scholarly journals Low anti-Müllerian hormone level is not a risk factor for early pregnancy loss in IVF/ICSI treatment

2020 ◽  
Vol 35 (3) ◽  
pp. 504-515 ◽  
Author(s):  
P Peuranpää ◽  
H Hautamäki ◽  
M Halttunen-Nieminen ◽  
C Hydén-Granskog ◽  
A Tiitinen
Keyword(s):  
Live Birth ◽  
Early Pregnancy ◽  
Pregnancy Loss ◽  
Birth Rate ◽  
Loss Rate ◽  
Live Birth Rate ◽  
University Hospital ◽  
Early Pregnancy Loss ◽  
Inverse Probability ◽  
The Impact

Abstract STUDY QUESTION Is a low (<1.0 μg/L) or moderately low (1.0–1.9 μg/L) serum anti-Müllerian hormone (AMH) level a risk factor for early pregnancy loss in IVF/ICSI with a fresh or frozen-thawed embryo transfer (ET)? SUMMARY ANSWER A low or moderately low serum AMH level does not associate with miscarriage, non-visualized pregnancy loss or overall early pregnancy loss rate in the IVF/ICSI treatment. WHAT IS KNOWN ALREADY Low AMH predicts poor ovarian response and small oocyte yield in IVF/ICSI treatment, but its value in the evaluation of live birth rate (LBR) is modest. Little is known about the risk of early pregnancy loss in ART among women with low AMH. STUDY DESIGN, SIZE, DURATION A retrospective cohort study on 1383 women undergoing their first oocyte retrieval for IVF/ICSI in Helsinki University Hospital in Helsinki, Finland, between 2012 and 2016, with all associated fresh (n = 1315) and frozen-thawed (n = 1418) ET cycles finished by August 2018. AMH was measured within 12 months before the IVF/ICSI stimulation. PARTICIPANTS/MATERIALS, SETTING, METHODS Of all the women, 235 (17.0%) had low (<1.0 μg/L), 278 (20.1%) had moderately low (1.0–1.9 μg/L) and 870 (62.9%) had normal (≥2.0 μg/L) AMH. The primary outcomes were miscarriage, non-visualized pregnancy loss and early pregnancy loss (miscarriage and non-visualized pregnancy loss combined) after fresh or frozen-thawed ET. The impact of AMH on these outcomes was calculated in three populations: among all women who became pregnant, among women with AMH ≤6.0 μg/L and in a population weighted by the inverse probability of becoming pregnant (inverse probability weighting, IPW). The impact of AMH was also assessed on the secondary outcomes, cumulative pregnancy rate (cPR) and cumulative live birth rate (cLBR) across all ET cycles in the woman’s first IVF/ICSI. Potential confounders (the woman’s age, overweight, smoking, history of endometriosis and underlying medical conditions) adjusted the final results. MAIN RESULTS AND THE ROLE OF CHANCE Of 1123 pregnancies, 285 (25.4%) ended in non-visualized pregnancy loss and 143 (12.7%) in miscarriage. The LBR was 24.6% per ET (673/2733). Low or moderately low AMH, compared with normal AMH, did not associate with miscarriage or non-visualized pregnancy loss in analyses among all women who became pregnant (adjusted relative risk (RR) for miscarriage vs live birth, 0.70 and 95% CI 0.42–1.17 in low AMH and adjusted RR, 1.00 and 95% CI, 0.68–1.49 in moderately low AMH; adjusted RR for non-visualized pregnancy loss vs live birth, 0.90 and 95% CI, 0.65–1.23 in low AMH and adjusted RR, 1.09 and 95% CI 0.85–1.41 in moderately low AMH), nor did low or moderately low AMH associate with the overall early pregnancy loss rate (adjusted RR for early pregnancy loss vs live birth, 0.86 and 95% CI, 0.68–1.10 in low AMH and adjusted RR, 1.01 and 95% CI, 0.86–1.27 in moderately low AMH). Results remained similar after restricting the analysis to women with AMH ≤6.0 μg/L. Women with low or moderately low AMH had fewer pregnancies and live births than women with normal AMH in their first IVF/ICSI (cPR/cLBR in women with low AMH 50.6/34.0%, moderately low AMH 59.0/36.3% and normal AMH 68.3/49.2%). When the lower probability for pregnancy was considered by using IPW, women with low or moderately low AMH did not have a higher risk for miscarriage, non-visualized pregnancy loss or overall early pregnancy loss compared with women with normal AMH. LIMITATIONS, REASONS FOR CAUTION The number of miscarriages in women with low AMH was moderately small, limiting the power of the study. The real-world clinical setting of the study restricted the ability to control for all factors causing selection bias. WIDER IMPLICATIONS OF THE FINDINGS The cLBR was higher among women with normal AMH than among women with low or moderately low AMH in their first IVF/ICSI treatment because these women had more oocytes and embryos. Women with low or moderately low AMH did not have an increased risk for early pregnancy loss. This information is reassuring for couples and useful in counseling. These results are also valuable when assessing the overall effectiveness of IVF/ICSI treatment. STUDY FUNDING/COMPETING INTEREST(S) Research funds from Helsinki University Hospital (no. TYH2018232), Hyvinkää Hospital (no. M3080TUT18) and the Emil Aaltonen Foundation for P.P. Grants from the Paulo Foundation and the Finnish Medical Foundation for H.H. The authors report no conflicts of interest. TRIAL REGISTRATION NUMBER HUS/138/2017.

scholarly journals Relationship of Vaginal Bacteria and Inflammation With Conception and Early Pregnancy Loss FollowingIn-VitroFertilization

2003 ◽  
Vol 11 (1) ◽  
pp. 11-17 ◽  
Author(s):  
Linda O. Eckert ◽  
Donald E. Moore ◽  
Dorothy L. Patton ◽  
Kathy J. Agnew ◽  
David A. Eschenbach
Keyword(s):  
Hydrogen Peroxide ◽  
Bacterial Vaginosis ◽  
Live Birth ◽  
Early Pregnancy ◽  
Pregnancy Loss ◽  
Vaginal Flora ◽  
Early Pregnancy Loss ◽  
Gram Stain ◽  
Normal Flora ◽  
The Impact

Objective:The aim of this study was investigate the impact of vaginal flora and vaginal inflammation on conception and early pregnancy loss followingin-vitrofertilization (IVF).Methods:We enrolled 91 women who were undergoing IVF. At embryo transfer (ET), all of the women had quantitative vaginal culture, ET catheter-tip culture, and vaginal Gram stain scored for bacterial vaginosis and quantitated for polymorphonuclear leukocytes (PMNs). Conception and early pregnancy loss were compared with culture and Gram stain results. Statistical analyses included the Chi-square test, Fisher's exact test and the Mann–WhitneyU-test.Results:The overall live birth rate (LBR) was 30% (27/91), and the rate of early pregnancy loss was 34% (14/41). In women with bacterial vaginosis, intermediate flora and normal flora, the conception rates were 30% (3/10), 39% (12/31) and 52% (26/50), respectively (p= 0.06 for trend). Early pregnancy loss occurred in 33% (1/3), 42% (5/12) and 31% (8/26) of women, respectively (p= 0.06, comparing intermediate and normal flora). The vaginal log concentration of hydrogen peroxide-producing lactobacilli was 7.3 ± 1.7 in women with a live birth (n= 27) and 4.9 ± 2.5 in those with early pregnancy loss (n= 14) (p= 0.1).Conclusions:IVF patients with bacterial vaginosis and with a decreased vaginal log concentration of hydrogen peroxide-producing lactobacilli may have decreased conception rates and increased rates of early pregnancy loss. A larger prospective treatment trial designed to evaluate the impact on IVF outcomes of optimizing the vaginal flora prior to IVF may be warranted.

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

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.

P-377 Association between antinuclear antibodies and pregnancy prognosis in recurrent pregnancy loss patients

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
H Yoshihara ◽  
M Sugiura-Ogasawara ◽  
T Kitaori ◽  
S Goto
Keyword(s):  
Live Birth ◽  
Pregnancy Loss ◽  
Birth Rate ◽  
Recurrent Pregnancy Loss ◽  
Live Birth Rate ◽  
Negative Group ◽  
Birth Rates ◽  
Positive Group ◽  
Live Birth Rates ◽  
Uterine Anomaly

Abstract Study question Can antinuclear antibody (ANA) affect the subsequent live birth rate in patients with recurrent pregnancy loss (RPL) who have no antiphospholipid antibodies (aPLs)? Summary answer ANA did not affect the pregnancy prognosis of RPL women. What is known already The prevalence of ANA is well-known to be higher in RPL patients. Our previous study found no difference in the live birth rates of ANA-positive and -negative patients who had no aPLs. Higher miscarriage rates were also reported in ANA-positive patients compared to ANA-negative patients with RPL. The RPL guidelines of the ESHRE state that “ANA testing can be considered for explanatory purposes.” However, there have been a limited number of studies on this issue and sample sizes have been small, and the impact of ANA on the pregnancy prognosis is unclear. Study design, size, duration An observational cohort study was conducted at Nagoya City University Hospital between 2006 and 2019. The study included 1,108 patients with a history of 2 or more pregnancy losses. Participants/materials, setting, methods 4D-Ultrasound, hysterosalpingography, chromosome analysis for both partners, aPLs and blood tests for ANA and diabetes mellitus were performed before a subsequent pregnancy. ANAs were measured by indirect immunofluorescence. The cutoff dilution used was 1:40. In addition, patients were classified according to the ANA pattern on immunofluorescence staining. Live birth rates were compared between ANA-positive and ANA-negative patients after excluding patients with antiphospholipid syndrome, an abnormal chromosome in either partner and a uterine anomaly. Main results and the role of chance The 994 patients were analyzed after excluding 40 with a uterine anomaly, 43 with a chromosome abnormality in either partner and 32 with APS. The rate of ANA-positive patients was 39.2 % (390/994) when the 1: 40 dilution result was positive. With a 1:160 dilution, the rate of ANA-positive patients was 3.62 % (36/994). The live birth rate was calculated for 798 patients, excluding 196 patients with unexplained RPL who had been treated with any medication. With the use of the 1 40 dilution, the subsequent live birth rates were 71.34 % (219/307) for the ANA-positive group and 70.67 % (347/491) for the ANA-negative group (OR, 95%CI; 0.968, 0.707-1.326). After excluding miscarriages with embryonic aneuploidy, chemical pregnancies and ectopic pregnancies, live birth rates were 92.41 % (219/237) for the ANA-positive group and 92.04 % (347/377) for the ANA-negative group (0.951, 0.517-1.747). Using the 1:160 dilution, the subsequent live birth rates were 84.62 % (22/26) for the ANA-positive group, and 70.47 % (544/772) for the ANA-negative group (0.434, 0.148-1.273). Subgroup analyses were performed for each pattern on immunofluorescence staining, but there was no significant difference in the live birth rate between the two groups. Limitations, reasons for caution The effectiveness of immunotherapies could not be evaluated. However, the results of this study suggest that it is not necessary. Wider implications of the findings The measurement of ANA might not be necessary for the screening of patients with RPL who have no features of collagen disease. Trial registration number not applicable

P–304 The endometrial preparation protocol does not affect the live-birth-rate after vitrified-warmed euploid single blastocyst transfers: an analysis of 1884 procedures

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
C Petriglia ◽  
A Vaiarelli ◽  
D Cimadomo ◽  
C Gentile ◽  
F Fiorini ◽  
...  
Keyword(s):  
Live Birth ◽  
Gestational Age ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Blastocyst Transfer ◽  
Workload Management ◽  
Endometrial Preparation ◽  
Blastocyst Quality ◽  
The Impact ◽  
Micronized Progesterone

Abstract Study question Is the live-birth-rate (LBR) different when comparing artificial (AC) and modified-natural (M-NC) cycle for endometrial preparation to vitrified-warmed euploid blastocyst transfer? Summary answer The LBR after vitrified-warmed euploid blastocyst transfer seem independent of the endometrial preparation administered. What is known already Only the transfer of a competent embryo on a receptive endometrium might result in successful implantation. Three main protocols for endometrial preparation to vitrified-warmed embryo transfer exist: NC, M-NC, and AC. None among them, though, has been shown more appropriate than the others to date, especially since, only in a few studies, the analysis was restricted to single euploid blastocyst transfers to limit the impact of embryonic issues on implantation. In conclusion, no clear consensus exists and the choice is still largely based on menstrual/ovarian cycle characteristics and patient’s needs. Study design, size, duration All first vitrified-warmed single euploid blastocyst transfers performed between April–2013 and March–2020 were included in the analysis. Endometrial preparation was conducted with either an AC (N = 1211) or a M-NC (N = 673). The protocol was chosen based on patients’ logistical reasons. The primary outcome was the LBR per transfer. Sub-analyses based on blastocyst quality and day of development were conducted. Birthweight, gestational age, gestational and perinatal issues were secondary outcomes. Participants/materials, setting, methods AC: oral estradiol-valerate 3-times/day from day2–3 of the cycle until the endometrial thickness reached ≥7mm, then 600 mg/day of micronized progesterone. The transfer was conducted on day6 of progesterone administration. M-NC: an intramuscular dose of 10,000IU hCG was administrated when the leading follicle was &gt;17 mm and the endometrium was thicker than 7mm and trilaminar, plus 400 mg/day of micronized-progesterone as luteal phase support starting 36–40hr post-hCG. The transfer was conducted on day7 after trigger. Main results and the role of chance The two groups were similar for maternal age at retrieval (38.0±3.3yr) and transfer (38.3±3.3yr), reproductive history, embryological outcomes of the IVF cycle, body-mass-index, basal hormonal levels, and blastocyst features (Gardner’s classification: AA = 73%, AB/BA=11%, BB/AC/CA=8%, CC/BC/CB=8%; day5=48%, day6=47%, day7=5%). The LBR was 46.7% (N = 565/1211) and 49.9% (N = 336/673) after AC and M-NC, respectively, resulting in an odds-ratio 1.14, 95%CI:0.94–1.37. The absence of significant differences was confirmed also when adjusted for blastocyst quality and day of full-development (1.16, 95%CI:0.96–1.41). Among the 565 and 336 deliveries, the birthweight was similar (3290.3±470.7 versus 3251.7±521.5 g, Mann-Whitney-U-test=0.5), the gestational age was similar (38.5±1.7 versus 38.4±1.9 weeks, Mann-Whitney-U-test=0.5). Also, the rates of newborns who were normal (81% versus 82%), large (8% versus 9%), and small (11% versus 9%) for gestational age were similar (Chi-squared-test=0.5). The rates of patients experiencing gestational (6% versus 7%) and/or perinatal issues (3% versus 3%) were also similar (Fisher’s-exact-tests=0.4). Limitations, reasons for caution This is a retrospective study conducted in poor prognosis patients indicated to preimplantation genetic testing for aneuploidies. Future randomized controlled trials and cost-effectiveness analysis are desirable, as well as studies in different patient populations. Lastly, each gestational/perinatal issue shall be analyzed per se (e.g. different placentation disorders). Wider implications of the findings: The absence of clinical and perinatal differences between the two protocols for endometrial preparation supports the adoption, whenever needed, of AC. This approach, in fact, allows a higher flexibility in patients’ and daily workload management. Trial registration number None

scholarly journals Association of a family history of autoimmune disease with time to pregnancy, pregnancy loss, and live birth rate

2017 ◽  
Vol 108 (3) ◽  
pp. e34
Author(s):  
T.C. Plowden ◽  
M.T. Connell ◽  
P. Mendola ◽  
K. Kim ◽  
C. Nobles ◽  
...  
Keyword(s):  
Family History ◽  
Autoimmune Disease ◽  
Live Birth ◽  
Pregnancy Loss ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Time To Pregnancy ◽  
History Of

Preimplantation genetic testing for aneuploidy: a comparison of live birth rates in patients with recurrent pregnancy loss due to embryonic aneuploidy or recurrent implantation failure

2019 ◽  
Vol 34 (12) ◽  
pp. 2340-2348 ◽  
Author(s):  
Takeshi Sato ◽  
Mayumi Sugiura-Ogasawara ◽  
Fumiko Ozawa ◽  
Toshiyuki Yamamoto ◽  
Takema Kato ◽  
...  
Keyword(s):  
Live Birth ◽  
Pregnancy Loss ◽  
Birth Rate ◽  
Recurrent Pregnancy Loss ◽  
Live Birth Rate ◽  
Not Given ◽  
Recurrent Implantation Failure ◽  
Miscarriage Rate ◽  
Preimplantation Genetic Testing ◽  
Biochemical Pregnancy

Abstract STUDY QUESTION Can preimplantation genetic testing for aneuploidy (PGT-A) improve the live birth rate and reduce the miscarriage rate in patients with recurrent pregnancy loss (RPL) caused by an abnormal embryonic karyotype and recurrent implantation failure (RIF)? SUMMARY ANSWER PGT-A could not improve the live births per patient nor reduce the rate of miscarriage, in both groups. WHAT IS KNOWN ALREADY PGT-A use has steadily increased worldwide. However, only a few limited studies have shown that it improves the live birth rate in selected populations in that the prognosis has been good. Such studies have excluded patients with RPL and RIF. In addition, several studies have failed to demonstrate any benefit at all. PGT-A was reported to be without advantage in patients with unexplained RPL whose embryonic karyotype had not been analysed. The efficacy of PGT-A should be examined by focusing on patients whose previous products of conception (POC) have been aneuploid, because the frequencies of abnormal and normal embryonic karyotypes have been reported as 40–50% and 5–25% in patients with RPL, respectively. STUDY DESIGN, SIZE, DURATION A multi-centre, prospective pilot study was conducted from January 2017 to June 2018. A total of 171 patients were recruited for the study: an RPL group, including 41 and 38 patients treated respectively with and without PGT-A, and an RIF group, including 42 and 50 patients treated respectively with and without PGT-A. At least 10 women in each age group (35–36, 37–38, 39–40 or 41–42 years) were selected for PGT-A groups. PARTICIPANTS/MATERIALS, SETTING, METHODS All patients and controls had received IVF-ET for infertility. Patients in the RPL group had had two or more miscarriages, and at least one case of aneuploidy had been ascertained through prior POC testing. No pregnancies had occurred in the RIF group, even after at least three embryo transfers. Trophectoderm biopsy and array comparative genomic hybridisation (aCGH) were used for PGT-A. The live birth rate of PGT-A and non-PGT-A patients was compared after the development of blastocysts from up to two oocyte retrievals and a single blastocyst transfer. The miscarriage rate and the frequency of euploidy, trisomy and monosomy in the blastocysts were noted. MAIN RESULT AND THE ROLE OF CHANCE There were no significant differences in the live birth rates per patient given or not given PGT-A: 26.8 versus 21.1% in the RPL group and 35.7 versus 26.0% in the RIF group, respectively. There were also no differences in the miscarriage rates per clinical pregnancies given or not given PGT-A: 14.3 versus 20.0% in the RPL group and 11.8 versus 0% in the RIF group, respectively. However, PGT-A improved the live birth rate per embryo transfer procedure in both the RPL (52.4 vs 21.6%, adjusted OR 3.89; 95% CI 1.16–13.1) and RIF groups (62.5 vs 31.7%, adjusted OR 3.75; 95% CI 1.28–10.95). Additionally, PGT-A was shown to reduce biochemical pregnancy loss per biochemical pregnancy: 12.5 and 45.0%, adjusted OR 0.14; 95% CI 0.02–0.85 in the RPL group and 10.5 and 40.9%, adjusted OR 0.17; 95% CI 0.03–0.92 in the RIF group. There was no difference in the distribution of genetic abnormalities between RPL and RIF patients, although double trisomy tended to be more frequent in RPL patients. LIMITATIONS, REASONS FOR CAUTION The sample size was too small to find any significant advantage for improving the live birth rate and reducing the clinical miscarriage rate per patient. Further study is necessary. WIDER IMPLICATION OF THE FINDINGS A large portion of pregnancy losses in the RPL group might be due to aneuploidy, since PGT-A reduced the overall incidence of pregnancy loss in these patients. Although PGT-A did not improve the live birth rate per patient, it did have the advantage of reducing the number of embryo transfers required to achieve a similar number live births compared with those not undergoing PGT-A. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by the Japan Society of Obstetrics and Gynecology and grants from the Japanese Ministry of Education, Science, and Technology. There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A

P–326 Presence of adenomyosis at MRI in endometriosis women negatively affect live birth chances in IVF cycles

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
P Santulli ◽  
M Bourdon ◽  
L Melka ◽  
C Bordonne ◽  
A E Millisher ◽  
...  
Keyword(s):  
Live Birth ◽  
Signal Intensity ◽  
Birth Rate ◽  
Live Birth Rate ◽  
High Signal Intensity ◽  
High Signal ◽  
Ivf Outcomes ◽  
Mri Characteristics ◽  
The Impact ◽  
Work Up

Abstract Study question What is the impact of adenomyosis and its magnetic resonance imaging (MRI) characteristics on live birth rate (LBR) in endometriosis-affected women undergoing in-vitro fertilization (IVF) treatment? Summary answer Among women undergoing IVF, the presence of adenomyosis at MRI, and especially T2 high signal-intensity spots within the myometrium have a negative impact on LBR. What is known already: Adenomyosis is a frequent gynecologic disease. With the development of imaging technics for the diagnosis (notably MRI), several adenomyosis phenotypes have been described and fertility issues seem variable according to the lesions characteristics. Moreover, on IVF outcomes, controversial results have been found in studies assessing the impact of adenomyosis. What make the impact-assessment of adenomyosis on fertility issues even more difficult is the frequent association with endometriosis, another known risk factor of infertility. Some data suggested that adenomyosis could worsen IVF prognostics, however there is no clear consensus about the impact of the adenomyosis on IVF outcomes in endometriosis affected-women. Study design, size, duration This was an observational study including phenotyped endometriosis patients, aged between 18 to 42 years, who underwent IVF/intra-cytoplasmic sperm injection (ICSI) treatment in a tertiary care center, from June 2015 through July 2018.Only women who had performed a pelvic MRI during the pre-therapeutic ART work-up, were retained for this study. The MRI data were interpreted by radiologists who had expertise in gynaecological MRI. Participants/materials, setting, methods A continuous series of 202 endometriosis affected women was included. The women were followed until four ART cycles had been completed, until delivery or until discontinuation of treatment before the completion of four cycles. The primary outcome was the delivery of one or more live infant(s) after up to four IVF/ICSI cycles. Patients and MRI characteristics were compared between women who gave a live birth and those without live birth. Main results and the role of chance The mean age of the included population was 32.5 ±3.7 years. 90.1% (182/202) had deep infiltrating endometriosis whereas only 5.4% (11/202) and 4.5% (9/202) had respectively isolated ovarian endometriosis (OMA) and superficial peritoneal endometriosis (SUP). The presence of adenomyosis (internal and/or external lesions) was found in 71.8% (145/202) of included women. The cumulative live birth rate was 57.4% (116/202). Women that gave birth (‘live birth +’) were significantly younger, (33.3±4.1 vs 32.0±3.3 p = 0.026) and had significant better ovarian reserve parameters (AMH, AFC). The presence of adenomyosis (internal and/or external lesions) (76/116 (65.5%) versus 69/86 (80.2%), p = 0.022) and the presence of T2 high-signal intensity myometrial spots (27/116 (23.3%) and 37/86 (43.0%), p = 0.003) were significantly less frequently found in the group of women ‘Live birth +’. After multivariate analysis, the presence of adenomyosis (OR: 0.48 95% CI (0.29–0.99) p = 0.048) and the presence of T2 high-signal intensity myometrial spots (OR: 0.43 95% CI (0.22–0.86) p = 0.018) were independently found to be associated with a decrease in cumulative chances of live birth. Limitations, reasons for caution The inclusion of patients from our referral center could constitute a possible selection bias, as those women may have suffered from particularly severe forms of adenomyosis ± endometriosis. Wider implications of the findings: In women presenting endometriosis, the practitioner should perform an appropriate imaging work-up searching for adenomyosis, to identify prognostic factors and to plan the strategy of patient management in the setting of ART. Trial registration number NA

P–677 Endometrial thickness, endometrial preparation protocol and number of euploid embryos transferred, significantly impact the live birth in frozen embryo transfer cycles

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
A Liñá. Tegedor ◽  
I Elkhatib ◽  
A Abdala ◽  
A Bayram ◽  
K Ab. Ali ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Embryo Transfer ◽  
Live Birth ◽  
Birth Rate ◽  
Endometrial Thickness ◽  
Live Birth Rate ◽  
Frozen Embryo Transfer ◽  
Endometrial Preparation ◽  
The Impact ◽  
Ploidy Status

Abstract Study question Is the live birth rate (LBR) in euploid frozen embryo transfer (FET) cycles affected by the endometrial thickness (EMT)? Summary answer A significantly higher LBR was observed in patients with an endometrial thickness of at least 7.5mm (46.24% vs. 54.63%) What is known already Parameters assessing the endometrium prior planning a FET include endometrial thickness, pattern and blood flow. The impact of the endometrial thickness on ART outcomes is controversial, with conflicting results published. A recent meta-analysis evaluated whether EMT could predict pregnancy outcomes and suggested that lower EMT was associated with lower incidence of clinical pregnancy rate (CPR), implantation rate (IR) and LBR. Due to heterogeneity of parameters evaluated between different publications, where embryos with unknown ploidy status were transferred, in conjunction with variability of stimulation protocols and the number of embryos transferred, the real effect of the EMT was difficult to infer. Study design, size, duration This was a two-center retrospective observational study including a total of 1522 euploid FET cycles between March 2017 and March 2020 at ART Fertility Clinics Muscat, Oman and Abu Dhabi, UAE. Participants/materials, setting, methods Trophectoderm biopsies were analyzed with Next Generation Sequencing (NGS). Vitrification/warming of blastocysts was performed using Cryotop method (Kitazato). EMT was measured by vaginal ultrasound prior initiating the progesterone administration (± 1 day) and LBR was recorded. Multivariate analysis was performed between LB outcomes and median EMT while controlling for confounding factors. Main results and the role of chance A total of 1522 FET cycles were analyzed: 975 single embryo transfer (SET) and 547 double embryo transfer (DET). The mean age of the patients was 33.38 years with a mean BMI of 27.1 kg/m2. FET were performed in EMT ranging from 3 to 15 mm and 50.52% resulted in a live birth. Though potentially all ranges of EMT were associated with LB, the median EMT in patients with LB was significantly higher than the median EMT of patients without LB (7.6mm vs. 7.4mm; p &lt; 0.001). The dataset was stratified into two groups based on the median EMT (7.5mm): &lt; 7.5mm (n = 744 cycles) and ≥ 7.5mm (n = 778 cycles). A significantly higher live birth rate was observed in ≥ 7.5mm group (46.24% vs. 54.63%. p = 0.0012). In multivariate analysis, EMT, FET endometrial preparation protocol, and number of embryos transferred were the main parameters influencing the chance to achieve LB: OR 1.10 [1.01–1.19], p &lt; 0.015 for the EMT; OR 1.84 [1.47–2.30], p &lt; 0.0001 for Natural Cycle protocol and OR 1.55 [1.25–1.93], p &lt; 0.0001 for DET. Intercept 0.18 [0.07–0.44] p &lt; 0.0002. Female age did not reach significance: OR 1.02 [1.00–1.04], p = 0.056. Limitations, reasons for caution Besides the retrospective nature of the study, the inter-observer variability in EMT assessment between different physicians is a limitation. The physician and embryologist performing the embryo transfer could not been standardized due to the multicenter design of the study. Wider implications of the findings: The EMT in FET may influence the LBR and should be considered as an important factor for the success of embryo transfer cycles. Whether these results can be extrapolated to fresh embryo transfer and to blastocysts with unknown ploidy status, needs further investigation. Trial registration number Not applicable

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