Projecting the potential impact of the Cap-Score™ on Clinical Pregnancy, Live Births, and Medical Costs in Couples with Unexplained Infertility.

Purpose The Cap-Score™ was developed to assess the capacitation status of men, thereby enabling personalized management of unexplained infertility by choosing timed intrauterine insemination (IUI), versus immediate in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) in individuals with a low Cap-Score™. The objective of this study was to estimate the differences in outcomes and costs comparing the use of the Cap-Score™ with timed IUI (CS-TI) and the standard of care (SOC), which was assumed to be three IUI cycles followed by three IVF-ICSI cycles. Methods We developed and parameterized a decision-analytic model of management of unexplained infertility for women based on data from the published literature. We calculated the clinical pregnancy rates, live birth rates, and medical costs comparing CS-TI and SOC. We used Monte Carlo simulation to quantify uncertainty in projected estimates and performed univariate sensitivity analysis. Results Compared to SOC, CS-TI was projected to increase the pregnancy rate by 1–26%, marginally reduce live birth rates by 1–3% in couples with women below 40 years, increase live birth rates by 3–7% in couples with women over 40 years, reduce mean medical costs by $4000–$19,200, reduce IUI costs by $600–$1370, and reduce IVF costs by $3400–$17,800, depending on the woman’s age. Conclusion The Cap-Score™ is a potentially valuable clinical tool for management of unexplained infertility because it is projected to improve clinical pregnancy rates, save money, and, depending on the price of the test, increase access to treatment for infertility

Modern management of thin lining

Objective: To define “thin” endometrium in fertility treatment, and to critically explore the available treatment options. Design: A review of the scientific literature. Setting: N/A. Methods: An electronic literature search pertaining to patients with “thin” endometrium undergoing fertility treatment was performed through April 2016. Results: Adequate endometrial growth is an integral step in endometrial receptivity and embryo implantation. Whether idiopathic or resulting from an underlying pathology, a thin endometrium of <7 mm is linked to a lower probability of pregnancy; however, no reported thickness excludes the occurrence of pregnancy. Several treatment modalities have been studied and include extended estrogen, gonadotropin therapy, low-dose hCG, tamoxifen, pentoxifylline, tocopherol, l-arginine, low-dose aspirin, vaginal sildenafil, acupuncture and neuromuscular electric stimulation, intrauterine G-CSF, and stem cell therapy. All treatment modalities except vaginal sildenafil, intrauterine GCF, and stem cell therapy were inconsistent in showing significant improvement in pregnancy rates. Early results of stem cell therapy trials seem promising. Conclusions: EMT <7 mm is associated with lower probability of pregnancy in ART. Vaginal sildenafil appears to be a reasonable first line therapy option, and G-CSF appears to be a potential second option, while stem cell therapy seems to be a promising new treatment modality

Is there a role for DHEA supplementation in women with diminished ovarian reserve?

PURPOSE: Poor ovarian reserve and poor ovarian response presents a challenge to IVF centers. Dehydroepiandrosterone (DHEA) supplementation is increasingly being used by many IVF centers around the world in poor responders despite the lack of convincing data. We therefore examined the rationale for the use of DHEA in poor responders, address the relevant studies, present new data, and address its potential mechanisms of action. METHODS: All published articles on the role of DHEA in infertile women from 1990 to April 2013 were reviewed. RESULTS: Several studies have suggested an improvement in pregnancy rates with the use of DHEA. Potential mechanisms include improved follicular steroidogenesis, increased IGF-1, acting as a pre-hormone for follicular testosterone, reducing aneuploidy, and increasing AMH and antral follicle count. While the role of DHEA is intriguing, evidence-based recommendations are lacking. CONCLUSIONS: While nearly 25 % of IVF programs use DHEA currently, large randomized prospective trials are sorely needed. Until (and if) such trials are conducted, DHEA may be of benefit in suitable, well informed, and consented women with diminished ovarian reserve

Racial differences in ART outcome between white and South Asian women

Objective: Racial differences in ART outcome have been previously reported in white compared to ethnic minorities, with larger studies showing better ART outcome in white compared with all the minority groups. Only one study assessed the outcome differences between whites and South Asians in the US, which showed a poorer outcome in South Asians despite similar embryo quality. Design: Retrospective. Patient(s): 238 Cycles in white women compared to 54 cycles in South Asians undergoing blastocyst transfers at a single private ART center. Intervention(s): None. Main outcome measure(s): Age, FSH, number of retrieved oocytes, IR, clinical PR and live birth rates. Results: South Asians were younger than white women, had lower basal FSH level, had a higher incidence of PCOS, but had equivalent gonadotropin use, # retrieved oocytes, #ET, IR, clinical PR, and live birth rates. Conclusions: Contrary to previous studies, we found no differences in ART outcome between white and South Asian women undergoing RT, despite the significantly younger age group and lower basal FSH in the South Asian population. Larger studies are needed to confirm our findings

Current Advancements in Noninvasive Profiling of the Embryo Culture Media Secretome

There have been over 8 million babies born through in vitro fertilization (IVF) and this number continues to grow. There is a global trend to perform elective single embryo transfers, avoiding risks associated with multiple pregnancies. It is therefore important to understand where current research of noninvasive testing for embryos stands, and what are the most promising techniques currently used. Furthermore, it is important to identify the potential to translate research and development into clinically applicable methods that ultimately improve live birth and reduce time to pregnancy. The current focus in the field of human reproductive medicine is to develop a more rapid, quantitative, and noninvasive test. Some of the most promising fields of research for noninvasive assays comprise cell-free DNA analysis, microscopy techniques coupled with artificial intelligence (AI) and omics analysis of the spent blastocyst media. High-throughput proteomics and metabolomics technologies are valuable tools for noninvasive embryo analysis. The biggest advantages of such technology are that it can differentiate between the embryos that appear morphologically identical and has the potential to identify the ploidy status noninvasively prior to transfer in a fresh cycle or before vitrification for a later frozen embryo transfer

Platelet-rich plasma: inconclusive evidence of reproductive outcomes in menopausal women

PURPOSE: The use of platelet-rich plasma is being investigated in reproductive medicine and clinically promoted as a fertility treatment for menopause. We aimed to review the literature on the impact of PRP on fertility in menopause. METHODS: A literature search was performed using the PubMed and MEDLINE search engines. The search was limited to the English language. Articles studying PRP use in menopause were selected for the purpose of this review. RESULTS: Limited case reports and case series studied fertility outcomes of PRP in menopause. Randomized controlled trials are lacking. Furthermore, no studies have been conducted to evaluate the effect of different PRP concentrations, injection techniques, or side effects on reproductive outcomes in menopausal women. CONCLUSION: There is a dearth of data to support the routine implementation of intraovarian PRP injections for fertility restoration in menopausal women. Patients considering such therapy need to be well aware of the lack of adequate data for PRP use in menopause and should be counseled accordingly

The Disparities in ART (DART) Hypothesis of Racial and Ethnic Disparities in Access and Outcomes of IVF Treatment in the USA

We propose the Disparities in ART (DART) hypothesis which identifies underlining causes that contribute to racial disparities in access and outcomes of ART treatment in the USA. Reasons for disparities in access and outcomes of ART treatment for infertility are derived from some relative contribution of four identified causes. They are simply stated as delays in obtaining treatment, higher dropout during and following unsuccessful ART treatment, provider factors, and differences in patient biological factors. Each of these causes has a subset of 4-6 factors that contribute to each of the 4 broad categorical causes that are discussed. This hypothesis may serve as a platform for better understanding the scope of the challenges and potential research inquiries that may lead to narrowing of racial/ethnic disparities in access and outcomes in ART