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Lebovitz O, Noach-Hirsh M, Taieb S, Haas J, Zilberberg E, Nahum R, Orvieto R, Aizer A. Embryos derived from single pronucleus are suitable for preimplantation genetic testing. Fertil Steril 2024:S0015-0282(24)00462-X. [PMID: 38788891 DOI: 10.1016/j.fertnstert.2024.05.152] [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: 09/04/2023] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE To study and compare the preimplantation genetic testing for monogenic disorders (PGT-M) results, and to evaluate the treatment cycle outcomes of embryos derived from a single pronucleus (1PN) vs. two pronuclei (2PN). DESIGN A retrospective cohort study from January 2018 to December 2022 involving in vitro fertilization (IVF)-PGT-M treatment cycles. SETTING Single, academically affiliated fertility center. PATIENTS A total of 244 patients underwent 351 IVF-PGT-M treatment cycles. INTERVENTION Embryo biopsy with molecular testing for a monogenic disorder. MAIN OUTCOME MEASURES The molecular diagnosis results and clinical outcomes after the transfer of embryos derived from 1PN and 2PN in IVF-PGT-M treatment cycles. RESULTS Embryos derived from 1PN have a significantly low developmental potential with a lower rate of embryos that underwent biopsy compared with 2PN-derived embryos; 1PN-derived embryos demonstrated a significantly lower number of blastocysts (24% vs. 37.9%) and top-quality blastocysts (22.3% vs. 48.1%) compared with 2PN-derived embryos. Lower successfully completed and unaffected PGT-M results were achieved in 1PN compared with 2PN-derived embryos (47.1% vs. 65.5% and 18.7% vs. 31.6%, respectively), with significantly higher abnormal molecular results (39.6% vs. 22.7%). The embryo transfer of 24 1PN-derived embryos with no affected genetic disorder resulted in 5 (20.8%) clinical pregnancies and 4 (16.7%) live births (LBs). CONCLUSIONS Within the limits of fewer embryos derived from 1PN that yielded unaffected embryos suitable for transfer, the clinical pregnancy and LB rate of 1PN embryos undergoing PGT-M are reassuring. We, therefore, suggest applying PGT-M to embryos derived from 1PN embryos to improve the cumulative clinical pregnancy and LB rates.
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Affiliation(s)
- Oshrit Lebovitz
- Department of Obstetrics and Gynecology, IVF Unit, Chaim Sheba Medical Center, Tel- Hashomer, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Meirav Noach-Hirsh
- Department of Obstetrics and Gynecology, IVF Unit, Chaim Sheba Medical Center, Tel- Hashomer, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sarah Taieb
- Department of Obstetrics and Gynecology, IVF Unit, Chaim Sheba Medical Center, Tel- Hashomer, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jigal Haas
- Department of Obstetrics and Gynecology, IVF Unit, Chaim Sheba Medical Center, Tel- Hashomer, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Zilberberg
- Department of Obstetrics and Gynecology, IVF Unit, Chaim Sheba Medical Center, Tel- Hashomer, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ravit Nahum
- Department of Obstetrics and Gynecology, IVF Unit, Chaim Sheba Medical Center, Tel- Hashomer, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raoul Orvieto
- Department of Obstetrics and Gynecology, IVF Unit, Chaim Sheba Medical Center, Tel- Hashomer, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation at the Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adva Aizer
- Department of Obstetrics and Gynecology, IVF Unit, Chaim Sheba Medical Center, Tel- Hashomer, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Carvalho MOC, Lima SMRR, Glina CG, Tso LDO, Romano RS, Glina S, Busso NE, Busso CE. A randomized clinical trial of transdermal (gel) versus oral estrogen for endometrial preparation in frozen embryo transfer cycle. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20231548. [PMID: 38775510 PMCID: PMC11111116 DOI: 10.1590/1806-9282.20231548] [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: 12/11/2023] [Accepted: 01/24/2024] [Indexed: 05/24/2024]
Abstract
OBJECTIVE The aim of this study was to compare endometrial thickness with the use of transdermal estrogen (gel) versus oral estrogen (pills) for endometrial preparation in the frozen embryo transfer cycle and serum estrogen concentrations during the preparation cycle, side effects, and chemical and clinical pregnancy rates. METHODS This was a prospective, randomized controlled trial of women undergoing endometrial preparation for cryopreserved blastocyst transfer. A total of 88 women were randomized, of which 82 completed the study protocol. Of this group, 44 received 6 mg/day of estradiol valerate orally (pills group) and 38 received 4.5 mg/day of estradiol hemihydrate transdermally (gel group). Endometrial thickness was measured using transvaginal ultrasound between the 7 and 10th day of the cycle. Serum estradiol concentrations were measured on the day of initiating the cycle, on control transvaginal ultrasounds, and on the day of embryo transfer. Side effects were documented at each study visit. p<0.05 were adopted as statistically significant. The groups were compared using Student's t-test for continuous variables and chi-square or Fisher's exact test for categorical variables. RESULTS There were no significant group differences (p>0.05) in endometrial thickness, biochemical and clinical pregnancy rates, miscarriage rate, blood estradiol concentrations, duration of estradiol administration, or cycle cancellation rates. CONCLUSION Endometrial preparation with transdermal estrogen yielded similar reproductive outcomes to oral estrogen with fewer side effects.
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Affiliation(s)
| | - Sônia Maria Rolim Rosa Lima
- Santa Casa de Sao Paulo School of Medical Sciences, Department of Obstetrics and Gynecology – São Paulo (SP), Brazil
| | - Claudia Godman Glina
- Project Alliance of Assisted Fertility Laboratories/BETA – São Paulo (SP), Brazil
| | | | | | - Sidney Glina
- Project Alliance of Assisted Fertility Laboratories/BETA – São Paulo (SP), Brazil
| | - Newton Eduardo Busso
- Project Alliance of Assisted Fertility Laboratories/BETA – São Paulo (SP), Brazil
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Jiang WJ, Sun ZG, Song JY. Premature timing of progesterone luteal phase support initiation did not negatively impact live birth rates in modified natural frozen thawed embryo transfer cycles. Heliyon 2023; 9:e13218. [PMID: 36793963 PMCID: PMC9922970 DOI: 10.1016/j.heliyon.2023.e13218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/20/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
Study question In a modified natural cycle frozen-thawed embryo transfer (mNC-FET), does the premature timing of progesterone luteal phase support (LPS) initiation 24 h following human chorionic gonadotropin (hCG) trigger impact live birth? Summary answer Premature LPS initiation did not negatively affect the live birth rate (LBR) in mNC-FET cycles compared with conventional LPS initiation 48 h after hCG triggering. What is known already During natural cycle FET, human chorionic gonadotropin is routinely used to mimic endogenous luteinizing hormone (LH) surge to induce ovulation, which allows more flexibility in embryo transfer scheduling, thus relieving the burden of multiple visits by patients and laboratory workloads, which is also known as mNC-FET. Moreover, recent data demonstrates that ovulatory women undergoing natural cycle FETs have a lower risk of maternal and fetal complications due to the essential role of the corpus luteum in implantation, placentation and pregnancy maintenance. While several studies have confirmed the positive effects of LPS in mNC-FETs, the timing of progesterone LPS initiation is still unclear, as compared with fresh cycles where robust research has been conducted. To the best of our knowledge, no clinical studies comparing different beginning days in mNC-FET cycles have been published. Study design size duration This retrospective cohort study involved 756 mNC-FET cycles performed at a university-affiliated reproductive center between January 2019 and August 2021. The primary outcome measured was the LBR. Participants/materials setting methods Ovulatory women ≤42 years of age who were referred for their autologous mNC-FET cycles were included in the study. According to the timing of progesterone LPS initiation following the hCG trigger, patients were assigned into two categories: premature LPS group (progesterone initiation 24 h after hCG trigger, n = 182) versus conventional LPS group (progesterone initiation 48 h after hCG trigger, n = 574). Multivariate logistic regression analysis was used to control for confounding variables. Main results and the role of chance There were no differences in background characteristics between the two study groups, except for the proportion of assisted hatching (53.8% in premature LPS group versus 42.3% in conventional LPS group, p = 0.007). In the premature LPS group, 56 of 182 patients (30.8%) had a live birth, compared to 179 of 574 patients (31.2%) in the conventional LPS group, with no significant difference observed between groups (adjusted odds ratio [aOR] 0.98, 95% confidence interval [CI] 0.67-1.43, p = 0.913). In addition, there was no significant difference between the two groups in other secondary outcomes. A sensitivity analysis for LBR according to the serum LH and progesterone levels on hCG trigger day also confirmed the aforementioned findings. Limitations reasons for caution In this study, retrospective analysis was conducted in a single center and was therefore prone to bias. Additionally, we did not anticipate monitoring the patient's follicle rupture and ovulation after hCG triggering. Future prospective clinical trials remain necessary to confirm our results. Wider implications of the findings While exogenous progesterone LPS was added 24 h after hCG triggering, embryo-endometrium synchrony would not be adversely affected so long as sufficient time was allowed for endometrial exposure to exogenous progesterone. Our data support promising clinical outcomes following this event. As a result of our findings, clinicians and patients will be able to make better informed decisions. Study funding/competing interests No specific funding was available for this study. The authors have no personal conflicting interests to declare. Trial registration number N/A.
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Affiliation(s)
- Wen-Jing Jiang
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zhen-Gao Sun
- Reproductive Center of Integrated Medicine, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China,Corresponding author.
| | - Jing-Yan Song
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China,Reproductive Center of Integrated Medicine, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China,Corresponding author. The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China.
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Jiang WJ, Sun ZG, Song JY. Impact of progesterone-free luteal phase support following natural cycle frozen embryo transfer: Study protocol for a multicenter, non-inferiority, randomized controlled trial. Front Med (Lausanne) 2022; 9:1014946. [DOI: 10.3389/fmed.2022.1014946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/28/2022] [Indexed: 11/17/2022] Open
Abstract
IntroductionNowadays, frozen-thawed embryo transfer (FET) has become one of the standard treatments for infertility in the field of assisted reproductive technology (ART). Natural cycle FET (NC-FET) has many advantages, such as simplicity and economics, no effect on patients’ menstrual cycles, estrogen and progesterone levels, as well as no interference in endometrial growth and transformation, which is aligned with the natural physiological state of embryo implantation. Nonetheless, there is a controversy regarding the need for luteal phase support (LPS) during NC-FET cycles. The purpose of this study is to assess whether LPS was not inferior to non-LPS in terms of OPR in NC-FET cycles.Methods and analysisThis study including 1,010 ovulatory women undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles with an elective freeze-all strategy followed by NC-FET will be performed at four university-affiliated reproductive centers. Participants will be randomly assigned in a 1:1 ratio to receive LPS treatment or not. This study is designed as an open-label, non-inferiority, randomized controlled trial (RCT), and the primary statistical strategies were intention-to-treat (ITT) and per-protocol (PP) analysis.DiscussionThere may not have been any significant difference in the chance of a live birth after FET if no progesterone was supplemental during the luteal phase. However, due to the limited number of previous studies, which are mainly retrospective, evidence is still limited. Thus, by conducting this multicenter RCT, we intend to evaluate whether LPS is necessary in NC-FET.Ethics and disseminationA Reproductive Ethics Committee of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine (SDUTCM) has approved this study. This study will handle the data as required by general data protection regulations. Participants will sign a written informed consent regarding participation in the study and storage of blood samples in a biobank for future research. This study will be monitored by study personnel trained in Good Clinical Practice who are not involved in the study. The results of this study will be disseminated through publication in international peer-reviewed scientific journals.Clinical trial registration[https://www.chictr.org.cn/], identifier [ChiCTR2200057498].
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Demirdağ E, Güler İ, Cevher Akdulum MF, Şahin E, Tufan AD, Erdem A, Erdem M. Comparison of natural and artificial cycles in frozenthawed embryo transfer: A retrospective analysis of 1696 cycles. Turk J Obstet Gynecol 2022; 19:28-34. [PMID: 35343217 PMCID: PMC8966319 DOI: 10.4274/tjod.galenos.2021.17981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Su S, Zeng M, Duan J. Luteal phase support for natural cycle frozen embryo transfer: a meta-analysis. Gynecol Endocrinol 2022; 38:116-123. [PMID: 34730071 DOI: 10.1080/09513590.2021.1998438] [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] [Indexed: 10/19/2022] Open
Abstract
PURPOSE We aimed to evaluate the effect of luteal phase support (LPS) on pregnancy outcome in natural cycle frozen embryo transfer (NC-FET). METHOD We searched PubMed, Cochrane Library, Embase for related literature from start to February 2020. Relative risk ratio (RR) and 95% confidence intervals (95% CI) in random-effects, fixed-effects models were calculated using Review Manager 5.3. RESULTS Totally 9 studies were included in the meta-analysis. The results showed no significant difference could be found regarding chemical pregnancy rate (RR 1.07, 95% CI 0.93-1.22; I2 = 54%) and miscarriage rate (RR 0.92, 95% CI 0.70-1.22; I2 = 0%) between the LPS groups and no LPS groups in NC-FET. LPS groups has increased the rate of clinical pregnancy rate (RR 1.23, 95% CI 1.12-1.34; I2 = 52%) compared with no LPS groups. Subgroup analysis according to trigger administration also showed a significant difference between the two groups. CONCLUSION LPS might improve the clinical pregnancy rate in NC-FET. HCG trigger for ovulating may result in luteal phase deficiency. LPS subsequently improved clinical pregnancy rate and chemical pregnancy rate for patients undergoing HCG trigger and NC-FET. RETROSPECTIVELY REGISTERED This meta-analysis was registered at PROSPERO, PROSPERO ID is CRD42020171758.
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Affiliation(s)
- SuQin Su
- Reproductive Medical Center, Guilin, Guangxi, P.R. China
| | - MeiFang Zeng
- Reproductive Medical Center, Guilin, Guangxi, P.R. China
| | - JinLiang Duan
- Reproductive Medical Center, Guilin, Guangxi, P.R. China
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Aizer A, Noach-Hirsh M, Dratviman-Storobinsky O, Nahum R, Machtinger R, Yung Y, Haas J, Orvieto R. The effect of COVID-19 immunity on frozen-thawed embryo transfer cycles outcome. Fertil Steril 2022; 117:974-979. [PMID: 35216833 PMCID: PMC8743570 DOI: 10.1016/j.fertnstert.2022.01.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/12/2021] [Accepted: 01/04/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Adva Aizer
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Meirav Noach-Hirsh
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
| | - Olga Dratviman-Storobinsky
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
| | - Ravit Nahum
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Machtinger
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Yung
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
| | - Jigal Haas
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raoul Orvieto
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, at the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Alsbjerg B, Kesmodel US, Elbaek HO, Laursen R, Laursen SB, Andreasen D, Povlsen BB, Humaidan P. GnRH agonist supplementation in hormone replacement therapy-frozen embryo transfer cycles: a randomized controlled trial. Reprod Biomed Online 2021; 44:261-270. [PMID: 34924287 DOI: 10.1016/j.rbmo.2021.10.019] [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: 05/18/2021] [Revised: 10/14/2021] [Accepted: 10/20/2021] [Indexed: 11/18/2022]
Abstract
RESEARCH QUESTION Will two boluses of gonadotrophin-releasing hormone agonist (GnRHa) during hormone replacement therapy-frozen embryo transfer (HRT-FET) cycles reduce the total pregnancy loss rate? DESIGN Randomized controlled trial including a total of 287 HRT-FET cycles performed between 2013 and 2019. After randomization participants allocated to the GnRHa group (n = 144) underwent a standard HRT protocol, supplemented with a total of two boluses of triptorelin 0.1 mg; one bolus 2 days before starting vaginal progesterone and one bolus on the 7th day of progesterone. The control group (n = 143) underwent a standard HRT-FET protocol only. RESULTS The intention-to-treat analysis showed no significant difference in total pregnancy loss between the GnRHa group and the control group (21% versus 33%; relative risk [RR] 0.63, 95% confidence interval [CI] 0.35-1.11), nor was the biochemical pregnancy loss per positive human chorionic gonadotrophin (HCG) significantly lower in the GnRHa group (12%, 8/67) compared with the control group (25%, 18/72) (RR 0.48, 95% CI 0.22-1.02). Participants with a live birth had a significantly higher mean progesterone concentration compared with participants without a live birth (25.0 ± 12.2 versus 23.8 ± 8.9 nmol/l; P = 0.001). Furthermore, a trend for a higher live birth rate (LBR) correlated with the highest oestradiol quartile concentration (oestradiol >0.957 nmol/l). CONCLUSIONS Although a difference of 14% in biochemical loss and 12% in total pregnancy loss in favour of GnRHa supplementation was seen this did not reach statistical difference. Luteal progesterone and oestradiol concentrations correlate with LBR in the HRT-FET cycle, emphasizing the importance of luteal serum progesterone and oestradiol monitoring.
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Affiliation(s)
- Birgit Alsbjerg
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Ulrik S Kesmodel
- Department of Obstetrics and Gynaecology, Aalborg University Hospital, Aalborg, Denmark
| | - Helle O Elbaek
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark
| | - Rita Laursen
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark
| | | | | | | | - Peter Humaidan
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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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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Comparison of two mainstream endometrial preparation regimens in vitrified-warmed embryo transfers after PGT. Reprod Biomed Online 2021; 44:239-246. [PMID: 34848150 DOI: 10.1016/j.rbmo.2021.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 08/26/2021] [Accepted: 09/06/2021] [Indexed: 12/16/2022]
Abstract
RESEARCH QUESTION Which of the two mainstream endometrial preparation regimens, assisted natural cycle (NC) or hormone replacement treatment cycle (HRT), help frozen-thawed embryo transfer (FET) cycles after preimplantation genetic testing (PGT) achieve better clinical outcomes? DESIGN This retrospective analysis included 3400 vitrified-warmed single blastocyst transfer cycles after PGT from January 2011 to November 2020, and involved 2332 patients with regular menstrual cycles. The decision to proceed with an assisted NC (n = 827) or HRT (n = 2573) before FET was reached based on a combination of patient preference and physician guidance. Clinical pregnancy rate, live birth rate, early miscarriage rate and obstetric outcomes were compared. RESULTS No significant difference was observed between the assisted NC and HRT groups in terms of clinical pregnancy rate (51.6% versus 50.7%, P = 0.634), live birth rate (44.0% versus 43.4%, P = 0.746) or early miscarriage rate (12.6% versus 12.0%, P = 0.707). Multivariate analysis indicated that the endometrial preparation protocol was not an independent factor for a clinical pregnancy or live birth. In the HRT group, the Caesarean section rate (64.7% versus 51.9%, P < 0.001) and pregnancy complication rate (20.2% versus 13.8%, P = 0.003) were significantly higher. The two groups were not statistically different with respect to gestational age, early preterm birth rate, fetal weight or fetal birth defect rate. CONCLUSIONS For patients undergoing a PGT-FET cycle involving a single blastocyst transfer, using assisted NC and HRT for the endometrial preparation could lead to comparable rates of clinical pregnancy and live birth. Additionally, NC is safer than HRT in terms of avoiding pregnancy complications and adverse obstetric outcomes.
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Wan Q, Han L, Liu J, Li H, Li Y, Long QM, Tan L, Li JJ. Fertility preservation among young breast cancer patients: A single-center experience in China. Taiwan J Obstet Gynecol 2021; 60:827-830. [PMID: 34507656 DOI: 10.1016/j.tjog.2021.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE This study aims to investigate the status of fertility preservation (FP) in young breast cancer patients. MATERIALS AND METHODS A clinical database of six women with breast cancer who wished to undergo FP before starting chemotherapy were analyzed between January 2018 and December 2019 in our hospital. Among the six women, three were unmarried and three were married. RESULTS Three patients chose oocyte preservation and obtained 23, 7, and 17 MII oocytes, respectively. One patient chose embryo freezing, and three embryos were frozen. Fertility preservation failed for two patients, one of whom had premature ovulation, while the other patient abandoned egg retrieval on the human chorionic gonadotropin (HCG) day. CONCLUSION The present results indicate that oocyte and embryo cryopreservation are effective optional methods for young breast cancer patients. However, a lack of knowledge, the urgency of cancer treatment, and financial constraints are causes for a low access rate regarding this process.
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Affiliation(s)
- Qi Wan
- Department of Reproductive Medicine, Chengdu Jinjiang Maternal and Child Health Hospital, Chengdu, 610041, Sichuan, China; Department of Gynaecology and Obstetrics, West China Second University Hospital, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ling Han
- Department of Gynaecology and Obstetrics, West China Second University Hospital, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jing Liu
- Department of Reproductive Medicine, Chengdu Jinjiang Maternal and Child Health Hospital, Chengdu, 610041, Sichuan, China
| | - Hui Li
- Department of Breast Surgery, Sichuan Cancer Hospital, Chengdu, 610041, Sichuan, China
| | - Ya Li
- Department of Reproductive Medicine, Chengdu Jinjiang Maternal and Child Health Hospital, Chengdu, 610041, Sichuan, China
| | - Qi-Ming Long
- Department of Breast Surgery, Sichuan Cancer Hospital, Chengdu, 610041, Sichuan, China
| | - Li Tan
- Department of Reproductive Medicine, Chengdu Jinjiang Maternal and Child Health Hospital, Chengdu, 610041, Sichuan, China
| | - Jun-Jie Li
- Department of Breast Surgery, Sichuan Cancer Hospital, Chengdu, 610041, Sichuan, China.
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Su Y, Ji H, Jiang W, Xu L, Lu J, Zhao C, Zhang M, Cao S, Ling X, Shen R. Effect of unplanned spontaneous follicular growth and ovulation on pregnancy outcomes in planned artificial frozen embryo transfer cycles: a propensity score matching study. Hum Reprod 2021; 36:1542-1551. [PMID: 33764448 DOI: 10.1093/humrep/deab059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/14/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Does unplanned spontaneous follicular growth and ovulation affect clinical outcomes after planned artificial frozen-thawed embryo transfer (AC-FET) cycles? SUMMARY ANSWER AC-FET and spontaneous follicular growth and ovulation events resulted in notably better pregnancy outcomes with a significantly higher implantation rate (IR), clinical pregnancy rate (CPR), ongoing pregnancy rate (OPR) and live birth rate (LBR) and a significantly lower miscarriage rate. WHAT IS KNOWN ALREADY The AC-FET protocol without GnRH agonist administration is associated with a low incidence of follicular growth and ovulation. In the literature, authors often refer to these types of cycles with concern due to possibly impaired FET outcomes. However, the real impact of such cycles has yet to be elucidated due to the lack of existing data. STUDY DESIGN, SIZE, DURATION This was a retrospective clinical study involving 2256 AC-FET cycles conducted between January 2017 and August 2019. Propensity score (PS) matching was used to control for confounding variables. PARTICIPANTS/MATERIALS, SETTING, METHODS Subjects were divided into two groups: a study group: cycles with spontaneous follicular growth and ovulation (the maximum diameter of follicles in any ovary was ≥14 mm and ovulation was confirmed by consecutive ultrasound examinations) and a control group featuring cycles without growing follicles (the maximum diameter of follicles in both ovaries were <10 mm). The study group was matched by PS with the control group at a ratio of 1:2. The study group consisted of 195 patients before PS matching and 176 patients after matching. The numbers of participants in the control group before and after PS matching were 2061 and 329, respectively. MAIN RESULTS AND THE ROLE OF CHANCE This analysis showed that patient age (adjusted odds ratio [aOR] 1.05; 95% CI 1.01-1.09; P=0.010) and basal FSH level (aOR 1.06; 95% CI 1.01-1.11; P=0.012) were significantly and positively related with the spontaneous follicular growth and ovulation event. In addition, this event was negatively correlated with BMI (aOR 0.92; 95% CI 0.87-0.97; P=0.002), AMH level (aOR 0.66; 95% CI 0.59-0.74; P<0.001) and a high starting oestrogen dose (aOR 0.53; 95% CI 0.38-0.76 for 6 mg vs. 4 mg; P<0.001). Baseline characteristics were similar between groups after PS matching. Patients in the study group had a significantly higher IR (28.8% vs. 21.8%, P=0.016), CPR (44.9% vs. 33.4%, P=0.011), OPR (39.2% vs. 26.1%, P=0.002) and LBR (39.2% vs. 24.9%, P=0.001) and a lower miscarriage rate (12.7% vs. 25.5%, P=0.030), compared with those in the control group. LIMITATIONS, REASONS FOR CAUTION This was a retrospective study carried out in a single centre and was therefore susceptible to bias. In addition, we only analysed patients with normal ovulation patterns and excluded those with follicular growth but without ovulation. Further studies remain necessary to confirm our results. WIDER IMPLICATIONS OF THE FINDINGS It is not necessary to cancel cycles that experience spontaneous follicular growth and ovulation. Our data support promising clinical outcomes after this event. Our findings are important as they can better inform clinicians and patients. STUDY FUNDING/COMPETING INTEREST(S) This research was supported by National Natural Science Foundation of China (grant no. 81701507, 81801404, 81871210, 82071648), Natural Science Foundation of Jiangsu Province (grant no. BK20171126, BK20201123) and Jiangsu Province '333' project. The authors declare that they have no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Yan Su
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Hui Ji
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China.,State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
| | - Wei Jiang
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Lu Xu
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Jing Lu
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Chun Zhao
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Mianqiu Zhang
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Shanren Cao
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Xiufeng Ling
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Rong Shen
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China.,State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
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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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14
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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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15
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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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16
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Zemet R, Orvieto R, Watad H, Barzilay E, Zilberberg E, Lebovitz O, Mazaki-Tovi S, Haas J. The association between level of physical activity and pregnancy rate after embryo transfer: a prospective study. Reprod Biomed Online 2021; 42:930-937. [PMID: 33832865 DOI: 10.1016/j.rbmo.2021.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/05/2021] [Accepted: 01/22/2021] [Indexed: 11/25/2022]
Abstract
RESEARCH QUESTION Is physical activity after embryo transfer, as assessed by a smart band activity tracker, associated with decreased pregnancy rates? DESIGN Prospective observational cohort study comprising infertile women aged < 38 years, who had undergone fewer than three previous embryo transfers, achieved a good ovarian response and were undergoing frozen-thawed embryo transfer in a tertiary-referral centre. A validated smart band activity tracker was used to assess physical activity level immediately after the embryo transfer and until the pregnancy test. No specific recommendations were given to participants on level or intensity of physical activity. Physicians and patients were blinded to the data stored in the pedometer. Primary outcome was ongoing pregnancy rate. RESULTS Fifty women met the inclusion criteria. Ongoing pregnancy rate was 30%. In a pooled analysis, participants walked significantly fewer steps per day on the day of embryo transfer compared with the first 2 days after embryo transfer (4075, interquatile range [IQR] 2932-5592 versus 5204, IQR4203-8584, P = 0.01). No significant difference was observed between pregnant women and non-pregnant women in the median steps per day after embryo transfer until serum beta-HCG was measured (7569, IQR 6008-10884 versus 6572.5, IQR 5299-8786, P = 0.43). No significant difference was observed in the median number of steps on the day of embryo transfer or the first 2 days after embryo transfer between pregnant and non-pregnant women. CONCLUSIONS A quantitative objective assessment of the association between physical activity and pregnancy rates after frozen-thawed embryo transfer was conducted. Ambulation after embryo transfer has no adverse effect on pregnancy rates and, therefore, women should resume regular activity immediately after embryo transfer.
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Affiliation(s)
- Roni Zemet
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Tel-Hashomer, Ramat-Gan 52621, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
| | - Raoul Orvieto
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Tel-Hashomer, Ramat-Gan 52621, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Hadel Watad
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Tel-Hashomer, Ramat-Gan 52621, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Eran Barzilay
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod 7747629, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
| | - Eran Zilberberg
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Tel-Hashomer, Ramat-Gan 52621, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Oshrit Lebovitz
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Tel-Hashomer, Ramat-Gan 52621, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Shali Mazaki-Tovi
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Tel-Hashomer, Ramat-Gan 52621, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Jigal Haas
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Tel-Hashomer, Ramat-Gan 52621, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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17
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Orvieto R, Venetis CA, Fatemi HM, D’Hooghe T, Fischer R, Koloda Y, Horton M, Grynberg M, Longobardi S, Esteves SC, Sunkara SK, Li Y, Alviggi C. Optimising Follicular Development, Pituitary Suppression, Triggering and Luteal Phase Support During Assisted Reproductive Technology: A Delphi Consensus. Front Endocrinol (Lausanne) 2021; 12:675670. [PMID: 34040586 PMCID: PMC8142593 DOI: 10.3389/fendo.2021.675670] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/08/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND A Delphi consensus was conducted to evaluate global expert opinions on key aspects of assisted reproductive technology (ART) treatment. METHODS Ten experts plus the Scientific Coordinator discussed and amended statements plus supporting references proposed by the Scientific Coordinator. The statements were distributed via an online survey to 35 experts, who voted on their level of agreement or disagreement with each statement. Consensus was reached if the proportion of participants agreeing or disagreeing with a statement was >66%. RESULTS Eighteen statements were developed. All statements reached consensus and the most relevant are summarised here. (1) Follicular development and stimulation with gonadotropins (n = 9 statements): Recombinant human follicle stimulating hormone (r-hFSH) alone is sufficient for follicular development in normogonadotropic patients aged <35 years. Oocyte number and live birth rate are strongly correlated; there is a positive linear correlation with cumulative live birth rate. Different r-hFSH preparations have identical polypeptide chains but different glycosylation patterns, affecting the biospecific activity of r-hFSH. r-hFSH plus recombinant human LH (r-hFSH:r-hLH) demonstrates improved pregnancy rates and cost efficacy versus human menopausal gonadotropin (hMG) in patients with severe FSH and LH deficiency. (2) Pituitary suppression (n = 2 statements): Gonadotropin releasing hormone (GnRH) antagonists are associated with lower rates of any grade ovarian hyperstimulation syndrome (OHSS) and cycle cancellation versus GnRH agonists. (3) Final oocyte maturation triggering (n=4 statements): Human chorionic gonadotropin (hCG) represents the gold standard in fresh cycles. The efficacy of hCG triggering for frozen transfers in modified natural cycles is controversial compared with LH peak monitoring. Current evidence supports significantly higher pregnancy rates with hCG + GnRH agonist versus hCG alone, but further evidence is needed. GnRH agonist trigger, in GnRH antagonist protocol, is recommended for final oocyte maturation in women at risk of OHSS. (4) Luteal-phase support (n = 3 statements): Vaginal progesterone therapy represents the gold standard for luteal-phase support. CONCLUSIONS This Delphi consensus provides a real-world clinical perspective on the specific approaches during the key steps of ART treatment from a diverse group of international experts. Additional guidance from clinicians on ART strategies could complement guidelines and policies, and may help to further improve treatment outcomes.
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Affiliation(s)
- Raoul Orvieto
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- *Correspondence: Raoul Orvieto,
| | - Christos A. Venetis
- Centre for Big Data Research in Health & School of Women’s and Children’s Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
- IVF Australia, Sydney, NSW, Australia
| | - Human M. Fatemi
- Assisted Reproductive Technology (ART), Fertility Clinics, Abu Dhabi, United Arab Emirates
| | - Thomas D’Hooghe
- Global Medical Affairs, Research and Development, Merck Healthcare KGaA, Darmstadt, Germany
- Research Group Reproductive Medicine, Department of Development and Regeneration, Organ Systems, Group Biomedical Sciences, KU Leuven (University of Leuven), Leuven, Belgium
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States
| | | | - Yulia Koloda
- Center of Reproduction “Life Line”, Moscow, Russia
- Department of Obstetrics and Gynecology, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Marcos Horton
- Pregna Medicina Reproductiva, Buenos Aires, Argentina
| | - Michael Grynberg
- Service de Médecine de la Reproduction et Préservation de la Fertilité, Hôpital Antoine Béclère, Clamart, France
| | - Salvatore Longobardi
- Global Clinical Development, Merck Serono, Italy, an Affiliate of Merck KGaA, Darmstadt, Germany
| | - Sandro C. Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Center for Male Reproduction, Campinas, Brazil
- Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Sesh K. Sunkara
- Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Yuan Li
- Medical Center for Human Reproduction, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
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18
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Aizer A, Haas J, Shimon C, Konopnicki S, Barzilay E, Orvieto R. Is There Any Association Between the Number of Oocytes Retrieved, Women Age, and Embryo Development? Reprod Sci 2020; 28:1890-1900. [PMID: 33237517 DOI: 10.1007/s43032-020-00391-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/09/2020] [Indexed: 12/18/2022]
Abstract
While most studies focused on the association between the number of oocytes retrieved and LBR, there is lack of analysis highlighting the effect of the number of oocyte retrieved on top quality embryo (TQE) rate in different age groups. We aimed to study the correlations between the number and ratio of TQE, as assessed by morphology only, according to the number of oocytes retrieved, and to evaluate the impact of patients' age. This was a retrospective study that includes 1639 patients who underwent 2263 IVF cycles between 2016 and 2019. Patients were categorized into four groups according to the number of oocytes retrieved: 1-3, 4-9, 10-14, or > 15 oocytes (OPU groups A-D, respectively). Another classification was according to patient's age < 35, 35-40, and > 40 years. Morphologically, TQE (both cleavage stage and blastocyst) was defined as those eligible for transfer or vitrification. TQE was assessed both as a fraction of oocytes retrieved per patients (rate) and the average TQE per number oocytes retrieved category. For all age subgroups, a negative significant association was observed between the number of oocytes retrieved and TQE rate (56.1%, 43.6%, 35.9%, and 34.3% for groups A-D, respectively). The reduction was significant up to 14 oocytes retrieved and plateau thereafter. On the other hand, TQE rate was significantly increased as women age increased, from 36.1% TQE rate in young women (< 35 years) to 40.3% for 35-40 years to 42.5% in older patients (> 40 years). Finally, a linear regression revealed a drop in TQE rate of - 0.5% for every oocyte retrieved, while an increased in TQE rate of + 0.7%, as the women age increased by 1 year. While young women are able to recruit more oocyte, including medium/low quality, older women recruit less oocytes, with good quality, as demonstrated by their higher morphologically TQE rate relative to the number of oocyte retrieved.
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Affiliation(s)
- Adva Aizer
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.
| | - Jigal Haas
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Chen Shimon
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Sarah Konopnicki
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Eran Barzilay
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Raoul Orvieto
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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19
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Aizer A, Shimon C, Dratviman-Storobinsky O, Shani H, Harel Inbar N, Maman E, Orvieto R. Timing day-3 vitrification for PGT-M embryos: pre- or post-blastomere biopsy? J Assist Reprod Genet 2020; 37:2413-2418. [PMID: 32772269 DOI: 10.1007/s10815-020-01914-3] [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: 06/16/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To assess the efficacy and clinical outcomes of preimplantation genetic testing for monogenic diseases (PGT-M), following blastomere biopsy prior or following vitrification. METHODS A cohort-historical study of all consecutive patients admitted to IVF in a large tertiary center for PGT-M and PCR cycle from September 2016 to March 2020. Patients were divided into 4 groups: Group A1 consisted of patients undergoing day-3 embryos biopsy followed by a fresh transfer of unaffected embryos. Group A2 consisted of Group A1 patients that their surplus unaffected embryos were vitrified, thawed, and transferred in a subsequent FET cycle. Group B1 consisted of patients that their day-3 embryos were vitrified intact (without biopsy) for a subsequent FET cycle. Later embryos were thawed and underwent blastomere biopsies, and the unaffected embryos were transferred, while the surplus unaffected embryos were re-vitrified for a subsequent FET cycle. Group B2 consisted of Group B1 patients that their surplus unaffected embryos were re-vitrified, thawed, and transferred in a subsequent FET cycle. The laboratory data and clinical results were collected and compared between groups. RESULTS A total of 368 patients underwent 529 PGT-M cycles in our center: 347 with day-3 embryos biopsied before undergoing vitrification (Group A1) and 182 following vitrification and thawing (Group B1). There were no between group differences in embryo survival rate post-thawing, nor the ongoing implantation and pregnancy rates. CONCLUSION In PGT-M cycles, the timing of embryos vitrification, whether prior or following blastomere biopsy, has no detrimental effect on post-thawing embryo survival rate, nor their potential ongoing implantation and pregnancy rates.
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Affiliation(s)
- Adva Aizer
- Department of Obstetrics and Gynecology, Infertility and IVF Unit, Sheba Medical Center, Ramat Gan, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Chen Shimon
- Department of Obstetrics and Gynecology, Infertility and IVF Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Olga Dratviman-Storobinsky
- Department of Obstetrics and Gynecology, Infertility and IVF Unit, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagit Shani
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Danek Gertner Institute of Human Genetics, Sheba Medical Center, Ramat Gan, Israel
| | - Noa Harel Inbar
- Danek Gertner Institute of Human Genetics, Sheba Medical Center, Ramat Gan, Israel
| | - Ettie Maman
- Department of Obstetrics and Gynecology, Infertility and IVF Unit, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raoul Orvieto
- Department of Obstetrics and Gynecology, Infertility and IVF Unit, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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20
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Isikoglu M, Aydinuraz B, Avci A, Kendirci Ceviren A. Modified natural protocol seems superior to natural and artificial protocols for preparing the endometrium in frozen embryo transfer cycles. MINERVA GINECOLOGICA 2020; 72:195-201. [PMID: 32403918 DOI: 10.23736/s0026-4784.20.04570-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Although several studies claim higher success rates in natural cycle (NC) and modified natural cycle (mNC) protocols, currently, there is no consensus on the most effective method of endometrium preparation prior to frozen embryo transfer (FET) cycles. We aimed to find out the best protocol by comparing three different protocols for preparing the endometrium in FET cycles. METHODS This retrospective cohort study was conducted at a private in-vitro fertilization (IVF) center. Medical records of all patients enrolled in frozen embryo transfer cycles between November 2017 and February 2019 were reviewed. Group I (N.=94) included patients who underwent artificial endometrial preparation (AC), group II (N.=23) confined patients enrolled in mNC and group III (N.=12) included patients who had NC protocol. Main outcome parameters were clinical pregnancy rates, implantation rates and miscarriage rates. RESULTS There was a tendency towards higher clinical pregnancy rate in mNC group. Clinical pregnancy rates of the three groups were 54.3%, 65.2% and 33.3% respectively (P=0.199). Implantation rate was significantly higher in group II (34%, 50% and 12% respectively, P=0.006). Miscarriage rates were similar for the three groups. CONCLUSIONS Although not reaching a statistically significant level, there is a tendency towards higher implantation rate and pregnancy rate in mNC protocol compared to true NC and AC protocols.
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Affiliation(s)
- Mete Isikoglu
- GELECEK The Center For Human Reproduction, Antalya, Turkey -
| | - Batu Aydinuraz
- GELECEK The Center For Human Reproduction, Antalya, Turkey
| | - Aysenur Avci
- GELECEK The Center For Human Reproduction, Antalya, Turkey
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21
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Pakes C, Volovsky M, Rozen G, Agresta F, Gardner DK, Polyakov A. Comparing pregnancy outcomes between natural cycles and artificial cycles following frozen-thaw embryo transfers. Aust N Z J Obstet Gynaecol 2020; 60:804-809. [PMID: 32691424 DOI: 10.1111/ajo.13213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/18/2020] [Accepted: 06/20/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Frozen embryo transfer (FET) is increasing in prevalence. In contrast to the amount of research performed on the actual cryopreservation procedure, there are limited data with respect to optimal endometrial preparation in FET cycles. Increasingly artificial cycle (AC) preparation is being adopted over the natural cycle (NC) to facilitate greater access to FET. However, there remains a paucity of data comparing pregnancy outcomes between these two commonly used cycle types. AIMS To examine the efficacy of AC vs NC following FET, by comparing pregnancy outcomes including biochemical, clinical and live birth rates, along with miscarriage rates. MATERIALS AND METHOD This is a large single-centre retrospective analysis, examining a standardised data set from January 2015 to July 2018. It included 3030 cycles (NC = 2033, AC = 997). Main outcomes were biochemical pregnancy (beta-human chorionic gonadotropin > 5 IU), ultrasound-diagnosed clinical pregnancy, and live births. Using the χ2 test, the above pregnancy outcomes were compared between AC and NC. A multivariate logistic regression, controlling for factors such as age, embryo quality, and day of blastocyst freeze was further utilised to assess for confounding variables. RESULTS No difference was observed between biochemical pregnancy rates (NC = 39.45% vs AC = 37.71%, P = 0.357); statistically significant differences were observed between clinical pregnancy (30.84% vs 26.08%, P = 0.007), and live birth rates (24.40% vs 18.86% P = 0.001). Multivariate analysis confirmed that NC produces superior pregnancy outcomes when controlling for confounding variables. CONCLUSION This analysis demonstrates the non-inferiority of NC thaw compared to AC, on continuing pregnancy rates. Taken together with patient acceptability and possibly increased obstetric risks with AC, these findings support the use of NC when medically possible.
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Affiliation(s)
| | | | - Genia Rozen
- Royal Women's Hospital, Melbourne, Victoria, Australia.,Melbourne IVF, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Alex Polyakov
- Royal Women's Hospital, Melbourne, Victoria, Australia.,Melbourne IVF, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
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Liu X, Shi W, Shi J. Natural cycle frozen-thawed embryo transfer in young women with regular menstrual cycles increases the live-birth rates compared with hormone replacement treatment: a retrospective cohort study. Fertil Steril 2020; 113:811-817. [PMID: 32147171 DOI: 10.1016/j.fertnstert.2019.11.023] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine the optimal endometrial preparation protocols of frozen-thawed embryo transfer (FET) in young women with regular menstrual cycles. DESIGN Retrospective cohort study. SETTING Public fertility center. PATIENT(S) Infertile women with regular menstrual cycles undergoing FET. INTERVENTION(S) Natural cycle (NC) treatment for patients with proven ovulation in previous cycles or who refused medication (n = 308), or hormone treatment (HT) for patients who could not be frequently monitored (n = 1,538). MAIN OUTCOME MEASURE(S) Live-birth rates. RESULT(S) The live-birth rates were 61.73% in the NC group and 55.11% in the HT group. The effect size of the endometrial preparation on live-birth rates was evaluated in prespecified and exploratory subgroups in each subgroup, and multivariable logistic regression analysis was used to determine which variables could be independently associated with the live-birth rate. The HT patients had a lower chance of live birth in all subgroups: endometrial thickness on the day of progesterone administration, triple-line endometrial pattern, female age at embryo transfer, fertilization type, and protocol in the fresh cycle. Multivariable analysis showed NC to be associated with an increased likelihood of live birth compared with HT. CONCLUSION(S) Natural cycle treatment has a higher chance of live birth than HT for endometrial preparation in young women with regular menstrual cycles.
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Affiliation(s)
- Xitong Liu
- Assisted Reproduction Center, Northwest Women's and Children's Hospital Affiliated to Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Wenhao Shi
- Assisted Reproduction Center, Northwest Women's and Children's Hospital Affiliated to Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Juanzi Shi
- Assisted Reproduction Center, Northwest Women's and Children's Hospital Affiliated to Xi'an Jiaotong University, Xi'an, People's Republic of China.
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Orvieto R, Kirshenbaum M, Gleicher N. Is Embryo Cryopreservation Causing Macrosomia-and What Else? Front Endocrinol (Lausanne) 2020; 11:19. [PMID: 32047479 PMCID: PMC6997460 DOI: 10.3389/fendo.2020.00019] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/10/2020] [Indexed: 12/14/2022] Open
Abstract
The number of embryos transferred during an IVF cycle is directly related to the high incidence of multiple births, which is the culprit of perinatal morbidity. Therefore, single fresh embryo transfer (ET) strategy, or freeze-all, followed by a single frozen-thawed embryo transfer (FET) cycle, may dramatically reduce the rate of multiple births, without compromising the cumulative live birth rates (LBRs). A literature review was conducted for all available evidences assessing obstetrics and perinatal outcomes associated with FET compared to fresh ET and natural conception. While studies comparing fresh and FET cycles in normal responders have yielded conflicting results for pregnancy rate, FET was associated with lower risk of prematurity and low birth weight and increased risk of large for gestational age (LGA) and/or macrosomic in singletons, when compared with fresh ET. Macrosomic/LGA births have a higher risk of fetal hypoxia, stillbirth, shoulder dystocia, perineal lacerations, cesarean section, postpartum hemorrhage and neonatal metabolic disturbances at birth. Nonetheless, it seems that other than higher risk of fetal macrosomia, there are additional obstetric complications associated with FET. The relative risk of hypertensive disorders in pregnancy, as well as perinatal mortality were also demonstrated to be increased in FET compared with singletons from fresh ET and natural conception. Therefore, when considering elective freeze-all policy, in addition to LBR and the risk of ovarian hyperstimulation syndrome, physicians should consider the aforementioned increased FET cycles' pregnancy complications, including LGA/ macrosomia, hypertensive disorders of pregnancy, as well as perinatal mortality.
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Affiliation(s)
- Raoul Orvieto
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
- The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- *Correspondence: Raoul Orvieto
| | - Michal Kirshenbaum
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Norbert Gleicher
- The Center for Human Reproduction, New York, NY, United States
- The Foundation for Reproductive Medicine, New York, NY, United States
- Stem Cell Biology and Molecular Embryology Laboratory, Rockefeller University, New York, NY, United States
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Higher live birth rate with stimulated rather than artificial cycle for frozen-thawed embryo transfer. Eur J Obstet Gynecol Reprod Biol 2019; 243:144-149. [PMID: 31704531 DOI: 10.1016/j.ejogrb.2019.10.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To study which endometrial preparation allows a better ongoing pregnancy rates (OPR) and live birth rate (LBR) after frozen-thawed embryo transfer (FET) between mild gonadotropin ovarian stimulation (OS) and artificial cycles (AC). STUDY DESIGN Retrospective follow-up study including all FET performed in one fertility center from 2013 to 2016. In the OS group, gonadotropins were followed by r-hCG triggering. Vaginal micronized progesterone (200 mg/day) was given systematically. In the AC group, estradiol (E2) was started on Day 1. Vaginal micronized progesterone (600 mg/d) was added to E2 for 12 weeks. Data were analyzed using a multiple regression model. RESULTS Among 1021 FETs, 35% underwent OS preparation, 65% had an AC. As expected, patients in the AC group suffered more from endometriosis (18.5% vs. 12.9%; p = .021) and polycystic ovarian syndrome (21.7% vs. 10.9%; p < .0001) than patients in the OS group. There was no difference between groups with respect to endometrial thickness, number of embryos transferred, development stage at FET, cryopreservation technique. Despite a similar clinical pregnancy rate (CPR) (24.4% vs. 20.8%; p = .189), the OPR was significantly higher in the OS than in the AC group (17.9% vs. 11%; p = .002), leading to an increased LBR (17.1% vs. 9.8%; p < .001). After adjusting for parameters usually linked to early pregnancy losses or potential bias (patient age at freezing, smoking status, PCOS, endometriosis, rank of transfer and previous miscarriages), the results remained significant. CONCLUSION Despite a similar CPR, LBR was significantly higher with mild OS than with the AC preparation, even after adjusting for potential confounders. In light of these results, the first-line endometrial preparation could be OS instead of an AC. In an AC, a potential defect of the luteal phase may exist, treatment could be optimized to avoid pregnancy losses. A randomized controlled trial should be undertaken to assess the role of OS and ACs in FET.
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25
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Bartels CB, Ditrio L, Grow DR, O'Sullivan DM, Benadiva CA, Engmann L, Nulsen JC. The window is wide: flexible timing for vitrified–warmed embryo transfer in natural cycles. Reprod Biomed Online 2019; 39:241-248. [DOI: 10.1016/j.rbmo.2019.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/08/2019] [Accepted: 04/05/2019] [Indexed: 10/27/2022]
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26
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Schwartz E, Bernard L, Ohl J, Bettahar K, Rongières C, Lichtblau I, Pirrello O. Luteal phase progesterone supplementation following induced natural cycle frozen embryo transfer: A retrospective cohort study. J Gynecol Obstet Hum Reprod 2019; 48:95-98. [DOI: 10.1016/j.jogoh.2018.10.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/11/2018] [Accepted: 10/17/2018] [Indexed: 10/28/2022]
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Kalem Z, Namlı Kalem M, Bakırarar B, Kent E, Gurgan T. Natural cycle versus hormone replacement therapy cycle in frozen-thawed embryo transfer. Saudi Med J 2019; 39:1102-1108. [PMID: 30397709 PMCID: PMC6274666 DOI: 10.15537/smj.2018.11.23299] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To compare implantation rates, clinical pregnancy rates and live birth rates associated with natural and hormone replacement therapy (HRT) methods of endometrial preparation in frozen-thawed embryo transfer (FET) cycles. Methods: The results of 108 natural cycles and 224 HRT cycles of FET transfers performed in a private in vitro fertilization (IVF) center between June 2013 and August 2015 were retrospectively compared with respect to implantation rate, clinical pregnancy rate, and live birth rate. Results: A total of 144 embryos were transferred in 108 natural cycles and 357 embryos were transferred in 224 HRT cycles. No statistically significant differences were found in the implantation rate (p=0.796), clinical pregnancy rate per cycle (p=0.900), clinical pregnancy rate per transferred embryo (p=0.283), live birth rate per cycle (p=0.821), or live birth rate per transferred embryo (p=0.481) between the 2 groups. Conclusion: This study showed no difference between the implantation rate, clinical pregnancy rate or live birth rate between the natural cycle group and HRT cycle group. These results may provide clinicians with more freedom to individualize patient treatment, particularly with respect to the selection of the endometrial preparation method, if these results are supported by large randomized controlled studies in the future.
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Affiliation(s)
- Ziya Kalem
- Department of IVF, Gurgan Clinic, IVF and Women Health Center, Liv Hospital Ankara, Turkey. E-mail.
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Li S, Li Y. Administration of a GnRH agonist during the luteal phase frozen-thawed embryo transfer cycles: a meta-analysis. Gynecol Endocrinol 2018; 34:920-924. [PMID: 29996682 DOI: 10.1080/09513590.2018.1480714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
At present, the precise role of GnRH agonists during the luteal phase remains uncertain. In the present study, a meta-analysis was used to evaluate the effect of administering a GnRH agonist to during the luteal phase in patients undergoing FET cycles. A literature review was carried out by searching the current content of MEDLINE, Embase, the Cochrane Controlled Trials Register and Ovid. We particularly focused upon implantation rate, CPR per transfer, and ongoing pregnancy rate. All of the trials analyzed involved a GnRH agonist administered during the luteal phase. Six trials involving 1137 women were included in our meta-analysis. All of the cycles analyzed exhibited significantly higher implantation rates, clinical pregnancy rates, and ongoing pregnancy rates in the group of patients administered with a GnRH agonist during the luteal phase compared with the control group that did not receive a GnRH agonist during the luteal phase. Our data, therefore, demonstrate that the administration of a GnRH agonist during the luteal phase can significantly increase clinical pregnancy and ongoing pregnancy rates in FET cycles. The implantation rates, clinical pregnancy rates, and ongoing pregnancy rates can significantly increase in the group of patients administered with a GnRH agonist in natural cycle FET.
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Affiliation(s)
- Shuyi Li
- a Department of Reproductive Medicine, Xiangya Hospital , Central South University , Changsha , Hunan , PR China
| | - Yanping Li
- a Department of Reproductive Medicine, Xiangya Hospital , Central South University , Changsha , Hunan , PR China
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Kirshenbaum M, Ben-David A, Zilberberg E, Elkan-Miller T, Haas J, Orvieto R. Influence of seasonal variation on in vitro fertilization success. PLoS One 2018; 13:e0199210. [PMID: 29975717 PMCID: PMC6033407 DOI: 10.1371/journal.pone.0199210] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/04/2018] [Indexed: 11/21/2022] Open
Abstract
Objective To evaluate the influence of seasonal variation on in vitro fertilization (IVF) outcome in a large cohort population. Methods & materials A total of 5,765 IVF cycles conducted in Sheba medical center between 2013 and 2016 were retrospectively analyzed. The treatment cycles included 4214 ovarian stimulation and ovum pick up (OPU) cycles of which 3020 resulted in fresh embryo transfer and 1551 vitrified- warmed cycles of which1400 resulted in warmed embryo transfer. Cycles were assigned to seasons according to the date of OPU for fresh embryo transfer cycles or according to the date of embryo warming for vitrified warmed embryo transfer cycles. Results There were no statistically significant differences between the calendar months or seasons concerning the number of oocytes retrieved or fertilization rate in the fresh cycles. Throughout the 4 years of the study, the monthly clinical pregnancy rate fluctuated between 18.2% and 27.9% per fresh embryo transfer (mean 23.3%) and between 17.7% and 29.4% per vitrified warmed embryo transfer (mean 23%). These fluctuations did not follow any specific seasonal pattern. Conclusions Our study did not demonstrate any significant influence of the calendar months or seasons on the clinical pregnancy rates of fresh or vitrified warmed embryo transfers. It might be speculated that the complete pharmaceutical control of the ovarian and endometrial function, as well as the homogeneous treatments, procedures and laboratory equipment used during the study period have lowered the influence of seasonal effect on IVF treatment outcome.
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Affiliation(s)
- Michal Kirshenbaum
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- * E-mail:
| | - Alon Ben-David
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Zilberberg
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Elkan-Miller
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jigal Haas
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raoul Orvieto
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel-Aviv University, Israel
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Groenewoud ER, Cohlen BJ, Macklon NS. Programming the endometrium for deferred transfer of cryopreserved embryos: hormone replacement versus modified natural cycles. Fertil Steril 2018; 109:768-774. [DOI: 10.1016/j.fertnstert.2018.02.135] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 02/13/2018] [Accepted: 02/19/2018] [Indexed: 12/01/2022]
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Agha-Hosseini M, Hashemi L, Aleyasin A, Ghasemi M, Sarvi F, Shabani Nashtaei M, Khodarahmian M. Natural cycle versus artificial cycle in frozen-thawed embryo transfer: A randomized prospective trial. Turk J Obstet Gynecol 2018; 15:12-17. [PMID: 29662710 PMCID: PMC5894530 DOI: 10.4274/tjod.47855] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/03/2018] [Indexed: 01/20/2023] Open
Abstract
Objective: To investigate whether there was a difference in pregnancy outcomes between modified natural cycle frozen-thawed embryo transfer (NC-FET) cycles and artificial cycles (AC)-FET in women who all had regular menstrual cycles. Materials and Methods: One hundred seventy patients who met the inclusion criteria and had at least two cryopreserved embryos were included in a prospective randomized controlled trial. Eighty-five patients were randomized based on Bernoulli distribution into the following two groups: 1) Modified NC-FET using human chorionic gonadotropin for ovulation induction and 2) AC-FET, in which endometrial timing was programmed with estrogen and progesterone. The main studied outcome measure was the clinical pregnancy rate per cycle. Results: No significant differences were found between the two groups with regard to the chemical, clinical, and ongoing pregnancy rates (48.2% vs 45.9%, p>0.05; 38.9% vs 35.3%, p>0.05; and 37.6% vs 34.1%, p>0.05, respectively), as well as the live birth or miscarriage rates per cycle (35.3% vs 31.8%, p>0.05; and 1.2% vs 1.2%, p>0.05, respectively). Conclusion: These findings suggest that although both FET protocols are equally effective in terms of pregnancy outcomes in women with regular menstrual cycles, NC-FET is more favorable because it requires no medication, has no adverse events, and has a significant cost reduction.
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Affiliation(s)
- Marzieh Agha-Hosseini
- Tehran University of Medical Sciences Faculty of Medicine, Shariati Hospital, Department of Infertility, Tehran, Iran
| | - Leila Hashemi
- Tehran University of Medical Sciences Faculty of Medicine, Shariati Hospital, Department of Infertility, Tehran, Iran
| | - Ashraf Aleyasin
- Tehran University of Medical Sciences Faculty of Medicine, Shariati Hospital, Department of Infertility, Tehran, Iran
| | - Marzieh Ghasemi
- Zahedan University of Medical Sciences, Aliebneabitaleb Hospital, Pregnancy Health Research Center, Department of Obstetrics and Gynecology, Zahedan, Iran
| | - Fatemeh Sarvi
- Zahedan University of Medical Sciences, Aliebneabitaleb Hospital, Pregnancy Health Research Center, Department of Obstetrics and Gynecology, Zahedan, Iran
| | - Maryam Shabani Nashtaei
- Tehran University of Medical Sciences Faculty of Medicine, Shariati Hospital, Department of Infertility, Tehran, Iran
| | - Mahshad Khodarahmian
- Tehran University of Medical Sciences Faculty of Medicine, Department of Anatomy, Tehran, Iran
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Cardellicchio L, Reschini M, Paffoni A, Guarneri C, Restelli L, Somigliana E, Vegetti W. Frozen-thawed blastocyst transfer in natural cycle: feasibility in everyday clinical practice. Arch Gynecol Obstet 2017; 295:1509-1514. [PMID: 28455581 DOI: 10.1007/s00404-017-4383-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 04/25/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE Transfer of frozen-thawed embryos in natural cycle is gaining consensus but evidence on this approach is scanty. The aim of this study is reporting on the feasibility of this type of policy in everyday clinical practice. METHODS We retrospectively selected all women undergoing the procedure between July 2013 and December 2014. During the study period, women were systematically scheduled for natural cycle if they referred regular menstrual cycles. Hormone replacement therapy (HRT) was conversely prescribed if the woman had irregular menstrual cycles or if the monitoring of the natural cycle failed. The analysis exclusively focussed on the first cycle per woman. RESULTS Overall, 251 women were selected. HRT was initially chosen in 52 women, leaving 199 women suitable for the natural cycle. This procedure could be performed in 194 of these women (97%, 95% CI 95-99%). Two additional women initially allocated to HRT ultimately performed the blastocyst transfer with natural cycle. Overall, 196 were thus treated with natural cycle (78%, 95% CI 73-83%). The basal characteristics of the women who did and did not undergo natural cycles were similar with the exceptions of serum FSH (p < 0.001) and AMH (p = 0.03). The live birth rate did not also differ (34% versus 31%, p = 0.63). Characteristics of women treated with the natural cycle who did (n = 67) and did not (n = 129) achieve a live birth did not differ. CONCLUSION Frozen-thawed blastocyst transfer in natural cycle can be successfully performed in the vast majority of women.
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Affiliation(s)
- Lucia Cardellicchio
- Infertility Unit, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Via Fanti 6, 20122, Milan, Italy
- Università degli Studi di Milano, Milan, Italy
| | - Marco Reschini
- Infertility Unit, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Via Fanti 6, 20122, Milan, Italy.
| | - Alessio Paffoni
- Infertility Unit, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Via Fanti 6, 20122, Milan, Italy
| | - Cristina Guarneri
- Infertility Unit, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Via Fanti 6, 20122, Milan, Italy
| | - Liliana Restelli
- Infertility Unit, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Via Fanti 6, 20122, Milan, Italy
| | - Edgardo Somigliana
- Infertility Unit, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Via Fanti 6, 20122, Milan, Italy
- Università degli Studi di Milano, Milan, Italy
| | - Walter Vegetti
- Infertility Unit, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Via Fanti 6, 20122, Milan, Italy
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Yarali H, Polat M, Mumusoglu S, Yarali I, Bozdag G. Preparation of endometrium for frozen embryo replacement cycles: a systematic review and meta-analysis. J Assist Reprod Genet 2016; 33:1287-1304. [PMID: 27549760 DOI: 10.1007/s10815-016-0787-0] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 07/29/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the best protocol to prepare endometrium for frozen embryo replacement (FER) cycles. METHODS This study is a systematic review and meta-analysis. Following PubMed and OvidSP search, a total of 1166 studies published after 1990 were identified following removal of duplicates. Following exclusion of studies not matching our inclusion criteria, a total of 33 studies were analyzed. Primary outcome measure was live birth. The following protocols, including true natural cycle (tNC), modified natural cycle (mNC), artificial cycle (AC) with or without suppression, and mild ovarian stimulation (OS) with gonadotropin (Gn) or aromatase inhibitor (AI), were compared. RESULTS No statistically significant difference for both clinical pregnancy and live birth was noted between tNC and mNC groups. When tNC and AC without suppression groups are compared, there was a statistically significant difference in clinical pregnancy rate in favor of tNC, whereas it failed to reach statistical significance for live birth. When tNC and AC with suppression groups are compared, there was a statistically significant difference in live birth rate favoring the latter. Similar pregnancy outcome was noted among mNC versus AC with or without suppression groups. Similarly, no difference in clinical pregnancy and live birth was noted when ACs with or without suppression groups are compared. CONCLUSIONS There is no consistent superiority of any endometrial preparation for FER. However, mNC has several advantages (being patient-friendly; yielding at least equivalent or better pregnancy rates when compared with tNC and AC with or without suppression; may not require LPS). Mild OS with Gn or AI may be promising.
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Affiliation(s)
- Hakan Yarali
- Department of Obstetric and Gynecology, Hacettepe University School of Medicine, 06100, Ankara, Turkey. .,Anatolia IVF and Women Health Centre, Ankara, Turkey.
| | - Mehtap Polat
- Anatolia IVF and Women Health Centre, Ankara, Turkey
| | - Sezcan Mumusoglu
- Department of Obstetric and Gynecology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Irem Yarali
- Anatolia IVF and Women Health Centre, Ankara, Turkey
| | - Gurkan Bozdag
- Department of Obstetric and Gynecology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
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Guan Y, Fan H, Styer AK, Xiao Z, Li Z, Zhang J, Sun L, Wang X, Zhang Z. A modified natural cycle results in higher live birth rate in vitrified-thawed embryo transfer for women with regular menstruation. Syst Biol Reprod Med 2016; 62:335-42. [DOI: 10.1080/19396368.2016.1199064] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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