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Elenkov A, Al-Jebari Y, Giwercman YL, Giwercman A. Testosterone replacement therapy in men who conceived with intracytoplasmic sperm injection: nationwide register study. Eur J Endocrinol 2020; 182:423-428. [PMID: 32061160 PMCID: PMC7087494 DOI: 10.1530/eje-19-0734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 02/11/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Male hypogonadism is associated with higher risk of co-morbidity and premature mortality. It is, therefore, of utmost importance to identify young men who are at the highest risk of testosterone deficiency and who may benefit from preventive measures. In this context, infertile men constitute a high-risk group. The extent of testosterone replacement therapy (TRT) among infertile men, defined as men who have to undergo assisted reproduction for fatherhood, is currently unknown. Therefore, we evaluated the pattern of prescription of TRT in the years following child conception among men who have fathered children with the help of intracytoplasmic sperm injection (ICSI) or in vitro fertilization (IVF). DESIGN By sourcing data from national population registries, hazard ratio (HR) for subsequent TRT was assessed for IVF and ICSI-treated men and compared to those who conceived spontaneously with age Cox regression analysis adjusted for age, educational level and previous intake of medicines for metabolic diseases. RESULTS ICSI and IVF fathers had increased incidence of newly prescribed TRT compared to fathers conceiving spontaneously (ICSI: HR = 3.81, 95% CI = 3.09-4.69, P < 0.001; IVF: HR = 1.54, 95% CI = 1.15-2.05, P = 0.003). After adjustment for prescription of medication for one or more components of the MetS prior to TRT, the risk estimates attenuated but remained robust both for ICSI-treated (HR = 3.17 (95% CI: 2.56-3.9) and IVF-treated men (HR = 1.06 (95% CI: 1.05-1.07). CONCLUSION Men who have to utilise powerful techniques, such as ICSI for fathering children, may be at risk for testosterone deficiency. Routine endocrine evaluation of men seeking fertility treatment is hence warranted.
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Affiliation(s)
- Angel Elenkov
- Lund University, Molecular Genetic Reproductive Medicine, Malmö, Sweden
- Skåne University Hospital Malmö, Reproductive Medicine Center, Malmö, Sweden
- Correspondence should be addressed to A Elenkov;
| | - Yahia Al-Jebari
- Lund University, Molecular Genetic Reproductive Medicine, Malmö, Sweden
| | | | - Aleksander Giwercman
- Lund University, Molecular Genetic Reproductive Medicine, Malmö, Sweden
- Skåne University Hospital Malmö, Reproductive Medicine Center, Malmö, Sweden
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Bahadur G, Homburg R, Bosmans JE, Huirne JAF, Hinstridge P, Jayaprakasan K, Racich P, Alam R, Karapanos I, Illahibuccus A, Al-Habib A, Jauniaux E. Observational retrospective study of UK national success, risks and costs for 319,105 IVF/ICSI and 30,669 IUI treatment cycles. BMJ Open 2020; 10:e034566. [PMID: 32184314 PMCID: PMC7076239 DOI: 10.1136/bmjopen-2019-034566] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To compare success rates, associated risks and cost-effectiveness between intrauterine insemination (IUI) and in vitro fertilisation (IVF). DESIGN Retrospective observational study. SETTING The UK from 2012 to 2016. PARTICIPANTS Data from Human Fertilisation and Embryology Authority's freedom of information request for 2012-2016 for IVF/ICSI (intracytoplasmic sperm injection)and IUI as practiced in 319 105 IVF/ICSI and 30 669 IUI cycles. Direct-cost calculations for maternal and neonatal expenditure per live birth (LB) was constructed using the cost of multiple birth model, with inflation-adjusted Bank of England index-linked data. A second direct-cost analysis evaluating the incremental cost-effective ratio (ICER) was modelled using the 2016 national mean (baseline) IVF and IUI success rates. OUTCOME MEASURES LB, risks from IVF and IUI, and costs to gain 1 LB. RESULTS This largest comprehensive analysis integrating success, risks and costs at a national level shows IUI is safer and more cost-effective than IVF treatment.IVF LB/cycle success was significantly better than IUI at 26.96% versus 11.49% (p<0.001) but the IUI success is much closer to IVF at 2.35:1, than previously considered. IVF remains a significant source of multiple gestation pregnancy (MGP) compared with IUI (RR (Relative Risk): 1.45 (1.31 to 1.60), p<0.001) as was the rate of twins (RR: 1.58, p<0.001).In 2016, IVF maternal and neonatal cost was £115 082 017 compared with £2 940 196 for IUI and this MGP-related perinatal cost is absorbed by the National Health Services. At baseline tariffs and success rates IUI was £42 558 cheaper than IVF to deliver 1LB with enhanced benefits with small improvements in IUI. Reliable levels of IVF-related MGP, OHSS (ovarian hyperstimulation syndrome), fetal reductions and terminations are revealed. CONCLUSION IUI success rates are much closer to IVF than previously reported, more cost-effective in delivering 1 LB, and associated with lower risk of complications for maternal and neonatal complications. It is prudent to offer IUI before IVF nationally.
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Affiliation(s)
- Gulam Bahadur
- Reproductive Medicine Clinic, North Middlesex University Hospital NHS Trust, London, N18 1QX, UK
| | - Roy Homburg
- Homerton Fertility Unit, Homerton University Hospital, Homerton Row, London E9 6SR, UK
| | - Judith E Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Judith A F Huirne
- Research Institute Reproduction and development, University Medical Centers Amsterdam, location VUmc and AMC, De Boelelaan 1081, 1081 HV Amsterdam, The Netherlands
| | - Peter Hinstridge
- Reproductive Medicine Clinic, North Middlesex University Hospital NHS Trust, London, N18 1QX, UK
| | - Kanna Jayaprakasan
- University Hospitals of Derby and Burton NHS Trust, Royal Derby Hospital, Derby, Derby, UK
| | - Paul Racich
- Linacre College, Oxford University, St. Cross Road, Oxford, OX13JA, Oxfordshire, UK
| | - Rakib Alam
- Reproductive Medicine Clinic, North Middlesex University Hospital NHS Trust, London, N18 1QX, UK
| | - Ioannis Karapanos
- Reproductive Medicine Clinic, North Middlesex University Hospital NHS Trust, London, N18 1QX, UK
| | - Afeeza Illahibuccus
- Reproductive Medicine Clinic, North Middlesex University Hospital NHS Trust, London, N18 1QX, UK
| | - Ansam Al-Habib
- Reproductive Medicine Clinic, North Middlesex University Hospital NHS Trust, London, N18 1QX, UK
| | - Eric Jauniaux
- EGA Institute for Womens Health, Faculty of Population Health Science, University College London, London, WC1E 6HX, UK
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Pantos K, Sfakianoudis K, Grigoriadis S, Maziotis E, Tsioulou P, Rapani A, Giannelou P, Atzampos A, Koulouraki S, Koutsilieris M, Vlahos N, Mastorakos G, Simopoulou M. Could the Age Difference of a Single Calendar Year between Patients Undergoing IVF at 34, 35 or at 36 Years Old Affect the IVF Outcome? A Retrospective Data Analysis. ACTA ACUST UNITED AC 2020; 56:medicina56020092. [PMID: 32102386 PMCID: PMC7074270 DOI: 10.3390/medicina56020092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 01/24/2023]
Abstract
Background and Objectives: Clinicians are called to overcome age-related challenges in decision making during In Vitro Fertilization (IVF) treatment. The aim of this study was to investigate the possible impact of a single calendar year difference among patients aged 34, 35 and 36 on IVF outcomes. Materials and Methods: Medical records between 2008 and 2019 were analyzed retrospectively. The study group consisted of women diagnosed with tubal factor infertility. Sample size was divided in three categories at 34, 35 and 36 years of age. Embryo transfer including two blastocysts was performed for every patient. Comparisons were performed regarding hormonal profile, response to stimulation, quality of transferred embryos, positive hCG test and clinical pregnancy rate. Results: A total of 706 women were eligible to participate. Two-hundred and forty-eight women were 34, 226 were 35 while the remaining 232 were 36 years old. Regarding the hormonal profile, the number of accumulated oocytes and the quality of embryos transferred, no statistically significant difference was documented between the three age groups. Women aged 34 and 35 years old indicated a significantly increased positive hCG rate in comparison to women aged 36 years old (p-value = 0.009, p-value = 0.023, respectively). Women aged 34 and 35 years old presented with a higher clinical pregnancy rate in comparison to those aged 36 years old (p-value = 0.04, p-value = 0.05, respectively). Conclusion: A calendar year difference between patients undergoing IVF treatment at 34 or 35 years of age does not appear to exert any influence regarding outcome. When treatment involves patients above the age of 35, then a single calendar year may exert considerable impact on IVF outcome. This observation indicates that age 35 may serve as a valid cut-off point regarding IVF outcome.
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Affiliation(s)
- Konstantinos Pantos
- Centre for Human Reproduction, Genesis Athens Clinic, 14–16, Papanikoli, 15232 Athens, Greece; (K.P.); (K.S.); (P.G.)
| | - Konstantinos Sfakianoudis
- Centre for Human Reproduction, Genesis Athens Clinic, 14–16, Papanikoli, 15232 Athens, Greece; (K.P.); (K.S.); (P.G.)
| | - Sokratis Grigoriadis
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece; (S.G.); (E.M.); (P.T.); (A.R.); (A.A.); (M.K.)
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece; (S.K.); (N.V.); (G.M.)
| | - Evangelos Maziotis
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece; (S.G.); (E.M.); (P.T.); (A.R.); (A.A.); (M.K.)
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece; (S.K.); (N.V.); (G.M.)
| | - Petroula Tsioulou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece; (S.G.); (E.M.); (P.T.); (A.R.); (A.A.); (M.K.)
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece; (S.K.); (N.V.); (G.M.)
| | - Anna Rapani
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece; (S.G.); (E.M.); (P.T.); (A.R.); (A.A.); (M.K.)
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece; (S.K.); (N.V.); (G.M.)
| | - Polina Giannelou
- Centre for Human Reproduction, Genesis Athens Clinic, 14–16, Papanikoli, 15232 Athens, Greece; (K.P.); (K.S.); (P.G.)
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece; (S.G.); (E.M.); (P.T.); (A.R.); (A.A.); (M.K.)
| | - Anastasios Atzampos
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece; (S.G.); (E.M.); (P.T.); (A.R.); (A.A.); (M.K.)
| | - Sevasti Koulouraki
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece; (S.K.); (N.V.); (G.M.)
| | - Michael Koutsilieris
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece; (S.G.); (E.M.); (P.T.); (A.R.); (A.A.); (M.K.)
| | - Nikolaos Vlahos
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece; (S.K.); (N.V.); (G.M.)
| | - George Mastorakos
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece; (S.K.); (N.V.); (G.M.)
| | - Mara Simopoulou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece; (S.G.); (E.M.); (P.T.); (A.R.); (A.A.); (M.K.)
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece; (S.K.); (N.V.); (G.M.)
- Correspondence: ; Tel.: +302107462592
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Zhang X, Liu X, Xi Q, Zhu H, Li L, Liu R, Yu Y. Reproductive outcomes of 3 infertile males with XYY syndrome: Retrospective case series and literature review. Medicine (Baltimore) 2020; 99:e19375. [PMID: 32118782 PMCID: PMC7478696 DOI: 10.1097/md.0000000000019375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/11/2020] [Accepted: 01/30/2020] [Indexed: 12/31/2022] Open
Abstract
The aim of this study is to evaluate the pregnancy outcomes of males with a 47, XYY karyotype following assisted reproductive treatment.A retrospective study was performed using data from infertile men with 47, XYY at a center for reproductive medicine in 2004 to 2017. Of the 19,842 infertile males treated, a total of 21 showed the 47, XYY karyotype and were included in the present study. Clinical variables were collected. Three men were under treatment with their partner before either in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).The incidence of 47, XYY in infertile men is 1/945 (21/19842). Most men are azoospermic or severely oligospermic. Three men and their partners underwent IVF or ICSI treatment with fresh ejaculate samples. The fertilization rate was 52.94% to 83.33%. The embryo cleavage rate was 50% to 90%. One man had abnormal sex hormonal levels and his partner had no clinical pregnancy. The other 2 couples had healthy baby boys.Live spermatozoa can be gathered and fertility is possible for infertile males with 47, XYY syndrome when IVF or ICSI treatment is used. It is recommended that genetic counseling is provided in such cases.
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Abbas AM, Hussein RS, Elsenity MA, Samaha II, El Etriby KA, Abd El-Ghany MF, Khalifa MA, Abdelrheem SS, Ahmed AA, Khodry MM. Higher clinical pregnancy rate with in-vitro fertilization versus intracytoplasmic sperm injection in treatment of non-male factor infertility: Systematic review and meta-analysis. J Gynecol Obstet Hum Reprod 2020; 49:101706. [PMID: 32018045 DOI: 10.1016/j.jogoh.2020.101706] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 01/14/2020] [Accepted: 01/21/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the evidence about in-vitro fertilization (IVF) versus intracytoplasmic sperm injection (ICSI) for the treatment of non-male factor infertility. DATA SOURCES Electronic databases searched using the following MeSH terms (Sperm Injection, Intracytoplasmic) AND (in Vitro Fertilisation) AND (Infertility). METHODS OF STUDY SELECTION All RCTs included infertile patients due to non-male factors underwent IVF or ICSI were considered for this meta-analysis. One-thousand twenty-two studies were identified of which 20 studies deemed eligible for this review. DATA EXTRACTION Three independent authors extracted the relevant data from included studies. The study outcomes were pooled in the form of relative risk (RR) and 95 % confidence interval (CI) using Mantel-Hansel method. The main outcome measures are the fertilization rate, the implantation rate, the clinical pregnancy rate (CPR), the total fertilization failure and the live birth rate. RESULTS Regarding the fertilization rate, the pooled estimate did not favour either IVF or ICSI group (RR = 0.94; 95 %CI [0.82, 1.07]; p = 0.34). However, IVF significantly increased the CPR than ICSI (RR = 1.28, 95 %CI [1.11, 1.49]; p = 0.001). The overall effect estimate did not favor either of two groups regarding the implantation rate (RR = 1.25, 95 % CI [0.92, 1.68], p = 0.15). Similarly, no difference between both groups regarding the live birth rate (RR = 1.08, 95 % CI [0.79, 1.49]; p = 0.62). CONCLUSIONS No difference between ICSI and IVF regarding fertilization rate per oocytes, implantation rate and live birth rate in the treatment of non-male factor infertility, while IVF has significantly higher clinical pregnancy rate and higher risk of total fertilization failure.
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Affiliation(s)
- Ahmed M Abbas
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Assiut University, Assiut, Egypt.
| | - Reda S Hussein
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Assiut University, Assiut, Egypt; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Mohamed A Elsenity
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ihab I Samaha
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Karim A El Etriby
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Mohamed F Abd El-Ghany
- Department of Obstetrics and Gynaecology, Faculty of Medicine, South Valley University, Qena, Egypt
| | - Mansour A Khalifa
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Shaimaa S Abdelrheem
- Department of Public Health and Community Medicine, Faculty of Medicine, Aswan University, Aswan, Egypt
| | - Amal Abdrabbo Ahmed
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mostafa M Khodry
- Department of Obstetrics and Gynaecology, Faculty of Medicine, South Valley University, Qena, Egypt
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Abstract
METHODS Observational, comparative, prospective, multicenter study (n = 425). Group 1 (n = 228) received estradiol hemihydrate (Divigel, Orion Corporation, Finland), group 2 (n = 197) received oral estradiol valerate (Proginova, Delpharm Lille, France). RESULTS An increase in endometrial thickness was comparable (10.1 (2.0) mm versus 10.0 (2.3) mm; p = .571). There was significantly shorter mean duration of estrogen therapy (13.9 (3.9) days versus 14.7 (4.7) days; p = .038) and lower total dose in group 1 (43.6 (27.3) mg versus (71.9 (37.2) mg; p = .0001). Pregnancy rates were comparable (143/228 (62.7%) versus 105/197 (53.3%); p = .077) so as "take home baby" rates (80/228 (35.1%) versus 68/197 (34.5%); p = .077). CONCLUSION Estrogens improve the state of the endometrium and increase pregnancy rates in cases of thin endometrium in in vitro fertilization programs. The use of transdermal estrogens (Divigel, Orion Corporation, Finland) ensures an adequate increase in endometrial thickness and significantly lower estrogen doses.
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Affiliation(s)
- Emma Vartanyan
- LLCAssisted Reproductive Technology Clinic "Test-Tube Babies", Moscow, Russia
- Department of Obstetrics and Gynecology, Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia, Moscow, Russia
| | - Kristina Tsaturova
- LLCAssisted Reproductive Technology Clinic "Test-Tube Babies", Moscow, Russia
| | - Ekaterina Devyatova
- LLCAssisted Reproductive Technology Clinic "Test-Tube Babies", Moscow, Russia
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Alksere B, Grinfelde I, Kornejeva L, Dzalbs A, Vedmedovska N, Kovalova I, Conka U, Andersone S, Krasucka S, Blumberga A, Berzina D, Fodina V. The outcomes after transfers of embryos with chromosomal mosaicism: a single reproductive medicine center experience at iVF Riga clinic. Gynecol Endocrinol 2020; 36:53-57. [PMID: 33305664 DOI: 10.1080/09513590.2020.1816719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Aim: The aim of this study is to summarize the outcomes of transfers of mosaic embryos, which were classified according to guidelines and in strong collaboration of reproductologists, clinical geneticists and patients approved as suitable for transfer. Material and Methods: Retrospective data were collected from 70 patients from a private IVF center to whom embryos with mosaic changes in chromosomal material were transferred from 2015 to 2019. Results and Conclusion: Implantation outcomes and continuing pregnancies showed slight differences, when compared to fully normal embryos. Artifacts have to be differentiated from undeniable aberrations, and correct interpretation of results must be done with following patient counselling and prenatal testing if necessary.
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Affiliation(s)
| | - Ieva Grinfelde
- Clinic 'iVF-Riga', Riga, Latvia
- Children's Clinical University Hospital, Riga, Latvia
| | | | - Aigars Dzalbs
- Clinic 'iVF-Riga', Riga, Latvia
- Children's Clinical University Hospital, Riga, Latvia
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Abstract
The number of embryos transferred during an IVF cycle is directly related to the high incidence of multiple births, which is the culprit of perinatal morbidity. Therefore, single fresh embryo transfer (ET) strategy, or freeze-all, followed by a single frozen-thawed embryo transfer (FET) cycle, may dramatically reduce the rate of multiple births, without compromising the cumulative live birth rates (LBRs). A literature review was conducted for all available evidences assessing obstetrics and perinatal outcomes associated with FET compared to fresh ET and natural conception. While studies comparing fresh and FET cycles in normal responders have yielded conflicting results for pregnancy rate, FET was associated with lower risk of prematurity and low birth weight and increased risk of large for gestational age (LGA) and/or macrosomic in singletons, when compared with fresh ET. Macrosomic/LGA births have a higher risk of fetal hypoxia, stillbirth, shoulder dystocia, perineal lacerations, cesarean section, postpartum hemorrhage and neonatal metabolic disturbances at birth. Nonetheless, it seems that other than higher risk of fetal macrosomia, there are additional obstetric complications associated with FET. The relative risk of hypertensive disorders in pregnancy, as well as perinatal mortality were also demonstrated to be increased in FET compared with singletons from fresh ET and natural conception. Therefore, when considering elective freeze-all policy, in addition to LBR and the risk of ovarian hyperstimulation syndrome, physicians should consider the aforementioned increased FET cycles' pregnancy complications, including LGA/ macrosomia, hypertensive disorders of pregnancy, as well as perinatal mortality.
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Affiliation(s)
- Raoul Orvieto
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
- The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- *Correspondence: Raoul Orvieto
| | - Michal Kirshenbaum
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Norbert Gleicher
- The Center for Human Reproduction, New York, NY, United States
- The Foundation for Reproductive Medicine, New York, NY, United States
- Stem Cell Biology and Molecular Embryology Laboratory, Rockefeller University, New York, NY, United States
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Xue X, Shi W, Zhou H, Tian L, Zhao Z, Zhou D, Shi J. Cumulative Live Birth Rates According to Maternal Body Mass Index After First Ovarian Stimulation for in vitro Fertilization: A Single Center Analysis of 14,782 Patients. Front Endocrinol (Lausanne) 2020; 11:149. [PMID: 32328028 PMCID: PMC7160227 DOI: 10.3389/fendo.2020.00149] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/04/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate the cumulative live birth rates (CLBR) according to body mass index (BMI) in women undergoing their first in vitro fertilization (IVF). Design: Retrospective cohort analysis. Setting: An IVF clinic in a public hospital. Patients: This is a retrospective study of 14,782 patients undergoing their first fresh IVF cycles and subsequent frozen embryo transfers in our clinic from January 2014 to January 2017. The follow-up for CLBR continued until January 2019. Patients with a BMI <18.5 kg/m2 were considered to be underweight and those with a BMI > 24 kg/m2 were considered to be overweight. Patients with a BMI ≥ 28 kg/m2 were considered to be obese. Intervention(s): None. Primary Outcome Measure: The primary outcome was cumulative live birth rate (CLBR). Result(s): This study illustrated the "inverted U shape" associations between body weight and IVF outcome (CLBR). The turning points in threshold analysis, as found by an automatic search, were BMIs of 18.5 and 30.4 kg/m2. The main finding of this retrospective data analysis is that the CLBR increased in underweight women, plateaued for normal weight and overweight women with a BMI between 18.5 and 30.4 kg/m2, and decreased in obese women. Conclusion(s): The data suggested an "inverted U shape" association between BMI and CLBR. The CLBR increases in underweight women, plateaus in normal weight and overweight women, and then decreases in obese women.
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Affiliation(s)
- Xia Xue
- Department of Pathology, Medical School, Xi'an Jiaotong University, Xi'an, China
- The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Affiliated With Xi'an Jiaotong University, Xi'an, China
| | - Wenhao Shi
- The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Affiliated With Xi'an Jiaotong University, Xi'an, China
| | - Hanying Zhou
- The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Affiliated With Xi'an Jiaotong University, Xi'an, China
| | - Li Tian
- The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Affiliated With Xi'an Jiaotong University, Xi'an, China
| | - Zhenghao Zhao
- The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Affiliated With Xi'an Jiaotong University, Xi'an, China
| | - Dangxia Zhou
- Department of Pathology, Medical School, Xi'an Jiaotong University, Xi'an, China
- *Correspondence: Dangxia Zhou
| | - Juanzi Shi
- The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Affiliated With Xi'an Jiaotong University, Xi'an, China
- Juanzi Shi
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Anderson KN, Rueter MA, Connor JJ, Koerner AF. Parental Conformity Expectations' Effect on Twins' and Singletons' Parent-Adolescent Relationships: Associations With Change in Adjustment From Middle Childhood to Adolescence. J Res Adolesc 2019; 29:832-845. [PMID: 29917282 DOI: 10.1111/jora.12416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Growing use of in vitro fertilization (IVF) has resulted in an elevated twin birth rate, and a burgeoning population of IVF twins who are now aging into adolescence and beyond. This study tests a model examining whether parental conformity expectations have differential effects on twins' versus singletons' parent-adolescent relationship satisfaction, and if this effect is indirectly associated with relative changes in twins' and singletons' internalizing and externalizing behavior from middle childhood to adolescence. Using a sample of 278 IVF twins and singletons, path models demonstrate that twin status and conformity expectations interact to influence parent-adolescent relationships. Although there was an association between twin status and mother-adolescent relationship satisfaction among parents with high conformity expectations (r = .25, p < .01), this relationship was nonsignificant among parents with low conformity expectations (r = .05, p = .85). The differential effect of conformity expectations on parent-adolescent relationship satisfaction for twins and singletons was indirectly associated with relative changes in twins' and singletons' externalizing behavior from middle childhood to adolescence. Results demonstrate that higher levels of parental conformity expectations may not have the same effect on adolescent twins and singletons.
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Satirapod C, Sukprasert M, Panthan B, Charoenyingwattana A, Chitayanan P, Chantratita W, Choktanasiri W, Trachoo O, Hongeng S. Clinical utility of combined preimplantation genetic testing methods in couples at risk of passing on beta thalassemia/hemoglobin E disease: A retrospective review from a single center. PLoS One 2019; 14:e0225457. [PMID: 31751397 PMCID: PMC6872132 DOI: 10.1371/journal.pone.0225457] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 11/05/2019] [Indexed: 12/11/2022] Open
Abstract
Thalassemia and hemoglobinopathy is a group of hereditary blood disorder with diverse clinical manifestation inherited by autosomal recessive manner. The Beta thalassemia/Hemoglobin E disease (HbE/βthal) causes a variable degree of hemolysis and the most severe form of HbE/βthal disease develop a lifelong transfusion-dependent anemia. Preimplantation genetic testing (PGT) is an established procedure of embryo genetic analysis to avoid the risk of passing on this particular condition from the carrier parents to their offspring. Preimplantation genetic testing for chromosomal aneuploidy (PGT-A) also facilitates the selection of embryos without chromosomal aberration resulting in the successful embryo implantation rate. Herein, we study the clinical outcome of using combined PGT-M and PGT-A in couples at risk of passing on HbE/βthal disease. The study was performed from January 2016 to December 2017. PGT-M was developed using short tandem repeat linkage analysis around the beta globin gene cluster and direct mutation testing using primer extension-based mini-sequencing. Thereafter, we recruited 15 couples at risk of passing on HbE/βthal disease who underwent a combined total of 22 IVF cycles. PGT was performed in 106 embryos with a 3.89% allele drop-out rate. Using combined PGT-M and PGT-A methods, 80% of women obtained satisfactory genetic testing results and were able to undergo embryo transfer within the first two cycles. The successful implantation rate was 64.29%. PGT accuracy was evaluated by prenatal and postnatal genetic confirmation and 100% had a genetic status consistent with PGT results. The overall clinical outcome of successful live birth for couples at risk of producing offspring with HbE/βthal was 53.33%. Conclusively, combined PGT-M and PGT-A is a useful technology to prevent HbE/βthal disease in the offspring of recessive carriers.
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Affiliation(s)
- Chonthicha Satirapod
- Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Matchuporn Sukprasert
- Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Bhakbhoom Panthan
- Center for Medical Genomics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Angkana Charoenyingwattana
- Center for Medical Genomics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Wasun Chantratita
- Center for Medical Genomics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wicharn Choktanasiri
- Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Objoon Trachoo
- Center for Medical Genomics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- * E-mail:
| | - Suradej Hongeng
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Männistö J, Mentula M, Bloigu A, Gissler M, Heikinheimo O, Niinimäki M. Induced abortion and future use of IVF treatment; A nationwide register study. PLoS One 2019; 14:e0225162. [PMID: 31725766 PMCID: PMC6855489 DOI: 10.1371/journal.pone.0225162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 10/30/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE In this nationwide study we assessed the use and factors associated with future in vitro fertilization (IVF) treatment after induced abortion. MATERIALS AND METHODS The study population was collected by means of record linkage between Finnish national registers. All women who underwent induced abortion between 2000 and 2009 in Finland were identified through the Register of Induced Abortions (n = 88 522). The study group consisted of women who underwent induced abortion and subsequently had an IVF treatment (n = 379); the comparison group were all women who had a spontaneous pregnancy and delivery 12-24 months after the index abortion (n = 7434). Demographic characteristics at the time of index abortion, and factors associated with the abortion (gestational age at abortion, indication and method of abortion, complications after abortion) were compared between the study groups. Logistic regression was used to assess whether some of the demographic characteristics or abortion associated factors increased the use of IVF treatment in the future. RESULTS The proportion of women with IVF treatment after induced abortion in the whole cohort was 0.4%. Women needing IVF treatment were older, of a higher socioeconomic status, and had fewer previous induced abortions and deliveries compared to women in the comparison group. No statistically significant differences were observed in the gestational age (≤ 12 weeks or >12 weeks of gestation) at abortion, method or complications of abortion. In multivariable analysis higher age increased, and history of previous deliveries or one or two abortions decreased the use of IVF. CONCLUSIONS Infertility necessitating the use of IVF treatment after induced abortion is uncommon. The factors associated with use of IVF after abortion are those generally recognized as risk factors of infertility. Abortion-related outcomes are not associated with an increased need of future IVF-treatment.
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Affiliation(s)
- Jaana Männistö
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center Oulu, University Hospital of Oulu and University of Oulu, Oulu, Finland
| | - Maarit Mentula
- Department of Obstetrics and Gynecology, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
| | - Aini Bloigu
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center Oulu, University Hospital of Oulu and University of Oulu, Oulu, Finland
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
- * E-mail:
| | - Maarit Niinimäki
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center Oulu, University Hospital of Oulu and University of Oulu, Oulu, Finland
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Busnelli A, Reschini M, Cardellicchio L, Vegetti W, Somigliana E, Vercellini P. How common is real repeated implantation failure? An indirect estimate of the prevalence. Reprod Biomed Online 2019; 40:91-97. [PMID: 31924493 DOI: 10.1016/j.rbmo.2019.10.014] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/12/2019] [Accepted: 10/21/2019] [Indexed: 01/08/2023]
Abstract
RESEARCH QUESTION What is the real prevalence of repeated implantation failure (RIF) and what reliable estimates can be given on the risk of false-positive diagnosis after two or three failed IVF attempts. DESIGN A recent theoretical model suggested that commonly used definitions (two or three failed IVF attempts in good-prognosis couples) may expose couples to substantial odds of overdiagnosis and overtreatment. This model, however, was theoretical and based on unproven assumptions that the pregnancy rate in the non-RIF population was 30% and the prevalence of RIF was 10%. In the present study, we applied this model to real data to distinguish the real prevalence of RIF and to provide more reliable estimates on the risk of false-positive diagnosis after two or three failed IVF attempts. To this aim, we retrospectively selected 1221 good-prognosis couples and evaluated pregnancy rates up to the third cycle. RESULTS The clinical pregnancy rate at first, second and third IVF cycle was 52%, 41% and 28%, respectively. A pregnancy rate of 61% was extrapolated in the non-RIF population and 15% among women who had experienced RIF. Therefore, the rate of false-positive diagnoses of RIF after two, three and six failed cycles would be 46%, 25%, and 2%, respectively. CONCLUSIONS Our analyses show that estimated prevalence of RIF is 15%. The frequently used definition of RIF based on three failed attempts (but not two) in good-prognosis couples seems justified. Physicians, however, should bear in mind that couples may be inappropriately labelled with this condition in one out of four cases.
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Affiliation(s)
- Andrea Busnelli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy.
| | - Marco Reschini
- Obstetric amd Gynaecology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122, Milan, Italy
| | - Lucia Cardellicchio
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy; Obstetric amd Gynaecology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122, Milan, Italy
| | - Walter Vegetti
- Obstetric amd Gynaecology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122, Milan, Italy
| | - Edgardo Somigliana
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy; Obstetric amd Gynaecology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122, Milan, Italy
| | - Paolo Vercellini
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy; Obstetric amd Gynaecology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122, Milan, Italy
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Liao S, Xiong J, Tu H, Hu C, Pan W, Geng Y, Pan W, Lu T, Jin L. Prediction of in vitro fertilization outcome at different antral follicle count thresholds combined with female age, female cause of infertility, and ovarian response in a prospective cohort of 8269 women. Medicine (Baltimore) 2019; 98:e17470. [PMID: 31593108 PMCID: PMC6799863 DOI: 10.1097/md.0000000000017470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Antral follicle count (AFC) has been widely investigated for the prediction of clinical pregnancy or live birth. This study discussed the effects of AFC quartile levels on pregnancy outcomes combined with female age, female cause of infertility, and ovarian response undergoing in vitro fertilization (IVF) treatment. At present, many research about AFC mainly discuss its impact on clinical practice at different thresholds, or the analyses of AFC with respect to assisted reproductive technology outcomes under using different ovarian stimulation protocols. Factors that include ovarian sensitivity index, female age, and infertility cause are all independent predictors of live birth undergoing IVF/intracytoplasmic sperm injection, while few researchers discussed influence of female-related factors for clinical outcomes in different AFC fields.A total of 8269 infertile women who were stimulated with a long protocol with normal menstrual cycles were enrolled in the study, and patients were categorized into 4 groups based on AFC quartiles (1-8, 9-12, 13-17, and ≥18 antral follicles).The clinical pregnancy rates increased in the 4 AFC groups (28.25% vs 35.38% vs 37.38% vs 40.13%), and there was a negative association between age and the 4 AFC groups. In addition, female cause of infertility like polycystic ovary syndrome, Tubal factor, and other causes had great significance on clinical outcome, and ovarian response in medium (9-16 oocytes retrieved) had the highest clinical pregnancy rate at AFC quartiles of 1 to 8, 9 to 12, 13 to 17, and ≥18 antral follicles.This study concludes that the female-related parameters (female cause of infertility, female age, and ovarian response) combined with AFC can be useful to estimate the probability of clinical pregnancy.
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Affiliation(s)
- ShuJie Liao
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Jianwu Xiong
- School of Economic and Management
- Management Science and Data Analytics Research Center, Wuhan University, Wuhan
| | - Haiting Tu
- School of Economic and Management
- Management Science and Data Analytics Research Center, Wuhan University, Wuhan
| | - Cheng Hu
- School of Economic and Management
- Management Science and Data Analytics Research Center, Wuhan University, Wuhan
| | - Wulin Pan
- School of Economic and Management
- Management Science and Data Analytics Research Center, Wuhan University, Wuhan
| | - Yudi Geng
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Wei Pan
- School of Economic and Management
- Management Science and Data Analytics Research Center, Wuhan University, Wuhan
| | - Tingjuan Lu
- 117th Hospital of PLA, Hangzhou, Zhejiang, China
| | - Lei Jin
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
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Selter J, Huang Y, Grossman Becht LC, Palmerola KL, Williams SZ, Forman E, Ananth CV, Hur C, Neugut AI, Hershman DL, Wright JD. Use of fertility preservation services in female reproductive-aged cancer patients. Am J Obstet Gynecol 2019; 221:328.e1-328.e16. [PMID: 31108063 DOI: 10.1016/j.ajog.2019.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/09/2019] [Accepted: 05/13/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of the study was to determine the rates and predictors of fertility preservation services among reproductive-aged women with common cancers in the United States. STUDY DESIGN We used the MarketScan database to identify women 18-45 years of age with lung, breast, colorectal, or cervical cancer who underwent surgery and chemotherapy from 2009 through 2016. Services from 3 months before to 3 months after chemotherapy for evaluation for fertility preservation, laboratory testing for fertility evaluation, and fertility-preserving procedures were captured. Multivariable models were used to assess the factors associated with the use of fertility-preservation services. RESULTS A total of 18,781 women, including 386 cervical, 1372 colorectal, 246 lung, and 16,777 with breast cancer, were identified. In women 18-35 years old, 11.7% underwent evaluation for fertility preservation, 13.7% underwent laboratory testing, and 6.3% pursued fertility-preserving procedures. The rates of office evaluation, laboratory testing, and performance of procedure were 3.3%, 7.5%, and 1.9 % in women aged 36-40 years and 0.5%, 7.2%, and 0.3% in those aged 41-45 years, respectively. The rate of fertility preservation evaluation rose from 1.0% in 2009 to 5.5% in 2016 (risk ratio, 4.66, 95% confidence interval, 2.38-9.11) while use of fertility-preserving procedures increased from 1.0% to 4.6% (risk ratio, 3.84, 95% confidence interval, 1.94-7.59) during the same time period. In a multivariable model, use of any fertility-preserving interventions were more common in patients with breast cancer (adjusted risk ratio, 2.30, 95% confidence interval, 1.30-4.06), those in the Northeast (adjusted risk ratio, 1.24, 95% confidence interval, 1.10-1.40), and in younger women (18-35 years) (adjusted risk ratio, 2.59, 95% confidence interval, 2.32-2.89). CONCLUSION Although limited by lack of information regarding cancer stage and desire for future fertility, only a small fraction of reproductive-aged female cancer patients receiving chemotherapy are evaluated in a nationwide sample for fertility preservation or undergo fertility-preserving procedures.
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Affiliation(s)
- Jessica Selter
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY; New York Presbyterian Hospital, New York, NY
| | - Yongmei Huang
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY
| | - Lisa C Grossman Becht
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY; New York Presbyterian Hospital, New York, NY
| | - Katherine L Palmerola
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY; New York Presbyterian Hospital, New York, NY
| | - S Zev Williams
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY; New York Presbyterian Hospital, New York, NY
| | - Eric Forman
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY; New York Presbyterian Hospital, New York, NY
| | - Cande V Ananth
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY
| | - Chin Hur
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY; New York Presbyterian Hospital, New York, NY
| | - Alfred I Neugut
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; New York Presbyterian Hospital, New York, NY
| | - Dawn L Hershman
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; New York Presbyterian Hospital, New York, NY
| | - Jason D Wright
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY; New York Presbyterian Hospital, New York, NY.
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Sfakianoudis K, Simopoulou M, Rapani A, Grigoriadis S, Maziotis E, Giannelou P, Pantou A, Vaxevanoglou T, Fakiridou M, Koutsilieris M, Pantos K. The Impact of the Economic Recession in Greece on Assisted Reproduction Demand: A Retrospective Longitudinal Study. Medicina (Kaunas) 2019; 55:medicina55100654. [PMID: 31569483 PMCID: PMC6843187 DOI: 10.3390/medicina55100654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 09/12/2019] [Accepted: 09/27/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Since 2009, the decline of the Greek economy has been in the spotlight of the world's financial agenda. This study assesses the economic crisis' impact on assisted reproduction demand dynamics. MATERIALS AND METHODS Patient records were recruited between 2005-2017. In 2013 the clinic proceeded with a cost reduction. The studied time-frames were defined accordingly: Period A: Prior to economic crisis, Period B: During the economic crisis-prior to cost reduction, and Period C: During the economic crisis-following cost reduction. Analysis focused on parameters reflecting on patient characteristics, decision to inquire on IVF treatment, embarking on it, and proceeding with multiple cycles. RESULTS The mean annual number of first visit patients was significantly decreased during Period B (1467.00 ± 119.21) in comparison to period A (1644.40 ± 42.57) and C (1637.8 ± 77.23). Furthermore, Period C in comparison to B and A, refers to women of more advanced age (37.27 ± 5.62 vs 36.04 ± 5.76 vs 35.53 ± 5.28), reporting a longer infertility period (8.49 ± 6.25 vs 7.01 ± 5.66 vs 6.46 ± 5.20), being inclined to abandon IVF treatment sooner (2.78 ± 2.51 vs 2.60 ± 1.92 vs 4.91 ± 2.28). CONCLUSIONS A decline regarding assisted reproduction techniques (ART) demand was noted as anticipated. Redefining the cost of infertility treatments may contribute towards overcoming the troubling phenomenon of postponing pregnancy due to financial concerns.
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Affiliation(s)
| | - Mara Simopoulou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece.
- Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece.
| | - Anna Rapani
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece.
| | - Sokratis Grigoriadis
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece.
| | - Evangelos Maziotis
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece.
| | - Polina Giannelou
- Centre for Human Reproduction, Genesis Athens Clinic, 14-16, Papanikoli, 15232 Athens, Greece.
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece.
| | - Agni Pantou
- Centre for Human Reproduction, Genesis Athens Clinic, 14-16, Papanikoli, 15232 Athens, Greece.
| | - Terpsithea Vaxevanoglou
- Centre for Human Reproduction, Genesis Athens Clinic, 14-16, Papanikoli, 15232 Athens, Greece.
| | - Maria Fakiridou
- Centre for Human Reproduction, Genesis Athens Clinic, 14-16, Papanikoli, 15232 Athens, Greece.
| | - Michael Koutsilieris
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece.
| | - Konstantinos Pantos
- Centre for Human Reproduction, Genesis Athens Clinic, 14-16, Papanikoli, 15232 Athens, Greece.
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Pachler FR, Toft G, Bisgaard T, Laurberg S. Use and Success of In Vitro Fertilisation Following Restorative Proctocolectomy and Ileal Pouch-anal Anastomosis. A Nationwide 17-year Cohort Study. J Crohns Colitis 2019; 13:1283-1286. [PMID: 30840765 DOI: 10.1093/ecco-jcc/jjz055] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND AIMS Fertility decreases in women following restorative proctocolectomy for ulcerative colitis. The use and success of in vitro fertilisation [IVF] after restorative proctocolectomy for ulcerative colitis is not systematically studied. We aimed to estimate the use and success of in vitro fertilisation treatment in female ulcerative colitis patients, with and without restorative proctocolectomy. METHODS Women of fertile age [15-49 years] with restorative proctocolectomy for ulcerative colitis were compared with females with ulcerative colitis without restorative proctocolectomy. Data from the IVF registry from 1994-2010 were cross-linked with data from the National Danish Patient Registry and the Medical Birth Registry. RESULTS In vitro fertilisation is significantly more frequent in females with restorative proctocolectomy compared with females without restorative proctocolectomy, adjusted hazard ratio 3.2, 95% confidence interval [CI] [2.5;4.0]. The odds for having a live birth after in vitro fertilisation are no different in females with restorative proctocolectomy compared with females without restorative proctocolectomy, adjusted odds ratio 0.8, 95% CI [0.6;1.1]. The percentage of children born as a result of in vitro fertilisation is significantly higher in females with restorative proctocolectomy compared with females without restorative proctocolectomy (31.0%, 95% CI [24.1; 37.7] vs 5.0%, 95% CI [4.4; 5.6]). CONCLUSIONS Females with restorative proctocolectomy for ulcerative colitis have increased incidence of in vitro fertilisation by more than a factor three, the odds that a treatment results in a live birth are similar and six times more children are born as a result of in vitro fertilisation compared with females without restorative proctocolectomy.
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Affiliation(s)
| | - Gunnar Toft
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Thue Bisgaard
- Centre for Surgical Research, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Søren Laurberg
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
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Al-Jebari Y, Elenkov A, Wirestrand E, Schütz I, Giwercman A, Lundberg Giwercman Y. Risk of prostate cancer for men fathering through assisted reproduction: nationwide population based register study. BMJ 2019; 366:l5214. [PMID: 31554611 PMCID: PMC6759809 DOI: 10.1136/bmj.l5214] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the risk and severity of prostate cancer between men achieving fatherhood by assisted reproduction and men conceiving naturally. DESIGN National register based cohort study. SETTING Sweden from January 1994 to December 2014. PARTICIPANTS 1 181 490 children born alive in Sweden during 1994-2014 to the same number of fathers. Fathers were grouped according to fertility status by mode of conception: 20 618 by in vitro fertilisation (IVF), 14 882 by intra-cytoplasmic sperm injection (ICSI), and 1 145 990 by natural conception. MAIN OUTCOME MEASURES Prostate cancer diagnosis, age of onset, and androgen deprivation therapy (serving as proxy for advanced or metastatic malignancy). RESULTS Among men achieving fatherhood by IVF, by ICSI, and by non-assisted means, 77 (0.37%), 63 (0.42%), and 3244 (0.28%), respectively, were diagnosed as having prostate cancer. Mean age at onset was 55.9, 55.1, and 57.1 years, respectively. Men who became fathers through assisted reproduction had a statistically significantly increased risk of prostate cancer compared with men who conceived naturally (hazard ratio 1.64, 95% confidence interval 1.25 to 2.15, for ICSI; 1.33, 1.06 to 1.66, for IVF). They also had an increased risk of early onset disease (that is, diagnosis before age 55 years) (hazard ratio 1.86, 1.25 to 2.77, for ICSI; 1.51, 1.09 to 2.08, for IVF). Fathers who conceived through ICSI and developed prostate cancer received androgen deprivation therapy to at least the same extent as the reference group (odds ratio 1.91; P=0.07). CONCLUSIONS Men who achieved fatherhood through assisted reproduction techniques, particularly through ICSI, are at increased risk for early onset prostate cancer and thus constitute a risk group in which testing and careful long term follow-up for prostate cancer may be beneficial.
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Affiliation(s)
- Yahia Al-Jebari
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Angel Elenkov
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Urology, Medical University Sofia, Sofia, Bulgaria
- Reproductive Medicine Center, Skåne University Hospital Malmö, Malmö, Sweden
| | - Elin Wirestrand
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Indra Schütz
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Aleksander Giwercman
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Reproductive Medicine Center, Skåne University Hospital Malmö, Malmö, Sweden
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Abstract
Background: IVF is now a wide spread procedure globally, and currently 65 countries report annually all or part of their IVF/ICSI cycles, from which the International Committee Monitoring progress in Assisted Reproduction Technology (ICMART) published its report. There is considerable variation in the utilization (number of cycles per population) globally. Aims: The objectives of this study were to assess whether utilization is related to national wealth, presented as gross domestic product (GDP), and whether the GDP has any effect on success in IVF treatment, mainly delivery and clinical pregnancy rates. Results: The results demonstrated a significant positive correlation between utilization and GDP (CC = 0.563, p = 0.00000194), and both utilization and GDP have strong negative correlations to successful outcome of the treatment-clinical pregnancy rate (CC: -0.460, p = 0.00015; CC: -0.399, p = 0.0012, respectively) and delivery rates (cc = -0.396, p = 0.00484; cc = -0.3, p = 0.0179, respectively). Conclusions: Poor nations have less utilization of IVF, probably due to the limited affordability of the treatment, but reassuringly do not seem to have less success in the treatment. Further research is required to fully understand the implications of these correlations and to better design national and international fertility policies.
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Affiliation(s)
| | | | - Geffen Lass
- c Department of Women and Children's Health, King's College London , London , UK
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Gricius R, Balciuniene G, Jakubauskiene L, Ramasauskaite D. The Significance of Endometrial Scratching for Clinical Pregnancy Rate in Long Agonist and Antagonist Protocols. ACTA ACUST UNITED AC 2019; 55:medicina55090527. [PMID: 31450870 PMCID: PMC6780940 DOI: 10.3390/medicina55090527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Assisted reproductive techniques today have helped many infertile couples achieve their desired pregnancy. However, unsuccessful implantation is usually the key failure in in vitro fertilization cycles. Many factors are now being studied to improve the implantation rate, one being endometrial artificial injury (endometrial scratching). The purpose of this study was to assess whether local endometrial artificial injury improved pregnancy rate, in long agonist and antagonist protocols. Materials and Methods: A retrospective analysis was carried out at the JSC Baltic American Clinic from January 1, 2016 to December 31, 2018. Women who were undergoing in vitro fertilization treatment were enrolled in the study. Medical data including demographic factors, menstrual history, and anamnesis of infertility were collected from medical records. Subjects were divided into intervention and control groups. The outcome of this study was clinical pregnancy rate (CPR). Results: A total of 137 women presenting with primary or secondary infertility were enrolled in the study. Clinical pregnancy was observed in 44/71 (61.9%) patients in the intervention group and 33/66 (50%) in the group without endometrial scratching (p value = 0.16). CPR in the intervention group was significantly higher in the patient group that had undergone ovarian stimulation with a long agonist protocol rather than the antagonist protocol (73.8% vs. 41.4%; p value = 0.006). In the multivariable logistic regression model, previously failed in vitro fertilization (IVF) (odds ratio (OR) = 0.07, 95% confidence interval (CI) 0.01–0.47), stimulation with the long agonist protocol (OR = 19.89, 95% CI 3.57–18.63), antagonist protocol (OR = 0.05, 95% CI 0.01–0.34), number of embryos (OR = 1.37, 95% CI 1.05–1.38), and number of blastocysts (OR = 2.96, 95% CI 1.43–8.36) remained important independent prognostic factors for clinical pregnancy. Conclusions: Our study findings indicate that randomized controlled studies are required to define patients for this procedure and to prove the effect and safety of local endometrial injury, before it is introduced to routine clinical practice.
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Affiliation(s)
- Rimantas Gricius
- JSC Baltic Amrican Clinic, 10103 Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania
| | - Greta Balciuniene
- Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania.
- Clinic of Obstetrics, and Gynecology, Institute of Clinical Medicine,Faculty of Medicine,Vilnius University, 03101 Vilnius, Lithuania.
| | - Lina Jakubauskiene
- Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania
- Clinic of Obstetrics, and Gynecology, Institute of Clinical Medicine,Faculty of Medicine,Vilnius University, 03101 Vilnius, Lithuania
| | - Diana Ramasauskaite
- Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania
- Clinic of Obstetrics, and Gynecology, Institute of Clinical Medicine,Faculty of Medicine,Vilnius University, 03101 Vilnius, Lithuania
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71
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Xu L, Ding L, Jiang J, Liu P, Wei D, Qin Y. Effects of oral contraceptive pretreatment on IVF outcomes in women following a GnRH agonist protocol. Reprod Biomed Online 2019; 39:924-930. [PMID: 31680062 DOI: 10.1016/j.rbmo.2019.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 07/09/2019] [Accepted: 08/12/2019] [Indexed: 11/17/2022]
Abstract
RESEARCH QUESTION Does oral contraceptive pretreatment impact IVF-embryo transfer cycle outcomes in women following the gonadotrophin-releasing hormone agonist (GnRHa) protocol? DESIGN This retrospective study was designed to compare cycle outcomes after oral contraceptive pretreatment versus the standard protocol in women within the GnRHa long protocol or the GnRHa short protocol. A total of 2052 women undergoing their first IVF treatment with the GnRHa long protocol and 3557 women with the GnRHa short protocol between 2012 and 2017 were enrolled. RESULTS No significant differences in the rates of clinical pregnancy (long protocol: 49.2% versus 46.7%; short protocol: 39.4% versus 38.0%) or live birth (long protocol: 44.3% versus 41.3%; short protocol: 32.8% versus 31.4%) after fresh embryo transfer were observed between the oral contraceptive group and the control group in either the long protocol or the short protocol. CONCLUSIONS Oral contraceptive pretreatment has no effect on IVF outcomes in either the GnRHa long protocol or short protocol.
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Affiliation(s)
- Lan Xu
- Centre for Reproductive Medicine, Shandong University, Centre for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, National Research Centre for Assisted Reproductive Technology and Reproductive Genetics, The Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan, China
| | - Lingling Ding
- Centre for Reproductive Medicine, Shandong University, Centre for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, National Research Centre for Assisted Reproductive Technology and Reproductive Genetics, The Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan, China
| | - Jingjing Jiang
- Centre for Reproductive Medicine, Shandong University, Centre for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, National Research Centre for Assisted Reproductive Technology and Reproductive Genetics, The Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan, China
| | - Peihao Liu
- Centre for Reproductive Medicine, Shandong University, Centre for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, National Research Centre for Assisted Reproductive Technology and Reproductive Genetics, The Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan, China
| | - Daimin Wei
- Centre for Reproductive Medicine, Shandong University, Centre for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, National Research Centre for Assisted Reproductive Technology and Reproductive Genetics, The Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan, China.
| | - Yingying Qin
- Centre for Reproductive Medicine, Shandong University, Centre for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, National Research Centre for Assisted Reproductive Technology and Reproductive Genetics, The Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan, China.
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72
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Zhang WY, von Versen-Höynck F, Kapphahn KI, Fleischmann RR, Zhao Q, Baker VL. Maternal and neonatal outcomes associated with trophectoderm biopsy. Fertil Steril 2019; 112:283-290.e2. [PMID: 31103283 PMCID: PMC6527329 DOI: 10.1016/j.fertnstert.2019.03.033] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/25/2019] [Accepted: 03/26/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess whether pregnancies achieved with trophectoderm biopsy for preimplantation genetic testing (PGT) have different risks of adverse obstetric and neonatal outcomes compared with pregnancies achieved with IVF without biopsy. DESIGN Observational cohort. SETTING University-affiliated fertility center. PATIENT(S) Pregnancies achieved via IVF with PGT (n = 177) and IVF without PGT (n = 180) that resulted in a live birth. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Maternal outcomes including preeclampsia and placenta previa and neonatal outcomes including birth weight and birth defects. RESULT(S) There was a statistically significant increase in the risk of preeclampsia among IVF+PGT pregnancies compared with IVF without PGT pregnancies, with an incidence of 10.5% versus 4.1% (adjusted odds ratio [aOR] = 3.02; 95% confidence interval [95% CI], 1.10, 8.29). The incidence of placenta previa was 5.8% in IVF+PGT pregnancies versus 1.4% in IVF without PGT pregnancies (aOR = 4.56; 95% CI, 0.93, 22.44). Similar incidences of gestational diabetes, preterm premature rupture of membranes, and postpartum hemorrhage were observed. IVF+PGT and IVF without PGT neonates did not have a significantly different gestational age at delivery or rate of preterm birth, low birth weight, neonatal intensive care unit admission, neonatal morbidities, or birth defects. All trends, including the significantly increased risk of preeclampsia in IVF+PGT pregnancies, persisted upon stratification of analysis to only singleton live births. CONCLUSION(S) To date, this is the largest and most extensively controlled study examining maternal and neonatal outcomes after trophectoderm biopsy. There was a statistically significant three-fold increase in the odds of preeclampsia associated with trophectoderm biopsy. Given the rise in PGT use, further investigation is warranted.
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Affiliation(s)
- Wendy Y. Zhang
- Stanford University Medical Center, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, 1195 West Fremont Avenue, Sunnyvale, CA 94087, United States of America. , , ,
| | - Frauke von Versen-Höynck
- Stanford University Medical Center, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, 1195 West Fremont Avenue, Sunnyvale, CA 94087, United States of America. , , ,
- Hannover Medical School, Department of Obstetrics and Gynecology, Lower Saxony, Germany.
| | - Kristopher I. Kapphahn
- Stanford University School of Medicine, Quantitative Science Unit, Stanford, California, United States of America.
| | - Raquel R. Fleischmann
- Stanford University Medical Center, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, 1195 West Fremont Avenue, Sunnyvale, CA 94087, United States of America. , , ,
| | - Qianying Zhao
- Stanford University Medical Center, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, 1195 West Fremont Avenue, Sunnyvale, CA 94087, United States of America. , , ,
| | - Valerie L. Baker
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
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73
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Shenhav-Goldberg R, Brym R, Lenton-Brym T. Family Welfare Effort, Total Fertility, and In Vitro Fertilization: Explaining the Israeli Anomaly. Can Rev Sociol 2019; 56:421-438. [PMID: 31387159 DOI: 10.1111/cars.12255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The theory of family welfare effort is a leading macro-sociological explanation of variation in human fertility. It holds that states which provide universally available, inexpensive, high-quality day care, generous parental leave, and flexible work schedules lower the opportunity cost of motherhood. They thus enable women, especially those in lower socioeconomic strata, to have the number of babies they want. A considerable body of research supports this theory. However, it is based almost exclusively on analyses of Western European and North American countries. This paper examines the Israeli case because Israel's total fertility rate is anomalously high given its family welfare effort. Based on a review of the relevant literature and a reanalysis of data from various published sources, it explains the country's unusually high total fertility rate as the product of (1) religious and nationalistic sentiment that is heightened by the Jewish population's perception of a demographic threat in the form of a burgeoning Palestinian population and (2) the state's resulting support for pro-natal policies, including the world's most extensive in vitro fertilization (IVF) system. The paper also suggests that Israel's IVF policy may not be in harmony with the interests of many women insofar as even women with an extremely low likelihood of becoming pregnant are encouraged to undergo the often lengthy, emotionally and physically painful, and risky process of IVF.
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74
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Abstract
To evaluate the preterm delivery and other obstetrics complications similar in singleton pregnancies achieved through IVF compared to spontaneous pregnancies. Retrospective case-control study included 1663 women with singleton pregnancies following IVF-ICSI (study group) and 3326 women with singleton spontaneous pregnancies (control group) who delivered between January 2015 and January 2018 at the Peking University Third Hospital. The control group matched 1:2 by age, BMI, parity, and gravidity. Maternal outcomes included preterm delivery and complications. There was significantly higher incidence of gestational diabetes, hypertensive disorders, and placenta previa in IVF-ICSI pregnancies versus controls (p < .05). IVF-ICSI resulted in significantly higher rate of preterm birth than in spontaneous pregnancies (p < .05) and the difference remained significant for deliveries that occurred before 28, 32, and 34 weeks gestation (p < .05). Multivariate logistic regression analysis revealed that female-factor infertility, hypertensive disorder, placenta previa, and PROM were significant prognostic factors associated with increased risk of prematurity. IVF-ICSI is associated with increased risk of obstetric complications including preterm delivery in singleton pregnancies. Female-factor infertility is an independent prognostic factor for preterm birth. This information is important for patient counseling and helps to refine the recommendation to optimize maternal health before embarking on fertility treatments.
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Affiliation(s)
- Puyu Yang
- a Center for Reproductive Medicine, Department of Obstetrics and Gynecology , Peking University Third Hospital , Beijing , China
| | - Huixian Kang
- b Department of Obstetrics and Gynecology , Peking University Third Hospital , Beijing , China
| | - Caihong Ma
- a Center for Reproductive Medicine, Department of Obstetrics and Gynecology , Peking University Third Hospital , Beijing , China
| | - Yuan Wei
- b Department of Obstetrics and Gynecology , Peking University Third Hospital , Beijing , China
| | - Liyuan Tao
- c Research center of clinical epidemiology , Peking University Third Hospital , Beijing , China
| | - Zhangxin Wu
- b Department of Obstetrics and Gynecology , Peking University Third Hospital , Beijing , China
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75
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JING M, ZHANG R. [Economic studies of in vitro fertilization and embryo transfer]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2019; 48:580-585. [PMID: 31901035 PMCID: PMC8800743 DOI: 10.3785/j.issn.1008-9292.2019.10.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/25/2019] [Indexed: 06/10/2023]
Abstract
In vitro fertilization and embryo transplantation (IVF-ET) technology is one of the main treatments for infertility. But IVF-ET is expensive and has not be covered by health insurance in most developing countries. Therefore, how to obtain the maximum success rate with the minimum cost is a common concern of clinicians and patients. At present, the economic studies on IVF-ET mainly focus on different ovulation stimulating drugs, different ovulation stimulating protocols, different transplantation methods and the number of transplants. But the process of IVF-ET is complex, the relevant methods of economic study are diverse, and there are no unified standard for outcome indicators, so there is no unified conclusion for more economical and effective protocol by now. Therefore, to analyze the economic studies of IVF-ET, and to explore appropriate evaluation methods and cost-effective protocols will be helpful for reasonable allocation of medical resources and guidance of clinical selection. It would provide policy reference to include the costs of IVF-ET treatment in health insurance in the future.
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Affiliation(s)
| | - Runju ZHANG
- 张润驹(1978-), 男, 博士, 副主任医师, 硕士生导师, 主要从事生殖内分泌、子宫内膜容受性、胚胎着床研究; E-mail:
;
https://orcid.org/0000-0003-4438-4416
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76
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Tan J, Qi YN, Zhang J, Wang W, Zhang GT, Zou K, Liu XH, Sun X. The mediation effect of multiple gestations on the association between in vitro fertilisation and severe maternal morbidities: a retrospective cohort study. BMJ Open 2019; 9:e022670. [PMID: 31289046 PMCID: PMC6629382 DOI: 10.1136/bmjopen-2018-022670] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To investigate whether the association between in vitro fertilisation (IVF) and severe maternal morbidity (SMM) was mediated by multiple gestations. DESIGN A retrospective cohort study. SETTING The study was conducted at six hospitals in China. PARTICIPANTS Pregnant women at 20 gestational weeks or longer. OUTCOME MEASURE The outcome was SMM, which was a composite of potential life-threatening conditions, the use of critical medical interventions, or the status of maternal near-miss that occurred during pregnancy, childbirth or within 42 days of pregnancy termination, as defined by WHO. RESULTS In total, 22 368 eligible pregnant women were included, among whom 497 (2.2%) received IVF, and 776 developed SMM (incidence 34.7/1000 live births, 95% CI 32.3/1000 to 37.1/1000). Four multivariable logistic regression models were constructed. Model 1, without including the variable of multiple gestations, showed that IVF was associated with higher risk of SMM (adjusted OR (aOR) 1.54, 95% CI 1.03 to 2.29). Model 2, assessing the association between IVF and multiple gestations, showed that IVF was strongly associated with multiple gestations (aOR 14.75, 95% CI 11.38 to 19.10). Model 3, by adding the variable of multiple gestations to model 1, showed that IVF was not statistically associated with SMM (aOR 0.89, 95% CI 0.58 to 1.36), but multiple gestations were associated with higher risk of SMM (aOR 5.92, 95% CI 4.88 to 7.83). Model 4, investigating the association between IVF and SMM among singleton pregnancies, showed no statistically significant association (aOR 0.70, 95% CI 0.37 to 1.32). An additional analysis by adding the interaction term of IVF by multiple gestations to model 3 showed no statistical significance of the interaction term (aOR 1.15, 95% CI 0.36 to 3.68), confirming the absence of exposure-mediator interaction. CONCLUSIONS Using the established rule for judging mediation effect, the results suggested that multiple gestations might mediate the association between the use of IVF and higher risk of SMM. Further prospective studies are warranted to test our finding.
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Affiliation(s)
- Jing Tan
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ya-Na Qi
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Zhang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Wen Wang
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Gui-Ting Zhang
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Kang Zou
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xing-Hui Liu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xin Sun
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
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Vogiatzi P, Pouliakis A, Siristatidis C. An artificial neural network for the prediction of assisted reproduction outcome. J Assist Reprod Genet 2019; 36:1441-1448. [PMID: 31218565 PMCID: PMC6642243 DOI: 10.1007/s10815-019-01498-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 05/28/2019] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To construct and validate an efficient artificial neural network (ANN) based on parameters with statistical correlation to live birth, to be used as a comprehensive tool for the prediction of the clinical outcome for patients undergoing ART. METHODS Data from 257 infertile couples that underwent a total of 426 IVF/ICSI cycles from 2010 to 2017 was collected on an ensemble of 118 parameters for each cycle. Statistical correlation of the parameters with the outcome of live birth was performed, using either t test or χ2 test, and the parameters that demonstrated statistical significance were used to construct the ANN. Cross-validation was performed by random separation of data and repeating the training-testing procedure by 10 times. RESULTS 12 statistically significant parameters out of the initial ensemble were used for the ANN construction, which exhibited a cumulative sensitivity and specificity of 76.7% and 73.4%, respectively. During cross-validation, the system exhibited the following: sensitivity 69.2% ± 2.36%, specificity 69.19% ± 2.8% (OR 5.21 ± 1.27), PPV 36.96 ± 3.44, NPV 89.61 ± 1.09, and OA 69.19% ± 2.69%. A rather small standard deviation in the performance indices between the training and test sets throughout the validation process indicated a stable performance of the constructed ANN. CONCLUSIONS The constructed ANN is based on statistically significant variables with the outcome of live birth and represents a stable and efficient system with increased performance indices. Validation of the system allowed an insight of its clinical value as a supportive tool in medical decisions, and overall provides a reliable approach in the routine practice of IVF units in a user-friendly environment.
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Affiliation(s)
- Paraskevi Vogiatzi
- Assisted Reproduction Unit, Third Department of Obstetrics and Gynecology, Medical School, "Attikon" University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, Chaidari, 12642, Athens, Greece
| | - Abraham Pouliakis
- Second Department of Pathology, Medical School, "Attikon" University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, Chaidari, 12642, Athens, Greece
| | - Charalampos Siristatidis
- Assisted Reproduction Unit, Third Department of Obstetrics and Gynecology, Medical School, "Attikon" University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, Chaidari, 12642, Athens, Greece.
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78
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Sperling CD, Kjaer SK, Hargreave M, Jensen A. Risk of juvenile idiopathic arthritis among children conceived after fertility treatment: a nationwide registry-based cohort study. Hum Reprod 2019; 34:1139-1145. [PMID: 30927428 DOI: 10.1093/humrep/dez035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/15/2019] [Accepted: 02/25/2019] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Is the risk of juvenile idiopathic arthritis (JIA) increased in children conceived after fertility treatment, and is an observed association caused by specific types of fertility treatment or by factors associated with the underlying infertility? SUMMARY ANSWER The risk of JIA in children conceived after fertility treatment (any and specific types of fertility treatment) was not convincingly affected when compared with children born to fertile women. WHAT IS KNOWN ALREADY It has been suggested that fertility treatment may affect the development of the immune system and thereby increase the risk of developing autoimmune diseases, including JIA. STUDY DESIGN, SIZE, DURATION This retrospective population-based cohort study included all live-born children in Denmark between 1 January 1996 and 31 December 2012 (n = 1 084 184). The study population was followed from date of birth until first diagnosis of JIA as registered in the Danish National Patient Registry, date of 16th birthday, date of emigration, date of death or end of follow-up (31 December 2014), whichever occurred first. PARTICIPANTS/MATERIALS, SETTING, METHODS The study cohort was linked to the Danish Infertility Cohort in order to identify children born to women with fertility problems (n = 174 702) and fertility treatment (n = 89 931). Cox proportional hazard regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for potential confounders. MAIN RESULTS AND THE ROLE OF CHANCE During a median follow-up period of 10.3 years, 2237 children were diagnosed with JIA. Children born to women with fertility problems had an increased risk of JIA (HR 1.18, 95% CI 1.05-1.32) compared with children born to fertile women. However, the risk was not increased in children conceived after any fertility treatment (HR 1.11; 95% CI 0.95-1.29), or after specific types of fertility treatment being ART (HR 1.05; 95% CI 0.83-1.33), IVF (HR 1.01; 95% CI 0.73-1.38), ICSI (HR 0.98; 95% CI 0.64-1.50) or any fertility drugs (HR 1.10; 95% CI 0.94-1.28) compared with children born to fertile women. The associations between fertility treatment and JIA were also assessed by using children born to women with fertility problems without fertility treatment in the index pregnancy as a reference group, however, the findings did not change substantially. LIMITATIONS REASONS FOR CAUTION Despite a large study population, the statistical precision in some subgroup analyses may be affected due to the low number of JIA cases. There may be some misclassification of fertility problems, as some women have undiagnosed fertility problems and are therefore not included in the Danish Infertility Cohort; potentially leading to slight attenuation of the association between fertility problems and JIA. WIDER IMPLICATIONS OF THE FINDINGS The results are based on national data and our findings can therefore be applied to other similar populations. Our results indicate that fertility treatment per se do not increase the risk of JIA but merely that the increased risk of JIA observed among children born to women with fertility problems may be due to underlying factors related to both infertility and JIA. However, as this is the first large study in this field, further studies are needed to confirm our findings. STUDY FUNDING/COMPETING INTEREST(S) The study was supported by grants from the Jascha Foundation, the Aase and Ejner Danielsens Foundation and The Danish Rheumatism Association. All authors report no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- C D Sperling
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - S K Kjaer
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - M Hargreave
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - A Jensen
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
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Jin H, Huang X, Lin J, Jin C, Teng Y, Yu R. Impact of high body mass index with or without polycystic ovarian syndrome on the outcome of in vitro fertilization. J PAK MED ASSOC 2019; 69:852-856. [PMID: 31189294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To investigate the effect of high body mass index and polycystic ovarian syndrome alone or both on the outcome of in vitro fertilisation-embryo transfer. METHODS The retrospective study was conducted at the First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China, and comprised data from August 2015 to November 2016 of infertility patients with polycystic ovarian syndrome or tubal factors who underwent agonist long-protocol in vitro fertilisation-embryo transfer. Group A comprised polycystic ovarian syndrome patients who were further divided into normal weight A1 and overweight A2. Group B had tubal patients who were further divided into normal weight B1 and overweight B2. SPSS 16 was used for data analysis. RESULTS Of the 428 patients, 153 were in Group A and 275 in Group B. Further, Group A1 had 94(61.44%) patients and Group A2 had 59(38.56%) (p<0.01), while Group B1 had 219(81.64%) and Group B 56(18.36%) patients. The dose of gonadotropins and the duration of stimulation were significantly greater in Group A2 than Group A1(p<0.01), but there was no statistically significant difference in the tubal groups (p>0.05). Significantly more retrieved oocytes and high-quality embryos were observed in the Group A1 (p<0.01). The difference of the maturating rate, fertilisation rate, implantation rate, pregnancy rate and early abortion rate were not significant among the groups (p>0.05).. CONCLUSIONS Polycystic ovarian syndrome with high body mass index had a negative effect on the ovarian response to gonadotropins. Pregnancy outcomes were not influenced by body mass index in tubal patients.
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Affiliation(s)
- Hao Jin
- Organ transplant center, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Xuefeng Huang
- Reproductive medical center, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Jinju Lin
- Reproductive medical center, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Congcong Jin
- Reproductive medical center, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Yill Teng
- Reproductive medical center, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Rong Yu
- Reproductive medical center, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
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Abstract
Objectives The Ontario Fertility Program (OFP) funds 5,000 annual in vitro fertilization (IVF) cycles. We hypothesized that after introduction of the OFP, there would be an increase in duplicate infertility consultations by patients attempting to increase chances at obtaining publicly funded IVF through enlisting at multiple fertility clinics. Methods This retrospective observational study included women eligible for healthcare services in Ontario from 2014 to 2016 and compared infertility consultations pre- and post-initiation of the OFP. Results Post-OFP, the average number of consultations per patient and the proportion of patients with more than one consult increased (1.04 vs. 1.05, p = 0.015 and 3.8% vs. 4.2%, p = 0.027, respectively). Total consultations for infertility increased from 24,565 to 27,714 post-OFP. The OFP had the largest impact in the Greater Toronto Area (GTA). Conclusion The OFP resulted in a statistically significant increase in duplicate consultations, although unlikely to be of clinical relevance. The disproportionate impact seen in the GTA highlights the inequitable access to fertility care in Ontario.
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Affiliation(s)
- Angela Assal
- Endocrinologist, Division of Endocrinology and Metabolism, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Claire Ann Jones
- GREI Specialist, Department of Obstetrics and Gynaecology, Mount Sinai Fertility, Sinai Health System, Toronto, ON
| | - Tamas Gotz
- GREI Specialist, Department of Obstetrics and Gynaecology, Mount Sinai Fertility, Sinai Health System, Toronto, ON
| | - Baiju R Shah
- Endocrinologist, Division of Endocrinology and Metabolism, Sunnybrook Health Sciences Centre, Institute for Clinical Evaluative Sciences, Toronto, ON
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81
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Tulić L, Vidaković S, Tulić I, Ćurčić M, Bulat Z. Toxic Metal and Trace Element Concentrations in Blood and Outcome of In Vitro Fertilization in Women. Biol Trace Elem Res 2019; 188:284-294. [PMID: 29951726 DOI: 10.1007/s12011-018-1421-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/20/2018] [Indexed: 01/20/2023]
Abstract
The aim of this study was to investigate the association of trace element and toxic metal concentrations in blood and the outcome of in vitro fertilization (IVF). The study included 104 consecutive patients that underwent assisted reproductive technology (ART) procedures. The following parameters were determined: cadmium (Cd), mercury (Hg), arsenic (As), and lead (Pb); and copper (Cu), zinc (Zn), selenium (Se), and magnesium (Mg). Serum samples were obtained before commencing stimulation. Patients with smoking habit had significantly higher Pb concentrations (P = 0.022), as well as higher concentrations of As and Hg but not significantly. All subjects were divided into groups of pregnant and nonpregnant patients. Pregnant patients had lower mean values of Mg (P = 0.009), As (P < 0.05), and Pb (P = 0.034), compared to nonpregnant, and a significant correlation between pregnancy outcome and concentrations of Mg, Cd, and Pb was found. Women who had had delivered had lower Mg (P = 0.009) and Cd (P = 0.014) concentrations. There was a significant correlation of the negative outcome of IVF procedure with higher concentrations of Pb (P = 0.046) and Cd (P = 0.012). In conclusion, our results suggest that there is a difference in Mg, Pb, and Cd concentrations between pregnant and nonpregnant women. There was no association between toxic metals and number and quality of oocytes and embryos, while there was with fertilization rate. Concerning trace elements, we did not find the correlation of trace elements with oocyte number and quality, nor with a number of fertilized oocytes, except for Cu. Patients who were pregnant had lower concentrations of Mg.
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Affiliation(s)
- Lidija Tulić
- Department of In Vitro Fertilization, Clinic of Gynecology and Obstetrics, Clinical Center of Serbia, Koste Todorovica 26, Belgrade, 11000, Serbia.
- Gynecology and Obstetrics, Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia.
| | - Snezana Vidaković
- Department of In Vitro Fertilization, Clinic of Gynecology and Obstetrics, Clinical Center of Serbia, Koste Todorovica 26, Belgrade, 11000, Serbia
- Gynecology and Obstetrics, Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia
| | - Ivan Tulić
- Department of In Vitro Fertilization, Clinic of Gynecology and Obstetrics, Clinical Center of Serbia, Koste Todorovica 26, Belgrade, 11000, Serbia
- Gynecology and Obstetrics, Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia
| | - Marijana Ćurčić
- Department of Toxicology "Akademik Danilo Soldatović," Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, Belgrade, 11221, Serbia
| | - Zorica Bulat
- Department of Toxicology "Akademik Danilo Soldatović," Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, Belgrade, 11221, Serbia
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82
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Abstract
Patients who undergo several in-vitro fertilization (IVF) treatment cycles and fail to conceive present a frustrating problem to the clinician. When 1 cycle of IVF treatment fails, should we offer the couples to choose additional cycle of IVF instead of evaluation of the potential peritoneal factor? In cases of otherwise unexplained infertility, the investigation cannot be considered to be complete until laparoscopy has been performed. The aim of the study is to investigate the fertility outcome of laparoscopic treatment in infertile women with repeated IVF failures.This is a retrospective case-control study conducted in a tertiary care, academic teaching hospital from January 2012 to December 2015. Patients recruited in this study were classified into 2 groups. Study group (n = 45) were offered laparoscopy for evaluation of infertility, control group (n = 45) elected to proceed to IVF without laparoscopy. Diagnostic laparoscopy and subsequent excision of suspected endometriotic lesions, lysis of adhesion and treatment of tubal pathology were performed when indicated.Forty-four (97.8%) patients in study had pelvic pathologies and the treatment was performed at the same time. Twenty-four patients in study group conceived including 16 patients conceived spontaneously and 14 patients conceived with additional IVF following laparoscopy management. There was a significant difference in the ongoing pregnancy rates between patients conceived through IVF in study group and control group (41.9% vs 19.6%, P < .05).Laparoscopy in women with normal hysterosalpingography but recurrent IVF failures can detect unrecognized pelvic pathologies. Laparoscopy evaluation prior to additional cycle of IVF seems to improve the subsequent pregnancy rate.
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83
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Mao X, Wu L, Chen Q, Kuang Y, Zhang S. Effect of hysteroscopy before starting in-vitro fertilization for women with recurrent implantation failure: A meta-analysis and systematic review. Medicine (Baltimore) 2019; 98:e14075. [PMID: 30762725 PMCID: PMC6408091 DOI: 10.1097/md.0000000000014075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To study if hysteroscopy (HSC) before starting an in-vitro fertilization (IVF) cycle improves IVF outcomes in women with recurrent implantation failure (RIF). METHODS The Medline, Cochrane, EMBASE, and Google Scholar databases were searched using the following keywords until March 31, 2017: in-vitro fertilization; infertility; hysteroscopy; recurrence; embryo implantation; and pregnancy. Randomized controlled trials (RCTs), two-arm prospective studies, and retrospective studies were included. RESULTS Three RCTs, 3 nonrandomized prospective studies, and 2 retrospective cohort studies were included. The eligible studies included 3932 women with RIF: 1841 in the HSC group and 2091 in the control group. The clinical pregnancy rate and implantation rate was significantly higher in the HSC group compared with the control group (for clinical pregnancy rate, pooled odds ratio [OR] = 1.64, 95% confidence intervals [CI]: 1.30-2.07, P < 0.001; for implantation rate, pooled OR = 1.22, 95% CI: 1.02-1.45, P = 0.025). The live birth rate (pooled OR = 1.30, 95% CI: 0.90-1.88, P = 0.168) and the miscarriage rate (pooled OR = 0.94, 95% CI: 0.66-1.35, P = 0.744) of the 2 groups were not statistically significantly. CONCLUSIONS HSC improved the implantation rate and clinical pregnancy rates, but failed to improve live birth rate and did not affect the miscarriage rate in women with RIF undergoing IVF. Since HSC plays a significant role in pregnancy and birth outcomes of women with RIF, further studies are warranted.
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Affiliation(s)
- Xiaoyan Mao
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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84
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Kim MS, Choi DH, Kwon H, Ahn E, Cho HY, Baek MJ, Shin JE, Moon MJ. Procedural and obstetric outcomes after embryo reduction vs fetal reduction in multifetal pregnancy. Ultrasound Obstet Gynecol 2019; 53:214-218. [PMID: 29418029 DOI: 10.1002/uog.19024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/28/2018] [Accepted: 02/02/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To compare the obstetric outcome and incidence of procedure-related adverse events after embryo reduction (ER) vs fetal reduction (FR), in multifetal pregnancies undergoing reduction to twins or singletons. METHODS We analyzed retrospectively data from multifetal pregnancies that underwent transvaginal ER (n = 181) at a mean gestational age of 7.6 weeks or transabdominal FR (n = 115) at a mean gestational age of 12.9 weeks between December 2006 and January 2017. FR was performed after a detailed fetal anomaly scan. The two groups were compared with respect to obstetric outcomes, such as incidence of miscarriage, early or late preterm delivery, maternal complications and fetal loss, and procedure-related adverse events, including incidence of subchorionic hematoma and procedure-related fetal loss. RESULTS Compared with pregnancies that underwent ER, the incidence of procedure-related fetal loss was lower in the FR group (7.2% vs 0.9%; P = 0.039; odds ratio (OR), 0.12; 95% CI, 0.02-0.89). Mean gestational age at delivery for twins was 34.2 weeks in the ER group and 35.7 weeks in the FR group (P = 0.014). Compared with the ER group, the FR group had lower miscarriage (8.8% vs 2.6%; P = 0.045; OR, 0.28; 95% CI, 0.08-0.97) and overall fetal loss (13.3% vs 5.2%; P = 0.031; OR, 0.36; 95% CI, 0.14-0.91) rates. CONCLUSIONS The FR procedure is, overall, a better and safer approach to reducing morbidity and mortality in multifetal pregnancies. Spontaneous demise of one fetus may occur after ER, and FR has the advantage that chorionic villus sampling and ultrasound screening for increased nuchal translucency and anatomical defects can be conducted before the procedure. The ER approach is still reasonable when a patient's religious or other ethical concerns are of primary importance. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M S Kim
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - D H Choi
- Fertility Center of CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - H Kwon
- Fertility Center of CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - E Ahn
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - H Y Cho
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - M J Baek
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - J E Shin
- Fertility Center of CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - M J Moon
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, Seongnam, Republic of Korea
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85
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Xu B, Chen Y, Geerts D, Yue J, Li Z, Zhu G, Jin L. Cumulative live birth rates in more than 3,000 patients with poor ovarian response: a 15-year survey of final in vitro fertilization outcome. Fertil Steril 2019; 109:1051-1059. [PMID: 29935642 DOI: 10.1016/j.fertnstert.2018.02.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/30/2018] [Accepted: 02/01/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To estimate the cumulative live birth rates (CLBRs) in women with poor ovarian response (POR) diagnosed according to the Bologna criteria. DESIGN A 15-year population-based observational cohort study. SETTING Teaching hospital. PATIENT(S) Between 2002 and 2016 a total of 3,391 women with POR were followed from their first fresh, nondonor IVF cycle until they had a live birth or discontinued treatment. All IVF and intracytoplasmic sperm injection (ICSI) cycles and cryocycles were included. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Live birth rates per initiated cycle, the conservative and optimistic CLBR for multiple IVF cycles. RESULT(S) The CLBRs after six IVF cycles were 14.9% for the conservative and 35.3% for the optimistic estimate. The CLBR decreased from 22% for women ≤30 years to 18.3% for women aged 31-34 years, 17.2% for 35-37 years, 13.5% for 38-40 years, 10.5% for 41-43 years, and 4.4% among women >43 years in the conservative analysis. There was a significant decreased CLBR starting at age 38 years compared with women <35 years. After adjusting for age, antral follicle count, basal FSH level, and IVF cycle number, natural cycles were associated with the lowest CLBR among all the protocols, and this difference was significant compared with the other protocols. CONCLUSION(S) For women with POR, the CLBR declined with increasing age. Women with advanced age (≥38 years) achieved a significantly lower CLBR than young poor responders (<35 years). Very low CLBR was associated with women aged >43 years old. Natural cycle IVF is of no benefit for these patients.
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Affiliation(s)
- Bei Xu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Yingjia Chen
- Department of Neurology, University of California, San Francisco, California
| | - Dirk Geerts
- Department of Medical Biology, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | - Jing Yue
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Zhou Li
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Guijin Zhu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Lei Jin
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
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Safarian GK, Gzgzyan AM, Dzhemlikhanova Lyailya K, Niauri Dariko A. Does subclinical hypothyroidism and/or thyroid autoimmunity influence the IVF/ICSI outcome? Review of the literature. Gynecol Endocrinol 2019; 35:56-59. [PMID: 31532314 DOI: 10.1080/09513590.2019.1653564] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
While overt hypothyroidism is a well-known risk factor for infertility, the association of subclinical hypothyroidism (SCH) or thyroid autoimmunity and reproductive failure has been still not elucidated. In this literature review, the current data on the effect of SCH and/or thyroid autoimmunity and human reproduction is presented. The main ART outcome measures are as follows: number of oocytes retrieved, fertilization rate, implantation rate, clinical pregnancy rate per embryo transfer, embryo quality, miscarriage rate, and live birth rate. Current guidelines on the management of women with SCH and/or thyroid autoimmunity undergoing ART cycles will be presented in this review.
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Affiliation(s)
| | - Alexander Mkrtichevich Gzgzyan
- St. Petersburg State University , St. Petersburg , Russia
- The Research Institute of Obstetrics, Gynecology and Reproduction Named after D.O. Ott , St. Petersburg , Russia
| | - Kharryasovna Dzhemlikhanova Lyailya
- St. Petersburg State University , St. Petersburg , Russia
- The Research Institute of Obstetrics, Gynecology and Reproduction Named after D.O. Ott , St. Petersburg , Russia
| | - Alexandrovna Niauri Dariko
- St. Petersburg State University , St. Petersburg , Russia
- The Research Institute of Obstetrics, Gynecology and Reproduction Named after D.O. Ott , St. Petersburg , Russia
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87
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Shrem G, Brudner Y, Atzmon Y, Michaeli M, Ellenbogen A, Shalom-Paz E. The influence of obesity, smoking, and serum follicular stimulating hormone in azoospermic patients on testicular sperm extraction-intra cytoplasmic sperm injection outcomes: A retrospective cohort study. Medicine (Baltimore) 2019; 98:e14048. [PMID: 30681561 PMCID: PMC6358354 DOI: 10.1097/md.0000000000014048] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
To examine the effect of serum follicle-stimulating hormone (sFSH) level, body-mass index (BMI) and smoking on Testicular Sperm Extraction-Intracytoplasmic Sperm Injection (TESE-ICSI), and pregnancy outcomes.In this retrospective study, data were extracted from files of 52 azoospermic men who underwent TESE and in-vitro fertilization (IVF)-ICSI in our IVF unit. Demographic information, treatment cycle follow-up and pregnancy outcomes were collected.Fifty-two patients underwent 79 TESE due to azoospermia in 143 IVF cycles. Smoking was found to significantly affect sperm motility in TESE specimens before freezing (45.5% vs 14.8%; P <.001); however, this finding did not influence the pregnancy rate. Male FSH was inversely correlated with testicle volume (r = -0.595, P <.0001). Body weight did not affect semen parameters after TESE or ICSI outcomes.Among azoospermic patients with extremely poor sperm quality, male BMI, male FSH or smoking did not have an adverse effect sperm parameters or pregnancy and delivery rates.
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Affiliation(s)
- Guy Shrem
- Department of Obstetrics & Gynecology, Hillel Yaffe Medical Center, Hadera
| | - Yana Brudner
- Department of Obstetrics & Gynecology, Hillel Yaffe Medical Center, Hadera
| | - Yuval Atzmon
- Department of Obstetrics & Gynecology, Hillel Yaffe Medical Center, Hadera
| | - Mediea Michaeli
- Department of Obstetrics & Gynecology, Hillel Yaffe Medical Center, Hadera
| | - Adrian Ellenbogen
- The Bruce and Ruth Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Israel
| | - Einat Shalom-Paz
- Department of Obstetrics & Gynecology, Hillel Yaffe Medical Center, Hadera
- The Bruce and Ruth Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Israel
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88
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Abstract
To explore the effect of interventional embolization treatment for hydrosalpinx on the outcome of in vitro fertilization and embryo transfer (IVF-ET).During the period from January 2013 to January 2015, a total of 129 patients with unilateral or bilateral hydrosalpinx were treated with IVF-ET and selected for retrospective analysis. Seventy-three patients (intervention group) with unilateral or bilateral hydrosalpinx were treated with fallopian tube embolization, which was followed by IVF-ET. During the same period, 56 patients (control group) with unilateral or bilateral hydrosalpinx directly received IVF-ET without receiving any treatment for hydrosalpinx.The clinical pregnancy rate of the control group was significantly lower than that of the intervention group (P < .05), while the abortion rate and ectopic pregnancy rate of the control group were strikingly higher than that of the intervention group (P < .05).Hydrosalpinx can decrease the clinical pregnancy rate of IVF-ET, and increase the incidence of abortion and ectopic pregnancy. The interventional embolization treatment for hydrosalpinx before IVF-ET can improve the clinical pregnancy rate and reduce adverse pregnancy outcome and which, with the advantages of a high success rate, convenient use, low cost, less pain, no anesthetic risk and no effect on the ovarian function it may further be developed for use in the clinic.
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Affiliation(s)
- Xin Hong
- Department of Interventional Radiology, The Second Affiliated Hospital of Nantong University
| | - Wen-bin Ding
- Department of Interventional Radiology, The Second Affiliated Hospital of Nantong University
| | - Rui-fan Yuan
- Department of Interventional Radiology, The Second Affiliated Hospital of Nantong University
| | - Jia-yi Ding
- Center for Reproductive Medicine, Nantong Maternal and Child Care Service Centre, Nantong, Jiangsu Province, China
| | - Jie Jin
- Department of Interventional Radiology, The Second Affiliated Hospital of Nantong University
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89
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Kwek LK, Saffari SE, Tan HH, Chan JK, Nada S. Comparison between Single and Double Cleavage-Stage Embryo Transfers, Single and Double Blastocyst Transfers in a South East Asian In Vitro Fertilisation Centre. Ann Acad Med Singap 2018; 47:451-454. [PMID: 30578424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION This study investigated the differences in clinical pregnancy rate (CPR), live birth rate (LBR) and multiple pregnancy rate (MPR) between double cleavage-stage embryo transfers compared to single and double blastocysts stage embryo transfers in a single academic medical centre. MATERIALS AND METHODS This was a retrospective cohort study performed at the KK Women's and Children's Hospital In Vitro Fertilisation (KKIVF) Centre of all women who underwent fresh-cycle in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) cycles over a 5-year period. The outcome measures were CPR, LBR and MPR. The study included 5294 cycles, of which 539 patients underwent single embryo transfer (SET); 4533 patients underwent double embryo transfer (DET); 84 patients underwent double blastocyst embryo transfer (DBT); and 65 patients underwent single blastocyst embryo transfer (SBT). RESULTS The mean age of patients undergoing single blastocysts stage embryo transfer was lower than the other 2 groups. The DET, single and double blastocysts stage embryo transfer groups achieved similar LBR (33.9%, 38.7%, 35.4%, P >0.05) and CPR (42.4%, 46.2%, 46.9%). CONCLUSION We found that single blastocysts stage embryo transfer is associated with similar LBR and CPR compared to double blastocysts stage embryo transfer and DET, with lower MPRs, and should be offered as standard practice, where possible.
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Affiliation(s)
- Lee Koon Kwek
- Department of Obstetrics & Gynaecology, KK Women's and Children's Hospital, Singapore
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90
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Kreines FM, Nasioudis D, Minis E, Irani M, Witkin SS, Spandorfer S. IL-1β predicts IVF outcome: a prospective study. J Assist Reprod Genet 2018; 35:2031-2035. [PMID: 30225820 DOI: 10.1007/s10815-018-1296-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 08/21/2018] [Indexed: 01/28/2023] Open
Abstract
PURPOSE Retrospective cohort studies have shown a relationship between maternal serum interleukin-1β (IL-1β) and interleukin-1 receptor antagonist (IL-1Ra) levels and in vitro fertilization (IVF) cycle outcome. The objective of this investigation was to explore the correlation between serum IL-1β and/or IL-1Ra levels obtained prospectively and IVF outcomes. METHODS Sera from 205 women were collected just prior to initiation of their IVF cycle, at the time of human chorionic gonadotropin administration, day 24 of IVF cycle, day 28, and day 35. Sera were analyzed for IL-1β and IL-1Ra using commercially available ELISA kits. Cycle outcomes were followed prospectively. Data were analyzed using Friedman analysis of variance by ranks and chi-square analysis. RESULTS Among women with a viable pregnancy, IL-1β serum levels increased over time for those that proceeded to deliver or had an ongoing pregnancy. There was no increase in serum levels for those with subsequent pregnancy loss. Of the women that had an embryo transfer, detectable IL-1β levels at the start of the cycle were associated with successful IVF outcome (p = 0.027). Of women with a positive pregnancy test, undetectable IL-1β at the start of the cycle were associated with subsequent pregnancy loss (p = 0.046). For all IL1-Ra serum analysis, there were no significant results. CONCLUSIONS The increasing levels of IL-1β over time are consistent with the known role of the IL-1 cytokine family in implantation and pregnancy. Additionally, we confirm in a prospective investigation the positive relationship between detectable serum IL-1β at the start of IVF cycle and outcome.
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Affiliation(s)
- Fabiana M Kreines
- Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA
| | - Dimitrios Nasioudis
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, 1300 York Ave, New York, NY, 10065, USA
| | - Evelyn Minis
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, 1300 York Ave, New York, NY, 10065, USA
| | - Mohamad Irani
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Ave, New York, NY, 10021, USA
| | - Steven S Witkin
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, 1300 York Ave, New York, NY, 10065, USA
| | - Steven Spandorfer
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Ave, New York, NY, 10021, USA.
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Grin L, Mizrachi Y, Cohen O, Lazer T, Liberty G, Meltcer S, Friedler S. Does progesterone to oocyte index have a predictive value for IVF outcome? A retrospective cohort and review of the literature. Gynecol Endocrinol 2018; 34:638-643. [PMID: 29373930 DOI: 10.1080/09513590.2018.1431772] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The potential adverse effect of Serum progesterone (SP) elevation on the day of hCG administration is a matter of continued debate. Our study aimed to evaluate the relative value of progesterone to a number of aspirated oocytes ratio (POI) to predict clinical pregnancy (CP) and live birth (LB) in fresh IVF cycles and to review the relevant literature. A retrospective analysis of GnRH Antagonist IVF-ET cycles. POI was calculated by dividing the SP on the day of hCG by the number of aspirated mature oocytes. A multivariate logistic regression analysis was performed to evaluate the predictive value of POI for CP and LB. Cycle outcome parameters included clinical pregnancy, live-birth and miscarriage. A total of 2,693 IVF/ICSI cycles were analyzed. POI was inversely associated with CP adjusted OR 0.063 (95% CI 0.016-0.249, p < .001) and with LB adjusted OR 0.036 (95% CI 0.007-0.199, p < .001). For prediction of LB, the area under the curve (AUC) was 0.68 (95% CI 0.64-0.71, p < .001) for the POI model. POI above the 90th percentile with a value of 0.36 ng/mL/oocyte results in CP and LB rates of 8.0 and 5.9%, respectively. POI is a simple index for the prediction of IVF-ET cycle outcomes, it can advocate a limit above which embryo transfer should be reconsidered.
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Affiliation(s)
- Leonti Grin
- a Department of OBGYN and Infertility, Barzilai University Medical Center, Faculty of Health Sciences , Ben-Gurion University of the Negev Ashkelon , Ashkelon , Israel
| | - Yossi Mizrachi
- b Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Sackler Faculty of Medicine , Tel Aviv University , Holon , Israel
| | - Ornit Cohen
- a Department of OBGYN and Infertility, Barzilai University Medical Center, Faculty of Health Sciences , Ben-Gurion University of the Negev Ashkelon , Ashkelon , Israel
| | - Tal Lazer
- a Department of OBGYN and Infertility, Barzilai University Medical Center, Faculty of Health Sciences , Ben-Gurion University of the Negev Ashkelon , Ashkelon , Israel
| | - Gad Liberty
- a Department of OBGYN and Infertility, Barzilai University Medical Center, Faculty of Health Sciences , Ben-Gurion University of the Negev Ashkelon , Ashkelon , Israel
| | - Simion Meltcer
- a Department of OBGYN and Infertility, Barzilai University Medical Center, Faculty of Health Sciences , Ben-Gurion University of the Negev Ashkelon , Ashkelon , Israel
| | - Shevach Friedler
- a Department of OBGYN and Infertility, Barzilai University Medical Center, Faculty of Health Sciences , Ben-Gurion University of the Negev Ashkelon , Ashkelon , Israel
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92
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Gluck O, Tamayev L, Torem M, Bar J, Raziel A, Sagiv R. The Impact of Salpingectomy on Anti-Mullerian Hormone Levels and Ovarian Response of In Vitro Fertilization Patients. Isr Med Assoc J 2018; 20:509-512. [PMID: 30084578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Laparoscopic salpingectomy is strongly related to successful in vitro fertilization (IVF) treatments. OBJECTIVES To compare the ovarian reserve, including anti-mullerian hormone (AMH) levels, in patients who underwent salpingectomy before IVF to IVF patients who had not been salpingectomized. METHODS In this retrospective study, medical records of women who were treated by the IVF unit at our institute were reviewed. We retrieved demographic data, surgical details, and data regarding the ovarian reserve. Details of 35 patients who were treated by IVF after salpingectomy were compared to 70 IVF patients with no history of salpingectomy treatment. Nine women underwent IVF treatment before and after having salpingectomy, and their details were included in both groups. RESULTS The levels of AMH, follicular stimulating hormone (FSH), estradiol, and progesterone were not significantly different in the groups. The antral follicular count (AFC), number of oocytes retrieved, amount of gonadotropin administered for ovarian stimulation, and number of embryos transferred (ET) were also not significantly different. CONCLUSIONS Salpingectomy does not seem to affect ovarian reserve in IVF patients.
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Affiliation(s)
- Ohad Gluck
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liliya Tamayev
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maya Torem
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arieh Raziel
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Sagiv
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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93
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Kitano Y, Hashimoto S, Matsumoto H, Yamochi T, Yamanaka M, Nakaoka Y, Fukuda A, Inoue M, Ikeda T, Morimoto Y. Oral administration of l-carnitine improves the clinical outcome of fertility in patients with IVF treatment. Gynecol Endocrinol 2018; 34:684-688. [PMID: 29378447 DOI: 10.1080/09513590.2018.1431769] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Age-dependent decline of mitochondrial function has been proposed to be a main cause of decline of embryo quality. Then, l-carnitine plays important roles in reducing the membranous toxicity of free-fatty acids by forming acyl-carnitine and promoting β-oxidation, preventing cell damage. Recent research revealed that l-carnitine played important roles in vitro in oocyte growth, oocyte maturation and embryo development. However, such beneficial effects of l-carnitine in vivo have yet to be verified. The effect of oral l-carnitine supplementation on embryo quality and implantation potential was examined. A total of 214 patients were included in this study. They all previously received in vitro fertilization-embryo transfer (IVF-ET) and failed to conceive. Then they were administered l-carnitine for 82 days on average and underwent IVF-ET again. There were no significant differences in the total number of retrieved oocytes, and their maturation and fertilization rates between before and after l-carnitine administration. The quality of embryos on Days 3 and 5 after insemination was improved following l-carnitine administration (p < .05) in cycles after l-carnitine administration compared with previous cycles. Healthy neonates were born after IVF-ET following l-carnitine administration. Our data suggested that oral administration of l-carnitine to fertility patients improved the developmental competence of their oocytes after insemination.
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Affiliation(s)
- Yuko Kitano
- a IVF Namba Clinic , Osaka , Japan
- b Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| | | | | | | | | | | | | | | | - Tomoaki Ikeda
- b Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
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94
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Yang W, Yang R, Yang S, Li J, Tu B, Gao C, Wang Y. Infertile polycystic ovary syndrome patients undergoing in vitro fertilization with the gonadotropin-releasing hormone-antagonist protocol: role of hyperandrogenism. Gynecol Endocrinol 2018; 34:715-718. [PMID: 29376451 DOI: 10.1080/09513590.2018.1431773] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This retrospective cohort study is to assess the effects of hyperandrogenism (HA) in polycystic ovary syndrome (PCOS) patients with gonadotropin-releasing hormone (GnRH)-antagonist protocol during in vitro fertilization (IVF). Total 892 infertile Patients between 20 and 35 years of age with normal body mass index (BMI, 18.50 -24.99 kg/m2), including those with tubal factor infertility (control, n = 318), PCOS infertility with HA (HA PCOS, n = 244), and PCOS infertility without HA (non-HA PCOS, n = 330), were included. Number of retrieved oocytes was significantly higher and total Gonadotropin consumption was significant lower in the HA PCOS group, whereas abortion rate was significantly higher and live birth rate was significantly lower in the HA PCOS group, compared with the control and non-HA PCOS groups. In the HA PCOS group, the number of available embryos tended to be higher with no significance. The GnRH-antagonist protocol is more suitable for HA PCOS patients, with lower cost and more number of embryos available for transfer. Due to the high abortion rate and low live birth rate, a freeze-all approach might be a preferable option for HA PCOS patients so as to create a buffer for reducing androgen levels before transferring freeze-thawed embryos.
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Affiliation(s)
- Wan Yang
- a Reproductive Medical Center , Peking University Third Hospital , Beijing , China
| | - Rui Yang
- a Reproductive Medical Center , Peking University Third Hospital , Beijing , China
| | - Shuo Yang
- a Reproductive Medical Center , Peking University Third Hospital , Beijing , China
| | - Jia Li
- a Reproductive Medical Center , Peking University Third Hospital , Beijing , China
| | - Binbin Tu
- a Reproductive Medical Center , Peking University Third Hospital , Beijing , China
| | - Chang Gao
- a Reproductive Medical Center , Peking University Third Hospital , Beijing , China
| | - Ying Wang
- a Reproductive Medical Center , Peking University Third Hospital , Beijing , China
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95
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Liu AL, Liao HQ, Zhou J, Nie YL, Zhou CL, Li ZL, Guo ZF, He DX, Zhu YH, Peng CY. The role of FTO variants in the susceptibility of polycystic ovary syndrome and in vitro fertilization outcomes in Chinese women. Gynecol Endocrinol 2018; 34:719-723. [PMID: 29463151 DOI: 10.1080/09513590.2018.1441397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
We investigated the association between single nucleotide polymorphisms (SNPs) in the fat mass and obesity associated (FTO) gene (rs9926289 A/G, rs79206939 A/G, rs9930506 A/G, rs8050136 A/C, and rs1588413 C/T) and polycystic ovary syndrome (PCOS), as well as outcomes of in vitro fertilization (IVF). A case-control study consisting of 147 PCOS patients and 120 healthy controls was conducted. FTO SNPs were genotyped by PCR to determine allelic frequencies, and IVF outcomes were analyzed. The results showed that FTO rs8050136 (p = .025) and rs1588413 (p = .042) were significantly associated with PCOS susceptibility, and women with risk alleles were often found to be obese (p < .05). For SNP rs8050136, women with AA + AC genotypes had higher body mass indexes (BMIs), oral glucose tolerance test/2 h (OGTT) levels and implantation rates but lower follicle-stimulating hormone (FSH) and human chorionic gonadotropin (hCG) day progesterone levels and ovulation numbers (all p < .05) than those with the CC genotype. For SNP rs1588413, women carrying risk alleles exhibited higher BMIs, implantation rate, and levels of luteinizing hormone (LH), estradiol, and OGTT/2 h (all p < .05) compared with those with non-risk genotypes. Therefore, these findings suggest that rs8050136 and rs1588413 are associated with PCOS susceptibility, and that women with risk alleles have less ovulation numbers but higher implantation rates than those with other genotypes.
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Affiliation(s)
- Ai Ling Liu
- a Institute of Biology, School of Pharmaceutical and Biological Science , University of South China , Hengyang , PR China
- b Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study , Hengyang , PR China
- c The Key Laboratory of Biological Toxicology and Ecological Restoration of Hengyang City , Hengyang , PR China
| | - Hong Qing Liao
- d The Second Affiliated Hospital , University of South China in Hengyang City , Hengyang , PR China
| | - Jing Zhou
- d The Second Affiliated Hospital , University of South China in Hengyang City , Hengyang , PR China
| | - Yu Lin Nie
- d The Second Affiliated Hospital , University of South China in Hengyang City , Hengyang , PR China
| | - Cui Lan Zhou
- e Department of Anatomy , University of South China , Hengyang , PR China
| | - Zhi Liang Li
- a Institute of Biology, School of Pharmaceutical and Biological Science , University of South China , Hengyang , PR China
| | - Zi Fen Guo
- f Institute of Pharmacy and Pharmacology , University of South China , Hengyang , PR China
| | - Dong Xiu He
- f Institute of Pharmacy and Pharmacology , University of South China , Hengyang , PR China
| | - Yun Hua Zhu
- a Institute of Biology, School of Pharmaceutical and Biological Science , University of South China , Hengyang , PR China
| | - Cui Ying Peng
- a Institute of Biology, School of Pharmaceutical and Biological Science , University of South China , Hengyang , PR China
- b Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study , Hengyang , PR China
- c The Key Laboratory of Biological Toxicology and Ecological Restoration of Hengyang City , Hengyang , PR China
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96
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Daniel S, Rotem R, Koren G, Lunenfeld E, Levy A. Vaginal antimycotics and the risk for spontaneous abortions. Am J Obstet Gynecol 2018; 218:601.e1-601.e7. [PMID: 29510088 DOI: 10.1016/j.ajog.2018.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 02/18/2018] [Accepted: 02/26/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Spontaneous abortions are the most common complication of pregnancy. Clotrimazole and miconazole are widely used vaginal-antimycotic agents used for the treatment of vulvovaginal candidiasis. A previous study has suggested an increased risk of miscarriage associated with these azoles, which may lead health professionals to refrain from their use even if clinically indicated. OBJECTIVE The aim of the current study was to assess the risk for spontaneous abortions following first trimester exposure to vaginal antimycotics. STUDY DESIGN A historical cohort study was conducted including all clinically apparent pregnancies that began from January 2003 through December 2009 and admitted for birth or spontaneous abortion at Soroka Medical Center, Clalit Health Services, Beer-Sheva, Israel. A computerized database of medication dispensation was linked with 2 computerized databases containing information on births and spontaneous abortions. Time-varying Cox regression models were constructed adjusting for mother's age, diabetes mellitus, hypothyroidism, obesity, hypercoagulable or inflammatory conditions, recurrent miscarriages, intrauterine contraceptive device, ethnicity, tobacco use, and the year of admission. RESULTS A total of 65,457 pregnancies were included in the study: 58,949 (90.1%) ended with birth and 6508 (9.9%) with a spontaneous abortion. Overall, 3246 (5%) pregnancies were exposed to vaginal antimycotic medications until the 20th gestational week: 2712 (4.2%) were exposed to clotrimazole and 633 (1%) to miconazole. Exposure to vaginal antimycotics was not associated with spontaneous abortions as a group (crude hazard ratio, 1.11; 95% confidence interval, 0.96-1.29; adjusted hazard ratio, 1.11; 95% confidence interval, 0.96-1.29) and specifically for clotrimazole (adjusted hazard ratio, 1.05; 95% confidence interval, 0.89-1.25) and miconazole (adjusted hazard ratio, 1.34; 95% confidence interval, 0.99-1.80). Furthermore, no association was found between categories of dosage of vaginal antimycotics and spontaneous abortions. CONCLUSION Exposure to vaginal antimycotics was not associated with spontaneous abortions.
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Affiliation(s)
- Sharon Daniel
- Department of Public Health, Beer-Sheva, Israel; Faculty of Health Sciences, Beer-Sheva, Israel; Clalit Health Services (Southern District), Beer-Sheva, Israel
| | - Reut Rotem
- Department of Public Health, Beer-Sheva, Israel; Faculty of Health Sciences, Beer-Sheva, Israel
| | - Gideon Koren
- Faculty of Health Sciences, Beer-Sheva, Israel; Motherisk Israel and Maccabi Health Services, Tel Aviv, Israel
| | - Eitan Lunenfeld
- Department of Obstetrics and Gynecology, Beer-Sheva, Israel; Faculty of Health Sciences, Beer-Sheva, Israel; Ben-Gurion University of the Negev, Soroka Medical Center, Beer-Sheva, Israel
| | - Amalia Levy
- Department of Public Health, Beer-Sheva, Israel; Faculty of Health Sciences, Beer-Sheva, Israel.
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97
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Gaskins AJ, Hart JE, Mínguez-Alarcón L, Chavarro JE, Laden F, Coull BA, Ford JB, Souter I, Hauser R. Residential proximity to major roadways and traffic in relation to outcomes of in vitro fertilization. Environ Int 2018; 115:239-246. [PMID: 29605676 PMCID: PMC5970056 DOI: 10.1016/j.envint.2018.03.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 03/19/2018] [Accepted: 03/19/2018] [Indexed: 05/05/2023]
Abstract
BACKGROUND Emerging data from animal and human studies suggest that traffic-related air pollution adversely affects early pregnancy outcomes; however evidence is limited. OBJECTIVE We examined whether residential proximity to major roadways and traffic, as proxies for traffic-related air pollution, are associated with in vitro fertilization (IVF) outcomes. METHODS This analysis included 423 women enrolled in the Environment and Reproductive Health (EARTH) Study, a prospective cohort study, who underwent 726 IVF cycles (2004-2017). Using geocoded residential addresses collected at study entry, we calculated the distance to nearest major roadway and the traffic density within a 100 m radius. IVF outcomes were abstracted from electronic medical records. We used multivariable generalized linear mixed models to evaluate the associations between residential proximity to major roadways and traffic density and IVF outcomes adjusting for maternal age, body mass index, race, education level, smoking status, and census tract median income. RESULTS Closer residential proximity to major roadways was statistically significantly associated with lower probability of implantation and live birth following IVF. The adjusted percentage of IVF cycles resulting in live birth for women living ≥400 m from a major roadway was 46% (95% CI 36, 56%) compared to 33% (95% CI 26, 40%) for women living <50 m (p-for-comparison, 0.04). Of the intermediate outcomes, there were suggestive associations between living closer to major roadways and slightly higher estradiol trigger concentrations (p-trend = 0.16) and lower endometrial thickness (p-trend = 0.06). Near-residence traffic density was not associated with outcomes of IVF. CONCLUSION Closer residential proximity to major roadways was related to reduced likelihood of live birth following IVF.
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Affiliation(s)
- Audrey J Gaskins
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Jaime E Hart
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lidia Mínguez-Alarcón
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jorge E Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Francine Laden
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Brent A Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jennifer B Ford
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Irene Souter
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Vincent Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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98
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Lepage J, Keromnes G, Epelboin S, Luton D, Yazbeck C. Premature progesterone rise on day of hCG negatively correlated with live birth rate in IVF cycles: An analysis of 1022 cycles. J Gynecol Obstet Hum Reprod 2018; 48:51-54. [PMID: 29783037 DOI: 10.1016/j.jogoh.2018.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 05/15/2018] [Accepted: 05/17/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the relationship between serum P levels on the day of hCG administration and pregnancy outcomes in patients undergoing IVF. DESIGN Retrospective study. SETTING Teaching hospital. PATIENTS A total of 1022 IVF-ICSI cycles, frozen embryo transfer excluded. INTERVENTION(S) Patients-all types of responder - underwent IVF with agonist or antagonist protocols. Clinical outcomes of IVF were analyzed according to plasma P levels. MAIN OUTCOME MEASURE(S) Ongoing pregnancy rates. RESULTS We proposed a serum P level of 1.57ng/ml on day of hCG as a threshold for all types of responders and all protocols combined. Ongoing implantation rates were not affected by elevated progesterone. Live birth rate was inversely associated with serum P levels on day of hCG and more miscarriages were associated with P>1.57ng/ml. We have not found the progesterone>1.57ng/ml on the day of hCG as a prognostic factor for pregnancy. CONCLUSION(S) Elevated P level on the day of hCG administration negatively influence live birth rate and is correlated to an increase of miscarriage. The detrimental effect of P elevation on pregnancy seems not to be related substantially to endometrium receptivity. Thus, despite a comparable clinical pregnancy rate and an initial implantation rate, we demonstrate more spontaneous abortion and it would seem that the effect of progesterone is later.
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Affiliation(s)
- Julien Lepage
- Bichat Claude Bernard Hospital, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.
| | - Gwenola Keromnes
- Groupe hospitalier Diaconesses Croix Saint-Simon, 12-18, rue du Sergent-Bauchat, 75012 Paris, France
| | - Sylvie Epelboin
- Bichat Claude Bernard Hospital, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - Dominique Luton
- Bichat Claude Bernard Hospital, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France; Paris 7 Denis Diderot University Paris, France
| | - Chadi Yazbeck
- Cherest Fertility Center, 5, rue Pierre-Cherest, 92200 Neuilly-Sur-Seine, France
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99
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Browne K. Voluntary sterilisation and access to IVF in Québec. J Med Ethics 2018; 44:262-265. [PMID: 28780526 DOI: 10.1136/medethics-2016-103726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 04/19/2017] [Accepted: 07/11/2017] [Indexed: 06/07/2023]
Abstract
Bill 20, An Act to Enact the Act to promote access to family medicine and specialized medicine services and to amend various legislative provisions relating to assisted procreation, was introduced to reduce costs associated with Québec's healthcare in general and in vitro fertilisation (IVF) in particular. Passed in November 2015, the new law introduces a number of exclusion criteria for access to and funding for IVF treatment. Remarkably, one exclusion criterion-prior voluntary sterilisation-has prompted little critical commentary. The two justifications offered for restricting funding for IVF on the basis of voluntary sterilisation are that (1) there are cheaper options than IVF for sterilised individuals who want children, and (2) society should not have to pay for IVF for persons who are infertile by choice. I argue that both of these justifications are unsatisfactory, insofar as they contravene the chief value underlying, and current practices of, Canadian healthcare, and rely on problematic ascriptions of personal responsibility for health.
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100
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Carignan CC, Mínguez-Alarcón L, Williams PL, Meeker JD, Stapleton HM, Butt CM, Toth TL, Ford JB, Hauser R. Paternal urinary concentrations of organophosphate flame retardant metabolites, fertility measures, and pregnancy outcomes among couples undergoing in vitro fertilization. Environ Int 2018; 111:232-238. [PMID: 29241080 PMCID: PMC5800983 DOI: 10.1016/j.envint.2017.12.005] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/20/2017] [Accepted: 12/04/2017] [Indexed: 05/18/2023]
Abstract
BACKGROUND Use of organophosphate flame retardants (PFRs) has increased over the past decade following the phase out of some brominated flame retardants, leading to increased human exposure. We recently reported that increasing maternal PFR exposure is associated with poorer pregnancy outcomes among women from a fertility clinic. Because a small epidemiologic study previously reported an inverse association between male PFR exposures and sperm motility, we sought to examine associations of paternal urinary concentrations of PFR metabolites and their partner's pregnancy outcomes. METHODS This analysis included 201 couples enrolled in the Environment and Reproductive Health (EARTH) prospective cohort study (2005-2015) who provided one or two urine samples per IVF cycle. In both the male and female partner, we measured five urinary PFR metabolites [bis(1,3-dichloro-2-propyl) phosphate (BDCIPP), diphenyl phosphate (DPHP), isopropylphenyl phenyl phosphate (ip-PPP), tert-butylphenyl phenyl phosphate (tb-PPP) and bis(1-chloro-2-propyl) phosphate (BCIPP)] using negative electrospray ionization liquid chromatography tandem mass spectrometry (LC-MS/MS). The sum of the molar concentrations of the urinary PFR metabolites was calculated. We used multivariable generalized linear mixed models to evaluate the association of urinary concentrations of paternal PFR metabolites with IVF outcomes, accounting for multiple in vitro fertilization (IVF) cycles per couple. Models were adjusted for year of IVF treatment cycle, primary infertility diagnosis, and maternal urinary PFR metabolites as well as paternal and maternal age, body mass index, and race/ethnicity. RESULTS Detection rates were high for paternal urinary concentrations of BDCIPP (84%), DPHP (87%) and ip-PPP (76%) but low for tb-PPP (12%) and zero for BCIPP (0%). We observed a significant 12% decline in the proportion of fertilized oocytes from the first to second quartile of male urinary ΣPFR and a 47% decline in the number of best quality embryos from the first to third quartile of male urinary BDCIPP in our adjusted models. An 8% decline in fertilization was observed for the highest compared to lowest quartile of urinary BDCIPP concentrations (95% CI: 0.01, 0.12, p-trend=0.06). CONCLUSIONS Using IVF as a model to investigate human reproduction and pregnancy outcomes, we found that paternal urinary concentrations of BDCIPP were associated with reduced fertilization. In contrast to previously reported findings for the female partners, the paternal urinary PFR metabolites were not associated with the proportion of cycles resulting in successful implantation, clinical pregnancy, and live birth. These results indicate that paternal preconception exposure to TDCIPP may adversely impact successful oocyte fertilization, whereas female preconception exposure to ΣPFRs may be more relevant to adverse pregnancy outcomes.
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Affiliation(s)
- Courtney C Carignan
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Food Science and Human Nutrition, Department of Pharmacology and Toxicology, Michigan State University, East Lansing, MI, USA.
| | - Lidia Mínguez-Alarcón
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Paige L Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - John D Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | | | - Craig M Butt
- Nicholas School of the Environment, Duke University, Durham, NC, USA; SCIEX, Framingham, MA, USA.
| | - Thomas L Toth
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Jennifer B Ford
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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