scholarly journals Fertility Outcomes following Laparoscopy-Assisted Hysteroscopic Fallopian Tube Cannulation: A Preliminary Study

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Joseph I. Ikechebelu ◽  
George U. Eleje ◽  
Prashant Bhamare ◽  
Ngozi N. Joe-Ikechebelu ◽  
Chidimma D. Okafor ◽  
...  
Keyword(s):  
Live Birth ◽  
Birth Rate ◽  
Intrauterine Insemination ◽  
Live Birth Rate ◽  
Conception Rate ◽  
Inclusion Criteria ◽  
Infertile Women ◽  
Procedural Complications ◽  
Preliminary Study

Objectives. To determine fertility outcomes following laparoscopy-guided hysteroscopic tubal cannulation for cornual obstruction. Study Design. A prospective cohort study in Life Institute for Endoscopy at Life Specialist Hospital Nnewi, Southeast Nigeria. Patients with unilateral or bilateral cornual tubal obstruction as the only cause of infertility were included. Outcome measures included successful tubal recanalization, procedural complications, conception rates (first spontaneous conception after the procedure), and live birth rates. Results. Forty-nine infertile women were assessed for eligibility, but 27 met the inclusion criteria. Of 27 women, 24 (88.9%) had bilateral cornual obstruction and 3 (11.1%) had unilateral obstruction. Only three (11.1%) patients had failed cannulation. Successful recanalization rate was 90.2% (46/51) per tube and 88.9% (24/27) per patient. In the 24 patients with successfully recanalization, six spontaneous pregnancies (25.0%) and two intrauterine insemination-assisted pregnancies (8.3%) occurred within first six months of follow-up. All the eight (100.0%) pregnancies were intrauterine. The overall conception rate and live birth rate was 33.3%. There were no pre- or postprocedural complications. Conclusion. Successful recanalization rate was 90.2% per tube and 88.9% per patient with a conception rate of 33.3%. Women with only cornual obstruction should be considered first for laparoscopy-assisted hysteroscopic cannulation before assisted reproduction.

scholarly journals The Time Interval between Insemination and Ovulation as Given by Ultrasound Predicts Live Birth Rate After Intrauterine Insemination with Donor Sperm (IUI-D)

2020 ◽  
Author(s):  
XIN MU ◽  
HUI WANG ◽  
NA ZHANG ◽  
WEN WEN ◽  
QIONG WU ◽  
...  
Keyword(s):  
Live Birth ◽  
Birth Rate ◽  
Intrauterine Insemination ◽  
Medical Center ◽  
Live Birth Rate ◽  
Clinical Pregnancy ◽  
Time Interval ◽  
Donor Sperm ◽  
Logistic Analysis ◽  
Factor Combination

Abstract Background: A proper interval from insemination to ovulation (I-O interval) may increase the chance of pregnancy. Due to lack of studies for I-O interval in IUI-D cycles, we aimed to determine whether short I-O interval would contribute to better IUI-D outcomes.Methods: One thousand and one hundred sixty-five couples for 209 IUI-D cycles from a single public medical center participated in this retrospective analytical study. The data were collected from the medical records of couples. Generalized estimating equations (GEEs) were used to evaluate the effects of these variables on IUI outcome. Stepwise multivariate logistic analysis was used to construct a predictive model for the clinical pregnancy rate and live birth rate in independent samples.Results: The I-O interval was the predictor for LBR. An I-O interval ≥19 hours significantly decreased CPR (odds ratio [OR], 95% confidence interval [CI] =0.285, 0.171-0.475) and LBR (OR, 95%CI =0.322, 0.189-0.549). The presence of at least two follicles ≥18mm on ovulation day significantly increased the LBR (OR, 95%CI =1.274, 1.012-1.602). Women aged 35 years and older had a significant decreased LBR (OR, 95% CI =0.607, 0.377-0.976).Conclusion(s): The I-O interval, a new prognostic factor, combination with the women’s age and number of dominant follicles, can predict the outcome after IUI-D. IUI-D is best performed within 19 hours of I-O interval for a higher probability of clinical pregnancy and live birth.

scholarly journals Cumulative live birth rates after weight reduction in obese women scheduled for IVF: follow-up of a randomized controlled trial

2019 ◽  
Vol 2019 (4) ◽  
Author(s):  
L Kluge ◽  
C Bergh ◽  
S Einarsson ◽  
A Pinborg ◽  
A-L Mikkelsen Englund ◽  
...  
Keyword(s):  
Live Birth ◽  
Weight Reduction ◽  
Birth Rate ◽  
Controlled Trial ◽  
Live Birth Rate ◽  
Obese Women ◽  
Live Births ◽  
Randomized Controlled ◽  
Cumulative Live Birth

Abstract STUDY QUESTION Did weight reduction in obese women scheduled for IVF increase cumulative live birth rate (CLBR) after 2 years? SUMMARY ANSWER Weight loss prior to IVF did not increase CLBR. WHAT IS KNOWN ALREADY Few studies have investigated the effect of weight reduction in obese infertile women scheduled for IVF. In a recent randomized controlled trial (RCT), including one IVF cycle, we found no increase in live birth rate after weight reduction. Weight regain after obesity reduction treatment often occurs, and children born to obese women have a higher risk of childhood obesity. STUDY DESIGN, SIZE, DURATION A 2-year follow-up of a multicenter, RCT running between 2012 and 2018 was performed. Out of 317 women randomized to weight reduction followed by IVF treatment or IVF treatment-only, 305 remained in the full analysis set. Of these women, 90.5% (276/305) participated in this study. PARTICIPANTS/MATERIALS, SETTING, METHODS Nine infertility clinics in Sweden, Denmark and Iceland participated in the RCT. Obese women under 38 years of age having a BMI ≥30 and < 35 kg/m2 were randomized to weight reduction and IVF or IVF-only. In all, 160 patients were randomized to a low calorie diet for 12 weeks and 3–5 weeks of weight stabilization, before IVF and 157 patients to IVF-only. Two years after randomization, the patients filled in a questionnaire regarding current weight, live births and ongoing pregnancies. MAIN RESULTS AND THE ROLE OF CHANCE 42 additional live births were achieved during the follow-up in the weight reduction and IVF group, and 40 additional live births in the IVF-only group, giving a CLBR, the main outcome of this study, of 57.2% (87/152) and 53.6% (82/153), respectively (P = 0.56; odds ratio (OR) 1.16, 95% CI: 0.74–1.52). Most of the women in the weight reduction and IVF group had regained their pre-study weight after 2 years. The mean weight gain over the 2 years was 8.6 kg, while women in the IVF-only group had a mean weight loss of 1.2 kg. At the 2-year follow-up, the weight standard deviation scores of the children born in the original RCT (index cycle) were 0.218 (1.329) (mean, SD) in the weight reduction and IVF group and − 0.055 (1.271) (mean, SD) in the IVF-only group (P = 0.25; mean difference between groups, 0.327; 95% CI: −0.272 to 0.932). LIMITATIONS, REASON FOR CAUTION All data presented in this follow-up study were self-reported by the participants, which could affect the results. A further limitation is in power for the main outcome. The study is a secondary analysis of a large RCT, where the original power calculation was based on live-birth rate after one cycle and not on CLBR. WIDER IMPLICATIONS OF THE FINDINGS The follow-up indicates that for women with a BMI ≥30 and < 35 kg/m2 and scheduled for IVF, the weight reduction did not increase their chance of a live birth either in the index cycle or after 2 years. It also shows that even in this highly motivated group, a regain of pre-study weight occurred. STUDY FUNDING/COMPETING INTEREST(S) The 2-year follow-up was financed by grants from the Swedish state under the agreement between the Swedish Government and the county councils, the ALF-agreement (ALFGBG-70940 and ALFGBG-77690), Merck AB, Solna, Sweden (an affiliate of Merck KGaA, Darmstadt, Germany), Hjalmar Svensson Foundation. Ms Kluge has nothing to disclose. Dr Bergh has been reimbursed for lectures and other informational activities (Ferring, MSD, Merck, Gedeon Richter). Dr Einarsson has been reimbursed for lectures for Merck and Ferring. Dr Thurin-Kjellberg reports grants from Merck, and reimbursement for lectures from Merck outside the submitted work. Dr Pinborg has been reimbursed for lectures and other informational activities (Ferring, MSD, Merck, Gedeon Richter). Dr Englund has nothing to disclose. TRIAL REGISTRATION NUMBER ClinicalTrials.gov number, NCT01566929.

scholarly journals IVF outcomes in patients with a history of bariatric surgery: a multicenter retrospective cohort study

2020 ◽  
Vol 35 (12) ◽  
pp. 2755-2762
Author(s):  
V Grzegorczyk-Martin ◽  
T Fréour ◽  
A De Bantel Finet ◽  
E Bonnet ◽  
M Merzouk ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Live Birth ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Obese Women ◽  
Infertile Women ◽  
Severely Obese ◽  
History Of ◽  
Group 3 ◽  
Group 1

Abstract STUDY QUESTION How does a history of dramatic weight loss linked to bariatric surgery impact IVF outcomes? SUMMARY ANSWER Women with a history of bariatric surgery who had undergone IVF had a comparable cumulative live birth rate (CLBR) to non-operated patients of the same BMI after the first IVF cycle. WHAT IS KNOWN ALREADY In the current context of increasing prevalence of obesity in women of reproductive age, weight loss induced by bariatric surgery has been shown to improve spontaneous fertility in obese women. However, little is known on the clinical benefit of bariatric surgery in obese infertile women undergoing IVF. STUDY DESIGN, SIZE, DURATION This exploratory retrospective multicenter cohort study was conducted in 10 287 IVF/ICSI cycles performed between 2012 and 2016. We compared the outcome of the first IVF cycle in women with a history of bariatric surgery to two age-matched groups composed of non-operated women matched on the post-operative BMI of cases, and non-operated severely obese women. PARTICIPANTS/MATERIALS, SETTING, METHODS The three exposure groups of age-matched women undergoing their first IVF cycle were compared: Group 1: 83 women with a history of bariatric surgery (exposure, mean BMI 28.9 kg/m2); Group 2: 166 non-operated women (non-exposed to bariatric surgery, mean BMI = 28.8 kg/m2) with a similar BMI to Group 1 at the time of IVF treatment; and Group 3: 83 non-operated severely obese women (non-exposed to bariatric surgery, mean BMI = 37.7 kg/m2). The main outcome measure was the CLBR. Secondary outcomes were the number of mature oocytes retrieved and embryos obtained, implantation and miscarriage rates, live birth rate per transfer as well as birthweight. MAIN RESULTS AND THE ROLE OF CHANCE No significant difference in CLBR between the operated Group 1 patients and the two non-operated Groups 2 and 3 was observed (22.9%, 25.9%, and 12.0%, in Groups 1, 2 and 3, respectively). No significant difference in average number of mature oocytes and embryos obtained was observed among the three groups. The implantation rates were not different between Groups 1 and 2 (13.8% versus 13.7%), and although lower (6.9%) in obese women of Group 3, this difference was not statistically significant. Miscarriage rates in Groups 1, 2 and 3 were 38.7%, 35.8% and 56.5%, respectively (P = 0.256). Live birth rate per transfer in obese patients was significantly lower compared to the other two groups (20%, 18%, 9.3%, respectively, in Groups 1, 2 and 3, P = 0.0167). Multivariate analysis revealed that a 1-unit lower BMI increased the chances of live birth by 9%. In operated women, a significantly smaller weight for gestational age was observed in newborns of Group 1 compared to Group 3 (P = 0.04). LIMITATIONS, REASONS FOR CAUTION This study was conducted in France and nearly all patients were Caucasian, questioning the generalizability of the results in other countries and ethnicities. Moreover, 950 women per group would be needed to achieve a properly powered study in order to detect a significant improvement in live birth rate after bariatric surgery as compared to infertile obese women. WIDER IMPLICATIONS OF THE FINDINGS These data fuel the debate on the importance of pluridisciplinary care of infertile obese women, and advocate for further discussion on whether bariatric surgery should be proposed in severely obese infertile women before IVF. However, in light of the present results, infertile women with a history of bariatric surgery can be reassured that surgery-induced dramatic weight loss has no significant impact on IVF prognosis. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by unrestricted grants from FINOX—Gédéon Richter and FERRING Pharmaceuticals awarded to the ART center of the Clinique Mathilde to fund the data collection and the statistical analysis. There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER NCT02884258

scholarly journals Prognostic Factors to Achieve Higher Pregnancy and Live Birth Rate in Intrauterine Insemination Among Subfertile Women

2019 ◽  
Vol 01 (02) ◽  
pp. 106-114
Author(s):  
Shiuan Yee Tan ◽  
Yi-Xuan Lee ◽  
Cindy Chan ◽  
Chii-Ruey Tzeng
Keyword(s):  
Prognostic Factors ◽  
Live Birth ◽  
Birth Rate ◽  
Endometrial Thickness ◽  
Intrauterine Insemination ◽  
Sperm Count ◽  
Live Birth Rate ◽  
University Hospital ◽  
Serum Estradiol ◽  
Live Births

Background: The purpose of this study was to evaluate the prognostic factors that could affect the clinical pregnancy rate (CPR) and live birth rate (LBR) among subfertile women undergoing intrauterine insemination (IUI). Methods: A retrospective analysis study of a total of 2186 cycles of IUI among 1784 subfertile women between 2012 and 2017 at the infertility clinic in Taipei Medical University Hospital was conducted. Social demographics, CPR, and LBR were measured. Eleven prognostic factors were analysed with multivariable logistic regression. Results: Of the 2186 cycles, 569 became pregnant (26.0%), resulting in 454 live births. The LBR per cycle and per patient were 20.8% and 24.6%, respectively. Eight factors were found to significantly predict the obstetric outcome among the women who underwent IUI (p [Formula: see text] 0.05). Age, [Formula: see text] 35.0 years old; serum anti-Müllerian hormone (AMH) level, [Formula: see text] 1.2 ng/mL; delayed sperm insemination, [Formula: see text] 36.0 hour following human chorionic gonadotropin (HCG) injection; serum estradiol level, [Formula: see text] 500 pg/mL; endometrial thickness, [Formula: see text] 7.0 mm on the day of HCG administration; and post-wash total motile sperm count (TMSC), [Formula: see text] 5 million/mL were found to be prognostic factors in determining the CPR and LBR (p [Formula: see text] 0.05). However, duration of subfertility and the presence of urine luteinizing hormone surge during the day of the HCG trigger inversely affected the LBR (p = 0.006 and p = 0.033, respectively) but not the CPR (p [Formula: see text] 0.05). The type of infertility, total antral follicle count, and pre-wash TMSC were not able to predict pregnancy outcome (p [Formula: see text] 0.05). Conclusions: Six out of 11 factors were identified as strong prognostic factors for successful pregnancies and live births: age, serum AMH and serum estradiol levels, endometrial thickness, post-wash TMSC, and delayed sperm insemination after HCG injection.

scholarly journals High-Normal Preconception TSH Levels Have No Adverse Effects on Reproductive Outcomes in Infertile Women Undergoing the First Single Fresh D5 Blastocyst Transfer

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Yuchao Zhang ◽  
Wenbin Wu ◽  
Yanli Liu ◽  
Yichun Guan ◽  
Xingling Wang ◽  
...  
Keyword(s):  
Live Birth ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Blastocyst Transfer ◽  
Reproductive Outcomes ◽  
Miscarriage Rate ◽  
Infertile Women ◽  
Live Birth Rates ◽  
Serum Tsh ◽  
Tsh Levels

Purpose. To investigate the association between high-normal preconception TSH levels and reproductive outcomes in infertile women undergoing the first single fresh D5 blastocyst transfer. Methods. This was a retrospective study. Euthyroid patients undergoing the first single fresh D5 blastocyst transfer from January 2018 to May 2019 were initially included. The patients were divided into a low TSH (0.27–2.5 mIU/L) group and a high-normal TSH (2.5–4.2 mIU/L) group. The reproductive outcomes were compared between the groups. Results. A total of 824 women were ultimately included, 460 of whom had serum TSH levels less than 2.5 mIU/L and 364 of whom had serum TSH levels between 2.5 and 4.2 mIU/L. The patients were highly homogeneous in terms of general characteristics. High-normal TSH levels had no adverse impact on the clinical pregnancy rate, miscarriage rate, or live birth rate (respectively, aOR = 0.84, 0.65, 0.61, and P=0.234, 0.145, 0.083). No significant differences were observed in terms of gestational age, single live birth rates, birth weight, or birth length. Conclusion. High-normal TSH levels did not significantly influence reproductive outcomes in infertile women undergoing the first single fresh D5 blastocyst transfer. Further studies are needed to test whether the results might be applicable to a wider population.

scholarly journals Low BMI is associated with poor IUI outcomes: a retrospective study in 13,745 cycles

2021 ◽  
Author(s):  
Juan Zhen ◽  
Jiali Cai ◽  
Lanlan Liu ◽  
Yanwen Guo ◽  
Jingxue Sun ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Live Birth ◽  
Birth Rate ◽  
Cox Regression ◽  
Endometrial Thickness ◽  
Intrauterine Insemination ◽  
Live Birth Rate ◽  
Normal Weight ◽  
Low Bmi

Abstract Objective: To evaluate the association between body mass index (BMI) and pregnancy outcomes in women receiving intrauterine insemination (IUI) treatment． Design: Retrospective cohort study. Setting: University-affiliated hospital. Population: Six thousand four hundred and seven women undergoing 13,745 IUI cycles stratified by body mass index (BMI). Method: Cox regression was used to analyze the association between BMI and cumulative live birth across multiple IUI cycles. GEE was used to analyze the live birth rate per cycle. Main Outcome Measure(s): Cumulative outcomes for IUI cycles. Result(s): Compared with normal weight women (n = 4,563), underweight women (n = 990) had a lower cumulative pregnancy and live birth rate (20.71% vs 25.93%, 17.07% vs 21.61%, respectively), while overweight women (n = 854) had a higher cumulative pregnancy and live birth rate (31.97%, 26.58%). Adjusted for confounders, hazard Ratio (HR) for achieving live birth following up to a maximal of 4 IUI cycles was 0.8(95%CI: 0.67-0.95) comparing underweight with normal weight. In generalized estimating equation (GEE) analyses, low BMI was also associated with a lower per-cycle live birth rate 0.77(95%CI: 0.64-0.92) with adjustment for cycle-specific parameters, including ovarian stimulation, endometrial thickness and follicular diameter. Conclusion(s): Underweight is associated with poor IUI outcomes. Funding: Clinical Research Special Fund of Chinese Medical Association (NO.18010360765) and Xiamen Medical Advantage Subspecialty Construction Project (2018[296])

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