Influence of Embryo Scoring and Number of Embryos Transferred on Clinical Pregnancy Outcomes in ICSI Cycles

2005 ◽  
Vol 84 ◽  
pp. S295-S296
Author(s):  
C.J.W. Lim ◽  
E.B. Prasath ◽  
S.K.E. Loh
Keyword(s):  
Pregnancy Outcomes ◽  
Clinical Pregnancy

scholarly journals Comparison of the predictive value of progesterone‐related indicators for pregnancy outcomes of women undergoing the short‐acting GnRH agonist long protocol: a retrospective study

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Yangyang Zhang ◽  
Yang Xu ◽  
Yuqiong Wang ◽  
Qing Xue ◽  
Jing Shang ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Gnrh Agonist ◽  
Pregnancy Outcomes ◽  
Predictive Value ◽  
Ovarian Response ◽  
Clinical Pregnancy ◽  
Short Acting ◽  
Good Quality Embryo ◽  
Response Group ◽  
Long Protocol

Abstract Background There are many progesterone (P) elevation-related indicators for predicting pregnancy outcomes, including the serum P, P-to-oestradiol ratio (P/E2), P-to-follicle index (PFI), and P-to-mature oocyte index (PMOI); however, due to inconsistencies in study populations and controlled ovarian hyperstimulation (COH) protocols among studies, these indicators are controversial. Moreover, no researchers have included these four commonly used indicators in one study to compare their predictive efficacies. The objective of this study was to compare the predictive value of P-related indicators for pregnancy outcomes of women undergoing the short-acting GnRH agonist long protocol. Methods A total of 612 infertile women undergoing IVF/ICSI were recruited for this study. Serum samples were obtained on the morning of HCG injection for serum P and E2 measurements. Transvaginal ultrasound was performed to determine the follicle count (≥ 14 mm in diameter). The number of mature oocytes was observed in the embryo laboratory after oocyte retrieval. Results In cases of P < 2.5 ng/ml, there was no significant difference in the serum P level or P/E2 between the pregnant group and the non-pregnant group. The PFI and PMOI of the pregnant group were significantly lower than those of the non-pregnant group. According to the stratified analysis of the ovarian response, only the PMI and PMOI of the pregnant women in the normal ovarian response group were lower than those of the non-pregnant women. To compare the predictive value of the PFI and PMOI in IVF/ICSI outcomes, the patients were divided into four groups. The good-quality embryo rate and clinical pregnancy rate were highest in Group A (low PFI and low PMOI) and lowest in Group D (high PFI and high PMOI). In the two groups with discordant PFI and PMOI, namely Group B (low PFI and high PMOI) and Group C (high PFI and low PMOI), the good-quality embryo rate and clinical pregnancy rate were not significantly different. Conclusions The PFI and PMOI had equal value in predicting clinical pregnancy outcomes in the normal ovarian response group undergoing the short-acting GnRH agonist long protocol. Each clinical centre can choose one of the indicators according to their actual situation in clinical practice and establish individual cut-off values for PFI and PMOI based on their own hormonal measurements.

scholarly journals Effect of blastocyst morphology and developmental speed on transfer strategy for grade “C” blastocyst in vitrified‐warmed cycles

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Yuxia He ◽  
Shiping Chen ◽  
Jianqiao Liu ◽  
Xiangjin Kang ◽  
Haiying Liu
Keyword(s):  
Pregnancy Rate ◽  
Live Birth ◽  
Pregnancy Outcomes ◽  
Multiple Pregnancy ◽  
Poor Quality ◽  
Clinical Pregnancy ◽  
Neonatal Outcomes ◽  
Blastocyst Transfer ◽  
Blastocyst Development ◽  
Multiple Pregnancy Rate

Abstract Background High-quality single blastocyst transfer (SBT) is increasingly recommended to patients because of its acceptable pregnancy outcomes and significantly reduced multiple pregnancy rate compared to double blastocyst transfer (DBT). However, there is no consensus on whether this transfer strategy is also suitable for poor-quality blastocysts. Moreover, the effect of the development speed of poor-quality blastocysts on pregnancy outcomes has been controversial. Therefore, this study aimed to explore the effects of blastocyst development speed and morphology on pregnancy and neonatal outcomes during the frozen embryo transfer (FET) cycle of poor-quality blastocysts and to ultimately provide references for clinical transfer strategies. Methods A total of 2,038 FET cycles of poor-quality blastocysts from patients 40 years old or less were included from January 2014 to December 2019 and divided based on the blastocyst development speed and number of embryos transferred: the D5-SBT (n = 476), D5-DBT (n = 365), D6-SBT (n = 730), and D6-DBT (n = 467) groups. The SBT group was further divided based on embryo morphology: D5-AC/BC (n = 407), D5-CA/CB (n = 69), D6-AC/BC (n = 580), and D6-CA /CB (n = 150). Results When blastocysts reach the same development speed, the live birth and multiple pregnancy rates of DBT were significantly higher than those of SBT. Moreover, there was no statistical difference in the rates of early miscarriage and live birth between the AC/BC and CA/CB groups. When patients in the SBT group were stratified by blastocyst development speed, the rates of clinical pregnancy (42.44 % vs. 20.82 %) and live birth (32.35 % vs. 14.25 %) of D5-SBT group were significantly higher than those of D6-SBT group. Furthermore, for blastocysts in the same morphology group (AC/BC or CA/CA group), the rates of clinical pregnancy and live birth in the D5 group were also significantly higher than those of D6 group. Conclusions For poor-quality D5 blastocysts, SBT can be recommended to patients because of acceptable pregnancy outcomes and significantly reduced multiple pregnancy rate compared with DBT. For poor-quality D6, the DBT strategy is recommended to patients to improve pregnancy outcomes. When blastocysts reach the same development speed, the transfer strategy of selecting blastocyst with inner cell mass “C” or blastocyst with trophectoderm “C” does not affect the pregnancy and neonatal outcomes.

P–371 Clinical value assessment between endometrial receptivity array and immune profiling in patients with implantation failure

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Y Dong ◽  
Y Jia ◽  
Y Sha ◽  
L Diao ◽  
S Cai ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Pregnancy Outcomes ◽  
Statistical Difference ◽  
Endometrial Receptivity ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Implantation Failure ◽  
Clinical Value ◽  
Evaluation Approaches ◽  
Immune Profiling

Abstract Study question To evaluate whether the pregnancy outcomes could be improved in implantation failure patients by endometrial receptivity array, endometrial immune profiling, or a combination of both. Summary answer There was no statistical difference between different endometrial receptivity evaluation and treatment in improving the clinical pregnancy rate. What is known already Both endometrial receptivity array and endometrial immune profiling were promised to improve the endometrial receptivity and subsequent clinical pregnancy. However, less is known about the efficiency between each other and whether the combination could further enhance their clinical value. Study design, size, duration Between November 2019 and September 2020, 143 women with a history of at least two or more consecutive implantation failure in IVF/ICSI treatment in Chengdu Xinan Gynecology Hospital were included. They were divided into three groups: ‘ERA + Immune Profiling’ (n = 70), ‘Immune Profiling’ (n = 41), and ‘ERA’ (n = 32). Participants/materials, setting, methods Inclusion criteria were age ≤ 38, with normal uterus and uterine cavity. All patients were suggested to evaluate endometrial receptivity by ERA test (Igenomix, Valencia, Spain) and endometrial immune profiling based on immunohistochemistry simultaneously, who would be free to choose each or both evaluation approaches. Personal Embryo Transfer and/or personal medical care were adopted according to evaluation results. Clinical pregnancy was confirmed by gestational sacs observed under ultrasonography. Main results and the role of chance The overall prevalence of displaced window of implantation (WOI) is 84.3%, and nearly 74.8% (83/111) patients were diagnosed as endometrial immune dysregulation. Clinical Pregnancy rate and embryonic implantation rate decreased in the ‘Immune Test’ groups, but without a statistical difference (P = 0.311, and 0.158, respectively). Multivariable logistic regression analysis showed that different endometrial receptivity evaluation and treatment was not associated the clinical pregnancy rate, suggesting the performance of different endometrial receptivity evaluation and treatment is similar in improving the clinical pregnancy rate. Neither the immune profiling (CD56, P = 0.591; FOXP3, P = 0.195; CD68, P = 0.820; CD163, P = 0.926; CD1a, P = 0.561; CD57, P = 0.221; CD8, P = 0.427; CD138 CE, P = 0.372) nor histologic endometrial dating defined by Noyes criteria (P = 0.374) were associated with ERA phases. Limitations, reasons for caution Although the selection of evaluation approaches was based on patients’ willingness, the variances of baseline characteristics and immune profiling existed in different groups. The immunological treatment efficacy based on immune profiling was not evaluated before embryo transfer. Wider implications of the findings: To our knowledge, this is the first study comparing the pregnancy outcomes after two typical endometrial receptivity evaluation approaches. The findings highlight the unsubstitutability for each assessment, indicating that both asynchronous and pathological WOI contribute to implantation failure. Trial registration number X2019004

Hormone Replacement Therapy With GnRH Agonist Pretreatment Improves Pregnancy Outcomes in Patients With Previous Intrauterine Adhesions: a Retrospective Study

2021 ◽  
Author(s):  
Meilan Mo ◽  
Qizhen Zheng ◽  
Hongzhan Zhang ◽  
Shiru Xu ◽  
Fen Xu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Retrospective Study ◽  
Pregnancy Outcomes ◽  
Preparation Method ◽  
Clinical Pregnancy ◽  
Ongoing Pregnancy ◽  
Intrauterine Adhesions ◽  
Endometrial Preparation ◽  
History Of ◽  
Early Miscarriage

Abstract Objective: This retrospective study aimed to explore the optimal endometrial preparation method in women with intrauterine adhesions (IUAs).Method: A total of 882 frozen-thawed embryo transfer (FET) cycles from patients with history of IUAs were categorized into three groups based on endometrial preparation methods: hormone replacing therapy cycle (HRT, n=636), natural cycle (NC n=174), and HRT with GnRH-a pretreatment (HRT+GnRH-a, n=72. Logistic regression was performed to investigate the association between cycle regimens and pregnancy outcomes. Subgroup analysis of IUAs combined with thin endometrium (≤7mm) was also performed.Results: HRT with GnRH-a pretreatment was associated with higher incidences of clinical pregnancy, ongoing pregnancy, and live birth, but lower early miscarriage compared with either HRT or NC. Logistic regression indicated that after controlling for potential confounders, the incidences of live birth (HRT+GnRH-a as reference; NC: aOR=0.577, 95%CI 0.304-1.093; HRT: aOR=0.434, 95%CI 0.247-0.765) and ongoing pregnancy (NC: aOR=0.614, 95%CI 0.324-1.165; HRT: aOR=0.470, 95%CI 0.267-0.829) remained significantly higher in HRT+GnRH-a compared to those in HRT, but comparable to those in NC. While there was no significant difference with respect to the clinical pregnancy rate (NC: aOR=0.695, 95%CI 0.374-1.291; HRT: aOR=0.650, 95%CI 0.374-1.127) and early miscarriage rate (NC: aOR=1.734, 95%CI 0.417-7.175; HRT: aOR=2.594, 95%CI 0.718-9.378) between groups. Subgroup analysis suggested there was no superiority of endometrial preparation method in IUAs combined with thin endometrium.Conclusion: HRT with GnRH-a pretreatment improves pregnancy outcomes in women with history of IUAs. GnRH-a may restore the endometrial receptivity in the FET cycles in IUAs.

O-222 An artificial intelligence model that was trained on pregnancy outcomes for embryo viability assessment is highly correlated with Gardner Score

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
S Diakiw ◽  
M VerMilyea ◽  
J M M Hall ◽  
K Sorby ◽  
T Nguyen ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Pregnancy Outcomes ◽  
Embryo Quality ◽  
Cell Mass ◽  
Clinical Pregnancy ◽  
Morphological Features ◽  
Embryo Morphology ◽  
Embryo Viability ◽  
Viability Assessment ◽  
Highly Correlated

Abstract Study question Do artificial intelligence (AI) models used to assess embryo viability (based on pregnancy outcomes) also correlate with known embryo quality measures such as Gardner score? Summary answer An AI for embryo viability assessment also correlated with Gardner score, further substantiating the use of AI for assessment and selection of good quality embryos. What is known already The Gardner score consists of three separate components of embryo morphology that are graded individually, then combined to give a final score describing Day 5 embryo (blastocyst) quality. Evidence suggests the Gardner score has some correlation with clinical pregnancy. We hypothesized that an AI model trained to evaluate likelihood of clinical pregnancy based on fetal heartbeat (in clinical use globally) would also correlate with components of the Gardner score itself. We also compared the ability of the AI and Gardner score to predict pregnancy outcomes. Study design, size, duration This study involved analysis of a prospectively collected dataset of single static Day 5 embryo images with associated Gardner scores and AI viability scores. The dataset comprised time-lapse images of 1,485 embryos (EmbryoScope) from 638 patients treated at a single in vitro fertilization (IVF) clinic between November 2019 and December 2020. The AI model was not trained on data from this clinic. Participants/materials, setting, methods Average patient age was 35.4 years. Embryologists manually graded each embryo using the Gardner method, then subsequently used the AI to obtain a score between 0 (predicted non-viable, unlikely to lead to a pregnancy) and 10 (predicted viable, likely to lead to a pregnancy). Correlation between the AI viability score and Gardner score was then assessed. Main results and the role of chance The average AI score was significantly correlated with the three components of the Gardner score: expansion grade, inner cell mass (ICM) grade, and trophectoderm grade. Average AI score generally increased with advancing blastocyst developmental stage. Blastocysts with expansion grades of ≥ 3 are generally considered suitable for transfer. This study showed that embryos with expansion grade 3 had lower AI scores than those with grades 4-6, consistent with a reduced pregnancy rate. AI correlation with trophectoderm grade was more significant than with ICM grade, consistent with studies demonstrating that trophectoderm grade is more important than ICM in determining clinical pregnancy likelihood. The AI predicted Gardner scores of ≥ 2BB with an accuracy of 71.7% (sensitivity 75.1%, specificity 45.9%), and an AUC of 0.68. However, when used to predict pregnancy outcome, the AI performed 27.9% better than the Gardner score (accuracies of 49.8% and 39.0% respectively). Even though the AI was highly correlated with the Gardner score, the improved efficacy for predicting pregnancy suggests that a) the AI provides an advantage in standardization of scoring over the manual and subjective Gardner method, and b) the AI is likely identifying and evaluating morphological features of embryo quality that are not captured by the Gardner method. Limitations, reasons for caution The Gardner score is not a linear score, creating challenges with setting a suitable threshold relating to the prediction of pregnancy. The 2BB treshold was chosen based on literature (Munné et al 2019) and verified by experienced embryologists. This correlative study may also require additional confirmatory studies on independent datasets. Wider implications of the findings The correlation between AI scores and known features of embryo quality (Gardner score) substantiates the use of the AI for embryo assessment. The AI score provides further insight into components of the Gardner score, and may detect morphological features related to clinical pregnancy beyond those evaluated by the Gardner method. Trial registration number Not applicable

scholarly journals Effect of large follicle puncture on IVF-ET outcome in patients with unsynchronized follicle maturationcan

2019 ◽  
Vol 47 (5) ◽  
pp. 2056-2066
Author(s):  
Xinrong Wang ◽  
Wenjuan Wang ◽  
Qinglan Qu ◽  
Ning Zhang ◽  
Cuifang Hao ◽  
...  
Keyword(s):  
Pregnancy Outcome ◽  
Pregnancy Outcomes ◽  
Endometrial Thickness ◽  
Multivariate Logistic Regression Analysis ◽  
Clinical Pregnancy ◽  
Control Group ◽  
Large Follicle ◽  
Vitro Fertilization ◽  
Follicular Maturation

Objective This retrospective study was conducted to explore causes of unsynchronized follicular maturation (UFM) and analyze the effects of large follicle puncture on embryo quality and pregnancy outcome. Methods Clinical features and controlled ovulation hyperstimulation (COH) were compared between the puncture group (n = 48) and the control group (n = 2545). We analyzed the COH process with in vitro fertilization during fresh cycle embryo transfer with different clinical pregnancy outcomes. We compared clinical characteristics and COH process of patients in the clinical pregnancy (n = 774) and non-clinical pregnancy (n = 527) groups. Finally, factors related to pregnancy outcomes were analyzed using multivariate logistic regression analysis. Results Age, level of estradiol on down-regulation day, and initial gonadotropin dose were significantly higher in the puncture group than in the control group. We detected significant differences in age, infertility, and body mass index (BMI) between the clinical and non-clinical pregnancy groups. Age, BMI, and endometrial thickness on the day of human chorionic gonadotropin administration were the independent factors influencing pregnancy outcome. Conclusions Patient’s age and level of anti-Müllerian hormone were the main factors causing UFM in patients undergoing COH. Large follicle puncture had no significant effect on pregnancy outcome.

scholarly journals Association between ambient air pollution and in vitro fertilization pregnancy outcomes in Taiyuan: A retrospective study in a heavy polluted city in northern China

2020 ◽  
Author(s):  
Suming Xu ◽  
Chunqing Sun ◽  
Xingyu Bi ◽  
Dan Feng ◽  
Lei Zhang ◽  
...  
Keyword(s):  
Air Pollution ◽  
Air Quality ◽  
Pregnancy Outcomes ◽  
Northern China ◽  
Ambient Air ◽  
Clinical Pregnancy ◽  
Ambient Air Pollution ◽  
Vitro Fertilization ◽  
Biochemical Pregnancy

Abstract BackgroundGlobally, air pollution has a significant impact on human health. However, the effects of air pollution on pregnancy outcomes in patients undergoing in vitro fertilization (IVF) have not been fully understood. In this study, we analyzed the effects of air pollution on IVF pregnancy outcomes in Taiyuan, which is a heavy polluted city in northern China.Methods516 patients who underwent first fresh IVF cycle were enrolled in the retrospective study from January 1, 2015 to May 31, 2020. We collected medical record data from the electronic medical record system and daily average air pollution data from air quality monitoring station. Logistic regression was used to analyze the relationship between six atmospheric pollutants (PM2.5, PM10, O3, NO2, SO2, CO) and air quality index (AQI) and IVF pregnancy outcomes (biochemical pregnancy and clinical pregnancy) in different exposure periods. ResultsThe results indicated that exposure to NO2 was negatively associated with the odds of biochemical pregnancy and clinical pregnancy, whereas exposure to O3 presented positive association. Furthermore, we also found that AQI was negatively associated with IVF pregnancy outcomes. ConclusionsOur findings suggested that exposure to ambient air pollution during any period may have an impact on IVF pregnancy outcomes, and poor air quality is more likely to reduce clinical pregnancy rates.

scholarly journals Association of the Cervical Microbiota With Pregnancy Outcome in a Subfertile Population Undergoing In Vitro Fertilization: A Case-Control Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Xinyao Hao ◽  
Pingping Li ◽  
Shanshan Wu ◽  
Jichun Tan
Keyword(s):  
Pregnancy Outcomes ◽  
Reproductive Tract ◽  
Case Control Study ◽  
Case Control ◽  
Clinical Pregnancy ◽  
Α Diversity ◽  
Significant Difference ◽  
Control Study ◽  
Ivf Et

The microorganisms of the reproductive tract have been implicated to affect in vitro fertilization (IVF) outcomes. However, studies on the reproductive tract microbiota of infertile women are limited and the correlation between cervical microbiota and IVF outcome remains elusive. This study aimed to characterize the cervical microbiota of IVF patients undergoing embryo transfer (ET) and assess associations between the cervical microbiota and pregnancy outcomes while exploring the underlying contributing factors. We launched a nested case-control study of 100 patients with two fresh or frozen-thawed cleavage embryos transferred per IVF cycle. Cervical swabs were collected on the day of ET and divided into four groups according to clinical pregnancy outcomes. Variable regions 3 and 4 (V3-V4) of the 16S rRNA gene were amplified and sequenced on the Illumina MiSeq platform. In fresh IVF-ET cycles, the clinical pregnancy group (FP, n = 25) demonstrated higher α diversity (P = 0.0078) than the non-pregnancy group (FN, n = 26). Analysis of similarity (ANOSIM) revealed a significant difference in β diversity between the two groups (R = 0.242, P = 0.001). In frozen-thawed ET cycles, though not significant, similar higher α diversity was found in the clinical pregnancy group (TP, n = 27) compared to the non-pregnancy group (TN, n = 22) and ANOSIM analysis showed a significant difference between the two groups (R = 0.062, P = 0.045). For patients in fresh IVF-ET groups, Lactobacillus, Akkermansia, Desulfovibrio, Atopobium, and Gardnerella showed differentially abundance between pregnant and non-pregnant women and they accounted for the largest share of all taxa investigated. Among them, Lactobacillus was negatively correlated with the other genera and positively correlated with serum estradiol levels. Logistic regression analysis suggested that the composition of the cervical microbiota on the day of ET was associated with the clinical pregnancy in fresh IVF-ET cycles (P = 0.030). Our results indicate that cervical microbiota composition has an impact on the outcome of assisted reproductive therapy.

scholarly journals Frozen Embryo Transfer in Mildly Stimulated Cycle With Letrozole Compared to Natural Cycle in Ovulatory Women: A Large Retrospective Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Danjun Li ◽  
Shuzin Khor ◽  
Jialyu Huang ◽  
Qiuju Chen ◽  
Qifeng Lyu ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Pregnancy Outcomes ◽  
Endometrial Thickness ◽  
Clinical Pregnancy ◽  
Frozen Embryo Transfer ◽  
Clinical Pregnancy Rate ◽  
Natural Cycle ◽  
Mild Stimulation ◽  
Early Miscarriage ◽  
Hcg Test

ObjectiveTo evaluate the clinical effect of mild stimulation with letrozole on pregnancy outcomes in ovulatory women undergoing frozen embryo transfer (FET) compared to natural cycle.DesignRetrospective observational study.SettingTertiary care academic medical center.PopulationA total of 6,874 infertile women with regular menstrual cycles (21-35 days) met the criteria for this study in the period from 2013 to 2020.MethodsAll patients who were prepared for and underwent FET were divided into two groups: a modified natural cycle (NC) group (n=3,958) and a letrozole cycle group (n=2,916).Main Outcome MeasuresThe primary outcome of the study was clinical pregnancy rate. Secondary outcome measures were endometrial thickness, rates of implantation, positive HCG test, live birth, early miscarriage and ectopic pregnancy.ResultsThe clinical pregnancy rate was not statistically different between the modified NC-FET group and the letrozole-FFT group before (crude OR 0.99, 95% CI 0.90-1.09, P=0.902&gt;0.05) and after propensity score matching (PSM) (crude OR 1.01, 95% CI 0.91-1.12, P=0.870&gt;0.05). After multivariable logistic regression analysis, the clinical pregnancy rate remained insignificant before (adjusted OR 1.00, 95% CI 0.91-1.10, P=0.979&gt;0.05) and after matching (adjusted OR 1.00, 95% CI 0.89-1.11, P=0.936&gt;0.05), respectively. Similarly, in the crude and adjusted analysis, the positive HCG test, implantation, live birth and early miscarriage rates were also comparable in the letrozole-FFT group and modified NC-FET group before and after matching. Furthermore, the endometrial thickness of letrozole-FFT group was similar to that of modified NC-FET group with adjusted analysis.ConclusionOur observation suggests that mild stimulation with letrozole could produce similar pregnancy outcomes in ovulatory patients who undergo FET when compared with a natural cycle.

Sign in / Sign up

Export Citation Format

Share Document