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Objective: To evaluate if racial/ethnic differences in pregnancy outcomes persisted in frozen-thawed embryo transfer (FET) cycles on a national level.Design: Retrospective cohort study.Setting: Clinic-based data.Patient(s): A total of 189,000 Society for Assisted Reproductive Technology FET cycles from 2014-2016 were screened, of which 12,000 cycles had available fresh cycle linkage information and ultimately, because of missing data, 7,002 FET cycles were included. Cycles were stratified by race (White, Black, Asian, and Hispanic).Intervention(s): None.Main Outcome Measure(s): The primary outcome was live birth rate. Secondary outcomes were implantation rate, clinical pregnancy rate, multiple pregnancy rate, and clinical loss rate (CLR).Result(s): Live birth rate was significantly lower in the Black vs. White and Asian, but not Hispanic group. Implantation rate was also significantly lower and CLR higher in the Black group compared with all other groups (all P<.01). Black women had a lower risk of live birth (adjusted risk ratio, 0.82; 95% confidence interval [CI], 0.73-0.92) and a higher risk of clinical loss (adjusted risk ratio, 1.59; 95% CI, 1.28-1.99) compared with White women. There was no significant difference between groups in clinical pregnancy rate or multiple pregnancy rate. When the analysis was limited to preimplantation genetic testing FET cycles, there remained a significantly lower implantation rate in the Black group compared with all other groups (all P<.01).Conclusion(s): Black race remains an independent predictor of reduced live birth rate in FET cycles, likely because of higher CLR. [ABSTRACT FROM AUTHOR]

Objective: To examine the relationship between insurance mandates and the utilization and outcomes of assisted reproductive technologies (ART). Design: Using clinic-level data from 1990 to 2001, we examined differences between states with and without insurance mandates in rates of utilization and outcomes of ART using multivariable least squares regression. Setting: National clinic registry data. Patient(s): Clinics performing ART, no patient-level data. Intervention(s): The type of insurance mandate in each state during each year of the study. Main Outcome Measure(s): Cycles per 1,000 women aged 25–44 years, live births per 1,000 cycles, and multiple births per live ART birth. Result(s): Use of ART grew rapidly during the 1990s and grew most quickly in states that adopted comprehensive insurance mandates. Compared with states without mandates, births per cycle were 4% lower and multiples per ART birth were 2% lower in states with comprehensive mandates. Conclusion(s): Comprehensive insurance mandates are associated with greater utilization of ART and lower rates of births per cycle and multiple births per ART birth. Whether the differences in outcomes are due to differences in embryo transfer practices or to patient characteristics is unclear. [Copyright &y& Elsevier]

Objective: To analyze the effect of human papilloma virus (HPV) sperm infection on sperm parameters and in vitro fertilization (IVF) outcomes.Design: Systematic review and meta-analysis.Setting: Not applicable.Patients: Men with HPV sperm infection and couples undergoing IVF.Interventions: Searches were conducted in the following databases: Medline(R), PubMed, Embase, Web of Science, Scopos, and the Cochrane Library. We included studies examining sperm parameters and IVF results in patients with and without HPV sperm infection.Main Outcome Measures: Sperm analysis (concertation, count, volume, motility, morphology), according to the World Health Organization manual, pregnancy rate (PR), and miscarriage rate (MR).Results: Sixteen studies were included in this meta-analysis. The presence of HPV had a significant association with impaired sperm parameters in terms of concentration (mean difference [MD] -4.48, 95% confidence interval [CI] - 6.12 to -2.83), motility (MD -11.71, 95% CI - 16.15 to -7.26), and morphology (MD -2.44, 95% CI - 4.08 to -0.79. A review of the literature regarding ART outcomes showed an association between HPV infection and decreased PR, and an even stronger association between HPV infection and increased MR.Conclusion: Our meta-analysis shows a negative effect of HPV on sperm concentration, motility, and morphology. Further subgroup and categorical analysis confirmed the clinical significance of impaired sperm motility in HPV-infected sperm, although the sperm count and morphology must be carefully analyzed. The studies reviewed reported lower PR and increased MR in couples with HPV-infected sperm. As most studies had a moderate risk of bias, these observations warrant further large, well-designed studies before introducing clinical management recommendations.Prospero Registration Number: CRD42019127419. [ABSTRACT FROM AUTHOR]