Cumulative Live Birth Rates of Women ≥ 38 Years With Poor, Normal and High Ovarian Response

Abstract Background Previous studies have reported that live birth rate (LBR) decreased with aging, however, no study has evaluated the cumulative LBR (CLBR) in accordance with the ovarian response in advanced maternal age (AMA) patients. This study aims to investigate the relationship between the ovarian response and the CLBR in AMA patients. Methods 913 women ≥ 38 years underwent in vitro fertilization (IVF) and fresh embryo transfer (ET) between January 2014 and June 2019 were enrolled in this retrospective study. All subjects were categorized into three groups, poor ovarian response (POR) group: 1–3 oocytes retrieved (n = 127), normal ovarian response (NOR) group: 4–15 oocytes retrieved, and high ovarian response (HOR) group: more than 15 oocytes retrieved. The primary outcome was the CLBR in one oocyte retrieval cycle after transfer of all fresh and frozen embryos. Logistic regression models were used to derive the odds ratio (OR) to identify the relationship of CLBR with different ovarian response, adjusting for age and body mass index. Results Compared with women in POR group, the women in other groups (NOR and HOR groups) achieved higher CLBR [adjusted OR (aOR) = 2.12, 95% confidence interval (CI), 1.16–4.38 for NOR group; aOR = 2.93, 95% CI, 1.44–5.97 for HOR]. The LBR of the fresh ET and the neonate characteristics showed no significant difference among the three groups. Conclusion Ovarian response is significantly associated with CLBR in women with advanced age.

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Predictive Model for Live Birth at 12 Months After Starting In-Vitro Fertilization Treatment

MedPharmRes ◽

10.32895/ump.mpr.2.2.5 ◽

2018 ◽

Vol 2 (2) ◽

pp. 5-20

Author(s):

Vu Ho ◽

Toan Pham ◽

Tuong Ho ◽

Lan Vuong

Keyword(s):

In Vitro Fertilization ◽

Live Birth ◽

Cox Regression ◽

Financial Burden ◽

Oocyte Retrieval ◽

Operating Characteristics ◽

Vitro Fertilization ◽

Cox Regression Analysis ◽

Significant Difference

IVF carries a considerable physical, emotional and financial burden. Therefore, it would be useful to be able to predict the likelihood of success for each couple. The aim of this retrospective cohort study was to develop a prediction model to estimate the probability of a live birth at 12 months after one completed IVF cycle (all fresh and frozen embryo transfers from the same oocyte retrieval). We analyzed data collected from 2600 women undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) at a single center in Vietnam between April 2014 and December 2015. All patients received gonadotropin-releasing hormone (GnRH) antagonist stimulation, followed by fresh and/or frozen embryo transfer (FET) on Day 3. Using Cox regression analysis, five predictive factors were identified: female age, total dose of recombinant follicle stimulating hormone used, type of trigger, fresh or FET during the first transfer, and number of subsequent FET after the first transfer. The area under the receiver operating characteristics curve for the final model was 0.63 (95% confidence interval [CI] 0.60‒0.65) and 0.60 (95% CI 0.57‒0.63) for the validation cohort. There was no significant difference between the predicted and observed probabilities of live birth (Hosmer-Lemeshow test, p > 0.05). The model developed had similar discrimination to existing models and could be implemented in clinical practice.

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Impact of Endometrial Thickness and Volume Compaction on the Live Birth Rate Following Fresh Embryo Transfer of In Vitro Fertilization

Journal of Ultrasound in Medicine ◽

10.1002/jum.15830 ◽

2021 ◽

Author(s):

Mei T. Lam ◽

Hang W. R. Li ◽

Ernest H. Y. Ng

Keyword(s):

In Vitro Fertilization ◽

Embryo Transfer ◽

Live Birth ◽

Birth Rate ◽

Endometrial Thickness ◽

Live Birth Rate ◽

Fresh Embryo Transfer ◽

Vitro Fertilization

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O-107 Searching for the optimal number of oocytes to reach a life birth following in vitro fertilization: a systematic review with meta-analysis

Human Reproduction ◽

10.1093/humrep/deab126.011 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

N Sermondade ◽

C Sonigo ◽

M Pasquier ◽

N Yata-Ahdad ◽

E Fraison ◽

...

Keyword(s):

In Vitro Fertilization ◽

Live Birth ◽

Birth Rate ◽

Meta Analysis ◽

Live Birth Rate ◽

Cumulative Live Birth Rate ◽

Continuous Increase ◽

Vitro Fertilization ◽

The Relationship

Abstract Study question To investigate the relationship between the number of oocytes and both the live birth rate after fresh embryo transfer and the cumulative live birth rate. Summary answer Above a 15-oocyte threshold, live birth rate (LBR) following fresh transfer plateaus, whereas a continuous increase in cumulative live birth rate (CLBR) is observed. What is known already Several lines of evidence indicate that number of oocytes represents a key point for in vitro fertilization (IVF) success. However, consensus is lacking regarding the optimal number of oocytes for expecting a live birth. This is a key question because it might impact the way practitioners initiate and adjust COS regimens. Study design, size, duration A systematic review and meta-analysis was performed. MEDLINE, EMBASE, and Cochrane Library were searched for studies published between January 01, 2004, and August 31, 2019 using the search terms: “(intracytoplasmic sperm injection or icsi or ivf or in vitro fertilization or fertility preservation)” and “(oocyte and number)” and “(live birth)”. Participants/materials, setting, methods Two independent reviewers carried out study selection, quality assessment using the adapted Newcastle-Ottawa Quality Assessment Scales, bias assessment using ROBIN-1 tools, and data extraction according to Cochrane methods. Independent analyses were performed according to the outcome (LBR and CLBR). The mean-weighted threshold of optimal oocyte number was estimated from documented thresholds, followed by a one-stage meta-analysis on articles with documented or estimable relative risks. Main results and the role of chance After reviewing 843 records, 64 full-text articles were assessed for eligibility. A total of 36 studies were available for quantitative syntheses. Twenty-one and 18 studies were included in the meta-analyses evaluating the relationship between the number of retrieved oocytes and LBR or CLBR, respectively. Given the limited number of investigations considering mature oocytes, association between the number of metaphase II oocytes and IVF outcomes could not be investigated. Concerning LBR, 7 (35.0%) studies reported a plateau effect, corresponding to a weighted mean of 14.4 oocytes. The pooled dose-response association between the number of oocytes and LBR showed a non-linear relationship, with a plateau beyond 15 oocytes. For CLBR, 4 (19.0%) studies showed a plateau effect, corresponding to a weighted mean of 19.3 oocytes. The meta-analysis of the relationship between the number of oocytes and CLBR found a non-linear relationship, with a continuous increase in CLBR, including for high oocyte yields. Limitations, reasons for caution Statistical models show a high degree of deviance, especially for high numbers of oocytes. Further investigations are needed to assess the generalization of those results to frozen mature oocytes, especially in a fertility preservation context, and to evaluate the impact of female age. Wider implications of the findings Above a 15-oocyte threshold, LBR following fresh transfer plateaus, suggesting that the freeze-all strategy should probably be performed. In contrast, the continuous increase in CLBR suggests that high numbers of oocytes could be offered to improve the chances of cumulative live births, after evaluating the benefit–risk balance. Trial registration number Not applicable

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The Impact of Laparoscopic Treated Endometrioma on the Live Birth Rate in IVF/ICSI Cycles Compared with Unexplained Infertility: A Prospective Randomized Study

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.4638 ◽

2020 ◽

Vol 8 (B) ◽

pp. 160-165

Author(s):

Snezhana Stojkovska ◽

Gligor Dimitrov ◽

Jane Stojkovski ◽

Stefan Saltirovski ◽

Makuli Hadzi-Lega

Keyword(s):

Embryo Transfer ◽

Live Birth ◽

Birth Rate ◽

Randomized Study ◽

Live Birth Rate ◽

Unexplained Infertility ◽

Fresh Embryo Transfer ◽

Vitro Fertilization ◽

The Impact

BACKGROUND: It is estimated that 30–70% of patients who undergo treatment for infertility are afflicted with endometriosis. AIM: The objectives of this study are to evaluate the impact of laparoscopic treated endometrioma compared to unexplained subfertility on the live birth rate in women undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). METHODS: This randomized prospective study included 120 women who contacted the department of IVF in the period from 2010 to 2015. Women were divided into two groups according to the findings obtained by laparoscopy. The treated endometrioma group (n = 60) with unilateral ovarian endometriomas and the non-endometriosis group (n = 60) with unexplained infertility undergoing the first cycle of IVF-embryo transfer (IVF-ET) were included in the study. In all participants, ICSI was used and all had fresh embryo transfer per cycle. The primary outcome was to live birth. RESULTS: Our results demonstrated that clinical pregnancy rates (p = 0.54) and live birth rate (p = 0.63) are similar. The preservation of a good ovarian response to stimulation by gonadotropins after laparoscopic ovarian cystectomy was presented. Laparoscopic cystectomy is followed by good IVF/ICSI outcome into the level expected in women with unexplained subfertility. CONCLUSION: Therefore, operative treatment is justified by not altering the live birth rate. Additional study is needed to be considered cystectomy before IVF as an effective approach for managing endometriosis-associated infertility.

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Effectiveness of progesterone-primed ovarian stimulation in assisted reproductive technology: a systematic review and meta-analysis

Archives of Gynecology and Obstetrics ◽

10.1007/s00404-020-05939-y ◽

2021 ◽

Author(s):

Ling Cui ◽

Yonghong Lin ◽

Fang Wang ◽

Chen Chen

Keyword(s):

Live Birth ◽

Ovarian Stimulation ◽

Meta Analysis ◽

Reproductive Function ◽

Live Birth Rate ◽

Oocyte Retrieval ◽

Vitro Fertilization ◽

Control Protocol ◽

Randomized Controlled Studies

Abstract Purpose Progestin-primed ovarian stimulation (PPOS) is a new ovarian stimulation protocol that has been used over the last decade to enhance reproductive function. The purpose of this study is to evaluate whether PPOS is as effective as conventional protocols (without GnRHa downregulation). Method Search terms included “medroxyprogesterone”, “dydrogesterone”, “progestin-primed ovarian stimulation”, “PPOS”, “oocyte retrieval”, “in vitro fertilization”, “IVF”, “ICSI”, “ART”, and “reproductive”. The selection criteria were nonrandomized studies and randomized controlled studies. For data collection and analysis, the Review Manager software, Newcastle–Ottowa Quality Assessment Scale and GRADE approach were used. Results The clinical pregnancy rates were not significantly different in either RCTs or NRCTs [RR 0.96, 95% CI (0.69–1.33), I2 = 71%, P = 0.81]; [RR 0.99, 95% CI (0.83–1.17), I2 = 38%, P = 0.88]. The live birth rates of RCTs and NRCTs did not differ [RCT: RR 1.08, 95% CI (0.74, 1.57), I2 = 66%, P = 0.69; NRCT: OR 1.03 95% CI 0.84–1.26), I2 = 50%, P = 0.79]. The PPOS protocol had a lower rate of OHSS [RR 0.52, 95% CI (0.36–0.75), I2 = 0%, P = 0.0006]. The secondary results showed that compared to the control protocol, the endometrium was thicker [95% CI (0.00–0.78), I2 = 0%, P = 0.05], the number of obtained embryos was higher [95% CI (0.04–0.65), I2 = 17%, P = 0.03] and more hMG was needed [in NRCT: 95% CI (307.44, 572.73), I2 = 0%, P < 0.00001] with the PPOS protocol. Conclusion The PPOS protocol produces more obtained embryos and a thicker endometrium than the control protocol, with a lower rate of OHSS and an equal live birth rate. The PPOS protocol could be a safe option as a personalized protocol for infertile patients. Trial registration Registration at PROSPERO: CRD42020176577.

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Luteal phase support for in vitro fertilization/intracytoplasmic sperm injection fresh cycles: a systematic review and network meta-analysis

Reproductive Biology and Endocrinology ◽

10.1186/s12958-021-00782-5 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Hanglin Wu ◽

Songying Zhang ◽

Xiaona Lin ◽

Shasha Wang ◽

Ping Zhou

Keyword(s):

Live Birth ◽

Pregnancy Outcomes ◽

Luteal Phase ◽

Meta Analysis ◽

Oocyte Retrieval ◽

Gnrh Agonists ◽

Ongoing Pregnancy ◽

Vitro Fertilization ◽

Lps Treatment

Abstract Background Various luteal phase supports (LPSs) have been proven to increase the pregnancy rate in fresh cycles of in vitro fertilization or intracytoplasmic sperm injection; however, there is still significant debate regarding the optimal use of LPS. Methods A systematic review with the use of a network meta-analysis was performed via electronic searching of Ovid MEDLINE, the Cochrane Library, Embase, Web of Science, ClinicalTrials.gov and Google Scholar (up to January 2021) to compare the effectiveness and safety of various LPSs, as well as to evaluate the effects of different initiations of LPSs on pregnancy outcomes. The primary outcomes included live birth and ongoing pregnancy, with the results presented as odds ratios (ORs) with 95% confidence intervals (CIs). Results Eighty-nine randomized controlled trials with 29,625 women comparing 14 interventions or placebo/no LPS treatments were included in the meta-analyses. No significant differences were found in terms of the pregnancy outcomes when LPS was started within 48 h after oocyte retrieval versus a delayed initiation between 48 h and 96 h after oocyte retrieval. The addition of gonadotropin-releasing hormone (GnRH) agonists to progesterone vaginal pessaries showed a significant benefit in terms of live birth (OR 1.39, 95% CI 1.08 to 1.78). Only human chorionic gonadotropin (HCG) was found to be more efficacious than the placebo/no LPS treatment in terms of live birth (OR 15.43, 95% CI 2.03 to 117.12, low evidence). Any active LPSs (except for rectal or subcutaneous progesterone) was significantly more efficacious than the placebo/no LPS treatment in terms of ongoing pregnancy, with ORs ranging between 1.77 (95% CI 1.08 to 2.90) for the vaginal progesterone pessary and 2.14 (1.23 to 3.70) for the intramuscular progesterone treatment. Among the comparisons of efficacy and tolerability between the active treatments, the differences were small and very uncertain. Conclusion Delays in progesterone supplementation until 96 h after oocyte retrieval does not affect pregnancy outcomes. The safety of GnRH agonists during the luteal phase needs to be evaluated in future studies before the applications of these agonists in clinical practice. With comparable efficacy and acceptability, there may be several viable clinical options for LPS.

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Effects of Hydrosalpinx on Endometrial Implantation Failures: Evaluating Salpingectomy in Women Undergoing in vitro fertilization

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0040-1722155 ◽

2021 ◽

Author(s):

Antonio Palagiano ◽

Mauro Cozzolino ◽

Filippo Maria Ubaldi ◽

Chiara Palagiano ◽

Maria Elisabetta Coccia

Keyword(s):

In Vitro Fertilization ◽

Oocyte Retrieval ◽

Ovarian Response ◽

Antral Follicle ◽

Antral Follicle Count ◽

Endometrial Receptivity ◽

Vitro Fertilization ◽

Ovid Medline ◽

Ultrasonographic Guidance

AbstractHydrosalpinx is a disease characterized by the obstruction of the salpinx, with progressive accumulation in the shape of a fluid-filled sac at the distal part of the tuba uterina, and closed to the ovary. Women with hydrosalpinges have lower implantation and pregnancy rates due to a combination of mechanical and chemical factors thought to disrupt the endometrial environment. Evidence suggests that the presence of hydrosalpinx reduces the rate of pregnancy with assisted reproductive technology. The main aim of the present is review to make an overview of the possible effects of hydrosalpinx on in vitro fertilization (IVF). We conducted a literature search on the PubMed, Ovid MEDLINE, and Google Scholar data bases regarding hydrosalpinx and IVF outcomes. Hydrosalpinx probably has a direct toxic effect on sperm motility and on the embryos. In addition, the increasing liquid inside the salpinges could alter the mechanisms of endometrial receptivity. The window of endometrial receptivity is essential in the implantation of blastocysts, and it triggers multiple reactions arising from the endometrium as well as the blastocysts. Hydrosalpinx could influence the expression of homeobox A10 (HOXA10) gene, which plays an essential role in directing embryonic development and implantation. Salpingectomy restores the endometrial expression of HOXA10; therefore, it may be one mechanism by which tubal removal could result in improved implantation rates in IVF. In addition, salpingectomy does not affect the ovarian response, nor reduces the antral follicle count. Further studies are needed to establish the therapeutic value of fluid aspiration under ultrasonographic guidance, during or after oocyte retrieval, in terms of pregnancy rate and ongoing pregnancy.

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Cumulative live birth rate after up to three consecutive embryo transfer cycles in women with poor ovarian response

Clinical and Experimental Reproductive Medicine ◽

10.5653/cerm.2019.03349 ◽

2020 ◽

Vol 47 (2) ◽

pp. 135-139

Author(s):

Se Jeong Kim ◽

Dayong Lee ◽

Seul Ki Kim ◽

Byung Chul Jee ◽

Seok Hyun Kim

Keyword(s):

Embryo Transfer ◽

Live Birth ◽

Birth Rate ◽

Live Birth Rate ◽

Ovarian Response ◽

Rank Test ◽

Poor Ovarian Response ◽

Cumulative Live Birth Rate ◽

Cumulative Live Birth

Objective: In the present study, we aimed to retrospectively evaluate the cumulative live birth rate (LBR) after up to three consecutive embryo transfer (ET) cycles, either fresh or frozen, in women with expected poor ovarian response (ePOR). Methods: We selected 115 women who entered the first <i>in vitro</i> fertilization (IVF) cycle between August 2013 and July 2016. The women were divided into an ePOR group (37 women) and a non-ePOR group (78 women). All women in the ePOR group were ≥40 years old or had serum anti-Müllerian hormone levels of less than 1.1 ng/mL at the time of the first IVF cycle. Live birth outcomes were monitored until December 2017. The cumulative LBR (with both conservative and optimistic estimates) was calculated according to the serial number of ET cycles. Results: After up to three ET cycles, the overall cumulative LBR was significantly lower in the ePOR group than in the non-ePOR group (conservative estimate, 10.8% vs. 44.9%, respectively; optimistic estimate, 14.7% vs. 56.1%, respectively; log-rank test, <i>p</i>=0.003). Conclusion: Women with ePOR exhibited a lower cumulative LBR than women in the non-ePOR group, and this information should be provided to ePOR women during counseling before starting IVF.

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Effect of the trends of estradiol level on the outcome of in vitro fertilization-embryo transfer with antagonist regimens: a single center retrospective cohort study

10.21203/rs.3.rs-1066884/v1 ◽

2021 ◽

Author(s):

Chun-Xiao Wei ◽

liang zhang ◽

Cong-Hui Pang ◽

Ying-Hua qi ◽

Jian-Wei Zhang

Keyword(s):

In Vitro Fertilization ◽

Pregnancy Rate ◽

Pregnancy Outcome ◽

Embryo Transfer ◽

Ovarian Response ◽

Vitro Fertilization ◽

The Relationship ◽

Estradiol Levels

Abstract BackgroundThe outcome of in vitro fertilization-embryo transfer is often determined according to follicles and estradiol levels following gonadotropin stimulation. However, there is no accurate indicator to predict pregnancy outcome, and it has not been determined how to choose subsequent drugs and dosage based on the ovarian response. This study aimed to make timely adjustments to follow-up medication to improve clinical outcomes based on the potential value of estradiol growth rate. MethodsSerum estradiol levels were measured on the day of gonadotrophin treatment (Gn0), four days later (Gn4), seven days later (Gn7), and on the trigger day (HCG). The ratio was used to determine the increase in estradiol levels. According to the ratio of estradiol increase, the patients were divided into four groups: group A1 (Gn4/Gn0≤6.44), group A2 (6.44˂Gn4/Gn0≤10.62), group A3 (10.62˂Gn4/Gn0 ≤21.33), and group A4 (Gn4/Gn0>21.33); group B1 (Gn7/Gn4≤2.39), group B2 (2.39˂Gn7/Gn4≤3.03), group B3 (3.03˂Gn7/Gn4≤3.84), and group B4 (Gn7/Gn4>3.84). We analyzed and compared the relationship between data in each group and pregnancy outcome. ResultsIn the statistical analysis, the estradiol levels of Gn4 (P = 0.029, P = 0.042), Gn7 (P< 0.001, P = 0.001), and HCG (P< 0.001, P = 0.002), as well as the ratios of Gn4/Gn0 (P = 0.004, P = 0.006), Gn7/Gn4 (P = 0.001, P = 0.002), and HCG/Gn0 (P< 0.001, P< 0.001) both had clinical guiding significance, and the lower one significantly reduced the pregnancy rate. The outcomes were positively linked to groups A (P = 0.040, P = 0.041) and B (P = 0.015, P = 0.017). The logistical regression analysis revealed that group A1 (OR = 0.440 [0.223–0.865]; P = 0.017, OR = 0.368 [0.169–0.804]; P = 0.012) and B1 (OR = 0.261 [0.126–0.541]; P< 0.001, OR = 0.299 [0.142–0.629]; P = 0.001) had opposite influence on outcomes. ConclusionMaintaining a serum estradiol increase ratio at least above 2.39 on Gn7/Gn4 may result in a higher pregnancy rate. When estradiol growth is not ideal, gonadotrophin dosage should be adjusted appropriately to ensure the desired outcome.

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