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Boogaerts M, Mengels A, Lie Fong S, Peeraer K, Tomasseti C, Vanhie A. Impact of Indication for Oocyte and Embryo Reception on Reproductive and Obstetric Outcomes. Gynecol Obstet Invest 2023; 88:267-277. [PMID: 37231826 DOI: 10.1159/000530885] [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: 01/07/2023] [Accepted: 04/18/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVES This study aimed to assess if the indication for oocyte reception (OR) or embryo reception (ER) impacts the reproductive and obstetric outcomes by evaluating our experience at a tertiary fertility centre and by performing a literature review on this subject. Several previous studies have reported that, in contrast to other types of fertility treatment, the indication for OR/ER seems to have little impact on the outcomes. However, the compared indication groups vary considerably between these studies, and some data indicates worse outcomes in patients who developed premature ovarian insufficiency (POI) due to Turner syndrome or treatment with chemotherapy/radiotherapy. DESIGN A retrospective analysis of all cases of OR/ER at a tertiary fertility centre from 2001 until 2020 was conducted. We analysed 584 cycles from 194 individual patients. A literature review on the impact of indication on reproductive or obstetric outcomes of OR/ER was performed using the following databases: PubMed/MEDLINE, Embase, and the Cochrane Library. A total of 27 studies were included and analysed. PARTICIPANTS, SETTING, METHODS For the retrospective analysis, patients were divided into three major indication groups: failure of autologous assisted reproductive technology, POI, and genetic disease carrier. To assess reproductive outcomes, we determined pregnancy rate, implantation rate, miscarriage rate, and live birth rate. For comparing obstetric outcomes, we reviewed the term of birth, mode of delivery, and birthweight. Outcomes were compared using Fisher's exact test, χ2 test, and one-way ANOVA utilizing the GraphPad tool. RESULTS There were no significant differences in reproductive and obstetric outcomes between the three major indication groups in our population, in line with the findings reported by existing literature. Data on impaired reproductive outcomes in patients with POI after chemotherapy/radiotherapy are conflicting. Obstetrically, these patients are at higher risk of preterm birth and possibly also low birthweight, especially after abdomino-pelvic or total body irradiation. For patients with POI due to Turner syndrome, most data suggest similar pregnancy rates but a higher rate of pregnancy loss, and obstetrically an increased risk of hypertensive disorders and caesarean section. LIMITATIONS The small number of patients in the retrospective analysis resulted in low statistical power when evaluating differences between smaller subgroups. There were some missing data on the occurrence of complications during pregnancy. Our analysis covers a period of 20 years, during which several technological innovations have also been made. CONCLUSIONS Our study shows that the important heterogeneity in couples treated with OR/ER does not significantly impact their reproductive or obstetric outcomes, except for POI due to Turner syndrome or treatment with chemotherapy/radiotherapy, where there seems to be an important uterine/endometrial component that cannot be entirely overcome by providing a healthy oocyte.
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Affiliation(s)
- Matthias Boogaerts
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Annemie Mengels
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Sharon Lie Fong
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Karen Peeraer
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Carla Tomasseti
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Arne Vanhie
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
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Peigné M, de Mouzon J, Khiel A, Fraissinet A, Maget V, Saïas-Magnan J, Mathieu-D'Argent E, Gervereau O, Letur H. Donated-embryo pregnancies are associated with increased risk of hypertensive disorders even for young recipients: a retrospective matched-cohort study. Fertil Steril 2023; 119:69-77. [PMID: 36283865 DOI: 10.1016/j.fertnstert.2022.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether pregnancies with donated embryos are at a higher risk of complications than the pregnancies from autologous frozen-thawed embryo transfer (FET). DESIGN Anonymous, multicenter, comparative, observational, retrospective, matched-cohort study. SETTING Six French assisted reproductive technique centers from 2003 to 2018. PATIENT(S) Seventy-three singleton pregnancies with donated embryos (exposed) and 136 singleton pregnancies after autologous FET (nonexposed) were matched at 7-8 weeks of gestation (pregnancy date, parity, and women's age) (2:1 ratio, respectively). In accordance with French practices, all women were <44 years old and donated embryos were discarded frozen embryos from other couples. INTERVENTION(S) Not applicable. MAIN OUTCOME MEASURE(S) Percentages of hypertensive disorders of pregnancy (HDPs) with donated embryos versus autologous FET. RESULT(S) Groups were comparable (mean age: 34.5 years) and HDPs (24.6% vs. 11.9%) were significantly more frequent among the donated-embryo pregnancies, mostly in its severe forms (17.5% vs. 4.6%). In contrast, their respective isolated hypertension frequencies were comparable (7.0% vs. 7.3%). Multivariate analysis retained increased severe HDP risk with donated embryos (odds ratio 2.08 [95% confidence interval: 1.08-4.02]). No significant effect of endometrial preparation was observed. C-sections were more frequent for donated-embryo pregnancies (47.3% vs. 29.2%). Newborns from embryo donation or autologous FET were comparable for prematurity, birth weight and length, Apgar score, small for gestational age, large for gestational age, neonatal malformations, and sex ratio. CONCLUSION(S) Even for young women, the risk of severe HDP was 4 times higher for donated-embryo pregnancies than for autologous-FET pregnancies. The HDP risk must be acknowledged to inform donated-embryo recipients and provide careful pregnancy monitoring.
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Affiliation(s)
- Maëliss Peigné
- Assistance Publique-Hôpitaux de Paris, Université Sorbonne Paris Nord, Service de Médecine de la Reproduction et Préservation de la Fertilité, Hôpital Jean-Verdier, Bondy, France.
| | - Jacques de Mouzon
- Institut national de la santé et de la recherche médicale (INSERM), Service de Gynécologie-Obstétrique II et Médecine de la Reproduction, Assistance Publique-Hôpitaux de Paris, Cochin Port Royal, Paris, France
| | - Amélie Khiel
- Service de Gynécologie-Obstétrique, Centre Médico-Chirurgical et Obstétrical, Centre Hospitalier Universitaire, Schiltigheim, France
| | - Alice Fraissinet
- Service de Médecine de la Reproduction, Hôpital Jeanne-de-Flandre, Centre Hospitalier Universitaire Lille, Lille, France
| | - Victoria Maget
- Service de Gynécologie-Obstétrique, Centre Hospitalier Intercommunal des 4 Villes, Sèvres, France
| | - Jacqueline Saïas-Magnan
- Centre Clinico-Biologique d'Assistance Médicale à la Procréation, Centre d'etude et de conservation des oeufs et du sperme (CECOS), Pole Femmes-Parents-Enfants, Assistance Publique-Hôpitaux de Marseille, La Conception, Marseille, France
| | | | - Olivia Gervereau
- Service de Médecine de la Reproduction, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Hélène Letur
- Service de Gynecologie Obstétrique et Médecine de la Reproduction, Hôpital Foch, Suresnes, France
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Keukens A, van Wely M, van der Meulen C, Mochtar MH. Pre-eclampsia in pregnancies resulting from oocyte donation, natural conception or IVF: a systematic review and meta-analysis. Hum Reprod 2021; 37:586-599. [PMID: 34931678 DOI: 10.1093/humrep/deab267] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/01/2021] [Indexed: 12/31/2022] Open
Abstract
STUDY QUESTION What is the prevalence of pre-eclampsia (PE) in pregnancies after oocyte donation (OD) compared to natural conception (NC) and to IVF with autologous oocytes (AO)? SUMMARY ANSWER Overall the prevalence of PE after OD was 4-5 times higher than after NC and 2-3 times higher than after IVF with AO. WHAT IS KNOWN ALREADY The indication for OD is expanding to lesbian women requesting shared lesbian motherhood. Previous reviews have shown that the risk of PE is higher in pregnancies after OD than after NC and after IVF with AO. Classification on the severity of PE is lacking as is the relationship with known risk factors such as maternal age and multiple gestations. Furthermore the actual prevalence of PE in pregnancies resulting from OD is not known. STUDY DESIGN, SIZE, DURATION A systematic review and meta-analysis was conducted. A literature search was performed using the following databases: PubMed, EMBASE and CINAHL, OpenGrey and Greynet from January 1980 through July 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS We included retrospective and prospective cohort studies. The study population consisted of pregnancies after OD and NC or IVF and data had to be available about prevalence of PE. We compared the risk of (severe) PE in OD versus NC and IVF pregnancies, subgrouped by plurality and maternal age. We calculated individual and pooled odds ratios (OR) and prevalence estimates with 95% CI using a random effect model, while heterogeneity was assessed by the I2. MAIN RESULTS AND THE ROLE OF CHANCE In total, 27 studies comprising of 7089 OD pregnancies, 1 139 540 NC pregnancies and 72 742 IVF pregnancies were available for analysis. The risks of PE and severe PE was increased in OD pregnancies compared to NC pregnancies (pooled OR of all subgroups: 5.09, 95% CI: 4.29-6.04; I2 = 19% and OR: 7.42, 95% CI: 4.64-11.88; I2 = 49%, respectively). This suggests that compared to a PE risk of 2.9% with NC, the risk with OD was between 11.5% and 15.4%. Compared to a severe PE risk of 0.5% with NC, the risk with OD was between 2.3% and 5.6%. The pooled adjusted OR for PE was 3.24 (95% 2.74-3.83) for OD versus NC pregnancies. The risks of PE and severe PE were also increased in OD pregnancies compared to IVF pregnancies (pooled OR of all subgroups: 2.97, 95% CI: 2.49-3.53; I2 = 51% and OR: 2.97, 95% CI: 2.15-4.11; I2 = 0%, respectively). This suggests that compared to a PE risk of 5.9% with IVF, the risk with OD was between 13.5% and 18.0%. Compared to a severe PE risk of 3.3% with IVF, the risk with OD was between 6.8% and 12.2%. The pooled adjusted OR for PE was 2.67 (95% 2.28-3.13) for OD versus IVF. The pooled prevalence of PE in singleton pregnancies after OD was 10.7% (95% CI 6.6-15.5) compared to 2.0% (95% CI 1.0-3.1) after NC and 4.1% (95% CI 2.7-5.6) after IVF. The prevalence in multiple pregnancies was 27.8% (95% CI 23.6-32.2) after OD, 7.5% (95% CI 7.2-7.8) after NC and 9.7% (95% CI 6.2-13.9) after IVF. LIMITATIONS, REASONS FOR CAUTION The precise definition of PE is still a matter of debate. The different criteria could have affected the prevalence estimate. WIDER IMPLICATIONS OF THE FINDINGS Nearly one in six women will suffer PE after OD. Although it is uncertain whether these risks are consistent for lesbian couples undergoing shared motherhood, we feel that women who can conceive naturally could be advised to reconsider. In women with primary ovarian insufficiency, we feel that factors that may increase risk of PE ever further, such as double embryo transfer, should be avoided whenever possible. STUDY FUNDING/COMPETING INTEREST(S) No funding or competing interests. REGISTRATION NUMBER CRD42020166899.
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Affiliation(s)
- A Keukens
- Centre for Reproductive Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M van Wely
- Centre for Reproductive Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C van der Meulen
- Centre for Reproductive Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M H Mochtar
- Centre for Reproductive Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Tian X, Aiyer KTS, Kapsenberg JM, Roelen DL, van der Hoorn ML, Eikmans M. Uncomplicated oocyte donation pregnancies display an elevated CD163-positive type 2 macrophage load in the decidua, which is associated with fetal-maternal HLA mismatches. Am J Reprod Immunol 2021; 87:e13511. [PMID: 34738274 PMCID: PMC9286476 DOI: 10.1111/aji.13511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/07/2021] [Accepted: 11/01/2021] [Indexed: 11/27/2022] Open
Abstract
PROBLEM The embryo of an oocyte donation (OD) pregnancy is completely allogeneic to the mother, which may challenge the maternal immune system to tolerize the fetus. Decidual macrophages are essential in maintaining a healthy pregnancy, and type 2 macrophages may exhibit immune suppressive activity. We hypothesized that the composition of decidual macrophages is different between uncomplicated OD pregnancies and non-OD in vitro fertilization (IVF) pregnancies, and is related to fetal-maternal incompatibility. METHOD OF STUDY Women with uncomplicated pregnancy were enrolled: 25 singleton OD pregnancies and 17 non-OD IVF pregnancies. The extent of immunohistochemical staining of CD14 (pan-macrophage marker) and CD163 (type 2 macrophage marker) in both decidua basalis and parietalis was quantitated by digital image analysis. Maternal and fetal DNA was typed for human leukocyte antigen (HLA)-A, -B, C, -DRB1, and -DQB1, and fetal-maternal HLA mismatches were calculated. RESULTS OD pregnancies showed a higher percentage of CD163+ staining (P = .040) and higher CD163/CD14 ratio (P = .032) in the parietalis than non-OD IVF. The OD group was separated into a semi-allogeneic group (≤5 fetal maternal HLA mismatches) and a fully allogeneic group (> 5 mismatches). The HLA-fully-allogeneic OD group, but not the HLA-semi-allogeneic OD group, showed significantly elevated CD163/CD14 ratio in the parietalis compared with the non-OD IVF group (P < .05). CONCLUSIONS Uncomplicated OD pregnancies display a higher CD163-positive cell fraction in the total decidual macrophage population compared to autologous pregnancies, which may suggest that a local type 2 macrophage-related mechanism is needed to compensate for the higher fetal-maternal HLA mismatch load.
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Affiliation(s)
- Xuezi Tian
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, Netherlands
| | - Kaveri T S Aiyer
- Department of Immunology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Dave L Roelen
- Department of Immunology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Michael Eikmans
- Department of Immunology, Leiden University Medical Center, Leiden, Netherlands
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Gekka Y, Adachi T, Oi R, Nakayama S, Kawana Y, Takeda Y, Nomura S, Ozaki A, Tanimoto T, Sakamoto H, Yamashita T. Hypertensive disorders of pregnancy by oocyte donation pregnancy in Japanese women aged 40 years or older: a single-center retrospective cohort study. Hypertens Pregnancy 2021; 40:36-44. [PMID: 33428480 DOI: 10.1080/10641955.2020.1861461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study aimed to examine the incidence of hypertensive disorders of pregnancy (HDP) among Japanese women with oocyte donation pregnancy (ODP) aged 40 years or older and estimate whether the women with ODP were more likely to develop HDP than those with autologous oocyte pregnancy (AOP) and spontaneous pregnancy (SP). In our study (N = 1361), the proportions of women who developed HDP were 20.5%, 12.8%, and 7.6% for ODP, AOP, and SP, respectively. After adjustment of covariables, the women with ODP were more likely to develop HDP than those with AOP or SP.
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Affiliation(s)
- Yoko Gekka
- Department of Obstetrics and Gynecology, Maternal and Child Hearth Center, Aiiku Hospital , Tokyo, Japan.,Division of Reproductive Medicine, Sugiyama Clinic , Tokyo, Japan
| | - Tomoko Adachi
- Department of Obstetrics and Gynecology, Maternal and Child Hearth Center, Aiiku Hospital , Tokyo, Japan
| | - Rie Oi
- Department of Obstetrics and Gynecology, Maternal and Child Hearth Center, Aiiku Hospital , Tokyo, Japan
| | - Setsuko Nakayama
- Department of Obstetrics and Gynecology, Maternal and Child Hearth Center, Aiiku Hospital , Tokyo, Japan
| | - Yukiko Kawana
- Department of Obstetrics and Gynecology, Maternal and Child Hearth Center, Aiiku Hospital , Tokyo, Japan
| | - Yoshiharu Takeda
- Department of Obstetrics and Gynecology, Maternal and Child Hearth Center, Aiiku Hospital , Tokyo, Japan
| | - Shuhei Nomura
- Department of Health Policy and Management, School of Medicine, Keio University , Tokyo, Japan.,Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo , Tokyo, Japan
| | - Akihiko Ozaki
- Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation , Iwaki, Fukushima, Japan
| | - Tetsuya Tanimoto
- Department of Internal Medicine, Jyoban Hospital of Tokiwa Foundation , Iwaki, Fukushima, Japan
| | - Hideki Sakamoto
- Department of Obstetrics and Gynecology, Maternal and Child Hearth Center, Aiiku Hospital , Tokyo, Japan
| | - Takahiro Yamashita
- Department of Obstetrics and Gynecology, Maternal and Child Hearth Center, Aiiku Hospital , Tokyo, Japan
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Gleicher N, Barad DH, Adashi EY. Why is use of donor eggs not viewed as treatment failure? A call for improvements in treatments with autologous oocytes. J Assist Reprod Genet 2020; 37:1583-1588. [PMID: 32504304 PMCID: PMC7376996 DOI: 10.1007/s10815-020-01847-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022] Open
Abstract
Based on national registry reports, after age 42, the number of IVF cycles utilizing autologous oocytes is very small; after age 43, autologous oocyte use in US IVF cycles is almost non-existent. We here argue that the in vitro fertilization (IVF) field has created a self-fulfilling prophecy by basically abandoning the utilization of autologous oocytes after ages 42-43 years. This not only resulted in almost no IVF cycles with autologous oocytes being performed but also in abandonment of research that could lead to improvements in IVF outcomes in older women when using autologous oocytes. As a consequence, IVF has largely stagnated in this area. We further argue that third-party oocyte donation in clinical IVF should be considered a treatment failure, as it requires patients to choose a second rather than a first-choice treatment. Such a redesignation of third-party egg donation would not only be appropriate but could lead to necessary changes in physician attitudes, considering that women almost exclusively prefer to conceive with their autologous oocytes.
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Affiliation(s)
- Norbert Gleicher
- The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA.
- Foundation for Reproductive Medicine, New York, NY, USA.
- Stem Cell Biology and Molecular Embryology Laboratory, The Rockefeller University, New York, USA.
- Department of Obstetrics and Genecology, Vienna University of Medicine, Vienna, Austria.
| | - David H Barad
- The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA
- Foundation for Reproductive Medicine, New York, NY, USA
| | - Eli Y Adashi
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
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Boria F, de la Calle M, Cuerva M, Sainz A, Bartha JL. Impact of oocyte donation on obstetric and perinatal complications in twin pregnancies. J Matern Fetal Neonatal Med 2020; 33:1960-1963. [PMID: 30293468 DOI: 10.1080/14767058.2018.1533944] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 10/28/2022]
Abstract
Aim: To evaluate obstetric and perinatal outcomes of twin pregnancies obtained after in vitro fertilization with donated oocytes.Methods: This is a case-control study comparing 50 women with twin pregnancies after oocyte donation (OD) and 50 women after in vitro fertilization with autologous oocytes. Clinical records were reviewed and obstetric and perinatal outcome variables including rates of preeclampsia, gestational diabetes, pregnancy-induced hypertension, preterm delivery, premature rupture of membranes, cesarean delivery, birth weight, Apgar score, pH test were compared.Results: Women in the OD group were significantly older than those in the AO group (mean 40.8 versus 36 years old, p < .001). There were a higher risk of preeclampsia (OD 24% versus AO 8%), cesarean delivery (OD 90% versus AO 66%), and preterm birth before 37 weeks (OD 52% versus AO 32%). After adjustment for maternal age, only the risk of preterm birth remained significantly higher (OR 3.2 (1.15-8.86); p = .025). Comparing neonatal outcomes, there were no differences in birth weight, pH or Apgar score at birth.Conclusions: Twin pregnancies after OD are associated with a higher risk of preterm birth before 37 weeks of gestation. However, this did not translate into increased rate of adverse perinatal outcomes.
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Affiliation(s)
- Felix Boria
- Hospital Universitario La Paz, Madrid, Spain
| | | | - Marcos Cuerva
- Department of Obstetrics, Quiron San Jose Hospital, Madrid, Spain
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Martinez CA, Rubér M, Rodriguez-Martinez H, Alvarez-Rodriguez M. Pig Pregnancies after Transfer of Allogeneic Embryos Show a Dysregulated Endometrial/Placental Cytokine Balance: A Novel Clue for Embryo Death? Biomolecules 2020; 10:E554. [PMID: 32260537 PMCID: PMC7226322 DOI: 10.3390/biom10040554] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 12/24/2022] Open
Abstract
Pig embryo transfer (ET) is burdened by high embryo mortality, with cytokines playing a significant role in recruitment of immune cells during embryo attachment and placentation. We hereby tested if their levels in endometrium and placenta from sows carrying hemi-allogeneic (artificially inseminated sows; C+ positive control) or allogeneic embryos (sows subjected to ET; ET) during peri-implantation (D18) or post-implantation (D24) are suitable mirrors of embryo rejection or tolerance after ET. Non-pregnant sows (C-) were used as negative controls. A set of cytokines was assayed in the tissues through multiplexed microsphere-based flow cytometry (Luminex xMAP, Millipore. USA). Fewer (58.7%. p < 0.003) conceptuses were recovered at D24 after ET compared to C+ (80.9%); with more than 20% of the ET conceptuses being developmentally delayed. Cytokine levels shifted during implantation. Anti-inflammatory IL-10 levels were significantly (p < 0.05) lower in ET sows compared to C+ at D24 of pregnancy. The C+ controls (carrying hemi-allogeneic embryos) consistently showed higher levels of pro-inflammatory TNF-α, IFN-γ, and IL-2 cytokines at D18 and IL-1α at D24, compared to the ET group. This clear dysregulation of pro- and anti-inflammatory cytokine levels in sows subjected to ET could be associated with an impaired maternal immune tolerance, explaining the high embryonic mortality of ET programs.
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Affiliation(s)
- Cristina A. Martinez
- Department of Clinical & Experimental Medicine (IKE), BHK/O&G Linköping University, SE-58185 Linköping, Sweden; (M.R.); (H.R.-M.); (M.A.-R.)
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Al Shammary M, Shaw A, Bacal V, Menzies-Toman D, Rozon C, Weir A, Tang K, de Nanassy J, El Demellawy D. Risk of Lower Birth Weight and Shorter Gestation in Oocyte Donation Pregnancies Compared With Other Assisted Reproductive Technology Methods: Systematic Review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 42:889-899.e1. [PMID: 31882287 DOI: 10.1016/j.jogc.2019.08.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Oocyte donation (OD) is associated with an increased risk of pregnancy-induced hypertension, but the evidence of an association between OD and infant outcomes, including birth weight and gestational age, is conflicting. This study sought to determine the associations between oocyte donation and birth weight or gestational age compared with other forms of autologous oocyte assisted reproductive technology (ART). METHODS Medline, Embase, and the CENTRAL Trials Registry of the Cochrane Collaboration were searched using a comprehensive search strategy. Studies of women over 24 weeks gestation compared infant outcomes among OD pregnancies versus other ART. Study quality was assessed, and a meta-analysis of mean birth weight and gestational age was conducted using a random effects model. RESULTS Nineteen studies were included. Four studies showed a significant association between OD and lower birth weights, and five studies found significant differences in gestational age between OD and autologous oocyte ART. The pooled difference in birth weight means between OD and autologous ART was -42 (-88, 4) . The pooled difference in gestational age was -0.4 weeks (-0.8, 0.0 weeks). CONCLUSION A high degree of interstudy heterogeneity exists, and the association between OD and infant outcomes remains unclear.
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Affiliation(s)
- Mofeedah Al Shammary
- Department of Obstetrics and Gynecology, King Fahad Specialist Hospital- Dammam, Damman, Saudi Arabia
| | - Ashley Shaw
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON
| | - Vanessa Bacal
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON
| | | | - Chloé Rozon
- Pathology Department, Children's Hospital of Eastern Ontario, Ottawa, ON
| | - Arielle Weir
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON; Pathology Department, Children's Hospital of Eastern Ontario, Ottawa, ON
| | - Ken Tang
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON
| | - Joseph de Nanassy
- Pathology Department, Children's Hospital of Eastern Ontario, Ottawa, ON
| | - Dina El Demellawy
- Pathology Department, Children's Hospital of Eastern Ontario, Ottawa, ON.
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Fassio F, Attini R, Masturzo B, Montersino B, Chatrenet A, Saulnier P, Cabiddu G, Revelli A, Gennarelli G, Gazzani IB, Muccinelli E, Plazzotta C, Menato G, Piccoli GB. Risk of Preeclampsia and Adverse Pregnancy Outcomes after Heterologous Egg Donation: Hypothesizing a Role for Kidney Function and Comorbidity. J Clin Med 2019; 8:E1806. [PMID: 31661864 PMCID: PMC6912476 DOI: 10.3390/jcm8111806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 10/22/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Preeclampsia (PE) is a risk factor for kidney diseases; egg-donation (ED) increasingly used for overcoming fertility reduction, is a risk factor for PE. CKD is also a risk factor for PE. However, kidney function is not routinely assessed in ED pregnancies. Objective of the study is seeking to assess the importance of kidney function and maternal comorbidity in ED pregnancies. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS DESIGN retrospective observational study from clinical charts. SETTING Sant'Anna Hospital, Turin, Italy (over 7000 deliveries per year). SELECTION cases: 296 singleton pregnancies from ED (gestation > 24 weeks), who delivered January 2008-February 2019. Controls were selected from the TOrino Cagliari Observational Study (1407 low-risk singleton pregnancies 2009-2016). MEASUREMENTS Standard descriptive analysis. Logistic multiple regression analysis tested: PE; pregnancy-induced hypertension; preterm delivery; small for gestational age; explicatory variables: age; BMI; parity; comorbidity (kidney diseases; immunologic diseases; thyroid diseases; other). Delivery over time was analyzed according to Kaplan Meier; ROC (Relative Operating Characteristic) curves were tested for PE and pre-term delivery, employing serum creatinine and e-GFR as continuous variables. The analysis was performed with SPSS v.14.0 and MedCalc v.18. RESULTS In keeping with ED indications, maternal age was high (44 years). Comorbidity was common: at least one potential comorbid factor was found in about 40% of the cases (kidney disease: 3.7%, immunologic 6.4%, thyroid disease 18.9%, other-including hypertension, previous neoplasia and all other relevant diseases-10.8%). No difference in age, parity and BMI is observed in ED women with and without comorbidity. Patients with baseline renal disease or "other" comorbidity had a higher risk of developing PE or preterm delivery after ED. PE was recorded in 23% vs. 9%, OR: 2.513 (CI 1.066-5.923; p = 0.039); preterm delivery: 30.2% vs. 14%, OR 2.565 (CI: 1.198-5.488; p = 0.044). Limiting the analysis to 124 cases (41.9%) with available serum creatinine measurement, higher serum creatinine (dichotomised at the median: 0.67 mg/dL) was correlated with risk of PE (multivariate OR 17.277 (CI: 5.125-58.238)) and preterm delivery (multivariate OR 2.545 (CI: 1.100-5.892). CONCLUSIONS Within the limits of a retrospective analysis, this study suggests that the risk of PE after ED is modulated by comorbidity. While the cause effect relationship is difficult to ascertain, the relationship between serum creatinine and outcomes suggests that more attention is needed to baseline kidney function and comorbidity.
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Affiliation(s)
- Federica Fassio
- Obstetrics, Department of Surgery, University of Torino, Torino 10100, Italy.
| | - Rossella Attini
- Obstetrics, Department of Surgery, University of Torino, Torino 10100, Italy.
| | - Bianca Masturzo
- Obstetrics, Department of Surgery, University of Torino, Torino 10100, Italy.
| | | | | | - Patrick Saulnier
- Laboratory of Statistics, University of Angers, Angers 49035, France.
| | | | - Alberto Revelli
- Obstetrics, Department of Surgery, University of Torino, Torino 10100, Italy.
| | - Gianluca Gennarelli
- Obstetrics, Department of Surgery, University of Torino, Torino 10100, Italy.
| | | | | | - Claudio Plazzotta
- Obstetrics, Department of Surgery, University of Torino, Torino 10100, Italy.
| | - Guido Menato
- Obstetrics, Department of Surgery, University of Torino, Torino 10100, Italy.
| | - Giorgina Barbara Piccoli
- Nephrology, Centre Hospitalier Le Mans, Le Mans 72000, France.
- Department of Clinical and Biological Sciences, University of Torino, Torino 10100, Italy.
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11
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Moreno - Sepulveda J, Checa MA. Risk of adverse perinatal outcomes after oocyte donation: a systematic review and meta-analysis. J Assist Reprod Genet 2019; 36:2017-2037. [PMID: 31440959 PMCID: PMC6823473 DOI: 10.1007/s10815-019-01552-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 07/26/2019] [Indexed: 01/10/2023] Open
Abstract
RESEARCH QUESTION In women with singleton pregnancies conceived after assisted reproductive technologies, does the in vitro fertilization with oocyte donation (IVF-OD) affect the perinatal and maternal outcomes compared to autologous in vitro fertilization (IVF-AO)? DESIGN Systematic review and meta-analysis of studies comparing perinatal and maternal outcomes in singleton pregnancies resulting from IVF-OD versus IVF-AO. An electronic literature search in Pubmed, MEDLINE, and Cochrane database was performed. The main outcome measures were hypertensive disorders in pregnancy, preeclampsia, severe preeclampsia, pregnancy-induced hypertension, preterm birth, early preterm birth, low birth weight, and very low birth weight. RESULTS Twenty-three studies were included. IVF-OD is associated with a higher risk of hypertensive disorders in pregnancy (OR 2.63, 2.17-3.18), preeclampsia (OR 2.64; 2.29-3.04), severe preeclampsia (OR 3.22; 2.30-4.49), pregnancy-induced hypertension (OR 2.16; 1.79-2.62), preterm birth (OR 1.57; 1.33-1.86), early preterm birth (OR 1.80; 1.51-2.15), low birth weight (OR 1.25, 1.20-1.30), very low birth weight (OR 1.37, 1.22-1.54), gestational diabetes (OR 1.27; 1.03-1.56), and cesarean section (OR 2.28; 2.14-2.42). There was no significant difference in the risk of preterm birth or low birth weight when adjusted for preeclampsia. CONCLUSIONS IVF-OD patients should be considered an independent risk factor for some adverse perinatal outcomes, mainly hypertensive disorders in pregnancy, preeclampsia, and severe preeclampsia. Immunological and hormonal aspects may be involved in these results, and further research focusing in the etiopathogenesis of these pathologies are needed.
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Affiliation(s)
- Jose Moreno - Sepulveda
- Obstetrics and Gynecology Department, Parc de Salut Mar, Universitat Autonoma de Barcelona, Campus Universitario UAB, 08193 Bellaterra, Cerdanyola del Vallès, Balmes 10, 1-1, 08007 Barcelona, Spain
- Clínica de la Mujer Medicina Reproductiva, Alejandro Navarrete 2606, Viña del Mar, Chile
| | - Miguel A. Checa
- Obstetrics and Gynecology Department, Parc de Salut Mar, Universitat Autonoma de Barcelona, Campus Universitario UAB, 08193 Bellaterra, Cerdanyola del Vallès, Balmes 10, 1-1, 08007 Barcelona, Spain
- GRI-BCN, Barcelona Infertility Research Group, IMIM, Institut Hospital del Mar d’Investigacions Mèdiques, Carrer del Dr. Aiguader, 88, 08003 Barcelona, Spain
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12
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Masturzo B, Di Martino D, Prefumo F, Cavoretto P, Germano C, Gennarelli G, Roletti E, Bottazzoli E, Fusè F, Ferrazzi E, Morano D, Farina A. Higher rate of early-onset preeclampsia in pregnancies following oocyte donation according to increasing maternal age. Arch Gynecol Obstet 2019; 300:861-867. [PMID: 31520261 DOI: 10.1007/s00404-019-05291-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 09/03/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To assess the influence of maternal age on the incidence of early-onset preeclampsia requiring delivery before 34 weeks of gestation in pregnancies obtained after oocyte donation. METHODS We carried out a prospective cohort analysis of 431 single and twin pregnancies, admitted to 3 Tertiary Referral Hospital in Northern Italy between 2008 and 2017. The rate of early-onset PE was calculated and stratified according to maternal age (from 30 to 49 years). A reference population of 11,197 single pregnancies collected prospectively at the first trimester of pregnancy in the same geographic area of Italy and in same hospitals was used to calculate the expected incidence of early-onset PE. RESULTS In women who delivered after 24 weeks of gestation, the rate of early-onset PE was much higher in oocyte-donation pregnancies, reaching 6.7% (29/431), than the expected rate of 0.5% of the cohort of reference. The mean early PE rate was 4.1% (10/242) in singletons and 10.1% (19/189) in twin pregnancies. According to maternal age, the rate of early PE was 1.16% and 3.12% at 30 years, and 4.98% and 13.14% at 49 years in single and twin pregnancies obtained after oocyte donation, respectively. CONCLUSION Pregnancies obtained after oocyte donation delivering after 24 weeks had a higher risk of early-onset PE requiring delivery before 34 weeks of gestation, than the general population. The risk is directly correlated with the increase of maternal age and is also higher in twin pregnancies.
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Affiliation(s)
- Bianca Masturzo
- Department of Surgical Sciences, OIRM S. Anna Hospital, University of Turin, Turin, EU, Italy
| | - Daniela Di Martino
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, EU, Italy
| | - Federico Prefumo
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, EU, Italy
| | - Paolo Cavoretto
- Gynecology and Obstetrics Department, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, EU, Italy
| | - Chiara Germano
- Department of Surgical Sciences, OIRM S. Anna Hospital, University of Turin, Turin, EU, Italy
| | - Gianluca Gennarelli
- Department of Surgical Sciences, OIRM S. Anna Hospital, University of Turin, Turin, EU, Italy
| | - Enrica Roletti
- Gynecology and Obstetrics Department, Maggiore University Hospital, Parma, EU, Italy
| | - Elisa Bottazzoli
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, University of Milan, Milan, Eu, Italy
| | - Federica Fusè
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, University of Milan, Milan, Eu, Italy
| | - Enrico Ferrazzi
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, EU, Italy
| | - Danila Morano
- Department of Obstetrics and Gynecology, Sant'Anna University Hospital, Cona, Ferrara, EU, Italy
| | - Antonio Farina
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery (DIMEC) Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, EU, Italy.
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13
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Omani-Samani R, Alizadeh A, Almasi-Hashiani A, Mohammadi M, Maroufizadeh S, Navid B, Khedmati Morasae E, Amini P. Risk of preeclampsia following assisted reproductive technology: systematic review and meta-analysis of 72 cohort studies. J Matern Fetal Neonatal Med 2019; 33:2826-2840. [PMID: 30563382 DOI: 10.1080/14767058.2018.1560406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Previous studies have indicated that women with assisted reproductive technology (ART) pregnancy have an increased risk of preeclampsia. The aim of this current study was to estimate, through a systematic review and meta-analysis of cohort studies, the risk of preeclampsia in women who conceived with ART.Materials and methods: We searched ISI Web of Knowledge, Medline/PubMed, Scopus and Embase up to August 2017 for English-language articles pertaining to risk of preeclampsia in ART pregnancy using standard keywords. Data extraction was conducted by two authors and quality of the studies was assessed using the Newcastle-Ottawa Scale. A random-effects model was used for the meta-analysis.Results: In total, 72 cohort studies (n = 164 870) were included. The results of Cochran test and I2 statistic indicated considerable heterogeneity among studies (Q = 15 415.61, df = 71, p < .001, I2=99.5%). The pooled estimate of preeclampsia risk using the random effects model was 10.8% (95% CI: 9.10-12.5). Furthermore, the funnel plot and Begg's test showed evidence of publication bias.Conclusions: We found that the risk of preeclampsia was very high among women who conceived with ART. Women should be counseled carefully before undergoing ART treatment.
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Affiliation(s)
- Reza Omani-Samani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Ahad Alizadeh
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.,Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
| | - Maryam Mohammadi
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Saman Maroufizadeh
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Behnaz Navid
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Esmaeil Khedmati Morasae
- Department of Health Services Research, National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care North West Coast (NIHR CLAHRC NWC), Institute of Psychology, Health, and Society, University of Liverpool, Liverpool, UK
| | - Payam Amini
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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14
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Fatini C, Cirillo M, Coccia ME. Assisted Reproductive Technology, Comorbidities, and Cardiovascular Risk: The Experience of an Italian Center. J Womens Health (Larchmt) 2018; 27:1285-1292. [DOI: 10.1089/jwh.2018.6981] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Cinzia Fatini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Division of Obstetrics and Gynecology, Center for Assisted Reproductive Technology, Careggi University Hospital, Florence, Italy
- Center for Research and Innovation in Health and Gender Medicine, CISMEG, Careggi University Hospital, Florence, Italy
| | - Michela Cirillo
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Division of Obstetrics and Gynecology, Center for Assisted Reproductive Technology, Careggi University Hospital, Florence, Italy
| | - Maria Elisabetta Coccia
- Division of Obstetrics and Gynecology, Center for Assisted Reproductive Technology, Careggi University Hospital, Florence, Italy
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
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15
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Rymer-Haskel N, Schushan-Eisen I, Hass Y, Rahav R, Maayan-Metzger A, Hendler I. Characteristics and severity of preeclampsia in young and elderly gravidas with hypertensive disease. Eur J Obstet Gynecol Reprod Biol 2018; 228:120-125. [DOI: 10.1016/j.ejogrb.2018.05.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 05/05/2018] [Accepted: 05/31/2018] [Indexed: 11/30/2022]
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16
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Klenov VE, Boulet SL, Mejia RB, Kissin DM, Munch E, Mancuso A, Van Voorhis BJ. Live birth and multiple birth rates in US in vitro fertilization treatment using donor oocytes: a comparison of single-embryo transfer and double-embryo transfer. J Assist Reprod Genet 2018; 35:1657-1664. [PMID: 29931407 DOI: 10.1007/s10815-018-1243-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 06/13/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To compare live birth rates (LBRs) and multiple birth rates (MBRs) between elective single-embryo transfer (eSET) and double-embryo transfer (DET) in donor oocyte in vitro fertilization (IVF) treatments in both a cycle-level and clinic-level analysis. METHODS Donor oocyte IVF treatments performed by US IVF clinics reporting to the Centers for Disease Control and Prevention in 2013-2014 were included in the analysis. Primary outcomes included LBR and MBR. Secondary outcomes included gestational age at delivery (GA) and birth weight (BW) of offspring. These outcomes were evaluated on an individual cycle level as well as on the clinic level. RESULTS In multivariable models, LBR did not change significantly as clinics utilized eSET more frequently. MBR decreased significantly as utilization of eSET increased, from 39% MBR in clinics that utilized eSET 0-9% of the time to 7% MBR in clinics that used eSET 70% of the time (P < .0001). Mean BW and GA of IVF-conceived offspring both increased as clinics utilized eSET more frequently (2778 to 3185 g [P < .0001] and 37.5 to 38.5 weeks [P = .02] for clinics with the lowest and highest eSET utilization, respectively). CONCLUSIONS US IVF clinics utilizing eSET with higher frequencies have clinically comparable LBRs and significantly lower MBRs than clinics with lower-frequency eSET utilization. Mean offspring BW and GA increased with higher eSET utilization, further confirming the improved safety of this practice.
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Affiliation(s)
- V E Klenov
- Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 31141 PFP, Iowa City, IA, 52242, USA.
| | - S L Boulet
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - R B Mejia
- Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 31141 PFP, Iowa City, IA, 52242, USA
| | - D M Kissin
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - E Munch
- Texas Fertility Center, San Antonio, TX, USA
| | - A Mancuso
- Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 31141 PFP, Iowa City, IA, 52242, USA
| | - B J Van Voorhis
- Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 31141 PFP, Iowa City, IA, 52242, USA
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17
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Marklund A, Nasiell J, Berger AS, Fagerberg A, Rodriguez-Wallberg KA. Pregnancy Achieved Using Donor Eggs in Cancer Survivors with Treatment-Induced Ovarian Failure: Obstetric and Perinatal Outcome. J Womens Health (Larchmt) 2018; 27:939-945. [PMID: 29715049 PMCID: PMC6159345 DOI: 10.1089/jwh.2017.6703] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Egg donation is a common fertility treatment in female cancer survivors with reproductive wish and iatrogenic ovarian failure. We examined whether women previously treated for cancer have a higher risk of pregnancy complications after egg donation treatments when compared to women without cancer history. METHODS In this prospective cohort treated during 2003-2015 at a single center, 31 women with previous history of cancer achieved 25 deliveries and 212 women without cancer history achieved 244 deliveries. All egg donor treatments were performed with a strict policy of single embryo transfer to reduce pregnancy and perinatal complications. Data were analyzed using logistic regression with adjustment for relevant confounders, to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for perinatal and obstetric outcomes. Women without previous history of cancer were used as the reference group in the regression models. RESULTS Women with a history of cancer presented with a significantly increased risk of pregnancy complications, including preterm birth (aOR 5.54, 95% CI 2.01-15.31) and preeclampsia (aOR 2.79, 95% CI 1.07-7.34), compared to women without cancer history. CONCLUSIONS The findings of this study suggest that the risks of preterm birth and preeclampsia in women with prior cancers who become pregnant by egg donor treatment significantly exceed those of women without cancer history undergoing similar treatments. As pregnancies using donor eggs are already acknowledged of higher risk for hypertensive pathologies, this study alerts toward characterization of specific increased risks in women who are cancer survivors to provide adapted pregnancy monitoring.
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Affiliation(s)
- Anna Marklund
- 1 Department of Oncology-Pathology, Intervention and Technology - CLINTEC, Karolinska Institutet , Stockholm, Sweden .,3 Department of Obstetrics and Gynecology, Södersjukhuset , Stockholm, Sweden
| | - Josefine Nasiell
- 2 Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet , Stockholm, Sweden .,4 Department of Obstetrics and Gynecology Clintec, Karolinska University Hospital , Stockholm, Sweden
| | - Ann-Sofie Berger
- 4 Department of Obstetrics and Gynecology Clintec, Karolinska University Hospital , Stockholm, Sweden .,5 Reproductive Medicine, Karolinska University Hospital , Stockholm, Sweden
| | - Antonia Fagerberg
- 4 Department of Obstetrics and Gynecology Clintec, Karolinska University Hospital , Stockholm, Sweden .,5 Reproductive Medicine, Karolinska University Hospital , Stockholm, Sweden
| | - Kenny A Rodriguez-Wallberg
- 1 Department of Oncology-Pathology, Intervention and Technology - CLINTEC, Karolinska Institutet , Stockholm, Sweden .,5 Reproductive Medicine, Karolinska University Hospital , Stockholm, Sweden
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18
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Outcomes of pregnancies achieved by double gamete donation: A comparison with pregnancies obtained by oocyte donation alone. Eur J Obstet Gynecol Reprod Biol 2018; 222:1-6. [DOI: 10.1016/j.ejogrb.2017.12.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 12/09/2017] [Accepted: 12/13/2017] [Indexed: 12/22/2022]
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19
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Bayersdorf R, Fruscalzo A, Catania F. Linking autoimmunity to the origin of the adaptive immune system. EVOLUTION MEDICINE AND PUBLIC HEALTH 2018; 2018:2-12. [PMID: 29423226 PMCID: PMC5793817 DOI: 10.1093/emph/eoy001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In jawed vertebrates, the adaptive immune system (AIS) cooperates with the innate immune system (IIS) to protect hosts from infections. Although targeting non-self-components, the AIS also generates self-reactive antibodies which, when inadequately counter-selected, can give rise to autoimmune diseases (ADs). ADs are on the rise in western countries. Why haven’t ADs been eliminated during the evolution of a ∼500 million-year old system? And why have they become more frequent in recent decades? Self-recognition is an attribute of the phylogenetically more ancient IIS and empirical data compellingly show that some self-reactive antibodies, which are classifiable as elements of the IIS rather then the AIS, may protect from (rather than cause) ADs. Here, we propose that the IIS’s self-recognition system originally fathered the AIS and, as a consequence of this relationship, its activity is dampened in hygienic environments. Rather than a mere breakdown or failure of the mechanisms of self-tolerance, ADs might thus arise from architectural constraints.
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Affiliation(s)
- Robert Bayersdorf
- Institute for Genome Stability in Aging and Disease, Medical Faculty, University of Cologne, 50931 Cologne, Germany.,Institute for Evolution and Biodiversity, University of Münster, 48149 Münster, Germany
| | - Arrigo Fruscalzo
- Clinic of Obstetrics and Gynecology, St Franziskus Hospital, 59227 Ahlen, Germany.,Department of Obstetrics and Gynecology, University Hospital of Münster, 48149 Münster, Germany
| | - Francesco Catania
- Institute for Evolution and Biodiversity, University of Münster, 48149 Münster, Germany
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20
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Kenny LC, Kell DB. Immunological Tolerance, Pregnancy, and Preeclampsia: The Roles of Semen Microbes and the Father. Front Med (Lausanne) 2018; 4:239. [PMID: 29354635 PMCID: PMC5758600 DOI: 10.3389/fmed.2017.00239] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 12/12/2017] [Indexed: 12/18/2022] Open
Abstract
Although it is widely considered, in many cases, to involve two separable stages (poor placentation followed by oxidative stress/inflammation), the precise originating causes of preeclampsia (PE) remain elusive. We have previously brought together some of the considerable evidence that a (dormant) microbial component is commonly a significant part of its etiology. However, apart from recognizing, consistent with this view, that the many inflammatory markers of PE are also increased in infection, we had little to say about immunity, whether innate or adaptive. In addition, we focused on the gut, oral and female urinary tract microbiomes as the main sources of the infection. We here marshall further evidence for an infectious component in PE, focusing on the immunological tolerance characteristic of pregnancy, and the well-established fact that increased exposure to the father's semen assists this immunological tolerance. As well as these benefits, however, semen is not sterile, microbial tolerance mechanisms may exist, and we also review the evidence that semen may be responsible for inoculating the developing conceptus (and maybe the placenta) with microbes, not all of which are benign. It is suggested that when they are not, this may be a significant cause of PE. A variety of epidemiological and other evidence is entirely consistent with this, not least correlations between semen infection, infertility and PE. Our view also leads to a series of other, testable predictions. Overall, we argue for a significant paternal role in the development of PE through microbial infection of the mother via insemination.
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Affiliation(s)
- Louise C. Kenny
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
- Department of Obstetrics and Gynecology, University College Cork, Cork, Ireland
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Douglas B. Kell
- School of Chemistry, The University of Manchester, Manchester, United Kingdom
- The Manchester Institute of Biotechnology, The University of Manchester, Manchester, United Kingdom
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21
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Licciardi F. Toward a better understanding of the oocyte donation/pre-eclampsia connection. Fertil Steril 2016; 106:267. [PMID: 27140289 DOI: 10.1016/j.fertnstert.2016.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 04/13/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Frederick Licciardi
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York
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