scholarly journals Endometrial thickness on the day of the LH surge: an effective predictor of pregnancy outcomes after modified natural cycle-frozen blastocyst transfer

2020 ◽  
Vol 2020 (4) ◽  
Author(s):  
Sachie Onogi ◽  
Kenji Ezoe ◽  
Seiko Nishihara ◽  
Junichiro Fukuda ◽  
Tamotsu Kobayashi ◽  
...  
Keyword(s):  
Live Birth ◽  
Pregnancy Outcomes ◽  
Birth Rate ◽  
Endometrial Thickness ◽  
Live Birth Rate ◽  
Pregnancy Rates ◽  
Ongoing Pregnancy ◽  
Female Age ◽  
Lh Surge ◽  
Natural Cycles

Abstract STUDY QUESTION Can the endometrial thickness (EMT) on the day of the LH surge predict pregnancy outcomes after single vitrified-warmed blastocyst transfers (SVBTs) in modified natural cycles? SUMMARY ANSWER Decreased EMT on the day of the LH surge is associated with older female age and a shortened proliferation phase and may be associated with low live birth and high chemical pregnancy rates. WHAT IS KNOWN ALREADY The relation between EMT on the day of embryo transfer (ET) and pregnancy outcomes remains controversial; although numerous studies reported an association between decreased EMT on the day of ET and a reduced likelihood of pregnancy, recent studies demonstrated that the EMT on the day of ET had limited independent prognostic value for pregnancy outcomes after IVF. The relation between EMT on the day of the LH surge and pregnancy outcomes after SVBT in modified natural cycles is currently unknown. STUDY DESIGN, SIZE, DURATION In total, 808 SVBTs in modified natural cycles, performed from November 2018 to October 2019, were analysed in this retrospective cohort study. Associations of EMT on the days of the LH surge with SVBT and clinical and ongoing pregnancy rates were statistically evaluated. Clinical and ongoing pregnancy rates were defined as the ultrasonographic observation of a gestational sac 3 weeks after SVBTs and the observation of a foetal heartbeat 5 weeks after SVBTs, respectively. Similarly, factors potentially associated with the EMT on day of the LH surge, such as patient and cycle characteristics, were investigated. PARTICIPANTS/MATERIALS, SETTING, METHODS The study includes IVF/ICSI patients aged 24–47 years, who underwent their first SVBT in the study period. After monitoring follicular development and serum hormone levels, ovulation was triggered via a nasal spray containing a GnRH agonist. After ovulation was confirmed, SVBTs were performed on Day 5. The EMT was evaluated by transvaginal ultrasonography on the day of the LH surge and immediately before the SVBT procedure. MAIN RESULTS AND THE ROLE OF CHANCE Of the original 901 patients, 93 who were outliers for FSH or proliferative phase duration data were excluded from the analysis. Patients were classified according to quartiles of EMT on day of the LH surge, as follows: EMT < 8.1 mm, 8.1 mm ≤ EMT < 9.1 mm, 9.1 mm ≤ EMT < 10.6 mm and EMT ≥ 10.6 mm. Decreased EMT on day of the LH surge was associated with lower live birth (P = 0.0016) and higher chemical pregnancy (P = 0.0011) rates. Similarly, patients were classified according to quartiles of EMT on day of the SVBT, as follows: EMT < 9.1 mm, 9.1 mm ≤ EMT < 10.1 mm, 10.1 mm ≤ EMT < 12.1 mm and EMT ≥ 12.1 mm. A decreased EMT on the day of SVBT was associated with a lower live birth rate (P = 0.0095) but not chemical pregnancy rate (P = 0.1640). Additionally, multivariate logistic regression analysis revealed a significant correlation between EMT on day of the LH surge and ongoing pregnancy; however, no correlation was observed between EMT on the day of SVBT and ongoing pregnancy (adjusted odds ratio 0.952; 95% CI, 0.850–1.066; P = 0.3981). A decreased EMT on day of the LH surge was significantly associated with greater female age (P = 0.0003) and a shortened follicular/proliferation phase (P < 0.0001). LIMITATIONS, REASONS FOR CAUTION The data used in this study were obtained from a single-centre cohort; therefore, multi-centre studies are required to ascertain the generalisability of these findings to other clinics with different protocols and/or patient demographics. WIDER IMPLICATIONS OF THE FINDINGS This is the first report demonstrating a significant correlation between EMT on day of the LH surge and pregnancy outcomes after frozen blastocyst transfer in modified natural cycles. Our results suggest that EMT on day of the LH surge may be an effective predictor of the live birth rate. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by resources from the Kato Ladies Clinic. The authors have no conflicts of interest to declare.

P–610 Optimal timing of ovulation triggering to achieve highest success rates in natural cycles – an analysis based on follicle size and estradiol concentration in NC-IVF

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
M Vo. Wolff ◽  
I Magaton ◽  
O Stalder ◽  
D Surbek ◽  
P Stute ◽  
...  
Keyword(s):  
Live Birth ◽  
Birth Rate ◽  
Endometrial Thickness ◽  
Live Birth Rate ◽  
Cross Sectional ◽  
Lh Surge ◽  
Infertility Treatments ◽  
Follicle Size ◽  
Estrogen Concentration ◽  
Natural Cycles

Abstract Study question What is the best follicle size, estradiol (E2) serum concentration and endometrial thickness to trigger ovulation in natural cycles? Summary answer Optimal follicles size is 18–22mm but estrogen concentration also need to be considered to maximize oocyte maturity and to minimize premature LH surge. What is known already Timing of the ovulation triggering is essential in infertility treatments based on natural menstrual cycles such as optimized vaginal intercourse, intrauterine inseminations and thawing cycles without hormone replacement therapy. Common parameters to define the day of ovulation triggering are the follicle size and the estrogen concentration. However, data on follicle size and estrogen concentration are either derived from longitudinal evaluations of few ideal participants, are not very detailed or were studied in stimulated cycles. The model of Natural Cycle IVF (NC-IVF) which provides more detailed information has never been used to study this issue. Study design, size, duration Retrospective cross sectional analysis of monofollicular NC-IVF cycles. Follicle size, E2 and LH serum concentrations and endometrial thickness were evaluated on day –5 to 0 (day 0 = day of aspiration). Ovulation was triggered with 5.000IE HCG 36h before aspiration if follicle size was 14–22mm. Patients with irregular cycles, endometriosis >II°, cycles with azoospermia or cryptozoospermia and with inconsistent data were excluded. 606 cycles from 290 women were analysed from 2016 to 2019. Participants/materials, setting, methods Mean age of women undergoing NC-IVF was 35.8±4.0y, median 36y [IQ-range: 34;39]. Each woman performed mean 2.1±1.4, median: 2 [IQ-range: 1–3] NC-IVF cycles at an university based IVF center. All parameters were analysed inter and intraindividually and associations were adjusted for maturity of oocyte, zygote development rate, embryo score, implantation rate and live birth rate. Associations were adjusted for age, cause of infertility and number of previous transfers. Main results and the role of chance Follicle size, E2 concentration and endometrial thickness increased constantly over time. The increase was computed for each cycle without considering any correlation intra patient, revealing an increase of follicle size by 1.04±0.64mm, an increase of E2 concentration by 167.3±76.8pmol/L and endometrial thickness by 0.69±0.59mm per day. Based on a multivariate adjusted model with follicle size, E2 and their interaction, number of retrieved oocytes was associated with E2 concentration (aOR 1.80, 95% CI 1.05–3.11; p = 0.034). Maturity of oocytes was associated not only with E2 concentration (aOR 1.84, 95% CI 1.15–2.94; p = 0.010) but also with follicle size (aOR 1.24, 95% CI 1.01–1.53; p = 0.037) and so was also the interaction of both parameters (aOR 0.96, 95% CI 0.94–0.99; p = 0.017). LH surge was calculated to start in 25% of cases at an E2 level of 545 pmol/l, in 50% of cases at 907pmol/l and in 75% of cases at an E2 level of 1531pmol/l. Live birth rate in cycles with follicles size 14–17 mm was 2.2–3.5% per initiated cycle and in cycles with follicle size 18–22mm 8.5–12.5%. Limitations, reasons for caution Cross sectional studies provides less precise information than longitudinal studies. Follicle size and endometrial thickness were evaluated by several physicians possibly causing some imprecision. Wider implications of the findings: There is a trend towards natural treatment cycles. The study contribute to an optimisation of infertility treatments involving natural cycles. The study gives guidance about the number of days required after a follicle monitoring to reach the optimal time for triggering ovulation. Trial registration number Not applicable

scholarly journals Influence of surgical evacuation on pregnancy outcomes of subsequent embryo transfer cycle following miscarriage in an initial IVF cycle: a retrospective cohort study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Junan Meng ◽  
Mengchen Zhu ◽  
Wenjuan Shen ◽  
Xiaomin Huang ◽  
Haixiang Sun ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Pregnancy Outcomes ◽  
Birth Rate ◽  
Endometrial Thickness ◽  
Live Birth Rate ◽  
First Trimester ◽  
Miscarriage Rate ◽  
Significant Difference ◽  
Surgical Evacuation

Abstract Background It is still uncertain whether surgical evacuation adversely affects subsequent embryo transfer. The present study aims to assess the influence of surgical evacuation on the pregnancy outcomes of subsequent embryo transfer cycle following first trimester miscarriage in an initial in vitro fertilization and embryo transfer (IVF-ET) cycle. Methods A total of 645 patients who underwent their first trimester miscarriage in an initial IVF cycle between January 2013 and May 2016 in Nanjing Drum Tower Hospital were enrolled. Surgical evacuation was performed when the products of conception were retained more than 8 h after medical evacuation. Characteristics and pregnancy outcomes were compared between surgical evacuation patients and no surgical evacuation patients. The pregnancy outcomes following surgical evacuation were further compared between patients with ≥ 8 mm or < 8 mm endometrial thickness (EMT), and with the different EMT changes. Results The EMT in the subsequent embryo transfer cycle of surgical evacuation group was much thinner when compared with that in the no surgical evacuation group (9.0 ± 1.6 mm vs. 9.4 ± 1.9 mm, P = 0.01). There was no significant difference in implantation rate, clinical pregnancy rate, live birth rate or miscarriage rate between surgical evacuation group and no surgical evacuation group (P > 0.05). The live birth rate was higher in EMT ≥ 8 mm group when compared to < 8 mm group in surgical evacuation patients (43.0% vs. 17.4%, P < 0.05). Conclusions There was no significant difference in the pregnancy outcomes of subsequent embryo transfer cycle between surgical evacuation patients and no surgical evacuation patients. Surgical evacuation led to the decrease of EMT, especially when the EMT < 8 mm was association with a lower live birth rate.

P–332 Endometrium thickness is increased in gonadotropin stimulated IVF compared to unstimulated cycles, but this increase does not have a positive effect on pregnancy rate

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
I M Magaton ◽  
A Helmer ◽  
M Vo. Wolff ◽  
P Stute ◽  
M C Roumet
Keyword(s):  
Pregnancy Rate ◽  
Live Birth ◽  
Birth Rate ◽  
Endometrial Thickness ◽  
Live Birth Rate ◽  
Pregnancy Rates ◽  
Embryo Selection ◽  
Growth Dynamic ◽  
Live Birth Rates ◽  
Positive Effect

Abstract Study question Is endometrial growth and endometrial thickness different in controlled ovarian stimulation (COS)-IVF compared to unstimulated cycles and does this have an effect on pregnancy rates? Summary answer Endometrial growth dynamic is different and endometrium is thicker in COS-IVF but this does not have a positive effect on pregnancy and live birth rates. What is known already Endometrial growth and endometrial thickness are a function of duration and concentration of estradiol (E2) stimulation. Endometrial thickness &lt;8mm is related with lower pregnancy rates in IVF treatments. It is commonly assumed that an increase of endometrial thickness by increasing estrogen stimulation could have a positive effect on pregnancy rate. However, such a relationship has never been systematically analysed. Natural Cycle IVF (NC-IVF) is an ideal model to analyse the effect of high dose gonadotropin stimulation on several parameters such as thickness of endometrium and pregnancy rate. Study design, size, duration Retrospective single center, University based study including 235 COS-IVF and 616 NC-IVF cycles from 2015 to 2019. Polyfollicular COS-IVF cycles were only analysed until 09 2017 as embryo selection was introduced in Switzerland afterwards. Limiting the analysis to cycles without embryo selection enabled us to compare embryos derived from cIVF and NC-IVF. 1550 endometrial and 1068 E2 measurements were included in the analysis. Participants/materials, setting, methods Mean female age at the time when the cycles were performed was in NC-IVF 35.8±3.9y and in COS-IVF 34.9±4.2y (maximum 42y). Each woman performed on average 1.96±1.45 IVF cycles. Endometrial thickness and E2 serum concentrations were evaluated daily between day –4 and –2 (0=day of aspiration). Pregnancy and live birth rate were evaluated per transferred embryo. Statistically, student test and a repeated measure model and a logistic regression model both adjusted for age were used. Main results and the role of chance Endometrial thickness was different in COS-IVF and NC-IVF. At each time point endometrial thickness was found to be higher in COS-IVF compared to NC-IVF (p &lt; 0.001 on days –4,–3, and –2). On day –2, the day when ovulation was triggered, mean endometrial thickness was 9.75 ±2.05mm in COS-IVF and 8.12 ±1.66mm in NC-IVF. Endometrial growth dynamic was also different in COS-IVF and NC-IVF. Endometrial thickness increased significantly faster in NC-IVF cycles (0.58mm/day [0.43,0.73]) than in cIVF cycles (0.22mm/day [–0.12, 0.55], Pval= 0.034). The increase of endometrial thickness per day was less pronounced if E2 concentrations were high (–0.19 [–0.34, 0.05]). Therefore it can be assumed that the observed differences in growth dynamics in both treatments are caused by differences in E2. Increased endometrial thickness in COS-IVF was not associated with higher success rate. There was no significant effect of endometrium thickness on pregnancy (Pval=0.318) and Live birth rate (Pval=0.461). Limitations, reasons for caution Pregnancy and live birth rates might be affected by more than just endometrial thickness. The study was only based on the thickness of the endometrium but not on its ultrasound pattern. Wider implications of the findings: Postponing the aspiration to allow endometrium to further proliferate has only a limited effect in COS-IVF. Increasing gonadotropin stimulation dosage just to increase endometrial thickness is not a feasible strategy to improve pregnancy rate. The need to apply high dosages of estrogen supplementation in thawing cycles need to be questioned. Trial registration number “not applicable”

P–159 Slow-growing embryos should be frozen on day 5

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
M J Zamora ◽  
I Katsouni ◽  
D Garcia ◽  
R Vassena ◽  
A Rodríguez
Keyword(s):  
Pregnancy Rate ◽  
Embryo Transfer ◽  
Live Birth ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Study Groups ◽  
Pregnancy Rates ◽  
Clinical Pregnancy ◽  
Patient Counselling ◽  
Slow Growing

Abstract Study question What is the live birth rate after frozen embryo transfer (FET) of slow-growing embryos frozen on day 5 (D5) or on day 6 (D6)? Summary answer The live birth rate after single FET is significantly higher for slow-growing embryos frozen on D5 compared to those frozen on D6. What is known already Most data on the outcomes of blastocyst transfer stem from studies that evaluate fresh transfer from normal growing D5 blastocyst ET. However not all embryos will begin blastulation nor reach the fully expanded stage by D5; those are the slow-growing embryos. Studies that compare D5 to D6 embryos in FET cycles show contradictory results. Some have reported higher clinical pregnancy rates after D5 FET, while others have reported similar outcomes for D5 and D6 cryopreserved blastocyst transfers. There is a lack of evidence regarding the best approach for vitrifying embryos that exhibit a slow developmental kinetic. Study design, size, duration This retrospective cohort study included 821 single FET of slow-growing embryos frozen on D5 or D6, belonging to patients undergoing in vitro fertilization with donor oocytes between January 2011 and October 2019, in a single fertility center. The origin of blastocysts was either supernumerary embryos after fresh embryo transfer or blastocysts from freeze-all cycles. All embryos were transferred 2- 4h after thawing. Participants/materials, setting, methods We compared reproductive outcomes of slow-growing embryos frozen on D5 versus (n = 442) slow-growing embryos frozen on D6 (n = 379). D5 group consisted in embryos graded 0, 1, 2 of Gardner scale and frozen on D5. Similarly, D6 group consisted in embryos graded 3, 4, 5 of Gardner scale (blastocyst stage) and frozen on D6. Differences in pregnancy rates between study groups were compared using a Chi2 test. A p-value &lt;0.05 was considered statistically significant. Main results and the role of chance Baseline characteristics were comparable between study groups. Overall, mean age of the woman was 42.3±5.4 years old; donor sperm was used in 25% of cycles, and it was frozen in 73.2% of cycles. Pregnancy rates were significantly higher when transferring slow D5 embryos compared to D6 for all the pregnancy outcomes analyzed: biochemical pregnancy rate was 27.7% vs 20.2%, p &lt; 0.016; clinical pregnancy rate was 17.5% vs 10.2%, p &lt; 0.004); ongoing pregnancy rate was: 15.7% vs 7.8% (p &lt; 0.001); live birth rate was: 15.4% vs 7.5%, (p &lt; 0.001). These results suggest that when embryos exhibit a slow development behavior (not reaching full blastocysts at D5), waiting until D6 for blastulation and expansion does not improve clinical outcomes. Vitrification at D5 will should the preferred option in cases where the oocyte is assumed of high quality Limitations, reasons for caution The retrospective design of the study is its main limitation. Also, morphology as sole selection criterion for transfer. However, blastocyst morphology is a very good predictor of implantation and pregnancy, and a good indicator of the embryo’s chromosomal status (higher euploidy rate in higher morphological quality blastocysts). Wider implications of the findings: These results can help to the standardization of laboratory protocols. As the decision of vitrifying slow developing embryos on D5 or D6 is made by the laboratory team or by the gynaecologist in agreement with the patient, having an evidence based strategy simplifies patient counselling and decision making. Trial registration number Not applicable

P–411 Does subcutaneous progesterone (SC-P) administration eliminate the necessity of serum progesterone level monitoring in frozen embryo transfer (FET) cycles?

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
F K Boynukalin ◽  
R Abalı ◽  
M Gultomruk ◽  
B Demir ◽  
Z Yarkiner ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Clinical Outcomes ◽  
Embryo Transfer ◽  
Endometrial Thickness ◽  
Hormone Replacement ◽  
Pregnancy Rates ◽  
Ongoing Pregnancy ◽  
Ongoing Pregnancy Rate ◽  
Serum Progesterone ◽  
Female Age

Abstract Study question Does SC-P provide similar ongoing pregnancy rates (OPRs) as intramuscular progesterone(IM-P) in hormone replacement therapy (HRT)-FET cycles and do serum progesterone (P) levels on FET day effect on pregnancy outcome? Summary answer: SC-P administration had similar OPR compared to IM-P in HRT-FET cycles. In SC-P group embryo transfer(ET) day P found to be insignificant factor for outcome. What is known already Different P routes can be used in HRT-FET cycles such as vaginal P, IM-P and recently SC-P. Only retrospective studies evaluated the comparison of SC-P with other routes in HRT-FET cycles. Here, we assessed prospectively whether SC-P is effective for HRT-FET cycles. Previous studies reported that serum P levels on ET day after vaginal P administration clinical outcomes were closely correlated. The correlation between serum P after IM-P administration and clinical outcomes were conflicting. In addition, there is lack of data on the serum P levels after SC-P administration. Serum P levels on ET day were evaluated in this study. Study design, size, duration This prospective cohort study was performed between July 1-October 31 2020, enrolled 224 patients scheduled for HRT-FET cycles with SC-P(25 mg twice daily) or IM-P(50 mg once daily). The route of P was decided according to the patient’s eligibility to hospital. First FET cycle was included after freeze-all cycles for each patients. Female age&gt;35, PGT-A cycles, cleavage ET, &gt;1 ET, patients with uterine pathology and hydrosalpinx, FET with surplus embryos, endometrial thickness&lt;7mm were excluded. Participants/materials, setting, methods Female age ≤ 35 years old with a triple-layer endometrium &gt;7 mm underwent transfer of single blastocysts after the first ET after freeze-all cycles. The indications for freeze-all were ovarian hyperstimuation syndrome and trigger day P level&gt;1.5 ng/ml. 224 patients were eligible for study; 133 in SC-P group and 91 in IM-P group.The primary endpoint was the ongoing pregnancy rate (OPR) beyond pregnancy week 12. Main results and the role of chance The demographic, cycle, embryologic characteristics were similar between groups. The median circulating P levels on the day of ET were 19.92(15.195–27.255)ng/&#x2028;ml and 21(16.48–28)ng/ml in the SC-P and IM-P groups,(p = 0.786). The clinical pregnancy rates [86/133(64.7%) vs 57/91(62.6%);p=0.757], miscarriage rates [21/86(24.4%) vs 10/57(17.5%) ;p=0.329], and OPR [65/133 (48.9%) vs 47/91(51.6%); p = 0.683] were comparable between the SC-P and IM-P. Binary logistic regression was performed for ongoing pregnancy as the dependent factor blastocyst morphology was found to be the only significant independent prognostic factor (p = 0.006), whereas the route of P was insignificant. In the SC-P and IM-P &#x2028;groups, the effect of ET day P levels were divided into quartiles(Q) to evaluate the effect on ongoing pregnancy. In SC-P group OPR were similar in four Q [Q1:33.3%(11/33),Q2:50%(17/34),Q3:60.6%(20/33),Q4:51.5%(17/33) (p = 0.1)].For IM-P group; Q1 had a significantly reduced OPR than Q2, Q3, Q4. [26.1%(6/23),65.2%(15/23),54.5%(12/22) and 60.9%(14/23), p = 0.031]. Logistic regression analysis for OP was performed separately in SC-P group and IM-P group. Although in SC-P group, ET day P levels was not found to be a significant factor, in IM-P ET day P level was found to be an independent factor for OP in IM-P group (Q1vs Q2+Q3+Q4; OR: 8,178 95% CI: [1.387–48.223] p:0.02). . Limitations, reasons for caution Although this study has the advantage of being prospective and in a homogenous study population, randomized controlled trials are warranted to evaluate the effectiveness of SC-P to other routes of P. Extrapolation to unselected populations of this study is needed. Wider implications of the findings: Assignment of threshold of serum P on the day of ET for HRT-FET cycles to optimize outcomes is critical for every route of P. Regarding these results, individual luteal phase for HRT-FET cycles can improve IVF outcome. Trial registration number None

scholarly journals P–595 Systematic dydrogesterone supplementation of artificial endometrial preparation cycles for frozen-thawed embryo transfer during Covid–19 pandemic: a good way to limit monitoring visits and optimize outcomes

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
I Cedri. . Durnerin ◽  
M Peigné ◽  
J Labrosse ◽  
M Guerout ◽  
C Vinolas ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Endometrial Thickness ◽  
Pregnancy Rates ◽  
Ongoing Pregnancy ◽  
Live Birth Rates ◽  
Endometrial Preparation ◽  
Time Periods ◽  
Frozen Thawed Embryo Transfer ◽  
Thawed Embryo Transfer

Abstract Study question Does systematic dydrogesterone supplementation in artificial cycles (AC) for frozen-thawed embryo transfer (FET) during Covid–19 pandemic modify outcomes compared to prior individualized supplementation adjusted on serum progesterone (P) levels ? Summary answer Systematic dydrogesterone supplementation in AC for FET is associated with similar outcomes compared to prior individualized supplementation in patients with low P levels. What is known already In AC for FET using vaginal P for endometrial preparation, low serum P levels following P administration have been associated with decreased pregnancy and live birth rates. This deleterious effect can be overcome by addition of other routes of P administration. We obtained effective results by adding dydrogesterone to vaginal P and postponing FET by one day in patients with low P levels. However, in order to limit patient monitoring visits and to schedule better FET activity during Covid–19 pandemic, we implemented a systematic dydrogesterone supplementation without luteal P measurement in artificial FET cycles. Study design, size, duration This retrospective study aimed to analyse outcomes of 394 FET after 2 different protocols of artificial endometrial preparation. From September 2019 to Covid–19 lockdown on 15th March 2020, patients had serum P level measured on D1 of vaginal P administration. When P levels were &lt; 11 ng/ml, dydrogesterone supplementation was administered and FET was postponed by one day. From May to December 2020, no P measurement was performed and dydrogesterone supplementation was systematically used. Participants/materials, setting, methods In our university hospital, endometrial preparation was performed using sequential administration of vaginal estradiol until endometrial thickness reached &gt;7 mm, followed by transdermal estradiol combined with 800 mg/day vaginal micronized P started in the evening (D0). Oral dydrogesterone supplementation (30 mg/day) was started concomitantly to vaginal P in all patients during Covid–19 pandemic and only after D1 P measurement followed by one day FET postponement in patients with P levels &lt;11 ng/ml before the lockdown. Main results and the role of chance During the Covid–19 pandemic, 198 FET were performed on D2, D3 or D5 of P administration with dydrogesterone supplementation depending on embryo stage at cryopreservation. Concerning the 196 FET before lockdown, 124 (63%) were performed after dydrogesterone addition from D1 onwards and postponement by one day in patients with serum P levels &lt;11 ng/ml at D1 while 72 were performed in phase following introduction of vaginal P without dydrogesterone supplementation in patients with P &gt; 11 ng/ml. Characteristics of patients in the 2 time periods were similar for age (34.5 + 5 vs 34.1 + 4.8 years), endometrial thickness prior to P introduction (9.9 + 2.1 vs 9.9 + 2.2 mm), number of transferred embryos (1.3 + 0.5 vs 1.4 + 0.5) , embryo transfer stage (D2/D3/blastocyst: 8/16/76% vs 3/18/79%). No significant difference was observed between both time periods [nor between “dydrogesterone addition and postponement by 1 day” and “in phase” FET before lockdown] in terms of positive pregnancy test (39.4% vs 39.3% [44% vs 30.5%]), heartbeat activity at 8 weeks (29.3% vs 28% [29% vs 26.4%]) and ongoing pregnancy rates at 12 weeks (30.7% but truncated at end of October 2020 vs 25.5% [26.6% vs 23.6%]). Limitations, reasons for caution Full results of the Covid–19 period will be further provided concerning ongoing pregnancy rates as well as comparison of live birth rates and obstetrical and neonatal outcomes. Wider implications of the findings: These results suggest that systematic dydrogesterone supplementation is as effective as individualized supplementation according to serum P levels following administration of vaginal P. This strategy enabled us to schedule easier FET and limit patient visits for monitoring while maintaining optimal results for FET in AC during the Covid–19 pandemic. Trial registration number Not applicable

scholarly journals The Dynamics of the Vaginal Micro-Ecology During in Vitro Fertilization and Embryo Transfer (IVF-ET) Cycles and its Impact on Pregnancy Outcomes

2021 ◽  
Author(s):  
Quan Tian ◽  
Yujie Liu ◽  
Jiane Liu ◽  
Jianru Wu ◽  
Jianxin Liu ◽  
...  
Keyword(s):  
Live Birth ◽  
Pregnancy Outcomes ◽  
Evaluation System ◽  
Birth Rate ◽  
Assisted Reproductive Technologies ◽  
Live Birth Rate ◽  
Reproductive Technologies ◽  
Multivariable Logistic Regression Model ◽  
Hormonal Milieu ◽  
Ivf Et

Abstract BackgroundAbnormal reproductive tract flora may cause infertility, and it may play a key role in the success of assisted reproductive technologies (ART). The obvious short-term changes in estrogen caused by clinical protocols with IVF-ET provide a unique perspective for us to assess the vaginal flora, shifting hormonal condition and investigate the potential associations of the vaginal micro-ecology with cycle outcome of pregnancy. The Vaginal Micro-ecology Evaluation System (VMES) as a tool to analyze the vaginal microbiomes in most areas of China. This study aims to apply the VMES to evaluate the dynamics of vaginal micro-ecology during IVF-ET, and investigate the correlations between vaginal micro-ecology with pregnancy outcome.Methods　150 patients were enrolled who underwent early follicular phase prolonged protocol IVF-ET due to tubal factors. The VMES is used to evaluate vaginal microbiology indicators of vaginal swabs obtained in different hormonal milieu during the IVF-ET cycle. The pregnancy outcomes were observed, if pregnant.Results　In our data, the prevalence of bacterial vaginitis (BV) accounts for 3.3%. During IVF procedure, the vaginal microbiome varied across hormonal milieu in some but not all patients. The proportion of BV, and unidentified dysbiosis were increased significantly on the day of human chorionic gonadotropin (HCG) administration. The vaginal micro-ecology on the day of HCG administration correlated with outcome (live birth / no live birth). The multivariable logistic regression model showed that the average age, the duration of infertility, and the vaginal micro-ecology after controlled ovarian hyperstimulation (COH) were associated with the live birth rate.ConclusionOur retrospective cohort study suggests that the VEMS has enabled discovery of unidentified dysbiosis shift in the vaginal micro-ecology during IVF-ET therapy. More importantly, the vaginal micro-ecology on the day of HCG administration was significantly associated with the live birth rate.

The entire range of trigger-day endometrial thickness in fresh IVF cycles is independently correlated with live birth rate

2020 ◽  
Vol 41 (2) ◽  
pp. 239-247 ◽  
Author(s):  
Monica Simeonov ◽  
Onit Sapir ◽  
Yechezkel Lande ◽  
Avi Ben-Haroush ◽  
Galia Oron ◽  
...  
Keyword(s):  
Live Birth ◽  
Entire Range ◽  
Birth Rate ◽  
Endometrial Thickness ◽  
Live Birth Rate
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