Pregnancy Rate In Patients Research Articles

Efficacy of N-Acetylcysteine on Endometriosis-Related Pain, Size Reduction of Ovarian Endometriomas, and Fertility Outcomes

Endometriosis is a chronic, estrogen-dependent, inflammatory disease, whose pivotal symptoms are dysmenorrhea, dyspareunia, and chronic pelvic pain (CPP). Besides the usual medical treatments, recent evidence suggests there are potential benefits of oral N-acetylcysteine (NAC) on endometriotic lesions and pain. The primary objective of this prospective single-cohort study was to confirm the effectiveness of NAC in reducing endometriosis-related pain and the size of ovarian endometriomas. The secondary objective was to assess if NAC may play a role in improving fertility and reducing the Ca125 serum levels. Patients aged between 18-45 years old with a clinical/histological diagnosis of endometriosis and no current hormonal treatment or pregnancy were included in the study. All patients received quarterly oral NAC 600 mg, 3 tablets/day for 3 consecutive days of the week for 3 months. At baseline and after 3 months, dysmenorrhea, dyspareunia and CPP were assessed using the Visual Analog Scale score (VAS), while the size of the endometriomas was estimated through a transvaginal ultrasound. Analgesics (NSAIDs) intake, the serum levels of Ca125 and the desire for pregnancy were also investigated. Finally, the pregnancy rate of patients with reproductive desire was evaluated. One hundred and twenty patients were recruited. The intensity of dysmenorrhea, dyspareunia and CPP significantly improved (p < 0.0001). The use of NSAIDs (p = 0.001), the size of the endometriomas (p < 0.0001) and the serum levels of Ca125 (p < 0.0001) significantly decreased. Among the 52 patients with reproductive desire, 39 successfully achieved pregnancy within 6 months of starting therapy (p = 0.001). Oral NAC improves endometriosis-related pain and the size of endometriomas. Furthermore, it decreases Ca125 serum levels and may improve fertility in patients with endometriosis.

Comparison of Reproductive Outcomes in ICSI Cycles Using Sperm Chip Technique and Density Gradient Technique in Men with Normal Semen Analysis

Background: Microfluidic sperm sorting procedure or sperm chip technique is a chemical-free method of selecting sperm using a disposable chip. It is a new gentle alternative for sperm processing which has been produced to obtain sperm with higher rates of motility and better morphology, as well as to reduce DNA fragmentation in sperm with high DNA fragmentation to nearly undetectable levels. We aimed to evaluate sperm chip techniques on clinical pregnancy rates in patients who underwent intracytoplasmic sperm injection (ICSI). Methods: The patients in whom fresh embryo transfer (ET) on Day-3 or 5 after ICSI had been performed were analyzed in this prospective randomized cohort study. Results: Of those, 102 patients underwent ICSI with sperm isolated using sperm chip technique (study group) while 111 patients underwent ICSI with sperm isolated using swim-up technique (control group). No significant difference was observed between the groups in terms of fertilization rate in patients who underwent ET on the 3rd or 5th day. In the patients having ET on Day-3, Grade 1 embryos were obtained similarly between the sperm chip group and the control group. Grade 1 embryos transferred on Day-5 were observed significantly more frequently in the study group (p = 0.050). However, clinical pregnancy rates did not show significant differences between the groups in patients who were transferred on both the 3rd and 5th days. Conclusions: Although sperm selection using by sperm chip technique provides advantage in terms of blastocyst quality, use of this technique does not enhance success in terms of clinical pregnancy. Clinical Trial Registration: Approval was obtained from ClinicalTrials.gov with NCT03355937 approval number.

Platelet-Rich Plasma Improves Pregnancy Outcomes in Moderate to Severe Intrauterine Adhesion: A Retrospective Cohort Study.

The purpose of the present study was to investigate the therapeutic effects of platelet-rich plasma (PRP) in women with moderate to severe intrauterine adhesion (IUA). A retrospective cohort study was conducted at a reproductive medical center between July 2020 and June 2021 to compare the clinical pregnancy rate of two groups (PRP and non-PRP groups) after hysteroscopic adhesiolysis. A multivariate logistic regression analysis and propensity score matching (PSM) were performed to minimize potential bias. According to our inclusion and exclusion criteria, 133 patients were finally enrolled and divided into the PRP group (n = 48) and non-PRP group (n = 85). In the primary comparison, the clinical pregnancy rate in the PRP group was higher than that in the non-PRP group (41.7% vs. 28.2%, p = 0.114), albeit without statistical significance. Multivariate logistic regression analysis was performed, and the results of the adjusted model showed that PRP treatment significantly improved the clinical pregnancy rate (adjusted OR = 3.00, 95% CI = 1.22-7.38, p = 0.017). After PSM, the clinical pregnancy rate was higher in the PRP group than that in the non-PRP group (46.2% vs. 20.5%, p = 0.031). Based on the present study, we concluded that intrauterine perfusion of PRP had great potential in improving the clinical pregnancy rate in patients with moderate to severe IUA. Therefore, we recommend the application of PRP in the treatment of IUA.

Effect of intrauterine infusion of autologous platelet-rich plasma in patients with refractory thin endometrium undergoing in vitro fertilization.

Treatment of refractory thin endometrium during IVF is a relatively challenging problem, considering that optimal endometrium thickness is one of the critical factors for successful implantation and pregnancy. Autologous intrauterine platelet-rich plasma (PRP) infusion is an adjuvant therapeutic alternative for enhancing the endometrial thickness (EMT) and echo pattern. It was shown that PRP could expand EMT and improve pregnancy outcomes with its high content of growth factors and cytokines, and its role in the regulation of the immunological interaction between the embryo and the endometrium. The aim of the study is to evaluate the effect of autologous PRP in improving the ongoing pregnancy rate in patients with refractory thin endometrium undergoing IVF. A prospective study in Ain Shams University Hospital including 66 infertile women with a refractory thin endometrium below 7 mm by ultrasound on the day of human chorionic gonadotropin injection in fresh embryo transfer (ET) cycle, who did not respond to standard medical therapies after more than 2 cycles of previous medical therapy, and who were candidates for IVF cycle were given intrauterine PRP. A significant increase in EMT was noted and enhancement of endometrial pattern after intrauterine PRP infusion in the days of ovum pick-up and ET. There was also a significant increase in ongoing pregnancy, chemical pregnancy, clinical pregnancy, and implantation rates, while the miscarriage rate decreased after PRP infusion. Intrauterine PRP infusion improved ongoing pregnancy, chemical pregnancy, clinical pregnancy, and implantation rates, in addition to EMT and pattern on the days of ovum pick-up and ET, while the miscarriage rate significantly decreased.

Postoperative Pregnancy Outcomes Following Laparoscopic Surgical Management in Women with Stage III/IV Endometriosis: A Single-Center Follow-Up Study.

The effects of laparoscopic surgical management in women with stage III/IV endometriosis remain controversial. The standard extent of resection for stage III/IV endometriosis with deep endometriosis to treat endometriosis-associated infertility is debatable. This study aimed to assess the postoperative pregnancy outcomes following a routine surgical intervention for stage III/IV endometriosis patients. Patients with stage III/IV endometriosis who underwent conservative laparoscopic surgery at our hospital between January 2010 and December 2018 were retrospectively analyzed. Statistical analyses were performed to determine the correlations between endometriosis features and postoperative pregnancy outcomes. Of 256 patients enrolled, 94 wished to conceive. Exclusion criteria: ≥40 years, adenomyosis, partners with infertility issues. Finally, 71 women were included. The overall postoperative pregnancy rate was 76.1% (n = 54): 49 and five from non-assisted reproductive technology (ART) and ART, respectively. The postoperative pregnancy rate in patients diagnosed with infertility presurgery (40/71) was 70.0% (n = 28): 24 (non-ART) and four (ART). The endometriosis fertility index (EFI) score was higher in the pregnant than in the nonpregnant group (P = 0.03). The EFI score and surgical score of EFI were higher in the non-ART than in the ART group (P = 0.04; P = 0.02); in the infertile group, they were higher in the pregnant than in the nonpregnant group (P = 0.018; P = 0.027). Our postoperative pregnancy rate after conservative laparoscopic surgery for patients with stage III/IV endometriosis compared favorably with previous reports. EFI was a significant predictor of postoperative pregnancy. Our surgical approach to maintain a high surgical score of EFI might help treat endometriosis-associated infertility.

Comparison of Adjunctive Use of G-CSF Vs Autologous PRP in IVF Patients with a Refractory Thin Endometrium: A Retrospective Record Review

Background: In Vitro Fertilization (IVF) is an important treatment option in the management of couples with infertility. Sadly, however, failure to achieve a pregnancy through IVF is not uncommon. Amongst the many causes of IVF failure, implantation failure has emerged as one of the more common and important factors. The refractory thin endometrium as a cause of recurrent IVF failure has been well documented. The use of either Granulocyte Colony Stimulating Factor (G-CSF) or autologous Platelet Rich Plasma (PRP) has emerged as potential adjunctive treatments that may mitigate the rate of implantation failure; however, no conclusive evidence exists to favour the use of one over the other. Objective: To compare the measured change in endometrial thickness and pregnancy rates in patients with Recurrent implantation Failure (RIF) and/or thin endometrium following the intrauterine administration of either G-CSF or autologous PRP. In addition, to compare the pregnancy rates in patients with fluid in the endometrial cavity who underwent either therapy. Design: A retrospective analysis was conducted on patients who underwent endometrial therapy (either G-CSF or PRP) between January and June 2020. The measured change in endometrial thickness and the clinical pregnancy outcome of the two groups were compared. Subjects: 36 patients with a mean age of 40.36 years met the inclusion criteria of the study. 20 received autologous intrauterine PRP treatment and 16 received intrauterine G-CSF treatment. Both groups were well matched for age, pre-intervention endometrial thickness and embryo quality. Intervention: Administration of G-CSF (One ampoule Neupogen® (filgrastim)) or PRP (1ml) into the uterine cavity transcervical 48 hours prior to embryo transfer. Main Outcome Measures: The change in endometrial thickness measured 48 hours prior to embryo transfer and at the time of embryo transfer (ET) was compared. Positive clinical pregnancy outcome was determined by a positive serum B-HCG test 10 days post insertion. A statistically significant difference was set at p=0.05. Results: There was a statistically significant difference in endometrial expansion post intervention in both the G-CSF and PRP groups. However, the difference between the two groups did not reach statistical significance (p=0.077). Additionally, the collective pregnancy rate of the total study population was 44.4% (16 of 36), a significant increase over the expected pregnancy rate in the published literature [1,2]. Of the positive pregnancies, 9 (56.25%) were in the autologous PRP group and 7 (43.75%) in the G-CSF group. This difference was, however, determined not to be statistically significant (p=0.603). Conclusion: Both G-CSF and PRP are effective interventions in the management of the thin refractory endometrium. Both result in significant endometrial expansion and increased pregnancy rates. Despite a marginally higher endometrial response and pregnancy rate in the PRP group, the differences in these metrics between the two groups were not statistically significant.

Assisted biomimetic electrostimulation therapy can improve the clinical pregnancy rate of patients with abnormal endometrial receptivity undergoing frozen-thawed embryo transfer cycles

This study aimed to explore whether assisted biomimetic electrostimulation (BES) therapy can improve clinical outcomes in patients with abnormal endometrial receptivity undergoing frozen-thawed embryo transfer (FET) cycles. We retrospectively collected data from 132 patients who underwent FET cycles and divided them into the BES (n = 86) and non-BES (NBES) groups (n = 46). The clinical pregnancy rate (55.8 vs. 37.0%), biochemical pregnancy rate (59.3 vs. 41.3%), and live birth rate (44.2 vs. 23.9%) of the BES group were significantly higher than those of the NBES group (p < 0.05). No significant difference between the two groups was observed in endometrial thickness at FET day, embryo implantation rate, and early abortion rate (p > 0.05). The logistic regression analysis indicated that blastocyst transfer (adjusted OR = 3.617; 1.337–9.783; p = 0.011) and BES (adjusted OR = 2.398; 1.094–5.256; p = 0.029) were positively associated with the clinical pregnancy rate. These results suggested that assisted BES therapy can improve clinical outcomes in patients with diseases affecting endometrial receptivity. Impact statement What is already known on this subject? Biomimetic electrostimulation (BES) therapy can increase endometrial thickness in patients with thin endometria undergoing embryo transfers and to some extent improve their clinical outcomes. What do the results of this study add? Assisted BES therapy can improve clinical pregnancy rates in patients with abnormal endometrial receptivity undergoing FET cycles (55.8 vs. 37.0%, p = 0.039). After adjusting for covariates, BES was still positively associated with the clinical pregnancy rate (adjusted OR = 2.398; 1.094–5.256; p = 0.029). What are the implications of these findings for clinical practice and/or further research? BES therapy can improve endometrial receptivity. Further studies are needed to understand its specific mechanisms.

Clinical pregnancy rate of women with unexplained infertility with or without cervical mucus aspiration before intrauterine insemination

Objective: To detect effect of removing cervical mucus before performing intrauterine insemination (IUI) on pregnancy rate in patients with unexplained infertility. Methods: The randomized controlled trial was conducted in Infertility Division of Department of Obstetrics and Gynaecology of a tertiary care hospital. Totally 80 patients of unexplained infertility were recruited. By computer generated block randomization in block size of 4 and 6, patients were randomly allocated at time of starting ovarian stimulation into the cervical mucus removal group or the non-removal of cervical mucus group before IUI, 40 in each group. Ovarian stimulation with clomiphene 100 mg from day 2-6 of menstrual cycle along with human menopausal gonadotropin 150 IU was given alternate day starting from day 7. Follicular monitoring was done and further doses given as per response; trigger was planned when 1-3 follicle reach a diameter of &gt;18 mm. IUI was planned after trigger. IUI was done as per the group allocated. Mucus cleaning was done in the cervical mucus removal group by aspirating mucus with IUI syringe and sterile cotton swab before IUI. The primary outcome was clinical pregnancy rate. Number of difficult IUIs and cycle cancellation due to ovarian hyperstimulation were also noted. Results: IUI was not done in 4 patients due to hyperstimulation. Pregnancies per IUI cycle occurred in 7.9% (3/38) in the cervical mucus removal group and 21.1% (8/38) in the non-removal of cervical mucus group. There was no statistically significant difference in clinical pregnancy rate between two groups (P=0.19). Conclusions: There is a trend towards a lower clinical pregnancy rate with removal of cervical mucus before IUI in women of unexplained infertility though the difference is not statistically significant. Further studies with large sample size need to be done on this intervention. Trial registration: The trial registration was done with Clinical Trial Registry-India (Registration number: CTRI/2019/03/018326).

Spontaneous pregnancy rate after fallopian tube recanalization for unilateral obstruction with a patent contralateral tube

BackgroundInfertility is a common sociomedical problem worldwide, affecting up to 15% of couples. Tubal obstruction is currently one of the most important causes of female infertility. This study was designed to determine the spontaneous pregnancy rate in patients undergoing unilateral transcervical fallopian tube recanalization, performed by an interventional radiologist, for proximal fallopian tube obstruction with a patent contralateral tube. The secondary objective was to analyze pregnancy rates in relation to the type and duration of infertility, patient age, and body mass index.ResultsThirty-eight patients with unilateral tube obstruction were included in this study. Transcervical fallopian tube recanalization was successfully performed in all cohorts. At the one-year follow-up; 13 women (34.2%) had become pregnant, nine (23.7%) delivered healthy babies, and four (10.5%) had miscarriages. The time interval between the application of the technique and spontaneous pregnancy was 1–12 months, with a mean of approximately 4 months. Multivariate analysis showed a significantly higher pregnancy rate in young (< 35 years), nonobese (BMI < 30 kg/m2) females with a history of primary infertility for < 5 years. Minor complications were noted in 27 patients (71%). No major complications were noted.ConclusionsOur study showed that transcervical fallopian tube recanalization of proximal fallopian tube obstruction with a patent contralateral tube increased the spontaneous pregnancy rate in cases of tubal factor infertility. Moreover, transcervical fallopian tube recanalization is recommended as a first-line treatment for women with unilateral proximal fallopian tube obstruction and a patent contralateral tube owing to the low risks associated.

Oil-based contrast for hysterosalpingography-regulated Th1/Th2-type cytokines and alleviated inflammation in rats with LPS-induced chronic endometritis.

The chronic endometritis (CE) prevalence in people experiencing infertility is 2.8-56.8%, pregnancy rates in patients with infertility increase after hysterosalpingography with oil-based contrast, but the effect and mechanism are not clear. Here, we analyzed the effects of intrauterine ethiodized poppyseed oil (EPO) bathing on a rat model of CE and the possible underlying mechanism. CE rats were induced by lipopolysaccharide (LPS) exposure, and rats were subjected to intrauterine bathing with EPO or phosphate-buffered saline (PBS) after model verification. Serum and uterus levels of IFN-γ, IL-4, TNF-α, and IL-1β were detected by ELISA kit, and the number of CD138+ and CD68+ cells and uterine IFN-γ, IL-4, TNF-α, IL-1β, and NF-κB P65 expression were detected by immunohistochemistry after bathing. LPS exposure induced the typical CE phenotype with CD138+ phagocyte infiltration of the endometrial stroma. Compared with PBS bathing, bathing with EPO in CE rats showed decreases in the CD138+ and CD68+ cells populations and significant decreases in serum and uterine IFN-γ levels, moreover, uterine IL-4 levels were slightly higher, and the IFN-γ/IL-4(Th1/Th2-type cytokine ratio) in the uterus was significantly lower. Local IFN-γ, TNF-α, and NF-κB P65 expression in the endometrium was significantly downregulated, while IL-4 expression was upregulated. Intrauterine oil-based contrast bathing significantly alleviated local inflammation in the rat CE model by downregulating NF-κB P65 expression, reducing IFN-γ (Th1), increasing IL-4 levels (Th2) in the endometrium, and regulating the Th1/Th2-type cytokine trends toward Th2.

Reproductive outcomes after uterine septum resection in patients with recurrent miscarriage or infertility: a retrospective study in Chinese women.

Septate uterus is the most common structural uterine anomaly, which is related to the adverse pregnancy outcomes in women of childbearing age. This article provides a retrospective review of hysteroscopic uterine septum resection performed in our hospital during recent years, focusing on the patients with recurrent miscarriage and primary infertility, and also to identify which patients are more likely to benefit from the surgery. This is a single-center retrospective study. Cases of women who underwent hysteroscopic septum resection at West China Second Hospital of Sichuan University from January 2014 to December 2019, retrieved through the medical record system, were divided into three groups: Group A was the recurrent miscarriage group, Group B had a history of pregnancy with spontaneous abortion once at most, and Group C was the primary infertility group. Each patient was followed up by telephone about further pregnancy, miscarriage and live birth for at least 1year. A total of 176 surgical patients were included in this study. Group A, B, and C include 42, 74, and 60 cases, respectively. The postoperative pregnancy rates of the three groups were 71.4, 82.4, and 75.0%; live births rates were 50.0, 74.3, and 71.7%; and spontaneous abortion rates were 21.4, 17.6, and 13.3%. 62 patients had a complete uterine septum and 114 had a partial uterine septum. For patients with complete septate uterus, the preoperative pregnancy rate was 54.84% and the pregnancy rate increased to 85.48% after surgery; and yet the preoperative and postoperative pregnancy rates in patients with partial septate uterus were close (from 71.9 to 72.8%). After uterine septum resection, the pregnancy rate and spontaneous abortion rate in RSA patients were not significantly different from the other two groups, but the live birth rate was still significantly lower. Patients with complete uterine septum may benefit more from surgery. The surgical indications should be carefully and strictly evaluated.

Luteal phase support with progesterone does not improve pregnancy rates in patients undergoing ovarian stimulation with letrozole

Research questionDoes luteal phase support with vaginal progesterone improve clinical pregnancy rates in patients undergoing ovarian stimulation with letrozole? DesignThis was a retrospective cohort study of patients undergoing ovarian stimulation with letrozole paired with intrauterine insemination (IUI) or timed intercourse (TIC) from January 2018 to October 2021. The primary outcome of clinical pregnancy rate (CPR) was calculated for cycles with and without luteal phase progesterone support. Univariate logistic regressions were done to evaluate predictor variables for CPR. Clinically important covariates including age, body mass index, anti-Müllerian hormone concentration, diagnosis of ovulatory dysfunction and multifollicular development were included in a multivariate analysis evaluating the relationship between luteal progesterone use and odds of clinical pregnancy. Secondary outcomes including spontaneous abortion, biochemical pregnancy and ectopic pregnancy were calculated. Live birth rates were calculated for cycles in a secondary analysis. ResultsA total of 492 letrozole ovarian stimulation cycles in 273 patients were included. Of these cycles, 387 (78.7%) used vaginal progesterone for luteal support and 105 (21.3%) did not. The unadjusted CPR per cycle was 11.6% (45/387) with progesterone and 13.3% (14/105) without progesterone (P = 0.645). After adjusting for significant covariates including age, BMI, diagnosis of ovulatory dysfunction and multifollicular development, the odds for clinical pregnancy were not significantly improved in cycles with exogenous progesterone (odds ratio [OR] 1.15, 95% confidence interval [CI] 0.48–2.75, P = 0.762). A follow-up analysis demonstrated that live birth rate was 10.7% (41/384) with and 12.5% (13/104) without luteal progesterone, respectively (P = 0.599). ConclusionsLuteal support with vaginal progesterone does not significantly improve CPR in ovarian stimulation cycles using letrozole.

Effectiveness of Hysteroscopic Surgery for Intrauterine Lesions on Pregnancy Rates in Patients with Primary infertility

Effectiveness of Hysteroscopic Surgery for Intrauterine Lesions on Pregnancy Rates in Patients with Primary infertility

Exploring the Mechanism of Wenshen Huatan Quyu Decotion for PCOS Based on Network Pharmacology and Molecular Docking Verification.

Objective To identify the active chemical in Wenshen Huatan Quyu Decotion (WHQD) and to explore its possible network interactions with the polycystic ovary syndrome (PCOS). Methods The Traditional Chinese Medicine Systematic Pharmacology Database and Analysis Platform (TCMSP) and the Bioinformatics Analysis Tool for Molecular Mechanisms in Chinese Medicine (BATMAN-TCM) were used to decompose compound formulations, detect active chemicals and their corresponding target genes, and then convert them into UniProt gene symbols. Meanwhile, PCOS-related target genes were collected from GeneCards to construct a protein-protein interaction (PPI) network, which was further analyzed by STRING online database. Gene Ontology (GO) functional analysis was also performed afterwards to construct the component-target gene-disease network to visualize the correlation between WHQD and PCOS. We then performed an in silico molecular docking study to validate the predicted relationships. Results WHQD consists of 14 single drugs containing a total of 67 chemical components. 216 genes were predicted as possible targets. 123 of the 216 target genes overlapped with PCOS. GO annotation analysis revealed that 1968 genes were associated with biological processes, 145 with molecular functions, and 71 with cellular components. KEGG analysis revealed 146 pathways involved PPI, and chemical-target gene-disease networks suggest that PGR, AR, ADRB2, IL-6, MAPK1/8, ESR1/2, CHRM3, RXRA, PPARG, BCL2/BAX, GABRA1, and NR3C2 may be key genes for the pharmacological effects of WHQD on PCOS. Molecular docking analysis confirmed that hydrogen bonding was the main interaction between WHQD and its targets. Conclusion WHQD exerts its pharmacological effects by improving insulin sensitivity, subfertility, and hormonal imbalance, increasing ovulation rates, which in turn may increase pregnancy rates in patients with significant efficacy.

Accumulated Vitrified Embryos Could Be a Method for Increasing Pregnancy Rates in Patients with Poor Ovarian Response.

We aimed to assess the efficacy of accumulated embryo transfer (ACC-ET) through several controlled ovarian hyperstimulation (COS) cycles to increase the rates of pregnancy in patients with poor ovarian response (POR). We retrospectively reviewed the medical records of 588 patients with POR under 43-years old who underwent embryo transfer from January 2010 to December 2015. We compared the pregnancy rate (PR), clinical pregnancy rate (CPR), and live birth rate (LBR) between ACC-ET (frozen-thawed: 47; fresh + frozen-thawed: 24) group (n = 71) and fresh ET groups (n = 517). Characteristics of ACC-ET patients were similar to those of fresh ET groups (Age: 38.1 ± 3.5 vs. 38.2 ± 3.7, p = 0.88; Anti Müllerian Hormone (AMH; ng/mL): 0.5 ± 0.4 vs. 0.6 ± 0.6, p = 0.38; follicle stimulating hormone (FSH: mIU/mL): 11.9 ± 8.0 vs. 10.8 ± 9.0, p = 0.35). The total number of transferred embryos (3.1 ± 0.9 vs. 1.5 ± 0.7, p = 0.00), PR (29.6% (21/71) vs. 18.8% (97/517), p = 0.040), and CPR (23.5% (16/68) vs. 14.0% (71/508) p = 0.047) were significantly higher in the ACC-ET group than in the fresh ET group. In addition, PR, CPR, and LBR increased with the number of ET in the fresh ET group. However, there were no significant differences observed in LBR between ACC-ET and fresh ET groups (14.9% (10/67) vs. 9.8% (50/508), p = 0.203). From our knowledge, there is no clinical evidence reported to prove that transfer of multiple embryos of adequate quality obtained through multiple cycles can compensate for the limited number of retrieved oocytes from POR patients. We concluded that ACC-ET from several COS cycles could be an alternative method to increase PR and CPR in <43-year-old patients with POR.

Endometrial polyps and their insinuation in the pregnancy rates of patients undergoing ICSI-FET cycles: A retrospective cohort study

To study the effect of endometrial polyps in infertility patients and their insinuation in pregnancy rates in patients undergoing ICSI-FET cycles following polypectomy.This is a retrospective study in 345 infertility patients attending Reproductive center of Sudha Hospital, Erode. Infertile women with endometrial polyps diagnosed by transvaginal ultrasound were subjected to hysteroscopic polypectomy. Vitrified embryo transfer was done one to three months following polypectomy and the clinical pregnancy rates were analysed. The age, body mass index, the type of infertility (primary or secondary), duration of infertility, pattern of menstruation, were precisely evaluated. An endometrial polyp based on their location inside the uterine cavity is assessed by hysteroscopy and the significance of the polyp location with pregnancy rates is evaluated.Of the 345 women who underwent hysteroscopic polypectomy 229 became pregnant and 116 women were non pregnant in ICSI-FET cycles. There is a strong positive association between endometrial polypectomy and pregnancy rate in ICSI-FET cycles. The incidence of Endometrial Polyps in pregnant and non-pregnant group was not related to the age, gravida and parity. Pregnancy rate after polypectomy based on polyp location is statistically insignificant. Multiple polyps are common compared to solitary polyp. Polyps are more common in posterior uterine wall than anterior, lateral walls and uterotubal junction.Hysteroscopic polypectomy gives promising results in infertility patients undergoing ICSI cycles prior to vitrified embryo transfer and location of polyps does not determine the pregnancy outcomes.

Does endometrial thickness affect pregnancy outcomes in isolated male infertility IVF cycles? A retrospective cohort study

In our retrospective cohort study, we aimed to determine the role of endometrial thickness (ET) in isolated male factor infertile women in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) fresh embryo cycles. The patients were classified as having an endometrial thickness of <7 mm (n: 80), 7–9.9 mm (n: 335), 10–14 mm (n: 579) and >14 mm (n: 50) according to their ETs on the human chorionic gonadotropin (hCG) day. The overall clinical pregnancy rate was 37.4%, and no significant difference was found between the groups (p = .262). There was no significant difference between live birth rates (p = .094), but the highest pregnancy (46%) and live birth (34%) rates were found in the group with >14 mm ET. The increase in ET in IVF cycles increases pregnancy rates, albeit partially. When it is desired to determine a cut-off value, it can be said that pregnancy rates increase significantly in thicknesses of 14 mm and above. Impact Statement What is already known on this subject? When the literature is examined, many studies conclude that clinical pregnancy rates increase with the increase in endometrial thickness (ET) in IVF cycles, but there are also studies that argue the opposite. There is no study in the literature investigating the effect of ET on clinical pregnancy rates in patients with isolated male factor infertility. What do the results of this study add? In support of the literature, an increase in ET was found to be associated with an increase in clinical pregnancy rates, regardless of male and female factors. Although pregnancy occurs in thin endometriums, abortion rates are undesirably high. What are the implications of these findings for clinical practice and/or further research? Although the risk of abortion is high in thin endometriums, live birth rates are satisfactory. As a result, thin endometrium does not require cycle cancellation.

Effectiveness of hysteroscopic surgery for intrauterine lesions on pregnancy rates in patients with primary infertility

Background: Infertility is an important part of reproductive health that has a big impact on society. The use of hysteroscopy in routine gynaecological practise was a real revolution in diagnosing and treating intrauterine disease, which had a big impact on how these diseases were treated and how they were dealt with. Objective: To find out how well therapeutic intervention through operative hysteroscopy works in increasing the number of pregnancy rate in women with primary infertility with diagnosed intrauterine lesions. Patients and methods: In the current study, fifty patients, who have been met the requirements of the inclusion and exclusion criteria participated prospectively in this study to evaluate the impact of detected and treated uterine and cervical abnormalities on the pregnancy rate and reproductive outcome. They underwent operative hysteroscopy for resection of submucous myoma, polypectomy or resection of intrauterine septum during the follicular phase of their cycles. Results: After operative hysteroscopy the reproductive outcome was 29 out of 50 patients (58%) achieved pregnancy. Of those, 26 women (52%) had singleton pregnancies while 3 women (6%) had twin pregnancies.

The importance of serum progesterone concentration at embryo transfer day and effect of rescue additional progesterone during programmed artificial frozen embryo transfer cycles

Research questionWhat is the efficacy and possible positive effect of additional rescue subcutaneous (s.c.) progesterone therapy for restoration of progesterone concentration on embryo transfer day and pregnancy rates during programmed artificial frozen embryo transfer (FET) cycles with vaginal progesterone tablet plus i.m. progesterone? DesignMulticentre prospective cohort study (NCT04769401) including a total of 238 programmed artificial FET between February 2021 and September 2021. Patients were divided into ≥10 ng/ml and <10 ng/ml according to serum progesterone concentrations on embryo transfer day; 25 mg of s.c. progesterone was added to patients with <10 ng/ml; blood samples were taken 2 days later. The primary outcome was the ongoing pregnancy rate. ResultsThe proportion of patients having ≥10 ng/ml serum progesterone concentrations on embryo transfer day was 70.7%. There was no statistically significant difference with regard to cumulative pregnancy rate, ongoing pregnancy rate and miscarriage between the groups (55.4% versus 61.5%, P = 0.4; 78.2% versus 72.5% per pregnancy, P = 0.5; 21.8% versus 27.5%, P = 0.5, respectively, ≥10 ng/ml and <10 ng/ml). Eighty-three per cent of patients with low serum progesterone concentrations on embryo transfer day reached an adequate progesterone concentration with rescue s.c. progesterone treatment; 90% of pregnancy rates in patients with serum progesterone concentrations <10 ng/ml on embryo transfer day were in patients who reached adequate serum progesterone concentrations with daily rescue s.c. progesterone treatment. ConclusionsThe measurement of serum progesterone concentrations on embryo transfer day may create the opportunity for rescue progesterone administration on that day for patients who fail to reach adequate serum progesterone concentrations, achieving similar pregnancy rates without cancellation of the cycle.

Evaluation of the effect of intrauterine injection of platelet-rich plasma on the pregnancy rate of patients with a history of implantation failure in the in vitro fertilization cycle.

ABSTRACTObjectives:Implantation failure is a major problem in reproductive medicine, and despite the various methods described for treatment, there is little consensus on the most effective method. This study was conducted to investigate the effect of intrauterine injection of platelet-rich plasma (PRP) on the pregnancy rate of patients with a history of implantation failure in the in vitro fertilization (IVF) cycle.Study Design:In this study, women attending the infertility clinic of Ali ibn Abi Taleb Hospital, who had a history of implantation failure and were candidates for frozen embryo transfer (FET), were examined in Zahedan (Iran) in 2019. The patients were divided into two groups of PRP recipients and the control group. IVF was performed routinely, and in the PRP-receiving group, an intrauterine injection was given 48 h before embryo transfer (ET). The number of gestational sacs, the rate of implantation, the frequency of chemical and clinical pregnancies as well as the frequency of abortion were compared in the two groups. The collected data were analyzed by the SPSS software version 21Results:Ninety patients with a history of implantation failure participated in the study, and finally, the information of 85 patients was studied. The frequency of chemical pregnancy was 40% in the experimental group, 27% in the control group, and regarding clinical pregnancy, 33% in the experimental group and 24% in the control group, but there was no significant difference between the two groups. The rate of implantation, the mean thickness of the endometrium, and the frequency of abortion did not differ significantly between the two groupsConclusion:In patients with endometrial thickness greater than 8 mm with a history of recurrent implantation failure, intrauterine injection of PRP had no effect on the fertility outcome.