The predictability of serum anti-Müllerian level in IVF/ICSI outcomes for patients of advanced reproductive age

<p>Abstract</p> <p>Background</p> <p>The role of serum anti-Müllerian hormone (AMH) as predictor of in-vitro fertilization outcomes has been much debated. The aim of the present study is to investigate the practicability of combining serum AMH level with biological age as a simple screening method for counseling IVF candidates of advanced reproductive age with potential poor outcomes prior to treatment initiation.</p> <p>Methods</p> <p>A total of 1,538 reference patients and 116 infertile patients aged greater than or equal to 40 years enrolled in IVF/ICSI cycles were recruited in this retrospective analysis. A reference chart of the age-related distribution of serum AMH level for Asian population was first created. IVF/ICSI patients aged greater than or equal to 40 years were then divided into three groups according to the low, middle and high tertiles the serum AMH tertiles derived from the reference population of matching age. The cycle outcomes were analyzed and compared among each individual group.</p> <p>Results</p> <p>For reference subjects aged greater than or equal to 40 years, the serum AMH of the low, middle and high tertiles were equal or lesser than 0.48, 0.49-1.22 and equal or greater than 1.23 ng/mL respectively. IVF/ICSI patients aged greater than or equal to 40 years with AMH levels in the low tertile had the highest cycle cancellation rate (47.6%) with zero clinical pregnancy. The nadir AMH level that has achieved live birth was 0.56 ng/mL, which was equivalent to the 36.4th percentile of AMH level from the age-matched reference group. The optimum cut-off levels of AMH for the prediction of nonpregnancy and cycle cancellation were 1.05 and 0.68 ng/mL, respectively.</p> <p>Conclusions</p> <p>Two criteria: (1) age greater than or equal to 40 years and (2) serum AMH level in the lowest tertile (equal or lesser than 33.3rd percentile) of the matching age group, may be used as markers of futility for counseling IVF/ICSI candidates.</p

Genetically engineered mouse models for the study of follistatin biology

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Early blastulation (EB) of day 4 embryo is predictive of outcomes in single embryo transfer (SET) cycles

Objective: The aim of this study was to assess whether the early blastulation (EB) of day 4 embryo is a useful predictor for outcomes in fresh elective single embryo transfer (eSET) cycles. Materials and methods: We retrospectively enrolled patients undergoing fresh SET cycles in our hospital from April 2014 to September 2016 and met with the following criteria: 1) age <38 years, 2) first IVF/ICSI cycle, 3) at least two blastocysts with morphological grading better than or equal to 4BB. Results: A total of 81 patients were included. Of whom, 55 patients (68%) had undergone eSET with embryos that had early blastulation on day 4 while the other 26 patients had had no EB. Early blastulation has shown a higher rate of good blastocyst (84.3% vs. 60.5%, p < 0.0001). The clinical pregnancy rate of EB group was significantly higher than that of non-EB group (56.4% vs. 27.0%, p = 0.013). There is also a tendency in EB group to have a lower abortion rate (3.23% vs. 28.6%, p = 0.081). Conclusions: EB on day 4 is a useful predictor of the quality of the following embryos (i.e. day 5 embryo). It is a simple tool in selecting the best embryo to get a higher pregnancy rate in fresh eSET cycles.Trial registration: This study was supplementally registered by the MacKay Memorial Hospital Institutional Review Board on April 18, 2017 (registration No. 17MMHIS039e). Keywords: Early blastulation, Single-embryo transfer, Blastocyst morphology, Clinical pregnanc

#202 : Adverse Effect on Pregnancy Outcome of Oocyte Preservation in Women with Advanced Maternal Age

Background and Aims: For women facing inevitable fertility decline, oocyte freezing is an effective method for fertility preservation. However, few studies discussed the pregnancy potential from autologous freezing oocytes. Thus, this study characterizes the realistic outcomes of advanced maternal age patients who underwent oocyte thawing. Method: In this retrospective cohort study, the selected 694 patients underwent oocyte freezing cycles (n=1,163) and oocyte thawing cycles (n=218) from Mar 2020 to Mar 2022 at our fertility center. All oocytes thaw cycles from Mar 2020 to Mar 2022 at TFC clinic, including social egg freezing (SEF) and egg collection (EC). Parameters for IVF laboratory outcome and pregnancy outcome were recorded, and statistics were analyzed with Chi-square. Results: Those patients who underwent egg freezing at average age for 40.2 years old, and 49.7% were over 37 years old. Secondly, the survival rate of oocyte thawing was 94.9% in patients under 38 years old, 93.7% were 38-40 years old, and 91.4% for patients over 41 years old. For patients under 38 years old, 72.2% of were conceived for thawing cycle. For advanced maternal age groups, 46.7% for patients in 38-40 years old group, and only 23.3% of patients over 41 years old were conceived. The live birth rate declines as the age increases, which were 55.6%, 33.3%, and 7.1% in different age groups. Conclusion: In this study, we found the survival rate of oocytes and blastulation of embryo showed no significant difference between different age groups. Clinical pregnancy outcome demonstrated a dramatic decline in patients aged over 41 years old compared with other groups. Therefore, these data suggested that oocyte collection strategy is more suitable for patients who are under 41 years old

#41 : The Effectiveness of GnRH Agonist Administration Prior to Frozen-Thawed Embryo Transfer with Artificial Cycle: A Systematic Review and Meta-Analysis of Different Protocols and Infertile Populations

Background and Aims: We investigated the use of GnRHa pretreatment with different protocols and durations of treatment on pregnancy outcomes in women undergoing FET with artificial cycles (AC-FET). Method: A systematic search of PubMed, EMBASE, Google Scholar, and Cochrane library was performed to include only eligible peer-reviewed studies in English published before September 01, 2022. This review was registered on PROSPERO (CRD42022299259) Results: A total of 41 studies (43021 individuals) were included with low to moderate risk of bias. Overall, GnRHa pretreatment improved clinical pregnancy rate (CPR) (OR=1.27, 95%CI:1.12-1.44), implantation rate (IR) (OR=1.24, 95%CI:1.07-1.45), live birth rate (LBR) (OR=1.31, 95%CI:1.07-1.60) and endometrial thickness (MD=0.16, 95%CI:0.03-0.30). Subgroup analyses of randomized and non-randomized studies both demonstrated the benefits of GnRHa pretreatment in CPR, IR, and LBR. Protocols using depot GnRHa (OR=1.19, 95%CI:1.04-1.36) showed a better LBR than daily GnRHa (OR=1.04, 95%CI:0.93-1.16). Women administered GnRHa for more than one cycle had better CPR (OR=2.01, 95%CI:1.29-3.13) and IR (OR=2.14, 95%CI:0.98-4.67) than those treated with GnRHa within one cycle before FET ([OR=1.18, 95%CI:1.04-1.33] and [OR=1.16, 95%CI:1.01-1.32], respectively). In women with PCOS, pituitary suppression with GnRHa significantly improved CPR (OR=1.24, 95%CI:0.98-4.67), LBR (OR=1.22, 95%CI:1.05-1.42) and reduced the miscarriage rate (OR=0.75, 95%CI:0.59-0.95). In contrast, women with regular menstruation had a higher endometrial thickness (MD=0.16, 95%CI: 0.04-0.28) but no significant improvements in pregnancy outcomes. GnRHa pretreatment considerably improved IR (OR=2.21, 95%CI:1.60-3.07) in women with adenomyosis and CPR (OR=1.74, 95%CI:1.12-2.71), and LBR (OR=1.67, 95%CI:1.06-2.63) in women with endometriosis. Conclusion: GnRHa pretreatment, especially with longer suppression duration and the use of depot GnRHa, demonstrates a beneficial role during AC-FET cycles. Individuals with PCOS benefit from GnRHa pretreatment, though this FET protocol should be carefully considered in ovulatory women with regular menstruation. Albeit having the potential, effectiveness of this protocol on adenomyosis or endometriosis remains controversial and requires more rigorous investigatio

#201 : Comparison of the Sensitivity of Detecting Cervical Bacteria with Next Generation Sequencing and Third Generation Sequencing Technologies

Background and Aims: In in vitro fertilization (IVF) cycles, some patients suffering with vaginosis showed poor reproductive outcome even transferring with good quality embryos. The aim of this pilot study was to evaluate whether the species of Lactobacillus could be detected by next generation sequencing (NGS) and Third generation sequencing (TGS). Method: 18 Patients aged 32–48 years-old who visited our fertility center from February 2021 to June 2022 with previous failure of transfer cycle were included. Exclusion criteria was antibiotic treatment within 3 months prior to enrolment. Genomic DNA of cervical microbiota taken from Cervico vaginal swabs in all patients were extracted and amplified. NGS was performed following the protocol of Ion 16S Metagenomics Kit by detecting V2–4–8 and V3–6, 7–9 regions of 16S. Amplicons were sequenced with Ion GeneStudio S5 Prime System. For TGS, full length of 16S was sequenced with Single Molecule, Real-Time (SMRT) Sequencing (Pacific Biosciences) and analyzed. Results: All of the 18 cervical samples could be amplified with V2–4–8 and V3–6, 7–9 primers and the genus could be 100% identified by NGS. However, most of the Lactobacillus includes L. crispatus, L. jensenii. and L. gasseri showed indistinguishable except of L. iners. On the other hand, TGS clearly identified all Lactobacillus. For Gardnerella, Atopobium and Prevotella, TGS and NGS showed equivalent sensitivity in genus level. However, due to the sequence similarity, Escherichia/Shigella could not be identified from the Lactobacillus. Conclusion: In this report, we aim to compare the sensitivity of detecting bacteria by 16S amplification method. Preliminary results suggest that NGS can distinguish bacterium causes vaginosis in genus level, but there might be misleading if the existence of pathogen such as Escherichia/Shigella. Till now, TGS still exhibits the best sensitivity for distinguish Lactobacillus in species level