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The use of preimplantation genetic testing for aneuploidy: a committee opinion. Fertil Steril 2024:S0015-0282(24)00241-3. [PMID: 38762806 DOI: 10.1016/j.fertnstert.2024.04.013] [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: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 05/20/2024]
Abstract
The use of preimplantation genetic testing for aneuploidy (PGT-A) in the United States has been increasing steadily. Moreover, the underlying technology used for 24-chromosome analysis continues to evolve rapidly. The value of PGT-A as a routine screening test for all patients undergoing in vitro fertilization has not been demonstrated. Although some earlier single-center studies reported higher live-birth rates after PGT-A in favorable-prognosis patients, recent multicenter, randomized control trials in women with available blastocysts concluded that the overall pregnancy outcomes via frozen embryo transfer were similar between PGT-A and conventional in vitro fertilization. The value of PGT-A to lower the risk of clinical miscarriage is also unclear, although these studies have important limitations. This document replaces the document of the same name, last published in 2018.
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Luo XF, Wu HL, Ji XR, Tang YL, Zhou WJ, Huang ZH, Liu Q, Fan LQ, Huang C, Zhu WB. Comparison of Clinical Outcomes, Risks, and Costs for 20,910 Donor In Vitro Fertilization and 16,850 Donor Artificial Insemination Treatment Cycles: A Retrospective Analysis in China. J Clin Med 2023; 12:jcm12030954. [PMID: 36769601 PMCID: PMC9917547 DOI: 10.3390/jcm12030954] [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: 12/17/2022] [Revised: 01/16/2023] [Accepted: 01/21/2023] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To evaluate the effectiveness of donor in vitro fertilization (IVF-D) and donor artificial insemination (AI-D) in clinical outcomes, risks, and costs. METHODS This study analyzed the cycle changes and clinical outcomes in 20,910 IVF-D and 16,850 AI-D cycles between 2013 and 2021 in the Reproductive and Genetic Hospital of CITIC-Xiangya. A cost-effectiveness analysis was performed to evaluate the costs per couple and per live birth cycle in the two treatment groups. RESULTS IVF-D had higher pregnancy and live birth rates than AI-D (p < 0.001). The cumulative pregnancy and live birth rates for three AI-D cycles were 41.01% and 32.42%, respectively, higher than the rates for one or two AI-D cycles. The multiple birth and birth defect rate of AI-D was lower than that of IVF-D significantly. IVF-D mean cost per couple was higher than that of AI-D (CNY32,575 vs. CNY11,062, p < 0.001), with a mean cost difference of CNY21,513 (95% confidence interval, CNY20,517-22,508). The mean costs per live birth cycle for IVF-D and AI-D were CNY49,411 and CNY31,246, respectively. CONCLUSION AI-D is more cost-effective and poses a lower risk for infertility couples than IVF-D, and patients should undergo three AI-D cycles to obtain the highest success rate.
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Affiliation(s)
- Xue-Feng Luo
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha 410006, China
- Institute of Reproductive and Stem Cell Engineering, Basic Medicine College, Central South University, Changsha 410000, China
| | - Hui-Lan Wu
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha 410006, China
| | - Xi-Ren Ji
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha 410006, China
- Institute of Reproductive and Stem Cell Engineering, Basic Medicine College, Central South University, Changsha 410000, China
| | - Yu-Lin Tang
- Institute of Reproductive and Stem Cell Engineering, Basic Medicine College, Central South University, Changsha 410000, China
| | - Wen-Jun Zhou
- Institute of Reproductive and Stem Cell Engineering, Basic Medicine College, Central South University, Changsha 410000, China
| | - Zeng-Hui Huang
- Institute of Reproductive and Stem Cell Engineering, Basic Medicine College, Central South University, Changsha 410000, China
| | - Qian Liu
- Institute of Reproductive and Stem Cell Engineering, Basic Medicine College, Central South University, Changsha 410000, China
| | - Li-Qing Fan
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha 410006, China
- Institute of Reproductive and Stem Cell Engineering, Basic Medicine College, Central South University, Changsha 410000, China
| | - Chuan Huang
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha 410006, China
- Institute of Reproductive and Stem Cell Engineering, Basic Medicine College, Central South University, Changsha 410000, China
- Correspondence: (C.H.); (W.-B.Z.)
| | - Wen-Bing Zhu
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha 410006, China
- Institute of Reproductive and Stem Cell Engineering, Basic Medicine College, Central South University, Changsha 410000, China
- Correspondence: (C.H.); (W.-B.Z.)
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Gursu T, Goksever Celik H, Eraslan A, Angun B, Ozaltin S, Yeh J, Bastu E. Impact of endometrial thickness change in response to progesterone on live birth rates embryo transfers with fresh oocyte donation cycles. J OBSTET GYNAECOL 2022; 42:3260-3267. [PMID: 35983690 DOI: 10.1080/01443615.2022.2112022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Endometrial thickness (ENT) measurements are important to evaluate endometrial receptivity. The effect of endometrial thickness on pregnancy outcomes has been discussed for many years with conflicting results. The aim of our study was to find out the effect of endometrial thickness (ENT) change in response to progesterone on pregnancy outcomes in embryo transfer (ET) of fresh oocyte donation (OD) recipients. The study was designed retrospectively including 134 embryo transfers with fresh OD recipients. ENT was measured by ultrasonography (USG) on the day of initial progesterone administration (ENT1) and on ET day (ENT2). The primary outcome was to determine any correlation between the ENT change and pregnancy outcomes. ENT increased in 56.7% of cases and decreased in 43.4%. Clinical pregnancy rate (CPR) in recipients with increased ENT was 76.3%, and live birth rate (LBR) was 72.4%. CPR in recipients with decreased ENT was 69.0% and LBR was 65.5%. There was no significant difference between recipients with either increased or decreased ENT regarding CPR and LBR (p = .225 and p = .253, respectively). Our study revealed that ENT change after 6 days of progesterone administration, whether increased or decreased, does not have any significant effect on LBR and CPR in fresh OD recipients.IMPACT STATEMENTWhat is already known on this subject? Measurement of endometrial thickness is beneficial to determine the endometrial receptivity. However, there is controversy in the literature regarding the usefulness of measuring endometrial thickness.What do the results of this study add? To the best of our knowledge, this is the first study performed with fresh oocyte donation cycles with large number of recipients for live birth rate outcomes in the literature so far. In this study, we sought to assess the impact of endometrial thickness change, in response to 6 days of progesterone administration, on live birth rate and clinical pregnancy rate in embryo transfer of fresh oocyte donation recipients. We did not find no significant effect of endometrial thickness change on live birth rate when fresh young donor oocytes are fertilised with sperms having normal parameters, and implanted in oestrogen and progesterone primed endometrium.What are the implications of these findings for clinical practice and/or further research? Measurement of endometrial thickness in patients under infertility treatment provides little benefit to clinical outcomes.
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Affiliation(s)
- Turkan Gursu
- Department of Obstetrics and Gynecology, University of Health Sciences, Istanbul Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Hale Goksever Celik
- Department of Obstetrics and Gynecology, Acibadem Fulya Hospital, Istanbul, Turkey
| | - Alper Eraslan
- Department of Reproductive Endocrinology and Infertility, Dunya IVF Center, Kyrenia, Cyprus
| | - Berk Angun
- Department of Reproductive Endocrinology and Infertility, Dunya IVF Center, Kyrenia, Cyprus
| | - Selin Ozaltin
- Department of Obstetrics and Gynecology, Acibadem Mehmet Ali Aydinlar University Faculty of Medicine, Istanbul, Turkey
| | - John Yeh
- Department of Obstetrics and Gynecology, Harvard Medical School, Boston, MA, USA
| | - Ercan Bastu
- Nesta Clinic, Istanbul, Turkey.,UMass Chan Medical School, Worcester, MA, USA
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Rasouli MA, Roberts HE, Jackson DN. Genetic counseling decisions in gestational carrier pregnancies. J Assist Reprod Genet 2022; 39:1249-1252. [PMID: 35377088 DOI: 10.1007/s10815-022-02483-3] [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: 01/27/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Pregnancies conceived as contracted gestational carriers are a relatively new phenomenon for reproductive. Since the intended parents control genetic screening decisions, there may be differences in genetic decisions made for gestational carrier (GC) in vitro fertilization (IVF) pregnancies as compared to traditional non-gestational carrier IVF pregnancies. Our goal was to investigate the frequency and types of these genetic testing decisions. METHODS We performed a retrospective study of GC pregnancies counseled at a private maternal-fetal medicine practice between January 2006 and January 2021. Inclusion criteria were pregnancies that completed counseling with a certified genetic counselor and obtained high-resolution imaging. Controls were non-GC IVF pregnancies seen in the same period matched by parity, estimated delivery date (EDD), and the oocyte age utilized in conception. Statistical analysis included patient demographics, pre-implantation genetic testing (PGT-A) frequency and results, ultrasound imaging results, and the frequency with results of prenatal genetic screening (first or second-trimester serum screens), non-invasive prenatal testing (NIPT), or diagnostic testing (chorionic venous sampling (CVS) or amniocentesis). RESULTS One hundred and ninety one gestational carrier pregnancies were identified and 167 met inclusion criteria. Gestational carrier pregnancies were significantly more likely to pursue PGT-A, PGT-A with NIPT, first-trimester screening, and second-trimester screening. There were no differences in rates of amniocentesis or CVS over controls. CONCLUSIONS Regarding genetic counseling and screening options, our series is the first to demonstrate that gestational carrier parents seek additional genetic counseling resources, even with reassuring PGT-A and ultrasound.
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Affiliation(s)
- Melody A Rasouli
- Department of Obstetrics and Gynecology, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, 1701 W Charleston Blvd., Ste. 290, Las Vegas, NV, 89102, USA.
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