On the role of artificial intelligence in analysing oocytes during in vitro fertilisation procedures.

Nowadays, the most adopted technique to address infertility problems is in vitro fertilisation (IVF). However, its success rate is limited, and the associated procedures, known as assisted reproduction technology (ART), suffer from a lack of objectivity at the laboratory level and in clinical practice. This paper deals with applications of Artificial Intelligence (AI) techniques to IVF procedures. Artificial intelligence is considered a promising tool for ascertaining the quality of embryos, a critical step in IVF. Since the oocyte quality influences the final embryo quality, we present a systematic review of the literature on AI-based techniques used to assess oocyte quality; we analyse its results and discuss several promising research directions. In particular, we highlight how AI-based techniques can support the IVF process and examine their current applications as presented in the literature. Then, we discuss the challenges research must face in fully deploying AI-based solutions in current medical practice. Among them, the availability of high-quality data sets as well as standardised imaging protocols and data formats, the use of physics-informed simulation and machine learning techniques, the study of informative, descriptive yet observable features, and, above all, studies of the quality of oocytes and embryos, specifically about their live birth potential. An improved understanding of determinants for oocyte quality can improve success rates while reducing costs, risks for long-term embryo cultures, and bioethical concerns.

A Novel Homozygous Missense ZP1 Variant Result in Human Female Empty Follicle Syndrome.

Empty follicle syndrome (EFS) is a disorder characterised by the unsuccessful retrieval of oocytes from matured follicles following ovarian stimulation for in vitro fertilisation (IVF). Genetic factors significantly contribute to this pathology. To date, an increasing number of genetic mutations associated with GEFS have been documented, however, some cases still remain unexplained by these previously reported mutations. Here, we identified a novel homozygous missense ZP1 variant (c.1096 C > T, p.Arg366Trp) in a female patient with GEFS from a consanguineous family who failed to retrieve any oocytes during two cycles of IVF treatment. We conducted a molecular dynamics simulation analysis on the mutant ZP1 model, revealing that the mutant ZP1 protein has an altered 3D structure, lower fluctuation, higher compactness and higher instability than wild-type ZP1. Immunostaining, immunoblotting and co-immunoprecipitation results showed that the homozygous missense mutation in ZP1 impaired protein secretion and weakened interactions between ZP1 and other ZP proteins, which may affect the ZP assembly. This study contributes to a more comprehensive understanding of the genetic aetiopathogenesis of GEFS.

Inequity in Fertility Treatment for Patients that Speak a Language Other than English: A Retrospective Cohort Study.

OBJECTIVE: To assess fertility treatment outcomes according to primary language spoken in patients undergoing fertility treatment in an Australian setting. METHODS: This retrospective cohort study examined female patients who received fertility treatment through a public hospital fertility service between September 2020 and May 2023. The primary outcome was clinical pregnancy rate following embryo transfer for patients who spoke English and patients who primarily spoke a language other than English. Poisson regression was used to estimate the association between language spoken and clinical pregnancy rate. Secondary outcomes included rate of other pregnancy outcomes following embryo transfer, number of fertility treatments performed, embryo quality, IVF cancellation rate, discontinuation rate, and time from first fertility appointment to treatment commencement. RESULTS: Of the 916 patients who accessed fertility treatment during the study period, 112 patients (12.23%) primarily spoke a language other than English. There were no significant differences in clinical pregnancy rate following embryo transfer (IRR 0.92, 95% CI 0.60-1.36), or rates of biochemical pregnancy, miscarriage, or negative pregnancy. However, patients who spoke a language other than English received significantly fewer IVF cycles (1.29 ± 0.61 vs 1.63 ± 1.16 cycles, p = 0.006), greater all-cause IVF cancellation rate (41.33% vs 28.33%, p = 0.048), and longer median time from first appointment to first treatment of any type (341 vs 234.5 days, p < 0.001). CONCLUSION: Inequity in all-cause IVF cancellation rate, mean number of IVF cycles, and duration from first fertility appointment to treatment commencement were observed for patients who spoke a language other than English.

How do BMI-restrictive policies impact women seeking NHS-funded IVF in the United Kingdom? A qualitative analysis of online forum discussions.

BACKGROUND: Across the United Kingdom's National Health Service (NHS), women with a Body Mass Index (BMI) of > 30 face restrictions accessing In Vitro Fertilisation (IVF) treatment. This study asks: what are the (un)expected and (un)intended harms and consequences experienced by women restricted from accessing NHS-funded IVF due to BMI threshold criteria? METHODS: Posts from a popular infertility online forum were collected and reflexively thematically analysed. RESULTS: On the forum, users discussed how they struggled to lose weight, how they faced time pressures to meet BMI thresholds, and they shared knowledge on how to comply or appear compliant with BMI cut-offs. Our study found widespread moral discourses around body weight were reproduced in the forum, particularly commonplace narratives that body weight is under personal control, that people with a high BMI should 'work' to change their bodies, and that this work helps demonstrate deservingness for IVF treatment. Moralising discourses around weight were linked to the responsibilities of a hoped-for future of motherhood, as users performed deservingness through emphasising their commitment to meeting the BMI threshold. CONCLUSION: We conclude that NHS-IVF policies in the United Kingdom do not consider the burdensome emotional and moral work placed on people seeking treatment due to inflexible upper-limit BMI criteria.

In the United Kingdom, people can access public funding for In Vitro Fertilisation (IVF) treatment if certain criteria are met. Funding restrictions differ between geographical areas, but most areas restrict treatment to women with a Body Mass Index (BMI) below 30. This study explores the unexpected and unintended harms experienced by women restricted from NHS-funded IVF due to these BMI criteria. Posts from a popular infertility online forum were collected and thematically analysed. The study found moralising discourses around body weight which emphasized that women had personal control over their bodies and needed to 'work' to change their bodies to show deservingness for treatment. We conclude that NHS-IVF policies in the UK overlook the emotional and moral burdens placed on individuals due to rigid BMI criteria. As the impact of BMI limits on healthcare access is an under-researched topic, we believe this work is important for demonstrating the harms of BMI-restrictive policies.

Neurodevelopmental or behavioural disorders in children conceived after assisted reproductive technologies: A nationwide cohort study.

OBJECTIVE: To study differences in risk for drug-treated neurodevelopmental or behavioural disorders in children conceived through assisted reproductive technologies in comparison with children conceived without assisted reproductive technologies and to examine if different treatments alter these risks. DESIGN: Nationwide registry-based cohort study. SUBJECTS: Liveborn children born in Denmark between 1994 and 2012 after assisted reproductive technologies in comparison to children conceived without assisted reproductive technologies aged 0-7. EXPOSURE: Conception following assisted reproductive technologies treatment, including in vitro fertilisation, intra-cytoplasmic sperm injection, intrauterine insemination and 'others' comprising frozen embryo transfer, and frozen embryo transfer in both in vitro fertilisation and intra-cytoplasmic sperm injection and testicular sperm aspiration. MAIN OUTCOME MEASURES: Prescription of neurodevelopmental or behavioural disorders medication in offspring: Antipsychotics, anxiolytics, antidepressants, antiepileptics, attention deficit hyperactivity disorder medication and hypnotics/sedatives obtained from nationwide registers. Unadjusted and adjusted odds ratios with 95% confidence intervals were calculated. The association was examined in different sensitivity analyses, including sibling and mediator analyses. RESULTS: In total, 57,964 (4.7%) children conceived after assisted reproductive technologies and 1,183,070 (95.3%) children not conceived using assisted reproductive technologies were included. The adjusted analysis showed higher odds of prescribing neurodevelopmental or behavioural medication to assisted reproductive technology-conceived children (OR 1.15; 95% Cl 1.09-1.20) compared to other children. Prescription of antipsychotics in assisted reproductive technology-conceived children was the most common association in intrauterine insemination treatments, hypnotics/sedatives with both including in vitro fertilisation and intra-cytoplasmic sperm injection and antiepileptics with 'other' treatments. Birth weight partially mediated the association between assisted reproductive technologies and diminished the odds of neurodevelopmental or behavioural medication use in children conceived using assisted reproductive technologies. Sibling analysis showed no increased risk for the first-born child conceived without assisted reproductive technology vs. the second-born child conceived with assisted reproductive technology and vice-versa. CONCLUSION: Based on the minor observed effects, a potentially higher increased attentiveness of assisted reproductive technology parents, the demonstrated mediation effect of birth weight and preterm birth on the observed association, and the no effect of the within-mother analysis, we find little evidence for increased risk of neurodevelopmental or behavioural disorders in children conceived using assisted reproductive technologies.

Methodological approaches in 16S sequencing of female reproductive tract in fertility patients: a review.

BACKGROUND: The female genital tract microbiome has become a particular area of interest in improving assisted reproductive technology (ART) outcomes with the emergence of next-generation sequencing (NGS) technology. However, NGS assessment of microbiomes currently lacks uniformity and poses significant challenges for accurate and precise bacterial population representation. OBJECTIVE: As multiple NGS platforms and assays have been developed in recent years for microbiome investigation-including the advent of long-read sequencing technologies-this work aimed to identify current trends and practices undertaken in female genital tract microbiome investigations. RESULTS: Areas like sample collection and transport, DNA extraction, 16S amplification vs. metagenomics, NGS library preparation, and bioinformatic analysis demonstrated a detrimental lack of uniformity. The lack of uniformity present is a significant limitation characterised by gap discrepancies in generation and interpretation of results. Minimal consistency was observed in primer design, DNA extraction techniques, sample transport, and bioinformatic analyses. CONCLUSION: With third-generation sequencing technology highlighted as a promising tool in microbiota-based research via full-length 16S rRNA sequencing, there is a desperate need for future studies to investigate and optimise methodological approaches of the genital tract microbiome to ensure better uniformity of methods and results interpretation to improve clinical impact.

Comparative motility assessment of sperm retrieved from micro-testicular sperm extraction: A single-centre study comparing fresh and frozen-thawed sperm.

INTRODUCTION: Microsurgical testicular sperm extraction (microTESE) is crucial for treating non-obstructive azoospermia (NOA), offering both 'fresh' and 'frozen' options. This study evaluates the impact of fresh versus frozen microTESE on the progression to intra-cytoplasmic sperm injection (ICSI) cycles, focusing on sperm motility. MATERIALS AND METHODS: We conducted a retrospective analysis of microTESE procedures at a major medical centre from 2007 to 2021, excluding cases of obstructive azoospermia and cryptozoospermia. Patients were divided into two groups: fresh microTESE (Group FR) and frozen microTESE (Group FZ). Sperm motility was assessed, and ICSI outcomes were compared between groups. RESULTS: Out of 128 microTESE procedures on 113 NOA patients, 31 were fresh and 97 were frozen. Sperm was found in 67.7% of fresh cases and 45.3% of frozen cases. In fresh cases, 85.7% had motile sperm for ICSI, whereas in frozen cases, 81.8% had motile sperm initially, but only 52.7% retained motility post-thaw. CONCLUSIONS: Our findings indicate a significant drop in motile sperm availability for ICSI in frozen microTESE cases compared to fresh ones. This suggests a potential advantage of fresh microTESE for certain couples, despite the logistical challenges, highlighting the need for careful patient selection and counselling.

Day 3 embryo assessment does not provide a reliable prediction for blastocyst formation and designation: a retrospective cohort study.

Although many Fertility Centers have adopted day 5 or 6 embryo transfer policy, yet, 30% of embryo transfers in the US are performed on day 3. This is mainly due to concerns related to longer embryo culture effect and higher rates of embryo transfer cancellation on day 5, with no effect on cumulative pregnancy rate. We conducted a retrospective cohort study comparing individual embryo transfer order rank, best embryo for fresh transfer and intention to freeze, of day-3 and day-5 embryos based on their morphology score. Day-3 embryos of each patient were ranked by embryologists for the order of transfer and intention to freeze, based on morphological score, blinded to actual blastulation outcome. The corresponding blastocysts were similarly ranked for the order of transfer and vitrification intention. Ranking was compared to test the predictive value of day-3 morphological assessment. Sixty patients with 784 day-3 embryos were included. There was only a moderate positive significant correlation between ranks on day-3 and ranks on day-5 [r = 0.662 95% CI (0.611-0.706, p < 0.001)]. Only 25% of the best embryos for transfer on day 3 (rank = 1) were chosen for fresh transfer on day 5. A total of 441 embryos were intended to be frozen on day 3. Of those, 201 were not transferred nor vitrified on day 5-6 (45%), 3.35 embryos per patient. No significant difference was found between average day-3 rank of embryos ranked 1, 2 (3.12 vs 4.12, p = 0.074) and 3 (3.12 vs 4.08, p = 0.082) on day-5-6. To conclude, this study brings a different perspective to the comparison of day 3 and day 5 by following each embryo's putative and actual designation. Day-3 ranking of embryo morphology did not provide a reliable prediction for blastocyst formation, transfer order and vitrification intention, and may support transfer or cryopreservation of blastocysts over cleavage stage embryos.

Progestogen hypersensitivity: successful use of progesterone desensitisation and omalizumab to facilitate in vitro fertilisation.

Hypersensitivity to exogenous or endogenous progesterone presents with a variety of clinical, usually cutaneous, manifestations. The condition can occur at any age during the reproductive years, causes debilitating symptoms and can impact the use of exogenous hormones. Management strategies include symptom control or hormonal manipulation via desensitisation. Strategic testing confirms the diagnosis, while targeted intervention can significantly and positively impact quality of life and further childbearing.

The effectiveness of prolonged downregulation with gonadotrophin-releasing hormone analogue (GnRHa) treatment in women with adenomyosis undergoing IVF/ICSI: A systematic review and meta-analysis.

IMPORTANCE: Adenomyosis can reduce the chance of clinical pregnancy in women undergoing assisted conception. Treatment with prolonged gonadotrophin-releasing hormone analogue (GnRHa) downregulation prior to IVF/ICSI has been postulated to improve pregnancy outcomes. OBJECTIVE: We aimed to evaluate the effectiveness and safety of prolonged GnRHa treatment (minimum one month) versus no pre-treatment in women with adenomyosis undergoing IVF/ICSI using a systematic review and meta-analysis. DATA SOURCES: We searched electronic databases: Embase (OVID), MEDLINE® (OVID), APA PsycInfo (OVID), Maternity & Infant Care Database (MIDIRS (OVID), HMIC Health Management Information Consortium (OVID) and ClinicalTrials.gov from inception until 27th of March 2023. STUDY SELECTION AND SYNTHESIS: We included studies that reported on women with adenomyosis receiving GnRHa to down-regulate the hypothalamic-pituitary-ovarian axis for one to six months before IVF/ICSI. We pooled data using the Haensel-Mantel method and reported using Odds Ratio (OR) with 95 % confidence intervals (CI). We assessed the quality of included studies using the Newcastle-Ottowa Scale and confidence in evidence using the GRADE criteria. Bias analysis was conducted via the Cochrane recommended tool (RevMan Web, Academic License). MAIN OUTCOMES AND RESULTS: We screened 365 citations and eight retrospective studies were included in the meta-analysis (n = 2422 women). The median age was 34 years [IQR 31.95-35.05], median BMI 21.30 kg/m2 [IQR 21.05-23.55] and median duration of GnRHa downregulation was 2.5 months [Range 1-4; IQR 1.37-3]. Women with adenomyosis receiving prolonged GnRHa treatment had a higher implantation rate 1/OR 1.69 [95 % CI 1.09, 2.56], I2 = 81 %, (P = 0.02) and clinical pregnancy rate 1/OR 1.42 [95 % CI 1.03, 2.0], I2 70 %, P = 0.03. There was no overall difference in live birth rate 1/OR 1.12 [95 % CI 0.70, 1.79], I2 = 78 %, p = 0.63), miscarriage rate 1/OR 0.92 [95 % CI 0.63, 1.28, P = 0.61, I2 0 % or mean number of oocytes retrieved (10 oocytes [IQR 8.95; 11.15] vs. 9.28 [IQR 8; 10.20], p = 0.22) between groups. CONCLUSIONS AND RELEVANCE: The benefit of prolonged GnRHa treatment in women with adenomyosis undergoing assisted conception treatment is uncertain based on existing retrospective studies. Implantation and clinical pregnancy rates were higher following prolonged downregulation in this population, though there was no statistically significant difference in live birth and miscarriage rates. Given the limited, low-quality existing data, there is a need for a well-designed, prospective randomised controlled trial to precisely evaluate the effectiveness of prolonged GnRHa treatment in this population.

Knowledge, Attitudes, and Challenges: Irish General practitioners' preparedness for publicly funded Assisted reproductive technologies.

OBJECTIVES: Global access to assisted reproductive technologies (ART) remains highly inequitable. Until recently, access to ART in Ireland was solely available through private fertility clinics. Publicly funded ART was introduced in September 2023 but eligibility requires patients to meet strict access criteria that include referral by their primary care general practitioner (GP) to the local fertility service. Previous studies report that fertility training amongst doctors, including GPs, is variable and an obstetrics and gynaecology (O&G) rotation is not mandatory for GP trainees in Ireland. This study aimed to investigate GPs' knowledge of fertility investigations and management, as well as attitudes towards publicly funded ART access criteria. STUDY DESIGN: A cross-sectional online survey was distributed to GPs working in Ireland between September 2023 and January 2024. The survey questionnaire explored attitudes to, and knowledge of, ART including the publicly funded access criteria. Responses to free-text questions were qualitatively analysed using content analysis. RESULTS: The study had 154 respondents, representing approximately 4 % of GPs in Ireland. Three quarters (n = 120, 78 %) of respondents were female, 68 % (n = 105) had completed an O&G training rotation and 72 % (n = 111) had further O&G qualifications. However, 69 % (n = 107) reported that they had no training in subfertility investigation and management, and 34 % (n = 53) were not aware of the access criteria for publicly funded ART prior to completing the survey. Almost all GPs (97 %, n = 149) felt that they would benefit from more education on fertility. Qualitative content analysis generated two themes regarding publicly funded ART: (i) the access criteria are too restrictive and (ii) the workload for GPs will increase. CONCLUSIONS: GPs in Ireland are now being tasked with managing infertility and fertility treatment referrals, but most have not been provided with sufficient training. Our study shows that GPs in Ireland desire broader access criteria for publicly funded ART and better fertility training and education for their own clinical practice.

A missed Nobel: Dr Subhas Mukhopadhyay (1931-1981), the Father of Indian IVF.

The Indian journey of assisted reproductive therapy began in Calcutta on 3 October 1978, when Dr Subhas Mukhopadhyay discovered the technique of in vitro fertilisation (IVF) only 67 days following the birth of the world's first IVF baby, Louise Brown in the United Kingdom by Edwards and Steptoe. While Edwards won the Nobel Prize in 2010 for his groundbreaking work, Mukhopadhyay, the man behind the genesis of 'Durga', India's first IVF baby, never received any recognition. Instead, he faced severe humiliation from his peers. His colleagues and the government dismissed his claims and unable to live with dishonour and disgrace, he tragically took his life on 19 June 1981. Today his innovative techniques of cryopreservation, gonadotropin stimulation and transvaginal oocyte retrieval are used worldwide across millions of fertility clinics, helping childless couples live the dream of parenthood.

What Do the General Public Know about Infertility and Its Treatment?

Rates of infertility are rising, and informed decision making is an essential part of reproductive life planning with the knowledge that ART success decreases dramatically while a woman's age increases and that high costs can often be incurred during fertility treatment. We aimed to determine the current knowledge of infertility and its treatments in the general public through an online survey. We received 360 complete responses. The average age of respondents was 35 years with most respondents being female (90%), heterosexual (88%), white (85%) and university educated (79%). Of the total, 49% had children and 23% had a condition that affects their fertility; 41% had concerns about future fertility and 78% knew someone who had had fertility treatment. Participants' understanding of basic reproductive biology and causes of infertility varied with correct responses to questions ranging from 44% to 93%. Understanding of IVF outcomes was poorer with only 32% to 55% of responses being correct, and 76% of respondents felt that their education in fertility was inadequate. This survey highlights the inconsistencies in the general public's understanding of infertility in this relatively educated population. With increasing demands on fertility services and limited public funds, better education is essential to ensure patients are fully informed with regard to their reproductive life planning.

Coping Strategies Associated with Emotional Adjustment during the Dyadic Experience of Infertility and Its Treatment: A Systematic Review.

BACKGROUND: The aim of this systematic review was to reveal which of the coping strategies used by one partner are protective of and which pose a risk to the other partner's psychological adjustment during the treatment of infertility. MATERIAL AND METHODS: A systematic search of four electronic databases (PubMed, APA PsycINFO, SCOPUS, ScienceDirect), as well as the references of the retrieved articles, was performed between May and September 2023 for studies published from 1990 until 2023, using appropriate MeSH terms and associated text words. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Using an a priori developed pilot data extraction form, authors performed an independent extraction of articles. Information on participants, coping mechanisms, and psychological adjustment was extracted from each study. Relevant articles were critically appraised, and a narrative synthesis was conducted based on the different designs and outcome measures among the included studies. RESULTS: A total of 194 articles were retrieved, and 187 were excluded for not meeting the inclusion criteria. After duplicates had been removed, five studies were included in the review. The results revealed that the psychological adaptation of infertile couples at an interpersonal level may be correlated with both the type of coping and the stage of the stressor (infertility treatment or in vitro fertilisation - IVF). CONCLUSION: This systematic review suggests that health professionals could design and apply interventions based on modifying the coping mechanisms of infertile spouses to increase levels of well-being and decrease levels of distress.

Recent Australian Legislative Developments in the Regulation of Assisted Reproductive Technology.

This section considers the recent resurgence of regulatory interest in the field of assisted reproductive technology (ART) practices focusing on the new legislative framework in the Australian Capital Territory (ACT). It provides an overview of the Australian regulatory framework in this field and considers how the new legislation in the ACT sits alongside this framework. A detailed overview of the key provisions of the ACT legislation is provided, before considering whether the legislation goes far enough in addressing some of the more controversial issues in the field of ART.

Updates in preimplantation genetic testing (PGT).

Preimplantation genetic testing (PGT) involves taking a biopsy of an early embryo created through in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI). Genetic testing is performed on the biopsy, in order to select which embryo to transfer. PGT began as an experimental procedure in the 1990s, but is now an integral part of assisted human reproduction (AHR). PGT allows for embryo selection which can reduce the risk of transmission of inherited disease and may reduce the chance of implantation failure and pregnancy loss. This is a rapidly evolving area, which raises important ethical issues. This review article aims to give a brief history of PGT, an overview of the current evidence in PGT along with highlighting exciting areas of research to advance this technology.

Prognostic value of miR-223 for pregnancy outcomes in patients with in vitro fertilisation and intracytoplasmic sperm injection.

BACKGROUND: This study aimed to analyse the expression of microRNA-223 (miR-223) in embryo culture medium and its correlation with pregnancy outcomes. METHODS: Two hundred and two patients undergoing in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) were divided into clinical pregnancy group (n = 101) and non-pregnant group (n = 101). The baseline data, clinical indicators, and the expression level of miR-223 in the embryo medium were compared between the two groups. Logistic regression analysis was used to analyse the relationship between each index and the pregnancy outcome. Receiver operator characteristic curve was carried out to evaluate the differential ability of miR-223 in pregnancy status. Bioinformatics methods were used to identify the target genes of miR-223 and elucidate their functions. RESULTS: Compared with pregnancy group, the non-pregnancy group exhibited a reduction in miR-223 expression (p < 0.001). Multivariate analysis revealed that miR-223 reduction was an independent factor for pregnancy failure (p < 0.05). The ROC curve demonstrated the discriminative capability of miR-223 in distinguishing pregnancy and non-pregnancy. In addition, bioinformatics analysis indicated that the target genes of miR-223 were predominantly located in the endocytic vesicle membrane and were primarily enriched in adenosine monophosphate-activated protein kinase (AMPK) and mammalian target of rapamycin (mTOR) signalling pathways. CONCLUSION: In this study, levels of miR-223 in the embryo culture medium predicted pregnancy outcomes in subjects undergoing IVF/ICSI. Low expression of miR-223 was a risk factor for adverse pregnancy outcomes in subjects.

In this study, 202 patients who underwent IVF/ICSI were retrospectively analysed and categorised into pregnant and non-pregnant groups based on their pregnancy status. The examination of embryo culture medium samples from both groups revealed that the non-pregnant group exhibited lower miR-223 expression compared to the pregnant group. Subsequent ROC analysis demonstrated the clinical relevance of miR-223 in effectively distinguishing between pregnant and non-pregnant states. Multi-factor analysis further established that the diminished expression of miR-223 independently influenced the likelihood of successful pregnancy.

Nurturing Hope: Reproductive Outcomes with Sinosomatics following Unsuccessful in vitro Fertilization Attempts.

INTRODUCTION: For women who have experienced failed attempts at in vitro fertilization (IVF) and face medical issues, leading to infertility, the renewed effort to seek fertility treatment, coupled with decreasing likelihood of success, can exert substantial emotional and physical strains. Consequently, many couples opt to discontinue treatment before attaining pregnancy. The objective of this study was to evaluate the reproductive outcomes in patients with unsuccessful prior IVF attempts who received a complementary treatment designed to alleviate emotional distress and burden. PATIENTS AND METHODS: A retrospective analysis of data from infertile patients who initiated the complementary intervention at a private clinic between January 2014 and December 2016 was conducted. Information on diagnosis, history of infertility, prior assisted reproductive technology treatments, mode of conception, and pregnancy outcomes were retrieved. RESULTS: The data of 133 patients with a history of one or more unsuccessful IVF treatments were analyzed. Patients had an average age of 36.7 years (±4.4 SD) and had been experiencing infertility for an average of 4.6 years (±2.7 SD). The two main causes of their infertility were endometriosis (36.1%, 48 patients) and diminished egg quality (31.6%, 42 patients). By May 2020, a significant proportion of the patients, 81.2% (108 patients), had achieved pregnancy, leading to 94 live births, which represents a 70.7% success rate. These pregnancies mostly resulted from natural cycle IVF (35.1%), donor cycles (23.4%), and conventional IVF (21.3%). The dropout rate was comparatively low at 23.3%. The median time from the start of complementary treatment to delivery was 18 months, with a range of 12-28 months. CONCLUSIONS: This study highlights the potential value of complementary treatment approaches in conjunction with standard medical care for women who have experienced unsuccessful IVF treatments in the past and thus face a reduced chance of motherhood. The reported 71% live birth rate is notably high, indicating that the inclusion of complementary treatments may provide women with past IVF failures a tangible opportunity for achieving successful pregnancy and childbirth. However, these findings need to be confirmed through randomized controlled studies.

Ultrasonographic placental parameters at 11-13+6 weeks' gestation in the prediction of complications in pregnancy after assisted reproductive technology.

OBJECTIVE: To evaluate the performance of maternal factors, biophysical and biochemical markers at 11-13 + 6 weeks' gestation in the prediction of gestational diabetes mellitus with or without large for gestational age (GDM ± LGA) fetus and great obstetrical syndromes (GOS) among singleton pregnancy following in-vitro fertilisation (IVF)/embryo transfer (ET). MATERIALS AND METHODS: A prospective cohort study was conducted between December 2017 and January 2020 including patients who underwent IVF/ET. Maternal mean arterial pressure (MAP), ultrasound markers including placental volume, vascularisation index (VI), flow index (FI) and vascularisation flow index (VFI), mean uterine artery pulsatility index (mUtPI) and biochemical markers including placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) were measured at 11-13 + 6 weeks' gestation. Logistic regression analysis was performed to determine the significant predictors of complications. RESULTS: Among 123 included pregnancies, 38 (30.9%) had GDM ± LGA fetus and 28 (22.8%) had GOS. The median maternal height and body mass index were significantly higher in women with GDM ± LGA fetus. Multivariate logistic regression analysis demonstrated that in the prediction of GDM ± LGA fetus and GOS, there were significant independent contributions from FI MoM (area under curve (AUROC) of 0.610, 95% CI 0.492-0.727; p = 0.062) and MAP MoM (AUROC of 0.645, 95% CI 0.510-0.779; p = 0.026), respectively. CONCLUSION: FI and MAP are independent predictors for GDM ± LGA fetus and GOS, respectively. However, they have low predictive value. There is a need to identify more specific novel biomarkers in differentiating IVF/ET pregnancies that are at a higher risk of developing complications.

The prevalence of late-follicular phase progesterone elevation and impact on the ongoing pregnancy rate after fresh and frozen blastocyst transfer. Sub-study of an RCT.

The effect of late-follicular phase progesterone elevation (LFPE) during ovarian stimulation on reproductive outcomes in ART treatment remains controversial, but recent studies indicate lower pregnancy rates with rising progesterone levels. This study aims to investigate the prevalence of late-follicular phase progesterone elevation (LFPE) and possible impact on ongoing pregnancy rate after fresh or frozen blastocyst transfer in a sub-study setting of a randomised controlled trial. A total of 288 women were included (n=137 and n=151 in the fresh transfer and freeze-all group, respectively). Among these 11(3.8%) had a progesterone level ≥1.5 ng/ml, and 20(6.9%) had a progesterone level ≥1.2 ng/ml on trigger day. Spline regression analysis showed no significant effect of late follicular phase progesterone levels on ongoing pregnancy. In the multivariate regression analysis (n = 312) only age, but not progesterone level on trigger day was significantly associated with ongoing pregnancy. In conclusion, in a clinical setting with moderate gonadotrophin stimulation and well-defined trigger and fresh transfer cancellation criteria, the prevalence of women with LFPE ≥1.5 ng/ml was low and did not indicate the clinical value of routine measurement of progesterone in the late follicular phase.