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Dolisca S, Hammer KC, Vagios S, Hsu J, Sacha C, Souter I, Kanakasabapathy MK, Thirumalaraju P, Bormann CL, Shafiee H. IS THERE A DIFFERENCE IN IVF DEVELOPMENTAL OUTCOMES BETWEEN OOCYTES RETRIEVED IN ROOM TEMPERATURE OOCYTE COLLECTION MEDIUM OR MEDIUM MAINTAINED AT 37ºC? Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Fitz VW, Kanakasabapathy MK, Thirumalaraju P, Ramirez LB, Swain JE, Curchoe CL, James KE, Dimitriadis I, Souter I, Bormann CL, Shafiee H. SHOULD THERE BE AN “AI” IN TEAM?: EMBRYOLOGISTS IMPROVE SELECTION OF HIGH IMPLANTATION POTENTIAL EMBRYOS WITH THE AID OF AN ARTIFICIAL INTELLIGENCE ALGORITHM. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.09.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sacha CR, Vagios S, Hammer KC, Fitz VW, Souter I, Bormann CL. WHEN AND WHERE DURING COVID-19: THE EFFECT OF AT-HOME SEMEN COLLECTION ON SPERM PARAMETERS, FERTILIZATION RATE, AND BLASTOCYST RATE. Fertil Steril 2020. [PMCID: PMC7548557 DOI: 10.1016/j.fertnstert.2020.09.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ryan R, Sacha CR, James KE, Roberts DJ, Bormann CL, Souter I. MALE FACTOR INFERTILITY AND PLACENTAL PATHOLOGY IN LIVE BIRTHS CONCEIVED WITH IN VITRO FERTILIZATION. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gaskins AJ, Mínguez-Alarcón L, VoPham TM, Hart JE, Chavarro JE, Schwartz JD, Souter I, Hauser R, Laden F. IMPACT OF AMBIENT TEMPERATURE ON OVARIAN RESERVE AMONG WOMEN FROM A FERTILITY CLINIC. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.09.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Maldonado-Cárceles AB, Mínguez-Alarcón L, Souter I, Gaskins AJ, Arvizu M, Williams PL, Ford JB, Chavarro JE. Dietary patterns and ovarian reserve among women attending a fertility clinic. Fertil Steril 2020; 114:610-617. [PMID: 32712021 DOI: 10.1016/j.fertnstert.2020.04.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/28/2020] [Accepted: 04/14/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the associations between dietary patterns and antral follicle count (AFC), a marker of ovarian reserve. DESIGN Prospective cohort study. SETTING Fertility center at an academic hospital. PATIENT(S) A total of 363 women seeking preconception evaluation and infertility care at the Massachusetts General Hospital who participated in the Environment and Reproductive Health Study. INTERVENTION(S) None. At enrollment, women reported diet through a food frequency questionnaire, from which we computed three dietary pattern adherence scores: the Mediterranean diet, the Fertility diet, and the Profertility diet. MAIN OUTCOME MEASURE(S) The AFC was assessed with a transvaginal ultrasound performed on the third day of an unstimulated menstrual cycle or on the third day of a P withdrawal bleed. RESULT(S) Higher adherence to the three dietary patterns examined were unrelated to AFC. The multivariable adjusted AFC means and 95% confidence intervals for women in the highest compared with the lowest quartile of adherence score were 13.9 (13.0-14.9) and 13.5 (12.6-14.4) for the Mediterranean diet, 14.0 (13.2-14.9) and 13.5 (12.7-14.3) for the Fertility diet, and 12.5 (11.6-13.5) and 13.3 (12.5-14.2) for the Profertility diet. CONCLUSION(S) Dietary patterns were unrelated to AFC among a cohort of women presenting at a fertility center. Due to the limited and heterogeneous current evidence, it is important to evaluate this association in further studies, and in particular among women from the general population.
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Souter I, Bellavia A, Williams PL, Korevaar TIM, Meeker JD, Braun JM, de Poortere RA, Broeren MA, Ford JB, Calafat AM, Chavarro JE, Hauser R, Mínguez-Alarcón L. Urinary Concentrations of Phthalate Metabolite Mixtures in Relation to Serum Biomarkers of Thyroid Function and Autoimmunity among Women from a Fertility Center. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:67007. [PMID: 32515996 PMCID: PMC7282564 DOI: 10.1289/ehp6740] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Although previous epidemiological studies have explored associations of phthalate metabolites with thyroid function, no studies to date have assessed associations of mixtures with thyroid function and autoimmunity among potentially susceptible subgroups such as subfertile women. OBJECTIVE We aimed to explore associations of mixtures of urinary phthalate metabolites with serum markers of thyroid function and autoimmunity. METHODS This cross-sectional study included 558 women attending a fertility center who provided one spot urine and one blood sample at enrollment (2005-2015). We quantified urinary concentrations of eight phthalate metabolites using mass spectrometry, and biomarkers of thyroid function [thyroid-stimulating hormone (TSH), free and total thyroxine (fT4, TT4) and triiodothyronine (fT3, TT3), and autoimmunity [thyroid peroxidase and thyroglobulin antibodies (TPOAb and TgAb, respectively)] in serum using electrochemiluminescence assays. We applied principal component analysis (PCA) and Bayesian kernel machine regression (BKMR) to identify the main patterns of urinary phthalate metabolites. We used linear mixed models to assess the association between PCA-derived factor scores in quintiles and serum thyroid function and autoimmunity, adjusting for age, body mass index (BMI), specific gravity (SG), and, for the PCA, other factor scores. RESULTS We observed two factors using PCA, one representing the di(2-ethylhexyl) (DEHP) and another non-DEHP metabolites. Compared to women in the lowest quintile of the DEHP factor scores, women in the highest quintile had significantly lower serum concentrations of fT4, TT4, fT3, and TT3 [absolute difference: -0.62; 95% confidence interval (CI): -0.12, -0.01; p=0.04; absolute difference: -8.31; 95% CI: -13.8, -2.85; p=0.003; absolute difference: -0.37; 95% CI: 0.54, -0.19; p<0.0001; and absolute difference: -0.21; 95% CI: -0.32, -0.10; p=0.003, respectively]. Using BKMR, we observed that mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) was the primary contributor to these negative associations. DEHP and non-DEHP factor scores were not associated with serum TSH, TgAb, or TPOAb. CONCLUSIONS Mixtures of urinary DEHP metabolites were inversely associated with serum biomarkers of thyroid function but not with autoimmunity, which were within normal ranges for healthy adult women. https://doi.org/10.1289/EHP6740.
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Bormann CL, Thirumalaraju P, Kanakasabapathy MK, Kandula H, Souter I, Dimitriadis I, Gupta R, Pooniwala R, Shafiee H. Consistency and objectivity of automated embryo assessments using deep neural networks. Fertil Steril 2020; 113:781-787.e1. [PMID: 32228880 PMCID: PMC7583085 DOI: 10.1016/j.fertnstert.2019.12.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/04/2019] [Accepted: 12/02/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To evaluate the consistency and objectivity of deep neural networks in embryo scoring and making disposition decisions for biopsy and cryopreservation in comparison to grading by highly trained embryologists. DESIGN Prospective double-blind study using retrospective data. SETTING U.S.-based large academic fertility center. PATIENTS Not applicable. INTERVENTION(S) Embryo images (748 recorded at 70 hours postinsemination [hpi]) and 742 at 113 hpi) were used to evaluate embryologists and neural networks in embryo grading. The performance of 10 embryologists and a neural network were also evaluated in disposition decision making using 56 embryos. MAIN OUTCOME MEASURES Coefficients of variation (%CV) and measures of consistencies were compared. RESULTS Embryologists exhibited a high degree of variability (%CV averages: 82.84% for 70 hpi and 44.98% for 113 hpi) in grading embryo. When selecting blastocysts for biopsy or cryopreservation, embryologists had an average consistency of 52.14% and 57.68%, respectively. The neural network outperformed the embryologists in selecting blastocysts for biopsy and cryopreservation with a consistency of 83.92%. Cronbach's α analysis revealed an α coefficient of 0.60 for the embryologists and 1.00 for the network. CONCLUSIONS The results of our study show a high degree of interembryologist and intraembryologist variability in scoring embryos, likely due to the subjective nature of traditional morphology grading. This may ultimately lead to less precise disposition decisions and discarding of viable embryos. The application of a deep neural network, as shown in our study, can introduce improved reliability and high consistency during the process of embryo selection and disposition, potentially improving outcomes in an embryology laboratory.
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Cherston C, Sacha C, Sabatini M, Hammer KC, Souter I, Vagios S, Bormann CL, Donahoe PK, Pepin D. HIGHER LEVELS OF MATERNAL SERUM ANTI-MULLERIAN HORMONE ARE ASSOCIATED WITH AN INCREASED MALE-TO-FEMALE NEONATE RATIO AFTER IVF/ICSI. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.02.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bakkensen JB, Christou G, Dimitriadis I, James K, Souter I. The effect of follicular phase length on cycle outcomes and endometrial development in gonadotrophin ovarian stimulation/intrauterine insemination cycles. Reprod Biomed Online 2020; 40:362-368. [DOI: 10.1016/j.rbmo.2019.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 12/03/2019] [Accepted: 12/08/2019] [Indexed: 11/16/2022]
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Sacha CR, Dimitriadis I, Christou G, James K, Brock ML, Rice ST, Bhowmick P, Bormann CL, Souter I. The impact of male factor infertility on early and late morphokinetic parameters: a retrospective analysis of 4126 time-lapse monitored embryos. Hum Reprod 2020; 35:24-31. [DOI: 10.1093/humrep/dez251] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 09/19/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
STUDY QUESTION
Is there an effect of male factor infertility (MFI) on either early or late morphokinetic parameters obtained during embryonic culture to blastocyst stage in a time-lapse imaging (TLI) incubator?
SUMMARY ANSWER
Neither mild nor severe MFI had an impact on overall time to blastocyst or duration of individual cleavage stages in the total embryo population.
WHAT IS KNOWN ALREADY
Prior studies have suggested that paternal DNA and sperm quality affect embryo morphokinetic parameters, but the impact of MFI is not fully understood.
STUDY DESIGN, SIZE, DURATION
This retrospective cohort study, at a major academic fertility centre, included 536 couples (women, ≤44 years of age) undergoing IVF between September 2013 and September 2016.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Data from 4126 embryos cultured to the blastocyst stage in a TLI-monitored incubator were retrospectively reviewed. Embryos derived from the sperm of men with MFI were compared with those derived from patients with other infertility diagnoses. Generalized fixed and random effects models, t-test and χ2 were used as appropriate.
MAIN RESULTS AND THE ROLE OF CHANCE
Couples with MFI had a higher rate of ICSI utilization and fewer usable embryos on average, and the men were older compared with couples with other diagnoses. Additionally, the women in MFI couples were younger and had higher antral follicle counts (AFCs) and higher anti-Müllerian hormone (AMH) levels compared with the other women undergoing IVF. When controlling for maternal and paternal ages, AMH and fertilization method (conventional IVF versus ICSI), neither mild nor severe MFI affected duration of individual cleavage stages or overall time to the blastocyst stage, when all or only usable embryos were examined (coefficient 0.44 hours in all embryos, P = 0.57; coefficient 0.39 hours in usable embryos, P = 0.60). Whether the sperm was surgically extracted similarly had no significant effect on embryo morphokinetic parameters. When the fertilization method was assessed independently, ICSI lengthened the overall time to blastocyst stage by 1.66 hours (P = 0.03) on average, primarily due to an increase in duration of the time from 5-cell embryo stage to early blastulation (P5SB).
LIMITATIONS, REASONS FOR CAUTION
This large cohort study avoided embryo selection bias due to random assignment of embryos to the TLI incubators. However, our findings may not be generalizable to groups under-represented in our clinic population. Future studies should also evaluate the impact of male hormonal status and detailed sperm morphology, such as head versus flagellum defects, on embryo morphokinetic development.
WIDER IMPLICATIONS OF THE FINDINGS
Our findings suggest that the fertilization method rather than MFI per se impacts time to early blastulation. The clinical implications of this effect on embryo development warrant further investigation.
STUDY FUNDING/COMPETING INTEREST(S)
There were no sources of funding for this study. There are no competing interests.
TRIAL REGISTRATION NUMBER
N/A
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Kanakasabapathy MK, Thirumalaraju P, Bormann CL, Kandula H, Dimitriadis I, Souter I, Yogesh V, Kota Sai Pavan S, Yarravarapu D, Gupta R, Pooniwala R, Shafiee H. Development and evaluation of inexpensive automated deep learning-based imaging systems for embryology. LAB ON A CHIP 2019; 19:4139-4145. [PMID: 31755505 PMCID: PMC6934406 DOI: 10.1039/c9lc00721k] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Embryo assessment and selection is a critical step in an in vitro fertilization (IVF) procedure. Current embryo assessment approaches such as manual microscopy analysis done by embryologists or semi-automated time-lapse imaging systems are highly subjective, time-consuming, or expensive. Availability of cost-effective and easy-to-use hardware and software for embryo image data acquisition and analysis can significantly empower embryologists towards more efficient clinical decisions both in resource-limited and resource-rich settings. Here, we report the development of two inexpensive (<$100 and <$5) and automated imaging platforms that utilize advances in artificial intelligence (AI) for rapid, reliable, and accurate evaluations of embryo morphological qualities. Using a layered learning approach, we have shown that network models pre-trained with high quality embryo image data can be re-trained using data recorded on such low-cost, portable optical systems for embryo assessment and classification when relatively low-resolution image data are used. Using two test sets of 272 and 319 embryo images recorded on the reported stand-alone and smartphone optical systems, we were able to classify embryos based on their cell morphology with >90% accuracy.
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Ghayda RA, Williams PL, Chavarro JE, Ford JB, Souter I, Calafat AM, Hauser R, Mínguez-Alarcón L. Urinary bisphenol S concentrations: Potential predictors of and associations with semen quality parameters among men attending a fertility center. ENVIRONMENT INTERNATIONAL 2019; 131:105050. [PMID: 31376593 PMCID: PMC6736646 DOI: 10.1016/j.envint.2019.105050] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/25/2019] [Accepted: 07/22/2019] [Indexed: 05/24/2023]
Abstract
BACKGROUND Bisphenol S (BPS) was introduced in the market as a potentially safer alternative to bisphenol A (BPA). However, there are limited studies on health effects of BPS and no epidemiologic studies on its relationship with male reproductive health outcomes, specifically semen quality. OBJECTIVE To investigate predictors of urinary BPS concentrations and its association with semen parameters among men attending a fertility center. METHODS This cross-sectional analysis included 158 men of couples seeking fertility treatment (2011-2017) contributing 338 paired semen and urine samples. At the time of sample collection, men completed a questionnaire on self-reported use of household products and food intake within the previous 24 h. Urinary concentrations of BPA, BPS and bisphenol F were quantified using isotope-dilution tandem mass spectrometry. Semen samples were analyzed following WHO guidelines. Multivariable mixed models were used to investigate predictors of urinary BPS concentrations and to evaluate associations between urinary BPS concentrations and semen parameters, using random intercept to account for correlation in outcomes across multiple observations per man and adjusting for abstinence time, specific gravity, age, body mass index (BMI), year of sample collection and BPA concentrations. Analyses were also stratified by BMI (≥25 vs <25 kg/m2). RESULTS Median (IQR) urinary BPS concentration was 0.30 (0.20, 0.90) μg/L, and 76% of samples had detectable (>0.1 μg/L) concentrations. Self-reported fabric softener and paint/solvent use as well as intake of beef and cheese within 24 h before urine collection were positively associated with BPS concentrations. Men with higher BPS concentrations also had significantly higher BMI. Lower semen parameters were found among men with detectable BPS concentrations, compared to men with non-detectable BPS [2.66 vs. 2.91 mL for volume (p = 0.03), 30.7 vs. 38.3 mil/mL for concentration (p = 0.03), 76.8 vs. 90.0 mil for total count (p = 0.09), 43.7 vs. 47.0% for motility (p = 0.06), and 5.42 vs. 6.77% for morphologically normal sperm (p = 0.24)]. Some associations of BPS with lower semen parameters were only found among men with a BMI ≥ 25 kg/m2. CONCLUSIONS We identified dietary and lifestyle factors associated with BPS exposure, suggesting potential avenues for reducing exposures. We also observed negative associations between BPS and semen parameters, especially among overweight and obese men.
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Bortoletto P, Kanakasabapathy MK, Thirumalaraju P, Gupta R, Pooniwala R, Souter I, Dimitriadis I, Dickinson K, Hariton E, Bormann CL, Shafiee H. Predicting blastocyst formation of day 3 embryos using a convolutional neural network (CNN): a machine learning approach. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.807] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Vagios S, Sacha CR, Hsu JY, Dimitriadis I, Bormann CL, James KE, Souter I. Can anti-mullerian hormone (AMH) levels predict response to ovulation induction treatments in women with polycystic ovarian syndrome (PCOS)? Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.1118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hariton E, Thirumalaraju P, Kanakasabapathy MK, Gupta R, Pooniwala R, Souter I, Dimitriadis I, Veiga C, Bortoletto P, Bormann CL, Shafiee H. Deep learning can improve day 5 embryo scoring and decision making in an embryology laboratory. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Souter I, Mínguez-Alarcón L, Korevaar T, Ford JB, Chavarro JE, Hauser R. The association of urinary concentrations of bisphenol-A, and di-ethylhexyl phthalate metabolites with thyroid function & autoimmunity in women from a fertility center: results from the environment and reproductive health study. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Thirumalaraju P, Kanakasabapathy MK, Gupta R, Pooniwala R, Kandula H, Souter I, Dimitriadis I, Bormann CL, Shafiee H. Automated quality assessment of individual embryologists performing ICSI using deep learning-enabled fertilization and embryo grading technology. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Dimitriadis I, Bormann CL, Kanakasabapathy MK, Thirumalaraju P, Gupta R, Pooniwala R, Souter I, Rice ST, Bhowmick P, Shafiee H. Deep convolutional neural networks (CNN) for assessment and selection of normally fertilized human embryos. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Sacha CR, Mínguez-Alarcón L, Chavarro JE, Ford JB, Donahoe PK, Souter I, Hauser R, Pépin D. Follicular fluid (FF) concentration of anti-müllerian hormone (AMH) in women pursuing in vitro fertilization (IVF): variability and predictors. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hariton E, Dimitriadis I, Kanakasabapathy MK, Thirumalaraju P, Gupta R, Pooniwala R, Souter I, Rice ST, Bhowmick P, Ramirez LB, Curchoe CL, Swain JE, Boehnlein LM, Bormann CL, Shafiee H. A deep learning framework outperforms embryologists in selecting day 5 euploid blastocysts with the highest implantation potential. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.324] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Martín-Calvo N, Mínguez-Alarcón L, Gaskins AJ, Nassan FL, Williams PL, Souter I, Hauser R, Chavarro JE. Paternal preconception folate intake in relation to gestational age at delivery and birthweight of newborns conceived through assisted reproduction. Reprod Biomed Online 2019; 39:835-843. [PMID: 31564651 DOI: 10.1016/j.rbmo.2019.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/20/2019] [Accepted: 07/09/2019] [Indexed: 01/16/2023]
Abstract
RESEARCH QUESTION Studies in rodents have shown that paternal folate intake prior to conception is associated with pregnancy and offspring outcomes. The aim of this study was to assess whether those associations might apply to humans as well. DESIGN Between 2007 and 2017, the study prospectively analysed data from 108 couples participating in a preconception cohort of couples undergoing fertility treatment using their own gametes, whose treatment resulted in 113 pregnancies during the course of the study. Paternal and maternal preconception folate intake was assessed using a validated food frequency questionnaire. Linear mixed models were used to assess whether paternal preconception folate intake was associated with gestational age at delivery and gestational age-specific birthweight, while accounting for correlated data and potential confounders. RESULTS In a multivariable-adjusted model, a 400 μg/day increase in preconception paternal folate intake was associated with a 2.6-day longer gestation (95% confidence interval 0.8-4.3) after adjusting for potential confounders, including maternal folate intake. Similar associations were found for folate from food and supplements. Maternal folate intake was not associated with gestational age at delivery. Neither paternal nor maternal folate intake was associated with gestational-age-specific birthweight. CONCLUSIONS Higher paternal preconception folate intake was associated with slightly longer gestation among live births achieved through assisted reproduction. The results suggest that preconception exposures of the father may have an impact on the health of his offspring, and therefore that preconception care should shift from a woman-centric to a couple-based approach.
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Gaskins AJ, Fong KC, Abu Awad Y, Di Q, Mínguez-Alarcón L, Chavarro JE, Ford JB, Coull BA, Schwartz J, Kloog I, Souter I, Hauser R, Laden F. Time-Varying Exposure to Air Pollution and Outcomes of in Vitro Fertilization among Couples from a Fertility Clinic. ENVIRONMENTAL HEALTH PERSPECTIVES 2019; 127:77002. [PMID: 31268361 PMCID: PMC6792363 DOI: 10.1289/ehp4601] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND A few studies suggest that air pollution may decrease fertility, but prospective studies and examinations of windows of susceptibility remain unclear. OBJECTIVE We aimed to examine the association between time-varying exposure to nitrogen dioxide ([Formula: see text]), ozone ([Formula: see text]), fine particulate matter [Formula: see text] ([Formula: see text]), and black carbon (BC) on in vitro fertilization (IVF) outcomes. METHODS We included 345 women (522 IVF cycles) for the [Formula: see text], [Formula: see text], and [Formula: see text] analyses and 339 women (512 IVF cycles) for the BC analysis enrolled in a prospective cohort at a Boston fertility center (2004–2015). We used validated spatiotemporal models to estimate daily residential exposure to [Formula: see text], [Formula: see text], [Formula: see text], and BC. Multivariable discrete time Cox proportional hazards models with four periods [ovarian stimulation (OS), oocyte retrieval to embryo transfer (ET), ET to implantation, implantation to live birth] estimated odds ratios (OR) and 95% confidence intervals (CI) of failing at IVF. Time-dependent interactions were used to identify vulnerable periods. RESULTS An interquartile range (IQR) increase in [Formula: see text], [Formula: see text], and BC throughout the IVF cycle was associated with an elevated odds of failing at IVF prior to live birth ([Formula: see text], 95% CI: 0.95, 1.23 for [Formula: see text]; [Formula: see text], 95% CI: 0.88, 1.28 for [Formula: see text]; and [Formula: see text], 95% CI: 0.96, 1.41 for BC). This relationship significantly varied across the IVF cycle such that the association with higher exposure to air pollution during OS was strongest for early IVF failures. An IQR increase in [Formula: see text], [Formula: see text], and BC exposure during OS was associated with 1.42 (95% CI: 1.20, 1.69), 1.26 (95% CI: 0.96, 1.67), and 1.23 (95% CI: 0.96, 1.59) times the odds of failing prior to oocyte retrieval, and 1.32 (95% CI: 1.13, 1.54), 1.27 (95% CI: 0.98, 1.65), and 1.32 (95% CI: 1.10, 1.59) times the odds of failing prior to ET. CONCLUSION Increased exposure to traffic-related pollutants was associated with higher odds of early IVF failure. https://doi.org/10.1289/EHP4601.
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Gaskins AJ, Nassan FL, Chiu YH, Arvizu M, Williams PL, Keller MG, Souter I, Hauser R, Chavarro JE. Dietary patterns and outcomes of assisted reproduction. Am J Obstet Gynecol 2019; 220:567.e1-567.e18. [PMID: 30742825 DOI: 10.1016/j.ajog.2019.02.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/08/2019] [Accepted: 02/03/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is growing acceptance that nutrition may be related to fertility and specifically to assisted reproductive technologies success in women; however, there is still no specific dietary guidance. OBJECTIVE The objective of the study was to evaluate the relationship between pretreatment adherence to various dietary patterns and outcomes of assisted reproductive technologies. STUDY DESIGN We followed up 357 women enrolled in the prospective Environment and Reproductive Health (EARTH) study, who underwent 608 assisted reproductive technologies cycles (2007-2017). Using a validated food frequency questionnaire completed prior to treatment, we assessed adherence to the Mediterranean diet, the alternate Healthy Eating Index 2010, the Fertility Diet (developed based on risk factors for anovulatory infertility), and a profertility diet we developed based on factors previously related to assisted reproductive technologies outcomes (higher intake of supplemental folic acid, vitamin B12, vitamin D, low- rather than high-pesticide residue produce, whole grains, dairy, soy foods, and seafood rather than other meats). RESULTS Higher adherence to the alternate Healthy Eating Index 2010 and Fertility Diet was not related to live birth following assisted reproductive technologies. Women in the second through the fourth quartiles of Mediterranean diet adherence had significantly higher probability of live birth (0.44, 95% confidence interval, 0.39-0.49) compared with women in the first quartile (0.31, 95% confidence interval, 0.25-0.39); however, there was no additional benefit of adherence to the Mediterranean diet above the second quartile. Increased adherence to the profertility diet was linearly associated with assisted reproductive technologies outcomes. The adjusted odds (95% confidence interval) of implantation, clinical pregnancy, and live birth were higher by 47% (21%, 77%), 43% (19%, 72%), and 53% (26%, 85%), respectively, per SD increase. The adjusted difference in the proportion of cycles resulting in live birth for women in the fourth vs first quartile of adherence to the profertility diet was 0.28 (95% confidence interval, 0.16-0.38). While the profertility diet was not related to estradiol levels, oocyte counts, or endometrial thickness, it was inversely associated with clinical pregnancy loss (odds ratio, 0.69, 95% confidence interval, 0.53-0.90 per SD increase). CONCLUSION Higher pretreatment adherence to the profertility diet was associated with an increased probability of live birth among women undergoing assisted reproductive technologies. Commonly recommended dietary advice such as adhering to the Mediterranean diet may not provide the most appropriate guidance for women undergoing infertility treatment in the United States.
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Gaskins AJ, Missmer SA, Rich-Edwards JW, Williams PL, Souter I, Chavarro JE. Demographic, lifestyle, and reproductive risk factors for ectopic pregnancy. Fertil Steril 2019; 110:1328-1337. [PMID: 30503132 DOI: 10.1016/j.fertnstert.2018.08.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/19/2018] [Accepted: 08/07/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the relationship between demographic, lifestyle, and reproductive factors and the risk of ectopic pregnancy (EP). DESIGN Prospective cohort. SETTING United States. PATIENT(S) Nurses' Health Study II cohort comprising 41,440 pregnancies from 22,356 women. INTERVENTION(S) Demographic, lifestyle, and reproductive factors self-reported in 1989 then updated every 2 years. Multivariable log-binomial regression models with generalized estimating equations were used to estimate adjusted risk ratios (aRR). MAIN OUTCOME MEASURE(S) Ectopic pregnancy. RESULT(S) Incident EP was reported in 411 (1.0%) pregnancies. Former and current smokers had 1.22 (95% confidence interval [CI], 0.97-1.55) and 1.73 (95% CI, 1.28-2.32) times, respectively, the risk of EP compared with never smokers. The risk of EP 10 years after quitting was similar to never smokers (aRR 0.90; 95% CI, 0.60-1.33). Women consuming ≥10 g/day of alcohol had 1.50 (95% CI, 1.08-2.09) times the risk of EP compared with never consumers. In utero exposure to diethylstilbestrol (aRR 3.55; 95% CI, 2.51-5.01), earlier initiation of oral contraceptives (aRR 2.64; 95% CI, 1.70-4.09 for <16 years vs. never), intrauterine device use (aRR 3.99; 95% CI, 2.06-7.72), or history of infertility (aRR 3.03; 95% CI, 2.48-3.71) or tubal ligation (aRR 16.27; 95% CI, 11.76-22.53) also were associated with a higher risk of EP. CONCLUSION(S) Women who were current or former smokers, consumed ≥10 g/day of alcohol, were exposed to diethylstilbestrol in utero, initiated oral contraceptives at earlier than age 16 years (which may be a marker of riskier sexual behaviors), and who had a history of infertility, intrauterine device use, or tubal ligation had a higher risk of EP.
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