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Pereira N, O’Neill C, Lu V, Rosenwaks Z, Palermo GD. The safety of intracytoplasmic sperm injection and long-term outcomes. Reproduction 2017; 154:F61-F70. [DOI: 10.1530/rep-17-0344] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/10/2017] [Accepted: 07/14/2017] [Indexed: 01/09/2023]
Abstract
The pioneering of intracytoplasmic sperm injection (ICSI) approximately 25 years ago revolutionized the treatment of infertile couples. Today, ICSI remains an indispensable part of assisted reproductive treatments (ART) and has resulted in the birth of millions of babies. The 25th anniversary of ICSI marks a chronologic landmark in its evolving history. This landmark also serves as an opportunity to thoroughly appraise the safety of ICSI and analyze the long-term outcomes of ICSI-conceived children. In this review, we collate and analyze salient data accrued over the past 25 years pertaining to the long-term safety of ICSI and ICSI conceptions. We also evaluate the effects of ICSI on the perinatal outcomes, congenital malformation rates, cognitive development and reproductive health of ICSI-conceived neonates, children, adolescents and adults, respectively. In doing so, we also highlight the existence of potential confounders and biases that frequently obscure the interpretation of clinical follow-up studies.
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252
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Palermo GD, O'Neill CL, Chow S, Cheung S, Parrella A, Pereira N, Rosenwaks Z. Intracytoplasmic sperm injection: state of the art in humans. Reproduction 2017; 154:F93-F110. [PMID: 29158352 PMCID: PMC5719728 DOI: 10.1530/rep-17-0374] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 11/09/2017] [Accepted: 11/20/2017] [Indexed: 12/31/2022]
Abstract
Among infertile couples, 25% involve both male and female factors, while male factor alone accounts for another 25% due to oligo-, astheno-, teratozoospermia, a combination of the three, or even a complete absence of sperm cells in the ejaculate and can lead to a poor prognosis even with the help of assisted reproductive technology (ART). Intracytoplasmic sperm injection (ICSI) has been with us now for a quarter of a century and in spite of the controversy generated since its inception, it remains in the forefront of the techniques utilized in ART. The development of ICSI in 1992 has drastically decreased the impact of male factor, resulting in millions of pregnancies worldwide for couples who, without ICSI, would have had little chance of having their own biological child. This review focuses on the state of the art of ICSI regarding utility of bioassays that evaluate male factor infertility beyond the standard semen analysis and describes the current application and advances in regard to ICSI, particularly the genetic and epigenetic characteristics of spermatozoa and their impact on reproductive outcome.
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Affiliation(s)
- G D Palermo
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive MedicineWeill Cornell Medicine, New York, New York, USA
| | - C L O'Neill
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive MedicineWeill Cornell Medicine, New York, New York, USA
| | - S Chow
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive MedicineWeill Cornell Medicine, New York, New York, USA
| | - S Cheung
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive MedicineWeill Cornell Medicine, New York, New York, USA
| | - A Parrella
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive MedicineWeill Cornell Medicine, New York, New York, USA
| | - N Pereira
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive MedicineWeill Cornell Medicine, New York, New York, USA
| | - Z Rosenwaks
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive MedicineWeill Cornell Medicine, New York, New York, USA
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Banker M, Kotdawala A, Gupta R. The Impact of Vitrification in Artificial Reproductive Technology Programmes. EUROPEAN MEDICAL JOURNAL 2017. [DOI: 10.33590/emj/10312686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Cryopreservation is an integral part of the current methods of assisted reproductive technology (ART). In the past two decades, slow freezing has been replaced worldwide by vitrification due to its association with improved survival rates and clinical outcomes comparable to fresh embryo transfers. Successful embryo vitrification programmes have led to a significant reduction in the incidences of two major complications of ART: ovarian hyperstimulation syndrome and multiple gestations. Multiple embryo transfer cycles from the single ovum aspiration cycle have had a cumulative effect on the numbers of live births. Oocyte vitrification has also helped women to delay their pregnancies for medical or social reasons. This has made oocyte banking a viable option for better synchronisation of oocyte donation programmes. The emerging field of ovarian tissue vitrification has made fertility preservation possible for women undergoing gonadotoxic therapy. In this review, we have discussed the basic principles and methodology of slow freezing and vitrification along with its need and impact on ART.
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Affiliation(s)
| | | | - Reena Gupta
- Nova IVI Fertility, Navrangpura, Ahmedabad, India
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Saito H, Jwa SC, Kuwahara A, Saito K, Ishikawa T, Ishihara O, Kugu K, Sawa R, Banno K, Irahara M. Assisted reproductive technology in Japan: a summary report for 2015 by The Ethics Committee of The Japan Society of Obstetrics and Gynecology. Reprod Med Biol 2017; 17:20-28. [PMID: 29371817 PMCID: PMC5768979 DOI: 10.1002/rmb2.12074] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 10/16/2017] [Indexed: 12/02/2022] Open
Abstract
Purpose The Japan Society of Obstetrics and Gynecology (JSOG) implemented an assisted reproductive technology (ART) registry system in 1986. Here are reported the characteristics and treatment outcomes of ART cycles that were registered in 2015. Methods JSOG has requested all participating ART facilities to register cycle‐specific information for all ART cycles since 2007. A descriptive analysis was performed by using the registry database for 2015. Results In total, 424 151 cycles and 51 001 neonates (1 in 19.7 neonates born in Japan) were registered in 2015. The patients’ mean age was 38.2 years (standard deviation = 4.5). Among the fresh cycles, 94 158 of 244 718 (38.5%) egg retrieval cycles were cycles with freeze‐all embryos or oocytes, while fresh embryo transfer (ET) was performed in 70 254 cycles, signaling a decrease from 2014. There were 169 898 frozen‐thawed ET cycles, resulting in 56 355 pregnancies and 40 599 neonates. Single ET was performed at a rate of 79.7% for fresh and 81.8% for frozen cycles and the singleton pregnancy/live birth rates were 96.9%/96.5% and 96.8%/96.4% for the respective cycles. Conclusion The total ART cycles and live births resulting from ART has been increasing in Japan. Single ET was performed at a rate of almost 80% and ET cycles have shifted from fresh to frozen cycles.
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Affiliation(s)
- Hidekazu Saito
- Division of Reproductive Medicine Center of Maternal-Fetal, Neonatal, and Reproductive Medicine National Center for Child Health and Development Tokyo Japan
| | - Seung Chik Jwa
- Department of Obstetrics and Gynecology Saitama Medical University Saitama Japan.,Sora no Mori Clinic Okinawa Japan
| | - Akira Kuwahara
- Department of Obstetrics and Gynecology Graduate School of Biomedical Sciences Tokushima University Tokushima Japan
| | - Kazuki Saito
- Department of Comprehensive Reproductive Medicine Graduate School Tokyo Medical and Dental University Tokyo Japan
| | - Tomonori Ishikawa
- Department of Comprehensive Reproductive Medicine Graduate School Tokyo Medical and Dental University Tokyo Japan
| | - Osamu Ishihara
- Department of Obstetrics and Gynecology Saitama Medical University Saitama Japan
| | - Koji Kugu
- Department of Obstetrics and Gynecology Tokyo Metropolitan Bokutoh Hospital Tokyo Japan
| | - Rintaro Sawa
- Department of Obstetrics and Gynecology Nippon Medical School Tokyo Japan.,Japan Medical Association Research Institute Tokyo Japan
| | - Kouji Banno
- Department of Obstetrics and Gynecology School of Medicine Keio University Tokyo Japan
| | - Minoru Irahara
- Department of Obstetrics and Gynecology Graduate School of Biomedical Sciences Tokushima University Tokushima Japan
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Berkhout RP, Vergouw CG, van Wely M, de Melker AA, Schats R, Repping S, Hamer G, Mastenbroek S, Lambalk CB. The addition of a low-quality embryo as part of a fresh day 3 double embryo transfer does not improve ongoing pregnancy rates. Hum Reprod Open 2017; 2017:hox020. [PMID: 30895234 PMCID: PMC6276645 DOI: 10.1093/hropen/hox020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/14/2017] [Accepted: 10/17/2017] [Indexed: 01/19/2023] Open
Abstract
STUDY QUESTION Does the addition of a low-quality embryo in fresh Day 3 double embryo transfer (DET) affect the ongoing pregnancy rate (OPR) and multiple gestation rate in patients with only one or no high-quality embryos available? SUMMARY ANSWER In patients with only one- or no high-quality embryo available, the addition of a low-quality embryo in fresh Day 3 DET does not improve the OPR but increases multiple gestation rates in fresh DET. WHAT IS KNOWN ALREADY Pregnancy rates after DET are considered to be higher compared to single embryo transfer (SET) when analyzed per first embryo transfer only. However, these conclusions are based on RCTs in which mostly patients with two or more high-quality embryos were included, and can therefore not be applied to patients with only one or no high-quality embryo available. This is particularly relevant since it has been suggested that low-quality embryos could impair the implantation of simultaneously transferred embryos by paracrine signaling. Hence, we investigated in patients with only one or no high-quality embryo available whether the addition of a low-quality embryo in DET affects the OPR, multiple gestation rate and miscarriage rate. STUDY DESIGN SIZE DURATION This was a retrospective cohort study of 5050 patients receiving 7252 fresh embryo transfers on Day 3 after fertilization in IVF/ICSI cycles from 2012 to 2015 in two academic hospitals. PARTICIPANTS/MATERIALS SETTING METHODS We included all women that received fresh SET or DET with any combination of high-quality embryos (7, 8 or 9 blastomeres, with equal to or <20% fragmentation) or low-quality embryos (all other embryos). Outcomes were OPR (primary outcome, defined as a positive fetal heartbeat by transvaginal ultrasound at least 10 weeks after oocyte retrieval), miscarriage rate and multiple gestation rate. We used a generalized estimating equations model adjusting for maternal age, number of oocytes retrieved, center of treatment and the interaction between maternal age and number of oocytes retrieved. Other baseline characteristics, including infertility diagnosis, fertilization method and the number of consecutive fresh embryo transfers per patient, did not contribute significantly to the GEE model and were therefore excluded, and not adjusted for. MAIN RESULTS AND THE ROLE OF CHANCE Compared to SET with one high-quality embryo, DET with two high-quality embryos resulted in a higher OPR (adjusted odds ratio (OR) 1.38, 95% CI 1.14-1.67), while DET with one high- and one low-quality embryo resulted in a lower OPR (adjusted OR 0.65, 95% CI 0.49-0.90). However, SET in patients with only one high-quality embryo available resulted in a lower OPR compared to SET in patients with two or more high-quality embryos available (adjusted OR 0.52, 95% CI 0.39-0.70). After adjusting for this confounding factor, we found that both DET with two high-quality embryos (adjusted OR 0.99, 95% CI 0.74-1.31) and DET with one high- and one low-quality embryo (adjusted OR 0.78, 95% CI 0.47-1.27) resulted in a not significantly different OPR compared to SET with one high-quality embryo. If only low-quality embryos were available, DET did not increase the OPR as compared to SET with one low-quality embryo (adjusted OR 0.84, 95% CI 0.55-1.28). Multiple gestation rates were higher in all DET groups compared to SET (DET with ≥1 high-quality embryo(s) compared to SET with one high-quality embryo; DET with two low-quality embryos compared to SET with one low-quality embryo; all comparisons P < 0.001). Miscarriage rates were not different in all DET groups compared to SET (DET with ≥1 high-quality embryo(s) compared to SET with one high-quality embryo; DET with two low-quality embryos compared to SET with one low-quality embryo; all comparisons P > 0.05). LIMITATIONS REASONS FOR CAUTION Limitations to this study include the retrospective design and possible bias between study groups related to embryo transfer policies between 2012 and 2015. Consequently, we may have underestimated pregnancy chances in all DET groups. Furthermore, the OPR was calculated as a percentage of the number of fresh embryo transfers in each study group, and not the total number of started IVF/ICSI cycles. Therefore, the reported pregnancy outcomes may not truly reflect the pregnancy chances of couples at the start of treatment. A possible confounding effect of maternal age in our study is acknowledged but we could not compare clinical outcomes in different age groups separately owing to small sample sizes. Analysis of pregnancy outcomes in lower prognosis patients (higher maternal age, fewer oocytes retrieved) separately is an avenue for future research. WIDER IMPLICATIONS OF THE FINDINGS The decision to perform DET rather than SET in order to increase the OPR per fresh embryo transfer seems not to be justified for those patients with only one or no high-quality embryo(s) available. However, owing to the limitations of this study, prospective RCTs are needed that specifically investigate pregnancy outcomes in patients with only one or no high-quality embryo(s) available in SET and DET. STUDY FUNDING/COMPETING INTERESTS This study was funded by a grant from the joint Amsterdam Reproduction & Development Institute of the Academic Medical Center and VU University Medical Center (www.amsterdam-reproduction-and-development.org). The authors have no conflicts of interest to declare.
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Affiliation(s)
- R P Berkhout
- Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, VU University Medical Center, 1081 HV Amsterdam, The Netherlands
| | - C G Vergouw
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, VU University Medical Center, 1081 HV Amsterdam, The Netherlands
| | - M van Wely
- Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - A A de Melker
- Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - R Schats
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, VU University Medical Center, 1081 HV Amsterdam, The Netherlands
| | - S Repping
- Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - G Hamer
- Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - S Mastenbroek
- Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - C B Lambalk
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, VU University Medical Center, 1081 HV Amsterdam, The Netherlands
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Hatoum I, Bellon L, Swierkowski N, Ouazana M, Bouba S, Fathallah K, Paillusson B, Bailly M, Boitrelle F, Alter L, Bergère M, Selva J, Wainer R. Disparities in reproductive outcomes according to the endometrial preparation protocol in frozen embryo transfer : The risk of early pregnancy loss in frozen embryo transfer cycles. J Assist Reprod Genet 2017; 35:425-429. [PMID: 29110260 DOI: 10.1007/s10815-017-1078-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 10/24/2017] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The purpose of this study was to determine the effect of stimulated and artificial endometrial preparation protocols on reproductive outcomes in frozen embryo transfer (FET) cycles. METHODS We performed a retrospective study of 1926 FET cycles over a 3.5-year period in the Fertility Unit at a University Hospital. Stimulated and artificial protocols were used for endometrial preparation. The embryos for FET were obtained from either in vitro fertilization or intracytoplasmic sperm injection cycles. Live birth rate and early pregnancy loss rates were retrospectively compared. In artificial protocols, oral or vaginal administration of oestradiol 2 mg two or three times a day was followed by vaginal supplementation with progesterone 200 mg two or three times a day. In stimulated protocols, recombinant follicle-stimulating hormone was administered from day 4 onward. Vaginal ultrasound was used for endometrial and ovarian monitoring. A pregnancy test was performed 14 days after FET. If it was positive, oestradiol and progesterone were administered up until the 12th week of gestation in artificial cycles. We defined early pregnancy losses as biochemical pregnancies (preclinical losses) and miscarriages. RESULTS Data on 865 artificial cycles (45% of the total) and 1061 stimulated cycles (55%) were collected. Early pregnancy loss rate was significantly lower for stimulated cycles (34.2%) than for artificial cycles (56.9%), and the live birth rate was significantly higher for stimulated cycles (59.7%) than for artificial cycles (29.1%). CONCLUSION In frozen embryo transfer, artificial cycles were associated with more early pregnancy loss and lower live birth rate than stimulated cycles.
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Affiliation(s)
- I Hatoum
- Fertility Unit, Poissy-Saint-Germain-en-Laye General Hospital, 78303, Poissy, France
| | - L Bellon
- Fertility Unit, Poissy-Saint-Germain-en-Laye General Hospital, 78303, Poissy, France
| | - N Swierkowski
- Fertility Unit, Poissy-Saint-Germain-en-Laye General Hospital, 78303, Poissy, France
| | - M Ouazana
- Fertility Unit, Poissy-Saint-Germain-en-Laye General Hospital, 78303, Poissy, France
| | - S Bouba
- Fertility Unit, Poissy-Saint-Germain-en-Laye General Hospital, 78303, Poissy, France
| | - K Fathallah
- Fertility Unit, Poissy-Saint-Germain-en-Laye General Hospital, 78303, Poissy, France
| | - B Paillusson
- Fertility Unit, Poissy-Saint-Germain-en-Laye General Hospital, 78303, Poissy, France
| | - M Bailly
- Fertility Unit, Poissy-Saint-Germain-en-Laye General Hospital, 78303, Poissy, France
| | - F Boitrelle
- Fertility Unit, Poissy-Saint-Germain-en-Laye General Hospital, 78303, Poissy, France.,EA7404 "Gametes, Implantation, Gestation" Research Unit, University of Versailles Saint Quentin en Yvelines - Paris Saclay, 78180, Montigny-le-Bretonneux, France
| | - L Alter
- Fertility Unit, Poissy-Saint-Germain-en-Laye General Hospital, 78303, Poissy, France.,EA7404 "Gametes, Implantation, Gestation" Research Unit, University of Versailles Saint Quentin en Yvelines - Paris Saclay, 78180, Montigny-le-Bretonneux, France
| | - M Bergère
- Fertility Unit, Poissy-Saint-Germain-en-Laye General Hospital, 78303, Poissy, France.,EA7404 "Gametes, Implantation, Gestation" Research Unit, University of Versailles Saint Quentin en Yvelines - Paris Saclay, 78180, Montigny-le-Bretonneux, France
| | - J Selva
- Fertility Unit, Poissy-Saint-Germain-en-Laye General Hospital, 78303, Poissy, France.,EA7404 "Gametes, Implantation, Gestation" Research Unit, University of Versailles Saint Quentin en Yvelines - Paris Saclay, 78180, Montigny-le-Bretonneux, France.,Institut de Recherche en Santé de la Femme (Woman's Health Research Institute), 78180, Montigny-le-Bretonneux, France
| | - R Wainer
- Fertility Unit, Poissy-Saint-Germain-en-Laye General Hospital, 78303, Poissy, France. .,EA7404 "Gametes, Implantation, Gestation" Research Unit, University of Versailles Saint Quentin en Yvelines - Paris Saclay, 78180, Montigny-le-Bretonneux, France. .,Institut de Recherche en Santé de la Femme (Woman's Health Research Institute), 78180, Montigny-le-Bretonneux, France. .,Unité Clinique d'Assistance Médicale à la Procréation, CHI de Poissy/Saint-Germain-en-Laye, rue du champ gaillard, 78303, Poissy, France.
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257
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Präg P, Mills MC. Cultural determinants influence assisted reproduction usage in Europe more than economic and demographic factors. Hum Reprod 2017; 32:2305-2314. [PMID: 29040579 PMCID: PMC5850226 DOI: 10.1093/humrep/dex298] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 08/25/2017] [Accepted: 09/08/2017] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION To what extent do financial, demographic and cultural determinants explain the vast cross-national differences in ART treatments in Europe? SUMMARY ANSWER The normative cultural acceptance of ART is a major driver of ART treatments in Europe, above and beyond differences in country wealth, demographic aspects and religious composition. WHAT IS KNOWN ALREADY There are vast differences in the number of ART treatments across European countries, which are to some extent related to country affluence, regulation, and insurance coverage and costs. The role and impact of cultural and normative factors has not been explored in a larger cross-national comparison. STUDY DESIGN, SIZE, DURATION A descriptive and comparative cross-national analysis of ART treatment prevalence in over 30 European countries in 2010, with the outcome defined as the total number of ART cycles per million women of reproductive age (15-44 years). Data is drawn from multiple sources (ICMART, US Census Bureau Library, World Bank, Barro-Lee Educational Attainment Dataset, IFFS Surveillance reports, European Values Study and World Religion Database). PARTICIPANTS/MATERIALS, SETTING, METHODS Our sample includes data from 35 European countries, where we describe the associations between demographic and cultural factors and the prevalence of ART treatments. Bivariate correlation and ordinary least squares multiple regression analysis serves to establish the relationships between predictor variables and the number of ART treatments per million women aged 15-44 years in a country. MAIN RESULTS AND THE ROLE OF CHANCE A one-percent increase in national GDP is associated with 382 (95% CI: 177-587) additional ART procedures per million women of reproductive age, yet this effect is reduced to 99 (-92 to 290) treatments once cultural values and demographic factors are accounted for. In our fully adjusted model, normative cultural values measuring the acceptability of ART are the strongest predictor of ART usage, with a one-point increase of average approval in a country associated with 276 (167-385) additional ART treatments per million women of reproductive age. LIMITATIONS, REASONS FOR CAUTION Findings are based on a cross-sectional, cross-national analysis, making formal tests of causality impossible and prohibiting inferences to the individual level. WIDER IMPLICATIONS OF THE FINDINGS Results indicate that reproductive health policy should openly acknowledge the importance of cultural norms in informally shaping and regulating the wider availability of ART treatment. STUDY FUNDING/COMPETING INTEREST(S) Funding for this project was provided by the European Union's Seventh Framework Program (FP7 2007-2013) (No. 320116 Families and Societies), European Research Council for the SOCIOGENOME Consolidator Grant (ERC-2013-CoG-615603) and the Wellcome Trust Institutional Strategic Support Fund (all to M.C.M.). The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Patrick Präg
- Department of Sociology and Nuffield College, University of Oxford, Manor Road, Oxford OX1 3UQ, UK
| | - Melinda C Mills
- Department of Sociology and Nuffield College, University of Oxford, Manor Road, Oxford OX1 3UQ, UK
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Feichtinger M, Karlström PO, Olofsson JI, Rodriguez-Wallberg KA. Weekend-free scheduled IVF/ICSI procedures and single embryo transfer do not reduce live-birth rates in a general infertile population. Acta Obstet Gynecol Scand 2017; 96:1423-1429. [PMID: 28940191 PMCID: PMC6055597 DOI: 10.1111/aogs.13235] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 09/17/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Scheduling of ovum pickup only on weekdays may result in cases of apparently suboptimal timing for human chorionic gonadotropin and ovum pickup. This study aimed to assess whether live-birth rates were reduced in women with a potentially suboptimal day for human chorionic gonadotropin and ovum pickup to avoid weekend work, according to ultrasonographic data on the day of human chorionic gonadotropin planning. MATERIAL AND METHODS An evaluation of the optimal human chorionic gonadotropin priming date was performed in treatment protocols of 1000 consecutive patients undergoing their first in vitro fertilization/intracytoplasmatic sperm injection with single-embryo transfer. An ideal ovum pickup day was characterized by human chorionic gonadotropin-scheduling when three or more follicles reached 17 mm (day 0) or with one day of delay (day +1) (n = 760). A non-ideal ovum pickup was either early (day -1, -2, -3) (n = 24) or delayed (day +2, +3, +4) (n = 216). Live-birth rates in the ideal and non-ideal ovum pickup groups was set as primary outcome measure. RESULTS Early-ovum pickups were excluded as they were infrequent. No differences between ideal and delayed ovum pickup groups were found regarding number of oocytes retrieved (9.87 vs. 9.78, p = 0.990), pregnancy rates (28.3% vs. 29.6%, p = 0.701) or live-birth rates (26.2% vs. 25.9%, p = 0.939). However, sub analyses indicated that treatment with gonadotropin releasing hormone antagonists resulted in significantly lower clinical pregnancy rates in delayed ovum pickups (odds ratio 0.46, p = 0.014), compared with agonist treatments. CONCLUSIONS Weekend work may not be needed for in vitro fertilization/intracytoplasmatic sperm injection single-embryo transfer treatments. However, in gonadotropin releasing hormone antagonist cycles, delaying ovum pickup more than one day may result in unfavorable outcomes.
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Affiliation(s)
- Michael Feichtinger
- Reproductive Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria.,Wunschbaby Institute Feichtinger, Vienna, Austria
| | - Per O Karlström
- Reproductive Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - Jan I Olofsson
- Reproductive Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Kenny A Rodriguez-Wallberg
- Reproductive Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden.,Department of Oncology - Pathology, Karolinska Institute, Stockholm, Sweden
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260
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Tabbalat AM, Pereira N, Klauck D, Melhem C, Elias RT, Rosenwaks Z. Arabian Peninsula ethnicity is associated with lower ovarian reserve and ovarian response in women undergoing fresh ICSI cycles. J Assist Reprod Genet 2017; 35:331-337. [PMID: 29063502 DOI: 10.1007/s10815-017-1071-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 10/13/2017] [Indexed: 01/28/2023] Open
Abstract
PURPOSE Recent studies have demonstrated that ethnicity can be an independent determinant of assisted reproductive technology (ART) outcomes. In this context, we investigate whether ART outcomes differ between Arabian Peninsula and Caucasian women. METHODS This is a retrospective cohort study of women undergoing fresh intracytoplasmic sperm injection (ICSI)-embryo transfer (ET) cycles for male factor infertility. The study cohort was divided into 2 groups based on ethnicity-Arabian Peninsula or Caucasian. Ovarian reserve, ovarian response, and pregnancy outcomes were compared between the groups. A sub-analysis was performed between individual Arabian Peninsula nationalities for the same outcomes. A multiple linear regression model was used to assess the independent effect of ethnicity on ovarian response. RESULTS Seven hundred sixty-three patients were included-217 (28.4%) Arabian Peninsula and 546 (71.6%) Caucasian. There was no difference in the mean age of the two groups; however, the former had a higher body mass index (28.5 ± 7.5 vs. 23.3 ± 5.7; P < 0.001). Although follicle stimulating hormone (FSH) levels and antral follicle counts (AFC) were within the normal range in both groups, Arabian Peninsula women had higher FSH levels (5.7 ± 2.5 vs. 4.9 ± 2.8; P = 0.001) and lower AFC (13.9 ± 4.7 vs. 16.5 ± 4.3; P < 0.001) when compared to Caucasian women. Women from the Arabian Peninsula also had a statistically lower number of mature oocytes retrieved (15.6 ± 6.8 vs. 14.1 ± 8.4; P = 0.01), despite requiring higher gonadotropin doses. Multiple linear regression reveled that Arabian Peninsula women had 2.5 (95% CI 2.1-3.9) less mature oocytes, even after controlling for confounders. A sub-analysis within the Arab cohort demonstrated that Qatari women had a higher yield of mature oocytes when compared to Emirati, Kuwaiti, and Saudi women. There was no difference in the rates of implantation, clinical pregnancy, or live birth when comparing individual Arabian Peninsula nationalities with each other or to Caucasians. CONCLUSIONS Arabian Peninsula ethnicity is associated with lower ovarian reserve and ovarian response parameters in women undergoing their first ICSI-ET cycle.
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Affiliation(s)
| | - Nigel Pereira
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Ave., New York, NY, 10021, USA.
| | - Devon Klauck
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Ave., New York, NY, 10021, USA
| | - Clara Melhem
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Ave., New York, NY, 10021, USA
| | - Rony T Elias
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Ave., New York, NY, 10021, USA
| | - Zev Rosenwaks
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Ave., New York, NY, 10021, USA
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261
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Karlström PO, Holte J, Hadziosmanovic N, Rodriguez-Wallberg KA, Olofsson JI. Does ovarian stimulation regimen affect IVF outcome? a two-centre, real-world retrospective study using predominantly cleavage-stage, single embryo transfer. Reprod Biomed Online 2017; 36:59-66. [PMID: 29233501 DOI: 10.1016/j.rbmo.2017.10.102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 10/01/2017] [Accepted: 10/04/2017] [Indexed: 11/27/2022]
Abstract
In this study, ovarian stimulation using highly purified human menopausal gonadotrophin (HP-HMG) and recombinant FSH (rFSH) for IVF were compared in two large assisted reproduction technique centres in Sweden. A total of 5902 women underwent 9631 oocyte retrievals leading to 8818 embryo transfers (7720 on day 2): single embryo transfers (74.2%); birth rate per embryo transfer (27.7%); multiple birth rate (5.0%); incidence of severe ovarian hyperstimulation syndrome (0.71%). Compared with ovarian stimulation with rFSH, women who received HP-HMG were older, had higher dosages of gonadotrophins administered, fewer oocytes retrieved and more embryos transferred. After multivariate analysis controlling for age and generalized estimating equation model, no differences were found in delivery outcomes per embryo transfers between HP-HMG and rFSH, independent of gonadotrophin releasing hormone analogue (GnRH) used. Logit curves for live birth rate suggested differences for various subgroups, most prominently for women with high oocyte yield or when high total doses were used. Differences were not significant, perhaps owing to skewed distributions of the FSH compounds versus age and other covariates. These 'real-life patients' had no differences in live birth rate between HP-HMG and rFSH overall or in subgroups of age, embryo score, ovarian sensitivity or use of GnRH analogue regimen.
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Affiliation(s)
- Per-Olof Karlström
- Reproductive Medicine, Obstetrics and Gynecology, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Jan Holte
- Carl von Linné Clinic, SE-751 83 Uppsala, Sweden
| | | | - Kenny A Rodriguez-Wallberg
- Reproductive Medicine, Obstetrics and Gynecology, Karolinska University Hospital, SE-141 86 Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Jan I Olofsson
- Reproductive Medicine, Obstetrics and Gynecology, Karolinska University Hospital, SE-141 86 Stockholm, Sweden; Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet/ Karolinska University Hospital, SE-171 76 Stockholm, Sweden.
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262
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Tournaye H, Sukhikh GT, Kahler E, Griesinger G. A Phase III randomized controlled trial comparing the efficacy, safety and tolerability of oral dydrogesterone versus micronized vaginal progesterone for luteal support in in vitro fertilization. Hum Reprod 2017; 32:1019-1027. [PMID: 28333318 PMCID: PMC5400051 DOI: 10.1093/humrep/dex023] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 01/25/2017] [Indexed: 12/22/2022] Open
Abstract
STUDY QUESTION Is oral dydrogesterone 30 mg daily (10 mg three times daily [TID]) non-inferior to micronized vaginal progesterone (MVP) 600 mg daily (200 mg TID) for luteal support in in vitro fertilization (IVF), assessed by the presence of fetal heartbeats determined by transvaginal ultrasound at 12 weeks of gestation? SUMMARY ANSWER Non-inferiority of oral dydrogesterone versus MVP was demonstrated at 12 weeks of gestation, with a difference in pregnancy rate and an associated confidence interval (CI) that were both within the non-inferiority margin. WHAT IS KNOWN ALREADY MVP is routinely used in most clinics for luteal support in IVF, but it is associated with side effects, such as vaginal irritation and discharge, as well as poor patient acceptance. Dydrogesterone may be an alternative treatment due to its patient-friendly oral administration. STUDY DESIGN, SIZE, DURATION Lotus I was an international Phase III randomized controlled trial, performed across 38 sites, from August 2013 to March 2016. Subjects were premenopausal women (>18 to <42 years of age; body mass index (BMI) ≥18 to ≤30 kg/m2) with a documented history of infertility who were planning to undergo IVF. A centralized electronic system was used for randomization, and the study investigators, sponsor's study team, and subjects remained blinded throughout the study. PARTICIPANTS/MATERIALS, SETTING, METHODS In total, 1031 subjects were randomized to receive either oral dydrogesterone (n = 520) or MVP (n = 511). Luteal support was started on the day of oocyte retrieval and continued until 12 weeks of gestation (Week 10), if a positive pregnancy test was obtained at 2 weeks after embryo transfer. MAIN RESULTS AND THE ROLE OF CHANCE In the full analysis set (FAS), 497 and 477 subjects in the oral dydrogesterone and MVP groups, respectively, had an embryo transfer. Non-inferiority of oral dydrogesterone was demonstrated, with pregnancy rates at 12 weeks of gestation of 37.6% and 33.1% in the oral dydrogesterone and MVP treatment groups, respectively (difference 4.7%; 95% CI: −1.2–10.6%). Live birth rates of 34.6% (172 mothers with 213 newborns) and 29.8% (142 mothers with 158 newborns) were obtained in the dydrogesterone and MVP groups, respectively (difference 4.9%; 95% CI: −0.8–10.7%). Oral dydrogesterone was well tolerated and had a similar safety profile to MVP. LIMITATIONS, REASONS FOR CAUTION The analysis of the results was powered to consider the clinical pregnancy rate, but the live birth rate may be of greater clinical interest. Conclusions relating to the differences between treatments in live birth rate, observed in this study, should therefore be made with caution. WIDER IMPLICATIONS OF THE FINDINGS Oral dydrogesterone may replace MVP as the standard of care for luteal phase support in IVF, owing to the oral route being more patient-friendly than intravaginal administration, as well as it being a well tolerated and efficacious treatment. STUDY FUNDING/COMPETING INTEREST(S) Sponsored and supported by Abbott Established Pharmaceuticals Division. H.T.’s institution has received grants from Merck, MSD, Goodlife, Cook, Roche, Besins, Ferring and Mithra (now Allergan) and H.T. has received consultancy fees from Finox, Ferring, Abbott, ObsEva and Ovascience. G.S. has nothing to disclose. E.K. is an employee of Abbott GmbH. G.G. has received investigator fees from Abbott during the conduct of the study; outside of this submitted work, G.G. has received personal fees and non-financial support from MSD, Ferring, Merck-Serono, Finox, TEVA, Glycotope, as well as personal fees from VitroLife, NMC Healthcare LLC, ReprodWissen LLC and ZIVA LLC. TRIAL REGISTRATION NUMBER NCT01850030 (clinicaltrials.gov). TRIAL REGISTRATION DATE 19 April 2013. DATE OF FIRST PATIENT'S ENROLLMENT 23 August 2013.
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Affiliation(s)
- Herman Tournaye
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Gennady T Sukhikh
- Research Center for Obstetrics, Gynecology and Perinatology, Akademika Oparina Street, 4, 117497, Moscow, Russia
| | - Elke Kahler
- Clinical Development, Established Pharmaceuticals, Abbott Laboratories GmbH, Freundalllee 9A, 30173 Hannover, Germany
| | - Georg Griesinger
- Department of Gynecological Endocrinology and Reproductive Medicine, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
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263
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Pastore LM, Christianson MS, Stelling J, Kearns WG, Segars JH. Reproductive ovarian testing and the alphabet soup of diagnoses: DOR, POI, POF, POR, and FOR. J Assist Reprod Genet 2017; 35:17-23. [PMID: 28971280 DOI: 10.1007/s10815-017-1058-4] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 09/20/2017] [Indexed: 12/26/2022] Open
Abstract
There are large variations in the number of oocytes within each woman, and biologically, the total quantity is at its maximum before the woman is born. Scientific knowledge is limited about factors controlling the oocyte pool and how to measure it. Within fertility clinics, there is no uniform agreement on the diagnostic criteria for each common measure of ovarian reserve in women, and thus, studies often conflict. While declining oocyte quantity/quality is a normal physiologic occurrence as women age, some women experience diminished ovarian reserve (DOR) much earlier than usual and become prematurely infertile. Key clinical features of DOR are the presence of regular menstrual periods and abnormal-but-not-postmenopausal ovarian reserve test results. A common clinical challenge is counseling patients with conflicting ovarian reserve test results. The clinical diagnosis of DOR and the interpretation of ovarian reserve testing are complicated by changing lab testing options and processing for anti-mullerian hormone since 2010. Further, complicating the diagnostic and research scenario is the existence of other distinct yet related clinical terms, specifically premature ovarian failure, primary ovarian insufficiency, poor ovarian response, and functional ovarian reserve. The similarities and differences between the definitions of DOR with each of these four terms are reviewed. We recommend greater medical community involvement in terminology decisions, and the addition of DOR-specific medical subject-heading search terms.
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Affiliation(s)
- Lisa M Pastore
- Department of Obstetrics, Gynecology and Reproductive Medicine, Stony Brook Medicine, Stony Brook University, Stony Brook, NY, 11794-8091, USA.
| | - Mindy S Christianson
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James Stelling
- Department of Obstetrics, Gynecology and Reproductive Medicine, Stony Brook Medicine, Stony Brook University, Stony Brook, NY, 11794-8091, USA
- Reproductive Specialists of NY, Mineola, NY, USA
| | - William G Kearns
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- AdvaGenix Lab, Rockville, MD, USA
| | - James H Segars
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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264
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Liu Y, Maekawa T, Yoshida K, Kaneda H, Chatton B, Wakana S, Ishii S. The transcription factor ATF7 mediates in vitro fertilization-induced gene expression changes in mouse liver. FEBS Open Bio 2017; 7:1598-1610. [PMID: 28979846 PMCID: PMC5623699 DOI: 10.1002/2211-5463.12304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 08/09/2017] [Accepted: 08/10/2017] [Indexed: 12/25/2022] Open
Abstract
Assisted reproductive technologies, including in vitro fertilization (IVF), are now frequently used, and increasing evidence indicates that IVF causes gene expression changes in children and adolescents that increase the risk of metabolic diseases. Although such gene expression changes are thought to be due to IVF‐induced epigenetic changes, the mechanism remains elusive. We tested whether the transcription factor ATF7—which mediates stress‐induced changes in histone H3K9 tri‐ and dimethylation, typical marks of epigenetic silencing—is involved in the IVF‐induced gene expression changes. IVF up‐ and downregulated the expression of 688 and 204 genes, respectively, in the liver of 3‐week‐old wild‐type (WT) mice, whereas 87% and 68% of these were not changed, respectively, by IVF in ATF7‐deficient (Atf7−/−) mice. The genes, which are involved in metabolism, such as pyrimidine and purine metabolism, were upregulated in WT mice, but not in Atf7−/− mice. Of the genes whose expression was upregulated by IVF in WT mice, 37% were also upregulated by a loss of ATF7. These results indicate that ATF7 is a key factor in establishing the memory of IVF effects on metabolic pathways.
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Affiliation(s)
- Yang Liu
- Laboratory of Molecular Genetics RIKEN Tsukuba Institute Japan.,Department of Molecular Genetics and Ph.D. Program in Human Biology School of Integrative and Global Majors University of Tsukuba Japan
| | - Toshio Maekawa
- Laboratory of Molecular Genetics RIKEN Tsukuba Institute Japan
| | - Keisuke Yoshida
- Laboratory of Molecular Genetics RIKEN Tsukuba Institute Japan
| | - Hideki Kaneda
- Technology and Development Team for Mouse Phenotype Analysis RIKEN BRC Tsukuba Japan
| | - Bruno Chatton
- Université de Strasbourg UMR7242 Biotechnologie et Signalisation Cellulaire Ecole Supérieure de Biotechnologie de Strasbourg Il lkirch France
| | - Shigeharu Wakana
- Technology and Development Team for Mouse Phenotype Analysis RIKEN BRC Tsukuba Japan
| | - Shunsuke Ishii
- Laboratory of Molecular Genetics RIKEN Tsukuba Institute Japan.,Department of Molecular Genetics and Ph.D. Program in Human Biology School of Integrative and Global Majors University of Tsukuba Japan
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265
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Zegers-Hochschild F, Schwarze JE, Crosby J, Musri C, Urbina MT. Assisted reproduction techniques in Latin America: the Latin American Registry, 2014. Reprod Biomed Online 2017; 35:287-295. [DOI: 10.1016/j.rbmo.2017.05.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/24/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022]
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266
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Carrell DT, Hotaling J. Using sperm testing to improve patient and offspring health: rational, evidence-based care of the infertile male in the ART clinic. Transl Androl Urol 2017; 6:S443-S445. [PMID: 29082158 PMCID: PMC5643637 DOI: 10.21037/tau.2017.03.31] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Douglas T Carrell
- Department of Surgery (Urology), University of Utah School of Medicine, Salt Lake City, UT, USA.,Department of Human Genetics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - James Hotaling
- Department of Surgery (Urology), University of Utah School of Medicine, Salt Lake City, UT, USA
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267
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Stanford JB. What Kind of Policies for Fertility Treatment would Improve Affordability and Outcomes for Individuals and the Public? Paediatr Perinat Epidemiol 2017; 31:449-451. [PMID: 28898931 DOI: 10.1111/ppe.12411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Joseph B Stanford
- Departments of Family and Preventive Medicine, Obstetrics and Gynecology and Pediatrics, University of Utah, Salt Lake City, UT
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268
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High-risk of preterm birth and low birth weight after oocyte donation IVF: analysis of 133,785 live births. Reprod Biomed Online 2017; 35:318-324. [DOI: 10.1016/j.rbmo.2017.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 06/02/2017] [Accepted: 06/02/2017] [Indexed: 02/04/2023]
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269
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Esteves SC, Agarwal A, Majzoub A. An evidence-based perspective on the role of sperm chromatin integrity and sperm DNA fragmentation testing in male infertility. Transl Androl Urol 2017; 6:S665-S672. [PMID: 29082963 PMCID: PMC5643668 DOI: 10.21037/tau.2017.05.39] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil.,Division of Urology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Ahmad Majzoub
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
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270
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Zegers-Hochschild F, Schwarze JE, Crosby JA, Musri C, Urbina MT. Assisted reproductive techniques in Latin America: The Latin American Registry, 2014. JBRA Assist Reprod 2017; 21:164-175. [PMID: 28837023 PMCID: PMC5574636 DOI: 10.5935/1518-0557.20170034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 07/01/2017] [Indexed: 11/20/2022] Open
Abstract
Multinational data on assisted reproduction techniques undertaken in 2014 were collected from 159 institutions in 15 countries in Latin America. Treatments included IVF/ ICSI, FET, OD, PGD and fertility preservation (FP). 41.34% of IVF/ICSI cycles were performed in women aged 35 to 39 years and 23.35% in women aged 40 and older. After removing cases with total freezing, delivery rate per oocyte retrieval was 25.05% for ICSI and 27.41% for IVF. Multiple births included 20.78% twins and 0.92 % triplets and over. In OD, twins reached 28.93% and triplets 1.07 %. Preterm deliveries reached 16.4% in singletons, 55.02% in twins and 76% in triplets. Perinatal mortality in 18,162 births was 23 per 1000 in singletons, 35 per 1000 in twins, and 36 per 1000 in high-order multiples. Elective single embryo transfer (eSET) represented only 2.63 % of fresh transfers, with a delivery rate of 32.15% per transfer. Elective double embryo transfer (eDET) represented 23.74% of transfers, with a delivery rate of 41.03% per transfer. Among babies born during this period 11,373 (62.6%) were singletons; 6,398 (35.2%) twins, and 391 (2.2%), triplets and more. Given the effect of multiple births on prematurity, morbidity and perinatal mortality, reinforcing the existing trend of reducing the number of embryos transferred is mandatory.
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Affiliation(s)
- Fernando Zegers-Hochschild
- Reproductive Medicine Unit - Las Condes Clinic,
Chile
- Ethics and Public Policies Program in Human Reproduction, University
Diego Portales, Chile
- Latin American Network of Assisted Reproduction (REDLARA),
Uruguay
| | - Juan Enrique Schwarze
- Latin American Network of Assisted Reproduction (REDLARA),
Uruguay
- Reproductive Medicine Unit - Monteblanco Clinic, Chile
| | - Javier A. Crosby
- Reproductive Medicine Unit - Las Condes Clinic,
Chile
- Latin American Network of Assisted Reproduction (REDLARA),
Uruguay
| | - Carolina Musri
- Reproductive Medicine Unit - Las Condes Clinic,
Chile
- Latin American Network of Assisted Reproduction (REDLARA),
Uruguay
| | - Maria Teresa Urbina
- Latin American Network of Assisted Reproduction (REDLARA),
Uruguay
- Unifertes, Venezuela
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271
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Ferraretti A, Nygren K, Andersen AN, de Mouzon J, Kupka M, Calhaz-Jorge C, Wyns C, Gianaroli L, Goossens V. Trends over 15 years in ART in Europe: an analysis of 6 million cycles. Hum Reprod Open 2017; 2017:hox012. [PMID: 31486803 PMCID: PMC6276702 DOI: 10.1093/hropen/hox012] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 06/21/2017] [Accepted: 07/26/2017] [Indexed: 11/25/2022] Open
Abstract
STUDY QUESTION Was the European IVF Monitoring (EIM) Consortium, established in 1999 by ESHRE, able to monitor the trend over time of ART in Europe? SUMMARY ANSWER The initial aims of the EIM programme (to collect and publish regional European data on census and trends on ART utilization, effectiveness, safety and quality) have been achieved. WHAT IS ALREADY KNOWN ART data in Europe have been collected and reported annually in Human Reproduction. STUDY DESIGN SIZE DURATION A retrospective data analysis and summary of the first 15 years of ART activity in Europe (1997-2011) was carried out, using the key figures from the annual ESHRE reports and focusing on how the practice of ART has evolved over the years. PARTICIPANTS/MATERIALS SETTING METHOD A total of 5 919 320 ART cycles are reported, including IVF, ICSI, frozen embryo relacment and egg donation, resulting in the birth of more than 1 million infants. A total of 1 548 967 IUIs are also reported, including husband/partner's semen and donor semen cycles. The most relevant and complete data are analysed and discussed. MAIN RESULTS AND THE ROLE OF CHANCE With some fluctuations, the number of countries and clinics reporting to EIM increases significantly from 1997 to 2011. A constant increase was also registered in the number of annual cycles reported. Since 2005, the estimation of the EIM coverage on the total European activity was >80%. In countries with 100% of coverage, the mean availability of ART increased from 765 cycles per million inhabitants in 1997 to 1269 cycles per million inhabitants in 2011, and the proportion of ART infants of the total number of infants born in the country increased from 1.3% to 2.4%. The proportion of women aged > 39 years undergoing IVF and ICSI cycles gradually increased. For 12 consecutive years, the proportion of ICSI versus IVF cycles showed a marked increase before reaching a plateau from 2008. The proportion of transfers with three or more embryos decreased constantly and the proportion of SETs increased over the time period. The triplets deliveries were reduced from 3.7% in 1997 to less than 1% since 2005 (0.6% in 2011). The effectiveness (evaluated as clinical pregnancy rate per aspiration and per embryo transfer) increased until 2007, then the figure remained stable. The cumulative percentage of documented pregnancy losses was 17%. No differences have been noted in terms of outcomes in the IUI cycles. LIMITATIONS REASONS FOR CAUTION The data presented are accumulated from countries with different collection systems, regulations, insurance coverage and different practices. Each year a number of countries have been unable to provide some of the data. WIDER IMPLICATIONS OF THE FINDINGS The first summary of 15 years of the EIM reports offers interesting data on census and trends on ART utilization, safety and quality in Europe. The primary aim of the ESHRE effort in supporting European data collection has been reached. Owing to its importance inside and outside the professional community, European data collection and publication on ART have to be supported and implemented. STUDY FUNDING/COMPETING INTERESTS None.
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Affiliation(s)
- A.P. Ferraretti
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - K. Nygren
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | | | - J. de Mouzon
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - M. Kupka
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - C. Calhaz-Jorge
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - C. Wyns
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - L. Gianaroli
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - V. Goossens
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
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272
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Righarts A, Gray A, Dickson N, Parkin L, Gillett W. Resolution of infertility and number of children: 1386 couples followed for a median of 13 years. Hum Reprod 2017; 32:2042-2048. [DOI: 10.1093/humrep/dex271] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 07/30/2017] [Indexed: 12/16/2022] Open
Affiliation(s)
- A.A. Righarts
- Women's and Children's Health, Dunedin School of Medicine, The University of Otago, Dunedin 9054, New Zealand
- Preventive and Social Medicine, Dunedin School of Medicine, The University of Otago, Dunedin 9054, New Zealand
| | - A. Gray
- Preventive and Social Medicine, Dunedin School of Medicine, The University of Otago, Dunedin 9054, New Zealand
| | - N.P. Dickson
- Preventive and Social Medicine, Dunedin School of Medicine, The University of Otago, Dunedin 9054, New Zealand
| | - L. Parkin
- Preventive and Social Medicine, Dunedin School of Medicine, The University of Otago, Dunedin 9054, New Zealand
| | - W.R. Gillett
- Women's and Children's Health, Dunedin School of Medicine, The University of Otago, Dunedin 9054, New Zealand
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273
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Fouzas S, Panagiotopoulou O, Sinopidis X, Papadopoulou C, Dimitriou G, Karatza AA. Surgical anomalies in twins: The role of assisted reproductive technology and chorionicity: RE: "Congenital malformations associated with assisted reproductive technology: A California statewide analysis" by Kelley-Quon LI et al. J Pediatr Surg 2013; 48; 1218-1224. J Pediatr Surg 2017; 52:1379-1380. [PMID: 28456424 DOI: 10.1016/j.jpedsurg.2017.03.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 03/22/2017] [Indexed: 02/05/2023]
Affiliation(s)
- Sotirios Fouzas
- Department of Paediatrics, NICU, University of Patras Medical School, Patras, Greece.
| | - Olga Panagiotopoulou
- Department of Paediatrics, NICU, University of Patras Medical School, Patras, Greece
| | - Xenophon Sinopidis
- Department of Paediatric Surgery, University of Patras Medical School, Patras, Greece
| | | | - Gabriel Dimitriou
- Department of Paediatrics, NICU, University of Patras Medical School, Patras, Greece
| | - Ageliki A Karatza
- Department of Paediatrics, NICU, University of Patras Medical School, Patras, Greece
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274
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Gambadauro P, Iliadis S, Bränn E, Skalkidou A. Conception by means of in vitro fertilization is not associated with maternal depressive symptoms during pregnancy or postpartum. Fertil Steril 2017; 108:325-332. [DOI: 10.1016/j.fertnstert.2017.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/04/2017] [Accepted: 06/06/2017] [Indexed: 12/16/2022]
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275
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Chambers GM, Paul RC, Harris K, Fitzgerald O, Boothroyd CV, Rombauts L, Chapman MG, Jorm L. Assisted reproductive technology in Australia and New Zealand: cumulative live birth rates as measures of success. Med J Aust 2017; 207:114-118. [DOI: 10.5694/mja16.01435] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/07/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Georgina M Chambers
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women's and Children's Health, University of New South Wales, Sydney, NSW
| | - Repon C Paul
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women's and Children's Health, University of New South Wales, Sydney, NSW
| | - Katie Harris
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women's and Children's Health, University of New South Wales, Sydney, NSW
| | - Oisin Fitzgerald
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women's and Children's Health, University of New South Wales, Sydney, NSW
| | | | | | | | - Louisa Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW
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276
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Pereira N, Kligman I. Predictive factors for live birth in donor oocyte-recipient cycles. Fertil Steril 2017; 108:235. [PMID: 28669480 DOI: 10.1016/j.fertnstert.2017.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 05/31/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Nigel Pereira
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York
| | - Isaac Kligman
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York
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277
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Peeraer K, D'Hooghe TM, Vandoren C, Trybou J, Spiessens C, Debrock S, De Neubourg D. A 50% reduction in multiple live birth rate is associated with a 13% cost saving: a real-life retrospective cost analysis. Reprod Biomed Online 2017. [PMID: 28629925 DOI: 10.1016/j.rbmo.2017.05.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Belgian legislation limiting the number of embryos for transfer has been shown to result in a 50% reduction of the multiple live birth rate (MLBR) per cycle without having a negative impact on the cumulative delivery rate per patient within six cycles or 36 months. The objective of the current study was to evaluate the cost saving associated with a 50% reduction in MLBR. A retrospective cost analysis was performed of 213 couples, who became pregnant and had a live birth after one or more assisted reproductive technology treatment cycles, and their 254 children. The mean cost of a singleton (n = 172) and multiple (n = 41) birth was calculated based on individual hospital invoices. The cost analysis showed a significantly higher total cost (assisted reproductive technology treatment, pregnancy follow-up, delivery, child cost until the age of 2 years) for multiple births (both children: mean €43,397) than for singleton births (mean: €17,866) (Wilcoxon-Mann-Whitney P < 0.0001). A 50% reduction in MLBR resulted in a significant cost reduction related to hospital care of 13%.
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Affiliation(s)
- Karen Peeraer
- Leuven University Fertility Center, UZ Leuven Campus Gasthuisberg, Leuven 3000, Belgium.
| | - Thomas M D'Hooghe
- Leuven University Fertility Center, UZ Leuven Campus Gasthuisberg, Leuven 3000, Belgium
| | - Cindy Vandoren
- Department of Management Information and Reporting, UZ Leuven Campus Gasthuisberg, Leuven 3000, Belgium
| | - Jeroen Trybou
- Department of Public Health, Ghent University, De Pintelaan 183, Ghent 9000, Belgium
| | - Carl Spiessens
- Leuven University Fertility Center, UZ Leuven Campus Gasthuisberg, Leuven 3000, Belgium
| | - Sophie Debrock
- Leuven University Fertility Center, UZ Leuven Campus Gasthuisberg, Leuven 3000, Belgium
| | - Diane De Neubourg
- Leuven University Fertility Center, UZ Leuven Campus Gasthuisberg, Leuven 3000, Belgium; Center for Reproductive Medicine, Antwerp University Hospital, Edegem 2650, Belgium
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278
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Catford SR, McLachlan RI, O'Bryan MK, Halliday JL. Long-term follow-up of intra-cytoplasmic sperm injection-conceived offspring compared with in vitro fertilization-conceived offspring: a systematic review of health outcomes beyond the neonatal period. Andrology 2017. [DOI: 10.1111/andr.12369] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- S. R. Catford
- Hudson Institute of Medical Research; Clayton Vic. Australia
- Department of Obstetrics and Gynecology; Monash University; Clayton Vic. Australia
- Public Health Genetics; Murdoch Childrens Research Institute; Parkville Vic. Australia
| | - R. I. McLachlan
- Hudson Institute of Medical Research; Clayton Vic. Australia
- Department of Obstetrics and Gynecology; Monash University; Clayton Vic. Australia
- Monash IVF Group Pty Ltd; Richmond Vic. Australia
| | - M. K. O'Bryan
- Department of Anatomy and Developmental Biology; Development and Stem Cell Program of Monash Biomedicine Discovery Institute; Monash University; Clayton Vic. Australia
| | - J. L. Halliday
- Public Health Genetics; Murdoch Childrens Research Institute; Parkville Vic. Australia
- Department of Paediatrics; University of Melbourne; Parkville Vic. Australia
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279
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Wang X, Du M, Guan Y, Wang B, Zhang J, Liu Z. Comparative neonatal outcomes in singleton births from blastocyst transfers or cleavage-stage embryo transfers: a systematic review and meta-analysis. Reprod Biol Endocrinol 2017; 15:36. [PMID: 28472983 PMCID: PMC5418763 DOI: 10.1186/s12958-017-0255-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 04/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Comparative neonatal outcomes with respect to singleton births from blastocyst transfers or cleavage-state embryo transfers are controversial with respect to which method is superior. Many studies have yielded contradictory results. We performed a systematic review and meta-analysis for the purpose of comparing neonatal outcomes in single births following IVF/ICSI. METHODS We searched the Medline, Embase and Cochrane Central Register of Clinical Trials (CCTR) databases until October 2016. Studies and trials that contained neonatal outcomes for singleton births were included. Data were extracted in 2 × 2 tables. The analysis was performed using Rev Man 5.1 software. Risk ratios (RRs) and risk differences, with 95% confidence intervals, were calculated to assess the results of each outcome. Subgroups were applied in all outcomes. Newcastle-Ottawa scale (NOS) checklists were used to assess the quality of the referenced studies. RESULTS Twelve studies met the criteria in this meta-analysis. There was a high risk of preterm birth after blastocyst embryo transfer versus the risk after cleavage-stage transfer (RR: 1.11, 95% CI: 1.01-1.22). For the "only fresh" subgroup, the outcome was coincident (RR: 1.16, 95% CI: 1.06-1.27). For the "fresh and frozen" and "only frozen" subgroups, there were no differences. Patients who received fresh blastocyst embryo transfers had a high risk of very preterm births (RR: 1.16, 95% CI: 1.02-1.31). Finally, cleavage-stage embryo transfers were associated with a high risk of infants who were small for gestational age (0.83, 95% CI: 0.76-0.92) and a low risk of those who were large for gestation age (1.14, 95% CI: 1.04-1.25). CONCLUSIONS The risks of preterm and very preterm births increased after fresh blastocyst transfers versus the risks after fresh cleavage-stage embryo transfers. However, in frozen embryo transfers, there were no differences. Blastocyst embryo transfers resulted in high risks of infants who were large for gestational age, and cleavage-stage embryo transfers resulted in high risks of infants who were small for gestational age.
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Affiliation(s)
- Xingling Wang
- grid.412719.8The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfuqian Road, Zhengzhou, 450052 Henan People’s Republic of China
| | - Mingze Du
- grid.412719.8The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfuqian Road, Zhengzhou, 450052 Henan People’s Republic of China
| | - Yichun Guan
- grid.412719.8The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfuqian Road, Zhengzhou, 450052 Henan People’s Republic of China
| | - Bijun Wang
- grid.412719.8The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfuqian Road, Zhengzhou, 450052 Henan People’s Republic of China
| | - Junwei Zhang
- grid.412719.8The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfuqian Road, Zhengzhou, 450052 Henan People’s Republic of China
| | - Zihua Liu
- grid.412719.8The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfuqian Road, Zhengzhou, 450052 Henan People’s Republic of China
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280
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Abstract
There is biological plausibility that coagulation activation underlies a proportion of in vitro fertilisation IVF failures and recurrent early clinical pregnancy loss (RPL). However, low-molecular-weight heparin (LMWH) use, based upon previous clinical outcome alone, is not effective in preventing RPL. RPL is heterogeneous in mechanism. Identifying those with an underlying thrombotic mechanism would allow stratification for LMWH treatment. Annexin A5 is an anticoagulant protein expressed on the trophoblast surface. The annexin A5 M2 haplotype (ANXA5 M2) is associated with several placenta mediated pregnancy complications (PMPC) and poor IVF outcome. It is transmitted equally by males and females. A pragmatic observational study of IVF couples screened for M2 carriage and treated with LMWH achieved a 37.9% live birth rate, similar to an unscreened and untreated group with fewer adverse risk factors for conception and a better prognosis from assisted conception. This suggests that LMWH may counteract the adverse effects of M2 carriage. Using this biomarker to stratify IVF and PMPC patients for LMWH treatment merits further evaluation.
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Affiliation(s)
- Simon Fishel
- CARE Fertility Group, John Webster House, 6 Lawrence Drive, Nottingham, United Kingdom
| | - Deborah J Baker
- IHG Pharmaco Ltd, 20-22 Wenlock Road, London, United Kingdom.
| | - Ian A Greer
- Faculty of Biology Medicine and Health, Core Technology, Facility, University of Manchester, Manchester, United Kingdom
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281
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Messerlian C, Gaskins AJ. Epidemiologic Approaches for Studying Assisted Reproductive Technologies: Design, Methods, Analysis and Interpretation. CURR EPIDEMIOL REP 2017; 4:124-132. [PMID: 29034142 DOI: 10.1007/s40471-017-0105-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE While considerable progress has been made since the advent of assisted reproductive technology (ART), the field remains a complex and challenging one for clinicians and researchers alike. This review discusses some of the most salient issues pertaining to the study of ART and whenever possible suggestions on how to address them. RECENT FINDINGS More than 5 million babies have been born through ART to date, representing up to 4% of all births worldwide. While technologies continue to evolve and demand for treatment grows, it is more important than ever to conduct rigorous and timely research to help guide clinical practice that is safe and effective, and that minimizes potential short- and long-term adverse outcomes to mother and child. SUMMARY ART research will require exceedingly more sophisticated research methods, designs, and analyses that are rooted in a reproductive epidemiological framework in order to improve future research and ultimately promote better outcomes for all subfertile couples and their children.
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Affiliation(s)
- Carmen Messerlian
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Audrey J Gaskins
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.,Channing Division of Network Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, MA
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282
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Vanni VS, Viganò P, Papaleo E, Mangili G, Candiani M, Giorgione V. Advances in improving fertility in women through stem cell-based clinical platforms. Expert Opin Biol Ther 2017; 17:585-593. [PMID: 28351161 DOI: 10.1080/14712598.2017.1305352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Due to their regenerative ability, stem cells are looked at as a promising tool for improving infertility treatments in women. As the main limiting factor in female fertility is represented by the decrease of ovarian reserve, the main goals of stem cell-based clinical platforms would be to obtain in vitro or in vivo neo-oogenesis. Refractory endometrial factor infertility also represents an obstacle for female reproduction for which stem cells might provide novel treatment strategies. Areas covered: A systematic search of the literature was performed on MEDLINE/PubMed database to identify relevant articles using stem-cell based clinical or research platforms in the field of female infertility. Expert opinion: In vitro oogenesis has not so far developed beyond the stage of oocyte-like cells whose normal progression to mature oocytes and ability to be fertilized was not proved. Extensive epigenetic programming of gamete precursors and the complex interactions between somatic and germ cells required for human oogenesis likely represent the main obstacles in stem-cell-based neo-oogenesis. Also resuming oogenesis in vivo in adulthood still appears a distant hypothesis, as there is still a lack of consensus about the existence and functionality of adult ovarian stem cells.
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Affiliation(s)
- Valeria Stella Vanni
- a Obstetrics and Gynaecology Unit , IRCCS San Raffaele Hospital , Milano , Italy.,b Obstetrics and Gynaecology Unit , Vita-Salute San Raffaele University , Milano , Italy
| | - Paola Viganò
- c Division of Genetics and Cell Biology , IRCCS San Raffaele Hospital , Milano , Italy
| | - Enrico Papaleo
- a Obstetrics and Gynaecology Unit , IRCCS San Raffaele Hospital , Milano , Italy
| | - Giorgia Mangili
- a Obstetrics and Gynaecology Unit , IRCCS San Raffaele Hospital , Milano , Italy
| | - Massimo Candiani
- a Obstetrics and Gynaecology Unit , IRCCS San Raffaele Hospital , Milano , Italy.,b Obstetrics and Gynaecology Unit , Vita-Salute San Raffaele University , Milano , Italy
| | - Veronica Giorgione
- a Obstetrics and Gynaecology Unit , IRCCS San Raffaele Hospital , Milano , Italy.,b Obstetrics and Gynaecology Unit , Vita-Salute San Raffaele University , Milano , Italy
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283
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Kamath MS, Sunkara SK. Perinatal outcomes after oocyte donation and in-vitro fertilization. Curr Opin Obstet Gynecol 2017; 29:126-130. [PMID: 28234769 DOI: 10.1097/gco.0000000000000356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To critically appraise the existing literature on perinatal outcomes following oocyte donation (OD) pregnancies and compare it with autologous in-vitro fertilization (IVF) pregnancies. RECENT FINDINGS OD pregnancies are at higher risk of developing hypertensive disorders compared with autologous IVF. The risk of preterm birth and low birth weight is higher with singleton and multiple OD compared with autologous IVF pregnancies. There is no increased risk of congenital malformations following OD compared with autologous IVF births. SUMMARY OD pregnancies are at higher risk of developing hypertensive disorders and adverse perinatal outcomes compared with autologous IVF.
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Affiliation(s)
- Mohan S Kamath
- aReproductive Medicine Unit, Christian Medical College, Vellore, India bQueen's Hospital, Barking Havering Redbridge University Hospitals NHS Trust, Essex, UK
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284
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Predicting pregnancy rate following multiple embryo transfers using algorithms developed through static image analysis. Reprod Biomed Online 2017; 34:473-479. [PMID: 28236600 DOI: 10.1016/j.rbmo.2017.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 02/03/2017] [Accepted: 02/03/2017] [Indexed: 11/22/2022]
Abstract
Single-embryo image assessment involves a high degree of inaccuracy because of the imprecise labelling of the transferred embryo images. In this study, we considered the entire transfer cycle to predict the implantation potential of embryos, and propose a novel algorithm based on a combination of local binary pattern texture feature and Adaboost classifiers to predict pregnancy rate. The first step of the proposed method was to extract the features of the embryo images using the local binary pattern operator. After this, multiple embryo images in a transfer cycle were considered as one entity, and the pregnancy rate was predicted using three classifiers: the Real Adaboost, Gentle Adaboost, and Modest Adaboost. Finally, the pregnancy rate was determined via the majority vote rule based on classification results of the three Adaboost classifiers. The proposed algorithm was verified to have a good predictive performance and may assist the embryologist and clinician to select embryos to transfer and in turn improve pregnancy rate.
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285
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Kushnir VA, Barad DH, Albertini DF, Darmon SK, Gleicher N. Systematic review of worldwide trends in assisted reproductive technology 2004-2013. Reprod Biol Endocrinol 2017; 15:6. [PMID: 28069012 PMCID: PMC5223447 DOI: 10.1186/s12958-016-0225-2] [Citation(s) in RCA: 199] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 12/21/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Assisted Reproductive Technology (ART) has undergone considerable changes over the last decade, with consequences on ART outcomes in different regions of the world being unknown. METHODS We conducted a systematic review of published national and regional ART registry data to assess how changes in clinical practice between 2004 and 2013 have impacted outcomes in Australia and New Zealand, Canada, Continental Europe, the United Kingdom (U.K.), Japan, Latin America, and the United States (U.S.). The data reflect 7,079,145 total ART cycles utilizing both fresh and previously cryopreserved embryos from autologous oocytes that resulted in 1,454,724 live births. This review focused on the following measures: ART cycle volume, use of cryopreserved embryos, single embryo transfer (SET), live birth rates in fresh and frozen-thawed cycles, and perinatal outcomes in recent years. RESULTS SETs and utilization of frozen-thawed embryos increased worldwide over the study period. In 2012 SET utilization in all ART cycles was highest in Japan and Australia/New Zealand (82.6% and 76.3% respectively) and lowest in Latin America (16.0%). While gradual improvements in live birth rates were observed in most regions, some demonstrated declines. By 2012-2013, fresh cycle live birth rates were highest in the U.S. (29%) and lowest in Japan (5%). In Japan, the observed decline in fresh cycle live birth rate coincided with transition to minimal stimulation protocols, transfer of frozen-thawed rather than fresh embryos, and implementation of an SET policy. Similarly, implementation of an SET policy in parts of Canada was followed by a decline in fresh cycle live birth rate. Increasing live birth rates in frozen-thawed embryo cycles, seen all over the world, partially compensated for declines in fresh ART cycles. During 2012-2013 Australia/New Zealand and Japan reported the lowest multiple delivery rates of 5.6 and 4% respectively while the US had the highest of 27%. In recent years, preterm delivery rates in all regions ranged between 9.0 to 16.6% for singletons, 53.9 to 67.3% for twins, and 91.4 to 100% for triplets and higher order multiples. Inconsistencies in the way perinatal outcome data are presented by various registries, made comparison between regions difficult. CONCLUSIONS ART practices are characterized by outcome differences between regions. International consensus on the definition of ART success, which accounts for perinatal outcomes, may help to standardize worldwide ART practice and improve outcomes. TRIAL REGISTRATION PROSPERO ( CRD42016033011 ).
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Affiliation(s)
- Vitaly A. Kushnir
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- Wake Forest School of Medicine, Winston-Salem, NC USA
| | - David H. Barad
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- Foundation for Reproductive Medicine, New York, NY USA
| | - David F. Albertini
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- University of Kansas Medical Center, Kansas City, KS USA
- The Rockefeller University, New York, NY USA
| | - Sarah K. Darmon
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
| | - Norbert Gleicher
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- Foundation for Reproductive Medicine, New York, NY USA
- University of Vienna School of Medicine, Vienna, Austria
- The Rockefeller University, New York, NY USA
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286
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Perinatal Risks Associated with Early Vanishing Twin Syndrome following Transfer of Cleavage- or Blastocyst-Stage Embryos. J Pregnancy 2016; 2016:1245210. [PMID: 28101380 PMCID: PMC5212711 DOI: 10.1155/2016/1245210] [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] [Received: 08/16/2016] [Revised: 11/10/2016] [Accepted: 12/07/2016] [Indexed: 01/15/2023] Open
Abstract
Objective. To investigate whether the perinatal risks associated with early vanishing twin (VT) syndrome differ between cleavage- or blastocyst-stage embryo transfers (ET) in fresh in vitro fertilization (IVF) cycles. Methods. Retrospective, single-center, cohort study of IVF cycles with fresh cleavage- or blastocyst-stage ETs resulting in a live singleton birth. The incidence of preterm birth (PTB), low birth weight (LBW), and very low birth weight (VLBW) was compared between cleavage- and blastocyst-stage ET cycles complicated by early VT. Results. 7241 patients had live singleton births. Early VT was observed in 709/6134 (11.6%) and 70/1107 (6.32%) patients undergoing cleavage-stage and blastocyst-stage ETs, respectively. Patients in the blastocyst-stage group were younger compared to the cleavage-stage group. The cleavage-stage group had a similar birth weight compared to the blastocyst-stage group. There was no difference in the incidence of PTB (9.87% versus 8.57%), LBW (11.1% versus 11.4%), or VLBW (1.13 versus 1.43%) when comparing the cleavage-stage early VT and blastocyst-stage early VT groups, even after adjustment with logistic regression. Conclusions. Our study highlights that the adverse perinatal risks of PTB, LBW, and VLBW associated with early VT syndrome are similar in patients undergoing cleavage-stage or blastocyst-stage ETs during fresh IVF cycles.
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287
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Tannus S, Son WY, Gilman A, Younes G, Shavit T, Dahan MH. The role of intracytoplasmic sperm injection in non-male factor infertility in advanced maternal age. Hum Reprod 2016; 32:119-124. [DOI: 10.1093/humrep/dew298] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 10/26/2016] [Accepted: 11/02/2016] [Indexed: 11/12/2022] Open
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288
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Pereira N, Friedman C, Hutchinson AP, Lekovich JP, Elias RT, Rosenwaks Z. Increased odds of live birth in fresh in vitro fertilization cycles with shorter ovarian stimulation. Fertil Steril 2016; 107:104-109.e2. [PMID: 27793370 DOI: 10.1016/j.fertnstert.2016.09.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/23/2016] [Accepted: 09/27/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate the impact of prolonged ovarian stimulation on pregnancy outcomes in IVF cycles with fresh day 3 ET. DESIGN Retrospective cohort study. SETTING University-affiliated center. PATIENT(S) All patients initiating their first IVF cycle with fresh day 3 ET. Prolonged ovarian stimulation was defined as a duration of more than two standard deviations (95th percentile) for the study cohort (i.e., >13 days). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Live birth rate was considered the primary outcome and was compared between patients undergoing ovarian stimulation for ≤13 days and >13 days. Odds ratios (OR) with 95% confidence intervals (CI) for all pregnancy outcomes after day 3 ET were calculated. The OR for live birth was adjusted using logistic regression. RESULT(S) A total of 6,410 and 339 patients underwent ovarian stimulation for ≤13 days and >13 days, respectively. There were no differences in the demographics or mean number of day 3 embryos transferred between the two groups. Ovarian stimulation ≤13 days was associated with increased odds of clinical pregnancy (OR 2.15, 95% CI 1.19-3.89) and live birth (OR 2.35, 95% CI 1.25-4.43). The increased odds for live birth in the ≤13-day group remained unchanged after logistic regression. Patients with clinical pregnancies in the >13-day group were younger (34.6 ± 4.91 years) compared with those who did not conceive (38.2 ± 4.72 years). CONCLUSION(S) Our findings suggest that ovarian stimulation ≤13 days is associated with increased odds of clinical pregnancy and live birth. In patients undergoing ovarian stimulation >13 days, younger age is associated with live birth.
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Affiliation(s)
- Nigel Pereira
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York.
| | - Caroline Friedman
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York
| | - Anne P Hutchinson
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York
| | - Jovana P Lekovich
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York
| | - Rony T Elias
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York
| | - Zev Rosenwaks
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York
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289
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Banker M, Mehta V, Sorathiya D, Dave M, Shah S. Pregnancy outcomes and maternal and perinatal complications of pregnancies following in vitro fertilization/intracytoplasmic sperm injection using own oocytes, donor oocytes, and vitrified embryos: A prospective follow-up study. J Hum Reprod Sci 2016; 9:241-249. [PMID: 28216912 PMCID: PMC5296828 DOI: 10.4103/0974-1208.197666] [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] [Received: 10/03/2016] [Revised: 10/04/2016] [Accepted: 12/20/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Several global studies have assessed maternal and perinatal outcomes and complications with the type of embryo transfer (ET) following in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). The present study assessed the incidence of maternal and perinatal outcomes and complications following IVF/ICSI associated with the type of embryo transferred. METHODOLOGY A total of 2112 ETs were performed in 2092 female patients aged 21-50 years between January 1 and December 31, 2014 (Group A: Fresh ET using self-oocytes: 691; Group B: Fresh ET using donor oocytes: 810; and Group C: Thaw ET using vitrified-warmed embryos: 611). RESULTS Incidence of clinical pregnancy rate, abortion rate, ectopic pregnancy rate, multiple pregnancy rate, live birth rate, and maternal complications was: Group A: 40.8%, 15.9%, 2.8%, 27.3%, 31.9%, and 17.7%; Group B: 50.2%, 21.8%, 1.6%, 32.5%, 36.9%, and 23.7%; and Group C: 42.9%, 25.2%, 1.1%, 31.3%, 29.6%, and 17.8%, respectively. Incidence of prematurity (<36 weeks of pregnancy), lower birth weight (<2500 g), perinatal mortality, and congenital abnormalities was as follows: Group A (29.52%, 36.2%, 5.22%, and 1.39%), Group B (42.58%, 46.2%, 4.6%, and 1.32%), and Group C (35.74%, 32.4%, 7.85%, and 0.94%), respectively. CONCLUSION The higher incidence of the pregnancy outcomes in oocyte donation (OD) cycles can mainly be attributed to the younger age of oocyte donors. The higher incidence of complications in OD cycles could be due to advanced maternal age, different placentation, and immune tolerance.
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Affiliation(s)
| | | | | | - Mira Dave
- Nova IVI Fertility, Ahmedabad, Gujarat, India
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290
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Le Gac S, Nordhoff V. Microfluidics for mammalian embryo culture and selection: where do we stand now? Mol Hum Reprod 2016; 23:213-226. [DOI: 10.1093/molehr/gaw061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 09/02/2016] [Indexed: 12/26/2022] Open
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291
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Chambers GM, Wand H, Macaldowie A, Chapman MG, Farquhar CM, Bowman M, Molloy D, Ledger W. Population trends and live birth rates associated with common ART treatment strategies. Hum Reprod 2016; 31:2632-2641. [PMID: 27664207 DOI: 10.1093/humrep/dew232] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 07/26/2016] [Accepted: 08/22/2016] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Have ART live birth rates improved in Australia over the last 12 years? SUMMARY ANSWER There were striking improvements in per-cycle live birth rates observed for frozen/thaw embryo transfers, blastocyst transfer and single embryo transfer (SET), while live birth rates following ICSI were lower than IVF for non-male factor infertility in most years. WHAT IS ALREADY KNOWN ART and associated techniques have become the predominant treatment of infertility over the past 30 years in most developed countries. However, there are differences in ART laboratory and clinical practices, and success rates worldwide. Australia has one of the highest ART utilization rates and lowest multiple birth rates in the world, thus providing a unique setting to investigate the contribution of common ART strategies in an unrestricted population of patients to ART success rates. STUDY DESIGN, SIZE, DURATION A retrospective cohort study of 585 065 ART treatment cycles performed in Australia between 2002 and 2013 using the Australian and New Zealand Assisted Reproduction Database (ANZARD). PARTICIPANTS MATERIALS, SETTING, METHOD An unrestricted population of all women who underwent autologous ART treatment between 2002 and 2013. Visual descriptive analysis was used to assess the trends in ART procedures by the calendar years. Adjusted odds ratios (aORs) of a live birth for four common ART techniques were calculated after controlling for important confounders including female age, infertility diagnosis, stage of the embryo (blastocyst versus cleavage stage), type of embryo (fresh versus thawed), fertilization method (IVF versus ICSI) and number of embryos transferred (SET versus multiple embryos). MAIN RESULTS AND THE ROLE OF CHANCE The overall live birth rate per embryo transfer increased from 19.2% in 2002 to 23.3% in 2013 (21.9-24.3% for fresh embryo transfers and 14.6-23.3% for frozen/thaw embryo transfers). This occurred concurrently with an increase in SET from 29.7% to 78.9%, and an increase in the average age of women undergoing treatment from 35.0 to 35.9 years. Individuals who had a frozen/thaw embryo transfer cycle in 2002 had 43% (aOR: 0.57, 95% CI: 0.53-0.61) reduced odds of a live birth compared with a fresh embryo transfer cycle. This contrasted with 16% (aOR: 0.84, 95% CI: 0.80-0.98) reduced odds of a live birth from frozen/thaw embryo transfer cycles in 2013. In 2013, the odds of blastocyst transfer resulting in a live birth were more than twice as great as for cleavage stage transfer (aOR 2.01, 95% CI: 1.92-2.11). The adjusted odds of live birth per SET compared with multiple embryo transfer increased significantly over the last 12 years, from a 38% reduced odds of a live birth follow SET in 2002 (aOR: 062, 95% CI: 0.57-0.67) compared to an 8% reduced odds in 2013 (aOR: 0.92, 95% CI: 0.87-0.98). The aOR of a live birth using ICSI compared to IVF in non-male factor patients was lower in most years bringing into question its widespread use. LIMITATION, REASONS FOR CAUTION This is a retrospective cohort analysis and cannot confirm causality. High-level evidence on the effectiveness of particular ART techniques, particularly ICSI and blastocyst culture, requires prospective randomized controlled trials or detailed statistical analysis using large-scale data that counts for fertilization failure, embryo loss, prognostic factors and cycle characteristics. WIDER IMPLICATION OF THE FINDINGS The most striking improvements in ART success rates in Australia have been observed for frozen/thaw embryo transfers, blastocyst transfer and SET. Further studies of the role of ICSI in non-male factor infertility and blastocyst transfer success rates that take into account embryo loss are needed. STUDY FUNDING/COMPETING INTERESTS No funding was received to undertake this study. The authors declare that they do not have competing interests with this study. TRIAL REGISTRATION NUMBER NA.
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Affiliation(s)
- Georgina M Chambers
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women's and Children's Health, University of New South Wales, Level 1, AGSM Building, Sydney 2052, Australia
| | - Handan Wand
- The Kirby Institute, University of New South Wales, Sydney 2052, Australia
| | - Alan Macaldowie
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women's and Children's Health, University of New South Wales, Level 1, AGSM Building, Sydney 2052, Australia
| | | | - Cynthia M Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland 1142, New Zealand
| | - Mark Bowman
- Genea Fertility, Sydney 2000, Australia.,Department of Obstetrics and Gynaecology, University of Sydney, Sydney 2006, Australia
| | - David Molloy
- Queensland Fertility Group, Spring Hill, 4000, Australia
| | - William Ledger
- School of Women's and Children's Health, University of New South Wales, Sydney 2052, Australia
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292
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Maheshwari A, Raja EA, Bhattacharya S. Obstetric and perinatal outcomes after either fresh or thawed frozen embryo transfer: an analysis of 112,432 singleton pregnancies recorded in the Human Fertilisation and Embryology Authority anonymized dataset. Fertil Steril 2016; 106:1703-1708. [PMID: 27678031 DOI: 10.1016/j.fertnstert.2016.08.047] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/24/2016] [Accepted: 08/24/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To explore obstetric and perinatal outcomes in singleton pregnancies occurring as a result of fresh and thawed frozen embryo transfer using anonymized Human Fertilisation and Embryology Authority data. DESIGN Retrospective cohort study. SETTING Not applicable. PATIENT(S) Singleton births after IVF/intracytoplasmic sperm injection cycles in the United Kingdom (1991-2011). INTERVENTION(S) A total of 112,432 cycles (95,911 fresh and 16,521 frozen) were analyzed using multivariate logistic regression to explore associations between type of embryo transferred (frozen vs. fresh) and obstetric and perinatal outcomes. Relative risks (RRs) and their 99.5% confidence intervals (CIs) were calculated using Stata 14 MP, adjusting for potential confounders. MAIN OUTCOME MEASURE(S) Birth weight. RESULT(S) The adjusted RR (99.5% CI) of low birth weight [0.73 (0.66-0.80)] and very low birth weight [0.78 (0.63-0.96)] were all lower after frozen embryo transfer; however, RR of having a high birth weight baby was higher [1.64 (1.53-1.76)]. There was no difference in RR of preterm birth [0.96 (0.88-1.03)], very preterm birth [0.86 (0.70-1.05)], and congenital anomalies [0.86 (0.73-1.01)]. CONCLUSION(S) The findings of low birth and very low birth weight after thawed frozen embryo transfer are consistent with the literature and provide reassurance regarding the outcome of pregnancies after frozen embryo transfers. However, they highlight the possibility of high birth weight in these babies. Because these results are based on observational data, further evidence from randomized, controlled trials is needed before elective cryopreservation of all embryos is practiced in preference to the current practice of transfer of fresh embryos.
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Affiliation(s)
| | - Edwin Amalraj Raja
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
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293
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Blázquez A, Vassena R, Rodríguez A, Figueras F, Vernaeve V. Characteristics and clinical outcomes of patients undergoing fertility treatment by double gamete donation. HUM FERTIL 2016; 19:180-5. [DOI: 10.1080/14647273.2016.1209577] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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294
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295
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Ahmed M, Shareef O, Adam I, Rayis D. Maternal age and intracytoplasmic sperm injection outcome in infertile couples at Khartoum, Sudan. F1000Res 2015; 4:1339. [PMID: 27347370 PMCID: PMC4909122 DOI: 10.12688/f1000research.7386.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2015] [Indexed: 11/20/2022] Open
Abstract
Background Intracytoplasmic sperm injection (ICSI) was considered as the mainstay of treatment for male infertility. Nowadays, the scope of ICSI has been widened to include other causes of infertility. There are few published data on ICSI in countries with low incomes. Aims A cross-sectional study was conducted at Saad AbuAlla and Banoun Centers, Khartoum, Sudan to investigate outcomes of ICSI and to determine the parameters that might predict pregnancy success rate following ICSI. Methods The study included 191 infertile couples who underwent 296 ICSI cycles between 1st April 2013 and 31 March 2014. Results One hundred and ninety one couples (comprising 296 cycles of ICSI) were enrolled to the study. The mean (SD) number of retrieved oocytes was 9.7 (7.5). The mean (SD) number of transferred embryos was 2.9 (1.0). Out of these, 50 (26.2%) and 40 (20.9%) had chemical and clinical pregnancy, respectively. Thirty–six couples (18.8%) and five couples (2.6%) had miscarriage and had ectopic pregnancy, respectively. Under logistic regression, younger age (OR = 0.8, 95% CI= 0.81 ─ 0.96, P = 0.004) and endometrial thickness (OR = 1.3, 95% CI= 1.07─1.60, P = 0.009) were the significant predictors for the success of ICSI in inducing pregnancy. Conclusion The rates of successful fertilisation and pregnancy-to-term rates in this setting depend mainly on the maternal age.
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Affiliation(s)
- Mohamed Ahmed
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Khartoum, Khartoum, 11111, Sudan
| | - Osama Shareef
- Adam and Hawa Fertility Center, Khartoum, 11111, Sudan
| | - Ishag Adam
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Khartoum, Khartoum, 11111, Sudan
| | - Duria Rayis
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Khartoum, Khartoum, 11111, Sudan
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