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Zhang HM, Yao B, Li L, Guo SS, Deng HY, Ren YP. Causal relationship between OHSS and immune cells: A Mendelian randomization study. J Reprod Immunol 2024; 165:104314. [PMID: 39173334 DOI: 10.1016/j.jri.2024.104314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/22/2024] [Accepted: 08/06/2024] [Indexed: 08/24/2024]
Abstract
OBJECTIVE To confirm the causal relationship between immune cells and Ovarian Hyperstimulation Syndrome. DESIGN Obtaining data, collecting single nucleotide polymorphisms, detecting instrumental variables heterogeneity, assessing causality, and assessing bidirectional causality. SUBJECTS A two sample Mendelian study to confirm the causal relationship between immune cells and Ovarian Hyperstimulation Syndrome. EXPOSURE Immune cell phenotype (including 22 million SNPs from GWAS on 3757 European individuals). MAIN OUTCOME MEASURES Inverse variance weighting, one-sample analysis, MR-Egger, weighted median and weighted mode are used to assess the causal relationship between 731 immunophenotypes and Ovarian Hyperstimulation Syndrome. The weighted median and Mendelian Randomization multi-effect residuals and Mendelian Randomization multi-effect residuals and outlier tests are used to assess bidirectional causality between this two. RESULTS After False Discovery Rate correction, 9 immunophenotypes were found to be significantly associated with the risk of Ovarian Hyperstimulation Syndrome. B cell panel: IgD+ AC (OR, 0.90) 、CD19 on CD24+ CD27+ (OR, 0.86) 、BAFF-R on CD20- CD38 (OR, -1.22); Mature T cell group panel: EM DN (CD4 -CD8-) AC (OR, 1.46); Myeloid cell panel: Mo MDSC AC (OR, 1.13) 、CD45 on CD33br HLA-DR+ (OR, 0.87); Monocyte panel: HLA-DR on monocyte (OR, 0.86) 、CCR2 on CD14+ CD16+ monocyte (OR, 1.15) 、cDC panel: HLA-DR on myeloid DC (OR, 0.89). CONCLUSION This study shows the potential link between OHSS and immune cells by genetic means, providing new ideas for future clinical and basic research.
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Affiliation(s)
- Hai-Ming Zhang
- Department of Histology and Embryology, School of Preclinical Medical, Zunyi Medical University, Zunyi, Guizhou, China
| | - Bo Yao
- Department of Histology and Embryology, School of Preclinical Medical, Zunyi Medical University, Zunyi, Guizhou, China; Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Li Li
- Department of Histology and Embryology, School of Preclinical Medical, Zunyi Medical University, Zunyi, Guizhou, China
| | - Shi-Shi Guo
- Department of Histology and Embryology, School of Preclinical Medical, Zunyi Medical University, Zunyi, Guizhou, China
| | - Hong-Yi Deng
- Department of Histology and Embryology, School of Preclinical Medical, Zunyi Medical University, Zunyi, Guizhou, China
| | - Yan-Ping Ren
- Department of Histology and Embryology, School of Preclinical Medical, Zunyi Medical University, Zunyi, Guizhou, China.
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Al-Khatib A, Sagot P, Cottenet J, Aroun M, Quantin C, Desplanches T. Major postpartum haemorrhage after frozen embryo transfer: A population-based study. BJOG 2024; 131:300-308. [PMID: 37550089 DOI: 10.1111/1471-0528.17625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/12/2023] [Accepted: 07/13/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE To investigate the effect on major postpartum haemorrhage (PPH) of mode of conception, differentiating between naturally conceived pregnancies, fresh embryo in vitro fertilisation (fresh-IVF) and frozen embryo transfer (frozen-IVF). DESIGN Retrospective cohort study. SETTING The French Burgundy Perinatal Network database, including all deliveries from 2006 to 2020, was linked to the regional blood centre database. POPULATION OR SAMPLE In all, 244 336 women were included, of whom 240 259 (98.3%) were singleton pregnancies. METHODS The main analyses were conducted in singleton pregnancies, including 237 608 naturally conceived, 1773 fresh-IVF and 878 frozen-IVF pregnancies. Multivariate logistic regression models adjusted on maternal age, body mass index, smoking, parity, induction of labour, hypertensive disorders, diabetes, placenta praevia and/or accreta, history of caesarean section, mode of delivery, birthweight, birth place and year of delivery, were used. MAIN OUTCOME MEASURES Major PPH was defined as PPH requiring blood transfusion and/or emergency surgery and/or interventional radiology. RESULTS The prevalence of major PPH was 0.74% (n = 1749) in naturally conceived pregnancies, 1.92% (n = 34) in fresh-IVF pregnancies, and 3.30% (n = 29) in frozen-IVF pregnancies. The risk of major PPH was higher in frozen-IVF pregnancies than in both naturally conceived pregnancies (adjusted odds ratio [aOR] 2.63, 95% CI 1.68-4.10) and fresh-IVF pregnancies (aOR 2.78, 95% CI 1.44-5.35). CONCLUSIONS We found that frozen-IVF pregnancies have a higher risk of major PPH and they should be subject to increased vigilance in the delivery room.
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Affiliation(s)
- Amélie Al-Khatib
- Pôle de Gynécologie-Obstétrique et Biologie de la Reproduction, Dijon University Hospital, Dijon, France
| | - Paul Sagot
- Pôle de Gynécologie-Obstétrique et Biologie de la Reproduction, Dijon University Hospital, Dijon, France
| | - Jonathan Cottenet
- Service de Biostatistique et d'Informatique Médicale (DIM), Dijon University Hospital, Dijon, France
| | - Massinissa Aroun
- Pôle de Gynécologie-Obstétrique et Biologie de la Reproduction, Dijon University Hospital, Dijon, France
| | - Catherine Quantin
- Service de Biostatistique et d'Informatique Médicale (DIM), Dijon University Hospital, Dijon, France
- Clinical Epidemiology Unit, Inserm, CIC 1432, Dijon, France
- Clinical Investigation Centre, Dijon University Hospital, Dijon, France
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Thomas Desplanches
- Pôle de Gynécologie-Obstétrique et Biologie de la Reproduction, Dijon University Hospital, Dijon, France
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
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Smeenk J, Wyns C, De Geyter C, Kupka M, Bergh C, Cuevas Saiz I, De Neubourg D, Rezabek K, Tandler-Schneider A, Rugescu I, Goossens V. ART in Europe, 2019: results generated from European registries by ESHRE†. Hum Reprod 2023; 38:2321-2338. [PMID: 37847771 PMCID: PMC10694409 DOI: 10.1093/humrep/dead197] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/14/2023] [Indexed: 10/19/2023] Open
Abstract
STUDY QUESTION What are the data and trends on ART and IUI cycle numbers and their outcomes, and on fertility preservation (FP) interventions, reported in 2019 as compared to previous years? SUMMARY ANSWER The 23rd ESHRE report highlights the rising ART treatment cycles and children born, alongside a decline in twin deliveries owing to decreasing multiple embryo transfers; fresh IVF or ICSI cycles exhibited higher delivery rates, whereas frozen embryo transfers (FET) showed higher pregnancy rates (PRs), and reported IUI cycles decreased while maintaining stable outcomes. WHAT IS KNOWN ALREADY ART aggregated data generated by national registries, clinics, or professional societies have been gathered and analyzed by the European IVF-Monitoring (EIM) Consortium since 1997 and reported in a total of 22 manuscripts published in Human Reproduction and Human Reproduction Open. STUDY DESIGN, SIZE, DURATION Data on medically assisted reproduction (MAR) from European countries are collected by EIM for ESHRE each year. The data on treatment cycles performed between 1 January and 31 December 2019 were provided by either national registries or registries based on initiatives of medical associations and scientific organizations or committed persons in one of the 44 countries that are members of the EIM Consortium. PARTICIPANTS/MATERIALS, SETTING, METHODS Overall, 1487 clinics offering ART services in 40 countries reported, for the second time, a total of more than 1 million (1 077 813) treatment cycles, including 160 782 with IVF, 427 980 with ICSI, 335 744 with FET, 64 089 with preimplantation genetic testing (PGT), 82 373 with egg donation (ED), 546 with IVM of oocytes, and 6299 cycles with frozen oocyte replacement (FOR). A total of 1169 institutions reported data on IUI cycles using either husband/partner's semen (IUI-H; n = 147 711) or donor semen (IUI-D; n = 51 651) in 33 and 24 countries, respectively. Eighteen countries reported 24 139 interventions in pre- and post-pubertal patients for FP, including oocyte, ovarian tissue, semen, and testicular tissue banking. MAIN RESULTS AND THE ROLE OF CHANCE In 21 countries (21 in 2018) in which all ART clinics reported to the registry 476 760 treatment cycles were registered for a total population of approximately 300 million inhabitants, allowing the best estimate of a mean of 1581 cycles performed per million inhabitants (range: 437-3621). Among the reporting countries, for IVF the clinical PRs per aspiration slightly decreased while they remained similar per transfer compared to 2018 (21.8% and 34.6% versus 25.5% and 34.1%, respectively). In ICSI, the corresponding PRs showed similar trends compared to 2018 (20.2% and 33.5%, versus 22.5% and 32.1%) When freeze-all cycles were not considered for the calculations, the clinical PRs per aspiration were 28.5% (28.8% in 2018) and 26.2% (27.3% in 2018) for IVF and ICSI, respectively. After FET with embryos originating from own eggs, the PR per thawing was at 35.1% (versus 33.4% in 2018), and with embryos originating from donated eggs at 43.0% (41.8% in 2018). After ED, the PR per fresh embryo transfer was 50.5% (49.6% in 2018) and per FOR 44.8% (44.9% in 2018). In IVF and ICSI together, the trend toward the transfer of fewer embryos continues with the transfer of 1, 2, 3, and ≥4 embryos in 55.4%, 39.9%, 2.6%, and 0.2% of all treatments, respectively (corresponding to 50.7%, 45.1%, 3.9%, and 0.3% in 2018). This resulted in a reduced proportion of twin delivery rates (DRs) of 11.9% (12.4% in 2018) and a similar triplet DR of 0.3%. Treatments with FET in 2019 resulted in twin and triplet DR of 8.9% and 0.1%, respectively (versus 9.4% and 0.1% in 2018). After IUI, the DRs remained similar at 8.7% after IUI-H (8.8% in 2018) and at 12.1% after IUI-D (12.6% in 2018). Twin and triplet DRs after IUI-H were 8.7% and 0.4% (in 2018: 8.4% and 0.3%) and 6.2% and 0.2% after IUI-D (in 2018: 6.4% and 0.2%), respectively. Eighteen countries (16 in 2018) provided data on FP in a total number of 24 139 interventions (20 994 in 2018). Cryopreservation of ejaculated sperm (n = 11 592 versus n = 10 503 in 2018) and cryopreservation of oocytes (n = 10 784 versus n = 9123 in 2018) were most frequently reported. LIMITATIONS, REASONS FOR CAUTION Caution with the interpretation of results should remain as data collection systems and completeness of reporting vary among European countries. Some countries were unable to deliver data about the number of initiated cycles and/or deliveries. WIDER IMPLICATIONS OF THE FINDINGS The 23rd ESHRE data collection on ART, IUI, and FP interventions shows a continuous increase of reported treatment numbers and MAR-derived livebirths in Europe. Although it is the largest data collection on MAR in Europe, further efforts toward optimization of both the collection and the reporting, from the perspective of improving surveillance and vigilance in the field of reproductive medicine, are awaited. STUDY FUNDING/COMPETING INTEREST(S) The study has received no external funding and all costs are covered by ESHRE. There are no competing interests.
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Affiliation(s)
- Jesper Smeenk
- Elisabeth Twee Steden Ziekenhuis, Tilburg, The Netherlands
| | - Christine Wyns
- Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Christian De Geyter
- Reproductive Medicine and Gynecological Endocrinology (RME), University Hospital, University of Basel, Basel, Switzerland
| | - Markus Kupka
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - Christina Bergh
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Göteborg University, Göteborg, Sweden
| | | | - Diane De Neubourg
- Center for Reproductive Medicine, University of Antwerp-Antwerp University Hospital, Edegem, Belgium
| | - Karel Rezabek
- Department of Gynaecology, Obstetrics and Neonatology First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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Qi Q, Xia Y, Luo J, Wang Y, Xie Q. Cocktail treatment by GnRH-antagonist, letrozole, and mifepristone for the prevention of ovarian hyperstimulation syndrome: a prospective randomized trial. Gynecol Endocrinol 2023; 39:2269281. [PMID: 37844908 DOI: 10.1080/09513590.2023.2269281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 10/05/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE This study is aimed to determine the efficacy of a cocktail style treatment by combining GnRH-antagonist, letrozole, and mifepristone on the prevention of ovarian hyperstimulation syndrome (OHSS) in high-risk women. METHODS This prospective, randomized controlled clinical trial was performed between January 2018 and December 2018. A total of 170 women who identified as high risk of OHSS during the ovarian hyperstimulation and underwent cryopreservation of whole embryos. On the day of oocyte retrieval, the combination group received 0.25 mg Cetrorelix for 3 d, 5 mg letrozole for 5 d, and 50 mg mifepristone for 3 d, the mifepristone group received 50 mg mifepristone for 3 d. A total of 156 cases were included in final analysis. All the frozen embryo transfer (FET) cycles were followed up until December 2021. RESULTS The combination group showed significantly decreased incidence of moderate and severe OHSS than mifepristone group (20.5% vs. 42.3%), with remarkably reduced serum estradiol level on hCG + 3 and + 5 d, decreased ovarian diameter, and shortened luteal phase. Oocyte retrieval number, levels of estradiol on hCG + 0 and VEGF, and ovarian diameter on hCG + 5 were associated with the severity of the symptoms. There was no significant difference in cumulative live birth rates (LBRs) between the combination and mifepristone group (74.4% vs. 76.9%). CONCLUSIONS The combination treatment effectively reduces the incidence of moderate/severe OHSS in high-risk women.
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Affiliation(s)
- Qianrong Qi
- Center for Reproductive Medicine, Renmin Hospital of Wuhan University, Wuhan, PR China
| | - Yi Xia
- Center for Reproductive Medicine, Renmin Hospital of Wuhan University, Wuhan, PR China
| | - Jin Luo
- Center for Reproductive Medicine, Renmin Hospital of Wuhan University, Wuhan, PR China
| | - Yaqin Wang
- Center for Reproductive Medicine, Renmin Hospital of Wuhan University, Wuhan, PR China
| | - Qingzhen Xie
- Center for Reproductive Medicine, Renmin Hospital of Wuhan University, Wuhan, PR China
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Palomba S, Costanzi F, Nelson SM, Caserta D, Humaidan P. Interventions to prevent or reduce the incidence and severity of ovarian hyperstimulation syndrome: a systematic umbrella review of the best clinical evidence. Reprod Biol Endocrinol 2023; 21:67. [PMID: 37480081 PMCID: PMC10360244 DOI: 10.1186/s12958-023-01113-6] [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: 05/15/2023] [Accepted: 06/21/2023] [Indexed: 07/23/2023] Open
Abstract
Ovarian hyperstimulation syndrome (OHSS) is a potentially life-threating iatrogenic complication of the early luteal phase and/or early pregnancy after in vitro fertilization (IVF) treatment. The aim of the current study was to identify the most effective methods for preventing of and reducing the incidence and severity of OHSS in IVF patients. A systematic review of systematic reviews of randomized controlled trials (RCTs) with meta-analysis was used to assess each potential intervention (PROSPERO website, CRD 268626) and only studies with the highest quality were included in the qualitative analysis. Primary outcomes included prevention and reduction of OHSS incidence and severity. Secondary outcomes were maternal death, incidence of hospital admission, days of hospitalization, and reproductive outcomes, such as incidence of live-births, clinical pregnancies, pregnancy rate, ongoing pregnancy, miscarriages, and oocytes retrieved. A total of specific interventions related to OHSS were analyzed in 28 systematic reviews of RCTs with meta-analyses. The quality assessment of the included studies was high, moderate, and low for 23, 2, and 3 studies, respectively. The certainty of evidence (CoE) for interventions was reported for 37 specific situations/populations and resulted high, moderate, and low-to-very low for one, 5, and 26 cases, respectively, while it was not reported in 5 cases. Considering the effective interventions without deleterious reproductive effects, GnRH-ant co-treatment (36 RCTs; OR 0.61, 95% C 0.51 to 0.72, n = 7,944; I2 = 31%) and GnRH agonist triggering (8 RCTs; OR 0.15, 95% CI 0.05 to 0.47, n = 989; I2 = 42%) emerged as the most effective interventions for preventing OHSS with a moderate CoE, even though elective embryo cryopreservation exhibited a low CoE. Furthermore, the use of mild ovarian stimulation (9 RCTs; RR 0.26, CI 0.14 to 0.49, n = 1,925; I2 = 0%), and dopaminergic agonists (10 RCTs; OR 0.32, 95% CI 0.23 to 0.44, n = 1,202; I2 = 13%) coadministration proved effective and safe with a moderate CoE. In conclusion, the current study demonstrates that only a few interventions currently can be considered effective to reduce the incidence of OHSS and its severity with high/moderate CoE despite the numerous published studies on the topic. Further well-designed RCTs are needed, particularly for GnRH-a down-regulated IVF cycles.
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Affiliation(s)
- Stefano Palomba
- Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, via di Grottarossa, n. 1035/1039, Rome, 00189, Italy.
| | - Flavia Costanzi
- Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, via di Grottarossa, n. 1035/1039, Rome, 00189, Italy
| | - Scott M Nelson
- School of Medicine, University of Glasgow, Glasgow, UK
- NIHR Bristol Biomedical Research Centre, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
- TFP, Oxford Fertility, Institute of Reproductive Sciences, Oxford, UK
| | - Donatella Caserta
- Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, via di Grottarossa, n. 1035/1039, Rome, 00189, Italy
| | - Peter Humaidan
- The Fertility Clinic, Faculty of Health, Skive Regional Hospital, Aarhus University, Aarhus C, Denmark
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Youngster M, Kedem A, Avraham S, Yerushalmi G, Baum M, Maman E, Hourvitz A, Gat I. Treatment safety of ART cycles with extremely high oestradiol concentrations using GnRH agonist trigger. Reprod Biomed Online 2023; 46:519-526. [PMID: 36566147 DOI: 10.1016/j.rbmo.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/26/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
RESEARCH QUESTION Are IVF treatments with extremely high peak oestradiol levels and gonadotrophin releasing hormone (GnRH) agonist trigger associated with higher complication rates? DESIGN A retrospective cohort study including patients from two large medical centres treated between 2019 and 2021. A study group with extremely high peak oestradiol levels (≥20,000 pmol/l on the day of ovarian stimulation, or ≥15,000 pmol/l on the previous day) and a control group with normal range oestradiol levels (3000-12000 pmol/l) that received GnRH agonist triggering. Patients were surveyed about complaints and medical care related to ovum retrieval and medical files were reviewed. Major complication rates and the need for medical assistance were compared. RESULTS Several differences between the study and control group were observed because of the study design: mean age was 33.01 ± 5.14 versus 34.57 ± 4.52 (P < 0.001), mean peak oestradiol levels was 26645.34 ± 8592.57 pmol/l versus 7229.75 ± 2329.20 pmol/l (P < 0.001), and mean number of oocytes were 27.55 ± 13.46 versus 11.67 ± 5.76 (P < 0.001) for the study and control group, respectively. Major complications and hospitalization rates were similar between the study and control groups (three [1.25%] versus one [0.48%]; P = 0.62 and three [1.25%] versus two [0.96%]; P = 1.0, respectively). Thirty-six patients (15.1%) in the study group and 11 (5.3%) in the control group sought medical care after retrieval, mostly due to abdominal pain, without the need for further workup or hospitalization (P < 0.001). CONCLUSIONS Extremely high oestradiol levels were not associated with thromboembolic events, higher major complication or hospitalization rates, and therefore may be considered safe. Nevertheless, patients may be informed of possible higher rates of discomfort, mostly abdominal pain. Larger studies are warranted to confirm our results.
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Affiliation(s)
- Michal Youngster
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; IVF Unit, Herzliya Medical Centre, Herzliya, Israel.
| | - Alon Kedem
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; IVF Unit, Herzliya Medical Centre, Herzliya, Israel
| | - Sarit Avraham
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; IVF Unit, Herzliya Medical Centre, Herzliya, Israel
| | - Gil Yerushalmi
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Micha Baum
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; IVF Unit, Herzliya Medical Centre, Herzliya, Israel; IVF Unit, Department of Obstetrics and Gynecology, Sheba Medical Centre, Ramat-Gan, Israel
| | - Ettie Maman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; IVF Unit, Herzliya Medical Centre, Herzliya, Israel; IVF Unit, Department of Obstetrics and Gynecology, Sheba Medical Centre, Ramat-Gan, Israel
| | - Ariel Hourvitz
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; IVF Unit, Herzliya Medical Centre, Herzliya, Israel
| | - Itai Gat
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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De Neubourg D, Dancet EAF, Pinborg A. Single-embryo transfer implies quality of care in reproductive medicine. Reprod Biomed Online 2022; 45:899-905. [PMID: 35927209 DOI: 10.1016/j.rbmo.2022.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/22/2022] [Accepted: 04/04/2022] [Indexed: 12/24/2022]
Abstract
This review appraises evidence on the difference between single- and double-embryo transfer (SET, DET) in assisted reproductive technology (ART) regarding the four healthcare quality dimensions most important to fertility patients and doctors. Regarding safety, not only does DET create the uncontested perinatal risks of twin pregnancies, but compelling evidence has added that singleton pregnancies after a vanishing twin also have poorer perinatal outcomes. SET is as effective as DET, as shown by meta-analyses of randomized controlled trials, comparing two cycles of SET versus DET and shown by cumulative live birth rates of entire ART trajectories of up to six cycles. Proposing SET, which is safer than DET and as effective, as the gold standard is not irreconcilable with patient-centred care if patients are thoroughly informed on the reasoning behind the proposition and welcomed to challenge whether it fits their personal values. The cost-efficiency of SET is clearly higher, which has even induced certain countries to start reimbursing ART on the condition that SET is used. In conclusion, SET should be the gold standard offered to all patients. The question is not whether to apply SET but how to apply it in terms of patient selection, patient-centred counselling and coverage of treatment.
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Affiliation(s)
- Diane De Neubourg
- Center for Reproductive Medicine, Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium.
| | - Eline A F Dancet
- Leuven University Fertility Clinic - Leuven University Hospitals, Leuven, Belgium
| | - Anja Pinborg
- Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Sargisian N, Lannering B, Petzold M, Opdahl S, Gissler M, Pinborg A, Henningsen AKA, Tiitinen A, Romundstad LB, Spangmose AL, Bergh C, Wennerholm UB. Cancer in children born after frozen-thawed embryo transfer: A cohort study. PLoS Med 2022; 19:e1004078. [PMID: 36048761 PMCID: PMC9436139 DOI: 10.1371/journal.pmed.1004078] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/21/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The aim was to investigate whether children born after assisted reproduction technology (ART), particularly after frozen-thawed embryo transfer (FET), are at higher risk of childhood cancer than children born after fresh embryo transfer and spontaneous conception. METHODS AND FINDINGS We performed a registry-based cohort study using data from the 4 Nordic countries: Denmark, Finland, Norway, and Sweden. The study included 7,944,248 children, out of whom 171,774 children were born after use of ART (2.2%) and 7,772,474 children were born after spontaneous conception, representing all children born between the years 1994 to 2014 in Denmark, 1990 to 2014 in Finland, 1984 to 2015 in Norway, and 1985 to 2015 in Sweden. Rates for any cancer and specific cancer groups in children born after each conception method were determined by cross-linking national ART registry data with national cancer and health data registries and population registries. We used Cox proportional hazards models to estimate the risk of any cancer, with age as the time scale. After a mean follow-up of 9.9 and 12.5 years, the incidence rate (IR) of cancer before age 18 years was 19.3/100,000 person-years for children born after ART (329 cases) and 16.7/100,000 person-years for children born after spontaneous conception (16,184 cases). Adjusted hazard ratio (aHR) was 1.08, 95% confidence interval (CI) 0.96 to 1.21, p = 0.18. Adjustment was performed for sex, plurality, year of birth, country of birth, maternal age at birth, and parity. Children born after FET had a higher risk of cancer (48 cases; IR 30.1/100,000 person-years) compared to both fresh embryo transfer (IR 18.8/100,000 person-years), aHR 1.59, 95% CI 1.15 to 2.20, p = 0.005, and spontaneous conception, aHR 1.65, 95% CI 1.24 to 2.19, p = 0.001. Adjustment either for macrosomia, birth weight, or major birth defects attenuated the association marginally. Higher risks of epithelial tumors and melanoma after any assisted reproductive method and of leukemia after FET were observed. The main limitation of this study is the small number of children with cancer in the FET group. CONCLUSIONS Children born after FET had a higher risk of childhood cancer than children born after fresh embryo transfer and spontaneous conception. The results should be interpreted cautiously based on the small number of children with cancer, but the findings raise concerns considering the increasing use of FET, in particular freeze-all strategies without clear medical indications. TRIAL REGISTRATION Trial registration number: ISRCTN 11780826.
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Affiliation(s)
- Nona Sargisian
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Birgitta Lannering
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Signe Opdahl
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mika Gissler
- THL Finnish Institute for Health and Welfare, Information Services Department, Helsinki, Finland
- Karolinska Institute, Department of Molecular Medicine and Surgery, Stockholm, Sweden and Region Stockholm, Academic Primary Health Care Center, Stockholm, Sweden
| | - Anja Pinborg
- The Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Aila Tiitinen
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Finland
| | - Liv Bente Romundstad
- Center for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Spiren Fertility Clinic, Trondheim, Norway
| | - Anne Lærke Spangmose
- The Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christina Bergh
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ulla-Britt Wennerholm
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
- * E-mail:
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Wyns C, De Geyter C, Calhaz-Jorge C, Kupka MS, Motrenko T, Smeenk J, Bergh C, Tandler-Schneider A, Rugescu IA, Goossens V. ART in Europe, 2018: results generated from European registries by ESHRE. Hum Reprod Open 2022; 2022:hoac022. [PMID: 35795850 PMCID: PMC9252765 DOI: 10.1093/hropen/hoac022] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Indexed: 11/18/2022] Open
Abstract
STUDY QUESTION What are the data and trends on ART and IUI cycle numbers and their outcomes, and on fertility preservation (FP) interventions, reported in 2018 as compared to previous years? SUMMARY ANSWER The 22nd ESHRE report shows a continued increase in reported numbers of ART treatment cycles and children born in Europe, a decrease in transfers with more than one embryo with a further reduction of twin delivery rates (DRs) as compared to 2017, higher DRs per transfer after fresh IVF or ICSI cycles (without considering freeze-all cycles) than after frozen embryo transfer (FET) with higher pregnancy rates (PRs) after FET and the number of reported IUI cycles decreased while their PR and DR remained stable. WHAT IS KNOWN ALREADY ART aggregated data generated by national registries, clinics or professional societies have been gathered and analysed by the European IVF-monitoring Consortium (EIM) since 1997 and reported in 21 manuscripts published in Human Reproduction and Human Reproduction Open. STUDY DESIGN SIZE DURATION Data on medically assisted reproduction (MAR) from European countries are collected by EIM for ESHRE on a yearly basis. The data on treatment cycles performed between 1 January and 31 December 2018 were provided by either national registries or registries based on initiatives of medical associations and scientific organizations or committed persons of 39 countries. PARTICIPANTS/MATERIALS SETTING METHODS Overall, 1422 clinics offering ART services in 39 countries reported a total of more than 1 million (1 007 598) treatment cycles for the first time, including 162 837 with IVF, 400 375 with ICSI, 309 475 with FET, 48 294 with preimplantation genetic testing, 80 641 with egg donation (ED), 532 with IVM of oocytes and 5444 cycles with frozen oocyte replacement (FOR). A total of 1271 institutions reported data on IUI cycles using either husband/partner's semen (IUI-H; n = 148 143) or donor semen (IUI-D; n = 50 609) in 31 countries and 25 countries, respectively. Sixteen countries reported 20 994 interventions in pre- and post-pubertal patients for FP including oocyte, ovarian tissue, semen and testicular tissue banking. MAIN RESULTS AND THE ROLE OF CHANCE In 21 countries (21 in 2017) in which all ART clinics reported to the registry, 410 190 treatment cycles were registered for a total population of ∼ 300 million inhabitants, allowing a best estimate of a mean of 1433 cycles performed per million inhabitants (range: 641-3549). Among the 39 reporting countries, for IVF, the clinical PR per aspiration slightly decreased while the PR per transfer remained similar compared to 2017 (25.5% and 34.1% in 2018 versus 26.8% and 34.3% in 2017). In ICSI, the corresponding rates showed similar evolutions in 2018 compared to 2017 (22.5% and 32.1% in 2018 versus 24.0% and 33.5% in 2017). When freeze-all cycles were not considered for the calculations, the clinical PRs per aspiration were 28.8% (29.4% in 2017) and 27.3% (27.3% in 2017) for IVF and ICSI, respectively. After FET with embryos originating from own eggs, the PR per thawing was 33.4% (versus 30.2% in 2017), and with embryos originating from donated eggs 41.8% (41.1% in 2017). After ED, the PR per fresh embryo transfer was 49.6% (49.2% in 2017) and per FOR 44.9% (43.3% in 2017). In IVF and ICSI together, the trend towards the transfer of fewer embryos continues with the transfer of 1, 2, 3 and ≥4 embryos in 50.7%, 45.1%, 3.9% and 0.3% of all treatments, respectively (corresponding to 46.0%, 49.2%. 4.5% and 0.3% in 2017). This resulted in a reduced proportion of twin DRs of 12.4% (14.2% in 2017) and similar triplet DR of 0.2%. Treatments with FET in 2018 resulted in twin and triplet DRs of 9.4% and 0.1%, respectively (versus 11.2% and 0.2%, respectively in 2017). After IUI, the DRs remained similar at 8.8% after IUI-H (8.7% in 2017) and at 12.6% after IUI-D (12.4% in 2017). Twin and triplet DRs after IUI-H were 8.4% and 0.3%, respectively (in 2017: 8.1% and 0.3%), and 6.4% and 0.2% after IUI-D (in 2017: 6.9% and 0.2%). Among 20 994 FP interventions in 16 countries (18 888 in 13 countries in 2017), cryopreservation of ejaculated sperm (n = 10 503, versus 11 112 in 2017) and of oocytes (n = 9123 versus 6588 in 2017) were the most frequently reported. LIMITATIONS REASONS FOR CAUTION The results should be interpreted with caution as data collection systems and completeness of reporting vary among European countries. Some countries were unable to deliver data about the number of initiated cycles and/or deliveries. WIDER IMPLICATIONS OF THE FINDINGS The 22nd ESHRE data collection on ART, IUI and FP interventions shows a continuous increase of reported treatment numbers and MAR-derived livebirths in Europe. Although it is the largest data collection on MAR in Europe, further efforts towards optimization of both the collection and reporting, with the aim of improving surveillance and vigilance in the field of reproductive medicine, are awaited. STUDY FUNDING/COMPETING INTERESTS The study has received no external funding and all costs are covered by ESHRE. There are no competing interests.
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Affiliation(s)
- C Wyns
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - C De Geyter
- Reproductive Medicine and Gynecological Endocrinology (RME), University Hospital, University of Basel, Basel, Switzerland
| | - C Calhaz-Jorge
- Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - M S Kupka
- Fertility Center—Gynaekologicum, Hamburg, Germany
| | - T Motrenko
- Human Reproduction Center Budva, Budva, Montenegro
| | - J Smeenk
- Elisabeth Twee Steden Ziekenhuis, Tilburg, The Netherlands
| | - C Bergh
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Göteborg University, Göteborg, Sweden
| | | | - I A Rugescu
- National Transplant Agency, Bucharest, Romania
| | - V Goossens
- ESHRE Central Office, Strombeek-Bever, Belgium
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Skorupskaite K, Joy E, Balen A, Agarwal K, Cauldwell M, English K. Assisted Reproduction in Patients with Cardiac Disease: A Retrospective Review. Eur J Obstet Gynecol Reprod Biol 2022; 276:199-203. [DOI: 10.1016/j.ejogrb.2022.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/07/2022] [Accepted: 07/26/2022] [Indexed: 11/17/2022]
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Ghidini A, Gandhi M, McCoy J, Kuller JA, Kuller JA. Society for Maternal-Fetal Medicine Consult Series #60: Management of pregnancies resulting from in vitro fertilization. Am J Obstet Gynecol 2022; 226:B2-B12. [PMID: 34736912 DOI: 10.1016/j.ajog.2021.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The use of assisted reproductive technology has increased in the United States in the past several decades. Although most of these pregnancies are uncomplicated, in vitro fertilization is associated with an increased risk for adverse perinatal outcomes primarily caused by the increased risks of prematurity and low birthweight associated with in vitro fertilization pregnancies. This Consult discusses the management of pregnancies achieved with in vitro fertilization and provides recommendations based on the available evidence. The recommendations by the Society for Maternal-Fetal Medicine are as follows: (1) we suggest that genetic counseling be offered to all patients undergoing or who have undergone in vitro fertilization with or without intracytoplasmic sperm injection (GRADE 2C); (2) regardless of whether preimplantation genetic testing has been performed, we recommend that all patients who have achieved pregnancy with in vitro fertilization be offered the options of prenatal genetic screening and diagnostic testing via chorionic villus sampling or amniocentesis (GRADE 1C); (3) we recommend that the accuracy of first-trimester screening tests, including cell-free DNA for aneuploidy, be discussed with patients undergoing or who have undergone in vitro fertilization (GRADE 1A); (4) when multifetal pregnancies do occur, we recommend that counseling be offered regarding the option of multifetal pregnancy reduction (GRADE 1C); (5) we recommend that a detailed obstetrical ultrasound examination (CPT 76811) be performed for pregnancies achieved with in vitro fertilization and intracytoplasmic sperm injection (GRADE 1B); (6) we suggest that fetal echocardiography be offered to patients with pregnancies achieved with in vitro fertilization and intracytoplasmic sperm injection (GRADE 2C); (7) we recommend that a careful examination of the placental location, placental shape, and cord insertion site be performed at the time of the detailed fetal anatomy ultrasound, including evaluation for vasa previa (GRADE 1B); (8) although visualization of the cervix at the 18 0/7 to 22 6/7 weeks of gestation anatomy assessment with either a transabdominal or endovaginal approach is recommended, we do not recommend serial cervical length assessment as a routine practice for pregnancies achieved with in vitro fertilization (GRADE 1C); (9) we suggest that an assessment of fetal growth be performed in the third trimester for pregnancies achieved with in vitro fertilization; however, serial growth ultrasounds are not recommended for the sole indication of in vitro fertilization (GRADE 2B); (10) we do not recommend low-dose aspirin for patients with pregnancies achieved with IVF as the sole indication for preeclampsia prophylaxis; however, if 1 or more additional risk factors are present, low-dose aspirin is recommended (GRADE 1B); (11) given the increased risk for stillbirth, we suggest weekly antenatal fetal surveillance beginning by 36 0/7 weeks of gestation for pregnancies achieved with in vitro fertilization (GRADE 2C); (12) in the absence of studies focused specifically on timing of delivery for pregnancies achieved with IVF, we recommend shared decision-making between patients and healthcare providers when considering induction of labor at 39 weeks of gestation (GRADE 1C).
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Provision of fertility services for women at increased risk of complications during fertility treatment or pregnancy: an Ethics Committee opinion. Fertil Steril 2022; 117:713-719. [PMID: 35105445 DOI: 10.1016/j.fertnstert.2021.12.030] [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: 12/22/2021] [Accepted: 12/29/2021] [Indexed: 11/04/2022]
Abstract
This opinion addresses the ethics of providing fertility treatment to women at elevated risk from fertility treatment or pregnancy. It is ethically appropriate for providers to treat women who are at elevated risk provided that the women are carefully assessed, that specialists in their medical condition are consulted as appropriate, and that they are fully informed about the risks, benefits, and alternatives, which may include oocyte or embryo donation, use of a gestational surrogate, declining fertility treatment, and adoption. Providers also may conclude that the medical risks of fertility treatment for a given patient are too high, in which case it is ethical for them for them to decline to provide treatment. Such determinations must be made in a medically objective and unbiased manner, and patients must be fully informed of the decision and its rationale. Counseling for these women should incorporate the most current knowledge available, with cognizance of the woman's personal determinants in relation to her reproductive desires. In this way, both the physician and the patient will optimize decision making in an ethically sound, patient-supportive context. This document replaces the document of the same name, last published in 2016 (Fertil Steri 2016;106:1319-23).
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Costanian C, Farah R, Salameh R, Meisner BA, Aoun Bahous S, Sibai AM. The Influence of Female Reproductive Factors on Longevity: A Systematized Narrative Review of Epidemiological Studies. Gerontol Geriatr Med 2022; 8:23337214221138663. [DOI: 10.1177/23337214221138663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/22/2022] [Accepted: 10/27/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose: This systematized review presents a synthesis of epidemiological studies that examine the association between female reproductive factors and longevity indicators. Methods: A comprehensive literature search was conducted using four bibliographic databases: OVID Medline, Web of Science, PubMed, and Google Scholar, including English language articles published until March 2022. Results from the search strategy yielded 306 articles, 37 of which were included for review based on eligibility criteria. Results were identified within the following nine themes: endogenous androgens and estrogens, age at first childbirth, age at last childbirth, parity, reproductive lifespan, menopause-related factors, hormone therapy use, age at menarche, and offspring gender. Results: Evidence that links reproductive factors and long lifespan is limited. Several female reproductive factors are shown to be significantly associated with longevity, yet findings remain inconclusive. The most consistent association was between parity (fertility and fecundity) and increased female lifespan. Age at first birth and parity were consistently associated with increased longevity. Associations between age at menarche and menopause, premature menopause, reproductive lifespan, offspring gender and longevity are inconclusive. Conclusion: There is not enough evidence to consider sex a longevity predictor. To understand the mechanisms that predict longevity outcomes, it is imperative to consider sex-specific within-population differences.
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Affiliation(s)
| | | | | | | | | | - Abla M. Sibai
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Zheng X, Zheng Y, Qin D, Yao Y, Zhang X, Zhao Y, Zheng C. Regulatory Role and Potential Importance of GDF-8 in Ovarian Reproductive Activity. Front Endocrinol (Lausanne) 2022; 13:878069. [PMID: 35692411 PMCID: PMC9178251 DOI: 10.3389/fendo.2022.878069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/15/2022] [Indexed: 11/13/2022] Open
Abstract
Growth differentiation factor-8 (GDF-8) is a member of the transforming growth factor-beta superfamily. Studies in vitro and in vivo have shown GDF-8 to be involved in the physiology and pathology of ovarian reproductive functions. In vitro experiments using a granulosa-cell model have demonstrated steroidogenesis, gonadotrophin responsiveness, glucose metabolism, cell proliferation as well as expression of lysyl oxidase and pentraxin 3 to be regulated by GDF-8 via the mothers against decapentaplegic homolog signaling pathway. Clinical data have shown that GDF-8 is expressed widely in the human ovary and has high expression in serum of obese women with polycystic ovary syndrome. GDF-8 expression in serum changes dynamically in patients undergoing controlled ovarian hyperstimulation. GDF-8 expression in serum and follicular fluid is correlated with the ovarian response and pregnancy outcome during in vitro fertilization. Blocking the GDF-8 signaling pathway is a potential therapeutic for ovarian hyperstimulation syndrome and ovulation disorders in polycystic ovary syndrome. GDF-8 has a regulatory role and potential importance in ovarian reproductive activity and may be involved in folliculogenesis, ovulation, and early embryo implantation.
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Affiliation(s)
- Xiaoling Zheng
- Department of Pharmacy, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yongquan Zheng
- Department of Pharmacy, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Dongxu Qin
- Department of Pharmacy, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yao Yao
- Department of Pharmacy, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiao Zhang
- Department of Pharmacy, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yunchun Zhao
- Department of Pharmacy, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Caihong Zheng, ; Yunchun Zhao,
| | - Caihong Zheng
- Department of Pharmacy, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Reproductive Genetics (Ministry of Education) and Women’s Reproductive Health Laboratory of Zhejiang Province, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Caihong Zheng, ; Yunchun Zhao,
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Vassard D, Pinborg A, Kamper-Jørgensen M, Lyng Forman J, Glazer CH, Kroman N, Schmidt L. Assisted reproductive technology treatment and risk of breast cancer: a population-based cohort study. Hum Reprod 2021; 36:3152-3160. [PMID: 34580714 DOI: 10.1093/humrep/deab219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/28/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Is there an increased risk of breast cancer among women after ART treatment including ovarian hormone stimulation? SUMMARY ANSWER The risk of breast cancer was slightly increased among women after ART treatment compared to age-matched, untreated women in the background population, and the risk was further increased among women initiating ART treatment when aged 40+ years. WHAT IS KNOWN ALREADY The majority of breast cancer cases are sensitive to oestrogen, and ovarian hormone stimulation has been suggested to increase the risk of breast cancer by influencing endogenous oestrogen levels. Previous studies on ART treatment and breast cancer have varied in their findings, but several studies have small sample sizes or lack follow-up time and/or confounder adjustment. Recent childbirth, nulliparity and higher socio-economic status are breast cancer risk factors and the latter two are also associated with initiating ART treatment. STUDY DESIGN, SIZE, DURATION The Danish National ART-Couple II (DANAC II) cohort includes women treated with ART at public and private fertility clinics in 1994-2016. PARTICIPANTS/MATERIALS, SETTING, METHODS Women with no cancer prior to ART treatment were included (n = 61 579). Women from the background population with similar age and no prior history of ART treatment were randomly selected as comparisons (n = 579 760). The baseline mean age was 33.1 years (range 18-46 years). Results are presented as hazard ratios (HRs) with corresponding CIs. MAIN RESULTS AND THE ROLE OF CHANCE During follow-up (median 9.69 years among ART-treated and 9.28 years among untreated), 5861 women were diagnosed with breast cancer, 695 among ART-treated and 5166 among untreated women (1.1% versus 0.9%, P < 0.0001). Using Cox regression analyses adjusted for nulliparity, educational level, partnership status, year, maternal breast cancer and age, the risk of breast cancer was slightly increased among women treated with ART (HR 1.14, 95% CI 1.12-1.16). All causes of infertility were slightly associated with breast cancer risk after ART treatment. The risk of breast cancer increased with higher age at ART treatment initiation and was highest among women initiating treatment at age 40+ years (HR 1.37, 95% CI 1.29-1.45). When comparing women with a first birth at age 40+ years with or without ART treatment, the increased risk among women treated with ART persisted (HR 1.51, 95% CI 1.09-2.08). LIMITATIONS, REASONS FOR CAUTION Although this study is based on a large, national cohort of women, more research with sufficient power and confounder adjustment is needed, particularly in cohorts with a broad age representation. WIDER IMPLICATIONS OF THE FINDINGS An increased risk of breast cancer associated with a higher age at ART treatment initiation has been shown. Ovarian stimulation may increase the risk of breast cancer among women initiating ART treatment when aged 40+ years. Age-related vulnerability to hormone exposure or higher hormone doses during ART treatment may explain the increased risk. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by a PhD grant to D.V. from the Faculty of Health and Medical Sciences, University of Copenhagen, Denmark. Funding for establishing the DANAC II cohort was received from the Ebba Rosa Hansen Foundation. The authors report no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- D Vassard
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - A Pinborg
- Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - M Kamper-Jørgensen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - J Lyng Forman
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - C H Glazer
- Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen NV, Denmark
| | - N Kroman
- Department of Breast Surgery, Copenhagen University Hospital Herlev, Copenhagen Ø, Denmark
| | - L Schmidt
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
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Evidence around early induction of labor in women of advanced maternal age and those using assisted reproductive technology. Best Pract Res Clin Obstet Gynaecol 2021; 77:42-52. [PMID: 34538560 DOI: 10.1016/j.bpobgyn.2021.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/20/2021] [Accepted: 08/10/2021] [Indexed: 11/21/2022]
Abstract
Worldwide, there has been a trend toward later motherhood. Concurrently, the incidence of subfertility has been on the rise, necessitating conception using assisted reproductive technologies (ARTs). These pregnancies are considered high risk due to fetal complications such as antepartum stillbirth and growth restriction and maternal complications such as increase in maternal morbidity and mortality. Early induction of labor can help to mitigate these risks. However, this has to be balanced against the iatrogenic harms of earlier delivery to both the baby, including respiratory distress and NICU stay, and the mother who might experience longer labor and other complications such as uterine hyperstimulation. Induction of labor at 39 weeks is the optimal timing for preventing antepartum stillbirth and avoiding iatrogenic harm. Delivery by elective cesarean section is not advocated as its benefits in these patients are unclear compared with the short- and long-term complications of a major abdominal surgery.
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Murugappan G, Li S, Alvero RJ, Luke B, Eisenberg ML. Association between infertility and all-cause mortality: analysis of US claims data. Am J Obstet Gynecol 2021; 225:57.e1-57.e11. [PMID: 33577764 DOI: 10.1016/j.ajog.2021.02.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/25/2021] [Accepted: 02/02/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The consequences of an infertility diagnosis extend beyond the pursuit of family building, because women with infertility also face increased risks for severe maternal morbidity, cancer, and chronic disease. OBJECTIVE This study aimed to examine the association between female infertility and all-cause mortality. STUDY DESIGN This retrospective analysis compared 72,786 women with infertility, identified in the Optum Clinformatics Datamart from 2003 to 2019 by infertility diagnosis, testing, and treatment codes, with 3,845,790 women without infertility seeking routine gynecologic care. The baseline comorbidities were assessed using the presence of ≥1 metabolic syndrome diagnoses and the Charlson Comorbidity Index. The primary outcome, which was all-cause mortality, was identified by linkage to the Social Security Administration Death Master File outcomes and medical claims. The association between infertility and mortality was examined using a Cox proportional hazard regression by adjusting for age, hypertension, hyperlipidemia, type II diabetes, year of evaluation, smoking, number of visits per year, nulliparity, obesity, region of the country, and race. RESULTS Among 16,473,458 person-years of follow-ups, 13,934 women died. Women with infertility had a 32% higher relative risk for death from any cause (0.42% vs 0.35%, adjusted hazard ratio, 1.32; 95% confidence interval, 1.18-1.48) than women without infertility. The mean follow-up time per patient was 4.0±3.7 years vs 4.2±3.8 years for women with and without infertility, respectively. When stratified by age of <35 or ≥35 years or baseline medical comorbidity, the association between infertility and mortality remained. Women with infertility who delivered a child during the follow-up period faced a similar increased risk for mortality than the overall infertile group. Finally, receiving fertility treatment was not associated with a higher risk for death than receiving an infertility diagnosis or testing alone. CONCLUSION Although the absolute risk for death was low in both groups, women with infertility faced a higher relative risk for mortality than women without infertility. The association remained across all age, race and ethnicity groups, morbidities, and delivery strata. Importantly, infertility treatment was not associated with an increased risk for death. These findings reinforce the disease burden associated with infertility and its potential for long-term sequelae.
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Osaikhuwuomwan JA, Aziken ME. Pregnancy in Older Women: Analysis of Outcomes in Pregnancies from Donor oocyte In- vitro Fertilization. J Hum Reprod Sci 2021; 14:300-306. [PMID: 34759621 PMCID: PMC8527082 DOI: 10.4103/jhrs.jhrs_209_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 07/04/2021] [Accepted: 07/10/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND As the number of older women attempting to conceive through donor oocyte-in vitro fertilization (DO-IVF) rises, their safety in pregnancy needs to be judiciously considered. AIMS This study aims to review the obstetric and perinatal outcomes of pregnancies achieved by DO-IVF. STUDY SETTING AND DESIGN A retrospective study design conducted at a private health facility with services for assisted reproduction and gynecologic endoscopy. METHODS A retrospective comparative study of all pregnancies achieved using DO-IVF and that using Self oocyte In-vitro fertilization (SO-IVF) treatment over a 3 years' period was performed. STATISTICAL ANALYSIS Comparative analysis of demographic variables, major obstetric, and perinatal complications was done with Chi-square test and Student's t-test as appropriate. Regression analysis was done to determine a significant predictor variable for pregnancy and delivery outcome. The significance level was set at P < 0.05. RESULTS A total of 343 completed IVF treatment cycles was reviewed; there were 238 DO-IVF and 105 SO-IVF cycles, with clinical pregnancy rate of 41.6% and 37.1%, respectively. The DO-IVF group was significantly older than the SO-IVF group (46.1 years vs. 34.1 years, P < 0.001). Major obstetric complications identified, were hypertensive disorders in pregnancy (23.9%), preterm labor (16.7%), antepartum hemorrhage (11.6%). There was no statistically significant difference between the two groups in terms of obstetric complications and adverse maternal or perinatal outcomes. There were 97 (77.6%) singleton and 28 (22.4%) multiple pregnancies. Pregnancy complications were significantly associated with fetal plurality, P < 0.001. Multiple pregnancy had higher odds of experiencing adverse perinatal 4.96 (1.95-12.58) and maternal 7.16 (2.05-25.03) outcomes compared to singleton pregnancies, P < 0.001. CONCLUSION Key obstetric outcomes did not differ between DO or SO IVF achieved pregnancy. Even for older women, satisfactory outcomes can be expected for pregnancies achieved by DO-IVF. It is, however, instructive that for multiple pregnancies, obstetricians should institute appropriate surveillance strategies during pregnancy and delivery period and also to develop institutional capacity for quality neonatal care.
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Affiliation(s)
- James A. Osaikhuwuomwan
- Department of Obstetrics and Gynaecology, College of Medical Sciences, University of Benin, Benin-City, Nigeria
| | - Michael E. Aziken
- Department of Obstetrics and Gynaecology, College of Medical Sciences, University of Benin, Benin-City, Nigeria
- Assisted Reproduction and Endoscopy Unit, Graceland Medical Centre, Benin-City, Nigeria
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Shapiro M, Romanski P, Thomas A, Lanes A, Yanushpolsky E. Low dose hCG supplementation in a Gn-RH-agonist trigger protocol is associated with worse pregnancy outcomes: a retrospective cohort study. FERTILITY RESEARCH AND PRACTICE 2021; 7:12. [PMID: 34049598 PMCID: PMC8161625 DOI: 10.1186/s40738-021-00104-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/09/2021] [Indexed: 12/01/2022]
Abstract
Background A number of studies have looked at dual triggers with hCG and GnRH agonist (GnRHa) in varying doses, but the question remains: what is the optimal dose of hCG to minimize ovarian hyperstimulation syndrome (OHSS) and still offer adequate pregnancy rates? The purpose of this study was to compare pregnancy and OHSS rates following dual trigger for oocyte maturation with GnRHa and a low-dose hCG versus hCG alone. A secondary objective was the assess pregnancy outcomes in subsequent frozen cycles for the same population. Methods A total of 963 women < 41 years old, with a BMI 18–40 kg/m2 and an AMH > 2 ng/mL who underwent fresh autologous in vitro fertilization (IVF) with GnRH antagonist protocol at a University-based fertility center were included in this retrospective cohort study. Those who received a low dose dual trigger with hCG (1000u) and GnRHa (2 mg) were compared to those who received hCG alone (10,000u hCG/250-500 μg Ovidrel). Differences in implantation rates, pregnancy, live birth, and OHSS were investigated. Results The dual trigger group was younger (mean 33.6 vs 34.1 years), had a higher AMH (6.3 vs 4.9 ng/mL,) more oocytes retrieved (18.1 vs 14.9) and a higher fertilized oocyte rate (80% vs 77%) compared with the hCG only group. Yet, the dual trigger group had a lower probability of clinical pregnancy (gestational sac, 43.4% vs 52.8%) and live birth (33.4% vs 45.8%), all of which were statistically significant. There were 3 cases of OHSS, all in the hCG-only trigger group. In subsequent frozen cycles, pregnancy rates were comparable between the two groups. Conclusions The dual trigger group had a better prognosis based on age and AMH levels and had better stimulation outcomes, but significantly worse pregnancy outcomes, suggesting the low dose hCG (1000u) in the dual trigger may not have provided adequate luteal support, compared to an hCG-only trigger (10,000u hCG/250-500 μg Ovidrel). Interestingly, the pregnancy rates were comparable in subsequent frozen cycles, further supporting the hypothesis that the issue lies in inadequate luteal phase support, rather than embryo quality. Based on these findings, our program has changed the protocol to 1500u of hCG in a dual trigger.
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Affiliation(s)
- Maren Shapiro
- Obstetrics & Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. .,Center for Reproductive Health, University of California, 499 Illinois Street, 6th floor, San Francisco, CA, 94158, USA.
| | - Phillip Romanski
- Obstetrics & Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Ann Thomas
- Obstetrics & Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea Lanes
- Obstetrics & Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Elena Yanushpolsky
- Obstetrics & Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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20
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Kalinderis M, Kalinderi K, Srivastava G, Homburg R. When Should We Freeze Embryos? Current Data for Fresh and Frozen Embryo Replacement IVF Cycles. Reprod Sci 2021; 28:3061-3072. [PMID: 34033111 DOI: 10.1007/s43032-021-00628-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
Recent years have seen a dramatic rise in the number of frozen-thawed embryo replacement (FER) cycles. Along with the advances in embryo cryopreservation techniques, the optimization of endometrial receptivity has resulted in outcomes for FER that are similar to fresh embryo transfer. However, the question of whether the Freeze all strategy is for all is nowadays a hot topic. This review addresses this issue and describes current evidence based on randomized controlled trials and observational studies. To date, it is reasonable to perform FER in cases with a clear indication for the benefits of such strategy including impending ovarian hyperstimulation syndrome (OHSS) or preimplantation genetic testing for aneuploidy (PGT-A); however, this strategy does not fit for all. This review analyses the pros and cons of the freeze all strategy highlighting the need to follow a personalized plan in embryo transfer, avoiding a freeze all methodology for all patients in an unselected manner.
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Affiliation(s)
| | - Kallirhoe Kalinderi
- 3rd Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Roy Homburg
- Homerton Fertility Centre, Homerton University Hospital, London, UK.,Queen Mary University of London, London, UK
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21
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Luo J, Qi Q, Chen Y, Wang Y, Xie Q. Effect of GnRH-antagonist, mifepristone and letrozole on preventing ovarian hyperstimulation syndrome in rat model. Reprod Biomed Online 2021; 42:291-300. [PMID: 33249057 DOI: 10.1016/j.rbmo.2020.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/23/2020] [Accepted: 10/09/2020] [Indexed: 11/21/2022]
Abstract
RESEARCH QUESTION Can luteolysis-targeted drugs, gonadotrophin-releasing hormone antagonist (GnRH-ant), mifepristone and letrozole, administered separately or in combination, prevent the progression of ovarian hyperstimulation syndrome (OHSS) in a rat model? DESIGN Thirty-six female Wistar rats were randomly divided into six groups, including control group (OHSS group, ovarian hyperstimulation-induced OHSS); GnRH-ant group (OHSS with GnRH-ant treatment); mifepristone group (OHSS with mifepristone treatment); letrozole group (OHSS with letrozole treatment); combination group (OHSS with GnRH-ant, mifepristone and letrozole treatment in combination). The main outcomes were the alterations in OHSS-related indices, including ovarian weight, vascular permeability, serum oestradiol and progesterone levels, corpus luteum proportion and diameter, ovarian vascular endothelial growth factor (VEGF), interleukin 6 (IL-6), caspase-3 and cleaved caspase-3 levels. RESULTS No significant difference was found in body weight gain among the six groups. Compared with the control group, the OHSS group showed significant increases in all OHSS-related indices. GnRH-ant treatment showed decreases in vascular permeability, serum oestradiol level, corpus luteum diameter, ovarian VEGF /IL-6 mRNA levels, and increases in ovarian caspase-3 and cleaved caspase-3 levels. Mifepristone treatment demonstrated reduction in serum progesterone level and corpus luteum diameter, and elevation in ovarian caspase-3 and cleaved caspase-3 levels. Letrozole treatment displayed a decline in serum oestradiol level and corpus luteum diameter, and up-regulation in ovarian caspase-3 and cleaved caspase-3 levels. The combination treatment by GnRH-ant, mifepristone and letrozole showed enhanced synergistic effect on reducing OHSS-related indices. CONCLUSIONS GnRH-ant, mifepristone and letrozole are beneficial in preventing the progression of OHSS through different luteolytic mechanisms. Cocktail style treatment shows enhanced synergistic effect on preventing the progression of OHSS.
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Affiliation(s)
- Jin Luo
- Center for Reproductive Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Qianrong Qi
- Center for Reproductive Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Yinmei Chen
- Center for Reproductive Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Yaqin Wang
- Center for Reproductive Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Qingzhen Xie
- Center for Reproductive Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, China.
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22
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Zhang N, Law YJ, Venetis CA, Chambers GM, Harris K. Female age is associated with the optimal number of oocytes to maximize fresh live birth rates: an analysis of 256,643 fresh ART cycles. Reprod Biomed Online 2020; 42:669-678. [PMID: 33509664 DOI: 10.1016/j.rbmo.2020.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 11/16/2022]
Abstract
RESEARCH QUESTION What is the optimal number of oocytes retrieved at which maximum live birth rate is observed after fresh autologous assisted reproductive technology (ART) cycles for women of different ages? DESIGN Retrospective cohort study of all fresh autologous ART aspiration cycles (n = 256,643) undertaken in Australia and New Zealand between 2009 and 2015. Primary outcome measure was live birth rate (LBR) (delivery of at least one liveborn baby at 20 weeks' gestation or over per fresh aspiration cycle). Cycles were grouped according to female age (<30, 30-34, 35-49, 40-44 and ≥45 years) and ovarian response (one to three, four to nine, 10-14, 15-19, 20-25 and ≥25 oocytes). Secondary outcome was incidence of ovarian hyperstimulation syndrome (OHSS) requiring hospitalization. RESULTS At different oocyte yields, LBR per fresh aspiration cycle peaked and then declined at, depending on female age: <30 years: six to 11 oocytes (LBR 31-34%); 30-34 years: 11-16 oocytes (LBR 29-30%); 35-39 years: nine to 17 oocytes (LBR 21-24%); and 40-44 years: 15-17 oocytes (LBR 11-12%). The incidence of OHSS increased significantly with the number of oocytes retrieved, from 1.2% with 15 oocytes retrieved to 9.3% with 30 or more oocytes retrieved (P < 0.001). CONCLUSION The optimal number of oocytes at which maximum LBR was observed in a fresh aspiration cycle was highly dependent on age. Because of the observational nature of the results, a cause-effect relationship between the number of oocytes retrieved and LBR should not be assumed; evidence from well-designed randomized control trials is required before clinical advice can be suggested.
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Affiliation(s)
- Ning Zhang
- National Perinatal Epidemiology and Statistics Unit, School of Women's and Children's Health and Centre for Big Data Research in Health, Level 1, AGSM Building (G27), UNSW Medicine, Sydney NSW 2052
| | - Yin Jun Law
- National Perinatal Epidemiology and Statistics Unit, School of Women's and Children's Health and Centre for Big Data Research in Health, Level 1, AGSM Building (G27), UNSW Medicine, Sydney NSW 2052
| | - Christos A Venetis
- National Perinatal Epidemiology and Statistics Unit, School of Women's and Children's Health and Centre for Big Data Research in Health, Level 1, AGSM Building (G27), UNSW Medicine, Sydney NSW 2052; School of Women's and Children's Health, UNSW Medicine, Sydney NSW, Australia; IVF Australia, Sydney NSW, Australia
| | - Georgina M Chambers
- National Perinatal Epidemiology and Statistics Unit, School of Women's and Children's Health and Centre for Big Data Research in Health, Level 1, AGSM Building (G27), UNSW Medicine, Sydney NSW 2052
| | - Katie Harris
- National Perinatal Epidemiology and Statistics Unit, School of Women's and Children's Health and Centre for Big Data Research in Health, Level 1, AGSM Building (G27), UNSW Medicine, Sydney NSW 2052; The George Institute for Global Health, University of New South Wales, Sydney NSW, Australia.
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23
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Lainas GT, Lainas TG, Sfontouris IA, Venetis CA, Kyprianou MA, Petsas GK, Tarlatzis BC, Kolibianakis EM. A decision-making algorithm for performing or cancelling embryo transfer in patients at high risk for ovarian hyperstimulation syndrome after triggering final oocyte maturation with hCG. Hum Reprod Open 2020; 2020:hoaa013. [PMID: 32529046 PMCID: PMC7275634 DOI: 10.1093/hropen/hoaa013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/23/2020] [Accepted: 02/11/2020] [Indexed: 11/15/2022] Open
Abstract
STUDY QUESTION Can the grade of ascites, haematocrit (Ht), white blood cell (WBC) count and maximal ovarian diameter (MOD) measured on Day 3 be used to construct a decision-making algorithm for performing or cancelling embryo transfer in patients at high risk for severe ovarian hyperstimulation syndrome (OHSS) after an hCG trigger? SUMMARY ANSWER Using cut-offs of ascites grade>2, Ht>39.2%, WBC>12 900/mm3 and MOD>85 mm on Day 3, a decision-making algorithm was constructed that could predict subsequent development of severe OHSS on Day 5 with an AUC of 0.93, a sensitivity of 88.5% and a specificity of 84.2% in high-risk patients triggered with hCG. WHAT IS KNOWN ALREADY Despite the increasing popularity of GnRH agonist trigger for final oocyte maturation as a way to prevent OHSS, ≥75% of IVF cycles still involve an hCG trigger. Numerous risk factors and predictive models of OHSS have been proposed, but the measurement of these early predictors is restricted either prior to or during the controlled ovarian stimulation. In high-risk patients triggered with hCG, the identification of luteal-phase predictors assessed post-oocyte retrieval, which reflect the pathophysiological changes leading to severe early OHSS, is currently lacking. STUDY DESIGN, SIZE, DURATION A retrospective study of 321 patients at high risk for severe OHSS following hCG triggering of final oocyte maturation. High risk for OHSS was defined as the presence of at least 19 follicles ≥11 mm on the day of triggering of final oocyte maturation. PARTICIPANTS/MATERIALS, SETTING, METHODS The study includes IVF/ICSI patients at high risk for developing severe OHSS, who administered hCG to trigger final oocyte maturation. Ascites grade, MOD, Ht and WBC were assessed in the luteal phase starting from the day of oocyte retrieval. Outcome measures were the optimal thresholds of ascites grade, MOD, Ht and WBC measured on Day 3 post-oocyte retrieval to predict subsequent severe OHSS development on Day 5. These criteria were used to construct a decision-making algorithm for embryo transfer, based on the estimated probability of severe OHSS development on Day 5. MAIN RESULTS AND THE ROLE OF CHANCE The optimal Day 3 cutoffs for severe OHSS prediction on Day 5 were ascites grade>2, Ht>39.2%, WBC>12 900/mm3 and MOD>85 mm. The probability of severe OHSS with no criteria fulfilled on Day 3 is 0% (95% CI: 0–5.5); with one criterion, 0.8% (95% CI: 0.15–4.6); with two criteria, 13.3% (95% CI: 7.4–22.8); with three criteria, 37.2% (95% CI: 24.4–52.1); and with four criteria, 88.9% (95% CI, 67.2–98.1). The predictive model of severe OHSS had an AUC of 0.93 with a sensitivity of 88.5% and a specificity of 84.2%. LIMITATIONS, REASONS FOR CAUTION This is a retrospective study, and therefore, it cannot be excluded that non-apparent sources of bias might be present. In addition, we acknowledge the lack of external validation of our model. We have created a web-based calculator (http://ohsspredict.org), for wider access and usage of our tool. By inserting the values of ascites grade, MOD, Ht and WBC of high-risk patients on Day 3 after oocyte retrieval, the clinician instantly receives the predicted probability of severe OHSS development on Day 5. WIDER IMPLICATIONS OF THE FINDINGS The present study describes a novel decision-making algorithm for embryo transfer based on ascites, Ht, WBC and MOD measurements on Day 3. The algorithm may be useful for the management of high-risk patients triggered with hCG and for helping the clinician’s decision to proceed with, or to cancel, embryo transfer. It must be emphasized that the availability of the present decision-making algorithm should in no way encourage the use of hCG trigger in patients at high risk for OHSS. In these patients, the recommended approach is the use of GnRH antagonist protocols, GnRH agonist trigger and elective embryo cryopreservation. In addition, in patients triggered with hCG, freezing all embryos and luteal-phase GnRH antagonist administration should be considered for the outpatient management of severe early OHSS and prevention of late OHSS. STUDY FUNDING/COMPETING INTEREST(S) NHMRC Early Career Fellowship (GNT1147154) to C.A.V. No conflict of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- GT Lainas
- Eugonia Assisted Reproduction Unit, 7 Ventiri Street, 11528 Athens, Greece
- Correspondence address. Eugonia Assisted Reproduction Unit, 7 Ventiri Street, 11528 Athens, Greece. Tel: +302107236333; E-mail:
| | - TG Lainas
- Eugonia Assisted Reproduction Unit, 7 Ventiri Street, 11528 Athens, Greece
| | - IA Sfontouris
- Eugonia Assisted Reproduction Unit, 7 Ventiri Street, 11528 Athens, Greece
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
| | - CA Venetis
- UNSW Medicine, Centre for Big Data Research in Health, Sydney New South Wales Australia
| | - MA Kyprianou
- Eugonia Assisted Reproduction Unit, 7 Ventiri Street, 11528 Athens, Greece
| | - GK Petsas
- Eugonia Assisted Reproduction Unit, 7 Ventiri Street, 11528 Athens, Greece
| | - BC Tarlatzis
- Unit for Human Reproduction, 1st Department of Obstetrics & Gynaecology, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - EM Kolibianakis
- Unit for Human Reproduction, 1st Department of Obstetrics & Gynaecology, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Coddington CC, Gopal D, Cui X, Cabral H, Diop H, Stern JE. Influence of subfertility and assisted reproductive technology treatment on mortality of women after delivery. Fertil Steril 2020; 113:569-577.e1. [PMID: 32044090 PMCID: PMC7088468 DOI: 10.1016/j.fertnstert.2019.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/02/2019] [Accepted: 10/02/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare incidence, risk factors, and etiology of women's deaths in fertile, subfertile, and undergoing assisted reproductive technology (ART) in the years after delivery. DESIGN Retrospective cohort. SETTING University hospital. PATIENT(S) Women who had delivered in Massachusetts. INTERVENTION(S) This study used data from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System linked to vital records, hospital stays, and the Massachusetts death file. Mortality of patients delivered from 2004-2013 was evaluated through 2015. The exposure groups, determined on the basis of the last delivery, were ART-treated (linked to Society for Assisted Reproductive Technology Clinic Outcome Reporting System), subfertile (no ART but with indicators of subfertility including birth certificate checkbox for fertility treatment, prior hospitalization for infertility [International Classification of Disease codes 9 628 or V23], and/or prior delivery with checkbox or ART), or fertile (neither ART nor subfertile). Numbers (per 100,000 women-years) and causes of death were obtained from the Massachusetts death file. MAIN OUTCOME MEASURE(S) Mortality of women after delivery in each of the three fertility groups and the most common etiology of death in each. RESULT(S) We included 483,547 women: 16,429 ART, 11,696 subfertile, and 455,422 fertile among whom there were 1,280 deaths with 21.1, 25.5, and 44.7 deaths, respectively, per 100,000 women-years. External causes (violence, accidents, and poisonings) were the most common reasons for death in the fertile group. Deaths occurred on average 46 months after delivery. When external causes of death were removed, there were 19.1, 17.0, and 25.6 deaths per 100,000 women-years and leading causes of death in all groups were cancer and circulatory problems. CONCLUSION(S) The study presents reassuring data that death rates within 5 years of delivery in ART-treated and subfertile women do not differ from those in fertile women.
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Affiliation(s)
- Charles C Coddington
- Department of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, Minnesota; Atrium Health, Charlotte, North Carolina.
| | - Daksha Gopal
- Biostatistics, Boston University SPH, Boston, Massachusetts
| | - Xiaohui Cui
- Mass Department of Public Health, Boston, Massachusetts
| | - Howard Cabral
- Biostatistics, Boston University SPH, Boston, Massachusetts
| | - Hafsatou Diop
- Mass Department of Public Health, Boston, Massachusetts
| | - Judy E Stern
- Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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25
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Moreno - Sepulveda J, Checa MA. Risk of adverse perinatal outcomes after oocyte donation: a systematic review and meta-analysis. J Assist Reprod Genet 2019; 36:2017-2037. [PMID: 31440959 PMCID: PMC6823473 DOI: 10.1007/s10815-019-01552-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 07/26/2019] [Indexed: 01/10/2023] Open
Abstract
RESEARCH QUESTION In women with singleton pregnancies conceived after assisted reproductive technologies, does the in vitro fertilization with oocyte donation (IVF-OD) affect the perinatal and maternal outcomes compared to autologous in vitro fertilization (IVF-AO)? DESIGN Systematic review and meta-analysis of studies comparing perinatal and maternal outcomes in singleton pregnancies resulting from IVF-OD versus IVF-AO. An electronic literature search in Pubmed, MEDLINE, and Cochrane database was performed. The main outcome measures were hypertensive disorders in pregnancy, preeclampsia, severe preeclampsia, pregnancy-induced hypertension, preterm birth, early preterm birth, low birth weight, and very low birth weight. RESULTS Twenty-three studies were included. IVF-OD is associated with a higher risk of hypertensive disorders in pregnancy (OR 2.63, 2.17-3.18), preeclampsia (OR 2.64; 2.29-3.04), severe preeclampsia (OR 3.22; 2.30-4.49), pregnancy-induced hypertension (OR 2.16; 1.79-2.62), preterm birth (OR 1.57; 1.33-1.86), early preterm birth (OR 1.80; 1.51-2.15), low birth weight (OR 1.25, 1.20-1.30), very low birth weight (OR 1.37, 1.22-1.54), gestational diabetes (OR 1.27; 1.03-1.56), and cesarean section (OR 2.28; 2.14-2.42). There was no significant difference in the risk of preterm birth or low birth weight when adjusted for preeclampsia. CONCLUSIONS IVF-OD patients should be considered an independent risk factor for some adverse perinatal outcomes, mainly hypertensive disorders in pregnancy, preeclampsia, and severe preeclampsia. Immunological and hormonal aspects may be involved in these results, and further research focusing in the etiopathogenesis of these pathologies are needed.
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Affiliation(s)
- Jose Moreno - Sepulveda
- Obstetrics and Gynecology Department, Parc de Salut Mar, Universitat Autonoma de Barcelona, Campus Universitario UAB, 08193 Bellaterra, Cerdanyola del Vallès, Balmes 10, 1-1, 08007 Barcelona, Spain
- Clínica de la Mujer Medicina Reproductiva, Alejandro Navarrete 2606, Viña del Mar, Chile
| | - Miguel A. Checa
- Obstetrics and Gynecology Department, Parc de Salut Mar, Universitat Autonoma de Barcelona, Campus Universitario UAB, 08193 Bellaterra, Cerdanyola del Vallès, Balmes 10, 1-1, 08007 Barcelona, Spain
- GRI-BCN, Barcelona Infertility Research Group, IMIM, Institut Hospital del Mar d’Investigacions Mèdiques, Carrer del Dr. Aiguader, 88, 08003 Barcelona, Spain
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Qiu J, Li P, Dong M, Xin X, Tan J. Personalized prediction of live birth prior to the first in vitro fertilization treatment: a machine learning method. J Transl Med 2019; 17:317. [PMID: 31547822 PMCID: PMC6757430 DOI: 10.1186/s12967-019-2062-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/06/2019] [Indexed: 01/08/2023] Open
Abstract
Background Infertility has become a global health issue with the number of couples seeking in vitro fertilization (IVF) worldwide continuing to rise. Some couples remain childless after several IVF cycles. Women undergoing IVF face greater risks and financial burden. A prediction model to predict the live birth chance prior to the first IVF treatment is needed in clinical practice for patients counselling and shaping expectations. Methods Clinical data of 7188 women who underwent their first IVF treatment at the Reproductive Medical Center of Shengjing Hospital of China Medical University during 2014–2018 were retrospectively collected. Machine-learning based models were developed on 70% of the dataset using pre-treatment variables, and prediction performances were evaluated on the remaining 30% using receiver operating characteristic (ROC) analysis and calibration plot. Nested cross-validation was used to make an unbiased estimate of the generalization performance of the machine learning algorithms. Results The XGBoost model achieved an area under the ROC curve of 0.73 on the validation dataset and showed the best calibration compared with other machine learning algorithms. Nested cross-validation resulted in an average accuracy score of 0.70 ± 0.003 for the XGBoost model. Conclusions A prediction model based on XGBoost was developed using age, AMH, BMI, duration of infertility, previous live birth, previous miscarriage, previous abortion and type of infertility as predictors. This study might be a promising step to provide personalized estimates of the cumulative live birth chance of the first complete IVF cycle before treatment.
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Affiliation(s)
- Jiahui Qiu
- Reproductive Medical Center of Gynecology and Obstetrics Department, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.,Key Laboratory of Reproductive Dysfunction Diseases and Fertility Remodeling of Liaoning Province, Shenyang, Liaoning, China
| | - Pingping Li
- Reproductive Medical Center of Gynecology and Obstetrics Department, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.,Key Laboratory of Reproductive Dysfunction Diseases and Fertility Remodeling of Liaoning Province, Shenyang, Liaoning, China
| | - Meng Dong
- Reproductive Medical Center of Gynecology and Obstetrics Department, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.,Key Laboratory of Reproductive Dysfunction Diseases and Fertility Remodeling of Liaoning Province, Shenyang, Liaoning, China
| | - Xing Xin
- Reproductive Medical Center of Gynecology and Obstetrics Department, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.,Key Laboratory of Reproductive Dysfunction Diseases and Fertility Remodeling of Liaoning Province, Shenyang, Liaoning, China
| | - Jichun Tan
- Reproductive Medical Center of Gynecology and Obstetrics Department, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China. .,Key Laboratory of Reproductive Dysfunction Diseases and Fertility Remodeling of Liaoning Province, Shenyang, Liaoning, China.
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27
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Saavalainen L, But A, Tiitinen A, Härkki P, Gissler M, Haukka J, Heikinheimo O. Mortality of midlife women with surgically verified endometriosis—a cohort study including 2.5 million person-years of observation. Hum Reprod 2019; 34:1576-1586. [DOI: 10.1093/humrep/dez074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/18/2019] [Accepted: 04/25/2019] [Indexed: 12/23/2022] Open
Abstract
Abstract
STUDY QUESTION
Is all-cause and cause-specific mortality increased among women with surgically verified endometriosis?
SUMMARY ANSWER
The all-cause and cause-specific mortality in midlife was lower throughout the follow-up among women with surgically verified endometriosis compared to the reference cohort.
WHAT IS KNOWN ALREADY
Endometriosis has been associated with an increased risk of comorbidities such as certain cancers and cardiovascular diseases. These diseases are also common causes of death; however, little is known about the mortality of women with endometriosis.
STUDY DESIGN, SIZE, DURATION
A nationwide retrospective cohort study of women with surgically verified diagnosis of endometriosis was compared to the reference cohort in Finland (1987–2012). Follow-up ended at death or 31 December 2014. During the median follow-up of 17 years, 2.5 million person-years accumulated.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Forty-nine thousand nine hundred and fifty-six women with at least one record of surgically verified diagnosis of endometriosis in the Finnish Hospital Discharge Register between 1987 and 2012 were compared to a reference cohort of 98 824 age- and municipality-matched women. The age (mean ± standard deviation) of the endometriosis cohort was 36.4 ± 9.0 and 53.6 ± 12.1 years at the beginning and at the end of the follow-up, respectively. By using the Poisson regression models the crude and adjusted all-cause and cause-specific mortality rate ratios (MRR) and 95% confidence intervals (CI) were assessed. Calendar time, age, time since the start of follow-up, educational level, and parity adjusted were considered in the multivariate analyses.
MAIN RESULTS AND THE ROLE OF CHANCE
A total of 1656 and 4291 deaths occurred in the endometriosis and reference cohorts, respectively. A lower all-cause mortality was observed for the endometriosis cohort (adjusted MRR, 0.73 [95% CI 0.69 to 0.77])—there were four deaths less per 1000 women over 10 years. A lower cause-specific mortality contributed to this: the adjusted MRR was 0.88 (95% CI 0.81 to 0.96) for any cancer and 0.55 (95% CI 0.47 to 0.65) for cardiovascular diseases, including 0.52 (95% CI 0.42 to 0.64) for ischemic heart disease and 0.60 (95% CI 0.47 to 0.76) for cerebrovascular disease. Mortality due to alcohol, accidents and violence, respiratory, and digestive disease-related causes was also decreased.
LIMITATIONS, REASONS FOR CAUSATION
These results are limited to women with endometriosis diagnosed by surgery. In addition, the study does not extend into the oldest age groups. The results might be explained by the characteristics and factors related to women’s lifestyle, and/or increased medical attention and care received, rather than the disease itself.
WIDER IMPLICATIONS OF THE FINDINGS
These reassuring data are valuable to women with endometriosis and to their health care providers. Nonetheless, more studies are needed to address the causality.
STUDY FUNDING/COMPETING INTEREST
This research was funded by the Hospital District of Helsinki and Uusimaa and The Finnish Medical Foundation. None of the authors report any competing interest in relation to the present work; all the authors have completed the disclosure form.
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Affiliation(s)
- L Saavalainen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - A But
- Biostatistics Consulting, Department of Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - A Tiitinen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - P Härkki
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - M Gissler
- National Institute for Health and Welfare (THL), Information Services Department, Helsinki, Finland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - J Haukka
- Biostatistics Consulting, Department of Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - O Heikinheimo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Romanski PA, Farland LV, Tsen LC, Ginsburg ES, Lewis EI. Effect of class III and class IV obesity on oocyte retrieval complications and outcomes. Fertil Steril 2019; 111:294-301.e1. [PMID: 30691631 DOI: 10.1016/j.fertnstert.2018.10.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/19/2018] [Accepted: 10/15/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess the effect of class III (body mass index [BMI] 40-49.9 kg/m2) and class IV obesity (BMI ≥ 50 kg/m2) on oocyte retrieval complications and outcomes. DESIGN Cohort study. SETTING Academic center. PATIENT(S) Women who underwent an oocyte retrieval from January 1, 2012 to May 31, 2017. Women with BMI ≥ 40 kg/m2 (n = 144) were age-matched to women with BMI <25, 25-29.9, 30-34.9, and 35-39.9 kg/m2 (n = 1,016). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Anesthetic and procedural outcomes during oocyte retrieval. RESULT(S) Overall, 1,924 of 1,947 oocyte retrievals (98.8%) were performed under total intravenous anesthesia. No patients with BMI ≥ 40 kg/m2 required intraoperative conversion to endotracheal intubation or hospital admission. Two patients (0.8%) with BMI ≥ 40 kg/m2 required a laryngeal mask airway intraoperatively owing to oxygen desaturation. An oral/nasal airway was used to resolve oxygen desaturation in 16 patients (6.25%) with BMI ≥ 40 kg/m2, compared with in 17 patients (1.0%) with BMI < 40 kg/m2. As BMI increased, a statistically significant increase in propofol dose, fentanyl dose, and procedure time was observed. Eighteen patients (7.0%) with BMI ≥ 40 kg/m2 underwent a transabdominal retrieval, compared with 15 (0.9%) with BMI < 40 kg/m2. CONCLUSION(S) Serious intraoperative and postoperative complications were uncommon across all BMI groups, though minor complications were more common with class III and class IV obesity. These patients were also more likely to require higher doses of propofol and fentanyl, have longer oocyte retrievals, and require a transabdominal retrieval. Overall, oocyte retrieval can be safely performed as an outpatient procedure in women with class III and class IV obesity.
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Affiliation(s)
- Phillip A Romanski
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Leslie V Farland
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Lawrence C Tsen
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elizabeth S Ginsburg
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Erin I Lewis
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Gaafar S, El-Gezary D, El Maghraby HA. Early onset of cabergoline therapy for prophylaxis from ovarian hyperstimulation syndrome (OHSS): A potentially safer and more effective protocol. Reprod Biol 2019; 19:145-148. [PMID: 31133458 DOI: 10.1016/j.repbio.2019.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/20/2019] [Accepted: 03/28/2019] [Indexed: 01/11/2023]
Abstract
Vascular endothelial growth factor (VEGF) is the most important angiogenic mediator in ovarian hyperstimulation syndrome OHSS. Studies proved that cabergoline administration blocks the increase in vascular permeability via dephosphorylation of VEGF receptors and hence can be used as prophylactic agent against OHSS. This study aimed at evaluating the effectiveness of early administration of cabergoline in the prevention of OHSS in high risk cases prepared for ICSI. This case series study was conducted on 126 high risk patients prepared for ICSI using the fixed antagonist protocol. High risk patients were defined as having more than 20 follicles >12 mm in diameter, and/or E2 more than 3000 pg/ml when the size of the leading follicle is more than 15 mm. When the size of the leading follicle reached 15 mm, cabergoline was administered (0.5 mg/day) for 8 days. Patients were followed up clinically, ultrasonographically and hematologically. The final E2 was 6099.5 ± 2730 and the mean number of retrieved oocytes was 19.7 ± 7.8. The clinical pregnancy rate was 62/126 (49.2%). There were no significant changes (p > 0.05) comparing hematological parameters, renal function tests and liver function tests between the day of HCG and the day of blastocyst transfer. The incidence of severe OHSS in this group was 1/126 (0.9%), while moderate OHSS was 12 (9.5%) and there were no cases of critical OHSS. We concluded that early administration of cabergoline is a safe and potentially more effective approach for prophylaxis against OHSS in high risk cases.
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Affiliation(s)
- Sherif Gaafar
- Department of Obstetrics, Gynecology and Reproductive Medicine, El Shatby University Hospital, Alexandria University, Egypt.
| | - Dalal El-Gezary
- Clinical Pathology Department, Faculty of Medicine, Alexandria University, Egypt.
| | - Hassan A El Maghraby
- Department of Obstetrics, Gynecology and Reproductive Medicine, El Shatby University Hospital, Alexandria University, Egypt.
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Li Y, Fang L, Yu Y, Shi H, Wang S, Guo Y, Sun Y. Higher melatonin in the follicle fluid and MT2 expression in the granulosa cells contribute to the OHSS occurrence. Reprod Biol Endocrinol 2019; 17:37. [PMID: 30979376 PMCID: PMC6461819 DOI: 10.1186/s12958-019-0479-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/29/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Ovarian hyperstimulation syndrome (OHSS) is a common and severe complication for patients undergoing IVF/ICSI-ET. Melatonin widely participates in the regulation of female reproductive endocrine activity. However, whether melatonin participates in the progression of OHSS is largely unknown. This study aims to identify the predictive value of follicular fluid (FF) melatonin for OHSS establishment and the underlying mechanism. METHODS All participants of this case-control study were enrolled at the Reproductive Medicine Center located in the First Affiliated Hospital of Zhengzhou University in China from January to October in 2017. Quantitative real-time PCR and western blot were used to examine the mRNA and protein levels. Primary granulosa cells were extracted and cultured for in vitro studies. Melatonin concentration was measured by ELISA. Logistic analysis and receiver-operating characteristic (ROC) curves were used to evaluate the predicting value of melatonin on OHSS occurrence. MAIN OUTCOME MEASURES The expression level of melatonin receptor 2 (MT2), P450 aromatase cytochrome (aromatase), vascular endothelial growth factor (VEGF), and inducible nitric oxide synthase (iNOS) mRNA in human primary granulosa cells. The concentration of melatonin in FF. The predicting value of melatonin on OHSS and the cut-off value of the prediction. RESULTS FF melatonin concentrations were significantly higher in patients with OHSS compared to non-OHSS group (35.94 ± 10.18 ng/mL vs 23.93 ± 10.94 ng/mL, p<0.001). The expression of MT2 mRNA (p = 0.0459) and protein in granulosa cells was also significantly higher in the OHSS group. When using a cut-off level of 27.52 ng/ml, the sensitivity and specificity of FF melatonin to predict OHSS was 84.6 and 74.0%, respectively (p < 0.0001). We also found that melatonin could up-regulates aromatase mRNA, VEGF mRNA expression and down-regulates iNOS mRNA expression in the granulosa cells. CONCLUSION OHSS patients have higher melatonin in the FF as well as higher MT2 expression in the granulosa cells. The melatonin in FF might be used as an effective predictor for the occurrence of OHSS.
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Affiliation(s)
- Yiran Li
- grid.412633.1Reproductive Medical Center, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, People’s Republic of China Zhengzhou No. 1 construction east road, He’nan Province, China
| | - Lanlan Fang
- grid.412633.1Reproductive Medical Center, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, People’s Republic of China Zhengzhou No. 1 construction east road, He’nan Province, China
| | - Yiping Yu
- grid.412633.1Reproductive Medical Center, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, People’s Republic of China Zhengzhou No. 1 construction east road, He’nan Province, China
| | - Hao Shi
- grid.412633.1Reproductive Medical Center, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, People’s Republic of China Zhengzhou No. 1 construction east road, He’nan Province, China
| | - Sijia Wang
- grid.412633.1Reproductive Medical Center, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, People’s Republic of China Zhengzhou No. 1 construction east road, He’nan Province, China
| | - Yanjie Guo
- grid.412633.1Reproductive Medical Center, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, People’s Republic of China Zhengzhou No. 1 construction east road, He’nan Province, China
| | - Yingpu Sun
- grid.412633.1Reproductive Medical Center, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, People’s Republic of China Zhengzhou No. 1 construction east road, He’nan Province, China
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31
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Dayan N, Joseph KS, Fell DB, Laskin CA, Basso O, Park AL, Luo J, Guan J, Ray JG. Infertility treatment and risk of severe maternal morbidity: a propensity score-matched cohort study. CMAJ 2019; 191:E118-E127. [PMID: 30718336 PMCID: PMC6351248 DOI: 10.1503/cmaj.181124] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2018] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The extent to which infertility treatment predicts severe maternal morbidity is not well known. We examined the association between infertility treatment and severe maternal morbidity in pregnancy and the postpartum period. METHODS We conducted a cohort study using population-based registries from Ontario between 2006 and 2012. Pregnancies achieved using infertility treatment (ovulation induction, intrauterine insemination or in vitro fertilization with or without intracytoplasmic sperm injection) were compared with unassisted pregnancies using propensity score matching, based on demographic, reproductive and obstetric factors. The primary outcome was a validated composite of severe maternal morbidity or maternal death from 20 weeks' gestation to 42 days postpartum. We also calculated the odds ratio of a woman having 1, 2, or 3 or more severe maternal morbidity indicators in relation to invasive (e.g., in vitro fertilization) or noninvasive (e.g., intrauterine insemination) infertility treatment. RESULTS We matched 11 546 infertility treatment pregnancies with 47 553 untreated pregnancies. Severe maternal morbidity or maternal death occurred in 356 infertility-treated pregnancies (30.8 per 1000 deliveries) versus 1054 untreated pregnancies (22.2 per 1000 deliveries); relative risk 1.39 (95% confidence interval [CI] 1.23-1.56). The likelihood of a woman having 3 or more severe maternal morbidity indicators was increased in women who received invasive infertility treatment (odds ratio [OR] 2.28, 95% CI 1.56-3.33) but not in those who received noninvasive infertility treatment (OR 0.99, 95% CI 0.57-1.72). INTERPRETATION Women who undergo infertility treatment, particularly in vitro fertilization, are at somewhat higher risk of severe maternal morbidity or death. Efforts are needed to identify patient- and treatment-specific predictors of severe maternal morbidity that may influence the type of treatment a woman is offered.
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Affiliation(s)
- Natalie Dayan
- Department of Medicine and Research Institute (Dayan), Department of Obstetrics and Gynecology (Basso), McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology, and School of Population and Public Health (Joseph), University of British Columbia, Vancouver, BC; Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa, Ottawa, Ont.; Department of Medicine and Obstetrics and Gynecology (Laskin), University of Toronto; TRIO Fertility (Laskin); ICES (Park, Luo, Guan, Ray, Fell); Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont.
| | - K S Joseph
- Department of Medicine and Research Institute (Dayan), Department of Obstetrics and Gynecology (Basso), McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology, and School of Population and Public Health (Joseph), University of British Columbia, Vancouver, BC; Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa, Ottawa, Ont.; Department of Medicine and Obstetrics and Gynecology (Laskin), University of Toronto; TRIO Fertility (Laskin); ICES (Park, Luo, Guan, Ray, Fell); Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont
| | - Deshayne B Fell
- Department of Medicine and Research Institute (Dayan), Department of Obstetrics and Gynecology (Basso), McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology, and School of Population and Public Health (Joseph), University of British Columbia, Vancouver, BC; Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa, Ottawa, Ont.; Department of Medicine and Obstetrics and Gynecology (Laskin), University of Toronto; TRIO Fertility (Laskin); ICES (Park, Luo, Guan, Ray, Fell); Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont
| | - Carl A Laskin
- Department of Medicine and Research Institute (Dayan), Department of Obstetrics and Gynecology (Basso), McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology, and School of Population and Public Health (Joseph), University of British Columbia, Vancouver, BC; Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa, Ottawa, Ont.; Department of Medicine and Obstetrics and Gynecology (Laskin), University of Toronto; TRIO Fertility (Laskin); ICES (Park, Luo, Guan, Ray, Fell); Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont
| | - Olga Basso
- Department of Medicine and Research Institute (Dayan), Department of Obstetrics and Gynecology (Basso), McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology, and School of Population and Public Health (Joseph), University of British Columbia, Vancouver, BC; Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa, Ottawa, Ont.; Department of Medicine and Obstetrics and Gynecology (Laskin), University of Toronto; TRIO Fertility (Laskin); ICES (Park, Luo, Guan, Ray, Fell); Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont
| | - Alison L Park
- Department of Medicine and Research Institute (Dayan), Department of Obstetrics and Gynecology (Basso), McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology, and School of Population and Public Health (Joseph), University of British Columbia, Vancouver, BC; Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa, Ottawa, Ont.; Department of Medicine and Obstetrics and Gynecology (Laskin), University of Toronto; TRIO Fertility (Laskin); ICES (Park, Luo, Guan, Ray, Fell); Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont
| | - Jin Luo
- Department of Medicine and Research Institute (Dayan), Department of Obstetrics and Gynecology (Basso), McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology, and School of Population and Public Health (Joseph), University of British Columbia, Vancouver, BC; Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa, Ottawa, Ont.; Department of Medicine and Obstetrics and Gynecology (Laskin), University of Toronto; TRIO Fertility (Laskin); ICES (Park, Luo, Guan, Ray, Fell); Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont
| | - Jun Guan
- Department of Medicine and Research Institute (Dayan), Department of Obstetrics and Gynecology (Basso), McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology, and School of Population and Public Health (Joseph), University of British Columbia, Vancouver, BC; Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa, Ottawa, Ont.; Department of Medicine and Obstetrics and Gynecology (Laskin), University of Toronto; TRIO Fertility (Laskin); ICES (Park, Luo, Guan, Ray, Fell); Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont
| | - Joel G Ray
- Department of Medicine and Research Institute (Dayan), Department of Obstetrics and Gynecology (Basso), McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology, and School of Population and Public Health (Joseph), University of British Columbia, Vancouver, BC; Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa, Ottawa, Ont.; Department of Medicine and Obstetrics and Gynecology (Laskin), University of Toronto; TRIO Fertility (Laskin); ICES (Park, Luo, Guan, Ray, Fell); Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont
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Santos-Ribeiro S, Mackens S, Racca A, Blockeel C. Towards complication-free assisted reproduction technology. Best Pract Res Clin Endocrinol Metab 2019; 33:9-19. [PMID: 30473208 DOI: 10.1016/j.beem.2018.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Assisted reproductive technology (ART) has vastly improved over the last 40 years, from a frequently unsuccessful and complicated procedure requiring hospital admission and routine laparoscopy to a fairly simple outpatient technique with relatively high success rates. However, it is important to stress that ART is not without risk and medical complications may still occur. The incidence of most of these ART-related complications is associated with how women undergo ovarian stimulation. For this reason, physicians should be aware that a carefully thought-out ovarian stimulation protocol and cycle monitoring are of paramount importance to maximise the success of the treatment while avoiding potentially life-threating complications to occur in this frequently otherwise healthy patient population. This review discusses the rationale and evolution of ovarian stimulation strategies over the years and the current developments towards finding a balance between the retrieval of a sufficient number of oocytes and ART-related complication prevention.
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Affiliation(s)
| | - Shari Mackens
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium.
| | - Annalisa Racca
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium; Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino-IST, University of Genoa, Largo Rosanna Benzi 10, Genova 16132, Italy.
| | - Christophe Blockeel
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium; Department of Obstetrics and Gynaecology, School of Medicine, University of Zagreb, Šalata 3, Zagreb 10000, Croatia.
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Sakkas D, Barrett CB, Alper MM. Types and frequency of non-conformances in an IVF laboratory. Hum Reprod 2018; 33:2196-2204. [PMID: 30388228 DOI: 10.1093/humrep/dey320] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/22/2018] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION How many non-conformances occur in an ART laboratory and how often do they occur? SUMMARY ANSWER The limited data to date demonstrate that IVF laboratories have a very low non-conformance rate compared with reported non-conformances in other medical laboratories, especially when one considers the high-complexity of procedures performed. WHAT IS KNOWN ALREADY ART involves a series of very complex patient and laboratory procedures. Although it is assumed that strict measures control ART laboratories, there is very little published data on non-conformances. STUDY DESIGN, SIZE, DURATION In accordance with the ISO 9001:2008 standard, Boston IVF has created an electronic database to record non-conformances in the IVF laboratory. We reviewed the non-conformances reported between March 2003 and December 2015. The non-conformances were categorized into four grades largely based upon their impact on the outcome or continuation of an IVF treatment cycle: None/Minimal (not measurably decreasing the likelihood of success), Moderate (a negative impact but not loss of a cycle), Significant (loss of a cycle or majority of gametes or embryos) and Major (infrequent errors that have an extreme impact on a patient or patients such as a confirmed pregnancy or birth involving misidentification of sperm, egg or embryo, or an extreme equipment or documentation failure that affects numerous patients). The category of problem or error associated with the Non-conformance Report was also noted. PARTICIPANTS/MATERIALS, SETTING, METHOD Retrospective analysis of an electronic database registering non-conformances at a large IVF laboratory. MAIN RESULTS AND THE ROLE OF CHANCE During the study period, a total of 36 654 IVF treatment cycles (fresh and frozen embryo transfer cycles) were conducted which involved a total of 181 899 individual laboratory procedures encompassing egg retrievals, sperm preparations, inseminations, embryo transfers, etc. When combining both moderate and significant non-conformances, 99.96% of procedures and 99.77% of cycles proceeded with no non-conformances. No Major grade non-conformances were reported. LIMITATIONS, REASONS FOR CAUTION A comparison of non-conformances between IVF clinics is difficult because of different classifications. WIDER IMPLICATIONS OF THE FINDINGS Errors are inevitable and it is incumbent on all IVF centers to be honest and transparent, both within the organization and with patients when errors occur. Robust systems for identifying, documenting, analyzing and implementing improvements should be established and maintained. STUDY FUNDING/COMPETING INTEREST(S) No external funding was used for this study. The authors have no conflicts of interest.
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Affiliation(s)
- Denny Sakkas
- Boston IVF Inc., 130 Second Avenue, Waltham, MA, USA
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Elnory MA, Elmantwe ANM. Comparison of cabergoline versus calcium infusion in ovarian hyperstimulation syndrome prevention: A randomized clinical trial. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2018. [DOI: 10.1016/j.mefs.2018.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Meldrum DR, Adashi EY, Garzo VG, Gleicher N, Parinaud J, Pinborg A, Van Voorhis B. Prevention of in vitro fertilization twins should focus on maximizing single embryo transfer versus twins are an acceptable complication of in vitro fertilization. Fertil Steril 2018; 109:223-229. [PMID: 29447664 DOI: 10.1016/j.fertnstert.2017.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 12/05/2017] [Indexed: 11/30/2022]
Affiliation(s)
- David R Meldrum
- Reproductive Partners San Diego, San Diego, California; Division of Reproductive Endocrinology and Infertility, University of California, San Diego, California.
| | - Eli Y Adashi
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - V Gabriel Garzo
- Reproductive Partners San Diego, San Diego, California; Division of Reproductive Endocrinology and Infertility, University of California, San Diego, California
| | | | - Jean Parinaud
- Department of Reproductive Medicine, Paule de Viguier Hospital, Toulouse Teaching Hospital Group, Toulouse, France
| | - Anja Pinborg
- Fertility Clinic, Department of Obstetrics and Gynecology, Hvidovre University Hospital, Hvidovre, Copenhagen, Denmark
| | - Brad Van Voorhis
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Abbara A, Clarke SA, Dhillo WS. Novel Concepts for Inducing Final Oocyte Maturation in In Vitro Fertilization Treatment. Endocr Rev 2018; 39:593-628. [PMID: 29982525 PMCID: PMC6173475 DOI: 10.1210/er.2017-00236] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 06/27/2018] [Indexed: 01/20/2023]
Abstract
Infertility affects one in six of the population and increasingly couples require treatment with assisted reproductive techniques. In vitro fertilization (IVF) treatment is most commonly conducted using exogenous FSH to induce follicular growth and human chorionic gonadotropin (hCG) to induce final oocyte maturation. However, hCG may cause the potentially life-threatening iatrogenic complication "ovarian hyperstimulation syndrome" (OHSS), which can cause considerable morbidity and, rarely, even mortality in otherwise healthy women. The use of GnRH agonists (GnRHas) has been pioneered during the last two decades to provide a safer option to induce final oocyte maturation. More recently, the neuropeptide kisspeptin, a hypothalamic regulator of GnRH release, has been investigated as a novel inductor of oocyte maturation. The hormonal stimulus used to induce oocyte maturation has a major impact on the success (retrieval of oocytes and chance of implantation) and safety (risk of OHSS) of IVF treatment. This review aims to appraise experimental and clinical data of hormonal approaches used to induce final oocyte maturation by hCG, GnRHa, both GnRHa and hCG administered in combination, recombinant LH, or kisspeptin. We also examine evidence for the timing of administration of the inductor of final oocyte maturation in relationship to parameters of follicular growth and the subsequent interval to oocyte retrieval. In summary, we review data on the efficacy and safety of the major hormonal approaches used to induce final oocyte maturation in clinical practice, as well as some novel approaches that may offer fresh alternatives in future.
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Affiliation(s)
- Ali Abbara
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Sophie A Clarke
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Waljit S Dhillo
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
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Vassard D, Schmidt L, Pinborg A, Petersen GL, Forman JL, Hageman I, Glazer CH, Kamper-Jørgensen M. Mortality in Women Treated With Assisted Reproductive Technology-Addressing the Healthy Patient Effect. Am J Epidemiol 2018; 187:1889-1895. [PMID: 29846493 DOI: 10.1093/aje/kwy085] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 04/09/2018] [Indexed: 11/12/2022] Open
Abstract
In previous studies, investigators have reported reduced mortality among women undergoing assisted reproductive technology (ART) treatment, possibly related to selection of healthy women into ART treatment. Our aim in this study was to explore the impact of relevant selection factors on the association between ART treatment and mortality and to explore effect modification by parity. Women treated with ART in fertility clinics in Denmark during 1994-2009 (n = 42,897) were age-matched with untreated women from the background population (n = 204,514) and followed until December 31, 2010. With adjustment for relevant confounders, the risk of death was lower among ART-treated women during the first 2 years after ART treatment (hazard ratio (HR) = 0.68, 95% confidence interval (CI): 0.63, 0.74), but there was no apparent difference after 10 years (HR = 0.92, 95% CI: 0.79, 1.07). Having children prior to ART treatment was associated with markedly reduced mortality (HR = 0.45, 95% CI: 0.38, 0.53), possibly due to better health among fertile women. While the frequencies of previous medical and psychiatric diagnoses among ART-treated and untreated women were similar, differences in disease severity could explain the reduced mortality among ART-treated women, as poor prognosis would make initiation of ART treatment unlikely. The survival advantage among ART-treated women is likely a selection phenomenon rather than a biological phenomenon.
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Affiliation(s)
- Ditte Vassard
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lone Schmidt
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anja Pinborg
- Fertility Clinic, Department of Obstetrics/Gynecology, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
| | - Gitte Lindved Petersen
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Julie Lyng Forman
- Section of Biostatistics, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ida Hageman
- Psychiatric Center Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Clara Helene Glazer
- Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Mads Kamper-Jørgensen
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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De Geyter C, Calhaz-Jorge C, Kupka MS, Wyns C, Mocanu E, Motrenko T, Scaravelli G, Smeenk J, Vidakovic S, Goossens V, Gliozheni O, Strohmer H, Obruca, Kreuz-Kinderwunschzentrum SPG, Petrovskaya E, Tishkevich O, Wyns C, Bogaerts K, Balic D, Sibincic S, Antonova I, Vrcic H, Ljiljak D, Pelekanos M, Rezabek K, Markova J, Lemmen J, Sõritsa D, Gissler M, Tiitinen A, Royere D, Tandler—Schneider A, Kimmel M, Antsaklis AJ, Loutradis D, Urbancsek J, Kosztolanyi G, Bjorgvinsson H, Mocanu E, Scaravelli G, de Luca R, Lokshin V, Ravil V, Magomedova V, Gudleviciene Z, Belo lopes G, Petanovski Z, Calleja-Agius J, Xuereb J, Moshin V, Simic TM, Vukicevic D, Romundstad LB, Janicka A, Calhaz-Jorge C, Laranjeira AR, Rugescu I, Doroftei B, Korsak V, Radunovic N, Tabs N, Virant-Klun I, Saiz IC, Mondéjar FP, Bergh C, Weder M, De Geyter C, Smeenk JMJ, Gryshchenko M, Baranowski R. ART in Europe, 2014: results generated from European registries by ESHRE†. Hum Reprod 2018; 33:1586-1601. [DOI: 10.1093/humrep/dey242] [Citation(s) in RCA: 314] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 06/18/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
- Ch De Geyter
- Institute of Reproductive Medicine and Gynecological Endocrinology (RME), Vogesenstrasse 134, Basel, Switzerland
- ESHRE Central Office, Meerstraat 60, Grimbergen, Belgium
| | - C Calhaz-Jorge
- CNPMA, assembleia da Republica, Palacio de Sao Bento, Lisboa, Portugal
| | - M S Kupka
- Gynaekologicum Hamburg, Gynaecology and Obstetrics, Altonaer Strasse 59, Hamburg, Germany
| | - C Wyns
- Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Av. Hippocrate, 10, Brussels, Belgium
| | - E Mocanu
- Human Assisted Reproduction Ireland Rotunda Hospital, HARI Unit, Master's House, Parnell Square, 1 Dublin, Ireland
| | - T Motrenko
- Medical Centre Cetinje, Human Reproduction Department, Vuka Micunovica 4, Cetinje, Montenegro
| | - G Scaravelli
- Istituto Superiore di Sanità, Registro Nazionale della Procreazione Medicalmente Assistita, CNESPS, Viale Regina Elena, 299, Roma, Italy
| | - J Smeenk
- Department of Obstetrics and Gynaecology, St Elisabeth Hospital Tilburg, Hilv, The Netherlands
| | - S Vidakovic
- Institute for Obstetrics and Gynecology, Clinical Center Serbia ‘GAK’, Visegradska 26, Belgrade, Serbia
| | - V Goossens
- ESHRE Central Office, Meerstraat 60, Grimbergen, Belgium
| | - Orion Gliozheni
- University Hospital for Obst&Gynecology, Departement of Obstetrics & Gynecology, Bul.B.Curri, Tirana, Albania. Tel: +355-4-222-3632; Fax: +355-4-225-7688; Mobile: +355-682029313. E-mail:
| | - Heinz Strohmer
- Lazarettgasse 16-18, 1090 Wien, Austria. Tel: +43-40-111-1400; Fax: +43-40-111-1401. E-mail:
| | - Obruca
- Lazarettgasse 16-18, 1090 Wien, Austria. Tel: +43-40-111-1400; Fax: +43-40-111-1401. E-mail:
| | | | | | - Oleg Tishkevich
- Centre For Assisted Reproduction ‘Embryo’ Belivpul, Filimonova Str. 53, 220114 Minsk, Belarus. Tel: +375-29-622-2722; Fax: +375-17-237-6404; Mobile: +375-296222722; E-mail:
| | - Christine Wyns
- Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Av. Hippocrate, 10, 1200 Brussels, Belgium. Tel. +32-27-64-6576; Fax: +32-27-64-9050; E-mail:
| | - Kris Bogaerts
- I-Biostat, Kapucijnenvoer 35 bus 7001, 3000 Leuven, Belgium. Tel: +32-016-33-6890; Fax: +32-016-33-7015. E-mail:
| | - Devleta Balic
- Zavod za humanu reprodukciju ‘Dr Balic’, Kojsino 25, 75000 Tuzla, Bosnia—Herzegovina. Tel: +387-35-26-0650; Mobile: +387-61140222; E-mail:
| | - Sanja Sibincic
- Health Centre Medico-S, Jevrejska 58/A, 78000 Banja Luka, Bosnia—Herzegovina. Tel: +387-51-232-100; Mobile: +387-65515942; E-mail:
| | - Irena Antonova
- ESHRE certified clinical embryologist (2011), Ob/Gyn Hospital Dr Shechterev, 25-31, Hristo Blagoev Strasse, 1330 Sofia, Bulgaria. Tel: +359-88-712-7651; E-mail:
| | - Hrvoje Vrcic
- Zagreb University Medical School, Obstetrics and Gynecology, Petrova 13, 10000 Zagreb, Croatia. Tel: +385-14-60-4646; Fax: +385-14-63-3512; E-mail:
| | - Dejan Ljiljak
- Clinical Hospital Centre ‘Sestre milosrd’, Department for Biology of Human Reproduction, Ob/Gyn Clinic, Vinogradska c. 29, 10000 Zagreb, Croatia. Tel: +385-378-7597; Fax: +385-13-76-8272; Mobile: +385-378-7125; E-mail:
| | - Michael Pelekanos
- Fertility Centre Aceso, 1, Pavlou Nirvana str., 3021 Limassol, Cyprus. Tel: +357-99-64-5333; Fax: +357-25-82-4477; Mobile +30-6944248433; E-mail:
| | - Karel Rezabek
- Medical Faculty, University Hopsital, CAR-Assisited Reproduction Centre, Gyn/Ob departement, Apolinarska 18, 12000 Prague, Czech Republic. Tel: +420-22-496-7479; Fax: +420-22-492-2545; Mobile: +420-724685276; E-mail:
| | - Jitka Markova
- Institute of Health Information and Statistics of the Czech Republic, Palackeho namesti 4, 12801 Prague, Czech Republic. Tel: +420-22-497-2832; Mobile: +420-72-182-7532; E-mail:
| | - Josephine Lemmen
- Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark. Tel: +45-35-450-934; Fax: +45-35-454-945; Mobile: +45-30285712; E-mail:
| | - Deniss Sõritsa
- Tartu University Hospital and Elitre Clinic, Tartu, Estonia. Tel: +372-740-9930; Fax: +372-740-9931; E-mail:
| | - Mika Gissler
- THL National Institute for Health and Welfare, PO Box 30, 00271 Helsinki, Finland. Tel: +385-29-524-7279; E-mail:
| | - Aila Tiitinen
- Helsinki University Central Hospital, Dept. of Ob/Gyn, Haartmaninkatu, 2, PO Box 140, 00029 HUS—Helsinki, Finland. Tel: + 358-50-427-1217; E-mail:
| | - Dominique Royere
- Agence de la Biomédecine, 1 Av du stade de France, 93212 Saint-Denis La Plaine Cedex, France.Tel.: +33-15-593-6555; Fax: +33-15-593-6561; E-mail:
| | - Andreas Tandler—Schneider
- Fertility Centre Berlin; Spandauer damm 130; 14050 Berlin; Germany. Tel: +49-30-23-320-8110; Fax: +49-30-23-320-8119; E-mail:
| | - Markus Kimmel
- D.I.R. Geschäftsstelle, Torstrasse 140, D-10119 Berlin, Germany. Tel: +49-303-980-0743; E-mail:
| | - Aris J Antsaklis
- Professor of Obstetrics and Gynecology, University of Athens, President Hellenic Authority of Assisted Human Reproduction. Tel: +30-694-429-9699; E-mail:
| | - Dimitris Loutradis
- Athens Medical School, 1st Department of OB/GYN, 62, Sirinon Street, 17561 P. Faliro, Athens, Greece. Tel: +30-19-83-3576; Fax: +30-19-88-3834; Mobile: +30-693-242-1747; E-mail:
| | - Janos Urbancsek
- Semmelweis University, 1st Dept. of Ob/Gyn, Baross utca 27, 1088 Budapest, Hungary. Tel: +36-12-66-0115; Fax: +36-12-66-0115; E-mail:
| | - G Kosztolanyi
- University of Pecs, Dept. of Medical Genetics and Child Development, Jozsef A.u.7., 7623 Pecs, Hungary. Tel: +36-72-53-5977; Fax: +36-72-53-5972; E-mail:
| | - Hilmar Bjorgvinsson
- Art Medica, Baejarlind 12, 201 Kopavogur, Iceland. Tel: +354-515-8100; Fax: +354-515-8103; E-mail:
| | - Edgar Mocanu
- Human Assisted Reproduction Ireland Rotunda Hospital, HARI Unit, Master’s House, Parnell Square, 1 Dublin, Ireland. Tel: +353-18-07-2732; Mobile: +353-86-81-8839; Fax: +353-18-72-7831; E-mail:
| | - Giulia Scaravelli
- Istituto Superiore di Sanità, Registro Nazionale della Procreazione Medicalmente Assistita, CNESPS, Viale Regina Elena, 299, 00161 Roma. Tel: +39-49-90-4050; Fax: +39-49-90-4324; E-mail:
| | - Roberto de Luca
- Istituto Superiore di Sanità, Registro Nazionale della Procreazione Medicalmente Assistita, CNESPS, Viale Regina Elena, 299, 00161 Roma. Tel: +39-064-990-4320; E-mail:
| | - Vyacheslav Lokshin
- The Urban Centre of Human Reproduction, Tole Be Street 99, 50012 Almaty, Kazakhstan. Tel: +7-727-234-3434; Fax: +7-727-264-6615; Mobile: +7-7017558209; E-mail:
| | - Valiyev Ravil
- The Scientific Centre for Obstetrics, Gynecology and Perinatology, Dostyk street 125, 050020 Almaty, Kazakhstan. Tel: +7-727-300-4530; Fax: +7-727-300-4529; Mobile: +7-7772258189; E-mail:
| | - Valeria Magomedova
- Jusu Arsti Private Clinic, Apuzes 14, 1046 Riga, Latvia. Tel: +371-67-87-0029; E-mail:
| | - Zivile Gudleviciene
- Baltic American Clinic, IVF Laboratory, Nemencines rd 54 A, 10103 Vilnius, Lithuania. Tel: + 370-52-34-2020; Mobile: +370-68682417; E-mail:
| | - Giedre Belo lopes
- Northway Medical Centre, S. Žukausko g. 19, Vilnius 08234, Lithuania. Tel: + 370-529-8290; E-mail:
| | - Zoranco Petanovski
- Re-medika Hospital; Jane dandaniski 87/1/4, 1000 Skopje, Macedonia. Tel: +389-23-07-3335; Mobile: +389-72443114; E-mail:
| | - Jean Calleja-Agius
- University of Malta, 12, Mon Nid, Gianni Faure Street, TXN2421 Tarxien, Malta. Tel: +356-21-69-3041; Mobile: +356-99-55-3653; E-mail:
| | - Josephine Xuereb
- Mater Dei Hospital Malta, Apt 1 Hampton Place, BKR 104 B’Kara, Malta. Tel: +356-99-99-2382; E-mail:
| | - Veaceslav Moshin
- Medical Director at Repromed Moldova, Centre of Mother @ Child protection, State Medical and Pharmaceutical University ‘N.Testemitanu’, Bd. Cuza Voda 29/1, Chisinau, Republic of Moldova. Tel: +373-22-26-3855; Mobile: +373-69724433; E-mail:
| | - Tatjana Motrenko Simic
- Medical Centre Cetinje, Human Reproduction Departement, Vuka Micunovica 4, 81310 Cetinje, Montenegro. Tel: +382-41-23-2690; Fax: +382-41-23-1212; Mobile: +382-69-05-2331; E-mail:
| | - Dragana Vukicevic
- Hospital ‘Danilo I’, Humana reprodukcija, Vuka Micunovica bb, 86000 Cetinje, Montenegro. Tel: +382-67-55-1371; E-mail:
| | - Liv Bente Romundstad
- St. Olavs Hospital, Postboks 3250 Sluppen, Olav Kyrres gt.17, 7006 Trondheim, Norway. Tel: +47-73-86-8000; Fax: +47-73-86-7602; Mobile: +47-90-55-0207; E-mail: ,
| | - Anna Janicka
- VitroLive, Kasprzaka 2 A, 71-074 Szczecin, Poland. Tel: +48-69-167-6305; E-mail:
| | - Carlos Calhaz-Jorge
- CNPMA, assembleia da Republica, Palacio de Sao Bento, 1249-068 Lisboa, Portugal. Tel: +351-21-391-9303; Fax: +351-21-391-7502; E-mail:
| | - Ana Rita Laranjeira
- CNPMA, Assembleia da Republica, Palaio de Sao Bento 1249-068 Lisboa, Portugal. Tel: +351-21-391-9303; Fax: +351-21-391-7502; E-mail:
| | - Ioana Rugescu
- Gen Secretary of AER Embryologist association and Representative for Human Reproduction Romanian Society. Tel: +40-74-450-0267; E-mail:
| | - Bogdan Doroftei
- Univ. of Medicine and Pharmacy Iasi; Teaching Hospital Obgyn ‘Cuza Voda’; Cuza Voda Str. 34; 700038 Iasi; Romania. Tel: + 40-23-221-3000/int. 176; Mobile: +40-744515297; E-mail: ;
| | - Vladislav Korsak
- International Centre for Reproductive Medicine, General Director, Liniya 11, Building 18B, Vasilievsky Island, 199034 St-Petersburg, Russia C.I.S. Tel: +7-812-328-2251; Fax: +7-812-327-1950; Mobile: +7-921-965-1977; E-mail:
| | - Nebosja Radunovic
- Institute for Obstetrics and Gynecology, Visegradska 26, 11000 Belgrade, Serbia. Tel: +38-111-361-5592; Fax: +38-111-361-5603; Mobile: +381-63200204; E-mail:
| | - Nada Tabs
- Klinika za ginekologiju i akuserstvo, Klinicki centar Vojvodine, Branimira Cosica 37, 21000 Novi Sad, Serbia. Mobile: +381-63508185; E-mail:
| | - Irma Virant-Klun
- University Medical Centre Ljubljana, Departement of Obstetrics and Gynecology, Slajmerjeva 3, 1000 Ljubljana, Slovenia. Tel: +386-1-522-6013; Fax: +386-1-431-4355; Mobile:+386-31625774; E-mail:
| | - Irene Cuevas Saiz
- Hospital General de Alicante, Infertility Dept., Av Pintor Baeza, 12, 03010 Valencia, Spain;. Tel: +34-96-197-2000; Fax: +34-91-799-4407; Mobile +34-677245650; E-mail:
| | - Fernando Prados Mondéjar
- Hospital de Madrid-Montepríncipe, HM Fertility Centre Monteprincipe, C/Montepríncipe 25, 28660 Boadilla del Monte, Spain. Tel: +34-91-708-9931; Mobile +34-646737237; E-mail:
| | - Christina Bergh
- Sahlgrenska University Hospital, Department of Obstetrics and Gynaecology, Bla Straket 6, 413 45 Göteborg, Sweden. Tel: +46-31-342-1000, +46-73-688-9325; Fax: +46-31-41-8717; Mobile +46-736889325; E-mail:
| | - Maya Weder
- Administration FIVNAT, Postfach 754, 3076 Worb, Switzerland. Tel: +41-031-819-7602; Fax + 41-031-819-8920; E-mail:
| | - Christian De Geyter
- University Women’s Hospital of Basel, Abteilungsleiter gyn. Endokrinologie und Reproduktionsmedizin, Spitalstrasse 21, 4031 Basel, Switzerland. Tel: +41-61-265-9315; Fax: + 41-61-265-9194; E-mail:
| | - Jesper M J Smeenk
- St Elisabeth Hospital Tilburg, Dept. of obstetrics and Gynaecology, Hilv, The Netherlands. Tel: +31-13-539-3108; Mobile: +31-622753853; E-mail:
| | - Mykola Gryshchenko
- IVF Clinic Implant Ltd, Academician V.I.Gryshchenko Clinic for Reproductive Medicine, 25 Karl Marx Str., 61000 Kharkiv, Ukraine. Tel: +380-57-12-4522; Fax: +380-57-70-507-0703; Mobile +380-57705070703; E-mail:
| | - Richard Baranowski
- Deputy Information Manager, Human Fertilization and Embryology Authority (HFEA), Finsbury Tower, 103-105 Bunhill Row, London EC1 Y 8HF, UK. Tel: +44-020-7539-3329; Fax: +44-020-7377-1871; E-mail:
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Yadav V, Bakolia P, Malhotra N, Mahey R, Singh N, Kriplani A. Comparison of Obstetric Outcomes of Pregnancies after Donor-Oocyte In vitro Fertilization and Self-Oocyte In vitro Fertilization: A Retrospective Cohort Study. J Hum Reprod Sci 2018; 11:370-375. [PMID: 30787523 PMCID: PMC6333036 DOI: 10.4103/jhrs.jhrs_115_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Aims: The aim of this study is to evaluate and compare multiple obstetric and perinatal outcomes between donor-oocyte in vitro fertilization (IVF) and self-oocyte IVF group. Settings and Design: This study was done in a tertiary care center with ART unit. This was a retrospective comparative cohort study. Materials and Methods: The present study comprised all women between 20 and 45 years who conceived from oocyte donation (n = 78) between December 1, 2010, and December 31, 2016, and compared with all women who underwent self-oocyte IVF (n = 112). The process involved controlled ovarian stimulation and retrieval of the donor oocytes, preparation of recipient endometrium, and pregnancy management. Obstetric and perinatal outcomes were compared. Statistical Analysis Used: Chi-square test was used for categorical variables. Analysis for confounding variables was performed using multivariable linear and logistic regression analysis. Results: Baseline characteristics between the two groups were comparable. Miscarriage, first-trimester bleeding, pregnancy-induced hypertension (PIH), and gestational diabetes mellitus were significantly higher in donor-oocyte IVF group compared to self-oocyte cycles (P = 0.001). Using multiple logistic regression analysis, age class adjusted PIH incidence was significantly higher in donor-oocyte group as compared to self-oocyte group (P = 0.010). There was no significant variation in perinatal outcomes between the donor- and self-oocyte IVF cycles (P > 0.05). Conclusion: Oocyte donation should be treated as an independent risk factor for PIH.
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Affiliation(s)
- Vikas Yadav
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Priyanka Bakolia
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Neena Malhotra
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Neeta Singh
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Alka Kriplani
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
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Yovich JL, Keane KN, Borude G, Dhaliwal SS, Hinchliffe PM. Finding a place for corifollitropin within the PIVET FSH dosing algorithms. Reprod Biomed Online 2018; 36:47-58. [DOI: 10.1016/j.rbmo.2017.09.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 09/26/2017] [Accepted: 09/29/2017] [Indexed: 10/18/2022]
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41
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Naredi N, Singh S, Lele P, Nagraj N. Severe ovarian hyperstimulation syndrome: Can we eliminate it through a multipronged approach? Med J Armed Forces India 2018; 74:44-50. [PMID: 29386731 PMCID: PMC5771764 DOI: 10.1016/j.mjafi.2017.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 04/24/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Prevention of severe Ovarian Hyperstimulation Syndrome (OHSS), a potentially fatal complication of controlled ovarian hyperstimulation has been the aim of all fertility experts. Various pharmacologic and non-pharmacologic interventions have been instituted but the results have been conflicting. These preventive strategies were administered in isolation or as a combination of few aiming to eliminate this iatrogenic sequel. This study aimed to eliminate severe OHSS by multipronged approach incorporating almost all preventive modalities available in patients at high risk for this dreadful complication. METHODS It was a prospective observational study wherein 112 high risk patients planned for IVF were studied. The multipronged approach was in the form administering calcium gluconate infusion, cabergoline, albumin infusion, GnRH antagonist in luteal phase in addition to elective cryopreservation of embryos. The primary outcome measure was incidence of severe OHSS in the study group and the rate of hospitalisation. The secondary outcome measure was the number of days required for complete recovery and resolution of signs and symptoms. RESULTS Out of the 112 high risk patients only one patient (1/112; 0.9%) developed severe OHSS with an overall incidence of 0.095% of severe OHSS in all the cycles. There was no biochemical or haematological derangement in any of the high risk patients. CONCLUSION Although this is the first study evaluating the multipronged approach in preventing the dreaded complication of severe OHSS, it does add to the knowledge that targeting the various pathophysiological pathways at different time frames will bring about prevention of OHSS but further randomised studies may reveal superiority of one intervention over the other.
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Affiliation(s)
- Nikita Naredi
- Classified Specialist (Obst & Gynae) & IVF Specialist, Assisted Reproductive Technology Centre, Command Hospital (Southern Command), Pune 411040, India
| | - S.K. Singh
- Classified Specialist (Obst & Gynae), Command Hospital (Southern Command), Pune 411040, India
| | - Prasad Lele
- Senior Advisor (Obst & Gynae) & IVF Specialist, Command Hospital (Eastern Command), Kolkata, India
| | - N. Nagraj
- Classified Specialist (Obst & Gynae) & IVF Specialist, Assisted Reproductive Technology Centre, Army Hospital (R&R), New Delhi 110 010, India
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Elective frozen-thawed embryo transfer (FET) in women at risk for ovarian hyperstimulation syndrome. Reprod Biol 2017; 18:46-52. [PMID: 29279182 DOI: 10.1016/j.repbio.2017.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 12/16/2017] [Accepted: 12/18/2017] [Indexed: 11/22/2022]
Abstract
Elective cryopreservation of cultured embryos has become a treatment option for women at risk for ovarian hyperstimulation syndrome (OHSS). The aim of our study was to investigate the outcome of elective cryopreservation and consecutive frozen-thawed embryo transfer (FET) in a large IVF clinic in Austria. A total of 6104 controlled ovarian hyperstimulation cycles (COH) were performed on 2998 patients including 200 patients (6.7%) who were undergoing elective cryopreservation and FET due to high risk of OHSS. We estimated the cumulative live birth rate using the Kaplan-Meier method and evaluated independent predictors for successful live births with a Cox model. A total of 270 frozen-thawed embryo transfers were performed on 200 patients with up to 4 transfers per patient. The first embryo transfer showed a live birth rate of 42.0%, the second transfer showed a cumulative rate of 58.5%. After a total of 4 FETs from the same COH cycle, a cumulative live birth rate of 61.0% per COH cycle could be achieved. Four cases of OHSS occurred amongst these patients (2.0%), all of them of moderate severity. Multivariate analysis identified maternal age, the use of assisted hatching and the number of embryos transferred at the blastocyst stage as independent predictors for cumulative live birth. Our study clearly suggests that elective FET is safe and shows excellent cumulative live birth rates. This concept can, therefore, be used to avoid the severe adverse events caused by COH and the inefficient use of cultured embryos.
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Hallak J. A call for more responsible use of Assisted Reproductive Technologies (ARTs) in male infertility: the hidden consequences of abuse, lack of andrological investigation and inaction. Transl Androl Urol 2017; 6:997-1004. [PMID: 29184804 PMCID: PMC5673814 DOI: 10.21037/tau.2017.08.03] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Jorge Hallak
- Androscience, Science and Innovation Center in Andrology and High-Complex Clinical and Andrology Laboratory, São Paulo, Brazil.,Department of Pathology, Reproductive Toxicology Unit, University of São Paulo Medical School, São Paulo, Brazil.,Division of Urology, Department of Surgery, Hospital das Clinicas, University of Sao Paulo Medical School, São Paulo, Brazil.,Institute for Advanced Studies, University of Sao Paulo (IEA-USP), São Paulo, Brazil
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Zhai J, Liu J, Zhao S, Zhao H, Chen ZJ, Du Y, Li W. Kisspeptin-10 inhibits OHSS by suppressing VEGF secretion. Reproduction 2017; 154:355-362. [DOI: 10.1530/rep-17-0268] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/08/2017] [Accepted: 07/04/2017] [Indexed: 11/08/2022]
Abstract
The aim of the present study was to elucidate the effects of kisspeptin-10 (Kp-10) on ovarian hyperstimulation syndrome (OHSS) and its related mechanism in OHSS rat models, human umbilical vein endothelial cells (HUVECs) and human luteinized granulosa cells. OHSS is a systemic disorder with high vascular permeability (VP) and ovarian enlargement. KISS1R (KISS1 receptor) is the specific receptor of kisspeptin. The kisspeptin/KISS1R system inhibits the expression of vascular endothelial growth factor (VEGF), which is the main regulator of VP. In our study, decreased expression of Kiss1r was observed in both ovaries and lung tissue of OHSS rats. Injection of exogenous Kp-10 inhibited the increase of VP and VEGF while promoting the expression of Kiss1r in both the ovarian and lung tissue of OHSS rats. Using HUVECs, we revealed that a high level of 17-β estradiol (E2), a feature of OHSS, suppressed the expression of KISS1R and increased VEGF and nitric oxide (NO) through estrogen receptors (ESR2). Furthermore, KISS1R mRNA also decreased in the luteinized human granulosa cells of high-risk OHSS patients, and was consistent with the results in rat models and HUVECs. In conclusion, Kp-10 prevents the increased VP of OHSS by the activation of KISS1R and the inhibition of VEGF.
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Saad AS, Mohamed KAA. Diosmin versus cabergoline for prevention of ovarian hyperstimulation syndrome. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2017. [DOI: 10.1016/j.mefs.2017.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Sabban H, Zakhari A, Patenaude V, Tulandi T, Abenhaim HA. Obstetrical and perinatal morbidity and mortality among in-vitro fertilization pregnancies: a population-based study. Arch Gynecol Obstet 2017; 296:107-113. [PMID: 28547098 DOI: 10.1007/s00404-017-4379-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 04/21/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare patient characteristics and obstetrical/neonatal outcomes of in-vitro fertilization (IVF) and spontaneously conceived pregnancies. METHODS Using the Nationwide Inpatient Sample, we conducted a retrospective cohort study from 2008 to 2011 comparing IVF conceptions to spontaneous ones. Patient characteristics were descriptively compared, and after adjusting for baseline characteristics with logistic regression, obstetrical/neonatal outcomes were also compared. RESULTS Among 3,315,764 pregnancies, 5773 (0.17%) were a result of IVF. These patients were more often older, wealthier, Caucasian, non-smokers, and more likely to carry a higher order pregnancy. IVF was strongly associated with pre-eclampsia (OR 1.48, 95% CI 1.32-1.62), gestational diabetes (OR 1.27, 95% CI 1.17-1.38), antepartum hemorrhage (OR 2.04, 95% CI 1.79-2.32), placenta previa (OR 3.14, 95% CI 2.71-3.64), pre-term premature rupture of membranes (OR 1.49, 95% CI 1.30-1.70), chorioamnionitis (OR 1.52, 1.29-1.79), and cesarean section (OR 1.60, 95% CI 1.51-1.70). There was a significantly increased risk of post-partum hemorrhage (OR 2.95, 95% CI 2.29-3.80) and hysterectomy (OR 1.73, 95% CI 1.12-2.69), as well as disseminated intravascular coagulopathy (OR 2.23, 95% CI 1.24-3.99), transfusion (OR 1.78, 95% CI 1.53-2.07), prolonged hospitalization (OR 1.96, 95% CI 1.80-2.14), intrauterine growth restriction (OR 1.81, 95% CI 1.63-2.02), and pre-term birth (OR 1.31, 95% CI 1.22-1.41). CONCLUSION IVF is still primarily used by only a subset of the population, and is associated with increased obstetrical and perinatal morbidity and mortality. These patients may benefit from more vigilant antenatal surveillance and delivery in a tertiary care center.
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Affiliation(s)
- Hussein Sabban
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Pav H, Room 325, 5790 Cote-Des-Neiges Road, Montreal, QC, H3S 1Y9, Canada
| | - Andrew Zakhari
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Pav H, Room 325, 5790 Cote-Des-Neiges Road, Montreal, QC, H3S 1Y9, Canada
| | - Valerie Patenaude
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada
| | - Togas Tulandi
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Pav H, Room 325, 5790 Cote-Des-Neiges Road, Montreal, QC, H3S 1Y9, Canada
| | - Haim A Abenhaim
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Pav H, Room 325, 5790 Cote-Des-Neiges Road, Montreal, QC, H3S 1Y9, Canada.
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada.
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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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Kim SJ, Yoon JH, Kim HK, Kang HC. Spontaneous ovarian hyperstimulation syndrome in a young female subject with a lingual thyroid and primary hypothyroidism. Korean J Intern Med 2017; 32:559-562. [PMID: 27510824 PMCID: PMC5432798 DOI: 10.3904/kjim.2015.372] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 03/29/2016] [Accepted: 05/15/2016] [Indexed: 12/16/2022] Open
Affiliation(s)
- Soo Jeong Kim
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Jee Hee Yoon
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Hee Kyung Kim
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
- Correspondence to Ho-Cheol Kang M.D. Department of Internal Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun 58128, Korea Tel: +82-61-379-7620 Fax: +82-61-379-7628 E-mail:
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Kol S, Fainaru O. GnRH Agonist Triggering of Ovulation Replacing hCG: A 30-Year-Old Revolution in IVF Practice Led by Rambam Health Care Campus. Rambam Maimonides Med J 2017; 8:RMMJ.10300. [PMID: 28467768 PMCID: PMC5415369 DOI: 10.5041/rmmj.10300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Final oocyte maturation is a crucial step in in vitro fertilization, traditionally achieved with a single bolus of human chorionic gonadotropin (hCG) given 36 hours before oocyte retrieval. This bolus exposes the patient to the risks of ovarian hyperstimulation syndrome (OHSS), particularly in the face of ovarian hyper-response to gonadotropins. Although multiple measures were developed to prevent OHSS, gonadotropin-releasing hormone (GnRH) agonist triggering is now globally recognized as the best approach to achieve this goal. The first report on the use of GnRH agonist as ovulation trigger in the context of OHSS prevention came from Rambam Health Care Campus, Haifa, Israel and appeared in 1988. This review details the events that culminated in worldwide acceptance of this measure and describes its benefit in the field of assisted reproductive technology.
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Affiliation(s)
- Shahar Kol
- IVF Unit, Rambam Health Care Campus, Haifa, Israel; and The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institution of Technology, Haifa, Israel
| | - Ofer Fainaru
- IVF Unit, Rambam Health Care Campus, Haifa, Israel; and The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institution of Technology, Haifa, Israel
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Jiang X, Deng CY, Sun ZY, Chen WL, Wang HB, Zhou YZ, Jin L. Pregnancy Outcomes of In Vitro Fertilization with or without Ovarian Hyperstimulation Syndrome: A Retrospective Cohort Study in Chinese Patients. Chin Med J (Engl) 2016; 128:3167-72. [PMID: 26612291 PMCID: PMC4794889 DOI: 10.4103/0366-6999.170280] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background: The effect of ovarian hyperstimulation syndrome (OHSS) on pregnancy outcomes of in vitro fertilization (IVF) patients is still ambiguous. This study aimed to analyze pregnancy outcomes of IVF with or without OHSS in Chinese patients. Methods: A retrospective cohort study was undertaken to compare pregnancy outcomes between 190 women with OHSS and 197 women without OHSS. We examined the rates of clinical pregnancy, multiple pregnancies, miscarriage, live birth, preterm delivery, preterm birth before 34 weeks’ gestation, cesarean delivery, low birth weight (LBW), and small-for-gestational age (SGA) between the two groups. Odds ratios (ORs) and 95% confidence intervals (CIs) of measure of clinical pregnancy were also analyzed. Results: The clinical pregnancy rate of OHSS patients was significantly higher than that of non-OHSS patients (91.8% vs. 43.5%, P < 0.001). After controlling for drug protocol and causes of infertility, the adjusted ORs of moderate OHSS and severe/critical OHSS for clinical pregnancy were 4.65 (95% CI, 1.86–11.61) and 5.83 (95% CI, 3.45–9.86), respectively. There were no significant differences in rates of multiple pregnancy (4.0% vs. 3.7%) and miscarriage (16.1% vs. 17.5%) between the two groups. With regard to ongoing clinical pregnancy, we also found no significant differences in the rates of live birth (82.1% vs. 78.8%), preterm delivery (20.9% vs. 17.5%), preterm birth before 34 weeks’ gestation (8.6% vs. 7.9%), cesarean delivery (84.9% vs. 66.3%), LBW (30.2% vs. 23.5%), and SGA (21.9% vs. 17.6%) between the two groups. Conclusion: OHSS, which occurs in the luteal phase or early pregnancy in IVF patients and represents abnormal transient hemodynamics, does not exert any obviously adverse effect on the subsequent pregnancy.
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Affiliation(s)
| | | | | | | | | | | | - Li Jin
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
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