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Liu L, Liang H, Yang J, Shen F, Chen J, Ao L. Clinical data-based modeling of IVF live birth outcome and its application. Reprod Biol Endocrinol 2024; 22:76. [PMID: 38978032 PMCID: PMC11229224 DOI: 10.1186/s12958-024-01253-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 06/27/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND The low live birth rate and difficult decision-making of the in vitro fertilization (IVF) treatment regimen bring great trouble to patients and clinicians. Based on the retrospective clinical data of patients undergoing the IVF cycle, this study aims to establish classification models for predicting live birth outcome (LBO) with machine learning methods. METHODS The historical data of a total of 1405 patients undergoing IVF cycle were first collected and then analyzed by univariate and multivariate analysis. The statistically significant factors were identified and taken as input to build the artificial neural network (ANN) model and supporting vector machine (SVM) model for predicting the LBO. By comparing the model performance, the one with better results was selected as the final prediction model and applied in real clinical applications. RESULTS Univariate and multivariate analysis shows that 7 factors were closely related to the LBO (with P < 0.05): Age, ovarian sensitivity index (OSI), controlled ovarian stimulation (COS) treatment regimen, Gn starting dose, endometrial thickness on human chorionic gonadotrophin (HCG) day, Progesterone (P) value on HCG day, and embryo transfer strategy. By taking the 7 factors as input, the ANN-based and SVM-based LBO models were established, yielding good prediction performance. Compared with the ANN model, the SVM model performs much better and was selected as the final model for the LBO prediction. In real clinical applications, the proposed ANN-based LBO model can predict the LBO with good performance and recommend the embryo transfer strategy of potential good LBO. CONCLUSIONS The proposed model involving all essential IVF treatment factors can accurately predict LBO. It can provide objective and scientific assistance to clinicians for customizing the IVF treatment strategy like the embryo transfer strategy.
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Affiliation(s)
- Liu Liu
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hua Liang
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jing Yang
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Fujin Shen
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China.
| | - Jiao Chen
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Liangfei Ao
- Wuhan Jinxin Gynecology and Obstetrics Hospital of Integrative Medicine, Wuhan, Hubei, China.
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Zhang H, Yang S, Chen L, Ma C, Liu P, Qiao J, Li R. The late-follicular-phase progesterone to retrieved oocytes ratio in normal ovarian responders treated with an antagonist protocol can be used as an index for selecting an embryo transfer strategy and predicting the success rate: a retrospective large-scale study. Front Endocrinol (Lausanne) 2024; 15:1338683. [PMID: 38812812 PMCID: PMC11133602 DOI: 10.3389/fendo.2024.1338683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/29/2024] [Indexed: 05/31/2024] Open
Abstract
Objective To determine whether the late-follicular-phase progesterone to retrieved oocytes (P/O) ratio during in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) impacts pregnancy outcomes. Design 12,874 cycles were retrospectively categorized into four groups according to the P/O ratio percentile, with divisions at the 25th, 50th and 75th percentiles. Results The clinical pregnancy and live birth rates of fresh cycle embryos in Group D were significantly lower than those in the other three groups (45.1% and 39.0%, 43.2% and 37.2%, 39.6% and 33.5%, 33.4% and 28.2% in Group A, B, C, D, respectively; both P < 0.008). Multivariate logistic regression analysis revealed a significant negative correlation between the P/O ratio and live birth, particularly when the P/O ratio was ≥0.22 (OR = 0.862, 95% CI [0.774-0.959], P = 0.006). Conclusions The P/O ratio has certain predictive value for IVF/ICSI pregnancy outcomes and can be used for decision-making decision regarding fresh embryo transfer.
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Affiliation(s)
| | - Shuo Yang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | | | | | | | | | - Rong Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
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Somigliana E, Piani LL, Paffoni A, Salmeri N, Orsi M, Benaglia L, Vercellini P, Vigano' P. Endometriosis and IVF treatment outcomes: unpacking the process. Reprod Biol Endocrinol 2023; 21:107. [PMID: 37936154 PMCID: PMC10629090 DOI: 10.1186/s12958-023-01157-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/26/2023] [Indexed: 11/09/2023] Open
Abstract
Advanced endometriosis is associated with a reduction of IVF success. Surgical damage to the ovarian reserve following the excision of endometriomas has been claimed as a critical factor in the explanation of this detrimental effect. However, it is generally inferred that other mechanisms might also hamper IVF success in affected women. They include diminished responsiveness to ovarian stimulation, altered steroidogenesis, a decline in oocyte quality, reduced fertilization and embryo development, and impaired implantation. To navigate these limitations, we scrutinized available literature for studies specifically designed to address distinct phases of the IVF process. Utmost consideration was given to intra-patient ovarian response comparisons in women with unilateral endometriomas and to studies applying a meticulous matching to control confounders. The following observations have been drawn: 1) endometriosis has a negligible impact on ovarian response. A slight reduction in stimulation response can only be observed for endometriomas larger than 4 cm. Follicular steroidogenesis is unaffected; 2) oocyte quality is not hampered. Fertilization rates are similar, and intracytoplasmic sperm injection (ICSI) is not justified. Embryonic development is uncompromised, with no increase in aneuploidy rate; 3) endometrial receptivity is either unaffected or only slightly impacted. In conclusion, our study suggests that, aside from the well-known negative effect on ovarian reserve from excisional endometrioma surgeries, endometriosis does not significantly affect IVF outcomes.
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Affiliation(s)
- Edgardo Somigliana
- Academic Center for Research on Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Dipartimento Area Materno Infantile, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Letizia Li Piani
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | | | - Noemi Salmeri
- Gynecology and Obstetrics Unit, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
| | - Michele Orsi
- Dipartimento Area Materno Infantile, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Benaglia
- Dipartimento Area Materno Infantile, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Vercellini
- Academic Center for Research on Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Dipartimento Area Materno Infantile, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Vigano'
- Dipartimento Area Materno Infantile, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Zhai J, Zhang J, He J, Lv M, Zhang B, Li G, Du Y, Hao G. Live Birth Outcomes for PCOS Patients Under the Follicular-Phase Long-Acting GnRH Agonist Protocol or Antagonist Protocol - A Retrospective Chinese Cohort. J Multidiscip Healthc 2023; 16:2781-2792. [PMID: 37753342 PMCID: PMC10518358 DOI: 10.2147/jmdh.s432936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Abstract
Objective For patients with polycystic ovary syndrome (PCOS) to undergo in vitro fertilization (IVF) and embryo transfer (ET), there has been no consensus regarding which protocol is the most optimal for live birth rate in fresh cycles. We sought to evaluate depot gonadotropin-releasing hormone (GnRH) agonist protocol versus GnRH antagonist protocol in IVF outcomes for PCOS patients in a single fertility center. Methods In this retrospective cohort, PCOS patients who visited the Second Hospital of Hebei Medical University reproductive center between February 2012 and December 2019 were screened, and 533 PCOS infertility patients were included undergoing their first IVF cycle, with 470 in the depot GnRH agonist group and 63 in the GnRH antagonist group. The primary of this study outcome was the fresh live birth rate (LBR). Results PCOS women in the depot GnRH agonist group had a higher LBR (49.79%) than those in the GnRH antagonist group (34.92%, p = 0.027). The multivariable logistic regression also confirmed that women in the depot GnRH agonist group had a higher LBR than those in the GnRH antagonist group (OR = 1.83, 95% CI 1.05~3.18, p = 0.032). After propensity score matching (PSM), the LBR in the depot GnRH agonist group was higher (50.32%) than that of the GnRH antagonist group (35.48%), p = 0.033. The ovarian hyperstimulation syndrome (OHSS) rates were similar between the two groups, with 35 in the depot GnRH group and 6 in the GnRH antagonist group (p = 0.561). Conclusions For PCOS patients in fresh embryo transfer cycles, the depot GnRH agonist protocol may lead to a higher LBR than the antagonist protocol with satisfied lower OHSS rates.
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Affiliation(s)
- Jiajia Zhai
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Junyan Zhang
- Shanxi Bethune Hospital, Shanxi Academy Of Medical Sciences, Department of Clinical Epidemiology and Evidence-Based Medicine, Taiyuan, People’s Republic of China
- Bothwin Clinical Study Consultant, Shanghai, People’s Republic of China
| | - Jingfang He
- Bothwin Clinical Study Consultant, Shanghai, People’s Republic of China
| | - Minzhi Lv
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
- Center of Evidence-Based Medicine, Fudan University, Shanghai, People’s Republic of China
| | - Bozheng Zhang
- Department of Psychology, College of Arts and Sciences, University of Washington, Seattle, WA, 98053, USA
| | - Guanqun Li
- Technoderma Medicines Inc, Shanghai, People’s Republic of China
| | - Yuanjie Du
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Guimin Hao
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
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Pang C, Wang K, Wang R, Guo D, Wen Z. LH level on the antagonist administration day as a predictor of the reproductive outcomes in women with normal ovarian function. Front Endocrinol (Lausanne) 2023; 14:1232361. [PMID: 37795370 PMCID: PMC10546410 DOI: 10.3389/fendo.2023.1232361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/30/2023] [Indexed: 10/06/2023] Open
Abstract
Introduction The addition of antagonists is mainly based on estrogen level and follicle size, while LH level has not received sufficient attention.In this study, LH Level on the antagonist administration day was used as the main research objective to explore its relationship with laboratory indicators and pregnancy outcomes. Methods and Analysis We enrolled 854 patients with normal ovarian function undergoing in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) between May 2021 to May 2022 at the Reproductive Center of Shandong University of Traditional Chinese Medicine.We used the quartile method to group LH levels on the antagonist administration day. There were four groups: Q1 (0.53IU/L≤LH ≤ 1.89IU/L); Q2 (1.89IU/L Result There were significant differences among the four groups in terms of total Gn dosage, E2, P and LH on trigger day, number of retrieved oocytes, number of 2PN embryos, number of blastocysts, Number of ET and fresh ETR.There is a significant correlation between LH on antagonist administration day and Basal LH Level,LH on trigger day,number of oocytes retrieved,number of 2PN embryos,number of blastocysts, number of ET.Using Fresh ETR,Fresh CPR,OHSS and Cumulative CPR as the criterion respectively, the optimal cut-off value for evaluating LH on antagonist administration day was 4.18IU/L,3.99IU/L,4.63IU/L,4.66IU/L. Conclusion There was a significant positive correlation between LH on the antagonist administration day and number of oocytes retrieved,number of 2PN embryos,number of blastocysts.LH on the antagonist administration day could predict Fresh CPR,OHSS and Cumulative CPR to some extent.
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Affiliation(s)
- Conghui Pang
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Department of Reproduction and Genetics, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Kehua Wang
- Department of Reproduction and Genetics, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Ruihan Wang
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Danyang Guo
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Zixi Wen
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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Yang T, Zhao J, Liu F, Li Y. Lipid metabolism and endometrial receptivity. Hum Reprod Update 2022; 28:858-889. [PMID: 35639910 DOI: 10.1093/humupd/dmac026] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Obesity has now been recognized as a high-risk factor for reproductive health. Although remarkable advancements have been made in ART, a considerable number of infertile obese women still suffer from serial implantation failure, despite the high quality of embryos transferred. Although obesity has long been known to exert various deleterious effects on female fertility, the underlying mechanisms, especially the roles of lipid metabolism in endometrial receptivity, remain largely elusive. OBJECTIVE AND RATIONALE This review summarizes current evidence on the impacts of several major lipids and lipid-derived mediators on the embryonic implantation process. Emerging methods for evaluating endometrial receptivity, for example transcriptomic and lipidomic analysis, are also discussed. SEARCH METHODS The PubMed and Embase databases were searched using the following keywords: (lipid or fatty acid or prostaglandin or phospholipid or sphingolipid or endocannabinoid or lysophosphatidic acid or cholesterol or progesterone or estrogen or transcriptomic or lipidomic or obesity or dyslipidemia or polycystic ovary syndrome) AND (endometrial receptivity or uterine receptivity or embryo implantation or assisted reproductive technology or in vitro fertilization or embryo transfer). A comprehensive literature search was performed on the roles of lipid-related metabolic pathways in embryo implantation published between January 1970 and March 2022. Only studies with original data and reviews published in English were included in this review. Additional information was obtained from references cited in the articles resulting from the literature search. OUTCOMES Recent studies have shown that a fatty acids-related pro-inflammatory response in the embryo-endometrium boundary facilitates pregnancy via mediation of prostaglandin signaling. Phospholipid-derived mediators, for example endocannabinoids, lysophosphatidic acid and sphingosine-1-phosphate, are associated with endometrial receptivity, embryo spacing and decidualization based on evidence from both animal and human studies. Progesterone and estrogen are two cholesterol-derived steroid hormones that synergistically mediate the structural and functional alterations in the uterus ready for blastocyst implantation. Variations in serum cholesterol profiles throughout the menstrual cycle imply a demand for steroidogenesis at the time of window of implantation (WOI). Since 2002, endometrial transcriptomic analysis has been serving as a diagnostic tool for WOI dating. Numerous genes that govern lipid homeostasis have been identified and, based on specific alterations of lipidomic signatures differentially expressed in WOI, lipidomic analysis of endometrial fluid provides a possibility for non-invasive diagnosis of lipids alterations during the WOI. WIDER IMPLICATIONS Given that lipid metabolic dysregulation potentially plays a role in infertility, a better understanding of lipid metabolism could have significant clinical implications for the diagnosis and treatment of female reproductive disorders.
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Affiliation(s)
- Tianli Yang
- Reproductive Medicine Center, Xiangya Hospital of Central South University, Changsha, P.R. China.,Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha, P.R. China
| | - Jing Zhao
- Reproductive Medicine Center, Xiangya Hospital of Central South University, Changsha, P.R. China.,Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha, P.R. China
| | - Feng Liu
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, and Key Laboratory of Diabetes Immunology, Ministry of Education, The Second Xiangya Hospital of Central South University, Changsha, P.R. China
| | - Yanping Li
- Reproductive Medicine Center, Xiangya Hospital of Central South University, Changsha, P.R. China.,Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha, P.R. China
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Fernandez RGO, Barbosa CP, Christofolini DM, de Alcantara Sousa LV, de Oliveira R, Bianco B. Impact of blood levels of progesterone on the day of ovulation onset on clinical, laboratory and reproductive parameters of young patients undergoing assisted reproduction: a cross-sectional study. EINSTEIN-SAO PAULO 2022; 20:eAO6896. [PMID: 35649054 PMCID: PMC9126603 DOI: 10.31744/einstein_journal/2022ao6896] [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: 07/22/2021] [Accepted: 09/22/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: To assess whether there is an association between the level of progesterone on the day of administration of human chorionic gonadotropin and clinical and laboratory characteristics, in addition to the results of in vitro fertilization of patients with a good prognosis. Methods: A cross-sectional study comprising 103 women who underwent intracytoplasmic sperm injection treatment, between November 2009 and May 2015, aged ≤35 years, with no comorbidities, with fresh embryo transfer. Data were collected from patient medical records. Results: There was a weak positive correlation between the level of progesterone on the day of human chorionic gonadotropin and the number of follicles larger than 14mm (ß=0.02, p=0.001), retrieved oocytes (ß=0.01, p=0.01) and oocytes in metaphase II (MII) (ß=0.02, p=0.02); that is, the increase in progesterone level has a slight association with increased values of these variables. Body mass index was inversely correlated with progesterone level on the day of human chorionic gonadotropin (ß=-0.01, p=0.02). No association was found between the level of progesterone on the day of human chorionic gonadotropin and the protocols used for controlled ovarian stimulation, quality of transferred embryos and the pregnancy rate. Conclusion: There is an association between the value of progesterone on the day of human chorionic gonadotropin administration with body mass index, number of follicles larger than 14mm, number of retrieved oocytes and oocytes in metaphase II. Unlike embryo quality and pregnancy rate, which do not have a statistically significant relation with this value in the population studied.
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Feng L, Fan R, Jiang A, Jiang J, Wang Q, Sun Y, Qiao P, Ren C, Yang T. The effect of flexible low-dose GnRH antagonist on pregnancy outcome in the fresh embryo transfer cycle of IVF-ET: a randomized controlled trial. Reprod Biol Endocrinol 2022; 20:55. [PMID: 35317821 PMCID: PMC8939190 DOI: 10.1186/s12958-022-00927-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 03/09/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To explore the practicality and effectiveness of a flexible low-dose protocol in the fresh embryo transfer cycle: reducing the total amount of antagonist by increasing the interval between administrations of Cetrotide. METHODS A total of 211 patients with normal ovarian reserve who accepted GnRH-ant protocol for IVF-ET were selected, and they were randomized to the flexible low-dose antagonist group (test group, n = 101) or the conventional dose antagonist group (control group, n = 110). The initial dose of Cetrotide in the test group was 0.25 mg every other day, and then the dose was adjusted to 0.25 mg every day based on the subsequent luteinizing hormone (LH) levels. The dosage of Cetrotide in the control group was 0.25 mg per day. The primary outcome was the clinical pregnancy rate. Secondary outcomes included the incidence of premature LH rise, total dosage of Cetrotide, number of oocytes retrieved, number of fertilized oocytes, number of high-quality embryos, biochemical pregnancy rate and ongoing pregnancy rate. RESULTS There was no significant difference in the general condition of the two groups. There was no significant difference in the clinical pregnancy rate (51.49% vs. 48.18%, p = 0.632) or the incidence of premature LH rise (18.81% vs. 15.45%, p = 0.584) between the two groups. However, the amount of Cetrotide used in the test group was significantly lower than that in the conventional dose antagonist group (1.13 ± 0.41 vs. 1.61 ± 0.59 mg, p < 0.001). CONCLUSION The flexible low-dose antagonist protocol and the conventional dose antagonist protocol were equally effective in people with a normal ovarian reserve in the fresh embryo transfer cycle of IVF-ET.
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Affiliation(s)
- Liping Feng
- grid.268079.20000 0004 1790 6079Department of Reproductive Medicine, Affiliated Hospital of Weifang Medical University, Shandong Province, People’s Republic of China
| | - Ruiqi Fan
- grid.268079.20000 0004 1790 6079Department of Reproductive Medicine, Affiliated Hospital of Weifang Medical University, Shandong Province, People’s Republic of China
| | - Aifang Jiang
- grid.268079.20000 0004 1790 6079Department of Reproductive Medicine, Affiliated Hospital of Weifang Medical University, Shandong Province, People’s Republic of China
| | - Junyi Jiang
- grid.268079.20000 0004 1790 6079Department of Reproductive Medicine, Affiliated Hospital of Weifang Medical University, Shandong Province, People’s Republic of China
| | - Qian Wang
- grid.268079.20000 0004 1790 6079Department of Reproductive Medicine, Affiliated Hospital of Weifang Medical University, Shandong Province, People’s Republic of China
| | - Yujun Sun
- grid.268079.20000 0004 1790 6079Department of Reproductive Medicine, Affiliated Hospital of Weifang Medical University, Shandong Province, People’s Republic of China
| | - Pengyun Qiao
- grid.268079.20000 0004 1790 6079Department of Reproductive Medicine, Affiliated Hospital of Weifang Medical University, Shandong Province, People’s Republic of China
| | - Chune Ren
- grid.268079.20000 0004 1790 6079Department of Reproductive Medicine, Affiliated Hospital of Weifang Medical University, Shandong Province, People’s Republic of China
| | - Tingting Yang
- grid.268079.20000 0004 1790 6079Department of Reproductive Medicine, Affiliated Hospital of Weifang Medical University, Shandong Province, People’s Republic of China
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Kim YJ. Glucocorticoid therapy in assisted reproduction. Clin Exp Reprod Med 2021; 48:295-302. [PMID: 34875736 PMCID: PMC8651763 DOI: 10.5653/cerm.2021.04819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/02/2021] [Indexed: 12/02/2022] Open
Abstract
As glucocorticoids are well-known as important regulators of stress and the immune system, their function and clinical use have elicited substantial interest in the field of reproduction. In particular, the effect of glucocorticoid therapy on endometrial receptivity during assisted reproduction, including in vitro fertilization (IVF) cycles, has led to a great deal of interest and controversy. However, previous studies have not been able to provide consistent and reliable evidence due to their small, non-controlled designs and use of different criteria. Considering the potential risk of exposure to glucocorticoids for mothers and fetuses in early pregnancy, the use of glucocorticoids in IVF cycles should be carefully evaluated, including the balance between risk and benefit. To date, there is no conclusive evidence that the use of glucocorticoids improves the pregnancy rate in IVF cycles with unselected subjects, and a further investigation should be considered with a proper study design.
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Affiliation(s)
- Yong Jin Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
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10
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Boynukalin FK, Yarkiner Z, Gultomruk M, Turgut NE, Ecemis S, Findikli N, Bahceci M. Elevation of progesterone on the trigger day exerts no carryover effect on live birth in freeze-all cycles. Gynecol Endocrinol 2021; 37:367-371. [PMID: 32611219 DOI: 10.1080/09513590.2020.1786510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
AIM To evaluate the effect of trigger day progesterone (P) levels on live birth in freeze-all cycles. MATERIAL AND METHODS Retrospective analysis of 1034 freeze-all female patients aged <38 years with single blastocyst transfers. Patients with (n = 268) or without (n = 766) preimplantation genetic test for aneuploidy (PGT-A) arm were further categorized into three subgroups based on trigger day P levels; low (<0.80 ng/ml), medium (0.8-1.49 ng/ml), and high (≥1.50 ng/ml). RESULTS Estradiol (E2) levels on trigger day, the number of oocytes retrieved and the number of mature oocytes increased significantly with increasing serum p values in cycles without and with PGT-A arms. Significant correlation was found between E2 levels on trigger day and serum P levels and between the number of total oocytes retrieved and serum P levels Live birth rates were similar in the three subgroups in without PGT-A arm (51%, 52.6%, and 51.5%, respectively; p = .922) and with PGT-A arm (55.1%, 55.1%, and 62.5%, respectively; p = .730). Multivariate regression analysis revealed that trigger day P levels were not significant for live birth. CONCLUSION The proposal that trigger day progesterone elevation (PE) exerts a detrimental effect on oocyte and embryo competence has no clinical validity.
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Affiliation(s)
| | - Zalihe Yarkiner
- Department of Statistics, Cyprus Science University, Ozankoy, Cyprus
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11
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Assisted reproductive technology for women with endometriosis, a clinically oriented review. Curr Opin Obstet Gynecol 2021; 33:225-231. [PMID: 33769421 DOI: 10.1097/gco.0000000000000710] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW To discuss optimal management of an assisted reproductive technology (ART) cycle in women with endometriosis. RECENT FINDINGS New studies involving euploid embryo transfers provide more insight on the etiology of endometriosis-associated infertility. Oocyte competence to reach live birth seems unlikely to be affected by the disease. Routine medical or surgical treatment prior to an ART cycle does not appear beneficial. Short gonadotropin releasing hormone (GnRH) antagonist or progestin primed ovarian stimulation protocols seem to be proper first choices, depending on the intention for a fresh embryo transfer. Low-quality evidence supports frozen thawed over fresh embryo transfer. Ovarian stimulation for ART does not seem to be associated with symptom progression or recurrence. SUMMARY How endometriosis affects fertility is still unclear, but ART is an effective pragmatic treatment. Each woman with endometriosis must be assessed with a holistic approach, and in the absence of an indication for otherwise, ART cycles can be kept simple with patient-friendly protocols. Whether a frozen embryo transfer is better than a fresh one should be investigated.
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12
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Luti S, Fiaschi T, Magherini F, Modesti PA, Piomboni P, Semplici B, Morgante G, Amoresano A, Illiano A, Pinto G, Modesti A, Gamberi T. Follicular microenvironment: Oxidative stress and adiponectin correlated with steroids hormones in women undergoing in vitro fertilization. Mol Reprod Dev 2020; 88:175-184. [PMID: 33336494 DOI: 10.1002/mrd.23447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 05/27/2020] [Accepted: 12/06/2020] [Indexed: 01/31/2023]
Abstract
Research has been focused on determining the follicular microenviroment produced by the theca and granulosa cells since the molecular characterisation of this body fluid could lead to the understanding of several fertility problems. Oxidative stress may be one of the factors involved in female infertility since it plays a key role in the modulation of oocyte maturation and finally pregnancy. An increase in oxidative stress is correlated with inflammation and intense research was developed to understand the interaction between inflammation and adiponectin, based on the fact that many adipokines are inflammation related proteins linked to reactive oxygen species production. The aim of this study is to investigate the correlation between total adiponectin levels and oxidative stress amount in the serum and follicular fluid (FF) of women who undergone in vitro fertilization. Moreover we verified the expression of adiponectin in granulosa and cumulus cells. To clarify the predictive value of steroid hormones in human assisted reproduction, twelve steroid hormones in FF and serum, were quantified in a single run liquid chromatography/mass spectrometry, by using a multiple reaction monitoring mode and we related the serum and follicular fluids adiponectin levels with the concentration of the investigated steroid hormones.
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Affiliation(s)
- Simone Luti
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Tania Fiaschi
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Francesca Magherini
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Pietro A Modesti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Paola Piomboni
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Bianca Semplici
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Giuseppe Morgante
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Angela Amoresano
- Department of Chemical Sciences, University of Naples Federico II, Naples, Italy
| | - Anna Illiano
- Department of Chemical Sciences, University of Naples Federico II, Naples, Italy
| | - Gabriella Pinto
- Department of Chemical Sciences, University of Naples Federico II, Naples, Italy
| | - Alessandra Modesti
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Tania Gamberi
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
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Salmasi S, Sharifi M, Rashidi B. Evaluating the effect of ovarian stimulation and exogenous progesterone on CD31-positive cell density, VEGF protein, and miR-17-5p expression of endometrium immediately before implantation. Biomed Pharmacother 2020; 133:110922. [PMID: 33232927 DOI: 10.1016/j.biopha.2020.110922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/18/2020] [Accepted: 10/20/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND MicroRNAs (miRNAs) form a special class of RNAs regulating endometrial functions like cell proliferation, differentiation, angiogenesis, and blastocyst implantation. In addition to providing suitable conditions for embryo development, angiogenesis is a prerequisite to natural pregnancy. The family of vascular endothelial growth factor (VEGF) and its receptors are the main physiological and pathological angiogenesis regulators in the endometrium. In the past, research has demonstrated alteration of angiogenesis and subsequent endometrial receptivity in the stimulated and luteal phase support cycles, when compared with natural cycles. OBJECTIVE The objective of this study is to investigate the effect of ovarian stimulation and exogenous progesterone on the density of CD31-positive cell (Endothelial cell), VEGF protein, and miR-17-5p expression in the mouse endometrium immediately before implantation. METHODS We employed ovarian stimulated and luteal phase support mice models induced by HMG/HCG and progesterone. The endometrial CD31-positive cell density was determined by immunohistochemistry (IHC) staining, the level of VEGF protein by IHC and western blot analysis, and finally the miR-17-5p expression was determined by the real-time PCR method. RESULTS The density of endothelial cell, VEGF protein, and miR-17-5p expression increased in all of the experimental mice when compared to the control group, with the maximum increase having been seen in the group that had received progesterone after ovarian stimulation. CONCLUSION This research indicates that ovarian stimulation and exogenous progesterone lead to an increase in the number of endothelial cells by upregulating the VEGF protein. Moreover, except for miR-17-5p, other microRNAs and molecules are presumably involved in angiogenic pathways, thereby requiring more studies.
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Affiliation(s)
- Soheila Salmasi
- Department of Anatomical Sciences, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mohammadreza Sharifi
- Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Bahman Rashidi
- Department of Anatomical Sciences, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
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Ovarian stimulation and exogenous progesterone affect the endometrial miR-16-5p, VEGF protein expression, and angiogenesis. Microvasc Res 2020; 133:104074. [PMID: 32949576 DOI: 10.1016/j.mvr.2020.104074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/01/2020] [Accepted: 09/04/2020] [Indexed: 12/20/2022]
Abstract
Angiogenesis, where vascular endothelial growth factor (VEGF) is critically involved, is an important factor in endometrial receptivity. Angio-miRNAs form a special class of microRNAs (miRNAs) that target angiogenic genes and regulate angiogenesis. Various studies have shown that ovarian stimulation and exogenous progesterone affect endometrial vascular density. The present research aimed to assess the impact of HMG/HCG and progesterone on miR-16-5p, VEGF protein expression, and angiogenesis in the mouse endometrium during the preimplantation period. Forty adult female mice were divided into four groups: 1) control, 2) ovarian stimulation (HMG and 48 h after HCG IP), 3) progesterone (progesterone IP for 3 days), 4) ovarian stimulation + progesterone (HMG and 48 h after HCG IP) + (progesterone IP for 3 days) groups.The mice were sacrificed 96 h following HCG administration. miR-16-5p, VEGF protein expression, and CD31-positive cell (Endothelial cell) density were specified.The results showed that endothelial cell density,VEGF protein, and miR-16-5p expression increased in all treatment groups, with the maximum increase belonging to the ovarian stimulation + progesterone group. This study provides evidence that ovarian stimulation and progesterone administration enhance endometrial angiogenesis through VEGF protein upregulation. Furthermore, except for miR-16-5p, other miRNAs and molecules appear to be involved in angiogenic pathways, thereby requiring further studies.
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Orvieto R, Kirshenbaum M, Galiano V, Zilberberg E, Haas J, Nahum R. Stop GnRH-Agonist Combined with Multiple-Dose GnRH-Antagonist for Patients with Elevated Peak Serum Progesterone Levels Undergoing Ovarian Stimulation for IVF: A Proof of Concept. Gynecol Obstet Invest 2020; 85:357-361. [PMID: 32580194 DOI: 10.1159/000508875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/21/2020] [Indexed: 11/19/2022]
Abstract
AIM The aim of the study was to examine whether the Stop GnRH-agonist combined with multiple-dose GnRH-antagonist protocol may overcome progesterone elevation during the late follicular phase. PATIENTS AND METHODS A cohort historical, proof of concept study consisting of 11 patients with progesterone elevation (>3.1 nmol/L) during conventional IVF/intracytoplasmic sperm injection (ICSI), who underwent a subsequent Stop GnRH-agonist combined with multiple-dose GnRH-antagonist ovarian stimulation (OS) protocol, within 3 months of the previous failed conventional IVF/ICSI cycle. RESULTS The Stop GnRH-agonist combined with multiple-dose GnRH-antagonist COH protocol revealed significantly lower peak progesterone levels, with significantly higher numbers of follicles >13 mm in diameter on the day of hCG administration, oocytes retrieved, mature oocytes, and top-quality embryos, with an acceptable clinical pregnancy rate (18.2%). CONCLUSIONS The combined Stop GnRH-ag/GnRH-ant OS protocol is a valuable tool in the armamentarium for treating patients with progesterone elevation during the late follicular phase. Further large prospective studies are needed to validate our observation and to characterize the appropriate patients' subgroup, which might benefit from the combined Stop GnRH-ag/GnRH-ant COH protocol.
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Affiliation(s)
- Raoul Orvieto
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Tel Aviv University, Tel Aviv, Israel, .,The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, at the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel,
| | - Michal Kirshenbaum
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Tel Aviv University, Tel Aviv, Israel
| | - Valentina Galiano
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Tel Aviv University, Tel Aviv, Israel
| | - Eran Zilberberg
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Tel Aviv University, Tel Aviv, Israel
| | - Jigal Haas
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Tel Aviv University, Tel Aviv, Israel
| | - Ravit Nahum
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Tel Aviv University, Tel Aviv, Israel
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Effect of ovarian stimulation on the expression of piRNA pathway proteins. PLoS One 2020; 15:e0232629. [PMID: 32365144 PMCID: PMC7197780 DOI: 10.1371/journal.pone.0232629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/17/2020] [Indexed: 12/11/2022] Open
Abstract
PIWI-interacting RNAs (piRNAs) play an important role in gametogenesis, fertility and embryonic development. The current study investigated the effect of different doses of pregnant mare serum gonadotrophin/human chorionic gonadotrophin (PMSG/hCG) and repeated ovarian stimulation (OS) on the expression of the Mili, Miwi, Mael, Tdrd1, Tdrd9, qnd Mitopld genes, which have crucial roles in the biogenesis and function of piRNAs. Here, we found that after treatment with 7.5 I.U. PMSG/hCG and two repeated rounds of OS, both the mRNA and protein levels of Tdrd9, Tdrd1 and Mael showed the greatest decrease in the ovarian tissue, but the plasma E2 levels showed the strongest increases (p<0.05). However, we found that the Mitopld, Miwi and Mili gene levels were decreased significantly after treatment with 12.5 I.U. PMSG/hCG. Our results suggested that exogenous gonadotropin administration leads to a significant decrease in the expression of the Mili, Miwi, Mael, Tdrd1, Tdrd9 and Mitopld genes, which are critically important in the piRNA pathway, and the changes in the expression levels of Tdrd9, Tdrd1 and Mael may be associated with plasma E2 levels. New comprehensive studies are needed to reduce the potential effects of OS on the piRNA pathway, which silences transposable elements and maintains genome integrity, and to contribute to the safety of OS.
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Is ovarian response associated with adverse perinatal outcomes in GnRH antagonist IVF/ICSI cycles? Reprod Biomed Online 2020; 41:263-270. [PMID: 32505544 DOI: 10.1016/j.rbmo.2020.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/12/2020] [Accepted: 03/14/2020] [Indexed: 11/22/2022]
Abstract
RESEARCH QUESTION Is there an association between ovarian response and perinatal outcomes? DESIGN A retrospective, single-centre cohort study including all women undergoing their first ovarian stimulation cycle in a gonadotrophin releasing hormone antagonist protocol, with a fresh embryo transfer that resulted in a singleton live birth from January 2009 to December 2015. Patients were categorized into four groups according to the number of oocytes retrieved: one to three (category 1), four to nine (category 2), 10-15 (category 3), or over 15 oocytes (category 4). RESULTS The overall number of patients analysed was 964. No relevant statistical difference was found among neonatal outcomes across the four ovarian response categories. Neonatal weight (in grams) was comparable between all groups (3222 ± 607 versus 3254 ± 537 versus 3235 ± 575 versus 3200 ± 622; P = 0.85, in categories 1, 2, 3 and 4, respectively). No statistically significant differences were found among the ovarian response categories for birth weight z-scores (taking into account neonatal sex and delivery term). The incidence of pre-term birth and low birth weight was comparable across the different ovarian response groups (P = 0.127 and P = 0.19, respectively). Finally, the occurrence of adverse obstetric outcomes did not differ among the ovarian response categories. Multivariate regression analysis revealed that the number of oocytes was not associated with neonatal birth weight. CONCLUSIONS No association was found between ovarian response and adverse perinatal outcomes in antagonist IVF and intracytoplasmic sperm injection cycles. Future, larger scale and prospectively designed investigations are needed to validate these results.
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