Justin Tan

Background: Despite significant advances in assisted reproductive technology (ART), disparities in clinical outcomes persist. While patient-related factors are well-studied, the role of partner ethnicity remains understudied. We hypothesized that partner ethnicity affects ART outcomes. This study examined the association between partner ethnicity and ART outcomes. Methods: We conducted a retrospective cohort study among patients and their partners undergoing IVF treatment in the United Kingdom between 2017 and 2018. The exposure was partner ethnicity. Outcomes included biochemical pregnancy, clinical pregnancy, pregnancy loss, and live birth. We calculated risk ratios (RR) and 95% confidence intervals (CI) using multivariable regression models to estimate the association between partner ethnicity and IVF outcomes, adjusting for female patient age, partner age, patient ethnicity, gravidity, infertility diagnosis, treatment type, preimplantation genetic testing for aneuploidy, and number of prior in vitro fertilization (IVF) cycles. Results: Among 158,813 IVF cycles, live birth rates per cycle were 26.3% for couples with White partners and 23.1% for those with non-White partners. Non-White partners were associated with a 5% lower clinical pregnancy rate (RR 0.95, 95% CI 0.92–0.97) and a 6% lower live birth rate (RR 0.94, 95% CI 0.92–0.97). Specifically, Black (RR 0.82, 95% CI 0.77–0.87) and Asian (RR 0.67, 95% CI 0.59–0.76) partners had significantly reduced live birth rates, though these associations were attenuated after adjusting for patient ethnicity. Couples in which both the partner and patient were Black or Asian had 24–42% lower live birth rates compared with White couples (Black: RR 0.76, 95% CI 0.70–0.82; Asian: RR 0.58, 95% CI 0.49–0.68). Conclusions: Partner ethnicity is independently associated with IVF outcomes, with non-White partners showing lower rates of these outcomes. These findings suggest the clinical relevance of partner ethnicity in reproductive outcomes. Further research is warranted to elucidate the mechanisms underlying these associations.

True empty follicle syndrome is a subtype of oocyte maturation abnormalities - Turkish Journal of Obstetrics and Gynecology

Given the estrogen-dependence associated with endometriosis, hyper-stimulation associated with assisted reproduction treatment may exacerbate the disease process and adversely affect endometrial receptivity and subsequent implantation. In this way, a freeze-all deferred embryo transfer (ET) approach may benefit patients with endometriosis, although controversy exists regarding the mechanism of endometriosis-associated infertility and benefits of deferred ET on endometrial receptivity. Hence, the purpose of this study was to compare in vitro fertilization (IVF) outcomes in women with endometriosis, diagnosed by histology, undergoing fresh versus deferred-ET after elective cryopreservation. Of the 728 women included, no significant differences were observed in baseline patient characteristics and response to gonadotrophin stimulation between fresh and deferred ET groups. Furthermore, no significant differences in implantation rate (49.7 vs. 49.9%, p = 0.73), clinical pregnancy rate (40.9 vs. 39.9%, p = 0.49), and miscarriage rate (9.4 vs. 9.9%, p = 0.63) were observed between fresh and deferred ET groups, respectively. Hence, contrary to previous studies, our results suggest that a deferred ET “freeze-all” IVF strategy does not improve early pregnancy outcomes among women with endometriosis. However, prospective studies are required to validate these findings and further insight into the etiology and pathogenesis of endometriosis-associated infertility are necessary to optimize IVF protocols in this population.

Purpose Despite the increasing use of GnRHa to trigger final oocyte maturation in segmented IVF cycles, the effects of trigger modality on chromosomal competence and embryo quality remain controversial. Hence, the purpose of this study was to compare euploidy rates and pregnancy outcomes among hyper-responding women using hCG versus GnRHa trigger. Methods This retrospective study included 333 hyper-responders, defined as >15 oocytes retrieved, who underwent preimplantation genetic testing (PGT-A) in segmented IVF cycles using either GnRHa or urinary hCG trigger. Live birth rate (LBR) was the primary outcome of interest. Implantation rate (IR), clinical pregnancy rate (CPR), and euploidy rate were secondary outcomes. Results GnRH triggering was associated with improved IR (70.5 vs. 53.2%, p = 0.0475), LBR (51.3 vs. 33.8%, p = 0.0170) compared to hCG. A greater number of oocytes were retrieved (21.9 vs 18.4%, p < 0.001) and euploid embryos produced (2.8 vs. 2.1, p = 0.0109) after GnRHa triggering, while higher euploidy rates were only observed among women p = 0.0307) using GnRHa trigger. Higher OHSS rates were observed after hCG triggering (10.6 vs. 2.1%, p = 0.0009). Conclusion Hyper-responders who received GnRHa trigger experienced improved pregnancy outcomes and lower rates of OHSS compared to hCG triggering. The higher number of oocytes retrieved and euploid embryos produced may reflect an improved developmental competence using GnRHa triggering due to physiologic induction of both LH and FSH surge or other undefined mechanisms that improve embryo development. However, higher overall euploid rates were only observed among women <35-years-old using the GnRHa trigger. Further prospective studies are required to validate this observation and evaluate the specific influence of different ovulation triggers on gamete developmental competence among hyper-responder women.

In vitro maturation (IVM) is one of the most controversial aspects of assisted reproductive technology. Although it has been studied extensively, it is still not a conventional treatment option and is accepted as an alternative treatment. However, studies have shown that IVM can be used in almost all areas where in vitro fertilization (IVF) is used and it has a strong place in fertility protection and Ovarian Hyperstimulation syndrome management. The aim of this systematic review was to address all aspects of the current knowledge of IVM treatment together with the evolution of IVM and IVF.