Transfer Cycles Research Articles

Correlation between uterine microbiota and pregnancy outcomes of embryo transfer in overweight and obese women

ObjectiveCurrently, it has been reported that uterine microbiota affected pregnancy outcomes in assisted reproductive technology, but little was known in obese women. Thus, this study aims to explore how body weight affects pregnancy outcomes by comparing the differences in uterine microbiota between women of normal weight and those with obesity or overweight.MethodsThe study included 45 embryo transfer cycles. Patients were divided into two groups based on body mass index (BMI): normal-weight group, BMI ≤23.9 kg/m² (Con group, n=31) and obesity/overweight group, BMI >23.9 kg/m² (OwOb group, n=14). Microbial samples were collected from the catheter tips and analyzed using RNA Ribosomal 16S.ResultsIn 45 women, the β-human chorionic gonadotropin (β-hCG) positivity rate and clinical pregnancy rate 10-12 days after embryo transfer were higher in the Con group. At the genus level, the relative abundance of Lactobacillus in the Con group was 2.2 times higher than that in the OwOb group. The Alpha diversity in the OwOb group was significantly higher than in the Con group (p=0.028). After regrouping based on β-hCG results 10-12 days post-transfer, in the Con-negative group (the group with negative β-hCG in the Con group, n=16) the relative abundances of pathogenic bacteria such as Klebsiella (p<0.001), Parasutterella (p=0.004), Dialister (p=0.01), and Gardnerella (p=0.029) were significantly higher than in the Con-positive group (the group with positive β-hCG in the Con group, n=15).ConclusionOverweight and obese women possess a distinct uterine microbiota, characterized by a lower relative abundance of Lactobacillus and an increased relative abundance of pathogenic bacteria, along with specific genera strongly associated with obesity. In individuals with higher BMI, pathogenic bacteria are more likely to impair endometrial receptivity, ultimately leading to adverse pregnancy outcomes. Therefore, modulating the uterine microbiota in overweight/obese women may improve assisted reproductive technology success rates.

Continuous overnight monitoring of body temperature during embryo transfer cycles as a proxy for establishing progesterone fluctuations by comparison with P4 blood progesterone results: a prospective, observational study

BackgroundA prospective, observational study to identify relationships between body temperature and levels of peripheral P4 blood progesterone, and examine if these differ according to body temperature cycle pattern.Methods62 data points from 18 patients undergoing hormone assisted embryo transfer cycles at IVIRMA IVF clinics in Madrid, Mallorca and Malaga, Spain volunteered to use OvuSense, an intra-vaginal body temperature monitor. Primary outcome measures were OvuSense Raw and Smooth Temperature (ST) (°C), P4 (ng/ml). Secondary outcome measures: Ongoing Pregnancy, Miscarriage or biochemical pregnancy. Graphical time based comparison analyses and multilevel regression analyses using MLwiN 3.10 [Charlton C, Rasbash J, Browne WJ, Healy M, Cameron B. MlwiN Version 3.10. Centre for Multilevel Modelling. University of Bristol; 2024.] software were conducted.ResultsA graphical analysis showed an apparent relationship between P4 levels and Temperature taken on P4 blood draw day. A multilevel regression analysis using MLwiN 3.10 Centre for Multilevel Modelling. University of Bristol software investigated this relationship, allowing between-patient variation to be accounted for and estimated. This established a strong linear relationship between LnP4 and ST, and cross correlation was carried out which identified the optimum predictor of levels of LnP4 was ST measured on the day prior to blood sampling. Further graphical analyses showed an apparent lower luteal level of P4 for cycles flagged as atypical by OvuSense, and for negative outcomes, except on embryo transfer day.ConclusionsThe results provide extremely strong evidence of a linear relationship between LnP4 and Smooth Temperature (ST) measured the day before blood sampling (Z = 15.6, p < 0.0001, 2 sided). This suggests that ST could provide a less invasive, continuous, and more practical method of assessing P4 response. Secondary outcomes may be related to ST pattern established during an embryo transfer cycle. Further investigation is required to establish the value of the ST pattern for improving outcomes.

The numbers of biopsied cells in routine clinical process of preimplantation genetic testing (PGT) do not affect the pregnancy outcomes of embryos

Abstract STUDY QUESTION Does the number of biopsied trophectoderm cells sampled for preimplantation genetic testing for monogenic disease (PGT-M) affect subsequent clinical outcomes for those selected embryos? SUMMARY ANSWER The number of biopsied cells does not affect the pregnancy outcome of preimplantation genetically tested embryos. WHAT IS KNOWN ALREADY The successful execution of PGT relies on the availability of a certain number of high-quality biopsied cells. Evidence in the literature has reported that blastocyst biopsies may have a negative impact on clinical outcomes. STUDY DESIGN, SIZE, DURATION A retrospective cohort study including 850 single-blastocyst transfer cycles from 605 couples between May 2014 and August 2024 was conducted at Peking University Third Hospital. The primary clinical outcome measure was the biochemical pregnancy rate, while other indicators such as the live birth rate, the clinical pregnancy rate, and the miscarriage rate were also recorded. PARTICIPANTS/MATERIALS, SETTING, METHODS This study included 850 blastocysts obtained from routine PGT-M cycles. Based on biopsied cell numbers, data were categorized into four groups: Group 1 (1–5 cells) (n = 234), Group 2 (6–10 cells) (n = 328), Group 3 (11–15 cells) (n = 192), and Group 4 (&amp;gt;15 cells) (n = 96). MAIN RESULTS AND THE ROLE OF CHANCE The number of cells biopsied from the embryo did not significantly affect either the biochemical pregnancy rate or the live birth rate in the routine PGT process (P &amp;gt; 0.05). There were 129 of 234 embryos (55.1%) in the 1–5 biopsied cell group, 183 of the 328 embryos (55.8%) with 6–10 biopsied cells, 92 of 192 embryos (47.9%) with 11–15 biopsied cells, and 48 of 96 (50.0%) embryos with more than 15 biopsied cells which achieved successful pregnancies. The live birth rates were 42.7%, 49.7%, 43.2%, and 43.8% for each of the biopsy groups, respectively. LIMITATIONS, REASONS FOR CAUTION Data for this study were collected from one center only, therefore multicenter, large-scale cohort studies are essential to confirm the accuracy and the reliability of this study. WIDER IMPLICATIONS OF THE FINDINGS The number of biopsied cells in a blastocyst is associated with the embryo quality and hatching status. The conclusion of this study emphasizes that routine procedures during the biopsy process do not affect pregnancy outcomes. It is crucial to strike a balance between minimizing damage to the blastocyst’s developmental potential and achieving the highest possible detection efficiency for PGT-M. STUDY FUNDING/COMPETING INTEREST(S) This project is funded by the National Key Research and Development Program of China (2019YFA0801401, 2019YFA0110001) and the National Natural Science Foundation of China (82125013). The authors declare that they have no competing interests. TRIAL REGISTRATION NUMBER N/A.

Aneuploidy rates and clinical pregnancy outcomes after preimplantation genetic testing for aneuploidy using the progestin-primed ovarian stimulation protocol or the gonadotropin-releasing hormone antagonist protocol.

To investigate the chromosome abnormality rates and clinical pregnancy outcomes after preimplantation genetic testing for aneuploidy (PGT-A) using either the progestin-primed ovarian stimulation (PPOS) protocol or the gonadotropin-releasing hormone (GnRH) antagonist protocol. The study included 431 PGT-A cycles in which controlled ovarian stimulation was performed using the PPOS protocol (n = 320 cycles) or GnRH antagonist protocol (n = 111 cycles) between January 2018 and December 2021. Frozen embryo transplantation was subsequently performed in 309 cycles with transplantable blastocysts. The number of retrieved oocytes, embryo development, next-generation sequencing results, and clinical pregnancy outcomes were compared between the two protocols. The primary outcome measure was the aneuploidy rate. Secondary outcome measures were clinical pregnancy per first frozen-thawed embryo transfer cycle and cumulative live birth rates per PGT-A cycle. There were no statistically significant between-group differences in the number of retrieved oocytes, available blastocysts, and high-quality blastocyst rate. The aneuploidy rates were similar between the two groups. There was no significant difference in clinical pregnancy outcomes, including the clinical pregnancy, implantation, miscarriage, live birth, or cumulative live birth rates, after frozen-thawed embryo transfer cycles (P>0.05). The study found no significant difference in the aneuploidy rate, clinical pregnancy rate and cumulative live birth rate after PGT-A cycles between those using the PPOS protocol and those using the GnRH antagonist protocol.

How to estimate the probability of a live birth after one or more complete IVF cycles? the development of a novel model in a single-center.

To develop a predictive tool in the form of a Nomogram based on the Cox regression model, which incorporates the impact of the length of treatment cycles on the outcome of live birth, to evaluate the probability of infertile couples having a live birth after one or more complete cycles of In Vitro Fertilization (IVF), and to provide patients with a risk assessment that is easy to understand and visualize. A retrospective study for establishing a prediction model was conducted in the reproductive center of Shenzhen Zhongshan Obstetrics & Gynecology Hospital (formerly Shenzhen Zhongshan Urology Hospital). A total of 4413 patients who completed ovarian stimulation treatment and reached the trigger were involved. 70% of the patients were randomly placed into the training set (n = 3089) and the remaining 30% of the patients were placed into the validation set (n = 1324) randomly. Live birth rate (LBR) and cumulative LBR (CLBR) were calculated for one retrieval cycle and the subsequent five frozen embryo transfer (FET) cycles. Proportional Hazards (PH) Assumption test was used for selecting the parameter in the predictive model. A Cox regression model was built based on the basis of training set, and ROC curves were used to test the specificity and sensitivity of the prediction model. Subsequently, the validation set was applied to verify the validity of the model. Finally, for a more intuitive assessment of the CLBR more intuitively for clinicians and patients, a Nomogram model was established based on predictive model. By calculating the scores of the model, the clinicians could more effectively predict the probability for an individual patient to obtain at least one live birth. In the fresh embryo transfer cycle, the LBR was 38.7%. In the first to fifth FET cycle, the optimal estimate and conservative estimate CLBRs were 59.95%, 65.41%, 66.35%, 66.58%, 66.61% and 56.81%, 60.84%, 61.50%, 61.66%, 61.68%, respectively. Based on PH test results, the potential predictive factors for live birth were insemination method, infertility factors, serum progesterone level (R = 0.043, p = 0.059), and luteinizing hormone level (R = 0.015, p = 0.499) on the day initiated with gonadotropin, basal follicle-stimulating hormone (R = -0.042, p = 0.069) and BMI (R = -0.035, p = 0.123). We used ROC curve to test the predictive power of the model. The AUC was 0.782 (p < 0.01, 95% CI: 0.764-0.801). Then the model was verified using the validation data. The AUC was 0.801 (p < 0.01, 95% CI: 0.774-0.828). A Nomogram model was built based on potential predictive factors that might influence the event of a live birth. The Cox regression and Nomogram prediction models effectively predicted the probability of infertile couples having a live birth. Therefore, this model could assist clinicians with making clinical decisions and providing guidance for patients. N/A.

The effect of hyaluronic acid-enriched transfer medium on the implantation rate in frozen-thawed embryo transfer cycles

Background: The treatment strategy for patients with a history of multiple failures in in vitro fertilization cycles remains a subject of active research. Embryo transfer in cryocycles is known to be more successful than “fresh” embryo transfer, when ovarian stimulation, follicle puncture, fertilization, and embryo culture were performed but the overall efficiency of in vitro fertilization cycles decreases with maternal age and transfer of poor quality embryos. One of the key factors influencing the failure of high quality embryo implantation is the deficiency of the adhesive matrix, which ensures the interaction between the embryo and the endometrium. The implementation of protocols that include the use of hyaluronic acid-enriched transfer media in the process of embryo transfer is a promising direction for improving implantation outcomes. Special attention of researchers is paid to determining the indications for the use of this technique. Aim: The aim of this study was to evaluate the effect of hyaluronic acid-enriched transfer media on the pregnancy rate in cryocycles. Materials and methods: This retrospective cohort comparative study, included 609 women who underwent controlled ovarian stimulation and frozen-thawed embryo transfer. Results: The main outcomes of frozen-thawed embryo transfer cycles were analyzed, taking into account the quality of the transferred embryos and the use of hyaluronic acid-enriched transfer media. The latter was not shown to be associated with an increase in biochemical and clinical pregnancy rates in women under 35 years of age with a history of repeated implantation failures or after transfer of poor quality embryos. However, in patients over 40 years of age with poor quality embryos, the use of hyaluronic acid-enriched transfer media was effective, since it increased the clinical pregnancy rate. As expected, our data showed an increase in the clinical pregnancy rate in women with high quality embryos on the day of transfer, regardless of the patient’s age. At the same time, in patients with a thin (thickness less than 7 mm) endometrium or a history of miscarriage, the use of hyaluronic acid-enriched transfer media was also associated with an increase in the clinical pregnancy rate and live birth during embryo transfer in cryocycles. Conclusions: The data obtained have shown that the use of hyaluronic acid-enriched transfer media in cryocycles may be recommended for women over 40 years of age, regardless of the quality of the transferred embryos, as well as for women of any reproductive age with a thin endometrium and a history of miscarriage when transferring good quality embryos.

Impact of blastocyst biopsy for preimplantation genetic testing on maternal and neonatal outcomes following single frozen embryo transfer cycles

BackgroundUp to now, a number of studies have explored the influence of blastocyst biopsy on maternal and neonatal outcomes, and the results have been somewhat inconsistent. Therefore, the aim of this study was to investigate whether blastocyst biopsy is associated with an elevated risk of hypertensive disorders of pregnancy (HDP) and other adverse perinatal outcomes during frozen embryo transfer (FET) cycles in singleton live births resulting from intracytoplasmic sperm injection (ICSI) in women aged ≤ 35 years.MethodsA total of 1,008 women were involved in this study from January 2020 to June 2022, who underwent ICSI cycles and received single FET, leading to the birth of a live singleton newborn. The study population were categorized into two groups: the preimplantation genetic testing (PGT) group, comprising 269 women whose blastocysts underwent trophectoderm biopsy, and the control group, consisting of 739 women whose blastocysts did not undergo biopsy. The primary outcome assessed in this study was HDP. Additionally, various relevant perinatal outcomes related to both maternal and neonatal health were also evaluated.ResultsIn comparison to the control group, notable disparities were observed between the groups in relation to infertility duration, EMT, infertility type, infertility cause and endometrial preparation protocol (P < 0.05, for all). The percentage of female gender significantly increased in the PGT group in comparison with the control group (P < 0.05). However, the risk of HDP, other maternal and neonatal outcomes exhibited comparable results between the two groups (P > 0.05, for all). Moreover, univariate regression analyses further revealed that PGT had no influence on maternal and neonatal outcomes, except for gender (aOR 1.44; 95% CI, 1.03–2.01; P = 0.031).ConclusionsIn the short-term perspective, it could be inferred that blastocyst biopsy may not increase the risks associated with HDP or other unfavorable maternal and neonatal outcomes. However, despite the limited sample size, our findings may not be applicable to those aged 35 or over; therefore, larger cohort studies are imperative for the validation of our results.

Intra-guild competition and ecosystem services of mammal scavengers in a new colonized wolf landscape

Carcass utilization by scavengers is crucial for ecosystem dynamics, influencing energy transfer and nutrient cycling. Through the provision of unconsumed carcasses, the return of wolves (Canis lupus) to European ecosystems can trigger complex cascading effects on scavenger communities. Here, we investigate the scavenging dynamics of mammalian species in a prey-rich Mediterranean coastal area close to a large city where wolves have recently returned. Using camera traps, we monitored the scavenging activity on fallow deer (Dama dama) carcasses preyed upon by wolves over a five-year period following the predator’s return. We developed models to assess how competition between red foxes (Vulpes vulpes), wild boars (Sus scrofa), and wolves evolved over time, focusing on their carcass use, direct interactions, and spatiotemporal associations. Wolves exhibited consumption of only minor portions of prey and a negligible reuse of carcasses, while foxes and wild boars engaged in indirect competition for access to this emerging trophic niche. We found a notable temporal change in scavenging activity over the monitoring period, with wild boars progressively emerging as the primary scavenger and providing a substantial removal of carcass biomass. Our findings suggest that wild boars can assume a prominent scavenging role in environments where carcass availability is both abundant and predictable. This study underscores the importance of understanding scavenger temporal dynamics in the context of apex predator recolonization and highlights the need for further research to explore the long-term impacts of these interactions on community structure and ecosystem services as wolf populations continue to expand across Europe.

Impact of Male Age and Semen Parameters on Blastocyst Morphology, Beta-HCG Positivity and Pregnancy Viability: A Retrospective Analysis in Frozen Embryo Transfer Cycles

Impact of Male Age and Semen Parameters on Blastocyst Morphology, Beta-HCG Positivity and Pregnancy Viability: A Retrospective Analysis in Frozen Embryo Transfer Cycles

Sublingual progesterone lozenges are a viable alternative to intramuscular progesterone-in-oil for programmed frozen embryo transfer cycles.

To compare pregnancy outcomes and serum progesterone levels between women who took sublingual (SL) progesterone lozenges versus intramuscular (IM) progesterone-in-oil for endometrial preparation and luteal support in programmed frozen embryo transfer (pFET) cycles. Retrospective cohort study. All patients who underwent pFET of a single euploid good-quality blastocyst between January 2018 and April 2023 at a single fertility center. Patients received either compounded SL lozenges containing 200mg micronized progesterone three times per day or 50mg progesterone-in-oil daily. Both groups also took 100mg vaginal micronized progesterone three times per day. Primary outcomes included clinical pregnancy (hCG ≥ 5 mIU/mL), ongoing pregnancy (pregnancy progressing past 8 weeks), live birth, and miscarriage. Secondary outcomes included progesterone levels at or one day prior to embryo transfer and at the time of the first pregnancy test. 1,951 pFET cycles were included, 1,030 (52.8%) who received IM progesterone and 921 (47.2%) who received SL progesterone. There were no significant differences between the IM and SL groups, respectively, in clinical pregnancy (69.5% vs. 74.4%, odds ratio (OR) 0.81, 95% confidence interval (CI) [0.61-1.09]), ongoing pregnancy (56.1% vs. 61.1%, OR 0.78, 95% CI [0.60-1.01]), live birth (50.1% vs. 57.0%, OR 0.85, 95% CI [0.64-1.14]), or miscarriage (25.1% vs. 24.1%, OR 1.24, 95% CI [0.87-1.79]) after controlling for age, race, estrogen preparation, endometrial thickness, physician performing the transfer, and number of prior embryo transfers (P>0.05, all). In the IM progesterone group, mean serum progesterone levels were significantly higher at the time of embryo transfer (41.6 ± 10.9 vs. 30.5 ± 15.7 ng/mL, P<0.01) and at first bhCG measurement (36.5 ± 11.5 vs. 29.4 ± 15.0 ng/mL, P<0.01) as compared to the SL group. SL progesterone is a viable alternative to IM progesterone for pFET cycles that can minimize injection burden and likely improve patient satisfaction without compromising pregnancy outcomes. Progesterone levels, while slightly lower than the IM route, are in an acceptable range for luteal support.

The Impact of BMI on PCOS Patients and Transcriptome Profiling and Bioinformatic Analysis of Granulosa Cells in PCOS Patients with High and Low BMI.

To explore the impact of high body mass index (BMI) on the embryo quality and clinical outcomes of polycystic ovary syndrome (PCOS) patients, and the possible genes involved. Patients who underwent in-vitro fertilization (IVF) treatment and embryo transfer in our center from November 2014 to September 2023, were divided into low BMI PCOS (LBP) group, high BMI PCOS (HBP) group, and high BMI control (HBC) group. Transcriptome sequencing was performed in eight PCOS patients' granulosa cells (GCs). A total of 812 IVF/intracytoplasmic sperm injection (ICSI) cycles in the embryo part; and 489 fresh, 634 frozen-warmed embryo transfer (FET) cycles from the clinical part were included. The ICSI normal fertilization rate of HBP group was decreased compared to LBP and HBC groups (p = 0.013&0.008). The IVF blastocyst development rate in HBP group was lower than LBP group (p = 0.01). The preterm birth rate in HBP group was higher than in LBP (30.66% vs. 16.48%, p = 0.041) and HBC groups (30.66% vs. 11.34%, p = 0.002), the adjusted OR (AOR) of preterm birth and BMI was 1.124 (p = 0.023) in FET cycles. Transcriptome sequencing result of GCs showed that differentially expressed miRNAs/lncRNA/circRNA/mRNAs in two PCOS groups were 61, 450, 83, and 568, respectively. The hub genes analysis, enrichment analysis and competing endogenous RNA network revealed that cell cycle, oocyte maturation, systemic lupus erythematosus, oxidative phosphorylation, and mitogen-activated protein kinases (MAPK) signaling pathways had important roles in the embryo development and pregnancy process. The combined effect of PCOS and obesity reduced oocyte quality and embryonic development potential, finally led to poorer clinical outcomes.

Impact of endometrial thickness and its combined effect with maternal age on singleton adverse neonatal outcomes in frozen-thawed embryo transfer cycles.

Thin endometrial thickness (EMT) and advanced age are both common risk factors for adverse neonatal outcomes (ANOs). However, studies evaluating the impact of EMT and combined effect of EMT and age on ANOs remain scarce with conflicts. A retrospective cohort study was conducted on 7,715 singleton deliveries from frozen embryo transfer (FET) cycles between 2017 and 2021. The participants were categorized into four groups based on EMT quartiles (≤8.5, 8.6-9.5, 9.6-10.5, and >10.5 mm). The primary outcome was preterm birth (PTB), and the secondary outcome included early PTB (EPTB), small/large for gestational age (SGA/LGA), and low birth weight (LBW). Baseline characteristics were unevenly distributed across EMT groups. After adjusting for the confounders, EMT was found to be associated with the incidence of PTB (aOR 0.922, 95% CI 0.874-0.973, p = 0.003), EPTB (aOR 0.795, 95% CI 0.663-0.954, p = 0.014), LBW (aOR 0.886, 95% CI 0.796-0.986, p = 0.027), and LGA (aOR 1.038, 95% CI 1.004-1.074, p = 0.030). Furthermore, the rates of LBW in the group of EMT at 9.6-10.5 mm (aOR 0.551, 95% CI 0.339-0.895, p = 0.016) and >10.5 mm (aOR 0.536, 95% CI 0.332-0.865, p = 0.011) were lower compared to those with EMT ≤8.5 mm. Among women aged over 35, EMT of 9.6-10.5 mm was associated with a significantly lower incidence of LBW compared to thinner EMT, without increasing the risk of ANOs related to thicker EMT. Our study demonstrated the independent nonlinear impact of EMT on PTB, EPTB, LGA, and LBW. It provided new insights into the combined effects of EMT and age in FET cycles and offered valuable references for the clinical management and treatment strategies aimed at EMT.

The use of propensity score matching to assess the effectiveness of the endometrial receptivity analysis in patients with recurrent implantation failure.

One potential cause of implantation failure is abnormal endometrial receptivity, and how to objectively evaluate endometrial receptivity has been a matter of great concern. Endometrial receptivity analysis (ERA), a next-generation sequencing-based test that assesses endometrial gene expression, may be valuable in predicting endometrial receptivity, but whether ERA improves pregnancy outcomes in patients with recurrent implantation failure (RIF) is currently controversial. The purpose of this study was to investigate the effect of ERA on pregnancy outcomes in patients with RIF. We performed a retrospective cohort study analysis for a population of patients with RIF undergoing frozen embryo transfer (FET) cycles in the reproductive center of the Third Affiliated Hospital of Zhengzhou University from January 2019 to December 2022(n=1598). FET cycles with personalized embryo transfer (PET) under ERA guidance were included in the ERA group (n=43); after using propensity score matching (PSM), a total of 120 FET cycles were included as a control group. Pregnancy outcomes were compared between the two groups. Further, the relationship between the number of previous implant failures and the rate of implant window displacement was discussed. The factors affecting the window of implantation (WOI) displacement were also assessed. There was no statistically significant difference in embryo implantation rate, clinical pregnancy rate, spontaneous abortion rate, and live birth rate between the ERA group and the matched control patients (P > 0.05). There was no significant difference in the rate of WOI displacement between patients in the moderate or severe groups (P > 0.05) and no significant difference in pregnancy outcome ( P>0.05). Finally, analysis of the clinical data of patients in the receptive and non-receptive groups did not uncover any factors influencing WOI displacement. The results of the study showed no significant difference in pregnancy outcomes in patients who received ERA compared to those who did not.

Association of insulin resistance surrogates with live birth outcomes in women with polycystic ovary syndrome undergoing in vitro fertilization

BackgroundInsulin resistance (IR) is a common pathophysiologic feature in patients with polycystic ovary syndrome (PCOS). However, there have been no studies investigating the association of IR surrogates with pregnancy outcomes in women with PCOS undergoing in vitro fertilization (IVF). Therefore, we explored the association between these factors among PCOS patients.MethodsWe conducted a retrospective study that included patients with PCOS who underwent IVF at a university-affiliated hospital. Blood samples and physical examinations are collected at reproductive center on fasting in the morning of the 2nd to 4th day of the menstrual cycle prior to medication. We categorized participants into “Non-IR group” (HOMA-IR < 2.2) and “IR group” (HOMA-IR ≥ 2.2). The association of IR surrogates [triglyceride-glucose-body mass index (TyG-BMI), triglyceride-glucose (TyG) and homeostasis model assessment (HOMA-IR)] with IVF outcomes was evaluated by regression model analysis. Moreover, we also performed sensitivity analyses with stratification and interaction tests. The primary outcome variable was the live birth rate.ResultsA total of 543 PCOS patients were finally included in the study. In all three regression models for the fresh embryo transfer (ET) cycles, all three IR surrogates showed stable negative correlations with live birth rate (in Model III: TyG-BMI OR = 0.99, 95% CI: 0.98 ~ 0.99; TyG OR = 0.47, 95% CI: 0.27 ~ 0.82; HOMA-IR OR = 0.84, 95% CI: 0.72 ~ 0.97; all P < 0.05), and this association was stable across all subgroups of the population (all P-interaction > 0.05). However, this relationship did not exist in frozen-thawed embryo transfer (FET) cycles. Furthermore, our study found that TyG-BMI was superior to TyG and HOMA-IR in predicting the rate of live birth in fresh ET cycles [TyG-BMI: 0.64 (95% CI: 0.58, 0.69) vs. TyG: 0.61 (95% CI: 0.55, 0.67) vs. HOMA-IR: 0.60 (95% CI: 0.55, 0.67)].ConclusionsOur study revealed that the three IR surrogates (TyG-BMI, TyG and HOMA-IR) were negatively associated with the live birth rates in fresh ET cycles. However, this relationship did not exist in FET cycles. Furthermore, our study found that TyG-BMI was superior to TyG and HOMA-IR in predicting the rate of live birth in fresh ET cycles.

Optimising Luteinising Hormone Levels on Trigger Day for Improved Ovarian Response and Pregnancy Outcomes in Gonadotropin-Releasing Hormone Antagonist Protocols: A Retrospective Cohort Study.

To determine the optimal luteinising hormone (LH) level on the trigger day and its impact on pregnancy outcomes in gonadotropin-releasing hormone (GnRH) antagonist protocols using a data-driven approach. Retrospective cohort study. Third Affiliated Hospital of Guangzhou Medical University. Overall, 6107 invitro fertilisation/intra-cytoplasmic sperm injection fresh embryo transfer cycles with GnRH-antagonist protocols were performed between January 1, 2018 and February 1, 2023. Restricted cubic spline analysis and segmented regression identified the optimal LH threshold. Patients were categorised into low (≤ 1.6 IU/L) and high (> 1.6 IU/L) LH groups. Propensity score matching (PSM) and multivariable logistic regression were applied to adjust for confounding factors. Live birth rate per embryo transfer cycle. The high LH group showed significantly higher live birth rates (42.9% vs. 36.9%, adjusted odds ratio [aOR]: 1.468; 95% CI: 1.220-1.766, p < 0.001), ongoing pregnancy rates (51.4% vs. 43.6%, aOR: 1.498; 95% CI: 1.338-1.678, p < 0.001), clinical pregnancy rates (52.4% vs. 45.6%, aOR: 1.439; 95% CI: 1.285-1.611, p < 0.001) and biochemical pregnancy rates compared with the low LH group, despite retrieving fewer oocytes (median 10 vs. 12, p < 0.001). These results remained consistent after PSM and multivariable logistic regression analysis. Higher LH levels on the trigger day are associated with improved pregnancy outcomes in GnRH-antagonist protocols. Maintaining an optimal LH range is crucial for balancing oocyte yield and assisted reproductive technology success, highlighting the importance of individualised ovarian stimulation protocols.

The Effects of Three Methods of Luteal Phase Support on Pregnancy Outcomes in Poor Ovarian Responders: A Randomized Clinical Trial.

The effectiveness of changing the type of luteal phase support in patients with poor ovarian response (POR) remains unclear based on the available evidence. This study aimed to compare the effectiveness of various luteal phase support (LPS) methods, including progesterone alone, human chorionic gonadotropin (hCG) alone, and the combination of progesterone with hCG, in these patients. In this randomized clinical trial, 375 patients diagnosed with POR based on the Bologna criteria underwent intracytoplasmic sperm injection-embryo transfer (ET) cycles at the Royan Institute between November 2015 and June 2019. The patients were allocated randomly into three different LPS groups on the day of oocyte pickup. In the first group, 1500 IU of hCG on the ET day, as well as 4 days after that were administrated intramuscularly. In the second group, the patients received 1500 IU of hCG IM on the ET day, as well as 3 and 6 days after the ET along with vaginal progesterone suppositories of 400 mg twice daily. For the third group, only vaginal suppositories twice daily were administrated from the day of oocyte pick up until the pregnancy test day. The clinical pregnancy, miscarriage and live birth rates were compared among groups using appropriate statistical tests. The data analysis indicated that the three groups were comparable, and there were no significant differences among the groups in terms of implantation, clinical pregnancy, miscarriage, and live birth rates. The twin pregnancy rate in the hCG-only group was higher than in the other two groups, although this difference did not reach statistical significance (P=0.060). Similar pregnancy and live birth rates were observed among different LPS regimens. Interestingly, the use of two boluses of low-dose hCG (1500) was associated with a slight increase in multiple pregnancies. We suggest this effective method, which is easier and more patient-friendly (registration number: NCT02798653).

Application of pilot-scale two-stage ZVI-based biofilter for advanced nitrogen and phosphorus removal from the actual secondary effluent under high DO conditions: Focusing on the effect of DO on electron transfer and Fe cycle

Application of pilot-scale two-stage ZVI-based biofilter for advanced nitrogen and phosphorus removal from the actual secondary effluent under high DO conditions: Focusing on the effect of DO on electron transfer and Fe cycle

Gonadotropin Releasing Hormone Agonists Combined with Hormone Replacement Therapy Significantly Improves Reproductive Outcomes for Patients with Thin Endometrium and Intramural Fibroids in Frozen Embryo Transfer Cycles.

Both intramural myomas and thin endometrium exert a detrimental influence on the outcomes of assisted reproductive technology (ART). The downregulation of gonadotropin releasing hormone agonists (GnRH-a) is regarded as an effective approach to reducing the size of intramural fibroids and enhancing endometrial receptivity. Consequently, we conducted this study to assess whether the GnRH-a combined with hormone replacement therapy (GnRH-a-HRT) can improve reproductive outcomes in frozen embryo transfer cycles for patients with a thin endometrium (≤7 mm) and intramural fibroids. This retrospective cohort study encompassed 360 patients who underwent frozen embryo transfer following in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles. Patients were stratified into three groups based on the endometrial preparation protocol: the natural cycle (NC) group (n=96), the hormone replacement therapy (HRT) group (n=180), and the GnRH-a-HRT group (n=84). The live birth rate (LBR) was designated as the primary outcome, while clinical pregnancy rate (CPR), miscarriage rate, and ectopic pregnancy rate were classified as secondary outcomes. The LBR and CPR in the GnRH-a-HRT group were significantly higher than those in both the HRT group and the NC group (both P < 0.0001). A logistic regression model indicated that the LBR was significantly higher in the GnRH-a-HRT group compared to both the HRT group (odds ratio, 0.269; 95% confidence interval, 0.114-0.637; P = 0.003) and the NC group (odds ratio, 0.524; 95% confidence interval, 0.457-0.956; P = 0.023). Subgroup analyses based on the number and dimension of fibroids demonstrate the positive efficacy of the GnRH-a-HRT regimen. Compared to NC and HRT protocol, improved reproductive outcomes were observed in the GnRH-a-HRT group. These findings provide valuable insights for exploration of the underlying mechanisms by which the GnRH-a-HRT protocol enhances reproductive outcomes in patients of thin endometrium with intramural fibroids.

Maternal and Perinatal Outcomes in Women with Polycystic Ovary Syndrome Undergoing Artificial Frozen-Thawed Embryo Transfer Cycles: A Retrospective Study

Background: Polycystic ovary syndrome (PCOS) is a worldwide endocrine disorder of reproductive-aged women. In addition to infertility, PCOS may lead to unfavorable maternal and prenatal outcomes in assisted reproductive technology cycles. The aim of the study was to investigate the risk of adverse maternal and perinatal outcomes using frozen-thawed embryo transfer (FET) among women with and without PCOS. Materials and Methods: The data of 1064 women in the PCOS group and 1473 women in the control group were analyzed after FET. Adverse maternal and prenatal outcomes including gestational diabetes mellitus, pre-eclampsia, premature rupture of membranes, preterm birth, low birth weight, and stillbirth were compared between the two groups. Results: We did not find significant differences in the above-mentioned variables between the two groups. Gestational diabetes (7.1% vs. 11%), pre-eclampsia (12% vs. 11.8%), premature rupture of membranes (3.8% vs. 6.5%), preterm birth (13% vs. 15.9%), and low birth weight (10.9% vs. 14.7%) between PCOS and non-PCOS groups, respectively (P &gt; 0.05). Conclusions: Our result showed that there are no differences between PCOS and non-PCOS women undergoing FET regarding maternal and neonatal outcomes.

A Qualitative Exploration of Emotional Experiences in Patients with Thin Endometrium Undergoing Repeated Cancellations of Frozen-Thawed Embryo Transfer Cycles.

The aim of this study was to investigate the emotional experience of patients with thin endometrium (TE) who have repeatedly cancelled their cycles due to unsuitability for embryo implantation during the endometrial preparation phase of freeze-thaw embryo transfer (FET). The overall aim is to improve management strategies and quality of life for these patients. A descriptive phenomenological methodology was utilized to conduct in-depth, semi-structured interviews with ten patients diagnosed with TE who had experienced repeated FET cancellations between January and June 2024. The emotional responses elicited were systematically analyzed to identify core themes. Four primary themes emerged: 1) a spectrum of negative emotional responses; 2) deterioration in marital relationships; 3) a pronounced need for professional support, including a) expanded treatment options and b) informational guidance; and 4) diverse coping mechanisms employed by patients. Healthcare providers must recognize and address the complex emotional responses associated with repeated transfer cancellations in patients with TE. Tailored psychological interventions and comprehensive support services may not only foster emotional well-being but also potentially improve clinical outcomes in assisted reproductive technology (ART) settings.