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.

GnRH antagonist vs 黃體素LH suppression

GnRHantagonist 活產率較高 (36.0% vs. 32.2%)

尤其高齡>35y 差異更加明顯

https://doi.org/10.1016/j.fertnstert.2022.06.012

Comparison of the cumulative live birth rates after 1 in vitro fertilization cycle in women using gonadotropin-releasing hormone antagonist protocol vs. progestin-primed ovarian stimulation: a propensity score–matched study

Objective

To determine whether gonadotropin-releasing hormone (GnRH) antagonist protocol can improve cumulative live birth rates (CLBRs) and shorten the time to live birth (TTLB) in unselected patients compared with progestin-primed ovarian stimulation (PPOS).

Patient(s)

A total of 6,520 women with infertility aged 20–50 years were included.

Intervention(s)

Patients underwent either the GnRH antagonist protocol (n = 5,004) or PPOS (n = 1,516) on the basis of the assessment of the attending physicians. One-to-one propensity score matching was performed with a caliper of 0.02. Women who were not matched were excluded from the analyses.

Main Outcome Measure(s)

The CLBR of which the ongoing status had to be achieved within 22 months from the day of ovarian stimulation and TTLB.

Result(s)

Each group comprised 1,424 couples after propensity score matching, and the baseline demographic characteristics of the couples after matching were comparable between the 2 groups. The cycle cancellation rate was significantly lower in the GnRH antagonist group than in the PPOS group (12.9% vs. 19.6%). The implantation rate, clinical pregnancy rate, ongoing pregnancy rate, and live birth rate per transfer were comparable between the 2 groups. However, CLBRs after 1 complete IVF cycle were significantly higher in the GnRH antagonist group than in the PPOS group (36.0% vs. 32.2%; Risk ratio = 1.12; 95% confidence interval [CI], 1.01–1.24). The average TTLB was significantly shorter in the GnRH antagonist group than in the PPOS group (9.3 months vs. 12.4 months). Using the Kaplan-Meier analysis, the cumulative incidence of ongoing pregnancy leading to live birth was significantly higher in the GnRH antagonist group than in the PPOS group (85.1% vs. 66.1%, Log-rank test). A Cox proportional hazard model revealed that women who underwent the antagonist protocol were 2.32 times more likely to achieve a live birth than those who used PPOS (hazard ratio [HR] = 2.32; 95% CI, 1.91–2.83). Subgroup analysis revealed that women who used the antagonist protocol were more likely to achieve a live birth than women who used PPOS across the 3 antral follicle count (AFC) strata (AFC ≤ 5, AFC 6–15, and AFC > 15), 2 age strata (<35 and ≥35 years), and first cycle or repeated cycle. The difference was greatest among women whose AFC was ≤5 and who were aged ≥35 years, effectively becoming smaller in the group with high ovarian reserve and younger age.

Conclusion(s)

In unselected women undergoing IVF, the GnRH antagonist protocol was associated with a higher CLBR and a shorter TTLB compared with PPOS.