Comparison of pregnancy rates following fresh and frozen embryo transfer in women undergoing assisted reproductive techniques

Freezing embryos is the best way to increase fertility for women with ovarian hyper-stimulation syndrome and women at risk for ovarian dysfunction. Due to the importance of freezing and pregnancy embryos, the present study was conducted to compare the fertility rate and the affecting factors following fresh embryos and frozen embryos in women treated with assisted reproductive techniques. In this study, 250 infertile women and IVF/ICSI candidates were studied. Embryos were used in fresh or frozen groups for transfer to the uterus. The expression of the caspase-3 gene was also examined for further evaluation. Data analysis was performed using SPSS 16 software, Chi-square, independent t-test, and Kruskal-Wallis tests. Out of 250 infertile women, 96 (38.4%) became pregnant, of which 54 were in the fresh embryo group and 42 were in the frozen embryo group, which was not statistically significant (P=0.32). Infertility causes, number of embryonic cells and grading of transferred embryos, delivery complications, embryo implantation methods, number of produced embryos after delivery, and endometrial thickness were not significantly different between the two groups (P=0.53). The difference between the mean number of transferred embryos in the two groups was significant (P<0.05), which was no longer significant after excluding non-pregnant women, and in comparing with only pregnant women (P=0.36). The result of caspase-3 gene expression showed that there was significant differences between fresh embryos, healthy thawed frozen embryos, and destroyed thawed frozen embryos. But these results were totally different from the results of the Pregnancy rate section. Therefore, it is inferred that although caspase-3 genes are expressed in frozen embryos after thawing and are ready to destroy the embryo, there are probably a number of involved factors that prevent the activity of caspase-3 and do not allow the apoptotic process to occur. What these factors are and how they prevent this process needs further study.

Effectiveness of Cryopreservation in Patients of Young Reproductive Age with the Risk of Ovarian Hyperstimulation, "Thin" Endometrium and Previous IVF Failures

The article provides an analysis of clinical, anamnestic and laboratory parameters for patients of young reproductive age who participated in IVF programs and have cryopreserved embryos. The main reasons for embryo cryopreservation were prevention of OHSS, "thin" endometrium and "previous IVF failures." It has been found that the patients from the group of transfer cancellation due to prevention of ovarian hyperstimulation had a higher ovarian reserve, a larger number of eggs, fresh and frozen embryos, and shorter shelf life of frozen embryos. All embryos were of the best quality (corresponding to the day of cultivation); the “post-thaw cultivation” technique was applied. During stimulation, lower amounts of gonadotropins were used. Patients with thin endometrium and previous IVF failures demonstrated slow growth of follicles, which required a higher course dose of gonadotropins with the addition of LH-containing preparations. Regardless of the group, in most cases, frozen/thawed embryos were transferred at the blastocyst stage (Day 5). The pregnancy rate was high in patients at risk of OHSS and with thin endometrium (48.6%, 48.0%). Patients with IVF failures had a lower pregnancy rate; this is due to endometrial pathology in the medical history, a smaller number of antral follicles, oocytes, fresh and frozen embryos, and longer shelf life of frozen embryos.

A randomized Clinical Trial comparing embryo quality and clinical pregnancy rate in PCOS patients underwent controlled ovarian stimulation using antagonist protocol with freeze all strategy and triggered for final oocyte maturation by gonadotropin agonist versus human chorionic gonadotropin in IVF cycles

Background: The use of Gonadotropin-releasing hormone (GnRH) antagonist protocol rather than the long agonist protocol showed a marked reduction in the incidence of OHSS Aim: To compare the effect of triggering oocytes by agonist versus HCG on reduction of risk of OHSS, embryo quality and clinical pregnancy rate. Patients and methods: A randomized Clinical Trial was conducted at IVF unit in Cairo University Obstetric and Gynecologic hospital. The patients were divided into two groups, the 1st group received GnRH agonist trigger, the 2nd group received hCG trigger; all embryos were frozen at day 5 and frozen embryos were transferred the next cycle. Results: There was an obvious reduction in the risk of OHSS in the GnRH agonist triggered group than in the HCG triggered group but with no statistically significant difference. In the current study, there was no statistically significant difference between the HCG triggered group in comparison to the GnRH agonist triggered group regarding chemical and clinical pregnancy rates. Conclusion: The use of GnRH triggering for women with PCOS undergoing ICSI cycle with antagonist protocol with freeze all and transfer of frozen embryos in a later cycle has a lower risk of OHSS than using HCG triggering method.

Prior Thromboembolic Disease and Assisted Reproductive Therapy

Assisted reproductive therapy (ART) increases the risk of venous thrombosis (VT) by 2- to 4-fold, whereas pregnancy increases the risk by 5- to 10-fold. Women with a history of VT undergoing ART are often suggested thromboprophylaxis. The literature is scarce and international guidelines are lacking. We made a review of the literature and base our suggestions primarily on expert opinions. We suggest women with a prior VT to use low-molecular-weight heparin as thromboprophylaxis starting from ovarian stimulation, throughout pregnancy, and 6 weeks postpartum. Assessment of VT risk should be done prior to ART. Adjustment of treatment to minimize the thrombotic risk, such as preventing ovarian hyperstimulation syndrome, single-embryo transfer, cryopreservation, and transfer of frozen embryos instead of fresh embryo in high-risk women, is suggested. Women with previous arterial thrombosis should continue aspirin during ART treatment, pregnancy, and postpartum.

Inconsistency arguments still do not matter

William Simkulet has recently criticised Colgrove et al’s defence against what they have called inconsistency arguments—arguments that claim opponents of abortion (OAs) act in ways inconsistent with their underlying beliefs about human fetuses (eg, that human fetuses are persons at conception). Colgrove et al presented three objections to inconsistency arguments, which Simkulet argues are unconvincing. Further, he maintains that OAs who hold that the fetus is a person at conception fail to act on important issues such as the plight of frozen embryos, poverty and spontaneous abortion. Thus, they are morally negligent. In response, we argue that Simkulet has targeted a very narrow group of OAs, and so his criticisms are inapplicable to most OAs. We then explain why his responses to each of Colgrove et al’s objections do not succeed, even for this restricted group. Finally, we note that Simkulet fails to provide evidence for his claims regarding OAs’ supposed failures to act, and we show that OAs veritably do invest resources into these important issues. We conclude that Colgrove et al’s reasons for rejecting inconsistency arguments (en masse) remain intact.