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OBJECTIVE: We aim to demonstrate a clinical difference in pregnancy outcomes in IVF cycles undergoing blastocyst-stage embryo biopsy and preimplantation genetic screening (PGS) in comparison to patients undergoing standard (non-PGS) IVF treatment. DESIGN: We conducted a retrospective cohort analysis of a private IVF clinic in Melbourne, Australia. MATERIALS AND METHODS: Details of patients undergoing PGS utilising blastocyst biopsy and next-generation sequencing from January 2015 to March 2018 were extracted from the clinic's database and compared to patients receiving standard IVF treatment and a blastocyst transfer from January 2010 to March 2018. Our analysis compared 719 PGS cases to 2920 non-PGS cases of single, frozen embryo transfer. Statistical analysis was conducted using Windows SPSS Version 25 and STATA 15. Demographic and stimulation cycle details were compared between groups using a combination of the Mann-Whitney-U test, Welch's t-test and student's ttest. Outcomes were analysed using logistic and linear regressions. RESULT(S): Statistically significant differences in some demographic factors, notably age and previous pregnancy/IVF history were apparent in PGS cycles. Our primary outcome was an ongoing and delivered pregnancy, with secondary outcomes of clinical pregnancy, twin delivery, gestation at delivery and birthweight. Adjustment regression models utilised almost all demographic and stimulation variables (except gravidity, parity and number of embryos biopsied). PGS had a statistically significant superior rate of ongoing and delivered pregnancies compared to non-PGS cases (OR 1.86, 95% CI 1.50-2.29, p=<0.001), with an associated superior clinical pregnancy rate (OR 1.66, 95% CI 1.36-2.04, p=<0.001). PGS produced superior ongoing and delivered pregnancy rates for women above 35 years (p=<0.001), but no difference under 35 years (p=0.92). Of note, there was no statistically significant difference between PGS and non-PGS groups related to twin del

OBJECTIVE: To evaluate whether GnRH-agonist (GnRHa) triggering improves embryo quality and live birth rates in 'freeze-all' cycles compared to human chorionic gonadotrophin (hCG). DESIGN: Retrospective cohort study. MATERIALS AND METHODS: This retrospective cohort study from January 2012 and December 2014 compared GnRHa and hCG-triggered 'freeze-all' cycles. Limiting for first cycle per patient, 396 GnRHa and 1,868 hCG-triggered cycles were included. Only cycles where embryos were available and thawed for transfer were included for live birth rates (LBR). 217 GnRHa and 509 hCG-triggered cycles were analysed for LBR. A multiple imputation approach was used to account for missing data. The primary outcome was LBR. Secondary outcomes included number of oocytes collected, embryo grade and quality, clinical pregnancy rates and the incidence of ovarian hyperstimulation syndrome (OHSS). Regression analysis was performed to adjust for confounders. P-values <0.05 were considered statistically significant. RESULT(S): The singleton LBR after one embryo transfer was higher in GnRHa triggered 'freeze-all' cycles compared to hCG (38.4% vs. 24.6%, p=0.001), as well as a non-significantly higher cumulative LBR (57.4% vs. 41.1%, p=0.18). There was no difference in the number of embryos thawed or transferred, and there was no difference in embryo grade or expansion. The incidence of OHSS was significantly lower in GnRHa triggered cycles (0.5% vs. 1.9%, p=0.008). CONCLUSION(S): GnRHa triggering resulted in a superior LBR compared to hCG in 'freeze-all' cycles, even after adjusting for confounders. GnRHa triggering did not compromise embryo quality and significantly reduced the risk of OHSS compared to hCG. Given these findings, GnRHa triggering appears to be the way of the future for 'freeze-all' cycles.

Objective: To evaluate oocyte maturation and fertilisation rates of intracytoplasmic sperm injection (ICSI) cycles triggered with intranasal and subcutaneous GnRH-agonists (GnRHa). Design(s): Retrospective cohort study. Material(s) and Method(s): This retrospective cohort study from May 2016 to August 2018 compared intranasal and subcutaneous GnRHa triggers in ICSI cycles. Data was extracted from 9588 ICSI cycles. A total of 781 cycles were included for analysis after excluding cycles triggered with hCG (n=8521), duplicate patient cycles (n=182), where a duel trigger was used (n=55) or where the trigger was not recorded (n=49). 214 cycles utilised the intranasal Nafarelin trigger (Synarel; Pfizer Pty Ltd) and 567 cycles used a subcutaneous formulation, either Triptorelin (Decapeptyl; Ferring Pharmaceuticals Pty Ltd) or Leuprorelin (Lucrin; AbbVie Pty Ltd). The primary outcome was oocyte maturation rate. Secondary outcomes included number of mature oocytes collected, number of fertilised oocytes, fertilisation rate and the incidence of ovarian hyperstimulation syndrome (OHSS). Categorical data was presented as a proportion (%) and p-values were obtained by performing a Mann-Whitney U test. Continuous and count data was presented as a mean with standard deviation and standard error of mean, and p-values were obtained by performing the student's T-test. Univariate and adjusted analyses were performed using negative binomial regression for count measures and linear regression for continuous measures. Statistical significance was defined as a p-value <0.05. Result(s): There was a trend towards higher oocyte maturation rates in patients receiving a subcutaneous GnRHa trigger compared to intranasal formulations (78.1% vs. 77.6%, p=0.059). There was a statistically significant difference in fertilisation rate in favour of the subcutaneous trigger (68.0% vs. 67.9%, p=0.016). There was no difference in the age or BMI of patients, nor was there a difference in the crude number

Objective: To evaluate whether GnRH-agonist (GnRHa) triggering improves embryo quality and live birth rates in 'freeze-all' cycles compared to human chorionic gonadotrophin (hCG). Design(s): Retrospective cohort study. Material(s) and Method(s): This retrospective cohort study from January 2012 and December 2014 compared GnRHa and hCG-triggered 'freeze-all' cycles. Limiting for first cycle per patient, 396 GnRHa and 1,868 hCG-triggered cycles were included. Only cycles where embryos were available and thawed for transfer were included for live birth rates (LBR). 217 GnRHa and 509 hCG-triggered cycles were analysed for LBR. A multiple imputation approach was used to account for missing data. The primary outcome was LBR. Secondary outcomes included number of oocytes collected, embryo grade and quality, clinical pregnancy rates and the incidence of ovarian hyperstimulation syndrome (OHSS). Regression analysis was performed to adjust for confounders. P-values <0.05 were considered statistically significant. Result(s): The singleton LBR after one embryo transfer was higher in GnRHa triggered 'freeze-all' cycles compared to hCG (38.4% vs. 24.6%, p=0.001), as well as a non-significantly higher cumulative LBR (57.4% vs. 41.1%, p=0.18). There was no difference in the number of embryos thawed or transferred, and there was no difference in embryo grade or expansion. The incidence of OHSS was significantly lower in GnRHa triggered cycles (0.5% vs. 1.9%, p=0.008). Conclusion(s): GnRHa triggering resulted in a superior LBR compared to hCG in 'freeze-all' cycles, even after adjusting for confounders. GnRHa triggering did not compromise embryo quality and significantly reduced the risk of OHSS compared to hCG. Given these findings, GnRHa triggering appears to be the way of the future for 'freeze-all' cycles. Reference: None.Copyright © 2019

OBJECTIVE: To investigate the association between uterine adenomyosis diagnosed by ultrasound and the outcomes of in vitro fertilisation and embryo transfer (IVF/ET). DESIGN: Prospective cohort study. MATERIALS AND METHODS: All patients from our unit aged 18- 45 years undergoing a stimulated IVF cycle with embryo transfer between January 2016 and March 2017 were identified. Six-hundred and two of these patients had a standardised tertiary level pre-treatment ultrasound where signs of adenomyosis were actively investigated. Adenomyosis was identified in 113 (18.7%) of these patients and the IVF/ET coutcomes were compared with the remaining 489 patients. The data was not normally distributed and univariate analysis with Mann-Whitney testing was undertaken using SPSS. The primary outcome was clinical pregnancy rate per patient. Logistic regression was used to allow for potential confounders. This is an interim analysis. RESULT(S): A total of 602 patients were investigated. Patients with adenomyosis were older (37.9 years vs 36.9 years; p < 0.001), more likely to smoke (7.1% vs 1.6%; p = 0.001), have endometriosis (17.7% vs 9%; p = 0.007) and have poorer grade embryos (p = 0.001). Patients with adenomyosis had a significantly lower clinical pregnancy rate (23.9% vs 40.7%; p = 0.045) with an odds-ratio of 0.46 (0.28 - 0.75). This result remained significant even after logistic regression to control for confounders with an adjusted odds-ratio of 0.35 (0.14 - 0.88; p = 0.045). CONCLUSION(S): The presence of adenomyosis diagnosed by tertiary ultrasound is associated with lower clinical pregnancy rates in IVF/ET. The lower clinical pregnancy rate seen with adenomyosis is independent of the effects of poorer grade embryos, smoking, and advanced age. Further analysis of this trial once a larger population is collected will be done to verify these findings and assess effect on live births.

OBJECTIVE: Poor uterine receptivity may be one reason for implantation failure in IVF. Some evidence [1-3] suggests an immunological role for reduced uterine receptivity hence many interventions targeted at achieving an 'ideal' immune environment are being investigated. One such therapy, intralipid, has been shown to be effective at suppressing natural kill cell cytotoxicity [4-5] but it remains unclear as to the actual effect in improving pregnancy rates. Thus, the objective of our study was to evaluate the effect of intralipid on chemical pregnancy, clinical pregnancy, live births and clinical pregnancy loss. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: The study evaluated all fresh and frozen embryo transfers (ETs) between 2011 and 2015 (N=29,852) from a multi-site IVF clinic. In patients who had one or more ETs with intralipid, all other ETs were excluded and a randomly selected single ET cycle was chosen for each patient, leaving 11,028 ETs for analysis. This included 545 ETs where intralipid was used and 10,483 control ETs. Intervention and control groups were matched for: year, cycle number, age, number of embryos transferred, number of previous ETs without a live birth, and use of adjuvant therapies. Univariate comparison of proportions was performed using the Chi square test, while Mann Whitney U testing was used for univariate comparison of continuous variables. Logistic regression was used to allow for potential confounding variables. Analysis was performed initially on the full cohort and then on matched cases and controls. RESULT(S): Analysis of the full cohort demonstrated reduced rates for the intralipid group of chemical pregnancy (crude OR 0.61 CI 0.50-0.70), clinical pregnancy (crude OR 0.58 CI 0.48-0.71) and live birth (crude OR 0.52 CI 0.42-0.65). Once confounding factors had been allowed for through logistic regression (adjusted ORs) no statistically significant differences were seen between ET cycles with or without intralipid.