Hubungan Usia Ibu, Jumlah AFC, dan Total Pemberian Gonadotropin terhadap Kualitas Embrio pada Program Fertilisasi In Vitro di Klinik Fertilitas Graha Amerta RSUD Dr. Soetomo Surabaya Periode 2018 – 2019

Fertilisasi In Vitro merupakan metode untuk mendapatkan kehamilan pada pasangan infertil. Meskipun dengan FIV, angka keberhasilan kehamilan masih cukup rendah yang tentu tidak terlepas dari pengaruh kualitas embrio yang didapatkan. Banyak faktor yang dapat mempengaruhinya, beberapa contohnya adalah usia ibu, jumlah AFC, dan total pemberian gonadotropin. Namun, penelitian mengenai ini masih terbatas terkait literatur dan informasinya. Mengetahui hubungan usia ibu, jumlah AFC, dan total gonadotropin terhadap kualitas embrio pada program FIV di Klinik Fertilitas Graha Amerta Periode 2018- 2019. Penelitian ini menggunakan rancangan cross sectional dengan metode total sampling. Bahan penelitian dari rekam medis pasien yang menjalami program FIV di Klinik Fertilitas Graha Amerta periode 2018-2019. Dari 52 pasangan yang menjalani FIV didapatkan hasil p-value antara usia dengan kualitas embrio baik hari ke-3 0,020, degenerasi 0,003, kualitas embrio baik hari ke-5 0,007, buruk 0,048. AFC dengan kualitas embrio baik hari ke-3 0,000, degenerasi 0,001, kualitas embrio baik hari ke-5 0,001. Total gonadotropin dengan kualitas embrio hari ke-3 dan ke-5 <0,05. Biochemical pregnancy dengan kualitas embrio baik hari ke-3 0,013. Penelitian ini membuktikan bahwa usia ibu dan jumlah AFC berhubungan dengan kualitas embrio. Total pemberian gonadotropin tidak berhubungan dengan kualitas embrio. Namun, apabila diteliti secara bersamaan terdapat hasil pengaruh signifikan secara simultan antara usia ibu, jumlah AFC dan total pemberian gonadotropin terhadap persentase kualitas embrio baik pada hari ke-3 dan hari ke-5.

Comparison of Frozen Embryo Transfer Outcomes Between Uterine Infusion of Granulocyte Colony-Stimulating Factor and Growth Hormone Application in Patients With Thin Endometrium: A Retrospective Study

ObjectiveTo investigate the effect of two treatments on the outcome of freeze-thaw embryo transfer for pregnancy assistance in thin endometrium.MethodsA retrospective study was conducted on 66 patients who failed in the first cycle treated in the reproductive medicine center of the Second Hospital of Hebei Medical University from January 2018 to December 2019. Granulocyte colony stimulating factor (G-CSF) was used through cavity infusion in one group (n=25, and growth hormone (GH) was subcutaneously injected in the group (n=41). The clinical data of the two groups were compared, including morphology and thickness of the endometrium, biochemical pregnancy rate, clinical pregnancy rate, implantation rate, miscarriage rate, and live birth rate in each period of the hormone replacement cycle.ResultsThere was no significant difference in age, BMI, AMH, FSH, LH, E2, infertility years, number of transferred embryos, basal endometrium, and thickness of endometrium on the day of P administration before and after treatment (P&gt; 0.05). After treatment, compared to the GH group, the G-CSF group presented higher biochemical pregnancy rate (56% versus 48.8%; P=0.569), clinical pregnancy rate (52% versus 46.3%; P=0.655), implantation rate (34.8% versus 27.5%; P=0.391), and live birth rate (40% versus 31.7%; P=0.493), but the differences were not statistically significant (P &gt; 0.05). On the 5th day of treatment, the endometrial thickness in the G-CSF group was thinner than that in the GH group (4.83 ± 0.85 versus 5.75 ± 1.27; P&lt; 0.05), but it had no correlation with pregnancy outcome (P &gt; 0.05). There was no significant difference in endometrial thickness between the two groups on the 7th, 9th day of treatment and the day of P administration (P &gt; 0.05). On the 5th day of treatment, the proportion of endometrial type A morphology in the GH group was significantly higher than that in the G-CSF group (P &lt; 0.05), while the type B morphology in the G-CSF group was significantly higher than that in the GH group (P&lt; 0.05).ConclusionAlthough G-CSF and GH may not have a role in increasing endometrium, both of them can improve the pregnancy outcomes of patients with thin endometrium in the FET cycle. And the effects of the two treatments were similar.

Combined treatment of prednisone and hydroxychloroquine may improve outcomes of frozen embryo transfer in antinuclear antibody-positive patients undergoing IVF/ICSI treatment

Background The influence of anti-nuclear antibody (ANA) on induced ovulation was controversial, and the effect of prednisone plus hydroxychloroquine (HCQ) treatment on frozen embryo transfer outcomes of in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) for ANA-positive women was unclear. Methods Fifty ANA-positive women and one-hundred ANA-negative women matched for age and anti-Mullerian hormone (AMH) were included from a Reproductive Medical Central of a University Hospital. Sixty-one oocytes pick-up (OPU) cycles in ANA+ group and one-hundred OPU cycles in ANA− group were compared; 30 frozen embryo transfer cycles without treatment and 66 with prednisone plus HCQ treatment among ANA-positive women were compared. Results There was no statistical difference in number of retrieved oocytes (13.66 ± 7.71 vs 13.72 ± 7.23, p = .445), available embryos (5.23 ± 3.37 vs 5.47 ± 3.26, p = .347), high-quality embryos (3.64 ± 3.25 vs 3.70 ± 3.52, p = .832), and proportion of high-quality embryos (26.5% vs. 26.7%, p = .940). Biochemical pregnancy rate (33.3% vs. 68.2%, p < .05), clinical pregnancy rate (20.0% vs. 50.1%, p < .05), and implantation rate (5.6% vs. 31.8%, p < .05) were lower, and pregnancy loss rate (83.3% vs. 23.1%, p < .05) was higher in patients with treatment than no treatment. Conclusion The influence of ANA on number of retrieved oocytes, available embryos, high-quality embryos, and proration of high-quality embryos was not found. The treatment of prednisone plus HCQ may improve implantation rate, biochemical pregnancy rate, and clinical pregnancy rate, and reduce pregnancy loss rate in frozen embryo transfer outcomes for ANA-positive women.

Clinical outcomes for Day 3 double cleavage-stage embryo transfers versus Day 5 or 6 single blastocyst transfer in frozen–thawed cycles: a retrospective comparative analysis

Objective This study aimed to compare the clinical outcomes for transfer of Day 3 (D3) double cleavage-stage embryos and Day 5/6 (D5/6) single blastocysts in the frozen embryo transfer (FET) cycle to formulate a more appropriate embryo transplantation strategy. Methods We retrospectively analyzed 609 FET cycles from 518 women from April 2017 to March 2021. All FETs were assigned to the D3-DET group (transfer of a Day 3 double cleavage-stage embryo), D5-SBT group (transfer of a Day 5 single blastocyst), or D6-SBT group (transfer of a Day 6 single blastocyst). Clinical outcomes were comparatively analyzed. Results There were no significant differences in the biochemical pregnancy rate, clinical pregnancy rate, or ongoing pregnancy rate between the D3-DET and D5-SBT groups, but these rates in the two groups were all significantly higher compared with those in the D6-SBT group. The implantation rate in the D5-SBT group was significantly higher than that in the D3-DET group. The twin pregnancy rate in the D5-SBT and D6-SBT groups was significantly lower than that in the D3-DET group. Conclusion This study suggests that D5-SBT is the preferred option for transplantation. D6-SBT reduces the pregnancy rate, making it a more cautious choice for transfer of such embryos.

In Vitro Fertilization Pregnancy Outcomes and Effect of Atosiban Among Women With Endometriosis in Presence or Absence of Adenomyosis

BackgroundThe use of atosiban during embryo transfer (ET), an oxytocin receptor antagonist, has been demonstrated to enhance pregnancy rate among infertile patients with endometriosis. However, its efficacy has not been assessed among those with concurrent adenomyosis, which may further affect pregnancy rate.MethodsThis retrospective cohort study assessed in vitro fertilization (IVF) pregnancy, and the effect of atosiban among 34 women with both endometriosis and adenomyosis (with 66 ET cycles), compared to 34 endometriosis patients without adenomyosis (with 54 ETs) and 38 patients with tubal factor (with 56 ETs). Multivariable logistic generalized estimating equation analyses were performed to assess pregnancy outcomes with adjustment for maternal and treatment characteristics.ResultsSignificantly higher chances of biochemical pregnancy and live birth among endometriosis patients without adenomyosis versus those with both endometriosis and adenomyosis were found (odds ratios [95% confidence intervals]: 2.981 [1.307, 6.803]; p=0.009, 2.694 [1.151, 6.304]; p=0.022). A significant positive association between atosiban use and biochemical pregnancy existed among endometriosis cases without adenomyosis (a 2.43-fold [1.01, 5.89] increase in successful pregnancy; p<0.05), but not for the other groups. An insignificant increase in pregnancy rates was found for atosiban-treated extensive adenomyosis cases (i.e., ≥50%) versus non-treated cases (biochemical pregnancy, ongoing pregnancy, and live birth: 42.9% versus 33.3%, 37.5% versus 14.3%, and 25.0% versus 14.3%, respectively).ConclusionsPoor pregnancy outcomes among adenomyosis-affected women were confirmed. The use of atosiban significantly enhanced IVF pregnancy among endometriosis patients without adenomyosis. Atosiban use might benefit those with more extensive adenomyosis.

Comparison of intracytoplasmic sperm injection outcomes in azoospermic men who underwent testicular sperm extraction vs. microdissection testicular sperm extraction: A cross-sectional study

Background: Outcomes of intracytoplasmic sperm injection (ICSI) may be different in azoospermic men who undergo testicular sperm extraction (TESE) vs. microdissection-TESE (micro-TESE). Objective: This study was conducted to compare the ICSI outcomes in men who underwent TESE vs. micro-TESE due to obstructive azoospermia and nonobstructive azoospermia, respectively. Materials and Methods: A total of 310 azoospermic men who underwent ICSI from September 2016 to September 2020 were enrolled in this cross-sectional study and divided into two groups (172 cases in the TESE and 138 cases in the micro-TESE group). The paternal and maternal age, and the fertilization, biochemical pregnancy, abortion and live birth rates were compared between the two groups. Results: Maternal mean age was significantly higher in the TESE group (34.9 ± 4.2 yr vs. 32.3 ± 5.7 yr). The fertilization and biochemical pregnancy rates were significantly higher in the TESE group, but the abortion rate was similar in the two groups. The live birth rate was higher in the TESE group, but this difference was not significant (p = 0.06). Also, the maternal and paternal age did not affect ICSI outcomes. Conclusion: Individuals who underwent TESE had higher fertilization and biochemical pregnancy rates than those who underwent micro-TESE, but the live birth rate was not significantly different. Keywords: Intracytoplasmic sperm injection, Azoospermia, Testicular sperm extraction, Microdissection testicular sperm extraction, Pregnancy outcome.

Success rate and ART outcome of microsurgical sperm extraction in non obstructive azoospermia: A retrospective study

Background: The management of non-obstructive azoospermia (NOA) disease relies on microdissection testicular sperm extraction (micro-TESE). Few studies have assessed the role of micro-TESE in men with NOA in our country. Objective: The aim of the current study was to investigate the success rate of micro- TESE. Materials and Methods: This retrospective descriptive-analytical study was conducted on 463 men with NOA in Yazd Reproductive Sciences Institute during September 2017 through September 2019. Sperm were retrieved and frozen according to the rapid sperm freezing protocol. After preparing the oocyte of the male partner’s spouse, sperms were thawed and then entered the intracytoplasmic sperm injection process. The clinical pregnancy of individuals was confirmed via ultrasound. Demographic data were extracted from medical records. Results: The success rate of micro-TESE was 38% and successful fertilization, biochemical pregnancy, clinical pregnancy, and live birth were observed in 111 (85.4%), 29 (22.3%), 29 (22.3%) and 14 (10.7%) men, respectively. A significant difference was seen between the two groups, regarding age (p = 0.01). In addition, the mean follicle-stimulating hormone in men with positive micro-TESE was significantly lower than in men with negative micro-TESE (p = 0.02). Conclusion: The success of pregnancy in couples with NOA managed via micro-TESE was significant. The study found that the success rate of micro-TESE was higher in older men and in those with lower follicle-stimulating hormone levels. Key words: Azoospermia, Fertilization, Microdissection, Testicular.

Effects of Anti-TPO Antibodies on the Outcome of In Vitro Fertilization-Embryo Transfer Cycles

BACKGROUND The objectives of the study were to investigate whether the incidence of antithyroid antibodies (ATAs) is related to an adverse outcome in the in-vitro fertilization and embryo transfer (IVF-ET) in terms of quality of oocytes retrieved, fertilisation, cleavage, embryo quality and implantation rate (primary outcome) as compared to patients without anti-thyroid antibodies and also evaluate the association of ATAs with abortion rate, biochemical pregnancy and clinical pregnancy (secondary outcome). METHODS A total of 52 women having anti-thyroid peroxidase antibody (anti- TPO Ab) level ≥ 35 IU/mL (Cases) and 21 women having anti-TPO Ab level < 35 IU/mL (Controls) undergoing IVF / ICSI from Jan 2014 to Dec 2014 at Milann – The Fertility Centre, Bangalore, were retrospectively analysed. RESULTS There was no difference among the cases and controls for the primary outcome, viz. maturation rate, fertilisation rate, cleavage rate, implantation rate, and embryo quality. However, the abortion rate and biochemical pregnancy rate were significantly higher in the cases than in controls (P = 0.027 for each parameter). On the other hand, the clinical pregnancy rate was significantly lower among the cases (P = 0. 045). CONCLUSIONS There was no statistically significant difference in the primary outcome among the two groups. The secondary outcome of abortion rate and biochemical pregnancy rate was significantly higher in the cases than controls. The clinical pregnancy rate was significantly lower among the cases as compared to controls. Clinical Significance - Anti-TPO Ab acts as a prognostic factor and is disadvantageous to the pregnancy outcome following IVF-ET. KEY WORDS Abortion Rate, Clinical Pregnancy Rate, Fertilisation Rate, Implantation Rate, IVF/ICSI, Oocyte Maturation Rate

Comparison of Dydrogesterone and Medroxyprogesterone in the Progestin-Primed Ovarian Stimulation Protocol for Patients With Poor Ovarian Response

ObjectiveTo compare the clinical outcomes of dydrogesterone (DYG) and medroxyprogesterone (MPA) in the progestin-primed ovarian stimulation (PPOS) protocol for patients with poor ovarian response (POR).Patients and MethodsThis was a retrospective cohort study. Women with POR who underwent IVF/ICSI at the Reproductive Center of Third Affiliated Hospital of Zhengzhou University between January 2020 and January 2021 were included. The primary outcome measure of our study was the number of oocytes retrieved. The secondary outcome measures in the present study were the number of 2PN, number of available embryos, oocyte retrieval rate, fertilization rate, viable embryo rate per oocyte retrieved, cancellation rate and pregnancy outcomes of the first embryo transfer cycle, including the biochemical pregnancy, clinical pregnancy and miscarriage rates.ResultsIn total, 118 women underwent hMG +DYG protocols, and 692 women who underwent hMG +MPA met the Bologna criteria for POR. After baseline characteristics were balanced using the PSM model, 118 hMG +DYG protocols were matched to 118 hMG +MPA protocols, and the baseline characteristics were comparable between the two groups. The numbers of oocytes retrieved, 2PN, and available embryos and the oocyte retrieval rate, fertilization rate, viable embryo rate per oocyte retrieved and cancellation rate of the hMG+DYG and hMG+MPA protocols were comparable. Altogether, 66 women in the hMG+DYG group and 87 women in the hMG+MPA group underwent first embryo transfers. In the hMG+DYG group, 81.8% (54/66) of the patients underwent cleavage embryo transfers; similarly, 79.3% (69/87) of patients in the hMG+MPA group had cleavage embryo transfers (P=0.70).The biochemical pregnancy rate of the hMG+DYG group was 42.4%, and this was comparable to the rate in the hMG+DYG group, at 34.5% (P=0.32). The clinical pregnancy rates were similar between the two groups (36.4% vs. 31.0%, P=0.49), and there was no significant difference in the rate of miscarriage between the two groups (12.5% vs. 29.6%, P=0.14).ConclusionFor women with POR, the clinical outcome of the hMG + DYG group was similar to that of the hMG + MPA group, indicating that both combinations can be useful options for PPOS protocols.

First trimester pregnancy outcomes in a large IVF center from the Lombardy County (Italy) during the peak COVID-19 pandemic

At the beginning of 2020, the Italian Lombardy region was hit by an “epidemic tsunami” which was, at that point in time, one of the worst pandemics ever. At that moment the effects of SARS-COV 2 were still unknown. To evaluate whether the pandemic has influenced ART (Assisted Reproduction Techniques) outcomes in an asymptomatic infertile population treated at one of the major COVID-19 epicentres during the weeks immediately preceding lockdown. All ART procedures performed during two time periods were compared: November 1st, 2018 to February 28th, 2019 (non-COVID-19 risk) and November 1st, 2019 to February 29th, 2020 (COVID-19 risk). In total 1749 fresh cycles (883 non-COVID-19 risk and 866 COVID-19 risk) and1166 embryos and 63 oocytes warming cycles (538 and 37 during non-COVID and 628 and 26 during COVID-19 risk, respectively) were analysed. Clinical pregnancies per cycle were not different: 370 (25.38%) in non-COVID versus 415 (27.30%) (p = 0.237) during COVID-19 risk. There were no differences in biochemical pregnancy rates 52 (3.57%) versus 38 (2.50%) (p = 0.089) nor in ectopic pregnancies 4 (1.08%) versus 3 (0.72%) (p = 0.594), spontaneous miscarriages 84 (22.70%) versus 103 (24.82%) p = 0.487, nor in intrauterine ongoing pregnancies 282 (76.22%) versus 309 (74.46%) p = 0.569. A multivariate analysis investigating differences in spontaneous miscarriage rate showed no differences between the two timeframes. Our results support no differences in asymptomatic infertile couples’ ART outcomes between the pre COVID and COVID-19 periods in one of the earliest and most severe pandemic areas.