Effect of different starting doses of FSH on laboratory and clinical outcomes in patients with moderate AMH level

BACKGROUND

IVF and ICSI-ET are widely used ART for addressing infertility which have been developed and improved over the last four decades. COS is a crucial step in IVF/ICSI-ET, whereby medications stimulate the ovaries to produce multiple eggs. The success of the procedure depends on the number of eggs retrieved, and individualized ovarian stimulation protocols based on factors like age and ovarian reserve can optimize the chances of obtaining mature oocytes. The optimal starting dose of FSH at moderate AMH levels remains a topic of debate., tThis study aims to compare different starting doses of FSH in clinical outcomes by analyzing data from a single center.

METHODS

This retrospective study collected clinical material from patients with moderate AMH levels at 1.2 ~ 4.5 ng/mL who received IVF/ICSI-ET under a follicular phase long protocol from July 2018 to December 2021 at Guiyang Maternal and Child Health Care Hospital, China. The patients' clinical data were retrieved from the hospital's software database and divided into two groups based on FSH starting dose, as follows: lower starting dose group: FSH ≤ 150 IU; and higher starting dose group: FSH > 150 IU. Multiple laboratory and clinical outcomes were compared between the two groups.

RESULTS

A total of 1784 patients with moderate serum AMH levels who received IVF/ICSI-ET under a follicular phase long protocol were enrolled based on eligibility criteria. In the population with moderate AMH levels, a lower starting dose of FSH might have more benefit than a higher starting dose in numbers of follicles with diameters ≥ 14 mm and < 16 mm, ≥ 16 mm and < 18 mm, and ≥ 18 mm; numbers of retrieved oocytes, 2PNs, transferable embryos, high-quality embryos, and cleavage stage embryos transferred; and clinical pregnancy rate, intrauterine pregnancy rate, and parturition rate. Moreover, rFSH had a statistically significantly higher number of oocytes retrieved, number of 2PNs, and number of transferable embryos than that of patients who received uFSH.

CONCLUSIONS

The starting dose of FSH in the moderate AMH population remains controversial and a higher starting dose may not lead to more benefit in laboratory and clinical outcomes.

Gut Microbiota-Derived Short Chain Fatty Acids Are Associated with Clinical Pregnancy Outcome in Women Undergoing IVF/ICSI-ET: A Retrospective Study

Gut microbiota and its metabolites are related to the female reproductive system. Animal experiments have demonstrated the relationship between gut microbiota-derived short chain fatty acids (SCFAs) and embryo quality. However, few studies have linked SCFAs to clinical pregnancy outcomes in humans. This retrospective cross-sectional study recruited 147 patients undergoing in vitro fertilization or intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) (70 with no pregnancies and 77 with clinical pregnancies). The association between SCFAs levels and clinical pregnancy outcomes was evaluated using univariate and multivariate logistic regression analyses. The association between SCFAs and metabolic parameters was analyzed using a linear regression model. Receiver operating characteristic (ROC) curve analysis was used for assessing the efficiency of SCFAs to evaluate the clinical pregnancy outcomes. Fecal propionate levels were significantly higher in the no pregnancy group than in the clinical pregnancy group (p < 0.01). Fecal acetate and butyrate levels were not significantly different between females with and without clinical pregnancies (p > 0.05). There were positive relationships between fecal propionate levels and fasting serum insulin (FSI) (r = 0.245, p = 0.003), Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) (r = 0.276, p = 0.001), and triglycerides (TG) (r = 0.254, p = 0.002). Multivariate analyses determined that fecal propionate (OR, 1.103; 95% CI, 1.045-1.164; p < 0.001) was an independent risk factor for no pregnancies. The area under the ROC curve (AUC) of fecal propionate was 0.702 (p < 0.001), with a sensitivity of 57.1% and a specificity of 79.2%. High fecal propionate concentration has a negative association on clinical pregnancy outcomes and is positively correlated with FSI, TG, and HOMA-IR.

Women undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) might benefit from maintaining serum luteinizing hormone levels: A retrospective analysis

We aimed to evaluate the effect of serum luteinizing hormone (LH) levels on human chorionic gonadotropin (HCG) injection day (LH_HCG) on outcomes of in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) patients. It is a retrospective cohort study involving 620 women who had an IVF cycle in Taizhou Hospital Affiliated to Wenzhou Medical University between 2018-2020. The participants were divided into different groups according to LH_HCG level and age. The clinical data and outcomes were compared between groups. The numbers of follicles (≥ 14 mm) on HCG day, retrieved oocytes, mature oocytes, and two pronuclei (2PN) embryos in women with LH_HCG < 2 IU/L were more than those with LH_HCG ≥ 2 IU/L. Women with LH_HCG < 2 IU/L had lower high-quality embryo rate (42.2% vs. 46.5%, p = 0.002) and implantation rate (40.0% vs. 58.8%, p = 0.044) compared to those with LH_HCG ≥ 2 IU/L. When LH_HCG < 2 IU/L, there was no significant difference in implantation rates in patients < 35 years compared to those ≥ 35 years. When LH_HCG ≥ 2 IU/L, patients < 35 years old had higher implantation rates (71.7% vs. 41.2%, p < 0.001) compared to those ≥ 35 years old. The success rates of IVF fertilization and ICSI fertilization and biochemical and clinical pregnancy rates were not significantly different between groups. Our results demonstrated that women undergoing IVF/ICSI-ET might benefit from maintaining LH_HCG levels at ≥ 2 IU/L. In addition, age might associate with LH_HCG levels and be a better determining factor of the transfer outcome than serum LH_HCG levels for IVF/ICSI-ET.

Does vitamin D level associate with pregnancy outcomes in Chinese women undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer? A retrospective cohort study

AIM

To explore the relationship between serum 25(OH)D level and pregnancy outcomes (clinical pregnancy rate [CPR] and live birth rate [LBR]) in Chinese women receiving in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI)-embryo transfer (ET) (IVF/ICSI-ET).

METHODS

A total of 612 patients included in the study were divided into four cohorts according to serum 25(OH)D with the threshold of 20 ng/ml, 25 ng/ml, 30 ng/ml, and retrospectively analyzed.

RESULTS

None of the baseline characteristics of participants was significantly different in the four cohorts except gravid status. The trend of 25(OH)D concentration was positively correlated with CPR and LBR. The younger (age: p < 0.001 both in CPR and LBR) women with primary infertility (infertility type: p = 0.004 in LBR) were more likely to get a better pregnancy outcome under the same 25(OH)D concentration stages. As shown on heatmap plots, CPR, and LBR were significantly increased for 25(OH)D concentrations above 30.00 ng/ml and women younger than 30 years old. The adjusted binary logistic regression and restricted cubic spline (RCS) showed that there existed a nonlinear positive correlation between 25(OH)D concentration and pregnancy outcome (CPR and LBR) (P_nonlinear  < 0.001, respectively). The women with a sufficient 25(OH)D concentration (30 ng/ml) had 1.07 (clinical pregnancy) and 1.05 (live birth) times higher successful birth outcomes compared to women with an insufficient 25(OH)D concentration (25 ng/ml). (OR_{25 ng/ml, ref = 30 ng/ml} [95% CI] = 0.935 [0.932-0.938] and 0.947 [0.945-0.950], p < 0.001, respectively).

CONCLUSION

In Chinese women receiving IVF/ICSI-ET, the serum level of 25(OH)D demonstrated a nonlinear positive correlation with pregnancy outcomes (CPR and LBR), with stronger correlations above 25 ng/ml and worse yields below 30 ng/ml. However, it could not yet be considered different in distinct ages.

Association of MTHFR 677C>T polymorphism with pregnancy outcomes in IVF/ICSI-ET recipients with adequate synthetic folic acid supplementation

Methylenetetrahydrofolate reductase (MTHFR) genetic polymorphism rs1801133 (677C>T) will decrease the utilization of folate. Folate deficiency and its resulting homocysteine (HCY) accumulation can impair female fertility. Folic acid (FA) supplementation is necessary in pregnant women who are undergoing in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) - embryo transfer (ET), and especially in women with MTHFR rs1801133 C-to-T mutations. At present, affordable and accessible synthetic FA is mainly used. However, some studies have suggested that 5-methylenetetrahydrofolate (5-MTHF), a type of active FA, may be more suitable for women with the MTHFR 677C>T polymorphism, since it is safer and more effective. This retrospective study aimed to evaluate whether the MTHFR rs1801133 gene polymorphism is related to the pregnancy outcomes of IVF/ICSI-ET recipients after sufficient supplementation with FA instead of 5-MTHF. Data on 692 women undergoing IVF/ICSI-ET and taking adequate FA were collected. Participant characteristics were compared using the Kruskal-Wallis test and Pearson chi-square test. Logistic regressions were used to calculate the odds ratio (OR) and 95% confidence interval (95% CI), after adjusting for age, BMI, method of fertilization, method of embryo transfer and number of embryos transferred. An additive model (T/T vs. C/C), dominant model (C/T + T/T vs. C/C), and recessive model (T/T vs. C/T + C/C) were evaluated. Analysis revealed that MTHFR rs1801133 in IVF/ICSI-ET women with adequate FA supplementation was not associated with the pregnancy rate but with age (OR = 0.91, 95% CI = 0.88, 0.94, P < 0.001) and BMI (OR = 0.95, 95% CI = 0.90, 0.997, P = 0.037). In 349 clinically pregnant women, no association of the MTHFR 677C>T with pregnancy outcomes was found in the additive model, dominant model, or recessive model. Of the 273 women with positive pregnancy outcomes, 34 had a preterm delivery. MTHFR 677C>T was not associated with a preterm delivery after adjusting for age and BMI. The current results indicated that MTHFR polymorphism rs1801133 was not related to the pregnancy rate or pregnancy outcomes of women undergoing IVF/ICSI-ET with adequate synthetic FA supplementation, suggesting that simple supplementation with less expensive and readily available FA, rather than expensive 5-MTHF, appeared to be appropriate.

Homeostatic Model Assessment for Insulin Resistance Is Associated With Late Miscarriage in Non-Dyslipidemic Women Undergoing Fresh IVF/ICSI Embryo Transfer

OBJECTIVE

To evaluate the associations between homeostatic model assessment for insulin resistance (HOMA-IR) and pregnancy outcomes in non-dyslipidemic infertile women undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET).

MATERIALS AND METHODS

This is a retrospective study involving 3,615 non-dyslipidemic infertile women who attend to the Reproductive Medicine Center of Xiangya Hospital, Central South University (CSU) between January 2014 and October 2021. Eligible participants were divided into three groups according to the quartiles of HOMA-IR: Group 1 (HOMA-IR <1.46), Group 2 (1.46 to <2.71) and Group 3 (HOMA-IR ≥2.71). Baseline data, clinical characteristics during the assisted reproductive technology (ART) procedure, pregnancy, and neonatal outcomes were compared among the three groups. Subgroup analysis based on presence or absence of the polycystic ovary syndrome (PCOS) status was also performed to analyze the effects of HOMA-IR among non-PCOS populations.

RESULTS

The late miscarriage rate and percentage of macrosomia increased with the HOMA-IR group (for late miscarriage rate: 2.23% vs. 3.04% vs. 7.35%, P<0.001; for macrosomia: 0.21% vs. 1.70% vs. 3.23%, P=0.002). Increased HOMA-IR (HOMA-IR≥2.71) was positively associated with late miscarriage (crude OR 3.50, 95% CI 1.64-7.47, P=0.001; adjusted OR 3.56, 95% CI 1.56-8.15, P=0.003). In the subgroup analysis, there were 3,165 participants in the non-PCOS group and 450 were assigned to the PCOS group. Late miscarriage rate increased with the HOMA-IR group among non-PCOS populations (2.20% vs. 3.03% vs. 7.67%, P<0.001). Late miscarriage rate of PCOS women were comparable among the three HOMA-IR groups (2.50% vs. 3.06% vs. 5.71%, P=0.634). Among non-PCOS women, increased HOMA-IR (HOMA-IR≥2.71) was positively associated with late miscarriage (crude OR 3.71, 95% CI 1.66-8.30, P=0.001; adjusted OR 3.82, 95% CI 1.59-9.17, P=0.003).

CONCLUSIONS

Late miscarriage rate and prevalence of macrosomia increased with the HOMA-IR index. Preconception HOMA-IR is an independent risk factor for late miscarriage in normolipidemic women undergoing IVF/ICSI-ET. Controlling insulin resistance before ART might prevent the occurrence of late miscarriage and macrosomia.

Effect of miR-451 on IVF/ICSI-ET outcome in patient with endometriosis and infertility

OBJECTIVE

This study aimed to explore the effect of miR-451 on IVF/ICSI-ET outcome in endometriosis patients with infertility.

METHODS

Eighty patients with endometriosis and infertility who came to our hospital for IVF/ICSI-ET from February 2018 to November 2019 were collected as the research participants, and 66 healthy women at the same time were selected as the control group. The miR-451 and MIF expression levels in serum, tissues and cell lines of patients with endometriosis and infertility were quantitatively detected by qRT-PCR. Correlation between miR-451 and endometriosis complicated with infertility was analyzed. The effect of miR-451 on IVF/ICSI-ET outcome in those patients was assessed.

RESULTS

The miR-451 and MIF expression levels in endometriosis complicated with infertility tissues and cell lines were quantitatively detected by qRT-PCR. Compared with normal people, miR-451 was abnormally low in endometriosis complicated with infertility tissues and cell lines (P<0.001), while MIF was abnormally high (P<0.001), and the miR-451 expression was dramatically down-regulated and the MIF expression was markedly up-regulated in serum of endometriosis patients complicated with infertility. ROC analysis identified that the area under the miR-451 curve (AUC=0.9078) was >0.8, and the AUC (0.8606) of MIF was >0.8. Correlation analysis showed that the expression of miR-451 and MIF was negatively correlated in endometriosis complicated with infertility. According to miR-451 expression in endometriotic lesions, the subjects were divided into the miR-451 high expression group and miR-451 low expression group, with 40 cases in each group. The pregnancy rate after IVF/ICSI-ET in patients with endometriosis and infertility with high expression of miR-451 was higher than that in those with low expression (P>0.05). The incidence of complications during pregnancy after IVF/ICSI-ET in patients with endometriosis and infertility with high expression of miR-451 was lower than that in those with low expression (P>0.05). The pregnancy outcome after IVF/ICSI-ET in the miR-451 high expression group was better than that in the miR-451 low expression group (P<0.05).

CONCLUSION

miR-451 was down-regulated in endometriosis patients complicated with infertility, and low expression of miR-451 after IVF/ICSI-ET indicated a poor outcome.

Predicting Ectopic Pregnancy Using Human Chorionic Gonadotropin (hCG) Levels and Main Cause of Infertility in Women Undergoing Assisted Reproductive Treatment: Retrospective Observational Cohort Study

Background

Ectopic pregnancy (EP) is a serious complication of assisted reproductive technology (ART). However, there is no acknowledged mathematical model for predicting EP in the ART population.

Objective

The goal of the research was to establish a model to tailor treatment for women with a higher risk of EP.

Methods

From December 2015 to July 2016, we retrospectively included 1703 women whose serum human chorionic gonadotropin (hCG) levels were positive on day 21 (hCG21) after fresh embryo transfer. Multivariable multinomial logistic regression was used to predict EP, intrauterine pregnancy (IUP), and biochemical pregnancy (BCP).

Results

The variables included in the final predicting model were (hCG21, ratio of hCG21/hCG14, and main cause of infertility). During evaluation of the model, the areas under the receiver operating curve for IUP, EP, and BCP were 0.978, 0.962, and 0.999, respectively, in the training set, and 0.963, 0.942, and 0.996, respectively, in the validation set. The misclassification rates were 0.038 and 0.045, respectively, in the training and validation sets. Our model classified the whole in vitro fertilization/intracytoplasmic sperm injection–embryo transfer population into four groups: first, the low-risk EP group, with incidence of EP of 0.52% (0.23%-1.03%); second, a predicted BCP group, with incidence of EP of 5.79% (1.21%-15.95%); third, a predicted undetermined group, with incidence of EP of 28.32% (21.10%-35.53%), and fourth, a predicted high-risk EP group, with incidence of EP of 64.11% (47.22%-78.81%).

Conclusions

We have established a model to sort the women undergoing ART into four groups according to their incidence of EP in order to reduce the medical resources spent on women with low-risk EP and provide targeted tailor-made treatment for women with a higher risk of EP.

The Association Between Previous TORCH Infections and Pregnancy and Neonatal Outcomes in IVF/ICSI-ET: A Retrospective Cohort Study

Objective: This study aimed to investigate the associations between previous TORCH infection (cytomegalovirus, toxoplasmosis, herpes simplex virus, and rubella) with pregnancy and neonatal outcomes in couples undergoing IVF/ICSI-ET. Materials and Methods: A total of 18,074 couples underwent fresh IVF/ICSI-ET (in vitro fertilization/intracytoplasmic sperm injection-embryo transfer) cycles were included in our analyses. TORCH infection status was determined by serological confirmation of cytomegalovirus, toxoplasmosis, herpes simplex virus, and rubella IgG in the absence of IgM antibodies. Clinical pregnancy, ectopic pregnancy, miscarriage, live birth, preterm birth, congenital malformation, and perinatal death were evaluated in both infection and non-infection group. Multivariate logistic regression was applied to calculate odds ratio. Results: Previous toxoplasmosis infection is associated with a significantly decreased preterm birth rate [P = 0.045, OR = 0.755 (95% CI, 0.571-0.997), Adjusted OR = 0.749 (95%CI, 0.566-0.991)]. No differences in clinical pregnancy, ectopic pregnancy, miscarriage, and perinatal death were observed between the corresponding TORCH infection group [IgM (-) IgG(+)] and the non-infection group [IgM (-) IgG (-)]. Conclusions: Previous TORCH infections were not associated with adverse pregnancy and neonatal outcomes in IVF/ICSI-ET overall, and toxoplasmosis infection might be associated with a lower preterm birth rate in patients underwent IVF/ICSI-ET. The necessity of TORCH IgG screening in IVF procedure might need re-evaluation, and further cost-effective analysis might be helpful for the clinical management strategy.

Assessing predictors for the success of GnRH antagonist protocol in reproductive women in IVF/ICSI - in fresh cycles

The aim of the present study was to evaluate the factors that affect the success rate of gonadotropin-releasing hormone antagonist on in vitro fertilization/intracytoplasmic sperm injection cycles. Multivariate analysis was performed to assess the factors that influence the outcomes, such as oocytes retrieved, and the success of pregnancy. The results showed that E₂, P on human chorionic gonadotropin (HCG) day and body mass index (BMI) were positively correlated with the number of oocytes retrieved (P=0.001, P=0.024, P=0.017, respectively). The duration of infertility as well as the luteinizing hormone on HCG day were negatively correlated with the number of oocytes (P=0.048, P=0.002, respectively). The age of the women and P on HCG day were negatively correlated with successful pregnancy (P<0.001, P=0.022). In conclusion, some parameters, such as E₂, P, and LH on the HCG day, as well as age and BMI, may affect treatment outcomes.

The degree of serum estradiol decline in early and midluteal phase had no adverse effect on IVF/ICSI outcome

BACKGROUND:

Estradiol levels fall rapidly in the luteal phase of ART cycles. So far, the effect of this estradiol decline on pregnancy outcome has remained controversial.

AIM:

To study the effect of early and midluteal estradiol decline on pregnancy and miscarriage rate. We also sought to determine whether estradiol fall was related to increased risk of bleeding per vagina in the first trimester among pregnancies which crossed 12 weeks.

SETTING:

Tertiary Assisted conception center.

DESIGN:

Retrospective study.

MATERIALS AND METHODS:

We analyzed data of 360 consecutive patients who underwent IVF-ET/ICSI cycles using one of the three protocols: Midluteal downregulation, short flare, and antagonist protocol.

STATISTICAL METHODS:

Statistical evaluation was performed with the Student's t test, Chi square, Fischer's exact test, analysis of variance, and Mann-Whitney tests were appropriate using SPSS for Windows, Standard version 11.0.

RESULTS:

The mean % EL-E2 and % ML-E2 declines were not significantly different in the pregnant and nonpregnant groups when analyzed separately in the three protocols. Also, the degree of midluteal estradiol decline did not correlate with pregnancy outcome. Moreover, the mean % early and midluteal estradiol decline did not differ significantly in patients with preclinical, clinical abortions, and ongoing pregnancy. The estradiol decline was not found to influence the risk of bleeding in the first trimester.

CONCLUSIONS:

Our results show that the degree of estradiol fall in the luteal phase of ART cycles does not influence pregnancy and first trimester miscarriage rate.