151
|
Wang W, Yang F, Bai Y, Lu Y, Mao X. Association between domain-specific physical activity and mental health status after embryo transfer in IVF-ET-assisted pregnancy patients. Sci Rep 2024; 14:4928. [PMID: 38418518 PMCID: PMC10902343 DOI: 10.1038/s41598-024-55097-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/20/2024] [Indexed: 03/01/2024] Open
Abstract
Physical activity has been shown to impact mental health in in vitro fertilization-embryo transfer (IVF-ET) patients, but the relationship between domain-specific physical activity and mental health in this population remains unclear. In a cross-sectional observational study, 208 patients undergoing IVF-ET with long-term ovulation induction cycles were recruited from a reproductive center. The International Physical Activity Questionnaire and the symptom checklist 90 (SCL-90) were used to assess physical activity levels and mental health status, respectively. Analyses of variance and linear regression analyses were conducted to identify the relationship between physical activity and mental health. There were differences between different physical activity level in times of transfers, years of infertility, and times of abortions. Patients with high levels of physical activity had fewer symptoms than those with low levels of physical activity. Occupation, transport and household physical activity had significant negative correlations with the respective SCL-90 factor scores. Linear regression analysis revealed that occupation physical activity was associated with lower depression and anxiety, and transport physical activity and household physical activity were associated with lower obsessive-compulsive, interpersonal sensitivity, depression, anxiety, and psychoticism scores. The study indicates that increased engagement in physical activity, specifically activities related to occupation, transportation, and household, may be associated with improved mental health among IVF-ET patients.
Collapse
Affiliation(s)
- Wei Wang
- Department of Psychology, Qilu Hospital of Shandong University, Wenhuaxi Road 107, Jinan, 250012, Shandong, China
| | - Fang Yang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Yunfeng Bai
- Department of Anesthesiology, Linyi People's Hospital, Linyi, China
| | - Yanxia Lu
- Department of Medical Psychology and Ethics, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
| | - Xueqin Mao
- Department of Psychology, Qilu Hospital of Shandong University, Wenhuaxi Road 107, Jinan, 250012, Shandong, China.
| |
Collapse
|
152
|
Florêncio RDS, Rocha MNDC, de Oliveira VA, Finotti MCCF. Frozen-thawed embryo transfer: does the addition of low-dose choriogonadotropin alfa to progesterone in the luteal phase of artificial cycles improve the endometrium and increase the chances of pregnancy? JBRA Assist Reprod 2024; 28:33-38. [PMID: 37962964 PMCID: PMC10936907 DOI: 10.5935/1518-0557.20230053] [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] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 02/21/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE Primary: To evaluate the effect of low doses of recombinant hCG (choriogonadotropin alfa) in the luteal phase of frozen-thawed embryo transfers (FET) of artificial cycles on the chances of pregnancy in patients aged ≤38years. Secondary: To assess the chances of pregnancy in the FET groups of artificial cycles using micronized vaginal progesterone (VP) versus injectable intramuscular progesterone (IMP) and the chances of pregnancy in type-1 embryo transfers (two top embryos). METHODS This retrospective cohort study included 122 cycles of FET and compared two groups of patients aged 38 years or younger, one given hCG in the luteal phase and one not administered hCG. RESULTS The clinical pregnancy rates (CPR) in the control and hCG groups were 45% and 45.16%, respectively (p=0.9999). The live birth rates (LBR) were 33.33% and 32.25%, respectively, (p=0.99909). The CPR in the VP group (83 patients) was 46.89% versus 41.02% in the IMP group, (p=0.5459). The LBR was 33.73% in the VP group and 30.76% in the IMP group (39 patients), (p=0.7559). CONCLUSIONS The CPR and LBR of patients undergoing FET in groups prescribed and not prescribed low doses of recombinant hCG were similar. No significant difference was found between patients given VP or IMP.
Collapse
|
153
|
Huang Y, Cheng Y, Zhang M, Chen Y, Zhou R, Lin D, Guo X. Effect of repeated vitrification of human embryos on pregnancy and neonatal outcomes. J Ovarian Res 2024; 17:51. [PMID: 38402194 PMCID: PMC10893706 DOI: 10.1186/s13048-024-01370-y] [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] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/05/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Repeated cryopreservation of embryos should occasionally be considered when embryos were not suitable for transfer. The effect of re-cryopreservation on embryos remains contentious. METHODS This retrospective cohort study aimed to evaluate the pregnancy and neonatal outcomes of twice vitrificated blastocyst derived from once vitrified embryos. Total 410 vitrified-warmed blastocyst transfer cycles were divided into two groups according to the times of embryo vitrification: (1) vitrified blastocysts derived from fresh blastocysts (control group, n = 337); (2) twice vitrified blastocysts derived from once vitrified embryos (n = 73). The primary outcome was live birth rate. Multivariable logistic or linear regression analysis model was performed to describe the association between embryo cryopreservation times and clinical outcomes. RESULTS No difference was observed in female age at retrieval and transfer, infertility period, body mass index (BMI), infertility type, endometrial thickness, and embryo transfer numbers between the two groups. The pregnancy outcomes of embryos in repeated cryopreservation group were comparable to those of embryos in control group, including implantation rate, clinical pregnancy rate, and live birth rate. In multivariate logistic regression analysis, the cryopreservation times did not affect the outcomes of biochemical pregnancy, clinical pregnancy, and live birth. Moreover, there was no difference in gestational age, birthweight and sex ratio of singleton newborns between groups. After correcting several possible confounding variables, no significant association was observed between cryopreservation times and neonatal birthweight. CONCLUSION In conclusion, pregnancy and neonatal outcomes achieved with twice vitrified blastocyst transfer were comparable to those achieved with vitrified blastocyst transfer in control group.
Collapse
Affiliation(s)
- Yan Huang
- Reproductive Medicine Center, the General Hospital of Southern Theatre Command, Guangzhou, 510010, China
- The First Clinical Medical College, Southern Medical University, Guangzhou, China
| | - Yi Cheng
- Reproductive Medicine Center, the General Hospital of Southern Theatre Command, Guangzhou, 510010, China
| | - Min Zhang
- Reproductive Medicine Center, the General Hospital of Southern Theatre Command, Guangzhou, 510010, China
| | - Yiqing Chen
- Reproductive Medicine Center, the General Hospital of Southern Theatre Command, Guangzhou, 510010, China
| | - Rong Zhou
- Reproductive Medicine Center, the General Hospital of Southern Theatre Command, Guangzhou, 510010, China
| | - Dewei Lin
- Reproductive Medicine Center, the General Hospital of Southern Theatre Command, Guangzhou, 510010, China.
| | - Xinyu Guo
- Reproductive Medicine Center, the General Hospital of Southern Theatre Command, Guangzhou, 510010, China.
- The First Clinical Medical College, Southern Medical University, Guangzhou, China.
| |
Collapse
|
154
|
Zhao H, Gan K, Ji X, Zheng L, Ou S, Mei M, Zhang Q, Chen H, Yuan P, Wang W. The impact of clinical and laboratory parameters on clinical pregnancy and live birth rates in fresh cycles: a retrospective study of 9608 high-quality cleavage-stage embryos. J Ovarian Res 2024; 17:47. [PMID: 38383460 PMCID: PMC10882753 DOI: 10.1186/s13048-024-01371-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/08/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Evidence from the Istanbul consensus workshop suggests correlations between morphological parameters and embryo developments. 8-cell embryos are the best blastomere stage on day 3. No good quality evidence exists to support high-quality embryonic selection following blastulation and clinical outcomes. This study aimed to investigate the factors that affect blastocyst formation, blastocyst quality, and clinical outcomes of high-quality cleavage-stage embryos in fresh cycles. METHODS This study was a retrospective analysis of 9608 high-quality cleavage-stage embryos from 2987 couples between January 2017 to June 2021, namely 1520 embryos categorized as "812" (8-cell, grade 2, mild fragmentation), 2961 as "821" (8-cell, grade 2, mild asymmetry), 896 as "711" (7-cell, grade 1), and 517 as "911" (9-cell, grade 1) compared with 3714 embryos categorized as "811" (8-cell, grade 1). The primary outcomes were clinical pregnancy rate (CPR) and live birth rate (LBR). Blastulation rate (BR), available late blastocyst rate (ABR) and high-quality late blastocyst rate (HBR) were secondary outcome measures. RESULTS BR, ABR, and HBR had significant differences among the five groups (P < 0.001), while CPR and LBR were also significantly different in cleavage-stage fresh transfer (P < 0.01). The multivariable multilevel logistic regression analysis revealed a significant association between cell number, cell size, blastocyst development and clinical outcomes. For 7 to 9-cell highest-quality embryo, mild fragmentation and more blastomeres were more conducive to blastocyst formation and clinical outcomes. While cleavage-stage embryos developed into blastocysts, the negative impact of their initial morphology on clinical outcomes would be erased. CONCLUSIONS Our study firstly evaluated blastocyst development and clinical outcomes of high-quality cleavage-stage embryos in fresh cycles, with rankings of 811, 812, 911, 821, and 711. We found the initial morphological characteristics of the high-quality cleavage-stage embryos did not adversely impact clinical outcomes, even as they progressed to the blastocyst stage.
Collapse
Affiliation(s)
- Haijing Zhao
- IVF Center, Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China
- Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, Guangzhou, China
| | - Keer Gan
- IVF Center, Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China
| | - Xiaohui Ji
- IVF Center, Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China
- Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, Guangzhou, China
- Medical College, Jinan University, Guangzhou, Guangdong, 510632, China
| | - Lingyan Zheng
- IVF Center, Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China
- Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, Guangzhou, China
| | - Songbang Ou
- IVF Center, Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China
- Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, Guangzhou, China
| | - Mei Mei
- IVF Center, Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China
| | - Qingxue Zhang
- IVF Center, Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China
- Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, Guangzhou, China
| | - Hui Chen
- IVF Center, Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China
- Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, Guangzhou, China
| | - Ping Yuan
- IVF Center, Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China.
- Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, Guangzhou, China.
| | - Wenjun Wang
- IVF Center, Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China.
- Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, Guangzhou, China.
| |
Collapse
|
155
|
Zeng C, Lu RH, Li X, Wang S, Kuai YR, Xue Q. Effect of frozen-thawed embryo transfer with a poor-quality embryo and a good-quality embryo on pregnancy and neonatal outcomes. Reprod Biol Endocrinol 2024; 22:26. [PMID: 38383391 PMCID: PMC10880350 DOI: 10.1186/s12958-024-01194-x] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 02/09/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND To evaluate the impact of embryo quality and quantity, specifically a poor quality embryo (PQE) in combination with a good quality embryo (GQE), by double embryo transfer (DET) on the live birth rate (LBR) and neonatal outcomes in patients undergoing frozen-thawed embryo transfer (FET) cycles. METHODS A study on a cohort of women who underwent a total of 1462 frozen-thawed cleavage or blastocyst embryo transfer cycles with autologous oocytes was conducted between January 2018 and December 2021. To compare the outcomes between single embryo transfer (SET) with a GQE and DET with a GQE and a PQE, propensity score matching (PSM) was applied to control for potential confounders, and a generalized estimating equation (GEE) model was used to determine the association between the effect of an additional PQE and the outcomes. Subgroup analysis was also performed for patients stratified by female age. RESULTS After PS matching, DET-GQE + PQE did not significantly alter the LBR (adjusted odds ratio [OR] 1.421, 95% CI 0.907-2.228) compared with SET-GQE in cleavage-stage embryo transfer but did increase the multiple birth rate (MBR, [OR] 3.917, 95% CI 1.189-12.911). However, in patients who underwent blastocyst-stage embryo transfer, adding a second PQE increased the live birth rate by 7.8% ([OR] 1.477, 95% CI 1.046-2.086) and the multiple birth rate by 19.6% ([OR] 28.355, 95% CI 3.926-204.790), and resulted in adverse neonatal outcomes. For patients who underwent cleavage-stage embryo transfer, transferring a PQE with a GQE led to a significant increase in the MBR ([OR] 4.724, 95% CI 1.121-19.913) in women under 35 years old but not in the LBR ([OR] 1.227, 95% CI 0.719-2.092). The increases in LBR and MBR for DET-GQE + PQE compared with SET-GQE in women older than 35 years were nonsignificant toward. For patients who underwent blastocyst-stage embryo transfer, DET-GQE + PQE had a greater LBR ([OR] 1.803, 95% CI 1.165-2.789), MBR ([OR] 24.185, 95% CI 3.285-178.062) and preterm birth rate (PBR, [OR] 4.092, 95% CI 1.153-14.518) than did SET-GQE in women under 35 years old, while no significant impact on the LBR ([OR] 1.053, 95% CI 0.589-1.884) or MBR (0% vs. 8.3%) was observed in women older than 35 years. CONCLUSIONS The addition of a PQE has no significant benefit on the LBR but significantly increases the MBR in patients who underwent frozen-thawed cleavage-stage embryo transfer. However, for patients who underwent blastocyst-stage embryo transfer, DET-GQE + PQE resulted in an increase in both the LBR and MBR, which may lead to adverse neonatal outcomes. Thus, the benefits and risks of double blastocyst-stage embryo transfer should be balanced. In patients younger than 35 years, SET-GQE achieved satisfactory LBR either in cleavage-stage embryo transfer or blastocyst-stage embryo transfer, while DET-GQE + PQE resulted in a dramatically increased MBR. Considering the low LBR in women older than 35 years who underwent single cleavage-stage embryo transfer, selective single blastocyst-stage embryo transfer appears to be a more promising approach for reducing the risk of multiple live births and adverse neonatal outcomes.
Collapse
Affiliation(s)
- Cheng Zeng
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, 100034, P. R. China
| | - Rui-Hui Lu
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, 100034, P. R. China
| | - Xin Li
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, 100034, P. R. China
| | - Sheng Wang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, 100034, P. R. China
| | - Yan-Rong Kuai
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, 100034, P. R. China
| | - Qing Xue
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, 100034, P. R. China.
| |
Collapse
|
156
|
Herman T, Török P, Laganà AS, Chiantera V, Venezia R, Jakab A. Hashimoto's Thyroiditis Negatively Influences Intracytoplasmic Sperm Injection Outcome in Euthyroid Women on T4 Substitution Therapy: A Retrospective Study. Gynecol Obstet Invest 2024; 89:150-158. [PMID: 38368857 DOI: 10.1159/000537836] [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] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/10/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE The objective of this study was to analyze the impact of thyroid autoimmunity (TAI) on reproductive outcome parameters of intracytoplasmic sperm injection (ICSI) cycles as compared to TAI-negative ICSI cycles. DESIGN In this single in vitro fertilization (IVF) center retrospective study, 86 infertile women with elevated thyroid peroxidase or TGAb levels, but euthyroid after thyroxine replacement (study group), were compared to 69 female patients with no thyroid abnormalities (controls). Following ICSI treatment fertilization rate (FR), clinical pregnancy rate (CPR), miscarriage rate (MR), and live birth rate (LBR) were analyzed. MATERIALS, SETTING, METHODS All subjects with various infertility factors were treated with ICSI in university-based IVF center. Patients in the study group received thyroxine replacement and were euthyroid at IVF treatment. Before the IVF cycles, endocrinological parameters were uniformly assessed: thyroid function and antibodies, reproductive hormones (anti-Müllerian hormone [AMH], follicular stimulating hormone [FSH], luteinizing hormone, E2, PRL, testosterone, DHEAS, 17-OHP, AD) and OGTT (0-60-120 min glucose and insulin). Following descriptive comparison of laboratory parameters, age-adjusted analyses of FR, CPR, MR, and LBR were performed. RESULTS TAI-positive women were older (mean age 35.31 ± 4.95 vs. 32.15 ± 4.87 years; p = 0.002), had higher FSH (8.4 ± 3.4 vs. 7.4 ± 2.32 U/L; p = 0.024), higher E2 (53.94 ± 47.61 vs. 42.93 ± 18.92 pg/mL; p = 0.025) levels, while AMH (2.88 ± 2.62 vs. 3.61 ± 1.69 ng/mL; p = 0.0002) was lower. There were no differences in TSH levels (1.64 ± 0.96 vs. 1.66 ± 0.65 µIU/mL; p = 0.652) between the two groups. FT3 (2.63 ± 0.58 vs. 2.98 ± 0.55 pg/mL; p = 0.002) was lower and FT4 (1.3 ± 0.29 vs. 1.13 ± 0.21 ng/dL; p = 0.0002) was higher in the TAI-positive group, reflecting clinically irrelevant differences. Egg cell counts (6 ± 3.8 vs. 7.5 ± 3.95; p = 0.015) were lower in TAI and remained so following age adjustment. Although the overall ICSI FR did not differ (62.9% vs. 69.1%, p = 0.12), it was lower for patients under 35 with TAI showing decreasing differences in line with age. The CPR (36.04% vs. 69.56%; p < 0.001) and LBR (23.25% vs. 60.86%; p < 0.001) were lower, the MR (35.48% vs. 12.5%; p = 0.024) was higher in the TAI group, and these differences remained after age adjustment. LIMITATIONS Since the higher age of the study group may interfere with the effect of TAI, age adjustment calculations were necessary to perform to eliminate this confounding factor. CONCLUSION Despite optimal thyroid supplementation in clinical or subclinical hypothyroidism, the presence of TAI negatively influences CPR and is connected to a higher MR, thus resulting in a lower LBR after ICSI. Decreased FR with ICSI in TAI patients may also contribute to poorer outcomes, especially in younger women.
Collapse
Affiliation(s)
- Tünde Herman
- Assisted Reproduction Center, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - Péter Török
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Vito Chiantera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
- Unit of Gynecologic Oncology, National Cancer Institute - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Renato Venezia
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Attila Jakab
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| |
Collapse
|
157
|
Zou W, Liu D, Peng J, Tang Z, Li Y, Zhang J, Liu Z. Sequential embryo transfer combined with intrauterine perfusion improved pregnancy outcomes in patients with recurrent implantation failure. BMC Womens Health 2024; 24:126. [PMID: 38365686 PMCID: PMC10873986 DOI: 10.1186/s12905-024-02966-8] [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] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 02/11/2024] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVE To compare the application of sequential embryo transfer, cleavage embryo transfer, and blastocyst transfer combined with intrauterine perfusion in frozen-thawed embryo transfer cycles in patients with recurrent implantation failure to provide a reference for reproductive clinicians. METHODS The 166 patients who underwent frozen-thawed embryo transfer due to recurrent implantation failure in the reproductive center from January 2021 to March 2022 were retrospectively analyzed. According to the different embryos transferred, they were divided into cleavage embryo transfer groups (72 cases in Group A), blastocyst transfer group (29 cases in Group B), and sequential transfer group (65 cases in Group C). All three groups were treated with intrauterine perfusion 5 days before embryo transfer. The general data and clinical pregnancy outcome indicators, such as embryo implantation rate, clinical pregnancy rate, ongoing pregnancy rate, live birth rate, twin rate, were compared among the three groups. RESULTS The embryo implantation rate (53.1%), clinical pregnancy rate (76.9%), ongoing pregnancy rate (67.7%) and live birth rate(66.15%) in the sequential transfer group were significantly higher than those in the other two groups (P < 0.05), and the ectopic pregnancy rate was lower in the sequential transfer group. CONCLUSION Sequential transfer combined with intrauterine perfusion partially improves clinical pregnancy outcomes and reduces the risk of ectopic pregnancy in frozen embryo cycle transfers in patients with recurrent implantation failure, which may be a favourable transfer reference strategy for patients with recurrent implantation failure.
Collapse
Affiliation(s)
- Wenda Zou
- Department of Reproductive Medicine Center, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, South Changjiang Road, Tianyuan District, ZhuZhou, China
| | - Dan Liu
- Department of Reproductive Medicine Center, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, South Changjiang Road, Tianyuan District, ZhuZhou, China
| | - Juan Peng
- Department of Reproductive Medicine Center, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, South Changjiang Road, Tianyuan District, ZhuZhou, China
| | - Zhijing Tang
- Department of Reproductive Medicine Center, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, South Changjiang Road, Tianyuan District, ZhuZhou, China
| | - Yukun Li
- Department of Reproductive Medicine Center, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, South Changjiang Road, Tianyuan District, ZhuZhou, China
| | - Juan Zhang
- Department of Reproductive Medicine Center, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, South Changjiang Road, Tianyuan District, ZhuZhou, China.
| | - Ziwei Liu
- Department of Urology, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, South Changjiang Road, Tianyuan District, ZhuZhou, 412007, China.
| |
Collapse
|
158
|
Wang Q, Tang X, Lv X, Meng X, Geng L, Zhong Z, Ding Y, Li T, Wan Q. Age at menarche and risk of ovarian hyperstimulation syndrome in women undergoing IVF/ICSI cycles: a retrospective cohort study. BMJ Open 2024; 14:e076867. [PMID: 38365296 PMCID: PMC10875511 DOI: 10.1136/bmjopen-2023-076867] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 01/08/2024] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVES We aimed to explore the association between age at menarche (AAM) and ovarian hyperstimulation syndrome (OHSS) in fresh in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) cycles. DESIGN A retrospective cohort study. SETTING Data were collected from a large obstetrics and gynaecology hospital in Sichuan, China. PARTICIPANTS This study included 17 419 eligible women aged ≤40 years who underwent the first IVF/ICSI cycles from January 2015 to December 2021. Women were divided into three groups according to their AAM: ≤12 years (n=5781), 13-14 years (n=9469) and ≥15 years (n=2169). RESULTS The means of age at recruitment and AAM were 30.4 years and 13.1 years, respectively. Restricted cubic spline models suggested that early menarche age increased the risk of OHSS. The multivariable logistic analysis showed that women with menarche age ≤12 years were more likely to suffer from OHSS (OR 1.321, 95% CI 1.113 to 1.567) compared with those aged 13-14 years among the whole cohort. This significant relationship remained in women administered with different ovarian stimulation protocols and gonadotrophin doses. When stratified by female age, this correlation was presented only in patients aged ≤30 years (OR 1.362, 95% CI 1.094 to 1.694). And the mediation analysis showed that the relationship between AAM and OHSS was totally mediated by antral follicle counts (AFC). CONCLUSION Menarche age earlier than 12 years may increase the OHSS risk in women aged ≤30 years through the mediation of AFC. More prospective studies are required to verify the results.
Collapse
Affiliation(s)
- Qiaofeng Wang
- Sichuan University West China Second University Hospital, Chengdu, Sichuan, China
- Chongqing University Three Gorges Hospital, Wanzhou, Chongqing, China
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Xiaojun Tang
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Xingyu Lv
- Department of Gynecology and Obstetrics, Chengdu Jinjiang Hospital for Women's and Children's Health, Chengdu, Sichuan, China
| | - Xiangqian Meng
- Department of Gynecology and Obstetrics, Chengdu Jinjiang Hospital for Women's and Children's Health, Chengdu, Sichuan, China
| | - Lihong Geng
- Department of Gynecology and Obstetrics, Chengdu Jinjiang Hospital for Women's and Children's Health, Chengdu, Sichuan, China
| | - Zhaohui Zhong
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Yubin Ding
- School of Public Health, Chongqing Medical University, Chongqing, China
- Department of Pharmacology, Academician Workstation, Changsha Medical University, Changsha, China
| | - Tian Li
- Department of Reproductive Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Wan
- Sichuan University West China Second University Hospital, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University West China Second University Hospital, Chengdu, Sichuan, China
| |
Collapse
|
159
|
Mahmood K, Ali Channa A, Ghafoor A, Riaz A. Factors affecting the efficiency of equine embryo transfer (EET) in polo mares under subtropical conditions of Pakistan. PLoS One 2024; 19:e0298066. [PMID: 38346056 PMCID: PMC10861068 DOI: 10.1371/journal.pone.0298066] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/17/2024] [Indexed: 02/15/2024] Open
Abstract
Equine embryo transfer (EET) is a prominent technology in the equine breeding industry, and its efficacy is affected by a number of factors. The current study aimed to determine the effects of the breed of donor/recipient mares, estrus/ovulation induction treatment, cooled transportation of embryos, and synchrony between donor and recipient mares on the efficiency of the EET under subtropical conditions of Pakistan. A total of eighty-four (n = 84) Polo-playing donor mares (Argentino-polo = 41 and Anglo-Arab = 43) and seventy (n = 70) recipient mares (light breed = 26 and heavy breed = 44) were used for EET. The donor mares exhibiting natural estrus (n = 28) were detected by teaser a stallion, and corpus luteum (CL) having mares (n = 56) were treated with prostaglandin (150 μg of Cloprostenol) for estrus induction. The mares' follicular growth was monitored through ultrasonography until the dominant follicle's size reached 35 mm or more with a moderate to obvious uterine edema score. Afterward, the mares were treated either with GnRH, i.e., 50 μg of Lecirelin acetate (n = 41) or Ovusyn, i.e., 1500 IU hCG (n = 43). Insemination with chilled semen was performed 24 hours later. The embryos were collected non-surgically, 7 or 8 days after ovulation, from the donor mares. The collected embryos were transferred into the well-synchronized recipient mares as fresh (n = 44) or chilled (n = 26) embryos. The pregnancy after ET was checked through ultrasonography. Statistical analysis revealed that the embryo recovery rate (ERR) remained significantly higher (P<0.05) for the Prostaglandin (PG) treated group of donors as compared to the natural heat group of donors. The breed of donor mares, type of ovulatory treatment given, and day of embryo collection did not significantly (P>0.05) affect the ERR. There was no significant effect of the type (fresh vs chilled), classification, and stage of development of embryo on pregnancy outcomes (P>0.05). ET pregnancy rate was significantly affected by the breed of recipient mares and ovulation synchrony between donor and recipient mares (P<0.05). In conclusion, under the subtropical conditions of Pakistan, PG-based estrus induction of donor mares, breed of recipient mares, and ovulation synchrony between the donor and recipient mares had a substantial effect on the efficiency of EET.
Collapse
Affiliation(s)
- Khalid Mahmood
- Department of Theriogenology, University of Veterinary and Animal Sciences, Lahore, Punjab, Pakistan
| | - Aijaz Ali Channa
- Department of Theriogenology, University of Veterinary and Animal Sciences, Lahore, Punjab, Pakistan
| | - Aamir Ghafoor
- University Diagnostic Lab (UDL) at Institute of Microbiology, University of Veterinary and Animal Sciences, Lahore, Punjab, Pakistan
| | - Amjad Riaz
- Department of Theriogenology, University of Veterinary and Animal Sciences, Lahore, Punjab, Pakistan
| |
Collapse
|
160
|
Xu Z, Tong W, Yang Z, Zhang H, Chen X. Comparative efficacy of different growth hormone supplementation protocols in improving clinical outcomes in women with poor ovarian response undergoing assisted reproductive therapy: a network meta-analysis. Sci Rep 2024; 14:3377. [PMID: 38336836 PMCID: PMC10858197 DOI: 10.1038/s41598-024-53780-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 02/05/2024] [Indexed: 02/12/2024] Open
Abstract
Growth hormone (GH) has a long-standing history of use as an adjunctive therapy in the treatment of poor ovarian response (POR), but the optimal dosage and timing remains unclear. The aim of this study was to evaluate and compare the efficacy of different GH supplementation protocols through a network meta-analysis (NMA) and determine the optimal treatment protocol. This study was reported based on the Preferred Reporting Items for Systematic Reviews for Network Meta-Analysis (PRISMA-NMA) statement. Databases including PubMed, Web of Science, Cochrane Library and Embase were searched until June 2023. A total of 524 records were retrieved in our search, and 23 clinical studies comprising 4889 cycles were involved. Seven different GH protocols were identified. Results showed that compared to the control group, daily administration of 4-8 IU of GH during the follicular phase of the stimulation cycle had the best comprehensive therapeutic effects on improving the number of retrieved oocytes, mature oocytes, endometrial thickness, and reducing gonadotropin requirements in POR patients undergoing assisted reproductive therapy, with a relatively brief treatment duration and a moderate total GH dose. Subgroup analysis demonstrated that this protocol could significantly improve the clinical pregnancy rate of POR patients in the randomized controlled trials (RCT) subgroup and the African subgroup. Therefore, its clinical application is suggested. Besides, the potential advantages of long-term GH supplementation protocol (using GH for at least 2 weeks before oocyte retrieval) has merit for further research. Rigorous and well-designed multi-arm RCTs are needed in the future to confirm the conclusions drawn from this study.
Collapse
Affiliation(s)
- Zheyun Xu
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Weiquan Tong
- Department of Emergency Medicine, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Ze Yang
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Hongyan Zhang
- Department of Reproductive Medicine Center, Hangzhou Women's Hospital, Hangzhou, China
| | - Xingbei Chen
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China.
| |
Collapse
|
161
|
Han QS, Zhou Y, Xu Y, Ai KL, Song JY, Sun ZG. Optimal timing of GnRH antagonist initiation in IVF-ET: a retrospective cohort study on advanced maternal age women. Front Endocrinol (Lausanne) 2024; 15:1340230. [PMID: 38375197 PMCID: PMC10875460 DOI: 10.3389/fendo.2024.1340230] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/18/2024] [Indexed: 02/21/2024] Open
Abstract
Background Several studies have compared the effects of fixed and flexible gonadotropin releasing hormone antagonist (GnRH-ant) protocols during in vitro fertilization and embryo transfer (IVF-ET). However, which GnRH-ant initiation strategy is better remains controversial. Moreover, no studies have assessed the optimal timing of GnRH-ant initiation in women of advanced maternal age (AMA). Methods In this retrospective cohort study, a total of 472 infertile women aged ≥ 35 years old undergoing their first IVF cycle from August 2015 to September 2021 at a tertiary academic medical center were recruited, of whom 136 followed fixed GnRH-ant protocol and 336 followed flexible GnRH-ant protocol. The primary outcomes measured were the cumulative live birth rate (CLBR) per IVF cycle and the time to live birth (TTLB) from the date of oocyte retrieval. Cox proportional models were used to calculate the hazard ratio (HR) and 95% confidence interval (CI) of CLBR regarding GnRH-ant timing. Results No significant difference in CLBR was found between the fixed and flexible GnRH-ant groups (27.9% vs 20.5%, p=0.105). The TTLB was also comparable between groups (10.56 vs 10.30 months, p=0.782). The Kaplan-Meier analysis for CLBR also showed comparable results between groups (P=0.351, HR=0.83; 95%CI: 0.56-1.23). After establishing a multiple Cox proportional hazard model, the fixed GnRH-ant group still had comparable CLBR with the flexible GnRH-ant group (HR=0.85; 95%CI: 0.53-1.38; P=0.518). Subgroup and sensitivity analyses also demonstrated similar results. Conclusion GnRH-ant protocols can be tailored to the needs of AMA women, and timing of GnRH-ant initiation can be adjusted flexibly.
Collapse
Affiliation(s)
- Qiao-Song Han
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yue Zhou
- The College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Ying Xu
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Kai-Liang Ai
- The College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jing-Yan Song
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zhen-Gao Sun
- Reproductive Center of Integrated Medicine, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| |
Collapse
|
162
|
Yu C, Bai L, Mei-Zhou J, Yu-Wang X, Chen L, Zhang J. Analysis of factors associated with IUI pregnancy outcomes in elderly and young patients. BMC Womens Health 2024; 24:86. [PMID: 38310215 PMCID: PMC10838432 DOI: 10.1186/s12905-024-02934-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/27/2024] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVE The objective of this study was to investigate the correlation between various factors and the clinical outcomes of Intrauterine Insemination (IUI) in both young and aged patients, aiming to provide a theoretical basis for clinical consultations. METHODS This retrospective analysis examined a total of 4,221 IUI cycles conducted at the Reproductive Center of Changzhou Maternal and Child Health Hospital between January 2016 and December 2020. The patients were categorized into two groups based on age: the elder group (≥ 35 years) and the young group (< 35 years). RESULTS The findings of this study revealed a significant association between woman's age and BMI with pregnancy outcomes (0.93, 95% CI: 0.89-0.97) (1.04, 95% CI: 1.01-1.06). Moreover, in young women, both age and Body Mass Index (BMI)were found to be related to pregnancy outcomes (0.97, 95% CI: 0.89-0.97) (1.08, 95% CI: 1.01-1.06). Additionally, BMI and the number of cycles in aged IUI patients were found to be associated with pregnancy outcomes. The pregnancy rate in the second cycle was approximately 1.9 times higher than that in the first cycle (1.9, 95% CI: 0.97-3.77), and in the third cycle, it was approximately 3 times higher than that in the first cycle (3.04, 95% CI: 1.43-6.42). CONCLUSIONS In conclusion, there is an association between woman's age and BMI and the clinical outcomes of IUI. However, the number of cycles did not affect the pregnancy outcomes in young women. Conversely, in elder women, the number of cycles was found to be related to the IUI pregnancy outcomes, with significantly higher pregnancy rates observed in the second and third cycles compared to the first cycle.
Collapse
Affiliation(s)
- Chunmei- Yu
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, 213000, China
| | - Lijing- Bai
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, 213000, China
| | - Jian Mei-Zhou
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, 213000, China
| | - Xiao Yu-Wang
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, 213000, China
| | - Li Chen
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, 213000, China.
| | - Jinghua- Zhang
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, 213000, China.
| |
Collapse
|
163
|
Xie B, Huang Y, Hang F, Yu J, Hu Q, Li J, Qin A. Impact of oil-based contrast agents in hysterosalpingography on fertility outcomes in endometriosis: a retrospective cohort study. Reprod Biol Endocrinol 2024; 22:19. [PMID: 38308329 PMCID: PMC10837917 DOI: 10.1186/s12958-024-01190-1] [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] [Received: 12/07/2023] [Accepted: 01/25/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Previous studies have suggested that oil-based contrast agents used during hysterosalpingography (HSG) in infertile patients can enhance fertility. However, limited research has investigated the effect of oil-based contrast medium specifically in individuals with endometriosis-related infertility. OBJECTIVE This study aims to explore the impact of oil-based contrast medium on fertility outcomes in women with endometriosis-related infertility. METHODS Conducted at the First Affiliated Hospital of Guangxi Medical University (January 2020 to June 2022), the study included 512 patients undergoing HSG. Patients were categorized into oil-based and non-oil-based groups, and after propensity score matching, demographic characteristics were compared. Main outcomes included clinical pregnancy rates, live birth rates, early miscarriage rates, and ectopic pregnancy rates. RESULTS In our analysis, the Oil-based group showed significantly better outcomes compared to the Non-oil-based group. Specifically, the Oil-based group had higher clinical pregnancy rates (51.39% vs. 27.36%) and increased live birth rates (31.48% vs. 19.93%). This trend held true for expectant treatment, IUI, and IVF/ICSI, except for surgical treatment where no significant difference was observed. After adjusting for various factors using propensity score matching, the Non-oil-based group consistently exhibited lower clinical pregnancy rates compared to the Oil-based group. The Odds Ratio (OR) was 0.38 (95%CI: 0.27-0.55) without adjustment, 0.34 (0.22-0.51) in multivariable analysis, 0.39 (0.27-0.57) using inverse probability of treatment weighting (IPTW), and 0.22 (0.14-0.35) in propensity score matching. CONCLUSION Oil-based contrast medium used in HSG for women with endometriosis-related infertility is associated with higher clinical pregnancy rates and live birth rates compared to Non-oil-based contrast medium.
Collapse
Affiliation(s)
- Baoli Xie
- Center of Reproductive Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Yingqin Huang
- Center for Reproductive Medicine, Maternal and Child Health Hospital in Guangxi, Guangxi, 530021, China
| | - Fu Hang
- Center of Reproductive Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Jiaxin Yu
- Center of Reproductive Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Qianwen Hu
- Center of Reproductive Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Jiaxu Li
- Center of Reproductive Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Aiping Qin
- Center of Reproductive Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China.
| |
Collapse
|
164
|
Yang T, Wu L, Peng J, Wang C, Li G, Zhang J, He X, Cao Y, Song B. Effects of SARS-CoV-2 infection during ovarian stimulation on ART outcomes. Reprod Biomed Online 2024; 48:103422. [PMID: 38030535 DOI: 10.1016/j.rbmo.2023.103422] [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] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/11/2023] [Accepted: 09/22/2023] [Indexed: 12/01/2023]
Abstract
RESEARCH QUESTION Does severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection during ovarian stimulation affect assisted reproductive technology outcomes? DESIGN This retrospective cohort study conducted at the Reproductive Medicine Centre of The First Affiliated Hospital of Anhui Medical University aimed to assess the effects of acute SARS-CoV-2 infection during IVF on treatment outcomes and the reproductive system. The study included 151 treatment cycles involving couples with coronavirus disease 2019 (COVID-19) during ovarian stimulation, along with 224 cycles of non-infected couples as a control group. Clinical characteristics and laboratory parameters were analysed, including total gonadotrophin dosage, duration of ovarian stimulation, number of oocytes retrieved, fertilization method, fertilization rate, and number of blastocyst embryos available. Forty-six follicular fluid samples, 38 semen samples and 78 embryo culture medium samples from patients with COVID-19 were tested for SARS-CoV-2 RNA using reverse transcription polymerase chain reaction assay. RESULTS The treatment and control groups showed similar cycle characteristics, including fertilization method, total gonadotrophin dosage and duration of ovarian stimulation. The mean number of oocytes retrieved per cycle and rate of mature oocytes in intracytoplasmic sperm injection cycles were comparable. No significant difference was observed in the total number of blastocyst embryos available between the groups. Furthermore, no SARS-CoV-2 RNA was detected in any of the samples of patients with COVID-19. CONCLUSIONS In conclusion, acute SARS-CoV-2 infection during ovarian stimulation does not have a significant impact on IVF treatment outcomes. Additionally, no risk to the reproductive system was observed in patients infected with SARS-CoV-2. Therefore, individuals with asymptomatic or mild COVID-19 can safely continue IVF treatment. Future research is needed to investigate the long-term effects of COVID-19 on fertility and reproductive outcomes.
Collapse
Affiliation(s)
- Tianjin Yang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Longmei Wu
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Obstetrics and Gynaecology, Anhui Public Health Clinical Centre, Hefei, China
| | - Jing Peng
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Chao Wang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
| | - Guanjian Li
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
| | - Junfei Zhang
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiaojin He
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei, China; Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Centre, Anhui Medical University, Hefei, China
| | - Yunxia Cao
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei, China; Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Centre, Anhui Medical University, Hefei, China.
| | - Bing Song
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei, China; Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Centre, Anhui Medical University, Hefei, China.
| |
Collapse
|
165
|
Ata B, Kalafat E. Progestin-primed ovarian stimulation: for whom, when and how? Reprod Biomed Online 2024; 48:103639. [PMID: 38159467 DOI: 10.1016/j.rbmo.2023.103639] [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] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/10/2023] [Accepted: 10/18/2023] [Indexed: 01/03/2024]
Abstract
Progestin-primed ovarian stimulation (PPOS) is being increasingly used for ovarian stimulation in assisted reproductive technology. Different progestins have been used with similar success. The available studies suggest a similar response to ovarian stimulation with gonadotrophin-releasing hormone (GnRH) analogues. Any differences in the duration of stimulation or gonadotrophin consumption are minor and clinically insignificant. PPOS has the advantage of oral administration and lower medication costs than GnRH analogues. As such it is clearly more cost-effective for fertility preservation and planned freeze-all cycles, but when fresh embryo transfer is intended PPOS can be less cost-effective depending on the local direct and indirect costs of the additional initial frozen embryo transfer cycle. Oocytes collected in PPOS cycles have similar developmental potential, including blastocyst euploidy rates. Frozen embryo transfer outcomes of PPOS and GnRH analogue cycles seem to be similar in terms of both ongoing pregnancy/live birth rates and obstetric and perinatal outcomes. While some studies have reported lower cumulative live birth rates with PPOS, they have methodological issues, including arbitrary definitions of the cumulative live birth rate. PPOS has been used in all patient types (except progesterone receptor-positive breast cancer patients) with consistent results and seems a patient friendly and cost-effective choice if a fresh embryo transfer is not intended.
Collapse
Affiliation(s)
- Baris Ata
- Department of Obstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey; ART Fertility Clinics, Dubai, United Arab Emirates.
| | - Erkan Kalafat
- Department of Obstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey; ART Fertility Clinics, Dubai, United Arab Emirates
| |
Collapse
|
166
|
Zhang Q, Yang G, Tan J, Xiong Y, Xu Y, Xu Y, Gu F. Antibiotic cured chronic endometritis remains a risk factor for early pregnancy loss in the subsequent frozen euploid embryo transfer. Reprod Biomed Online 2024; 48:103611. [PMID: 38118232 DOI: 10.1016/j.rbmo.2023.103611] [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] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/01/2023] [Accepted: 10/04/2023] [Indexed: 12/22/2023]
Abstract
RESEARCH QUESTION Do patients with antibiotic-cured chronic endometritis (CCE) have a comparable pregnancy outcome to those with non-chronic endometritis (NCE) in the subsequent frozen embryo transfer (FET) cycle? DESIGN A retrospective cohort analysis included 833 patients in their first FET cycles with single euploid embryo transfer. Chronic endometritis (≥5 CD138+ plasma cells per high-power field [CD138+/HPF]) was treated with standard antibiotic therapy. Patients were classified into two groups: the NCE group (n = 611, <5 CD138+/HPF) and the CCE group (n = 222, ≥5 CD138+/HPF and cured after antibiotic treatment). Pregnancy outcomes were compared. NCE group was divided into subgroup 1 (CD138+/HPF = 0) and subgroup 2 (CD138+/HPF = 1-4) for further analysis. RESULTS The rate of early pregnancy loss (EPL), incorporating all losses before 10 weeks' gestation, was significantly higher in the CCE group than the NCE group (21.2% versus 14.2%, P = 0.016), and the difference was statistically significant (adjusted odds ratio [AOR] 1.68, 95% confidence interval [CI] 1.11-2.55). No significant differences were observed between the two groups with regard to other pregnancy outcomes. In the subgroup analysis, the EPL rate and biochemical pregnancy rate were significantly higher in subgroup 2 than subgroup 1 (17.2% versus 9.4%, AOR 2.21, 95% CI 1.30-3.74; 12.2% versus 6.9%, AOR 2.01, 95% CI 1.09-3.68). CONCLUSIONS Chronic endometritis cured by standard antibiotic therapy remains a risk factor for EPL in FET cycles, although no differences were found in live birth rates between patients with CCE or with NCE.
Collapse
Affiliation(s)
- Qingyan Zhang
- Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; The Key Laboratory of Reproductive Medicine of Guangdong Province, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, Guangzhou, China
| | - Guoxia Yang
- Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; The Key Laboratory of Reproductive Medicine of Guangdong Province, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, Guangzhou, China
| | - Jinfeng Tan
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yujing Xiong
- Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; The Key Laboratory of Reproductive Medicine of Guangdong Province, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, Guangzhou, China
| | - Yan Xu
- Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; The Key Laboratory of Reproductive Medicine of Guangdong Province, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, Guangzhou, China
| | - Yanwen Xu
- Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; The Key Laboratory of Reproductive Medicine of Guangdong Province, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, Guangzhou, China.
| | - Fang Gu
- Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; The Key Laboratory of Reproductive Medicine of Guangdong Province, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, Guangzhou, China.
| |
Collapse
|
167
|
Zhao QH, Song YW, Chen J, Zhou X, Xie JL, Yao QP, Dong QY, Feng C, Zhou LM, Fu WP, Jin M. Embryo Transfer Strategies for Women with Recurrent Implantation Failure During the Frozen-thawed Embryo Transfer Cycles: Sequential Embryo Transfer or Double-blastocyst Transfer? Curr Med Sci 2024; 44:212-222. [PMID: 38393529 DOI: 10.1007/s11596-024-2827-9] [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] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/03/2023] [Indexed: 02/25/2024]
Abstract
OBJECTIVE Both sequential embryo transfer (SeET) and double-blastocyst transfer (DBT) can serve as embryo transfer strategies for women with recurrent implantation failure (RIF). This study aims to compare the effects of SeET and DBT on pregnancy outcomes. METHODS Totally, 261 frozen-thawed embryo transfer cycles of 243 RIF women were included in this multicenter retrospective analysis. According to different embryo quality and transfer strategies, they were divided into four groups: group A, good-quality SeET (GQ-SeET, n=38 cycles); group B, poor-quality or mixed-quality SeET (PQ/MQ-SeET, n=31 cycles); group C, good-quality DBT (GQ-DBT, n=121 cycles); and group D, poor-quality or mixed-quality DBT (PQ/MQ-DBT, n=71 cycles). The main outcome, clinical pregnancy rate, was compared, and the generalized estimating equation (GEE) model was used to correct potential confounders that might impact pregnancy outcomes. RESULTS GQ-DBT achieved a significantly higher clinical pregnancy rate (aOR 2.588, 95% CI 1.267-5.284, P=0.009) and live birth rate (aOR 3.082, 95% CI 1.482-6.412, P=0.003) than PQ/MQ-DBT. Similarly, the clinical pregnancy rate was significantly higher in GQ-SeET than in PQ/MQ-SeET (aOR 4.047, 95% CI 1.218-13.450, P=0.023). The pregnancy outcomes of GQ-SeET were not significantly different from those of GQ-DBT, and the same results were found between PQ/MQ-SeET and PQ/MQ-DBT. CONCLUSION SeET relative to DBT did not seem to improve pregnancy outcomes for RIF patients if the embryo quality was comparable between the two groups. Better clinical pregnancy outcomes could be obtained by transferring good-quality embryos, no matter whether in SeET or DBT. Embryo quality plays a more important role in pregnancy outcomes for RIF patients.
Collapse
Affiliation(s)
- Qiao-Hang Zhao
- The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Yu-Wei Song
- The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Jian Chen
- The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Xiang Zhou
- The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Ji-Lai Xie
- The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Qiu-Ping Yao
- The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310052, China
- Jiaxing Maternity and Child Health Care Hospital, Jiaxing, 314051, China
| | - Qi-Yin Dong
- Huzhou Maternity and Child Care Hospital, Huzhou, 313002, China
| | - Chun Feng
- The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Li-Ming Zhou
- Ningbo Women and Children's Hospital, Ningbo, 315000, China
| | - Wei-Ping Fu
- Jiaxing Maternity and Child Health Care Hospital, Jiaxing, 314051, China.
| | - Min Jin
- The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310052, China.
| |
Collapse
|
168
|
Alkan H, Tekindal MA, Demirel MA, Soyturk BI, Golbasi M, Deniz YE, Satilmis F, Alkan KK. Effect of strategies to increase progesterone levels on fertility of bovine embryo transfer recipients - A meta-analysis. Theriogenology 2024; 215:177-186. [PMID: 38086311 DOI: 10.1016/j.theriogenology.2023.12.005] [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] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/06/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024]
Abstract
The pregnancy rate following embryo transfer (ET) is a very important factor in the success of embryo production programs. Different strategies were therefore developed to increase pregnancy rates. The aim of this meta-analysis was to investigate the effects of hormone treatments used to increase the success of embryo transfer programs on pregnancy rates. A meta-analysis was performed of 46 trials from 39 publications involving treated (n = 7856) and control (n = 6663) cattle. The meta-analysis explained the effect size with its 95 % confidence interval (CI) for pregnancy per embryo transfer (P/ET) after hormonal treatment under different moderators. Hormonal support was found to increase P/ET compared to the control group (P < 0.05). However, GnRH treatment was found to increase P/ET by approximately 4.3 % and hCG treatment by 8.0 %. Progesterone supplementation was not found to have a statistically significant effect on P/ET. In addition, GnRH treatment significantly increased P/ET when used to transfer in vitro or frozen-thawed embryos or in studies using cows as recipients. It was observed that hCG treatment had a positive effect on P/ET according to all moderators. Progesterone supplementation significantly increased P/ET when frozen embryos were transferred and reduced P/ET, especially in publications where fresh or in vitro produced embryos were transferred or cows were used as recipients. The results of this meta-analysis showed that the use of GnRH, and hCG, in bovine embryo transfer programs increased P/ET, whereas the use of progesterone had no effect on P/ET. However, it was found that P/ET could increase/decrease depending on the moderator.
Collapse
Affiliation(s)
- Hasan Alkan
- Department of Obstetrics and Gynecology, Faculty of Veterinary Medicine, Selcuk University, Konya, Turkey.
| | - Mustafa Agah Tekindal
- Department of Biostatistics, Faculty of Medicine, Izmir Katip Çelebi University, Izmir, Turkey
| | - Mehmet Akif Demirel
- Department of Obstetrics and Gynecology, Faculty of Veterinary Medicine, Selcuk University, Konya, Turkey
| | - Berrak Isik Soyturk
- Department of Obstetrics and Gynecology, Faculty of Veterinary Medicine, Selcuk University, Konya, Turkey
| | - Maide Golbasi
- Department of Obstetrics and Gynecology, Faculty of Veterinary Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Yunus Emre Deniz
- Department of Obstetrics and Gynecology, Faculty of Veterinary Medicine, Selcuk University, Konya, Turkey
| | - Fatma Satilmis
- Department of Obstetrics and Gynecology, Faculty of Veterinary Medicine, Selcuk University, Konya, Turkey
| | - Kubra Karakas Alkan
- Department of Obstetrics and Gynecology, Faculty of Veterinary Medicine, Selcuk University, Konya, Turkey
| |
Collapse
|
169
|
Du T, Xie Q, Qiu J, Zhang S, Mol BW, Zhang S, Kuang Y, Zhao D, Li W. Effect of small follicles on clinical pregnancy and multiple pregnancy rates in intrauterine insemination: a cohort study. Hum Reprod 2024; 39:335-345. [PMID: 38148021 DOI: 10.1093/humrep/dead259] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/20/2023] [Indexed: 12/28/2023] Open
Abstract
STUDY QUESTION What is the effect of small follicles on clinical pregnancy and multiple pregnancy rates in women undergoing IUI with ovarian stimulation (IUI-OS)? SUMMARY ANSWER The presence of ≥2 small follicles with a diameter of 10-12 or 12-14 mm was associated with an increased chance of clinical pregnancy and the presence of any 12-14 mm or larger follicles, but not smaller follicles, was statistically significantly associated with an increased risk for multiple pregnancy. WHAT IS KNOWN ALREADY IUI-OS is widely used as the first-line treatment for unexplained or mild male factor infertility. However, IUI is associated with the risk of multiple pregnancy. While the positive association between the number of follicles ≥14 mm and the chance of pregnancy and the risk of multiple pregnancy is known, the impact of smaller follicles is uncertain. STUDY DESIGN, SIZE, DURATION This was a retrospective cohort study that included women undergoing IUI cycles from January 2007 to May 2021 in one assisted reproduction center. PARTICIPANTS/MATERIALS, SETTING, METHODS We studied the impact of the number and size of follicles on trigger day on clinical pregnancy and multiple pregnancy rates. Generalized estimation equation regression models were used to compute unadjusted and adjusted odds ratios and 95% CI in all women and only women who achieved clinical pregnancy separately. The chance of clinical pregnancy and multiple pregnancy for different numbers of small follicles in cycles with one >18-mm follicle was calculated using marginal effects estimate. MAIN RESULTS AND THE ROLE OF CHANCE This cohort included 12 933 IUI cycles in 7504 women. The overall clinical pregnancy rate was 16.1% (2081/12 933), with a multiple pregnancy rate of 10.5% (218/2081). In the adjusted analysis, the chance of clinical pregnancy increased significantly with the increase in the number of follicles with the diameter of 14-16, 16-18, and 18-20 mm. As for 10-12 mm [adjusted odds ratio (aOR) 1.22, 95% CI 1.02-1.46] and 12-14 mm (aOR 1.29, 95% CI 1.07-1.56) follicles, only groups with ≥2 follicles of those sizes showed significantly increased chance of clinical pregnancy. In cycles that led to pregnancy, follicles with the diameter of 12-14 mm were associated with an increased risk of multiple pregnancy (aOR 1.73, 95% CI 1.19-2.53 for one such follicle; aOR 2.27, 95% CI 1.44-3.56 for ≥2 such follicles), while 10- to 12-mm follicles were not significantly associated with multiple pregnancy (aOR 1.18, 95% CI 0.72-1.95 for ≥2 such follicles). The associations of multiple pregnancy were similar when including all cycles. LIMITATIONS, REASONS FOR CAUTION This was a retrospective observational study from a single center. The records of follicle diameter in our center were of a 2-mm interval which limited our ability to analyze the size of follicle as a continuous variable. Also, the number of cycles with a high number of small follicles was still limited which impeded more detailed analysis on the ≥2 follicles subgroup. Similarly, the value of some parts of the marginal probability estimation for multiple pregnancy versus pregnancy according to size and number of follicles was also limited by the low sample size of certain combinations. WIDER IMPLICATIONS OF THE FINDINGS Follicles larger than 10 mm, especially those ≥12 mm, may need to be clearly recorded during transvaginal ultrasound surveillance and their potential effects on both pregnancy and multiple pregnancy can be discussed with couples undergoing IUI. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the National Natural Science Foundation of China (Grant numbers 82201912, 82371651, and 82071615) and Shanghai Sailing Program (21YF1423200). B.W.M. is supported by an NHMRC Investigator grant (GNT1176437). B.W.M. reports consultancy for ObsEva and Merck and travel support from Merck. B.W.M. has received research funding from Ferring and Merck. The authors declare no other competing interests. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- Tong Du
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qin Xie
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaxin Qiu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shiyi Zhang
- School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, The School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Department of Obstetrics and Gynaecology, Aberdeen Centre for Women's Health Research, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Shaozhen Zhang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanping Kuang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dong Zhao
- Department of Obstetrics and Gynaecology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wentao Li
- Department of Obstetrics and Gynaecology, The School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- National Perinatal Epidemiology and Statistics Unit (NPESU), Centre for Big Data Research in Health, and School of Clinical Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
170
|
Fabozzi G, Cimadomo D, Maggiulli R, Vaiarelli A, Badajoz V, Aura M, Canosa S, Bongioanni F, Benini F, Livi C, Zacà C, Borini A, Alviggi E, Iussig B, Hebles M, Sànchez P, Cimadomo V, Rienzi L, Llàcer J. Association between oocyte donors' or recipients' body mass index and clinical outcomes after first single blastocyst transfers-the uterus is the most affected. Fertil Steril 2024; 121:281-290. [PMID: 37549838 DOI: 10.1016/j.fertnstert.2023.07.029] [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] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE To assess whether high body mass index (BMI) in either oocyte donors or recipients is associated with poorer outcomes after the first single blastocyst transfer. DESIGN Retrospective study including 1,394 first blastocyst single embryo transfers (SETs) conducted by 1,394 recipients during oocyte donation cycles with the gametes retrieved from 1,394 women (January 2019-July 2021). Four BMI clusters were defined for both donors and recipients (underweight: <18.5 kg; normal weight: 18.5-24.9 kg; overweight: 25-29.9 kg; and obese: ≥30 kg). SETTING Network of private IVF centers. PATIENTS A total of 1,394 recipients aged 42.4 ± 4.0 and with a BMI of 23.2 ± 3.8 kg/m2, and 1,394 donors aged 26.1 ± 4.2 and with a BMI of 21.9 ± 2.5 kg/m2. INTERVENTION All oocytes were vitrified at 2 egg banks and warmed at 8 in vitro fertilization clinics that were part of the same network. Intracytoplasmic sperm injection, blastocyst culture, and either fresh or vitrified-warmed SETs were conducted. Putative confounders were investigated, and the data were adjusted through regression analyses. MAIN OUTCOME MEASURES The primary outcome was the live birth rate (LBR) per SET according to donors' and/or recipients' BMI. The main secondary outcome was the miscarriage rate (<22 gestational weeks) per clinical pregnancy. RESULTS The LBR per blastocyst SET showed no significant association with donors' BMI. Regarding recipients' BMI, instead, the multivariate odds ratio was significant in obese vs. normal-weight recipients (0.58, 95% confidence interval, 0.37-0.91). The miscarriage rate per clinical pregnancy was also significantly associated with recipients' obesity, with a multivariate odds ratio of 2.31 (95% confidence interval, 1.18-4.51) vs. normal-weight patients. A generalized additive model method was used to represent the relationship between predicted LBR or miscarriage rates and donors' or recipients' BMI; it pictured a scenario where the former outcome moderately but continuously decreases with increasing recipients' BMI to then sharply decline in the BMI range of 25-35 kg/m2. The miscarriage rate, instead, increases almost linearly with respect to both donors' and recipients' increasing BMI. CONCLUSION Obesity mostly affects the uterus, especially because of higher miscarriage rates. Yet, poorer outcomes can be appreciated already with a BMI of 25 kg/m2 in both oocyte donors and recipients. Finer markers of nutritional homeostasis are therefore desirable; recipients should be counseled about poorer expected outcomes in cases of overweight and obesity; and oocyte banks should avoid assigning oocytes from overweight donors to overweight and obese recipients.
Collapse
Affiliation(s)
- Gemma Fabozzi
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy; IVIRMA Global Research Alliance, B-WOMAN, Rome, Italy; Department of Biomedicine and Prevention, University of Rome, Tor Vergata, Rome, Italy
| | - Danilo Cimadomo
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy.
| | - Roberta Maggiulli
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - Alberto Vaiarelli
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | | | - Monica Aura
- IVIRMA Global Research Alliance, GINEFIV, Barcelona, Spain
| | | | | | | | - Claudia Livi
- IVIRMA Global Research Alliance, DEMETRA, Florence, Italy
| | - Carlotta Zacà
- IVIRMA Global Research Alliance, 9.baby, Bologna, Italy
| | - Andrea Borini
- IVIRMA Global Research Alliance, 9.baby, Bologna, Italy
| | - Erminia Alviggi
- IVIRMA Global Research Alliance, GENERA, Clinica Ruesch, Naples, Italy
| | - Benedetta Iussig
- IVIRMA Global Research Alliance, GENERA, GENERA Veneto, Marostica, Italy
| | - Maria Hebles
- IVIRMA Global Research Alliance, GINEMED, Sevilla, Spain
| | | | | | - Laura Rienzi
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy; Department of Biomolecular Sciences, the University of Urbino "Carlo Bo", Urbino, Italy
| | | |
Collapse
|
171
|
Vergara F, Fernández J, Pedrosa C, Muñoz M, Jerez E, Varón M, Moyano C, Yoldi A, Ponce J. Comparative study of intracytoplasmic sperm injection using the traditional holding and the oocyte-holding pipette without aspiration. ZYGOTE 2024; 32:96-101. [PMID: 38173402 DOI: 10.1017/s0967199423000618] [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] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Despite the high level of standardization of the intracytoplasmic sperm injection (ICSI) technique, there are some aspects that deserve special attention and should still be improved. The major drawback of the technique is its invasiveness, as during cytoplasmic aspiration different structures of the oocyte may be lost or damaged. This is partly because the microtools used in ICSI were not specially designed for assisted reproduction but for other medical-biological disciplines. In view of the above caveats, the aim of the study was to compare the results of ICSI with the traditional oocyte-holding pipette and the oocyte-holding pipette without aspiration (PiWA). In total, 155 patients and 1037 oocytes were included in the study. In each ICSI cycle, half of the oocytes were microinjected using a traditional holding pipette and the other half using a PiWA. In result, the PiWA technique produced a significant increase in the fertilization rate: 88.12% (95%CI: 84.62-90.92%); holding pipette: 73.33% (95%CI: 68.72-77.49%). Also, it produced a significant decrease in the embryo degeneration rate compared with the traditional holding pipette [PiWA: 2.07% (95%CI: 1.11-3.8%); holding pipette: 4.51% (95%CI: 3.06-6.59%)]. Pregnancy rate depended on the holding technique used, both in single embryo transfers (n = 59; χ2 = 4.608; P-value = 0.032) and double embryo transfers (n = 156; χ2 = 4.344; P-value = 0.037); with PiWA presenting a significantly higher pregnancy rate than the traditional holding technique. Based on current evidence and the present results, improvements should focus on decreasing the invasiveness of the microinjection itself by minimizing or avoiding aspiration and cytoplasmic disorganization, as is successfully achieved with PiWA.
Collapse
|
172
|
van den Berg JS, Molina NM, Altmäe S, Arends B, Steba GS. A systematic review identifying seminal plasma biomarkers and their predictive ability on IVF and ICSI outcomes. Reprod Biomed Online 2024; 48:103622. [PMID: 38128376 DOI: 10.1016/j.rbmo.2023.103622] [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] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 06/30/2023] [Accepted: 10/12/2023] [Indexed: 12/23/2023]
Abstract
The diverse nature and high molecule concentration of seminal plasma (SP) makes this fluid a good potential source for a potential biomarker that could predict assisted reproductive technology (ART) outcomes. Currently, semen quality parameters cannot accurately predict ART outcomes. A systematic literature search was conducted to identify human SP biomarkers with potential predictive ability for the outcomes of IVF and intracytoplasmic sperm injection. Observational cohort and case-control studies describing the association between biomarkers in human SP and the outcome of infertile men attending for ART were included. Forty-three studies were selected, reporting on 89 potential SP biomarkers (grouped as oxidative stress, proteins glycoproteins, metabolites, immune system components, metals and trace elements and nucleic acids). The present review supports 32 molecules in SP as potentially relevant biomarkers for predicting ART outcomes; 23 molecules were reported once and nine molecules were reported in more than one study; IL-18 and TGF-β1-IL-18 ratio were confirmed in distinct studies. This review presents the most comprehensive overview of relevant SP biomarkers to predict ART outcomes to date, which is of clinical interest for infertility investigations and assisted reproduction; nevertheless, its potential is under-exploited. This review could serve as starting point for designing an all-encompassing study for biomarkers in SP and their predictive ability for ART outcomes, and for developing a non-invasive diagnostic tool.
Collapse
Affiliation(s)
- Jonna S van den Berg
- Department of Reproductive Medicine and Gynaecology, Division Female and Baby, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Nerea M Molina
- Department of Biochemistry and Molecular Biology I, Faculty of Sciences, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Signe Altmäe
- Department of Biochemistry and Molecular Biology I, Faculty of Sciences, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Brigitte Arends
- Department of Reproductive Medicine and Gynaecology, Division Female and Baby, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Gaby Sarina Steba
- Department of Reproductive Medicine and Gynaecology, Division Female and Baby, University Medical Centre Utrecht, Utrecht, the Netherlands.
| |
Collapse
|
173
|
George JS, Srouji SS, Little SE, Ginsburg ES, Lanes A. The impact of increasing body mass index on in vitro fertilization treatment, obstetrical, and neonatal outcomes. Am J Obstet Gynecol 2024; 230:239.e1-239.e14. [PMID: 37852521 DOI: 10.1016/j.ajog.2023.10.018] [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] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Citing the risks of administering anesthesia to patients with obesity, few fertility centers offer in vitro fertilization as a treatment modality for patients with body mass indexes ≥40 kg/m2. Although previous studies have assessed clinical pregnancy and cumulative live birth rates in patients who spontaneously conceive with body mass indexes ≥50 kg/m2, there is a paucity of in vitro fertilization, obstetrical, and neonatal outcome data in patients with severe obesity who conceive after in vitro fertilization. OBJECTIVE This study aimed to evaluate the impact of increasing body mass index on in vitro fertilization, obstetrical, and neonatal outcomes in patients with obesity undergoing in vitro fertilization. STUDY DESIGN This was a retrospective cohort study within an academic fertility center including 2069 fresh in vitro fertilization/intracytoplasmic sperm injection and frozen embryo transfer cycles from January 1, 2012 to April 30, 2020; this cohort was used to determine in vitro fertilization treatment outcomes. A second embedded cohort of 867 fresh in vitro fertilization/intracytoplasmic sperm injection and frozen embryo transfer cycles that resulted in ongoing clinical pregnancies and deliveries within a single tertiary hospital system was used to determine pregnancy, maternal, and neonatal outcomes. All patients with a body mass index ≥40 kg/m2 underwent consultation with a maternal-fetal medicine specialist before starting treatment and a preoperative evaluation with an anesthesiologist before oocyte retrieval. Cycles were grouped by body mass index at cycle start (30-34.9, 35-39.9, 40-44.9, 45-49.9, and ≥50 kg/m2). Log-binomial regression and Poisson regression with an offset were fitted with body mass index of 30 to 34.9 kg/m2 as the reference group, adjusting for potential confounders including oocyte age, patient age, embryo quality, transfer type, and coexisting comorbidities. The primary outcome was live birth rate. Secondary outcomes included fertilization rate, blastulation rate, miscarriage rate, incidence of preeclampsia with severe features, gestational diabetes, labor induction, cesarean delivery, preterm delivery, and birthweight. RESULTS There were 2069 fresh in vitro fertilization/intracytoplasmic sperm injection and frozen embryo transfer cycle starts from January 1, 2012 to April 30, 2020. Of these, 1008 cycles were in the 30 to 34.9 kg/m2 group, 547 in the 35 to 39.9 kg/m2 group, 277 in the 40 to 44.9 kg/m2 group, 161 in the 45 to 49.9 kg/m2 group, and 76 in the ≥50 kg/m2 body mass index group. Live birth rate was not significantly different between groups. The body mass index ≥50 kg/m2 group was significantly more likely to experience preeclampsia with severe features when compared with the 30 to 34.9 kg/m2 body mass index group (absolute risk reduction, 2.75; 95% confidence interval, 1.13-6.67). Fertilization rate, blastulation rate, miscarriage rate, incidence of gestational diabetes, labor induction, cesarean delivery, preterm delivery, and neonatal birthweights were not significantly different between groups. CONCLUSION Among patients with body mass indexes from 30 to 60 kg/m2 who conceived via in vitro fertilization and received comprehensive prenatal care at a tertiary care hospital, in vitro fertilization, obstetrical, and neonatal outcomes were largely comparable. These data support a collaborative care approach with maternal-fetal medicine specialists and skilled anesthesiologists, reinforcing the notion that in vitro fertilization should not be withheld as a treatment modality from patients with obesity.
Collapse
Affiliation(s)
- Jenny S George
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; From the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Serene S Srouji
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; From the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sarah E Little
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; From the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Elizabeth S Ginsburg
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; From the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Andrea Lanes
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; From the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
174
|
Xu S, Zhao W, Zhang Y, Qiang C, Zhang C. The effect of previous induced abortion history on the assisted reproduction outcomes. Arch Gynecol Obstet 2024; 309:469-474. [PMID: 36708427 DOI: 10.1007/s00404-023-06928-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/10/2023] [Indexed: 01/29/2023]
Abstract
PURPOSE To study whether the history of induced abortion has an effect on the assisted reproduction outcomes in patients undergoing in vitro fertilization-embryo transfer (IVF-ET). METHODS 3045 patients who underwent IVF-ET in the Department of Human Reproductive Center of Renmin Hospital from January 2017 to June 2021. They were divided into two groups according to whether there was a history of induced abortion in the past, and the outcomes were compared between the two groups. RESULTS The clinical pregnancy rate in the group with induced abortion history was lower than that in the group without induced abortion history (63.1% vs 67.1%), but the difference was not statistically significant (P = 0.059). The spontaneous abortion rate in the group with induced abortion history was higher than that in the group without induced abortion history (14.9% vs 11.2%) (P = 0.044). The live birth rate in the group with induced abortion history was lower than that in the group without induced abortion history (52.8% vs 59.0%) (P = 0.006). Stepwise logistic regression analysis showed that endometrial thickness (OR = 0.928, 95% CI = 0.886 ~ 0.972, P = 0.002) and live birth rate (OR = 0.682, 95% CI = 0.495 ~ 0.939, P = 0.019) were negatively correlated with induced abortion history. The rate of spontaneous abortion (OR = 1.452, 95% CI = 1.042 ~ 2.024, P = 0.028) was positively correlated with the history of induced abortion. CONCLUSIONS The previous history of induced abortion is related to the outcomes of IVF /ICSI-ET, the endometrial thickness on HCG trigger day decreased, the risk of spontaneous abortion increased and the live birth rate decreased in patients with induced abortion history when undergoing IVF/ICSI-ET.
Collapse
Affiliation(s)
- Shaoyuan Xu
- Department of Human Reproductive Center, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
- Hubei Clinical Research Center for Reproductive Medicine, Shiyan, Hubei, China
| | - Wenxian Zhao
- Department of Human Reproductive Center, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
- Hubei Clinical Research Center for Reproductive Medicine, Shiyan, Hubei, China
| | - Ying Zhang
- Department of Human Reproductive Center, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
- Hubei Clinical Research Center for Reproductive Medicine, Shiyan, Hubei, China
| | - Cancan Qiang
- Department of Cardiology, Renmin Hospital, Hubei University of Medicine, Shiyan, China.
| | - Changjun Zhang
- Department of Human Reproductive Center, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
- Hubei Clinical Research Center for Reproductive Medicine, Shiyan, Hubei, China
| |
Collapse
|
175
|
Qu H, Lv H, Kang Y, Yan L, Du Y. Reproductive outcomes of single frozen-thawed embryo transfer in patients with endometriosis after preimplantation genetic testing. J Assist Reprod Genet 2024; 41:429-435. [PMID: 38079077 PMCID: PMC10894775 DOI: 10.1007/s10815-023-02996-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/21/2023] [Indexed: 02/27/2024] Open
Abstract
PURPOSE The reproductive outcomes of patients with endometriosis who are infertile have attracted recent attention. We aimed to explore whether endometriosis affects endometrial receptivity by observing pregnancy outcomes following a euploid blastocyst frozen embryo transfer. METHODS This retrospective cohort study analyzed the data of patients with endometriosis from the reproductive hospital affiliated to Shandong University between January 2015 and December 2021. Control groups were matched using the 1:3 propensity score. The live birth, clinical pregnancy, biochemical pregnancy, clinical abortion, premature birth, and aneuploid rates were compared between the control group and endometriosis group. RESULTS A total of 625 patients who underwent preimplantation genetic testing (PGT) prior to embryo implantation were included in the analysis. There were no significant differences in the live birth, clinical pregnancy, biochemical pregnancy, clinical abortion, and premature birth rates between the two groups. The aneuploidy rate of blastocysts obtained from the endometriosis group was higher than that of the control group (P = 0.012). CONCLUSION Pregnancy outcomes using frozen embryos after PGT in patients with endometriosis did not differ from those in other women experiencing infertility. However, endometriosis may affect the quality of oocytes, resulting in a higher rate of aneuploidy.
Collapse
Affiliation(s)
- Huiling Qu
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China
- Center for Reproductive Medicine, The Reproductive Hospital Affiliated to Shandong University, Jinan, 250012, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Hong Lv
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China
- Center for Reproductive Medicine, The Reproductive Hospital Affiliated to Shandong University, Jinan, 250012, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Yan Kang
- Department of Obstetrics, Maternal Child Health Hospital of Shandong Province, Jinan, 250014, China
| | - Lei Yan
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China.
- Center for Reproductive Medicine, The Reproductive Hospital Affiliated to Shandong University, Jinan, 250012, Shandong, China.
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China.
- Medical Integration and Practice Center, Shandong University, Jinan, China.
| | - Yanbo Du
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China.
- Center for Reproductive Medicine, The Reproductive Hospital Affiliated to Shandong University, Jinan, 250012, Shandong, China.
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China.
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China.
| |
Collapse
|
176
|
Zhang Y, Wang H, Zhang X, Hao Y, Yang J, Li Y, Feng T, Chen Y, Qian Y. The effects of flexible short protocol with gonadotropin-releasing hormone antagonist on preventing premature ovulation in poor responders. Arch Gynecol Obstet 2024; 309:689-697. [PMID: 38051371 PMCID: PMC10808440 DOI: 10.1007/s00404-023-07287-z] [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] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/31/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE The proportion of patients with poor ovarian response (POR) is increasing, but effective treatment remains a challenge. To control the hidden peaks of luteinizing hormone (LH) and premature ovulation for poor responders, this study investigated the efficacy of flexible short protocol (FSP) with gonadotropin-releasing hormone antagonist (GnRH-ant) on trigger day. METHODS The 662 cycles of POR patients were retrospectively analyzed. The cohort was divided into control and intervention groups. The intervention group (group A) with 169 cycles received a GnRH-ant given on trigger day. The control (group B) with 493 cycles received only FSP. The clinical outcomes of the two groups were compared. RESULTS Compared with group B, with gonadotropin-releasing hormone antagonist (GnRH-ant) on trigger day in group A the incidences of spontaneous premature ovulation decreased significantly (2.37% vs. 8.72%, P < 0.05). The number of fresh embryo-transfer cycles was 45 in group A and 117 in group B. There were no significant differences in clinical outcomes, including implantation rate, clinical pregnancy rate, live birth rate and the cumulative live birth rate (12.0% vs. 9.34%; 22.22% vs. 21.93%; 17.78% vs. 14.91%; 20.51% vs. 20%, respectively; P > 0.05) between the two group. CONCLUSION FSP with GnRH-ant addition on trigger day had no effect on clinical outcomes, but could effectively inhibit the hidden peaks of luteinizing hormone (LH) and spontaneous premature ovulation in POR. Therefore, it is an advantageous option for POR women.
Collapse
Affiliation(s)
- Yan Zhang
- Reproductive Center, Second Affiliated Hospital, Nanjing Medical University, Nanjing, 210011, China
| | - Hongyou Wang
- Department of Obstetrics and Gynecology, Binhai County People's Hospital, Yancheng, 224000, China
| | - Xinyue Zhang
- Reproductive Center, Second Affiliated Hospital, Nanjing Medical University, Nanjing, 210011, China
| | - Yingying Hao
- Reproductive Center, Second Affiliated Hospital, Nanjing Medical University, Nanjing, 210011, China
| | - Jihong Yang
- Reproductive Center, Second Affiliated Hospital, Nanjing Medical University, Nanjing, 210011, China
| | - Yangbai Li
- Reproductive Center, Second Affiliated Hospital, Nanjing Medical University, Nanjing, 210011, China
| | - Ting Feng
- Reproductive Center, Second Affiliated Hospital, Nanjing Medical University, Nanjing, 210011, China
| | - Yandong Chen
- Reproductive Center, Second Affiliated Hospital, Nanjing Medical University, Nanjing, 210011, China
| | - Yun Qian
- Reproductive Center, Second Affiliated Hospital, Nanjing Medical University, Nanjing, 210011, China.
| |
Collapse
|
177
|
Park W, Kim M, Kim HS, Song G, Park SJ, Lim W, Park S. Alteration in Effects of Endometriosis on Fecundity According to Pregnancy Experience in Mouse Model. Reprod Sci 2024; 31:404-412. [PMID: 38180609 DOI: 10.1007/s43032-023-01426-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/08/2023] [Indexed: 01/06/2024]
Abstract
This study is aimed at identifying variations in the effect of endometriosis on fecundity in a mouse model based on prior pregnancy experience. Endometriosis is one of the most prevalent gynecological diseases and is known to impact female fecundity adversely. In this study, an endometriosis mouse model was established by allografting uterine horn tissue using Pelch's method. The effect of endometriosis on fecundity was confirmed in primiparous and multiparous female mice. As fecundity indicators, the pregnancy rate, number of litters, pregnancy period, and survival rate of the pups were investigated. As a result of the experiment, the pregnancy rate decreased, and the pregnancy period tended to be shorter in primiparous female mice. However, there was no significant change in the multiparous mice. In addition, it has been established that correlations exist between the size of lesions and certain fecundity indicators of the lesion, even among primiparous and multiparous females with endometriosis. The study attempted to demonstrate a link between pregnancy experience and fecundity changes caused by endometriosis by experimentally reproducing clinical results using mouse models. These results suggest strategies for identifying several pathophysiological characteristics of endometriosis.
Collapse
Affiliation(s)
- Wonhyoung Park
- Institute of Animal Molecular Biotechnology and Department of Biotechnology, College of Life Sciences and Biotechnology, Korea University, Seoul, 02841, Republic of Korea
| | - Miji Kim
- Institute of Animal Molecular Biotechnology and Department of Biotechnology, College of Life Sciences and Biotechnology, Korea University, Seoul, 02841, Republic of Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, 03080, Republic of Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Gwonhwa Song
- Institute of Animal Molecular Biotechnology and Department of Biotechnology, College of Life Sciences and Biotechnology, Korea University, Seoul, 02841, Republic of Korea
| | - Soo Jin Park
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, 03080, Republic of Korea.
| | - Whasun Lim
- Department of Biological Sciences, College of Science, Sungkyunkwan University, Suwon, 16419, Republic of Korea.
| | - Sunwoo Park
- Department of Plant & Biomaterials Science, Gyeongsang National University, Jinju, 52725, Republic of Korea.
- Department of GreenBio Science, Gyeongsang National University, Jinju, 52725, Republic of Korea.
| |
Collapse
|
178
|
Yabuki A, Muraoka A, Tamauchi S, Seki T, Takeda T, Sonehara R, Miyake N, Nakamura T, Osuka S, Kajiyama H. The influence of radical trachelectomy on endometrial thickness in in vitro fertilization-embryo transfer. J Obstet Gynaecol Res 2024; 50:218-224. [PMID: 37994299 DOI: 10.1111/jog.15841] [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] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/10/2023] [Indexed: 11/24/2023]
Abstract
AIM Both morbidity and mortality rates of cervical cancer are increasing, especially in reproductive-aged women. Radical trachelectomy (RT) is an effective fertility-preserving surgery for early-stage cervical cancer. This study aimed to determine the influence of RT on endometrial thickness during in vitro fertilization-embryo transfer (IVF-ET). METHODS Forty-four patients had undergone RT, and 23 women undergoing IVF-ET treatment (105 ET cycles) were included. Endometrial thickness during hormone replacement therapy (HRT) was retrospectively evaluated and compared between patients with and without RT. RESULTS Eleven patients (50 ET cycles) in the RT group and 12 (52 ET cycles) in the control group were investigated. Compared with the control group, higher ET cancellation rates were observed in patients in the RT group (1 of 52 cycles [control group] vs. 8 of 50 cycles [RT group], p < 0.01). Endometrial thinning was not affected by patient age at first IVF-ET treatment, history of artificial abortion, preservation of uterine arteries during RT, or postoperative chemotherapy (p = 0.27, 1, 1, and 1, respectively). CONCLUSIONS Our data revealed that RT influenced endometrial thickness in IVF-ET. This was not affected by the background of the patients or perioperative management in this study. We could not reveal the underlying mechanism, but it is postulated that the transient postoperative uterine blood flow status and postoperative infections may have some effect on the endometrium. To resolve these issues, accumulation of evidences are required. We recommend informing patients about the impact of RT on IVF-ET before starting assisted reproductive technology (ART).
Collapse
Affiliation(s)
- Atsushi Yabuki
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ayako Muraoka
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Tamauchi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomomi Seki
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takehiko Takeda
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Reina Sonehara
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Natsuki Miyake
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoko Nakamura
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoko Osuka
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
179
|
He T, Xue X, Shi J. Effect of re-cryopreservation on pregnancy and neonatal outcomes: Analysis using propensity score matching. Int J Gynaecol Obstet 2024; 164:684-692. [PMID: 37574836 DOI: 10.1002/ijgo.15023] [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] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 06/30/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To comprehensively assess the effect of re-cryopreservation procedure on pregnancy and neonatal outcomes by using propensity matching (PSM) analysis. METHODS The patients were divided into two groups according to the times of embryo cryopreservation: the cryopreservation group (n = 8034) and the re-cryopreservation group (n = 66). To optimize the precision of the present study, we used PSM to adjust the different baseline characteristics between the two groups, including maternal age, the number of good-quality embryos transferred and endometrial preparation protocols. The primary outcome was live-birth rate. The secondary outcomes were biochemical pregnancy rate, clinical pregnancy rate, and miscarriage rate. RESULTS We found that the rates of biochemical pregnancy and clinical pregnancy were comparable between the two groups, whereas miscarriage rate was increased, resulting in significantly reduced live-birth rate in the re-cryopreservation group. No differences were observed in terms of neonatal outcomes, including cesarean section, birth weight, and malformation as well as pregnancy complications. Moreover, multivariable analysis demonstrated that re-cryopreservation was an independent risk factor for live-birth rate. CONCLUSION The present study demonstrated the adverse effect of re-cryopreservation on pregnancy outcomes, providing valuable information for clinical decision making and patient counseling.
Collapse
Affiliation(s)
- Tingting He
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Xia Xue
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Juanzi Shi
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| |
Collapse
|
180
|
Fawzy M. Regarding "A Controversial Old Topic Revisited: Should Diagnostic Hysteroscopy Be Routinely Performed Prior to the First IVF Cycle? A Systematic Review and Updated Meta-analysis". J Minim Invasive Gynecol 2024; 31:166-167. [PMID: 37951566 DOI: 10.1016/j.jmig.2023.07.017] [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] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/08/2023] [Indexed: 11/14/2023]
|
181
|
Khairy M, Harb H, Eapen A, Melo P, Kazem R, Rajkhowa M, Ndukuwe G, Coomarasamy A. The use of immunomodulation therapy in women with recurrent implantation failure undergoing assisted conception: A multicentre cohort study. Am J Reprod Immunol 2024; 91:e13819. [PMID: 38348954 DOI: 10.1111/aji.13819] [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] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 01/11/2024] [Accepted: 01/26/2024] [Indexed: 02/15/2024] Open
Abstract
PROBLEM Recurrent implantation failure (RIF) after multiple embryo transfers remains a vexing problem and immunomodulators have been used with conflicting results. This study aims to assess the effect of immunomodulation therapy on live birth rate (LBR) in women with RIF undergoing assisted reproduction treatment (ART). METHOD OF STUDY DESIGN This is a retrospective cohort study in multicentre network of private assisted conception units in the UK. The study included women who had at least two failed attempts of embryo transfers at CARE fertility network in the period from 1997 to 2018. Women in the treatment group had immunomodulator drugs in the form of corticosteroids, low molecular weight heparin (LMWH), and intravenous intralipid (IVIL) infusions, either separately or in combination, after immunological testing, in addition to standard ART whilst women in the control group had only ART without immunomodulators. The primary outcome was LBR per cycle. Secondary outcomes included the rates of clinical pregnancy (CPR), cumulative live birth (CLBR), and miscarriage. RESULTS A total of 27 163 ART cycles fulfilled the inclusion criteria, of which 5083 had immunomodulation treatment in addition to standard ART treatment, and 22 080 had standard ART treatment alone. Women in the treatment group were significantly older (mean age 38.5 vs. 37.1 years, p < .001), and had a higher number of previous failed ART cycles (mean 4.3 vs. 3.8, p < .01). There was a higher LBR in women who received immunomodulation therapy when compared with the control group (20.9% vs. 15.8%, odds ratio [OR] 1.4, 95% confidence interval [CI] 1.29-1.53, p < .001). Multivariate regression analysis showed that immunomodulation treatment was a significant independent predictor of live birth after adjusting for other confounders (adjusted OR [aOR] 1.33, 95% CI 1.15-1.54, p < .001). Survival analysis showed a higher CLBR in the treatment group (adjusted hazard ratio [aHR] 1.78, 95% CI 1.62-1.94, p < .001). CONCLUSION(S) This study provides evidence of a potential beneficial effect of immunomodulation therapy in women with RIF after immunological testing. There remains a need for high quality, adequately powered multicentre RCTs to robustly address the role of immunomodulation in women with RIF. There is also an urgent need for standardised screening tests for immune disorders that could preclude implantation.
Collapse
Affiliation(s)
| | - Hoda Harb
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, Edgbaston, UK
| | - Abey Eapen
- Department of Obstetrics and Gynaecology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Pedro Melo
- CARE Fertility Birmingham, Birmingham, Edgbaston, UK
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, Edgbaston, UK
| | | | | | | | - Arri Coomarasamy
- CARE Fertility Birmingham, Birmingham, Edgbaston, UK
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, Edgbaston, UK
| |
Collapse
|
182
|
Peterson A, Wu H, Kappy M, Kucherov A, Singh M, Lieman H, Jindal S. Higher live birth rates are associated with a normal body mass index in preimplantation genetic testing for aneuploidy frozen embryo transfer cycles: a Society for Assisted Reproductive Technology Clinic Outcome Reporting System study. Fertil Steril 2024; 121:291-298. [PMID: 37952915 DOI: 10.1016/j.fertnstert.2023.11.005] [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] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE To determine whether body mass index (BMI) was associated with live birth in patients undergoing transfer of frozen-thawed preimplantation genetic testing for aneuploidy (PGT-A) embryos. DESIGN Retrospective cohort study of cycles reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System. SUBJECTS All autologous and donor recipient PGT-A-tested cycles reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System from 2014 to 2017. INTERVENTION(S) Body mass index. MAIN OUTCOME MEASURE(S) The primary outcome measure was the live birth rate, and the secondary outcome measures were the clinical pregnancy and biochemical pregnancy rates. Multivariable generalized additive mixed models and log-binomial models were used to model the relationship between BMI and outcome measures. RESULT(S) A total of 77,018 PGT-A cycles from 55,888 patients were analyzed. Of these cycles, 70,752 were autologous, and 6,266 were donor recipient. In autologous cycles, a statistically significant and clear nonlinear relationship was observed between the BMI and live birth rates, with the highest birth rates observed for the BMI range of 23-24.99 kg/m2. When using 23-24.99 kg/m2 as the referent, other BMI ranges demonstrated a lower probability of live birth and clinical pregnancy that continued to decrease as the BMI moved further from the reference value. Patients with a BMI of <18.5 kg/m2 had a 11% lower probability of live birth, whereas those with a BMI of ≥40 kg/m2 had a 27% lower probability than the referent. CONCLUSION(S) A normal-weight BMI range of 23-24.99 kg/m2 was associated with the highest probability of clinical pregnancy and live birth after a frozen-thawed PGT-A-tested blastocyst transfer in both autologous and donor recipient cycles. A BMI outside the range of 23-24.99 kg/m2 is likely associated with a malfunction in the implantation process, which is presumed to be related to a uterine factor and not an oocyte factor, as both autologous and donor recipient cycle outcomes were associated similarly with the BMI of the intended parent.
Collapse
Affiliation(s)
- Andrea Peterson
- Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore's Institute for Reproductive Medicine and Health, Hartsdale, New York.
| | - Haotian Wu
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University Medical Center, New York, New York
| | - Michelle Kappy
- Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | | | - Manvinder Singh
- Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore's Institute for Reproductive Medicine and Health, Hartsdale, New York
| | - Harry Lieman
- Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore's Institute for Reproductive Medicine and Health, Hartsdale, New York
| | - Sangita Jindal
- Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore's Institute for Reproductive Medicine and Health, Hartsdale, New York
| |
Collapse
|
183
|
Kovacs P, Sun S, Lu Y, Romanski P, Lindheim SR. Benefits of Blastocyst Transfer With at Least Three Good-Quality Cleavage-stage Embryos in Women of Advanced Maternal Age: A Retrospective Analysis. J Obstet Gynaecol Can 2024; 46:102233. [PMID: 37820927 DOI: 10.1016/j.jogc.2023.102233] [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] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/14/2023] [Accepted: 09/14/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES Limited studies on the benefits of blastocyst transfer in advanced maternal age (AMA) (≥40 years) have been reported. Our objective was to find whether blastocyst-stage embryo transfer improves pregnancy and live birth rates in women ≥40 years who have 3 or more good-quality cleavage-stage embryos. METHODS All fresh in vitro fertilization-intracytoplasmic sperm injection cycles performed from January 2020 to December 2021 in AMA women that progressed to transfer were considered for analysis. We compared fresh and cumulative ongoing pregnancy rates in AMA women of those who had a cleavage-stage transfer, while meeting the criteria for extended culture (≥3 high-quality embryos, group 1), and those who underwent blastocyst transfer (group 2). Demographic parameters, stimulation, embryology, fresh and cumulative ongoing pregnancy rates, and clinical miscarriage rates were compared. RESULTS During the study period, 255 cycles were analyzed including group 1 (n = 99) and group 2 (n = 156). Group 1 participants were older and had a greater number of embryos for transfer. Fresh and cumulative ongoing pregnancy rates per transfer were higher in group 2 compared to group 1 (23.4% vs. 13.1%, P = 0.04; 25.5% vs. 14.1%, P = 0.03), while overall miscarriage rates were higher in group 1 than group 2 (51.7% vs. 25%, P = 0.01). CONCLUSIONS Blastocyst culture provides a benefit to AMA women who have at least 3 good-quality embryos on day 3 resulting in significantly higher fresh and cumulative ongoing pregnancy rates and lower miscarriage compared to cleavage-stage transfers.
Collapse
Affiliation(s)
| | - Samantha Sun
- University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Yao Lu
- Center for Reproductive Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | | | - Steven R Lindheim
- University of Central Florida College of Medicine, Orlando, Florida, USA; Center for Reproductive Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China; Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, Dayton, Ohio, USA
| |
Collapse
|
184
|
van den Tweel MM, van den Munckhof EHA, van der Zanden M, Molijn AC, van Lith JMM, Le Cessie S, Boers KE. Bacterial vaginosis in a subfertile population undergoing fertility treatments: a prospective cohort study. J Assist Reprod Genet 2024; 41:441-450. [PMID: 38087161 PMCID: PMC10894785 DOI: 10.1007/s10815-023-03000-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/10/2023] [Accepted: 11/28/2023] [Indexed: 02/27/2024] Open
Abstract
PURPOSE This study investigates the role of bacterial vaginosis (BV) on pregnancy rates during various fertility treatments. BV is known to influence several obstetric outcomes, such as preterm delivery and endometritis. Only few studies investigated the effect of BV in subfertile women, and studies found a negative effect on fecundity especially in the in vitro fertilisation population. METHODS Observational prospective study, 76 couples attending a fertility clinic in the Netherlands between July 2019 and June 2022, undergoing a total of 133 attempts of intra uterine insemination, in vitro fertilization or intra cytoplasmatic sperm injection. Vaginal samples taken at oocyte retrieval or insemination were analysed on qPCR BV and 16S rRNA gene microbiota analysis of V1-V2 region. Logistic regression with a Generalized Estimated Equations analysis was used to account for multiple observations per couples. RESULTS A total of 26% of the 133 samples tested positive for BV. No significant differences were observed in ongoing pregnancy or live birth rates based on BV status (OR 0.50 (0.16-1.59), aOR 0.32 (0.09-1.23)) or microbiome community state type. There was a tendency of more miscarriages based on positive BV status (OR 4.22 (1.10-16.21), aOR 4.28 (0.65-28.11)) or community state type group III and IV. On baseline qPCR positive participants had significantly higher body mass index and smoked more often. Odds ratios were adjusted for smoking status, body mass index, and socioeconomic status. CONCLUSION Bacterial vaginosis does not significantly impact ongoing pregnancy rates but could affect miscarriage rates.
Collapse
Affiliation(s)
- Marjolein M van den Tweel
- Department of Obstetrics and Gynecology, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
- Department of Obstetrics and Gynecology, Haaglanden Medical Center, Bronovolaan 5, 2597AX, The Hague, The Netherlands
| | | | - Moniek van der Zanden
- Department of Obstetrics and Gynecology, Haaglanden Medical Center, Bronovolaan 5, 2597AX, The Hague, The Netherlands
| | - Anco C Molijn
- Eurofins NMDL-LCPL, 2288ER, Rijswijk, The Netherlands
| | - Jan M M van Lith
- Department of Obstetrics and Gynecology, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
| | - Saskia Le Cessie
- Department of Biomedical Data Sciences, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
| | - Kim E Boers
- Department of Obstetrics and Gynecology, Haaglanden Medical Center, Bronovolaan 5, 2597AX, The Hague, The Netherlands.
| |
Collapse
|
185
|
Aksakalli T, Utlu A, Demirdogen SO, Cinislioglu AE, Karabulut I. Effects of smoking on varicocelectomy outcomes: a retrospective cohort study. Int Urol Nephrol 2024; 56:415-421. [PMID: 37812377 DOI: 10.1007/s11255-023-03816-6] [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] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 09/16/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE To evaluate the effects of smoking on semen parameters and spontaneous pregnancy development by comparing smoker and non-smoker varicocelectomy patients. METHODS This study included 63 male patients with primary infertility for at least one year, and underwent microscopic subinguinal varicocelectomy at the Erzurum City Hospital urology clinic between 2020 and 2023. Patient files were retrospectively evaluated, and 27 patients were assigned to smoker group, whereas 36 patients were assigned to non-smoker group. Demographic data, semen parameters, spontaneous pregnancy development and timing were compared between two groups. RESULTS No statistically significant differences were observed in age, partner's age, BMI, clinical presentation, varicocele grade, side of varicocele, testicular volume, or testicular vein diameters (p > 0.05). The mean age of the study group was determined to be 30.7 ± 4.9 years. In the non-smoker group, 27 patients (75%) had only subfertility complaints, while 9 patients (25%) also experienced scrotal pain. Progressive motility was significantly higher in the non-smoker group at the 3rd month (28.11 ± 5.78 vs. 24.51 ± 4.24, p < 0.05) and 6th month (29.61 ± 5.16 vs. 26.22 ± 4.14, p < 0.05) evaluations. When comparing the rates of pregnancy development, the non-smoker group was determined to have a higher rate (53%), but this comparison was not statistically significant. (p < 0.05) Regarding the timing of pregnancy, the non-smoker group was associated with earlier spontaneous pregnancy. (5.84 ± 2.26 vs. 9.20 ± 2.30, p < 0.05). CONCLUSION Smoking negatively affects the outcomes of varicocelectomy in terms of semen parameters, spontaneous pregnancy development and timing. Prospective, randomized, and larger sample-sized studies are required on this subject. TRIAL REGISTRATION This study was approved by the Ataturk University Local Ethics Committee (approval number: B.30.2.ATA.0.01.00/234).
Collapse
Affiliation(s)
- Tugay Aksakalli
- Department of Urology, University of Health Sciences, Erzurum Regional Training and Research Hospital, Erzurum, Turkey.
| | - Adem Utlu
- Department of Urology, University of Health Sciences, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | | | - Ahmet Emre Cinislioglu
- Department of Urology, University of Health Sciences, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Ibrahim Karabulut
- Department of Urology, University of Health Sciences, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| |
Collapse
|
186
|
Vitagliano A, Cicinelli E, Viganò P, Sorgente G, Nicolì P, Busnelli A, Dellino M, Damiani GR, Gerli S, Favilli A. Isthmocele, not cesarean section per se, reduces in vitro fertilization success: a systematic review and meta-analysis of over 10,000 embryo transfer cycles. Fertil Steril 2024; 121:299-313. [PMID: 37952914 DOI: 10.1016/j.fertnstert.2023.11.007] [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] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/14/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
IMPORTANCE Previous reviews have shown that a history of cesarean section (CS) is associated with a worse in vitro fertilization (IVF) prognosis. To date, whether the decline in the IVF chances of success should be attributed to the CS procedure itself or to the presence of isthmocele remains to be clarified. OBJECTIVE To summarize the available evidence regarding the impact of isthmocele on IVF outcomes. DATA SOURCES Electronic databases and clinical registers were searched until May 30, 2023. STUDY SELECTION AND SYNTHESIS Observational studies were included if they assessed the effect of isthmocele on IVF outcomes. Comparators were women with isthmocele and women without isthmocele with a previous CS or vaginal delivery. Study quality was assessed using the modified Newcastle-Ottawa Scale. MAIN OUTCOMES The primary outcome was the live birth rate (LBR). The effect measures were expressed as adjusted odds ratios (aORs) and unadjusted odds ratios (uORs) with 95% confidence intervals (95% CIs). The body of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation working group methodology. RESULTS Eight studies (n = 10,873 patients) were included in the analysis. Women with isthmocele showed a lower LBR than both women with a previous CS without isthmocele (aOR, 0.62; 95% CI, 0.53-0.72) and those with a history of vaginal delivery (aOR, 0.55; 95% CI, 0.42-0.71). The LBRs in women with a previous CS without isthmocele and those with a history of vaginal delivery were similar (aOR, 0.74; 95% CI, 0.47-1.15). Subgroup analysis suggested a negative effect of the intracavitary fluid (ICF) in women with isthmocele on the LBR (uOR, 0.36; 95% CI, 0.18-0.75), whereas the LBRs in women without ICF and those without isthmocele were similar (uOR, 0.94; 95% CI, 0.61-1.45). CONCLUSION AND RELEVANCE We found moderate quality of evidence (Grading of Recommendations Assessment, Development and Evaluation grade 3/4) supporting a negative impact of isthmocele, but not of CS per se, on the LBR in women undergoing IVF. The adverse effect of isthmocele on IVF outcomes appears to be worsened by ICF accumulation before embryo transfer. CLINICAL TRIAL REGISTRATION NUMBER CRD42023418266.
Collapse
Affiliation(s)
- Amerigo Vitagliano
- 1(st) Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari, Bari, Italy
| | - Ettore Cicinelli
- 1(st) Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari, Bari, Italy
| | - Paola Viganò
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Giuseppe Sorgente
- 1(st) Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari, Bari, Italy
| | - Pierpaolo Nicolì
- 1(st) Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari, Bari, Italy
| | - Andrea Busnelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Miriam Dellino
- 1(st) Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari, Bari, Italy
| | - Gianluca Raffaello Damiani
- 1(st) Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari, Bari, Italy
| | - Sandro Gerli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Alessandro Favilli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
| |
Collapse
|
187
|
Rydze RT, Wang S, Schoyer KD. Endometrial thickness and hypertensive disorders of pregnancy: delving into the thick of things. Fertil Steril 2024; 121:261. [PMID: 38101560 DOI: 10.1016/j.fertnstert.2023.12.011] [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] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023]
Affiliation(s)
- Robert T Rydze
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Shunping Wang
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kate D Schoyer
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
| |
Collapse
|
188
|
Haziza R, Margueritte F, Labaye S, Fauconnier A, Bailleul A. [Role of endometrial thickness in managing pregnancy unknow location]. Gynecol Obstet Fertil Senol 2024; 52:114-115. [PMID: 38145742 DOI: 10.1016/j.gofs.2023.12.006] [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] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 12/27/2023]
Affiliation(s)
- Roxane Haziza
- Service de Gynécologie-Obstétrique, Centre hospitalier de Poissy Saint-Germain-en-Laye, 78300 Poissy, France
| | - François Margueritte
- Service de Gynécologie-Obstétrique, Centre hospitalier de Poissy Saint-Germain-en-Laye, 78300 Poissy, France; Équipe RISCQ « Risques cliniques et sécurité en santé des femmes et en santé périnatale », université Paris-Saclay, UVSQ, 78180 Montigny-le-Bretonneux, France
| | - Solene Labaye
- Service de Gynécologie-Obstétrique, Centre hospitalier de Poissy Saint-Germain-en-Laye, 78300 Poissy, France
| | - Arnaud Fauconnier
- Service de Gynécologie-Obstétrique, Centre hospitalier de Poissy Saint-Germain-en-Laye, 78300 Poissy, France; Équipe RISCQ « Risques cliniques et sécurité en santé des femmes et en santé périnatale », université Paris-Saclay, UVSQ, 78180 Montigny-le-Bretonneux, France
| | - Alexandre Bailleul
- Service de Gynécologie-Obstétrique, Centre hospitalier de Poissy Saint-Germain-en-Laye, 78300 Poissy, France; Équipe RISCQ « Risques cliniques et sécurité en santé des femmes et en santé périnatale », université Paris-Saclay, UVSQ, 78180 Montigny-le-Bretonneux, France.
| |
Collapse
|
189
|
Wei Y, Luan T, Shen J, Zhang J, Zhang J, Su Y, Ling X, Li X, Zhao C. LH on GnRH-ant day to basal LH affects the IVF/ICSI outcome of PCOS women undergoing GnRH-antagonist protocol. Int J Gynaecol Obstet 2024; 164:624-632. [PMID: 37724009 DOI: 10.1002/ijgo.15131] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the influence of ratio of serum luteinizing hormone (LH) on gonadotropin-releasing hormone antagonist (GnRH-ant) day to basal LH (hLH/bLH) on in-vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) outcome in polycystic ovary syndrome (PCOS) women who received GnRH-ant protocol for controlled ovarian hyperstimulation (COH). METHODS This retrospective study was conducted in women with PCOS (n = 1116) who underwent the GnRH-ant protocol for COH between 2015 and 2022 and were stratified as group A (hLH/bLH < 1, n = 489) and group B (hLH/bLH ≥ 1, n = 627) according to the variation of serum LH. The outcomes of COH and the first frozen embryo transfer (FET) cycle were compared between group A, B and the linear relationship between hLH/bLH ratio and IVF/ICSI outcomes were studied by multivariate linear regression analysis and restricted cubic spline (RCS) models. RESULTS There were significant differences in baseline characteristics and outcomes between group A and B. Group A had higher levels of bLH, AMH, estradiol (E2) on GnRH-ant start day and lower levels of LH on GnRH-ant start day. Group B has better ovulation induction outcomes: more retrieved oocytes, normally fertilized oocytes (2PN), cleavage embryos, available embryos and high-quality blastocysts. Multivariate linear regression analysis found no statistically significant connection between hLH/bLH and clinical outcomes. RCS models showed hLH/bLH had nonlinear association with outcomes, including number of oocytes retrieved, 2PN, available embryos, incidence of OHSS, chemical pregnancy, clinical pregnancy, abortion and live birth. CONCLUSIONS hLH/bLH ratio could be a more forward-looking indicator of clinical outcome in women with PCOS undergoing GnRH-ant protocols than LH on trigger day and the ratio of LH level on trigger day to basal LH. hLH/bLH = 1 may be the best condition for higher live birth rate and lower OHSS rate.
Collapse
Affiliation(s)
- Yi Wei
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Ting Luan
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Jingjing Shen
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Juanjuan Zhang
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Juan Zhang
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Yan Su
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Xiufeng Ling
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Xin Li
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Chun Zhao
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| |
Collapse
|
190
|
Bosch E, Alamá P, Romero JL, Marí M, Labarta E, Pellicer A. Serum progesterone is lower in ovarian stimulation with highly purified HMG compared to recombinant FSH owing to a different regulation of follicular steroidogenesis: a randomized controlled trial. Hum Reprod 2024; 39:393-402. [PMID: 38037188 DOI: 10.1093/humrep/dead251] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
STUDY QUESTION Does ovarian stimulation with highly purified (hp)-HMG protect from elevated progesterone in the follicular phase compared to recombinant FSH (r-FSH) cycles through a different regulation of follicular steroidogenesis? SUMMARY ANSWER hp-HMG enhanced the Δ4 pathway from pregnenolone to androstenodione leading to lower serum progesterone at the end of the cycle, while r-FSH promoted the conversion of pregnenolone to progesterone causing higher follicular phase progesterone levels. WHAT IS KNOWN ALREADY Elevated progesterone in the follicular phase has been related to lower clinical outcome in fresh IVF cycles. Progesterone levels are positively correlated to ovarian response, and some studies have shown that when r-FSH alone is used for ovarian stimulation serum progesterone levels on the day of triggering are higher than when hp-HMG is given. Whether this is caused by a lower ovarian response in hp-HMG cycles or to a difference in follicular steroidogenesis in the two ovarian stimulation regimens has not been well characterized. STUDY DESIGN, SIZE, DURATION A randomized controlled trial including 112 oocyte donors undergoing ovarian stimulation with GnRH antagonists and 225 IU/day of r-FSH (n = 56) or hp-HMG (n = 56) was carried out in a university-affiliated private infertility clinic. Subjects were recruited between October 2016 and June 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS The women were aged 18-35 years with a regular menstrual cycle (25-35 days) and normal ovarian reserve (serum anti-Müllerian hormone (AMH) = 10-30 pMol/l) undergoing ovarian stimulation for oocyte donation. FSH, LH, estradiol (E2), estrone, progesterone, pregnenolone, 17-OH-progesterone, androstenodione, dehidroepiandrostenodione, and testosterone were determined on stimulation Days 1, 4, 6, and 8 and on day of triggering in serum and in follicular fluid. Samples were frozen at -20°C until assay. Total exposures across the follicular phase were compared by polynomic extrapolation. MAIN RESULTS AND THE ROLE OF CHANCE Subjects in both groups were comparable in terms of age, BMI, and AMH levels. Ovarian response was also similar: 17.5 ± 7.9 (mean ± SD) versus 16.5 ± 7.5 oocytes with r-FSH and hp-HMG, respectively (P = 0.49). Serum progesterone (ng/ml) on day of trigger was 0.46 ± 0.27 in the hp-HMG group versus 0.68 ± 0.50 in the r-FSH group (P = 0.010). Differences for progesterone were also significant on stimulation days 6 and 8. The pregnenolone: progesterone ratio was significantly increased in the r-FSH group from stimulation day 8 to the day of trigger (P = 0.019). Serum androstenodione (ng/ml) on day of trigger was 3.0 ± 1.4 in the hp-HMG group versus 2.4 ± 1.1 in the r-FSH group (P = 0.015). Differences in adrostenodione were also significant on stimulation Day 8. The pregnenolone:androstenodione ratio was significantly higher in the hp-HMG group (P = 0.012) on Days 6 and 8 and trigger. There were no other significant differences between groups. Follicular fluid E2, FSH, LH, dehidroepioandrostenodione, androstenodione, and testosterone were significantly higher in the hp-HMG than r-FSH group. No differences were observed for progesterone, estrone, 17-OH-progesterone, and pregnenolone in follicular fluid. LIMITATIONS, REASONS FOR CAUTION All women included in the study were young, not infertile, and had a normal BMI and a good ovarian reserve. The findings might be different in other patient subpopulations. Hormone analyses with immunoassays are subject to intra-assay variations that may influence the results. WIDER IMPLICATIONS OF THE FINDINGS Stimulation with hp-HMG may prevent progesterone elevation at the end of the follicular phase because of a different follicular steroidogenesis pathway, regardless of ovarian response. This should be considered, particularly in patients at risk of having high progesterone levels at the end of the follicular phase when a fresh embryo transfer is planned. STUDY FUNDING/COMPETING INTEREST(S) Roche Diagnostics provided unrestricted funding for all serum and follicular fluid hormone determinations. J.L.R., M.M., and A.P. have nothing to declare. E.B. has received consulting fees from Ferring, Merck, Gedeon Richter, and Roche and has participated in a research cooperation with Gedeon-Richter. In addition, the author has participated in speakers' bureau and received fees from Ferring, Gedeon Richter, Merck, and Roche. P.A. has received consulting fees from MSD and has participated in speakers' bureau and received fees from Ferring. P.A. also declares travel/meeting support from MSD. E.L. has received consulting fees from Ferring and MSD. In addition, the author has participated in a research cooperation with Gedeon-Richter. Also, the author has participated in speakers' bureau and received fees from Ferring and IBSA, as well as travel/meeting support from IBSA and Gedeon Richter. E.B., P.A., and E.L. also own stocks in IVIRMA Valencia. TRIAL REGISTRATION NUMBER NCT: NCT02738580. TRIAL REGISTER DATE 19 February 2016. DATE OF FIRST PATIENT’S ENROLMENT 03 October 2016.
Collapse
Affiliation(s)
- Ernesto Bosch
- IVIRMA Global Research Alliance, IVIRMA Valencia, Valencia, Spain
- IVI Foundation, Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, Valencia, Spain
| | - Pilar Alamá
- IVIRMA Global Research Alliance, IVIRMA Valencia, Valencia, Spain
- IVI Foundation, Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, Valencia, Spain
| | | | - Marta Marí
- IVIRMA Global Research Alliance, IVIRMA Valencia, Valencia, Spain
| | - Elena Labarta
- IVIRMA Global Research Alliance, IVIRMA Valencia, Valencia, Spain
- IVI Foundation, Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, Valencia, Spain
| | - Antonio Pellicer
- IVI Foundation, Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, Valencia, Spain
- IVIRMA Global Research Alliance, IVIRMA Rome, Roma, Italy
| |
Collapse
|
191
|
Racca A, Bernabeu A, Bernabeu R, Ferrero S. Endometrial receptivity in women with endometriosis. Best Pract Res Clin Obstet Gynaecol 2024; 92:102438. [PMID: 38183768 DOI: 10.1016/j.bpobgyn.2023.102438] [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] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/21/2023] [Indexed: 01/08/2024]
Abstract
As endometriosis is recognized as a contributing factor to infertility, prompting couples to embark on Assisted Reproductive Technology (ART) treatments, it becomes crucial to comprehend the extent and way this condition can affect success rates. Natural conception data reveal lower success rates for women with endometriosis, yet the same cannot be extrapolated to the outcomes of in vitro fertilization (IVF). In recent years, advancements in the ART process, particularly the distinct stages of the IVF pathway and investigations into embryo quality have shown a comparable rate of embryonic quality and chromosomal normalcy (euploidy) between embryos obtained from individuals with or without endometriosis. Thus, the primary question that lingers relates to the functionality of the endometrium. This review addresses whether endometriosis can influence endometrial receptivity and implantation rates.
Collapse
Affiliation(s)
| | | | | | - Simone Ferrero
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; DINOGMI, University of Genova, Italy
| |
Collapse
|
192
|
Sarkar P, Zalles L, Caswell W, Stratton M, Devine K, Harris BS, Romanski PA. Optimal antimüllerian hormone levels in oocyte donors: a national database analysis. Fertil Steril 2024; 121:221-229. [PMID: 37949348 DOI: 10.1016/j.fertnstert.2023.11.003] [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] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To study the relationship between high antimüllerian hormone (AMH) levels in oocyte donors and embryo development and pregnancy outcomes among donor oocyte recipients. DESIGN Retrospective cohort study. SETTING Donor Egg Bank Database. PATIENTS Patients undergoing in vitro fertilization using vitrified donor oocytes from 35 in vitro fertilization centers in the United States between 2013 and 2021. For each recipient, the first oocyte lot that was received with a planned insemination and embryo transfer (ET) was included. INTERVENTION Oocyte donor-recipient cycles. MAIN OUTCOME MEASURES Ongoing pregnancy rate (OPR) per ET. RESULTS A total of 3,871 donor oocyte-recipient thaw cycles were analyzed. On the basis of donor AMH serum concentration, cycles were stratified into the high AMH group (AMH ≥5 ng/mL; n = 1,821) and the referent group (AMH <5 ng/mL; n = 2,050). Generalized estimating equation models were used to account for donors that contributed more than one lot of oocytes. The number of usable embryos per lot (median [interquartile range]) was significantly increased in the high AMH group (2 [2-4]) compared with the referent group (2 [1-3]) (relative risk [RR] 1.06; confidence interval [CI] 1.01-1.12). Among recipients with a planned ET, there was no difference in OPR between the high AMH group (45.4%) and the referent group (43.5%) (RR 1.04; 95% CI 0.94-1.15). Among preimplantation genetic testing for aneuploidy cycles, the embryo euploidy rate per biopsy was similar at 66.7% (50%-100%) in both groups (RR 1.04; CI 0.92-1.17). The OPR per euploid ET among patients who used preimplantation genetic testing for aneuploidy was also comparable, at 52% in the high AMH group and 54.1% in the referent group (RR 0.95; CI 0.74-1.23). CONCLUSION This large national database study observed that there was no association between a high level of AMH (≥5 ng/mL) in oocyte donors and an OPR in the recipient after the first ET. On the basis of these findings, recipients and physicians can be reassured that oocyte donors with a high AMH level can be expected to produce outcomes that are at least as good as donors with an AMH level (<5 ng/mL).
Collapse
Affiliation(s)
- Papri Sarkar
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, Florida.
| | - Laura Zalles
- Shady Grove Fertility Washington, Washington, District of Columbia
| | | | | | - Kate Devine
- Shady Grove Fertility Washington, Washington, District of Columbia
| | - Benjamin S Harris
- Shady Grove Fertility Richmond, Richmond, Virginia; Department of Obstetrics and Gynecology, Shady Grove Fertility Jones Institute, Eastern Virginia Medical School, Norfolk, Virginia
| | | |
Collapse
|
193
|
Hou JH, Lu BJ, Huang YL, Chen CH, Chen CH. Outpatient hysteroscopy impact on subsequent assisted reproductive technology: a systematic review and meta-analysis in patients with normal transvaginal sonography or hysterosalpingography images. Reprod Biol Endocrinol 2024; 22:18. [PMID: 38302947 PMCID: PMC10832084 DOI: 10.1186/s12958-024-01191-0] [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] [Received: 11/28/2023] [Accepted: 01/29/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Standard management for intrauterine lesions typically involves initial imaging followed by operative hysteroscopy for suspicious findings. However, the efficacy of routine outpatient hysteroscopy in women undergoing assisted reproductive technology (ART) remains uncertain due to a lack of decisive high-quality evidence. This study aimed to determine whether outpatient hysteroscopy is beneficial for infertile women who have unremarkable imaging results prior to undergoing ART. METHODS A systematic review and meta-analysis were conducted following PRISMA guidelines, incorporating data up to May 31, 2023, from databases such as PubMed, Embase, and the Cochrane Library. The primary outcome assessed was the live birth rate, with secondary outcomes including chemical pregnancy, clinical pregnancy rates, and miscarriage rates. Statistical analysis involved calculating risk ratios with 95% confidence intervals and assessing heterogeneity with the I2 statistic. RESULTS The analysis included ten randomized control trials. Receiving outpatient hysteroscopy before undergoing ART was associated with increased live birth (RR 1.22, 95% CI 1.03-1.45, I2 61%) and clinical pregnancy rate (RR 1.27 95% CI 1.10-1.47, I2 53%). Miscarriage rates did not differ significantly (RR 1.25, CI 0.90-1.76, I2 50%). Subgroup analyses did not show a significant difference in clinical pregnancy rates when comparing normal versus abnormal hysteroscopic findings (RR 1.01, CI 0.78-1.32, I2 38%). We analyzed data using both intention-to-treat and per-protocol approaches, and our findings were consistent across both analytical methods. CONCLUSIONS Office hysteroscopy may enhance live birth and clinical pregnancy rates in infertile women undergoing ART, even when previous imaging studies show no apparent intrauterine lesions. Treating lesions not detected by imaging may improve ART outcomes. The most commonly missed lesions are endometrial polyps, submucosal fibroids and endometritis, which are all known to affect ART success rates. The findings suggested that hysteroscopy, given its diagnostic accuracy and patient tolerability, should be considered in the management of infertility. DATABASE REGISTRATION The study was registered in the International Prospective Register of Systemic Review database (CRD42023476403).
Collapse
Affiliation(s)
- Jung-Hsiu Hou
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan
- Graduate Institute of Medical Science, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Buo-Jia Lu
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Ya-Li Huang
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chih-Heng Chen
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Huang Chen
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan.
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
194
|
Loreti S, Thiele K, De Brucker M, Olsen C, Centelles-Lodeiro J, Bourgain C, Waelput W, Tournaye H, Griesinger G, Raes J, Vieira-Silva S, Arck P, Blockeel C, Mackens S. Oral dydrogesterone versus micronized vaginal progesterone for luteal phase support: a double-blind crossover study investigating pharmacokinetics and impact on the endometrium. Hum Reprod 2024; 39:403-412. [PMID: 38110714 DOI: 10.1093/humrep/dead256] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/06/2023] [Indexed: 12/20/2023] Open
Abstract
STUDY QUESTION How do plasma progesterone (P) and dydrogesterone (D) concentrations together with endometrial histology, transcriptomic signatures, and immune cell composition differ when oral dydrogesterone (O-DYD) or micronized vaginal progesterone (MVP) is used for luteal phase support (LPS)? SUMMARY ANSWER Although after O-DYD intake, even at steady-state, plasma D and 20αdihydrodydrogesterone (DHD) concentrations spiked in comparison to P concentrations, a similar endometrial signature was observed by histological and transcriptomic analysis of the endometrium. WHAT IS KNOWN ALREADY O-DYD for LPS has been proven to be noninferior compared to MVP in two phase III randomized controlled trials. Additionally, a combined individual participant data and aggregate data meta-analysis indicated that a higher pregnancy rate and live birth rate may be obtained in women receiving O-DYD versus MVP for LPS in fresh IVF/ICSI cycles. Little data are available on the pharmacokinetic (PK) profiles of O-DYD versus MVP and their potential molecular differences at the level of the reproductive organs, particularly at the endometrial level. STUDY DESIGN, SIZE, DURATION Thirty oocyte donors were planned to undergo two ovarian stimulation (OS) cycles with dual triggering (1.000 IU hCG + 0.2 mg triptorelin), each followed by 1 week of LPS: O-DYD or MVP, in a randomized, cross-over, double-blind, double-dummy fashion. On both the first and eighth days of LPS, serial blood samples upon first dosing were harvested for plasma D, DHD, and P concentration analyses. On Day 8 of LPS, an endometrial biopsy was collected for histologic examination, transcriptomics, and immune cell analysis. PARTICIPANTS/MATERIALS, SETTING, METHODS All oocyte donors were <35 years old, had regular menstrual cycles, no intrauterine contraceptive device, anti-Müllerian hormone within normal range and a BMI ≤29 kg/m2. OS was performed on a GnRH antagonist protocol followed by dual triggering (1.000 IU hCG + 0.2 mg triptorelin) as soon as ≥3 follicles of 20 mm were present. Following oocyte retrieval, subjects initiated LPS consisting of MVP 200 mg or O-DYD 10 mg, both three times daily. D, DHD, and P plasma levels were measured using liquid chromatography-tandem mass spectrometry. Histological assessment was carried out using the Noyes criteria. Endometrial RNA-sequencing was performed for individual biopsies and differential gene expression was analyzed. Endometrial single-cell suspensions were created followed by flow cytometry for immune cell typing. MAIN RESULTS AND THE ROLE OF CHANCE A total of 21 women completed the entire study protocol. Subjects and stimulation characteristics were found to be similar between groups. Following the first dose of O-DYD, the average observed maximal plasma concentrations (Cmax) for D and DHD were 2.9 and 77 ng/ml, respectively. The Cmax for D and DHD was reached after 1.5 and 1.6 h (=Tmax), respectively. On the eighth day of LPS, the first administration of that day gave rise to a Cmax of 3.6 and 88 ng/ml for D and DHD, respectively. For both, the observed Tmax was 1.5 h. Following the first dose of MVP, the Cmax for P was 16 ng/ml with a Tmax of 4.2 h. On the eighth day of LPS, the first administration of that day showed a Cmax for P of 21 ng/ml with a Tmax of 7.3 h. All 42 biopsies showed endometrium in the secretory phase. The mean cycle day was 23.9 (±1.2) in the O-DYD group versus 24.0 (±1.3) in the MVP group. RNA-sequencing did not reveal significantly differentially expressed genes between samples of both study groups. The average Euclidean distance between samples following O-DYD was significantly lower than following MVP (respectively 12.1 versus 18.8, Mann-Whitney P = 6.98e-14). Immune cell profiling showed a decrease of CD3 T-cell, γδ T-cell, and B-cell frequencies after MVP treatment compared to O-DYD, while the frequency of natural killer (NK) cells was significantly increased. LIMITATIONS, REASONS FOR CAUTION The main reason for caution is the small sample size, given the basic research nature of the project. The plasma concentrations are best estimates as this was not a formal PK study. Whole tissue bulk RNA-sequencing has been performed not correcting for bias caused by different tissue compositions across biopsies. WIDER IMPLICATIONS OF THE FINDINGS This is the first study comparing O-DYD/MVP, head-to-head, in a randomized design on a molecular level in IVF/ICSI. Plasma serum concentrations suggest that administration frequency is important, in addition to dose, specifically for O-DYD showing a rapid clearance. The molecular endometrial data are overall comparable and thus support the previously reported noninferior reproductive outcomes for O-DYD as compared to MVP. Further research is needed to explore the smaller intersample distance following O-DYD and the subtle changes detected in endometrial immune cells. STUDY FUNDING/COMPETING INTEREST(S) Not related to this work, C.Bl. has received honoraria for lectures, presentations, manuscript writing, educational events, or scientific advice from Abbott, Ferring, Organon, Cooper Surgical, Gedeon-Richter, IBSA, and Merck. H.T. has received honoraria for lectures, presentations, manuscript writing, educational events, or scientific advice from Abbott, Ferring, Cooper Surgical, Gedeon-Richter, Cook, and Goodlife. S.M. has received honoraria for lectures, presentations, educational events, or scientific advice from Abbott, Cooper Surgical, Gedeon-Richter, IBSA, and Merck and Oxolife. G.G. has received honoraria for lectures, presentations, educational events, or scientific advice from Merck, MSD, Organon, Ferring, Theramex, Gedeon-Richter, Abbott, Biosilu, ReprodWissen, Obseva, PregLem, Guerbet, Cooper, Igyxos, and OxoLife. S.V.-S. is listed as inventor on two patents (WO2019115755A1 and WO2022073973A1), which are not related to this work. TRIAL REGISTRATION NUMBER EUDRACT 2018-000105-23.
Collapse
Affiliation(s)
- S Loreti
- Brussels IVF, Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Jette, Belgium
| | - K Thiele
- Division of Experimental Feto-Maternal Medicine, Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M De Brucker
- Brussels IVF, Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Jette, Belgium
| | - C Olsen
- Brussels Interuniversity Genomic High-Throughput Core Facility (BrightCore), Vrije Universiteit Brussel, Brussels, Belgium
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Clinical Sciences, Research Group Reproduction and Genetics, Centre for Medical Genetics, Brussels, Belgium
- Interuniversity Institute of Bioinformatics in Brussels (IB)2, VUB-ULB, Brussels, Belgium
| | - J Centelles-Lodeiro
- Vlaams Instituut voor Biotechnologie (VIB), Katholieke Universiteit Leuven, Leuven, Belgium
| | - C Bourgain
- Reproductive Immunology and Implantation Research Group (REIM), Vrije Universiteit Brussel, Brussels, Belgium
| | - W Waelput
- Department of Pathology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - H Tournaye
- Brussels IVF, Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Jette, Belgium
| | - G Griesinger
- Department of Gynecological Endocrinology and Reproductive Medicine, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany
| | - J Raes
- Vlaams Instituut voor Biotechnologie (VIB), Katholieke Universiteit Leuven, Leuven, Belgium
| | - S Vieira-Silva
- Institute of Medical Microbiology and Hygiene and Research Center for Immunotherapy (FZI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Institute of Molecular Biology (IMB), Mainz, Germany
| | - P Arck
- Division of Experimental Feto-Maternal Medicine, Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Blockeel
- Brussels IVF, Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Jette, Belgium
| | - S Mackens
- Brussels IVF, Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Jette, Belgium
- Reproductive Immunology and Implantation Research Group (REIM), Vrije Universiteit Brussel, Brussels, Belgium
| |
Collapse
|
195
|
Vanderhoff A, Lanes A, Go K, Dobson L, Ginsburg E, Patel J, Srouji SS. Multiple embryo manipulations in PGT-A cycles may result in inferior clinical outcomes. Reprod Biomed Online 2024; 48:103619. [PMID: 38147814 DOI: 10.1016/j.rbmo.2023.103619] [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] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 12/28/2023]
Abstract
RESEARCH QUESTION Do embryos that undergo a thaw, biopsy and re-vitrification (TBR) for pre-implantation genetic testing for aneuploidy (PGT-A) have different ploidy and transfer outcomes compared with fresh biopsied embryos? DESIGN Retrospective cohort study of all embryos that underwent the following procedures: fresh biopsy for PGT-A (fresh biopsy); embryos that were warmed, biopsied for PGT-A and re-vitrified (single biopsy TBR); embryos with a no signal result after initial biopsy that were subsequently warmed, biopsied and re-vitrified (double biopsy TBR). The patients who underwent transfers of those embryos at a single academic institution between March 2013 and December 2021 were also studied. RESULTS About 30% of embryos planned for TBR underwent attrition. Euploidy rates were similar after biopsy: fresh biopsy (42.7%); single biopsy TBR (47.5%) (adjusted RR: 0.99, 0.88 to 1.12); and double biopsy TBR 50.3% (adjusted RR: 0.99, 0.80 to 1.21). Ongoing pregnancy over 8 weeks was not statistically significant (double biopsy TBR: 6/19 [31.6%] versus fresh biopsy: 650/1062 [61.2%]) (adjusted RR 0.52, 95% CI 0.26 to 1.03). The miscarriage rate increased (double biopsy TBR: 4/19 [21.1%] versus fresh biopsy: 66/1062 [6.2%])(RR 3.39, 95% CI 1.38 to 8.31). Live birth rate was also lower per transfer for the double biopsy TBR group (double biopsy TBR [18.75%] versus fresh biopsy [53.75%]) (RR 0.35, 95% CI 0.12 to 0.98), though not after adjustment (adjusted RR 0.37, 95% CI 0.13 to 1.09). These differences were not seen when single biopsy TBR embryos were transferred. CONCLUSIONS Embryos that undergo TBR have an equivalent euploidy rate to fresh biopsied embryos. Despite that, double biopsy TBR embryos may have impaired transfer outcomes.
Collapse
Affiliation(s)
- Anna Vanderhoff
- Center for Infertility and Reproductive Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02130, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Andrea Lanes
- Center for Infertility and Reproductive Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02130, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Kathryn Go
- Center for Infertility and Reproductive Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02130, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Lori Dobson
- Center for Infertility and Reproductive Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02130, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Elizabeth Ginsburg
- Center for Infertility and Reproductive Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02130, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Jay Patel
- Center for Infertility and Reproductive Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02130, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Serene S Srouji
- Center for Infertility and Reproductive Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02130, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| |
Collapse
|
196
|
Gadenne C, Miquel L, Faust C, Berbis J, Perrin J, Courbiere B. Impact of a positive Chlamydia trachomatis serology on cumulative IVF live birth rate. Reprod Biomed Online 2024; 48:103586. [PMID: 38113763 DOI: 10.1016/j.rbmo.2023.103586] [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] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 09/22/2023] [Accepted: 09/28/2023] [Indexed: 12/21/2023]
Abstract
RESEARCH QUESTION Does positive Chlamydia trachomatis serology have an impact on the cumulative live birth rate from IVF? DESIGN A retrospective matched cohort study compared women with positive Chlamydia trachomatis serology (group A) who underwent IVF treatment between January 2016 and December 2021 with a control group of women with negative Chlamydia trachomatis serology (group B). The main outcome measures were the cumulative live birth rate per IVF cycle and the live birth rate per embryo transfer. Secondary outcomes were the cumulative rates of clinical pregnancy, ectopic pregnancy and pregnancy loss calculated per IVF cycle and per embryo transfer. RESULTS A total of 151 women in group A were matched 1:2 to 302 women in group B, representing 220 and 440 IVF cycles, respectively. Women with a history of Chlamydia trachomatis infection had a significantly higher rate of tubal obstruction (P < 0.001), excluded or operated hydrosalpinx (P = 0.002) and/or history of chronic endometritis (P < 0.001). There were no statistically significant differences between the two groups in the mean number of mature oocytes retrieved, fertilization rate or implantation rate. The IVF cumulative live birth rate per cycle was similar in the two groups (36.7% in group A versus 34.9% in group B, P = 0.692). The cumulative rates of clinical pregnancy, pregnancy loss, biochemical pregnancy and ectopic pregnancy were comparable between the two groups. CONCLUSION Positive Chlamydia trachomatis serology has no impact on IVF pregnancy outcomes.
Collapse
Affiliation(s)
- Clara Gadenne
- Department of Gynecology-Obstetric and Reproductive Medicine, Assistance Publique - Hôpitaux de Marseille, La Conception University Hospital, Aix-Marseille Univ, Marseille, France.
| | - Laura Miquel
- Department of Gynecology-Obstetric and Reproductive Medicine, Assistance Publique - Hôpitaux de Marseille, La Conception University Hospital, Aix-Marseille Univ, Marseille, France
| | - Cindy Faust
- Public Health Department, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille Univ, Marseille, France
| | - Julie Berbis
- Public Health Department, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille Univ, Marseille, France
| | - Jeanne Perrin
- Department of Gynecology-Obstetric and Reproductive Medicine, Assistance Publique - Hôpitaux de Marseille, La Conception University Hospital, Aix-Marseille Univ, Marseille, France; IMBE, CNRS, IRD, Avignon Univ, Marseille, France
| | - Blandine Courbiere
- Department of Gynecology-Obstetric and Reproductive Medicine, Assistance Publique - Hôpitaux de Marseille, La Conception University Hospital, Aix-Marseille Univ, Marseille, France; IMBE, CNRS, IRD, Avignon Univ, Marseille, France
| |
Collapse
|
197
|
Ata B, Cakar A, Türkgeldi E, Yildiz S, Keles İ, Kalafat E. Should the trigger to oocyte retrieval interval be different in progestin-primed ovarian stimulation cycles? Reprod Biomed Online 2024; 48:103626. [PMID: 38160486 DOI: 10.1016/j.rbmo.2023.103626] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 01/03/2024]
Abstract
RESEARCH QUESTION Does the trigger to oocyte retrieval interval (TORI) affect oocyte maturation rates differently in progestin-primed ovarian stimulation (PPOS) and gonadotrophin-releasing hormone (GnRH) antagonist cycles? DESIGN This was a retrospective cohort study. The interaction between the stimulation protocol and TORI was assessed in a linear mixed effects multivariable regression analysis with oocyte maturation rate as the dependent variable, and stimulation protocol (GnRH antagonist or PPOS), age (continuous), gonadotrophin type (FSH or human menopausal gonadotrophin), trigger (human chorionic gonadotrophin [HCG] or GnRH agonist), TORI (continuous) and days of stimulation (continuous) as the independent variables. Oocyte maturation rate was defined as number of metaphase II oocytes/number of cumulus-oocyte complexes retrieved. The maturation rate was calculated per cycle and treated as a continuous variable. RESULTS A total of 473 GnRH antagonist and 205 PPOS cycles (121 conventional PPOS and 84 flexible PPOS) were analysed. The median (quartiles) female age was 36 (32-40) years. Of these cycles, 493 were triggered with HCG and 185 with a GnRH agonist. The TORI ranged between 33.6 and 39.1 h, with a median (quartiles) of 36.2 (36-36.4) hours. Maturation rates were similar between fixed PPOS, flexible PPOS and antagonist cycles (median 80%, 75% and 75%, respectively, P = 0.15). There was no significant interaction between the stimulation protocols and TORI for oocyte maturation. CONCLUSIONS PPOS cycles do not seem to require a longer TORI than GnRH antagonist cycles.
Collapse
Affiliation(s)
- Baris Ata
- Department of Obstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey; ART Fertility Clinics, Dubai, United Arab Emirates; Assisted Reproduction Unit, Koc University Hospital, Istanbul, Turkey.
| | - Aysu Cakar
- Department of Obstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey
| | - Engin Türkgeldi
- Department of Obstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey; Assisted Reproduction Unit, Koc University Hospital, Istanbul, Turkey
| | - Sule Yildiz
- Department of Obstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey; Assisted Reproduction Unit, Koc University Hospital, Istanbul, Turkey
| | - İpek Keles
- Assisted Reproduction Unit, Koc University Hospital, Istanbul, Turkey
| | - Erkan Kalafat
- Department of Obstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey; ART Fertility Clinics, Dubai, United Arab Emirates; Assisted Reproduction Unit, Koc University Hospital, Istanbul, Turkey
| |
Collapse
|
198
|
Chen X, Zhang W, Xu Y, Li W, Wang X, Shi S, Liu X. Efficacy of the long-acting gonadotropin-releasing hormone agonist long protocol on IVF/ICSI outcomes of patients with repeated implantation failure. Int J Gynaecol Obstet 2024; 164:563-570. [PMID: 37792887 DOI: 10.1002/ijgo.15070] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/09/2023] [Accepted: 08/17/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE The present study aimed to investigate the effect of long-acting gonadotropin-releasing hormone agonist (GnRHa) long protocol on in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes of patients with repeated implantation failure (RIF). METHODS The present study was carried out from June 1, 2016 to June 30, 2021. A total of 665 patients with RIF were enrolled into the study and classified by the ovarian stimulation protocols. The outcome parameters were compared in each group. In addition, we evaluated the expression of homeobox A10 (HOXA10), integrin β3 and leukemia inhibitory factor (LIF) in endometrial tissues between groups by quantitative RT-PCR. RESULTS Patients who received the long-acting GnRHa long protocol had significantly higher clinical pregnancy rates (58.0%, 41.7% and 39.9%, respectively; P = 0.008 and 0.003), implantation rates (38.1%, 30.3%, and 30.1%, respectively; P = 0.001 and <0.001) and live birth rates (50.3%, 36.3%, and 31.3%, respectively; P = 0.020 and 0.002) compared with the short-acting GnRHa long protocol and GnRH antagonist protocol. In addition, we found that long-acting GnRHa could improve the expression of HOXA10 (P < 0.05). CONCLUSION The long-acting GnRHa long protocol could improve endometrial receptivity and IVF/ICSI clinical outcomes of RIF patients compared with the short-acting GnRHa long protocol and GnRH antagonist protocol.
Collapse
Affiliation(s)
| | - Wei Zhang
- Reproductive Medicine Center, Yantai Yuhuangding Hospital, Yantai, China
| | - Yanping Xu
- Reproductive Medicine Center, Yantai Yuhuangding Hospital, Yantai, China
| | - Wenshu Li
- Department of Obstetrics and Gynecology, Yantai Yuhuangding Hospital, Yantai, China
| | | | - Shulei Shi
- Weifang Medical University, Weifang, China
| | - Xuemei Liu
- Reproductive Medicine Center, Yantai Yuhuangding Hospital, Yantai, China
| |
Collapse
|
199
|
Aghajanova L, Zhang A, Lathi RB, Huddleston HG. Platelet-rich plasma infusion as an adjunct treatment for persistent thin lining in frozen embryo transfer cycles: first US experience report. J Assist Reprod Genet 2024; 41:483-491. [PMID: 37996549 PMCID: PMC10894781 DOI: 10.1007/s10815-023-02993-8] [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] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023] Open
Abstract
PURPOSE To study effect of intrauterine infusion of platelet-rich plasma (PRP) on endometrial growth in the setting of thin endometrial lining in patients with prior cancelled or failed frozen embryo transfer (FET) cycles. MATERIALS AND METHODS Single-arm cohort study of forty-six patients (51 cycles) with endometrial lining thickness (EMT) < 6 mm in prior cancelled or failed FET cycles requesting intrauterine PRP treatment in upcoming FET cycle. The primary outcomes were final EMT in FET cycle and change in EMT after PRP. The secondary outcomes were overall pregnancy rate, clinical pregnancy rate, miscarriage rate, ongoing pregnancy, and live birth rates. RESULTS The mean pre-PRP EMT in all FET cycles was 4.0 ± 1.1 mm, and mean post-PRP EMT (final) was 7.1 ± 1.0 mm. Of 51 cycles, 33 (64.7%) reached ≥ 7 mm after PRP administration. There was a significant difference between pre-PRP EMT and post-PRP EMT in all FET cycles, with mean difference of 3.0 ± 1.5 mm. Three cycles were cancelled for failure to reach adequate lining. Total pregnancy rate was 72.9% in our cohort of 48 cycles that proceeded to transfer. Clinical pregnancy rate was 54.2% (26/48 FET cycles); clinical miscarriage rate was 14.3% (5/35 pregnancies). Twenty six women had live birth (18 with EMT ≥ 7 mm and 8 with EMT < 7 mm). Response to PRP was not correlated with any pre-cycle characteristics. CONCLUSION We demonstrate a significant improvement in lining thickness and pregnancy rates in this challenging cohort of women after PRP infusion, with no adverse events. Cost-effectiveness of PRP with benefits and alternatives should be carefully considered.
Collapse
Affiliation(s)
- Lusine Aghajanova
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford School of Medicine, 1195 West Fremont Avenue, MC 7717, Sunnyvale, CA, 94087, USA.
| | - Amy Zhang
- Quantitative Sciences Unit, Department of Medicine, Stanford School of Medicine, Stanford, CA, USA
| | - Ruth B Lathi
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford School of Medicine, 1195 West Fremont Avenue, MC 7717, Sunnyvale, CA, 94087, USA
| | - Heather G Huddleston
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
200
|
Liu Z, Cai J, Liu L, Ouyang L, Chen J, Yang C, Chen K, Yang X, Ren J, Jiang X. Does cleavage stage morphology increase the discriminatory power of prediction in blastocyst transfer outcome? J Assist Reprod Genet 2024; 41:347-358. [PMID: 38040894 PMCID: PMC10894791 DOI: 10.1007/s10815-023-02997-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 11/22/2023] [Indexed: 12/03/2023] Open
Abstract
PURPOSE To evaluate the contribution of the cleavage stage morphological parameters to the prediction of blastocyst transfer outcomes. METHODS A retrospective study was conducted on 8383 single-blastocyst transfer cycles including 2246 fresh and 6137 vitrified-warmed cycles. XGboost, LASSO, and GLM algorithms were employed to establish models for assessing the predictive value of the cleavage stage morphological parameters in transfer outcomes. Four models were developed using each algorithm: all-in model with or without day 3 morphology and embryo quality-only model with or without day 3 morphology. RESULTS The live birth rate was 48.04% in the overall cohort. The AUCs of the models with the algorithm of XGboost were 0.83, 0.82, 0.63, and 0.60; with LASSO were 0.66, 0.66, 0.61, and 0.60; and with GLM were 0.66, 0.66, 0.61, and 0.60 respectively. In models 1 and 2, female age, basal FSH, peak E2, endometrial thickness, and female BMI were the top five critical features for predicting live birth; In models 3 and 4, the most crucial factor was blastocyst formation on D5 rather than D6. In model 3, incorporating cleavage stage morphology, including early cleavage, D3 cell number, and fragmentation, was significantly associated with successful live birth. Additionally, the live birth rates for blastocysts derived from on-time, slow, and fast D3 embryos were 49.7%, 39.5%, and 52%, respectively. CONCLUSIONS The value of cleavage stage morphological parameters in predicting the live birth outcome of single blastocyst transfer is limited.
Collapse
Affiliation(s)
- Zhenfang Liu
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Xiamen, 361003, Fujian, China
| | - Jiali Cai
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Xiamen, 361003, Fujian, China
- School of Medicine, Xiamen University, Xiamen, 361005, Fujian, China
| | - Lanlan Liu
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Xiamen, 361003, Fujian, China
- School of Medicine, Xiamen University, Xiamen, 361005, Fujian, China
| | - Ling Ouyang
- Medical Quality Management Department, Xiamen University Affiliated Chenggong Hospital, Xiamen, 361003, Fujian, China
| | - Jinghua Chen
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Xiamen, 361003, Fujian, China
| | - Chao Yang
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Xiamen, 361003, Fujian, China
| | - Kaijie Chen
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Xiamen, 361003, Fujian, China
| | - Xiaolian Yang
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Xiamen, 361003, Fujian, China
| | - Jianzhi Ren
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Xiamen, 361003, Fujian, China
| | - Xiaoming Jiang
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Xiamen, 361003, Fujian, China.
- School of Medicine, Xiamen University, Xiamen, 361005, Fujian, China.
| |
Collapse
|