A picture of medically assisted reproduction activities during the COVID-19 pandemic in Europe

STUDY QUESTION: How did coronavirus disease 2019 (COVID-19) impact on medically assisted reproduction (MAR) services in Europe during the COVID-19 pandemic (March to May 2020)? SUMMARY ANSWER: MAR services, and hence treatments for infertile couples, were stopped in most European countries for a mean of 7 weeks. WHAT IS KNOWN ALREADY: With the outbreak of COVID-19 in Europe, non-urgent medical care was reduced by local authorities to preserve health resources and maintain social distancing. Furthermore, ESHRE and other societies recommended to postpone ART pregnancies as of 14 March 2020. STUDY DESIGN, SIZE, DURATION: A structured questionnaire was distributed in April among the ESHRE Committee of National Representatives, followed by further information collection through email. PARTICIPANTS/MATERIALS, SETTING, METHODS: The information was collected through the questionnaire and afterwards summarised and aligned with data from the European Centre for Disease Control on the number of COVID-19 cases per country. MAIN RESULTS AND THE ROLE OF CHANCE: By aligning the data for each country with respective epidemiological data, we show a large variation in the time and the phase in the epidemic in the curve when MAR/ART treatments were suspended and restarted. Similarly, the duration of interruption varied. Fertility preservation treatments and patient supportive care for patients remained available during the pandemic. LARGE SCALE DATA: N/A. LIMITATIONS, REASONS FOR CAUTION: Data collection was prone to misinterpretation of the questions and replies, and required further follow-up to check the accuracy. Some representatives reported that they, themselves, were not always aware of the situation throughout the country or reported difficulties with providing single generalised replies, for instance when there were regional differences within their country. WIDER IMPLICATIONS OF THE FINDINGS: The current article provides a basis for further research of the different strategies developed in response to the COVID-19 crisis. Such conclusions will be invaluable for health authorities and healthcare professionals with respect to future similar situations.peer-reviewe

Live Birth Rates in Various Subgroups of Poor Ovarian Responders Fulfilling the Bologna Criteria

The European Society of Human Reproduction and Embryology published Bologna criteria to generate a definition of poor ovarian responders IPORsI. However, there are few data on whether PORs are homogenous for ovarian response or live birth rates ILBRsI. In this retrospective study, 821 patients fulfilling Bologna criteria and undergoing intracytoplasmic sperm injection were stratified into four groups: Group A: female age >= 40 with a previous poor response [cycle cancelled or oocytesl (105 patients, 123 cycles); Group B: female age >= 40 with an antral follicle count IAFCI = 40 with an AFC <7 and previous poor response (207 patients, 30b cycles). Cluster data analysis was performed. Although median number of oocytes was higher in Group B (P< 0.001), higher implantation (P = 0.024) and LBR per embryo transfer (P < 0.001) or cycle (P = 0.001) were noted in Group C. We conclude that, once a patient fulfils Bologna criteria, prognosis is poor, with fewer than 10% recorded LBRs per cycle. However, the LBRs are not homogenous and 'young proven' PORs have the most favourable pregnancy outcome. (C) 2017 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.WoSScopu

Preparation of Endometrium for Frozen Embryo Replacement Cycles: A Systematic Review and Meta-Analysis

The purpose of this study was to evaluate the best protocol to prepare endometrium for frozen embryo replacement (FER) cycles. This study is a systematic review and meta-analysis. Following PubMed and OvidSP search, a total of 1166 studies published after 1990 were identified following removal of duplicates. Following exclusion of studies not matching our inclusion criteria, a total of 33 studies were analyzed. Primary outcome measure was live birth. The following protocols, including true natural cycle (tNC), modified natural cycle (mNC), artificial cycle (AC) with or without suppression, and mild ovarian stimulation (OS) with gonadotropin (Gn) or aromatase inhibitor (AI), were compared. No statistically significant difference for both clinical pregnancy and live birth was noted between tNC and mNC groups. When tNC and AC without suppression groups are compared, there was a statistically significant difference in clinical pregnancy rate in favor of tNC, whereas it failed to reach statistical significance for live birth. When tNC and AC with suppression groups are compared, there was a statistically significant difference in live birth rate favoring the latter. Similar pregnancy outcome was noted among mNC versus AC with or without suppression groups. Similarly, no difference in clinical pregnancy and live birth was noted when ACs with or without suppression groups are compared. There is no consistent superiority of any endometrial preparation for FER. However, mNC has several advantages (being patient-friendly; yielding at least equivalent or better pregnancy rates when compared with tNC and AC with or without suppression; may not require LPS). Mild OS with Gn or AI may be promising.Wo

Assessment of Endocervical and Endometrial Damage Inflicted By Embryo Transfer Trial: A Hysteroscopic Evaluation

The aim was to assess the endocervical and endometrial damage inflicted by embryo transfer trial using office hysteroscopy. Seventy-five consecutive infertile women who underwent office hysteroscopy were enrolled. Hysteroscopy was performed immediately after embryo transfer trial. The relationship between clinical perception of easiness of transfer, presence of blood on the catheter, degree of endocervical and endometrial damage was examined. In the difficult transfer group, minor and moderate endocervical lesions were noted in 35% and 24% of the cases, respectively. The respective figures for the easy transfer group were 19% and 3% (P >.05). There was a statistically significant concordance between the perceived difficulty of transfer and degree of endometrial damage (P < 0.05). Of interest, in the easy transfer group, 32% of the patients had minor, 3% moderate and 65% no endometrial damage. The respective figures were 42%, 29% and 29% in the difficult transfer group. There was blood on the catheter in 25%, 56% and 71% of the easy, moderate and difficult transfer groups, respectively. There was a statistically significant concordance between the perceived difficulty of embryo transfer and presence of blood on the catheter (P < 0.05). These results suggest that clinical perception of difficulty of transfer and the presence of blood on the catheter are directly associated with endometrial disruption.WoSScopu

The true natural cycle frozen embryo transfer - impact of patient and follicular phase characteristics on serum progesterone levels one day prior to warmed blastocyst transfer

Abstract Background In a true-natural cycle (t-NC), optimal progesterone (P4) output from the corpus luteum is crucial for establishing and maintaining an intrauterine pregnancy. In a previous retrospective study, low P4 levels ( 17 IU/L) and increased serum P4 (> 1.5 ng/mL). FET was scheduled on follicular collapse + 5 or LH surge + 6 in LUF cycles. Primary outcome was serum P4 on FET − 1. Results Among the 178 patients, 86% (n = 153) experienced follicular collapse, while 14% (n = 25) had LUF. On FET-1, the median serum luteal P4 level was 12.9 ng/mL (IQR: 9.3–17.2), ranging from 1.8 to 34.4 ng/mL. Linear stepwise regression revealed a negative correlation between body mass index (BMI) and LUF, and a positive correlation between follicular phase peak-E2 and peak-P4 levels with P4 levels on FET-1. The ROC curve analyses to predict < 9.3 ng/mL (< 25th percentile) P4 levels on FET-1 day showed AUC of 0.70 (95%CI 0.61–0.79) for BMI (cut-off: 23.85 kg/m2), 0.71 (95%CI 0.61–0.80) for follicular phase peak-P4 levels (cut-off: 0.87 ng/mL), and 0.68 (95%CI 0.59–0.77) for follicular phase peak-E2 levels (cut-off: 290.5 pg/mL). Combining all four independent parameters yielded an AUC of 0.80 (95%CI 0.72–0.88). The adjusted-odds ratio for having < 9.3 ng/mL P4 levels on FET-1 day for patients with LUF compared to those with follicle collapse was 4.97 (95%CI 1.66–14.94). Conclusion The BMI, LUF, peak-E2, and peak-P4 levels are independent predictors of low serum P4 levels on FET-1 (< 25th percentile; <9.3 ng/ml) in t-NC FET cycles. Recognition of risk factors for low serum P4 on FET-1 may permit a personalized approach for LPS in t-NC FET to maximize reproductive outcomes

Endometrioma <= 3 Cm In Diameter Per Se Does Not Affect Ovarian Reserve In Intracytoplasmic Sperm Injection Cycles

Background: Our aim was to determine the effect of single endometriomas <= 3 cm in diameter per se on ovarian reserve in intracytoplasmic sperm injection (ICSI) cycles. Methods: We enrolled 19 consecutive infertile patients (29 cycles) who had unilateral single endometriomas <= 3 cm in diameter and who underwent ICSI. Results: The mean age of the patients was 33.3 +/- 8 4.9 years. The mean diameter of endometriomas was 21.8 +/- 8 4.9 mm. Left-and right-sided endometriomas were 34.5 and 65.5%, respectively. The number of oocytes retrieved from ovaries with endometriomas and contralateral normal ovaries was comparable (5.9 +/- 8 4.3 vs. 5.4 +/- 8 3.8). Conclusion: Endometriomas <= 3 cm in diameter per se did not have a deleterious effect on ovarian reserve in ICSI cycles. Copyright (C) 2012 S. Karger AG, BaselWoSScopu