Optimal time interval between laparoscopic tubal ligation for hydrosalpinges and ICSI-ET

Objective: To determine the optimal time interval between performing laparoscopic tubal ligation for hydrosalpinges and an ICSI-ET treatment cycle. Design: A retrospective cohort study. Setting: Private infertility clinic. Patient(s): The study group included 69 infertile women who had laparoscopic tubal ligation for hydrosalpinges. 41 patients (group A) had an ICSI-ET cycle 16 weeks after surgery. Intervention(s): laparoscopic tubal ligation and ICSI-ET. Main outcome measure(s): Pregnancy rate, clinical pregnancy rate and implantation rate. Result(s): Pregnancy rates were 39%, 50% and 50%, clinical pregnancy rates 31.7%, 45% and 50%, and implantation rates 14.8%, 21.5% and 18% for groups A, B and C respectively. Conclusion(s): Although the reduction in pregnancy rate, clinical pregnancy rate and implantation rate in Group A, as compared Groups B and C, did not reach statistical significance, our results suggest that ICSI-ET treatment cycles be postponed for at least 10 weeks after laparoscopic tubal ligation for hydrosalpinx. A larger prospectively randomized study should be conducted to confirm the minimum delay period required for endometrial receptivity to recover

Intracytoplasmic sperm injection in male renal transplant recipients

Objective: In this study, we reviewed the reproductive outcomes following ICSI in 5 couples where the male partners had undergone renal transplantations. Chronic renal failure and dialysis may adversely affect male reproductive function resulting in severely depressed semen parameters or even azoospermia, which maybe further adversely affected by the immunosuppression taken from after transplantation. Study design: Case report. Setting: A private fertility clinic. Patients: The study included five infertile couples where the male partners were the recipients of renal transplants, 3–15 years prior to having ICSI treatment. All couples suffered from male factor infertility, with diagnoses of; azoospermia, asthenoteratozoospermia, oligoasthenoteratozoopsermia. Results: In the 5 case reports 5 ICSI and 3 FET treatment procedures were completed. In all but one of the cases grade 1 quality embryos were obtained and transferred. From the 8 embryo transfers performed 4 pregnancies were obtained, one miscarried at 8 weeks and 3 resulted in live births. Conclusions: In this study, we showed that pregnancy and normal live birth were possible following ICSI treatment for male factor infertility, where male partners had had renal transplants and were under immunosuppressive therapy

Risk of ovarian torsion is reduced in GnRH agonist triggered freeze-all cycles: a retrospective cohort study

Ovarian torsion (OT) in IVF is rare, however, the consequences are significant, which include ovariotomy. In the present study, it was aimed for the first time to compare the incidence of OT between hCG triggered cycles with ICSI and fresh transfer and GnRH-agonist triggered cycles with the ICSI-freeze-all and frozen embryo transfer (FET). In total, 15,577 ICSI cycles performed between 2001 and 2016 were categorised into two groups (Group 1, n: 9978): cycles with controlled ovarian stimulation (COS) and hCG-triggered (Group 2, n: 5599) and COS, with GnRH-agonist only triggered and freeze-all. Thirteen patients (0.13%) were diagnosed with OT and corrected by laparoscopy (12) and laparotomy (1) in Group 1. One patient (0.018%) was diagnosed with OT and corrected by laparotomy in Group 2 (Group 1 vs. Group 2, p = .049). The incidence of severe ovarian hyperstimulation syndrome (OHSS) was 2.4% in Group 1 and 0.05% in Group 2 (p < .001). The use of freeze-all with GnRH agonist trigger in ART significantly reduced the incidence of OT and concomitantly OHSS, with no effect on the reproductive outcome.Impact Statement What is already known on this subject? Adnexal ovarian torsion (OT) is a well-known gynaecological event that constitutes a surgical emergency. Assisted reproduction technologies (ART) may result in ovarian conditions that predispose patients to ovarian hyperstimulation syndrome (OHSS) and torsion. What the results of this study add? The combined use of GnRH agonist trigger for final oocyte maturation after OS with freeze-all and frozen embryo transfer (FET) significantly reduces the incidence of OT, as well as OHSS. What the implications are of these findings for clinical practice and/or further research? The treatment strategy of GnRH agonist trigger with freeze-all significantly reduces the risks of adverse complications

Increased body mass index associated with increased preterm delivery in frozen embryo transfers

The present study was performed to investigate whether maternal body mass index (BMI) affected the live birth (LB) outcomes of frozen embryo transfers (FET) in patients who underwent freeze-all treatment cycles. The autologous intracytoplasmic sperm injection (ICSI) cycles with blastocyst freeze-all cycles performed between February 2015 and January 2016 were retrospectively investigated. The 1188 subsequent FET performed were grouped according to maternal BMI classes for analysis; underweight (<18.5 kg/m2; 3.5%), normal-weight (18.5–24.9 kg/m2; 40.1%), overweight (25.0–29.9 kg/m2; 33.7%), or obese (classes I–III; ≥30.0 kg/m2; 22.8%). Uni- and multivariate analyses were performed, with LB as the primary outcome measure. In the categorical analyses of only the single blastocyst transfers (SBT), positive pregnancy (PP), LB and total pregnancy loss (totPL) rates were similar in the maternal BMI classes; however, the preterm delivery (PTD) rate in the obese class was significantly higher. In the multiple logistic regression models, maternal age was the most significant predictor of LB (OR = 0.9, 95%CI (0.90–0.98), p = .006) and the maternal BMI was the most significant predictor of PTD (OR = 1.1, 95% CI (1.02–1.14), p = .010). In conclusion, maternal BMI was the most significant variable in the outcome of PTD, with obese female patients at an increased risk of PTD.Impact statement What is known already? Obesity is rising worldwide to epidemic proportions and is expected to continue rising in the foreseeable future. Overweight and obesity not only increases the morbidity and mortality in the female populations but also significantly increases the risks of infertility in the women of reproductive age. Body mass index (BMI) has been the most widely used measure to describe the body weight of infertile patients. What do the results of this study add? Underweight, overweight and obesity do not significantly contribute to live birth outcomes. Maternal BMI was a significant predictor of PTD, with obesity most significantly at risk of PTD. What are the implications of these findings for clinical practice and/or further research? The evidence suggests that the weight management policy remain unchanged in IVF practice, with weight loss recommended for both young and ageing infertile patients. Performing a ‘therapeutic’ freeze-all IVF in the patients with weight-associated infertility may be a more suitable treatment strategy

Oocyte maturation-index as measure of oocyte cohort quality; a retrospective analysis of 3135 ICSI cycles

Objective: To investigate the use of an oocyte M-Index as a measure of the reproductive competence of oocyte cohorts collected following COS for ICSI. Design: A retrospective analysis of 3135 autologous ICSI cycles. Setting: A private IVF clinic. Materials and methods: Oocytes were denuded immediately after oocyte collection and the in vivo oocyte M-Index was calculated for the oocyte cohort collected (number of normal metaphase II oocytes per total number of normal oocytes collected). The measured outcomes were analyzed according to the M-Index (0–20%, 21–40%, 41–60%, 61–80%, and 81–100%) and female age (20–30, 31–40 years). Main outcomes: Clinical pregnancy. Results: 60,955 oocytes were collected from the 3135 ICSI cycles, 57,214 (93.9%) were normal and 39,364 (68.8%) of these were metaphase II oocytes. 71.6% of metaphase I oocytes reached nuclear maturity by the time of the ICSI procedure. Trend analyses of fertilization and clinical pregnancy to M-Index showed that fertilization increased significantly (p 40%. Conclusion: Our analysis shows that a simple maturation index calculated at the time of oocyte collection in a given ICSI cycle provides important prognostic information with regard to potential pregnancy outcomes and may reflect the importance of cytoplasmic maturation in oocyte competence

Six-month recovery needed after dilation and curettage (D and C) for reproductive outcomes in frozen embryo transfer

In this study, the endometrial developmental and reproductive outcomes of frozen embryo transfers (FETs) which were performed subsequent to miscarriages managed by dilation and curettage (D and C) were investigated. The intracytoplasmic sperm injection (ICSI) blastocyst freeze-all cycles performed between January 2014 and August 2016 were screened for the patients who had undergone their FET (first), miscarriages (>5 20 weeks) of FET (2nd) were analysed in two time-interval sub-groups: ≤6 months or >6 months. In the study and reference groups, the median endometrial thickness at the second FET of the ≤6 months sub-groups was found to be significantly reduced. The relative risk for LB was significantly higher (1.65 [0.994–2.723] p = .043) in the >6 months study sub-group, with a lower risk for PL (0.62 [0.268–1.427] p = .329), whereas, there were no significant differences between the reference sub-groups. The management of miscarriage with D and C results in a significant and transient decrease in reproductive function in subsequent FET.Impact Statement What is already known on this subject? Approximately, 15–30% of positive pregnancies in assisted reproductive technology (ART) end in biochemical pregnancy losses (PLs) or miscarriages. Cervical dilation with suction or blunt curettage (D and C), has been the procedure most often used to manage the retained products of conception (RPOC) after miscarriage. Intrauterine surgery has the potential to directly affect reproduction, depending on the endometrial impact. What the results of this study add? The endometrium after D and C surgery may require 6 months to recover normal reproductive function, in terms of both live birth and PL. The extent of the damage to endometrial function is not found to be reflected in the endometrial thickness. What the implications are of these findings for clinical practice and/or further research? Patients who undergo miscarriage after their ART treatment may need to delay further treatment for 6 months to optimise their chances of LB. Alternative miscarriage management procedures need to be investigated; procedures that have lower risks for an adverse reproductive function and allow for shorter time intervals between treatments

Dydrogesterone versus medroxyprogesterone acetate co-treatment ovarian stimulation for IVF: a matched cohort study of 236 freeze-all-IVF cycles

This matched cohort study was retrospectively performed, with cycles extracted from freeze-all-IVF treatments performed between March and November 2019, to compare the efficacy of flexible-start dydrogesterone (DYG) co-treatment ovarian stimulations (OS) with flexible-start medroxyprogesterone acetate (MPA) co-treatment OS. DYG cycles were matched 1:1 with MPA cycles using female age and antral follicle count, resulting in 236 matched cycles. OS durations and total FSH doses were similar in DYG and MPA OS cycles. The numbers of mature oocytes retrieved were similar; however, the mature oocyte retrieval rate was significantly lower (66.7 vs. 78.2%; p = .001) and the cycle cancellation rates were higher (29.2 vs. 21.2%; p = .056) in DYG co-treatments. A linear regression selected OS co-treatment protocol (0.53 DYG (0.356–0.776), p = .001) into the final model to predict a ≥ 80% mature oocyte retrieval rate. The per transfer (47.2 vs. 49.7; p = .721) and per treatment ongoing pregnancy rates (32.2 vs. 38.1%, p = .210) were similar in the two co-treatment groups. Flexible-start DYG co-treatment OS was as effective in blastocyst freeze-all-IVF cycles as MPA co-treatment, with similar ongoing pregnancy rates; however, mature oocyte retrieval was significantly decreased and cycle cancellation increased in DYG cycles.Impact statement What is already known on this subject? Progestin (i.e. artificial progesterone) co-treatment has long been known to be a feasible alternative to conventional GnRH-analogue co-treatment in OS for IVF, because of the long-standing evidence that progestin formulations have in oral contraceptive therapies. The recent evolution of effective freeze-all-IVF (in which high mid-cycle progesterone levels is not of concern because of the postponement of embryo transfer) has now made it possible to investigate progestin co-treatment OS in IVF. What do the results of this study add? Ongoing pregnancy rates from blastocyst frozen embryo transfers in flexible-start dydrogesterone (DYG) co-treatment ovarian stimulation (OS) cycles were similar to rates in flexible-start medroxyprogesterone acetate (MPA) co-treatment OS cycles. The mature oocyte retrieval rate was significantly lower and the cycle cancellation rate higher in DYG than in MPA cycles. What are the implications of these findings for clinical practice and/or further research? The evidence suggests that MPA co-treatment should be preferred in OS for IVF. Further investigation is required to refine progestin co-treatment protocols, because of their potential to reduce the number of viable blastocysts