Thicker endometrial linings are associated with better IVF outcomes: a cohort of 6331 women.

Our objective was to determine if a correlation exists between endometrial thickness measured on the day of ovulation trigger during an in vitro fertilization (IVF) cycle and pregnancy outcomes among non-cancelled cycles. We performed a retrospective cohort study looking at 6331 women undergoing their first, fresh autologous IVF cycle from 1 May 2004 to 31 December 2012 at Boston IVF (Waltham, MA). Our primary outcome was the risk ratio (RR) of live birth and positive ß-hCG. We found that thicker endometrial linings were associated with positive ß-hCG and live birth rates. For each additional millimetre of endometrial thickness, we found a statistically significant increased risk of positive ß-hCG (adjusted RR: 1.14; 95% CI: 1.09-1.18) and live birth (RR: 1.08; 95% CI: 1.05-1.11). There was no association between endometrial thickness and miscarriage (RR: 0.99; 95% CI: 0.91-1.07). Similar results were seen when categorizing endometrial thickness. Compared with an endometrial thickness >7 to <11 mm, the likelihood of a live birth was significantly higher for an endometrial thickness ≥11 mm (adjusted RR: 1.23; 95% CI: 1.11-1.37) and significantly lower for the ≤7 mm group (adjusted RR: 0.64; 95% CI: 0.45-0.90). In conclusion, thicker endometrial linings were associated with increased pregnancy and live birth rates.

Complement factors are secreted in human follicular fluid by granulosa cells and are possible oocyte maturation factors.

AIMS: In this study, we identify components of the complement system present in human follicular fluid that affect oocyte development and maturation. MATERIAL AND METHODS: Using bottom-up liquid chromatography/mass spectrometry/mass spectrometry, we identified complement factors as consistently present in human follicular fluid from 15 different subjects. RESULTS: According to our gene-chip data, these complement factors are actively produced by granulosa cells. CONCLUSIONS: By applying the computational Ingenuity Pathway Analysis software and database we have identified complement pathways that play a role in oocyte maturation and follicular development.

High levels of mineralocorticoids in preovulatory follicular fluid could contribute to oocyte development.

OBJECTIVE: To identify aldosterone and precursors in ovarian follicles and to relate levels of mineralocorticoids to previously described renin-angiotensin system follicular fluid content. DESIGN: Experimental. SETTING: Academic laboratory and affiliated large private practice. PATIENT(S): Women undergoing oocyte retrieval for in vitro fertilization (IVF). MAIN OUTCOME MEASURE(S): The concentrations of mineralocorticoids were measured in plasma and follicular fluid. Granulosa cell mRNA expression and oocyte receptor content were evaluated. RESULT(S): High concentrations of preovulatory aldosterone and corticosterone were measured in follicular fluid (419.5±122.2 and 218,383±124,143 pg/mL, respectively). Increased mineralocorticoid levels are found in follicular fluid compared with in plasma and in large follicles compared with in small. Plasma aldosterone levels increase before ovulation. Granulosa cell gene expression that promotes aldosterone production and accumulation of corticosterone is increased in younger patients. Aldosterone receptors are localized to the surface of human oocytes. CONCLUSION(S): High levels of aldosterone and its precursor, corticosterone, were found in ovarian follicles. This combined with the presence of aldosterone receptors on oocytes suggests a possible role for aldosterone in oocyte development.

Clomiphene citrate and intrauterine insemination: analysis of more than 4100 cycles.

OBJECTIVE: To evaluate the outcomes of a large cohort of patients undergoing fertility treatment with clomiphene citrate and intrauterine insemination. DESIGN: A retrospective cohort study. SETTING: Boston IVF, a large university-affiliated reproductive medicine practice. PATIENT(S): A total of 4,199 cycles performed in 1,738 infertility patients between September 2002 and July 2007. INTERVENTION(S): All patients received oral clomiphene citrate, and patients with completed cycles had intrauterine insemination performed. MAIN OUTCOME MEASURE(S): Cumulative and per cycle pregnancy rates achieved among subsets of patients defined by age, completed cycles, and intention to treat (ITT). RESULT(S): For women under age 35 years, 2,351 cycles were initiated in 983 patients. A total of 238 pregnancies ensued, yielding a pregnancy rate (PR) per completed cycle of 11.5% and 10.1% per cycle initiated with ITT. In women aged 35-37 years, 947 cycles in 422 women lead to a PR per completed cycle and ITT of 9.2% and 8.2%, respectively. For patients aged 38-40 years, 614 cycles in 265 women lead to a PR per completed cycle and ITT of 7.3% and 6.5%, respectively. In women aged 41-42 years, 166 cycles in 81 patients lead to a PR per completed cycle and ITT of 4.3% and 3.6%, respectively. For women above age 42 years, 120 cycles in 55 patients lead to a PR per completed cycle and ITT of 1.0% and 0.8%, respectively. On a per-patient treated basis, cumulative PRs were 24.2% under age 35, 18.5% ages 35-37, and 15.1% ages 38-40, whereas only 7.4% ages 41-42 and 1.8% above 42 became pregnant (one pregnancy in 55 patients). CONCLUSION(S): As anticipated, younger patients have a higher PR per cycle than older patients. The PR per cycle for patients who initiate only one or only two treatment cycles is notably higher than the corresponding per cycle rates for cycles 3 through 9. The drop in success per patient among 41- and 42-year-olds is sharp, but the exceptionally low success rate above age 42 suggests that CC with IUI has virtually no place in their treatment.

Pregnancy loss in the first in vitro fertilization cycle is not predictive of subsequent delivery in women over 40 years.

OBJECTIVE: To determine if there is an association between first IVF cycle outcome and subsequent delivery rate for women over 40 years. DESIGN: Retrospective data analysis. SETTING: Large, private academically affiliated IVF center. INTERVENTION(S): Patients over 40 years of age undergoing IVF. MAIN OUTCOME MEASURE(S): Delivery rate compared between patients with a pregnancy loss versus a negative beta-hCG in their first cycle. Additional factors including subsequent pregnancy losses, total number of IVF cycles, and delivery rates per cycle were also analyzed. RESULT(S): Among women who underwent their first IVF cycle over age 40, 8% of women had a pregnancy loss and 82% had a negative beta-hCG in their initial IVF cycle. In the pregnancy loss and negative beta-hCG groups, 17.9% and 21.9%, respectively, had a successful delivery in a future cycle. There were no further pregnancies leading to delivery after the fourth treatment cycle for the pregnancy loss group and the sixth treatment cycle for the negative beta-hCG group. The average number of cycles and the number of subsequent pregnancy losses were similar in both groups. CONCLUSION(S): Outcome of initial IVF cycle is not prognostic of future delivery for women over the age of 40 years.