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BACKGROUND: There is no consensus regarding optimal endometrial thickness and duration of estrogen supplementation in embryo transfer cycles, at present. AIMS: To observe the effect of endometrial thickness and/or duration of estrogen supplementation on in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) outcomes in fresh ovum/embryo donation cycles. SETTINGS AND DESIGN: This was a retrospective observational study. The study was conducted from January 2015 to November 2017. SUBJECTS AND METHODS: Nine hundred and fifty seven fresh blastocyst transfer cycles in the recipients of oocyte/embryo donation regardless of reproductive history and diagnosis conducted at Nova IVF Fertility, Ahmedabad, Gujarat, India. Of these, 315 women had single embryo transfer (SET), while 642 had double embryo transfer (DET). Only fresh blastocysts derived from oocytes of young donors (≤30 years) and transferred in a uniform hormone replacement therapy (HRT) cycle were included. The effect of endometrial thickness and duration of estrogen on live birth rate (LBR) and other IVF/ICSI outcomes were analyzed. STATISTICAL ANALYSIS: Univariate logistic regression. RESULTS: A significant improvement in LBR was noted in the recipients with each millimeter increase in endometrial thickness starting from 6 mm after transfer of either single (odds ratio [OR] = 1.3, P = 0.003) or double (OR = 1.14, P = 0.0218) blastocysts. Lower LBR was observed in recipients having SET and who received estrogen supplementation of <10 days (OR = 0.72; P = 0.02). Implantation rate and clinical pregnancy rate also improved significantly with endometrial thickness, but there was no change in clinical abortion rate and ectopic pregnancy rate. CONCLUSIONS: After minimizing the possible oocyte factor by including only donor oocytes and that of COH using a uniform HRT protocol, LBR improved with each millimeter increase in endometrial thickness starting from 6 mm. Shorter duration of estrogen supplementation (<10 days) reduced the chances of live birth in recipients after transfer of a single blastocyst.
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AIMS: This study aims to compare clinical outcomes in patients of recurrent implantation failure (RIF), who had embryo transfer (ET) following a receptive (R) endometrial receptivity array (ERA) and a personalized embryo transfer (pET) after a nonreceptive (NR) ERA. SETTINGS AND DESIGN: This was a retrospective observational study. STUDY PERIOD: July 2013-September 2017. SUBJECTS AND METHODS: Two hundred and forty-eight patients having unexplained RIF who underwent ERA test were included in the study. Clinical outcomes were compared between patients having a receptive (R) ERA and those having a NR ERA who underwent a pET-based on ERA. STATISTICAL ANALYSIS USED: Chi-square and t-test. RESULTS: ERA predicted receptive (R) endometrium at P + 5 in 82.3% (204/248) patients and NR in 17.7% (44/248) patients. Average failed previous in vitro fertilization cycles were 3.67 ± 1.67 among receptive ERA patients and 4.09 ± 1.68 among NR ERA patients. Pregnancy rate (PR), clinical PR, implantation rate (IR), abortion rate (AR), ongoing pregnancy rate (OPR), and cumulative PR were comparable between patients having receptive ERA who had a routine Embryo Transfer (ET) and those with an NR ERA who underwent a pET. CONCLUSIONS: ERA is helpful in identifying the window of implantation (WOI) through genetic expressions of the endometrium to pinpoint embryo transfer timing. pET guided by ERA in patients of RIF with displaced WOI improves IRs and OPRs.
RESUMO
AIMS: The aim of this study is to compare cumulative in vitro fertilization-intracytoplasmic sperm injection outcomes following two elective single embryo transfer (eSET) versus one double embryo transfer (DET) using blastocyst(s). SETTINGS AND DESIGN: This was retrospective observational study. STUDY PERIOD: The study was conducted during January 2015-December 2015. SUBJECTS AND METHODS: Forty-one fresh + 25 frozen eSET versus 123 DET using self-oocytes and 68 fresh + 35 frozen eSET versus 184 DET using donor-oocytes were included in the study. All failing to achieve live birth after first eSET underwent frozen embryo transfer cycle with second blastocyst. Cumulative outcome after two eSET were compared with one DET. STATISTICAL ANALYSIS USED: The analysis was performed by Chi-square and t-test. RESULTS: In self-oocytes group, higher but statistically nonsignificant cumulative clinical pregnancy rate (CPR) (58.5% vs. 57.7%, P = 0.92) and live birth rate (LBR) (48.7% vs. 44.7%, P = 0.65) with significantly lower multiple pregnancy rate (MPR) (4.2% vs. 45%, P = 0.0002) were obtained; whereas in donor-oocytes group, comparable cumulative CPR (73.5% vs. 65.7%, P = 0.24), significantly higher LBR (64.7% vs. 48.9%, P = 0.02) and significantly lower MPR (4% vs. 51.2%, P = 0.00005) were obtained after two eSET vs. one DET. In self-oocytes group, the incidence of prematurity (10% vs. 21.4%, P > 0.05) and low birth weight (25% vs. 45.6%, P > 0.05) were lower but statistically nonsignificant, whereas in donor-oocytes group, incidence of prematurity was lower but statistically nonsignificant (26.7% vs. 38.8%, P > 0.05) while of low birth weight was significantly lower (32.7% vs. 51.2%, P = 0.0038) after two eSET versus one DET. CONCLUSION: Cumulative LBR was higher with lower incidence of multiple births, prematurity and low birth weight after two eSET versus one DET using self- or donor-oocytes. Higher use of eSET improves reproductive outcomes in patients with good prognosis.