scholarly journals Comparison of pregnancy outcomes using a time-lapse monitoring system for embryo incubation versus a conventional incubator in in vitro fertilization: an age-stratification analysis

Pattraporn Chera-aree ◽  
Isarin Thanaboonyawat ◽  
Benjawan Thokha ◽  
Pitak Laokirkkiat

Objective: The aim of this study was to compare the pregnancy outcomes of in vitro fertilization with embryo transfer between embryos cultured in a time-lapse monitoring system (TLS) and those cultured in a conventional incubator (CI).Methods: The medical records of 250 fertilized embryos from 141 patients undergoing infertility treatment with assisted reproductive technology at a tertiary hospital from June 2018 to May 2020 were reviewed. The study population was divided into TLS and CI groups at a 1 to 1 ratio (125 embryos per group). The primary outcome was the live birth rate. Results: The TLS group had a significantly higher clinical pregnancy rate (46.4% vs. 27.2%, p=0.002), implantation rate (27.1% vs. 12.0%, p=0.004), and live birth rate (32% vs. 18.4%, p=0.013) than the CI group. Furthermore, subgroup analyses of the clinical pregnancy rate and live birth rate in the different age groups favored the TLS group. However, this difference only reached statistical significance in the live birth rate in women aged over 40 years and the clinical pregnancy rate in women aged 35–40 years (p=0.048 and p=0.031, respectively). The miscarriage rate, cleavage rate, and blastocyst rate were comparable.Conclusion: TLS application improved the live birth rate, implantation rate, and clinical pregnancy rate, particularly in the advanced age group in this study, while the other reproductive outcomes were comparable. Large randomized controlled trials are needed to further explore the ramifications of these findings, especially in different age groups.

2021 ◽  
Vol 21 (1) ◽  
Junrong Diao ◽  
Ge Gao ◽  
Yunshan Zhang ◽  
Xinyan Wang ◽  
Yinfeng Zhang ◽  

Abstract Background Caesarean section rates are rising worldwide. One adverse effect of caesarean section reported in some studies is an increased risk of subfertility. Only a few studies have assessed the relationship between the previous mode of delivery and in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) reproductive outcomes. In this study, we primarily investigated the impact of a history of caesarean section with or without defects on IVF/ICSI-ET outcomes compared to a vaginal delivery history. Methods This retrospective study included 834 women who had a IVF or ICSI treatment at our centre between 2015 and 2019 with a delivery history. In total, 401 women with a previous vaginal delivery (VD) were assigned to the VD group, and 433 women with a history of delivery by caesarean section were included, among whom 359 had a caesarean scar (CS) without a defect and were assigned to the CS group and 74 had a caesarean section defect (CSD) and were assigned to the CSD group. Baseline characteristics of the three groups were compared and analysed. Binary logistic regression analyses were performed to explore the association between clinical outcomes and different delivery modes. Results There were no significant differences in the live birth rate, biochemical pregnancy rate, clinical pregnancy rate, mean implantation rate or abnormal pregnancy rate between the CS and VD groups However, the live birth rate and mean implantation rate in the CSD group were significantly lower than those in the VD group (21.6 vs 36.4%, adjusted OR 0.50 [0.27–0.9]; 0.25 ± 0.39 vs 0.35 ± 0.41, adjusted OR 0.90 [0.81–0.99]). Among women aged ≤ 35 years, the subgroup analyses showed that the live birth rate, biochemical pregnancy rate, clinical pregnancy rate, and mean implantation rate in the CSD group were all significantly lower than those in the VD group (21.4 vs 45.8%, adjusted OR 0.35[0.15 ~ 0.85]; 38.1 vs 59.8%, adjusted OR 0.52[0.24–0.82]; 31.0 vs 55.6%, adjusted OR 0.43[0.19–0.92]; 0.27 ± 0.43 vs 0.43 ± 0.43, adjusted OR 0.85[0.43 ± 0.43]). For women older than 35 years, there was no statistically significant difference in any pregnancy outcome among the three groups. Conclusions This study suggested that the existence of a CS without a defect does not decrease the live birth rate after IVF or ICSI compared with a previous VD. However, the presence of a CSD in women, especially young women (age ≤ 35 years), significantly impaired the chances of subsequent pregnancy.

2021 ◽  
Myung Joo Kim ◽  
Seung-Ah Choe ◽  
Eun A Park ◽  
Ran Kim ◽  
You Shin Kim

Abstract Backgound: IVM has emerged as a safe and promising alternative procedure to conventional in vitro fertilization (IVF) for minimizing the risk of ovarian hyperstimulation syndrome (OHSS) in patients with PCOS. Despite the comparable obstetric and perinatal outcomes, there are no definite factors known to affect the outcomes of IVM.Methods: Retrospective analysis of a total of 313 women with PCOS undergoing 427 hCG-primed IVM cycles between January 2010 and February 2016 at the Fertility Center of CHA Gangnam Medical Center, Seoul, Korea. The number of retrieved oocytes and maturation, fertilization, and implantation rates were analyzed. Results: After transferring a mean of 2.4 ± 0.5 fresh embryos, the clinical pregnancy rate was 39.1% (n = 167), and the live birth rate was 30.7% (n = 131) with the implantation rate of 20.9%. The numbers of retrieved (18.1 ± 9.7 vs. 15.6 ± 8.7, p = 0.014), fertilized (8.6 ± 5.2 vs. 6.6 ± 3.8, p < 0.001) oocytes; good-quality embryos (1.3 ± 0.9 vs. 1.0 ± 0.9, p = 0.001); and blastocyst transfer cycles (22 vs. 15, p < 0.001) were significantly higher in the live birth group than in the no live birth group. Among the factors associated with live births, retrieved oocytes had a slightly positive effect on live birth (RR = 1.03; 95% CI, 1.00, 1.06; p = 0.021).Conclusions: It seems that the number of retrieved oocytes has a favorable effect in increasing the clinical pregnancy rate and live birth rate during hCG-primed IVM procedure in women with PCOS. Physicians’ skills and cautious efforts may be required to retrieve a higher number of oocytes in IVM procedures.

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Yanxia Zhang ◽  
Meiqing Li ◽  
Lian Li ◽  
Jianghua Xiao ◽  
Zhe Chen

Objective. To investigate the effect of dehydroepiandrosterone (DHEA) on the outcome of in vitro fertilization (IVF) in patients with endometriosis (EMT). Methods. Female patients diagnosed with EMT in our hospital from May 2018 to May 2019 were selected. The patients were divided into the control group (n = 22) and the DHEA group (n = 22) according to the random number table. Patients in the control group received placebo and patients in the DHEA group received DHEA. Patients in both groups received either DHEA (25 mg) or placebo orally 3 times a day for 90 days from the first day of menstruation. Patients were subsequently treated with an IVF cycle. In the control group, 22 patients completed the first cycle and 13 patients completed the second cycle. In the DHEA group, 22 patients completed the first cycle and 11 patients completed the second cycle. Serum sex hormone levels including serum E2 on hCG day, mean progesterone on hCG day, FSH on day 2, AMH on day 2, and gonadotropin dose were determined using a chemiluminescent immunoassay kit. The number of antral follicles of the bilateral ovaries was counted by transvaginal B-ultrasound, and the maximum length and transverse diameter of the ovaries were measured at the same time, to calculate the average diameter of the ovaries, observe the morphology of endometrium, and measure the thickness of the endometrium. The implantation rate, clinical pregnancy rate, persistent pregnancy rate, and live birth rate were compared between the two groups. Results. There were no significant differences in serum E2, progesterone, endometrial thickness, recovered oocytes, mean number of transferred embryos, and mean score of leading embryo transfer between the DHEA group and the women who completed the first and second cycles ( P > 0.05 ). The AMH, antral follicle count, serum E2 on hCG day, the number of recovered oocytes, fertilized oocytes, and the fertilization rate in the DHEA group were higher than those in the control group ( P < 0.05 ). The doses of FSH on day 2, COH on day 3, and gonadotropin were lower than those in the control group ( P < 0.05 ). There was no significant difference in the total number of embryos, the number of high-quality embryos, and the number of transplanted embryos between the two groups ( P > 0.05 ). The implantation rate, clinical pregnancy rate, persistent pregnancy rate, and live birth rate in the DHEA group were higher than those in the control group ( P < 0.05 ). Conclusion. DHEA can significantly increase serum E2 level and improve IVF outcome by regulating the hormone synthesis process, thus improving oocyte and embryo quality.

2021 ◽  
Vol 21 (1) ◽  
Han-Chih Hsieh ◽  
Chun-I Lee ◽  
En-Yu Lai ◽  
Jia-Ying Su ◽  
Yi-Ting Huang ◽  

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

2021 ◽  
Vol 12 ◽  
Haiyan Zhu ◽  
Chenqiong Zhao ◽  
Yibin Pan ◽  
Hanjing Zhou ◽  
Xiaoying Jin ◽  

Study QuestionDoes dual trigger in freeze-all in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles improve the cumulative live-birth outcome compared with human chorionic gonadotropin (hCG) trigger?Summary AnswerDual trigger for final follicular maturation improves the cumulative pregnancy and live-birth rates compared with hCG trigger in freeze-all IVF/ICSI cycles.What Is Known AlreadyDual trigger could increase the numbers of oocytes and mature oocytes and improve pregnancy rates.Study Design, Size, DurationThis retrospective cohort analysis included data from 4438 freeze-all IVF/ICSI cycles between January 2012 and December 2017.Participants/Materials, Setting, MethodsWomen aged 20−49 years who underwent ovarian stimulation and oocyte retrieval for autologous IVF/ICSI with a freeze-all policy in our centre were enrolled. Data on number of oocytes retrieved, number of mature oocytes, clinical pregnancy rate, live-birth rate, cumulative pregnancy rate, and cumulative live-birth rate (CLBR) were assessed and compared between patients who underwent a dual trigger and hCG trigger. Multivariate logistic regression was performed to identify and adjust for factors known to independently affect the CLBR.Main Results and the Role of ChanceA total of 4438 IVF/ICSI cycles were analyzed, including 1445 cycles with single hCG trigger and 2993 cycles with dual trigger. The cumulative biochemical pregnancy rate (60.8% vs. 68.1%, P&lt;0.001; odds ratio (OR): 0.727; 95% confidence interval (CI): 0.638–0.828), cumulative clinical pregnancy rate (52.9% vs. 58.5%, P&lt;0.001; OR: 0.796; 95%CI: 0.701–0.903), and CLBR (44.3% vs. 50.5%, P&lt;0.001; OR: 0.781; 95%CI: 0.688–10.886) were all significantly lower in the hCG-trigger group compared with the dual-trigger group. The clinical pregnancy rate (48.2% vs. 58.2%, P=0.002; OR: 0.829; 95%CI: 0.737–0.934) and embryo implantation rate (34.4% vs. 38.9%, P&lt;0.001; OR: 0.823; 95%CI: 0.750–0.903) in each transfer cycle were also significantly lower in the hCG-trigger group compared with the dual-trigger group. After controlling for all potential confounding variables, the trigger method was identified as an independent factor affecting the CLBR. The OR and 95%CI for hCG trigger were 0.780 and 0.641–0.949 (P=0.013).Limitations, Reasons for CautionThe data used to analyse the effect of dual trigger on cumulative pregnancy and live-birth outcomes were retrospective, and the results may thus have been subject to inherent biases. Further prospective randomized controlled trials are required to verify the beneficial effects of dual trigger.Wider Implications of the FindingsDual trigger had a positive effect on CLBRs, suggesting that it could be used as a routine trigger method in freeze-all cycles.Study Funding/Competing Interest(s)This study was supported by grants from National Key Research and Development Program of China (2018YFC1004800), the Natural Science Program of Zhejiang (LY19H040009), the National Natural Science Foundation of China (No. 81601236). No authors have competing interests to declare.

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Tal Lazer ◽  
Shir Dar ◽  
Ekaterina Shlush ◽  
Basheer S. Al Kudmani ◽  
Kevin Quach ◽  

We examined whether treatment with minimum-dose stimulation (MS) protocol enhances clinical pregnancy rates compared to high-dose stimulation (HS) protocol. A retrospective cohort study was performed comparing IVF and pregnancy outcomes between MS and HS gonadotropin-antagonist protocol for patients with poor ovarian reserve (POR). Inclusion criteria included patients with an anti-Müllerian hormone (AMH) ≤8 pmol/L and/or antral follicle count (AFC) ≤5 on days 2-3 of the cycle. Patients from 2008 exclusively had a HS protocol treatment, while patients in 2010 had treatment with a MS protocol exclusively. The MS protocol involved letrozole at 2.5 mg over 5 days, starting from day 2, overlapping with gonadotropins, starting from the third day of letrozole at 150 units daily. GnRH antagonist was introduced once one or more follicles reached 14 mm or larger. The HS group received gonadotropins (≥300 IU/day) throughout their antagonist cycle. Clinical pregnancy rate was significantly higher in the MS protocol compared to the HS protocol (P=0.007). Furthermore, the live birth rate was significantly higher in the MS group compare to the HS group (P=0.034). In conclusion, the MS IVF protocol is less expensive (lower gonadotropin dosage) and resulted in a higher clinical pregnancy rate and live birth rate than a HS protocol for poor responders.

2021 ◽  
Tingting Yang ◽  
Bo Chen ◽  
Xiaoyan Sun ◽  
Qingyang Li ◽  
Qiumei Li ◽  

Abstract Background So far, only few literatures have studied the relationship between blastocyst transfer position and ART outcomes, and the conclusions are still controversial. Our study is to evaluate the effect of air bubble position on ART outcome and to find the optimal embryo transfer position in frozen-thawed blastocyst transfer. Methods This study included a retrospective cohort analysis of 399 frozen-thawed single blastocyst transfers ultrasound-guided performed between June 1, 2017 and November 30, 2020. All of the women scheduled for frozen-thawed single blastocyst transfers ultrasound-guided. The primary outcome is clinical pregnancy rate and the secondary outcome is live birth rate. Statistical analyses were conducted using One-way Anova, Kruscal Whallis H test, chi-square test and Smooth curve fitting. Results When BFD was less than 19 mm, there was no significant change in clinical pregnancy rate as BFD increased (OR = 0.95, 95% CI: 0.89 to 1.02, P = 0.1373); when BFD was more than 19 mm, the clinical pregnancy rate decreased by 16% for every 1 mm increase in BFD (OR = 0.84, 95% CI: 0.72 to 0.98, P = 0.0363). The effect of BFD on live birth rate were similar to that on clinical pregnancy rate, the inflection point was 19mm, when BFD was more than 19 mm, the live birth rate decreases by 58% for every 1 mm increase in BFD (OR = 0.42, 95% CI: 0.21 to 0.86, P = 0.0174) Conclusions The ideal pregnancy outcome can be achieved within 19mm from uterus fundus after single blastocyst transfer, The clinical pregnancy and live birth at a distance of more 19mm from the uterus fundus have a cliff-like downward trend.

2020 ◽  
Xiaoyan Ding ◽  
Jingwei Yang ◽  
Lan Li ◽  
Na Yang ◽  
Ling Lan ◽  

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.

Akshaya Kumar Mahapatro ◽  
Abhishek Radhakrishan

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

2021 ◽  
Vol 36 (Supplement_1) ◽  
D Se. Sharma

Abstract Study question Male infertility due to idiopathic oligoasthenoteratozoospermia- Does combining Letrozole as antiestrogenic with Coenzyme Q10 as antioxidant give better pregnancy rate ? Summary answer Combination of Co enzyme Q10 with Letrozole can significantly improve semen parameters and outcome of clinical pregnancy rate in idiopathic oligoasthenoteratozoospermic patients. What is known already Elevated levels of reactive oxygen species(ROS) are a major cause of idiopathic male factor infertility which results in sperm membrane lipid peroxidation, DNA damage and apoptosis leading to decrease sperm viability and motility. Antioxidant like Coenzyme Q10 have been used empiricallyin the treatment of oligoasthenozoospermia based on its ability to reverse oxidative stress and sperm dysfunction. Aromatase inhibitor like Letrozolehave been used in idiopathic male infertility by reducing estrogenic effect on spermatogenesis and reducing feedback inhibition of hypothalamopituatarygonadal axis. Thus a therapeutic strategy would need to use supplements to increase sperm energy metabilism, minimise free radical damage. Study design, size, duration Study design: prospective comperative clinical study Primary purpose: treatmenr Size: 60 infertile male attending OPD of SHRISTI HEALTHCARE diagnosed as idiopathic oligoasthenoteratozoospermia Duration: from March2018 to February 2020 Primary outcome: improvement in sperm count, motility and morphology after treatment Secondary outcome: clinical pregnancy rate and live birth rate. Participants/materials, setting, methods Exclusion criteria: Smoker, drug and alcohol abuse, medical treatment with gonadotropin and steroids, varicocele.60 patients were randomisedinto 3 groups. Gr A(N = 20) received Letrozole 2.5mg/day + Co enzyme Q10 300mg/day for 3 months, Gr B(N = 20) received Letrozole 2.5mg/day for 3 months, and Gr C(N = 20) received Coenzyme Q10 300mg/day for 3 months. History taking, general examination, semen analysis, sr.FSH,LH, Testesteron, E2 and scrotal duplex were done for all patients. Main results and the role of chance After treatment, Gr A as compared to Gr B and C showed significant imprivement in all 3 parameters of semen eg sperm count( 3.15±3.38 - 20.9±2.11, p &lt; 0.001), sperm motility( 5.25±3.25 - 42.85±3.30, p &lt; 0.001), sperm morphology( 2.26±7.81 - 25.89±7.05, p &lt; 0.001). Improvement in sperm count and morphology was seen in Gr B(Letrozole gr) but not in sperm motility whereas Gr C ( Co enzyme Q10 gr)showed significant improvement in sperm motility and morphology but not in sperm count. 10 pregnancies occured during follow up period of 1 yr. Clinical pregnancy rate was 30%in Gr A(6/20), 5% in Gr B(1/20), AND 15% in Gr C( 3/20). Live birth rate was 83% in Gr A(5/6), 33.3% inGr C(1/3) whereas sponteneous abortion occured in Gr B pregnancy. Limitations, reasons for caution Limitation of my study was the small sample sizewhich could have some bias in outcome. I did not evaluate DNA fragmentation and level of ROS. Latest evidences report that evaluating ROS can be a diagnostic tool in predictingthe best responder to supplementation. Wider implications of the findings: Majority of studies had investigated the effect of antioxidant and aromatase inhibitor on semen parameter but few concluded their effect on live birth rate. Assisted reproductive techniques are expensive and not universally available, so any pharmacological agent with satisfactory effectiveness should be considered as 1st line treatment of oligoasthenoteratozoospermia. Trial registration number Not applicable

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