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PGT-A, what’s it for? Considering the increase in fetal aneuploidies with a woman’s age and the high number of miscarriages associated with fetal karyotype anomalies, the concept of selecting IVF embryos based on their karyotype in order to transfer only euploid embryos and eliminate aneuploid ones was proposed. Preimplantation genetic testing for aneuploidy (PGT-A) was then established, nearly 30 years ago, with the expectation that the transfer of euploid embryos would lead to a significant improvement in medically assisted reproduction (MAR) outcomes. PGT-A, what’s wrong? Despite the practice and widespread use, PGT-A has not consistently proven its effectiveness. The clinical value of PGT-A remains controversial. The initial studies reported an increase in MAR outcomes. However, these studies used embryo transfer as the reference point. More recent studies, which use intention-to-treat as the reference point, show, at best, slight improvements and, at worst, a reduction in the considered IVF outcomes. In this article, we attempt to answer two key questions: “What is it for?” and “What’s wrong with PGT-A?”. We also explore some of the ethical issues raised by these conclusions. Ultimately, we suggest that PGT-A should no longer be offered to infertile couples. [ABSTRACT FROM AUTHOR]

International research has consistently identified that care-experienced young women are disproportionately likely to become mothers at an early age and benefit from the availability of comprehensive services and supports. This study addresses a paucity of prevalence data in the Australian context by identifying and describing the population of young mothers, aged 15–24, who spent time in out-of-home care (OOHC) in New South Wales between 2009 and 2019. It also makes a novel contribution to the literature by identifying placement patterns during and after first pregnancies. Main findings include that care-experienced young women are three times more likely to give birth than their peers in the majority population and report high rates of smoking during pregnancy and receipt of fewer than the recommended number of prenatal health care visits. The findings also indicate that pathways into motherhood from OOHC are often marked by instability and uncertainty, consisting of frequent perinatal placement changes and exits from OOHC during pregnancy. This indicates that targeted interventions are needed to promote placement stability and supported transitions from OOHC to enhance the health and well-being of care-experienced young mothers and their babies. Directions for future research include the identification of variables associated with perinatal placement stability, consistent healthcare usage, and smoking cessation. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate pregnancy rates, time to pregnancy (TTP) and obstetric outcomes in female childhood cancer survivors (CCSs) and to identify specific diagnosis- and treatment-related factors associated with these outcomes. Methods: The study is part of the DCOG LATER-VEVO study, a nationwide multicenter cohort study evaluating fertility among long-term Dutch female CCSs. Data were collected by questionnaire. The current study included 1095 CCSs and 812 controls, consisting of sisters of CCSs and a random sample of women from the general population. Results: Among the subgroup of women who ever had the desire to become pregnant, the chance of becoming pregnant was significantly lower for CCSs than controls (OR 0.5, 95%CI 0.4–0.8). Moreover, TTP was 1.1 times longer for CCSs compared to controls (p = 0.09) and was significantly longer in survivors of CNS and renal tumours. Overall, no differences were found between CCSs and controls regarding the probability of ever having had a miscarriage, still birth, or induced abortion. However, CCSs had a significantly increased risk of delivering preterm (OR 2.2, 95%CI 1.3–3.7) and delivering via caesarean section (OR 1.8, 95%CI 1.2–2.6). Treatment with lower abdominal/pelvic radiotherapy was strongly associated with several adverse obstetric outcomes. Conclusion: CCSs are less likely to have ever been pregnant. Among those who do become pregnant, certain subgroups of CCSs are at increased risk of longer TTP. Moreover, as pregnant CCSs, especially those treated with lower abdominal/pelvic radiotherapy, are more likely to develop various adverse obstetric outcomes, appropriate obstetric care is highly advocated. [ABSTRACT FROM AUTHOR]

A study was conducted to compare conception rates in 71 Tuli and 86 Afrikander beef cattle bred using either artificial insemination (AI) or the bull. Animals were bred using either artificial insemination or natural service at Matopos Research Station. Animals were grouped into three groups of heifers (parity 0; P0), second calvers (parity 1; P1) and mature cows (parity 2; P2) before being randomly assigned to one of the two breeding methods. A binary logistic regression was used for statistical analysis where breeding method (AI vs natural service) was the treatment factor and conception rate was the measured response while breed, parity and last calving date were non-treatment factors. No significant differences were observed in conception rates between breeds (P > 0.05). However, the method of breeding animals, parity and calving interval affected (P < 0.05) conception rates. The breeding method, parity and calving interval had a positive Kendall's tau-b correlation coefficients to conception. More animals were pregnant when AI (77.6%) was used compared with natural mating (56.79%). Conception rates were significantly lower (P < 0.05) in C1 compared with C2 cattle. The odds ratio for breeding method and parity are positive and significant (P < 0.05). In conclusion, the study confirms that artificial inseminated animals had similar conception rates to naturally serviced animals for both Tuli and Afrikander breeds. As such, artificial insemination technology can be used to complement or substitute natural service in indigenous cattle's of Zimbabwe. [ABSTRACT FROM AUTHOR]

Purpose: We investigated if automated TLI selection may be a valuable strategy to identify those euploid embryos with the best chances of success.Methods: This is a unicentric and retrospective study involving 244 patients undergoing preimplantational genetic screening (PGS) cycles with autologous oocytes or oocyte donation (OD) with single euploid embryo transferred. We examined euploid embryos selected for transfer based on morphology evaluation alone (PGS-only; control group) or by assessment using an automated TLI system (Eeva™; PGS-TLI group).Results: In both, autologous oocytes and OD patients, significantly better implantation and clinical and ongoing pregnancy rates were obtained in the PGS-TLI group when euploid embryos with high implantation potential as predicted by the automated TLI System (Eeva™) were transferred compared with the PGS-only group. This improvement was also observed when only transfers of good morphological quality embryos were compared. TLI categories showed significant differences on blastocyst formation and euploidy rate.Conclusions: Automated TLI combined with PGS is a useful prognostic tool to identify euploid embryos with the highest potential for implantation and pregnancy. Further, these results provide evidence that a healthy pregnancy does not only depend upon normal chromosomal status. [ABSTRACT FROM AUTHOR]

Purpose: Advances in reproductive techniques, mainly the introduction of oocyte vitrification, have provided the opportunity to conceive from oocyte banks. The aim of this study was to compare the clinical outcomes of fresh and vitrified oocytes in an egg donation program following blastocyst transfer. Methods: This retrospective observational study included 504 oocyte donation cycles. All donor women were younger than 30 years of age. The recipient cycles were divided into two groups: fresh oocytes ( n = 78) or vitrified oocytes ( n = 426). All oocytes were fertilized by ICSI using ejaculated sperm, followed by blastocyst transfer. Endometrium preparation was performed with estradiol valerate plus micronized progesterone according to standard protocols. Results: Recipients were of similar age (fresh 42.0 ± 4.5 years vs vitrified 41.8 ± 4.8 years; p = 0.790). The fresh group received more mature oocytes for injection compared to the vitrified group (10.1 ± 2.8 vs 9.2 ± 2.2; p = 0.005). The two pronuclei (2PN) rate (74.5 vs 77.4%; p = 0.195) and blastocyst rate (48.8 vs 51.6%; 0.329) were similar between the fresh and vitrified groups, respectively. The rates of clinical pregnancy were 60.9% in the fresh and 59.0% in the vitrified groups ( p = 0.771). Conclusions: Our findings suggest that vitrified oocytes result in similar pregnancy rates when compared to fresh oocytes with blastocyst transfer in an egg donation program. Moreover, vitrified oocytes may allow for a better cycle schedule, starting with a lower number of oocytes to be fertilized. Therefore, we hypothesize that egg banks with vitrified oocytes could be safely utilized in an egg donation program. [ABSTRACT FROM AUTHOR]

Purpose: The study aims to describe two promising therapeutic options for resistant 'thin' endometrium in fertility treatment: granulocyte colony-stimulating factor (G-CSF) and stem cell therapy. Methods: A review of the scientific literature related to patients with thin endometrium undergoing fertility treatment. Results: Sufficient endometrial growth is fundamental for embryo implantation. Whether idiopathic or resulting from an underlying pathology, a thin endometrium of <7 mm is associated with lower probability of pregnancy; however, no specific thickness excludes the occurrence of pregnancy. We specifically reviewed two relatively new treatment options for resistant thin lining: intrauterine G-CSF and stem cell therapy. The majority of the reviewed trials showed a significant benefit for intrauterine G-CSF infusion in improving endometrial thickness and pregnancy rates. Early results of stem cell therapy trials seem promising. Conclusions: EMT <7 mm is linked to lower probability of pregnancy in assisted reproductive technology. Intrauterine G-CSF infusion appears to be a potentially successful treatment option for resistant cases, while stem cell therapy seems to be a promising new treatment modality in severely refractory cases. [ABSTRACT FROM AUTHOR]

This review addresses the misplaced facts about the IUI procedure within a lucrative fertility industry. Evidence suggests IUI must be a first-line treatment option for most couples except in cases of bilateral tubal blockage and severe oligozoospermia. We introduce the concept of using 'consecutive ejaculation' in men with subfertility and one which can radically alter the male infertility definition, thereby providing a new approach to examining and managing male factor infertility. The review also explores various aspects affecting the IUI procedure, its determinants of success, risks and areas for future improvements. Areas such as choice of patients, clinical management of patients, the type of stimulation regime, timing and the management of sperm usage have significant bearing to whether IUI will succeed. The paper asserts that IUI should be the first choice of fertility treatment. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the present study is to study the relationship between oxidative stress (OS) in semen, semen characteristics, and reproductive outcomes in oocyte donation intracytoplasmic sperm injection (ICSI) cycles. Methods: OS was measured in 132 semen samples. Results: OS levels were as follows: very high (1.5 %), high (43.2 %), low (30.3 %), and very low (25.0 %). Overall seminal parameters were as follows: volume (ml) = 4.2 (SD 2.1), concentration (millions/ml) = 61.6 (SD 59.8), motility (a+b%) = 47.4 (SD 18.0), and normal spermatozoa (%) = 8.2 (SD 5.1). Of the 101 cycles that reached embryo transfer, 55.4 % evolved in biochemical, 46.5 % in clinical, and 43.6 % in ongoing pregnancy. OS level does not relate to seminal parameters, fertilization rate, or pregnancy outcomes. Conclusions: OS testing by nitro blue tetrazolium (NBT) in fresh ejaculate might not be useful for all patients. Reproductive results with young oocytes and ICSI do not seem to be affected by OS-level semen. [ABSTRACT FROM AUTHOR]

Purpose: Anti-Müllerian hormone has a regulative function in the activation of folliculogenesis and an influence on atresia rate. It is considered a marker for the ovarian reserve. We know that a relationship exists between AMH levels and oocyte retrieval numbers, antral follicle count, pregnancy rates and birth rates. The role of AMH as an efficient prognostic factor in determining the probability of pregnancy has been largely discussed in the literature. The aim of this study is to determine the role age and AMH levels play in success rates of IVF/ICSI therapies. To date, the sample group we examined was one of the biggest ever included in a single study of the subject.Methods: All patients who underwent an IVF/ICSI treatment with FSH stimulation in the Wiesbaden Kinderwunschzentrum between 2003 and 2010, were no older than 44 years old, and had an evaluation of serum AMH levels before treatment were included in this study. In total, 1287 patients were analysed retrospectively. Statistical analysis was performed with SPSS.Results: Females' mean age was 34.89, ranging from 21 to 44 years. The patients underwent between 1 and 11 IVF cycles. Younger women had significantly higher AMH levels (p = 0.001). Patients with higher AMH levels had significantly lower break-off rates (p < 0.0005) and a significantly higher number of oocytes retrieved (p < 0.0005). Higher levels of AMH corresponded to higher pregnancy rates (p = 0.017). AMH levels do not influence pregnancy rates in younger patients (<36 years).Conclusions: AMH is a useful parameter that should be measured before performing an IVF/ICSI treatment. In younger patients, AMH levels do not predict pregnancy outcomes. In patients older than 36 years, AMH can be used as a prognostic factor. Even when a woman's AMH levels are too low to be detected, she still an acceptable chance of becoming pregnant. [ABSTRACT FROM AUTHOR]

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Copyright of Gynäkologische Endokrinologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To evaluate the influence of ultrasound guidance during intrauterine insemination (IUI) on pregnancy rates (PRs). The impacts of two different groups of providers were also investigated. Methods: Study population consisted of 387 gonadotropin stimulated IUI cycles performed for unexplained infertility. The patients were randomized into two groups as ultrasound-guided IUI ( n = 180) and classical IUI ( n = 207). Pregnancy rates were compared. Two groups were further analyzed based on the experience of the provider (senior versus junior subgroups) who performed IUI. Results: Pregnancy rates were higher in the ultrasound-guided IUI group (17.2 %) compared to the classical IUI (10.1 %) ( p = 0.042). In further analysis based on the experience of the provider; in the classical IUI group, PRs were similar for both subgroups, however, in the ultrasound-guided group it was higher when IUI was performed by a senior physician (21.7 versus 9.2 %, p = 0.033). Logistic regression revealed that the experience of the provider was the independent variable for improved PRs. Conclusions: Ultrasound guidance improves PRs only when a senior provider performs the IUI procedure. It seems that the experience of the provider physician is one of the determinants of IUI success. [ABSTRACT FROM AUTHOR]

Purpose: This prospective randomized study used sibling oocytes of 258 women with ≥8 oocytes to compare the effect of 5 % O versus 20 % O concentrations on embryo development and clinical outcome. Methods: Oocytes of each case were divided between incubators with either 5 % or 20 % O concentration. Outcome measures were fertilization, cleavage, embryo quality, blastocyst formation, and implantation, pregnancy and live birth rates. Results: Fertilization and cleavage rates were similar in both groups. The 5 % O group had significantly more blastomeres ( P < 0.05) and more top-quality embryos on day 3 ( P < 0.02), as well as significantly more available embryos for transfer (31.6 % vs. 23.1 % for the 20 % O group; P < 0.0001). There were significantly more cycles with good embryos in the 5 % group (76/258) than in the 20 % group (38/258) ( P < 0.0001). Implantation and pregnancy rates were significantly higher for 5 % O embryos ( P < 0.03 and P < 0.05, respectively). Live birth rates per embryo transfer were 34.2 % and 15.8 %, respectively, P < 0.05. Conclusions: Implantation, pregnancy and live birth rates are higher, and more good quality embryos are available for transfer and freezing with reduced rather than with atmospheric oxygen concentrations during embryo incubation. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether androgen conversion rates after supplementation with dehydroepiandrosterone (DHEA) differ, and whether differences between patients with diminished ovarian reserve (DOR) are predictive of pregnancy chances in association with in vitro fertilization (IVF). Methods: In a prospective cohort study we investigated 213 women with DOR, stratified for age (≤38 or >38 years) and ovarian FMR1 genotypes/sub-genotypes. All women were for at least 6 weeks supplemented with 75 mg of DHEA daily prior to IVF, between initial presentation and start of 1st IVF cycles. Levels of DHEA, DHEA-sulfate (DHEAS), total T (TT) and free T (FT) at baseline () and IVF cycle start () were then compared between conception and non-conception cycles. Results: Mean age for the study population was 41.5 ± 4.4 years. Forty-seven IVF cycles (22.1 %) resulted in clinical pregnancy. Benefits of DHEA on pregnancy rates were statistically associated with efficiency of androgen conversion from DHEA to T and amplitude of T gain. Younger women converted significantly more efficiently than older females, and selected FMR1 genotypes/sub-genotypes converted better than others. FSH/androgen and AMH/androgen ratios represent promising new predictors of IVF pregnancy chances in women with DOR. Conclusions: DOR at all ages appears to represent an androgen-deficient state, benefitting from androgen supplementation. Efficacy of androgen supplementation with DHEA, however, varies depending on female age and FMR1 genotype/sub-genotype. Further clarification of FMR1 effects should lead to better individualization of androgen supplementation, whether via DHEA or other androgenic compounds. [ABSTRACT FROM AUTHOR]

Progesterone receptor (PGR) and estrogen receptor alpha (ESRα), which mediate the biological effects of the steroid hormones progesterone and estrogen, play a central role in the establishment and maintenance of pregnancy. The objectives of this study were to detect bovine PGR and ESRα genes polymorphisms and analyze their relationships with the pregnancy rates after embryo transfer and the hormone concentrations at the day of embryo transfer. One reported SNP of PGR G59752C and a novel SNP of ESRα G75935C were analyzed in 132 recipients of Luxi cattle. For the PGR gene, recipients with g.59752 GG and g.59752 GC genotypes had obviously higher pregnancy rates than g.59752 CC genotype. For the ESRα gene, recipients with g.75935 GC and g.75935 CC genotypes had obviously higher pregnancy rates than g.75935 GG genotype. Furthermore, the same tendency was observed for these two genes that the same genotype groups with high pregnancy rates had high progesterone concentration and low estrogen concentration at the day of embryo transfer. These results showed for the first time that PGR G59752C and ESRα G75935C polymorphisms had obvious effects on the pregnancy rates after embryo transfer, and indicated that PGR G59752C and ESRα G75935C polymorphisms could be potential markers for recipient selection of embryo transfer. [ABSTRACT FROM AUTHOR]

Purpose: Several culture media are available to be used in ART. However it is uncertain whether embryos would preferably benefit from one type of medium or the association of different media. Methods: We performed this study to evaluate the impact of simultaneous transfer of embryos independently cultured in two distinct culture media, on pregnancy outcome. A total of 722 couples who underwent infertility treatment were sequentially allocated into three groups: those who had half of the embryos individually cultured in MEM and the other half cultured in sequential media (MEM + Seq Group) ( n = 243); those who had all embryos cultured only in sequential medium (Seq Group) ( n = 239); and those who had all embryos cultured only in MEM (MEM Group) ( n = 240). Results: The pregnancy rate was higher in the MEM + Seq group (51.8 %) than the Seq group (36.7 %) ( p < 0.001). However the pregnancy rate observed in the MEM group was similar to the others (44.2 %). When a logistic regression test was applied it demonstrated that the number of transferred embryos did not interfere in the pregnancy rates. Conclusions: Our results suggests that offering different culture conditions for sibling embryos with subsequent transfer of embryos that were kept in distinct culture media, might increase pregnancy rates in assisted reproduction cycles. [ABSTRACT FROM AUTHOR]

To assess the reproductive benefits of hysteroscopic polypectomy in previous infertile women depending on the size or number of the polyps. In this retrospective study, from February 2000 to September 2005, totally 83 selected women were included with: a) diagnoses of primary or secondary infertility, endometrial polyp/polyps and abnormal uterine bleeding. Endometrial polyps were diagnosed by transvaginal ultrasound followed by diagnostic hysteroscopy, to confirm diagnosis, and hysteroscopic polypectomy. All 83 subjects who consisted the study group, met inclusion criteria: age under 35 years, at least 12 months of infertility, from 3 to 8 months menstrual disorders (intermenstrual bleeding or spotting, menometrorrhagia or menorrhagia) and from 3 to 18 months of follow-up with attempts to conceive after hysteroscopic polypectomy. The endometrial polyp/polyps appeared to be the only reason to explain their infertility after infertility workup of the couples. There was a comparison of fertility rates after hysteroscopic polypectomy between patients having endometrial polyp ≤ 1 cm and patients with bigger or multiple polyps. Of the 83 subjects, all were found to have endometrial polyps in diagnostic hysteroscopy, confirmed at histologic examination after hysteroscopic polypectomy . Among patients of the study group, there were no significant differences in age, type or length of infertility, or follow-up period after the procedure. The mean size of the endometrial polyps was 1.9 ± 1.4.cm. Thirty-one patients had endometrial polyp ≤ 1 cm and 52 patients had bigger or multiple endometrial polyps. Following polypectomy, menstrual pattern was normalized in 91.6% of patients. Spontaneous pregnancy and delivery at term rates, in the total population of the study, increased after the procedure and were 61.4% and 54.2% respectively. There was no statistical difference in fertility rates between patients having polyps ≤ 1 cm and patients having >1 cm polyps or multiple polyps. Spontaneous abortion rate in the first trimester of pregnancy was 6% of the total number of patients and there was no statistical difference between patients with small or bigger/multiple polyps. Type of infertility did not affect fertility rates after hysteroscopic polypectomy. Complication rate after hysteroscopic polypectomy was as low as 2.4%, while recurrence rate of the procedure reached 4.9% of patients. Hysteroscopic polypectomy of endometrial polyps appeared to improve fertility and increase pregnancy rates in previous infertile women with no other reason to explain their infertility, irrespective of the size or number of the polyps. Type of infertility of patients seems not to affect fertility rates after hysteroscopic polypectomy. Menstrual pattern was normalized in the majority of patients after hysteroscopic polypectomy. In addition, hysteroscopic polypectomy is a safe procedure with low complication rate. [ABSTRACT FROM AUTHOR]

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Objective We assessed the role of DHEA supplementation on pregnancy rates in women with diminished ovarian function. Design This is a case control study of 190 women with diminished ovarian function. The study group includes 89 patients who used supplementation with 75 mg daily of oral, micronized DHEA for up to 4 months prior to entry into in vitro fertilization (IVF). The control group is composed of 101 couples who received infertility treatment, but did not use DHEA. The primary outcome was clinical pregnancy after the patient's initial visit. We developed a Cox proportional hazards model to compare the proportional hazards of pregnancy among women using DHEAwith the controls group. Results Cumulative clinical pregnancy rates were significantly higher in the study group (25 pregnancies; 28.4% vs. 11 pregnancies; 11.9%; relative hazard of pregnancy in study group (HR 3.8; 95% CI 1.2-11.8; p<0.05). Conclusions DHEA treatment resulted in significantly higher cumulative pregnancy rates. These data support a beneficial effect of DHEA supplementation among women with diminished ovarian function. [ABSTRACT FROM AUTHOR]

Purpose: To compare pregnancy rates of embryo transfers performed by a patient's own IVF physician to pregnancy rates of embryo transfers performed by other physicians on the IVF team. Methods: Retrospective cohort study; University hospital. Results: A total of 3029 embryo transfers were included. 434 patients (14%) had an embryo transfer by their own IVF physician. There was no difference in pregnancy rates comparing patients who had embryos transferred by a different physician than their own IVF physician when all cycle attempts were analyzed [Odds ratio (OR) 1.1; Confidence interval (CI) 0.9-1.4]. There was no significant difference between the groups' population characteristics. A subset analysis of 1st cycle only embryo transfers (n = 1416) also revealed no difference in pregnancy rates [OR 1.1; CI 0.8-1.5]. Conclusions: Patients can be reassured that their chances of pregnancy are the same whether their embryo transfer is performed by their own physician or another physician in the practice. [ABSTRACT FROM AUTHOR]

Objective: To compare the results of intrauterine insemination (IUI) when GnRH antagonist was added-to avoid IUI on weekend-with those obtained with the standard IUI protocol. Study design: In an IUI program under ovarian stimulation with gonadotropins when one or more follicles of 15-16 mm were seen, if it was not possible for logistic reasons (weekend) to perform the insemination 72 h later, GnRH antagonist was administered until human chorionic gonadotropin (hCG) administration. The IUI was performed on Monday. We compared the results of this IUI "weekend-free" group with our results in standard IUI cycles, where IUI was performed 36-38 h after reaching optimal follicular growth. Results: Both groups were comparable regarding the main demographic parameters, except for higher estradiol levels, due to the prolonging ovarian stimulation. The per cycle pregnancy rate (PR) were very similar in both groups: 15.7% in the weekend-free IUI versus 16.5% in standard IUI. The multiple pregnancy rate and the hyperstimulation rate were also similar. A non-significant trend to higher high-order multiple pregnancy was observed in the weekendfree IUI. Conclusions: In IUI cycles under ovarian suprastimulation with gonadotrophins, the use of GnRH antagonist allows the manipulation of the follicular development in such a way that it is possible to avoid inseminations on the weekends, without apparently reducing the PR. [ABSTRACT FROM AUTHOR]

Copyright of Reproduktionsmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)