1
|
Yakin K, Urman B, Balaban B. Dynamic view of assisted reproduction in Turkey from 1996 to 2020. Reprod Biomed Online 2021; 44:747-754. [DOI: 10.1016/j.rbmo.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 10/28/2021] [Accepted: 12/10/2021] [Indexed: 10/19/2022]
|
2
|
Hatirnaz E, Hatirnaz S, Kanat-Pektas M, Dokuzeylul Gungor N, Erol O, Kalyoncu S, Dahan MH. The impact of timing for estrogen supplementation in polycystic ovary syndrome patients undergoing primed in vitro maturation. J Obstet Gynaecol Res 2021; 47:2684-2691. [PMID: 34028123 DOI: 10.1111/jog.14858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/24/2021] [Accepted: 05/08/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aims to determine the effects of early and late onset estrogen supplementation on the immature oocyte retrieval, fertilization and clinical pregnancy rates in follicle stimulating hormone (FSH) and human chorionic hormone (hCG) primed in vitro maturation (IVM) cycles of the patients with polycystic ovary syndrome (PCOS). METHODS This is a retrospective analysis of 161 patients with PCOS who underwent FSH and hCG primed IVM. Group 1 included 120 patients who received early onset estrogen supplementation while group 2 consisted of 41 patients who had late onset estrogen supplementation in primed IVM cycles. Immature oocyte (germinal vesicle and/or metaphase I) retrieval and fertilization rates were the primary outcomes, whereas clinical pregnancy and live rates were the secondary outcomes. RESULTS Group 1 patients had significantly higher body mass index and more previous IVF attempts (p = 0.001 and p = 0.008, respectively). All of the retrieved oocytes from the PCOS patients were either germinal vesicle or metaphase I oocytes and there were no metaphase II oocytes among the retrieved oocytes. Both groups had statistically similar numbers of metaphase I and fertilized oocytes (p > 0.05 for both). However, group 1 patients had significantly lower number of germinal vesicle oocytes but significantly higher number of metaphase II oocytes (p = 0.001 for both). Both groups had statistically similar fertilization (85.0% vs 78.0%), clinical pregnancy (49.2% vs 43.9%) and live birth (37.5% vs 39.0%) rates (p > 0.05 for all). CONCLUSION Early onset estrogen supplementation appears to improve the quality of retrieved immature oocytes and contribute to the maturation of oocytes in stimulated IVM cycles.
Collapse
Affiliation(s)
- Ebru Hatirnaz
- In Vitro Fertilization Center, Department of Obstetrics and Gynecology, Medicana International Hospital, Samsun, Turkey
| | - Safak Hatirnaz
- In Vitro Fertilization Center, Department of Obstetrics and Gynecology, Medicana International Hospital, Samsun, Turkey
| | - Mine Kanat-Pektas
- Department of Obstetrics and Gynecology, School of Medicine, Kocatepe University, Afyonkarahisar, Turkey
| | - Nur Dokuzeylul Gungor
- In Vitro Fertilization Center, Department of Obstetrics and Gynecology, BAU MedicalparkGöztepe Hospital, Istanbul, Turkey
| | - Onur Erol
- Department of Obstetrics and Gynecology, Antalya Training and Research Hospital, Health Sciences University, Antalya, Turkey
| | - Senol Kalyoncu
- Department of Obstetrics and Gynecology, TOBB ETU Hospital, Ankara, Turkey
| | - Michael H Dahan
- McGill Fertility Center, Department of Obstetrics and Gynecology, McGill University, Montreal, Canada
| |
Collapse
|
3
|
Hatırnaz Ş, Kanat Pektaş M. Day 3 embryo transfer versus day 5 blastocyst transfers: A prospective randomized controlled trial. Turk J Obstet Gynecol 2017; 14:82-88. [PMID: 28913142 PMCID: PMC5558418 DOI: 10.4274/tjod.99076] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 03/16/2017] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE This study aimed to show whether transferring day 5 embryos resulted in higher implantation and pregnancy rates than transferring day 3 embryos in Turkish women undergoing an intracytoplasmic sperm injection (ICSI) cycle. MATERIALS AND METHODS A total of 190 women who had ICSI after retrieval of more than four oocytes on the day of fertilization check were randomly assigned to undergo embryo transfer either on day 3 or day 5. RESULTS Day 3 and day 5 transfers were statistically similar with respect to the age of woman (p=0.107), duration of infertility (p=0.528), cause of infertility (p=0.850), number of collected oocytes (p=0.119), number of metaphase II oocytes (p=0.178), number of fertilized oocytes (p=0.092), and number of transferred embryos (p=0.556). The number of grade 1 embryos was significantly higher in day 5 transfers than in day 3 transfers (p=0.001). Day 3 and day 5 embryo transfers had statistically similar implantation, clinical pregnancy, twinning, and live birth rates (p=0.779, p=0.771, p=0.183, and p=0.649, respectively). The live birth rates in singleton pregnancies conceived after day 3 and day 5 embryo transfers were statistically similar (p=0.594). CONCLUSION The efficacy of blastocyst transfer is not inferior to that of embryo transfer on cleavage stage. Performing blastocyst transfer may have benefits because it is associated with acceptable pregnancy rates and morphologic assessment on day 3 has limited predictive value for subsequent embryonic development.
Collapse
Affiliation(s)
- Şafak Hatırnaz
- Private Bilge Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Mine Kanat Pektaş
- Afyon Kocatepe University Faculty of Medicine, Department of Obstetrics and Gynecology, Afyon, Turkey
| |
Collapse
|
4
|
Hatırnaz S, Hatırnaz E, Dahan MH, Tan SL, Ozer A, Kanat-Pektas M, Ata B. Is elective single-embryo transfer a viable treatment policy in in vitro maturation cycles? Fertil Steril 2016; 106:1691-1695. [PMID: 27678036 DOI: 10.1016/j.fertnstert.2016.08.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/10/2016] [Accepted: 08/10/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the clinical outcome of single-embryo transfer (SET) with double-embryo transfer (DET) in in vitro maturation (IVM) cycles performed in patients with polycystic ovary syndrome (PCOS), and to determine which factors predict those outcomes. DESIGN A retrospective analysis. SETTING Private assisted reproduction center. PATIENT(S) One hundred and fifty-nine women with PCOS. INTERVENTION(S) In vitro maturation with elective SET or DET conducted between September 2007 and May 2014. MAIN OUTCOME MEASURE(S) Live-birth rates. RESULT(S) Single-embryo transfer was performed in 83 patients (52.2%), and DET was performed in 76 patients (47.7%). When compared with the patients who had DET, the patients who had SET were statistically significantly younger (32.4 ± 3.5 vs. 24.1 ± 4.2 years) and had a shorter infertility duration (9.2 ± 4.5 vs. 4.4 ± 2.1 years), fewer previous ART cycles (<2 prior attempts, 39.5% vs. 6%; ≥2 prior attempts, 60.5% vs. 0), fewer collected oocytes (15.1 ± 4.6 vs. 12.6 ± 3.8), fewer metaphase II oocytes (9.0 ± 4.1 vs. 5.7 ± 2.9), fewer fertilized oocytes (8.2 ± 3.7 vs. 3.6 ± 2.3), and a higher implantation rate (27% vs. 47%). The SET and DET groups had similar embryo quality and similar clinical pregnancy (44.6% vs. 44.7%) and live-birth rates (34.9% vs. 34.2%). Twin pregnancy rates were statistically significantly higher in the DET compared with the SET groups (9.2% vs. 2.4%). CONCLUSION(S) In vitro maturation is a successful assisted reproduction technique that can be an alternative to conventional in vitro fertilization in women presenting with PCOS-related infertility. Our observations suggest that SET is a feasible option to prevent multiple pregnancies while maintaining the live-birth rate.
Collapse
Affiliation(s)
- Safak Hatırnaz
- In Vitro Fertilization Center, Konak Hastanesi, İzmit, Kocaeli, Turkey
| | - Ebru Hatırnaz
- In Vitro Fertilization Center, Konak Hastanesi, İzmit, Kocaeli, Turkey
| | - Michael H Dahan
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada; OriginElle Reporductive and Womens' Health Center, Montreal, Quebec, Canada
| | - Seang Lin Tan
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada; OriginElle Reporductive and Womens' Health Center, Montreal, Quebec, Canada
| | - Alev Ozer
- Department of Obstetrics and Gynecology, Sutcu Imam University, Kahramanmaras, Turkey
| | - Mine Kanat-Pektas
- Department of Obstetrics and Gynecology, Afyon Kocatepe University Hospital, Afyon, Turkey
| | - Baris Ata
- Department of Obstetrics and Gynecology, School of Medicine, Koc University, Istanbul, Turkey.
| |
Collapse
|
5
|
Impact of single embryo transfer policy on perinatal outcomes in fresh and frozen cycles-analysis of the Japanese Assisted Reproduction Technology registry between 2007 and 2012. Fertil Steril 2015; 105:337-46.e3. [PMID: 26518122 DOI: 10.1016/j.fertnstert.2015.10.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 09/13/2015] [Accepted: 10/05/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate whether the introduction of single embryo transfer (SET) policy in Japan has improved perinatal outcomes. DESIGN A retrospective cohort study. SETTING Not applicable. PATIENT(S) A total of 140,718 live births and 510 stillbirths (after 22 weeks of gestation) conceived by assisted reproductive technology in Japan between 2007 and 2012 were reviewed. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Preterm birth (PTB), low birth weight (LBW), very low birth weight (VLBW), small for gestational age (SGA), large for gestational age (LGA), perinatal mortality, and other pregnancy complications. RESULT(S) The rate of SET increased significantly from 52.2% in 2007 to 82.6% in 2012, while the rate of multiple pregnancy decreased significantly from 10.7% to 4.1% over the same period. The rates of PTB, LBW, and SGA decreased significantly, while that of LGA increased. Perinatal mortality decreased from 0.70% to 0.40% in fresh cycles, while that of frozen cycles did not change. Double ET or more was associated with a significantly increased risk for multiple pregnancy, placenta accreta, preterm premature rupture of membrane, cesarean section (CS), PTB, LBW, SGA, and early neonatal death compared with SET. Compared with before the SET policy was launched, the risks of multiple pregnancy, CS, early PTB before 32 weeks, LBW, VLBW, and SGA were significantly decreased after the policy was launched, with significant interactions of fresh/frozen status. CONCLUSION(S) The results suggest that the SET policy improved perinatal outcomes in Japan. The impact of SET policy was different in fresh and frozen cycles for several perinatal outcomes.
Collapse
|
6
|
Kultursay N, Yalaz M, Koroglu OA. Neonatal outcome following new assisted reproductive technology regulations in Turkey – a nationwide multicenter point prevalence study. J Matern Fetal Neonatal Med 2014; 28:204-9. [DOI: 10.3109/14767058.2014.908844] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
7
|
Guven S, Kart C, Unsal MA, Yildirim O, Odaci E, Yulug E. Endometrial injury may increase the clinical pregnancy rate in normoresponders undergoing long agonist protocol ICSI cycles with single embryo transfer. Eur J Obstet Gynecol Reprod Biol 2014; 173:58-62. [DOI: 10.1016/j.ejogrb.2013.11.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 08/30/2013] [Accepted: 11/05/2013] [Indexed: 11/24/2022]
|
8
|
Kessler LM, Craig BM, Plosker SM, Reed DR, Quinn GP. Infertility evaluation and treatment among women in the United States. Fertil Steril 2013; 100:1025-32. [PMID: 23849845 DOI: 10.1016/j.fertnstert.2013.05.040] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 05/14/2013] [Accepted: 05/24/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To examine the characteristics of women seeking infertility evaluation and treatment. DESIGN Cross-sectional survey based on in-person interviews, followed by two-step hurdle analysis. SETTING Not applicable. PATIENT(S) 4,558 married or cohabitating women ages 25 to 44 years. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Likelihood of seeking a preliminary infertility evaluation and of seeking infertility treatment once evaluated, and the treatment type provided. RESULT(S) Of 623 women (13.7%) who reported seeking an infertility evaluation, 328 reported undergoing subsequent infertility treatment. Age at marriage, marital status, education, health insurance status, race/ethnicity, and religion were associated with the likelihood of seeking infertility evaluation. For example, the predicted probability that a non-white woman who married at age 25 will seek evaluation was 12%. This probability increased to 34% for white women with a graduate degree who had married at age 30. Among women who were evaluated, income, employment status, and ethnicity correlated strongly with the likelihood of seeking infertility treatment. Infertility drug therapy was the most frequent treatment used, and reproductive surgery and in vitro fertilization (IVF) were used the least often. CONCLUSION(S) The use of infertility services is not random. Understanding the sociodemographic factors correlated with use may assist new couples with family planning. Roughly 50% of the women evaluated for infertility progressed to treatment, and only a small proportion were treated with more advanced assisted reproductive technologies such as in vitro fertilization. Future research aimed at improving access to effective health-care treatments within the boundaries of affordability is warranted.
Collapse
Affiliation(s)
- Lawrence M Kessler
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, Florida; Department of Economics, College of Arts and Sciences, University of South Florida, Tampa, Florida.
| | | | | | | | | |
Collapse
|
9
|
Yilmaz N, Engin-Üstün Y, Inal H, Gorkem U, Bardakci Y, Gulerman C. The impact of single embryo transfer policy on pregnancy outcomes after legislative change. Gynecol Endocrinol 2013; 29:600-2. [PMID: 23656390 DOI: 10.3109/09513590.2013.788629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We evaluated the effect of mandatory single embryo transfer (SET) on live birth rates and pregnancy outcomes in Turkey. A retrospective study was conducted in Zekai Tahir Burak Women's Health Education and Research Hospital. Four hundred and four patients undergoing intracytoplasmic sperm injection (ICSI) cycles were included in the study. In Turkey, the number of embryos to be transferred in an assisted cycle was limited to three under normal circumstances until 6 March 2010. After that, new legislation was introduced to promote the application of SET. Outcomes were compared in periods of 1 year before and after the new law. We compared pregnancy outcomes of all assisted reproductive cycles in SET cycles (group 1: n = 281) with double embryo transfer (DET) cycles (group 2: n = 123). There were significant differences in oocyte number, multiple pregnancy, gestational age, birth weight and perinatal fetal morbidity between the groups (p = 0.023, 0.001, 0.001, 0.001, 0.001, respectively). But there were no differences in age, baseline FSH, infertility period, stimulation protocol, stimulation day, gonadotrophin dose, clinical pregnancy rate, abortion rate, live birth rate and cesarean rate (p > 0.05). These results suggest that under the new legislation multiple pregnancy rates and perinatal complications are significantly reduced without causing a significant decline in the pregnancy rates.
Collapse
Affiliation(s)
- Nafiye Yilmaz
- Zekai Tahir Burak Women's Health Education and Research Hospital, Reproductive Endocrinology Department, Ankara, Turkey.
| | | | | | | | | | | |
Collapse
|
10
|
Barrington KJ, Janvier A. The paediatric consequences of Assisted Reproductive Technologies, with special emphasis on multiple pregnancies. Acta Paediatr 2013; 102:340-8. [PMID: 23278110 DOI: 10.1111/apa.12145] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 12/06/2012] [Accepted: 12/19/2012] [Indexed: 01/07/2023]
Abstract
UNLABELLED Paediatricians will encounter many babies and children who are the result of assisted reproductive technologies. Although in most cases, there are no adverse health consequences, assisted reproductive technologies (ART) are associated with some risks that are reviewed in this article. CONCLUSION ART has had a major impact on multiple gestation and the incidence of prematurity in many countries. Among singletons, there are also increases in prematurity, small for gestational age, congenital anomalies and perinatal mortality.
Collapse
|