Qualifying the difficulty of embryo transfer with a visual analogue scale and assessing its impact on IVF outcomes.

The aim of this study was to determine whether a continuous visual analogue scale (VAS) is a reliable tool to grade embryo transfer (ET) difficulty when assessing IVF outcomes. No standardized grading system exists for reporting ET 'difficulty' which is typically recorded in descriptive terms. Clinicians performing 188 fresh single ETs between November 2014 and May 2016 also recorded a VAS score (0-100).

Use of double decidual sac sign to confirm intrauterine pregnancy location prior to sonographic visualization of embryonic contents.

Objectives: To determine the diagnostic accuracy of the double decidual sac sign (DDSS) for predicting an intrauterine pregnancy (IUP) prior to visualization of embryonic contents, using modern high-resolution transvaginal sonography (TVS).

Methods: The study was conducted following STARD guidelines and participants were recruited prospectively from Nurture Fertility, Nottingham, UK, following in-vitro fertilization/intracytoplasmic sperm injection treatment between 1 January 2015 and 31 October 2015. Women were excluded if there was no evidence of intrauterine fluid collection during the index test, a yolk sac or fetal pole was visible during the index test, no outcome data were available or pregnancy location could not be determined by the reference standard.

A clinically useful simplified blastocyst grading system.

The aim of this study was to investigate whether a new simplified blastocyst grading system (A: fully expanded, clear inner cell mass, cohesive trophectoderm; B: not yet expanded, clear inner cell mass, cohesive trophectoderm; C: small inner cell mass ± irregular trophectoderm ± excluded/degenerate cells) was clinically useful. All day-5 single embryo transfers between 15 June 2009 and 29 June 2012 were reviewed. Implantation, clinical pregnancy and live birth rates were related to embryo quality.

Effect of ethnicity on live birth rates after in vitro fertilisation or intracytoplasmic sperm injection treatment.

Objective: To assess the relationship between the ethnicity of women and the clinical success of in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) treatment.

Design: Observational cohort study.

Setting: Nottingham University Research and Treatment Unit in Reproduction (NURTURE), UK.

Aspirin and heparin as adjuvants during IVF do not improve live birth rates in unexplained implantation failure.

This study tested the hypothesis that using aspirin and/or heparin as adjuvants in IVF improves the treatment outcome. This retrospective cohort-control study recruited 234 consecutive subjects aged ≤ 44 years who had previously had one or more unsuccessful IVF cycle. All underwent IVF using conventional protocols.

Brief communication: assessment and validation of nonspermicidal condoms as specimen collection sheaths for semen analysis and assisted conception.

The choice of nonspermicidal sheaths for specimen collection for diagnosis and/or fertility treatment is limited. Those that are available tend to be relatively expensive and as a results, offered selectively to patients. This study describes the evaluation of three over-the-counter nonspermicidal condoms as alternatives to specialized specimen collection sheaths.

Prediction of in vitro fertilization outcome at different antral follicle count thresholds in a prospective cohort of 1,012 women.

Objective: To estimate the probability of live birth, adverse treatment outcome, and extremes of ovarian response at different antral follicle count (AFC) cutoff levels in a large prospective cohort of women undergoing IVF treatment.

Design: Prospective study.

Setting: University-based assisted conception unit.

Initial evaluation of a new device for gynaecological laparoscopic surgery: the Atiomo-Laparoscopic Assistant™.

The aim of this study was to evaluate the number of surgeons required to successfully complete a range of gynaecological laparoscopic procedures using a new device (the Atiomo-Laparoscopic Assistant™), which enables one surgeon to easily simultaneously manipulate the uterus and the laparoscope. The number of surgeons required to complete the operation in 15 women undergoing a range of laparoscopic procedures using the Atiomo-Laparoscopic Assistant™ was compared with data retrospectively collected from theatre records. It was possible for one surgeon to assess the pelvis during laparoscopy in 10 (67%) of the 15 procedures where the Atiomo-Laparoscopic Assistant™ was used, compared with 177 of the 599 (30%) procedures where it was not used (p = 0.

Sperm donor recruitment within an NHS fertility service since the removal of anonymity.

The marked decline in the number of sperm donors recruited in the UK has been largely attributed to changes in regulations and in particular those related to the removal of anonymity. After a 5-year period of inactivity, the sperm donor bank in Nottingham was provided with limited resources to try and recruit donors who were willing to be identified on the HFEA register. Marketing was sporadic and at first low cost and the enquiry rate only increased significantly when the centre's website became operational and higher cost advertising was used.

A randomised controlled trial of 300 versus 225 IU recombinant FSH for ovarian stimulation in predicted normal responders by antral follicle count.

Objective: To test the hypothesis that among women predicted to have a normal ovarian response, ovarian stimulation using 300 IU follicle-stimulating hormone (FSH) results in the retrieval of more mature oocytes than 225 IU during in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) treatment.

Design: Prospective randomised controlled study.

Setting: University-based assisted conception unit.

The cohort of antral follicles measuring 2-6 mm reflects the quantitative status of ovarian reserve as assessed by serum levels of anti-Müllerian hormone and response to controlled ovarian stimulation.

Objective: To evaluate the relationship between serum anti-Müllerian hormone (AMH) and antral follicle size, and to ascertain which cohort of antral follicles is most predictive of the response to controlled ovarian stimulation during assisted reproduction treatment (ART).

Design: Prospective study.

Setting: University-based Assisted Conception Unit.

The predictive value of the automated quantification of the number and size of small antral follicles in women undergoing ART.

Background: Sono-automatic volume calculation (SonoAVC) automatically identifies and measures the dimensions of hypoechogenic areas within datasets acquired using three-dimensional ultrasound. The objective of this study was to evaluate the predictive value of automated antral follicle counts according to their relative sizes in women undergoing assisted reproduction treatment (ART).

Methods: A total of 156 subjects aged < or =40 years with a baseline FSH < or =15 IU that undergo their first cycle of ART were prospectively recruited.

Timing of oocyte maturation and egg collection during controlled ovarian stimulation: a randomized controlled trial evaluating manual and automated measurements of follicle diameter.

Objective: To evaluate the effect of a new automated technique of follicle measurement (Sono automated volume calculation [SonoAVC]) on the timing of oocyte maturation and subsequent oocyte retrieval.

Design: Prospective randomized controlled trial.

Setting: University-based Assisted Conception Unit.

Validation of a novel computer-assisted sperm analysis (CASA) system using multitarget-tracking algorithms.

Objective: To determine the accuracy and precision of a novel computer-assisted sperm analysis (CASA) system by comparison with existing recommended manual methods.

Design: Prospective study using comparative measurements of sperm concentration and motility on latex beads and immotile and motile sperm.

Setting: Tertiary referral fertility center with strong academic links.

A prospective, comparative analysis of anti-Müllerian hormone, inhibin-B, and three-dimensional ultrasound determinants of ovarian reserve in the prediction of poor response to controlled ovarian stimulation.

Objective: To compare three-dimensional ultrasound parameters, antral follicle count (AFC), ovarian volume, and ovarian vascularity indices with anti-Müllerian hormone (AMH) and other conventional endocrine markers for the prediction of poor response to controlled ovarian hyperstimulation (COH) during assisted reproduction treatment (ART).

Design: Prospective study.

Setting: University-based assisted conception unit.

The three-dimensional ultrasonographic ovarian vascularity of women developing poor ovarian response during assisted reproduction treatment and its predictive value.

Objective: To test the hypothesis that ovarian vascularity is decreased in women who demonstrate poor ovarian response to controlled ovarian stimulation as part of assisted reproduction treatment.

Design: Prospective study.

Setting: University-based Assisted Conception Unit.

Effect of pituitary desensitization on the early growing follicular cohort estimated using anti-Mullerian hormone.

Background: This study evaluated the effect of pituitary desensitization on the early growing follicle population through assessment of serum anti-Mullerian hormone (AMH) concentration. Other markers of ovarian reserve, basal follicular stimulating hormone (FSH), luteinizing hormone (LH), estradiol, inhibin-B and three-dimensional ultrasound ovarian parameters were also assessed for comparison.

Methods: One hundred and two subjects aged <40 years with FSH levels <12 IU/l underwent venepuncture and transvaginal ultrasound in the early follicular phase of the menstrual cycle and after 14 days of down-regulation using gonadotrophin releasing hormone (GnRH) agonists.

Quantification of the effect of pituitary down-regulation on 3D ultrasound predictors of ovarian response.

Background: This study evaluated the effect of pituitary desensitization on ovarian volume, antral follicle count (AFC), and ovarian blood flow indices and their value as predictors of ovarian response during assisted reproduction treatment.

Methods: A total of 115 subjects aged <40 years with follicle-stimulating hormone (FSH) levels <12 IU/l underwent transvaginal ultrasound in the early follicular phase of the menstrual cycle and after 14 days of down-regulation using gonadotrophin-releasing hormone agonists. 3D power Doppler was used to quantify ovarian volume, AFC and ovarian blood flow.

Establishing the intercycle variability of three-dimensional ultrasonographic predictors of ovarian reserve.

Objective: To estimate the intercycle variability of antral follicle counts (AFCs) and ovarian volume, as measured by using three-dimensional ultrasound, and to compare these to the variation in basal FSH levels.

Design: Prospective study.

Setting: University-based assisted conception unit.

Peripartum group A streptococcal sepsis: a case report.

Background: Infections of the upper respiratory tract and skin are commonly attributed to group A Streptococcus (GAS). The organism can be found in the female genital tract and can cause peripartum sepsis in rare cases.

Case: A case of GAS peripartum sepsis did not respond to conservative measures despite early initiation of intravenous antibiotics.

Does 3D ultrasound offer any advantage in the pretreatment assessment of ovarian reserve and prediction of outcome after assisted reproduction treatment?

Background: This study compared the predictive value of the antral follicle count (AFC) measured from stored 3D data by three methods including a '2D equivalent technique' and two 3D techniques, the 'multiplanar view' and 'rendered inversion mode', as a test of ovarian reserve and treatment outcome.

Methods: One hundred consecutive subjects aged<40 years with basal FSH levels<12 IU/l underwent transvaginal ultrasound in the early follicular phase prior to their first cycle of assisted reproduction treatment. The relationship between the AFC made with each method and outcome was evaluated.