Fast and furious: pregnancy outcome with one-step rehydration in the warming protocol for human blastocysts.

RESEARCH QUESTION: Do embryos warmed using a one-step rehydration protocol with a more efficient workflow result in comparable pregnancy rates to the standard multi-step rehydration protocol? DESIGN: A retrospective cohort study of 3439 frozen embryo transfers (FET). Clinical outcomes of 833 FETs using a one-step rehydration protocol were reviewed and compared with results from the control group (2606 FETs using standard multi-step rehydration protocol). Primary outcome was ongoing pregnancy rate. Secondary outcomes were survival, positive pregnancy, clinical pregnancy, implantation and miscarriage rates. RESULTS: Survival rates were identical between the two groups (99.5%). Clinical pregnancy rate was 63.0% in the one-step warming protocol, comparable to 59.9% in the multi-step rehydration protocol. A significant increase was observed in the ongoing pregnancy rate with 60.4% in the one-step rehydration versus 55.4% in the multi-step rehydration group (P = 0.011); implantation rate was 63.6% versus 57.0% (P = 0.0005). The miscarriage rate of 4.0% in the one-step rehydration protocol was significantly lower compared with 7.6% in the multi-step rehydration protocol (P = 0.0001). Comparable outcomes persisted even when the analysis was extended to embryos that had and had not undergone preimplantation genetic testing (PGT), as well as day of development of the blastocysts. When controlling for variables of age, PGT, blastocyst development day and embryo expansion, rapid warming significantly increased chances of an ongoing pregnancy (adjusted OR 1.264, 95% CI 1.076 to 1.484). CONCLUSION: A one-step rehydration protocol resulted in identical survival rates and improved ongoing pregnancy rates compared with the multi-step rehydration technique.

The Impact of the FertiStrong Mobile Application on Anxiety and Depression in Men: A Randomised Control Pilot Study.

Background: Male factor accounts for up to half of all cases of infertility. Previously, research has focused on the psychological effects of infertility on female partners, but recent studies show negative consequences on male patients as well. Despite evidence that men are affected by infertility, there is limited studies focusing on coping methods for them. Aims: Determine if a cognitive-behavioral and relaxation mobile application, targeted at men experiencing infertility, could lead to decreases in psychological distress. Settings and Design: Randomized controlled. Materials and Methods: Thirty-nine men participated in a randomized pilot study of the FertiStrong application. Participants completed a demographic form, the Hospital Anxiety and Depression Scale (HADS) and Fertility Problem Inventory (FPI) at baseline and one month follow-up. The intervention group downloaded the FertiStrong application and used it when needed. Control participants received routine infertility care. Statistical Analysis Used: Normally distributed data is presented as mean+/- SD; Differences in proportions were tested using Chi-square test and within group comparison were performed using paired t-test. Results: One participant was excluded, resulting in 38 participants, 19 in each group. There were no baseline differences in demographic characteristics (P>0.31). For the HADS anxiety domain, the control group had a small increase between baseline and follow up, while the intervention group had a small decrease. For the HADS depression domain, there was a slight increase in the controls. For the FPI, the control group had a two-point increase, from moderately stressed to extremely high while the intervention group had a five-point decrease, from extremely high to moderately high, but was not significant. Each FPI domain-specific score in the intervention group decreased and one, Rejection of Childfree lifestyle, was significant (P=0.03). The increase in stress level was significantly greater in the control group (P<0.02). Conclusion: Recruitment was challenging due to the short recruitment phase and the sample size was smaller than planned. However, there were several significant improvements noted in the intervention group and on all testing, the intervention group trended to less distress. More research is needed on convenient interventions for men experiencing infertility.

Evaluating the Utility of Intralipid Infusion to Improve Live Birth Rates in Patients with Recurrent Pregnancy Loss or Recurrent Implantation Failure.

CONTEXT: Intralipid is used to improve clinical outcomes in patients with recurrent pregnancy loss (RPL) or recurrent implantation failure (RIF) with elevated natural killer (NK) cells. Data supporting this practice is conflicting but suggestive of minimal benefit. AIMS: The aims of this study are to determine if intralipid infusion improves live birth rates and if is a cost-effective therapy in the RPL/RIF population. SETTINGS AND DESIGN: This was a large REI private practice, retrospective cohort study. SUBJECTS AND METHODS: Charts of 127 patients who received intralipid from 2012 to 2015 were reviewed and compared to historical control data. T-tests and Chi-square analyses evaluated demographics and cycle statistics. Chi-square analyses assessed impact on clinical pregnancy and live birth rates. Cost analysis was performed from societal perspective with a one-way sensitivity analysis. RESULTS: Patients with live births were noted to have a higher average number of previous live births and were more likely to have had a frozen embryo transfer in the intralipid cycle in comparison to those with unsuccessful pregnancy outcomes. Neither clinical pregnancy nor live birth rates were significantly improved from baseline rates quoted in the literature (P = 0.12 and 0.80, respectively). Intralipid increased costs by $681 per live birth. If live birth rates were >40% using intralipid and <51% without intervention, neither strategy was favored. CONCLUSIONS: Intralipid does not improve live birth rates and is not cost-effective for patients with RIF or RPL and elevated NK cells. This study supports the growing literature demonstrating the minimal benefit of screening for and treating elevated peripheral NK cells.