Embryo Transfer Research Articles

Effect of Preimplantation Genetic Testing for Aneuploidy on Live Birth Rate in Young Women With Recurrent Implantation Failure: A Secondary Analysis of a Multicentre Randomised Trial.

To investigate the benefit of preimplantation genetic testing for aneuploidy (PGT-A) in recurrent implantation failure (RIF). Secondary analysis of a multicentre, randomised, double-blind, placebo-controlled clinical trial. Eight academic fertility centres in China, 2018-2020. Overall, 485 infertile women aged < 38 years were evaluated. They had a history of two or more unsuccessful embryo transfer cycles with at least three good-quality embryos that had been transferred cumulatively and underwent a single blastocyst transfer with or without PGT-A. Those with thin endometrium or recurrent pregnancy loss were excluded. Patients were categorised into PGT-A and non-PGT-A groups. All pregnancies were followed to delivery. Pregnancy and neonatal outcomes were obtained from obstetric and neonatal medical records. Propensity score matching (PSM) and multivariate logistic regression models were applied to adjust for potential confounding factors. LBR per embryo transfer. There was no significant difference in LBR between the PGT-A and non-PGT-A groups both before (39.1% vs. 41.5%, p = 0.760) and after (39.1% vs. 40.6%, p = 0.862) PSM. Unadjusted and adjusted logistic regression models revealed no beneficial effect of PGT-A on LBR per embryo transfer (crude odds ratio: 0.91, 95% confidence interval: 0.49-1.69; adjusted odds ratio: 1.04, 95% confidence interval: 0.53-2.03). The incidence of maternal and neonatal complications was not significantly different between the groups. Patients with RIF aged < 38 years do not benefit from PGT-A. Thus, factors other than genetic abnormalities may contribute to this clinical conundrum.

Effects and safety of propofol intravenous anesthesia in transvaginal oocyte retrieval on outcomes of in vitro fertilization and embryo transplantation

PurposePropofol, a widely utilized anesthetic, is employed to alleviate pain and anxiety in outpatient oocyte retrieval procedures. However, its potential impact and safety profile in the context of in vitro fertilization and embryo transfer (IVF-ET) remain unclear.MethodsThis retrospective study enrolled 1187 patients undergoing IVF-ET, and divided into two groups depending on whether they received propofol (propofol group, n=140) or not (control group, n=1047) for anesthesia during oocyte retrieval.ResultsThe baseline characteristics were comparable between the groups. Compared with control group, the number of oocytes retrieved in propofol group was more (p=0.012), while both the estradiol (E2) level on the trigger day and the pre-ovulatory follicle count were higher in propofol group ((p&amp;lt;0.01). Additionally, the rate of preterm delivery was significantly higher in the propofol group (p&amp;lt;0.001). To further analyze the effect of propofol on the oocyte retrieval rate, patients were divided into three subgroups depending on the pre-ovulatory follicle count (≤10, 11–20, and &amp;gt;20) to eliminate the influence of inconsistency in the estimation of the pre-ovulatory follicle count between the two groups. Analysis revealed that the use of propofol during oocyte retrieval was particularly advantageous in the subgroup with a pre-ovulatory follicle count of 11–20, yielding a higher oocyte retrieval rate (p&amp;lt;0.001).ConclusionThe use of propofol in oocyte retrieval did not adversely affect fertilization, embryo quality, or clinical outcomes. Moreover, it was found to increase the oocyte retrieval rate among patients with an estimated pre-ovulatory follicle count of 11–20. These findings offer valuable evidence supporting the clinical application of propofol in oocyte retrieval procedures.

The embryo stage at fresh ET does not affect the cumulative live birth rate in women with a thin endometrium: a retrospective matched-controlled cohort study

BackgroundThe blastocyst-stage embryo has been considered more advantageous for increasing the cumulative live birth rate (CLBR) at fresh embryo transfer (ET) compared to the cleavage-stage embryo. However, it remains uncertain whether this advantage extends to specialized subpopulations, such as women with thin endometrium (TE), who are characteristic of impaired endometrial receptivity. Thus, this study aims to evaluate the difference in the CLBR between cleavage-stage and blastocyst-stage embryos at fresh ET specifically in women with TE.MethodsA retrospective cohort comprising 1089 women from three centers, ranging from September 2017 to January 2022, was established. These women were diagnosed with TE (defined as endometrium thickness &amp;lt;= 8 mm) and underwent their first fresh ET. To create a comparable cohort between the cleavage and blastocyst groups while adjusting for key covariates, the propensity score matching (PSM) method was employed. The primary outcome assessed was the CLBR per woman. Both cohorts underwent Kaplan-Meier analysis, Cox proportional hazard models, cumulative incidence function (CIF) curve analysis, and Fine-Grey competing risk models to ascertain the impact of embryo stage at fresh ET on CLBR. Additionally, a sensitivity analysis was conducted within a subgroup defining thin endometrium as an endometrium thickness (EMT) &amp;lt; 7 mm.ResultsIn the matched cohort after PSM, the CLBR was comparable between groups (p=0.331). However, the cleavage-stage fresh ET was associated with an elevated risk of low birth weight (LBW) (p=0.005) and small for gestational age (SGA) (p=0.037). Kaplan-Meier analysis showed that the median number of embryo transfer cycles was 2 in the cleavage group and 3 in the blastocyst group. The CLBR for the cleavage group reached 78.1%, while the blastocyst group reached 60.0% after 5 cycles of embryo transfers (log-rank test, p=0.09). A multivariable Cox proportional hazard model indicated no significant association between the embryo stage at fresh ET and CLBR (HR=0.80, 95% CI=0.60-1.07). The CIF curve and Fine-Grey competing risk models demonstrated similar results. These analyses were repeated in the original cohort before PSM and in the subgroup with EMT &amp;lt; 7 mm, and the results remained robust.ConclusionFor TE women receiving fresh ET, the choice between the cleavage-stage embryo and the blastocyst-stage embryo yields comparable CLBR. However, selecting the cleavage-stage embryo is associated with increased risks of LBW and SGA births.

Preimplantation genetic testing for a Chinese pedigree affected with Primary carnitine deficiency

To investigate the results of preimplantation genetic testing for monogenic diseases (PGT-M) in a Chinese pedigree affected with Primary carnitine deficiency (PCD). A pedigree affected with PCD who visited Hainan Women and Children's Medical Center in April 2023 due to "SLC22A5 gene mutation found in offspring genetic testing and preparing for a second child" was selected as the study subject. Pathogenicity of the proband's variant sites was determined by referring to the Standards and Guidelines for the Interpretation of Sequence Variants established by the American College of Medical Genetics and Genomics (ACMG). Sanger sequencing was used to verify the variant sites of SLC22A5 gene in the proband and her parents, and the single nucleotide polymorphism (SNP) haplotype of the family was constructed by SNP microarray (SNP array) method to determine the carrier status of pathogenic genes. After fertilization via assisted reproductive technology, whole genome amplification (WGA) was performed on the biopsied trophoblastic cells. Sanger sequencing, next-generation sequencing (NGS), and SNP array techniques were then used to detect the variants in the SLC22A5 gene and chromosome copy number variation (CNV) in the embryos. Embryos without the variants were selected for transferring. After the successful pregnancy of the proband's mother, amniocentesis was not performed for prenatal diagnosis due to repeated vaginal bleeding. After delivery, neonatal peripheral blood sample was collected to verify the results of PGT-M, and follow-up was conducted. This study was reviewed and approved by the Medical Ethics Committee of Hainan Women and Children's Medical Center (Ethics No. HNWCMC-2022-178). In this study, the c.338G>A and c.760C>T variants in SLC22A5 gene were evaluated as pathogenic variants. Sanger sequencing results of this family showed that the c.338G>A and c.760C>T variants of the proband were inherited from his father and mother, respectively. Haplotypes of c.338G>A and c.760C>T variants of SLC22A5 gene were successfully constructed. PGT-M results showed that 2 of the 8 blastulas biopsied failed WGA, and the CNV detection results of the remaining 6 blastocysts were all euploid: 2 had no mutations in the SLC22A5 gene, 3 were single heterozygous carriers of paternal or maternal origin, and 1 was compound heterozygous carriers of paternal and maternal origin. Combined with the embryo morphology score, an intrauterine singleton pregnancy was achieved after the successful transfer of an optimal embryo with no CNV abnormalities and no paternal or maternal SLC22A5 gene mutations, resulting in the birth of a healthy female baby at 38+3 weeks of gestation. The results of peripheral blood chromosomal karyotyping analysis, CNV detection and SLC22A5 gene c.338G>A and c.760C>T site variant detection of the infant were consistent with those of PGT-M, and no abnormality was found. PGT-M had helped the couple carrying SLC22A5 gene variant to have a healthy offspring and effectively blocked the transmission of PCD in this family.

Effects of Intrauterine Infusion of G-CSF and HCG on Peripheral Blood Treg and Pregnancy Outcome in Patients with Thin Endometrium Undergoing Frozen-thawed Embryo Transfer.

Patients with thin endometrium undergoing frozen-thawed embryo transfer often encounter challenges with pregnancy outcomes. Enhancing endometrial receptivity and immune tolerance may improve these outcomes. To investigate the effects of intrauterine perfusion of granulocyte colony-stimulating factor (G-CSF) and human chorionic gonadotropin (HCG) on regulatory T cells (Tregs) and pregnancy outcomes in patients with thin endometrium undergoing frozen-thawed embryo transfer. 150 patients with thin endometrium were randomly assigned to three groups: a control group that received no intervention, an HCG group, and a G-CSF group. The effectiveness of the treatments was assessed by comparing uterine parameters, Treg levels, and pregnancy outcomes across the groups. The HCG and G-CSF groups exhibited significant improvements compared to the control group, including increased endometrial thickness, enhanced blood flow, higher expression of endometrial receptivity markers (integrin αvβ3, osteopontin), and elevated Treg levels. Notably, the G-CSF group demonstrated even greater enhancements compared to the HCG group, with significantly higher endometrial thickness, better blood flow, increased receptivity markers, and elevated Treg levels. Additionally, the G-CSF group achieved significantly higher biochemical and clinical pregnancy rates compared to both the HCG and control groups. This highlights the potential of G-CSF in improving pregnancy outcomes for patients with a thin endometrium. The intrauterine perfusion of G-CSF significantly enhanced pregnancy outcomes in patients with thin endometrium by improving endometrial blood flow, immune tolerance, thickness, Treg induction, and embryo implantation. These findings suggest that G-CSF could be a promising therapeutic option for this patient population.

Stringent Regulations of Oocyte Donation Among Jewish Women in Israel: Characteristics and Outcomes of the National Oocyte Donation Program in One Central IVF Unit.

On September 5, 2010, the Israeli Parliament passed a law that allows Israeli female residents to donate their oocytes to infertile Israeli female residents. This law includes unique restrictions that do not exist in other countries. Our aim was to characterize Israeli oocyte donors and recipients and the outcomes of the oocyte donation program as regulated by national law. This retrospective study included 26 financially compensated volunteer donors (mean age 29 ± 3.52 years) and 69 recipients (mean age 44.6 ± 3.53 years) who underwent 30 intracytoplasmic sperm injection cycles and 166 embryo transfers (ETs) in our unit between March 2016 and November 2020. Stringent legal caveats unique to Israel (e.g., Jewish/Moslem donor only to Jewish/Moslem recipient, only unmarried donor, eggs in one cycle restricted to ≤ 3 recipients, donated sperm only from non-Jewish donors, and more) were meticulously applied. Sociodemographic characterizations of donors and recipients were reviewed, and pregnancy and obstetric outcomes were determined. Variables that were significant in achieving live births among the recipients were examined. Twenty-five donors and all 69 recipients were Jewish, and most were unmarried and childless. The main indication for seeking egg donation was age ≥ 40 years/perimenopause (80%). One-half of the recipients used donor sperm and one-half used partner sperm. The pregnancy, clinical pregnancy, live birth, and miscarriage rates were 28.6%, 19.2%, 18.2%, and 2.8%. The live birth rate was negatively associated with multiple ETs. Maternal complications included hypertensive disorders of pregnancy (18.2%), gestational diabetes mellitus (32.3%), and caesarean sections(78.8%). There were no adverse neonatal outcomes. In conclusion, few young women are interested in donating oocytes in Israel. Pregnancy and live birth rates are lower than published values in other egg donation programs.

Detecting defects: low initial serum human chorionic gonadotropin (hCG) level may predict future fetal anomalies following frozen embryo transfer (FET).

To investigate the relationship between early serum hCG levels after frozen embryo transfer and fetal anomalies. This was acase-control study at a single academic fertility center between 1/2010 and 12/2021, including all patients who underwent euploid frozen embryo transfers resulting in any fetal anomaly confirmed at the time of induced abortion > 10weeks or any anomaly reported at delivery. Controls included patients with healthy live births matched for age and day/grade of embryo after euploid FET. The primary outcome was fetal anomaly, with comparisons made using serum hCG levels from cycle day 28 to cycle day 35 and percent change between days 28 and 35. Both cycle day 28 serum hCG levels and day 35 serum hCG levels were significantly lower in the anomalous group (day 28: 152 vs 177.5 mIU/mL, p < 0.04; day 35: 3033 vs 3744 mIU/mL, p < 0.05). Patients with anomalous outcomes had a significantly lower hCG to start with 5/78 (6.4%) < 50mIU/mL, 16/78 (20.5%) 51-100mIU/mL, and 57/78 (73.1%) > 101mIU/mL, compared to controls 3/78 (3.8%) < 50mIU/mL, 8/77 (10.3%) 51-100mIU/mL, and 66/77 (85.7%) > 101mIU/mL (p < 0.02). However, the rate of rise between day 28 and day 35 was not statistically different (1758.0% vs 2097.0%, p = 0.23). Patients with anomalous fetal outcomes following frozen embryo transfer had lower early serum hCG levels than controls with healthy live births, highlighting the potential utility of this serum marker to identify high-risk pregnancies in the first trimester and expedite treatment as appropriate for this rare but devastating outcome.

Clinical impact of endogenous luteinizing hormone in frozen-thawed embryo transfer during hormone replacement cycle without gonadotropin-releasing hormone analog coadministration: Effects on pregnancy outcomes.

To assess the correlation between serum luteinizing hormone (LH) levels preceding luteal replacement initiation and outcomes of frozen-thawed embryo transfer (FET) cycles during hormone replacement therapy (HRT) without co-administration of gonadotropin-releasing hormone (GnRH) analog. We retrospectively enrolled 490 FET cycles performed between March 2018 and May 2023. Patients were categorized into quartiles based on their serum LH levels preceding luteal replacement. Multivariate logistic regression analysis was performed, with clinical pregnancy and live birth rates as dependent variables. The independent variables included women's mean age, serum LH, and estradiol levels preceding luteal replacement, and endometrial thickness during transfer. Mean age, serum estradiol, and LH levels preceding luteal replacement were 36.8 ± 0.2 years, 306.5 ± 7.7 pg/mL, and 10.3 ± 0.3 mIU/mL, respectively. The clinical pregnancy and live birth rates were 46.8% and 31.9%, respectively, and varied significantly between quartiles. Multivariate analysis revealed that younger age and higher LH levels were significantly associated with increased clinical pregnancy and live birth rates. Endogenous LH may facilitate pregnancy within FET cycles under HRT without GnRH analogs by preparing the endometrium for implantation.

Value of PGT-A when only one or two blastocysts are obtained: propensity-score matching and cost-effectiveness study.

To compare the effectiveness and cost of in-vitro fertilization (IVF) with or without preimplantation genetic testing for aneuploidy (PGT-A) when only one or two blastocysts are obtained. A dataset was gathered from 1829 patients including 368 non-PGT-A and 1461 PGT-A cycles with one or two blastocysts obtained, between April 2013 and July 2022. Patients were matched 1:1 by propensity-score matching for maternal age, number of metaphase-II oocytes inseminated and number of blastocysts obtained, achieving a database of 242 patients per group. The non-PGT-A and PGT-A groups were compared for differences in live birth rate (LBR) per embryo transfer (ET), cumulative LBR per patient, miscarriage rate (MR) per clinical pregnancy, number of days between oocyte retrieval and conclusion of the IVF cycle (primary outcome), mean expenses incurred at the clinic and incremental cost-effectiveness ratio (ICER). More than twice as many ETs were conducted in the non-PGT-A group compared with the PGT-A group, yet the cumulative LBR per patient was similar between groups (23.6% (95% CI, 18.5-29.5%) vs 27.3% (95% CI, 21.9-33.4%)). This outcome was achieved with a higher LBR per ET (16.2% (95% CI, 12.6-20.5%) vs 41.5% (95% CI, 33.9-49.4%)) and lower MR per clinical pregnancy (30.1% (95% CI, 21.8-42.6%) vs 13.9% (95% CI, 7.5-24.0%)) in the PGT-A group. The MR per patient was also lower in the PGT-A group (9.5% (95% CI, 6.2-14.1%) vs 4.5% (95% CI, 2.4-8.2%)). The mean duration between oocyte retrieval and IVF cycle conclusion was 131 (95% CI, 113-150) days in the non-PGT-A group vs 74 (95% CI, 61-87) days in the PGT-A group (P < 0.001; power = 99.8%). The ICER of PGT-A for the months saved between oocyte retrieval and conclusion of the IVF cycle was €499 overall, ranging between €170 and €2065 according to the number of blastocysts obtained and/or maternal age. The ICER of PGT-A for prevented miscarriages was €18 968, decreasing to €3525 when calculated among patients aged ≥ 35 years with two blastocysts obtained. When conducted in expert IVF clinics for patients indicated for the procedure, PGT-A is clinically valuable even when only one or two blastocysts are obtained. PGT-A reduces the number of ETs and miscarriages while the cumulative LBR per patient remains unaffected, and allows these outcomes to be achieved in a shorter timeframe. The ICER of PGT-A vs non PGT-A decreased as maternal age increased. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Optimal duration of progesterone before cryopreserved embryo transfer in hormone replacement therapy cycles: A prospective pilot study.

This prospective pilot cohort study aimed to ascertain the optimal duration of progesterone supplementation prior to frozen embryo transfer (FET) in women undergoing hormone replacement therapy (HRT) cycles. A total of 127 participants were enrolled and divided into 2 cohorts. The first cohort, comprising of 39 women, was used to determine the peak period of endometrial receptivity. These participants underwent serial assessments of integrin alphavbeta3, homeobox gene A10, and leukemia inhibitory expression levels from days 3 to 7 (P + 3 to P + 7) during the mock HRT cycles. The second cohort included 88 women who embarked on their inaugural HRT-FET cycle and were monitored for pregnancy outcomes after the transfer of D3 embryos after 3 or 4 days of progesterone administration. The results indicated a significant enhancement in biochemical pregnancy and embryo implantation rates in the P + 3 group (87.18% and 74.36%, respectively) compared to those in the P + 4 group (68.42% and 65.79%; P = .047 and P = .044, respectively). These data suggest that a 3-day progesterone regimen prior to D3 embryo transfer may be more beneficial. Notably, the maximal expression of endometrial receptivity markers was observed on day P + 6 within the HRT cycles, which is consistent with previous research that correlated day 6 embryos with peak endometrial receptivity. Therefore, a 3-day progesterone lead-in may enhance synchrony between D3 embryos and the endometrium. Our findings suggest that initiating D3 embryo transfer after 3 days of progesterone administration may optimize embryo-endometrial synchronization, thereby potentially enhancing clinical outcomes in FET cycles.

Is oral dydrogesterone equivalent to vaginal micronized progesterone for luteal phase support in women receiving oocyte donation?

Research questionTo determine whether the use of oral dydrogesterone (DYD) in luteal phase support (LPS) during an artificial cycle provides equivalent clinical and ongoing pregnancy, delivery and miscarriage rates as micronized vaginal progesterone (MVP) in oocyte donation recipients.DesignThis was a retrospective observational study of prospectively collected data from the assisted reproductive technology (ART) Department of Lille University Hospital from July 2018 to July 2022. All recipients underwent endometrial preparation by an artificial cycle. Luteal phase support (LPS) was provided by weekly intramuscular progesterone (IM) (500 mg/2 ml) and either DYD (40 mg/day) or MVP (800 mg/day) for 12 weeks if the pregnancy test was positive. The primary endpoint was the clinical pregnancy rate.ResultsOur study analysed 372 oocyte donation cycles with embryo transfer: 162 embryo transfers with DYD + IM progesterone and 210 embryo transfers with MVP + IM progesterone. After adjustment for confounding factors, our two groups were comparable in terms of clinical pregnancy rates, with 36.7% in the MVP group versus 30.3% in the DYD group (p = 0.55); ongoing pregnancy rates (29,1% versus 25.3%, p = 0.95); miscarriage rates (7.6% versus 4.9%, p = 0.35); and live birth rates (26.7% versus 25.3%, p = 0.86).ConclusionOral dydrogesterone seems to be a good alternative to vaginal micronized progesterone for LPS treatment during an artificial cycle, especially in combination with a weekly injection of intramuscular progesterone in the course of oocyte donation.

Embryo Cryopreservation Strategy May Improve Live Birth for Women Underwent In Vitro Maturation After Early Oocyte Retrieval: A Retrospective Cohort Study.

There is limited clinical research investigating the optimal transplantation strategy in early oocyte retrieval cycles. We aimed to assess whether the maturation of oocytes from early oocyte retrieval influenced pregnancy outcomes, and to find the optimal embryo transfer strategy (fresh or frozen-thawed embryo transfers) for patients who had early oocyte retrieval and underwent in vitro maturation (IVM). A retrospective cohort study was conducted in a university-based reproductive medical center. A total of 234 women who underwent single embryo transfer after early oocyte retrieval were included. The primary outcome was live birth rate. The live birth rate (12.5% vs. 27.5%, p = 0.005, adjusted p = 0.010) was significantly lower in IVM cycles compared with no IVM cycles. There was a significant decrease in live birth (3.6% vs. 19.0%, p = 0.008, adjusted p = 0.011) and a markedly elevated early pregnancy loss rate (62.5% vs. 11.1%, p = 0.014, adjusted p = 0.012) for IVM fresh cycles compared with no IVM fresh cycles. However, these findings were not repeated in subgroup analysis when frozen-thaw embryos were transferred. These results indicate that patients who underwent early oocyte retrieval and then IVM-intracytoplasmic sperm injection should be recommended the embryo cryopreservation strategy. Resynchronization of the embryo and the endometrium in frozen-thaw embryo transfer cycles may optimize live birth and decrease early pregnancy loss in IVM-intracytoplasmic sperm injection cycles after early oocyte retrieval.

Clinical utilization and outcomes over eight consecutive years following oocyte cryopreservation.

To compare embryologic and clinical outcomes following oocyte cryopreservation (OC) and immediate fertilization for embryo cryopreservation (EC) in non-infertile patients. Retrospective cohort study SUBJECTS: Patients treated at a single fertility center from 2016 to 2023. OC MAIN OUTCOME MEASURES: Blastocyst development was compared between women undergoing OC and non-infertile women undergoing immediate fertilization for EC between 18 and 42years of age. ICSI, PGT-A, and eSET were used in all cycles. Outcomes from 3697 thawed MII oocytes obtained from 239 OC patients were compared to 28,959 fresh MII oocytes obtained from 2031 patients undergoing immediate fertilization for EC. Average thaw MII survival rate was 92% and high across age groups. Post-thaw oocytes demonstrate lower fertilization rate compared to fresh oocytes (85% v 90%, p < 0.05). As oocyte age increased, the mean number of MII used per blastocyst increased to a greater extent among thawed compared to fresh oocytes (2.9 v 2.2 MII age 18-34, 3.3 v 2.5 MII age 34-37, 3.9 v 2.9 MII age 38-40, 7.5 v 3.9 MII age 41-42, p < 0.05). Among patients achieving transfer of a euploid blastocyst, clinical pregnancy rate and live birth rate per transfer were similar using thawed and fresh oocytes (p = 0.82 and p = 0.79, respectively). Blastocyst conversion is lower from thawed oocytes compared to fresh oocytes. Differences in blastocyst development between thawed and frozen oocytes increase with advancing oocyte age, suggesting that older oocytes may be less efficient in their conversion to blastocysts after vitrification and warming.

Dynamics of blood adipokine levels and their ratios in assisted reproductive technology programs depending on the clinical pregnancy onset

BACKGROUND: The adipokines leptin, adiponectin, and ghrelin are expressed not only in adipose tissue but also in the hypothalamic-pituitary-gonadal axis organs and the uterus. They regulate the gonadotropin-releasing hormone and gonadotropin secretion, steroidogenesis, folliculogenesis, and implantation, and serve as promising markers of assisted reproductive technology program outcomes. AIM: The aim of this study was to evaluate the dynamics of blood adipokine levels and their ratios during the controlled ovarian hyperstimulation in assisted reproductive technology programs depending on the onset of clinical pregnancy. MATERIALS AND METHODS: This study involved 51 patients undergoing infertility treatment using assisted reproductive technology in a short protocol with gonadotropin-releasing hormone antagonists. Depending on the onset of clinical pregnancy, two study groups were formed: non-pregnant (group 1, n = 22) and pregnant (group 2, n = 29). Blood leptin, adiponectin, and ghrelin levels were assessed using enzyme immunoassay at three points: assisted reproductive technology protocol start-up, the day of oocyte pick-up, and the day of embryo transfer. RESULTS: On the day of oocyte pick-up, patients in group 1 had higher leptin levels (5.47 ± 1.92 vs. 3.76 ± 0.75 ng/ml; p = 0.0004), leptin/adiponectin ratios (11.45 ± 4.50 vs. 4.73 ± 1.08; p 0.001), and leptin/ghrelin ratios (0.43 ± 0.17 vs. 0.24 ± 0.07; p 0.001). On the day of embryo transfer, patients in group 1 had higher levels of leptin (6.37 ± 2.13 vs. 3.29 ± 1.21 ng/ml; p 0.001) and adiponectin (0.75 ± 0.22 vs. 0.60 ± 0.09 ng/ml; p = 0.001), as well as ratios of leptin/adiponectin (9.06 ± 3.73 vs. 5.59 ± 2.32; p 0.001), leptin/ghrelin (0.48 ± 0.15 vs. 0.20 ± 0.07; p 0.001), and adiponectin/ghrelin (0.06 ± 0.02 vs. 0.04 ± 0.01; p 0.001). CONCLUSIONS: The data obtained indicate that blood adipokine levels change during the controlled ovarian hyperstimulation in assisted reproductive technology protocols depending on clinical pregnancy and can be used to predict its onset.

Government subsidy for infertility treatment: impact on quality of life for infertile women undergoing in vitro fertilization-embryo transfer

Infertility and the economic burden of treatment can impose considerable psychosocial stress with negative consequences for the quality of life for all involved. The objective of this study was to determine the effects of government subsidies for infertility treatment on the quality of life among infertile women undergoing in vitro fertilization-embryo transfer. Infertile women undergoing in intro fertilization-embryo transfer were recruited from the Assisted Reproductive Technology Center at National Cheng Kung University Hospital, Taiwan, between 2019 and 2022. This study examined the issue of fertility using the FertiQoL survey, which measures the quality of life among individuals facing the struggles associated with infertility. Generalized estimating equation analysis was used to examine the relationship between government subsidies and pregnancy outcomes and quality of life following infertility treatment. This study analyzed 497 infertile women with 727 embryo transfer cycles. The mean core domain and total FertiQoL scores of subsidy recipients were significantly higher (2.68 score increase, p=0.026 and 2.38 score increase, p=0.026, respectively) than those of women who did not receive a subsidy. We also observed a negative correlation between the provision of subsidies and the likelihood of clinical pregnancy (odds ratio=0.57, 95% confidence interval: [0.35, 0.93], p=0.03) and ongoing (odds ratio=0.56, 95% confidence interval: [0.33, 0.95], p=0.03). The government subsidy for infertility treatment was negatively correlated with clinical and live birth rates while positively correlated with quality of life.

Embryo transfer on day 5 or day 6 blastocysts versus blastocysts quality in programs for frozen blastocysts

The aim of the present study was to analyze the high-quality blastocyst (HB) rate in all embryo frozen cycles and investigate the pregnancy outcomes for day 5/day 6 (D5/D6) blastocysts with respect to the blastocyst quality in programmed single vitrified-warmed blastocyst transfer (SVBT). We performed a retrospective study comparing D5/D6 HBs in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) for all blastocyst frozen cycles. Patients were below 37 years at the oocyte collection in their first fresh cycle without fresh transfer. A total of 195 IVF/ICSI cycles and 670 blastocysts were analyzed. The IVF HB rate was higher than that of ICSI (52.7% vs. 42.6%; P&lt;0.05). The D5 HB rate was much higher than the D6 HB rate (61.6% vs. 29.4%; P&lt;0.05). There were 21% (40/195) of cycles that only had D6 blastocysts, of which IVF cycles were lower than ICSI (19.8% vs. 28.5%; P&lt;0.05). The clinical pregnancy rate and implantation rate in the D5 group were significantly higher than the rates in the D6 group (57.4% vs. 46.2%, 58.9% vs. 47.3%; P&lt;0.05). However, the clinical pregnancy rate and implantation rate of the D5 HBs were not significantly different from those of the D6 HBs (60% vs. 54.5%, 62% vs. 56.3%; P&gt;0.05).

Genomic regions associated with Holstein heifer times bred to artificial insemination and embryo transfer services

This study aimed to identify loci (p < 1 × 10−5) and gene sets (normalized enrichment score (NES) ≥ 3.0) associated with the number of times a heifer is bred to attain a successful pregnancy (TBRD) for Holstein heifers bred by artificial insemination (AI, n = 2754) or that were embryo transfer (ET, n = 1566) recipients. Eight loci were associated (p < 1 × 10−5) with TBRD in AI bred heifers and four loci were associated with TBRD in ET recipients. The gene set enrichment analysis with SNP data identified one gene set enriched (NES ≥ 3.0) with TBRD in AI bred heifers and two gene sets that were enriched with TBRD in ET recipients. The estimated pseudo-heritability for times bred to AI was 0.063 and 0.043 for ET. The identification of loci associated with embryonic loss aids in the selection of Holstein heifers with higher reproductive efficiencies that are AI bred or that are ET recipients.

Impact of corpus luteum number on maternal pregnancy and birth outcomes: the Rotterdam Periconception Cohort.

To investigate associations between assisted reproductive technology (ART) -induced alterations in corpus luteum (CL) number during implantation, and maternal pregnancy and birth outcomes. Pregnancies conceived through ART are associated with increased risks of adverse obstetric and perinatal outcomes, with discrepancies in outcomes between different ART treatment protocols. We hypothesize this is due to the periconceptional hormonal environment regulated by the CL. ART protocols affect CL quantity at conception resulting in CL absence or a supraphysiological number of CL. This study is embedded in the Rotterdam Periconceptional Cohort, an ongoing tertiary center prospective cohort at the Erasmus University Medical Center in Rotterdam, the Netherlands. Women with a singleton pregnancy with data on CL. The number of CL, based on mode of conception: 0 CL (artificial cycle frozen embryo transfer (AC-FET), n=72); >1 CL (ovarian stimulated fresh embryo transfer, n=462) and 1 CL (natural cycle frozen embryo transfer (NC-FET) and natural conceptions, n=1327). Hypertensive disorders of pregnancy, gestational diabetes, gestational age at birth and birthweight, derived from medical records. We included 1,861 pregnancies. The results were adjusted for maternal age, maternal body mass index, nulliparity and obstetric history. In comparison with natural conceptions (1 CL), a pregnancy with CL absence (0 CL) was associated with a higher risk of gestational diabetes (aOR 2.59 [95% CI 1.31;5.15]), and a higher risk of preeclampsia, albeit non-significantly (aOR 2.02 [95% CI 0.91;4.51]). In comparison with pregnancies with >1 CL the risk of preeclampsia was significantly lower (aOR 0.36 [95% CI 0.18;0.72]). Post hoc analyses revealed that in male neonates, >1 CL was associated with a lower birthweight percentile (aβ -6.18 [95% CI -11.16;-1.20]). In contrast, female neonates showed no association with >1 CL, whereas CL absence was associated with a higher birthweight percentile (aβ 12.93 [95% CI 2.52;23.34]). Risks of hypertensive disorders of pregnancy, gestational diabetes and relative birthweight differ between CL groups. These findings support the hypothesis that an aberrant number of CL impacts maternal pregnancy and or birth outcomes. Additional studies need to be conducted to investigate causes and underlying pathophysiology.

A Nomogram Model for Predicting Clinical Pregnancy after Fresh IVF/ICSI-ET in Patients with Infertility and Endometriosis.

To determine the clinical and embryo laboratory factors that affect the clinical pregnancy rate of infertile patients with endometriosis (EMs), and establish a model for predicting clinical pregnancy. An observational study. Place and Duration of the Study: Reproductive Medicine Centre, Jiangxi Provincial Maternal and Child Health Hospital, China, from January 2016 to December 2023. Inclusion criteria were EMs patients diagnosedand treated through laparoscopic surgery, aged 22 - 37 years, who did not undergo surgery within 3 months before oocyte retrieval, and received fresh embryo transfer; and the causes of infertility included male factors, tubal infertility, intrauterine adhesions, and others. The exclusion criteria were EMs patients with combined uterine adenomyosis, chromosomal abnormalities, abnormal uterine structure, endocrine diseases, cardiovascular diseases and autoimmune diseases. The research variables included clinical and embryonic factors that affect clinical pregnancy rates, such as age, duration of infertility, type of infertility, and sex hormone levels. The outcome variable was the clinical pregnancy rate. The clinical pregnancy rate was 61.84%. This predictive model was built on the basis of the number of high-quality cleavage embryos, number of embryos transferred, progesterone on HCG day, infertility duration, female age, number of oocytes retrieved, and body mass index showing good calibration and discriminatory abilities, with the area under the curve of receiver operating characteristic curve of 0.641 (95% CI = 0.599 - 0.684) for training set and 0.583 (95% CI = 0.515 - 0.650) for testing set. The Hosmer-Lemeshow test showed no significant difference (p >0.05) between the predicted and the true clinical pregnancy probabilities. The clinical decision curve analysis showed that both the training and testing sets achieved maximum net benefit within a threshold probability range of 0.4 - 0.8, indicating good clinical efficacy within this threshold probability range. The model for predicting clinical pregnancy in patients with EMs after fresh IVF/ICSI-ET had high accuracy, and can provide useful guidance for clinical doctors and individual adjuvant treatment of patients. Endometriosis, Predictive model, Clinical pregnancy, Nomogram, In vitro fertilisation.

Cornual Pregnancy as a Rare Entity of Ectopic Pregnancy After Assisted Reproductive Therapy‐Embryo Transfer (ART‐ET): A Case Report

ABSTRACTCornual pregnancy, a rare and life‐threatening form of ectopic pregnancy, poses significant diagnostic and therapeutic challenges due to its deep implantation in the uterus. This report presents a case of a 31‐year‐old woman with a history of assisted reproductive technology (ART) and prior salpingectomy, who was diagnosed with a right cornual pregnancy following embryo transfer. The patient experienced lower abdominal pain and was found to have an enlarged uterus on ultrasonography. Early diagnosis via three‐dimensional transvaginal ultrasonography enabled timely intervention, preventing rupture and severe hemorrhage. Surgical management involved a combined hysteroscopy and minilaparotomy to resect the cornual pregnancy. Histopathology confirmed the diagnosis, and the patient's recovery was uneventful. Elective cesarean section at 36–37 weeks was advised for future pregnancies to prevent uterine rupture.