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Pier BD, Roshong A, Santoro N, Sammel MD. Association of duration of embryo culture with risk of large for gestational age delivery in cryopreserved embryo transfer cycles. Fertil Steril 2024; 121:814-823. [PMID: 38185197 DOI: 10.1016/j.fertnstert.2024.01.002] [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: 10/14/2023] [Revised: 12/31/2023] [Accepted: 01/02/2024] [Indexed: 01/09/2024]
Abstract
OBJECTIVE To examine the relationship between the day of embryo cryopreservation and large for gestational age (LGA) infants in women undergoing frozen embryo transfers (FETs) after cryopreservation on days 2-7 after fertilization and to compare the risk of the day of embryo cryopreservation to other possible risk factors of LGA after FET cycles. DESIGN Retrospective cohort study. SETTING Society of Assisted Reproduction Clinical Outcomes Reporting System. PATIENTS Women undergoing FET cycles. INTERVENTION Day of cryopreservation. MAIN OUTCOME MEASURE Singleton LGA infant. RESULTS A total of 33,030 (18.2%) FET cycles in the study group (n = 181,592) resulted in LGA infants during the study period of 2014-2019. There was an increase in LGA risk when cryopreservation was performed from day 2 (13.7%) to days 3-7 (14.4%, 15.0%, 18.2%, 18.5%, and 18.9%). In the log-binomial model, the risk increased compared with days 2-3 combined when cryopreservation was performed on days 5-7 (adjusted relative risk [aRR] 1.32, 95% confidence interval [CI] 1.22-1.44 for day 5, aRR 1.34, 95% CI 1.23-1.46 for day 6, and aRR 1.42, 95% CI 1.25-1.61 for day 7). Other factors most associated with LGA risk in the log-binomial model were preterm parity of >3 compared with 0 (aRR 1.82, 95% CI 1.24-2.69) and body mass index (BMI) of >35 kg/m2 compared with normal weight (aRR 1.94, 95% CI 1.88-2.01). Increasing gravity, parity, BMI, number of oocytes, and embryo grade were also associated with LGA in this model. Asian, Black, Hispanic, and combined Hawaiian and Pacific Islander were protective factors in the model compared with White patients. Low BMI (<18.5 kg/m2) was also considered a protective factor in the model compared with normal BMI. CONCLUSION Duration of embryo culture was associated with an increased risk of LGA in this study cohort when controlling for known confounders such as maternal BMI and parity. This study sheds new light on the possible link between FET and LGA infants.
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Affiliation(s)
- Bruce D Pier
- Department of Gynecologic Surgery and Obstetrics, Womack Army Medical Center, Fort Liberty, North Carolina.
| | - Anne Roshong
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Texas at San Antonio, San Antonio, Texas
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
| | - Mary D Sammel
- Department of Biostatistics, School of Public Health, University of Colorado School of Medicine, Aurora, Colorado
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Pregnancy Outcomes for Day 5 Versus Day 6 Single Frozen-thawed Blastocyst Transfer with Different Qualities of Embryos: A Large Matched-cohort Study. Curr Med Sci 2023; 43:297-303. [PMID: 36929109 DOI: 10.1007/s11596-023-2699-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 12/01/2022] [Indexed: 03/18/2023]
Abstract
OBJECTIVE This study aimed to determine whether the day of blastocyst expansion affects pregnancy outcomes in frozen-thawed blastocyst transfer (FBT) cycles. METHODS A retrospective match-cohort study was conducted. Patients who underwent blastocyst transfer in frozen-thawed cycles at day 5 or 6 were matched for potential confounding factors. A total of 2207 matched pairs of FBT cycles were included from January 2016 to December 2019 in our Reproductive Medicine Center. RESULTS The clinical pregnancy rate (CPR) and live birth rate (LBR) were significantly increased in day 5 blastocyst transfers when compared to day 6 blastocyst transfers, in terms of the same embryo quality. For FBT cycles with good-quality embryo, the CPR at day 5 and 6 was 61.30% and 57.56%, respectively (P=0.045), and the LBR was 44.79% and 36.16%, respectively (P<0.001). For FBT cycles with poor-quality embryo, the CPR at day 5 and 6 was 48.61% and 40.89%, respectively (P=0.006), and the LBR was 31.71% and 25.74%, respectively (P=0.019). The CPR for FBT cycles with good-quality embryo was statistically higher at day 6 than that at day 5 with poor-quality embryo transferred (57.56% vs. 48.61%, P=0.001). Maternal age, anti-Müllerian hormone (AMH), endometrial thickness, embryo quality, and the day of blastocyst expansion were independently correlated with the CPR and LBR. The FBT cycles at day 5 had significantly higher CPR (adjusted odds ratio [OR]=1.246, 95% confidence intervals [CI]: 1.097-1.415, P=0.001) and LBR (adjusted OR=1.435, 95% CI: 1.258-1.637, P<0.001) than those at day 6. CONCLUSION The embryo quality is the primary indicator for FBT cycles. Day 5 blastocysts should be preferred when the quality of embryo at day 5 is the same as that at day 6.
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He Y, Tang Y, Liu H, Liu J, Mao Y. No advantage of single day 6 good-quality blastocyst transfer versus single day 5 poor-quality blastocyst transfer in frozen-thawed cycles stratified by age: a retrospective study. BMC Pregnancy Childbirth 2023; 23:79. [PMID: 36717810 PMCID: PMC9885555 DOI: 10.1186/s12884-023-05387-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 01/16/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Blastocyst developmental speed, morphological grading and patient age are associated with pregnancy outcomes of frozen-thawed cycles. This study aimed to compare the clinical and neonatal outcomes between poor-quality D5 blastocysts and good-quality D6 blastocysts stratified by patient age. METHODS A total of 1,623 cycles were divided into two groups: group A (n = 723) received one D5 poor-quality blastocyst; group B (n = 900) received one D6 good-quality blastocyst. Pregnancy and neonatal outcomes were compared among the four groups stratified by 35 years of age. RESULTS When patients were in the same age group, there was no significant difference in terms of age, body mass index, infertility duration, infertility type, fertilization method, proportion of endometrial preparation protocols, and endometrial thickness between D5 poor-quality and D6 high-quality blastocysts groups. Live birth rate of D5 poor-quality blastocysts was higher than that of D6 high-quality blastocysts for patients aged < 35 years (35.48% vs. 31.13%, p > 0.05), but there was no statistical difference. The same trend was showed for patients aged ≥ 35 years (29.09% vs. 21.28%, p > 0.05). Moreover, when patients were in the same age category, there was no significant difference in terms of gestational age, birth weight, birth height, and rates of preterm birth, low birth weight, and very low birth weight between groups A and B. CONCLUSIONS The preferential selection of poor-quality D5 blastocysts for transfer compared to high-quality D6 blastocysts is recommended, especially for advanced age patients. Single good-quality D6 blastocyst transfer can be considered for the acceptable live birth rate.
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Affiliation(s)
- Yuxia He
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, Center of Reproductive Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Guangzhou, Guangdong China ,grid.417009.b0000 0004 1758 4591Key Laboratory for Reproductive Medicine of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Yan Tang
- grid.476868.30000 0005 0294 8900Department of Obstetrics and Gynecology, Center of Reproductive Medicine, Zhongshan City People’s Hospital, Zhongshan, China
| | - Haiying Liu
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, Center of Reproductive Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Guangzhou, Guangdong China ,grid.417009.b0000 0004 1758 4591Key Laboratory for Reproductive Medicine of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Jianqiao Liu
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, Center of Reproductive Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Guangzhou, Guangdong China ,grid.417009.b0000 0004 1758 4591Key Laboratory for Reproductive Medicine of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Yuling Mao
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, Center of Reproductive Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Guangzhou, Guangdong China ,grid.417009.b0000 0004 1758 4591Key Laboratory for Reproductive Medicine of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
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Factors associated with large-for-gestational-age infants born after frozen embryo transfer cycles. F S Rep 2022; 3:332-341. [PMID: 36568928 PMCID: PMC9783147 DOI: 10.1016/j.xfre.2022.09.002] [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: 04/07/2022] [Revised: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 12/27/2022] Open
Abstract
Objective To examine trends of frozen embryo transfer (FET) proportions and large-for-gestational-age (LGA) incidence and determine risk factors for LGA infants after FET. Design Retrospective cohort study. Setting Not applicable. Patients Frozen embryo transfer cycles. Interventions None. Main Outcome Measures Singleton LGA infant. Results The percentage of FETs increased from 20%-74% of transfers, whereas the rate of LGA among FET singleton births decreased from 18%-12% during 2004-2018. In a subanalysis of 127,525 FET-associated singleton live births during 2016-2018, patient factors associated with LGA were higher-than-normal maternal body mass index (body mass index [BMI], 25.0-29.9 kg/m2; adjusted relative risk [aRR], 1.31; 95% confidence interval [CI], 1.26-1.36; BMI, 30.0-34.9 kg/m2; aRR, 1.48; 95% CI, 1.41-1.55; and BMI, >35 Kg/m2; aRR, 1.68; 95% CI, 1.59-1.77) and ≥1 prior birth vs. none. Low maternal BMI (<18.5 vs. 18.5-24.9 kg/m2) and cycles involving patients who were non-Hispanic (NH) Asian/Native Hawaiian/Pacific Islander, NH Black, or Hispanic (compared with NH White) were at lower risk of LGA infants. Cycle factors associated with LGA included gestational carrier use (aRR, 1.25; 95% CI, 1.16-1.34) and donor sperm (aRR, 1.17; 95% CI, 1.10-1.25). Conclusions Although the number and proportion of FET cycles increased from 2004-2018, the rate of LGA after FET decreased. Maternal BMI, parity, and race/ethnicity were the strongest risk factors for LGA infants after FET.
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Yang J, Wang Z, Cao H, Liu L, Yuan Q, Xu H, Tang R. Birthweight After Frozen Embryos Formed on the Fifth Day Versus the Sixth Day: A Retrospective Analysis Including 17,127 Singleton Newborns. Front Endocrinol (Lausanne) 2022; 13:868335. [PMID: 35685207 PMCID: PMC9171029 DOI: 10.3389/fendo.2022.868335] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Transferring blastocysts frozen on day 6 (D6) may adversely affect the pregnancy rate compared with day 5 (D5). Moreover, it remains unclear whether delayed embryo transfer affects neonatal birth weight. METHODS A retrospective cohort study consisting of 17,127 singleton births from single frozen embryo transfer (FET) cycles, between January 2011 and January 2020, was performed including 14,166 blastocysts frozen on D5 and 2,961 on D6. The primary outcomes of this study were neonatal birth weight and incidence of small for gestational age (SGA), large for gestational age (LGA), low birth weight (LBW), and macrosomia. RESULTS The mean neonatal birth weight in the D5 group (3.47 ± 0.49 kg) was significantly higher compared with the D6 group (3.45 ± 0.50 kg), although the discrepancy was only 0.02 kg. Multiple linear regression analysis for birth weight between the two groups showed no statistically significant difference (β= -0.01 t= -1.218; P>0.05). Logistic regression analysis revealed that the risks of SGA (OR 1.166; 95%CI, 0.911-1.491; P>0.05), LGA (OR 0.917; 95%CI, 0.831-1.012; P>0.05), LBW (OR 1.192; 95%CI, 0.926-1.533; P>0.05), and macrosomia (OR 0.975; 95%CI, 0.864-1.100; P>0.05) were similar in the two groups after adjusting for confounders. CONCLUSIONS In the FET cycle, the neonatal birth weight and incidence of LGA, SGA, LBW, or macrosomia were similar between the D5 and D6 groups, suggesting that delayed blastocyst transfer would not affect the neonatal birth weight.
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Affiliation(s)
- Junlan Yang
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ze Wang
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Hairu Cao
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lu Liu
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qiaona Yuan
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Haiyan Xu
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Rong Tang
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong First Medical University, Jinan, China
- *Correspondence: Rong Tang,
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Blastocyst development rate influences singleton gestational age of similarly graded blastocysts after vitrified–warmed single embryo transfer cycles. Reprod Biomed Online 2021; 44:449-458. [DOI: 10.1016/j.rbmo.2021.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 11/03/2021] [Accepted: 11/19/2021] [Indexed: 11/22/2022]
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Wang X, Cai J, Liu L, Jiang X, Li P, Sha A, Ren J. Association between outdoor air pollution during in vitro culture and the outcomes of frozen-thawed embryo transfer. Hum Reprod 2020; 34:441-451. [PMID: 30689907 DOI: 10.1093/humrep/dey386] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 11/07/2018] [Accepted: 12/07/2018] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Does outdoor air pollution differentially affect the outcomes of frozen-thawed embryo transfer (FET) and fresh transfer in IVF treatment? SUMMARY ANSWER Increased SO2 and O3 levels at the site of IVF unit were significantly associated with lower live birth rates following FET but did not affect the contemporary fresh transfer outcomes. WHAT IS KNOWN ALREADY Ambient air pollution has been associated with human infertility and IVF outcomes. However, most of the studies excluded FET cycles. STUDY DESIGN, SIZE, DURATION A retrospective cohort study of 11148 patients contributing to 16290 transfer cycles between January 2013 and December 2016 was carried out. PARTICIPANTS/MATERIALS, SETTING, METHODS The average age of the cohort was 31.51 ± 4.48 years and the average BMI was 21.14 ± 2.37 kg/cm2. Inverse distance weighting interpolation was used to estimate the daily ambient exposures to six pollutants (PM2.5, PM10, SO2, NO2, CO, O3) at an IVF clinical site, according to the data from fixed air quality monitoring stations in the city. The exposures of each cycle were presented as average daily concentrations of pollutants from oocyte retrieval to embryo transfer/cryopreservation. Exposures were analyzed in quartiles. A generalized estimating equation was used to evaluate the association between pollutants and IVF outcomes, adjusted for important confounding factors including maternal age, infertility diagnosis, BMI, endometrial status and embryo transfer policy. MAIN RESULTS AND THE ROLE OF CHANCE The clinical pregnancy rate and live birth rate of the cycles was 55.1% (8981/16290) and 47.1% (7672/16290), respectively. Among the included cycles, 4013 patients received 5299 FET cycles, resulting in 2263 live births (42.7% per ET), whereas 9553 patients received 10991 fresh transfer cycles, resulting in 5409 live births (49.2% per ET). SO2 and O3 levels were significantly associated with live birth rates in FET cycles, whereas none of the pollutants were significantly associated with IVF outcomes in contemporary fresh transfer cycles. The FET cycles in the highest quartile of SO2 and O3 exposure had significantly lower live birth rates (adjusted odds ratio (OR) 0.63, 95%CI 0.53-0.74; 0.69, 95% CI 0.58-0.82, respectively) in comparison with those in the lowest quartile. Models involving all transfer cycles and interaction terms (FET×exposures) suggested that FET significantly enhanced the effects of SO2 and O3 exposure on IVF outcomes (P < 0.001). Multi-pollutant models gave consistent results for the association between SO2 and live birth in FET cycles. Accounting for all six pollutants, women in the highest quartile of SO2 still had the lowest live birth rates (OR 0.61, 95%CI 0.47-0.80). LIMITATIONS, REASONS FOR CAUTION The study was limited by its retrospective nature. The exposure data were estimated according to monitoring data rather than measured directly from the IVF unit. Unknown confounding factors may skew the results. WIDER IMPLICATIONS OF THE FINDINGS Our data implied that embryos undergoing FET may be more vulnerable to a suboptimal environment than those undergoing fresh transfer. In heavily polluted sites or seasons, fluctuation in FET outcomes may be partially explained by the dynamic changes of ambient gaseous air pollutant. STUDY FUNDING/COMPETING INTEREST(S) National Natural Science Foundation (81302454). The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Xinli Wang
- College of the Environment and Ecology Xiamen University, Xiamen, Fujian, China
| | - Jiali Cai
- Reproductive Medicine Center, The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China.,Medical College of Xiamen University, Xiamen, Fujian, China
| | - Lanlan Liu
- Reproductive Medicine Center, The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China.,Medical College of Xiamen University, Xiamen, Fujian, China
| | - Xiaoming Jiang
- Reproductive Medicine Center, The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China
| | - Ping Li
- Reproductive Medicine Center, The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China
| | - Aiguo Sha
- Reproductive Medicine Center, The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China
| | - Jianzhi Ren
- Reproductive Medicine Center, The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China
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Zeng M, Su Qin S, Wen P, Xu C, Duan J. Perinatal outcomes after vitrified-warmed day 5 blastocyst transfers compared to vitrified-warmed day 6 blastocyst transfers: A meta analysis. Eur J Obstet Gynecol Reprod Biol 2020; 247:219-224. [DOI: 10.1016/j.ejogrb.2020.02.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 02/18/2020] [Accepted: 02/21/2020] [Indexed: 10/24/2022]
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Wang X, Cai J, Liu L, Jiang X, Li P, Sha A, Ren J. Ambient outdoor air pollutants and sex ratio of singletons born after in vitro fertilization: the effect of single blastocyst transfer. Fertil Steril 2020; 113:140-148.e2. [DOI: 10.1016/j.fertnstert.2019.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/22/2019] [Accepted: 09/03/2019] [Indexed: 11/17/2022]
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Cai J, Ren J. Authors' reply Re: Supraphysiological estradiol level in ovarian stimulation cycles affects the birthweight of neonates conceived through subsequent frozen-thawed cycles: a retrospective study. BJOG 2019; 126:947-948. [PMID: 30985069 DOI: 10.1111/1471-0528.15687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Jiali Cai
- Reproductive Medicine Centre, Affiliated Chenggong Hospital of Xiamen University, Xiamen, China
| | - Jianzhi Ren
- Reproductive Medicine Centre, Affiliated Chenggong Hospital of Xiamen University, Xiamen, China
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Cai J, Liu L, Xu Y, Liu Z, Jiang X, Li P, Sha A, Ren J. Supraphysiological estradiol level in ovarian stimulation cycles affects the birthweight of neonates conceived through subsequent frozen‐thawed cycles: a retrospective study. BJOG 2019; 126:711-718. [PMID: 30628169 DOI: 10.1111/1471-0528.15606] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2018] [Indexed: 12/01/2022]
Affiliation(s)
- J Cai
- The Affiliated Chenggong Hospital of Xiamen University Xiamen China
- Medical College of Xiamen University Xiamen China
| | - L Liu
- The Affiliated Chenggong Hospital of Xiamen University Xiamen China
- Medical College of Xiamen University Xiamen China
| | - Y Xu
- The Affiliated Chenggong Hospital of Xiamen University Xiamen China
| | - Z Liu
- The Affiliated Chenggong Hospital of Xiamen University Xiamen China
| | - X Jiang
- The Affiliated Chenggong Hospital of Xiamen University Xiamen China
| | - P Li
- The Affiliated Chenggong Hospital of Xiamen University Xiamen China
| | - A Sha
- The Affiliated Chenggong Hospital of Xiamen University Xiamen China
| | - J Ren
- The Affiliated Chenggong Hospital of Xiamen University Xiamen China
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