Birth Rate Research Articles

Dual Trigger in IVF—A SWOT Analysis

The typical agent used for final oocyte maturation and resumption of meiosis in in-vitro fertilisation (IVF) has been human chorionic gonadotropin (hCG). This acts as a surrogate for the physiological spontaneous luteinising hormone (LH) surge. Gonadotropin-releasing hormone agonist (GnRH-a) has been used as an alternative trigger in cycles where endogenous LH control is achieved using GnRH-antagonist and has been shown to be an effective method of reducing the risk of OHSS. However, GnRHa trigger is associated with poor corpus luteum function, leading to impaired endometrial receptivity. A combination of a GnRHa and hCG (dual trigger) was proposed to improve IVF cycle outcomes, especially in poor and normo-responder patients. Dual trigger aims to provide a more physiological alternative to HCG-only trigger while obviating some of the problems associated with GnRHa alone. Clinical evidence now supports the value of dual trigger where there has been a previous low proportion of mature eggs or where there is a suboptimal LH response to GnRHa alone. In poor responders, dual triggers could be considered as an effective first line. Dual trigger allows for comparable outcomes in normal and high responders, allowing the possibility of fresh embryo transfer with good clinical pregnancy and live birth rates while minimising OHSS risk.

A Study on the Standardization of Smart Farm Communication

Background: Smart farming uses information and communication technology (ICT) to optimize crop and livestock environments. It is applied in greenhouses, vinyl houses, and livestock barns. By collecting data on crop growth and environmental conditions, smart farms create optimal growth environments. This leads to higher productivity and better quality with less labor, energy, and nutrient input than traditional farming methods. In Korea, crop production has declined due to fewer farmers, and over 80% of agricultural products are imported. The low birth rate and aging population are worsening the shortage of agricultural workers. It is predicted that Korea could face a food shortage in three years due to low self-sufficiency. Smart farms are seen as a solution. They can be implemented in urban areas and are considered a profitable model due to their high production potential. Methods: Nutrient machines are a vital part of smart farming. They dilute and supply essential nutrients for crop growth. However, different machines require varying nutrient ratios, which complicates crop management. To address this, a recipe program has been developed. It automatically adjusts nutrient ratios according to the user’s standard settings. This ensures uniform nutrient delivery, regardless of the type of machine used. Result: The recipe program is expected to improve crop production. It ensures consistent nutrient supply, optimizing growth conditions. It also enhances user convenience by standardizing nutrient management across different machines, reducing complexity in crop cultivation.

No improvement in pregnancy and perinatal outcomes with combined luteal support in modified natural cycle frozen embryo transfer

ObjectiveWe investigated whether the addition of a luteal phase support drug benefits pregnancy and perinatal outcomes in modified natural-cycle frozen-thawed embryo transfer (mNC-FET) for women up to the age of 35 years.MethodsWe analyzed the clinical data of 3658 mNC-FET cycles of women up to the age of 35 years from the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from January 2018 to December 2020 in a retrospective cohort study. The cycles were divided into three groups based on the luteal phase support protocol used. The patients in group A received a combination of progesterone soft capsules and dydrogesterone (882 cycles), those in group B received dydrogesterone only (627 cycles), and those in group C received a combination of progesterone vaginal sustained-release gel and dydrogesterone (2149 cycles). Pregnancy and perinatal outcomes were compared among the three groups.ResultsLogistic regression analysis indicated that the three luteal phase support regimens were not associated with the live birth rate [OR(95% CI)B vs A=1.080, p=0.960; OR(95% CI)B vs C=0.252, p=0.291]. There were no significant differences in the newborn weight, premature delivery rate, pregnancy complications rate, and incidence of birth defects among the three groups.ConclusionsIn the mNC-FET cycle, patients under the age of 35 who chose dydrogesterone alone as a luteal phase support drug exhibited no difference in the live birth rate and perinatal outcome from patients who combined dydrogesterone with progesterone soft capsules or with progesterone vaginal sustained-release gel. However, the outcome still requires confirmation by large-sample prospective studies.

Retraction and replacement of: Comparison of Cumulative Live Birth Rates Between Progestin and GnRH Analogues in Preimplantation Genetic Testing Cycles.

Retraction and replacement of: Comparison of Cumulative Live Birth Rates Between Progestin and GnRH Analogues in Preimplantation Genetic Testing Cycles.

Pre-pregnancy obesity and weight gain during pregnancy: impact on newborn outcomes

BackgroundOverweight and obesity are global issues, especially among women of childbearing age, linked to adverse maternal and neonatal outcomes. These risks vary by age, race, and ethnicity, with increasing rates among immigrant and minority women. This study compares overweight and obesity rates, pregnancy weight gain, and neonatal outcomes in Turkish and Syrian immigrant/refugee women.MethodsIn this retrospective study, at Buca Seyfi Demirsoy Hospital in Izmir, Turkey a total of 1353 mother-infant pairs were checked for eligibility. Of the entire cohort of 1353 mother-infant pairs, 323 pairs with complete medical records were included. The primary outcome was rate of pregestational obesity or overweight as secondary outcomes were weight gain during pregnancy and adherence to guidelines, neonatal outcomes according to different BMI categories and possible impact of maternal weight gain on neonatal morbidities in two different ethic populations.ResultsOf the 323 mother-infant pairs, overweight/obese mothers had higher birth weights and cesarean-section rates. Syrian mothers were more likely to gain less weight than recommended. Neonatal outcomes, such as hospitalization and SGA/LGA birth rates, were similar across groups, with varying compliance to weight gain guidelines.ConclusionsPre-pregnancy BMI and gestational weight gain significantly affect some of the neonatal outcomes. High obesity rates and ethnic disparities highlight the need for culturally tailored prenatal care to improve maternal and neonatal health, especially in immigrant populations. Further research with larger, diverse cohorts is needed.

The effects of growth hormone on the outcomes of in vitro fertilization and embryo transfer in age-grouped patients with decreased ovarian reserve: a prospective cohort study

BackgroundGrowth hormone (GH) could improve the outcomes of in vitro fertilization and embryo transfer (IVF-ET) in patients with decreased ovarian reserve (DOR), but which age group will benefit the most has remained controversial. This study aims to explore the outcome of IVF-ET among differently aged patients with DOR treated with GH.MethodsA total of 846 patients with DOR undergoing IVF-ET from May 2018 to June 2023 at the Reproductive Medicine Center of Sichuan Provincial Women’s and Children’s Hospital were prospectively enrolled. The patients were divided into group A (< 35 year old, n = 399), group B (35 ~ 40 year old, n = 286), and group C (> 40 year old, n = 161). Each group was sub-divided into the GH part and the control part, with the former receiving pretreatment with GH 4 IU/day on day 2 of the previous menstrual cycle before the injection of gonadotrophin (Gn) until the trigger day. The ovarian stimulation protocol was gonadotrophin-releasing hormone antagonist (GnRH-A) or long-acting GnRH agonist protocol. The quality of oocytes and embryos and the outcome of pregnancy were compared.ResultsIn group B, the number (1.16 ± 0.12 vs. 0.74 ± 0.09) and rate (34.27% vs. 23.90%) of high-quality cleavage embryos, rate of implantation (32.37% vs. 22.35%), clinical pregnancy (48.98% vs. 33.67%), and live birth (44.90% vs. 29.59%) were significantly higher, whereas the canceled oocyte retrieval rate was significantly lower (1.49% vs. 6.58%) in the GH part than those of the control part (P < 0.05). In group B, the duration and dose of Gn, number of oocyte retrieved, and rates of normal fertilization, cleavage embryo, blastocyst, high-quality blastocyst, and early miscarriage were not significantly different between the GH and control parts (P > 0.05). In groups A and C, no significant difference was detected in the quality of embryos and outcomes of embryo transfer with or without pretreatment (P > 0.05).ConclusionGH could improve the quality of embryos and live birth rate for patients with DOR aged 35–40 years old.

The use of propensity score matching to assess the effectiveness of the endometrial receptivity analysis in patients with recurrent implantation failure

BackgroundOne potential cause of implantation failure is abnormal endometrial receptivity, and how to objectively evaluate endometrial receptivity has been a matter of great concern. Endometrial receptivity analysis (ERA), a next-generation sequencing-based test that assesses endometrial gene expression, may be valuable in predicting endometrial receptivity, but whether ERA improves pregnancy outcomes in patients with recurrent implantation failure (RIF) is currently controversial. The purpose of this study was to investigate the effect of ERA on pregnancy outcomes in patients with RIF.MethodsWe performed a retrospective cohort study analysis for a population of patients with RIF undergoing frozen embryo transfer (FET) cycles in the reproductive center of the Third Affiliated Hospital of Zhengzhou University from January 2019 to December 2022(n=1598). FET cycles with personalized embryo transfer (PET) under ERA guidance were included in the ERA group (n=43); after using propensity score matching (PSM), a total of 120 FET cycles were included as a control group. Pregnancy outcomes were compared between the two groups. Further, the relationship between the number of previous implant failures and the rate of implant window displacement was discussed. The factors affecting the window of implantation (WOI) displacement were also assessed.ResultsThere was no statistically significant difference in embryo implantation rate, clinical pregnancy rate, spontaneous abortion rate, and live birth rate between the ERA group and the matched control patients (P > 0.05). There was no significant difference in the rate of WOI displacement between patients in the moderate or severe groups (P > 0.05) and no significant difference in pregnancy outcome ( P>0.05). Finally, analysis of the clinical data of patients in the receptive and non-receptive groups did not uncover any factors influencing WOI displacement.ConclusionThe results of the study showed no significant difference in pregnancy outcomes in patients who received ERA compared to those who did not.

Perinatal outcomes of patients who underwent cervical cerclage and their relationship to systemic inflammatory indices

Aims: This study aimed to evaluate the perinatal outcomes of patients who underwent cervical cerclage and to investigate the relationship between these outcomes and systemic inflammatory indices. Methods: A retrospective study was conducted at Ankara Etlik City Hospital between November 2022 and November 2023. Patients were divided into three groups based on the indication for cerclage: history-indicated cerclage (H-IC), ultrasound-indicated cerclage (U-IC) and physical examination-indicated cerclage (PE-IC). The systemic inflammatory markers neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), Systemic Immune-Inflammation Index (SII), Systemic Inflammatory Response Index (SIRI), pan-immune inflammation value (PIV) and multi-inflammation indices (MII), were measured. The perinatal outcomes, including gestational age at delivery, birth weight and APGAR Scores, were compared among the groups. Results: Seventy patients were included in the study. The rate of preterm birth was highest in the PE-IC group (61.1%), followed by the U-IC group (40.9%) and the H-IC group (36.7%). Birth weight, 1- and 5-minute APGAR Scores were significantly lower in the PE-IC group, and neonatal intensive care unit admission rates were significantly higher in the PE-IC group. Inflammatory markers NLR, SII and PIV were significantly higher in the U-IC group compared to the H-IC group. However, no significant differences were observed between the U-IC and PE-IC groups in terms of these markers. Conclusion: Patients who underwent PE-IC had poorer perinatal outcomes compared to those who underwent H-IC or U-IC. The systemic inflammatory indices NLR, SII and PIV may serve as useful markers for predicting pregnancy outcomes and guiding early interventions in patients at risk of preterm birth. Further large-scale prospective studies are needed to validate these findings.

Association of insulin resistance surrogates with live birth outcomes in women with polycystic ovary syndrome undergoing in vitro fertilization

BackgroundInsulin resistance (IR) is a common pathophysiologic feature in patients with polycystic ovary syndrome (PCOS). However, there have been no studies investigating the association of IR surrogates with pregnancy outcomes in women with PCOS undergoing in vitro fertilization (IVF). Therefore, we explored the association between these factors among PCOS patients.MethodsWe conducted a retrospective study that included patients with PCOS who underwent IVF at a university-affiliated hospital. Blood samples and physical examinations are collected at reproductive center on fasting in the morning of the 2nd to 4th day of the menstrual cycle prior to medication. We categorized participants into “Non-IR group” (HOMA-IR < 2.2) and “IR group” (HOMA-IR ≥ 2.2). The association of IR surrogates [triglyceride-glucose-body mass index (TyG-BMI), triglyceride-glucose (TyG) and homeostasis model assessment (HOMA-IR)] with IVF outcomes was evaluated by regression model analysis. Moreover, we also performed sensitivity analyses with stratification and interaction tests. The primary outcome variable was the live birth rate.ResultsA total of 543 PCOS patients were finally included in the study. In all three regression models for the fresh embryo transfer (ET) cycles, all three IR surrogates showed stable negative correlations with live birth rate (in Model III: TyG-BMI OR = 0.99, 95% CI: 0.98 ~ 0.99; TyG OR = 0.47, 95% CI: 0.27 ~ 0.82; HOMA-IR OR = 0.84, 95% CI: 0.72 ~ 0.97; all P < 0.05), and this association was stable across all subgroups of the population (all P-interaction > 0.05). However, this relationship did not exist in frozen-thawed embryo transfer (FET) cycles. Furthermore, our study found that TyG-BMI was superior to TyG and HOMA-IR in predicting the rate of live birth in fresh ET cycles [TyG-BMI: 0.64 (95% CI: 0.58, 0.69) vs. TyG: 0.61 (95% CI: 0.55, 0.67) vs. HOMA-IR: 0.60 (95% CI: 0.55, 0.67)].ConclusionsOur study revealed that the three IR surrogates (TyG-BMI, TyG and HOMA-IR) were negatively associated with the live birth rates in fresh ET cycles. However, this relationship did not exist in FET cycles. Furthermore, our study found that TyG-BMI was superior to TyG and HOMA-IR in predicting the rate of live birth in fresh ET cycles.

Heterogeneous fertility reponses to the two-child policy: growth-induced domestic migration and income effect

ABSTRACT The deteriorating demographic structure in China has already invalidated its one-child policy ineffective. However, smoothing the ripple effects generated by this policy will require more comprehensive population policies. This context led to the introduction of the two-child policy in China. This paper examines the effects of the two-child policy by observing the regions that were previously subject to the one-child rule. The findings indicate that a geographic mismatch between people’s willingness to have children and household income has resulted in an uneven distribution of birth rates following the implementation of the two-child policy, with higher birth rates concentrated in rural areas experiencing rapid urbanization. As the Chinese economy progresses towards a higher level of urbanization, population policies aimed at encouraging larger families will become less effective, as fertility norms will have permanently altered in tandem with the rising costs of urban living. With more affluent populations less likely to have more than one child, understanding how to increase fertility rates in demographic groups that have not fully transitioned to the advanced urban sector will be crucial for developing effective population growth policies.

MODELING THE MONKEY POX OUTBREAK WITH THE REFINED SEIR MODEL INCLUDING VITAL DYNAMICS FOR THE US

The Monkeypox (Mpox) outbreak has renewed interest in using infectious disease modeling to predict and manage its spread. In this study, we apply an enhanced Susceptible-Exposed-Infectious-Recovered (SEIR) model to the Mpox epidemic in the United States, incorporating vital dynamics such as births and deaths to account for long-term population changes. By extending the traditional SEIR framework, our model captures more realistic infection dynamics, offering deeper insights into transmission patterns, peak infection periods, and the eventual decline of the outbreak. This approach aims to provide a clearer understanding of Mpox transmission dynamics and to assist health authorities in developing strategies to mitigate the spread. Our findings highlight the importance of early interventions and illustrate the potential for long-term epidemic control through strategic planning The SEIR model provides a basic framework for understanding the evolution of an epidemic [4] that divides the population into four segments: Susceptible (S), Exposed (E), Infectious (I), and Recovered (R). To model infectious diseases like Mpox more realistically, especially over an extended period, it is important to include vital dynamics, such as birth and death rates, in the SEIR model.

Intradermal lymphocyte therapy: A promising treatment for recurrent pregnancy loss in patients without anti-TPO antibodies.

Recurrent pregnancy loss (RPL) remains a complex and challenging reproductive issue often associated with immunological abnormalities. This study investigates the immunomodulatory effects of intradermal lymphocyte therapy in RPL patients, exploring cellular, molecular, and cytokine changes, with specific attention to individuals with positive anti-thyroid peroxidase antibodies (Anti-TPO). The study included 105 patients with RPL, divided into Anti-TPO positive RPL patients (n=25), Anti-TPO negative RPL patients (n=38), and RPL patients without lymphocyte immunotherapy (LIT) (n=42). LIT was administered according to a standardized protocol, and various immune parameters including flow cytometry analysis of Th1/Th2, Th17, Treg, and NK cells, real-time PCR analysis of gene expression levels, and ELISA analysis of cytokine levels were assessed before and after LIT. Clinical outcomes including clinical miscarriage rates, delivery or pregnancy rates, and live birth rates were also evaluated. Flow cytometry analysis revealed significant decreases in Th1/Th2 and NK cell percentages post-LIT in both Anti-TPO positive and negative RPL patients. Real-time PCR analysis showed significant alterations in gene expression levels of FoxP3, T-bet, GATA3, RORγt, IL-17, TGF-β, IFNγ, and IL-4 post-LIT in both groups. ELISA analysis demonstrated significant changes in levels of IL-17, TGF-β, IFNγ, and IL-4 post-LIT in both groups. Anti-TPO negative RPL patients with LIT had a lower miscarriage rate (10.53%) compared to Anti-TPO positive RPL patients with LIT (40%). Also, the pregnancy rate and the live birth rate were higher (89.47%) in Anti-TPO negative RPL patients with LIT compared to Anti-TPO positive RPL patients with LIT (60% and 56% respectively). Moreover, the average pregnancy rate and live birth rate were significantly higher in RPL patients with LIT than in those without LIT (30.95%). These findings suggest that while LIT may confer benefits in improving pregnancy outcomes, its efficacy may be influenced by the presence of Anti-TPO Abs. These findings highlight the complex interplay between immune dysregulation and pregnancy outcomes in RPL patients and underscore the need for personalized treatment approaches.

Routine Sperm Cryopreservation before Vasectomy Is Not Cost-Effective and Does Not Increase Live Birth Rates Compared to Surgical Sperm Retrieval or Vasectomy Reversal.

To determine if routine pre-vasectomy sperm cryopreservation is more cost-effective than fertility restoration for patients who desire additional children following vasectomy? A scoping review was performed to collect published data regarding efficacy and outcomes of cryopreservation, vasectomy reversal, surgical sperm retrieval, and assisted reproductive technologies (ART). Cost data were collected from US-based facilities performing cryopreservation and andrology clinical care. A cost-effectiveness model was generated using TreeAge Pro cost-effectiveness modeling software with three different variations representing a balanced scenario with median expected parameter values, a scenario with assumptions/variables favoring pre-vasectomy cryopreservation, and a scenario favoring fertility restoration. The primary outcome was cost per live birth and the secondary outcome was overall live birth rate. Pre-vasectomy cryopreservation cost ($140,247, range $48,232 - $552,807 per live birth) was significantly higher than with fertility restoration ($20,059, range $20,059 - $30,698). Surprisingly, pregnancy success rates appeared to be incrementally higher in the fertility restoration group (62%, range 44% - 66%) compared to cryopreservation (46%, range 36% - 58%) when using published literature values. Routine sperm cryopreservation prior to vasectomy conveys a significantly higher cost to patients and the healthcare system and does not appear to increase live birth rate compared to fertility restoration with sperm retrieval or vasectomy reversal. Patients without fertility risk factors should be counseled on the added cost and need for ART with pre-vasectomy cryopreservation but should still be allowed to proceed if desired.

The Impact of Dating Twin Pregnancy by the Larger, Smaller or Mean Twin Crown-Rump Length: A Retrospective Cohort Study.

To evaluate the impact of twin dating by ultrasound-measured crown-rump length (CRL) of the larger (CRL-L), smaller (CRL-S) or mean twin measurement (CRL-M) on the rates of preterm birth (PTB) and detection of small for gestational age (SGA) births. A retrospective cohort study. A tertiary fetal medicine centre (London, UK). All twin pregnancies between 1998 and 2023 who underwent first trimester CRL ultrasound assessment and fetal growth assessment. Data collection included CRL measurement, estimated fetal weight (EFW), pregnancy outcome and birthweight (BW) for each twin. Pregnancies were retrospectively re-dated by CRL-S, CRL-L and CRL-M. SGA < 10th centile and extreme PTB rates (< 28 weeks). In the 1129 twin pregnancies, median CRL-S was 61 mm (interquartile range [IQR]: 56.0-66.0) and CRL-L was 63 mm (IQR: 58.4-68.9) with a mean discordance of 4.0%. Prenatal SGA diagnosis occurred in 19.8% and 23.1% of smaller twins when dated by CRL-S and CRL-L, respectively. When pregnancies were dated by CRL-M versus CRL-S or CRL-L, there was no difference in prenatal SGA diagnosis (p = 0.275 and p = 0.419); SGA at birth (p = 0.132 and p = 0.325); or extreme PTB (p = > 0.999 and p = 0.765 respectively). Dating by the smaller, larger or mean twin CRL does not significantly alter rates of extreme preterm birth, SGA detection or SGA birth. Dating by the mean twin CRL reduces stigmatisation of the smaller twin and retains the utility of accurate gestational age assessment without impacting clinical outcomes.

Association of serum vitamin D level and live birth rate in women undergoing frozen embryo transfer-a retrospective cohort study.

To assess the association of serum vitamin D level and the live birth rate in women undergoing frozen embryo transfer (FET). This is a retrospective cohort study involving 1489 infertile women who had frozen embryo transfer at two tertiary reproductive medicine centres from 2019 to 2021. Only the first frozen embryo transfer was included for women who had repeated transfers during the period. Archived serum samples taken at LH surge or before the start of progestogens for FET were analysed for 25(OH)D levels using mass spectrometry. The main outcome measure was the live birth rate. Vitamin D deficiency was defined as serum 25(OH)D < 50nmol/l (< 20ng/ml) based on the Endocrine Society Clinical Practice guidelines. The median age was 36 (25th-75th percentile 34-38) years. 37.7% (561/1489) women had cleavage stage embryo transfer and 62.3% (928/1489) women had blastocyst transfer. When analysing the results based on the threshold in the Endocrine Society guideline of 50 nmol/l (20 ng/ml) for vitamin D deficiency, there were no statistically significant differences in the live birth rate in the vitamin D deficient and non-deficient groups [151/489 (30.9%) vs 341/998 (34.2%), OR 0.861, 95% CI 0.683-1.086 P = 0.205]. There were no statistically significant differences in the pregnancy rates, ongoing pregnancy rates, and miscarriage rates between the two groups. Serum vitamin D is not associated with birth rate in women undergoing FET.

Ultra-Fast Warming Procedure of Vitrified Blastocysts Results in Maintained Embryology and Clinical Outcomes.

Vitrification has revolutionized embryo cryopreservation, but represents a significant workload in the IVF lab. We evaluated here an ultrafast blastocyst warming procedure in order to improve workflow while maintaining clinical outcome. We first evaluated the expression of main markers of lineage specification in a subset of blastocysts donated to research warmed with ultrafast protocol. We then performed a prospective pseudo-randomized pilot study comparing blastocyst survival, reexpansion and live birth rates between standard (3 steps, 15min), and ultrafast warming protocol (1 step, 2min). Finally, survival, reexpansion and live birth rates (LBR) obtained with ultrafast warming protocol were prospectively collected during 3months and compared with previous indicators. Immunofluorescence experiments showed that staining and spatial organization of cell fate markers were conserved with ultrafast protocol. Survival, reexpansion and LBR were strictly comparable between standard (n = 47 cycles) and ultrafast (n = 39 cycles) groups in the pilot study (100 vs 100%, 80 vs 76% and 29.8 vs 30.7% in standard and simplified groups respectively). Survival, expansion and LBR obtained with the ultrafast warming protocol over the next 3-month period (321 cycles, 336 embryos) were comparable with those obtained with the standard protocol throughout the 6months (547 FBT cycles, 578 embryos) preceding shifting protocol (97.6 and 29.6% vs 97.8 and 28.3% respectively, p > 0.05 for both). In conclusion, using an ultrafast blastocyst warming procedure results in similar embryology and clinical outcomes compared with standard protocol, but significantly shortens the technical procedure, ultimately improving the overall lab's workflow.

Oocyte maturation defect in women undergoing IVF: contributing factors and effects on mature sibling oocyte outcomes.

This study aimed to identify demographic and clinical factors associated with low maturation rates and to investigate if the rate of immature oocytes impacts the outcomes of mature sibling oocytes. Women undergoing their first IVF-ICSI cycle between 2018 and 2022 at a fertility clinic were included. Cycles were classified into five groups according to the proportion of Metaphase II stage oocytes (MII): Null (0% MII, n = 46), Poor (1-25% MII, n = 44), Low (26-50% MII, n = 453), Acceptable (51-75% MII, n = 1641), and Optimal (76-100% MII, n = 2642). Demographic characteristics and clinical outcomes were compared between the five groups. In patients with a Null/Poor maturation rate, subsequent cycle outcomes were also evaluated. A total of 4826 cycles were included in the study; 69,909 oocytes were recovered, and 53,065 were MIIs (75.9%). The Null group was older, had lower levels of anti-Müllerian hormone (AMH), needed more gonadotropins and days of stimulation, had higher follicle stimulating hormone (FSH) levels on day 3, and had less follicles > 15mm on the day of trigger. When the outcomes of mature oocytes were compared, fertilization, usable blastocyst, aneuploidy, and life birth rates were comparable among groups. A binary logistic regression model using number of oocytes, paternal age, and trigger type with live birth rate endpoint found no differences between the categories and the base line Poor category. When patients whose maturation rate was Null/Poor, 42 (47.0%) carried out a second cycle; the maturation rate increased (56.9 ± 31.5 vs. 11.6 ± 11.2%, P < 0.0001). Our data suggest that poor responders are more likely to have low rates of oocyte maturation. The proportion of immature oocytes does not impact the outcomes of mature sibling oocytes. In patients with Null/Poor maturation in their first cycle, the subsequent cycle is often associated with improved maturation rates.

Could cleaved embryo morphology and morphokinetics be associated with prenatal and neonatal outcomes?

To evaluate if morphology and morphokinetics of cleaved embryos affect prenatal and perinatal outcomes. This retrospective cohort study included 734 single fresh embryo transfer (SET) from ICSI from January 2014 to December 2020 at the Dijon University Hospital. Using time-lapse technology, embryos were defined as TOP or non-TOP according to morphological/morphokinetic criteria. Linear regression, adjusted for maternal factors, explored the association between cleaved-embryo quality and implantation rate, miscarriage rate, live birth rate, term, birthweight, and birthweight Z-score. Multivariate analyses showed that non-implanted embryos were significantly more often out of the interquartile range than implanted embryos for cell events t2 (p = 0.019), t3 (p = 0.038), t4 (p = 0.013), ECC1 (p = 0.047), and ECC2 (p = 0.001). After implantation, the morphokinetics was significantly different for non-TOP embryos ending in miscarriage or live birth. A significant high risk of miscarriage was found for embryos with a short or long ECC1 (3.27 [95% CI: 1.44;8.37]. There was no significant difference in birthweight, birthweight Z-score, or term between TOP and non-TOP embryos. An association with increased birthweight was observed in multivariate analysis for pronuclei appearance (tPNa) (p = 0.001out of the range. Late tPNa was associated with a higher birthweight Z-score (p < 0.0001) while late pronuclei disappearance (tPNf) was associated with a lower Z-score (p = 0.006). Morphological and morphokinetic parameters significantly influence implantation rates and the likelihood of a live birth from embryos with non-optimal morphological features. Birthweight Z-scores were significantly higher with late tPNa and lower with late tPNf.

Prevalence, characteristics, and adverse birth outcomes of teen births in West Virginia: A population-based study.

Despite falling teen birth rates in the United States, there is a disproportionate burden of teen births in rural regions. The study aims to investigate the characteristics of teenage mothers and examine the relationships between teen birth and adverse birth outcomes in the rural Appalachian state of West Virginia (WV). Data was obtained from a population-based cohort (Project WATCH) of all singleton live births in WV between May 2018 and April 2023. The primary exposure variable was mothers who gave birth when they were less than 20 years old (teenage births v. adult). Primary outcomes included birthweight, gestational age, NICU admission, 5-minute Apgar score, and breastfeeding status. Of 86,447 live births, 5,310 (6.15%) were birth to teenage mothers. Maternal characteristics of teenage mothers included minority racial groups, lower education, Medicaid, rural residence, and inadequate prenatal care. Teenage births were associated with lower mean birthweight aMD [b = -49.31g. (-65.37, -33.24)], low birthweight [<2500g. vs. ≥2500 g., aRR = 1.11 (1.0, 1.24)], and small for gestational age [v. appropriate for gestational age, aRR = 1.21 (1.12,1.30)]. Teenage mothers were less likely to exclusively breastfeed at discharge [aRR, 1.20 (1.11, 1.28)]. Analyses adjusted for maternal race/ethnicity, education, health insurance, smoking, substance use, prenatal care, diabetes, and residence type. Teenage births are high in WV and are linked to adverse infant outcomes. These findings may help identify at-risk groups for support and provide policymakers with information to design effective interventions to prevent teenage births and its negative outcomes.

Optimising Luteinising Hormone Levels on Trigger Day for Improved Ovarian Response and Pregnancy Outcomes in Gonadotropin-Releasing Hormone Antagonist Protocols: A Retrospective Cohort Study.

To determine the optimal luteinising hormone (LH) level on the trigger day and its impact on pregnancy outcomes in gonadotropin-releasing hormone (GnRH) antagonist protocols using a data-driven approach. Retrospective cohort study. Third Affiliated Hospital of Guangzhou Medical University. Overall, 6107 invitro fertilisation/intra-cytoplasmic sperm injection fresh embryo transfer cycles with GnRH-antagonist protocols were performed between January 1, 2018 and February 1, 2023. Restricted cubic spline analysis and segmented regression identified the optimal LH threshold. Patients were categorised into low (≤ 1.6 IU/L) and high (> 1.6 IU/L) LH groups. Propensity score matching (PSM) and multivariable logistic regression were applied to adjust for confounding factors. Live birth rate per embryo transfer cycle. The high LH group showed significantly higher live birth rates (42.9% vs. 36.9%, adjusted odds ratio [aOR]: 1.468; 95% CI: 1.220-1.766, p < 0.001), ongoing pregnancy rates (51.4% vs. 43.6%, aOR: 1.498; 95% CI: 1.338-1.678, p < 0.001), clinical pregnancy rates (52.4% vs. 45.6%, aOR: 1.439; 95% CI: 1.285-1.611, p < 0.001) and biochemical pregnancy rates compared with the low LH group, despite retrieving fewer oocytes (median 10 vs. 12, p < 0.001). These results remained consistent after PSM and multivariable logistic regression analysis. Higher LH levels on the trigger day are associated with improved pregnancy outcomes in GnRH-antagonist protocols. Maintaining an optimal LH range is crucial for balancing oocyte yield and assisted reproductive technology success, highlighting the importance of individualised ovarian stimulation protocols.