51
|
Mussa A, Molinatto C, Cerrato F, Palumbo O, Carella M, Baldassarre G, Carli D, Peris C, Riccio A, Ferrero GB. Assisted Reproductive Techniques and Risk of Beckwith-Wiedemann Syndrome. Pediatrics 2017. [PMID: 28634246 DOI: 10.1542/peds.2016-4311] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The emerging association of assisted reproductive techniques (ART) with imprinting disorders represents a major issue in the scientific debate on infertility treatment and human procreation. We studied the prevalence of Beckwith-Wiedemann syndrome (BWS) in children conceived through ART to define the specific associated relative risk. METHODS Patients with BWS born in Piemonte, Italy, were identified and matched with the general demographic data and corresponding regional ART registry. RESULTS Between 2005 and 2014, live births in Piemonte were 379 872, including 7884 from ART. Thirty-eight patients with BWS were born, 7 from ART and 31 naturally conceived. BWS birth prevalence in the ART group was significantly higher than that of the naturally conceived group (1:1126 vs 1:12 254, P < .001). The absolute live birth risk in the ART group was 887.9 per 1 000 000 vs 83.3 per 1 000 000 in the naturally conceived group, providing a relative risk of 10.7 (95% confidence interval 4.7-24.2). During the 1997-2014 period, 67 patients were diagnosed with BWS out of 663 834 newborns (1:9908 live births). Nine out of the 67 BWS patients were conceived through ART (13.4%), and 8 were molecularly tested, with 4 having an imprinting center 2 loss of methylation, 2 with 11p15.5 paternal uniparental disomy, and 2 negative results. CONCLUSIONS ART entails a 10-fold increased risk of BWS and could be implicated in the pathogenesis of genomic events besides methylation anomalies. These data highlight the need for awareness of ART-associated health risk.
Collapse
Affiliation(s)
- Alessandro Mussa
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy.,NICU and Neonatology, Department of Gynecology and Obstetrics, S. Anna Hospital, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Cristina Molinatto
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
| | - Flavia Cerrato
- DiSTABiF, Second University of Naples and Institute of Genetics and Biophysics "A. Buzzati-Traverso" - CNR, Naples, Italy
| | - Orazio Palumbo
- Medical Genetics Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy; and
| | - Massimo Carella
- Medical Genetics Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy; and
| | | | - Diana Carli
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
| | | | - Andrea Riccio
- DiSTABiF, Second University of Naples and Institute of Genetics and Biophysics "A. Buzzati-Traverso" - CNR, Naples, Italy
| | | |
Collapse
|
52
|
Valenzuela-Alcaraz B, Crispi F, Cruz-Lemini M, Bijnens B, García-Otero L, Sitges M, Balasch J, Gratacós E. Differential effect of assisted reproductive technology and small-for-gestational age on fetal cardiac remodeling. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:63-70. [PMID: 27420642 DOI: 10.1002/uog.16217] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 07/04/2016] [Accepted: 07/08/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Fetuses conceived by assisted reproductive technology (ART) and those that are small-for-gestational age (SGA) show cardiovascular remodeling in utero; however, these two conditions are often associated. We aimed to evaluate the differential effect of ART and SGA on fetal cardiac remodeling. METHODS This was a prospective cohort study of term singleton pregnancies seen at our department between April 2011 and September 2013. The cohort was divided according to fetal growth and mode of conception into the following four groups: 102 appropriate-for-gestational-age (AGA) fetuses conceived spontaneously (controls), 72 AGA fetuses conceived by ART (ART-AGA), 31 SGA fetuses conceived by ART (ART-SGA) and 28 SGA fetuses conceived naturally (Spont-SGA). SGA was defined as birth weight < 10th centile. Fetal echocardiography was performed at 28-32 weeks to assess cardiac dimensions, geometry and function. RESULTS ART fetuses had dilated atria (mean left atrium-to-heart area ratio: controls, 15 ± 2.7%; ART-AGA, 18 ± 4.1%; Spont-SGA, 14 ± 3.7%) and more globular ventricles (left ventricular sphericity index: controls, 1.77 ± 0.2; ART-AGA, 1.68 ± 0.2; Spont-SGA, 1.72 ± 0.2), with normally sized hearts. In contrast, SGA fetuses had enlarged hearts (cardiothoracic ratio: controls, 24 ± 3%; ART-AGA, 24 ± 4%; Spont-SGA, 29 ± 6%), preserved atrial size, more globular and concentric hypertrophic ventricles (left ventricle relative wall thickness: controls, 0.48 ± 0.17; ART-AGA, 0.54 ± 0.13; Spont-SGA, 0.63 ± 0.23). Both ART and SGA fetuses had decreased longitudinal motion (tricuspid annular ring displacement: controls, 6.5 ± 0.8 mm; ART-AGA, 5.5 ± 0.7 mm; Spont-SGA, 5.9 ± 0.6 mm) and impaired relaxation (left isovolumetric relaxation time: controls, 47.0 ± 7.3 ms; ART-AGA, 50.0 ± 7.9 ms; Spont-SGA, 49.5 ± 9.3 ms). ART-SGA fetuses presented a combination of features from both ART and SGA groups. CONCLUSION SGA and conception with ART were associated with distinct patterns of fetal cardiac remodeling, supporting the concept that they are independent causes of cardiac programming. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- B Valenzuela-Alcaraz
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - F Crispi
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - M Cruz-Lemini
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
- Fetal Medicine Mexico, Fetal Medicine and Surgery Research Unit, Unidad de Investigación en Neurodesarrollo, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM) Campus Juriquilla, Querétaro, Mexico
| | - B Bijnens
- ICREA - Universitat Pompeu Fabra, Barcelona, Spain
| | - L García-Otero
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - M Sitges
- Department of Cardiology, Institut Clínic del Tòrax, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - J Balasch
- Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - E Gratacós
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| |
Collapse
|
53
|
Karami M, Jenabi E, Fereidooni B. The association of placenta previa and assisted reproductive techniques: a meta-analysis. J Matern Fetal Neonatal Med 2017; 31:1940-1947. [DOI: 10.1080/14767058.2017.1332035] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Manoochehr Karami
- Social Determinates of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ensiyeh Jenabi
- Department of Midwifery, Tuyserkan Branch, Islamic Azad University, Tuyserkan, Iran
| | | |
Collapse
|
54
|
Abdou CM. Age-Based Reproductive Healthcare Stereotype Threat (HCST) as a Stressor Affecting Prenatal Mental Health in Pregnant Women of Advanced Maternal Age: Measurement, Process, Outcomes, and Interactions with Ethnicity/Race, SES, and Other Social Identities. CURR EPIDEMIOL REP 2017; 4:133-144. [PMID: 30345220 PMCID: PMC6191845 DOI: 10.1007/s40471-017-0113-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW Reproductive health, and pregnancy more specifically, is the first critical link between generations. Beginning with this first critical link, pregnancy acts as a domino, affecting the expression of genes and determining the lifespan mental and physical health and reproductive potential of offspring and, likely, of subsequent generations. Given the powerful intergenerational domino that is pregnancy, the development of innovative models to enhance reproductive health and outcomes is an invaluable public health investment. RECENT FINDINGS While U.S. pregnancy and birth outcomes have improved dramatically since the 1960s- including substantial progress within the past 15 years, largely catalyzed by the Healthy People initiative-group-based disparities remain. What's more, social change and medical advancements have led to an evolving window of female reproductive age. Despite becoming more common, being an older expectant mother remains a stigmatized social identity. The concept of healthcare stereotype threat (HCST) is introduced in relation to reproductive health. Stereotype threat is a situational predicament in which an individual who possesses a stigmatized social identity fears confirming negative group-based stereotypes. HCST is a healthcare-specific form of stereotype threat, arising out of stereotypes that are salient in healthcare settings. It is hypothesized that the experience of age-based reproductive HCST is an overlooked stressor affecting prenatal mental and physical health among women of advanced maternal age. SUMMARY The hypothesized process of age-based reproductive HCST is described; outcomes and consequences are discussed; interactions with ethnicity/race, SES, and other aspects of social identity are considered; and strategies for prevention and intervention are explored, including active and passive shifts in three areas: (1) internally, in both providers and patients; (2) in the external environment, or the physical healthcare setting itself; and (3) within interpersonal interactions that occur within healthcare settings, particularly between physicians and patients. Implications for gynecological, infertility, and obstetric care and improving the reproductive outcomes of older women are discussed.
Collapse
|
55
|
Siristatidis CS, Sertedaki E, Vaidakis D. Metabolomics for improving pregnancy outcomes in women undergoing assisted reproductive technologies. Cochrane Database Syst Rev 2017; 5:CD011872. [PMID: 28534597 PMCID: PMC6481756 DOI: 10.1002/14651858.cd011872.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND In order to overcome the low effectiveness of assisted reproductive technologies (ART) and the high incidence of multiple births, metabolomics is proposed as a non-invasive method to assess oocyte quality, embryo viability, and endometrial receptivity, and facilitate a targeted subfertility treatment. OBJECTIVES To evaluate the effectiveness and safety of metabolomic assessment of oocyte quality, embryo viability, and endometrial receptivity for improving live birth or ongoing pregnancy rates in women undergoing ART, compared to conventional methods of assessment. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility Group Trials Register, CENTRAL, MEDLINE, Embase, CINAHL and two trial registers (November 2016). We also examined the reference lists of primary studies and review articles, citation lists of relevant publications, and abstracts of major scientific meetings. SELECTION CRITERIA Randomised controlled trials (RCTs) on metabolomic assessment of oocyte quality, embryo viability, and endometrial receptivity in women undergoing ART. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility and risk of bias, and extracted the data. The primary outcomes were rates of live birth or ongoing pregnancy (composite outcome) and miscarriage. Secondary outcomes were clinical pregnancy, multiple and ectopic pregnancy, cycle cancellation, and foetal abnormalities. We combined data to calculate odds ratios (ORs) for dichotomous data and 95% confidence intervals (CIs). Statistical heterogeneity was assessed using the I² statistic. We assessed the overall quality of the evidence for the main comparisons using GRADE methods. MAIN RESULTS We included four trials with a total of 802 women, with a mean age of 33 years. All assessed the role of metabolomic investigation of embryo viability. We found no RCTs that addressed the metabolomic assessment of oocyte quality or endometrial receptivity.We found low-quality evidence of little or no difference between metabolomic and non-metabolomic assessment of embryos for rates of live birth or ongoing pregnancy (OR 1.11, 95% CI 0.83 to 1.48; I² = 0%; four RCTs; N = 802), or miscarriage (OR 0.96, 95% CI 0.52 to 1.78; I² = 0%; two RCTs; N = 434). A sensitivity analysis excluding studies at high risk of bias did not change the interpretation of the results for live birth or ongoing pregnancy (OR 0.99, 95% CI 0.71 to 1.38; I² = 0%; two RCTs; N = 621). Our findings suggested that if the rate of live birth or ongoing pregnancy was 36% in the non-metabolomic group, it would be between 32% and 45% with the use of metabolomics.We found low-quality evidence of little or no difference between groups in rates of clinical pregnancy (OR 1.22, 95% CI 0.92 to 1.62; I²= 26%; four trials; N = 802), or multiple pregnancy (OR 1.52, 95% CI 0.71 to 3.23; I² = 0%; two RCTs, N = 181). There was very low-quality evidence of little or no difference between groups in ectopic pregnancy rates (OR 3.37, 95% CI 0.14 to 83.40; one RCT; N = 309), and foetal abnormalities (no events; one RCT; N = 125), and very low-quality evidence of higher rates of cycle cancellation in the metabolomics group (OR 1.78, 95% CI 1.18 to 2.69; I² = 51%; two RCTs; N = 744). Data were lacking on other adverse effects. A sensitivity analysis excluding studies at high risk of bias did not change the interpretation of the results for clinical pregnancy (OR 1.14, 95% CI 0.83 to 1.57; I² = 0%; two RCTs; N = 621).The overall quality of the evidence ranged from very low to low. Limitations included serious risk of bias (associated with poor reporting of methods, attrition bias, selective reporting, and other biases), imprecision, and inconsistency across trials. AUTHORS' CONCLUSIONS According to current trials in women undergoing ART, there is insufficient evidence to show that metabolomic assessment of embryos before implantation has any meaningful effect on rates of live birth, ongoing pregnancy, or miscarriage rates. The existing evidence varied from very low to low-quality. Data on adverse events were sparse, so we could not reach conclusions on these. At the moment, there is no evidence to support or refute the use of this technique for subfertile women undergoing ART. Robust evidence is needed from further RCTs, which study the effects on live birth and miscarriage rates for the metabolomic assessment of embryo viability. Well designed and executed trials are also needed to study the effects on oocyte quality and endometrial receptivity, since none are currently available.
Collapse
Affiliation(s)
- Charalampos S Siristatidis
- Medical School, National and Kapodistrian University of AthensAssisted Reproduction Unit, 3rd Department of Obstetrics and GynaecologyAttikon University Hospital,Rimini 1AthensGreece12462
| | - Eleni Sertedaki
- Medical School, National and Kapodistrian University of Athens75 M. Assias StreetGoudiAthensGreece115 27
| | - Dennis Vaidakis
- University of Athens3rd Department of Obstetrics and Gynecology'Attikon' Hospital, ChaidariAthensGreece
| |
Collapse
|
56
|
Deltombe-Bodart S, Deruelle P, Drumez E, Cordiez S, Catteau-Jonard S, Garabedian C. Obstetrical and perinatal complications of twin pregnancies: is there a link with the type of infertility treatment? Acta Obstet Gynecol Scand 2017; 96:844-851. [DOI: 10.1111/aogs.13135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 03/19/2017] [Indexed: 11/28/2022]
Affiliation(s)
| | - Philippe Deruelle
- Department of Obstetrics; GemJDF Project; CHU Lille; Lille France
- EA 4489 - Perinatal Health and Environment; University of Lille; Lille France
| | - Elodie Drumez
- Department of Biostatistics; EA 2694 - Public Health: Epidemiology and Healthcare Quality; CHU Lille; Lille France
| | - Sophie Cordiez
- Department of Obstetrics; GemJDF Project; CHU Lille; Lille France
| | | | - Charles Garabedian
- Department of Obstetrics; GemJDF Project; CHU Lille; Lille France
- EA 4489 - Perinatal Health and Environment; University of Lille; Lille France
| |
Collapse
|
57
|
Kumaresan A, Johannisson A, Nordqvist S, Kårehed K, Åkerud H, Lindgren KE, Morrell JM. Relationship of DNA integrity to HRG C633T SNP and ART outcome in infertile couples. Reproduction 2017; 153:865-876. [PMID: 28356499 DOI: 10.1530/rep-17-0058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/17/2017] [Accepted: 03/29/2017] [Indexed: 11/08/2022]
Abstract
The status of sperm DNA fragmentation, protamine deficiency, free thiols and disulphide bonds in colloid-selected samples and its relationship to ART outcome or HRG C633T SNP is not known. The objective of this study was to determine these relationships in spermatozoa from men with male factor or unknown factor infertility (n = 118) undergoing in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI). Sperm DNA integrity was analysed by flow cytometry using three fluorescent probes (acridine orange, monobromobimane and chromomycin A3). Principal component analysis (PCA) was used to identify the parameters that most influenced fertility. The relationships of sperm DNA integrity with seminal parameters, HRG C633T SNP and ART outcome were established using ANOVA and t-test. Sperm concentration and yield after preparation accounted for 27% of the total variance; sperm DNA integrity (%DFI and disulphide bonds) accounted for 16% of the variance in men from infertile couples. Sperm %DFI was significantly higher (P < 0.05) in older men than in younger men. A significant difference (P < 0.01) was observed in %DFI between smokers and non-smokers. Sperm %DFI was significantly higher (P < 0.01) in male factor infertility compared to either female factor or unknown factor infertility while free thiols were significantly higher (P < 0.01) in unknown infertility factor. No significant difference was observed between IVF success/failure in any of the seminal parameters studied. There was a tendency for protamine deficiency to be higher and disulphide concentration to be lower in men with HRG 633T. Such assessments may provide additional useful information about the prognosis for ART outcome, although more research is needed before clinical guidelines can be provided.
Collapse
Affiliation(s)
- Arumugam Kumaresan
- Department of Clinical Sciences/Division of ReproductionSwedish University of Agricultural Sciences, Uppsala, Sweden.,Theriogenology LaboratoryAnimal Reproduction, Gynaecology & Obstetrics, National Dairy Research Institute, Karnal, Haryana, India
| | - Anders Johannisson
- Department of Clinical Sciences/Division of ReproductionSwedish University of Agricultural Sciences, Uppsala, Sweden
| | - Sarah Nordqvist
- Department of GeneticsImmunology and Pathology, and Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Karin Kårehed
- Department of GeneticsImmunology and Pathology, and Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Helena Åkerud
- Department of GeneticsImmunology and Pathology, Uppsala University, Uppsala, Sweden
| | - Karin E Lindgren
- Department of GeneticsImmunology and Pathology, and Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Jane M Morrell
- Department of Clinical Sciences/Division of ReproductionSwedish University of Agricultural Sciences, Uppsala, Sweden
| |
Collapse
|
58
|
Wainstock T, Walfisch A, Shoham-Vardi I, Segal I, Harlev A, Sergienko R, Landau D, Sheiner E. Fertility treatments and pediatric neoplasms of the offspring: results of a population-based cohort with a median follow-up of 10 years. Am J Obstet Gynecol 2017; 216:314.e1-314.e14. [PMID: 28153657 DOI: 10.1016/j.ajog.2017.01.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 12/19/2016] [Accepted: 01/13/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Studies have questioned the long-term health effects of offspring conceived after fertility treatments. METHODS We aimed to evaluate whether an association exists between mode of conception (in vitro fertilization, ovulation induction, or spontaneous pregnancy) and neoplasm risk (both benign and malignant tumors) among the offspring; we observed the offspring for up to 18 years. STUDY DESIGN A population-based cohort analysis was performed that compared the risk for neoplasms among children (up to the age of 18 years) based on mode of conception. Neoplasm diagnoses were based on hospital records of the same single tertiary center in the region. All singletons born during from 1991-2013 and discharged alive were included in the study. Offspring with congenital malformations were excluded from the analysis. Kaplan-Meier survival curves were constructed to compare cumulative neoplasms incidence; multivariable survival analyses were used to control for confounders that included gestational age, pregnancy complications, and maternal factors. RESULTS During the study period, 242,187 newborn infants met the inclusion criteria: 2603 (1.1%) were conceived after in vitro fertilization; 1721 (0.7%) were conceived after ovulation induction treatments, and 237,863 (98.3%) were conceived spontaneously. During the follow-up period (median, 10.55 years), 1498 neoplasms(0.6%) were diagnosed. Incidence density rate for neoplasms was higher among children conceived either after in vitro fertilization (1.5/1000 person years) or ovulation induction treatments (1.0/1000 person years), as compared with naturally conceived children (0.59/1000 person years; Kaplan-Meier log rank, P<.001). The association between in vitro fertilization and total pediatric neoplasms and the association between any fertility treatments and malignancies remained significant; we controlled for confounders such as gestational diabetes mellitus, hypertensive disorders, preterm birth, and maternal age (adjusted hazard ratio, 2.48; 95% confidence interval, 1.71-3.50; and adjusted hazard ratio, 1.96; 95% confidence interval, 1.14-3.36, for all neoplasms and all malignancies, respectively). CONCLUSION Children conceived after fertility treatments are at an increased risk for pediatric neoplasms.
Collapse
|
59
|
Bhide P, Maheshwari A, Cutting R, Seenan S, Patel A, Khan K, Homburg R. Time lapse imaging: is it time to incorporate this technology into routine clinical practice? HUM FERTIL 2017; 20:74-79. [DOI: 10.1080/14647273.2017.1283068] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Priya Bhide
- Homerton Fertility Centre, Homerton University Hospital NHS foundation Trust, London, United Kingdom
| | - Abha Maheshwari
- NHS Grampian, Aberdeen Fertility Centre, Aberdeen, United Kingdom
| | - Rachel Cutting
- Jessop Fertility, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Susan Seenan
- Fertility Network UK, East Sussex, United Kingdom
| | - Anita Patel
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Khalid Khan
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Roy Homburg
- Homerton Fertility Centre, Homerton University Hospital NHS foundation Trust, London, United Kingdom
| |
Collapse
|
60
|
Lédée N, Prat-Ellenberg L, Chevrier L, Balet R, Simon C, Lenoble C, Irani EE, Bouret D, Cassuto G, Vitoux D, Vezmar K, Bensussan A, Chaouat G, Petitbarat M. Uterine immune profiling for increasing live birth rate: A one-to-one matched cohort study. J Reprod Immunol 2017; 119:23-30. [DOI: 10.1016/j.jri.2016.11.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 11/16/2016] [Accepted: 11/18/2016] [Indexed: 01/31/2023]
|
61
|
Epigenetic Influences During the Periconception Period and Assisted Reproduction. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1014:15-39. [PMID: 28864983 DOI: 10.1007/978-3-319-62414-3_2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The periconception period starts 6 months before conception and lasts until the tenth week of gestation. In this chapter, we will focus on epigenetic modifications to DNA and gene expression within this period and during assisted reproduction. There are two critical times during the periconception window when significant epigenetic 'reprogramming' occur: one during gametogenesis and another during the pre-implantation embryonic stage. Furthermore, assisted conception treatments, laboratory protocols and culture media can affect the embryo development and birth weights in laboratory animals. There is, however, an ongoing debate as to whether epigenetic changes in humans, causing embryo mal-development, placenta dysfunction and birth defects, result from assisted reproductive technologies or are consequences of pre-existing medical and/or genetic conditions in the parents. The periconception period starts from ovarian folliculogenesis, through resumption of oogenesis, fertilisation, peri-implantation embryo development, embryogenesis until the end of organogenesis. In men, it is the period from spermatogenesis to epididymal sperm storage and fertilisation. Gametes and developing embryos are sensitive to environmental factors during this period, and epigenetic modifications can occur in response to adverse lifestyles and environmental factors. We now know that lifestyle factors such as advanced parentage age, obesity or undernutrition, smoking, excessive alcohol and caffeine intake and recreational drugs used during gamete production and embryogenesis could induce epigenetic alterations, which could impact adversely on pregnancy outcomes and health of the offspring. Furthermore, these can also result in a permanent and irreversible effect in a dose-dependent manner, which can be passed on to the future generations.
Collapse
|
62
|
Crespo E, Bestard J. Psychosocial needs of women and their partners after successful assisted reproduction treatment in Barcelona. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2016; 3:90-99. [PMID: 29774254 PMCID: PMC5952818 DOI: 10.1016/j.rbms.2017.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 12/28/2016] [Accepted: 04/21/2017] [Indexed: 06/08/2023]
Abstract
It is assumed that pregnancy and parenthood after a period of infertility are unproblematic and gratifying. However, a review of the literature highlights the complexity of the psychological and social consequences of pregnancy, childbirth and parenting after successful treatment with assisted reproductive technology. These experiences, including those following the creation of new forms of non-genetic and/or social parenthood, require investigation in order to understand how women and their partners integrate their journey from infertility to pregnancy and parenthood after successful assisted reproductive treatment. This paper presents results derived from qualitative interviews with 30 pregnant women and 21 couples after assisted reproductive treatment (repeated rounds of individual interviews with the study participants) conducted from July 2010 to April 2014 as part of a larger ethnographic study exploring the psychosocial needs of women and partners following assisted reproductive treatment in Barcelona's. The transcribed text was coded into categories of either predetermined or emergent topics. Prior studies have found that couples who achieve pregnancy after infertility may experience higher levels of anxiety in relation to pregnancy. This anxiety can be linked with a higher risk of complications during pregnancy after assisted reproductive treatment compared with spontaneous conception. However, the evidence concerning adjustment to pregnancy and parenthood is inconclusive. This study highlights the necessity for participants to give meaning to these treatments, given the variability that exists in perceptions of infertility and pregnancy after successful assisted reproductive treatment.
Collapse
|
63
|
Guo H, Wang Y, Chen Q, Chai W, Lv Q, Kuang Y. Effect of Natural Cycle Endometrial Preparation for Frozen-Thawed Embryo Transfer in Patients with Advanced Endometriosis. Med Sci Monit 2016; 22:4596-4603. [PMID: 27889789 PMCID: PMC5126939 DOI: 10.12659/msm.898044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The aim of this study was to investigate the effect of natural cycle (NC) endometrial preparation for frozen-thawed embryo transfer (FET) in women with advanced endometriosis. Material/Methods This retrospective study included 179 patients with stage III–IV endometriosis who underwent 233 FET cycles at a tertiary care academic reproductive medical center between March 2011 and August 2013 (group A). The control group included 258 patients with tubal factor infertility who underwent 300 FET cycles (group B). Both groups were prepared for FET using a NC protocol. Rates of implantation, clinical pregnancy, live birth, ongoing pregnancy, miscarriage, and pregnancy complication were recorded. Results The implantation rate (A: 36.0%, B: 30.4%, P=0.06), the pregnancy rate (A: 50.2%, B: 45.3%, P=0.263), and the live birth rate (A: 39.91%, B: 39.0%, P=0.428) were similar between the stage III–IV endometriosis and tubal factor infertility groups. No differences were observed in ongoing rates of pregnancy, miscarriage, and pregnancy complications, independent of endometriosis severity. No congenital birth defects were found. When high-quality embryos are transferred, pregnancy results were not affected by active endometriosis. Although severe endometriosis did not affect birth rate, higher frequencies of premature delivery (mean gestational age A: 37 weeks, B: 38.3 weeks, P=0.044) and low birth weight were observed (<2500 g A: 26.4%, B: 16.6%, P=0.047). Conclusions There was no difference in pregnancy outcomes between patients with endometriosis and those with tubal infertility. Pregnancy outcomes in patients with endometriosis were not affected by endometriosis severity. Pregnancy outcomes were not affected by active endometrial cyst.
Collapse
Affiliation(s)
- Haiyan Guo
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai, China (mainland)
| | - Yun Wang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai, China (mainland)
| | - Qiuju Chen
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai, China (mainland)
| | - Weiran Chai
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai, China (mainland)
| | - Qifeng Lv
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai, China (mainland)
| | - Yanping Kuang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai, China (mainland)
| |
Collapse
|
64
|
A direct healthcare cost analysis of the cryopreserved versus fresh transfer policy at the blastocyst stage. Reprod Biomed Online 2016; 34:19-26. [PMID: 27746110 DOI: 10.1016/j.rbmo.2016.09.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 09/15/2016] [Accepted: 09/21/2016] [Indexed: 11/22/2022]
Abstract
A cost analysis covering direct healthcare costs relating to IVF freeze-all policy was conducted. Normal- and high- responder patients treated with a freeze-all policy (n = 63) compared with fresh transfer IVF (n = 189) matched by age, body mass index, duration and cause of infertility, predictive factors for IVF (number of oocytes used for fertilization) and study period, according to a 1:3 ratio were included. Total costs per patient (€6952 versus €6863) and mean costs per live birth were similar between the freeze-all strategy (€13,101, 95% CI 10,686 to 17,041) and fresh transfer IVF (€15,279, 95% CI 13,212 to 18,030). A mean per live birth cost-saving of €2178 (95% CI -1810 to 6165) resulted in a freeze-all strategy owing to fewer embryo transfer procedures (1.29 ± 0.5 versus 1.41 ± 0.7); differences were not significant. Sensitivity analysis revealed that the freeze-all strategy remained cost-effective until the live birth rate is either higher or only slightly lower (≥-0.59%) in the freeze-all group compared with fresh cycles. A freeze-all policy does not increase costs compared with fresh transfer, owing to negligible additional expenses, i.e. vitrification, endometrial priming and monitoring, against fewer embryo transfer procedures required to achieve pregnancy.
Collapse
|
65
|
Chistyakova G, Gazieva I, Remizova I, Ustyantseva L, Lyapunov V, Bychkova S. Risk factors vary early preterm birth and perinatal complications after assisted reproductive technology. Gynecol Endocrinol 2016; 32:56-61. [PMID: 27759457 DOI: 10.1080/09513590.2016.1232543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
We conducted a study of markers of endothelial dysfunction and angiogenesis regulation, as well as the identification of the main lymphocyte populations, activated CD3 + CD95+-cells and cytokine-producing CD4 + IFN-γ+-, CD4 + IL-4+ -lymphocytes in the 1st trimester of gestation in women with ART-induced pregnancy and spontaneous pregnancy. We used the same indicators to assess the immune status of ELBW infants at birth and at the post-conceptual age of 38-40 weeks. It was determined that the risk factors of very early preterm delivery are: threatened miscarriage, chronic placental insufficiency, endothelial dysfunction, increased spontaneous production of intracellular cytokines. Adverse perinatal outcomes in ELBW infants from ART-induced pregnancy are associated with lower anthropometric measures, low Apgar scores high level of inflammatory infections (pneumonia), grade II intraventricular hemorrhage, movement disorders in the form of lower paraparesis. Immune status of those infants is characterized by the increase in the number of CD8+- and CD3-CD16 + CD56+ -lymphocytes, the expression level of Fas-receptor by T-cells, and the increased production of intracellular and serum IFNγ against the decrease in the number of CD4+-cells, which indicates enhancing of cytotoxic effector potential and proinflammatory orientation of cell responses.
Collapse
Affiliation(s)
- G Chistyakova
- a Ural Scientific Research Institute of Maternity and Infancy , Yekaterinburg , Russia
| | - I Gazieva
- a Ural Scientific Research Institute of Maternity and Infancy , Yekaterinburg , Russia
| | - I Remizova
- a Ural Scientific Research Institute of Maternity and Infancy , Yekaterinburg , Russia
| | - L Ustyantseva
- a Ural Scientific Research Institute of Maternity and Infancy , Yekaterinburg , Russia
| | - V Lyapunov
- a Ural Scientific Research Institute of Maternity and Infancy , Yekaterinburg , Russia
| | - S Bychkova
- a Ural Scientific Research Institute of Maternity and Infancy , Yekaterinburg , Russia
| |
Collapse
|
66
|
Zhao J, Xu B, Zhang Q, Li YP. Which one has a better obstetric and perinatal outcome in singleton pregnancy, IVF/ICSI or FET?: a systematic review and meta-analysis. Reprod Biol Endocrinol 2016; 14:51. [PMID: 27577996 PMCID: PMC5006501 DOI: 10.1186/s12958-016-0188-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 08/23/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The present study aims to compare which one has a better obstetric and perinatal outcome in singleton pregnancy, frozen embryo transfer (FET) or. in vitro fertilization treatment/intracytoplasmic sperm injection (IVF/ICSI)? METHODS MEDLINE, Google Scholar and the Cochrane Library were searched for the obstetric and perinatal outcomes in singleton pregnancy after assisted reproductive technology (ART) from inception until July 2016. Clinical trials, which compared obstetric/perinatal outcomes in singleton pregnancy after FET and IVF/ICSI-ET, were included. The primary outcome was low birth weight, preterm birth, perinatal mortality, still birth, and cesarean section. RESULTS Thirteen cohort studies with 126,911 women were included, of which 12, 11, 6, 6, 5 studies were used to analyze low birth weight, preterm birth, perinatal mortality, still birth, and cesarean section, respectively. IVF/ICSI is associated with a high risk of preterm birth (OR = 1.14, 95 % CI: 1.02, 1.28) and low birth rate (OR = 1.48, 95 % CI: 1.37, 1.60). There was no significant difference in the risk of the still birth (OR = 1.01, 95 % CI: 0.76, 1.35) and perinatal mortality (OR = 1.11, 95 % CI: 0.85, 1.46) between FET and IVF/ICSI. Singleton pregnancy after FET was associated with higher cesarean section rate compared with IVF/ICSI (OR = 0.85, 95 % CI: 0.80, 0.91). CONCLUSIONS Singleton pregnancy after FET seems to have a better perinatal outcome compared with that after IVF/ICSI. Further randomized controlled trials which adjust for a variety of meaningful confounders are needed in order to draw sound conclusions.
Collapse
Affiliation(s)
- J. Zhao
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha City, 410008 Hunan Province People’s Republic of China
| | - B. Xu
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha City, 410008 Hunan Province People’s Republic of China
| | - Q. Zhang
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha City, 410008 Hunan Province People’s Republic of China
| | - Y. P. Li
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha City, 410008 Hunan Province People’s Republic of China
| |
Collapse
|
67
|
Palini S, Primiterra M, De Stefani S, Pedna MF, Sparacino M, Farabegoli P, Benedetti S, Bulletti C, Sambri V. A new micro swim-up procedure for sperm preparation in ICSI treatments: preliminary microbiological testing. JBRA Assist Reprod 2016; 20:94-8. [PMID: 27584599 PMCID: PMC5264371 DOI: 10.5935/1518-0557.20160023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective This study aimed to assess the levels of microbial contamination in semen
samples before and after the micro swim-up (MSU) procedure in
intra-cytoplasmic sperm injection (ICSI). The new method is an upgrade to
the classic wash swim-up procedure. Methods Semen analysis and microbiological tests were carried out before and after
the MSU procedure. A total of twenty semen samples were analyzed. Results Pathogens were observed in semen samples only before MSU and never after
ICSI. Microbiological tests revealed a large prevalence of gram-positive
cocci [Staphylococcus spp. (n=16, 80%) and viridans streptococci (n=10,
50%)]. The results of this study indicate that direct MSU in ICSI improved
the ICSI workflow. Conclusion The new workflow is faster and more affordable, and is likely to prevent
infection problems that could arise from the normal microbial flora of the
semen.
Collapse
Affiliation(s)
| | | | | | - Maria Federica Pedna
- Unit of Microbiology, The Greater Romagna Hub Laboratory, AUSL della Romagna, Pievesestina, Cesena, Italy
| | - Monica Sparacino
- Unit of Microbiology, The Greater Romagna Hub Laboratory, AUSL della Romagna, Pievesestina, Cesena, Italy
| | - Patrizia Farabegoli
- Unit of Microbiology, The Greater Romagna Hub Laboratory, AUSL della Romagna, Pievesestina, Cesena, Italy
| | - Serena Benedetti
- University of Urbino "Carlo Bo", Department of Biomolecular Sciences, Section of Clinical Biochemistry and Molecular Genetics, Urbino, Italy
| | | | - Vittorio Sambri
- Unit of Microbiology, The Greater Romagna Hub Laboratory, AUSL della Romagna, Pievesestina, Cesena, Italy.,DIMES, University of Bologna, Bologna, Italy
| |
Collapse
|
68
|
Guan Y, Fan H, Styer AK, Xiao Z, Li Z, Zhang J, Sun L, Wang X, Zhang Z. A modified natural cycle results in higher live birth rate in vitrified-thawed embryo transfer for women with regular menstruation. Syst Biol Reprod Med 2016; 62:335-42. [DOI: 10.1080/19396368.2016.1199064] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
69
|
Hossain A, Phelps J, Agarwal A, Sanz E, Mahadevan M. A Review of The Society for Assisted Reproductive Technology Embryo Grading System and Proposed Modification. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2016; 10:141-7. [PMID: 27441045 PMCID: PMC4948064 DOI: 10.22074/ijfs.2016.4956] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 08/30/2015] [Indexed: 01/17/2023]
Abstract
The Society for Assisted Reproductive Technology (SART) method of embryo grad- ing is unique, simple, and widely practiced, and its use has been mandatory for SART membership programs since 2010. Developed by SART in 2006, the current embryo grading system categories, "good, fair, and poor," are limited because they do not describe the best 1-2 embryos in the interest of keeping pace with the shift in clinical practice to be more selective and to transfer fewer embryos. This inspired us to conduct a review on the SART embryo grading system. In this retrospective study, the literature on evaluation of human embryo quality in gen- eral, and the SART method of evaluation in particular, were reviewed for the period of 2000 to 2014. A multifaceted search pertaining to methods of embryo grading and trans- fer using a combination of relevant terms [embryo, mammalian, embryo transfer, grade, grading, morphology, biomarkers, SART, and in vitro fertilization (IVF)] was performed. The inclusion and exclusion in this review were dictated by the aim and scope of the study. Two investigators independently assessed the studies and extracted information. A total of 61 articles were reviewed. Very few studies have evaluated the efficacy of the SART embryo grading method. The present study suggests the necessity for revision of the current SART grading system. The system, as it is now, lacks criteria for describing the cohort specific best embryo and thus is of limited use in single embryo transfer. The study foresees heightened descriptive efficiency of the SART system by implementing the proposed changes. Strengths and weaknesses of the SART embryo grading were identified. Ideas for selecting the best cohort-specific embryo have been discussed, which may trigger methodological improvement in SART and other embryo grading systems.
Collapse
Affiliation(s)
- Amjad Hossain
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology,
The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - John Phelps
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology,
The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Ashok Agarwal
- Department of Urology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Eduardo Sanz
- Center for Reproductive Health, Crest Hill, IL, USA
| | - Maha Mahadevan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology,
University of Arkansas for Medical Sciences, Little Rock, AR, USA
| |
Collapse
|
70
|
Brabers AEM, van Dijk L, Groenewegen PP, van Peperstraten AM, de Jong JD. Does a strategy to promote shared decision-making reduce medical practice variation in the choice of either single or double embryo transfer after in vitro fertilisation? A secondary analysis of a randomised controlled trial. BMJ Open 2016; 6:e010894. [PMID: 27154481 PMCID: PMC4861095 DOI: 10.1136/bmjopen-2015-010894] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 03/29/2016] [Accepted: 04/05/2016] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES The hypothesis that shared decision-making (SDM) reduces medical practice variations is increasingly common, but no evidence is available. We aimed to elaborate further on this, and to perform a first exploratory analysis to examine this hypothesis. This analysis, based on a limited data set, examined how SDM is associated with variation in the choice of single embryo transfer (SET) or double embryo transfer (DET) after in vitro fertilisation (IVF). We examined variation between and within hospitals. DESIGN A secondary analysis of a randomised controlled trial. SETTING 5 hospitals in the Netherlands. PARTICIPANTS 222 couples (woman aged <40 years) on a waiting list for a first IVF cycle, who could choose between SET and DET (ie, ≥2 embryos available). INTERVENTION SDM via a multifaceted strategy aimed to empower couples in deciding how many embryos should be transferred. The strategy consisted of decision aid, support of IVF nurse and the offer of reimbursement for an extra treatment cycle. Control group received standard IVF care. OUTCOME MEASURE Difference in variation due to SDM in the choice of SET or DET, both between and within hospitals. RESULTS There was large variation in the choice of SET or DET between hospitals in the control group. Lower variation between hospitals was observed in the group with SDM. Within most hospitals, variation in the choice of SET or DET appeared to increase due to SDM. Variation particularly increased in hospitals where mainly DET was chosen in the control group. CONCLUSIONS Although based on a limited data set, our study gives a first insight that including patients' preferences through SDM results in less variation between hospitals, and indicates another pattern of variation within hospitals. Variation that results from patient preferences could be potentially named the informed patient rate. Our results provide the starting point for further research. TRIAL REGISTRATION NUMBER NCT00315029; Post-results.
Collapse
Affiliation(s)
- Anne E M Brabers
- NIVEL, the Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Liset van Dijk
- NIVEL, the Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Peter P Groenewegen
- NIVEL, the Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Department of Sociology, Utrecht University, Utrecht, The Netherlands
- Department of Human Geography, Utrecht University, Utrecht, The Netherlands
| | - Arno M van Peperstraten
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Judith D de Jong
- NIVEL, the Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| |
Collapse
|
71
|
Luke S, Sappenfield WM, Kirby RS, McKane P, Bernson D, Zhang Y, Chuong F, Cohen B, Boulet SL, Kissin DM. The Impact of ART on Live Birth Outcomes: Differing Experiences across Three States. Paediatr Perinat Epidemiol 2016; 30:209-16. [PMID: 26913961 PMCID: PMC10976649 DOI: 10.1111/ppe.12287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Research has shown an association between assisted reproductive technology (ART) and adverse birth outcomes. We identified whether birth outcomes of ART-conceived pregnancies vary across states with different maternal characteristics, insurance coverage for ART services, and type of ART services provided. METHODS CDC's National ART Surveillance System data were linked to Massachusetts, Florida, and Michigan vital records from 2000 through 2006. Maternal characteristics in ART- and non-ART-conceived live births were compared between states using chi-square tests. We performed multivariable logistic regression analyses and calculated adjusted odds ratios (aOR) to assess associations between ART use and singleton preterm delivery (<32 weeks, <37 weeks), singleton small for gestational age (SGA) (<5th and <10th percentiles) and multiple birth. RESULTS ART use in Massachusetts was associated with significantly lower odds of twins as well as triplets and higher order births compared to Florida and Michigan (aOR 22.6 vs. 30.0 and 26.3, and aOR 37.6 vs. 92.8 and 99.2, respectively; Pinteraction < 0.001). ART use was associated with increased odds of SGA in Michigan only, and with preterm delivery (<32 and <37 weeks) in all states (aOR range: 1.60, 1.87). CONCLUSIONS ART use was associated with an increased risk of preterm delivery among singletons that showed little variability between states. The number of twins, triplets and higher order gestations per cycle was lower in Massachusetts, which may be due to the availability of insurance coverage for ART in Massachusetts.
Collapse
Affiliation(s)
- Sabrina Luke
- College of Public Health, University of South Florida, Tampa, FL
| | | | - Russell S. Kirby
- College of Public Health, University of South Florida, Tampa, FL
| | | | - Dana Bernson
- Massachusetts Department of Public Health, Boston, MA
| | - Yujia Zhang
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Bruce Cohen
- Massachusetts Department of Public Health, Boston, MA
| | | | | |
Collapse
|
72
|
Nwaru BI, McCleary N, Erkkola M, Kaila M, Virtanen SM, Sheikh A. Assisted reproductive technology and risk of asthma and allergy in the offspring: protocol for a systematic review and meta-analysis. BMJ Open 2016; 6:e010697. [PMID: 27105714 PMCID: PMC4853991 DOI: 10.1136/bmjopen-2015-010697] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION The use of assisted reproductive technology (ART) procedures has increased globally over the last three decades. Recent observational studies suggest that children conceived through ART may be at increased risk of asthma and atopic disease compared with children conceived naturally, but findings are mixed. We aim to synthesise the evidence on the impact of ART on the risk of asthma and atopic disease in the offspring. METHODS AND ANALYSIS We will identify relevant studies by searching MEDLINE, EMBASE, Cochrane Library, ISI Web of Science, CINAHL, Scopus, Google Scholar, AMED, Global Health, PsychINFO, CAB International and the WHO Global Health Library from 1978 to 2016. We will locate additional studies through searching databases of the proceedings of international conferences, contacting international experts in the field, and searching the references cited in identified studies. We will include analytic observational studies (cohort studies, case-control studies and cross-sectional studies) that have investigated the impact of any type of ART on offspring's asthma and atopic disease. Screening of identified records, data extraction from eligible studies and risk of bias assessment of eligible studies will be independently undertaken by two reviewers, with arbitration by a third reviewer. The Effective Public Health Practice Project will be employed for risk of bias assessment. Estimates from studies judged to be clinically, methodologically and statistically homogeneous will be synthesised using random-effects meta-analysis. ETHICS AND DISSEMINATION As this study is based solely on the published literature, no ethics approval is required. We will publish our findings in a peer-reviewed scientific journal and present the results at national and international scientific conferences. PROTOCOL REGISTRATION We will register a detailed protocol for the review with the International Prospective Register of Systematic Reviews (PROSPERO) prior to starting the review.
Collapse
Affiliation(s)
- Bright I Nwaru
- School of Health Sciences, University of Tampere, Tampere, Finland Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Nicola McCleary
- Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Maijaliisa Erkkola
- Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - Minna Kaila
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Suvi M Virtanen
- Nutrition Unit, Department of Lifestyle and Participation, National Institute for Health and Welfare, Helsinki, Finland Tampere Centre for Child Health Research, Tampere University Hospital, Tampere, Finland Science Centre of Pirkanmaa Hospital District, Tampere University Hospital and University of Tampere, Tampere, Finland School of Health Sciences, University of Tampere, Tampere, Finland
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| |
Collapse
|
73
|
Davidson LM, Coward K. Molecular mechanisms of membrane interaction at implantation. ACTA ACUST UNITED AC 2016; 108:19-32. [DOI: 10.1002/bdrc.21122] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/22/2016] [Indexed: 01/01/2023]
Affiliation(s)
- Lien M. Davidson
- Nuffield Department of Obstetrics and Gynaecology; University of Oxford, Level 3, Women's Centre, John Radcliffe Hospital; Headington Oxford OX3 9DU United Kingdom
| | - Kevin Coward
- Nuffield Department of Obstetrics and Gynaecology; University of Oxford, Level 3, Women's Centre, John Radcliffe Hospital; Headington Oxford OX3 9DU United Kingdom
| |
Collapse
|
74
|
Valenzuela-Alcaraz B, Crispi F, Manau D, Cruz-Lemini M, Borras A, Balasch J, Gratacós E. Differential effect of mode of conception and infertility treatment on fetal growth and prematurity. J Matern Fetal Neonatal Med 2016; 29:3879-84. [PMID: 26856245 DOI: 10.3109/14767058.2016.1151868] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objectives To examine perinatal outcomes in pregnancies conceived by different methods: fertile women with spontaneous pregnancies, infertile women who achieved pregnancy without treatment, pregnancies achieved by ovulation induction (OI) and in vitro fertilization or intra-cytoplasmic sperm injection (IVF/ICSI). Methods Retrospective single-center cohort study including 200 fertile and 748 infertile women stratified according to infertility treatment. The outcome measurements were preterm delivery (PTD), small-for-gestational-age (SGA), gestational diabetes, placenta previa or preeclampsia. Results The overall rate of pregnancy complications was significantly increased in all infertility groups regardless of the infertility treatment (adjusted odds ratio (OR): infertile without treatment 2.3 versus OI 2.2 versus IVF/ICSI 3.4). While PTD was mainly associated to IVF/ICSI (adjusted OR: infertile without treatment 1.3 versus OI 1.6 versus IVF/ICSI 3.3), SGA was significantly associated to both OI and IVF/ICSI (adjusted OR: infertile without treatment 1.9 versus OI 2.7 versus IVF/ICSI 2.6). All these associations remained statistically significant after adjusting by maternal age and twin pregnancy. Conclusions This study confirms the higher prevalence of pregnancy complications in infertile women irrespectively of receiving infertility treatment or not, and further describes a preferential association of prematurity with IVF/ICSI, and SGA with treated infertility (OI and IVF/ICSI).
Collapse
Affiliation(s)
- Brenda Valenzuela-Alcaraz
- a BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan De Deu), Institut D'investigacions Biomèdiques August Pi I Sunyer, Universitat De Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER) , Barcelona , Spain and
| | - Fátima Crispi
- a BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan De Deu), Institut D'investigacions Biomèdiques August Pi I Sunyer, Universitat De Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER) , Barcelona , Spain and
| | - Dolors Manau
- b Infertility and Assited Reproduction Unit, Faculty of Medicine, University of Barcelona, Hospital Clínic Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) , Barcelona , Spain
| | - Mónica Cruz-Lemini
- a BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan De Deu), Institut D'investigacions Biomèdiques August Pi I Sunyer, Universitat De Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER) , Barcelona , Spain and
| | - Aina Borras
- b Infertility and Assited Reproduction Unit, Faculty of Medicine, University of Barcelona, Hospital Clínic Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) , Barcelona , Spain
| | - Juan Balasch
- b Infertility and Assited Reproduction Unit, Faculty of Medicine, University of Barcelona, Hospital Clínic Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) , Barcelona , Spain
| | - Eduard Gratacós
- a BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan De Deu), Institut D'investigacions Biomèdiques August Pi I Sunyer, Universitat De Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER) , Barcelona , Spain and
| |
Collapse
|
75
|
Kato K. Vitrification of embryos and oocytes for fertility preservation in cancer patients. Reprod Med Biol 2016; 15:227-233. [PMID: 29259440 DOI: 10.1007/s12522-016-0239-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 02/12/2016] [Indexed: 12/24/2022] Open
Abstract
As survival rates and the life expectancy of those with malignancy have increased, more women in their reproductive years are referred for fertility preservation. Chemotherapy and radiotherapy can severely affect ovarian function, and the effect is irreversible. Therefore, it is optimal to attempt fertility preservation before chemotherapy and radiotherapy are initiated. Oocyte and embryo cryopreservation is the most common option for fertility preservation in women. Several reports have proven that embryo and oocyte cryopreservation can achieve a successful pregnancy. This review discusses the impact of chemotherapy and radiotherapy on ovarian function, and the importance of oocyte and embryo cryopreservation for fertility preservation. In addition, the current status of pregnancy outcomes and potential for cryopreserved oocytes to result in live births in cancer patients was reviewed. This may provide useful information for decision-making in cancer patients regarding oocyte and embryo cryopreservation and fertility preservation.
Collapse
Affiliation(s)
- Keiichi Kato
- Kato Ladies' Clinic7-20-3 Nishishinjuku, Shinjuku-ku 160-0023 Tokyo Japan
| |
Collapse
|
76
|
McLernon DJ, Maheshwari A, Lee AJ, Bhattacharya S. Cumulative live birth rates after one or more complete cycles of IVF: a population-based study of linked cycle data from 178,898 women. Hum Reprod 2016; 31:572-81. [PMID: 26783243 DOI: 10.1093/humrep/dev336] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 12/09/2015] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What is the chance of a live birth following one or more linked complete cycles of IVF (including ICSI)? SUMMARY ANSWER The chance of a live birth after three complete cycles of IVF was 42.3% for treatment commencing from 1999 to 2007. WHAT IS KNOWN ALREADY IVF success has generally been reported on the basis of live birth rates after a single episode of treatment resulting in the transfer of a fresh embryo. This fails to capture the real chance of having a baby after a number of complete cycles-each involving the replacement of fresh as well as frozen-thawed embryos. STUDY DESIGN, SIZE AND DURATION Population-based observational cohort study of 178 898 women between 1992 and 2007. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants included all women who commenced IVF treatment at a licenced clinic in the UK as recorded in the Human Fertilisation and Embryology Authority (HFEA) national database. Exclusion criteria included women whose treatment involved donor insemination, egg donation, surrogacy and the transfer of more than three embryos. Cumulative rates of live birth, term (>37 weeks) singleton live birth, and multiple pregnancy were estimated for two time-periods, 1992-1998 and 1999-2007. Conservative estimates assumed that women who did not return for IVF would not have the outcome of interest while optimal estimates assumed that these women would have similar outcome rates to those who continued IVF. MAIN RESULTS AND THE ROLE OF CHANCE A total of 71 551 women commenced IVF treatment during 1992-1998 and an additional 107 347 during 1999-2007. After the third complete IVF cycle (defined as three fresh IVF treatments-including replacement of any surplus frozen-thawed embryos), the conservative CLBR in women who commenced IVF during 1992-1998 was 30.8% increasing to 42.3% during 1999-2007. The optimal CLBRs were 44.6 and 57.1%, respectively. After eight complete cycles the optimal CLBR was 82.4% in the latter time period. The conservative rate for multiple pregnancy per pregnant woman fell from 31.9% during the earlier time period to 26.2% during the latter. LIMITATIONS AND REASON FOR CAUTION Linkage of all IVF treatments to individual women was conducted. However, it was not possible to identify with certainty in all cases the episode of ovarian stimulation which generated some of the frozen embryos. Cumulative live birth rates could not be calculated for women who started treatment beyond 2007 as follow-up data were incomplete in some of them. Following a change in legislation in 2008, linked data were only made available for research in women who gave formal consent for this purpose. BMI and ethnicity could not be reported: these demographics are not recorded in the HFEA database. WIDER IMPLICATIONS OF THE FINDINGS Our results demonstrate, at a national level, the chances of live birth in couples undergoing a number of complete (fresh and frozen) IVF cycles. They reflect improvements in reproductive technology and a more conservative embryo transfer policy. Although most couples in the UK still do not receive three complete IVF cycles; assuming no barriers to continuation of IVF treatment, around 83% of women receiving IVF would achieve a live birth by the eighth complete cycle, similar to the natural live birth rate in a non-contraception practising population. Our results support the call from NICE to develop consistent IVF policies based on three complete cycles. STUDY FUNDING/COMPETING INTERESTS This work was funded by a Chief Scientist Office Postdoctoral Training Fellowship in Health Services Research and Health of the Public Research (Ref PDF/12/06). The views expressed here are those of the authors and not necessarily those of the Chief Scientist Office. S.B. reports grants from Chief Scientist Office Scotland during the conduct of the study. His institution has received support from Pharmaceutical companies (for educational seminars), which is not related to the submitted work. D.J.M., A.M. and A.J.L. have no conflicts of interest to declare.
Collapse
Affiliation(s)
- David J McLernon
- Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Aberdeen AB25 2ZD, UK
| | - Abha Maheshwari
- Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Aberdeen AB25 2ZD, UK
| | - Amanda J Lee
- Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Aberdeen AB25 2ZD, UK
| | - Siladitya Bhattacharya
- Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Aberdeen AB25 2ZD, UK
| |
Collapse
|
77
|
Kupka MS, D'Hooghe T, Ferraretti AP, de Mouzon J, Erb K, Castilla JA, Calhaz-Jorge C, De Geyter C, Goossens V. Assisted reproductive technology in Europe, 2011: results generated from European registers by ESHRE. Hum Reprod 2016; 31:233-48. [PMID: 26740578 DOI: 10.1093/humrep/dev319] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/05/2015] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION The 15th European IVF-monitoring (EIM) report presents the results of treatments involving assisted reproductive technology (ART) initiated in Europe during 2011: are there any changes in the trends compared with previous years? SUMMARY ANSWER Despite some fluctuations in the number of countries reporting data, while the overall number of ART cycles has continued to increase year by year, the pregnancy rates in 2011 decreased slightly to those reported in 2010, and the number of transfers with multiple embryos (3+) and the multiple delivery rates declined. WHAT IS KNOWN ALREADY Since 1997, ART data in Europe have been collected and reported in 14 manuscripts, published in Human Reproduction. STUDY DESIGN, SIZE, DURATION Retrospective data collection of European ART data by the EIM Consortium for the European Society of Human Reproduction and Embryology (ESHRE); cycles started between 1 January and 31 December 2011 are collected on a yearly basis. The data are collected by National Registers, when existing, or on a voluntary basis by personal information. PARTICIPANTS/MATERIALS SETTING, METHODS From 33 countries (+2 compared with 2010), 1064 clinics reported 609 973 treatment cycles including: IVF 138 592, ICSI 298 918, frozen embryo replacement (FER) 129 693, egg donation (ED) 30 198, in vitro maturation 511, preimplantation genetic diagnosis/screening 6824 and frozen oocyte replacements 5237. European data on intrauterine insemination (IUI) using husband/partner's semen (IUI-H) and donor semen (IUI-D) were reported from 861 IUI laboratories in 24 countries. A total of 174 390 IUI-H and 41 151 IUI-D cycles were included. MAIN RESULTS AND THE ROLE OF CHANCE In 17 countries where all clinics reported to the ART register, a total of 361 972 ART cycles were performed in a population of 285 million inhabitants, corresponding to 1269 cycles per million inhabitants. For all IVF cycles, the clinical pregnancy rates per aspiration and per transfer were stable with 29.1 and 33.2%, respectively, and for ICSI, the corresponding rates also were stable with 27.9 and 31.8%, respectively. In FER cycles, the pregnancy rate per thawing increased to 21.3% if compared with previous years. In ED cycles, the pregnancy rate per fresh transfer decreased to 45.8% (47.4% in 2010) and increased to 33.6% (33.3% in 2010) per thawed transfer. The delivery rate after IUI-H decreased to 8.3 (8.9 in 2010), and to 12.2% (13.8% in 2010) after IUI-D. In IVF and ICSI cycles, 1, 2, 3 and 4+ embryos were transferred in 27.5, 56.7, 14.5 and 1.3% of cycles, respectively. The proportions of singleton, twin and triplet deliveries after IVF and ICSI (added together) were 80.8, 18.6 and 0.6%, respectively, resulting in a total multiple delivery rate of 19.2% compared with 20.6% in 2010, 20.2% in 2009, 21.7% in 2008, 22.3% in 2007 and 20.8% in 2006. In FER cycles, the multiple delivery rate was 13.2% (12.8% twins and 0.4% triplets). Twin and triplet delivery rates associated with IUI cycles were 9.7/0.6% and 7.3/0.3%, following IUI-H and IUI-D treatment, respectively. LIMITATIONS, REASONS FOR CAUTION The method of reporting varies among countries, and registers from a number of countries have been unable to provide some of the relevant data such as initiated cycles and deliveries. As long as data are incomplete and generated through different methods of collection, results should be interpreted with caution. WIDER IMPLICATIONS OF THE FINDINGS The 15th ESHRE report on ART shows a continuing expansion of the number of treatment cycles in Europe, with more than 600 000 cycles reported in 2011. Since 2006, the proportion of IVF to ICSI cycles has reached a plateau after a small decrease in 2009. Pregnancy and delivery rates after IVF remained relatively stable compared with 2010 and 2009. The pregnancy rate per aspiration in ICSI cycles declined for the first time by 0.9%. The multiple delivery rate is lower than ever before. STUDY FUNDING/COMPETING INTERESTS The study had no external funding; all costs are covered by ESHRE. There are no competing interests.
Collapse
Affiliation(s)
| | | | - M S Kupka
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - T D'Hooghe
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - A P Ferraretti
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - J de Mouzon
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - K Erb
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - J A Castilla
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - C Calhaz-Jorge
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - Ch De Geyter
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - V Goossens
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| |
Collapse
|
78
|
Gopinathan KK, Pillai A, Parasuram G, Thalakottoor FL. Evaluation of the Role of Hysteroscopic Endometrial Injury and Its Timing Prior to in vitro Fertilization Treatment. ACTA ACUST UNITED AC 2016. [DOI: 10.5005/jp-journals-10016-1128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Aim
To evaluate the role of hysteroscopic endometrial injury and its timing prior to embryo transfer in patients undergoing IVF (in vitro fertilization) treatment.
Materials and methods
A total of 133 patients who underwent hysteroscopy at CIMAR Fertility Centre at Kochi, between January 2013 and December 2014, and had normal hysteroscopic findings were enrolled for the study. These women subsequently underwent IVF treatment and were evaluated in three groups based on the timing of hysteroscopy before embryo transfer: Group I – hysteroscopy performed 50 days or less before embryo transfer (n = 54), group II – hysteroscopy performed between 51 days and 6 months of embryo transfer (n = 45), and group III – hysteroscopy performed more than 6 months before embryo transfer (n = 34).
Results
The implantation rates were 21.8, 22.6, and 21.6% in groups I, II, and III respectively. Overall pregnancy rates were 44.4, 48.9, and 44.1%. Clinical pregnancy rates (CPR) were 40.7, 46.7, and 44.1% and live birth rates (LBR) were 30, 29, and 26% in groups I, II, and III respectively. Thus the implantation rate, overall pregnancy rate, and CPR were not significantly different in the three groups.
Conclusion
Hysteroscopic endometrial injury prior to IVF does not improve the pregnancy rate in patients with normal hysteroscopic findings.
Clinical significance
Due to the lack of definitive evidence regarding the role of hysteroscopic endometrial injury, ideal technique, and its timing prior to embryo transfer, it is necessary to evaluate the role of endometrial injury as a fertility treatment in women undergoing assisted reproductive technology (ART) cycles, as well as to present it in a way that supports clinical practice. At this stage, there is little evidence to support hysteroscopic endometrial injury prior to embryo transfer as a standard of care, and its use should be limited to selected cases after careful deliberation between the medical team and patient.
How to cite this article
Pillai A, Parasuram G, Thalakottoor FL, Gopinathan KK. Evaluation of the Role of Hysteroscopic Endometrial Injury and Its Timing Prior to in vitro Fertilization Treatment. Int J Infertil Fetal Med 2016;7(2):52-57.
Collapse
|
79
|
Superimposed Preeclampsia. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 956:409-417. [DOI: 10.1007/5584_2016_82] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
80
|
Schulte K, Ehmcke J, Schlatt S, Boiani M, Nordhoff V. Lower total cell numbers in mouse preimplantation embryos cultured in human assisted reproductive technique (ART) media are not induced by apoptosis. Theriogenology 2015; 84:1620-30. [DOI: 10.1016/j.theriogenology.2015.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 08/10/2015] [Accepted: 08/21/2015] [Indexed: 12/23/2022]
|
81
|
Abstract
BACKGROUND One-third of subfertile couples have no identifiable cause for their inability to conceive. In vitro fertilisation (IVF) is a widely accepted treatment for this condition; however, this treatment is invasive and expensive and is associated with risks. OBJECTIVES To evaluate the effectiveness and safety of IVF compared with expectant management, unstimulated intrauterine insemination (IUI) or intrauterine insemination along with ovarian stimulation with gonadotropins (IUI + gonadotropins) or clomiphene (IUI + CC) or letrozole (IUI + letrozole) in improving pregnancy outcomes. SEARCH METHODS This review has drawn on the search strategy developed by the Cochrane Menstrual Disorders and Subfertility Group. We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (searched May 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, first quarter), MEDLINE (1946 to May 2015), EMBASE (1985 to May 2015), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (May 2015) and reference lists of articles. We searched the following trial registries: clinicaltrials.gov (http://www.clinicaltrials.gov) and the World Health Organization International Trials Registry Platform search portal (http://www.who.int/trialsearch/Default.aspx). We searched the Web of Science (http://wokinfo.com/) as another source of trials and conference abstracts, OpenGrey (http://www.opengrey.eu/) for unpublished literature from Europe and the Latin American Caribbean Health Sciences Literature (LILACS) database (http://regional.bvsalud.org/php/index.php?lang=en). Moreover, we handsearched relevant conference proceedings and contacted study authors to ask about additional publications.Two review authors independently assessed trial eligibility, extracted data and assessed risk of bias. The primary review outcome was cumulative live birth rate. Multiple pregnancy and other adverse effects were secondary outcomes. We combined data to calculate pooled risk ratios (RRs) and 95% confidence intervals (CIs). We assessed statistical heterogeneity by using the I(2) statistic. We assessed the overall quality of evidence for the main comparisons using Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methods. SELECTION CRITERIA We included randomised controlled trials (RCTs) in which the effectiveness of IVF in couples with unexplained subfertility was compared with that of other treatments, including expectant management, unstimulated IUI and stimulated IUI using gonadotropins or clomiphene or letrozole.Live birth rate (LBR) per woman was the primary outcome. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility and quality of trials and evaluated the quality of the evidence by using GRADE criteria. MAIN RESULTS IVF versus expectant management (two RCTs):Live birth rate per woman was higher with IVF than with expectant management (odds ratio (OR) 22.00, 95% confidence interval (CI) 2.56 to 189.37, one RCT, 51 women, very low quality evidence). Multiple pregnancy rates (MPRs), ovarian hyperstimulation syndrome (OHSS) and miscarriage were not reported. IVF versus unstimulated IUI (two RCTs):Live birth rate was higher with IVF than with unstimulated IUI (OR 2.47, 95% CI 1.19 to 5.12, two RCTs, 156 women, I(2) = 60%, low quality evidence). There was no evidence of a difference between the groups in multiple pregnancy rates (OR 1.03, 95% CI 0.04 to 27.29, one RCT, 43 women, very low quality evidence) IVF versus IUI + ovarian stimulation with gonadotropins (three RCTs) or clomiphene (one RCT) or letrozole (no RCTs):Data from these trials could not be pooled because of high statistical heterogeneity (I(2) = 93.3%). Heterogeneity was eliminated when studies were stratified by pretreatment status.In trials comparing IVF versus IUI + gonadotropins among treatment-naive women, there was no conclusive evidence of a difference between the groups in live birth rates (OR 1.27, 95% CI 0.94 to 1.73, four RCTs, 745 women, I(2) = 8.0%, moderate-quality evidence). In women pretreated with IUI + clomiphene, a higher live birth rate was reported among those who underwent IVF than those given IUI + gonadotropins (OR 3.90, 95% CI 2.32 to 6.57, one RCT, 280 women, moderate-quality evidence).There was no conclusive evidence of a difference in live birth rates between IVF and IUI + CC in treatment-naive women (OR 2.51, 95% CI 0.96 to 6.55, one RCT, 103 women, low quality evidence).In treatment-naive women, there was no evidence of a difference in rates of multiple pregnancy between women who underwent IVF and those who received IUI + gonadotropins (OR 0.79, 95% CI 0.45 to 1.39, four RCTs, 745 women, I(2) = 0%, moderate quality evidence). There was no evidence of a difference in MPRs between women who underwent IVF compared with those given IUI + CC (OR 1.02, 95% CI 0.20 to 5.31, one RCT, 103 women, low-quality evidence).There was no evidence of a difference in ovarian hyperstimulation syndrome rate between treatment-naive women who underwent IVF and those given IUI + gonadotropins (OR 1.23, 95% CI 0.36 to 4.14, two RCTs, 221 women, low quality evidence). There was no evidence of a difference in OHSS rates between groups receiving IVF versus those receiving IUI + CC (OR 1.02, 95% CI 0.20 to 5.31, one RCT, 103 women, low-quality evidence).In treatment naive women, there was no evidence of a difference in miscarriage rates between IVF and IUI + CC (OR 1.16, 95% CI 0.44 to 3.02, one RCT, 103 women, low-quality evidence), nor between women treated with IVF versus those receiving IUI+ gonadotropins (OR 1.16, 95% CI 0.44 to 3.02, one RCT, 103 women).No studies compared IVF with IUI + letrozole.The quality of the evidence ranged from very low to moderate. The main limitation was serious imprecision resulting from small study numbers and low event rates. AUTHORS' CONCLUSIONS IVF may be associated with higher live birth rates than expectant management, but there is insufficient evidence to draw firm conclusions. IVF may also be associated with higher live birth rates than unstimulated IUI. In women pretreated with clomiphene + IUI, IVF appears to be associated with higher birth rates than IUI + gonadotropins. However in women who are treatment-naive there is no conclusive evidence of a difference in live birth rates between IVF and IUI + gonadotropins or between IVF and IUI + clomiphene. Adverse events associated with these interventions could not be adequately assessed owing to lack of evidence.
Collapse
Affiliation(s)
- Zabeena Pandian
- Aberdeen Maternity HospitalObstetrics and GynaecologyForesterhillAberdeenUKAB25 2ZD
| | - Ahmed Gibreel
- Faculty of Medicine, Mansoura UniversityObstetrics & GynaecologyMansouraEgypt
| | | | | |
Collapse
|
82
|
Maheshwari A, McLernon D, Bhattacharya S. Cumulative live birth rate: time for a consensus? Hum Reprod 2015; 30:2703-7. [PMID: 26466912 DOI: 10.1093/humrep/dev263] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 09/24/2015] [Indexed: 11/13/2022] Open
Abstract
Traditionally, IVF success rates have been reported in terms of live birth per fresh cycle or embryo transfer. With the increasing use of embryo freezing and thawing it is essential that we report not only outcomes following fresh but also those after frozen embryo transfer as a complete measure of success of an IVF treatment. Most people agree that an individual's chance of having a baby following fresh and frozen embryo transfer should be described as cumulative live birth rate. However, views on the most appropriate parameters required to calculate such an outcome have been inconsistent. There is an additional dimension-time for all frozen embryos to be used up by a couple, which can influence the outcome. Given that cumulative live birth rate is generally perceived to be the preferred reporting system in IVF, it is time to have an international consensus on how this statistic is calculated, reported and interpreted by stakeholders across the world.
Collapse
Affiliation(s)
- Abha Maheshwari
- Aberdeen Fertility Centre, NHS Grampian, Foresterhill, Aberdeen, UK
| | - David McLernon
- Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB24 2ZD, UK
| | - Siladitya Bhattacharya
- Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB24 2ZD, UK
| |
Collapse
|
83
|
Çekmez Y, Korkmaz V, Çakır A, Göçmen A, Ergün Y, Gülşen S, Akpak YK. Does metoclopramide exposure alter endometrial receptivity and decrease pregnancy rates? J Matern Fetal Neonatal Med 2015; 29:2703-6. [PMID: 26421644 DOI: 10.3109/14767058.2015.1102221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effect of metoclopramide on endometrial receptivity with an immunohistochemical investigation of integrin β3 expression in pregnant rats. MATERIALS AND METHODS In the present study, the pregnant mice administrated by different doses of metoclopramide were used to explore the effect of metoclopramide on embryo implantation, especially on the endometrial receptivity. RESULTS The statistical results showed that the number of implanted embryos was gradually declining along the increasing dose of metoclopramide. When the administrated dose of metoclopramide was 3 mg/kg per day, great changes were observed in the exposed uterine morphology and down-regulated integrin β3 were also found in high dose metoclopramide-exposed mice. CONCLUSION Metoclopramide exposure, especially in high doses may alter endometrial receptivity by effecting integrin expression on decidual tissue which can decrease pregnancy rates. This drug should only be recommended for use during pregnancy when benefit outweighs the risk.
Collapse
Affiliation(s)
- Yasemin Çekmez
- a Department of Obstetrics and Gynecology , Umraniye Medical and Research Hospital , İstanbul , Turkey
| | - Vakkas Korkmaz
- b Department of Obstetrics and Gynecology , Ankara Medical and Research Hospital , Ankara , Turkey
| | - Aslı Çakır
- c Department of Pathology , Medipol University Hospital , İstanbul , Turkey , and
| | - Ahmet Göçmen
- a Department of Obstetrics and Gynecology , Umraniye Medical and Research Hospital , İstanbul , Turkey
| | - Yusuf Ergün
- b Department of Obstetrics and Gynecology , Ankara Medical and Research Hospital , Ankara , Turkey
| | - Serdar Gülşen
- a Department of Obstetrics and Gynecology , Umraniye Medical and Research Hospital , İstanbul , Turkey
| | - Yasam K Akpak
- d Department of Obstetrics and Gynecology , Ankara Mevki Military Hospital , Ankara , Turkey
| |
Collapse
|
84
|
Developmentally delayed cleavage-stage embryos maintain comparable implantation rates in frozen embryo transfers. J Assist Reprod Genet 2015; 32:1477-81. [PMID: 26347340 DOI: 10.1007/s10815-015-0561-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/23/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE In fresh IVF cycles, embryos reaching the eight-cell stage on day 3 of development are thought to have a higher chance of implantation than those reaching this stage on day 4. To determine whether this difference persists after cryopreservation, we compared pregnancy and implantation rates between frozen embryo transfer (FET) cycles using delayed cleavage-stage embryos (cryopreserved day 4) and normal cleavage-stage embryos (cryopreserved day 3). METHODS Participants underwent FET between 2008 and 2012 using embryos cryopreserved on either day 3 (n = 76) or day 4 (n = 48), depending on the length of time needed to achieve the eight-cell stage. All embryos, regardless of day of cryopreservation, were thawed and transferred on the 4th day of vaginal progesterone following endometrial preparation with oral estradiol. Chi-square and Mann-Whitney U tests were used to compare patient demographics and cycle outcomes. RESULTS More women in the day 4 group had diminished ovarian reserve (44 vs 16 %, p = 0.003). Pregnancy outcomes in preceding fresh cycles were not different between the two groups. Pregnancy, implantation, and live birth rates following FET did not differ between the day 3 and day 4 groups. CONCLUSIONS This is the first study to address outcomes using day 3 versus day 4 cryopreserved embryos. Despite a higher prevalence of diminished ovarian reserve (DOR) in the day 4 group, delayed cleavage-stage embryos utilized in FET cycles performed as well as embryos growing at the normal rate, suggesting delayed embryo development does not affect embryo implantation as long as endometrial synchrony is maintained.
Collapse
|
85
|
Chambers GM, Chughtai AA, Farquhar CM, Wang YA. Risk of preterm birth after blastocyst embryo transfer: a large population study using contemporary registry data from Australia and New Zealand. Fertil Steril 2015; 104:997-1003. [PMID: 26253819 DOI: 10.1016/j.fertnstert.2015.07.1130] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 06/27/2015] [Accepted: 07/15/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate whether there is an increased risk of preterm birth with blastocyst transfer compared with cleavage-stage embryo transfer (ET) after assisted reproductive technology (ART). DESIGN A retrospective, population-based study. SETTING Not applicable. PATIENT(S) A total of 50,788 infants conceived after ART treatment performed from 2009 to 2012. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The rates of preterm birth, low birth weight (LBW), and small for gestational age (SGA) for 43,952 singleton and 3,418 twin deliveries after transfers of blastocyst or cleavage-stage embryos. RESULT(S) Among singletons, there was no significant difference in the odds of preterm birth between blastocyst and cleavage-stage ET (9.1% compared with 9.3%, respectively, adjusted odds ratio 1.00, 95% confidence interval 0.94-1.08). Among twins, the crude rates of preterm birth were similar after blastocyst and cleavage-stage ETs (61.5% and 64.4%, respectively). However, after adjusting for potential confounders, blastocyst transfer was associated with a lower odds of preterm birth among twins (adjusted odds ratio 0.80, 95% confidence interval 0.70-0.93). There was no difference in risks of LBW and SGA between blastocyst and cleavage-stage ETs for both singletons and twins after adjusting for potential confounders. CONCLUSION(S) In contrast with the findings from a number of other studies, blastocyst culture in Australian and New Zealand is not associated with an increased risk of preterm, LBW, and SGA for singletons. Further studies are needed to assess longer-term outcomes of children born after ART treatment and possible biological or treatment factors related to adverse outcomes.
Collapse
Affiliation(s)
- Georgina M Chambers
- National Perinatal Epidemiology and Statistics Unit, Center for Big Data Research in Health, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
| | - Abrar A Chughtai
- National Perinatal Epidemiology and Statistics Unit, Center for Big Data Research in Health, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Cynthia M Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Yueping A Wang
- Faculty of Health, University of Technology, Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
86
|
Chaplia OV, Gontar JV, Bilko NM. Preimplantation development of human embryos with numerical chromosome abnormalities in vitro. CYTOL GENET+ 2015. [DOI: 10.3103/s0095452715040039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
87
|
Hyrapetian M, Loucaides EM, Sutcliffe AG. Health and disease in children born after assistive reproductive therapies (ART. J Reprod Immunol 2015; 106:21-6. [PMID: 25438931 DOI: 10.1016/j.jri.2014.08.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 07/15/2014] [Accepted: 08/04/2014] [Indexed: 01/20/2023]
Abstract
In vitro fertilisation (IVF) and other assisted reproductive therapies (ART) offer hope to subfertile couples worldwide. At least 5 million ART children have been born to date. Their health is an issue that is increasingly relevant: first, to those children and young adults themselves; second, to couples considering fertility treatment; and third, to the general population as ART has progressed from experimental treatment to routine practice. Many concerns about the potential risks to these children have been voiced with varying degrees of supportive evidence. This article summarises some key long-term data. Current evidence suggests that ART does increase risk of: higher order pregnancy (with its inherent pre- and perinatal risks); prematurity and low birth weight; congenital malformations in particular of the male urogenital system; imprinting disorders. Reassuringly, evidence points away from an increased overall cancer risk or differences in neurodevelopmental outcomes. Many unknowns remain, including future fertility and cardiovascular risks and risk of cerebral palsy.
Collapse
Affiliation(s)
- Mariyum Hyrapetian
- The Whittington Hospital, Whittington NHS Trust, Magdala Avenue, N19 5NF London, United Kingdom
| | | | | |
Collapse
|
88
|
van der Linden M, Buckingham K, Farquhar C, Kremer JAM, Metwally M. Luteal phase support for assisted reproduction cycles. Cochrane Database Syst Rev 2015; 2015:CD009154. [PMID: 26148507 PMCID: PMC6461197 DOI: 10.1002/14651858.cd009154.pub3] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Progesterone prepares the endometrium for pregnancy by stimulating proliferation in response to human chorionic gonadotropin(hCG) produced by the corpus luteum. This occurs in the luteal phase of the menstrual cycle. In assisted reproduction techniques(ART), progesterone and/or hCG levels are low, so the luteal phase is supported with progesterone, hCG or gonadotropin-releasing hormone (GnRH) agonists to improve implantation and pregnancy rates. OBJECTIVES To determine the relative effectiveness and safety of methods of luteal phase support provided to subfertile women undergoing assisted reproduction. SEARCH METHODS We searched databases including the Cochrane Menstrual Disorders and Subfertility Group (MDSG) Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO and trial registers. We conducted searches in November 2014, and further searches on 4 August 2015. SELECTION CRITERIA Randomised controlled trials (RCTs) of luteal phase support using progesterone, hCG or GnRH agonist supplementation in ART cycles. DATA COLLECTION AND ANALYSIS Three review authors independently selected trials, extracted data and assessed risk of bias. We calculated odds ratios (ORs) and 95%confidence intervals (CIs) for each comparison and combined data when appropriate using a fixed-effect model. Our primary out come was live birth or ongoing pregnancy. The overall quality of the evidence was assessed using GRADE methods. MAIN RESULTS Ninety-four women RCTs (26,198 women) were included. Most studies had unclear or high risk of bias in most domains. The main limitations in the evidence were poor reporting of study methods and imprecision due to small sample sizes.1. hCG vs placebo/no treatment (five RCTs, 746 women)There was no evidence of differences between groups in live birth or ongoing pregnancy (OR 1.67, 95% CI 0.90 to 3.12, three RCTs,527 women, I2 = 24%, very low-quality evidence, but I2 of 61% was found for the subgroup of ongoing pregnancy) with a random effects model. hCG increased the risk of ovarian hyperstimulation syndrome (OHSS) (1 RCT, OR 4.28, 95% CI 1.91 to 9.6, low quality evidence).2. Progesterone vs placebo/no treatment (eight RCTs, 875 women)Evidence suggests a higher rate of live birth or ongoing pregnancy in the progesterone group (OR 1.77, 95% CI 1.09 to 2.86, five RCTs, 642 women, I2 = 35%, very low-quality evidence). OHSS was not reported.3. Progesterone vs hCG regimens (16 RCTs, 2162 women)hCG regimens included comparisons of progesterone versus hCG and progesterone versus progesterone + hCG. No evidence showed differences between groups in live birth or ongoing pregnancy (OR 0.95, 95% CI 0.65 to 1.38, five RCTs, 833 women, I2 = 0%, low quality evidence) or in the risk of OHSS (four RCTs, 615 women, progesterone vs hCG OR 0.54, 95% CI 0.22 to 1.34; four RCTs,678 women; progesterone vs progesterone plus hCG, OR 0.34, 95% CI 0.09 to 1.26, low-quality evidence).4. Progesterone vs progesterone with oestrogen (16 RCTs, 2577 women)No evidence was found of differences between groups in live birth or ongoing pregnancy (OR 1.12, 95% CI 0.91 to 1.38, nine RCTs,1651 women, I2 = 0%, low-quality evidence) or OHSS (OR 0.56, 95% CI 0.2 to 1.63, two RCTs, 461 women, I2 = 0%, low-quality evidence).5. Progesterone vs progesterone + GnRH agonist (seven RCTs, 1708 women)Live birth or ongoing pregnancy rates were lower in the progesterone-only group and increased in women who received progester one and one or more GnRH agonist doses (OR 0.62, 95% CI 0.48 to 0.81, nine RCTs, 2861 women, I2 = 55%, random effects, low quality evidence). Statistical heterogeneity for this comparison was high because of unexplained variation in the effect size, but the direction of effect was consistent across studies. OHSS was reported in one study only (OR 1.00, 95% CI 0.33 to 3.01, 1 RCT, 300 women, very low quality evidence).6. Progesterone regimens (45 RCTs, 13,814 women)The included studies reported nine different comparisons between progesterone regimens. Findings for live birth or ongoing pregnancy were as follows: intramuscular (IM) versus oral: OR 0.71, 95% CI 0.14 to 3.66 (one RCT, 40 women, very low-quality evidence);IM versus vaginal/rectal: OR 1.24, 95% CI 1.03 to 1.5 (seven RCTs, 2309 women, I2 = 71%, very low-quality evidence); vaginal/rectal versus oral: OR 1.19, 95% CI 0.83 to 1.69 (four RCTs, 857 women, I2 = 32%, low-quality evidence); low-dose versus high-dose vaginal: OR 0.97, 95% CI 0.84 to 1.11 (five RCTs, 3720 women, I2 = 0%, moderate-quality evidence); short versus long protocol:OR 1.04, 95% CI 0.79 to 1.36 (five RCTs, 1205 women, I2 = 0%, low-quality evidence); micronised versus synthetic: OR 0.9, 95%CI 0.53 to 1.55 (two RCTs, 470 women, I2 = 0%, low-quality evidence); vaginal ring versus gel: OR 1.09, 95% CI 0.88 to 1.36 (oneRCT, 1271 women, low-quality evidence); subcutaneous versus vaginal gel: OR 0.92, 95% CI 0.74 to 1.14 (two RCTs, 1465 women,I2 = 0%, low-quality evidence); and vaginal versus rectal: OR 1.28, 95% CI 0.64 to 2.54 (one RCT, 147 women, very low-quality evidence). OHSS rates were reported for only two of these comparisons: IM versus oral, and low versus high-dose vaginal. No evidence showed a difference between groups.7. Progesterone and oestrogen regimens (two RCTs, 1195 women)The included studies compared two different oestrogen protocols. No evidence was found to suggest differences in live birth or ongoing pregnancy rates between a short and a long protocol (OR 1.08, 95% CI 0.81 to 1.43, one RCT, 910 women, low-quality evidence) or between a low dose and a high dose of oestrogen (OR 0.65, 95% CI 0.37 to 1.13, one RCT, 285 women, very low-quality evidence).Neither study reported OHSS. AUTHORS' CONCLUSIONS Both progesterone and hCG during the luteal phase are associated with higher rates of live birth or ongoing pregnancy than placebo.The addition of GnRHa to progesterone is associated with an improvement in pregnancy outcomes. OHSS rates are increased with hCG compared to placebo (only study only). The addition of oestrogen does not seem to improve outcomes. The route of progester one administration is not associated with an improvement in outcomes.
Collapse
Affiliation(s)
- Michelle van der Linden
- Radboud University Medical CenterDepartment of Obstetrics and GynaecologyPO Box 9101NijmegenNetherlands6500 HB
| | | | - Cindy Farquhar
- University of AucklandDepartment of Obstetrics and GynaecologyFMHS Park RoadGraftonAucklandNew Zealand1003
| | - Jan AM Kremer
- Radboud University Nijmegen Medical CenterDepartment of Obstetrics and GynaecologyPO Box 9101NijmegenNetherlands6500 HB
| | - Mostafa Metwally
- Sheffield Teaching HospitalsThe Jessop Wing and Royal Hallamshire HospitalSheffieldUKS10 2JF
| | | |
Collapse
|
89
|
Manders M, McLindon L, Schulze B, Beckmann MM, Kremer JAM, Farquhar C. Timed intercourse for couples trying to conceive. Cochrane Database Syst Rev 2015:CD011345. [PMID: 25775926 DOI: 10.1002/14651858.cd011345.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Fertility problems are very common, as subfertility affects about 10% to 15% of couples trying to conceive. There are many factors that may impact a couple's ability to conceive and one of these may be incorrect timing of intercourse. Conception is only possible from approximately five days before up to several hours after ovulation. Therefore, to be effective, intercourse must take place during this fertile period. 'Timed intercourse' is the practice of prospectively identifying ovulation and, thus, the fertile period to increase the likelihood of conception. Whilst timed intercourse may increase conception rates and reduce unnecessary intervention and costs, there may be associated adverse aspects including time consumption and stress. Ovulation prediction methods used for timing intercourse include urinary hormone measurement (luteinizing hormone (LH), estrogen), tracking basal body temperatures, cervical mucus investigation, calendar charting and ultrasonography. This review considered the evidence from randomised controlled trials for the use of timed intercourse on positive pregnancy outcomes. OBJECTIVES To assess the benefits and risks of ovulation prediction methods for timing intercourse on conception in couples trying to conceive. SEARCH METHODS We searched the following sources to identify relevant randomised controlled trials, the Menstrual Disorders and Subfertility Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, PubMed, LILACS, Web of Knowledge, the World Health Organization (WHO) Clinical Trials Register Platform and ClinicalTrials.gov. Furthermore, we manually searched the references of relevant articles. The search was not restricted by language or publication status. The last search was on 5 August 2014. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing timed intercourse versus intercourse without ovulation prediction or comparing different methods of ovulation prediction for timing intercourse against each other in couples trying to conceive. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility and risk of bias and extracted the data. The primary review outcomes were cumulative live birth and adverse events (such as quality of life, depression and stress). Secondary outcomes were clinical pregnancy, pregnancy (clinical or self-reported pregnancy, not yet confirmed by ultrasound) and time to conception. We combined data to calculate pooled risk ratios (RRs) and 95% confidence intervals (CIs). Statistical heterogeneity was assessed using the I(2) statistic. We assessed the overall quality of the evidence for the main comparisons using GRADE methods. MAIN RESULTS We included five RCTs (2840 women or couples) comparing timed intercourse versus intercourse without ovulation prediction. Unfortunately one large study (n = 1453) reporting live birth and pregnancy had not published outcome data by randomised group and therefore could not be analysed. Consequently, four RCTs (n = 1387) were included in the meta-analysis. The evidence was of low to very low quality. Main limitations for downgrading the evidence included imprecision, lack of reporting clinically relevant outcomes and the high risk of publication bias.One study reported live birth, but the sample size was too small to draw any relevant conclusions on the effect of timed intercourse (RR 0.75, 95% CI 0.16 to 3.41, 1 RCT, n = 17, very low quality).One study reported stress as an adverse event. There was no evidence of a difference in levels of stress (mean difference 1.98, 95 CI% -0.87 to 4.83, 1 RCT, n = 77, low level evidence). No other studies reported adverse events.Two studies reported clinical pregnancy. There was no evidence of a difference in clinical pregnancy rates (RR 1.10, 95% CI 0.57 to 2.12, 2 RCTs, n = 177, I(2) = 0%, low level evidence). This suggested that if the chance of a clinical pregnancy following intercourse without ovulation prediction is assumed to be 16%, the chance of success following timed intercourse would be between 9% and 33%.Four studies reported pregnancy rate (clinical or self-reported pregnancy). Timed intercourse was associated with higher pregnancy rates compared to intercourse without ovulation prediction in couples trying to conceive (RR 1.35, 95% CI 1.06 to 1.71, 4 RCTs, n = 1387, I(2) = 0%, very low level evidence). This suggests that if the chance of a pregnancy following intercourse without ovulation prediction is assumed to be 13%, the chance following timed intercourse would be between 14% and 23%. Subgroup analysis by duration of subfertility showed no difference in effect between couples trying to conceive for < 12 months versus couples trying for ≥ 12 months. One trial reported time to conception data and showed no evidence of a difference in time to conception. AUTHORS' CONCLUSIONS There are insufficient data available to draw conclusions on the effectiveness of timed intercourse for the outcomes of live birth, adverse events and clinical pregnancy. Timed intercourse may improve pregnancy rates (clinical or self-reported pregnancy, not yet confirmed by ultrasound) compared to intercourse without ovulation prediction. The quality of this evidence is low to very low and therefore findings should be regarded with caution. There is a high risk of publication bias, as one large study remains unpublished 8 years after recruitment finished. Further research is required, reporting clinically relevant outcomes (live birth, clinical pregnancy rates and adverse effects), to determine if timed intercourse is safe and effective in couples trying to conceive.
Collapse
Affiliation(s)
- Marlies Manders
- Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | | | | | | | | | | |
Collapse
|
90
|
Kang YJ, Lees M, Matthews LC, Kimber SJ, Forbes K, Aplin JD. MiR-145 suppresses embryo-epithelial juxtacrine communication at implantation by modulating maternal IGF1R. J Cell Sci 2015; 128:804-14. [PMID: 25609710 DOI: 10.1242/jcs.164004] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Successful implantation requires the synchronization of viable embryonic development with endometrial receptivity. The mechanisms allowing for the initiation of crosstalk between the embryo and the endometrium remain elusive; however, recent studies have revealed that there are alterations in endometrial microRNAs (miRs) in women suffering repeated implantation failure and that one of the altered miRs is miR-145. We assessed the role of miR-145 and its target IGF1R, in early implantation. miR-145 overexpression and IGF1R knockdown were achieved in Ishikawa endometrial cells. Quantitative PCR, western blotting and 3'UTR luciferase reporter assays confirmed that IGF1R is a direct target of miR-145 in the endometrium. Attachment of mouse embryos or IGF1-coated beads to endometrial epithelial cells was used to study the effects of altered miR-145 and/or IGF1R expression on early implantation events. miR-145 overexpression or specific reduction of IGF1R impaired attachment in both cases. An IGF1R target protector prevented the miR-145-mediated reduction in IGF1R and reversed the effect of miR-145 overexpression on attachment. The data demonstrate that miR-145 influences embryo attachment by reducing the level of IGF1R in endometrium.
Collapse
Affiliation(s)
- Youn-Jung Kang
- Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, Manchester M13 9WL, UK St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Level 3, Women's Centre, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
| | - Miranda Lees
- Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, Manchester M13 9WL, UK St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Laura C Matthews
- Centre for Endocrinology & Diabetes, Institute of Human Development, University of Manchester, AV Hill Building, Oxford Road, Manchester, M13 9PT, UK
| | - Susan J Kimber
- Faculty of Life Sciences, Michael Smith Building, Oxford Road, Manchester, M13 9PT, UK
| | - Karen Forbes
- Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, Manchester M13 9WL, UK St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - John D Aplin
- Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, Manchester M13 9WL, UK St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| |
Collapse
|
91
|
Gong X, Lou J, Lu Q, Huang H, Jin Z. Bu Shen Huo Xue decoction restores endometrial leukemia-inhibitory factor but not Angiopoietin-2 expression, and improves uterine receptivity in the controlled ovarian stimulation rat model. Exp Ther Med 2015; 9:751-757. [PMID: 25667623 PMCID: PMC4316862 DOI: 10.3892/etm.2015.2193] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 07/14/2014] [Indexed: 12/17/2022] Open
Abstract
Leukemia-inhibitory factor (LIF) and Angiopoietin-2 (Ang-2) are important factors in fertility. In the present study, it was investigated whether Bu Shen Huo Xue Decoction (BSHXD) prevents controlled ovarian hyperstimulation (COH) treatment-induced changes in endometrial LIF and Ang-2 expression and whether it has an effect on the number of implantation sites and live births in rats. Uteri were collected on day (D) 3, 4 and 5 of pregnancy, and LIF and Ang-2 protein and mRNA expression were detected using western blot analysis and quantitative polymerase chain reaction. On pregnancy D10, the average number of implantation sites was observed. The number of live births from each group was recorded. The results indicated that BSHXD treatment markedly increased the number of live births by restoring endometrial LIF expression and the implantation capacity in the COH rat model. In addition, no association was identified between LIF and Ang-2 expression. Therefore, this suggests that BSHXD may be useful for female reproduction.
Collapse
Affiliation(s)
- Xin Gong
- Reproductive Endocrinology Center, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, P.R. China
| | - Jiaoying Lou
- Reproductive Endocrinology Center, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, P.R. China
| | - Qiudan Lu
- Reproductive Endocrinology Center, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, P.R. China
| | - Haitao Huang
- Reproductive Endocrinology Center, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, P.R. China
| | - Zhe Jin
- Reproductive Endocrinology Center, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, P.R. China
| |
Collapse
|
92
|
Gong X, Tong Q, Chen Z, Zhang Y, Xu C, Jin Z. Microvascular density and vascular endothelial growth factor and osteopontin expression during the implantation window in a controlled ovarian hyperstimulation rat model. Exp Ther Med 2015; 9:773-779. [PMID: 25667627 PMCID: PMC4316967 DOI: 10.3892/etm.2015.2181] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 12/11/2014] [Indexed: 02/06/2023] Open
Abstract
Vascular endothelial growth factor (VEGF) and osteopontin (OPN) are suggested to facilitate angiogenesis and vascular remodeling in endometrial receptivity. Determination of the endometrial microvascular density (MVD) is the commonest method used to indirectly assess the levels of vasculogenesis and angiogenesis; however, the associations among VEGF, OPN and MVD remain unclear. Controlled ovarian hyperstimulation (COH) with the gonadotrophin-releasing hormone agonist-long protocol may impair endometrial receptivity, and Traditional Chinese Medicine (TCM) may exert therapeutic effects to relieve this impairment. The aim of the present study was to investigate the effects of COH on implantation biology and pregnancy outcome, and to explore the potential therapeutic role of the TCM Zi Dan Yin (ZDY). Female Sprague Dawley rats were divided into four groups: Control, COH, ZDY and COH + ZDY. On days 3, 4 and 5 of pregnancy (D3, D4 and D5, respectively), endometrial MVD was measured with cluster of differentiation 34 immunohistochemical detection, and VEGF and OPN protein and mRNA expression was detected through western blotting and reverse transcription-quantitative polymerase chain reaction (RT-qPCR) analysis. On D10, the average number of implantation sites was observed. Subsequent to conceiving and bearing newborn rats, the number of live births from each group was recorded. COH was shown to have adverse effects on implantation and pregnancy outcome. The MVD was found to be significantly increased in the COH group compared with that in the control, ZDY and COH+ZDY groups. The results of the protein and RT-qPCR analysis of VEGF and OPN revealed the same trend. Conversely, ZDY reversed the changes in endometrial MVD, VEGF and OPN, and was indicated to improve uterine receptivity and pregnancy outcome. No significant difference was observed among the control, ZDY and COH + ZDY groups. In conclusion, since the results for MVD and VEGF and OPN expression were consistent, MVD could be used as an alternative approach to identify the period of receptivity in rats.
Collapse
Affiliation(s)
- Xin Gong
- Reproductive Endocrinology Center, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing 100078, P.R. China
| | - Qing Tong
- Reproductive Endocrinology Center, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing 100078, P.R. China
| | - Zhenzhen Chen
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100102, P.R. China
| | - Yunna Zhang
- Reproductive Endocrinology Center, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing 100078, P.R. China
| | - Cai Xu
- Reproductive Endocrinology Center, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing 100078, P.R. China
| | - Zhe Jin
- Reproductive Endocrinology Center, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing 100078, P.R. China
| |
Collapse
|
93
|
Impact of assisted reproductive technology on the incidence of multiple-gestation infants: a population perspective. Fertil Steril 2015; 103:179-83. [DOI: 10.1016/j.fertnstert.2014.09.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/19/2014] [Accepted: 09/22/2014] [Indexed: 11/21/2022]
|
94
|
Ezugwu EC, Van der Burg S. Debating Elective Single Embryo Transfer after in vitro Fertilization: A Plea for a Context-Sensitive Approach. Ann Med Health Sci Res 2015; 5:1-7. [PMID: 25745568 PMCID: PMC4350055 DOI: 10.4103/2141-9248.149761] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The number of embryos transferred after in vitro fertilization (IVF) have been a topic of debate for over a decade now. Due to the risk associated with multiple pregnancy, there has been a global effort at reducing the multiple pregnancy rates to a minimum while maintaining an acceptable level of successful IVF pregnancy rate. Elective single embryo transfer (eSET) is advocated in most European countries. In Belgium and Sweden, eSET is mandatory for couples with a good prognosis. However, despite clinical recommendations and policy statements, patients in clinical practice frequently do request for the transfer of multiple embryos in order to have twins. Such requests conflict with policy guidelines and create an ethical dilemma for physicians: Should the physician do as the couple requests, and there with respect the autonomy of patients, or adhere to medical policy that takes the health of the mother and children at heart? This article provides an exploration of the arguments found in the literature that plays a role in the discussion on this topic and eventually argues that what a physician should do depends on the specificities of the context in which patients and physicians are implicated. These contextual issues can be taken into account in a shared decision-making procedure, which allows reflections and the responsibilities of both patients and physicians to be attended in decision about assisted reproduction.
Collapse
Affiliation(s)
- EC Ezugwu
- Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Itukku-Ozalla, PMB 01129, Enugu State, Nigeria
| | - S Van der Burg
- IQ Healthcare, Radboud University Nijmegen Medical Centre, 114 IQ Healthcare, 6500 HB Nijmegen, Netherlands
| |
Collapse
|
95
|
Clinical validation of embryo culture and selection by morphokinetic analysis: a randomized, controlled trial of the EmbryoScope. Fertil Steril 2014; 102:1287-1294.e5. [DOI: 10.1016/j.fertnstert.2014.07.738] [Citation(s) in RCA: 224] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 07/09/2014] [Accepted: 07/09/2014] [Indexed: 11/19/2022]
|
96
|
van de Belt TH, Faber MJ, Knijnenburg JML, van Duijnhoven NTL, Nelen WLDM, Kremer JAM. Wikis to facilitate patient participation in developing information leaflets: first experiences. Inform Health Soc Care 2014; 39:124-39. [PMID: 24517459 DOI: 10.3109/17538157.2013.872107] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Although patients have gained a wealth of experienced based knowledge they are usually not involved in the development of patient information. We sought to determine the technical feasibility of wikis in generating dynamic patient information leaflets with participation from patients and healthcare professionals and identified barriers and facilitators for wiki use. METHODS An open wiki for patients receiving intrauterine inseminations and a closed wiki for patients receiving in vitro fertilization at one Dutch university clinic were used. Feasibility was assessed by analyzing logging data, content and users' experiences and expectations. The latter were addressed by means of semi-structured interviews, which were also used to identify barriers and facilitators to wiki use. RESULTS Both patients and professionals worked on the information simultaneously, not hindered by time or location restrictions. The open IUI wiki was visited by 2957 and the closed IVF wiki by 424 users. About 28 barriers and 14 facilitators for using the wiki were identified. CONCLUSION Wikis are promising tools to improve patient participation in the creation of patient information. Future projects should aim to increase active use of wikis by testing interventions based on the wide spectrum of barriers and should evaluate the quality of the content produced.
Collapse
Affiliation(s)
- Tom H van de Belt
- Department of Obstetrics and Gynaecology, Division of Reproductive Medicine, Radboud University Medical Center Nijmegen , Nijmegen , The Netherlands
| | | | | | | | | | | |
Collapse
|
97
|
Wang YQ, Yu N, Xu WM, Xie QZ, Yan WJ, Wu GX, Yang J. Cetrotide administration in the early luteal phase in patients at high risk of ovarian hyperstimulation syndrome: A controlled clinical study. Exp Ther Med 2014; 8:1855-1860. [PMID: 25371744 PMCID: PMC4217764 DOI: 10.3892/etm.2014.2005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 09/11/2014] [Indexed: 11/16/2022] Open
Abstract
The aim of the present pilot study was to assess the feasibility and efficacy of Cetrotide administration in the early luteal phase in patients at high risk of ovarian hyperstimulation syndrome (OHSS), undergoing embryo cryopreservation following superovulation. A total of 135 patients at high risk of OHSS and undergoing embryo cryopreservation were divided into two groups. In the treatment group (n=39), the patients received daily subcutaneous injections of 0.25 mg Cetrotide between days 1 and 5 following ooctye retrieval, and volume expansion and symptomatic treatment were also provided. In the control group (n=96), the patients received routine treatments, including volume expansion therapy. The serum steroid hormone concentrations of the patients were measured on days 2, 5 and 8 following ooctye retrieval, while the incidence of moderate or severe OHSS, self-evaluated clinical symptoms and various clinical indicators were recorded. The serum estradiol (E2), luteinizing hormone and progesterone levels in the treatment group on days 2, 5 and 8 following oocyte retrieval were not found to differ significantly when compared with the patients in the control group (P>0.05). The incidence of severe OHSS did not differ significantly between the two groups (P>0.05). The average length of hospital stay and length of luteal phase were not found to be significantly different between the treatment and control groups (P>0.05). In conclusion, Cetrotide injections in the early luteal phase did not alter the serum steroid levels of patients at high risk of OHSS undergoing embryo cryopreservation, and were unable to reduce the incidence of severe early OHSS. However, further randomized studies are required to evaluate the effectiveness of Cetrotide in the prevention of OHSS.
Collapse
Affiliation(s)
- Ya-Qin Wang
- Reproductive Medical Center, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Nan Yu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Wang-Min Xu
- Reproductive Medical Center, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Qin-Zhen Xie
- Reproductive Medical Center, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Wen-Jie Yan
- Reproductive Medical Center, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Geng-Xiang Wu
- Reproductive Medical Center, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Jing Yang
- Reproductive Medical Center, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| |
Collapse
|
98
|
Main Characteristics of Hungarian Twin and Multiple Births in Official Statistics. Twin Res Hum Genet 2014; 17:359-68. [DOI: 10.1017/thg.2014.52] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Since 1876, statistical data on twin and multiple (TAM) births and deliveries have been registered in Hungary. Although there were some years during this 138-year period when twin births and deliveries were left out of the statistics, the trends can be followed, except for the period of World War II. The trends of twinning over the past four decades are summarized in this article, relying on official statistical data since 1970. Notably, the TAM birth rate rose following the Act CLIV of 1997 on Health. The Act provided state support for assisted reproductive treatments (ART), which spectacularly increased the ratio of twins — and especially of triplets — among live births. The trend has turned around since 2009–2010, and a decreasing era of TAM births seems to have begun. This article discusses some of the main and most interesting findings connected with TAM births, including twinning rates associated with different age groups, educational level, and actual place of residence by mothers, and the number of previous pregnancies of the mother. Ratios of live born males compared with live born females, lengths and weights at birth both among twins and singletons, and infant mortality rates have been calculated from the data. Twinning rates are higher in the western counties, the capital and its suburbs, and lower in the eastern counties.
Collapse
|
99
|
Gao Q, Pan HT, Lin XH, Zhang JY, Jiang Y, Tian S, Chen LT, Liu ME, Xiong YM, Huang HF, Sheng JZ. Altered Protein Expression Profiles in Umbilical Veins: Insights into Vascular Dysfunctions of the Children Born after In Vitro Fertilization1. Biol Reprod 2014; 91:71. [DOI: 10.1095/biolreprod.114.120659] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
100
|
Kupka MS, Ferraretti AP, de Mouzon J, Erb K, D'Hooghe T, Castilla JA, Calhaz-Jorge C, De Geyter C, Goossens V, Strohmer H, Obruca, Kreuz-Kinderwunschzentrum SPG, Bogaerts K, Biostat I, D'Hooghe T, Kyurkchiev S, Antonova I, Rezabek K, Markova J, Erb K, Gissler M, Tiitinen A, Royere D, Buhler K, Uszkoriet M, Loutradis D, Tarlatzis BC, Kosztolanyi G, Urbancsek J, Bjorgvinsson H, Mocanu E, Scaravelli G, Lokshin V, Ravil V, Gudleviciene Z, Matkeviciute G, Lazarevski S, Moshin V, Simic TM, Vukicevic D, Hazekamp JT, Kurzawa R, Calhaz--Jorge C, Laranjeira AR, Rugescu I, Korsak V, Radunovic N, Tabs N, Tomazevic T, Virant-Klun I, Hernandez JH, Castilla Alcala JA, Bergh C, Weder M, De Geyter C, Smeenk JMJ, Lambalk C, Veselovsky V, Baranowski R. Assisted reproductive technology in Europe, 2010: results generated from European registers by ESHRE. Hum Reprod 2014; 29:2099-113. [DOI: 10.1093/humrep/deu175] [Citation(s) in RCA: 306] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|