IVF取卵後受孕胚胎超過9個懷孕率反而下降
受孕胚胎未超過9個，懷孕率與胚胎數量成正比

Fertil Steril. 2019 Sep;112(3):520-526.e1. doi: 10.1016/j.fertnstert.2019.04.023. Epub 2019 Jun 18.

Clinical pregnancy (CP) and live birth (LB) increase significantly with each additional fertilized oocyte up to nine, and CP and LB decline after that: an analysis of 15,803 first fresh in vitro fertilization cycles from the Society for Assisted Reproductive Technology registry.

Smeltzer S1, Acharya K1, Truong T2, Pieper C2, Muasher S3.

Author information

Abstract

OBJECTIVE:

To study the association between the total number of fertilized oocytes available and pregnancy outcomes in first fresh IVF cycles with a single blastocyst transfer.

DESIGN:

Retrospective cohort study.

SETTING:

Not applicable.

PATIENT(S):

A total of 15,803 patients from SART reporting fertility clinics.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Primary outcomes were clinical pregnancy (CP), live birth (LB), and miscarriage rates. Logistic regression was used to investigate the association between the number of fertilized eggs and each outcome.

RESULT(S):

The median number of total oocytes was 15, and the median number of fertilized oocytes was nine. The odds of a clinical pregnancy were 8% higher for each additional fertilized oocyte up to nine (odds ratio [OR] 1.08; 95% confidence interval [CI] 1.07-1.10) and declined by 9% for every additional fertilized oocyte after nine (OR 0.91; 95% CI 0.89-0.94). Similarly, the odds of an LB was 8% higher for every additional fertilized oocyte up to none (OR 1.08; 95% CI 1.06-1.10) and declined by 8% for every additional fertilized oocyte over nine (OR 0.92; 95% CI 0.90-0.94).

CONCLUSION(S):

Odds of pregnancy outcomes (CP, LB) increase significantly with every additional fertilized oocyte up to nine, and CP and LB decline after that in first fresh autologous cycles with a single blastocyst transfer.

囊胚5顆之內  鮮胚植入與囊胚數量成正比
囊胚超過5顆  該周期鮮胚植入反而會下降懷孕率
囊胚超過5顆  囊胚數量與懷孕率成反比
原因再於卵巢過度刺激造成子宮內膜之干擾

Fertil Steril. 2019 Aug 5. pii: S0015-0282(19)30563-1. doi: 10.1016/j.fertnstert.2019.06.030. [Epub ahead of print]

Clinical pregnancy and live birth increase significantly with every additional blastocyst up to five and decline after that: an analysis of 16,666 first fresh single-blastocyst transfers from the Society for Assisted Reproductive Technology registry.

Smeltzer S1, Acharya K1, Truong T2, Pieper C2, Muasher S3.

OBJECTIVE:

To study the association between the number of blastocysts available and pregnancy outcomes in first fresh autologous single blastocyst transfer cycles.

DESIGN:

Retrospective cohort study.

SETTING:

Not applicable.

PATIENT(S):

Patients from the Society for Assisted Reproductive Technology reporting fertility clinics (n=16,666).

INTERVENTIONS(S):

None.

MAIN OUTCOME MEASURE(S):

Primary outcomes were clinical pregnancy (CP), live birth (LB), and miscarriage rates. Logistic regression was used to investigate the association between the number of blastocysts and each outcome.

RESULT(S):

When comparing fresh single blastocyst transfer rates, the odds of a positive pregnancy outcome (CP) increased significantly with each additional supernumerary blastocyst up to five and declined by 2% for every additional blastocyst after five. Similarly, the odds of an LB was 17% higher for each additional blastocyst up to five and declined by 2% for every additional blastocyst after five. There was no significant association between blastocyst number and miscarriage rate.

CONCLUSION(S):

Odds of positive pregnancy outcomes (CP, LB) increased significantly with every additional blastocyst up to five, but declined after that, in first fresh autologous cycles with single-blastocyst transfer. The decline after five may be explained by a detrimental effect on endometrial receptivity in patients with a large number of oocytes or inadequate selection of the best embryo for transfer based on morphology alone.

精蟲分離晶片比傳統grading分離法可達到較高懷孕率(18 vs 15%)

Fertil Steril. 2019 Sep 19. pii: S0015-0282(19)30578-3. doi: 10.1016/j.fertnstert.2019.06.037. [Epub ahead of print]

Comparison of microfluid sperm sorting chip and density gradient methods for use in intrauterine insemination cycles.

Gode F1, Bodur T2, Gunturkun F3, Gurbuz AS4, Tamer B2, Pala I2, Isik AZ5.

Author information

Abstract

OBJECTIVE:

To compare the effect of microfluiding sperm sorting chip and density gradient methods on ongoing pregnancy rates (PRs) of patients undergoing IUI.

DESIGN:

Retrospective cohort study.

SETTING:

Hospital IVF unit.

PATIENT(S):

Couples with infertility undergoing IUI cycles between 2017 and 2018.

INTERVENTION(S):

Not applicable.

MAIN OUTCOME MEASURE(S):

Ongoing PRs.

RESULT(S):

A total of 265 patients were included in the study. Microfluid sperm sorting and density gradient were used to prepare sperm in 133 and 132 patients, respectively. Baseline spermiogram parameters, including volume, concentration, motility, and morphology, were similar between the two groups. Total motile sperm count was lower in the microfluiding sperm sorting group at baseline (35.96 ± 37.69 vs. 70.66 ± 61.65). After sperm preparation sperm motility was higher in the microfluid group (96.34 ± 7.29 vs. 84.42 ± 10.87). Pregnancy rates were 18.04% in the microfluid group and 15.15% in the density gradient group, and ongoing PRs were 15.03% and 9.09%, respectively. After using multivariable logistic regression and controling for confounding factors, there was a significant increase in ongoing PRs in the microfluid sperm sorting group. The adjusted odds ratio for ongoing pregnancy in the microfluid group compared with the density gradient group was 3.49 (95% confidence interval 1.12-10.89).

CONCLUSION(S):

The microfluid sperm sorting method significantly increased the ongoing PRs compared with the density gradient group in IUI cycles.

PGS並無法明顯提高臨床懷孕率 (50 vs 46%)
PGS對於高齡(35-40 years)&據有2個以上囊胚 可能可以提高懷孕率

Fertil Steril. 2019 Sep 21. pii: S0015-0282(19)31979-X. doi: 10.1016/j.fertnstert.2019.07.1346. [Epub ahead of print]

Preimplantation genetic testing for aneuploidy versus morphology as selection criteria for single frozen-thawed embryo transfer in good-prognosis patients: a multicenter randomized clinical trial.

Abstract

OBJECTIVE:

To evaluate the benefit of next-generation sequencing (NGS)-based preimplantation genetic testing for aneuploidy (PGT-A) for embryo selection in frozen-thawed embryo transfer.

DESIGN:

Randomized controlled trial.

SETTING:

Not applicable.

PATIENT(S):

Women aged 25-40 years undergoing IVF with at least two blastocysts that could be biopsied.

INTERVENTION(S):

Randomization for single frozen-thawed embryo transfer with embryo selection based on PGT-A euploid status versus morphology.

MAIN OUTCOME MEASURE(S):

Ongoing pregnancy rate (OPR) at 20 weeks' gestation per embryo transfer.

RESULT(S):

A total of 661 women (average age 33.7 ± 3.6 years) were randomized to PGT-A (n = 330) or morphology alone (n = 331). The OPR was equivalent between the two arms, with no significant difference per embryo transfer (50% [137/274] vs. 46% [143/313]) or per intention to treat (ITT) at randomization (41.8% [138/330] vs. 43.5% [144/331]). Post hoc analysis of women aged 35-40 years showed a significant increase in OPR per embryo transfer (51% [62/122] vs. 37% [54/145]) but not per ITT.

CONCLUSION(S):

PGT-A did not improve overall pregnancy outcomes in all women, as analyzed per embryo transfer or per ITT. There was a significant increase in OPR per embryo transfer with the use of PGT-A in the subgroup of women aged 35-40 years who had two or more embryos that could be biopsied, but this was not significant when analyzed by ITT.