Effect of deprivation on in vitro fertilisation outcome: a cohort study.

OBJECTIVE: To determine whether socioeconomic deprivation affects IVF outcome independent of the number of cycles undertaken. DESIGN: A retrospective review of prospectively collected data. SETTING: A tertiary level fertility clinic in the North of England. POPULATION: All participants undergoing their first fresh single-embryo transfer, funded by the National Health Service (NHS), between January 2012 and December 2017. METHODS: For each case, identified from the clinic database, we recorded the following: age; body mass index; FSH; number of eggs retrieved; ethnicity; cause of subfertility; stage of embryo transfer; and whether any adjuncts i.e. EmbryoGlue® or Time Lapse Imaging were used. Socio-economic deprivation was assessed using the Index of Multiple Deprivation (IMD) determined by the residential postcode. MAIN OUTCOME MEASURES: Clinical pregnancy (CP) and live birth (LB) rates across IMD quintiles. RESULTS: Three thousand ninety-one women were included. Overall, CP and LB rates were 35.9% and 31.3% respectively. CP rates increased significantly from 31.0% in the most deprived group to 38.8% in the least deprived group (P < 0.01). Similarly, LB rates were significantly lower in the most deprived group compared with the least deprived group (26.8 versus 35.4%, P < 0.01). After adjusting for confounding variables, women in the least deprived group were significantly more likely to have a LB (aRR 1.18, 95% CI 1.00-1.39) than women in the most deprived group. CONCLUSIONS: More socio-economically deprived patients are significantly less likely to achieve a LB than less deprived patients independent of the number of cycles of IVF undertaken. TWEETABLE ABSTRACT: More deprived patients are less likely to have a LB per cycle of IVF than less deprived patients.

Investigation and treatment of premature ovarian insufficiency: A multi-disciplinary review of practice.

Objectives: To assess compliance with the European Society for Human Reproduction and Embryology (ESHRE) guidelines on the investigation and management of women with premature ovarian insufficiency at the Leeds Teaching Hospitals NHS Trust (LTHT) and to determine whether this varies depending on the clinical setting in which the women present. Study design: A retrospective review of all females diagnosed with premature ovarian insufficiency between 1 July 2016 and 30 June 2017, presenting to one of the following clinics: reproductive medicine, specialist menopause, general gynaecology, oncology long-term follow-up, general endocrinology or paediatric endocrinology. Main outcome measures: Proportion of patients who had the necessary investigations performed and relevant treatment options discussed. Results: 103 women were included in the study. Overall, 40.6% had a karyotype. Screening for the Fragile-X pre-mutation, thyroid peroxidase and 21-hydroxylase antibodies occurred in 7.4%, 11.1% and 13.6% of women, respectively. Only 35.9% had their bone mineral density measured. There was significant variation in the performance of a karyotype (p < 0.001) and thyroid peroxidase antibodies (p < 0.01) between the different clinical settings. Overall, lifestyle advice was offered to 30.1%. Estrogen replacement, contraception, fertility options and bone protection were discussed with 76.0%, 38.4%, 59.0% and 75.0%, respectively. Psychological support was offered to 25.2%. There was significant variation for all apart from contraception. Conclusion: The investigation and treatment of women with premature ovarian insufficiency at the LTHT is not consistent with the ESHRE guidelines and requires improvement. Furthermore, there is significant variation in management depending on the department to which the patient initially presents.

Understanding subfertility at a molecular level in the female through the application of nuclear magnetic resonance (NMR) spectroscopy.

BACKGROUND: Understanding the aetiology of subfertility and female reproductive tract disorders at a molecular level may improve success rates in fertility treatment. Such understanding may be gained by the application of metabonomics technologies to tissues or biofluids. Metabonomics is concerned with the quantification of molecules in the metabolome and uses nuclear magnetic resonance (NMR) spectroscopy as one of the main technological platforms. This review concentrates on NMR studies of the female reproductive tract and discusses further possible applications. While full metabolic profiling is relatively recent, targeted NMR studies of biofluid and tissue has a longer history. METHODS: Searches were carried out on MEDLINE(®), PubMed, SciFinder(®) Scholar 2007 and ISI Web of Knowledge(SM) for papers about NMR spectroscopy or metabonomics of the female reproductive tract and subfertility. RESULTS: NMR spectroscopy has been employed for the compositional analysis of various elements of the female reproductive tract, including cervical mucus, follicular fluid (FF), ovarian tissue, fallopian tubes and uterine matter. NMR was used to document for the first time a change in FF lipoprotein concentration during follicular development. NMR analysis of granulosa cells from rats has revealed that follicle-stimulating hormone increases the activity of the pentose pathway, having crucial implications for ovarian stimulation regimens. In the uterine matter work, it has been shown by NMR that glycolysis is rapidly stimulated by estrogen, and in another study, citrate in uterine fluid was found as a potential biomarker for adenomyosis. NMR has also been used to show that chlamydiae are able to achieve higher energy reserves by stimulating glucose transport in host cells. CONCLUSIONS: A range of NMR spectroscopic techniques have been applied to the analysis of the female reproductive tract, however great potential remains for further studies. Incorporation of metabonomics techniques into female fertility research may be valuable for understanding subfertility and predicting outcomes of assisted conception treatments.