Women Undergoing In Vitro Fertilization Treatment Research Articles

First effective mHealth nutrition and lifestyle coaching program for subfertile couples undergoing in vitro fertilization treatment: a single-blinded multicenter randomized controlled trial

To study compliance and effectiveness of the mHealth nutrition and lifestyle coaching program Smarter Pregnancy in couples undergoing invitro fertilization (IVF) treatment with or without intracytoplasmic sperm injection (ICSI). Multicenter, single-blinded, randomized controlled trial, conducted from July 2014 to March2017. IVF clinics. A total of 626 women undergoing IVF treatment with or without ICSI and 222 male partners. Couples were randomly assigned to the light (control group) or regular (intervention group) Smarter Pregnancy program. Both groups filled out a baseline screening questionnaire on nutrition and lifestyle behaviors, and the intervention group received coaching tailored to inadequate behaviors during the 24-week period. Difference in improvement of a composite dietary and lifestyle risk score for the intake of vegetables, fruits, folic acid supplements, smoking, and alcohol use after 24 weeks of the program. Compared with control subjects, women and men in the intervention group showed a significantly larger improvement of inadequate nutrition behaviors after 24 weeks of coaching. At the same time, the women also showed a significantly larger improvement of inadequate lifestyle behaviors. The mHealth coaching program Smarter Pregnancy is effective and improves the most important nutritional and lifestyle behaviors among couples undergoing IVF/ICSI treatment. International multicenter randomized trials are recommended to study the effect of using Smarter Pregnancy on pregnancy, live birth, and neonatal outcome. NTR4150.

Maternal physical activity and sedentary behaviour before and during in vitro fertilization treatment: a longitudinal study exploring the associations with controlled ovarian stimulation and pregnancy outcomes.

To evaluate the association of objectively measured physical activity (PA) and sedentary behaviour before and during in vitro fertilization (IVF) with controlled ovarian stimulation (COS) and pregnancy outcomes. This longitudinal study involved 107 infertile women undergoing IVF treatment. PA and sedentary behaviour were measured for 14 consecutive days using accelerometry as follows: (1) before IVF treatment, (2) during IVF at the implantation time, immediately after embryo transfer, and (3) after positive pregnancy test. Total screen time was assessed by questionnaires. COS results were measured as the number of oocytes and embryos obtained, and the study outcomes included positive hCG, clinical pregnancy, and live birth. Compared with baseline activity levels, women significantly reduced their PA and increased sedentary behaviour during IVF (p ≤ 0.001). Higher average PA, light PA, and ratio between breaks in every ≥ 30-min blocks of sedentary time showed positive associations, while sedentary time, number, and time accumulated in blocks of ≥ 30min of sedentary time associated negatively with oocyte and embryo counts (all p < 0.05). Women with high total screen time during non-work days (≥ 7h) obtained 4.7 oocytes (p = 0.005) and 2.8 embryos (p = 0.008) less in COS. PA and sedentary behaviour before and during IVF did not affect the positive hCG, clinical pregnancy, and live birth outcomes. Our study results suggest that higher time spent in PA and lower time spent in sedentary behaviour before entering assisted reproduction is associated with better COS outcomes, while activity levels before and during IVF do not affect the implantation, pregnancy, and live birth outcomes.

Atosiban and Pregnancy Outcomes Following In Vitro Fertilization Treatment for Infertile Women Requiring One, Two, or More Embryo Transfer Cycles: A Longitudinal Cohort Study.

We assessed the effect of atosiban on pregnancy outcomes following in vitro fertilization (IVF) treatment among infertile women requiring different numbers of embryo transfer (ET) cycles (i.e., one, two, and more than two ET cycles). A longitudinal cohort study was conducted by utilizing the data from the Assisted Reproductive Technology Center in a university tertiary hospital during 2007-2017. Patients receiving IVF treatment with at least one ET cycle were included. Pregnancy outcomes following IVF treatment, including biochemical, clinical, and ongoing pregnancies, were investigated. The association between atosiban and IVF pregnancy was assessed using logistic generalized estimating equation models, with adjustment for time-varying clinical characteristics (e.g., maternal age) across multiple ET cycles for an individual. 403 women with 838 ET cycles were included, where 165 patients required one ET cycle, 133 patients required two ET cycles (a total of 266 ET cycles), and 105 patients required more than two ET cycles (a total of 407 ET cycles). Atosiban use was not significantly associated with pregnancy outcomes among all study infertile women undergoing IVF treatment. However, the results for women requiring more than two ET cycles showed significantly increased pregnancy rates associated with atosiban use (i.e., odds ratios [95% confidence interval] of 4.40 [1.52, 12.73] and 2.85 [1.45, 5.60] for clinical and ongoing pregnancies, respectively). This association was not observed for the women requiring only one or two ET cycles. Atosiban is a potential treatment for enhancing IVF pregnancy, especially among infertile women requiring more than two ET cycles.

Effect of Mindfulness-Based Group Counseling on Depression in Infertile Women: Randomized Clinical Trial Study.

BackgroundAssisted reproductive technologies (ARTs) such as in vitro fertilization (IVF) can lead to depressive symptoms in infertile women due to their low success and high costs. Mindfulness-based group counseling can decrease depressive symptoms by increasing mental concentration. The aim of the present study was to evaluate the effect of mindfulness-based group counseling on depression in infertile women undergoing IVF.Materials and MethodsThe present clinical trial included 90 infertile women undergoing IVF treatment in an infertility center in 2016. Women were divided into two groups, intervention and control. Both groups completed a demographic questionnaire and the Beck depression inventory (BDI). Eight 90-minute sessions (two each week) of mindfulness-based group counseling were held with the intervention group, while the control group received treatment as normal. Following the intervention, the BDI was again completed by both groups. The data were analyzed and independent t tests and, paired t tests conducted at a significance level of P<0.05.ResultsNo statistically significant demographic differences were observed between the two groups. Women in the control group had a somewhat lower depressive symptom score than the intervention group before the intervention. However, compared with before, the depressive symptom score among women in the intervention group decreased significantly (48%) (P<0.001) after the intervention. In contrast, the depressive symptom score in control women was higher after the intervention than before.ConclusionAccording to the findings of the present research, mindfulness-based group counseling is able to reduce depressive symptoms in infertile women under IVF treatment. Therefore, group counseling sessions are suggested for all depressed women undergoing infertility treatment (Registration number: IRCT2015082013405N14).

The Impact of Noncavity-Distorting Intramural Fibroids on Live Birth Rate in In Vitro Fertilization Cycles: A Systematic Review and Meta-Analysis.

What is the impact of noncavity-distorting intramural fibroids on live birth rates in in vitro fertilization (IVF) cycles? We searched Embase, MEDLINE, Google Scholar, Cochrane Library, and PUBMED from inception to May 2018. We included studies with women undergoing IVF treatment who had at least one noncavity-distorting intramural fibroid. The studies had to report one or more of the following outcomes: live birth rate as our primary outcome, and implantation rate, clinical pregnancy rate, or miscarriage rate as our secondary outcomes. We excluded studies where women also had submucosal fibroids or had undergone myomectomy. Two authors independently selected studies and extracted data. Methodological quality was assessed using Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. We included 15 studies with 5029 patients. Patients with noncavity-distorting intramural fibroids had 44% lower odds of live birth (estimated average odds ratio [OR] = 0.56, 95% confidence interval [CI] = 0.46-0.69) and 32% lower odds of clinical pregnancy (estimated average OR = 0.68, 95% CI = 0.56-0.83). Subgroup analysis of women with purely intramural fibroids showed significantly lower odds of live birth rates and clinic pregnancy rates. Analysis of prospective and retrospective studies shows that noncavity-distorting intramural fibroids have a significant adverse effect on live birth rates in women undergoing IVF. Further, well-designed prospective studies are needed to investigate whether removal of these fibroids improves IVF outcomes in this population.

The effects of daily meteorological perturbation on pregnancy outcome: follow-up of a cohort of young women undergoing IVF treatment

BackgroundHuman reproduction follows a seasonal pattern with respect to spontaneous conception, a phenomenon wherein the effect of meteorological fluctuations might not be unique. However, the effect of seasonal variations on patients who underwent in vitro fertilization (IVF) treatment is unclear. We aimed to evaluate the effects of meteorological variation on the pregnancy rate in a cohort undergoing IVF treatment by performing multivariable analyses.MethodsWe conducted a cohort study in a sub-tropical region with prominent seasonal variations (2005–2016). Women aged < 35 years who were treated with a long ovarian stimulation protocol and underwent fresh embryo transfer (ER) were included. Data on gonadotropin administration (CYCL), oocyte retrieval (OR), ER, and pregnancy outcomes were prospectively recorded. For each patient, the daily average of meteorological data (temperature, humidity, sunlight duration, solar radiation) was recorded from the date of CYCL to ER. Multiple logistic regression analysis adjusted for age, fertilization method, year of the cycle, gonadotropin dose, and transferred embryo grade was performed to determine the relationship between the meteorological parameters and clinical pregnancy. Patients with one successful cycle and one failed cycle were subtracted for a case-control subgroup analysis through mixed effect logistics regressions. Time-series analysis of data in the epidemic level was conducted using the distributed lag linear and non-linear models (DLNMs).ResultsThere were 1029 fresh cycles in 860 women (mean age 31.9 ± 2.0 years). Higher mean temperature from CYCL to OR (adjusted odds ratio [aOR] 1.04; 95% confidence interval [CI] 1.01–1.07, P = 0.01) increased the odds of pregnancy, while OR to ER did not show any statistical significance. Compared to that in winter, the odds of becoming pregnant were higher during higher temperature seasons, summer and autumn (aOR 1.47, 95%CI 0.97–2.23, P = 0.07 (marginally significant) and aOR 1.73, 95%CI 1.12–2.68, P = 0.02, respectively). Humidity, sunlight duration, and solar radiation had no effect on the outcome. The subgroup analysis confirmed this finding. The time-series analysis revealed a positive association between temperature and relative risk for pregnancy.ConclusionsIn IVF treatment, the ambient temperature variation alters the pregnancy rates; this aspect must be considered when obtaining patient consent for assisted conception.

Mobile Health Coaching on Nutrition and Lifestyle Behaviors for Subfertile Couples Using the Smarter Pregnancy Program: Model-Based Cost-Effectiveness Analysis.

BackgroundThe health care costs for reproductive care have substantially increased with the use of in vitro fertilization (IVF) treatment. The mobile health (mHealth) coaching program Smarter Pregnancy is an effective intervention to improve nutrition and lifestyle behaviors and pregnancy rates in (sub)fertile couples, including those who undergo IVF treatment. Therefore, we hypothesize that this mHealth program can also reduce health care costs associated with IVF treatment.ObjectiveThis study aimed to evaluate the cost-effectiveness of the mHealth coaching program Smarter Pregnancy and compare it to usual care in women of subfertile couples who start their first IVF cycle.MethodsThis model-based cost-effectiveness analysis was performed on data from couples undergoing IVF treatment at the Erasmus MC, University Medical Center Rotterdam. A decision tree model was used to assess the incremental cost-effectiveness ratio (ICER) of ongoing pregnancies and costs of use of the mHealth program as compared to usual care. A probabilistic sensitivity analysis was performed to consider the uncertainty surrounding the point estimates of the input parameters.ResultsBased on our model including 793 subfertile women undergoing IVF treatment, use of the mHealth program resulted in 86 additional pregnancies and saved €270,000 compared to usual care after two IVF cycles, with an ICER of –€3050 (95% CI –3960 to –540) per additional pregnancy. The largest cost saving was caused by the avoided IVF treatment costs. Sensitivity analyses showed that the mHealth program needs to increase the ongoing pregnancy rate by at least 51% after two IVF cycles for cost saving.ConclusionsThe mHealth coaching program Smarter Pregnancy is potentially cost saving for subfertile couples preceding their first IVF treatment. Implementation of this mHealth program in routine preconception care for subfertile couples should be seriously considered, given the relatively low costs and promising cost-effectiveness estimates.

Serum AMH levels are not associated with adverse perinatal outcomes in women undergoing IVF treatment due to diminished ovarian reserve

Objective: Anti-Mullerian hormone (AMH) is used as a biomarker for the estimation of fertility related parameters such as quality and quantity of oocytes in in vitro fertilization (IVF) procedures. High oocyte quality may also be associated with healthy trophoblastic invasion and lower complication rates during pregnancy. The aim of this study is to evaluate the relationship between AMH values and perinatal complications in infertile women with poor ovarian reserve (POR).&#x0D; Material and Methods: A total of 68 women undergoing IVF treatment were included in the study. Thirty six of them constituted the study group (POR) and 32 pregnant women constituted the control group (Tubal factor). All women in the study were chosen from patients who have undergone to their first IVF cycle. Serum AMH levels were analyzed with an ELISA kit in all patients.&#x0D; Results: AMH level was 5.4 times higher in the control group compared to that of the study group (p&lt;0.05). No significant differences were observed between the groups with regard to preterm birth rate, gestational age at birth, birth weight, 1st and 5th minute Apgar scores, and neonatal intensive care unit admission rates (all, p&gt;0.05).&#x0D; Conclusion: We found that AMH did not predict adverse perinatal outcomes in women with POR.

Quality of life and pregnancy outcomes among women undergoing in vitro fertilization treatment: A longitudinal cohort study

This study assessed the quality of life (QoL) and pregnancy outcomes among infertile women undergoing invitro fertilization (IVF) treatment to investigate the association between QoL and IVF pregnancy outcomes. This study included 686 women with 1205 embryo transfers (ETs). QoL was measured using the fertility quality of life (FertiQoL) tool before ET. FertiQoL comprises two modules: a Core module (including mind/body, emotional, relational, and social domains) and a Treatment module (covering treatment environment and tolerability domains). The FertiQol total and subscale scores were computed and scored in the range of 0-100 (higher scores indicate better QoL). Multivariate generalized estimating equation analyses were carried out to assess the association between QoL and IVF pregnancy outcomes, with adjustment for time-varying factors across multiple ETs for a given person. The lowest score in the core module was for the emotional domain (62.0), and that in the Treatment module was for the tolerability domain (59.4). QoL scores were significantly and positively associated with pregnancy outcomes (i.e., ongoing pregnancy, live birth); with a one unit increase in the emotional domain score, the probabilities of ongoing pregnancy and live birth significantly increased by 2.4% and 2.6%, respectively (p<0.05). This study evaluated the prospective association between QoL and IVF pregnancy outcomes among infertile women. The results highlight the importance of developing clinical strategies to improve QoL among infertile women undergoing IVF treatment, which may further improve the pregnancy rates of this population.

Are there preferred coping and communication strategies while undergoing IVF, and do cognitive behavioral interventions help?

PurposeCoping and communication strategies affect how one perceives potentially stressful life events, such as infertility. Cognitive behavioral interventions (CBI) can reduce the distress related to undergoing in vitro fertilization (IVF). The purpose of this paper is to examine the effect of CBI on the coping and communication skills as well as perceived stress and depressive symptoms of women undergoing IVF treatment. The authors also explored the relationship between coping strategies and pregnancy rates.Design/methodology/approachThe authors conducted a randomized controlled trial of CBI in 50 women undergoing IVF (NCT00685282).FindingsThe authors found that CBI was associated with reductions in active-confrontive coping among over 50 percent of participants, which was also found to be positively related to depressive symptoms. Furthermore, high meaning-based coping at baseline and high-avoidant coping at the end of IVF treatment were associated with increased pregnancy rates.Research limitations/implicationsCBI can be helpful in reducing the perceived stress of women undergoing IVF; however, the adaptiveness of individual coping skills and communication skills vary. Since different coping strategies seem to be of benefit at different time points, further studies might benefit from the examination of engaging in context-dependent coping strategies.Practical implicationsIntegrating mental health care on infertility units may assist in reducing the stress and thus quality of care in women undergoing IVF. Mental health care can be tailored to meet the individual needs of infertility patients based on their preferred coping strategies and communication style. Further research is needed to examine the cost benefit of reducing perceived stress in fertility patients.Social implicationsInfertility is a social and medical problem that has vast implications on the mental health of individuals. Providing support along with practical tools for stress reduction and improved coping and communication can result in reduced stress and improved coping.Originality/valueThis paper examined the effect of a cognitive behavioral intervention on the coping strategies and communication skills of women undergoing IVF and can contribute to our understanding of the value of integrating mental health and medical care.

Urinary concentrations of phenols and phthalate metabolites reflect extracellular vesicle microRNA expression in follicular fluid

BackgroundPhenols and phthalates are potential endocrine disrupting chemicals (EDCs) that are associated with adverse health outcomes. These EDCs dysregulate a number of biomolecules and pathways, including microRNAs. MicroRNAs can be carried in transport systems called extracellular vesicles (EVs) that are present in most biofluids. EVs in the follicular fluid, which fills the ovarian follicle and influences oocyte developmental competency, carry microRNAs (EV-miRNAs) that have been associated with In Vitro Fertilization (IVF) outcomes. However, it remains unclear whether EDCs affect EV-miRNAs in follicular fluid. ObjectivesThis study sought to determine whether urinary concentrations of phenols and phthalates biomarkers are associated with EV-miRNAs expression in follicular fluid collected from women undergoing IVF treatment. MethodsThis cross-sectional study included 130 women recruited between January 2014 and August 2016 in a tertiary university-affiliated hospital. Participants provided urine samples during ovarian stimulation and on the day of oocyte retrieval. We assessed urinary concentrations of five phenols, eight phthalate metabolites, and one phthalate alternative metabolite. EV-miRNAs were isolated from follicular fluid and their expression profiles were measured using the TaqMan Open Array® Human microRNA panel. We fitted multivariable linear regression models and principal component analysis to examine associations between individual and molar sums of exposure biomarkers and EV-miRNAs. ResultsOf 754 miRNAs tested, we detected 133 EV-miRNAs in the microRNA array which expressed in at least 50% of the follicular fluid samples. After adjusting for multiple testing, we identified eight EV-miRNAs associated with individual phenols and phthalate metabolites, as well as molar ΣDEHP that met a q < 0.10 false-discovery rate (FDR) threshold. Hsa-miR-125b, hsa-miR-106b, hsa-miR-374a, and hsa-miR15b was associated with mono(2-ethylhexyl) phthalate concentrations, hsa-let-7c with concentrations mono-2-ethyl-5-hydroxyhexyl phthalate (MEHHP), mono-2-ethyl-5-oxohexyl phthalate (MEOHP), mono-2-ethyl-5-carboxypentyl phthalate (MECPP), and the sum of metabolites of di(2-ethylhexyl) phthalate, hsa-miR-24 with mono-n-butyl phthalate concentrations, hsa-miR-19a with cyclohexane-1,2-dicarboxylic acid monohydroxy isononyl ester (MHiNCH), and hsa-miR-375 with ethyl paraben concentrations. Using Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses, gene targets and pathways of these EV-miRNAs were predicted in silico and 17 KEGG FDR-significant pathways related to follicular development and oocyte competence were identified. ConclusionsOur results show that urinary concentrations of select phenol and phthalate metabolites are correlated with altered EV-miRNAs expression in follicular fluid. These findings may provide insight regarding the molecular mechanisms underlying adverse effects of phenol and phthalate exposure on female fertility.

Effect of Low-dose Human Chorionic Gonadotropin on the Prevention of Ovarian Hyperstimulation Syndrome and in Vitro Fertilization Outcome

Background & aim: Ovarian hyperstimulation syndrome (OHSS) is a rare but most potentially life-threatening disorder in women under in vitro fertilization (IVF). This study aimed to determine the effect of low-dose human chorionic gonadotropin (hCG) on the prevention of OHSS and IVF outcome. Methods: This single-blind non-randomized clinical trial was performed from October 2008 to November 2012 in Motahari Hospital, Urmia, Iran. Overall, 202 infertile women undergoing IVF treatment were divided into two groups based on OHSS risk factors. Then, 87 women with serum estradiol level of 5000-8000 pg/ml received 5000 units of intramuscular hCG, and 115 women with serum estradiol level of > 8000 pg/ml, who were at high risk for OHSS, received 1600 units of hCG. Data were analyzed using independent t-test and Chi-square test in SPSS, version 16. Results: There were no significant differences in age, infertility duration, infertility factor, quality of embryo, pregnancy rate and number of abortions and OHSS rate between the groups (P>0.05). The group that received 1600 units of hCG was in a better condition regarding the mean number of ova (11.45±5.41 versus 9.24±4.24; P=0.01), mean number of good quality ova (11.10± 5.47 versus 8.68± 4.03; P=0.001), and mean number of embryos (7.38± 4.24 versus 5.53± 2.85; P=0.001). There was no significant difference in the rate of OHSS incidence and cancellation of embryo transfer between the two groups (1600 and 5000 units). Conclusion: Overall, the current study indicated that prescribing 1600 units of hCG in women who are at risk of hypersensitivity reaction may induce similar or perhaps better results regarding the quantity and quality of ova and embryos, however, OHSS risk is not completely eliminated by using a lower dose of hCG. It is therefore suggested to perform randomized clinical trials with greater sample size to verify these results.

Daytime Variation in Serum Progesterone During the Mid-Luteal Phase in Women Undergoing In Vitro Fertilization Treatment.

To investigate whether mid-luteal serum progesterone (P4) exhibits significant fluctuations during a 12-h daytime period in women undergoing in vitro fertilization (IVF) and to explore whether the extent of these fluctuations could impact the interpretation of luteal progesterone levels in a clinical setting. Explorative pilot study. Public hospital-based fertility unit. Ten women undergoing IVF treatment. Seven days after oocyte pick-up, patients underwent frequent repeated blood sampling (every 60 min for 12 h and during two of these hours, every 15 min). Serum samples were analyzed for progesterone, estradiol, and luteinizing hormone (LH). Daytime fluctuations in s-progesterone and s-estradiol. There was a significant positive correlation between median P4 levels and the magnitude of P4 variations-women with median P4 < 60 nmol/l had clinically stable P4 levels throughout the day, while patients with median P4 > 250 nmol/l exhibited periodic P4 peaks of several hundred nanomoles per liter. These endogenous P4 fluctuations were observed irrespective of the type of stimulation protocol or mode of triggering of final oocyte maturation and despite the fact that LH was under the detection limit at the time of measurement. Simultaneously, large fluctuations were seen in s-estradiol. Monitoring of early to mid-luteal P4 levels in IVF cycles may be valuable in the planning of individualized luteal phase support in the attempt to increase reproductive outcomes. The prerequisite for luteal phase monitoring is, however, that the validity of a single measured P4 value is reliable. We show for the first time, that a single P4 measurement in the low progesterone patient quite accurately reflects the corpus luteum function and that the measurement can be used to detect IVF patients with a need of additional exogenous luteal P4 administration.

Homocysteine pathway and in vitro fertilization outcome

A prospective study investigating whether levels of the homocysteine pathway are associated with pregnancy rate in in vitro fertilization (IVF). Prior to initiate treatments, women gave a blood sample to test serum and red blood cell (RBC) folates, homocysteine and vitamin B12. The main outcome was cumulative clinical pregnancy rate according to basal levels of serum and RBC folates, homocysteine and vitamin B12. Two-hundred-nine women were selected, of whom 56 achieved a clinical pregnancy (27%). Median [interquartile range] levels of RBC and serum folate in women who did and did not become pregnant were 328 and 263 ng/ml (p = 0.018) and 13.6 and 9.4 ng/ml (p = 0.001), respectively. The adjusted ORs (95%CI) of pregnancy in women with RBC and serum folate concentrations in the upper tertile of the distributions were 2.6 (1.4–5.1) and 1.9 (1.0–3.7), respectively. Women undergoing IVF treatments with higher levels of folate have a higher chance of clinical pregnancy

Oral medications including clomiphene citrate or aromatase inhibitors with gonadotropins for controlled ovarian stimulation in women undergoing in vitro fertilisation.

Oral medications including clomiphene citrate or aromatase inhibitors with gonadotropins for controlled ovarian stimulation in women undergoing in vitro fertilisation.

A randomized controlled trial with addition of letrozole as an adjunct to FSH in high responders in stimulated IVF cycles show negative impact of ovarian stimulation on the endomterium

Can letrozole reduces the incidence of premature progesterone rises late follicular phase, and thus impact positively on endometrial receptivity to high responders in stimulated in vitro fertilization (IVF) cycles? A randomized parallel controlled trial This randomized parallel controlled trial was conducted in from the Hospital from October 2015 to August 2016.Altogether 133 women undergoing IVF treatment were randomized into two groups using computer-generated randomization plan, to one of the following two treatment regimens: A standard GnRH-a protocol and 100 IU-225IU recFSH were applied from stimulation day 1 and letrozole 2.5 mg/day from cycle day 5 to the day before hCG administration (Letrozole group, n=69) or none (control group, n=64).Standard luteal phase support with progesterone were provided. While estradiol levels were significantly lower in the letrozole group (P < 0.001), the progesterone levels (1.09±0.40,0.93±0.38)ng/ml and P/E2(0.74,0.30) (P < 0.05) on the day of hCG administration were increased in the letrozole group. RecFSH , the recovery rate of eggs, Fertilization rate, high-quality embryo rate,thickness of endometrium,were similar between the letrozole and control groups. Clinical pregnancy rate: 58.5%(31/53),72.9%(35/48) was lower in the letrozole group, although there was no statistical significance by T test( P=0.128 ). The results suggest that co-treatment with letrozole can not reduce the incidence of premature progesterone rise at the late follicular phase,thus show negative impact on endometrial receptivityin in stimulated IVF cycles.With no increase in clinical pregnancy rates compared with control group in high responders undergoing assisted reproductive technology.

Anti-Mullerian hormone (AMH) and embryo quality assessed by time-lapse imaging (TLI): a cross-sectional observational study.

Serum anti-Mullerian hormone shows a strong positive correlation to the quantitative ovarian reserve but its correlation to embryo quality is unclear. This study assessed the association between serum AMH as a marker of ovarian reserve and embryo quality, using the technology of time-lapse imaging of the embryos in women undergoing in vitro fertilisation (IVF) treatment. 304 embryos from 198 women undergoing IVF were included in the study. Serum AMH was assessed for all women. Embryo quality was assessed with the known implantation data (KID) score generated by the time-lapse imaging system. There was no statistically significant difference in mean serum AMH among different KID score categories (p=0.135). This remained non-significant after controlling for confounding variables (p=0.305). The results of our study show no significant association between serum AMH and embryo quality in women undergoing IVF treatment when embryo quality was assessed using the KID scores generated by time-lapse imaging which is a better method of embryo assessment rather than conventional morphological assessment.

The effect of G-CSF on infertile women undergoing IVF treatment: A meta-analysis

ABSTRACTEvidence for the effect of granulocyte colony stimulating factor (G-CSF) on infertile women undergoing in vitro fertilization (IVF) remains inconsistent. This study aimed to evaluate the effectiveness of G-CSF on infertile women undergoing IVF. PubMed and EMBASE databases were searched before August 2016. Comparing the transvaginal perfusion of G-CSF and placebo or no treatment, the available studies were considered. The pooled risk ratio (RR) with 95% confidence intervals (CIs) was used in the analysis and six studies were included. Transvaginal perfusion of G-CSF was significantly associated with a higher clinical pregnancy rate versus the placebo (RR=1.563, 95%CI: 1.122, 2.176), especially for the Asian population. Among patients with a thin endometrium or repeated IVF failure, the implantation and biochemical pregnancy rates were also significantly increased in patients with the use of G-CSF (implantation rate: RR = 1.887, 95% CI: 1.256, 2.833; biochemical pregnancy rate: RR = 2.385, 95% CI: 1.414, 4.023). However, no statistical significance in increasing endometrial thickness was detected. Transvaginal perfusion of G-CSF for infertile women may play a critical role in assisting human reproduction, especially for patients with a thin endometrium or repeated IVF failure in the Asian population.

Correlation of basal serum anti-Mullerian hormone level with oocyte quality and embryo development potential in women undergoing IVF-ICSI

Objectives: To assess and correlate the oocyte morphological characteristics and embryo development in women with normal serum anti-Mullerian hormone (AMH) levels for different age groups women undergoing in vitro fertilisation (IVF). Materials and Methods: It is a retrospective study. A total of 92 women undergoing IVF treatment with normal AMH levels within two different age groups were included in the study based on retrospectively collected data from medical records. Based on age, women were subdivided into two groups: Group A with age >23 to 30 to 23 to 30 to Results: Patients’ demographic characteristics did not show significant difference in Groups A and B, except age (P Conclusion: AMH seems to be a better predictor of quality of oocytes and subsequently embryo development in older age group women when compared to the younger group women. Normal AMH level is a better predictor for ovarian reserve and along with this, it may help to predict oocyte quality and embryo development in older women undergoing IVF. Statistical Analysis: A student t test was applied to compare the means of two groups by online GraphPad software ( www.graphpad.com/quickcalcs/ , GraphPad Software, La Jolla, CA, USA). A P Ethics: This is a retrospective study, and informed, signed consent was obtained from every couple prior to IVF treatment. Further, permission to use their data for analysis with guarantees of confidentiality was obtained. This study was exempted of institutional review board approval, since it involved only the analysis of medical records from established clinical practices.

The Role of Interleukin-18 in Serum and Follicular Fluid during In Vitro Fertilization and Intracytoplasmic Sperm Injection.

Cytokines are key modulators of the immune system and play an important role in the ovarian cycle. IL-18 levels in serum and follicular fluid were analyzed in women undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment. The cohort study group consisted of 90 women, who were undergoing IVF or ICSI. The body mass index (BMI) was determined in all patients; IL-18 levels were measured in follicular fluid and serum. IL-18 levels in serum were significantly higher than those in follicular fluid. The median level in serum was 162.75 (80.21) pg/mL and that in follicular fluid, 138.24 (91.78) pg/mL. Women undergoing IVF treatment had lower IL-18 levels in serum (median, 151.19 (90.73) pg/mL) than those treated with ICSI (median, 163.57 (89.97) pg/mL). The correlation between IL-18 levels in serum and BMI was statistically significant, as well as the correlation between IL-18 levels in follicular fluid and ovarian stimulation response (p = 0.003). IL-18 was correlated with the response to ovarian stimulation and was the reason for successful pregnancy after IVF or ICSI treatment. Among other cytokines, IL-18 appears to be a promising prognostic marker of success in reproductive treatment and should be evaluated as such in further prospective studies.