Modified natural-cycle cryopreserved embryo transfer: is a washout period needed after a failed fresh cycle?

Research questionAre the characteristics of the natural cycle or modified natural cycle (mNC), or live birth rates (LBR), affected by delaying frozen embryo transfer (FET) after a failed fresh IVF cycle?DesignIn a retrospective study, conducted at a university-affiliated tertiary centre, 198 women aged 18–45 years undergoing their first FET cycle after a failed fresh embryo transfer attempt using an mNC were evaluated. Cycles were divided according to the time interval between oocyte retrieval and the start of the FET cycle into the immediate FET group (<22 days) and the delayed FET group (≥22 days). The main outcome measures were ovulation day and LBR.ResultsThe mean interval between oocyte retrieval and the start of the FET cycle was 15.6 ± 3.2 days in the immediate FET group and 84.8 ± 73.7 days in the delayed FET group (P < 0.001). Ovulation day was significantly delayed in the immediate FET group (day 17.1 ± 4.4 versus day 15.4 ± 3.7; P = 0.004). There was no difference between the immediate and delayed FET groups in terms of clinical pregnancy rate (CPR) (25.4% and 25.0%, respectively) or LBR (21.2% and 20.0%, respectively).ConclusionsNatural-cycle characteristics are similar in immediate and delayed cycles, except for a slight delay in ovulation day. Deferring mNC-FET after a failed fresh IVF cycle does not improve the reproductive outcome. These results should encourage patients and clinicians who want to proceed with FET immediately after failure of fresh IVF.     

The artificial cycle method improves the pregnancy outcome in frozen–thawed embryo transfer: a retrospective cohort study

Abstract

The aim of this retrospective cohort study was to investigate which preparation method is optimal for frozen–thawed embryo transfer (FET) treatment. Analyses were performed on 3160 FET cycles, including 654 cycles with a natural cycle (NC) protocol and 2506 cycles with an artificial cycle (AC) protocol. The primary outcome measures were the clinical pregnancy rate (CPR) and the live birth rate (LBR) per transfer. The Student’s t-test, chi-square test and multiple logistic regression were used for statistical analysis. The CPR per transfer was 49.4% in the NC group and 58.6% in the AC group (OR?=?1.270, 95% CI: 1.037–1.554). The LBR per transfer was 42.2% and 50.8% in the NC and AC groups, respectively (OR?=?1.269, 95% CI: 1.037–1.552). Dividing the patients according to the type of transferred embryos, the CPR (67.3% versus 57.0%, p?<?0.01) and LBR (58.8% versus 49.7%, p?<?0.01) were higher after the AC protocol than after NC protocol in patients with blastocyst transfer. The NC and AC protocols yielded comparable CPR and LBR in the patients with cleavage embryo transfer. Our data indicate better pregnancy outcomes after the AC protocol than after the NC protocol. The AC protocol should be recommended in patients who were counseled before receiving FET treatment. Further studies are needed to confirm this finding.     

The effect of adenomyosis types on clinical outcomes of IVF embryo transfer after ultra-long GnRH agonist protocol

Research questionWhat is the effect of adenomyosis types on IVF and embryo transfer (IVF-ET) after ultra-long gonadotrophin-releasing hormone (GnRH) agonist protocol?DesignPatients who underwent the first cycle of IVF-ET with ultra-long GnRH agonist protocol were included in this retrospective cohort study. They were divided into three groups: (A) 428 patients with diffuse adenomyosis; (B) 718 patients with focal adenomyosis; and (C) 519 patients with tubal infertility. Reproduction outcomes were analysed.ResultsLogistic regression analysis revealed that, compared with focal adenomyosis and tubal infertility, diffuse adenomyosis was negatively associated with clinical pregnancy and live birth (clinical pregnancy: A versus B: OR 0.708, 95% CI 0.539 to 0.931, P = 0.013; A versus C: OR 0.663, 95% CI 0.489 to 0.899, P = 0.008; live birth: A versus B: OR 0.530, 95% CI 0.385 to 0.730, P < 0.001; A versus C: OR 0.441, 95% CI 0.313 to 0.623, P < 0.001), but positively associated with miscarriage (A versus B: OR 1.727, 95% CI 1.056 to 2.825, P = 0.029; A versus C: OR 2.549, 95% CI 1.278 to 5.082, P = 0.008). Compared with patients with tubal infertility, focal adenomyosis was also a risk factor for miscarriage (B versus C: OR 1.825, 95% CI 1.112 to 2.995, P = 0.017).ConclusionsCompared with patients with focal adenomyosis or tubal infertility, the reproduction outcomes of IVF-ET in patients with diffuse adenomyosis seems to be worse.     

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.     

Which factors affect the likelihood of miscarriage after single euploid blastocyst transfer?

Research questionWhich parameters affect the likelihood of miscarriage after single euploid frozen–thawed blastocyst transfer (FBT)?DesignIn this retrospective study, clinical and laboratory data from 1051 single euploid FBTs were evaluated. Exclusion criteria were endocrine or systemic pathologies, uterine anomalies or pathologies, unilateral or bilateral hydrosalpinx, karyotypic abnormalities (either maternal or paternal) or thrombophilia. Patients were divided into two groups according to pregnancy outcome: live birth and miscarriage.ResultsBody mass index (BMI) (25.98 ± 0.5 versus 24.36 ± 0.21, P = 0.019), duration of infertility (6.62 ± 0.54 versus 4.92 ± 0.18, P = 0.006) and number of previous miscarriages (1.36 ± 0.13 versus 0.79 ± 0.05, P < 0.001) were significantly higher in the miscarriage group (n = 100) than in the live birth group (n = 589). Although the trophectoderm and inner cell mass (ICM) percentage scores were not statistically different among the miscarriage and live birth groups, the percentage of day-6 biopsied embryos was significantly higher in the miscarriage group. Binary logistic regression analysis revealed that BMI (OR 1.083, 95% CI 1.013 to 1.158, P = 0.02) and number of previous miscarriages (OR 1.279, 95% CI 1.013 to 1.158, P = 0.038) were independent factors for miscarriage. Patients with elevated BMI and a higher number of miscarriages were at increased risk of miscarriage.ConclusionAfter a single euploid FBT, BMI and number of previous miscarriages are predictors of miscarriage. Lifestyle interventions before FBT may decrease miscarriage rates.     

Ovulation before or after intrauterine insemination does not affect live birth rates: a retrospective cohort study of 6701 cycles

Research questionShould intrauterine insemination be carried out before or after follicle rupture, and is there a difference in sex ratio, according to follicle rupture at the time of insemination?DesignIn this retrospective cohort study conducted at the Fertility Clinic, Odense University Hospital, Denmark, data from 6701 homologous insemination cycles were analysed. Follicle rupture was determined by transvaginal ultrasonography at the time of insemination. The pregnancy rate, clinical pregnancy rate (CPR) and live birth rate (LBR) were recorded.ResultsIn 2831 cycles (42.2%), follicle rupture had occurred at the time of insemination, whereas, in 3870 cycles (57.8%), no follicle rupture had occurred at the time of insemination. Overall, 1186 (17.7%) cycles resulted in a positive pregnancy test and no significant differences were found in pregnancy rate between rupture and no rupture of follicle (17.8% versus 17.7%, P = 0.90). Follicle rupture before or after insemination did not affect CPR (14.8% versus 15.0%, P = 0.86) or LBR (11.9% versus 12.2%, P = 0.75) per cycle. Moreover, the sex ratio of children born did not depend on follicle rupture (P = 0.20). After logistic regression with cluster and adjusting for baseline characteristics, no significant differences between groups were observed.ConclusionOvulation at the time of insemination is not associated with pregnancy rate, CPR, LBR or gender.     

Reproductive outcomes after preimplantation genetic testing in mosaic Turner syndrome: a retrospective cohort study of 100 cycles

PurposeThe purpose of this study is to explore the reproductive outcomes of women with Turner syndrome (TS) in preimplantation genetic testing (PGT) cycles.MethodsA retrospective study of 100 controlled ovarian stimulating cycles, 68 TS (sixty-four mosaic Turner syndrome (MTS) and four pure Turner syndrome (PTS)) women underwent PGT was conducted from 2013 to 2018.ResultsEmbryo X chromosome abnormal rates of TS women were significantly higher than women with normal karyotype (7.04 vs 1.61%, P<0.01). Cumulative live birth rates (CLBR) after PGT-NGS treatment were lower in TS than control (31.15 vs 45.59%, P<0.05). Clinical pregnancy rates per transfer (CPR), miscarriage rates (MR) and live birth rates per transfer (LBR) remained comparable between TS and control group. Reproductive outcomes (X chromosome abnormal rates, CPR, MR, LBR and CLBR) among low (<10%), medium (10–50%) and high (>50%) level 45,X mosaicism groups were not statistically different.ConclusionsTo avoid high risk of embryo X chromosome abnormalities, prenatal or preimplantation genetic testing should be recommended to mosaic or pure TS patients.     

Impact of paternal age on IVF and pregnancy outcomes with only normal sperm parameters

ObjectivePrevious reports on advanced paternal age effects on assisted reproductive technology (ART) vary considerably and those on frozen–thawed embryo transfer (FET) are rare. We investigated whether paternal age affects in vitro fertilisation (IVF) and FET pregnancy outcomes.Materials and methods1657 IVF cycles performed from January 2014 to May 2018 were retrospectively investigated excluding cases of poor semen parameters. Paternal and maternal ages were categorised into groups, namely, <35, 35–39 and ≥ 40 years, to compare normal fertilisation (2 PN (pronuclei)) and high-quality blastocyst rates. Furthermore, 741 FET cycles were investigated and pregnancy, live birth and miscarriage rates were compared.ResultsFor the maternal age group (35–39), the 2 PN rate was significantly higher with paternal age group of <35 than groups of 35–39 and ≥ 40 (median%, <35 vs. 35–39 vs. ≥40 = 100.0 vs. 71.4 vs. 77.7; P = 0.005). The miscarriage rate was significantly higher with paternal age group of ≥40 than that of <35 and 35–39 when maternal age was <35 (median %, <35 vs. 35–39 vs. ≥40 = 13.1 vs. 7.8 vs. 33.3; P = 0.038).ConclusionOur findings show that when maternal age was <35, advanced paternal age reduces the normal fertilisation rate and increases the FET miscarriage rate when maternal age was 35–39.     

Retrospective Review of Reproductive Outcomes Comparing Vaginal Progesterone to Intramuscular Progesterone as Luteal Support in Frozen Embryo Transfer Cycles

ObjectiveRecent literature suggests that progesterone in oil (PIO) is superior to vaginal progesterone (VP; Prometrium) for endometrial preparation in frozen embryo transfer cycles (FET), improving the live birth rate and reducing the rate of miscarriage. PIO has disadvantages including cost, pain, and stress of administration. The objective of this study was to evaluate whether VP is non-inferior to PIO for medicated FET cycles.MethodsWe conducted a retrospective analysis comparing pregnancy, miscarriage, and live birth rates for PIO versus VP for medicated FET cycles, from 2017 to 2020 at a single fertility clinic. A total of 745 participants were included in the study; 438 received VP, and 307 received PIO. Univariate and multivariate binary and ordinal logistic regression analyses were performed to compare the rates of pregnancy, miscarriage, and live birth between VP and PIO.ResultsOur data demonstrated no difference between PIO and VP with respect to the rates of pregnancy (51% vs. 53%), miscarriage (20% vs. 18%), or live birth (31% vs. 34%) (all P > 0.05). For participants taking PIO, the odds of pregnancy were 0.93 [95% CI (0.70, 1.25), P = 0.65] that of participants on VP.ConclusionIn our single-centre experience, VP was non-inferior to PIO for endometrial preparation in FET cycles.     

Clinical and pregnancy outcomes of double and single blastocyst transfers related with morphological grades in vitrified-warmed embryo transfer

ObjectiveTo evaluate clinical and pregnancy outcomes of double and single blastocyst transfers related with morphological grades in vitrified-warmed embryo transfer.Materials and methodsIn a retrospective cohort analysis, data were assessed from women who underwent vitrified-warmed blastocyst transfers (VBT) at CHA Gangnam Medical Center between 2014 and 2015. All VBT cycles were categorized into three groups according to blastocyst quality: GG (double good blastocysts transfer), GP (one good and one poor blastocyst transfer), and GS (single good blastocyst transfer). Blastocysts were graded morphologically and ⩾3BB grade was considered good quality.ResultsThere were 628 transfers in group GG, 401 transfers in group GP, and 277 transfers in group GS. Both clinical pregnancy rate (CPR) and live birth rate (LBR) were the highest in group GG (CPR 65.9%, LBR 55.3%, p < 0.001), but not significantly different between group GP and GS. Multiple pregnancy rates increased significantly in the following order: GS (1.4%), GP (13.5%), and GG (25.6%). Single LBR was the highest in group GS (38.6%, p < 0.001).ConclusionAs an effective VBT, especially for reducing multiple pregnancy and increasing single live birth, single good blastocyst transfer may be recommended rather than any double blastocyst transfer methods. Moreover, transferring a good and a poor blastocyst simultaneously should be avoided.     

Influence of Ethnicity on Clinical Presentation and Quality of Life in Women With Uterine Fibroids: Results From a Prospective Observational Registry

ObjectiveThis study sought to evaluate ethnic variations in the clinical presentation of women with uterine fibroids.MethodsA total of 996 premenopausal women with symptomatic uterine fibroids were enrolled in a prospective, non-interventional, observational registry at 19 clinical sites across Canada (CAPTURE Registry). Patient-reported outcomes were assessed using Uterine Fibroid Symptom and Health-Related Quality of Life Symptom Severity questionnaires and the Aberdeen Menorrhagia Severity Scale (Ruta score). Linear and logistic regression models, adjusted for patient and fibroid characteristics, were used to examine differences among ethnicities for continuous and binary outcomes of interest.ResultsBlack women were 4.9 years younger (P < 0.001), were more likely to be nulligravid (P = 0.046), had a 41% longer duration of symptoms before enrolment (P = 0.01), had a 49% larger fibroid volume (P = 0.01), and were more likely to be anemic (P < 0.001) compared with White women. Black women reported lower health-related quality of life scores (−5.19 points; 95% CI −9.90 to −0.48, P = 0.03) compared with White women. East Asian women were 2.0 years younger (P = 0.01), were more likely to be nulligravid (P < 0.001), had a 53% longer duration of symptoms (P = 0.01), had 67% larger fibroid volume (P = 0.01), and were more likely to be anemic (P = 0.003) compared with White women. East Asian women had lower symptom severity scores (−5.95 points; 95% CI −11.16 to −0.75, P = 0.02). Non-White women preferred uterine-preserving treatment options (P < 0.001).ConclusionBlack and East Asian women have an increased burden of disease compared with White women and prefer uterine preservation. There is a discrepancy between disease burden and patient-reported outcomes that may reflect ethnocultural differences in disease experience.     

Clinical Application and Midterm Results of Laparoscopic Partial Resection of Symptomatic Adenomyosis Combined with Uterine Artery Occlusion

Study ObjectiveTo examine the clinical application of laparoscopic partial resection of symptomatic adenomyosis combined with uterine artery occlusion (UAO).DesignRetrospective cohort study (Canadian Task Force classification III).SettingA district hospital.PatientsA total of 37 patients with symptomatic adenomyosis who had indication for surgical intervention but needed conservative treatment.InterventionUterine artery occlusion combined with partial resection of adenomyosis via laparoscopy.Measurements and Main ResultsFrom July 2003 through October 2005, 37 patients with symptomatic adenomyosis were treated by UAO combined with partial resection of adenomyosis via laparoscopy. All patients were followed up at 1, 6, and 12 months after the operation to estimate the volume of the uterus and changes of symptoms including pelvic pain and abnormal bleeding. Patients also were asked to participate in a clinical interview every year thereafter. No severe complications were noted during the surgical procedure or follow-up. The mean surgical time was 115.7 ± 27.5 minutes (Mean ± SD, 61–171 minutes), the mean blood loss was 80.0 ± 35.2 mL (50–150 mL), and the median highest body temperature after the procedure was 38°C (range 37.4°C–39°C). The postoperative fever morbidity was 10.8% (4/37). Improvement of menorrhagia occurred in all of 37 and 35 of 37 for dysmenorrhea. Hysterectomy was carried out in 2 patients because of persistence of dysmenorrhea. Pictorial blood loss assessment chart was used to measure menstrual blood loss and an 11-point numeric rating scale was used to evaluate the pain intensity during menstruation. The postoperative median scores of menorrhagia were 58, 56, and 59 at 1, 6, and 12 months, respectively, compared with 158 before treatment. Significant improvement occurred (p <.001, p <.001, p <.001), compared with each other, no significant difference existed (1 vs 6 months, p =.720; 6 vs 12 months, p =.992; 1 vs 12 months, p =.709). The postoperative median scores of dysmenorrhea were 7, 5, and 4 at 1, 6, and 12 months. Respectively, compared with 8 before operation; significant symptom lessening occurred (p <.001, p <.001, p <.001). Comparing with each other, significant difference also existed (1 vs 6 months, p <.001; 6 vs 12 months, p <.001; 1 vs 12 months, p =.0018). The volume of the uterus before procedure was 224.6 ± 48.7 cm³ (156.0–336.1 cm³). At 6 and 12 months it was 169.2 ± 78.1 cm³ (118.4–218.2 cm³) and 91.6 ± 28.4 cm³ (43.1–127.5 cm³), respectively. At 6 months after surgery the volume of uterus shrank 24.7% compared with preoperative volume; shrinkage rate was 59.2% at 12 months after surgery. A continuous decrease occurred (p <.001, p <.001, p <.001).ConclusionLaparoscopic partial resection of adenomyosis combined with UAO is an effective treatment modality for symptomatic adenomyosis, but further controlled studies with large samples and long-term follow-up is needed for a decisive conclusion.     

Live birth rate in fresh and frozen embryo transfer cycles in women with endometriosis

Objectives

To test the hypothesise that the treatment protocol used for preparation of the endometrium for frozen embryo transfer (ET) has a beneficial effect on the disorganised endometrium in women with endometriosis and leads to a higher pregnancy rate.

Study design

We performed a retrospective, database-searched cohort study. Relevant information was collected from the electronic records of women who underwent IVF/ICSI between 1/1/2000 and 31/12/2008 in our unit. Endometriosis patients formed the study group. The rest of the women formed the control group. The two groups were subdivided, depending on whether they had fresh or frozen ET. The main outcome was live birth rate (LBR). Secondary outcomes were clinical pregnancy rate (CPR) and miscarriage rate (MR). Comparisons were performed by Chi-square and Mann-Whitney tests (SPSS 16.0).

Results

A total of 3763 fresh and 3523 frozen ET IVF cycles were included in our study, of which 415 (5.7%) were due to endometriosis related subfertility. In the non-endometriosis group, fresh ET had significantly higher LBR, CBR and MR than frozen ET. In women with endometriosis, down-regulated frozen ET cycles had a markedly high LBR and CPR (16.9%, 18.2%), comparable to the LBR and CPR of fresh ET cycles in the same group (19.5%, 20.2%). No significant differences were found in the LBR and CPR in fresh ET cycles between the study and the control group. In frozen ET, however, the CPR was significantly higher in the endometriosis group (18.2% versus 12.7%, P = 0.048).

Conclusion

Unlike the general IVF population, in women with endometriosis undergoing IVF, the preparation of the endometrium for frozen ET with GnRH agonists compared to fresh cycles is associated with higher LBR (16.9% versus 11.9%) and a significantly higher CPR (18.2% versus 12.7%, P = 0.048). These results suggest that, in cases of endometriosis, the combined effect of GnRHa on the endometrium and the low level of ovarian steroids may simultaneously offer a better endometrial environment for implantation which may lead to better outcomes.     

Karyotype of first clinical miscarriage and prognosis of subsequent pregnancy outcome

Research questionIs the karyotype of the first clinical miscarriage in an infertile patient predictive of the outcome of the subsequent pregnancy?DesignRetrospective cohort study of infertile patients undergoing manual vacuum aspiration with chromosome testing at the time of the first (index) clinical miscarriage with a genetic diagnosis and a subsequent pregnancy. Patients treated at two academic-affiliated fertility centres from 1999 to 2018 were included; those using preimplantation genetic testing for aneuploidy were excluded. Main outcome was live birth in the subsequent pregnancy.ResultsOne hundred patients with euploid clinical miscarriage and 151 patients with aneuploid clinical miscarriage in the index pregnancy were included. Patients with euploid clinical miscarriage in the index pregnancy had a live birth rate of 63% in the subsequent pregnancy compared with 68% among patients with aneuploid clinical miscarriage (adjusted odds ratio [aOR] 0.75, 95% CI 0.47–1.39, P = 0.45, logistic regression model adjusting for age, parity, body mass index and mode of conception). In a multinomial logistic regression model with three outcomes (live birth, clinical miscarriage or biochemical miscarriage), euploid clinical miscarriage for the index pregnancy was associated with similar odds of clinical miscarriage in the subsequent pregnancy compared with aneuploid clinical miscarriage for the index pregnancy (32% versus 24%, respectively, aOR 1.49, 95% CI 0.83–2.70, P = 0.19). Euploid clinical miscarriage for the index pregnancy was not associated with likelihood of biochemical miscarriage in the subsequent pregnancy compared with aneuploid clinical miscarriage (5% versus 8%, respectively, aOR 0.46, 95% CI 0.14–1.55, P = 0.21).ConclusionPrognosis after a first clinical miscarriage among infertile patients is equally favourable among patients with euploid and aneuploid karyotype, and independent of the karyotype of the pregnancy loss.     

Influence of cleavage-stage embryo quality on the in-vitro fertilization outcome after single embryo transfer in fresh cycles

ObjectiveEmbryo quality is crucial for determining the outcome of embryo implantation. This study aimed to assess the impact of embryo quality on the outcome of in vitro fertilization/single-embryo transfer (IVF-SET).Materials and methodsThis retrospective study included 2531 fresh IVF-SET cycles, including 277 poor-quality and 2254 top-quality embryos. The clinical pregnancy rate, miscarriage rate, live birth, implantation rate, pregnancy outcome and complication were analyzed and compared. Risk factors associated with miscarriage rate and pregnancy complication were identified using logistics regression analysis.ResultsTop-quality embryos resulted in higher clinical pregnancy rate (30.5% vs. 12.6%, P < 0.001) and live birth rate (23.9% vs. 9.7%, P < 0.001) compared with poor-quality embryos. Logistics regression analysis revealed that embryo quality was not correlated with miscarriage rate (95% CI 0.33–1.89) and pregnancy complications (95% CI 0.12–7.84). Maternal age and body mass index was a risk factor for miscarriage rate (95% CI 1.05–1.22) and pregnancy complication (95% CI 1.01–1.29), respectively.ConclusionClinical miscarriage rate and pregnancy complication were embryo quality independent. Maternal age was the risk factor for miscarriage rate. Embryo quality did not affect miscarriage once a clinical pregnancy is achieved.     

Three-dimensional ultrasound diagnosis of T-shaped uterus is associated with adverse pregnancy outcomes after embryo transfer

Research questionIs T-shaped uterine cavity morphology associated with adverse pregnancy outcomes after transfer of a single thawed euploid blastocyst?DesignIn this secondary analysis of a prospective cohort study, 648 patients with three-dimensional ultrasound (3D-US) data obtained on the day before embryo transfer were categorized into three groups according to uterine cavity morphology: normal (n = 472), intermediate (n = 166) and T-shaped (n = 10). Quantitative uterine cavity dimensions were used to evaluate uterine cavity morphology. Pregnancy outcomes, including live birth, clinical miscarriage and ectopic pregnancy, were compared among the groups.ResultsThe prevalence of a T-shaped uterus in this cohort was 1.5%. Uterine cavity morphology was strongly associated with the ratio of interostial distance and isthmic diameter (P < 0.01). Live birth rates were 66.5% for normal, 65.7% for intermediate and 40.0% for T-shaped cavity morphology. Women with a T-shaped uterus had an increased risk of clinical miscarriage (40.0% versus 7.0% for normal and 9.0% for intermediate cavity morphology, P < 0.01) and ectopic pregnancy (10.0% versus 1.1% for normal and 1.9% for intermediate cavity morphology, P = 0.05). When evaluating interostial distance and isthmic diameter ratio to determine pregnancy outcomes, a cut-off value of 2 was noted to have weak predictive value for live birth, but not clinical miscarriage or ectopic pregnancy.ConclusionsT-shaped uterine cavity morphology is associated with adverse pregnancy outcomes after transfer of a single thawed euploid blastocyst. Given the low prevalence of this condition, quantifying the magnitude of risk will require a larger cohort of patients.     

Investigation of the role of platelets in the aetiopathogenesis of adenomyosis

Research questionDo platelets aggregate in adenomyotic lesions and participate in adenomyosis pathogenesis and related fibrosis?DesignEutopic and ectopic endometrium from 17 patients with adenomyosis and endometrium from 23 healthy controls were collected. Immunohistochemical analyses of platelet marker CD41, transforming growth factor beta 1 (TGF-β1) and vascular endothelial growth factor (VEGF) were performed to investigate aggregation and activation of platelets in the stroma. Picrosirius staining was carried out to evaluate the extent of fibrotic tissue.ResultsStroma in the control group showed higher CD41 staining levels than ectopic stroma from patients with adenomyosis (P < 0.001). In patients with adenomyosis, eutopic stroma expressed more extensive CD41 staining than ectopic stroma (P < 0.0001). Stroma in the control group exhibited higher TGF-β1 expression than eutopic and ectopic stroma from adenomyosis patients (P = 0.009 and P < 0.0001). Stroma in the control group also expressed higher VEGF levels than ectopic stroma from patients with adenomyosis (P < 0.001). In patients with adenomyosis, eutopic stroma showed higher VEGF expression than ectopic stroma (P = 0.021). Stroma in ectopic endometrium from adenomyosis patients displayed greater Picrosirius staining compared with both eutopic stroma from adenomyosis patients and stroma in the control group (P < 0.0001).ConclusionThe results of this study did not detect a primary role for platelet activation or aggregation in the pathophysiological process of adenomyosis. Higher rates of collagen fibres were found in adenomyotic lesions, likely to be related to a TGF-β1-independent pathway. Collagen fibre deposition was more extensive in adenomyotic lesions, consistent with fibrosis.     

IVF in women aged 43 years and older: a 20-year experience

Research questionWhat are the reproductive outcomes of women aged 43 years and older undergoing IVF and intracytoplasmic sperm injection (ICSI) treatment using their own eggs.DesignRetrospective study of 833 woman aged 43 years or older undergoing their first IVF and ICSI cycle using autologous oocytes at a tertiary referral hospital between January 1995 and December 2019. Live birth rate (LBR) after 24 weeks’ gestation was the primary outcome.ResultsNinety-five out of 833 (11.4%) had a positive HCG, whereas 59 (62.1% per positive HCG) had a miscarriage before 12 weeks’ gestation and 36 (4.3%) live births were achieved. Analysis by age showed that the number of cumulus–oocyte complexes retrieved was significantly different between the four age groups: 43 years (5 [3–9]); 44 years (5 [2–7]); 45 years (3 [2–8)]); ≥45 years (2.5 [2–6]); P < 0.01; the number of metaphase II oocytes, however, was similar. Positive HCG rates remained low: 43 years (78/580 [13.4%]); 44 years (14/192 [7.3%]); 45 years (1/39 [2.6%]; and ≥46 years (2/22 [9.1%]); P = 0.03, as did LBR: 43 years (28 [4.8%]); 44 (7 [3.6%]); 45 years (0 [0%]); and ≥46 years (1 [4.5%]); P = 0.5. Multivariate regression analysis revealed that only number of metaphase II was significantly associated with LBR, when age was considered as a continuous (OR 1.08, 96% CI 1.004 to 1.16) or categorical variable (OR 1.08, 95% CI 1.005 to 1.16).ConclusionThe chances of achieving a live birth in patients aged 43 years and older undergoing IVF/ICSI with their own gametes are low, even in cases of patients with a relatively ‘normal’ ovarian reserve for their age.     

Efficacy of Transabdominal Ultrasound–guided Percutaneous Microwave Ablation in the Treatment of Symptomatic Adenomyosis: A Retrospective Cohort Study

Study ObjectiveTo evaluate and compare the clinical efficacy of transabdominal ultrasound–guided percutaneous microwave ablation (PMWA) in the treatment of symptomatic focal and nonfocal adenomyosis.DesignRetrospective cohort study.SettingLongyan First Affiliated Hospital of Fujian Medical University.PatientsFrom May 2019 to October 2021, 107 patients with symptomatic adenomyosis who refused hysterectomy received PMWA.InterventionsPatients were divided into a focal group (n = 47, including 40 focal adenomyosis and 7 adenomyoma cases) and a nonfocal group (n = 60, including 36 diffuse and 24 mixed adenomyosis cases) according to the extent of lesion involvement.Measurements and Main ResultsWe collected and analyzed preoperative baseline data on patient characteristics; postoperative efficacy measures at 3, 6, and 12 months; and intraoperative and postoperative complications. There was a significant post-treatment reduction in the uterine corpus volume and cancer antigen 125 levels, an increase in hemoglobin levels, and an improvement in the Uterine Fibroid Symptom and Health-related Quality of Life scores (consisting of the Symptom Severity Scale and the Health-related Quality of Life scale), dysmenorrhea visual analog scale, and menstrual volume score (MVS) (all p <.05). One patient had recurrence. Most adverse events (72.0%) were mild. Although the nonfocal group had significantly greater anemia severity, higher Symptom Severity Scale and MVS, lower Health-related Quality of Life scale, greater extent and severity of myometrial involvement, and larger uterine corpus volume, after treatment, the uterine corpus volume, uterine corpus reduction rate, cancer antigen 125 levels, hemoglobin levels, Uterine Fibroid Symptom and Health-related Quality of Life score, dysmenorrhea visual analog scale, MVS score, and clinical response rate were similar between the groups (p >.05).ConclusionPMWA had good, similar, short-term efficacy for symptomatic focal and nonfocal adenomyosis.