A prospective study using Hatha Yoga for stress reduction among women waiting for IVF treatment.

Yoga has been found to be effective in treating anxiety and depression, reducing stress and improving the overall quality of life in the general population. Minimal research is available on the effect of stress-management programmes with IVF patients. Owing to the diversity of conditions treated, the poor quality of most studies, and the different assessment tools used to evaluate the psychological state, it is difficult to draw definite conclusions. Previous studies have used different mind-body interventions and general measures of stress without evaluation of specific stresses known to result from infertility and its treatment using standardized measures. In this single-centre study, 49 infertile women were recruited to participate in a 6-week Yoga class during 2013 while awaiting their IVF treatment. Study participants were asked to complete standardized questionnaires assessing fertility-related quality of life (FertiQoL), marital harmony (Dyadic Adjustment Scale [DAS]), state and trait anxiety (State-Trait Anxiety Inventory [STAI]) and depression (Beck Depression Inventory [BDI]) before commencing and after completing the Yoga workshops. Anxiety, depression and fertility-specific quality of life showed improvement over time in association with participation in a 6-week Yoga programme in women awaiting their treatment with IVF.

Live birth of twins after performing early hCG administration as a modification of natural cycle in vitro fertilization, in a women with decreased ovarian reserve.

PURPOSE: This case reports the first twin live births achieved in a woman with a serum FSH of such magnitude -80 IU/L, after following early hCG administration in natural cycle in vitro fertilization (IVF). METHOD: Case report. RESULTS: A 27-year-old with 2 years of primary infertility presented with regular menses since menarche. FSH following clomiphene citrate challenge test was 80 IU/L. Antral follicle count was 1. After failing two IVF cycles, natural cycle IVF with early hCG administration was attempted. Ovulation with 10,000 IU hCG was triggered when the dominant follicle was 10 mm in mean diameter. Two smaller follicles were also present. Oocyte collection was performed 38 h after hCG injection. Three mature oocytes were retrieved. Two oocytes fertilized normally. Two good-quality embryos were transferred on day 2. Bichorionic biamniotic pregnancy was achieved and healthy twins were delivered at term. CONCLUSIONS: This case suggests that natural cycles with early hCG administration should be investigated further as an option for poor responders to retrieve more than one mature oocyte, and prevent premature ovulation. We believe this case to represent the patient with the highest serum FSH level, reflective of ovarian reserve at the time of treatment, to achieve a live birth. It is also the first case report to describe this modification on the traditional natural cycle.

Extended embryo culture is not associated with increased adverse obstetric or perinatal outcome.

OBJECTIVE: We sought to compare obstetric and perinatal outcomes of singletons born after extended embryo culture and a single blastocyst stage embryo vs a single cleavage stage embryo transfer. STUDY DESIGN: This was a retrospective cohort study of 1543 fresh single embryo transfers using nondonor oocytes in women ≤40 years old from December 2008 through December 2012 at the reproductive unit of McGill University Health Center. The main outcome measures were perinatal outcomes including birthweight, low birthweight, small for gestational age, preterm delivery, preeclampsia, placental abruption, and neonatal complications. Covariates were maternal age, body mass index, smoking, cause of infertility, parity, and sex of the baby. RESULTS: Transfers of 693 fresh single cleavage embryos and 850 fresh single blastocysts resulting in 564 pregnancies and 381 singleton deliveries were analyzed. Blastocyst transfer resulted in a higher clinical pregnancy rate (50.1% and 19.9%) and live birth rate (33.5% and 13.8%) compared to cleavage embryo transfer, respectively (P < .001). Multivariate analyses for pregnancy revealed no increased risk of maternal or neonatal complications in pregnancies resulting from extended embryo culture. CONCLUSION: Live births resulting from extended embryo culture and a single blastocyst transfer are not associated with increased adverse obstetric and perinatal outcome compared to live births from a single cleavage embryo transfer in women ≤40 years old.

Age-related normogram for antral follicle count in women with polycystic ovary syndrome.

Antral follicle count (AFC) has been shown to be a reliable marker for ovarian reserve. The aims of this study were to create an age-related normogram for AFC in infertile women with polycystic ovary syndrome (PCOS) and to compare age-related decline in AFC between infertile women with and without PCOS. A retrospective cohort study was conducted. Of a total of 4956 women, 619 women fit criteria for PCOS. In those with PCOS, there were large variations in the AFC between the 10th and 90th percentiles in all age groups. The rate of decline in AFC among women with PCOS was linear, while in those with non-PCOS, it was exponential until 30 years of age, and then became similar to that of PCOS. The rate of follicle loss per year was significantly slower in PCOS women compared with that in non-PCOS women. In both groups, the fastest period of follicle loss was between the ages of 18 and 30. The average follicle loss was 0.8 follicles/year in PCOS women and 1.7 follicles/year in those without PCOS (P<0.001). This study concludes that age-related decline in AFC among women with PCOS is slower than in those without PCOS. Antral follicle count (AFC) has been shown to be a reliable marker for ovarian reserve. The aims of this study were to create an age-related normogram for AFC in women with polycystic ovary syndrome (PCOS), and to compare age-related decline in AFC between women with and without PCOS. A retrospective cohort study was conducted. All patients underwent a baseline transvaginal ultrasound that was performed on day 2-4 of the menstrual cycle. The total number of antral follicles of 2-9mm in diameter was recorded. Of total 4956 women, 619 women fit criteria for PCOS. In those with PCOS, there were large variations in the AFC between the 10th 90th percentiles in all age groups. The rate of decline in AFC among women with PCOS was linear; while in those with non-PCOS, it was exponential until 30 years of age, and then became similar to that of PCOS. The rate of follicle loss per year was significantly slower in PCOS women compared with that in non-PCOS women. In both groups, the fastest period of follicle loss was between the ages 18-30 years. The average follicle loss was 0.8 follicles/year in PCOS women and 1.7 follicles/year in those without PCOS (P<0.001). We have concluded that age-related decline in AFC among women with PCOS is slower than in those without PCOS. Further studies are needed to determine if the AFC normogram in women with PCOS could be clinically relevant to select the optimal gonadotrophin dose for ovulation induction.