Receiving Fertility Treatment Research Articles

P-640 Dynamics of IGF signalling during the ovulatory peak in women undergoing ovarian stimulation

Abstract Study question How is the IGF system expressed and regulated during the midcycle surge in women? Summary answer The IGF system becomes downregulated after ovulation trigger (OT) highlighted by a significant upregulation of the inhibitor, stanniocalcin-1, and a downregulation of protease-induced IGF release. What is known already IGF signalling is known to affect human ovarian follicular function during growth and development. Particularly during the preovulatory stage, IGF activity appears to be highly significant and has been proposed as one of the primary factors contributing to the remarkable mitotic activity observed in the granulosa cells (GCs). However, the role and regulation of the IGF system is unknown during the ovulatory peak, which is characterized by profound changes in GC function. Study design, size, duration Follicular fluid (FF) and GCs were collected from fifty women during the ovulatory peak from two specific time-points. One sample was obtained before oocyte pick up (OPU): before OT (T = 0 h (n = 23)), at 12 h (n = 10), 17 h (n = 6), or 32 h (n = 11) after OT, and one sample was obtained at OPU 36 h after OT (n = 50). Participants/materials, setting, methods Fifty women receiving fertility treatment at the Fertility Clinic, Department of Gynaecology and Obstetrics, Holbæk Hospital, Denmark, were included. For ethical reasons, only women who had developed more than eight mature follicles at their final control visit before OT were approached and asked for possible participation. Gene expression profiles were assessed by microarray analysis of GCs. Intrafollicular levels of IGF-related proteins were assessed with immunoassays and a proteinase assay was used to quantify activity. Main results and the role of chance This study presents a novel insight into the dynamics of IGF bioavailability within human ovarian follicles during the midcycle surge of gonadotropins. Notably, this investigation reports a significant downregulation of genes promoting IGF signalling, i.e., IGF-2, PAPPA, and IRS1, along with a concurrent upregulation of genes associated with IGF binding and inactivation, including IGFBPs, IGF2R, and STC1. Particularly, the substantial increase in the inhibitor, stanniocalcin-1 (STC1), at both gene and protein levels likely plays a key role in the downregulation of IGF signalling. Additionally, this study reveals a marked reduction in intrafollicular PAPP-A proteolytic activity after OT, further emphasizing the importance of PAPP-A within human ovaries. In addition, this study indicates a pronounced decline in GC mitotic activity during the midcycle surge, as evidenced by the downregulation of proliferation markers, including MKI67, E2F1, E2F8, and FOXM1, highlighting a substantial decrease in GC proliferation rate during this critical phase. Previous research has demonstrated that IGF signalling stimulates the proliferation and differentiation of cultured human GCs. Therefore, the significant changes in IGF bioavailability observed in human GCs during the ovulatory surge suggest an essential role of IGF signalling in controlling the proliferation and differentiation of GCs within the preovulatory follicle. Limitations, reasons for caution This study highlights the need for future functional studies to confirm a direct mechanism to account for the abrupt cessation of GC proliferation. Differences between using hCG or GnRH agonist for final maturation of follicles were not shown, thus future studies should be powered to reveal effects of the protocols. Wider implications of the findings These data suggest that downregulation of IGF signalling mediated by increased STC1 expression is instrumental for the sudden cessation in GC proliferation and onset of differentiation during the ovulatory peak. Furthermore, this study implies importance of IGF-independent functions of STC1, especially during the ovulatory peak, where elevated levels are observed. Trial registration number Not applicable

Against age limits for men in reproductive care.

Almost all countries and fertility clinics impose age limits on women who want to become pregnant through Assisted Reproductive Technologies (ART). Age limits for aspiring fathers, however, are much less common and remain a topic of debate. This article departs from the principle of reproductive autonomy and a conditional positive right to receive ART, and asks whether there are convincing arguments to also impose age limits on aspiring fathers. After considering three consequentialist approaches to justifying age limits for aspiring fathers, we take in a concrete normative stance by concluding that those are not strong enough to justify such cut-offs. We reinforce our position by drawing a comparison between the case of a 39-year-old woman who wants to become a single mother via a sperm donor on the one hand, and on the other hand the same woman who wants to have a child with a 64-year-old man who she loves and who is willing to care for the child as long as he is able to. We conclude that, as long as appropriate precautions are taken to protect the welfare of the future child, couples who want to receive fertility treatment should never be limited on the basis of the age of the (male) partner. An absence of age limits for men would respect the reproductive autonomy of both the man and the woman.

Exploring the psycho-social burden of infertility: Perspectives of infertile couples in Cape Coast, Ghana.

Infertility is a complex and often sensitive issue with far-reaching psycho-social ramifications for couples and their families. This study therefore seeks to delve into the psycho-social burden of infertility in Cape Coast, a major city in Ghana. Specifically, we explored the impact of infertility on the psychological and social health of infertile couples receiving fertility treatment. It also delves into the strategies they adopt to cope with their conditions. The study employs a qualitative approach to inquiry using phenomenology as a study design to explore the experiences of the study participants. In-depth interviews were conducted using interview guides, voice recorded and transcribed verbatim. Both inductive and deductive/framework coding techniques were used to code the data leading to the generation of themes and sub-themes. The results show that most of the study participants dealing with infertility faced psychological burdens from different sources including their families, society and themselves. These burdens take a toll on their mental health, pushing them into a state of desperation and depression. It was, however, revealed that infertile couples are able to cope with the help of their family, spouses and the church. Curiously, some of them opt for withdrawal from social events as a coping mechanism. Infertility exerts an enormous negative psycho-social impact on affected couples, especially women. The family and society serve as the main sources of stressors for infertile couples. Therefore, programmes that are aimed at fertility treatment should deliberately consider addressing the psychosocial burden of infertility through education targeting actors, especially interpersonal-level actors.

Cardiovascular disease hospitalizations among women who undergo fertility treatment

Research questionAre women who receive fertility treatment at increased risk of cardiovascular disease (CVD) hospitalization compared with women who do not? DesignA retrospective cohort study of all women registered for fertility treatment at Monash IVF between 1998 and 2014. This cohort was linked to the Victorian Admitted Episodes Dataset, which contains records of all hospital admissions in the Australian state of Victoria. Age- and Index of Relative Socioeconomic Disadvantage (IRSD)-adjusted relative risks of CVD hospitalization for women who did or did not undergo fertility treatment were determined using Poisson regression. Risks were calculated overall by CVD subtype and stratified by area-based social disadvantage using IRSD fifths, number of stimulated cycles and mean oocytes per cycle. ResultsOf 27,262 women registered for fertility treatment, 24,131 underwent treatment and 3131 did not. No significant difference was found in risk of CVD hospitalization between treated and untreated women overall (adjusted RR 0.93, 95% 0.82 to 1.05) or by CVD subtype. The admission risk for CVD was significantly lower in treated women who had a mean of fewer than five oocytes per cycle (adjusted RR 0.80, 95% CI 0.70 to 0.92) compared with untreated women. Treated women residing in areas within the second IRSD fifth were less likely to be hospitalized for CVD compared with untreated women (age-adjusted RR 0.66, 95% CI 0.49 to 0.89). ConclusionsFertility treatment is not associated with increased risk of CVD hospitalization. Lower risk among some subgroups of treated women may be explained by social disadvantage.

Evidence for Functional Roles of MicroRNAs in Lineage Specification During Mouse and Human Preimplantation Development.

Proper formation of the blastocyst, including the specification of the first embryonic cellular lineages, is required to ensure healthy embryo development and can significantly impact the success of assisted reproductive technologies (ARTs). However, the regulatory role of microRNAs in early development, particularly in the context of preimplantation lineage specification, remains largely unknown. Taking a cross-species approach, this review aims to summarize the expression dynamics and functional significance of microRNAs in the differentiation and maintenance of lineage identity in both the mouse and the human. Findings are consolidated from studies conducted using in vitro embryonic stem cell models representing the epiblast, trophectoderm, and primitive endoderm lineages (modeled by naïve embryonic stem cells, trophoblast stem cells, and extraembryonic endoderm stem cells, respectively) to provide insight on what may be occurring in the embryo. Additionally, studies directly conducted in both mouse and human embryos are discussed, emphasizing similarities to the stem cell models and the gaps in our understanding, which will hopefully lead to further investigation of these areas. By unraveling the intricate mechanisms by which microRNAs regulate the specification and maintenance of cellular lineages in the blastocyst, we can leverage this knowledge to further optimize stem cell-based models such as the blastoids, enhance embryo competence, and develop methods of non-invasive embryo selection, which can potentially increase the success rates of assisted reproductive technologies and improve the experiences of those receiving fertility treatments.

Mental health status and the quality of life of infertile women receiving fertility treatment in Bangladesh: A cross-sectional study

Infertility poses significant physical and psychological challenges for women of reproductive age. In low- and middle-income countries, the prevalence of depression among infertile women is alarmingly high, reaching 44.32%. Additionally, over 50% of infertile women worldwide experience varying degrees of decline in their quality of life. Therefore, this study aimed to assess the effects of infertility on the mental health status and quality of life of infertile women in Bangladesh. Between December 2022 and March 2023, 375 infertile women in Dhaka, Bangladesh were selected using simple random sampling for this cross-sectional study. The participants’ mental health status was assessed using the Depression Anxiety and Stress Scale (DASS-21), while their quality of life was evaluated by the Short Form-12 (SF-12) scale. The prevalence of depression, anxiety, and stress were 59.7%, 55.0%, and 48.7%, respectively. Multiple logistic regression showed that infertile homemakers had 2.98 (95% CI: 1.30 to 6.80) times the odds of depression than government service holders. Aborted infertile women had 1.8 (95% CI: 1.10 to 3.26) times the odds of depression. Infertile women who married between 20 and 24 years old were 49% (95% CI: 0.27 to 0.98) less anxious than those who married earlier. Low-income infertile women (<30,000 BDT) were 2.29 (95% CI: 1.02 to 5.14) times more likely to be stressed than those with higher incomes (>60,000 BDT). Multiple linear regression analysis suggests that education and infertility diagnosis status significantly affect the Mental Component Summary (MCS-12) scores of the Short Form-12 (SF-12). In contrast, age, occupation, and Body Mass Index (BMI) were the significant predictors for the Physical Component Summary (PCS-12). Policymakers may use lessons learned from this study to incorporate appropriate counseling techniques, social awareness campaigns, and media involvement to control the added burden of infertility on women’s psychological health and quality of life.

Infertility and Risk of Autism Spectrum Disorder in Children

Previous studies on the risk of childhood autism spectrum disorder (ASD) following fertility treatment did not account for the infertility itself or the mediating effect of obstetrical and neonatal factors. To assess the association between infertility and its treatments on the risk of ASD and the mediating effect of selected adverse pregnancy outcomes on that association. This was a population-based cohort study in Ontario, Canada. Participants were all singleton and multifetal live births at 24 or more weeks' gestation from 2006 to 2018. Data were analyzed from October 2022 to October 2023. The exposure was mode of conception, namely, (1) unassisted conception, (2) infertility without fertility treatment (ie, subfertility), (3) ovulation induction (OI) or intrauterine insemination (IUI), or (4) in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). The study outcome was a diagnosis of ASD at age 18 months or older. Cox regression models generated hazard ratios (HR) adjusted for maternal and infant characteristics. Mediation analysis further accounted for the separate effect of (1) preeclampsia, (2) cesarean birth, (3) multifetal pregnancy, (4) preterm birth at less than 37 weeks, and (5) severe neonatal morbidity. A total of 1 370 152 children (703 407 male [51.3%]) were included: 1 185 024 (86.5%) with unassisted conception, 141 180 (10.3%) with parental subfertility, 20 429 (1.5%) following OI or IUI, and 23 519 (1.7%) following IVF or ICSI. Individuals with subfertility or fertility treatment were older and resided in higher-income areas; the mean (SD) age of each group was as follows: 30.1 (5.2) years in the unassisted conception group, 33.3 (4.7) years in the subfertility group, 33.1 (4.4) years in the OI or IUI group, and 35.8 (4.9) years in the IVF or ICSI group. The incidence rate of ASD was 1.93 per 1000 person-years among children in the unassisted conception group. Relative to the latter, the adjusted HR for ASD was 1.20 (95% CI, 1.15-1.25) in the subfertility group, 1.21 (95% CI, 1.09-1.34) following OI or IUI, and 1.16 (95% CI, 1.04-1.28) after IVF or ICSI. Obstetrical and neonatal factors appeared to mediate a sizeable proportion of the aforementioned association between mode of conception and ASD risk. For example, following IVF or ICSI, the proportion mediated by cesarean birth was 29%, multifetal pregnancy was 78%, preterm birth was 50%, and severe neonatal morbidity was 25%. In this cohort study, a slightly higher risk of ASD was observed in children born to individuals with infertility, which appears partly mediated by certain obstetrical and neonatal factors. To optimize child neurodevelopment, strategies should further explore these other factors in individuals with infertility, even among those not receiving fertility treatment.

Wishes and obstacles to having children – Results from the nationwide Healthy Finland survey

Abstract Background Fertility rates have been declining globally since 2010, also in the Nordics. In Finland this decline has been steep and the country has now hit lowest fertility level ever. Changes in fertility rates often occur with economic status and life expectancy improvements in a population. In Finland, delaying childbearing is a major cause for declining fertility rates. The aim of this study was to examine how ethical, economic and societal factors affect having children. Methods In total 65,986 randomly selected adults living in Finland were invited to answer the Healthy Finland questionnaire-based survey in 2022-2023. Subjects (n = 28,480, participation rate 32.3 %, males 42.1 % and females 57.9 %) aged 20 to 54 years were asked questions on childlessness and infertility. Results 17.6% of subjects reported not wanting more or any children while 9.3% wanted to have (more) children. 14.7% reported never wanting to having nor wanting to have children. 4.2% reported having had an experience of infertility and 3.1% reported receiving fertility treatments. Currently 0.5 % were expecting a baby and 1.5% actively trying for a baby. In the sample population, most common reasons for not having children were economic situation (6.2%), never wanting to have children (6.1%), relationship situation (5.9%), and work or studies (5.6%). Other reasons included capability issues (4.3%), ecological or environmental reasons (4.1%), other miscellaneous reasons (4.0%), and loneliness or lack of social network (3.9%), lack of societal support (3.2%), and own, spousal or family illnesses (2.9%). Conclusions While childlessness may be a temporary state in many people's lives, close to every seventh person chooses it permanently. Several external reasons affect voluntary childlessness ranging from ethical to practical. Further data is needed to evaluate the societal and economic obstacles to make childlessness a truly voluntary choice. Key messages • The Healthy Finland population survey provides information on the major causes of voluntary childlessness, including economic reasons and never wanting to have children. • In this population, every seventh person did not have nor ever want to have children.

Pregnancy outcomes following natural conception and assisted reproduction treatment in women who received COVID-19 vaccination prior to conception: a population-based cohort study in China.

The coronavirus disease-2019 (COVID-19) pandemic has swept across the world and continues to exert serious adverse effects on vulnerable populations, including pregnant women and neonates. The vaccines available at present were designed to prevent infection from COVID-19 strains and control viral spread. Although the incidence of pregnancy cycle outcomes are not likely to increase patients vaccinated prior to pregnancy compared with unvaccinated patients based on our knowledge of vaccination safety, there is no specific evidence to support this hypothesis. Therefore, the current study aimed to investigate the association between maternal vaccination prior to conception and pregnancy outcomes. We retrospectively analyzed 2,614 women who received prenatal care and delivered in the Obstetrical Department of The First Affiliated Hospital of Anhui Medical University between February 2022 and November 2022. Of the 1,380 eligible pregnant women, 899 women who had received preconception vaccination were assigned to a vaccine group and 481 women who were not vaccinated were control group. Of the enrolled patients, 291 women received fertility treatment (141 vaccinated women, 150 unvaccinated women). The primary outcomes were pregnancy complications (hypothyroidism, gestational diabetes mellitus, pregnancy-induced hypertension, polyhydramnios, oligohydramnios, premature rupture of membranes and postpartum hemorrhage), obstetric outcomes (preterm birth rate, cesarean section rate) and neonatal outcomes (birth-weight, body length, low-birth-weight rate, rate of congenital defects, neonatal mortality and admission to the neonatal intensive care unit). There was no significant difference in the incidence of complications during pregnancy and delivery when compared between the vaccine group and control group in either univariate- or multivariate-models. The type of vaccine was not associated with the odds of adverse pregnancy outcome. Among the women with infertility treatment, the vaccinated group and the unvaccinated group had similar pregnancy outcomes. Women who received COVID-19 vaccination prior to conception had similar maternal and neonatal outcomes as women who were unvaccinated. Our findings indicate that COVID-19 vaccinations can be safely administered prior to pregnancy in women who are planning pregnancy or assisted reproductive treatment. During new waves of COVID-19 infection, women who are planning pregnancy should be vaccinated as soon as possible to avoid subsequent infections.

Fertility treatments and breast cancer risk: A case control-retrospective study

Objective: To investigate a possible association between fertility treatments and breast cancer (BC) risk in Greek women. Material-Methods: A series of 391 women who visited two breast clinics in Greece were studied in our case-control retrospective study. The case group comprised 238 women with BC, while the control group had 153 women without BC. All participants were examined clinically and also with breast ultrasound, while those aged over 40 years underwent digital bilateral mammography. All women answered a questionnaire about whether they had received fertility treatment. Results: Using the Chi-square test, there appears to be no significant statistical association between fertility treatments and BC (p=0.178). Conclusion: This study did not find a significant association between fertility treatments and BC risk. Further studies with a larger number of patients are mandatory in order to confirm this result. Women considering fertility treatments such as IVF should be informed that it does not appear to increase BC risk.

Ovarian reserve in women with cystic fibrosis: is this a cause of sub-fertility?

BackgroundOver the past two decades, increasing number of people with cystic fibrosis (CF) survive into adulthood. Compared to the general population, sub-fertility is an obstacle for many women with CF (wwCF). Decreased ovarian reserve has been proposed as a possible cause, but limited data is available to support this. The aim of this study was to evaluate the ovarian reserve in wwCF and to correlate this with patients’ demographic and clinical data.MethodsReproductive-aged wwCF were enrolled during their routine medical appointments. Assessment included Anti-Mullerian hormone (AMH) levels, routine blood tests and antral follicular count (AFC) evaluation. Additionally, demographic, and clinical information were collected.ResultsA total of wenty-three wwCF were enrolled, with ages ranging from 19 to 40 years (median 27 years). Among the fourteen wwCF who were considering pregnancy, five (35.7%) disclosed undergoing an infertility assessment and receiving fertility treatments. All but one patient had an Anti-Mullerian hormone (AMH) level between the 5th and 95th % for age. Measurement of the antral follicular count (AFC) was possible in 12 of the 23 patients and was ranging 8–40 with a median of 17. The proportion of wwCF presenting below median AMH values was not different in sub-fertile as compared to fertile wwCF (P value 0.54). There were no correlations between AMH levels and disease severity parameters. AMH seemed to be relatively higher in wwCF with mild class mutations, but this was not shown to have statistical significance.ConclusionsOur results, in contrast with the limited available published data, do not support the hypothesis that decreased ovarian reserve plays a major role in infertility in wwCF.

P-441 Frequency of sexual intercourse and fecundability among women trying to conceive in Japan

Abstract Study question To what extent is the frequency of sexual intercourse associated with fecundability? Summary answer Frequency of sexual intercourse was the most influential factor in achieving pregnancy but was low among women trying to conceive in Japan. What is known already The Japanese National Fertility Survey showed that 39% of married couples had experienced some fertility problems. A recent national survey revealed that 47% of married couples were sexless. The effect of intercourse frequency on time-to-pregnancy (TTP) has not been well investigated in Japan despite the high prevalence of fertility problems and sexless marriages. Study design, size, duration We used a social research panel in Japan to conduct an internet-based preconception cohort study of pregnancy planners who were not undergoing fertility treatment. In total, 3,796 women were enrolled in February 2021 and followed up for six months. We used data from 2,371 (62%) participants who discontinued contraception. Participants/materials, setting, methods Participants were married women between the ages of 25 and 39 who planned to conceive within a year but were not pregnant at the time of enrolment. Those receiving fertility treatment or trying to conceive for more than six months were excluded from the recruitment. Participants reported frequency and timing of intercourse along with sociodemographic and lifestyle factors. TTP was measured in months, and discrete-time Cox regression was used to estimate fecundability odds ratios (FORs). Main results and the role of chance Of the 2,371 women, 31% had intercourse “less than once in a few months” (hereafter, the Lowest Frequency), 54% had intercourse “several times per month” (hereafter, the Middle Frequency), and 15% engaged in intercourse “several times or more per week” (hereafter, the Highest Frequency). Higher frequency groups were younger, were married for a shorter period, and were less likely to have kids (all Ps for trend<0.05). Adjusted FORs of the Middle and the Highest Frequency groups were 2.20 (95% confidence interval [CI]: 1.56—3.10) and 3.41 (95% CI:2.29—5.08), respectively, resulting in a shorter TTP compared to the Lowest Frequency group. Covariates showing significant associations with fecundability were timed intercourse of fertile window (adjusted FOR=1.76, 95% CI: 1.37—2.27), folic acid and/or multivitamin use (adjusted FOR=1.44, 95%CI: 1.12—1.84), and participant age (adjusted FOR=0.96, 95% CI: 0.92—0.99), whereas the other variables, such as partner age, sociodemographic factors, health indicators (e.g., body mass index, cycle regularity), or lifestyles (e.g., smoking, physical activity), did not show significant associations. Limitations, reasons for caution Intention to conceive could be a confounder, although we used timed intercourse as a proxy measure. Misclassification may have occurred due to self-reported information. Wider implications of the findings Occasional intercourse among pregnancy planners might be linked to the high prevalence of infertility in Japan through a direct reduction in fecundability before the age-related fertility decline. Informing couples about the frequency of intercourse and TTP might help them achieve pregnancy earlier. Trial registration number NA

The Impact of the Microbiological Vaginal Swab on the Reproductive Outcome in Infertile Women.

The thesis on which this paper is based intended to investigate whether the result of the microbiological vaginal swab has an influence on the outcome of the fertility treatment. The microbiological vaginal swabs of patients who received fertility treatment at Saarland University Hospital were evaluated. Depending on the microorganisms detected, the swab result was classified as inconspicuous, intermediate, or conspicuous. The SPSS software was used to determine the correlation between the swab result and the outcome of the fertility treatment. Dysbiosis was associated with a worse outcome of fertility treatment. The pregnancy rate with a conspicuous swab was 8.6%, whereas it was 13.4% with an inconspicuous swab. However, this association was not statistically significant. Furthermore, an association of endometriosis with dysbiosis was found. Endometriosis was more frequent with a conspicuous swab result than with an inconspicuous result (21.1% vs. 17.7%), yet the correlation was not statistically significant. However, the absence of lactobacilli was significantly associated with endometriosis (p = 0.021). The association between endometriosis and a lower pregnancy rate was also statistically significant (p = 0.006). The microbiological vaginal and cervical swabs can be used as predictors for the success of fertility treatments. Further studies are needed to assess the impact of transforming a dysbiotic flora into a eubiotic environment on the success of fertility treatments.

Intrauterine Insemination (IUI) Pregnancy Rates After COVID-19 Vaccination [ID: 1376042

INTRODUCTION: Public concern over the potential negative effect of COVID-19 vaccines on fertility has persisted, as confidence in COVID-19 vaccines remains low, especially in certain Midwestern populations. We evaluated the success of intrauterine inseminations (IUIs) in achieving pregnancy in women who self-report receiving at least one dose of the vaccine against SARS-CoV-2, compared with women who self-report declining the vaccine. METHODS: This is a retrospective cohort study of 109 IUI procedures in women receiving fertility treatment at the University of Missouri Reproductive Endocrinology and Infertility clinic from October 2021 through September 2022. Participants were grouped based on self-reported COVID-19 vaccination status, prior to their IUI. The primary outcome was pregnancy after IUI, as verified by a serum pregnancy test. This study was performed under University of Missouri IRB approval (IRB #MU2062683). RESULTS: In comparing women self-reporting COVID-19 vaccination versus nonvaccination, no statistical differences were found for positive serum pregnancy tests after IUI (17.3% among vaccinated; 21.7% among nonvaccinated). Although these IUI success rates are higher than the national average, there was no significant difference in pregnancy rates (P=.6331). CONCLUSION: In this limited sample, self-reported COVID-19 vaccination status does not appear to have a significant negative effect on the ability to conceive a pregnancy with IUI. Further prospective studies should evaluate the effect of male partner or sperm donor vaccination, the number and type of COVID-19 vaccines received, pregnancy outcomes, and confounders. This study may help address the ongoing questions of whether the COVID-19 vaccines have a significant negative effect on fertility and pregnancy outcomes.

Time-to-conception and clinical pregnancy rate with a myo-inositol, probiotics, and micronutrient supplement: secondary outcomes of the NiPPeR randomized trial

To determine whether a combined myo-inositol, probiotics and micronutrient nutritional supplement impacts time-to-natural-conception and clinical pregnancy rates. Secondary outcomes of a double-blind randomized controlled trial. Community recruitment. Women aged 18 to 38 years planning to conceive in the United Kingdom, Singapore, and New Zealand, excluding those with diabetes mellitus or receiving fertility treatment. A standard (control) supplement (folic acid, iron, calcium, iodine, β-carotene), compared with an intervention additionally containing myo-inositol, probiotics, and other micronutrients (vitamins B2, B6, B12, D, zinc). Number of days between randomization and estimated date of natural conception of a clinical pregnancy, as well as cumulative pregnancy rates at 3, 6, and 12 months. Of 1729 women randomized, 1437 (83%; intervention, n=736; control, n=701) provided data. Kaplan-Meier curves of conception were similar between intervention and control groups; the time at which 20% achieved natural conception was 90.5 days (95% confidence interval: 80.7, 103.5) in the intervention group compared with 92.0 days (76.0, 105.1) in the control group. Cox's proportional hazard ratios (HRs) comparing intervention against control for cumulative achievement of pregnancy (adjusted for site, ethnicity, age, body mass index, and gravidity) were similar at 3, 6, and 12 months. Among both study groups combined, overall time-to-conception lengthened with higher preconception body mass index, and was longer in non-White than in White women. Among women who were overweight the intervention shortened time-to-conception compared with control regardless of ethnicity (12-month HR=1.47 [1.07, 2.02], P=.016; 20% conceived by 84.5 vs. 117.0 days) and improved it to that comparable to nonoverweight/nonobese women (20% conceived by 82.1 days). In contrast, among women with obesity, time-to-conception was lengthened with intervention compared with control (12-month HR=0.69 [0.47, 1.00]; P=.053; 20% conceived by 132.7 vs. 108.5 days); an effect predominantly observed in non-White women with obesity. Time-to-natural-conception and clinical pregnancy rates within a year were overall similar in women receiving the intervention supplement compared with control. Overweight women had a longer time-to-conception but there was suggestion that the supplement may shorten their time-to-conception to that comparable to the nonoverweight/nonobese women. Further studies are required to confirm this. clinicaltrials.gov (NCT02509988).

The cost of preterm birth and cesarean section as a result of infertility and its treatment: A review.

Infertility, irrespective of receipt of fertility treatment, is associated with an increased risk of adverse pregnancy outcomes, including cesarean section (CS) and preterm birth (PTB). These complications are associated with significant physical, mental, emotional, social, and financial costs to individuals, healthcare systems, and society at large. Although multiple pregnancy is one of the most significant contributors to the elevated CS and PTB rates in women receiving fertility treatment, singleton pregnancy is also at an increased risk of these outcomes. Single embryo transfer policies through publicly funded invitro fertilization programs have demonstrated beneficial health outcomes and cost savings. Low-dose aspirin prophylaxis may be considered for PTB reduction in patients with infertility. Finally, upstream prevention strategies such as lifestyle modification and social policies to address the underlying needs for fertility treatment may also beneficially impact both CS and PTB rates.

Psychological Issues among Women Undergoing Fertility Treatment in a Specialist Fertility Hospital, South East Nigeria

Introduction: In Nigeria, a major reason for marriage is procreation and married couples look forward to having children within a year or two of marriage. The inability to achieve conception and subsequently have a child among couples may lead to psychological complications. Objective: This study assessed the psychological impact of infertility and its management on women receiving treatment at a Fertility Specialist Hospital in a poor resource setting. Methods: This was a cross-sectional study of 376 consenting married women who sought and received fertility treatment at a private Fertility Specialist Hospital, located at Abakaliki, South-East Nigeria between May 1, 2017 and May 31, 2022. Socio-demographic and Structured questionnaires were administered to the participants over a 5-year period. Results: The mean age of the women at presentation was 36.9 (±7.2 SD) years. The majority of the women (227) presented with secondary infertility accounting for 60.4%, while the rest had primary infertility (χ2 = 16.18, P = 0.001). Male-only factor infertility accounted for 22.9% of all the infertility cases, female-only factor 21.3% while both (male and female factors co-existing) accounted for 52.7% of all the cases. The commonest cause of infertility in the study was poor sperm parameters (176) accounting for 46.8% of cases, tubal factor 19.1% and anovulatory factor 22.3% (χ2 = 214.21, P = 0.001). Three hundred and thirty four (88.8%) felt depressed, 266 (70.7%) felt guilty about the past, and 222 (59.0%) had suicidal tendencies because of the infertility ordeal. Two hundred and fifty one (66.8%) felt inferior, 237 (63.0%) cried often and 174 (46.3%) were socially withdrawn. However, 10.4% of the women felt satisfied and well. These negative psychological feelings were statistically significant. Concerning the effect on marriage, the closeness of couples was reduced significantly in 57.7%, 62.8% had reduced coital intimacy, 79.3% had frequent quarrel and misunderstanding, 27.9% had threats of divorce while 4.5% had actually divorced and 11.% separated. However, there was no negative effect of infertility in 8.8% of couples. Conclusion: Psychological issues associated with infertility and its management in women include feelings of depression, guilt feelings, suicidal ideation, weeping episodes, social withdrawal, feelings of inferiority, reduced libido, and poverty of intimacy with frequent quarrels and misunderstanding. Women appear to bear more of the psychological issues associated with infertility. Early marriage on the part of the women, preservation of their reproductive youthful ages, and a better understanding of the concept of infertility by the couple will not only reduce the prevalence of infertility but will also reduce the dangerous psychological issues associated with infertility.

The Incidence of Moderate and Severe Ovarian Hyperstimulation Syndrome in Hospitalized Patients in China.

Ovarian hyperstimulation syndrome (OHSS) occurs in women receiving fertility treatments. Moderate and severe OHSS cases are required to be admitted to hospital for treatment. The incidence of moderate and severe OHSS and the characteristics of these cases are unknown in China. We aimed to assess the incidence of moderate and severe OHSS in national databases from China between 2013 and 2017. We extracted moderate and severe OHSS cases from the Hospital Quality Monitoring System, the nationwide inpatient data collection system. We used ovum pick-up (OPUbaidu) cycle data from the annual report of China's National Health Commission, developed on the basis of OPU data collected by National ART Management Information System. Overall incidence of moderate and severe OHSS (women aged 20 to 50 years) and year-specific incidence by each calendar year in China were calculated. We also investigated the age distribution in OHSS and OHSS with different comorbidities. We extracted 18,022 eligible patients with moderate or severe OHSS and 1,581,703 OPU cycles. The overall incidence of moderate and severe OHSS between 2013 and 2017 was 1.14%. The year-specific moderate and severe OHSS incidence was 1.1% in 2013, 1.4% in 2014, 1.4% in 2015, 1.1% in 2016, 0.9% in 2017, respectively. Women aged 26 to 30 years accounted for 48.4% of OHSS cases, followed by women aged 31 to 35 years (30%) and 20 to 25 years (14.2%). The age distribution pattern was consistent across OHSS with different comorbidities. This study reported the incidence of moderate and severe OHSS in China using nationwide data for the first time. Our findings support that women aged under 35 years receiving assisted reproductive technology need more attention than other age groups in terms of OHSS risk control.

Risk of ovarian hyperstimulation syndrome in infertile patients with PCOS treated by HP HMG

Polycystic ovarian syndrome (PCOS) is the commonest endocrinopathy affecting women in reproductive age group. The prevalence may vary from 8.7% to 17% depending on clinical criteria used. PCOS in women having IVF presents multiple challenges ranging from a poor to an exaggerated response, poor fertilization, poor blastocyst conversion and ovarian hyperstimulation syndrome (OHSS). OHSS is at increased risk in PCOS patients receiving fertility treatments varying from mild to severe cases which can be life threatening. Aim of the study: The presence of OHSS in infertile PCOS patients who followed non-pituitary down regulation protocol by using HP HMG injections. Materials and methods: The study type was case series study. It was done in Lamis IVF center - Misurata / Libya during the period 1- 9 -2021 to 31- 8 -2022. 118 infertile patients with PCOS were randomly selected for the study. All patients were selected started ovulation induction with non-pituitary down regulation protocol using highly purified HMG injections. Results: The age of the patients ranges between 18 and 45 years with a mean age of 30 years. The mean number of retrieved oocytes was 19.33 ± 10. The study also showed that the mean number of mature oocytes picked up was 9.41 ± 5.5 with mean success of 77.6%. Hyperstimulation syndrome was reported only in one case (prevalence of 0.8%) which was mild (needed no admission). Regarding the embryo, the mean number of transfers was 2.36 ± 0.6 with two cases showed no fertilization and 82 cases were associated with poor sperm. Conclusion: In our study OHSS in PCOS patients treated by highly purified HMG injections developed in only one case which was mild (needed no admission).

Variation in Anti-Mullerian Hormone Levels with Age in Women Accessing In Vitro Fertilization Services in Ghana

Background: The emergence of AMH as a reliable biomarker for assessing ovarian reserve and optimization of assisted reproductive technology (ART) remains a promising tool for the evaluation and prediction of controlled ovarian stimulation (COS) outcomes. This study assessed the association between serum AMH levels and maternal age in females receiving in vitro fertilization (IVF) treatment in Ghana. Methods: We conducted a prospective cohort study at a specialized fertility center in Ghana. Descriptive analysis was performed, and the differences between maternal age and AMH categories were assessed by the Kruskal–Wallis test. Results: We included 426 women with mean (±SD) age and AMH levels of 35.25 ± 6.33 years and 2.80 ± 2.60 ng/mL, respectively. Women with very-low AMH levels (0.94 ± 73 ng/mL) were older (>40 years), whereas the younger (20–25 years) group had higher levels (4.85 ± 3.34 ng/mL). There was a significant negative correlation between women’s age and serum AMH levels (R = −0.46; p < 0.001). None of the younger women had AMH levels <0.30 ng/mL, while 70% of women who had AMH levels of <0.30 ng/mL were older women (>40years). In addition, none of the older women had AMH levels >4 ng/mL with only 5% having AMH levels between 2.20 and 4.0 ng/mL. Conclusions: AMH levels ≤0.3 ng/mL are archetypal of 70% of Ghanaian women >40 years old receiving fertility treatment. A combined assessment of AMH levels and age supports clinical decisions in predicting ovarian response to controlled ovarian stimulation (COS) and may be valuable in predicting of IVF success. Further research to evaluate the combined use of age, AMH, and other ovarian reserve markers in assessing ovarian response to COS is recommended.