scholarly journals Endometrial Scratch (Injury): Does Timing Matter?

2019 ◽  
Author(s):  
Abigail Bernard ◽  
Katelyn Schumacher ◽  
Courtney Marsh
Keyword(s):  
Menstrual Cycle ◽  
Embryo Transfer ◽  
Implantation Rate ◽  
Oocyte Retrieval ◽  
Fresh Embryo Transfer ◽  
Endometrial Injury ◽  
Beta Hcg ◽  
Significant Difference ◽  
Endometrial Scratch ◽  
Three Phases

Objective: To examine the timing of endometrial scratch in a patient’s menstrual cycle and whether there is an association with subsequent implantation. Materials and methods: This study is a retrospective chart review on women, aged 18-45, seen in a reproductive endocrine clinic seeking conception. Timing of endometrial scratch was defined as proliferative (cycle day 1-9), periovulatory (CD11-16), or secretory (CD19+). All periovulatory biopsies were performed at time of oocyte retrieval in women freezing all oocytes/embryos for future use. Primary outcome of interest was positive beta-hCG within ninety days of the endometrial scratch. Results: Sixty-nine cases of endometrial scratch met the inclusion criteria. There were no statistically significant differences in baseline demographic characteristics between those who received endometrial injury in the three phases. There was no significant difference in frequency of positive beta-hCG within 90 days of endometrial scratch between the patients who received an endometrial scratch in the three phases (proliferative 65.6%, periovulatory 69.6%, secretory 64.3%; p = 0.9332). Conclusion: In contrast to prior studies which showed up to 65% decrease in implantation rate after endometrial scratch performed at time of oocyte retrieval, this study shows no significant difference in implantation when the injury is performed at the time of oocyte retrieval as compared to other phases of the menstrual cycle. Possible explanation may be that we did not perform a scratch if fresh embryo transfer was planned. As endometrial injury is associated with patient discomfort, performing the scratch while under conscious sedation for oocyte retrieval may be desirable in cycles where fresh embryo transfer is not planned. Future studies are needed to assess the validity of these findings

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.

CO2 sensitivity changes during the menstrual cycle

1989 ◽  
Vol 67 (2) ◽  
pp. 517-522 ◽  
Author(s):  
K. Dutton ◽  
B. A. Blanksby ◽  
A. R. Morton
Keyword(s):  
Menstrual Cycle ◽  
Analysis Of Variance ◽  
Luteal Phase ◽  
Threshold Level ◽  
Oral Temperature ◽  
Co2 Sensitivity ◽  
Co2 Rebreathing ◽  
Significant Difference ◽  
Sensitivity Changes ◽  
Three Phases

A study of the changes in CO2 sensitivity at rest was undertaken in 20 regularly menstruating females in an attempt to determine the influence of the menstrual cycle on this variable. A biphasic oral temperature graph was used to signify fertility and demarcate three phases of the cycle. A CO2-rebreathing test was conducted 3 times/wk for 6 wk to obtain CO2 sensitivity and CO2 threshold measures. An analysis of variance was used to compare the results collected in each phase of the cycle for each of the variables. A significant increase was found in the sensitivity to CO2 between the follicular and luteal phases, a significant decrease between the luteal and menstrual phases, and no significant difference between the follicular and menstrual phases. The change between follicular and luteal phases was attributed to the effect of progesterone, which is elevated during the luteal phase. No significant change was found in the CO2 threshold level.

scholarly journals Use of a new set of key performance indicators for evaluating the performance of an in vitro fertilization laboratory in which blastocyst culture and the freeze-all strategy are the primary treatment in patients with in vitro fertilization

2021 ◽  
Vol 49 (9) ◽  
pp. 030006052110443
Author(s):  
Hui-tian Wang ◽  
Ping-ping Hong ◽  
Hai-yang Li ◽  
Wen Zhou ◽  
Tao Li
Keyword(s):  
In Vitro Fertilization ◽  
Embryo Transfer ◽  
Performance Indicators ◽  
Implantation Rate ◽  
Key Performance Indicators ◽  
Control Analysis ◽  
Fresh Embryo Transfer ◽  
Blastocyst Culture ◽  
Vitro Fertilization

Objective To evaluate the performance of an in vitro fertilization (IVF) laboratory using a new set of key performance indicators (KPIs) when the main treatment of IVF patients had been changed. Methods Patients who underwent fresh embryo transfer and the freeze-all strategy in August, September, and October 2017 were retrospectively studied to evaluate the performance of an IVF laboratory in September when implantation rate of fresh embryo transfer decreased. KPIs associated with blastocyst culture and the first frozen embryo transfer (FET) cycle in patients with the freeze-all strategy were compared over 3 months. Results Day 5 usable blastocyst and good quality blastocyst rates, and day 3 usable/good quality embryo rates were not different among the three periods. The implantation rate and KPIs associated with morphological changes in warmed blastocysts in the first FET cycle in patients with the freeze-all strategy were also not different among the periods. Conclusions KPIs associated with embryo quality, blastocyst culture, and the pregnancy outcome of the first FET cycle in patients with the freeze-all strategy suggested that performance was unaffected in our IVF laboratory in September. These KPIs might be useful for internal quality control analysis of IVF laboratories.

scholarly journals 2017–2018 Assisted Reproduction Cost Analysis Performance Indexes: Lombardy County Case Study

2021 ◽  
Vol 3 ◽  
Author(s):  
Paolo Emanuele Levi-Setti ◽  
Andrea Busnelli ◽  
Annalisa Bodina ◽  
Roberto De Luca ◽  
Giulia Scaravelli
Keyword(s):  
Embryo Transfer ◽  
Multiple Pregnancy ◽  
Economic Cost ◽  
Oocyte Retrieval ◽  
Delivery Rate ◽  
Success Rates ◽  
Performance Indexes ◽  
Significant Difference ◽  
The Mean ◽  
Lost To Follow Up

Objective: The aim of the present study was to analyze the IVF success rates and the economic cost per delivery in all the public funded IVF Units in Lombardy in the 2017–2018 period and to assess any significant difference in ART outcomes among the enrolled centers.Methods: Analysis of costs for the 2017 and 2018 fresh transfer delivery rate (DR) and Cumulative delivery rate (CDR) considering both fresh and frozen cycles were extracted from the ART Italian Registry on oocytes retrievals, fresh and frozen embryos and oocytes embryo transfer performed in 22 Lombardy IVF Units.Results: In 2017, 29,718 procedures were performed, resulting in 4,543 pregnancies and 3,253 deliveries. In 2018, there were 29,708 procedures, 4,665 pregnancies and 3,348 deliveries. Pregnancies lost to follow up were 5.0% with a (range of 0–67.68%) in 2017 and 3.4% (range of 0–45.1%) in 2018. The cost reimbursement for the cycles were €2,232 ($2,611) for oocyte retrieval and €2,194 ($2,567) for embryo transfer, excluding ovarian stimulation therapy and luteal phase support. 19.33 (5.80). The DR was 13.23 ± 5.69% (range 2.86–29.11%) in 2017 and 19.33 ± 5.80% in 2018 (range 11.82–34.98 %) and the CDR was 19.86 ± 9.38% (range 4.43–37.88%) in 2017 and 21.32 ± 8.84% (range 4.24–37.11%). The mean multiple pregnancy delivery rate (MDR) was 11.08 ± 5.55% (range 0.00–22.73%) in 2017 and 10.41 ± 4.99% (range 1.33–22.22%) in 2018. The mean CDR cost in euros was 26,227 ± 14,737 in 2017 and 25,018 ± 16,039 in 2018. The mean CDR cost among centers was 12,480 to 76,725 in 2017 and 12,973 to 86,203 in 2018.Conclusions: Our findings show impressive differences in the DR and CDR among centers and the importance of cryopreservation in patients' safety and economic cost reduction suggesting the formulation of specific KPI's (Key performance indexes) and minimal performance indexes (PI) as a basis for the allocation of public or insurance resources. In particular, the reduction of multiple pregnancy rates costs, may lead to a more widespread use of ART even in lower resources countries.

scholarly journals Seasonal variability does not impact in vitro fertilization success

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Xitong Liu ◽  
Haiyan Bai ◽  
Ben W. Mol ◽  
Wenhao Shi ◽  
Ming Gao ◽  
...  
Keyword(s):  
Seasonal Variation ◽  
Embryo Transfer ◽  
Live Birth ◽  
Seasonal Variability ◽  
Multivariate Logistic Regression Analysis ◽  
Small Sample ◽  
Frozen Embryo Transfer ◽  
Fresh Embryo Transfer ◽  
Significant Difference

AbstractIt is unknown whether seasonal variation influences the outcome of in vitro fertilization (IVF). Previous studies related to seasonal variation of IVF were all small sample size, and the results were conflicting. We performed a retrospective cohort study evaluating the relationship between seasonal variability and live birth rate in the year of 2014–2017. Patients were grouped into four seasons (Winter (December-February), Spring (March-May), Summer (June-August), and Autumn (September-November)) according to the day of oocyte pick-up (OPU). Multivariate logistic regression analysis was performed to evaluate association between seasonal variation and live birth. Models were adjusted for covariates including temperature, sunshine hour, infertility type, infertility duration, infertility factor and BMI. In total 38,476 women were enrolled, of which 25,097 underwent fresh cycles, 13,379 were frozen embryo transfer. Live birth rates of fresh embryo transfer were 50.36%, 53.14%, 51.94% and 51.33% for spring, summer, autumn and winter, respectively. Clinical pregnancy rate between the calendar months varied between 55.1% and 63.4% in fresh embryo transfer (ET) and between 58.8% and 65.1% in frozen embryo transfer (FET) (P-values 0.073 and 0.220). In the unadjusted model and adjust model, seasonal variation was not associated with live birth. In conclusion, there was no significant difference of seasonal variations in the outcome of IVF with fresh embryo transfer and frozen embryo transfer.

P–325 The impact of letrozole on endometrial thickness in IVF cycles

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
J Ruiter-Ligeti ◽  
S Arab ◽  
W Buckett
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Fertility Preservation ◽  
Embryo Transfer ◽  
Endometrial Thickness ◽  
Oocyte Retrieval ◽  
Estradiol Level ◽  
Poor Responders ◽  
Fresh Embryo Transfer ◽  
The Impact

Abstract Study question Does daily administration of letrozole during IVF stimulation affect endometrial thickness ? Summary answer Patients treated with letrozole during fresh IVF cycles had a thinner endometrium on the day of trigger compared to patients who did not receive letrozole. What is known already Letrozole supplementation is commonly used during fertility preservation for breast cancer patients to reduce peak estrogen levels with no adverse effects on embryo outcomes. Studies in poor responders have found that letrozole use resulted in a shorter duration of stimulation and a lower total dose of gonadotropin, with no detrimental effect on IVF outcomes. In normal responders, studies have shown an increase in blastocysts obtained, but have not yet shown an increase in clinical pregnancy rates. There is concern that when a fresh embryo transfer is planned letrozole use may negatively affect endometrial thickness and subsequently diminish pregnancy rates. Study design, size, duration In a retrospective cohort study between January 2009 and June 2019 at a single academic fertility center, we compared the endometrial thickness in 97 cancer patients who underwent IVF-fertility preservation with daily letrozole use to 158 cancer patients who underwent IVF-fertility preservation without letrozole. Participants/materials, setting, methods All women diagnosed with cancer were referred for fertility preservation prior to gonadotoxic treatment exposure and were less than 40 years old at the time of oocyte retrieval. All patients who received letrozole started on day one of stimulation and continued until the day of oocyte retrieval. The primary outcome was endometrial thickness on the day of trigger. The secondary outcomes were number of oocytes retrieved, number of MII retrieved, and maximal estradiol level. Main results and the role of chance During the study period, 336 cancer patients underwent fertility preservation. Eighty-one patients were excluded; 50 because they had an intrauterine device or were on long term oral contraceptives and 31 because endometrial thickness was not documented. Of the remaining 255 patients, 86 had breast cancer, 95 had a hematological cancer and 74 had various other cancers. Ninety-seven cancer patients treated with letrozole were compared to 158 cancer patients who did not receive letrozole. Patients who received letrozole were significantly older (34 vs 28yrs, P &lt; 0.0001). There were no significant differences in baseline characteristics such as BMI, AFC nor in the total duration for stimulation. Endometrial thickness on the day of trigger was significantly less in letrozole treated patients (8 vs 9mm, P &lt; 0.003). There were no significant differences in total number of oocytes retrieved (12.5 vs 11, P = 0.126) nor in the number of mature oocytes (8 vs 8, P = 0.312). Patients in the letrozole group received a higher total gonadotropin dose (2680IU vs 1980IU, P = 0.016). The maximum estradiol level was significantly lower in patients treated with letrozole (1068 vs 3838ml/dl, P = &lt;0.0001). A regression analysis showed that using letrozole during stimulation decreased the endometrial thickness by 0.81mm (CI –1.37 to –0.253, P = 0.005). Limitations, reasons for caution The retrospective nature of this study could have introduced selection and misinformation bias. We report on cancer patients where all oocytes or embryos were vitrified. Without fresh embryo transfer data, it is unclear if a thinner endometrium due to letrozole will effect the implantation or pregnancy rate. Wider implications of the findings: As the use of letrozole expands beyond cancer patients and poor responders, it is important to understand the impact on the endometrium. This study shows that letrozole reduces endometrial thickness. However, the effect on endometrial function remains unknown. Further study is needed before letrozole can be used with fresh transfers. Trial registration number 2020–6370

A fine tuning of embryo loading technique by eliminating the air bubble in the outer sheath of embryo catheter among women undergoing IVF treatment

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Jasdev Singh Harbhajan Singh ◽  
Mohd Faizal Ahmad ◽  
Muhammad Azrai Abu ◽  
Mohd Hashim Omar ◽  
Abdul Kadir Abdul Karim
Keyword(s):  
Negative Impact ◽  
Implantation Rate ◽  
Oocyte Retrieval ◽  
Fine Tuning ◽  
Air Bubbles ◽  
Air Bubble ◽  
Beta Hcg ◽  
Group A ◽  
Group B

Abstract Objectives The role of air bubbles in bracketing the embryo-containing medium in inner catheter during embryo transfer (ET) has already been established. However, the role of air bubbles in outer catheter (OC) during implantation is yet to be determined. This study aimed to compare the implantation rates between women who have undergone ET with or without ASP (Vitrolife®; Sweden), a medium use for oocyte retrieval and rinsing in OC embryo catheter. The purpose of introducing the ASP medium to the OC was to eliminate air bubbles in that space during implantation. Methods A total of 312 women were randomly divided into two groups with 156 participants each group. In Group A, ASP medium was used during ET, whereas in Group B, no ASP medium was utilized. Positive implantation was defined as serum beta-hCG level >5 mIU/mL taken on the 7th day following ET. Results The average age of the majority of the participants was 30–39 years and had at least 4–5 years of subfertility. The unexplained subfertility was the prominent cause of ET failure in both groups. In most of the participants in both groups, ET was done using fresh embryo cycles with good to excellent embryo grades. After the ASP medium was manipulated in the OC in both groups, the positive implantation rate was not different in both groups (p>0.05). Conclusions The elimination of air bubbles in OC by using the ASP medium during ET did not confer an additional benefit nor exert a negative impact on implantation rate.

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