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Li M, Zhang N, Huang J, Li Q, Li J, Li R, Liu P, Qiao J. Obstetrical and neonatal outcomes after vitrified-warmed blastocyst transfer in day 1 rescue intracytoplasmic sperm injection cycles: a retrospective cohort study. J Assist Reprod Genet 2024:10.1007/s10815-024-03126-5. [PMID: 38709401 DOI: 10.1007/s10815-024-03126-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/17/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Fertilization failure often occurs in conventional IVF cycles, and day 1 rescue ICSI is frequently recommended. In this study, the effect of rescue ICSI on obstetrical and neonatal outcomes after a single blastocyst transfer in vitrified-warmed cycles is evaluated. METHODS This cohort study was a retrospective analysis of 703 vitrified-warmed single blastocyst transfers and 219 singletons in the r-ICSI group compared with 11,611 vitrified-warmed single blastocyst transfers in the IVF/ICSI and 4472 singletons in the IVF/ICSI group, respectively, and patients just undergoing their first IVF treatments were included in this study. Pregnancy rate (PR), live birth rate (LBR), and singleton birthweight were the primary outcome measures. Multiple linear regression analysis and logistic regression analysis were performed to evaluate the possible relationship between obstetrical and neonatal outcomes and fertilization method (including IVF, ICSI, and r-ICSI) after adjusting for other potential confounding factors. RESULTS PR and the LBR were lower in the r-ICSI group compared with the IVF/ ICSI group. Singletons from the r-ICSI group had a higher Z-score and the proportion of large for gestational age (LGA) newborns was greater compared with singletons from the IVF/ICSI group. CONCLUSION The results of the study indicated that a 31% LBR after r-ICSI is acceptable for vitrified-warmed blastocyst transfer, but the safety of transfer is a concern because of the lower PR and LBR compared with IVF/ICSI. The safety of r-ICSI newborns is also a concern because of the significantly higher birthweight and the proportion of LGA in r-ICSI group newborns compared with the IVF/ICSI group.
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Affiliation(s)
- Ming Li
- Department of Obstetrics and Gynecology, Center for Reproductive Medical, Peking University Third Hospital, Haidian District, No. 49 North Huayuan Road, Beijing, 10091, China.
- Key Laboratory of Assisted Reproduction Peking University, Ministry of Education, Beijing, 10091, China.
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction Technology, Beijing, 100191, China.
- National Clinical Research Center for Obstetrics and Gynecology, Beijing, 10091, China.
| | - Nan Zhang
- Department of Obstetrics and Gynecology, Center for Reproductive Medical, Peking University Third Hospital, Haidian District, No. 49 North Huayuan Road, Beijing, 10091, China
- Key Laboratory of Assisted Reproduction Peking University, Ministry of Education, Beijing, 10091, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction Technology, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Beijing, 10091, China
| | - Jin Huang
- Department of Obstetrics and Gynecology, Center for Reproductive Medical, Peking University Third Hospital, Haidian District, No. 49 North Huayuan Road, Beijing, 10091, China
- Key Laboratory of Assisted Reproduction Peking University, Ministry of Education, Beijing, 10091, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction Technology, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Beijing, 10091, China
| | - Qin Li
- Department of Obstetrics and Gynecology, Center for Reproductive Medical, Peking University Third Hospital, Haidian District, No. 49 North Huayuan Road, Beijing, 10091, China
- Key Laboratory of Assisted Reproduction Peking University, Ministry of Education, Beijing, 10091, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction Technology, Beijing, 100191, China
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, 10091, China
| | - JunSheng Li
- Department of Obstetrics and Gynecology, Center for Reproductive Medical, Peking University Third Hospital, Haidian District, No. 49 North Huayuan Road, Beijing, 10091, China
- Key Laboratory of Assisted Reproduction Peking University, Ministry of Education, Beijing, 10091, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction Technology, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Beijing, 10091, China
| | - Rong Li
- Department of Obstetrics and Gynecology, Center for Reproductive Medical, Peking University Third Hospital, Haidian District, No. 49 North Huayuan Road, Beijing, 10091, China
- Key Laboratory of Assisted Reproduction Peking University, Ministry of Education, Beijing, 10091, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction Technology, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Beijing, 10091, China
| | - Ping Liu
- Department of Obstetrics and Gynecology, Center for Reproductive Medical, Peking University Third Hospital, Haidian District, No. 49 North Huayuan Road, Beijing, 10091, China.
- Key Laboratory of Assisted Reproduction Peking University, Ministry of Education, Beijing, 10091, China.
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction Technology, Beijing, 100191, China.
- National Clinical Research Center for Obstetrics and Gynecology, Beijing, 10091, China.
| | - Jie Qiao
- Department of Obstetrics and Gynecology, Center for Reproductive Medical, Peking University Third Hospital, Haidian District, No. 49 North Huayuan Road, Beijing, 10091, China
- Key Laboratory of Assisted Reproduction Peking University, Ministry of Education, Beijing, 10091, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction Technology, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Beijing, 10091, China
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Liang MY, Lin M, Qin X, Yang R, Hu KL, Li R. Long-term embryo vitrification is associated with reduced success rates in women undergoing frozen embryo transfer following a failed fresh cycle. Eur J Obstet Gynecol Reprod Biol 2024; 296:244-249. [PMID: 38484616 DOI: 10.1016/j.ejogrb.2024.03.002] [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: 10/31/2023] [Revised: 01/08/2024] [Accepted: 03/02/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE To investigate the association of long-term embryo vitrification with the success rates and neonatal outcomes in frozen cycles. STUDY DESIGN A single-center, retrospective cohort study was performed in Peking University Third Hospital. We included women who had undergone their first vitrified-warmed cycles following an unsuccessful fresh embryo transfer cycle between January 2013 and December 2019. Restricted cubic splines with 4 knots (at min-3.0 months, 3.1-6.0 months, 6.1-12.0 months, 12.1-max months) were used to map the non-linear relationship between live birth and embryo storage time as a continuous variable after adjustment for covariates. Multiple logistic regression was used to calculate crude odds ratios (OR) and adjusted OR (aOR) with 95 % confidence intervals (CI). RESULTS A total of 10,167 women undergoing their first frozen cycle following an unsuccessful fresh embryo transfer cycle were included, among whom 3,708 resulted in a live birth (3,254 singleton live births). Restricted cubic splines, both before and after adjusting for covariates, showed that the predicted live birth rate (LBR) progressively decreased with an increase in the duration of embryo cryopreservation. This trend was also evident when women were categorized into four groups based on the length of cryopreservation. The live birth rate (LBR) was highest in the 0.8-3.0 months group (38 %) compared to the other groups. Multivariable logistic regression with the 0.8-3.0 months group as the reference, demonstrated that the 6.1-12.0 months group and >12.0 months group experienced lower live birth rates (aOR = 0.82 (0.72, 0.94) and aOR = 0.71 (0.57, 0.88), respectively). The LBR for the 3.1-6.0 months group was comparable to that of the 0.8-3.0 months group, with an aOR of 0.98 (0.90, 1.07). Sensitivity analyses in women who underwent single blastocyst transfer, in women with at least one good-quality embryo for transfer, and in women with age less than 36 at embryo transfer demonstrated a similar association between LBR and embryo frozen time. The neonatal outcomes were not significantly different among the four groups. CONCLUSIONS Embryo vitrification greater than six months is associated with a reduction in success rate but does not appear to alter neonatal outcome.
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Affiliation(s)
- Ming-Yu Liang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, 100191 Beijing, China; National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), 100191 Beijing, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, 100191 Beijing, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, 100191 Beijing, China
| | - Mingmei Lin
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, 100191 Beijing, China; National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), 100191 Beijing, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, 100191 Beijing, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, 100191 Beijing, China
| | - Xunsi Qin
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, 100191 Beijing, China; National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), 100191 Beijing, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, 100191 Beijing, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, 100191 Beijing, China
| | - Rui Yang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, 100191 Beijing, China; National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), 100191 Beijing, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, 100191 Beijing, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, 100191 Beijing, China
| | - Kai-Lun Hu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, 100191 Beijing, China; National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), 100191 Beijing, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, 100191 Beijing, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, 100191 Beijing, China.
| | - Rong Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, 100191 Beijing, China; National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), 100191 Beijing, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, 100191 Beijing, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, 100191 Beijing, China.
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Huang Y, Cheng Y, Zhang M, Chen Y, Zhou R, Lin D, Guo X. Effect of repeated vitrification of human embryos on pregnancy and neonatal outcomes. J Ovarian Res 2024; 17:51. [PMID: 38402194 PMCID: PMC10893706 DOI: 10.1186/s13048-024-01370-y] [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: 11/07/2023] [Accepted: 02/05/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Repeated cryopreservation of embryos should occasionally be considered when embryos were not suitable for transfer. The effect of re-cryopreservation on embryos remains contentious. METHODS This retrospective cohort study aimed to evaluate the pregnancy and neonatal outcomes of twice vitrificated blastocyst derived from once vitrified embryos. Total 410 vitrified-warmed blastocyst transfer cycles were divided into two groups according to the times of embryo vitrification: (1) vitrified blastocysts derived from fresh blastocysts (control group, n = 337); (2) twice vitrified blastocysts derived from once vitrified embryos (n = 73). The primary outcome was live birth rate. Multivariable logistic or linear regression analysis model was performed to describe the association between embryo cryopreservation times and clinical outcomes. RESULTS No difference was observed in female age at retrieval and transfer, infertility period, body mass index (BMI), infertility type, endometrial thickness, and embryo transfer numbers between the two groups. The pregnancy outcomes of embryos in repeated cryopreservation group were comparable to those of embryos in control group, including implantation rate, clinical pregnancy rate, and live birth rate. In multivariate logistic regression analysis, the cryopreservation times did not affect the outcomes of biochemical pregnancy, clinical pregnancy, and live birth. Moreover, there was no difference in gestational age, birthweight and sex ratio of singleton newborns between groups. After correcting several possible confounding variables, no significant association was observed between cryopreservation times and neonatal birthweight. CONCLUSION In conclusion, pregnancy and neonatal outcomes achieved with twice vitrified blastocyst transfer were comparable to those achieved with vitrified blastocyst transfer in control group.
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Affiliation(s)
- Yan Huang
- Reproductive Medicine Center, the General Hospital of Southern Theatre Command, Guangzhou, 510010, China
- The First Clinical Medical College, Southern Medical University, Guangzhou, China
| | - Yi Cheng
- Reproductive Medicine Center, the General Hospital of Southern Theatre Command, Guangzhou, 510010, China
| | - Min Zhang
- Reproductive Medicine Center, the General Hospital of Southern Theatre Command, Guangzhou, 510010, China
| | - Yiqing Chen
- Reproductive Medicine Center, the General Hospital of Southern Theatre Command, Guangzhou, 510010, China
| | - Rong Zhou
- Reproductive Medicine Center, the General Hospital of Southern Theatre Command, Guangzhou, 510010, China
| | - Dewei Lin
- Reproductive Medicine Center, the General Hospital of Southern Theatre Command, Guangzhou, 510010, China.
| | - Xinyu Guo
- Reproductive Medicine Center, the General Hospital of Southern Theatre Command, Guangzhou, 510010, China.
- The First Clinical Medical College, Southern Medical University, Guangzhou, China.
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He T, Xue X, Shi J. Effect of re-cryopreservation on pregnancy and neonatal outcomes: Analysis using propensity score matching. Int J Gynaecol Obstet 2024; 164:684-692. [PMID: 37574836 DOI: 10.1002/ijgo.15023] [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: 02/25/2023] [Revised: 06/30/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To comprehensively assess the effect of re-cryopreservation procedure on pregnancy and neonatal outcomes by using propensity matching (PSM) analysis. METHODS The patients were divided into two groups according to the times of embryo cryopreservation: the cryopreservation group (n = 8034) and the re-cryopreservation group (n = 66). To optimize the precision of the present study, we used PSM to adjust the different baseline characteristics between the two groups, including maternal age, the number of good-quality embryos transferred and endometrial preparation protocols. The primary outcome was live-birth rate. The secondary outcomes were biochemical pregnancy rate, clinical pregnancy rate, and miscarriage rate. RESULTS We found that the rates of biochemical pregnancy and clinical pregnancy were comparable between the two groups, whereas miscarriage rate was increased, resulting in significantly reduced live-birth rate in the re-cryopreservation group. No differences were observed in terms of neonatal outcomes, including cesarean section, birth weight, and malformation as well as pregnancy complications. Moreover, multivariable analysis demonstrated that re-cryopreservation was an independent risk factor for live-birth rate. CONCLUSION The present study demonstrated the adverse effect of re-cryopreservation on pregnancy outcomes, providing valuable information for clinical decision making and patient counseling.
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Affiliation(s)
- Tingting He
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Xia Xue
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Juanzi Shi
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
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Makieva S, Sachs MK, Xie M, Velasco Gil A, El-Hadad S, Kalaitzopoulos DR, Dedes I, Stiller R, Leeners B. Reply: Double vitrification and warming do not compromise the chance of live birth-a potential invalid conclusion. Hum Reprod Open 2024; 2024:hoad050. [PMID: 38204940 PMCID: PMC10776349 DOI: 10.1093/hropen/hoad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Affiliation(s)
- Sofia Makieva
- Department of Reproductive Endocrinology, University Hospital
Zurich, Zurich, Switzerland
| | - Maike Katja Sachs
- Department of Reproductive Endocrinology, University Hospital
Zurich, Zurich, Switzerland
| | - Min Xie
- Department of Reproductive Endocrinology, University Hospital
Zurich, Zurich, Switzerland
| | - Ana Velasco Gil
- Department of Reproductive Endocrinology, University Hospital
Zurich, Zurich, Switzerland
| | - Samia El-Hadad
- Department of Reproductive Endocrinology, University Hospital
Zurich, Zurich, Switzerland
- Department of Gynaecology, University Hospital Zurich,
Zurich, Switzerland
| | - Dimitrios Rafail Kalaitzopoulos
- Department of Reproductive Endocrinology, University Hospital
Zurich, Zurich, Switzerland
- Department of Gynaecology, University Hospital Zurich,
Zurich, Switzerland
| | - Ioannis Dedes
- Department of Gynaecology, University Hospital Zurich,
Zurich, Switzerland
| | - Ruth Stiller
- Department of Reproductive Endocrinology, University Hospital
Zurich, Zurich, Switzerland
| | - Brigitte Leeners
- Department of Reproductive Endocrinology, University Hospital
Zurich, Zurich, Switzerland
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Nanassy L, Schoepper B, Schultze-Mosgau A, Depenbusch M, Eggersmann TK, Hiller RAF, Griesinger G. Evaluation of live birth rates and perinatal outcomes following two sequential vitrification/warming events at the zygote and blastocyst stages. J Assist Reprod Genet 2023; 40:2357-2365. [PMID: 37582908 PMCID: PMC10504135 DOI: 10.1007/s10815-023-02909-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/07/2023] [Indexed: 08/17/2023] Open
Abstract
PURPOSE To study the outcome of sequential cryopreservation-thawing of zygotes followed by the cryopreservation-thawing of blastocysts in the course of an IVF treatment on live birth rate and neonatal parameters. METHODS Single center, retrospective chart review for the time period of 2015-2020. Clinical and perinatal outcomes were compared between frozen embryo transfer cycles utilizing twice-cryopreserved (n = 182) vs. once-cryopreserved (n = 282) embryos. Univariate and multivariable analyses were used to adjust for relevant confounders. RESULTS After adjustment for maternal age, gravidity, parity, body mass index (BMI), paternal age, fertilization method used, the number of oocytes retrieved in the fresh cycle, fertilization rate, and transfer medium, the transfer of twice-cryopreserved embryos resulted in a reduced probability of live birth (OR, 0.52; 95% CI 0.27-0.97; p=0.041) compared to once-cryopreserved embryos. No differences in the sex ratio, the mean gestational age, the mean length at birth, or the mean birth weight were found between the two groups. CONCLUSION The circumstantial use of sequential double vitrification-warming in course of treatment is associated with a reduced (but still reasonable) live birth rate compared to once-cryopreserved embryos. As the neonatal outcomes of twice-cryopreserved embryos are similar to once-cryopreserved embryos, this treatment option appears still valid as a rescue scenario in selected cases.
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Affiliation(s)
- Laszlo Nanassy
- Universitäres Kinderwunschzentrum, Lübeck und Manhagen, Ratzeburger Allee 111-125, 23562, Lübeck, Germany.
| | - Beate Schoepper
- Universitäres Kinderwunschzentrum, Lübeck und Manhagen, Ratzeburger Allee 111-125, 23562, Lübeck, Germany
- Department of Reproductive Medicine and Gynecological Endocrinology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Askan Schultze-Mosgau
- Universitäres Kinderwunschzentrum, Lübeck und Manhagen, Ratzeburger Allee 111-125, 23562, Lübeck, Germany
- Department of Reproductive Medicine and Gynecological Endocrinology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marion Depenbusch
- Universitäres Kinderwunschzentrum, Lübeck und Manhagen, Ratzeburger Allee 111-125, 23562, Lübeck, Germany
- Department of Reproductive Medicine and Gynecological Endocrinology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Tanja K Eggersmann
- Universitäres Kinderwunschzentrum, Lübeck und Manhagen, Ratzeburger Allee 111-125, 23562, Lübeck, Germany
- Department of Reproductive Medicine and Gynecological Endocrinology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Roman A F Hiller
- Department of Reproductive Medicine and Gynecological Endocrinology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Georg Griesinger
- Universitäres Kinderwunschzentrum, Lübeck und Manhagen, Ratzeburger Allee 111-125, 23562, Lübeck, Germany
- Department of Reproductive Medicine and Gynecological Endocrinology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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Makieva S, Sachs MK, Xie M, Velasco A, El-Hadad S, Kalaitzopoulos DR, Dedes I, Stiller R, Leeners B. Double vitrification and warming does not compromise the chance of live birth after single unbiopsied blastocyst transfer. Hum Reprod Open 2023; 2023:hoad037. [PMID: 37840636 PMCID: PMC10576635 DOI: 10.1093/hropen/hoad037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 08/11/2023] [Indexed: 10/17/2023] Open
Abstract
STUDY QUESTION Does double vitrification and thawing of an embryo compromise the chance of live birth after a single blastocyst transfer? SUMMARY ANSWER The live birth rate (LBR) obtained after double vitrification was comparable to that obtained after single vitrification. WHAT IS KNOWN ALREADY Double vitrification-warming (DVW) is commonly practiced to accommodate surplus viable embryos suitable for transfer, to allow retesting of inconclusively diagnosed blastocysts in preimplantation genetic testing (PGT), and to circumvent limitations associated with national policies on embryo culture in certain countries. Despite its popularity, the evidence concerning the impact of DVW practice on ART outcomes is limited and lacking credibility. This is the first thorough investigation of clinical pregnancy and LBR following DVW in the case where the first round of vitrification occurred at the zygote stage and the second round occurred at the blastocyst stage in the absence of biopsy. STUDY DESIGN SIZE DURATION This is a retrospective observational analysis of n = 407 single blastocyst transfers whereby embryos created by IVF/ICSI were vitrified-warmed once (single vitrification-warming (SVW) n = 310) or twice (DVW, n = 97) between January 2017 and December 2021. PARTICIPANTS/MATERIALS SETTING METHODS In the SVW group, blastocysts were vitrified on Day 5/6 and warmed on the day of embryo transfer (ET). In the DVW group, two pronuclear (2PN) zygotes were first vitrified-warmed and then re-vitrified on Day 5/6 and warmed on the day of ET. Exclusion criteria were ETs from PGT and vitrified-warmed oocyte cycles. All of the ETs were single blastocyst transfers performed at the University Hospital Zurich in Switzerland following natural or artificial endometrial preparation. MAIN RESULTS AND THE ROLE OF CHANCE The biochemical pregnancy rate, clinical pregnancy rate (CPR), and LBR were all comparable between the DVW and SVW groups. The CPR for DVW was 44.3% and for SVW it was 42.3% (P = 0.719). The LBR for DVW was 30.9% and for SVW it was 28.7% (P = 0.675). The miscarriage rate was additionally similar between the groups: 27.9% for DVW and 32.1% for SVW groups (P = 0.765). LIMITATIONS REASONS FOR CAUTION The study is limited by its retrospective nature. Caution should be taken concerning interpretation of these findings in cases where DVW occurs at different stages of embryo development. WIDER IMPLICATIONS OF THE FINDINGS The result of the present study on DVW procedure provides a framework for counselling couples on their chance of clinical pregnancy per warming cycle. It additionally provides confidence and reassurance to laboratory professionals in certain countries where national policies limit embryo culture strategies making DVW inevitable. STUDY FUNDING/COMPETING INTERESTS This work was supported by the University Research Priority Program 'Human Reproduction Reloaded' of the University of Zurich. The authors have no conflict of interest related to this study to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- S Makieva
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
| | - M K Sachs
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
| | - M Xie
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
| | - A Velasco
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
| | - S El-Hadad
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
- Department of Gynaecology, University Hospital Zurich, Zurich, Switzerland
| | - D R Kalaitzopoulos
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
- Department of Gynaecology, University Hospital Zurich, Zurich, Switzerland
| | - I Dedes
- Department of Gynaecology, University Hospital Zurich, Zurich, Switzerland
| | - R Stiller
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
| | - B Leeners
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
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Li X, Li W, Jia H, Gao Y, Shi W, Bai H. Double vitrification-warming cycles, coupled with blastocyst biopsy, impair live birth but do not affect neonatal outcomes. Int J Gynaecol Obstet 2023; 160:806-813. [PMID: 35844048 DOI: 10.1002/ijgo.14355] [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: 01/10/2022] [Revised: 06/28/2022] [Accepted: 07/08/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To identify whether the transfer of blastocysts that have been vitrified, thawed, biopsied, revitrified, and subsequently rethawed affects clinical outcome and neonatal outcome. METHODS A retrospective study was conducted in a single assisted reproduction technology center from September 2016 to March 2021. Women undergoing single frozen euploid blastocysts transfer were stratified into two groups based on number of vitrification-thawing cycles: single vitrification coupled with single biopsy (group A, n = 177) and double vitrification coupled with single biopsy (group B, n = 30). Pregnancy and perinatal outcomes of the two groups were compared. RESULTS Clinical pregnancy rates were similar between the two groups. Group B was associated with an increased likelihood of live birth when compared with group A by different multivariable analysis models (model 1: odds ratio, 0.42 [95% confidence interval, 0.18-0.97], P = 0.041; model 2: odds ratio, 0.38 [95% confidence interval, 0.16-0.92], P = 0.033). No major obstetrical complication was reported in the two groups and only one malformation live birth was reported in group A. CONCLUSION The procedure of double vitrification-warming cycles, coupled with single biopsy, increases pregnancy loss and ultimately diminishes live birth but does not affect perinatal outcome. Future studies with a larger sample size would help to validate the results.
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Affiliation(s)
- Xiaofang Li
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, People's Republic of China
| | - Wei Li
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, People's Republic of China
| | - Hongran Jia
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, People's Republic of China
| | - Yan'e Gao
- Department of gynecology and obstetrics, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Wenhao Shi
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, People's Republic of China
| | - Haiyan Bai
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, People's Republic of China
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Shen X, Ding M, Yan Y, Huang C, Wang S, Zhou J, Xing J. Perinatal outcomes of singletons following double vitrification-warming procedures: a retrospective study using propensity score analysis. BMC Pregnancy Childbirth 2023; 23:30. [PMID: 36641430 PMCID: PMC9840308 DOI: 10.1186/s12884-023-05369-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Although repeated cryopreservation is an occasional occurrence, the effect on perinatal outcomes is unclear. Therefore, the aim of this study was to evaluate the perinatal outcomes of singletons after embryo re-cryopreservation. METHODS In this retrospective study, a total of 647 singleton live births after blastocyst freeze-thaw embryo transfer cycles were investigated. They were divided into two groups: vitrified-warmed blastocysts (once-vitrified group) and vitrified-warmed blastocysts derived from thawed cleaved embryos (re-vitrified group). Propensity score matching (PSM) was used to control for potential confounding factors. RESULTS A total of 592 infants were included in the once-vitrified group, and 55 infants were included in the re-vitrified group. After PSM, 108 cases were generated for comparison. The median gestational age was 38 weeks for both groups, and the birthweights were comparable (3390.6 ± 601.5 g vs. 3412.8 ± 672.6 g, P > 0.05). The incidence of preterm birth (PTB) (20.4% vs. 16.7%), low birthweight (LBW) (3.7% vs. 7.4%), macrosomia (11.1% vs. 16.7%) and large for gestational age (LGA) (29.6% vs. 22.2%) were not significantly different between the two groups. Logistic regression analysis indicated that double vitrification-warming procedures did not affect the occurrence of PTB (OR, 2.58 [95% CI, 0.77, 8.63]), LBW (OR, 0.83 [95% CI, 0.08, 8.29]), macrosomia (OR, 0.60 [95% CI, 0.13, 2.69]), or LGA (OR, 1.51 [95% CI, 0.53, 4.27]) (P > 0.05, for all). CONCLUSION Our findings demonstrate that double vitrification-warming procedures do not increase the risk of adverse neonatal outcomes compared with those of once-vitrified embryos.
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Affiliation(s)
- Xiaoyue Shen
- grid.41156.370000 0001 2314 964XReproductive Medicine Center, Drum Tower Hospital Affiliated to Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008 China
| | - Min Ding
- grid.41156.370000 0001 2314 964XReproductive Medicine Center, Drum Tower Hospital Affiliated to Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008 China
| | - Yuan Yan
- grid.41156.370000 0001 2314 964XReproductive Medicine Center, Drum Tower Hospital Affiliated to Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008 China
| | - Chenyang Huang
- grid.41156.370000 0001 2314 964XReproductive Medicine Center, Drum Tower Hospital Affiliated to Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008 China
| | - Shanshan Wang
- grid.41156.370000 0001 2314 964XReproductive Medicine Center, Drum Tower Hospital Affiliated to Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008 China
| | - Jianjun Zhou
- Reproductive Medicine Center, Drum Tower Hospital Affiliated to Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China.
| | - Jun Xing
- Reproductive Medicine Center, Drum Tower Hospital Affiliated to Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China.
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Hu KL, Yang R, Xu H, Mol BW, Li R, Wang R. Anti-Müllerian hormone in guiding the selection of a freeze-all versus a fresh embryo transfer strategy: a cohort study. J Assist Reprod Genet 2022; 39:2325-2333. [PMID: 35870096 PMCID: PMC9596674 DOI: 10.1007/s10815-022-02564-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/04/2022] [Indexed: 10/16/2022] Open
Abstract
PURPOSE To explore an interaction effect between serum anti-Müllerian hormone (AMH) levels and the relative treatment effect of a freeze-all versus a fresh embryo transfer strategy on live birth. METHODS This was a retrospective cohort study investigating couples with infertility and eligible for both freeze-all and fresh embryo transfer between 2017 and 2019. Women with an absolute indication for a freeze-all strategy were excluded. Multivariable fractional polynomial interaction analysis within a logistic regression model was used to evaluate whether the treatment effect of a freeze-all versus a fresh transfer strategy varied at different AMH levels. Non-linear interactions were also considered. The primary outcome was the live birth after the first transfer. RESULTS A total of 13,503 women underwent a fresh embryo transfer and 2247 women underwent a freeze-all strategy. Live birth rates were slightly higher in the freeze-all group compared to those in the fresh embryo transfer group (35% vs 33%). There was a non-linear interaction between baseline serum AMH levels and the relative treatment effect of a freeze-all strategy versus a fresh transfer strategy on live birth (P = 0.0161). The benefit on live birth from a freeze-all embryo transfer strategy was greatest in women with a high serum level (> 7 ng/ml). The interaction remained valid when different imputation methods were used. CONCLUSION As serum AMH level increased, there was a nonlinear increase in relative treatment effect of a freeze-only transfer versus a fresh transfer strategy on live birth, and such an effect reaches its maximum in women with high AMH levels.
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Affiliation(s)
- Kai-Lun Hu
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, No. 49 HuaYuan North Road, Haidian District, Beijing, 100191, China
| | - Rui Yang
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, No. 49 HuaYuan North Road, Haidian District, Beijing, 100191, China
| | - Huiyu Xu
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, No. 49 HuaYuan North Road, Haidian District, Beijing, 100191, China
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, 3168, Australia
| | - Rong Li
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, No. 49 HuaYuan North Road, Haidian District, Beijing, 100191, China.
| | - Rui Wang
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, 3168, Australia
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11
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Hu KL, Hunt S, Zhang D, Li R, Mol BW. The association between embryo storage time and treatment success in women undergoing freeze-all embryo transfer. Fertil Steril 2022; 118:513-521. [PMID: 35934542 DOI: 10.1016/j.fertnstert.2022.06.003] [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: 03/03/2022] [Revised: 05/11/2022] [Accepted: 06/03/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To investigate the relationship between the embryo frozen time and live birth rate (LBR) in women having a freeze-all cycle. DESIGN Retrospective cohort study. SETTING Academic hospital. PATIENT(S) Women who underwent their first vitrified-warmed cycles from January 2013 to December 2019. INTERVENTION(S) Embryo storage time. MAIN OUTCOME MEASURE(S) The primary outcome was the LBR. RESULT(S) A total of 14,928 women were eligible for the analysis. Women with the frozen time of transferred embryos for 2-5 months were associated with a higher LBR compared with other groups. The results were confirmed by an inverted U curve in the restricted cubic splines before as well as after adjustment for covariables, which suggested that an embryo storage time of 3-4 months was associated with the highest LBR. Subgroup analyses demonstrated that the inverted U curve relationship between embryo storage time and LBR was only observed in women with the high response. Sensitivity analyses in women with at least one good-quality embryo for transfer, in women aged <36 years at embryo transfer, or in women with double cleavage embryo transfer showed that the association remained valid. The association was weakened in women with single blastocyst transfer probably because of the small sample size in these women. CONCLUSION(S) An inverted U-shaped relationship was found between embryo storage time and treatment success in women with high ovarian response in freeze-all embryo transfer cycles. Prolonged storage time of >6 months was associated with reduced pregnancy rates.
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Affiliation(s)
- Kai-Lun Hu
- Center for Reproductive Medicine, Peking University Third Hospital, Haidian District, Beijing, the People's Republic of China; Key Laboratory of Reproductive Genetics (Ministry of Education) and Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, the People's Republic of China
| | - Sarah Hunt
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Dan Zhang
- Key Laboratory of Reproductive Genetics (Ministry of Education) and Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, the People's Republic of China
| | - Rong Li
- Center for Reproductive Medicine, Peking University Third Hospital, Haidian District, Beijing, the People's Republic of China.
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
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12
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Guo Y, Zong X, Li H, Qiao J. Analysis of Factors Associated With Recurrence of Early-Stage Endometrial Carcinoma and Atypical Endometrial Hyperplasia in Infertile Women After In Vitro Fertilization Treatment. Front Oncol 2022; 12:892995. [PMID: 35832548 PMCID: PMC9272564 DOI: 10.3389/fonc.2022.892995] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To explore the relationship between different artificial reproductive treatment (ART) strategies and tumor outcomes, by analyzing clinical data of patients with endometrial carcinoma (EC) and atypical endometrial hyperplasia (AEH). Methods This retrospective study was performed in a tertiary hospital. Patients (n=131) with EC or AEH, who underwent in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment between June 2010 and June 2021, were divided into a recurrence group and a non-recurrence group. Clinical characteristics and tumor outcomes were assessed. Results 131 patients were followed up for 4-132 months; 33 patients had recurrence, the recurrence rate was 25.2%, 3-year recurrence-free survival (RFS) rate was 83.2 ± 3.4%, and the 5-year RFS rate was 72.9 ± 4.4%. Factors including the frequency of controlled ovarian stimulation (COS) and the total days of ovarian stimulation had no significant effect on the recurrence of tumor lesions (p=0.368 and 0.969, respectively). Histology type (HR: 4.94, 95%CI: 2.41-10.15, p <0.001) and successful/un successful live birth (HR: 0.30, 95%CI: 0.14-0.65, p=0.003) were independent factors of recurrence. Twenty-two of the 82 patients who received a single COS had recurrence. Different COS protocols, the total dose of gonadotropin (Gn), and the serum E2 level on the trigger day had no significant effect on recurrence (p=0.326, 0.889 and 0.468, respectively). Conclusions The degree at which an endometrial lesion progresses into carcinoma is a key factor affecting the recurrence of EC/AEH in patients after IVF/ICSI treatment, and successful live birth is a protective factor for the recurrence of endometrial lesions. Different COS protocols and COS frequencies, as well as the dosage and duration of Gn used during IVF did not affect the recurrence of endometrial lesions.
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Affiliation(s)
- Yaxing Guo
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Xuan Zong
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Hongzhen Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.,National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.,Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Peking University Third Hospital, Beijing, China
| | - Jie Qiao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.,National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.,Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Peking University Third Hospital, Beijing, China
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13
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Analysis of IVF/ICSI outcomes in infertile women with early-stage endometrial cancer and atypical endometrial hyperplasia after conservative treatment. J Assist Reprod Genet 2022; 39:1643-1651. [PMID: 35648323 DOI: 10.1007/s10815-022-02475-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/19/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To investigate the in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes and identify factors that might affect live births in patients with early-stage endometrial cancer (EEC) and atypical endometrial hyperplasia (AEH). METHODS This retrospective study was performed in a tertiary hospital. Patients (n = 123) with EEC or AEH, who underwent IVF/ICSI treatment between January 2010 and December 2019, were divided into a live birth group and a non-live birth group. Clinical characteristics and IVF/ICSI outcomes were assessed. RESULTS A total of 123 patients (28 with EEC and 95 with AEH) underwent 215 ovarian stimulation cycles, resulting in 121 fresh embryo transfer (ET) and 108 frozen-thawed ET. Among 229 ET cycles, 91 (23.7%) of 384 embryos were implanted and 86 pregnancies were achieved, including five ectopic pregnancies (5.8%), 28 miscarriages (32.6%), and 53 live births (61.6%). The clinical pregnancy and live birth rates in each ET cycle were 37.6% and 23.1%, respectively. Fifty-one patients gave birth to 57 live neonates, and the cumulative live birth rate was 41.46%. Multiple logistic regression analysis showed that maternal age, histological type, thin endometrium, and time after complete remission (CR) to IVF cycle started were significantly associated with live births. CONCLUSIONS The live birth rate after IVF/ICSI is promising in infertile patients with EEC and AEH. A shorter interval between CR and IVF/ICSI treatment might be a positive factor, while age > 35 years, endometrial thickness < 8 mm on the day of ET, and degree of endometrial lesion progressing into carcinoma can negatively influence IVF/ICSI outcomes.
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Cryopreservation Does Not Affect the Clinical Pregnancy Rate of Blastocysts Derived from Vitrified Oocytes. Sci Rep 2022; 12:8970. [PMID: 35624188 PMCID: PMC9142575 DOI: 10.1038/s41598-022-12992-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 05/19/2022] [Indexed: 11/27/2022] Open
Abstract
Vitrified, or “frozen”, donor eggs can either be fertilized and cultured for fresh transfer (group 1), or fertilized and cryopreserved for transfer in a “frozen embryo transfer” cycle (group 2). This study compared the pregnancy rates between the two groups. Frozen donor egg cycles (N = 1213) were analyzed at the World Egg Bank. The outcome studied was clinical pregnancy rate. Cycles included only single embryo transfers (ET) without preimplantation genetic testing (PGT). A total of 600 cycles met the inclusion criteria. Group 1 included 409 cycles and group 2 had 191 cycles. There was no statistical significance in clinical pregnancy rate between the two groups (38.63% vs 32.46%, p = 0.14). Mean embryo age was higher in group 2 (5.1 vs. 5.4 days, p < 0.01). The compounding effect of vitrification when applied to two distinct stages (oocyte and embryo), has not been studied. When comparing the two groups, we found no difference in pregnancy rate. However, there was a trend towards fewer pregnancies in group 2. A larger study should be done to determine the validity of this result (Ramadan et al. in Fertil Steril, 2020).
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15
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Ding M, Diao Z, Zhou J. The preimplantation genetic testing clinical outcomes of biopsy on vitrification-warming embryos: A retrospective study. J Obstet Gynaecol Res 2022; 48:1621-1631. [PMID: 35585784 DOI: 10.1111/jog.15275] [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: 11/19/2021] [Revised: 03/21/2022] [Accepted: 04/18/2022] [Indexed: 11/26/2022]
Abstract
AIM The objective of this study was to assess whether PGT conducted with previously untested vitrified embryos affect the clinical outcomes. METHODS A total of 49 patients who underwent biopsy on vitrification-warming embryos for PGT were enrolled from January 2016 to January 2019. The cleavage-stage embryos were thawed and cultured into the blastocyst stage for biopsy. During this period, 195 patients underwent routine PGT and FET, whose embryos were biopsied before frozen were used as the control group. The clinical outcomes were further compared between the two groups after a 1:2 PSM. RESULTS There were 47 transferable blastocysts in 30 patients, while 19 patients without transferable embryos, who performed biopsy on vitrification-warming embryos for PGT. During this study period, 27 patients have already underwent FET with the clinical pregnancy rate was 66.7% (18/27). After 1:2 PSM, 24 patients in the biopsy on vitrification-warming embryo group and 48 patients in the control group were compared, the clinical pregnancy rate (68.8% vs. 70.8%, p = 0.86), miscarriage rate (18.2% vs. 11.8%, p = 0.86), or live birth rate (52.1% vs. 62.5%, p = 0.40) had no significant difference. And the transferable blastocyst rate or the clinical pregnancy rate in the vitrification-warming cleavage-stage embryo group was not significantly different from those in the vitrification-warming blastocyst group. In addition, the PGT clinical outcomes of biopsy on vitrification-warming embryos had no significant difference between IVF-fertilized embryos and ICSI-fertilized embryos. CONCLUSION Biopsy on the vitrification-warming embryos with a dual vitrified cryopreservation does not affect the embryo quality or the PGT clinical outcomes.
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Affiliation(s)
- Min Ding
- Reproductive Medicine Centre, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zhenyu Diao
- Reproductive Medicine Centre, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Jianjun Zhou
- Reproductive Medicine Centre, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China.,Reproductive Medicine Centre, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
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16
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Live birth rate following a euploid blastocyst transfer is not affected by double vitrification and warming at cleavage or blastocyst stage. J Assist Reprod Genet 2022; 39:987-993. [PMID: 35217947 PMCID: PMC9050981 DOI: 10.1007/s10815-022-02440-0] [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: 08/24/2021] [Accepted: 02/17/2022] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To compare reproductive outcomes following a euploid embryo transfer, between those embryos vitrified-warmed twice to those vitrified-warmed once. METHODS We retrospectively analysed 694 single euploid frozen embryo transfer cycles following preimplantation genetic testing for aneuploidy (PGT-A). For cycles in group 1 (N = 451), embryos were biopsied for PGT-A at blastocyst stage and vitrified. For cycles in group 2 (N = 146), embryos were vitrified at blastocyst stage, before being warmed and biopsied for PGT-A and vitrified again. For cycles in group 3 (N = 97), embryos were vitrified on day-3, before being warmed, cultured to day-5 and biopsied for PGT-A and re-vitrified. RESULTS The pregnancy, clinical pregnancy and livebirth rate in group 2 were not statistically different to group 1 (pregnancy rate, adjusted OR 1.09, 95% CI 0.62-1.91; clinical pregnancy, aOR 0.89, 95% CI 0.58-1.37; live birth rate, aOR 0.85, 95% CI 0.56-1.28). There was also no significant difference between group 3 and group 1, with similar pregnancy rate (aOR 1.22, 95% CI 0.74-1.99), clinical pregnancy rate (aOR 1.21, 95% CI 0.75-1.96) and live birth rate (aOR 1.15, 95% CI, 0.73-1.80). There was no significant difference in miscarriage rates between all three groups. The age at the oocyte collection, embryo quality and day of biopsy were associated with pregnancy, clinical pregnancy and live birth rate. CONCLUSION This study suggests that vitrifying and warming embryos twice at blastocyst or at cleavage and then blastocyst stage, can lead to similar reproductive outcomes to embryos vitrified-warmed once, after a single euploid embryo transfer.
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Xiong S, Hao X, Gao Y, Wu L, Liu J, Wang J, Zhu J, Li J, Liu D, Han W, Huang G. Accumulation of Cleavage-Stage Embryos by Vitrification may Compromise Embryonic Developmental Potential in Preimplantation Genetic Testing. Reprod Sci 2022; 29:1930-1938. [PMID: 35212931 DOI: 10.1007/s43032-022-00880-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/07/2022] [Indexed: 11/26/2022]
Abstract
It was suggested that the embryo pooling was an alternative for patients with insufficient number of embryos for preimplantation genetic testing (PGT) in a single ovarian stimulation cycle. However, limited study noticed whether it is an efficient strategy to pool cleavage-stage embryos by vitrification. This study included 71 cycles with vitrified-warmed and fresh embryos simultaneously for PGT between May 2016 and May 2021. The embryos from the same patients were split into two groups based on the origin: warming group and fresh group. Embryo development, sequencing results, clinical and neonatal outcomes were compared. The results showed that the rate of high-quality embryos in the warming group was significantly higher than that in the fresh group (64.53% versus 52.61%, P = 0.011); however, the available blastocyst rate in this group was significantly lower than that in the fresh group (47.29% versus 57.83%, P = 0.026). There were 96 and 144 blastocysts that underwent trophectoderm (TE) biopsy in warming and fresh groups, respectively. The high-quality blastocyst rate was significantly lower in the warming group compared to the fresh group (57.29% versus 70.14%, P = 0.041). The rates of genetic transferable blastocyst were comparable between the two groups (P = 0.956). There were no statistical differences in terms of embryo implantation, clinical pregnancy, miscarriage rates, and neonatal outcomes between the two groups. In conclusion, this study demonstrated that the cleavage-stage embryo pooling strategy might be unfavorable for the maintenance of embryonic development potential. If not necessary, it is not recommended to pool cleavage-stage embryos for PGT.
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Affiliation(s)
- Shun Xiong
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Xiangwei Hao
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Yang Gao
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Lihong Wu
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Junxia Liu
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Jiang Wang
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Jiahong Zhu
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - Jingyu Li
- Chongqing Key Laboratory of Human Embryo Engineering, Chongqing, People's Republic of China
| | - Dongyun Liu
- Chongqing Clinical Research Center for Reproductive Medicine, Chongqing, People's Republic of China
| | - Wei Han
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China.
| | - Guoning Huang
- Chongqing Health Center for Women and Children, Chongqing, People's Republic of China.
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18
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Hu KL, Zheng X, Hunt S, Li X, Li R, Mol BW. Blastocyst quality and perinatal outcomes in women undergoing single blastocyst transfer in frozen cycles. Hum Reprod Open 2022; 2021:hoab036. [PMID: 35187269 PMCID: PMC8849119 DOI: 10.1093/hropen/hoab036] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/10/2021] [Indexed: 12/31/2022] Open
Abstract
STUDY QUESTION Is the morphological grading system for blastocysts associated with perinatal outcomes in women undergoing frozen-thawed single blastocyst transfer (SBT)? SUMMARY ANSWER Preferential transfer of a blastocyst based on their inner cell mass (ICM) and trophectoderm (TE) grading appears to be supported by observed differences in perinatal outcomes. WHAT IS KNOWN ALREADY The transfer of a morphologically good quality blastocyst is associated with a higher chance of implantation and pregnancy as compared to transfer of a poor quality blastocyst. However, to date, the association of the morphological parameters of the blastocyst with perinatal outcomes after blastocyst transfer remains unknown. STUDY DESIGN SIZE DURATION This retrospective cohort study started with 27 336 frozen-thawed SBT cycles from January 2013 to December 2019. PARTICIPANTS/MATERIALS SETTING METHODS There were 7469 women with singleton deliveries in Peking University Third Hospital eligible for analysis. Multivariate logistic regression was used to test the risk of factors with the expression of crude odds ratios (ORs) and adjusted OR with 95% CIs. MAIN RESULTS AND THE ROLE OF CHANCE Transfer of a blastocyst with a low overall grading was associated with a higher chance of female baby (48% vs 42%, adjusted OR = 1.26 (1.13, 1.39)) and a higher rate of caesarian section (C-section; 71% vs 68%, adjusted OR = 1.15 (1.02, 1.29)). Compared with Grade A ICM blastocyst transfer, Grade B ICM and Grade C ICM blastocyst transfers were associated with a lower chance of a female baby (adjusted OR = 0.83 (0.73, 0.95), 0.63 (0.50, 0.79), respectively) and a higher risk of large for gestational age (LGA; adjusted OR = 1.23 (1.05, 1.45), 1.47 (1.12, 1.92), respectively); Grade C ICM blastocyst transfer was also associated with an increased risk of macrosomia (adjusted OR = 1.66 (1.20, 2.30)). Compared with Grade A TE blastocyst transfer, there was an increased risk of small for gestational age with Grade C TE blastocyst transfer (adjusted OR = 1.74 (1.05, 2.88)). Both Grade B TE and Grade C TE blastocyst transfer had a higher chance of female baby (adjusted OR = 1.30 (1.11, 1.53), 1.88 (1.57, 2.26), respectively) and a lower risk of gestational diabetes mellitus (adjusted OR = 0.74 (0.59, 0.94), 0.67 (0.50, 0.88), respectively) than Grade A TE blastocyst transfer. LIMITATIONS REASONS FOR CAUTION The main limitations of this study were its retrospective nature and the relative subjectivity of blastocyst scoring. The follow-up was conducted through a phone call and some patients may not have reported their obstetrical and neonatal outcomes, leading to a relatively lower rate of several obstetrical outcomes. Due to the missing information in our dataset, we were not able to separate out iatrogenic preterm birth nor adjust for obstetric complications in previous pregnancies as a confounder in the mutivariate analysis. Because the days of blastocyst culture in total were unclear in our dataset, analysis of the association between the time to reach blastocyst expansion and perinatal outcomes was not performed. WIDER IMPLICATIONS OF THE FINDINGS Transfer of a blastocyst with a low overall grading is associated with a higher rate of C-section and a higher chance of a female baby. The association between ICM grading and LGA would suggest that Grade A ICM blastocysts should be transferred preferentially to Grade B/C ICM blastocysts. Our results support the use of current morphological systems for embryo prioritization. STUDY FUNDING/COMPETING INTERESTS This study was supported by the National Key Research and Development Program of China (2018YFC1004100 to R.L.), the National Science Fund for Distinguished Young Scholars (81925013 to R.L.) and a Zhejiang University Scholarship for Outstanding Doctoral Candidates (to K.-L.H.). All authors have read the journal's authorship agreement and policy on disclosure of potential conflicts of interest, and have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Kai-Lun Hu
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Peking University Third Hospital, Beijing, People's Republic of China.,Key Laboratory of Reproductive Genetics (Ministry of Education), Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Xiaoying Zheng
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Peking University Third Hospital, Beijing, People's Republic of China
| | - Sarah Hunt
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Xiaohong Li
- Department of Obstetrics and Gynecology, Centre for Reproductive Medicine, West China Second University Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Rong Li
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Peking University Third Hospital, Beijing, People's Republic of China
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
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Ren Y, Li H, Jie Q, Xiaoying Z, Li R, Wang HY. Combined analysis of human chorionic gonadotrophin concentrations at different time points after frozen-thawed blastocyst transfer can improve our ability to predict the pregnancy outcomes of single gestations. J OBSTET GYNAECOL 2022; 42:1424-1430. [PMID: 35014918 DOI: 10.1080/01443615.2021.1985442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In this study, we conducted a retrospective single-centre study of 1664 singleton pregnancies derived from frozen-thawed blastocyst transfer between January 2017 and December 2018. Analysis showed that there were 596 early pregnancy losses and 1068 ongoing pregnancies. We compared serum HCG (human chorionic gonadotophin) concentrations on days 12, 14, 19, and 21, between the pregnancy loss group and the ongoing pregnancy group. The cut-off level of HCG at each time point was calculated to predict pregnancy outcome. Joint analysis of two single HCG levels taken one week apart was carried out to improve predictive accuracy. The levels of HCG at four time points were significantly lower in the early pregnancy loss group than in the ongoing pregnancy group. According to the area under ROC (receiver operating characteristic curve) curves, all levels of HCG taken at four time points showed good ability to predict the outcome of pregnancy. The joint analysis of two single HCG levels taken one week apart further improved the accuracy of prediction.Impact statementWhat is already known on this subject? Multiple studies have shown that the maternal level of serum HCG is the best parameter for predicting the course of pregnancy.What do the results of this study add? The levels of HCG on days 12, 14, 19 and 21 were significantly lower in the early pregnancy loss group than in the group of ongoing pregnancies. According to the area under ROC curves, all levels of HCG taken at four time points showed a good ability to predict the outcome of pregnancy.What are the implications of these findings for clinical practice and/or further research? The joint analysis of two single HCG levels, taken one week apart, further improved the accuracy of prediction.
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Affiliation(s)
- Yun Ren
- Centre of Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University, Third Hospital, Beijing, China.,Ministry of Education, Key Laboratory of Assisted Reproduction, Beijing, China
| | - Hongzhen Li
- Centre of Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University, Third Hospital, Beijing, China.,Ministry of Education, Key Laboratory of Assisted Reproduction, Beijing, China
| | - Qiao Jie
- Centre of Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University, Third Hospital, Beijing, China.,Ministry of Education, Key Laboratory of Assisted Reproduction, Beijing, China
| | - Zhen Xiaoying
- Centre of Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University, Third Hospital, Beijing, China.,Ministry of Education, Key Laboratory of Assisted Reproduction, Beijing, China
| | - Rong Li
- Centre of Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University, Third Hospital, Beijing, China.,Ministry of Education, Key Laboratory of Assisted Reproduction, Beijing, China
| | - Hai-Yan Wang
- Centre of Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University, Third Hospital, Beijing, China.,Ministry of Education, Key Laboratory of Assisted Reproduction, Beijing, China
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Gao J, Zhang Y, Cui L, Zhang T, Wu B, Gao S, Chen ZJ. "Double Frozen Transfer" Could Influence the Perinatal and Children's Growth: A Nested Case-Control Study of 6705 Live Birth Cycles. Front Endocrinol (Lausanne) 2022; 13:878929. [PMID: 36034419 PMCID: PMC9413401 DOI: 10.3389/fendo.2022.878929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study aims to evaluate neonatal and children growth outcomes of cryotransfer of embryos developed from frozen gametes [double frozen transfer (DFT)]. METHODS This nested case-control study included 6,705 women who had a singleton live birth after embryo transfer at the Center for Reproductive Medicine, Shandong University, from 2008 to 2020. Of these, 745 women underwent frozen embryo transfer (FET) using embryos developed from frozen gametes (DFT). Propensity score methodology was used to balance the two groups by maternal age and body mass index (BMI) before evaluating outcomes. After age and BMI were matched using the propensity score methodology in a ratio of 1:4, the control groups enrolled 2,980 women who underwent fresh embryo transfer (ET) and 2,980 women underwent FET from fresh gametes. The children born were followed to at least 5 years of age, and some were followed up to 10 years. Neonatal outcomes and childhood growth measurements were compared among the three groups. RESULTS The average birth weight of the DFT group (3,462 g) was significantly higher than the FET group (3,458 g) and ET group (3,412 g). The rate of large for gestational age (LGA) babies in the DFT and FET group was higher than that for the ET group (30.9% vs. 24.8%; 29.4% vs. 24.8%, respectively). After adjusting for different confounder combinations in the three models, the birth weight and risk of LGA in the DFT and FET groups were still higher than in the ET group, and the values group of P for trend in the models were significant. In multiple linear regression analysis of the children's development, the height Z-score of children born from the DFT and FET group was higher than that for children from the ET group (β = 0.21, 95% CI 0.07-0.35; b = 0.17, 95% CI 0.05-0.28, respectively). However, childhood growth measurements including body weight Z-score and BMI Z-score were not significantly different among the three groups. In addition, the proportion of male children born from DET was higher than that from ET. CONCLUSIONS There is an increased risk of LGA babies associated with pregnancies conceived from DFT. Children are inclined to be taller in the future in this group than after FET. The related etiology and pathophysiology mechanisms still need to be revealed. In the future, well-designed, observational studies with in-depth collection of patients' characteristics may shed more light on this issue.
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Affiliation(s)
- Jie Gao
- Center for Reproductive Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences, Jinan, China
- Key laboratory for Reproductive Endocrinology, Ministry of Education, Shandong University, Jinan, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Jinan, China
| | - Yiyuan Zhang
- Center for Reproductive Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences, Jinan, China
- Key laboratory for Reproductive Endocrinology, Ministry of Education, Shandong University, Jinan, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Jinan, China
| | - Linlin Cui
- Center for Reproductive Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences, Jinan, China
- Key laboratory for Reproductive Endocrinology, Ministry of Education, Shandong University, Jinan, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Jinan, China
| | - Tao Zhang
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, China
| | - Bingjie Wu
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, China
| | - Shanshan Gao
- Center for Reproductive Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key laboratory for Reproductive Endocrinology, Ministry of Education, Shandong University, Jinan, China
- *Correspondence: Shanshan Gao,
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences, Jinan, China
- Key laboratory for Reproductive Endocrinology, Ministry of Education, Shandong University, Jinan, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Jinan, China
- Center for Reproductive Medicine, Renji Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
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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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22
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National Survey Highlights the Urgent Need for Standardisation of Embryo Transfer Techniques in the UK. J Clin Med 2021; 10:jcm10132839. [PMID: 34198995 PMCID: PMC8267796 DOI: 10.3390/jcm10132839] [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: 04/29/2021] [Revised: 05/31/2021] [Accepted: 06/18/2021] [Indexed: 11/23/2022] Open
Abstract
Embryo transfer (ET) is one of the vital steps in the in vitro fertilisation (IVF) process, yet there is wide variation in ET technique throughout the UK, without a nationally approved standardised approach. The aim of this study was to gain contemporaneous information regarding the current clinical ET practice in the UK. Method: A 38-question electronic survey was distributed to the 79 UK Human Fertilisation and Embryology Authority (HFEA) registered clinics performing ETs. Results: In total, 59% (47/79) of units responded, 83% (39/47) performing ultrasound-guided transfers, with 42% (20/47) of units using a tenaculum; 22% (10/45) would proceed with transfer regardless of fluid in the endometrial cavity. In 91% (43/47) of units, embryos were deposited in the upper/middle portion of the uterine cavity, but interpretation of this area ranged from 0.5 to >2 cm from the fundus, with 68% (32/47) allowing patients to mobilise immediately after transfer. In 60% (27/45) of clinics, success rates were based on clinical pregnancy rates (CPR). Conclusion: Within the UK there is a wide range of variability in ET techniques, with >70% of discordance in survey-responses between clinics. Whilst there are areas of good practice, some disadvantageous techniques continue to persist. This survey emphasises the importance of developing a standardised, evidence-based approach to improve ET success rates.
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23
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Blastocyst cryopreservation and cryopreservation-warming transfer is an effective embryo transfer strategy for day 1 rescue intracytoplasmic sperm injection cycles. Sci Rep 2021; 11:8260. [PMID: 33859312 PMCID: PMC8050289 DOI: 10.1038/s41598-021-87693-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/30/2021] [Indexed: 11/08/2022] Open
Abstract
This was a retrospective analysis of a total of 625 r-ICSI cycles using freeze-all-embryos and embryo transfers (ET) in subsequent cryopreservation-warming cycles to determine the effect of the ET method for day 1 rescue intracytoplasmic sperm injection cycles (r-ICSI). Two methods were used: in method 1, cleavage-stage embryos were frozen and were directly transferred in a subsequent cryopreservation-warming cycle (r-ICSI frozen cleavage), and 144 cleavage-stage ETs occurred. Similarly, in method 2, there were 188 blastocyst-stage ETs (r-ICSI frozen blast) performed. The live birth rate (LBR) for r-ICSI frozen blast was better than that for r-ICSI frozen cleavage in calculation of ET cycles (19.44% vs. 37.77%) and also remained better after the use of logistic regression analysis (OR = 2.721, 95% CI 1.604–4.616). Conservative cumulative LBR were compared between r-ICSI frozen cleavage and r-ICSI frozen blast with regard to oocyte retrieval cycles (17.39% vs. 15.30%). The same results were obtained for conservative cumulative LBR after logistic regression analysis (OR = 0.925, 95% CI 0.557–1.535). The results of this study confirmed that it was valuable to perform r-ICSI if using freeze-all-embryos. Further, r-ICSI embryos were cultured to blastocyst stage, cryopreserved, and used in subsequent cryopreservation-warming cycles, which was an effective embryo transfer strategy and obtained satisfactory results.
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Aluko A, Vaughan DA, Modest AM, Penzias AS, Hacker MR, Thornton K, Sakkas D. Multiple cryopreservation-warming cycles, coupled with blastocyst biopsy, negatively affect IVF outcomes. Reprod Biomed Online 2021; 42:572-578. [PMID: 33516664 PMCID: PMC10036156 DOI: 10.1016/j.rbmo.2020.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 11/13/2020] [Accepted: 11/25/2020] [Indexed: 11/28/2022]
Abstract
RESEARCH QUESTION Do multiple cryopreservation-warming cycles, coupled with blastocyst biopsy, negatively affect IVF outcomes? DESIGN Patients undergoing IVF with homologous single embryo transfer, and who underwent trophectoderm biopsy for preimplantation genetic testing for aneuploidy (PGT-A) between 2013 and 2017, were divided into three groups based on degree of embryonic micromanipulation: once-biopsied, once-cryopreserved (group BC, n = 2603), once-biopsied, twice-cryopreserved (group CBC, n = 95) and twice-biopsied, twice-cryopreserved (group BCBC, n = 15). The primary outcome was live birth; secondary outcomes included positive serum pregnancy test, clinical pregnancy and miscarriage. RESULTS Group CBC had a significantly lower chance of live birth (adjusted RR 0.57, 95% CI 0.41 to 0.79) and clinical pregnancy (adjusted RR 0.67, 95% CI 0.53 to 0.85) compared with group BC. Miscarriage rates were similar between groups BC and CBC (adjusted RR 1.3, 95% CI 0.64 to 2.7). CONCLUSIONS Multiple cryopreservation-warming cycles, coupled with blastocyst biopsy, negatively affect IVF outcomes. Although PGT-A is thought to improve reproductive outcomes on a per transfer basis, caution must be exercised in counselling patients on the possibility of diminishing returns owing to further embryonic micromanipulation after an embryo has been cryopreserved.
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Affiliation(s)
- Ashley Aluko
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA
| | - Denis A Vaughan
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA; Boston IVF, Waltham MA, USA.
| | - Anna M Modest
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA
| | - Alan S Penzias
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA; Boston IVF, Waltham MA, USA
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston MA, USA
| | - Kim Thornton
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA; Boston IVF, Waltham MA, USA
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Hu KL, Zhang D, Li R. Endometrium preparation and perinatal outcomes in women undergoing single-blastocyst transfer in frozen cycles. Fertil Steril 2021; 115:1487-1494. [PMID: 33487443 DOI: 10.1016/j.fertnstert.2020.12.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/05/2020] [Accepted: 12/14/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate the association of endometrium preparation with perinatal outcomes. DESIGN Retrospective cohort study. SETTING University-affiliated fertility center. PATIENT(S) Twenty-one thousand six hundred and forty-eight women who underwent frozen single-blastocyst transfer from January 2013 to March 2019. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Cesarean delivery, preterm delivery (PTD), vaginal PTD, very preterm delivery (VPTD), postterm delivery, low birth weight (LBW), macrosomia, small for gestational age (SGA), large for gestational age (LGA), hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), premature rupture of membrane (PROM), placenta previa, and congenital abnormality. RESULT(S) Compared with natural cycles, hormone replacement cycles were associated with an increased risk of PTD, VPTD, cesarean delivery, macrosomia, PROM, and HDP. There was a trend toward an increased risk of vaginal PTD and LGA in hormone replacement cycles. Stimulated cycles were associated with an increased risk of postterm delivery and GDM. There was no statistically significant difference in the rate of SGA, placenta previa, or congenital abnormality among the three endometrium preparation methods. CONCLUSION(S) Hormone replacement cycles are associated with an increased risk of PTD, VPTD, cesarean delivery, LBW, macrosomia, PROM, and HDP. Stimulated cycles are associated with an increased risk of postterm delivery and GDM.
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Affiliation(s)
- Kai-Lun Hu
- Center for Reproductive Medicine, Third Hospital, Peking University, Beijing, People's Republic of China; Key Laboratory of Reproductive Genetics (Ministry of Education) and Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Dan Zhang
- Key Laboratory of Reproductive Genetics (Ministry of Education) and Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Rong Li
- Center for Reproductive Medicine, Third Hospital, Peking University, Beijing, People's Republic of China.
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Li J, Xiong S, Zhao Y, Li C, Han W, Huang G. Effect of the Re-Vitrification of Embryos at Different Stages on Embryonic Developmental Potential. Front Endocrinol (Lausanne) 2021; 12:653310. [PMID: 34335464 PMCID: PMC8317612 DOI: 10.3389/fendo.2021.653310] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 06/30/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Using re-vitrified human embryos for frozen-warmed embryo transfer (FET) is a valuable option when there are no other cryopreserved embryos to use, however, except for the PGT cases, no published data are available for FET with human embryos that were re-vitrified at different developmental stages. OBJECTIVE To evaluate the effect of re-vitrification of embryos at different stages on embryonic developmental potential. METHOD This study included clinical retrospective and mouse experimental studies. For the retrospective study, a total of 25 FET cycles with re-vitrified day 3 embryos (re-vitrification group 1) and 54 FET cycles with re-vitrified day 5 blastocysts (re-vitrification group 2) between January 2015 and December 2019 were included in this study. The corresponding FET cycles with once-vitrified embryos were identified using propensity score (PS) matching according to the time of embryo transfer. For the mouse experimental study, we divided embryos into 5 groups: fresh (group 1), vitrified at the 8-cell stage (group 2), vitrified at the early blastocyst stage (group 3), vitrified at the 8-cell stage, and re-vitrified at the 8-cell (group 4) or early blastocyst stage (group 5). The fresh embryos was selected as control group. The primary outcome in this study was delivery outcomes. RESULTS No significant difference in delivery rate was detected between re-vitrification group 1 (24.00%) and the corresponding control group (28.00%). However, re-vitrification group 2 (46.3%) showed a significant decrease in delivery rate compared with the two corresponding control groups (63.89% and 64.12%) (P < 0.05). Our experiment using mouse embryos also confirmed the clinical data, and showed that re-vitrification at the blastocyst stage following the first round of vitrification at the 8-cell stage reduced the delivery rate. In addition, both re-vitrified groups showed a significantly higher expression level of BAX. However, only re-vitrification at the blastocyst stage increased the expression level of CASPASE3. CONCLUSIONS Re-vitrification at the 8-cell and blastocyst stages has different effects on embryonic developmental potential, as re-vitrification at blastocyst stage following a previous vitrification at 8-cell stage reduced the delivery rate, while vitrification at the 8-cell stage twice achieved comparable pregnancy outcomes to the once-vitrified group.
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Repeated cryopreservation process impairs embryo implantation potential but does not affect neonatal outcomes. Reprod Biomed Online 2020; 42:75-82. [PMID: 33309388 DOI: 10.1016/j.rbmo.2020.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/20/2020] [Accepted: 11/13/2020] [Indexed: 11/20/2022]
Abstract
RESEARCH QUESTION Does repeated cryopreservation process affect embryo implantation potential and neonatal outcomes of human embryos? DESIGN This retrospective cohort study was conducted in the Reproductive Medicine Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. All assisted reproductive technology (ART) cycles were carried out between January 2014 and December 2018. Preferentially matched participants were divided into three groups according to the times of embryo cryopreservation: the fresh group (n = 249), the cryopreservation group (n = 244) and the re-cryopreservation group (n = 216). Embryo implantation rate, live birth rate, miscarriage rate and neonatal complication rate were compared among these three groups. RESULTS The embryo implantation rate, clinical pregnancy rate and live birth rate in the re-cryopreservation group were significantly lower, and the miscarriage rate also slightly increased. Logistic regression analysis indicated that embryos with repeated cryopreservation and lower trophectoderm scores were at higher risk of embryo implantation failure in single embryo transfer cycles (OR 1.79 and 1.56, respectively). No significant differences were observed in gender, gestational age, birthweight, neonatal abnormality and neonatal complications among the groups. CONCLUSIONS Our findings demonstrate the adverse effect of repeated cryopreservation on embryo implantation potential. The study offers embryologists and reproductive clinicians a warning of detrimental role of repeated cryopreservation. If unnecessary, it is strongly recommended to avoid repeated practice of vitrification and warming on embryos.
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Obstetric and neonatal outcomes after the transfer of vitrified-warmed blastocysts developing from nonpronuclear and monopronuclear zygotes: a retrospective cohort study. Fertil Steril 2020; 115:110-117. [PMID: 32826046 DOI: 10.1016/j.fertnstert.2020.07.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/11/2020] [Accepted: 07/13/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the obstetric and neonatal outcomes after the transfer of vitrified-warmed single blastocysts developing from nonpronuclear (0PN) and monopronuclear (1PN) zygotes. DESIGN Cohort study. SETTING Affiliated hospital. PATIENT(S) This study was a retrospective analysis of 435 0PN and 281 1PN vitrified-warmed single blastocyst transfers, and 151 0PN and 75 1PN singletons, compared with 13,167 two-pronuclear (2PN) vitrified-warmed single blastocyst transfers and 4,559 2PN singletons, respectively. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Pregnancy rate (PR), abortion rate (AR), live birth rate (LBR), and singleton birthweight were the primary outcome measures. RESULT(S) PR, AR, and LBR were similar when compared between the 0PN and 2PN groups after vitrified-warmed blastocyst transfer. However, the 0PN group had a higher birthweights, higher z scores, and a greater proportion of very large for gestational age newborns. When comparing the 1PN and 2PN groups, we found that the PR was similar whereas the AR was higher and the LBR was lower. No differences were detected in the other neonatal outcomes. CONCLUSION(S) The results of the present study show that the transfer of 2PN blastocysts should be prioritized because of a higher AR and a lower LBR after 1PN blastocyst transfers and a higher birthweight after 0PN blastocyst transfers when compared with 2PN blastocyst transfers. Our data indicate the need for concern about the safety of 1PN and 0PN embryo transfers.
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29
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Hu KL, Liu FT, Xu H, Li R, Qiao J. Association of serum anti-Müllerian hormone and other factors with cumulative live birth rate following IVF. Reprod Biomed Online 2020; 40:675-683. [PMID: 32268980 DOI: 10.1016/j.rbmo.2020.01.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 01/07/2020] [Accepted: 01/24/2020] [Indexed: 11/13/2022]
Abstract
RESEARCH QUESTION What are the optimal values of maternal age and body mass index (BMI), paternal age and BMI, number of oocytes retrieved, and serum AMH concentrations for cumulative live birth rate (CLBR) in IVF and embryo transfer (IVF-ET)? DESIGN This retrospective cohort study included 9494 women who underwent their first IVF-ET cycle between January 2017 and July 2018. The primary outcome was the CLBR within one complete cycle. Cox regression analysis was used to test the hazard ratio, with 95% confidence intervals. RESULTS CLBR was significantly lower when maternal age was over 35 (adjusted P < 0.01 for age 36-38 years, adjusted P < 0.00001 for all age groups above 38 years). CBLR increased with increasing serum AMH concentrations and number of retrieved oocytes up to peak values at 5-7 ng/ml AMH and 16-20 oocytes in all women. CLBR was significantly increased when serum AMH concentrations were 3-7 ng/ml (adjusted P < 0.001) and number of oocytes retrieved was more than five (adjusted P < 0.00001). Overweight had a negative effect on CLBR compared with normal BMI in women under 35 years of age (adjusted P = 0.037). In women aged over 35 years, paternal overweight had a negative effect on CLBR compared with normal paternal BMI (adjusted P < 0.01). CONCLUSIONS Maternal age had an impact on optimal serum AMH concentrations and number of oocytes retrieved. Maternal overweight negatively affected CLBR in women under 35 years of age, and paternal overweight negatively affected CLBR in women over 35 years.
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Affiliation(s)
- Kai-Lun Hu
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology and Key Laboratory of Assisted Reproduction, Ministry of Education, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital Beijing, China; Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fen-Ting Liu
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology and Key Laboratory of Assisted Reproduction, Ministry of Education, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital Beijing, China
| | - Huiyu Xu
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology and Key Laboratory of Assisted Reproduction, Ministry of Education, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital Beijing, China; National Clinical Center for Obstetrics and Gynecology, Peking University Third Hospital Beijing, China
| | - Rong Li
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology and Key Laboratory of Assisted Reproduction, Ministry of Education, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital Beijing, China; National Clinical Center for Obstetrics and Gynecology, Peking University Third Hospital Beijing, China.
| | - Jie Qiao
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology and Key Laboratory of Assisted Reproduction, Ministry of Education, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital Beijing, China; National Clinical Center for Obstetrics and Gynecology, Peking University Third Hospital Beijing, China
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Hu KL, Zhang Y, Yang Z, Zhao H, Xu H, Yu Y, Li R. Predictive value of serum kisspeptin concentration at 14 and 21 days after frozen-thawed embryo transfer. Reprod Biomed Online 2019; 39:161-167. [PMID: 31230668 DOI: 10.1016/j.rbmo.2019.03.202] [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] [Received: 12/21/2018] [Revised: 02/18/2019] [Accepted: 03/08/2019] [Indexed: 01/31/2023]
Abstract
RESEARCH QUESTION Can serum kisspeptin levels 14 and 21 days after frozen-thawed embryo transfer predict the early pregnancy outcome of patients? DESIGN Prospective study, with 133 patients undergoing frozen-thawed embryo transfer. Patients were divided into non-pregnant group and pregnant group (including biochemical pregnancy, singleton pregnancy, miscarriage and twin groups). RESULTS Serum kisspeptin levels on day 21 were significantly higher than day 14 in singleton pregnancy, miscarriage and twin groups (all P < 0.0001), but not in the biochemical pregnancy group. Similarly, serum human chorionic gonadotrophin (HCG) levels were higher on day 21 compared with day 14 except for the biochemical pregnancy group. Compared with the twin group (296.9 pg/ml), the other four groups showed significantly higher serum kisspeptin levels on day 14 (non-pregnant 548.9, biochemical pregnancy 440.4, miscarriage 434.9, singleton pregnancy group 420.9 pg/ml, P < 0.01, P = 0.016, P = 0.034, P = 0.036, respectively). The miscarriage (762.2 pg/ml), singleton pregnancy (730.8 pg/ml) and twin groups (826.3 pg/ml) had significantly higher kisspeptin levels than the biochemical pregnancy group (397.3 pg/ml) on day 21 (P < 0.001, P < 0.01, P < 0.001, respectively). Serum kisspeptin levels on day 14 were negatively correlated with embryo implantation rate (P = 0.035, R2 = -0.880). Serum kisspeptin levels on day 21 have a poor predictive value of miscarriage compared with serum HCG levels (area under the curve = 0.53 and 0.78, respectively). CONCLUSIONS Serum kisspeptin levels on day 14 are negatively correlated with embryo implantation rate. Serum kisspeptin levels on day 21 have a poor predictive value of miscarriage.
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Affiliation(s)
- Kai-Lun Hu
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology and Key Laboratory of Assisted Reproduction, Ministry of Education, Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China
| | - Yongli Zhang
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology and Key Laboratory of Assisted Reproduction, Ministry of Education, Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
| | - Zi Yang
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology and Key Laboratory of Assisted Reproduction, Ministry of Education, Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
| | - Hongcui Zhao
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology and Key Laboratory of Assisted Reproduction, Ministry of Education, Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; National Clinical Centre for Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
| | - Huiyu Xu
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology and Key Laboratory of Assisted Reproduction, Ministry of Education, Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; National Clinical Centre for Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
| | - Yang Yu
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology and Key Laboratory of Assisted Reproduction, Ministry of Education, Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; National Clinical Centre for Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
| | - Rong Li
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology and Key Laboratory of Assisted Reproduction, Ministry of Education, Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; National Clinical Centre for Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.
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