Hormone Replacement Therapy With GnRH Agonist Pretreatment Improves Pregnancy Outcomes in Patients With Previous Intrauterine Adhesions: a Retrospective Study

2021 ◽  
Author(s):  
Meilan Mo ◽  
Qizhen Zheng ◽  
Hongzhan Zhang ◽  
Shiru Xu ◽  
Fen Xu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Retrospective Study ◽  
Pregnancy Outcomes ◽  
Preparation Method ◽  
Clinical Pregnancy ◽  
Ongoing Pregnancy ◽  
Intrauterine Adhesions ◽  
Endometrial Preparation ◽  
History Of ◽  
Early Miscarriage

Abstract Objective: This retrospective study aimed to explore the optimal endometrial preparation method in women with intrauterine adhesions (IUAs).Method: A total of 882 frozen-thawed embryo transfer (FET) cycles from patients with history of IUAs were categorized into three groups based on endometrial preparation methods: hormone replacing therapy cycle (HRT, n=636), natural cycle (NC n=174), and HRT with GnRH-a pretreatment (HRT+GnRH-a, n=72. Logistic regression was performed to investigate the association between cycle regimens and pregnancy outcomes. Subgroup analysis of IUAs combined with thin endometrium (≤7mm) was also performed.Results: HRT with GnRH-a pretreatment was associated with higher incidences of clinical pregnancy, ongoing pregnancy, and live birth, but lower early miscarriage compared with either HRT or NC. Logistic regression indicated that after controlling for potential confounders, the incidences of live birth (HRT+GnRH-a as reference; NC: aOR=0.577, 95%CI 0.304-1.093; HRT: aOR=0.434, 95%CI 0.247-0.765) and ongoing pregnancy (NC: aOR=0.614, 95%CI 0.324-1.165; HRT: aOR=0.470, 95%CI 0.267-0.829) remained significantly higher in HRT+GnRH-a compared to those in HRT, but comparable to those in NC. While there was no significant difference with respect to the clinical pregnancy rate (NC: aOR=0.695, 95%CI 0.374-1.291; HRT: aOR=0.650, 95%CI 0.374-1.127) and early miscarriage rate (NC: aOR=1.734, 95%CI 0.417-7.175; HRT: aOR=2.594, 95%CI 0.718-9.378) between groups. Subgroup analysis suggested there was no superiority of endometrial preparation method in IUAs combined with thin endometrium.Conclusion: HRT with GnRH-a pretreatment improves pregnancy outcomes in women with history of IUAs. GnRH-a may restore the endometrial receptivity in the FET cycles in IUAs.

Gonadotropin-releasing hormone agonist combined with hormone replacement therapy improves pregnancy outcome in intrauterine adhesion

2021 ◽  
Author(s):  
Meilan Mo ◽  
Qizhen Zheng ◽  
Hongzhan Zhang ◽  
Shiru Xu ◽  
Fen Xu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Live Birth ◽  
Subgroup Analysis ◽  
Pregnancy Outcomes ◽  
Preparation Method ◽  
Clinical Pregnancy ◽  
Ongoing Pregnancy ◽  
Endometrial Preparation ◽  
Significant Difference ◽  
Early Miscarriage

Abstract Objective: This retrospective study aimed to explore the optimal endometrial preparation method in women with intrauterine adhesions (IUAs).Method: A total of 882 frozen-thawed embryo transfer (FET) cycles were categorized into three groups based on endometrial preparation methods: hormone replacing therapy cycle (HRT, n=636), natural cycle (NC n=174), and HRT with GnRH-a pretreatment (HRT+GnRH-a, n=72. Logistic regression was performed to investigate the association between cycle regimens and pregnancy outcomes. Subgroup analysis of IUAs combined with thin endometrium (≤7mm) was also performed.Results: HRT with GnRH-a pretreatment was associated with higher incidences of clinical pregnancy, ongoing pregnancy, and live birth, but lower early miscarriage compared with either HRT or NC. Logistic regression indicated that after controlling for potential confounders, the incidences of live birth (HRT+GnRH-a as reference; NC: aOR=0.577, 95%CI 0.304-1.093; HRT: aOR=0.434, 95%CI 0.247-0.765) and ongoing pregnancy (NC: aOR=0.614, 95%CI 0.324-1.165; HRT: aOR=0.470, 95%CI 0.267-0.829) remained significantly higher in HRT+GnRH-a compared to those in HRT, but comparable to those in NC. While there was no significant difference with respect to the clinical pregnancy rate (NC: aOR=0.695, 95%CI 0.374-1.291; HRT: aOR=0.650, 95%CI 0.374-1.127) and early miscarriage rate (NC: aOR=1.734, 95%CI 0.417-7.175; HRT: aOR=2.594, 95%CI 0.718-9.378) between groups. Subgroup analysis suggested there was no priority of endometrial preparation method in IUAs combined with thin endometrium.Conclusion: HRT with GnRH-a pretreatment improves pregnancy outcomes in women with history of IUAs. GnRH-a may restore the endometrial receptivity in the FET cycles in IUAs.

scholarly journals Effect of different endometrial preparation protocols on pregnancy outcomes in frozen- embryo transfer cycles: a retrospective cohort study

2021 ◽  
Author(s):  
Yue Qian ◽  
Qi Wan ◽  
Xiao-Qing Bu ◽  
Tian Li ◽  
Xiao-Jun Tang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Pregnancy Rate ◽  
Live Birth ◽  
Pregnancy Outcomes ◽  
Multiple Logistic Regression Analysis ◽  
Clinical Pregnancy ◽  
The Other ◽  
Multiple Logistic Regression ◽  
Endometrial Preparation ◽  
Natural Cycles

Abstract Background Owing to the crucial role the endometrium plays in embryo implantation, the four main endometrial preparation protocols have become important factors in the study of pregnancy outcomes in the FET cycles. Previous studies have shown that the best of these four protocols remains controversial for women undergoing FET. Methods A total of 10333 FET cycles from January 2018 to December 2018 were analyzed in this study. They were categorized into four groups according to endometrial preparation regimen: natural cycles (Group NC,n = 815), hormone replacement therapy cycles (Group HRT ,n = 6434), GnRH agonist artificial cycles (Group GAC,n = 1392) and ovarian stimulation cycles (Group OC, n = 1692). All patients were followed up for at least 1 year. Pregnancy outcomes were compared between the four groups and multiple logistic regression models were used to adjust for the effects of confounding factors. Results The ectopic pregnancy rate (P = 0.627) and miscarriage rate (P = 0.164) were not statistically significant between the four groups. Moreover, biochemical pregnancy rate, clinical pregnancy rate and live birth rate in the NC group were not statistically significant compared to the other three groups. After adjusting for covariates, multiple logistic regression analysis showed no statistical significance in pregnancy outcomes in the HRT, GAC and OC groups compared to the NC group.And the adjusted OR for live births was 0.988 (95 % CI0.847-1.152) for the HRT group, 0.955 (95 % CI0.795-1.146) for the GAC group,0.898 (95 % CI0.754-1.070) for the OC group. Conclusions Our study showed that natural cycles have similar pregnancy outcomes in terms of clinical pregnancy and live birth to the other three endometrial preparation options. As it has other advantages, the natural cycle protocol can therefore be the recommended option for endometrial preparation in the FET population.

Individualised luteal phase support in artificially prepared frozen embryo transfer cycles based on serum progesterone levels: a prospective cohort study

2021 ◽  
Author(s):  
Manuel Álvarez ◽  
Sofía Gaggiotti-Marre ◽  
Francisca Martínez ◽  
Lluc Coll ◽  
Sandra García ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Embryo Transfer ◽  
Pregnancy Outcomes ◽  
Luteal Phase ◽  
Frozen Embryo Transfer ◽  
Ongoing Pregnancy ◽  
Serum Progesterone ◽  
Endometrial Preparation ◽  
Group 2 ◽  
Group 1

Abstract STUDY QUESTION Does an individualised luteal phase support (iLPS), according to serum progesterone (P4) level the day prior to euploid frozen embryo transfer (FET), improve pregnancy outcomes when started on the day previous to embryo transfer? SUMMARY ANSWER Patients with low serum P4 the day prior to euploid FET can benefit from the addition of daily subcutaneous P4 injections (Psc), when started the day prior to FET, and achieve similar reproductive outcomes compared to those with initial adequate P4 levels. WHAT IS KNOWN ALREADY The ratio between FET/IVF has spectacularly increased in the last years mainly thanks to the pursuit of an ovarian hyperstimulation syndrome free clinic and the development of preimplantation genetic testing (PGT). There is currently a big concern regarding the endometrial preparation for FET, especially in relation to serum P4 levels around the time of embryo transfer. Several studies have described impaired pregnancy outcomes in those patients with low P4 levels around the time of FET, considering 10 ng/ml as one of the most accepted reference values. To date, no prospective study has been designed to compare the reproductive outcomes between patients with adequate P4 the day previous to euploid FET and those with low, but restored P4 levels on the transfer day after iLPS through daily Psc started on the day previous to FET. STUDY DESIGN, SIZE, DURATION A prospective observational study was conducted at a university-affiliated fertility centre between November 2018 and January 2020 in patients undergoing PGT for aneuploidies (PGT-A) IVF cycles and a subsequent FET under hormone replacement treatment (HRT). A total of 574 cycles (453 patients) were analysed: 348 cycles (leading to 342 euploid FET) with adequate P4 on the day previous to FET, and 226 cycles (leading to 220 euploid FET) under iLPS after low P4 on the previous day to FET, but restored P4 levels on the transfer day. PARTICIPANTS/MATERIALS, SETTING, METHODS Overall we included 574 HRT FET cycles (453 patients). Standard HRT was used for endometrial preparation. P4 levels were measured the day previous to euploid FET. P4 > 10.6 ng/ml was considered as adequate and euploid FET was performed on the following day (FET Group 1). P4 < 10.6 ng/ml was considered as low, iLPS was added in the form of daily Psc injections, and a new P4 analysis was performed on the following day. FET was only performed on the same day when a restored P4 > 10.6 ng/ml was achieved (98.2% of cases) (FET Group 2). MAIN RESULTS AND THE ROLE OF CHANCE Patient’s demographics and cycle parameters were comparable between both euploid FET groups (FET Group 1 and FET Group 2) in terms of age, weight, oestradiol and P4 levels and number of embryos transferred. No statistically significant differences were found in terms of clinical pregnancy rate (56.4% vs 59.1%: rate difference (RD) −2.7%, 95% CI [−11.4; 6.0]), ongoing pregnancy rate (49.4% vs 53.6%: RD −4.2%, 95% CI [−13.1; 4.7]) or live birth rate (49.1% vs 52.3%: RD −3.2%, 95% CI [−12; 5.7]). No significant differences were also found according to miscarriage rate (12.4% vs 9.2%: RD 3.2%, 95% CI [−4.3; 10.7]). LIMITATIONS, REASONS FOR CAUTION Only iLPS through daily Psc was evaluated. The time for Psc injection was not stated and no serum P4 determinations were performed once the pregnancy was achieved. WIDER IMPLICATIONS OF THE FINDINGS Our study provides information regarding an ‘opportunity window’ for improved ongoing pregnancy rates and miscarriage rates through a daily Psc injection in cases of inadequate P4 levels the day previous to FET (P4 < 10.6 ng/ml) and restored values the day of FET (P4 > 10.6 ng/ml). Only euploid FET under HRT were considered, avoiding one of the main reasons of miscarriage and implantation failure and overcoming confounding factors such as female age, embryo quality or ovarian stimulation protocols. STUDY FUNDING/COMPETING INTEREST(S) No external funding was received. B.C. reports personal fees from MSD, Merck Serono, Ferring Pharmaceuticals, IBSA and Gedeon Richter outside the submitted work. N.P. reports grants and personal fees from MSD, Merck Serono, Ferring Pharmaceuticals, Theramex and Besins International and personal fees from IBSA and Gedeon Richter outside the submitted work. The remaining authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER NCT03740568.

scholarly journals Association between the use of free-of-charge intrauterine devices and a history of induced abortion: a retrospective study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Sabina Ulbricht ◽  
Angelika Beyer ◽  
Ulrich John
Keyword(s):  
Logistic Regression ◽  
Retrospective Study ◽  
Intrauterine Device ◽  
Induced Abortion ◽  
Multivariate Model ◽  
Unemployment Benefits ◽  
Intrauterine Devices ◽  
Cross Sectional ◽  
History Of ◽  
To Receive

Abstract Background To determine whether use of intrauterine device (IUD) is influenced by a history of induced abortion and the type of contraceptives used until costs are covered. Methods We analyzed data from 301 female residents in Mecklenburg-West Pomerania, an economically challenged community. The women, aged between 20 and 35 years, were entitled to receive unemployment benefits, and had access to free-of-charge oral contraceptives, ring or IUD. Cross-sectional data were analyzed using logistic regression. Results There were 112 (37.2%) women with a history of induced abortion, and 46 (15.3%) reported exclusively using less effective contraceptives (e.g. condoms). In a univariate logistic regression, use of an IUD was associated with a history of having had an induced abortion. Furthermore, uptake of an IUD was associated with women who had, until costs were covered, exclusively choice to use less effective contraceptives (OR = 3.281, 95% CI: 1.717; 6.273). Both associations remained significant in a multivariate model. Conclusions Free contraceptives provided to women receiving unemployment benefits may increase the use of IUDs, especially among those with a history of an induced abortion and those using less effective contraceptives.

scholarly journals Frozen Embryo Transfer in Mildly Stimulated Cycle With Letrozole Compared to Natural Cycle in Ovulatory Women: A Large Retrospective Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Danjun Li ◽  
Shuzin Khor ◽  
Jialyu Huang ◽  
Qiuju Chen ◽  
Qifeng Lyu ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Pregnancy Outcomes ◽  
Endometrial Thickness ◽  
Clinical Pregnancy ◽  
Frozen Embryo Transfer ◽  
Clinical Pregnancy Rate ◽  
Natural Cycle ◽  
Mild Stimulation ◽  
Early Miscarriage ◽  
Hcg Test

ObjectiveTo evaluate the clinical effect of mild stimulation with letrozole on pregnancy outcomes in ovulatory women undergoing frozen embryo transfer (FET) compared to natural cycle.DesignRetrospective observational study.SettingTertiary care academic medical center.PopulationA total of 6,874 infertile women with regular menstrual cycles (21-35 days) met the criteria for this study in the period from 2013 to 2020.MethodsAll patients who were prepared for and underwent FET were divided into two groups: a modified natural cycle (NC) group (n=3,958) and a letrozole cycle group (n=2,916).Main Outcome MeasuresThe primary outcome of the study was clinical pregnancy rate. Secondary outcome measures were endometrial thickness, rates of implantation, positive HCG test, live birth, early miscarriage and ectopic pregnancy.ResultsThe clinical pregnancy rate was not statistically different between the modified NC-FET group and the letrozole-FFT group before (crude OR 0.99, 95% CI 0.90-1.09, P=0.902>0.05) and after propensity score matching (PSM) (crude OR 1.01, 95% CI 0.91-1.12, P=0.870>0.05). After multivariable logistic regression analysis, the clinical pregnancy rate remained insignificant before (adjusted OR 1.00, 95% CI 0.91-1.10, P=0.979>0.05) and after matching (adjusted OR 1.00, 95% CI 0.89-1.11, P=0.936>0.05), respectively. Similarly, in the crude and adjusted analysis, the positive HCG test, implantation, live birth and early miscarriage rates were also comparable in the letrozole-FFT group and modified NC-FET group before and after matching. Furthermore, the endometrial thickness of letrozole-FFT group was similar to that of modified NC-FET group with adjusted analysis.ConclusionOur observation suggests that mild stimulation with letrozole could produce similar pregnancy outcomes in ovulatory patients who undergo FET when compared with a natural cycle.

scholarly journals Is home-based-monitoring of ovulation to time frozen embryo transfer a cost-effective alternative for hospital-based-monitoring of ovulation? Study protocol of the multicentre, non-inferiority Antarctica-2 randomised controlled trial

2021 ◽  
Author(s):  
T R Zaat ◽  
J P de Bruin ◽  
M Goddijn ◽  
M van Baal ◽  
E B Benneheij ◽  
...  
Keyword(s):  
Pregnancy Outcomes ◽  
Controlled Trial ◽  
Clinical Pregnancy ◽  
Frozen Embryo Transfer ◽  
Natural Cycle ◽  
Ongoing Pregnancy ◽  
Miscarriage Rate ◽  
Home Based ◽  
Secondary Outcomes ◽  
Randomised Controlled

Abstract STUDY QUESTIONS The objective of this trial is to compare the effectiveness and costs of true natural cycle (true NC-) frozen embryo transfer (FET) using urinary LH tests to modified NC-FET using repeated ultrasound monitoring and ovulation trigger to time FET in the natural cycle. Secondary outcomes are the cancellation rates of FET (ovulation before hCG or no dominant follicle, no ovulation by LH urine test, poor embryo survival), pregnancy outcomes (miscarriage rate, clinical pregnancy rates, multiple ongoing pregnancy rates, live birth rates, costs) and neonatal outcomes (including gestational age, birthweight and sex, congenital abnormalities or diseases of babies born). WHAT IS KNOWN ALREADY FET is at the heart of modern IVF. To allow implantation of the thawed embryo, the endometrium must be prepared either by exogenous estrogen and progesterone supplementation (artificial cycle (AC)-FET) or by using the natural cycle to produce endogenous oestradiol before and progesterone after ovulation to time the transfer of the thawed embryo (NC-FET). During a NC-FET, women visit the hospital repeatedly and receive an ovulation trigger to time FET (i.e. modified (m)NC-FET or hospital-based monitoring). From the woman’s point of view, a more natural approach using home-based monitoring of the ovulation with LH urine tests to allow a natural ovulation to time FET may be desired (true NC-FET or home-based monitoring). STUDY DESIGN, SIZE, DURATION This is a multicentre, non-inferiority prospective randomised controlled trial design. Consenting women will undergo one FET cycle using either true NC-FET or mNC-FET based on randomisation. PARTICIPANTS/MATERIALS, SETTING, METHODS Based on our sample size calculation the study group will consist of 1464 women between 18 and 45 years old who are scheduled for FET. Women with anovulatory cycles, women who need ovulation induction and women with a contra indication for pregnancy will be excluded. The primary outcome is ongoing pregnancy. Secondary outcomes are cancellation rates of FET, pregnancy outcomes (including miscarriage rate, clinical pregnancy, multiple pregnancy rate and live birth rate). Costs will be estimated by counting resource use and calculating unit prices. STUDY FUNDING/COMPETING INTEREST(S) The study received a grant from The Dutch Organisation for Health Research and Development (ZonMw 843002807; www.zonmw.nl). ZonMw has no role in the design of the study, collection, analysis, and interpretation of data or writing of the manuscript. Dr. Broekmans reports personal fees from member of the external advisory board for Merck Serono, grants from Research support grant Merck Serono, outside the submitted work;. Dr. Cantineau reports and Unrestricted grant of Ferring B.V. to the Center for Reproductive medicine, no personal fee. Author up-to-date on Hyperthecosis. Congress meetings 2019 with Ferring B.V. and Theramex B.V. Dr. Goddijn reports Department research and educational grants from Guerbet, Merck and Ferring (location VUMC) outside the submitted work. Dr. Groenewoud reports personal fees from Titus Health Care, outside the submitted work; Dr. Lambalk reports grants from Ferring, grants from Merck, from Guerbet, outside the submitted work. The other authors have none to declare. TRIAL REGISTRATION NUMBER Dutch Trial Register (Trial NL6414 (NTR6590), https://www.trialregister.nl/). TRIAL REGISTRATION DATE 23 July 2017 DATE OF FIRST PATIENT’S ENROLMENT 10 April 2018

A Retrospective Study of Recipient-related Predictors of Success in an Oocyte Donation Program

2017 ◽  
Vol 8 (2) ◽  
pp. 75-82
Author(s):  
Sathya Balasubramanyam ◽  
Ritu Punhani ◽  
Kundavi Shankar ◽  
Thankam R Varma
Keyword(s):  
Retrospective Study ◽  
Pregnancy Rate ◽  
Live Birth ◽  
Endometrial Thickness ◽  
Roc Curves ◽  
Oocyte Donation ◽  
Clinical Pregnancy ◽  
Predictors Of Success ◽  
Ongoing Pregnancy ◽  
Chi Square Analysis

ABSTRACT Introduction Prior to the era of in vitro fertilization, no options for conception were available to women with primary ovarian insufficiency, decreased ovarian reserve, or genetically transmittable diseases. Oocyte donation (OD) has been used in such women for almost 30 years. It also offers an opportunity to study the participation of the uterus in the process of human embryo implantation. Aim To identify recipient variables that may have a significant impact on the pregnancy outcome of an OD program. Materials and methods The present study was conducted at Madras Medical Mission Hospital, Chennai, India. We retrospectively evaluated 192 patients and 283 embryo transfer cycles as a result of OD over a period of 5 years. Rates of implantation, clinical pregnancy, ongoing pregnancy, miscarriage, and live birth were calculated for different age groups, endometrial thickness (ET), indications of OD, fresh and frozen embryo transfers (FET), type of subfertility, past history of endometriosis, and body mass index (BMI) of the recipients. Data evaluation was mainly done by Chi-square analysis, and receiver operating characteristic (ROC) curves were made for age and ET. Results The results of this study showed a clinical pregnancy rate (CPR) of 37.1%, implantation rate (IR) of 19.3%, miscarriage rate of 20.4%, ongoing pregnancy rate (OPR) of 32.2%, and live birth rate (LBR) of 26.6%. Significant association was seen between age of recipient and OPR (p = 0.014), and also between fresh embryo transfers, CPR, OPR, and LBR (p < 0.05). The ROC curves showed a significant association of LBR with age of recipient. Conclusion Although no single or combined recipient variable(s) could be identified as predictor(s) of pregnancy, significant association was found between OPR, LBR, and recipient's age and also between fresh embryo transfers with CPR, OPR, and LBR. How to cite this article Punhani R, Balasubramanyam S, Shankar K, Varma TR. A Retrospective Study of Recipient-related Predictors of Success in an Oocyte Donation Program. Int J Infertil Fetal Med 2017;8(2):75-82.

scholarly journals Age-specific definition of low anti-Mullerian hormone and associated pregnancy outcome in women undergoing IVF treatment

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Depeng Zhao ◽  
Jing Fan ◽  
Ping Wang ◽  
Xuan Jiang ◽  
Jilong Yao ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Clinical Pregnancy ◽  
Specific Reference ◽  
Reference Ranges ◽  
Least Squares Regression ◽  
Ongoing Pregnancy ◽  
Child Healthcare ◽  
Specific Equation ◽  
Definition Of ◽  
Specific Definition

Abstract Background The age-specific definition of low anti-müllerian hormone (AMH) is lacking. This study aims to define an age-specific reference for low AMH and to evaluate the associated outcome in women undergoing IVF treatment. Methods A retrospective study was performed in women receiving IVF treatment at the Shenzhen maternity and child healthcare hospital between September 2016 and September 2018. We excluded cases without AMH concentration. Polynomial least-squares regression was used to estimate the age-specific reference ranges for AMH after log-transformed. The age-specific 10th centile was defined as the threshold of low AMH concentration. Results A total of 909 patients were analyzed in this study. The age-specific reference ranges for AMH were established using linear regression model and resulted in an age-specific equation for mean: mean of LnAMH = (− 0.085 × age) + 3.722 (ng/ml, in unit). Women with AMH level higher than 10th centile had favorable outcomes in ovarian stimulation compared to those with low AMH level. In patients younger than 35 years, the rates of clinical pregnancy per transfer and ongoing pregnancy per transfer in the subgroup with AMH level higher than 10th centile were significantly higher than that in the subgroup of low AMH level, 57% versus 31.3% p = 0.003 and 51.9% versus 21.9% p = 0.001, respectively. Conclusion Women with AMH lower than age-specific 10th centile had significantly unfavorable outcomes after IVF treatment. The age-specific 10th centile of AMH concentration may be useful to predict the outcome of IVF treatment.

scholarly journals Using Deep Learning in a Monocentric Study to Characterize Maternal Immune Environment for Predicting Pregnancy Outcomes in the Recurrent Reproductive Failure Patients

2021 ◽  
Vol 12 ◽  
Author(s):  
Chunyu Huang ◽  
Zheng Xiang ◽  
Yongnu Zhang ◽  
Dao Shen Tan ◽  
Chun Kit Yip ◽  
...  
Keyword(s):  
Pregnancy Outcome ◽  
Live Birth ◽  
Pregnancy Outcomes ◽  
Prediction Models ◽  
Reproductive Failure ◽  
Clinical Pregnancy ◽  
Clinical Samples ◽  
Ongoing Pregnancy ◽  
Biochemical Pregnancy ◽  
Immune Factors

Recurrent reproductive failure (RRF), such as recurrent pregnancy loss and repeated implantation failure, is characterized by complex etiologies and particularly associated with diverse maternal factors. It is currently believed that RRF is closely associated with the maternal environment, which is, in turn, affected by complex immune factors. Without the use of automated tools, it is often difficult to assess the interaction and synergistic effects of the various immune factors on the pregnancy outcome. As a result, the application of Artificial Intelligence (A.I.) has been explored in the field of assisted reproductive technology (ART). In this study, we reviewed studies on the use of A.I. to develop prediction models for pregnancy outcomes of patients who underwent ART treatment. A limited amount of models based on genetic markers or common indices have been established for prediction of pregnancy outcome of patients with RRF. In this study, we applied A.I. to analyze the medical information of patients with RRF, including immune indicators. The entire clinical samples set (561 samples) was divided into two sets: 90% of the set was used for training and 10% for testing. Different data panels were established to predict pregnancy outcomes at four different gestational nodes, including biochemical pregnancy, clinical pregnancy, ongoing pregnancy, and live birth, respectively. The prediction models of pregnancy outcomes were established using sparse coding, based on six data panels: basic patient characteristics, hormone levels, autoantibodies, peripheral immunology, endometrial immunology, and embryo parameters. The six data panels covered 64 variables. In terms of biochemical pregnancy prediction, the area under curve (AUC) using the endometrial immunology panel was the largest (AUC = 0.766, accuracy: 73.0%). The AUC using the autoantibodies panel was the largest in predicting clinical pregnancy (AUC = 0.688, accuracy: 78.4%), ongoing pregnancy (AUC = 0.802, accuracy: 75.0%), and live birth (AUC = 0.909, accuracy: 89.7%). Combining the data panels did not significantly enhance the effect on prediction of all the four pregnancy outcomes. These results give us a new insight on reproductive immunology and establish the basis for assisting clinicians to plan more precise and personalized diagnosis and treatment for patients with RRF.

scholarly journals Optimal Endometrial Preparation Protocols for Frozen-thawed Embryo Transfer Cycles by Maternal Age

2020 ◽  
Author(s):  
Qizhen Zheng ◽  
Hongzhan Zhang ◽  
Shiru Xu ◽  
Shan Xiao ◽  
Xuejin Wang ◽  
...  
Keyword(s):  
Older Women ◽  
Embryo Transfer ◽  
Live Birth ◽  
Pregnancy Outcomes ◽  
Maternal Age ◽  
Independent Effect ◽  
Miscarriage Rate ◽  
Younger Women ◽  
Endometrial Preparation ◽  
Early Miscarriage

Abstract Background: It is paramount to consider the appropriate preparation of the endometrium to receive the transferred embryos as the amount of frozen embryo transfer (FET) cycles is increasing worldwide. However, there remains lack of evidence about what is the most optimal protocol of endometrial preparation regarding pregnancy outcomes in different subgroup of infertile women. This retrospective cohort study was aim to explore the best endometrial preparation protocols among different maternal age groups.Methods: A total of 16870 FET cycles were categorized into three groups based on endometrial preparation protocols: Natural cycle (NC n=3893), artificial cycles (AC, n=11459) and AC with pretreatment with GnRH-a (AC+GnRH-a, n=1518). Logistic regression was performed to investigate the independent effect of endometrial preparation protocols on IVF pregnancy outcomes. Subgroup analyses were conducted to evaluate the most optimal endometrial preparation protocols for different maternal age groups.Results: In overall populations, after controlling for potential confounders, the incidence of live birth (NC as reference; AC: adjusted odds ratio (aOR) =0.840, 95%CI 0.774-0.912; AC+GnRHa: aOR=0.907, 95%CI 0.795-1.034) in NC was significantly higher than that of AC, while comparable to that of AC+GnRH-a. The early miscarriage rate (AC: aOR=1.413, 95%CI 1.220-1.638; AC+GnRHa: aOR=1.537, 95%CI 1.232-1.919) was significantly lower in NC compared to either AC group. In younger women, the live birth rates (AC: aOR=0.894, 95%CI 0.799-1.001; AC+GnRHa: aOR=1.111, 95%CI 0.923-1.337) were comparable between the three groups, with a slightly higher in AC+GnRH-a. Early miscarriage rate was only significantly lower in NC compared to that of AC without GnRH-a (aOR=1.452, 95%CI 1.159-1.820). While in older women, the incidence of live birth (AC: aOR=0.811, 95%CI 0.718-0.916; AC+GnRHa: aOR=0.760, 95%CI 0.626-0.923) was significantly higher, and early miscarriage (AC: aOR=1.358, 95%CI 1.114-1.655; AC+GnRHa: aOR=1.717, 95%CI 1.279-2.305) was significantly lower in NC compared to those of two AC groups.Conclusions: NC protocol is associated with lower early miscarriage late in overall IVF population. There is a mild favor of AC+GnRH-a in younger women, while the priority of NC is remarkable in older women. Maternal age should be a considerable factor when determine endometrial preparation method for FET.

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