The need for longitudinal data on the value of fertility treatment for infertile patients' quality of life: A review and pilot study

Infertility threatens the life goal of parenthood and, hence, quality of life (QoL) of (wo)men, but the fertility clinic trajectory might be burdensome. This review of longitudinal studies and pilot longitudinal study examines the impact of the pre-in vitro fertilization (IVF) fertility clinic trajectory on patient-reported outcome measures (PROMs) for emotional well-being, including QoL. A publication found that the diagnostic workup decreases men's infertility-specific distress while publications disagree whether it decreases (wo)men's anxious and depressive reactions. Intrauterine insemination (IUI) was found to increase (wo)men's depressive reactions. Publications on infertility-specific, health-related, and overall QoL were missing. The pilot indicated that (wo)men's overall QoL is not affected by the diagnostic workup but is decreased by the time of the third IUI. Longitudinal studies on the impact of starting the fertility clinic trajectory on PROMs are needed as they are essential for patient-centered clinical decision-making and patient-centered policy-level decision-making.

Stress, anxiety, and depression in infertile couples are not associated with a first IVF or ICSI treatment outcome

BACKGROUND

Psychological distress may exert a negative influence on reproductive function of couples at reproductive age. Couples seeking assisted reproductive technology (ART) treatment may have a higher prevalence of psychological distress than fertile couples. However, whether psychological distress is associated with the outcome of ART treatment remains unknown. We aimed to investigate the association of pre-treatment psychological distress and clinical pregnancy rate among infertility couples undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment.

METHODS

This nested case-control study was conducted based on women who underwent their first fresh IVF or ICSI cycle in the Jiangsu Birth Cohort Study (JBC) between November 2015 and January 2019. A total of 150 women who did not obtain clinical pregnancy after first IVF or ICSI fresh embryo transfer were identified as cases, and a total of 300 age matched women who obtained clinical pregnancy were identified as controls. Conditional logistic regression analyses were used to investigate the association between psychological distress and the outcome of first IVF or ICSI treatment, adjusting for multiple potential confounders.

RESULTS

No statistically significant association was observed between score of maternal symptoms of psychological distress and clinical pregnancy. Adjusted ORs of logistic regression were 1.00 (95% CI 0.97-1.03) for anxiety, 0.98 (95% CI 0.95-1.02) for depression, and 0.98 (95% CI 0.95-1.01) for perceived stress, respectively. When treat depression and anxiety as categorical variables, 62 (13.8%) were classified as clinical depression, 11 (2.4%) were classified as clinical anxiety, among 450 women in the present study. Psychological distress symptoms were also not associated with clinical pregnancy rate. Adjusted ORs of logistic regression were 0.27 (95% CI 0.03-2.33) for anxiety, 0.88 (95% CI 0.46-1.68) for depression, respectively.

CONCLUSIONS

Our findings firstly indicated that psychological distress experienced prior to IVF/ICSI treatment was not associated with clinical pregnancy.

Hyoscine butylbromide in pain reduction associated with ultrasound-guided manual vacuum aspiration: a randomized placebo-controlled trial

RESEARCH QUESTION

What is the effect of adding an anti-spasmodic drug to an existing ultrasound-guided manual vacuum aspiration (USG-MVA) protocol to alleviate immediate post-procedure abdominal cramping pain in women treated for early pregnancy loss?

DESIGN

Double-blind, placebo-controlled, randomized controlled trial conducted between February 2018 and January 2020. Participants were assigned to receive a 1-ml intravenous injection containing 20-mg hyoscine butylbromide (HBB) (n=55) or saline (n =56) as a control immediately before USG-MVA. Primary outcome was reduced abdominal pain after adding a 20-mg dose of HBB to the current pain control regimen. Secondary outcomes were vaginal pain, complications and side-effects, women's pre- and post-procedure psychological state, physiological stress (saliva alpha-amylase) and procedure pain control satisfaction. Two-way mixed ANOVA was used to evaluate the main effects and interactions.

RESULTS

VAS abdominal pain scores in the HBB group were 16% lower immediately after and 21% lower 2 h after surgery (not statistically significant). Two-way ANOVA indicated that time (F[₁₁₀₈] = 83.41, P < 0.001) was the only significant main effect for reduced abdominal pain after the procedure and vaginal pain score (F[1108] = 180.1, P < 0.0001) but not drug received. No adverse events were reported. No significant difference was found for psychological state, physiological stress and procedure pain control satisfaction between the two groups.

CONCLUSIONS

Anti-spasmodic drugs can help to reduce abdominal cramping pain associated with USG-MVA; HBB produced an insignificant decrease in abdominal pain score. Further studies with longer acting or larger doses of anti-spasmodic drugs are warranted.

The association between level of physical activity and pregnancy rate after embryo transfer: a prospective study

RESEARCH QUESTION

Is physical activity after embryo transfer, as assessed by a smart band activity tracker, associated with decreased pregnancy rates?

DESIGN

Prospective observational cohort study comprising infertile women aged < 38 years, who had undergone fewer than three previous embryo transfers, achieved a good ovarian response and were undergoing frozen-thawed embryo transfer in a tertiary-referral centre. A validated smart band activity tracker was used to assess physical activity level immediately after the embryo transfer and until the pregnancy test. No specific recommendations were given to participants on level or intensity of physical activity. Physicians and patients were blinded to the data stored in the pedometer. Primary outcome was ongoing pregnancy rate.

RESULTS

Fifty women met the inclusion criteria. Ongoing pregnancy rate was 30%. In a pooled analysis, participants walked significantly fewer steps per day on the day of embryo transfer compared with the first 2 days after embryo transfer (4075, interquatile range [IQR] 2932-5592 versus 5204, IQR4203-8584, P = 0.01). No significant difference was observed between pregnant women and non-pregnant women in the median steps per day after embryo transfer until serum beta-HCG was measured (7569, IQR 6008-10884 versus 6572.5, IQR 5299-8786, P = 0.43). No significant difference was observed in the median number of steps on the day of embryo transfer or the first 2 days after embryo transfer between pregnant and non-pregnant women.

CONCLUSIONS

A quantitative objective assessment of the association between physical activity and pregnancy rates after frozen-thawed embryo transfer was conducted. Ambulation after embryo transfer has no adverse effect on pregnancy rates and, therefore, women should resume regular activity immediately after embryo transfer.

Progesterone, reproduction, and psychiatric illness

Mood and anxiety disorders are vastly overrepresented in women, and one important contributor to these differences is the fluctuation in sex steroids in women during the reproductive years. Considerable evidence supports a role for abnormal sensitivity to these hormonal fluctuations for some women, who develop mood symptoms associated with reproductive transitions. This chapter presents evidence of the role of endogenous progesterone and its metabolites in such mood symptoms, and then goes on to cover the evidence concerning exogenous progesterone's effects on mood. Overall, the literature does not support an association between exogenous progesterone and negative mood in the general population, but does indicate that subset of women may be vulnerable to such effects. Research is lacking on women with psychiatric illness.

Cumulative probabilities of live birth across multiple complete IVF/ICSI cycles: a call for attention

PURPOSE

To call attention to the fact that cumulative live birth (LB) proportions exhibit an inverted pattern to that displayed by each individual oocyte retrieval cycle (ORC-specific LB proportions) as well as when grouping together all the ORCs undergone by a woman (TNORC-specific LB proportions).

METHODS

A retrospective study of 1433 infertile women that had a LB using autologous fresh or frozen embryos and/or dropped out of IVF/ICSI treatment after completing a maximum number of three treatment cycles. Generalized Estimating Equations (GEE) and standard and landmark Kaplan-Meier survival analyses were applied.

RESULTS

A standard Kaplan-Meier analysis indicated that cumulative LB proportions rose as number of ORCs increased (0.320, 0.484, and 0.550 at ORC 1, 2, and 3, respectively). In contrast, landmark ORC-specific LB proportions showed an inverted pattern (0.320, 0.242, and 0.127 at ORC 1, 2, and 3, respectively). GEE models revealed that women's clinical outcomes decreased as TNORCs increased. In particular, compared to women that experienced just one ORC, women that underwent two and three ORCs displayed higher incidences of cycle cancellations before either oocyte retrieval or embryo transfer, and clinical pregnancy losses, and lower odds of LB.

CONCLUSION

Infertile women should be informed that cumulative LB probabilities exhibit an inverted pattern to that displayed by each individual ORC as well as when grouping together all the ORCs undergone by a woman.

Embryo transfer techniques

Embryo transfer is the final and rate-limiting step of the assisted reproductive technique. Few advances have occurred in the last few decades with regard to this procedure. Studies conducted thus far have focused on factors and interventions taking place before, during and after this procedure. These factors are highly varied and range from methods to improve the psychological state of the patients to methods aimed at reducing uterine contractility and methods aimed at optimising the precise transfer of the embryo. The key question is which factors and interventions have thus far been proven to increase pregnancy rates and live birth rates. This paper aims to review the evidence relating to embryo transfer techniques in a systematic manner with a view to provide practical recommendations to practitioners involved in the procedure.