Early clinical pregnancy loss rate in poor responder patients does not change compared to age-matched normoresponders

Background The influence of anti-nuclear antibody (ANA) on induced ovulation was controversial, and the effect of prednisone plus hydroxychloroquine (HCQ) treatment on frozen embryo transfer outcomes of in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) for ANA-positive women was unclear. Methods Fifty ANA-positive women and one-hundred ANA-negative women matched for age and anti-Mullerian hormone (AMH) were included from a Reproductive Medical Central of a University Hospital. Sixty-one oocytes pick-up (OPU) cycles in ANA+ group and one-hundred OPU cycles in ANA− group were compared; 30 frozen embryo transfer cycles without treatment and 66 with prednisone plus HCQ treatment among ANA-positive women were compared. Results There was no statistical difference in number of retrieved oocytes (13.66 ± 7.71 vs 13.72 ± 7.23, p = .445), available embryos (5.23 ± 3.37 vs 5.47 ± 3.26, p = .347), high-quality embryos (3.64 ± 3.25 vs 3.70 ± 3.52, p = .832), and proportion of high-quality embryos (26.5% vs. 26.7%, p = .940). Biochemical pregnancy rate (33.3% vs. 68.2%, p < .05), clinical pregnancy rate (20.0% vs. 50.1%, p < .05), and implantation rate (5.6% vs. 31.8%, p < .05) were lower, and pregnancy loss rate (83.3% vs. 23.1%, p < .05) was higher in patients with treatment than no treatment. Conclusion The influence of ANA on number of retrieved oocytes, available embryos, high-quality embryos, and proration of high-quality embryos was not found. The treatment of prednisone plus HCQ may improve implantation rate, biochemical pregnancy rate, and clinical pregnancy rate, and reduce pregnancy loss rate in frozen embryo transfer outcomes for ANA-positive women.

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The Prediction of Sperm Chromatin Structure Assay (SCSA) Parameters for Outcomes of Intrauterine Insemination

10.21203/rs.3.rs-127024/v1 ◽

2020 ◽

Author(s):

Jiangman Gao ◽

Liying Yan ◽

Ying Huang ◽

Hui Jiang ◽

Yuanyuan Wang ◽

...

Keyword(s):

Dna Fragmentation ◽

Pregnancy Loss ◽

Loss Rate ◽

Intrauterine Insemination ◽

Sperm Concentration ◽

Clinical Pregnancy ◽

Sperm Chromatin ◽

Sperm Dna Fragmentation ◽

Female Age ◽

Sperm Dna

Abstract Background: Many studies have assessed the association between sperm DNA fragmentation and outcomes of ART. But the published papers have not offered enough evidence about whether sperm DNA fragmentation tests could make suggestions to predict intrauterine insemination (IUI) outcomes. The aim of this study was to assess whether the sperm chromatin structure assay (SCSA) parameters, sperm DNA fragmentation index (DFI) and high DNA stainability (HDS), could be used as predictors for treatment outcomes in IUI program.Methods: A retrospective cohort study was conducted at a large reproductive medicine center. 1139 IUI cycles from 1139 couples were studied. The association of SCSA parameters with the clinical pregnancy and early pregnancy loss after IUI were analyzed. Results: Clinical pregnancy rate per cycle in DFI<15%, 15%≤DFI<30%, and DFI≥30% groups were 11.1%, 7.3%, and 8.9%, respectively, with no statistical differences between the groups (P=0.127). Pregnancy loss rate were 24.3%, 27.6%, and 14.3%, respectively, with no statistical differences (P=0.762). Clinical pregnancy rate per cycle in HDS≤15% and HDS>15% groups were 9.8% and 7.5%, respectively, with no significant difference (P=0.468), and the pregnancy loss rate were 26.2% and 0, respectively, and also no statistical difference (P=0.191). Multivariate logistic regression analysis showed a higher rate of clinical pregnancy in couples with a younger female (OR=0.90, 95% CI: 0.83-0.97, P=0.007), and in couples with a male who had higher sperm concentration after washing (OR=1.02, 95% CI: 1.00-1.04, P=0.035). A higher risk of pregnancy loss was observed with increased female age (OR= 1.43, 95% CI:1.09-1.89, P=0.010) and lower sperm concentration after washing (OR= 0.92, 95% CI: 0.84-0.99, P= 0.029). Conclusions: Sperm DFI and HDS were not significantly correlated with clinical pregnancy and pregnancy loss in cycles of IUI. Female age and motile sperm concentration had statistically significant effects on both clinical pregnancy and pregnancy loss after IUI treatment.

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Comparison of Serum Progesterone Levels of the Day of Frozen Embryo Transfers According to Type of Endometrial Preparation: A Monocentric, Retrospective Study

10.21203/rs.3.rs-97769/v1 ◽

2020 ◽

Author(s):

Olivier Pouget ◽

Irma Zuna ◽

Marine Bonneau ◽

Marie Laure Tailland ◽

Sylvie Neveu-Ripart ◽

...

Keyword(s):

Embryo Transfer ◽

Pregnancy Loss ◽

Loss Rate ◽

Preparation Method ◽

Endometrial Thickness ◽

Clinical Pregnancy ◽

Progesterone Level ◽

Serum Progesterone ◽

Endometrial Preparation ◽

Artificial Cycle

Abstract Background: Live birth rate following embryo transfer is comparable between natural cycle and hormonal therapy. However, pregnancy loss rate appears elevated with hormonal therapy, possibly due to luteal insufficiency, characterised by a low level of serum progesterone in the luteal phase. The primary objective of this study, was to determine whether serum progesterone level on transfer day differed according to endometrial preparation method in patients undergoing frozen embryo transfer (FET). Secondary objectives were to compare the clinical pregnancy with foetal heartbeat rate and pregnancy loss rate according to endometrial preparation method and to compare the level of serum progesterone on the transfer day between pregnancy loss and pregnancy with foetal heartbeat.Methods: Forty-seven natural/stimulated cycles and 68 artificial cycle FET were retrospectively studied from May to December 2019 from a single French hospital. The primary endpoint was the level of serum progesterone on the day of FET. The type of infertility, aetiology, serum basal FSH, LH, oestradiol and AMH dosage, endometrial thickness, clinical pregnancy rate, pregnancy loss rate, and maternal and embryo characteristics were compared between natural/stimulated cycle (OS group) and artificial cycle (AC group). Results: Mean serum progesterone level on embryo transfer day was 25.47 ng/mL in the OS group versus 14.32 ng/mL AC group (p <0.0001). There was no significant difference in demographic and hormone characteristics (age, type of embryo, type of infertility, basal FSH, LH, oestradiol and AMH levels), endometrial thickness, number and type of embryos transferred, duration of infertility, pregnancy rate and pregnancy loss rate. Body mass index was lower in the OS group than AC group (22.9 kg/m2 vs 24.8 kg/m2, p=0.03). No difference was found in serum progesterone level between clinical pregnancy with foetal heartbeat and pregnancy loss (respectively 17.48 ng/mL vs 20.82 ng/mL, p=0.7 and 22 ongoing pregnancies and 12 pregnancy loss).Conclusions: Serum progesterone level on FET day is lower with endometrial preparation with artificial cycle than with a natural/stimulated cycle. Further research is necessary to determine if this difference has any relation with higher pregnancy loss rate with artificial cycle.

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A Comparison of Pattern of Pregnancy Loss in Women with Infertility Undergoing IVF and Women with Unexplained Recurrent Miscarriages Who Conceive Spontaneously

Obstetrics and Gynecology International ◽

10.1155/2015/989454 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Vidya A. Tamhankar ◽

Beiyu Liu ◽

Junhao Yan ◽

Tin-Chiu Li

Keyword(s):

Pregnancy Loss ◽

Loss Rate ◽

Unexplained Infertility ◽

Clinical Pregnancy ◽

Male Factor ◽

Recurrent Miscarriages ◽

Group I ◽

Tubal Factor ◽

Group Ii ◽

Male Factors

Objective. Women with infertility and recurrent miscarriages may have an overlapping etiology. The aim of this study was to compare the pregnancy loss in pregnancies after IVF treatment with spontaneous pregnancies in women with recurrent miscarriages and to assess differences related to cause of infertility.Methods. The outcome from 1220 IVF pregnancies (Group I) was compared with 611 spontaneous pregnancies (Group II) in women with recurrent miscarriages. Subgroup analysis was performed in Group I based on cause of infertility: tubal factor (392 pregnancies); male factor (610 pregnancies); and unexplained infertility (218 pregnancies).Results. The clinical pregnancy loss rate in Group I (14.3%) was significantly lower than that of Group II (25.8%,p<0.001) and this was independent of the cause of infertility. However the timing of pregnancy loss was similar between Groups I and II. The clinical pregnancy loss rate in Group I was similar in different causes of infertility.Conclusions. The clinical pregnancy loss rate following IVF treatment is lower than that of women with unexplained recurrent miscarriages who conceived spontaneously. This difference persists whether the infertility is secondary to tubal factors, male factors, or unexplained cause.

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Comparative effectiveness of recombinant human follicle-stimulating hormone alfa (r-hFSH-alfa) versus highly purified urinary human menopausal gonadotropin (hMG HP) in assisted reproductive technology (ART) treatments: a non-interventional study in Germany

Reproductive Biology and Endocrinology ◽

10.1186/s12958-021-00768-3 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Klaus F. Bühler ◽

Robert Fischer ◽

Patrice Verpillat ◽

Arthur Allignol ◽

Sandra Guedes ◽

...

Keyword(s):

Assisted Reproductive Technology ◽

Live Birth ◽

Pregnancy Loss ◽

Follicle Stimulating Hormone ◽

Reproductive Technology ◽

Clinical Pregnancy ◽

Human Menopausal Gonadotropin ◽

Ongoing Pregnancy ◽

Complete Cycle ◽

Significant Difference

Abstract Background This study compared the effectiveness of recombinant human follicle-stimulating hormone alfa (r-hFSH-alfa; GONAL-f®) with urinary highly purified human menopausal gonadotropin (hMG HP; Menogon HP®), during assisted reproductive technology (ART) treatments in Germany. Methods Data were collected from 71 German fertility centres between 01 January 2007 and 31 December 2012, for women undergoing a first stimulation cycle of ART treatment with r-hFSH-alfa or hMG HP. Primary outcomes were live birth, ongoing pregnancy and clinical pregnancy, based on cumulative data (fresh and frozen-thawed embryo transfers), analysed per patient (pP), per complete cycle (pCC) and per first complete cycle (pFC). Secondary outcomes were pregnancy loss (analysed per clinical pregnancy), cancelled cycles (analysed pCC), total drug usage per oocyte retrieved and time-to-live birth (TTLB; per calendar week and per cycle). Results Twenty-eight thousand six hundred forty-one women initiated a first treatment cycle (r-hFSH-alfa: 17,725 [61.9%]; hMG HP: 10,916 [38.1%]). After adjustment for confounding variables, treatment with r-hFSH-alfa versus hMG HP was associated with a significantly higher probability of live birth (hazard ratio [HR]-pP [95% confidence interval (CI)]: 1.10 [1.04, 1.16]; HR-pCC [95% CI]: 1.13 [1.08, 1.19]; relative risk [RR]-pFC [95% CI]: 1.09 [1.05, 1.15], ongoing pregnancy (HR-pP [95% CI]: 1.10 [1.04, 1.16]; HR-pCC [95% CI]: 1.13 [1.08, 1.19]; RR-pFC [95% CI]: 1.10 [1.05, 1.15]) and clinical pregnancy (HR-pP [95% CI]: 1.10 [1.05, 1.14]; HR-pCC [95% CI]: 1.14 [1.10, 1.19]; RR-pFC [95% CI]: 1.10 [1.06, 1.14]). Women treated with r-hFSH-alfa versus hMG HP had no statistically significant difference in pregnancy loss (HR [95% CI]: 1.07 [0.98, 1.17], were less likely to have a cycle cancellation (HR [95% CI]: 0.91 [0.84, 0.99]) and had no statistically significant difference in TTLB when measured in weeks (HR [95% CI]: 1.02 [0.97, 1.07]; p = 0.548); however, r-hFSH-alfa was associated with a significantly shorter TTLB when measured in cycles versus hMG HP (HR [95% CI]: 1.07 [1.02, 1.13]; p = 0.003). There was an average of 47% less drug used per oocyte retrieved with r-hFSH-alfa versus hMG HP. Conclusions This large (> 28,000 women), real-world study demonstrated significantly higher rates of cumulative live birth, cumulative ongoing pregnancy and cumulative clinical pregnancy with r-hFSH-alfa versus hMG HP.

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Cordocentesis: Overall Pregnancy Loss Rate as Important as Procedure Loss Rate

Fetal Diagnosis and Therapy ◽

10.1159/000263922 ◽

1994 ◽

Vol 9 (3) ◽

pp. 142-148 ◽

Cited By ~ 23

Author(s):

Douglas Wilson ◽

D.F. Farquharson ◽

B.K. Wittmann ◽

D. Shaw

Keyword(s):

Pregnancy Loss ◽

Loss Rate

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The Natural History of Trisomy 21: Outcome Data from a Large Tertiary Referral Centre

Fetal Diagnosis and Therapy ◽

10.1159/000517729 ◽

2021 ◽

pp. 1-7

Author(s):

Clare O’Connor ◽

Rebecca Moore ◽

Peter McParland ◽

Heather Hughes ◽

Barbara Cathcart ◽

...

Keyword(s):

Trisomy 21 ◽

Pregnancy Loss ◽

Loss Rate ◽

Outcome Data ◽

Second Trimester ◽

Referral Centre ◽

Tertiary Referral ◽

Tertiary Referral Centre ◽

History Of ◽

Baseline Demographic

Objective: The aim of the study was to prospectively gather data on pregnancy outcomes of prenatally diagnosed trisomy 21 (T21) in a large tertiary referral centre. Methods: Data were gathered prospectively in a large tertiary referral centre over 5 years from 2013 to 2017 inclusively. Baseline demographic and pregnancy outcome data were recorded on an anonymized computerized database. Results: There were 1,836 congenital anomalies diagnosed in the study period including 8.9% (n = 165) cases of T21. 79% (n = 131) were age 35 or older at diagnosis. 79/113 (69.9%) women chose a termination of pregnancy (TOP) following a diagnosis of T21. Amongst pregnancies that continued, there were 4 second-trimester miscarriages (4/34, 11.7%), 9 stillbirths (9/34, 26.4%), and 1 neonatal death, giving an overall pregnancy and neonatal loss rate of 14/34 (41.1%). Conclusion: The risk of foetal loss in prenatally diagnosed T21 is high at 38% with an overall pregnancy loss rate of 41.1%. This information may be of benefit when counselling couples who are faced with a diagnosis of T21 particularly in the context of limited access to TOP.

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Live Birth Rate of Fresh Embryo Transfer with GnRH Agonist Long Protocol is Higher Than Frozen Embryo Transfer

10.21203/rs.3.rs-70853/v1 ◽

2020 ◽

Author(s):

Xiaoyan Ding ◽

Jingwei Yang ◽

Lan Li ◽

Na Yang ◽

Ling Lan ◽

...

Keyword(s):

Pregnancy Rate ◽

Embryo Transfer ◽

Live Birth ◽

Pregnancy Loss ◽

Birth Rate ◽

Implantation Rate ◽

Live Birth Rate ◽

Clinical Pregnancy ◽

Fresh Embryo Transfer ◽

Long Protocol

Abstract Background: Along with progress in embryo cryopreservation, especially in vitrification has made freeze all strategy more acceptable. Some studies found comparable or higher live birth rate with frozen embryo transfer (FET) than with fresh embryo transfer（ET）in gonadotropin releasing hormone antagonist (GnRH-ant) protocol. But there were no reports about live birth rate differences between fresh ET and FET with gonadotropin releasing hormone agonist (GnRH-a) long protocol. The aim of this study is to analyze whether patients benefit from freeze all strategy in GnRH-a protocol from real-world data.Methods: This is a retrospective cohort study, in which women undergoing fresh ET or FET with GnRH-a long protocol at Chongqing Reproductive and Genetics Institute from January 2016 to December 2018 were evaluated. The primary outcome was live birth rate. The secondary outcomes were implantation rate, clinical pregnancy rate, pregnancy loss and ectopic pregnancy rate.Results: A total of 7,814 patients met inclusion criteria, implementing 5,216 fresh ET cycles and 2,598 FET cycles, respectively. The demographic characteristics of the patients were significantly different between two groups, except BMI. After controlling for a broad range of potential confounders (including age, infertility duration, BMI, AMH, no. of oocytes retrieved and no. of available embryos), multivariate logistic regression analysis demonstrated that there was no significant difference in terms of clinical pregnancy rate, ectopic pregnancy rate and pregnancy loss rate between two groups (all P>0.05). However, the implantation rate and live birth rate of fresh ET group were significantly higher than FET group (P<0.001 and P=0.012, respectively).Conclusion: Compared to FET, fresh ET following GnRH-a long protocol could lead to higher implantation rate and live birth rate in infertile patients underwent in vitro fertilization (IVF). The freeze all strategy should be individualized and made with caution especially with GnRH-a long protocol.

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