Peter S Humaidan

• DMSc
• Professor at Aarhus University, Aarhus, Denmark and University of Southern Denmark, Odense, Denmark

The primary aim of the present randomised, double-blind, placebo-controlled trial was to investigate whether clindamycin and live Lactobacillus crispatus CTV-05 (LACTIN-V) would improve clinical pregnancy rates in IVF patients with abnormal vaginal microbiota (AVM) defined by high quantitative PCR loads of Fannyhessea vaginae and Gardnerella spp. I...

It is widely recognized that luteinizing hormone (LH) activity is pivotal during folliculogenesis. Nonetheless, the use of LH during ovarian stimulation remains a matter of debate. Indeed, women with good LH function are able to sustain follicle growth and maturation during ovarian stimulation carried out with regimens based on follicle-stimulating...

The production of spermatozoa, a process known as spermatogenesis, is primarily controlled by follicle-stimulating hormone (FSH) and luteinizing hormone (LH)-driven testosterone. LH acts on the Leydig cells, stimulating steroid production, predominantly testosterone, and activating critical inter-related spermatogenesis regulatory pathways. Despite...

Background In a global effort to assess expert perspectives on the use of recombinant gonadotropins, recombinant human luteinizing hormone (r-hLH) and recombinant human follicle-stimulating hormone (r-hFSH), a consensus meeting was held in Dubai. The key aim was to address three critical questions: What are the factors that influence follicle respo...

Description: This poster presents findings from the Arabian Gulf Delphi Consensus Group on the role of FSH/LH co-stimulation in controlled ovarian stimulation (COS), particularly for patients with advanced maternal age (AMA) and hypo-responsiveness to gonadotropins. Through a structured three-step Delphi method involving 35 expert statements, the...

Purpose To explore whether a 25 mg subcutaneous progesterone daily rescue daily improves the reproductive outcomes in patients with low serum progesterone (P4) levels (7–10 ng/mL), measured one day before true natural cycle (t-NC) frozen embryo transfer (FET). Methods A cohort study of 192 women undergoing t-NC warmed blastocyst transfer. Patients...

(Abstracted from Fertil Steril 2024;121:1000–1009) In hormone replacement therapy frozen embryo transfer cycles used in fertility treatment, estradiol is used to stimulate the development of the endometrium to prepare for implantation. Ideal estradiol levels before implantation have yet to be determined, but recent studies have shown that live birt...

Recent studies have observed an association between genital tract microbiota and reproductive outcomes in patients undergoing in vitro fertilization (IVF). This finding could be caused by ascending dysbiosis from the vagina to the endometrium. The main objective of this study was to compare the microbiota and total bacterial load in the vagina, cer...

Background Currently, there is no consensus on the optimal management of women with low prognosis in ART. In this Delphi consensus, a panel of international experts provided real-world clinical perspectives on a series of literature-supported consensus statements regarding the overall relevance of the POSEIDON criteria for women with low prognosis...

STUDY QUESTION Which decision-making factors influence family building among permanently infertile couples? SUMMARY ANSWER Ethical, legal, and financial considerations outweigh genetic relatedness in decision-making, favouring domestic gestational surrogacy, if this were possible, over international options. WHAT IS KNOWN ALREADY Permanent infert...

Non-obstructive azoospermia (NOA) is found in up to 15% of infertile men. While several causes for NOA have been identified, the exact etiology remains unknown in many patients. Advances in assisted reproductive technology, including intracytoplasmic sperm injection (ICSI) and testicular sperm retrieval, have provided hope for these patients. This...

Background The serum progesterone (P4) level during the luteal phase (LP) plays a crucial role in the initiation and maintenance of pregnancy. However, it is unclear whether the natural cycle consistently provides the best endocrine profile and whether mid-luteal serum P4 levels are always sufficient to support implantation and early pregnancy. The...

Background and Purpose: Among different routes of estrogen formulations, the transdermal route has obtained popularity in recent years for endometrial preparation in hormone replacement (HRT) frozen embryo transfer (FET) cycles. However, no clear evidence is available regarding clinical outcome of the transdermal route. This meta-analysis investiga...

Study question Does subcutaneous (SC) progesterone treatment provide progesterone levels comparable to intramuscular (IM) progesterone when using a cut-off level of 118nmol/l(37.1ng/ml) during intensive luteal phase support? Summary answer As part of an intensive luteal phase support regimen SC progesterone provides higher P4 levels compared to th...

Introduction This study compares rectal administration with vaginal administration of progesterone as luteal phase support in hormone replacement therapy frozen embryo transfer (HRT-FET) cycles. The reason for comparing the two routes of administration is that rectal administration has been suggested to be more patient friendly. Methods and analys...

The effect of late-follicular phase progesterone elevation (LFPE) during ovarian stimulation on reproductive outcomes in ART treatment remains controversial, but recent studies indicate lower pregnancy rates with rising progesterone levels. This study aims to investigate the prevalence of late-follicular phase progesterone elevation (LFPE) and poss...

The aim of the present randomised, double-blind, placebo-controlled trial was to investigate whether antibiotics and live lactobacilli would improve clinical pregnancy rates in IVF patients with abnormal vaginal microbiota (AVM) defined by high quantitative PCR loads of Fannyhessea vaginae and Gardnerella spp. IVF patients were randomised prior to...

Purpose of review To examine impact of vaginal dysbiosis (VD), including bacterial vaginosis (BV) and aerobic vaginitis (AV) on reproductive outcomes of in vitro fertilization (IVF) patients. Recent findings BV-bacteria (e.g. Gardnerella ) and AV-bacteria (e.g. Streptococci and Enterococci ) have been identified in the endometrium. However, there...

Gestational surrogacy, in which an infertile couple contracts with a woman to carry a foetus that the intended parents will raise, increases worldwide, and offers a route to parenthood for individuals and couples who otherwise have limited options. However, the situation in Denmark at present is that surrogacy with the help of healthcare profession...

In recent years, there has been a growing interest in identifying subcellular causes of male infertility, and sperm DNA fragmentation (SDF) research has been at the forefront of this focus. DNA damage can occur during spermatogenesis due to faulty chromatin compaction or excessive abortive apoptosis. It can also happen as sperm transit through the...

STUDY QUESTION How common is bleeding in early pregnancy after Hormone Replacement Therapy (HRT) Frozen Embryo Transfer (FET) and does bleeding affect the reproductive outcome? SUMMARY ANSWER A total of 47% of HRT-FET patients experience bleeding before the eighth week of gestation, however, bleeding does not affect the reproductive outcome. WHAT...

Aim To develop a model that predicts low progesterone (P) levels on the day of embryo transfer (ET) based on patient and cycle characteristics, including serum estradiol (E 2 ) concentration after vaginal administration of micronized E 2 for endometrial preparation. Methods A prospective cohort of 193 patients scheduled for cryopreserved blastocys...

Study question: Can supplementation with rectal administration of progesterone secure high ongoing pregnancy rates (OPRs) in patients with low serum progesterone (P4) on the day of blastocyst transfer (ET)? Summary answer: Rectally administered progesterone commencing on the ET day secures high OPRs in patients with serum P4 levels below 35 nmol...

STUDY QUESTION Is the psychosocial wellbeing affected in women and men shortly after allocation to a freeze-all strategy with postponement of embryo transfer compared to a fresh transfer strategy? SUMMARY ANSWER In general, psychosocial wellbeing (i.e. emotional reactions to the treatment, quality-of-life, infertility-related stress, and marital b...

Background: In a true-natural cycle (t-NC), optimal progesterone (P4) output from the corpus luteum is crucial for establishing and maintaining an intrauterine pregnancy. In a previous retrospective study, low P4 levels (< 10 ng/mL) measured one day before warmed blastocyst transfer in t-NC were associated with significantly lower live-birth rates...

Ovarian hyperstimulation syndrome (OHSS) is the main severe complication of ovarian stimulation for in vitro fertilization (IVF) cycles. The aim of the current study was to identify the interventions for the prevention of and reduction in the incidence and severity of OHSS in patients who undergo IVF not included in systematic reviews with meta-ana...

To provide agreed-upon guidelines on the management of a hyper-responsive patient undergoing ovarian stimulation (OS) A literature search was performed regarding the management of hyper-response to OS for assisted reproductive technology. A scientific committee consisting of 4 experts discussed, amended, and selected the final statements. A priori,...

Ovarian hyperstimulation syndrome (OHSS) is the main severe complication of the ovarian stimulation for in vitro fertilization (IVF) cycles. The aim of the current study was to identify the interventions for prevention of and reduction in the incidence and severity of OHSS in patients who undergo IVF not included in systematic reviews with meta-ana...

Ovarian hyperstimulation syndrome (OHSS) is a potentially life-threating iatrogenic complication of the early luteal phase and/or early pregnancy after in vitro fertilization (IVF) treatment. The aim of the current study was to identify the most effective methods for preventing of and reducing the incidence and severity of OHSS in IVF patients. A s...

Introduction Worldwide infertility is highly prevalent, and lifestyle factors, such as food intake, could have an essential role in the success of a fertility treatment. The literature is not consistent and adequate for recommendations to the increasing number of women and men of reproductive age who ask for lifestyle guidance. Therefore, the aims...

Study question Can supplementation with additional rectal administration of progesterone secure high ongoing pregnancy rates (OPR) in patients with low serum progesterone (P4) at blastocyst transfer (ET)? Summary answer Rectally administered progesterone starting on the blastocyst transfer day secures high OPR in patients with serum P4 levels lowe...

Study question What are the intimate hygiene practices of women in IVF treatment and do they correlate with the vaginal microbiota? Summary answer Hygiene practices, in specific douching and use of intimate soap significantly increased the risk of abnormal vaginal microbiota (AVM). What is known already The normal vaginal microbiota acts as a def...

Study question How do IVF patients perceive rectal administration of progesterone for luteal phase support compared to vaginally administered progesterone? Summary answer Rectal administration of progesterone causes less discomfort in IVF patients, undergoing Hormone Replacement Therapy Frozen Embryo Transfer (HRT-FET) and is preferred compared to...

Study question Does treatment of abnormal vaginal microbiota improve the reproductive outcomes of IVF patients? Summary answer Data is being analysed and will be presented at ESHRE 2023. What is known already An increasing number of studies reported an association between abnormal genital tract microbiota and adverse reproductive outcomes in IVF...

Study question Should blastocysts cryopreserved D6 be transferred on the 5th or 6th day of progesterone administration in HRT-FET cycles? Summary answer No significant differences in outcome parameters were found when D6 vitrified blastocysts were transferred on either day 5 or day 6 of progesterone in HRT-FET. What is known already Several studi...

Study question Is there an association between follicular phase endocrine and ultrasonographic characteristics and ongoing pregnancy rates (OPRs) in true-natural cycle (t-NC) frozen embryo transfers (FETs)? Summary answer Endometrial thickness one day before ovulation is the only independent predictor of ongoing pregnancy (OP) in t-NC FET cycles....

Study question How common is bleeding in early pregnancy after HRT-FET? And does bleeding affect the reproductive outcome in this population? Summary answer A total of 47% of HRT-FET patients experience bleeding before the 8th week of gestation, however, bleeding does not seem to affect the reproductive outcome. What is known already Bleeding occ...

Study question Are ongoing pregnancy rates (OPRs) similar between subcutaneous (sc) progesterone (P) and vaginal P administration in hormone replacement therapy (HRT) frozen embryo transfer (FET) cycles? Summary answer The OPRs were similar between sc and vaginal P administration; however, 15.8% of patients in the vaginal group needed additional P...

Study question Do luteal serum progesterone levels (P4) vary in relation to time of blood sampling, the type and dosing of vaginal progesterone products used for HRT-FET? Summary answer Significant differences in luteal serum P4 levels exist between time of blood sampling as well as between different vaginal progesterone products and the administr...

Study question How do permanently infertile couples experience surrogacy in cross border reproductive care (CBRC) and which considerations do they have in relation to this? Summary answer The couples find surrogacy treatment in CBRC satisfying but feel forced to use CBRC, and estranged from own country, missing reproductive body, and home What is...

Study question Does administration of 2 months of transdermal testosterone prior to ovarian stimulation for IVF/ICSI increase clinical pregnancy rates in Bologna criteria poor ovarian responders? Summary answer Pre-treatment with 5.5mg testosterone for 2 months prior to ovarian stimulation for IVF/ICSI does not increase clinical pregnancy rates as...

Background: Specific polymorphisms might influence controlled ovarian stimulation in women undergoing assisted reproductive technologies (ARTs). Data regarding possible interactions of these polymorphisms are still scanty. The aim of this analysis was to evaluate the effect of polymorphisms of gonadotropins and their receptors in women undergoing A...

Follicle-stimulating hormone (FSH), together with luteinizing hormone (LH) and human chorionic gonadotropin (hCG), plays a fundamental role in human reproduction. The discovery of FSH and other gonadotropins was a defining moment in our understanding of reproduction and led to the development of many treatments for infertility. In this regard, exog...

Research question: Does administration of subcutaneous (s.c.) progesterone support ongoing pregnancy rates (OPR) similar to vaginal progesterone using a rescue protocol in hormone replacement therapy frozen embryo transfer cycles? Design: Retrospective cohort study. Two sequential cohorts - vaginal progesterone gel (December 2019-October 2021; n...

Male infertility is a disease that deserves greater clinical attention and research. A universally accepted definition that emphasizes the modulatory impact of age, lifestyle and environmental factors and includes comprehensive diagnostic and treatment guidelines is needed to ensure accurate evaluation and effective care. Accordingly, male infertil...

Purpose To provide an agreed upon definition of hyper-response for women undergoing ovarian stimulation (OS)? Methods A literature search was performed regarding hyper-response to ovarian stimulation for assisted reproductive technology. A scientific committee consisting of 5 experts discussed, amended, and selected the final statements in the que...

The objective of this invited review is to describe the introduction and development of the GnRH agonist (GnRHa) trigger protocol in modern in vitro fertilization, focusing on ovarian hyperstimulation syndrome (OHSS) prevention and, equally important on the role of GnRHa trigger as an opener of the luteal phase "black box." The GnRHa trigger and fr...

STUDY QUESTION Do early- and mid-luteal serum progesterone (P4) levels impact ongoing pregnancy rates (OPRs) in fresh blastocyst transfer cycles using standard luteal phase support (LPS)? SUMMARY ANSWER A drop in serum P4 level from oocyte pick-up (OPU) + 3 days to OPU + 5 days (negative ΔP4) is associated with a ∼2-fold decrease in OPRs. WHAT IS...

Background: The role of motile sperm count in intrauterine insemination (IUI) success rate is controversial. This retrospective cohort study performed among unselected infertile couples undergoing IUI was to explore the association between the total progressive motile sperm count (TPMSC) and the live birth rate (LBR) following IUI. Methods: The tot...

Research question Is low-grade inflammation, detected by CRP, a marker of in vitro fertilization (IVF) outcomes addressing both blastocyst quality and pregnancy outcome? Design A sub-study of a multicenter randomized controlled trial including 440 women undergoing IVF treatment in a GnRH-antagonist protocol. Serum CRP was measured on cycle day 2-3...

The current commentary paper follows the historical introduction of gonadotropins and gonadotropin releasing hormone (GnRH) analogues to the in-vitro fertilization (IVF) market. We maintain that business decisions significantly influenced research and development; however, pharma decisions did not always align with physiology and clinical interests...

Study question What is the optimal serum progesterone (P4) cut-off level for endometriosis patients undergoing hormone replacement therapy frozen embryo transfer (HRT-FET) with intensive exogenous progesterone luteal phase support? Summary answer Endometriosis patients with luteal serum P4 levels≥118nmol/l had significantly higher live birth rates...

Study question Does timing of WBT in t-NC differ according to six different commonly definitions for LH surge, and if so, do differences in timing impact OPRs? Summary answer Performing WBT on follicular collapse+5 days is equivalent to LH surge +7/+8 /+9 days in terms of OPRs, using six different definitions of LH surge. What is known already Pi...

Study question Does the ongoing pregnancy rate (OPR) of HRT with or without GnRH-agonist suppression and t-NC protocols differ in patients undergoing warmed blastocyst transfer? Summary answer HRT, with or without GnRH-agonist suppression, and t-NC protocols are associated with comparable OPRs in patients undergoing warmed blastocyst transfer. Wh...

Study question Is the cumulative live birth rate(CLBR) similar following a freeze-all and fresh transfer strategy including nearly all subsequent frozen-thaw cycles from the same oocyte retrieval? Summary answer The chance of at least one live birth after use off all fresh and frozen blastocysts is similar following a freeze-all and fresh transfer...

Purpose Nonobstructive azoospermia (NOA) associated with primary spermatogenic failure is a common cause of male infertility usually considered untreatable; however, some reports have suggested that hormonal stimulation to boost the intra-testicular testosterone level and spermatogenesis might increase the chance of achieving pregnancy using homolo...

The Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number (POSEIDON) criteria identify and classify the so-called ‘low-prognosis’ patients undergoing assisted reproductive technology (ART). Recent large-scale studies using real-world data (RWD) have shown that patients classified under this system have distinct reproductive outcomes...

Background: Efficient and safe embryo vitrification techniques have contributed to a marked worldwide increase in the use of elective frozen embryo transfer (FET). Pinpointing the day of ovulation, more commonly by documentation of the LH surge and less commonly by ultrasonography, is crucial for timing of FET in a true natural cycle (t-NC) to max...

Purpose: Nonobstructive azoospermia (NOA) associated with primary spermatogenic failure is a common cause of male infertility usually considered untreatable; however, some reports have suggested that hormonal stimulation to boost the intra-testicular testosterone level and spermatogenesis might increase the chance of achieving pregnancy using homo...

One of modern healthcare's most controversial areas, reproductive medicine is an emerging discipline that fosters hugely divergent opinions on topics such as laboratory techniques, clinical management and ethical considerations. Highlighting over 50 contentious topics in reproductive medicine, this book presents expertly argued opinions are present...

Individualised treatment strategies, including personalised gonadotropin dosing according to ovarian reserve markers, and GnRH-antagonist co-treatment should be the “gold standard” in in vitro fertilisation therapy. For the patient at risk of ovarian hyperstimulation syndrome (OHSS) GnRH-agonist trigger followed by a “freeze-all” embryos policy wil...

Introduction: Today, it is widespread practice to postpone frozen embryo transfer (FET) in a modified natural cycle (mNC) for at least one menstrual cycle after oocyte retrieval and failed fresh embryo transfer or freeze-all. The rationale behind this practice is the concern that suboptimal ovarian, endometrial or endocrinological conditions follo...

Research Question Will two boluses of GnRHa during Hormonal Replacement Therapy Frozen Embryo Transfer (HRT-FET) cycles reduce the total pregnancy loss rate? Design Randomized controlled trial, including a total of 287 HRT-FET cycles performed between 2013 and 2019. After randomization participants allocated to the GnRHa Group (n=144) underwent a...

Purpose: Sperm DNA fragmentation (SDF) and seminal oxidative stress are emerging measurable factors in male factor infertility, which interventions could potentially reduce. We evaluated (i) the impact of lifestyle changes combined with oral antioxidant intake on sperm DNA fragmentation index (DFI) and static oxidation-reduction potential (sORP),...

Study question Is there an association between the hCG dose used for ovulation trigger and the endogenous progesterone production during the luteal phase? Summary answer Increased hCG dosing significantly increased the endogenous progesterone level during the luteal phase. What is known already During the luteal phase of an IVF treatment, the end...

Study question Is there an association between the hCG dose used for ovulation trigger and the endogenous progesterone production during the luteal phase? Summary answer Increased hCG dosing significantly increased the endogenous progesterone level during the luteal phase. What is known already During the luteal phase of an IVF treatment, the end...

Despite the worldwide increase in frozen embryo transfer, the search for the best protocol to prime endometrium continues. Well-designed trials comparing various frozen embryo transfer protocols in terms of live birth rates, maternal, obstetric and neonatal outcome are urgently required. Currently, low-quality evidence indicates that, natural cycle...

Abstract Introduction Several studies suggest that luteinizing hormone (LH) could improve IVF outcome in women of advanced reproductive age by optimizing androgen production. In this review, we assessed the role of recombinant-human LH (r-hLH) and recombinant human follicle stimulating hormone (r-hFSH) co-treatment in ovarian stimulation for assist...

Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) play complementary roles in follicle development and ovulation via a complex interaction in the hypothalamus, anterior pituitary gland, reproductive organs, and oocytes. Impairment of the production or action of gonadotropins causes relative or absolute LH and FSH deficiency that compr...

Research Question Will luteal phase rescue with additional progesterone (P) increase serum progesterone (P4) levels and save the reproductive outcomes in patients with low serum P4 levels undergoing hormone replacement therapy (HRT) cycles? Design Case-control study. Forty consecutive patients with serum P4 levels <8.75ng/ml on the 5th day of P su...

The POSEIDON (Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number) criteria were developed to help clinicians identify and classify low-prognosis patients undergoing assisted reproductive technology (ART) and provide guidance for possible therapeutic strategies to overcome infertility. Since its introduction, the number of publish...

Recent advances in molecular microbiology have enabled refined studies of the genital tract microbiota. This constitutes the basis of the present updated systematic review and meta-analysis which investigate vaginal dysbiosis (VD) as defined by either microscopy (e.g., Nugent score for bacterial vaginosis) or molecular methods (qPCR and Next Genera...

Research Question This pilot RCT explored whether GnRHa trigger followed by two small hCG boluses during the early luteal phase resulted in reproductive outcomes similar to those of hCG trigger and a standard LPS. Design Two open-label pilot RCTs of N=250 patients were conducted from 2014 - 2019. The primary outcome was ongoing pregnancy per embry...

Research questions : Should intrauterine insemination be performed before or after follicle rupture? Is there a difference in pregnancy test rate (PR), clinical pregnancy rate (CPR) and live birth rates (LBR) when insemination is performed either before or after ovulation in relation to intrauterine homologous insemination, and is there a differenc...

The prolonged lockdown of health facilities providing non‐urgent gamete cryopreservation –as currently recommended by many reproductive medicine entities and regulatory authorities due to the SARS‐CoV‐2 pandemic will be detrimental for subgroups of male infertility patients. We believe the existing recommendations should be promptly modified and pr...

Abstract The prolonged lockdown of health services providing high-complexity fertility treatments –as currently recommended by many reproductive medicine entities– is detrimental for society as a whole, and infertility patients in particular. Globally, approximately 0.3% of all infants born every year are conceived using assisted reproductive techn...