全球精蟲濃度數量逐年下降

1970-2000每年以1.16%逐年下降

2000年以後每年以2.64%逐年下降

Temporal trends in sperm count: a systematic review and meta-regression analysis of samples collected globally in the 20th and 21st centuries 

Human Reproduction Update, dmac035, https://doi.org/10.1093/humupd/dmac035

BACKGROUND

Numerous studies have reported declines in semen quality and other markers of male reproductive health. Our previous meta-analysis reported a significant decrease in sperm concentration (SC) and total sperm count (TSC) among men from North America–Europe–Australia (NEA) based on studies published during 1981–2013. At that time, there were too few studies with data from South/Central America–Asia–Africa (SAA) to reliably estimate trends among men from these continents.

OBJECTIVE AND RATIONALE

The aim of this study was to examine trends in sperm count among men from all continents. The broader implications of a global decline in sperm count, the knowledge gaps left unfilled by our prior analysis and the controversies surrounding this issue warranted an up-to-date meta-analysis.

SEARCH METHODS

We searched PubMed/MEDLINE and EMBASE to identify studies of human SC and TSC published during 2014–2019. After review of 2936 abstracts and 868 full articles, 44 estimates of SC and TSC from 38 studies met the protocol criteria. Data were extracted on semen parameters (SC, TSC, semen volume), collection year and covariates. Combining these new data with data from our previous meta-analysis, the current meta-analysis includes results from 223 studies, yielding 288 estimates based on semen samples collected 1973–2018. Slopes of SC and TSC were estimated as functions of sample collection year using simple linear regression as well as weighted meta-regression. The latter models were adjusted for predetermined covariates and examined for modification by fertility status (unselected by fertility versus fertile), and by two groups of continents: NEA and SAA. These analyses were repeated for data collected post-2000. Multiple sensitivity analyses were conducted to examine assumptions, including linearity.

OUTCOMES

Overall, SC declined appreciably between 1973 and 2018 (slope in the simple linear model: –0.87 million/ml/year, 95% CI: –0.89 to –0.86; P < 0.001). In an adjusted meta-regression model, which included two interaction terms [time × fertility group (P = 0.012) and time × continents (P = 0.058)], declines were seen among unselected men from NEA (–1.27; –1.78 to –0.77; P < 0.001) and unselected men from SAA (–0.65; –1.29 to –0.01; P = 0.045) and fertile men from NEA (–0.50; –1.00 to –0.01; P = 0.046). Among unselected men from all continents, the mean SC declined by 51.6% between 1973 and 2018 (–1.17: –1.66 to –0.68; P < 0.001). The slope for SC among unselected men was steeper in a model restricted to post-2000 data (–1.73: –3.23 to –0.24; P = 0.024) and the percent decline per year doubled, increasing from 1.16% post-1972 to 2.64% post-2000. Results were similar for TSC, with a 62.3% overall decline among unselected men (–4.70 million/year; –6.56 to –2.83; P < 0.001) in the adjusted meta-regression model. All results changed only minimally in multiple sensitivity analyses. 

超過一半以上染色體鑲嵌化胚胎仍可發展成為健康胚胎

新一代非侵犯式PGS (noninvasive preimplantation genetic testing for aneuploidy (niPGT-A)

已經具有相當臨床準確性

. 2022 Nov;39(11):2483-2504.

 doi: 10.1007/s10815-022-02651-5. Epub 2022 Nov 24.

Majority of transferred mosaic embryos developed healthy live births revealed by a preclinical study using embryonic morphology assessment and noninvasive PGT-A on cell-free DNA in blastocoel fluid

Purpose: This preclinical study aimed to evaluate whether using transferred mosaic embryos (primarily selected by embryonic morphology assessment (EMA) and compared by the noninvasive preimplantation genetic testing for aneuploidy (niPGT-A) on cell-free DNA in blastocoel fluid (BF)) increases the rates of clinical pregnancies (CPs) and healthy live births (HLBs) and to investigate whether niPGT-A could provide valuable genetic information for the EMA-selected transferred mosaic embryos.

Methods: This study collected 215 blastocyst culture samples and 182 BF samples. Cell-free DNA from the BF was amplified and examined by next-generation sequencing-based niPGT-A. All 182 patients underwent EMA. However, only 147 underwent in vitro fertilization and embryo transfer, and only 113 clinical outcomes were followed up. Comprehensive chromosome screening for the chorionic villus sampling of spontaneous miscarriages and noninvasive prenatal testing for ongoing pregnancies were also performed.

Results: The implantation rate was 77.55% in 147 transferred high-quality embryos selected by EMA. Among 113 CPs, 16 led to spontaneous miscarriage (14.16%), and 97 resulted in HLBs (85.84%). According to the niPGT-A results for 113 patients with clinical outcomes, 80.4% had CP (euploid, 20.54%; single aneuploid, 1.79%; mosaic chromosome aneuploid and/or segmental aneuploid, 58.04%). Of all the mosaic aneuploids, 90.76% were false positive, transforming to euploid.

Conclusions: Transferred EMA-selected embryos showed higher implantation rates. The niPGT-A of BF provided valuable genetic status ("-ploid") information, which helped reduce aneuploid-induced implantation failure and miscarriage, thereby increasing the CP and HLB rates. Additionally, majority of the transferred embryos with complex/chaotic mosaic aneuploid would likely develop HLBs.

懷孕早期low HCG(low 10th%, corresponded to 149 mUI/mL)---常合併早產等懷孕併發症

Pregnancy complications and placental histology in in vitro fertilization pregnancies with initial low serum β-hCG levels

• Hadas Ganer Herman, M.D. 
• Alexander Volodarsky-Perel, M.D.
• Tuyet Nhung Ton Nu, M.D.
• Yiming Cui, M.D.
• Jonathan Shaul, M.D.
• Michael H. Dahan, M.D.
• Show all authors

Objective

To assess perinatal outcomes and placental findings after in vitro fertilization (IVF) with an initial low serum β-human chorionic gonadotropin (hCG).

Intervention(s)

Low serum β-hCG after transfer, defined as the low 10th percentile for the cohort on day 16 embryo age (low β-hCG group), compared with an initial serum β-hCG at or above the low 10th percentile (control group).

Patient(s)

Live singleton births after IVF between 2009 and 2017.

Main Outcome Measure(s)

Primary outcomes were placental findings, including anatomic, inflammatory, vascular malperfusion, and villous maturation lesions, as categorized according to the Amsterdam Placental Workshop Group Consensus. Secondary outcomes included obstetric and perinatal outcomes.

Result(s)

The low 10th percentile of β-hCG results corresponded to 149 mUI/mL. There were 103 cases in the low β-hCG group, and 928 in the control group. Maternal demographics were similar between the groups, whereas blastocyte transfer was more common in the control group. Deliveries in the low β-hCG group were associated with an increased rate of preterm births, 15.5% vs. 8.1%, which maintained significance after adjustment for confounders. Placentas in the low β-hCG group were notable for a high rate of velamentous cord insertion, 19.4% vs. 7.7%, single umbilical artery 3.8% vs. 0.6%, and histological maternal vasculopathy, 10.6% vs. 4.8%.

Conclusion

Live births after IVF with an initial low β-hCG level are associated with a twofold increase in preterm births and placental gross and histological changes. It may thus be considered to observe such cases in a high-risk pregnancy setting.

 卵巢退化(AMH<1)病患

使用antiestrogen agent (Letrozole) vs injection gonadotropin

懷孕率並無差異(8.7  vs  8.1%)

Pregnancy outcomes after oral and injectable ovulation induction in women with infertility with a low antimüllerian hormone level compared with those with a normal antimüllerian hormone level

• Phillip A. Romanski, M.D., M.Sc. 
• Pietro Bortoletto, M.D., M.Sc.
• Jonas E. Malmsten, D.P.S.
• Kay See Tan, Ph.D.
• Steven D. Spandorfer, M.D.

https://www.fertstert.org/article/S0015-0282(22)01427-3/fulltext

Objective

To determine the ongoing pregnancy rate among patients with infertility with a low antimüllerian (AMH) level compared with those with a normal AMH level after oral and injectable ovulation induction (OI)/intrauterine insemination (IUI).

Patient(s)

Patients completing ≥1 medicated OI/IUI cycle at our center between 2015 and 2019 were included. The AMH levels were measured within 12 months of treatment initiation. The cohort was stratified into low AMH (AMH level, <1.0 ng/mL) and normal AMH (AMH level, ≥1.0 ng/mL) groups. All subsequent medicated OI/IUI cycles occurring within 1 year of initial cycle start date were included up to the third completed cycle or until an ongoing pregnancy was recorded. Patients were stratified by age (<35, 35–40, and >40 years), and the relationship between the low and normal AMH groups and each binary endpoint were quantified as risk ratios using the age-adjusted Poisson models.

Main Outcome Measure(s)

Ongoing pregnancy.

Result(s)

A total of 3,122 patients completed 5,539 oral antiestrogen cycles, and 1,060 completed 1,630 injectable gonadotropin cycles. For oral antiestrogen treatment, pregnancy outcomes, including ongoing pregnancy rate per cycle, for patients with a low AMH level were comparable with those for patients with a normal AMH level (<35 years, 15.4% vs. 14.9%; 35–40 years, 10.0% vs. 11.0%; and >40 years, 2.8% vs. 3.3%). For injectable gonadotropin treatment, the ongoing pregnancy rate was lower in the low AMH group than in the normal AMH group for the ages of <35 (12.1% vs. 23.5%; relative risk [RR], 0.52 [95% confidence interval {CI}, 0.28–0.97]) and 35–40 (12.5% vs. 18.5%; RR, 0.70 [95% CI, 0.49–0.99]) years but comparable with that for patients aged >40 years (3.0% vs. 4.0%; RR, 0.86 [95% CI, 0.31–2.35]). The proportion of multifetal gestations was similar between the low and normal AMH groups treated with oral antiestrogens (13.1% vs. 10.8%); however, for injectable gonadotropin treatment, patients with a normal AMH level had a higher proportion of multifetal gestations (18.6% vs. 31.1%).

Conclusion(s)

Compared with normal ovarian reserve, treatment with oral antiestrogens for OI/IUI for patients with low ovarian reserve results in comparable follicular development and ongoing pregnancy rates for all age groups. When patients with low ovarian reserve are treated with gonadotropins for OI/IUI, multifollicular recruitment is less likely resulting in a significantly decreased ongoing pregnancy rate for patients aged <35 and 35–40 years but also a decrease in multifetal gestations. Overall, the ongoing pregnancy rates of 8.7% per oral antiestrogen cycle and 8.1% per injectable gonadotropin cycle in patients with low ovarian reserve are comparable with the expected rates in the general infertility population.

 好胚&差胚一起植入 vs 單一好胚植入 

懷孕率並無差異

但 好胚&差胚一起植入多胞胎機率會提高

Transfer of a poor-quality along with a good-quality embryo on in vitro fertilization/intracytoplasmic sperm injection-embryo transfer clinical outcomes: a systematic review and meta-analysis

 Fertil steril VOLUME 118, ISSUE 6, P1066-1079, DECEMBER 01, 2022

Objective

To investigate the effect on the pregnancy rate of transfer of a good-quality embryo (GQE) and a poor-quality embryo (PQE) in comparison with a single GQE transfer.

Patient(s)

Infertility patients undergoing in vitro fertilization/intracytoplasmic sperm injection- embryo transfer.

Intervention(s)

Three major electronic databases (PubMed, Embase, and Cochrane Library) for studies those compared single GQE transfer to double embryo transfer of a GQE + PQE were searched. The Newcastle–Ottawa Quality Assessment Scale was used to evaluate the study quality. Random-effect meta-analysis was performed on all data for an overall analysis, followed by a subgroup analysis (fresh cleavage-stage embryos, fresh blastocysts, frozen-thawed blastocysts, and the same assessment criteria for blastocyst quality).

Main Outcome Measure(s)

The primary outcome was clinical pregnancy rate (CPR).

Result(s)

A total of 17 studies with 17,612 cycles for GQE transfer and 6,431 cycles for GQE + PQE transfer were included in the meta-analysis. No significant differences were found in CPR (relative risk [RR] = 1.02; 95% confidence interval [CI], 0.91–1.14) and live birth rate (RR = 0.96; 95% CI, 0.87–1.07) between GQE + PQE and GQE transfers. However, the transfer of GQE + PQE increased multiple pregnancy rate (RR = 0.14; 95% CI, 0.09–0.20) and multiple birth rate (RR = 0.08; 95% CI, 0.06–0.12), when compared with the patients undergoing a single GQE transfer. Subgroup analyses by type of embryo for transfer and assessment criteria for embryo quality showed similar trends.

Conclusion(s)

Double embryo transfer with GQE + PQE does not result in increased or decreased CPR and live birth rate when compared with a single GQE transfer but leads to a higher multiple pregnancy rate and multiple birth rate.

卵巢明顯退化定義

AMH<0.7

FSH>10

卵巢明顯退化仍有相當比率有機會懷孕

Markers of ovarian reserve as predictors of future fertility

https://doi.org/10.1016/j.fertnstert.2022.10.014

Objective

To determine the association between ovarian reserve biomarkers and future fertility among late reproductive-age women.

Design

Cohort study of participants enrolled in Time to Conceive (TTC), a time-to-pregnancy cohort study of the ovarian reserve biomarkers.

Setting

Community.

Patient(s)

Women aged 30–44 years without a history of infertility who provided a blood sample at enrollment in TTC and who agreed to future follow-up.

Intervention(s)

Not applicable.

Main Outcome Measure(s)

The primary outcomes were probability of achieving a live birth >3 years after enrollment in TTC, diagnosis of infertility at any time, and time-to-pregnancy in future pregnancy attempts.

Result(s)

Women with diminished ovarian reserve, defined as those with an antimüllerian hormone (AMH) level <0.7 ng/mL or follicle-stimulating hormone (FSH) level ≥10 mIU/mL, did not have low risk of future live birth (relative risk [RR], 1.32; 95% confidence interval [CI], 0.95–1.83 and RR, 1.28; 95% CI, 0.97–1.70, respectively) compared with women with normal ovarian reserve after adjusting for age at blood draw, race, obesity, use of hormonal contraception, and year of enrollment in original study. Among women in the cohort that attempted to conceive, there was not a significant association between diminished ovarian reserve, as measured by AMH or FSH, and risk of future infertility (RR, 0.65; 95% CI, 0.21–2.07 and RR,1.69; 95% CI, 0.86–3.31, respectively). Similarly, there was no association between AMH and FSH levels and future fecundability (fecundability ratio, 0.97; 95% CI, 0.59, 1.60; and fecundability ration, 0.86; 95% CI, 0.55–1.36, respectively).

Conclusion

Diminished ovarian reserve is not associated with reduced future reproductive capacity. Given the lack of association, women should be cautioned regarding use biomarkers of ovarian reserve as predictors of their future reproductive capacity.

 大型捐贈卵子IVF(<34y) 之  PGS顯示

Euploid blastocyst 胚胎染色體正常機率為52-73%

活產率(LBR per euploid transfer) 47-58%

胚胎染色體鑲嵌Mosaic機率  2.8-11.5%

Reproductive genetics laboratory may impact euploid blastocyst and live birth rates: a comparison of 4 national laboratories' PGT-A results from vitrified donor oocytes

• Jonah Bardos, M.D., M.B.E. 
• Jaclyn Kwal, M.D.
• Wayne Caswell, M.S.
• Kae Devine, M.D.
• Micah Hill, D.O.
• Jeanne E. O’Brien, M.D., M.Sc.
• Show all authors

Published:November 29, 2022DOI:https://doi.org/10.1016/j.fertnstert.2022.10.010

Objective

To evaluate potential variation in the euploid blastocyst rate and live birth rate (LBR) per single frozen euploid blastocyst transfer, among 4 unique United States reproductive genetics laboratories. Analyses were limited to blastocysts derived from vitrified donor oocytes, to minimize variation in oocyte quality.

Design

Retrospective cohort study from 2016 to 2020.

Setting

Donor Egg Bank Database.

Patient(s)

Patients undergoing in vitro fertilization with donor oocytes. We excluded patients with uterine factor, male factor, or surgically extracted sperm. Only healthy women <34 years old were accepted as oocyte donors.

Intervention(s)

Next generation sequencing platforms for chromosomal analysis

Main Outcome Measure(s)

Euploid blastocyst rate and LBR per euploid transfer. Secondary outcomes included the rate of aneuploidy, mosaic calls, biochemical pregnancy loss, and miscarriage rate.

Result(s)

A total of 2,633 embryos were included. Four laboratories had >200 embryos tested. Euploid blastocyst rate was significantly higher in laboratory A (73.6%) vs. B (63.3%), C (60.9%), and D (52.3%). Mosaic rate was significantly lower for Laboratories B (2.8%) and C (5.5%) vs. Laboratories A (9.9%) and D (11.5). The LBR was significantly higher in laboratory A (58.73%) vs. laboratory D (47.3%). There were no significant differences in the implantation or miscarriage rate among laboratories.

Conclusion(s)

In this large study, controlling for oocyte quality, some preimplantation genetic testing for aneuploidy (PGT-A) laboratories report a significantly higher euploid blastocyst rate with concurrent higher LBR. This type of comparison is important as it provides insight into the role of the PGT-A process in outcomes. Further research is needed to evaluate the differences in laboratory techniques and bioinformatic algorithms accounting for variable outcomes across PGT-A laboratories.

傳統卵泡測量成熟使用2D超音波1.6-2.2cm

3D超音波標準為

2 follicles with a volume of >2 cc 

70% of the follicles having a volume of >0.7 cc.

Volume-based follicular output rate improves prediction of the number of mature oocytes: a prospective comparative study

https://doi.org/10.1016/j.fertnstert.2022.07.017

Objective

To test whether volume-based follicular output rate (FORT-V) is superior to diameter based follicular output rate (FORT-D) in predicting the number of mature oocytes. The follicular output rate (FORT) is the ratio between preovulatory follicle count (PFC) and antral follicle count (AFC) and has been proposed as a better predictor of the ovarian response compared with AFC alone.

Design

A prospective observational study of 215 consecutive women (80 oocyte donors and 135 in vitro fertilization [IVF] patients) undergoing ovarian stimulation for IVF.

Patient(s)

Women undergoing ovarian stimulation between May 2018 and September 2021.

Intervention(s)

Manual two-dimensional ultrasound and computer-generated (three-dimensional ultrasound, [3D]) AFCs were performed at baseline. During ovulation induction, follicular growth was monitored in each patient using both two-dimensional and 3D ultrasound. Preovulatory follicles were defined as those with a mean diameter of 16–22 mm. The trigger was based on the follicular volume according to our standard protocol: at least 2 follicles with a volume of >2 cc with 70% of the follicles having a volume of >0.7 cc.

Main Outcome Measure(s)

The primary outcome was the difference between FORT-V and FORT-D in their ability to predict the mature oocyte output rate.

Result(s)

In both IVF patients and oocyte donors, the computer-generated AFC was greater than the manual AFC. The FORT-V was higher than the FORT-D for both computer-generated (the difference was 35 [95% CI {confidence interval}, 32–45] in oocyte donors and 21 [95% CI, 5–46] in IVF patients) and manual FORT (the difference was 38 [95% CI, 32–45] in oocyte donors and 15 [95% CI, 3–43] in IVF patients) and was closer to the mature oocyte output rate. There was a direct correlation between the computer-generated AFC and the PFC based on volume and between PFC based on volume and the number of mature oocytes in oocyte donors and IVF patients.

Conclusion(s)

In this prospective study of 215 women, the FORT based on 3D ultrasound derived follicular volume (FORT-V) was superior to the FORT-D in determining the ovarian response in both oocyte donors and IVF patients. Moreover, our results support the non–inferiority of the computer-generated method compared with the manual method for the determination of AFC. Further studies on the role of computer-generated antral follicle characteristics may be useful in evaluating follicle stimulation regimens.

 ERA無法明顯提高前次植入失敗病患之懷孕率 (自體  捐贈   鮮胚  凍胚植入)

Use of the endometrial receptivity array to guide personalized embryo transfer after a failed transfer attempt was associated with a lower cumulative and per transfer live birth rate during donor and autologous cycles

https://doi.org/10.1016/j.fertnstert.2022.07.007

Objective

To determine whether personalized embryo transfer (pET) guided by endometrial receptivity array (ERA) test improves reproductive outcomes for fresh embryo transfers (fsETs) or frozen embryo transfers (FETs) during autologous and donor cycles.

Design

A retrospective, observational, multicenter cohort study.

Setting

University-affiliated in vitro fertilization center.

Patient(s)

The study included patients with a single previous failed transfer and yielded 3,239 autologous transfers and 2,133 donor transfers. Among autologous transfers, 255 were pET guided by ERA; among unguided autologous transfers, 1,122 and 1,862 transfers involved fresh or previously frozen embryos, respectively. Among donor transfers, 319 were ERA-guided; among unguided donor transfers, 1,175 and 639 involved fsETs or FETs, respectively.

Intervention(s)

None.

Main Outcome Measure(s)

Primary outcomes were live birth rate per embryo transfer and cumulative live birth rate on consecutive transfers until live birth or cessation of pregnancy. Secondary outcomes were implantation, pregnancy rate, clinical pregnancy rates per embryo transfer, and miscarriage rate per pregnancy.

Result(s)

During both autologous or donor transfers, live birth rate and cumulative live birth rate were higher in FET and fsET than in pET groups, even with euploid transfers. Logistic regression analysis, considering possible confounders, indicated patients receiving pET had poorer outcomes than those undergoing FET and fsET in autologous and donor cycles. Implantation, pregnancy, and clinical pregnancy rates were lower in patients undergoing pET.

Conclusion(s)

Using ERA to guide pET during either autologous or donor cycles after a failed transfer attempt did not improve reproductive outcomes. Conversely, worse outcomes were detected when ERA was used.

 AMH高低與胚胎染色體異常率無明顯關聯

AMH低的病患，染色體異常率並無明顯較高

ANTI-MÜLLERIAN HORMONE IS NOT ASSOCIATED WITH EMBRYO PLOIDY IN PATIENTS WITH AND WITHOUT INFERTILITY UNDERGOING IN VITRO FERTILIZATION WITH PREIMPLANTATION GENETIC TESTING

 2022DOI:https://doi.org/10.1016/j.fertnstert.2022.11.018

Objective

To assess the association between anti-müllerian hormone (AMH) and embryo ploidy rates in two cohorts of patients undergoing in vitro fertilization (IVF) with trophectoderm biopsy for preimplantation genetic testing for aneuploidy (PGT-A): (1) the general population of women pursuing IVF with PGT-A (Infertile cohort) and (2) women pursuing IVF with preimplantation genetic testing for monogenic disorders (PGT-M) due to risk for hereditary monogenic diseases (Non-infertile cohort).

Patients

Patients undergoing their first cycle of IVF with trophectoderm biopsy and PGT-A or PGT-A and PGT-M in our center between 03/2012 and 06/2020. Patients of advanced maternal age according to Bologna criteria (age ≥40) and patients who underwent fresh embryo transfers were excluded.

Main Outcome Measure

Proportion of euploid, mosaic, and aneuploid embryos per cycle.

Results

“Infertile” (n= 926) and “Non-infertile” (n= 214) patients were stratified based on AMH levels, with low AMH defined as <1.1 ng/ml in accordance with the Bologna criteria. Age-adjusted regression models showed no relationship between AMH classification and proportion of euploid, mosaic, and aneuploid embryos in the Infertile or Non-infertile cohorts. In the Infertile cohort, no association between AMH classification and embryo ploidy rates was identified in a subgroup analysis of patients less than 35 years, patients 35-37, and patients 38-39 years old. These findings persisted in a sensitivity analysis of Infertile patients stratified into AMH (ng/ml) quartile categories.

Conclusion

AMH is not associated with proportion of euploid, mosaic, or aneuploid embryos in two large cohorts of patients undergoing IVF with PGT-A (Infertile patients) or PGT-A and PGT-M (Non-infertile patients), suggesting that a quantitative depletion of ovarian reserve does not predict the ploidy status of the embryo cohort.

<34歲存卵  vs  >40歲取卵+PGS

<34歲存卵 懷孕率較高

A SART data cost-effectiveness analysis of planned oocyte cryopreservation versus in vitro fertilization with preimplantation genetic testing for aneuploidy considering ideal family size

https://doi.org/10.1016/j.fertnstert.2022.07.022

Objective

To determine the cost-effectiveness of planned oocyte cryopreservation (OC) as a strategy for delayed childbearing to achieve 1 or 2 live births (LB) compared with in vitro fertilization (IVF) and preimplantation genetic testing for aneuploidy (PGT-A) at advanced reproductive age.

Patient(s)

A data-driven simulated cohort of patients desiring delayed childbearing with an ideal family size of 1 or 2 LB.

Main Outcome Measure(s)

Probability of achieving ≥1 or 2 LB, average and maximum cost per patient, cost per percentage point increase in chance of LB, and population-level cost/LB.

Result(s)

For those desiring 1 LB, planned OC at age 33 with warming at age 43 decreased the average total cost per patient from $62,308 to $30,333 and increased the likelihood of LB from 50% to 73% when compared with no OC with up to 3 cycles of IVF/PGT-A at age 43. For those desiring 2 LB, 2 cycles of OC at age 33 and warming at age 40 yielded the lowest cost per patient and highest likelihood of achieving 2 LB ($51,250 and 77%, respectively) when compared withpursuing only 1 cycle of OC ($75,373 and 61%, respectively), no OC and IVF/PGT-A with embryo banking ($79,728 and 48%, respectively), or no OC and IVF/PGT-A without embryo banking ($79,057 and 19%, respectively). Sensitivity analyses showed that OC remained cost-effective across a wide range of ages at cryopreservation. For 1 LB, OC achieved the highest likelihood of success when pursued before age 32 and remained more effective than IVF/PGT-A when pursued before age 39, and for 2 LB, 2 cycles of OC achieved the highest likelihood of success when pursued before age 31 and remained more effective than IVF/PGT-A when pursued before age 39.

Conclusion(s)

Among patients planning to postpone childbearing, OC is cost-effective and increases the odds of achieving 1 or 2 LB when compared with IVF/PGT-A at a more advanced reproductive age.

Endometrial Receptivity Array (ERA)對於凍胚植入frozen embryo transfer 懷孕率無明顯助益

Endometrial Receptivity Array Before Frozen Embryo Transfer Cycles: A Systematic Review and Meta-analysis

 https://doi.org/10.1016/j.fertnstert.2022.11.012

 Importance

There is a lack of consensus regarding the use of Endometrial Receptivity Array (ERA) for increasing the success rate of In Vitro Fertilization (IVF) cycles, mainly in terms of the live birth rate.

Objective

To investigate the impact of ERA prior to frozen embryo transfer (FET) in patients undergoing IVF.

Data Sources

PubMed, Web of Science and Embase were searched from inception up to February 15, 2022.

Study selection and synthesis

Only comparative studies evaluating pregnancy rates of patients undergoing FET cycles with or without prior ERA were included. Inter-study heterogeneity was also assessed using Cochrane’s Q test and the I2 statistic. The random-effects model was used to pool the odds ratio (OR) with the corresponding 95% confidence intervals (CIs). Subgroup analyses were performed to investigate the impact of ERA on pregnancy rates according to the number of prior embryo transfer (ET) failures (≤ 2 previous failed ETs vs > 2 failed ETs, defined as recurrent implantation failure). Separate analyses were performed according to the study design and adjustment for confounders.

Main outcome(s)

The primary outcomes of the study were livebirth rate and/or ongoing pregnancy rate. Implantation rate, biochemical pregnancy rate, clinical pregnancy rate, and miscarriage rate were considered secondary outcomes.

Result(s)

Eight studies (representing data on n=2,784 patients; n=831 had undergone ERA and n=1,953 without ERA) were found to be eligible for this meta-analysis. The live birth or ongoing pregnancy rate for the ERA group was not significantly different compared to the non-ERA group (OR 1.38, 95% CI 0.79-2.41, P 0.25, I2 83.0%), nor was a difference seen in subgroup analyses based on the number of prior failed ETs. The rates of implantation, biochemical pregnancy, clinical pregnancy and miscarriage were also comparable between the ERA and the non-ERA groups. After separate analyses according to the study design and adjustment for confounding factors, overall pooled estimates remained statistically non-significant.

Conclusion(s) and Relevance

The findings of the current meta-analysis did not reveal a significant change in the rate of pregnancy after IVF cycles using ERA and it is not clear whether ERA can increase the pregnancy rate or not.