Association between estradiol levels and clinical outcomes of IVF cycles with single blastocyst embryo transfer

Objective:To determine the correlation of different serum estradiol levels on the trigger day with the clinical and laboratory outcomes of in-vitro fertilization(IVF)cycles comprising a single fresh top-quality blastocyst transfer.Methods:This was a retrospective observational study performed in Morula IVF Clinic Jakarta.Five hundred forty-two women were recruited and grouped according to their serum estradiol levels on the trigger day of follicular maturation as follows:<2000 pg/mL,2000-2999 pg/mL,3000-3999 pg/mL,and≥4000 pg/mL.Clinical pregnancy and miscarriage rates were evaluated as the primary outcomes and embryology laboratory results as the secondary outcomes which consisted of the number of retrieved,mature,and fertilized oocytes,the total sum of derived embryos,and top-quality embryos at cleavage and blastocyst stage.Results:Clinical pregnancy and miscarriage rates did not differ among the groups(P>0.05).Nonetheless,the study demonstrated a positive correlation of the serum estradiol levels with the overall laboratory outcomes including the number of retrieved,mature,and fertilized oocytes,the total sum of derived embryos,and top-quality embryos at cleavage and blastocyst stage(P<0.001).The subject group with estradiol level of≥4000 pg/mL was superior to the other groups in its respective median number of retrieved,mature,fertilized oocytes,total derived embryos,and top-quality cleavage-and blastocyst-stage embryos.Conclusions:Although an apparent positive correlation is observed between estradiol levels and laboratory outcomes,serum estradiol level on hCG trigger day is not associated with the clinical outcomes of IVF.

Comparison of Effects of Recombinant FSH versus Highly Purified Urinary FSH for COH in the Outcome of IVF-ET

Objective To investigate the difference in the outcome of IVF-ET between the patients using recombinant FSH versus highly purified urinary FSH for controlled ovarian stimulation （COH）. Methods A comparative retrospective analysis was performed between the patients undergoing IVF using recombinant FSH （rFSH） 562 cycles （rFSH group） versus using highly purified urinary FSH（uFSH） 555 cycles （uFSH group） for COH from August 2009 to July 2010. Main outcome measures included： duration of stimulation, total amount of FSH, E2 level on hCG injection day, number of oocytes collected, average number of frozen embryos, and the rate of cancellation, implantation, clinical pregnancy and miscarriage rate. Results uFSH group required a significantly higher total amount of FSH and a longer duration of stimulation than thouse rFSH group （19.3 ± 7.6 vs 18.3 ± 7.0 ampoules, P=0.02, and 9.1 ± 1.6 d vs 8.9 ± 1.5 d, P=0.04, respectively）. There was no statistically significant difference in the implantation rate, clinical pregnancy rate and miscarriage rate between uFSH and rFSH groups （22.57% vs 20.16%, 38.15% vs 35.18%, and 10.6% vs 13.45%, respectively, P〉0.05）. The other measures including E2 level on hCG injection day, cancellation, number of oocytes collected, fertilization, average number of frozen embryos showed no difference between the two groups. Conclusion There is no significant difference in the outcome of IVF-ET between two groups in effects of recombinant FSH versus highly purified urinary FSH for COH.

Effect of embryo quality on pregnancy outcomes for women completing biochemical pregnancy in in vitro fertilizationembryo transfer(IVF-ET)

Objective To analyze the effect of the numbers of transferred good-quality embryos on pregnancy outcomes in in vitro fertilization-embryo transfer （IVF-ET）, supplying a reference for selection of transferred embryos.Methods Five hundreds and one infertile patients who underwent IVF-ET were retrospectively analyzed. All cycles were divided into 3 groups by the number of transferred good-quality embryos （group A： two good-quality embryos, group B： one good-quality embryo, group C： no good-quality embryo）, with no significant difference in general condition such as age, infertility duration and infertility types. The pregnancy outcomes were compared and analyzed among the three groups.Results 1） Live-birth rate was improved with increasing good-quality transferred embryo numbers. Groups A （70.3%） and B （69.8%） had no significant difference （P=0. 409）, whereas it was significantly greater in groups A and B than in group C （57. 7%） （P=0.009, P=0.036）. 2） The loss of single gestational sacs rate, which have no significant difference among 3 groups （P=0.221, P=0.539, P=0.226）, reduced with increasing good-quality transferred embryos numbers. 3） Biochemical pregnancy abortion rate in groups A （10.9%） and B （10.1%） was significantly lower than that in group C （18.3%）（P=0.049, P=0.049）. 4） There was no significant difference among 3 groups in ectopic pregnancy rate （P=0.174, P=0.129, P=0.404）. 5）Multiple-birth rate was improved with increasing good-quality transferred embryos numbers, it was significantly greater in group A （31.6%） than in group C （15.0%）（P=0.020）, while groups B and A had no significant difference （P=0.489, P=0.126）.Conclusion Two good-quality transferred embryos have no significantly difference to 1 good-quality embryo in all pregnancy outcomes. In clinic treatment, we can select 1 good-quality embryo and 1 poor-quality embryo when patients only have few goodquality embryos. Meanwhile, a good-quality embryo can improve live-birth rate and multiple pregnancy rate simultaneously. In order to meet a better assisted reproductive technology （ART） outcome, we need to seek a balance between pregnancy rate and multiple pregnancy rate.

Intrafollicular Soluble RAGE Benefits Embryo Development and Predicts Clinical Pregnancy in Infertile Patients of Advanced Maternal Age Undergoing In Vitro Fertilization

Soluble receptor for advanced glycation end products（s RAGE） can decoy the toxic AGEs and is considered to be a protective factor.This study aimed to evaluate the correlation between intrafollicular s RAGE levels and clinical outcomes in infertile women of young or advanced maternal age（AMA） undergoing in vitro fertilization（IVF）.A total of 62 young women and 62 AMA women who would undergo IVF were included in this prospective study.The intrafollicular s RAGE concentration was measured to determine its association with the number of retrieved oocytes,fertilized oocytes,high-quality embryos or achievement of clinical pregnancy in young and AMA women,respectively.Besides,correlations between sR AGE and age or follicle-stimulating hormone（FSH） were examined.We found that the intrafollicular s RAGE levels were higher in young patients than those in AMA patients,suggesting that the s RAGE levels were inversely correlated with age.In young patients,sR AGE showed no correlation with the number of retrieved oocytes,fertilized oocytes,high-quality embryos or achievement of clinical pregnancy.But it was found that AMA patients with more retrieved oocytes,fertilized oocytes and high-quality embryos demonstrated higher sR AGE levels,which were a prognostic factor for getting clinical pregnancy independent of age or FSH level.In conclusion,the s RAGE levels decrease with age.Elevated intrafollicular s RAGE levels indicate good follicular growth,fertilization and embryonic development,and successful clinical pregnancy in AMA women,while in young women,the role of s RAGE may not be so predominant.