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Ageheim M, Skalkidou A, Bergman E, Iliadis S, Lampa E, Lindström L, Oberg AS. Fetal growth after fresh and frozen embryo transfer and natural conception: A population-based register study. BJOG 2024; 131:1229-1237. [PMID: 38351638 DOI: 10.1111/1471-0528.17786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/07/2024] [Accepted: 01/24/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVE To investigate fetal growth trajectories and risks of small and large for gestational age (SGA and LGA), and macrosomia in pregnancies after fresh and frozen embryo transfer (ET), and natural conception (NC). DESIGN Longitudinal population-based cohort study. SETTING Swedish national registers. POPULATION A total of 196 008 singleton pregnancies between 2013 and 2017. METHODS Of all singleton pregnancies resulting in live births in the Swedish Pregnancy Register, 10 970 fresh ET, 6520 frozen ET, and 178 518 NC pregnancies with ultrasound data were included. A general least squares model was used to examine the effect of fresh or frozen ET on fetal growth while adjusting for confounders. MAIN OUTCOME MEASURES Fetal growth velocity. SGA, LGA and macrosomia. RESULTS At 120 days, fetal weights were lower in fresh ET pregnancies compared with NC pregnancies. Thereafter fresh ET as well as FET fetuses had higher fetal weights than NC fetuses, with no differences between themselves until the second trimester. From 210 days, FET fetuses were heavier than fresh ET fetuses, whereas fresh ET fetuses had lower fetal weights than NC fetuses from 245 days. After fresh ET, SGA was more frequent, whereas LGA and macrosomia were less frequent, than after FET. CONCLUSIONS This study gives new insights into the differences in fetal growth dynamics between fresh and frozen ET and NC pregnancies. Clinically relevant differences in proportions of SGA, LGA and macrosomia were observed.
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Affiliation(s)
- Mårten Ageheim
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Alkistis Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Eva Bergman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Stavros Iliadis
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Erik Lampa
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Linda Lindström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anna Sara Oberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Salmeri N, Alteri A, Farina A, Pozzoni M, Vigano' P, Candiani M, Cavoretto PI. Preterm birth in singleton pregnancies conceived by in vitro fertilization or intracytoplasmic sperm injection: an overview of systematic reviews. Am J Obstet Gynecol 2024:S0002-9378(24)00623-9. [PMID: 38796038 DOI: 10.1016/j.ajog.2024.05.037] [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: 02/09/2024] [Revised: 05/06/2024] [Accepted: 05/15/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND The rate of preterm birth of singletons conceived through in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) is increased, being as high as 15% to 16% across Europe and the United States. However, the underlying etiology, phenotype, and mechanisms initiating preterm birth (PTB) are poorly understood. OBJECTIVE To quantify the PTB risk and examine supposed etiology in IVF/ICSI singleton pregnancies compared to naturally conceived. STUDY DESIGN Overview of reviews including all available systematic reviews with meta-analysis comparing PTB risk in IVF/ICSI and naturally conceived singletons. A comprehensive search of PubMed/MEDLINE, Embase, Scopus, and Cochrane Library databases was performed up to December 31, 2023. Information available on etiology, phenotype, initiation of PTB, and relevant moderators was retrieved and employed for subgroup analyses. Random-effects meta-analysis models were used for pooling effect measures. Estimates were presented as odds ratios (ORs) with 95% confidence intervals (CIs). The extent of overlap in the original studies was measured using the corrected covered area assessment. The quality of the included reviews was evaluated with the AMSTAR 2 tool. The Grading of Recommendations Assessment, Development and Evaluation approach was applied to rate evidence certainty. The protocol was registered on PROspective Register of Systematic Reviews (CRD42023411418). RESULTS Twelve meta-analyses (16,522,917 pregnancies; ˃433,330 IVF/ICSI) were included. IVF/ICSI singletons showed a significantly higher PTB risk compared to natural conception (PTB ˂37 weeks: OR: 1.72, 95% CI: 1.57-1.89; PTB<32 weeks: OR: 2.19, 95% CI: 1.82-2.64). Influential analysis reinforced the strength of this association. Subgroup analyses investigating supposed etiology revealed a comparable risk magnitude for spontaneous PTB (OR: 1.79, 95% CI: 1.56-2.04) and a greater risk for iatrogenic PTB (OR: 2.28, 95% CI: 1.72-3.02). PTB risk was consistent in the subgroup of conventional IVF (OR: 1.95, 95% CI: 1.76-2.15) and higher in the subgroup of fresh only (OR: 1.79, 95% CI: 1.55-2.07) vs frozen-thawed embryo transfers (OR: 1.39, 95% CI: 1.34-1.43). There was minimal study overlap (13%). The certainty of the evidence was graded as low to very low. CONCLUSION Singletons conceived through IVF/ICSI have a 2-fold increased risk of PTB compared to natural conception, despite the low certainty of the evidence. There is paucity of available data on PTB etiology, phenotype, or initiation. The greater risk increase is observed in fresh embryo transfers and involves iatrogenic PTB and PTB ˂32 weeks, likely attributable to placental etiology. Future studies should collect data on PTB etiology, phenotype, and initiation. IVF/ICSI pregnancies should undertake specialistic care with early screening for placental disorders, cervical length, and growth abnormalities, allowing appropriate timely follow-up, preventive measures, and therapeutic interventions strategies.
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Affiliation(s)
- Noemi Salmeri
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandra Alteri
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Farina
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Mirko Pozzoni
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Vigano'
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Candiani
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Ivo Cavoretto
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
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Alyahyawi A, Adam GK, AlHabardi N, Adam I. Problems with gestational age estimation by last menstrual period and ultrasound among late antenatal care attendant women in a low-resource setting in Africa, Sudan. J Ultrasound 2024; 27:129-135. [PMID: 38236459 PMCID: PMC10909061 DOI: 10.1007/s40477-023-00844-x] [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: 08/28/2023] [Accepted: 10/30/2023] [Indexed: 01/19/2024] Open
Abstract
INTRODUCTION Accurate estimation of gestational age is essential to interpret and manage several maternal and perinatal indicators. Last menstrual period (LMP) and ultrasound are the two most common methods used for estimating gestational age. There are few published studies comparing the use of LMP and ultrasound in Sub-Saharan Africa to estimate gestational age and no studies on this topic in Sudan. MATERIAL AND METHODS A cross-sectional study was conducted in Gadarif Maternity Hospital in Sudan during November through December 2022. Sociodemographic information was collected, and the date of the first day of each participant's LMP was recorded. Ultrasound examinations were performed (measuring crown-rump length in early pregnancy and biparietal diameter and femur length in late pregnancy) using a 3.5-MHz electronic convex sector probe. Bland-Altman analysis was performed. RESULTS Four-hundred seventy-six pregnant women were enrolled. The median (interquartile range [IQR]) age and gravidity was 24.0 (20.0‒29.0) years and 2 (1‒4), respectively. There was a strong positive correlation between gestational age determined by LMP and ultrasound (r = 0.921, P < 0.001). The mean gestational age estimate according to LMP was higher than that determined by ultrasound, with a difference, on average, of 0.01 week (95% confidence interval [CI]: - 0.05, 0.07). Bland-Altman analysis showed the limits of agreement varied from - 1.36 to 1.38 weeks. A linear regression analysis showed proportional bias. The coefficient of difference of the mean was equal to 0.26 (95% CI: 0.01, 0.03, P < 0.001). CONCLUSION Based on our results, there was a bias in LMP-based gestational age estimates when compared with the reproducible method (ultrasound).
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Affiliation(s)
- Amjad Alyahyawi
- Department of Diagnostic Radiology, College of Applied Medical Sciences, University of Ha'il, Ha'il, Saudi Arabia
- Department of Physics, Centre for Nuclear and Radiation Physics, University of Surrey, Guildford, GU2 7XH, UK
| | - Gamal K Adam
- Faculty of Medicine, Gadarif University, Gadarif, 32211, Sudan
| | - Nadiah AlHabardi
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, 56219, Unaizah, Saudi Arabia
| | - Ishag Adam
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, 56219, Unaizah, Saudi Arabia.
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Li X, Jauniaux E. Antenatal fetal growth patterns in uncomplicated pregnancies according to mode of conception and placental location. Placenta 2024; 145:89-91. [PMID: 38109799 DOI: 10.1016/j.placenta.2023.11.016] [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: 04/07/2023] [Revised: 10/20/2023] [Accepted: 11/25/2023] [Indexed: 12/20/2023]
Abstract
Newborns resulting from in-vitro fertilisation (IVF) had a significantly (P= 0.002) higher birthweight centile than those resulting from spontaneous conception (SC) but no significant changes were found in ultrasound estimated fetal weight (EFW) centile between 20-22 and 32-34 weeks between the IVF and SC groups. When stratified for the IVF methods used, significant (P = 0.02) fastest in-utero fetal growth (mean increase in centile of 5 between 2nd to 3rd trimester) was observed in the frozen embryo transfer (FET) subgroup compared to SC, and to IVF pregnancies resulting from fresh blastocyst transfer (FBT) or from oocyte donation (OD). Low placentation was significantly (P < 0.001) more common in the IVF group than in the SC group but was not associated with a change in growth pattern suggesting that fetal growth in-utero is independent of placental location but may be influenced by embryo freezing.
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Affiliation(s)
- Xueyan Li
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, UK
| | - Eric Jauniaux
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, UK.
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Ginod P, Dahan MH. Polygenic embryo screening: are there potential maternal and fetal harms? Reprod Biomed Online 2023; 47:103327. [PMID: 37820464 DOI: 10.1016/j.rbmo.2023.103327] [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: 03/31/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 10/13/2023]
Abstract
Polygenic embryo screening (PES) and its derivate the Embryo Health Score (EHS) have generated interest in both infertile and fertile populations due to their potential ability to select embryos with a reduced risk of disease and improved long-term health outcomes. Concerns have been raised regarding the potential harms of IVF itself, including possible epigenetic changes that may affect the health of the offspring in late adulthood, which are not fully captured in the EHS calculation. Knowledge of the potential impacts of the trophectoderm biopsy, which is a key component of the PES procedure, on the offsprings' health is limited by the heterogeneity of the population characteristics used in the published studies. Nonetheless, the literature suggests a possible increased risk of preterm delivery, birth defects and pre-eclampsia after trophectoderm biopsy. Overall, the risks of PES for prenatal and postnatal health remain uncertain, and further research is needed. Counselling patients regarding these risks before considering PES is important, to provide an understanding of the risks and benefits. This review aims to highlight some of these issues, the need for continued investigation in this area, and the importance of informed decision-making in the context of PES.
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Affiliation(s)
- Perrine Ginod
- MUHC Reproductive Centre, McGill University, Montréal, Quebec, Canada; CHU Dijon Bourgogne, Service de Gynécologie-Obstétrique et Assistance Médicale à la Procréation, Dijon, France
| | - Michael H Dahan
- MUHC Reproductive Centre, McGill University, Montréal, Quebec, Canada; Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montréal, Quebec, Canada.
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Wang J, Ma L, Mei J, Li L, Xu W, Jiang W, Wei Y, Xu Y, Sun S, Ma Y, Li Q. Impacts of different culture times on pregnancy outcomes after thawing of cleavage stage embryos. BMC Pregnancy Childbirth 2023; 23:824. [PMID: 38031033 PMCID: PMC10685551 DOI: 10.1186/s12884-023-06139-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVE This study assessed the impacts of in vitro culture times of cleavage embryos on clinical pregnancy outcomes. METHODS This retrospective cohort study was performed at the Reproductive Medicine Department of Hainan Modern Women and Children's Hospital in China between January 2018 and December 2022. Patients who first underwent frozen embryo transfer with in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles on day 3 were included. According to the time of embryo culture after thawing, the embryos were divided into long-term culture group(18-20 h) and short-term culture group (2-4 h). The clinical pregnancy rate was regarded as he primary outcome. To minimize confounding factors and reduce selection bias, the propensity score matching was used to balance the effects of known confounding factors and to reduce selection bias. Stratified analyses and multiple logistic regression analyses were used to evaluate the risk factors affecting the clinical pregnancy outcomes after matching. RESULTS General characteristics between two groups were comparable after matching. In the long-term culture group, 266/381 (69.81%) embryos had more than 10 blastomeres, and 75/381 (19.68%) reached the morula stage. After overnight culture, the implantation rate (27.97% vs. 14.28%, P = 0.018) and clinical pregnancy rate (38.46% vs. 22.5%, P = 0.05) were increased in the group with proliferating blastomeres. The long-term culture group trended to have a higher clinical pregnancy rate compared with the short-term culture group (35.74% vs. 29.79%). No statistical differences in clinical pregnancy outcomes between the two groups were observed after matching, including the rates of implantation (25.46% vs23.98%), miscarriages (25% vs. 22.85%), ongoing pregnancy rate (76.2% vs. 77.15%) and live birth rate (26.8% vs. 22.98%). Stratified analyses were performed according to the age of the patients. After matching, there were no significant differences in the clinical pregnancy, implantation and miscarriage rates between the two groups for patients > 35 or ≤ 35 years of age. Subgroup analyses were performed according to the quality of the transferred embryos. There were no significant differences in the clinical outcomes, between two groups after embryos transferred with the same quality. Multivariate Logistic regression analysis was used to evaluate the influencing factors of clinical pregnancy outcomes after matching. Culture time was not found to be an independent predictor for clinical pregnancy [OR 0.742, 95%CI 0.487 ~ 1.13; P = 0.165]. The age of oocyte retrieval [OR 0.906, 95%CI 0.865 ~ 0.949; P <0.001] and the number of high-quality embryos transferred [OR 1.787, 95%CI 1.256 ~ 2.543; P = 0.001] were independent factors affecting clinical pregnancy outcomes. CONCLUSIONS In vitro 18-20 h culture of embryos with either good-or non-good-quality will not adversely affect the clinical pregnancy.
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Affiliation(s)
- Jieyou Wang
- Hainan Modern Women and Children's Hospital, 18 Qiongzhou Road, Haikou, 570100, China
| | - Linna Ma
- Hainan Provincial Key Laboratory for Human Reproductive Medicine and Genetic Research, Hainan Clinical Research Center for Thalassemia, Haikou Key Laboratory for Preservation of Human Genetic Resource, Reproductive Medical Center, National Center for International Research "China-Myanmar Joint Research Center for Prevention and Treatment of Regional Major Disease", The First Affiliated Hospital of Hainan Medical University, Hainan Medical University, Haikou, 570102, China
- Key Laboratory of Tropical Translational Medicine of Ministry of Education, Hainan Medical University, 3 Xueyuan Road, Haikou, 571199, China
| | - Jiaoqi Mei
- Hainan Provincial Key Laboratory for Human Reproductive Medicine and Genetic Research, Hainan Clinical Research Center for Thalassemia, Haikou Key Laboratory for Preservation of Human Genetic Resource, Reproductive Medical Center, National Center for International Research "China-Myanmar Joint Research Center for Prevention and Treatment of Regional Major Disease", The First Affiliated Hospital of Hainan Medical University, Hainan Medical University, Haikou, 570102, China
- Key Laboratory of Tropical Translational Medicine of Ministry of Education, Hainan Medical University, 3 Xueyuan Road, Haikou, 571199, China
| | - Linjiang Li
- Hainan Modern Women and Children's Hospital, 18 Qiongzhou Road, Haikou, 570100, China
| | - Wen Xu
- Hainan Modern Women and Children's Hospital, 18 Qiongzhou Road, Haikou, 570100, China
| | - Weimin Jiang
- Hainan Modern Women and Children's Hospital, 18 Qiongzhou Road, Haikou, 570100, China
| | - Yueyan Wei
- Hainan Modern Women and Children's Hospital, 18 Qiongzhou Road, Haikou, 570100, China
| | - Yu Xu
- Hainan Modern Women and Children's Hospital, 18 Qiongzhou Road, Haikou, 570100, China
| | - Shaoqing Sun
- Hainan Modern Women and Children's Hospital, 18 Qiongzhou Road, Haikou, 570100, China
| | - Yanlin Ma
- Hainan Provincial Key Laboratory for Human Reproductive Medicine and Genetic Research, Hainan Clinical Research Center for Thalassemia, Haikou Key Laboratory for Preservation of Human Genetic Resource, Reproductive Medical Center, National Center for International Research "China-Myanmar Joint Research Center for Prevention and Treatment of Regional Major Disease", The First Affiliated Hospital of Hainan Medical University, Hainan Medical University, Haikou, 570102, China.
- Key Laboratory of Tropical Translational Medicine of Ministry of Education, Hainan Medical University, 3 Xueyuan Road, Haikou, 571199, China.
| | - Qi Li
- Hainan Modern Women and Children's Hospital, 18 Qiongzhou Road, Haikou, 570100, China.
- Hainan Provincial Key Laboratory for Human Reproductive Medicine and Genetic Research, Hainan Clinical Research Center for Thalassemia, Haikou Key Laboratory for Preservation of Human Genetic Resource, Reproductive Medical Center, National Center for International Research "China-Myanmar Joint Research Center for Prevention and Treatment of Regional Major Disease", The First Affiliated Hospital of Hainan Medical University, Hainan Medical University, Haikou, 570102, China.
- Key Laboratory of Tropical Translational Medicine of Ministry of Education, Hainan Medical University, 3 Xueyuan Road, Haikou, 571199, China.
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Li J, Ji J, Guo H, Wang F, Fu Y, Hu R. Stratified analysis of clinical pregnancy outcomes of sequential embryo transfer in frozen embryo transfer cycles based on different factors: a retrospective study. BMC Pregnancy Childbirth 2023; 23:806. [PMID: 37990167 PMCID: PMC10664651 DOI: 10.1186/s12884-023-06111-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE To explore the effect of sequential embryo transfer (ET) on the pregnancy outcome of frozen-thawed embryo transfer (FET) cycle and the indications of sequential transfer. METHODS A total of 1440 FET cycles were enrolled in this retrospective study, of which 1080 patients received conventional ET and 360 patients received sequential ET. Further stratified analysis was performed according to the number of previous failed cycles, the number of embryos transferred and the stage of blastocyst (day 5 or 6, denoted D5 or D6) transferred. Comparison of pregnancy rates, implantation rate, miscarriage rate and multiple pregnancy rate among the groups of patients. RESULTS The clinical pregnancy rate and implantation rate of the sequential ET group were higher than those of the conventional ET group (P < 0.01); however, there was no statistical difference in multiple pregnancy rate and miscarriage rate (P > 0.05). In sequential transfer, the number of transferred embryos (2 or 3) and the stage of transferred blastocysts (D5 or D6) had no effect on clinical pregnancy rate, implantation rate, multiple pregnancy rate and miscarriage rate (P > 0.05). In patients with three or more previous failure cycles, the sequential ET group showed higher clinical pregnancy rate and implantation rate (P > 0.05). CONCLUSIONS Compared with conventional ET in FET cycle, sequential ET strategy could significantly improve the clinical pregnancy rate and implantation rate. In sequential transfer, patients with three embryos transferred don't have higher pregnancy rate and implantation rate. Besides, sequential transfer is more suitable for patients with repeated implantation failures (RIF), and increase the utilization rate of D6 blastocysts.
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Affiliation(s)
- Jialing Li
- Reproductive Medicine Center, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, China
- Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, China
- Ningxia Medical University, Yinchuan, Ningxia, 750004, China
| | - Jing Ji
- Ningxia Medical University, Yinchuan, Ningxia, 750004, China
| | - Hua Guo
- Department of Gynecology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, China
| | - Feimiao Wang
- Reproductive Medicine Center, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, China
| | - Yunxing Fu
- Ningxia Medical University, Yinchuan, Ningxia, 750004, China
| | - Rong Hu
- Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, China.
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Caradeux J, Ávila F, Vargas F, Fernández B, Winkler C, Mondión M, Rojas I, Figueras F. Fetal Growth Velocity according to the Mode of Assisted Conception. Fetal Diagn Ther 2023; 50:299-308. [PMID: 37307807 DOI: 10.1159/000531451] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/31/2023] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Pregnancies conceived through assisted reproductive techniques (ARTs) are on the rise worldwide and have been associated with a higher risk of placental-related disease in the third trimester. METHODS A cohort was created of singleton pregnancies after assisted reproduction, admitted at our institution for delivery, between January 2020 and August 2022. Fetal growth velocity from the second trimester to delivery was compared against a gestational-age-matched group of pregnancies spontaneously conceived according to the origin of the selected oocyte (i.e., autologous vs. donated). RESULTS 125 singleton pregnancies conceived through ART were compared to 315 singleton spontaneous conceptions. Overall, after adjusting for possible confounders, multivariate analysis demonstrated that ART pregnancies had a significantly lower estimated fetal weight (EFW) z-velocity from the second trimester to delivery (adjusted mean difference = -0.002; p = 0.035) and a higher frequency of EFW z-velocity in the lowest decile (adjusted OR = 2.32 [95% CI, 1.15-4.68]). Also, when ART pregnancies were compared according to the type of oocyte, those conceived with donated oocytes showed a significantly lower EFW z-velocity from the second trimester to delivery (adjusted mean difference = -0.008; p = 0.001) and a higher frequency of EFW z-velocity in the lowest decile (adjusted OR = 5.33 [95% CI, 1.34-21.5]). CONCLUSIONS Pregnancies achieved through ART exhibit a pattern of lower growth velocity across the third trimester, especially those conceived with donated oocytes. The former represents a sub-group at the highest risk of placental dysfunction that may warrant closer follow-up.
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Affiliation(s)
- Javier Caradeux
- Department of Obstetrics and Gynecology, Clínica Santa María, Santiago, Chile
| | - Francisco Ávila
- Department of Obstetrics and Gynecology, Clínica Santa María, Santiago, Chile
| | - Francisco Vargas
- Department of Obstetrics and Gynecology, Clínica Santa María, Santiago, Chile
- Shady Groove Fertility, Santiago, Chile
| | - Benjamín Fernández
- Department of Obstetrics and Gynecology, Clínica Santa María, Santiago, Chile
| | - Carolina Winkler
- Department of Obstetrics and Gynecology, Clínica Santa María, Santiago, Chile
| | | | - Iván Rojas
- Department of Obstetrics and Gynecology, Clínica Santa María, Santiago, Chile
| | - Francesc Figueras
- Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Universitat de Barcelona, Barcelona, Spain
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Alteri A, Cermisoni GC, Pozzoni M, Gaeta G, Cavoretto PI, Viganò P. Obstetric, neonatal, and child health outcomes following embryo biopsy for preimplantation genetic testing. Hum Reprod Update 2023; 29:291-306. [PMID: 36655536 PMCID: PMC10152168 DOI: 10.1093/humupd/dmad001] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/06/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Preimplantation genetic testing (PGT) of embryos developed in vitro requires a biopsy for obtaining cellular samples for the analysis. Signs of cell injury have been described in association with this procedure. Thus, the consequences of the biopsy on obstetric and neonatal outcomes have been the subject of some quantitative analyses, although the reliability of data pooling may be limited by important issues in the various reports. OBJECTIVE AND RATIONALE The present review identifies evidence for whether pregnancies conceived after embryo biopsy are associated with a higher risk of adverse obstetric, neonatal, and long-term outcomes. Available evidence has been summarized considering manipulation at various stages of embryo development. SEARCH METHODS We used the scoping review methodology. Searches of article databases were performed with keywords pertaining to the embryo biopsy technique and obstetric, neonatal, and postnatal outcomes. Studies in which embryos were biopsied at different stages (i.e. both at the cleavage and blastocyst stages) were excluded. We included data on fresh and frozen embryo transfers. The final sample of 31 documents was subjected to qualitative thematic analysis. OUTCOMES Sound evidence is lacking to fully address the issues on the potential obstetric, neonatal or long-term consequences of embryo biopsy. For polar body biopsy, the literature is too scant to draw any conclusion. Some data, although limited and controversial, suggest a possible association of embryo biopsy at the cleavage stage with an increased risk of low birthweight and small for gestational age neonates compared to babies derived from non-biopsied embryos. An increase in preterm deliveries and birth defects in cases of trophectoderm biopsy was suggested. For both biopsy methods (at the cleavage and blastocyst stages), an increased risk for hypertensive disorders of pregnancy was found. However, these findings may be explained by confounders such as other embryo manipulation procedures or by intrinsic patient or population characteristics. WIDER IMPLICATIONS Since there is inadequate evidence to assess obstetric, neonatal, and long-term health outcomes following embryo biopsy, an invasive PGT strategy should be developed with a cautious approach. A non-invasive approach, based on the analysis of embryo cell-free DNA, needs to be pursued to overcome the potential limitations of embryo biopsy.
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Affiliation(s)
- Alessandra Alteri
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | | | - Mirko Pozzoni
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Gerarda Gaeta
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Ivo Cavoretto
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Viganò
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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10
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Tang H, Yang M, Yi H, Lin M. Risk Factors of Preterm Birth and Low Birth Weight in Singletons Conceived Through Frozen Embryo Transfer: A Retrospective Study. Int J Gen Med 2022; 15:8693-8704. [PMID: 36575734 PMCID: PMC9790167 DOI: 10.2147/ijgm.s394231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Background The risks of adverse perinatal outcomes in offspring conceived following frozen-thawed embryo transfer (FET) assisted reproductive technology (ART) are inconsistent. The aim of this study was to analyze the risk factors for preterm birth and low birth weight in singletons after FET. Methods 386 FET cycles was conducted at the Reproductive Medicine Center of Meizhou People's Hospital. The relationship between clinical characteristics and outcomes (term birth and preterm birth, normal birth weight and low birth weight) was analyzed. Results The rate of primary infertility, basal FSH and T levels, gestational age, birth weight, and proportion of male fetuses were significantly different in the preterm and full-term groups. Logistic regression analysis showed that high maternal age (≥35 years) (OR 3.652, 95% CI: 1.683-7.925, P=0.001), primary infertility (OR 2.869, 95% CI: 1.461-5.632, P=0.002), low FSH level (<6.215 mIU/mL) (OR 3.272, 95% CI: 1.743-6.144, P<0.001), and hormone replacement therapy (HRT) method (OR 2.780, 95% CI: 1.088-7.100, P=0.033) may increase risk of preterm birth after FET. Gestational age and birth weight were significantly different in fetuses with low birth weight (<2500g, n=38) and normal birth weight (≥2500g and <4000g, n=333). Logistic regression analysis showed that low basal FSH level (<6.215 mIU/mL) (OR 0.425, 95% CI: 0.209-0.865, P=0.018), and HRT method of endometrial preparation for FET (OR 0.272, 95% CI: 0.079-0.934, P=0.039) may reduce the risk of low birth weight after FET. Conclusion High maternal age, primary infertility, low FSH level, HRT method of endometrial preparation for FET, and male fetus may increase risk of preterm birth after FET. In addition, primary infertility, low basal FSH level, and HRT method of endometrial preparation may reduce the risk of low birth weight after FET.
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Affiliation(s)
- Haiyu Tang
- Reproductive Medicine Center, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China,Correspondence: Haiyu Tang, Reproductive Medicine Center, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, No. 63 Huang tang Road, Meijiang District, Meizhou, People’s Republic of China, Tel +86 753-2131-883, Email
| | - Man Yang
- Reproductive Medicine Center, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China
| | - Honggan Yi
- Reproductive Medicine Center, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China
| | - Mei Lin
- Reproductive Medicine Center, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China
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11
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Yin J, Cao Y, Liang C, Peng X, Xu X, Zhou W, Khutan R, Tao FB, Chen R. Cohort profile: Anhui Maternal-Child Health Study in China. BMJ Open 2022; 12:e060091. [PMID: 35768099 PMCID: PMC9240940 DOI: 10.1136/bmjopen-2021-060091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The Anhui Maternal-Child Health Study (AMCHS) aims to examine determinants of reproduction, pregnancy and postpartum maternal and child health outcomes in Chinese women who received assisted reproductive technology (ART). STUDY DESIGN AND PARTICIPANTS AMCHS is an ongoing cohort study starting from May 2017. AMCHS recruits participants from all couples who sought ART treatment in the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China. The participants are interviewed to document baseline sociodemography, lifestyles, dietary intake and environmental exposure. Their clinical characteristics are obtained from hospital records. Samples of blood, follicular fluid and semen are collected at the clinic. Participants receive a standard long pituitary downregulation or a short protocol with an antagonist for the treatment. They are followed up from preconception to delivery, or discontinuation of ART treatment. Details of their children's health are documented through a questionnaire focusing on developmental status and anthropometry measurement. FINDINGS TO DATE Until April 2021, AMCHS had recruited 2042 couples in the study. 111 women withdrew from the study and 19 failed to retrieve oocytes. Among the 1475 confirmed pregnancies, 146 had miscarriages or terminated their pregnancies, 9 had stillbirths and 263 were ongoing pregnancies. The implantation failure increased with maternal age; adjusted OR was 1.43 (95% CI 1.16 to 1.77) in the age of 31-35 years, 1.97 (95% CI 1.46 to 2.66) in 35-39 years and 6.52 (95% CI 3.35 to 12.68) in ≥40 years compared with those aged 20-30 years. Among the 1057 couples with successful ART who were followed up for delivering babies, 576 had their children examined at age 30-42 days, 459 at 6 months and 375 at 12 months. FUTURE PLANS The AMCHS will identify comprehensive risk factors for poor ART outcomes and explore potential interaction effects of multiple factors including sociopsychological aspects of environmental exposure, dietary intake and genetics on maternal and child health.
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Affiliation(s)
- Jiaqian Yin
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
| | - Yunxia Cao
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital, Anhui Medical University, Hefei, China
- National Health Commission Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
| | - Chunmei Liang
- National Health Commission Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Medical University, Hefei, China
| | | | - Xiaofeng Xu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Weiju Zhou
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
- The Chinese University of Hong Kong, Hong Kong, China
| | - Ranjit Khutan
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
| | | | - Ruoling Chen
- Centre for Health and Social Care Improvement, University of Wolverhampton, Wolverhampton, UK
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12
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Jia N, Hao H, Zhang C, Xie J, Zhang S. Blastocyst quality and perinatal outcomes of frozen-thawed single blastocyst transfer cycles. Front Endocrinol (Lausanne) 2022; 13:1010453. [PMID: 36313773 PMCID: PMC9596975 DOI: 10.3389/fendo.2022.1010453] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/21/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To investigate the effects of blastocyst quality and morphological grade on the perinatal outcomes in patients undergoing frozen-thawed single blastocyst transfer cycles. METHODS This single-center retrospective cohort study included 2648 singleton neonates resulting from frozen-thawed single blastocyst transfers performed between January 2017 and September 2021. Multivariate logistic regression was performed to evaluate perinatal outcomes for their association with blastocyst quality and morphological parameters. RESULT Transfer of a good-quality blastocyst in a frozen-thawed cycle was associated with a lower rate of preterm delivery (PTD, adjusted OR =0.7, 95% CI 0.5-0.9; P=0.020) and a higher likelihood of a male neonate (adjusted OR =1.2, 95%CI 1.0-1.5; P=0.048). Compared with grade C inner cell mass (ICM) blastocyst transfer, grade B ICM (adjusted OR =0.5, 95%CI 0.2-0.9; P=0.027) and grade A ICM (adjusted OR =0.6, 95%CI 0.3-1.5; P=0.290) blastocyst transfers were associated with a lower rate of PTD, which was more evident for grade B ICM. After adjusting for confounders, the likelihood of a male neonate (grade B TE, OR =1.2, 95%CI 1.0-1.5, P=0.037; grade A TE OR =1.9, 95%CI 1.3-28, P=0.002) increased with increasing trophectoderm (TE) quality. Compared with expansion stage 4, the likelihood of a male neonate was 1.5 times greater with transfer of a stage 6 blastocyst (OR =1.5, 95%CI 1.0-2.3; P=0.06), and the risk of small for gestational age (SGA) was greater with transfer of a stage 5 blastocyst (adjusted OR =3.5, 95%CI 1.5-8.0; P=0.004). The overall grading of the blastocyst, expansion stage, ICM grade, and TE grade were not associated with length at birth, birthweight, large for gestational age (LGA), or birth defects (all P>0.05). CONCLUSIONS In frozen-thawed single blastocyst transfer cycles, transfer of a good-quality blastocyst was associated with a lower rate of PTD and a greater likelihood of a male neonate. Transfer of grade B ICM blastocysts decreased the rate of PTD, and TE quality was positively correlated with the likelihood of a male neonate.
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Affiliation(s)
- Nan Jia
- Reproductive Medicine Center, Henan Provincial People’s Hospital, ZhengZhou, China
- People’s Hospital of ZhengZhou University, People’s Hospital of Henan University, ZhengZhou, China
| | - Haoying Hao
- Reproductive Medicine Center, Henan Provincial People’s Hospital, ZhengZhou, China
- People’s Hospital of ZhengZhou University, People’s Hospital of Henan University, ZhengZhou, China
| | - Cuilian Zhang
- Reproductive Medicine Center, Henan Provincial People’s Hospital, ZhengZhou, China
- People’s Hospital of ZhengZhou University, People’s Hospital of Henan University, ZhengZhou, China
- *Correspondence: Shaodi Zhang, ; Cuilian Zhang,
| | - Juanke Xie
- Reproductive Medicine Center, Henan Provincial People’s Hospital, ZhengZhou, China
- People’s Hospital of ZhengZhou University, People’s Hospital of Henan University, ZhengZhou, China
| | - Shaodi Zhang
- Reproductive Medicine Center, Henan Provincial People’s Hospital, ZhengZhou, China
- People’s Hospital of ZhengZhou University, People’s Hospital of Henan University, ZhengZhou, China
- *Correspondence: Shaodi Zhang, ; Cuilian Zhang,
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13
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Alteri A, Campo G, Pagliardini L, Privitera L, Cavoretto P, Candiani M, Papaleo E, Viganò P. The impact of vitrified-warmed blastocyst transfer on postnatal growth: A 1-year follow-up questionnaire study. Reprod Biomed Online 2022; 44:907-914. [DOI: 10.1016/j.rbmo.2021.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 12/01/2021] [Accepted: 12/27/2021] [Indexed: 11/16/2022]
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