應在解凍後1小時內開始回復膨脹
應在解凍後2.5小時內完全膨脹
J Assist Reprod Genet. 2017 Feb;34(2):239-244. doi: 10.1007/s10815-016-0855-5. Epub 2016 Dec 9.
2017年3月30日
解凍囊胚之囊胚腔
應在解凍後1小時內開始回復膨脹
應在解凍後2.5小時內完全膨脹
It was studied whether morphokinetics of blastocoele re-expansion and hatching in vitrified-warmed blastocysts is predictive of implantation, clinical pregnancy, and live birth.
In 144 patients aiming for single warmed blastocyst transfer, blastocysts were cultured in a new time-lapse system (Miri® TL) immediately after warming. Video sequences with an image interval of 5 min were annotated and the corresponding morphokinetic variables were correlated with pregnancy outcome. In detail, tRE (start of re-expansion), tCRE (completion of re-expansion), tAH (hatching from the manipulated zona pellucida), and presence of collapses were recorded.
In the pregnant group, tRE and tCRE were significantly lower (0.69 ± 0.45 h and 2.16 ± 0.94 h) as compared to the non-pregnant group (1.23 ± 1.08 h and 2.70 ± 1.20 h). Both variables and the duration of re-expansion (tCRE-tRE) allowed for distinction between "non-pregnant," "loss of pregnancy," and live birth/ongoing pregnancy. Presence and number of collapses showed no correlation with outcome.
Time-lapse imaging of vitrified-warmed blastocysts offers additional selection criteria allowing for prediction of implantation potential. As a consequence, cumulative pregnancy rate could be increased and time-to-pregnancy reduced.
應在解凍後1小時內開始回復膨脹
應在解凍後2.5小時內完全膨脹
冷凍液配方(VS), 改用40% EG 比15%EG+15%DMSO冷凍卵子效果更好
To examine the maturational competence, embryo development and expression of genes involved in oocyte maturation and cumulus expansion (GDF9, BMP15, HAS2, TNFAIP6, FGF17 and FSHr) following two standard methods of bovine COCsvitrification.
Bovine cumulus-oocyte complexes (COCs) were aspirated from slaughtered ovaries and then distributed into three groups: non-vitrified COCs (control), vitrification 1 group (V1); vitrification was performed by 15% ethylene glycol (EG) and 15% DMSO in holding media (TCM-199 with 20% FCS); and vitrification 2 group (V2); vitrification was performed by 40% EG in holding media. Aftervitrification, COCs were warmed in two steps and cultured and then evaluated for nuclear maturation, embryo development and gene expressions.
The mean (±SD) percentages of nuclear maturation and blastocyst/cleaved were higher in control group (79.5 ± 8.0 and 31.0 ± 5.1%) than the V1 (34.8 ± 9.1 and 4.4 ± 5.1%) and V2 (47.8 ± 11.7 and 7.1 ± 5.8%) groups (P < 0.05), respectively. Further, COCs in V2 group showed higher mean (±SD) percentages of cleavage compared to V1 group (31.8 ± 1.0 vs 21.7 ± 2.8%; P < 0.05). GDF9 and BMP15 expression levels were higher in COCs in the control than of the vitrification groups (P < 0.05). In addition, expression level of GDF9 and BMP15 was higher in V2 group than in V1group (P < 0.05). The expression of HAS2 and FGF17 in V1 group was lower (P < 0.05) than that of the V2 groups.
Expression of oocyte maturation genes was affected by vitrification procedure and conditions. Using EG alone forvitrification of bovine immature COCs, resulted in higher expression of GDF9, BMP15 and production of more in vitro matured and cleaved oocytes.
Vet Res Commun. 2017 Mar;41(1):49-56. doi: 10.1007/s11259-016-9671-8. Epub 2016 Dec 10.
Oocyte maturation, embryo development and gene expression following two different methods of bovine cumulus-oocyte complexes vitrification.
Abstract
OBJECTIVE:
METHODS:
RESULTS:
CONCLUSIONS:
7%乙醇可激活ICSI後之受精卵進一步發育成熟
Sucrose and trehalose are conventional cryoprotectant additives for oocytes and embryos. Ethanol can artificially enhance activation of inseminated mature oocytes. This study aims to investigate whether artificial oocyte activation (AOA) with ethanol can promote the development competence of in vitro matured oocytes. A total of 810 human immature oocytes, obtained from 325 patients undergoing normal stimulated oocyte retrieval cycles, were in vitro maturated (IVM) either immediately after collection (Fresh group n = 291)) or after being vitrified as immature oocytes (Vitrified group n = 519). These groups were arbitrarily assigned. All fresh and vitrified oocytes which matured after a period of IVM then underwent intra-cytoplasmic sperm injection (ICSI). Half an hour following ICSI, they were either activated by 7% ethanol (AOA group) or left untreated (Non-AOA group). Fertilization, cleavage rate, blastocyst quality and aneuploidy rate were then evaluated. High-quality blastocysts were only obtained in both the fresh and vitrified groups which had undergone AOA after ICSI. Trehalose vitrification slightly, but not significantly, increased the formation rates of high-quality embryos (21.7% VS 15.4%, P > 0.05) and blastocysts (15.7% VS 7.69%, P > 0.05)) when compared with sucrose vitrification. Aneuploidy was observed in 12 of 24 (50%) of the AOA derived high quality blastocysts. High-quality blastocysts only developed from fresh or vitrified immature oocytes if the ICSI was followed by AOA. This information may be important for human immature oocytes commonly retrieved in normal stimulation cycles and may be particularly important for certain patient groups, such as cancer patients. AOA with an appropriate concentration of ethanol can enhance the developmental competence of embryos.
Cryobiology. 2017 Feb;74:43-49. doi: 10.1016/j.cryobiol.2016.12.004. Epub 2016 Dec 9.
Effects of trehalose vitrification and artificial oocyte activation on the development competence of human immature oocytes.
Abstract
囊胚解凍後囊胚腔膨脹速度是懷孕率重要指標
囊胚腔膨脹<1小時懷孕率最高
囊胚腔膨脹>2小時懷孕率明顯下降
To assess the predictive value of blastocoele re-expansion time in clinical pregnancy outcome in vitrified-warmed cycles.
Data on 468 single vitrified-thawed blastocyst transfer cycles (in patients aged <38 years) carried out from January 2012 through December 2012, at the Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, were analyzed. Vitrified-warmed blastocysts were divided into three groups according to blastocoele re-expansion time: group A, <1 h; group B, 1-2 h; and group C, >2 h, and the clinical pregnancy outcomes (i.e. live birth rate, miscarriage rate and occurrence of singleton pregnancies) compared between the groups.
Significant differences were observed in the implantation/clinical pregnancy rate between groups A, B and C (70.10%, 51.76% and 28.74%, respectively, P < 0.01). There was a significant linear decline in this rate with increasing blastocyst re-expansion time. The rate of miscarriage also tended to increase with increasing blastocyst re-expansion time, but the difference was not statistically significant (P > 0.05). Of the pregnant patients, no significant difference was observed in the rates of monozygotic twins and ectopic pregnancy between the three groups. For the newborns, similar live birth, low-birthweight and premature delivery rates were observed between the groups.
Timing of blastocoele re-expansion in vitrified-warmed cycles is a strong predictor of clinical pregnancy outcome. The faster the re-expansion of the blastocoele, the higher the developmental potential of the blastocysts.
囊胚腔膨脹<1小時懷孕率最高
囊胚腔膨脹>2小時懷孕率明顯下降
J Obstet Gynaecol Res. 2017 Jan 26. doi: 10.1111/jog.13257. [Epub ahead of print]
Blastocoele re-expansion time in vitrified-warmed cycles is a strong predictor of clinical pregnancy outcome.
Abstract
AIM:
METHODS:
RESULTS:
CONCLUSIONS:
© 2017 Japan Society of Obstetrics and Gynecology.
2017年3月28日
AMH抑制原始濾泡之進一步成熟&啟動
AMH不會抑制已啟動成熟濾泡之生長
Does anti-Müllerian hormone (AMH) inhibit activation (initiation of growth) of primordial follicles and attenuate the growth of primary follicles in cattle, an excellent animal model for human ovarian follicular development?
AMH inhibited activation of bovine primordial follicles and attenuated the growth of activated follicles in vitro.
In mice null mutant for AMH, the pool of primordial follicles is depleted prematurely and AMH inhibits follicle activation in vitro. Results of studies with human ovarian tissue in vitro were inconsistent. Our previous work provided indirect evidence that AMH inhibits follicle activation in bovine ovaries.
Pieces of fetal bovine ovarian cortex (2 pieces/culture well), obtained during mid or late pregnancy, were cultured in control medium or with graded doses of AMH for 2, 10 or 12 days. Effects of treatment on follicle activation and growth were determined by histological morphometry; follicles in every 20th histological section were staged (primordial or primary), counted, and measured. In addition, AMH was immunolocalized in bovine ovaries obtained at various times during pregnancy (n = 20 ovaries).
Bovine fetal ovaries at mid or late gestation were obtained at a commercial abattoir. Pieces of ovarian cortex were cultured without or with AMH and fixed for histological morphometry on Day 0 and at the end of culture. Treatments were applied to duplicate cultures from each of two or three fetuses. In 12-day cultures, addition of AMH was delayed until the third day. Histological analysis provided information about the types, numbers and sizes of follicles in cortical pieces before and after treatments. Ovaries obtained during the second and third trimesters were assessed for the presence of AMH by immunohistochemistry.
AMH (100-500 ng/ml) inhibited follicle activation in response to an activator (insulin) in ovarian cortical pieces from fetal ovaries in late gestation. Dose-dependent inhibitory effects on the diameters of primary follicles and their oocytes were also observed. These results were obtained only when AMH was added to cultures in advance of insulin (presumably because it penetrates tissue more slowly than insulin). Results of experiments with cortical pieces from fetal ovaries at mid-gestation, when follicles are forming, showed that AMH did not inhibit the formation of follicles. Immunohistochemical localization of AMH showed that it is not present in fetal ovaries until the third trimester, when it was localized to the granulosa cells of secondary and small antral follicles.
AMH不會抑制已啟動成熟濾泡之生長
Mol Hum Reprod. 2017 Mar 17:1-10. doi: 10.1093/molehr/gax010. [Epub ahead of print]
Anti-Müllerian hormone inhibits activation and growth of bovine ovarian follicles in vitro and is localized to growing follicles.
Abstract
STUDY QUESTION:
SUMMARY ANSWER:
WHAT IS KNOWN ALREADY:
STUDY DESIGN, SIZE, DURATION:
PARTICIPANTS/MATERIALS, SETTING, METHODS:
MAIN RESULTS AND THE ROLE OF CHANCE:
2017年3月27日
COH當中補充DHEA會造成P4假性上升
Dehydroepiandrosterone (DHEA) is often prescribed for poor responders in IVF in an effort to improve response to ovarian stimulation. The effect of DHEA supplementation and resultant supraphysiologic DHEA-S serum levels on sex steroid assays has not been evaluated in this population. This study seeks to determine the relationship between DHEA supplementation and progesterone measurements to characterize the degree of interference with particular immunoassays.
Characterization was accomplished in two phases. First, DHEA-S standard control reagents with no progesterone present were assayed for both DHEA-S and progesterone levels. Second, serum pools from 60 unique IVF patients' serum were used to create six pooled serum samples: three from patients on DHEA supplementation and three from patients not on DHEAsupplementation. The three pools were composed of patients whose serum fell into low, medium, and high progesterone ranges. Baseline DHEA-S and progesterone were measured, and the mean level of DHEA-S in the mid-range progesterone pool was used as the mid-point for addition of DHEA-S standard to the serum pools from patients without DHEA supplementation. Progesterone from these pools was then measured on three commercially available immunoassay systems.
The first experiment revealed a linear increase in progesterone when analyzing the DHEA-S standard ranging from 0.5 ng/mL in the blank control (no DHEA-S) to up to 2.0 ng/mL in the high control (DHEA-S >700 μg/mL), indicating that the DHEA-S cross-reacts with the progesterone assays. In the second experiment, patients' serum DHEA-S and progesterone were measured from pooled serum samples of those taking DHEA and those not taking DHEA. Adding DHEA-S to the pooled serum of those not takingDHEA resulted in a linear increase in progesterone levels on two of three commercially available immunoassays (p < 0.05).
DHEA-S can interfere with standard progesterone immunoassays used in clinical ART programs, and thus serum progesterone levels in IVF patients on DHEA supplementation may not reflect truly bioactive progesterone.
J Assist Reprod Genet. 2016 Mar;33(3):387-91. doi: 10.1007/s10815-016-0650-3. Epub 2016 Jan 12.
Dehydroepiandrosterone (DHEA) supplementation results in supraphysiologic DHEA-S serum levels and progesterone assay interference that may impact clinical management in IVF.
Abstract
PURPOSE:
METHODS:
RESULTS:
CONCLUSIONS:
服用Co-Q 10有助於IVF卵子生成
The objective of this study is to compare the combination of dehydroepiandrosterone (DHEA) and coenzyme Q10 (CoQ10) (D + C) with DHEA alone (D) in intrauterine insemination (IUI) and in vitro fertilization (IVF) cycles among patients with decreased ovarian reserve.
We retrospectively extracted data from patients charts treated by DHEA with/without CoQ10 during IUI or IVF between February 2006 and June 2014. Prestimulation parameters included age, BMI, day 3 FSH and antral follicular count (AFC). Ovarian response parameters included total gonadotropins dosage, peak serum estradiol, number of follicles > 16 mm and fertilization rate. Clinical outcomes included clinical and ongoing pregnancy rates.
Three hundred and thirty IUI cycles involved D + C compared with 467 cycles of D; 78 IVF cycles involved D + C and 175 D. In both IUI and IVF, AFC was higher with D + C compared with D (7.4 ± 5.7 versus 5.9 ± 4.7, 8.2 ± 6.3 versus 5.2 ± 5, respectively, p < 0.05). D + C resulted in a more follicles > 16 mm during IUI cycles (3.3 ± 2.3 versus 2.9 ± 2.2, respectively, p = 0.01), while lower mean total gonadotropin dosage was administered after D + C supplementation compared with D (3414 ± 1141 IUs versus 3877 ± 1143 IUs respectively, p = 0.032) in IVF cycles. Pregnancy and delivery rates were similar for both IUI and IVF.
D + C significantly increases AFC and improves ovarian responsiveness during IUI and IVF without a difference in clinical outcome.
Gynecol Endocrinol. 2016 Jul;32(7):534-7. doi: 10.3109/09513590.2015.1137095. Epub 2016 Feb 1.
The use of coenzyme Q10 and DHEA during IUI and IVF cycles in patients with decreased ovarian reserve.
Abstract
OBJECTIVE:
METHODS:
RESULTS:
CONCLUSION:
2017年3月26日
Duphaston vs Utrogestan
應用於IVF-ET黃體期補充, 活產率無差異(34.6% vs 29.8%)
Is oral dydrogesterone 30 mg daily (10 mg three times daily [TID]) non-inferior to micronized vaginal progesterone (MVP) 600 mg daily (200 mg TID) for luteal support in in vitro fertilization (IVF), assessed by the presence of fetal heartbeats determined by transvaginal ultrasound at 12 weeks of gestation?
Non-inferiority of oral dydrogesterone versus MVP was demonstrated at 12 weeks of gestation, with a difference in pregnancy rate and an associated confidence interval (CI) that were both within the non-inferiority margin.
MVP is routinely used in most clinics for luteal support in IVF, but it is associated with side effects, such as vaginal irritation and discharge, as well as poor patient acceptance. Dydrogesterone may be an alternative treatment due to its patient-friendly oral administration.
Lotus I was an international Phase III randomized controlled trial, performed across 38 sites, from August 2013 to March 2016. Subjects were premenopausal women (>18 to <42 years of age; body mass index (BMI) ≥18 to ≤30 kg/m2) with a documented history of infertility who were planning to undergo IVF. A centralized electronic system was used for randomization, and the study investigators, sponsor's study team, and subjects remained blinded throughout the study.
In total, 1031 subjects were randomized to receive either oral dydrogesterone (n = 520) or MVP (n = 511). Luteal support was started on the day of oocyte retrieval and continued until 12 weeks of gestation (Week 10), if a positive pregnancy test was obtained at 2 weeks after embryo transfer.
In the full analysis set (FAS), 497 and 477 subjects in the oral dydrogesterone and MVP groups, respectively, had an embryo transfer. Non-inferiority of oral dydrogesterone was demonstrated, with pregnancy rates at 12 weeks of gestation of 37.6% and 33.1% in the oral dydrogesterone and MVP treatment groups, respectively (difference 4.7%; 95% CI: -1.2-10.6%). Live birth rates of 34.6% (172 mothers with 213 newborns) and 29.8% (142 mothers with 158 newborns) were obtained in the dydrogesterone and MVP groups, respectively (difference 4.9%; 95% CI: -0.8-10.7%). Oral dydrogesterone was well tolerated and had a similar safety profile to MVP.
應用於IVF-ET黃體期補充, 活產率無差異(34.6% vs 29.8%)
Hum Reprod. 2017 Mar 1:1-9. doi: 10.1093/humrep/dex023. [Epub ahead of print]
A Phase III randomized controlled trial comparing the efficacy, safety and tolerability of oral dydrogesterone versus micronized vaginal progesterone for luteal support in in vitro fertilization.
Abstract
STUDY QUESTION:
SUMMARY ANSWER:
WHAT IS KNOWN ALREADY:
STUDY DESIGN, SIZE, DURATION:
PARTICIPANTS/MATERIALS, SETTING, METHODS:
MAIN RESULTS AND THE ROLE OF CHANCE:
輸卵管結紮後再接通手術, 懷孕率約50%(42-69%)
子宮外孕機率約5%(4-8%)
Hum Reprod Update. 2017 Feb 22:1-13. doi: 10.1093/humupd/dmx003. [Epub ahead of print]
Female sterilization is one of the most common contraceptive methods. A small number of women, however, opt for reversal of sterilization procedures after they experience regret. Procedures can be performed by laparotomy or laparoscopy, with or without robotic assistance. Another commonly utilized alternative is IVF. The choice between surgery and IVF is often influenced by reimbursement politics for that particular geographic location.
We evaluated the fertility outcomes of different surgical methods available for the reversal of female sterilization, compared these to IVF and assessed the prognostic factors for success.
Two search strategies were employed. Firstly, we searched for randomized and non-randomized clinical studies presenting fertility outcomes of sterilization reversal up to July 2016. Data on the following outcomes were collected: pregnancy rate, ectopic pregnancy rate, cost of the procedure and operative time. Eligible study designs included prospective or retrospective studies, randomized controlled trials, cohort studies, case-control studies and case series. No age restriction was applied. Exclusion criteria were patients suffering from tubal infertility from any other reason (e.g. infection, endometriosis and adhesions from previous surgery) and studies including <10 participants. The following factors likely to influence the success of sterilization reversal procedures were then evaluated: female age, BMI and duration and method of sterilization. Secondly, we searched for randomized and non-randomized clinical studies that compared reversal of sterilization to IVF and evaluated them for pregnancy outcomes and cost effectiveness.
We included 37 studies that investigated a total of 10 689 women. No randomized controlled trials were found. Most studies were retrospective cohort studies of a moderate quality. The pooled pregnancy rate after sterilization reversal was 42-69%, with heterogeneity seen from the different methods utilized. The reported ectopic pregnancy rate was 4-8%. The only prognostic factor affecting the chance of conception was female age. The surgical approach (i.e. laparotomy [microscopic], laparoscopy or robotic) had no impact on the outcome, with the exception of the macroscopic laparotomic technique, which had inferior results and is not currently utilized. For older women, IVF could be a more cost-effective alternative for the reversal of sterilization. However, direct comparative data are lacking and a cut-off age cannot be stated.
子宮外孕機率約5%(4-8%)
Hum Reprod Update. 2017 Feb 22:1-13. doi: 10.1093/humupd/dmx003. [Epub ahead of print]
Tubal anastomosis after previous sterilization: a systematic review.
Abstract
BACKGROUND:
OBJECTIVE AND RATIONALE:
SEARCH METHODS:
OUTCOMES:
2017年3月25日
困難胚胎植入會明顯下降懷孕率10個百分點(38.2% vs. 27.1%)
To establish the relationship between the degree of difficulty of ET and pregnancy rate (PR), with a view to proposing an algorithm for the objective assessment of ET.
Retrospective, observational study.
In vitro fertilization unit.
Women undergoing assisted reproductive technology (ART) with ET after IVF/intracytoplasmic sperm injection, in whom fresh embryo transfer or frozen-thawed embryo transfer was performed.
None.
Clinical pregnancy rate (CPR).
A total of 7,714 ETs were analyzed. The CPR was significantly higher in the cases of easy ET compared with difficult ET (38.2% vs. 27.1%). Each instrumentation needed to successfully deposit the embryos in the fundus involves a progressive reduction in the CPR: use of outer catheter sheath (odds ratio [OR] 0.89; 95% confidence interval [CI] 0.79-1.01), use of Wallace stylet (OR 0.71; 95% CI 0.62-0.81), use of tenaculum (OR 0.54; 95% CI 0.36-0.79). Poor ultrasound visualization significantly diminish the CPR.
The CPR decreases progressively with the use of additional maneuvers during ET. An objective classification of the instrumentation applied during ET is proposed.
Fertil Steril. 2017 Mar;107(3):657-663.e1. doi: 10.1016/j.fertnstert.2016.11.020. Epub 2017 Jan 12.
What is a difficult transfer? Analysis of 7,714 embryo transfers: the impact of maneuvers during embryo transfers on pregnancy rate and a proposal of objective assessment.
Abstract
OBJECTIVE:
DESIGN:
SETTING:
PATIENT(S):
INTERVENTION(S):
MAIN OUTCOME MEASURE(S):
RESULT(S):
CONCLUSION(S):
培養液必含6種無機離子: Na(+), K(+), Cl(-), Ca(2+), Mg(2+), and SO(4)(2-)
多數含PO(4)(2-)
胺基酸主要: glycine
The main components of embryo culture media are salts, which dissociate into their component inorganic ions in aqueous solution. All embryo culture media contain the same six inorganic ions: Na(+), K(+), Cl(-), Ca(2+), Mg(2+), and SO(4)(2-), while most also contain PO(4)(2-). The salts that are used to formulate embryo culture media can be traced back to classic saline solutions, particularly Krebs-Ringer Bicarbonate (KRB), that were developed for somatic cells in the first half of the twentieth century. The salt and inorganic ion concentrations in the first successful defined mouse embryo culture medium, Whittens medium, were identical to those in KRB. These remained largely unchanged in embryo culture media for decades, with similar levels found in the standard mouse embryo culture medium, M16, formulated in the 1970s. Human embryos were initially cultured in undefined somatic cell media such as Earles and Hams F-10 with serum added. This changed in the mid-1980s, however, with the development of Quinns HTF, a defined medium specifically formulated for human embryo culture, in which the inorganic ion concentrations are similar to those in M16 and Whittens. While these media were useful both for experimental work and clinically, embryos suffered developmental blocks in all of them, with mouse embryos blocking at the 2-cell stage and human embryos at the 4- to 8-cell stage. Starting in the late 1980s, however, mouse embryo culture media were first developed that alleviated these developmental blocks. These media, CZB and KSOM, had much lower osmolalities than previous media, mainly due to lower inorganic ion concentrations. Indeed, lowering total inorganic ion concentration and osmolality proved key to understanding how media that supported complete preimplantation development in vitro can be formulated. A subsequent improvement was the addition of amino acids to culture media for both mouse and human embryos. At least in part, their beneficial effect during the cleavage stages of development is due to the presence in early preimplantation embryos of mechanisms for cell volume regulation that depend on the accumulation of amino acids as organic osmolytes to provide intracellular osmotic support. These amino acids, principally glycine, replace a portion of the intracellular inorganic ions that would otherwise be needed to maintain cell size, preventing the intracellular ionic strength from rising to deleterious levels and blocking development. Thus, the optimum salts levels, osmolality, and amino acid contents of culture media are not independent, but interact strongly because of their roles in cell volume regulation. In the absence of compounds that preimplantation embryos can use as organic osmolytes, embryos will develop only at lower osmolalities and salt concentrations in the medium. However, when organic osmolytes such as some amino acids are present, embryos will develop in culture at higher osmolarities that are similar to those they experience in tubal fluid in vivo.
多數含PO(4)(2-)
胺基酸主要: glycine
Methods Mol Biol. 2012;912:61-80. doi: 10.1007/978-1-61779-971-6_5.
Media composition: salts and osmolality.
Baltz JM1.
Abstract
非子宮腔內肌瘤對COH+IUI懷孕率無明顯影響
To investigate the association of non-cavity-distorting uterine fibroids and pregnancy outcomes after ovarian stimulation-intrauterine insemination (OS-IUI) in couples with unexplained infertility.
Secondary analysis from a prospective, randomized, multicenter clinical trial investigating fertility outcomes after OS-IUI.
Reproductive Medicine Network clinical sites.
Nine hundred couples with unexplained infertility who participated in the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS) clinical trial.
Participants were randomized to one of three arms (clomiphene citrate, letrozole, or gonadotropins), and treatment was continued for up to four cycles or until pregnancy was achieved.
Conception (serum hCG increase), clinical pregnancy (fetal cardiac activity), and live birth rates.
A total of 102/900 participants (11.3%) had at least one documented fibroid and a normal uterine cavity. Women with fibroids were older, more likely to be African American, had a greater uterine volume, lower serum antimüllerian hormone levels, and fewer antral follicles than women without fibroids. In conception cycles, clinical pregnancy rates were significantly lower in participants with fibroids than in those without uterine fibroids. Pregnancy loss before 12 weeks was more likely in African American women with fibroids compared with non-African American women with fibroids. There was no difference in conception and live birth rates in subjects with and without fibroids.
No differences were observed in conception and live birth rates in women with non-cavity-distorting fibroids and those without fibroids. These findings provide reassurance that pregnancy success is not impacted in couples with non-cavity-distorting fibroids undergoing OS-IUI for unexplained infertility.
Fertil Steril. 2017 Mar;107(3):756-762.e3. doi: 10.1016/j.fertnstert.2016.12.012. Epub 2017 Jan 12.
Association of uterine fibroids and pregnancy outcomes after ovarian stimulation-intrauterine insemination for unexplained infertility.
Styer AK1, Jin S2, Liu D2, Wang B3, Polotsky AJ4, Christianson MS5, Vitek W6, Engmann L7, Hansen K8, Wild R8, Legro RS9,Coutifaris C10, Alvero R11, Robinson RD12, Casson P13, Christman GM14, Christy A15, Diamond MP16, Eisenberg E17, Zhang H2,Santoro N4; National Institute of Child Health and Human Development Reproductive Medicine Network.
Abstract
OBJECTIVE:
DESIGN:
SETTING:
PATIENT(S):
INTERVENTION(S):
MAIN OUTCOMES MEASURE(S):
RESULT(S):
CONCLUSION(S):
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