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Schottler NI, Sutcliffe AG. Children born to subfertile couples, how are they doing? Evidence from research. Arch Dis Child 2024:archdischild-2023-326023. [PMID: 38589201 DOI: 10.1136/archdischild-2023-326023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/22/2024] [Indexed: 04/10/2024]
Abstract
More than 10 million children have been born with assisted reproductive technology (ART) as we begin to enter the third generation of individuals conceived by ART. Here we summarise key messages from an enlarging body of literature regarding their health. Earlier research had pointed towards increases in perinatal, neonatal and neurological risks, such as preterm birth, low birth weight, congenital malformations and cerebral palsy. Many of these risks have continued to persist in most recent work but have shown reduction. Newer research proposes long-term cardiometabolic and endocrine concerns. Fortunately, most reports conclude there is little or no risk of increased childhood malignancy or abnormal neurodevelopment. Moving forward, new research may benefit from changes in comparator groups and a better understanding of infertility per se in ART, and the confounding role it probably plays in many of the known risk associations, to reliably scan the horizon for health threats for individuals born after ART.
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Gullo G, Scaglione M, Cucinella G, Chiantera V, Perino A, Greco ME, Laganà AS, Marinelli E, Basile G, Zaami S. Neonatal Outcomes and Long-Term Follow-Up of Children Born from Frozen Embryo, a Narrative Review of Latest Research Findings. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091218. [PMID: 36143894 PMCID: PMC9500816 DOI: 10.3390/medicina58091218] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022]
Abstract
In recent years, the growing use of ART (assisted reproductive techniques) has led to a progressive improvement of protocols; embryo freezing is certainly one of the most important innovations. This technique is selectively offered as a tailored approach to reduce the incidence of multiple pregnancies and, most importantly, to lower the risk of developing ovarian hyperstimulation syndrome when used in conjunction with an ovulation-triggering GnRH antagonist. The increase in transfer cycles with frozen embryos made it possible to study the effects of the technique in children thus conceived. Particularly noteworthy is the increase in macrosomal and LGA (large for gestational age) newborns, in addition to a decrease in SGA (small for gestational age) and LBW (low birth weight) newborns. The authors aimed to outline a broad-ranging narrative review by summarizing and elaborating on the most important evidence regarding the neonatal outcome of children born from frozen embryos and provide information on the medium and long-term follow- up of these children. However, given the relatively recent large-scale implementation of such techniques, further studies are needed to provide more conclusive evidence on outcomes and implications.
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Affiliation(s)
- Giuseppe Gullo
- IVF Unit, Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy
| | - Marco Scaglione
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences, University of Genoa, 16132 Genoa, Italy
| | - Gaspare Cucinella
- IVF Unit, Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS “Civico-Di Cristina-Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Antonino Perino
- IVF Unit, Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy
| | - Maria Elisabetta Greco
- IVF Unit, Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico-Di Cristina-Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Enrico Marinelli
- Department of Medico-Surgical Sciences and Biotechnologies, “Sapienza” University of Rome, 04100 Rome, Italy
- Correspondence:
| | | | - Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, “Sapienza” University of Rome, 00161 Rome, Italy
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Influences of fresh and frozen embryo transfer on neonatal birthweight and the expression of imprinted genes PEG10 /L3MBTL1 in placenta. Reprod Biol 2022; 22:100665. [PMID: 35714554 DOI: 10.1016/j.repbio.2022.100665] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 11/20/2022]
Abstract
To investigate the influences of fresh embryo transfer (ET) and frozen embryo transfer (FET) on neonatal birthweight and the expression of imprinted genes PEG10 and L3MBTL1 in the placenta after in vitro fertilization-embryo transfer (IVF-ET), we analyzed the neonatal birthweight between fresh ET and FET transfer cycles. Then, we collected placentas delivered by fresh ET and FET, and real-time quantitative PCR, Western blotting and immunohistochemistry were used to detect the expression of PEG10 and L3MBTL1. The mean neonatal birthweight of fresh ET was lower than that of FET(3348.48 ± 521.05 vs. 3450.34 ± 524.13, P < 0.001). The risks of low birthweight (LBW) and small-for-gestational age (SGA) were lower after FET (3.9 % vs. 5.4 %; 7.2 % vs. 10.3 %), with adjusted rate ratios of 0.74 (95 % CI, 0.59-0.93; P = 0.003) and 0.70 (95 % CI, 0.59-0.84; P < 0.001), respectively. FET resulted in higher frequencies of macrosomia and large-for-gestational age (LGA) (14.2 % vs. 10.3; 11.0 % vs. 7.1 %) than fresh ET, with adjusted rate ratios of 1.45 (95 % CI, 1.26-1.68; P < 0.001) and 1.62 (95 % CI, 1.37-1.91; P < 0.001), respectively. We also observed PEG10 mRNA and protein expression levels in placentas delivered by fresh ET and FET were significantly different, but there were no significant differences in L3MBTL1 between the two groups. Fresh ET may affect the expression of the imprinted gene PEG10 in the placenta and adverse to placental implantation and development, resulting to increasing incidences of LBW and SGA.
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Muharam R, Umami EA, Gunardi H. IVF-conceived children outcome from birth to 3 years at a single IVF center in Indonesia: frozen versus fresh embryo transfer. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2022. [DOI: 10.1186/s43043-022-00103-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Frozen embryo transfer procedure is becoming more common in assisted reproduction technology. The effect of this technology is still not yet well studied in developing countries with limited resources, including Indonesia. This study explores the clinical outcomes between frozen and fresh embryo transfer-conceived children aged 0–3 years in Indonesia.
Results
The participants were divided into frozen embryo (n = 30) and fresh embryo (n = 30) transfer groups. There were no differences in growth and development. However, in vitro fertilization (IVF) children with frozen embryo transfer had a lower risk of developing low birth weight compared to the fresh embryo group with an OR of 0.17 (95% CI: 0.03–0.85). All children, both in the fresh and frozen embryos, have normal development.
Conclusions
Frozen versus fresh embryo transfer does not affect child growth and development.
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Porcu E, Cipriani L, Dirodi M, De Iaco P, Perrone AM, Zinzani PL, Taffurelli M, Zamagni C, Ciotti PM, Notarangelo L, Calza N, Damiano G. Successful Pregnancies, Births, and Child Development Following Oocyte Cryostorage in Female Cancer Patients During 25 Years of Fertility Preservation. Cancers (Basel) 2022; 14:cancers14061429. [PMID: 35326578 PMCID: PMC8946047 DOI: 10.3390/cancers14061429] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary The study goal is to demonstrate that oocyte cryopreservation is a feasible and efficient option for fertility preservation in cancer patients through the comparison of in vitro fertilization treatments in nononcological patients. Abstract The preservation of fertility in cancer patients is a crucial aspect of modern reproductive medicine. Amenorrhea and infertility often occur after cancer therapy, worsening the quality of life. Cryopreservation of oocytes in young cancer patients is a therapeutic option for preserving fertility. A prospective study was conducted on 508 cancer patients who underwent oocyte cryopreservation to preserve fertility between 1996 and 2021 including the COVID-19 pandemic period. Patients underwent ovarian stimulation, followed by egg retrieval, and oocytes were cryopreserved by slow freezing or vitrification. Sixty-four thawing/warming cycles were performed. Survival, fertilization, pregnancy, and birth rate over the thawing/warming cycles were obtained. The data were compared with those from a group of 1042 nononcological patients who cryopreserved supernumerary oocytes. An average of 8.8 ± 6.9 oocytes were retrieved per cycle, and 6.1 ± 4.2 oocytes were cryopreserved. With their own stored oocytes, 44 patients returned to attempt pregnancy. From a total of 194 thawed/warmed oocytes, 157 survived (80%). In total, 100 embryos were transferred in 57 transfer/cycles, and 18 pregnancies were achieved. The pregnancy rate per transfer and pregnancy rate per patient were 31% and 41%, respectively. No statistically significant differences were observed between oncological patients and nononcological patients. A total of 15 babies were born from oncological patients. Children born showed normal growth and development. One minor malformation was detected.
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Affiliation(s)
- Eleonora Porcu
- Infertility and IVF Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy; (L.C.); (M.D.); (P.M.C.); (L.N.); (N.C.); (G.D.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
- Correspondence: ; Tel.: +39-0512144364
| | - Linda Cipriani
- Infertility and IVF Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy; (L.C.); (M.D.); (P.M.C.); (L.N.); (N.C.); (G.D.)
| | - Maria Dirodi
- Infertility and IVF Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy; (L.C.); (M.D.); (P.M.C.); (L.N.); (N.C.); (G.D.)
| | - Pierandrea De Iaco
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy; (P.D.I.); (A.M.P.)
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy
| | - Anna Myriam Perrone
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy; (P.D.I.); (A.M.P.)
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy
| | - Pier Luigi Zinzani
- Institute of Haematology “Seragnoli”, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy;
| | - Mario Taffurelli
- Breast Unit, Department of Woman and Child, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy;
| | - Claudio Zamagni
- “Addari” Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40126 Bologna, Italy;
| | - Patrizia Maria Ciotti
- Infertility and IVF Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy; (L.C.); (M.D.); (P.M.C.); (L.N.); (N.C.); (G.D.)
| | - Leonardo Notarangelo
- Infertility and IVF Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy; (L.C.); (M.D.); (P.M.C.); (L.N.); (N.C.); (G.D.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
| | - Nilla Calza
- Infertility and IVF Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy; (L.C.); (M.D.); (P.M.C.); (L.N.); (N.C.); (G.D.)
| | - Giuseppe Damiano
- Infertility and IVF Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy; (L.C.); (M.D.); (P.M.C.); (L.N.); (N.C.); (G.D.)
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Medically Assisted Reproduction Treatment Types and Birth Outcomes. Obstet Gynecol 2022; 139:211-222. [PMID: 34991148 PMCID: PMC8759539 DOI: 10.1097/aog.0000000000004655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/04/2021] [Indexed: 11/27/2022]
Abstract
Medically assisted reproduction treatments are associated with adverse birth outcomes; however, those risks are unlikely to be associated with the infertility treatments themselves. OBJECTIVE: To compare risks of adverse birth outcomes among pregnancies conceived with and without medically assisted reproduction treatments. METHODS: Birth certificates were used to study birth outcomes of all neonates born in Utah from 2009 through 2017. Of the 469,919 deliveries, 52.8% (N=248,013) were included in the sample, with 5.2% of the neonates conceived through medically assisted reproduction. The outcome measures included birth weight, gestational age, low birth weight (LBW, less than 2,500 g), preterm birth (less than 37 weeks of gestation), and small for gestational age (SGA, birth weight less than the 10th percentile). Linear models were estimated for the continuous outcomes (birth weight, gestational age), and linear probability models were used for the binary outcomes (LBW, preterm birth, SGA). First, we compared the birth outcomes of neonates born after medically assisted reproduction and natural conception in the overall sample (between-family analyses), before and after adjustment for parental background and neonatal characteristics. Second, we employed family fixed effect models to investigate whether the birth outcomes of neonates conceived through medically assisted reproduction differed from those of their naturally conceived siblings (within-family comparisons). RESULTS: Neonates conceived through medically assisted reproduction weighed less, were born earlier, and were more likely to be LBW, preterm, and SGA than neonates conceived naturally. More invasive treatments (assisted reproductive technology [ART] and artificial insemination [AI] or intrauterine insemination) were associated with worse birth outcomes; for example, the proportion of LBW and preterm birth was 6.1% and 7.9% among neonates conceived naturally and 25.5% and 29.8% among neonates conceived through ART, respectively. After adjustments for various neonatal and parental characteristics, the differences in birth outcomes between neonates conceived through medically assisted reproduction and naturally were attenuated yet remained statistically significant; for example, neonates conceived through ART were at 3.2 percentage points higher risk for LBW (95% CI 2.4–4.1) and 4.8 percentage points higher risk for preterm birth (95% CI 3.9–5.7). Among siblings, the differences in the frequency of adverse outcomes between neonates conceived through medically assisted reproduction and neonates conceived naturally were small and statistically insignificant for all types of treatments. CONCLUSION: Medically assisted reproduction treatments are associated with adverse birth outcomes; however, those risks are unlikely to be associated with the infertility treatments itself.
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Zareii A, Davoodi S, Alborzi M, Moghadam ME, Askary E. Co-administration of GnRH agonists with vaginal progesterone compared to vaginal progesterone in luteal phase support of the frozen-thawed embryo transfer cycle: An RCT. Int J Reprod Biomed 2021; 19:863-872. [PMID: 34805726 PMCID: PMC8595909 DOI: 10.18502/ijrm.v19i10.9817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/01/2020] [Accepted: 11/24/2020] [Indexed: 12/02/2022] Open
Abstract
Background Since progesterone alone does not seem to be enough for luteal phase support (LPS), especially in frozen embryo transfer (FET) cycles, so gonadotropin-releasing hormone agonist (GnRH-a) is suggested as an adjuvant therapy in combination with progesterone for LPS. Objective To evaluate the effects of the administration of GnRH-a with vaginal progesterone compared to vaginal progesterone alone in luteal phase support of the frozen-thawed embryo transfer cycles. Materials and Methods In this randomized controlled clinical trial, 240 infertile women who were candidates for FET were evaluated into two groups (n = 120/each). Group I received 400 mg vaginal progesterone twice a day from the time of transfer. The second group received vaginal progesterone and also 0.1 mg diphereline on days 0, 3, and 6 of FET for LPS. Finally, the clinical and ongoing pregnancy rates, and the implantation, and spontaneous abortion rates were compared in two groups. Results Results showed that there was no significant difference between the mean age of women and the duration of infertility (p = 0.78, p = 0.58, respectively). There were no significant differences between groups in the terms of implantation and spontaneous abortion rates (p = 0.19, p = 0.31, respectively). However, in terms of clinical and ongoing pregnancy rates, the significant differences were seen between groups (p = 0.008 and p = 0.005, respectively). Conclusion Co-administration of GnRH-a and vaginal progesterone in LPS may be superior to vaginal progesterone alone in women who underwent a frozen-selected embryo transfer cycle.
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Affiliation(s)
- Afsoon Zareii
- Infertility Division, Infertility Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Davoodi
- Infertility Division, Infertility Research Center, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahshid Alborzi
- Infertility Division, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
| | | | - Elham Askary
- Department of Obstetrics and Gynecology, Laparoscopy Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Boutet ML, Casals G, Valenzuela-Alcaraz B, García-Otero L, Crovetto F, Cívico MS, Borrás A, Manau D, Gratacós E, Crispi F. Cardiac remodeling in fetuses conceived by ARTs: fresh versus frozen embryo transfer. Hum Reprod 2021; 36:2697-2708. [PMID: 34323946 DOI: 10.1093/humrep/deab159] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 05/19/2021] [Indexed: 01/10/2023] Open
Abstract
STUDY QUESTION Do fetuses from frozen embryo transfer (FET) present signs of cardiac remodeling and suboptimal function similar to those observed in fetuses from fresh embryo transfer (ET)? SUMMARY ANSWER Fetuses from both fresh ET and FET present signs of fetal cardiac remodeling and suboptimal function, with more pronounced changes after fresh ET as compared to FET. WHAT IS KNOWN ALREADY Our group and others have previously demonstrated that fetuses and children conceived by ARTs present cardiac remodeling and suboptimal function. These fetuses show dilated atria, more globular and thicker ventricles, reduced longitudinal motion, and impaired relaxation. Cardiac changes were already present in utero and persisted after birth. Most of the ART fetuses included in previous publications were from fresh ET. However, singletons from FET have different perinatal outcomes compared to those from fresh ET. There are no previous studies comparing cardiac morphology and function between fetuses following fresh and FET. STUDY DESIGN, SIZE, DURATION This is a prospective cohort study of 300 singleton pregnancies recruited from 2017 to 2020, including 100 spontaneously conceived (SC) pregnancies, 100 fetuses conceived by IVF with FET, and 100 fetuses conceived by IVF with fresh ET. Fetal structural and functional echocardiography was performed in all pregnancies. PARTICIPANTS/MATERIALS, SETTING, METHODS Pregnancies conceived by IVF were recruited from a single assisted reproduction center, ensuring homogeneity in IVF stimulation protocols, endometrial preparation for FET, laboratory procedures, and embryo culture conditions. SC pregnancies from fertile couples were selected from the general population and matched to IVF pregnancies by maternal age. Epidemiological and perinatal outcomes were collected in all cases. Fetal echocardiography was performed at 28-33 weeks of pregnancy to assess cardiac structure and function in all pregnancies. All echocardiographic comparisons were adjusted by maternal age, nulliparity, birthweight centile, preeclampsia, and prematurity. MAIN RESULTS AND THE ROLE OF CHANCE Parental age, ethnicity, body mass index and smoking were similar among the study groups. Median gestational age at echocardiography and estimated fetal weight were similar in all study groups. Both fresh ET and FET groups showed similar fetal echocardiographic changes, with more pronounced features in the fresh ET as compared to FET pregnancies. Fetuses conceived by IVF showed larger atria (right atria-to-heart ratio: fresh ET mean 18.1% (SD 3.2) vs FET 18.0% (3.9) vs SC 17.3% (3.2); linear tendency P-value <0.001), more globular ventricles (right ventricular sphericity index: fresh ET 1.62 (0.29) vs FET 1.61 (0.25) vs SC 1.68 (0.26); <0.001) and thicker myocardial walls (relative wall thickness: fresh ET 0.79 (0.21) vs FET 0.74 (0.22) vs SC 0.65 (0.25); <0.001) as compared to SC pregnancies. Both fresh ET and FET groups also had signs of suboptimal systolic and diastolic function, with reduced tricuspid annular systolic peak velocity (fresh ET 7.17 cm/s (1.22) vs FET 7.41 cm/s (1.19) vs SC 7.58 cm/s (1.32); <0.001) and increased left myocardial performance index (fresh ET 0.53 (0.08) vs FET 0.53 (0.08) vs SC 0.50 (0.09); <0.001) as compared to SC pregnancies. LIMITATIONS, REASONS FOR CAUTION The cardiac changes reported here are subclinical, with most cardiovascular indexes lying within normal ranges. Although echocardiographic changes are recognized as potential cardiovascular risk factors, their association with the long-term cardiovascular disease remains to be proven. The observed milder fetal cardiac features in FET fetuses cannot condition the choice of this technique and must be considered together with the global perinatal results related to these gestations. WIDER IMPLICATIONS OF THE FINDINGS The identification of cardiac remodeling in fetuses conceived by IVF with fresh ET and FET represents an opportunity for early detection. Future studies are warranted to study the potential long-term consequences of these findings. STUDY FUNDING/COMPETING INTEREST(S) This project has been partially funded with support from the Erasmus + Programme of the European Union (Framework Agreement number: 2013-0040). This publication reflects the views only of the author, and the Commission cannot be held responsible for any use, which may be made of the information contained therein. Additionally, the research leading to these results has received funding from 'la Caixa' Foundation under grant agreement LCF/PR/GN18/10310003, the Instituto de Salud Carlos III (PI15/00130, PI17/00675, PI18/00073) integrated into the Plan Nacional de I + D+I and cofinanced by ISCIII-Subdirección General de Evaluación and Fondo Europeo de Desarrollo Regional (FEDER) 'Una manera de hacer Europa', Cerebra Foundation for the Brain Injured Child (Carmarthen, Wales, UK) and AGAUR 2017 SGR grant n° 1531. The authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- M L Boutet
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - G Casals
- Assisted Reproduction Unit, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - B Valenzuela-Alcaraz
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - L García-Otero
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - F Crovetto
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - M S Cívico
- Assisted Reproduction Unit, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - A Borrás
- Assisted Reproduction Unit, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - D Manau
- Assisted Reproduction Unit, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - E Gratacós
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - F Crispi
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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Aljaser F. Preservation of fertility in female: Indications, available options, and current status in Saudi Arabia. Semin Oncol 2020; 47:390-397. [PMID: 33131895 DOI: 10.1053/j.seminoncol.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 07/13/2020] [Accepted: 09/27/2020] [Indexed: 11/11/2022]
Abstract
Refinement of therapies continues to improve the prognosis and survival of cancer patients. However, women of reproductive age face a risk of premature ovarian failure due to the gonadotoxicity of aggressive oncological treatment, which may also be used to treat other nonmalignant disorders. Development of cryobiology and assisted reproduction has allowed fertility preservation, which is increasingly requested, and can also aid fertility in iatrogenic and noniatrogenic conditions. Established protocols including embryo and oocyte freezing are only performed for adult women; however, ovarian tissue cryopreservation is an approach that can also assist prepubertal girls. Medical fertility cryopreservation for females has been recently legalized in Saudi Arabia. However, prior to implementing the service in clinical practice in Saudi Arabia, guidelines on patient selection criteria and adequate staff training are essential. Moreover, worldwide registry data and the findings of long-term studies involving many patients on the safety of ovarian tissue freezing are required to conclusively establish medical fertility cryopreservation as a safe procedure. Progress can be achieved in oncofertility by improving and optimizing techniques that include immature oocyte growth and maturation and artificial ovary development.
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Affiliation(s)
- Feda Aljaser
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Kingdom of Saudi Arabia.
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Yang M, Lin L, Sha C, Li T, Gao W, Chen L, Wu Y, Ma Y, Zhu X. Which is better for mothers and babies: fresh or frozen-thawed blastocyst transfer? BMC Pregnancy Childbirth 2020; 20:559. [PMID: 32967652 PMCID: PMC7513314 DOI: 10.1186/s12884-020-03248-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 09/14/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In recent years, there have been many reports on the pregnancy outcomes of fresh blastocyst transfer (BT) and frozen-thawed BT, but the conclusions are controversial and incomplete. To compare the pregnancy outcomes, maternal complications and neonatal outcomes of fresh and frozen-thawed BT in the context of in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) cycles, we conducted a meta-analysis. METHODS A meta-analysis was conducted by searching the PubMed, Embase, and Cochrane Library databases through May 2020. Data were extracted independently by two authors. RESULTS Fifty-four studies, including 12 randomized controlled trials (RCTs), met the inclusion criteria. Fresh BT was associated with a lower implantation rate, pregnancy rate, ongoing pregnancy rate, and clinical pregnancy rate and higher ectopic pregnancy rate than frozen-thawed BT according to the results of the RCTs. The risks of moderate or severe ovarian hyperstimulation syndrome, placental abruption, placenta previa and preterm delivery were higher for fresh BT than for frozen-thawed BT. The risk of pregnancy-induced hypertension and pre-eclampsia was lower for fresh BT; however, no significant differences in risks for gestational diabetes mellitus and preterm rupture of membrane were found between the two groups. Compared with frozen-thawed BT, fresh BT appears to be associated with small for gestational age and low birth weight. No differences in the incidences of neonatal mortality or neonatal malformation were observed between fresh and frozen-thawed BT. CONCLUSIONS At present there is an overall slight preponderance of risks in fresh cycles against frozen, however individualization is required and current knowledge does not permit to address a defintive response.
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Affiliation(s)
- Meiling Yang
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Obstetrics and Gynecology, Nantong City No 1 People's Hospital and Second Affiliated Hospital of Nantong University, Nantong, 226000, China
| | - Li Lin
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Chunli Sha
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Taoqiong Li
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Wujiang Gao
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Lu Chen
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Ying Wu
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Yanping Ma
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Xiaolan Zhu
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China.
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China.
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Gu F, Li S, Zheng L, Gu J, Li T, Du H, Gao C, Ding C, Quan S, Zhou C, Li P, Xu Y. Perinatal outcomes of singletons following vitrification versus slow-freezing of embryos: a multicenter cohort study using propensity score analysis. Hum Reprod 2020; 34:1788-1798. [PMID: 31407797 DOI: 10.1093/humrep/dez095] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 05/06/2019] [Indexed: 01/02/2023] Open
Abstract
STUDY QUESTION Is embryo vitrification associated with a higher risk of adverse perinatal outcomes than slow-freezing? SUMMARY ANSWER Embryo vitrification was not associated with increased risks of adverse perinatal outcomes of pre-term birth (PTB), low birthweight (LBW), small for gestational age (SGA), large for gestational age (LGA) and macrosomia, as compared to slow-freezing. WHAT IS KNOWN ALREADY Vitrification is becoming a widely adopted technology for embryo cryopreservation with higher embryo survival rate and live birth rate than the slow-freezing technique. However, limited data are currently available on risks of adverse perinatal outcomes following vitrification as compared to that of slow-freezing. The impact of vitrification on perinatal outcomes remains further to be elucidated. STUDY DESIGN, SIZE, DURATION Six large reproductive medical centers in Guangdong province, Southeast of China, took part in this multicenter retrospective cohort study. Cohorts of 3199 live born singletons after Day 3 frozen-thawed embryo transfer (FET) cycles with either vitrification or slow-freezing between January 2011 and December 2015 were included in the study. Each patient only contributed one cycle per cohort and vanishing twins were excluded. Propensity score (PS) matching was used to control for potential confounding factors. PARTICIPANTS/MATERIALS, SETTING, METHODS All live-born singletons following either a vitrified or a slow-frozen cleavage FET cycle during the period from 2011 to 2015 were analyzed. Perinatal outcomes of PTB, LBW, macrosomia, SGA and LGA were compared. The vitrified and slow-frozen cohorts were matched by propensity scores with a 1:1 ratio accounting for potential confounding factors associated with perinatal outcomes. These variables included baseline demographics (maternal age, BMI, education level, parity, type of infertility and cause of infertility), as well as IVF characteristics (insemination method, endometrial preparation protocol and embryo cryopreservation duration). MAIN RESULTS AND THE ROLE OF CHANCE A total of 2858 cases from vitrified embryo transfer (ET) and 341 babies from the slow-freezing group were included. After PS matching, 297 pairs of newborns were generated for comparison. The median gestational age was 39 weeks for both cohorts and the birthweights were comparable (3187.7 ± 502.1 g in the vitrified group vs. 3224.6 ± 483.6 in the slow-freezing group, P>0.05). There were no significant differences between the two groups on the incidence of PTB (5.4% vs. 7.7%), LBW (6.7% vs. 5.7%), macrosomia (5.7% vs. 6.1%), SGA (12.5% vs. 8.4%) and LGA (6.4% vs. 8.1%). Parallel logistic regression analysis indicated that vitrification was non-inferior to slow-freezing method in terms of the occurrence of PTB (OR, 0.68 [95% CI, 0.35, 1.31]), LBW (OR, 1.19[0.61-2.32]), macrosomia (OR, 0.94 [0.48-1.86]), SGA (1.55[0.91-2.64]) and LGA (0.78[0.42-1.45]), P>0.05. Sex-stratified PS matching models with multivariable regression analysis further confirmed that vitrification did not increase the risks of above-mentioned adverse perinatal outcomes in either the male or female infant cohort. LIMITATIONS, REASONS FOR CAUTION Although the analysis was adjusted for a number of important confounders, the hospital dataset did not contain other potential confounders such as the medical history and obstetrics outcomes of women during pregnancy to allow adjustment. In addition, the current findings are only applicable to cleavage stage FET, but not pronuclei stage or blastocyst stage ET. WIDER IMPLICATIONS OF THE FINDINGS Vitrified ET, in comparison with slow-frozen ET, was not associated with increased risks of adverse neonatal outcomes. With its superiority on live birth rates and non-inferiority on safety perinatal outcomes, transition from slow-freezing to the use of vitrification for embryo cryopreservation is reassuring. Nonetheless, future research is needed for the long-term effects of vitrification method on offspring's health outcomes. STUDY FUNDING/COMPETING INTEREST(S) The study was funded by the National Key Research and Development Program (2016YFC100205), Guangzhou Science and Technology Project (201804020087), Guangdong Province Science and Technology Project (2016A020218008) and Guangdong Provincial Key Laboratory of Reproductive Medicine (2012A061400003). The authors have no conflicts of interest to declare.
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Affiliation(s)
- Fang Gu
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shuzhen Li
- Jiangmen Central Hospital, Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Lingyan Zheng
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Sun Yat-Sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jing Gu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Tingting Li
- Reproductive Medicine Research Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Hongzi Du
- Center for Reproductive Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Caifeng Gao
- The Huizhou Municipal Central Hospital, Huizhou, Guangdong, China
| | - Chenhui Ding
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Song Quan
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Canquan Zhou
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, Guangdong, China
| | - Ping Li
- Jiangmen Central Hospital, Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yanwen Xu
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, Guangdong, China
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Huo Y, Qin Q, Zhang L, Kuo Y, Wang H, Yan L, Li R, Zhang X, Yan J, Qiao J. Effects of oocyte vitrification on the behaviors and physiological indexes of aged first filial generation mice. Cryobiology 2020; 95:20-28. [PMID: 32598946 DOI: 10.1016/j.cryobiol.2020.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/21/2020] [Accepted: 06/21/2020] [Indexed: 12/17/2022]
Abstract
To evaluate the long-term effects of oocyte cryopreservation on the health of the first filial generation (F1), we used B6D2F1 mice for oocyte collection, in vitro fertilization, and breeding. The female F1 mice born from the offspring of fresh mature oocytes (control group) and from the offspring of vitrified oocytes with traditional vitrification medium (VM group) and new improved vitrification medium (2P10E7D group) were maintained until 14-15 months of age for behavioral tests and 16-17 months of age for physiological analyses. Behavioral indexes, including anxiety-like status, discrimination ability, learning and memory ability, were investigated. Physiological indexes including body weight, body fat, heart rate, blood pressure, and blood lipids were also analyzed. In our results, the behavioral indexes, body weight, body fat, heart rate, blood pressure, total cholesterol (TC), high-density lipoprotein cholesterol (HDL), and low-density lipoprotein cholesterol (LDL) did not show significant differences among the three groups. However, the triglyceride (TG) level of the VM group was higher than that of the 2P10E7D group. Moreover, compared with the control group, both the VM group and the 2P10E7D group showed greatly increased diastolic blood pressure. This study is the first to report that oocyte vitrification might affect metabolic physiological indexes via transgenerational inheritance rather than behaviors related to anxiety-like status and cognitive ability. Furthermore, different vitrification media might have differential transgenerational effects.
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Affiliation(s)
- Ying Huo
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing, 100191, China; Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, 100191, China; Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Beijing, 100191, China
| | - Qingyuan Qin
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing, 100191, China; Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, 100191, China
| | - Lu Zhang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing, 100191, China; Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, 100191, China
| | - Ying Kuo
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing, 100191, China; Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, 100191, China
| | - Haiyan Wang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
| | - Liying Yan
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing, 100191, China; Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, 100191, China
| | - Rong Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing, 100191, China; Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, 100191, China
| | - Xiaowei Zhang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing, 100191, China; Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, 100191, China
| | - Jie Yan
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing, 100191, China; Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, 100191, China.
| | - Jie Qiao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing, 100191, China; Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, 100191, China; Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, 100871, China; National Clinical Research Center of Obstetrics and Gynecology, Beijing, 100191, China
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Argyraki M, Damdimopoulou P, Chatzimeletiou K, Grimbizis GF, Tarlatzis BC, Syrrou M, Lambropoulos A. In-utero stress and mode of conception: impact on regulation of imprinted genes, fetal development and future health. Hum Reprod Update 2020; 25:777-801. [PMID: 31633761 DOI: 10.1093/humupd/dmz025] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/04/2019] [Accepted: 07/12/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Genomic imprinting is an epigenetic gene regulatory mechanism; disruption of this process during early embryonic development can have major consequences on both fetal and placental development. The periconceptional period and intrauterine life are crucial for determining long-term susceptibility to diseases. Treatments and procedures in assisted reproductive technologies (ART) and adverse in-utero environments may modify the methylation levels of genomic imprinting regions, including insulin-like growth factor 2 (IGF2)/H19, mesoderm-specific transcript (MEST), and paternally expressed gene 10 (PEG10), affecting the development of the fetus. ART, maternal psychological stress, and gestational exposures to chemicals are common stressors suspected to alter global epigenetic patterns including imprinted genes. OBJECTIVE AND RATIONALE Our objective is to highlight the effect of conception mode and maternal psychological stress on fetal development. Specifically, we monitor fetal programming, regulation of imprinted genes, fetal growth, and long-term disease risk, using the imprinted genes IGF2/H19, MEST, and PEG10 as examples. The possible role of environmental chemicals in genomic imprinting is also discussed. SEARCH METHODS A PubMed search of articles published mostly from 2005 to 2019 was conducted using search terms IGF2/H19, MEST, PEG10, imprinted genes, DNA methylation, gene expression, and imprinting disorders (IDs). Studies focusing on maternal prenatal stress, psychological well-being, environmental chemicals, ART, and placental/fetal development were evaluated and included in this review. OUTCOMES IGF2/H19, MEST, and PEG10 imprinted genes have a broad developmental effect on fetal growth and birth weight variation. Their disruption is linked to pregnancy complications, metabolic disorders, cognitive impairment, and cancer. Adverse early environment has a major impact on the developing fetus, affecting mostly growth, the structure, and subsequent function of the hypothalamic-pituitary-adrenal axis and neurodevelopment. Extensive evidence suggests that the gestational environment has an impact on epigenetic patterns including imprinting, which can lead to adverse long-term outcomes in the offspring. Environmental stressors such as maternal prenatal psychological stress have been found to associate with altered DNA methylation patterns in placenta and to affect fetal development. Studies conducted during the past decades have suggested that ART pregnancies are at a higher risk for a number of complications such as birth defects and IDs. ART procedures involve multiple steps that are conducted during critical windows for imprinting establishment and maintenance, necessitating long-term evaluation of children conceived through ART. Exposure to environmental chemicals can affect placental imprinting and fetal growth both in humans and in experimental animals. Therefore, their role in imprinting should be better elucidated, considering the ubiquitous exposure to these chemicals. WIDER IMPLICATIONS Dysregulation of imprinted genes is a plausible mechanism linking stressors such as maternal psychological stress, conception using ART, and chemical exposures with fetal growth. It is expected that a greater understanding of the role of imprinted genes and their regulation in fetal development will provide insights for clinical prevention and management of growth and IDs. In a broader context, evidence connecting impaired imprinted gene function to common diseases such as cancer is increasing. This implies early regulation of imprinting may enable control of long-term human health, reducing the burden of disease in the population in years to come.
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Affiliation(s)
- Maria Argyraki
- First Department of Obstetrics and Gynecology, Laboratory of Genetics, School of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Ring Road, Nea Efkarpia, 56403 Thessaloniki, Greece
| | - Pauliina Damdimopoulou
- Karolinska Institutet, Department of Clinical Sciences, Intervention and Technology, Unit of Obstetrics and Gynecology, K57 Karolinska University Hospital Huddinge, SE-14186 Stockholm, Sweden
| | - Katerina Chatzimeletiou
- First Department of Obstetrics and Gynecology, Unit for Human Reproduction, School of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Ring Road, Nea Efkarpia, 56403 Thessaloniki, Greece
| | - Grigoris F Grimbizis
- First Department of Obstetrics and Gynecology, Unit for Human Reproduction, School of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Ring Road, Nea Efkarpia, 56403 Thessaloniki, Greece
| | - Basil C Tarlatzis
- First Department of Obstetrics and Gynecology, Unit for Human Reproduction, School of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Ring Road, Nea Efkarpia, 56403 Thessaloniki, Greece
| | - Maria Syrrou
- Department of Biology, Laboratory of Biology, School of Health Sciences, University of Ioannina, Dourouti University Campus, 45110, Ioannina, Greece
| | - Alexandros Lambropoulos
- First Department of Obstetrics and Gynecology, Laboratory of Genetics, School of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Ring Road, Nea Efkarpia, 56403 Thessaloniki, Greece
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Abstract
Over the past 40 years access and effectiveness of assisted reproductive technologies (ART) have increased, and to date more than 8 million children have been conceived after ART globally. Most pregnancies resulting from ART are uncomplicated and result in the birth of healthy children. Yet, it is well known that pregnancies following ART are more likely to be affected by obstetric complications such as hypertensive disorders in pregnancy, preterm birth, and low birth weight compared with spontaneously conceived pregnancies. ART children are also at increased risk of birth defects. The majority of the problems arise as a result of multiple pregnancies and can be reduced by transferring a single embryo, thereby avoiding multiple pregnancies. New ART technologies are constantly introduced, and monitoring of the health of ART children is crucial.
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Affiliation(s)
- Ulla-Britt Wennerholm
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital East, Gothenburg, Sweden
- CONTACT Ulla-Britt Wennerholm Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital East, GothenburgSE 416 85, Sweden
| | - Christina Bergh
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Leary C, Sturmey RG. Metabolic profile of in vitro derived human embryos is not affected by the mode of fertilization. Mol Hum Reprod 2020; 26:277-287. [PMID: 32059054 PMCID: PMC8598873 DOI: 10.1093/molehr/gaaa015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 02/05/2020] [Indexed: 11/24/2022] Open
Abstract
The pattern of metabolism by early embryos in vitro has been linked to a range of phenotypes, including viability. However, the extent to which metabolic function of embryos is modified by specific methods used during ART has yet to be fully described. This study has sought to determine if the mode of fertilization used to create embryos affects subsequent embryo metabolism of substrates. A metabolic profile, including consumption of key substrates and the endogenous triglyceride content of individual IVF and ICSI supernumerary embryos, was assessed and compared. Embryo development and quality was also recorded. All embryos were donated at a single clinical IVF center, on Day 5, from 36 patients aged 18-38 years, The data revealed that consumption of glucose and pyruvate, and production of lactate, did not differ between embryos created by IVF or ICSI. Similarly, the mode of insemination did not impact on the triglyceride content of embryos. However, ICSI-derived embryos displayed a more active turnover of amino acids (P = 0.023), compared to IVF embryos. The specific amino acids produced in higher quantities from ICSI compared to IVF embryos were aspartate (P = 0.016), asparagine (P = 0.04), histidine (P = 0.021) and threonine (P = 0.009) while leucine consumption was significantly lower (P = 0.04). However, importantly neither individual nor collective differences in amino acid metabolism were apparent for sibling oocytes subjected to either mode of fertilization. Embryo morphology (the number of top grade embryos) and development (proportion reaching the blastocyst stage) were comparable in patients undergoing IVF and ICSI. In conclusion, the microinjection of spermatozoa into oocytes does not appear to have an impact on subsequent metabolism and viability. Observed differences in amino acid metabolism may be attributed to male factor infertility of the patients rather than the ICSI procedure per se.
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Affiliation(s)
- Christine Leary
- Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, Faculty of Health Sciences, The University of Hull, Hull, HU6 7RX, UK
- The Hull IVF Unit, The Women and Children’s Hospital, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK
| | - Roger G Sturmey
- Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, Faculty of Health Sciences, The University of Hull, Hull, HU6 7RX, UK
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Ferreiro E, de Uralde BL, Abreu R, García-Velasco JA, Muñoz E. Aromatase Inhibitors for Ovarian Stimulation in Patients with Breast Cancer. Curr Drug Targets 2020; 21:910-921. [PMID: 32077823 DOI: 10.2174/1389450121666200220124607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/07/2020] [Accepted: 02/10/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Breast cancer is the most common malignancy diagnosed in women, and its treatment has a high probability of loss of fertility. Oocyte vitrification is the most commonly used technique to preserve fertility before starting oncological treatment. Aromatase inhibitors induce hypoestrogenemia while promoting the release of gonadotropins and constitute an alternative drug for ovarian stimulation in patients with breast cancer. OBJECTIVE In this mini-review, we update and describe the current status of aromatase inhibitor use in controlled ovarian stimulation for oocyte vitrification in patients with breast cancer. RESULTS Aromatase inhibitors are commonly used in combination with gonadotropins for ovarian stimulation in patients with breast cancer who preserve their fertility through oocyte vitrification. They achieve similar ovarian responses as conventional ovarian stimulation protocols in regards to the number of oocytes, and no additional complications after their use have been reported. Furthermore, aromatase inhibitors seem to be safe not only for offspring, as no more congenital defects occur in newborns from pregnancies achieved after their use, but also for the patients, as no more malignancy recurrence or increased mortality was found in cohort studies. CONCLUSION Aromatase inhibitors are elective drugs for ovarian stimulation in patients with breast cancer who decide to preserve their fertility through oocyte vitrification.
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Affiliation(s)
- Esteban Ferreiro
- IVIRMA Vigo, Plaza Francisco Fernandez del Riego, 7 36203, Vigo Pontevedra, Spain
| | | | - Rita Abreu
- IVIRMA Vigo, Plaza Francisco Fernandez del Riego, 7 36203, Vigo Pontevedra, Spain
| | | | - Elkin Muñoz
- IVIRMA Vigo, Plaza Francisco Fernandez del Riego, 7 36203, Vigo Pontevedra, Spain
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Frozen-thawed embryo transfer is better than fresh embryo transfer in GnRH antagonist cycle in women with 3–10 oocytes retrieved: a retrospective cohort study. Arch Gynecol Obstet 2019; 300:1791-1796. [DOI: 10.1007/s00404-019-05373-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 10/31/2019] [Indexed: 10/25/2022]
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Laval M, Garlantézec R, Guivarc'h-Levêque A. Birthweight difference of singletons conceived through in vitro fertilization with frozen versus fresh embryo transfer: An analysis of 5406 embryo transfers in a retrospective study 2013-2018. J Gynecol Obstet Hum Reprod 2019; 49:101644. [PMID: 31593781 DOI: 10.1016/j.jogoh.2019.101644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 09/24/2019] [Accepted: 09/29/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Perinatal risks after frozen embro transfer (FET) have been reassuring but some authors suggest that birthweights are higher after FET than after fresh embryo transfer (ET). The primary objective of this retrospective study, conducted in Clinique de la Sagesse, Rennes (France) from December 2013 to March 2017, was to determine whether a difference in birthweight exists between children conceived through in vitro fertilization (IVF) with frozen versus fresh ET. The secondary objective was to compare live birth rates after frozen versus fresh cycles. MATERIAL AND METHODS All couples undergoing IVF were included. Cycles with gamete donation and twin pregnancies were excluded. Hormone therapy was used in all embryo transfers. The main outcome measures were the child's birthweight, mode of delivery, gestation length and sex, maternal characteristics, and IVF characteristics. The primary endpoint was birthweight. RESULTS We studied 5406 embryo transfers and the 708 resulting singleton live births on which birthweight data were available. Mean birthweight was 3357g after frozen embryo transfer versus 3183g after fresh embryo transfer (p<0.001). After adjusting for confounding factors, the children born after frozen embryo transfer were 165.2g heavier (95%CI [92.96-237.51]). No difference was found in gestation length. Live birth was obtained after the 1.6th IVF attempt. Live birth rate was higher for fresh cycles (19% versus 12%, p<0.001), and the caesarean rate lower (16% versus 21%). DISCUSSION Birthweight was higher after frozen embryo transfer for a similar gestational age. Further research is needed to elucidate the mechanisms responsible for this difference.
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Affiliation(s)
- Maude Laval
- Reproductive Medicine, Groupe Hospitalier Bretagne Sud, 5 avenue Choiseul, 56322 Lorient, France.
| | - Ronan Garlantézec
- University of Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), 9 Avenue du Professeur Léon Bernard, 35000 Rennes, France; Centre Hospitalier Universitaire de Rennes, 2 Rue Henri le Guilloux, 35000 Rennes, France.
| | - Anne Guivarc'h-Levêque
- Reproductive Medicine, Clinique de La Sagesse, 4 Place Saint Guénolé, 35043 Rennes, France.
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Bakkensen JB, Brady P, Carusi D, Romanski P, Thomas AM, Racowsky C. Association between blastocyst morphology and pregnancy and perinatal outcomes following fresh and cryopreserved embryo transfer. J Assist Reprod Genet 2019; 36:2315-2324. [PMID: 31512049 DOI: 10.1007/s10815-019-01580-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 09/04/2019] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To assess the importance of each blastocyst morphological criteria with pregnancy and perinatal outcomes. METHODS This single-center retrospective cohort study included blastocyst single embryo transfers (SET) performed between 1/2012-2/2018. Poisson regression was used to evaluate pregnancy outcomes following fresh and cryopreserved embryo transfer (CET) for association with blastocyst expansion, inner cell mass (ICM) quality, and trophectoderm (TE) quality. Among cycles resulting in live birth, associations with preterm birth, small for gestational age (SGA) and large for gestational age (LGA), were evaluated using logistic regression. RESULTS A total of 1023 fresh and 1222 CET cycles were included, of which 465 (45.1%) fresh and 600 (48.5%) CET cycles resulted in singleton live birth. Clinical pregnancy rates increased with increasing expansion among fresh transfers (p for trend = 0.001) but not CET (p = 0.221), and with TE quality for both fresh and CET cycles (p = 0.005 and < 0.0001, respectively). Live birth rates increased with increasing expansion (fresh p = 0.005, CET p = 0.018) and TE quality (fresh p = 0.028, CET p = 0.023). ICM grade was not associated with pregnancy outcomes; however, higher ICM quality among CET cycles was associated with increased chance of preterm birth (p = 0.005). CONCLUSIONS In blastocyst SET, blastocyst expansion and TE quality were each associated with clinical pregnancy and live birth. While higher ICM quality was associated with increased chance of preterm birth among CET, no other associations with perinatal outcomes were identified. Clinicians can be reassured that pregnancies from blastocysts with lower expansion, ICM, or TE qualities are not more likely to result in adverse perinatal outcomes.
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Affiliation(s)
- Jennifer B Bakkensen
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham & Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Paula Brady
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham & Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Daniela Carusi
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham & Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Phillip Romanski
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham & Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Ann M Thomas
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham & Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Catherine Racowsky
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham & Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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21
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Hwang SS, Dukhovny D, Gopal D, Cabral H, Diop H, Coddington CC, Stern JE. Health outcomes for Massachusetts infants after fresh versus frozen embryo transfer. Fertil Steril 2019; 112:900-907. [PMID: 31466699 DOI: 10.1016/j.fertnstert.2019.07.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/09/2019] [Accepted: 07/11/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare neonatal health outcomes after fresh versus frozen ET (FET). DESIGN Retrospective analysis of a population-based database of linked clinically assisted reproductive technology (ART) data with state vital records. Multivariable logistic regression was used to model the association between deliveries from fresh versus FET and adverse health outcomes, controlling for maternal characteristics. SETTING Not applicable. PATIENT(S) Live-born singleton infants born to Massachusetts women who conceived by fresh or FET after ART using autologous oocytes between July 1, 2004, and December 31, 2013. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Preterm birth, low birth weight, neonatal mortality, birth defects, organ system conditions. RESULT(S) Compared with infants conceived from fresh embryos, those born to mothers who underwent FET were less likely to be small for gestational age (adjusted odds ratio [AOR] = 0.56; 95% confidence interval [CI], 0.44-0.70) and low birth weight (AOR = 0.72; 95% CI, 0.59-0.88) but more likely to be large for gestational age (AOR = 1.47; 95% CI, 1.26-1.70) and to experience greater odds of infectious disease (AOR = 1.46; 95% CI, 1.03-2.06), respiratory (AOR = 1.23; 95% CI, 1.07-1.41), and neurologic (AOR = 1.32; 95% CI, 1.04-1.68) conditions. There were no statistically significant differences in preterm birth, neonatal mortality, birth defects, cardiovascular, hematologic, and gastrointestinal/feeding conditions, and for infants ≥ 35 weeks, no statistically significant differences in prolonged hospital stay (>3 days for vaginal delivery, >5 days for cesarean). CONCLUSION(S) Compared with infants conceived from fresh ET, those born by FET have higher birth weight but increased odds of infectious disease, hematologic, respiratory, and neurologic abnormalities. These risks should be considered when making decisions on fresh versus FET.
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Affiliation(s)
- Sunah S Hwang
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.
| | - Dmitry Dukhovny
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
| | - Daksha Gopal
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Hafsatou Diop
- Office of Data Translation, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Charles C Coddington
- Division of Reproductive Medicine, Carolinas Medical Center/Atrium Health, Charlotte, North Carolina
| | - Judy E Stern
- Department of Obstetrics and Gynecology and Pathology, Dartmouth-Hitchcock
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Iussig B, Maggiulli R, Fabozzi G, Bertelle S, Vaiarelli A, Cimadomo D, Ubaldi FM, Rienzi L. A brief history of oocyte cryopreservation: Arguments and facts. Acta Obstet Gynecol Scand 2019; 98:550-558. [PMID: 30739329 DOI: 10.1111/aogs.13569] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/02/2019] [Accepted: 02/04/2019] [Indexed: 12/11/2022]
Abstract
The term "cryopreservation" refers to the process of cooling cells and tissues and storing them at subzero temperatures in order to stop all biological activity and preserve their viability and physiological competences for future use. Cooling to subzero temperatures is not a physiological condition for human cells; this is probably due to the high content of water in the living matter, whose conversion to ice crystals may be associated with severe and irreversible damage. Among reproductive cells and tissues, metaphase II oocytes are notably vulnerable to cryopreservation, mainly because of their large size, low surface area to volume ratio, relatively high water content and presence of the meiotic spindle. As human biological systems lack efficient internal defense mechanisms against chilling injuries, it is of the utmost importance to supply adequate external support, in terms of cryoprotectant additives, appropriate cooling/warming rates, and suitable long-term storage. Over the years, scientists have proposed different cryopreservation strategies in the effort to achieve an optimized recipe ensuring cell survival and, at the same time, maintenance of the physiological functions and abilities necessary to continue life. However, despite the first success obtained in the 1980s with frozen oocytes, it was not until recently that notable improvements in the cryopreservation technique, thanks to the advent of vitrification, allowed a breakthrough of this fine procedure.
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Affiliation(s)
- Benedetta Iussig
- G.EN.E.R.A. Center for Reproductive Medicine, G.EN.E.R.A. Veneto, Marostica, Italy
| | - Roberta Maggiulli
- G.EN.E.R.A. Center for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
| | - Gemma Fabozzi
- G.EN.E.R.A. Center for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
| | - Sara Bertelle
- G.EN.E.R.A. Center for Reproductive Medicine, G.EN.E.R.A. Veneto, Marostica, Italy
| | - Alberto Vaiarelli
- G.EN.E.R.A. Center for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
| | - Danilo Cimadomo
- G.EN.E.R.A. Center for Reproductive Medicine, G.EN.E.R.A. Veneto, Marostica, Italy.,G.EN.E.R.A. Center for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
| | - Filippo M Ubaldi
- G.EN.E.R.A. Center for Reproductive Medicine, G.EN.E.R.A. Veneto, Marostica, Italy.,G.EN.E.R.A. Center for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
| | - Laura Rienzi
- G.EN.E.R.A. Center for Reproductive Medicine, G.EN.E.R.A. Veneto, Marostica, Italy.,G.EN.E.R.A. Center for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
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23
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Maris E, Ferrieres-Hoa A, Gala A, Coffy A, Vintejoux E, Ranisavljevic N, Hamamah S. [Comparison of birth weights of children born after slow frozen embryo replacement versus fresh embryo transfer]. ACTA ACUST UNITED AC 2019; 47:305-310. [PMID: 30745159 DOI: 10.1016/j.gofs.2019.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE It is already known that children born after slow frozen embryo replacement have a significantly higher birth weight compared to children born after fresh embryo transfer. Similar data have been reported related to frozen embryo transfer using an open vitrification system. However, few data relative to birth weight using a complete embryo closed vitrification system has been reported. The purpose of this study was to know if frozen embryo in closed vitrification system is associated with a higher birth weight compared to fresh embryo replacement. DESIGN This was a monocentric retrospective cohort study, 371 children were issued from fresh embryo replacement and 127 from vitrified embryo transfer. MATERIALS AND METHODS All singletons born after fresh or vitrified embryo transfer between January 2011 and April 2015 were included. Births from the vitrified or fresh transfers of egg or sperm donation, and preimplantation genetic diagnosis were excluded. In addition, pregnancies with more than one gestational sac at the first ultrasound were excluded. An analysis of covariance (ANCOVA) was used for multivariate analysis. RESULTS Mean birth weight was 205g higher in the frozen embryo compared with fresh embryos transfer groups (3368g vs. 3163g respectively, P<0.001). This difference remained after multivariate analysis adjusted on confounding factors such as gestational age, maternal age, maternal body mass index (BMI), tobacco exposure, number of embryo transferred and birth order (P<0.001).. CONCLUSIONS Embryo frozen in closed vitrification system is associated with a higher birth weight compared to fresh embryo replacement. Our findings are consistent with the previous studies related to slow freezing and open vitrification systems data. The effects of controlled ovarian stimulation (COS), ex vivo culture conditions and cryopreservation systems on birth weight of children born should be further explored.
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Affiliation(s)
- E Maris
- Département de médecine de la reproduction, CHU de Montpellier, 34000 Montpellier France; Département de gynécologie obstétrique, CHU de Nîmes, 30000 Nîmes, France.
| | - A Ferrieres-Hoa
- Département de biologie de la reproduction, CHU de Montpellier, 34000 Montpellier, France; Inserm, U1203, institut de médecine régénératrice et de biothérapie, CHU de Montpellier, 34000 Montpellier, France
| | - A Gala
- Département de biologie de la reproduction, CHU de Montpellier, 34000 Montpellier, France; Inserm, U1203, institut de médecine régénératrice et de biothérapie, CHU de Montpellier, 34000 Montpellier, France
| | - A Coffy
- Laboratoire de biostatistiques et d'épidémiologie, institut universitaire de recherche clinique, 34000 Montpellier, France
| | - E Vintejoux
- Département de médecine de la reproduction, CHU de Montpellier, 34000 Montpellier France
| | - N Ranisavljevic
- Département de médecine de la reproduction, CHU de Montpellier, 34000 Montpellier France
| | - S Hamamah
- Département de biologie de la reproduction, CHU de Montpellier, 34000 Montpellier, France; Inserm, U1203, institut de médecine régénératrice et de biothérapie, CHU de Montpellier, 34000 Montpellier, France
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24
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Berntsen S, Söderström-Anttila V, Wennerholm UB, Laivuori H, Loft A, Oldereid NB, Romundstad LB, Bergh C, Pinborg A. The health of children conceived by ART: ‘the chicken or the egg?’. Hum Reprod Update 2019; 25:137-158. [DOI: 10.1093/humupd/dmz001] [Citation(s) in RCA: 177] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 10/31/2018] [Accepted: 01/08/2019] [Indexed: 12/11/2022] Open
Affiliation(s)
- Sine Berntsen
- Department of Obstetrics and Gynaecology, Hvidovre Hospital, University of Copenhagen, Kettegaard Alle 30, Hvidovre, Denmark
| | - Viveca Söderström-Anttila
- Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, Helsinki, Finland
| | - Ulla-Britt Wennerholm
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital East, Gothenburg, Sweden
| | - Hannele Laivuori
- Department of Obstetrics and Gynecology, Tampere University Hospital, Teiskontie 35, Tampere, Finland
- Faculty of Medicine and Life Sciences, University of Tampere, Arvo Ylpön Katu 34, Tampere, Finland
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 8, Helsinki, Finland
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Tukhomankatu 8, Helsinki, Finland
| | - Anne Loft
- Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Nan B Oldereid
- Livio IVF-klinikken Oslo, Sørkedalsveien 10A, Oslo, Norway
| | - Liv Bente Romundstad
- Spiren Fertility Clinic, Norwegian Institute of Public Health, PO Box 222 Skøyen, Oslo, Norway
- Centre for Fertility and Health, Norwegian Institute of Public Health, PO Box 222 Skøyen, Oslo, Norway
| | - Christina Bergh
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anja Pinborg
- Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
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25
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Castiglione Morelli MA, Iuliano A, Schettini SCA, Petruzzi D, Ferri A, Colucci P, Viggiani L, Cuviello F, Ostuni A. NMR metabolomics study of follicular fluid in women with cancer resorting to fertility preservation. J Assist Reprod Genet 2018; 35:2063-2070. [PMID: 30069850 PMCID: PMC6240554 DOI: 10.1007/s10815-018-1281-7] [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: 05/14/2018] [Accepted: 07/24/2018] [Indexed: 01/01/2023] Open
Abstract
PURPOSE The purpose of this study was to evaluate the possible application of metabolomics to identify follicular fluid changes in cancer patients undergoing fertility preservation. Although metabolomics have been applied already in cancer studies, this is the first application on follicular fluid of cancer patients. METHODS We selected for the study ten patients with breast cancer and lymphoma who resorted to oocyte cryopreservation to preserve fertility and ten healthy women undergoing in vitro fertilization treatments. Follicular fluid was collected at the time of oocytes retrieval. Metabolomic analysis of follicular fluids was performed by 1H-nuclear magnetic resonance (NMR) spectroscopy in combination with multivariate analysis to interpret the spectral data. Univariate statistical analysis was applied to find correlations between patients' features and metabolites identified by NMR. RESULTS Partial least squares discriminant analysis allowed to discriminate samples from cancer patients and healthy controls. Univariate statistical analysis found significant correlations between patients' features and metabolites identified by NMR. This finding allowed to identify biomarkers to differentiate both healthy controls from cancer patients and the two different classes of oncological patients. CONCLUSION The follicular fluids of cancer patients display significant metabolic alterations in comparison to healthy subjects. NMR-based metabolomics could be a valid prognostic tool for identifying and selecting the best cryopreserved oocytes and improving the outcome prediction in cancer women undergoing in vitro fertilization.
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Affiliation(s)
| | - Assunta Iuliano
- Center for Reproductive Medicine of "San Carlo" Hospital, Potenza, Italy
| | | | - Donatina Petruzzi
- Center for Reproductive Medicine of "San Carlo" Hospital, Potenza, Italy
| | - Angela Ferri
- Center for Reproductive Medicine of "San Carlo" Hospital, Potenza, Italy
| | - Paola Colucci
- Center for Reproductive Medicine of "San Carlo" Hospital, Potenza, Italy
| | - Licia Viggiani
- Department of Sciences, University of Basilicata, viale Ateneo Lucano 10, 85100, Potenza, Italy
| | - Flavia Cuviello
- Department of Sciences, University of Basilicata, viale Ateneo Lucano 10, 85100, Potenza, Italy
| | - Angela Ostuni
- Department of Sciences, University of Basilicata, viale Ateneo Lucano 10, 85100, Potenza, Italy.
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26
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Blazquez A, García D, Vassena R, Figueras F, Rodriguez A. Risk of pre-eclampsia after fresh or frozen embryo transfer in patients undergoing oocyte donation. Eur J Obstet Gynecol Reprod Biol 2018; 227:27-31. [PMID: 29879546 DOI: 10.1016/j.ejogrb.2018.05.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/14/2018] [Accepted: 05/21/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVES Different perinatal and neonatal adverse outcomes have been reported to be increased in frozen embryo transfer pregnancies compared with fresh embryo transfer with patient's own oocytes. Concerning preeclampsia, it has also been reported to be increased after frozen embryo transfer. The objective of this study is to asses if there is an increased risk of preeclampsia and gestational hypertension in pregnancies achieved with oocyte donation after frozen embryo transfer compared to fresh embryo transfer. STUDY DESIGN Retrospective cohort study of 433 patients who underwent a cycle with donated oocytes either after fresh (n = 353) or frozen embryo transfer (n = 80) between March 2013 and April 2016 at a large fertility clinic. Participants are pregnant patients who reached the 20th week of gestation. The risk of preterm preeclampsia (presenting before 37 weeks of gestation), term preeclampsia (presenting at or after 37 weeks of gestation) and gestational hypertension are presented as unadjusted and adjusted odds ratio (OR). RESULTS Frozen embryo transfer have similar risk for developing preterm preeclampsia compared to fresh embryo transfer, with an OR of 1.95 (CI 95% 0.72, 5.26, p = 0.18), as well as term preeclampsia (OR 0.3, 95%CI 0.04, 2.35, p = 0.25), and gestational hypertension (OR 1.45, 95% CI 0.75, 2.81, P = 0.27). CONCLUSIONS Despite a high prevalence of preeclampsia in pregnancies achieved by oocyte donation, the freezing-thawing process does not confer more risk than the fresh embryo transfers in preterm preeclampsia, term preeclampsia or gestational hypertension.
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Affiliation(s)
| | | | | | - Francesc Figueras
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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27
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Maheshwari A, Pandey S, Amalraj Raja E, Shetty A, Hamilton M, Bhattacharya S. Is frozen embryo transfer better for mothers and babies? Can cumulative meta-analysis provide a definitive answer? Hum Reprod Update 2018; 24:35-58. [PMID: 29155965 DOI: 10.1093/humupd/dmx031] [Citation(s) in RCA: 324] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/09/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Initial observational studies and a systematic review published 5 years ago have suggested that obstetric and perinatal outcomes are better in offspring conceived following frozen rather than fresh embryo transfers, with reduced risks of preterm birth, small for gestational age, low birth weight and pre-eclampsia. More recent primary studies are beginning to challenge some of these findings. We therefore conducted an updated systematic review and cumulative meta-analysis to examine if these results have remained consistent over time. OBJECTIVE AND RATIONALE The aim of this study was to perform a systematic review and cumulative meta-analysis (trend with time) of obstetric and perinatal complications in singleton pregnancies following the transfer of frozen thawed and fresh embryos generated through in-vitro fertilisation. SEARCH METHODS Data Sources from Medline, EMBASE, Cochrane Central Register of Clinical Trials DARE and CINAHL (1984-2016) were searched using appropriate key words. Observational and randomised studies comparing obstetric and perinatal outcomes in singleton pregnancies conceived through IVF using either fresh or frozen thawed embryos. Two independent reviewers extracted data in 2 × 2 tables and assessed the methodological quality of the relevant studies using CASP scoring. Both aggregated as well as cumulative meta-analysis was done using STATA. OUTCOMES Twenty-six studies met the inclusion criteria. Singleton babies conceived from frozen thawed embryos were at lower relative risk (RR) of preterm delivery (0.90; 95% CI 0.84-0.97) low birth weight (0.72; 95% CI 0.67-0.77) and small for gestational age (0.61; 95% CI 0.56-0.67) compared to those conceived from fresh embryo transfers, but faced an increased risk (RR) of hypertensive disorders of pregnancy (1.29; 95% CI 1.07-1.56) large for gestational age (1.54; 95% CI 1.48-1.61) and high birth weight (1.85; 95% CI 1.46-2.33). There was no difference in the risk of congenital anomalies and perinatal mortality between the two groups. The direction and magnitude of effect for these outcomes have remained virtually unchanged over time while the degree of precision has improved with the addition of data from newer studies. WIDER IMPLICATIONS The results of this cumulative meta-analysis confirm that the decreased risks of small for gestational age, low birth weight and preterm delivery and increased risks of large for gestational age and high birth weight associated with pregnancies conceived from frozen embryos have been consistent in terms of direction and magnitude of effect over several years, with increasing precision around the point estimates. Replication in a number of different populations has provided external validity for the results, for outcomes of birth weight and preterm delivery. Meanwhile, caution should be exercised about embarking on a policy of electively freezing all embryos in IVF as there are increased risks for large for gestational age babies and hypertensive disorders of pregnancy. Therefore, elective freezing should ideally be undertaken in specific cases such as ovarian hyperstimulation syndrome, fertility preservation or in the context of randomised trials.
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Affiliation(s)
- Abha Maheshwari
- Aberdeen Maternity Hopsital NHS Grampian, AB 25 2ZL, Scotland, UK
| | - Shilpi Pandey
- CARE Fertility Nottingham, John Webster House, 6 Lawrence Drive, Nottingham Business Park, Nottingham NG8 6PZ, UK
| | - Edwin Amalraj Raja
- School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Ashalatha Shetty
- Aberdeen Maternity Hopsital NHS Grampian, AB 25 2ZL, Scotland, UK
| | - Mark Hamilton
- Aberdeen Maternity Hopsital NHS Grampian, AB 25 2ZL, Scotland, UK
| | - Siladitya Bhattacharya
- School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
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28
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Anav M, Ferrières-Hoa A, Gala A, Fournier A, Zaragoza S, Vintejoux E, Vincens C, Hamamah S. [Birth weight and frozen embryo transfer: State of the art]. ACTA ACUST UNITED AC 2018; 46:489-496. [PMID: 29680508 DOI: 10.1016/j.gofs.2018.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Indexed: 11/26/2022]
Abstract
The aim of this study was to update our acknowledgment if there is a link between assisted embryo cryopreservation and epigenetics in human? Animal studies have demonstrated epigenetics consequence and especially imprinting disorders due to in vitro culture. In human, it is important to note that after frozen embryo transfer birth weight is significantly increased by 81 to 250g. But these studies cannot identify the reasons of such difference. This review strongly suggests that embryo cryopreservation is responsible for birth weight variations but mechanisms not yet elucidated. Epigenetics is probably one of these but to date, none study is able to prove it. We have to be attentive on a possible link between assisted reproductive technology (ART) and epigenetics reprogrammation.
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Affiliation(s)
- M Anav
- Département biologie de la reproduction/DPI, hôpital Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34295, Montpellier, France
| | - A Ferrières-Hoa
- Département biologie de la reproduction/DPI, hôpital Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34295, Montpellier, France
| | - A Gala
- Département biologie de la reproduction/DPI, hôpital Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34295, Montpellier, France
| | - A Fournier
- Département biologie de la reproduction/DPI, hôpital Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34295, Montpellier, France
| | - S Zaragoza
- Département biologie de la reproduction/DPI, hôpital Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34295, Montpellier, France
| | - E Vintejoux
- Service de gynécologie obstétrique, CHU Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34295, Montpellier, France
| | - C Vincens
- Service de gynécologie obstétrique, CHU Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34295, Montpellier, France
| | - S Hamamah
- Département biologie de la reproduction/DPI, hôpital Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34295, Montpellier, France.
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Neumann C, Thompson DA, Thorson H, Sidman JD, Roby BB. Assisted Reproduction is Not Associated with Increased Risk of Congenital Head and Neck Defects. Cureus 2018; 10:e2287. [PMID: 31431829 PMCID: PMC6693793 DOI: 10.7759/cureus.2287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This abstract was presented at the American Academy of Otolaryngology-Head and Neck Surgery Annual Meeting, Orlando, FL, September 2014 with the abstract published (Neumann C, Thompson D, and Sidman J; Assisted reproduction is not associated with increased risk of head and neck defects; Otolaryngology-Head and Neck Surgery; Vol 151, Issue 1, supplement, 2014). Objectives - Compare the rate of head and neck anomalies between children conceived via artificial reproductive technology (ART) versus those conceived via natural methods. - Determine the risk of congenital head and neck abnormalities associated with ART. Study design A retrospective chart review cross-sectional study from 2004-2014 of all patients admitted to the neonatal intensive care unit (NICU) at a tertiary pediatric hospital. Results A total of 14,857 charts were examined; 2,288 patients were conceived via ART, while 12,569 patients were conceived via natural methods. There were 8,022 males and 6,637 females. There were 40 patients born with defects via ART, while there were 681 patients born with defects via natural conception. The total occurrence of congenital malformations was higher for patients conceived naturally versus those conceived with artificial reproduction (5.41% vs. 1.74%). The odds ratio was 0.31 with a 95% CI of 0.23 to 0.43 and a P-value of < 0.0001; the relative risk of having any one of the head and neck defects with ART was 1.04 with a 95% CI of 1.03 to 1.05 and a P-value < 0.0001. Conclusion There appears to be no increased risk of congenital head and neck defects in children conceived via ART versus those conceived naturally.
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Affiliation(s)
- Colin Neumann
- General Surgery, Hofstra Northwell School of Medicine.,Minnesota Perinatal Physicians, Allina Health.,Otolaryngology Head and Neck Surgery, University of Minnesota.,Pediatric Ent and Facial Plastic Surgery, Children's Hospital of Minnesota, St. Paul, USA
| | | | | | - James D Sidman
- Otolaryngology Head and Neck Surgery, University of Minnesota
| | - Brianne B Roby
- Pediatric Ent and Facial Plastic Surgery, Children's Hospital of Minnesota, St. Paul, USA
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Yasmin E, Balachandren N, Davies MC, Jones GL, Lane S, Mathur R, Webber L, Anderson RA. Fertility preservation for medical reasons in girls and women: British fertility society policy and practice guideline. HUM FERTIL 2018; 21:3-26. [DOI: 10.1080/14647273.2017.1422297] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Ephia Yasmin
- Department of Women’s Health, University College London Hospitals, London, UK
| | | | - Melanie C. Davies
- Department of Women’s Health, University College London Hospitals, London, UK
| | - Georgina L. Jones
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - Sheila Lane
- Department of Paediatric Oncology and Haematology, Children’s Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Raj Mathur
- Central Manchester University Hospitals NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK
| | - Lisa Webber
- Department of Women’s Health, University College London Hospitals, London, UK
| | - Richard A. Anderson
- MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
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Liss J, Pastuszek E, Pukszta S, Hoffmann E, Kuczynski W, Lukaszuk A, Lukaszuk K. Effect of next-generation sequencing in preimplantation genetic testing on live birth ratio. Reprod Fertil Dev 2018; 30:1720-1727. [DOI: 10.1071/rd17428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 05/24/2018] [Indexed: 01/17/2023] Open
Abstract
The present study analysed live birth ratios in frozen embryo transfer (FET) cycles where embryo ploidy status was determined with preimplantation genetic testing (PGT) using next-generation sequencing (NGS). PGT was performed on trophectoderm cells biopsied at the blastocyst stage. The present prospective cohort study included 112 women undergoing frozen embryo transfer, with NGS PGT. The control group consisted of 85 patients who underwent the IVF procedure with FET planned for a subsequent cycle. The live birth rate per cycle was higher by ~18.5 percentage points in the investigated compared with control group (42.0% vs 23.5% respectively; P = 0.012). The differences between the study and control groups were also significant for clinical pregnancy (42.0% vs 23.5% respectively; P = 0.012), implantation (41.2% vs 22.2% respectively; P = 0.001) and pregnancy loss rates (9.6% vs 28.6% respectively; P = 0.027). The results show that PGT NGS is a useful method for embryo selection and it may be implemented in routine clinical practice with propitious results.
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Gonadotropin-Releasing Hormone–Agonist Triggering and a Freeze-All Approach: The Final Step in Eliminating Ovarian Hyperstimulation Syndrome? Obstet Gynecol Surv 2017; 72:296-308. [DOI: 10.1097/ogx.0000000000000432] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Beltran Anzola A, Pauly V, Montjean D, Meddeb L, Geoffroy-Siraudin C, Sambuc R, Boyer P, Gervoise-Boyer MJ. No difference in congenital anomalies prevalence irrespective of insemination methods and freezing procedure: cohort study over fourteen years of an ART population in the south of France. J Assist Reprod Genet 2017; 34:867-876. [PMID: 28444613 DOI: 10.1007/s10815-017-0903-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 03/05/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE A retrospective cohort study was conducted to evaluate and compare the prevalence of congenital anomalies in babies and fetuses conceived after four procedures of assisted reproduction technologies (ART). METHODS The prevalence of congenital anomalies was compared retrospectively between 2750 babies and fetuses conceived between 2001 and 2014 in vitro fertilization with standard insemination (IVF), IVF with intracytoplasmic sperm injection (ICSI), IVF with frozen embryo transfer (FET-IVF), and ICSI with frozen embryo transfer (FET-ICSI). Congenital anomalies were described according to European Surveillance of Congenital Anomalies (EUROCAT) classification. The parental backgrounds, biologic parameters, obstetric parameters, and perinatal outcomes were compared between babies and fetuses with and without congenital anomalies. Data were analyzed by the generalized estimating equation. RESULTS Between 2001 and 2014, a total of 2477 evolutionary pregnancies were notified. Among these pregnancies, 2379 were included in the analysis. One hundred thirty-four babies and fetuses had a congenital anomaly (4.9%). The major prevalences found among the recorded anomalies were congenital heart defects, chromosomal anomalies, and urinary defects. However, the risk of congenital anomalies in babies and fetuses conceived after FET was not increased compared with babies and fetuses conceived after fresh embryo transfer, even when adjusted for confounding factors (p = 0.40). CONCLUSIONS There is no increased risk of congenital anomalies in babies and fetuses conceived by fresh versus frozen embryo transfer after in vitro fertilization with and without micromanipulation. Indeed, distribution of congenital anomalies found in our population is consistent with the high prevalence of congenital heart defects, chromosomal anomalies, and urinary defects that have been found by other authors in children conceived by infertile couples when compared to children conceived spontaneously.
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Affiliation(s)
- Any Beltran Anzola
- Département de Santé Publique et Maladies Chroniques, Unité de recherche EA 3279, Faculté de médecine, Aix-Marseille Université, 27 Boulevard Jean Moulin, 13005, Marseille, France. .,Service de Médecine et Biologie de la Reproduction, Hôpital Saint Joseph, 26 Boulevard du Louvain, 13008, Marseille, France.
| | - Vanessa Pauly
- Département de Santé Publique et Maladies Chroniques, Unité de recherche EA 3279, Faculté de médecine, Aix-Marseille Université, 27 Boulevard Jean Moulin, 13005, Marseille, France.,Assistance Publique Hôpitaux de Marseille - Service d'information médicale, Hôpital de la Conception, 147 Boulevard Baille, 13005, Marseille, France
| | - Debbie Montjean
- Service de Médecine et Biologie de la Reproduction, Hôpital Saint Joseph, 26 Boulevard du Louvain, 13008, Marseille, France
| | - Line Meddeb
- Assistance Publique Hôpitaux de Marseille - Service des Maladies Infectieuses, Hôpital de la Conception, 147 Boulevard Baille, 13005, Marseille, France
| | - Cendrine Geoffroy-Siraudin
- Service de Médecine et Biologie de la Reproduction, Hôpital Saint Joseph, 26 Boulevard du Louvain, 13008, Marseille, France
| | - Roland Sambuc
- Département de Santé Publique et Maladies Chroniques, Unité de recherche EA 3279, Faculté de médecine, Aix-Marseille Université, 27 Boulevard Jean Moulin, 13005, Marseille, France.,Assistance Publique Hôpitaux de Marseille - Service d'information médicale, Hôpital de la Conception, 147 Boulevard Baille, 13005, Marseille, France
| | - Pierre Boyer
- Service de Médecine et Biologie de la Reproduction, Hôpital Saint Joseph, 26 Boulevard du Louvain, 13008, Marseille, France
| | - Marie-José Gervoise-Boyer
- Service de Médecine et Biologie de la Reproduction, Hôpital Saint Joseph, 26 Boulevard du Louvain, 13008, Marseille, France
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Rienzi L, Gracia C, Maggiulli R, LaBarbera AR, Kaser DJ, Ubaldi FM, Vanderpoel S, Racowsky C. Oocyte, embryo and blastocyst cryopreservation in ART: systematic review and meta-analysis comparing slow-freezing versus vitrification to produce evidence for the development of global guidance. Hum Reprod Update 2017; 23:139-155. [PMID: 27827818 PMCID: PMC5850862 DOI: 10.1093/humupd/dmw038] [Citation(s) in RCA: 200] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 09/15/2016] [Accepted: 10/14/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Successful cryopreservation of oocytes and embryos is essential not only to maximize the safety and efficacy of ovarian stimulation cycles in an IVF treatment, but also to enable fertility preservation. Two cryopreservation methods are routinely used: slow-freezing or vitrification. Slow-freezing allows for freezing to occur at a sufficiently slow rate to permit adequate cellular dehydration while minimizing intracellular ice formation. Vitrification allows the solidification of the cell(s) and of the extracellular milieu into a glass-like state without the formation of ice. OBJECTIVE AND RATIONALE The objective of our study was to provide a systematic review and meta-analysis of clinical outcomes following slow-freezing/thawing versus vitrification/warming of oocytes and embryos and to inform the development of World Health Organization guidance on the most effective cryopreservation method. SEARCH METHODS A Medline search was performed from 1966 to 1 August 2016 using the following search terms: (Oocyte(s) [tiab] OR (Pronuclear[tiab] OR Embryo[tiab] OR Blastocyst[tiab]) AND (vitrification[tiab] OR freezing[tiab] OR freeze[tiab]) AND (pregnancy[tiab] OR birth[tiab] OR clinical[tiab]). Queries were limited to those involving humans. RCTs and cohort studies that were published in full-length were considered eligible. Each reference was reviewed for relevance and only primary evidence and relevant articles from the bibliographies of included articles were considered. References were included if they reported cryosurvival rate, clinical pregnancy rate (CPR), live-birth rate (LBR) or delivery rate for slow-frozen or vitrified human oocytes or embryos. A meta-analysis was performed using a random effects model to calculate relative risk ratios (RR) and 95% CI. OUTCOMES One RCT study comparing slow-freezing versus vitrification of oocytes was included. Vitrification was associated with increased ongoing CPR per cycle (RR = 2.81, 95% CI: 1.05-7.51; P = 0.039; 48 and 30 cycles, respectively, per transfer (RR = 1.81, 95% CI 0.71-4.67; P = 0.214; 47 and 19 transfers) and per warmed/thawed oocyte (RR = 1.14, 95% CI: 1.02-1.28; P = 0.018; 260 and 238 oocytes). One RCT comparing vitrification versus fresh oocytes was analysed. In vitrification and fresh cycles, respectively, no evidence for a difference in ongoing CPR per randomized woman (RR = 1.03, 95% CI: 0.87-1.21; P = 0.744, 300 women in each group), per cycle (RR = 1.01, 95% CI: 0.86-1.18; P = 0.934; 267 versus 259 cycles) and per oocyte utilized (RR = 1.02, 95% CI: 0.82-1.26; P = 0.873; 3286 versus 3185 oocytes) was reported. Findings were consistent with relevant cohort studies. Of the seven RCTs on embryo cryopreservation identified, three met the inclusion criteria (638 warming/thawing cycles at cleavage and blastocyst stage), none of which involved pronuclear-stage embryos. A higher CPR per cycle was noted with embryo vitrification compared with slow-freezing, though this was of borderline statistical significance (RR = 1.89, 95% CI: 1.00-3.59; P = 0.051; three RCTs; I2 = 71.9%). LBR per cycle was reported by one RCT performed with cleavage-stage embryos and was higher for vitrification (RR = 2.28; 95% CI: 1.17-4.44; P = 0.016; 216 cycles; one RCT). A secondary analysis was performed focusing on embryo cryosurvival rate. Pooled data from seven RCTs (3615 embryos) revealed a significant improvement in embryo cryosurvival following vitrification as compared with slow-freezing (RR = 1.59, 95% CI: 1.30-1.93; P < 0.001; I2 = 93%). WIDER IMPLICATIONS Data from available RCTs suggest that vitrification/warming is superior to slow-freezing/thawing with regard to clinical outcomes (low quality of the evidence) and cryosurvival rates (moderate quality of the evidence) for oocytes, cleavage-stage embryos and blastocysts. The results were confirmed by cohort studies. The improvements obtained with the introduction of vitrification have several important clinical implications in ART. Based on this evidence, in particular regarding cryosurvival rates, laboratories that continue to use slow-freezing should consider transitioning to the use of vitrification for cryopreservation.
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Affiliation(s)
- Laura Rienzi
- GENERA Centre for Reproductive Medicine, Clinica Valle Giulia, via de Notaris 2b, Rome, Italy
| | - Clarisa Gracia
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA
| | - Roberta Maggiulli
- GENERA Centre for Reproductive Medicine, Clinica Valle Giulia, via de Notaris 2b, Rome, Italy
| | | | - Daniel J. Kaser
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Filippo M. Ubaldi
- GENERA Centre for Reproductive Medicine, Clinica Valle Giulia, via de Notaris 2b, Rome, Italy
| | - Sheryl Vanderpoel
- HRP (the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction), Geneva, Switzerland(at the time of the study)
- Population Council, Reproductive Health Programme, New York, USA
| | - Catherine Racowsky
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Luke B, Brown MB, Wantman E, Stern JE, Toner JP, Coddington CC. Increased risk of large-for-gestational age birthweight in singleton siblings conceived with in vitro fertilization in frozen versus fresh cycles. J Assist Reprod Genet 2016; 34:191-200. [PMID: 27909843 DOI: 10.1007/s10815-016-0850-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 11/22/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Children born from fresh in vitro fertilization (IVF) cycles are at greater risk of being born smaller and earlier, even when limited to singletons; those born from frozen cycles have an increased risk of large-for-gestational age (LGA) birthweight (z-score ≥1.28). This analysis sought to overcome limitations in other studies by using pairs of siblings, and accounting for prior cycle outcomes, maternal characteristics, and embryo state and stage. METHODS Pairs of singleton births conceived with IVF and born between 2004 and 2013 were identified from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System database, matched for embryo stage (blastocyst versus non-blastocyst) and infant gender, categorized by embryo state (fresh versus frozen) in 1st and 2nd births (four groups). RESULTS The data included 7795 singleton pairs. Birthweight z-scores were 0.00-0.04 and 0.24-0.26 in 1st and 2nd births in fresh cycles, and 0.25-0.34 and 0.50-0.55 in frozen cycles, respectively. LGA was 9.2-9.8 and 14.2-15.4% in 1st and 2nd births in fresh cycles, and 13.1-15.8 and 20.8-21.0% in 1st and 2nd births in frozen cycles. The risk of LGA was increased in frozen cycles (1st births, adjusted odds ratios (AOR) 1.74, 95% CI 1.45, 2.08; and in 2nd births when the 1st birth was not LGA, AOR 1.70, 95% CI 1.46, 1.98 for fresh/frozen and 1.40, 1.11, 1.78 for frozen/frozen). CONCLUSIONS Our results with siblings indicate that frozen embryo state is associated with an increased risk for LGA. The implications of these findings for childhood health and risk of obesity are unclear, and warrant further investigation.
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Affiliation(s)
- Barbara Luke
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, 965 Fee Road, East Fee Hall, Room 628, East Lansing, MI, USA.
| | - Morton B Brown
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Judy E Stern
- Department of Obstetrics and Gynecology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - James P Toner
- Atlanta Center for Reproductive Medicine, Atlanta, GA, USA
| | - Charles C Coddington
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, MN, USA
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Abstract
PURPOSE OF REVIEW To assess the effectiveness and ethical dimensions of oocyte cryopreservation for both medical and social indications. RECENT FINDINGS As more women are postponing motherhood for a variety of reasons, including lack of partner, for completing career plans and reaching financial stability, they are resorting to oocyte cryopreservation. To make informed choices, women rely on their primary care physicians (PCPs) for initial advice, but PCPs are not always fully prepared to discuss oocyte cryopreservation. Interestingly, there are mixed feelings among obstetricians/gynecologists on whether oocyte cryopreservation should be used for elective reasons, whereas it is fully supported for medical indications. SUMMARY Oocyte vitrification has become an established procedure for safeguarding future reproductive chances for medical reasons, and its use is progressively expanding. There is an urgent need in preparing future PCPs and obstetricians/gynecologists as to how to initiate discussions with their patients about elective oocyte banking consistent with fully respecting patient autonomy so as to facilitate informed decisions.
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Affiliation(s)
- Pasquale Patrizio
- aYale University Fertility Center, Department of Obstetrics, Gynaecology & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut bNYU Langone Medical Center, Division of Medical Ethics, New York, New York, USA
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Berkkanoglu M, Coetzee K, Bulut H, Ozgur K. Optimal embryo transfer strategy in poor response may include freeze-all. J Assist Reprod Genet 2016; 34:79-87. [PMID: 27832397 DOI: 10.1007/s10815-016-0825-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 09/30/2016] [Indexed: 12/17/2022] Open
Abstract
PURPOSE In this retrospective cohort study, we investigated the best embryo transfer strategy in ICSI cycles with ≤4 oocytes collected at oocyte retrieval. METHODS Women who underwent antagonist co-treatment COS for ICSI treatment between January 2010 and December 2015 at a private ART clinic (N = 2263). Eight hundred seventy-nine women (group 1) had ≤4 oocytes collected at oocyte retrieval, of whom 645 (group A) had cleavage stage embryo transfer (ET), and 234 (group B) had blastocyst ET. One thousand three hundred eighty-four women (group 2) had 10-15 oocytes collected at oocyte retrieval, of whom 676 (group C) had cleavage stage ET, and 708 women (group D) had blastocyst ET. Blastocyst vitrification was performed using the Cryotop method and FET using artificial cycles. RESULTS In group 1, the cancellation rate was significantly lower in group A (25.2 vs 38 %). The pregnancy rate (PR), clinical PR, implantation rate (IR), and live birth rate (LBR) per ET and per oocyte retrieval were all lower in group A. The clinical PR, IR, and LBR per ET of vitrified-warmed blastocyst ET were significantly the highest. In group 2, the cycle cancellation rate was significantly lower in group C (3.5 vs 13.4 %). The PR, clinical PR, and IR per ET and per oocyte retrieval were all lower in group C. The LBR per ET was significantly lower, but the LBR per oocyte retrieval was not significantly lower in group C. Again, the PR, clinical PR, and IR per ET of vitrified-warmed blastocyst ET were significantly the highest. CONCLUSIONS Day 5 ET strategy has been reserved for normal or high responders. The improved pregnancy outcomes from blastocyst culture and cryopreservation may challenge ART to extend this benefit to poor responders.
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Affiliation(s)
- Murat Berkkanoglu
- Antalya IVF, Halide Edip Cd. No: 7, Kanal Mh, Antalya, 07080, Turkey.
| | - Kevin Coetzee
- Antalya IVF, Halide Edip Cd. No: 7, Kanal Mh, Antalya, 07080, Turkey
| | - Hasan Bulut
- Antalya IVF, Halide Edip Cd. No: 7, Kanal Mh, Antalya, 07080, Turkey
| | - Kemal Ozgur
- Antalya IVF, Halide Edip Cd. No: 7, Kanal Mh, Antalya, 07080, Turkey
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Palomba S, Homburg R, Santagni S, La Sala GB, Orvieto R. Risk of adverse pregnancy and perinatal outcomes after high technology infertility treatment: a comprehensive systematic review. Reprod Biol Endocrinol 2016; 14:76. [PMID: 27814762 PMCID: PMC5097409 DOI: 10.1186/s12958-016-0211-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 10/26/2016] [Indexed: 11/10/2022] Open
Abstract
In the literature, there is growing evidence that subfertile patients who conceived after infertility treatments have an increased risk of pregnancy and perinatal complications and this is particularly true for patients who conceived through use of high technology infertility treatments. Moreover, high technology infertility treatments include many concomitant clinical and biological risk factors. This review aims to summarize in a systematic fashion the current evidence regarding the relative effect of the different procedures for high technology infertility treatments on the risk of adverse pregnancy and perinatal outcome. A literature search up to August 2016 was performed in IBSS, SocINDEX, Institute for Scientific Information, PubMed, Web of Science and Google Scholar and an evidence-based hierarchy was used to determine which articles to include and analyze. Data on prepregnancy maternal factors, low technology interventions, specific procedures for male factor, ovarian tissue/ovary and uterus transplantation, and chromosomal abnormalities and malformations of the offspring were excluded. The available evidences were analyzed assessing the level and the quality of evidence according to the Oxford Centre for Evidence-Based Medicine guidelines and the Grading of Recommendations Assessment, Development, and Evaluation system, respectively. Current review highlights that every single procedure of high technology infertility treatments can play a crucial role in increasing the risk of pregnancy and perinatal complications. Due to the suboptimal level and quality of the current evidence, further well-designed studies are needed.
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Affiliation(s)
- Stefano Palomba
- Center of Reproductive Medicine and Surgery, Arcispedale Santa Maria Nuova (ASMN)-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Viale Risorgimento 80, 42123 Reggio Emilia, Italy
| | - Roy Homburg
- Homerton Fertility Unit, Homerton University Hospital, Homerton Row, London, UK
| | - Susanna Santagni
- Center of Reproductive Medicine and Surgery, Arcispedale Santa Maria Nuova (ASMN)-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Viale Risorgimento 80, 42123 Reggio Emilia, 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), Viale Risorgimento 80, 42123 Reggio Emilia, Italy
- University of Modena, Reggio Emilia, Italy
| | - Raoul Orvieto
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abstract
The aim of the study was to determine the level of awareness and acceptance of in vitro fertilization pre-embryo transfer (IVF-ET) patients for freeze-all embryo transfer, improve relevant technical specifications, and optimize treatment results based on medical experience.Questionnaires were completed by women who received in vitro fertilization embryo transfer. A total of 377 valid samples were included into this study. Through focus group discussions and tablet assisted intercept interviews, we analyzed the basic situation, the awareness for frozen-all embryo transfer, and the need for frozen-all embryo transfer information for infertile patients.In this study, 60% of patients received IVF-ET for the first time, whereas the remaining patients received IVF-ET more than once. We investigated the current awareness and acceptance of IVF-ET patients for freeze-all embryo transfer quantificationally. Patients were grouped based on quantitative measurements, and the mainstream group of patients (72.7%) was precisely the patients who were worried and concerned of frozen-all embryo transfers. Although few of them could "rationally accept the comparative advantage of the technology," this group was vulnerable to doctors' guidance and education. Eventually, this group of patients accepted the frozen-all embryo transfer.Since there are no certain criteria for the kind of embryo transfer patients and reproductive centers should take, the choice should be taken individually according to the social economic situation and acceptance of patients for the frozen embryo transfer, as well as the technology of the reproductive center.
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Affiliation(s)
- Yan-Xiu Guo
- Reproductive Medical Center, Peking University People's Hospital
| | - Yan-Jing Yin
- Department of Obstetrics and Gynecology, Changping District Hospital, Beijing, China
| | - Li Tian
- Reproductive Medical Center, Peking University People's Hospital
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40
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Beyer DA, Amari F. Maternal risk factors and neonatal outcomes after ART treatment – A German monocenter experience. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2016. [DOI: 10.1016/j.mefs.2015.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Barik M, Bajpai M, Patnaik S, Mishra P, Behera P, Dwivedi SN. Development of new method and protocol for cryopreservation related to embryo and oocytes freezing in terms of fertilization rate: A comparative study including review of literature. Adv Biomed Res 2016; 5:117. [PMID: 27512686 PMCID: PMC4964661 DOI: 10.4103/2277-9175.185576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 11/09/2015] [Indexed: 11/04/2022] Open
Abstract
Background: Cryopreservation is basically related to meritorious thin samples or small clumps of cells that are cooled quickly without loss. Our main objective is to establish and formulate an innovative method and protocol development for cryopreservation as a gold standard for clinical uses in laboratory practice and treatment. The knowledge regarding usefulness of cryopreservation in clinical practice is essential to carry forward the clinical practice and research. Materials and Methods: We are trying to compare different methods of cryopreservation (in two dozen of cells) at the same time we compare the embryo and oocyte freezing interms of fertilization rate according to the International standard protocol. Results: The combination of cryoprotectants and regimes of rapid cooling and rinsing during warming often allows successful cryopreservation of biological materials, particularly cell suspensions or thin tissue samples. Examples include semen, blood, tissue samples like tumors, histological cross-sections, human eggs and human embryos. Although presently many studies have reported that the children born from frozen embryos or “frosties,” show consistently positive results with no increase in birth defects or development abnormalities is quite good enough and similar to our study (50–85%). Conclusions: We ensure that cryopreservation technology provided useful cell survivability, tissue and organ preservation in a proper way. Although it varies according to different laboratory conditions, it is certainly beneficial for patient's treatment and research. Further studies are needed for standardization and development of new protocol.
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Affiliation(s)
- Mayadhar Barik
- Department of Pediatric Surgery, AIIMS, New Delhi, India
| | - Minu Bajpai
- Department of Pediatric Surgery, AIIMS, New Delhi, India
| | - Santosh Patnaik
- Department of Ocular Pharmacology and Pharmacy, AIIMS, New Delhi, India
| | - Pravash Mishra
- Department of Anatomy, AIIMS, Bhubaneshwar, Odisha, India
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Chen ZJ, Shi Y, Sun Y, Zhang B, Liang X, Cao Y, Yang J, Liu J, Wei D, Weng N, Tian L, Hao C, Yang D, Zhou F, Shi J, Xu Y, Li J, Yan J, Qin Y, Zhao H, Zhang H, Legro RS. Fresh versus Frozen Embryos for Infertility in the Polycystic Ovary Syndrome. N Engl J Med 2016; 375:523-33. [PMID: 27509101 DOI: 10.1056/nejmoa1513873] [Citation(s) in RCA: 479] [Impact Index Per Article: 59.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The transfer of fresh embryos is generally preferred over the transfer of frozen embryos for in vitro fertilization (IVF), but some evidence suggests that frozen-embryo transfer may improve the live-birth rate and lower the rates of the ovarian hyperstimulation syndrome and pregnancy complications in women with the polycystic ovary syndrome. METHODS In this multicenter trial, we randomly assigned 1508 infertile women with the polycystic ovary syndrome who were undergoing their first IVF cycle to undergo either fresh-embryo transfer or embryo cryopreservation followed by frozen-embryo transfer. After 3 days of embryo development, women underwent the transfer of up to two fresh or frozen embryos. The primary outcome was a live birth after the first embryo transfer. RESULTS Frozen-embryo transfer resulted in a higher frequency of live birth after the first transfer than did fresh-embryo transfer (49.3% vs. 42.0%), for a rate ratio of 1.17 (95% confidence interval [CI], 1.05 to 1.31; P=0.004). Women who underwent frozen-embryo transfer also had a lower frequency of pregnancy loss (22.0% vs. 32.7%), for a rate ratio of 0.67 (95% CI, 0.54 to 0.83; P<0.001), and of the ovarian hyperstimulation syndrome (1.3% vs. 7.1%), for a rate ratio of 0.19 (95% CI, 0.10 to 0.37; P<0.001), but a higher frequency of preeclampsia (4.4% vs. 1.4%), for a rate ratio of 3.12 (95% CI, 1.26 to 7.73; P=0.009). There were no significant between-group differences in rates of other pregnancy and neonatal complications. There were five neonatal deaths in the frozen-embryo group and none in the fresh-embryo group (P=0.06). CONCLUSIONS Among infertile women with the polycystic ovary syndrome, frozen-embryo transfer was associated with a higher rate of live birth, a lower risk of the ovarian hyperstimulation syndrome, and a higher risk of preeclampsia after the first transfer than was fresh-embryo transfer. (Funded by the National Basic Research Program of China and others; ClinicalTrials.gov number, NCT01841528.).
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Affiliation(s)
- Zi-Jiang Chen
- From the Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan (Z.-J.C., Y. Shi, D.W., J. Li, J. Yan, Y.Q., H. Zhao), Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University (Z.-J.C., Y. Sun), and Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics (Z.-J.C., Y. Sun), Shanghai, Center for Reproductive Medicine, Maternal and Child Health Hospital in Guangxi, Guangxi (B.Z.), Reproductive Medicine Center, the Sixth Affiliated Hospital of Sun Yat-sen University (X.L.) and Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University (D.Y.), Guangzhou, Center for Reproductive Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei (Y.C.), Center for Reproductive Medicine, Wuhan University, Wuhan (J. Yang), Department of Obstetrics and Gynecology, First Affiliated Hospital of Nanjing Medical University, Nanjing (J. Liu), Reproductive Medicine Center of Jinghua Hospital, Shenyang (N.W.), Center for Reproductive Medicine, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang (L.T.), Center for Reproductive Medicine of Yantai Yuhuangding Hospital, Yantai (C.H.), Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou (F.Z.), Assisted Reproduction Center, Maternal and Child Health Care Hospital of Shanxi Province, Xi'an (J.S.), and Center for Reproduction and Genetics, Suzhou Municipal Hospital, Suzhou (Y.X.) - all in China; Department of Biostatistics, Yale University School of Public Health, New Haven, CT (H. Zhang); and Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey (R.S.L.)
| | - Yuhua Shi
- From the Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan (Z.-J.C., Y. Shi, D.W., J. Li, J. Yan, Y.Q., H. Zhao), Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University (Z.-J.C., Y. Sun), and Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics (Z.-J.C., Y. Sun), Shanghai, Center for Reproductive Medicine, Maternal and Child Health Hospital in Guangxi, Guangxi (B.Z.), Reproductive Medicine Center, the Sixth Affiliated Hospital of Sun Yat-sen University (X.L.) and Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University (D.Y.), Guangzhou, Center for Reproductive Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei (Y.C.), Center for Reproductive Medicine, Wuhan University, Wuhan (J. Yang), Department of Obstetrics and Gynecology, First Affiliated Hospital of Nanjing Medical University, Nanjing (J. Liu), Reproductive Medicine Center of Jinghua Hospital, Shenyang (N.W.), Center for Reproductive Medicine, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang (L.T.), Center for Reproductive Medicine of Yantai Yuhuangding Hospital, Yantai (C.H.), Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou (F.Z.), Assisted Reproduction Center, Maternal and Child Health Care Hospital of Shanxi Province, Xi'an (J.S.), and Center for Reproduction and Genetics, Suzhou Municipal Hospital, Suzhou (Y.X.) - all in China; Department of Biostatistics, Yale University School of Public Health, New Haven, CT (H. Zhang); and Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey (R.S.L.)
| | - Yun Sun
- From the Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan (Z.-J.C., Y. Shi, D.W., J. Li, J. Yan, Y.Q., H. Zhao), Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University (Z.-J.C., Y. Sun), and Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics (Z.-J.C., Y. Sun), Shanghai, Center for Reproductive Medicine, Maternal and Child Health Hospital in Guangxi, Guangxi (B.Z.), Reproductive Medicine Center, the Sixth Affiliated Hospital of Sun Yat-sen University (X.L.) and Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University (D.Y.), Guangzhou, Center for Reproductive Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei (Y.C.), Center for Reproductive Medicine, Wuhan University, Wuhan (J. Yang), Department of Obstetrics and Gynecology, First Affiliated Hospital of Nanjing Medical University, Nanjing (J. Liu), Reproductive Medicine Center of Jinghua Hospital, Shenyang (N.W.), Center for Reproductive Medicine, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang (L.T.), Center for Reproductive Medicine of Yantai Yuhuangding Hospital, Yantai (C.H.), Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou (F.Z.), Assisted Reproduction Center, Maternal and Child Health Care Hospital of Shanxi Province, Xi'an (J.S.), and Center for Reproduction and Genetics, Suzhou Municipal Hospital, Suzhou (Y.X.) - all in China; Department of Biostatistics, Yale University School of Public Health, New Haven, CT (H. Zhang); and Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey (R.S.L.)
| | - Bo Zhang
- From the Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan (Z.-J.C., Y. Shi, D.W., J. Li, J. Yan, Y.Q., H. Zhao), Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University (Z.-J.C., Y. Sun), and Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics (Z.-J.C., Y. Sun), Shanghai, Center for Reproductive Medicine, Maternal and Child Health Hospital in Guangxi, Guangxi (B.Z.), Reproductive Medicine Center, the Sixth Affiliated Hospital of Sun Yat-sen University (X.L.) and Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University (D.Y.), Guangzhou, Center for Reproductive Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei (Y.C.), Center for Reproductive Medicine, Wuhan University, Wuhan (J. Yang), Department of Obstetrics and Gynecology, First Affiliated Hospital of Nanjing Medical University, Nanjing (J. Liu), Reproductive Medicine Center of Jinghua Hospital, Shenyang (N.W.), Center for Reproductive Medicine, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang (L.T.), Center for Reproductive Medicine of Yantai Yuhuangding Hospital, Yantai (C.H.), Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou (F.Z.), Assisted Reproduction Center, Maternal and Child Health Care Hospital of Shanxi Province, Xi'an (J.S.), and Center for Reproduction and Genetics, Suzhou Municipal Hospital, Suzhou (Y.X.) - all in China; Department of Biostatistics, Yale University School of Public Health, New Haven, CT (H. Zhang); and Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey (R.S.L.)
| | - Xiaoyan Liang
- From the Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan (Z.-J.C., Y. Shi, D.W., J. Li, J. Yan, Y.Q., H. Zhao), Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University (Z.-J.C., Y. Sun), and Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics (Z.-J.C., Y. Sun), Shanghai, Center for Reproductive Medicine, Maternal and Child Health Hospital in Guangxi, Guangxi (B.Z.), Reproductive Medicine Center, the Sixth Affiliated Hospital of Sun Yat-sen University (X.L.) and Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University (D.Y.), Guangzhou, Center for Reproductive Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei (Y.C.), Center for Reproductive Medicine, Wuhan University, Wuhan (J. Yang), Department of Obstetrics and Gynecology, First Affiliated Hospital of Nanjing Medical University, Nanjing (J. Liu), Reproductive Medicine Center of Jinghua Hospital, Shenyang (N.W.), Center for Reproductive Medicine, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang (L.T.), Center for Reproductive Medicine of Yantai Yuhuangding Hospital, Yantai (C.H.), Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou (F.Z.), Assisted Reproduction Center, Maternal and Child Health Care Hospital of Shanxi Province, Xi'an (J.S.), and Center for Reproduction and Genetics, Suzhou Municipal Hospital, Suzhou (Y.X.) - all in China; Department of Biostatistics, Yale University School of Public Health, New Haven, CT (H. Zhang); and Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey (R.S.L.)
| | - Yunxia Cao
- From the Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan (Z.-J.C., Y. Shi, D.W., J. Li, J. Yan, Y.Q., H. Zhao), Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University (Z.-J.C., Y. Sun), and Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics (Z.-J.C., Y. Sun), Shanghai, Center for Reproductive Medicine, Maternal and Child Health Hospital in Guangxi, Guangxi (B.Z.), Reproductive Medicine Center, the Sixth Affiliated Hospital of Sun Yat-sen University (X.L.) and Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University (D.Y.), Guangzhou, Center for Reproductive Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei (Y.C.), Center for Reproductive Medicine, Wuhan University, Wuhan (J. Yang), Department of Obstetrics and Gynecology, First Affiliated Hospital of Nanjing Medical University, Nanjing (J. Liu), Reproductive Medicine Center of Jinghua Hospital, Shenyang (N.W.), Center for Reproductive Medicine, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang (L.T.), Center for Reproductive Medicine of Yantai Yuhuangding Hospital, Yantai (C.H.), Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou (F.Z.), Assisted Reproduction Center, Maternal and Child Health Care Hospital of Shanxi Province, Xi'an (J.S.), and Center for Reproduction and Genetics, Suzhou Municipal Hospital, Suzhou (Y.X.) - all in China; Department of Biostatistics, Yale University School of Public Health, New Haven, CT (H. Zhang); and Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey (R.S.L.)
| | - Jing Yang
- From the Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan (Z.-J.C., Y. Shi, D.W., J. Li, J. Yan, Y.Q., H. Zhao), Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University (Z.-J.C., Y. Sun), and Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics (Z.-J.C., Y. Sun), Shanghai, Center for Reproductive Medicine, Maternal and Child Health Hospital in Guangxi, Guangxi (B.Z.), Reproductive Medicine Center, the Sixth Affiliated Hospital of Sun Yat-sen University (X.L.) and Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University (D.Y.), Guangzhou, Center for Reproductive Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei (Y.C.), Center for Reproductive Medicine, Wuhan University, Wuhan (J. Yang), Department of Obstetrics and Gynecology, First Affiliated Hospital of Nanjing Medical University, Nanjing (J. Liu), Reproductive Medicine Center of Jinghua Hospital, Shenyang (N.W.), Center for Reproductive Medicine, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang (L.T.), Center for Reproductive Medicine of Yantai Yuhuangding Hospital, Yantai (C.H.), Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou (F.Z.), Assisted Reproduction Center, Maternal and Child Health Care Hospital of Shanxi Province, Xi'an (J.S.), and Center for Reproduction and Genetics, Suzhou Municipal Hospital, Suzhou (Y.X.) - all in China; Department of Biostatistics, Yale University School of Public Health, New Haven, CT (H. Zhang); and Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey (R.S.L.)
| | - Jiayin Liu
- From the Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan (Z.-J.C., Y. Shi, D.W., J. Li, J. Yan, Y.Q., H. Zhao), Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University (Z.-J.C., Y. Sun), and Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics (Z.-J.C., Y. Sun), Shanghai, Center for Reproductive Medicine, Maternal and Child Health Hospital in Guangxi, Guangxi (B.Z.), Reproductive Medicine Center, the Sixth Affiliated Hospital of Sun Yat-sen University (X.L.) and Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University (D.Y.), Guangzhou, Center for Reproductive Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei (Y.C.), Center for Reproductive Medicine, Wuhan University, Wuhan (J. Yang), Department of Obstetrics and Gynecology, First Affiliated Hospital of Nanjing Medical University, Nanjing (J. Liu), Reproductive Medicine Center of Jinghua Hospital, Shenyang (N.W.), Center for Reproductive Medicine, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang (L.T.), Center for Reproductive Medicine of Yantai Yuhuangding Hospital, Yantai (C.H.), Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou (F.Z.), Assisted Reproduction Center, Maternal and Child Health Care Hospital of Shanxi Province, Xi'an (J.S.), and Center for Reproduction and Genetics, Suzhou Municipal Hospital, Suzhou (Y.X.) - all in China; Department of Biostatistics, Yale University School of Public Health, New Haven, CT (H. Zhang); and Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey (R.S.L.)
| | - Daimin Wei
- From the Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan (Z.-J.C., Y. Shi, D.W., J. Li, J. Yan, Y.Q., H. Zhao), Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University (Z.-J.C., Y. Sun), and Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics (Z.-J.C., Y. Sun), Shanghai, Center for Reproductive Medicine, Maternal and Child Health Hospital in Guangxi, Guangxi (B.Z.), Reproductive Medicine Center, the Sixth Affiliated Hospital of Sun Yat-sen University (X.L.) and Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University (D.Y.), Guangzhou, Center for Reproductive Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei (Y.C.), Center for Reproductive Medicine, Wuhan University, Wuhan (J. Yang), Department of Obstetrics and Gynecology, First Affiliated Hospital of Nanjing Medical University, Nanjing (J. Liu), Reproductive Medicine Center of Jinghua Hospital, Shenyang (N.W.), Center for Reproductive Medicine, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang (L.T.), Center for Reproductive Medicine of Yantai Yuhuangding Hospital, Yantai (C.H.), Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou (F.Z.), Assisted Reproduction Center, Maternal and Child Health Care Hospital of Shanxi Province, Xi'an (J.S.), and Center for Reproduction and Genetics, Suzhou Municipal Hospital, Suzhou (Y.X.) - all in China; Department of Biostatistics, Yale University School of Public Health, New Haven, CT (H. Zhang); and Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey (R.S.L.)
| | - Ning Weng
- From the Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan (Z.-J.C., Y. Shi, D.W., J. Li, J. Yan, Y.Q., H. Zhao), Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University (Z.-J.C., Y. Sun), and Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics (Z.-J.C., Y. Sun), Shanghai, Center for Reproductive Medicine, Maternal and Child Health Hospital in Guangxi, Guangxi (B.Z.), Reproductive Medicine Center, the Sixth Affiliated Hospital of Sun Yat-sen University (X.L.) and Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University (D.Y.), Guangzhou, Center for Reproductive Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei (Y.C.), Center for Reproductive Medicine, Wuhan University, Wuhan (J. Yang), Department of Obstetrics and Gynecology, First Affiliated Hospital of Nanjing Medical University, Nanjing (J. Liu), Reproductive Medicine Center of Jinghua Hospital, Shenyang (N.W.), Center for Reproductive Medicine, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang (L.T.), Center for Reproductive Medicine of Yantai Yuhuangding Hospital, Yantai (C.H.), Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou (F.Z.), Assisted Reproduction Center, Maternal and Child Health Care Hospital of Shanxi Province, Xi'an (J.S.), and Center for Reproduction and Genetics, Suzhou Municipal Hospital, Suzhou (Y.X.) - all in China; Department of Biostatistics, Yale University School of Public Health, New Haven, CT (H. Zhang); and Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey (R.S.L.)
| | - Lifeng Tian
- From the Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan (Z.-J.C., Y. Shi, D.W., J. Li, J. Yan, Y.Q., H. Zhao), Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University (Z.-J.C., Y. Sun), and Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics (Z.-J.C., Y. Sun), Shanghai, Center for Reproductive Medicine, Maternal and Child Health Hospital in Guangxi, Guangxi (B.Z.), Reproductive Medicine Center, the Sixth Affiliated Hospital of Sun Yat-sen University (X.L.) and Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University (D.Y.), Guangzhou, Center for Reproductive Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei (Y.C.), Center for Reproductive Medicine, Wuhan University, Wuhan (J. Yang), Department of Obstetrics and Gynecology, First Affiliated Hospital of Nanjing Medical University, Nanjing (J. Liu), Reproductive Medicine Center of Jinghua Hospital, Shenyang (N.W.), Center for Reproductive Medicine, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang (L.T.), Center for Reproductive Medicine of Yantai Yuhuangding Hospital, Yantai (C.H.), Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou (F.Z.), Assisted Reproduction Center, Maternal and Child Health Care Hospital of Shanxi Province, Xi'an (J.S.), and Center for Reproduction and Genetics, Suzhou Municipal Hospital, Suzhou (Y.X.) - all in China; Department of Biostatistics, Yale University School of Public Health, New Haven, CT (H. Zhang); and Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey (R.S.L.)
| | - Cuifang Hao
- From the Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan (Z.-J.C., Y. Shi, D.W., J. Li, J. Yan, Y.Q., H. Zhao), Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University (Z.-J.C., Y. Sun), and Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics (Z.-J.C., Y. Sun), Shanghai, Center for Reproductive Medicine, Maternal and Child Health Hospital in Guangxi, Guangxi (B.Z.), Reproductive Medicine Center, the Sixth Affiliated Hospital of Sun Yat-sen University (X.L.) and Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University (D.Y.), Guangzhou, Center for Reproductive Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei (Y.C.), Center for Reproductive Medicine, Wuhan University, Wuhan (J. Yang), Department of Obstetrics and Gynecology, First Affiliated Hospital of Nanjing Medical University, Nanjing (J. Liu), Reproductive Medicine Center of Jinghua Hospital, Shenyang (N.W.), Center for Reproductive Medicine, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang (L.T.), Center for Reproductive Medicine of Yantai Yuhuangding Hospital, Yantai (C.H.), Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou (F.Z.), Assisted Reproduction Center, Maternal and Child Health Care Hospital of Shanxi Province, Xi'an (J.S.), and Center for Reproduction and Genetics, Suzhou Municipal Hospital, Suzhou (Y.X.) - all in China; Department of Biostatistics, Yale University School of Public Health, New Haven, CT (H. Zhang); and Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey (R.S.L.)
| | - Dongzi Yang
- From the Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan (Z.-J.C., Y. Shi, D.W., J. Li, J. Yan, Y.Q., H. Zhao), Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University (Z.-J.C., Y. Sun), and Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics (Z.-J.C., Y. Sun), Shanghai, Center for Reproductive Medicine, Maternal and Child Health Hospital in Guangxi, Guangxi (B.Z.), Reproductive Medicine Center, the Sixth Affiliated Hospital of Sun Yat-sen University (X.L.) and Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University (D.Y.), Guangzhou, Center for Reproductive Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei (Y.C.), Center for Reproductive Medicine, Wuhan University, Wuhan (J. Yang), Department of Obstetrics and Gynecology, First Affiliated Hospital of Nanjing Medical University, Nanjing (J. Liu), Reproductive Medicine Center of Jinghua Hospital, Shenyang (N.W.), Center for Reproductive Medicine, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang (L.T.), Center for Reproductive Medicine of Yantai Yuhuangding Hospital, Yantai (C.H.), Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou (F.Z.), Assisted Reproduction Center, Maternal and Child Health Care Hospital of Shanxi Province, Xi'an (J.S.), and Center for Reproduction and Genetics, Suzhou Municipal Hospital, Suzhou (Y.X.) - all in China; Department of Biostatistics, Yale University School of Public Health, New Haven, CT (H. Zhang); and Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey (R.S.L.)
| | - Feng Zhou
- From the Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan (Z.-J.C., Y. Shi, D.W., J. Li, J. Yan, Y.Q., H. Zhao), Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University (Z.-J.C., Y. Sun), and Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics (Z.-J.C., Y. Sun), Shanghai, Center for Reproductive Medicine, Maternal and Child Health Hospital in Guangxi, Guangxi (B.Z.), Reproductive Medicine Center, the Sixth Affiliated Hospital of Sun Yat-sen University (X.L.) and Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University (D.Y.), Guangzhou, Center for Reproductive Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei (Y.C.), Center for Reproductive Medicine, Wuhan University, Wuhan (J. Yang), Department of Obstetrics and Gynecology, First Affiliated Hospital of Nanjing Medical University, Nanjing (J. Liu), Reproductive Medicine Center of Jinghua Hospital, Shenyang (N.W.), Center for Reproductive Medicine, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang (L.T.), Center for Reproductive Medicine of Yantai Yuhuangding Hospital, Yantai (C.H.), Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou (F.Z.), Assisted Reproduction Center, Maternal and Child Health Care Hospital of Shanxi Province, Xi'an (J.S.), and Center for Reproduction and Genetics, Suzhou Municipal Hospital, Suzhou (Y.X.) - all in China; Department of Biostatistics, Yale University School of Public Health, New Haven, CT (H. Zhang); and Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey (R.S.L.)
| | - Juanzi Shi
- From the Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan (Z.-J.C., Y. Shi, D.W., J. Li, J. Yan, Y.Q., H. Zhao), Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University (Z.-J.C., Y. Sun), and Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics (Z.-J.C., Y. Sun), Shanghai, Center for Reproductive Medicine, Maternal and Child Health Hospital in Guangxi, Guangxi (B.Z.), Reproductive Medicine Center, the Sixth Affiliated Hospital of Sun Yat-sen University (X.L.) and Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University (D.Y.), Guangzhou, Center for Reproductive Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei (Y.C.), Center for Reproductive Medicine, Wuhan University, Wuhan (J. Yang), Department of Obstetrics and Gynecology, First Affiliated Hospital of Nanjing Medical University, Nanjing (J. Liu), Reproductive Medicine Center of Jinghua Hospital, Shenyang (N.W.), Center for Reproductive Medicine, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang (L.T.), Center for Reproductive Medicine of Yantai Yuhuangding Hospital, Yantai (C.H.), Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou (F.Z.), Assisted Reproduction Center, Maternal and Child Health Care Hospital of Shanxi Province, Xi'an (J.S.), and Center for Reproduction and Genetics, Suzhou Municipal Hospital, Suzhou (Y.X.) - all in China; Department of Biostatistics, Yale University School of Public Health, New Haven, CT (H. Zhang); and Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey (R.S.L.)
| | - Yongle Xu
- From the Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan (Z.-J.C., Y. Shi, D.W., J. Li, J. Yan, Y.Q., H. Zhao), Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University (Z.-J.C., Y. Sun), and Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics (Z.-J.C., Y. Sun), Shanghai, Center for Reproductive Medicine, Maternal and Child Health Hospital in Guangxi, Guangxi (B.Z.), Reproductive Medicine Center, the Sixth Affiliated Hospital of Sun Yat-sen University (X.L.) and Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University (D.Y.), Guangzhou, Center for Reproductive Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei (Y.C.), Center for Reproductive Medicine, Wuhan University, Wuhan (J. Yang), Department of Obstetrics and Gynecology, First Affiliated Hospital of Nanjing Medical University, Nanjing (J. Liu), Reproductive Medicine Center of Jinghua Hospital, Shenyang (N.W.), Center for Reproductive Medicine, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang (L.T.), Center for Reproductive Medicine of Yantai Yuhuangding Hospital, Yantai (C.H.), Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou (F.Z.), Assisted Reproduction Center, Maternal and Child Health Care Hospital of Shanxi Province, Xi'an (J.S.), and Center for Reproduction and Genetics, Suzhou Municipal Hospital, Suzhou (Y.X.) - all in China; Department of Biostatistics, Yale University School of Public Health, New Haven, CT (H. Zhang); and Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey (R.S.L.)
| | - Jing Li
- From the Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan (Z.-J.C., Y. Shi, D.W., J. Li, J. Yan, Y.Q., H. Zhao), Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University (Z.-J.C., Y. Sun), and Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics (Z.-J.C., Y. Sun), Shanghai, Center for Reproductive Medicine, Maternal and Child Health Hospital in Guangxi, Guangxi (B.Z.), Reproductive Medicine Center, the Sixth Affiliated Hospital of Sun Yat-sen University (X.L.) and Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University (D.Y.), Guangzhou, Center for Reproductive Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei (Y.C.), Center for Reproductive Medicine, Wuhan University, Wuhan (J. Yang), Department of Obstetrics and Gynecology, First Affiliated Hospital of Nanjing Medical University, Nanjing (J. Liu), Reproductive Medicine Center of Jinghua Hospital, Shenyang (N.W.), Center for Reproductive Medicine, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang (L.T.), Center for Reproductive Medicine of Yantai Yuhuangding Hospital, Yantai (C.H.), Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou (F.Z.), Assisted Reproduction Center, Maternal and Child Health Care Hospital of Shanxi Province, Xi'an (J.S.), and Center for Reproduction and Genetics, Suzhou Municipal Hospital, Suzhou (Y.X.) - all in China; Department of Biostatistics, Yale University School of Public Health, New Haven, CT (H. Zhang); and Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey (R.S.L.)
| | - Junhao Yan
- From the Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan (Z.-J.C., Y. Shi, D.W., J. Li, J. Yan, Y.Q., H. Zhao), Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University (Z.-J.C., Y. Sun), and Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics (Z.-J.C., Y. Sun), Shanghai, Center for Reproductive Medicine, Maternal and Child Health Hospital in Guangxi, Guangxi (B.Z.), Reproductive Medicine Center, the Sixth Affiliated Hospital of Sun Yat-sen University (X.L.) and Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University (D.Y.), Guangzhou, Center for Reproductive Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei (Y.C.), Center for Reproductive Medicine, Wuhan University, Wuhan (J. Yang), Department of Obstetrics and Gynecology, First Affiliated Hospital of Nanjing Medical University, Nanjing (J. Liu), Reproductive Medicine Center of Jinghua Hospital, Shenyang (N.W.), Center for Reproductive Medicine, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang (L.T.), Center for Reproductive Medicine of Yantai Yuhuangding Hospital, Yantai (C.H.), Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou (F.Z.), Assisted Reproduction Center, Maternal and Child Health Care Hospital of Shanxi Province, Xi'an (J.S.), and Center for Reproduction and Genetics, Suzhou Municipal Hospital, Suzhou (Y.X.) - all in China; Department of Biostatistics, Yale University School of Public Health, New Haven, CT (H. Zhang); and Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey (R.S.L.)
| | - Yingying Qin
- From the Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan (Z.-J.C., Y. Shi, D.W., J. Li, J. Yan, Y.Q., H. Zhao), Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University (Z.-J.C., Y. Sun), and Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics (Z.-J.C., Y. Sun), Shanghai, Center for Reproductive Medicine, Maternal and Child Health Hospital in Guangxi, Guangxi (B.Z.), Reproductive Medicine Center, the Sixth Affiliated Hospital of Sun Yat-sen University (X.L.) and Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University (D.Y.), Guangzhou, Center for Reproductive Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei (Y.C.), Center for Reproductive Medicine, Wuhan University, Wuhan (J. Yang), Department of Obstetrics and Gynecology, First Affiliated Hospital of Nanjing Medical University, Nanjing (J. Liu), Reproductive Medicine Center of Jinghua Hospital, Shenyang (N.W.), Center for Reproductive Medicine, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang (L.T.), Center for Reproductive Medicine of Yantai Yuhuangding Hospital, Yantai (C.H.), Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou (F.Z.), Assisted Reproduction Center, Maternal and Child Health Care Hospital of Shanxi Province, Xi'an (J.S.), and Center for Reproduction and Genetics, Suzhou Municipal Hospital, Suzhou (Y.X.) - all in China; Department of Biostatistics, Yale University School of Public Health, New Haven, CT (H. Zhang); and Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey (R.S.L.)
| | - Han Zhao
- From the Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan (Z.-J.C., Y. Shi, D.W., J. Li, J. Yan, Y.Q., H. Zhao), Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University (Z.-J.C., Y. Sun), and Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics (Z.-J.C., Y. Sun), Shanghai, Center for Reproductive Medicine, Maternal and Child Health Hospital in Guangxi, Guangxi (B.Z.), Reproductive Medicine Center, the Sixth Affiliated Hospital of Sun Yat-sen University (X.L.) and Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University (D.Y.), Guangzhou, Center for Reproductive Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei (Y.C.), Center for Reproductive Medicine, Wuhan University, Wuhan (J. Yang), Department of Obstetrics and Gynecology, First Affiliated Hospital of Nanjing Medical University, Nanjing (J. Liu), Reproductive Medicine Center of Jinghua Hospital, Shenyang (N.W.), Center for Reproductive Medicine, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang (L.T.), Center for Reproductive Medicine of Yantai Yuhuangding Hospital, Yantai (C.H.), Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou (F.Z.), Assisted Reproduction Center, Maternal and Child Health Care Hospital of Shanxi Province, Xi'an (J.S.), and Center for Reproduction and Genetics, Suzhou Municipal Hospital, Suzhou (Y.X.) - all in China; Department of Biostatistics, Yale University School of Public Health, New Haven, CT (H. Zhang); and Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey (R.S.L.)
| | - Heping Zhang
- From the Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan (Z.-J.C., Y. Shi, D.W., J. Li, J. Yan, Y.Q., H. Zhao), Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University (Z.-J.C., Y. Sun), and Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics (Z.-J.C., Y. Sun), Shanghai, Center for Reproductive Medicine, Maternal and Child Health Hospital in Guangxi, Guangxi (B.Z.), Reproductive Medicine Center, the Sixth Affiliated Hospital of Sun Yat-sen University (X.L.) and Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University (D.Y.), Guangzhou, Center for Reproductive Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei (Y.C.), Center for Reproductive Medicine, Wuhan University, Wuhan (J. Yang), Department of Obstetrics and Gynecology, First Affiliated Hospital of Nanjing Medical University, Nanjing (J. Liu), Reproductive Medicine Center of Jinghua Hospital, Shenyang (N.W.), Center for Reproductive Medicine, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang (L.T.), Center for Reproductive Medicine of Yantai Yuhuangding Hospital, Yantai (C.H.), Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou (F.Z.), Assisted Reproduction Center, Maternal and Child Health Care Hospital of Shanxi Province, Xi'an (J.S.), and Center for Reproduction and Genetics, Suzhou Municipal Hospital, Suzhou (Y.X.) - all in China; Department of Biostatistics, Yale University School of Public Health, New Haven, CT (H. Zhang); and Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey (R.S.L.)
| | - Richard S Legro
- From the Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan (Z.-J.C., Y. Shi, D.W., J. Li, J. Yan, Y.Q., H. Zhao), Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University (Z.-J.C., Y. Sun), and Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics (Z.-J.C., Y. Sun), Shanghai, Center for Reproductive Medicine, Maternal and Child Health Hospital in Guangxi, Guangxi (B.Z.), Reproductive Medicine Center, the Sixth Affiliated Hospital of Sun Yat-sen University (X.L.) and Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University (D.Y.), Guangzhou, Center for Reproductive Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei (Y.C.), Center for Reproductive Medicine, Wuhan University, Wuhan (J. Yang), Department of Obstetrics and Gynecology, First Affiliated Hospital of Nanjing Medical University, Nanjing (J. Liu), Reproductive Medicine Center of Jinghua Hospital, Shenyang (N.W.), Center for Reproductive Medicine, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang (L.T.), Center for Reproductive Medicine of Yantai Yuhuangding Hospital, Yantai (C.H.), Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou (F.Z.), Assisted Reproduction Center, Maternal and Child Health Care Hospital of Shanxi Province, Xi'an (J.S.), and Center for Reproduction and Genetics, Suzhou Municipal Hospital, Suzhou (Y.X.) - all in China; Department of Biostatistics, Yale University School of Public Health, New Haven, CT (H. Zhang); and Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey (R.S.L.)
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Beyer DA, Griesinger G. Vitrified-warmed embryo transfer is associated with mean higher singleton birth weight compared to fresh embryo transfer. Eur J Obstet Gynecol Reprod Biol 2016; 203:104-7. [DOI: 10.1016/j.ejogrb.2016.05.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 05/05/2016] [Accepted: 05/21/2016] [Indexed: 10/21/2022]
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Majidi Gharenaz N, Movahedin M, Mazaheri Z, Pour beiranvand S. Alternation of apoptotic and implanting genes expression of mouse embryos after re-vitrification. Int J Reprod Biomed 2016. [DOI: 10.29252/ijrm.14.8.511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Vazharova R, Kremensky I. Individual capacity for DNA repair and maintenance of genomic integrity: a fertile ground for studies in the field of assisted reproduction. BIOTECHNOL BIOTEC EQ 2016. [DOI: 10.1080/13102818.2016.1159923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Radoslava Vazharova
- Department of Biology, Medical Genetics and Microbiology, Faculty of Medicine, Sofia University “St. Kliment Ohridski”, Sofia, Bulgaria
| | - Ivo Kremensky
- Center of Molecular Medicine, University Hospital of Obstetrics and Gynaecology “Maichin Dom”, Medical University of Sofia, Sofia, Bulgaria
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Cavoretto P, Dallagiovanna C, Viganò P, Somigliana E, Persico N, Papaleo E, Faulisi S, Candiani M. First trimester combined screening test in pregnancies derived from blastocyst transfer. Eur J Obstet Gynecol Reprod Biol 2016; 198:50-55. [DOI: 10.1016/j.ejogrb.2015.12.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 11/27/2015] [Accepted: 12/21/2015] [Indexed: 10/22/2022]
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Hoeijmakers L, Kempe H, Verschure PJ. Epigenetic imprinting during assisted reproductive technologies: The effect of temporal and cumulative fluctuations in methionine cycling on the DNA methylation state. Mol Reprod Dev 2016; 83:94-107. [PMID: 26660493 DOI: 10.1002/mrd.22605] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 12/04/2015] [Indexed: 12/22/2022]
Affiliation(s)
- Lianne Hoeijmakers
- Swammerdam Institute for Life Sciences; University of Amsterdam; Amsterdam the Netherlands
| | - Hermannus Kempe
- Swammerdam Institute for Life Sciences; University of Amsterdam; Amsterdam the Netherlands
| | - Pernette J. Verschure
- Swammerdam Institute for Life Sciences; University of Amsterdam; Amsterdam the Netherlands
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Basirat Z, Adib Rad H, Esmailzadeh S, Jorsaraei SGA, Hajian- Tilaki K, Pasha H, Ghofrani F. Comparison of pregnancy rate between fresh embryo transfers and frozen-thawed embryo transfers following ICSI treatment. Int J Reprod Biomed 2016. [DOI: 10.29252/ijrm.14.1.39] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Difference in birth weight of consecutive sibling singletons is not found in oocyte donation when comparing fresh versus frozen embryo replacements. Fertil Steril 2015; 104:1411-8.e1-3. [DOI: 10.1016/j.fertnstert.2015.08.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 08/04/2015] [Accepted: 08/10/2015] [Indexed: 12/30/2022]
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Independent factors influencing large-for-gestation birth weight in singletons born after in vitro fertilization. J Assist Reprod Genet 2015; 33:9-17. [PMID: 26547202 DOI: 10.1007/s10815-015-0601-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 10/21/2015] [Indexed: 10/22/2022] Open
Abstract
PURPOSE Higher risk for birth of singletons being large for gestational age (LGA) has been revealed after in vitro fertilization (IVF) frozen-thawed embryo-transfer (FET). This phenomenon is now being investigated, since there is a speculation that these neonates could suffer from underlying epigenetic disturbances. The aim of the study was to expose independent LGA risk factors and to identify those connected to the IVF techniques. METHODS Altogether, 4508 singleton pregnancies and births were included in the cohort case-matched study. Two hundred eleven singleton pregnancies and births after FET and 916 after fresh embryo transfer (ET) were included into two study groups. The IVF procedures were performed at the University Medical Centre Ljubljana between 2004 and 2011. For each IVF pregnancy, three matched consecutive controls after natural conception were included. Using logistic regression models, we observed LGA connection to maternal parameters (smoking, hypertension, parity, BMI, gestational diabetes, IVF conception, FET, double ET, and ICSI procedure). RESULTS Singletons born after FET had a significantly higher risk for being LGA (p = 0.032; OR 1.697; 95 % CI 1.047-2.752). BMI 25-30 was a significant independent risk factor for LGA in the IVF groups (FET p = 0.041, OR 2.460, 95 % CI 1.030-5.857 and fresh ET p = 0.003; OR 2.188, 95 % CI 1.297-3.691). ICSI and double ET had no significant effect on LGA occurrence. CONCLUSIONS Besides maternal BMI, FET is a significant independent LGA risk factor in IVF patients. Other observed factors (smoking, hypertension, multiparity, GDM, ICSI procedure, or number of embryos transferred) do not influence LGA risk significantly.
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