (%)22.531.80.38MR (%)15.014.00.99 Open table in a new tab IVF soon after SMR does not appear to negatively affect outcome. Consequently, women do not have to delay IVF after surgery, and can safely start IVF within 2-3 menstrual cycles after SMR, without any negative impact on pregnancy rates.

Adverse Outcomes of IVF/ICSI Pregnancies Vary Depending on Aetiology of Infertility

In vitro fertilization (IVF) is a risk factor for pregnancy, but there have been few studies on the effect of infertility's aetiology. Thus, we have assessed the role of aetiology on IVF pregnancy outcomes in a retrospective cohort study comparing the outcomes of IVF singleton pregnancies with those of spontaneous pregnancies in the general Finnish population. The study group consisted of 255 women with births resulting from singleton IVF pregnancies. Six subgroups were formed according to the following causes of infertility: anovulation (27%), endometriosis (19%), male factor (17%), tubal factor (15%), polycystic ovary syndrome (11%), and unexplained infertility (12%). The reference group consisted of 26,870 naturally conceived women. Adjusted odds ratios (AORs), for confounding factors such as age and parity, were estimated using logistic regression analysis. Women with endometriosis and anovulation had increased risks of preterm birth (AOR 3.25, 95% CI 1.5–7.1 and AOR 2.1, and 95% CI 1.0–4.2, resp.), while women in couples with male factor infertility had a twofold risk of admission to neonatal intensive care (AOR 2.5, 95% CI 1.2–5.3). The findings show that the aetiology of infertility influenced the obstetrics outcome, and that pooling results may obscure some increased risks among subgroups.

Is Endometrial Thickness on the Day of ET Really Predictive of IVF Outcome?

ABSTRACTBackgroundThe effect of endometrial thickness on pregnancy rates in assisted reproductive technology (ART) patients has been evaluated by many authors, with controversial results. Endometrial thickness has been utilized as an indirect indicator for endometrial receptivity.ObjectiveTo evaluate relationship between endometrial thickness on day of embryo transfer and pregnancy outcome inin vitrofertilization and embryo transfer (IVF-ET) cycles. Should we cancel cycles based on endometrial thickness only?Material and methodsA prospective analysis was conducted at Dr Kamini Rao Hospital, Bangaluru, of 239 patients. Various parameters were compared between pregnant and nonpregnant patients to see whether there is any cut-off for endometrial thickness on day of embryo transfer by which we can predict good prognosis in form of pregnancy and what effect other variables on endometrial thickness and pregnancy respectively and should we cancel embryo transfer, if endometrial thickness is not within certain range?ResultsIn the study population, 174 (73%) had primary and 65 (27%) had secondary infertility, Ovarian stimulation was performed with long protocol in 37% cases, antagonist protocol in 47% and other protocols like microflare, short, ultralong, ultrashort in 15%. Mean age of patients was 31.04 ± 3.79 years. Among causes of infertility male factor was present in 39%, tubal factor was seen in 18%, unexplained were 13%, polycystic ovarian syndrome in 11%, poor ovarian reserve in 4.1% and mixed causes in 13%. Majority of our patients were in normal and overweight as per body mass index (BMI). ET were easy in 90% of cases and 14 (5.8%) ETs were cancelled. The reason for cancellation was ovarian hyperstimulation syndrome (OHSS) in 9 cases, fluid in cavity in 2 cases, one patient had hyperpyrexia on day of ET and 2 cases of failed fertilization. Endometrial thickness was &gt;10 mm in 35% cases. Overall clinical pregnancy rate was 39% with implantation rate of 21%, fertilization rate of 92% and cleavage rate of 95% and live birth rate of 26%. There were more follicles, oocytes and embryos, the endometrium was &gt;10 mm and embryo quality was higher among women who became pregnant when compared with nonpregnant women after assisted reproduction though not statistically significant (p &gt; 0.05). The pregnancy rate improved as endometrial thickness increased showing a linear association.ConclusionIncreased endometrial thickness is associated with higher pregnancy rates, but as such a cut off cannot be decided. In our study we have seen pregnancies at both thin and thick endometrium so we should not cancel ET merely on the basis of endometrial thickness as pregnancy is affected by multiple variables and not by endometrial thickness alone.How to cite this articleSharma R, Rao K, Srinivas MS, Jones T. Is Endometrial Thickness on the Day of ET Really Predictive of IVF Outcome? Int J Infertility Fetal Med 2012;3(2): 40-47.

The level of vascular endothelial cell growth factor, nitric oxide, and endothelin-1 was correlated with ovarian volume or antral follicle counts: A potential predictor of pregnancy outcome in IVF

The objective of this study was to investigate the correlation between the concentrations of vascular endothelial cell growth factor (VEGF), nitric oxide (NO), or endothelin-1 (ET-1) in follicular fluid with antral follicle counts (AFCs) or ovarian volume in order to predict the outcome of in vitro fertilization (IVF). One hundred and thirty-one patients were enrolled in this study, and the pregnancy rate was 37.4%. The concentration of VEGF or NO was significantly increased, while the concentration of ET-1 in follicular fluid was decreased in the group who became pregnant (P < 0.05). The ovarian volume or AFC was significantly higher in groups that became pregnant (P < 0.05). In addition, the ovarian volume or AFC was positively correlated with the concentration of VEGF or NO and negatively correlated with the concentration of ET-1 in follicular fluid. Our data suggest that these correlations may be associated with the successful pregnancies through IVF.

Blastocyst embryo transfer decreases risk of ectopic pregnancy compared to cleavage stage transfer

OBJECTIVE: Ectopic pregnancy can be a life-threatening complication of in vitro fertilization (IVF) and is estimated to occur in 2-5% of cycles. It has been proposed that embryo transfer (ET) at the blastocyst stage may decrease the incidence of ectopic pregnancy compared to cleavage stage ET, but the few small studies in the literature that have investigated this question have been inconclusive. The objective of this study was to determine the risk of ectopic pregnancy following day 5 blastocyst ET compared to cleavage stage ET. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: All patients who achieved pregnancy following fresh IVF at our center from January 1, 2000 through December 31, 2008 were identified. The data collected included age, IVF cycle number, cycle type, and pregnancy outcome. Repeated measures log-binomial regression was used to calculate risk ratios (RR) and 95% confidence intervals (CI). RESULTS: From 2000 through 2008, 13,571 pregnancies occurred in 8,420 women following fresh IVF cycles. The majority of these pregnancies occurred in fresh homologous IVF cycles (93.2%), and the remainder were fresh oocyte recipient cycles (6.8%). Mean patient age was 36.4 years and median cycle number was 2.0. Of these 13,571 IVF pregnancies, 171 (1.3%) were ectopics diagnosed in 169 women. Of these ectopic pregnancies, 159 (93.0%) followed day 3 ET, and 12 (7.0%) followed day 5 ET. The crude RR of ectopic pregnancy following blastocyst ET compared with cleavage stage ET was 0.59 (CI 0.33-1.05). The age-adjusted RR was unchanged. No other variables (including cycle number and cycle type) had an appreciable effect on the RR. CONCLUSIONS: Our findings suggest that blastocysts are less likely to implant outside the endometrial cavity than cleavage stage embryos. This could be due to the shorter time between ET and implantation for blastocysts compared to day 3 embryos. This report represents the largest study to date evaluating the risk of ectopic pregnancy following blastocyst ET compared to cleavage stage ET.