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Taniguchi M, Akinaga C, Suzuki K, Tarui K, Tamura N, Shiko Y, Kawasaki Y, Nakajima Y. The effect of assisted reproductive technology on postpartum bleeding: hormonal cycle frozen embryo transfer might increase blood loss. J Anesth 2024; 38:19-28. [PMID: 37945905 DOI: 10.1007/s00540-023-03268-3] [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: 05/31/2022] [Accepted: 09/29/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Among assisted reproductive technologies, frozen thawed embryo transfer (FET) is associated with increased blood loss at delivery. Anesthesiologists need to be aware of new factors that affect postpartum blood loss. This study investigated whether FET cycles with or without hormonal support affect the amount of postpartum bleeding. METHODS We conducted a retrospective cohort study of patients admitted for delivery at a single university hospital between January 2015 and December 2018. Patients were divided into no-assisted reproductive technology (No-ART), hormonal cycle FET (HC-FET) and natural cycle FET (NC-FET) group. The primary outcome was the amount of blood loss after delivery (median [interquartile range]), which was compared among the three groups. Multiple regression analysis was performed to investigate the factors affecting blood loss. RESULTS Between 2015 and 2018, 3187 women delivered neonates. In vaginal delivery, postpartum blood loss in the HC-FET group (1060 [830] g) was significantly greater than in the NC-FET group (650 [485] g, P = 0.001) and in the No-ART group (590 [420] g P < 0.001). Multiple linear regression analysis showed that HC-FET (P < 0.001) was one of the independent factors for the amount of bleeding. In cesarean delivery, the HC-FET group had more blood loss than the No-ART group (910 [676] g vs. 784 [524] g, P = 0.039). However, HC-FET was not an independent factor for postpartum blood loss. CONCLUSIONS The HC-FET group had more blood loss than the No-ART group for both vaginal and cesarean deliveries. Furthermore, HC-FET was an independent factor that increased postpartum blood loss in vaginal deliveries.
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Affiliation(s)
- Mizuki Taniguchi
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan.
| | - Chieko Akinaga
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan
| | - Kota Suzuki
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan
| | - Kaori Tarui
- Department of Anesthesiology, Adachi Hospital, Kyoto, Japan
| | - Naoaki Tamura
- Department of Obstetrics & Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuki Shiko
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yoshiki Nakajima
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan
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Smith J, Fell DB, Basso O, Velez M, Dayan N. Fresh Compared With Frozen Embryo Transfer and Risk of Severe Maternal Morbidity: A Study of In Vitro Fertilization Pregnancies in Ontario, Canada. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:202-210. [PMID: 36716961 DOI: 10.1016/j.jogc.2023.01.001] [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: 09/28/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To quantify the risk of severe maternal morbidity (SMM) in fresh versus frozen-thawed embryo transfers (ETs) among pregnancies conceived by in vitro fertilization and to assess SMM risk according to the number of fresh ETs prior to the index pregnancy. METHODS Retrospective cohort study using the provincial birth registry in Ontario, Canada. We included 13 929 individuals aged 18-55 years who conceived via in vitro fertilization between January 1, 2013, and March 5, 2018, and delivered a live or stillborn infant ≥20 weeks gestation. We compared the primary outcome, a composite of SMM or death, between fresh and frozen ETs. RESULTS A total of 174 individuals who conceived via fresh ETs had SMM (30.7 per 1000), compared with 280 among individuals who received frozen ETs (33.9 per 1000); adjusted risk ratio (aRR) 0.85 (95% CI 0.70-1.04). Compared with frozen ET, fresh ET was associated with a lower risk of severe hemorrhage (aRR 0.63; 95% CI 0.48-0.82) but no difference in risk of preeclampsia. Among individuals with 1 (n = 211) or ≥2 (n = 88) prior fresh cycles, the risk of SMM was not increased compared with having no prior cycles; aRR 0.96 (95% CI 0.78-1.18) and 0.91 (95% CI 0.67-1.25), respectively. CONCLUSION Fresh ET was associated with a lower risk of severe hemorrhage compared with frozen ET. These findings may be partly explained by the increased popularity of a freeze-all strategy, reserving fresh ETs for patients with fewer comorbidities.
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Affiliation(s)
- Julia Smith
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC; Research Institute, McGill University Health Centre, Montreal, QC
| | - Deshayne B Fell
- School of Epidemiology and Public Health (SEPH), University of Ottawa, Ottawa, ON; Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON
| | - Olga Basso
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC; Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal, QC
| | - Maria Velez
- Department of Obstetrics & Gynecology, Queen's University, Kingston, ON
| | - Natalie Dayan
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC; Research Institute, McGill University Health Centre, Montreal, QC.
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PGT pregnancies have a similar risk for post-partum complications as naturally conceived pregnancies. Reprod Biomed Online 2023; 46:189-195. [PMID: 36335017 DOI: 10.1016/j.rbmo.2022.09.009] [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: 05/26/2022] [Revised: 09/02/2022] [Accepted: 09/13/2022] [Indexed: 01/31/2023]
Abstract
RESEARCH QUESTION Do preimplantation genetic testing (PGT) pregnancies have higher post-partum complications compared with naturally conceived pregnancies? DESIGN Retrospective cohort study conducted in 2008-2020 at the Shaare Zedek Medical Center (SZMC), including all patients aged 18-45 years old who conceived following PGT with a singleton live birth >24 weeks. Data were collected from computerized hospital databases and patient files. There were two control groups: (i) pregnancies following IVF-ICSI (intracytoplasmic sperm injection); (ii) four neighbourhood controls for each case delivery (two women delivered before and two after) of women with naturally conceived pregnancies. RESULTS Overall, 120 PGT, 779 IVF-ICSI and 3507 naturally conceived deliveries were included. Demographic variables were similar apart from slightly higher age in the PGT (P = 0.003) and ICSI (P = 0.002) groups (31.07 ± 4.38 PGT, 31.66 ± 5.03 ICSI, 28.77 ± 5.72 naturally conceived). Composite post-partum placental-related complications (manual lysis of placenta, revision of uterine cavity, haemoglobin drop ≥3 g/dl, post-partum haemorrhage, need for blood transfusion) were more prevalent in both the PGT and IVF-ICSI groups as opposed to naturally conceived (20.0% versus 18.9% versus 10.3%, respectively, P < 0.001, P = 0.007). In a multivariate regression model PGT was not found to be independently associated with composite post-partum placental-related complications (adjusted odds ratio [aOR] 1.44, 95% confidence interval [CI] 0.83-2.15), while IVF-ICSI pregnancies had increased risk (aOR 1.52, 95% CI 1.20-1.97) compared with natural conception. No difference was found between fresh and frozen cycles or between day 3 and day 5 embryo transfer. CONCLUSIONS PGT pregnancies have a comparable risk of post-partum placental-related complications to naturally conceived pregnancies, unlike IVF-ICSI pregnancies. It is possible that infertility itself is the main mediator for post-partum complications in IVF-ICSI pregnancies.
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Liu N, Wang Y, Lu J, Zhang X, Zhang Y, Zhao H, Zhang Y, Chang W. Analysis of Relevant Factors Affecting the Pregnancy Rate of Frozen-Thawed Embryo Transfer Cycle. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:2842278. [PMID: 35646152 PMCID: PMC9132664 DOI: 10.1155/2022/2842278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/20/2022] [Accepted: 03/24/2022] [Indexed: 11/24/2022]
Abstract
Objective The aim of this study is to explore the relevant factors affecting the pregnancy rate of frozen-thawed embryo transfer cycle. Methods The clinical data of 931 patients who underwent artificial cycle preparation for endometrial FET from April 2017 to November 2020 in the reproductive center of our hospital were retrospectively analyzed. Results According to the pregnancy situation, the patients were divided into 450 cases of pregnancy and 481 cases of biochemical pregnancy. The univariate analysis of FET biochemical pregnancy showed that there were statistically significant differences between pregnancy and biochemical pregnancy in terms of years of infertility, age, endometrial thickness, P level, E2/P, and the number of high-quality embryos (P < 0.05). Multivariate analysis of pregnancy showed that age <30 years was a protective factor for biochemical pregnancy and endometrial thickness <8 mm and E2/P < 0.3 were risk factors (P < 0.05). Conclusion The regulation of endometrial thickness and E2/P serves as the key of treatment for patients undergoing FET using artificial cycle preparation for endometrial transfer, and it contributes to improve the pregnancy rate; also, the patient's age is an important indicator influencing the pregnancy rate.
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Affiliation(s)
- Ning Liu
- Department of Reproductive Medicine, Handan Central Hospital, Handan 056000, Hebei Province, China
| | - Yuhong Wang
- Department of Reproductive Medicine, Handan Central Hospital, Handan 056000, Hebei Province, China
| | - Jing Lu
- Department of Reproductive Medicine, Handan Central Hospital, Handan 056000, Hebei Province, China
| | - Xihui Zhang
- Department of Reproductive Medicine, Handan Central Hospital, Handan 056000, Hebei Province, China
| | - Yunjing Zhang
- Department of Reproductive Medicine, Handan Central Hospital, Handan 056000, Hebei Province, China
| | - Haijun Zhao
- Department of Reproductive Medicine, Handan Central Hospital, Handan 056000, Hebei Province, China
| | - Yijiao Zhang
- Department of Reproductive Medicine, Handan Central Hospital, Handan 056000, Hebei Province, China
| | - Wenliang Chang
- Department of Reproductive Medicine, Handan Central Hospital, Handan 056000, Hebei Province, China
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Zheng Y, Dong X, Sui C, Zhang S, Yao J, Jin L, Huang B. Culture medium is associated with the risks of placenta previa and macrosomia in pregnancies after in vitro fertilization. Arch Gynecol Obstet 2022; 306:239-247. [PMID: 35224651 DOI: 10.1007/s00404-022-06443-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/09/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The culture medium plays an important role in embryonic development and subsequent pregnancy outcomes of in vitro fertilization (IVF) cycles. The sequential culture media of Vitrolife and Cook are the two most commonly used reagents in China. This study aimed to assess their effects on IVF success rates, obstetric outcomes and neonatal outcomes. METHODS This was a retrospective cohort study on 6352 patients undergoing first IVF attempts between January 2018 and December 2019, resulting in 3153 clinical pregnancies, 2646 live births, and 2668 babies. Patients were grouped according to the culture media they used. There were 4680 patients in the Vitrolife group and 1672 patients in the Cook group. The primary outcome measures were maternal and neonatal outcomes. ANOVA and Chi-square tests were used for statistical comparison, and multivariate logistic regression and multivariate general linear model were used to adjust for potential confounders. RESULTS The rates of live birth, clinical pregnancy, monozygotic twins, miscarriage, and ectopic pregnancy were all comparable between the groups of Vitrolife and Cook. The incidence of placenta previa was higher in the Vitrolife group [4.86 vs. 3.09%, adjusted odds ratio = 2.048 (1.146-3.657)]. The incidence of macrosomia was higher in the Cook group [7.51 vs. 5.39%, adjusted odds ratio = 1.445 (1.010-2.069)]. CONCLUSION The culture media of Vitrolife and Cook are comparably effective in IVF success. Vitrolife is associated with a higher risk of placenta previa, while Cook is associated with a higher risk of macrosomia.
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Affiliation(s)
- Yu Zheng
- Reproductive Medicine Center, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Jiefang Avenue No. 1095, Wuhan, 430030, China
| | - Xiyuan Dong
- Reproductive Medicine Center, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Jiefang Avenue No. 1095, Wuhan, 430030, China
| | - Cong Sui
- Reproductive Medicine Center, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Jiefang Avenue No. 1095, Wuhan, 430030, China
| | - Sijia Zhang
- Reproductive Medicine Center, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Jiefang Avenue No. 1095, Wuhan, 430030, China
| | - Junning Yao
- Reproductive Medicine Center, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Jiefang Avenue No. 1095, Wuhan, 430030, China
| | - Lei Jin
- Reproductive Medicine Center, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Jiefang Avenue No. 1095, Wuhan, 430030, China.
| | - Bo Huang
- Reproductive Medicine Center, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Jiefang Avenue No. 1095, Wuhan, 430030, China.
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Waschkies F, Kroning L, Schill T, Chandra A, Schippert C, Töpfer D, Ziert Y, von Versen-Höynck F. Pregnancy Outcomes After Frozen-Thawed Embryo Transfer in the Absence of a Corpus Luteum. Front Med (Lausanne) 2021; 8:727753. [PMID: 34568385 PMCID: PMC8460906 DOI: 10.3389/fmed.2021.727753] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Nowadays, frozen-thawed embryo transfer (FET) cycles represent a high proportion of fertility treatments worldwide. Recent studies suggest differences in pregnancy outcomes depending on the FET treatment protocol used. The reason for this is still unclear, but the number of corpora lutea (CL) at conception is discussed as a possible factor. This study aims to investigate whether maternal and neonatal outcomes for pregnancies following FET lacking a CL differ from FET with one or more CL in order to explore a potential link between CL absence and adverse pregnancy outcomes. Methods: The study was designed as a retrospective, multi-center observational study with two cohorts after singleton live birth [0 CL cohort (FET in a programmed cycle, n = 114) and ≥ 1 CL cohort (FET in a natural or stimulated cycle, n = 68)]. Participants completed a questionnaire on the outcome of pregnancy and birth records were analyzed in a descriptive way. Multivariable logistic and linear regressions were performed in order to explore associations between CL absence and pregnancy outcomes. The strength of the agreement between the information in the survey and the diagnoses extracted from the files was assessed by Cohen's Kappa. Results: The risk of hypertensive disorders of pregnancy was higher after FET in the absence of a CL compared to FET with CL presence (aOR 5.56, 95% CI 1.12 – 27.72). Birthweights and birthweight percentiles were significantly higher in the 0 CL group. CL absence was a predictor of higher birthweight (adjusted coefficient B 179.74, 95% CI 13.03 – 346.44) and higher birthweight percentiles (adjusted coefficient B 10.23, 95%, 95% CI 2.28 – 18.40) particularly in female newborns of the 0 CL cohort. While the strength of the agreement between the reported information in the survey and the actual diagnoses extracted from the files was good for the majority of outcomes of interest it was fair in terms of hypertension (κ = 0.38). Conclusion: This study supports observations suggesting a potential link between a lack of CL at conception and adverse maternal and neonatal outcomes. Further investigations on causes and pathophysiological relationships are yet to be conducted.
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Affiliation(s)
- Freya Waschkies
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Luka Kroning
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Thilo Schill
- Fertility Center Langenhagen, Langenhagen, Germany
| | | | - Cordula Schippert
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Dagmar Töpfer
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Yvonne Ziert
- Institute of Biostatistics, Hannover Medical School, Hannover, Germany
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