RESUMO
Improving the historically low reproductive performance of beef cattle in smallholder systems is essential for its productivity and profitability. Therefore, identifying and addressing risk factors associated with low performance in this system present an opportunity for improvement. The study aimed to evaluate the effect of animal and management risk factors on pregnancy rate (PR), fetal and calf loss (FC), calving interval (CI) and days open (DO) in smallholder beef cattle farms. A multi-stage selection approach was conducted in five provinces of South Africa. Cow records (3694) collected from 40 smallholder herds over two years (2018-2019) were analysed. Data on animal and herd management factors including body condition score (BCS), cow age class, breed type, lactation status, culling old/non-productive cows, record-keeping, and breeding and calving seasons were recorded. The GLIMMIX procedure was computed to determine risk factors associated with performance indicators (PR, FC, CI and DO). Risk factors highly associated with performance were breed type, BCS, cow-age class and breeding/calving season (P ≤ 0.05). Indicators FC, DO and CI increased with decreased BCS, autumn calving seasons, and in first calvers and aged cows. Whereas, PR increased with increasing odds of BCS and breeding seasons between December-March, November-February and January-March. Optimizing reproductive performance in smallholder beef cattle herds may involve managing cow body condition, breeding with adapted genotypes and synchronizing breeding with favourable seasons. Therefore, record keeping and regular monitoring of herd nutrition, climate and breed performance may be significant in improving reproductive performance in smallholder herds.
Assuntos
Criação de Animais Domésticos , Reprodução , Animais , Bovinos/fisiologia , África do Sul , Feminino , Fatores de Risco , Gravidez , Criação de Animais Domésticos/métodos , Taxa de Gravidez , Estações do Ano , Lactação/fisiologia , CruzamentoRESUMO
BACKGROUND: Obesity poses a significant global health challenge, with profound implications for women's reproductive health. The relationship between ovarian reserve and body mass index (BMI) remains a subject of debate. While obesity is generally associated with poorer outcomes in assisted reproductive technology (ART), the evidence remains inconclusive. This study aimed to investigate the effect of pre-pregnancy BMI on ovarian reserve and ART outcomes in infertile patients. METHODS: We conducted a retrospective cohort study involving women who underwent in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) procedures at Tongji Hospital between 2016 and 2023. The study included 30,746 initial fresh cycles and 5,721 singleton deliveries. Patients were stratified by age and further categorized into four BMI groups: lean (< 18.5 kg/m²), normal weight (18.5-24.9 kg/m²), overweight (25.0-29.9 kg/m²), and obese (≥ 30.0 kg/m²). The primary endpoints of the study were pregnancy and perinatal outcomes. To explore the association between BMI and these outcomes, we adjusted for relevant confounding factors and utilized multivariate linear regression models, complemented by multifactorial logistic regression analyses. RESULTS: Anti-Müllerian hormone (AMH) levels were significantly lower in the overweight and obese groups compared to the normal weight group. After adjusting for age, a negative correlation was found between AMH and BMI in the age subgroups of 20-30 and 30-35 years. Among women aged 20-35 years, those in the overweight and obese groups had significantly fewer retrieved oocytes, mature oocytes, and two-pronuclear (2PN) embryos than their normal weight counterparts. Despite these differences, pregnancy outcomes in the overweight and obese groups were comparable to those in the normal weight group across all age categories. Additionally, obesity was linked to an increased risk of gestational diabetes mellitus, hypertensive disorders of pregnancy, and macrosomia. CONCLUSIONS: An age-related decrease in AMH levels was evident with increasing BMI. Although being overweight or obese is associated with poorer embryo and perinatal outcomes, it does not seem to have a substantial impact on fertility.
Assuntos
Índice de Massa Corporal , Infertilidade Feminina , Reserva Ovariana , Humanos , Feminino , Estudos Retrospectivos , Adulto , Gravidez , Técnicas de Reprodução Assistida , Hormônio Antimülleriano/sangue , Obesidade/complicações , Obesidade/fisiopatologia , Fertilização in vitro , Taxa de Gravidez , Resultado da Gravidez , Injeções de Esperma IntracitoplásmicasRESUMO
Objective: This study aimed to evaluate the effectiveness of oral L-carnitine administration in patients after treatment failure to lay the groundwork for targeted in vivo use. Methods and materials: A total of 515 In Vitro Fertilization (IVF) patients undergoing subsequent cycles were included after applying exclusion criteria. They were divided into a control group of 362 patients and a study group of 153 patients who received oral L-carnitine until oocyte retrieval.140 patients were matched according to maternal age, infertility duration, body mass index (BMI), day three top-quality embryos rate, by propensity score matching (PSM). The study investigated the relationship between L-carnitine treatment and in vivo oocyte maturation, normal fertilization, and subsequent embryo development. Results: Following PSM, initial differences in BMI and Day3 top-quality embryo rate between groups were nullified, we created two comparable cohorts with highly similar characteristics. In the subsequent cycles, the study group showed significant improvements in in vivo oocyte maturation rate at retrieval (p=0.002), normal in vitro fertilization rate (p=0.003), blastocyst formation rate (p=0.003), and usable blastocyst rate compared to controls. Although there was no significant difference in the top-quality embryo rate on Day 3, the study group showed a 10% increase in the upper quartile (55.35% vs. 66.67%). The cumulative clinical pregnancy and live birth rates showed a significant improvement (59.82% vs. 68.42%,p=0.004, 47.41% vs. 59.80%, p=0.002). Furthermore, self-control analysis revealed substantial enhancements (p<0.001) in all outcome measures following L-carnitine administration, resulting in the birth of 74 healthy neonates without congenital anomalies. Conclusion: We theorized that daily oral intake of L-carnitine before oocyte retrieval could boost oocyte quality and embryonic development, thus improving IVF outcomes. Ongoing investigations hold the potential to offer valuable insights into the applications and mechanisms underlying the therapeutic effectiveness of L-carnitine.
Assuntos
Carnitina , Fertilização in vitro , Pontuação de Propensão , Humanos , Carnitina/administração & dosagem , Feminino , Adulto , Fertilização in vitro/métodos , Gravidez , Administração Oral , Taxa de Gravidez , Recuperação de Oócitos/métodos , Infertilidade Feminina/tratamento farmacológico , Doenças Ovarianas/tratamento farmacológico , Resultado do Tratamento , Estudos RetrospectivosRESUMO
OBJECTIVE: To disclose the relationships between serum LH and reproductive outcomes in Gonadotropin-releasing hormone (GnRH) antagonist protocol pretreated with luteal estradiol. METHODS: 371 patients, pretreated with estradiol, followed the GnRH antagonist protocol. They were divided into four groups based on the quartiles of serum LH levels on the day of gonadotropin (Gn) initiation(LHGI) and trigger (LHtrigger). Data on various pregnancy outcomes were collected. RESULTS: As serum LHGI increased, anti-Müllerian hormone (AMH) level, antral follicle count (AFC), LHtrigger, estradiol (E2) and P on the trigger day, E2/oocytes, and oocyte numbers increased and peaked in Q4, while Gn dose decreased. Good-quality embryo and blast formation rates increased and peaked in Q3. LHGI <3.93 mIU/ml impaired ongoing pregnancy rate and LBR. After adjusting for AMH and AFC, the impacts were not significant. As LHtrigger increased, E2/oocytes and good-quality embryo rate increased and peaked in T4 and implantation rate increased and peaked in T3. LHtrigger <1.49 mIU/ml independently influenced clinical pregnancy rate (CPR) after adjusting for AMH and AFC. LHGI was positively related to AMH, AFC, LHtrigger, blast formation rate and negatively related to BMI, age and Gn dose. LHtrigger was positively related to E2/oocytes and good quality embryo rate. CONCLUSIONS: Lower serum LH represents as a potential indicator for embryo quality and reproductive outcomes in GnRH antagonist fixed protocol pretreated with estradiol. Early identification of excessive suppression of LH levels will benefit individuals with normal ovarian reserve more.
Assuntos
Estradiol , Hormônio Liberador de Gonadotropina , Hormônio Luteinizante , Indução da Ovulação , Resultado da Gravidez , Humanos , Feminino , Gravidez , Estradiol/sangue , Hormônio Liberador de Gonadotropina/antagonistas & inibidores , Adulto , Hormônio Luteinizante/sangue , Indução da Ovulação/métodos , Resultado da Gravidez/epidemiologia , Taxa de Gravidez , Antagonistas de Hormônios/administração & dosagem , Estudos Retrospectivos , Fertilização in vitro/métodos , Hormônio Antimülleriano/sangueRESUMO
BACKGROUND: Modifying the maternal immune system is necessary to facilitate embryo implantation. Modifying the immune system can occur in several ways, including maternal exposure to the partner's seminal plasma. Seminal plasma exposure can occur through sexual intercourse. To prove this theory, we investigate the effect of sexual intercourse on the chances of successful in vitro fertilization (IVF) in both fresh and frozen embryo transfer (ET) groups in terms of biochemical and clinical pregnancy. METHODS: This is an observational analytical study with a retrospective cohort study design. This study compared biochemical and clinical pregnancy in patient groups who had sexual intercourse with those who did not have sexual intercourse during the IVF process. This study involved 132 participants. RESULTS: The results of this study reported that there was no significant difference in pregnancy rates between patients who had sex before ET and those who did not have sex before ET. However, patients who experience orgasm during sex show significant rates of biochemical (p = 0.009) and clinical pregnancy (p = 0.027) rates. CONCLUSIONS: Sexual intercourse did not show a significant difference between the groups who had sex before ET and those who did not have sex, but the experience of orgasm every time they had sex recently had a positive impact on reproductive health, especially pregnancy.
Assuntos
Coito , Transferência Embrionária , Fertilização in vitro , Taxa de Gravidez , Humanos , Feminino , Gravidez , Estudos Retrospectivos , Transferência Embrionária/métodos , Adulto , Fertilização in vitro/métodos , Estudos de Coortes , Masculino , Orgasmo , Técnicas de Reprodução AssistidaRESUMO
PURPOSE: Explore the effect of blastomere cell number on ART outcome of fresh embryo transfer on day 3. METHODS: Retrospective analysis of 540 fresh single day 3 embryo transfer cycles at the Reproductive Center of the Third Affiliated Hospital of Guangzhou Medical University from January 1, 2018 to October 31, 2022. Patients were divided into 5-6 cell group (n = 55), 7-9 cell group (n = 457), and ≥ 10 cell group(n = 28) based on the number of blastomeres. Single factor analysis of variance and Pearson's chi square test were used to compare the basic data, cycle information, pregnancy outcome and neonatal outcome. Univariate logistic regression was used to correct for confounding factors and analyze the influencing factors of pregnancy outcome. RESULTS: The positive HCG rate were 20%, 43%, 25% for the 5-6-cell, 7-9 cell and ≥ 10 cell groups respectively, with statistically significant differences (P < 0.001). The clinical pregnancy rate was 18%, 42%,21%, respectively (P < 0.001). The live birth rates were 13%, 34%,21% with P-value less than 0.05 which is statistically significant. In order to exclude the influence of confounding factors, multivariable logistic regression analysis was performed, and the outcomes were consistent with previous findings. There were no significant differences found in neonatal outcome between groups (P > 0.05). CONCLUSION: The results suggested that intermediate cleaving embryos (7-9 cell) still presents the highest clinical potential. Fast and slow cleaving embryos are not conducive to the ART outcome.
Assuntos
Blastômeros , Resultado da Gravidez , Taxa de Gravidez , Humanos , Feminino , Gravidez , Blastômeros/citologia , Estudos Retrospectivos , Adulto , Resultado da Gravidez/epidemiologia , Transferência Embrionária/métodos , Transferência Embrionária/estatística & dados numéricos , Nascido Vivo , Contagem de Células , Transferência de Embrião Único/estatística & dados numéricos , ChinaRESUMO
Purpose: This study aimed to investigate the impact of paternal age > 40 years on clinical pregnancy and perinatal outcomes among patients undergoing in vitro fertilization treatment. Methods: We selected 75 male patients (aged > 40 years) based on predefined inclusion and exclusion criteria. Propensity score matching was performed in a 1:3 ratio, resulting in a control group (aged ≤ 40 years) of 225 individuals. Various statistical tests, including the Mann-Whitney U test, Chi-square test, Fisher's exact test, and binary logistic regression, were used to analyze the association between paternal age and clinical outcomes. Results: We found no statistically significant differences in semen routine parameters, clinical pregnancy outcomes, and perinatal outcomes between paternal aged > 40 and ≤ 40 years. However, in the subgroup analysis, the live birth rate significantly decreased in those aged ≥ 45 compared to those aged 41-42 and 43-44 years (31.25% vs. 69.23% and 65%, respectively; all p < 0.05). Additionally, the clinical pregnancy rate was significantly lower among those aged ≥ 45 than among those aged 41-42 (43.75% vs. 74.36%; p=0.035). Conclusion: Paternal age ≥ 45 years was associated with lower live birth and clinical pregnancy rates.
Assuntos
Transferência Embrionária , Fertilização in vitro , Idade Paterna , Resultado da Gravidez , Taxa de Gravidez , Humanos , Gravidez , Fertilização in vitro/métodos , Feminino , Adulto , Masculino , Transferência Embrionária/métodos , Resultado da Gravidez/epidemiologia , Pessoa de Meia-Idade , Nascido Vivo/epidemiologia , Estudos RetrospectivosRESUMO
Purpose: With the rapid advancement of time-lapse culture and artificial intelligence (AI) technologies for embryo screening, pregnancy rates in assisted reproductive technology (ART) have significantly improved. However, clinical pregnancy rates in fresh cycles remain dependent on the number and type of embryos transferred. The selection of embryos with the highest implantation potential is critical for embryologists and influences transfer strategies in fertility centers. The superiority of AI over traditional morphological scoring for ranking cleavage-stage embryos based on their implantation potential remains controversial. Methods: This retrospective study analyzed 105 fresh embryo transfer cycles at the Centre for Reproductive Medicine from August 2023 to March 2024, following IVF/ICSI treatment at the cleavage stage. All embryos were cultured using time-lapse technology and scored using an automated AI model (iDAScore V2.0). Embryos were categorized into three groups based on the iDAScore V2.0: Group A (8 cells, iDA: 1.0-5.7); Group B (8 cells, iDA: 5.8-8.0); and Group C (>8 cells, iDA: 5.8-8.0). Clinical treatment outcomes, embryonic development, and pregnancy outcomes were analyzed and compared across the groups. Results: Baseline characteristics such as patient age, AMH levels, AFC, and basal sex hormones showed no significant differences among the three groups (p > 0.05). The iDAscores were significantly higher in Group C (7.3 ± 0.5) compared to Group B (6.7 ± 0.5) and the iDAscores were significantly higher in Group B (6.7 ± 0.5) compared to Group A (4.8 ± 1.0) (p < 0.001).The mean number of high-quality embryos was highest in Group C (4.7 ± 3.0), followed by Group B (3.6 ± 1.7) and Group A (2.1 ± 1.2) (p < 0.001). There was no statistical difference (p = 0.392) in the ongoing pregnancy rate for single cleavage-stage transfers between Group B (54.5%, 30/55) and Group A (38.1%, 8/21), although there was a tendency for Group B to be higher. Conclusion: Combining time-lapse culture with AI scoring may enhance ongoing pregnancy rates in single cleavage-stage fresh transfer cycles.
Assuntos
Inteligência Artificial , Técnicas de Cultura Embrionária , Transferência Embrionária , Taxa de Gravidez , Imagem com Lapso de Tempo , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Adulto , Transferência Embrionária/métodos , Técnicas de Cultura Embrionária/métodos , Fase de Clivagem do Zigoto/fisiologia , Fase de Clivagem do Zigoto/citologia , Fertilização in vitro/métodos , Resultado da Gravidez , Desenvolvimento Embrionário/fisiologia , Implantação do EmbriãoRESUMO
BACKGROUND: Infertility, which affects 8%-12% of couples worldwide and 21.9% of couples in Pakistan in particular, is a major reproductive health issue. In vitro fertilization (IVF) has emerged as a prevalent therapeutic intervention. Recent studies have identified insulin-like growth factor-I (IGF-I) as a promising biomarker for assessing embryo viability and predicting implantation outcomes in IVF procedures.
Assuntos
Fertilização in vitro , Infertilidade Feminina , Fator de Crescimento Insulin-Like I , Resultado da Gravidez , Humanos , Feminino , Gravidez , Fator de Crescimento Insulin-Like I/metabolismo , Fator de Crescimento Insulin-Like I/análise , Estudos Prospectivos , Adulto , Infertilidade Feminina/terapia , Biomarcadores/sangue , Paquistão/epidemiologia , Taxa de Gravidez , Peptídeos Semelhantes à InsulinaRESUMO
OBJECTIVE: This study aimed to evaluate the impact of adding 4 mg estradiol valerate to progesterone for luteal support on pregnancy rates in IVF cycles following a long protocol with reduced luteal serum estradiol levels post-hCG triggering. DESIGN, SETTING, AND PARTICIPANTS: The prospective randomized controlled trial was conducted at a public tertiary hospital reproductive center with 241 patients who experienced a significant decrease in serum estrogen levels post-oocyte retrieval. INTERVENTIONS: Participants received either a daily 4 mg dose of estradiol valerate in addition to standard progesterone or standard progesterone alone for luteal support. RESULTS: The ongoing pregnancy rate did not show a significant difference between the E2 group and the control group (56.6% vs. 52.2%, with an absolute rate difference (RD) of 4.4%, 95% CI -0.087 to 0.179, P = 0.262). Similarly, the live birth rate, implantation rate, clinical pregnancy rate, early abortion rate, and severe OHSS rate were comparable between the two groups. Notably, the E2 group had no biochemical miscarriages, contrasting significantly with the control group (0.0% vs. 10.7%, RD -10.7%, 95% CI -0.178 to -0.041, P = 0.000). In the blastocyst stage category, the clinical pregnancy rate was notably higher in the E2 group compared to the control group (75.6% vs. 60.8%, RD 14.9%, 95% CI 0.012 to 0.294, P = 0.016). CONCLUSION: Adding 4 mg estradiol valerate to progesterone for luteal support does not affect the ongoing pregnancy rate in embryo transfer cycles using a long protocol with a significant decrease in serum estradiol levels after hCG triggering. However, it may reduce biochemical miscarriages and positively impact clinical pregnancy rates in blastocyst embryo transfer cycles. TRIAL REGISTRATION: ChiCTR1800020342.
Assuntos
Gonadotropina Coriônica , Estradiol , Fertilização in vitro , Fase Luteal , Indução da Ovulação , Taxa de Gravidez , Progesterona , Humanos , Feminino , Estradiol/sangue , Estradiol/administração & dosagem , Gravidez , Adulto , Gonadotropina Coriônica/administração & dosagem , Fase Luteal/efeitos dos fármacos , Fase Luteal/sangue , Fertilização in vitro/métodos , Progesterona/sangue , Progesterona/administração & dosagem , Estudos Prospectivos , Indução da Ovulação/métodos , Transferência Embrionária/métodos , Recuperação de Oócitos/métodosRESUMO
OBJECTIVE: This research was conducted to assess the therapeutic advantage of combined letrozole and clomiphene citrate versus monotherapy for polycystic ovarian syndrome (PCOS) patients. STUDY DESIGN: Five databases were searched using the search string: (letrozole and clomiphene) AND (clomiphene OR clomiphene citrate OR CC) AND (letrozole OR LE) AND (ovulation induc* OR fertility induc* OR fertility preserv*) AND (polycystic ovarian syndrome OR PCOS). All statistical analyses were conducted in Review Manager 5.4.1. Random effect-effect model was used to pool risk ratio (RR), mean difference (MD), and odds ratio (OR) and their corresponding 95% confidence interval (CI). Moreover, qualitative analysis was conducted to qualitatively analyze ovulation, secondary outcomes, and cycle characteristics. RESULTS: One clinical trial and three randomized clinical trials (RCTs) were used in the study. Two studies were used in a quantitative analysis showing that combination was superior for ovulation induction (RR = 1.86 [1.37, 2.53]; p < 0.0001; I2 = 0%), but the number of follicles ≥15 mm was significantly associated with the combination (MD = 0.40[0.14, 0.66]; p = 0.002; I2 = 0%). On subgroup analysis, only hot flushes were significantly associated with the combination (RR = 2.67[1.12, 6.36]; p = 0.03; I2 = 0%). The meta-analysis of two studies reported a significantly higher ovulation rate and number of dominant follicles in the combination therapy group compared with the LE alone arm but no significant difference in pregnancy rate, endometrial thickness, and adverse events. CONCLUSION: Our study demonstrates a significant effect of the combination on ovulation induction. The combination yielded a better chance of conception and viable pregnancy. Further studies are needed to determine the live birth rate. HighlightsCombined Letrozole and Clomiphene is superior to either of these drugs alone for ovulation induction in PCOS.Our results conclude that the combination results in better ovulation, cycle characteristics, and secondary changes.Only the incidence of hot flushes as an adverse effect is increasingly reported in combination.
Assuntos
Clomifeno , Quimioterapia Combinada , Fármacos para a Fertilidade Feminina , Letrozol , Indução da Ovulação , Síndrome do Ovário Policístico , Humanos , Letrozol/administração & dosagem , Letrozol/uso terapêutico , Clomifeno/administração & dosagem , Clomifeno/uso terapêutico , Feminino , Síndrome do Ovário Policístico/tratamento farmacológico , Indução da Ovulação/métodos , Fármacos para a Fertilidade Feminina/administração & dosagem , Fármacos para a Fertilidade Feminina/uso terapêutico , Fármacos para a Fertilidade Feminina/efeitos adversos , Gravidez , Taxa de Gravidez , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
The objective of this study was to determine the optimal timing, sperm concentration, and body condition score (BCS) for laparoscopic artificial insemination (LAI) in the subtropical Lohi sheep breed. In Experiment 1, Lohi ewes (n = 80) were synchronised through progestin-sponges (day 0-day 11), administering PGF2α (d-cloprostenol 75 µg/mL; i.m. @ 75 µg /ewe) on day 09 and eCG (i.m. @ 300 IU/ewe) on day 11. Ewes were divided equally into four groups (n = 20 each) and then LAI was performed at 48 (T48), 60 (T60), 72 (T72) and 96 (T96) hours post-sponge removal using 200 million sperm/insemination. In Experiment 2, ewes (n = 81) were synchronised as in Experiment I. Following synchronisation ewes were divided into four groups, each subjected to LAI employing varying sperm concentrations: 10 (S10; n = 21), 20 (S20; n = 20), 50 (S50; n = 20), or 100 (S100; n = 20) million per insemination. Inseminations were performed within a time window of 48-60 h post-sponge removal, based on the findings from Experiment 1. In both experiments ewes were categorised according to BCS, that is, medium 3 and high > 3. Results of Experiment 1 revealed a quadratic response that ewes inseminated at 60-h post-sponge removal exhibited significantly higher pregnancy and twinning rates (p = 0.02). The results of Experiment 2 revealed that sperm concentration had a quadratic effect, 50 million sperm per insemination resulted in maximal pregnancy rates (p = 0.01). Additionally, ewes with medium BCS (≤ 3) had higher pregnancy rates than high BCS (> 3) ewes. In conclusion, ewes with medium BCS (≤ 3) are ideal candidate for LAI and can be inseminated at 60 h with minimal sperm 50 × 106/dose post-sponge removal to achieve a maximum pregnancy rate.
Assuntos
Sincronização do Estro , Fertilidade , Inseminação Artificial , Laparoscopia , Contagem de Espermatozoides , Animais , Inseminação Artificial/veterinária , Inseminação Artificial/métodos , Feminino , Masculino , Gravidez , Sincronização do Estro/métodos , Contagem de Espermatozoides/veterinária , Laparoscopia/veterinária , Laparoscopia/métodos , Carneiro Doméstico/fisiologia , Taxa de Gravidez , Espermatozoides/fisiologia , Fatores de Tempo , Ovinos/fisiologia , Gonadotropina Coriônica/farmacologia , Gonadotropina Coriônica/administração & dosagem , ClimaRESUMO
In this multicenter, non-inferiority, randomized trial, we randomly assigned 992 women undergoing in-vitro fertilization (IVF) with a good prognosis (aged 20-40, ≥3 transferrable cleavage-stage embryos) to strategies of blastocyst-stage (n = 497) or cleavage-stage (n = 495) single embryo transfer. Primary outcome was cumulative live-birth rate after up to three transfers. Secondary outcomes were cumulative live-births after all embryo transfers within 1 year of randomization, pregnancy outcomes, obstetric-perinatal complications, and livebirths outcomes. Live-birth rates were 74.8% in blastocyst-stage group versus 66.3% in cleavage-stage group (relative risk 1.13, 95%CI:1.04-1.22; Pnon-inferiority < 0.001, Psuperiority = 0.003) (1-year cumulative live birth rates of 75.7% versus 68.9%). Blastocyst transfer increased the risk of spontaneous preterm birth (4.6% vs 2.0%; P = 0.02) and neonatal hospitalization >3 days. Among good prognosis women, a strategy of single blastocyst transfer increases cumulative live-birth rates over single cleavage-stage transfer. Blastocyst transfer resulted in higher preterm birth rates. This information should be used to counsel patients on their choice between cleavage-stage and blastocyst-stage transfer (NCT03152643, https://clinicaltrials.gov/study/NCT03152643 ).
Assuntos
Blastocisto , Fertilização in vitro , Nascido Vivo , Humanos , Feminino , Gravidez , Fertilização in vitro/métodos , Adulto , Nascido Vivo/epidemiologia , Prognóstico , Transferência Embrionária/métodos , Resultado da Gravidez/epidemiologia , Transferência de Embrião Único , Fase de Clivagem do Zigoto , Nascimento Prematuro/epidemiologia , Adulto Jovem , Taxa de GravidezRESUMO
PURPOSE: To investigate the correlation between hysteroscopic findings of chronic endometritis and CD138 immunohistochemistry positive in endometritis and to analyze the pregnancy outcomes and associated risk factors following embryo transfer in women diagnosed with chronic endometritis via hysteroscopy. METHODS: A retrospective observational study carried out at the Reproductive Medicine Center of Tangdu Hospital of Air Force Medical University, from January 2021 to December 2021, was performed by obtaining data from 194 medical records of women who underwent hysteroscopies for infertility and were diagnosed with chronic endometritis based on Delphi criteria. Spearman correlation analysis was used to evaluate the correlation between hysteroscopic findings and endometrial CD138 immunohistochemistry. The study also observed the differences in relevant indexes between the CD138-positive and CD138-negative groups after embryo transfer and analyzed factors influencing implantation failure using logistic regression analysis. RESULTS: The correlation analysis between hysteroscopic findings and CD138 immunohistochemistry showed that micropolyps were correlated with CD138 immunohistochemistry positivity. The correlation coefficient was 0.32 (P < 0.01). After embryo transfer, the clinical pregnancy rate of the CD138-positive group was lower compared to that of the CD138-negative group [64.79% (46/71) vs. 81.30% (100/123), P < 0.05]. The results of the multivariate logistic regression analysis revealed that age (P = 0.43) and CD138 immunohistochemistry positivity (P = 0.008) were the independent risk factors for predicting whether or not embryo implantation was successful. CONCLUSION: Hysteroscopic findings do not correlate strongly with endometrial CD138 immunohistochemistry, and chronic endometritis cannot be diagnosed by hysteroscopy alone. CD138 immunohistochemistry positivity is an independent factor contributing to the decrease in clinical pregnancy rate following embryo transfer.
Assuntos
Transferência Embrionária , Endometrite , Histeroscopia , Imuno-Histoquímica , Resultado da Gravidez , Taxa de Gravidez , Sindecana-1 , Humanos , Feminino , Gravidez , Sindecana-1/metabolismo , Endometrite/patologia , Endometrite/metabolismo , Histeroscopia/métodos , Adulto , Imuno-Histoquímica/métodos , Estudos Retrospectivos , Implantação do Embrião , Endométrio/patologia , Endométrio/metabolismo , Fertilização in vitro , Doença CrônicaRESUMO
This study aimed to evaluate the effect of different growth hormone (GH) pretreatment times in assisted reproductive therapy in patients with diminished ovarian reserve (DOR). A retrospective pilot cohort analysis was performed on patients with DOR receiving GH pretreatment in the Assisted Reproduction Unit of Sir Run Run Shaw Hospital. A total of 1459 patients met the criteria and were divided into four groups according to GH pretreatment time as follows: 53 were in the 2-month pretreatment group (GH1), 400 were in the 1-month pretreatment group (GH2), 414 were in the ovulation induction period pretreatment group (GH3), and 592 were in the non-GH pretreatment group (control group). In addition, GH1, GH2, and GH3 were combined in the GH pretreatment group. Baseline characteristics and treatment outcomes were compared between the groups. The number of oocytes retrieved in the GH pretreatment, GH1, GH2, and GH3 groups was significantly higher than that in the control group (all Pâ <â .01). The numbers of oocytes retrieved in the GH1 and GH2 groups were similar but were nominally higher than those in the GH3 group. Estradiol concentrations in the GH pretreatment, GH2, and GH3 groups were significantly higher than those in the control group on the day of human chorionic gonadotropin injection (all Pâ <â .01). In the GH1 group, 22 patients had >1 assisted reproductive therapy cycle (non-GH pretreatment) before GH pretreatment, and the number of oocytes retrieved in the GH pretreatment cycle was higher than that in the non-GH pretreatment cycle, but this was not significant. These findings suggest that the GH pretreatment time was appropriately prolonged, and the number of oocytes retrieved nominally increased. In patients with DOR, GH pretreatment improved treatment outcomes. More than 1 month of GH pretreatment did not increase the number of oocytes retrieved.
Assuntos
Hormônio do Crescimento Humano , Reserva Ovariana , Indução da Ovulação , Humanos , Feminino , Estudos Retrospectivos , Projetos Piloto , Adulto , Reserva Ovariana/efeitos dos fármacos , Indução da Ovulação/métodos , Hormônio do Crescimento Humano/uso terapêutico , Hormônio do Crescimento Humano/administração & dosagem , Técnicas de Reprodução Assistida , Fatores de Tempo , Gravidez , Resultado do Tratamento , Taxa de Gravidez , Recuperação de Oócitos/métodosRESUMO
Background: Coronavirus disease 2019 (COVID-19) has raised concerns about its potential effects on human fertility, particularly among individuals undergoing assisted reproductive therapy (ART). However, the impact of COVID-19 on female reproductive and assisted reproductive outcomes is unclear. In this study, we aimed to evaluate the effects of COVID-19 on pregnancy outcomes during frozen-thawed embryo transfer (FET) cycles. Methods: This retrospective cohort study included 327 enrolled patients who underwent FET cycles at a single reproductive centre. The study group consisted of patients treated between 1 January 2023 and 31 March 2023 who recently recovered from COVID-19. The embryos for transfer were generated prior to COVID-19 infection. The control group consisted of patients treated between 1 January 2021 and 31 March 2021 who were not infected and did not receive a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. Demographic and cycle characteristics and outcomes were compared. Results: A total of 160 recovered women and 167 controls were included. The primary outcome-the live birth rate-was similar between the two groups (43.8% vs. 43.1%, P > 0.05). The secondary outcomes, such as the implantation rates (41.2% vs. 39.3%), biochemical pregnancy rates (56.3% vs. 56.3%), clinical pregnancy rates (52.5% vs. 52.1%), early abortion rates (8.3% vs. 12.6%) and ongoing pregnancy rates (46.9% vs. 44.3%), were also similar (P < 0.05). According to a logistic regression model, the live birth rate did not decrease after SARS-CoV-2 infection after adjusting for confounding factors (adjusted OR (95% CI) = 0.953 (0.597â¼1.523)). Regardless of stratification by age or the number of embryos transferred, the differences remained nonsignificant. Subgroup logistic regression demonstrated that the time interval from infection to transplant had no significant influence on the live birth rate. Conclusions: SARS-CoV-2 infection after oocyte retrieval had no detrimental effect on subsequent FET outcomes.
Assuntos
COVID-19 , Criopreservação , Transferência Embrionária , Resultado da Gravidez , SARS-CoV-2 , Humanos , Feminino , COVID-19/epidemiologia , Gravidez , Transferência Embrionária/métodos , Estudos Retrospectivos , Adulto , Resultado da Gravidez/epidemiologia , Taxa de Gravidez , Nascido Vivo/epidemiologiaRESUMO
STUDY QUESTION: Can a simplified ovarian hyperstimulation syndrome (OHSS) risk assessment index be developed and validated with sufficient discrimination of moderate/severe OHSS from those without OHSS? SUMMARY ANSWER: This easy-to-use OHSS risk assessment index shows good discriminative power and high calibration accuracy in internal and external validation cohorts. WHAT IS KNOWN ALREADY: An early alert and risk stratification is critical to prevent the occurrence of OHSS. We have previously developed a multi-stage smartphone app-based prediction model to evaluate the risk of OHSS, but app use might not be so convenient in many primary institutions. A simplified OHSS risk assessment index has been required. STUDY DESIGN, SIZE, DURATION: This training and internal validation of an OHSS risk assessment index used retrospective cohort data from January 2016 to December 2020. External validation was performed with a prospective cohort database from January 2021 to May 2022. There were 15 066 cycles in the training cohort, 6502 cycles in the internal validation cohort, and 8097 cycles in the external validation cohort. PARTICIPANTS/MATERIALS, SETTING, METHODS: This study was performed in the reproductive medicine center of a tertiary hospital. Infertile women who underwent ovarian stimulation were included. Data were extracted from the local database with detailed medical records. A multi-stage risk assessment index was constructed at multiple stages. The first stage was before the initiation of ovarian stimulation, the second was before the ovulation trigger, the third was after oocyte retrieval, and the last stage was on the embryo transfer day if fresh embryo transfer was scheduled. MAIN RESULTS AND THE ROLE OF CHANCE: We established a simplified multi-stage risk assessment index for moderate/severe OHSS, the performance of which was further evaluated with discrimination and calibration abilities in training and internal and external validation cohorts. The discrimination abilities of the OHSS risk assessment index were determined with C-statistics. C-statistics in training (Stages 1-4: 0.631, 0.692, 0.751, 0.788, respectively) and internal (Stages 1-4: 0.626, 0.642, 0.755, 0.771, respectively) and external validation (Stages 1-4: 0.668, 0.670, 0.754, 0.773, respectively) cohorts were all increased from Stage 1 to 3 with similar trends, and were comparable between Stages 3 and 4. Calibration plots showed high agreement between observed and predicted cases in all three cohorts. Incidences of OHSS based on diverse risk stratification (negligible risk, low risk, medium risk, and high risk) were 0%, 0.6%, 2.7%, and 8.3% in the training cohort, 0%, 0.6%, 3.3%, and 8.5% in the internal validation cohort, and 0.1%, 1.1%, 4.1%, and 7.2% in the external validation cohort. LIMITATIONS, REASONS FOR CAUTION: The influence from clinical interventions including cryopreservation of all embryos cannot be eliminated and thus certain risk factors like estrogen level on trigger day might be assigned with a lower risk score. Another weakness of the study is that several preventive treatments, for instance oral aspirin and letrozole, were not recorded and evaluated in the model. Despite the robust reliability of OHSS assessment index, this tool cannot be used directly for clinical decision-making or as a diagnostic tool. Its value lies in its capacity to evaluate the prognosis of various interventions and to facilitate clinician-patient communication. The combination of this tool and further symptoms and examinations should be all taken into consideration for accurate and personalized management of OHSS. WIDER IMPLICATIONS OF THE FINDINGS: The OHSS risk assessment index can be implemented to facilitate personalized counseling and management of OHSS. STUDY FUNDING/COMPETING INTEREST(S): This study was supported by National Key R&D Program of China (2022YFC2702504), Medical Research Fund Guangdong Provincial (A2024003), and Xinjiang Support Rural Science and Technology (Special Correspondent) Program in Guangdong Province (KTPYJ 2023014). All authors had nothing to disclose. TRIAL REGISTRATION NUMBER: N/A.
Assuntos
Síndrome de Hiperestimulação Ovariana , Indução da Ovulação , Humanos , Síndrome de Hiperestimulação Ovariana/diagnóstico , Feminino , Medição de Risco/métodos , Adulto , Indução da Ovulação/efeitos adversos , Indução da Ovulação/métodos , Estudos Prospectivos , Estudos Retrospectivos , Gravidez , Medicina de Precisão/métodos , Índice de Gravidade de Doença , Taxa de Gravidez , Infertilidade Feminina/terapia , Fertilização in vitro/métodos , Aplicativos MóveisRESUMO
STUDY QUESTION: Is there a difference in clinical pregnancy rates (CPRs) in good prognosis patients after single embryo transfer (SET) on Day 5, in case of stable culture at 36.6°C or 37.1°C? SUMMARY ANSWER: CPR (with heartbeat at 7 weeks) after blastocyst transfer do not differ after culturing at 36.6°C or 37.1°C. WHAT IS KNOWN ALREADY: Since the beginning of IVF, embryo culture has been performed at 37.0°C; however, the optimal culture temperature remains unknown. Changes in incubator types have led to significant improvements in temperature control. Stable temperature control, i.e. with temperature differences of max. 0.1°C between chambers, is possible in some incubators. A previous prospective pilot study showed that embryo development on Day 5/6 was not affected when embryos were cultured at a stable temperature of 36.6°C or 37.1°C, but culture at 37.1°C resulted in an increased CPR when compared to culture at 36.6°C (74.2% vs 46.4%). STUDY DESIGN, SIZE, DURATION: A prospective randomized controlled trial was performed in a tertiary fertility centre between February 2017 and November 26, 2022. A sample size of 89/89 patients with fresh single embryo transfer (SET) was required to achieve 80% power to detect a difference of 0.22 between group proportions (0.43-0.65) at a significance level of 0.05 using a two-sided z-test with continuity correction. PARTICIPANTS/MATERIALS, SETTING, METHODS: Patients were recruited on the day of oocyte retrieval based on inclusion criteria with final randomization after denudation once six mature oocytes were present. The primary endpoint was CPR (heartbeat at 7 weeks); secondary endpoints were fertilization rate, blastocyst development, biochemical pregnancy rate, live birth rate (LBR), and cumulative live birth rate (CLBR). MAIN RESULTS AND THE ROLE OF CHANCE: A total of 304 patients were eligible for the study; of these 268 signed the consent, 234 (intention-to-treat) were randomized and 181 (per-protocol) received a SET on Day 5: 90 received culture at 36.6°C and 91 at 37.1°C. Patients were on average 32.4 ± 3.5 versus 32.5 ± 4.2 years old, respectively. No differences were observed in embryological outcomes per cycle between culture at 36.6°C versus 37.1°C: 12.0 ± 3.8 vs 12.1 ± 3.8 COCs retrieved (P = 0.88), 10.0 ± 3.1 versus 9.9 ± 2.9 mature oocytes inseminated (P = 0.68), with a maturation rate of 84.2% (901/1083) versus 83.5% (898/1104) (P = 0.87); and 8.0 ± 3.1 versus 7.9 ± 2.7 normally fertilized oocytes with a fertilization rate of 79.7% (720/901) vs 80.5% (718/898) (P = 0.96), respectively. On average 1.5 ± 1.7 versus 1.4 ± 1.9 (P = 0.25) and 1.1 ± 1.1 versus 0.9 ± 1.0 (P = 0.45) supernumerary blastocysts were vitrified on Day 5 and Day 6, respectively. The utilization rate per fertilized oocyte was 46.1% vs 41.5% (P = 0.14). A SET was performed for 181 patients, leading to a biochemical pregnancy rate of 72.2% (65/90) versus 62.7% (57/91) (P = 0.17), respectively. The CPR per fresh transfer cycle was 51.1% (46/90) versus 48.4% (44/91) [OR (95% CI) 1.11 (0.59-2.08), P = 0.710]. To date, a CLBR of 73.3% (66/90) versus 67.0% (61/91) (P = 0.354) has been observed, respectively. In each group, seven patients without live birth have remaining blastocysts frozen. The CPR for the intention-to-treat groups were 38.3% vs 38.6% [OR (95% CI) 0.98 (0.56-1.73), P = 0.967], respectively, for culture at 36.6°C versus 37.1°C. LIMITATIONS, REASONS FOR CAUTION: Only selected patients with expected good prognosis were eligible for the study. WIDER IMPLICATIONS OF THE FINDINGS: Embryos tend to tolerate small changes in temperature deviations during culture to the blastocyst stage, as demonstrated by their similar implantation potential at two slightly different temperatures. STUDY FUNDING/COMPETING INTEREST(S): There is no funding or conflicts of interest to declare. TRIAL REGISTRATION NUMBER: NCT03548532. TRIAL REGISTRATION DATE: 23 October 2017. DATE OF FIRST PATIENT'S ENROLMENT: 10 November 2017.
Assuntos
Blastocisto , Técnicas de Cultura Embrionária , Fertilização in vitro , Taxa de Gravidez , Temperatura , Humanos , Feminino , Gravidez , Técnicas de Cultura Embrionária/métodos , Adulto , Estudos Prospectivos , Fertilização in vitro/métodos , Transferência de Embrião Único/métodos , Transferência Embrionária/métodosRESUMO
To investigate the effects of pretreatment with long-acting gonadotropin-releasing hormone agonist (GnRH-a) before frozen-thawed embryo transfer (FET) on pregnancy outcomes in patients after minimal-mild (stages I-II) peritoneal endometriosis surgery. A retrospective cohort study was performed from March 2018 to May 2019. Overall, 274 patients met inclusion criteria of undergoing FET after minimal/mild peritoneal endometriosis surgery. For the FET protocol, patients were divided into 2 groups: GnRH-a plus hormone replacement therapy (HRT) (group A, nâ =â 154) and HRT-only (group B, nâ =â 120), with the former divided into 2 subgroups receiving 1 (group A1, nâ =â 80) or 2 doses (group A2, nâ =â 74) of GnRH-a. Basic characteristics and pregnancy outcomes of groups A and B and groups A1 and A2 were compared. Clinical pregnancy rate (CPR) and live birth rate (LBR) were the primary outcomes and logistic regression was used to analyze independent correlation factors. The CPR and LBR in group A were 58.4% and 50.0%, respectively, and were not significantly higher than in group B (49.2% and 40.0%; respectively, χ2â =â 2.339, Pâ =â .126 and χ2â =â 2.719, Pâ =â .099, respectively). CPR and LBR in group A1 were not significantly lower than those in group A2 (52.5% and 45.0% vs 64.9% and 55.4%, respectively; χ2â =â 2.420, Pâ =â .120 and χ2â =â 1.665, Pâ =â .197, respectively). However, group A2's CPR and LBR were significantly higher than group B's (64.9% and 55.4% vs 49.2% and 40.0%, respectively; χ2â =â 4.560, Pâ =â .023 and χ2â =â 4.375, Pâ =â .026, respectively). Logistic regression analysis showed that GnRH-a pretreatment (1 or 2 doses) had no significant effect on CPR and LBR compared with the HRT-only group. Patients with minimal-mild (stages I-II) peritoneal endometriosis surgery may not require GnRH-a pretreatment before FET.