Background Patients with recurrent implantation failure (RIF) may have more uterine contractions. Several observational studies suggested that atosiban administration around embryo transfer resulted in higher pregnancy rates in RIF patients. This study aimed to evaluate the effect of atosiban given before fresh embryo transfer on pregnancy outcomes of women with RIF. Methods A prospective, randomized, double-blind controlled clinical trial was performed in IVF center of Shanghai First Maternity and Infant Hospital. According to a computer-generated randomization list, 194 infertile women with RIF received fresh embryo transfer between July 2017 and December 2019 were randomly allocated into the atosiban (n = 97) and the placebo (n = 97) groups. Women in the treatment group received atosiban intravenously about 30 min before embryo transfer with a bolus dose of 6.75 mg over one minute. Those in the placebo group received only normal saline infusion for the same duration. Results There was no significant difference in the live birth rate between the atosiban and placebo groups (42.3% vs 35.1%, P = 0.302, RR = 1.206 (0.844–1.723)). No significant differences were found between the two groups in the positive pregnancy test, clinical pregnancy, ongoing pregnancy, miscarriage, multiple pregnancy, ectopic pregnancy and implantation rates. Similar results were found when stratified by the number of embryos previously transferred, number of previous failed embryo transfers, frequency of endometrial peristalsis on embryo transfer day (≥ 3 waves/min) or serum estradiol (E2) on the day of hCG above the median level. And, there was no correlation between the serum E2 level on the day of hCG and the frequency of endometrial peristalsis on embryo transfer day. The frequency of endometrial peristalsis on embryo transfer day, total FSH/HMG dosage and duration were the significant factors which independently predicted the likelihood of a live birth. Conclusions These results suggested that atosiban treatment before fresh embryo transfer might not improve the live birth rate in RIF patients. Trial registration The study had been approved by the Institutional Review Board of the hospital (2017 ethics No.43) and was registered under Clinicaltrials.gov with an identifier NCT02893722.

No abstract

Background: Patients with recurrent implantation failure (RIF) may have more uterine contractions. Several observational studies suggested that atosiban administration around embryo transfer resulted in higher pregnancy rates in RIF patients. This study aimed to evaluate the effect of atosiban given before fresh embryo transfer on pregnancy outcomes of women with RIF.Methods: A prospective, randomized, double-blind controlled clinical trial was performed in IVF center of Shanghai First Maternity and Infant Hospital. According to a computer-generated randomization list, 194 infertile women with RIF received fresh embryo transfer between July 2017 and December 2019 were randomly allocated into the atosiban (n=97) and the placebo (n=97) groups. Women in the treatment group received atosiban intravenously about 30 min before embryo transfer with a bolus dose of 6.75 mg over one minute. Those in the placebo group received only normal saline infusion for the same duration. Results: There was no significant difference in the live birth rate between the atosiban and placebo groups (42.3% vs 35.1%, P=0.302, RR=1.206 (0.844-1.723)). No significant differences were found between the two groups in the positive pregnancy test, clinical pregnancy, ongoing pregnancy, miscarriage, multiple pregnancy, ectopic pregnancy and implantation rates. Similar results were found when stratified by the number of embryos previously transferred, number of previous failed embryo transfers, frequency of endometrial peristalsis on embryo transfer day (≥3 waves/min) or serum estradiol (E2) on the day of hCG above the median level. And, there was no correlation between the serum E2 level on the day of hCG and the frequency of endometrial peristalsis on embryo transfer day. The frequency of endometrial peristalsis on embryo transfer day, total FSH/HMG dosage and duration were the significant factors which independently predicted the likelihood of a live birth.Conclusions: These results suggested that atosiban treatment before fresh embryo transfer might not improve the live birth rate in RIF patients. Trial registration: The study had been approved by the Institutional Review Board of the hospital (2017 ethics No.43) and was registered under Clinicaltrials.gov with an identifier NCT02893722.

Background Although increasing the oocyte/embryo yield via an accumulation from consecutive stimulation cycles may be an effective approach towards improving IVF outcomes in POR patients, there are no robust data indicating the efficiency of the ‘accumulation scenario’ in women with a poor response undergoing IVF after multiple treatment cycles in a certain period of time. Methods This is a retrospective study of 276 infertile women in poor ovarian responders according to the Bologna criteria undergoing IVF between October 2016 to March 2020. Infertile women fulfilling the Bologna criteria in which at least two of the following three features (age ≥ 40 years, a previous POR, an abnormal ovarian reserve test) undergoing IVF were included. They used either embryo pooling (study group, n = 121) or conventional non-pooling strategy (control group, n = 155) at the discretion of the attending physicians. The primary outcome measure was the cumulative live birth rate (CLBR) of which the ongoing status had to be achieved within 24 months since ovarian stimulation. LBR was calculated by including the first live birth generated during the 24 months period whether via fresh or FET cycles. Results Implantation rate was significantly lower in the study group compared to that in the control group(17.4%vs27.8%, P = 0.002). The CLBR after multiple IVF stimulation cycle and subsequent fresh embryo transfer and /or FET cycles within 24 months follow-up were significantly lower in the study group compared to that in the control group (31.4% (38/121) and 43.2% (67/151), RR = 0.727; 95%CI: 0.528-1.000). The average time from ovarian stimulation to live birth was significantly longer in the study group compared to the control group (20.5(15.4–25.8) months vs.16(14.5–22.6) months respectively, P < 0.001). In Kaplan-Meier analysis, the cumulative incidence of ongoing pregnancy leading to live birth was significantly lower in the study group compared with control group (Log rank test, chi-square = 21.958, P < 0.001). Cox proportional hazard modelling revealed that the embryo pooling (HR = 1.896; 95% CI: (1.114–3.229), P = 0.018), age of women, number of stimulation cycles per woman (HR = 0.900; 95% CI:(0.849–0.955), P < 0.001) were strongly associated with the CLBR after adjusting other confounding factors. Conclusions The embryo pooling strategy can achieve significantly lower cumulative live birth rate when compared with the conventional non-pooling strategy. Moreover, the time to live birth was significantly longer in the embryo pooling group than the non-pooling group.