Subsequent In Vitro Fertilization Cycles Research Articles

A Pilot Prospective Study Evaluating the Effect of Curcuma-Based Herbal Food Supplement on the Outcome of In Vitro Fertilization in Patients Testing Positive for Four Immunological Biomarkers.

Background and Objectives: Inflammation and oxidative stress have been described to reduce the chance for pregnancy instauration and maintenance. NOFLAMOX, a recently developed herbal preparation with recognized antioxidant and anti-inflammatory properties, can represent an interesting treatment to increase the chance of pregnancy, both physiological or after in vitro fertilization (IVF). The aim of this study was to assess NOFLAMOX's effect; a population with unexplained infertility was screened for the recently described IMMUNOX panel based on four immunological biomarkers with a prospective study approach. Materials and Methods: Patients with unexplained infertility and positive for at least one of the biomarkers of the IMMUNOX panel were included in this study and treated with NOFLAMOX for three months prior to an IVF cycle. Results: Eighty-six patients (n = 86) were screened with the IMMUNOX panel and the forty-seven (54.5%) found positive were included in this study. In more detail, 11 were positive for TNFα (23.4%), 18 (38.3%) for glycodelin (GLY), 29 (61.7%) for Total Oxidative Status (TOS), and 32 (68.1%) for Complement Activity Toxic Factor (CATF). After three months of treatment, a significant reduction in the number of IMMUNOX-positive patients was observable, with 26 patients who turned IMMUNOX-negative displaying a quantitative statistically significant variation of 100% (11/11), 38.9% (7/18), 65.5% (18/29), and 75% (24/32), for TNFα, glycodelin, TOS, and CATF, respectively. Followed in the subsequent IVF cycle, this NOFLAMOX-treated population showed a pregnancy rate of 42.3% compared to the 4.7% of the IMMUNOX-positive group of patients. Conclusions: Taken together, the results of this study suggest that NOFLAMOX could represent an interesting option for those patients with unexplained infertility of inflammatory/oxidative origin. Further studies are needed to confirm these results and explore possible strategies to restore fertility in women with immune-mediated sterility.

Outcomes of the Next In Vitro Fertilization Cycle in Women with Polycystic Ovary Syndrome after a Failed In Vitro Maturation Attempt.

In vitro maturation (IVM) is indicated in women with polycystic ovary syndrome (PCOS) who have a very good ovarian response during in vitro fertilization (IVF) and are therefore at high risk of ovarian hyperstimulation syndrome (OHSS). According to the latest practice committee document, IVM could be a major advance in assisted reproductive technology (ART) procedures (reduced cost and simplified treatment); nevertheless, retrospective studies of IVM versus IVF still demonstrate lower chances of a live birth with IVM. Could IVM prove to be an optimal first-line treatment approach? And limited information is available concerning the success of the subsequent IVF cycle after the failure of an IVM cycle. Does IVM treatment adversely affect the subsequent IVF cycle, and is this worth considering before performing the IVF cycle for women with PCOS? This prospective nested case-control study at the Peking University Reproductive Medicine center in China was performed between March 2018 and September 2020. Women aged 20-38 years with PCOS and infertility and who were scheduled for their first IVF attempt were eligible. A total of 351 women were randomly allocated to receive one cycle of unstimulated natural IVM (n = 175) or one cycle of standard IVF with a flexible GnRH antagonist protocol followed by hCG as an ovulation trigger (n = 176). This study involved 234 women (58 women with no blastocysts in the first IVM cycle and 158 women who underwent the first IVF cycle). Cumulative live birth rate at 12 months after oocyte retrieval and OHSS of a standard controlled ovarian stimulation (COS) IVF cycle were compared between 58 women in an IVF cycle following a failed IVM cycle and 158 women who underwent the first IVF cycle. No significant differences were found in the cumulative live birth rate (CLBR), ongoing pregnancy rate, or clinical pregnancy rate at 12 months after oocyte retrieval between the two groups (56.9% vs. 58.9%, p = 0.795; 58.6% vs. 60.8%, p = 0.776; and 84.5% vs. 76.0%, p = 0.178). The incidence of moderate-to-severe OHSS was not significantly different between the groups (6.9% vs. 5.7%, p = 0.742). Additionally, there were no significant differences in the total gonadotropin dose, stimulation duration, number of retrieved oocytes, number of retrieved mature oocytes, or fertilization rates. Even if the first IVM attempt failed in subfertile women with PCOS, comparable cumulative live birth rates were observed in the subsequent IVF cycle. IVM treatment does not adversely affect the subsequent IVF cycle.

Adding a ketogenic dietary intervention to IVF treatment in patients with polycystic ovary syndrome improves implantation and pregnancy

Patients with polycystic ovary syndrome (PCOS) on a high-carbohydrate diet intrinsically suffer from exacerbated glucotoxicity, insulin resistance (IR), and infertility. Lowering the carbohydrate content has improved fertility in patients with IR and PCOS; however, the effects of a well-controlled ketogenic diet on IR and fertility in PCOS patients undergoing in vitro fertilization (IVF) have not been reported. Twelve PCOS patients with a previous failed IVF cycle and positive for IR (HOMA1-IR>1.96) were retrospectively evaluated. Patients followed a ketogenic diet (50 g of total carbohydrates/1800 calories/day). Ketosis was considered when urinary concentrations were > 40 mg/dL. Once ketosis was achieved, and IR diminished, patients underwent another IVF cycle. The nutritional intervention lasted for 14 ± 11 weeks. Carbohydrate consumption decreased from 208 ± 50.5 g/day to 41.71 ± 10.1 g/day, which resulted in significant weight loss (−7.9 ± 1.1 kg). Urine ketones appeared in most patients within 13.4 ± 8.1 days. In addition, there was a decrease in fasting glucose (−11.4 ± 3.5 mg/dl), triglycerides (−43.8 ± 11.6 mg/dl), fasting insulin (−11.6 ± 3.7 mIU/mL), and HOMA-IR (−3.28 ± 1.27). All patients underwent ovarian stimulation, and compared to the previous cycle, there was no difference in oocyte number, fertilization rate, and viable embryos produced. However, there was a significant improvement in the implantation (83.3 vs. 8.3 %), clinical pregnancy (66.7 vs. 0 %), and ongoing pregnancy/live birth rates (66.7 vs. 0 %). Here, restriction in carbohydrate consumption in PCOS patients induced ketosis, improved key metabolic parameters, and decreased IR. Even though this did not affect oocyte or embryo quality or quantity, the subsequent IVF cycle significantly improved embryo implantation and pregnancy rates.

Prior salpingectomy impairs the retrieved oocyte number in in vitro fertilization cycles of women under 35 years old without optimal ovarian reserve.

The impairment of the ovarian response in in vitro fertilization (IVF) cycles after salpingectomy remains contentious. Therefore, we investigated whether a history of salpingectomy affects the number of oocytes retrieved in women undergoing IVF in comparison with the number in women without underlying tubal disease. Case-control study (Canadian Task Force Classification II-2). A tertiary hospital-affiliated fertility center. Fifty-four women aged <35 years with a history of salpingectomy and 59 age-matched women without tubal disease. Gonadotropin-releasing hormone antagonist protocol for controlled ovarian stimulation and transvaginal oocyte retrieval. The antral follicle count (AFC), anti-Müllerian hormone (AMH) levels, and the number of retrieved oocytes were significantly lower in women with prior salpingectomy than in women without tubal disease. Day-3 follicle-stimulating hormone (FSH) levels, total gonadotropin dosage, and stimulation days did not significantly differ between the groups. The indications of salpingectomy (i.e., hydrosalpinx and ectopic pregnancy) did not differ significantly in terms of ovarian response or reserve among women with salpingectomy history. A history of salpingectomy and other factors related to ovarian response in IVF, such as age, AMH, AFC, day-3 FSH, and total gonadotropin dose, were significantly correlated with the number of oocytes retrieved by univariate regression analysis. In the multivariate-adjusted model after controlling all the above-mentioned variables, only AFC and AMH levels continued to exhibit significant associations with the number of retrieved oocytes. In a subgroup analysis, the negative impact of prior salpingectomy on the number of retrieved oocytes was especially significant in women with suboptimal ovarian reserves (defined as AMH < 4 ng/mL), regardless of the indication of salpingectomy or whether salpingectomy was bilateral or unilateral. A negative effect on the number of retrieved oocytes in the subsequent IVF cycle after salpingectomy is more likely in women aged <35 years with suboptimal ovarian reserve. Nevertheless, postsurgical AMH and AFC levels still possess a more direct predictive value on ovarian response than the history of salpingectomy.

Histopathological profile of women who had previously failed in-vitro fertilization and the association to the outcome in the subsequent in-vitro fertilization cycle.

ObjectiveTo evaluate the endometrial histopathological profile of patients undergoing curettage and the association of the histopathological profile with the pregnancy outcome during the subsequent in-vitro fertilization (IVF) cycle.MethodsIn this retrospective cohort study, a total of 248 women with at least one failed attempt of IVF and who underwent curettage and a subsequent IVF were included. Demographic data, endometrial histopathological records, stimulation information, and pregnancy outcomes were collected and analyzed.ResultsThe histopathological analysis of endometrial tissues showed that 130 women (52.4%) had endometrial pathologies. Of these women, 103 (41.5%) had endometrial polyps, 22 (8.9%) had chronic endometritis, and five (2.0%) had both polyps and endometritis. No statistical difference was observed between the normal histopathology group and the abnormal histopathology group in the outcome of the subsequent IVF cycle. Subgroup analyses were performed to further characterize and compare women with normal histopathology and women with endometrial polyps (polyp subgroup) or chronic endometritis (endometritis subgroup). No statistical differences were found among the three groups in the rates of pregnancy (44.1% vs. 49.5% vs. 45.5%, P=0.72), biochemical pregnancy loss (13.5% vs. 15.7% vs. 20.0%, P=0.86), clinical pregnancy loss (25.0% vs. 31.4% vs. 30.0%, P=0.77), and live birth (27.1% vs. 26.2% vs. 22.7%, P=0.91) during the subsequent IVF cycle.ConclusionWomen with previously failed IVF and abnormal endometrial histopathology treated with curettage had the same outcome in the subsequent IVF cycle as women with normal endometrial histopathology.

Endometrial thickness following early miscarriage in IVF patients \u2013 is there a preferred management approach?

BackgroundEndometrial thickness (ET) has previously been shown to positively correlate with implantation and clinical pregnancy rates. Pregnancies achieved using in-vitro fertilization (IVF) technique are prone to higher rates of early miscarriage. The aim of this study was to compare the effects of expectant management, medical treatment (Misoprostol) and dilation and curettage (D&C) for early miscarriage following IVF cycles on the subsequent cycle outcomes - endometrial thickness and reproductive outcomes.MethodsA retrospective cohort study of women who underwent embryo transfer, conceived and had first trimester miscarriage with at least one subsequent embryo transfer. ET measurements during fresh or frozen-thawed IVF cycles were assessed for each patient. Comparisons of ET differences between the miscarriage and the subsequent cycles, as well as reproductive outcomes, were performed according to the initial miscarriage management approach.ResultsA total of 223 women were included in the study. Seventy-eight women were managed conservatively, 61 were treated with Misoprostol and 84 women underwent D&C. Management by D&C, compared to conservative management and Misoprostol treatment was associated with higher prevalence of a significant (> 2 mm) ET decrease (29.8%% vs. 14.1and 6.6%, respectively; p < .001) and was the only approach associated with a significant increase in the rates of ET under 7 and 8 mm in the following cycle (p = 0.006 and 0.035; respectively).Clinical pregnancy rates were significantly lower following D&C compared with conservative management and Misoprostol (16.7% vs. 38.5 and 27.9%, respectively; p = 0.008) as well as implantation rate (11.1% vs. 30.5.% and 17.7, respectively; p < 0.001).ConclusionOur data suggest that D&C management of a miscarriage is associated with decreased ET and higher rates of thin endometrium in the subsequent IVF cycle, compared with conservative management and Misoprostol treatment. In addition, implantation and pregnancy rates were significantly lower after D&C.

Does COVID-19 infection influence patients’ performance during IVF-ET cycle?: an observational study

Objective No information exists in the literature regarding the effect of coronavirus disease 19 (COVID-19) infection on subsequent in vitro fertilization (IVF) cycle attempt. We, therefore, aim to assess the influence of COVID-19 infection on IVF treatments. Design An observational study. Setting A tertiary, university-affiliated medical center. Patients and methods All consecutive couples undergoing ovarian stimulation (OS) for IVF, before and after recovering from COVID-19 infection, and reached the ovum pick-up (OPU) stage. The stimulation characteristics and embryological variables of couples undergoing IVF treatments after recovering from COVID-19 infection were assessed and compared to their IVF cycles prior to COVID-19 infection. Main outcome measures Stimulation characteristics and embryological variables. Results Nine couples (seven with the female partner infection and two with the male partner) resumed IVF treatment 8–92 d after recovering from the COVID-19 infection (negative polymerase chain reaction [PCR]). No in-between cycles differences were observed in OS and embryological variables between the cycles before and after recovering from the COVID-19 infection, except for a significantly lower proportion of top-quality embryos. Conclusions COVID-19 infection did not affect patients’ performance or ovarian reserve in their immediate subsequent IVF cycle, except for a reduced proportion of top-quality embryos (TQEs). We therefore suggest, to postpone IVF treatment for a least 3 months (duration of folliculogenesis and spermatogenesis) after recovering from COVID-19 infection, aiming to recruit healthy gametes that were not exposed to COVID-19 infection during their development.

Could surgical management improve the IVF outcomes in infertile women with endometrioma?: a review.

Endometriosis is a chronic inflammatory condition that affects fertility and could be toxic to the ovary. Endometrioma per se and surgical interventions for endometrioma significantly reduce the ovarian reserve. Therefore, to prepare for surgical intervention for endometrioma, the high-risk group with decreased ovarian reserve must be considered. There is no evidence to support the use of surgical intervention before in vitro fertilization (IVF) to improve the reproductive outcomes of subsequent IVF in infertile women with advanced-stage endometriosis or endometrioma. As surgical treatment has few benefits, IVF could be recommended immediately for aiding conception in these women. However, the reproductive prognosis of IVF may be worse in the more advanced stages of endometriosis. When dysmenorrhea is severe or when cancer is suspected, surgery prior to IVF may be necessary and justified. When the size of the endometrioma is very large, surgery could be required prior to IVF to facilitate access to follicles during oocyte retrieval or to improve the ovarian response to controlled ovarian stimulation. Prolonged pituitary downregulation in women with surgically diagnosed endometriosis may be helpful to increase the clinical pregnancy rate in subsequent IVF cycles. The purpose of this paper was to review the efficiency and clinical application of the surgical intervention and IVF for infertile women with advanced-stage endometriosis or endometrioma.

First Trimester Pregnancy Loss May Temporary Reduce the Ovarian Response during the Subsequent IVF Cycle

The aim of this study was to compare the in vitro fertilization (IVF) cycles ended by miscarriage with subsequent IVF cycles in relation to various IVF cycle parameters and pregnancy termination modalities. Comparison of pre-miscarriage to post-miscarriage IVF cycles parameters demonstrated that lower peak E2 levels (1087 ± 593 versus 1237 ± 676 pg/ml, respectively; p < 0.05) were achieved in the post miscarriage cycles despite higher total gonadotropin consumption (2341 ± 1488 versus 2115 ± 1101 IU; p <0.05). A greater endometrial thickness (10.4 ± 2.16 versus 9.98 ± 1.74 mm, respectively; p < 0.05) and a higher number of embryos (4.62 ± 2.63 versus 3.78 ± 2.54, respectively; p < 0.05) were observed in the pre-miscarriage cycles. A comparison of IVF parameters between the first and second IVF cycles following miscarriage showed an increase in peak estradiol level (954 ± 800 and 1257 ± 838 pg/ml, respectively; p < 0.05), an increased number of retrieved oocytes (7.38 ± 4.2 and 10.49 ± 4.99, respectively; p < 0.05), more fertilized embryos (3.87 ± 2.38 and 5.66 ± 3.64, respectively; p < 0.05), and an increase in the conception rate (34.7% versus 42.2%, respectively) at the second post-miscarriage IVF cycle.

Empty follicular syndrome: incidence in 2729 IVF cycles and prognosis in subsequent attempts

Introduction: The empty follicle syndrome (EFS) is described as the failure to retrieve oocytes at ovum pick-up (OPU) after an adequate controlled ovarian stimulation (COS) in patients undergoing in vitro fertilization (IVF). Objectives: To retrospectively calculate the incidence of EFS in IVF cycles and to assess the prognosis of these patients in subsequent IVF attempts. Patient(s): Women undergoing 2729 IVF cycles of homologous IVF at our IVF Unit in the years 2010-2014. Intervention(s): All cases with no retrieved oocytes at OPU were considered and divided into two sub-categories: (a) genuine EFS (gEFS), when a correct ovulation trigger was performed; and (b) false or iatrogenic EFS (iEFS), when no urinary hCG was detected the day of OPU, indicating a mistake in the administration of exogenous hCG for triggering. Main Outcome Measure(s): We calculated the incidence of EFS and then analyzed the outcome of subsequent IVF cycles in the same patients. Result(s): Eighty cases of EFS were identified in 2729 cycles (overall incidence 2.9%). Among EFS cases, 88% were gEFS and 11% were iEFS. The incidence of EFS was higher among patients above 40 years than in younger women (6.26% vs. 1.81%) (Table 1). Twenty-nine patients with gEFS underwent subsequent IVF cycles, and oocytes were retrieved in 88.6% of them, leading to a pregnancy rate/cycle of 20%, with no relevant differences according to age (PR/cycle 16.6% in younger women, 23.5% in women older than 40) (Table 1). Conclusion(s): We observed that EFS has an overall low prevalence among women undergoing IVF, but its incidence is five-times higher after 40 years of age, involving mainly patients with a low ovarian reserve. The iatrogenic form of EFS, iEFS, can be easily identified by testing hCG levels in urine samples the day of OPU, and occurs independently from age. Patients who experienced gEFS in an IVF attempt had a high chance of retrieving eggs in the subsequent IVF cycle and an acceptable pregnancy rate; interestingly, age did not negatively affect their prognosis.

The effect of medical versus surgical treatment of spontaneous miscarriage on subsequent in vitro fertilization cycles

Objective: To evaluate the effect of dilation and curettage (D&C) and misoprostol as treatments for spontaneous miscarriage (SM) on in vitro fertilization (IVF) parameters in the subsequent IVF cycle.Design: Multicenter, retrospective, cohort study. Women treated for SM after IVF treatment with D&C or misoprostol and underwent a subsequent IVF cycle was included. The main outcome measures were ovarian response, endometrial thickness and pregnancy rate in the subsequent IVF cycle after MA.Results: Among 73 patients with miscarriage, 41 had D&C and 32 were given misoprostol. Baseline serum follicle stimulating hormone (FSH) levels and ovarian responses before and after treatment of miscarriage were comparable. No significant differences were observed between the D&C and the misoprostol groups in basal FSH levels, endometrial thickness and parameters of ovarian response in the subsequent IVF cycle.Conclusion: D&C and misoprostol are both effective treatments for IVF patients with miscarriage, without an adverse effect on subsequent IVF treatment outcome.

Ovarian cystectomy of an ovarian ectopic pregnancy conceived by in vitro fertilization

A rare case of a 28-year-old female who suffered from a right ovarian ectopic pregnancy conceived by in vitro fertilization (IVF) is illustrated in this paper. She had history of one earlier pregnancy conceived with intrauterine insemination (IUI) that led to right tubal ectopic pregnancy, which was treated conservatively. At subsequent IVF cycle, she presented at 9 weeks of gestation with the compliant of severe pain in lower abdomen and mild vaginal bleeding. Serum β-human chorionic gonadotropin (β-hCG) concentration was 7,843 IU/L. Transvaginal sonography suggested a mass of 4.0 cm × 3.6 cm × 4.9 cm adjacent to the right ovary with cystic area interpreting right ovarian ectopic pregnancy. Prompt decision of laparoscopic management was taken depending upon the status of the patient and the desire to preserve her fertility. The ectopic tissue was aspirated laparoscopically while conserving more than 50% of the ovary. The ovarian pregnancy was also confirmed histologically. Early and accurate diagnosis and prompt management of ovarian ectopic pregnancy can preserve fertility.

Impact of luteal phase hysteroscopy and concurrent endometrial biopsy on subsequent IVF cycle outcome

Endometrial biopsy preceding implantation in in vitro fertilization (IVF) treatment causes a type of injury which facilitates implantation. Pre-treatment hysteroscopic evaluation of uterine cavity also raises the success in IVF. This study investigates whether office hysteroscopy and concurrent endometrial biopsy performed in the luteal phase, on the day of GnRH agonist initiation for long protocol, improves subsequent IVF outcome. A prospective, nonrandomized, controlled study of 128 normoresponder women was performed: In 70 women (study group), office hysteroscopy and concurrent endometrial biopsy were performed on the day of GnRH agonist initiation preceding ET cycle and in 58 women (control group), GnRH agonist was initiated without any intervention. However, uterine cavity was shown to be normal with hysteroscopy within the previous 6 months in those women. Implantation and pregnancy rates were compared between the groups. Intrauterine pathologies were observed in 28 % of women in the study group. Implantation rate (38 vs. 25 %; p = 0.04) and pregnancy rate per ET (67 vs. 45 %; p = 0.01) were found to be significantly higher in the study group compared to the control group. Office hysteroscopy and concurrent endometrial biopsy performed in the luteal phase, on the day of GnRH agonist initiation for long protocol, provide direct evaluation of the uterine cavity immediately before ET cycle and also significantly improve the implantation and IVF outcome.

Impact of dehydroepiandrosterone on clinical outcome in poor responders: A pilot study in women undergoing in vitro fertilization, using bologna criteria.

OBJECTIVE:To evaluate the role of dehydroepiandrosterone (DHEA) supplementation in women with poor ovarian response (POR) undergoing in vitro fertilization (IVF).DESIGN:Prospective case-control study.SETTING:Private tertiary fertility clinic.MATERIALS AND METHODS:31 infertile women with POR diagnosed as per the Bologna criteria.INTERVENTIONS:DHEA supplementation for 2 months and a subsequent IVF cycle, after two previous IVF cycles with POR.MAIN OUTCOME MEASURE(S):Dose and duration of gonadotropin therapy, oocyte yield, embryo number and quality, pregnancy and live birth rate.RESULTS:No difference was seen in gonadotropin requirement before and after DHEA supplementation. There was a significant increase in total and metaphase II oocytes (5.9 ± 0.68 vs. 2.73 ± 0.24; 4.45 ± 0.47 vs. 2.09 ± 0.26), fertilization (3.65 ± 0.49 vs. 2.00 ± 0.27), Grade I embryos (1.52 ± 0.25 vs. 0.55 ± 0.18), pregnancy rate (30% vs. 9.1%) and live birth rate (25% vs 0%) in those who completed the cycle, following DHEA supplementation.CONCLUSIONS:Dehydroepiandrosterone supplementation results in an improvement in oocyte yield, embryo quality, and live birth rate in a group of women with POR having undergone at least two previous failures due to POR.

A Time-motion Comparison of Itemized Treatment Costs in First and Second In Vitro Fertilization Attempts: A United Kingdom Fertility Centre Experience.

Objective: To assess the difference in cost between initial and second in vitro fertilization (IVF) cycles in the United Kingdom. Methods: This prospective time-motion analysis captured data on average time spent on 31 representative components of the IVF sequence as provided by clinical team members in seven categories. Audits of consumables and observations on personnel costs were made from total of 120 fertility patients undergoing initial or second IVF cycles (n=736) between 1 January 2002 and 31 December 2002 at a UK assisted fertility unit. Results: Patients spent an average of 16.71±4.3 hrs with staff during an initial IVF cycle, resulting in direct personnel costs of £577.05±151.01. When consumables were included, each initial cycle cost the clinic approximately £2246.57±151.01. For second IVF cycles, patients spent significantly less time with staff compared to their first IVF cycle (6.94±2.44 hrs; p<0.05), corresponding to £257.53±90.77 in personnel cost. Conclusions: This is the first economic appraisal of the IVF treatment sequence in the UK using a timemotion analysis model. Our study found that when combined with consumables, total institutional costs for second IVF cycles were significantly reduced when compared to initial cycles (£1813.12±90.77; p<0.05). Aggregating data from all IVF cycles performed within the fertility centre during the study interval, initial cycles were found to be front-loaded, resulting in £252,420 more in institutional costs as compared with subsequent IVF cycles. While these observations were registered in 2003, an inflation adjustment using recent European Commission Eurostat data for healthcare finds the difference between initial and subsequent fresh IVF cycles in present currency to be approximately £579.14 per cycle. Time-motion analysis can identify episodes of care that can be streamlined to improve outcomes and reduce cost.

The effect of time interval between hysteroscopic submucous fibroid resection (SMR) and subsequent in vitro fertilization (IVF) cycle on pregnancy outcomes

Traditionally, many physicians have advised their patients to delay starting IVF for at least two menstrual cycles after an extensive SMR, in order to allow for thorough healing of the endometrium prior to embryo transfer. The purpose of this study was to determine whether the time interval between SMR and subsequent IVF cycle significantly affects pregnancy outcomes. Retrospective cohort study. IVF cycle characteristics and pregnancy outcomes were compared between women who had undergone a single SMR less than 90 days prior to starting an IVF cycle, and women who waited between 91 and 365 days before starting IVF. Volumes of fibroid pathology specimens for each SMR were recorded. Mann-Whitney and Fisher's exact tests were used for statistical analysis. The mean number of days between having surgery and starting IVF was 52.6 days in the shorter time interval group, and 188.3 days in the longer time interval group. No significant differences in demographics, volume of removed fibroid, endometrial stripe on the day of HCG, implantation rate (IR), total pregnancy rate (TPR), live birth rate (LBR) or miscarriage rate (MR) were seen between women who had an IVF cycle within 90 days of their SMR and those who waited between 91 and 365 days.Tabled 1IVF Outcome byTime Interval After SMR≤90 days (52.6±22.0)91-365 days (188.3±75.3)P valueN=4066Age (yrs)39.9±2.539.1±3.10.14Fibroid volume (cm3)6.3±11.24.8±9.00.82Protocol (% Luteal suppression)73820.33# Prior IVF Cycles1.4±2.51.1±1.50.94Endometrial stripe on day of HCG9.77±2.099.67±2.090.76# Mature Oocytes9.8±8.28.3±4.10.63# embryos transferred3.72±1.202.95±1.470.20IR0.12±0.20.16±0.30.31TPR (%)37.545.40.54LBR (%)22.531.80.38MR (%)15.014.00.99 Open table in a new tab IVF soon after SMR does not appear to negatively affect outcome. Consequently, women do not have to delay IVF after surgery, and can safely start IVF within 2-3 menstrual cycles after SMR, without any negative impact on pregnancy rates.

Age as determinant of in vitro fertilization (IVF) outcome with extremely low anti- müllerian hormone (AMH)

Though widely considered a contraindication to IVF, we reported robust pregnancy rates with AMH at < 0.1 (undetectable) to 0.4 ng/mL, though AMH = 1.05ng/mL separates lower and higher pregnancy chances (Fertil Steril 2010;94:2824-7). We here investigated if significance of AMH changes with age. Cohort study. We assessed 254 IVF cycle outcomes with AMH < 0.4 ng/mL in 128 women: Patient age 40.8 ± 4.1 (SD) years; follicle stimulating hormone (FSH) 15.7 ± 11.1 mIU/mL; AMH 0.2 ± 0.1 ng/mL. All women with diminished ovarian reserve are prior to IVF supplemented with dehydroepiandrosterone (DHEA, 25 mg p. o. TID) for at least 6 weeks. Ovarian stimulation involved microdose agonist, daily FSH (450-600 IU) and human menopausal gonadotropin (hMG, 150 IU). Ovulation was triggered with human chorionic gonadotropin (10,000 IU). Twenty clinical pregnancies were recorded (7.9% per cycle start [95% CI 4.9%-11.9%]; 15.6% cumulative [9.8%-23.1%]); resulting in 13 live births in 12 women (11 singletons and a pair of twins); eight miscarried. Eight deliveries occurred after first (6.3% per cycle start), 4 after subsequent IVF cycles (3.2%). 70 women ≤ 42 years presented with 16 clinical pregnancies that resulted in 10 deliveries (14.3%), while 58 patients above age 42 presented with four clinical pregnancies that resulted in two deliveries (3.4%), representing a significantly reduced pregnancy chance and delivery rate versus age ≤ 42 years (P=0.013; P=0.036). These data confirm our prior publications suggesting surprisingly robust pregnancy chances, even at undetectable to extremely low AMH levels. They, however, significantly decline above age 42. Since patients were supplemented with DHEA, here reported outcomes may not be universally applicable. Even extremely low AMH can, however, no longer be considered an absolute contraindication for IVF.

BMI influences the impact of oral contraceptive pills and GnRH agonists on antral follicle count (AFC) ovarian reserve screens

AFC is a popular ovarian reserve screen and predictor of response to gonadotropin stimulation. Yet, data regarding the impact of suppressive medications commonly used prior to in vitro fertilization (IVF) cycles and the influence of obesity on AFC, are scarce. Our aim was to compare AFC in women who underwent both controlled ovarian hyperstimulation (COH)/IUI cycles and then subsequent IVF cycles to determine the effect of ovarian suppression on AFC in obese and nonobese women.

Outcome of subsequent IVF cycles after antibiotic therapy following previously failed IVF cycles. Study II

Abstract Objective: To determine whether broad-spectrum antibiotic therapy administered after a failed in vitro fertilization (IVF) cycle will improve the chance of achieving a successful pregnancy in the subsequent IVF cycle and to determine whether further antibiotic therapy administered immediately after conception, during the course of pregnancy, and at the time of delivery will reduce the incidence of maternal and fetal complications. Design: A retrospective analysis was performed on the clinical data of 63 couples who had previously failed one or more IVF cycles and were subsequently treated with broad-spectrum antibiotics. All women were treated with intravenous Clindamycin and daily intrauterine lavages using a broad-spectrum antibiotic combination. All men received intravenous Clindamycin and simultaneously underwent five direct transrectal injections of an antibiotic cocktail into the prostate gland if clinical or sonographic evidence of chronic prostatitis was documented. For both men and women...

Use of versapoint to refashion the cervical canal to overcome unusually difficult embryo transfers and improve in-vitro fertilization-embryo transfer outcome: A case series

BACKGROUND:Smooth atraumatic embryo transfer is paramount for the success of in-vitro fertilization (IVF). In difficult cases, cervical canal manipulation may be required.AIM:To see if surgical correction of the cervical canal or cervical canal refashioning could improve ease of embryo transfer.SETTING:Private infertility and IVF hospital.Design:Prospective study.MATERIALS AND METHODS:Patients: 11 women with failed 1-3 IVF cycles with history of extremely difficult embryo transfers (ETs) despite undergoing cervical dilatation in the cycle prior to IVF.INTERVENTIONS:Operative hysteroscopy using Versapoint for refashioning of the cervical canal.MAIN OUTCOME MEASURES:Ease of ET in the subsequent IVF cycle. Secondary outcome measure was to assess reproductive outcome.RESULTS:Easy and atraumatic ET in the IVF cycle after procedure in 100% patients. PR was 46.5%.CONCLUSIONS:Use of Versapoint for refashioning the cervical canal can improve the quality of ET and PR.