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Lersten IL, Grau L, Jahandideh S, Devine K, Zalles L, Plosker SM, Imudia AN, Hoyos LR, Uhler ML, Homer M, Roeca C, Sammel MD, Polotsky AJ. High estradiol levels in fresh embryo transfer cycles are not associated with detrimental impact on birth outcomes. J Assist Reprod Genet 2024; 41:893-902. [PMID: 38600428 PMCID: PMC11052734 DOI: 10.1007/s10815-024-03062-4] [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: 11/30/2023] [Accepted: 02/09/2024] [Indexed: 04/12/2024] Open
Abstract
PURPOSE There is an unclear relationship between estradiol levels and fresh embryo transfer (ET) outcomes. We determined the relationship between estradiol on the day of trigger, in fresh ET cycles without premature progesterone elevation, and good birth outcomes (GBO). METHODS We identified autologous fresh ET cycles from 2015 to 2021 at multiple clinics in the USA. Patients with recurrent pregnancy loss, uterine factor, and elevated progesterone on the day of trigger (progesterone > 2 ng/mL or 3-day area under the curve > 4.5 ng/mL) were excluded. The primary outcome was GBO (singleton, term, live birth with appropriate weight). Log-binomial generalized estimating equations determined the likelihood of outcomes. RESULTS Of 17,608 fresh ET cycles, 5025 (29%) yielded GBO. Cycles with estradiol ≥ 4000 pg/mL had a greater likelihood of GBO compared to cycles < 1000 pg/mL (aRR = 1.32, 95% CI 1.13-1.54). Pairwise comparisons of estradiol between < 1000 pg/mL versus 1000-1999 pg/mL and 1000-1999 pg/mL versus 2000-2999 pg/mL revealed a higher likelihood of GBO with higher estradiol (aRR 0.83, 95% CI 0.73-0.95; aRR 0.91, 95% CI 0.85-0.97, respectively). Comparisons amongst more elevated estradiol levels revealed that the likelihood of GBO remained similar between groups (2000-2999 pg/mL versus 3000-3999 pg/mL, aRR 1.04, 95% CI 0.97-1.11; 3000-3999 pg/mL versus ≥ 4000 pg/mL, aRR 0.96, 95% CI 0.9-1.04). CONCLUSION In fresh ET cycles, higher estradiol levels were associated with an increased prevalence of GBO until estradiol 2000-2999 pg/mL, thereafter plateauing. In fresh ET candidates, elevated estradiol levels should not preclude eligibility though premature progesterone rise, and risk of ovarian hyperstimulation syndrome must still be considered.
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Affiliation(s)
- Ivy L Lersten
- University of Colorado, Aurora, CO, USA.
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, School of Medicine, 12631 E 17Th Ave, Mail Stop B-198, Aurora, CO, USA.
- Shady Grove Fertility, Greenwood Village, CO, USA.
| | - Laura Grau
- University of Colorado, Aurora, CO, USA
- Department of Biostatistics and Informatics, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | | | | | | | - Shayne M Plosker
- Shady Grove Fertility, Tampa, FL, USA
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Anthony N Imudia
- Shady Grove Fertility, Tampa, FL, USA
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Luis R Hoyos
- IVF Florida Reproductive Associates, Margate, FL, USA
| | | | - Michael Homer
- Reproductive Science Center of the Bay Area, San Francisco, CA, USA
| | - Cassandra Roeca
- University of Colorado, Aurora, CO, USA
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, School of Medicine, 12631 E 17Th Ave, Mail Stop B-198, Aurora, CO, USA
- Shady Grove Fertility, Greenwood Village, CO, USA
| | - Mary D Sammel
- University of Colorado, Aurora, CO, USA
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, School of Medicine, 12631 E 17Th Ave, Mail Stop B-198, Aurora, CO, USA
- Department of Biostatistics and Informatics, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Alex J Polotsky
- University of Colorado, Aurora, CO, USA
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, School of Medicine, 12631 E 17Th Ave, Mail Stop B-198, Aurora, CO, USA
- Shady Grove Fertility, Greenwood Village, CO, USA
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Parisi F, Fenizia C, Introini A, Zavatta A, Scaccabarozzi C, Biasin M, Savasi V. The pathophysiological role of estrogens in the initial stages of pregnancy: molecular mechanisms and clinical implications for pregnancy outcome from the periconceptional period to end of the first trimester. Hum Reprod Update 2023; 29:699-720. [PMID: 37353909 PMCID: PMC10628507 DOI: 10.1093/humupd/dmad016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/12/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Estrogens regulate disparate female physiological processes, thus ensuring reproduction. Altered estrogen levels and signaling have been associated with increased risks of pregnancy failure and complications, including hypertensive disorders and low birthweight babies. However, the role of estrogens in the periconceptional period and early pregnancy is still understudied. OBJECTIVE AND RATIONALE This review aims to summarize the current evidence on the role of maternal estrogens during the periconceptional period and the first trimester of pregnancies conceived naturally and following ART. Detailed molecular mechanisms and related clinical impacts are extensively described. SEARCH METHODS Data for this narrative review were independently identified by seven researchers on Pubmed and Embase databases. The following keywords were selected: 'estrogens' OR 'estrogen level(s)' OR 'serum estradiol' OR 'estradiol/estrogen concentration', AND 'early pregnancy' OR 'first trimester of pregnancy' OR 'preconceptional period' OR 'ART' OR 'In Vitro Fertilization (IVF)' OR 'Embryo Transfer' OR 'Frozen Embryo Transfer' OR 'oocyte donation' OR 'egg donation' OR 'miscarriage' OR 'pregnancy outcome' OR 'endometrium'. OUTCOMES During the periconceptional period (defined here as the critical time window starting 1 month before conception), estrogens play a crucial role in endometrial receptivity, through the activation of paracrine/autocrine signaling. A derailed estrogenic milieu within this period seems to be detrimental both in natural and ART-conceived pregnancies. Low estrogen levels are associated with non-conception cycles in natural pregnancies. On the other hand, excessive supraphysiologic estrogen concentrations at time of the LH peak correlate with lower live birth rates and higher risks of pregnancy complications. In early pregnancy, estrogen plays a massive role in placentation mainly by modulating angiogenic factor expression-and in the development of an immune-tolerant uterine micro-environment by remodeling the function of uterine natural killer and T-helper cells. Lower estrogen levels are thought to trigger abnormal placentation in naturally conceived pregnancies, whereas an estrogen excess seems to worsen pregnancy development and outcomes. WIDER IMPLICATIONS Most current evidence available endorses a relation between periconceptional and first trimester estrogen levels and pregnancy outcomes, further depicting an optimal concentration range to optimize pregnancy success. However, how estrogens co-operate with other factors in order to maintain a fine balance between local tolerance towards the developing fetus and immune responses to pathogens remains elusive. Further studies are highly warranted, also aiming to identify the determinants of estrogen response and biomarkers for personalized estrogen administration regimens in ART.
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Affiliation(s)
- F Parisi
- Department of Woman, Mother and Neonate, 'V. Buzzi' Children Hospital, ASST Fatebenefratelli Sacco, Milan, via L. Castelvetro 32, Milan, Italy
| | - C Fenizia
- Department of Pathophysiology and Transplantation, University of Milan, Milan, via F. Sforza 35, Milan 20122, Italy
- Department of Biomedical and Clinical Sciences, "L.Sacco" Hospital, University of Milan, Milan, via G.B. Grassi 74, Milan 20157, Italy
| | - A Introini
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Nobels väg 5, Stockholm, Sweden
| | - A Zavatta
- Department of Woman, Mother and Neonate, 'V. Buzzi' Children Hospital, ASST Fatebenefratelli Sacco, Milan, via L. Castelvetro 32, Milan, Italy
| | - C Scaccabarozzi
- Department of Biomedical and Clinical Sciences, "L.Sacco" Hospital, University of Milan, Milan, via G.B. Grassi 74, Milan 20157, Italy
| | - M Biasin
- Department of Biomedical and Clinical Sciences, "L.Sacco" Hospital, University of Milan, Milan, via G.B. Grassi 74, Milan 20157, Italy
| | - V Savasi
- Department of Biomedical and Clinical Sciences, "L.Sacco" Hospital, University of Milan, Milan, via G.B. Grassi 74, Milan 20157, Italy
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Wu J, Zhang H, Wang X. E2 level > 2950 pg/ml on hCG trigger day is an independent predictor for birthweight loss of full-term singletons born after fresh embryo transfers in non-PCOS patients. Reprod Biol Endocrinol 2022; 20:162. [PMID: 36411437 PMCID: PMC9677889 DOI: 10.1186/s12958-022-01027-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 10/26/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Previous studies have demonstrated that the supraphysiological E2 level is negatively correlated with birthweight. However, the cut-off value of E2 level that significantly affects birthweight is unknown, and there is no definite conclusion regarding this level. Our study aimed to explore the threshold of the effect of E2 levels on birthweight. DESIGN A retrospective cohort study of 1846 samples was performed. All patients ≤42-years-old underwent autologous IVF cycles between August 1st, 2016 and April 30th, 2020. We categorized our data into four groups according to the E2 level: Group 1: ≤2000 pg/mL; Group 2: 2001-3000 pg/mL; Group 3: 3001-4000 pg/mL; and Group 4: > 4000 pg/mL. RESULTS The results of the multivariate regression analyses showed that when the E2 level was 3001-4000 pg/mL (adjusted β: - 89.64, 95% [CI]: - 180.29 to - 6.01; P = 0.0336) and greater than 4000 pg/mL (adjusted β: - 138.10, 95% [CI]: - 272.87 to - 10.33; P = 0.0181), weight loss was significant. Furthermore, the odds of full-term SGA were 1.40 times higher with E2 levels of 3001-4000 pg/mL (adjusted OR: 1.40, 95% [CI]: 1.090 to 3.18; P = 0.0256) and 2.55 times higher with E2 > 4000 pg/mL (adjusted OR: 2.55, 95% [CI]: 1.84 to 3.86; P = 0.0063) compared to the reference group. It can also be seen from the adjusted curves and the threshold effects that when the E2 level > 2950 pg/mL and > 3121 pg/mL, the incidence of SGA increased and the birthweight decreased, respectively. CONCLUSIONS Our data suggest that E2 levels > 2950 pg/mL is an independent predictor for greater odds of full-term SGA singletons born after fresh embryo transfer.
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Affiliation(s)
- Jing Wu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Tang Du Hospital, The Air Force Military medical University, 1 Xinsi Rd, Xi'an, 710038, Baqiao District, China
| | - Hengde Zhang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Tang Du Hospital, The Air Force Military medical University, 1 Xinsi Rd, Xi'an, 710038, Baqiao District, China
| | - Xiaohong Wang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Tang Du Hospital, The Air Force Military medical University, 1 Xinsi Rd, Xi'an, 710038, Baqiao District, China.
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Kavoussi SK, Chen SH, Wininger JD, Lal A, Roudebush WE, Lanford HC, Esqueda AS, Barsky M, Lebovic DI, Kavoussi PK, Gilkey MS, Chen J, Machen GL, Chosed RJ. The expression of pregnancy-associated plasma protein-A (PAPP-A) in human blastocoel fluid-conditioned media: a proof of concept study. J Assist Reprod Genet 2022; 39:389-394. [PMID: 35013837 PMCID: PMC8956765 DOI: 10.1007/s10815-022-02393-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/04/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose The aim of this study was to determine if pregnancy-associated plasma protein-A (PAPP-A), typically measured in maternal serum and a potential predictor of adverse maternal and fetal outcomes such as spontaneous miscarriage, pre-eclampsia, and stillbirth, is expressed in blastocoel fluid–conditioned media (BFCM) at the embryonic blastocyst stage. Design This is an in vitro study. Methods BFCM samples from trophectoderm-tested euploid blastocysts (n = 80) from in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) patients were analyzed for PAPP-A mRNA. BFCM was obtained from blastocyst stage embryos in 20 uL drops. Blastocysts underwent trophectoderm biopsy for preimplantation genetic testing for aneuploidy prior to blastocyst vitrification and BFCM collection for snap freezing. cfDNA was synthesized using BFCM collected from 80 individual euploid blastocysts. Next, real-time qPCR was performed to detect expression of PAPP-A with GAPDH for normalization of expression in each sample. Results PAPP-A mRNA was detected in 45 of 80 BFCM samples (56.3%), with varying levels of expression across samples. Conclusion Our study demonstrates the expression of PAPP-A in BFCM. To our knowledge, this is the first study to report detection of PAPP-A mRNA in BFCM. Further studies are required and underway to investigate a greater number of BFCM samples as well as the possible correlation of PAPP-A expression with pregnancy outcomes of transferred euploid blastocysts. If found to predict IVF and obstetric outcomes, PAPP-A may provide additional information along with embryonic euploidy for the selection of the optimal blastocyst for embryo transfer.
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Affiliation(s)
- Shahryar K Kavoussi
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Bldg B, Suite 200, Austin, TX, 78746, USA.
| | - Shu-Hung Chen
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Bldg B, Suite 200, Austin, TX, 78746, USA
| | - John David Wininger
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Bldg B, Suite 200, Austin, TX, 78746, USA
| | - Arnav Lal
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC, 29605, USA
| | - William E Roudebush
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC, 29605, USA
| | - Hayes C Lanford
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC, 29605, USA
| | - Amy S Esqueda
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Bldg B, Suite 200, Austin, TX, 78746, USA
| | - Maya Barsky
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Bldg B, Suite 200, Austin, TX, 78746, USA
| | - Dan I Lebovic
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Bldg B, Suite 200, Austin, TX, 78746, USA
| | - Parviz K Kavoussi
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Bldg B, Suite 200, Austin, TX, 78746, USA
| | - Melissa S Gilkey
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Bldg B, Suite 200, Austin, TX, 78746, USA
| | - Justin Chen
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Bldg B, Suite 200, Austin, TX, 78746, USA
| | - Graham L Machen
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Bldg B, Suite 200, Austin, TX, 78746, USA
| | - Renee J Chosed
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC, 29605, USA
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Supraphysiological estradiol levels on the hCG trigger day are associated with SGA for singletons born from fresh embryo transfer. J Dev Orig Health Dis 2021; 13:244-251. [PMID: 33971999 DOI: 10.1017/s2040174421000234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The effects of supraphysiological estradiol (E2) on neonatal outcomes and the significance of specific E2 concentrations remain unclear. The purpose of this study was to investigate whether supraphysiological E2 levels on the human chorionic gonadotropin (hCG) trigger day are associated with small size for gestational age (SGA) in singletons born from fresh embryo transfer (ET) cycles. Patients with singleton pregnancies who delivered after the transfer of fresh embryos, during the period from July 2012 to December 2017, at our center were included. We excluded cycles involving a vanishing twin, maternal age >35 years, basal follicle-stimulating hormone ≥10 mIU/ml, or anti-Müllerian hormone ≤1 ng/ml. We then divided all cycles into five groups by E2 level on trigger day: group A, <2000 pg/ml (reference group); group B, 2000 pg/ml≤E2<2999 pg/ml; group C, 3000 pg/ml≤E2<3999 pg/ml; group D, 4000 pg/ml≤E2<4999 pg/ml; and group E, ≥5000 pg/ml. The prevalence of SGA among singletons from fresh ET was the primary outcome. The SGA rate significantly increased when the E2 level was ≥4000 pg/ml, as observed by comparing groups D (odds ratio [OR]: 1·79, 95% confidence interval [CI]: 1·16-2·76, P = 0·01) and E (OR: 1·68, 95% CI: 1·10-2·56, P = 0·02) with the reference group. Multivariate logistic regression indicated that a serum E2 level of at least 4000 pg/ml on the hCG trigger day was associated with increased SGA and with significant differences for groups D (adjusted OR [AOR]: 1·65, 95% CI: 1·05-2·59, P = 0·03) and E (AOR: 1·60, 95% CI: 1·03-2·53, P = 0·04) relative to the reference group. In conclusion, in fresh ET cycles, the supraphysiological E2 ≥4000 pg/ml on the hCG trigger day increases the risk of SGA.
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Chang KT, Su YT, Tsai YR, Lan KC, Hsuuw YD, Kang HY, Chan WH, Huang FJ. High levels estradiol affect blastocyst implantation and post-implantation development directly in mice. Biomed J 2021; 45:179-189. [PMID: 35148258 PMCID: PMC9133257 DOI: 10.1016/j.bj.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 12/25/2020] [Accepted: 01/11/2021] [Indexed: 01/09/2023] Open
Abstract
Background Previous studies have demonstrated that high levels of estradiol (E2) impair blastocyst implantation through effects on the endometrium; however, whether high E2 directly affects blastocysts is not well established. The present study sought to clarify the direct impacts of high E2 levels on blastocysts in vitro. Methods ICR virgin albino mice were used. Using an in-vitro 8-day blastocyst culture model, immunofluorescence staining for the estrogen receptor (ER), blastocyst outgrowth assays, differential staining and TUNEL assays of blastocysts, and embryo transfer, we investigated the main outcomes of exposure to different E2 concentrations (10−7 to 10−4 M) in vitro and in vivo. Results ERα and ERβ expression were detected in pre-implantation stage embryos. In vitro exposure of blastocysts to 10−4 M E2 for 24 h followed by 7 days culture in the absence of E2 caused severe inhibition of implantation and post-implantation development. The late adverse effects of E2 on post-implantation development still occurred at concentrations of 10−7 to 10−5 M. In addition, blastocyst proliferation was reduced and apoptotic cells were increased following exposure to 10−4 M E2. Using an in vivo embryo-transfer model, we also showed that treatment with high E2 resulted in fewer implantation sites (38% vs. 72% in control) and greater resorption of implanted blastocysts (81% vs. 38% in control). Conclusion Exposure to high E2 concentrations in vitro is deleterious to blastocyst implantation and early post-implantation development, mainly owing to direct impacts of E2 on implanting blastocysts. In clinical assisted reproductive technique (ART), high serum E2 concentrations not only affects the endometrium, but also affects blastocysts directly at the period of implantation.
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Affiliation(s)
- Ko-Tung Chang
- Department of Biological Science and Technology, National Pingtung University of Science and Technology, Taiwan
| | - Yu-Ting Su
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Taiwan
| | - Yi-Ru Tsai
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Taiwan
| | - Kuo-Chung Lan
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Taiwan; Chang Gung University College of Medicine, Taiwan
| | - Yan-Der Hsuuw
- Department of Tropical Agriculture and International Cooperation, National Pingtung University of Science and Technology, Taiwan
| | - Hong-Yo Kang
- Chang Gung University College of Medicine, Taiwan
| | - Wen-Hsiung Chan
- Department of Bioscience Technology and Center for Nanotechnology, Chung Yuan Christian University, Taiwan.
| | - Fu-Jen Huang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Taiwan; Chang Gung University College of Medicine, Taiwan.
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Zhang W, Ma Y, Xiong Y, Xiao X, Chen S, Wang X. Supraphysiological serum oestradiol negatively affects birthweight in cryopreserved embryo transfers: a retrospective cohort study. Reprod Biomed Online 2019; 39:312-320. [DOI: 10.1016/j.rbmo.2019.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/27/2019] [Accepted: 04/16/2019] [Indexed: 01/01/2023]
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Risk of ischemic placental disease in fresh and frozen embryo transfer cycles. Fertil Steril 2019; 111:714-721. [PMID: 30826115 DOI: 10.1016/j.fertnstert.2018.11.043] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 11/07/2018] [Accepted: 11/29/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To evaluate the association of fresh and frozen embryo transfer with the development of ischemic placental disease (IPD), hypothesizing that differences in implantation environment affect placentation and thus pregnancy outcomes. DESIGN We performed a secondary analysis of a retrospective cohort study of deliveries linked to IVF cycles. SETTING Tertiary hospital and infertility treatment center. PATIENT(S) We included all women who underwent an autologous IVF cycle and had a live-born infant or an intrauterine fetal demise (IUFD). We excluded women less than 18 years of age. INTERVENTION(S) We compared pregnancies resulting from frozen embryo transfer (frozen) cycles with those resulting from fresh embryo transfer (fresh) cycles. MAIN OUTCOME MEASURE(S) The primary outcome was a composite outcome of IPD or IUFD due to placental insufficiency. Ischemic placental disease included pre-eclampsia, placental abruption, and small for gestational age (SGA). We calculated risk ratios (RRs) and 95% confidence intervals (CIs). RESULT(S) Compared with fresh cycles, frozen cycles had a lower risk of IPD or IUFD from placental insufficiency (RR 0.75, 95% CI 0.59-0.97). Frozen cycles also conferred a lower risk of SGA than fresh cycles (RR 0.58, 95% CI 0.41-0.81). Risks of pre-eclampsia (RR 1.3, 95% CI 0.84-1.9) and abruption (RR 1.2, 95% CI 0.56-2.4) were similar. CONCLUSION(S) There was a lower risk of IPD among frozen cycles compared with fresh cycles. This association was largely driven by lower risk of SGA among frozen cycles.
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