A randomized Clinical Trial comparing embryo quality and clinical pregnancy rate in PCOS patients underwent controlled ovarian stimulation using antagonist protocol with freeze all strategy and triggered for final oocyte maturation by gonadotropin agonist versus human chorionic gonadotropin in IVF cycles

Background: The use of Gonadotropin-releasing hormone (GnRH) antagonist protocol rather than the long agonist protocol showed a marked reduction in the incidence of OHSS Aim: To compare the effect of triggering oocytes by agonist versus HCG on reduction of risk of OHSS, embryo quality and clinical pregnancy rate. Patients and methods: A randomized Clinical Trial was conducted at IVF unit in Cairo University Obstetric and Gynecologic hospital. The patients were divided into two groups, the 1st group received GnRH agonist trigger, the 2nd group received hCG trigger; all embryos were frozen at day 5 and frozen embryos were transferred the next cycle. Results: There was an obvious reduction in the risk of OHSS in the GnRH agonist triggered group than in the HCG triggered group but with no statistically significant difference. In the current study, there was no statistically significant difference between the HCG triggered group in comparison to the GnRH agonist triggered group regarding chemical and clinical pregnancy rates. Conclusion: The use of GnRH triggering for women with PCOS undergoing ICSI cycle with antagonist protocol with freeze all and transfer of frozen embryos in a later cycle has a lower risk of OHSS than using HCG triggering method.

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Day-2 serum progesterone level and IVF/ICSI outcome: a comparative study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20171939 ◽

2017 ◽

Vol 6 (5) ◽

pp. 1871

Author(s):

Akshaya Kumar Mahapatro ◽

Abhishek Radhakrishan

Keyword(s):

Pregnancy Rate ◽

Live Birth ◽

Live Birth Rate ◽

Clinical Pregnancy ◽

Clinical Pregnancy Rate ◽

Progesterone Level ◽

In Vitro Fertilisation ◽

Serum Progesterone ◽

Significant Difference

Background: Purpose of this study was to evaluate the in vitro fertilisation outcome in patients having normal or elevated day-2 serum progesterone level undergone IVF by using GnRH antagonist.Methods: A retrospective study conducted in Institute of Reproductive Medicine, Chennai during January 2013 to March 2014. According to patient’s Day-2 serum progesterone level the total no of cases (N=151) were divided into two groups group-1 (N=116) with progesterone value ≤1.5ng/ml and group-2 (N=35) with progesterone value>1.5ng/ml. Ovarian stimulation was started with recombinant FSH on day 2 and GnRH antagonist injections started from day 6 of stimulation. Total dose of gonadotropins, days of gonadotrophin injections, no of eggs collected, Clinical pregnancy rate and live birth rate were compared between two groups.Results: Two groups were similar with regards to age, BMI, days of gonadotrophins and total doses of gonadotrophins. Incidence of elevated P level was 23.17%. Total pregnancy rate was 36.42%. A non-statistically-significant difference was observed in clinical pregnancy (37.06% vs 34.28%) and live birth (32.75% vs 28.57%) between the normal and elevated progesterone groups.Conclusions: Elevated day-2 serum progesterone level was associated with lower clinical pregnancy rate but it was not statistically-significant.

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Depression and Anxiety Among Men Undergoing ART Treatment

10.21203/rs.3.rs-474654/v1 ◽

2021 ◽

Author(s):

Zhangshun Liu ◽

Li Zhang ◽

Hongfang Shao ◽

Mian Huo ◽

Jie Chen ◽

...

Keyword(s):

Prospective Study ◽

Pregnancy Rate ◽

Clinical Pregnancy ◽

Clinical Pregnancy Rate ◽

The Self ◽

Anxiety And Depression ◽

Depression And Anxiety ◽

Self Rating ◽

Significant Difference ◽

Prospective Longitudinal

Abstract Objective: This prospective longitudinal study aimed at assessing the psychological status, especially depression and anxiety across different phases of ART treatments in subfertile men. Methods: During January 2016 to December 2018, 1248 fertile couples were recruited to participate in the prospective study. The Self-rating Anxiety Scale (SAS) and the Self-rating Depression Scale (SDS) were used to evaluate the presence of mental health problems in both husbands and wives at the day of initiation, oocyte retrieval and embryo transplantation respectively. Clinical pregnancy is defined as the presence of at least one intrauterine gestational sac with ultrasound assessment after a positive human chorionic gonadotropin assessment.Results: In total, 1248 infertile couples undergoing ART treatment participated in this prospective study. The clinical pregnancy rate was 42.4% in this study. The subject with SAS score ≥ 50 was classified as anxiety and SDS ≥ 53 as depression. The incidence of male anxiety and depression in the three assessment points in pregnant group were 8.48%, 8.07%, 8.07% and 9.04%, 8.90%, 10.71% respectively; In the nonpregnant group, the corresponding data were 9.75%, 6.05%, 10.02% and 6.43%, 6.99%, 9.07% respectively, and there was no significant difference between the two groups (P > 0.05).Conclusions: Although the SAS and SDS scores were higher in the nonpregnant group than those in the pregnant group, there was no statistical difference in the incidence of anxiety and depression between the two groups, and we concluded that male anxiety and depression are not closely associated with the ART clinical pregnancy rate.

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P–249 Does the re-expansion of thawed embryos affect the clinical outcomes of human blastocyst vitrification?

Human Reproduction ◽

10.1093/humrep/deab130.248 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

T Huong ◽

A Ph. Th. Tú ◽

L H Mai ◽

N Doã. Thảo ◽

C A Mạnh

Keyword(s):

Pregnancy Rate ◽

Clinical Outcomes ◽

Embryo Quality ◽

Cell Mass ◽

Clinical Pregnancy ◽

Clinical Pregnancy Rate ◽

Ongoing Pregnancy ◽

Ongoing Pregnancy Rate ◽

Group 2 ◽

Group 1

Abstract Study question Is that essential for prolonged culture of thawed blastocysts in order to be fully re-expanded before transferring? Summary answer Ongoing pregnancy rates decreased in blastocysts that not fully re-expanded after thawing. What is known already: The thaw survival of blastocysts is examined based on morphology of inner cell mass (ICM) and trophectoderm (TE). However, thawed blastocysts experience multiple changes in morphology and might be collapse after thawing due to the presence of blastocoel cavity. It is then difficult to evaluate blastocyst quality. Therefore, the blastocyst re-expansion is considered as a criteria to assess quickly the competent embryos. It also reflects the status energy metabolism from high quality embryo. After all, there are still some controversial opinions about the influence of re-expansion status after thawing. Study design, size, duration This was a retrospective study based on data collected between October 2019 and December 2020. A total 528 thawed blastocysts which were divided into two groups according to the post-thaw reexpansion status: fully re-expanded blastocysts (n = 416), partial or no re-expanded blastocysts (n = 112). The re-expansion status of blastocyst was assess prior to loading on the catheter by senior embryologists. Participants/materials, setting, methods Primary outcome is ongoing pregnancy. Only frozen single D5 transfer cycles were included. We excluded the frozen sperm/oocytes/embryos donation cycles, missing data, non-intact embryos after thawing. Statistical analyses were performed with T or chi-squared tests. Multivariable regression analysis was performed adjusting for the following confounding factors: age, BMI, embryo quality, re-expansion status, biopsied blastocyst. Main results and the role of chance Female age, BMI, number of previous cycles, endometrial thickness, positive HCG results, clinical pregnancy rate were comparable among patients within two groups. The rate of ongoing pregnancy rate in group 1 was significant higher compared with group 2 (51 vs 40.2, p < 0.05). The number of good quality blastocyst transferred in group 1 was higher than in group 2 (p < 0.001). However, under the same embryo quality, there were no difference between clinical pregnancy rate and ongoing pregnancy rate between two groups. When logistic regression were performed: only embryo quality, but not the re-expansion status, was noted to be an independent predictor of ongoing pregnancy (OR = 3.53;95% CI; 1.734–7.184;p=0.001). Limitations, reasons for caution The main limitation of the study is its retrospective design. Wider implications of the findings: Clinical outcomes are comparable between re-expanded blastocyst and partial or no re-expanded blastocysts, although ongoing pregnancy can be improved when embryos are fully expanded. As expected, blastocysts quality has the most important impact on ongoing pregnancy rate. Trial registration number Not applicable

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Progestin-primed ovarian stimulation vs mild stimulation in women with advanced age above 40: a retrospective cohort study

Reproductive Biology and Endocrinology ◽

10.1186/s12958-019-0518-3 ◽

2019 ◽

Vol 17 (1) ◽

Author(s):

Qian Peng ◽

Xiang Cao ◽

Jing Wang ◽

Lin Wang ◽

Jun Xu ◽

...

Keyword(s):

Cohort Study ◽

Pregnancy Rate ◽

Retrospective Cohort Study ◽

Ovarian Stimulation ◽

Retrospective Cohort ◽

Clinical Pregnancy ◽

Clinical Pregnancy Rate ◽

Advanced Age ◽

Significant Difference ◽

Mild Stimulation

Abstract Background Previous studies have demonstrated that progestin-primed ovarian stimulation (PPOS) protocol was a feasible and efficient method in in vitro fertilization (IVF) cycle. However, its application in women with advanced age has not been determined yet. The purpose of this study was to investigate its efficacy in women aged ≥40 years old. Methods This retrospective cohort study included patients with ages of ≥40 years old at the time of ovarian stimulation. The embryonic and clinical outcome of mild stimulation and PPOS were compared. Primary outcome was top-quality embryo rate on day 3, and secondary outcome was clinical pregnancy rate. Results Baseline characteristics of patients was similar in mild stimulation (122 cycles) and PPOS (47 cycles). No significant difference was found in the number of retrieved and mature oocytes and the fertilization and cleavage rates. Of interest, the rate of top-quality embryos was significantly higher in PPOS group (50.08% vs 33.29%, p = 0.015), with an increasing trend of viable embryo rate (73.55% vs 61.16%). A greater amount of gonadotropin was observed in PPOS group (2061.17 ± 1254.63 IU vs 1518.14 ± 547.25 IU, p < 0.05) in spite of comparable duration of stimulation. After FET cycle, no significant difference was found in the clinical pregnancy rates between mild stimulation (12.5%) and PPOS group (16.7%). Conclusions Higher percentage of top-quality embryos on Day 3 and comparable clinical pregnancy rate was obtained in PPOS protocol, which could be considered as a feasible ovarian stimulation protocol in women aged above 40 years old.

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Antioxidant pretreatment for male partner before ART for male factor subfertility: a randomized controlled trial

Human Reproduction Open ◽

10.1093/hropen/hoaa050 ◽

2020 ◽

Vol 2020 (4) ◽

Author(s):

Treasa Joseph ◽

Mariano Mascarenhas ◽

Reka Karuppusami ◽

Muthukumar Karthikeyan ◽

Aleyamma T Kunjummen ◽

...

Keyword(s):

Pregnancy Rate ◽

Embryo Transfer ◽

Controlled Trial ◽

Male Partner ◽

Clinical Pregnancy ◽

Clinical Pregnancy Rate ◽

Semen Parameters ◽

Male Factor ◽

Sperm Dna ◽

Significant Difference

Abstract STUDY QUESTION Does oral antioxidant pretreatment for the male partner improve clinical pregnancy rate in couples undergoing ART for male factor subfertility? SUMMARY ANSWER There was no significant difference in clinical pregnancy rate following oral antioxidant pretreatment for male partner in couples undergoing ART for male factor subfertility compared to no pretreatment. WHAT IS KNOWN ALREADY Damage to sperm mediated by reactive oxygen species (ROS) contributes significantly to male factor infertility. The ROS-related injury reduces fertilization potential and adversely affects the sperm DNA integrity. Antioxidants act as free radical scavengers to protect spermatozoa against ROS induced damage. During ART, use of sperms which have been exposed to ROS-mediated damage may affect the treatment outcome. Pretreatment with antioxidants may reduce the ROS-mediated sperm DNA damage. Currently, antioxidants are commonly prescribed to men who require ART for male factor subfertility but there is ambiguity regarding their role. STUDY DESIGN, SIZE, DURATION This was an open label, randomized controlled trial conducted at a tertiary level infertility clinic between February 2013 and October 2019. The trial included 200 subfertile couples who were undergoing ART treatment for male factor subfertility. PARTICIPANTS/MATERIALS, SETTING, METHODS Couples were randomized into treatment arm (n = 100) and control arm (n = 100). In the treatment arm, the male partner received oral antioxidants (Vitamin C, Vitamin E and Zinc) for 3 months just prior to the ART cycle. In the control arm, no antioxidant was given to the male partner. The primary outcome was clinical pregnancy rate, while live birth rate (LBR), miscarriage rate and changes in semen parameters were the secondary outcomes. MAIN RESULTS AND THE ROLE OF CHANCE Out of 200 women randomized, 135 underwent embryo transfer as per protocol. Following intention to treat analysis, no significant difference was noted in clinical pregnancy (36/100, 36% vs 26/100, 26%; odds ratio (OR) 1.60, 95% CI 0.87 to 2.93) and LBR (25/100, 25% vs 22/100, 22%; OR 1.18, 95% CI 0.61 to 2.27) between antioxidant and no pretreatment arms. The clinical pregnancy rate per embryo transfer was significantly higher following antioxidant pretreatment (35/64, 54.7% vs 26/71, 36.6%; OR 2.09, 95% CI 1.05 to 4.16) compared to no pretreatment. There was no significant difference in LBR per embryo transfer (25/64, 39.1%, vs 22/71, 31.0%; OR 1.43, 95% CI 0.70 to 2.91) after antioxidant pretreatment versus no pretreatment. The semen parameters of sperm concentration (median, interquartile range, IQR) (18.2, 8.6 to 37.5 vs 20.5, 8.0 to 52.5, million/ml; P = 0.97), motility (median, IQR) (34, 20 to 45 vs 31, 18 to 45%; P = 0.38) and morphology (mean ± SD) (2.0 ± 1.4 vs 2.2 ± 1.5%; P = 0.69) did not show any significant improvement after intake of antioxidant compared to no treatment, respectively. LIMITATIONS, REASONS FOR CAUTION The objective assessment of sperm DNA damage was not carried out before and after the antioxidant pretreatment. Since the clinicians were aware of the group allotment, performance bias cannot be ruled out. WIDER IMPLICATIONS OF THE FINDINGS The current study did not show any significant difference in clinical pregnancy and LBR following antioxidant pretreatment for the male partner in couples undergoing ART for male subfertility. The findings need further validation in a larger placebo-controlled randomized trial. STUDY FUNDING/COMPETING INTEREST(S) This trial has been funded by Fluid Research grant of Christian Medical College, Vellore (internal funding). The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER CTRI/2013/02/003431 TRIAL REGISTRATION DATE 26 February 2013 DATE OF FIRST PATIENT’S ENROLMENT 11 February 2013

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Male adiposity impairs clinical pregnancy rate by in vitro fertilization without affecting day 3 embryo quality

Obesity ◽

10.1002/oby.20164 ◽

2013 ◽

Vol 21 (8) ◽

pp. 1608-1612 ◽

Cited By ~ 25

Author(s):

Zaher O. Merhi ◽

Julia Keltz ◽

Athena Zapantis ◽

Joshua Younger ◽

Dara Berger ◽

...

Keyword(s):

In Vitro Fertilization ◽

Pregnancy Rate ◽

Embryo Quality ◽

Clinical Pregnancy ◽

Clinical Pregnancy Rate ◽

Vitro Fertilization ◽

Day 3 Embryo

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Estimating the causal effect of embryo transfer day on clinical in vitro fertilization outcomes using propensity score matching

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04013-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Han-Chih Hsieh ◽

Chun-I Lee ◽

En-Yu Lai ◽

Jia-Ying Su ◽

Yi-Ting Huang ◽

...

Keyword(s):

Pregnancy Rate ◽

Embryo Transfer ◽

Live Birth ◽

Implantation Rate ◽

Clinical Pregnancy ◽

Clinical Pregnancy Rate ◽

Vitro Fertilization ◽

Significant Difference ◽

Day 5 Transfer

Abstract Background For women undergoing in vitro fertilization (IVF), the clinical benefit of embryo transfer at the blastocyst stage (Day 5) versus cleavage stage (Day 3) remains controversial. The purpose of this study is to compare the implantation rate, clinical pregnancy rate and odds of live birth of Day 3 and Day 5 embryo transfer, and more importantly, to address the issue that patients were chosen to receive either transfer protocol due to their underlying clinical characteristics, i.e., confounding by indication. Methods We conducted a retrospective cohort study of 9,090 IVF cycles collected by Lee Women’s Hospital in Taichung, Taiwan from 1998 to 2014. We utilized the method of propensity score matching to mimic a randomized controlled trial (RCT) where each patient with Day 5 transfer was matched by another patient with Day 3 transfer with respect to other clinical characteristics. Implantation rate, clinical pregnancy rate, and odds of live birth were compared for women underwent Day 5 transfer and Day 3 transfer to estimate the causal effects. We further investigated the causal effects in subgroups by stratifying age and anti-Mullerian hormone (AMH). Results Our analyses uncovered an evidence of a significant difference in implantation rate (p=0.04) favoring Day 5 transfer, and showed that Day 3 and Day 5 transfers made no difference in both odds of live birth (p=0.27) and clinical pregnancy rate (p=0.11). With the increase of gestational age, the trend toward non-significance of embryo transfer day in our result appeared to be consistent for subgroups stratified by age and AMH, while all analyses stratified by age and AMH were not statistically significant. Conclusions We conclude that for women without strong indications for Day 3 or Day 5 transfer, there is a small significant difference in implantation rate in favor of Day 5 transfer. However, the two protocols have indistinguishable outcomes on odds of live birth and clinical pregnancy rate.

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Effect of granulocyte colony stimulating factor on pregnancy rate in women with unexplained infertility after intrauterine insemination: a randomized clinical trial

10.21203/rs.3.rs-23356/v1 ◽

2020 ◽

Author(s):

Shahintaj Aramesh ◽

Maryam Azizi Kutenaee ◽

Fataneh Najafi ◽

Parvin Ghafari ◽

seyed abdolvahab taghavi

Keyword(s):

Pregnancy Rate ◽

Endometrial Thickness ◽

Intrauterine Insemination ◽

Intervention Group ◽

Unexplained Infertility ◽

Clinical Pregnancy ◽

Clinical Pregnancy Rate ◽

Biochemical Pregnancy ◽

Significant Difference

Abstract Background The cause of infertility has not been found in unexplained infertile patients,, and perhaps one of the possible reasons is impairment of fetal implantation, as well as the multiple role of GCSF in improving implantation and quality of blastocyst. Therefore, the aim of this study was to investigate the role of GCSF in the pregnancy rate of patients undergoing IUI.Methods The patients with unexplained infertility were divided into two groups: one group was received GCSF in their IUI cycle and the other group had the routine IUI. Both groups were stimulated by letrozole, metformin, and monotropin during the cycle. When at least one follicle was greater than 18 mm, 5000 IU hCG intramuscularly was administered for ovulation induction and IUI was performed 34–36 hours later. In intervention group, 300 ug GCSF subcutaneously administrated in two days after IUI. Biochemical pregnancy rate was evaluated two weeks after IUI and clinical pregnancy rate was identified by the presence of a gestational sac on ultrasonography 8 weeks after IUI.Results There was no significant difference in demographic and clinical characteristics between the two groups. The chemical pregnancy rate(16.3% vs 12.2%) and the clinical pregnancy rates (16.3% vs 8.3%) were improved in patients receiving GCSF compared to controls, but these differences was not significant (P = 0.56) and (P = 0.21).Conclusion Systemic administration of a single dose of 300 µg GCSF subcutaneously two days after IUI may slightly improve clinical pregnancy rate in patients with unexplained infertility. Nevertheless, our findings do not support routine use of G-CSF in unexplained infertility women with normal endometrial thickness.

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