Association between the number of top-quality blastocysts and live births after single blastocyst transfer in the first fresh or vitrified–warmed IVF/ICSI cycle

Research questionIs there an association between the total number of top-quality blastocysts (TQB) developed in the first IVF/intracytoplasmic sperm injection cycle (ICSI) and live births after a single blastocyst transfer (SBT)?DesignPregnancy outcomes from 1336 infertile women who had undergone their first IVF/ICSI treatment and accepted a first-time embryo transfer with a single fresh or vitrified–warmed blastocyst between January 2016 and August 2018 were assessed retrospectively. The restricted cubic splines method was used to evaluate the association between the number of TQB, and ongoing pregnancies and live births.ResultsA significant non-linear functional form was found between the number of TQB and the ongoing pregnancies and live births (P < 0.05). The odds of an ongoing pregnancy or live birth were similar, at about 11% or higher for each additional TQB up to five TQB (odds ratio [OR] 1.11; 95% confidence interval [CI] 1.01–1.21). After this, pregnancy outcomes nearly plateaued, indicating that the number of TQB was not related to pregnancy when it was greater than five.ConclusionsThe quantity of TQB available for transfer or cryopreservation can provide important predictors for pregnancy and live birth after the first embryo transfer cycle with a single blastocyst. This valuable information may assist with the future application of SBT.     

The effect of chromosomal polymorphisms on the outcomes of fresh IVF/ICSI–ET cycles in a Chinese population

Purpose

Chromosomal polymorphisms (CPs) have been reported to be associated with infertility; however, their effects on the outcomes of in vitro fertilization/intracytoplasmic sperm injection–embryo transfer (IVF/ICSI–ET) are still controversial. In this retrospective study, we aimed to evaluate the effect of CPs on IVF/ICSI–ET outcomes.

Methods

To investigate whether CPs affected the outcomes of fresh IVF/ICSI–ET cycles in a Chinese population, we evaluated infertile couples with male carriers of CPs (n?=?348), infertile couples with female carriers (n?=?99), and unaffected couples (n?=?400) who had received their first treatment cycles in our hospital between January 2013 and March 2015.

Results

CPs in either male or female carriers seemed to have adverse effects on IVF/ICSI–ET outcomes. CPs in male carriers affected outcomes mainly by decreasing the rates of fertilization, embryo cleavage, good quality embryos, clinical pregnancies, ongoing pregnancies, and deliveries as well as increasing the biochemical pregnancy rate (P?<?0.05); CPs in female carriers affected outcomes only by lowering the embryo cleavage rate (P?<?0.05). The mean fertilization rate of couples with male CP carriers undergoing IVF was significantly lower than that in those undergoing ICSI (61.1 versus 66.5 %, respectively; P?=?0.0004).

Conclusions

Our data provide evidence for the involvement of CPs in the poor outcomes of fresh IVF/ICSI–ET cycles in a Chinese population. The use of ICSI might improve outcomes by increasing the fertilization rate for men with CPs.

     

GnRH Antagonist Improved Blastocyst Quality and Pregnancy Outcome After Multiple Failures of IVF/ICSI–ET with a GnRH Agonist Protocol

BACKGROUND: To determine the efficacy of a gonadotrophin-releasing hormone (GnRH) antagonist, cetrorelix, in improving the quality of embryos and pregnancy outcome, we performed a study in patients with a history of multiple failures of in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles with a GnRH agonist (GnRHa) long protocol. METHODS: Forty women with no live births after conventional IVF or ICSI embryo transfer (ET) and subsequent blastocyst transfer (BT) with a GnRHa long protocol entered this study. The treatment protocol consisted of a daily dose of clomiphene citrate 100 mg for 5 days and gonadotrophin injections daily from cycle day 4 onward. Cetrorelix, 0.25 mg/day, was started when the leading follicle reached 14 mm. Induction of ovulation was triggered with human chorionic gonadotrophin (HCG) (N = 36) or GnRHa (N = 4). It was possible to perform BT in 38 patients. RESULTS: Comparison of the results with the results for BT with the previous GnRHa protocol showed no significant differences in number of oocytes retrieved or the zygote- and blastocyst-development rate. With the cetrorelix protocol, however, number of patients whose embryos had developed to at least one expanded blastocyst on day 5 was significantly higher than with the GnRHa protocol (25 vs. 9) (p < 0.001), and 16 of the women became pregnant (42.1%), with 7 delivering 9 infants, 4 ending in abortion (25%), and 5 in progressing. CONCLUSIONS: The use of a GnRH antagonist in controlled ovarian hyperstimulation improves the outcome of pregnancy of patients with a history of multiple failure of IVF/ICSI-ET in a GnRHa protocol, most likely due to improvement of the quality of the blastocysts generated.     

Effect of chromosomal polymorphisms of different genders on fertilization rate of fresh IVF–ICSI embryo transfer cycles

To explore whether chromosomal polymorphisms of different genders affect outcomes of fresh IVF and intracytoplasmic sperm injection (ICSI) embryo transfer cycles differently, 37 couples with chromosomal polymorphisms were identified out of 614 infertile couples undergoing IVF–ICSI treatments. Group 1 included 20 couples in which only the male carried chromosomal polymorphisms; group 2 included 17 couples with female carriers only; group 3 included 19 infertile couples with normal karyotypes randomly selected as controls. A significantly lower fertilization rate was found in group 1 compared with groups 2 and 3 (56.68% in Group 1, 78.02% in group 2 and 71.74% in group 3; group 1 versus group 2, P < 0.001; group 1 versus group 3, P = 0.001; respectively). When stratified according to fertilization method, the fertilization rate in IVF cycles of group 1 was significantly lower than group 3 (50.00% in Group 1, 73.89% in Group 3, P < 0.001). Fertilization rates in ICSI cycles between groups 1 and 3 were not significantly different. This study suggests that male chromosomal polymorphisms adversely influence fertilization rates of IVF cycles. The use of ICSI may improve the success of infertility treatment by increasing the fertilization rate for men with chromosomal polymorphisms.     

Does Body Mass Index of Infertile Women Have an Impact on IVF Procedure and Outcome?

Purpose: The objective was to explore whether body mass index (BMI) of women related to the different parameters of the in vitro fertilization (IVF) procedure and outcome. Methods: This retrospective study on 398 couples analyzed epidemiological features, characteristics of ovarian stimulation, number and quality of retrieved oocytes, as well as pregnancy outcome according to three groups of BMI values: BMI < 20, 20 BMI < 25 and BMI 25 kg/m². Results: The prevalence of underweight and overweight women was 21.8% and 22.3%, respectively. The mean ratio follicle-stimulating hormone–luteinizing hormone increased significantly according to BMI. An increase in the mean number of consummated gonadotropin ampoules together with a decrease in the number of collected oocytes was observed in long stimulation protocol cycles when BMI 25 kg/m². The same observations were made in short stimulation protocol cycles for BMI < 20 and 25 kg/m². No significant difference could be found in clinical pregnancy and miscarriage rates between underweight, normal weight, and overweight patients. Conclusions: Both underweight and overweight have negative effects on IVF parameters and outcome leading to decreased chances of pregnancy.     

Association between the number of oocytes retrieved and cumulative live birth rate in women aged 35–40 years undergoing long GnRH agonist IVF/ICSI cycles

Purpose

To study the association between the numbers of oocytes retrieved and the cumulative live birth rates (LBR) in women aged 35–40 years undergoing long GnRH agonist IVF/ICSI cycles.

Methods

A total of 931 women aged 35–40 years who underwent their first cycle of IVF/ICSI treatment between January 2010 and December 2013 at Nanjing Drum Tower Hospital were identified and reviewed. The main endpoint of this study was the cumulative LBR after one complete oocyte retrieval, which included fresh and all subsequent frozen–thaw embryo transfer cycles. Odds ratios (OR) and 95% confidence interval (CI) for live birth were estimated by multivariate logistic regression analysis. Furthermore, all the women were divided into four groups based on the number of oocytes retrieved: 0–4, 5–9, 10–14 or ≥15 oocytes group. Variables were then compared among groups.

Results

We found that 634 out of the 931 patients (68.1%) achieved at least one live birth. The number of oocytes retrieved was an independent predictive factor for live birth, with OR 1.20 (95% CI 1.15–1.26) when adjusted for age (years), duration of infertility and Gn (gonadotrophin) doses. The cumulative LBR in the four different oocyte groups was 35.6, 68.8, 83.4 and 89.2%, respectively. When the 1–4 oocytes group was issued as a reference, the ORs for cumulative LBR gradually increased to 3.66, 6.74 and 11.77 in other three oocytes groups, respectively. The moderate–severe ovarian hyperstimulation syndrome (OHSS) rate was dramatically increased in the ≥15 oocytes group (6.9%) when compared to that in the 10–14 oocytes group (0.8%), while the cumulative LBR only increased 5.8% (from 83.4 to 89.2%).

Conclusions

The ideal number of oocytes retrieved in women aged 35–40 years is 10–14 oocytes, which achieves a high cumulative LBR while maintaining an acceptable low OHSS rate.

     

Effects of the Number of Transferred and Implanted Embryos upon Serum β-hCG Level in Early Pregnancy

目的:探讨移植胚胎数和着床胚胎数与妊娠早期血清β-hCG值的关系.方法:回顾性分析IVF/ICSI新鲜胚胎移植后820个宫内妊娠周期,根据移植胚胎数及移植后35dB超显示的妊娠囊数分组,比较移植14d、18d血清β-hCG水平及其上升幅度.结果:不同移植胚胎数相同妊娠囊数组间比较血清β-hCG差异无统计学意义(P＞0.05);妊娠早期血清β-hCG水平:三妊娠囊组＞双妊娠囊组＞单妊娠囊组,差异有统计学意义(P＜0.05);血清β-hCG上升幅度各组比较无统计学意义(P＞0.05).结论:移植胚胎数对妊娠早期血清β-hCG无直接影响;着床胚胎数影响妊娠早期血清β-hCG水平.妊娠囊越多,其hCG水平就越高.     

Serum Progesterone Before and After Human Chorionic Gonadotropin Injection Depends on the Estradiol Response to Ovarian Hyperstimulation During In Vitro Fertilization–Embryo Transfer Cycles

Purpose: Our purpose was to assess if periovulatory serum progesterone is reflective of ovarian responsiveness in controlled ovarian hyperstimulation (COH). Methods: One-hundred forty-two in vitro fertilization–embryo transfer cycles in women using GnRH-a suppression and human menopausal gonadotropin (hMG) stimulation were evaluated. Responses were studied according to ovarian response to hMG and age. Outcome measures included peak serum estradiol, serum progesterone and estrogen/progesterone ratios on the day of hCG injection, number of harvested oocytes, fertilization rates, and delivered pregnancy rates. Results: A periovulatory rise in serum progesterone (>0.9 ng/ml) occurred only among younger women (<40 years old) with a good response (P<0.05). Though the number of oocytes was greater in good responders, fertilization and pregnancy rates were similar among all women regardless of age and ovarian response. Conclusions: Periovulatory levels of serum progesterone vary according to ovarian response to COH. Elevations in progesterone do not appear to be a manifestation of poor responders. Reduced periovulatory progesterone may reflect inadequate steroidogenesis.     

Association of Umbilical Coiling Index by Colour Doppler Ultrasonography at 18–22 Weeks of Gestation and Perinatal Outcome

Objective

To study the association between antenatal umbilical coiling index (aUCI) and perinatal outcome.

Methods

600 primigravidas with uncomplicated singleton pregnancies had an ultrasonography between 18 and 22 weeks of gestation for aUCI by colour Doppler. The aUCI was calculated as the reciprocal of the distance between a pair of coils. It was then correlated with the following pregnancy outcomes: birth weight, mode of delivery, meconium staining of liquor, Apgar scores and gestational age. The results were statistically analysed by χ²-test.

Results

The mean aUCI was 0.41. Undercoiling was associated with spontaneous preterm delivery (47.87 %), low Apgar score (52.13 %), LBW (52.59 %), FGR (21.28 %) and NICU admission (76.34 %). Overcoiling was associated with preterm deliveries (65.38 %), increased caesarean sections (61.54 %), meconium staining of liquor (67.31 %), low Apgar score (63.46 %) and NICU admission (72.55 %). There was a positive strong correlation between aUCI and birth weight (r = +0.426)

Conclusions

Abnormal coiling is strongly correlated with low birth weight.     

Can dissenting findings regarding the comparative effectiveness of ICSI and IVF be explained by a learning curve?

Purpose : To determine whether between-trial heterogeneity in relative risk of fertilisation for intracytoplasmic sperm injection (ICSI) compared to in vitro fertilisation (IVF) can be explained by learning or by between-trial variation in patient characteristics. Methods : Systematic review and meta-analysis of trials comparing fertilisation outcomes for ICSI and IVF (without surgical sperm retrieval). Meta-regressions to identify associations between treatment effect and trial characteristics. Results : Coefficients on individually significant covariates from the meta-regressions confirm that the ICSI versus IVF treatment effect is increased when patients are “unsuited for IVF” but reduced as semen quality improves and when IVF insemination concentrations are increased. However, the relative risk of fertilisation varies inversely with publication date; contrary to the hypothesised learning effect. Conclusion : While it is recognised that publication date might proxy for unobserved covariates, the possibility of a learning effect in favour of ICSI is not supported by the meta-regression.     

Does Serum Homocysteine Explain the Connection Between Sexual Frequency and Cardiovascular Risk?

BackgroundSexual activity correlates with various health issues, and homocysteine is considered an independent risk factor for cardiovascular events and atherosclerosis. Research on the relation of sexual activity to sexual frequency and homocysteine is sparse.AimTo examine the association between sexual frequency and homocysteine in the general population in the United States.MethodsIn total, 2,267 eligible participants 20 to 59 years old who had serum homocysteine data and completed a sexual behavior questionnaire were enrolled from the National Health and Nutrition Examination Survey of 2005 to 2006. The correlation between sexual frequency and serum homocysteine levels was analyzed using a linear regression model and an extended-model approach was performed for covariate adjustment.OutcomesIndividuals, especially men, in the lower quartiles of sexual frequency had significantly higher serum homocysteine levels, and a sex difference was identified in subgroup analysis.ResultsIn a model of quartile-based analysis after adjustment for age, sex, and race and ethnicity, the regression coefficient of the highest quartile of sexual frequency compared with the lowest quartile was −1.326 (P = .012). After further adjustment for multiple covariates, the inverse association between sexual frequency and serum homocysteine levels remained unchanged. Negative trends maintained statistical significance (P for trend < .05). In subgroup analysis by sex, a negative association between sexual frequency and serum homocysteine levels remained unchanged in men even after adjusting for multiple covariates, but not in women.Clinical ImplicationsClinical physicians in primary care should support patients’ sexual activity, and there are implications for health promotion programs.Strengths and LimitationsThis is the first observational investigation stratified by sex to evaluate the correlation between sexual frequency and serum homocysteine levels. The study was a cross-sectional observational investigation and the causal relation should be evaluated in a follow-up study.ConclusionDecreased sexual frequency correlated with higher homocysteine levels in a nationally representative sample of US adults, especially men; this might increase the risk of cardiovascular disease or other atherothrombotic events.Yang H-F, Kao T-W, Lin Y-Y, et al. Does Serum Homocysteine Explain the Connection Between Sexual Frequency and Cardiovascular Risk? J Sex Med 2017;14:910–917.     

What’s on the mind of IVF consumers?

During economic downturns demographers note that birth rates often decline as couples are more concerned with job security than providing for an additional child. The effects of economic conditions are likely to be amplified in infertile couples because there is often the need to pay for treatment. To try and understand changes in public interest in IVF over time, this study explored publicly available data (Google? Insights) that reports changes in internet search activity relative to baseline volumes for search queries entered into Google search engines. Using the USA and the UK as case studies, it was observed that interest in internet searches using the term ‘IVF’ relative to searches within the infertility category remained relatively unchanged in the USA, with a small decrease observed in the UK. Internet searches using the combined terms ‘IVF cost’ and ‘cost of IVF’ have increased over the past 2 years relative to the infertility category. Additionally, inclusion of the term ‘cost’ appears concentrated in US states without insurance mandates compared with states with mandated insurance coverage. The extent to which Google internet search queries reflect public interest, and more importantly interest from infertile couples, is difficult to know for certain; however, there appears to be increased interest in the cost of treatment.     

A Case‐Control Analysis on the Association Between Erectile Dysfunction and Sudden Sensorineural Hearing Loss in Taiwan

IntroductionAlthough the cause of sudden sensorineural hearing loss (SSNHL) is yet to be elucidated, many theories have been proposed regarding potentially contributory etiologies. One increasingly well‐supported theory purports an underlying vascular pathomechanism. If this is the case, SSNHL may also associate with conditions comorbid with vascular diseases, such as erectile dysfunction (ED). However, no studies to date have investigated the association between ED and SSNHL.AimThis study set out to estimate a putative association between ED and having been previously diagnosed with SSNHL using a population‐based dataset with a case‐control design.MethodsThis study used administrative claim data from the Taiwan National Health Insurance program. We identified 4,504 patients with ED as the study group and randomly selected 22,520 patients as the comparison group. Conditional logistic regression was used to examine the association between ED and having previously received a diagnosis of SSNHL.Main Outcome MeasureThe prevalence and risk of SSNHL between cases and controls were calculated.ResultsOf the sampled patients, 41 (0.15%) had been diagnosed with SSNHL before the index date; 22 (0.49% of the cases) were from the study group and 19 (0.08% of controls) were from the control group. Conditional logistic regression analysis revealed that after adjusting for the patient's monthly income, geographic location, hypertension, diabetes, hyperlipidemia, coronary heart disease, obesity, and alcohol abuse/alcohol dependence syndrome status, patients with ED were more likely than controls to have been diagnosed with SSNHL before the index date (odds ratio = 6.06, 95% confidence interval = 3.25–11.29).ConclusionsThere was an association between ED and prior SSNHL. The results of this study add to the evidence supporting an underlying vascular pathomechanism regarding the development of SSNHL and highlight a need for clinicians dealing with SSNHL patients to be alert to the development of ED. Keller JJ, Chen Y‐K, and Lin H‐C. A case‐control analysis on the association between erectile dysfunction and sudden sensorineural hearing loss in Taiwan. J Sex Med 2012;9:1411–1417.     

Influence of resveratrol supplementation on IVF–embryo transfer cycle outcomes

Research questionDoes resveratrol, a polyphenolic compound, affect IVF–embryo transfer outcomes?DesignThis single-centre, cross-sectional retrospective study was designed to compare the outcomes of embryo transfer cycles in women receiving resveratrol supplementation (200 mg/day) continuously (RES group) with a control group (non-RES group). Of 8686 embryo transfer cycles, 1409 cycles with poor prognostic factors were excluded, including cycles in women aged ≥43 years and those with poor-quality embryos. The RES group (204 cycles, 102 women) was compared with the non-RES group (7073 cycles, 2958 women).ResultsAfter matching patients by age at the time of oocyte retrieval, grade and developmental stage of embryos, number of embryos transferred, and fresh or vitrified-warmed embryo transfer, multivariate logistic regression analysis showed that resveratrol supplementation is strongly associated with a decrease in clinical pregnancy rate [odds ratio (OR) 0.539, 95% confidence interval (CI) 0.341–0.853] and an increased risk of miscarriage (OR 2.602, 95% CI 1.070–6.325).ConclusionsResveratrol supplementation during embryo transfer cycles appears to be detrimental for pregnancy outcomes. An analysis of the supplementation protocol and randomized controlled studies are needed.     

Maternal and Perinatal Outcome During Expectant Management of Severe Pre-Eclampsia Between 24 and 34?Weeks of Gestation

Objective

To determine the maternal and perinatal outcome after expectant management of severe pre-eclampsia between 24 and 34 weeks of gestation.

Method

The maternal and fetal status was monitored by an intensive, non-invasive method among 94 women with severe pre-eclampsia between 24 and 34 weeks of gestation who were scheduled for expectant management in the OICU at a tertiary care center. Pregnancy prolongation and maternal and perinatal morbidity and mortality were analyzed by the Student ‘t’ test and the Mann–Whitney U test.

Results

The days of pregnancy prolongation and perinatal mortality were significantly higher among those managed at <30 weeks. Increasing gestational age correlated with a reduction of RDS. Maternal morbidities were significantly higher among those managed at <28 weeks. But, there was no maternal mortality.

Conclusion

Expectant management of severe pre-eclampsia at 30–34 weeks in a tertiary care center of a developing country is associated with good perinatal outcome and risk reduction for the mother.