scholarly journals The Effects of Ovulation Documentation before Insemination on Intrauterine Insemination Cycle Outcomes: A Retrospective Analysis

2021 ◽  
Author(s):  
Sujata Pradhan ◽  
Padmalaya Thakur
Keyword(s):  
Pregnancy Rate ◽  
Live Birth ◽  
Birth Rate ◽  
Intrauterine Insemination ◽  
Live Birth Rate ◽  
Categorical Variables ◽  
P Value ◽  
Continuous Variables ◽  
Chi Square ◽  
Exact Test

Introduction: Ovulation is the key event in Intrauterine Insemination (IUI) cycles. Monitoring ovulation prior to insemination will help to alter insemination time to improve pregnancy rate. Aim: To compare pregnancy rates and live birth rates in presence and absence of ultrasonographic features of ovulation before insemination in IUI cycles. Materials and Methods: This was a retrospective cohort study conducted in a Institute of Medical Sciences and SUM Hospital, Bhubaneswar. Three hundred eighty eight IUI cycles performed in the period of January 2017 to December 2018 were analysed. On the day of IUI prior to insemination, transvaginal ultrasonography was done 36-38 hours after ovulation trigger to document ovulation. Presumptive signs of ovulation were documented in 201 cycles (Group A) and there was no feature suggestive of ovulation in 187 cycles (Group B). In all the cycles, single insemination was performed at 38-40 hours after ovulation trigger. Baseline characteristics were compared. Mann-Whitney U test was used to compare continuous variables. Chi-square test and Fisher’s-exact test were applied to find out the differences in the categorical variables as well as the pregnancy outcomes among the groups. Pregnancy rate and live birth rate were considered as the primary outcomes. Results: Pregnancy rate (17.9% vs 18.2%, p-value=0.945) and live birth rate (17.9% vs 16.0%, p-value=0.625) were similar irrespective of ovulation status documented in ultrasonography performed before insemination. Conclusion: IUI cycle outcomes are independent of the ovulation status documented before insemination.

scholarly journals GnRH agonist and hCG (dual trigger) versus hCG trigger for follicular maturation: a systematic review and meta-analysis of randomized trials

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Kai-Lun Hu ◽  
Siwen Wang ◽  
Xiaohang Ye ◽  
Dan Zhang ◽  
Sarah Hunt
Keyword(s):  
Systematic Review ◽  
Pregnancy Rate ◽  
Live Birth ◽  
Gnrh Agonist ◽  
Birth Rate ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Live Birth Rate ◽  
Follicular Maturation ◽  
Hcg Trigger

Abstract Background Traditionally, final follicular maturation is triggered by a single bolus of human chorionic gonadotropin (hCG). This acts as a surrogate to the naturally occurring luteinizing hormone (LH) surge to induce luteinization of the granulosa cells, resumption of meiosis and final oocyte maturation. More recently, a bolus of gonadotropin-releasing hormone (GnRH) agonist in combination with hCG (dual trigger) has been suggested as an alternative regimen to achieve final follicular maturation. Methods This study was a systematic review and meta-analysis of randomized trials evaluating the effect of dual trigger versus hCG trigger for follicular maturation on pregnancy outcomes in women undergoing in vitro fertilization (IVF). The primary outcome was the live birth rate (LBR) per started cycle. Results A total of 1048 participants were included in the analysis, with 519 in the dual trigger group and 529 in the hCG trigger group. Dual trigger treatment was associated with a significantly higher LBR per started cycle compared with the hCG trigger treatment (risk ratio (RR) = 1.37 [1.07, 1.76], I2 = 0%, moderate evidence). There was a trend towards an increase in both ongoing pregnancy rate (RR = 1.34 [0.96, 1.89], I2 = 0%, low evidence) and implantation rate (RR = 1.31 [0.90, 1.91], I2 = 76%, low evidence) with dual trigger treatment compared with hCG trigger treatment. Dual trigger treatment was associated with a significant increase in clinical pregnancy rate (RR = 1.29 [1.10, 1.52], I2 = 13%, low evidence), number of oocytes collected (mean difference (MD) = 1.52 [0.59, 2.46), I2 = 53%, low evidence), number of mature oocytes collected (MD = 1.01 [0.43, 1.58], I2 = 18%, low evidence), number of fertilized oocytes (MD = 0.73 [0.16, 1.30], I2 = 7%, low evidence) and significantly more usable embryos (MD = 0.90 [0.42, 1.38], I2 = 0%, low evidence). Conclusion Dual trigger treatment with GnRH agonist and HCG is associated with an increased live birth rate compared with conventional hCG trigger. Trial registration CRD42020204452.

scholarly journals Comparison of IVF Outcomes between Minimal Stimulation and High-Dose Stimulation for Patients with Poor Ovarian Reserve

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Tal Lazer ◽  
Shir Dar ◽  
Ekaterina Shlush ◽  
Basheer S. Al Kudmani ◽  
Kevin Quach ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Live Birth ◽  
Ovarian Reserve ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Poor Responders ◽  
High Dose ◽  
Poor Ovarian Reserve

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.

scholarly journals Evaluation of the Risk of Clinical Deterioration among Inpatients with COVID-19

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Víctor O. Costa ◽  
Eveline M. Nicolini ◽  
Bruna M. A. da Costa ◽  
Fabrício M. Teixeira ◽  
Júlia P. Ferreira ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Lung Parenchyma ◽  
Clinical Deterioration ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Exact Test ◽  
Laboratory Confirmation ◽  
Chi Square Test ◽  
Imaging Markers

This study aims to assess the risk of severe forms of COVID-19, based on clinical, laboratory, and imaging markers in patients initially admitted to the ward. This is a retrospective observational study, with data from electronic medical records of inpatients, with laboratory confirmation of COVID-19, between March and September 2020, in a hospital from Juiz de Fora-MG, Brazil. Participants (n = 74) were separated into two groups by clinical evolution: those who remained in the ward and those who progressed to the ICU. Mann–Whitney U test was taken for continuous variables and the chi-square test or Fisher’s exact test for categorical variables. Comparing the proposed groups, lower values of lymphocytes ( p  = <0.001) and increases in serum creatinine ( p  = 0.009), LDH ( p  = 0.057), troponin ( p  = 0.018), IL-6 ( p  = 0.053), complement C4 ( p  = 0.040), and CRP ( p  = 0.053) showed significant differences or statistical tendency for clinical deterioration. The average age of the groups was 47.9 ± 16.5 and 66.5 ± 7.3 years ( p  = 0.001). Hypertension ( p  = 0.064), heart disease ( p  = 0.048), and COPD ( p  = 0.039) were more linked to ICU admission, as well as the presence of tachypnea on admission ( p  = 0.051). Ground-glass involvement >25% of the lung parenchyma or pleural effusion on chest CT showed association with evolution to ICU ( p  = 0.027), as well as bilateral opacifications ( p  = 0.030) when compared to unilateral ones. Laboratory, clinical, and imaging markers may have significant relation with worse outcomes and the need for intensive treatment, being helpful as predictive factors.

scholarly journals Pregnancy Outcomes Following the First Frozen Blastocyst Transfer Among Women Aged Less Than 35 Years Old: A Retrospective Cohort Study

2021 ◽  
pp. 1-7
Author(s):  
Le Hoang ◽  
Le Duc Thang ◽  
Nguyen Thi Lien Huong ◽  
Nguyen Minh Thuy ◽  
Vu Thi Mai Anh ◽  
...  
Keyword(s):  
Cohort Study ◽  
Pregnancy Rate ◽  
Live Birth ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Birth Rate ◽  
Multiple Pregnancy ◽  
Live Birth Rate ◽  
Group 2 ◽  
Group 1

Background: Many guidelines have been issued regarding the number of embryos to be transferred after in vitro fertilization (IVF), but patients and clinicians may be reluctant to accept or offer a single embryo transfer due to the expected lower chance of pregnancy or live birth. This study was aimed to provide additional information on cycle outcome according to the number and quality of thawed transferred blastocysts. Methods:A retrospective cohort study was designed to collect the data of 505 patients who performed the first frozen blastocysts transfer at Tam Anh General Hospital from June 2018 to September 2019. One good-quality embryo was transferred for 121 patients (Group 1), two good for 214 patients (Group 2), one good and one poor for 112 patients (Group 3), one good and two poor for 25 patients (Group 4), and one or two poor for 33 patients (Group 5). Results:The pregnancy rate was 71.9%, 74.8%, 69.4%, 84.0%, and 39.4% in Group 1–5, respectively. The multiple pregnancy rate was 36.9%, 16.9%, and 32.0% in Groups 2–4, respectively, higher than Group 1 (4.9%). The live birth rate was 55.6%, 50.9%, and 60.0% in Group 2–4, respectively, but not significantly different from the Group 1 (47.9%). Conclusions:Transferring an additional good or poor embryo, along with a good embryo, does not increase the live birth rate while the incidence of multiple pregnancies rises significantly.

scholarly journals The effect of air bubble position on ART outcome in frozen-thawed blastocyst transfer

2021 ◽  
Author(s):  
Tingting Yang ◽  
Bo Chen ◽  
Xiaoyan Sun ◽  
Qingyang Li ◽  
Qiumei Li ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Live Birth ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Blastocyst Transfer ◽  
Ultrasound Guided ◽  
Air Bubble ◽  
Art Outcome

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.

scholarly journals Live Birth Rate of Fresh Embryo Transfer with GnRH Agonist Long Protocol is Higher Than Frozen Embryo Transfer

2020 ◽  
Author(s):  
Xiaoyan Ding ◽  
Jingwei Yang ◽  
Lan Li ◽  
Na Yang ◽  
Ling Lan ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Embryo Transfer ◽  
Live Birth ◽  
Pregnancy Loss ◽  
Birth Rate ◽  
Implantation Rate ◽  
Live Birth Rate ◽  
Clinical Pregnancy ◽  
Fresh Embryo Transfer ◽  
Long Protocol

Abstract Background: Along with progress in embryo cryopreservation, especially in vitrification has made freeze all strategy more acceptable. Some studies found comparable or higher live birth rate with frozen embryo transfer (FET) than with fresh embryo transfer（ET）in gonadotropin releasing hormone antagonist (GnRH-ant) protocol. But there were no reports about live birth rate differences between fresh ET and FET with gonadotropin releasing hormone agonist (GnRH-a) long protocol. The aim of this study is to analyze whether patients benefit from freeze all strategy in GnRH-a protocol from real-world data.Methods: This is a retrospective cohort study, in which women undergoing fresh ET or FET with GnRH-a long protocol at Chongqing Reproductive and Genetics Institute from January 2016 to December 2018 were evaluated. The primary outcome was live birth rate. The secondary outcomes were implantation rate, clinical pregnancy rate, pregnancy loss and ectopic pregnancy rate.Results: A total of 7,814 patients met inclusion criteria, implementing 5,216 fresh ET cycles and 2,598 FET cycles, respectively. The demographic characteristics of the patients were significantly different between two groups, except BMI. After controlling for a broad range of potential confounders (including age, infertility duration, BMI, AMH, no. of oocytes retrieved and no. of available embryos), multivariate logistic regression analysis demonstrated that there was no significant difference in terms of clinical pregnancy rate, ectopic pregnancy rate and pregnancy loss rate between two groups (all P>0.05). However, the implantation rate and live birth rate of fresh ET group were significantly higher than FET group (P<0.001 and P=0.012, respectively).Conclusion: Compared to FET, fresh ET following GnRH-a long protocol could lead to higher implantation rate and live birth rate in infertile patients underwent in vitro fertilization (IVF). The freeze all strategy should be individualized and made with caution especially with GnRH-a long protocol.

P–159 Slow-growing embryos should be frozen on day 5

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
M J Zamora ◽  
I Katsouni ◽  
D Garcia ◽  
R Vassena ◽  
A Rodríguez
Keyword(s):  
Pregnancy Rate ◽  
Embryo Transfer ◽  
Live Birth ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Study Groups ◽  
Pregnancy Rates ◽  
Clinical Pregnancy ◽  
Patient Counselling ◽  
Slow Growing

Abstract Study question What is the live birth rate after frozen embryo transfer (FET) of slow-growing embryos frozen on day 5 (D5) or on day 6 (D6)? Summary answer The live birth rate after single FET is significantly higher for slow-growing embryos frozen on D5 compared to those frozen on D6. What is known already Most data on the outcomes of blastocyst transfer stem from studies that evaluate fresh transfer from normal growing D5 blastocyst ET. However not all embryos will begin blastulation nor reach the fully expanded stage by D5; those are the slow-growing embryos. Studies that compare D5 to D6 embryos in FET cycles show contradictory results. Some have reported higher clinical pregnancy rates after D5 FET, while others have reported similar outcomes for D5 and D6 cryopreserved blastocyst transfers. There is a lack of evidence regarding the best approach for vitrifying embryos that exhibit a slow developmental kinetic. Study design, size, duration This retrospective cohort study included 821 single FET of slow-growing embryos frozen on D5 or D6, belonging to patients undergoing in vitro fertilization with donor oocytes between January 2011 and October 2019, in a single fertility center. The origin of blastocysts was either supernumerary embryos after fresh embryo transfer or blastocysts from freeze-all cycles. All embryos were transferred 2- 4h after thawing. Participants/materials, setting, methods We compared reproductive outcomes of slow-growing embryos frozen on D5 versus (n = 442) slow-growing embryos frozen on D6 (n = 379). D5 group consisted in embryos graded 0, 1, 2 of Gardner scale and frozen on D5. Similarly, D6 group consisted in embryos graded 3, 4, 5 of Gardner scale (blastocyst stage) and frozen on D6. Differences in pregnancy rates between study groups were compared using a Chi2 test. A p-value &lt;0.05 was considered statistically significant. Main results and the role of chance Baseline characteristics were comparable between study groups. Overall, mean age of the woman was 42.3±5.4 years old; donor sperm was used in 25% of cycles, and it was frozen in 73.2% of cycles. Pregnancy rates were significantly higher when transferring slow D5 embryos compared to D6 for all the pregnancy outcomes analyzed: biochemical pregnancy rate was 27.7% vs 20.2%, p &lt; 0.016; clinical pregnancy rate was 17.5% vs 10.2%, p &lt; 0.004); ongoing pregnancy rate was: 15.7% vs 7.8% (p &lt; 0.001); live birth rate was: 15.4% vs 7.5%, (p &lt; 0.001). These results suggest that when embryos exhibit a slow development behavior (not reaching full blastocysts at D5), waiting until D6 for blastulation and expansion does not improve clinical outcomes. Vitrification at D5 will should the preferred option in cases where the oocyte is assumed of high quality Limitations, reasons for caution The retrospective design of the study is its main limitation. Also, morphology as sole selection criterion for transfer. However, blastocyst morphology is a very good predictor of implantation and pregnancy, and a good indicator of the embryo’s chromosomal status (higher euploidy rate in higher morphological quality blastocysts). Wider implications of the findings: These results can help to the standardization of laboratory protocols. As the decision of vitrifying slow developing embryos on D5 or D6 is made by the laboratory team or by the gynaecologist in agreement with the patient, having an evidence based strategy simplifies patient counselling and decision making. Trial registration number Not applicable

Abstract P165: Comparing Grip Strength, Weakness, And Frailty Based On Comorbidity And Laboratory Data Among Patients With Cardiovascular Disease

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Gloria Kim ◽  
Arati A Gangadharan ◽  
Matthew A Corriere
Keyword(s):  
Grip Strength ◽  
Frailty Index ◽  
Laboratory Data ◽  
Categorical Variables ◽  
P Value ◽  
Continuous Variables ◽  
Chi Square ◽  
Mean Values ◽  
Multivariable Models ◽  
And Gender

Introduction: Some approaches to frailty screening use diagnostic or laboratory data that may be incomplete. Grip strength can identify weakness, a component of phenotype-based frailty assessment. We compared grip strength as a reductionist, phenotype-based approach to frailty screening with comorbidity and laboratory-based alternatives. Hypothesis: Grip strength and categorical weakness are correlated with the modified frailty index-5 (mFI-5) and lab values associated with frailty. Methods: Weakness based on grip, BMI, and gender was compared with mFI-5 comorbidities and lab values. Patients with at least 3/5 mFI-5 comorbidities were considered frail. Lab data collected within 6 months of grip measurement was assessed. Associations were evaluated using multivariable models and kappa. Methods: 2,597 patients had grip strength measured over 5 months. Mean age was 64.4±14.6, mean BMI was 29.5±6.9;46% were women, and 87% white. Prevalent comorbidities included hypertension (28%), CHF (22%), diabetes (29%), and COPD (26%); 9% were functionally dependent. 34% were weak, but only 13% were frail based on mFI-5. Hemoglobin, creatinine, and CRP differed significantly based on weakness ( Table ). Laboratory data were missing for 36%- 95% of patients. Multivariable models identified significant associations between weakness, hemoglobin, and all MFI-5 comorbidities. Categorical agreement between weakness and frailty was limited (kappa =0.09; 95% CL 0.0641-0.1232). Conclusion: Weakness based on grip strength provides a practical, inexpensive approach to risk assessment, especially when incomplete data excludes other approaches. Comorbidity-based assessment categorizes many weak patients as non-frail. Table. Demographic, laboratory values, and comorbidities by categorical weakness based on grip 20 th percentile. Mean values for continuous variables by weakness adjusted for gender and BMI, p-value for T-test; frequency and total percent for categorical variables, p-value represents chi-square test.

Sign in / Sign up

Export Citation Format

Share Document