Significant Differences In Implantation Rates Research Articles

THE BENEFICIAL EFFECT FOR LBR OF SERUM LH (5-10IU/L) ON TRIGGER DAY WITH GnRH ANTAGONIST PROTOCOL

To investigate the effect of various serum LH on trigger day with GnRH antagonist protocol in patients receiving in-vitro fertilization (IVF) /Intracytoplasmic sperm injection (ICSI) for pregnancy outcomes. A retrospective, single-center cohort study. Setting: We retrospectively reviewed the medical documents of patients receiving IVF/ICSI with fresh embryo transfers in the Reproductive Medicine Center of Peking University People's Hospital between January 2016 and December 2018. Patients: 894 patients were included and divided into three groups by various serum LH on trigger day. Interventions: Group A ,Group B and Group C were defined as LH concentration <1.0 IU/l, ≥1.0 IU/l and ≤5.0 IU/l, >5.0 IU/l and ≤10.0 IU/l on trigger day during the cycle, respectively. Main Outcome Measures: implantation rate, clinical pregnancy rate, early pregnancy loss rate and live-birth rate (LBR). Pregnancy results were compared among these three groups. There was significant difference in implantation rates between Group A and Group C (20.57%versus 35.90%, respectively). The clinical pregnancy rates (35.42% versus 48.65%) and LBR (29.17% versus 41.89%) appeared higher in Group C, though the differences were not significant. According to Multivariate logistic regression analysis, compared with Group A, the LBR of Group B(OR=4.160, P = 0.039) and Group C(OR=5.037, P = 0.034) increase and the differences were significant. Our study has proposed Chinese patients in 5-10 IU/l of the serum LH on trigger day with GnRH antagonist protocol may have better clinical outcomes than 1-5IU/l of LH. So the serum LH on trigger day with GnRH antagonist protocol should not be very low. The level of LH should be beneficial for outcomes in our suggested LH range. Whereas, we still need more adequate sample size and multi-center research to make RCTs and in-depth study on the mechanism.

Pregnancy outcomes after frozen-thawed single euploid blastocyst transfer following IVF cycles using GNRH agonist or HCG trigger for final oocyte maturation.

To assess whether GnRH agonist trigger impacts the implantation potential of euploid embryos. Retrospective cohort study done at an academic IVF center evaluating frozen-thawed embryo transfer (FET) cycles in which single-euploid blastocysts were transferred between 2014 and 2019. All embryos were generated in an IVF cycle which used GnRHa or hCG trigger and then were transferred in a programmed or natural FET cycle. Only the first FET cycle was included for each patient. Primary outcome was ongoing pregnancy rate or live birth rate (OPR/LBR). Secondary outcomes were implantation rate (IR), clinical pregnancy rate (CPR), clinical loss rate (CLR), and multiple pregnancy rate (MPR). Logistic regression was performed to control for confounding variables. A p value of < 0.05 was considered statistically significant. Two hundred sixty-three FET cycles were included for analysis (GnRHa = 145; hCG = 118). The GnRHa group was significantly younger (35.2 vs. 37.5 years) and had higher AMH values (4.50 ng/ml vs. 2.03 ng/ml) than the hCG group, respectively (p < 0.05). There was no significant difference in OPR/LBR (64.1% (93/145) vs. 65.3% (77/118); p = 0.90) between the GnRHa and hCG groups, respectively. There was also no significant difference in IR, CPR, CLR, or MPR between groups. After controlling for confounding variables, the adjusted odds ratio for OPR/LBR was 0.941 (95% CI, 0.534-1.658); p = 0.83) comparing GnRHa to hCG. Pregnancy outcomes did not significantly differ when groups were stratified by age (< 35 vs. > 35 years old). Our findings confirm that euploid embryos created after hCG or GnRHa trigger have the same potential for pregnancy.

Impact of Iron Overload and Iron Removal Therapy on Outcome of Allogeneic Hematopoietic Stem Cell Transplantation in the Patients with Severe Aplastic Anemia

Abstract:The aim of this study was to evaluate the Impact of iron overload and iron removal therapy on the outcome of allogeneic hematopoietic stem cell transplantation (SCT) in patients with severe aplastic anemia (SAA). Forty-five transplant patients with SAA were retrospectively analyzed. Patients were divided into two groups according to whether there was iron overload or not: iron overload group (n=23) and non-iron overload group (n=22). The iron overload group had higher 1-year transplant-related mortality (TRM) (30.4% vs. 4.5%, P = 0.02), lower 1-year transfusion-free survival (TFS) (40.6% vs. 81.8%, P = 0.007) and lower 1-year overall survival (OS) (54.8% vs. 90.2%, P = 0.003) than the non-iron overload group. However, there was no significant difference in implantation rate, pre-engraftment syndrome (PES) and acute graft-versus-host disease (aGVHD, grade III-IV) between the two groups. Furthermore, the multivariate analysis revealed that iron overload was an independent risk factor affecting OS (HR = 36.88, P = 0.03). The patients in iron overload group were divided into two subgroups according to the time of iron removal using deferasirox 20mg/kg/d. Specifically, group A (n=17) was treated with deferasirox 20mg/kg/d for 3 months or less and group B (n=6) treated for more than 3 months. The results showed that group B had a lower one-year TRM (0% vs. 41.2% , P = 0.07), higher 1-year TFS (66.7% vs. 31.4%, P = 0.18) and higher 1-year OS (100% vs. 31.4% , P = 0.02) than group A. There were no significant difference in implantation rate, PES and aGVHD ( III-IV) between the two groups. In conclusion, the results indicate that iron overload before transplantation was associated with increased TRM and decreased OS, suggesting that iron overload was associated with worse transplantation outcomes. However, standardized iron removal therapy could reverse the adverse effects of iron overload on the outcomes of transplantation to a certain extent and improve the prognosis significantly. Disclosures No relevant conflicts of interest to declare.

Influence of surgical evacuation on pregnancy outcomes of subsequent embryo transfer cycle following miscarriage in an initial IVF cycle: a retrospective cohort study

BackgroundIt is still uncertain whether surgical evacuation adversely affects subsequent embryo transfer. The present study aims to assess the influence of surgical evacuation on the pregnancy outcomes of subsequent embryo transfer cycle following first trimester miscarriage in an initial in vitro fertilization and embryo transfer (IVF-ET) cycle.MethodsA total of 645 patients who underwent their first trimester miscarriage in an initial IVF cycle between January 2013 and May 2016 in Nanjing Drum Tower Hospital were enrolled. Surgical evacuation was performed when the products of conception were retained more than 8 h after medical evacuation. Characteristics and pregnancy outcomes were compared between surgical evacuation patients and no surgical evacuation patients. The pregnancy outcomes following surgical evacuation were further compared between patients with ≥ 8 mm or < 8 mm endometrial thickness (EMT), and with the different EMT changes.ResultsThe EMT in the subsequent embryo transfer cycle of surgical evacuation group was much thinner when compared with that in the no surgical evacuation group (9.0 ± 1.6 mm vs. 9.4 ± 1.9 mm, P = 0.01). There was no significant difference in implantation rate, clinical pregnancy rate, live birth rate or miscarriage rate between surgical evacuation group and no surgical evacuation group (P > 0.05). The live birth rate was higher in EMT ≥ 8 mm group when compared to < 8 mm group in surgical evacuation patients (43.0% vs. 17.4%, P < 0.05).ConclusionsThere was no significant difference in the pregnancy outcomes of subsequent embryo transfer cycle between surgical evacuation patients and no surgical evacuation patients. Surgical evacuation led to the decrease of EMT, especially when the EMT < 8 mm was association with a lower live birth rate.

Implantation failures in women with infertility associated endometriosis

Endometriosis is currently considered as one of the most common diseases associated with infertility. A controversial issue is whether endometriosis per se exerts a detrimental effect on IVF outcomes. Failure of implantation due to endometriosis-associated infertility is a contradictory and widely discussed burden nowadays. The purpose of the study is to assess the quality of embryos and implantation rate in women with infertility associated with endometriosis. The study included infertile reproductive aged women, between 26 and 40 years who underwent IVF and ICSI procedures. The patients were divided into two groups: group I (n = 70) involved 70 patients with recurrent unilateral endometriomas, II control group (n = 50) with tubal factor infertility. The quality of the retrieved embryos was assessed according to the generally accepted classification of Gardner, indicating the rate of implantation in each group. Embryo transfer was performed in case of high quality embryos. Assessing the ovarian reserve indicators, in the group I patients with recurrent unilateral endometriomas the serum level of AMH was significantly lower (2.1 ± 1.75 vs. 3.2 ± 1.4, p < .005), as well as the number of retrieved oocytes (8.1 ± 3.9 and 10.1 ± 6.8, p < .005). The analysis of the results demonstrated that the duration of stimulation in the group patients with recurrent unilateral endometriomas was significantly higher in comparison with the group II (12.2 ± 1.8 and 10.2 ± 1.6 days, p < .001). Nevertheless, the number of good quality embryos retrieved was comparable in both groups (2.2 ± 1.5 and 2.8 ± 1.8). In the group I patients with recurrent unilateral endometriomas, there was a statistically significant decrease of implantation rate (17.1% vs. 24% p < .005). The results of the study revealed no statistical difference in embryo quality in the study cohort. However, it is important to note that a statistically significant difference in implantation rate in the group of endometriosis-associated infertility compared was obtained 1.5 times lower than in the control group (15.8% vs. 24.0% p < .005). The achieved results demonstrated an adverse IVF outcome in infertile women with recurrent endometrioma compared to the control group.

Efficacy evaluation of low-dose aspirin in IVF/ICSI patients evidence from 13 RCTs: A systematic review and meta-analysis.

Background:We conducted a systematic review and meta-analysis of existing literature to evaluate the different outcomes of low-dose aspirin on patients undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI), including clinical pregnancy rate, implantation rate, live birth rate, miscarriage rate, fertilization rate, number of oocytes retrieved, and so forth.Methods:Electronic databases including PubMed, MEDLINE, and Embase were searched between 1997 and March 2016 to identity eligible studies. The following comparisons between treatment groups were included: aspirin versus placebo; aspirin versus control group; aspirin versus aspirin + prednisolone + control.Results:Thirteen randomized controlled trials which included 3104 participants were selected. There were no significant differences in implantation rate (RR = 1.15; 95% CI = 0.78–1.70), live birth rate (RR = 1.06; 95% CI = 0.93–1.21), miscarriage rate (RR = 1.28; 95% CI = 0.93–1.77), fertilization rate (RR = 0.91; 95% CI = 0.75–1.11), and endometrial thickness (WMD = 0.15; 95% CI = −0.38–0.67). But the research showed that aspirin treatment may improve the clinical pregnancy rate (RR = 1.16; 95% CI = 1.04–1.28) compared to placebo or no treatment, and reduce the number of oocytes retrieved (WMD = −0.68; 95% CI = −0.91–0.46).Conclusions:Our findings suggest that low-dose aspirin may improve the pregnancy rate in IVF/ICSI, with the recommended clinical use dose of 100 mg/day. Considering the limitation of included studies, further well-designed large-scaled RCTs are necessary to clarify whether aspirin may improve assisted reproduction outcomes in IVF/ICSI patients.

Pregnancy outcome of in vitro fertilization after Essure and laparoscopic management of hydrosalpinx: a systematic review and meta-analysis

To assess and compare pregnancy outcomes in hydrosalpinx (HX) patients treated by Essure, laparoscopic salpingectomy, and proximal tubal occlusion (LPTO) before IVF. Systematic review and meta-analysis. University-affiliated teaching hospital. Women undergoing Essure, laparoscopic salpingectomy, and LPTO for HX before IVF. The overall combined risk estimates were calculated by means of fixed- or random-effects models. Clinical pregnancy rate (CPR) and live birth rate (LBR). In total, 3,065 patients were included in 33 studies. Thirteen of them were comparative studies among 3 surgical methods and no intervention. In the analysis of comparative studies, there were no significant differences in implantation rate (IR), CPR, and ongoing pregnancy rate/LBR between salpingectomy and LPTO groups. The CPR, IR, and LBR of Essure were significantly lower than those of the laparoscopic surgery (salpingectomy and LPTO) group, with a CPR of 34.1% vs. 44.0% (relative risk [RR] 0.71; 95% confidence interval [CI] [0.51, 0.98]), an IR of 17.3% vs. 38.0% (RR 0.45; 95% CI [0.27, 0.74]), and an LBR of 22.2% vs. 37.4% (RR 0.57; 95% CI [0.35, 0.91]). Management of HX by laparoscopic salpingectomy and LPTO yielded the same effect on the improvement of the pregnancy outcome after IVF. The hysteroscopic placement of Essure devices to treat HX before IVF produces inferior pregnancy outcomes compared with those following the laparoscopic approach. More multicenter randomized, controlled trials are warranted in future research to further examine the conclusion from this meta-analysis.

A correlative study of oocytes morphology with fertilization, cleavage, embryo quality and implantation rates after intra cytoplasmic sperm injection

Introduction: Non-invasive selection of developmentally human oocytes may increase the overall efficiency of human assisted reproduction. Morphologic abnormalities in the oocyte are relevant for determining its developmental fate. The objective is to evaluate the influence of MII oocyte morphology on intra cytoplasmic sperm injection (ICSI) outcomes. Material and Methods: 132 patients undergoing ICSI cycles and having female factors of infertility and unexplained infertility. Couples having male factors of infertility were excluded. A total of 1200 oocytes were retrieved from 132 ICSI cycles, of which 1056 MII oocytes were evaluated. The criteria for morphological evaluations were: (i) Normal MII oocytes showing clear cytoplasm with uniform texture and homogenous fine granularity, a round or ovoid first polar body with a smooth surface, and perivitelline space of normal size. (ii) MII oocytes with extra cytoplasmic abnormalities (first polar body and perivitelline space abnormalities). (iii) MII oocytes with cytoplasmic abnormalities (dark cytoplasm, granular cytoplasm, inclusion body and presents of vacuoles). (iv) MII oocytes with combined abnormalities. Result: From 1056 MII oocytes, 180 (17.04%) had normal morphology while 876 (82.95%) had at least one demonstrable morphological abnormality. Cytoplasmic abnormalities were observed in 516 (58.9%) of the oocytes. Extra cytoplasmic abnormalities were observed in 104 (11.87%) while combined abnormalities were responsible for the remaining 256 (29.22%). There were no significant differences in fertilization, cleavage, and embryo quality between the groups but there was a highly significant difference in implantation rate which was higher in the group of normal oocytes morphology than abnormal oocytes morphology, oocytes with cytoplasmic, extracytoplasmic and combined abnormality 11.11%, 7.33%, 9.03%, 2.3%, and 4.34% respectively. Conclusion: MII oocyte morphology did not affect fertilization, cleavage, and embryo quality, but affecting implantation rate.

Optimizing embryo selection for single embryo transfer

Optimizing embryo selection for single embryo transfer

Chronic hepatitis B virus infection in women is not associated with IVF/ICSI outcomes

This study was to evaluate whether chronic HBV (Hepatitis B virus) infection in women is associated with poor performance following IVF/ICSI (in vitro fertilization/intracytoplasmic sperm injection) treatments. 123 cycles with female chronic HBV infection were compared with 246 cycles with no-infected couples, matched for female age, D3 serum FSH (follicles stimulation hormone) levels, body mass index and assisted reproductive technology approach used (IVF or ICSI), in a ratio of 1:2. The details in IVF/ICSI cycles, including the dosage of gonadotrophin used, the serum estradiol levels and the endometrial thickness on the day of hCG (human chorionic gonadotrophin) injection, the mean number of oocytes retrieved, and the embryology data, were similar among seropositive and seronegative women. And there was no significant differences in implantation rates and live birth rates between seropositive women group and matched control (30.52 versus 28.34% per transfer; 42.28 versus 40.65%). The results indicated that women with chronic HBV infection is not associated with outcomes of IVF/ICSI treatments.

Clinical outcome according to timing of cabergoline initiation for prevention of OHSS: a randomized controlled trial

Cabergoline, a dopamine receptor-2 agonist, is suggested to prevent ovarian hyperstimulation syndrome (OHSS) during ovarian stimulation. The aim of this study was to evaluate the influence of different timing of cabergoline administration on clinical outcome among patients at risk of developing OHSS. Among infertile women undergoing IVF treatment at risk of developing OHSS, 206 were enrolled in this study. The subjects were randomly allocated into two groups, i.e. the study group (n=100) receiving cabergoline beginning on the day of human chorionic gonadotrophin (HCG) injection and the control group (n=100) receiving cabergoline starting on the day of oocyte retrieval. Oocyte metaphase-II rate, fertilization rate, clinical outcome and incidence of severe OHSS were compared between the two groups. There were no significant differences in oocyte metaphase-II rate (0.86±0.16 versus 0.85±0.15) or fertilization rate (0.79±0.22 versus 0.76±0.20) or in the incidence of OHSS between two groups. Similarly, there were no significant differences in implantation or clinical pregnancy rate between the two groups. Cabergoline can be administered as soon as HCG injection to prevent early OHSS, without adverse effects on oocyte maturation, fertilization rate and clinical outcome.Cabergoline, a dopamine receptor-2 agonist, is suggested to prevent ovarian hyperstimulation syndrome (OHSS) during ovarian stimulation. Nevertheless, the most suitable timing of cabergoline administration has not yet been studied. The aim of this study was to evaluate the influence of different timing of cabergoline administration on final oocyte maturation, fertilization rate and clinical outcome among patients at risk of developing OHSS. Among infertile women undergoing IVF treatment at risk of developing OHSS, 206 were enrolled in this study. The subjects were randomly allocated into two groups, i.e. the study group (n=100) receiving cabergoline beginning on the day of human chorionic gonadotrophin (HCG) injection and the control group (n=100) receiving cabergoline starting on the day of oocyte retrieval. Oocyte metaphase II rate, fertilization rate, clinical outcome and incidence of severe OHSS were compared between the two groups. There were no significant differences in oocyte metaphase II rate (0.86±0.16 versus 0.85±0.15) or fertilization rate (0.79±0.22 versus 0.76±0.20) or in the incidence of OHSS (3/100 versus 1/100) between the control and study groups. Similarly, there were no significant differences in implantation rate (36.6% versus 34.0%) or clinical pregnancy rate (54.0% versus 51.0%) between the two groups. Among women at high risk of OHSS, cabergoline can be administered as soon as the HCG injection to prevent early OHSS, without adverse effects on oocyte maturation, fertilization rate and clinical outcome.

Day 3 embryo transfer may have better pregnancy outcomes in younger than 35-year-old patients with poor ovarian response

To explore the pregnancy outcomes of embryo transfer with D2 or D3 embryos in patients with poor ovarian response. The pregnancy outcomes of 620 patients who had poor ovarian response and underwent the first in vitro fertilization-embryo transfer (IVF-ET) were retrospectively analyzed. Of the 620 cycles, all available fresh D2 embryos were used in 365 cycles (day 2 embryo transfer) and all available fresh D3 embryos were used in 255 cycles (day 3 embryo transfer) without superfluous embryos for freezing. There was a significant difference in clinical pregnancy rate between day 2 (32.73 %) and day 3 (50.83 %) embryo transfer in younger than 35-year-old patients, but no significant differences in implantation rate, live birth rate and spontaneous abortion rate (P > 0.05). There were similar pregnancy outcomes between day 2 and 3 embryo transfer in 35-year and older patients. D3 embryo transfer may have better pregnancy outcomes in younger than 35-year-old patients with poor ovarian response.

Cumulus cell-oocyte complexes retrieved from antral follicles in IVM cycles: relationship between COCs morphology, gonadotropin priming and clinical outcome

To assess retrospectively the developmental potential of different types of cumulus cell-oocyte complexes (COCs) derived from IVM cycles. IVM cycles were performed in natural cycles or after HCG, FSH, or FSH/HCG priming. COCs recovered were morphologically characterized in different types: compact (CC) or expanded (EC) cumulus mass but including an immature oocyte, and expanded cumulus mass enclosing a mature oocyte (EC-MII). Embryo developmental competence was investigated analysing exclusively cycles in which all transferred embryos derived from the same COC category. Fertilization rates did not differ significantly. Significant differences in pregnancy rates (14.5%, 10.0% and 27.6 % in the CC, EC, and EC-MII categories, respectively) were observed. Likewise, significant differences in implantation rates (8.9%, 6.3% and 19.1% in the CC, EC, and EC-MII categories, respectively) were found. Overall, priming with FSH/HCG had a beneficial effect on pregnancy and implantation rates, while no priming or HCG alone generated oocytes with poor competence. In IVM cycles, morphological evaluation at the time of collection can predict the developmental ability of different COCs. FSH/HGC priming has a positive effect on oocyte competence.

The role of embryonic stage at biopsy and uterine receptivity at transfer in the clinical outcome of preimplantation genetic screening

To determine whether the improved clinical outcomes observed by various groups following day-5 biopsy (and vitrification) is due to the nature of the biopsy procedure or improved uterine receptivity in a hormone replacement cycle. Retrospective study including preimplantation genetic screening (PGS) performed in a single clinic. All PGS cycles were performed using 9 or 12 fluorescent in situ hybridization (FISH) probes. Patients were divided into five groups as detailed in Table 1 below. Results are summarized in Table 1. There were significant differences in implantation rate, defined as the number of gestational sacs per embryo transferred, in Groups 1 to 3 vs. the control Groups 4 and 5 (P<0.001). A higher implantation rate was noted in Groups 2 and 3 vs. control Group 4, and in control Group 5 vs. control Group 4, but these differences were not statistically significant.Table 1Summary of Results.Day of Biopsy/Transfer Cycle# of CyclesAvg. Age (Yrs)% Normal Embryos# Embryos Transferred# Gestational Sacs% Implantation/TransferGroup 1Day 3 - Fresh ET12539.622.0%1062826.4% aGroup 2Day 3 - Thaw ET2353920.0%1846736.4% aGroup 3Day 5 - Thaw ET9039.534.0%611931.1% aGroup 4No Bx - Fresh Day 5 ET5039.5-2293515.3% bGroup 5No Bx - Thaw Day 5 ET51139.5-74413718.4% ba vs. b P<0.001 (Chi-square test) Open table in a new tab a vs. b P<0.001 (Chi-square test) The results show that the day of biopsy does not have an effect on clinical outcome of PGS by FISH if embryos are cryopreserved and transferred in a natural or hormone-replacement thaw cycle. They further suggest that improved uterine receptivity in a thaw cycle is an advantage for PGS cycles. It would be interesting to see whether the same trends are observed following array-based PGS, which allows comprehensive analysis of chromosome integrity in embryos. A randomized clinical trial is needed to further substantiate these observations.

The effect of a mind-body therapeutic program for infertile women repeating in vitro fertilization (IVF) treatment on uncertainty, anxiety, and implantation rate

OBJECTIVE: The study aimed to develop a mind-body therapeutic program to mitigate uncertainty and anxiety, and improve the implantation rate of infertile women under IVF treatments. DESIGN: Non-equivalent control group non-synchronized design (IRB-approved). MATERIALS AND METHODS: A preliminary survey of 8 women under IVF and literature survey showed that uncertainty is a major factor of anxiety for infertile women. Based on the intervention framework by Cousineau and Domar (2007), the program was constructed to alleviate three uncertainty-induced anxieties cognitive, emotional, and biological responses of infertile women through cognitive restructuring and informing, self-reflective activities and emotional support, and abdominal breathing, respectively. During a 5-week long IVF treatment, five 2-hour sessions were given on emotional refreshment, uncertainty factors and anxiety confirmation, mistaken ideas, preparing for a new start, and confidence. The intervention was evaluated with a convenience sample of 50 women with unexplained infertility awaiting a second-round IVF (26 for experimental and 24 for control group). Uncertainty and anxiety were measured by the difference between pre and post, and implantation rate was noted by serum β-HCG level. RESULTS: Between the experimental and control groups, there was a statistically significant difference in the alleviation of uncertainty (Z=-5.32, p=0.00) and anxiety (state anxiety inventory with Z=-5.17, p=0.00, and visual analog scale-anxiety with Z=-2.91, p=0.00). There was no significant difference in the implantation rate between the two groups (χ=1.94, p=0.16). However, the matching of 14 pairs showed a statistically significant difference in implantation rate (χ=4.09, p=0.04). CONCLUSIONS: The proposed intervention was found to effectively alleviate uncertainty and anxiety in infertile women receiving repeated IVF treatments. The clinical application of such an intervention program also appears to have a positive effect on implantation.

Male age negatively impacts embryo development and reproductive outcome in donor oocyte assisted reproductive technology cycles

To determine whether male age influences embryo development and reproductive potential in assisted reproductive technology cycles. Retrospective cohort analysis. Private IVF center. One thousand twenty-three male partners participating in anonymous oocyte donation cycles. Infertile couples undergoing 1,023 anonymous oocyte donation cycles. Live birth rate. A significant increase in pregnancy loss, decrease in live birth rate, and decrease in blastocyst formation rate were noted in men >50 years of age. There was no significant difference in implantation rate, pregnancy rate, or early embryo development through the cleavage stage (demonstrated by fertilization rate, embryo cleavage rate, percentage of nonfertilized or polyspermic embryos, rate of embryo arrest, or seven or more cell embryo development on day 3). Men < or =45 years of age had significantly more semen volume and more motile sperm than men >45 years of age. There was no significant change in sperm morphology or concentration. After controlling for female age with use of the donor oocyte model, male age >50 years significantly affected pregnancy outcomes and blastocyst formation rates. Semen volume and total motility decreased with increasing male age. Initial embryo morphology through the cleavage stage was not affected.

Estradiol levels after human chorionic gonadotropin (hCG) administration are not predicitive of IVF outcome: analysis of 7,474 initial fresh IVF cycles

Decreased estradiol levels after hCG administration often leads to IVF cycle cancellation. However, this decision is based on limited data. Our objective is to determine whether estradiol (E2) levels after hCG administration in IVF cycles correlate with clinical outcome. A large retrospective study of 7,474 fresh first IVF cycles from 1999 to 2007. Patients were grouped by age; group A <35, group B ≥35 to <38, group C ≥38 to <41, and group D ≥41 years old. Cycles were categorized into four groups based on the 24 hour change in estradiol from the day of HCG administration as follows: 1) Having an E2 level that increased by more than 10%, 2) No more then a 10% change (increase or decrease), 3) Decrease by more than 10% but less than 20%, 4). Decrease greater than 20%. Pearson's chi square and ANOVA using Stata were used to determine whether E2 response were associated with oocyte number, implantation, and pregnancy rates. When patients are stratified by age according to SART guidelines, a significant difference was noted in the number of follicles and retrieved oocytes, however, there was no significant difference in implantation rates, pregnancy rates, or loss rates (Table 1). TableParameters by Age and Estradiol Response After hCGAge GroupE2 Increase >10%E2 Changed <10%E2 Dropped 10%–20%E2 Dropped >20%P ValueRetrieved OocytesA17.7 ± 10.115.4 ± 9.214.9 ± 9.117.3 ± 13.2<.001B14.6 ± 9.112.0 ± 7.211.2 ± 6.915.1 ± 9.3<.001C12.8 ± 7.910.6 ± 6.69.7 ± 5.911.7 ± 11.3<.001D10.5 ± 6.99.6 ± 6.57.6 ± 3.97.4 ± 4.90.025Implantation RateA42.0 ± 40.840.2 ± 39.533.8 ± 37.938.3 ± 40.20.153B33.6 ± 37.332.2 ± 36.031.0 ± 36.935.4 ± 39.10.855C21.4 ± 30.120.3 ± 29.119.8 ± 28.126.7 ± 31.70.710D11.4 ± 22.411.4 ± 21.29.1 ± 20.110.9 ± 21.50.957Pregnancy RateA59.4%58.6%51.9%55.1%0.427B54.7%53.5%50.9%55.9%0.923C42.1%40.4%40.0%53.9%0.580D26.4%28.7%18.8%27.3%0.675Pregnancy LossA21.6%21.2%29.0%19.4%0.542B26.6%23.3%27.8%31.8%0.678C34.1%42.0%41.2%43.8%0.249D54.0%56.3%75.0%100%0.158 Open table in a new tab There is no association between estradiol response after hCG administration and implantation rates or pregnancy rates. This is also true for dramatic decreases in estradiol. Thus, the E2 level should not be used in determining whether the cycle should be cancelled or allowed to continue.

Increased nitric oxide levels in peritoneal fluids of minor-endometriosis patients and its relation to IVF-ET outcomes

To investigate the role of nitric oxide (NO) in the pathogenesis of early endometriosis-associated infertility. The volume of peritoneal fluids was recorded and the concentration of NO in peritoneal fluid and serum was measured with a fluorescence method using 4, 5-diaminofluorescein (DAF-2) as an indicator, in 60 patients with early endometriosis-associated infertility ( endometriosis group), 60 patients with tubal infertility (tubal infertility group) and 20 patients without infertility (control group). The IVF-ET outcomes between patients with endometriosis and tubal infertility were compared. The volume of peritoneal fluids from endometriosis group patients increased significantly compared with that in tubal infertility group patients and control groups. The concentration of NO in peritoneal fluid of the control group,the tubal infertility group and the endometriosis group was 9.98, 13.76 and 20.72, respectively (P<0.017). Furthermore the concentration of NO in serum of the patients of control group,tubal infertility group and endometriosis group was 12.25, 13.00, 13.60, respectively; there were no significant differences among these three groups. There were no significant differences in implantation rate, pregnancy rate and abortion rate of IVF-ET between endometriosis group patients and tubal infertility group patients. However, the fertilization rate was significantly lower in endometriosis group patients than that in tubal infertility group patients. Changes of nitric oxide in peritoneal fluids may play an important role in the pathogenesis of early endometriosis-associated infertility and IVF-ET may serve as an alternative method for this type of infertility.

Sidestream Smoking is Equally as Damaging as Mainstream Smoking on IVF Outcomes

BACKGROUND: Cigarette smoking (CS) is a widely recognized health hazard, yet it remains prevalent in society and the effects of environmental tobacco smoke exposure on fertility are unknown. Our objective was to measure the effects of CS on the fertility of mainstream (MS) or sidestream (SS) smoke-exposed women compared to their non-smoking (NS) counterparts. METHODS: This retrospective study investigated 225 female patients undergoing IVF (n 5 97) or ICSI (n 5 128). Patients were grouped based on their smoking status for comparison. This included: 39 MS (18 IVF and 21 ICSI); 40 SS (16 IVF and 24 ICSI); and 146 NS (63 IVF and 83 ICSI) women. Fertility treatment outcomes including embryo quality, implantation and pregnancy rate were measured. RESULTS: No difference in embryo quality between the three groups was observed. However, there was a significant difference in implantation rate (MS 5 12.0%, SS 5 12.6%, and NS 5 25.0%) and pregnancy rate (MS 5 19.4%, SS 5 20.0%, and NS 5 48.3%) per embryo transfer. CONCLUSIONS: Despite similar embryo quality there was a striking difference in implantation and pregnancy rates of MS and SS smokers when compared with NS. Our data demonstrate that the effects of SS smoking are equally as damaging as MS smoke on fertility.

A Prospective Randomized Trial Evaluating Endometrial Preparation for Implantation of Frozen/Thawed Embryos Using an Artificial Cycle Versus a Stimulated Cycle

A Prospective Randomized Trial Evaluating Endometrial Preparation for Implantation of Frozen/Thawed Embryos Using an Artificial Cycle Versus a Stimulated Cycle