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Han Y, Deng X, Cai J, Peng W, Duan C, Huang K. Trade-off between double cleavage-stage embryos transfer and single blastocyst-stage embryo transfer in patients with few good quality embryos in antagonist cycles: a retrospective study using a propensity score matching analysis. BMC Pregnancy Childbirth 2024; 24:339. [PMID: 38702596 PMCID: PMC11067270 DOI: 10.1186/s12884-024-06537-5] [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: 12/12/2023] [Accepted: 04/21/2024] [Indexed: 05/06/2024] Open
Abstract
OBJECTIVE This study aimed to compare the per OPU clinical outcomes for transfer of Day 3 double cleavage-stage embryos (DET) and Day 5 single blastocyst-stage (SBT) in patients with five or fewer good quality embryos on day 3 per occyte pick-up cycle (OPU) in antagonist cycles with consideration of blastocyst formation failure. METHODS This was a retrospective, observational cohort study of 2,116 cases of OPU treated with antagonist protocol in the affiliated Chenggong Hospital of Xiamen University between January 2013 and December 2020. DET was performed in 1,811cycles and SBT was performed in 305 cycles. The DET group was matched to the SBT group by propensity score (PS) matching according to multiple maternal baseline covariates. After PS matching, there were 303 ET cycles in each group. The primary outcomes were the cumulative live birth rate (CLBR), cumulative multiple pregnancy rate(CMPR)per OPU and the number of ET to achieve live birth per OPU. Secondary outcomes were the percentage of clinical pregnancy(CPR), live birth rate(LBR), multiple pregnancy rate(MPR). RESULTS Following PS mating, the CLBR was slightly higher (48.8% versus 40.3% ; P = 0.041) and the CMPR was significantly higher in the DET group compared to SBT group(44.2% versus 7.9%, P < 0.001). The CPR, LBR and MPR per fresh transfer were higher in DET group compared to SBT group(50.2% versus 28.7%; 41.3% versus 21.5%;29.6% versus 0%, P < 0.001). The number of ET to achieve live birth per OPU in SBT group was obiviously more than in DET group(1.48 ± 0.578 versus 1.22 ± 0.557 ,P < 0.001). CONCLUSION With a marginal difference cumulative live birth rate, the lower live birth rate per fresh transfer and higher number of ET per OPU in the SBT group suggested that it might take longer time to achieve a live birth with single blastocyst strategy. A trade-off decision should be made between efficiency and safety.
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Affiliation(s)
- Yan Han
- The Assisted Reproduction Department, Yichun Maternal and Child Health Hospital, Yichun, China
| | - Xing Deng
- The Assisted Reproduction Department, Yichun Maternal and Child Health Hospital, Yichun, China
| | - Jiali Cai
- Reproductive Medicine Centre, Affifiliated Chenggong Hospital of Xiamen University, Xiamen, China
- School of Medicine, Xiamen University, Xiamen, China
| | - Wei Peng
- The Assisted Reproduction Department, Yichun Maternal and Child Health Hospital, Yichun, China
| | - Chaoqun Duan
- The Assisted Reproduction Department, Yichun Maternal and Child Health Hospital, Yichun, China
| | - Kezhen Huang
- Reproductive Medicine Centre, Affifiliated Chenggong Hospital of Xiamen University, Xiamen, China.
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Zou H, Wang R, Morbeck DE. Diagnostic or prognostic? Decoding the role of embryo selection on in vitro fertilization treatment outcomes. Fertil Steril 2024; 121:730-736. [PMID: 38185198 DOI: 10.1016/j.fertnstert.2024.01.005] [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: 11/28/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 01/09/2024]
Abstract
In this review, we take a fresh look at embryo assessment and selection methods from the perspective of diagnosis and prognosis. On the basis of a systematic search in the literature, we examined the evidence on the prognostic value of different embryo assessment methods, including morphological assessment, blastocyst culture, time-lapse imaging, artificial intelligence, and preimplantation genetic testing for aneuploidy.
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Affiliation(s)
- Haowen Zou
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Rui Wang
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Dean E Morbeck
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia; Principle, Morbeck Consulting Ltd, Auckland, New Zealand.
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Ji J, Ling X, Zhou Q, Zhou L, Ji H, Wu X, Zhang J, Cao S. Prioritized single vitrified blastocyst to be warmed between grades 3 or 4 blastocyst on day 5 transfer cycles. Arch Gynecol Obstet 2024; 309:1629-1641. [PMID: 38315199 DOI: 10.1007/s00404-023-07336-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/05/2023] [Indexed: 02/07/2024]
Abstract
PURPOSE Selecting the optimal blastocyst to implant during cryopreservation and warming is critial for in vitro fertilization success. Therefore, the aim of this study was to explore which blastocyst should be prioritized to be thawed when facing a single vitrified blastocyst on day 5 transfer. METHODS A retrospective study including 1,976 single vitrified-warmed blastocyst transfer cycles was conducted from January 2016 to December 2020. RESULTS We found that grade 4 vitrified blastocyst had a higher clinical pregnancy (60.64% vs. 49.48%, P < 0.001) and live birth rates (50.12% vs 39.59%, P < 0.001) than the grade 3 vitrified blastocyst. However, no statistical difference was found between groups in miscarriage rate, birth weight, or gestational age. Besides, the grade 4 vitrified-thawed blastocyst had significant potential to develop into grade 6 blastocyst after further culturing for 16 h (73.68% vs. 48.60%, P < 0.001). The grade 6 transferred blastocyst was markedly higher in both clinical pregnancy rate (61.88% vs. 51.53%, P < 0.001) and live birth rate (50.91% vs. 40.46%, P < 0.001) compared to grade 5 transferred blastocyst. CONCLUSIONS Grade 4 vitrified blastocyst is recommended when facing single vitrified blastocyst on day 5 transfer. More importantly, the "embryonic escape hypothesis" was firstly proposed to reveal the findings.
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Affiliation(s)
- Juan Ji
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, 123 Tianfeixiang, Mochou Road, Nanjing, 210004, Jiangsu, China
| | - Xiufeng Ling
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, 123 Tianfeixiang, Mochou Road, Nanjing, 210004, Jiangsu, China
| | - Qiao Zhou
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, 123 Tianfeixiang, Mochou Road, Nanjing, 210004, Jiangsu, China
| | - Lin Zhou
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, 123 Tianfeixiang, Mochou Road, Nanjing, 210004, Jiangsu, China
| | - Hui Ji
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, 123 Tianfeixiang, Mochou Road, Nanjing, 210004, Jiangsu, China
| | - Xun Wu
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, 123 Tianfeixiang, Mochou Road, Nanjing, 210004, Jiangsu, China
| | - Juanqiang Zhang
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, 123 Tianfeixiang, Mochou Road, Nanjing, 210004, Jiangsu, China
| | - Shanren Cao
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, 123 Tianfeixiang, Mochou Road, Nanjing, 210004, Jiangsu, China.
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Bar-El L, Lenchner E, Gulersen M, Gobioff S, Yeshua A, Eliner Y, Grünebaum A, Chervenak FA, Bornstein E. Comprehensive appraisal of pregnancy and neonatal outcomes in singleton pregnancies conceived via in vitro fertilization in the USA (2016-2021). J Perinat Med 2024; 52:343-350. [PMID: 38126220 DOI: 10.1515/jpm-2023-0409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/11/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES We set out to compare adverse pregnancy and neonatal outcomes in singleton gestations conceived via in vitro fertilization (IVF) to those conceived spontaneously. METHODS Retrospective, population-based cohort using the CDC Natality Live Birth database (2016-2021). All singleton births were stratified into two groups: those conceived via IVF, and those conceived spontaneously. The incidence of several adverse pregnancy and neonatal outcomes was compared between the two groups using Pearson's chi-square test with Bonferroni adjustments. Multivariate logistic regression was used to adjust outcomes for potential confounders. RESULTS Singleton live births conceived by IVF comprised 0.86 % of the cohort (179,987 of 20,930,668). Baseline characteristics varied significantly between the groups. After adjusting for confounding variables, pregnancies conceived via IVF were associated with an increased risk of several adverse pregnancy and neonatal outcomes compared to those conceived spontaneously. The maternal adverse outcomes with the highest risk in IVF pregnancies included maternal transfusion, unplanned hysterectomy, and maternal intensive care unit admission. Increased rates of hypertensive disorder of pregnancy, preterm birth (delivery <37 weeks of gestation), and cesarean delivery were also noted. The highest risk neonatal adverse outcomes associated with IVF included immediate and prolonged ventilation, neonatal seizures, and neonatal intensive care unit admissions, among others. CONCLUSIONS Based on this large contemporary United States cohort, the risk of several adverse pregnancy and neonatal outcomes is increased in singleton pregnancies conceived via IVF compared to those conceived spontaneously. Obstetricians should be conscious of these associations while caring for and counseling pregnancies conceived via IVF.
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Affiliation(s)
- Liron Bar-El
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital - Northwell Health/Zucker School of Medicine, New York, NY, USA
| | - Erez Lenchner
- Biostatistics and Data Management, New York University Rory Meyers College of Nursing, New York, NY, USA
| | - Moti Gulersen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Samantha Gobioff
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital - Northwell Health/Zucker School of Medicine, New York, NY, USA
| | - Arielle Yeshua
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital - Northwell Health/Zucker School of Medicine, New York, NY, USA
| | - Yael Eliner
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital - Northwell Health/Zucker School of Medicine, New York, NY, USA
| | - Amos Grünebaum
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital - Northwell Health/Zucker School of Medicine, New York, NY, USA
| | - Frank A Chervenak
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital - Northwell Health/Zucker School of Medicine, New York, NY, USA
| | - Eran Bornstein
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital - Northwell Health/Zucker School of Medicine, New York, NY, USA
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Zhou Y, Ji H, Zhang M, Zhang J, Li X, Zhang J, Ling X, Chen L, Zhao C. Single versus double blastocyst transfer in first and second frozen-thawed embryo transfer cycle in advance-aged women: a two-center retrospective cohort study. BMC Womens Health 2024; 24:51. [PMID: 38238733 PMCID: PMC10795208 DOI: 10.1186/s12905-023-02753-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 10/31/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND The present evidence is deficient for the trade-offs between the pros and cons of single blastocyst transfer (SBT) versus double blastocyst transfer (DBT) in frozen-thawed embryo transfer cycles for women in advanced reproductive age, especially in the second cycle. The current study aimed to investigate the impact of transferred blastocyst numbers on pregnancy outcomes in the first and second embryo transfer for women ≥ 35 years. METHODS This was a retrospective cohort study including 1284 frozen-thawed blastocyst transfer (FBT) cycles from two reproductive centers. We analyzed the pregnancy outcomes after SBT and DBT in the first and second FBT cycles. Moreover, stratified analysis was conducted by maternal age. RESULTS In the first FBT cycle, the LBR was higher in the DBT group than that in the SBT group [52.3% vs. 33.9%; adjusted odds ratio (aOR), 1.65; 95% confidence interval (CI), 1.26-2.15, P < 0.001]. However, the LBR of the DBT group showed no remarkable difference compared with that of the SBT group in the second cycle of FBT (44.3% vs. 33.3%; aOR, 1.30; 95% CI, 0.81-2.08; P = 0.271). Furthermore, stratified analysis by age showed a higher LBR for the DBT group than the SBT group in patients aged 38-42 years (43.1% vs. 33.9%; aOR, 2.27; 95% CI, 1.05-4.90; P = 0.036). CONCLUSIONS The present study demonstrated that the SBT regimen is a better choice for both, the first and second frozen-thawed embryo transfer cycles, for women aged 35-37 years. Additionally, the DBT regimen is still recommended to achieve a high LBR in women aged 38-42 years in the second FBT cycle. These findings may be beneficial for deciding the embryo transfer regimens in women of advanced reproductive age.
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Affiliation(s)
- Yuxi Zhou
- Department of Reproductive Medicine, Nanjing Women and Children's Healthcare Hospital, Women's Hospital of Nanjing Medical University, Nanjing, 210004, China
| | - Hui Ji
- Department of Reproductive Medicine, Nanjing Women and Children's Healthcare Hospital, Women's Hospital of Nanjing Medical University, Nanjing, 210004, China
| | - Mianqiu Zhang
- Department of Reproductive Medicine, Nanjing Women and Children's Healthcare Hospital, Women's Hospital of Nanjing Medical University, Nanjing, 210004, China
| | - Juanjuan Zhang
- Department of Reproductive Medicine, Nanjing Women and Children's Healthcare Hospital, Women's Hospital of Nanjing Medical University, Nanjing, 210004, China
| | - Xin Li
- Department of Reproductive Medicine, Nanjing Women and Children's Healthcare Hospital, Women's Hospital of Nanjing Medical University, Nanjing, 210004, China
| | - Junqiang Zhang
- Department of Reproductive Medicine, Nanjing Women and Children's Healthcare Hospital, Women's Hospital of Nanjing Medical University, Nanjing, 210004, China
| | - Xiufeng Ling
- Department of Reproductive Medicine, Nanjing Women and Children's Healthcare Hospital, Women's Hospital of Nanjing Medical University, Nanjing, 210004, China
| | - Li Chen
- Department of Reproductive Medicine, Changzhou Maternal and Child Health Care Hospital, Changzhou, 213000, China
| | - Chun Zhao
- Department of Reproductive Medicine, Nanjing Women and Children's Healthcare Hospital, Women's Hospital of Nanjing Medical University, Nanjing, 210004, China.
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Cai H, Mol B, Gordts S, Wang H, Shi J. Elective single versus double blastocyst-stage embryo transfer in women aged 36 years or older: a retrospective cohort study. HUM FERTIL 2023; 26:1185-1194. [PMID: 36719262 DOI: 10.1080/14647273.2022.2153348] [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: 09/15/2021] [Accepted: 08/29/2022] [Indexed: 02/01/2023]
Abstract
We evaluated if elective single-blastocyst transfer (eSBT) could be adopted in women aged 36 or older. In this retrospective cohort, women aged ≥36 years received IVF ovarian stimulation cycles and had ≥ two blastocysts. A total of 240 women underwent eSBT and 189 double-blastocyst transfer (DBT) in the first transfer cycle. The subsequent frozen-thawed embryo transfer cycles were a combination of single- and double- blastocyst transfers. Analysis was stratified for patients in age groups 36-37, 38-39 and ≥40, considering the quality of the blastocyst transferred. The cumulative live birth rates (cLBR) were 74.2% (178/240) versus 63.0% (119/189) after eSBT versus DBT, respectively (aOR: 1.09 (0.68, 1.75)). Time to live birth did not vary significantly between the two groups (HR: 0.85 (0.68, 1.08)). The total number of children born was 194 after eSBT (162 singletons and 16 pairs of twins) versus 154 (84 singletons and 35 twins) after DBT. The odds ratios for preterm birth (0.37 (0.21-0.64)), and low birth weight (0.31 (0.16, 0.60)) were all lower in eSBT. In women aged ≥36 years, cLBR following single- versus double- blastocyst transfer was comparable while the odds of multiple live births and adverse perinatal outcomes were reduced.
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Affiliation(s)
- He Cai
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, People's Republic of China
| | - Ben Mol
- Medicine Department, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Parkville, Victoria, Australia
- Pregnancy Research Centre, Department of Maternal-Fetal Medicine, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Stephan Gordts
- Leuven Institute for Fertility & Embryology, Leuven, Belgium
| | - Hui Wang
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, People's Republic of China
| | - Juanzi Shi
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, People's Republic of China
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Jiang Y, Wang L, Wang S, Shen H, Wang B, Zheng J, Yang J, Ma B, Zhang X. The effect of embryo selection using time-lapse monitoring on IVF/ICSI outcomes: A systematic review and meta-analysis. J Obstet Gynaecol Res 2023; 49:2792-2803. [PMID: 37778750 DOI: 10.1111/jog.15797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/12/2023] [Indexed: 10/03/2023]
Abstract
AIM To explore the effect of embryo selection using the time-lapse monitoring (TLM) system compared with conventional morphological selection (CMS) on in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes. METHODS We searched PubMed, Ovid-Embase, and The Cochrane Library for the following studies: At Comparison 1, embryo selection using TLM images in a TLM incubator based on morphology versus embryo selection using CMS in a conventional incubator based on morphology; at Comparison 2, embryo selection using TLM based on morphokinetics versus embryo selection using CMS based on morphology. The primary outcomes were the live birth rate (LBR), ongoing pregnancy rate (OPR), clinical pregnancy rate (CPR), and implantation rate (IR), and the secondary outcome was the miscarriage rate (MR). RESULTS A total of 14 randomized control trials (RCTs) were included. Both based on morphology, TLM incubators increased the IR (risk ratio [RR]: 1.10; 95% confidence interval [CI]: 1.01, 1.18; I2 = 0%, moderate-quality evidence) compared to conventional incubators. Low- to moderate-quality evidence suggests that TLM incubators did not improve LBR, OPR, CPR, and MR compared to conventional incubators. In addition, low- to moderate-quality evidence indicates that embryo selection using TLM based on morphokinetics did not improve LBR, OPR, CPR, IR, or MR compared to CMS based on morphology. CONCLUSIONS Low- to moderate-quality evidence suggests that neither TLM incubators nor embryo selection using TLM based on morphokinetics improved clinical outcomes (LBR, OPR, CPR, and MR) compared with CMS based on morphology. TLM is still an investigational procedure for IVF/ICSI practice.
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Affiliation(s)
- Yanbiao Jiang
- The First Clinical Medical College, Lanzhou University, Lanzhou, People's Republic of China
| | - Liyan Wang
- The First Clinical Medical College, Lanzhou University, Lanzhou, People's Republic of China
- The First Hospital of Lanzhou University, Lanzhou, People's Republic of China
- Key Laboratory for Reproductive Medicine and Embryo of Gansu Province, Lanzhou, People's Republic of China
| | - Sha Wang
- The First Clinical Medical College, Lanzhou University, Lanzhou, People's Republic of China
| | - Haofei Shen
- The First Clinical Medical College, Lanzhou University, Lanzhou, People's Republic of China
| | - Bin Wang
- The First Clinical Medical College, Lanzhou University, Lanzhou, People's Republic of China
| | - Jianxiu Zheng
- The First Clinical Medical College, Lanzhou University, Lanzhou, People's Republic of China
| | - Jinwei Yang
- Gansu Provincial Maternity and Child-care Hospital (Gansu Province Central Hospital), Lanzhou, People's Republic of China
| | - Bin Ma
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, People's Republic of China
| | - Xuehong Zhang
- The First Clinical Medical College, Lanzhou University, Lanzhou, People's Republic of China
- The First Hospital of Lanzhou University, Lanzhou, People's Republic of China
- Key Laboratory for Reproductive Medicine and Embryo of Gansu Province, Lanzhou, People's Republic of China
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Hynes JS, Weber JM, Truong T, Acharya KS, Eaton JL. Body mass index is negatively associated with a good perinatal outcome after in vitro fertilization among patients with polycystic ovary syndrome: a national study. F S Rep 2023; 4:77-84. [PMID: 36959962 PMCID: PMC10028420 DOI: 10.1016/j.xfre.2022.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 11/23/2022] [Accepted: 11/29/2022] [Indexed: 12/05/2022] Open
Abstract
Objective To evaluate the association between body mass index (BMI) and good perinatal outcomes after in vitro fertilization (IVF) among women with polycystic ovary syndrome (PCOS). Design Retrospective cohort study using 2012-2015 Society for Assisted Reproductive Technology Clinic Outcomes Reporting System data. Setting Fertility clinics. Patients To identify patients most likely to have PCOS, we included women with a diagnosis of ovulation disorder and serum antimüllerian hormone >4.45 ng/mL. Exclusion criteria included age ≥ 41 years, secondary diagnosis of diminished ovarian reserve, preimplantation genetic testing, and missing BMI or primary outcome data. Interventions None. Main Outcome Measures Good perinatal outcome, defined as a singleton live birth at ≥ 37 weeks with birth weight ≥ 2,500 g and ≤ 4,000 g. Results The analysis included 9,521 fresh, autologous IVF cycles from 8,351 women. Among women with PCOS, the proportion of cycles with a good perinatal outcome was inversely associated with BMI: underweight 25.1%, normal weight 22.7%, overweight 18.9%, class I 18.4%, class II 14.9%, and class III or super obesity 12.2%. After adjusting for confounders, women in the highest BMI category had 51% reduced odds of a good perinatal outcome compared with normal weight women (adjusted odds ratio 0.49, 95% confidence interval 0.36-0.67). Conclusions Among women with PCOS undergoing fresh, autologous IVF, the odds of a good perinatal outcome decline with increasing BMI. Women with PCOS should be counseled that the odds of achieving a good perinatal outcome decrease as their weight increases.
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Affiliation(s)
- Jenna S. Hynes
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke Fertility Center, Durham, NC
- Reprint requests: Jenna S. Hynes, M.D., Division of Reproductive Endocrinology and Infertility, Columbia University Fertility Center, 5 Columbus Circle, PH Floor, New York, New York 10019.
| | - Jeremy M. Weber
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
| | - Tracy Truong
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
| | - Kelly S. Acharya
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke Fertility Center, Durham, NC
| | - Jennifer L. Eaton
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke Fertility Center, Durham, NC
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Yin R, Dang Y, Ma Z, Sun M. The effects of unexpected follicular growth and ovulation in artificial cycles: a retrospective cohort study of frozen, single-blastocyst transfer. Fertil Steril 2023; 119:985-993. [PMID: 36805040 DOI: 10.1016/j.fertnstert.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 02/21/2023]
Abstract
OBJECTIVE To study the effects of unexpected follicular development and ovulation in artificial cycles (ACs) on pregnancy outcomes. DESIGN A retrospective cohort study. SETTING A university-affiliated fertility center. PATIENT(S) A total of 1,427 patients who underwent a single, frozen-thawed blastocyst transfer with AC regimens from January 2014 to December 2020 at a university-affiliated fertility center were included. INTERVENTION(S) Unexpected follicular development and ovulation in ACs. MAIN OUTCOME MEASURE(S) Live birth rate (LBR), biochemical pregnancy rate, clinical pregnancy rate, and ongoing pregnancy rate. RESULT(S) A total of 161 patients with unexpected follicular development and ovulation in ACs (ovulation group) and 1,266 patients without growing follicles in ACs (control group) were enrolled. The patients in the ovulation group were older and had higher levels of serum follicle-stimulating hormone and lower levels of serum antimüllerian hormone. After propensity score matching, the baseline characteristics between the 2 groups were comparable and no significant difference was observed in the LBR (ovulation group, 39.0% vs. control group, 39.0%), biochemical pregnancy rate (ovulation group, 60.3% vs. control group, 58.2%), clinical pregnancy rate (ovulation group, 53.4% vs. control group, 50.7%), or ongoing pregnancy rate (ovulation group, 42.5% vs. control group, 40.4%). Moreover, the patients in the ovulation group showed a lower risk of hypertensive disorders of pregnancy (HDP) (1.6% vs. 15.3%). A subgroup analysis of women who delivered singleton live-born babies also demonstrated that unexpected follicular development and ovulation in ACs was associated with a decreased risk of HDP (adjusted odds ratio, 0.070; 95% confidence interval, 0.007-0.712) and an increased risk of large-for-gestational-age infants (adjusted odds ratio, 4.046; 95% confidence interval, 1.319-12.414). CONCLUSION(S) Women with unexpected follicular development and ovulation during single frozen-thawed blastocyst transfer with AC regimens had a similar LBR and a reduced risk of HDP compared with those with routine AC regimens, and singleton neonates had an increased risk of being large for gestational age.
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Affiliation(s)
- Rusha Yin
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, China
| | - Yujie Dang
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, China; Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China; Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, China; Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China
| | - Zengxiang Ma
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, China; Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China; Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, China; Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China
| | - Mei Sun
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, China; Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China; Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, China; Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China.
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Salas Valdivia C, Carpio Valderrama G, Bernedo Moscoso AA, Torres Flor A, Berríos Garaycochea M. Adopción embrionaria: estado de la cuestión ético-jurídica en el Perú. PERSONA Y BIOÉTICA 2023. [DOI: 10.5294/pebi.2022.26.2.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
La técnica de reproducción asistida trae consigo un número de embriones sobrantes. Se propone una revisión del estado de la cuestión de estos embriones en el Perú. Se revisa desde las perspectivas biológica, ética y jurídica. Se profundiza en el ordenamiento jurídico peruano, sobre el estado de desprotección de estos embriones y se contrasta con una posible solución: la adopción embrionaria. Se constata el estado de incertidumbre de la situación de estos embriones y se concluye como ilegítima la práctica de la adopción embrionaria, por vulnerar la dignidad y condición de sujeto de derecho del embrión sobrante.
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11
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Wu X, Zhou WJ, Xu BF, Chen Q, Xia L, Zhao S, Xu HH, Zhang AJ, Niu ZH. Association between transferred embryos and multiple pregnancy/live birth rate in frozen embryo transfer cycles: A retrospective study. Front Endocrinol (Lausanne) 2023; 13:1073164. [PMID: 36686447 PMCID: PMC9849691 DOI: 10.3389/fendo.2022.1073164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/07/2022] [Indexed: 01/06/2023] Open
Abstract
Background Physicians need an appropriate embryo transfer strategy to address the challenge of reducing multiple birth rates, while maintaining the couples' live birth rate during assisted reproductive technology. Methods We included 10,060 frozen embryo transfer cycles from January 2015 to March 2020 in reproductive medical center of Ruijin hospital, Shanghai, China. Patients were grouped according to the number and grade of cleavage-stage embryo or blastocysts transferred. Live birth rate and multiple live birth rate were compared among groups of women of different ages. Multivariable logistic regression models were used to estimate the risk of multiple live birth using different combinations of transferred embryos. Results The transfer of double good-quality embryos was an independent predictor for multiple birth in women aged <30 years and those aged 36-39 years [<30 years: aOR =1.54 (95% CI: 1.14-2.06, P < 0.01); 36-39 years: aOR =1.84 (95% CI: 1.0-3.4, P < 0.01)]. Further, for women aged <36 years, the transfer of good-quality + poor-quality blastocysts was an independent predictor for multiple birth rate [<30 years: aOR=2.46 (95% CI: 1.45-4.18, P < 0.01); 31-35 years: aOR =4.45 (95% CI: 1.97-10.06, P < 0.01)]. Conclusions Single-good-quality blastocyst transfer is recommended for women of all ages. When good-quality cleavage embryos are available, the choice of single or double embryo transfer with good- or average-quality embryo should depend on the age of women. Double embryo transfer with the highest possible grade of embryos is recommended for women aged ≥40 years.
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Affiliation(s)
| | | | | | | | | | | | | | - Ai-jun Zhang
- Department of Obstetrics and Gynecology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhi-hong Niu
- Department of Obstetrics and Gynecology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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12
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Wong KY, Tan HH, Allen JC, Chan JKY, Ee TX, Chua KH, Liu S, Phoon JWL, Viardot-Foucault V, Nadarajah S, Tan TY. Outcomes and cost analysis of single-embryo transfer versus double-embryo transfer. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231206312. [PMID: 37899602 PMCID: PMC10617257 DOI: 10.1177/17455057231206312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 08/09/2023] [Accepted: 09/21/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Studies had compared single-embryo transfer to double-embryo transfer with cleavage stage embryos and found that while single-embryo transfer was less costly, it was also associated with a lower live birth rate than double-embryo transfer. A single blastocyst transfer has been shown to improve the live birth rate per cycle compared to single-embryo transfer at cleavage stage. OBJECTIVES To compare live birth rates and real costs of elective single-embryo transfer to double-embryo transfer and to determine the incremental cost-effectiveness ratio of these two strategies in an unselected pool of women in a single center. DESIGN Retrospective study. METHODS We analyzed data of 4232 women who underwent their first fresh in vitro fertilization/intra-cytoplasmic sperm injection cycles with at least two embryos available for transfer in KK Women's and Children's Hospital from 2010 to 2017. RESULTS Five hundred and sixty-four women underwent elective single-embryo transfer and 3668 women underwent double-embryo transfer. One hundred and fifty-six women who failed to achieve a live birth in their fresh elective single-embryo transfer cycle underwent a sequential thaw single-embryo transfer cycle. Live birth rate of fresh elective single-embryo transfer was significantly higher at 41.3% than that of double-embryo transfer at 32.6%. Cumulative live birth rate for sequential elective single-embryo transfer (fresh elective single-embryo transfer + thaw single-embryo transfer) was 47.9%. After accounting for variables which may affect live birth rates such as age and stage of embryo transfer, the odds of achieving a live birth from double-embryo transfer was 24% lower than that from sequential single-embryo transfer, although not statistically significant. For every live birth gained from an elective single-embryo transfer compared to double-embryo transfer, cost savings were S$20,172 per woman. If a woman had to have a sequential single-embryo transfer after a failed single-embryo transfer in her fresh cycle, cost savings were reduced to S$1476 per woman. CONCLUSION Single-embryo transfer is a dominant strategy in an unselected population and adopting it in assisted reproductive treatments (ART) can produce cost savings without compromising on live birth rates.
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Affiliation(s)
- Ker Yi Wong
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, Singapore
| | - Heng Hao Tan
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, Singapore
| | - John Carson Allen
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - JKY Chan
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, Singapore
| | - Tat Xin Ee
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, Singapore
| | - Ka-Hee Chua
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, Singapore
| | - Shuling Liu
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, Singapore
| | | | | | - Sadhana Nadarajah
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, Singapore
| | - Tse Yeun Tan
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, Singapore
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13
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Embryo Blastomere Exclusion Identified in a Time-Lapse Culture System Is Associated with Embryo Ploidy. Reprod Sci 2022; 30:1911-1916. [DOI: 10.1007/s43032-022-01141-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022]
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14
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Liu W, Akbarpour-Beni M, Movahed S, Gorzi A, Cheraghi E, Amini H. Neutralising the testosterone enanthate-induced oxidative stress in rats uterine tissue by propolis and chicory as natural antioxidants. COMPARATIVE EXERCISE PHYSIOLOGY 2022. [DOI: 10.3920/cep220010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
The objective of this study was to investigate the effect of eight weeks of propolis and chicory on oxidative stress of uterine tissue in rats consuming testosterone enanthate. Thirty-five female Wistar rats (8 weeks old and weighing 200±12 g) were randomly divided between five groups (n=8) resistance training+ testosterone enanthate (RT+TE), resistance training+ testosterone enanthate+ chicory (RT+TE+CH), resistance training+ testosterone enanthate+ propolis (RT+TE+PR), control (CO), and sham (RT). The protocols were as follows: exercise protocol including climb on a 1-meter ladder with 26 steps five days a week for eight weeks, received a dose of 20 mg/kg of body weight of testosterone weekly for eight weeks, and received a dose of 400 mg/kg proplis and 6 g/kg chicory of body weight all days a week for eight weeks. Superoxide dismutase (SOD), glutathione peroxidase (GPX), and malondialdehyde (MDA) were measured as oxidative stress markers. Testosterone treatment resulted in a significant decrease in the amount of SOD and GPX only in RT+TE group compared to the RT+TE+CH and RT+TE+PR groups (P=0.001). There was no significant difference in mean SOD and GPX levels between RT+TE+CH and RT+TE+PR with CO and RT groups (P>0.05). MDA level was significantly higher in RT+TE group compared to the other groups (P=0.001). This level was also significantly higher in RT+TE+CH group compared to the CO group (P=0.000) and in RT+TE+PR group compared to CO (P=0.000) and RT (P=0.003) groups. Although testosterone enanthate leads to oxidative stress in uterine tissue, propolis and chicory reduced this oxidative stress. It seems that more research can be done on the potential effects of natural antioxidants to neutralise the harmful effects of steroids.
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Affiliation(s)
- W. Liu
- Department of Physical Education, Anhui Vocational and Technical College of Sports, Wenzhong Rd, Yaohai District, Hefei, 230013 Anhui, China P.R
- Key Research Base of Humanities and Social Sciences in Colleges and Universities in Anhui Province, Quality Education Research Center for College Students of Anhui, Xinhua University, Wangjiang W Rd, Shushan District, Hefei, 230094 Anhui, China, P.R
| | - M. Akbarpour-Beni
- Department of Sports Science, Faculty of Literature and Human Sciences, University of Qom, Qom, Iran
| | - S. Movahed
- Department of Sports Science, Faculty of Literature and Human Sciences, University of Qom, Qom, Iran
| | - A. Gorzi
- Department of sport sciences, Faculty of Humanities, University of Zanjan, Zanjan, Iran
| | - E. Cheraghi
- Department of Biology, Faculty of Sciences, University of Qom, Qom, Iran
| | - H. Amini
- Department of Physical Education & Sport Sciences, Tolou-e-Mehr Non-profit Institute of Higher Education, Qom, Iran
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15
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Park JK, Ahn SY, Seok SH, Park SY, Bang S, Eum JH, Kwak IP, Kim JW, Lee WS. Clinical Usability of Embryo Development Using a Combined Qualitative and Quantitative Approach in a Single Vitrified-Warmed Blastocyst Transfer: Assessment of Pre-Vitrified Blastocyst Diameter and Post-Warmed Blastocyst Re-Expansion Speed. J Clin Med 2022; 11:jcm11237085. [PMID: 36498659 PMCID: PMC9736480 DOI: 10.3390/jcm11237085] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/08/2022] [Accepted: 11/25/2022] [Indexed: 12/04/2022] Open
Abstract
Improving the safety and efficacy of assisted reproductive technology programs has been a continuous challenge. Traditionally, morphological grading has been used for embryo selection. However, only a few studies have assessed the morphokinetic variables and morphological dynamics of blastocysts. In the present study, we aimed to perform a quantitative analysis of blastocyst diameter and re-expansion speed. This in-depth morphokinetic evaluation can correlate with currently observed pregnancy outcomes. In total, 658 single vitrified-warmed blastocyst transfer cycles were performed between October 2017 and December 2021, which were divided into four groups according to the pre-vitrified blastocyst diameter. After warming, the groups were subdivided according to the blastocyst re-expansion speed. These quantitative measurements were performed using a time-lapse system. Both diameter and speed are essential in determining the blastocyst quality, while age, day of freezing, and blastocyst quality are crucial from a clinical perspective. The application of both quantitative (diameter and speed) and qualitative (blastocyst quality scores) parameters can help evaluate the clinical usability of blastocysts. This method can prove useful for embryologists in counseling their patients and determining pregnancy patient-oriented strategies.
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16
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The Efficacy and Safety of the Zhuyun Formula and Auricular Acupressure for the Infertile Women with Recurrent Implantation Failure: A Randomized Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:5274638. [PMID: 36267092 PMCID: PMC9578856 DOI: 10.1155/2022/5274638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022]
Abstract
Background Recurrent implantation failure (RIF), a clinical disorder characterized by failure to achieve pregnancy after repeated (≥3) embryo transfer, is a challenge for reproductive demands worldwide. In our preliminary work, the Zhuyun formula (ZYF) with auricular acupressure, a complementary and alternative medicine (CAM) with a small sample size for RIF, can improve the clinical pregnancy rate (41.2% vs. 26.7%, treatment group vs. control group, p < 0.05). Based on the toxicological and pregnancy-related pharmacological analysis of ZYF for RIF, the T-cell receptor signaling pathway might be involved in the pharmacological activity. This study aimed at evaluating the efficacy and safety of the CAM therapy according to pregnancy outcomes and maternal and child health and investigating the changes of T-helper (Th) cells in the peripheral blood of unexplained RIF women. Materials and Methods We conducted a prospective, two-arms, randomized, nonblinded study. All eligible women were randomly assigned to the treatment group (TG) and the control group (CG) according to a computer-generated randomization list in sealed opaque envelopes. Blood samples were collected from the two groups, and serum Th1, Th2, and Treg were detected by flow cytometry. The cytokines were detected by an enzyme-linked immunosorbent assay (ELISA). The TG was administrated with ZYF and auricular acupressure for three months before ovarian stimulation, while the control group was on a waiting list for the same period. The primary outcome was CPR. The second outcomes were the serum levels of immune parameters. For the safety evaluation, the perinatal outcomes of maternal and child were obtained by follow-up. Post-hoc sensitivity analyses were performed to assess the effect of missing data. Results One hundred and twenty-three women were randomized into the TG (n = 62) and CG (n = 61). The CPR was increased significantly in the TG (45.2%) than CG (26.2%) (p = 0.029). Twenty blood samples were collected, and the Th2/Th1 and Treg expression level was significantly higher in the TG than in the CG. IL-2, IL-10, and Foxp3 were higher significantly in the TG than in the CG. The maternal and child perinatal outcomes were not significantly different between the two groups. Conclusions The ZYF with auricular acupressure was effective and safe in improving the pregnancy outcomes of RIF. It might be related to balancing the level of cytokines related to the immune tolerance of the maternal-fetal interface to protect the embryo from the maternal immune system. Clinical Trial Registration: Clinical Trial Registry; date: 14/Dec/2013; no. NCT03078205.
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17
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Nam JY, Hwang S, Jang SI, Park EC. Effects of assisted reproductive technology on severe maternal morbidity risk in both singleton and multiple births in Korea: A nationwide population-based cohort study. PLoS One 2022; 17:e0275857. [PMID: 36215280 PMCID: PMC9550088 DOI: 10.1371/journal.pone.0275857] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 09/25/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Whether infertility treatment predicts severe maternal morbidity in both singleton and twin pregnancies is controversial. We conducted this nationwide population-based cohort study to compare pregnancies conceived through assisted reproductive technology treatments, such as intrauterine insemination or in vitro fertilization, with unassisted pregnancies. METHODS This study included 269,930 women who experienced childbirth in 2018, using data of the National Health Insurance Service National Delivery Cohort in Korea. The primary outcome was assessed using a severe maternal morbidity algorithm developed by the Centers for Disease Control and Prevention in the United States. A modified Poisson regression was used to estimate the adjusted risk ratio of severe maternal morbidity. RESULTS Severe maternal morbidity occurred in 6,333 (2.3%) of 280,612 deliveries investigated. The risk of severe maternal morbidity was approximately 1.5-fold higher among women who received in vitro fertilization (risk ratio: 1.51, 95% confidence interval: 1.36-1.68) than among fertile women. However, no significant association between intrauterine insemination and maternal morbidity was identified. Via subgroup analysis, in vitro fertilization increased the risk of severe maternal morbidity by 1.6- and 1.3-fold in singleton and multiple births, respectively (singleton: risk ratio: 1.62, 95% confidence interval: 1.43-1.83; multiple birth: risk ratio: 1.31, 95% confidence interval: 1.07-1.60). CONCLUSIONS This study suggested that in vitro fertilization was associated with the risk of severe maternal morbidity in both singleton and multiple births. Further research should identify patient- and treatment-specific factors that may mitigate or prevent adverse maternal health risks.
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Affiliation(s)
- Jin Young Nam
- Department of Healthcare Management, Eulji University, Seongnam, Republic of Korea
| | - Seoyeon Hwang
- Department of Healthcare Management, Eulji University, Seongnam, Republic of Korea
| | - Sung-In Jang
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- * E-mail:
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18
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Liu Y, Li Y, Li K, Li S. Abdominal heterotopic pregnancy after in vitro fertilization and embryo transfer following bilateral salpingectomy: A case report and literature review. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:921141. [PMID: 36303660 PMCID: PMC9580738 DOI: 10.3389/frph.2022.921141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/27/2022] [Indexed: 12/02/2022] Open
Abstract
Background Risk of heterotopic pregnancy following bilateral salpingectomy has increased considerably due to the widespread use of assisted reproductive technology. Poor understanding of this condition often causes delayed or missed diagnosis. Objective In this report, we describe the case of a 30-year-old pregnant woman with lower abdominal pain lasting for half a day and a history of bilateral salpingectomy. Two embryos had been transferred 21 days preceding her presentation. Methods Case report. Results Laparoscopic surgery revealed intraperitoneal hemorrhage and proper ovarian ligament pregnancy confirmed by histopathology. Viable intrauterine pregnancy was verified 3 days later by ultrasound examination. Conclusion Heterotopic pregnancy is a serious condition that may be life-threatening. Clinicians should be aware of the potential for heterotopic pregnancy in patients receiving in vitro fertilization and embryo transfer after bilateral salpingectomy.
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Affiliation(s)
- Yifeng Liu
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yu Li
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Keting Li
- Department of Ultrasonography, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shuangdi Li
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Shuangdi Li
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19
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Taylor H, Li HJ, Carson S, Flores V, Pal L, Robbins J, Santoro NF, Segars JH, Seifer D, Huang H, Young S, Zhang H. Pre-IVF treatment with a GnRH antagonist in women with endometriosis (PREGNANT): study protocol for a prospective, double-blind, placebo-controlled trial. BMJ Open 2022; 12:e052043. [PMID: 35715184 PMCID: PMC9207753 DOI: 10.1136/bmjopen-2021-052043] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Infertility is a common complication of endometriosis. While in vitro fertilisation-embryo transfer (IVF) successfully treats endometriosis-associated infertility, there is some evidence that pregnancy rates may be diminished in women seeing fertility treatment for endometriosis-associated infertility compared with other etiologies of infertility. The use of gonadotropin releasing hormone (GnRH) agonist prior to IVF has been suggested to improve success, however studies have been small and rarely reported live birth rates. Recent approval of an oral GnRH antagonist for endometriosis provides a novel option for women with endometriosis who are undergoing IVF. There have been no studies on the efficacy of GnRH antagonists for the treatment of endometriosis-related infertility. METHODS AND ANALYSIS This study is a multicentre, prospective, randomised, double-blind, placebo-controlled trial to study the efficacy of GnRH antagonist pretreatment for women with endometriosis who are undergoing IVF. A total of 814 patients with endometriosis undergoing fertility treatment will be enrolled and randomised 1:1 into two groups: elagolix 200 mg two times per day or placebo for 8 weeks, prior to undergoing IVF. All participants will then undergo IVF treatment per local protocols. The primary outcome is live birth. Secondary outcomes include oocyte number, fertilisation rate, embryo morphology and implantation rates, as well as rates of known endometriosis-related obstetrical outcomes (pregnancy-induced hypertension, antepartum haemorrhage, caesarean delivery and preterm birth). ETHICS AND DISSEMINATION The PREGnant trial was approved by the Institutional Review Board at Johns Hopkins University. Results will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04173169.
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Affiliation(s)
- Hugh Taylor
- Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Howard J Li
- Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sandra Carson
- Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Valerie Flores
- Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lubna Pal
- Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jared Robbins
- Obstetrics and Gynecology, Northwestern University, Evanston, Chicago, USA
| | - Nanette F Santoro
- Obstetrics and Gynecology, University of Colorado, Denver, Colorado, USA
| | - James H Segars
- Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David Seifer
- Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Hao Huang
- Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Steven Young
- Obstetrics and Gynecology, The University of North Carolina, Chapel Hill, North Carolina, USA
| | - Heping Zhang
- Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USA
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20
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Peregrino PFM, Bonetti TCDS, Gomes AP, de Martin H, Soares Júnior JM, Baracat EC, Monteleone PAA. One Plus One is Better than Two: An Approach Towards a Single Blastocyst Transfer Policy for All IVF Patients. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:578-585. [PMID: 35576968 PMCID: PMC9948105 DOI: 10.1055/s-0042-1743096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE It is known that the single embryo transfer (SET) is the best choice to reduce multiples and associated risks. The practice of cryopreserving all embryos for posterior transfer has been increasingly performed for in vitro fertilization (IVF) patients at the risk of ovarian hyperstimulation syndrome or preimplantation genetic testing for aneuploidy. However, its widespread practice is still controverse. The aim of this study was to evaluate how effective is the transfer of two sequential SET procedures compared with a double embryo transfer (DET) in freeze-only cycles. METHODS This retrospective study reviewed 5,156 IVF cycles performed between 2011 and 2019, and 506 cycles using own oocytes and freeze-only policy with subsequent elective frozen-thawed embryo transfers (eFET) were selected for this study. Cycles having elective SET (eSET, n = 209) comprised our study group and as control group we included cycles performed with elective DET (eDET, n = 291). In the eSET group, 57 couples who had failed in the 1st eSET had a 2nd eFET, and the estimated cumulative ongoing pregnancy rate was calculated and compared with eDET. RESULTS After the 1st eFET, the ongoing pregnancy rates were similar between groups (eSET: 35.4% versus eDET: 38.5%; p = 0.497), but the estimated cumulative ongoing pregnancy rate after a 2nd eFET in the eSET group (eSET + SET) was significantly higher (48.8%) than in the eDET group (p < 0.001). Additionally, the eSET + SET group had a 2.7% rate of multiple gestations, which is significantly lower than the eDET group, with a 30.4% rate (p < 0.001). CONCLUSION Our study showed the association of freeze-only strategy with until up to two consecutive frozen-thawed eSETs resulted in higher success rates than a frozen-thawed DET, while drastically reducing the rate of multiple pregnancies.
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Affiliation(s)
- Pedro Felipe Magalhães Peregrino
- Centro de Reprodução Humana Monteleone, São Paulo, SP, Brazil.,Centro de Reprodução Humana "Governador Mario Covas", Discipline of Gynecology, Department of Obstetrics and Gynecology, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Tatiana Carvalho de Souza Bonetti
- Centro de Reprodução Humana Monteleone, São Paulo, SP, Brazil.,Molecular Gynecology Laboratory, Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.,Centro de Neurociências e Saúde da Mulher "Professor Geraldo Rodrigues de Lima", Neuroscience Discipline of the Department of Neurology and Neurosurgery, Escola Paulista de Medicina - Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Hamilton de Martin
- Centro de Reprodução Humana Monteleone, São Paulo, SP, Brazil.,Centro de Reprodução Humana "Governador Mario Covas", Discipline of Gynecology, Department of Obstetrics and Gynecology, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - José Maria Soares Júnior
- Centro de Reprodução Humana "Governador Mario Covas", Discipline of Gynecology, Department of Obstetrics and Gynecology, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Edmund Chada Baracat
- Centro de Reprodução Humana "Governador Mario Covas", Discipline of Gynecology, Department of Obstetrics and Gynecology, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Pedro Augusto Araújo Monteleone
- Centro de Reprodução Humana Monteleone, São Paulo, SP, Brazil.,Centro de Reprodução Humana "Governador Mario Covas", Discipline of Gynecology, Department of Obstetrics and Gynecology, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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21
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Comprehensive guidance for human embryology, andrology, and endocrinology laboratories: management and operations: a committee opinion. Fertil Steril 2022; 117:1183-1202. [PMID: 35487770 DOI: 10.1016/j.fertnstert.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/04/2022]
Abstract
This document is a comprehensive guidance for human embryology, andrology, and endocrinology laboratories. Universal guidance applicable to all laboratories includes requirements and recommendations for accreditation and staffing in the United States, and specific guidance is included for each laboratory specialty.
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Affiliation(s)
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- American Society for Reproductive Medicine, Birmingham, AL
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22
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Ingilizova G, Kovachev E, Yaneva G. Obstetric Outcomes and Successful Reduction of Twin Pregnancies Achieved by In Vitro Fertilization. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The use of in vitro fertilization methods around the world is constantly increasing. In some developed countries, up to 5% of newborns are as a result of pregnancies after IVF procedures. In vitro fertilization as one of the main and widespread methods for treatment of infertility is the main reason for the high frequency of multiple pregnancies, which, in many countries, is still too high. Most of the multiple pregnancies are in fact twin pregnancies. Twin pregnancies, regardless of how they are achieved, are associated with large number of complications compared with singleton ones. More often these pregnancies can lead to maternal complications and adverse pregnancy outcomes. Maternal complications include development of preeclampsia, gestational diabetes, placenta previa, placental abruption, premature rupture of membranes, antepartum and postpartum hemorrhage, and delivery by cesarean sections. Adverse pregnancy outcomes mostly include preterm birth (PTB), low birth weight (LBW), small for gestational age newborn (SGA), intrauterine growth restriction (IUGR), neonatal respiratory distress syndrome (RDS), and admission to neonatal intensive care unit (NICU). A number of studies have found differences in the course of twin pregnancies according to their mode of occurrence – spontaneous or after IVF. Some of them have found that twin pregnancies after IVF are associated with poorer obstetric and perinatal outcomes, others do not find such a difference, and there are even studies that find a better outcome in IVF twin pregnancies. Twin pregnancy is a common occurrence after IVF procedure, because multiple-embryo transfer is commonly regarded as an effective strategy to improve the likelihood of a successful pregnancy. Understanding the risks of these pregnancies should be a strong motive for the transfer of fewer embryos during IVF procedures. The most effective way to do this is to transfer a single-embryo into the uterus in cases, where this is justified and the chances of getting pregnant are high. An important element in achieving this goal is the use of methods for vitrification of embryos, which leads to a sufficiently high rate of clinical pregnancies after freezing of embryos obtained by IVF and their subsequent transfer after thawing in case of failure of fresh ET.
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Xiong F, Sun Q, Wang S, Yao Z, Chen P, Wan C, Zhong H, Zeng Y. A nomogram to assist blastocyst selection in vitrified‐warmed embryo transfer cycles. J Obstet Gynaecol Res 2022; 48:1816-1828. [PMID: 35373468 DOI: 10.1111/jog.15138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/14/2021] [Accepted: 12/14/2021] [Indexed: 01/21/2023]
Affiliation(s)
- Feng Xiong
- Shenzhen Key Laboratory of Reproductive Immunology for Peri‐implantation Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital Shenzhen Guangdong People's Republic of China
| | - Qing Sun
- Shenzhen Key Laboratory of Reproductive Immunology for Peri‐implantation Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital Shenzhen Guangdong People's Republic of China
| | - Sisi Wang
- Shenzhen Key Laboratory of Reproductive Immunology for Peri‐implantation Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital Shenzhen Guangdong People's Republic of China
| | - Zhihong Yao
- Shenzhen Key Laboratory of Reproductive Immunology for Peri‐implantation Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital Shenzhen Guangdong People's Republic of China
| | - Peilin Chen
- Shenzhen Key Laboratory of Reproductive Immunology for Peri‐implantation Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital Shenzhen Guangdong People's Republic of China
| | - Caiyun Wan
- Shenzhen Key Laboratory of Reproductive Immunology for Peri‐implantation Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital Shenzhen Guangdong People's Republic of China
| | - Huixian Zhong
- Shenzhen Key Laboratory of Reproductive Immunology for Peri‐implantation Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital Shenzhen Guangdong People's Republic of China
| | - Yong Zeng
- Shenzhen Key Laboratory of Reproductive Immunology for Peri‐implantation Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital Shenzhen Guangdong People's Republic of China
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24
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Meng Q, Xu Y, Zheng A, Li H, Ding J, Xu Y, Pu Y, Wang W, Wu H. Noninvasive embryo evaluation and selection by time-lapse monitoring vs. conventional morphologic assessment in women undergoing in vitro fertilization/intracytoplasmic sperm injection: a single-center randomized controlled study. Fertil Steril 2022; 117:1203-1212. [PMID: 35367059 DOI: 10.1016/j.fertnstert.2022.02.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/12/2022] [Accepted: 02/15/2022] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine whether time-lapse monitoring (TLM) for cleavage-stage embryo selection improves reproductive outcomes in comparison with conventional morphological assessment (CMA) selection. DESIGN Prospective randomized controlled trial. SETTING Single academic center. PATIENTS We randomly assigned 139 women who were undergoing their first in vitro fertilization or intracytoplasmic sperm injection cycle to undergo either fresh embryo transfer or first frozen embryo transfer (FET). Only 1 cleavage-stage embryo was transferred to each participant. INTERVENTIONS The patients were randomly assigned to either the CMA or the TLM group. In the CMA group, day 2 and day 3 embryos were observed. A good-quality cleavage-stage embryo was selected for transfer or freezing in both groups. MAIN OUTCOME MEASURES The primary and secondary outcomes were the clinical pregnancy rate (CPR) and the live birth rate (LBR), respectively, after the first embryo transfer (fresh embryo transfer or FET). RESULTS The CPR and LBR were significantly lower in the TLM group than in the CMA group (CPR: 49.18% vs. 70.42%; relative risk, 0.70; 95% confidence interval [CI], 0.52-0.94; LBR: 45.90% vs. 64.79%; relative risk, 0.71; 95% CI, 0.51-0.98). The CPR with fresh embryo transfer or FET did not significantly differ between the TLM and the CMA groups (fresh embryo transfer: 44.44% vs. 70.0%, relative risk, 0.63, 95% CI, 0.39-1.03; FET: 52.94% vs. 70.73%, relative risk, 0.75, 95% CI, 0.52-1.09). There was a significant difference in the LBR with fresh embryo transfer between the TLM and the CMA groups (40.74% vs. 66.67%; relative risk, 0.61; 95% CI, 0.36-1.03). The LBRs with FET were similar in the TLM and the CMA groups (50.0% vs. 63.41%; relative risk, 0.79; 95% CI, 0.52-1.19). The rates of early spontaneous abortion and ectopic pregnancy did not differ between the TLM and the CMA groups. CONCLUSIONS Elective single cleavage-stage embryo transfer with TLM-based selection did not have any advantages over CMA when day 2 and day 3 embryo morphology was combined in young women with a good ovarian reserve. Because of these results, we conclude that TLM remains an investigational procedure for in vitro fertilization practice. CLINICAL TRIAL REGISTRATION NUMBER ChiCTR1900021981.
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Affiliation(s)
- Qingxia Meng
- Center of Reproduction and Genetics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
| | - Yunyu Xu
- State Key Laboratory of Reproductive Medicine, Center of Reproduction and Genetics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
| | - Aiyan Zheng
- Center of Reproduction and Genetics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
| | - Hong Li
- Center of Reproduction and Genetics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China.
| | - Jie Ding
- Center of Reproduction and Genetics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
| | - Yongle Xu
- Center of Reproduction and Genetics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
| | - Yan Pu
- Center of Reproduction and Genetics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
| | - Wei Wang
- Center of Reproduction and Genetics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
| | - Huihua Wu
- Center of Reproduction and Genetics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
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25
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Fouks Y, Yogev Y. Twinning in ART: Single embryo transfer policy. Best Pract Res Clin Obstet Gynaecol 2022; 84:88-95. [PMID: 35430161 DOI: 10.1016/j.bpobgyn.2022.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/13/2022] [Indexed: 11/16/2022]
Abstract
It is more than thirty years that perinatologists and healthcare personnel aim to reduce the morbidity associated with multiple pregnancy. In many cases, these complications stem from pregnancies achieved through artificial reproductive technologies (ART). Although dramatic measures have been taken to control those risks by increasing the proportion of single embryo transfers, the multiple pregnancy rate still remains relatively high among patient conceived through ART, carrying risks to both mothers and newborns, and is coupled with the related economic burden associated with prematurity. The aim of this review is to provide the current evidence regarding single embryo transfer to assist decision-makers and to promote patient knowledge toward an elective policy to reduce the risk of twinning. Single embryo transfer may aid in the further reduction of multiple pregnancy and, in most cases, will maintain patient autonomy and right of choice.
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Affiliation(s)
- Yuval Fouks
- Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yariv Yogev
- Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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26
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Chao SB, Wang YH, Li JC, Cao WT, Zhou Y, Sun QY. Down-Regulation Ovulation-Induction Leads to Favorable Outcomes in a Single Frozen-Thawed Blastocyst Transfer RCT. Front Endocrinol (Lausanne) 2022; 13:797121. [PMID: 35321334 PMCID: PMC8934774 DOI: 10.3389/fendo.2022.797121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Elective single embryo transfer (eSET) has been increasingly advocated to achieve the goal of delivering a single healthy baby. A novel endometrial preparation approach down-regulation ovulation-induction (DROI) proposed by our team was demonstrated in an RCT that DROI could significantly improve the reproductive outcome compared with modified natural cycle. We aimed to evaluate whether DROI improved clinic pregnancy rate in this single frozen-thawed blastocyst transfer RCT compared with hormone replace treatment (HRT). Method Eligible participants were recruited and randomized into one of two endometrial preparation regimens: DROI or HRT between March 15, 2019 and March 12, 2021. The primary outcome was clinical pregnancy rate (CPR). The secondary endpoints included ongoing pregnancy rate (OPR), biochemical miscarriage and first trimester pregnancy loss. This trial is registered at the Chinese Clinical Trial Registry, number ChiCTR2000039804. Result s A total of 330 women were randomized in a 1:1 ratio between two groups and 289 women received embryo transfer and completed the study (142 DROI; 147HRT). Pregnancy outcomes were significantly different between the two groups. The CPR and OPR in the DROI group were significantly higher than those of the HRT group (64.08% versus 46.94%, P<0.01; 56.34% versus 38.78%,P<0.01). The biochemical miscarriage and first trimester pregnancy loss were comparable between the two groups. Conclusion s The findings of this RCT support the suggestion that the DROI might be a more efficient and promising alternative endometrial preparation approach for FET. Moreover, DROI could play a critical role in promoting uptake of single embryo transfer strategies in FET.
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Affiliation(s)
- Shi-Bin Chao
- Department of Clinical Medicine, Fuzhou Medical College of Nanchang University, Fuzhou, China
- ART Centre, Maternal and Child Health Care Hospital, Shangrao, China
| | - Yan-Hong Wang
- ART Centre, Maternal and Child Health Care Hospital, Shangrao, China
| | - Jian-Chun Li
- ART Centre, Maternal and Child Health Care Hospital, Shangrao, China
- Department of Clinical Laboratory, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wen-Ting Cao
- Department of Clinical Laboratory, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yun Zhou
- ART Centre, Maternal and Child Health Care Hospital, Shangrao, China
| | - Qing-Yuan Sun
- Fertility Preservation Lab, Guangdong-Hong Kong Metabolism and Reproduction Joint Laboratory, Reproductive Medicine Centre, Guangdong Second Provincial General Hospital, Guangzhou, China
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27
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Katler QS, Kawwass JF, Hurst BS, Sparks AE, McCulloh DH, Wantman E, Toner JP. Vanquishing multiple pregnancy in in vitro fertilization in the United States-a 25-year endeavor. Am J Obstet Gynecol 2022; 227:129-135. [PMID: 35150636 DOI: 10.1016/j.ajog.2022.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 11/18/2022]
Abstract
The practice of in vitro fertilization has changed tremendously since the birth of the first in vitro fertilization infant in 1978. With the success of early in vitro fertilization programs in the United States, there was a substantial rise in twin births nationwide. In the mid-1990s, more than 30% of in vitro fertilization cycles resulted in twin or higher-order multifetal pregnancies. Since that time, we not only have witnessed improvements in laboratory and treatment efficacy but also have seen a dramatic impact on pregnancy outcomes, specifically regarding twin pregnancies. Because the field evolved and the risks of multifetal pregnancies became more salient, in 2019, the rate of twin pregnancies had dropped to <7% of cycles. This improvement was largely because of technical advancements and revised professional guidance: culturing embryos longer before transfer, improved freezing technology, embryo preimplantation genetic testing, and revised professional guidance regarding the number of embryos to transfer. These developments have led to single-embryo transfer becoming the standard of care in most scenarios. We used national in vitro fertilization surveillance data of all autologous in vitro fertilization cycles from 1996 to 2019 to illustrate trends in the following improved outcomes: autologous embryo transfer cycles involving blastocyst-stage embryos, vitrified embryos, preimplantation genetic testing cycles, total number of embryos being transferred per cycle, and single-embryo transfer usage over time. Among deliveries from autologous embryo transfers, we highlighted trends in singleton births over time and proportion of deliveries involving twins, triplets, quadruplets, or greater. The notable progress in reducing the rate of multifetal pregnancies with in vitro fertilization was largely attributed to a series of technical and clinical actions, culminating in an 80% reduction in the incidence of multiple births without a loss in overall treatment effectiveness.
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Affiliation(s)
- Quinton S Katler
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Emory University School of Medicine, Atlanta, GA.
| | - Jennifer F Kawwass
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Emory University School of Medicine, Atlanta, GA
| | - Bradley S Hurst
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Atrium Health Carolinas Medical Center, Charlotte, NC
| | - Amy E Sparks
- Division Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA
| | - David H McCulloh
- Department of Obstetrics and Gynecology, New York University Langone Fertility Center, New York University Langone Health, New York, NY
| | | | - James P Toner
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Emory University School of Medicine, Atlanta, GA
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28
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Multiple gestation associated with infertility therapy: a committee opinion. Fertil Steril 2022; 117:498-511. [PMID: 35115166 DOI: 10.1016/j.fertnstert.2021.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 11/19/2022]
Abstract
This Committee Opinion provides practitioners with suggestions to reduce the likelihood of iatrogenic multiple gestation resulting from infertility treatment. This document replaces the document of the same name previously published in 2012 (Fertil Steril 2012;97:825-34 by the American Society for Reproductive Medicine).
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Yimin Z, Minyue T, Yanling F, Huanmiao Y, Saijun S, Qingfang L, Xiaoling H, Lanfeng X. Fetal Reduction Could Improve but Not Completely Reverse the Pregnancy Outcomes of Multiple Pregnancies: Experience From a Single Center. Front Endocrinol (Lausanne) 2022; 13:851167. [PMID: 35813622 PMCID: PMC9263074 DOI: 10.3389/fendo.2022.851167] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate the effectiveness and limitations of multifetal pregnancy reduction (MFPR) on the improvement of pregnancy outcomes of triplet or twin pregnancies conceived by in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). METHODS We performed a cohort study of women undergoing IVF or ICSI from 2002-2016 in reproductive center, women's hospital, Zhejiang University School of Medicine. The cohort included 502 women who underwent MFPR and 9641 non-reduced women. Pregnancy outcomes were gestational age (GA) at delivery, pregnancy loss, preterm delivery, low birth weight (LBW), very low birth weight (VLBW), and small for gestational age (SGA). Multiple linear regression and logistic regression models were used to compare pregnancy outcomes between groups. RESULTS Triplets reduced to singletons had a longer median GA (39.07 vs 37.00, P<0.001), and lower rates of LBW (8.9% vs 53.2%, P<0.001) and SGA (17.8% vs 44.7%, P=0.001) than triplets reduced to twins, with a similar pregnancy loss rate (6.7% vs 6.6%, P=0.701). Twins reduced to singletons had a comparable pregnancy loss rate (4.8% vs. 6.5%, P=0.40), a longer median GA (38.79 vs. 37.00, P<0.001), and lower rates of LBW (13.5% vs. 47.0%, P<0.001) and SGA (13.5% vs. 39.6%, P<0.001) than primary twins. Triplets reduced to twins had higher rates of LBW (53.2% vs. 47.0%, P=0.028) and SGA (44.7% vs. 39.6%, P=0.040) than primary twins, with a similar pregnancy loss rate (6.6% vs. 6.5%, P=0.877). Singletons reduced from triplets/twins had higher rates of preterm delivery (15.8% vs. 7.3%, P<0.001), LBW (12.3% vs. 4.32%, P<0.001), VLBW (2.3% vs. 0.4%, P=0.002), and SGA (14.6% vs.6.6%, P<0.001) than primary singletons, with a comparable pregnancy loss rate (5.3% vs. 5.4%, P=0.671). CONCLUSIONS This study suggests that the pregnancy loss rate is similar between reduction and non-reduction groups. MFPR improves pregnancy outcomes, including the risk of preterm delivery, LBW, and SGA, but still could not completely reverse the adverse pregnancy outcomes of multiple pregnancies.
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30
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Kelly AG, Blakemore JK, McCaffrey C, Grifo JA. Evaluation of clinical parameters as predictors of monozygotic twins after single frozen embryo transfer. F S Rep 2021; 2:428-432. [PMID: 34934983 PMCID: PMC8655405 DOI: 10.1016/j.xfre.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/03/2021] [Accepted: 07/07/2021] [Indexed: 10/25/2022] Open
Abstract
Objective To determine if recent evolutions in laboratory protocols, including the increased use of natural cycles and the use of a hyaluronan-containing transfer medium, affected the rate of monozygotic twin (MZT) pregnancies after single frozen embryo transfer (FET). Design Retrospective cohort study. Setting Urban university-based fertility center. Patients Patients who underwent single FET between January 2016 and December 2018 resulting in an intrauterine pregnancy. Interventions Transition to a transfer protocol with a hyaluronan-containing transfer medium in July 2017. Main Outcome Measures Number of MZT pregnancies. Results There were 1,619 cycles that met the inclusion criteria and 31 (1.9%) resulted in MZT pregnancies. A hyaluronan-containing transfer medium was used in 875 (54.1%) cycles. Programmed cycles were used for 1,385 (85.5%) FETs and 234 (14.5%) cycles were natural. The mean age at FET, oocyte age, endometrial echo thickness, inner cell mass grade, trophectoderm grade, expansion, and day of blastocyst vitrification were similar between the groups. The use of a hyaluronan-containing transfer medium resulted in fewer MZTs. After controlling potential confounders with a multivariate regression, the use of the hyaluronan-containing medium still resulted in fewer MZTs. Monozygotic twins were colinear with preimplantation genetic testing (PGT), so PGT was excluded as a variable in our regression. A regression of PGT only cycles showed that the use of the hyaluronan-containing medium was still associated with a reduction in MZT pregnancies. Conclusions The use of a hyaluronan-containing transfer medium was associated with a lower rate of MZTs. Other clinical parameters, including cycle type, were not associated with changes in the number of MZTs. The use of PGT needs to be further investigated as a risk factor for MZTs.
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Affiliation(s)
- Amelia G Kelly
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, New York
| | - Jennifer K Blakemore
- Division of Reproductive Endocrinology and Infertility, New York University Langone Fertility Center, New York, New York
| | - Caroline McCaffrey
- Division of Reproductive Endocrinology and Infertility, New York University Langone Fertility Center, New York, New York
| | - James A Grifo
- Division of Reproductive Endocrinology and Infertility, New York University Langone Fertility Center, New York, New York
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Dietrich JE, Strowitzki T. Embryotransfer an Tag 2/3 vs. Tag 5/6 und „time-lapse imaging“. GYNAKOLOGISCHE ENDOKRINOLOGIE 2021. [DOI: 10.1007/s10304-021-00422-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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32
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Lee JY, Lee SM, Jeong M, Oh S, Hong S, Choe SA, Jun JK. Short-term and long-term outcomes of trichorionic triplet pregnancies with expectant management. Acta Obstet Gynecol Scand 2021; 101:111-118. [PMID: 34747006 DOI: 10.1111/aogs.14281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/09/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Reproductive endocrinologists recommend selective multifetal pregnancy reduction (MFPR) to save at least one or two babies, because triplet pregnancy is known to increase the risk of miscarriage and preterm delivery. However, recently improved obstetric and neonatal care may affect pregnancy outcomes differently in triplet pregnancies, which could alter practice. We compared the maternal, perinatal, and long-term outcomes of triplet pregnancies managed expectantly with those of pregnancies reduced to twins. MATERIAL AND METHODS In this retrospective cohort study, we reviewed the clinical records of 552 trichorionic triplet pregnancies for obstetric, perinatal, and neurodevelopmental outcomes, which consisted of the expectant management (EM) group (n = 225) and MFPR group (n = 327), in Seoul National University Hospital and CHA Bundang Medical Center from January 2006 to December 2018. Neuromotor development was evaluated using the Korean-Ages and Stages Questionnaire, Bayley-III tests, and/or Gross Motor Function Measure. The two groups were compared for the following outcomes: (1) nonviable pregnancy loss before 23 weeks, (2) preterm birth before 32 weeks of gestation, (3) fetal and neonatal survival and (4) long-term neurodevelopmental outcomes. RESULTS There were no differences in maternal age, body mass index, nulliparity or previous preterm birth between the two groups. The risk of nonviable pregnancy loss was lower in the EM group than that in the MFPR group (2 [0.9%] vs 21 [6.4%], p = 0.001). The risk of preterm delivery before 34 weeks of gestation was lower in the MFPR group (adjusted odds ratios [aOR] = 0.47, 95% confidence interval [CI] 0.30-0.73, p = 0.001). The survival rate of neonates until discharge (644 [95.4%] vs 572 [87.5], p < 0.001) and the rate of pregnancies with at least one survivor (220 [97.8%] vs 301 [92.0], p = 0.002) were higher in the EM group than those in the MFPR group. In the MFPR group, the risk of developmental delay (aOR = 2.89, 95% CI 1.38-6.02, p = 0.005) was higher. CONCLUSIONS In trichorionic triplet pregnancies, the possibility of EM to improve survival and reduce the risk of developmental delay has been shown.
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Affiliation(s)
- Ji Yeon Lee
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Mina Jeong
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Subeen Hong
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung-Ah Choe
- Department of Preventive Medicine, Korea University, Seoul, Republic of Korea
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Institute of Reproductive Medicine and Population, Seoul National University Medical Research Center, Seoul, Republic of Korea
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Hallamaa M, Seikkula J, Willman S, Ollila H, Jokimaa V. Pregnancy potential and perinatal outcomes of embryos cryopreserved twice: a case-control study. Reprod Biomed Online 2021; 43:607-613. [PMID: 34412972 DOI: 10.1016/j.rbmo.2021.06.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/27/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
RESEARCH QUESTION What are the pregnancy and perinatal outcomes of twice-cryopreserved embryos compared with embryos cryopreserved once? DESIGN Retrospective register-based case-control study. The case group consisted of transfers of twice-cryopreserved embryos (n = 89), and the control group of transfers of embryos cryopreserved once (n = 304). Matching criteria were embryonic age at transfer and female age category of less than 35 years or 35 and greater. RESULTS The survival rate of twice-cryopreserved embryos was 92.2%, and 93.7% of the planned frozen embryo transfers (FET) could be completed. FET was performed with cleavage-stage embryos in 17 cases and 68 controls and with blastocysts in 72 cases and 238 controls. The rates of live birth (27.0% versus 31.9%, adjusted odds ratio [OR] 0.70, 95% CI 0.40-1.22, P = 0.21), clinical pregnancy (31.5% versus 36.8%, adjusted OR 0.71, 95% CI 0.42-1.21, P = 0.21) and miscarriage (4.5% versus 3.9%, adjusted OR 1.10, 95% CI 0.33-3.60, P = 0.88) in the case and the control groups were comparable. No difference was seen in the preterm delivery rate (cases 4.2% versus controls 10.3%, P = 0.69). Twenty-five children were born in the case group and 100 in the control group. No difference in birthweight was detected between the groups and there were no large for gestational age fetuses or congenital malformations in the case group. CONCLUSIONS Uncompromised live birth rates and neonatal outcomes may be expected after the transfer of twice-cryopreserved embryos. To avoid embryo wastage and transfer of multiple embryos, good quality surplus embryos from FET cycles may be cryopreserved again by vitrification.
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Affiliation(s)
- Marianne Hallamaa
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku 20520, Finland.
| | - Jaana Seikkula
- Department of Obstetrics and Gynecology, Central Hospital of Central Finland, Jyväskylä 40620, Finland
| | - Sami Willman
- Ovumia Fertinova Jyväskylä, Jyväskylä 40100, Finland
| | - Helena Ollila
- Turku Clinical Research Centre, Turku University Hospital, Turku 20521, Finland
| | - Varpu Jokimaa
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku 20520, Finland
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Guidance on the limits to the number of embryos to transfer: a committee opinion. Fertil Steril 2021; 116:651-654. [PMID: 34330423 DOI: 10.1016/j.fertnstert.2021.06.050] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 06/30/2021] [Indexed: 11/22/2022]
Abstract
On the basis of American Society for Reproductive Medicine and Society for Assisted Reproductive Technology data, the American Society for Reproductive Medicine's guidelines for the limits on the number of embryos to be transferred during in vitro fertilization cycles have been further refined in continuing efforts to promote singleton gestation and reduce the number of multiple pregnancies. This version replaces the document titled "Criteria for number of embryos to transfer: a committee opinion" that was published most recently in August of 2017 (Fertil Steril 2017;107:901-3).
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Awadalla M, Kim A, Vestal N, Ho J, Bendikson K. Effect of Age and Embryo Morphology on Live Birth Rate After Transfer of Unbiopsied Blastocysts. JBRA Assist Reprod 2021; 25:373-382. [PMID: 33565291 PMCID: PMC8312298 DOI: 10.5935/1518-0557.20200101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 12/10/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To determine the rate of live birth per blastocyst based on morphology and oocyte age using data from a single center. METHODS This is a mathematical analysis and model building study of autologous blastocyst stage embryo transfers at a University-affiliated center. A total of 448 blastocyst stage embryos were transferred in 244 fresh and frozen embryo transfers from May 2015 through April 2018. Blastocyst morphology was divided into good, fair, and poor overall morphology grades. Each embryo transfer was modeled as an equation equating the sum of the unknown live birth rates of the transferred embryos to the number of live births that resulted. The least squares solution to the system of embryo transfer equations was determined using linear algebra. RESULTS Trophectoderm morphology was a better predictor of live birth rate than inner cell mass morphology. Embryos graded AA/AB/BA (good) had the highest live birth rates followed by BB/CB (fair), and BC/CC (poor). In our youngest age group (25-32 years) live birth rates per embryo were 51% for good, 39% for fair, and 25% for poor quality embryos. In our oldest age group (40-44 years) the live birth rates per embryo were 22% for good, 14% for fair, and 8% for poor quality embryos. CONCLUSIONS These techniques can help analyze small datasets such as those from individual clinics to aid in determining the ideal number of embryos to transfer to achieve live birth while limiting the risk of multiple gestations.
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Affiliation(s)
- Michael Awadalla
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Ashley Kim
- Department of Obstetrics and Gynecology, Kaiser Permanente, Los Angeles, California
| | - Nicole Vestal
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jacqueline Ho
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kristin Bendikson
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
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Multifetal Pregnancy Reduction in Quadruplets: Perinatal Outcome—Analysis of 20 Consecutive Cases. JOURNAL OF FETAL MEDICINE 2021. [DOI: 10.1007/s40556-021-00305-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Dongye H, Ji X, Ma X, Song J, Yan L. The Impact of Endometriosis on Embryo Quality in in-vitro Fertilization/Intracytoplasmic Sperm Injection: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:669342. [PMID: 34150804 PMCID: PMC8206501 DOI: 10.3389/fmed.2021.669342] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/26/2021] [Indexed: 12/30/2022] Open
Abstract
Background: The association between endometriosis and embryological outcomes remains uncertain. The meta-analysis aimed to evaluate the impact of endometriosis on embryo quality. Methods: A systematic review and meta-analysis was conducted to investigate the association between the endometriosis and embryo quality. Searches were performed on the three electronic databases: PubMed, EMBASE, and Web of Science. The detailed characteristics and data of the included studies were extracted. The risk ratio with 95% confidence intervals were calculated using the random and fixed effects model. The main outcome measures were high-quality embryo rate, cleavage rate, and embryo formation rate. Results: A total of 22 studies included were analyzed. Compared with the control group, women with endometriosis had a similar high-quality embryo rate (RR = 1.00; 95% CI, 0.94–1.06), a comparable cleavage rate (RR = 1.00; 95% CI, 0.97–1.02), and a similar embryo formation rate (RR = 1.10; 95% CI, 0.97–1.24). In women with stage III-IV endometriosis, there was no statistically significantly difference in high-quality embryo rate (RR = 1.02; 95% CI, 0.94–1.10), cleavage rate (RR = 1.00; 95% CI, 0.98–1.02), and embryo formation rate (RR = 1.05; 95% CI, 0.97–1.14), compared with those without endometriosis. For women with unilateral endometrioma, pooling of results from the affected ovaries did not show a statistically significantly difference in high-quality embryo rate (RR = 0.99; 95% CI, 0.60–1.63) in comparison to the normal contralateral ovaries. Conclusions: Our results seem to indicate that endometriosis does not compromise embryo quality from the perspective of morphology.
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Affiliation(s)
- Houjin Dongye
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Xiaofeng Ji
- Department of Gynecology, The Eighth People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Xiaopei Ma
- Department of Gynecology, The Eighth People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Jialun Song
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Lei Yan
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China.,Department of Gynecology, The Eighth People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
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Reimundo P, Gutiérrez Romero JM, Rodríguez Pérez T, Veiga E. Single-embryo transfer: a key strategy to reduce the risk for multiple pregnancy in assisted human reproduction. ADVANCES IN LABORATORY MEDICINE 2021; 2:179-198. [PMID: 37363329 PMCID: PMC10197809 DOI: 10.1515/almed-2021-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/05/2020] [Indexed: 06/28/2023]
Abstract
In the early days of assisted reproductive technology (ART), the main target was achieving gestation. Success rates were low, and multiple embryo transfers became common practice, with multiple pregnancies being 20 times higher than in natural conception. Multiple pregnancy is associated with a higher risk of complications for the mother and the baby than a singleton pregnancy. Added to healthcare costs, multiple pregnancy also involves other costs and psychosocial risks, with a high social and health costs. At present, success rates of assisted human reproduction (AHR) have improved dramatically, partially due to advances in laboratory techniques such as culture of blastocyst-stage embryos and vitrification. Additionally, there is a wide range of counseling, health and economic policies that have demonstrated being effective in increasing single-embryo transfer (SET) practices and reducing multiple pregnancies, which ensures satisfactory success rates. Therefore, single-embryo transfer emerges as the approach of choice for AHR to result in a full-term healthy newborn.
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Affiliation(s)
- Pilar Reimundo
- Laboratory of Assisted Reproduction and Andrology, Area of Clinical Biochemistry, Vall d’Hebron Clinical Laboratories, Vall d’Hebron University Hospital, Barcelona, Spain
| | | | - Tamara Rodríguez Pérez
- Laboratory of Andrology and Assisted Reproduction Techniques, Service of Clinical Biochemistry, La Paz University Hospital, Madrid, Spain
| | - Ernesto Veiga
- Unit of Assisted Human Reproduction, Complejo Hospitalario Universitario de Santiago de Compostela (CHUS), SERGAS, Santiago de Compostela, Spain
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Sitler C, Lustik M, Levy G, Pier B. Single Embryo Transfer Versus Double Embryo Transfer: A Cost-Effectiveness Analysis in a Non-IVF Insurance Mandated System. Mil Med 2021; 185:e1700-e1705. [PMID: 32633326 DOI: 10.1093/milmed/usaa119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Because of increased morbidity seen in multiple gestations, the American Society of Reproductive Medicine recommends transfer of blastocysts one at a time for most patients. While cost-effectiveness models have compared single embryo transfer (SET) versus double embryo transfer (DET), few incorporate maternal and neonatal morbidity, and none have been performed in U.S. Military facilities. The purpose of this study was to determine the cost effectiveness of sequential SET versus DET in a U.S. Military treatment facility. MATERIALS AND METHODS A cost-effectiveness model was created based on 250 patients between the ages of 20-44 who previously underwent in vitro fertilization (IVF) at our facility. The model consisted of patients pursuing either SET or DET with two total embryos. Cycle outcomes were determined using the published SARTCORS success calculator. Neonatal and obstetrical outcomes were simulated based on singleton and twin IVF pregnancies. Neonatal and obstetrical cost estimates were based on internal data as well. RESULTS If 250 model patients pursue SET, 140 live births would occur, with total cost of $5.7 million, and cost per delivery of $40,500. If the model patients pursued DET, 117 live births would occur, with total cost of $9.2 million and a cost per delivery of $77.700. DET would lead to more total infants (207 vs. 143 in SET cohort). Personal costs are higher in SET versus DET cohorts ($23,036 vs. $20,535). CONCLUSIONS SET in a system with no infertility coverage saves approximately $3.5 million per 250 patients. Higher personal costs as seen with SET may incentivize patients to seek DET. The total savings should encourage alteration to practice patterns with the U.S Military Healthcare System.
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Affiliation(s)
- Collin Sitler
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Tripler Army Medical Center, 1 Jarrett White Rd Honolulu, HI 96859
| | - Michael Lustik
- Department of Clinical Investigation, Tripler Army Medical Center, 1 Jarrett White Rd Honolulu, HI 96859
| | - Gary Levy
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Tripler Army Medical Center, 1 Jarrett White Rd Honolulu, HI 96859
| | - Bruce Pier
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Tripler Army Medical Center, 1 Jarrett White Rd Honolulu, HI 96859
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Kim HH, Matevossian K. Are two better than one? Two sequential transfers of a single embryo may be better than a double-embryo transfer. Fertil Steril 2021; 114:267-268. [PMID: 32741464 DOI: 10.1016/j.fertnstert.2020.04.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 04/29/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Helen H Kim
- Northwestern University Feinberg School of Medicine, Department of Obstetrics and Gynecology, Division Reproductive Endocrinology and Infertility, Chicago, Illinois
| | - Karine Matevossian
- Advocate Aurora Lutheran General Hospital, Department of Obstetrics and Gynecology, Park Ridge, Illinois
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Awadalla MS, Park KE, Latack KR, McGinnis LK, Ahmady A, Paulson RJ. Influence of Trophectoderm Biopsy Prior to Frozen Blastocyst Transfer on Obstetrical Outcomes. Reprod Sci 2021; 28:3459-3465. [PMID: 33768514 DOI: 10.1007/s43032-021-00552-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/17/2021] [Indexed: 11/28/2022]
Abstract
The purpose of this study is to determine if trophectoderm biopsy prior to autologous frozen blastocyst transfer in programmed cycles is associated with gestational age at delivery, birth weight, or cesarean rate in viable singleton gestations. We conducted a retrospective cohort study of patients at a university-affiliated center that had viable singleton gestations after autologous frozen blastocyst transfer in programmed cycles. Obstetrical outcomes of 67 pregnancies after blastocyst trophectoderm biopsy for preimplantation genetic testing were compared to 78 pregnancies from unbiopsied blastocysts. There were no significant differences between the two cohorts in terms of maternal age, BMI, or ethnicity. There were no differences in the preimplantation genetic testing cohort compared to the reference cohort for median gestational age at delivery (39.4 vs 39.4 weeks, p = 0.80), median birth weight (3420 vs 3430 g, p = 0.97), cesarean rate (51% vs 44%, p = 0.41), preterm delivery rate (12% vs 8%, p = 0.41), rate of low birth weight (12% vs 9%, p = 0.59), or rate of birth weight over 4000 g (13% vs 8%, p = 0.29). There were no differences in the primary outcomes with subgroup analysis based on fetal sex, single embryo transfer, gravidity, history of prior term birth, and maternal age < or ≥ 35 years. Trophectoderm biopsy prior to frozen blastocyst transfer in programmed cycles was not associated with adverse obstetrical outcomes related to gestational age at delivery, birth weight, or cesarean rate.
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Affiliation(s)
- Michael S Awadalla
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Kristen E Park
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kyle R Latack
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lynda K McGinnis
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ali Ahmady
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Richard J Paulson
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Khudhari A, Mourad A, Phillips S, Alam MZ, Hemmings R, Jamal W. Perinatal outcomes of human singletons conceived naturally versus assisted reproductive technologies: analysis of the effect of stimulated IVF, modified natural IVF, and frozen embryo transfer. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2021. [DOI: 10.1186/s43043-021-00051-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Obstetrical outcomes in assisted reproduction techniques (ART) were compared with naturally conceived pregnancies and among each other in multiple reports. However, many important changes in the practice of in vitro fertilization (IVF) over the years, including single embryo transfers (sET) and the introduction of modified natural IVF (mnIVF), and the advances in the frozen embryo transfer (FET) might have impacted the outcomes. Our study is the first to our knowledge to assess four different groups, including spontaneous pregnancies, mnIVF, stimulated IVF (sIVF), and FET altogether in a head-to-head comparison. This is a retrospective study on perinatal outcomes of singleton babies conceived naturally or using three different ART protocols between 2011 and 2014. The primary objective was the comparison of gestational age and birth weight between spontaneously conceived pregnancies (NAT, n= 15,770), mnIVF (n=235), sIVF (n=389), and FET (n=222).
Results
Our results show a significant difference in favor of naturally conceived pregnancies over ART in term of gestational age. In fact, the gestational age of babies in the NAT group was statistically higher compared to each one of the ART groups alone. Regarding the birth weight, the mean was significantly higher in the FET group compared to the other categories.
Conclusion
Differences in perinatal outcomes are still found among babies born after different modes of conception. However, there is still need for well-designed high-quality trials assessing perinatal outcomes between naturally conceived pregnancies and different ART protocols based on different maternal and treatment characteristics.
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Shi W, Sun C, Chen Q, Ye M, Niu J, Meng Z, Bukulmez O, Chen M, Teng X. Association between ambient air pollution and pregnancy outcomes in patients undergoing in vitro fertilization in Shanghai, China: A retrospective cohort study. ENVIRONMENT INTERNATIONAL 2021; 148:106377. [PMID: 33482441 DOI: 10.1016/j.envint.2021.106377] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/13/2020] [Accepted: 01/02/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The effects of ambient air pollutants on adverse pregnancy outcomes have been reported. However, studies about air pollutants exposure and pregnancy outcomes in patients undergoing IVF were limited and inconclusive. To date Shanghai has been the only city in China to implement a compulsory single embryo transfer policy for all patients undergoing their first embryo transfer procedure effective from January 2019. We aimed to investigate the associations between exposure to ambient air pollutants and biochemical pregnancy and live births, and to identify potential vulnerability characteristics of patients undergoing IVF in Shanghai, China. METHODS A retrospective cohort study was conducted on 2766 infertile patients aged ≤ 45 years who underwent first fresh or frozen-thawed cleavage stage embryo transfer in the Shanghai First Maternity and Infant Hospital during April 2016 and December 2019. Daily average ambient levels of six air pollutants (PM2.5, PM10, NO2, SO2, CO and O3 max-8h) were obtained from fixed air monitors located in closest proximity to patients' residences. The cumulative average level was calculated during three different exposure periods (period1: three months before oocyte retrieval to serum hCG test; period 2: from serum hCG test to live birth outcome; period 3: from three months before oocyte retrieval to live birth). Multiple logistic regression model was performed to investigate associations between exposure to ambient air pollutants and pregnancy outcomes. Stratified analyses were conducted to explore the potential effects modifier. RESULTS The biochemical pregnancy rate and live birth rate were 54.2% and 36.4%, respectively. The ambient NO2 exposure was significantly associated with a 14% lower pregnancy rate during period 1 (aOR = 0.86, 95%CI: 0.75-0.99). The ambient PM10 was related to significantly increased risk of lowering live birth rate among the patients during period 3 [aOR = 0.88(0.79-0.99)]. Stratified analysis showed that ambient PM10 was also significantly associated with a reduced pregnancy rate (aOR = 0.82, 95% CI: 0.69-0.97) in patients who underwent single embryo transfer during period 1. Subjects who underwent single embryo transfer also had a decreased likelihood of a live birth when exposed to ambient SO2 and O3 during period 3 [aOR = 0.74(0.57-0.95), and 0.92 (0.83-0.98), respectively]. Moreover, O3 exposure was associated with decreased live birth rates in patients living in non-urban areas. Sensitivity analyses indicated robust negative association between PM10 exposure and live birth outcomes. CONCLUSIONS Our study suggested that exposure to ambient air pollutants, in particular NO2 and PM10, was associated with an increased risk of lower rates of pregnancy and live birth respectively in patients undergoing IVF. Stratified analyses indicated that ambient SO2 and O3 levels were related to adverse pregnancy outcomes in some subgroups of IVF patients in this study. Notably, patients who underwent single embryo transfer were more susceptible to ambient air pollution exposure. Thus, prospective cohort studies are needed to investigate the underlying mechanisms and the susceptibility windows for women undergoing IVF treatment.
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Affiliation(s)
- Wenming Shi
- Clinical and Translational Research Center, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, 201204 Shanghai, China
| | - Chunyan Sun
- Centre for Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, China
| | - Qiaoyu Chen
- Centre for Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, China
| | - Mingming Ye
- Centre for Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, China
| | - Jianing Niu
- Centre for Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, China
| | - Zhenzhen Meng
- Centre for Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, China
| | - Orhan Bukulmez
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Miaoxin Chen
- Centre for Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, China.
| | - Xiaoming Teng
- Centre for Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, China; School of Life Sciences and Technology, Tongji University, Shanghai 200092, China.
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El-Damen A, Elkhatib I, Bayram A, Arnanz A, Abdala A, Samir S, Lawrenz B, De Munck N, Fatemi HM. Does blastocyst mitochondrial DNA content affect miscarriage rate in patients undergoing single euploid frozen embryo transfer? J Assist Reprod Genet 2021; 38:595-604. [PMID: 33398514 PMCID: PMC7910391 DOI: 10.1007/s10815-020-02050-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To determine whether the blastocyst mitochondrial DNA (mtDNA) content is related to the miscarriage rate in patients undergoing single euploid frozen embryo transfer (SEFET). METHODS A total of 355 single euploid frozen embryo transfer cycles were studied retrospectively between April 2017 and December 2018. A trophectoderm biopsy was performed on day 5/6 blastocysts. Post next-generation sequencing (NGS), the mtDNA content was calculated as the ratio of mitochondrial DNA over nuclear DNA, and the association between blastocyst mtDNA content and miscarriage rate was evaluated. RESULT(S) Three hundred fifty-five euploid blastocysts were selected for SEFET in 314 patients with an average age of 33.7 ± 5.6 years; 255 were biopsied on day 5 (71.8%) and 100 on day 6 (28.2%). Frozen embryo transfer (FET) was performed either in a hormone replacement therapy (HRT) cycle (71.8%; n = 255) or in a natural cycle (NC) (28.2%; n = 100). A pregnancy rate of 66.2% (235/355) was obtained with clinical pregnancy and miscarriage rates of 52.4% (n = 186) and 5.6% (n = 20), respectively. There was no significant difference neither between the blastocyst mtDNA content of pregnant and nonpregnant patients (27.7 ± 9.2 vs. 29.4 ± 8.6, P = 0.095) nor between patients with a clinical pregnancy and miscarriage (30.5 ± 9.3 vs. 27.3 ± 9.2, P = 0.136). Multivariate logistic regression analysis showed the same nonsignificant relationship, except for the miscarriage rate and BMI (OR 1.149, 95% CI 1.03-1.28; P = 0.012). CONCLUSION(S) Mitochondrial DNA content is unable to predict the miscarriage of implanted human euploid blastocysts.
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Affiliation(s)
- Ahmed El-Damen
- ART Fertility Clinics, Abu Dhabi, P.O. Box 60202, United Arab Emirates
| | - Ibrahim Elkhatib
- ART Fertility Clinics, Abu Dhabi, P.O. Box 60202, United Arab Emirates
| | - Asina Bayram
- ART Fertility Clinics, Abu Dhabi, P.O. Box 60202, United Arab Emirates
| | - Ana Arnanz
- ART Fertility Clinics, Abu Dhabi, P.O. Box 60202, United Arab Emirates
| | - Andrea Abdala
- ART Fertility Clinics, Abu Dhabi, P.O. Box 60202, United Arab Emirates
| | - Suzan Samir
- ART Fertility Clinics, Abu Dhabi, P.O. Box 60202, United Arab Emirates
| | - Barbara Lawrenz
- ART Fertility Clinics, Abu Dhabi, P.O. Box 60202, United Arab Emirates
- Obstetrical Department, Women’s University Hospital Tübingen, Tübingen, Germany
| | - Neelke De Munck
- ART Fertility Clinics, Abu Dhabi, P.O. Box 60202, United Arab Emirates
| | - Human M. Fatemi
- ART Fertility Clinics, Abu Dhabi, P.O. Box 60202, United Arab Emirates
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Awadalla M, Vestal N, McGinnis L, Ahmady A. Effect of Age and Morphology on Live Birth Rate After Cleavage Stage Embryo Transfer. Reprod Sci 2021; 28:43-51. [PMID: 32648121 PMCID: PMC7782445 DOI: 10.1007/s43032-020-00249-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/10/2020] [Accepted: 06/30/2020] [Indexed: 11/25/2022]
Abstract
Accurate knowledge of the live birth rate for cleavage stage embryos is essential to determine an appropriate number of embryos to transfer at once. Results from previous studies lack details needed for practical use. This is a mathematical analysis and model building study of day 3 cleavage stage embryo transfers. A total of 996 embryos were transferred in 274 fresh and 83 frozen embryo transfers. Embryo morphology was divided into 4 groups based on number of cells and fragmentation percentage. Each embryo transfer was modeled as an equation equating the sum of the live birth rates of the transferred embryos to the number of live births that resulted. The least squares solution to the system of embryo transfer equations was determined using linear algebra. This analysis was repeated for ages 35 to 42 years old at oocyte retrieval. The best fit live birth rates per embryo in the age group centered on 35 years old were 29%, 13%, 10%, and 9% for embryos in the 8-cell with ≤ 5% fragmentation, 8-cell with > 5% fragmentation, 9-12 cell, and 6-7 cell groups, respectively. Cleavage stage embryos with fewer than 6 cells on day 3 had very low best fit live birth rates close to 0% at age 39 years and were excluded from the primary analysis to prevent overfitting. These live birth rates can be used with a simple embryo transfer model to predict rates of single and multiple gestation prior to a planned cleavage stage embryo transfer.
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Affiliation(s)
- Michael Awadalla
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| | - Nicole Vestal
- Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| | - Lynda McGinnis
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| | - Ali Ahmady
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
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Ji H, Zhou Y, Cao S, Zhang J, Ling X, Zhao C, Shen R. Effect of Embryo Developmental Stage, Morphological Grading, and Ploidy Status on Live Birth Rate in Frozen Cycles of Single Blastocyst Transfer. Reprod Sci 2020; 28:1079-1091. [PMID: 33174188 DOI: 10.1007/s43032-020-00381-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/30/2020] [Indexed: 11/30/2022]
Abstract
To determine whether embryo developmental stage or morphological grading can predict live birth rate (LBR) from a single blastocyst in nonbiopsied and biopsied frozen embryo transfer (FET) cycles. This retrospective study included 1336 nonbiopsied and 360 euploid FET cycles. Blastocysts were divided according to developmental stage (day 5 [D5] and day 6 [D6]) and morphology (good quality and low quality). Nonbiopsied cycles in which D5 blastocysts were transferred were associated with a significantly higher LBR than those in the D6 group (48.5 vs. 24.3%; p < 0.001), as well as in good-quality embryo transfer cycles than that in low-quality embryo cycles (52.6 vs. 25.3%; p < 0.001). Embryos reaching good-quality blastocysts on D5 yielded significantly higher LBR than those similar quality blastocysts on D6. The same trend was seen in low-quality embryos. Concerning only D5 or D6 blastocyst transfer, the LBRs of good-quality embryos were still superior to those of low-quality embryos. In the case of euploid embryo transfers, the LBR (48.9 vs. 44.9%, p = 0.444) of D5 blastocysts did not significantly differ from that of D6 blastocysts. Good-quality embryos showed a higher LBR than low-quality embryos (51.6 vs. 40.0%, p = 0.030); the adjusted odds ratio remained insignificant after controlling for confounders (aOR 1.56; 95% CI 0.99-2.45; p = 0.056). The LBRs in the same developmental stage or morphology subgroups were not statistically significant. Embryo developmental stage and morphological grade are useful predictors of LBR in nonbiopsied FET cycles. However, no association was found in euploid transfer cycles.
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Affiliation(s)
- Hui Ji
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, 123 Tianfeixiang, Mochou Road, Nanjing, 210004, Jiangsu, China.,State Key Laboratory of Reproductive Medicine, Nanjing Medical University, 101 Longmian Rd, Nanjing, 211166, Jiangsu, China
| | - Yuxi Zhou
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, 123 Tianfeixiang, Mochou Road, Nanjing, 210004, Jiangsu, China
| | - Shanren Cao
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, 123 Tianfeixiang, Mochou Road, Nanjing, 210004, Jiangsu, China
| | - Junqiang Zhang
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, 123 Tianfeixiang, Mochou Road, Nanjing, 210004, Jiangsu, China
| | - Xiufeng Ling
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, 123 Tianfeixiang, Mochou Road, Nanjing, 210004, Jiangsu, China
| | - Chun Zhao
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, 123 Tianfeixiang, Mochou Road, Nanjing, 210004, Jiangsu, China.
| | - Rong Shen
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, 123 Tianfeixiang, Mochou Road, Nanjing, 210004, Jiangsu, China. .,State Key Laboratory of Reproductive Medicine, Nanjing Medical University, 101 Longmian Rd, Nanjing, 211166, Jiangsu, China.
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Chen S, Du H, Liu J, Liu H, Li L, He Y. Live birth rate and neonatal outcomes of different quantities and qualities of frozen transferred blastocyst in patients requiring whole embryo freezing stratified by age. BMC Pregnancy Childbirth 2020; 20:655. [PMID: 33121448 PMCID: PMC7596959 DOI: 10.1186/s12884-020-03353-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/22/2020] [Indexed: 11/23/2022] Open
Abstract
Background Multiple pregnancies are associated with significant complications and health risks for both mothers and infants. Single blastocyst transfer (SBT) is a logical and effective measure to reduce the incidence of multiple pregnancy with assisted reproductive technology (ART). Whether it is suitable for everyone undergoing SBT was inconclusive, in view of the consideration of embryo quality and patients’ age. Therefore, this study aimed to explore live birth rate (LBR) and neonatal outcomes of different quantities and qualities of blastocysts in patients stratified by age, using a cutoff of 35 years, who required whole embryo freezing and underwent a subsequent frozen thawed transfer (FET) cycle. Methods Atotal of 3,362 patients were divided into five groups: group A (n=1569) received a single good-quality blastocyst, group B (n=1113) received two good-quality blastocysts, group C (n=313) received one good-and one average-quality blastocyst, group D (n=222) received two average-quality blastocysts, and group E (n=145) received one average-quality blastocyst. Results For patients who received good-quality blastocysts, irrespective of age, the LBR of double blastocyst transfer (DBT) was about 50–65% and the multiple pregnancy rate (MPR) was 40–60%; however, the LBR of SBT was 40–55%, and the MPR was 3.5–6.3%. For patients who only had average-quality blastocysts, the MPR of double average-quality blastocyst transfer was as high as 30–50%. Moreover, about 70–90% of preterm births resulted from multiple pregnancies, and about 85–95% of low birth weight babies come from multiple pregnancies. The neonatal outcomes (gestational age, birth weight, and birth height) of DBT were significantly lower than those of SBT regardless of age, and this statistical difference disappeared if the patients were subgrouped by singleton or twin. There is no significant difference in neonatal outcomes between single good-quality blastocyst and single average-quality blastocyst transfer. Conclusions SBT is a preferable option for patients regardless of age when good-quality blastocysts are available. For patients who only had average-quality blastocysts, they should be informed that DBT was associated with higher multiple pregnancy and adverse neonatal outcomes when compared with SBT regardless of age, suggesting that the practice of SBT is also feasible for these patients.
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Affiliation(s)
- Shiping Chen
- Department of Reproductive Medicine, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, China.,Key Laboratory of Reproductive Medicine of Guangdong Province, Guangdong, Guangzhou, China.,Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou, Guangdong, China.,Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, Guangzhou, Guangdong, China
| | - Hongzi Du
- Department of Reproductive Medicine, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, China
| | - Jianqiao Liu
- Department of Reproductive Medicine, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, China
| | - Haiying Liu
- Department of Reproductive Medicine, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, China
| | - Lei Li
- Department of Reproductive Medicine, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, China
| | - Yuxia He
- Department of Reproductive Medicine, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, China.
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Kim HJ, Park JK, Eum JH, Song H, Lee WS, Lyu SW. Embryo Selection Based on Morphological Parameters in a Single Vitrified-Warmed Blastocyst Transfer Cycle. Reprod Sci 2020; 28:1060-1068. [PMID: 33051819 DOI: 10.1007/s43032-020-00349-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/05/2020] [Indexed: 12/31/2022]
Abstract
The process of selecting a good quality embryo to improve the pregnancy outcomes is very important. The aim of our study was to elaborate the embryo selection process in a single vitrified-warmed blastocyst transfer (VBT) cycle by analyzing pre-vitrified and post-warmed blastocyst morphological factors to improve pregnancy outcomes. In this retrospective cohort study, we performed 329 single VBT cycles. The pre-vitrified and post-warmed morphological factors of all blastocysts were analyzed. Logistic regression analysis was conducted to select the independent morphological factor associated with ongoing pregnancy. The expansion of blastocoel (mid blastocoel; aOR 2.27, 95% CI.0.80-6.42, p = 0.12, expanded blastocoel; aOR 3.15, 95% CI.1.18-8.44, p = 0.02) in a pre-vitrified blastocyst and the grade of inner cell mass (ICM) (grade B; aOR 0.47, 95% CI.0.27-0.83, p = 0.01, grade C; aOR 0.22, 95% CI 0.09-0.56 p < 0.01) in post-warmed blastocysts significantly predicted the ongoing pregnancy. After fertilization, the embryo developed as a blastocyst on day 5 (day 5) showed a higher ongoing pregnancy than that on day 6 (day 6) (aOR 0.50, 95% CI.0.26-0.94, p = 0.03). The results suggest that while selecting a vitrified-warmed blastocyst in a single VBT cycle, the day 5 vitrified blastocyst should be considered, and a higher expansion grade in the pre-vitrified blastocyst should be selected. Our study has shown that post-warmed ICM grade tends to be a predictive indicator for the selection of the best blastocyst and allows for successful pregnancy, with ongoing pregnancy in a single blastocyst transfer.
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Affiliation(s)
- Hyun Jin Kim
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, 566 Nonhyeon-Ro, Gangnam-gu, Seoul, 0635, South Korea
| | - Jae Kyun Park
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, 566 Nonhyeon-Ro, Gangnam-gu, Seoul, 0635, South Korea.,Department of Biomedical Science, CHA University, Seongnam, South Korea
| | - Jin Hee Eum
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, 566 Nonhyeon-Ro, Gangnam-gu, Seoul, 0635, South Korea
| | - Haengseok Song
- Department of Biomedical Science, CHA University, Seongnam, South Korea
| | - Woo Sik Lee
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, 566 Nonhyeon-Ro, Gangnam-gu, Seoul, 0635, South Korea
| | - Sang Woo Lyu
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, 566 Nonhyeon-Ro, Gangnam-gu, Seoul, 0635, South Korea.
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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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50
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Adamson GD, Norman RJ. Why are multiple pregnancy rates and single embryo transfer rates so different globally, and what do we do about it? Fertil Steril 2020; 114:680-689. [PMID: 33010940 DOI: 10.1016/j.fertnstert.2020.09.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 12/18/2022]
Abstract
In the early years of in vitro fertilization, overall pregnancy rates were low, and it was considered necessary to transfer more than one embryo to increase the chances of pregnancy. It was not until advances in assisted reproductive technologies resulting in increased pregnancy rates that the concept of transferring just one embryo was considered possible. A consequence of improvements in implantation rates was also an increase in multiple pregnancies when more than one embryo was transferred. Although some countries have reduced the number of embryos transferred, international data show that in many parts of the world high twin and higher order multiple pregnancy rates still exist. Even in developed countries these problems persist depending on clinical practice, funding of health services, and patient demands. Perinatal and other outcomes are significantly worse with twins compared with singleton pregnancies and there is an urgent need to reduce multiple pregnancy rates to at least 10%. This has been achieved in several countries and clinics by introducing single embryo transfer but there are many barriers to the introduction of this technique in most clinics worldwide. We discuss the background to the high multiple rate in assisted reproduction and the factors that contribute to its persistence even in excellent clinics and in high-quality health services. Practices that may promote single embryo transfer are discussed.
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Affiliation(s)
| | - Robert J Norman
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
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