排卵正常女性月经周期与体外受精-胚胎移植鲜胚移植活产率相关性研究

目的探讨排卵正常女性月经周期长短是否与体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)鲜胚移植活产率相关。方法回顾性分析2013年1月至2019年12月于中国医科大学附属盛京医院生殖一科行拮抗剂方案促排卵的所有鲜胚移植周期,在排卵正常患者中,比较活产组与非活产组临床资料,对影响活产的因素进行单因素和多因素logistic回归,采用限制性立方样条法判断月经周期与活产率间的变化趋势并分析其剂量-反应关系。结果活产组(周期数=462周期)与非活产组(周期数=807周期)相比,两组在年龄、月经周期等方面存在明显差异(P0.05);随着月经周期延长,鲜胚移植活产率增加6%(HR=1.06,95%CI 1.01～1.10,P=0.014);基于剂量-反应关系曲线对月经周期进行分组,月经周期处于28～35d的患者与月经周期28d的患者相比,活产率增加36%(HR=1.36,95%CI 1.02～1.81,P=0.036)。结论月经周期是影响鲜胚移植活产率的独立因素,并且月经史可作为一个简单有效的指标预测IVF-ET鲜胚移植成功率。     

获卵数小于15个的多囊卵巢综合征患者胚胎移植方案的比较

目的:探讨体外受精-胚胎移植(IVF-ET)周期中获卵数15个的多囊卵巢综合征(PCOS)患者采用鲜胚移植与全胚冷冻方案后的妊娠情况。方法:回顾性分析2014年1月至2018年12月在我院接受IVF治疗获卵数15个的PCOS患者共441例,根据胚胎移植方案分为两组,鲜胚移植方案组(A组,313例),全胚冷冻方案组(B组,128例),比较两组患者的妊娠情况。结果:B组扳机日的血清孕酮(P)水平显著高于A组(P0.05),两组囊胚移植率差异无统计学意义(P0.05)。A组患者的累计活产率显著高于B组(72.84%vs 63.28%,P0.05),两组患者第一周期(A组鲜胚移植,B组第一次冻融胚胎移植周期)移植的活产率(47.60%vs 51.56%,P0.05)及胚胎着床率差异无统计学意义(46.00%±33.09%vs 49.08%±36.80%,P0.05)。结论:对于低获卵数(15个)的PCOS患者,鲜胚移植较全胚冷冻方案能获得更高的累计活产率。     

胚胎源性PAF水平联合胚胎质量对体外受精-胚胎移植结局的预测价值

目的:探讨接受IVF/ICSI-ET治疗的不孕妇女Day3胚胎培养液中PAF水平对IVF结局的影响。方法:选取接受IVF/ICSI-ET助孕且当月移植新鲜胚胎的85例患者,按移植胚胎质量分为优质胚胎组(64例)和非优质胚胎组(21例)。于Day3收集移植胚胎的培养液并测定PAF含量。结果:移植优质胚胎组患者的植入率、临床妊娠率和活产率均明显高于移植非优质胚胎组,差异有统计学意义(P0.05)。优胚培养液中PAF水平明显高于非优胚培养液,差异有统计学意义(P0.05)。结论:优质胚胎及种植的胚胎可分泌更高水平的PAF,可通过联合胚胎质量和培养液中PAF水平挑选具有种植潜能的胚胎进行移植,从而改善IVF最终结局。     

肌壁间子宫肌瘤及子宫动脉血流参数对IVF/ICSI-ET患者临床妊娠及围生期结局的影响

目的探讨经阴道三维超声和宫腔镜检查诊断的未改变宫腔形态子宫肌壁间肌瘤助孕患者肌壁间肌瘤及子宫动脉血流参数对体外授精/单精子卵细胞浆内注射-胚胎移植(IVF/ICSI-ET)临床妊娠及围生期结局的影响。方法采用回顾性队列研究,选取2012年1月至2013年12月在郑州大学第三附属医院生殖医学中心超声及宫腔镜检查显示未改变宫腔形态的单发或多发肌壁间子宫肌瘤180例患者作为研究组;并采用随机数字法抽取180例年龄匹配但未合并子宫肌瘤患者作为对照组。比较两组的一般基线资料、人绒毛膜促性腺激素(h CG)日子宫动脉血流参数、临床妊娠结局及围生期结局等相关指标;采用logistic回归分析影响活产率的相关因素。结果两组h CG日子宫动脉搏动指数(pulsat ile i ndex,PI)、子宫动脉收缩期最高血流速度/舒张期最低血流速度(S/D)、着床率、活产率比较,差异有统计学意义(P0.05),临床妊娠结局及围生期结局等指标比较,差异均无统计学意义(P0.05)。logistic回归分析显示,年龄(OR=0.849,95%CI:0.796~0.906,P0.001)、有无肌瘤(OR=0.532,95%CI:1.196~5.359,P0.05)、子宫动脉PI、S/D(OR=1.3 46,95%CI:0.205~0.586,P0.001;OR=1.371,95%CI:1.184~1.588;P0.001)、h CG日内膜厚度(OR=1.732,95%CI:0.639~0.839,P0.001)是影响IVF/ICSI助孕患者活产率的独立因素;年龄、子宫动脉S/D、h CG日内膜厚度是影响合并肌壁间肌瘤的IVF/ICSI助孕患者活产率的独立因素(OR=0.876,95%CI:0.790~0.970,P0.05;OR=2.265,95%CI:1.663~3.087,P0.001;OR=1.751,95%CI:0.595~0.947,P0.05)。结论 h CG日子宫动脉血流参数及子宫内膜厚度是影响IVF/ICSI助孕患者活产率的独立因素,肌壁间肌瘤对IVF/ICSI助孕有不利影响。     

宫腔镜下宫腔粘连分离术后行体外受精-胚胎移植的妊娠结局及影响因素

目的:分析不孕症合并宫腔粘连(IUA)患者在宫腔镜下行宫腔粘连分离术(TCRA)后行体外受精-胚胎移植(IVF-ET)的妊娠结局及相关影响因素。方法:选择2016年3月至2017年8月就诊于湖北医药学院附属人民医院生殖医学中心行宫腔镜检查的不孕患者,行IVF-ET助孕治疗的临床资料及妊娠结局,根据宫腔情况分为对照组:正常宫腔形态行IVF-ET助孕患者425例;IUA组:IUA经TCRA治疗后行IVF-ET助孕患者119例。比较两组患者一般资料及妊娠结局,分析影响术后妊娠的相关因素。结果:IUA组的临床妊娠率、活产率较低,流产率较高,但差异无统计学意义(P0.05)。根据年龄、BMI、流产次数、粘连程度分组比较,临床妊娠率差异有统计学意义(P0.05);多因素Logistic回归分析显示:年龄(≥35岁)、流产次数(≥3次)、粘连程度(中、重度)及BMI(≥24 kg/m~2)是影响TCRA术后妊娠结局的独立危险因素。结论:不孕症合并IUA患者,TCRA术后行IVF-ET助孕治疗的临床妊娠率接近于正常宫腔形态患者,年龄、粘连程度、流产次数及BMI是影响术后妊娠结局的主要因素。     

输卵管积水患者冻融胚胎移植周期移植卵裂胚及囊胚妊娠结局的对比分析

目的:对比分析输卵管积水患者冻融胚胎移植(FET)周期中卵裂期胚胎及囊胚移植的妊娠结局。方法:回顾性分析2017年1月至2019年12月在空军军医大学唐都医院生殖医学中心合并输卵管积水患者行FET助孕的235个周期。根据移植不同时期胚胎,分为两组:卵裂胚组(n=132);囊胚组(n=103)。收集患者一般资料,包括女方年龄、男方年龄、体质量指数(BMI)、抗苗勒管激素(AMH)、不孕类型、不孕年限、不孕因素、输卵管积水诊断方式及分布情况、FET周期子宫内膜准备方案、移植日子宫内膜厚度及形态、移植次数、移植胚胎数、辅助孵化(AH);比较两组临床妊娠率、种植率、异位妊娠率、流产率及活产率等差异。结果:两组患者一般情况差异无统计学意义。FET周期临床资料中,移植胚胎数(1.88±0.33个vs 1.04±0.19个,P0.05)及AH比率(30.30%vs 23.30%,P0.05)卵裂胚组均显著高于囊胚组;移植日子宫内膜形态两组差异有统计学意义(P0.05)。妊娠结局中,临床妊娠率(42.42%vs 47.57%,P0.05)、种植率(30.12%vs 46.73%,P0.05)及活产率(36.36%vs 42.72%,P0.05)囊胚组均显著高于卵裂胚组,而异位妊娠率(8.93%vs 4.08%,P0.05)囊胚组显著低于卵裂胚组,两组流产率差异无统计学意义。通过多元回归模型校正后,临床妊娠率(OR 1.66,95%CI 1.06～2.52,P0.05)、种植率(OR 1.75,95%CI 1.46～3.18,P0.05)、异位妊娠率(OR 0.40,95%CI 0.01～0.92,P0.05)及活产率(OR 1.87,95%CI 1.49～3.07,P0.05),两组间差异有统计学意义。结论:对于输卵管积水患者,相较于移植卵裂期胚胎,FET周期行囊胚移植临床妊娠率、种植率及活产率更高,异位妊娠率更低,妊娠结局更好。【     

月经周期不同时期行宫腔粘连分离术后行辅助生殖技术妊娠结局分析

目的:分析在不同月经周期行宫腔粘连分离术对术后行辅助生殖技术(ART)妊娠结局的影响。方法:回顾分析2015年1月至2018年12月在山东大学生殖医学研究中心行宫腔粘连分离术后行ART的124例中重度宫腔粘连(IUA)不孕症患者的临床资料,根据患者手术日月经天数,分为增殖期组(74例)和分泌期组(50例)。比较两组患者的临床资料和妊娠结局,分析患者妊娠结局的相关影响因素。结果:宫腔粘连分离术后行ART患者的总临床妊娠率为63.7%;增殖期组与分泌期组的临床妊娠率比较,差异无统计学意义(67.6%vs 58%,P0.05)。两组患者的流产率与活产率比较,差异均无统计学意义(P0.05)。logistic回归模型分析显示,患者移植前子宫内膜厚度与宫腔粘连美国生育协会(AFS)评分为妊娠结局的影响因素(P0.05)。宫腔粘连分离手术日月经天数、患者年龄、不孕症类型与临床妊娠率均无相关性(P0.05)。结论:IUA患者在子宫内膜增殖期与分泌期均可行宫腔粘连分离术,术后行ART的妊娠结局无统计学差异。     

ABO血型系统对新鲜周期胚胎移植妊娠结局的影响

目的:研究接受新鲜周期胚胎移植的体外受精/卵胞浆内单精子注射(IVF/ICSI)助孕治疗的卵巢功能正常患者的ABO血型与妊娠结局之间的关系。方法:回顾分析2015年5月1日至2017年5月1日于郑州大学第三附属医院生殖中心行新鲜胚胎移植的2323例IVF/ICSI周期,根据血型分为A组(n=637)、B组(n=803)、O组(n=664)、AB组(n=219)。比较各组的一般情况及妊娠结局。应用二元逻辑回归分析患者血型与活产及临床妊娠结果的关系,同时控制混杂因素,估算优势比(OR)及95%置信区间(95%CI)。结果:ABO血型组间的临床妊娠率、活产率、早产率、流产率、OHSS发生率、孕龄及新生儿出生体重比较,差异均无统计学意义(P0.05)。年龄、BMI是临床妊娠的危险因素,OR(95%CI)分别为1.477(1.222～1.785)、1.255(1.057～1.490)。年龄是活产的危险因素,Gn总剂量、Gn天数是活产的保护因素,OR(95%CI)分别为1.380(1.145～1.662)、0.808(0.670～0.976)、0.763(0.614～0.946)。结论:卵巢功能正常接受新鲜周期胚胎移植的IVF/ICSI助孕患者的ABO血型与妊娠结局无关。考虑如年龄、BMI、卵巢刺激持续时间、促性腺激素剂量和移植日子宫内膜厚度等多种混杂因素后,结果不变。这些结果需更大规模的队列研究或前瞻性研究验证。     

宫腔粘连分离术后患者复发现状及其相关影响因素分析

目的探讨宫腔粘连分离术后患者复发现状及其相关影响因素。方法回顾性选取280例2018年1月至2020年12月于江苏省淮安市妇幼保健院行宫腔粘连分离术的患者,根据其是否复发为重度宫腔粘连分为重度组(n=28)和非重度组(n=252)。收集两组临床资料,并分析宫腔粘连分离术后患者复发为重度宫腔粘连的危险因素。结果 280例宫腔粘连分离术后患者复发为重度宫腔粘连28例(10.00%)。多因素Logistic回归分析结果显示,孕次、刮宫后闭经史、宫腔粘连分离频次、初次发现宫腔粘连时为重度是宫腔粘连分离术后患者复发为重度宫腔粘连的危险因素(OR=0.573;3.216;1.865;11.473, P 0.05)。结论宫腔粘连分离术后患者复发为重度宫腔粘连与患者孕次、刮宫后闭经史、宫腔粘连分离频次、初次发现宫腔粘连时为重度等有关,临床可据此给予患者针对性措施以降低宫腔粘连分离术后患者复发为重度宫腔粘连的风险。     

移植前宫腔灌注人绒毛膜促性腺激素对于体外受精-胚胎移植妊娠结局影响的Meta分析

目的评价移植前宫腔灌注人绒毛膜促性腺激素(hCG)是否能影响体外受精-胚胎移植(IVF-ET)患者的妊娠结局。方法计算机检索Pub Med、EMBase、ISI Web of Science、Cochrane Library、中国知网全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方和维普等数据库,查找关于宫腔灌注hCG对于妊娠结局的影响的研究,检索年限自建库至2017年7月,对检索到的文献按照纳入和排除标准进行筛选、质量评价和数据提取,采用RevMan5.3软件进行数据分析。结果共纳入符合要求的12个随机对照研究,灌注组与对照组相比,临床妊娠率(OR=1.24,95%CI=1.08~1.43)和种植率(OR=1.21,95%CI=1.00~1.46)组间差异有统计学意义,活产率(OR=1.05,95%CI=0.81~1.36)和流产率(OR=1.02,95%CI=0.78~1.34)组间差异有统计学意义。其中移植卵裂期胚胎的患者,移植前宫腔灌注≥500 IU的hCG,与对照组相比,种植率(OR=1.61,95%CI=1.32~1.97)、临床妊娠率(OR=1.46,95%CI=1.26~1.70)和活产率(OR=1.52,95%CI=1.27~1.84)差异具有统计学意义。结论移植前宫腔灌注hCG能够改善不孕症患者胚胎移植的妊娠结局。     

Prospective randomized study of two cryopreservation policies avoiding embryo selection: the pronucleate stage leads to a higher cumulative delivery rate than the early cleavage stage

OBJECTIVE: To compare the cumulative live birth rates obtained after cryopreservation of either pronucleate (PN) zygotes or early-cleavage (EC) embryos. DESIGN: Prospective randomized study. SETTING: University hospital. PATIENT(S): Three hundred eighty-two patients, involved in an IVF/ICSI program from January 1993 to December 1995, who had their supernumerary embryos cryopreserved either at the PN (group I) or EC (group II) stage. For 89 patients, cryopreservation of EC embryos was canceled because of poor embryo development (group III). Frozen-thawed embryo transfers performed up to December 1998 were considered. MAIN OUTCOME MEASURE(S): Age, oocytes, zygotes, cryopreserved and transferred embryos, damage after thawing, cumulative embryo scores, implantation, and cumulative live birth rates. RESULT(S): The clinical pregnancy and live birth rates were similar in all groups after fresh embryo transfers. Significantly higher implantation (10.5% vs. 5.9%) and pregnancy rates (19.5% vs. 10.9%; P< or = .02 per transfer after cryopreserved embryo transfers were obtained in group I versus group II, leading to higher cumulative pregnancy (55.5% vs. 38.6%; P < or = .002 and live birth rates (46.9% vs. 27.7%; P< or = .0001.Conclusion(s): The transfer of a maximum of three unselected embryos and freezing of all supernumerary PN zygotes can be safely done with significantly higher cumulative pregnancy chances than cryopreserving at a later EC stage.     

薄型子宫内膜新鲜胚胎和冻融胚胎移植妊娠结局比较

目的探讨在薄型子宫内膜患者中新鲜胚胎移植与冻融胚胎移植(FET)妊娠结局的差异。方法回顾性分析接受体外受精/卵胞质内单精子显微注射-胚胎移植(IVF/ICSI-ET)治疗采用长方案胚胎移植h CG注射日与冻融周期胚胎移植内膜转化日的内膜厚度≤7 mm的患者共592个周期的临床资料。将移植周期按胚胎是否冻融分为新鲜胚胎移植组(n=173)和FET组(n=419)。比较组间的胚胎种植率、临床妊娠率、流产率、多胎率和异位妊娠率有无差异。结果新鲜胚胎移植组患者平均移植胚胎(2.1±0.4)枚,与FET组患者平均移植胚胎(2.1±0.5)枚比较,组间有统计学差异(P0.05);按照移植胚胎数分为3个亚组,新鲜胚胎移植组1枚胚胎者,妊娠率为7.7%,2枚者为30.2%,3枚者为23.8%;FET组1枚胚胎者15.6%,2枚者为34.9%,3枚者为41.6%,新鲜胚胎移植组与FET组间差异均无统计学意义(P0.05)。组间着床率、流产率、异位妊娠率等结果也均无统计学差异(P0.05)。移植3枚胚胎新鲜组多胎率(80.0%)高于FET组(29.7%)(P0.05)。新鲜胚胎移植组多胎率3个亚组间有统计学差异(P0.05),FET组妊娠率和流产率3个亚组间均有统计学差异(P0.05)。将移植胚胎数作为协变量,纳入Logistics回归模型对结果变量进行分析,说明周期类型与临床妊娠率间无显著相关性(OR=0.726,95%CI=0.504~1.104)。结论子宫内膜厚度≤7 mm的薄型内膜患者新鲜胚胎移植和FET妊娠结局相似,选择新鲜周期移植不影响妊娠结局并可缩短治疗周期,降低总费用。     

Quality of embryos transferred and progesterone levels are the most important predictors of live birth after fresh embryo transfer: a retrospective cohort study

Purpose

To identify the independent predictors of live birth following IVF, and to assess the role of cohort-specific parameters, including antral follicle count (AFC), the number of oocytes retrieved, the total number of embryos, and the total number of good-quality embryos, in fresh IVF cycles.

Methods

A retrospective cohort study of 2,525 infertile women undergoing IVF between 2002 and 2007. The hypothesis that the number and quality of embryos transferred capture the effects previously attributed to cohort-specific variables was examined using mediation analysis and spline analysis. Independent predictors were identified by a bootstrap algorithm. Multivariable logistic regression was performed and the proportion of explained variation was measured to compare the relative importance of transfer-specific vs. cohort-specific predictors.

Results

The number of good-quality embryos transferred and progesterone level on the day of hCG administration ranked as the two most important predictors of live birth. Prospects of pregnancy started to decrease after progesterone level exceeded 0.6 ng/ml. The achievement of live birth in a fresh IVF cycle is primarily determined by the number and quality of embryos transferred, rather than by embryo cohort-specific variables.

Conclusions

The associations between cohort-specific variables and live birth in a fresh IVF cycle are completely mediated by the quality of embryos transferred. Progesterone level on the day of hCG administration is an independent predictor of pregnancy and merits further investigation.     

常规体外受精后未见原核胚胎的相关因素分析及临床价值探讨

目的探讨常规体外受精(IVF)后的未见原核(0PN)合子发生的相关因素及0PN来源胚胎的利用价值。方法对2013年1月至2016年12月在河北医科大学第二医院生殖医学科行常规IVF 10 834个周期进行回顾性分析。(1)将周期分为两组,A1组:存在1个或以上0PN;A2组:无0PN。比较A1、A2两组的临床、实验室指标及新鲜移植周期的妊娠率、流产率、活产率、胎儿畸形率。(2)以每周期0PN的发生率为应变量,回归分析0PN周期产生的相关因素。(3)将新鲜移植周期按移植胚胎来源分为3组,B1组:均为0PN胚胎,B2组:0PN+双原核(2PN)胚胎,B3组:均为2PN胚胎。比较B1、B2、B3 3组的临床、实验室及妊娠结局。结果 (1)A1组与A2组比较,年龄低[(30.3±4.5)岁vs.(30.6±4.7)岁]、刺激周期数少[(1.1±0.6)个vs.(1.2±0.6)个]、基础卵泡刺激素(FSH)低[(8.4±2.2)U/L vs.(8.8±1.6)U/L]、周期获卵数多[(11.2±5.7)枚vs.(10.1±5.7)枚],hCG注射日血清雌二醇(E2)高[(11 482.0±1219.5)pmol/L vs.(10 556.4±1330.4)pmol/L],差异有统计学意义(P<0.05)。(2)患者年龄(r=0.858,P<0.001)、刺激周期数(r=0.892,P<0.05)、基础FSH(r=0.768,P<0.001)、获卵数(r=2.602,P<0.001)及hCG注射日血清E2(r=2.714,P<0.001)与0PN的发生率显著相关。(3)B1组、B2组、B3组种植率分别为16.0%、27.5%、32.0%,妊娠率分别为19.8%、41.6%、47.4%,流产率分别为23.5%、23.5%、15.4%,活产率分别为14.0%、31.8%、39.8%,3组比较差异均有统计学意义,且B3组种植率、妊娠率和活产率明显高于B1、B2组,流产率明显低于B1、B2组(P<0.05)。结论常规IVF后0PN合子形成可能与卵巢储备功能较好有关,而0PN来源卵裂期胚胎在无2PN可利用胚胎的情况下具有一定的移植价值,但是应该充分告知并知情同意。     

辅助生殖技术助孕后单胎妊娠早期流产的相关因素分析

目的 探讨辅助生殖技术(assisted reproductive technology,ART)助孕后单胎妊娠发生早期自然流产的相关因素.方法 对2003年1月1日至2008年8月31日在本院生殖中心行常规体外受精/卵母细胞浆内单精子注射的新鲜胚胎移植周期治疗后的1636例单胎妊娠病例进行分析,除外失访、子宫畸形、赠卵、晚期流产及资料不齐全者后,分为早期流产组(n=196)和活产分娩组 (n=1195),分析早期流产的相关因素.同时,比较新鲜胚胎移植周期和冷冻胚胎复苏移植周期(n=386)的流产率.结果 多因素Logistic回归分析早期自然流产的危险因素是孕妇年龄(OR=1.143,95%CI:1.096～1.196)、多囊卵巢综合征因素不孕(OR=4.309,95%CI:2.564～7.243),保护因素是移植胚胎的平均评分(OR=0.808,95%CI:0.717～0.912)、人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)注射日子宫内膜三线型(OR=0.431,95%CI:0.243～0.764).早期流产组和活产分娩组孕妇的年龄[(32.22±4.10)岁和(30.28±3.66)岁]、不孕年限[(5.90±4.26)年和(5.20±3.32)年]、基础卵泡刺激素水平[(6.35±2.30)mIU/ml和(5.95±2.12)mIU/ml]、移植胚胎数[(2.31±0.51)个和(2.18±0.49)个]、hCG注射日雌二醇水平[(2467.1±1588.8)pg/ml和(2934.5±1785.2)pg/ml]、胚胎平均评分(7.03±1.35和7.74±1.25)比较,差异均有统计学意义(P＜0.05),冷冻胚胎复苏移植周期流产率高于新鲜周期[17.36%(67/386)和13.02%(213/1636),χ2=4.296,P=0.023].结论 年龄大、不孕年限长、基础卵泡刺激素高、多囊卵巢综合征因素不孕、移植胚胎的平均评分低、hCG注射日子宫内膜非三线型的妇女ART妊娠后易发生早期流产.冷冻胚胎复苏移植周期的早期自然流产率高于新鲜胚胎移植周期.

Abstract：

Objective To investigate the relative risk factors for early abortion among singleton pregnancies after assisted reproductive technology (ART) treatment. Methods A retrospective analysis was performed on 1636 singleton pregnancies, including 196 early abortion cases and 1195pregnancies with live birth after exclusion of those lost cases during follow-up, or complicated with uterine deformity, or oocyte receptor, or late abortion, or incomplete medical record, following in vitro fertilization(IVF)/ intracytoplasmic sperm injection (ICSI) treatment and the risk factors of early abortion were investigated. The early abortion rate was also compared between fresh IVF/ICSI group and frozen embryo transfer (FET) group (n=386). Results Multivariate Logistic regression analysis indicated that elder women (OR= 1. 143,95%CI: 1. 096-1. 196) and patients with polycystic ovarian syndrome (OR = 4. 309,95 % CI : 2. 564-7.243) were risk factors of spontaneous early abortion,and high mean score of transferred embryos (MSTE) (OR = 0. 808, 95% CI: 0. 717-0. 912) and endometrial triple-lined pattern on the day of human chorionic gonadotropin (hCG) administration (OR=0. 431, 95% CI: 0. 243-0.764)were protective factors. Significant difference were found in the maternal age [(32.22±4. 10) yrs vs (30.28±3. 66) yrs],the duration of infertility [(5. 90±4.26) yrs vs (5.20 ± 3. 32) yrs], basal serum follicle-stimulating hormone (FSH) level [(6. 35 ±2.30) mIU/ml vs (5.95±2.12) mIU/ml], number of transferred embryos (2. 31±0. 51) vs (2. 18±0.49), serum estradiol level on the day of hCG administration [(2467. 1 ± 1588. 8) pg/ml vs (2934. 5 ±1785.2) pg/ml] and MSTE (7.03 ±1.35 vs 7.74 ± 1.25) between the abortion group and livebirth group (all P＜0. 05). The spontaneous abortion rate was higher in the FET group than in the fresh embryo transfer group [17. 36%(67/386) vs 13.02% (213/1636), χ2 =4. 296, P=0. 023].Conclusions Women at elder age, or with long duration of infertility, high basal FSH level,polycystic ovarian syndrome, low MSTE, non-triple-lined pattern of endometrium on the day of hCG administration are at risk of spontaneous early abortion in pregnancies after ART. The rate of spontaneous abortion is higher in FET group than in fresh IVF/ICSI group.     

Factors predicting IVF treatment outcome: a multivariate analysis of 5310 cycles

The objective of this study was to analyse factors predicting live birth rate following IVF. A computerized database of 1928 women who underwent 5310 consecutive IVF cycles in a single IVF unit was evaluated. Data on the women's age, number of retrieved oocytes, performance of intracytoplasmic sperm injection (ICSI), aetiology of infertility, number of transferred embryos and option of choosing embryos for transfer were evaluated. There were 1126 pregnancies that resulted in 689 live births. Transferring two embryos doubled the chances of delivery compared with one embryo, but transferring three embryos was not significantly superior to two embryos. Moreover, following a three-embryo transfer, the multiple delivery rates were significantly higher (P < 0.01) compared with transferring two embryos. Optimal delivery rates were observed in women aged 26-30 years, with gradual decline with advanced age. The performance of ICSI resulted in higher delivery rates compared with conventional insemination. According to these data, the best live birth results following IVF treatment were achieved when the maternal age was 26-30 years, in couples with male factor infertility undergoing ICSI, and when two embryos were transferred.     

Multivariate analysis of the factors associated with live births during in vitro fertilisation in Southeast Asia: a cross-sectional study of 104,015 in vitro fertilisation records in Taiwan

Purpose

To investigate the factors associated with live births and the interaction between age and the number of embryos transferred after in vitro fertilisation (IVF) treatment.

Methods

This study analyses data from a population-based-assisted reproductive database of all registered artificial reproduction institutions (n = 80) from 2010 to 2016 in Taiwan. The probability of a live birth in correlation with the treatment parameters was measured with multivariate logistic regression analyses using the generalised additive model (GAM) and Pearson’s chi-square exact test.

Results

A total of 104,015 IVF treatments performed between 2010 and 2016 were included in our analysis. From these treatments, 31,467 (30.3%) were successfully delivered, and 40,565 test-tube babies were born. Pearson’s chi-square exact test indicated that parents’ age, cause of infertility, type of ovarian stimulation, additional assisted reproductive technology techniques, donated egg or sperm, fresh or frozen embryo, presence or absence of ovarian hyperstimulation syndrome, and day of embryo transfer were significantly associated with live births after an IVF cycle (p < 0.05). Multiple logistic regression analysis with the GAM revealed that the odds of a live birth with IVF treatment in patients < 34 years of age were 2.55 times higher than that in patients ≥ 45 years of age (odds ratio = 2.55, 95% confidence interval = 1.69–2.90) for patients who underwent a single-embryo transfer (SET); a similar pattern was observed when two or more embryos were transferred. Egg donation, the assisted hatching technique, oral ovarian stimulation agents, and implantation of frozen embryos during SET were shown to improve the chance of a live birth by 29–90%. Implantation of the embryo after the 5th day of culture yielded the highest odds of a live birth. The interaction plot revealed that maternal age, especially < 40 years, was associated with the probability of a live birth. SET and double-embryo transfer showed similar associations with the probability of a live birth across age groups. Transferring more than two embryos might reduce the probability of a live birth during IVF treatment for women ≥ 40 years of age.

Conclusions

Implanting a greater number of embryos did not improve the age-related decrease in fertility for patients undergoing IVF. Therefore, we suggested that ≤ 2 blastocysts could be transferred during IVF treatments for women ≥ 40 years. Transferring a blastocyst on day 5 of culture was associated with a significant increase in the odds of a live birth resulting from IVF.

     

Do donor spermatozoa improve reproductive outcomes after oocyte donation failure? A retrospective analysis of cumulative live birth rates per donor oocyte consumed

Research questionDo donor spermatozoa improve IVF outcomes after first oocyte donation failure?DesignRetrospective, multicentre study including couples undergoing oocyte donation cycles using autologous or donor spermatozoa after a failed first attempt. Male partners were further characterized as normozoospermic or oligoasthenoteratospermic, i.e. fewer than 5 million motile progressive spermatozoa in the ejaculate. The main outcomes measured were live birth rate (LBR) per embryo transfer, LBR per number of embryos transferred, and cumulative LBR (CLBR) considering oocytes consumed in the previous donation cycles.ResultsAnalysis comprised 6065 cycles of oocyte donation failure; among these, subgroup analyses by sperm quality comprised 4113 cycles with severe male factor and 1150 cycles with suboptimal/normal spermatozoa. Sperm replacement in the first cycle after failure increased LBR per embryo transfer (OR 2.21, 95% CI 1.7–2.8, P < 0.001) and per number of embryos transferred (OR 2.46, 95% CI 1.9–3.1, P < 0.001) for normospermic and oligoasthenoteratospermic men. Replacement by the third cycle after failure was less beneficial (LBR per embryo transfer: OR 1.35, 95% CI 0.9–2.1, P = 0.16; LBR per embryos transferred: OR 1.33, 95% CI 0.9–2.0, P = 0.186). Kaplan–Meier curves of CLBR per oocyte fertilized with autologous or donor spermatozoa were statistically different (P < 0.001) and demonstrate how each additional oocyte may affect success based on sperm source (donor/autologous).ConclusionsDonor spermatozoa improved outcomes when used after an initial failed oocyte donation cycle. The CLBR curves can be used to determine the cumulative chances of live birth using either autologous or donor spermatozoa, providing guidance on when to replace spermatozoa.     

Reproductive Outcomes of In Vitro Fertilization–Intracytoplasmic Sperm Injection after Transcervical Resection of Adhesions: A Retrospective Cohort Study

Study ObjectiveTo investigate pregnancy and obstetric outcomes of patients with intrauterine adhesions (IUAs) after treatment with in vitro fertilization–intracytoplasmic sperm injection (IVF-ICSI) and fresh embryo transplantation after transcervical resection of adhesions (TCRA).DesignRetrospective cohort study.SettingUniversity-based reproductive medical center.PatientsA total of 535 patients with IUAs and with a history of TCRA and 1605 matched patients without a history of IUAs underwent IVF-ICSI and received fresh embryo transfers.InterventionsBetween January 2014 and December 2018, all patients underwent IVF-ICSI treatment and received fresh embryo transfers.Measurements and Main ResultsThe patients in the TCRA group were matched with the control group according to strict criteria. Pregnancy and obstetric outcomes were compared. There were no significant differences in clinical pregnancies, ectopic pregnancies, live births, preterm births, and obstetric outcomes between the 2 groups (p >.05). However, the TCRA group had a higher risk of miscarriage than the control group (p = .048).ConclusionTCRA improved the reproductive outcomes of patients with IUAs, but the risk of miscarriage was higher than that in the general population. To avoid miscarriage, careful monitoring is critical for pregnant patients with a history of TCRA who undergo embryo transfers during IVF treatment.     

Could ethnicity have a different effect on fresh and frozen embryo transfer outcomes: a retrospective study

Research questionDoes a woman's ethnicity affect her fresh and frozen embryo transfer outcomes differently?DesignA retrospective cohort study of the first fresh and first frozen embryo transfer per woman carried out at a single tertiary level fertility unit between 2010 and 2016 using data retrieved from an electronic database. Biochemical pregnancy, biochemical pregnancy loss, clinical pregnancy, miscarriage and live birth rates per embryo transfer were compared between 5876 white Caucasian, 1071 South Asian and 114 Black Afro-Caribbean women undergoing their first fresh embryo transfer and for 1418 Caucasian, 273 South Asian and 31 Afro-Caribbean women undergoing their first frozen embryo transfer. Logistic regression was used to adjust for age, number of oocytes retrieved, and number and stage of embryos transferred.ResultsSouth Asian (26% versus 32%, adjusted OR 0.622, 95% CI 0.533 to 0.725) and Black Afro-Caribbean women (21% versus 32%, adjusted OR 0.528, 95% CI 0.332 to 0.839) had a lower live birth rate per fresh embryo transfer compared with white Caucasian women. In contrast, the live birth rates per frozen embryo transfer were not significantly different between South Asian and Caucasian women (26% versus 28%, adjusted OR 0.890, 95% CI 0.661 to 1.200) and between Afro-Caribbean and Caucasian women (29% versus 28%, adjusted OR 0.983, 95% CI 0.447 to 2.162).ConclusionSouth Asian and Black Afro-Caribbean women have a significantly lower live birth rate than white Caucasian women after fresh embryo transfer, but their frozen embryo transfer live birth rates are not significantly different.