Predicting live birth, preterm and low birth weight infant after in-vitro fertilisation: a prospective study of 144018 treatment cycles

Background The extent to which baseline couple characteristics affect the probability of live birth and adverse perinatal outcomes after assisted conception is unknown. Methods and Findings We utilised the Human Fertilisation and Embryology Authority database to examine the predictors of live birth in all in vitro fertilisation (IVF) cycles undertaken in the UK between 2003 and 2007 (n = 144,018). We examined the potential clinical utility of a validated model that pre-dated the introduction of intracytoplasmic sperm injection (ICSI) as compared to a novel model. For those treatment cycles that resulted in a live singleton birth (n = 24,226), we determined the associates of potential risk factors with preterm birth, low birth weight, and macrosomia. The overall rate of at least one live birth was 23.4 per 100 cycles (95% confidence interval [CI] 23.2–23.7). In multivariable models the odds of at least one live birth decreased with increasing maternal age, increasing duration of infertility, a greater number of previously unsuccessful IVF treatments, use of own oocytes, necessity for a second or third treatment cycle, or if it was not unexplained infertility. The association of own versus donor oocyte with reduced odds of live birth strengthened with increasing age of the mother. A previous IVF live birth increased the odds of future success (OR 1.58, 95% CI 1.46–1.71) more than that of a previous spontaneous live birth (OR 1.19, 95% CI 0.99–1.24); p-value for difference in estimate <0.001. Use of ICSI increased the odds of live birth, and male causes of infertility were associated with reduced odds of live birth only in couples who had not received ICSI. Prediction of live birth was feasible with moderate discrimination and excellent calibration; calibration was markedly improved in the novel compared to the established model. Preterm birth and low birth weight were increased if oocyte donation was required and ICSI was not used. Risk of macrosomia increased with advancing maternal age and a history of previous live births. Infertility due to cervical problems was associated with increased odds of all three outcomes—preterm birth, low birth weight, and macrosomia. Conclusions Pending external validation, our results show that couple- and treatment-specific factors can be used to provide infertile couples with an accurate assessment of whether they have low or high risk of a successful outcome following IVF

Live birth rate, multiple pregnancy rate, and obstetric outcomes of elective single and double embryo transfers: Hong Kong experience

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Factors affecting pregnancy outcome in a gamete intrafallopian transfer (GIFT) programme

Objective. To identify the factors that most significantly affected pregnancy rates in a gamete intrafallopian transfer (GIFT) programme.Methods. A total of 863 GIFT cycles were analysed retrospectively. The variables found to be associated significantly with pregnancy were then used to obtain multivariate analysis using logistical regression.Results. Overall and ongoing pregnancy rates were significantly better in patients ≤ 38 years than in patients > 38 years (37.3% and 28.4% v. 23.7% and 11.0% respectively), and age was positively associated with success after GIFT (odds ratio (OR) 1.87, 95% confidence interval (CI): 1.22- 2.85). Metaphase I (MI) oocytes were negatively associated with pregnancy (OR 1.54, 95% CI: 0.28 - 1.04). The highest pregnancy rates occurred when 3 metaphase II (MII) oocytes were transferred (39.8%, OR 7.51, 95% CI: 1.74 - 32.42). With regard to sperm morphology, overall pregnancy rates of 25.5% (≤ 4% normal forms) and 37.2% (> 4% normal forms) were obtained. Morphology of > 4% normal forms was positively associated with pregnancy (OR 1.58, 95% CI: 1.04 - 2.42).Conclusion. The results of this study suggest that the most important factors influencing pregnancy rates in a GIFT programme are the woman's age and those factors pertaining to the characteristics of the gametes. Considering the emotional and financial costs it is important to relate this information to all prospective participants in a GIFT programme

Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities

Background : Observational studies suggest higher pregnancy rates after the hysteroscopic removal of endometrial polyps, submucous fibroids, uterine septum or intrauterine adhesions, which are detectable in 10% to 15% of women seeking treatment for subfertility. Objectives : To assess the effects of the hysteroscopic removal of endometrial polyps, submucous fibroids, uterine septum or intrauterine adhesions suspected on ultrasound, hysterosalpingography, diagnostic hysteroscopy or any combination of thesemethods inwomenwith otherwise unexplained subfertility or prior to intrauterine insemination (IUI), in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI). Search methods : We searched theCochraneMenstrualDisorders and Subfertility SpecialisedRegister (8 September 2014), theCochrane Central Register of Controlled Trials (The Cochrane Library 2014, Issue 9), MEDLINE (1950 to 12 October 2014), EMBASE (inception to 12 October 2014), CINAHL (inception to 11 October 2014) and other electronic sources of trials including trial registers, sources of unpublished literature and reference lists. We handsearched the American Society for Reproductive Medicine (ASRM) conference abstracts and proceedings (from January 2013 to October 2014) and we contacted experts in the field. Selection criteria : Randomised comparisons between operative hysteroscopy versus control in women with otherwise unexplained subfertility or undergoing IUI, IVF or ICSI and suspected major uterine cavity abnormalities diagnosed by ultrasonography, saline infusion/ gel instillation sonography, hysterosalpingography, diagnostic hysteroscopy or any combination of these methods. Primary outcomes were live birth and hysteroscopy complications. Secondary outcomes were pregnancy and miscarriage. Data collection and analysis : Two review authors independently assessed studies for inclusion and risk of bias, and extracted data. We contacted study authors for additional information. Main results : We retrieved 12 randomised trials possibly addressing the research questions. Only two studies (309 women) met the inclusion criteria. Neither reported the primary outcomes of live birth or procedure related complications. In women with otherwise unexplained subfertility and submucous fibroids there was no conclusive evidence of a difference between the intervention group treated with hysteroscopic myomectomy and the control group having regular fertility-oriented intercourse during 12 months for the outcome of clinical pregnancy. A large clinical benefit with hysteroscopic myomectomy cannot be excluded: if 21% of women with fibroids achieve a clinical pregnancy having timed intercourse only, the evidence suggests that 39% of women (95% CI 21% to 58%) will achieve a successful outcome following the hysteroscopic removal of the fibroids (odds ratio (OR) 2.44, 95% confidence interval (CI) 0.97 to 6.17, P = 0.06, 94 women, very low quality evidence). There is no evidence of a difference between the comparison groups for the outcome of miscarriage (OR 0.58, 95% CI 0.12 to 2.85, P = 0.50, 30 clinical pregnancies in 94 women, very low quality evidence). The hysteroscopic removal of polyps prior to IUI can increase the chance of a clinical pregnancy compared to simple diagnostic hysteroscopy and polyp biopsy: if 28% of women achieve a clinical pregnancy with a simple diagnostic hysteroscopy, the evidence suggests that 63% of women (95% CI 50% to 76%) will achieve a clinical pregnancy after the hysteroscopic removal of the endometrial polyps (OR 4.41, 95% CI 2.45 to 7.96, P < 0.00001, 204 women, moderate quality evidence). Authors' conclusions : A large benefit with the hysteroscopic removal of submucous fibroids for improving the chance of clinical pregnancy in women with otherwise unexplained subfertility cannot be excluded. The hysteroscopic removal of endometrial polyps suspected on ultrasound in women prior to IUI may increase the clinical pregnancy rate. More randomised studies are needed to substantiate the effectiveness of the hysteroscopic removal of suspected endometrial polyps, submucous fibroids, uterine septum or intrauterine adhesions in women with unexplained subfertility or prior to IUI, IVF or ICSI

Influence of different eCG doses on the rabbit doe ovary response, fertilizing aptitude and embryo development

[EN] The aim of this experiment was to compare the ovary response, the fertilising aptitude and the embryo development of multiparous rabbit does having received during the whole career 0 (control: no injection, group 0), 8 or 25 IU of eCG (groups 8 and 25, respectively) 48 h before each 4 d post partum insemination. After the 11th series of insemination, two groups of 60 does were sacrifi ced 30 h or 14 d after insemination. The percentage of ovulating females does not vary according to the eCG treatment, but the ovulation rate (number of corpora lutea per ovulating does) and the fertilising rate (number of segmented ova/number of corpora lutea x100) increases with eCG dose [10.2, 11.1, 12.3 corpora lutea (P=0.011); 61.6 vs 97.5, 81.2% (P<0.001), for groups 0, 8 and 25 IU respectively]. In a same way, at 14 d of pregnancy, the embryo survival (1-(number of corpora lutea ¿ number of alive embryos/ number of corpora lutea)) increases with the injected amount of eCG (55.1 vs 69.9 and 83.1% for groups 0, 8 and 25, respectively, P=0.023). Moreover, eCG completely removes the fertilising failure independent of ovulation. Compared with the other does, lactating-non-receptive does have a lower fertilisation rate (70.0 vs 90.2%, P=0.008) and a weaker embryo survival (55.3 vs 83.5%, P<0.001). It is concluded that with intensive reproduction rhythm (4 d post partum insemination), an 8 IU of eCG injected 48 h before insemination is enough to enhance the ovulation rate, the embryo survival and the fertilisation rate of multiparous does.Ttheau-Clément, M.; Lebas, F.; Falières, J. (2010). Influence of different eCG doses on the rabbit doe ovary response, fertilizing aptitude and embryo development. World Rabbit Science. 16(2). doi:10.4995/wrs.2008.62916

Frozen-thawed embryo transfer cycles

Objective: To review the outcomes of frozen-thawed embryo transfer cycles. Design: Retrospective review. Setting: Tertiary assisted reproduction centre, Hong Kong. Patients: Subfertile patients undergoing frozen-thawed embryo transfer between July 2005 and December 2007. Main outcome measures: Clinical and ongoing pregnancy rates. Results: A total of 983 frozen-thawed embryo transfer cycles performed during the study period were reviewed. The clinical pregnancy and ongoing pregnancy rates were 35% and 30%, respectively. Factors associated with successful outcome included younger maternal age (≤35 years) and 4 or more blastomeres at replacement, but not the method of insemination, the cause of subfertility, or the type of frozen-thawed embryo transfer cycle. The overall multiple pregnancy rate was 18%. For cycles with a single embryo replaced, embryos having 4-cell or higher stages at replacement gave an ongoing pregnancy rate of 25%, whereas those with less than 4 cells had a significantly lower ongoing pregnancy rate of 5% only. Blastomere lysis after thawing significantly reduced the clinical pregnancy and ongoing pregnancy rates of cycles with one embryo replaced. Conclusions Clinical pregnancy and ongoing pregnancy rates of frozen-thawed embryo transfer cycles were 35% and 30%, respectively. Higher pregnancy rates were associated with younger maternal age (≤35 years), blastomere numbers of 4 or more, and no blastomere lysis after thawing.published_or_final_versio

Emotional distress in infertile women and failure of assisted reproductive technologies: meta-analysis of prospective psychosocial studies

Objective To examine whether pretreatment emotional distress in women is associated with achievement of pregnancy after a cycle of assisted reproductive technology

Endometrial injury in women undergoing assisted reproductive techniques

ACKNOWLEDGEMENTS We would like to express our appreciation to Dra Abha Maheshwari for her important authorial contribution to the previous version of this review. We also acknowledge the important help provided by the Cochrane Menstrual Disorders and Subfertility Group team, specially by Marian Showell, Trials Search Co-ordinator; by Helen Nagels, Managing Editor; and by Prof. Cindy Farquhar, Co-ordinating Editor. Finally, we would like to express our gratitude to the following investigators, who provided essential information for the preparation of this review: TK Aleyamma, Erin F Wolff, Lukasz Polanski, Nava Dekel, Neeta Singh, Suleyman Guven and Tracy YeungPeer reviewedPublisher PD

Utilisation of sperm‐binding assay combined with computer‐assisted sperm analysis to evaluate frozen‐thawed bull semen

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110567/1/and12225.pd

A comparison of pregnancy outcome between high-order multiple and twin pregnancies: matched-pair retrospective study

OBJECTIVE. To compare the pregnancy outcome between high-order multiple and twin pregnancies. DESIGN. Matched-pair retrospective analysis. SETTING. University teaching hospital, Hong Kong. PATIENTS. Patient records from 38 high-order multiple pregnancies that were delivered over a period of 15 years, and those from matched twin pregnancies. MAIN OUTCOME MEASURES. Obstetric and perinatal outcomes. RESULTS. The incidence of high-order multiple pregnancies increased over the study period in association with the more frequent practice of ovulation induction and other assisted reproductive techniques. High-order multiple pregnancies were associated with a higher incidence of maternal complications and a significantly higher perinatal mortality rate than were twin pregnancies. CONCLUSION. Efforts should be made to prevent multiple pregnancies by carefully monitoring ovulation treatment and by limiting the number of embryos transferred.published_or_final_versio