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Cavoretto P, Candiani M, Giorgione V, Inversetti A, Abu-Saba MM, Tiberio F, Sigismondi C, Farina A. Risk of spontaneous preterm birth in singleton pregnancies conceived after IVF/ICSI treatment: meta-analysis of cohort studies. Ultrasound Obstet Gynecol 2018; 51:43-53. [PMID: 29114987 DOI: 10.1002/uog.18930] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [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: 06/13/2017] [Revised: 10/05/2017] [Accepted: 10/13/2017] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Preterm birth (PTB) is more common in pregnancies conceived by in-vitro fertilization (IVF) as compared with those conceived naturally. However, the extent to which this is attributed to spontaneous labor or to iatrogenic indications has not been determined. The aim of this study was to quantify the risk of spontaneous PTB (sPTB) in singleton pregnancies resulting from IVF or intracytoplasmic sperm injection (ICSI) treatment as compared with that in spontaneously conceived pregnancies. METHODS An electronic search of PubMed/MEDLINE, Scopus and Web of Science to September 2017 and manual search of reference lists identified articles comparing the risk of sPTB in IVF/ICSI vs spontaneously conceived singleton pregnancies. Inclusion criteria were singleton conception with IVF/ICSI, PTB defined as delivery before 37 weeks' gestation and cohort design with clear distinction between spontaneous and indicated PTB. The primary outcome was sPTB < 37 weeks. Relevant secondary outcomes were also analyzed, including sPTB < 34 and < 32 weeks, preterm prelabor rupture of membranes, stillbirth, perinatal mortality, neonatal sepsis, respiratory distress syndrome and gastrointestinal morbidity. A meta-analysis provided the estimation of risk of sPTB in IVF/ICSI pregnancies. RESULTS In total, 674 records were identified from the search, of which 15 met the inclusion criteria and were included in the meta-analysis. A pooled crude analysis of the primary outcome generated a total sample size of 61 677 births, including 8044 singletons conceived after IVF/ICSI and 53 633 conceived spontaneously. A pooled crude data analysis showed a significant increase in the incidence of sPTB < 37 weeks in singleton IVF/ICSI pregnancies compared with those conceived spontaneously (810/8044 (10.1%) vs 2932/53 633 (5.5%); odds ratio (OR), 1.75; 95% CI, 1.50-2.03; I2 = 39%). A subgroup analysis of studies matching for maternal age and parity confirmed the finding (OR, 1.63; 95% CI, 1.30-2.05; I2 = 33%). A pooled crude analysis of secondary outcomes showed a significant increase in the incidence of sPTB < 34 weeks in pregnancies conceived after IVF/ICSI compared with those conceived spontaneously (37/1012 (3.6%) vs 24/1107 (2.2%); OR, 1.78; 95% CI, 1.03-3.08; I2 = 6%) and did not show any significant difference for any of the other secondary outcomes analyzed. The quality of evidence, rated using the GRADE criteria, was low for the outcome sPTB < 37 weeks and very low for sPTB < 34 weeks. CONCLUSIONS The risk of sPTB in singleton pregnancies resulting from IVF/ICSI is significantly greater than that in spontaneously conceived singletons. These findings should be interpreted with caution given the low quality of the available evidence. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- P Cavoretto
- Gynecology and Obstetrics Department, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - M Candiani
- Gynecology and Obstetrics Department, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - V Giorgione
- Gynecology and Obstetrics Department, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - A Inversetti
- Gynecology and Obstetrics Department, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - M M Abu-Saba
- Gynecology and Obstetrics Department, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - F Tiberio
- Gynecology and Obstetrics Department, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - C Sigismondi
- Gynecology and Obstetrics Department, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - A Farina
- Division of Obstetrics and Gynecology, St. Orsola-Malpighi Polyclinic, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
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Zhang T, Li Z, Ren X, Huang B, Zhu G, Yang W, Jin L. Endometrial thickness as a predictor of the reproductive outcomes in fresh and frozen embryo transfer cycles: A retrospective cohort study of 1512 IVF cycles with morphologically good-quality blastocyst. Medicine (Baltimore) 2018; 97:e9689. [PMID: 29369190 PMCID: PMC5794374 DOI: 10.1097/md.0000000000009689] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [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] [Indexed: 11/25/2022] Open
Abstract
To evaluate the relationship between endometrial thickness during fresh in vitro fertilization (IVF) cycles and the clinical outcomes of subsequent frozen embryo transfer (FET) cycles.FET cycles using at least one morphological good-quality blastocyst conducted between 2012 and 2013 at a university-based reproductive center were reviewed retrospectively. Endometrial ultrasonographic characteristics were recorded both on the oocyte retrieval day and on the day of progesterone supplementation in FET cycles. Clinical pregnancy rate, spontaneous abortion rate, and live birth rate were analyzed.One thousand five hundred twelve FET cycles was included. The results showed that significant difference in endometrial thickness on day of oocyte retrieval (P = .03) was observed between the live birth group (n = 844) and no live birth group (n = 668), while no significant difference in FET endometrial thickness was found (P = .261) between the live birth group and no live birth group. For endometrial thickness on oocyte retrieval day, clinical pregnancy rate ranged from 50.0% among patients with an endometrial thickness of ≤6 mm to 84.2% among patients with an endometrial thickness of >16 mm, with live birth rate from 33.3% to 63.2%. Multiple logistic regression analysis of factors related to live birth indicated endometrial thickness on oocyte retrieval day was associated with improved live birth rate (OR was 1.069, 95% CI: 1.011-1.130, P = .019), while FET endometrial thickness did not contribute significantly to pregnancy outcomes following FET cycles. The ROC curves revealed the cut-off points of endometrial thickness on oocyte retrieval day was 8.75 mm for live birth.Endometrial thickness during fresh IVF cycles was a better predictor of endometrial receptivity in subsequent FET cycles than FET cycle endometrial thickness. For those females with thin endometrium in fresh cycles, additional estradiol stimulation might be helpful for adequate endometrial development.
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McPherson NO, Zander-Fox D, Vincent AD, Lane M. Combined advanced parental age has an additive negative effect on live birth rates-data from 4057 first IVF/ICSI cycles. J Assist Reprod Genet 2017; 35:279-287. [PMID: 28980182 DOI: 10.1007/s10815-017-1054-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 08/10/2017] [Accepted: 09/15/2017] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The purpose of this study is to determine if there is an additive effect of combined advanced maternal and paternal age on pregnancy and live birth rates. METHODS Retrospective data analysis of 4057 first cycles at a fertility centre between 2009 and 2013 was compiled. Donor, preimplantation genetic screening and double embryo transfer cycles were excluded. Main outcomes measured were clinical pregnancy, viable pregnancy, live birth and term birth. RESULTS Logistic regression indicated strong negative associations for maternal ages exceeding 27 years with clinical pregnancies (p < 0.001), viable pregnancies (p < 0.001), live births (p < 0.001) and term births (p < 0.001). There was evidence of negative associations between paternal age and both viable pregnancies (p = 0.06) and live births (p = 0.04), such that the probability of pregnancy was 10% further reduced for women who were 35 years with a partner over 40 years vs. women aged 35 years with a partner under 30 years. There was evidence of an interaction between maternal age and the paternal age on term births (p = 0.02) such that advanced paternal age's effect on the probability of a term birth was only evident in couples where the maternal age ranged between ~27 and 35 years. CONCLUSIONS There is an additive effect to pregnancy and live birth rates when both partners are of an advanced age, thus highlighting the need for pre-conception public health messaging and a combined approach to ART counselling assessing both parental ages in combination.
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Affiliation(s)
- Nicole O McPherson
- School of Medicine, Robinson Research Institute, Discipline of Obstetrics and Gynaecology, University of Adelaide, Level 3 Medical School South, Adelaide, South Australia, 5005, Australia.
- Repromed, Dulwich, Adelaide, South Australia, 5065, Australia.
- Freemasons Centre for Men's Health, University of Adelaide, Adelaide, South Australia, 5005, Australia.
| | - Deirdre Zander-Fox
- School of Medicine, Robinson Research Institute, Discipline of Obstetrics and Gynaecology, University of Adelaide, Level 3 Medical School South, Adelaide, South Australia, 5005, Australia
- Repromed, Dulwich, Adelaide, South Australia, 5065, Australia
- Monash IVF Group, Richmond, Victoria, 3121, Australia
| | - Andrew D Vincent
- Freemasons Centre for Men's Health, University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - Michelle Lane
- School of Medicine, Robinson Research Institute, Discipline of Obstetrics and Gynaecology, University of Adelaide, Level 3 Medical School South, Adelaide, South Australia, 5005, Australia
- Freemasons Centre for Men's Health, University of Adelaide, Adelaide, South Australia, 5005, Australia
- Monash IVF Group, Richmond, Victoria, 3121, Australia
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Bas-Lando M, Rabinowitz R, Farkash R, Algur N, Rubinstein E, Schonberger O, Eldar-Geva T. Prediction value of anti-Mullerian hormone (AMH) serum levels and antral follicle count (AFC) in hormonal contraceptive (HC) users and non-HC users undergoing IVF-PGD treatment. Gynecol Endocrinol 2017; 33:797-800. [PMID: 28454495 DOI: 10.1080/09513590.2017.1320376] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 02/05/2023] Open
Abstract
Use of hormone contraceptives (HC) is very popular in the reproductive age and, therefore, evaluation of ovarian reserve would be a useful tool to accurately evaluate the reproductive potential in HC users. We conducted a retrospective cohort study of 41 HC users compared to 57 non-HC users undergoing IVF-preimplantation genetic diagnosis (PGD) aiming to evaluate the effect of HC on the levels of anti-Mullerian hormone (AMH), small (2-5 mm), large (6-10 mm) and total antral follicle count (AFC) and the ability of these markers to predict IVF outcome. Significant differences in large AFC (p = 0.04) and ovarian volume (p < 0.0001) were seen, however, there were no significant differences in small and total AFC or in serum AMH and FSH levels. Oocyte number significantly correlated with AMH and total AFC in HC users (p < 0.001) while in non-HC users these correlations were weaker. In HC users, the significant predictors of achieving <6 and >18 oocytes were AFC (ROC-AUC; 0.958, p = 0.001 and 0.883, p = 0.001) and AMH (ROC-AUC-0.858, p = 0.01 and 0.878, p = 0.001), respectively. The predictive values were less significant in non-HC users. These findings are important in women treated for PGD, in ovum donors and for assessing the fertility prognosis in women using HC and wishing to postpone pregnancy.
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Affiliation(s)
- Maayan Bas-Lando
- a Department of Obstetrics & Gynecology , Shaare Zedek Medical Center, Affiliated with the Hebrew University Hadassah School of Medicine , Jerusalem , Israel
| | - Ron Rabinowitz
- a Department of Obstetrics & Gynecology , Shaare Zedek Medical Center, Affiliated with the Hebrew University Hadassah School of Medicine , Jerusalem , Israel
| | - Rivka Farkash
- a Department of Obstetrics & Gynecology , Shaare Zedek Medical Center, Affiliated with the Hebrew University Hadassah School of Medicine , Jerusalem , Israel
| | - Nurit Algur
- a Department of Obstetrics & Gynecology , Shaare Zedek Medical Center, Affiliated with the Hebrew University Hadassah School of Medicine , Jerusalem , Israel
| | - Esther Rubinstein
- a Department of Obstetrics & Gynecology , Shaare Zedek Medical Center, Affiliated with the Hebrew University Hadassah School of Medicine , Jerusalem , Israel
| | - Oshrat Schonberger
- a Department of Obstetrics & Gynecology , Shaare Zedek Medical Center, Affiliated with the Hebrew University Hadassah School of Medicine , Jerusalem , Israel
| | - Talia Eldar-Geva
- a Department of Obstetrics & Gynecology , Shaare Zedek Medical Center, Affiliated with the Hebrew University Hadassah School of Medicine , Jerusalem , Israel
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Abstract
Most IVF-conceived children are healthy, but IVF has also been associated with adverse obstetric and perinatal outcomes as well as congenital anomalies. There is also literature suggesting an association between IVF and neurodevelopmental disorders as well as potentially long-term metabolic outcomes. The main driver for adverse outcomes is the higher risk of multiple gestations in IVF, but as the field moves toward single embryo transfer, the rate of multiple gestations is decreasing. Studies have shown that singleton IVF pregnancies still have a higher incidence of adverse outcomes compared to unassisted singleton pregnancies. Infertility itself may be an independent risk factor. Animal models suggest that epigenetic changes in genes involved in growth and development are altered in IVF during the hormonal stimulation and embryo culture. Further animal research and prospective human data are needed to elucidate the mechanisms by which IVF may contribute to adverse outcomes and to decrease risks.
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Affiliation(s)
- Chantae S Sullivan-Pyke
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, 3701 Market St, Suite 810, Philadelphia, PA 19104
| | - Suneeta Senapati
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, 3701 Market St, Suite 810, Philadelphia, PA 19104.
| | - Monica A Mainigi
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, 3701 Market St, Suite 810, Philadelphia, PA 19104
| | - Kurt T Barnhart
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, 3701 Market St, Suite 810, Philadelphia, PA 19104
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Churchill SJ, Wang ET, Akhlaghpour M, Goldstein EH, Eschevarria D, Greene N, Macer M, Zore T, Williams J, Pisarska MD. Mode of conception does not appear to affect placental volume in the first trimester. Fertil Steril 2017; 107:1341-1347.e1. [PMID: 28501362 PMCID: PMC5628758 DOI: 10.1016/j.fertnstert.2017.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 12/15/2016] [Revised: 04/13/2017] [Accepted: 04/14/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To study whether infertility treatments, including IVF and non-IVF fertility treatments, are associated with diseases of placental insufficiency in early gestation. First trimester placental volumes by ultrasound and chorionic villi weight during sampling (CVS) were performed to detect differences between pregnancies conceived spontaneously versus with fertility treatments. DESIGN Retrospective cohort. SETTING Academic tertiary center. PATIENT(S) Women with singleton pregnancies undergoing CVS and first trimester ultrasound from April 2007 to November 2015. INTERVENTION(S) Estimated placental volume (EPV) was calculated from ultrasound images using a validated computation and CVS estimated tissue weight was performed using a validated visual analogue scale. MAIN OUTCOME MEASURE(S) Adjusted linear regression was used to compare EPV and CVS weight based on mode of conception. RESULT(S) A total of 1,977 spontaneous and 334 conceived with fertility treatments (133 non-IVF and 201 IVF) pregnancies were included. Significant differences in maternal age, gravidity, hypertension, and smoking status were identified. EPV and CVS weight were correlated with maternal age, gestational age, and maternal hypertension. Adjusted linear regression showed no difference in EPV in pregnancies conceived with fertility treatments versus spontaneously. The CVS weight was significantly lower in the IVF conceptions in unadjusted univariate analyses. However, after adjusted regression, this was no longer significant. CONCLUSION(S) Mode of conception does not appear to affect first trimester placental size. As differences in maternal age, hypertension, and smoking status differ among the groups and are correlated to placental size, it may be the underlying patient population leading to abnormal placentation and insufficiency, not the fertility treatments used.
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Affiliation(s)
- Sara J Churchill
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, California
| | - Erica T Wang
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, California
| | - Marcy Akhlaghpour
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, California
| | - Ellen H Goldstein
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, California
| | - Dina Eschevarria
- David Geffen School of Medicine, University of California, Los Angeles, California
| | - Naomi Greene
- David Geffen School of Medicine, University of California, Los Angeles, California
| | - Matthew Macer
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, California
| | - Temeka Zore
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, California
| | - John Williams
- David Geffen School of Medicine, University of California, Los Angeles, California; Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Margareta D Pisarska
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, California.
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Abstract
BACKGROUND Previous studies examining associations between subclinical hypothyroidism (SCH) with in vitro fertilization (IVF) outcome indicate some benefits of levothyroxine (LT4) treatment. But IVF outcomes in treated SCH women whose serum Thyroid Stimulating Hormone (TSH) concentration did and did not exceed 2.5 mIU/L before the IVF cycle has not been studied thoroughly. METHODS In this study, we performed a prospective cohort study with 270 treated subclinical hypothyroidism patients undergoing their first IVF retrieval cycle at a single cite. RESULTS SCH in women receiving LT4 replacement with a basal TSH level between 0.2-2.5mIU/L displayed a similar rate of clinical pregnancy (47.4% vs 38.7%, P = .436), miscarriage (7.4% vs 16.7%, P = .379) and live birth (43.9% vs 32.3%, P = .288) compared to women with a basal TSH level between 2.5-4.2 mIU/L. CONCLUSION Strictly controlled TSH (less than 2.5 mIU/L) before IVF may have no effect on the pregnancy rate in LT4 treated SCH women.
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Affiliation(s)
- YunYing Cai
- 0000 0000 8571 108Xgrid.218292.2Faculty of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming, Yunnan Province 650500 People’s Republic of China
- grid.414918.1Department of Endocrinology, The Affiliated Hospital of Kunming University of Science and Technology, The First People’s Hospital of Yunnan, Kunming, Yunnan Province 650032 People’s Republic of China
| | - LanPing Zhong
- grid.414918.1Reproductive Medicine Center, The Affiliated Hospital of Kunming University of Science and Technology, The First People’s Hospital of Yunnan, Kunming, Yunnan 650032 People’s Republic of China
| | - Jie Guan
- grid.414918.1Reproductive Medicine Center, The Affiliated Hospital of Kunming University of Science and Technology, The First People’s Hospital of Yunnan, Kunming, Yunnan 650032 People’s Republic of China
| | - RuiJin Guo
- grid.414918.1Department of Endocrinology, The Affiliated Hospital of Kunming University of Science and Technology, The First People’s Hospital of Yunnan, Kunming, Yunnan Province 650032 People’s Republic of China
| | - Ben Niu
- grid.414918.1Department of Endocrinology, The Affiliated Hospital of Kunming University of Science and Technology, The First People’s Hospital of Yunnan, Kunming, Yunnan Province 650032 People’s Republic of China
| | - YanPing Ma
- grid.414918.1Reproductive Medicine Center, The Affiliated Hospital of Kunming University of Science and Technology, The First People’s Hospital of Yunnan, Kunming, Yunnan 650032 People’s Republic of China
| | - Heng Su
- 0000 0000 8571 108Xgrid.218292.2Faculty of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming, Yunnan Province 650500 People’s Republic of China
- grid.414918.1Department of Endocrinology, The Affiliated Hospital of Kunming University of Science and Technology, The First People’s Hospital of Yunnan, Kunming, Yunnan Province 650032 People’s Republic of China
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108
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Eskew AM, Jungheim ES. A History of Developments to Improve in vitro Fertilization. Mo Med 2017; 114:156-159. [PMID: 30228571 PMCID: PMC6140213] [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
Methods of in vitro fertilization (IVF) have advanced dramatically since the first IVF baby was born in 1978. Originally yielding single-digit success rates, IVF is now successful in nearly 50% of cases in which the woman is younger than 35 years. Here, we describe the improvements in laboratory techniques and advances in our abilities to manipulate reproductive physiology that have facilitated this improvement. Additionally, we describe efforts to ensure safety standards in this competitive field.
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Affiliation(s)
- Ashley M Eskew
- Ashley Eskew, MD, is Fellow, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Washington University School of Medicine
| | - Emily S Jungheim
- Emily S. Jungheim, MD, MSCI, is Associate Professor, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Washington University School of Medicine
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109
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Grøndahl ML, Christiansen SL, Kesmodel US, Agerholm IE, Lemmen JG, Lundstrøm P, Bogstad J, Raaschou-Jensen M, Ladelund S. Effect of women's age on embryo morphology, cleavage rate and competence-A multicenter cohort study. PLoS One 2017; 12:e0172456. [PMID: 28422964 PMCID: PMC5396884 DOI: 10.1371/journal.pone.0172456] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 02/06/2017] [Indexed: 11/26/2022] Open
Abstract
This multicenter cohort study on embryo assessment and outcome data from 11,744 IVF/ICSI cycles with 104,830 oocytes and 42,074 embryos, presents the effect of women’s age on oocyte, zygote, embryo morphology and cleavage parameters, as well as cycle outcome measures corrected for confounding factors as center, partner’s age and referral diagnosis. Cycle outcome data confirmed the well-known effect of women’s age. Oocyte nuclear maturation and proportion of 2 pro-nuclear (2PN) zygotes were not affected by age, while a significant increase in 3PN zygotes was observed in both IVF and ICSI (p<0.0001) with increasing age. Maternal age had no effect on cleavage parameters or on the morphology of the embryo day 2 post insemination. Interestingly, initial hCG value after single embryo transfer followed by ongoing pregnancy was increased with age in both IVF (p = 0.007) and ICSI (p = 0.001) cycles. For the first time, we show that a woman’s age does impose a significant footprint on early embryo morphological development (3PN). In addition, the developmentally competent embryos were associated with increased initial hCG values as the age of the women increased. Further studies are needed to elucidate, if this increase in initial hCG value with advancing maternal age is connected to the embryo or the uterus.
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Affiliation(s)
- Marie Louise Grøndahl
- Herlev Hospital, Fertility Clinic, Copenhagen University Hospital, Herlev, Denmark
- * E-mail:
| | | | - Ulrik Schiøler Kesmodel
- Herlev Hospital, Fertility Clinic, Copenhagen University Hospital, Herlev, Denmark
- Aarhus University Hospital, Fertility Clinic, Aarhus, Denmark
| | | | | | | | - Jeanette Bogstad
- Hvidovre Hospital, Fertility Clinic, Copenhagen University Hospital, Hvidovre, Denmark
| | | | - Steen Ladelund
- Hvidovre Hospital, Statistics, Clinical Research Center, Copenhagen University Hospital, Hvidovre, Denmark
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Huang QY, Rong MH, Lan AH, Lin XM, Lin XG, He RQ, Chen G, Li MJ. The impact of atosiban on pregnancy outcomes in women undergoing in vitro fertilization-embryo transfer: A meta-analysis. PLoS One 2017; 12:e0175501. [PMID: 28422984 PMCID: PMC5396917 DOI: 10.1371/journal.pone.0175501] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 10/04/2016] [Accepted: 03/26/2017] [Indexed: 12/01/2022] Open
Abstract
Background Atosiban is administered to women undergoing in vitro fertilization-embryo transfer (IVF-ET) to improve pregnancy outcomes. However, the results of this treatment were controversial. We conducted this meta-analysis to investigate whether atosiban improves pregnancy outcomes in the women undergoing in vitro fertilization (IVF). Methods Databases of PubMed, EMBASE, Web of Science, China BioMedicine, and Google Scholar were systematically searched. Meta-analyses were performed to investigate whether atosiban improves pregnancy outcomes in the women undergoing IVF. Results Our results showed that atosiban was associated with higher implantation (OR = 1.63, 95% CI: 1.17–2.27; P = 0.004) and clinical pregnancy (OR = 1.84, 95% CI: 1.31–2.57; P < 0.001) rates. However, atosiban showed no significant association with the miscarriage, live birth, multiple pregnancy or ectopic pregnancy rates. When a further subgroup analysis was performed in the women undergoing repeated implantation failure (RIF), implantation (OR = 1.93, 95% CI: 1.45–2.57; P < 0.001), clinical pregnancy (OR = 2.48, 95% CI: 1.70–3.64; P <0.001) and the live birth (OR = 2.89, 95% CI: 1.78–4.67; P < 0.001) rates were significantly higher in the case group. Nevertheless, no significant difference was detected in the miscarriage and multiple pregnancy rates between the case and control groups. Conclusion Atosiban may be more appropriate for women undergoing RIF and play only a limited role in improving pregnancy outcomes in the general population of women undergoing IVF. These conclusions should be verified in large and well-designed studies.
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Affiliation(s)
- Qian-Yi Huang
- Department of Reproductive Medical Research Center, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Min-Hua Rong
- Research Department, Affiliated Cancer Hospital, Guangxi Medical University, Nanning, China
| | - Ai-Hua Lan
- Department of Reproductive Medical Research Center, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiao-Miao Lin
- Department of Children Rehabilitation Medicine, Guangxi Matemal and Child Health Hospital, Nanning, China
| | - Xing-Gu Lin
- Center of Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China
| | - Rong-Quan He
- Center of Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China
| | - Gang Chen
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Mu-Jun Li
- Department of Reproductive Medical Research Center, First Affiliated Hospital of Guangxi Medical University, Nanning, China
- * E-mail:
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Mantzavinos SD, Vlahos NP, Rizos D, Botsis D, Sergentanis TN, Deligeoroglou E, Mantzavinos T. Correlation of serum anti-Müllerian hormone levels with positive in vitro fertilization outcome using a short agonist protocol. Hormones (Athens) 2017; 16:161-170. [PMID: 28742504 DOI: 10.14310/horm.2002.1731] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/04/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We examined the predictive ability of anti-Müllerian hormone (AMH) for clinical pregnancy in women who underwent in vitro fertilization (IVF) cycles in a short agonist protocol. DESIGN This is a retrospective cohort study of 222 women undergoing their first IVF attempt between June 2010 and March 2016. Multivariate logistic regression analysis was performed to evaluate the independent associations between clinical pregnancy and its possible predictors. RESULTS 14.9% of cycles were cancelled, >3 oocytes were retrieved in 55.4% of cycles and embryo transfer was performed in 70.7% of cases. Live birth was the final outcome in 19.8% of subjects, miscarriage occurred in 4.1%, whereas no pregnancy occurred in the remaining 76.1% of the study sample. The number of oocytes, number of embryos, embryo transfer rate and pregnancy rates were positively associated with serum AMH concentrations (p <0.001, for each association). When analyzed by age quartiles, the overall association between AMH and clinical pregnancy rates was evident across all age strata. CONCLUSIONS Serum AMH levels are a strong predictive marker of clinical pregnancy in women undergoing a short agonist IVF protocol. There is also a strong association with cancellation rate, number of oocytes retrieved, poor response (≤3 oocytes), number of embryos, embryo transfer rate and live birth rates.
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Affiliation(s)
- Spyridon D Mantzavinos
- 2nd Department of Obstetrics and Gynecology, "Aretaieion" University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Nikolaos P Vlahos
- 2nd Department of Obstetrics and Gynecology, "Aretaieion" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Demetrios Rizos
- 2nd Department of Obstetrics and Gynecology, Hormonologic Laboratory, "Aretaieion" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Demetrios Botsis
- 2nd Department of Obstetrics and Gynecology, "Aretaieion" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros N Sergentanis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Efthimios Deligeoroglou
- 2nd Department of Obstetrics and Gynecology, "Aretaieion" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Themistoklis Mantzavinos
- 2nd Department of Obstetrics and Gynecology, "Aretaieion" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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112
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Affiliation(s)
- Emily S Jungheim
- Washington University in St Louis School of Medicine, St Louis, Missouri
| | | | - George A Macones
- Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Randall R Odem
- Washington University in St Louis School of Medicine, St Louis, Missouri
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Abstract
BACKGROUND During in vitro fertilization, rapid growth of vitrification and liquid nitrogen storage of embryos have been well characterized. However, the effect of storage time on vitrified cleavage-stage embryos in an open system is poorly understood. AIMS To investigate the influence of storage time on the survival and pregnancy outcomes of vitrified human cleavage-stage embryos froze and stored in an open system. METHODS A retrospective study of 786 vitrified-warmed cycles of 735 patients was performed from January 2013 to October 2013. The cycles were divided into five groups according to storage time: 1-3 months, 4-6 months, 7-12 months, 13-24 and 25-60 months. The clinical outcomes of cycles with different storage time were analyzed. RESULTS There were no significant differences of the survival rate, clinical pregnancy outcomes, birth rate, gestational weeks and singleton birthweights at various storage times. CONCLUSION For vitrified embryos froze and stored in an open system, the storage time would not influence the survival rate and pregnancy outcomes by storage time up to 5 years.
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Affiliation(s)
- Wei Li
- a The ART Center, Northwest Women's and Children's Hospital , Xi'an , China
| | - Wanqiu Zhao
- a The ART Center, Northwest Women's and Children's Hospital , Xi'an , China
| | - Xia Xue
- a The ART Center, Northwest Women's and Children's Hospital , Xi'an , China
| | - Silin Zhang
- a The ART Center, Northwest Women's and Children's Hospital , Xi'an , China
| | - Xin Zhang
- a The ART Center, Northwest Women's and Children's Hospital , Xi'an , China
| | - Juanzi Shi
- a The ART Center, Northwest Women's and Children's Hospital , Xi'an , China
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Sun Q, Li HR, Liang YJ, Yao B, Chen L. [Value of sperm acrosin activity detection in selecting the method of assisted reproduction for patients with unexplained infertility]. Zhonghua Nan Ke Xue 2017; 23:152-156. [PMID: 29658254] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the clinical significance of sperm acrosin activity detection in selecting the method of assisted reproduction for patients with unexplained infertility (UI). METHODS This retrospective study included 49 UI couples treated by IVFET (49 cycles) after three failures in intrauterine insemination (IUI) and another 95 couples with uterine tube obstruction (UTO) treated by IVF (131 cycles). We analyzed the laboratory data, clinical outcomes and sperm acrosin activity in the two groups of patients. According to the level of sperm acrosin activity of the males, we further divided the UI patients into two subgroups, a < 36 IU/106 sperm group (20 cycles) and a ≥36 IU/106 sperm group (29 cycles), and compared the fertilization rates between the two groups. RESULTS Compared with UI couples treated by IVFET, the UTO couples treated by IVF had a significantly lower rate of fertilization (67.0% vs 76.4%, P < 0.05) and a higher rate of remedial intracytoplasmic sperm injection (ICSI) (20.4% vs 6.1%, P < 0.05), but showed no statistically significant differences in the rates of MII oocytes, available embryos, highquality embryos, implantation, and clinical pregnancy from the latter group (P >0.05). The sperm acrosin activity was remarkably lower in the UI than in the UTO patients (36.03 vs 61.98 IU/106, P < 0.01), and so was the fertilization rate in the < 36 IU/106 than in the ≥36 IU/106 sperm subgroup (47.7% vs 80.3%, P < 0.01). CONCLUSIONS The low fertilization rate caused by decreased sperm acrosin activity may be the main cause of infertility and the potential factor of UI. When sperm acrosin activity is < 36 IU/106 sperm, IVF plus shortterm fertilization by remedial ICSI should be preferred to IUI.
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Affiliation(s)
- Qin Sun
- Center of Reproductive Medicine, Nanjing General Hospital of Nanjing Military Region, Nanjing, Jiangsu 210002, China
| | - Hong-Ru Li
- Center of Reproductive Medicine, Nanjing General Hospital of Nanjing Military Region, Nanjing, Jiangsu 210002, China
| | - Yuan-Jiao Liang
- Center of Reproductive Medicine, Nanjing General Hospital of Nanjing Military Region, Nanjing, Jiangsu 210002, China
| | - Bing Yao
- Center of Reproductive Medicine, Nanjing General Hospital of Nanjing Military Region, Nanjing, Jiangsu 210002, China
| | - Li Chen
- Center of Reproductive Medicine, Nanjing General Hospital of Nanjing Military Region, Nanjing, Jiangsu 210002, China
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Jiang H, Wang X. Pregnancy outcomes in Chinese urban women at a very advanced maternal age. CLIN EXP OBSTET GYN 2017; 44:56-60. [PMID: 29714866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM To compare the maternal-fetal outcomes in Chinese urban women at the maternal age of 40 years with those aged between 35 and 39 years. MATERIALS AND METHODS In this retrospective study, women in a single-center that delivered from January 1 to December 31, 2013, were included. The authors divided the subjects into two groups according to the age, and evaluated the obstetric history, delivery mode, incidence of obstetric diseases, and neonatal outcomes of each group. RESULTS They enrolled 1,965 pregnant women in total. The women between 35 to 39 years of age reached 1,727 (87.9%), and the remaining 238 (12.1%) were women ≥ 40-years-old. The incidence rates of in vitro fertilization (IVF,p < 0.01), gestational diabetes mellitus (GDM) (p < 0.05), and hypertension (p < 0.05) for the elder group were higher than the younger group. Furthermore, women ≥ 40-years-old were associated with a higher rate of cesarean section (84.0% vs. 67.6%,p < 0.001) compared with the younger group, varying significantly on intrauterine infection (1.5% vs. 0.5%,p < 0.05), IVF (6.5% vs. 3.2%,p < 0.01), and maternal request (41.0% vs. 30.6%,p < 0.001). No significant differences in neonatal outcomes were found and no neonatal deaths were recorded for the two groups. CONCLUSIONS These results showed an increase risk of pregnancy complications for the women giving birth at ≥ 40 years of age, yet most of them still carried a favorable pregnancy and neonatal outcome, similar to the younger women.
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Spencer EA, Mahtani KR, Goldacre B, Heneghan C. Claims for fertility interventions: a systematic assessment of statements on UK fertility centre websites. BMJ Open 2016; 6:e013940. [PMID: 27890866 PMCID: PMC5168515 DOI: 10.1136/bmjopen-2016-013940] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [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] [Received: 08/18/2016] [Revised: 09/23/2016] [Accepted: 11/22/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Fertility services in the UK are offered by over 200 Human Fertilisation and Embryology Authority (HFEA)-registered NHS and private clinics. While in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) form part of the National Institute for Health and Care Excellence (NICE) guidance, many further interventions are offered. We aimed to record claims of benefit for interventions offered by fertility centres via information on the centres' websites and record what evidence was cited for these claims. METHODS We obtained from HFEA a list of all UK centres providing fertility treatments and examined their websites. We listed fertility interventions offered in addition to standard IVF and ICSI and recorded statements about interventions that claimed or implied improvements in fertility in healthy women. We recorded which claims were quantified, and the evidence cited in support of the claims. Two reviewers extracted data from websites. We accessed websites from 21 December 2015 to 31 March 2016. RESULTS We found 233 websites for HFEA-registered fertility treatment centres, of which 152 (65%) were excluded as duplicates or satellite centres, 2 were andrology clinics and 5 were unavailable or under construction websites. In total, 74 fertility centre websites, incorporating 1401 web pages, were examined for claims. We found 276 claims of benefit relating to 41 different fertility interventions made by 60 of the 74 centres (median 3 per website; range 0 to 10). Quantification was given for 79 (29%) of the claims. 16 published references were cited 21 times on 13 of the 74 websites. CONCLUSIONS Many fertility centres in the UK offer a range of treatments in addition to standard IVF procedures, and for many of these interventions claims of benefit are made. In most cases, the claims are not quantified and evidence is not cited to support the claims. There is a need for more information on interventions to be made available by fertility centres, to support well-informed treatment decisions.
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Affiliation(s)
- E A Spencer
- Nuffield Department of Primary Care Health Sciences, Centre for Evidence-Based Medicine, University of Oxford, Oxford, UK
| | - K R Mahtani
- Nuffield Department of Primary Care Health Sciences, Centre for Evidence-Based Medicine, University of Oxford, Oxford, UK
| | - B Goldacre
- Nuffield Department of Primary Care Health Sciences, Centre for Evidence-Based Medicine, University of Oxford, Oxford, UK
| | - C Heneghan
- Nuffield Department of Primary Care Health Sciences, Centre for Evidence-Based Medicine, University of Oxford, Oxford, UK
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Ren XL, Liu P, Lian Y, Huang J, Zheng XY, Zhu YJ, Qiao J. [Effect of catheter choice during embryo transfer on the clinical outcome of in vitro fertilization-embryo transfer]. Beijing Da Xue Xue Bao Yi Xue Ban 2016; 48:905-909. [PMID: 27752179] [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: 06/06/2023]
Abstract
OBJECTIVE To compare two flexible embryo catheters and determine whether clinical outcome differs in the in vitro fertilization-embryo transfer (IVF-ET) cycles. METHODS This prospective control study was conducted by one doctor between July 2012 and November 2013. In the study, 2 064 patients undergoing fresh embryo transfer by using IVF-ET/intracytoplasmic sperm injection (ICSI)-ET in Reproductive Medical Center of Peking University Third Hospital were recruited. The subjects were divided into two groups. Cook Sydney IVF embryo transfer catheters (product model: K-JETS-7019-SIVF) were used for embryo transfer in group 1 (n=949), and Frydman-CCD catheters (product model: 131230301) were used in group 2 (n=1 115). Pregnancy outcomes were compared between these two groups. RESULTS There was no significant difference in age, diagnosis for infertility and stimulation protocol used between the two groups. In addition, there was no difference in the number of oocytes collected and in the number and score of embryos transferred. The significantly higher implantation rate, clinical pregnancy rate, and live birth rate (34.40% vs. 26.92%, 51.21% vs. 41.52%, 42.57% vs. 33.09%, P<0.05) were observed in group 1 compared with group 2. The abortion rate was not significantly different between the two groups (11.93% vs. 15.98%, P>0.05). The proportion of difficult transfer was higher in group 1 than that in group 2 (5.27% vs. 3.41%, P<0.05). There was no difference in the clinical pregnancy rate and live birth rate between the two difficult transfer cycles. CONCLUSION The type of embryo transfer catheter affects the clinical outcome in IVF. Good clinical outcome can be obtained by using Cook Sydney IVF catheter, which is worthy of clinical promotion.
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Affiliation(s)
- X L Ren
- Reproductive Medical Center, Peking University Third Hospital, Beijing 100191, China
| | - P Liu
- Reproductive Medical Center, Peking University Third Hospital, Beijing 100191, China
| | - Y Lian
- Reproductive Medical Center, Peking University Third Hospital, Beijing 100191, China
| | - J Huang
- Reproductive Medical Center, Peking University Third Hospital, Beijing 100191, China
| | - X Y Zheng
- Reproductive Medical Center, Peking University Third Hospital, Beijing 100191, China
| | - Y J Zhu
- Reproductive Medical Center, Peking University Third Hospital, Beijing 100191, China
| | - J Qiao
- Reproductive Medical Center, Peking University Third Hospital, Beijing 100191, China
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Abstract
BACKGROUND In Germany there is an emerging trend for postponing parenthood due to non-medical, sociocultural reasons. This clearly impacts on the reproductive success due to an age-dependent decrease in fertility. Thus, strategies and techniques are currently discussed which could preserve the female fertility status, among which social freezing (cryopreservation of oocytes) for later fertilization is the most realistic one; however, while there is an intensive discussion on the procedure and timing of oocyte cryopreservation, virtually no attention has been paid to the male side and the aging effects on the male germ cells. AIM To evaluate the risk paternal age poses for the integrity of germ cells. METHODS For this review a literature search using PubMed, data from the Federal Statistical Office of Germany, the German in vitro fertilization (IVF) register as well as own data were used. RESULTS Sperm cell integrity is clearly affected by age both at the genetic as well as at the epigenetic levels. The estimated mutation rate for spermatozoa doubles every 16.5 years. Monogenic and multifactorial diseases are strongly associated with paternal age. Men aged >40 years have an increased risk of passing age-related mutations to their children. CONCLUSIONS Cryopreservation of spermatozoa is an option for men who postpone planning a family. Genetic counseling is recommended for couples undertaking social freezing and a male age of >40 years.
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Affiliation(s)
- J Gromoll
- Centrum für Reproduktionsmedizin und Andrologie, Abteilung Klinische Andrologie, WHO Kooperationszentrum, EAA Ausbildungszentrum, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude D11, 48149, Münster, Deutschland
| | - F Tüttelmann
- Institut für Humangenetik, Universitätsklinikum Münster, Münster, Deutschland
- Deutsche Gesellschaft für Andrologie, Dortmund, Deutschland
| | - S Kliesch
- Centrum für Reproduktionsmedizin und Andrologie, Abteilung Klinische Andrologie, WHO Kooperationszentrum, EAA Ausbildungszentrum, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude D11, 48149, Münster, Deutschland.
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Muller V, Makhmadalieva M, Kogan I, Fedorova I, Lesik E, Komarova E, Dzhemlikhanova L, Niauri D, Gzgzyan A, Ailamazyan E. Ectopic pregnancy following in vitro fertilization: meta-analysis and single-center experience during 6 years. Gynecol Endocrinol 2016; 32:69-74. [PMID: 27759446 DOI: 10.1080/09513590.2016.1232550] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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
BACKGROUND Ectopic pregnancy (EP) has been reported to occur in 1.4-5.4% of all clinical pregnancies resulting from in vitro fertilization (IVF) and embryo transfer (ET). Data on factors associated with abnormal embryo implantation following assisted conception are limited. MATERIALS AND METHODS A systematic review and meta-analysis was performed to determine whether there is an association between the day (cleavage-stage, D3, versus blastocyst, D5) or the type (fresh versus frozen/thawed) of ET and EP rate. Risk factors for EP were evaluated in a retrospective study of 1194 women, who achieved pregnancy at our IVF unit between 2010 and 2016. RESULTS Sixteen papers were considered for the meta-analysis. EP rate did not differ between D3 and D5 fresh ET groups (RR = 0.99, 95%CI: 0.76-1.30) and was higher after fresh versus frozen ET (RR = 1.56, 95%CI: 1.25-1.95). At our clinic, 21 (1.76%) pregnancies were documented as ectopic. The risk of EP was associated with tubal pathology (OR = 3.37, 95%CI: 1.39-8.2), previous appendectomy and past chlamydial infection. CONCLUSIONS Present meta-analysis suggests that EP rate is similar following fresh blastocyst and cleavage ETs, but is significantly reduced after frozen compared with fresh ET. Our own findings demonstrate that tubal pathology has the major impact on EP occurrence following assisted conception.
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Affiliation(s)
- V Muller
- a Department of Assisted Reproduction Technologies , FSBI D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology , Saint-Petersburg , Russia and
| | - M Makhmadalieva
- a Department of Assisted Reproduction Technologies , FSBI D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology , Saint-Petersburg , Russia and
| | - I Kogan
- a Department of Assisted Reproduction Technologies , FSBI D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology , Saint-Petersburg , Russia and
| | - I Fedorova
- a Department of Assisted Reproduction Technologies , FSBI D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology , Saint-Petersburg , Russia and
| | - E Lesik
- a Department of Assisted Reproduction Technologies , FSBI D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology , Saint-Petersburg , Russia and
| | - E Komarova
- a Department of Assisted Reproduction Technologies , FSBI D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology , Saint-Petersburg , Russia and
| | - L Dzhemlikhanova
- a Department of Assisted Reproduction Technologies , FSBI D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology , Saint-Petersburg , Russia and
- b Department of Obstetrics, Gynecology and Reproductology, Faculty of Medicine , Saint-Petersburg State University, Saint-Petersburg , Russia
| | - D Niauri
- b Department of Obstetrics, Gynecology and Reproductology, Faculty of Medicine , Saint-Petersburg State University, Saint-Petersburg , Russia
| | - A Gzgzyan
- a Department of Assisted Reproduction Technologies , FSBI D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology , Saint-Petersburg , Russia and
- b Department of Obstetrics, Gynecology and Reproductology, Faculty of Medicine , Saint-Petersburg State University, Saint-Petersburg , Russia
| | - E Ailamazyan
- a Department of Assisted Reproduction Technologies , FSBI D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology , Saint-Petersburg , Russia and
- b Department of Obstetrics, Gynecology and Reproductology, Faculty of Medicine , Saint-Petersburg State University, Saint-Petersburg , Russia
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Patel AP, Patel JA, Cruz M, Gupte-Shah A, Garcia Velasco JA, Banker MR. Ethnicity is an independent predictor of IVF-ICSI outcome: a study of 5,549 cycles in Spain and India. Gynecol Endocrinol 2016; 32:819-822. [PMID: 27243388 DOI: 10.1080/09513590.2016.1188377] [Citation(s) in RCA: 6] [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: 10/21/2022] Open
Abstract
AIM To determine the role of ethnicity on IVF/ICSI outcomes between Indian and white Caucasian women. SETTINGS AND DESIGN Retrospective cohort study. MATERIALS AND METHODS White Caucasian and Indian women undergoing IVF/ICSI treatment cycles. Total 5549 self, non-donor, fresh IVF cycles conducted from January 2014 to March 2015, out of which, 4227 were white Caucasian and 1322 were Indian. Data were collected on baseline characteristics, IVF cycle parameters and outcomes. Ongoing pregnancy rate (OPR) was measured as main outcome. RESULTS Indian women differed significantly from white Caucasian women in baseline characteristics like age (30.6 ± 0.2 versus 37.6 ± 0.1 years; p < 0.001), BMI (22.3 ± 0.2 versus 26.6 ± 1.0 kg/m2; p < 0.05), duration of infertility (6.9 ± 3.0 versus 2.5 ± 0.1 years; p < 0.001) and antral follicle count (AFC) (8.9 ± 0.4 versus 7.5 ± 0.2; p < 0.001). Indian women had lower implantation rate (30.1% versus 39.6%: p < 0.001) and OPR (35.1% versus 41.7%: p < 0.001) compared with white Caucasian women. Regression analysis proved independent effect of ethnicity on OPR (OR 0.944; 95% CI 0.928-0.961: p < 0.001) Conclusions: OPR was significantly lower among Indian ethnic group following IVF/ICSI suggest that ethnicity, like age, is a major and an independent predictor of IVF outcome.
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Affiliation(s)
- Azadeh P Patel
- a Department of Reproductive Medicine , NIF (Nova IVI Fertility) Clinic , Ahmedabad , India and
| | - Jayesh A Patel
- a Department of Reproductive Medicine , NIF (Nova IVI Fertility) Clinic , Ahmedabad , India and
| | - Maria Cruz
- b Department of Reproductive Medicine , IVI (Instituto Valenciano de Infertilidad) , Madrid , Spain
| | - Arati Gupte-Shah
- a Department of Reproductive Medicine , NIF (Nova IVI Fertility) Clinic , Ahmedabad , India and
| | - Juan A Garcia Velasco
- b Department of Reproductive Medicine , IVI (Instituto Valenciano de Infertilidad) , Madrid , Spain
| | - Manish R Banker
- a Department of Reproductive Medicine , NIF (Nova IVI Fertility) Clinic , Ahmedabad , India and
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121
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Abstract
Aims: The purpose of this study was to describe equity in the use of in vitro fertilization (IVF; including micro-injections and frozen-embryo transfers), and compare its use with that of other assisted reproduction technologies (other ARTs; including ovulation inductions with or without inseminations). Methods: The women who received IVF (n=9, 175) and other ARTs (n=10,254) between 1996 and 1998 were identified from the reimbursement records of the Social Insurance Institution (SII) covering all Finns. Population controls, matched by age and municipality, were selected for IVF women (n=9,175). Information concerning background characteristics came from the Central Population Register and the SII's reimbursement files. The sector (public vs. private) was defined using prescribing physicians' codes. IVF use was studied by the proportions of women treated and the frequency of treatment. Results: The age-standardized IVF incidence per thousand 20-to-49-year-old women was 8.8 in urban and 7.3 in rural areas, but the use of other ARTs did not vary correspondingly (9.2, 9.3). The regional incidence of IVF and other ARTs varied considerably. In the private sector, women in the highest socioeconomic position were over-represented (29% private, 18% public, 16% controls). During the mean 1.5 years of the study period, the IVF women had somewhat more treatment cycles in the private than in the public sector (mean 3.3, 2.7), and those in the highest socioeconomic position had more cycles than others (3.5, 3.2); the frequency was not age-dependent. In the public sector the number of cycles did not differ by socioeconomic group (mean 2.7 - 2.8 per woman), and women aged 25 to 39 had more cycles than others. Conclusion: There were socioeconomic differences in use of IVF services, but they were small because of the equitable use of public services.
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Affiliation(s)
- Reija Klemetti
- STAKES, National Research and Development Centre for Welfare and Health, Health Services Research, Helsinki, Finland.
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Taweepolcharoen C. Risk Factors of Ectopic Pregnancy in Women Undergoing In Vitro Fertilization and Embryo Transfer (IVF-ET). J Med Assoc Thai 2016; 99:969-974. [PMID: 29927194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To identify risk factors associated with ectopic pregnancy (EP) in women undergoing assisted reproductive technology (ART). MATERIAL AND METHOD A retrospective study was conducted among pregnant women after in vitro fertilization and embryo transfer (IVF-ET) in an assisted conception unit of a university hospital between 1994 and 2013. The factors evaluated included the use of donor oocyte, use of intracytoplasmic sperm injection (ICSI), stage of embryo, number of embryos transferred, and fresh or frozen-thawed cycle. RESULTS One thousand three hundred eighty five pregnancies were identified of which 29 were ectopic pregnancies. Embryo transfer (ET) in fresh cycle significantly increased risk for EP compared with frozen-thawed cycle (p = 0.005). Day-5 ET also significantly increased higher EP risk than day-3 ET (p = 0.041). Three or more embryos transfer (p = 0.085), use of donor oocyte (p = 0.999), and use of ICSI (p = 0.246) did not significantly influence EP risk. CONCLUSION Embryo transfer in fresh cycle and day-5 embryo transfer significantly increased EP risk. More patients and embryo characteristics are necessary to be studied to identify more valid predictors.
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Gürhan N, Oflaz F, Atici D, Akyüz A, Vural G. Effectiveness of Nursing Counseling on Coping and Depression in Women Undergoing in Vitro Fertilization. Psychol Rep 2016; 100:365-74. [PMID: 17564210 DOI: 10.2466/pr0.100.2.365-374] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of present study was to evaluate the effectiveness of counseling provided by nurses on depression and coping strategies of infertile women undergoing in vitro fertilization ( N = 67). Of the 84 women who were interviewed, 30 were accepted as a comparison group, and 37 were included in the study group. The study group women were given counseling in addition to routine nursing care services, including group education and individual interviews about treatment and coping strategies. The nurses also provided support by accompanying the women during the invasive procedures. The Beck Depression Inventory and Jalowiec's Coping Strategies Form were used for measurements. All the women were using emotional coping and had moderate depression prior to the study. There was no statistically significant difference between the comparison and study groups before or after the counseling with respect to depression and coping strategies. Parameters to evaluate the efficacy of counseling are discussed.
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Shavit T, Shalom-Paz E, Samara N, Aslih N, Michaeli M, Ellenbogen A. Comparison between stimulation with highly purified hMG or recombinant FSH in patients undergoing IVF with GnRH antagonist protocol. Gynecol Endocrinol 2016; 32:629-633. [PMID: 26939574 DOI: 10.3109/09513590.2016.1153058] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 11/13/2022] Open
Abstract
PURPOSE Highly purified Human Menopausal Gonadotropins (hp-hMG) and recombinant FSH (rFSH) are widely used in assisted reproductive technology (ART). The aim of this study was to compare ART results of the two preparations in GnRH antagonist cycles. METHODS In this retrospective cohort study, IVF antagonist cycles performed from 2011 through 2013 were reviewed. There were 508 antagonist cycles: 320 stimulated with rFSH and 188 with hp-hMG. For every hp-hMG, two rFSH were matched for patient's age and infertility diagnosis. Subgroup analysis of patients younger and older than 35 was done as well. RESULTS Both treatments were resulted in comparable pregnancy and live birth rates. However, cumulative pregnancy rates were higher for the rFSH group. In the matching analysis, the rFSH group had more mature oocytes and more embryos while using lower doses of gonadotropins. Pregnancy, cumulative pregnancy rates, and live birth rates were comparable. In the subgroup analysis, young patients in the rFSH group had better cycle outcomes compared with those in the hp-hMG group. CONCLUSION In antagonist protocol, different gonadotropin products are equally effective. The choice of one or the other should depend on the availability, convenience of use, and cost.
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Affiliation(s)
- Tal Shavit
- a IVF Unit, Department of Obstetrics & Gynecology, Hillel Yaffe Medical Center, Rappaport School of Medicine, Technion, Israel Institute of Technology , Haifa , Hadera , IL , Israel
| | - Einat Shalom-Paz
- a IVF Unit, Department of Obstetrics & Gynecology, Hillel Yaffe Medical Center, Rappaport School of Medicine, Technion, Israel Institute of Technology , Haifa , Hadera , IL , Israel
| | - Nivin Samara
- a IVF Unit, Department of Obstetrics & Gynecology, Hillel Yaffe Medical Center, Rappaport School of Medicine, Technion, Israel Institute of Technology , Haifa , Hadera , IL , Israel
| | - Nardin Aslih
- a IVF Unit, Department of Obstetrics & Gynecology, Hillel Yaffe Medical Center, Rappaport School of Medicine, Technion, Israel Institute of Technology , Haifa , Hadera , IL , Israel
| | - Madiea Michaeli
- a IVF Unit, Department of Obstetrics & Gynecology, Hillel Yaffe Medical Center, Rappaport School of Medicine, Technion, Israel Institute of Technology , Haifa , Hadera , IL , Israel
| | - Adrian Ellenbogen
- a IVF Unit, Department of Obstetrics & Gynecology, Hillel Yaffe Medical Center, Rappaport School of Medicine, Technion, Israel Institute of Technology , Haifa , Hadera , IL , Israel
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Hauser R, Gaskins AJ, Souter I, Smith KW, Dodge LE, Ehrlich S, Meeker JD, Calafat AM, Williams PL. Urinary Phthalate Metabolite Concentrations and Reproductive Outcomes among Women Undergoing in Vitro Fertilization: Results from the EARTH Study. Environ Health Perspect 2016; 124:831-9. [PMID: 26545148 PMCID: PMC4892919 DOI: 10.1289/ehp.1509760] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 10/30/2015] [Indexed: 05/18/2023]
Abstract
BACKGROUND Evidence from both animal and human studies suggests that exposure to phthalates may be associated with adverse female reproductive outcomes. OBJECTIVE We evaluated the associations between urinary concentrations of phthalate metabolites and outcomes of assisted reproductive technologies (ART). METHODS This analysis included 256 women enrolled in the Environment and Reproductive Health (EARTH) prospective cohort study (2004-2012) who provided one to two urine samples per cycle before oocyte retrieval. We measured 11 urinary phthalate metabolites [mono(2-ethylhexyl) phthalate (MEHP), mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono(2-ethyl-5-oxohexyl) phthalate (MEOHP), mono(2-ethyl-5-carboxypentyl) phthalate (MECPP), mono-isobutyl phthalate (MiBP), mono-n-butyl phthalate (MBP), monobenzyl phthalate (MBzP), monoethyl phthalate (MEP), monocarboxyisooctyl phthalate (MCOP), monocarboxyisononyl phthalate (MCNP), and mono(3-carboxypropyl) phthalate (MCPP)]. We used generalized linear mixed models to evaluate the association of urinary phthalate metabolites with in vitro fertilization (IVF) outcomes, accounting for multiple IVF cycles per woman. RESULTS In multivariate models, women in the highest as compared with lowest quartile of MEHP, MEHHP, MEOHP, MECPP, ΣDEHP (MEHP + MEHHP + MEOHP + MECPP), and MCNP had lower oocyte yield. Similarly, the number of mature (MII) oocytes retrieved was lower in the highest versus lowest quartile for these same phthalate metabolites. The adjusted differences (95% CI) in proportion of cycles resulting in clinical pregnancy and live birth between women in the fourth versus first quartile of ΣDEHP were -0.19 (-0.29, -0.08) and -0.19 (-0.28, -0.08), respectively, and there was also a lower proportion of cycles resulting in clinical pregnancy and live birth for individual DEHP metabolites. CONCLUSIONS Urinary concentrations of DEHP metabolites were inversely associated with oocyte yield, clinical pregnancy, and live birth following ART. CITATION Hauser R, Gaskins AJ, Souter I, Smith KW, Dodge LE, Ehrlich S, Meeker JD, Calafat AM, Williams PL, for the EARTH Study Team. 2016. Urinary phthalate metabolite concentrations and reproductive outcomes among women undergoing in vitro fertilization: results from the EARTH study. Environ Health Perspect 124:831-839; http://dx.doi.org/10.1289/ehp.1509760.
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Affiliation(s)
- Russ Hauser
- Department of Environmental Health, and
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Obstetrics and Gynecology, Harvard Medical School/Massachusetts General Hospital Fertility Center, Boston, Massachusetts, USA
- Address correspondence to R. Hauser, Environmental and Occupational Medicine and Epidemiology Program, Department of Environmental Health, Building I, Room 1409, 665 Huntington Ave., Boston, MA 02115 USA. Telephone: (617) 432-3326. E-mail:
| | - Audrey J. Gaskins
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Irene Souter
- Department of Obstetrics and Gynecology, Harvard Medical School/Massachusetts General Hospital Fertility Center, Boston, Massachusetts, USA
| | | | - Laura E. Dodge
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Shelley Ehrlich
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - John D. Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Antonia M. Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paige L. Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Goldberg D, Tsafrir A, Srebnik N, Gal M, Margalioth EJ, Mor P, Farkash R, Samueloff A, Eldar-Geva T. How Many Embryos should be Transferred? The Relevance of Parity and Obstetric History. Isr Med Assoc J 2016; 18:313-317. [PMID: 27468521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Fertility treatments are responsible for the rise in high order pregnancies in recent decades and their associated complications. Reducing the number of embryos returned to the uterus will reduce the rate of high order pregnancies. OBJECTIVES To explore whether obstetric history and parity have a role in the clinician's decision making regarding the number of embryos transferred to the uterus during in vitro fertilization (IVF). METHODS In a retrospective study for the period August 2005 to March 2012, data of twin deliveries > 24 weeks were collected, including parity, mode of conception (IVF vs. spontaneous), gestational age at delivery, preeclampsia, birth weight, admission to the neonatal intensive care unit (NICU), and Apgar scores. RESULTS A total of 1651 twin deliveries > 24 weeks were record- ed, of which 959 (58%) were at term (> 37 weeks). The early preterm delivery (PTD) rate (< 32 weeks) was significantly lower with increased parity (12.6%, 8.5%, and 5.6%, in women with 0, 1, and ≥ 2 previous term deliveries, respectively). Risks for PTD (< 37 weeks), preeclampsia and NICU admission were significantly higher in primiparous women compared to those who had one or more previous term deliveries. Primiparity and preeclampsia, but not IVF, were significant risk factors for PTD. CONCLUSIONS The risk for PTD in twin pregnancies is significantly lower in women who had a previous term delivery and decreases further after two or more previous term deliveries. This finding should be considered when deciding on the number of embryos to be transferred in IV.
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Brabers AEM, van Dijk L, Groenewegen PP, van Peperstraten AM, de Jong JD. Does a strategy to promote shared decision-making reduce medical practice variation in the choice of either single or double embryo transfer after in vitro fertilisation? A secondary analysis of a randomised controlled trial. BMJ Open 2016; 6:e010894. [PMID: 27154481 PMCID: PMC4861095 DOI: 10.1136/bmjopen-2015-010894] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES The hypothesis that shared decision-making (SDM) reduces medical practice variations is increasingly common, but no evidence is available. We aimed to elaborate further on this, and to perform a first exploratory analysis to examine this hypothesis. This analysis, based on a limited data set, examined how SDM is associated with variation in the choice of single embryo transfer (SET) or double embryo transfer (DET) after in vitro fertilisation (IVF). We examined variation between and within hospitals. DESIGN A secondary analysis of a randomised controlled trial. SETTING 5 hospitals in the Netherlands. PARTICIPANTS 222 couples (woman aged <40 years) on a waiting list for a first IVF cycle, who could choose between SET and DET (ie, ≥2 embryos available). INTERVENTION SDM via a multifaceted strategy aimed to empower couples in deciding how many embryos should be transferred. The strategy consisted of decision aid, support of IVF nurse and the offer of reimbursement for an extra treatment cycle. Control group received standard IVF care. OUTCOME MEASURE Difference in variation due to SDM in the choice of SET or DET, both between and within hospitals. RESULTS There was large variation in the choice of SET or DET between hospitals in the control group. Lower variation between hospitals was observed in the group with SDM. Within most hospitals, variation in the choice of SET or DET appeared to increase due to SDM. Variation particularly increased in hospitals where mainly DET was chosen in the control group. CONCLUSIONS Although based on a limited data set, our study gives a first insight that including patients' preferences through SDM results in less variation between hospitals, and indicates another pattern of variation within hospitals. Variation that results from patient preferences could be potentially named the informed patient rate. Our results provide the starting point for further research. TRIAL REGISTRATION NUMBER NCT00315029; Post-results.
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Affiliation(s)
- Anne E M Brabers
- NIVEL, the Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Liset van Dijk
- NIVEL, the Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Peter P Groenewegen
- NIVEL, the Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Department of Sociology, Utrecht University, Utrecht, The Netherlands
- Department of Human Geography, Utrecht University, Utrecht, The Netherlands
| | - Arno M van Peperstraten
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Judith D de Jong
- NIVEL, the Netherlands Institute for Health Services Research, Utrecht, The Netherlands
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128
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Li MZ, Xue X, Zhang SL, Zhang X, Shi JZ. [The rate of morphologically normal sperm does not affect the clinical outcomes of conventional IVF in patients with one retrieved oocyte]. Zhonghua Nan Ke Xue 2016; 22:143-146. [PMID: 26939399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To investigate the influence of the rate of morphologically normal sperm (MNS) on the clinical outcomes of conventional in vitro fertilization (IVF) in patients with one retrieved oocyte. METHODS From January 2013 to January 2015, a total of 256 couples with one retrieved oocyte underwent conventional IVF in our center. According to the rate of MNS, the patients were divided into two groups: MNS < 4% (134 cycles) and MNS ≥ 4% (122 cycles). We compared the rates of no transferrable embryo cycles, fertilization, cleavage, normal fertilization, abnormal fertilization, high-quality embryo and transferrable embryo between the two groups. A total of 75 fresh embryo transfer cycles were performed, 43 in the MNS < 4% group and the other 32 in the MNS ≥ 4% group. We also compared the rates of implantation, clinical pregnancy and abortion between the two groups. RESULTS There were no statistically significant differences between the two groups in the rates of no transferrable embryo cycles, fertilization, cleavage, normal fertilization, abnormal fertilization, high-quality embryo and transferrable embryo (P > 0.05). The rates of implantation, clinical pregnancy and abortion exhibited no remarkable differences either in the fresh embryo transfer cycles between the two groups (P > 0.05). CONCLUSION The rate of MNS does not affect the clinical outcomes of conventional IVF in patients with one retrieved oocyte.
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129
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Jiang WJ, Jin F, Zhou LM. [Values of the sperm deformity index, acrosome abnormity rate, and sperm DNA fragmentation index of optimized sperm in predicting IVF fertilization failure]. Zhonghua Nan Ke Xue 2016; 22:147-152. [PMID: 26939400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To investigate the values of the sperm deformity index (SDI), acrosome abnormity rate (AAR), and DNA fragmentation index (DFI) of optimized sperm in the prediction of fertilization failure (fertilization rate < 25%) in conventional in vitro fertilization (IVF). METHODS We selected 695 cycles of conventional IVF for pure oviductal infertility in this study, including 603 cycles of normal fertilization and 92 cycles of fertilization failure. On the day of oocyte retrieval, we examined sperm morphology, acrosome morphology, and DNA fragmentation using the Diff-Quik, PSA-FITC and SCD methods. We established the joint predictor (JP) by logistic equation and analyzed the values of different parameters in predicting fertilization failure with the receiver operating characteristic (ROC) curve. RESULTS The fertilization rate was negatively correlated with SDI (r = - 0.07; P = 0.03), AAR (r = -0.49; P < 0.01), and DFI (r = -0. 21; P < 0.01). The SDI, AAR, and DFI in the normal fertilization group were 1.24 ± 0.20, (7.75 ± 2.28)%, and (7.87 ± 3.15)%, and those in the fertilization failure group were 1.42 ± 0.15, (12.02 ± 3.06)%, and (13.32 ± 4.13)%, respectively, all with statistically significant differences between the two groups (P < 0.05). SDI, AAR, and DFI were all risk factors of fertilization failure ( OR = 2.68, 14.11, and 3.85; P = 0.01, < 0.01, and < 0.01). The areas under the ROC curves for SDI, AAR, DFI, and JP were 0.651 ± 0.033, 0.895 ± 0.019, 0.789 ± 0.022, and 0.915 ± 0.017, respectively. According to the Youden index, the optimal cut-off values of SDI, AAR, and DFI obtained for the prediction of fertilization failure were approximately 1.45, 10%, and 12%. CONCLUSION The SDI, AAR and DFI of optimized sperm are closely associated with the fertilization rate, and all have the value for predicting fertilization failure in IVF. The AAR is more valuable than the other single predictors, but JP is more effective than the AAR.
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130
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Tamir R, Allouche S, Weissman A, Haikin Herzberger E, Oberman-Farhi S, Shalom-Paz E, Shulman A, Wiser A. The effect of medical versus surgical treatment of spontaneous miscarriage on subsequent in vitro fertilization cycles. Gynecol Endocrinol 2016; 32:231-3. [PMID: 26486224 DOI: 10.3109/09513590.2015.1110693] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the effect of dilation and curettage (D&C) and misoprostol as treatments for spontaneous miscarriage (SM) on in vitro fertilization (IVF) parameters in the subsequent IVF cycle. DESIGN Multicenter, retrospective, cohort study. Women treated for SM after IVF treatment with D&C or misoprostol and underwent a subsequent IVF cycle was included. The main outcome measures were ovarian response, endometrial thickness and pregnancy rate in the subsequent IVF cycle after MA. RESULTS Among 73 patients with miscarriage, 41 had D&C and 32 were given misoprostol. Baseline serum follicle stimulating hormone (FSH) levels and ovarian responses before and after treatment of miscarriage were comparable. No significant differences were observed between the D&C and the misoprostol groups in basal FSH levels, endometrial thickness and parameters of ovarian response in the subsequent IVF cycle. CONCLUSION D&C and misoprostol are both effective treatments for IVF patients with miscarriage, without an adverse effect on subsequent IVF treatment outcome.
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Affiliation(s)
- Rina Tamir
- a IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center , Kfar Saba , Israel
- b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Sarit Allouche
- b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
- c IVF Unit, Department of Obstetrics and Gynecology Wolfson Medical Center , Holon , Israel
| | - Ariel Weissman
- b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
- c IVF Unit, Department of Obstetrics and Gynecology Wolfson Medical Center , Holon , Israel
| | - Einat Haikin Herzberger
- a IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center , Kfar Saba , Israel
- b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Suzi Oberman-Farhi
- d IVF Unit, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center , Hadera , Israel , and
- e Faculty of Medicine , Technion-Israel Institute of Technology , Haifa , Israel
| | - Einat Shalom-Paz
- d IVF Unit, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center , Hadera , Israel , and
- e Faculty of Medicine , Technion-Israel Institute of Technology , Haifa , Israel
| | - Adrian Shulman
- a IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center , Kfar Saba , Israel
- b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Amir Wiser
- a IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center , Kfar Saba , Israel
- b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
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Itoi F, Asano Y, Shimizu M, Honnma H, Murata Y. Embryological outcomes in cycles with human oocytes containing large tubular smooth endoplasmic reticulum clusters after conventional in vitro fertilization. Gynecol Endocrinol 2016; 32:315-8. [PMID: 26607857 DOI: 10.3109/09513590.2015.1115831] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 11/13/2022] Open
Abstract
There have been no studies analyzing the effect of large aggregates of tubular smooth endoplasmic reticulum (aSERT) after conventional in vitro fertilization (cIVF). The aim of this study was to investigate whether aSERT can be identified after cIVF and the association between the embryological outcomes of oocytes in cycles with aSERT. This is a retrospective study examining embryological data from cIVF cycles showing the presence of aSERT in oocytes 5-6 h after cIVF. To evaluate embryo quality, cIVF cycles with at least one aSERT-metaphase II (MII) oocyte observed (cycles with aSERT) were compared to cycles with normal-MII oocytes (control cycles). Among the 4098 MII oocytes observed in 579 cycles, aSERT was detected in 100 MII oocytes in 51 cycles (8.8%). The fertilization rate, the rate of embryo development on day 3 and day 5-6 did not significantly differ between cycles with aSERT and control group. However, aSERT-MII oocytes had lower rates for both blastocysts and good quality blastocysts (p < 0.05). aSERT can be detected in the cytoplasm by removing the cumulus cell 5 h after cIVF. However, aSERT-MII oocytes do not affect other normal-MII oocytes in cycles with aSERT.
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Affiliation(s)
- Fumiaki Itoi
- a Department of Infertility , Green Bell Clinic, Toyota , Japan
- b Department of Infertility , Angel Bell Hospital , Okazaki , Japan
- c Faculty of Life and Environmental Sciences, University of Yamanashi , Kofu , Yamanashi, , Japan
| | - Yukiko Asano
- d Department of Infertility , Royal Bell Clinic , Nagoya , Japan , and
| | - Masashi Shimizu
- b Department of Infertility , Angel Bell Hospital , Okazaki , Japan
| | | | - Yasutaka Murata
- b Department of Infertility , Angel Bell Hospital , Okazaki , Japan
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132
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Huang L, Wang S, Ma Y. Combined evaluation of risk factors predicting poor ovarian responders in Chinese patients undergoing in vitro fertilization. Gynecol Endocrinol 2016; 32:124-7. [PMID: 26489886 DOI: 10.3109/09513590.2015.1101442] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study aimed to explore the parameters associated with poor ovarian response (POR) to develop an early warning score model (EWSM) for detecting POR in Chinese women undergoing in vitro fertilization, in order to improve the outcomes. Between 2005 and 2011, we recruited 736 patients with POR after IVF and 736 individuals with normal ovarian response after IVF as controls. Clinical parameters were determined to evaluate the ovarian reserve. We then compared the clinical parameters between the POR and control groups, and performed a multivariate analysis to determine the independent factors associated with ovarian response. Receiver-operator characteristic (ROC) was used to analyze the predicted values of individual and combined risk factors. The predicted values were further tested in another cohort of 957 patients. Age, basal follicle-stimulating hormone (bFSH), antral follicle count (AFC), and FSH/luteinizing hormone (LH) ratio were identified as independent factors associated with ovarian response. The EWSM was established using a combination of these parameters. The sensitivity and specificity of the EWSM were 74.6% and 93.6%, respectively. In conclusion, combination of individual risk factors could predict POR with high specificity. The EWSM may help in the evaluation of IVF treatment at an early stage.
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Affiliation(s)
- Lu Huang
- a Reproductive Medicine Department , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
| | - Shuyu Wang
- a Reproductive Medicine Department , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
| | - Yanmin Ma
- a Reproductive Medicine Department , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
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133
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Wise J. Extending IVF cycles beyond usual three or four shows benefit. BMJ 2015; 351:h6913. [PMID: 26702087 DOI: 10.1136/bmj.h6913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
IMPORTANCE The likelihood of achieving a live birth with repeat in vitro fertilization (IVF) is unclear, yet treatment is commonly limited to 3 or 4 embryo transfers. OBJECTIVE To determine the live-birth rate per initiated ovarian stimulation IVF cycle and with repeated cycles. DESIGN, SETTING, AND PARTICIPANTS Prospective study of 156,947 UK women who received 257,398 IVF ovarian stimulation cycles between 2003 and 2010 and were followed up until June 2012. EXPOSURES In vitro fertilization, with a cycle defined as an episode of ovarian stimulation and all subsequent separate fresh and frozen embryo transfers. MAIN OUTCOMES AND MEASURES Live-birth rate per IVF cycle and the cumulative live-birth rates across all cycles in all women and by age and treatment type. Optimal, prognosis-adjusted, and conservative cumulative live-birth rates were estimated, reflecting 0%, 30%, and 100%, respectively, of women who discontinued due to poor prognosis and having a live-birth rate of 0 had they continued. RESULTS Among the 156,947 women, the median age at start of treatment was 35 years (interquartile range, 32-38; range, 18-55), and the median duration of infertility for all 257,398 cycles was 4 years (interquartile range, 2-6; range, <1-29). In all women, the live-birth rate for the first cycle was 29.5% (95% CI, 29.3%-29.7%). This remained above 20% up to and including the fourth cycle. The cumulative prognosis-adjusted live-birth rate across all cycles continued to increase up to the ninth cycle, with 65.3% (95% CI, 64.8%-65.8%) of women achieving a live birth by the sixth cycle. In women younger than 40 years using their own oocytes, the live-birth rate for the first cycle was 32.3% (95% CI, 32.0%-32.5%) and remained above 20% up to and including the fourth cycle. Six cycles achieved a cumulative prognosis-adjusted live-birth rate of 68.4% (95% CI, 67.8%-68.9%). For women aged 40 to 42 years, the live-birth rate for the first cycle was 12.3% (95% CI, 11.8%-12.8%), with 6 cycles achieving a cumulative prognosis-adjusted live-birth rate of 31.5% (95% CI, 29.7%-33.3%). For women older than 42 years, all rates within each cycle were less than 4%. No age differential was observed among women using donor oocytes. Rates were lower for women with untreated male partner-related infertility compared with those with any other cause, but treatment with either intracytoplasmic sperm injection or sperm donation removed this difference. CONCLUSIONS AND RELEVANCE Among women in the United Kingdom undergoing IVF, the cumulative prognosis-adjusted live-birth rate after 6 cycles was 65.3%, with variations by age and treatment type. These findings support the efficacy of extending the number of IVF cycles beyond 3 or 4.
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Affiliation(s)
- Andrew D.A.C. Smith
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, UK
- School of Social and Community Medicine, University of Bristol, UK
| | - Kate Tilling
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, UK
- School of Social and Community Medicine, University of Bristol, UK
| | - Scott M Nelson
- School of Medicine, University of Glasgow, UK
- Corresponding Author: DA Lawlor, School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Clifton, Bristol, BS8 1BN, United Kingdom, , +44 (0)117 3310096
| | - Debbie A Lawlor
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, UK
- School of Social and Community Medicine, University of Bristol, UK
- Corresponding Author: DA Lawlor, School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Clifton, Bristol, BS8 1BN, United Kingdom, , +44 (0)117 3310096
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135
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Affiliation(s)
- Evan R Myers
- Department of Obstetrics and Gynecology and Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
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136
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Onat G, Aba YA. The Effects of a Healthy Lifestyle and of Anxiety Levels on IVF Outcomes. Afr J Reprod Health 2015; 19:92-101. [PMID: 27337858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study investigated effects of a healthy lifestyle and anxiety levels on in vitro fertilization (IVF) outcomes. This follow-up study on 102 infertile women and 66 infertile men (total: 168) was carried out at a infertility clinic in university hospital in Instanbul, Turkey. Health-Promoting-Lifestyle-Profile-II (HPLP II) and State-Trait Anxiety Inventory (STAI) instruments were used. Female participants were called following their IVF treatment to determine whether they were pregnant or not. The mean age for female respondents was 31.38 ± 4.66; for men it was 34.22 ± 4.34 (t:-3.96; p:0.00). Their subjects' infertility types were unexplained 23.8%, male factor 41.1% and female factor 24.4%. Their total HPLP-II scores were 129.21 ± 22.33 (a range of 63-204). Their rate of pregnancy following IVF was 19%. The HPLP-II scores were upper-intermediate. Despite the State anxiety levels being moderate, the Trait anxiety levels were high. Comparison of the scales by gender was not significant. In addition, on HPLP-II and STAI scores, there were no differences between pregnant and non-pregnant women following IVF.
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Kotelchuck M, Hoang L, Stern JE, Diop H, Belanoff C, Declercq E. The MOSART database: linking the SART CORS clinical database to the population-based Massachusetts PELL reproductive public health data system. Matern Child Health J 2015; 18:2167-78. [PMID: 24623195 DOI: 10.1007/s10995-014-1465-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Although Assisted Reproductive Technology (ART) births make up 1.6 % of births in the US, the impact of ART on subsequent infant and maternal health is not well understood. Clinical ART treatment records linked to population data would be a powerful tool to study long term outcomes among those treated or not by ART. This paper describes the development of a database intended to accomplish this task. We constructed the Massachusetts Outcomes Study of Assisted Reproductive Technology (MOSART) database by linking the Society of Assisted Reproductive Technologies Clinical Outcomes Reporting System (SART CORS) and the Massachusetts (MA) Pregnancy to Early Life Longitudinal (PELL) data systems for children born to MA resident women at MA hospitals between July 2004 and December 2008. PELL data representing 282,971 individual women and their 334,152 deliveries and 342,035 total births were linked with 48,578 cycles of ART treatment in SART CORS delivered to MA residents or women receiving treatment in MA clinics, representing 18,439 eligible women of whom 9,326 had 10,138 deliveries in this time period. A deterministic five phase linkage algorithm methodology was employed. Linkage results, accuracy, and concordance analyses were examined. We linked 9,092 (89.7 %) SART CORS outcome records to PELL delivery records overall, including 95.0 % among known MA residents treated in MA clinics; 70.8 % with full exact matches. There were minimal differences between matched and unmatched delivery records, except for unknown residency and out-of-state ART site. There was very low concordance of reported use of ART treatment between SART CORS and PELL (birth certificate) data. A total of 3.4 % of MA children (11,729) were identified from ART assisted pregnancies (6,556 singletons; 5,173 multiples). The MOSART linked database provides a strong basis for further longitudinal ART outcomes studies and supports the continued development of potentially powerful linked clinical-public health databases.
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Affiliation(s)
- Milton Kotelchuck
- MGH Center for Child and Adolescent Health Research and Policy, MassGeneral Hospital for Children, 100 Cambridge Street, 15-1545, Boston, MA, 02114, USA,
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Chen M, Wei S, Hu J, Quan S. Can Comprehensive Chromosome Screening Technology Improve IVF/ICSI Outcomes? A Meta-Analysis. PLoS One 2015; 10:e0140779. [PMID: 26470028 PMCID: PMC4607161 DOI: 10.1371/journal.pone.0140779] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [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: 08/06/2015] [Accepted: 09/30/2015] [Indexed: 02/05/2023] Open
Abstract
Objective To examine whether comprehensive chromosome screening (CCS) for preimplantation genetic screening (PGS) has an effect on improving in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes compared to traditional morphological methods. Methods A literature search was conducted in PubMed, EMBASE, CNKI and ClinicalTrials.gov up to May 2015. Two reviewers independently evaluated titles and abstracts, extracted data and assessed quality. We included studies that compared the IVF/ICSI outcomes of CCS-based embryo selection with those of the traditional morphological method. Relative risk (RR) values with corresponding 95% confidence intervals (CIs) were calculated in RevMan 5.3, and subgroup analysis and Begg’s test were used to assess heterogeneity and potential publication bias, respectively. Results Four RCTs and seven cohort studies were included. A meta-analysis of the outcomes showed that compared to morphological criteria, euploid embryos identified by CCS were more likely to be successfully implanted (RCT RR 1.32, 95% CI 1.18–1.47; cohort study RR 1.74, 95% CI 1.35–2.24). CCS-based PGS was also related to an increased clinical pregnancy rate (RCT RR 1.26, 95% CI 0.83–1.93; cohort study RR 1.48, 95% CI 1.20–1.83), an increased ongoing pregnancy rate (RCT RR 1.31, 95% CI 0.64–2.66; cohort study RR 1.61, 95% CI 1.30–2.00), and an increased live birth rate (RCT RR 1.26, 95% CI 1.05–1.50; cohort study RR 1.35, 95% CI 0.85–2.13) as well as a decreased miscarriage rate (RCT RR 0.53, 95% CI 0.24–1.15; cohort study RR 0.31, 95% CI 0.21–0.46) and a decreased multiple pregnancy rate (RCT RR 0.02, 95% CI 0.00–0.26; cohort study RR 0.19, 95% CI 0.07–0.51). The results of the subgroup analysis also showed a significantly increased implantation rate in the CCS group. Conclusions The effectiveness of CCS-based PGS is comparable to that of traditional morphological methods, with better outcomes for women receiving IVF/ICSI technology. The transfer of both trophectoderm-biopsied and blastomere-biopsied CCS-euploid embryos can improve the implantation rate.
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Affiliation(s)
- Minghao Chen
- Department of Obstetrics and Gynecology, Reproductive Centre, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shiyou Wei
- Thoracic Department, West China Hospital, Sichuan University, Chengdu, China
| | - Junyan Hu
- Emergency Department, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Song Quan
- Department of Obstetrics and Gynecology, Reproductive Centre, Nanfang Hospital, Southern Medical University, Guangzhou, China
- * E-mail:
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Li MZ, Zhao WQ, Ren AQ, Shi JZ. [Association of fertilization strategy and embryo transfer time with the incidence of ectopic pregnancy]. Zhonghua Nan Ke Xue 2015; 21:913-916. [PMID: 26665681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To investigate the correlation of the fertilization strategy and embryo transfer (ET) time with the incidence of ectopic pregnancy. METHODS We selected 3,331 fresh and 2,706 frozen-thawed ET cycles for the patients undergoing in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). The fresh transfers included 2 546 IVF-ET and 785 ICSI-ET cycles and 2,220 day-3 embryo and 1,111 day-5 blastocyst transfers, while the frozen-thawed transfers included 2,080 IVF-ET and 626 ICSI-ET cycles and 741 day-3 embryo and 1 965 day-5 or -6 blastocyst transfers. We compared the incidence rate of ectopic pregnancy associated with different fertilization strategies and ET time. RESULTS The incidence rate of ectopic pregnancy was 1. 41% (36/2 546) in the IVF-ET cycles and 3.44% (27/785) in the ICSI-ET cycles of the fresh transfers, significantly lower in the IVF-ET than in the ICSI-ET cycles (P < 0.01), and it was 1.01% (21/2,080) in the IVF-ET cycles and 0.80% (5/626) in the ICSI-ET cycles of the frozen-thawed transfers, with no remarkable difference between the two groups (P > 0.05). The IVF-ET and ICSI-ET cycles included 2,220 fresh day-3 (F-D3) embryos, 1,111 F-D5 blastocysts, 741 frozen-thawed day-3 (T-D3) embryos, and 1,965 T-D5/6 blastocysts. The incidence rate of ectopic pregnancy was 1.71% (n = 38) in the F-D3, 2.25% (n = 25) in the F-D5, 1.35% (n = 10) in the T-D3, and 0.81% (n = 16) in the T-D5/6 group, respectively, significantly lower in the T-D5/6 than in the other three groups (P < 0.05). CONCLUSION The incidence rate of ectopic pregnancy is associated with fertilization strategies, which is significantly lower in frozen-thawed than in fresh embryo transfers.
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Vichinsartvichai P, Siriphadung S, Traipak K, Promrungrueng P, Manolertthewan C, Ratchanon S. The Influence of Women Age and Successfulness of Intrauterine Insemination (IUI) Cycles. J Med Assoc Thai 2015; 98:833-838. [PMID: 26591391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate the association between success and the benefit of repeated intrauterine insemination (IUI) cycles among women of different age groups. MATERIAL AND METHOD A retrospective analysis of 466 IUI cycles from 221 patients treated in afertility center of a university hospital between 2005 and 2013. The female age was stratified as younger than 35 years, 35 to 40 years, and older than 40 years old. The outcomes were the biochemical pregnancy rate, clinical pregnancy rate, live birth rate, and miscarriage rate. Kaplan-Meier analysis of the suitability cycle in each age group was also performed. RESULTS The average age ofpatients was 35.2±4.6 years (range 21 to 49 years). The overall biochemical pregnancy rate was 18.6%. The biochemical pregnancy rate significantly decreased with advancing female age groups (27.6%, 12.8%, and 7.1% infemale age group younger than 35 years, 35 to 40 years, and older than 40 years respectively, p = 0.008). The other pregnancy outcomes were not different among female age groups. In all age groups, the increment of the cumulative biochemical pregnancy rate was observed up to four cycles. CONCLUSION The biochemical pregnancy rate of IUI cycle decreased with advancingfemale age; however clinical pregnancy rate, live birth rate, and miscarriage rate were not different among female age groups. We recommend performing up to four insemination cycles before proceeding to IVF/ICSI cycle.
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Li MZ, Shi WH, Li W, Shi JZ. [Intracytoplasmic sperm injection does not improve the clinical outcomes of the males with 100% teratozoospermia]. Zhonghua Nan Ke Xue 2015; 21:819-823. [PMID: 26552216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To investigate whether intracytoplasmic sperm injection (ICSI) can improve the clinical outcomes of the male patients with 100% teratozoospermia. METHODS We retrospectively analyzed the clinical data of 152 couples undergoing in vitro fertilization-embryo transfer (IVF-ET), including 75 cycles of IVF and 77 cycles of ICSI. We compared the rates of normal fertilization, high-quality embryos, transferrable embryos, implantation, clinical pregnancy, and abortion between the two groups. RESULTS In the 100% teratozoospermia patients the number of transferrable embryos was significantly lower in the IVF than in the ICSI group (78.91% vs 84.92%, P < 0.05), while the rates of normal fertilization and implantation were higher in the former than in the latter (60.26% vs 57.87% and 48.00% vs 39.55%, both P > 0.05). There were no statistically significant differences between the two groups in the female age, Gn days, Gn dose, BMI, infertility duration, endometrial thickness, and basal serum FSH and E2. CONCLUSION ICSI cannot improve the clinical outcomes of the male patients with 100% teratozoospermia.
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Shaulov T, Belisle S, Dahan MH. Public health implications of a North American publicly funded in vitro fertilization program; lessons to learn. J Assist Reprod Genet 2015; 32:1385-93. [PMID: 26169074 DOI: 10.1007/s10815-015-0530-2] [Citation(s) in RCA: 11] [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: 03/17/2015] [Accepted: 06/30/2015] [Indexed: 12/13/2022] Open
Abstract
PURPOSE A retrospective study was conducted to determine trends in practice and outcomes that occurred since the implementation of the publicly funded in vitro fertilization (IVF) and single embryo transfer (SET) program in Quebec, in August, 2010. METHODS Data presented was extracted from an advisory report by the Health and Welfare Commissioner, and from a report by the Ministry of Health and Social Services published in June 2014 and October 2013, respectively. This data is publicly available, and was collected from all six private and three public-assisted reproduction centers in Quebec providing IVF services. Data pertains to all IVF cycles performed from the 2009-2010 to 2012-2013 fiscal years. RESULTS SET was performed in 71 % of cycles in 2012. The number of children born from IVF was 1057 in 2009-2010 and 1723 in 2012-2013 (p < 0.0001). Multiple birth rates from IVF were 24 % in 2009-2010 (before the program began) and 9.45 % in 2012-2013 (p < 0.0001). The proportions of IVF babies that were premature, that were the result of multiple births, or that required neonatal intensive care unit admission (NICU) all decreased by 35.5 % (p < 0.0001), 55 % (p < 0.0001), and 37 % (p < 0.0001), respectively, from 2009-2010 to 2012-2013. The cost per NICU admission for an IVF baby increased from $19,990 to $28,418 from 2009-2010 to 2011-2012. CONCLUSION This first North American publicly funded IVF program with a SET policy shows that such a program contributes substantially to number of births. It has also succeeded in increasing access to treatment and decreasing perinatal morbidity by decreasing multiple birth rates from IVF. A substantial increase in global public health care costs occurred as well.
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Affiliation(s)
- Talya Shaulov
- Reproductive Centre, McGill University Health Centre, 687 Pine Avenue West, Montreal, QC, H3A 2B4, Canada.
| | - Serge Belisle
- Department of Obstetrics and Gynecology, University of Montreal Hospital Centre, 1058 rue Saint-Denis, Montreal, QC, H2X 3J4, Canada
| | - Michael H Dahan
- Reproductive Centre, McGill University Health Centre, 687 Pine Avenue West, Montreal, QC, H3A 2B4, Canada
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Salih SM, Albayrak S, Seo S, Stewart SL, Bradley K, Kushner DM. Diminished Utilization of in Vitro Fertilization Following Ovarian Transposition in Cervical Cancer Patients. J Reprod Med 2015; 60:345-353. [PMID: 26380495 PMCID: PMC4869987] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To assess subsequent utilization of fertility treatment in reproductive-age women with cervical cancer (CC) who underwent ovarian transposition (OT) to preserve fertility prior to pelvic radiation. STUDY DESIGN This is a case series of 216 CC patients seen in a comprehensive cancer center. Sixteen patients underwent OT for fertility preservation prior to pelvic radiation. Patients were assessed for utilization of fertility treatment, follicle-stimulating hormone (FSH) levels as a measure of ovarian reserve, and functional assessment of chronic illness therapy-cervix cancer (FACT-CX) to assess quality of life after OT. RESULTS Of the patients, 94% of patients [corrected] maintained regular menstrual cycles 3 years after ovarian transposition (OT) [corrected] surgery (15/16). When measured (n = 5), serum FSH was normal at baseline and showed a transient elevation at 3 months following chemoradiation, with a return to normal levels at 6 months (means, 6.33 ± 2.94, 48.44 ± 18.63, and 12.52 ± 8.25 mIU/mL, respectively). Only 1 patient in this series attempted fertility treatment (in vitro fertilization) following OT, and she did not become pregnant. FACT-CX indicated that quality of life did not change significantly over the 6 months' duration following OT and chemoradiation therapy. CONCLUSION OT preserves menstrual cycle regularity without negatively impacting patients' quality of life. The utility of OT as an effective fertility preservation option is hampered by the low utilization rate of in vitro fertilization and lack of ovarian reserve assessment following OT.
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Affiliation(s)
- Sana. M. Salih
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, W1
| | - Samet Albayrak
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, W1
| | - Songwon Seo
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, W1
| | - Sarah L. Stewart
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, W1
| | - Kristen Bradley
- Department of Radiation Oncology, University of Wisconsin School of Medicine and Public Health, Madison, W1
| | - David. M. Kushner
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, W1
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Smith ADAC, Tilling K, Lawlor DA, Nelson SM. External validation and calibration of IVFpredict: a national prospective cohort study of 130,960 in vitro fertilisation cycles. PLoS One 2015; 10:e0121357. [PMID: 25853703 PMCID: PMC4390202 DOI: 10.1371/journal.pone.0121357] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 11/18/2014] [Accepted: 01/30/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Accurately predicting the probability of a live birth after in vitro fertilisation (IVF) is important for patients, healthcare providers and policy makers. Two prediction models (Templeton and IVFpredict) have been previously developed from UK data and are widely used internationally. The more recent of these, IVFpredict, was shown to have greater predictive power in the development dataset. The aim of this study was external validation of the two models and comparison of their predictive ability. METHODS AND FINDINGS 130,960 IVF cycles undertaken in the UK in 2008-2010 were used to validate and compare the Templeton and IVFpredict models. Discriminatory power was calculated using the area under the receiver-operator curve and calibration assessed using a calibration plot and Hosmer-Lemeshow statistic. The scaled modified Brier score, with measures of reliability and resolution, were calculated to assess overall accuracy. Both models were compared after updating for current live birth rates to ensure that the average observed and predicted live birth rates were equal. The discriminative power of both methods was comparable: the area under the receiver-operator curve was 0.628 (95% confidence interval (CI): 0.625-0.631) for IVFpredict and 0.616 (95% CI: 0.613-0.620) for the Templeton model. IVFpredict had markedly better calibration and higher diagnostic accuracy, with calibration plot intercept of 0.040 (95% CI: 0.017-0.063) and slope of 0.932 (95% CI: 0.839-1.025) compared with 0.080 (95% CI: 0.044-0.117) and 1.419 (95% CI: 1.149-1.690) for the Templeton model. Both models underestimated the live birth rate, but this was particularly marked in the Templeton model. Updating the models to reflect improvements in live birth rates since the models were developed enhanced their performance, but IVFpredict remained superior. CONCLUSION External validation in a large population cohort confirms IVFpredict has superior discrimination and calibration for informing patients, clinicians and healthcare policy makers of the probability of live birth following IVF.
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Affiliation(s)
- Andrew D. A. C. Smith
- Medical Research Council Integrative Epidemiology Unit, the University of Bristol, Bristol, United Kingdom
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Kate Tilling
- Medical Research Council Integrative Epidemiology Unit, the University of Bristol, Bristol, United Kingdom
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Debbie A. Lawlor
- Medical Research Council Integrative Epidemiology Unit, the University of Bristol, Bristol, United Kingdom
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- * E-mail: (DAL); (SMN)
| | - Scott M. Nelson
- School of Medicine, University of Glasgow, Glasgow, United Kingdom
- * E-mail: (DAL); (SMN)
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Okhowat J, Murtinger M, Schuff M, Wogatzky J, Spitzer D, Vanderzwalmen P, Wirleitner B, Zech NH. Massage therapy improves in vitro fertilization outcome in patients undergoing blastocyst transfer in a cryo-cycle. Altern Ther Health Med 2015; 21:16-22. [PMID: 25830275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
CONTEXT Massage therapy is increasingly used to relieve physical and mental discomfort and is suggested as a safe therapeutic modality, without any significant risks or any known side effects. Although a multitude of complementary therapies, such as acupuncture, are applied in reproductive medicine, no information is available with regard to the application of massage as an adjuvant therapy in assisted-reproduction techniques (ARTs). OBJECTIVES This study was intended to assess the effectiveness of a deep relaxation (andullation) therapy based on oscillating vibrations when used prior to embryo transfer (ET) in in vitro fertilization (IVF) cryo-cycles. DESIGN The research team designed a retrospective, observational study. Participants willing to undergo the massage treatment were allocated to the intervention (andullation) group. SETTING The study was performed at the IVF Centers Prof. Zech-Bregenz in Bregenz, Austria. PARTICIPANTS A total of 267 IVF patients, with a mean age of 36.3 y, participated in this single-center study. INTERVENTION All patients receiving a transfer of vitrified and warmed blastocysts between January and December 2012 were included in the evaluation. Prior to ET, the andullation group received a standardized program of therapy-a 30-min, deep relaxation massage on an oscillating (vibrating) device, whereas the control group did not. OUTCOME MEASURES To determine efficacy, the primary outcomes that the study measured were (1) pregnancy rates (PRs), by testing urine and obtaining a positive β-human chorionic gonadotropin (β-hCG); and (2) ongoing, pregnancies (oPR), by observation of fetal heartbeat and birth rates (BR) as well as miscarriage rates. The patients' medical histories and types of infertility as well as the quality of the embryo transfers (ETs) were evaluated. RESULTS In patients using the massage therapy prior to ET, significantly higher PRs, oPRs, and BRs were observed compared with the control group-PR: 58.9% vs 41.7%, P<.05; oPR: 53.6% vs 33.2%, P<.01; and BR: 32.0% vs 20.3%, P<.05. No differences were detected among groups for patients' ages, hormonal substitution protocols, endometrium structures and buildups, quality of transferred embryos, or quality of transfers. No adverse effects were noted in the massage group. CONCLUSIONS The research team's results suggested that andullation therapy prior to blastocyst transfer in a cryo-cycle improves embryo implantation, most likely due to a reduction in stress (ie, a relaxation effect on patients), a reduction in uterine contractions, and, probably, an enhancement of the blood flow in the abdominal region. These findings provide support for use of andullation as a complementary therapy for ART.
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Evans JM. A broader conclusion to a well-conceived study: must it be massage before reproductive technology? Altern Ther Health Med 2015; 21:23. [PMID: 25830276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Dayan N, Pilote L, Opatrny L, Basso O, Messerlian C, El-Messidi A, Daskalopoulou SS. Combined impact of high body mass index and in vitro fertilization on preeclampsia risk: a hospital-based cohort study. Obesity (Silver Spring) 2015; 23:200-6. [PMID: 25293810 DOI: 10.1002/oby.20896] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 08/18/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Overweight and obese women may be heavy users of in vitro fertilization (IVF) owing to obesity-related oligo-anovulation. The higher doses of gonadotropins required to achieve pregnancy in obese women may contribute to impaired placentation and the development of preeclampsia. This study was designed to assess the combined effect of high maternal body mass index (BMI) and IVF on risk of preeclampsia and to evaluate for an interaction between the two factors. METHODS This is a hospital-based cohort study of 10,013 singleton pregnancies that delivered from 2001 to 2008 at a tertiary hospital in Montreal, Canada. The combined effect of high BMI and IVF on preeclampsia versus no risk factors was estimated in multivariate logistic regression models fitted with an interaction term between high BMI (> 25 or > 30 kg/m(2) ) and IVF. RESULTS IVF pregnancies in obese women had a considerably higher risk of preeclampsia than spontaneous nonobese pregnancies (OR 6.7, 95% CI 3.3-13.8; p interaction 0.03). IVF was not independently associated with preeclampsia (OR 0.6, 95% CI 0.3-1.4). Analyses were similar in subgroup analyses and in analyses correcting for bias. CONCLUSIONS High BMI is strongly associated with preeclampsia, and this risk is compounded in IVF pregnancies.
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Affiliation(s)
- Natalie Dayan
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
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Abstract
BACKGROUND Childbirth is associated with increased risk of first-time psychiatric episodes, and an unwanted pregnancy has been suggested as a possible etiologic contributor. To what extent childbirth causes psychiatric episodes and whether a planned pregnancy reduces the risk of postpartum psychiatric episodes has not been established. METHODS We conducted a cohort study using data derived from Danish population registers, including all women having in vitro fertilization (IVF) treatment and their partners with recorded information in the IVF register covering fertility treatments in Denmark at all public and private treatment sites from January 1994 to December 2005. We compared parents and childless persons to examine whether childbirth is directly associated with onset of first-time psychiatric episodes, with incidence rate ratios (risk of first psychiatric inpatient or outpatient treatment) as the main outcome measures. RESULTS The incidence rate for any type of psychiatric disorder 0 to 90 days postpartum was 11.3 per 1000 person-years (95% confidence interval = 8.2-15.0), and 3.8 (3.4-4.3) among women not giving birth. IVF-treated mothers had an increased risk of a psychiatric episode postpartum (incidence rate ratio [IRR] = 2.9 [2.0-4.2]) compared with the risk of psychiatric episodes in childless women. Risk of psychiatric episodes later than 90 days postpartum was decreased (IRR = 0.9 [0.7-1.0]). CONCLUSIONS Using a study design paralleling a natural experiment, our results showed that childbirth is associated with first-time psychiatric disorders in new mothers, indicating that a planned pregnancy does not reduce risks of or prevent postpartum psychiatric episodes.
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Affiliation(s)
- Trine Munk-Olsen
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, National Centre for Register-based Research, Aarhus University, Fuglesangs Allé 4, 8210 Aarhus V, Denmark
| | - Esben Agerbo
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, National Centre for Register-based Research, Aarhus University, Fuglesangs Allé 4, 8210 Aarhus V, Denmark
- CIRRAU - Centre for Integrated Register-based Research, National Centre for Register-based Research, Aarhus University, Fuglesangs Allé 4, 8210 Aarhus V, Denmark
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Kushnir VA, Khanna P, Barad DH, Gleicher N. Establishment of comparative performance criteria for IVF centers: correlation of live birth rates in autologous and donor oocyte IVF cycles. Reprod Biol Endocrinol 2014; 12:122. [PMID: 25475407 PMCID: PMC4267438 DOI: 10.1186/1477-7827-12-122] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 11/28/2014] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND To assess whether an objective performance criterion for in vitro fertilization (IVF) centers can be established. METHODS A retrospective analysis of 2011 National ART Surveillance System data for 451 U.S. IVF centers, 137 of which were included in the analysis since they performed >20 fresh embryo transfers per age group and >20 fresh oocyte donor transfers. The analysis of autologous cycles was restricted to women under age 40. The main outcome measure was correlation between center-specific live birth rates (LBR) in autologous and donor oocyte cycles. RESULTS 55.6% donor and 46.7%, 39.1% and 28.7% (for ages <35, 35-37 and 38-40 years) autologous cycles resulted in live births per fresh embryo transfer. Donor LBR predicted autologous LBR (< 35 years, P < 0.001; 35 - 38 years, P < 0.001; 38 - 40 years, P = 0.015). Clinics with high prevalence of patients with diminished ovarian reserve had lower autologous LBR per age group (P = 0.015). Every 10% increase in donor LBR increased odds of autologous LBR above the age-adjusted national average by 68% (OR 1.68; 95% CI 1.36 - 2.07; P < 0.001). CONCLUSIONS Since center-specific donor and autologous IVF cycle outcomes correlate, and as donor cycles reflect fewer patient covariates, they represent a first comparable performance measure between centers, allowing for internal as well as external quality control.
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Affiliation(s)
- Vitaly A Kushnir
- The Center for Human Reproduction (CHR), 21 East 69th Street, New York, NY 10021 USA
| | - Pallavi Khanna
- Icahn School of Medicine at Mount Sinai (Jamaica) Program, Queens Hospital Center, Jamaica, NY USA
| | - David H Barad
- The Center for Human Reproduction (CHR), 21 East 69th Street, New York, NY 10021 USA
- The Foundation for Reproductive Medicine, New York, NY USA
| | - Norbert Gleicher
- The Center for Human Reproduction (CHR), 21 East 69th Street, New York, NY 10021 USA
- The Foundation for Reproductive Medicine, New York, NY USA
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Lawson AK, Klock SC, Pavone ME, Hirshfeld-Cytron J, Smith KN, Kazer RR. Prospective study of depression and anxiety in female fertility preservation and infertility patients. Fertil Steril 2014; 102:1377-84. [PMID: 25154674 DOI: 10.1016/j.fertnstert.2014.07.765] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 07/07/2014] [Accepted: 07/08/2014] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To prospectively assess anxiety, depression, coping, and appraisal in female fertility preservation (FP) patients compared with infertile patients. DESIGN Prospective pre- and post-treatment survey. SETTING Academic medical center. PATIENT(S) Forty-seven women with cancer (FP patients) and 91 age-matched infertile patients. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Depression, anxiety, coping, infertility-related stress, appraisal of treatment, and medical outcomes. RESULT(S) FP patients reported more symptoms of anxiety and depression than infertile patients, but infertile patients' symptoms worsened over time; 44% of FP and 14% of infertile patients' scores exceeded the clinical cutoff for depression before treatment. The interval between surveys and medical treatment data did not predict changes in mood symptoms. Coping strategies and infertility-related stress did not differ between groups, and avoidant coping predicted higher depression and anxiety scores. CONCLUSION(S) FP patients reported more anxiety and depression than infertile patients at enrollment in treatment, with more than one-third of FP patients reporting clinically significant depressive symptoms. However, infertile patients' anxiety and depressive symptoms increased across treatment. This increase was not related to time between registration for IVF and oocyte retrieval or the medical aspects of treatment. FP and infertile patients should be provided psychologic consultation before treatment to identify mood and anxiety symptoms and to refer patients for counseling as needed to prevent worsening of symptoms.
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