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Ganer Herman H, Mizrachi Y, Marom O, Weissman A, Farhi J, Kovo M, Raziel A, Horowitz E. Obstetric and Perinatal Outcomes following Ovulation Induction and Unassisted Pregnancies in the Same Mother. Am J Perinatol 2024; 41:e2145-e2150. [PMID: 37230475 DOI: 10.1055/a-2099-8399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE We aimed to assess whether ovulation induction treatments affect obstetric and neonatal outcomes. STUDY DESIGN This was a historic cohort study of deliveries in a single university-affiliated medical center between November 2008 and January 2020. We included women who had one pregnancy following ovulation induction and one unassisted pregnancy. The obstetric and perinatal outcomes were compared between pregnancies following ovulation induction and unassisted pregnancies, so that each woman served as her own control. The primary outcome measure was birth weight. RESULTS A total of 193 deliveries following ovulation induction and 193 deliveries after unassisted conception by the same women were compared. Ovulation induction pregnancies were characterized by a significantly younger maternal age and a higher rate of nulliparity (62.7 vs. 8.3%, p < 0.001). In pregnancies achieved by ovulation induction, we found a higher rate of preterm birth (8.3 vs. 4.1%, p = 0.02) and instrumental deliveries (8.8 vs. 2.1%, p = 0.005), while cesarean delivery rates were higher following unassisted pregnancies. Birth weight was significantly lower in ovulation induction pregnancies (3,167 ± 436 vs. 3,251 ± 460 g, p = 0.009), although the rate of small for gestational age neonates was similar between the groups. On multivariate analysis, birth weight remained significantly associated with ovulation induction after adjustment for confounders, while preterm birth did not. CONCLUSION Pregnancies following ovulation induction treatments are associated with lower birth weight. This may be related to an altered placentation process following uterine exposure to supraphysiological hormonal levels. KEY POINTS · Ovulation induction entails lower birthweight.. · This may relate to supraphysiological hormonal levels.. · Monitoring fetal growth is advised in such cases..
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Affiliation(s)
- Hadas Ganer Herman
- In-Vitro Fertilization Unit, the Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Twig Fertility, Toronto, Canada
| | - Yossi Mizrachi
- In-Vitro Fertilization Unit, the Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Or Marom
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Weissman
- In-Vitro Fertilization Unit, the Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Farhi
- In-Vitro Fertilization Unit, the Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arieh Raziel
- In-Vitro Fertilization Unit, the Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Horowitz
- In-Vitro Fertilization Unit, the Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Stern JE, Farland LV, Hwang SS, Dukhovny D, Coddington CC, Cabral HJ, Missmer SA, Declercq E, Diop H. Assisted Reproductive Technology or Infertility: What underlies adverse outcomes? Lessons from the Massachusetts Outcome Study of Assisted Reproductive Technology. F&S REVIEWS 2022; 3:242-255. [PMID: 36505962 PMCID: PMC9733832 DOI: 10.1016/j.xfnr.2022.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Numerous studies have demonstrated that assisted reproductive technology (ART: defined here as including only in vitro fertilization and related technologies) is associated with increased adverse pregnancy, neonatal, and childhood developmental outcomes, even in singletons. The comparison group for many had often been a fertile population that conceived without assistance. The Massachusetts Outcome Study of Assisted Reproductive Technology (MOSART) was initiated to define a subfertile population with which to compare ART outcomes. Over more than 10 years, we have used the MOSART database to study pregnancy abnormalities and delivery complications but also to evaluate ongoing health of women, infants, and children. This article will review studies from MOSART in the context of how they compare with those of other investigations. We will present MOSART studies that identified the influence of ART and subfertility/infertility on adverse pregnancy (pregnancy hypertensive disorder, gestational diabetes, placental abnormality) and delivery (preterm birth, low birthweight) outcomes as well as on maternal and child hospitalizations. We will provide evidence that although subfertility/infertility increases the risk of adverse outcomes, there is additional risk associated with the use of ART. Studies exploring the contribution of placental abnormalities as one factor adding to this increased ART-associated risk will be described.
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Affiliation(s)
- Judy E. Stern
- Department of Obstetrics & Gynecology, Dartmouth-Hitchcock and the Geisel School of Medicine at Dartmouth
| | - Leslie V. Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona
| | - Sunah S. Hwang
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine
| | - Dmitry Dukhovny
- Department of Pediatrics, Oregon Health & Science University
| | - Charles C. Coddington
- Department of Obstetrics & Gynecology, Carolinas Medical Center, University of North Carolina
| | - Howard J. Cabral
- Department of Biostatistics, Boston University School of Public Health
| | - Stacey A. Missmer
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University
| | - Eugene Declercq
- Department of Community Health Sciences, Boston University School of Public Health
| | - Hafsatou Diop
- Division of MCH Research and Analysis, Massachusetts Department of Public Health
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Gao X, Sun S, Xie L, Lu S. Effects of donor sperm on perinatal and neonatal outcomes resulting from in vitro fertilization-intracytoplasmic sperm injection and embryo transfer cycles: a retrospective cohort study. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:819. [PMID: 36034991 PMCID: PMC9403916 DOI: 10.21037/atm-21-5492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 06/24/2022] [Indexed: 12/02/2022]
Abstract
Background The impact of donor sperm on pregnancy outcomes is controversial. The aim of this study was to investigate whether donor sperm in in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment could reduce the rate of live births or increase the incidence of adverse pregnancy outcomes and birth defects in neonates. Methods This single-centre, retrospective cohort study included 1,559 patients with infertility who received donor sperm at our hospital from 2015 to 2019. All the patients received fresh embryos and underwent first-cycle transfer. After propensity score matching, 4,677 controls who received their partners’ sperm were matched at 1:3. Clinical pregnancy, perinatal, and neonatal outcomes were compared between the donor sperm and partner sperm groups. Results The embryo development was better in the donor sperm group than in the partner sperm group. The high-quality embryo and available embryo rates were significantly higher in the donor sperm group (P<0.05 for both groups). The rate of high-quality embryos transferred from the donor sperm group was higher than that from the partner sperm group (P<0.05). The clinical pregnancy (62.99% vs. 59.65%; P=0.02) and live birth (54.65% vs. 51.59%; P=0.036) rates were higher in the donor sperm group. After adjusting for confounding factors, no significant difference in live birth rates was observed between the two groups (adjusted P=0.057). The low birthweight (18.21% vs. 21.39%; P=0.023) and small for gestational age (SGA) (7.60% vs. 11.97%; P<0.001) rates were lower in the donor sperm group. To exclude the effect of multiple pregnancies, we evaluated neonatal outcomes of singleton pregnancies. No significant differences were noted in preterm and very preterm birth, SGA, mean birthweight, high birthweight, and low birth weight (LBW) and very low birth weight (VLBW) rates (P>0.05 for both groups). Further, no significant between group differences were observed in the ectopic pregnancy rate, early and late spontaneous abortion rates, gestational age, rate of large for gestational age (LGA), and neonatal defects. Conclusions Compared with partner sperm, donor sperm did not reduce live birth rate and did not increase neonatal LBW or low birth defects.
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Affiliation(s)
- Xinyan Gao
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China.,Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, China
| | - Shihu Sun
- Tengzhou Maternal and Child Health Hospital, Zaozhuang, China
| | - Lei Xie
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China.,Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, China
| | - Shaoming Lu
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China.,Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, China
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Obstetric and perinatal risks after the use of donor sperm: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2022; 274:210-228. [PMID: 35671665 DOI: 10.1016/j.ejogrb.2022.05.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/23/2022]
Abstract
Donor sperm is widely used in infertility treatments. The purpose of the study was to investigate, whether use of donor sperm in intrauterine insemination (IUI) or in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatments affect maternal and perinatal risks compared with spontaneously conceived pregnancies or use of partner sperm in IUI, IVF or ICSI. We provide a systematic review and meta-analyses on the most clinically relevant obstetric and perinatal outcomes after use of donor sperm compared with partner sperm: hypertensive disorders of pregnancy, preeclampsia, low birth weight, and preterm birth. Our meta-analyses showed an increased risk for preeclampsia (pooled adjusted odds ratio (aOR) 1.77, 95% CI 1.26-2.48) and hypertensive disorders of pregnancy (pooled aOR 1.55, 95%, CI 1.20-2.00) in pregnancies resulting from IUI with donor sperm compared with IUI with partner sperm. No increased risk was seen for low birth weight or preterm birth after the use of donor sperm in IUI compared with the use of partner sperm in IUI. Subgroup analysis for singletons only did not change these results. The meta-analysis on low birth weight showed a lower risk after in IVF with donor sperm compared with IVF with partner sperm (pooled aOR 0.89, 95% CI 0.83-0.94). For hypertensive disorders of pregnancy, preeclampsia and preterm birth, no difference was found between IVF with donor sperm vs. partner sperm. Patients need to be informed about the moderately increased risk of hypertensive disorders of pregnancy and preeclampsia in pregnancies after IUI with donor sperm.
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Navarro-Rubio S, Güell F. The Principle of "Damage Exclusion" as a Benchmark in Catholic Discussions of Homologous Artificial Insemination. JOURNAL OF RELIGION AND HEALTH 2021; 60:268-281. [PMID: 31522326 DOI: 10.1007/s10943-019-00913-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The Catholic perspective rejects assisted human reproduction techniques, but the morality of artificial insemination (AI) is open for discussion. This article aims to analyze the morality of AI from a new angle, namely whether these interventions exclude all possibility of damaging the human embryo and the offspring's health. The scientific evidence about the children's health who are born through AI allows us to affirm that the procedures do not comply with the principle of damage exclusion: AI does not exclude all possibility of damaging the embryo and impacting the health and exposure to disease of the offspring born through these techniques.
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Affiliation(s)
- Sonsoles Navarro-Rubio
- Mind-Brain Group, Institute for Culture and Society (ICS), University of Navarra, Office 2160, Campus Universitario, 31009, Pamplona, Spain
| | - Francisco Güell
- Mind-Brain Group, Institute for Culture and Society (ICS), University of Navarra, Office 2160, Campus Universitario, 31009, Pamplona, Spain.
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Allen CP, Marconi N, McLernon DJ, Bhattacharya S, Maheshwari A. Outcomes of pregnancies using donor sperm compared with those using partner sperm: systematic review and meta-analysis. Hum Reprod Update 2020; 27:190-211. [PMID: 33057599 DOI: 10.1093/humupd/dmaa030] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 05/25/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Registry data from the Human Fertilisation and Embryology Authority (HFEA) show an increase of 40% in IUI and 377% in IVF cases using donor sperm between 2006 and 2016. OBJECTIVE AND RATIONALE The objective of this study was to establish whether pregnancies conceived using donor sperm are at higher risk of obstetric and perinatal complications than those conceived with partner sperm. As more treatments are being carried out using donor sperm, attention is being given to obstetric and perinatal outcomes, as events in utero and at delivery have implications for long-term health. There is a need to know if there is any difference in the outcomes of pregnancies between those conceived using donor versus partner sperm in order to adequately inform and counsel couples. SEARCH METHODS We performed a systematic review and meta-analysis of the outcomes of pregnancies conceived using donor sperm compared with partner sperm. Searches were performed in the OVID MEDLINE, OVID Embase, CENTRAL and CINAHL databases, including all studies published before 11 February 2019. The search strategy involved search terms for pregnancy, infant, donor sperm, heterologous artificial insemination, donor gametes, pregnancy outcomes and perinatal outcomes. Studies were included if they assessed pregnancies conceived by any method using, or infants born from, donor sperm compared with partner sperm and described early pregnancy, obstetric or perinatal outcomes. The Downs and Black tool was used for quality and bias assessment of studies. OUTCOMES Of 3391 studies identified from the search, 37 studies were included in the review and 36 were included in the meta-analysis. For pregnancies conceived with donor sperm, versus partner sperm, there was an increase in the relative risk (RR) (95% CI) of combined hypertensive disorders of pregnancy: 1.44 (1.17-1.78), pre-eclampsia: 1.49 (1.05-2.09) and small for gestational age (SGA): 1.42 (1.17-1.79) but a reduced risk of ectopic pregnancy: 0.69 (0.48-0.98). There was no difference in the overall RR (95% CI) of miscarriage: 0.94 (0.80-1.11), gestational diabetes: 1.49 (0.62-3.59), pregnancy-induced hypertension (PIH): 1.24 (0.87-1.76), placental abruption: 0.65 (0.04-10.37), placenta praevia: 1.19 (0.64-2.21), preterm birth: 0.98 (0.88-1.08), low birth weight: 0.97 (0.82-1.15), high birthweight: 1.28 (0.94-1.73): large for gestational age (LGA): 1.01 (0.84-1.22), stillbirth: 1.23 (0.97-1.57), neonatal death: 0.79 (0.36-1.73) and congenital anomaly: 1.15 (0.86-1.53). WIDER IMPLICATIONS The majority of our findings are reassuring, except for the mild increased risk of hypertensive disorders of pregnancy and SGA in pregnancies resulting from donor sperm. However, the evidence for this is limited and should be interpreted with caution because the evidence was based on observational studies which varied in their quality and risk of bias. Further high-quality population-based studies reporting obstetric outcomes in detail are required to confirm these findings.
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Affiliation(s)
| | - Nicola Marconi
- Aberdeen Fertility Centre, University of Aberdeen, Aberdeen AB25 2ZL, UK
| | - David J McLernon
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZL, UK
| | - Sohinee Bhattacharya
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZL, UK
| | - Abha Maheshwari
- Aberdeen Fertility Centre, Aberdeen Maternity Hospital, Aberdeen AB25 2ZL, UK
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Lavie I, Lavie M, Doyev R, Fouks Y, Azem F, Yogev Y. Pregnancy outcomes in women with inflammatory bowel disease who successfully conceived via assisted reproduction technique. Arch Gynecol Obstet 2020; 302:611-618. [PMID: 32529298 DOI: 10.1007/s00404-020-05644-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 06/08/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Women with inflammatory bowel disease (IBD) have an increased risk for adverse pregnancy outcome, so as women using assisted reproduction technology (ART). However, data are scarce regarding the risk imposed by the combination of both. Thus, we aimed to assess pregnancy outcome in these women. METHODS A retrospective case-control study, of women with IBD who conceived using ART due to female infertility. The study group (IBD-ART) was matched using propensity score and compared in a 1:1 ratio with three control groups, IBD patients who conceived spontaneously (IBD-SP), women using ART (H-ART) and women who conceived spontaneously (H-SP). RESULTS The study group comprised of 49 women with IBD conceived via ART that gave birth at our center during the study period. All studied groups did not differ in demographics and obstetric characteristics. IBD groups (both ART and spontaneous) were comparable in disease status prior and throughout pregnancy. Maternal outcome showed no difference regarding preterm birth and pregnancy complications among all studied groups. Women in the IBD-ART group had decreased rates of vaginal delivery (34.7% vs 57.1%, p = 0.032) and higher rates of elective CS (32.7% vs 14.3%, p = 0.048) in comparison to H-SP group, but comparable rates to both IBD-SP and H-ART groups. Neonatal outcomes were comparable among all studied groups. In a sub-analysis by disease type, a higher rate of gestational diabetes was found among ulcerative colitis patients using ART (29.4% Crohn's vs 6.1% UC, p = 0.025). CONCLUSION Patients with IBD undergoing ART have comparable pregnancy outcome to women using ART and to patients with IBD with spontaneous pregnancy.
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Affiliation(s)
- Inbar Lavie
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michael Lavie
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. .,Lis Hospital for Women, Tel-Aviv Sourasky Medical Center, Weizman 6 St, Tel-Aviv, Israel.
| | - Reut Doyev
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Lis Hospital for Women, Tel-Aviv Sourasky Medical Center, Weizman 6 St, Tel-Aviv, Israel
| | - Yuval Fouks
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Lis Hospital for Women, Tel-Aviv Sourasky Medical Center, Weizman 6 St, Tel-Aviv, Israel
| | - Foad Azem
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Lis Hospital for Women, Tel-Aviv Sourasky Medical Center, Weizman 6 St, Tel-Aviv, Israel
| | - Yariv Yogev
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Lis Hospital for Women, Tel-Aviv Sourasky Medical Center, Weizman 6 St, Tel-Aviv, Israel
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Huang J, Lin J, Lu X, Gao H, Song N, Cai R, Kuang Y. Association between endometrial thickness and neonatal outcomes in intrauterine insemination cycles: a retrospective analysis of 1,016 live-born singletons. Reprod Biol Endocrinol 2020; 18:48. [PMID: 32410619 PMCID: PMC7222451 DOI: 10.1186/s12958-020-00597-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/22/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Decreased endometrial thickness (EMT) has been suggested to be associated with reduced birthweight of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) newborns. Considering the differences in ovarian stimulation degree and laboratory procedures between IVF/ICSI and IUI treatment, we aim to investigate whether EMT has any influence on IUI infant outcomes as well. METHODS This was a retrospective cohort study of 1016 patients who had singleton livebirths after IUI treatment cycles from January 2008 to December 2018 at a tertiary-care academic medical center in China. Patients were categorized into three groups by the 10th and 90th percentile of peak EMT: ≤7.6, 7.7-13.0 and ≥ 13.1 mm. The primary outcomes of the study were preterm birth (PTB), low birthweight (LBW) and small-for-gestational age (SGA). Multiple regression analyses were performed after controlling for a variety of potential confounders. RESULTS No significant differences were found among the three groups in gestational age, birthweight and birthweight Z-score. Compared with the EMT 7.7-13.0 mm group, the incidences of PTB, LBW and SGA were 5.5% (adjusted odds ratio [aOR] 0.81, 95% confidence interval [CI] 0.33-2.01), 6.4% (aOR 1.44, 95% CI 0.58-3.58) and 7.3% (aOR 1.21, 95% CI 0.53-2.76) in the EMT ≤7.6 mm group, respectively. Similarly, EMT ≥13.1 mm was not significantly associated with risks of PTB (aOR 0.63, 95% CI 0.24-1.65), LBW (aOR 0.57, 95% CI 0.17-1.95) and SGA (aOR 0.73, 95% CI 0.28-1.92). The odds of other adverse neonatal outcomes, including macrosomia, large-for-gestational age and major congenital malformations, did not show significant differences before and after adjustment in both EMT ≤7.6 and ≥ 13.1 mm groups. CONCLUSIONS EMT is not independently associated with adverse perinatal outcomes in IUI cycles. This novel finding would provide reassuring information for IUI patients with thin endometrial linings regarding their neonatal health. However, further prospective cohort studies with larger datasets are needed to confirm the conclusion.
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Affiliation(s)
- Jialyu Huang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China
| | - Jiaying Lin
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China
| | - Xuefeng Lu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China
| | - Hongyuan Gao
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China
| | - Ning Song
- Department of Histology, Embryology, Genetics and Developmental Biology, Shanghai Key Laboratory for Reproductive Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Renfei Cai
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China.
| | - Yanping Kuang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China.
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Navarro-Rubio S, Güell F. Understanding the correlation between artificial insemination and offspring health outcomes. Birth Defects Res 2020; 112:7-18. [PMID: 31837206 DOI: 10.1002/bdr2.1617] [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: 10/02/2019] [Revised: 10/24/2019] [Accepted: 11/03/2019] [Indexed: 11/12/2022]
Abstract
Although numerous articles have shown intracytoplasmic sperm injection and in vitro fertilization to be correlated with increased risk of disease, a few works have been published on the risks associated with artificial insemination. Meanwhile, questions about the possible causes underlying these correlations have remained in the background. The main objective of this work is not to review the risks associated with artificial insemination, but rather to describe how developmental processes may be affected by these techniques. Thus, we offer a theoretical framework for understanding the possible causes that underlie the correlation between low-complexity or milder techniques and offspring health outcomes.
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Affiliation(s)
- Sonsoles Navarro-Rubio
- Mind-brain group, Institute for Culture and Society (ICS), University of Navarra, Pamplona, Spain
| | - Francisco Güell
- Mind-brain group, Institute for Culture and Society (ICS), University of Navarra, Pamplona, Spain
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Abdul-Aziz M, Mahdy MAK, Abdul-Ghani R, Alhilali NA, Al-Mujahed LKA, Alabsi SA, Al-Shawish FAM, Alsarari NJM, Bamashmos W, Abdulwali SJH, Al Karawani M, Almikhlafy AA. Bacterial vaginosis, vulvovaginal candidiasis and trichomonal vaginitis among reproductive-aged women seeking primary healthcare in Sana'a city, Yemen. BMC Infect Dis 2019; 19:879. [PMID: 31640583 PMCID: PMC6805389 DOI: 10.1186/s12879-019-4549-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/09/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In Yemen, the underlying causes of infectious vaginitis have been neglected. Therefore, this study aimed to determine the prevalence and risk factors associated with bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) and trichomonal vaginitis (TV) among non-pregnant reproductive-aged women. METHODS A cross-sectional study was conducted among 347 non-pregnant reproductive-aged women seeking primary healthcare in Sana'a city, Yemen. Data about sociodemographic characteristics, lifestyle-related behaviors, routine hygienic practices, menstrual care and history and type of contraceptive intake were collected using a structured questionnaire. Vaginal discharge samples were collected and examined for discharge characteristics and pH by a gynecologist. Then, samples were examined for BV, VVC and TV. Data were analyzed using suitable statistical tests. RESULTS Vaginal infections were prevalent among 37.6% of reproductive-aged women, where BV was the most prevalent (27.2%). VVC was significantly higher among symptomatic women and significantly associated with itching (P = 0.005). Using bivariate analysis, the age of < 25 years (odds ratio [OR] = 1.9, 95% confidence interval [CI]: 1.16-3.10; P = 0.010) and using intrauterine contraceptive devices (IUCDs) (OR = 1.8, 95% CI: 1.09-2.89; P = 0.020) were significantly associated with BV, while history of miscarriage was significantly associated with a lower risk of BV (OR = 0.5, 95% CI: 0.31-0.85, P = 0.009). However, polygyny was significantly associated with VVC (OR = 3.4, 95% CI: 1.33-8.66; P = 0.007). Multivariable analysis confirmed that age of < 25 years and using IUCD were the independent predictors of BV, while history of miscarriage was an independent protective factor against BV. On the other hand, marriage to a polygamous husband was the independent predictor of VVC. CONCLUSIONS More than a third of non-pregnant reproductive-aged women seeking PHC in Sana'a have single or mixed infections with BV, VVC or TV. BV is the most frequent cause of vaginitis and is significantly associated with the age of < 25 years and using IUCDs, while VVC is significantly higher among women with polygamous husbands. Health education of polygamous husbands and their wives, regular monitoring of BV among IUCD users and screening women for vaginitis before treatment are recommended.
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Affiliation(s)
- Maha Abdul-Aziz
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Science and Technology, Sana'a, Yemen
| | - Mohammed A K Mahdy
- Tropical Disease Research Center, Faculty of Medicine, University of Science and Technology, Sana'a, Yemen. .,Department of Parasitology, Faculty of Medicine, Sana'a University, Sana'a, Yemen.
| | - Rashad Abdul-Ghani
- Tropical Disease Research Center, Faculty of Medicine, University of Science and Technology, Sana'a, Yemen.,Department of Parasitology, Faculty of Medicine, Sana'a University, Sana'a, Yemen
| | - Nuha A Alhilali
- Medical Laboratory Sciences Program, Faculty of Medicine, University of Science and Technology, Sana'a, Yemen
| | - Leena K A Al-Mujahed
- Medical Laboratory Sciences Program, Faculty of Medicine, University of Science and Technology, Sana'a, Yemen
| | - Salma A Alabsi
- Medical Laboratory Sciences Program, Faculty of Medicine, University of Science and Technology, Sana'a, Yemen
| | - Fatima A M Al-Shawish
- Medical Laboratory Sciences Program, Faculty of Medicine, University of Science and Technology, Sana'a, Yemen
| | - Noura J M Alsarari
- Medical Laboratory Sciences Program, Faculty of Medicine, University of Science and Technology, Sana'a, Yemen
| | - Wala Bamashmos
- Medical Laboratory Sciences Program, Faculty of Medicine, University of Science and Technology, Sana'a, Yemen
| | - Shahad J H Abdulwali
- Medical Laboratory Sciences Program, Faculty of Medicine, University of Science and Technology, Sana'a, Yemen
| | - Mahdi Al Karawani
- Department of Community Medicine, Faculty of Medicine, University of Science and Technology, Sana'a, Yemen
| | - Abdullah A Almikhlafy
- Department of Community Medicine, Faculty of Medicine, University of Science and Technology, Sana'a, Yemen
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Singleton fetal growth kinetics depend on the mode of conception. Fertil Steril 2019; 110:1109-1117.e2. [PMID: 30396555 DOI: 10.1016/j.fertnstert.2018.06.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/25/2018] [Accepted: 06/20/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To study the impact of in vitro fertilization, with or without intracytoplasmic sperm injection (IVF/ICSI), frozen-embryo transfer (FET), and intrauterine insemination (IUI) on fetal growth kinetics throughout pregnancy and to compare the different modes of conception. DESIGN Retrospective cohort study. SETTING University. PATIENT(S) A total of 560 singleton pregnancies were included (96 IVF, 210 ICSI, 121 FET, and 133 IUI). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) We compared crown-rump length (CRL) at the first trimester (T1: 11-13 weeks of gestation [WG] + 6 days), estimated fetal weight (EFW) at the second (T2: 21-23 WG + 6 days) and third (T3: 31-33 WG + 6 days) trimesters, and birth weight (BW) z-scores with those in the reference curves (Papageorghiou for T1, and Ego M2 for T2, T3, and birth). Multivariate analyses were performed. RESULT(S) For T1, the CRL was longer than the reference curve whatever the assisted reproductive technique (ART). For T2, EFW was significantly greater for all groups compared with the reference curve, and for T3 only FET singletons had a greater EFW. ICSI, IVF, and IUI singletons had a significantly lower BW compared with reference curves. For all ART fetuses, growth kinetics differed from T2. Only FET fetuses maintained their significantly above-reference growth values. The proportion of fetuses for which at least one period of growth loss was observed from T2 to birth was higher after IVF, ICSI, and IUI than after FET. CONCLUSION(S) For the first time, we have highlighted that fetal growth kinetics differed from T2 depending on the ART protocols used. They could have an impact on trophoblastic invasiveness and might lead to long-term health effects.
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Cohlen B, Bijkerk A, Van der Poel S, Ombelet W. IUI: review and systematic assessment of the evidence that supports global recommendations. Hum Reprod Update 2018; 24:300-319. [PMID: 29452361 DOI: 10.1093/humupd/dmx041] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 12/19/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND IUI with or without ovarian stimulation (OS) has become a first-line treatment option for many infertile couples, worldwide. The appropriate treatment modality for couples and their clinical management through IUI or IUI/OS cycles must consider maternal and perinatal outcomes, most notably the clinical complication of higher-order multiple pregnancies associated with IUI-OS. With a current global emphasis to continue to decrease maternal and perinatal mortality and morbidity, the World Health Organization (WHO) had established a multi-year project to review the evidence for the establishment of normative guidance for the implementation of IUI as a treatment to address fertility problems, and to consider its cost-effectiveness for lower resource settings. OBJECTIVE AND RATIONALE The objective of this review is to provide a review of the evidence of 13 prioritized questions that cover IUI with and without OS. We provide summary recommendations for the development of global, evidence-based guidelines based upon methodology established by the WHO. SEARCH METHODS We performed a comprehensive search using question-specific relevant search terms in May 2015. For each PICO (Population, Intervention, Comparison and Outcomes) drafted by WHO, specific search terms were used to find the available evidence in MEDLINE (1950 to May 2015) and The Cochrane Library (until May 2015). After presentation to an expert panel, a further hand search of references in relevant reviews was performed up to January 2017. Articles that were found to be relevant were read and analysed by two investigators and critically appraised using the Cochrane Collaboration's tool for assessing risk of bias, and AMSTAR in case of systematic reviews. The quality of the evidence was assessed using the GRADE system. An independent expert review process of our analysis was conducted in November 2016. OUTCOMES This review provides an assessment and synthesis of the evidence that covers 13 clinical questions including the indications for the use of IUI versus expectant management, the sperm parameters required, the best and optimal method of timing and number of inseminations per cycle, prevention strategies to decrease multiple gestational pregnancies, and the cost-effectiveness of IUI versus IVF. We provide an evidence-based formulation of 20 recommendations, as well as two best practice points that address the integration of methods for the prevention of infection in the IUI laboratory. The quality of the evidence ranges from very low to high, with evidence that may be decades old but of high quality, however, we further discuss where critical research gaps in the evidence remain. WIDER IMPLICATIONS This review presents an evidence synthesis assessment and includes recommendations that will assist health care providers worldwide with their decision-making when considering IUI treatments, with or without OS, for their patients presenting with fertility problems.
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Affiliation(s)
- Ben Cohlen
- Isala Fertility Center, Isala, Dr van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Aartjan Bijkerk
- Isala Fertility Center, Isala, Dr van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Sheryl Van der Poel
- WHO/HRP (the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction), Avenue Appia 20, 1202 Geneva, Switzerland
| | - Willem Ombelet
- Genk Institute for Fertility Technology, Department of Obstetrics and Gynaecology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium.,Department of Physiology, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium
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13
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Update on: a meta-analysis of sperm donation offspring health outcomes – 2018 update. J Dev Orig Health Dis 2018; 9:561-562. [DOI: 10.1017/s2040174418000272] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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14
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Gerkowicz SA, Crawford SB, Hipp HS, Boulet SL, Kissin DM, Kawwass JF. Assisted reproductive technology with donor sperm: national trends and perinatal outcomes. Am J Obstet Gynecol 2018; 218:421.e1-421.e10. [PMID: 29291411 PMCID: PMC11056969 DOI: 10.1016/j.ajog.2017.12.224] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/05/2017] [Accepted: 12/21/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Information regarding the use of donor sperm in assisted reproductive technology, as well as subsequent treatment and perinatal outcomes, remains limited. Outcome data would aid patient counseling and clinical decision making. OBJECTIVES The objectives of the study were to report national trends in donor sperm utilization and live birth rates of donor sperm-assisted reproductive technology cycles in the United States and to compare assisted reproductive technology treatment and perinatal outcomes between cycles using donor and nondonor sperm. We hypothesize these outcomes to be comparable between donor and nondonor sperm cycles. STUDY DESIGN This was a retrospective cohort study using data from all US fertility centers reporting to the Centers for Disease Control and Prevention's National Assisted Reproductive Technology Surveillance System, accounting for ∼98% of assisted reproductive technology cycles (definition excludes intrauterine insemination). The number and percentage of assisted reproductive technology cycles using donor sperm and rates of pregnancy, live birth, preterm birth (<37 weeks), and low birthweight (<2500 g) were the primary outcomes measured. Treatments assessed include use of donor vs nondonor sperm. The trends analysis included all banking and fresh assisted reproductive technology cycles using donor and autologous oocytes performed between 1996 and 2014 (n = 1,710,034). The outcomes analysis was restricted to include only fresh autologous cycles performed between 2010 and 2014 (n = 437,569) to focus on cycles with a potential outcome and cycles reflective of current practice, thereby improving the clinical relevance. Cycles canceled prior to retrieval were excluded. Statistical analysis included linear regression to explore polynomial trends and log-binomial regression to estimate relative risk for outcomes among cycles using donor and nondonor sperm. RESULTS Of all banking and fresh donor and autologous oocyte assisted reproductive technology cycles performed between 1996 and 2014, 74,892 (4.4%) used donor sperm. In 2014, 7351 assisted reproductive technology cycles using donor sperm were performed, as compared with 1763 in 1996 (6.2% vs 3.8% of all cycles). Among all autologous oocyte cycles performed between 2010 and 2014, the live birth rate was lower for donor sperm (27.9%) than nondonor sperm cycles (32.5%); however, after adjustment for maternal age, donor sperm use was associated with an increased likelihood of live birth (adjusted relative risk, 1.06, 95% confidence interval, 1.01-1.10). Per transfer, there was no significant difference in live birth rates for donor vs nondonor sperm (31.9% vs 36.8%; adjusted relative risk, 1.04, 95% confidence interval, 0.998-1.09). Per singleton live birth, there was no significant difference in preterm birth (11.5% vs 11.8%; adjusted relative risk, 0.98, 95% confidence interval, 0.90-1.06); however, low birthweight delivery was slightly lower in donor sperm cycles (8.8% vs 9.4%; adjusted relative risk, 0.91, 95% confidence interval, 0.83-0.99). CONCLUSION Donor sperm use in assisted reproductive technology has increased in the United States, accounting for approximately 6% of all assisted reproductive technology cycles in 2014. Assisted reproductive technology treatment and perinatal outcomes were clinically similar in donor and nondonor sperm cycles.
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Affiliation(s)
- Sabrina A Gerkowicz
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University, Atlanta, GA; Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Sara B Crawford
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Heather S Hipp
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University, Atlanta, GA
| | - Sheree L Boulet
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Dmitry M Kissin
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jennifer F Kawwass
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University, Atlanta, GA; Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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15
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Palomba S, Santagni S, Daolio J, Gibbins K, Battaglia FA, La Sala GB, Silver RM. Obstetric and perinatal outcomes in subfertile patients who conceived following low technology interventions for fertility enhancement: a comprehensive review. Arch Gynecol Obstet 2018; 297:33-47. [PMID: 29082423 DOI: 10.1007/s00404-017-4572-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 10/18/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Low technology interventions for fertility enhancement (LTIFE) are strategies that avoid retrieval, handling, and manipulation of female gametes. The definition of LTIFE is yet to be widely accepted and clarified, but they are commonly used in milder cases of infertility and subfertility. Based on these considerations, the aim of the present study was comprehensively to review and investigate the obstetric and perinatal outcomes in subfertile patients who underwent LTIFE. METHODS A literature search up to May 2017 was performed in IBSS, SocINDEX, Institute for Scientific Information, PubMed, Web of Science, and Google Scholar. An evidence-based hierarchy was used according to The Oxford Centre for Evidence-Based Medicine to determine which articles to include and analyze, and to provide a level of evidence of each association between intervention and outcome. RESULTS This analysis identified preliminary and low-grade evidence on the influence of LTIFE on obstetric and perinatal outcomes in subfertile women. CONCLUSIONS LTIFE women should deserve major consideration from Clinicians/Researchers of Reproductive Medicine, because these treatments could be potentially responsible for mothers' and babies' complications. So far, the lack of well-designed and unbiased studies makes further conclusions difficult to be drawn.
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Affiliation(s)
- Stefano Palomba
- Unit of Obstetrics and Gynecology, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Via Melacrino, Reggio Calabria, Italy.
| | - Susanna Santagni
- Center of Reproductive Medicine and Surgery, Arcispedale Santa Maria Nuova (ASMN), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy
| | - Jessica Daolio
- Center of Reproductive Medicine and Surgery, Arcispedale Santa Maria Nuova (ASMN), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy
| | - Karen Gibbins
- Division of Maternal-Fetal Medicine, Utah University, Salt Lake City, UT, USA
| | - Francesco Antonino Battaglia
- Unit of Obstetrics and Gynecology, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Via Melacrino, Reggio Calabria, Italy
| | - Giovanni Battista La Sala
- Center of Reproductive Medicine and Surgery, Arcispedale Santa Maria Nuova (ASMN), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy
- University of Modena and Reggio Emilia, Modena, Italy
| | - Robert M Silver
- Division of Maternal-Fetal Medicine, Utah University, Salt Lake City, UT, USA
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Yılmaz NK, Sargın A, Erkılınç S, Özer İ, Engin-Üstün Y. Does ovulation induction and intrauterine insemination affect perinatal outcomes in singletons? J Matern Fetal Neonatal Med 2017; 31:14-17. [DOI: 10.1080/14767058.2016.1223033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Nafiye Karakaş Yılmaz
- Department of Reproductive Endocrinology, Zekai Tahir Burak Women’s Health, Education and Research Hospital, Ankara, Turkey
| | - Ayla Sargın
- Department of Reproductive Endocrinology, Zekai Tahir Burak Women’s Health, Education and Research Hospital, Ankara, Turkey
| | - Selçuk Erkılınç
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, İzmir, Turkey
| | - İrfan Özer
- Çiğli Regional Education Hospital, İzmir, Turkey
| | - Yaprak Engin-Üstün
- Department of Reproductive Endocrinology, Zekai Tahir Burak Women’s Health, Education and Research Hospital, Ankara, Turkey
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17
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Yamatoya K, Saito K, Saito T, Kang W, Nakamura A, Miyado M, Kawano N, Miyamoto Y, Umezawa A, Miyado K, Saito H. Birthweights and Down syndrome in neonates that were delivered after frozen-thawed embryo transfer: The 2007-2012 Japan Society of Obstetrics and Gynecology National Registry data in Japan. Reprod Med Biol 2017; 16:228-234. [PMID: 29259472 PMCID: PMC5661821 DOI: 10.1002/rmb2.12033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 02/10/2017] [Indexed: 11/08/2022] Open
Abstract
Aim To evaluate the use of frozen embryos on the outcome of assisted reproductive technology (ART), a retrospective study of the Japanese Assisted Reproductive Technology Registry data during the years 2007-2012 was conducted. Methods A total of 124 946 singleton neonates who reached term gestation following ART from 2007-2012, with 80 660 achieved through frozen-thawed embryo transfer (ET) and 44 286 being achieved through fresh ET, were analyzed for their birthweights and chromosomal abnormalities. Results The birthweight of the neonates from the frozen-thawed ETs was significantly higher than that of those from the fresh ETs throughout all the study years. The frequency of Down syndrome was 0.17% for the fresh ETs and 0.13% for the frozen-thawed ETs in the period 2007-2012. This study showed that frozen-thawed ETs result in a constant increase of the average birthweight between 37 and 41 weeks gestational age and lower frequencies of Down syndrome. Conclusion Frozen-thawed ETs were comparable to the fresh ET method, with the exceptions of higher birthweights and a lower frequency of Down syndrome in the neonates that were born from frozen-thawed ET. The increase in birthweights was not proportional to the gestational ages. This cannot be explained with any well-known mechanism. The frequency of chromosomal abnormalities needs detailed data for analysis.
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Affiliation(s)
- Kenji Yamatoya
- Department of Perinatal Medicine and Maternal CareNational Center for Child Health and DevelopmentTokyoJapan
- Department of Reproductive BiologyNational Research Institute for Child Health and DevelopmentTokyoJapan
| | - Kazuki Saito
- Department of Perinatal Medicine and Maternal CareNational Center for Child Health and DevelopmentTokyoJapan
- Department of Molecular EndocrinologyNational Research Institute for Child Health and DevelopmentTokyoJapan
| | - Takakazu Saito
- Department of Perinatal Medicine and Maternal CareNational Center for Child Health and DevelopmentTokyoJapan
| | - Woojin Kang
- Department of Perinatal Medicine and Maternal CareNational Center for Child Health and DevelopmentTokyoJapan
- Department of Reproductive BiologyNational Research Institute for Child Health and DevelopmentTokyoJapan
| | - Akihiro Nakamura
- Department of Life SciencesSchool of AgricultureMeiji UniversityKawasakiJapan
| | - Mami Miyado
- Department of Molecular EndocrinologyNational Research Institute for Child Health and DevelopmentTokyoJapan
| | - Natsuko Kawano
- Department of Reproductive BiologyNational Research Institute for Child Health and DevelopmentTokyoJapan
- Department of Life SciencesSchool of AgricultureMeiji UniversityKawasakiJapan
| | - Yoshitaka Miyamoto
- Department of Reproductive BiologyNational Research Institute for Child Health and DevelopmentTokyoJapan
| | - Akihiro Umezawa
- Department of Reproductive BiologyNational Research Institute for Child Health and DevelopmentTokyoJapan
| | - Kenji Miyado
- Department of Reproductive BiologyNational Research Institute for Child Health and DevelopmentTokyoJapan
| | - Hidekazu Saito
- Department of Perinatal Medicine and Maternal CareNational Center for Child Health and DevelopmentTokyoJapan
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18
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Qin J, Sheng X, Wu D, Gao S, You Y, Yang T, Wang H. Adverse Obstetric Outcomes Associated With In Vitro Fertilization in Singleton Pregnancies. Reprod Sci 2016; 24:595-608. [DOI: 10.1177/1933719116667229] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jiabi Qin
- Information Management Division, Hunan Provincial Maternal and Child Health Hospital, Changsha, Hunan, China
| | - Xiaoqi Sheng
- Division of Medical Genetics, Hunan Provincial Maternal and Child Health Hospital, Changsha, Hunan, China
| | - Di Wu
- Enrollment and Employment Office, Hunan University of Traditional Chinese Medicine, Changsha, Hunan, China
| | - Shiyou Gao
- Reproductive Medicine Center, Hunan Provincial Maternal and Child Health Hospital, Changsha, Hunan, China
| | - Yiping You
- Maternity Department, Hunan Provincial Maternal and Child Health Hospital, Changsha, Hunan, China
| | - Tubao Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Hunan, China
| | - Hua Wang
- Division of Medical Genetics, Hunan Provincial Maternal and Child Health Hospital, Changsha, Hunan, China
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Abstract
Although the use of donor sperm as a treatment modality for male infertility has become common place, the health outcomes for those conceived has been poorly studied. A structured search of the literature using PubMed, EMBASE and Cochrane Reviews was performed to investigate the health outcomes of offspring conceived from donor sperm. Eight studies were eligible and included in the review, and of these, three were included in a meta-analysis. Meta-analysis of clinical outcomes showed that donor sperm neonates are not at increased risk of being born of low birth weight (<2500 g), preterm (<37 weeks) or with increased incidences of birth defects, than spontaneously conceived neonates.
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20
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Stanford JB, Simonsen SE, Baksh L. Fertility treatments and adverse perinatal outcomes in a population-based sampling of births in Florida, Maryland, and Utah: a cross-sectional study. BJOG 2015; 123:718-29. [PMID: 26148540 DOI: 10.1111/1471-0528.13510] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate perinatal outcomes associated with fertility treatments, including assisted reproductive technology (ART), intrauterine insemination with ovulation stimulation (IUI), and ovulation stimulation alone (OS). DESIGN Population-representative cross-sectional survey of women with live births, 2004-2008. SETTING Florida, Maryland, and Utah, USA. SAMPLE 21 803 women, weighted to represent 1 022 597 women. METHODS Survey and birth certificate data were analysed with logistic regression models adjusted for age, education, race, income, and parity, using separate models for singletons and all births. We used two referent groups: (1) women who never used fertility treatment and (2) subfertile women conceiving without treatment. MAIN OUTCOME MEASURES Preterm birth (<37 weeks), very preterm birth (<34 weeks), low birthweight (<2500 g), and very low birthweight (<1500 g). RESULTS Referent group 1: In singletons, ART was associated with preterm birth (OR 3.28; 95% CI 1.74, 6.20) and low birthweight (OR 2.91; 95% CI 1.99, 4.26). OS was also associated with low birthweight (OR 1.62; 95% CI 1.19, 2.19). Including all births, treatment was associated with preterm birth and low birthweight: ART (OR 6.21; 95% CI 4.21, 9.16 and OR 6.51; 95% CI 4.85, 8.73); IUI (OR 2.10; 95% CI 1.24, 3.56 and OR 2.41; 95% CI 1.54, 3.76); OS (OR 1.40; 95% CI 1.01, 1.94 and OR 2.10; 95% CI 1.60, 2.75), respectively. Referent group 2: ART was associated with both outcomes in all births, but not singletons. CONCLUSIONS Preterm birth and low birthweight associated with fertility treatments are largely attributable to multiple gestation, but are also related to underlying subfertility. TWEETABLE ABSTRACT Preterm birth is associated with subfertility, and with fertility treatments through multiple gestation.
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Affiliation(s)
- J B Stanford
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - S E Simonsen
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - L Baksh
- Utah Department of Health, Maternal and Infant Health Program, Salt Lake City, UT, USA
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Declercq E, Luke B, Belanoff C, Cabral H, Diop H, Gopal D, Hoang L, Kotelchuck M, Stern JE, Hornstein MD. Perinatal outcomes associated with assisted reproductive technology: the Massachusetts Outcomes Study of Assisted Reproductive Technologies (MOSART). Fertil Steril 2015; 103:888-95. [PMID: 25660721 DOI: 10.1016/j.fertnstert.2014.12.119] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 10/28/2014] [Accepted: 12/18/2014] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To compare on a population basis the birth outcomes of women treated with assisted reproductive technologies (ART), women with indicators of subfertility but without ART, and fertile women. DESIGN Longitudinal cohort study. SETTING Not applicable. PARTICIPANT(S) A total of 334,628 births and fetal deaths to Massachusetts mothers giving birth in a Massachusetts hospital from July 1, 2004, to December 31, 2008, subdivided into three subgroups for comparison: ART 11,271, subfertile 6,609, and fertile 316,748. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Four outcomes-preterm birth, low birth weight, small for gestational age, and perinatal death-were modeled separately for singletons and twins with the use of logistic regression for the primary comparison between ART births and those to the newly created population-based subgroup of births to women with indicators of subfertility but no ART. RESULT(S) For singletons, the risks for both preterm birth and low birth weight were higher for the ART group (adjusted odds ratios [AORs] 1.23 and 1.26, respectively) compared with the subfertile group, and risks in both the ART and the subfertile groups were higher than those among the fertile births group. For twins, the risk of perinatal death was significantly lower among ART births than fertile (AOR 0.55) or subfertile (AOR 0.15) births. CONCLUSION(S) The use of a population-based comparison group of subfertile births without ART demonstrated significantly higher rates of preterm birth and low birth weight in ART singleton births, but these differences are smaller than differences between ART and fertile births. Further refinement of the measurement of subfertile births and examination of the independent risks of subfertile births is warranted.
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Affiliation(s)
- Eugene Declercq
- Boston University School of Public Health, Boston, Massachusetts.
| | - Barbara Luke
- Michigan State University, East Lansing, Michigan
| | - Candice Belanoff
- Boston University School of Public Health, Boston, Massachusetts
| | - Howard Cabral
- Boston University School of Public Health, Boston, Massachusetts
| | - Hafsatou Diop
- Massachusetts Department of Public Health, Boston, Massachusetts
| | - Daksha Gopal
- Boston University School of Public Health, Boston, Massachusetts
| | - Lan Hoang
- Boston University School of Public Health, Boston, Massachusetts
| | - Milton Kotelchuck
- Mass General Hospital for Children, Harvard Medical School, Boston, Massachusetts
| | - Judy E Stern
- Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Mark D Hornstein
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Messerlian C, Platt RW, Tan SL, Gagnon R, Basso O. Low-technology assisted reproduction and the risk of preterm birth in a hospital-based cohort. Fertil Steril 2014; 103:81-8.e2. [PMID: 25456793 DOI: 10.1016/j.fertnstert.2014.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 10/02/2014] [Accepted: 10/02/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To estimate the risk of preterm birth in singleton infants conceived through low-technology assisted reproduction (intrauterine insemination and/or ovulation induction/stimulation). DESIGN Hospital-based cohort study. SETTING University-affiliated hospital. PATIENT(S) Singleton babies born between 2001 and 2007 to 16,712 couples with no reported infertility (reference category), 378 babies conceived with low-technology treatment; 437 conceived with high-technology treatment; and 620 conceived naturally after a period of infertility. INTERVENTION(S) None. Treatment data were obtained from couples undergoing standard infertility investigation and care. MAIN OUTCOME MEASURE(S) Preterm birth, defined at three clinical endpoints: <37, <35, and <32 weeks of completed gestation. RESULT(S) After adjustment for age, parity, education, smoking, alcohol/drug use, and body mass index, the risk ratios and 95% confidence intervals (CI) of preterm birth for low technology were: 1.49 (CI: 1.12-2.00); 2.02 (CI: 1.30-3.13); and 2.93 (CI: 1.63-5.26) at <37, <35, and <32 weeks gestation, respectively, not dissimilar from the estimates for in vitro fertilization. Restricting the analysis to primiparas strengthened the association between treatment and preterm birth at the lower gestational endpoints. The increased risk persisted when the untreated group was used as the reference category, although the estimates were attenuated. CONCLUSION(S) In this large hospital-based cohort study, low-technology assisted reproduction appeared to be a moderately strong predictor of preterm birth, with similar associations observed in the high-technology treatment group. After adjusting for confounders, as well as the shared characteristics of infertile couples, associations were attenuated but remained significant, suggesting that part of the risk is likely attributable to the treatment.
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Affiliation(s)
- Carmen Messerlian
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
| | - Robert W Platt
- Departments of Pediatrics and of Epidemiology and Biostatistics, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
| | - Seang-Lin Tan
- Department of Obstetrics and Gynecology, McGill University, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Robert Gagnon
- Department of Obstetrics and Gynecology, McGill University, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Olga Basso
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Department of Obstetrics and Gynecology, McGill University, Royal Victoria Hospital, Montreal, Quebec, Canada
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Chen M, Wu L, Wu F, Wittert GA, Norman RJ, Robker RL, Heilbronn LK. Impaired glucose metabolism in response to high fat diet in female mice conceived by in vitro fertilization (IVF) or ovarian stimulation alone. PLoS One 2014; 9:e113155. [PMID: 25405530 PMCID: PMC4236136 DOI: 10.1371/journal.pone.0113155] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 10/20/2014] [Indexed: 12/20/2022] Open
Abstract
Individuals conceived by in vitro fertilization (IVF) may be at increased risk of cardio-metabolic disorders. We recently reported that IVF conceived male mice displayed impaired glucose metabolism at normal and high body weights. In this study, we examined glucose metabolism in mature female C57BL/6J mice that were conceived by natural conception (NC), by ovarian stimulation (OS) or by IVF following chow or high-fat diet (HFD) for 8 weeks. By design, litter size was comparable between groups, but interestingly the birth weight of IVF and OS females was lower than NC females (p ≤ 0.001). Mature IVF female mice displayed increased fasting glucose as compared to NC and OS mice, irrespective of diet. Mature IVF and OS mice were also more susceptible to the metabolic consequences of high fat diet as compared with NC females, with impaired glucose tolerance (p ≤ 0.01), whereas peripheral insulin resistance and increased hepatic expression of gluconeogenic genes Ppargc1α, Pck1 and G6pc was observed in IVF mice only (p<0.05). This study suggests that ovarian stimulation alone and IVF program distinct metabolic effects in females, but that high fat diet may be required to unmask these effects. This study adds to the growing body of literature that assisted reproduction procedures may increase the risk of developing type 2 diabetes in an obesity prone environment.
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Affiliation(s)
- Miaoxin Chen
- Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia, 5005
- Department of Obstetrics and Gynaecology, The Affiliated Hospital of Guiyang Medical College, Guiyang, China, 550004
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia, 5005
| | - Linda Wu
- Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia, 5005
| | - Fang Wu
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia, 5005
- Department of Emergency, The Affiliated Hospital of Guiyang Medical College, Guiyang, China, 550004
| | - Gary A. Wittert
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia, 5005
| | - Robert J. Norman
- Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia, 5005
| | - Rebecca L. Robker
- Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia, 5005
| | - Leonie K. Heilbronn
- Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia, 5005
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia, 5005
- * E-mail:
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Malchau SS, Loft A, Henningsen AKA, Nyboe Andersen A, Pinborg A. Perinatal outcomes in 6,338 singletons born after intrauterine insemination in Denmark, 2007 to 2012: the influence of ovarian stimulation. Fertil Steril 2014; 102:1110-1116.e2. [DOI: 10.1016/j.fertnstert.2014.06.034] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/13/2014] [Accepted: 06/19/2014] [Indexed: 11/15/2022]
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Chen M, Wu L, Zhao J, Wu F, Davies MJ, Wittert GA, Norman RJ, Robker RL, Heilbronn LK. Altered glucose metabolism in mouse and humans conceived by IVF. Diabetes 2014; 63:3189-98. [PMID: 24760136 DOI: 10.2337/db14-0103] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In vitro fertilization (IVF) may influence the metabolic health of children. However, in humans, it is difficult to separate out the relative contributions of genetics, environment, or the process of IVF, which includes ovarian stimulation (OS) and embryo culture. Therefore, we examined glucose metabolism in young adult humans and in adult male C57BL/6J mice conceived by IVF versus natural birth under energy-balanced and high-fat-overfeeding conditions. In humans, peripheral insulin sensitivity, as assessed by hyperinsulinemic-euglycemic clamp (80 mU/m(2)/min), was lower in IVF patients (n = 14) versus control subjects (n = 20) after 3 days of an energy-balanced diet (30% fat). In response to 3 days of overfeeding (+1,250 kcal/day, 45% fat), there was a greater increase in systolic blood pressure in IVF versus controls (P = 0.02). Mice conceived after either OS alone or IVF weighed significantly less at birth versus controls (P < 0.01). However, only mice conceived by IVF displayed increased fasting glucose levels, impaired glucose tolerance, and reduced insulin-stimulated Akt phosphorylation in the liver after 8 weeks of consuming either a chow or high-fat diet (60% fat). Thus, OS impaired fetal growth in the mouse, but only embryo culture resulted in changes in glucose metabolism that may increase the risk of the development of metabolic diseases later in life, in both mice and humans.
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Affiliation(s)
- Miaoxin Chen
- Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, South Australia, Australia Department of Obstetrics and Gynaecology, The Affiliated Hospital of Guiyang Medical College, Guiyang, People's Republic of China Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Linda Wu
- Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Junli Zhao
- Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, South Australia, Australia Reproductive Medicine Center, The General Hospital of Ningxia Medical University, Yinchuan, People's Republic of China
| | - Fang Wu
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia Department of Emergency, The Affiliated Hospital of Guiyang Medical College, Guiyang, People's Republic of China
| | - Michael J Davies
- Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Gary A Wittert
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Robert J Norman
- Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Rebecca L Robker
- Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Leonie K Heilbronn
- Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, South Australia, Australia Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
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Mirghafourvand M, Sehhati F, Rahimi M. Health-promoting Lifestyle and its Demographic Predictors in Infertile Couples Referred to Infertility Clinic of Tabriz Al-Zahra Hospital, 2013. J Caring Sci 2014; 3:175-84. [PMID: 25276761 DOI: 10.5681/jcs.2014.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 06/18/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Improving the lifestyle of infertile couples led to the preservation of their performance, increase their quality of life, and reduce health cost. So, the aims of this study were to determine the health-promoting lifestyle and its predictors among infertile couples. METHODS In a cross-sectional, analytical study 322 infertile couples referred to an infertility clinic in Tabriz was participated with convenience sampling method. The demographic and the standard Health Promoting Lifestyle-II (HPLP II) questionnaires were completed by all couples individually. For determining the demographic predictors of health-promoting lifestyle, the multivariate linear regression was used. RESULTS The mean (standard deviation) score of health-promoting lifestyle in couples was 2.4 (0.4) of the achievable score ranged from 1 to 4. The highest mean score was for nutrition subscale 2.6 (0.5) in both men and women and the lowest mean score was for physical activity subscale in women 2.1(0.5) and men 2.3(0.5) and health responsibility subscale (2.3(0.5) in both men and women. Educational level, cause of infertility, adequacy of income for living expense, and living situation were predictors of health-promoting lifestyle. CONCLUSION The results showed that participants do not carry out all health-promoting behaviors, especially physical activity and health responsibility, in an acceptable level. These behaviors have an important role in improving the quality of life, health maintenance, and fertility. Thus, the provision of strategies, including those in accordance with predictors of health-promoting behaviors, is important for improving the health status of infertile couples.
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Affiliation(s)
- Mojgan Mirghafourvand
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fahimeh Sehhati
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mareieh Rahimi
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Vargas-Hernández V, Tovar-Rodríguez J, Acosta-Altamirano G, Moreno-Eutimio M. Papel de la inseminación intrauterina en la era de la fertilización in vitro. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2014. [DOI: 10.1016/j.gine.2013.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chambers GM, Lee E, Hoang VP, Hansen M, Bower C, Sullivan EA. Hospital utilization, costs and mortality rates during the first 5 years of life: a population study of ART and non-ART singletons. Hum Reprod 2013; 29:601-10. [DOI: 10.1093/humrep/det397] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Poon WB, Lian WB. Perinatal outcomes of intrauterine insemination/clomiphene pregnancies represent an intermediate risk group compared with in vitro fertilisation/intracytoplasmic sperm injection and naturally conceived pregnancies. J Paediatr Child Health 2013; 49:733-40. [PMID: 23758121 DOI: 10.1111/jpc.12257] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2013] [Indexed: 11/30/2022]
Abstract
AIM To compare the pregnancy outcomes in terms of perinatal morbidities and mortality for different types of assisted reproductive technology (ART). METHODS A retrospective cohort study was conducted of all babies born by ART in Singapore General Hospital, between 1 November 2001 and 11 January 2012. RESULTS Incidence of ART was 3.5% in our birth cohort. Pregnancies conceived by ART were more likely to be multiple pregnancies OR 43.50, and were more likely to be premature OR 5.51. Mortality OR was 3.93. IVF/ICSI contributed to an increased OR for multiple gestation of 48.26, an increased OR for prematurity of 5.95 and increased OR for low birthweight of 5.54. Mortality OR was 4.33. Intrauterine insemination (IUI)/clomiphene may represent a lower risk group compared with in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI). Prematurity OR was only 2.35, and low birthweight OR was 2.38. These were less than half of IVF/ICSI. Fewer neonatal morbidities were found. Mortality was insignificant. Multiplicity had significant impact on perinatal outcomes in ART and IVF/ICSI but not in IUI/clomiphene conceptions, demonstrated by singleton subgroup analyses and by logistic regression using prematurity as outcome. CONCLUSION IUI/clomiphene represented an intermediate risk group compared with the IVF/ICSI.
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Affiliation(s)
- Woei Bing Poon
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore, Singapore; Duke-NUS Medical School, Singapore, Singapore
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Impact of assisted reproduction treatments on Spanish newborns: report of 14,119 pregnancies. J Assist Reprod Genet 2013; 30:897-905. [PMID: 23779097 DOI: 10.1007/s10815-013-0023-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 05/24/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To investigate neonatal malformation, prematurity, and stillbirth in singleton and multiple pregnancies derived from different Assisted Reproductive Techniques (ART). METHODS In this prospective cohort study data were collected, from private and public Spanish IVF units, during the years 2008 and 2009. During this period, 8,682 pregnancies were analysed from the initial 14,119 pregnancies reported. Pregnancies included in the study derived from IUI (n = 1,065), IVF (n = 838), ICSI (n = 5,080), FET (n = 1,404) and PGD (n = 295). This first analysis focuses primarily on neonatal malformation, prematurity, and stillbirth both in singleton and multiple pregnancies derived from different ART. Malformations were classified according to the WHO ICD 10 code. RESULTS Malformations were found in 0.83 % of our newborns. No differences in malformations were observed between singletons or multiples independently of the ART used. There was a significant difference in prematurity rate among singletons depending on treatment but this association was not observed in multiple pregnancies. Stillbirth was significantly lower in singleton (0.72 %) than in multiple pregnancies (1.82 %). CONCLUSIONS The percentage of malformations observed in ART newborns was similar to the rate observed in the normally-conceived Spanish population. Multiplicity seems to be the most important factor associated with an increased incidence of newborn complications such as prematurity or stillbirth.
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Pinborg A, Wennerholm UB, Romundstad LB, Loft A, Aittomaki K, Söderström-Anttila V, Nygren KG, Hazekamp J, Bergh C. Why do singletons conceived after assisted reproduction technology have adverse perinatal outcome? Systematic review and meta-analysis. Hum Reprod Update 2012; 19:87-104. [PMID: 23154145 DOI: 10.1093/humupd/dms044] [Citation(s) in RCA: 470] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Assisted reproduction technology (ART) is used worldwide, at increasing rates, and data show that some adverse outcomes occur more frequently than following spontaneous conception (SC). Possible explanatory factors for the well-known adverse perinatal outcome in ART singletons were evaluated. METHODS PubMed and Cochrane databases from 1982 to 2012 were searched. Studies using donor or frozen oocytes were excluded, as well as those with no control group or including <100 children. The main outcome measure was preterm birth (PTB defined as delivery <37 weeks of gestation), and a random effects model was used for meta-analyses of PTB. Other outcomes were very PTB, low-birthweight (LBW), very LBW, small for gestational age and perinatal mortality. RESULTS The search returned 1255 articles and 65 of these met the inclusion criteria. The following were identified as predictors for PTB in singletons: SC in couples with time to pregnancy (TTP) > 1 year versus SC singletons in couples with TTP ≤ 1 year [adjusted odds ratio (AOR) 1.35, 95% confidence interval (CI) 1.22, 1.50]; IVF/ICSI versus SC singletons from subfertile couples (TTP > 1 year; AOR 1.55, 95% CI 1.30, 1.85); conception after ovulation induction and/or intrauterine insemination versus SC singletons where TTP ≤ 1 year (AOR 1.45, 95% CI 1.21, 1.74); IVF/ICSI singletons versus their non-ART singleton siblings (AOR 1.27, 95% CI 1.08, 1.49). The risk of PTB in singletons with a 'vanishing co-twin' versus from a single gestation was AOR of 1.73 (95% CI 1.54, 1.94) in the narrative data. ICSI versus IVF (AOR 0.80, 95% CI 0.69-0.93), and frozen embryo transfer versus fresh embryo transfer (AOR 0.85, 95% CI 0.76, 0.94) were associated with a lower risk of PTB. CONCLUSIONS Subfertility is a major risk factor for adverse perinatal outcome in ART singletons, however, even in the same mother an ART singleton has a poorer outcome than the non-ART sibling; hence, factors related to the hormone stimulation and/or IVF methods per se also may play a part. Further research is required into mechanisms of epigenetic modification in human embryos and the effects of cryopreservation on this, whether milder ovarian stimulation regimens can improve embryo quality and endometrial conditions, and whether longer culture times for embryos has a negative influence on the perinatal outcome.
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Affiliation(s)
- A Pinborg
- Fertility Clinic, Section 4071, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK - 2100 Copenhagen, Denmark.
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Nakashima A, Araki R, Tani H, Ishihara O, Kuwahara A, Irahara M, Yoshimura Y, Kuramoto T, Saito H, Nakaza A, Sakumoto T. Implications of assisted reproductive technologies on term singleton birth weight: an analysis of 25,777 children in the national assisted reproduction registry of Japan. Fertil Steril 2012; 99:450-5. [PMID: 23058683 DOI: 10.1016/j.fertnstert.2012.09.027] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 09/01/2012] [Accepted: 09/18/2012] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the implications of assisted reproductive technologies (ART) on neonatal birth weight. DESIGN A retrospective study using analysis of covariance and multiple logistic regression analysis of the Japanese ART registry. SETTING Japanese institutions providing ART treatment. PATIENT(S) A total of 25,777 singleton neonates reaching term gestation following ART during the years 2007-2008, with 11,374 achieved through fresh embryo transfers (fresh ET) and 14,403 achieved through frozen-thawed embryo transfers (FET). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Birth weight. RESULT(S) The mean birth weight after FET was significantly higher compared with fresh ET and all Japanese births (3,100.7 ± 387.2 g, 3,009.8 ± 376.8 g, and 3,059.6 ± 369.6 g, respectively). The risk for low birth weight in FET was significantly lower compared with fresh ET. In fresh ET, ovarian stimulations were associated with about twofold risk of low birth weight compared with natural cycle. Regarding to the duration of embryonic culture, the risks resulting from a shorter culturing time were significantly higher compared with a longer culturing time in fresh ET. CONCLUSION(S) The best method of embryo transfer for fetal growth was FET after extended culturing until blastocyst stage. However, further investigations should be performed to understand the safety of ART treatment.
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Affiliation(s)
- Akira Nakashima
- Division of Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
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Joshi N, Kissin D, Anderson JE, Session D, Macaluso M, Jamieson DJ. Trends and correlates of good perinatal outcomes in assisted reproductive technology. Obstet Gynecol 2012; 120:843-51. [PMID: 22996102 PMCID: PMC4454287 DOI: 10.1097/aog.0b013e318269c0e9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate trends in good perinatal outcomes (singleton live births at term with birthweight more than 2,500 g) among live births after assisted reproductive technology in the United States from 2000 to 2008, and associated factors among singletons in 2008. METHODS Using retrospective cohort data from the National Assisted Reproductive Technology Surveillance System from 2000 to 2008, we calculated relative change and χ tests for trend in the proportion of good perinatal outcomes among assisted reproductive technology live births (n=444,909) and liveborn singletons (n=222,500). We conducted univariable analyses followed by multiple logistic regression to estimate the effects of various characteristics on the outcome among singletons born in 2008 after fresh, nondonor assisted reproductive technology cycles (n=20,780). RESULTS The proportion of good perinatal outcomes among all liveborn neonates increased from 38.6% in 2000 to 42.5% in 2008, whereas it declined marginally among singletons from 83.6% to 83.4%. One previous birth, transfer of fewer than three embryos, and the presence of fewer than three fetal hearts on 6-week ultrasound examination were associated with good perinatal outcome among singletons. Non-Hispanic black race, tubal factor infertility, uterine factor infertility, ovulatory disorder, and 5-day embryo culture were associated with reduced odds for a good outcome. The strongest association was the presence of one fetal heart compared with more than two (adjusted odds ratio 2.43, 95% confidence interval 1.73-3.42). CONCLUSION From 2000 to 2008, good perinatal outcomes increased among assisted reproductive technology live births. Among singleton live births, odds for good outcome were greatest with the presence of a single fetal heart and lowest in women of non-Hispanic black race. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Nikhil Joshi
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia 30303, USA.
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Cooper AR, O'Neill KE, Allsworth JE, Jungheim ES, Odibo AO, Gray DL, Ratts VS, Moley KH, Odem RR. Smaller fetal size in singletons after infertility therapies: the influence of technology and the underlying infertility. Fertil Steril 2011; 96:1100-6. [PMID: 21944928 DOI: 10.1016/j.fertnstert.2011.08.038] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 08/24/2011] [Accepted: 08/25/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To determine whether fetal size differences exist between matched fertile and infertile women and among women with infertility achieving pregnancy through various treatment modalities. DESIGN Retrospective cohort study with propensity score analysis. SETTING Tertiary care center and affiliated community hospitals. PATIENT(S) 1,246 fertile and 461 infertile healthy women with singleton livebirths over a 10-year period. INTERVENTION(S) Infertile women conceiving without medical assistance, with ovulation induction, or with in vitro fertilization. MAIN OUTCOME MEASURE(S) Birthweight; secondary outcomes included crown-rump length, second-trimester estimated fetal weight, and incidence of low birth weight and preterm delivery. RESULT(S) Compared with matched fertile women, infertile women had smaller neonates at birth (3,375 ± 21 vs. 3,231 ± 21 g) and more low-birth-weight infants (relative risk = 1.68, 95% confidence interval, 1.06, 2.67). Neonates conceived via ovulation induction were the smallest among the infertility subgroups compared with the neonates of fertile women (3,092 ± 46 vs. 3,397 ± 44 g). First-trimester fetal size was smaller in infertile versus fertile women (crown-rump length 7.9 ± 0.1 vs. 8.5 ± 0.1 mm). Within the infertility subgroups, no differences in fetal or neonatal size were found. CONCLUSION(S) The inherent pathologic processes associated with infertility may have a larger impact on fetal growth than infertility therapies.
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Affiliation(s)
- Amber R Cooper
- Division of Reproductive Endocrinology and Infertility, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, Missouri 63108, USA.
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Clinical outcomes and development of children born after intracytoplasmic sperm injection (ICSI) using extracted testicular sperm or ejaculated extreme severe oligo-astheno-teratozoospermia sperm: a comparative study. Fertil Steril 2011; 96:567-71. [DOI: 10.1016/j.fertnstert.2011.06.080] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 06/14/2011] [Accepted: 06/30/2011] [Indexed: 11/19/2022]
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Díaz-García C, Estella C, Perales-Puchalt A, Simón C. Reproductive medicine and inheritance of infertility by offspring: the role of fetal programming. Fertil Steril 2011; 96:536-45. [PMID: 21794856 DOI: 10.1016/j.fertnstert.2011.06.066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Revised: 06/22/2011] [Accepted: 06/23/2011] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To summarize the molecular processes involved in fetal programming, to describe how assisted reproduction technologies (ART) may affect the epigenetic pattern of the embryo, and to highlight the current knowledge of the role of perinatal events in the subsequent development of reproductive pathology affecting infertile patients. DESIGN A literature review of fetal programming of adulthood gynecologic diseases and ART. A Medline search was performed with the following keywords: (fetal programming OR epigenetics OR methylation OR acetylation) AND (IVF OR ART) AND (gynecology). Articles up to October 2010 were selected. Articles and recent reviews were classified by human and animals studies and also according to their experimental or observational design. SETTING University hospital research center. PATIENT(S) None. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) None. RESULT(S) Data from experimental animal models and case-control studies support the potential effect of ART in changing methylation patterns in gametes and embryos. However, these findings are not supported by population studies or experimental studies performed in human gametes/embryos. Experimental and epidemiologic studies support the hypothesis that some adult gynecologic diseases causing infertility may have a fetal origin. CONCLUSION(S) Although it seems clear that some adult gynecologic diseases causing infertility may have a fetal origin, there is insufficient evidence to confirm that ART is the origin of later onset, adulthood diseases. Further research in this field must be conducted.
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Affiliation(s)
- César Díaz-García
- Department of Gynecology and Obstetrics, La Fe University Hospital, University of Valencia, Valencia, Spain.
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The potential use of intrauterine insemination as a basic option for infertility: a review for technology-limited medical settings. Obstet Gynecol Int 2011; 2009:584837. [PMID: 20011061 PMCID: PMC2778500 DOI: 10.1155/2009/584837] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 01/15/2009] [Indexed: 11/17/2022] Open
Abstract
Objective. There is an asymmetric allocation of technology and other resources for infertility services. Intrauterine insemination (IUI) is a process of placing washed spermatozoa transcervically into the uterine cavity for treatment of infertility. This is a review of literature for the potential use of IUI as a basic infertility treatment in technology-limited settings. Study design. Review of articles on treatment of infertility using IUI. Results. Aspects regarding the use of IUI are reviewed, including ovarian stimulation, semen parameters associated with good outcomes, methods of sperm preparation, timing of IUI, and number of inseminations. Implications of the finding in light of the needs of low-technology medical settings are summarized. Conclusion. The reviewed evidence suggests that IUI is less expensive, less invasive, and comparably effective for selected patients as a first-line treatment for couples with unexplained or male factor infertility. Those couples may be offered three to six IUI cycles in technology-limited settings.
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D'Angelo DV, Whitehead N, Helms K, Barfield W, Ahluwalia IB. Birth outcomes of intended pregnancies among women who used assisted reproductive technology, ovulation stimulation, or no treatment. Fertil Steril 2011; 96:314-320.e2. [PMID: 21718990 DOI: 10.1016/j.fertnstert.2011.05.073] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 05/20/2011] [Accepted: 05/22/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To study birth outcomes among live born infants conceived by women who used infertility treatment. DESIGN Population-based surveillance of women who recently delivered a live infant. SETTING The birth outcomes among infants whose mothers used assisted reproductive technology (ART) or ovulation stimulation medications alone were compared with the outcomes of infants conceived without treatment. PATIENT(S) Stratified random sample of women who were attempting conception and gave birth to a live infant in six US states (n = 16,748). INTERVENTION(S) Assisted reproductive technology and ovulation stimulation. MAIN OUTCOME MEASURE(S) Adjusted odds ratios for perinatal outcomes. RESULT(S) The prevalence of infertility treatment use overall among women attempting conception was 10.9% (5.4% ART procedures, 5.5% ovulation stimulation medications). Singletons of mothers who received ART procedures were more likely to be born with low birthweight, preterm, and small for gestational age (SGA) than singleton infants conceived without treatment. Singleton infants of mothers who used ovulation stimulation medications alone were more likely to be SGA than singleton infants conceived without treatment. No differences were found between ART and no treatment twin infants. CONCLUSION(S) Among singleton infants, ART is associated with decreased fetal growth, decreased gestational length, and SGA; ovulation stimulation alone is associated with SGA.
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Affiliation(s)
- Denise V D'Angelo
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, 4770 Buford Highway, NE Mailstop K-22, Atlanta, Georgia 30341, USA.
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Ludwig M, Ludwig A. Genetische Risiken der assistierten Reproduktion. MED GENET-BERLIN 2011. [DOI: 10.1007/s11825-011-0273-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Zusammenfassung
Kinderwunschpatienten müssen vor einer Behandlung über die genetischen Risiken individuell beraten werden. Chromosomenanomalien sind für etwa 5% der männlichen Subfertilität verantwortlich. Im Fall einer Azoospermie liegt die Rate bei 15%. Daher sollte bei einer männlichen Subfertilität bei einer Spermienzahl <20 Mio./ml eine Chromosomenanalyse bei beiden Partnern durchgeführt werden, da ein erhöhtes Risiko für genetische Veränderungen besteht. Ein Klinefelter-Syndrom oder eine Robertson-Translokation können für eine männliche Subfertilität verantwortlich sein. Mutationen des CFTR-Gens sowie Veränderungen des Y-Chromosoms findet man gehäuft bei männlicher Subertiltät. Mikrodeletionen treten am häufigsten am langen Arm des Y-Chromosoms auf (Yq) und betreffen Gene, die direkt in die Spermatogenese involviert sind, insbesondere das AZF-Gen.
Bezüglich Schwangerschaftsverlauf und neonatalem Outcome der Kinder müssen Kinderwunschpatienten darüber aufgeklärt werden, dass während der Schwangerschaft und der Geburt häufiger Komplikationen auftreten als nach Spontankonzeption. Das Fehlgeburtsrisiko ist um das 1,3-Fache erhöht, dies ist jedoch vermutlich Folge der Subfertilität sowie weiterer Risikofaktoren, die die Paare mitbringen, und nicht Folge der Therapie. Das Risiko für Schwangerschaftskomplikationen wie Präeklampsie, Wachstumsretardierung und Totgeburt ist ebenfalls erhöht. Zudem ist das Fehlbildungsrisiko sowohl bei der IVF-Therapie als auch bei der ICSI-Therapie um das 1,3-Fache erhöht.
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Affiliation(s)
- M. Ludwig
- Aff1_273 amedes, Zentrum für Endokrinologie, Kinderwunsch und Pränatale Medizin Mönckebergstr. 10 (Barkhof) 20095 Hamburg Deutschland
| | - A.K. Ludwig
- Aff1_273 amedes, Zentrum für Endokrinologie, Kinderwunsch und Pränatale Medizin Mönckebergstr. 10 (Barkhof) 20095 Hamburg Deutschland
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Schwangerschaft und Geburt nach assistierter Reproduktion. GYNAKOLOGISCHE ENDOKRINOLOGIE 2010. [DOI: 10.1007/s10304-010-0377-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Reid SM, Jaques AM, Susanto C, Breheny S, Reddihough DS, Halliday J. Cerebral palsy and assisted reproductive technologies: a case-control study. Dev Med Child Neurol 2010; 52:e161-6. [PMID: 20015250 DOI: 10.1111/j.1469-8749.2009.03556.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To determine whether assisted reproductive technologies (ART) were more likely to be the method of conception in singletons with cerebral palsy (CP) than in those without CP. METHOD Singletons with CP born between 1991 and 2004 were selected from the Victorian Cerebral Palsy Register and matched for birth year to two singletons randomly selected from the Victorian Perinatal Data Collection Unit. Data from both sources were linked to records from three ART centres. Conditional logistic regression was used to assess the association between CP and aspects of conception using ART. Multivariate models were adjusted for parity, previous miscarriages, sex, gestational age, birthweight, and weight for gestational age. RESULTS We identified 1241 singletons with CP (males n=721 [58%], females n=420 [42/100]; motor type: spastic [87%; unilateral 37%; bilateral 63%], ataxic n=60 [5/100], dyskinetic n=46 [4/100], hypotonic n=29 [2/100], unknown n=25 [2/100]. Gross Motor Function Classification System levels were I n=363 [29/100], II n=297 [24/100], III n=137 [11/100], IV n=160 [13/100], V n=192 [15/100], and unknown n=92 [7/100]). Sixteen (1.3/100) of the children with CP and 25 (1.0/100) of 2482 children without CP were conceived using ART. There was no significant increase in the odds of children with CP being conceived using ART (adjusted odds ratio 1.19, 95% confidence interval (CI) 0.63, 2.24) nor in the odds of them being conceived by a subfertile couple without ART (adjusted odds ratio 2.7, 95% CI 0.87, 8.36). INTERPRETATION Singleton conception using ART is not strongly associated with an increased risk of CP.
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Affiliation(s)
- Susan M Reid
- Developmental Disability Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
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Hvidtjørn D, Grove J, Schendel D, Svaerke C, Schieve LA, Uldall P, Ernst E, Jacobsson B, Thorsen P. Multiplicity and early gestational age contribute to an increased risk of cerebral palsy from assisted conception: a population-based cohort study. Hum Reprod 2010; 25:2115-23. [PMID: 20554642 DOI: 10.1093/humrep/deq070] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This paper assesses the risk of cerebral palsy (CP) in children born after assisted conception compared with children born after natural conception (NC). METHODS This population based follow-up study included all 588,967 children born in Denmark from 1995 to 2003. Assisted conception was defined as IVF, with or without ICSI, and ovulation induction (OI), with or without subsequent insemination. RESULTS There were 33 139 (5.6%) children born in Denmark from 1995 to 2003 as a result of assisted conception and through to June 2009, 1146 (0.19%) children received a CP diagnosis. Children born after assisted conception had an increased risk of a CP diagnosis, crude hazard rate ratio (HRR) 1.90 (95% CI: 1.57-2.31) compared with NC children. Divided into IVF and OI children compared with NC children, the risk was HRR 2.34 (95% CI: 1.81-3.01) and HRR 1.55 (95% CI: 1.17-2.06), respectively. When we included the intermediate factors multiplicity and gestational age in multivariate models, the risk of CP in assisted conception disappeared. In general, children with CP born after assisted conception had similar CP subtypes and co-morbidities as children with CP born after NC. CONCLUSION The risk of CP is increased after both IVF and OI. The increased risk of CP in children born after assisted conception, and in particular IVF, is strongly associated with the high proportion of multiplicity and preterm delivery in these pregnancies. A more widespread use of single embryo transfer warrants consideration to enhance the long-term health of children born after IVF.
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Affiliation(s)
- D Hvidtjørn
- Institute of Public Health, Department of Epidemiology, University of Aarhus, 8000 Arhus, Denmark.
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Gallot V, Even M, Da Silva ALB, Grynberg M, Lamazou F, Fanchin R. [Against performing homologous intrauterine insemination beyond 35 years of age]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2010; 38:290-291. [PMID: 20374977 DOI: 10.1016/j.gyobfe.2010.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- V Gallot
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, AP-HP, Université Paris-Sud, Clamart, France.
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Schieve LA, Devine O, Boyle CA, Petrini JR, Warner L. Estimation of the contribution of non-assisted reproductive technology ovulation stimulation fertility treatments to US singleton and multiple births. Am J Epidemiol 2009; 170:1396-407. [PMID: 19854803 DOI: 10.1093/aje/kwp281] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Infertility treatments that include ovulation stimulation, both assisted reproductive technologies (ARTs) and non-ART ovulation stimulation, are associated with increased risks of multiple birth and concomitant sequelae and adverse outcomes, even among singletons. While a US surveillance system for ART-induced births is ongoing, no population-based tracking system exists for births resulting from non-ART treatments. The authors developed a multistage model to estimate the uncertain proportion of US infants born in 2005 who were conceived by using non-ART ovulation treatments. Using published surveillance data, they estimated proportions of US multiple births conceived naturally and by ART and assumed that the remainder were conceived with non-ART treatments. They used Bayesian meta-analyses to summarize published clinical studies on the multiple-gestation risk associated with non-ART ovulation treatments, applied a fetal survival factor, and used this multiple-birth risk estimate and their own estimate of the proportion of US multiple births attributable to non-ART ovulation stimulation to estimate the total (and, through subtraction, singleton) proportion of infants conceived with such treatments. On the basis of the model, the authors estimate that 4.6% of US infants born in 2005 (95% uncertainty range: 2.8%-7.1%) resulted from non-ART ovulation treatments. Notably, this figure is 4 times greater than the ART contribution.
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Affiliation(s)
- Laura A Schieve
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, MS E-86, 1600 Clifton Road, Atlanta, GA 30333, USA.
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Abstract
PURPOSE OF REVIEW Observational studies have reported small but increased risk of birth defects associated with assisted reproductive technology (ART) pregnancies. We intend to review the current data on this issue to provide essential information for patient counseling. RECENT FINDINGS There is lack of consensus on whether ART per se increases the risk of birth defects, genetic and imprinting disorders, mostly due to the bias inherent to the observational studies, which suggest 30-40% increased risk of birth defects with ART. Recent reports suggest that apparent risks for adverse outcome following ART may be largely related to parental infertility-linked factors. Criteria used to define birth defects bring challenges as well. SUMMARY All couples undergoing these procedures should be counseled about the current information suggesting elevated risks of birth defects, genetic abnormalities and imprinting disorders associated with infertility and the infertility treatment with ART. In order to elucidate the controversy whether ART is associated with adverse outcome in the offspring, a multinational collaborative effort is needed, as the required sample size is between 10 000 and 84 000 or more.
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Abstract
In vitro fertilisation and intra-cytoplasmic sperm injection are well recognised techniques for assisted reproduction, helping over 85% of infertile couples conceive within a year, contributing to over 1% of the annual birth rate in the western world. There is currently limited data on the health of these children in later life as the techniques are relatively new. Certain trends have started to emerge with high order births proving to be responsible for a large proportion of premature and low-birth weight infants. The increased risk of perinatal morbidity and mortality associated with singleton births has been linked to the infertility of the couple rather than the techniques used. This theory has also been suggested to account for the increase in congenital malformations observed. No discrepancies in neurodevelopmental outcome of these children have been established and no detrimental psychological effects on the families have been reported. There has been an increase in childhood illness observed and the future fertility of these children is a major concern for many parents. Further follow up of these children is needed to fully establish the long-term health implications of in vitro fertilisation and intra-cytoplasmic sperm injection.
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Affiliation(s)
- Anna Judith Steel
- Department of Paediatrics, University College London Hospital, London, UK.
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Hansen M, Colvin L, Petterson B, Kurinczuk JJ, de Klerk N, Bower C. Twins born following assisted reproductive technology: perinatal outcome and admission to hospital. Hum Reprod 2009; 24:2321-31. [PMID: 19458317 DOI: 10.1093/humrep/dep173] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Compared with spontaneously conceived (SC) singletons, adverse perinatal outcome, neonatal intensive care unit (NICU) admission and hospital admission in infancy are more common in those born following Assisted Reproductive Technology (ART). Similar comparisons for twins have shown conflicting results. METHODS We investigated perinatal outcome and hospital admission during the first 3 years of life for all twin children born in Western Australia between 1994 and 2000 [700 ART, 4097 SC]. RESULTS ART twins had a greater risk of adverse perinatal outcome including preterm birth, low birthweight and death compared with SC twins of unlike-sex. In their first year of life, ART twins had a longer birth admission; were 60% more likely to be admitted to a NICU; and had a higher risk of hospital admission. The increased risk of hospital admission continued in the second and third year but was not statistically significant in the third year. CONCLUSIONS Couples undertaking ART should be aware that in addition to the known increased perinatal risks associated with a twin birth, ART twins are more likely than SC twins to be admitted to a NICU and hospitalized in the first 3 years of life.
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Affiliation(s)
- Michèle Hansen
- Centre for Child Health Research, Telethon Institute for Child Health Research, The University of Western Australia, West Perth, WA 6872, Australia.
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Klemetti R, Sevón T, Gissler M, Hemminki E. Health of children born after ovulation induction. Fertil Steril 2009; 93:1157-68. [PMID: 19171331 DOI: 10.1016/j.fertnstert.2008.12.025] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Revised: 12/09/2008] [Accepted: 12/11/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To study the health of children born after ovulation induction (OI). DESIGN Nationwide register-based study. SETTING The OI children were followed up to the age of 4 years and compared with other children. PATIENT(S) The OI children (N = 4,467). Two control groups: all other children (excluding children born after IVF, N = 190,398) and a random sample of those children (n = 26,877). INTERVENTION(S) Ovulation induction treatment in ordinary practice. MAIN OUTCOME MEASURE(S) Mortality rates and adjusted odds ratios for perinatal outcomes, hospitalizations, health-related benefits, and long-term medication use. RESULT(S) A total of 12% of OI and 2% of control children were multiples. Even after stratifying for multiplicity and adjusting for the available confounding factors (region, smoking, maternal age, socioeconomic position, and parity for perinatal health and mother's socioeconomic position for other indicators), most indicators showed worse health among OI children compared with control children. The OI children had poorer perinatal health and more episodes of long hospitalization than the control children. Singleton OI children had more long-term illnesses in childhood, as measured by child disability allowance, long-term medication use, and hospital care episodes. CONCLUSION(S) Either OI treatment or the reasons for the treatment increase the risk of health problems in early childhood.
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Affiliation(s)
- Reija Klemetti
- Health Services Research, STAKES, National Research and Development Centre for Welfare and Health, Helsinki, Finland.
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Ombelet W, Campo R, Bosmans E, Nijs M. Intrauterine insemination (IUI) as a first-line treatment in developing countries and methodological aspects that might influence IUI success. ACTA ACUST UNITED AC 2008. [DOI: 10.1093/humrep/den165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Male reproductive proteins and reproductive outcomes. Am J Obstet Gynecol 2008; 198:620.e1-4. [PMID: 18191798 DOI: 10.1016/j.ajog.2007.09.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Accepted: 09/08/2007] [Indexed: 11/22/2022]
Abstract
Male reproductive proteins (MRPs), associated with sperm and semen, are the moieties responsible for carrying male genes into the next generation. Evolutionary biologists have focused on their capacity to control conception. Immunologists have shown that MRPs cause female genital tract inflammation as preparatory for embryo implantation and placentation. These observations argue that MRPs are critically important to reproductive success. Yet the impact of male reproductive proteins on obstetrical outcomes in women is largely unstudied. Epidemiologic and clinical observations suggest that shorter-duration exposure to MRPs prior to conception may elevate the risk for preeclampsia. A limited literature has also linked sexual behavior to bacterial vaginosis and preterm birth. We offer a clinical opinion that MRPs may have broad implications for successful reproduction, potentially involved in the composition of vaginal microflora, risks of preterm birth and preeclampsia, and success of assisted reproduction.
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