P–082 Effect of semen hyper viscosity (SHV) on blastocyst formation rate and implantation rate

Abstract Study question Does semen hyper viscosity effects blastocyst formation rate Summary answer Hyper viscosity of semen sample later results in poor blastocyst formation rate and lower implantation rate. What is known already Normal range of semen hyper viscosity ranges between 12–29%.Highly viscous semen samples impairs the physical and chemical characteristics of seminal fluid and due to which seminal oxidative damage increases which further increases the ROS and reduces the sperm motility there are some factors that can affect the seminal viscosity out of which one is Male accessory gland infection, Hypo function of prostate seminal vesicles and varicoceles. SHV create hindrance in semen preparation. Study design, size, duration Retrospective study was conducted from June 2019 to Oct 2020 at IVF unit IKDRC hospital. Participants/materials, setting, methods 142 patients were enrolled from June 2019 to Oct 2020 in IVF unit IKDRC hospital and divided into two groups. Group A (n = 83) patients with hyper semen viscosity and Group B (n = 69) patients with normal semen viscosity, inclusion and exclusion criteria’s were same for both the groups, only patient with normozoospermia were taken. Semen analysis was done by using WHO manual 2010. Main results and the role of chance In group A with hyper semen viscosity fertilization rate was (49.2% vs. 70% p = <0.001) vs in group B with normal semen viscosity which is significantly higher in group B, Blastocyst formation rate ( 18.4% vs 35% p = <0.01) and implantation rate (9.4% vs 20% p = <0.005) both are significantly higher in group B . Which implies fertilization rate , blastocyst formation rate and implantation rate is significantly lower in patients with semen hyper viscosity. Limitations, reasons for caution Larger randomized control studies are needed to strengthen these results. Wider implications of the findings: Our study demonstrates that patients having higher semen viscosity have poor blastocyst formation rate and implantation rate due to oxidative stress. Trial registration number Not applicable

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Increasing dominant follicular proportion negatively associated with good clinical outcomes in GnRH-a prolonged protocol: a large-sample retrospective analysis

10.21203/rs.3.rs-870140/v1 ◽

2021 ◽

Author(s):

Houming Su ◽

Youhua Lai ◽

Jie Li ◽

Tingting Liao ◽

Licheng Ji ◽

...

Keyword(s):

Regression Analysis ◽

Linear Regression ◽

Retrospective Analysis ◽

Formation Rate ◽

Clinical Pregnancy ◽

Blastocyst Formation ◽

Negatively Associated ◽

Large Sample ◽

Group A ◽

Group B

Abstract Background: Nowadays, there is no universal criteria for trigger time during controlled ovarian hyperstimulation (COH). Particularly, in the so-called GnRH-a prolonged protocol, widely used in China, the ideal time to trigger ovulation is not yet well defined. Methods: This was a large-sample retrospective analysis. Between January 2016 and January 2020, 1,925 young patients who underwent their first in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles with normal ovarian response were divided into three groups based on their dominant follicular proportions (DFP, defined as ≥18 mm follicles /≥14 mm follicles; Group A: < 30%; Group B: 30% - 60%; Group C: ≥ 60%). Binary logistic regression and multivariate linear regression were used to assessed whether DFP levels were related to clinical pregnancy, number of blastocysts frozen, blastocyst formation rate and low blastocysts frozen. Results: Binary logistics regression analysis showed that compared with Group A, the OR for clinical pregnancy was 1.345 in Group B (P = 0.023); however, there was no statistical difference between Group C and Group A (P = 0.216). On one hand, multivariate linear regression analysis indicated that DFP was negatively associated with number of blastocysts frozen (β ± SE: Group B vs Group A = -0.319 ± 0.115, P = 0.006; Group C vs Group A = -0.432 ± 0.154, P = 0.005) as well as blastocyst formation rate (β ± SE: Group B vs Group A = -0.035 ± 0.016, P = 0.031; Group C vs Group A = -0.039 ± 0.021, P = 0.067). On the other hand, compared with group A, the OR for low blastocyst frozen was 1.312 in Group B (P = 0.039) and was 1.417 in Group C (P = 0.041). Conclusions: Excessive delay of trigger in GnRH-a prolonged protocol might reduce the developmental potential of oocytes and reduce the number of available blastocysts, which might result in a lower cumulative pregnancy rate. But further confirmation by strict prospective randomized controlled study should be needed.Trial registration: https://clinicaltrials.gov/; NCT03305510; Registered 08 October 2017 - Retrospectively registered.

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Effects of Gender of Reciprocal Chromosomal Translocation on Blastocyst Formation and Pregnancy Outcome in Preimplantation Genetic Testing

Frontiers in Endocrinology ◽

10.3389/fendo.2021.704299 ◽

2021 ◽

Vol 12 ◽

Author(s):

Hui Song ◽

Hao Shi ◽

En-tong Yang ◽

Zhi-qin Bu ◽

Zi-qi Jin ◽

...

Keyword(s):

Genetic Testing ◽

Pregnancy Outcome ◽

Reciprocal Translocation ◽

Maternal Age ◽

Formation Rate ◽

Chromosomal Translocation ◽

Blastocyst Formation ◽

Preimplantation Genetic Testing ◽

Group A ◽

Group B

ObjectiveTo determine the effect of gender of reciprocal chromosomal translocation on blastocyst formation and pregnancy outcome in preimplantation genetic testing, including different parental ages.MethodsThis was a retrospective cohort study that enrolled 1034 couples undergoing preimplantation genetic testing-structural rearrangement on account of a carrier of reciprocal chromosomal translocation from the Reproductive Medicine Center of the First Affiliated Hospital of Zhengzhou University from January 2015 to December 2019. Group A represented 528 couples in which the man was the carrier of reciprocal translocation and group B represented 506 couples in which the woman was the carrier of reciprocal translocation. All patients were divided into two groups according to their age: female age<35 and female age≥35. Furthermore, the differences in blastocyst condition and pregnancy outcome between male and female carriers in each group were further explored according to their father’s age.ResultsThe blastocyst formation rate of group A (55.3%) is higher than that of group B (50%) and the results were statistically significant (P<0.05). The blastocyst formation rate of group A is higher than that of group B, no matter in young maternal age or in advanced maternal age (P<0.05). The blastocyst formation rate in maternal age<35y and paternal age<30y in group A(57.1%) is higher than that of Group B(50%); Similarly, the blastocyst formation rate in maternal age≥35 and paternal age≥38y(66.7%) is higher than that of Group B(33.3%)(all P<0.05). There was no difference in fertilization rate, aeuploidy rate, clinical pregnancy rate, miscarriage rate and live birth rate between Group A and Group B.ConclusionWhen the carrier of reciprocal translocation is male, the blastocyst formation rate is higher than that of female carrier. While there is no significant difference between the two in terms of fertilization rate, aeuploidy rate, clinical pregnancy rate, miscarriage rate and live birth rate.

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Analysis of the difference in characteristics of patients and IVF cycles and the parameters of in vitro embryo culture between normal individuals with high and low blastocyst formation rate

10.21203/rs.3.rs-17214/v1 ◽

2020 ◽

Author(s):

Chun-mei Yu ◽

Xiu-liang Dai ◽

yu-feng Wang ◽

Li Chen

Keyword(s):

Embryo Culture ◽

Formation Rate ◽

Ovarian Response ◽

Individual Characteristics ◽

Blastocyst Formation ◽

Significant Difference ◽

Group A ◽

The Difference ◽

Group B

Abstract Background: The main purpose of this study is to analyze the possible factors that were related with high useful blastocyst formatio rate in normal patients.Methods: This was a retrospective cohort study included 706 normal patients(excluding PCOS, DOR, endometriosis and other special diseases),according to the useful blastocyst in vitro formation rate(UBIVFR), the patients were divided into two groups respectively,group A（0-50%,including 50%）and group B（50%-100%). Results: There were no significant difference in patient ages between the two groups,compared with group A , the level of basic LH(bLH) was significantly increased. The clincal data showed that ,compared with group A ,the total Gn dose and the number of dominant follicles , oocytes retrieved，MII mature oocytes, normal fertilized oocytes rate,high-quality embryos rate and FET clinical pregnancy rate were significantly higher than group B.Conclusion:Our study is to investigate the useful blastocyst formation rate in relation to bLH levels in IVF/ICSI cycles, showing that high bLH is associated with higher ovarian response and higher UBIVFR.AMH,bFSH and AFC which were defined as ovarian reserve and ovarian response are seem not associated with the useful blastocyst formation. Key words:Useful blastocyst formation; normal patients; individual characteristics; basic LH; ovarian response; in vitro embryo culture

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P–010 Timing of TESE does not affect laboratory outcomes

Human Reproduction ◽

10.1093/humrep/deab130.009 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

C Goktas ◽

M Basar ◽

M Fetahovic ◽

H Spahovic ◽

E Goktas ◽

...

Keyword(s):

Fertilization Rate ◽

Utilization Rate ◽

Testicular Spermatozoa ◽

Chi Squared ◽

Registration Number ◽

Group A ◽

Retrospective Nature ◽

The One ◽

Group B

Abstract Study question What is the outcome of intracytoplasmic sperm injection (ICSI) using testicular spermatozoa obtained on the day of oocyte pick-up (OPU) or the day before OPU. Summary answer Testicular spermatozoa were obtaining the one day before OPU does not affect fertilization rate, top quality embryo on day 3, and blastocyst utilization rate. What is known already Usually, TESE is performed just before OPU. OPU is generally cancelled if no sperm is retrieved. The use of fresh testicular spermatozoa, obtained the day before OPU could offer the couple and the caring team both medical and practical advantages. The benefits of this approach, however, has not been evaluated in detail. An uncontrolled preliminary study has revealed that regular fertilization and pregnancy rates could be achieved with sperm extraction performed one day before OPU. Study design, size, duration This was a single-center retrospective study in Bahceci BIH IVF center. Sixty-six patients suffering from azoospermia from January 2015 to December 2020 were evaluated. TESE was performed either on the OPU day (43 patients; group A) or one day before OPU (23 patients; group B). Participants/materials, setting, methods In this study, primary outcomes were motile spermatozoa at ICSI, fertilization, top quality embryo on day 3, and blastocyst utilization rate. Statistical analyses were performed with chi-squared tests. Main results and the role of chance There is no statistical difference fertilization rate (72.3% vs. 72.2, p > 0.05), top quality embryo rate on day 3 (58.3% vs 58.3%, p > 0.05) and blast utilization rate (43.98% vs 49.58%, p > 0.05) between group A and B, respectively. Limitations, reasons for caution The retrospective nature of this study may not eliminate potential bias. On the contrary, the strength of our study is that all procedures were performed by the same operators, so there are no operator-dependent differences. More research is needed to prove our findings. Wider implications of the findings: TESE procedure can be performed one day before OPU without compromising success. Trial registration number 1

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ARTIFICIAL OOCYTE ACTIVATION IMPROVES THE LABORATORY AND CLINICAL OUTCOME IN VITRIFIED DONOR OOCYTE GROUP

Reproductive Medicine ◽

10.37800/rm2021-1-5 ◽

2021 ◽

pp. 55-62

Author(s):

N.P. Nigmatova ◽

B.Zh. Abdilmanova ◽

B.B. Kaldarbekova ◽

G.G. Arstanbaeva ◽

Y. Buyanzhargal ◽

...

Keyword(s):

Clinical Outcome ◽

Formation Rate ◽

Calcium Ionophore ◽

Oocyte Activation ◽

Blastocyst Formation ◽

Group A ◽

Donor Egg ◽

Artificial Oocyte Activation ◽

Group B ◽

Donor Eggs

Introduction: Oocyte donation is proved effective. Vitrification of donor eggs allows creation of donor egg banking. Simultaneously, for good clinical outcome it is recommended to thaw 10-15 oocytes at once. In the current study, we demonstrate the benefit of using artificial oocyte activation in order to reduce the number of thawed donor eggs for IVF program without any affect on laboratory and clinical outcome. Aim of study: To improve the good quality blastocyst formation rate using artificial activation with vitrified donor eggs. Is it possible to increase the clinical pregnancy rate (CPR) and live birth rate (LBR) thawing only 6-8 donor eggs? Materials and Methods: The retrospective cohort studyincluded 40 fresh (Group A) and 12 vitrified (Group B) donor egg programs. ICSI was conducted to all oocytes. In Group B, we also used artificial oocyte activation with calcium ionophore. Student T test was used to infer statistical significance. P value < 0.05 was considered significant. Results: The fertilization and good quality blastocyst formation rate is not different between the groups. The majority of usable blastocysts, 72% in Group A and 93% in Group B were formed on Day 5. The CPR is not statistically different between groups A and B and is 52.5% and 50% respectively. The IR is not statistically significant and is 39% in Group A and 42% in Group B. The LBR is higher in Group A (50%) comparing to Group B (25%), but the difference is not statistically significant. Conclusions: Considering our data, we suggest that artificial oocyte activation is feasible for use with vitrified donor eggs. It might decrease the expenses of patients on thawing less number of donor oocytes without negative impact on the laboratory and clinical outcome.

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Correlation between the DNA fragmentation index (DFI) and sperm morphology of infertile patients

Journal of Assisted Reproduction and Genetics ◽

10.1007/s10815-021-02080-w ◽

2021 ◽

Author(s):

Alberto Ferrigno ◽

Giovanni Ruvolo ◽

Giuseppina Capra ◽

Nicola Serra ◽

Liana Bosco

Keyword(s):

Dna Fragmentation ◽

Sperm Morphology ◽

Seminal Fluid ◽

Image Analyzer ◽

Fragmented Dna ◽

Fragmentation Index ◽

Group A ◽

Group B ◽

Infertile Patients ◽

Dna Fragmentation Index

Abstract Purpose To evaluate the correlation between the DNA Fragmentation Index (DFI) and sperm morphology in patients undergoing ICSI, as a predictive parameter in reproductive outcomes. Methods A retrospective study was conducted on 125 infertile patients enrolled in a fertility clinic. Seminal characteristics were measured following the WHO guidelines (2010) for the examination of the seminal fluid. After collecting motile sperm population by pellet swim up, DFI was calculated and simultaneously associated with sperm morphology using in situ TUNEL assay and an image analyzer software in at least 250 spermatozoa for each patient. Results All subjects were divided into two groups according to a cutoff established, by choice, of the sperm DFI (15%): group A (< 15%) consisting of 65 patients and group B (≥ 15%) of 60 patients. Data were analyzed using non-parametric statistical methods. The results demonstrate that there is no statistical difference between the two groups in seminal characteristics. The collective data show a high significant correlation, suggesting that spermatozoa with abnormal morphology are the best candidates to contain DNA damage (p < 0.001). Also, when group A is compared with group B, an increased percentage of morphologically normal spermatozoa with fragmented DNA was observed in patients, with DFI values ≥ 15% (p < 0.001). Conclusion These results are aimed at providing an exact value of DFI in morphologically normal spermatozoa, which will be helpful to the embryologist in evaluating the risk of transferring, during the ICSI procedure, a spermatozoon whit normal morphology but fragmented DNA.

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Oocytes with smooth endoplasmic reticulum aggregates do not impact blastocyst euploidy rate

10.21203/rs.3.rs-917473/v1 ◽

2021 ◽

Author(s):

Jian Xu ◽

Li Yang ◽

Zhi-Heng Chen ◽

Min-Na Yin ◽

Juan Chen ◽

...

Keyword(s):

Endoplasmic Reticulum ◽

Smooth Endoplasmic Reticulum ◽

Formation Rate ◽

Tertiary Hospital ◽

Fertilization Rate ◽

Blastocyst Formation ◽

Preimplantation Genetic Testing ◽

Significant Difference ◽

Normal Fertilization ◽

Euploidy Rate

Abstract Objective: To investigate whether the euploidy rate of blastocysts derived from smooth endoplasmic reticulum (SERa) positive cycles and oocytes are impacted.Design: Retrospective cohort study.Setting: A tertiary hospital-based reproductive medicine center.Patient(s): A total of 601 preimplantation genetic testing (PGT) cycles with obtained oocytes in our center between April 2017 and May 2021 were included in the study. Intervention(s): Women＞35 years and PGT cycles with chromosomal structural rearrangements (PGT-SR) were excluded. Embryological and blastocyst ploidy outcomes were compared between SERa+ oocyte, sibling SERa- oocytes and oocytes in SERa- cycles.Main Outcome Measure(s): Embryological outcomes and blastocyst euploidy rate.Results: No significant difference was observed in the normal fertilization rate (82.1 % vs. 77.8 % vs. 83.1 %, respectively, P=0.061), blastocyst formation rate (71.0 % vs. 72.5 % vs. 68.4 %, respectively, P=0.393), good quality blastocyst formation rate (46.4 % vs. 48.3 % vs. 42.6 %, respectively, P=0.198) between the SERa+ oocyte group, sibling SERa- oocyte group and SERa- oocyte group. No significant difference was observed in the euploidy rate (50.0 % vs. 62.5 % vs. 63.3 %, respectively, P=0.324), mosaic rate (12.5 % vs. 9.7 % vs. 13.4 %, respectively, P=0.506) and aneuploidy rate (37.5 % vs. 27.8% vs. 23.2 %, respectively, P=0.137) between the three groups.Conclusion: Our results suggest that the euploidy rate of blastocysts derived from SERa+ cycles and oocytes are not impacted.

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The influence of balanced complex chromosomal rearrangements on preimplantation embryonic development potential and molecular karyotype

10.21203/rs.2.14678/v2 ◽

2019 ◽

Author(s):

Gang Li ◽

Weiyi Shi ◽

Wenbin Niu ◽

Jiawei Xu ◽

Yihong Guo ◽

...

Keyword(s):

Embryonic Development ◽

Formation Rate ◽

Early Embryonic Development ◽

High Quality ◽

Abnormal Embryo ◽

Molecular Karyotype ◽

Group A ◽

The Difference ◽

Group B ◽

Euploid Embryo

Abstract Background: Balanced complex chromosome rearrangements (BCCR) are balanced chromosomal structural aberrations that involve two or more chromosomes and at least three breakpoints. It is very rare in the population. The objective is to explore the difference of influence of three types of BCCR on early embryonic development and molecular karyotype. Results: Twelve couples were recruited including four couples of three-way rearrangements carriers (group A), three couples of double two-way translocations carriers (group B) and five couples of exceptional CCR carriers (group C). A total of 243 oocytes were retrieved in the seventeen preimplantation genetic testing (PGT) cycles, and 207 of these were available for fertilization. After intracytoplasmic sperm injection, 181 oocytes normally fertilized.The rates of embryos forming on day3 in three groups were 87.88%, 97.78% and 77.14%, which was significantly different (P=0.01). Compared with group B, the rate of embryo formation was statistically significantly lower in group C (P=0.01). Furthermore, the rates of high-quality blastocysts in three group were 14.71%, 48.15% and 62.96%, respectively, which was significantly different (P=0.00). Compared with group B and C, the rate of high-quality blastocysts in group A was statistically significantly lower (P=0.00; P=0.00). Comprehensive chromosome analysis was performed on 83 embryos, including 75 trophectoderm cells and 8 blastomeres. Except 7 embryos failed to amplify, 9.01% embryos were diagnosed as euploidy, and 90.91% were diagnosed as abnormal. As for group A, the euploid embryo rate was 10.71% and the abnormal embryo rate was 89.29%. In group B, the euploid embryo rate was 3.85%, the abnormal embryo rate was 96.15%. The euploid embryo rate was 13.04%, the abnormal embryo rate was 86.96% in group C. There were no significant differences among the three groups (P = 0.55). Conclusions: The double two-way translocations couples have more chance to get balanced or normal embryos probably, and there may be more high-quality blastocysts in exceptional CCRs, but the blastocyst formation rate was similar among the three type of BCCR. Different types of BCCR maybe have little effect on the embryonic molecular karyotype. The difference of influence of BCCR on early embryonic development and molecular karyotype should be further studied.

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The Effect of Omega-3 on the Number of Retrieved Ova, Fertilization Rate, and Embryonic Grading in Subfertile Females Experiences Intracytoplasmic Sperm Injection Management Protocols

Biomedical & Pharmacology Journal ◽

10.13005/bpj/1605 ◽

2018 ◽

Vol 11 (4) ◽

pp. 2221-2232 ◽

Cited By ~ 1

Author(s):

Tabark Adel Al-Alousi ◽

Abdulaziz Ahmed Aziz ◽

MousaMohsin Ali Al-Allak ◽

Basima Sh. Al Ghazali

Keyword(s):

Fatty Acids ◽

Polyunsaturated Fatty Acids ◽

Intracytoplasmic Sperm Injection ◽

Liquid Paraffin ◽

Fertilization Rate ◽

Controlled Clinical Trial ◽

Omega 3 ◽

Group A ◽

Group B ◽

Metaphase Ii Oocytes

Maternal preconceiving nutrition is thought to affect fertility outcomes. The current emphasis on the omega-3 fatty acids, which has been associated with improved fertility in both spontaneous and assisted reproduction conceptions. This study aims to evaluate the role of preconceiving omega 3 polyunsaturated fatty acids supplementation in enhancing the proportion between follicles and retrieved ova, the fertilization rate, and the embryonic grading in subfertile females experiencing intracytoplasmic sperm injection management protocols. One-hundred twenty subfertile women aged 20-40 years-old undergoing intra-cytoplasmic sperm injection were recruited in this randomized double-blinded placebo-controlled clinical trial, at Fertility Center/ Al-Sadr Teaching Hospital/ Al Najaf/ Iraq. They were randomly assigned into two groups; group A (omega-3) includes 60 subfertile women who received one capsule 1000mg omega-3 and Group B (placebo) includes 60 subfertile women who received a placebo contain Liquid Paraffin 500mg for eight weeks. The number of follicles, number of oocytes, fertilization rates, and embryonic quality were recorded in both groups. The study result revealed that the ratio of follicle/retrieved oocyte, the number of metaphase II oocytes, fertilization rate, and grade I embryo were more in the group A compared to group B. Supplementation with Omega-3 polyunsaturated fatty acids can increase the ratio of follicle/retrieved oocyte, the number of metaphase II oocytes, fertilization rate, and grade I embryo, and thereby improving the pregnancy outcome in intracytoplasmic sperm injection cycles.

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A concise infertility work-up results in fewer pregnancies

Human Reproduction Open ◽

10.1093/hropen/hoab033 ◽

2021 ◽

Vol 2021 (4) ◽

Cited By ~ 1

Author(s):

J A M Hamilton ◽

J W van der Steeg ◽

C J C M Hamilton ◽

J P de Bruin

Keyword(s):

Success Rate ◽

Pregnancy Rate ◽

Semen Analysis ◽

Prognostic Score ◽

Ongoing Pregnancy ◽

Ongoing Pregnancy Rate ◽

Group A ◽

Group B ◽

Work Up

Abstract STUDY QUESTION Is pregnancy success rate after a concise infertility work-up the same as pregnancy success rate after the traditional extensive infertility work-up? SUMMARY ANSWER The ongoing pregnancy rate within a follow-up of 1 year after a concise infertility work-up is significantly lower than the pregnancy success rate after the traditional and extensive infertility work-up. WHAT IS KNOWN ALREADY Based on cost-effectiveness studies, which have mainly focused on diagnosis, infertility work-up has become less comprehensive. Many centres have even adopted a one-stop approach to their infertility work-up. STUDY DESIGN, SIZE, DURATION We performed a historically controlled cohort study. In 2012 and 2013 all new infertile couples (n = 795) underwent an extensive infertility work-up (group A). In 2014 and 2015, all new infertile couples (n = 752) underwent a concise infertility work-up (group B). The follow-up period was 1 year for both groups. Complete follow-up was available for 99.0% of couples in group A and 97.5% in group B. PARTICIPANTS/MATERIALS, SETTING, METHODS The extensive infertility work-up consisted of history taking, a gynaecological ultrasound scan, semen analysis, ultrasonographic cycle monitoring, a timed postcoital test, a timed progesterone and chlamydia antibody titre. A hysterosalpingography (HSG) was advised routinely. The concise infertility work-up was mainly based on history taking, a gynaecological ultrasound scan and semen analysis. A HSG was only performed if tubal pathology was suspected or before the start of IUI. Laparoscopy and hormonal tests were only performed if indicated. Couples were treated according to the diagnosis with either expectant management (if the Hunault prognostic score was >30%), ovulation induction (in case of ovulation disorders), IUI in natural cycles (in case of cervical factor), IUI in stimulated cycles (if the Hunault prognostic score was <30%) or IVF/ICSI (in case of tubal factor, advanced female age, severe male factor and if other treatments remained unsuccessful). The primary outcomes were time to pregnancy and the ongoing pregnancy rates in both groups. The secondary outcomes were the number of investigations, the distribution of diagnoses made, the first treatment (started) after infertility work-up and the mode of conception. MAIN RESULTS AND THE ROLE OF CHANCE The descriptive data, such as age, duration of infertility, type of infertility and lifestyle habits, in both groups were comparable. In group A, more than twice the number of infertility investigations were performed, compared to group B. An HSG was made less frequently in group B (33% versus 42%) and at a later stage. A Kaplan–Meier curve shows a shorter time to pregnancy in group A. Also, a significantly higher overall ongoing pregnancy rate within a follow-up of 1 year was found in group A (58.7% versus 46.8%, respectively, P < 0.001). In group A, more couples conceived during the infertility work-up (14.7% versus 6.5%, respectively, P < 0.05). The diagnosis cervical infertility could only be made in group A (9.3%). The diagnosis unexplained infertility differed between groups, at 23.5% in group A and 32.2% in group B (P < 0.001). LIMITATIONS, REASONS FOR CAUTION This was a historically controlled cohort study; introduction of bias cannot be ruled out. The follow-up rate was similar in the two groups and therefore could not explain the differences in pregnancy rate. WIDER IMPLICATIONS OF THE FINDINGS Re-introduction of an extensive infertility work-up should be considered as it may lead to higher ongoing pregnancy rates within a year. The therapeutic effects of HSG and timing of intercourse may improve the fertility chance. This finding should be verified in a randomized controlled trial. STUDY FUNDING/COMPETING INTEREST(S) No funding was obtained for this study. No conflicts of interest were declared. TRIAL REGISTRATION NUMBER N/A.

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