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Chen H, Cai J, Sun X, Liu L, Liu Z, Gao P, Jiang X, Ren J. Atosiban interacts with growth hormones as adjuvants in frozen-thawed embryo transfer cycles. Front Endocrinol (Lausanne) 2024; 15:1380778. [PMID: 38841302 PMCID: PMC11150816 DOI: 10.3389/fendo.2024.1380778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/06/2024] [Indexed: 06/07/2024] Open
Abstract
Objective To investigate the interaction between atosiban and growth hormone (GH) as adjuvants in frozen-thawed embryo transfer (FET) cycles. Method A total of 11627 patients who underwent FET at Xiamen University Affiliated Chenggong Hospital between January 2018 to December 2022 were retrospectively analyzed. Among them, 482 patients received atosiban and 275 patients received GH. The interactions were estimated by comparing the odds ratio (OR) for pregnancy comparing patients with or without atosiban adjuvant in cohorts stratified according to the presence of GH use in either the overall cohort or a propensity score (PS) matched cohort. An interaction term (atosiban × GH) was introduced to a multivariate model to calculate the ratio of OR (ORR) adjusted for confounders. Results For all patients receiving atosiban administration, no obvious effect on pregnancy was observed in comparison with either matched or unmatched controls. However, when the patients were stratified according to GH administration, atosiban showed a significant association with clinical pregnancy in comparison with either matched or unmatched controls among patients with GH treatment with rate ratios (RR) of 1.32 (95%CI: 1.05,1.67) and 1.35 (95%CI: 1,1.82), respectively. On the other hand, however, the association was absent among patients without GH treatment. The adjusted ORRs in both matched and unmatched cohorts were 2.44 (95%CI: 1.07,5.84) and 1.95 (95%CI: 1.05, 3.49) respectively. Conclusion The combination use of atosiban and GH in FET cycles is potentially beneficial to the pregnancy. However, indications for the use of atosiban and GH may need further assessment.
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Affiliation(s)
- Haixiao Chen
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Xiamen, Fujian, China
| | - Jiali Cai
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Xiamen, Fujian, China
- Medical College, Xiamen University, Xiamen, Fujian, China
| | - Xiaohua Sun
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Xiamen, Fujian, China
| | - Lanlan Liu
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Xiamen, Fujian, China
- Medical College, Xiamen University, Xiamen, Fujian, China
| | - Zhenfang Liu
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Xiamen, Fujian, China
| | - Peng Gao
- Medical College, Xiamen University, Xiamen, Fujian, China
- Quality Management Department, Xiamen University Affiliated Chenggong Hospital, Xiamen, Fujian, China
| | - Xiaoming Jiang
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Xiamen, Fujian, China
- Medical College, Xiamen University, Xiamen, Fujian, China
| | - Jianzhi Ren
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Xiamen, Fujian, China
- Medical College, Xiamen University, Xiamen, Fujian, China
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De la Torre Perez E, Carratalá-Munuera MC, Castillo-Farfán JC, Lledó-Bosch B, Moliner-Renau B, Bernabeu-García A, Bernabeu-Pérez R. Impact of endometrial compaction on reproductive outcomes after cryotransfer of euploid embryos in a modified natural cycle: protocol for a prospective cohort study. Front Endocrinol (Lausanne) 2023; 14:1285040. [PMID: 38027116 PMCID: PMC10666753 DOI: 10.3389/fendo.2023.1285040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Embryo implantation is a complex and poorly understood process. Most studies to date have focused on the analysis of the endometrium at the end of the estrogenic phase, while the available data on its importance after secretory transformation are limited and inconsistent. Current evidence does not allow for a conclusive interpretation of the changes observed in the pre-implantation endometrium, whether in the natural or replacement cycle, and their relevance in the development of a pregnancy or the implications for clinical practice. Methods Multicenter prospective observational cohort study. Based on our sample size calculation, the study group will consist of 206 women (exposed or "compaction" group: 103 women with a decrease of ≥ 5% in endometrial thickness between the estrogenic phase and the day of embryo transfer; non-exposed "non-compaction" group: 103 women with similar or greater endometrial thickness between these time points). The main objective of this study is to compare the ongoing pregnancy rates in natural cycles for euploid embryo transfer in patients who present endometrial compaction at the time of transfer versus those who with a stable or greater endometrial thickness with respect to the estrogenic phase. The estimated duration of the study is 30 months. Inclusion criteria are: 18 to 50 years of age, with primary or secondary infertility, subjected to endometrial preparation in a modified natural cycle for transfer of a genetically euploid blastocyst, from their own oocyte or oocyte donation, with a normal uterine cavity. Exclusion criteria are: uterine or endometrial disease (e.g., multiple myomatosis, severe adenomyosis, Asherman syndrome, refractory endometrium), conditions that prevent correct ultrasound assessment (tilted uterus), or a history of recurrent implantation failure or repeated miscarriages. Discussion The findings from this study will provide valuable insights into the potential influence of the "endometrial compaction" phenomenon on reproductive outcomes during natural cycle endometrial preparation. By examining this aspect, we aim to contribute to a better understanding of the factors that may impact successful outcomes in fertility treatments.
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Affiliation(s)
| | | | - Juan Carlos Castillo-Farfán
- Medical Department, Bernabeu Institute, Alicante, Spain
- University Chair of Community Medicine and Reproductive Health, Miguel Hernandez University of Elche, Alicante, Spain
| | | | | | - Andrea Bernabeu-García
- Medical Department, Bernabeu Institute, Alicante, Spain
- University Chair of Community Medicine and Reproductive Health, Miguel Hernandez University of Elche, Alicante, Spain
| | - Rafael Bernabeu-Pérez
- Medical Department, Bernabeu Institute, Alicante, Spain
- University Chair of Community Medicine and Reproductive Health, Miguel Hernandez University of Elche, Alicante, Spain
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Li Q, Deng X, Liu A, Shen H, Zhang X. Establishment of a prediction model for the impact of endometrial thickness on the day of embryo transfer on ectopic pregnancy in frozen-thawed embryo transfer cycle. Front Endocrinol (Lausanne) 2023; 14:1259608. [PMID: 38027161 PMCID: PMC10666774 DOI: 10.3389/fendo.2023.1259608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Objective This study aims to investigate the factors affecting the ectopic pregnancy (EP) rate in the frozen-thawed embryo transfer (FET) cycle. Methods This study retrospectively analyzed 5606 FET cycles, including 5496 cycles resulting in intrauterine pregnancy and 110 cycles resulting in EP. Smooth curve fitting and piece-wise linear regression were utilized to evaluate a non-linear association between endometrial thickness (EMT) and EP. Multiple logistic regression analysis was used to study the effect of EMT on the embryo transfer (ET) day and other indexes on EP rate after adjusting for confounding factors. A nomographic prediction model was employed to predict EP occurrence. The predictive efficacy of the model was assessed using the area under the receiver operating characteristic (ROC) curve (AUC), utilizing the bootstrap sampling method for internal validation. Results After accounting for the confounding factors, the segmented linear regression analysis indicated that the EMT inflection point was 9 mm; the EP rate significantly decreased by 28% with each additional millimeter of EMT up to 9 mm (odds ratio (OR) = 0.72; 95% confidence interval (CI), 0.53-0.99; P = 0.0412) while insignificantly decreased when the EMT was greater than 9 mm (OR = 0.91; 95% CI, 0.76-1.08; P = 0.2487). Multivariate logistic regression analysis revealed that after adjusting for confounders, EP risk significantly increased in the number of previous EPs ≥ 1 (OR = 2.29; 95% CI, 1.26-4.16; P = 0.0064) and tubal factor infertility (OR = 3.86; 95% CI, 2.06-7.24; P < 0.0001). Conversely, EP risk was significantly reduced by the increased EMT (OR = 0.84; 95% CI, 0.74-0.96; P = 0.0078) and the blastocyst transfer (OR = 0.45; 95% CI, 0.27-0.76; P = 0.0027). These variables were used as independent variables in a nomogram prediction model, resulting in an AUC of 0.685. The nomination models were internally verified using self-sampling (bootstrap sampling resampling times = 500). This validation yielded an AUC of 0.689, with a sensitivity of 0.6915 and a specificity of 0.5790. The internal validation indicated minimal fluctuations in the AUC, signifying a relatively stable model. Conclusion Undergoing EMT on the day of ET poses a separate EP risk in the FET cycle; to mitigate the EP incidence, the EMT should exceed 9 mm before ET. Furthermore, previous EPs and tubal factor infertility were additional factors independently increasing EP risk. Furthermore, implementing blastocyst transfer demonstrated that EP incidence was significantly reduced. Utilizing a nomogram predicting system enables EP risk evaluation before ET for individual patients, establishing a basis for devising clinical strategies for ET.
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Affiliation(s)
- Qiuyuan Li
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
- Reproductive Medicine Center, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Xiyuan Deng
- Gansu Province Prenatal Diagnosis Center, Key Laboratory of Prevention and Control of Birth Defects of Gansu Province, Gansu Provincial Maternity and Child-Care Hospital/Central Hospital of Gansu Province, Lanzhou, China
- Department of Obstetrics and Gynecology, the First Hospital of Lanzhou University, Key Laboratory of Gynecologic Oncology of Gansu Province, Lanzhou, China
| | - Ahui Liu
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
- Reproductive Medicine Center, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Haofei Shen
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
- Reproductive Medicine Center, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Xuehong Zhang
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
- Reproductive Medicine Center, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
- Key Laboratory for Reproductive Medicine and Embryo, Lanzhou, Gansu, China
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Bausyte R, Vaigauskaite - Mazeikiene B, Borutinskaite V, Valatkaite E, Besusparis J, Valkiuniene RB, Kazenaite E, Ramasauskaite D, Navakauskiene R. Human endometrium-derived mesenchymal stem/stromal cells application in endometrial-factor induced infertility. Front Cell Dev Biol 2023; 11:1227487. [PMID: 37731819 PMCID: PMC10507732 DOI: 10.3389/fcell.2023.1227487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/15/2023] [Indexed: 09/22/2023] Open
Abstract
Endometrial-factor induced infertility remains one of the most significant pathology among all fertility disorders. Stem cell-based therapy is considered to be the next-generation approach. However, there are still issues about successfully retrieving human endometrium-derived mesenchymal stem/stromal cells (hEnMSCs). Moreover, we need to establish a better understanding of the effect of hEnMSCs on the endometrial recovery and the clinical outcome. According to these challenges we created a multi-step study. Endometrium samples were collected from females undergoing assisted reproductive technology (ART) procedure due to couple infertility. These samples were obtained using an endometrium scratching. The hEnMSCs were isolated from endometrium samples and characterized with flow cytometry analysis. Groups of endometrium injured female mice were established by the mechanical injury to uterine horns and the intraperitoneal chemotherapy. The hEnMSCs suspension was injected to some of the studied female mice at approved time intervals. Histological changes of mice uterine horns were evaluated after Masson's trichrome original staining, hematoxylin and eosin (H&E) staining. The fertility assessment of mice was performed by counting formed embryo implantation sites (ISs). The expression of fibrosis related genes (Col1a1, Col3a1, Acta2, and CD44) was evaluated by the reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Results showed that endometrium scratching is an effective procedure for mesenchymal stem/stromal cells (MSCs) collection from human endometrium. Isolated hEnMSCs met the criteria for defining MSCs. Moreover, hEnMSCs-based therapy had a demonstrably positive effect on the repair of damaged uterine horns, including a reduction of fibrosis, intensity of inflammatory cells such as lymphocytes and polymorphonuclear cells (PMNs) and the number of apoptotic bodies. The injured mice which recieved hEnMSCs had higher fertility in comparison to the untreated mice. Gene expression was reflected in histology changes and outcomes of conception. In conclusion, hEnMSCs demonstrated a positive impact on endometrium restoration and outcomes of endometrial-factor induced infertility. Further exploration is required in order to continue exploring the multifactorial associations between stem cell therapy, gene expression, endometrial changes and reproductive health, so we can identify individually effective and safe treatment strategies for endometrial-factor induced infertility, which is caused by mechanical effect or chemotherapy, in daily clinical practise.
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Affiliation(s)
- Raminta Bausyte
- Life Sciences Center, Department of Molecular Cell Biology, Institute of Biochemistry, Vilnius University, Vilnius, Lithuania
- Center of Obstetrics and Gynaecology of Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Brigita Vaigauskaite - Mazeikiene
- Life Sciences Center, Department of Molecular Cell Biology, Institute of Biochemistry, Vilnius University, Vilnius, Lithuania
- Center of Obstetrics and Gynaecology of Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Veronika Borutinskaite
- Life Sciences Center, Department of Molecular Cell Biology, Institute of Biochemistry, Vilnius University, Vilnius, Lithuania
| | - Elvina Valatkaite
- Life Sciences Center, Department of Molecular Cell Biology, Institute of Biochemistry, Vilnius University, Vilnius, Lithuania
| | - Justinas Besusparis
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- National Center of Pathology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Ruta Barbora Valkiuniene
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- National Center of Pathology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Edita Kazenaite
- Faculty of Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius University, Vilnius, Lithuania
| | - Diana Ramasauskaite
- Center of Obstetrics and Gynaecology of Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ruta Navakauskiene
- Life Sciences Center, Department of Molecular Cell Biology, Institute of Biochemistry, Vilnius University, Vilnius, Lithuania
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Song L, Bu Z, Sun Y. Endometrial thickness and early pregnancy complications after frozen-thawed embryo transfers. Front Endocrinol (Lausanne) 2023; 14:1066922. [PMID: 37670886 PMCID: PMC10475533 DOI: 10.3389/fendo.2023.1066922] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 03/02/2023] [Indexed: 09/07/2023] Open
Abstract
Background The relationship between endometrial thickness and pregnancy safety after in vitro fertilization treatment is an important topic that should provoke attention. The aim of this study was to demonstrate the relationship between endometrial thickness on day of embryo transfer and early pregnancy complications, including ectopic pregnancy and early miscarriage, in frozen thawed embryo transfer (FET) cycles. Methods Patients undergoing their first FET cycles were included into this study from January 2010 to December 2021. Patients were divided into three groups according to endometrial thickness on day of embryo transfer: Thin, ≤ 7 mm; Medium, 7-14 mm; Thick, ≥ 14 mm. Ectopic pregnancy and early miscarriage were the two primary outcomes. Endometrial thickness was the main measured variable. The risk factors of these two compilations were determined based on univariate analysis and multivariate logistic regression analysis. Results A total of 11138 clinical pregnancies were included. The overall ectopic pregnancy and early spontaneous miscarriage rates were 2.62% and 13.40%. The ectopic pregnancy and early spontaneous miscarriage rates were significantly higher in patients with thin endometrium as compared with those in the other two groups (ectopic pregnancy rate: 5.06% vs. 2.62% vs. 1.05%; P < 0.001; early spontaneous miscarriage rate: 15.18% vs. 13.45% vs. 11.53%; P < 0.001). In multivariate logistic regression analysis, thin endometrium was an independent factor to predict ectopic pregnancy [adjusted odds ratio (aOR): 5.62; 95% confidence interval (CI): 2.51-12.58, P < 0.001], and to predict early spontaneous miscarriage rate (aOR: 1.57; 95% CI: 1.21-1.74, P < 0.001). Conclusion Thin endometrium on day of embryo transfer in FET cycles is an independent predictor for early pregnancy compilations, including ectopic pregnancy and early spontaneous miscarriage.
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Affiliation(s)
- Lin Song
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhiqin Bu
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingpu Sun
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Sun X, Cai J, Liu L, Chen H, Jiang X, Ren J. Uterine factors modify the association between embryo transfer depth and clinical pregnancy. Sci Rep 2022; 12:14269. [PMID: 35995967 PMCID: PMC9395418 DOI: 10.1038/s41598-022-18636-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 08/16/2022] [Indexed: 11/09/2022] Open
Abstract
The embryo transfer depth may affect the chance of pregnancy. However, embryo dislodging caused by uterine contraction may occur after the transfer. The aim of the retrospective study was to investigate whether the factors associated with uterine contractilities, such as endometrial thickness and progesterone elevation, affect the association between transfer depth and implantation. A total of 7849 fresh transfer cycles on conventional stimulation in a single in vitro fertilization (IVF) center during the period 2013–2015 was reviewed. Patients were categorized according to quartiles of embryo transfer depth (≤ 9 mm, n = 1735, 9.1–11 mm, n = 2557, 11.1–14 mm, n = 1933, ≥ 1.4 mm, n = 1624, respectively). Adjusted for confounding factors, the adjusted odds ratio (aOR) (95% confidence interval, CI) for clinical pregnancy was 0.90 (0.79–1.02), 0.86 (0.74–0.99), and 0.70 (0.60–0.82) respectively in quartiles 2 through 4, comparing with quartile 1. However, the aORs were significantly increased when the endometrial thickness was < 8 mm. In comparison with that in the cycles with a normal endometrial thickness (8–11 mm), the aORs comparing quartiles 2 through 4 with quartile 1 in the cycles with an endometrial thickness < 8 mm increased from 0.78 (95% CI 0.65–0.93), 0.79 (95% CI 0.65–0.97), and 0.64 (95% CI 0.51–0.81) to 1.73 (95% CI 1.21–2.47), 1.04 (95% CI 0.69–1.56), and 1.45 (95% CI 0.91–2.31), respectively. In the cycles with elevated progesterone and blastocyst stage transfer, the aORs comparing quartiles 4 with quartile 1 decreased from 0.73 (95% CI 0.62–0.87) and 0.74 (95% CI 0.63–0.87) to 0.58 (95% CI 0.40–0.84) and 0.42 (95% CI 0.25–0.73) than those in the cycles without. However, only blastocyst transfer showed a significant interaction with transfer depth (p = 0.043). Our data suggested that endometrial thickness and blastocyst transfer significantly affect the association between embryo transfer depth and clinical pregnancy.
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Affiliation(s)
- Xiaohua Sun
- The Affiliated Chenggong Hospital of Xiamen University, Xiamen, 361002, Fujian, China
| | - Jiali Cai
- The Affiliated Chenggong Hospital of Xiamen University, Xiamen, 361002, Fujian, China
| | - Lanlan Liu
- The Affiliated Chenggong Hospital of Xiamen University, Xiamen, 361002, Fujian, China
| | - Haixiao Chen
- The Affiliated Chenggong Hospital of Xiamen University, Xiamen, 361002, Fujian, China
| | - Xiaoming Jiang
- The Affiliated Chenggong Hospital of Xiamen University, Xiamen, 361002, Fujian, China
| | - Jianzhi Ren
- The Affiliated Chenggong Hospital of Xiamen University, Xiamen, 361002, Fujian, China.
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Eleftheriadou A, Francis A, Wilcox M, Jayaprakasan K. Frozen Blastocyst Embryo Transfer: Comparison of Protocols and Factors Influencing Outcome. J Clin Med 2022; 11:jcm11030737. [PMID: 35160185 PMCID: PMC8836366 DOI: 10.3390/jcm11030737] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/19/2021] [Accepted: 01/26/2022] [Indexed: 01/27/2023] Open
Abstract
Background: Various factors, including treatment protocols, can influence the outcomes of frozen embryo transfers (FETs). The study objectives were to compare different endometrial preparation protocols of FET cycles and to evaluate the factors, including the endometrial thickness (ET), that affect outcomes. Methods: This observational cohort study involved 5037 women undergoing FETs at eight tertiary clinics in the UK between January 2016 and March 2019. The endometrial preparation protocols used were natural cycle (NC-FETs), artificial hormone support cycle with oestradiol valerate but without pituitary downregulation (AC-FETs) and artificial hormone support cycle with agonist downregulation (ACDR-FETs). Results: The mean (±SD) ages across NC-FET, AC-FET and ACDR-FET groups were 36.5 (±4.2), 35.9 (±5.0) and 36.4(±4.9) years, respectively. LBRs were comparable (40.7%, 175/430; 36.8%, 986/2658; and 36.7%, 716/1949, respectively) across the three groups. Clinical pregnancy, implantation, multiple pregnancies, miscarriage and ectopic pregnancy rates were also similar. In the regression analysis of variables including age, duration of infertility, number of embryos transferred, protocol type and endometrial thickness, age was the only significant predictor of LBRs, although its predictive ability was poor (AUC: 0.55). With the overall LBR of the study population being 37.1%, the post-test probability of a live birth at an ET of <5 mm was 0%, and at 5–5.9, 6–6.9, 7–7.9 and 8–8.9 mm, the probabilities were 16.7%, 33.8%, 36.7% and 37.7%, respectively. The LBR remained above 35% up to the 14–14.9 mm range and then declined gradually to 23% for the 17–25 mm range. Conclusions: The FET outcomes were similar for the three protocols used for endometrial preparation. The protocol type and endometrial thickness were not predictive of FET outcomes; age was the only predictive variable, despite its low predictive ability.
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Affiliation(s)
| | | | - Mark Wilcox
- CARE Fertility, Nottingham NG8 6PZ, UK; (A.F.); (M.W.)
| | - Kanna Jayaprakasan
- School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK;
- CARE Fertility, Nottingham NG8 6PZ, UK; (A.F.); (M.W.)
- Correspondence:
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Zhao Y, Liu D, Liu N, Li Y, Yao Z, Tian F, Xu A, Li Y. An Endometrial Thickness < 8 mm Was Associated With a Significantly Increased Risk of EP After Freeze-Thaw Transfer: An Analysis of 5,960 Pregnancy Cycles. Front Endocrinol (Lausanne) 2022; 13:884553. [PMID: 35813636 PMCID: PMC9261458 DOI: 10.3389/fendo.2022.884553] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/11/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Endometrium characteristics that are most likely to induce ectopic pregnancy were investigated on the basis of the data of 5,960 pregnant freeze-thaw cycles. METHODS A total of 5,960 pregnancy cycles after freeze-thaw embryos transfer were included, with the number of intrauterine and ectopic pregnancies being 5,777 and 183, respectively. Ectopic pregnancy was the primary outcome. Endometrial thickness was the main measured variable. The risk factors of ectopic pregnancy were eventually determined based on univariate analysis and subsequent multiple-stepwise logistic regression analysis. RESULTS 1. After adjusting for confounders, endometrial thickness could independently predict ectopic pregnancy. The adjusted odd ratios for women with endometrial thickness in the ranges of < 8 mm, 8-9.9 mm, and 10-11.9 mm were 3.270 [95% confidence interval (CI), 1.113-9.605, P = 0.031], 2.758 (95% CI, 0.987-7.707, P = 0.053), and 1.456 (95% CI, 0.502-4.225, P = 0.489), respectively, when compared with those having an endometrial thickness of 12-13.9 mm. 2. Endometrial type and preparation protocol were however not identified as risk factors for ectopic pregnancy. DISCUSSION 1. After freeze-thaw embryo transfer, risks of ectopic pregnancy were significantly higher when the endometrial thickness was < 8 mm. 2. A thin endometrial thickness could be linked with abnormal endometrial peristaltic waves or abnormal endometrial receptivity. 3. Adequate attention should therefore be paid to patients with a thin endometrial thickness to prevent EP or to achieve early diagnosis during the peri-transplantation period.
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Affiliation(s)
- Ying Zhao
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Dong’e Liu
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Women’s Reproductive Health in Hunan Province, Hunan, China
| | - Nenghui Liu
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Women’s Reproductive Health in Hunan Province, Hunan, China
| | - Yumei Li
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Women’s Reproductive Health in Hunan Province, Hunan, China
| | - Zhongyuan Yao
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Women’s Reproductive Health in Hunan Province, Hunan, China
| | - Fen Tian
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Women’s Reproductive Health in Hunan Province, Hunan, China
| | - Aizhuang Xu
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Women’s Reproductive Health in Hunan Province, Hunan, China
- *Correspondence: Yanping Li, ; Aizhuang Xu,
| | - Yanping Li
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Women’s Reproductive Health in Hunan Province, Hunan, China
- *Correspondence: Yanping Li, ; Aizhuang Xu,
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Liu J, Kong H, Yu X, Zhou M, Liu X, Liu X, Zhang J, Liu Y, Wu S, Guan Y. The role of endometrial thickness in predicting ectopic pregnancy after in vitro fertilization and the establishment of a prediction model. Front Endocrinol (Lausanne) 2022; 13:895939. [PMID: 36157457 PMCID: PMC9493494 DOI: 10.3389/fendo.2022.895939] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To explore the risk factors of ectopic pregnancy after in vitro fertilization. METHODS This retrospective cohort study was conducted at the Reproductive Medical Center of the Third Affiliated Hospital of Zhengzhou University from January 2016 to April 2020. Univariate and multivariate analysis were used to analyze the related factors affecting the occurrence of ectopic pregnancy (EP) and to construct a nomographic prediction model for the incidence of ectopic pregnancy. RESULTS A total of 12,766 cycles of 10109 patients were included, comprising 214 cases of EP and 12,552 cases of intrauterine pregnancy (IUP). Multivariate logistic regression analysis showed that the tubal factor was associated with a 2-fold increased risk for EP (aOR = 2.72, 95% CI: 1.69-4.39, P < 0.0001). A stratified analysis showed that women with an endometrial thickness (EMT) between 7.6 to 12.1mm (aOR = 0.57, 95%CI: 0.36-0.90, P = 0.0153) and >12.1mm (aOR = 0.42, 95%CI: 0.24-0.74, P = 0.0026) had a significant reduction of the risk of EP compared to women with an EMT of <7.6mm. Compared to cleavage stage transfer, blastocyst transfer can reduce the risk of ectopic pregnancy (aOR = 0.36, 95%CI: 0.26-0.50, P < 0.0001). The saturation model (full mode) establishes a nomographic prediction model with an AUC = 0.68 and a sensitivity and specificity of 0.67and 0.64, respectively. The nomination model was internally verified by self-sampling method (bootstrap sampling resampling times = 500). The resulting AUC = 0.68 (sensitivity: 0.65; specificity: 0.65) showed that the model was relatively stable. CONCLUSIONS Our findings indicate that EMT is inversely proportional to the risk of EP. Embryo stage, number of embryos transferred were also significantly associated with EP rate. A simple nomogram for the predicting the risk of EP was established in order to reduce the occurrence of EP.
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Affiliation(s)
- Jing Liu
- Reproductive Medicine Center, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongjiao Kong
- National Health Commission Key Laboratory of Birth Defects Prevention, Henan Institute of Reproduction Health Science and Technology, Zhengzhou, China
| | - Xiaona Yu
- Reproductive Medicine Center, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengge Zhou
- Reproductive Medicine Center, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoyang Liu
- Reproductive Medicine Center, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinmi Liu
- Reproductive Medicine Center, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianrui Zhang
- Reproductive Medicine Center, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanli Liu
- Reproductive Medicine Center, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shanshan Wu
- Reproductive Medicine Center, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yichun Guan
- Reproductive Medicine Center, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Yichun Guan,
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Liao S, Wang R, Hu C, Pan W, Pan W, Yu D, Jin L. Analysis of endometrial thickness patterns and pregnancy outcomes considering 12,991 fresh IVF cycles. BMC Med Inform Decis Mak 2021; 21:176. [PMID: 34082727 PMCID: PMC8173785 DOI: 10.1186/s12911-021-01538-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 05/23/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Different endometrial patterns have an important effect on the relationship between endometrial thickness (EMT) and clinical pregnancy rate. There is a significant difference in age, selection of cycle protocols, and clinical pregnancy rates among four groups with diverse endometrial patterns. METHODS This retrospective study aimed to assess the association between EMT on human chorionic gonadotropin (HCG) administration day and the clinical outcome of fresh in vitro fertilization (IVF). The 5th, 50th, and 95th percentiles for EMT were determined as 8, 11, and 14 mm, respectively. Patients were sub-divided into four groups based on their EMT in different endometrial patterns (Group 1: < 8 mm; Group 2: ≥ 8 and ≤ 11 mm; Group 3: > 11 and ≤ 14 mm; Group 4: > 14 mm). We divided patients into three groups based on their endometrial pattern and evaluated the correlation between EMT and clinical pregnancy rate. RESULTS We found a positive correlation between pregnancy rates and EMT in all endometrial patterns. Multiple logistic regression analysis proved age, duration of infertility, cycle protocols, number of embryos transferred, progesterone on HCG day, endometrial patterns, and EMT have significant effects on clinical pregnancy rates. Meanwhile, there was a significant difference in age, selection of cycle protocols, and clinical pregnancy rates among four groups with diverse endometrial patterns. CONCLUSIONS Different endometrial patterns have an important effect on the relationship between EMT and clinical pregnancy rate.
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Affiliation(s)
- ShuJie Liao
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Renjie Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Cheng Hu
- School of Economic and Management, Wuhan University, Wuhan, 430072, People's Republic of China
| | - Wulin Pan
- School of Economic and Management, Wuhan University, Wuhan, 430072, People's Republic of China
| | - Wei Pan
- School of Applied Economics, Renmin University of China, Beijing, 100872, People's Republic of China.
| | - Dongyang Yu
- School of Economic and Management, Wuhan University, Wuhan, 430072, People's Republic of China.
| | - Lei Jin
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China.
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The effect of endometrial thickness on live birth outcomes in women undergoing hormone-replaced frozen embryo transfer. F S Rep 2021; 2:150-155. [PMID: 34278346 PMCID: PMC8267379 DOI: 10.1016/j.xfre.2021.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 01/18/2023] Open
Abstract
Objective To determine the impact of endometrial thickness on live birth outcomes and obstetric complication rate after hormone-replaced frozen embryo transfer. Design Retrospective cohort study. Setting Large, urban, academic fertility center. Patients All patients with a singleton live birth after single euploid embryo transfer (by array comparative genomic hybridization or next-generation sequencing) in a hormone-replaced frozen embryo transfer cycle between January 2017 and December 2018 were reviewed. Interventions None. Main Outcome measures The primary outcomes were birth weight and obstetric complication rate. Results A total of 492 patients were included. The median endometrial thickness was 8.60 mm (range, 6.0-20.0). The median gestational age at live birth was 39.4 weeks with a median birth weight of 3,345.2 g. Endometrial thickness was significantly correlated with birth weight. When patients were dichotomized into groups (those with an endometrial thickness of <7 mm and those with an endometrial thickness of >7 mm), neonates born from endometria with a thickness of <7 mm were born earlier (37.3 vs. 39.4 weeks and born with lower birth weights (2,749.9 vs. 3,345.2 g). It should be noted that only seven patients had an endometrium measuring <7 mm. Moreover, 7.1% (n = 35) of patients had an obstetric complication. Endometrial thickness was not significantly associated with obstetric complications, even with adjustments for age and medical history. Conclusions Endometrial thickness may be a valuable predictor of placental health and birth weight. Further study is required to examine the relationship with individual obstetric complications, as our study may not have been powered to observe differences in obstetric complication rate, as well as the relationship between endometrial thickness and outcomes in natural frozen embryo transfer cycles.
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12
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Ruderman RS, McQueen DB, Robins JC, Barnhart KT, Maisenbacher MK, Feinberg EC. Novel ploidy analysis in ectopic pregnancy. F S Rep 2020; 2:67-71. [PMID: 34223275 PMCID: PMC8244258 DOI: 10.1016/j.xfre.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/24/2020] [Accepted: 11/11/2020] [Indexed: 11/17/2022] Open
Abstract
Objective To study whether a single-nucleotide polymorphism (SNP) array could be used to test tissue from ectopic pregnancy to distinguish whether ectopic pregnancies were aneuploid. Design Case series report. Setting Academic medical center. Patients One hundred seventy-eight women who underwent surgery for ectopic pregnancy at Northwestern Memorial Hospital between 2015 and 2018 were eligible for participation; written consent was obtained from 33 patients. Eight subjects had sufficient DNA samples and were included in the analysis. Maternal and paternal DNA samples were self-collected by buccal swab. Archived paraffin tissue containing chorionic villi from each surgically removed ectopic specimen was analyzed using SNP microarray technology to determine chromosome number and evaluate for maternal cell contamination. Interventions None. Main Outcome Measures Prevalence of aneuploidy in ectopic pregnancy specimens as well as success of SNP array technology in formalin-fixed and paraffin-embedded specimens. Results Subjects had a mean (±SD) age of 33.4 ± 5.4 years, body mass index of 23.4 ± 5.7 kg/m2, 3.3 ± 1.8 prior pregnancies, and 1.5 ± 1.4 live births. Genetic testing revealed that all eight tested samples were euploid, 6 female and 2 male (two arr(1-22)x2, (X,Y)x1 and 6 arr(1-22, X)x2); maternal cell contamination was ruled out in all cases. Conclusions This study showed proof of concept for the use of routinely stored formalin-fixed, paraffin-embedded tissue blocks with DNA extraction for SNP array to detect ploidy status of ectopic pregnancy. Although all tested samples were euploid, further research is needed to gain a definitive answer to this question and better understand the mechanism that leads to ectopic implantation.
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Affiliation(s)
- Rachel S Ruderman
- Division of Reproductive Endocrinology and Infertility, Northwestern University, Chicago, Illinois
| | - Dana B McQueen
- Division of Reproductive Endocrinology and Infertility, Northwestern University, Chicago, Illinois
| | - Jared C Robins
- Division of Reproductive Endocrinology and Infertility, Northwestern University, Chicago, Illinois
| | - Kurt T Barnhart
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Eve C Feinberg
- Division of Reproductive Endocrinology and Infertility, Northwestern University, Chicago, Illinois
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Chen S, Zhu F, Zhang Y, Li J, Gao J, Deng G. A Model to Predict Treatment Failure of Single‑Dose Methotrexate in Patients with Tubal Pregnancy. Med Sci Monit 2020; 26:e920079. [PMID: 32383438 PMCID: PMC7236588 DOI: 10.12659/msm.920079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background In China, approximately 15% of tubal pregnancy patients treated with MTX eventually required surgery because the ectopic mass was ruptured; therefore, it is essential to develop a model to predict the risk of failure with methotrexate treatment in tubal pregnancy. Material/Methods In this research, 168 patients met the eligibility criteria, and 29 candidate risk factors for treatment failure were collected. Multivariable logistic regression analysis was used to analyze the factors, and a full model was developed. We used a multiple fractional polynomial model and a stepwise model to increase the reliability. Bootstrap resampling for 500 times was used to internally test the prediction model. The integral performance of the model depends on the evaluation of the nomogram, the discriminative performance by receiver operating characteristic (ROC) curve analysis, and calibration. Results The model showed excellent discrimination and calibration. The area under the ROC curve for the prediction model, mfp model, and stepwise model were 0.879 (95% CI: 0.812–0.942), 0.872 (95% CI: 0.805–0.931), and 0.880 (95% CI: 0.817–0.949), respectively. At a cutoff value of ≥0.40, sensitivity was 60%, specificity was 91%, positive predictive value (PPV) was 81%, and negative predictive value (NPV) was 77%. The model provides a net benefit when clinical decision thresholds are between 0% and 40% of predicted risk. Conclusion This model indicated good accuracy in predicting methotrexate treatment failure for tubal pregnancy patients.
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Affiliation(s)
- Si Chen
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China (mainland)
| | - Fangfang Zhu
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China (mainland)
| | - Yingxuan Zhang
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China (mainland)
| | - Jing Li
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China (mainland)
| | - Jie Gao
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China (mainland)
| | - Gaopi Deng
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China (mainland)
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Kim SW, Kim YJ, Shin JH, Kim H, Ku SY, Suh CS, Kim SH, Choi YM. Correlation between Ovarian Reserve and Incidence of Ectopic Pregnancy after In Vitro Fertilization and Embryo Transfer. Yonsei Med J 2019; 60:285-290. [PMID: 30799591 PMCID: PMC6391525 DOI: 10.3349/ymj.2019.60.3.285] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/27/2018] [Accepted: 11/19/2018] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To elucidate the correlation between ovarian reserve and the incidence of ectopic pregnancy (EP) following in vitro fertilization and embryo transfer (IVF/ET) cycles. MATERIALS AND METHODS In this observational study, 430 fresh IVF/ET cycles were examined from patient data of two university hospital infertility clinics. All included patients were positive for β-human chorionic gonadotropin (hCG) at 2 weeks after oocyte retrieval via controlled ovarian stimulation. For each cycle, information on age, duration of infertility, basal follicle stimulating hormone (FSH), anti-Müllerian hormone (AMH), days of ovarian stimulation, numbers of retrieved oocytes and transferred embryos, and pregnancy outcomes was collected. Patients with AMH lower than 1.0 ng/dL or basal FSH higher than 10 mIU/mL were classified into the decreased ovarian reserve (DOR) group, and the remaining patients were classified into the normal ovarian reserve (NOR) group. RESULTS In total, 355 cycles showed NOR, and 75 cycles DOR. There were no significant differences between the DOR and NOR groups regarding intrauterine (74.7% vs. 83.4%, respectively) or chemical (14.7% vs. 14.1%, respectively) pregnancies. The DOR group had a higher EP than that of NOR group [10.7% (8/75) vs. 2.5% (9/355), p=0.004]. In both univariate [odds ratio (OR) 5.6, 95% confidence interval (CI) 1.4-9.6, p=0.011] and multivariate (adjusted OR 5.1, 95 % CI 1.1-18.7, p=0.012) analysis, DOR was associated with a higher risk of EP. CONCLUSION DOR may be associated with a higher risk of EP in IVF/ET cycles with controlled ovarian stimulation. More careful monitoring may be necessary for pregnant women with DOR.
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Affiliation(s)
- Sung Woo Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Jin Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Jung Ho Shin
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Hoon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Yup Ku
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
| | - Chang Suk Suh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Young Min Choi
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Ishiguro T, Yamawaki K, Chihara M, Nishikawa N, Enomoto T. Myomectomy scar ectopic pregnancy following a cryopreserved embryo transfer. Reprod Med Biol 2018; 17:509-513. [PMID: 30377408 PMCID: PMC6194266 DOI: 10.1002/rmb2.12212] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/21/2018] [Indexed: 12/18/2022] Open
Abstract
CASE A 40 year old woman with a history of a myomectomy visited the Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan, following 2 years of infertility. Magnetic resonance imaging detected an abnormal endometrial-like pseudo-cavity. A hysterosalpingography also revealed an abnormal accumulation of contrast medium at the myometrial scar site. A transvaginal ultrasound showed a thin myometrium at the lower uterine body. The patient conceived via in vitro fertilization under a luteal phase down-regulation protocol (long protocol) for controlled ovarian stimulation, followed by a cryopreserved embryo transfer during her natural ovulation cycle. After the embryo transfer, the gestational sac was located at the subserosal site of the myomectomy scar. OUTCOME An emergent laparoscopic operation was performed and the embryo was removed successfully via laparoscopy under transvaginal ultrasonography. CONCLUSION A subserosal uterine pregnancy is a rare form of intramural pregnancy, which is a rare subtype of an ectopic pregnancy, which could occur at the myomectomy site, especially after an embryo transfer. It is believed that this rare ectopic pregnancy resulted from embryo implantation under the serosa through a micro-sinus tract that was a site of suture failure of the myomectomy scar and was partially affected by the embryo transfer. Clinicians should consider the possibility of an ectopic pregnancy after uterine surgery, including a myomectomy.
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Affiliation(s)
- Tatsuya Ishiguro
- Department of Obstetrics and GynecologyNiigata University Medical and Dental HospitalNiigataJapan
| | - Kaoru Yamawaki
- Department of Obstetrics and GynecologyNiigata University Medical and Dental HospitalNiigataJapan
| | - Makoto Chihara
- Department of Obstetrics and GynecologyNiigata University Medical and Dental HospitalNiigataJapan
| | - Nobumichi Nishikawa
- Department of Obstetrics and GynecologyNiigata University Medical and Dental HospitalNiigataJapan
| | - Takayuki Enomoto
- Department of Obstetrics and GynecologyNiigata University Medical and Dental HospitalNiigataJapan
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Nicolaus K, Jimenez-Cruz J, Bräuer DM, Lehmann T, Mothes AR, Runnebaum IB. Endometriosis and Beta-hCG > 775 IU/l Increase the Risk of Non-tube-preserving Surgery for Tubal Pregnancy. Geburtshilfe Frauenheilkd 2018; 78:690-696. [PMID: 30057425 PMCID: PMC6059851 DOI: 10.1055/a-0635-8453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/23/2018] [Accepted: 05/28/2018] [Indexed: 11/28/2022] Open
Abstract
Introduction
Tubal pregnancy is the most clinically relevant form of ectopic pregnancy. Surgery consisting of laparoscopic salpingotomy is the therapeutic gold standard. This study looked at risk factors for non-tube-preserving surgery. The aim was to determine a cut-off value for beta-hCG levels, which could be used to predict the extent of tubal surgery.
Materials and Method
97 patients with tubal pregnancy who underwent primary salpingotomy in the Department of Gynecology and Obstetrics of Jena University Hospital between 2010 and 2016 were retrospectively analyzed. A prior medical history of risk factors such as adnexitis, ectopic pregnancy, tubal surgery, treatment for infertility and intrauterine pessary was included in the analysis. The study population was divided into two subgroups: (1) a group which underwent laparoscopic linear salpingotomy, and (2) a group which had laparoscopic partial tubal resection or salpingectomy. Risk factors for salpingectomy were determined using binary logistic regression analysis. Statistical analysis was done using SPSS, version 24.0, to identify risk factors for non-tube-preserving surgery.
Results
68 patients (70.1%) underwent laparoscopic salpingotomy and 29 patients (29.9%) had laparoscopic salpingectomy. The two groups differed with regard to age (p = 0.01) but not with regard to the parameters ‘gestational age’, ‘viability and rupture status of the ectopic pregnancy’ or ‘symptoms at presentation’. Patients who were known to have endometriosis prior to surgery or who were diagnosed with endometriosis intraoperatively were more likely to undergo salpingectomy (OR: 3.28; 95% CI: 0.9 – 10.8; p = 0.05). Calculated mean beta-hCG levels were higher in the salpingectomy group compared to the group who had tube-preserving salpingotomy (3277.8 IU/l vs. 9338.3 IU/l, p = 0.01). A cut-off beta-hCG value of 775 IU/l prior to surgery was predictive for salpingectomy with a true positive rate of 86.2% and increased the probability that salpingectomy would be necessary (OR: 5.23; 95% CI: 0.229 – 0.471; p = 0.005).
Conclusion
Endometriosis and a beta-hCG value of more than 775 IU/l significantly increased the risk for non-tube-preserving surgery in women with tubal pregnancy.
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Affiliation(s)
- Kristin Nicolaus
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Jena, Germany
| | - Jorge Jimenez-Cruz
- Abteilung für Geburtshilfe und Pränatalmedizin, Universitatsklinikum Bonn, Bonn, Germany
| | - Dominik Michael Bräuer
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Jena, Germany
| | - Thomas Lehmann
- Institut für Medizinische Statistik, Informatik und Dokumentation, Universitätsklinikum Jena, Jena, Germany
| | - Anke Regina Mothes
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Jena, Germany
| | - Ingo B Runnebaum
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Jena, Germany
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Li C, Zhang HY, Liang Y, Xia W, Zhu Q, Zhang D, Huang Z, Liang GL, Xue RH, Qi H, He XQ, Yuan JJ, Tan YJ, Huang HF, Zhang J. Effects of Levonorgestrel and progesterone on Oviductal physiology in mammals. Reprod Biol Endocrinol 2018; 16:59. [PMID: 29925391 PMCID: PMC6011509 DOI: 10.1186/s12958-018-0377-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Our previous study indicated that emergency contraception, including levonorgestrel and progesterone, could lead to ectopic pregnancy following contraception failure. However, our understanding of the effects of levonorgestrel and progesterone on oviductal physiology is limited. METHODS The receptivity of the fallopian tubal epithelium after levonorgestrel and progesterone treatment was examined through western blots for receptivity markers and JAr-spheroid-fallopian tubal epithelial cell attachment assays. The ciliary beat frequency was analyzed using an inverted bright-field microscope. Furthermore, an in vivo animal model of embryo-tubal transplantation was also studied to determine the effects of levonorgestrel- and progesterone-induced ciliary beat reduction. RESULTS Our results showed that levonorgestrel and progesterone did not change the levels of fallopian tubal epithelial cell receptive markers, including LIF, STAT3, IGFBP1, ITGB3, MUC1, and ACVR1B, or affect JAr-spheroid implantation. However, levonorgestrel and progesterone reduced the ciliary beat frequency in fallopian tubes in a dose-dependent manner. An in vivo model also showed that levonorgestrel and progesterone could lead to embryo retention in the oviducts. CONCLUSIONS These findings show that levonorgestrel and progesterone can reduce the ciliary beat frequency without altering receptivity, indicating a possible mechanism for progesterone- or levonorgestrel-induced tubal pregnancy.
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Affiliation(s)
- Cheng Li
- Department of Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Embryo-Fetal Original Adult Disease Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Center of Reproductive Medicine, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, No. 910, Hengshan Rd, Shanghai, 200030, China
| | - Hui-Yu Zhang
- Department of Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Liang
- Department of Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Xia
- Department of Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qian Zhu
- Department of Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Duo Zhang
- Department of Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhen Huang
- Department of Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Embryo-Fetal Original Adult Disease Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Gui-Lin Liang
- Department of Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Rui-Hong Xue
- Institute of Embryo-Fetal Original Adult Disease Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Center of Reproductive Medicine, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, No. 910, Hengshan Rd, Shanghai, 200030, China
| | - Hang Qi
- Department of Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiao-Qing He
- Department of Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiang-Jing Yuan
- Department of Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ya-Jing Tan
- Institute of Embryo-Fetal Original Adult Disease Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Center of Reproductive Medicine, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, No. 910, Hengshan Rd, Shanghai, 200030, China
| | - He-Feng Huang
- Institute of Embryo-Fetal Original Adult Disease Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
- Center of Reproductive Medicine, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, No. 910, Hengshan Rd, Shanghai, 200030, China.
| | - Jian Zhang
- Department of Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
- Institute of Embryo-Fetal Original Adult Disease Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Yanaihara A, Ohgi S, Motomura K, Hagiwara Y, Mogami T, Saito K, Yanaihara T. An abdominal ectopic pregnancy following a frozen-thawed ART cycle: a case report and review of the literature. BMC Pregnancy Childbirth 2017; 17:108. [PMID: 28388882 PMCID: PMC5383944 DOI: 10.1186/s12884-017-1294-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 03/24/2017] [Indexed: 11/10/2022] Open
Abstract
Background Ectopic pregnancy (EP) occurs in 1% of pregnancies and is reported to be more common in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) pregnancies. An abdominal ectopic pregnancy (AEP) is a rare form of EP, and there are few reports of an AEP after IVF/ICSI. In this case report, a rare case of AEP after frozen-thawed cycle of ICSI is presented. Case presentation After a frozen-thawed cycle of ICSI, the beta-human chorionic gonadotropin (HCG) level at 4 weeks 0 days of gestation was 3.4 IU/L. Subsequent dysfunctional uterine bleeding was mistaken for menstruation; however, an AEP of 9 weeks with a fetal heart beat was observed by ultrasound. After the AEP was observed by ultrasound, it was extracted laparoscopically. Conclusion A rare case of an AEP, which developed after frozen-thawed cycle of ICSI, presented with a very low serum HCG level. Even if the HCG titer is low, follow-up HCG levels and frequent medical examinations are necessary.
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Affiliation(s)
- Atsushi Yanaihara
- Yanaihara Women's Clinic, 1-26-29 Ofuna, Kamakura, Kanagawa, Zip247-0056, Japan.
| | - Shirei Ohgi
- Yanaihara Women's Clinic, 1-26-29 Ofuna, Kamakura, Kanagawa, Zip247-0056, Japan
| | - Kenichirou Motomura
- Yanaihara Women's Clinic, 1-26-29 Ofuna, Kamakura, Kanagawa, Zip247-0056, Japan
| | - Yuko Hagiwara
- Department of Obstetrics & Gynecology, Women's Health, Yokohama City University Hospital, 3-9 Fukuura Kanazawa-ku, Yokohama, Zip 236-0004, Japan
| | - Tae Mogami
- Department of Obstetrics & Gynecology, Women's Health, Yokohama City University Hospital, 3-9 Fukuura Kanazawa-ku, Yokohama, Zip 236-0004, Japan
| | - Keisuke Saito
- Department of Obstetrics & Gynecology, Women's Health, Yokohama City University Hospital, 3-9 Fukuura Kanazawa-ku, Yokohama, Zip 236-0004, Japan
| | - Takumi Yanaihara
- Yanaihara Women's Clinic, 1-26-29 Ofuna, Kamakura, Kanagawa, Zip247-0056, Japan
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Brady PC, Missmer SA, Farland LV, Ginsburg ES. Clinical predictors of failing one dose of methotrexate for ectopic pregnancy after in vitro fertilization. J Assist Reprod Genet 2017; 34:349-356. [PMID: 28058611 DOI: 10.1007/s10815-016-0861-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 12/12/2016] [Indexed: 12/27/2022] Open
Abstract
PURPOSE The aim of this study is to investigate the clinical predictors of failure of a single dose of methotrexate (MTX) for management of ectopic pregnancy after in vitro fertilization (IVF). METHODS A retrospective cohort study was performed of women who conceived ectopic pregnancies following fresh or frozen IVF cycles at an academic infertility clinic between 2007 and 2014, and received intramuscular MTX (50 mg/m2). Successful single-dose MTX treatment was defined as a serum beta-human chorionic gonadotropin (hCG) decline ≥15% between days 4 and 7 post-treatment. Logistic regression models adjusted for oocyte age, number of embryos transferred, and prior ectopic pregnancy were used to estimate the adjusted odds ratio (OR) (95% confidence interval [CI]) of failing one dose of MTX. RESULTS Sixty-four patients with ectopic pregnancies after IVF were included. Forty required only one dose of MTX (62.5%), while 15 required additional MTX alone (up to four total doses, 23.4%), and 9 required surgery (14.1%). By multivariable logistic regression, the highest tertiles of serum hCG at peak (≥499 IU/L, OR = 9.73, CI 1.88-50.25) and at first MTX administration (≥342 IU/L, OR = 4.74, CI 1.11-20.26), fewer embryos transferred (OR = 0.37 per each additional embryo transferred, CI 0.19-0.74), and adnexal mass by ultrasound (OR = 3.65, CI 1.10-12.11) were each correlated with greater odds of requiring additional MTX and/or surgery. CONCLUSION This is the first study to report that in women with ectopic pregnancies after IVF, higher hCG-though well below treatment failure thresholds previously described in spontaneous pregnancies-fewer embryos transferred, and adnexal masses are associated with greater odds of failing one dose of MTX. These findings can be used to counsel IVF patients regarding the likelihood of success with single-dose MTX.
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Affiliation(s)
- Paula C Brady
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA.
| | - Stacey A Missmer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.,Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, 15 Michigan St NE, Grand Rapids, MI, 49503, USA
| | - Leslie V Farland
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Elizabeth S Ginsburg
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
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Ma NZ, Chen L, Dai W, Bu ZQ, Hu LL, Sun YP. Influence of endometrial thickness on treatment outcomes following in vitro fertilization/intracytoplasmic sperm injection. Reprod Biol Endocrinol 2017; 15:5. [PMID: 28056983 PMCID: PMC5216548 DOI: 10.1186/s12958-016-0222-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 12/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study was designed to investigate the roles of endometrial thickness (EMT) at the day of human chorionic gonadotropin (hCG) administration on pregnancy outcomes in a large patient population. METHODS This retrospective cohort study included 9,952 patients undergoing their first IVF/ICSI with autologous oocytes from January 2011 to January 2015. Patients were divided into three groups based on the EMT (group A:≤8 mm; group B: 9-14 mm and group C:≥15 mm). Live birth rate (LBR), clinical pregnancy rate (CPR), early miscarriage rate (EMR), and ectopic pregnancy rate (EPR) were analyzed. Additionally, the live birth rate was analyzed for patients with single or double gestational sacs. RESULTS Significant differences (p < 0.05) were detected in the LBRs (30.38%, 45.73% and 54.55% for groups A, B, and C, respectively), CPRs (38.57%, 55.04% and 64.32%, respectively), and EPRs (5.58%, 3.48% and 2.19%, respectively), with thicker endometrial thickness favoring all three parameters. However, no differences were found in the EMRs among the three groups (15.64%, 13.44% and 13.05%, respectively, p > 0.05). After adjusting for female age, body mass index (BMI) and endometrial pattern, the multivariate logistic regression analysis demonstrated that the associations between EMT and LBR (adjusted OR: 2.645; 95% CI 2.020-3.464; p < 0.01), CPR (adjusted OR 2.693 95% CI 2.012-3.605 p < 0.01), and EPR (adjusted OR: 0.298 95% CI 0.101-0.713; p < 0.05) were significant. Additionally, live birth rates in the double gestational sac group were different (p < 0.05) among patients with different EMT (72.73%, 87.28%, and 87.36%, respectively), whereas no difference was found in the single gestational sac group. In the double gestational sac group, LBR was positively correlated with increasing endometrial thickness only in patients with twin pregnancies but not in patients with singletons. CONCLUSIONS Our study shows that endometrial thickness at the day of hCG administration has an effect on LBR, CPR and EPR, with all three parameters increasing with the EMT. Furthermore, successful twin pregnancies are associated with a thicker endometrium.
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Affiliation(s)
- Ning-Zhao Ma
- Department of Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, JianShe Dong Road, Erqi District, Zhengzhou, Henan Province People’s Republic of China
| | - Lei Chen
- Department of Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, JianShe Dong Road, Erqi District, Zhengzhou, Henan Province People’s Republic of China
| | - Wei Dai
- Department of Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, JianShe Dong Road, Erqi District, Zhengzhou, Henan Province People’s Republic of China
| | - Zhi-Qin Bu
- Department of Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, JianShe Dong Road, Erqi District, Zhengzhou, Henan Province People’s Republic of China
| | - Lin-Li Hu
- Department of Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, JianShe Dong Road, Erqi District, Zhengzhou, Henan Province People’s Republic of China
| | - Ying-Pu Sun
- Department of Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, JianShe Dong Road, Erqi District, Zhengzhou, Henan Province People’s Republic of China
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Yoder N, Tal R, Martin JR. Abdominal ectopic pregnancy after in vitro fertilization and single embryo transfer: a case report and systematic review. Reprod Biol Endocrinol 2016; 14:69. [PMID: 27760569 PMCID: PMC5070159 DOI: 10.1186/s12958-016-0201-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 10/06/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Ectopic pregnancy is the leading cause of maternal morbidity and mortality during the first trimester and the incidence increases dramatically with assisted-reproductive technology (ART), occurring in approximately 1.5-2.1 % of patients undergoing in-vitro fertilization (IVF). Abdominal ectopic pregnancy is a rare yet clinically significant form of ectopic pregnancy due to potentially high maternal morbidity. While risk factors for ectopic pregnancy after IVF have been studied, very little is known about risk factors specific for abdominal ectopic pregnancy. We present a case of a 30 year-old woman who had an abdominal ectopic pregnancy following IVF and elective single embryo transfer, which was diagnosed and managed by laparoscopy. We performed a systematic literature search to identify case reports of abdominal or heterotopic abdominal ectopic pregnancies after IVF. A total of 28 cases were identified. RESULTS Patients' ages ranged from 23 to 38 (Mean 33.2, S.D. = 3.2). Infertility causes included tubal factor (46 %), endometriosis (14 %), male factor (14 %), pelvic adhesive disease (7 %), structural/DES exposure (7 %), and unexplained infertility (14 %). A history of ectopic pregnancy was identified in 39 % of cases. A history of tubal surgery was identified in 50 % of cases, 32 % cases having had bilateral salpingectomy. Transfer of two embryos or more (79 %) and fresh embryo transfer (71 %) were reported in the majority of cases. Heterotopic abdominal pregnancy occurred in 46 % of cases while 54 % were abdominal ectopic pregnancies. CONCLUSIONS Our systematic review has revealed several trends in reported cases of abdominal ectopic pregnancy after IVF including tubal factor infertility, history of tubal ectopic and tubal surgery, higher number of embryos transferred, and fresh embryo transfers. These are consistent with known risk factors for ectopic pregnancy following IVF. Further research focusing on more homogenous population may help in better characterizing this rare IVF complication and its risks.
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Affiliation(s)
- Nicole Yoder
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics, Gynecology, & Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510 USA
| | - Reshef Tal
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics, Gynecology, & Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510 USA
| | - J. Ryan Martin
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics, Gynecology, & Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510 USA
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Rombauts L, McMaster R, Motteram C, Fernando S. Reply: Every cycle counts. Hum Reprod 2016; 31:915-6. [DOI: 10.1093/humrep/dew002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Weiss A, Beck-Fruchter R, Golan J, Lavee M, Geslevich Y, Shalev E. Ectopic pregnancy risk factors for ART patients undergoing the GnRH antagonist protocol: a retrospective study. Reprod Biol Endocrinol 2016; 14:12. [PMID: 27005813 PMCID: PMC4804527 DOI: 10.1186/s12958-016-0146-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/02/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND In-vitro fertilization is a known risk factor for ectopic pregnancies. We sought to establish the risk factors for ectopic pregnancy in GnRH antagonist cycles examining patient and stimulation parameters with an emphasis on ovulation trigger. METHODS We conducted a retrospective, cohort study of 343 patients undergoing 380 assisted reproductive technology (ART) cycles with the GnRH antagonist protocol and achieving a clinical pregnancy from November 2010 through December 2015. RESULTS Significant risk factors for ectopic pregnancy in the univariate analysis included prior Cesarean section (CS), endometriosis, mechanical factor infertility, longer stimulation, elevated estradiol and progesterone levels, GnRH agonist trigger, higher number of oocytes aspirated, and insemination technique. Independent risk factors for ectopic pregnancy in the multivariate analysis included GnRH agonist trigger, higher number of oocytes aspirated, insemination technique, and prior Cesarean section. CONCLUSION Excessive ovarian response, IVF (as opposed to ICSI), prior Cesarean section and GnRH agonist trigger were found to be independent risk factors for ectopic pregnancy. Caution should be exercised before incorporating the GnRH agonist trigger for indications other than preventing OHSS. When excessive ovarian response leads to utilization of GnRH agonist trigger, strategies for preventing ectopic pregnancy, such as a freeze all policy or blastocyst transfer, should be considered. Further studies should elucidate whether adjusting the luteal support can reduce the ectopic pregnancy risk.
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Affiliation(s)
- A. Weiss
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - R. Beck-Fruchter
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - J. Golan
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - M. Lavee
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - Y. Geslevich
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - E. Shalev
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Santos-Ribeiro S, Tournaye H, Polyzos NP. Trends in ectopic pregnancy rates following assisted reproductive technologies in the UK: a 12-year nationwide analysis including 160 000 pregnancies. Hum Reprod 2016; 31:393-402. [PMID: 26724796 DOI: 10.1093/humrep/dev315] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/25/2015] [Indexed: 01/26/2023] Open
Abstract
STUDY QUESTION Have the advancement of assisted reproductive technologies (ART) and changes in the incidence of specific causes of infertility-altered ectopic pregnancy (EP) rates following ART over time in the UK? SUMMARY ANSWER EP rates in the UK following IVF/ICSI have progressively decreased, and this appears to be associated with a reduction in the incidence of tubal factor infertility and the increased use of both a lower number of embryos transferred and extended embryo culture. WHAT IS KNOWN ALREADY Historically, EP rates following ART are known to have increased over time. However, the impact of progress in ART procedures and changes in both policy and the incidence of specific causes of infertility on the overall EP rate in the UK has yet to be studied. STUDY DESIGN, SIZE, DURATION A population-based retrospective analysis was carried out on all pregnancies following ART cycles carried out in the UK between 2000 and 2012 included in the anonymized database of the Human Fertilisation and Embryology Authority. PARTICIPANTS/MATERIALS, SETTING, METHODS Overall, 161 967 treatment cycles resulting in a pregnancy were included in the analysis. Among them, 8852 pregnancies occurred after intrauterine insemination (IUI) and 153 115 following IVF/ICSI. MAIN RESULTS AND THE ROLE OF CHANCE During this period of 12 years, ∼1.4% (n = 2244) of all pregnancies following ART were an EP. Crude EP rates were significantly higher after IVF/ICSI when compared with following IUI (1.4 versus 1.1%, P = 0.043). The incidence of EP decreased significantly over time for IVF/ICSI cycles [incidence rate ratios (IRR) 0.96 per year, 95% confidence interval (CI) 0.94-0.97], but not after IUI (IRR 0.96 per year, 95% CI 0.91-1.03).Among pregnancies resulting from IVF/ICSI, multivariable logistic regression analysis demonstrated that the major risk factor for EP was the presence of tubal infertility [adjusted odds ratio (aOR) 2.23, 95% CI 1.93-2.58), followed by the increased number of embryos transferred (aOR 1.29 for 2 versus 1 embryo transferred, 95% CI 1.11-1.49; aOR 1.69 for 3 or more versus 1 embryo transferred, 95% CI 1.35-2.11). The use of extended embryo culture to Days 3-4 or 5-7 significantly reduced the risk of EP, when compared with the transfer of early cleavage (Days 1-2) embryos (respectively, aOR 0.85, 95% CI 0.76-0.94; and aOR 0.73, 95% CI 0.63-0.84). Finally, frozen embryo transfer (ET) had no effect on the risk of EP following IVF/ICSI (aOR 0.92, 95% CI 0.76-1.11). LIMITATIONS, REASONS FOR CAUTION Owing to the use of this particular registry data, well-established risk factors of EP, such as smoking habits or uterine surgery, could not be assessed. WIDER IMPLICATIONS OF THE FINDINGS Our results provide the first evidence of a potential benefit-in terms of the reduction in EP rates-of the implementation of national programmes aiming to reduce the incidence of tubal infertility, such as the National Chlamydia Screening Programme. In addition, campaigns for the widespread introduction of single ET may not only reduce the incidence of multiple pregnancies but also the incidence of EP following IVF/ICSI. STUDY FUNDING/COMPETING INTERESTS No funding was obtained for this study, and there are no conflicts of interest to declare.
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Affiliation(s)
- Samuel Santos-Ribeiro
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, Brussels 1090, Belgium Department of Obstetrics, Gynaecology and Reproductive Medicine, Santa Maria University Hospital, Avenida Professor Egas Moniz, Lisbon 1649-035, Portugal
| | - Herman Tournaye
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, Brussels 1090, Belgium
| | - Nikolaos P Polyzos
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, Brussels 1090, Belgium Department of Clinical Medicine, Faculty of Health, University of Aarhus, Incuba/Skejby, bld.2, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
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