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Objective To study the effect of patients' immunization following COVID-19 infection or mRNA SARS-CoV-2 vaccine on frozen-thawed embryo transfer (FET). Design A cohort retrospective study Setting Tertiary University Affiliated Medical Center Patients All consecutive patients undergoing FET cycles in our center. The study group (immune- group) consisted of patients treated during the COVID-19 pandemic (between January 2021 to August 2021), who either recovered from COVID-19 infection or received the mRNA SARS-CoV-2 vaccine. The control groups consisted of patients treated during the COVID-19 pandemic (between January 2021 to August 2021) but were not infected nor received the mRNA SARS-CoV-2 vaccine (not-immune2021 group) and those patients treated between January 2019 to August 2019 (prior to the pandemic) (not-immune2019 group). Intervention FET cycles Main outcome measures Ongoing pregnancy rates and FET cycles' characteristics. Data on patient age and variables related to infertility treatment were collected from the patient records. Results During the study periods, 428 patients underwent 672 FET cycles. The immune group consisted of 141 patients who underwent 264 FET cycles (44 in post-infection and 220 in post-vaccination), while the non-immune2021 and 2019 groups consisted of 93 and 194 patients, undergoing 125 and 283 FET cycles respectively. Patients' characteristics and the types of endometrial preparations were comparable between the study groups. Implantation rate, clinical and ongoing pregnancy rates per transfer were similar between the study groups (immune- group: post-infection and post-vaccination; not-immune2021 group; not-immune2019 group). Conclusions COVID-19 infection or vaccination did not affect patients' performance or implantation in their subsequent FET cycle., In the present study of patients undergoing frozen-thawed embryo transfer (FET) before and during the COVID-19 pandemic, COVID-19 immunity does not affect the immediate subsequent FET cycle outcome.

What are the cumulative clinical pregnancy rates (CPR) and live births rates (LBR) in intracytoplasmic sperm injection (ICSI) cycles using testicular motile compared with immotile spermatozoa, obtained from testicular sperm aspiration (TESA) or extraction (TESE)?A retrospective analysis of ICSI cycles using TESA or TESE over a period of 7 years. Cycles were divided into two groups according to the motility of the retrieved spermatozoa: Group A consisted of couples with motile spermatozoa; Group B of couples with immotile spermatozoa. Group B was subdivided into two groups: B1 consisted of couples with motile spermatozoa and B2 with immotile spermatozoa after the addition of pentoxifylline.No differences in CPR and LBR per transfer was found between the study groups after fresh embryo transfer. No pregnancies were achieved by vitrified-warmed embryo transfer in group B2. Fertilization rates decreased when using immotile spermatozoa (64.4%, 56%, 37.9%, for groups A, B1 and B2, respectively, P0.001). Top-quality embryo rates were higher in groups A and B1 compared with B2 (40.7% and 40.1% versus 19.1%, respectively, P = 0.015). Cumulative CPR (53%, 41.7%, 13.6% for groups A, B1 and B2, respectively, P = 0.005) and LBR (42.4%, 30%, 13.6% for groups A, B1 and B2, respectively P = 0.03) per oocyte retrieval was significantly higher when using motile spermatozoa compared with motile or immotile spermatozoa after adding pentoxifylline.Although fertilization, top-quality embryo rates, cumulative CPR and LBR decreased when using immotile spermatozoa, ICSI is still valid; therefore, it should be considered and offered to couples before embarking on a donor sperm insemination cycle, or cryopreserving oocytes for future additional testicular sperm retrieval.

Objective To assess whether the calculated difference in endometrial thickness from the end of the estrogen phase to the day of ET (after 6 days of P in hormonally prepared cycles) is associated with ongoing pregnancy rates in euploid frozen ETs (FETs). Design An observational cohort study. Setting Single tertiary care medical center. Patient(s) Ultrasound images from 234 hormonally prepared FET cycles were assessed. All the transfers were elective single ETs of a euploid embryo, post–preimplantation genetic testing for aneuploidy (PGT-A). Intervention(s) Ultrasound measurements of peak endometrial thickness at the end of the estrogen phase and again after 6 days of P at the time of ET. Main Outcome Measure(s) Ongoing pregnancy rate in relation to the delta between endometrial thickness at the end of estrogen phase and at the time of ET. Result(s) We calculated the ongoing pregnancy rate in cycles where the endometrial lining decreased (compacted) after addition of P by 5%, 10%, 15%, and 20% and demonstrated a significantly higher pregnancy rate after all rates of compaction of the endometrial lining in comparison with cycles where the endometrial lining did not compact. The ongoing pregnancy rate in this cohort, after compaction of 15% or more, was 51.5%, compared with 30.2% in cycles where the endometrial lining did not compact. Conclusion(s) There is a significant correlation between endometrial lining compaction and ongoing pregnancy rate in FET cycles of euploid embryos. These findings help to explain why some euploid embryos may fail to implant.

What is the cumulative incidence of live birth (CILB) for high-order consecutive IVF cycles, and which factors are associated with live birth in women aged ≥41 years using autologous oocytes?A retrospective cohort study including 146 patients aged 41 years to44 years who started their first IVF cycle attempt using autologous oocytes, between January 2006 and December 2013.After 13 IVF cycles, CILB reached up to 33.6%. After six IVF cycles, 42 (28.8%) women delivered a live infant (85.7% of the total live birth). Mean live birth rate per cycle declined with age at the initial cycle (8% at 41 years; 5.8% at 42 years; and 4.1% at 43 years). Multivariable modified Poisson regression models identified patient's age (RR for 41 years versus 43 years: 0.47; 95% CI 0.25 to 0.87; P = 0.01), smoking status (RR 0.21; 95% CI 0.05 to 0.08; P = 0.02), and mean number of fertilized oocytes (RR 1.23; 95% CI 1.08 to 1.39; P0.01) as factors significantly associated with the probability of a live birth.Multiple repeat IVF cycles in women aged 41-44 years offers a reasonable long-term success rate. After six cycles of treatment, about 29% of women of advanced reproductive age using autologous oocytes expected to achieve a live birth. This information might assist in fertility counselling and managing patients' expectations by adjusting the appropriate treatment strategy and number of IVF cycle attempts, especially in countries in which egg donation is prohibited or when multiple repeated IVF cycles attempts are financially affordable.

The current systematic review and meta-analysis evaluate the perinatal outcomes in twin pregnancies following multifetal pregnancy reduction (MPR) compared with non-reduced triplet pregnancies. All studies comparing perinatal outcome of twin pregnancies following MPR to non-reduced triplet pregnancies were considered. MEDLINE, non-indexed MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Web of Science were searched for relevant published articles up to August 2016. The search yielded 653 publications of which 92 were assessed for eligibility. A total of 24 studies met the inclusion criteria. Overall, the outcomes of pregnancies following MPR were better compared with expectantly managed triplets. The MPR group delivered at a later gestational age and was less likely to be delivered before 32 or 28 weeks' gestation. Newborns in the MPR group had significantly higher birthweight at delivery (mean difference 500 g [95% CI 439.95, 560.04]). Rates of pregnancy loss before 24 weeks' gestation and overall infant survival were comparable between the groups. This meta-analysis suggests that MPR of triplet pregnancies to twins is associated with improved perinatal outcome compared with non-reduced triplets. Should primary prevention of high order multiple pregnancy fail, MPR is an appropriate alternative to minimize the perinatal morbidity and mortality of triplet pregnancies.

Multifetal pregnancy reduction (MPR) is an accepted method of reducing complications of triplet pregnancies and higher-order multifetal pregnancies. Eighty-three pregnancies that underwent early (68 weeks) transvaginal MPR were compared with 125 pregnancies that underwent late (11-14 weeks) transabdominal MPR. Rates of pregnancy loss, preterm delivery, gestational diabetes and hypertensive disorders were similar among both groups. Early MPR was associated with a lower risk for small for gestational age newborns (6.5% versus 19.2%; P = 0.034; OR 0.32; 95% CI 0.11 to 0.92) and a higher risk for single-fetus loss (6% versus 0.8%; P = 0.041; OR 10.58; 95% CI 1.1 to 101.94). Preterm delivery rates seemed to be similar between the two groups. In MPR from triplets, an apparent benefit was observed for early MPR in preterm deliveries before 37 weeks, whereas, in MPR from high-order pregnancies, a benefit was observed for late MPR in deliveries before 32 weeks. Perinatal outcomes of twin pregnancies after early and late MPR seem to be grossly similar. Optimal timing for multifetal reduction depends on other factors, namely, the selectivity of the procedure and patient's preference.

Study Objective The relationship between various niche features and symptoms has not fully been elucidated. The aim of this study is to evaluate the association between the presence of niche to the presence of symptoms. Design A prospective cohort study conducted between December 2018 to March 2020. Setting Single tertiary medical center. Patients or Participants Women that underwent cesarean delivery during January 2011 to December 2018. Interventions All women were requested to arrive at the gynecological clinics. During their visit they completed questionnaire regarding symptoms related to the presence of niche (menorrhagia, spotting, pelvic pain and infertility) . A trans-vaginal 2-D ultrasound examination targeted to assess the uterine scar characteristics was performed. Primary outcome was defined as the presence of uterine niche evaluated by length, depth, residual myomtrial thickness (RMT) and the proportion between residual to adjacent myometrial thickness (RMT/AMT). Data are presented as median and Interquartile range. Measurements and Main Results Two hundred twenty-five women were included in the study. 128 (56.88%) and 97 (43.11%) were symptomatic and asymptomatic, respectively. Median time from delivery to follow-up was 16 months for both of the groups. RMT was the only measurement associated with symptoms. RMT Conclusion Residual myometrial thickness was found associated with infertility. All other niche measurements were comparable between symptomatic and asymptomatic women. Further investigation is required to strengthen this finding.

To examine whether patients with poor ovarian response (POR) during conventional IVF/intracytoplasmic sperm injection (ICSI) treatment cycle may benefit from a modified natural cycle (MNC)-IVF.Cohort historic study.Tertiary, university-affiliated medical center.One hundred eleven patients with POR, defined according to the Bologna criteria, who underwent a subsequent MNC-IVF within 3 months of the previous failed conventional IVF/ICSI cycle. The elimination of bias in this selection, for the purposes of this study, was achieved by including only a subgroup of "genuine" poor responder patients, those who yielded up to three oocytes after controlled ovarian hyperstimulation (COH) with a minimal gonadotropin daily dose of 300 IU.Modified natural cycle IVF protocol with GnRH antagonist (GnRH-a) supplementation. Gonadotropin-releasing hormone antagonist treatment was started when a follicle of 13 mm was present. Two to three ampules of hMG were coadministered daily during the GnRH-a treatment.Live birth rate, pregnancy rate (PR), number of oocytes retrieved, and number of embryos transferred.Live birth rate in "genuine" poor ovarian responders was1%. Furthermore, in the subgroup of patients with POR who underwent a previous conventional IVF/ICSI cycle with a yield of only one oocyte, no pregnancies were achieved during the MNC-IVF cycle.Modified natural cycle-IVF is of no benefit for genuine poor ovarian responders and the option of egg donation should be seriously considered for this population.

Objective To evaluate whether the change in endometrial thickness between the end of the estrogen phase and the day of embryo transfer has an impact on the pregnancy rate in frozen-thawed embryo transfer (FET) cycles. Design Retrospective observational cohort study. Setting Single tertiary care medical center. Patient(s) Ultrasound images in 274 FET cycles were reviewed. All patients underwent endometrial preparation with the use of hormonal therapy. Interventions(s) Ultrasound measurements of endometrial thickness at the end of the estrogen phase and the day of embryo transfer. Main Outcome Measure(s) The change in endometrial thickness and ongoing pregnancy rate. Result(s) We calculated the ongoing pregnancy rate in patients whose endometrial thickness decreased (compacted) after starting progesterone by 5%, 10%, 15%, or 20% compared with patients with no change or increased endometrial thickness. The ongoing pregnancy rate was significantly increased at all levels of compaction compared with no compaction. The ongoing pregnancy rate showed a significant increase with each decreasing quartile of change in thickness (increased percentage of compaction) in the progesterone phase compared with the estrogen phase. Conclusion(s) There is a highly significant inverse correlation between the ongoing pregnancy rate and the change of endometrial thickness between the end of estrogen administration and the day of embryo transfer

Early pregnancy loss is common among women treated with assisted reproduction treatment, but whether it is a prognostic factor for success in subsequent IVF cycles is not well established. The aim of this study was to determine whether a biochemical pregnancy (BP) or spontaneous abortion (SA) affects the pregnancy rates in the following cycle. A retrospective study of 2687 women undergoing 6678 cycles between January 1998 and March 2010 was performed. Ongoing pregnancy rate (PR) per cycle was compared between patients with a pregnancy loss versus a negative β-HCG in their previous cycles. Multivariate analysis of factors affecting ongoing pregnancy rate was performed. BP and/or SA in the first three cycles did not significantly alter the chances to conceive (16.9% patients with BP and/or SA in the previous cycle versus 16.5% patients with no previous pregnancy). From cycle 4 onwards, the presence of a previous abortion (either BP or SA) was associated with better ongoing PR (23.0% versus 11.2%, P

Objective To determine the efficacy of pre-emptive administration of the nonsteroidal anti-inflammatory drug (NSAID) ibuprofen vs. a placebo on pain relief during medical abortion and to evaluate whether NSAIDs interfere with the action of misoprostol. Design Prospective, double-blind, randomized, controlled study. Setting University-affiliated tertiary hospital. Patient(s) Sixty-one women who underwent first-trimester termination of pregnancy. Intervention(s) Patients received 600 mg mifepristone orally, followed by 400 μg oral misoprostol 2 days later. They were randomized to receive pre-emptively two tablets of 400 mg ibuprofen orally or a placebo, when taking the misoprostol. The patients completed a questionnaire about side effects and pain score and returned for an ultrasound follow-up examination 10–14 days after the medical abortion. Main Outcome Measure(s) Significant pain, assessed by the need for additional analgesia, and failure rates, defined by a need for surgical intervention. Result(s) Pre-emptive ibuprofen treatment was found to be more effective than a placebo in pain prevention, as determined by a significantly lower need for additional analgesia: 11 of 29 (38%) vs. 25 of 32 (78%), respectively. Treatment failure rate was not statistically different between the ibuprofen and placebo groups: 4 of 28 (14.2%) vs. 3 of 31 (9.7%), respectively. History of menstrual pain was predictive for the need of additional analgesia. Conclusion(s) Pre-emptive use of ibuprofen had a statistically significant beneficial effect on the need for pain relief during a mifepristone and misoprostol regimen for medical abortion. Ibuprofen did not adversely affect the outcome of medical abortion. Clinical Trial Registration Number NCT00997074.

birth (PTB). DESIGN: This was a retrospective case-control study of women in Iowa who conceived spontaneously and delivered between January 1, 2009 and December 31, 2010. MATERIALS AND METHODS: PTB was defined as delivery at 1 MoM), the highest probability for PTB was found in women with a stable or rising AMH levels along with an MSAFP >1 MoM. This equates to a 45% probability of PTB with an incidence rate of 15%. CONCLUSION: The change in AMH levels between the 1st and 2nd trimesters can be used as an indicator of PTB risk, and should be considered in future PTB risk models. This association does not depend on a previous history of PTB, and therefore can be used for both primiparous and multiparous women. Additional studies are needed to validate these findings and to further define the role of the ovary in early pregnancy. Supported by: The Iowa Women’s Reproductive Health Research Career Development Award and KL-2 grant, University of Iowa, 2009-2011.

OBJECTIVE: To compare the perinatal outcome of early transvaginal multifetal pregnancy reduction (MPR) from triplets to twins vs triplets to singletons. DESIGN: A prospective cohort study of 60 trichorionic triamniotic triplet pregnancies who underwent early transvaginal MPR at 7-8 weeks of gestation. The choice to reduce to twins or singleton was according to patient decision. Group 1 included 44 women who underwent MPR to twins and group 2 included 16 women, who underwent MPR to singletons. MATERIALS AND METHODS: The rates of early miscarriage, pregnancy loss before 24 weeks, preterm delivery prior to 32 weeks and 37 weeks of gestation, gestational diabetes, hypertension and IUGR were compared between the 2 groups. RESULTS: Altogether 2 pregnancies were lost before viability. In general, the outcome of triplet pregnancies reduced to twins was comparable to the outcome of triplet pregnancies reduced to singletons. The rates of pregnancy loss prior to 24 weeks of gestation, preterm delivery prior to 32 weeks and preterm delivery prior to 37 weeks were similar among both groups (4.55 vs 0, 2% vs 0 and 47% vs 37.5% respectively). Similarly, there was no significant difference in the incidence of gestational diabetes (13% vs 6%), hypertension (18% vs 18%) and IUGR (2% vs 0) between the 2 groups. CONCLUSION: The outcome of triplet pregnancies reduced to twins did not differ from that of triplets reduced to singeltons. This information should be taken into account when counseling couples with triplet pregnancies, who consider early transvaginal MPR.