Significant Difference In Pregnancy Rate Research Articles

Laparoscopic Intracapsular Myomectomy in Women 40 Years Old and Over with Symptomatic Uterine Fibroids. A Pilot Study.

Authors evaluated the impact of laparoscopic intracapsular myomectomy (LIM) in women 40 years of age and over with desire of future fertility compared with medical management of symptomatic fibroids, by a prospective cohort study in University affiliated Hospitals. This study includes a cohort of women 40 years of age and older with symptomatic intramural fibroids with desire of future fertility. Women with symptomatic fibroid uterus were offered to undergo LIM or medical management. They were encouraged to attempt conception either spontaneously or by assisted reproductive technology (ART) according to their individual preference. All women were followed for 2 years. Fibroid characteristics, pre- and post-surgical variables, including surgical complications, days of hospitalization, pregnancy rate, and obstetrical outcomes were collected. A total of 100 patient were included in the analysis. Fifty patients were assigned to the LIM group and 50 to the medical treatment group (MT). Groups were similar regarding age (43.5 ± 2.4 and 43.5 ± 2.4, p = 0.99), body mass index (23.8 ± 3.1 and 24.2 ± 3.1, p = 0.54), parity (0.46 ± 0.09 and 0.58 ± 0.09, p = 0.37), fibroid number (1.38 ± 0.6 and 1.46 ± 0.6, p = 0.53), and fibroid size (5.92 ± 1.62 cm vs. 5.94 ± 1.49 cm, p = 0.949). Of the patients who underwent LIM, 62% conceived within the study period compared with 56% in the control group ( p = 0.54). Pregnancy was achieved by ART in 44% of the patients of the LIM group and 30% in control group. There was no significant difference in pregnancy rates among the two groups regarding spontaneous pregnancy rate ( p = 0.332), nor in pregnancies obtained by ART with own eggs ( p = 0.146) and oocyte or embryo donation ( p = 0.821). The take home baby rate was 65% (20/31) in the LIM group and 61% (17/28) in the control group ( p = 0.7851). Both groups had similar rate of miscarriage ( p = 0.748). Patients 40 years old and over with symptomatic fibroid uterus who undergo LIM have similar subsequent fertility and obstetrical outcomes than women treated with medical management. LIM has no detrimental impact on future fertility in women 40 years old and over.

Different Timing of Intrauterine Insemination and Pregnancy Outcome in Patients with Unexplained Infertility: A Randomized Controlled Study

Background: In this era of rapid advancements in assisted reproductive technologies, intrauterine insemination (IUI) is still widely offered to subfertile couples, as a cheaper and less invasive treatment option before proceeding to IVF. Objective: To determine the most suitable timing of hCG administration prior to intrauterine insemination for optimizing pregnancy outcome and success rate. Patients and methods: A randomized controlled study conducted in Obstetrics and Gynecology Department, Sohag University from 30 June 2018 to 30 June 2019 and included couples with unexplained infertility. A total of 110 patients were recruited in our study, 30 patients dropped out; where 20 patients were due to inadequate stimulation, bad endometrium or more than 3 follicles were present, 6 patients did not show up for folliculometry after being given treatment and 4 patients did not show up for the procedure after being given the hCG trigger. Results: This study showed an improved pregnancy rate when IUI was performed with a time interval of 24–36 h (13 case with positive pregnancy test). Conclusion: IUI after ovulation induction can be done any time between 24 and 48 h after hCG injection without significant differences in pregnancy rates.

A comparative analysis of pregnancy outcomes of patients with uterine fibroids after high intensity focused ultrasound ablation and laparoscopic myomectomy: a retrospective study

Purpose The aim of this study was to retrospectively compare and analyze pregnancy outcomes of patients with uterine fibroids after high intensity focused ultrasound (HIFU) ablation and laparoscopic myomectomy (LM). Materials and methods The study group consisted of 346 patients with uterine fibroids who wished to conceive, in which 152 patients received HIFU ablation treatment (HIFU group) and 194 patients received LM treatment (LM group). The parents’ baseline characters were recorded and the pregnancy outcomes were evaluated in a median follow-up time of 42 months (range: 16 ∼ 81) after the treatment, and the differences of the two groups were compared. Results Patients with uterine fibroids in HIFU group had a significant shorter pregnancy interval than that in LM group (10 months VS. 13 months, p < .05). No significant differences were observed in pregnancy rate, miscarriage rate, live birth rate, natural pregnancy rate, cesarean section rate, and perinatal complications rate between the HIFU group and the LM group (p > .05). When stratified by age, infertility history, fibroid types, fibroid numbers, and fibroid sizes, there was no statistically significant difference in pregnancy rate between the HIFU group and the LM group (p > .05). Conclusions Based on the results from this study, both HIFU and LM can be safely used to treat patients who wish to conceive. The pregnancy outcomes of post-HIFU are similar to that of post-LM.

The Follicular Output Rate (FORT) as a method to evaluate transdermal testosterone efficacy in poor responders.

Objective:Follicular Output Rate (FORT) is an efficient quantitative and qualitative marker of ovarian responsiveness to gonadotropins. Transdermal testosterone (TT) has been used as adjuvant therapy to gonadotrophins in order to improve ovarian response in poor responders (PR). The aim of this study was to analyze whether TT can improve follicular sensitivity to gonadotropins using FORT.Methods:This retrospective study, held in a tertiary-care university hospital included 90 PR patients, according to the Bologna criteria. Patients in Group 1 (n = 46) received transdermal application of testosterone preceding gonadotrophin ovarian stimulation under pituitary suppression. In Group 2 (n = 44) ovarian stimulation was carried out with high-dose gonadotrophin in association with minidose GnRH agonist protocol. We analyzed ovarian stimulation parameters and IVF outcomes. We determined antral follicle count (AFC) (3-8 mm) before ovarian stimulation, pre-ovulatory follicle count (PFC) (16-22 mm) and the day of hCG administration. We calculated the FORT using the PFCx100/AFC ratio.Results:Baseline characteristics and ovarian reserve parameters were similar in both groups. FORT and oocytes retrieved were significantly higher in group 1 vs group 2. There were no significant differences in pregnancy rates. In group 1 there was a significant correlation between FORT and AFC.Conclusions:This study suggests that the potential beneficial mechanism of TT in poor responder patients may be based on increasing the antral follicle sensitivity to gonadotrophin. FORT is an excellent tool to demonstrate this.

The effectiveness of a collaborative infertility counseling (CIC) on pregnancy outcome in women undergoing in vitro fertilization: a randomized trial

BackgroundThe optimal objective of infertility treatments is to increase pregnancy rate. The aim of this study was to assess the effectiveness of a collaborative counseling program on pregnancy rate in women undergoing in vitro treatment.MethodsThis was a parallel group randomized trial on a sample of 60 women attending to an infertility research center affiliated to Mashhad University of Medical Sciences for fertility treatment. Women were randomly assigned to an intervention or a control group. Then, a five-session program offered to the intervention group while the control group received nothing expect the usual care. The primary outcome for the study was positive pregnancy test at the end of study. Statistical analyses including independent samples t-test were performed to explore the data.ResultsThe outcome analysis showed that there were no significant differences in pregnancy rate between the intervention and the control groups (P = 0.298). Also, there were no significant differences in follicle and embryo numbers between two groups. However, a significant difference was observed between two groups in terms of oocyte numbers where the intervention group had more oocyte (P = 0.014).ConclusionOverall the findings indicated that the collaborative infertility counseling did not improve treatment success in infertile women undergoing in vitro fertilization.Trial registrationIRCT201110267915N1. Registered 2014.07.25-Retrospectively registered (http://en.irct.ir/trial/8359).

A Retrospective Study Examining Phentermine on Preconception Weight Loss and Pregnancy Outcomes

Objective: Obesity is a well-known risk factor for infertility. However, the use of weight loss medications prior to conception is underutilized. The objectives of our study are to describe weight loss, pregnancy rates, and live birth rates after short-term phentermine use in women with obesity and infertility.Methods: This was a retrospective analysis of 55 women (18 to 45 years old) who were overweight or obese, diagnosed with infertility, and prescribed phentermine for weight loss in an ambulatory endocrinology clinic at a single, tertiary level academic medical center. Main outcome measures were mean percent weight change at 3 months after starting phentermine, and pregnancy, and live birth rates from start of phentermine to June 30, 2017.Results: Median duration of phentermine use was 70 days (Q1, Q3 [33, 129]). Mean ± SD percent weight change at 3 months after starting phentermine was -5.3 ± 4.1% (P<.001). The pregnancy rate was 60% and the live birth rate was 49%. There was no significant difference in pregnancy rates (52% versus 68%; P = .23) or live birth rates (44% versus 54%; P = .50) in women who lost ≥5% versus <5% of their baseline weight. The number of metabolic comorbidities was negatively associated with the pregnancy rate. Phentermine was generally well-tolerated with no serious adverse events.Conclusion: Phentermine can produce clinically significant weight loss in women with obesity during the preconception period. Higher pregnancy or live birth rates were not observed with a greater degree of weight loss with phentermine.

Effect of Heavy Metals Levels In Follicular Fluid on ICSI Outcome

Heavy metals and trace elements adversely affect animal health and the reproductive system and its functions through direct or indirect effects on numerous organs and systems. This study was aimed to evaluate the effect of heavy metals levels in follicular fluid on a patient undergoing Intracytoplasmic Sperm Injection (ICSI) outcomes namely Cadmium (Cd), Lead (Pb), and Arsenic (As). In comparison between the normal concentration level of Cd and the high concentration level of Cd the present study showed a significant difference in embryos quality (P=0.01611), while no statistically significant difference in pregnancy rate was observed. Although Pb showed a significant difference in embryos quality; grade I embryos in normal level concentration than high-level group (P=0.00021), and grade III embryos were significant in a high-level concentration of Pb than low-level group (P=0.0043). The present study concluded that a high level of heavy metal concentration in the follicular fluid has a harmful effect on the grading of embryos and these lead to a decrease in the chance to select the beast embryos before transferred (Cd and Pb).

Pregnancy rates after slow-release insemination (SRI) and standard bolus intrauterine insemination (IUI) \u2013 A multicentre randomised, controlled trial

This multicentre, randomised, controlled cross-over trial was designed to investigate the effect of intra-uterine slow-release insemination (SRI) on pregnancy rates in women with confirmed infertility or the need for semen donation who were eligible for standard bolus intra-uterine insemination (IUI). Data for a total of 182 women were analysed after randomisation to receive IUI (n = 96) or SRI (n = 86) first. The primary outcome was serological pregnancy defined by a positive beta human chorionic gonadotropin test, two weeks after insemination. Patients who did not conceive after the first cycle switched to the alternative technique for the second cycle: 44 women switched to IUI and 58 switched to SRI. In total, there were 284 treatment cycles (IUI: n = 140; SRI: n = 144). Pregnancy rates following SRI and IUI were 13.2% and 10.0%, respectively, which was not statistically significant (p = 0.202). A statistically significant difference in pregnancy rates for SRI versus IUI was detected in women aged under 35 years. In this subgroup, the pregnancy rate with SRI was 17% compared to 7% with IUI (relative risk 2.33; p = 0.032) across both cycles. These results support the hypothesis that the pregnancy rate might be improved with SRI compared to standard bolus IUI, especially in women aged under 35 years.

DMEM and FBS as thawing solutions for frozen semen of pigs can improve sperm motility and sow reproductive performance

The purpose of this experiment was to investigate the effects of Beltsville thawing solution BTS , Androhep, and Dulbecco?s modified Eagle medium + Fatal bovine serum D-F as diluents of frozen semen on sperm motility and sow reproductive performance. In experiment 1, boar semen was collected and diluted to 2.0 × 109/60 mL, 1.5 × 109/60 mL, and 1.5 × 109/40 mL with Androhep. The appropriate semen dose was determined by postcervical insemination. In experiment 2, boar semen was fumigated with liquid nitrogen and thawed semen was diluted to 1.5 × 109/40 mL with D-F, Androhep, and BTS, respectively. The effects of above diluents on sperm motility and sow reproductive performance were studied by postcervical insemination. The appropriate semen dose for postcervical insemination was 1.5 × 109/40 mL. After thawing of frozen semen, sperm motility of semen diluted with D-F was significantly higher than that of semen diluted with Androhep and BTS. There was no significant difference in pregnancy rates among sows via artificial insemination. The litter size of sows using D-F diluted semen was significantly higher than that of sows using Androhep and BTS diluted semen. In conclusion, D-F freezing diluent can improve sperm motility of frozen boar semen after thawing, prolong sperm survival time, and increase sow reproductive performance.

HERE COMES THE SUN: SERUM VITAMIN D LEVELS AND INTRAUTERINE INSEMINATION SUCCESS IN WOMEN OF ADVANCED MATERNAL AGE

Vitamin D is often thought to play an integral role in human reproduction. Previous research has shown vitamin D receptors to be located throughout the endometrium and on the granulosa cells of growing follicles, implicating its necessity in adequate reproductive function. As such, studies show that women deficient in vitamin D have decreased probability of live birth after IVF. Yet, more recent studies have found that the same is not true for women undergoing intrauterine insemination (IUI), as vitamin D levels did not seem to impact pregnancy rates. Thus, we sought to better understand the relationship between vitamin D and reproductive success among infertile women. The purpose of this study was to determine the relationship between serum vitamin D levels and IUI success rates in women of advanced maternal age. All patients over the age of 40 who underwent IUI between January 2017 - August 2019 were included. All patients received a basic fertility work up, including serum vitamin D and AMH levels, as well as ultrasound evaluations. Sufficient serum vitamin D levels were defined > 20 ng/mL. Thus, patients were divided into two groups: patients with vitamin D deficiency (0-19.99 ng/mL) and vitamin D sufficiency (>20 ng/mL) at baseline. Serum HCG levels were taken 12 days post-IUI. Positive pregnancy was defined as a blood HCG >5 (units). Clinical pregnancy rate and miscarriage rates were also noted. T-tests and chi square analysis were used to analyze the data using SPSS (SPSS Inc., Chicago, IL, USA). A total of 167 patients were analyzed. Baseline characteristics between the two groups, including age, BMI, and AMH were insignificant. The average baseline vitamin D level for deficient patients was 15.53 ng/mL while the average for sufficient patients was 35.83 ng/nL. There was a statistically significant difference in pregnancy rates between women over 40 with deficient and sufficient vitamin D levels (p<0.001). Of note, a negative correlation was found between vitamin D and AMH (p<0.05). Although previous research showed that vitamin D levels had no effect on IUI success in women under 40 years of age, here we demonstrated that vitamin D sufficiency in women over 40 years of age may play a role in IUI success. Further research is needed to analyze the costs and benefits of allotting time for women of advanced maternal age to replenish their vitamin D levels if they are pursuing IUI.

Effects of Vaginal Misoprostol after Intrauterine Insemination IUI

Intrauterine insemination has an important role in the treatment of infertile couples. Usage of vaginal misoprostol therapy at the time of intrauterine insemination has been investigated, and its tolerability and effects on clinical pregnancy rates still questionable. To assess the effectiveness of vaginal misoprostol on some demographic characteristics and hormones level with a success rate of Intrauterine Insemination. the period of collection of patients extended from Sep. 2018 until May 2019. Eighty- one infertile couples who attended Al Nahrain University, High Institute for Diagnostic Infertility and Assisted Reproductive Technologies, and private fertility clinics were enrolled through this study. Divided into two groups, the next group received 100 μg vaginal misoprostol immediately after completion of the IUI procedure, while the control group was subjected to ordinary IUI procedure without adjunctive therapy. The mean of demographic data of body mass index, age, and duration of infertility was statistically insignificant in control, Misoprostol post- intrauterine insemination. The percentage of pregnancy rate in the control group 5.0% and it 19.5% in the Misoprostol post-intrauterine insemination group. Moreover, there are significant differences in pregnancy rates among all study groups. According to this study, there is no significant result of pregnancy occurrences correlated with, female age, male age, and body mass index, duration of infertility or type of infertility, hormone levels. Misoprostol use after intrauterine insemination has a positive impact on pregnancy outcome in the control group 5.0% and it 19.5% in Misoprostol post- intrauterine insemination group. Smaller doses (100 μg) of misoprostol can decrease side effects without affecting the outcome.

Outcomes in poor responders treated with in vitro fertilization/intracytoplasmic sperm injection according to bologna criteria

Purpose of the study was to evaluate the effectiveness of various approaches of artificial reproductive technologies (ART) in advanced maternal age patients with poor ovarian response (POR). Materials and methods . This is retrospective cohort study of 455 patients with POR who have undergone an IVF and embryo transfer program at from June 2016 to June 2018. Researchers evaluated pregnancy rate (PR) per embryo transferand live birth rate (LBR) per embryo transferas in vitro fertilization (IVF) outcomes. The patients fulfilled Bologna criteria were divided into 5 groups: long protocol, ant-gonadotropin-releasing hormone protocol, freeze embryos transfer without preimplantation genetic diagnostic (PGS), freeze embryos transfer with PGS, natural cycle. Results. There was no statistically significant difference in the age, Anti-Mullerian hormone level and duration of infertility between the groups. Despite different protocols of ovarian stimulation, there was no statistically significant difference in pregnancy rate in fresh cycles. At the same time, cancellation of transfer was significantly higher observed in natural cycles (p <0.001). PR and LBR were statistically significant higher in freeze embryo transfer group 29% and 12.1% vs 13.3% and 5,5% respectively (p<0.001 and p = 0.040). During the transfer of the embryo unexamined by PGS and after PGS the pregnancy rate did not differ (29.4% vs 28.2%, p <0.05), but LBR was statistically significant higher after euploid embryo transfer (8.2% without PGS vs 20.5% after PGS, p = 0.028). Conclusion. The most effective approach in patients with a poor ovarian response was cycle segmentation, cryopreservation of embryos, PGS and transfer of an euploid embryo. This category of patients requires a personalized approach to the treatment of infertility. The choice of protocol in ART program must be carried out with the full voluntary and informed consent of the patient, depending on their desires and capabilities, including financial.

The effects of an expressive writing intervention on pregnancy rates, alexithymia and psychophysical health during an assisted reproductive treatment

Objective: World Health Organization reported that in developed countries one in four couples experience infertility with serious implications for the psychophysical well-being. Aim of this study was to evaluate the effects of Pennebaker’s writing technique on pregnancy rates, alexithymia and psychophysical health during an assisted reproductive treatment (ART).Method: 91 women admitted for an ART were randomly divided into two groups: an experimental one (n = 46), where women wrote about their thoughts and emotions concerning the infertility experience, and a control group (n = 45) where women did not write. All subjects completed a socio-demographic questionnaire, the 20-item Toronto Alexithymia Scale and the Symptoms Checklist-90-R before and after the writing sessions.Results: A significant difference in pregnancy rates between the experimental group (n = 13) and the control group (n = 5) was found (χ2 = 4.216; p < .04). A significant difference was also found between women who participated in the study (experimental + control= 91) and women who declined to participate, in the direction of more ART successes (n = 18 vs. n = 0) in the group of women who participated (χ2 = 10.17; p < .01).Conclusions: The findings support the usefulness of the writing technique during ART in promoting treatment success.

Effect of three commercial extenders on sperm motility and fertility in liquid ram semen stored at 15 °C or 5 °C

The effect of different extenders on sperm motility and fertility was evaluated during liquid storage of ram semen at 5 °C and 15 °C. The semen was collected, pooled and diluted in three commercial extenders: Inra 96® (INRA) based on skimmed milk, Biladyl® A fraction (BIL) based on egg yolk, and Ovixcell® (OVIX) based on soybean lecithin. Then, sperm motility was evaluated at 0, 6, 24, 48, 72 and 96 h. In order to evaluate fertility, samples stored at 15 °C were used after dilution in INRA and OVIX. Results showed that progressive motility was significantly higher up to 72 h of storage in sperm samples maintained at 5 °C in comparison with 15 °C, similarly for each tested diluent. When samples were stored at 5 °C in OVIX, kinematic parameters such as velocity (except curvilinear velocity, VCL), trajectory [linearity (LIN), straightness (STR), wobble (WOB)], amplitude of lateral head displacement (ALH) and beat/cross frequency (BCF) were higher than in INRA and BIL. No significant differences in pregnancy rate were detected between INRA (62.6%) and OVIX (58.9%). In conclusion, liquid storage at 5 °C with OVIX extender is an interesting option since non-animal components are used, and this extender offers similar in vitro and in vivo efficacy as other extenders containing animal components.

Impact du soutien de la phase lutéale par Human Chorionic Gonadotropine (hCG) dans les inséminations intra-utérines

ObjectivesThe objective of our study is to evaluate the impact of luteal phase support by hCG in intrauterine inseminations preceded by ovarian gonadotropin stimulation. MethodsA retrospective study was conducted at the CHU of Nice between March 1, 2016 and October 31, 2017. During this period, 300 intrauterine inseminations were included in data analysis. Ovarian stimulation was performed by gonadotropins and a GnRH antagonist was added, if needed. Following a modification of standard operative procedure in the department, patients who performed an intrauterine insemination from December 1, 2016 received luteal phase support with two injections of hCG 1500 IU, performed at three days of interval. Pregnancy and ovarian hyperstimulation syndrome were the primary and secondary study endpoints, respectively. ResultsOut of 300 inseminations included in the analysis, 144 were performed with luteal phase support and 156 without support. No statistically significant difference in pregnancy rate was observed between these two groups (19.4% of pregnancy in the luteal phase support group and 15.38% in the group without luteal phase support, P=0.353). No ovarian hyperstimulation syndrome occurred over the course of the study. ConclusionOur study shows a slight improvement of pregnancy rate in the group subjected to luteal phase support by hCG after intrauterine insemination, but the benefit was not significant. A randomised prospective study based on a large cohort could help to assess the effect of luteal phase support during intrauterine inseminations.

Comparison of the Microdose Flare Up GnRH Agonist and Antagonist Protocol in Assisted Reproduction with Poor Ovarian Response during Controlled Ovarian Stimulation Cycles

Background: Poor ovarian response presents a significant challenge in artificial reproductive treatment (ART). Poor responders are estimated to comprise approximately 9- 24% of IVF cycles patients. Recently, the development of protocol offered another approach for ovarian stimulation by blocking the pituitary receptors. There is evidence that application of protocol decreases the duration of ovulatory stimulus and reduce incidence of ovarian hyperstimulation syndrome (OHSS). Objectives: The aim of the current study was to evaluate the effect of the protocol to the microdose flare up agonist protocol for poor ovarian responders undergoing IVF/ICSl treatment. Patients and Methods: A total of sixty patients of IVF/ICSI assigned to be poor responders were randomized into two groups; group 1 Thirty patients received fixed protocol and group 2 thirty patients received a microdose flare up agonist protocol. Patients characteristics and treatment outcomes were statistically compared between groups. Results: Duration of stimulation was highly significantly lower in the group than that of the microdose flare up one (antagonist 8.60±1.63 versus microdose flare up 12.06±2.86; p=0.001). Number of ampoules of HMG was highly significantly lower in the group than that of the micro dose flare up agonist one (antagonist 23.53±7.33 versus micro dose agonist 71.97±9.35; p=0. 001). The number of oocytes retrieved in the group was not different from microdose flare agonist group (5.14±2.45 vs. 5.11±1.29; p=0.953), and the number of embryos transferred was similar in both groups (2.03±0.08 vs. 2.09 ± 1.05; p=0.674). No significant differences in pregnancy rates were reported. Conclusion: we offer using the GnRH antagonist as a patient friendly protocol in ART with poor ovarian response with Immediate mode of action, similar pregnancy rate, time saving, less duration of stimulation and number of ampoules for stimulation than microdose flare up protocol.

Application of embryo biopsy and sex determination via polymerase chain reaction in a commercial equine embryo transfer program in Argentina.

Embryo biopsy for fetal sexing has clinical application, but few reports are available of its use within an active embryo transfer program. We evaluated results on biopsy of 459 embryos over one breeding season. There were no significant differences in pregnancy rate between biopsied and non-biopsied embryos (72% vs 73%) or for biopsied embryos recovered at the centre (73%) compared with those shipped overnight (72%). However, the pregnancy rate decreased significantly in shipped embryos biopsied ≥20h after collection. Overall, 86% of biopsies provided a sex diagnosis. The likelihood of a positive genomic (g) DNA result was significantly higher for biopsies from large blastocysts (96%) than from smaller embryos (70-85%). In total, 38% of biopsies were positive for Y chromosome DNA (Y-DNA) and were diagnosed as male. Subsequently, 95% of Y-DNA-positive embryos were confirmed as male and 78% of Y-DNA-negative embryos were confirmed as female. The accuracy of prediction of female (Y-DNA negative) was significantly higher when the biopsy sample was probed for Y-DNA only compared with probing for both gDNA and Y-DNA. We estimate that by transferring only Y-DNA-negative embryos, 3% of potential female pregnancies may have been lost, and production of male pregnancies was reduced by 72%.

Comparison of pregnancy in cattle when non-vitrified and vitrified in vitro-derived embryos are transferred into recipients

The present study was conducted in cattle to test the null hypothesis that the pregnancy rate of recipient females is similar when in vitro-derived embryos are transferred either fresh (non-vitrified) or after being subjected to vitrification. Cumulus-oocyte complexes, collected twice (6 weeks apart) from 10 donor cows were matured in vitro and inseminated with frozen-thawed sperm from a single proven bull per donor collection. Cleaved embryos were cultured in vitro until day 7 and any resulting blastocysts were graded for stage [early (unexpanded), advanced (expanded, hatching, hatched)] and/or quality and either discarded (poor quality), or, if deemed suitable, transferred fresh or vitrified for later warming and transfer. All blastocysts were transferred singly to oestrus-synchronized cows and pregnancy monitored by transrectal palpation on days 35, 60 and 90. From 20 collections, 818 cumulus-oocyte complexes were aspirated; however, after grading, only 462 (56.5%) were ranked as suitable quality for maturation and insemination. From those 462 complexes inseminated, 363 (78.6%) cleaved during the process and 243 (52.6%) developed to the blastocyst stage with 194 (42.0%) deemed utilizable, of which 85 were vitrified and 109 were transferred fresh. There was a median of 13 (range 0–24) utilizable blastocysts per cow. Of the 109 non-vitrified blastocysts transferred, there were 45 (41.3%) and 41 (37.6%) recipients that were detected to be pregnant on day 35 and day 90, respectively, subsequent to transfer. Thus, an 8.9% abortion rate was observed (4/45). Of the 85 transferred vitrified-warmed blastocysts, 34 were detected to be pregnant (40.0%) on day 35 following transfer, and all pregnancies were maintained at day 90 (0% abortion rate), which was similar to non-vitrified transfers (P > 0.05, Chi-square test). There was no significant difference in pregnancy rate on day 90 in advanced compared to early blastocysts for either the non-vitrified transfers (9/23, 39.1% vs 33/86, 38.3%) or the vitrified transfers (30/72, 41.6% vs 4/13, 30.8%) (P > 0.05 in each case). In summary, these data show that vitrification of in vitro-derived early and advanced blastocysts is a suitable method of cryopreservation of bovine embryos, and, furthermore, that subsequent transfer of all vitrified/warmed blastocysts into recipient females results in pregnancy rates no different to those attained by non-vitrified transfers into recipient females.

EFFECTS OF OXYTOCIN AND HUMAN CHORIONIC GONADOTROPIN ON OVULATION IN PATIENTS WITH CLOMIPHENE CITRATE-RESISTANT PCOS

Introduction and Objective: Polycystic ovary syndrome (PCOS) is one of the causes of infertility due to the lack of chronic ovulation. Meanwhile, administration of human chorionic gonadotrophin (HCG) and possibility oxytocin is a method of trigger of ovulation. The present study aimed to investigate theeffect of oxytocin and HCG on ovulation in patients with clomiphene citrate-resistant PCOS. Materials and Methods: This is a double-blind clinical trial performed on 126 patients with clomiphene citrate-resistant PCOS, in Shahid Akbar-Abadi Hospital in Tehran. Ovulation stimulation was performed with (Letrozol 5mg + 10 units of oxytocin),(5,000 units of HCG +Letrozol 5 mg), and(HCG plus oxytocin+5 mg Letrozol). Then information including personal characteristics, contact number, clinic file number, gravidity, parity, history of abortion and previous illness, history of specific drug use, follicle count, dominant follicle size, ovulation symptoms in ultrasound, serum progesterone in luteal phase, and pregnancy outcome were evaluated and recorded in each of the three groups and the results were compared. Findings: Overall, 20% of patients responded to the treatments without any side effect and became pregnant. There was no significant difference in pregnancy rate of infertile women in different groups. In addition, the dominant follicle size and folliclecount in infertile women were studied, and there was no significant difference between the groups ( p -values 0.8 and 0.59, respectively). Of the 91 non-pregnant patients, ovulation induction occurred in 36 women (39.5%) in the next cycles of whom 8 (22.2%) were in the oxytocin group, 10 (27.8%) in the HCG group, and 18 (50.0%) in the oxytocin plus HCG group. Of these 36 patients, 10 (27.8%) were re-induced for ovulation in subsequent cycles of whom 2 (20.0%) were in the oxytocin group, 5 (50.0%) in the HCG group, and 3 (30.0%) in the oxytocin plus HCG group. There was no significant difference in mean endometrial thickness of infertile women treated in different groups ( p =0.1).Comparison of patients in terms of abortion rate showed that among 24 pregnant women, 21 (87.5%) had no abortion and 3 (12.5%) had. Of the 3 cases of abortion, 1 was in the oxytocin group and 2 werein the HCG group. In addition, comparing patients in terms of multiplepregnancy showed 2 cases of twin pregnancy, of which 1 occurred spontaneously 6 months after treatment in the oxytocin plus HCG group,and the second case was in the oxytocin group. In total, 1 out of 24 pregnancies (4.2%) were twin. Finally, there was no statistically significant difference between the three groups in terms of the mean serum progesterone ( p =0.2). Conclusion: Since there was no difference in the fertility rate in threegroups ((Letrozol 5mg + 10 units of oxytocin), (5,000 units of HCG +Letrozol 5 mg), and (HCG plus oxytocin+5 mg Letrozol) and given the low size of the study population, and considering the cost-effectiveness and the fewerside effects of oxytocin, this method(Use of oxytocin(seems effective for trigger of ovulation in clomiphene citrate-resistant PCOS patients.

Reporting on longitudinal live birth rates and cumulative delivery rates are more realistic outcome measures than sperm retrieval rates in couples undergoing mTESE–ICSI

The live birth rates (LBRs) in men with non-obstructive azoospermia (NOA) undergoing microdissection TESE (mTESE) are under reported, with surgical sperm retrieval rate often used as the primary outcome measure. We analysed longitudinal and cumulative delivery rates following mTESE– intracytoplasmic sperm injection (ICSI) in NOA. Sperm was retrieved in 45% of patients undergoing mTESE. Median male and female age were 42 years (IQR 37–47) and 35 years (IQR 31–38) respectively. A total of 141 ICSI cycles and 23 frozen embryo transfers resulted in 62 pregnancies and 37 LBRs. The longitudinal LBR, crude and expected cumulative delivery rates after five cycles were 15.5%, 48.7% and 71.1%, respectively. Reassuringly, there was no significant difference in pregnancy rate (PR) (p = 0.37) or LBR (p = 0.68) using fresh or frozen sperm or embryo (p = 0.74). Sperm retrieval was significantly correlated with Johnsen score (JS) (p = 0.006) and hypospermatogenesis (HS) (p = 0.04), whilst LBR only significantly correlated with female age (p = 0.04). The longitudinal LBR for a couple embarking on mTESE for azoospermia is only 15.5%, although the cumulative delivery rates are promising. Reassuringly, the outcomes using fresh versus frozen embryos or sperm are comparable. Reporting on delivery rates from a single mTESE procedure are more objective and realistic measures of treatment success in men with NOA.