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Gadenne C, Miquel L, Faust C, Berbis J, Perrin J, Courbiere B. Impact of a positive Chlamydia trachomatis serology on cumulative IVF live birth rate. Reprod Biomed Online 2024; 48:103586. [PMID: 38113763 DOI: 10.1016/j.rbmo.2023.103586] [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: 03/24/2023] [Revised: 09/22/2023] [Accepted: 09/28/2023] [Indexed: 12/21/2023]
Abstract
RESEARCH QUESTION Does positive Chlamydia trachomatis serology have an impact on the cumulative live birth rate from IVF? DESIGN A retrospective matched cohort study compared women with positive Chlamydia trachomatis serology (group A) who underwent IVF treatment between January 2016 and December 2021 with a control group of women with negative Chlamydia trachomatis serology (group B). The main outcome measures were the cumulative live birth rate per IVF cycle and the live birth rate per embryo transfer. Secondary outcomes were the cumulative rates of clinical pregnancy, ectopic pregnancy and pregnancy loss calculated per IVF cycle and per embryo transfer. RESULTS A total of 151 women in group A were matched 1:2 to 302 women in group B, representing 220 and 440 IVF cycles, respectively. Women with a history of Chlamydia trachomatis infection had a significantly higher rate of tubal obstruction (P < 0.001), excluded or operated hydrosalpinx (P = 0.002) and/or history of chronic endometritis (P < 0.001). There were no statistically significant differences between the two groups in the mean number of mature oocytes retrieved, fertilization rate or implantation rate. The IVF cumulative live birth rate per cycle was similar in the two groups (36.7% in group A versus 34.9% in group B, P = 0.692). The cumulative rates of clinical pregnancy, pregnancy loss, biochemical pregnancy and ectopic pregnancy were comparable between the two groups. CONCLUSION Positive Chlamydia trachomatis serology has no impact on IVF pregnancy outcomes.
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Affiliation(s)
- Clara Gadenne
- Department of Gynecology-Obstetric and Reproductive Medicine, Assistance Publique - Hôpitaux de Marseille, La Conception University Hospital, Aix-Marseille Univ, Marseille, France.
| | - Laura Miquel
- Department of Gynecology-Obstetric and Reproductive Medicine, Assistance Publique - Hôpitaux de Marseille, La Conception University Hospital, Aix-Marseille Univ, Marseille, France
| | - Cindy Faust
- Public Health Department, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille Univ, Marseille, France
| | - Julie Berbis
- Public Health Department, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille Univ, Marseille, France
| | - Jeanne Perrin
- Department of Gynecology-Obstetric and Reproductive Medicine, Assistance Publique - Hôpitaux de Marseille, La Conception University Hospital, Aix-Marseille Univ, Marseille, France; IMBE, CNRS, IRD, Avignon Univ, Marseille, France
| | - Blandine Courbiere
- Department of Gynecology-Obstetric and Reproductive Medicine, Assistance Publique - Hôpitaux de Marseille, La Conception University Hospital, Aix-Marseille Univ, Marseille, France; IMBE, CNRS, IRD, Avignon Univ, Marseille, France
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Ou S, Liao M, Cui L, Du Y, Zhao L, Peng C, Jiang L, Liu B. Associations between microbial presence in follicular fluid with IVF outcomes: a systematic review and meta-analysis. J Assist Reprod Genet 2023; 40:2501-2511. [PMID: 37688752 PMCID: PMC10643413 DOI: 10.1007/s10815-023-02912-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/09/2023] [Indexed: 09/11/2023] Open
Abstract
PURPOSE The aim of the study was to synthesize disparate studies to investigate potential impact of microbial presence in FF of infertile women on IVF outcomes. METHODS Following preliminary searches to find medical subject heading (MeSH) terms plus free terms, a systematic search was performed in the PubMed, Cochrane Library, Embase, Web of Science, and Clinicaltrials.gov databases from January 10, 2022, to July 5, 2023. Data collected for each study were analyzed using RevMan 5.4 software available on the Cochrane website. RESULTS After correcting for contamination from the vagina, the FFs of 289 women were detected positively by microbial culture and identification, ELISA, and IPA. The pregnancy rate of the FF-positive group was significantly lower than the FF-negative group (19.7% vs. 32.2%) and (OR: 0.57, 95% CI: 0.28-1.14, P=0.11; I2=56%) while the fertilization rate was almost equal (60.0% vs. 62.0%) and (OR: 1.03, 95% CI: 0.88-1.20, P=0.72; I2=0%). Evidence quality was very low. CONCLUSIONS The different species of microorganisms in FF of infertile women may have different effects on IVF outcomes. The Lactobacillus spp. may have a positive effect, while other microorganisms may have the opposite effect.
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Affiliation(s)
- Shanshan Ou
- Center of Reproductive Medicine, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, China
| | - Ming Liao
- Center of Reproductive Medicine, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, China
| | - Lanyu Cui
- Key Laboratory of Longevity and Aging-Related Diseases of Chinese Ministry of Education; Guangxi Colleges and Universities, Key Laboratory of Biological Molecular Medicine Research, School of Basic Medical Sciences, Guangxi Medical University, Nanning, 530021, Guangxi, People's Republic of China
| | - Yuehui Du
- Center of Reproductive Medicine, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, China
| | - Ling Zhao
- Center of Reproductive Medicine, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, China
| | - Chuyu Peng
- Center of Reproductive Medicine, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, China
| | - Li Jiang
- Center of Reproductive Medicine, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, China.
| | - Bo Liu
- Center of Reproductive Medicine, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, China.
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Zeng M, Yang L, Mao Y, He Y, Li M, Liu J, Zhu Q, Chen L, Zhou W. Preconception reproductive tract infections status and adverse pregnancy outcomes: a population-based retrospective cohort study. BMC Pregnancy Childbirth 2022; 22:501. [PMID: 35725418 PMCID: PMC9208112 DOI: 10.1186/s12884-022-04836-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 06/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background Reproductive tract infections can cause serious adverse outcomes for pregnant women such as spontaneous abortion and preterm birth. However, it is unclear whether maternal reproductive tract infection before pregnancy would also be related to any adverse pregnancy outcomes. This study aims to investigate the association of maternal preconception reproductive tract infections with subsequent adverse pregnancy outcomes. Methods A retrospective cohort study was conducted in the Chongqing Municipality of China between April 2010 and December 2016. A total of 57,586 women (57,708 pregnancies) from all 39 counties of Chongqing who participated in the National Free Preconception Health Examination Project were included. They all took preconception examinations for gonorrhea, chlamydia, trichomoniasis, syphilis, bacterial vaginosis and candidiasis before pregnancy within one year. Primary outcomes included spontaneous abortion (< 28 weeks gestation), preterm birth (< 37 weeks gestation), macrosomia and low birthweight. Results Of the 57,708 pregnancies, 2438 (4.22%) had at least one type of reproductive tract infections. Compared with women who were not infected with any reproductive tract infection before pregnancy, women with reproductive tract infections had a higher rate of spontaneous abortion (7.88% vs. 5.62%, p < 0.001). After analyzing by each infection, there were few significant associations between pre-pregnancy infections and adverse outcomes. Preconception syphilis infection was significantly associated with increased odds of spontaneous abortion (aOR = 2.07, 95%CI 1.50–2.85), induced abortion/labour due to medical reasons (aOR = 1.60, 95%CI 1.01–2.54) and preterm birth (aOR = 1.60, 95%CI 1.12–2.30) after adjusting for potential confounders. Preconception trichomoniasis was intended to relate to a higher risk of spontaneous abortion (aOR = 1.65, 95%CI 1.01–2.71), but its impact seemed to be attributed to its co-infection with other RTIs. Women who were chlamydia or bacterial vaginosis positive before pregnancy showed higher odds of macrosomia (aOR = 2.00, 95% CI 1.07–3.74 for chlamydia; aOR = 1.58, 95% CI 1.06–2.34 for bacterial vaginosis). Preconception bacterial vaginosis might also be associated with higher risks of very preterm birth (aOR = 2.16, 95%CI 1.23–3.78) and large for gestational age (aOR = 1.36, 95%CI 1.02–1.81). Conclusions Women with infections of the genital tract before pregnancy might also have increased risks of subsequent adverse outcomes including spontaneous abortion, preterm birth and macrosomia. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04836-3.
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Affiliation(s)
- Mengyao Zeng
- NHC Key Lab. of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Fudan University, 400020, Shanghai, China
| | - Liu Yang
- NHC Key Laboratory of Birth Defects and Reproductive Health, Chongqing Population and Family Planning Science and Technology Research Institute, 200237, Chongqing, China
| | - Yanyan Mao
- NHC Key Lab. of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Fudan University, 400020, Shanghai, China
| | - Yang He
- NHC Key Laboratory of Birth Defects and Reproductive Health, Chongqing Population and Family Planning Science and Technology Research Institute, 200237, Chongqing, China
| | - Min Li
- NHC Key Lab. of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Fudan University, 400020, Shanghai, China
| | - Jun Liu
- NHC Key Laboratory of Birth Defects and Reproductive Health, Chongqing Population and Family Planning Science and Technology Research Institute, 200237, Chongqing, China
| | - Qianxi Zhu
- NHC Key Lab. of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Fudan University, 400020, Shanghai, China
| | - Liang Chen
- NHC Key Laboratory of Birth Defects and Reproductive Health, Chongqing Population and Family Planning Science and Technology Research Institute, 200237, Chongqing, China.
| | - Weijin Zhou
- NHC Key Lab. of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Fudan University, 400020, Shanghai, China.
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Effect of previous Chlamydia Trachomatis infection on the outcomes of ivf/icsi treatment: a retrospective study. BMC Pregnancy Childbirth 2022; 22:305. [PMID: 35399086 PMCID: PMC8994901 DOI: 10.1186/s12884-022-04624-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/27/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The impact of Chlamydia trachomatis infection (CT) on the outcomes of In-Vitro Fertilization / Intracytoplasmic sperm injection (IVF/ICSI) has been controversial.
Methods
A total of 431 infertility women aged 20–38 years with or without Chlamydia trachomatis infection before fresh/ frozen embryo transfer were included to investigate the effect of cured CT infection. The infected group was divided into two subgroups for ≤3 months and > 3 months according to the different intervals between Chlamydia trachomatis positive testing and embryo transfer. The effect of chlamydia infection and the intervals between infection and embryo transfer on pregnancy outcomes was analyzed with correction for potential confounders within a multivariable model.
Results
Our results revealed that implantation rate was significantly lower and the premature rupture of membranes (PROM) was higher in women with CT infection than non-infection. The multivariate logistic regression analysis adjusting for baseline characteristics showed no significant difference in live birth rate between neither two groups nor two subgroups.
Conclusions
The study suggests that previous Chlamydia trachomatis infection would lead to high risk of PROM. The intervals between infection and embryo transfer would not impact the pregnancy outcomes of IVF/ICSI.
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Tjahyadi D, Ropii B, Tjandraprawira KD, Parwati I, Djuwantono T, Permadi W, Li T. Female urogenital chlamydia: Epidemiology, chlamydia on pregnancy, current diagnosis, and treatment. Ann Med Surg (Lond) 2022; 75:103448. [PMID: 35386801 PMCID: PMC8977933 DOI: 10.1016/j.amsu.2022.103448] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 11/26/2022] Open
Abstract
Female urogenital chlamydia is a disease caused by Chlamydia trachomatis infection in the female urogenital tract. It is a common bacterial sexually transmitted disease. The bacteria is transmitted through sexual contact with an infected partner or from mother to newborn during vaginal delivery. The prevalence varies among studies and the number is possibly higher due to the lack of massive screening. Many patients were asymptomatic and still be able to transmit the disease. The undiagnosed and untreated disease could cause pelvic inflammatory disease, which leads to infertility, ectopic pregnancy, and chronic pelvic pain. The prevalence among pregnant women is similar to non-pregnant women, therefore chlamydia screening in pregnant women is highly recommended. The nucleic acid amplification test is the most reliable method for the diagnosis due to high sensitivity. The current treatment is given by prescribing antibiotics. Female urogenital chlamydia is caused by Chlamydia trachomatis. Urogenital chlamydia affects young and sexually active women. Female urogenital chlamydia is diagnosed through indirect methods (serology-based tests) and direct methods (culture). Treatment of chlamydia consists of antibiotics with doxycycline being the first-line choice.
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Herrero Y, Pascuali N, Velázquez C, Oubiña G, Hauk V, de Zúñiga I, Peña MG, Martínez G, Lavolpe M, Veiga F, Neuspiller F, Abramovich D, Scotti L, Parborell F. SARS-CoV-2 infection negatively affects ovarian function in ART patients. Biochim Biophys Acta Mol Basis Dis 2022; 1868:166295. [PMID: 34718118 PMCID: PMC8550892 DOI: 10.1016/j.bbadis.2021.166295] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/24/2021] [Accepted: 10/15/2021] [Indexed: 01/08/2023]
Abstract
Several organs, such as the heart, breasts, intestine, testes, and ovaries, have been reported to be target tissues of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. To date, no studies have demonstrated SARS-CoV-2 infection in the female reproductive system. In the present study, we investigated the effects of SARS-CoV-2 infection on ovarian function by comparing follicular fluid (FF) from control and recovered coronavirus disease 2019 (COVID-19) patients and by evaluating the influence of these FF on human endothelial and non-luteinized granulosa cell cultures. Our results showed that most FFs (91.3%) from screened post COVID-19 patients were positive for IgG antibodies against SARS-CoV-2. Additionally, patients with higher levels of IgG against SARS-CoV-2 had lower numbers of retrieved oocytes. While VEGF and IL-1β were significantly lower in post COVID-19 FF, IL-10 did not differ from that in control FF. Moreover, in COV434 cells stimulated with FF from post COVID-19 patients, steroidogenic acute regulatory protein (StAR), estrogen-receptor β (Erβ), and vascular endothelial growth factor (VEGF) expression were significantly decreased, whereas estrogen-receptor α (ERα) and 3β-hydroxysteroid dehydrogenase (3β-HSD) did not change. In endothelial cells stimulated with post COVID-19 FF, we observed a decrease in cell migration without changes in protein expression of certain angiogenic factors. Both cell types showed a significantly higher γH2AX expression when exposed to post COVID-19 FF. In conclusion, our results describe for the first time that the SARS-CoV-2 infection adversely affects the follicular microenvironment, thus dysregulating ovarian function.
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Affiliation(s)
- Yamila Herrero
- Ovarian Pathophysiology Studies Laboratory, Institute of Experimental Biology and Medicine (IByME) - CONICET, Buenos Aires, Argentina
| | - Natalia Pascuali
- Ovarian Pathophysiology Studies Laboratory, Institute of Experimental Biology and Medicine (IByME) - CONICET, Buenos Aires, Argentina
| | - Candela Velázquez
- Ovarian Pathophysiology Studies Laboratory, Institute of Experimental Biology and Medicine (IByME) - CONICET, Buenos Aires, Argentina
| | - Gonzalo Oubiña
- Ovarian Pathophysiology Studies Laboratory, Institute of Experimental Biology and Medicine (IByME) - CONICET, Buenos Aires, Argentina
| | - Vanesa Hauk
- Immunopharmacology Laboratory, Institute of Biological Chemistry (IQUIBICEN), School of Exact and Natural Sciences, University of Buenos Aires-CONICET, Buenos Aires, Argentina
| | | | | | | | | | | | | | - Dalhia Abramovich
- Ovarian Pathophysiology Studies Laboratory, Institute of Experimental Biology and Medicine (IByME) - CONICET, Buenos Aires, Argentina
| | - Leopoldina Scotti
- Ovarian Pathophysiology Studies Laboratory, Institute of Experimental Biology and Medicine (IByME) - CONICET, Buenos Aires, Argentina; Centro de Investigaciones y Transferencia del Noroeste de la Provincia de Buenos Aires (CITNOBA) - CONICET - UNNOBA - UNSAdA, San Antonio de Areco, Argentina
| | - Fernanda Parborell
- Ovarian Pathophysiology Studies Laboratory, Institute of Experimental Biology and Medicine (IByME) - CONICET, Buenos Aires, Argentina.
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Ogbonmwan D, Hussey J, Gudipati M. Time to re-evaluate the guidance on sexual infections in fertility services. HUM FERTIL 2020; 24:230-235. [PMID: 31960732 DOI: 10.1080/14647273.2020.1714086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Current guidance in the UK for fertility services on the screening for sexually transmitted infections (STI) is solely directed towards Chlamydia trachomatis. Evidence used to formulate the guidance is based on research undertaken before more sensitive diagnostic methods were available and before testing of some organisms was even possible. This commentary outlines current STI trends, evidence available for STI effect on fertility and new diagnostic methods of screening. It aims to demonstrate that UK guidance should be updated and directed towards areas where further research is required.
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Affiliation(s)
- Daisy Ogbonmwan
- Sunderland Sexual Health, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Jane Hussey
- Sunderland Sexual Health, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Madhavi Gudipati
- Department of Obstetrics and Gynaecology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
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Kayiira A, Zaake D, Lwetabe MW, Sekweyama P. Impact of genital Chlamydia trachomatis infection on reproductive outcomes among infertile women undergoing tubal flushing: a retrospective cohort at a fertility centre in Uganda. FERTILITY RESEARCH AND PRACTICE 2019; 5:16. [PMID: 31890236 PMCID: PMC6909488 DOI: 10.1186/s40738-019-0069-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 12/05/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The impact of current C. trachomatis on clinical pregnancy and live birth rates among women undergoing tubal flushing is largely unknown. This study aimed to investigate whether current female genital C. trachomatis infection affects the chance of achieving a clinical pregnancy and a live birth, among infertile women undergoing tubal flushing, at a fertility centre in Uganda. METHODS A retrospective Cohort study at a peri-urban fertility centre. A total of 253 eligible women with tubal factor infertility, who underwent tubal flushing, were enrolled and categorised according to their exposure to current genital C. trachomatis infection. These women were followed up for a period of 12 months, with the primary outcome measure being clinical pregnancy and live birth. Secondary outcome measures included pregnancy loss and procedural related adverse events. RESULTS Exposure to current genital C. trachomatis infection reduced chance of clinical pregnancy (adjusted relative risk 0.42; 95% confidence interval, 0.18-0.96) and a live birth (adjusted relative risk 0.37; 95% confidence interval, 0.14-0.95) after tubal flushing. Women with current C. trachomatis infection had an increased risk of adverse events (adjusted relative risk, 1.20; 95% confidence interval, 1.08-1.34). However, current C. trachomatis infection did not affect the risk of spontaneous abortion and ectopic pregnancy. CONCLUSION Current genital C. trachomatis infection in women with tubal factor infertility, undergoing tubal flushing, lowers their chance of pregnancy and live birth.
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Affiliation(s)
- Anthony Kayiira
- Life Sure Fertility and Gynaecology centre, St. Francis Hospital Nsambya, postgraduate medical school, Uganda Martyr’s University Nkozi, Nsambya, Uganda
| | - Daniel Zaake
- Life Sure Fertility and Gynaecology centre, St. Francis Hospital Nsambya, postgraduate medical school, Uganda Martyr’s University Nkozi, Nsambya, Uganda
| | | | - Peter Sekweyama
- Life Sure Fertility and Gynaecology centre, St. Francis Hospital Nsambya, postgraduate medical school, Uganda Martyr’s University Nkozi, Nsambya, Uganda
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Galkin OY, Gorshunov YV, Besarab OB, Ivanova OM. Development and characterization of highly informative ELISA for the detection of IgG and IgA antibodies to Сhlamydia trachomatis. UKRAINIAN BIOCHEMICAL JOURNAL 2018. [DOI: 10.15407/ubj90.03.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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10
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Refaat B, Dalton E, Ledger WL. Ectopic pregnancy secondary to in vitro fertilisation-embryo transfer: pathogenic mechanisms and management strategies. Reprod Biol Endocrinol 2015; 13:30. [PMID: 25884617 PMCID: PMC4403912 DOI: 10.1186/s12958-015-0025-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/03/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Ectopic pregnancy (EP) is the leading cause of maternal morbidity and mortality during the first trimester and the incidence increases dramatically with in vitro fertilisation and embryo transfer (IVF-ET). The co-existence of an EP with a viable intrauterine pregnancy (IUP) is known as heterotopic pregnancy (HP) affecting about 1% of patients during assisted conception. EP/HP can cause significant morbidity and occasional mortality and represent diagnostic and therapeutic challenges, particularly during fertility treatment. Many risk factors related to IVF-ET techniques and the cause of infertility have been documented. The combination of transvaginal ultrasound (TVS) and serum human chorionic gonadotrophin (hCG) is the most reliable diagnostic tool, with early diagnosis of EP/HP permitting conservative management. This review describes the risk factors, diagnostic modalities and treatment approaches of EP/HP during IVF-ET and also their impact on subsequent fertility treatment. METHODS The scientific literature was searched for studies investigating EP/HP during IVF-ET. Publications in English and within the past 6 years were mostly selected. RESULTS A history of tubal infertility, pelvic inflammatory disease and specific aspects of embryo transfer technique are the most significant risk factors for later EP. Early measurement of serum hCG and performance of TVS by an expert operator as early as gestational week 5 can identify cases of possible EP. These women should be closely monitored with repeated ultrasound and hCG measurement until a diagnosis is reached. Treatment must be customised to the clinical condition and future fertility requirements of the patient. In cases of HP, the viable IUP can be preserved in the majority of cases but requires early detection of HP. No apparent negative impact of the different treatment approaches for EP/HP on subsequent IVF-ET, except for risk of recurrence. CONCLUSIONS EP/HP are tragic events in a couple's reproductive life, and the earlier the diagnosis the better the prognosis. Due to the increase incidence following IVF-ET, there is a compelling need to develop a diagnostic biomarker/algorithm that can predict pregnancy outcome with high sensitivity and specificity before IVF-ET to prevent and/or properly manage those who are at higher risk of EP/HP.
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Affiliation(s)
- Bassem Refaat
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al-Abdiyah Campus, PO Box 7607, Makkah, KSA.
| | - Elizabeth Dalton
- School of Women's & Children's Health, University of New South Wales, Sydney, NSW, 2031, Australia.
| | - William L Ledger
- School of Women's & Children's Health, University of New South Wales, Sydney, NSW, 2031, Australia.
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Coppus SFPJ, Land JA, Opmeer BC, Steures P, Eijkemans MJC, Hompes PGA, Bossuyt PMM, van der Veen F, Mol BWJ, van der Steeg JW. Chlamydia trachomatis IgG seropositivity is associated with lower natural conception rates in ovulatory subfertile women without visible tubal pathology. Hum Reprod 2011; 26:3061-7. [DOI: 10.1093/humrep/der307] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Detection of follicular fluid and serum antibodies by protein microarrays in women undergoing in vitro fertilization treatment. J Reprod Immunol 2011; 89:62-9. [PMID: 21477867 DOI: 10.1016/j.jri.2011.01.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 11/26/2010] [Accepted: 01/13/2011] [Indexed: 11/23/2022]
Abstract
A protein microarray serological assay was used to assess the antibody profile of 102 women subjected to in vitro fertilization treatment. The studies were conducted on pairs of serum and follicular fluid samples, collected from each woman on the same day at the time of oocyte recovery. The samples, stored as frozen aliquotes, were assessed by both microarray and ELISA. Follicular fluids and sera were screened to detect the presence of specific IgG and IgM antibodies against seven vertically transmitted pathogens. The IgG reactivity of follicular fluids closely mirrored that of serum in all the patients and for all the antigens, with an agreement of more than 85%. IgM antibodies were undetectable in follicular fluids. The antibody patterns were subsequently related to the biological and clinical outcomes of in vitro fertilization cycles. The results showed that varicella zoster virus (VZV) IgG positive women and cytomegalovirus (CMV) IgG negative women had on average a higher number of inseminated, good quality oocytes compared to VZV IgG negative and CMV IgG positive women. In addition, the rate of successful embryo transfers was significantly higher in Toxoplasma gondii IgG negative women than in their positive counterparts. Overall, the microarray was proven to be a suitable tool for detecting analytes in follicular fluids, therefore supporting its application in a wide spectrum of investigations.
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