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Objective: To compare the effectiveness of two methods in preventing ovarian hyperstimulation syndrome (OHSS) with cabergoline and coasting. Design: Systematic review and meta-analysis of randomized clinical trials (RCTs). Patients: Women were considered as have risk of OHSS undergoing fertility treatment. Interventions: Cabergoline, coasting. Result: There were included five RCT studies. The clinical pregnancy rate was no significantly difference between two groups (RR 1.22, 95% CI [0.86, 1.71]), implantation rate (RR 1.00, 95% CI [0.75, 1.32]), severe OHSS (RR 0.93, 95% CI [0.38, 2.31]), fertilization rate (SMD 0.70, 95% CI [-0.10, 1.50]), number of oocytes retrieved (SMD 0.80, 95% CI [0.30, 1.30]), number of embryo transfer (SMD-0.04, 95% CI [-0.24, 0.17]), E2 value on the day of HCG injection (SMD 0.21, 95% CI [-0.25, 0.68]), number of MII oocytes (SMD 0.71, 95% CI [0.32, 1.11]), abortion rate (RR 0.61, 95% CI [0.21, 1.83]), number of follicles > 17 mm on day of HCG (SMD -0.01, 95% CI [-0.26, 0.24]), number of follicles 15 - 17 mm on day of HCG (SMD -0.08, 95% CI [-0.33, 0.17]), number of follicles 10 - 14 mm on day of HCG (SMD -0.06, 95% CI [-0.31, 0.19]). Conclusion: Both cabergoline and coasting prevent the occurrence of OHSS, but no statistically significant difference between them. Compared with coasting group, a daily dose of 0.5 mg cabergoline significantly increased the number of oocytes retrieved, MII oocytes, and fertilization rate, but decreased the abortion rate.

Objective To compare pregnancy outcomes in patients undergoing artificial reproductive treatment (ART) and fresh embryo transfer (ET) who received twice-daily vaginal progesterone capsule (Cyclogest) alone verses twice daily vaginal progesterone capsule (Cyclogest) plus weekly intramuscular Hydroxyprogesterone Capronate (Proluton depot) for luteal phase support. Methods A retrospective cohort study that included 1162 patients who completed fresh ART/ET cycle from January 2015 to April 2018. Vaginal Cyclogest 400 mg twice daily was given to 985 patients following oocytes retrieval; whereas 177 patients received weekly intramuscular Proluton depot 250 mg in addition to twice-daily Cyclogest. The primary outcome was live birth rate. The secondary outcomes included biochemical pregnancy rate, clinical pregnancy, biochemical, and early and late pregnancy loss. Results There was no difference between the twice-daily vaginal progesterone and the addition of weekly intramuscular progesterone injections to the twice-daily vaginal progesterone regarding a positive pregnancy test (40.5% and 46.9%, respectively, p=0.112). There was no statistical difference in live birth rates between the groups (24% for group one, 26% for group two, p=0.582). Conclusions The administration of weekly intramuscular progesterone in addition to twice-daily vaginal progesterone capsule for luteal phase support post ART cycle does not result in higher live birth rate.

Background: Oral progestin has been used to prevent premature ovulation during follicle stimulation protocols performed in combination with a freeze-only strategy. However, no studies have determined how oral progestin clinically compares to gonadotropin-releasing hormone (GnRH) antagonists in women with normal ovulation. This study aimed to compare the efficacy and safety of controlled ovarian stimulation between progestin-primed ovarian stimulation (PPOS) protocol and GnRH antagonist (GnRH-ant) protocol.Methods: Young women with infertility and normal ovarian reserve who underwent in vitro fertilisation (IVF) treatments were screened and randomly allocated to the PPOS or GnRH-ant group. Women in the PPOS group underwent freeze-all and delayed embryo transfer, whilst fresh embryo transfer was preferred for those in the GnRH-ant group. The primary endpoint was the cumulative live birth rate (CLBR). Secondary endpoints included the incidence of premature luteinising hormone (LH) surge and the number of viable embryos.Results: CLBRs were similar in the PPOS and GnRH-ant group (55.75% vs. 52.87%, respectively, P > 0.05). No premature LH surge was observed during ovarian stimulation in the PPOS group, although six (3.45%) cases were observed in the GnRH-ant group. On the trigger day, LH level was lower in the PPOS group than in the GnRH-ant group (2.30 ± 1.78 mIU/ml vs. 3.66 ± 3.52 mIU/ml, P < 0.01). There were no differences in the number of retrieved oocytes, mature oocytes, or viable embryos between the two groups. Other clinical outcomes including implantation rates (37.27% vs. 36.77%), clinical pregnancy rates (55.75% vs. 55.89%), and miscarriage rates (12.28% vs. 13.76%) were comparable between the PPOS group and GnRH-ant group (P > 0.05). There was also no significant differences in newborn weights for singleton or twin births between the two groups (P > 0.05).Conclusion: Live birth outcomes are similar for PPOS and GnRH antagonist protocols in women with normal ovarian reserve. PPOS is likely to play a promising role in the freeze-only strategy given its simplicity and convenience for the patient. Trial registration: This trial was registered in the China Clinical Trial Registry on September 6, 2018 (number: ChiCTR1800018246).

Study question Can frozen embryo transfer (FET) be offered immediately after a stimulated IVF/ICSI cycle without compromising live birth rate (LBR)? Summary answer FET in the menstrual cycle immediately following the stimulated IVF/ICSI cycle was associated with a slightly higher LBR compared to standard postponed FET. What is known already It is standard clinical practice to postpone FET for at least one menstrual cycle following a failed fresh transfer or a freeze-all cycle. This practice is thought to minimize any possible residual negative effect of ovarian stimulation, with excessive steroid levels and multiple corpora lutea, on the resumption of a normal ovulatory cycle and receptivity of the endometrium. Even so, elective deferral of FET is an empirical strategy based on suggestions rather than solid scientific evidence and may unnecessarily delay time to pregnancy, causing frustration and decreased quality of life to couples. Study design, size, duration Systematic review and meta-analysis according to PRISMA guidelines. Original studies on subfertile women aged 18-46 with any indication for treatment with IVF/ICSI investigating the timing of FET after IVF/ICSI were included. Intervention was defined as FET in the menstrual cycle immediately following the stimulated IVF/ICSI cycle. Comparator was defined as FET in the second or subsequent menstrual cycle following IVF/ICSI. Risk of bias was assessed using Robins-I and quality of evidence using GRADE. Participants/materials, setting, methods PubMed (MEDLINE) and EMBASE databases were searched for MeSH and Emtree terms, as well as text words related to timing of FET, up to March 2020. There were no limitations regarding year of publication or duration of follow-up but to English language. The primary outcome was LBR. Secondary outcomes were implantation rate, pregnancy rate, clinical pregnancy rate (CPR), time-to-pregnancy, miscarriage rate (MR), cycle cancellation rate and patient wellbeing. Main results and the role of chance Out of 4124 search results, 15 studies were included in the review. Studies reporting adjusted odds ratios (aOR) for LBR, CPR and MR were included in meta-analyses. All studies (n = 15) were retrospective cohort studies involving a total of 6,304 immediate FET cycles and 13,851 postponed FET cycles including 8,019 matched controls. Twelve studies of very low to moderate quality reported no difference in LBR with immediate versus postponed FET. Two studies of moderate quality reported a statistically significant increase in LBR with immediate FET and one small study of very low quality reported better LBR with postponed FET. Trends in rates of secondary outcomes followed trends in LBR regarding timing of FET. The meta-analyses showed a significant advantage of immediate FET (n = 2,076) compared to postponed FET (n = 3,833), with a pooled aOR of 1.20 (95% CI 1.01-1.44) for LBR and a pooled aOR of 1.22 (95% CI 1.07-1.39) for CPR. Limitations, reasons for caution Limitations include the retrospective design and heterogeneity of studies included, limiting comparison and pooling of data. With little transparency regarding cancellation rates, the risk of selection bias is apparent. Further, confounding by embryo quality is a limitation. Small sample sizes are a limitation to subgroup meta-analyses. Wider implications of the findings The standard clinical practice of postponing FET for at least one menstrual cycle following a failed fresh transfer or a freeze-all cycle may not be best clinical practice. Randomized controlled trials including data on cancellation rates are highly needed to provide high grade evidence regarding clinical practice and patient counseling. Trial registration number not applicable

Study question Does GCSF by intrauterine route leads to better result in the treatment of thin endometrium as compared to GCSF by the subcutaneous route, in IVF-ICSI Cycles? Summary answer Yes, GCSF by intrauterine route leads to better result in the treatment of thin endometrium as compared to subcutaneous-GCSF, in ART Cycles? What is known already GCSF, is a member of the colony stimulating factor family of cytokines and growth factors. GCSF receptors are expressed in high concentration on dominant follicle, particularly at preovulatory stage.The endometrium also shows an increased expression of these receptors. GCSF concentration rises in the follicular fluid at the same time. Serum levels of GCSF are found to be in direct correlation with levels of GCSF in follicular fluid. Serum levels increase progressively from the day the embryo-transfer to the day of implantation. GCSF has been found to be beneficial in patients with thin endometrium and recurrent implantation failure. Study design, size, duration This was a RCT conducted between 2018–2019. 30 patients with thin endometrium were enrolled in each group. In either group, GCSF was given if endometrium was less than 7mm on day 14, maximum of two doses were administered. Patients undergoing frozen embryo transfer were recruited in the study, after meeting the inclusion and exclusion criteria. Primary outcome measured was increase in endometrium thickness and the secondary outcome was the clinical pregnancy rate and abortion-rate. Participants/materials, setting, methods 60 patients with thin endometrium were randomly divided into two groups. Group A: Inj. GCSF (300 mcg/1 ml) subcutaneously on Day 14 onwards alternate days for two doses. Group B: Inj. GCSF (300 mcg/1 ml) instilled slowly into the uterine cavity using an intrauterine insemination (IUI) catheter under USG guidance. Endometrial thickness was assessed after 48 h. If endometrial thickness was found to be Main results and the role of chance In the subcutaneous group (group-A) the mean endometrial thickness before GCSF injection was 5.8 ± 0.6 mm and, after injection it increased to 6.9 ± 0.4 mm. Similarly, in the intrauterine group (group-B) the mean endometrial thickness before GCSF was 5.9 ± 0.7 which increased to a mean of 7.9 ± 0.5 after GCSF instillation. The difference between endometrial thickness before and after intrauterine infusion of GCSF was more than that in the subcutaneous group. In group-A, 08 patients conceived out of 30 patients ( clinical pregnancy rate 26.6%) and in group B 11 conceived out of 30 patients in whom GCSF was instilled intrauterine (pregnancy rate 36.6%). Thus, there was a difference in the clinical pregnancy rate in the two groups, the intrauterine group yielding a higher clinical pregnancy rate, but it was not statistically significant. Because of the thin endometrium, we found an abortion rate of 25% (2/8) in the subcutaneous-GCSF group, and an abortion rate of 18% (2/11) in the intrauterine GCSF group. Limitations, reasons for caution There are few potential limitations because of the small sample size. Confounders such as obesity, smoking and alcohol intake, presence of adenomyosis and endometriosis, were not taken into consideration. Though prevalence of obesity is usually low in Indian women. Habits of smoking and alcohol are exceedingly uncommon in Indian women. Wider implications of the findings: Use of GCSF plays an important role in management of patients of thin endometrium undergoing embryo transfer. It is an easily available and economical preparation in developing countries and the intrauterine instillation of GCSF can be easily practiced in an ART unit with good results in resistant thin endometrium patients. Trial registration number Not applicable

Study question Is the outcome of IVF/ICSI cycles done with continuous (single step ) embryo culture system different from that with sequential embryo culture system ? Summary answer Yes the outcome of IVF / ICSI cycles done with continuous (single step ) embryo-culture system is better than that with sequential embryo-culture system . What is known already Embryo culture media are important factors in IVF, which can significantly influence the clinical outcome of IVF/ICSI cycles. However it is not clear which formulation is most optimal and whether sequential or continuous media (single step) should be favored. Sequential media complies with embryo demands based on developmental stage , taking into account metabolic changes embryos undergo in-vivo, while moving from the oviduct to the uterus. The embryos in the early cleavage stage prefer to use pyruvate to produce energy, whereas once development nears the blastocyst stage , the embryos start using glucose in the process of glycolysis . Study design, size, duration A prospective RCT was carried out at our centre between 2018–2019 and IVF-ICSI patients meeting inclusion criteria (at least six normal MII - Oocytes) were included in this study. The aim of study was to compare blastocyst formation rates after embryo-culture in two different culture media systems. 436 metaphase II Oocytes from 62 women were randomly and equally divided to be fertilized and cultured to the blastocyst stage in either sequential media or single-step media. Participants/materials, setting, methods In this prospective trial with sibling oocytes, 436 metaphase II oocytes from 62 women were randomly and equally divided to be fertilized and cultured to the blastocyst stage in either sequential media ( n = 218 MII oocytes) or a single medium ( n = 218 MII oocytes). In both groups, embryos were cultured in an interrupted fashion with media changes on day 3. Embryo transfer was performed on day 5. Main results and the role of chance Blastocyst formation rates on day 5 were significantly higher following culture in single step media 60.55% (132 / 218 ) as compared to sequential media 34.86% ( 76 / 218) . The percentage of good quality blastocysts was also significantly higher in single step media. In conclusion, culture in single step media was associated with higher blastocyst formation rates compared to sequential media , suggesting that the single medium may provide better support to the developing embryo. The proportion of poor quality embryos was significantly higher in the sequential media group. Results indicate that embryo culture in continuous media could be as efficient as embryo culture in sequential media. A significant difference observed was the proportion of poor quality embryos on day 5 , which was significantly higher when the embryos were cultured in sequential media. Our results suggest that the type of embryo culture media can influence the quality of embryos both at the cleavage stage and blastocyst stage. The use of continuous embryo culture media does not seem to cause an adverse effect; in fact, their use can lower the workload in busy IVF labs and lower the stress that embryos are exposed to during handling. Limitations, reasons for caution Although single-step-medium for extended culture has practical advantages and blastocyst formation rates appear to be higher, there is insufficient evidence to recommend either sequential or single-step media as being superior for the embryo-culture to days 5/6. Further studies comparing these two media systems in well-designed trials should be performed. Wider implications of the findings: When employing sequential media for embryo culture , it is necessary to transfer the embryos from one medium to another ( cleavage stage medium to blastocyst stage medium) which increases stress related embryo damage . Therefore, single-step media is beneficial as the embryos can develop undisturbed till blastocyst stage. Trial registration number Not applicable

Study question Does presence of endometrioma has worse IVF/ICSI outcome than endometriosis per se? What about the impact of cystectomy of endometrioma on IVF/ICSI outcomes? Summary answer IVF/ICSI outcome of patients with endometrioma is comparable than with endometriosis. Cystectomy for endometrioma did not alter IVF/ICSI outcomes if ovarian reserve is comparable. What is known already Previous studies revealed women with endometrioma undergoing IVF/ICSI had similar reproductive outcomes compared with those without. Most of the comparisons are between women with endometrioma and women without endometriosis. However, endometrioma per se, different from endometriosis may have specific impact on IVF/ICSI outcomes. There is now molecular, histological and morphological evidence to suggest endometrioma is detrimental to the ovaries. Studies comparing IVF/ICSI outcomes between women with endometrioma and women with endometriosis are few. Cystectomy of endometrioma may worse ovarian reserve, and subsequently adversely affect IVF/ICSI outcomes. But there are possible complications associated with the persistence of endometrioma during IVF/ICSI. Study design, size, duration Retrospective analysis of 2153 IVF/ICSI cases during Jan/01/2014 to Dec/31/2018 in VGHTC. We included women who received ART due to endometriosis(n = 208). Exclusion criteria including patients >40 years-old, simulation day < 5 days, severe male factor, uterine factor (including adenomyosis) and immunological factors. Patients whose embryos were not completely transferred back or who received embryo transfer from different OPU cycles are excluded. We followed up these patients till 2020/6. The primary outcome is cumulative LBR Participants/materials, setting, methods For first analysis, we divided 208 cases to patients with endometrioma during IVF/ICSI(n = 89), and patients only diagnosed of endometriosis (n = 119). Second analysis on the effect of cystectomy of endometrioma on IVF/ICSI outcomes. Patients with endometrioma (n = 89) during IVF/ICSI were further divided to patients with primary endometrioma (n = 70) and patients with recurrent endometrioma (n = 19, ever received cystectomy for endometrioma). Another group is patients without endometrioma during IVF/ICSI, but ever received cystectomy before (n = 40) Main results and the role of chance For the first analysis, age, BMI and AMH were comparable in endometrioma (n = 89) and endometriosis group(n = 119). The usage gonadotropin dose was significantly higher in the endometrioma group (FSH 3619IU vs 3471IU, p = 0.001. LH 1224 IU vs 941 IU, p = 0.009). The Blastocyst formation rate is lower in the endometrioma group (49.4% vs. 57.7% p = 0.005). The OPU number, LBR and cumulative LBR were comparable in both groups (10.3 vs 12.4 p = 0.131, 33.3% vs 37%, p = 0.687, 49.4% vs 60.5%, endometrioma vs endometriosis). For the second analysis, when comparing cystectomy before IVF/ICSI group with primary endometrioma group, cystectomy group were younger (32.8 vs 34.8 p = 0.006). AMH level were comparable. The BC formation rate was significantly higher in the cystectomy group (61.5% vs 50.4% 0= 0.007). The LBR and cumulative LBR were comparable in both groups (43.5% vs 28.1%, 60% vs 48% in cystectomy vs primary endometrioma group). As for the recurrent endometrioma group, the age and AMH level were comparable with cystectomy group, but the usage gonadotropin dose was significantly higher than other two groups. The BC formation rate was also lower than cystectomy group (47.8% vs 61.5% p = 0.042). The LBR and cumulative LBR were comparable with other two groups (55.6%, 57.9%). Limitations, reasons for caution This is a retrospective study, and the sample size is limit. We did not analysis the size of endometrioma nor the unilateral or bilateral endometrioma. Wider implications of the findings Cystectomy for endometrioma must be carefully selected since it did not alter IVF/ICSI outcome only if the ovarian reserve is not affected. Recurrent endometriomas do not have a worse impact on IVF/ICSI outcome than primary endometrioma. If there is recurrent endometrioma, IVF/ICSI may be the first priority. Trial registration number not applicable

Study question Is there any association between stage of embryo at transfer based on extended in vitro culture and gestational trophoblastic disease risk during assisted reproduction? Summary answer No significant association between stages of embryo transfer from zygote stage to blastocyst stage was found after analysing 540376 cycles of IVF and ICSI. What is known already Gestational trophoblastic disease (GTD), commonly referred to as molar pregnancy, results from abnormal proliferation of the trophoblast with a reported incidence of ∼1 in 700 in the UK. Despite technological advances such as ICSI, PGT and selection of normally fertilised (2PN) embryos, there are reported cases of GTD following assisted reproduction. Blastocyst transfer is associated with higher pregnancy and live birth rates but evidence is lacking whether extended embryo culture to blastocyst stage influences implantation of an abnormal embryo or abnormal trophoblastic proliferation leading to GTD. Study design, size, duration A retrospective study was carried out using Human Fertilisation and Embryology Authority (HFEA) anonymised register data from 1999 to 2016. HFEA holds the longest running register for fertility treatment data in the world and is the national database for fertility treatment data in UK. A total of 540376 fresh IVF or ICSI assisted reproduction cycles were analysed. Participants/materials, setting, methods There were 1033588 treatment cycles during the study period but only 540376 cycles met the inclusion criteria of fresh IVF or ICSI. Cycles with incomplete data, frozen embryo transfers, donor treatment or surrogacy were excluded. A subgroup analysis of those with primary subfertility was performed after excluding subjects with secondary infertility in order to exclude an effect of a previous molar pregnancy. Multivariate regression analysis was used to adjust for possible confounders. Main results and the role of chance 78 molar pregnancies were reported in the original sample giving a prevalence of 4/10000 live births (78/228461), much lower than the prevalence given with natural pregnancies. Prevalence of molar pregnancy amongst the study population after meeting exclusion criteria was 4 /10000 livebirths (53/156683). Incidence of molar pregnancy was not statistically different between treatment type (0.0001 vs 0.00009). Significantly higher incidence of GTD was seen in the 40 to 42 age category compared to 18–34 category(OR 1.86(95% CI 8.7–3.75)),in par with known higher GTD risk in women above 40 in the general population. Of interesting note, although the incidence of molar pregnancy was significantly lower in women undergoing assisted reproduction increased risk with advancing age is not totally eliminated with treatment. There was no significant association between the occurrence of molar pregnancy with the type and cause for infertility and number of embryos transferred. Crude (1.06 (95% CI 0.852–1.31)) and adjusted odds ratios (1.07 (95% CI (0.857–1.32)) did not show any association between day of embryo transfer and molar pregnancy even after adjusting for age and excluding secondary infertility. Selection of blastocyst stage embryo after extended culture did not alter the likelihood of having a GTD compared to cleavage stage embryo. Limitations, reasons for caution The retrospective analysis of anonymised HFEA data limited adjustments for confounders such as smoking, previous history of GTD, ethnicity etc that predispose to GTD. Caution needs to be exercised for under-reporting of GTD to HFEA and lack of information on type of GTD identified. Wider implications of the findings: Though GTD cannot be prevented by IVF/ICSI, the incidence is significantly low and extended culture is not associated with higher risk of abnormal trophoblastic proliferation or GTD occurrence with IVF/ ICSI treatment. These findings would aid informed implications counselling and reassurance of patients during assisted reproduction treatments. Trial registration number Not applicable

Background Assisted reproductive technologies (ART) such as in vitro fertilisation (IVF) and intra-cytoplasmic sperm injection (ICSI) are often used to aid fertility in women with endometrioma; however, the implications of endometrioma on ART are unresolved. Objective To determine the effect of endometrioma on reproductive outcomes in women undergoing IVF or ICSI. Methods A systematic review and meta-analysis was conducted to identify articles examining women who had endometrioma and had undergone IVF or ICSI. Electronic searches were performed in PubMed, BIOSIS and MEDLINE up to September 2019. The primary outcome was live birth rate (LBR). Secondary outcomes included clinical pregnancy rate (CPR), implantation rate (IR), number of oocytes retrieved, number of metaphase II (MII) oocytes retrieved, number of embryos and top-quality embryos and the duration of gonadotrophin stimulation and dose. Results Eight studies were included. Where significant heterogeneity between studies was identified, a random-effects model was used. The number of oocytes (weighted means difference; WMD-2.25; 95% CI 3.43 to − 1.06, p = 0.0002) and the number of MII oocytes retrieved (WMD-4.64; 95% CI 5.65 to − 3.63, p Conclusion Even though women with endometriomas had a reduced number of oocytes and MII oocytes retrieved when compared to women without, no other differences in reproductive outcomes were identified. This implies that IVF/ICSI is a beneficial ART approach for women with endometrioma.

Background: Elective frozen cleavage embryo transfer resulted in significantly higher live birth rate in patients with polycystic ovary syndrome but not in ovulatory women compared with fresh embryo transfer. Further, elective single frozen blastocyst transfer had significantly higher live birth rate in ovulatory women compared with single fresh blastocyst transfer. However, it is unknown whether single frozen cleavage embryo transfer results in higher cumulative live birth rate in women of advanced age undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). The aim of this study is to compare the effectiveness of frozen cleavage embryo transfer with fresh cleavage embryo transfer in Chinese women of advanced age. Methods: This study is a double-blind randomized controlled clinical trial (1:1 treatment ratio of frozen embryo transfer vs. fresh embryo transfer). A total of 840 women of advanced age with normal ovarian reserve undergoing the first cycle of IVF or ICSI will be enrolled and randomized into two parallel groups. Participants in group A will undergo frozen single cleavage embryo transfer, and participants in group B will undergo fresh single cleavage embryo transfer. The primary outcome is the cumulative live birth rate of the trial IVF/ICSI cycle within 12 months after randomization. This study is powered to detect an absolute difference of 8% (23% vs 15%) at the significance level of 0.05 and 80% statistical power based on a two-sided test. Discussion: The results of this study will provide evidence for the efficacy and safety of frozen cleavage embryo transfer compared with fresh cleavage embryo transfer in women of advanced age undergoing IVF/ICSI. Trial registration: Chinese Clinical Trial Registry, ChiCTR2000029330. Registered on 25 Jan 2020. Keywords: Frozen embryo transfer, advanced age, in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), live birth, randomized controlled trial.

[This corrects the article DOI: 10.1093/hropen/hoaa009.][This corrects the article DOI: 10.1093/hropen/hoaa009.].

Objectives: To study the prevalence of non- receptive endometrium in patients with tubal factor infertility and to compare that with patients with infertility due to other causes.

In this descriptive retrospective, single-center study, we analyzed the local database of 82 men treated for infertility due to retrograde ejaculation and anejaculation in the International Centre for Reproductive Medicine. Spermatozoa for IVF/ICSI cycles were retrieved from post-ejaculatory urine and by aspiration biopsies (PESA/TESA). An algorithm for diagnosis and treatment of infertile men with retrograde ejaculation and anejaculation has been suggested. (For citation: Korneyev IA, Zasseev RD. The infertility overcoming in men with retrograde ejaculation and anejaculation. Urologicheskie vedomosti. 2017;7(2):10-15. doi: 10.17816/uroved7210-15).

To investigate the ability of anti-Mullerian hormone (AMH) to predict the step up of human menopausal gonadotropins (HMG) dose in women with polycystic ovarian syndrome (PCOS) undergoing IVF/ICSI cycles.AMH was drawn before ovulation induction in 976 PCOS women scheduled for IVF/ICSI. After all cycles ended, a receiver operating characteristic (ROC) curve analysis was done to investigate the ability of AMH to predict step up of the HMG.The area under the curve (AUC) was 0.820 95%CI (0.792-0.848), and a cutoff value of 4.6 ng/ml (sensitivity 74%, specificity 82%) for AMH was taken (p 0.01). Cases were divided into two groups retrospectively; group (A) (AMH ≤4.6 ng/ml), and group (B) (AMH4.6 ng/ml). No difference in the mean age (p = 0.147); BMI (p = 0.411), basal FSH (p = 0.221), and starting dose (p = 0.195); however, the dose at which the first response occurred was higher in group (B) (p 0.01). The total dose and number of days were higher in group (B) (both p 0.01) irrespective of the PCOS subtype or androgen levels. Severe OHSS was also higher in group (B) (p = 0.026).PCOS with AMH4.6 ng/ml are resistant to HMG stimulation, require dose step up during ART cycles, and are at higher risk for severe OHSS.

Background: The aim of this study was to clarify related factors of no good quality embryos in IVF/ICSI cycle so as to improve the IVF/ICSI outcome. Methods: Data of Day 3 embryos and patients of 2518 cycles from January 2012 to December 2016 were analyzed in this study. A binary logistic regression model was conducted to examine the factors which led to no good quality embryo in one cycle.Results: The incidence of no good quality embryo in one cycle was 13.3%. Number of oocytes, fertilization methods, stimulation protocol, and fertilization rate were significant in logistic regression analysis. Further analysis showed significant correlations between increasing intracellular fragmentation and the following parameters: number of oocytes, fertilization rate, and infertility diagnosis; slow growing embryos: number of oocytes, fertilization rate, and fertilization methods; embryos with asymmetric cleavage: number of oocytes, fertilization rate, fertilization methods, female age, and male age; compound causes: number of oocytes, fertilization rate, infertility duration, stimulation protocol, and fertilization methods.Conclusions: The results suggested that gamete poor quality is the main reason for the embryo quality decline, which underlines the importance to improve gamete quality and eventually the fertility outcome in clinical practice.

To evaluate the effect of endometrial injury on clinical outcomes in subfertile women with repeated implantation failures (RIF) undergoing assisted reproduction. In this prospective nonrandomized controlled trial, 103 subfertile women with RIF were included. Fifty-one underwent endometrial injury through hysteroscopy in the early follicular phase of the previous cycle and 52 underwent the standard protocol without any intervention. Live birth and miscarriage were the primary outcomes. Clinical and in vitro fertilization (IVF) cycle characteristics, were also compared between groups. Both groups were comparable in terms of baseline and cycle characteristics. Live birth rates were significantly higher in the study, compared with the control group (18/51 vs. 8/52, odds ratio (OR) = 0.25; 95% confidence interval (CI) = 0.10-0.64; p = 0.020), although miscarriage rates were similar (7/51 vs. 10/52, OR= 0.25; 95%CI= 0.12-0.66; p = 0.452). The rest of the outcomes parameters were comparable between groups. Logistic regression analysis revealed that endometrial injury and duration of subfertility were independent predictors of live birth after control of other variables (OR = 2.818; 95%CI = 1.044-7.605; p = 0.041 and OR = 0.674; 95%CI = 0.461-0.985, p = 0.042, respectively). Endometrial injury induced through office hysteroscopy in the preceding cycle in subfertile women with RIF improves live birth rates.

This study explored the correlation between serum anti-Mullerian hormone (AMH) concentration and the number of retrieved oocytes after ovarian stimulation in Chinese infertile women undergoing assisted reproductive technology treatment and AMH cut-off values predicting low and high ovarian response. This was a prospective, multi-centre, observational study. A total of 615 subjects were included in nine assisted reproductive centres in China for outcome analysis. Subjects received assisted reproductive technology treatment and used recombinant human FSH (r-HFSH) or r-HFSH plus recombinant LH (rLH) for ovarian stimulation according to conventional treatment regimens. The main outcome variables were correlations between AMH and the number of retrieved oocytes and the cut-off values of AMH predicting low and high ovarian response. Serum AMH concentration was positively correlated with the number of oocytes retrieved in Chinese infertile women treated with IVF/intracytoplasmic sperm injection (ICSI) (Pearson correlation coefficient = 0.4754, P < 0.0001). The optimal AMH cut-off value was 2.6 ng/ml (sensitivity: 81.28%, specificity: 59.51%) in predicting high and normal response, and 1.1 ng/ml (sensitivity: 52.27%, specificity: 87.23%) in predicting low and normal response. In conclusion, serum AMH concentration can be used as a biomarker to predict ovarian response in Chinese infertile women treated with assisted reproductive technology.

This retrospective study assessed the predictive value of endometrial thickness (EMT) on HCG administration day for the clinical outcome of fresh IVF and intracytoplasmic sperm injection (ICSI) cycles. A total of 8690 consecutive women undergoing 10,787 cycles over a 5-year period were included. The 5th, 50th and 95th centiles for EMT were determined as 8, 11 and 15 mm, respectively. Group analysis according to these centiles (Group 1:8 mm; Group 2: ≥ 8 and ≤11 mm; Group 3:11 and ≤15 mm; Group 4:15 mm) demonstrated significant differences (P0.001) in clinical pregnancy rates (23.0%, 37.2%, 46.2% and 53.3%, respectively), live birth rates per clinical pregnancy (63.3%, 72.0%, 78.1% and 80.3%, respectively), spontaneous abortion rates (26.7%, 23.8%, 19.9% and 17.5%, respectively), and ectopic pregnancy rates (10.0%, 4.3%, 2.1% and 2.2%, respectively). Logistic regression analyses showed EMT as one of the independent variables predictive of clinical pregnancy (OR = 1.097; P0.001), live birth (OR = 1.078; P0.001), spontaneous abortion (OR = 0.948; P0.001), and ectopic pregnancy (OR = 0.851; P0.001). Future research should aim to understand the underlying mechanisms relating EMT to conception, ectopic implantation and spontaneous abortion.

Monochorionic twins are usually monozygotic and thus usually have the same sex. A case of monochorionic diamniotic twins following IVF/ICSI and laser treatment of the zona pellucida ("assisted hatching") is presented in which partial embryo amalgamation appears to have occurred. Discordant sex between the twins was suspected on detailed antenatal ultrasound at 13 + 3 weeks gestation and was confirmed on subsequent examinations. The sexual phenotype at birth was female for one twin and male for the other. Placental histology confirmed the monochorionic, diamniotic situation. Cytogenetic analysis of both twins was carried out postpartum on various tissues. On karyotyping of blood lymphocytes the male and female twins each had one mosaic of male and female cells. Oral mucosal cells showed normal male and female karyotypes respectively. Analysis of urothelium showed a normal result for the male infant, and a weak gonosomal mosaic with an XX and XY constellation for the female infant. At least for blood lymphocytes, a diagnosis of chimerism was proven.Üblicherweise sind monochoriale Zwillingsschwangerschaften monozygot und weisen dasselbe Geschlecht auf. Im vorliegenden Fall war nach IVF/ICSI und Laserbehandlung der Zona pellucida („assisted hatching“) eine monochoriale, diamniote Geminigravidität eingetreten, bei der es wohl zu einer partiellen Verschmelzung der Embryonen kam. Pränatal wurde in der 13 + 3 SSW im Rahmen einer detaillierten Ultraschalldiagnostik der Verdacht auf eine Diskrepanz der Geschlechter der Gemini gestellt, der sich in den Folgeuntersuchungen bestätigte. Post partum war das phänotypische Geschlecht des einen Zwillings weiblich und des anderen männlich. Die Histologie der Plazenta bestätigte die monochorialen, diamnioten Eihautverhältnisse. Postnatal erfolgte die zytogenetische Analyse der Zwillinge in verschiedenen Geweben. Die Karyotypisierung an Blutlymphozyten ergab für den weiblichen und männlichen Zwilling jeweils ein Mosaik aus männlichen und weiblichen Zellen. In den Mundschleimhautzellen zeigte sich für beide Neugeborene ein unauffälliger männlicher bzw. weiblicher Karyotyp. Die Diagnostik an Urothelzellen war für das männliche Neugeborene ebenfalls unauffällig und zeigte für das weibliche Neugeborene ein schwaches gonosomales Mosaik mit XX- und XY-Konstellation. Zumindest für Blutlymphozyten konnte die Diagnose der Chimären bewiesen werden.

Objective: The aim of this study was to assess the predictive value of endometrial thickness, morphology and vasculature using two-dimensional (2D) Doppler ultrasound on the IVF/ICSI cycle outcome. Subjects and methods: Endometrial thickness, morphology and subendometrial blood flow were assessed using transvaginal ultrasound on the day of hCG in 100 patients undergoing IVF/ICSI treatment in the period between June 2013 and January 2015. Statistical analysis was done. Results: There was no difference in the demographic features or details of ovarian stimulation between pregnant and non-pregnant women. Overall, 40 patients conceived; 23 (57.5%) of them had blood flow in zone III and 15 (37.5%) in zone II. All patients achieved pregnancy had endometrial thickness >8 mm. Using the ROC curve, the cutoff endometrial thickness for non-achieving pregnancy was 7 mm with a sensitivity and specificity of 100%. There was no significant difference in Doppler indices between pregnant and non-pregnant women. Conclusion: When the endometrial thickness is

Assessment of sperm morphology has been reconsidered since 2001 with the development of motile sperm organelle morphology examination (MSOME). This observation technique that combines high magnification microscopy and the Nomarski interference contrast makes it possible to select spermatozoa with as few vacuoles as possible before microinjection into the oocyte (intracytoplasmic morphologically selected sperm injection, IMSI). More than 10 years after the development of IMSI, the indications of the IMSI technique and its ability to increase pregnancy and/or birthrates (compared with conventional ICSI) are still subject to debate. We aimed to better define the interest of IMSI in the third attempt. We assessed the benefit of IMSI by carrying out a retrospective comparative study between IMSI and conventional ICSI during a third ART attempt. Two hundred sixteen couples with two previous ICSI failures were studied between February 2010 and June 2014. IMSI did not significantly improve the clinical outcomes compared with ICSI, either for implantation (12 vs 10 %), clinical pregnancy (23 vs 21 %), or live birth rates (20 vs 19 %). This study provides supplementary arguments for not achieving IMSI procedure in the third attempt after two previous ICSI failures.

The aim of this prospective, randomized clinical trial (RCT) was to evaluate whether the supplemental protein concentration in embryo transfer (ET) medium affects the clinical outcomes in IVF-ET. A total of 750 patients undergoing IVF-ET who met the inclusion criteria were randomly divided into three groups, according to the concentration of synthetic serum substitute (SSS) in ET medium as follows: 10% (Group A), 20% (Group B) and 50% (Group C). The patient characteristics and embryology data were all similar among the groups. The rates of implantation, clinical pregnancy and live birth were compared. Clinical pregnancy (44.61%, 48.79% and 45.49%), multiple pregnancy (24.18%, 28.71% and 25.0%), implantation (28.21%, 30.68% and 29.86%) and live birth (41.67%, 43.96% and 41.70%) rates in the three groups (A, B and C, respectively) showed no significant differences. This RCT demonstrates that supplemental protein concentration in the ET medium does not affect the treatment outcomes in IVF-ET. There was no statistical evidence to support the hypothesis that supplemental protein concentration in the ET medium influences treatment outcomes in IVF-ET.

The use of growth hormone in women “poor” response groups to the ovulatory stimulation in IVF cycles raises ovarian sensitivity to the gonadotropin exogenous influence, this way, increasing the probability of pregnancy. Taking into consideration small sample of women examined, it is necessary to continue the study of growth hormone use effectiveness and safety for the recommendation of its wide administration in clinical practice.

Scheduling gonadotrophin-releasing hormone antagonist (GnRH-ant) cycles for IVF intracytoplasmic sperm injection in patients is a challenge because of unpredictable ovum retrieval procedures on weekends, when less manpower is available. Recently, the use of GnRH-ant pre-treatment to delay an IVF and intracytoplasmic sperm injection (ICSI) cycle showed no negative effect on clinical pregnancy rates. An age-matched, case-control study was conducted to evaluate the effectiveness of such pre-treatment for scheduling purposes. Patients (n = 140) undergoing their first ovarian stimulation for IVF-ICSI were included. Patients starting their stimulation on Tuesdays or Wednesdays were most likely to have their ovum retrieval procedure on Saturdays. Seventy patients received a 3-day course of GnRH-ant before starting stimulation, and were compared with 70 age-matched controls not receiving pre-treatment. The main outcomes were the proportion of ovum retrieval procedures occurring on Saturdays, clinical pregnancy rate and live birth rates. A five-fold reduction in the number of ovum retrievals occurred on Saturdays compared with controls (7.1% versus 34.3%; OR 0.15; 95% CI 0.05 to 0.42; P0.001), with no significant differences in clinical pregnancy rate (40.9% versus 37.5%) and live birth rate (27.3% versus 31.3%). GnRH-ant pre-treatment is an effective tool for scheduling of GnRH-ant cycles.

Objective: To compare the effective of two GnRH-a protocols for ovarian stimulation in advanced age women undergoing IVF/ICSI cycles.Study design: A total of 1149 IVF-ET/ICSI cycles were retrospectively identified. The cycles were divided two groups, namely a long-protocol group and a short-protocol group.Results: The numbers of oocytes retrieved, and high-quality embryos in the long-protocol group were significantly greater than those in the short-protocol group. In the long-protocol group, the implantation and pregnancy rates were 17.22% and 33.67%, respectively, and these values were significantly higher than those in the short-protocol group (8.24% and 15.96%, p

Clinical case of a quadruple pregnancy (monochorionic diamniotic and dichorionic diamniotic) after the transfer of two blastocysts generated by intracytoplasmic sperm injection (ICSI). This is the case of a 29-year-old woman patient with transfer of two blastocysts after long cultivation of 6 embryos generated by ICSI and vitrified on day +3. This revealed quadruple clinical pregnancy (monochorionic diamniotic and dichorionic diamniotic) of 56 days of evolution by transvaginal ultrasound. The couple decided to undergo a selective embryonic reduction of the monochorionic diamniotic pregnancy after receiving information about the risks arising from it. After that embryonic reduction the uncomplicated pregnancy continued until 36 weeks of gestation, achieving reproductive success with the birth of two babies alive and healthy.

International audience; Objective: We aimed to define clinical criteria from the patients related to the occurrence of live birth in case of elective single embryo transfer (eSET). Study design: We analyzed retrospectively 409 eSET at day 2/3 between March 2005 and July 2012, proposed in case of (i) woman's age = 2 good quality embryos obtained (3-5/6-10 blastomeres at day 2/3 and = 30 kg/m(2), negatively associated with the occurrence of live birth. Conclusion: BMI appears to be the only clinical parameter statistically associated with delivery following eSET strategy in a good prognosis infertile population. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

All agree that in hindsight the rapid adoption of preimplantation genetic screening (PGS) using cleavage stage biopsy and fluorescence in situ hybridization (FISH) in routine clinical practice without proper evaluation of (cost-)effectiveness basically resulted in couples paying more money for a less effective treatment. Now, almost 20 years later, we are on the verge of a new era of PGS. But have things really changed or are we simply going back to the future?

To compare the clinical outcomes after day 3 embryo transfer, day 5 single blastocyst transfer (SBT) and frozen-thawed embryo transfer (FET) in high responder patients (15 retrieved oocytes) undergoing IVF/ICSI treatment.A retrospective analysis of three embryo transfer strategies for the high responder patients in IVF/ICSI cycles. The 1041 high responder patients diagnosed as primary infertility with more than 15 oocytes retrieved were recruited in Day 3 ET group, 308 patients with more than 15 oocytes retrieved first transferred with one blastocyst in SBT group and 425 patients with more than 15 oocytes retrieved in fresh cycle, first transferred with one frozen-thawed blastocyst were assigned in FET group.In the high responder patients, the clinical pregnancy rate after day 5 SBT was significantly lower than that of day 3 ET (43.18% VS 57.16%, p0.05). In addition, the clinical pregnant rate and implantation rate of FET cycles were significantly higher than SBT cycles (59.06% vs. 43.18% and 64.70% vs. 47.40%, p0.05). The multiple pregnancy rate in FET cycles was markedly lower than that of day 3 ET (2.35% VS 34.97%, p0.05).FET was the preferable strategy for the high responder patients in IVF/ICSI cycles to obtain both desirable clinical outcome and lower multiple pregnancy rates.

In this prospective study, we tested the hypothesis if E2 and P serum levels significantly differ during the luteal phase following in vitro-fertilization/intracytoplasmic sperm injection (IVF/ICSI) therapy in conception (CC) versus non-conception (NC) cycles, and their potential in the prediction of pregnancy at the earliest point in time. Serum was sampled from the day of embryo transfer (ET) and throughout the luteal phase until ET + 14 from patients consecutively enrolling for IVF/ICSI therapy. The luteal phase was supported by vaginal P suppositories only, clinical pregnancies were detected by ultrasound and followed up until the 20th week. Overall pregnancy rate was 30.9% constituting the two study groups of CC (n = 22) and NC cycles (n = 49). Significantly, higher E2 (3326 ± 804 versus 1072 ± 233 pmol/l, p = 0.014) and P (244 ± 68 versus 73 ± 10 nmol/l, p = 0.023) were present in CC versus NC from as early as ET + 7. In the CC group, patients with ongoing pregnancies (CC-OG) as compared with miscarriages (CC-MC) had significantly higher E2 and P from ET + 7, predicting ongoing pregnancy in receiver operator characteristics analysis.

Summary In IVF around 70% of embryos fail to implant. Often more than one embryo is transferred in order to enhance the chances of pregnancy, but this is at the price of an increased multiple pregnancy risk. In the aim to increase the success rate with a single embryo, research projects on prognostic factors of embryo viability have been initiated, but no marker has found a routine clinical application to date. Effects of soluble human leukocyte antigen-G (sHLA-G) on both NK cell activity and on Th1/Th2 cytokine balance suggest a role in the embryo implantation process, but the relevance of sHLA-G measurements in embryo culture medium and in follicular fluid (FF) are inconsistent to date. In this study, we have investigated the potential of sHLA-G in predicting the achievement of a pregnancy after IVF-ICSI in a large number of patients (n = 221). sHLA-G was determined in media and in FF by ELISA. In both FF and embryo medium, no significant differences in sHLA-G concentrations were observed between the groups “pregnancy” and “implantation failure”, or between the groups “ongoing” versus “miscarried pregnancies”. Our results do not favour routine sHLA-G determinations in the FF nor in embryo conditioned media, with the current assay technology available.

Objective: To identify predictors of ascites collected prior to the hCG administration in patients undergoing IVF/ICSI treatment at moderate risk of developing moderate/severe ovarian hyperstimulation syndrome (OHSS), and, based on these predictors, develop a nomogram for estimation of the probability of presence of ascites. Methods and Materials: Data were derived from 53 patients with 20 - 30 follicles ≥10 mmat end of stimulation. All patients received a single dose of hCG (250 mg) to trigger final follicular maturation when ≥2 follicles of ≥18 mmwere observed. Transvaginal ultrasound to measure ascites (total amount of peritoneal fluid ≥9 cm2inlithotomy position) was performed 2, 5 and 8 days after the hCG administration. Associations between clinical, sonographic and endocrinological variables recorded prior to the hCG administration and presence of ascites were analyzed by univariable and multivariable logistic regression. Results: Thirty-four patients (64%) had ultrasonic evidence of ascites. The multivariable analysis identified the total number of follicles [OR 1.29 (95% CI: 1.02 - 1.69, P = 0.043)], the ovarian volume [OR 1.05 (95% CI: 1.00 - 1.11, P = 0.047)] and BMI [OR 0.76 (95% CI: 0.56 - 0.99, P = 0.053)] as predictors of ascites (AUC = 0.825). A nomogram (PROFET) was designed with these three variables for individual prediction of the probability of development of ascites. Conclusions: This pilot investigation indicates that the risk of peritoneal fluid accumulation in IVF/ICSI patients at moderate risk of developing moderate/severe OHSS is influenced by the number of follicles and the ovarian volume on the day of hCG administration as well as the BMI.

Objective To externally validate a nomogram based on ovarian reserve markers as a tool to optimize the FSH starting dose in IVF/ICSI cycles. Study design A two-centres retrospective study including 398 infertile women undergoing their first IVF/ICSI cycle (June 2013–June 2014). IVF data were retrieved from two independent IVF centres in Italy (San Raffaele Hospital, Centre 1; Verona Hospital, Centre 2). A central lab for the routine measurement of AMH and FSH was used for both centres. All women were treated based on physical and hormonal characteristics according to locally adopted protocols. The nomogram was then retrospectively applied to the patients comparing the calculated starting dose to the one actually given. Results In Centre 1, 64/131 women (48.8%) had an ovarian response below the target. While 45 of these patients were treated with a maximal FSH starting dose (≥225 IU), n = 19/131 (14.5%) were treated with a submaximal dose. The vast majority of them (n = 17/19) would have received a higher FSH starting dose by using the nomogram. Seventeen patients (n = 17/131) had hyper response and about half of them would have been treated with a reduced FSH starting dose according to the nomogram. In Centre 2, 142/267 patients (53.2%) had an ovarian response below the target. While 136 of these were treated with a maximal FSH starting dose (≥225 IU), n = 6/267 were treated with a submaximal dose. The majority of them (n = 5/6) would have received a higher FSH starting dose. Thirty-two (n = 32/267) patients had hyper response and more than half of them would have been treated with a reduced FSH dose. Conclusion In both Centres, applying the nomogram would have resulted in more appropriate FSH starting doses compared to the the ones actually given based on clinicians choices. The use of an objective algorithm based on patient’s age, serum FSH and AMH levels may thus be an effective advice on the selection of the tailored FSH starting dose. Hence, the use of this easily available nomogram could increase the proportion of patients achieving the optimal ovarian response.

IVF-ICSI Split Insemination Reveals those Cases of Unexplained Infertility Benefitting from ICSI Even when the DNA Fragmentation Index is Reduced to 15% or Even 5% Purpose The aim of the study was to assess the fertilization rate (FR) of randomized sibling oocytes inseminated by conventional IVF or ICSI in couples with unexplained infertility. Methods The 16-month study was conducted at an established private IVF facility. Oocytes recovered from couples with normal semen parameters and normal DNA fragmentation index (DFI

Strongly Recommend Evaluation of Clinical Outcomes of IVF/ICSI with Cumulative Pregnancy Rate Objective: In order to reduce the multiple pregnancy rates, we strongly recommend the use of cumulative pregnancy rate after one oocytes retrieval cycle and all the available embryos transferred to assess the clinical outcomes of IVF/ICSI. Methods: We estimated cumulative pregnancy rate per oocyte retrieval among patients undergoing IVF/ICSI in 2011 at our center. Couples were followed until either discontinuation (no embryo to transfer) or pregnancy with visualization of gestational sac on ultrasound. Analyses were stratified according to maternal age.

To compare the IVF/ICSI outcomes of the long GnRH agonist and the fixed GnRH antagonist protocol in women with PCOS.Randomized controlled trial.Baskent University Department of Obstetrics and Gynecology.Three hundred women with PCOS.IVF/ICSI following the long GnRH agonist down-regulation or the fixed GnRH antagonist protocols.Ongoing pregnancy rates.Ongoing pregnancy rates were 36.4 % in the OCP + GnRH agonist group and 35.9 % in the OCP + GnRH antagonist group (p 0.05). Progesterone levels on the day of hCG (0.76 ± 0.71 vs. 0.58 ± 0.50), endometrial thickness on the day of hCG (11.57 ± 2.50 vs. 10.50 ± 2.01), total gonadotropin used (1388.71 ± 482.39 vs. 1253.25 ± 415.81), and duration of COH (9.07 ± 1.96 vs. 8.39 ± 1.75) were significantly lower in the OCP + GnRH antagonist group.The OCP + long GnRH agonist and the OCP + fixed GnRH antagonist protocols yield similar ongoing pregnancy rates in women with PCOS. Although this study consisting three hundred patients, seems to be large enough in a single center, we were not able to reach to the actual size of power analysis which was approximately 3,000.

This study assesses the outcome and the feasibility of an elective single embryo transfer (eSET) policy for the first and second IVF/ICSI attempts.This is a retrospective analysis performed on 611 couples attempting a first IVF cycle in Clermont-Ferrand University Hospital, France. eSET was offered to the couples when they had 2 embryos with at least one of good quality at day 2 for their first and second IVF/ICSI cycles.Among the couples selected for the study, 442 underwent an eSET and 341 a double embryo transfer (DET). The cumulative ongoing pregnancy rate (OPR) and the cumulative delivery rate (DR), including fresh and frozen embryo transfer, did not differ statistically between the two groups, respectively 40.7% and 30.9% in the eSET group and 42.5% and 34.6% in the DET group. The twin pregnancy rate was lower in the eSET group (0.7% vs. 21.2%; p0.0001) and neonatal and obstetrical outcomes were better than in the DET group. For the first attempt, the global twin rate (including eSET and DET) was 7.1% and the proportion of eSET was high, 67.6%, but for the second attempt the eSET rate was only 16.9%, with an increased global twin rate of 21.4% (p=0.042).In a selected population an eSET strategy decreases the twin pregnancy rate without decreasing the delivery rate, with a better outcome for the infants than DET. However, eSET is well accepted by patients only for the first attempt even though the pregnancy rate is not statistically different for the second.

Introduction. Coasting is the most commonly used strategy in prevention of severe OHSS. Serum FSH levels measurements during coasting may aid in optimizing the duration of coasting.Objective(s). To study live birth rates (LBRs), clinical pregnancy rates (CPRs), and optimal duration of coasting based on serum FSH levels on the hCG day.Materials and Methods.It is a retrospective study performed between 2005 and 2008 at Barts and The London Centre for Reproductive Medicine, NHS Trust, London, UK, on 349-coasted women undergoing controlled ovarian stimulation (COS) for IVF ± ICSI. The serum FSH level measurements on the hCG day during coasting programme were analysed to predict the LBR and CPR.Result(s). LBR and CPR were significantly higher when the FSH levels on the hCG day were >2.5 IU/L (LBR: 32.5%,P= 0.045 and CPR: 36.9%,P= 0.027) compared to FSH Conclusion(s). Coasting may be continued as long as either serum FSH level is > 2.5 IU/L on the hCG day without compromising the LBR and CPR or to maximum of 4 days.