Reproductive Treatment Research Articles

P-293 Influence of the endometrial microbiota composition on the clinical outcomes of egg donation PGT-A cycles with controlled endometrial receptivity

Abstract Study question Does the endometrial microbiota composition and diversity influence embryo implantation and pregnancy evolution in assisted reproduction treatment (ART) cycles? Summary answer Endometrial microbiota composition influences ART success. Detection of endometrial pathogens is associated with poor outcomes whereas sterile endometria show the highest pregnancy and live-birth rates What is known already The endometrial microbiota has emerged as a possible influencing factor in the results of ART. Recent research suggests its impact on female reproductive health, particularly in patients with chronic endometritis (CE), where the presence of microbial pathogens associated with this condition has been linked to infertility. In turn, the bioregulatory role of species of Lactobacillus in this tissue has been explored, although its essentiality or benefit for female reproductive function continues to be topics of debate. Study design, size, duration This is a case-control retrospective study analysing for the first time the influence of the endometrial microbiota composition on the clinical outcomes of 220 women undergoing egg donation cycles with Preimplantation Genetic Testing for Aneuploidy (PGT-A) and controlled endometrial receptivity between March 2016 and April 2021 in IVF-Life Alicante (Spain). ART results after the transfer of a single euploid blastocyst in the WOI of patients with different endometrial microbiota profiles were analysed and compared. Participants/materials, setting, methods Presence of 18 microbial CE pathogens and 4 Lactobacillus species was determined by high-throughput qPCR (MicrobioMap®, iGLS) in endometrial samples obtained during the WOI of a hormone replacement therapy cycle. In all cases, PGT-A by next generation sequencing (NGS) (EmbryoMap, Vitrolife) and study of endometrial receptivity by gene expression analysis (ER Map, iGLS) were performed. Clinical outcomes (β-hCG+, β+ and live birth, LB) in relation to the endometrial microbiota profile were analysed and compared. Main results and the role of chance In the study, 31.8% of patientś endometria were identified without microbial detection, 40% exclusively with Lactobacillus, 13.2% with pathogens only, and 15% with both. Clinical results revealed significant differences in β+ rates among the groups (p < 0.05). The absence of microorganisms was associated with higher success rates (β + 72.9%), while the presence of pathogens significantly reduced pregnancy success (β + 41.4%). A similar trend was observed in LB rates, although it did not reach statistical significance (44.3% and 24.1%, respectively). The presence of Lactobacillus alongside pathogens improved clinical outcomes (β + 57.6% LB 48.5%). Interestingly, exclusive presence of Lactobacillus showed lower implantation rates than patients without microbial detection (β + 58%). These findings highlight the impact of microbial composition on the clinical outcomes of ART cycles, underlining the association between endometrial microbiota patterns and pregnancy success. Limitations, reasons for caution This study is constrained by its retrospective nature, emphasizing the need for further validation through randomized controlled trials, non-selection studies, or other investigative approaches to confirm the extent of any clinical benefits. Endometrial biopsies were obtained transcervically, while executed with utmost care, risk of contamination cannot be completely excluded. Wider implications of the findings The composition and diversity of the endometrial microbiota is key for ART success. A sterile endometrial environment offers optimal conditions for implantation and pregnancy. The study highlights the potential of Lactobacillus in counteracting the negative impact of pathogenic presence. Trial registration number not applicable

Effect of Body Mass Index (BMI) on In Vitro Fertilization (IVF) Outcomes in Women with Polycystic Ovary Syndrome (PCOS)

Objective: Obesity is known to have negative impaction on reproductive health and ovarian functions. It may alter endocrine axis and quality of oocytes, and indirectly effect the success of in vitro fertilization (IVF). Methods: Medical records of patients with polycystic ovary syndrome (PCOS) who were applied for IVF between 2018 and 2024 were reviewed. Demographics, indications for reproductive treatment, IVF outcome parameters and the factors contributing to morbidity of treatment were recorded. Student’s test with one-way analysis of variance (ANOVA) and Kruskal-Wallis tests were used to compare the variables. P<0.05 was considered statistically significant. Results: 186 patients with PCOS were divided as lean (BMI<25 kg/m2, control), overweight (BMI 25-30 kg/m2) and obese (BMI>30 kg/m2). Mean ages and primary infertility rates were similar (both, p>0.05), but duration of infertility was longer in overweight and obese patients (p<0.05). Although patients with higher BMI required more induction dose for the cycle, number of retrieved oocytes did not change significantly, with achieved chemical and clinical pregnancy (each, p>0.05). Moreover, fertilization rates of transferred oocytes and rates of adverse outcomes during pregnancies were similar in the groups (each, p>0.05). Although overweight and obese patients with PCOS required more gonadotropin induction for IVF cycle (2311 vs 1920 vs 1752 IU, respectively, p<0.05), the numbers of metaphase II and fertilized oocytes were seen to be similar with increasing BMI (each, p>0.05). Conclusion: There is longer infertility duration and a higher requirement for gonadotropins in overweight and obese patients with no effect of BMI on most of IVF parameters such as retrieved oocyte, clinical pregnancy, obstetric complication and delivery rate.

Gynaecological pathology and assisted reproductive treatment: can we increase the chances of successful treatment by optimising the pelvis?

Key content: Pelvic pathologies such as fibroids, polyps, congenital uterine anomalies, intrauterine adhesions, hydrosalpinges, adenomyosis, endometriosis and ovarian cysts may have a negative impact on fertility and the success of assisted reproductive technology (ART). If pelvic pathologies are identified during the course of investigations for subfertility, information based on the latest available evidence should be provided so that individuals can make informed decisions about how they wish to proceed. In some situations, surgical intervention prior to ART is strongly recommended, but in others, the evidence is more limited/conflicting. Learning objectives: To learn more about how and why pelvic pathologies such as fibroids, polyps, congenital uterine anomalies, intrauterine adhesions, hydrosalpinges, adenomyosis, endometriosis and ovarian cysts affect fertility and outcomes following ART treatment. To understand when surgical intervention is (and equally is not) indicated in the management of different pelvic pathologies in women with subfertility who are contemplating ART. To appreciate the different options on how to manage women with different pelvic pathologies identified before and during an ART cycle. To smooth the transition between secondary/tertiary NHS care and ART providers so that women are given consistent advice and managed according to evidence based recommendations.

Effect of perinatal consumption of low-calorie sweetener on maternal health: A systematic review and meta-analysis

Background and AimsEvidence regarding perinatal low-calorie (or artificial) sweetener (LCS) consumption and its effect on maternal health outcomes is limited and inconclusive. The primary outcomes of our systematic review and meta-analysis were the effect of preconception and pregnancy LCS exposure on reproductive and pregnancy outcomes. Secondary outcomes included long-term maternal health . MethodsA systematic search of electronic databases, including PubMed, Embase, CINAHL, the Cochrane Library, Scopus, Web of Science, PsycINFO, ProQuest Health and Medical, ClinicalTrials.gov and Google Scholar, was conducted up to 20 November 2023. Primary studies, including interventional studies, cohort studies, case-control studies, which reported any LCS consumption during perinatal period and pregnancy and maternal health outcomes were eligible. A random effects model with restricted maximum likelihood estimation was used for the meta-analysis. We appraised the quality of the included studies using the National Institute of Health study quality appraisal tool and the overall quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation tool. ResultsA total of 19 eligible studies with 203,706 participants were included. LCS consumption during pregnancy was associated with 11% increased risk of preterm birth (RR = 1.11, 95% CI: 1.07-1.16, I2 = 0.01%) and 42% increased risk of gestational diabetes (RR = 1.42, 95% CI: 0.98-2.04, I2 = 67.60%) compared with no consumption, however, the effect size for gestational diabetes was not precise as the 95% CI indicated that the effect estimate could range from 2% lower risk to 204% (or 2.04 times) higher risk. We found no association between LCS consumption during pregnancy and gestational weight gain (standardized mean difference (SMD) = 0.04; 95% CI: -0.17 - 0.24, I2 = 41.31%) or gestational age at birth (SMD = 0.00; 95% CI: -0.13 – 0.14, I2 = 80.13%). The effect of LCS consumption on reproductive treatment outcomes were inconsistent. ConclusionsBased on the evidence available, LCS consumption in pregnancy was associated with increased risk of preterm birth and gestational diabetes. Robust research, such as well-designed randomized trials and large prospective cohort studies, is required to confirm the causal effect of LCS consumption during perinatal period on adverse maternal health outcomes.

LGBTIQ+ access to assisted reproductive treatment

AbstractThis article provides an overview of barriers faced by LGBTQ+ people with respect to Assisted Reproductive Treatment (ART). It proceeds in four parts and addresses four different identities who may be impacted differently. The article first addresses access to ART by gay and single men. It then focuses on the question of who is recognized as a parent legally and how that impacts ART. The article next addresses reciprocal intravenous fertilization (IVF) issues for lesbian couples. Finally, it focuses on access to ART for transmen and women. ART impacts the LGBTQ+ community in unique ways depending on many factors, and this article provides an overview of those factors and the importance of addressing all of them.

Associations between a normal-range free thyroxine concentration and ovarian reserve in infertile women undergoing treatment via assisted reproductive technology

BackgroundSome recent studies have shown that female subclinical hypothyroidism (SCH) is associated with diminished ovarian reserve (DOR). In this study, we aimed to investigate whether serum-free thyroxine (fT4) concentrations within the reference range are associated with ovarian reserve in women.MethodsThis cross-sectional study included 4933 infertile women with normal-range fT4 concentrations who received assisted reproductive technology treatment in our clinic. The data of women in different fT4 concentration tertiles (namely 12–15.33, 15.34–18.67, and 18.68–22 pmol/L) were compared with ovarian reserve markers, namely the anti-Müllerian hormone (AMH) concentration, the antral follicle count (AFC), and the number of aspirated oocytes. The primary outcomes were the AMH concentration and the risk of DOR, diagnosed as an AMH concentration < 1.1 ng/mL.ResultsThe average ages of women in the low-normal, middle-normal, and high-normal fT4 tertiles were 33.20 (standard deviation [SD]: 5.11), 32.33 (SD: 5.13), and 31.61 (SD: 5.10) years, respectively (p < 0.0001). AMH concentrations (adjusted mean: 3.32 [95% confidence interval {CI}: 3.16 to 3.50] vs. 3.51 [3.40 to 3.62] vs. 3.64 [3.50 to 3.80] ng/mL, p = 0.022) were significantly different between the fT4 concentration tertiles. The risk of DOR was significantly increased in the low-normal (adjusted odds ratio: 1.61 [95% CI: 1.01 to 2.58]) and middle-normal (1.47 [95% CI: 1.00 to 2.16]) tertiles compared with the high-normal tertile. Subgroup analysis showed that AMH concentrations were significantly different among the fT4 concentration tertiles in women aged < 35 years (adjusted mean: 3.94 [95% CI: 3.70 to 4.20] vs. 4.25 [4.11 to 4.39] vs. 4.38 [4.18 to 4.58], p = 0.028), whereas this difference was not significant in women aged ≥ 35 years (p = 0.534). The general additive models using fT4 as a continuous variable indicated that a lower fT4 concentration within the normal range was significantly associated with a lower AMH concentration (p = 0.027), a lower AFC (p = 0.018), a lower number of aspirated oocytes (p = 0.001), and a higher risk of DOR (p = 0.007).ConclusionLow-normal fT4 concentrations are associated with lower ovarian reserve in infertile women.

Characterization of chicken Relaxin3 gene: mRNA expression and response to reproductive hormone treatment in ovarian granulosa cells, and single nucleotide polymorphisms associated with egg laying traits in hens

As a protein structurally similar to insulin, relaxin3 (RLN3) plays a role in promoting arousal, suppressing depressive or anxious behaviors. Two studies revealed the increase of RLN3 expression during chicken follicle selection. In this study, by real-time quantitative PCR and luciferase assay, mRNA expression and single nucleotide polymorphisms (SNPs) of chicken RLN3 were investigated. The mRNA expression of chicken RLN3 was higher in the granulosa cell of hierarchal follicles (Post-GCs) than that of pre-hierarchal follicles (Pre-GCs). In Pre-GCs, the mRNA expression of chicken RLN3 was stimulated by FSH and progesterone; in Post-GCs, it was stimulated by higher concentration of estrogen and FSH, however, was inhibited by progesterone. Four SNPs including g.-655G > C, g-592G > A, g.-372T > A and g.-282G > C were identified in the critical promoter region from −1291 bp to −207 bp of chicken RLN3, among which g.-655G > C, and g-592G > A were associated with age at first laying and clutch size, respectively, in Zaozhuang Sunzhi chickens. At g.-655G > C and g-592G > A, allele C and allele A had higher transcriptional activity, respectively. These data suggest that RLN3 plays an important role in chicken follicle development and SNPs in its promoter region are potential DNA markers for improving egg production traits.

Treating refractory thin endometrium through a novel way of activation and administration of Platelet-rich plasma in sexually active women: An interventional prospective cohort clinical study.

A prospective cohort study investigated the effectiveness of platelet-rich plasma (PRP) infusion for refractory thin endometrium in 38 infertile patients. Patients showed significant improvement in endometrial thickness post-PRP injection, leading to successful implantation and pregnancy. The study revealed a negative correlation between antimullerian hormone (AMH) levels and the need for PRP interventions, suggesting higher ovarian reserve may reduce the necessity for repeated treatments. This implies AMH levels could serve as a prognostic indicator for treatment outcomes, aiding clinicians in optimizing protocols and reducing patient burden. Further research is needed to confirm these findings in larger and more diverse populations, along with exploring long-term reproductive success rates post-PRP treatment.

Complementary and Alternative Treatment Methods Used by Infertile Women in Turkiye: A Cross-Sectional Study

Objective: This study aims to determine the complementary and alternative therapy (CAM) methods used among infertile women in Turkiye, the prevalence of their use and the factors affecting their use. Method: The sample of the descriptive and cross-sectional study consisted of 142 women who applied to the Assisted Reproductive Treatment Centre of a public hospital and volunteered to participate in the study. The data were collected with "Personal Information Form" and "Complementary and Alternative Medicine Approaches Scale (CAMAS)". Descriptive statistics, Mann-Whitney U, Kruskal Wallis Test were used in the evaluation of the data. Results: While the average age of the women who contributed to the study was found to be 29.77±4.83 years. When the CAM methods used by women are examined, they are mostly prayer (88.0%), prayer (namaz) (78.2%), vow (25.4%), visit to the tomb (24.6%), amulet (20.4%), black pepper (17.6%), ginseng (15.5%), astralagus (13.4%), going to a teacher and having yourself read (13.4%), shark cartilage (13.4%), turtle blood (13.4%), lead casting (4.2%), reiki (2.8%), bioenergy (2.1%) and hypnosis it was determined to be (1.4%). When the mean scores in the CAMAS subscales were examined, it was determined that the highest score was body-mind approaches (40.46±17.37). Conclusion: In line with the research findings, it was determined that the use of CAM was common among infertile women in Turkiye and the most frequently used approaches were spiritual and herbal methods. Health professionals need to evaluate infertile women about their use of CAM methods and inform women about these methods.

Fertility outcomes in women undergoing Assisted Reproductive Treatments after COVID-19 vaccination: A prospective cohort study.

Vaccination against Coronavirus-19 disease (COVID-19) was widely administered from 2021 onwards. There is little information on how this vaccine affected fertility after assisted-reproductive-technology (ART). The aim of this study therefore was to determine if COVID-19 vaccination or time-since-vaccination influenced ART outcomes. In this prospective cohort study, 502 oocyte-retrieval-cycles and 582 subsequent embryo- transfer-cycles were grouped based on COVID-19 vaccine status of the female partner into those with no-exposure, 1-dose and ≥2-dose exposure. Within the exposed cohort, time-since-last-vaccination to embryotransfer- cycle (Ttr) was calculated in days. Main outcomes were mean-total-utilizable-embryos, mean-oocyteutilization- rates and cumulative-ongoing-pregnancy-rates per oocyte-retrieval-cycle, and ongoing-pregnancy and pregnancy-loss-rates per embryo-transfer cycle. The Beta-coefficient (ß) was calculated using linear regression for mean-total-utilizable-embryos and mean-oocyte-utilization-rates and adjusted-odds-ratio (OR) was calculated for cumulative-ongoing-pregnancy-rates, ongoing-pregnancy and pregnancy-loss-rates using binomial logistic regression. Influence of T(tr) on embryo-transfer outcomes was estimated using receiver-operator-curve (ROC) analysis and cut-offs determined that influenced embryo-transfer outcomes. Mean-total-utilizable-embryos and mean-oocyte-utilization-rate per oocyte-retrieval-cycle in no-exposure, 1-dose and ≥2 dose were 2.7 ± 1.8 vs. 2.5 ± 1.9 vs. 2.7 ± 2.0, P=0.78, (ß=0.42, 95% confidence-interval (CI)=0.15 to 0.69) and 21.2 ± 13.2 vs. 25.1 ± 19.0 vs. 26.7 ± 18.8, P=0.08, (ß=3.94, 95% CI=1.26 to 6.23) respectively. Ongoing-pregnancy-rates and pregnancy-loss-rates per embryo-transfer-cycle were 27.3% vs. 24.4% vs. 32.5% (aOR=1.38, 95% CI=0.3-5.6, P=0.52), and 13.6% vs. 13.4% vs. 15.2%, (aOR=0.97, 95% CI=0.18-5.2, P=0.97) respectively. Cumulative-ongoing-pregnancy-rates per oocyte-retrieval-cycle were 36.5% vs. 34.5% vs. 35.5% (aOR=1.53, 95% CI=0.57 to 4.07, P=0.35). Median T(tr) was 146 days (IQR: 80-220). T(tr) negatively affected ongoing pregnancy rates for intervals <60 days (AUC=0.59, 95% CI=0.54-0.66, P<0.01). For T(tr) >60 vs. <60 days, the aOR for ongoing-pregnancy-per-embryo-transfer-cycle was 2.85 (95% CI=1.50-5.46, P<0.01). Covid-19 vaccination does not negatively influence embryological-outcomes or cumulative-ongoing-pregnancies after ART-treatments. Duration since vaccination may have a weak negative effect on embryo-transfer-outcomes performed within 60 days.

Experimental accelerating testicular tissue recovery post-methotrexate treatment in rats: A promising role of Sertoli cell-conditioned medium: An experimental study.

Methotrexate (MET) is one of the most important chemotherapy agents used against various tumors and cancer diseases. One of the critical side effects of MET is inducing male infertility. The current study aimed to investigate Sertoli cell culture-conditioned medium (SCM) recovery effects on MET-induced conditions in rats. 30 mature male Wistar rats were randomly divided into 3 groups (n = 10). In the first group, rats received normal saline intraperitoneally. In the second group, animals received MET (10 mg/kg; intraperitoneally) once a week for 2 wk. The rats in the third group (MET+SCM) received MET and a single injection of SCM for 56 days post-MET administration. 56 days later, serum, epididymis, and testicular tissue samples were collected, and the animals were euthanized. Sperm parameters, serum levels of luteinizing hormone, follicle-stimulating hormone, and testosterone were examined. The testicular tissues were stained using hematoxylin and eosin solution, and histopathological changes were analyzed. The MET-induced condition resulted in significant pathological changes in the testis, decreased hormone levels, and downregulated sperm parameters. However, SCM injection improved hormonal levels, testicular changes, and sperm parameters. It can be concluded that a single intra-testicular SCM injection accelerates male reproductive system recovery post-MET treatment.

Effect of Marham-i-Bāsalīqūn on Cervical Erosion (Qurūḥ al-Raḥim)): A Randomized Comparative Clinical Study

Background and Objective: Cervical erosion (Qurūḥ al-Raḥim) is one of the most frequent gynecological conditions seen in clinical practice. Therefore, the objective of the current study was to assess the impact of the topical application of Marham-i-Bāsalīqūn in Qurūḥ al- Raḥim. Material and Method: A randomized comparative clinical study was carried out at the Institute Hospital in Bengaluru. Diagnosed cases (n=40) of cervical erosion were randomly assigned to test (n=20) and control (n=20) groups. A total of 6 g ointment of Marham-i-Bāsalīqūn (test drug) and tested Unani formulation (control drug) was applied with an applicator per vaginum over the eroded area of the cervix daily once at bedtime for 14 days. A single dose of the antibiotic regimen (azithromycin-1g and cefixime-400 mg) was administered orally in both groups. Subjective parameters like vaginal discharge, pruritus vulvae, low back ache, lower abdominal pain, and postcoital bleeding were assessed during the trial. The main outcome measure was an improvement in the cervical erosion grading score. The inference was executed with appropriate statistical analysis. Result: Improvement in the cervical erosion grading score was achieved in 50% and 40% of patients in the control and test groups, respectively, after 2 weeks of treatment with P&lt;0.0001, which was considered highly significant. A highly significant improvement in subjective parameters was observed during the trial with P&lt;0.0001. Conclusion: Considering the high prevalence of cervical erosion among women of reproductive age group, effective treatment and safe strategies are highly recommended. Marham-i-Bāsalīqūn is cost-effective and has several therapeutic actions that can help to promote the healing of erosion and relieve the associated symptoms. The clinical trial was registered at the Clinical Trial Registry of India (CTRI) with registration number CTRI/2022/02/040419.

The Psychological Effects of Hormonal Treatment on Women Under IVF Treatment: A Comprehensive Review

This comprehensive review delves into the intricate world of assisted reproductive technologies (ART) and hormonal treatments, exploring their profound psychological effects on women undergoing IVF treatment. The psychological distress of infertility, combined with the demanding nature of ART, has been widely acknowledged, yet a comprehensive examination of the psychological impacts has remained elusive. This study examined the psychological repercussions of hormonal medications used in IVF, addressing the complex interplay of hormones and their effects in each stage of the IVF process. This review followed PRISMA guidelines and included studies from PubMed, Google Scholar, and ScienceDirect. A total of nine papers were collected. The findings of this study identified that depression, anxiety, mood swings, irritability, sleep disturbances, and cognitive changes were the most commonly seen medically induced psychological effects among the IVF patients. This review offers a holistic understanding of the psychological intricacies of IVF treatment, highlighting the imperative need for a more comprehensive approach to address the emotional wellbeing of individuals undergoing fertility procedures.

Impact of maternal age on oxidation-reduction potential in follicular fluid and assisted reproductive technology treatment outcomes

Background: Maternal age influenced the quantity and quality of oocytes. The composition of follicular fluid was changed in advanced maternal age. This study was conducted to evaluate changes in redox potential and blastocyst formation potential in older women. Methods and materials: Retrospective study collected data from December 2020 to October 2023 on patients treated with in vitro fertilization with follicular fluid surveyed at the Center for Reproductive Endocrinology and Infertility (HUECREI), Hue University of Medicine and Pharmacy, Hue. Results: Two cohorts comprised the 456 patients: Group 1, consisting of individuals younger than 35 years of age, and Group 2, comprising those 35 years or older. Anti-Müllerian hormone (AMH), initial follicle-stimulating hormone (FSH), and total FSH dose utilized differed significantly between Groups 1 and 2, with median values of 3.79 versus 2.10 ng/mL (P value &lt; 0.001), 225.00 versus 277.50 IU/L (P value &lt; 0.001), and 2025.00 versus 2325.00 IU/L (P value &lt; 0.001), respectively. However, there were no significant differences in ORP, maturation rate, fertilization rate, or blastocyst formation rate between the two age groups. Variations in ORP were only observed among subgroups of patients with the ability to achieve an expected fertilization rate of ≥ 70% in Group 1. Specifically, the subgroup meeting expectations had a lower ORP of 83.00 ± 83.00 mV, in contrast to the non-expectation group which had an ORP of 96.14 ± 83.00 mV, accompanied by a P value of 0.005. The difference of ORP was not observed in the group that reached and did not reach the benchmark embryo formation ≥ 60% in the two age groups. Conclusion: Advanced maternal age have declined in ovarian function but no statistically significant difference in redox potential in follicular fluid has been observed. The fertilization rate and blastocyst formation rate were equivalent across the two age groups of women. The redox potential of follicular fluid was not statistically significant difference between cycles that reached and did not reach the benchmark of blastocyst formation ≥ 60% in the two age groups of women. Key words: Blastocyst, advanced maternal age, oxidative-reduction potential (ORP), in vitro fertilization.

Body Mass Index as a Factor Influencing Oocyte Competence and Implantation Potential – Distribution and Results in 4,882 Women Undergoing Fertility Treatment

Abstract Introduction The large amount of excess adipose tissue affects negatively every single step of the assisted reproductive treatment process – from the controlled ovarian hyperstimulation (COH) to obstetric complications and health consequences for the fetus. A number of scientific data show correlation between impaired clinical pregnancy rates (CPR) and obese patients maintaining high body mass index (BMI). The debate whether high proportion of body fat negatively affects oocyte quality or only impacts endometrial receptivity remains open. Aim The aim of this study is to investigate the specific effect of the different BMI range in patients undergoing assisted reproductive technology (ART) treatment with reference to oocyte quality, fertilization capacity and Implantation potential. Materials and methods We analyzed a total of 4,882 women from partner couples who underwent ART treatment. Height and weight data were entered at the start of the in vitro fertilization (IVF) procedure. According to their BMI the female patients were divided in four distinct groups: in group 1 (underweight and BMI below 18.5 kg/m2) – 498 women, group 2 (normal range from 18.5 to 24.9 kg/m2) – 3021 women, group 3 (overweight with BMI between 25 – 29.9 kg/m2) – 789 women and group 4 (obese with BMI over 30 kg/m2) - 484 women. Results Distribution of the women in different BMI groups indicates that most of the Bulgarian patients undergoing fertility treatment are in the normal range. No association between BMI and ovarian response was found. A total of 33,205 oocytes were obtained after the COH. The mean numbers of the retrieved oocytes were similar (6,85 in group 1; 6,83 in group 2, 6,77 in group 3 and 6,67 in group 4) per woman and the fertilization rate was comparable in the four groups as it varies between 74-75%. Proportional categories of good, fair and bad embryos at cleavage stage were found. On the contrary according to CPR, Statistical difference between normal weight group (34,38%) versus overweight (29,6%) and obese groups (28,80%) (p &lt; 0,05) was found. Conclusion No correlation was found between the number of the retrieved oocytes and BMI values. Statistically lower pregnancy rates were reported in overweight women with BMI ≥ 25 kg/m2 group and further onwards in the obesity group (BMI ≥ 30 kg/m2), which may be associated with impaired endometrial receptivity as a result of abnormally high levels of adipose tissue.

The effect of methyltestosterone on in vitro fertilization outcomes: A randomized clinical trial on patients with low ovarian response.

The aim of this study was to compare the outcomes of in vitro fertilization (IVF) in patients with a poor ovarian response who used methyltestosterone, versus those using a placebo, in an infertility clinic setting. This clinical trial included 120 women who had undergone IVF with intracytoplasmic sperm injection due to poor ovarian reserve and infertility. The study took place at the Yas Infertility Center in Tehran, Iran, between January 1, 2018 and January 1, 2019. In the intervention group, 25 mg of methyltestosterone was administered daily for 2 months prior to the initiation of assisted reproductive treatment. The control group was given placebo tablets for the same duration before starting their cycle. Each group was randomly assigned 60 patients. All analyses were performed using SPSS ver. 23 (IBM Corp.). The endometrial thickness in the intervention group was 7.57±1.22 mm, whereas in the control group, it was 7.11±1.02 (<italic>p</italic>=0.028). The gonadotropin number was significantly higher in the control group (64.7±13.48 vs. 57.9±9.25, <italic>p</italic>=0.001). However, there was no significant difference between the two groups in the antral follicular count. The chemical and clinical pregnancy rates in the intervention group were 18.33% and 15% respectively, compared to 8.33% and 6.67% in the control group. The rate of definitive pregnancy was marginally higher in the intervention group (13.3% vs. 3.3%, p=0.05). The findings of this study suggest that pretreatment with methyltestosterone significantly increases endometrium thickness and is associated with an increase in the definitive pregnancy rate.

Association Between Vitamin D Level and Clinical Outcomes of Assisted Reproductive Treatment: A Systematic Review and Dose-Response Meta-Analysis.

The investigation about association between vitamin D level and clinical outcomes of assisted reproductive treatment showed various outcomes. This study aimed to review the correlation between vitamin D and outcomes of assisted reproductive treatment. The search was registered on the PROSPERO database (CRD42023458040). PubMed, Embase, Medline, ClinicalTrials.gov, and Cochrane databases were searched up to July 2023. Twenty-three observational studies were selected for meta-analysis. Comparing groups with deficient and 'insufficient + sufficient' vitamin D level, meta-analysis showed positive correlation between clinical pregnancy rate and vitamin D (OR 0.81, 95%CI: 0.70, 0.95, P = 0.0001). Comparing groups with 'deficient + insufficient' and sufficient vitamin D level, meta-analysis showed positive correlation between vitamin D and clinical pregnancy rate (OR 0.71, 95%CI: 0.55, 0.91, P = 0.006), vitamin D and live birth rate (OR 0.69, 95%CI: 0.54, 0.89, P = 0.003). Subgroup analysis did not show the source of high heterogeneity. No correlation was found in biochemical pregnancy rate, ongoing pregnancy rate, miscarriage rate and implantation rate. In dose-response meta-analysis, a nonlinear association was found between vitamin D levels and outcomes when levels are below approximately 24 ng/L. The study shows that vitamin D level is associated with clinical pregnancy rate and live birth rate. Low vitamin D level does not influence biochemical pregnancy rate, ongoing pregnancy rate, miscarriage rate and implantation rate. Furthermore, 24 ng/L may be a possible threshold of vitamin D concentration in assisted reproduction therapy.

Nurturing Hope: Reproductive Outcomes with Sinosomatics following Unsuccessful in vitro Fertilization Attempts

Introduction: For women who have experienced failed attempts at in vitro fertilization (IVF) and face medical issues, leading to infertility, the renewed effort to seek fertility treatment, coupled with decreasing likelihood of success, can exert substantial emotional and physical strains. Consequently, many couples opt to discontinue treatment before attaining pregnancy. The objective of this study was to evaluate the reproductive outcomes in patients with unsuccessful prior IVF attempts who received a complementary treatment designed to alleviate emotional distress and burden. Patients and Methods: A retrospective analysis of data from infertile patients who initiated the complementary intervention at a private clinic between January 2014 and December 2016 was conducted. Information on diagnosis, history of infertility, prior assisted reproductive technology treatments, mode of conception, and pregnancy outcomes were retrieved. Results: The data of 133 patients with a history of one or more unsuccessful IVF treatments were analyzed. Patients had an average age of 36.7 years (±4.4 SD) and had been experiencing infertility for an average of 4.6 years (±2.7 SD). The two main causes of their infertility were endometriosis (36.1%, 48 patients) and diminished egg quality (31.6%, 42 patients). By May 2020, a significant proportion of the patients, 81.2% (108 patients), had achieved pregnancy, leading to 94 live births, which represents a 70.7% success rate. These pregnancies mostly resulted from natural cycle IVF (35.1%), donor cycles (23.4%), and conventional IVF (21.3%). The dropout rate was comparatively low at 23.3%. The median time from the start of complementary treatment to delivery was 18 months, with a range of 12–28 months. Conclusions: This study highlights the potential value of complementary treatment approaches in conjunction with standard medical care for women who have experienced unsuccessful IVF treatments in the past and thus face a reduced chance of motherhood. The reported 71% live birth rate is notably high, indicating that the inclusion of complementary treatments may provide women with past IVF failures a tangible opportunity for achieving successful pregnancy and childbirth. However, these findings need to be confirmed through randomized controlled studies.

Analysis of Risk Factors for Recurrent Pregnancy Loss in Patients Undergoing in vitro Fertilization-Embryo Transfer

Recurrent pregnancy loss (RPL) presents a formidable challenge for individuals undergoing in vitro fertilization-embryo transfer (IVF-ET), forming both a clinical dilemma and a focal point for scientific inquiry. This study endeavors to investigate the intricate interplay between clinical features, such as age, body mass index (BMI), and waist-to-hip ratio (WHR), and routine laboratory parameters, including sex hormones, blood composition, liver and thyroid functions, thyroid antibodies, and coagulation indicators, in RPL patients undergoing IVF-ET. By meticulously analyzing these variables, we aim to uncover the latent risk factors predisposing individuals to RPL. Identifying potential factors such as advanced maternal age, obesity, and insulin resistance will provide clinicians with vital insights and empirical evidence to strengthen preventive strategies aimed at reducing miscarriage recurrence. This retrospective case-controlled study included RPL patients who underwent IVF-ET treatment at Sun Yat-sen Memorial Hospital, Sun Yat-sen University, between January 2012 and March 2021 as the case cohort, compared with women receiving assisted reproductive treatment due to male infertility as the control cohort. The fasting peripheral blood was collected 5 days before the first menstrual cycle at least 12 weeks after the last abortion. The clinical characteristics and relevant laboratory indexes of the two groups were compared. Employing both univariate and multivariate logistic regression analyses, we sought to unearth potential high-risk factors underlying RPL. Additionally, a linear trend analysis was conducted to assess the linear relationship between total testosterone (TT) levels and the number of miscarriages. In contrast to the control cohort, the RPL cohort exhibited significant increases in age, BMI, and WHR (P<0.05). Notably, TT levels were markedly lower in the RPL cohort (P=0.022), while no significant differences were observed between the two groups concerning basal follicle-stimulating hormone, luteinizing hormone, estradiol, progesterone, prolactin levels, and anti-Müllerian hormone levels (P>0.05). Moreover, fasting insulin (FINS) levels and HOMA-IR index were notably elevated in the RPL cohort relative to the control cohort (P<0.001), although no significant differences were observed in fasting blood glucose levels (P>0.05). Furthermore, the neutrophil (NEU) count and NEU-to-lymphocyte ratio were notably higher in the RPL cohort (P<0.01). Univariate logistic regression analysis identified several factors, including age≥35 years old, BMI≥25 kg/m2, WHR>0.8, FINS>10 mU/L, HOMA-IR>2.14, NEU count>6.3×109 L－1, and an elevated NEU/lymphocyte ratio (NLR), as significantly increasing the risk of RPL (P<0.05). Although TT levels were within the normal range for both cohorts, higher TT levels were associated with a diminished RPL risk (odds ratio [OR]=0.67, 95% confidence interval [CI]: 0.510-0.890, P=0.005). After adjustments for confounding factors, age≥35 years old (OR=1.91, 95% CI: 1.06-3.43), WHR>0.8 (OR=2.30, 95% CI: 1.26-4.19), and FINS>10 mU/L (OR=4.50, 95% CI: 1.30-15.56) emerged as potent risk factors for RPL (P<0.05). Conversely, higher TT levels were associated with a reduced RPL risk (OR=0.59, 95% CI: 0.38-0.93, P=0.023). Furthermore, the linear trend analysis unveiled a discernible linear association between TT levels and the number of miscarriages (P trend=0.003), indicating a declining trend in TT levels with escalating miscarriage occurrences. In patients undergoing IVF-ET, advanced maternal age, lower TT levels, increased WHR, and elevated FINS levels emerged as potent risk factors for RPL. These findings provide clinicians with valuable insights and facilitate the identification of patients who are at high risks and the formulation of preventive strategies to reduce the recurrence of miscarriages.

Compatibility of Family Planning and Surgical Training in Switzerland

Abstract Background Surgeons undertake a long training and have stressful work schedules during optimal childbearing age. Training and career plans can entice young surgeons to renounce part-time work and delay pregnancy, risking pregnancy complications and infertility. Aims This survey study aims to determine the prevalence and constraints of part-time work and family planning among young surgeons in Switzerland. Methods An anonymous, voluntary survey was distributed to young board-certified surgeons. It queried work schedules and desire for part-time work as well as history of pregnancies and use of assisted reproductive treatment. Results A total of 375 surgeons participated, 308 were included (157 female, 151 male). There were no differences in current age (male median 37 (IQR 5), female 37 (6), p=0.93), median age at medical school graduation (male 26 (2), female 26 (2), p=0.90), and mean time to board certification (male 8.3 (SD 2.4), female 8.2 (SD 2.7), p=0.61). Female surgeons had a higher rate of part-time employment (38% vs 19%, p=0.0002). More male surgeons had children compared to their female counterparts (70% vs 45%, p&amp;lt;0.0001). Female surgeons were older (median 35 (IQR 4.5)) than male surgeons (median 33.5 (IQR 3.25), p=0.0002) and female partners of male surgeons (median 32 (IQR 3), p&amp;lt;0.0001) at birth of their first child. Female surgeons more frequently desired further children (71% vs 38%, p&amp;lt;0.0001) and delayed pregnancy due to training (74% vs 22%, p&amp;lt;0.0001). Female surgeons had longer time to conceive (&amp;gt;12 months 24% vs 10%, p=0.014), lower spontaneous pregnancy rates (82% vs 93%, p=0.029) and higher rates of assisted reproductive treatment (14% vs 4%, p=0.0089). Female surgeons more frequently perceived their gender as a negative career influence (67% vs 5%, p&amp;lt;0.0001). Conclusion Whilst part-time work and family planning are challenging for surgeons of both genders, female surgeons face striking inequities when trying to consolidate family planning with their profession.