Take-home Baby Research Articles

The effect of levothyroxine and prednisolone treatment on pregnancy in in vitro fertilization patients with positive thyroid autoantibodies.

To investigate the effects of levothyroxine and prednisolone treatment, or in combination, on positive thyroid autoantibodies in infertile patients undergoing in vitro fertilization (IVF) therapy. This retrospective study included a total of 190 patients with positive thyroid autoantibodies (anti-T and anti-TPO) who underwent IVF treatment between January 2008 and March 2016. Patients were divided into four groups: group 1-levothyroxine group (n = 50), group 2-prednisolone group (n = 50), group 3-levothyroxine and prednisolone combination (n = 25), group 4-control group (n = 65). Anti-T and anti-TPO levels before IVF and at the time of embryo transfer (ET), b-hcg positivity, clinical and biochemical pregnancy, miscarriage rate, and live birth rate were compared among groups. In levothyroxine-treated group, mean anti-TPO levels significantly decreased at the time of ET compared to before IVF treatment levels (p = 0.036). In group 3, mean anti-T and anti-TPO levels significantly decreased at the time of ET compared to levels before IVF treatment (p < 0.05). Patients who became pregnant in group 1, mean anti-T anti-TPO levels significantly decreased compared to before IVF treatment levels (p < 0.05). The biochemical pregnancy rate was significantly higher in group 2 (p = 0.03). Abortion rates were the highest in group 3, but no significant difference was found among groups. The group treated with levothyroxine had a significantly increased rate of live birth compared to the control group (p = 0.02). Levothyroxine addition during IVF treatment of patients with positive thyroid antibodies in subclinical hypothyroidism increases the take-home baby pregnancy rate. Whether subclinical hypothyroidism or not in IVF treatment, levothyroxine is more effective than low-dose corticosteroids.

Prediction of Reproductive Outcomes of Intracytoplasmic Sperm Injection Cycles Using a Multivariate Scoring System.

Prediction of in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) success is crucial in counselling patients about their real chance of getting a live birth before commencing treatment. A multivariate scoring system proposed by Younis et al., 2010, was amongst the predictive models used to evaluate IVF/ICSI success. The score entitles basal endocrine, clinical and sonographic parameters. The objective of this study is to assess the predictability of the Younis multivariate score for pregnancy outcomes in ICSI cycles. This prospective observational cohort study (NCT03846388) included patients who pursued IVF or ICSI in a tertiary infertility unit between February 2019 and December 2021. The score variables were age, body mass index, antral follicle count, basal follicle-stimulating hormone (FSH), basal FSH/luteinising hormone ratio, infertility duration, number of previous cancellations and mean ovarian volume. For each woman included in the study, Younis multivariate score was calculated. Then, we correlate the different reproductive outcomes with score levels to validate the score predictability. A score of ≤14 was defined as a low score based on the previous study's results. The student's t-test and Mann-Whitney test were used to compare numerical variables, whereas categorical variables were analysed using the Chi-square test. A receiver operating curve (ROC) and a multivariate logistic regression model were used to investigate the predictability of the Younis scoring model for cycle outcomes. Two hundred ninety-two ICSI-ET cycles were analysed. Of the total cohort, 143 (48.97%) women included showed a low score (≤14), whereas 149 (51.03%) women showed a high score (>14). Women with low scores had significantly higher pregnancy and live birth rates compared to women with high scores (60.1% vs. 7.4%, respectively, P < 0.001; 44.7% vs. 6.7%, respectively, P < 0.001). The area under the curve (AUC) in the ROC curve analysis showed a higher predictability for the scoring system for live birth rate with an AUC of 0.796, with a sensitivity of 86.5% and specificity of 63.8% when using a cut-off level of ≤14. For pregnancy prediction, the AUC was 0.829, with a sensitivity of 88.66% and a specificity of 70.77% when using the same cut-off. Women who have a low score have a high chance of having frozen embryos. Likewise, women who have a high score have a very high chance of cycle cancellation. The Younis multivariate score can be used for the prediction of ICSI cycle outcomes and to calculate the chance of cycle cancellation, pregnancy and take-home baby before ICSI.

Metroplasty increases the take-home baby rate by reducing pregnancy loss without changing the chance of conception in women with septate uterus: a retrospective, single-center, observational study

BackgroundAlthough abdominal or hysteroscopic metroplasty for septate uterus is considered to reduce pregnancy loss and increase the take-home baby (THB) rate in women with a history of recurrent pregnancy loss, there exists an inherent risk of impaired fertility. This study aimed to clarify the reproductive outcomes of women with septate uterus who underwent abdominal and hysteroscopic metroplasty in a single center.MethodsThis retrospective observational study enrolled 27 women who underwent metroplasty between 2007 and 2019. The analysis included women with septate uterus [European Society of Human Reproduction and Embryology (ESHRE)/European Society for Gynaecological Endoscopy (ESGE) type U2)] or septate-bicornuate uterus (ESHRE/ESGE type U3b) who underwent either abdominal or hysteroscopic metroplasty. Women who did not have an immediate desire to conceive were excluded from the analysis. As a rule, we recommended pregnancy without surgery for women who had not experienced repeated pregnancy loss. Abdominal metroplasty (ABM) was performed using the modified Tompkins’ method and hysteroscopic metroplasty was performed using hysteroscopic transcervical resection of the septum [transcervical metroplasty (TCM)]. The conception ratio was calculated as the number of women who achieved ≥ 1 conception/total number of women, the pregnancy loss ratio was calculated as the number of women who experienced ≥ 1 pregnancy loss/the number of women who conceived, and the THB ratio was calculated as the number of women who achieved ≥ 1 THB/total number of women.ResultsSeventeen women underwent ABM and 10 women underwent TCM. Thirty-three conceptions and 26 babies were taken home after surgery. ABM did not change the ≥ 1 conception ratio (76% vs. 83% before and after surgery, respectively; RR = 1.08, p = 0.80). Meanwhile, ABM decreased the ≥ 1 pregnancy loss ratio (100% vs. 36%, RR = 0.36, p < 0.001) and increased the ≥ 1 THB ratio (12% vs. 71%, RR = 6.00, p < 0.01). Similarly, TCM did not change the ≥ 1 conception ratio, decreased the ≥ 1 pregnancy loss ratio, and increased the ≥ 1 THB ratio.ConclusionsBoth abdominal and hysteroscopic metroplasty for septate uterus increased the THB rate by preventing pregnancy loss without affecting the chance of pregnancy.Trial registrationNot applicable.

Exploring the Impact of Controlled Ovarian Stimulation and Non-Invasive Oocyte Assessment in ART Treatments.

Invasive and noninvasive features are normally applied to select developmentally competent oocytes and embryos that can increase the take-home baby rates in assisted reproductive technology. The noninvasive approach mainly applied to determine oocyte and embryo competence has been, since the early days of IVF, the morphological evaluation of the mature cumulus-oocyte complex at the time of pickup, first polar body, zona pellucida thickness, perivitelline space and cytoplasm appearance. Morphological evaluation of oocyte quality is one of the options used to predict successful fertilization, early embryo development, uterine implantation and the capacity of an embryo to generate a healthy pregnancy to term. Thus, this paper aims to provide an analytical revision of the current literature relating to the correlation between ovarian stimulation procedures and oocyte/embryo quality. In detail, several aspects of oocyte quality such as morphological features, oocyte competence and its surrounding environment will be discussed. In addition, the main noninvasive features as well as novel approaches to biomechanical parameters of oocytes that might be correlated with the competence of embryos to produce a healthy pregnancy and live birth will be illustrated.

Mid-trimester cerclage outcomes in singleton and twin pregnancies: a single tertiary center experience

Objective: The aim of this study was to evaluate the maternal and neonatal outcomes of patients who underwent ultrasonography (USG) and emergency-indicated cerclage in the mid-trimester in singleton and twin pregnancies. Methods: A total of 55 patients, 43 with singleton and 12 with twin pregnancies who underwent cerclage for short cervix (&lt;25 mm) or cervical dilation between January 2015 and December 2021 were included in the study. The primary outcome was gestational age at birth, and secondary outcomes were neonatal birth weight, the status of admission to neonatal intensive care unit, neonatal survival, and the neonatal birth rates at &lt;24 weeks, 24–27⁺⁶ weeks, 28–33⁺⁶ weeks, 34–36⁺⁶ weeks and &gt;37 weeks. Results: In singleton pregnancies, delivery interval was 15.05 (±2.9) weeks in the USG indication group and 2.8 (±2.5) weeks in the emergency indication group (p&lt;0.001). The rate of pregnant women in the USG indication group who gave birth between 24–27⁺⁶ weeks of gestation was 4.9% (n=2), and the rate of pregnant women in the emergency indication group was 55.6% (n=5) (p&lt;0.001). In total, in singleton pregnancies the rate of take-home baby was 85.7%, and neonatal mortality was 14.3%. In twin pregnancies, delivery interval was 12±1.41 weeks in the USG indication group, and it was 1.8±0.83 weeks in the emergency indication group (p&lt;0.003). In twin pregnancies, the take-home baby rate was 94% and neonatal mortality was 6%. Conclusion: Cervical cerclage reduces the possible risks of preterm delivery by prolonging the interval until delivery, especially in patients with singleton and twin pregnancies for whom USG is indicated, and promising neonatal outcomes are achieved.

Anticardiolipin and/or anti-β2-glycoprotein-I antibodies are associated with adverse IVF outcomes.

The purpose of the study is to evaluate the effects of anticardiolipin (aCL) and/or anti-β2-glycoprotein-I (aβ2GPI) antibodies, namely antiphospholipid antibodies (aPL), on in vitro fertilization (IVF)outcomes. The study group comprised infertile women with aPL undergoing IVF-ET cycles. Controls were infertile women with tubal etiology without aPL. The impact of aPL on reproductive outcomes, such as oocyte quality, embryo quality, and implantation capacity, was compared between the study group and controls. Additionally, peripheral blood T cell subsets, such as T helper (Th)1, Th2, Th17, and T regulatory (Treg) cells and cytokines, were analyzed by the flow cytometry. Differences between the study group and controls were analyzed. A total of 132 infertile women, including 44 women with aPL, and 88 controls were sequentially recruited for this study. Women with aPL had lower numbers of total and perfect/available embryos and lower rates of MII oocytes, blastocyst formation, perfect and available embryos, implantation, clinical pregnancy, and take-home baby. Additionally, imbalanced Th1/Th2 and Th17/Treg ratios, significantly higher levels of serum IL-2, TNF-α, IFN-γ, and IL-17A, and a significantly lower serum IL-4 were noticed in women with aPL compared to controls. Women with aPL such as aCL and/or aβ2GPI antibodies were associated with adverse IVF outcomes. Early screening for aPL and appropriate consultation for couples undergoing IVF should be considered. In addition, underlying immunopathology and inflammatory immune mechanisms associated with aPL should be further explored.

Outcomes of patients who have undergone laparoscopic abdominal cerclage: A retrospective study

ObjectiveThis study aims to evaluate the surgical morbidity and obstetric outcomes following in-pregnancy or pre-pregnancy laparoscopic abdominal cerclage (LAC) for patients who were diagnosed with refractory cervical insufficiency or had a short cervix. MethodsA retrospective study was conducted on patients undergoing LAC between May 2017 and May 2019 at the Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital. The patients were diagnosed with refractory cervical insufficiency based upon a previous failed transvaginal cervical cerclage (TVC), or had a short cervix who were considered unsuitable for a TVC after a previous cervical procedure. All patients were followed-up after surgery with transperineal ultrasonography until May 2020. Subsequently, surgical and obstetric data were collected and analyzed. ResultsIn total, 44 patients underwent LAC, with 8 patients in-pregnancy and 36 pre-pregnancy. For the patient with pre-pregancy LAC, the pregnancy rate was 80.6% (29/36), including 3 patients with first-trimester loss, 1 patient with an ectopic pregnancy, and 25 patients with a delivery. For the remaining 7 patients, 3 did not conceive, and another 4 had no pregnancy plans. All the patients with in-pregnancy LAC had a delivery. The “take-home baby” rate was 89.2% (33/37), with a live-birth rate of 100% and a neonatal survival rate of 100% for both patients with in-pregnancy and pre-pregnancy LAC. For patients with in-pregnancy LAC, 75.0% (6/8) patients delivered at ≥37 wk of gestation, 12.5% (1/8) delivered between 34 and 36+6 wk, and 12.5% (1/8) delivered between 28 and 33+6 wk. For patients with pre-pregnancy LAC, 80.0% (20/25) patients delivered at ≥37 wk of gestation, 16.0% (4/25) delivered between 34 and 36+6 wk, and 4.0% (1/25) delivered between 28 and 33+6 wk. No adverse-event intra-operative or post-operative sequelae were noted. ConclusionsLAC is an effective and safe procedure that results in remarkable obstetric outcomes for women with refractory cervical insufficiency, or with a short cervix who are considered unsuitable for a TVC. The success rate of in-pregnancy or pre-pregnancy LAC depends on a full evaluation of patients, a proper peri-operative management and close follow-up.

Pregnancy and obstetric outcomes of dichorionic and trichorionic triamniotic triplet pregnancy with multifetal pregnancy reduction: a retrospective analysis study

BackgroundIt is generally beneficial for triplet gestation or high-order multiple pregnancies to operate multifetal pregnancy reduction (MFPR) after assisted reproductive techniques. However, data on pregnancy outcomes is lacking regarding dichorionic triamniotic (DCTA) and trichorionic triplets (TCTA) pregnancy.MethodThis research analyzes the difference between 128 DCTA and 179 TCTA pregnancies with or without MFPR after in vitro fertilization/intracytoplasmic sperm injection cycles between January 2015 and June 2020. The subdivided subgroups of the two groups are reduction to singleton, reduction to dichorionic twins, and expectant management groups. We also compare the pregnancy and obstetric outcomes between 2104 dichorionic twins and 122 monochorionic twins.ResultThe research subgroups were DCTA to monochorionic singleton pregnancies (n = 76), DCTA to dichorionic twin pregnancies (n = 18), DCTA-expectant management (n = 34), TCTA to monochorionic singleton pregnancies (n = 31), TCTA to dichorionic twin pregnancies (n = 130), and TCTA-expectant management (n = 18). In DCTA-expectant management group, the complete miscarriage rate is dramatically higher, and the survival rate and the rate of take-home babies are lower. However, there was no difference between the rates of complete miscarriages, survival rates, and take-home babies in TCTA-expectant management group. But the complete miscarriage rate of DCTA-expectant management was obviously higher than that of TCTA-expectant management group (29.41 vs. 5.56%, p = 0.044). For obstetric outcomes, MFPR to singleton group had higher gestational week and average birth weight, but lower premature delivery, gestational hypertension rates and low birth weight in both DCTA and TCTA pregnancy groups (all p < 0.05). DCTA to monochorionic singleton had the lowest incidence of gestational diabetes, whereas The subdivided subgroups of TCTA had no significant difference in the incidence of gestational diabetes. Monochorionic twins have higher rates of complete, early, and late miscarriage, premature delivery, and late premature delivery, and lower survival rate (p < 0.05).ConclusionMFPR could improve gestational week and average birth weight, reducing premature delivery, LBW, and gestational hypertension rates in DCTA and TCTA pregnancies. Monochorionic twins have worse pregnancy and obstetric outcomes. MFPR to singleton is preferable recommended in the pregnancy and obstetric management of complex triplets with monochorionic pair.

Selecting Euploid Embryos for Transfer by Preimplantation Genetic Testing with the Help of Next-Generation Sequencing in Poor Prognosis Patients: A Retrospective Cohort Analysis.

ABSTRACTBackground:The current embryo selection methods rely on subjective grading of embryo morphology or a real-time monitoring of the embryonic development and assessment of multiple quantitative endpoints. Even up to 40% of morphologically normal embryos harbour aneuploidies. Preimplantation genetic testing (PGT) is a technology, which gives opportunity to identify euploid embryos before implantation.Aims:This study seeks to determine the role of PGT in poor prognosis patients, i.e., patients with advanced maternal age (AMA) (maternal age ≥35 years), recurrent pregnancy loss (RPL) (miscarriages ≥2) and recurrent implantation failures (RIFs) (in vitro fertilisation failures ≥3).Study Setting and Design:A retrospective case–control study was done on a group of patients who underwent intracytoplasmic sperm injection for the indications of AMA, RPL and RIF.Materials and Methods:In 33 cases who opted for PGT, day 5 blastocysts were subjected to trophectoderm biopsy with the help of next-generation sequencing. Euploid blastocyst was transferred in hormone replacement cycle at a later date. In 154 controls, blastocyst transfer was done based on morphological grading. Pregnancy outcomes are compared in terms of implantation rate, pregnancy rate, miscarriage rate and multiple pregnancy rate.Statistical Analysis:Chi-square test was used for comparisons between the study groups with respect to percentage. P < 0.05 was considered statistically significant.Results:The highest aneuploidy rate was found in embryos with AMA. Implantation rate was found to be statistically significantly higher in the PGT group as compared to the non-PGT group. However, take-home baby rates were not improved by PGT. There were less number of mean embryos transferred in the PGT group and lower multiple pregnancy rate.Conclusions:With the application of PGT, embryo selection rates and implantation rates improved in poor prognosis patients.

Anti-Ro/SSA and/or anti-La/SSB antibodies are associated with adverse IVF and pregnancy outcomes

Anti-Ro/SSA and/or anti-La/SSB antibodies (anti-SSA/SSB) were reported to increase the risk of recurrent pregnancy loss. However, the effects of anti-SSA/SSB antibodies on in-vitro fertilization (IVF) and pregnancy outcomes were still unclear. The purpose of the study was to determine whether anti-SSA/SSB antibodies were detrimental to IVF and pregnancy outcomes. This study included 55 anti-SSA/SSB antibodies-positive women and 61 anti-SSA/SSB antibodies-negative control women receiving gonadotropin-releasing hormone (GnRH) agonist long protocol (n = 30 and 39, respectively) or GnRH antagonist protocol (n = 25 and 22, respectively) for in-vitro fertilization and embryo transfer (IVF-ET). The impact of anti-SSA/SSB antibodies on immune-related indicators, fertilization, embryo development and pregnancy outcomes were analyzed. With either GnRH agonist or antagonist protocol, women with anti-SSA/SSB had higher levels of peripheral blood cytokines, including TNF-α and IL-17A, lower levels of peripheral blood Th and NK cells, and poor IVF outcomes, including lower number of retrieved oocytes and embryos, lower M II oocytes rate, blastocyst formation rate, and perfect and available embryo rates. Moreover, clinical pregnancy rate, implantation rate, take-home baby rate, and birth weight were significantly lower in the study group as compared with those of the control group. In conclusion, women with anti-SSA/SSB are associated with adverse IVF and pregnancy outcomes. Screening for these antibodies and proper counselling of couples undergoing IVF-ET should be considered. Underlying immunopathology associated with SSA/SSB antibodies and reproduction should be explored further.

Dydrogesterone supplementation in addition to routine micronized progesterone administration for luteal support in cycles triggered with lone GnRH agonist results in an acceptable pregnancy rate and avoids the need to freeze embryos.

Ovarian hyperstimulation syndrome (OHSS) is reduced when using antagonist cycle with gonadotrophin releasing hormone (GnRH) agonist trigger before ovum pick up. This trigger induces short luteinizing hormone (LH) and follicle stimulating hormone (FSH) peaks, resulting in an inadequate luteal phase and a reduced implantation rate. We assessed whether the luteal phase can be rescued by supplementing with oral dydrogesterone (duphaston) in antagonist cycles after a lone GnRH agonist trigger. A retrospective cohort study. The study group (N.=123) included women who underwent IVF. Patients received a GnRH-antagonist with a lone GnRH-agonist trigger due to imminent OHSS. The control group (N.=374) included patients who underwent a standard antagonist protocol with a dual trigger of a GnRH-agonist and human chorionic gonadotrophin (hCG). All the patients were treated with micronized progesterone (utrogestan) for luteal phase support. Study patients were given duphaston in addition. The fertilization rate was comparable between the two groups. The mean number of embryos transferred, the clinical pregnancy rate and the take-home baby rate were comparable between groups (1.5±0.6 vs. 1.5±0.5 and 46.3% vs. 41.2%, and 66.7% vs. 87.7%, respectively). No OHSS event was reported in either group. This study was the first to evaluate outcomes of duphaston supplementation for luteal support in an antagonist cycle with lone GnRH agonist trigger. The functionality of the luteal phase of those cycles could be restored by adding duphaston. This approach was found to be safe and prevented the need to postpone embryo transfer in case of pending OHSS.

O-110 A randomised, controlled, assessor-blind trial assessing clinical outcomes of individualised dosing with follitropin delta in Asian IVF/ICSI patients

Abstract Study question To evaluate the efficacy and safety of individualised dosing with follitropin delta versus conventional dosing with follitropin alfa in an Asian population undergoing ovarian stimulation. Summary answer Individualised dosing with follitropin delta results in significantly higher live birth rate and fewer early OHSS and/or preventive interventions compared to conventional follitropin alfa dosing. What is known already Previous randomised controlled trials conducted in Europe, North- and South America mainly including Caucasian IVF/ICSI patients as well as in Japan have demonstrated that ovarian stimulation with the individualised follitropin delta dosing regimen based on serum AMH level and body weight modulated the ovarian response and reduced the risk of OHSS without compromising pregnancy and live birth rates. Study design, size, duration Randomised, controlled, assessor-blind trial conducted in 1,009 Asian patients from mainland China, South Korea, Vietnam and Taiwan, undergoing their first IVF/ICSI cycle. Randomisation was stratified by age (&amp;lt;35, 35-37, 38-40 years). The primary endpoint was ongoing pregnancy assessed 10-11 weeks after transfer (non-inferiority limit -10.0%; analysis adjusted for age strata). Patients &amp;lt;35 years underwent single embryo transfer if a good-quality embryo was available, otherwise double embryo transfer. Patients ≥35 years underwent double embryo transfer. Participants/materials, setting, methods Follitropin delta (Rekovelle, Ferring Pharmaceuticals) daily treatment consisted of a fixed dose individualised according to each patient’s initial AMH level (&amp;lt;15 pmol/L: 12 μg; ≥15 pmol/L: 0.19 to 0.10 μg/kg; min-max 6-12 μg) and body weight. Follitropin alfa (Gonal-f, Merck Serono) dose was 150 IU/day for the first five days with subsequent potential dose adjustments according to individual response. A GnRH antagonist protocol was applied. OHSS was classified based on Golan’s system. Main results and the role of chance The ongoing pregnancy rate was 31.3% with follitropin delta and 25.7% with follitropin alfa (adjusted difference 5.4% [95% CI: -0.2%; 11.0%]). The live birth rate was significantly higher at 31.3% with follitropin delta compared to 24.7% with follitropin alfa (adjusted difference 6.4% [95% CI: 0.9%; 11.9%]; p &amp;lt; 0.05). Live birth rates per age stratum were as follows for follitropin delta and follitropin alfa; &amp;lt;35 years: 31.0% versus 25.0%, 3537 years: 35.3% versus 26.7%, 38-40 years: 20.0% versus 14.3%. Early OHSS risk, evaluated as the incidence of early OHSS and/or preventive interventions, was significantly (p &amp;lt; 0.01) reduced from 9.6% with follitropin alfa to 5.0% with follitropin delta. The number of oocytes was 10.0±6.1 with follitropin delta and 12.4±7.3 with follitropin alfa. Individualised follitropin delta dosing compared to conventional follitropin alfa dosing resulted in 2 more oocytes (9.6±5.3 versus 7.6±3.5) in potential low responders (AMH &amp;lt;15 pmol/L) and 3 fewer oocytes (10.1±6.3 versus 13.8±7.5) in potential high responders (AMH ≥15 pmol/L). Among patients with AMH ≥15 pmol/L, excessive response occurred less frequently with individualised than conventional dosing (≥15 oocytes: 20.2% versus 39.1%; ≥20 oocytes: 6.7% versus 18.5%). Total gonadotropin dose was reduced from 109.9±32.9 μg with follitropin alfa to 77.5±24.4 μg with follitropin delta. Limitations, reasons for caution The trial only covered the clinical outcome of one treatment cycle with fresh cleavage-stage embryo transfers. Wider implications of the findings The present trial implies that in addition to reducing the early OHSS risk, individualised dosing has the potential to improve the take-home baby rate in fresh cycles across all ages and with a lower gonadotropin consumption. The benefits in outcomes appear to be explained by the modulation of ovarian response. Trial registration number NCT03296527

Pregnancy and neonatal outcomes in fresh and frozen cycles using blastocysts derived from ovarian stimulation with follitropin delta

PurposeTo describe the pregnancy and neonatal outcomes using fresh and vitrified/warmed blastocysts obtained from ovarian stimulation with follitropin delta in controlled trials versus follitropin alfa.MethodsThis investigation evaluated the outcome from 2719 fresh and frozen cycles performed in 1326 IVF/ICSI patients who could start up to three ovarian stimulations in the ESTHER-1 (NCT01956110) and ESTHER-2 (NCT01956123) trials, covering 1012 fresh cycles and 341 frozen cycles with follitropin delta and 1015 fresh cycles and 351 frozen cycles with follitropin alfa. Of the 1326 first cycle patients, 513 continued to cycle 2 and 188 to cycle 3, and 441 patients started frozen cycles after the fresh cycles. Pregnancy follow-up was continued until 4 weeks after birth.ResultsThe overall cumulative take-home baby rate after up to three stimulation cycles was 60.3% with follitropin delta and 60.7% with follitropin alfa (−0.2% [95% CI: −5.4%; 5.0%]), of which the relative contribution was 72.8% from fresh cycles and 27.2% from frozen cycles in each treatment group. Across the fresh cycles, the ongoing implantation rate was 32.1% for follitropin delta and 32.1% for follitropin alfa, while it was 27.6% and 27.8%, respectively, for the frozen cycles. Major congenital anomalies among the live-born neonates up until 4 weeks were reported at an incidence of 1.6% with follitropin delta and 1.8% with follitropin alfa (−0.2% [95% CI: −1.9%; 1.5%]).ConclusionsBased on comparative trials, the pregnancy and neonatal outcomes from fresh and frozen cycles provide reassuring data on the efficacy and safety of follitropin delta.Trial registrationClinicalTrials.gov Identifier: NCT01956110 registered on 8 October 2013; NCT01956123 registered on 8 October 2013.

Влияние переносов размороженных бластоцист, экспандированных на пятые или шестые сутки на эффективность программ ВРТ

Повышение эффективности программ вспомогательных репродуктивных технологий (ВРТ) невозможно без совершенствования и улучшения условий культивирования эмбрионов с последующим переносом или криоконсервацией экспандированных бластоцист достигших нужной стадии к пятым или шестым суткам развития.Цель исследования - оценка влияния дня культивирования бластоцист человека, достигших необходимой стадии экспандирования на эффективность программ ВРТ, частоту наступления клинической беременности (ЧКБ), частоту ранних потерь и частоту живорождения в криопротоколах при проведении программ ВРТ. Проанализированы данные программ переноса размороженных эмбрионов (ПРЭ) экспандированных на 5-е, группа А (N=2275) или 6-е сутки, группа Б (N=170). Частота наступления беременности (ЧНБ) в исследуемых группах составила 50,8 и 46,5%, соответственно. Не наблюдалось статистически достоверных различий в показателях частота наступления клинической беременности (ЧКБ) 37,4 и 37,0% и частота ранних потерь беременности 26,0 и 21,5% у пациенток обеих групп, соответственно. Основной показатель эффективности работы клиники ЭКО – частота живорождения (Take-HomeBabyRate) в криопротоколах с переносами экспандированных бластоцист на пятые (группа А) или шестые сутки (группа Б) составил 36,5 и 35,2%, соответственно (разница не достоверна).В криопротоколах день экспансии бластоцист (5-е или 6-е сутки развития) статистически не влияет на ЧКБ, частоту ранних потерь беременности и частоту живорождения. В программах ПРЭ в первую очередь следует отдавать приоритет качеству бластоцист (отличное и хорошее) не зависимо от дня их криоконсервации.

Outcomes after successful fallopian tube recanalization: A single institution experience: Observational Retrospective study

PurposeTo determine outcomes after successful fallopian tube recanalization (FTR) in women who suffer infertility with documented tubal occlusion on hysterosalpingogram. MethodsA retrospective review of consecutive successful FTR procedures from January 2010 to December 2016 was performed. 53 women who had hysterosalpingogram confirmed unilateral or bilateral tubal occlusion from a single tertiary academic medical center and successful FTR were eligible for inclusion. 35 (66.0%) patients had follow up at 12 months after FTR, with 13 conceiving within 1 year of the procedure. Data was collected from the medical record. Complication, conception, and take-home-baby (THB) rates were recorded. The average age of patients was 32.3 years (range 26–42 years). All patients received peri- and post-procedure antibiotics. The study was conducted with institutional IRB approval. ResultsAverage follow-up after FTR was 1335 days. All patients tolerated the procedure well with no immediate complications. One patient had a urinary tract infection a week after FTR. 13 (37.1%) became pregnant after FTR. Of these women, 2 had ectopic pregnancies and 2 patients had spontaneous abortions. The THB rate after FTR for all patients was 25.7%. The THB rate in women who became pregnant after FTR was 69.2%. Of those women who did not become pregnant after FTR, 19 (84.6%) went to assisted reproductive techniques, and of those, 8 (42.1%) became pregnant. ConclusionInfertility affects 8.4% of U.S. women, with tubal disease a major causative factor. In our study, successful FTR led to pregnancy in over a third of the patients with the majority giving birth to healthy babies. Given the success of obtaining pregnancy in combination with a low complication rate, FTR is a viable option in women who suffer from tubal infertility.

Effect of Intra Uterine Granulocyte Colony Stimulating Factor vs. Human Chorionic Gonadotropin at Ovum Pick Up Day on Pregnancy Rate in IVF/ICSI Cases With Recurrent Implantation Failure.

ObjectiveRecurrent implantation failure is defined as failure to achieve clinical pregnancy after the transfer of four or more good-quality embryos in a minimum of three fresh or frozen cycles in a woman aged less than 40 years. The objective is to compare between the effect of intrauterine G-CSF, hCG, and saline solution injection (as placebo) at the day of ovum pick-up on clinical pregnancy, chemical pregnancy, implantation, and miscarriage rates in patients with recurrent implantation failure undergoing IVF/ICSI.MethodsThis prospective, double blind, parallel, randomized controlled trial included 150 patients equally divided into 3 groups, each containing 50 individuals. Subjects in Group 1 received intrauterine injections of G-CSF; Group 2: received intrauterine injections of 500 IU of hCG; and Group 3 received intrauterine injections of saline solution as placebo. The primary outcome measure is clinical pregnancy rate. Secondary outcomes are biochemical pregnancy, implantation, and miscarriage rates.ResultsClinical pregnancy, biochemical pregnancy, and implantation rates were highest in the group given G-CSF and lowest in the group administered saline solution; miscarriage rates were not significantly different between the groups.ConclusionsIntrauterine administration of G-CSF at a dose of 100 µg/1.0 cc at the time of ovum pick-up is associated with better clinical pregnancy, chemical pregnancy, and implantation rates as compared with intrauterine saline solution administration. Further studies are needed to determine the optimum timing of intrauterine administration of G-CSF that achieves the best results, and longer follow-up is needed to determine take-home baby percentages.

Selection of competent oocytes by morphological criteria for assisted reproductive technologies.

Invasive and noninvasive methods are commonly used to select developmentally competent oocytes that can improve the take-home baby rates in assisted reproductive technology (ART) centers. One of the noninvasive methods conventionally utilized to determine competent oocytes is the morphological analysis of cumulus complex, first polar body, zona pellucida, perivitelline space, meiotic spindle, and ooplasm. Successful fertilization, early embryo development, uterine implantation, and healthy pregnancy depend on the quality of oocytes, and morphological evaluation is one of the options used to predict quality levels. In this review, the morphological criteria being utilized in certain ART centers are comprehensively evaluated with special references to their predictive values and potential contributions to selecting high-quality oocytes.

Protein Expression Profile in IVF Follicular Fluid and Pregnancy Outcome Analysis in Euthyroid Women with Thyroid Autoimmunity.

The objective of this study is to investigate the influence of the thyroid autoantibodies on the protein expression in follicular fluid and the clinical outcome of assisted reproductive technology. A total of 602 patients treated for infertility were screened; 49 euthyroid women who were positive for thyroid autoantibodies and 63 negative controls were recruited. Follicular fluid samples were analyzed using proteomics. Validation of target proteins in follicular fluid was performed by using parallel reaction monitoring. Differentially expressed proteins in follicular fluid, clinical pregnancy rate, abortion rate, and live-birth rate were analyzed. Clinical pregnancy rates and take-home baby rates in the thyroid autoimmunity (TAI) group were less than in the control group, but abortion rates in the TAI group were higher than in the control group (all P < 0.005). A total of 49 proteins were differentially expressed in the TAI-positive group. In Gene Ontology secondary annotations of all the proteins identified, five types of proteins were associated with the reproductive process. Among 11 proteins quantitatively identified by parallel reaction monitoring, angiotensinogen and fetuin-B were associated with reproduction. These differentially expressed proteins identified in this study involved multiple pathways according to the Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis. Our study provides evidence that some differentially expressed proteins between TAI-positive women and controls were associated with the reproductive process and closely related to important physiologic effects, which could partially explain the underlying mechanism link between TAI and the adverse outcomes of assisted reproductive technology.

Novel Use of a Social-Media-Based Survey to Detect Regional Differences in Management of Monochorionic-Diamniotic Twins.

This study aims to evaluate the utility of social media to distribute a patient survey on differences in management and outcomes of monochorionic-diamniotic (MCDA) pregnancies. A cross-sectional survey was posted to an English-language MCDA twins patient-centered support group within the social media site, Facebook from April 2, 2018 to June 26, 2018. Subjects were recruited through a technique called "snowballing," whereby individuals shared the survey to assist with recruiting. Patient reported data were analyzed using Chi-square and Kruskal-Wallis's tests to explore characteristics associated with surveillance and outcomes as related to region and provider type. Over 3 months, the post "reached" 14,288 Facebook users, among which 5,653 (40%) clicked on the post. A total of 2,357 respondents with MCDA pregnancies completed the survey. Total 1,928 (82%) were from the United States (US) and 419 (18%) from other countries. Total 85% of patients had co-management with maternal-fetal medicine (MFM), more in the US compared with the rest of the world (87 vs. 74%, p < 0.01). MFM involvement led to increased adherence to biweekly ultrasounds (91 vs. 65%, p < 0.01), diagnosis of monochorionicity by 12 weeks (74 vs. 69%, p < 0.01) and better education about twin-twin transfusion syndrome (90 vs. 66%, p < 0.01). Pregnancies with MFM involvement had a higher take-home baby rate for both babies (92 vs. 89%, p < 0.01) or for at least one baby (98 vs. 93%, p < 0.01) compared with those without MFM involvement. A survey distributed via social media can be effective in evaluating real-life management and outcomes of an uncommon obstetrical diagnosis. This survey elucidates wide international variation in adherence to guidelines, management, and outcomes.

Экстракорпоральное оплодотворение и перенос эмбрионов у пациенток после различных методов оперативного лечения миомы матки

Objective. To assess the efficacy of in vitro fertilization (IVF) and embryo transfer in patients who had gone surgical treatment for uterine fibroids using different methods. Patients and methods. This study included 133 patients who were divided into 4 groups depending on the type of treatment for uterine fibroids: no treatment (Group 1), laparotomic or laparoscopic myomectomy (Group 2), hysteroscopic resection of uterine fibroids (Group 3), and uterine artery embolization (UAE) (Group 4). Results. The total number of IVF cycles per patient was 1.8 ± 0.4 after laparoscopic myomectomy, 2.0 ± 0.4 after laparotomic myomectomy, 0.4 ± 0.2 after hysteroscopic resection, 2.1 ± 0.3 after no treatment, and 3.9 ± 0.5 after UAE. Mean number of punctures was 1.3 ± 0.4 after laparoscopic myomectomy, 1.4 ± 0.2 after laparotomic myomectomy, 2.4 ± 0.7 after hysteroscopic resection, 1.4 ± 0.7 after no treatment, and 2.1 ± 0.3 after UAE. Mean number of embryo per patient was 3.8 ± 0.1 after laparoscopic myomectomy, 3.7 ± 0.5 after laparotomic myomectomy, 2.8 ± 0.6 after hysteroscopic resection, 2.7 ± 0.2 after no treatment, and 2.2 ± 0.7 after UAE. Cumulative pregnancy rate was 28.0% after laparoscopic myomectomy, 21.0% after laparotomic myomectomy, 12.0% after hysteroscopic resection, 18.3% after no treatment, and 4.6% after UAE. The take-home baby rate was 30.0% after laparoscopic myomectomy, 23.8% after laparotomic myomectomy, 18.2% after hysteroscopic resection, 16.7% after no treatment, and 4.8% after UAE. Conclusion. The efficacy of IVF and embryo transfer after treatment for uterine fibroids is determined by numerous factors, including age, ovarian reserve, size of fibroids, methods used for treatment of uterine fibroids, time between surgical treatment and IVF and embryo transfer. In women planning pregnancy and treatment of uterine fibroids by uterine artery embolization, especially over 35 years of age, it is advisable to use IVF protocols for cryopreservation of oocytes or embryos before surgery. Key words: infertility and uterine fibroids, uterine fibroids and IVF, myomectomy and IVF, uterine artery embolization, efficiency of IVF and embryo transfer