What does the SART success rate for a given IVF program mean?

Day 2 embryo transfer (ET) and day 3 ET afford similar reproductive outcomes in the poor responder

Acknowledgements: We would like to thank the following for their contributions to the 2020 update. All staff at the editorial base of the Cochrane Gynaecology and Fertility Review Group; and in particular, Helen Nagels (Managing Editor) and Information Specialist Marian Showell, for help with the literature searches. Drs Jeanette MacKenzie, Evi Vogiatzi and Rik van Eekelen who provided peer review comments. We also thank all the authors who replied to our email queries about their study: Dr Elisabet Clua, Dr Maria Luisa López‐Regalado and Dr OM Abuzeid. We also thank the following. Zabeena Pandian, who was the lead author of the original review and two subsequent updates. Other co‐authors for their contribution in the previous versions: Allan Templeton, Ozkan Ozturk, Gamal Serour, and Jane Marjoribanks. Statistician Andy Vail (University of Manchester University, UK) for methodological advice.

Ovarian response determines the luteinizing hormone suppression threshold for patients following the gonadotrophin releasing hormone antagonist protocol: A retrospective cohort study

Background and Aims: Hydrosalpinx is a severe manifestation of tubal disease-causing infertility in women. It has an adverse effect on the outcome of in vitro fertilization (IVF), reducing live birth rate (LBR) by 50% compared to other tubal factors. Laparoscopic salpingectomy can effectively improve IVF outcome but is contraindicated in some women. It can also be expensive and is not without complications. Ultrasound-guided hydrosalpinx aspiration is a cheaper, less invasive procedure alternative to salpingectomy. It has been shown to improve clinical and ongoing pregnancy rates compared to patients with no aspiration. However, the published literature on the effectiveness of hydrosalpinx aspiration is equivocal. Method: This retrospective study aimed to evaluate the outcome of minimal stimulation (mild) IVF cycles wherein the women underwent hydrosalpinx aspiration prior to embryo transfer at a private fertility clinic in the Philippines. Results: A total of 98 IVF cycles satisfied the inclusion criteria. The average patient age was 35.22 ± 4.57 and average duration of infertility was 5.87 ± 3.70 years. The biochemical pregnancy rate was 48% and the clinical pregnancy rate was 39.8%. Live birth rate was 35.7%, which is comparable to that of mild IVF patients without hydrosalpinx. There was a negative correlation between patient age and biochemical pregnancy rate, clinical pregnancy rate, and LBR, however, the correlations were statistically insignificant (Pearson correlation, P = 0.081, 0.197, and 0.344, respectively). Binary logistic regression analyses showed that age, infertility type, infertility factor, basal hormone levels, and number of eggs retrieved were not predictive of the success of IVF among the women in the study. Conclusion: Our results show that hydrosalpinx aspiration is a safe and effective option in improving pregnancy and live birth rates in women undergoing mild IVF.

ObjectiveThe aim of this retrospective cohort study was to evaluate the clinical and neonatal outcomes between day 4 and day 5 embryo transfer across different fertilization methods.MethodsThis retrospective cohort study was conducted between January 2018 and March 2023, enrolling a total of 1,245 fresh embryo transfer cycles, including 1,023 in vitro fertilization (IVF) cycles and 222 intracytoplasmic sperm injection (ICSI) cycles. Among these, IVF cycles included 793 day 4 transfers and 230 day 5 transfers; ICSI cycles included 179 day 4 transfers and 43 day 5 transfers. The study conducted a comparative analysis of clinical pregnancy outcomes between day 4 and day 5 transfers.ResultsIn IVF or ICSI cycles, no significant differences were found in clinical pregnancy rate (CPR), implantation rate (IR), live birth rate (LBR), or other clinical outcomes between transfers of day 4 and day 5 embryos (P > 0.05). In IVF cycles with single high-quality embryo transfer, the CPR (62.72%, P = 0.026), gestational week of delivery (39 weeks, P = 0.026) of day 4 were significantly higher than day 5 (38 weeks). After controlling for potential confounding factors, the CPR of the day 4 group was also higher than day 5 (OR 0.578, 95% CI 0.352-0.949, P = 0.030). In IVF or ICSI cycles with day 4 high-quality embryo transfer, the LBR (63.06%, P = 0.006; 70.37%, P = 0.006) and multiple pregnancy rate (MPR; 53.29%, P < 0.001; 50%, P < 0.001) of transferring double high-quality embryo were significantly higher than transferring single high-quality embryo (LBR: 50.87%, 44.23%; MPR: 0%, 3.23%).ConclusionIn IVF or ICSI cycles, day 4 embryo transfer is considered a viable option or alternative to day 5 blastocyst transfer with no difference in clinical and neonatal outcomes. In IVF cycles with single high embryo transfer, day 4 transfer is recommended due to its significantly higher pregnancy rate compared to day 5 transfer. To reducing MPRs and preterm birth rates (PBRs), day 4 single embryo transfer is recommended if embryos achieve high-quality grade (full compaction) on day 4.

Effect of HCG-day serum progesterone and oestradiol concentrations on pregnancy outcomes in GnRH agonist cycles

The use of insulin-sensitising agents, such as metformin, in women with polycystic ovary syndrome (PCOS) who are undergoing ovulation induction or in vitro fertilisation (IVF) cycles has been widely studied. Suppression of insulin levels with metformin might reduce the hyperinsulinaemia and hyperandrogenism suppression of the ovarian response. As a consequence, metformin could improve both pregnancy and live birth rates. To determine the effectiveness of metformin as a co-treatment during IVF or intra-cytoplasmic sperm injection (ICSI) in achieving pregnancy or live birth in women with PCOS. The Menstrual Disorders and Subfertility Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, LILACS, the meta Register of Controlled Trials, and reference lists of articles were searched (to week 4, September 2008). Types of studies: randomised controlled trials (RCTs) comparing metformin treatment with placebo or no treatment in women with PCOS who underwent IVF or ICSI treatment. women of reproductive age with anovulation due to PCOS with or without co-existing infertility factors.Types of interventions: metformin administered before and during IVF or ICSI treatment.Types of outcome measures: live birth rate, clinical pregnancy rate, miscarriage rate, incidence of ovarian hyperstimulation syndrome (OHSS), incidence of patient-reported side effects, serum estradiol level on the day of trigger, serum androgen level, and fasting insulin and glucose levels. Two review authors independently extracted the data according to the protocol. The methods of randomisation and allocation concealment, and characteristics of the studied groups were evaluated. This review found no evidence that metformin treatment before or during assisted reproductive technique (ART) cycles improved live birth or clinical pregnancy rates. The pooled odds ratio (OR) for live birth rate (3 RCTs) was 0.77 ( 95% CI 0.27 to 2.18) and for clinical pregnancy rate (5 RCTS) was 0.71 (95% CI 0.39 to 1.28). The risk of OHSS in women with PCOS and undergoing IVF or ICSI cycles was reduced with metformin (pooled OR 0.27, 95% CI 0.16 to 0.47). This review found no evidence that metformin treatment before or during ART cycles improves live birth or pregnancy rates. The risk of OHSS in women with PCOS and undergoing IVF or ICSI cycles was reduced with metformin. Further large RCTs are necessary to definitively answer if the use of metformin in PCOS women undergoing ART improves live birth and pregnancy rates.

Study question Could the diagnosis of adenomyosis (AD) impact reproductive outcomes when applying the revised Morphological Uterus Sonographic Assessment (MUSA) criteria in fresh donor oocyte cycles? Summary answer Adenomyosis diagnosis following the revised MUSA criteria in recipients did not have adversely affect reproductive outcomes in fresh donor oocyte recipients pretreated with GnRH agonist What is known already Prior metanalysis on IVF outcomes in patients with adenomyosis suggested lower clinical pregnancy and live birth rates, and increased miscarriage rates. Some studies suggest improved pregnancy rates with ultra-long GnRH agonist pretreatment. Most studies focused on autologous embryo transfer without euploidy confirmation, and diagnostic criteria lacked consensus, in 2021 MUSA redefined criteria distinguishing direct and indirect features with different implications. Study design, size, duration A retrospective cohort study included all fresh oocyte donation cycles from January 2014 to September 2023, evaluating adenomyosis impact on implantation rate, clinical pregnancy rate, miscarriage rate, ectopic pregnancy rate. The study analyzed 252 cycles without a formal sample size calculation due to its retrospective nature. Participants/materials, setting, methods The study included 252 first fresh oocyte reception cycle with a fresh embryo transfer. Severe male factor cases were excluded. A transvaginal ultrasound (TUS) screening for adenomyosis criteria was performed, diagnosis required at least two criteria, with one being direct. Endometrial preparation involved one dose of 3,75mg triptorelin acetate intramuscularly injected in mid luteal phase, to facilitate the synchronization with donor and estradiol patches. Main results and the role of chance Adenomyosis was diagnosed in 10,7% (AD), endometriosis (END) was present in 21,8 % and 26,6% of patients presented both diagnoses. Endometriosis patients received more pre-treatment (oral contraceptive or 2-3 long-agonist doses) than those without (40,7% AD, 43,6% END vs 17,3% non-AD/END). Comparing patients with and without adenomyosis, no statistical differences were found in embryo transfer results between groups: clinical pregnancy rate (63% vs 56,9%), miscarriage rate (23,5% vs 14,1%), ectopic pregnancy rate (11,8% vs 4,7%) and live birth rate (40,7% vs 45,8%). No differences in gestational outcomes were observed in terms of the number of adenomyosis criteria present, the number of direct criteria, the type of criteria, or when differentiating between focal and diffuse adenomyosis. Similarly, there were no differences when comparing patients with both diagnoses to those with isolated adenomyosis. The most prevalent adenomyosis features reported were hyperechogenic islands (direct criteria), followed by an irregular junctional zone and asymmetrical wall thickening (indirect criteria). Finally, no differences were found in perinatal outcomes or complications during the pregnancy follow-up between groups. Limitations, reasons for caution Although this is the largest serie evaluating adenomyosisto the low adenomyosis prevalence in our population, these results should be confirmed in larger series. In our center all adenomyosis/endometriosis symptomatic patients are under medical treatment before assisted reproduction techniques, that may modify adenomyosis criteria over time and probably pregnancy outcomes. Wider implications of the findings This is the first study to characterize adenomyosis using the revised MUSA definitions in an oocyte donation programme. Applying these criteria and preparing endometrium with GnRH analog pretreatment and treating medically symptomatic patients before ART, adenomyosis did not adversely affect reproductive outcomes. Trial registration number Not applicable

ObjectivesTo explore the incidence of retained embryos (REs) in embryo transfer (ET) cycles and its effects on pregnancy outcomes in women undergoing in vitro fertilization (IVF).MethodsThis was a matched retrospective cohort study involving 29,160 ET cycles conducted from March 2016 to February 2021, in which ET cycles without RE were matched to the RE group at a 2:1 ratio. Clinical pregnancy, implantation, miscarriage, and live birth rates were compared between the with-RE and without-RE groups.ResultsOur study showed that the overall incidence of REs was 0.33% (95/29,160). There was a statistically significant difference in RE rate among the operators (P < 0.001), suggesting that the embryo retention rate may be affected by the individual operator. A total of 95 repeated ET cycles due to RE were included in the study group, and 190 ET cycles without RE were matched to the study group (1:2). There were no significant differences between the RE and matched groups in terms of implantation rate (35.6 vs. 38.0%; P = 0.608), clinical pregnancy rate (47.4 vs. 54.7%; P = 0.240), biochemical pregnancy rate (5.3 vs. 4.7%; P = 0.846), miscarriage rate (11.1 vs. 9.6%; P = 0.781), ectopic pregnancy rate (2.2 vs. 1.9%; P = 1.000) or live birth rate (41.1 vs. 48.9%; P = 0.208).ConclusionsThe present findings demonstrated that immediate retransfer of REs did not significantly affect IVF outcomes, which may provide counselling information for patients when REs are identified and ET is reattempted. The incidence of REs was associated with the operator who expelled the embryos from the catheter. Attention to detail and frequent assessment of the operator’s technique may facilitate avoidance of embryo retention.

Study question Is there a seasonal influence on fresh in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment outcomes? Summary answer Season does not seem to affect live birth rate, clinical pregnancy rate or miscarriage rate after fresh IVF/ICSI treatment. What is known already Seasonal variations in human natural conception and birth rates are well described. However, the impact of seasonal variation on IVF outcomes has not yet been clarified and conflicting reports have been published. Study design, size, duration Nationwide, register-based cohort study including all first time fresh IVF/ICSI treatments (n = 52 788) leading to oocyte pick up (OPU) in Sweden between 2009 and 2018. Participants/materials, setting, methods First time fresh IVF/ICSI cycles leading to OPU were identified in the National Quality Registry of Assisted Reproduction (Q-IVF). Data collected included patient characteristics, information about the treatment cycle and pregnancy outcome. The patients were divided into season subgroups based on the date for OPU. The primary outcomes of the study were live birth per OPU and per embryo transfer (ET), clinical pregnancy per ET and miscarriage per clinical pregnancy. Logistic regression was performed. Main results and the role of chance The impact of seasons on the outcome of first time fresh IVF/ICSI cycles leading to OPU was assessed. A statistically significant overall seasonal influence was seen on live birth rate per OPU in the unadjusted analysis (p =0.036), where cycles performed in summer showed lower live birth rate (OR 0.92, 95% CI 0.87-0.97, p =0.004) compared with the other seasons. After adjustment for relevant confounders the overall impact of seasons on live birth rate was no longer statistically significant (p =0.10). Although post-hoc analyses still showed lower live birth rate in summer compared with the other seasons (OR 0.93, 95% CI 0.88-0.99, p =0.019). The impact of seasons on clinical pregnancy rate, miscarriage rate and live birth rate was further assessed through the analysis of the first cycles where ET was performed. No overall statistically significant seasonal influence was seen on clinical pregnancy, miscarriage and live birth rates after adjustment for confounders. Limitations, reasons for caution Possible limitations are the retrospective design of the study and the lack of adjustment for other important confounders i.e. cause of infertility, not included in Q-IVF. Wider implications of the findings This large cohort study shows a lack of seasonal influence on live birth-, clinical pregnancy- and miscarriage rate after fresh IVF/ICSI treatment. In the clinical setting, season should not be taken into consideration when planning and performing fresh IVF/ICSI. Trial registration number non applicable

Gonadotropin-releasing hormone agonist to induce final oocyte maturation prevents the development of ovarian hyperstimulation syndrome in high-risk patients and leads to improved clinical outcomes compared with coasting

ObjectiveTo examine the impact of ethanol sclerotherapy (EST) for endometrioma on in vitro fertilization (IVF) cumulative live birth rates (CLBR) in women with moderate-severe endometriosis.MethodsThis retrospective cohort study included women with moderate-severe endometriosis (revised American Fertility Society stage III-IV) and endometrioma who underwent IVF with the ultra-long agonist protocol. We compared two groups: women undergoing EST for endometrioma before IVF (EST group), and women whose endometrioma was left in situ during IVF (No-EST group). The primary outcome was the CLBR per IVF cycle, including fresh and frozen embryo transfers. The secondary endpoints included the complication rate, number of mature oocytes retrieved, clinical pregnancy rate and pregnancy loss rate.ResultsSeventy-four women were included in the study, with 37 in the EST group and 37 in the No-EST group, representing 67 and 69 IVF cycles, respectively. The population and cycle characteristics were comparable between the two groups, especially the ovarian response to stimulation. The CLBR was significantly increased in the EST group compared to the No-EST group (31.3% vs. 14.5%, p = 0.03). The clinical and biochemical pregnancy rates were significantly increased in the EST group (37.3% vs. 15.9%, p = 0.01 and 43.3% vs. 23.2%, p = 0.01, respectively). Multivariate analysis revealed a significantly increased chance of live birth in women exposed to EST before IVF with an adjusted OR of 2.68 (95% confidence interval, CI: 1.13–6.36, p = 0.02). In the EST group, we reported one major complication Clavien and Dindo classification grade III, complication involving an ovarian abscess that required a laparoscopic drainage.ConclusionsEST is an interesting technique to improve IVF success rates in women with moderate-severe endometriosis. EST could be discussed before IVF in infertile women.

Recombinant FSH increases live birth rates as compared to clomiphene citrate in intrauterine insemination cycles in couples with subfertility: a prospective randomized study

Outcomes of assisted reproductive technology after radical abdominal trachelectomy for early-stage cervical cancer

Toward single embryo transfer policy