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Patel D, Patel RG, Patel T, Patel N, Maheshwari N. Limited Effects of Ultra-low Oxygen Concentration during Extended Embryo Culture on In vitro Fertilisation Outcomes in Indian Women: A Retrospective Cross-sectional Study. J Hum Reprod Sci 2023; 16:324-332. [PMID: 38322644 PMCID: PMC10841928 DOI: 10.4103/jhrs.jhrs_143_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 02/08/2024] Open
Abstract
Background Amongst various other factors, oxygen (O2) concentration in embryo culture plays an important role in determining pregnancy outcomes in women undergoing in vitro fertilisation. Some studies have reported that lowering O2 levels in embryo culture provides better results. Aims To explore the effects of low- and ultra-low- O2 concentrations (5% and 2%, respectively) in extended embryo culture on various outcome parameters of pregnancy. Settings and Design This was a retrospective cross-sectional study. Materials and Methods In this study 382 participants had their embryos cultured in varying O2 concentrations (5% or 2%), followed by either a fresh embryo transfer (ET) or frozen embryo transfer (FET). Outcomes such as pregnancy rate, implantation rate, abortion rate, twinning rate, and live birth rate were compared between the groups. Statistical Analysis Used Chi square test was applied to compare the primary and secondary outcomes between different groups. Results No significant differences were observed in pregnancy rate and implantation rate between 5% and 2% O2 groups, irrespective of their mode of ET. The abortion rate was significantly higher in 5% O2 group than in 2% group during FET (24.71% vs. 11.49%, P = 0.02). While the proportion of good-quality embryos was higher in 5% O2 group, these did not translate to better pregnancy outcomes. Additionally, embryos cultured in 2% O2 concentration had a significantly better implantation rate when they were transferred fresh rather than frozen (71.34% vs. 61.46%, P = 0.04). There were no other differences observed. Conclusion Only marginal benefits were observed in switching human embryos to ultra-low O2 concentration after the initial days of culture.
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Affiliation(s)
- Deven Patel
- Department of IVF Laboratory, Sunflower Women’s Hospital, Ahmedabad, Gujarat, India
| | - R. G. Patel
- Department of Clinician, Sunflower Women’s Hospital, Ahmedabad, Gujarat, India
| | - Trupti Patel
- Department of IVF Laboratory, Sunflower Women’s Hospital, Ahmedabad, Gujarat, India
| | - Nikunj Patel
- Department of Clinical Team, Sunflower Women’s Hospital, Ahmedabad, Gujarat, India
| | - Naroda Maheshwari
- Department of Clinical Team, Sunflower Women’s Hospital, Ahmedabad, Gujarat, India
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Vaiarelli A, Zacà C, Spadoni V, Cimadomo D, Conforti A, Alviggi C, Palermo R, Bulletti C, De Santis L, Pisaturo V, Vigiliano V, Scaravelli G, Ubaldi FM, Borini A. Clinical and laboratory key performance indicators in IVF: A consensus between the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR) and the Italian Society of Embryology, Reproduction and Research (SIERR). J Assist Reprod Genet 2023:10.1007/s10815-023-02792-1. [PMID: 37093443 DOI: 10.1007/s10815-023-02792-1] [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: 12/19/2022] [Accepted: 03/30/2023] [Indexed: 04/25/2023] Open
Abstract
PURPOSE Infertility is increasing worldwide, and many couples seek IVF. Clinical management and laboratory work are fundamental in the IVF journey. Therefore, the definition of reliable key performance indicators (KPIs) based on clinical and laboratory parameters, is essential for internal quality control (IQC). Laboratory performance indicators have been identified and a first attempt to also determine clinical ones has been recently published. However, more detailed indicators are required. METHODS An Italian group of experts in Reproductive Medicine from both public and private clinics on behalf of SIFES-MR and SIERR was established to define IVF indicators to monitor clinical performance. RESULTS The working group built a consensus on a list of KPIs, performance indicators (PIs) and recommendation indicators (RIs). When deemed necessary, the reference population was stratified by woman age, response to ovarian stimulation and adoption of preimplantation genetic testing for aneuploidies (PGT-A). Each indicator was scored with a value from 1 to 5 and a weighted average formula - considering all the suggested parameters-was defined. This formula generates a center performance score, indicating low, average, good, or excellent performance. CONCLUSION This study is intended to provide KPIs, PIs and RIs that encompass several essential aspects of a modern IVF clinic, including quality control and constant monitoring of clinical and embryological features. These indicators could be used to assess the quality of each center with the aim of improving efficacy and efficiency in IVF.
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Affiliation(s)
- Alberto Vaiarelli
- GeneraLife IVF, Clinica Valle Giulia, Via G. De Notaris, 2B, Rome, Italy.
| | | | | | - Danilo Cimadomo
- GeneraLife IVF, Clinica Valle Giulia, Via G. De Notaris, 2B, Rome, Italy
| | - Alessandro Conforti
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Carlo Alviggi
- Department of Public Health, Federico II University, Naples, Italy
| | - Roberto Palermo
- Unità Di Procreazione Medicalmente Assistita, Centro A.M.B.R.A., Palermo, Italy
| | - Carlo Bulletti
- Department of Obstetrics, Gynecology and Reproductive Science, Yale University, New Haven, CT, USA
- Scientific Partner of Incintas Therapeutics, New Haven, CT, USA
| | - Lucia De Santis
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Valerio Pisaturo
- Fondazione IRCCS, Ca' Granda, Ospedale Maggiore, Policlinico Di Milano, Milan, Italy
| | - Vincenzo Vigiliano
- ART Italian National Register, National Center for Diseases Prevention and Health Promotion, National Health Institute, Rome, Italy
| | - Giulia Scaravelli
- ART Italian National Register, National Center for Diseases Prevention and Health Promotion, National Health Institute, Rome, Italy
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Kopp TI, Pinborg A, Glazer CH, Magyari M. Assisted reproductive technology treatment and risk of multiple sclerosis - a Danish cohort study. Fertil Steril 2023; 119:291-299. [PMID: 36572624 DOI: 10.1016/j.fertnstert.2022.10.027] [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: 05/04/2022] [Revised: 09/24/2022] [Accepted: 10/14/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To compare the incidence of multiple sclerosis (MS) among women who had undergone assisted reproductive technology (ART) treatment with the women who had conceived a child without previous ART treatment. DESIGN A register-based nationwide cohort study. PATIENT(S) Women with a first ovarian stimulation cycle before in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) (i.e., ART treatment) recorded in the Danish IVF register between 1996 and 2018; and women recorded in the Danish Medical Birth Register with the birth of their first child where date of conception is between 1996 and 2018. The cohort was observed until March 10, 2021. INTERVENTION(S) Mainly included IVF, ICSI, and fresh embryo transfer with hormone stimulation. MAIN OUTCOME MEASURES A diagnosis of MS recorded in the Danish Multiple Sclerosis Registry. Crude and adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) were calculated. RESULTS A total of 585,716 women were included in the cohort of which 63,791 (11%) were exposed to at least one initiated IVF or ICSI cycle during the study period. Cycles with oocyte donation were excluded. The median follow-up time for the entire cohort was 12.4 years (Q1-Q3= 6.6-18.1). Compared with women conceiving without previous ART, ART treated women were older (31.8 years vs. 27.5 years), more often had a university degree (45% vs. 36%), and more often had received other fertility treatments than IVF or ICSI before cohort entry (26% vs. 3%). We found no association between incident MS and exposure to ART compared with non-ART pregnancy (aHR=1.08; 95 % CI, 0.93-1.25). An analysis following intention-to-treat principle on a propensity score matched sub cohort confirmed our results. In subgroup analysis including all ART cycles among the ART treated women, we found no increased risk of MS within 2 years of ART cycle start for successful ART cycles (pregnancy) compared with failed ART cycles (no pregnancy) (aHR=1.01; 95% CI, 0.58-1.76). We found a non-significant trend toward increased risk of MS with increasing numbers of ART cycles although based on small numbers. CONCLUSION(S) Women treated with ART do not seem to be at increased risk of developing MS compared with the women not exposed to ART.
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Affiliation(s)
- Tine Iskov Kopp
- The Danish Multiple Sclerosis Registry, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Glostrup, Denmark.
| | - Anja Pinborg
- The Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Melinda Magyari
- The Danish Multiple Sclerosis Registry, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Glostrup, Denmark; Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Glostrup, Denmark
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Shuai J, Chen QL, Chen WH, Liu WW, Huang GN, Ye H. Early Spontaneous Abortion in Fresh- and Frozen-Embryo Transfers: An Analysis of Over 35,000 Transfer Cycles. Front Endocrinol (Lausanne) 2022; 13:875798. [PMID: 35832421 PMCID: PMC9271787 DOI: 10.3389/fendo.2022.875798] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/25/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aim of this study was to explore the risk factors for early spontaneous abortion (ESA) in fresh- and frozen-embryo transfers. METHODS This retrospective cohort study comprised a total of 35,076 patients, including 15,557 women in the fresh-embryo transfer group and 19,519 women in the frozen-embryo transfer group from January 2016 to December 2020. The primary outcome of this study was ESA, which we defined as the termination of embryonic development before 12 weeks of pregnancy (i.e., an early abortion after artificial multi-fetal pregnancy reduction was excluded). RESULTS In the 35,076 ART transfer cycles, the incidence of ESA was 5.77% (2023/35,076), and the incidence rates for ESA in fresh and frozen cycles were 4.93% (767 of 15,557) and 6.43% (1,256 of 19,519), respectively. Using a multivariate logistic regression analysis model, maternal age, body mass index (BMI), and number of embryos transferred were independent predictors for ESA. In addition, frozen-thawed transfer was a risk factor for ESA as compared with fresh transfer (OR = 1.207; 95% CI, 1.094-1.331; P = 0.000), blastocyst transfer was risk factor for ESA as compared with cleavage transfer (OR =1.373; 95% CI, 1.186-1.591; P = 0.000 in the total group; OR = 1.291; 95% CI, 1.111-1.499; P = 0.001 in the frozen-transfer group), and unexplained infertility was a protective factor for ESA only in the frozen group (OR = 0.746; 95% CI, 0.565-0.984; P = 0.038). CONCLUSIONS Maternal age, BMI, number of embryos transferred, and frozen-thawed transfer were independent risk factors for ESA in assisted reproductive technology treatment cycles.
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Dwitama MA, Masni, Nur R, Indarty A, Tahir A M, Mallongi A, Basir M, Mahfudz, Ansyari A. Mapping of high-risk detection of women pregnancy on antenatal care in Talise Health Center, Palu City, Indonesia. GACETA SANITARIA 2021; 35 Suppl 2:S152-S158. [PMID: 34929800 DOI: 10.1016/j.gaceta.2021.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/30/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to map pregnant women with high-risk pregnancies based on age, parity, pregnancy history, childbirth history, illness history, and CED status history as well as the relationship between the six factors. METHOD This study utilized a survey method with descriptive data without the intervention of variables but observed phenomena or sought the relationship between phenomena and other variables. The survey was conducted with an approach using Geographic Information Systems (GIS). There were 243 respondents obtained using the Lemeshow formula, while the data were analyzed using spatial techniques and Chi-Square test with p>0.05. RESULTS The results of spatial analysis using a 1: 50,000 scale map showed that; (1) high-risk and very high-risk pregnancies dominated Talise, (2) based on age, parity, pregnancy history, childbirth history, illness history, and CED status, cases of high-risk pregnancies were all detected in Talise, (3) age (p=0.000). Furthermore, pregnancy history (p=0.004) correlated with a high-risk pregnancy. Besides, parity, childbirth history, illness history, and CED status did not correlate with high-risk pregnancy since the p-value>0.05; (4) age and pregnancy history influenced the high-risk pregnancy.
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Affiliation(s)
| | - Masni
- Faculty of Public Health, Universitas Hasanuddin, Makassar, Indonesia
| | - Rosmala Nur
- Public Health Department, Faculty of Public Health, Universitas Tadulako, Indonesia
| | - Apik Indarty
- Reproduction Health Department, Faculty of Public Health, Universitas Hasanuddin, Indonesia
| | - Muh Tahir A
- Reproduction Health Department, Faculty of Public Health, Universitas Hasanuddin, Indonesia
| | - Anwar Mallongi
- Environmental Health Department, Faculty of Public Health, Universitas Hasanuddin, Indonesia
| | - Muhammad Basir
- Agrotechnology Department, Faculty of Agriculture, Universitas Tadulako, Indonesia
| | - Mahfudz
- Agrotechnology Department, Faculty of Agriculture, Universitas Tadulako, Indonesia
| | - Alam Ansyari
- Agrotechnology Department, Faculty of Agriculture, Universitas Tadulako, Indonesia
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Xiao Z, Donjacour A, Harner R, Simbulan R, Kao CN, Ruggeri E, Liu X, Maltepe E, Rinaudo P. Effect of culture conditions and method of conception on mouse live birth rate. F&S SCIENCE 2020; 1:132-141. [PMID: 35559924 DOI: 10.1016/j.xfss.2020.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To understand in a mouse model whether there are differences in the decidua and live birth rate after transfer of blastocysts generated by in vitro fertilization (IVF) or by superovulation with spontaneous mating into unstimulated recipients. DESIGN Animal experiment. SETTING University-affiliated tertiary hospital. ANIMAL(S) Mice. INTERVENTION(S) IVF embryos were generated and cultured in either Whitten medium (WM, suboptimal conditions) and 20% O2 or KSOM medium with amino acids (KAA, optimal conditions) and 5% O2. The control blastocysts from superovulated mice were flushed out of the uterus 3.5 days (E3.5) after mating (FB group). The resulting blastocysts were transferred to nonsuperovulated CF1 recipients mated to vasectomized males. To understand whether anomalies of decidua were present, the expression of genes involved in decidual development and inflammation was analyzed at E7.5 and E18.5. Similarly, immunostaining was used to evaluate whether the pathways involved in activation of mTORC1 (p-S6) and Cox2 signaling (Cox 2 staining) were altered. MAIN OUTCOME MEASURE(S) Live birth rate, gene expression, and immunostaining of decidua. RESULT(S) Implantation rates at E7.5 were similar, but in vivo embryos (FB groups) were predicted to result in live births 3.3 times higher (2.2-5.1) and 6.6 times higher (4.7-9.3) compared with optimal and suboptimal cultures, respectively. Expression of genes involved in decidual development and inflammation or localization and intensity of staining for p-S6 (mTOR pathway), or inflammation (Cox 2 pathway) were not different among the groups. CONCLUSION(S) The predicted live birth rate was decreased in mouse embryos generated by IVF compared with embryos generated by mating, whereas the implantation rate was not different. Suboptimal culture conditions resulted in lower birth rate. We did not find evidence of abnormalities in decidualization that could explain these findings. These data indicate that blastocysts cultured in stressful conditions are less competent, suggesting that decreasing the number of embryonic manipulations may result in higher live birth rates.
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Affiliation(s)
- Zhuoni Xiao
- Center for Reproductive Medicine, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
| | - Annemarie Donjacour
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
| | - Royce Harner
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
| | - Rhodel Simbulan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
| | - Chia-Ning Kao
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
| | - Elena Ruggeri
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California; San Diego Zoo Global, Escondido, California
| | - Xiaowei Liu
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
| | - Emin Maltepe
- Department of Pediatrics, University of California, San Francisco, California
| | - Paolo Rinaudo
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California.
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Idelson A, Meiri H, Wertheimer A, Sammar M, Tenenbaum-Gavish K, Shufaro Y, Ben-Haroush A. New predictors of early impaired placentation preceding miscarriage before 10 weeks of gestation in IVF pregnancies: A prospective study. Placenta 2020; 100:30-34. [PMID: 32814235 DOI: 10.1016/j.placenta.2020.07.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/26/2020] [Accepted: 07/30/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION In a recent study of 10,011 pregnant women, 95% of miscarriages occurred before routine ultrasound scan at 11-14 weeks. Our study aimed to identify early first trimester parameters which may predict miscarriage before 10 weeks of gestation for in vitro fertilization (IVF) pregnancies. METHODS A cohort of 115 healthy IVF patients with a singleton viable embryo in early first trimester were studied in a tertiary university-affiliated medical center (April 2017-June 2018). Calculations included gestational age (GA); ultrasound evaluation of crown-rump length (CRL), mean gestational sac diameter (GSD) and volume (GSV), mean yolk sac diameter (YSD) and volume (YSV); fetal heart rate (FHR), mean uterine arteries pulsatility index (UtA-PI); and maternal blood placental protein 13 (PP13) levels. Patients were divided into three groups by GA; and early miscarriage versus ongoing pregnancy after GA 10 weeks. RESULTS Early fetal loss occurred in 14.8% of patients; miscarriage group had higher discrepancy between calculated and measured GA (P < 0.001), lower GSD and GSV (P = 0.005 and P = 0.02, respectively), significantly different YSD and YSV, and lower GSD/YSD and GSV/YSV ratios (P = 0.001 and P = 0.003, respectively). UtA-PI/CRL ratio was higher in patients with miscarriage at GA 46-48 days and GA >48 days (P = 0.034 and P = 0.026, respectively). PP13/CRL ratio was higher in patients with miscarriage at GA >48 days (P = 0.041). DISCUSSION In IVF pregnancies with live embryo at first ultrasound scan, high UtA-PI/CRL and maternal blood PP13/CRL ratios may indicate impaired placentation preceded early pregnancy loss. A larger cohort is needed to further verify these predictions.
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Affiliation(s)
- Ana Idelson
- Obstetrics and Gynecology Ultrasound Unit, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva, 4941492, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel.
| | | | - Avital Wertheimer
- IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva, 4941492, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel.
| | - Marei Sammar
- Ephraim Katzir Department of Biotechnology, ORT Braude College, Karmiel, 21982, Israel.
| | - Kineret Tenenbaum-Gavish
- Obstetrics and Gynecology Ultrasound Unit, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva, 4941492, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel.
| | - Yoel Shufaro
- IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva, 4941492, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel.
| | - Avi Ben-Haroush
- IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva, 4941492, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel.
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