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Quinn G, Caplan A. The Hypothetical Embryo and the Prosecutor's Fallacy. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:46-47. [PMID: 39158434 DOI: 10.1080/15265161.2024.2361876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
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Li Q, Zhang X, Jiang S, Pang W, Sun N. Hysteroscopic Management of Symptomatic Cesarean Scar Diverticulum in Patients Undergoing Frozen-Thawed Embryo Transfer: Impact on Clinical Pregnancy Rates and Pregnancy Complications. Reprod Sci 2024:10.1007/s43032-024-01642-4. [PMID: 38977643 DOI: 10.1007/s43032-024-01642-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/29/2024] [Indexed: 07/10/2024]
Abstract
This retrospective cohort study aimed to compare the clinical outcomes of patients with cesarean scar defect (CSD) undergoing frozen embryo transfer (FET) with or without hysteroscopic repair surgery. The study included 82 patients, with 48 patients in surgical group A (undergoing CSD repair) and 34 patients in surgical group B (undergoing hysteroscopic treatment for other uterine lesions). The results showed that patients in group A had a larger CSD volume and a different shape compared to group B. However, there was no significant difference in clinical pregnancy rates between the two groups. Additionally, there were no differences in miscarriage, live birth, or preterm birth rates, and no complications such as scar pregnancy or placental abnormalities were observed in either group. These findings suggest that hysteroscopic treatment of CSD in symptomatic patients undergoing FET does not increase the risk of pregnancy complications and can lead to comparable clinical pregnancy rates with asymptomatic patients. Further studies with larger sample sizes are needed to confirm these results and evaluate long-term reproductive outcomes following CSD repair.
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Affiliation(s)
- Qingxian Li
- Reproductive Medicine Center, Second Affiliated Hospital of Naval Medical University, No. 415 Fengyang Road, Shanghai, 200003, China
| | - Xin Zhang
- Reproductive Medicine Center, Second Affiliated Hospital of Naval Medical University, No. 415 Fengyang Road, Shanghai, 200003, China
| | - Song Jiang
- Department of Medical Imaging, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Wenjuan Pang
- Reproductive Medicine Center, Second Affiliated Hospital of Naval Medical University, No. 415 Fengyang Road, Shanghai, 200003, China
| | - Ningxia Sun
- Reproductive Medicine Center, Second Affiliated Hospital of Naval Medical University, No. 415 Fengyang Road, Shanghai, 200003, China.
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Wang XJ, Chen MX, Ruan LL, Tan L, Geng LH, Yang HJ, Fu LJ, Zhong ZH, Lv XY, Ding YB, Wan Q. Study on the optimal time limit of frozen embryo transfer and the effect of a long-term frozen embryo on pregnancy outcome. Medicine (Baltimore) 2024; 103:e37542. [PMID: 38552082 PMCID: PMC10977551 DOI: 10.1097/md.0000000000037542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/19/2024] [Indexed: 04/02/2024] Open
Abstract
In this retrospective study conducted at Sichuan Jinxin Xinan Women and Children's Hospital spanning January 2015 to December 2021, our objective was to investigate the impact of embryo cryopreservation duration on outcomes in frozen embryo transfer. Participants, totaling 47,006 cycles, were classified into 3 groups based on cryopreservation duration: ≤1 year (Group 1), 1 to 6 years (Group 2), and ≥6 years (Group 3). Employing various statistical analyses, including 1-way ANOVA, Kruskal-Wallis test, chi-square test, and a generalized estimating equation model, we rigorously adjusted for confounding factors. Primary outcomes encompassed clinical pregnancy rate and Live Birth Rate (LBR), while secondary outcomes included biochemical pregnancy rate, multiple pregnancy rate, ectopic pregnancy rate, early and late miscarriage rates, preterm birth rate, neonatal birth weight, weeks at birth, and newborn sex. Patient distribution across cryopreservation duration groups was as follows: Group 1 (40,461 cycles), Group 2 (6337 cycles), and Group 3 (208 cycles). Postcontrolling for confounding factors, Group 1 exhibited a decreased likelihood of achieving biochemical pregnancy rate, clinical pregnancy rate, and LBR (OR < 1, aOR < 1, P < .05). Furthermore, an elevated incidence of ectopic pregnancy was observed (OR > 1, aOR > 1), notably significant after 6 years of freezing time [aOR = 4.141, 95% confidence intervals (1.013-16.921), P = .05]. Cryopreservation exceeding 1 year was associated with an increased risk of early miscarriage and preterm birth (OR > 1, aOR > 1). No statistically significant differences were observed in birth weight or sex between groups. However, male infant birth rates were consistently higher than those of female infants across all groups. In conclusion, favorable pregnancy outcomes align with embryo cryopreservation durations within 1 year, while freezing for more than 1 year may diminish clinical pregnancy and LBRs, concurrently elevating the risk of ectopic pregnancy and preterm birth.
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Affiliation(s)
- Xue-Jiao Wang
- Sichuan Jinxin Xinan Women and Children’s Hospital, Chengdu, China
| | - Ming-Xing Chen
- Department of Obstetrics and Gynecology, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
- Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Ling-Ling Ruan
- Department of Obstetrics and Gynecology, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
- Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Li Tan
- Sichuan Jinxin Xinan Women and Children’s Hospital, Chengdu, China
| | - Li-Hong Geng
- Sichuan Jinxin Xinan Women and Children’s Hospital, Chengdu, China
| | - Hui-Jun Yang
- Assisted Reproductive Center, Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, China
| | - Li-Juan Fu
- Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, School of Public Health, Chongqing Medical University, Chongqing, China
- Department of Pharmacology, Academician Workstation, Changsha Medical University, Changsha, China
| | - Zhao-Hui Zhong
- Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Xing-Yu Lv
- Sichuan Jinxin Xinan Women and Children’s Hospital, Chengdu, China
| | - Yu-Bin Ding
- Department of Obstetrics and Gynecology, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
- Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Qi Wan
- Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
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Sachs MK, Makieva S, Velasco Gil A, Xie M, Ille F, Salvadori V, Schmidhauser M, Saenz-de-Juano MD, Ulbrich SE, Leeners B. Transcriptomic signature of luteinized cumulus cells of oocytes developing to live birth after women received intracytoplasmic sperm injection. F&S SCIENCE 2024; 5:24-38. [PMID: 38036000 DOI: 10.1016/j.xfss.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To compare the transcriptome of human cumulus cells (CCs) from oocytes with different outcomes (pregnancy yes/no, live birth [LB] yes/no), to identify noninvasive biomarkers for oocyte selection as well as new therapeutic targets to increase LB rates from assisted reproductive technologies (ART). DESIGN Retrospective observational study. SETTINGS This study was conducted at a University Hospital in Switzerland. PATIENTS Subfertile couples undergoing controlled ovarian superstimulation and intracytoplasmic sperm injection with subsequent unbiopsied embryo transfer below the female age of 43 years. INTERVENTION(S) RNA sequencing of CCs from oocytes results in a pregnancy, no pregnancy, LB, or no LB. MAIN OUTCOME MEASURES Differential gene expression (DEG) between CCs of oocytes results in "no pregnancy" vs. "pregnancy" and "pregnancy only" vs. "live birth." RESULTS Although RNA sequencing did not reveal DEGs when comparing the transcriptomic profiles of the groups "no pregnancy" with "pregnancy," we identified 139 DEGs by comparing "pregnancy only" with "live birth," of which 28 belonged to clusters relevant to successful ART outcomes (i.e., CTGF, SERPINE2, PCK1, HHIP, HS3ST, and BIRC5). A functional enrichment analysis revealed that the transcriptome of CCs associated with LB depicts pathways of extracellular matrix, inflammatory cascades leading to ovulation, cell patterning, proliferation, and differentiation, and silencing pathways leading to apoptosis. CONCLUSION We identified a CCs transcriptomic profile associated with LB after embryo transfer that, after further validation, could serve to predict successful ART outcomes. The definition of relevant pathways of CCs related to oocyte competency contributes to a broader understanding of the cumulus oocyte complex and helps identify further therapeutic targets for improving ART success.
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Affiliation(s)
- Maike K Sachs
- Department of Reproductive Endocrinology, University Hospital Zurich, Frauenklinikstrasse, Zurich, Switzerland.
| | - Sofia Makieva
- Department of Reproductive Endocrinology, University Hospital Zurich, Frauenklinikstrasse, Zurich, Switzerland
| | - Ana Velasco Gil
- Department of Reproductive Endocrinology, University Hospital Zurich, Frauenklinikstrasse, Zurich, Switzerland
| | - Min Xie
- Department of Reproductive Endocrinology, University Hospital Zurich, Frauenklinikstrasse, Zurich, Switzerland
| | - Fabian Ille
- Center of Bioscience and Medical Engineering, Institute of Medical Engineering, Lucerne University of Applied Sciences and Arts, Obermattweg, Hergiswil, Switzerland
| | - Vincent Salvadori
- Center of Bioscience and Medical Engineering, Institute of Medical Engineering, Lucerne University of Applied Sciences and Arts, Obermattweg, Hergiswil, Switzerland
| | - Meret Schmidhauser
- ETH Zürich, Animal Physiology, Institute of Agricultural Sciences, Universitätsstrasse Zurich, Switzerland
| | - Mara D Saenz-de-Juano
- ETH Zürich, Animal Physiology, Institute of Agricultural Sciences, Universitätsstrasse Zurich, Switzerland
| | - Susanne E Ulbrich
- ETH Zürich, Animal Physiology, Institute of Agricultural Sciences, Universitätsstrasse Zurich, Switzerland
| | - Brigitte Leeners
- Department of Reproductive Endocrinology, University Hospital Zurich, Frauenklinikstrasse, Zurich, Switzerland
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Capodanno F, Anastasi A, Cinti M, Bonesi F, Gallinelli A. Current and future methods for embryo selection: on a quest for reliable strategies to reduce time to pregnancy. Minerva Obstet Gynecol 2024; 76:80-88. [PMID: 37162493 DOI: 10.23736/s2724-606x.23.05257-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
INTRODUCTION The aim of this study was to analyze the usefulness of the principal embryological strategies to reduce time to pregnancy. EVIDENCE ACQUISITION A systematic search of publications in the PubMed/MEDLINE, Embase and Scopus databases from inception to present including "IVF," "blastocyst," "embryo colture," "competent embryo," "time to pregnancy," "aneuploid," "euploid," "vitrification," "preimplantation genetic," "IVF strategies" and "embryo selection" alone or in combinations has been done. EVIDENCE SYNTHESIS We have selected 230 articles and 9 of them have been included in this mini-review. CONCLUSIONS Several embryological strategies aimed to select the most competent embryo and reduce time to pregnancy have been proposed, even if few publications on this specific topic are available. preimplantation genetic testing (PGT-A) represents the unique method able to assess the embryonic chromosomal status, but this does not mean that PGT-A is a reliable strategy to reduce time to pregnancy. There is no consensus on a specific method to reduce time to pregnancy, nevertheless this final goal could be probably reached through a harmonious combination of procedures. Thus, a reliable strategy to reduce time to pregnancy could be achieved when embryo culture, embryo cryopreservation and PGT-A are perfectly integrated and appropriately offered to selected patients.
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Affiliation(s)
- Francesco Capodanno
- Center of Physiopathology of Human Reproduction, "Delta" Hospital, AUSL Ferrara, Ferrara, Italy
| | - Attilio Anastasi
- Center of Physiopathology of Human Reproduction, "Delta" Hospital, AUSL Ferrara, Ferrara, Italy -
| | - Marialuisa Cinti
- Center of Physiopathology of Human Reproduction, "Delta" Hospital, AUSL Ferrara, Ferrara, Italy
| | - Francesca Bonesi
- Center of Physiopathology of Human Reproduction, "Delta" Hospital, AUSL Ferrara, Ferrara, Italy
| | - Andrea Gallinelli
- Center of Physiopathology of Human Reproduction, "Delta" Hospital, AUSL Ferrara, Ferrara, Italy
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Ngwenya O, Lensen SF, Vail A, Mol BWJ, Broekmans FJ, Wilkinson J. Individualised gonadotropin dose selection using markers of ovarian reserve for women undergoing in vitro fertilisation plus intracytoplasmic sperm injection (IVF/ICSI). Cochrane Database Syst Rev 2024; 1:CD012693. [PMID: 38174816 PMCID: PMC10765476 DOI: 10.1002/14651858.cd012693.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
BACKGROUND During a stimulated cycle of in vitro fertilisation or intracytoplasmic sperm injection (IVF/ICSI), women receive daily doses of gonadotropin follicle-stimulating hormone (FSH) to induce multifollicular development in the ovaries. A normal response to stimulation (e.g. retrieval of 5 to 15 oocytes) is considered desirable. Generally, the number of eggs retrieved is associated with the dose of FSH. Both hyper-response and poor response are associated with an increased chance of cycle cancellation. In hyper-response, this is due to increased risk of ovarian hyperstimulation syndrome (OHSS), while poor response cycles are cancelled because the quantity and quality of oocytes is expected to be low. Clinicians often individualise the FSH dose using patient characteristics predictive of ovarian response. Traditionally, this meant women's age, but increasingly, clinicians use various ovarian reserve tests (ORTs). These include basal FSH (bFSH), antral follicle count (AFC), and anti-Müllerian hormone (AMH). It is unclear whether individualising FSH dose improves clinical outcomes. This review updates the 2018 version. OBJECTIVES To assess the effects of individualised gonadotropin dose selection using markers of ovarian reserve in women undergoing IVF/ICSI. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility Group Specialised Register of controlled trials, CENTRAL, MEDLINE, Embase, and two trial registers in February 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared (a) different doses of FSH in women with a defined ORT profile (i.e. predicted low, normal, or high responders based on AMH, AFC, and/or bFSH) or (b) an individualised dosing strategy (based on at least one ORT measure) versus uniform dosing or a different individualised dosing algorithm. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. Primary outcomes were live birth/ongoing pregnancy and severe OHSS. MAIN RESULTS We included 26 studies, involving 8520 women (6 new studies added to 20 studies included in the previous version). We treated RCTs with multiple comparisons as separate trials for the purpose of this review. Meta-analysis was limited due to clinical heterogeneity. Evidence certainty ranged from very low to low, with the main limitations being imprecision and risk of bias associated with lack of blinding. Direct dose comparisons according to predicted response in women Due to differences in dose comparisons, caution is required when interpreting the RCTs in predicted low responders. All evidence was low or very low certainty. Effect estimates were very imprecise, and increased FSH dosing may or may not have an impact on rates of live birth/ongoing pregnancy, OHSS, and clinical pregnancy. Similarly, in predicted normal responders (10 studies, 4 comparisons), higher doses may or may not impact the probability of live birth/ongoing pregnancy (e.g. 200 versus 100 international units (IU): odds ratio (OR) 0.88, 95% confidence interval (CI) 0.57 to 1.36; I2 = 0%; 2 studies, 522 women) or clinical pregnancy. Results were imprecise, and a small benefit or harm remains possible. There were too few events for the OHSS outcome to enable inferences. In predicted high responders, lower doses may or may not affect live birth/ongoing pregnancy (OR 0.98, 95% CI 0.66 to 1.46; 1 study, 521 women), severe OHSS, and clinical pregnancy. It is also unclear whether lower doses reduce moderate or severe OHSS (Peto OR 2.31, 95% CI 0.80 to 6.67; 1 study, 521 participants). ORT-algorithm studies Eight trials compared an ORT-based algorithm to a non-ORT control group. It is unclear whether live birth/ongoing pregnancy and clinical pregnancy are increased using an ORT-based algorithm (live birth/ongoing pregnancy: OR 1.12, 95% CI 0.98 to 1.29; I2 = 30%; 7 studies, 4400 women; clinical pregnancy: OR 1.04, 95% CI 0.91 to 1.18; I2 = 18%; 7 studies, 4400 women; low-certainty evidence). However, ORT algorithms may reduce moderate or severe OHSS (Peto OR 0.60, 95% CI 0.42 to 0.84; I2 = 0%; 7 studies, 4400 women; low-certainty evidence). There was insufficient evidence to determine whether the groups differed in rates of severe OHSS (Peto OR 0.74, 95% CI 0.42 to 1.28; I2 = 0%; 5 studies, 2724 women; low-certainty evidence). Our findings suggest that if the chance of live birth with a standard starting dose is 25%, the chance with ORT-based dosing would be between 25% and 31%. If the chance of moderate or severe OHSS with a standard starting dose is 5%, the chance with ORT-based dosing would be between 2% and 5%. These results should be treated cautiously due to heterogeneity in the algorithms: some algorithms appear to be more effective than others. AUTHORS' CONCLUSIONS We did not find that tailoring the FSH dose in any particular ORT population (low, normal, high ORT) affected live birth/ongoing pregnancy rates, but we could not rule out differences, due to sample size limitations. Low-certainty evidence suggests that it is unclear if ORT-based individualisation leads to an increase in live birth/ongoing pregnancy rates compared to a policy of giving all women 150 IU. The confidence interval is consistent with an increase of up to around six percentage points with ORT-based dosing (e.g. from 25% to 31%) or a very small decrease (< 1%). A difference of this magnitude could be important to many women. It is unclear if this is driven by improved outcomes in a particular subgroup. Further, ORT algorithms reduced the incidence of OHSS compared to standard dosing of 150 IU. However, the size of the effect is also unclear. The included studies were heterogeneous in design, which limited the interpretation of pooled estimates. It is likely that different ORT algorithms differ in their effectiveness. Current evidence does not provide a clear justification for adjusting the dose of 150 IU in poor or normal responders, especially as increased dose is associated with greater total FSH dose and cost. It is unclear whether a decreased dose in predicted high responders reduces OHSS, although this would appear to be the most likely explanation for the results.
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Affiliation(s)
- Olina Ngwenya
- Centre for Biostatistics, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK
| | - Sarah F Lensen
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Andy Vail
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Frank J Broekmans
- Department of Gynecology and Reproductive Medicine, University Medical Centre, Utrecht, Heidelberglaan, Netherlands
- Centre For Fertility Care, Dijklander Hospital, Waterlandlaan, Purmerend, Netherlands
| | - Jack Wilkinson
- Centre for Biostatistics, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK
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Liang Z, Wen Q, Li J, Zeng D, Huang P. A systematic review and meta-analysis: clinical outcomes of recurrent pregnancy failure resulting from preimplantation genetic testing for aneuploidy. Front Endocrinol (Lausanne) 2023; 14:1178294. [PMID: 37850092 PMCID: PMC10577404 DOI: 10.3389/fendo.2023.1178294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/11/2023] [Indexed: 10/19/2023] Open
Abstract
Background Preimplantation genetic testing for aneuploidy (PGT-A) is an emerging technology that aims to identify euploid embryos for transfer, reducing the risk of embryonic chromosomal abnormalities. However, the clinical benefits of PGT-A in recurrent pregnancy failure (RPF) patients, particularly in young RPF patients, remains uncertain. Objective and rationale This meta-analysis aimed to determine whether RPF patients undergoing PGT-A had better clinical outcomes compared to those not undergoing PGT-A, thus assessing the value of PGT-A in clinical practice. Search methods We systematically searched PubMed, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP Database for Chinese Technical Periodicals (VIP) from 2002 to 2022. Thirteen published studies involving 930 RPF patients screened using PGT-A and over 1,434 RPF patients screened without PGT-A were included in this meta-analysis. Clinical outcomes were evaluated based on embryo transfers after PGT-A (n=1,015) and without PGT-A (n=1,799). Clinical outcomes The PGT-A group demonstrated superior clinical outcomes compared to the in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) group. The PGT-A group had a significantly higher implantation rate (IR) (RR=2.01, 95% CI: [1.73; 2.34]), clinical pregnancy rate (CPR) (RR=1.53, 95% CI: [1.36; 1.71]), ongoing pregnancy rate (OPR) (RR=1.76, 95% CI: [1.35; 2.29]), live birth rate (LBR) (RR=1.75, 95% CI: [1.51; 2.03]), and significantly lower clinical miscarriage rate (CMR) (RR=0.74, 95% CI: [0.54; 0.99]). Subgroup analysis based on patient age (under 35 years and 35 years or older) showed that both PGT-A subgroups had significantly better CPR (P<0.01) and LBR (P<0.05) values compared to the IVF/ICSI groups. Summary This meta-analysis demonstrates that PGT-A in RPF patients, is associated with improved clinical outcomes, including higher IR, CPR, OPR, and LBR values, and lower CMR compared to the IVF/ICSI group. These findings support the positive clinical application of PGT-A in RPF patients. Systematic Review Registration http://INPLASY.com, identifier INPLASY 202320118.
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Affiliation(s)
- Zhuo Liang
- Center of Reproductive Medicine, Guangzhou Women and Children’s Medical Center-Liuzhou Hospital, Liuzhou, Guangxi, China
- Center of Reproductive Medicine, Liuzhou Maternal and Child Health Hospital, Liuzhou, Guangxi, China
- Center of Reproductive Medicine, Liuzhou Institute of Reproduction and Genetics, Liuzhou, Guangxi, China
- Affiliated Maternity Hospital and Affiliated Children’s Hospital of Guangxi, University of Science and Technology, Liuzhou, Guangxi, China
- Guangxi Clinical Research Center for Obstetrics and Gynecology, Liuzhou, Guangxi, China
- Graduate School, Guilin Medical College, Guilin, Guangxi, China
| | - Qiuyue Wen
- Center of Reproductive Medicine, Guangzhou Women and Children’s Medical Center-Liuzhou Hospital, Liuzhou, Guangxi, China
- Center of Reproductive Medicine, Liuzhou Maternal and Child Health Hospital, Liuzhou, Guangxi, China
- Center of Reproductive Medicine, Liuzhou Institute of Reproduction and Genetics, Liuzhou, Guangxi, China
- Affiliated Maternity Hospital and Affiliated Children’s Hospital of Guangxi, University of Science and Technology, Liuzhou, Guangxi, China
- Guangxi Clinical Research Center for Obstetrics and Gynecology, Liuzhou, Guangxi, China
| | - Jingjing Li
- Center of Reproductive Medicine, Guangzhou Women and Children’s Medical Center-Liuzhou Hospital, Liuzhou, Guangxi, China
- Center of Reproductive Medicine, Liuzhou Maternal and Child Health Hospital, Liuzhou, Guangxi, China
- Center of Reproductive Medicine, Liuzhou Institute of Reproduction and Genetics, Liuzhou, Guangxi, China
- Affiliated Maternity Hospital and Affiliated Children’s Hospital of Guangxi, University of Science and Technology, Liuzhou, Guangxi, China
- Guangxi Clinical Research Center for Obstetrics and Gynecology, Liuzhou, Guangxi, China
| | - Dingyuan Zeng
- Center of Reproductive Medicine, Guangzhou Women and Children’s Medical Center-Liuzhou Hospital, Liuzhou, Guangxi, China
- Center of Reproductive Medicine, Liuzhou Maternal and Child Health Hospital, Liuzhou, Guangxi, China
- Center of Reproductive Medicine, Liuzhou Institute of Reproduction and Genetics, Liuzhou, Guangxi, China
- Affiliated Maternity Hospital and Affiliated Children’s Hospital of Guangxi, University of Science and Technology, Liuzhou, Guangxi, China
- Guangxi Clinical Research Center for Obstetrics and Gynecology, Liuzhou, Guangxi, China
| | - Pinxiu Huang
- Center of Reproductive Medicine, Guangzhou Women and Children’s Medical Center-Liuzhou Hospital, Liuzhou, Guangxi, China
- Center of Reproductive Medicine, Liuzhou Maternal and Child Health Hospital, Liuzhou, Guangxi, China
- Center of Reproductive Medicine, Liuzhou Institute of Reproduction and Genetics, Liuzhou, Guangxi, China
- Affiliated Maternity Hospital and Affiliated Children’s Hospital of Guangxi, University of Science and Technology, Liuzhou, Guangxi, China
- Guangxi Clinical Research Center for Obstetrics and Gynecology, Liuzhou, Guangxi, China
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Bourdon M, Alwohaibi A, Maignien C, Marcellin L, Chargui A, Pocate Cheriet K, Patrat C, Chapron C, Santulli P. IVF/ICSI Outcomes After a Freeze-All Strategy: an Observational Cohort Study. Reprod Sci 2023; 30:2283-2291. [PMID: 36694083 DOI: 10.1007/s43032-023-01173-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 01/13/2023] [Indexed: 01/26/2023]
Abstract
In order to inform patients undergoing ART regarding their chances for motherhood, it seems useful to describe "freeze all" outcomes according to the different potential indications. The goal of this study was to examine the impact of a "freeze-all approach" on the cumulative live birth rate (cLBR) according to the indication. It is a cohort study including women who had undergone ovarian stimulation (OS) using an antagonist protocol with GnRH agonist triggering between 09.2016 and 09.2018 followed by a freeze-all cycle of blastocyst embryos. The ART outcomes were compared between the two main indications of the freeze-all strategy which were in our cohort: risk of ovarian hyperstimulation syndrome (OHSS) and endometriosis. The ART outcomes were also described for the others indications (inadequate endometrium and/or premature progesterone elevation at trigger day, two or more previous ART failures, and autoimmune disease and/or a high risk of thromboembolic disease (AI and/or TE risk)). In total, 658 women were included. The cLBR in the total population was 37.7% (248/658). The cLBR was significantly higher in the "OHSS risk" group (133/281, 47.3%) than in the "endometriosis" group (69/190, 36.3%) (p = 0.017). No significant differences were noted regarding perinatal outcomes, except a significantly higher risk of placenta praevia (PP) observed in the "endometriosis" group (10.1%) (p = 0.002). The "freeze-all approach" yielded good results in terms of the cLBR and especially in case of OHSS risk. These data should be taken into account when informing patients about the ART strategy and their chances of motherhood.
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Affiliation(s)
- Mathilde Bourdon
- Faculté de Santé, Faculté de Médecine Paris Centre, Université de Paris, Paris, France
- Service de Gynécologie-Obstétrique II Et de Médecine de La Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, 75014, Paris, France
- Department "Infection, Immunity, Inflammation", INSERM U1016, Institut Cochin, Université de Paris, Paris, France
| | - Asim Alwohaibi
- Faculté de Santé, Faculté de Médecine Paris Centre, Université de Paris, Paris, France
- Service de Gynécologie-Obstétrique II Et de Médecine de La Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, 75014, Paris, France
| | - Chloé Maignien
- Faculté de Santé, Faculté de Médecine Paris Centre, Université de Paris, Paris, France
- Service de Gynécologie-Obstétrique II Et de Médecine de La Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, 75014, Paris, France
| | - Louis Marcellin
- Faculté de Santé, Faculté de Médecine Paris Centre, Université de Paris, Paris, France
- Service de Gynécologie-Obstétrique II Et de Médecine de La Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, 75014, Paris, France
- Department "Infection, Immunity, Inflammation", INSERM U1016, Institut Cochin, Université de Paris, Paris, France
| | - Ahmed Chargui
- Faculté de Santé, Faculté de Médecine Paris Centre, Université de Paris, Paris, France
- Service d'Histologie-Embryologie-Biologie de La Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, 75014, Paris, France
| | - Khaled Pocate Cheriet
- Faculté de Santé, Faculté de Médecine Paris Centre, Université de Paris, Paris, France
- Service d'Histologie-Embryologie-Biologie de La Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, 75014, Paris, France
| | - Catherine Patrat
- Faculté de Santé, Faculté de Médecine Paris Centre, Université de Paris, Paris, France
- Service d'Histologie-Embryologie-Biologie de La Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, 75014, Paris, France
| | - Charles Chapron
- Faculté de Santé, Faculté de Médecine Paris Centre, Université de Paris, Paris, France
- Service de Gynécologie-Obstétrique II Et de Médecine de La Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, 75014, Paris, France
- Department "Infection, Immunity, Inflammation", INSERM U1016, Institut Cochin, Université de Paris, Paris, France
| | - Pietro Santulli
- Faculté de Santé, Faculté de Médecine Paris Centre, Université de Paris, Paris, France.
- Service de Gynécologie-Obstétrique II Et de Médecine de La Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, 75014, Paris, France.
- Department "Infection, Immunity, Inflammation", INSERM U1016, Institut Cochin, Université de Paris, Paris, France.
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9
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Önalan G, Tunç M, Tohma A, Günakan E, Eryılmaz T, Zeyneloğlu HB. Extending the culture of cleavage-stage embryos to the blastocyst stage after warming increases the chance of live birth: does it have a regenerative effect? Arch Gynecol Obstet 2023; 307:1969-1974. [PMID: 37022346 DOI: 10.1007/s00404-023-07031-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/28/2023] [Indexed: 04/07/2023]
Abstract
PURPOSE We aimed to evaluate the effect of extending the culture of cleavage-stage embryos to the blastocyst stage in vitrified-warmed cycles on pregnancy outcomes. METHODS This is a retrospectively designed pilot study of a single center. All patients who applied for freeze-all cycle procedures during in vitro fertilization treatment were included in the study. Patients were classified into three subgroups. The embryos obtained were frozen at the cleavage or blastocyst stage. After a warming process, the cleavage-stage embryos were divided into two subgroups: the first group of embryos was transferred (vitrification day 3-embryo transfer (ET) day 3 (D3T3)) on the warming day; for the second group, the embryo culture was extended to the blastocyst stage (vitrification day 3-ET day 5 (after the extension of the embryo culture to the blastocyst stage), (D3T5)). Frozen blastocyst-stage embryos were transferred after warming (vitrification day 5-ET day 5 (D5T5)). Hormone replacement treatment was the only endometrial preparation regimen given during the embryo transfer cycle. The main outcome of the study was live birth rates. The clinical pregnancy rate and positive pregnancy test rate were determined as the secondary outcomes of the study. RESULTS The study included a total of 194 patients. The positive pregnancy test rates (PPR) and clinical pregnancy rates (CPR) of the D3T3, D3T5, and D5T5 groups were 14.0% and 59.2%; 43.8% and 9.3%; and 56.3% and 39.6%, respectively (p < 0.001 and p < 0.001). The live birth rates (LBR) of patients in the D3T3, D3T5, and D5T5 groups were 7.0%, 44.7%, and 27.1%, respectively (p < 0.001). In subgroup analysis of patients with a poor number of 2PN embryos (defined as having < = 4 2PN embryos), the D3T5 group had significantly higher PPR (10.7%, 60.6%, 42.4%; p < 0.001), CPR (7.1%, 57.6%, 39.4%; p < 0.001), and LBR (3.6%, 39.4%, 21.2%; p: 0.001). CONCLUSION Extending the culture after warming to the blastocyst stage may be a better alternative than a cleavage-stage embryo transfer.
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Affiliation(s)
- Göğşen Önalan
- Department of Obstetrics and Gynecology, Başkent University School of Medicine, Şehit Temel Kuğuoğlu Cd. No: 34 Bahçelievler, Ankara, Turkey
| | - Mehmet Tunç
- Department of Obstetrics and Gynecology, Başkent University School of Medicine, Şehit Temel Kuğuoğlu Cd. No: 34 Bahçelievler, Ankara, Turkey.
| | - Aytaç Tohma
- Department of Obstetrics and Gynecology, Başkent University School of Medicine, Şehit Temel Kuğuoğlu Cd. No: 34 Bahçelievler, Ankara, Turkey
| | - Emre Günakan
- Department of Obstetrics and Gynecology, Başkent University School of Medicine, Şehit Temel Kuğuoğlu Cd. No: 34 Bahçelievler, Ankara, Turkey
| | - Tahir Eryılmaz
- Department of Obstetrics and Gynecology, Başkent University School of Medicine, Şehit Temel Kuğuoğlu Cd. No: 34 Bahçelievler, Ankara, Turkey
| | - Hulusi B Zeyneloğlu
- Department of Obstetrics and Gynecology, Başkent University School of Medicine, Şehit Temel Kuğuoğlu Cd. No: 34 Bahçelievler, Ankara, Turkey
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10
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Youngster M, Kedem A, Avraham S, Yerushalmi G, Baum M, Maman E, Hourvitz A, Gat I. Treatment safety of ART cycles with extremely high oestradiol concentrations using GnRH agonist trigger. Reprod Biomed Online 2023; 46:519-526. [PMID: 36566147 DOI: 10.1016/j.rbmo.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/26/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
RESEARCH QUESTION Are IVF treatments with extremely high peak oestradiol levels and gonadotrophin releasing hormone (GnRH) agonist trigger associated with higher complication rates? DESIGN A retrospective cohort study including patients from two large medical centres treated between 2019 and 2021. A study group with extremely high peak oestradiol levels (≥20,000 pmol/l on the day of ovarian stimulation, or ≥15,000 pmol/l on the previous day) and a control group with normal range oestradiol levels (3000-12000 pmol/l) that received GnRH agonist triggering. Patients were surveyed about complaints and medical care related to ovum retrieval and medical files were reviewed. Major complication rates and the need for medical assistance were compared. RESULTS Several differences between the study and control group were observed because of the study design: mean age was 33.01 ± 5.14 versus 34.57 ± 4.52 (P < 0.001), mean peak oestradiol levels was 26645.34 ± 8592.57 pmol/l versus 7229.75 ± 2329.20 pmol/l (P < 0.001), and mean number of oocytes were 27.55 ± 13.46 versus 11.67 ± 5.76 (P < 0.001) for the study and control group, respectively. Major complications and hospitalization rates were similar between the study and control groups (three [1.25%] versus one [0.48%]; P = 0.62 and three [1.25%] versus two [0.96%]; P = 1.0, respectively). Thirty-six patients (15.1%) in the study group and 11 (5.3%) in the control group sought medical care after retrieval, mostly due to abdominal pain, without the need for further workup or hospitalization (P < 0.001). CONCLUSIONS Extremely high oestradiol levels were not associated with thromboembolic events, higher major complication or hospitalization rates, and therefore may be considered safe. Nevertheless, patients may be informed of possible higher rates of discomfort, mostly abdominal pain. Larger studies are warranted to confirm our results.
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Affiliation(s)
- Michal Youngster
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; IVF Unit, Herzliya Medical Centre, Herzliya, Israel.
| | - Alon Kedem
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; IVF Unit, Herzliya Medical Centre, Herzliya, Israel
| | - Sarit Avraham
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; IVF Unit, Herzliya Medical Centre, Herzliya, Israel
| | - Gil Yerushalmi
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Micha Baum
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; IVF Unit, Herzliya Medical Centre, Herzliya, Israel; IVF Unit, Department of Obstetrics and Gynecology, Sheba Medical Centre, Ramat-Gan, Israel
| | - Ettie Maman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; IVF Unit, Herzliya Medical Centre, Herzliya, Israel; IVF Unit, Department of Obstetrics and Gynecology, Sheba Medical Centre, Ramat-Gan, Israel
| | - Ariel Hourvitz
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; IVF Unit, Herzliya Medical Centre, Herzliya, Israel
| | - Itai Gat
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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11
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Ikechebelu JI, Dim CC, Eleje GU, Joe-Ikechebelu N, Okpala BC, Okam PC. A randomised control trial on oral dydrogesterone versus micronized vaginal progesterone pessary for luteal phase support in in vitro fertilization cycles. J Med Life 2023; 16:62-69. [PMID: 36873122 PMCID: PMC9979184 DOI: 10.25122/jml-2022-0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/28/2022] [Indexed: 03/07/2023] Open
Abstract
This study aimed to evaluate the pregnancy rates, adverse reactions, and medication costs of two luteal phase support regimens: oral dydrogesterone and micronized vaginal progesterone (MVP) pessary in in vitro fertilization cycles. A randomized open-label trial with participants randomly assigned to either 400 mg MVP twice daily or 10 mg dydrogesterone three times daily. The primary endpoints were pregnancy rates, and the secondary endpoints included tolerance, miscarriage rates, and medication cost. Per-protocol principle analysis was performed. The baseline characteristics of the 162 participants were similar. Dydrogesterone had statistically similar (p>0.05) positive pregnancy test rates fifteen days post embryo transfer (35.8% vs. 32.7%), clinical pregnancy rates at the gestational age of 6 weeks (32.1% vs. 28.8%), ongoing pregnancy rates (26.4% vs. 23.1%) and miscarriage rates at 14 weeks of gestation (9.2% vs. 9.4%) and safety profile to MVP. Dydrogesterone was better tolerated as vaginal itching was significantly more prevalent in the MVP arm (p=0.008). Dydrogesterone is significantly less expensive than MVP pessary. Oral dydrogesterone and MVP pessary had similar pregnancy rates and adverse effects. Dydrogesterone appears more user-friendly and less expensive in cases of luteal-phase support in in vitro fertilization cycles.
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Affiliation(s)
- Joseph Ifeanyichukwu Ikechebelu
- Department of Obstetrics and Gynaecology, Faculty of Medicine, College of Health Sciences, Nnamdi Azikiwe University, Awka, Nigeria.,Life Fertility Centre, Life International Hospital, Awka, Nigeria.,Institute of Maternal and Child Health, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Cyril Chukwudi Dim
- Institute of Maternal and Child Health, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria.,Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - George Uchenna Eleje
- Department of Obstetrics and Gynaecology, Faculty of Medicine, College of Health Sciences, Nnamdi Azikiwe University, Awka, Nigeria.,Institute of Maternal and Child Health, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Ngozi Joe-Ikechebelu
- Life Fertility Centre, Life International Hospital, Awka, Nigeria.,Department of Community Medicine & Primary Health Care, College of Medicine, Chukwuemeka Odumegwu Ojukwu University, Awka, Nigeria
| | - Boniface Chukwuneme Okpala
- Department of Obstetrics and Gynaecology, Faculty of Medicine, College of Health Sciences, Nnamdi Azikiwe University, Awka, Nigeria.,Life Fertility Centre, Life International Hospital, Awka, Nigeria
| | - Princeston Chukwuemeka Okam
- Life Fertility Centre, Life International Hospital, Awka, Nigeria.,Department of Pharmacology & Therapeutics, Faculty of Basic Clinical Sciences, College of Health Sciences, Nnamdi Azikiwe University, Awka, Nigeria
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12
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Jia ZC, Li YQ, Li R, Hou S, Xia QC, Yang K, Wang PX, Li SM, Sun ZG, Guo Y. Comparison of two different starting dose of rhFSH in GnRH antagonist protocol for patients with normal ovarian reserve. Front Endocrinol (Lausanne) 2023; 14:1068141. [PMID: 36742378 PMCID: PMC9895085 DOI: 10.3389/fendo.2023.1068141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/05/2023] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To evaluate different starting doses of recombinant human follicle-stimulating hormone (rhFSH) on pregnancy outcomes for patients with normal ovarian reserve during gonadotropin- releasing hormone antagonist (GnRH-ant) protocol-controlled ovarian stimulation of in vitro fertilization (IVF) cycles. METHODS In this retrospective study, a total of 1138 patients undergoing IVF cycles following the GnRH-ant protocol were enrolled. Patients were divided into two groups according to the starting dose of rhFSH. 617 patients received a starting dose of rhFSH of 150 IU, and 521 patients received a starting dose of rhFSH of 225 IU. We compared demographic characteristics, ovarian stimulation and embryological characteristics, and pregnancy and birth outcomes between the two groups. Multivariate logistic regression analysis was performed to examine the possible effects of the known potential confounding factors on pregnancy outcomes. RESULTS The number of oocytes retrieved in the 150 IU rhFSH group was significantly lower than those in the 225 IU rhFSH group. There was no significant difference between the two groups referring to embryological characteristics. The proportion of fresh embryo transfer in the 150 IU rhFSH group was significantly higher than that in the 225 IU rhFSH group (48.30% vs. 40.90%), and there was no difference in the risk of ovarian hyperstimulation syndrome and pregnancy outcomes between the two groups. CONCLUSIONS In conclusion, the starting dose of rhFSH of 150 IU for ovarian stimulation has a similar pregnancy outcome as starting dose of rhFSH of 225 IU in GnRH-ant protocol for patients with normal ovarian reserve. Considering the potential cost-effectiveness and shorter time to live birth, the starting dose of rhFSH of 150 IU may be more suitable than 225 IU.
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Affiliation(s)
- Zhi-cheng Jia
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yong-qian Li
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Ran Li
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Sen Hou
- Reproductive and Genetic Center of Integrative Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Qing-chang Xia
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Kai Yang
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Pei-xuan Wang
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Shu-miao Li
- The Second Clinical College, Beijing University of Chinese Medicine, Beijing, China
| | - Zhen-gao Sun
- Reproductive and Genetic Center of Integrative Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Ying Guo
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
- Reproductive and Genetic Center of Integrative Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
- *Correspondence: Ying Guo,
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13
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Vuong VVH, Tran TH, Nguyen PD, Thi NN, Le Thi P, Minh Nguyet DT, Nguyen MH, Bui TH, Ta TV, Tran VK. Feasibility of combining short tandem repeats (STRs) haplotyping with preimplantation genetic diagnosis (PGD) in screening for beta thalassemia. PLoS One 2022; 17:e0278539. [PMID: 36476827 PMCID: PMC9728894 DOI: 10.1371/journal.pone.0278539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
β-thalassemia is an autosomal recessive disease with the reduction or absence in the production of β-globin chain in the hemoglobin, which is caused by mutations in the Hemoglobin subunit beta (HBB) gene. In Vietnam, the number of β-thalassemia carriers range from 1.5 to 25.0%, depending on ethnic and geographical areas, which is much higher than WHO's data worldwide (1.5%). Hence, preimplantation genetic diagnosis (PGD) plays a crucial role in reducing the rate of β-thalassemia affected patients/carriers. In this research, we report the feasibility and reliability of conducting PGD in combination with the use of short tandem repeat (STR) markers in facilitating the birth of healthy children. Six STRs, which were reported to closely linked with the HBB gene, were used on 15 couples of β-thalassemia carriers. With 231 embryos, 168 blastocysts were formed (formation rate of 72.73%), and 88 were biopsied and examined with STRs haplotyping and pedigree analysis. Thus, the results were verified by Sanger sequencing, as a definitive diagnosis. Consequently, 11 over 15 couples have achieved pregnancy of healthy or at least asymptomatic offspring. Only three couples failed to detect any signs of pregnancy such as increased Human Chorionic Gonadotropin (HCG) level, foetal sac, or heart; and one couple has not reached embryo transfer as they were proposed to continue with HLA-matching to screen for a potential umbilical cord blood donor sibling. Thus, these results have indicated that the combination of PGD with STRs analysis confirmed by Sanger sequencing has demonstrated to be a well-grounded and practical clinical strategy to improve the detection of β-thalassemia in the pregnancies of couples at-risk before embryo transfer, thus reducing β-thalassemia rate in the population.
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Affiliation(s)
- Vu Viet Ha Vuong
- Center for Gene and Protein Research, Hanoi Medical University, Hanoi, Vietnam
- Hospital of Post and Telecommunications, Hanoi, Vietnam
| | - Thinh Huy Tran
- Center for Gene and Protein Research, Hanoi Medical University, Hanoi, Vietnam
- Biochemistry Department, Hanoi Medical University, Hanoi, Vietnam
- Hanoi Medical University Hospital, Hanoi Medical University, Hanoi, Vietnam
| | - Phuoc-Dung Nguyen
- Center for Gene and Protein Research, Hanoi Medical University, Hanoi, Vietnam
| | | | - Phuong Le Thi
- Center for Gene and Protein Research, Hanoi Medical University, Hanoi, Vietnam
| | | | - Manh-Ha Nguyen
- Hanoi Medical University Hospital, Hanoi Medical University, Hanoi, Vietnam
| | - The-Hung Bui
- Center for Gene and Protein Research, Hanoi Medical University, Hanoi, Vietnam
- Center for Molecular Medicine, Clinical Genetics Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Thanh Van Ta
- Center for Gene and Protein Research, Hanoi Medical University, Hanoi, Vietnam
- Biochemistry Department, Hanoi Medical University, Hanoi, Vietnam
- Hanoi Medical University Hospital, Hanoi Medical University, Hanoi, Vietnam
| | - Van-Khanh Tran
- Center for Gene and Protein Research, Hanoi Medical University, Hanoi, Vietnam
- * E-mail:
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14
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Bulletti C, Bulletti FM, Sciorio R, Guido M. Progesterone: The Key Factor of the Beginning of Life. Int J Mol Sci 2022; 23:ijms232214138. [PMID: 36430614 PMCID: PMC9692968 DOI: 10.3390/ijms232214138] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/03/2022] [Accepted: 11/05/2022] [Indexed: 11/17/2022] Open
Abstract
Progesterone is the ovarian steroid produced by the granulosa cells of follicles after the LH peak at mid-cycle. Its role is to sustain embryo endometrial implantation and ongoing pregnancy. Other biological effects of progesterone may exert a protective function in supporting pregnancy up to birth. Luteal phase support (LPS) with progesterone is the standard of care for assisted reproductive technology. Progesterone vaginal administration is currently the most widely used treatment for LPS. Physicians and patients have been reluctant to change an administration route that has proven to be effective. However, some questions remain open, namely the need for LPS in fresh and frozen embryo transfer, the route of administration, the optimal duration of LPS, dosage, and the benefit of combination therapies. The aim of this review is to provide an overview of the uterine and extra-uterine effects of progesterone that may play a role in embryo implantation and pregnancy, and to discuss the advantages of the use of progesterone for LPS in the context of Good Medical Practice.
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Affiliation(s)
- Carlo Bulletti
- Extra Omnes, Assisted Reproductive Technology, ART Center, Via Gallinelli, 8, 47841 Cattolica, Italy
- Department of Obstetrics, Gynecology, and Reproductive Science, Yale University, New Haven, CT 06510, USA
- Correspondence:
| | | | - Romualdo Sciorio
- Edinburgh Assisted Conception Programme, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Maurizio Guido
- Obstetrics and Gynecology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
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15
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Oral S. Does hysteroscopic resection of polyps require cycle cancellation in women undergoing controlled ovarian hyperstimulation in the ICSI cycle? Turk J Obstet Gynecol 2022; 19:201-206. [PMID: 36149248 PMCID: PMC9511934 DOI: 10.4274/tjod.galenos.2022.79363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Endometrial polyps are one of the most extensive pathologies in the uterus and can be detected incidentally during assisted reproductive therapy in asymptomatic women. Materials and Methods: In patients planned for in vitro fertilization or intracytoplasmic sperm injection (ICSI) treatment, embryo freezing, or cycle cancelation options are mandatory in many clinics when detected at the beginning of the cycle. In our study, in ICSI treatment, patients with a single endometrial polyp smaller than 1.5 cm, who underwent hysteroscopic polyp resection at the beginning of the cycle and underwent fresh embryo transfer without canceling the treatment (n=31), and patients with the same characteristics of endometrial polyp who underwent hysteroscopic polyp resection before the cycle (n=34) are compared within the pregnancy, abortion and live birth rates. Results: As a result, no statistical difference was found between the two groups’ pregnancy, abortion, and live birth rates. Conclusion: Hysteroscopic resection of polyps during ovarian stimulation in ICSI treatment does not affect pregnancy and live birth rates and may eliminate the necessity of freezing.
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16
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Gullo G, Scaglione M, Cucinella G, Chiantera V, Perino A, Greco ME, Laganà AS, Marinelli E, Basile G, Zaami S. Neonatal Outcomes and Long-Term Follow-Up of Children Born from Frozen Embryo, a Narrative Review of Latest Research Findings. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091218. [PMID: 36143894 PMCID: PMC9500816 DOI: 10.3390/medicina58091218] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022]
Abstract
In recent years, the growing use of ART (assisted reproductive techniques) has led to a progressive improvement of protocols; embryo freezing is certainly one of the most important innovations. This technique is selectively offered as a tailored approach to reduce the incidence of multiple pregnancies and, most importantly, to lower the risk of developing ovarian hyperstimulation syndrome when used in conjunction with an ovulation-triggering GnRH antagonist. The increase in transfer cycles with frozen embryos made it possible to study the effects of the technique in children thus conceived. Particularly noteworthy is the increase in macrosomal and LGA (large for gestational age) newborns, in addition to a decrease in SGA (small for gestational age) and LBW (low birth weight) newborns. The authors aimed to outline a broad-ranging narrative review by summarizing and elaborating on the most important evidence regarding the neonatal outcome of children born from frozen embryos and provide information on the medium and long-term follow- up of these children. However, given the relatively recent large-scale implementation of such techniques, further studies are needed to provide more conclusive evidence on outcomes and implications.
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Affiliation(s)
- Giuseppe Gullo
- IVF Unit, Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy
| | - Marco Scaglione
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences, University of Genoa, 16132 Genoa, Italy
| | - Gaspare Cucinella
- IVF Unit, Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS “Civico-Di Cristina-Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Antonino Perino
- IVF Unit, Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy
| | - Maria Elisabetta Greco
- IVF Unit, Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico-Di Cristina-Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Enrico Marinelli
- Department of Medico-Surgical Sciences and Biotechnologies, “Sapienza” University of Rome, 04100 Rome, Italy
- Correspondence:
| | | | - Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, “Sapienza” University of Rome, 00161 Rome, Italy
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17
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Peipert BJ, Montoya MN, Bedrick BS, Seifer DB, Jain T. Impact of in vitro fertilization state mandates for third party insurance coverage in the United States: a review and critical assessment. Reprod Biol Endocrinol 2022; 20:111. [PMID: 35927756 PMCID: PMC9351254 DOI: 10.1186/s12958-022-00984-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/21/2022] [Indexed: 11/29/2022] Open
Abstract
The American Society for Reproductive Medicine estimates that fewer than a quarter of infertile couples have sufficient access to infertility care. Insurers in the United States (US) have long considered infertility to be a socially constructed condition, and thus in-vitro fertilization (IVF) an elective intervention. As a result, IVF is cost prohibitive for many patients in the US. State infertility insurance mandates are a crucial mechanism for expanding access to fertility care in the US in the absence of federal legislation. The first state insurance mandate for third party coverage of infertility services was passed by West Virginia in 1977, and Maryland passed the country's first IVF mandate in 1985. To date, twenty states have passed legislation requiring insurers to cover or offer coverage for the diagnosis and treatment of infertility. Ten states currently have "comprehensive" IVF mandates, meaning they require third party coverage for IVF with minimal restrictions to patient eligibility, exemptions, and lifetime limits. Several studies analyzing the impact of infertility and IVF mandates have been published in the past 20 years. In this review, we characterize and contextualize the existing evidence of the impact of state insurance mandates on access to infertility treatment, IVF practice patterns, and reproductive outcomes. Furthermore, we summarize the arguments in favor of insurance coverage for infertility care and assess the limitations of state insurance mandates as a strategy for increasing access to infertility treatment. State mandates play a key role in the promotion of evidence-based practices and represent an essential and impactful strategy for the advancement of gender equality and reproductive rights.
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Affiliation(s)
- Benjamin J Peipert
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Duke University Hospital, 2301 Erwin Rd, 27705, Durham, NC, USA.
| | - Melissa N Montoya
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Duke University Hospital, 2301 Erwin Rd, 27705, Durham, NC, USA
| | - Bronwyn S Bedrick
- Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David B Seifer
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Tarun Jain
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Tulek F, Kahraman A. Comparison of pregnancy and live birth rates between fresh day 5 morula transfer and fresh day 6 blastocyst transfer following extended culture for slow growing embryos. Arch Gynecol Obstet 2022; 306:1273-1280. [PMID: 35829764 DOI: 10.1007/s00404-022-06661-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 06/06/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study is to evaluate and compare the outcomes of fresh day 5 morula transfers and fresh day 6 blastocyst transfers after extended culture, in women with a whole cohort of slow growing embryos. METHODS Fresh embryo transfer cycles of patients that underwent intracytoplasmic sperm injection between 2013 and 2020 with a whole cohort of slow developing embryos on 5th day of fertilization were evaluated for this retrospective cohort study. Outcomes of day 5 morula transfers and day 6 blastocyst transfers after extended culture were compared. RESULTS Out of 479 patients, day 5 morula transfers were performed to 194 and embryo culturing was extended to day 6 in 285 women. Blastocyst formation was observed in 129 of 285 patients in extended culture group. Implantation rate of day 6 blastocyst transfer group was significantly higher than day 5 morula transfer group (27% vs. 12%, p < 0.001). However, clinical pregnancy (17% vs 15.4%) and live birth rates (14.4% vs 13%) were found similar in day 5 morula transfer and extended culture group per initiated cycle. CONCLUSION Although implantation capacity of day 6 blastocysts seems higher comparing to day 5 morulas, clinical pregnancy and live birth rates are similar among intention to treat population in fresh day 5 morula transfers and day 6 blastocyst transfers after extended culture for women that cohorts consist of only slow developing embryos.
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Affiliation(s)
- Firat Tulek
- Faculty of Health Sciences, Department of Midwifery, Uskudar University, Istanbul, Turkey. .,Department of Obstetrics and Gynecology, Memorial Atasehir Hospital, Istanbul, Turkey.
| | - Alper Kahraman
- Department of Obstetrics and Gynecology, Haseki Training and Research Hospital, Istanbul, Turkey
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19
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Lee JH, Choi YS. Cryopreservation of oocytes and embryos for fertility preservation. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2022. [DOI: 10.5124/jkma.2022.65.6.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: In recent years, the demand for fertility preservation for both oncologic and nononcologic reasons, as well as for personal reasons, has increased dramatically.Current Concepts: Currently, embryo and oocyte cryopreservation after ovarian stimulation are the mainstays of fertility preservation treatment in women. Embryo cryopreservation is an established and the most successful method of fertility preservation when sufficient time (approximately 2 weeks) is available to perform ovarian stimulation. Recent advances in freezing techniques (vitrification) have significantly improved the outcomes from oocyte cryopreservation that are comparable with those from embryo cryopreservation.Discussion and Conclusion: This review focuses on the indications for the two techniques of fertility preservation and their results. For women to receive timely opportunities to preserve fertility, it is necessary to raise awareness among all medical departments and the public.
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Chen H, Sun ZL, Chen MX, Yang Y, Teng XM, Wang Y, Wu YY. Predicting the probability of a live birth after a freeze-all based in vitro fertilization-embryo transfer (IVF-ET) treatment strategy. Transl Pediatr 2022; 11:797-812. [PMID: 35800265 PMCID: PMC9253936 DOI: 10.21037/tp-21-589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 04/02/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The predictors for live birth rate (LBR) following one episode of in vitro fertilization (IVF) cycle for patients using a "freeze-all" strategy are not entirely clear. METHODS A retrospective cohort study utilizing a prediction model was developed to assess the relationship to the LBR. Women undergoing IVF with a freeze-all strategy were screened. Univariate models were first fitted for female age at oocytes retrieval/frozen-thawed embryo transfer (FET), body mass index (BMI), duration and etiology of infertility, previous IVF failures, total dose and duration of gonadotrophin, ovarian sensitivity index (OSI), number of oocytes collected, method of fertilization, number of embryos created, number and stage of embryos frozen, type and number of FET cycles, endometrial thickness (EMT)/pattern, hormone level on transplantation day, storage duration, number of embryos thawed and damaged thawed embryos, number and stage of embryos transferred and number of different quality embryos transferred. Variables with P<0.05 in the univariate model were selected for further analysis of the final multivariate discrete-time logistic regression model. RESULTS A total of 7,602 women undergoing one ovarian stimulation resulted in 9,964 FETs, of whom 3,066 (40.33%) had a live-birth after their first FET and 3,929 (51.68%) after total FETs. The EMT and woman's age at oocyte retrieval were the most important predictors. In the first FET, the LBR of women with an EMT ≤8 mm [27.40%; 95% confidence interval (CI): (21.60-33.81%)] was significantly lower than that of women with EMT between 9 and 11 mm [36.51%; 95% CI: (34.25-38.81%)] and thicker than 12 mm [44.23%; 95% CI: (42.22-46.25%)] (P<0.05). The optimistic and conservative cumulative LBRs of women younger than 31 years [87.5%; 95% CI: (86.32-88.61%) and 63.04%; 95% CI: (61.36-64.69%)] were significantly decreased in women aged 31-35, 36-40 and >40 (P<0.001). CONCLUSIONS Our study provides an effective prediction model for a woman's chance of having a baby after a "freeze-all" policy. The use of EMT and female age as tools to identify LBR are shown to be justified, and repeated FETs cannot reverse the age-dependent decline in fertility.
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Affiliation(s)
- Hong Chen
- Department of Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zi-Li Sun
- Department of Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Miao-Xin Chen
- Department of Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yang Yang
- Department of Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiao-Ming Teng
- Department of Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yun Wang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan-Yuan Wu
- Department of Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
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21
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The Effect of Freezing Twice during Assisted Reproductive Technology on Perinatal and Neonatal Outcomes. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5623462. [PMID: 35419457 PMCID: PMC9001107 DOI: 10.1155/2022/5623462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 12/04/2022]
Abstract
Objective The aim of this paper was to investigate whether two freeze-thaw cycles before embryo transfer may affect perinatal and neonatal outcomes. Materials and Methods A total of 8,028 frozen-thawed embryo transfer patients who became pregnant between March 2013 and September 2019 were included. The patients were divided into two groups: the oocyte cryopreservation (OC) group (N = 96) and the control group (N = 7932). Propensity score matching (PSM) was used to adjust the baseline characteristics of the two groups at a proportion of 1 : 4. There were 96 patients in the OC group and 369 patients in the control group after PSM. The pregnancy-related complications and neonatal conditions after delivery of the two groups were compared. Results The OC group had a higher stillbirth rate (3.1% vs. 0.3%, P = 0.029) than the control group after PSM. Moreover, a slightly higher pregnancy defect rate was found in the OC group. There was no significant difference in the rates of diabetes mellitus, hypertension during pregnancy, cesarean section, multiple births, low birth weight (LBW), or premature birth defects between the two groups. Conclusions Our findings demonstrate that performing frozen-thawed embryo transfer (FET) with cryopreserved oocytes was associated with a higher rate of stillbirth than FET with fresh oocytes. The incidences of diabetes, gestational hypertension, cesarean section, multiple births, LBW, premature birth, and birth defects of the two groups were not significantly different.
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22
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Li J, Sun Q, Zhang M, Fu X, Zhang Y, Gao S, Ma J. Natural cycles achieve better pregnancy outcomes than artificial cycles in non-PCOS women undergoing vitrified single-blastocyst transfer: a retrospective cohort study of 6840 cycles. J Assist Reprod Genet 2022; 39:639-646. [PMID: 35122175 PMCID: PMC8995231 DOI: 10.1007/s10815-022-02424-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/31/2022] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To identify the optimal method for endometrial preparation in vitrified single-blastocyst transfer (VSBT) cycles. METHODS This was a retrospective cohort study for non-PCOS patients who underwent VSBT cycles from March 2015 to November 2019 in an academic reproductive medical center. A total of 6840 VSBT cycles were enrolled and classified into two groups according to different endometrial preparation methods. RESULTS The non-PCOS patients who underwent VSBT showed a significantly higher clinical pregnancy rate (61.96% vs 56.85%, p < 0.001) and live birth rate (49.09% vs 39.86%, p < 0.001), as well as a statistically lower early miscarriage rate (12.02% vs 18.08%, p < 0.001) in the natural cycle (NC) group compared with the artificial cycle (AC) group. Multivariable analysis further confirmed that NC was associated with an increased likelihood of clinical pregnancy (adjusted odds ratio (aOR) 0.852, 95% confidence interval (CI) 0.765-0.949, p = 0.004) and live birth (aOR 0.746, 95% CI 0.669-0.832, p < 0 .001), but decreased early miscarriage occurrence (aOR 1.447, 95% CI 1.215-1.724, p < 0.001) compared to AC. CONCLUSIONS Our study demonstrated that non-PCOS patients could benefit from NC in vitrified blastocyst transfer. Increased clinical pregnancy rate and decreased early miscarriage rate led to a significantly higher live birth rate in NC patients compared with AC with our present protocol.
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Affiliation(s)
- Jing Li
- grid.27255.370000 0004 1761 1174Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012 China ,grid.27255.370000 0004 1761 1174Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong 250012 China ,grid.27255.370000 0004 1761 1174Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong 250012 China ,Shandong Provincial Clinical Research Center for Reproductive Technology and Reproductive Genetics, Jinan, Shandong 250012 China ,grid.27255.370000 0004 1761 1174National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong 250012 China
| | - Qian Sun
- grid.27255.370000 0004 1761 1174Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012 China ,grid.27255.370000 0004 1761 1174Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong 250012 China ,grid.27255.370000 0004 1761 1174Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong 250012 China ,Shandong Provincial Clinical Research Center for Reproductive Technology and Reproductive Genetics, Jinan, Shandong 250012 China ,grid.27255.370000 0004 1761 1174National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong 250012 China
| | - Meng Zhang
- grid.27255.370000 0004 1761 1174Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012 China ,grid.27255.370000 0004 1761 1174Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong 250012 China ,grid.27255.370000 0004 1761 1174Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong 250012 China ,Shandong Provincial Clinical Research Center for Reproductive Technology and Reproductive Genetics, Jinan, Shandong 250012 China ,grid.27255.370000 0004 1761 1174National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong 250012 China
| | - Xiao Fu
- grid.27255.370000 0004 1761 1174Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012 China ,grid.27255.370000 0004 1761 1174Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong 250012 China ,grid.27255.370000 0004 1761 1174Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong 250012 China ,Shandong Provincial Clinical Research Center for Reproductive Technology and Reproductive Genetics, Jinan, Shandong 250012 China ,grid.27255.370000 0004 1761 1174National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong 250012 China
| | - Yiting Zhang
- grid.27255.370000 0004 1761 1174Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012 China ,grid.27255.370000 0004 1761 1174Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong 250012 China ,grid.27255.370000 0004 1761 1174Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong 250012 China ,Shandong Provincial Clinical Research Center for Reproductive Technology and Reproductive Genetics, Jinan, Shandong 250012 China ,grid.27255.370000 0004 1761 1174National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong 250012 China
| | - Shanshan Gao
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China. .,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, 250012, China. .,Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, 250012, China. .,Shandong Provincial Clinical Research Center for Reproductive Technology and Reproductive Genetics, Jinan, Shandong, 250012, China. .,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, 250012, China. .,Center for Reproductive Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China.
| | - Jinlong Ma
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China. .,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, 250012, China. .,Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, 250012, China. .,Shandong Provincial Clinical Research Center for Reproductive Technology and Reproductive Genetics, Jinan, Shandong, 250012, China. .,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, 250012, China.
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Sallam HN, Gelbaya TA, Rosas IM, Anagnostopoulou C, Sallam N, Agarwal A. Clinical aspects of oocyte retrieval and embryo transfer. Tips and tricks for the novice and experts. Panminerva Med 2022; 64:185-199. [PMID: 35179015 DOI: 10.23736/s0031-0808.22.04679-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Oocyte retrieval (ovum pick-up) and embryo transfer (ET) are essential steps in IVF and ICSI and over the years, the two procedures were developed in order to improve the clinical outcome. Many suggestions were proposed and applied before, during and after oocyte retrieval such as timing of HCG trigger, pre-operative pelvic scan, vaginal cleansing, type of anesthesia, type and gauge of aspiration needles, aspiration pressure, follicle flushing, and the need for prophylactic antibiotics. Similarly, many steps were suggested and implemented before, during and after ET including patient's position, type of anesthesia/analgesia, dummy (mock) ET, ultrasound-guidance, HCG injection in the uterine cavity, use of relaxing agents, full bladder, removal of the cervical mucus, flushing the cervix with culture medium, type of ET catheter, embryo loading techniques, site of embryo deposition, the use of adherence compounds, as well as bed rest after ET. Complications were also reported with oocyte retrieval and ET. The aim of this review is to evaluate the current practice of these two procedures in the light of available evidence.
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Affiliation(s)
- Hassan N Sallam
- Department of Obsterics and Gynaecology, Alexandria University Faculty of Medicine, Alexandria, Egypt -
| | - Tarek A Gelbaya
- Department of Obstetrics and Gynaecology, University Hospitals of Leicester, Leicester, UK
| | - Israel M Rosas
- Citmer Reproductive Medicine, IVF LAB, Mexico City, Mexico
| | | | - Nooman Sallam
- Department of Obstetrics and Gynaecology, Guy's and St Thomas' NHS Trust, London, UK
| | - Ashok Agarwal
- Andrology Center and American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
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Tang S, Du T, Huang J, Ye H, Zhao M, Lin J, Kuang Y. Effect of previous wedge resection for interstitial pregnancy on pregnancy and neonatal outcomes following frozen-thawed embryo transfer (FET) cycles of IVF/ICSI: a retrospective study. Reprod Biol Endocrinol 2022; 20:23. [PMID: 35105356 PMCID: PMC8805226 DOI: 10.1186/s12958-022-00896-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/17/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The present study aimed to evaluate pregnancy and neonatal outcomes in women, with a previous history of wedge resection for interstitial pregnancy, in frozen-thawed embryo transfer (FET) cycles of IVF/ICSI. METHODS The present study involved a retrospective case-control assessment of 75 cases and 375 control subjects over 6 years in a single center. To compare pregnancy and neonatal outcomes between cases, treated using wedge resection, and controls without any previous history of ectopic pregnancy, propensity score matching (1:5) was utilized. The study also compared subgroups in the case group. RESULTS Women with previous wedge resection exhibited higher rates of ectopic pregnancy and uterine rupture rate as compared to control subjects (9.1% vs 1.3%, P = 0.025 and 4.5% vs 0%, P = 0.035, respectively). No statistically significant differences were recorded between the two cohorts with regard to clinical pregnancy rate, live birth rate, and neonatal outcomes. For pregnancy type subgroup analysis, Z-score and rates of large for gestational age were recorded to be significantly lower in twin pregnancy subgroup when compared with singleton pregnancy subgroup (0.10 (- 0.59, 0.25) vs 0.50 (- 0.97, 1.39), P = 0.005; 4.5% vs 26.1%, P = 0.047, respectively). CONCLUSION The results of the present study indicated that previous wedge resection correlated to a higher risk of ectopic pregnancy and uterine rupture. However, it might not be related to an increased risk of adverse neonatal outcomes. The study recommended cesarean section in these patients. Further studies are required to verify the validity of current recommendations.
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Affiliation(s)
- Shengluan Tang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China
| | - Tong Du
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China
| | - Jialyu Huang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China
| | - Hongjuan Ye
- Department of Reproductive Medicine Center, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ming Zhao
- Shanghai Towako Hospital, No. 477, Fute West 1st Road, Shanghai, China
| | - Jiaying Lin
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China.
| | - Yanping Kuang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China.
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Huang J, Liu L, Wu Y, Miao B, Li Y, Zhou C, Xu Y. The earlier the initiation of gonadotropin in poor responders in luteal phase stimulation protocols, the better. Front Endocrinol (Lausanne) 2022; 13:979934. [PMID: 36465615 PMCID: PMC9709114 DOI: 10.3389/fendo.2022.979934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Luteal-phase ovarian stimulation has been proved to be feasible for producing competent oocytes/embryos and achieving live births, yet there is no standardized stimulation protocol for luteal-phase ovarian stimulation (LPS). The aim of this study was to explore the optimal timing of gonadotropin initiation in the LPS protocol for poor ovarian responders. METHODS This was a retrospective cohort study conducted in the reproductive medicine center of a tertiary hospital. A total of 327 poor responders fulfilling Bologna criteria underwent LPS with IVF/ICSI treatment. HMG and letrozole were administrated after ovulation. Patients were stratified into three groups according to the gonadotropin start day: early, early-mid, and mid-late luteal phase. A freeze-all strategy was performed for all cycles. The duration of ovarian stimulation, total gonadotropin dose, number of oocytes retrieved, implantation rate, clinical pregnancy rate, and live birth rate after frozen/thawed embryo transfer cycles were included for evaluation. RESULTS The group accepted ovarian stimulation in the earlier phase tended to have a shorter duration of ovarian stimulation [8 (7,10) in early luteal group, 9 (8,10.25) in early-mid luteal group, and 11 (10,12) in mid-late luteal group; P <0.001] and lower gonadotropin consumption [1993.35 ± 720.31, 2282.73 ± 703.38, and 2764.83 ± 722.26, respectively; P <0.001]. Logistic regression and multiple linear regression were used to assess the associations between the phase of gonadotropin initiation and duration of ovarian stimulation (or total gonadotropin dose) by adjusting for confounding factors. Compared with the early luteal group, longer ovarian stimulation(>9 days) was more likely to occur in the early-mid and mid-late luteal groups, with the adjusted odds ratios 0.584 (0.327-1.042) and 0.116 (0.049-0.271), respectively (P-trend<0.001). Delayed gonadotropin initiation showed an 113.200 IU increase (95%CI: 70.469, 155.930) per-day in the total gonadotropin dosage. Meanwhile, there were no significant differences in the mean number of oocytes, utilizable embryos, pregnancy outcomes among three groups. CONCLUSION Although the timing of gonadotropin initiation is not associated with pregnancy outcomes, earlier initiation of gonadotropin therapy after ovulation was associated with a shorter duration of ovarian stimulation and lower gonadotropin consumption in poor responders in LPS.
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Affiliation(s)
- Jia Huang
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Luxin Liu
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yue Wu
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Benyu Miao
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yubin Li
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Canquan Zhou
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yanwen Xu
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- *Correspondence: Yanwen Xu,
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Shuai J, Chen QL, Chen WH, Liu WW, Huang GN, Ye H. Early Spontaneous Abortion in Fresh- and Frozen-Embryo Transfers: An Analysis of Over 35,000 Transfer Cycles. Front Endocrinol (Lausanne) 2022; 13:875798. [PMID: 35832421 PMCID: PMC9271787 DOI: 10.3389/fendo.2022.875798] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/25/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aim of this study was to explore the risk factors for early spontaneous abortion (ESA) in fresh- and frozen-embryo transfers. METHODS This retrospective cohort study comprised a total of 35,076 patients, including 15,557 women in the fresh-embryo transfer group and 19,519 women in the frozen-embryo transfer group from January 2016 to December 2020. The primary outcome of this study was ESA, which we defined as the termination of embryonic development before 12 weeks of pregnancy (i.e., an early abortion after artificial multi-fetal pregnancy reduction was excluded). RESULTS In the 35,076 ART transfer cycles, the incidence of ESA was 5.77% (2023/35,076), and the incidence rates for ESA in fresh and frozen cycles were 4.93% (767 of 15,557) and 6.43% (1,256 of 19,519), respectively. Using a multivariate logistic regression analysis model, maternal age, body mass index (BMI), and number of embryos transferred were independent predictors for ESA. In addition, frozen-thawed transfer was a risk factor for ESA as compared with fresh transfer (OR = 1.207; 95% CI, 1.094-1.331; P = 0.000), blastocyst transfer was risk factor for ESA as compared with cleavage transfer (OR =1.373; 95% CI, 1.186-1.591; P = 0.000 in the total group; OR = 1.291; 95% CI, 1.111-1.499; P = 0.001 in the frozen-transfer group), and unexplained infertility was a protective factor for ESA only in the frozen group (OR = 0.746; 95% CI, 0.565-0.984; P = 0.038). CONCLUSIONS Maternal age, BMI, number of embryos transferred, and frozen-thawed transfer were independent risk factors for ESA in assisted reproductive technology treatment cycles.
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Heyward Q, Walter JR, Alur-Gupta S, Lal A, Berger DS, Koelper N, Butts SF, Gracia CR. Racial disparities in frozen embryo transfer success. J Assist Reprod Genet 2021; 38:3069-3075. [PMID: 34739643 DOI: 10.1007/s10815-021-02348-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/25/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To compare pregnancy and birth outcomes after frozen embryo transfers (FETs) among White, Black, and Asian women and evaluate the effect of patient, protocol, and cycle characteristics on success. METHODS A retrospective chart review identified women who underwent an autologous FET at an academic fertility center between January 2013 and March 2020. RESULTS White, Black, and Asian women completed 1,181 (71.7%), 230 (14.0%), and 235 (14.3%) cycles, respectively. Black women were significantly less likely to achieve a positive hCG level (AOR 0.66, 95% CI 0.49-0.90), clinical pregnancy (AOR 0.71, 95% CI 0.53-0.97), and live birth (AOR 0.65, 95% CI 0.47-0.89) compared to White women after adjusting for possible confounders. There were no differences in the aforementioned outcomes when looking at cycles completed by Asian versus White women. When comparing outcomes by endometrial preparation protocol, significant differences were seen amongst the three groups for live birth rates following natural cycle FETs (52.36%, 25.81%, and 44.19% for White, Black, and Asian women, respectively, p = 0.02), a difference not appreciated after programmed FETs. CONCLUSION Black race is associated with significantly worse pregnancy and live birth rates following FET when compared to White race. Additionally, significant differences in live birth rates among White, Black, and Asian women exist following natural cycle FET versus programmed FET. These disparities in success are not only important for patient counseling, but also when determining management strategies to improve fertility rates among minority women.
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Affiliation(s)
- Quetrell Heyward
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, 3400 Spruce Street, 1 West Gates, Philadelphia, PA, 19104, USA.
| | - Jessica R Walter
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, PA, Philadelphia, USA
| | | | - Arnav Lal
- University of Pennsylvania, Philadelphia, PA, USA
| | - Dara S Berger
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, PA, Philadelphia, USA
| | - Nathanael Koelper
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, PA, Philadelphia, USA
| | - Samantha F Butts
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Pennsylvania State Hershey Medical Center, Hershey, PA, USA
| | - Clarisa R Gracia
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, PA, Philadelphia, USA
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Zhao M, Chi F, Zhang T, Teng X, Li K. Human menstrual blood-derived mesenchymal stem cells regulation of the EGF/Ras p21 pathway as a potential therapeutic target for thin endometrium. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1476. [PMID: 34734028 PMCID: PMC8506758 DOI: 10.21037/atm-21-4652] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/18/2021] [Indexed: 11/17/2022]
Abstract
Background Human infertility is caused by many factors, among which thin endometrium is the main reason for poor embryo implantation. Currently, stem cell therapy could be a potential approach in treating human endometrial disorder like thin endometrium. In this study, we aimed to explore the influence of menstrual stem cells from non-thin endometrium (NTE-MenSCs) and thin endometrium (TE-MenSCs) on the phenotype of endometrial epithelial cells (EECs). Methods The MenSCs were isolated from women with and without thin endometria, characterized and co-cultured with the EECs. The expression of cytokeratin 7 (CK7) was verified by immunofluorescence while the detection stem cell markers was determined flow cytometry. Osteogenic and adipogenic differentiation were induced in appropriate media. The quantitative real-time PCR and western blotting were respectively used for detecting the mRNA and protein expression levels, respectively. The CCK-8 assay was used for cell viability analysis whereas ELISA was used for the detection of cytokine levels. Results The results showed that the co-culture of NTE-MenSCs or TE-MenSCs and EECs promoted the proliferation, migration, and angiogenesis of endothelial progenitor cells differently. Furthermore, the TE-MenSCs promoted the expression of inflammation, vascularized adipose, and extracellular matrix related proteins. The epidermal growth factor (EGF)/Ras p21 pathway was found to mediate the influence of MenSCs on EECs. Conclusions These findings are vital in that they may promote stem cell therapy of thin endometrium and enable embryo implantation in humans with thin endometrium.
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Affiliation(s)
- Mei Zhao
- Department of Assisted Reproductive Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Fengli Chi
- Department of Assisted Reproductive Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Tingyu Zhang
- Department of Assisted Reproductive Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiaoming Teng
- Department of Assisted Reproductive Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Kunming Li
- Department of Assisted Reproductive Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
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Gao DD, Li L, Zhang Y, Wang XX, Song JY, Sun ZG. Is Human Chorionic Gonadotropin Trigger Beneficial for Natural Cycle Frozen-Thawed Embryo Transfer? Front Med (Lausanne) 2021; 8:691428. [PMID: 34722559 PMCID: PMC8551612 DOI: 10.3389/fmed.2021.691428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 09/22/2021] [Indexed: 12/02/2022] Open
Abstract
Objective: The aim of this study is to investigate, in ovulatory patients, whether there is a difference in reproductive outcomes following frozen-thawed embryo transfer (FET) in natural cycles (NC) compared to modified natural cycles (mNC). Methods: This retrospective cohort study, performed at the public tertiary fertility clinic, involved all infertile patients undergoing endometrial preparation prior to FET in NC and mNC from January, 2017 to November, 2020. One thousand hundred and sixty-two patients were divided into two groups: mNC group (n = 248) had FET in a NC after ovulation triggering with human chorionic gonadotropin (hCG); NC group (n = 914) had FET in a NC after spontaneous ovulation were observed. The primary outcome was live birth rate. All pregnancy outcomes were analyzed by propensity score matching (PSM) and multivariable logistic regression analyses. Results: The NC group showed a higher live birth rate [344/914 (37.6%) vs. 68/248 (27.4%), P = 0.003; 87/240 (36.3%) vs. 66/240 (27.5%), P = 0.040] than the mNC group before and after PSM analysis. Multivariable analysis also showed mNC to be associated with a decreased likelihood of live birth compared with NC [odds ratio (OR) 95% confidence interval (CI) 0.71 (0.51–0.98), P = 0.039]. Conclusion: For women with regular menstrual cycles, NC-FET may have a higher chance of live birth than that in the mNC-FET cycles. As a consequence, it's critical to avoid hCG triggering as much as possible when FETs utilize a natural cycle strategy for endometrial preparation. Nevertheless, further more well-designed randomized clinical trials are still needed to determine this finding.
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Affiliation(s)
- Dan-Dan Gao
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Li Li
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yi Zhang
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiao-Xuan Wang
- Reproductive and Genetic Center of Integrated Medicine, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jing-Yan Song
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China.,Reproductive and Genetic Center of Integrated Medicine, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zhen-Gao Sun
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China.,Reproductive and Genetic Center of Integrated Medicine, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
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30
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Nahshon C, Dirnfeld M, Koifman M, Blais I, Lahav-Baratz S. Comparison of day 2 and overnight day 3 frozen embryo transfers: A prospective randomized controlled trial. Reprod Biol 2021; 21:100565. [PMID: 34600346 DOI: 10.1016/j.repbio.2021.100565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 11/19/2022]
Abstract
In certain patients cleavage stage embryos may be preferred. The relationship between an additional day in culture and pregnancy outcomes is not well established. We aimed to compare outcomes of day 2 versus overnight day 3 frozen embryo transfer (FET). In this randomized controlled trial, patients with day 2 cryopreserved embryos were allocated to two groups. In group A embryos were transferred on day 2, the same day of thawing. In group B embryos were transferred one day after thawing, on day 3 after overnight incubation. Out of 410 patients eligible, 92 were recruited. Finally, 72 patients participated, 39 in group A and 33 in group B. No significant difference in implantation (11 % in group A and 14 % in group B, p = 0.81), clinical pregnancy (18 % in group A and 21 % in group B, p = 0.73) or live birth rates (13 % in group A and 18 % in group B, p = 0.53) was found. To conclude, no significant difference in reproductive outcomes was found when comparing patients with day 2 or overnight day 3 FET. Considering published data on blastocyst transfer, cleavage stage ET may still be a relevant option and the decision between day 2 or overnight day 3 ET depends on patients' and physicians' preference and recommendation.
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Affiliation(s)
- Chen Nahshon
- Division of Reproductive Endocrinology and IVF, Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel; Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
| | - Martha Dirnfeld
- Division of Reproductive Endocrinology and IVF, Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel; Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Mara Koifman
- Division of Reproductive Endocrinology and IVF, Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel; Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Idit Blais
- Division of Reproductive Endocrinology and IVF, Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel; Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Shirly Lahav-Baratz
- Division of Reproductive Endocrinology and IVF, Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel; Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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El estudio de receptividad endometrial ER®map mejora los resultados reproductivos tras fallos previos de implantación en ciclos de fecundación in vitro. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2021. [DOI: 10.1016/j.gine.2021.100688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Baksh S, Casper A, Christianson MS, Devine K, Doody KJ, Ehrhardt S, Hansen KR, Lathi RB, Timbo F, Usadi R, Vitek W, Shade DM, Segars J, Baker VL. Natural vs. programmed cycles for frozen embryo transfer: study protocol for an investigator-initiated, randomized, controlled, multicenter clinical trial. Trials 2021; 22:660. [PMID: 34579768 PMCID: PMC8477459 DOI: 10.1186/s13063-021-05637-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 09/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background Randomized trials of assisted reproductive technology (ART) have been designed for outcomes of clinical pregnancy or live birth and have not been powered for obstetric outcomes such as preeclampsia, critical for maternal and fetal health. ART increasingly involves frozen embryo transfer (FET). Although there are advantages of FET, multiple studies have shown that risk of preeclampsia is increased with FET compared with fresh embryo transfer, and the reason for this difference is not clear. NatPro will compare the proportion of preeclampsia between two commonly used protocols for FET,modified natural and programmed cycle. Methods In this two-arm, parallel-group, multi-center randomized trial, NatPro will randomize 788 women to either modified natural or programmed FET and follow them for up to three FET cycles. Primary outcome will be the proportion of preeclampsia in women with a viable pregnancy assigned to a modified natural cycle FET (corpus luteum present) protocol compared to the proportion of preeclampsia in pregnant women assigned to a programmed FET (corpus luteum absent) protocol. Secondary outcomes will compare the proportion of live births and the proportion of preeclampsia with severe features between the protocols. Conclusion This study has a potential significant impact on millions of women who pursue ART to build their families. NatPro is designed to provide clinically relevant guidance to inform patients and clinicians regarding maternal risk with programmed and modified natural cycle FET protocols. This study will also provide accurate point estimates regarding the likelihood of live birth with programmed and modified natural cycle FET. Trial registration ClinicalTrials.govNCT04551807. Registered on September 16, 2020 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05637-3.
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Affiliation(s)
- Sheriza Baksh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington Street, 2nd Floor, Baltimore, MD, 21231, USA. .,Center for Clinical Trials and Evidence Synthesis, Johns Hopkins University, Baltimore, MD, 21205, USA.
| | - Anne Casper
- Center for Clinical Trials and Evidence Synthesis, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Mindy S Christianson
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Kate Devine
- Shady Grove Fertility, Washington, DC, 20006, USA
| | | | - Stephan Ehrhardt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington Street, 2nd Floor, Baltimore, MD, 21231, USA.,Center for Clinical Trials and Evidence Synthesis, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Karl R Hansen
- Section of Reproductive Endocrinoloogy and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, OK, 73104, USA
| | - Ruth B Lathi
- Department of Obstetrics and Gynecology, Stanford University Medical Center, Sunnyvale, CA, 94087, USA
| | - Fatmata Timbo
- Center for Clinical Trials and Evidence Synthesis, Johns Hopkins University, Baltimore, MD, 21205, USA
| | | | - Wendy Vitek
- University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - David M Shade
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington Street, 2nd Floor, Baltimore, MD, 21231, USA.,Center for Clinical Trials and Evidence Synthesis, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - James Segars
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Valerie L Baker
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
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A Comparative Study to Assess the Efficacy of Two Different Estradiol Formulations during In Vitro Fertilization. Int J Reprod Med 2021; 2021:3153307. [PMID: 34423024 PMCID: PMC8371662 DOI: 10.1155/2021/3153307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/23/2021] [Accepted: 07/29/2021] [Indexed: 11/17/2022] Open
Abstract
Improvements in stimulation protocols, introduction of vitrification, and changes in clinical practices have contributed to improved efficacy and safety of assisted reproductive technology (ART) procedures. This has also led to a concomitant increase in number of cycles requiring hormone replacement therapy (HRT) protocol for performing an embryo transfer. Successful implantation is dependent on endometrial thickness which in turn is regulated by temporal regulation of hormones. Careful control of estrogen levels determines uterine receptivity. One of the most used drugs for achieving appropriate endometrial lining of >7 mm in HRT is estradiol valerate. Although different estrogen formulations with varying physicochemical properties exist, there is not enough literature to support if the differences translate into a discernible clinical outcome in an in vitro fertilization (IVF) setting. Objective and Method. In this study, retrospective in nature, we compare the efficacy of oral estradiol hemihydrate with estradiol valerate in HRT cycles in 2,529 Indian women, undergoing treatment at a center in India between Jan 2017 and May 2019. Results. Our results primarily indicate that between the estradiol valerate and estradiol hemihydrate treatment groups, the implantation rate (IR) was 47.42% and 49.07%, respectively (P value 0.284), and the endometrial thickness (mean ± SEM in mm) that was achieved was 9.25 ± 0.038 mm and 9.57 ± 0.058 mm (P value < 0.001), respectively. There were no significant differences observed in the secondary outcome measures including clinical pregnancy rate, abortion rate, ectopic pregnancy, and live birth rate. Conclusions. Hence, this study concludes that oral estradiol hemihydrate and estradiol valerate are therapeutically equivalent and provide similar clinical outcomes in an IVF setting.
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Bick L, Nielsen AS, Knudsen UB. Embryo Culture Media Influence on Live Birth Rate and Birthweight after IVF/ICSI: A Systematic Review Comparing Vitrolife G5 Media to Other Common Culture Media. JBRA Assist Reprod 2021; 25:480-492. [PMID: 33710837 PMCID: PMC8312284 DOI: 10.5935/1518-0557.20200099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 11/20/2020] [Indexed: 12/02/2022] Open
Abstract
Previous studies have indicated that culture media vary in efficiency and outcomes, such as live birth rate, birthweight and embryo quality. Does Vitrolife G5 series culture media result in higher live birth rates and birthweight compared to other common culture media? This study is a systematic review based on the PRISMA criteria. Relevant search terms, mesh terms (PubMed and Cochrane) and Emtree terms (Embase) were identified. We searched the literature using PubMed, Embase and Cochrane, on November 10, 2019. The inclusion criteria involved published articles in English comparing Vitrolife G5 to other common culture media. We included randomized controlled trials (RCTs) and cohort studies. The quality of the studies was assessed using the Cochrane Risk of Bias tool 2.0 and the Newcastle-Ottawa Scale. Primary outcomes were live birth rate and birthweight. Secondary outcomes were fertilization rate, implantation rate, biochemical pregnancy rate, clinical pregnancy rate, miscarriage rate, multiple pregnancies and congenital malformations. Of 187 articles screened, 11 studies fulfilled the inclusion criteria: Five RCTs and six retrospective cohort studies. Only one study reported live birth rate, showing a non-significantly higher live birth rate for Vitrolife G5 media. Birthweight had equivocal results with three of six studies, showing significantly lower (2)/higher (1) birthweights, whereas the others were non-significant. Overall, there were no significant differences concerning secondary outcomes. The results are equivocal, and we need more studies to evaluate culture media and their effect on short- and long-term health.
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Affiliation(s)
- Lena Bick
- Faculty of Health, Aarhus University, Nordre Ringgade 1, 8000 Aarhus, Denmark
| | - Anja Schulz Nielsen
- Faculty of Health, Aarhus University, Nordre Ringgade 1, 8000 Aarhus, Denmark
| | - Ulla Breth Knudsen
- Faculty of Health, Aarhus University, Nordre Ringgade 1, 8000 Aarhus, Denmark
- Department of Obstetrics & Gynecology, Regional Hospital Horsens, Sundvej 30, 8700 Horsens, Denmark
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van Duijn L, Rousian M, Reijnders IF, Willemsen SP, Baart EB, Laven JSE, Steegers-Theunissen RPM. The influence of frozen-thawed and fresh embryo transfer on utero-placental (vascular) development: the Rotterdam Periconception cohort. Hum Reprod 2021; 36:2091-2100. [PMID: 33974704 PMCID: PMC8289318 DOI: 10.1093/humrep/deab070] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/28/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Does frozen-thawed or fresh embryo transfer (ET) influence utero-placental (vascular) development, when studied using three-dimensional (3D) ultrasound and virtual reality imaging techniques? SUMMARY ANSWER In the first trimester, placental developmental parameters, that is, placental volume (PV) and utero-placental vascular volume (uPVV), were comparable between pregnancies resulting from frozen-thawed ET, fresh ET and natural conception; and in the second and the third trimester, uterine artery Doppler indices were lower in pregnancies after frozen-thawed ET compared to pregnancies after fresh ET and natural conception. WHAT IS KNOWN ALREADY Pregnancies after frozen-thawed ET are at risk of developing placenta-related pregnancy complications. There is strong evidence that impaired first-trimester spiral artery remodelling is involved in the pathophysiology of these complications. Studies on longitudinal placental development in pregnancies with different modes of conception, that is, after frozen-thawed ET, fresh ET or natural conception, are lacking. STUDY, DESIGN, SIZE, DURATION Women with singleton pregnancies were included before 10 weeks of gestation, between January 2017 and July 2018, as a subcohort of the ongoing Rotterdam Periconception cohort. Results were partially validated in 722 women from the total cohort, which was conducted from November 2010 onwards. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 214 women, of whom 32 conceived after frozen-thawed ET, 56 conceived after fresh ET and 126 conceived naturally, were selected. PV and uPVV measurements were obtained at 7, 9 and 11 weeks of gestation by transvaginal 3D (power Doppler) ultrasound. The uterine artery pulsatility index (UtA-PI) and resistance index (UtA-RI) were measured transvaginally at 7, 9, 11 and 13 weeks and abdominally at 22 and 32 weeks of gestation by pulsed wave Doppler ultrasound. In the validation cohort, the PV was measured in 722 women. Associations between mode of conception and placental development were studied using linear mixed models. MAIN RESULTS AND THE ROLE OF CHANCE First-trimester parameters of placental development, that is, PV, uPVV, UtA-PI and UtA-RI, were comparable between pregnancies after frozen-thawed and fresh ET and naturally conceived pregnancies. In our validation cohort, comparable results were found for PV. However, the second- and third-trimester UtA-PI and UtA-RI in pregnancies after frozen-thawed ET were significantly lower than in pregnancies after fresh ET (βUtA-PI -0.158 (95% CI: -0.268, -0.048), P = 0.005; βUtA-RI -0.052 (95% CI: -0.089, -0.015), P = 0.006). The second- and third-trimester uterine artery indices in pregnancies after fresh ET were comparable to those in pregnancies after natural conception. LIMITATIONS, REASONS FOR CAUTION The main limitation of this study is the lack of power to optimally detect differences in placental development and placenta-related pregnancy outcomes between pregnancies after different modes of conception. Moreover, our population was selected from a tertiary hospital and included a relatively limited number of pregnancies. Therefore, external validity of the results should be confirmed in a larger sample size. WIDER IMPLICATIONS OF THE FINDINGS These findings indicate no significant impact of conception mode on early placental development and a beneficial impact for frozen-thawed ET on the second- and third-trimester Doppler indices. This suggests that frozen-thawed ET may not be as detrimental for placental perfusion as previous research has demonstrated. As the number of clinics applying the 'freeze-all strategy' increases, future research should focus on establishing the optimal uterine environment, with regards to hormonal preparation, prior to ET to reduce placental-related pregnancy complications after frozen-thawed ET. STUDY FUNDING/COMPETING INTEREST(S) This research was funded by the Erasmus MC Medical Research Advisor Committee's 'Health Care Efficiency Research' program and the department of Obstetrics and Gynaecology of the Erasmus MC, University Medical Center, Rotterdam, The Netherlands. JSEL reports grants and personal fees from Ferring, personal fees from Titus Healthcare, grants and personal fees from Ansh Labs, grants from NIH, grants from Dutch Heart Association and grants from ZonMW outside the submitted work. None of the other authors have a conflict of interest. TRIAL REGISTRATION NUMBER Registered at the Dutch Trial Register (NTR6684).
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Affiliation(s)
- Linette van Duijn
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Melek Rousian
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Igna F Reijnders
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Sten P Willemsen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Biostatistics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Esther B Baart
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Developmental Biology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Gleicher N, Mochizuki L, Barad DH. Time associations between U.S. birth rates and add-Ons to IVF practice between 2005-2016. Reprod Biol Endocrinol 2021; 19:110. [PMID: 34256798 PMCID: PMC8278617 DOI: 10.1186/s12958-021-00793-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/27/2021] [Indexed: 12/05/2022] Open
Abstract
Until 2010, the National Assisted Reproductive Technology Surveillance System (NASS) report, published annually by the Center for Disease Control and Prevention (CDC), demonstrated almost constantly improving live birth rates following fresh non-donor (fnd) in vitro fertilization (IVF) cycles. Almost unnoticed by profession and public, by 2016 they, however, reached lows not seen since 1996-1997. We here attempted to understand underlying causes for this decline. This study used publicly available IVF outcome data, reported by the CDC annually under Congressional mandate, involving over 90% of U.S. IVF centers and over 95% of U.S. IVF cycles. Years 2005, 2010, 2015 and 2016 served as index years, representing respectively, 27,047, 30,425, 21,771 and 19,137 live births in fnd IVF cycles. Concomitantly, the study associated timelines for introduction of new add-ons to IVF practice with changes in outcomes of fnd IVF cycles. Median female age remained at 36.0 years during the study period and center participation was surprisingly stable, thereby confirming reasonable phenotype stability. Main outcome measures were associations of specific IVF practice changes with declines in live IVF birth rates. Time associations were observed with increased utilization of "all-freeze" cycles (embryo banking), mild ovarian stimulation protocols, preimplantation genetic testing for aneuploidy (PGT-A) and increasing utilization of elective single embryo transfer (eSET). Among all add-ons, PGT-A, likely, affected fndIVF most profoundly. Though associations cannot denote causation, they can be hypothesis-generating. Here presented time-associations are compelling, though some of observed pregnancy and live birth loss may have been compensated by increases in frozen-thawed cycles and consequential pregnancies and live births not shown here. Pregnancies in frozen-thawed cycles, however, represent additional treatment cycles, time delays and additional costs. IVF live birth rates not seen since 1996-1997, and a likely continuous downward trend in U.S. IVF outcomes, therefore, mandate a reversal of current outcome trends, whatever ultimately the causes.
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Affiliation(s)
- Norbert Gleicher
- The Center for Human Reproduction, New York, NY, 10021, USA.
- Stem Cell Biology and Molecular Embryology Laboratory, The Rockefeller University, New York, NY, 10065, USA.
- Foundation for Reproductive Medicine, New York, NY, 10021 , USA.
- Department of Obstetrics and Gynecology, Vienna University School of Medicine, 1009, Vienna, Austria.
| | - Lyka Mochizuki
- The Center for Human Reproduction, New York, NY, 10021, USA
- Foundation for Reproductive Medicine, New York, NY, 10021 , USA
| | - David H Barad
- The Center for Human Reproduction, New York, NY, 10021, USA
- Foundation for Reproductive Medicine, New York, NY, 10021 , USA
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Wong KM, van Wely M, Verhoeve HR, Kaaijk EM, Mol F, van der Veen F, Repping S, Mastenbroek S. Transfer of fresh or frozen embryos: a randomised controlled trial. Hum Reprod 2021; 36:998-1006. [PMID: 33734369 PMCID: PMC7970725 DOI: 10.1093/humrep/deaa305] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/24/2020] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Is IVF with frozen-thawed blastocyst transfer (freeze-all strategy) more effective than IVF with fresh and frozen-thawed blastocyst transfer (conventional strategy)? SUMMARY ANSWER The freeze-all strategy was inferior to the conventional strategy in terms of cumulative ongoing pregnancy rate per woman. WHAT IS KNOWN ALREADY IVF without transfer of fresh embryos, thus with frozen-thawed embryo transfer only (freeze-all strategy), is increasingly being used in clinical practice because of a presumed benefit. It is still unknown whether this new IVF strategy increases IVF efficacy. STUDY DESIGN, SIZE, DURATION A single-centre, open label, two arm, parallel group, randomised controlled superiority trial was conducted. The trial was conducted between January 2013 and July 2015 in the Netherlands. The intervention was one IVF cycle with frozen-thawed blastocyst transfer(s) versus one IVF cycle with fresh and frozen-thawed blastocyst transfer(s). The primary outcome was cumulative ongoing pregnancy resulting from one IVF cycle within 12 months after randomisation. Couples were allocated in a 1:1 ratio to the freeze-all strategy or the conventional strategy with an online randomisation programme just before the start of down-regulation. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants were subfertile couples with any indication for IVF undergoing their first IVF cycle, with a female age between 18 and 43 years. Differences in cumulative ongoing pregnancy rates were expressed as relative risks (RR) with 95% CI. All outcomes were analysed following the intention-to-treat principle. MAIN RESULTS AND THE ROLE OF CHANCE Two-hundred-and-five couples were randomly assigned to the freeze-all strategy (n = 102) or to the conventional strategy (n = 102). The cumulative ongoing pregnancy rate per woman was significantly lower in women allocated to the freeze-all strategy (19/102 (19%)) compared to women allocated to the conventional strategy (32/102 (31%); RR 0.59; 95% CI 0.36-0.98). LIMITATIONS, REASONS FOR CAUTION As this was a single-centre study, we were unable to study differences in study protocols and clinic performance. This, and the limited sample size, should make one cautious in using the results as the basis for definitive policy. All patients undergoing IVF, including those with a poor prognosis, were included; therefore, the outcome could differ in women with a good prognosis of IVF treatment success. WIDER IMPLICATIONS OF THE FINDINGS Our results indicate that there might be no benefit of a freeze-all strategy in terms of cumulative ongoing pregnancy rates. The efficacy of the freeze-all strategy in subgroups of patients, different stages of embryo development, and different freezing protocols needs to be further established and balanced against potential benefits and harms for mothers and children. STUDY FUNDING/COMPETING INTEREST(S) The Netherlands Organisation for Health Research and Development (ZonMW grant 171101007). S.M., F.M. and M.v.W. stated they are authors of the Cochrane review 'Fresh versus frozen embryo transfers in assisted reproduction'. TRIAL REGISTRATION NUMBER Dutch Trial Register, NTR3187. TRIAL REGISTRATION DATE 9 December 2011. DATE OF FIRST PATIENT’S ENROLMENT 8 January 2013.
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Affiliation(s)
- K M Wong
- Amsterdam UMC, University of Amsterdam, Centre for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
| | - M van Wely
- Amsterdam UMC, University of Amsterdam, Centre for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
| | - H R Verhoeve
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - E M Kaaijk
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - F Mol
- Amsterdam UMC, University of Amsterdam, Centre for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
| | - F van der Veen
- Amsterdam UMC, University of Amsterdam, Centre for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
| | - S Repping
- Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,National Health Care Institute, Diemen, the Netherlands
| | - S Mastenbroek
- Amsterdam UMC, University of Amsterdam, Centre for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
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Kalinderis M, Kalinderi K, Srivastava G, Homburg R. When Should We Freeze Embryos? Current Data for Fresh and Frozen Embryo Replacement IVF Cycles. Reprod Sci 2021; 28:3061-3072. [PMID: 34033111 DOI: 10.1007/s43032-021-00628-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
Recent years have seen a dramatic rise in the number of frozen-thawed embryo replacement (FER) cycles. Along with the advances in embryo cryopreservation techniques, the optimization of endometrial receptivity has resulted in outcomes for FER that are similar to fresh embryo transfer. However, the question of whether the Freeze all strategy is for all is nowadays a hot topic. This review addresses this issue and describes current evidence based on randomized controlled trials and observational studies. To date, it is reasonable to perform FER in cases with a clear indication for the benefits of such strategy including impending ovarian hyperstimulation syndrome (OHSS) or preimplantation genetic testing for aneuploidy (PGT-A); however, this strategy does not fit for all. This review analyses the pros and cons of the freeze all strategy highlighting the need to follow a personalized plan in embryo transfer, avoiding a freeze all methodology for all patients in an unselected manner.
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Affiliation(s)
| | - Kallirhoe Kalinderi
- 3rd Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Roy Homburg
- Homerton Fertility Centre, Homerton University Hospital, London, UK.,Queen Mary University of London, London, UK
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Rigos I, Athanasiou V, Vlahos N, Papantoniou N, Profer D, Siristatidis C. The Addition of Endometrial Injury to Freeze-All Strategy in Women with Repeated Implantation Failures. J Clin Med 2021; 10:jcm10102162. [PMID: 34067637 PMCID: PMC8156614 DOI: 10.3390/jcm10102162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/04/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Recurrent implantation failure (RIF) after IVF remains a challenging topic for fertility specialists and a frustrating reality for patients with infertility. Various approaches have been investigated and applied towards the improvement of clinical outcomes. Through a nonrandomized clinical trial, we evaluated the effect of the combination of hysteroscopic endometrial injury and the freeze-all technique on pregnancy parameters in a cohort of RIF patients; (2) Methods: The study group comprised of 30 patients with RIF that underwent a hysteroscopic endometrial injury prior to a frozen embryo transfer cycle; another 30 patients with RIF, comprising the control group, underwent a standard frozen cycle with no adjuvant treatment before. Live birth comprised the primary outcome. Logistic and Poisson regression analyses were implemented to reveal potential independent predictors for all outcomes. (3) Results: Live birth rates were similar between groups (8/30 vs. 3/30, p = 0.0876). Biochemical and clinical pregnancy and miscarriages were also independent of the procedure (p = 0.7812, p = 0.3436 and p = 0.1213, respectively). The only confounding factor that contributed to biochemical pregnancy was the number of retrieved oocytes (0.1618 ± 0.0819, p = 0.0481); (4) Conclusions: The addition of endometrial injury to the freeze-all strategy in infertile women with RIF does not significantly improve pregnancy rates, including live birth. A properly conducted RCT with adequate sample size could give a robust answer.
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Affiliation(s)
- Ioannis Rigos
- Assisted Reproduction Unit, IVF Athens Center, Leof. Kifisias 5, 15123 Athens, Greece;
- Correspondence: ; Tel.: +30-693-820-1060
| | - Vasileios Athanasiou
- Assisted Reproduction Unit, IVF Athens Center, Leof. Kifisias 5, 15123 Athens, Greece;
| | - Nikolaos Vlahos
- Assisted Reproduction Unit, Second Department of Obstetrics and Gynecology, “Aretaieion Hospital”, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece; (N.V.); (C.S.)
| | - Nikolaos Papantoniou
- Third Department of Obstetrics and Gynecology, “Attikon Hospital”, Medical School, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12642 Athens, Greece;
| | | | - Charalampos Siristatidis
- Assisted Reproduction Unit, Second Department of Obstetrics and Gynecology, “Aretaieion Hospital”, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece; (N.V.); (C.S.)
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Nikolakopoulou K, Turco MY. Investigation of infertility using endometrial organoids. Reproduction 2021; 161:R113-R127. [PMID: 33621191 PMCID: PMC8052517 DOI: 10.1530/rep-20-0428] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 02/23/2021] [Indexed: 12/27/2022]
Abstract
Infertility is a common problem in modern societies with significant socio-psychological implications for women. Therapeutic interventions are often needed which, depending on the cause, can either be medical treatment, surgical procedures or assisted reproductive technology (ART). However, the treatment of infertility is not always successful due to our limited understanding of the preparation of the lining of the uterus, the endometrium, for pregnancy. The endometrium is of central importance for successful reproduction as it is the site of placental implantation providing the interface between the mother and her baby. Due to the dynamic, structural and functional changes the endometrium undergoes throughout the menstrual cycle, it is challenging to study. A major advancement is the establishment of 3D organoid models of the human endometrium to study this dynamic tissue in health and disease. In this review, we describe the changes that the human endometrium undergoes through the different phases of the menstrual cycle in preparation for pregnancy. We discuss defects in the processes of endometrial repair, decidualization and acquisition of receptivity that are associated with infertility. Organoids could be utilized to investigate the underlying cellular and molecular mechanisms occurring in non-pregnant endometrium and early pregnancy. These studies may lead to therapeutic applications that could transform the treatment of reproductive failure.
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Affiliation(s)
- Konstantina Nikolakopoulou
- Department of Pathology, University of Cambridge, Cambridge, Cambridgeshire, UK
- Centre for Trophoblast Research, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Margherita Y Turco
- Department of Pathology, University of Cambridge, Cambridge, Cambridgeshire, UK
- Centre for Trophoblast Research, University of Cambridge, Cambridge, Cambridgeshire, UK
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Trautmann C, von Versen-Höynck F. Optimales Protokoll für die Übertragung kryokonservierter Embryonen. GYNAKOLOGISCHE ENDOKRINOLOGIE 2021. [DOI: 10.1007/s10304-020-00373-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Matorras R, Pijoan JI, Perez‐Ruiz I, Lainz L, Malaina I, Borjaba S. Meta-analysis of the embryo freezing transfer interval. Reprod Med Biol 2021; 20:144-158. [PMID: 33850447 PMCID: PMC8022104 DOI: 10.1002/rmb2.12363] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/18/2020] [Accepted: 12/12/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The decision of whether frozen embryo transfer (FET) should be performed in the cycle immediately after OPU or at least one cycle later is controversial. FET could improve pregnancy rates in IVF; however, how much time is needed for the endometrium to return to optimal receptivity after ovarian stimulation is not known. METHODS Electronic search in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials to identify studies providing data on the influence of the interval between embryo freezing (or OPU) and FET in FET cycles published between January 1, 2007, and February 1, 2020. MAIN FINDINGS Data analyzed indicated that in the immediate FET cycles, there was a trend to an increased biochemical pregnancy rate (RR = 1.08; CI = 1.00-1.18), whereas the clinical pregnancy rate was somewhat higher, but without reaching statistical significance (RR = 1.07; CI = 0.99-1.15). The live birth rate was similar in the two groups (RR = 1.05; CI = 0.95-1.15), as was the implantation rate (RR = 0.98; CI = 0.83-1.16). Stratifying by embryo stage or FET type (freeze-all or FET after failed fresh transfer) showed no differences. CONCLUSION Systematically delaying FET does not offer benefits to IVF outcomes. In addition, immediate transfer is associated with a nonsignificant trend to better clinical pregnancy rate and it also avoids the psychological effects of prolonging the stress on prospective parents.
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Affiliation(s)
- Roberto Matorras
- Reproduction UnitCruces HospitalBiocruces Health Research InstituteBIOEFVizcayaSpain
- Department of Gynecology and ObstetricsFaculty of Medicine and NursingUniversity of the Basque CountryVizcayaSpain
- IVI BilbaoVizcayaSpain
| | - Jose Ignacio Pijoan
- Clinical Epidemiological UnitCruces HospitalBiocruces Health Research InstituteBIOEFVizcayaSpain
| | - Irantzu Perez‐Ruiz
- Reproduction UnitCruces HospitalBiocruces Health Research InstituteBIOEFVizcayaSpain
| | - Lucía Lainz
- Reproduction UnitCruces HospitalBiocruces Health Research InstituteBIOEFVizcayaSpain
| | - Iker Malaina
- Clinical Epidemiological UnitCruces HospitalBiocruces Health Research InstituteBIOEFVizcayaSpain
- Department of MathematicsFaculty of Science and TechnologyUniversity of the Basque CountryVizcayaSpain
| | - Sonia Borjaba
- Reproduction UnitCruces HospitalBiocruces Health Research InstituteBIOEFVizcayaSpain
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Aslih N, Dorzia D, Atzmon Y, Estrada D, Ellenbogen A, Bilgory A, Shalom-Paz E. Ovulatory-Based FET Cycles May Achieve Higher Pregnancy Rates in the General Population and among Anovulatory Women. J Clin Med 2021; 10:703. [PMID: 33670133 PMCID: PMC7916855 DOI: 10.3390/jcm10040703] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 12/03/2022] Open
Abstract
This study evaluated which endometrial preparation protocol in frozen embryo transfer (FET) cycles provides the best results for polycystic ovarian syndrome (PCOS) patients and the general population. This retrospective study of 634 FET cycles was conducted 2016-2018. Cycles were divided into Group A: Artificial endometrial preparations for FET (aFET; n = 348), Group B: Ovulatory cycle (n = 286) to compare two methods of endometrial preparation for FET. Artificial endometrial preparation with exogenous estrogen and progesterone versus natural ovulation cycles, modified natural cycles using hCG for the final triggering and letrozole-induced ovulation with hCG. Anovulatory patients were analyzed separately. Anovulatory PCOS patients had significantly higher pregnancy rates with letrozole treatment compared with aFET cycles (44% vs. 22.5%; p = 0.044). For the entire cohort, ovulatory cycles and aFET were similar in terms of patient characteristics, demographics, infertility causes, treatment protocols and number of embryos transferred. Although the mean ESHRE score of the transferred embryos was higher in the aFET group, we found higher clinical pregnancy rate in the ovulatory cycle FET (41.3% vs. 27.3%, p < 0.0001). A better pregnancy rate was found after ovulatory cycle FET. In the ovulatory cycles, the outcome of letrozole-induced and non-induced cycles were comparable. PCOS patients, as well as the general population, may benefit from ovulation induced FET cycles, with significantly better outcomes in FET in ovulatory cycles.
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Affiliation(s)
| | | | | | | | | | | | - Einat Shalom-Paz
- IVF Unit, Hillel Yaffe Medical Center, Hadera 3810101, Israel; (N.A.); (D.D.); (Y.A.); (D.E.); (A.E.); (A.B.)
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Zaat T, Zagers M, Mol F, Goddijn M, van Wely M, Mastenbroek S. Fresh versus frozen embryo transfers in assisted reproduction. Cochrane Database Syst Rev 2021; 2:CD011184. [PMID: 33539543 PMCID: PMC8095009 DOI: 10.1002/14651858.cd011184.pub3] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND In vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) treatments conventionally consist of a fresh embryo transfer, possibly followed by one or more cryopreserved embryo transfers in subsequent cycles. An alternative option is to freeze all suitable embryos and transfer cryopreserved embryos in subsequent cycles only, which is known as the 'freeze all' strategy. This is the first update of the Cochrane Review on this comparison. OBJECTIVES To evaluate the effectiveness and safety of the freeze all strategy compared to the conventional IVF/ICSI strategy in women undergoing assisted reproductive technology. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility Group Trials Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, and two registers of ongoing trials from inception until 23 September 2020 for relevant studies, checked references of publications found, and contacted study authors to obtain additional data. SELECTION CRITERIA Two review authors (TZ and MZ) independently selected studies for inclusion, assessed risk of bias, and extracted study data. We included randomised controlled trials comparing a 'freeze all' strategy with a conventional IVF/ICSI strategy including a fresh embryo transfer in women undergoing IVF or ICSI treatment. DATA COLLECTION AND ANALYSIS The primary outcomes were cumulative live birth rate and ovarian hyperstimulation syndrome (OHSS). Secondary outcomes included effectiveness outcomes (including ongoing pregnancy rate and clinical pregnancy rate), time to pregnancy and obstetric, perinatal and neonatal outcomes. MAIN RESULTS We included 15 studies in the systematic review and eight studies with a total of 4712 women in the meta-analysis. The overall evidence was of moderate to low quality. We graded all the outcomes and downgraded due to serious risk of bias, serious imprecision and serious unexplained heterogeneity. Risk of bias was associated with unclear blinding of investigators for preliminary outcomes of the study during the interim analysis, unit of analysis error, and absence of adequate study termination rules. There was an absence of high-quality evidence according to GRADE assessments for our primary outcomes, which is reflected in the cautious language below. There is probably little or no difference in cumulative live birth rate between the 'freeze all' strategy and the conventional IVF/ICSI strategy (odds ratio (OR) 1.08, 95% CI 0.95 to 1.22; I2 = 0%; 8 RCTs, 4712 women; moderate-quality evidence). This suggests that for a cumulative live birth rate of 58% following the conventional strategy, the cumulative live birth rate following the 'freeze all' strategy would be between 57% and 63%. Women might develop less OHSS after the 'freeze all' strategy compared to the conventional IVF/ICSI strategy (OR 0.26, 95% CI 0.17 to 0.39; I2 = 0%; 6 RCTs, 4478 women; low-quality evidence). These data suggest that for an OHSS rate of 3% following the conventional strategy, the rate following the 'freeze all' strategy would be 1%. There is probably little or no difference between the two strategies in the cumulative ongoing pregnancy rate (OR 0.95, 95% CI 0.75 to 1.19; I2 = 31%; 4 RCTs, 1245 women; moderate-quality evidence). We could not analyse time to pregnancy; by design, time to pregnancy is shorter in the conventional strategy than in the 'freeze all' strategy when the cumulative live birth rate is comparable, as embryo transfer is delayed in a 'freeze all' strategy. We are uncertain whether the two strategies differ in cumulative miscarriage rate because the evidence is very low quality (Peto OR 1.06, 95% CI 0.72 to 1.55; I2 = 55%; 2 RCTs, 986 women; very low-quality evidence) and cumulative multiple-pregnancy rate (Peto OR 0.88, 95% CI 0.61 to 1.25; I2 = 63%; 2 RCTs, 986 women; very low-quality evidence). The risk of hypertensive disorders of pregnancy (Peto OR 2.15, 95% CI 1.42 to 3.25; I2 = 29%; 3 RCTs, 3940 women; low-quality evidence), having a large-for-gestational-age baby (Peto OR 1.96, 95% CI 1.51 to 2.55; I2 = 0%; 3 RCTs, 3940 women; low-quality evidence) and a higher birth weight of the children born (mean difference (MD) 127 g, 95% CI 77.1 to 177.8; I2 = 0%; 5 RCTs, 1607 singletons; moderate-quality evidence) may be increased following the 'freeze all' strategy. We are uncertain whether the two strategies differ in the risk of having a small-for-gestational-age baby because the evidence is low quality (Peto OR 0.82, 95% CI 0.65 to 1.05; I2 = 64%; 3 RCTs, 3940 women; low-quality evidence). AUTHORS' CONCLUSIONS We found moderate-quality evidence showing that one strategy is probably not superior to the other in terms of cumulative live birth rate and ongoing pregnancy rate. The risk of OHSS may be decreased in the 'freeze all' strategy. Based on the results of the included studies, we could not analyse time to pregnancy. It is likely to be shorter using a conventional IVF/ICSI strategy with fresh embryo transfer in the case of similar cumulative live birth rate, as embryo transfer is delayed in a 'freeze all' strategy. The risk of maternal hypertensive disorders of pregnancy, of having a large-for-gestational-age baby and a higher birth weight of the children born may be increased following the 'freeze all' strategy. We are uncertain if 'freeze all' strategy reduces the risk of miscarriage, multiple pregnancy rate or having a small-for-gestational-age baby compared to conventional IVF/ICSI.
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Affiliation(s)
- Tjitske Zaat
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, Amsterdam, Netherlands
| | - Miriam Zagers
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, Amsterdam, Netherlands
| | - Femke Mol
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, Amsterdam, Netherlands
| | - Mariëtte Goddijn
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, Amsterdam, Netherlands
| | - Madelon van Wely
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, Amsterdam, Netherlands
| | - Sebastiaan Mastenbroek
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, Amsterdam, Netherlands
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Sayed GA, Al-Sawaf HA, Al-Sawaf AH, Saeid M, Maged A, Ibrahim IH. Mitochondrial DNA in Fresh versus Frozen Embryo Culture Media of Polycystic Ovarian Syndrome Patients Undergoing Invitro Fertilization: A Possible Predictive Marker of a Successful Pregnancy. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2021; 14:27-38. [PMID: 33469340 PMCID: PMC7810675 DOI: 10.2147/pgpm.s284064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 12/14/2020] [Indexed: 11/26/2022]
Abstract
Purpose Frozen embryos transfer (ET) may improve the live-birth and reduce rates of ovarian hyperstimulation in polycystic ovary syndrome (PCOS) patients. Morphological criteria are the classical way for embryo selection, yet recently, many biochemical and genetic markers have been developed. This study aimed to compare fresh and frozen ET using the mtDNA/gDNA ratio of embryo secretome and the possibility of using this ratio as a predictive marker of PCOS pregnancy rate. Subjects and Methods One hundred PCOS patients undergoing IVF were chosen according to Rotterdam criteria and divided into two groups. Group I (50 with fresh ET), group II (50 with frozen ET), and otherwise 33 apparently healthy women as a control group with fresh ET. We then carried out absolute quantification of embryo culture media mtDNA and gDNA by real-time PCR. Results mtDNA/gDNA ratio was significantly low in PCOS embryo culture media in comparison with control. Additionally, while the mtDNA/gDNA ratio was significantly high in pregnant PCOS embryo culture media, it was high, though not statistically significant, in the fresh ET than frozen ET group. mtDNA/gDNA ratio sensitivity and specificity in PCOS embryo culture media as a predictive value of pregnancy rate were (86% and 96%, respectively). Conclusion mtDNA/gDNA ratio measurement in PCOS embryo culture media is a novel marker that can be clinically applied as a predictive value of the quality of the morphologically good embryo. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/uqKkQgRrql4
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Affiliation(s)
- Ghadir A Sayed
- Department of Biochemistry, Faculty of Pharmacy, Egyptian Russian University, Cairo, Egypt
| | - Hussein A Al-Sawaf
- Department of Biochemistry, Faculty of Pharmacy, Egyptian Russian University, Cairo, Egypt
| | - Ahmed H Al-Sawaf
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Ahmed Maged
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Iman Hassan Ibrahim
- Department of Biochemistry, Faculty of Pharmacy (Girls), Al-Azhar University, Cairo, Egypt
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Huang J, Lin J, Cai R, Lu X, Song N, Gao H, Kuang Y. Significance of endometrial thickness change after human chorionic gonadotrophin triggering in modified natural cycles for frozen-thawed embryo transfer. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1590. [PMID: 33437789 PMCID: PMC7791260 DOI: 10.21037/atm-20-1459] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background Peak endometrial thickness (EMT), measured on the end of follicular phase or early luteal phase, is the most widely used marker for endometrial receptivity during infertility treatment. However, the clinical significance of follicular-to-luteal EMT change remains unclear. We aimed to study whether the change of EMT between the day of human chorionic gonadotrophin (hCG) triggering and the day of frozen-thawed embryo transfer (FET) has any influence on pregnancy outcomes in modified natural cycles (mNCs). Methods This was a retrospective cohort study of 2,768 regular ovulatory women who underwent their first mNC-FET cycles from January 2011 to June 2015. Patients were divided into three groups according to the percentage change of EMT from the hCG triggering day to the FET day: >5% decrease (n=405), ±5% plateau (n=1,259) and >5% increase (n=1,104). The main outcome measure was live birth rate. Results Live birth rates were 41.9%, 39.8% [crude odds ratio (cOR) 0.91, 95% CI, 0.73–1.15) and 42.4% (cOR 1.02, 95% CI, 0.87–1.20) in the EMT plateau, decrease and increase groups, respectively (P=0.649). Multiple regression analysis did not alter the finding after controlling for a variety of confounders. Compared with the post-trigger EMT plateau group, the adjusted OR of live birth was 0.88 (95% CI, 0.69–1.12) in the decrease group and 1.05 (95% CI, 0.88–1.25) in the increase group. Similarly, no significant associations were observed before or after adjustment between EMT change and other pregnancy outcomes including positive hCG test, clinical pregnancy, early miscarriage and ongoing pregnancy. Conclusions EMT change from hCG triggering to embryo transfer was not associated with pregnancy chances in mNC-FET cycles. This reassuring finding should provide guidance for physicians and patients when confronted with EMT decrease on the transfer day.
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Affiliation(s)
- Jialyu Huang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaying Lin
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Renfei Cai
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuefeng Lu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ning Song
- Department of Histology, Embryology, Genetics and Developmental Biology, Shanghai Key Laboratory of Reproductive Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongyuan Gao
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanping Kuang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Atzmon Y, Aslih N, Estrada D, Bilgory A, Ellenbogen A, Shalom-Paz E. Comparable Outcomes Using Oral Dydrogesterone Vs. Micronized Vaginal Progesterone in Frozen Embryo Transfer: a Retrospective Cohort Study. Reprod Sci 2020; 28:1874-1881. [PMID: 33140324 DOI: 10.1007/s43032-020-00376-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 10/26/2020] [Indexed: 12/27/2022]
Abstract
This retrospective study was conducted to determine whether using oral dydrogesterone (DYD) instead of micronized vaginal progesterone (MVP) in frozen embryo transfer (FET) cycles affects pregnancy outcomes. Women undergoing autologous FET in an academic fertility center were evaluated. Uses of 10 mg TID oral DYD or MVP for patients treated in FET cycles (artificial and ovulatory cycle, separately) were compared. The main outcome measure was live birth rates in each group. The study analyzed 599 cycles that occurred from January 2018 through December 2019. Chemical and clinical pregnancy rates were comparable between DYD vs. MVP groups (41.6% vs. 38.1%; P = 0.44 and 36.7% vs. 31.4%; P = 0.18, respectively). The ongoing pregnancy and delivery rates (29% vs. 22%, P = 0.06), as well as abortion rate (12.3% vs. 15.8%, P = 0.2), were comparable between the two groups. In a case-control sub-analysis of artificial FET cycles, we found comparable results between the two modes of luteal support. Similarly, results were comparable in ovulatory cycles using these medications for luteal support. Chemical and clinical pregnancy rates were comparable with DYD vs. MVP, in artificial FET (33.7% vs. 34.8%; P = 0.89 and 27.7% vs. 27.5%; P = 1), and in ovulatory FET (46.5% vs. 43.9%; P = 0.71 and 42.3% vs. 38.2%; P = 0.53), respectively. Our results indicate that in FET, pregnancy outcomes with oral DYD were not inferior to those with MVP.
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Affiliation(s)
- Yuval Atzmon
- IVF Unit, Hillel Yaffe Medical Center, Hadera, Israel
| | - Nardin Aslih
- IVF Unit, Hillel Yaffe Medical Center, Hadera, Israel
| | | | - Asaf Bilgory
- IVF Unit, Hillel Yaffe Medical Center, Hadera, Israel
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Tu YA, Yang PK, Chen SU, Yang JH. Optimal time interval between hysteroscopic polypectomy and frozen-thawed blastocyst transfer: A retrospective study. PLoS One 2020; 15:e0240882. [PMID: 33079974 PMCID: PMC7575078 DOI: 10.1371/journal.pone.0240882] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/05/2020] [Indexed: 11/19/2022] Open
Abstract
The optimal timing of frozen-thawed blastocyst transfer following hysteroscopic polypectomy is an important and unanswered clinical question. In this study, we conducted a retrospective survey of cases from an infertility center at an academic hospital. We reviewed the charts of all patients who received in-vitro fertilization and frozen-thawed blastocyst transfers (FBT) at the center from January 2009 to November 2019. One hundred and two patients with prior diagnosis of endometrial polyp that were treated with hysteroscopic polypectomy before received their first FBT at the center were identified as cases. Patients without prior diagnosis of endometrial polyp, and who received their first FBT at the center were defined as controls. Controls were enrolled at a 1-to-1 ratio to the cases. The cases and controls did not show differences in baseline characteristics, endometrial thickness, or the number of good blastocysts transferred. The clinical pregnancy rates and live birth rates were similar. Regarding the optimal interval between polypectomy and FBT, a cut-off of 120 days was identified from the ROC curve. A stratified analysis showed that when FBT was performed within an interval of 120 days after polypectomy, there were higher biochemical pregnancy rates (73.2%, 45.2%; OR 3.3; P = .007) and clinical pregnancy rates (64.8%, 41.9%; OR 2.54; P = .032), when compared with intervals greater than 120 days. There were no significant differences in implantation and live birth rates. In conclusion, pregnancy rates following FBT in patients who had received prior endometrial polypectomy were comparable to pregnancy rates after FBT in patients without endometrial polyp. Subgroup analysis showed that an interval greater than 120 days between hysteroscopic polypectomy and FBT was associated with decreased pregnancy rates. Patients who wish to receive embryo transfer after polypectomy should wait no longer than 120 days.
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Affiliation(s)
- Yi-An Tu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Kai Yang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shee-Uan Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jehn-Hsiahn Yang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- * E-mail:
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Adamson GD, Norman RJ. Why are multiple pregnancy rates and single embryo transfer rates so different globally, and what do we do about it? Fertil Steril 2020; 114:680-689. [PMID: 33010940 DOI: 10.1016/j.fertnstert.2020.09.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 12/18/2022]
Abstract
In the early years of in vitro fertilization, overall pregnancy rates were low, and it was considered necessary to transfer more than one embryo to increase the chances of pregnancy. It was not until advances in assisted reproductive technologies resulting in increased pregnancy rates that the concept of transferring just one embryo was considered possible. A consequence of improvements in implantation rates was also an increase in multiple pregnancies when more than one embryo was transferred. Although some countries have reduced the number of embryos transferred, international data show that in many parts of the world high twin and higher order multiple pregnancy rates still exist. Even in developed countries these problems persist depending on clinical practice, funding of health services, and patient demands. Perinatal and other outcomes are significantly worse with twins compared with singleton pregnancies and there is an urgent need to reduce multiple pregnancy rates to at least 10%. This has been achieved in several countries and clinics by introducing single embryo transfer but there are many barriers to the introduction of this technique in most clinics worldwide. We discuss the background to the high multiple rate in assisted reproduction and the factors that contribute to its persistence even in excellent clinics and in high-quality health services. Practices that may promote single embryo transfer are discussed.
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Affiliation(s)
| | - Robert J Norman
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
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Christianson MS, Stern JE, Sun F, Zhang H, Styer AK, Vitek W, Polotsky AJ. Embryo cryopreservation and utilization in the United States from 2004-2013. F S Rep 2020; 1:71-77. [PMID: 34223221 PMCID: PMC8244341 DOI: 10.1016/j.xfre.2020.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 05/23/2020] [Accepted: 05/29/2020] [Indexed: 12/21/2022] Open
Abstract
Objective To evaluate the quantity and use of embryos cryopreserved at assisted reproductive technology (ART) clinics in the United States from 2004 through 2013 and to characterize trends in ART cycles in which all embryos were cryopreserved. Design Retrospective analysis. Setting Not applicable. Patient(s) Registry data from the Society for Assisted Reproductive Technology. Intervention(s) Historical cohort of U.S. ART cycles reported to the Society for Assisted Reproductive Technology Clinical Outcomes Reporting System between 2004 and 2013. Main Outcome Measure(s) Number of embryos cryopreserved and factors associated with having cryopreserved embryos. Result(s) The percentage of fresh cycles in which all embryos were frozen increased dramatically each year after 2010: 15.6% (2010), 19.9% (2011), 30.7% (2012), and 40.7% (2013). During 10 years, 1,954,548 embryos were cryopreserved and 717,345 embryos were transferred. In freeze-only cycles from 2004 to 2013, there was a significant increase in the percentage of women with diminished ovarian reserve (19.9% to 34.1%) and in those who used preimplantation genetic testing (3.2% to 6.9%). During the 10-year period, there were 294,575 fresh cycles with embryo transfer and at least one embryo cryopreserved. Overall, 52.5% (n = 154,543) did not undergo a subsequent frozen embryo transfer, 29.5% (n = 40,462) were left with no frozen embryos, 50.4% (n = 68,875) had one–five embryos, and 20.0% (n = 27,396) had ≥six. Factors associated with having excess embryos included donor oocyte cycles and increased antimüllerian hormone levels. Conclusion(s) There has been a sharp increase in U.S. ART cycles in which all embryos are frozen and this may result in more embryos in storage.
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Affiliation(s)
- Mindy S Christianson
- Division of Reproductive Endocrinology, Johns Hopkins University School of Medicine, Lutherville, Maryland
| | - Judy E Stern
- Obstetrics and Gynecology, Dartmouth-Hitchcock, Lebanon, New Hampshire
| | - Fangbai Sun
- Collaborative Center for Statistics in Science, Yale School of Public Health, New Haven, Connecticut
| | - Heping Zhang
- Collaborative Center for Statistics in Science, Yale School of Public Health, New Haven, Connecticut
| | - Aaron K Styer
- Colorado Center for Reproductive Medicine (CCRM) Fertility Clinic, Boston, Massachusetts
| | - Wendy Vitek
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Alex J Polotsky
- Obstetrics and Gynecology, University of Colorado Denver, Denver, Colorado
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