The clinical and ongoing pregnancy rates in study group were comparable to those in control group. Therefore, PPOS with dydrogesterone is a reasonable option to provide COH.

No abstract

No abstract

Purpose: Lactobacillus -dominated microbiota (LDM, defined as >90% Lactobacillus species composition) in the endometrium was reported to be associated with favorable reproductive outcomes. We investigated in this study whether 16S ribosomal RNA (rRNA) gene sequencing technology analysis of the uterine microbiota improves pregnancy outcomes.Methods: The prospective cohort study consisted of 195 women with recurrent implantation failure (RIF) (defined as at least three previous failed in vitro fertilization (IVF)-embryo transfer (ET) attempts) and was carried out between March 2019 and April 2021 at our fertility center. Analyses of endometrial microbiota by 16S rRNA gene sequencing were suggested to all patients who had failed three or more ETs. One hundred and thirty-one patients underwent microbial 16S rRNA biomarker analysis (study group) before additional transfers, while 64 patients with a history of RIF proceeded to ET without endometrium analysis (control group). The primary outcome was the cumulative clinical pregnancy rate after two additional ETs. Main results: Abnormal endometrial microbiota was detected in 30 patients (22.9%). All but one of those 29 patients received antibiotics corresponding with the detected bacteria and probiotic treatment. As results, the cumulative clinical pregnancy rate (study group: 64.5% vs. control group: 33.3%, p=0.005) and the ongoing pregnancy rate (study group: 55.1% vs. control group: 32.8%, p=0.020) were both significantly higher in the study group compared to the control group. Conclusion: Personalized treatment recommendations based on the 16S rRNA analysis of the uterine microbiota can improve IVF outcomes of patients who have been experiencing RIF. Study funding/competing interest(s): None applicable.Trial registration number: a trial registration number is only required for clinical trials. the University hospital Medical Information Network (UMIN) Clinical Trial Registry in Japan, UMIN000036050 Date of registration: March 1 st , 2019

Study question What is the perinatal outcome of pregnancies resulting from a controlled ovarian hyperstimulation (COH) regimen of progestin-primed ovarian stimulation (PPOS) protocol using dienogest (DNG) in patients with endometriosis? Summary answer No difference in mean birth weight, however preterm and low birth weight babies are significantly more in the group treated with PPOS using DNG. What is known already Dienogest is an oral progestin effective for the treatment of endometriosis, such as reduction of endometrial lesion and control of pain intensity with safety profile and good tolerability. We reported for the first time in the world that DNG was better than dydrogesterone (DYG) for PPOS in terms of the mature oocytes rate and the fertilization rate in patients with endometriosis. Although there have been several reports of infants born with PPOS using DYG, it is essential to report on the perinatal outcome of embryos transferred after treatment with PPOS using DNG from now on. Study design, size, duration: We prospectively investigated the perinatal outcomes of 65 newborns which were the result of using a new COH regimen; PPOS with DNG. The results were compared with perinatal outcome data of babies born between 2018 and 2020 to 815 patients who underwent assisted reproductive technology (ART) treatment at our fertility center. As for the congenital malformation rate, the data was also compared with the 2017 Japanese data bank of babies born after ART treatment. Participants/materials, setting, methods We studied the perinatal data of all babies born after transfer of frozen embryos acquired by COH using PPOS protocol with DNG. The rate of maternal complications during pregnancy, pregnancy duration, birth weight, congenital malformations and method of delivery were investigated. We compared the perinatal outcomes of infants born after in vitro fertilization (IVF) and frozen embryo transfer at our center during the same period. Main results and the role of chance Perinatal data of 65 babies (study group) were compared with the perinatal data of 840 babies born after IVF at our center, and 47807 babies born after ART in Japan, 2017. We found 3 twin and 59 singleton pregnancies in the study group, compared to 23 twins, 1 triplet and 791 singleton pregnancies during the same period at our center. Considering singletons, there was no difference in mean birthweight (study group; 2893.2±652g vs. total at our center; 3001.2±425g, respectively, p = 0.102). Preterm births (<37 weeks) were significantly more frequent in the PPOS using DNG treatment group than in total at our center (19.2% vs. 9.7%, p = 0.016). The percentage of infants with a birth weight < 2.5 kg was also significantly higher in the PPOS treatment group compared to the total at our center (22.6% vs.11.9%, p = 0.015). The Caesarean section rate was 53.2% in the study group vs. 47.1% control group of our center respectively (p = 0.353). One babies in the study group had malformations in the ocular region. There was no significant difference in congenital malformations between the study group and ART data bank in Japan, 2017 (OR 0.67, 95% CI 0.093: 4.836). Limitations, reasons for caution The number of babies is still low, further prospective studies including larger populations are needed to confirm the efficacy of PPOS protocol with DNG. Wider implications of the findings: This is the first report on the perinatal outcome of babies born by a new COH method using PPOS with DNG, which is a combination of endometriosis treatment and COH for IVF. The association of endometriosis with preterm birth and low birth weight needs to be further investigated. Trial registration number UMIN000031111