The Dynamics of the Vaginal Micro-Ecology During in Vitro Fertilization and Embryo Transfer (IVF-ET) Cycles and its Impact on Pregnancy Outcomes

Abstract BackgroundAbnormal reproductive tract flora may cause infertility, and it may play a key role in the success of assisted reproductive technologies (ART). The obvious short-term changes in estrogen caused by clinical protocols with IVF-ET provide a unique perspective for us to assess the vaginal flora, shifting hormonal condition and investigate the potential associations of the vaginal micro-ecology with cycle outcome of pregnancy. The Vaginal Micro-ecology Evaluation System (VMES) as a tool to analyze the vaginal microbiomes in most areas of China. This study aims to apply the VMES to evaluate the dynamics of vaginal micro-ecology during IVF-ET, and investigate the correlations between vaginal micro-ecology with pregnancy outcome.Methods　150 patients were enrolled who underwent early follicular phase prolonged protocol IVF-ET due to tubal factors. The VMES is used to evaluate vaginal microbiology indicators of vaginal swabs obtained in different hormonal milieu during the IVF-ET cycle. The pregnancy outcomes were observed, if pregnant.Results　In our data, the prevalence of bacterial vaginitis (BV) accounts for 3.3%. During IVF procedure, the vaginal microbiome varied across hormonal milieu in some but not all patients. The proportion of BV, and unidentified dysbiosis were increased significantly on the day of human chorionic gonadotropin (HCG) administration. The vaginal micro-ecology on the day of HCG administration correlated with outcome (live birth / no live birth). The multivariable logistic regression model showed that the average age, the duration of infertility, and the vaginal micro-ecology after controlled ovarian hyperstimulation (COH) were associated with the live birth rate.ConclusionOur retrospective cohort study suggests that the VEMS has enabled discovery of unidentified dysbiosis shift in the vaginal micro-ecology during IVF-ET therapy. More importantly, the vaginal micro-ecology on the day of HCG administration was significantly associated with the live birth rate.

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The role of the growth hormone in assisted reproductive technologies cycles

GYNECOLOGY ◽

10.26442/20795696.2019.4.190526 ◽

2019 ◽

Vol 21 (4) ◽

pp. 6-8

Author(s):

Andrey Y Romanov ◽

Anastasiya G Syrkasheva ◽

Nataliya V Dolgushina ◽

Elena A Kalinina

Keyword(s):

Growth Hormone ◽

Live Birth ◽

Ovarian Stimulation ◽

Assisted Reproductive Technologies ◽

Polycystic Ovary ◽

Live Birth Rate ◽

Reproductive Technologies ◽

Blood Levels ◽

Main Research ◽

Poor Ovarian Responders

The paper analyzes the literature data on the use of the growth hormone (GH) in ovarian stimulation in assisted reproductive technologies (ART). Routine use of GH in ovarian stimulation in patients with a normal GH level does not increase pregnancy and childbirth rates in ART. Also, no benefits of using GH have been identified for patients with polycystic ovary syndrome, despite the increase in insulin and IGF-1 blood levels. The main research focus is to study the use of GH in patients with poor ovarian response. According to the meta-analysis conducted by X.-L. Li et al. (2017), GH in ovarian stimulation of poor ovarian responders increases the number of received oocytes, mature oocytes number, reduces the embryo transfer cancellation rate and does not affect the fertilization rate. The pregnancy and live birth rates are significantly higher in the group of GH use - by 1.65 (95% CI 1.23-2.22) and 1.73 (95% CI 1.25-2.40) times, respectively. Thus, it is advisable to use GH in ovarian stimulation in poor ovarian responders, since it allows to increases live birth rate in ART. However, further studies should determine the optimal GH dose and assesse it`s safety in ART programs.

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Influence of surgical evacuation on pregnancy outcomes of subsequent embryo transfer cycle following miscarriage in an initial IVF cycle: a retrospective cohort study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-019-2543-9 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Junan Meng ◽

Mengchen Zhu ◽

Wenjuan Shen ◽

Xiaomin Huang ◽

Haixiang Sun ◽

...

Keyword(s):

Embryo Transfer ◽

Live Birth ◽

Pregnancy Outcomes ◽

Birth Rate ◽

Endometrial Thickness ◽

Live Birth Rate ◽

First Trimester ◽

Miscarriage Rate ◽

Significant Difference ◽

Surgical Evacuation

Abstract Background It is still uncertain whether surgical evacuation adversely affects subsequent embryo transfer. The present study aims to assess the influence of surgical evacuation on the pregnancy outcomes of subsequent embryo transfer cycle following first trimester miscarriage in an initial in vitro fertilization and embryo transfer (IVF-ET) cycle. Methods A total of 645 patients who underwent their first trimester miscarriage in an initial IVF cycle between January 2013 and May 2016 in Nanjing Drum Tower Hospital were enrolled. Surgical evacuation was performed when the products of conception were retained more than 8 h after medical evacuation. Characteristics and pregnancy outcomes were compared between surgical evacuation patients and no surgical evacuation patients. The pregnancy outcomes following surgical evacuation were further compared between patients with ≥ 8 mm or < 8 mm endometrial thickness (EMT), and with the different EMT changes. Results The EMT in the subsequent embryo transfer cycle of surgical evacuation group was much thinner when compared with that in the no surgical evacuation group (9.0 ± 1.6 mm vs. 9.4 ± 1.9 mm, P = 0.01). There was no significant difference in implantation rate, clinical pregnancy rate, live birth rate or miscarriage rate between surgical evacuation group and no surgical evacuation group (P > 0.05). The live birth rate was higher in EMT ≥ 8 mm group when compared to < 8 mm group in surgical evacuation patients (43.0% vs. 17.4%, P < 0.05). Conclusions There was no significant difference in the pregnancy outcomes of subsequent embryo transfer cycle between surgical evacuation patients and no surgical evacuation patients. Surgical evacuation led to the decrease of EMT, especially when the EMT < 8 mm was association with a lower live birth rate.

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Is It Possible to Expand Oocyte Donors by Decreasing Number of Oocytes for Own Use? Insights From a Large Single-Center Study

Frontiers in Endocrinology ◽

10.3389/fendo.2021.727339 ◽

2021 ◽

Vol 12 ◽

Author(s):

Zhiqin Bu ◽

Jiaxin Zhang ◽

Yile Zhang ◽

Yingpu Sun

Keyword(s):

Live Birth ◽

Birth Rate ◽

Live Birth Rate ◽

Oocyte Donation ◽

Control Group ◽

Cumulative Live Birth Rate ◽

Oocyte Number ◽

Oocyte Donors ◽

Supernumerary Embryos ◽

Ivf Et

BackgroundCurrently, in China, only women undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles can donate oocytes to others, but at least 15 oocytes must be kept for their own treatment. Thus, the aim of this study was to determine whether oocyte donation compromises the cumulative live birth rate (CLBR) of donors and whether it is possible to expand oocyte donors’ crowd.MethodsThis was a retrospective cohort study from August 2015 to July 2017 including a total of 2,144 patients, in which 830 IVF–embryo transfer (IVF-ET) patients were eligible for oocyte donation and 1,314 patients met all other oocyte donation criteria but had fewer oocytes retrieved (10–17 oocytes). All 830 patients were advised to donate approximately three to five oocytes to others and were eventually divided into two groups: the oocyte donation group (those who donated) and the control group (those who declined). The basic patient parameters and CLBR, as well as the number of supernumerary embryos after achieving live birth, were compared. These two factors were also compared in all patients (2,144) with oocyte ≥10.ResultsIn 830 IVF-ET patients who were eligible for oocyte donation, only the oocyte number was significantly different between two groups, and the donation group had more than the control group (25.49 ± 5.76 vs. 22.88 ± 5.11, respectively; p = 0.09). No significant differences were found between the two groups in other factors. The results indicate that the live birth rate in the donation group was higher than that in the control group (81.31% vs. 82.95%, p = 0.371), without significance. In addition, CLBR can still reach as high as 73% when the oocyte number for own use was 10. Supernumerary embryos also increased as the oocyte number increased in all patients (oocyte ≥10).ConclusionsCurrently, oocyte donation did not compromise CLBR, and oocyte donation can decrease the waste of embryos. In addition, in patients with 10 oocytes retrieved, the CLBR was still good (73%). Thus, it is possible to expand oocyte donors if the number of oocyte kept for own use was decreased from 15 to 10 after enough communication with patients.

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Delay in IVF treatment up to 180 days does not affect pregnancy outcomes in women with diminished ovarian reserve

Human Reproduction ◽

10.1093/humrep/deaa137 ◽

2020 ◽

Vol 35 (7) ◽

pp. 1630-1636 ◽

Cited By ~ 9

Author(s):

Phillip A Romanski ◽

Pietro Bortoletto ◽

Zev Rosenwaks ◽

Glenn L Schattman

Keyword(s):

Embryo Transfer ◽

Live Birth ◽

Ovarian Reserve ◽

Subgroup Analysis ◽

Pregnancy Outcomes ◽

Birth Rate ◽

Live Birth Rate ◽

Oocyte Retrieval ◽

Diminished Ovarian Reserve ◽

Short Term Treatment

Abstract STUDY QUESTION Will a delay in initiating IVF treatment affect pregnancy outcomes in infertile women with diminished ovarian reserve? SUMMARY ANSWER A delay in IVF treatment up to 180 days does not affect the live birth rate for women with diminished ovarian reserve when compared to women who initiate IVF treatment within 90 days of presentation. WHAT IS KNOWN ALREADY In clinical practice, treatment delays can occur due to medical, logistical or financial reasons. Over a period of years, a gradual decline in ovarian reserve occurs which can result in declining outcomes in response to IVF treatment over time. There is disagreement among reproductive endocrinologists about whether delaying IVF treatment for a few months can negatively affect patient outcomes. STUDY DESIGN, SIZE, DURATION A retrospective cohort study of infertile patients in an academic hospital setting with diminished ovarian reserve who started an IVF cycle within 180 days of their initial consultation and underwent an oocyte retrieval with planned fresh embryo transfer between 1 January 2012 and 31 December 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS Diminished ovarian reserve was defined as an anti-Müllerian hormone (AMH) <1.1 ng/ml. In total, 1790 patients met inclusion criteria (1115 immediate and 675 delayed treatment). Each patient had one included cycle and no subsequent data from additional frozen embryo transfer cycles were included. Since all cycle outcomes evaluated were from fresh embryo transfers, no genetically tested embryos were included. Patients were grouped by whether their cycle started 1–90 days after presentation (immediate) or 91–180 days (delayed). The primary outcome was live birth (≥24 weeks of gestation). A subgroup analysis of more severe forms of diminished ovarian reserve was performed to evaluate outcomes for patients with an AMH <0.5 and for patients >40 years old with an AMH <1.1 ng/ml (Bologna criteria for diminished ovarian reserve). Logistic regression analysis, adjusted a priori for patient age, was used to estimate the odds ratio (OR) with a 95% CI. All pregnancy outcomes were additionally adjusted for the number of embryos transferred. MAIN RESULTS AND THE ROLE OF CHANCE The mean ± SD number of days from presentation to IVF start was 50.5 ± 21.9 (immediate) and 128.8 ± 25.9 (delayed). After embryo transfer, the live birth rate was similar between groups (immediate: 23.9%; delayed: 25.6%; OR 1.08, 95% CI 0.85–1.38). Additionally, a similar live birth rate was observed in a subgroup analysis of patients with an AMH <0.5 ng/ml (immediate: 18.8%; delayed: 19.1%; OR 0.99, 95% CI 0.65–1.51) and in patients >40 years old with an AMH <1.1 ng/ml (immediate: 12.3%; delayed: 14.7%; OR 1.21, 95% CI 0.77–1.91). LIMITATIONS, REASONS FOR CAUTION There is the potential for selection bias with regard to the patients who started their IVF cycle within 90 days compared to 91–180 days after initial consultation. In addition, we did not include patients who were seen for initial evaluation but did not progress to IVF treatment with oocyte retrieval; therefore, our results should only be applied to patients with diminished ovarian reserve who complete an IVF cycle. Finally, since we excluded patients who started their IVF cycle greater than 180 days from their first visit, it is not known how such a delay in treatment affects pregnancy outcomes in IVF cycles. WIDER IMPLICATIONS OF THE FINDINGS A delay in initiating IVF treatment in patients with diminished ovarian reserve up to 180 days from the initial visit does not affect pregnancy outcomes. This observation remains true for patients who are in the high-risk categories for poor response to ovarian stimulation. Providers and patients should be reassured that when a short-term treatment delay is deemed necessary for medical, logistic or financial reasons, treatment outcomes will not be affected. STUDY FUNDING/COMPETING INTEREST(S) No financial support, funding or services were obtained for this study. The authors do not report any potential conflicts of interest. TRIAL REGISTRATION NUMBER Not applicable.

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P1526HOW TO DEAL WITH PREGNANCY IN DIALYSIS? A CENTER EXPERIENCE ABOUT 7 CASES

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1526 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Ramia BENHAMOU ◽

Meriem Chettati ◽

Wafaa Fadili ◽

Inass Laouad

Keyword(s):

Live Birth ◽

Pregnancy Outcomes ◽

Birth Rate ◽

Live Birth Rate ◽

Fetal Outcome ◽

The Mean ◽

Adverse Pregnancy ◽

Stage Renal Disease ◽

End Stage ◽

Intensive Hemodialysis

Abstract Background and Aims Outcomes of pregnancy in patients with end-stage renal disease (ESRD) have long been considered to be extremely poor, and the literature concerning pregnancy while on dialysis is rather meagre. We reported our center experience about pregnancy management in patients on hemodialysis: how to deal with hypertension, ultrafiltration rate, dose dialysis in order to improve maternal and fetal outcome. Method We reported pregnancy outcomes of 7 pregnancies in the Tensift Region Pregnancy registry between March 2015 and March. 2019 The primary outcome was the live birth rate and secondary outcomes included gestational age and birth weight. Results We reported 7 pregnant women cases on hemodialysis. Mean age of our patients was 29,5 ±6,57 years. It was the first pregnancy for 3 patients (42,9%). In about half of patients dialysis was initiated during their pregnancy. The mean duration of pregnancy was 35±1,2 weeks and mean fetal weight was 1,950 ±0,353 kg. All patients were dialyzed over 20 hours per week. The mean urea value was 0,46 ±0,04g/L. Two patients needed anti hypertensive drugs (33,3%) mainly nicardipine. The live birth rate of our cohort (71,4%), all vaginal delivery, was significantly higher than the rate in the American cohort (61.4%). In your series we reported one fetal death at 28 SA explained by tocolysis failure for preterm labor. At 9 months all children had good cognitive and psychomotor involvement. Conclusion We conclude that pregnancy may be safe and feasible in women with ESRD receiving intensive hemodialysis. A multidisciplinary medical care with obstetricians is highly recommended. Despite a trend of increasing live birth rate over recent decades, pregnancies on dialysis high risk, with increased rates of adverse of adverse pregnancy outcomes including pregnancy loss.

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Elective and emergency cervical cerclage and immediate pregnancy outcomes: a retrospective observational study

JRSM Short Reports ◽

10.1258/shorts.2011.011043 ◽

2011 ◽

Vol 2 (11) ◽

pp. 1-6 ◽

Cited By ~ 16

Author(s):

Andrea Liddiard ◽

Sohinee Bhattacharya ◽

Lena Crichton

Keyword(s):

Birth Weight ◽

Observational Study ◽

Live Birth ◽

Complication Rate ◽

Pregnancy Outcomes ◽

Birth Rate ◽

Live Birth Rate ◽

Retrospective Observational Study ◽

Delivery Mode ◽

Cervical Cerclage

Objectives To look retrospectively at patients undergoing elective, ultrasound indicated and rescue cervical cerclage, examine the immediate pregnancy outcomes and compare them. Design This was a retrospective observational study using the maternity and neonatal databank to identify patients having cervical cerclage between 1985 and 2009 inclusive. Data extracted included patient demographics, gestation of suture insertion, gestation at delivery, mode of delivery and initial pregnancy outcome. Further information on selected patients having cerclages over 16 weeks gestation was collected from case-notes. Setting Aberdeen Maternity Hospital, North East Scotland. Participants All patients having cervical cerclage between 1985 and 2009. Main outcome measures Gestation at delivery, live birth rate and birth weight. Results A total of 177 sutures were inserted – 116 electively and 61 as an emergency procedure. Time trends of cervical cerclage revealed a bimodal distribution and in the last four years there has been a general increase in the number of emergency sutures while the number of elective cerclages has remained relatively constant. There was little difference in the gestation at delivery between the elective and emergency cerclage groups (35 and 33 weeks, respectively), live birth rate (93% and 92%, respectively) and the difference in mean birth weight did not reach statistical significance. Case-notes were obtained for 25 patients undergoing ultrasound indicated cerclage and nine patients undergoing rescue cerclage. There was a higher suture associated complication rate in the rescue cerclage group (33% vs. 12% in the ultrasound indicated cerclage group) and the mean gestation of delivery was lower (26 weeks vs. 32 weeks). The birth weight was significantly lower and the neonatal death rate higher in the rescue cerclage group. Conclusions Elective and ultrasound indicated cervical cerclage appear to have low complication rates and high live birth rates. Rescue cerclage has a high complication rate and is therefore associated with poor outcome.

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Systematic meta-analysis of subsequent pregnancy outcomes in recurrent pregnancy loss couples with parental abnormal chromosomal karyotype

10.22541/au.163424449.91097893/v1 ◽

2021 ◽

Author(s):

Peng-Sheng Zheng ◽

Shan Li ◽

Jing Jing He

Keyword(s):

Live Birth ◽

Pregnancy Outcomes ◽

Pregnancy Loss ◽

Birth Rate ◽

Recurrent Pregnancy Loss ◽

Meta Analysis ◽

Live Birth Rate ◽

Sufficient Evidence ◽

Current Evidence ◽

Miscarriage Rate

Background Parental abnormal chromosomal karyotypes are considered as reasons for recurrent pregnancy loss. Objective This systematic meta-analysis evaluated the current evidence on pregnancy outcomes amongst couples with abnormal versus normal chromosomal karyotypes. Search strategy Two independent reviewers screened titles and abstracts identified in EMBASE and PubMed from inception to January 2021. Selection criteria Studies were included if they provided a description of pregnancy outcomes of parental chromosomal abnormality. Data collection and analysis Random effects meta-analysis was used to compare odds of pregnancy outcomes associated with noncarriers and carriers. Main results A significantly lower first pregnancy live birth rate (FPLBR) was found in carriers than in noncarriers with RPL (OR: 0.55; 95% CI: 0.46-0.65; p<0.00001). Regarding FPLBR between translocation or inversion carriers and noncarriers, a markedly decreased FPLBR was found in translocation (OR: 0.44; 95% CI: 0.31–0.61; p<0.00001) but not inversion carriers. The accumulated live birth rate (ALBR) (OR: 0.96; 95% CI: 0.90–1.03; p=0.26) was similar, while the miscarriage rate (MR) of accumulated pregnancies (OR: 2.21; 95% CI: 1.69–2.89; p<0.00001) was significantly higher in the carriers than in noncarriers with RPL. The ALBR was not significant (OR: 1.82; 95% CI: 0.38–8.71; p=0.45) but the MR (OR: 5.75; 95% CI: 2.57–12.86; p<0.0001) was markedly lower for carriers who choose PGD than natural conception. Conclusions Carriers with RPL had higher risk of miscarriage but obtained a satisfying pregnancy outcome through multiple attempts. No sufficient evidence was found PGD could enhance the ALBR but it was an alternative to decrease the MR.

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Effect of orlistat on live birth rate in overweight or obese women undergoing IVF-ET: A randomized clinical trial

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgab340 ◽

2021 ◽

Author(s):

Ze Wang ◽

Junli Zhao ◽

Xiang Ma ◽

Yun Sun ◽

Guimin Hao ◽

...

Keyword(s):

Weight Loss ◽

Placebo Group ◽

Embryo Transfer ◽

Live Birth ◽

Birth Rate ◽

Randomized Clinical Trials ◽

Live Birth Rate ◽

Obese Women ◽

Significant Difference ◽

Ivf Et

Abstract Context Obesity management prior to infertility treatment remains a challenge. To date, results from randomized clinical trials involving weight loss by lifestyle interventions have shown no evidence of improved live birth rate. Objective To determine whether pharmacologic weight-loss intervention before in vitro fertilization and embryo transfer (IVF-ET) can improve live birth rate among overweight or obese women. Design, setting, and participants We conducted a randomized, double-blinded, placebo-controlled trial across 19 reproductive medical centers in China, from July 2017 to January 2019. A total of 877 infertile women scheduled for IVF who had a body mass index of 25kg/m 2 or greater were randomly assigned. Interventions The participants were randomized to receive orlistat (n=439) or placebo (n=438) treatment for 4-12 weeks. Main outcomes and measures Live birth rate after fresh embryo transfer. Results The live birth rate was not significantly different between the two groups (112 of 439 [25.5%] with orlistat and 112 of 438 [25.6%] with placebo; P=.984). No significant differences existed between the groups as to the rates of conception, clinical pregnancy, and pregnancy loss. A statistically significant increase in singleton birthweight was observed after orlistat treatment (3487.50g versus 3285.17g in the placebo group; P=.039). The mean change in body weight during the intervention was −2.49kg in the orlistat group, as compared to −1.22kg in the placebo group, with a significant difference (P=.005). Conclusions Orlistat treatment, prior to IVF-ET, did not improve live birth rate among overweight or obese women, although it was beneficial for weight reduction.

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Diclofenac Administered After the Initiation of Luteinizing Hormone Surge Increases Live Births in Natural-Cycle IVF-ET: A Cohort Study

10.21203/rs.3.rs-33392/v1 ◽

2020 ◽

Author(s):

Shokichi Teramoto ◽

Hisao Osada ◽

Tsuyoshi Okubo ◽

Tsuyoshi Ueno ◽

Fumihito Aono ◽

...

Keyword(s):

Live Birth ◽

Birth Rate ◽

Hormone Replacement ◽

Live Birth Rate ◽

Oocyte Retrieval ◽

Natural Cycle ◽

Lh Surge ◽

Follicle Rupture ◽

Natural Cycle Ivf ◽

Ivf Et

Abstract Background: Diclofenac inhibits follicle rupture and its use in natural-cycle in vitro fertilization and embryo transfer (IVF-ET) has been reported to increase oocyte retrieval chances but has not been reported to improve the therapeutic outcome (live birth). The question is whether the therapeutic utility of diclofenac is demonstrable when administered to a subgroup of women with an imminent LH surge, a higher risk group for premature ovulation.Methods: Infertile women indicated for the natural-cycle IVF-ET between September 2014 and February 2015 (n=183) were recruited in a private infertility clinic and diclofenac use (50 mg suppositories, thrice every 8 h before oocyte retrieval) was offered when their serum LH level was ≥14.0 IU/L on an LH-triggering day (n=137). Of the 137 women, 108 electively used diclofenac and 29 did not. Oocytes were retrieved from both dominant and subordinate nondominant follicles and were fertilized. The resulting blastocysts were frozen, thawed, and transferred one by one in the following spontaneous ovulatory or hormone replacement cycles. Results: Cumulative live birth rate (after the single oocyte retrieval) was calculated from the dominant and nondominant follicles. The live birth rate from dominant follicles was higher in the diclofenac group (21/108, 19%) than in the no diclofenac group (1/29, 3%) (P < .05). Conversely, the live birth rate from nondominant follicles, which had no potential for ovulation, was not different between the diclofenac group (13/108, 12%) and the no diclofenac group (3/29, 10%). Conclusion: Diclofenac improved the live birth rate from dominant follicles when it was administered to women with an imminent LH surge. However, diclofenac did not affect the live birth rate from non-dominant follicles which were not at risk of follicle rupture.

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