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Purpose: To evaluate the predictive value of serum AMH for clinical pregnancy in non-infertile population undergoing intrauterine insemination with donor sperm (ds-IUI). Methods: This multicenter prospective study (ClinicalTrials.gov ID: NCT06263192) recruited all non-infertile women undergoing ds-IUI from June 2020 to December 2022 in three different fertility clinics in Spain and Chile. Indications for ds-IUI included severe oligoasthenoteratozoospermia, female partner, or single status. Clinical pregnancy rates were compared between women with AMH ≥ 1.1 and < 1.1 ng/mL. The main outcome measure was the cumulative clinical pregnancy rate after up to 4 ds-IUI cycles. Results: A total of 458 ds-IUI cycles were performed among 245 patients, of whom 108 (44.08%) achieved clinical pregnancy within 4 cycles, 60.2% of these occurring in the first attempt and 84.2% after two attempts. We found no significant differences in AMH levels or other parameters (such as age, BMI, FSH, AFC) between women who became pregnant and those who did not. Cumulative pregnancy rates and logistic regression analysis revealed that AMH ≥ 1.1 ng/mL was not predictive of ds-IUI success. While a high positive correlation was observed between AFC and AMH (r = 0.67, p < 0.001), ROC curve analyses indicated that neither of these ovarian reserve markers accurately forecasts cumulative ds-IUI outcomes in non-infertile women. Conclusions: The findings of this multicenter study suggest that AMH is not a reliable predictor of pregnancy in non-infertile women undergoing ds-IUI. Even women with low AMH levels can achieve successful pregnancy outcomes, supporting the notion that diminished ovarian reserve should not restrict access to ds-IUI treatments in eligible non-infertile women. [ABSTRACT FROM AUTHOR]

Purpose: This study investigates the role of bacterial vaginosis (BV) on pregnancy rates during various fertility treatments. BV is known to influence several obstetric outcomes, such as preterm delivery and endometritis. Only few studies investigated the effect of BV in subfertile women, and studies found a negative effect on fecundity especially in the in vitro fertilisation population. Methods: Observational prospective study, 76 couples attending a fertility clinic in the Netherlands between July 2019 and June 2022, undergoing a total of 133 attempts of intra uterine insemination, in vitro fertilization or intra cytoplasmatic sperm injection. Vaginal samples taken at oocyte retrieval or insemination were analysed on qPCR BV and 16S rRNA gene microbiota analysis of V1–V2 region. Logistic regression with a Generalized Estimated Equations analysis was used to account for multiple observations per couples. Results: A total of 26% of the 133 samples tested positive for BV. No significant differences were observed in ongoing pregnancy or live birth rates based on BV status (OR 0.50 (0.16–1.59), aOR 0.32 (0.09–1.23)) or microbiome community state type. There was a tendency of more miscarriages based on positive BV status (OR 4.22 (1.10–16.21), aOR 4.28 (0.65–28.11)) or community state type group III and IV. On baseline qPCR positive participants had significantly higher body mass index and smoked more often. Odds ratios were adjusted for smoking status, body mass index, and socioeconomic status. Conclusion: Bacterial vaginosis does not significantly impact ongoing pregnancy rates but could affect miscarriage rates. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether using progesterone as a trigger of a gonadotropin surge will induce ovulation and a competent corpus luteum. Methods: Patients were administered 5 or 10 mg of progesterone intramuscularly when the leading follicle reached preovulatory size. Results: We demonstrate that progesterone injections result in classical ultrasonographic hallmarks of ovulation about 48 h later and the formation of a corpus luteum competent to support pregnancy. Conclusion: Our results support further exploration of using progesterone to trigger a gonadotropin surge in assisted human reproduction. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to clarify which pre-wash total motile count are associated with improved clinical pregnancy rate (CPR) and live birth rate (LBR) based on maternal age, AMH level, stimulation regimen, and infertility diagnosis. Methods: This was a retrospective cohort study of first completed IUI cycles at two academic fertility centers from 5/2015 to 9/2019. Cycles were stratified by pre-wash TMC, maternal age, AMH level, stimulation regimen, and infertility diagnosis. The primary outcome was CPR and secondary outcomes were live birth and miscarriage. Results: One thousand one hundred fifty-four cycles were analyzed. Of the 162 cycles that resulted in a CPR (14.0%), most had an insemination TMC > 20 million. Compared to TMC > 20 million, there was no difference in CPR or LBR for lower TMC categories, excluding the TMC < 2 million group, in which there were no pregnancies. When TMC was stratified by deciles, there was also no difference in CPR and LBR, including within the lowest decile (TMC 0.09–8.6 million). Younger age and higher ovarian reserve parameters were associated with higher pregnancy and LBR when stratified by TMC. There was no difference in pregnancy and LBR when considering different stimulation protocols. Conclusions: Our data suggest that pregnancy and LBR are equivalent above a TMC of 2 million. Data stratified by TMC and patient parameters can be used to counsel patients pursuing ART. [ABSTRACT FROM AUTHOR]

Purpose: To compare fertility outcomes of obese patients (body mass index [BMI] ≥ 30 kg/m2) undergoing superovulation and intrauterine insemination (SO-IUI) using gonadotropins versus letrozole.A single centre retrospective cohort study of obese patients undergoing SO-IUI using gonadotropins or letrozole between January/2019 and June/2022. Primary outcome was clinical pregnancy rate (intrauterine pregnancy with positive fetal heart rate). Secondary outcomes included rates of multifollicular development, multiple pregnancy, spontaneous abortion and cycle cancellation. Subgroup analysis was done stratifying by obesity class. A multivariate logistic regression model was used for primary/secondary outcomes, adjusting for clinically determined covariates.Out of 802 total identified SO-IUI cycles, 715 cycles were completed (518-gonadotropins and 197-letrozole cycles). The clinical pregnancy rates were not significantly different in obese patients undergoing SO-IUI with gonadotropins versus letrozole when adjusted for age, gravidity, parity, cause of infertility, IUI cycle number, endometrial thickness, sperm source and post-wash motile sperm count (adjusted odds ratio [aOR] 1.37, 95% confidence interval [CI] 0.72–2.59). Similarly, no significant associations were found in spontaneous abortion (aOR1.46, 95%CI 0.42–5.08), multiple pregnancy (aOR1.33, 95%CI 0.20–8.88) or cancellation rates (OR0.89, 95%CI 0.55–1.45) between the two groups. The rates of multifollicular development were also comparable between the two groups (aOR0.51, 95% CI 0.19–1.38). For cycles involving gonadotropins, higher BMI classes required higher total gonadotropin dose (p < 0.001).After adjusting for patient and cycle factors, gonadotropins and letrozole led to comparable odds of achieving pregnancy in obese patients undergoing SO-IUI. Future research in the obese population will help to better understand how to optimize fertility treatments for this growing population.Methods: To compare fertility outcomes of obese patients (body mass index [BMI] ≥ 30 kg/m2) undergoing superovulation and intrauterine insemination (SO-IUI) using gonadotropins versus letrozole.A single centre retrospective cohort study of obese patients undergoing SO-IUI using gonadotropins or letrozole between January/2019 and June/2022. Primary outcome was clinical pregnancy rate (intrauterine pregnancy with positive fetal heart rate). Secondary outcomes included rates of multifollicular development, multiple pregnancy, spontaneous abortion and cycle cancellation. Subgroup analysis was done stratifying by obesity class. A multivariate logistic regression model was used for primary/secondary outcomes, adjusting for clinically determined covariates.Out of 802 total identified SO-IUI cycles, 715 cycles were completed (518-gonadotropins and 197-letrozole cycles). The clinical pregnancy rates were not significantly different in obese patients undergoing SO-IUI with gonadotropins versus letrozole when adjusted for age, gravidity, parity, cause of infertility, IUI cycle number, endometrial thickness, sperm source and post-wash motile sperm count (adjusted odds ratio [aOR] 1.37, 95% confidence interval [CI] 0.72–2.59). Similarly, no significant associations were found in spontaneous abortion (aOR1.46, 95%CI 0.42–5.08), multiple pregnancy (aOR1.33, 95%CI 0.20–8.88) or cancellation rates (OR0.89, 95%CI 0.55–1.45) between the two groups. The rates of multifollicular development were also comparable between the two groups (aOR0.51, 95% CI 0.19–1.38). For cycles involving gonadotropins, higher BMI classes required higher total gonadotropin dose (p < 0.001).After adjusting for patient and cycle factors, gonadotropins and letrozole led to comparable odds of achieving pregnancy in obese patients undergoing SO-IUI. Future research in the obese population will help to better understand how to optimize fertility treatments for this growing population.Results: To compare fertility outcomes of obese patients (body mass index [BMI] ≥ 30 kg/m2) undergoing superovulation and intrauterine insemination (SO-IUI) using gonadotropins versus letrozole.A single centre retrospective cohort study of obese patients undergoing SO-IUI using gonadotropins or letrozole between January/2019 and June/2022. Primary outcome was clinical pregnancy rate (intrauterine pregnancy with positive fetal heart rate). Secondary outcomes included rates of multifollicular development, multiple pregnancy, spontaneous abortion and cycle cancellation. Subgroup analysis was done stratifying by obesity class. A multivariate logistic regression model was used for primary/secondary outcomes, adjusting for clinically determined covariates.Out of 802 total identified SO-IUI cycles, 715 cycles were completed (518-gonadotropins and 197-letrozole cycles). The clinical pregnancy rates were not significantly different in obese patients undergoing SO-IUI with gonadotropins versus letrozole when adjusted for age, gravidity, parity, cause of infertility, IUI cycle number, endometrial thickness, sperm source and post-wash motile sperm count (adjusted odds ratio [aOR] 1.37, 95% confidence interval [CI] 0.72–2.59). Similarly, no significant associations were found in spontaneous abortion (aOR1.46, 95%CI 0.42–5.08), multiple pregnancy (aOR1.33, 95%CI 0.20–8.88) or cancellation rates (OR0.89, 95%CI 0.55–1.45) between the two groups. The rates of multifollicular development were also comparable between the two groups (aOR0.51, 95% CI 0.19–1.38). For cycles involving gonadotropins, higher BMI classes required higher total gonadotropin dose (p < 0.001).After adjusting for patient and cycle factors, gonadotropins and letrozole led to comparable odds of achieving pregnancy in obese patients undergoing SO-IUI. Future research in the obese population will help to better understand how to optimize fertility treatments for this growing population.Conclusion: To compare fertility outcomes of obese patients (body mass index [BMI] ≥ 30 kg/m2) undergoing superovulation and intrauterine insemination (SO-IUI) using gonadotropins versus letrozole.A single centre retrospective cohort study of obese patients undergoing SO-IUI using gonadotropins or letrozole between January/2019 and June/2022. Primary outcome was clinical pregnancy rate (intrauterine pregnancy with positive fetal heart rate). Secondary outcomes included rates of multifollicular development, multiple pregnancy, spontaneous abortion and cycle cancellation. Subgroup analysis was done stratifying by obesity class. A multivariate logistic regression model was used for primary/secondary outcomes, adjusting for clinically determined covariates.Out of 802 total identified SO-IUI cycles, 715 cycles were completed (518-gonadotropins and 197-letrozole cycles). The clinical pregnancy rates were not significantly different in obese patients undergoing SO-IUI with gonadotropins versus letrozole when adjusted for age, gravidity, parity, cause of infertility, IUI cycle number, endometrial thickness, sperm source and post-wash motile sperm count (adjusted odds ratio [aOR] 1.37, 95% confidence interval [CI] 0.72–2.59). Similarly, no significant associations were found in spontaneous abortion (aOR1.46, 95%CI 0.42–5.08), multiple pregnancy (aOR1.33, 95%CI 0.20–8.88) or cancellation rates (OR0.89, 95%CI 0.55–1.45) between the two groups. The rates of multifollicular development were also comparable between the two groups (aOR0.51, 95% CI 0.19–1.38). For cycles involving gonadotropins, higher BMI classes required higher total gonadotropin dose (p < 0.001).After adjusting for patient and cycle factors, gonadotropins and letrozole led to comparable odds of achieving pregnancy in obese patients undergoing SO-IUI. Future research in the obese population will help to better understand how to optimize fertility treatments for this growing population. [ABSTRACT FROM AUTHOR]

Purpose: This study sought to compare sperm DNA fragmentation (SDF) in semen specimens after 3 days and then after 3 h of abstinence in men presenting for initial infertility evaluation. Methods: A prospective cohort study of 112 men undergoing their first semen analysis as part of an infertility work-up was conducted. All participants presented with 3 days of abstinence for a semen analysis and DNA-fragmentation test. Both tests were repeated on a second sample collected 3 h after the first ejaculation. DNA-fragmentation was evaluated with the halo test by one of two technicians blinded to duration of abstinence. Variables analyzed include ejaculate volume, sperm concentration and motility, smoking status, cannabis use, initial specimen DNA fragmentation, and use of sperm-directed anti-oxidant formulations. Results: Among all subjects, DNA fragmentation improved in the 3-h abstinence specimen (34.6 ± 19.4% vs. 23.7 ± 16.0%, p = 0.0001). Among subjects with high DNA fragmentation (> 35%) on the initial specimen, 55% improved into the normal range. Semen volume and sperm concentration decreased (3.1 ± 3.3 ml vs. 1.9 ± 0.8 ml, p < 0.01 and 41 ± 39 vs. 32 ± 31 (millions/ml), p = 0.01), while progressive motility tended to increase. Fifty-eight subjects demonstrated ≥ 30% improvement in SDF in the second specimen as compared to the first. Factors found to correlate with > 30% improvement in DNA fragmentation in the 3-h abstinence specimen compared to 3 days were younger age and use of anti-oxidants. Conclusion: High SDF can often be managed with a second ejaculation 3 h after the first in infertile couples, including in males with abnormal semen analyses per the 2010 WHO guide. Apart from SDF levels, changes in sperm quality were not clinically significant in the second specimen and did not increase rates of ICSI. However, a second ejaculation after 3 h probably may reduce the necessity of costly and/or invasive ART strategies. [ABSTRACT FROM AUTHOR]

Objective: To investigate the serum levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), monocyte chemotactic protein-1 (MCP-1), and Paraoxonase-1 (PON-1) during fertility treatment of women with endometriosis (Endo), PCOS or unexplained infertility (Unexpl). Methods: Thirty-six patients with Endo, PCOS or Unexpl undergoing controlled ovarian stimulation for IVF or IUI were consented and their serum, on day-3 (baseline) and at the end of FSH treatment (peak), was collected and investigated for levels of TNF-α, IL-6, MCP-1, and PON-1. Correlations, ANOVA and Student's t-test were used for statistical analysis. Results: Peak serum levels of IL-6, MCP-1 and PON-1 were positively correlated to E peak levels. TNF-α levels were inversely correlated to estradiol levels and they were lower in patients who ultimately became pregnant when compared to non-pregnant ( P < 0.05). Mean TNF-α levels were significantly higher in Unexpl group ( P < 0.05). The mean levels of IL-6, and MCP-1 were significantly ( p < 0.05) higher in women with PCOS compared with Endo and Unexpl. No differences were found between the three clinical groups in patient's age, BMI, Day-3 FSH, PON-1 and pregnancy outcome. Conclusion: Circulating cytokine levels were influenced by ovarian stimulation, as demonstrated by increased levels of IL-6, MCP-1 and PON-1, and decreased level of TNF-α at the end of controlled ovarian stimulation. While evidence of relationship between circulating cytokines with mild endometriosis was not found, PCOS was associated with elevated serum IL-6 and MCP-1 but lower TNF-α concentration. Unexplained infertility was associated with elevated TNF-α level. No relationship between serum PON-1 concentration and PCOS, mild endometriosis or unexplained infertility was noted. [ABSTRACT FROM AUTHOR]

Purpose: To summarise the causes of decreased fecundity with age and review chronological vs biological ovarian ageing. To explore the clinician's means of assessing a woman's ovarian reserve. To review the recent literature on the effectiveness of different assisted reproductive technology (ART) techniques for women aged 40 and over and offer a single best treatment option. Methods: Pubmed and google scholar were searched for relevant articles using key words. Data were extracted based on authors, year, aims, sample and results. Results: Success rates for women aged 40 or over with clomiphene, IUI, IUI with FSH are all extremely low, at less than 1 % live birth per cycle. However, IVF offers a success rate of around 13.7 % per cycle. Conclusion: An exploration of the effectiveness of available treatment options for older infertile women using their own gametes suggests that IVF offers the best prospects of success. Attempting treatments other than IVF will delay conception unnecessarily. [ABSTRACT FROM AUTHOR]

Purpose: We investigated the activities and relevance of a validated panel of antioxidant enzymes, cytokines, specific lipid peroxidation end products and six fatty acids by correlational analyses with peak E levels and pregnancy outcome after ovarian stimulation for IVF or IUI. Methods: Blood samples obtained from 15 patients undergoing ovarian stimulation with rFSH or hMG were divided into two groups. Group-1 was baseline blood collected on day-2-3 of women cycle. Group-2 is blood collected at the end of FSH/hMG injection. Serum was collected and stored in liquid nitrogen at -196 °C until analysis. Standard IVF and IUI procedures were followed. The serum levels of Paraoxonase (PON1), Superoxide Dismutases (SOD), Interleukin-6 (IL-6), Glutathione Peroxidase (GPx), 8-Isoprostane, and fatty acids Arachidic, Palmitic, Stearic, Oleic, Linoleic & Linolenic were measured. Results: With the exception of 8-Isoprostane, results showed a positive correlation between baseline and peak levels of E and that of SOD, GPx, PON1, and IL-6. The PON1, IL-6 and SOD were significantly ( p < 0.05) higher in pregnant than non-pregnant group. Fatty acid levels at baseline and peak E were not different but pregnancy rates were found to be decreasing with higher palmitic, and stearic acid levels. Conclusions: Ovarian stimulation causes a significant increase in serum PON1, SOD, GPx and IL-6 activity in women undergoing IVF or IUI. The high levels of IL-6, SOD, and PON1 and lower levels of palmitic, and stearic acids in the pregnancy positive group indicate that these oxidative stress and nutritional factors may be used as a predictive marker in controlled ovarian stimulation success. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the relationship between sperm apoptotic biomarkers and patient clinical characteristics, conventional sperm parameters and fertility potential. Material and methods: Sperm analysis, phospholipid asymmetry, mitochondrial membrane potential (MMP) and DNA denaturation were assessed in 142 males of infertile couples. Seventy-three couples were allocated to the natural conception group, and 55 couples underwent IVF or ICSI. Results: DNA denaturation correlated positively with age and negatively with testicular volume (TV). MMP correlated negatively with BMI and FSH and positively with TV. Normal viable sperm correlated positively with TV and negatively with age, BMI and FSH. DNA denaturation was associated with a significantly lower natural pregnancy rate (OR 5.4, 95% CI:1.3-22, p = 0.011). Conclusion: Sperm apoptosis is related to male age, BMI, testicular volume and FSH. Among the apoptotic markers, only DNA denaturation has been found to predict natural pregnancy better than conventional sperm parameters. [ABSTRACT FROM AUTHOR]

Aim To evaluate the influence of smoking on the outcome of COH and IUI in subfertile couples. Patients and methods We reviewed the medical files of all consecutive women, age =35 years, attending our infertility clinics over an eigth-year period. Data on patient age, smoking habits, and variable related to infertility-treatment were collected from the files. Results A total of 2,318 cases were evaluated: 1,803 in nonsmoking patients (n=679) and 515 in smokers (n=206). The smokers used significantly more gonadotropin ampoules and gained a thinner endometrium on the day of hCG administration than the nonsmokers (p<0.016 for both). There were no between-groups differences in patient age, duration of gonadotropin stimulation, number of follicle >14 mm in diameter, or E2 levels on the day of hCG administration. Conclusion Smokers undergoing COH with IUI required a significantly higher gonadotropin dosage than nonsmokers in order to achieved a comparable pregnancy rate. [ABSTRACT FROM AUTHOR]