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Sciorio R, Tramontano L, Campos G, Greco PF, Mondrone G, Surbone A, Greco E, Talevi R, Pluchino N, Fleming S. Vitrification of human blastocysts for couples undergoing assisted reproduction: an updated review. Front Cell Dev Biol 2024; 12:1398049. [PMID: 38827525 PMCID: PMC11140474 DOI: 10.3389/fcell.2024.1398049] [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: 03/08/2024] [Accepted: 04/25/2024] [Indexed: 06/04/2024] Open
Abstract
Over the past 40 years there has been a worldwide critical change in the field of assisted reproduction technology (ART), leading to the increased application of single blastocyst transfer, which is extremely important to avoid the risks of multiple pregnancy and associated complications for both mother and babies. Indeed, advancements in ART over the last few decades have been obtained thanks to several improvements, including ovarian stimulation, embryo culture conditions and, of course, progress in cryopreservation methods, especially with the application of vitrification. The ability to cryopreserve human embryos has improved significantly with vitrification compared to the initially adopted slow-freezing procedures. Since the introduction of vitrification, it has become the gold standard method to effectively cryopreserve human blastocysts. However, some new protocols are now being explored, such as the short warming procedure and even shorter exposure to the equilibration solution before vitrification, which seem to provide optimal results. Therefore, the main aim of the current narrative review, will be to illustrate the benefit of vitrification as an effective method to cryopreserve the human blastocyst and to illustrate new protocols and variations which in future may increase the performance of vitrification protocols.
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Affiliation(s)
- Romualdo Sciorio
- Fertility Medicine and Gynaecological Endocrinology Unit, Department Woman Mother Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Luca Tramontano
- Département de Gynécologie-Obstétrique, Réseau Hospitalier Neuchâtelois, Neuchâtel, Switzerland
| | - Gerard Campos
- Fertility Geisinger Medical Center, Women’s Health Fertility Clinic, Danville, PA, United States
- GIREXX Fertility Clinics, Girona-Barcelona, Spain
| | | | | | - Anna Surbone
- Fertility Medicine and Gynaecological Endocrinology Unit, Department Woman Mother Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Ermanno Greco
- Villa Mafalda, Centre for Reproductive Medicine, Rome, Italy
- Department of Obstetrics and Gynecology, UniCamillus, International Medical University, Rome, Italy
| | - Riccardo Talevi
- Dipartimento di Biologia Strutturale e Funzionale, Universita’ di Napoli ‘Federico II’, Complesso Universitario di Monte S, Napoli, Italy
| | - Nicola Pluchino
- Fertility Medicine and Gynaecological Endocrinology Unit, Department Woman Mother Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Steven Fleming
- Discipline of Anatomy and Histology, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia
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Sciorio R, Pluchino N, Fuller BJ. Review of human oocyte cryopreservation in ART programs: Current challenges and opportunities. Cryobiology 2023; 113:104590. [PMID: 37804949 DOI: 10.1016/j.cryobiol.2023.104590] [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: 05/16/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/09/2023]
Abstract
Oocyte cryopreservation has notably increased in recent times, to become an essential part of clinical infertility treatment. Since the 1980s, many improvements in oocyte cryopreservation (OC) have been adopted, including the great advance with the application of vitrification. The commonly used vitrification protocol applies different cryoprotectants (Ethylene glycol and/or DMSO and/or PROH and sucrose and/or Trehalose) and two different steps: firstly, exposure in equilibration solution for 5-15 min, followed by a vitrification solution for 60-90 s at room temperature. The warming method includes a first step for 1 min at 37 °C and 3 subsequent steps at room temperature to remove the cryoprotectant for a total of 9-12 min. In addition, biosafety is a critical aspect to mention, and it is related to devices used during the vitrification, mainly in terms of whether the biological vitrified material comes in direct contact with liquid nitrogen (open vitrification) or not (closed vitrification), where LN2 may contain potentially contaminating viruses or pathogens. Furthermore, during early development major waves of epigenetic reprogramming take place. Recent literature suggests that epigenetic and transcriptomic profiles are sensitive to the stress induced by vitrification, including osmotic shock, temperature, rapid changes of pH and toxicity of cryoprotectants. It is, therefore, important to better understand the potential perturbations of epigenetic modifications that may be associated with the globally used vitrification methods. Therefore, we here discuss the benefits and efficiency of human oocyte vitrification; we also review the evidence surrounding oocyte cryopreservation-related epigenetic modifications and potential epigenetic dysregulations, together with long-term consequences for offspring health.
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Affiliation(s)
- Romualdo Sciorio
- Fertility Medicine and Gynaecological Endocrinology Unit, Department Woman-Mother-Child, CHUV-Lausanne University Hospital, 1011, Lausanne, Switzerland.
| | - Nicola Pluchino
- Fertility Medicine and Gynaecological Endocrinology Unit, Department Woman-Mother-Child, CHUV-Lausanne University Hospital, 1011, Lausanne, Switzerland
| | - Barry J Fuller
- Division of Surgery & Interventional Science, University College London Medical School, London, UK
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Kornfield MS, Gurley SB, Vrooman LA. Increased Risk of Preeclampsia with Assisted Reproductive Technologies. Curr Hypertens Rep 2023; 25:251-261. [PMID: 37303020 DOI: 10.1007/s11906-023-01250-8] [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] [Accepted: 05/19/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE OF REVIEW We summarized recent available data to assess the association between assisted reproductive technology (ART) and risk for preeclampsia. RECENT FINDINGS The majority of clinical studies supporting the association of preeclampsia and ART are retrospective. Published data from both clinical and pre-clinical studies suggest specific ART procedures may contribute to the increased risk, including in vitro embryo handling and development, hormone stimulation, transfer cycle types, and use of donor oocytes/embryos. Potential mechanisms include epigenetic aberrations leading to abnormal placentation, absence of factors secreted by the corpus luteum, and immunologic responses to allogenic gametes. There is an increased risk of preeclampsia following ART. Treatment plans that favor reduced preeclampsia risk should be considered for ART pregnancies. To make ART pregnancies safer, additional clinical and animal model studies are needed to elucidate the underpinnings of this risk association.
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Affiliation(s)
- Molly S Kornfield
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Susan B Gurley
- Division of Nephrology & Hypertension, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Lisa A Vrooman
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, 505 NW 185th Ave, Beaverton, OR, USA.
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Niu Y, Suo L, Zhao D, Wang Y, Miao R, Zou J, Han X, Chen ZJ, Li Y, Wei D. Is artificial endometrial preparation more associated with early-onset or late-onset preeclampsia after frozen embryo transfer? J Assist Reprod Genet 2023; 40:1045-1054. [PMID: 37000343 PMCID: PMC10239427 DOI: 10.1007/s10815-023-02785-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/21/2023] [Indexed: 04/01/2023] Open
Abstract
PURPOSE To explore whether the risks of early- or late-onset preeclampsia vary among frozen embryo transfer (FET) with different regimens for endometrial preparation and fresh embryo transfer (FreET). METHODS We retrospectively included a total of 24129 women who achieved singleton delivery during their first cycles of in vitro fertilization (IVF) between January 2012 and March 2020. The risks of early- and late-onset preeclampsia after FET with endometrial preparation by natural ovulation cycles (FET-NC) or by artificial cycles (FET-AC) were compared to that after FreET. RESULTS After adjustment via multivariable logistic regression, the total risk of preeclampsia was higher in the FET-AC group compared to the FreET group [2.2% vs. 0.9%; adjusted odds ratio (aOR): 2.00; 95% confidence interval (CI): 1.45-2.76] and FET-NC group (2.2% vs. 0.9%; aOR: 2.17; 95% CI: 1.59-2.96).When stratified by the gestational age at delivery based on < 34 weeks or ≥ 34 weeks, the risk of late-onset preeclampsia remained higher in the FET-AC group than that in the and FreET group (1.8% vs. 0.6%; aOR: 2.56; 95% CI: 1.83-3.58) and the FET-NC group (1.8% vs. 0.6%; aOR: 2.63; 95% CI: 1.86-3.73). We did not find a statistically significant difference in the risk of early-onset preeclampsia among the three groups. CONCLUSIONS An artificial regimen for endometrial preparation was more associated with an increased risk of late-onset preeclampsia after FET. Given that FET-AC is widely used in clinical practice, the potential maternal risk factors for late-onset preeclampsia when using the FET-AC regimen should be further explored, considering the maternal origin of late-onset preeclampsia.
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Affiliation(s)
- Yue Niu
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Medical Integration and Practice Center, Shandong University, No. 44 Wenhua Xi Rd, Jinan, 250012, Shandong, China
| | - Lu Suo
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Medical Integration and Practice Center, Shandong University, No. 44 Wenhua Xi Rd, Jinan, 250012, Shandong, China
| | - Dingying Zhao
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Medical Integration and Practice Center, Shandong University, No. 44 Wenhua Xi Rd, Jinan, 250012, Shandong, China
| | - Yuhuan Wang
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Medical Integration and Practice Center, Shandong University, No. 44 Wenhua Xi Rd, Jinan, 250012, Shandong, China
| | - Ruolan Miao
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Medical Integration and Practice Center, Shandong University, No. 44 Wenhua Xi Rd, Jinan, 250012, Shandong, China
| | - Jialin Zou
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Medical Integration and Practice Center, Shandong University, No. 44 Wenhua Xi Rd, Jinan, 250012, Shandong, China
| | - Xinwei Han
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Medical Integration and Practice Center, Shandong University, No. 44 Wenhua Xi Rd, Jinan, 250012, Shandong, China
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Medical Integration and Practice Center, Shandong University, No. 44 Wenhua Xi Rd, Jinan, 250012, Shandong, China
| | - Yan Li
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.
- Medical Integration and Practice Center, Shandong University, No. 44 Wenhua Xi Rd, Jinan, 250012, Shandong, China.
| | - Daimin Wei
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.
- Medical Integration and Practice Center, Shandong University, No. 44 Wenhua Xi Rd, Jinan, 250012, Shandong, China.
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Daniel Juárez J, Marco-Jiménez F, Vicente JS. Effects of Rederivation by Embryo Vitrification on Performance in a Rabbit Paternal Line. FRONTIERS IN ANIMAL SCIENCE 2022. [DOI: 10.3389/fanim.2022.909446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Embryo cryopreservation is a valuable tool for maintaining genetic variability and preserving breeds and lines, allowing to assess the response to selection and enabling genetic diffusion. This study aimed to evaluate the impact of rederivation by embryo vitrification and transfer procedures on the growth and reproductive traits in a paternal rabbit line selected for average daily gain from weaning (28 days old) to fattening (63 days old). The rederived population was bred over two generations at the same time as a control population of this paternal line and, growth trait parameters (weights at weaning, end of the fattening period, and average daily gain) and reproductive performance (kindling rate, litter size at birth and at weaning) were compared with three filial generations. Moreover, fetal growth and litter size components were assessed for the second generation by ultrasonography and laparoscopy. Differences in postnatal growth traits (end of fattening weight and average daily gain) were observed in the three generations assessed. However, fetal growth, litter size components, and reproductive traits did not show significant differences. In conclusion, cryopreservation and embryo transfer processes cause changes in growth traits of reconstituted populations that influence the following generations, without changes in reproductive traits in a paternal line of rabbits.
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Conrad KP, von Versen-Höynck F, Baker VL. Potential role of the corpus luteum in maternal cardiovascular adaptation to pregnancy and preeclampsia risk. Am J Obstet Gynecol 2022; 226:683-699. [PMID: 34437863 DOI: 10.1016/j.ajog.2021.08.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 11/01/2022]
Abstract
Studies in the gravid rat model revealed a key role for the corpus luteal hormone, relaxin, in the maternal circulatory changes of early pregnancy epitomized by profound systemic vasodilation and increased arterial compliance. To determine whether the corpus luteum may play a similar role in human pregnancy, women who conceived by in vitro fertilization were studied. Implementation of artificial (programmed) cycles for embryo transfers, which precluded the formation of a corpus luteum, was associated with notable attenuation of the gestational rise in cardiac output and fall in carotid-femoral pulse wave velocity (reflecting impairment of arterial dilation and increased compliance, respectively) and deficiencies in other cardiovascular changes normally observed during the first trimester. Cardiac output and carotid-femoral pulse wave velocity were restored after the first trimester of pregnancy, consistent with rescue by placental vasodilators, such as placental growth factor. In addition, a potential role of corpus luteal factors in reducing the risk of developing preeclampsia was hypothesized. In most single and multiple center, prospective and retrospective cohort (and registry) studies, the risk of developing preeclampsia and preeclampsia with severe features was increased specifically in women undergoing autologous frozen embryo transfer in artificial cycles without the formation of a corpus luteum relative to natural, modified natural, stimulated, or controlled ovarian stimulation cycles and spontaneous pregnancies-all associated with the formation of at least 1 corpus luteum. Taken together, these observational studies are sufficiently compelling to warrant randomized clinical trials comparing preeclampsia risk in autologous frozen embryo transfer in natural vs artificial cycles. Impaired endometrial function because of suboptimal hormonal administration is an alternative but not mutually exclusive explanation for increased preeclampsia risk in autologous frozen embryo transfer in artificial cycles. Potential mechanisms by which the corpus luteum may reduce the risk of developing preeclampsia and whether autologous frozen embryo transfer in artificial cycles is associated with increased risk of preterm preeclampsia, term preeclampsia, or both are discussed. Last, suggestions for future investigations are noted.
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Lin Y, Da L, Du S, Chen Q, Chen S, Zheng B. The vitrification system may affect preterm and cesarean delivery rates after single vitrified blastocyst transfer. Syst Biol Reprod Med 2021; 68:113-120. [PMID: 34886718 DOI: 10.1080/19396368.2021.2005717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to investigate the possible effects of different vitrification systems on single vitrified blastocyst transfer cycles. The clinical and birth outcomes of 412 patients who underwent single vitrified blastocyst transfer between January 2018 and June 2020 were retrospectively analyzed and compared between patients who underwent blastocyst vitrification with kit A (group A, 196 patients) and those who underwent blastocyst vitrification with kit B (group B, 216 patients). Clinical outcomes, including the clinical pregnancy rate, ongoing pregnancy rate, early miscarriage rate, late miscarriage rate, ectopic pregnancy rate, twin pregnancy rate, and induced labor rate due to fetal malformation, were not significantly different between the two groups (P > 0.05). The preterm delivery rate among singleton newborns (11.57% vs. 3.23%, P < 0.05) and the cesarean delivery rate were significantly higher in group B than in group A (70.25% vs. 57.26%, P < 0.05). Birth outcomes, including the male-to-female ratio, low-birth-weight rate, macrosomia rate, birth defect rate, newborn gestational age, neonatal body weight, and singleton neonatal body length, were not significantly different (P > 0.05). Our findings suggest that different vitrification systems might differentially affect birth outcomes. Such disparity could reflect differences in kit composition and/or protocol.ABBREVIATIONS: DMSO: dimethyl sulfoxide; ES: equilibration solution; VS: vitrification solution; BMI: body mass index; ICSI: intracytoplasmic sperm injection; OR: odds ratio; CI: confidence interval.
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Affiliation(s)
- Yunhong Lin
- Center of Reproductive Medicine, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Lincui Da
- Center of Reproductive Medicine, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Shengrong Du
- Center of Reproductive Medicine, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Qingfen Chen
- Center of Reproductive Medicine, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Suzhu Chen
- Center of Reproductive Medicine, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Beihong Zheng
- Center of Reproductive Medicine, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
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Antioxidant supplementation of mouse embryo culture or vitrification media support more in-vivo-like gene expression post-transfer. Reprod Biomed Online 2021; 44:393-410. [DOI: 10.1016/j.rbmo.2021.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/08/2021] [Accepted: 11/13/2021] [Indexed: 11/23/2022]
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Barberet J, Romain G, Binquet C, Guilleman M, Bruno C, Ginod P, Chapusot C, Choux C, Fauque P. Do frozen embryo transfers modify the epigenetic control of imprinted genes and transposable elements in newborns compared with fresh embryo transfers and natural conceptions? Fertil Steril 2021; 116:1468-1480. [PMID: 34538459 DOI: 10.1016/j.fertnstert.2021.08.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/02/2021] [Accepted: 08/06/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether the epigenetic control of imprinted genes (IGs) and transposable elements (TEs) differs at birth between fresh or frozen embryo transfers and natural conceptions. DESIGN Prospective study. SETTING University hospital. PATIENT(S) A total of 202 singleton births were divided into three groups: 84 natural pregnancies (controls), 66 in vitro fertilization/intracytoplasmic sperm injection with fresh embryo transfers, and 52 vitro fertilization/intracytoplasmic sperm injection with frozen embryo transfers. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Pyrosequencing was used to assess the DNA methylation profiles of three IGs (H19/IGF2:IG-DMR [two sequences], KCNQ1OT1:TSS-DMR, and SNURF:TSS-DMR) and two TEs (LINE-1 and HERV-FRD) in cord blood and placenta. The quantitative reverse transcriptase polymerase chain reaction was used to study the transcription of three IGs (H19, KCNQ1, and SNRPN) and two TEs (LINE-1 and ORF2). RESULT(S) After adjustment, the placental DNA methylation levels of H19/IGF2 were lower in the fresh embryo transfer group than in the control (H19/IGF2-seq1) and frozen embryo transfer (H19/IGF2-seq2) groups. The DNA methylation rate for LINE-1 was lower in placentas from the fresh embryo transfer group than in placentas from the control and frozen embryo transfer groups and for HERV-FRD compared with controls. In cord blood, DNA methylation levels were not significantly associated with the mode of conception. The relative expression of LINE-1 and ORF2 was decreased in both cord blood and placental tissues from fresh embryo transfer conceptions compared with natural conceptions and frozen embryo transfer conceptions. CONCLUSION(S) Compared with natural conceptions and frozen embryo transfers, fresh embryo transfers were associated with methylation and/or transcription changes in some TEs and IGs, mostly in placental samples, which could indicate altered placental epigenetic regulation resulting from ovarian stimulation protocols.
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Affiliation(s)
- Julie Barberet
- Université Bourgogne Franche-Comté-Equipe Génétique des Anomalies du Développement (GAD), INSERM UMR1231, Dijon, France; Centre Hospitalier Universitaire Dijon-Bourgogne, Laboratoire de Biologie de la Reproduction-CECOS, Dijon, France
| | - Gaelle Romain
- Centre Hospitalier Universitaire Dijon-Bourgogne, Centre d'Investigation Clinique, Module Epidémiologie Clinique/Essais Cliniques (CIC-EC), Dijon, France; INSERM, CIC1432, Module Epidémiologie Clinique, Dijon, France
| | - Christine Binquet
- Centre Hospitalier Universitaire Dijon-Bourgogne, Centre d'Investigation Clinique, Module Epidémiologie Clinique/Essais Cliniques (CIC-EC), Dijon, France; INSERM, CIC1432, Module Epidémiologie Clinique, Dijon, France
| | - Magali Guilleman
- Université Bourgogne Franche-Comté-Equipe Génétique des Anomalies du Développement (GAD), INSERM UMR1231, Dijon, France; Centre Hospitalier Universitaire Dijon-Bourgogne, Laboratoire de Biologie de la Reproduction-CECOS, Dijon, France
| | - Céline Bruno
- Université Bourgogne Franche-Comté-Equipe Génétique des Anomalies du Développement (GAD), INSERM UMR1231, Dijon, France; Centre Hospitalier Universitaire Dijon-Bourgogne, Laboratoire de Biologie de la Reproduction-CECOS, Dijon, France
| | - Perrine Ginod
- Université Bourgogne Franche-Comté-Equipe Génétique des Anomalies du Développement (GAD), INSERM UMR1231, Dijon, France; Centre Hospitalier Universitaire Dijon-Bourgogne, Service de Gynécologie-Obstétrique, Dijon, France
| | - Caroline Chapusot
- Centre Hospitalier Universitaire Dijon-Bourgogne, Plateforme de Génétique des Cancers de Bourgogne, Dijon, France
| | - Cécile Choux
- Université Bourgogne Franche-Comté-Equipe Génétique des Anomalies du Développement (GAD), INSERM UMR1231, Dijon, France; Centre Hospitalier Universitaire Dijon-Bourgogne, Service de Gynécologie-Obstétrique, Dijon, France
| | - Patricia Fauque
- Université Bourgogne Franche-Comté-Equipe Génétique des Anomalies du Développement (GAD), INSERM UMR1231, Dijon, France; Centre Hospitalier Universitaire Dijon-Bourgogne, Laboratoire de Biologie de la Reproduction-CECOS, Dijon, France.
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Sites CK, Bachilova S, Gopal D, Cabral HJ, Coddington CC, Stern JE. Embryo biopsy and maternal and neonatal outcomes following cryopreserved-thawed single embryo transfer. Am J Obstet Gynecol 2021; 225:285.e1-285.e7. [PMID: 33894152 DOI: 10.1016/j.ajog.2021.04.235] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/06/2021] [Accepted: 04/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Contemporary embryo biopsy in the United States involves the removal of several cells from a blastocyst that would become the placenta for preimplantation genetic testing. Embryos are then cryopreserved while patients await biopsy results, with transfers occurring in a subsequent cycle as a single frozen-thawed embryo transfer, if euploid. OBJECTIVE We sought to determine if removal of these cells for preimplantation genetic testing was associated with adverse obstetrical or neonatal outcomes after frozen-thawed single embryo transfer. STUDY DESIGN We linked assisted reproductive technology surveillance data from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System to birth certificates and maternal and neonatal hospitalization discharge diagnoses in Massachusetts from 2014 to 2017, considering only singleton births after frozen-thawed single embryo transfers. We compared outcomes of cycles having embryo biopsy (n=585) to those having no biopsy (n=2191) using chi-square for categorical and binary variables and logistic regression for adjusted odds ratios and 95% confidence intervals, adjusting for mother's age, race, education, parity, body mass index, birth year, insurance, and all infertility diagnoses. RESULTS Considering no biopsy as the reference, there was no difference between groups with respect to preeclampsia (adjusted odds ratio, 0.82; 95% confidence interval, 0.42-1.61; P=.5685); pregnancy-induced hypertension (adjusted odds ratio, 0.85; 95% confidence interval, 0.46-1.59; P=.6146); placental disorders, including placental abruption, placenta previa, placenta accreta, placenta increta, and placenta percreta (adjusted odds ratio, 1.16; 95% confidence interval, 0.60-2.24; P=.6675); preterm birth (adjusted odds ratio, 1.22; 95% confidence interval 0.73-2.03; P=.4418); low birthweight (adjusted odds ratio, 1.12; 95% confidence interval, 0.58-2.15; P=.7355); cesarean delivery (adjusted odds ratio, 1.04; 95% confidence interval, 0.79-1.38; P=.7762); or gestational diabetes mellitus (adjusted odds ratio, 0.83; 95% confidence interval, 0.50-1.38; P=.4734). In addition, there was no difference between the groups for prolonged hospital stay for mothers (adjusted odds ratio, 1.23; 95% confidence interval, 0.83-1.80; P=.3014) or for infants (95% confidence interval, 1.29; 95% confidence interval, 0.72-2.29; P=.3923). CONCLUSION Embryo biopsy for preimplantation genetic testing does not increase the odds for diagnoses related to placentation (preeclampsia, pregnancy-related hypertension, placental disorders, preterm delivery, or low birthweight), maternal conditions (gestational diabetes mellitus), or maternal or infant length of stay after delivery.
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Tarlatzi T, Venetis C, Sassi A, Devreker F, Englert Y, Delbaere A. Higher estradiol levels are associated with lower neonatal birthweight after fresh and frozen embryo transfers. A cohort study of 3631 singleton IVF pregnancies. Gynecol Endocrinol 2021; 37:618-623. [PMID: 33016794 DOI: 10.1080/09513590.2020.1827383] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
AIM To assess the birthweight of neonates conceived after fresh and frozen embryo transfers (FET) and, if different, to investigate whether estradiol levels during the late follicular phase were associated with the observed difference. METHODS Singleton pregnancies from fresh and FET transfers between January 1990 and December 2013 were compared retrospectively. A total of 2885 singleton pregnancies after fresh embryo transfer and 746 after FET were analyzed. Obstetric and neonatal outcomes were compared between fresh and FET cycles. RESULTS The singletons born after FET were found to have a significantly higher birth weight (3313 g), compared to those born after fresh embryo transfer (3143 g); p < .001. The main predictor of this difference was found to be estradiol levels at the end of the follicular phase. The difference in birthweight was inversely correlated to estradiol levels considering all cycles together but also considering fresh and frozen cycles separately. CONCLUSIONS Our study demonstrates a link between high estradiol levels and low birth weight of singletons after IVF both in fresh and frozen-thawed embryo transfer cycles. It provides additional support to the involvement of hyperestrogenemia in the process of implantation and on the subsequent fetal development.
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Affiliation(s)
- Theoni Tarlatzi
- Hôpital Erasme - ULB, Fertility Clinic, Department of Obstetrics and Gynecology, Brussels, Belgium
| | - Christos Venetis
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Asma Sassi
- Hôpital Erasme - ULB, Fertility Clinic, Department of Obstetrics and Gynecology, Brussels, Belgium
| | - Fabienne Devreker
- Hôpital Erasme - ULB, Fertility Clinic, Department of Obstetrics and Gynecology, Brussels, Belgium
| | - Yvon Englert
- Hôpital Erasme - ULB, Fertility Clinic, Department of Obstetrics and Gynecology, Brussels, Belgium
| | - Anne Delbaere
- Hôpital Erasme - ULB, Fertility Clinic, Department of Obstetrics and Gynecology, Brussels, Belgium
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Pereira MM, Mainigi M, Strauss JF. Secretory products of the corpus luteum and preeclampsia. Hum Reprod Update 2021; 27:651-672. [PMID: 33748839 PMCID: PMC8222764 DOI: 10.1093/humupd/dmab003] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/18/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Despite significant advances in our understanding of the pathophysiology of preeclampsia (PE), there are still many unknowns and controversies in the field. Women undergoing frozen-thawed embryo transfer (FET) to a hormonally prepared endometrium have been found to have an unexpected increased risk of PE compared to women who receive embryos in a natural FET cycle. The differences in risk have been hypothesized to be related to the absence or presence of a functioning corpus luteum (CL). OBJECTIVE AND RATIONALE To evaluate the literature on secretory products of the CL that could be essential for a healthy pregnancy and could reduce the risk of PE in the setting of FET. SEARCH METHODS For this review, pertinent studies were searched in PubMed/Medline (updated June 2020) using common keywords applied in the field of assisted reproductive technologies, CL physiology and preeclampsia. We also screened the complete list of references in recent publications in English (both animal and human studies) on the topics investigated. Given the design of this work as a narrative review, no formal criteria for study selection or appraisal were utilized. OUTCOMES The CL is a major source of multiple factors regulating reproduction. Progesterone, estradiol, relaxin and vasoactive and angiogenic substances produced by the CL have important roles in regulating its functional lifespan and are also secreted into the circulation to act remotely during early stages of pregnancy. Beyond the known actions of progesterone and estradiol on the uterus in early pregnancy, their metabolites have angiogenic properties that may optimize implantation and placentation. Serum levels of relaxin are almost undetectable in pregnant women without a CL, which precludes some maternal cardiovascular and renal adaptations to early pregnancy. We suggest that an imbalance in steroid hormones and their metabolites and polypeptides influencing early physiologic processes such as decidualization, implantation, angiogenesis and maternal haemodynamics could contribute to the increased PE risk among women undergoing programmed FET cycles. WIDER IMPLICATIONS A better understanding of the critical roles of the secretory products of the CL during early pregnancy holds the promise of improving the efficacy and safety of ART based on programmed FET cycles.
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Affiliation(s)
- María M Pereira
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Monica Mainigi
- Division of Reproductive Endocrinology and Infertility, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Centre for Research on Reproduction and Women’s Health, University of Pennsylvania, Philadelphia, PA,19104 USA
| | - Jerome F Strauss
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, 23298, USA
- Centre for Research on Reproduction and Women’s Health, University of Pennsylvania, Philadelphia, PA,19104 USA
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Severino AI, Póvoa AM. Frozen Embryo Transfer and Preeclampsia Risk. J Gynecol Obstet Hum Reprod 2021; 50:102167. [PMID: 34015549 DOI: 10.1016/j.jogoh.2021.102167] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/04/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
Worldwide, the use of Assisted Reproductive Technology (ART) has been steadily rising over recent years. With the continuous improvements in cryopreservation techniques and the growing practice of single embryo transfer, the proportion of frozen embryo transfer (FET) cycles has been increasing, therefore raising concern about the safety of this ART technique to both mothers and infants. This review aims to summarize the current evidence regarding the risk of preeclampsia in singleton pregnancies achieved by autologous FET compared to fresh embryo transfer, and to discuss the influence of different protocols used for endometrium preparation in frozen cycles on the risk of this obstetric complication. Several studies have reported a higher risk of hypertensive disorders, including preeclampsia, in pregnancies following FET compared with fresh embryo transfer. Recently, artificial FET cycles, which preclude the development of a corpus luteum, were shown to be associated with an increased preeclampsia risk in comparison with natural and stimulated cycles. Importantly, no difference was found between FET in a modified natural cycle and spontaneous conception. It has been proposed that the absence of the corpus luteum in artificial cycles may, at least partly, contribute to the observed increased risk of preeclampsia. Indeed, the corpus luteum secretes vasoactive hormones, such as relaxin, which are not replaced in artificial cycles, thereby compromising maternal cardiovascular adaptations to pregnancy, resulting in an increased risk of preeclampsia. If these findings are confirmed by a randomized controlled trial, natural, modified natural or stimulated cycles might be preferred over artificial cycles in eligible patients.
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Affiliation(s)
- Ana Isabel Severino
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
| | - Ana Margarida Póvoa
- Department of Gynecology, Unit of Reproductive Medicine, Universitary Hospitalar Center São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; Department of Gynecology, Obstetrics and Pediatrics, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; Institute for Investigation and Innovation in Health, University of Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
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Truong TT, Gardner DK. Antioxidants increase blastocyst cryosurvival and viability post-vitrification. Hum Reprod 2021; 35:12-23. [PMID: 31916568 DOI: 10.1093/humrep/dez243] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/06/2019] [Indexed: 12/27/2022] Open
Abstract
STUDY QUESTION What is the effect of antioxidants acetyl-L-carnitine, N-acetyl-L-cysteine and α-lipoic acid (A3) in vitrification and warming solutions on mouse blastocyst development and viability? SUMMARY ANSWER The combination of three antioxidants in vitrification solutions resulted in mouse blastocysts with higher developmental potential in vitro and increased viability as assessed by both an outgrowth model in vitro and fetal development following uterine transfer. WHAT IS KNOWN ALREADY The antioxidant combination of acetyl-L-carnitine, N-acetyl-L-cysteine and α-lipoic acid present in IVF handling and embryo culture media has significant beneficial effects on mouse embryo and fetal development, especially under oxidative stress. STUDY DESIGN, SIZE, DURATION The study was a laboratory-based analysis of an animal model. Rapid cooling through vitrification was conducted on F1 mouse blastocysts, with antioxidants (A3) supplemented in vitrification and/or warming solutions, followed by culture and embryo transfer. PARTICIPANTS/MATERIALS, SETTINGS, METHODS Pronucleate oocytes were collected and cultured in groups to Day 4 blastocysts. Expanded blastocysts were vitrified and warmed in solutions with and without the A3 antioxidants and cultured for a further 24 h. Blastocyst cell number and allocation, apoptosis and histone acetylation levels were all quantified, and viability through outgrowths and transfers assessed. MAIN RESULTS AND THE ROLE OF CHANCE Mouse blastocysts vitrified with no antioxidants had significantly lower cell numbers (P < 0.001) and higher apoptotic cells (P < 0.05) compared to non-vitrified embryos. Addition of combined A3 antioxidants to the vitrification and warming solutions resulted in a significant increase in inner cell mass cell (ICM) number (P < 0.001) and total cell number (P < 0.01), and an increase in outgrowth area (P < 0.05), which correlated with the increased fetal weight (P < 0.05), crown rump length (P < 0.05) and limb development (P < 0.05) determined following transfer compared to embryos with no antioxidants. Furthermore, while blastocyst vitrification significantly reduced acetylation levels (P < 0.05) compared to non-vitrified embryos, the inclusion of A3 antioxidants helped to ameliorate this. LIMITATIONS, REASONS FOR CAUTION Embryo development was only examined in the mouse. WIDER IMPLICATIONS OF THE FINDINGS Results in this study demonstrate that vitrification and warming of blastocysts have significant detrimental effects on embryo histone acetylation and subsequent viability. The presence of antioxidants in the vitrification solutions helps to alleviate the negative effects of cryopreservation. Our data indicate that antioxidants need to be present in the medium at the time of exposure to increased oxidative stress associated with vitrification and that prior exposure (i.e. during culture or IVF alone) is insufficient to protect cells against cryo-induced injury. Hence, A3 antioxidants may assist in maintaining the viability of vitrified human embryos in ART through the reduction of oxidative stress. STUDY FUNDING/COMPETING INTEREST(S) This work was funded by a research grant from Vitrolife AB (Sweden). The authors have no conflict of interest to declare.
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Affiliation(s)
- Thi T Truong
- School of BioSciences, University of Melbourne, Parkville, Victoria, Australia
| | - David K Gardner
- School of BioSciences, University of Melbourne, Parkville, Victoria, Australia
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Stern JE, Liu CL, Hwang SS, Dukhovny D, Farland LV, Diop H, Coddington CC, Cabral H. Influence of Placental Abnormalities and Pregnancy-Induced Hypertension in Prematurity Associated with Various Assisted Reproductive Technology Techniques. J Clin Med 2021; 10:1681. [PMID: 33919833 PMCID: PMC8070757 DOI: 10.3390/jcm10081681] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Assisted reproductive technology (ART)-treated women exhibit increased risk of premature delivery compared to fertile women. We evaluated whether ART treatment modalities increase prematurity and whether placental abnormalities and pregnancy-induced hypertensive (PIH) disorders mediate these risks. METHOD(S) This retrospective study of ART-treated and fertile deliveries (2004-2017) used an ART-cycle database linked to Massachusetts birth certificates and hospital discharges. Outcomes of late preterm birth (LPTB: 34-36 weeks gestation) and early preterm birth (EPTB: <34 weeks gestation) were compared with term deliveries (≥37 weeks gestation) in ART-treated (linked to the ART database) and fertile (no indicators of infertility or ART) deliveries. ART treatments with autologous oocyte, donor oocyte, fresh or frozen embryo transfer (FET), intracytoplasmic sperm injection (ICSI) and no-ICSI were separately compared to the fertile group. Adjusted odds ratios (AOR) were calculated with multivariable logistic regression: placental abnormalities or PIH were quantified in the pathway as mediators. RESULTS There were 218,320 deliveries: 204,438 fertile and 13,882 ART-treated. All treatment types increased prematurity (AOR 1.31-1.58, LPTB; AOR 1.34-1.48, EPTB). Placental abnormalities mediated in approximately 22% and 38% of the association with LPTB and EPTB, respectively. PIH mediated 25% and 33% of the association with LPTB and EPTB in FET and donor oocyte cycles, more than other treatments (<10% LPTB and <13% EPTB). CONCLUSIONS ART-treatment and all ART modalities increased LPTB and EPTB when compared with fertile deliveries. Placental abnormalities modestly mediated associations approximately equally, while PIH was a stronger mediator in FET and donor oocyte cycles. Reasons for differences require exploration.
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Affiliation(s)
- Judy E. Stern
- Department of Obstetrics & Gynecology, Dartmouth-Hitchcock, Lebanon, NH 03756, USA
| | - Chia-ling Liu
- Bureau of Family Health and Nutrition, Massachusetts Department of Public Health, Boston, MA 02108, USA;
| | - Sunah S. Hwang
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA;
| | - Dmitry Dukhovny
- Division of Neonatology, School of Medicine, Oregon Health & Science University, Portland, OR 97239, USA;
| | - Leslie V. Farland
- Epidemiology and Biostatistics Department, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA;
| | - Hafsatou Diop
- Division of Maternal and Child Health Research and Analysis, Bureau of Family Health and Nutrition Massachusetts Department of Public Health, Boston, MA 02108, USA;
| | - Charles C. Coddington
- Department of Obstetrics and Gynecology, University of North Carolina, Charlotte, NC 28204, USA;
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA;
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Van Reckem M, Blockeel C, Bonduelle M, Buysse A, Roelants M, Verheyen G, Tournaye H, Hes F, Belva F. Health of 2-year-old children born after vitrified oocyte donation in comparison with peers born after fresh oocyte donation. Hum Reprod Open 2021; 2021:hoab002. [PMID: 33634217 PMCID: PMC7892365 DOI: 10.1093/hropen/hoab002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/14/2021] [Indexed: 11/25/2022] Open
Abstract
STUDY QUESTION Does oocyte vitrification adversely affect the health of 2-year-old children compared with peers born after use of fresh oocytes in a donation programme? SUMMARY ANSWER The growth and health of 2-year-old children born after oocyte vitrification are similar to those of peers born after use of fresh oocytes. WHAT IS KNOWN ALREADY Although oocyte vitrification is a well-established procedure in ART, the evidence on its safety for offspring is limited. Currently, no disadvantageous effects of oocyte vitrification have been shown in terms of obstetric and neonatal outcome. However, no data beyond the neonatal period are available to date. STUDY DESIGN, SIZE, DURATION A combined retrospective and prospective observational study was performed in a tertiary reproductive centre. The retrospective data were available in our extensive database of children born after ART. Donor cycles with an oocyte retrieval between January 2010 and March 2017 and a fresh embryo transfer resulting in the livebirth of a singleton were selected from the established oocyte donation programme. Fresh or vitrified oocytes were used in the donor cycles and all pregnancies in oocyte recipients were achieved after ICSI. Only children residing in Belgium were eligible for follow-up. PARTICIPANTS/MATERIALS, SETTING, METHODS Biometric and health parameters of 72 children born after oocyte vitrification were compared with those of 41 children born after use of a fresh oocyte. Data were collected by means of questionnaires and physical examinations at the age of 21–30 months. The primary outcome measures were anthropometry and health at 2 years of age. MAIN RESULTS AND THE ROLE OF CHANCE Length, weight, BMI, head circumference, left arm circumference and waist circumference at the age of 2 years were comparable between the vitrification and fresh group, also after adjustment for treatment, and maternal and neonatal characteristics (all P > 0.05). Health of the children in terms of hospital admission and surgical intervention rates were comparable between the vitrification and fresh group (both P > 0.05). LIMITATIONS, REASONS FOR CAUTION Although the current study is the largest series describing health parameters beyond the neonatal period, the small numbers still preclude definite conclusions. WIDER IMPLICATIONS OF THE FINDINGS This study provides the first evidence indicating that oocyte vitrification does not adversely affect the growth and health of offspring beyond the neonatal period. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by Methusalem grants and by grants from Wetenschappelijk Fonds Willy Gepts, all issued by the Vrije Universiteit Brussel. All co-authors declared no conflict of interest in relation to this work. Both the Centre for Reproductive Medicine and the Centre for Medical Genetics from the UZ Brussel have received several educational grants from IBSA, Ferring, MSD and Merck for either research on oocyte vitrification or for establishing the database for follow-up research and organizing the data collection.
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Affiliation(s)
- Marjan Van Reckem
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Christophe Blockeel
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), 1090 Brussels, Belgium.,Department of Obstetrics and Gynaecology, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Maryse Bonduelle
- Centre for Medical Genetics, Universitair Ziekenhuis Brussel (UZ Brussel), 1090 Brussels, Belgium
| | - Andrea Buysse
- Centre for Medical Genetics, Universitair Ziekenhuis Brussel (UZ Brussel), 1090 Brussels, Belgium
| | - Mathieu Roelants
- Department of Public Health and Primary Care, Environment and Health/Youth Health Care, 3000 Leuven, Belgium
| | - Greta Verheyen
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), 1090 Brussels, Belgium
| | - Herman Tournaye
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), 1090 Brussels, Belgium.,Department of Obstetrics, Gynecology, Perinatology and Reproduction, Institute of Professional Education, Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow 119992, Russia
| | - Frederik Hes
- Centre for Medical Genetics, Universitair Ziekenhuis Brussel (UZ Brussel), 1090 Brussels, Belgium
| | - Florence Belva
- Centre for Medical Genetics, Universitair Ziekenhuis Brussel (UZ Brussel), 1090 Brussels, Belgium
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Oluwayiose OA, Wu H, Saddiki H, Whitcomb BW, Balzer LB, Brandon N, Suvorov A, Tayyab R, Sites CK, Hill L, Marcho C, Pilsner JR. Sperm DNA methylation mediates the association of male age on reproductive outcomes among couples undergoing infertility treatment. Sci Rep 2021; 11:3216. [PMID: 33547328 PMCID: PMC7864951 DOI: 10.1038/s41598-020-80857-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 12/29/2020] [Indexed: 12/12/2022] Open
Abstract
Parental age at time of offspring conception is increasing in developed countries. Advanced male age is associated with decreased reproductive success and increased risk of adverse neurodevelopmental outcomes in offspring. Mechanisms for these male age effects remain unclear, but changes in sperm DNA methylation over time is one potential explanation. We assessed genome-wide methylation of sperm DNA from 47 semen samples collected from male participants of couples seeking infertility treatment. We report that higher male age was associated with lower likelihood of fertilization and live birth, and poor embryo development (p < 0.05). Furthermore, our multivariable linear models showed male age was associated with alterations in sperm methylation at 1698 CpGs and 1146 regions (q < 0.05), which were associated with > 750 genes enriched in embryonic development, behavior and neurodevelopment among others. High dimensional mediation analyses identified four genes (DEFB126, TPI1P3, PLCH2 and DLGAP2) with age-related sperm differential methylation that accounted for 64% (95% CI 0.42-0.86%; p < 0.05) of the effect of male age on lower fertilization rate. Our findings from this modest IVF population provide evidence for sperm methylation as a mechanism of age-induced poor reproductive outcomes and identifies possible candidate genes for mediating these effects.
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Affiliation(s)
- Oladele A Oluwayiose
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts Amherst, 173A Goessmann, 686 North Pleasant Street, Amherst, MA, 01003, USA
| | - Haotian Wu
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, USA
| | - Hachem Saddiki
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, 715 North Pleasant Street, Amherst, MA, USA
| | - Brian W Whitcomb
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, 715 North Pleasant Street, Amherst, MA, USA
| | - Laura B Balzer
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, 715 North Pleasant Street, Amherst, MA, USA
| | - Nicole Brandon
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts Amherst, 173A Goessmann, 686 North Pleasant Street, Amherst, MA, 01003, USA
| | - Alexander Suvorov
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts Amherst, 173A Goessmann, 686 North Pleasant Street, Amherst, MA, 01003, USA
| | - Rahil Tayyab
- Division of Reproductive Endocrinology and Infertility, Baystate Medical Center, 759 Chestnut Street, Springfield, MA, USA
| | - Cynthia K Sites
- Division of Reproductive Endocrinology and Infertility, Baystate Medical Center, 759 Chestnut Street, Springfield, MA, USA
| | - Lisa Hill
- Division of Reproductive Endocrinology and Infertility, Baystate Medical Center, 759 Chestnut Street, Springfield, MA, USA
| | - Chelsea Marcho
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts Amherst, 173A Goessmann, 686 North Pleasant Street, Amherst, MA, 01003, USA
| | - J Richard Pilsner
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts Amherst, 173A Goessmann, 686 North Pleasant Street, Amherst, MA, 01003, USA.
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Hu KL, Zhang D, Li R. Endometrium preparation and perinatal outcomes in women undergoing single-blastocyst transfer in frozen cycles. Fertil Steril 2021; 115:1487-1494. [PMID: 33487443 DOI: 10.1016/j.fertnstert.2020.12.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/05/2020] [Accepted: 12/14/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate the association of endometrium preparation with perinatal outcomes. DESIGN Retrospective cohort study. SETTING University-affiliated fertility center. PATIENT(S) Twenty-one thousand six hundred and forty-eight women who underwent frozen single-blastocyst transfer from January 2013 to March 2019. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Cesarean delivery, preterm delivery (PTD), vaginal PTD, very preterm delivery (VPTD), postterm delivery, low birth weight (LBW), macrosomia, small for gestational age (SGA), large for gestational age (LGA), hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), premature rupture of membrane (PROM), placenta previa, and congenital abnormality. RESULT(S) Compared with natural cycles, hormone replacement cycles were associated with an increased risk of PTD, VPTD, cesarean delivery, macrosomia, PROM, and HDP. There was a trend toward an increased risk of vaginal PTD and LGA in hormone replacement cycles. Stimulated cycles were associated with an increased risk of postterm delivery and GDM. There was no statistically significant difference in the rate of SGA, placenta previa, or congenital abnormality among the three endometrium preparation methods. CONCLUSION(S) Hormone replacement cycles are associated with an increased risk of PTD, VPTD, cesarean delivery, LBW, macrosomia, PROM, and HDP. Stimulated cycles are associated with an increased risk of postterm delivery and GDM.
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Affiliation(s)
- Kai-Lun Hu
- Center for Reproductive Medicine, Third Hospital, Peking University, Beijing, People's Republic of China; Key Laboratory of Reproductive Genetics (Ministry of Education) and Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Dan Zhang
- Key Laboratory of Reproductive Genetics (Ministry of Education) and Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Rong Li
- Center for Reproductive Medicine, Third Hospital, Peking University, Beijing, People's Republic of China.
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Repeated cryopreservation process impairs embryo implantation potential but does not affect neonatal outcomes. Reprod Biomed Online 2020; 42:75-82. [PMID: 33309388 DOI: 10.1016/j.rbmo.2020.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/20/2020] [Accepted: 11/13/2020] [Indexed: 11/20/2022]
Abstract
RESEARCH QUESTION Does repeated cryopreservation process affect embryo implantation potential and neonatal outcomes of human embryos? DESIGN This retrospective cohort study was conducted in the Reproductive Medicine Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. All assisted reproductive technology (ART) cycles were carried out between January 2014 and December 2018. Preferentially matched participants were divided into three groups according to the times of embryo cryopreservation: the fresh group (n = 249), the cryopreservation group (n = 244) and the re-cryopreservation group (n = 216). Embryo implantation rate, live birth rate, miscarriage rate and neonatal complication rate were compared among these three groups. RESULTS The embryo implantation rate, clinical pregnancy rate and live birth rate in the re-cryopreservation group were significantly lower, and the miscarriage rate also slightly increased. Logistic regression analysis indicated that embryos with repeated cryopreservation and lower trophectoderm scores were at higher risk of embryo implantation failure in single embryo transfer cycles (OR 1.79 and 1.56, respectively). No significant differences were observed in gender, gestational age, birthweight, neonatal abnormality and neonatal complications among the groups. CONCLUSIONS Our findings demonstrate the adverse effect of repeated cryopreservation on embryo implantation potential. The study offers embryologists and reproductive clinicians a warning of detrimental role of repeated cryopreservation. If unnecessary, it is strongly recommended to avoid repeated practice of vitrification and warming on embryos.
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20
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Conrad KP. Evidence for Corpus Luteal and Endometrial Origins of Adverse Pregnancy Outcomes in Women Conceiving with or Without Assisted Reproduction. Obstet Gynecol Clin North Am 2020; 47:163-181. [PMID: 32008666 DOI: 10.1016/j.ogc.2019.10.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Preeclampsia may arise from impaired decidualization in some women. Transcriptomics of mid-secretory biopsy endometrial stromal cells decidualized in vitro and of early gestation choriodecidua from women who experienced preeclampsia with severe features overlapped significantly with the classical endometrial disorders giving rise to the concept of "endometrium spectrum disorders". That is, recurrent implantation failure and miscarriage, endometriosis, normotensive intrauterine growth restriction, preeclampsia and preterm birth may all lie on a continuum of decidual dysregulation, in which phenotypic expression is determined by the specific molecular pathway(s) disrupted and severity of disruption. Women conceiving by programmed IVF protocols showed widespread dysregulation of cardiovascular function and increased rates of adverse pregnancy outcomes including preeclampsia. Programmed cycles preclude development of a corpus luteum (CL), a major regulator of endometrial function. Lack of circulating CL product(s) that are not replaced in programmed cycles (eg, relaxin) could adversely impact the maternal cardiovascular system directly and/or compromise decidualization, thereby increasing preeclampsia risk.
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Affiliation(s)
- Kirk P Conrad
- Department of Physiology and Functional Genomics, D.H. Barron Reproductive and Perinatal Biology Research Program, University of Florida College of Medicine, 1600 Southwest Archer RD, PO Box 100274, M552, Gainesville, FL 32610-0274, USA; Department of Obstetrics and Gynecology, University of Florida College of Medicine, 1600 Southwest Archer RD, PO Box 100294, N3-9, Gainesville, FL 32610-0274, USA.
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Conforti A, Picarelli S, Carbone L, La Marca A, Venturella R, Vaiarelli A, Cimadomo D, Zullo F, Rienzi L, Ubaldi FM, Alviggi C. Perinatal and obstetric outcomes in singleton pregnancies following fresh versus cryopreserved blastocyst transfer: a meta-analysis. Reprod Biomed Online 2020; 42:401-412. [PMID: 33234401 DOI: 10.1016/j.rbmo.2020.09.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/12/2020] [Accepted: 09/28/2020] [Indexed: 11/30/2022]
Abstract
The transfer of cryopreserved blastocysts is increasing in IVF centres. However, little is known about the perinatal and obstetric outcomes of this procedure. In an attempt to further elucidate these issues, a systematic review and meta-analysis was conducted to compare cryopreserved transfer with fresh blastocyst embryo transfer. The results show that the risk of both preterm (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.80-0.99, P = 0.04) and low birthweight births (OR 0.82, 95% CI 0.68-0.99, P = 0.04) was significantly lower after cryopreserved blastocyst transfer than after fresh blastocyst transfer. The rate of large for gestational age births was significantly higher (OR 1.68, 95% CI 1.55-1.82, P < 0.00001) and the rate of small for gestational age births significantly lower (OR 0.59, 95% CI 0.54-0.65, P < 0.00001) after cryopreserved blastocyst transfer. The transfer of cryopreserved blastocysts was associated with a significantly lower risk of placental abruption (OR 0.58, 95% CI 0.40-0.83, P = 0.003) but a significantly higher risk of Caesarean section (OR 1.21, 95% CI 1.01-1.43, P = 0.03). In conclusion, the perinatal and obstetric outcomes associated with the transfer of cryopreserved blastocysts differ from those associated with fresh blastocyst transfer.
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Affiliation(s)
- Alessandro Conforti
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy.
| | - Silvia Picarelli
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Luigi Carbone
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Antonio La Marca
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberta Venturella
- Unit of Obstetrics and Gynaecology, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Alberto Vaiarelli
- GENERA Centre for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
| | - Danilo Cimadomo
- GENERA Centre for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
| | - Fulvio Zullo
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Laura Rienzi
- GENERA Centre for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
| | | | - Carlo Alviggi
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
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Gu F, Li S, Zheng L, Gu J, Li T, Du H, Gao C, Ding C, Quan S, Zhou C, Li P, Xu Y. Perinatal outcomes of singletons following vitrification versus slow-freezing of embryos: a multicenter cohort study using propensity score analysis. Hum Reprod 2020; 34:1788-1798. [PMID: 31407797 DOI: 10.1093/humrep/dez095] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 05/06/2019] [Indexed: 01/02/2023] Open
Abstract
STUDY QUESTION Is embryo vitrification associated with a higher risk of adverse perinatal outcomes than slow-freezing? SUMMARY ANSWER Embryo vitrification was not associated with increased risks of adverse perinatal outcomes of pre-term birth (PTB), low birthweight (LBW), small for gestational age (SGA), large for gestational age (LGA) and macrosomia, as compared to slow-freezing. WHAT IS KNOWN ALREADY Vitrification is becoming a widely adopted technology for embryo cryopreservation with higher embryo survival rate and live birth rate than the slow-freezing technique. However, limited data are currently available on risks of adverse perinatal outcomes following vitrification as compared to that of slow-freezing. The impact of vitrification on perinatal outcomes remains further to be elucidated. STUDY DESIGN, SIZE, DURATION Six large reproductive medical centers in Guangdong province, Southeast of China, took part in this multicenter retrospective cohort study. Cohorts of 3199 live born singletons after Day 3 frozen-thawed embryo transfer (FET) cycles with either vitrification or slow-freezing between January 2011 and December 2015 were included in the study. Each patient only contributed one cycle per cohort and vanishing twins were excluded. Propensity score (PS) matching was used to control for potential confounding factors. PARTICIPANTS/MATERIALS, SETTING, METHODS All live-born singletons following either a vitrified or a slow-frozen cleavage FET cycle during the period from 2011 to 2015 were analyzed. Perinatal outcomes of PTB, LBW, macrosomia, SGA and LGA were compared. The vitrified and slow-frozen cohorts were matched by propensity scores with a 1:1 ratio accounting for potential confounding factors associated with perinatal outcomes. These variables included baseline demographics (maternal age, BMI, education level, parity, type of infertility and cause of infertility), as well as IVF characteristics (insemination method, endometrial preparation protocol and embryo cryopreservation duration). MAIN RESULTS AND THE ROLE OF CHANCE A total of 2858 cases from vitrified embryo transfer (ET) and 341 babies from the slow-freezing group were included. After PS matching, 297 pairs of newborns were generated for comparison. The median gestational age was 39 weeks for both cohorts and the birthweights were comparable (3187.7 ± 502.1 g in the vitrified group vs. 3224.6 ± 483.6 in the slow-freezing group, P>0.05). There were no significant differences between the two groups on the incidence of PTB (5.4% vs. 7.7%), LBW (6.7% vs. 5.7%), macrosomia (5.7% vs. 6.1%), SGA (12.5% vs. 8.4%) and LGA (6.4% vs. 8.1%). Parallel logistic regression analysis indicated that vitrification was non-inferior to slow-freezing method in terms of the occurrence of PTB (OR, 0.68 [95% CI, 0.35, 1.31]), LBW (OR, 1.19[0.61-2.32]), macrosomia (OR, 0.94 [0.48-1.86]), SGA (1.55[0.91-2.64]) and LGA (0.78[0.42-1.45]), P>0.05. Sex-stratified PS matching models with multivariable regression analysis further confirmed that vitrification did not increase the risks of above-mentioned adverse perinatal outcomes in either the male or female infant cohort. LIMITATIONS, REASONS FOR CAUTION Although the analysis was adjusted for a number of important confounders, the hospital dataset did not contain other potential confounders such as the medical history and obstetrics outcomes of women during pregnancy to allow adjustment. In addition, the current findings are only applicable to cleavage stage FET, but not pronuclei stage or blastocyst stage ET. WIDER IMPLICATIONS OF THE FINDINGS Vitrified ET, in comparison with slow-frozen ET, was not associated with increased risks of adverse neonatal outcomes. With its superiority on live birth rates and non-inferiority on safety perinatal outcomes, transition from slow-freezing to the use of vitrification for embryo cryopreservation is reassuring. Nonetheless, future research is needed for the long-term effects of vitrification method on offspring's health outcomes. STUDY FUNDING/COMPETING INTEREST(S) The study was funded by the National Key Research and Development Program (2016YFC100205), Guangzhou Science and Technology Project (201804020087), Guangdong Province Science and Technology Project (2016A020218008) and Guangdong Provincial Key Laboratory of Reproductive Medicine (2012A061400003). The authors have no conflicts of interest to declare.
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Affiliation(s)
- Fang Gu
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shuzhen Li
- Jiangmen Central Hospital, Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Lingyan Zheng
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Sun Yat-Sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jing Gu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Tingting Li
- Reproductive Medicine Research Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Hongzi Du
- Center for Reproductive Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Caifeng Gao
- The Huizhou Municipal Central Hospital, Huizhou, Guangdong, China
| | - Chenhui Ding
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Song Quan
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Canquan Zhou
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, Guangdong, China
| | - Ping Li
- Jiangmen Central Hospital, Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yanwen Xu
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, Guangdong, China
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Sites CK, Wilson D, Bernson D, Boulet S, Zhang Y. Number of embryos transferred and diagnosis of preeclampsia. Reprod Biol Endocrinol 2020; 18:68. [PMID: 32653045 PMCID: PMC7353780 DOI: 10.1186/s12958-020-00627-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/30/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Multiple births and first pregnancy are associated with higher preeclampsia risk. It is unknown if the transfer of multiple embryos or first embryo transfer with assisted reproductive technology (ART) is also associated with greater preeclampsia risk. METHODS We performed a retrospective cohort study of IVF clinics and hospitals in Massachusetts. We used linked ART surveillance, birth certificate, and maternal hospitalization discharge data for 21,188 births, considering resident singleton (12,810) and twin (8378) live-births from autologous or donor eggs from 2005 to 2012. We used log binomial and Poisson regression to calculate adjusted relative risks (aRRs) and 95% confidence intervals (CI) for the association between preeclampsia and predictors of preeclampsia. Outcomes were stratified by singleton and twin birth, donor versus autologous cycles, and use of fresh versus cryopreserved embryos. RESULTS Considering all singleton births, the transfer of multiple embryos increased the risk of preeclampsia [aRR = 1.10 (95% CI: 1.01-1.19)]. Relative risks were greatest for fresh non-donor cycles [aRR = 1.14 (95% CI: 1.03-1.26)]. Vanishing twin and number of prior ART cycles was not associated with preeclampsia among singleton births [aRR = 1.18 (95% CI: 0.91-1.53)], and aRR = 1.01 (95% CI: 0.96-1.05)], respectively. Considering all twin births, the transfer of > 2 embryos increased the risk of preeclampsia [aRR = 1.09 (95% CI: 1.001-1.19)]. Vanishing triplet and number of prior ART cycles were not associated with preeclampsia among twin births [aRR = 0.93 (95% CI: 0.69-1264), and aRR = 0.98 (CI: 0.95-1.02)], respectively. CONCLUSIONS Among ART births, the transfer of more than 1 embryo for singleton gestations and more than 2 embryos for twin gestations increased the risk for preeclampsia diagnosis.
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Affiliation(s)
- Cynthia K Sites
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Baystate, 759 Chestnut Street, S1683, Springfield, MA, 01199, USA.
| | - Donna Wilson
- Department of Epidemiology and Biostatistics, Baystate Medical Center, Springfield, MA, USA
| | | | - Sheree Boulet
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Yujia Zhang
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Bosch E, De Vos M, Humaidan P. The Future of Cryopreservation in Assisted Reproductive Technologies. Front Endocrinol (Lausanne) 2020; 11:67. [PMID: 32153506 PMCID: PMC7044122 DOI: 10.3389/fendo.2020.00067] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 01/31/2020] [Indexed: 01/12/2023] Open
Abstract
Societal changes and the increasing desire and opportunity to preserve fertility have increased the demand for effective assisted reproductive technologies (ART) and have increased the range of scenarios in which ART is now used. In recent years, the "freeze-all" strategy of cryopreserving all oocytes or good quality embryos produced in an IVF cycle to transfer later-at a time that is more appropriate for reasons of medical need, efficacy, or desirability-has emerged as an accepted and valuable alternative to fresh embryo transfer. Indeed, improvements in cryopreservation techniques (vitrification) and the development of more efficient ovarian stimulation protocols have facilitated a dramatic increase in the practice of elective frozen embryo transfer (eFET). Alongside these advances, debate continues about whether eFET should be a standard treatment option available to the whole IVF population or if it is important to identify patient subgroups who are most likely to benefit from such an approach. Achieving successful outcomes in ART, whether by fresh or frozen embryo transfer, is influenced by a wide range of factors. As well as the efficiency of IVF and embryo transfer protocols and techniques, factors affecting implantation include maternal aging, sperm quality, the vaginal and endometrial microbiome, and peri-implantation levels of serum progesterone. The safety of eFET, both during ART cycles and on longer-term obstetric and neonatal outcomes, is also an important consideration. In this review, we explore the benefits and risks of freeze-all strategies in different scenarios. We review available evidence on the outcomes achieved with elective cryopreservation strategies and practices and how these compare with more traditional IVF cycles with fresh embryo transfers, both in the general IVF population and in subgroups of special interest. In addition, we consider how to optimize and individualize "freeze-all" procedures to achieve successful reproductive outcomes.
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Affiliation(s)
- Ernesto Bosch
- Instituto Valenciano de Infertilidad, Valencia, Spain
- *Correspondence: Ernesto Bosch
| | - Michel De Vos
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Peter Humaidan
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark
- Faculty of Health, Aarhus University, Aarhus, Denmark
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25
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Risk of ischemic placental disease in fresh and frozen embryo transfer cycles. Fertil Steril 2019; 111:714-721. [PMID: 30826115 DOI: 10.1016/j.fertnstert.2018.11.043] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 11/07/2018] [Accepted: 11/29/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To evaluate the association of fresh and frozen embryo transfer with the development of ischemic placental disease (IPD), hypothesizing that differences in implantation environment affect placentation and thus pregnancy outcomes. DESIGN We performed a secondary analysis of a retrospective cohort study of deliveries linked to IVF cycles. SETTING Tertiary hospital and infertility treatment center. PATIENT(S) We included all women who underwent an autologous IVF cycle and had a live-born infant or an intrauterine fetal demise (IUFD). We excluded women less than 18 years of age. INTERVENTION(S) We compared pregnancies resulting from frozen embryo transfer (frozen) cycles with those resulting from fresh embryo transfer (fresh) cycles. MAIN OUTCOME MEASURE(S) The primary outcome was a composite outcome of IPD or IUFD due to placental insufficiency. Ischemic placental disease included pre-eclampsia, placental abruption, and small for gestational age (SGA). We calculated risk ratios (RRs) and 95% confidence intervals (CIs). RESULT(S) Compared with fresh cycles, frozen cycles had a lower risk of IPD or IUFD from placental insufficiency (RR 0.75, 95% CI 0.59-0.97). Frozen cycles also conferred a lower risk of SGA than fresh cycles (RR 0.58, 95% CI 0.41-0.81). Risks of pre-eclampsia (RR 1.3, 95% CI 0.84-1.9) and abruption (RR 1.2, 95% CI 0.56-2.4) were similar. CONCLUSION(S) There was a lower risk of IPD among frozen cycles compared with fresh cycles. This association was largely driven by lower risk of SGA among frozen cycles.
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26
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Omani-Samani R, Alizadeh A, Almasi-Hashiani A, Mohammadi M, Maroufizadeh S, Navid B, Khedmati Morasae E, Amini P. Risk of preeclampsia following assisted reproductive technology: systematic review and meta-analysis of 72 cohort studies. J Matern Fetal Neonatal Med 2019; 33:2826-2840. [PMID: 30563382 DOI: 10.1080/14767058.2018.1560406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Previous studies have indicated that women with assisted reproductive technology (ART) pregnancy have an increased risk of preeclampsia. The aim of this current study was to estimate, through a systematic review and meta-analysis of cohort studies, the risk of preeclampsia in women who conceived with ART.Materials and methods: We searched ISI Web of Knowledge, Medline/PubMed, Scopus and Embase up to August 2017 for English-language articles pertaining to risk of preeclampsia in ART pregnancy using standard keywords. Data extraction was conducted by two authors and quality of the studies was assessed using the Newcastle-Ottawa Scale. A random-effects model was used for the meta-analysis.Results: In total, 72 cohort studies (n = 164 870) were included. The results of Cochran test and I2 statistic indicated considerable heterogeneity among studies (Q = 15 415.61, df = 71, p < .001, I2=99.5%). The pooled estimate of preeclampsia risk using the random effects model was 10.8% (95% CI: 9.10-12.5). Furthermore, the funnel plot and Begg's test showed evidence of publication bias.Conclusions: We found that the risk of preeclampsia was very high among women who conceived with ART. Women should be counseled carefully before undergoing ART treatment.
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Affiliation(s)
- Reza Omani-Samani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Ahad Alizadeh
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.,Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
| | - Maryam Mohammadi
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Saman Maroufizadeh
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Behnaz Navid
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Esmaeil Khedmati Morasae
- Department of Health Services Research, National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care North West Coast (NIHR CLAHRC NWC), Institute of Psychology, Health, and Society, University of Liverpool, Liverpool, UK
| | - Payam Amini
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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27
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Zeng M, Li L. Single fresh blastocyst transfer or single cryopreserved-thawed blastocyst transfer: which is preferable for infertile patients in IVF/ICSI cycles? A meta-analysis. Gynecol Endocrinol 2019; 35:17-22. [PMID: 30303701 DOI: 10.1080/09513590.2018.1490408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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
PURPOSES Nowadays, an increasing number of studies have proposed single embryo transfer (SET), especially single blastocyst transfer (SBT). To compare the clinical outcomes of single fresh blastocyst transfer (BT) and single cryopreserved-thawed BT in patients undergoing in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) cycles. METHODS The PubMed, Embase, and Cochrane Library databases were searched from the start dates until February 2018. The primary outcomes were clinical pregnancy rate (CPR) and embryo implantation rate (IR). The secondary outcomes were multiple pregnancy rate (MPR), live birth rate (LBR), and miscarriage rate (MR). Using the Mantel-Haenszel random effects model to analyze summary risk ratio (RR) with 95% confidence intervals (CIs). Statistical heterogeneity scores were assessed with the standard Cochrane's Q test and I2 statistic. RESULTS In total, eight studies (two prospective studies, six retrospective studies) were included in our analysis. There was no statistically significant difference regarding clinical pregnancy (RR = 1.18, 95% CI = 0.91-1.55) and embryo implantation (RR = 1.04, 95% CI = 0.77-1.41). Regarding secondary outcomes, there was no significant difference regarding miscarriage (RR = 0.79, 95% CI = 0.60-1.03) and multiple pregnancy (RR = 1.23, 95% CI = 0.75-2.04). However, single fresh BT is associated with an increased live birth (RR = 1.28, 95% CI = 1.05-1.57) compared with single cryopreserved-thawed BT. CONCLUSIONS In summary, this meta-analysis supports the hypothesis that single cryopreserved BT might not be the best choice compared with single fresh BT in patients undergoing IVF/ICSI cycles.
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Affiliation(s)
- MeiFang Zeng
- a Reproductive Medicine Center, Guangxi Medical University First Affiliated Hospital , Nanning , Guangxi , China
| | - LiuMing Li
- a Reproductive Medicine Center, Guangxi Medical University First Affiliated Hospital , Nanning , Guangxi , China
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28
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Yu B, Vega M, Zaghi S, Fritz R, Jindal S, Buyuk E. Comparison of perinatal outcomes following frozen embryo transfer cycles using autologous versus donor oocytes in women 40 to 43 years old: analysis of SART CORS data. J Assist Reprod Genet 2018; 35:2025-2029. [PMID: 30128819 DOI: 10.1007/s10815-018-1287-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To study the differences in perinatal outcomes after frozen embryo transfer cycles using autologous or donor oocytes in women of advanced maternal age. DESIGN Historical cohort study. SETTING US national database from the Society of Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) from 2009 to 2013. PATIENT(S) Women at 40-43 years of age undergoing autologous frozen embryo transfers (a-FET) or donor oocyte frozen embryo transfers (d-FET) resulting in singleton pregnancies that were entered in the SART CORS database from 2009 to 2013. RESULTS a-FET resulted in 4402 singleton live births whereas d-FET resulted in 2703 singleton live births. d-FET resulted in a higher risk of preterm births (< 37 weeks), with adjusted odds ratio (aOR) 1.33 (95% CI 1.02-1.75), but similar risk of small for gestational age (SGA), with aOR 1.75 (95% CI 0.85-3.7), when compared to a-FET. However, when only single blastocyst transfer cycles are considered, d-FET and a-FET showed no difference in preterm births or other adverse perinatal outcomes. CONCLUSIONS Singletons resulting from d-FET are at increased risk for perinatal morbidity. However, the risk was diminished in single blastocyst transfer cycles. Our study supports the current American Society for Reproductive Medicine (ASRM) guidelines of transferring a single blastocyst in d-FET cycles.
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Affiliation(s)
- Bo Yu
- Department of OBGYN, University of Washington, 1959 NE Pacific Street, Box 356460, Seattle, WA, 98195-6460, USA.
| | - Mario Vega
- Department of OBGYN and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore's Institute for Reproductive Medicine and Health, Hartsdale, NY, USA
| | - Sahar Zaghi
- Department of OBGYN and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore's Institute for Reproductive Medicine and Health, Hartsdale, NY, USA
| | - Rani Fritz
- Department of OBGYN and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore's Institute for Reproductive Medicine and Health, Hartsdale, NY, USA
| | - Sangita Jindal
- Department of OBGYN and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore's Institute for Reproductive Medicine and Health, Hartsdale, NY, USA
| | - Erkan Buyuk
- Department of OBGYN and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore's Institute for Reproductive Medicine and Health, Hartsdale, NY, USA
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29
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Blazquez A, García D, Vassena R, Figueras F, Rodriguez A. Risk of preeclampsia in pregnancies resulting from double gamete donation and from oocyte donation alone. Pregnancy Hypertens 2018; 13:133-137. [PMID: 30177040 DOI: 10.1016/j.preghy.2018.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 05/02/2018] [Accepted: 06/09/2018] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Pregnancies after gamete donation are at higher risk of developing pre-eclampsia (PE) than those achieved by IVF with patient's own gametes. We aim to assess whether pregnancies achieved with both oocyte and sperm donation (double donation, DD) are at an increased risk of developing PE and gestational hypertension (GH) compared to those achieved by oocyte donation alone (OD). MATERIALS AND METHODS Retrospective cohort study of 433 patients who reached the 20th week of gestation with either DD (n = 81) or OD (n = 352) between March 2013 and April 2016 at a fertility clinic. The risk of preterm PE, term PE, and gestational hypertension (GH) are presented as unadjusted and adjusted odds ratio (OR). RESULTS DD have a higher risk of preterm PE than OD, with an OR of 3.02 (95%CI 1.11-8.24; p = 0.031). We found no difference in the risk of term PE (OR 0.26, 95%CI 0.03-1.98; p = 0.19) or of GH (OR 1.23, 95% CI 0.63-2.43; p = 0.55). DISCUSSION Pregnancies with DD are at higher risk of developing preterm PE than OD alone. Patients, and physicians treating them, should be made aware of the elevated risk of PE in these gestations, in order to start prophylactic measures during the first weeks of pregnancy.
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Affiliation(s)
| | | | | | - Francesc Figueras
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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30
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Litzky JF, Boulet SL, Esfandiari N, Zhang Y, Kissin DM, Theiler RN, Marsit CJ. Birthweight in infants conceived through in vitro fertilization following blastocyst or cleavage-stage embryo transfer: a national registry study. J Assist Reprod Genet 2018; 35:1027-1037. [PMID: 29633148 PMCID: PMC6030018 DOI: 10.1007/s10815-018-1168-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 03/16/2018] [Indexed: 01/12/2023] Open
Abstract
PURPOSE In vitro fertilization (IVF) infants have lower birthweights than their peers, predisposing them to long-term health consequences. Blastocyst transfer (BT), at day 5-6 post-fertilization, is increasing in usage, partially due to improved pregnancy outcomes over cleavage-stage transfer (CT, day 2-3). Data to date, however, have been inconclusive regarding BT's effects on birthweight. METHODS Participants included all US autologous, single-gestation, fresh embryo transfer cycles initiated from 2007 to 2014 that resulted in a term infant (N = 124,154) from the National Assisted Reproductive Technology Surveillance System. Generalized linear models including obstetric history, maternal demographics, and infant sex and gestational age were used to compare birthweight outcomes for infants born following BT (N = 67,169) with infants born following CT (N = 56,985) and to test for an interaction between transfer stage and single embryo transfer (SET). RESULTS Infants born following BT were 6 g larger than those born following CT (p = 0.04), but rates of macrosomia (RR 1.00, 95% CI 0.96-1.04) and low birthweight (LBW, RR 1.00, 95% CI 0.93-1.06) were not different between the groups. The interaction between SET and transfer stage was significant (p = 0.02). Among SET infants, BT was associated with 19.26 g increased birthweight compared to CT (p = 0.008). CONCLUSIONS The increase in birthweights identified following BT is unlikely to be clinically relevant, as there were no differences in rates of macrosomia or LBW. These findings are clinically reassuring and indicate that the increasing use of BT is unlikely to further decrease the on average lower birthweights seen in IVF infants compared to their naturally conceived peers.
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Affiliation(s)
- Julia F Litzky
- Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Hanover, NH, 03755, USA
| | - Sheree L Boulet
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA
| | - Navid Esfandiari
- Department of Obstetrics and Gynecology, Geisel School of Medicine at Dartmouth College, Hanover, NH, 03755, USA
- Department of Pathology and Laboratory Medicine, Geisel School of Medicine at Dartmouth College, Hanover, NH, 03755, USA
| | - Yujia Zhang
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA
| | - Dmitry M Kissin
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA
| | - Regan N Theiler
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, 55905, USA
| | - Carmen J Marsit
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.
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31
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Blazquez A, García D, Vassena R, Figueras F, Rodriguez A. Risk of pre-eclampsia after fresh or frozen embryo transfer in patients undergoing oocyte donation. Eur J Obstet Gynecol Reprod Biol 2018; 227:27-31. [PMID: 29879546 DOI: 10.1016/j.ejogrb.2018.05.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/14/2018] [Accepted: 05/21/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVES Different perinatal and neonatal adverse outcomes have been reported to be increased in frozen embryo transfer pregnancies compared with fresh embryo transfer with patient's own oocytes. Concerning preeclampsia, it has also been reported to be increased after frozen embryo transfer. The objective of this study is to asses if there is an increased risk of preeclampsia and gestational hypertension in pregnancies achieved with oocyte donation after frozen embryo transfer compared to fresh embryo transfer. STUDY DESIGN Retrospective cohort study of 433 patients who underwent a cycle with donated oocytes either after fresh (n = 353) or frozen embryo transfer (n = 80) between March 2013 and April 2016 at a large fertility clinic. Participants are pregnant patients who reached the 20th week of gestation. The risk of preterm preeclampsia (presenting before 37 weeks of gestation), term preeclampsia (presenting at or after 37 weeks of gestation) and gestational hypertension are presented as unadjusted and adjusted odds ratio (OR). RESULTS Frozen embryo transfer have similar risk for developing preterm preeclampsia compared to fresh embryo transfer, with an OR of 1.95 (CI 95% 0.72, 5.26, p = 0.18), as well as term preeclampsia (OR 0.3, 95%CI 0.04, 2.35, p = 0.25), and gestational hypertension (OR 1.45, 95% CI 0.75, 2.81, P = 0.27). CONCLUSIONS Despite a high prevalence of preeclampsia in pregnancies achieved by oocyte donation, the freezing-thawing process does not confer more risk than the fresh embryo transfers in preterm preeclampsia, term preeclampsia or gestational hypertension.
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Affiliation(s)
| | | | | | - Francesc Figueras
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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Sites CK, Wilson D, Barsky M, Bernson D, Bernstein IM, Boulet S, Zhang Y. Embryo cryopreservation and preeclampsia risk. Fertil Steril 2017; 108:784-790. [PMID: 28974308 PMCID: PMC10999961 DOI: 10.1016/j.fertnstert.2017.08.035] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/09/2017] [Accepted: 08/25/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine whether assisted reproductive technology (ART) cycles involving cryopreserved-warmed embryos are associated with the development of preeclampsia. DESIGN Retrospective cohort study. SETTING IVF clinics and hospitals. PATIENT(S) A total of 15,937 births from ART: 9,417 singleton and 6,520 twin. INTERVENTION(S) We used linked ART surveillance, birth certificate, and maternal hospitalization discharge data, considering resident singleton and twin births from autologous or donor eggs from 2005-2010. MAIN OUTCOME MEASURE(S) We compared the frequency of preeclampsia diagnosis for cryopreserved-warmed versus fresh ET and used multivariable logistic regression to adjust for confounders. RESULT(S) Among pregnancies conceived with autologous eggs resulting in singletons, preeclampsia was greater after cryopreserved-warmed versus fresh ET (7.51% vs. 4.29%, adjusted odds ratio = 2.17 [95% CI 1.67-2.82]). Preeclampsia without and with severe features, preeclampsia with preterm delivery, and chronic hypertension with superimposed preeclampsia were more frequent after cryopreserved-warmed versus fresh ET (3.99% vs. 2.55%; 2.95% vs. 1.41%; 2.76 vs. 1.48%; and 0.95% vs. 0.43%, respectively). Among pregnancies from autologous eggs resulting in twins, the frequency of preeclampsia with severe features (9.26% vs. 5.70%) and preeclampsia with preterm delivery (14.81% vs. 11.74%) was higher after cryopreserved versus fresh transfers. Among donor egg pregnancies, rates of preeclampsia did not differ significantly between cryopreserved-warmed and fresh ET (10.78% vs. 12.13% for singletons and 28.0% vs. 25.15% for twins). CONCLUSION(S) Among ART pregnancies conceived using autologous eggs resulting in live births, those involving transfer of cryopreserved-warmed embryos, as compared with fresh ETs, had increased risk for preeclampsia with severe features and preeclampsia with preterm delivery.
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Affiliation(s)
- Cynthia K Sites
- Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts.
| | - Donna Wilson
- Department of Epidemiology and Biostatistics, Baystate Medical Center, Springfield, Massachusetts
| | - Maya Barsky
- Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts
| | - Dana Bernson
- Massachusetts Department of Public Health, Boston, Massachusetts
| | - Ira M Bernstein
- Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont
| | - Sheree Boulet
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yujia Zhang
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Zeng M, Su S, Li L. Comparison of pregnancy outcomes after vitrification at the cleavage and blastocyst stage: a meta-analysis. J Assist Reprod Genet 2017; 35:127-134. [PMID: 28940130 DOI: 10.1007/s10815-017-1040-1] [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: 06/28/2017] [Accepted: 09/03/2017] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE This systematic review sought to evaluate the clinical outcomes of vitrification at the cleavage stage and blastocyst stage for embryo transfer in patients undergoing assisted reproductive technology (ART) treatment. METHODS We searched for related comparative studies published in the PubMed, EMBASE, and Cochrane Library databases up to July 2017. The primary outcomes were clinical pregnancy rate (CPR) and embryo implantation rate (IR). Secondary outcomes were multiple pregnancy rate (MPR), miscarriage rate (MR), live birth rate (LBR), and ongoing pregnancy rate (OPR). The Mantel-Haenszel fixed effects model and random effects model were used to analyze the summary risks ratios (RRs) with 95% confidence intervals (CIs). RESULTS Eight studies with more than 6590 cycles were included in our meta-analysis. Seven studies were observational retrospective comparative studies. One was a prospective study. Overall, the current study summarizes information from 6590 vitrification warming cycles (cleavage stage n = 4594; blastocysts n = 1996). There was no difference in the primary outcome clinical pregnancy rate (RR = 0.97, 95% CI = 0.90-1.04; fixed effects model; I 2 = 21%), whereas vitrified blastocyst transfer was significantly superior to vitrified cleavage-stage embryo transfer regarding the implantation rate (RR = 0.85, 95% CI = 0.74-0.97; random effects model; I 2 = 43). Regarding the secondary outcomes, no differences were found in the multiple pregnancy rate (RR = 1.20, 95% CI = 0.79-1.82; fixed effects model; I 2 = 22), live birth rate (RR = 1.07, 95% CI = 0.98-1.16; fixed effects model; I 2 = 0), and ongoing pregnancy rate (RR = 1.01, 95% CI = 0.92-1.120; fixed effects model; I 2 = 0), whereas a higher miscarriage rate was observed with vitrified blastocyst transfer (RR = 0.65, 95% CI = 0.45-0.93; random effects model; I 2 = 23). CONCLUSION In summary, this meta-analysis shows that vitrification at any stage has no detrimental effect on clinical outcome. Blastocyst transfer will still remain a favorable and promising option in ART. Due to the small sample evaluated in the pool of included studies, large-scale, prospective, and randomized controlled trials are required to determine if these small effects are clinically relevant.
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Affiliation(s)
- MeiFang Zeng
- Reproductive Medicine Center, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - SuQin Su
- Reproductive Medicine Center, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - LiuMing Li
- Reproductive Medicine Center, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
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Hiura H, Hattori H, Kobayashi N, Okae H, Chiba H, Miyauchi N, Kitamura A, Kikuchi H, Yoshida H, Arima T. Genome-wide microRNA expression profiling in placentae from frozen-thawed blastocyst transfer. Clin Epigenetics 2017; 9:79. [PMID: 28785370 PMCID: PMC5543431 DOI: 10.1186/s13148-017-0379-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/31/2017] [Indexed: 01/18/2023] Open
Abstract
Background Frozen-thawed embryo transfer (FET) is increasingly available for the improvement of the success rate of assisted reproductive technologies other than fresh embryo transfer (ET). There have been numerous findings that FET provides better obstetric and perinatal outcomes. However, the birth weight of infants conceived using FET is heavier than that of those conceived via ET. In addition, some reports have suggested that FET is associated with perinatal diseases such as placenta accreta and pregnancy-induced hypertension (PIH). Results In this study, we compared the microRNA (miRNA) expression profiles in term placentae derived from FET, ET, and spontaneous pregnancy (SP). We identified four miRNAs, miR-130a-3p, miR-149-5p, miR-423-5p, and miR-487b-3p, that were significantly downregulated in FET placentae compared with those from SP and ET. We found that DNA methylation of MEG3-DMR, not but IG-DMR, was associated with miRNA expression of the DLK1-DIO3 imprinted domain in the human placenta. In functional analyses, GO terms and signaling pathways related to positive regulation of gene expression, growth, development, cell migration, and type II diabetes mellitus (T2DM) were enriched. Conclusions This study supports the hypothesis that the process of FET may increase exposure of epigenome to external influences. Electronic supplementary material The online version of this article (doi:10.1186/s13148-017-0379-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hitoshi Hiura
- Department of Informative Genetics, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai, 980-8575 Japan
| | - Hiromitsu Hattori
- Department of Informative Genetics, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai, 980-8575 Japan
| | - Norio Kobayashi
- Department of Informative Genetics, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai, 980-8575 Japan.,Laboratory of Animal Reproduction and Development, Graduate School of Agricultural Science, Tohoku University, 1-1 Amamiya-machi, Tsutsumidori, Aoba-ku, Sendai, 981-8555 Japan
| | - Hiroaki Okae
- Department of Informative Genetics, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai, 980-8575 Japan
| | - Hatsune Chiba
- Department of Informative Genetics, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai, 980-8575 Japan
| | - Naoko Miyauchi
- Department of Informative Genetics, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai, 980-8575 Japan
| | - Akane Kitamura
- Department of Informative Genetics, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai, 980-8575 Japan
| | - Hiroyuki Kikuchi
- Center for Reproductive Medicine, Sendai ART Clinic, 206-13 Nakakecho, Miyagino-ku, Sendai, 983-0864 Japan
| | - Hiroaki Yoshida
- Center for Reproductive Medicine, Sendai ART Clinic, 206-13 Nakakecho, Miyagino-ku, Sendai, 983-0864 Japan
| | - Takahiro Arima
- Department of Informative Genetics, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai, 980-8575 Japan
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35
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Wang ET, Kathiresan ASQ, Bresee C, Greene N, Alexander C, Pisarska MD. Abnormal implantation after fresh and frozen in vitro fertilization cycles. Fertil Steril 2017; 107:1153-1158. [PMID: 28433367 PMCID: PMC5628741 DOI: 10.1016/j.fertnstert.2017.03.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 02/19/2017] [Accepted: 03/06/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To determine whether fresh embryo transfers are at a higher risk of abnormal implantation compared with frozen embryo transfers while accounting for the embryo stage at transfer. DESIGN Retrospective cohort study. SETTING Not applicable. PATIENT(S) We used data from the Society for Assisted Reproductive Technologies to identify all fresh and frozen autologous IVF cycles from 2004-2013 resulting in a positive pregnancy test. The cycles were parameterized into a four-level predictor of [1] fresh blastocyst transfer, [2] fresh non-blastocyst transfer, [3] frozen blastocyst transfer, and [4] frozen non-blastocyst transfer. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) We examined a composite outcome of abnormal implantation, defined as biochemical pregnancy, ectopic/heterotopic pregnancy, and first-trimester pregnancy loss. Regression modeling was performed with repeated measures multivariable logistic regression, adjusted for age, parity, number of embryos transferred, infertility diagnosis, and calendar year of treatment. RESULT(S) Of 509,938 cycles analyzed, 31.8% resulted in abnormal implantation. Compared with a fresh blastocyst transfer, a fresh non-blastocyst transfer had a 22% increase risk of abnormal implantation, a frozen blastocyst transfer had a 36% increase risk, and a frozen non-blastocyst transfer had a 57% increase risk. When individual outcomes were analyzed, fresh embryo transfers had a lower risk of biochemical pregnancy and pregnancy loss but a higher risk for ectopic/heterotopic pregnancy. CONCLUSION(S) Fresh blastocyst transfers had the lowest overall risk of abnormal implantation but a higher risk of ectopic/heterotopic pregnancy. Although embryo cryopreservation is indicated in certain treatment cycles, elective embryo cryopreservation may not be the optimal strategy to adopt for all cycles.
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Affiliation(s)
- Erica T Wang
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Anupama S Q Kathiresan
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Catherine Bresee
- Cedars Sinai Biostatistics & Bioinformatics Core, Cedars-Sinai Medical Center, Los Angeles, California
| | - Naomi Greene
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Carolyn Alexander
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Margareta D Pisarska
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California.
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36
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Dunietz GL, Holzman C, Zhang Y, Talge NM, Li C, Todem D, Boulet SL, McKane P, Kissin DM, Copeland G, Bernson D, Diamond MP. Assisted Reproductive Technology and Newborn Size in Singletons Resulting from Fresh and Cryopreserved Embryos Transfer. PLoS One 2017; 12:e0169869. [PMID: 28114395 PMCID: PMC5256964 DOI: 10.1371/journal.pone.0169869] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 12/22/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES AND STUDY DESIGN The aim of this study was two-fold: to investigate the association of Assisted Reproductive Technology (ART) and small newborn size, using standardized measures; and to examine within strata of fresh and cryopreserved embryos transfer, whether this association is influenced by parental infertility diagnoses. We used a population-based retrospective cohort from Michigan (2000-2009), Florida and Massachusetts (2000-2010). Our sample included 28,946 ART singletons conceived with non-donor oocytes and 4,263,846 non-ART singletons. METHODS Regression models were used to examine the association of ART and newborn size, measured as small for gestational age (SGA) and birth-weight-z-score, among four mutually exclusive infertility groups: female infertility only, male infertility only, combined female and male infertility, and unexplained infertility, stratified by fresh and cryopreserved embryos transfer. RESULTS We found increased SGA odds among ART singletons from fresh embryos transfer compared with non-ART singletons, with little difference by infertility source [adjusted odds-ratio for SGA among female infertility only: 1.18 (95% CI 1.10, 1.26), male infertility only: 1.20 (95% CI 1.10, 1.32), male and female infertility: 1.18 (95% CI 1.06, 1.31) and unexplained infertility: 1.24 (95% CI 1.10, 1.38)]. Conversely, ART singletons, born following cryopreserved embryos transfer, had lower SGA odds compared with non-ART singletons, with mild variation by infertility source [adjusted odds-ratio for SGA among female infertility only: 0.56 (95% CI 0.45, 0.71), male infertility only: 0.64 (95% CI 0.47, 0.86), male and female infertility: 0.52 (95% CI 0.36, 0.77) and unexplained infertility: 0.71 (95% CI 0.47, 1.06)]. Birth-weight-z-score was significantly lower for ART singletons born following fresh embryos transfer than non-ART singletons, regardless of infertility diagnoses.
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Affiliation(s)
- Galit Levi Dunietz
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States of America.,Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, United States of America
| | - Claudia Holzman
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, United States of America
| | - Yujia Zhang
- Division of Reproductive Health at the Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Nicole M Talge
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, United States of America
| | - Chenxi Li
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, United States of America
| | - David Todem
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, United States of America
| | - Sheree L Boulet
- Division of Reproductive Health at the Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Patricia McKane
- Michigan Department of Health and Human Services, Maternal and Child Health Epidemiology Section, Lansing, MI, United States of America
| | - Dmitry M Kissin
- Division of Reproductive Health at the Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Glenn Copeland
- Michigan Department of Health and Human Services, Division for Vital Records and Health Statistics, Lansing, MI, United States of America
| | - Dana Bernson
- Massachusetts Department of Public Health, Boston, MA, United States of America
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Augusta University, Augusta, GA, United States of America
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