BACKGROUND: Currently, more and more infertility couples are opting for combined acupuncture to improve success rate of in vitro fertilization (IVF). However, evidence from acupuncture for improving IVF pregnancy outcomes remains a matter of debate. OBJECTIVE: To quantitatively summarized the evidence of the efficacy of acupuncture among women undergoing IVF by means of systematic review and meta-analysis. METHODS: Four English (PubMed, Web of Science, EMBASE, and Cochrane Register of Controlled Clinical Trials) and Four Chinese databases (Wanfang Databases, Chinese National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, and SinoMed) were searched from database inception until July 2, 2023. Randomized controlled trials (RCTs) that evaluated the acupuncture's effects for women undergoing IVF were included. The subgroup analysis was conducted with respect to the age of participants, different acupuncture types, type of control, acupuncture timing, geographical origin of the study, whether or not repeated IVF failure, and acupuncture sessions. Sensitivity analyses were predefifined to explore the robustness of results. The primary outcomes were clinical pregnancy rate (CPR) and live birth rate (LBR), and the secondary outcomes were ongoing pregnancy rate and miscarriage rate. Random effects model with I² statistics were used to quantify heterogeneity. Publication bias was estimated by funnel plots and Egger's tests. RESULTS: A total of 58 eligible RCTs representing 10,968 women undergoing IVF for pregnant success were identifified. Pooled CPR and LBR showed a signifificant difference between acupuncture and control groups [69 comparisons, relative risk (RR) 1.19, 95% confifidence intervals (CI) 1.12 to 1.25, I²=0], extremely low evidence; 23 comparisons, RR 1.11, 95%CI 1.02 to 1.21, I²=14.6, low evidence, respectively). Only transcutaneous electrical acupoint stimulation showed a positive effect on both CPR (16 comparisons, RR 1.17, 95%CI 1.06 to 1.29; I²=0, moderate evidence) and LBR (9 comparisons, RR 1.20, 95%CI 1.04 to 1.37; I²=8.5, extremely low evidence). Heterogeneity across studies was found and no studies were graded as high-quality evidence. CONCLUSION Results showed that the convincing evidence levels on the associations between acupuncture and IVF pregnant outcomes were relatively low, and the varied methodological design and heterogeneity might inflfluence the fifindings. (Registration No. PROSPERO CRD42021232430).
Pregnancy ; Female ; Humans ; Live Birth ; Fertilization in Vitro/methods* ; Pregnancy Outcome ; Abortion, Spontaneous ; Acupuncture Therapy

Objective: To investigate the effect of embryo quality at different developmental stages on the secondary sex ratio (SSR) of single live birth neonates. Methods: Data for patients with singleton live births after embryo transferred between January 2016 and January 2022 were retrospectively analyzed. The effect of embryo quality at different development stages on the SSR of 11 713 singleton live births were investigated. The association of SSR and embryo quality at different development stages was examined in univariate analysis and in a multivariate logistic regression model, after adjustment for confounders, using two models (Ⅰ and Ⅱ). Results: The age of both male and female, body mass index of both male and female, basal follicle stimulating hormone and estradiol, smoking of male, methods of insemination, methods of sperm extraction, types of transfer cycle and the number of embryo transferred were not related with SSR (all P>0.05). After adjustment for confounders, the probability of a male live birth was higher after transfer of good-quality blastula than after transfer of poorer-quality blastula (model Ⅰ: aOR=0.73, 95%CI: 0.65-0.82, P<0.001; model Ⅱ: aOR=0.73, 95%CI: 0.65-0.82, P<0.001). The quality of cleavage stage embryo was not associated with SSR (model Ⅰ: aOR=0.99, 95%CI: 0.87-1.13, P=0.937; model Ⅱ: aOR=0.99, 95%CI: 0.87-1.13, P=0.899). Conclusions: The SSR of singleton live births after embryo transfer is not correlated with the quality of cleavage stage embryo, but is correlated with the quality of blastula. Good-quality blastula transfer is more likely to result in a male live birth.
Infant, Newborn ; Pregnancy ; Humans ; Male ; Female ; Live Birth ; Retrospective Studies ; Sex Ratio ; Semen ; Blastocyst

Pregnancy ; Female ; Humans ; Live Birth ; Calcium ; Oocytes ; Pregnancy, Multiple ; Pregnancy Rate ; Retrospective Studies ; Fertilization in Vitro ; Oocyte Retrieval

Background: Pre-implantation Genetic Testing for Aneuploidy (PGT-A) has enabled IVF specialists to screen embryos for abnormalities in chromosome number and structure. Subsequently, healthy embryos are selected for transfer, decreasing the rate of spontaneous miscarriages and improving pregnancy outcomes. In spite of this, almost only half of the PGTdetermined euploid embryos result in a pregnancy. Objective: This study aimed to determine what other factors among euploid embryo transfers will have an association with successful implantation and live birth. Methods: This study retrospectively analyzed 159 IVF-PGS cycles performed in CARMI SLMCGC from January 2017 to December 2019. Of these, a total of 231 euploid embryos (86 single embryo transfers and 73 double embryo transfers) were assessed. The relationship of eight predictive variables (maternal age, maternal BMI, etiology of infertility, history of failed IVF, blastocyst expansion stage, ICM grade, TE grade and endometrial thickness on transfer) with regard to the outcome of successful implantation and live birth among single or double euploid blastocyst transfers were determined via logistic regression analysis. Results: Overall, the implantation rate was significantly lower when using B-grade ICM or C-grade ICM blastocysts as compared to A-grade ICM blastocysts (OR 0.54, 95% CI 0.356- 0.815, p = 0.003). With regard to live birth rate, the success of transfer is statistically lower when using a B-grade or C-grade ICM blastocysts as compared to A-grade ICM blastocysts (OR 0.55, CI 0.354-0.863, p = 0.009). Other predictive factors such as maternal age, maternal BMI, etiology of infertility, number of previous IVF, blastocyst expansion stage, trophectoderm grade and endometrial thickness had no apparent effect on the outcome of implantation and live birth. Conclusion Present study results suggest that only the ICM grade of euploid blastocysts correlates with implantation and live birth in IVF-FET cycles. Therefore, the selection of euploid blastocysts based on the presence of a higher grade ICM is the most predictive factor that determines success among those undergoing IVF with PGT-A.
Live Birth ; Genetic Testing

BACKGROUND: More and more scholars have called for the cumulative live birth rate (CLBR) of a complete ovarian stimulation cycle as a key indicator for assisted reproductive technology. This research aims to study the CLBR of the first ovarian hyperstimulation cycles and analyze the related prognosis factors that might affect the CLBR. METHODS: Our retrospective study included first in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) cycles performed between January 2013 to December 2014. A total of 17,978 couples of first ovarian hyperstimulation IVF/ICSI cycles were included. The study was followed up for 4 years to observe the CLBR. The multivariable logistic regression model was used to analyze the prognosis factor, P value of <0.05 was considered statistically significant. RESULTS: The cumulative pregnancy rate was 58.14% (10,452/17,978), and the CLBR was 49.66% (8928/17,978). The female age was younger in the live birth group when compared with the non-live birth group (30.81 ± 4.05 vs. 33.09 ± 5.13, P < 0.001). The average duration of infertility was shorter than the non-live birth cohort (4.22 ± 3.11 vs. 5.06 ± 4.08, P < 0.001). The preliminary gonadotropin used and the total number of gonadotropin used were lower in the live birth group when compared with the non-live birth group (both P < 0.001). Meanwhile, the number of oocytes retrieved and transferrable embryos were both significantly higher in the live birth group (15.35 ± 7.98 vs. 11.35 ± 7.60, P < 0.001; 6.66 ± 5.19 vs. 3.62 ± 3.51, P < 0.001, respectively). CONCLUSIONS The women's age, body mass index, duration of infertility years, infertility factors, controlled ovarian hyperstimulation protocol, the number of acquired oocytes, and number of transferrable embryos are the prognosis factors that significantly affected the CLBR.
Birth Rate ; China ; Female ; Fertilization in Vitro ; Humans ; Live Birth ; Ovulation Induction ; Pregnancy ; Pregnancy Rate ; Retrospective Studies ; Sperm Injections, Intracytoplasmic

Objective: Prior pulmonary tuberculosis (PTB) on chest X-ray (CXR) was commonly found in infertile patients receiving examinations before Method: We conducted a retrospective cohort study of 14,254 infertile patients who had received IVF-ET at Peking University Third Hospital in 2017. Prior PTB was defined as the presence of signs suggestive of old or inactive PTB on CXR, with or without a clinical TB history. Patients who had prior PTB on CXR but had not received a clinical diagnosis and anti-TB therapy were included for analysis. Live birth, clinical pregnancy, and miscarriage rates were compared between the untreated PTB and non-PTB groups. Results: The untreated PTB group had significantly lower clinical pregnancy (31.7% Conclusions Untreated PTB was associated with adverse pregnancy outcomes after IVF-ET, especially in patients with unexplained infertility, highlighting the clinical significance of PTB in this specific patient population.
Abortion, Spontaneous/epidemiology* ; Adult ; China/epidemiology* ; Embryo Transfer/statistics & numerical data* ; Female ; Fertilization in Vitro/statistics & numerical data* ; Humans ; Infertility, Female/etiology* ; Live Birth/epidemiology* ; Middle Aged ; Pregnancy ; Pregnancy Complications, Infectious/epidemiology* ; Pregnancy Outcome/epidemiology* ; Radiography, Thoracic ; Retrospective Studies ; Tuberculosis, Pulmonary/epidemiology* ; Young Adult

INTRODUCTION: Pregnant women are reported to be at increased risk of severe coronavirus disease 2019 (COVID-19) due to underlying immunosuppression during pregnancy. However, the clinical course of COVID-19 in pregnancy and risk of vertical and horizontal transmission remain relatively unknown. We aim to describe and evaluate outcomes in pregnant women with COVID-19 in Singapore. METHODS: Prospective observational study of 16 pregnant patients admitted for COVID-19 to 4 tertiary hospitals in Singapore. Outcomes included severe disease, pregnancy loss, and vertical and horizontal transmission. RESULTS: Of the 16 patients, 37.5%, 43.8% and 18.7% were infected in the first, second and third trimesters, respectively. Two gravidas aged ≥35 years (12.5%) developed severe pneumonia; one patient (body mass index 32.9kg/m2) required transfer to intensive care. The median duration of acute infection was 19 days; one patient remained reverse transcription polymerase chain reaction (RT-PCR) positive >11 weeks from diagnosis. There were no maternal mortalities. Five pregnancies produced term live-births while 2 spontaneous miscarriages occurred at 11 and 23 weeks. RT-PCR of breast milk and maternal and neonatal samples taken at birth were negative; placenta and cord histology showed non-specific inflammation; and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific immunoglobulins were elevated in paired maternal and umbilical cord blood (n=5). CONCLUSION The majority of COVID-19 infected pregnant women had mild disease and only 2 women with risk factors (obesity, older age) had severe infection; this represents a slightly higher incidence than observed in age-matched non-pregnant women. Among the women who delivered, there was no definitive evidence of mother-to-child transmission via breast milk or placenta.
Abortion, Spontaneous/epidemiology* ; Adult ; COVID-19/transmission* ; COVID-19 Nucleic Acid Testing ; COVID-19 Serological Testing ; Cohort Studies ; Disease Transmission, Infectious/statistics & numerical data* ; Female ; Fetal Blood/immunology* ; Humans ; Infectious Disease Transmission, Vertical/statistics & numerical data* ; Live Birth/epidemiology* ; Maternal Age ; Milk, Human/virology* ; Obesity, Maternal/epidemiology* ; Placenta/pathology* ; Pregnancy ; Pregnancy Complications, Infectious/physiopathology* ; Pregnancy Outcome/epidemiology* ; Pregnancy Trimester, First ; Pregnancy Trimester, Second ; Prospective Studies ; RNA, Viral/analysis* ; Risk Factors ; SARS-CoV-2 ; Severity of Illness Index ; Singapore/epidemiology* ; Umbilical Cord/pathology* ; Young Adult

PURPOSE: To investigate clinical markers for the diagnosis of congenital cytomegalovirus (CMV) infection and determine the correlation between abnormal newborn hearing screening results and asymptomatic congenital CMV infection. METHODS: Medical records of newborns with congenital CMV infection, born at Cheil General Hospital & Women's Healthcare Center from July 2008 to June 2018, were retrospectively reviewed. Infants with congenital CMV infection were classified into “symptomatic,” “asymptomatic,” and “asymptomatic with isolated abnormal automated auditory brainstem response (AABR)” groups. Clinical data were analyzed based on this classification. RESULTS: Among the 59,424 live births, congenital CMV infection was found in 25 neonates, including 19 symptomatic (0.03%) infants, two asymptomatic, and four asymptomatic with isolated abnormal AABR. Diagnostic clues for the identification of congenital CMV infection were intrauterine growth restriction (IUGR), including microcephaly in 10 infants (40.0%), abnormal AABR in four (16.0%), initial complicated signs in four (16.0%), and abnormal findings on brain ultrasonography in three (12.0%). Other less common markers included petechiae, abnormal findings on antenatal ultrasonography, and co-twin with CMV infection. During the recent 10 years, 53,094 of 59,424 newborns (89.3%) had AABR for hearing screening and 493 (0.9%) did not pass. Among them, 477 (96.8%) were screened for CMV, and results were positive for seven (1.5%). Among the seven infants, four had asymptomatic congenital CMV infection. Overall, 0.8% of the newborns with abnormal AABR (four of 477 infants) were diagnosed as having asymptomatic congenital CMV infection. CONCLUSION: The incidence of symptomatic congenital CMV infection was 0.03%, and 0.8% of infants who failed in the newborn hearing screening tests had asymptomatic congenital CMV infection. The most common clinical marker to diagnose congenital CMV infection was IUGR, including microcephaly, and the second isolated marker was abnormal AABR.
Biomarkers ; Brain ; Classification ; Cytomegalovirus Infections ; Cytomegalovirus ; Delivery of Health Care ; Diagnosis ; Evoked Potentials, Auditory, Brain Stem ; Fetal Growth Retardation ; Hearing ; Hospitals, General ; Humans ; Incidence ; Infant ; Infant, Newborn ; Live Birth ; Mass Screening ; Medical Records ; Microcephaly ; Purpura ; Retrospective Studies ; Ultrasonography

OBJECTIVE: The male reproductive system generates, accumulates, and transports the sperm. In this study, 2 methods of surgically retrieving sperm, namely, testicular sperm aspiration (TESA) and percutaneous epididymal sperm aspiration (PESA), are discussed and studied in men aged ≤38 years to achieve successful conception using assisted reproductive technology. The purpose was to assess the fertilization rate (FA), clinical pregnancy, and live birth rate (LBR) with sperm. METHODS: A total of 287 semen samples were divided into 4 groups as follows: fresh PESA (n=73), frozen PESA (n=65), fresh TESA (n=128), and frozen TESA (n=21). The DNA fragmentation test using sperm chromatin dispersion assay was measured and reported. RESULTS: FA was 70.3% and 65.5%, (P<0.022) for fresh and frozen epididymal sperm and 53.8% and 49.5%, (P<0.032) for fresh and frozen testicular sperm. LBR was 33.6% and 30.2% (P<0.075) for fresh and frozen epididymal sperm (PESA) and 22.7% and 18.2% (P<0.063) for fresh and frozen-thawed TESA sperm. CONCLUSION: Exposure to tissue shearing may adversely affect sperm quality. Increased sperm DNA damage due to long-term exposure while teasing enhances reactive oxygen species production foremost to membrane damage because of the oxidation of polyunsaturated fatty acid in lipids (lipid peroxidation), oxidation of amino acid in proteins, and inactivation of specific enzymes, all leading to enzymatic dipping and possibility of less fertilization and conception as indicated by the increase in LBR with fresh/frozen PESA compared to with fresh/frozen TESA.
Chromatin ; DNA Damage ; DNA Fragmentation ; Fertilization ; Humans ; Infertility ; Live Birth ; Male ; Membranes ; Pregnancy ; Reactive Oxygen Species ; Reproductive Techniques, Assisted ; Retrospective Studies ; Semen ; Sperm Injections, Intracytoplasmic ; Sperm Retrieval ; Spermatozoa

The article "Effect of acupuncture vs sham acupuncture on live births among women undergoing in vitro fertilization: a randomized clinical trial", published in in May 2018, has concluded that acupuncture does not improve the rate of live births among women undergoing IVF. Through careful study of the article, the author analyzes its reliability from acupuncture therapeutic plan and specific acupuncture operation. As a result, although the research showed no significant difference between the acupuncture group and the sham acupuncture group, it could not prove no therapeutic effect in the sham acupuncture group, so the conclusion that the acupuncture did not improve the therapeutic effect could not be drawn; the compatibility of acupoints was inconsistent with the previous protocol, and its rationality was controversial; whether the frequency and duration of acupuncture treatment could highlight the live birth rate should be further discussed. In addition, the selection of acupuncturists may be another reason for the failure of the research aim.
Acupuncture Therapy ; Female ; Fertilization in Vitro ; Humans ; Live Birth ; Pregnancy ; Reproducibility of Results