Herbal medicine in women undergoing in vitro fertilization/ intracytoplasmic sperm injection: A systematic review and meta-analysis

A combination of in vitro fertilization (IVF) and herbal medicine (HM) has been widely used in Asian countries. We conducted a systematic review of randomized controlled trials (RCTs) that evaluated the effects of HM as an adjunct to IVF and reported the pregnancy outcomes, including the live birth rate (LBR) and clinical pregnancy rate (CPR). HM was consistently more likely to increase the LBR (RR 1.34, 95 % CI 1.05-1.72) and CPR (RR 1.38, 95 % CI 1.29-1.49) than those not receiving adjunctive treatment. The CPR in the HM treatment group was also improved compared to the placebo group (RR 1.85, 95 % CI 1.42-2.42). The adverse events were not significantly different between the HM and control groups. These findings indicate that HM may have beneficial effects on pregnancy outcomes in females undergoing IVF. Large-scale, long-term RCTs with robust methodological inputs are needed to clarify the role of HM.

Fertility Outcome after CO2 Laser Vaporization versus Cystectomy in Women with Ovarian Endometrioma: A Comparative Study

STUDY OBJECTIVE

To assess the postoperative likelihood of conception in patients with endometriomas managed by either CO₂ laser vaporization or cystectomy.

DESIGN

A retrospective study with prospective recording of data.

SETTING

University hospital.

PATIENTS

One hundred and forty-two patients with symptomatic endometriomas.

INTERVENTIONS

Patients underwent a standardized laparoscopic stripping technique (Group 1) or cyst vaporization with CO₂ fiber laser (Group 2). Patients wishing to become pregnant were allowed to attempt a spontaneous conception after surgery. If spontaneous conception failed, patients were referred for in vitro fertilization (IVF).

MEASUREMENTS AND MAIN RESULTS

The primary objective was to compare pregnancy rates between the 2 groups. The secondary objective was the identification of independent predictors of pregnancy. Thirty-nine women in Group 1 (53.4%) and 39 women in Group 2 (56.5%) desired to conceive after surgery. Three patients (7.7%) in Group 1 became pregnant following donor-IVF and were excluded. Pregnancies were recorded in 72.2% of patients treated with cystectomy and in 74.3% of those managed with CO₂ fiber laser (p = .83). Twenty patients (55.6%) in Group 1 and 14 patients (35.9%) in Group 2 conceived spontaneously (p = .08). Among patients who failed spontaneous conception, 21 patients (28%) achieved pregnancy through IVF (Group 1: n = 6, 16.7%; Group 2: n = 15, 38.5%; p = .08). Twenty patients (26.7%) never became pregnant. Age at the time of surgery (odds ratio (OR) = 0.86; 95% Confidence intervals (CI): 0.78-0.96, p = .002) and duration of infertility (OR=0.80; 95% CI: 0.69-0.92, p = .006) were identified as independent indicators for pregnancy.

CONCLUSION

CO₂ laser-treated endometrioma is associated with pregnancy rates equal to those observed after cystectomy and favorable IVF outcomes. The one step CO₂ fiber laser technique may represent a viable alternative to cystectomy.

Reproductive capacity and recurrence of disease after surgery for moderate and severe endometriosis - a retrospective single center analysis

BACKGROUND

Endometriosis can be associated with considerable pain and sterility. After surgical excision of moderate or severe endometriosis lesions, the rate of recurrence reaches up to 67%. The objective of this retrospective study was to establish the recurrence and pregnancy rates following surgical resection of stage III/IV endometriosis lesions. Indications for operation were endometriosis symptoms, sonographic findings and/or infertility.

METHODS

A total of 456 patients who underwent stage III/IV endometriosis surgery between 2004 and 2014 were sent a questionnaire relating to their postoperative medical treatment, pregnancies, relief of symptoms and recurrence. Responses of 206 patients (45.2%) and their clinical data were analysed for this study.

RESULTS

A total of 66.5% (N = 137) of patients had stage III disease, and 33.5% (N = 69) had stage IV disease. The average age was 37 years (17-59). A total of 63.1% (N = 130) of surgeries were performed by laparoscopy, 21.8% (N = 45) were performed by laparotomy and 15% (N = 31) were performed by conversion. Complete resection of endometriosis lesions was achieved in 90.8% of patients (N = 187). After surgery, 48.5% (N = 100) of the women did not receive hormonal treatment; the main reason was the desire for children in 53%. Complete or partial relief in complaints was achieved in 93.2% (N = 192). The rate of recurrence was 21.8% (N = 45). The statistically significant factors that was associated with a higher risk to develop recurrence was an age < 35 (p < 0.005). After surgery, 65.8% (79/120) of patients who wished to have children became pregnant. There was a statistically significant association among a higher postoperative pregnancy rate and age < 35 (p < 0.003) in multivariate logistic regression analysis and laparoscopic surgical access in univariate logistic regression analysis (p < 0.01).

CONCLUSION

We assessed the high percentage of complete or partial relief of symptoms of 93.2%, the high postoperative pregnancy rate of 65.8% and the low rate of recurrence of 21.8% compared to international literature to be very encouraging for women suffering from moderate and severe endometriosis. Though laparoscopy is considered the 'gold standard'of endometriosis surgery, laparotomy still may be indicated in patients with extensive endometriosis especially to preserve reproductive function.

Greater concentrations of IGF-1 are associated with increasing pregnancy rate in melatonin implanted anestrous Barki ewes

The present study was conducted to determine if increases in IGF-1 concentration, associated with treatment of ewes with melatonin, has beneficial effects on pregnancy rates when there is induction of estrus in anestrous ewes. A total of 120 multiparous lactating ewes were assigned to three groups (n = 10/group). Ewes of Group 1 were treated with a melatonin implant for 42 days followed by insertion of a controlled internal drug release (CIDR) device for 14 days with administration of equine chorionic gonadotropin (eCG) at day of CIDR removal. The ewes of Group 2 were treated with a CIDR and eCG at the same times as ewes of Group 1 and ewes of Group 3 were assigned to an be untreated control group. Melatonin implantation resulted in an increase in IGF-1 concentrations and lesser estradiol (E₂) and triiodothyronine (T₃) concentrations. Ewes of Groups 1 and 2 had the greatest progesterone (P₄) concentration compared ewes of Group 3. The E₂:P₄ ratio was less in ewes of Group 1 compared Group 3. Melatonin implantation of ewes resulted in a greater pregnancy rate compared to treatment with the CIDR and eCG which, in turn, had a greater rate than ewes of the control group. In conclusion, melatonin implantation modulates the hormonal milieu including P₄, E₂, T₃ and IGF-1 in seasonally anestrous ewes. Increased IGF-1concentrations, as a result of melatonin treatment, are associated with a greater percentage pregnancy rate when there is treatment of anestrous ewes to induce onset of estrus.

Cumulative live birth rate after up to three consecutive embryo transfer cycles in women with poor ovarian response

Objective

In the present study, we aimed to retrospectively evaluate the cumulative live birth rate (LBR) after up to three consecutive embryo transfer (ET) cycles, either fresh or frozen, in women with expected poor ovarian response (ePOR).

Methods

We selected 115 women who entered the first in vitro fertilization (IVF) cycle between August 2013 and July 2016. The women were divided into an ePOR group (37 women) and a non-ePOR group (78 women). All women in the ePOR group were ≥40 years old or had serum anti-Müllerian hormone levels of less than 1.1 ng/mL at the time of the first IVF cycle. Live birth outcomes were monitored until December 2017. The cumulative LBR (with both conservative and optimistic estimates) was calculated according to the serial number of ET cycles.

Results

After up to three ET cycles, the overall cumulative LBR was significantly lower in the ePOR group than in the non-ePOR group (conservative estimate, 10.8% vs. 44.9%, respectively; optimistic estimate, 14.7% vs. 56.1%, respectively; log-rank test, p=0.003).

Conclusion

Women with ePOR exhibited a lower cumulative LBR than women in the non-ePOR group, and this information should be provided to ePOR women during counseling before starting IVF.

Analysis of association between various fertility indicators and production traits in Mehsana buffaloes

Female fertility in domestic animals in India has exhaustively suffered owing to indiscriminate breeding with single objective of increasing milk production. First lactation data on 7782 Mehsana buffaloes sired by 184 bulls maintained under field progeny testing programme at Dudhsagar Research and Development Association, Dudhsagar Dairy, Mehsana, over a period of 24 years were used for study of fertility traits viz. days open, first to successful service period (FTSS) and daughter pregnancy rate (DPR) and production traits viz. first lactation milk yield (FLMY), first lactation fat yield (FLFY) and average fat percentage (AFP). The voluntary waiting period (VWP) was standardised based on the higher estimates for FLMY and FLMY per unit first calving interval. VWP for Mehsana buffaloes was standardised as 63 days after first calving and consequently DPR of Mehsana buffalo was also estimated as 31%. Fertility traits were further evaluated in terms of production traits. Regression analysis revealed that the increase in 1 kg FLFY and 100 kg FLMY led to the increase of First Service Period by 0.013 days and decrease in the DPR by 1.89%, respectively. Increase in milk yield led to increase in FTSS. However, for each 100 kg increase in fat yield and 1% increase in AFP, there is increase in DPR by 0.08% and 0.051%, respectively. Based on the present findings, it may be recommended to have a breeding programme which give due weightage to both production and fertility traits.

Effect of embryo quality and developmental stages on pregnancy rate during fresh embryo transfer in beef heifers

The objective of this study was to evaluate the effect of embryo quality and developmental stages on pregnancy rate in beef heifer recipients. The present study used 168 Simmental breed cows as donors, and 618 beef cattle breed heifers as recipients. The quality and developmental stages of the collected embryos were evaluated according to the criteria specified by the International Embryo Technology Society. Accordingly, the embryos in the compact morula, early blastocyst, blastocyst, and expanded blastocyst stages that were of Code I (excellent) and Code II (good) quality levels were transferred as fresh embryos to the recipient heifers. Prior to the transfer, the recipients were synchronized using the Ovsynch protocol, and the embryos obtained were transferred to 618 beef heifers. Pregnancy examinations were performed on days 30 and 60. On day 30, the pregnancy rates with Code I and Code II embryos were determined as 44.15% and 32.58%, respectively. According to the developmental stages, the pregnancy rates with Code I quality compact morula, early blastocyst, blastocyst, and expanded blastocyst were determined as 44.64%, 45.67%, 45.83%, and 33.33%, respectively. The rates of pregnancy with Code II quality compact morula, early blastocyst, and blastocyst were determined as 32.03%, 32.14%, and 50.0%, respectively. In conclusion, the pregnancy rates with Code I quality embryos were found to be higher compared with Code II embryos (P < 0.05). It was also determined that the embryonic developmental stages had no effect on the pregnancy rate (P > 0.05).

Fertility Outcomes After Laparoscopic Cystectomy in Infertile Patients with Stage III-IV Endometriosis: a Cohort with 6-10 years of Follow-up

INTRODUCTION

Ovarian endometriosis is the most common type of endometriosis (EM), affecting more than 40% of women with EM. Currently, surgical intervention is still controversial in infertile patients with ovarian endometriosis, especially in those with stage III-IV EM. Very few studies have been done to analyze long-term pregnancy results in patients with endometrioma more than 5 years after surgery. Therefore, the aim of this study was to explore the pregnancy outcomes and the related factors in patients with endometrioma and stage III-IV endometriosis during a long-term follow-up postoperatively.

METHODS

We collected 347 patients with ovarian endometriosis, which included 59 infertile patients with stage III-IV endometriosis who had a minimum of 5 years of postoperative follow-up after undergoing laparoscopic excision of ovarian endometriomas performed by a single doctor at the Peking Union Medical College Hospital from January 2009 to April 2013.

RESULTS

A total of 59 infertile patients were recruited. The mean age was 31.8 ± 3.6 years. The mean size of the endometriomas was 6.8 ± 3.3 cm. Before surgery, dysmenorrhea was present in 88.1% (52/59) of the cases, while chronic pelvic pain was reported in nine cases (15.3%). A total of 20.3% (12/59) of cases were concurrent with leiomyoma, 52.5% (31/59) with deep infiltrating endometriosis (DIE), and 39.0% (23/59) with adenomyosis. During laparoscopy, 21 cases were diagnosed as stage III (35.6%) and 38 as stage IV (64.4%) EM according to the revised American Fertility Society (AFS) classification. After laparoscopic cystectomy, 38 (64.4%) patients became successfully pregnant by the 5th year. All the patients were divided into two groups according to the postoperative pregnancy outcomes. In univariate analysis, the higher mean age and concurrent diagnosis of adenomyosis were seen to be related to poor postoperative pregnancy outcomes (p < 0.05). In multivariate analysis, however, the mean age, chronic pelvic pain (CPP), and adenomyosis were independent risk factors of pregnancy outcomes between the two groups (p < 0.05). With a minimum follow-up of 6 years, 23.7% (14/59) of recurrence was observed in the entire study cohort.

CONCLUSION

Infertile patients with endometrioma and stage III-IV EM may have lower pregnancy rates after laparoscopic cystectomy if they are older and present with CPP and adenomyosis. Our data showed a lower rate of recurrence but a higher rate of pregnancy after surgery.

GM-CSF does not rescue poor-quality embryos: secondary analysis of a randomized controlled trial

Purpose

To evaluate implantation potential of cleavage-stage embryos cultured in medium containing 2 ng/ml granulocyte–macrophage colony-stimulating factor (GM-CSF) versus control medium, according to embryo morphological quality and then transferred on day 3.

Methods

Explorative secondary data analysis of a multicenter, randomized, placebo-controlled, double-blinded prospective study of 1149 couples with embryo transfer after IVF/ICSI. This analysis includes a subgroup of 422 subjects with either single-embryo transfer (SET, N = 286) or double-embryo transfer of two embryos with equivalent morphological quality (DET, N = 136). Implantation rate and live birth rate were assessed according to category of morphological embryo quality on day 3.

Results

Culture with GM-CSF did not increase the implantation rate for embryos classified as poor quality. A trend towards greater benefit of GM-CSF on implantation and survival until live birth for top-quality embryos (TQEs) compared with poor-quality embryos was observed, although not statistically significant. For TQEs, the percentage of transferred embryos resulting in a live born baby was: 40.9 ± 5.3% (GM-CSF) versus 30.5 ± 4.6% (control) (P = 0.24; odds ratio [OR] 1.43, 95% confidence interval [CI] 0.79–2.59), and for embryos with less than 6 cells at day 3 this same rate was: 7.4 ± 3.3% (GM-CSF) versus 12.0 ± 4.0% (control) (P = 0.26; OR 0.53, 95% CI 0.17–1.61).

Conclusion

This exploratory analysis is consistent with GM-CSF protecting morphologically normal embryos from culture-induced stress and does not support an effect of GM-CSF in rescuing poor-quality embryos.

ClinicalTrials.gov identifier: NCT00565747.

Impact of embryo quality and endometrial thickness on implantation in natural cycle IVF

Purpose

The aim of this study is to assess the effect of the endometrial thickness and embryo quality on the implantation potential in natural cycle IVF (NC-IVF).

Methods

A retrospective single-center study was performed on 552 single embryo transfers after NC-IVF. The ‘quality' of the embryos was evaluated trough the number and regularity of blastomeres, degree of fragmentation, and nuclear content of cells. Endometrial thickness was measured in millimeters with transvaginal ultrasound on the day of hCG application.

Results

Our findings showed a statistically significant difference in successful implantation until a plateau of 10 mm is reached (p = 0.001). Only one pregnancy was achieved where endometrial thickness was less than 7 mm, and this resulted in an early miscarriage. The predictors of favorable implantation were fragmentation (≤ 10%, p < 0.05) and the number of blastomeres (preferably 8-cell, p < 0.01) on day 3. Embryo quality (R = 0.052) and endometrial thickness (R = 0.18) were closely related to pregnancy rate. The overall implantation rate per embryo transfer was 18.8%.

Conclusions

Embryo quality and endometrial thickness have a significant impact on implantation in NC-IVF. Highest implantation potential has an 8-cell embryo with ≤ 10% fragmentation in the third day following oocyte retrieval. Endometrial thickness of at least 7 mm seems to be the optimal edge of successful pregnancy.

Short communication: reproductive response to concentrate supplementation of mixed-breed goats on rangeland

The effect of concentrate supplementation to crossbred goats on rangeland during the dry period on their reproductive performance was investigated. Goats were assigned into two groups: a concentrate supplemented (S; n = 91) group and an unsupplemented (UNS; n = 118) group. S goats received 350 g/day of concentrate per head, 30 days prior to breeding (flushing in winter) and 30 days during the last trimester of pregnancy. UNS goats presented a lower (P < 0.01) liveweight at the onset of the breeding period than did the S group (38.2 ± 3.7 vs. 44.4 ± 3.6 kg). Average daily gains during pregnancy were higher (P < 0.01) in the S group than UNS goats (15.5 ± 1.2 vs. - 0.5 ± 5.1 g/d). S goats had a higher (P < 0.01) kidding rate (87.1%) than the UNS goats (54.7%). Litter size for UNS and S goats was 1.39 and 2.00, respectively (P < 0.01). Serum triiodothyronine, tetraiodothyronine, and cortisol concentration at the end of the flushing period were not affected by concentrate supplementation. Serum glucose (88.7 ± 3.8 vs. 95.7 ± 5.3 mg/dL), total protein (6.9 ± 1.1 vs. 8.2 ± 1.2 mg/dL), and blood urea nitrogen (17.1 vs. 21.0 ± 4.3 mg/dL) concentrations were lower for UNS goats as compared with S goats. In conclusion, concentrate supplementation in crossbred goats on rangeland markedly improved body mass changes during gestation and the reproductive performance, which implies that malnutrition is a major barrier affecting fertility of goats and liveweight of kids in this rangeland.

A prospective randomized trial comparing corifollitropin-α late-start (day 4) versus standard administration (day 2) in expected poor, normal, and high responders undergoing controlled ovarian stimulation for IVF

OBJECTIVE

To assess whether corifollitropin-α (CFα) late-start administration (day 4) and standard administration (day 2) can obtain similar oocyte yield and live birth rate.

STUDY DESIGN

A randomized controlled trial.

SETTING

University Hospital IVF Unit.

PATIENTS

One hundred thirteen women undergoing IVF.

INTERVENTIONS

Patients distributed in three subgroups (expected poor, normal, or high responders to FSH) were randomized into two treatment arms: (a) CFα late-start: CFα on day 4 + GnRH antagonist from day 8 + (when needed) recFSH from day 11; (b) CFα standard start: CFα on day 2 + GnRH antagonist from day 6 + (when needed) recFSH from day 9. IVF or ICSI was performed as indicated.

RESULTS

Considering the whole study group, the late-start regimen obtained comparable oocyte yield (8.9 ± 5.6 vs. 8.8 ± 6.2; p = n.s.), cPR/started cycle (25% vs. 31.6%, p = n.s.), and cumulative live birth rate (LBR)/ovum pickup (OPU) (29.2% vs. 37.7%, p = n.s.) than the standard regimen. The outcome of the two regimens was comparable in the two subgroups of high and normal responders. Differently, in poor responders, oocyte yield was similar, but LBR/OPU was significantly lower with late-start CFα administration that caused 40% cancellation rate due to monofollicular response. ROC curves showed that the threshold AMH levels associated with cycle cancellation were 0.6 ng/ml for late-start regimen and 0.2 ng/ml for standard regimen.

CONCLUSION

CFα may be administered on either day 2 or day 4 to patients with expected high or normal response to FSH without compromising oocyte yield and/or live birth rate. Differently, late-start administration is not advisable for expected poor responders with AMH ≤ 0.6 ng/ml.

TRIAL REGISTRATION

NCT03816670.

Reproductive Outcomes following Use of Barbed Suture during Laparoscopic Myomectomy

STUDY OBJECTIVE

To review pregnancy outcomes after laparoscopic myomectomy with the use of barbed suture.

DESIGN

Retrospective cohort study and follow-up survey.

SETTING

Single, large academic medical center.

PATIENTS

Patients who underwent laparoscopic myomectomy with the use of barbed suture for myometrial closure between 2008 and 2016.

INTERVENTION

Laparoscopic myomectomy and a follow-up survey regarding pregnancy outcome.

MEASUREMENTS AND MAIN RESULTS

A total of 486 patients met inclusion criteria and underwent a laparoscopic myomectomy between 2008 and 2016. Of the 428 with viable contact information, 240 agreed to participate (56%). Of those who responded to the survey, 101 (42%) attempted to get pregnant, and there were 4 unplanned pregnancies. There were 110 pregnancies among 76 survey respondents. In total, of the women attempting a postoperative pregnancy, 71% had at least 1 pregnancy. Comparing the women who did and did not conceive postoperatively, the group who got pregnant was on average younger, 33.8 ± 4.5 years vs 37.5 ± 6.5 years (p = .001); had fewer myomas removed, median = 2 (range 1-9) vs median = 2 (range 1-16) myomas (p = .038); and had a longer follow-up period, 30 months ( vs 30 (11-93 months) ± 20 (p <.001). The mean time to first postoperative pregnancy was 18.0 months (range 2-72 months). Of the 110 reported postoperative pregnancies, there were 60 live births (55%), 90% by means of cesarean section. The mean gestational age at birth was 37.8 weeks. In the cohort, there were 8 preterm births, 3 cases of abnormal placentation, 2 cases of fetal growth restriction, 3 cases of hypertensive disorders of pregnancy, and 2 cases of myoma degeneration requiring hospitalization for pain control. There were no uterine ruptures reported.

CONCLUSION

According to our findings, pregnancy outcomes after laparoscopic myomectomy with barbed suture are comparable with available literature on pregnancy outcomes with conventional smooth suture.

Estimation of the adolescent pregnancy rate in Thailand 2008-2013: an application of capture-recapture method

BACKGROUND

Adolescent pregnancy is an important health and social issue that affects both individual and social well-being. However, deriving a national estimate is challenging in a country with multiple incomplete national databases especially the abortion statistics. The objective of this study was to estimate the adolescent pregnancy rates in Thailand using capture-recapture method.

METHODS

An application of capture-recapture method was conducted using two cross-sectional databases (i.e., the national birth registration and the Ministry of Public Health standard health databases) and one hospital-based data source from medical record reviews. A 3-sources capture-recapture with log-linear model was applied to estimate adolescent pregnancy rates.

RESULTS

A total number of 741,084, 290,922 and 25,478 records were respectively identified from the birth registrations, standard health databases and hospital-based survey data during 2008 to 2013. The estimated adolescent pregnancy rates /1000 adolescent women (95% confidence intervals (CI)) ranged from 56.3 (49.4, 66.9) to 70.3 (60.3, 76.6). The estimated rates were about 12-31% higher than adolescent birth rates reported by the Thailand Public Health Statistics.

CONCLUSIONS

With the capture-recapture method, more accurate adolescent pregnancy rates were estimated. This method should be able to apply to any setting with similar context.

Replacing HMG/FSH by low-dose HCG to complete corifollitropin alfa stimulation reduces cost per clinical pregnancy: a randomized pragmatic trial

RESEARCH QUESTION

The cost of IVF treatment remains high, among other factors because of the medication needed for ovarian stimulation. This study investigated the effect of using low-dose human chorionic gonadotrophin (HCG) for the second phase of follicular maturation after corifollitropin alfa induction, to replace the more expensive, either recombinant or human menopausal gonadotrophin (HMG), on the cost of ovarian stimulation.

DESIGN

One hundred and five patients were randomly divided into two groups: patients in the HCG group (n = 50) received low-dose HCG from Day 7 until the diameter of at least three follicles reached 17 mm or more, while patients in the FSH group (n = 55) received conventional ovarian stimulation with highly purified HMG injections.

RESULTS

The clinical pregnancy rate in the HCG group was 38% higher than in the FSH group (number needed to treat, NNT = 13). The cost per pregnancy needed for ovarian stimulation was reduced from €4902 in the FSH group to €2684 in the HCG group. Hence, the cost of ovarian stimulation medication to obtain 10 pregnancies using the conventional FSH protocol is sufficient to attain 18 pregnancies when applying the low-dose HCG protocol.

CONCLUSION

This study provides evidence that using HCG instead of HMG/FSH for ovarian stimulation results in a significant reduction in the cost of IVF with, at least, an equivalent pregnancy rate.

Presynchronization with CIDR, with or without GnRH, prior to CO-Synch in beef heifers

Objectives were to compare ovarian responses and pregnancy per AI (P/AI) in Angus-cross beef heifers (n = 521; 4 locations) synchronized with CIDR-CO-Synch (CCOS) versus CIDR-GnRH-CO-Synch (CGCOS) protocols. Heifers were assigned a reproductive tract score (RTS: 1, immature, acyclic; 5, mature, cyclic), body condition score (BCS: 1, emaciated; 9, obese) and temperament score (0, calm, 1, excitable). Heifers in the CCOS (n = 261) group received a CIDR on Day -20 (removed on Day -13), 100 μg GnRH on Day -10, 25 mg PGF2α on Day -3 and were timed inseminated 60 h later, with concomitant GnRH (Day 0). Heifers in the CGCOS (n = 260) group received a CIDR on Day -26 (removed on Day -19), 100 μg of GnRH on days -16 and -10, 25 mg of PGF2α on Day -3 and were timed inseminated 60 h later, with concomitant GnRH (Day 0). Ovarian ultrasonography was done in a subset of heifers (n = 60; 30 in each group) to determine number and size of ovarian follicles and presence of corpus luteum (CL). There was increased (P < 0.05) percentage of heifers with CL in CGCOS group compared to heifers in CCOS group on Day -10 (82.3 vs 68.2%) and on Day -3 (88.3 vs 75.1%). Average size of the largest ovarian follicle on Day 0 was greater for heifers in CGCOS group compared to CCOS group (P < 0.05). However, P/AI did not differ between CCOS and CGCOS groups, 55.0% (143/260) and 59.8% (156/261), respectively (P > 0.1). In conclusion, CIDR presynchronization with or without GnRH (CCOS and CGCOS protocols) in beef heifers resulted in similar P/AI. Adding GnRH to presynchronization with CIDR resulted in more heifers with a CL at PGF2α and increased preovulatory follicle diameter at AI. Future studies are needed with bigger sample size and CIDR + CO-Synch treatment as control to determine economic benefit.

Cyclicity, estrus expression and pregnancy rates in beef heifers with different reproductive tract scores following progesterone supplementation

Two experiments were conducted to determine effects of progesterone (P4) on cyclicity, estrus expression rate (EER) and artificial insemination pregnancy rate (AIPR) in beef heifers with various reproductive tract scores (RTS; 1 to 5; 1, immature, acyclic; 5, mature, cyclic). In Experiment 1, Angus-cross heifers (n = 100, 20 per RTS category; mean (±SEM) age, 15 ± 0.8 mo) were randomly assigned to receive a CIDR (Days -17 to -10) or no CIDR (untreated control), with weekly blood samples and ultrasonography (Days 0-85). Among heifers with RTS 2 to 4, median interval to cyclicity were shorter (P < 0.05) for heifers in CIDR versus control. In Experiment 2, Angus-cross heifers (n = 11,098) were assigned RTS, body condition score (BCS; 1 to 9; 1, emaciated; 9, obese) and temperament score (calm versus excitable). Heifers with RTS 2-5 (n = 10,569) were allocated to CO-Synch (n = 5099) or CO-Synch + CIDR (n = 5470). Estrus was detected until AI (72 h after PGF2α), with pregnancy diagnosis ∼70 d later. Controlling for RTS (P < 0.0001), BCS (P < 0.0001), temperament (P < 0.0001), age (P < 0.0001), treatment by RTS (P < 0.01), treatment by BCS (P < 0.01), and treatment by age, EER differed between CO-Synch and CO-Synch + CIDR (71.0 vs 75.9%, respectively, P < 0.0001). Accounting for RTS (P < 0.0001), BCS (P < 0.0001), temperament (P < 0.0001), age (P < 0.0001), heifers detected in estrus (P < 0.0001), RTS by treatment (P < 0.01), BCS by treatment (P < 0.01), and age by treatment, AIPR differed between CO-Synch versus CO-Synch + CIDR (55.3 vs 61.0%, P < 0.0001). In conclusion, exogenous P4 hastened cyclicity in pre- and peri-pubertal beef heifers. Further, it increased EER and AIPR. However, RTS, BCS and age influenced EER and AIPR. Among RTS 4 and 5, EER was greater for CO-Synch + CIDR vs CO-Synch. Among RTS 3 to 5, AIPR was greater for CO-Synch + CIDR versus CO-Synch. Progesterone status or supplementation at onset of synchronization protocols was critical to pregnancy outcomes, emphasizing heifer development for early puberty or progesterone supplementation.

Association between in vitro fertilization success rate and ambient air pollution: a possible explanation of within-year variation of in vitro fertilization success rate

Objective

To evaluate patterns in air pollution concentrations and in vitro fertilization (IVF) success rates using data from a large, long-term clinical database.

Methods

We conducted a retrospective cohort study investigating South Korean women who pursued IVF and embryo transfer (IVF-ET) between 2011 and 2017. Hourly concentrations of air pollutants measured at 318 air quality monitoring sites in South Korea between 2011 and 2017 were obtained from the National Institute of Environmental Research. Monthly trends in pregnancy rates and concentrations of air pollutants were assessed.

Results

A total of 34,427 IVF-ET cycles in 18,478 patients were analyzed. The mean age of women at the time of IVF-ET was 36.6 years. The clinical pregnancy rate in the IVF-ET cycle was 30%. Analysis of pregnancy failure rates by month showed that IVF-ET failure rates tended to be higher in March and April and lower in July and August. Concentrations of air pollutants including particulate matter (PM) less than 10 μm in diameter, PM less than 2.5 μm in diameter, sulfur dioxide, nitrogen dioxide, and carbon monoxide were highest in March and April and lowest between July and September.

Conclusion

Within-year variations were similar between IVF-ET failure rates and air pollution concentrations based on analysis of a large, long-term database. Specifically, IVF-ET success rates were highest when PM concentrations were lowest. Further studies are warranted to examine the mechanisms accounting for the association between IVF success and air pollutant exposure.

IVF outcomes after hysteroscopic metroplasty in patients with T- shaped uterus

Background

T- shaped uterus may be associated with infertility and adverse pregnancy outcomes. Hysteroscopic metroplasty may improve the reproductivity for these cases. To our knowledge, there is no data in literature about the clinical consequences of in vitro fertilization (IVF) in patients undergoing hysteroscopic metroplasty for T-shaped uterus. The principal objective of the current study is to assess the impact of hysteroscopic metroplasty for T-shaped uterus on the reproductive outcomes of IVF.

Methods

IVF outcomes of 74 patients who underwent hysteroscopic metroplasty for T- shaped uterus and 148 patients without any uterine abnormalities and with diagnosis of unexplained infertility (control group) were retrospectively analyzed.

Results

Patients in metroplasty and control groups were comparable with respect to age, BMI, partner’s age and duration of infertility. Number of patients with a history of pregnancy beyond 20 weeks of gestation was significantly lower in the metroplasty group (4.1% vs 18.2%; p < 0.05). Number of previous unsuccessful cycles and percentage of patients with ≥3 unsuccessful IVF cycles (35.1% vs 17.6%; p < 0.05) were significantly higher in the metroplasty group. There were no significant differences in the reproductive outcomes such as the pregnancy rate, clinical pregnancy or live birth rate between the metroplasty and control groups. There were non-significant trends for higher rates of miscarriage (18.8% vs 8%, p > 0.05) and biochemical pregnancy (20.0% vs 10.7%, p > 0.05) in the metroplasty group compared to the control group.

Conclusions

Reproductive results of the IVF cycles after hysteroscopic correction of T-shaped uterus were comparable to those of the patients without any uterine abnormalities and with diagnosis of unexplained infertility. Hysteroscopic metroplasty may contribute to improved IVF outcomes in patients with T-shaped uterus.

The effects of daily meteorological perturbation on pregnancy outcome: follow-up of a cohort of young women undergoing IVF treatment

BACKGROUND

Human reproduction follows a seasonal pattern with respect to spontaneous conception, a phenomenon wherein the effect of meteorological fluctuations might not be unique. However, the effect of seasonal variations on patients who underwent in vitro fertilization (IVF) treatment is unclear. We aimed to evaluate the effects of meteorological variation on the pregnancy rate in a cohort undergoing IVF treatment by performing multivariable analyses.

METHODS

We conducted a cohort study in a sub-tropical region with prominent seasonal variations (2005-2016). Women aged < 35 years who were treated with a long ovarian stimulation protocol and underwent fresh embryo transfer (ER) were included. Data on gonadotropin administration (CYCL), oocyte retrieval (OR), ER, and pregnancy outcomes were prospectively recorded. For each patient, the daily average of meteorological data (temperature, humidity, sunlight duration, solar radiation) was recorded from the date of CYCL to ER. Multiple logistic regression analysis adjusted for age, fertilization method, year of the cycle, gonadotropin dose, and transferred embryo grade was performed to determine the relationship between the meteorological parameters and clinical pregnancy. Patients with one successful cycle and one failed cycle were subtracted for a case-control subgroup analysis through mixed effect logistics regressions. Time-series analysis of data in the epidemic level was conducted using the distributed lag linear and non-linear models (DLNMs).

RESULTS

There were 1029 fresh cycles in 860 women (mean age 31.9 ± 2.0 years). Higher mean temperature from CYCL to OR (adjusted odds ratio [aOR] 1.04; 95% confidence interval [CI] 1.01-1.07, P = 0.01) increased the odds of pregnancy, while OR to ER did not show any statistical significance. Compared to that in winter, the odds of becoming pregnant were higher during higher temperature seasons, summer and autumn (aOR 1.47, 95%CI 0.97-2.23, P = 0.07 (marginally significant) and aOR 1.73, 95%CI 1.12-2.68, P = 0.02, respectively). Humidity, sunlight duration, and solar radiation had no effect on the outcome. The subgroup analysis confirmed this finding. The time-series analysis revealed a positive association between temperature and relative risk for pregnancy.

CONCLUSIONS

In IVF treatment, the ambient temperature variation alters the pregnancy rates; this aspect must be considered when obtaining patient consent for assisted conception.

[Determinants of pregnancy rate in the donor oocyte model: a multivariate analysis of frozen-thawed embryo transfers]

Objective: To determine independent factors of pregnancy in the recipient after frozen-thawed embryo transfer (FTET). Methods: We performed a retrospective study of 431 patients who had undergone embryo transfer after oocyte donation (OD), in vitro fertilization and embryo cryopreservation between April 2009 and December 2018 at our Reproductive Center. Comparison of general data between clinical pregnant group and non-pregnant group; Logistic regression were used to identify independent factors of pregnancy. The ability of independent factors of pregnancy was assessed by receiver operating characteristics (ROC). Results: ①Pregnancy rates were significantly higher in women with more embryos, more high-quality embryos, more transferred embryos and higher basalfollicular stimulation hormone(FSH) (P<0.05). Pregnancy rate of premature ovarian insufficiency (POI) (75.00%) was higher than advanced age (55.83%,P=0.005) and chromosome abnormality (56.86%,P=0.021). ②Using logistic regression analysis, the POI (OR=2.065, 95%CI=1.026-4.156), basal FSH(OR=1.499, 95%CI=1.072-1.959), high-quality embryos (OR=1.449, 95%CI=1.072-1.959) and transferred embryos (OR=2.583, 95%CI=1.519-4.391)were independent predictors of pregnancy (P<0.05). ③The ROC curves revealed the cut-off points of basal FSH was 19.28U/L for pregnancy, the areas under the curve of basal FSH was 0.627, 95%CI=0.572-0.680. According basal FSH and age, all patients were further divided into four groups, pregnancy rates were significantly higher in ≤40 years and FSH>19U/L group (P<0.05). We contain pregnancy rates and multiple pregnancy rates of two transferred embryos were higher than one (P<0.01). Conclusions: This study supports that pregnancy rates of POI was higher than other infertility diagnosis needed OD. Pregnancy rates of two transferred embryos were higher than one, but multiple pregnancy rates was also higher than one.

Influence of temperature-humidity index on conception rate of Nelore embryos produced in vitro in northern Brazil

Considering the high temperatures that the tropical climate provides to most of Brazil and the effects of thermal stress on reproductive processes, the objective of the present study was to analyze, in the warmer months of 2016, conception rates of Nelore bovine embryos in Acre state. For this purpose, oocytes were aspirated (ultrasound-guided follicular aspiration), matured, fertilized with Nelore bull semen, cultured for 6 days, and then the embryos were transferred to crossbred recipients. Pregnancy diagnosis was performed 30 and 60 days after embryo transfer. Meteorological data were obtained at www.inmet.gov.br to generate temperature-humidity index (THI). The data from the conception rates and periods of the year were submitted to the chi-square test at 5% probability to verify independence. Regression analysis was used to verify the relationship between THI and gestation rate. There was a strong relationship between conception rates and THI values, verified by an increase in conception rates as THI values were reduced and a decrease when THI reached the highest value. Our findings demonstrated a negative effect of heat stress in conception rates of crossbred cows in northern Brazil.

Preservation of dromedary camel embryos at 4 °C for up to 5 days: Factors affecting the pregnancy and pregnancy loss rates

The aims of the present study were to evaluate the effect of cooling of the dromedary camel embryos on the pregnancy and pregnancy loss rates, and to investigate the factors which might affect the outcomes of the transfer of cooled embryos. After the donors (n = 56) had been super-ovulated and mated, they were flushed at Day 8 or 9 post-mating. Of 487 collected embryos, 110 were refrigerated at 4°C for up to 5 days in holding medium (HM), flushing medium supplemented with 10% fetal calf serum (FM + FCS) or TCM199 supplemented with 50% FCS and HEPES (TCM + FCS + HEPES). Both fresh (n = 377) and cooled embryos were transferred individually into synchronized recipients. Pregnancy diagnoses were carried out at Days 18-19, 30 and 60 post-mating of the donors. Transferring of fresh embryos into the recipients resulted in significantly higher pregnancy rates at Days 18-19 (53.1% vs. 38.2%, P < 0.01), Day 30 (46.4% vs. 31.8%, P < 0.01) and Day 60 (42.4% vs. 26.4%, P < 0.005) compared with those of cooled embryos, respectively. Pregnancy rates after transferring cooled embryos progressively decreased with the prolongation of the storage period. A significant difference in the pregnancy rate (56% vs. 13%, respectively, P < 0.05) was recorded only at Days 18-19 between cooled embryos held for one day and those held for 5 days. The pregnancy rates at Days 18-19, Day 30 and Day 60 were non-significantly higher when TCM + HEPES and FCS medium used for cooling of embryos compared to those of FM + FCS or HM medium. Cooling of spherical embryos resulted in significantly higher pregnancy rates at Days 30 (45.6% vs. 17.0%, respectively, P < 0.005) and 60 (42.1 vs. 9.4%, respectively, P < 0.005) and a significantly lower pregnancy loss rate (11.1% vs. 66.6%, respectively, P < 0.005) compared to those resulting from cooling of folded embryos. Neither the size of embryo nor the day of flushing had a significant effect on the pregnancy and pregnancy loss rates after the transfer of cooled embryos. In conclusion, pregnancy could be obtained after the transfer of camel embryos refrigerated for up to 5 days. In addition, higher pregnancy rates could be obtained if only spherical embryos are selected for cooling.

Effect of vitamin D supplementation on assisted reproduction technology (ART) outcomes and underlying biological mechanisms: protocol of a randomized clinical controlled trial. The "supplementation of vitamin D and reproductive outcome" (SUNDRO) study

Background

Vitamin D plays an important role in human physiology and pathology. The receptor for vitamin D regulates 0.5–5% of the human genome. Accordingly, vitamin D insufficiency has been shown to increase the risk of several diseases. In recent years, based on growing evidence, on a role of vitamin D has been also postulated in reproductive health both in animals and humans, especially in female fertility female fertility. In vitro fertilization success was shown to be higher in women with appropriate reserves of vitamin D. However a causal relation has not been demonstrated and randomized controlled trials testing the effectiveness of vitamin D supplementation in IVF are warranted.

Methods

This is a multicenter randomized double blinded placebo controlled study aimed at determining the benefits of vitamin D [25(OH)D] supplementation in improving clinical pregnancy rate in women undergoing IVF. Eligible women with a serum level of 25-hydroxyvitamin D [25(OH)D] < 30 ng/ml will be randomized. Recruited women will be given the drug (either 600,000 IU of 25(OH) D or placebo in a single oral administration) at the time of randomization. Two centres will participate and the sample size (700 women) is foreseen to be equally distributed between the two. Patients will be treated according to standard IVF protocols.

Discussion

The primary aim of the study is the cumulative clinical pregnancy rate per oocyte retrieval. Clinical pregnancy is defined as the presence of at least one intrauterine gestational sac with viable foetus at first ultrasound assessment (3 weeks after a positive human chorionic gonadotropin [hCG] assessment). Secondary outcomes include: 1) clinical and embryological variables; 2) oocyte and endometrium quality at a molecular level. To investigate this latter aspect, samples of cumulus cells, follicular and endometrial fluids will be obtained from a subgroup of 50 age-matched good-prognosis cases and controls.

Trial registration

The protocol was included in EudraCT on 22nd September 2015 with the registration number assigned ‘2015-004233-27’; it was submitted through the database of the Italian “Osservatorio Nazionale della Sperimentazione Clinica (OsSC)” - (National Monitoring Centre of Clinical Trials) to the National Competent Authority on 8th March 2016 and approved on 23rd June 2016.

Direct transfer of frozen-thawed bovine embryos and its application in cattle reproduction management

Embryo transfer entails many procedures and techniques, of which embryo freezing is an important component in bovine embryo transfer. Embryo freezing techniques have been developed over the last 40 years, allowing practical availability, and have become essential for cattle reproduction management under field conditions. The direct transfer methods of frozen-thawed, in vivo-derived, and in vitro-produced (IVF) bovine embryos using 1.5 M ethylene glycol (EG) with or without sucrose (SUC) are used widely under on-farm conditions, not only in Japan but also globally. The direct transfer method using 1.5 M glycerol (GLY) and 0.25 M SUC (GLY-SUC) is used mainly in Japan. The pregnancy rate with direct transfer of frozen-thawed bovine embryos in either EG or GLY-SUC has been found to not differ from conventional freezing with GLY and traditional dilution techniques. Pregnancy rates following direct transfer of frozen-thawed bovine embryos were affected by the developmental stage of the embryos and the parity of the recipients. The use of ultrasound-guided on-farm ovum pickup is ushering in a new revolution for the commercial application of IVF embryos. Globally, for the first time more IVF bovine embryos were transferred in 2017 than produced in vivo. More than 60% of IVF embryos were transferred fresh due to a low pregnancy rate of frozen-thawed IVF embryos. Many factors seemed to be involved in improving the survival rate of frozen-thawed IVF embryos. Therefore, further research is needed to improve the freezing tolerance of IVF embryos to develop efficient direct transfer methods analogous to those used for in vivo embryos.