scholarly journals Development of assisted reproductive technology services in Thailand between 2008 and 2014 before the new law: Results generated from the National ART Registry, Royal Thai College of Obstetricians and Gynecologists

2020 ◽  
Vol 13 (5) ◽  
pp. 189-196
Author(s):  
Charoenchai Chiamchanya ◽  
Kamthorn Pruksananonda
Keyword(s):  
Pregnancy Rate ◽  
Assisted Reproductive Technology ◽  
Birth Rate ◽  
Reproductive Technology ◽  
Pregnancy Rates ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Total Birth ◽  
Clinical Pregnancy Rates ◽  
Multifetal Pregnancy

AbstractBackgroundWhile the assisted reproductive technology (ART) relieves the burden of infertility in many couples, it presents significant public health challenges due to the substantial risk for multiple birth delivery and preterm birth, which are associated with poor maternal and fetal health outcomes. For this reason, it is important to monitor the development and effectiveness of ART services in Thailand.ObjectiveTo analyze the trends of ART services in Thailand between 2008 and 2014.MethodsART clinics in Thailand are required to submit data to the Royal Thai College of Obstetricians and Gynecologists via the National Reporting System. The data from 2008 to 2014 were collected and analyzed.ResultsThe number of ART centers was increased from 35 to 47. The total fresh ART cycles were also increased from 3,723 to 6,516. The percentage values of intracytoplasmic sperm injection (ICSI), in vitro fertilization, gamete intrafallopian transfer, and zygote intrafallopian transfer cycles were changed from 77.87 to 95.59, 21.43 to 4.31, 0.21 to 0.09, and 0.45 to 0.05, respectively. The clinical pregnancy rates were 28.79–33.19, 22.84–51.34, 14.29–42.86, and 0.00–26.67, respectively. The clinical pregnancy rates in fresh vs. frozen-thawed cycles were 31.01–36.33 vs. 31.54–37.34 (P < 0.05). The clinical pregnancy rates in female age <35 vs. 35–39 vs. ≥40 years were 36.97–40.70 vs. 32.74–33.42 vs. 21.08–31.34, respectively (P < 0.001), and the percentage values of multifetal pregnancy rate were 18.75 vs. 13.30 and 13.69, respectively (P < 0.001). There were increasing preimplantation genetic screening (PGS) cycles, with the percentage of the clinical pregnancy rate (25.90–42.63, P < 0.05). The clinical pregnancy rates in medium-sized ART centers (100–300 cycles per year) vs. in small and large centers were 30.79–41.14 vs. 28.01–34.04 and 8.70–40.35, respectively (P < 0.001). Trends of increasing percentage of ART birth rate to total birth rate ratio were 0.24–0.34 (P < 0.05).ConclusionsThere were higher clinical pregnancy rates in frozen-thawed cycles. Higher multifetal pregnancy rate and clinical pregnancy rate were also found in younger females. There were increasing uses of ICSI and PGS. A trend toward increasing ART birth to total birth ratio was observed.

P–360 Blastocyst biopsy day does have an impact on clinical pregnancies in different frozen embryo transfer (FET) regimens: natural cycle (NC) versus hormone replacement therapy (HRT)

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
A Abdala ◽  
N D Munck ◽  
I ElKhatib ◽  
A Bayram ◽  
A Arnanz ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Study Design ◽  
Hormone Replacement ◽  
Cell Mass ◽  
Pregnancy Rates ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Pregnancy Test ◽  
Blastocyst Biopsy ◽  
Clinical Pregnancy Rates

Abstract Study question Do euploid blastocysts biopsied on day (D) 5 or D6 differ in clinical pregnancy rates when single FET are performed in NC or HRT cycles? Summary answer In single FET cycles, euploid D5 blastocysts have higher clinical pregnancy rates than D6 in NC, while outcomes are comparable in HRT cycles. What is known already: The synchronization between the endometrium and the embryo development is fundamental for a successful implantation. When performing FET with euploid blastocysts biopsied on D5 or D6, higher clinical pregnancy rates have been reported with D5 blastocysts, however contradictory findings were described due to the study design heterogeneity and endometrial preparation (EP) protocol variabilities. In FET cycles, no consensus has been defined of the superiority of NC over HRT cycles when euploid blastocysts are transferred. Consequently, the question remains unanswered if the clinical pregnancy rates of single euploid FET with D5 or D6 blastocysts differ when the EP protocol remains constant. Study design, size, duration A single center observational study was performed between June 2017 and November 2020, including 1027 single euploid FET with blastocysts biopsied on D5 or D6. All patients with primary or secondary infertility who underwent a FET in a NC or HRT EP protocol, with blastocysts graded ≥ BL3CC (Gardner scoring system) prior to biopsy were included. Vitrified-warmed blastocysts that did not re-expand within 1-hour post-warming were excluded from the analysis. Participants/materials, setting, methods In NCs, vaginal progesterone (P4) (Endometrin®) was administrated (3x100mg) after endocrinological confirmation of ovulation until pregnancy test. For HRT cycles, oral estradiol administration was started on day 2 (4 mg) and increased to 6mg on D5 of the cycle. When endometrial thickness was ≥6 mm, P4 was given (3x100mg) until pregnancy test. All FET were performed on D5 after start of P4 administration. Clinical pregnancy was recorded as the presence of an intrauterine gestational sac. Main results and the role of chance Women’s mean age was 33.8 ± 5.5 years. A total of 651 FETs were performed with D5 euploid blastocysts (37.6% in NC and 62.4% in HRT) and 376 with D6 (43.1% in NC and 56.9% in HRT). Clinical pregnancy rate in NC was higher with D5 blastocysts compared to D6 (66.9% vs 50.0%; OR = 0.494, 95% CI = 0.322–0.758; p &lt; 0.001), while no significant differences were found when vitrified-warmed blastocysts were transferred in HRT cycles (64.3% vs 58.4%; OR = 0.781, 95% CI = 0.548–1.112; p = 0.164). Additionally, clinical miscarriage was significantly higher with D5 euploid blastocysts transferred in NC (D5=10.9% vs D6=3.7%, OR = 0.239, 95% CI = 0.044–0.837; p = 0.019). In HRT, miscarriage outcomes were similar between D5 and D6 euploid blastocysts (D5=18.7% vs D6=20.8%, OR = 0.781, 95% CI = 0.548–1.112; p = 0.164), but significantly higher (p &lt; 0.001) than in NC. From a multinomial logistic regression model including age, blastocyst quality and day of biopsy as confounding factors, the clinical pregnancy rate was significantly affected by D6 blastocyst biopsy (OR = 0.571, 95% CI = 0.360–0.906, p = 0.017) and inner cell mass (ICM) grade A (OR = 3.941, 95% CI = 1.149–10.402; p = 0.006) or B (OR = 2.601, 95% CI = 1.146–5.907, p = 0.022) in NC. In HRT cycles, exclusively ICM was statistically significant (OR = 2.555, 95% CI = 1.214–5.381, p = 0.015 and OR = 2.397, 95% CI = 1.286–4.470, p &lt; 0.001 for grade A and B, respectively). Limitations, reasons for caution The current results are based on an observational retrospective study. Live birth and perinatal outcomes should be considered in a further analysis to evaluate the performance of the NC vs HRT protocols when D5 or D6 euploid blastocysts are transferred in FET cycles. Wider implications of the findings: While the clinical pregnancies of D5 and D6 euploid blastocysts are comparable in HRT protocols only, the miscarriage rates seem to be significantly increased as compared to NC. Further studies are required to personalize EP protocols based on the day of blastocyst biopsy in order to improve clinical outcomes. Trial registration number No

P–604 Effectiveness comparison of antral follicular count (AFC), follicular-output-rate (FORT), follicle-to-oocyte-index (FOI), oocyte-sensitivity-index (OSI), and follicular-sensitivity-idex (FSI) for predicting clinical pregnancy rates in IVF

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
P Bayu ◽  
H H Syam
Keyword(s):  
Retrospective Study ◽  
Pregnancy Rate ◽  
Medical Record ◽  
Pregnancy Rates ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Ultrasound Measurement ◽  
Sensitivity Index ◽  
Clinical Pregnancy Rates ◽  
Ovulatory Follicles

Abstract Study question Which is better for predicting clinical pregnancy rate : AFC, FORT, FOI, FSI, or OSI? Summary answer Both AFC and OSI can be used to predict clinical pregnancy better than FORT, FOI or FSI. What is known already AFC, FORT, FOI, OSI, FSI can be used to predict clinical pregnancy, but no study compared which one is better Study design, size, duration Retrospective study using data from medical record (2016–2018) Subjects were patients underwent IVF cycle at Aster Clinic in Hasan Sadikin Hospital Bandung. Subjects divided into 2 groups: clinically pregnant that is visible gestational sac on ultrasound (n = 83) and not pregnant (n = 148). Inclusion criteria : antagonist protocols, &lt;45 years, basal follicle stimulating hormone (FSH) ≤ 12 IU/L, ICSI fertilization method, and fresh transfer cycle. Participants/materials, setting, methods AFC categorized &lt; 5 and ≥ 5 (poseidon) FORT=pre-ovulatory follicles(16–20 mm) x 100 divided by AFC(2–10 mm). FOI=oocytes obtained x 100 divided by AFC. OSI=oocytes obtained x 1000 divided by total FSH dose. FSI=pre-ovulatory follicles x 100,000 divided by (AFC x total FSH dose). FORT and FSI divided using percentil 33 and 67. OSI divided into 3 groups by cut-off 1.697/IU for poor-response and 10.07/IU for hyperresponse. FOI divided into 2 groups, ≤ 50% or &gt; 50% Main results and the role of chance Group of AFC ≥ 5 had a significantly higher clinical pregnancy rate than the AFC &lt; 5 group (39.49% vs. 16.67% ; p = 0.009). High and moderate OSI had higher clinical pregnancy rate than low OSI (66.37% vs. 37.72% vs. 25.45% ; p = 0.038). There is a significant negative correlation between OSI and age (–0.454) or total FSH dose (–0.594). There is a significant positive correlation between OSI and AFC (0.625), the number of follicles at trigger (0.792), and oocytes (0.923). There were no significant differences in clinical pregnancy rates between the FORT, FOI, and FSI groups. Limitations, reasons for caution Limitation Retrospective study using medical record data Ultrasound measurement was done by many reproductive gynecology specialist (not 1 person) --- observer bias. Wider implications of the findings: This study found no association between FORT, FOI, FSI on clinical pregnancy. Why? FORT, FSI, FOI use measurement number of follicles at trigger and antral follicle. Differences among observers in interpreting antral follicles and number of follicles at trigger, or inaccurate measurement. No FORT, FOI, and FSI cut off values from previous study. Trial registration number Not applicable

scholarly journals Effects of Chromosomal Abnormalities on Assisted Reproductive Technology: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Ling Cui ◽  
Yonghong Lin ◽  
Fang Wang ◽  
Xinting Yu ◽  
Wending Teng ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Birth Rate ◽  
Chromosomal Abnormalities ◽  
Live Birth Rate ◽  
Reproductive Technology ◽  
Clinical Pregnancy ◽  
Exposed Group ◽  
Clinical Pregnancy Rate ◽  
Cumulative Live Birth Rate ◽  
Cumulative Live Birth

Abstract Background: To ascertain whether couples with chromosomal abnormalities have a difference in cumulative clinical pregnancy rate and cumulative live birth rate among assisted reproductive technology population. Methods: Design: A retrospective cohort study. Setting: Department of reproduction and infertility in Chengdu Women's and Children's Central Hospital.Patients: A total of 112 couples were in exposed group with chromosomal abnormalities and 226 couples without chromosomal abnormalities in control group included in the study, totaling 338 cases. From 1st Jan 2017 to 31st Dec 2019. Control group (infertility couples without chromosomal abnormalities) was 1:2 matched by female age, type of infertility (primary, secondary), type of assisted reproductive technology (IVF, ICSI or IUI). Results: Primary outcomes: cumulative clinical pregnancy rate and cumulative live birth rate. The results indicated that chromosomes abnormalities had no statistical difference in primary outcomes. Further analysis revealed exposed group (couples with chromosomal abnormalities) had less 2 pronuclear stage count. The times of embryo transfer by ICSI was less than IVF in exposed group. We found out only female age had an effect on the primary results and the threshold was 33.5years old.Conclusions: There were no significant differences in cumulative clinical pregnancy rate and cumulative live birth rate between two groups. But 2 pronuclear stage count, and the times of embryo transfer were affected by chromosomal abnormalities. It may be better to choose ICSI and PGT in this population.

scholarly journals Analysis of endometrial thickness patterns and pregnancy outcomes considering 12,991 fresh IVF cycles

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
ShuJie Liao ◽  
Renjie Wang ◽  
Cheng Hu ◽  
Wulin Pan ◽  
Wei Pan ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Endometrial Thickness ◽  
Multiple Logistic Regression Analysis ◽  
Pregnancy Rates ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Significant Difference ◽  
Clinical Pregnancy Rates ◽  
The Relationship ◽  
Selection Of

Abstract Background Different endometrial patterns have an important effect on the relationship between endometrial thickness (EMT) and clinical pregnancy rate. There is a significant difference in age, selection of cycle protocols, and clinical pregnancy rates among four groups with diverse endometrial patterns. Methods This retrospective study aimed to assess the association between EMT on human chorionic gonadotropin (HCG) administration day and the clinical outcome of fresh in vitro fertilization (IVF). The 5th, 50th, and 95th percentiles for EMT were determined as 8, 11, and 14 mm, respectively. Patients were sub-divided into four groups based on their EMT in different endometrial patterns (Group 1: < 8 mm; Group 2: ≥ 8 and ≤ 11 mm; Group 3: > 11 and ≤ 14 mm; Group 4: > 14 mm). We divided patients into three groups based on their endometrial pattern and evaluated the correlation between EMT and clinical pregnancy rate. Results We found a positive correlation between pregnancy rates and EMT in all endometrial patterns. Multiple logistic regression analysis proved age, duration of infertility, cycle protocols, number of embryos transferred, progesterone on HCG day, endometrial patterns, and EMT have significant effects on clinical pregnancy rates. Meanwhile, there was a significant difference in age, selection of cycle protocols, and clinical pregnancy rates among four groups with diverse endometrial patterns. Conclusions Different endometrial patterns have an important effect on the relationship between EMT and clinical pregnancy rate.

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