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Shehab NG, Omolaoye TS, Du Plessis SS, Rawat SS, Naidoo N, Abushawish KY, Ahmed A, Alaa B, Ihsan H, Abdelhalim M, Ayman M, El Nebrisi E. Phytochemical Evaluation of Lepidium meyenii, Trigonella foenum-graecum, Spirulina platensis, and Tribulus arabica, and Their Potential Effect on Monosodium Glutamate Induced Male Reproductive Dysfunction in Adult Wistar Rats. Antioxidants (Basel) 2024; 13:939. [PMID: 39199185 PMCID: PMC11351587 DOI: 10.3390/antiox13080939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/19/2024] [Accepted: 07/25/2024] [Indexed: 09/01/2024] Open
Abstract
Monosodium glutamate (MSG), a sodium salt derived from glutamic acid, is widely used in commercial food products to improve taste, quality, and preservation. However, its consumption may have detrimental effects on male reproductive function. Nevertheless, plant extracts, such as Lepidium meyenii (Maca), Trigonella foenum-graecum (Fenugreek), Spirulina platensis (Spirulina), and Tribulus arabica (Tribulus), may ameliorate these adverse effects. To this effect, the phytochemical properties of Lepidium meyenii, Trigonella foenum-graecum, Spirulina platensis, and Tribulus arabica were assessed, and their potential impact on MSG-induced impairment of reproductive parameters was examined. The phytochemical composition (steroids, terpenes, phenols, flavonoids) of the plants was profiled through spectrophotometry and the antioxidant activity was assessed using the 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging assay. Thirty-six male Wistar rats were divided into six groups at random: a control group receiving distilled water, and five experimental groups (MSG, Maca, Fenugreek, Spirulina, and Tribulus) receiving 900 mg/kg/day of MSG dissolved in water for 45 days. Subsequently, the animals in the experimental groups were administered 500 mg/kg/day of the respective plant extract via oral gavage for an additional 35 days, while the MSG group continued to receive water only. Following the treatment period, the animals were sacrificed, and their reproductive tract organs were collected, weighed, and subjected to further analysis. Phytochemical analysis revealed the presence of diverse bioactive elements in the plant extracts, including phenolic and flavonoid compounds. Exposure to MSG negatively impacted total and progressive sperm motility, which was ameliorated by Lepidium meyenii treatment. Sperm morphology showed no significant differences among groups. Treatment of the phytochemical agents diminished histomorphometric alternations of the testicular length, germinal epithelium height, and number of cells in seminiferous tubules, which were caused by the initial administration of MSG. Testosterone and LH levels were reduced in the MSG group but improved in extract-treated groups. The study suggests Lepidium meyenii as a potential remedy for reproductive dysfunction. However, further investigation into its mechanisms and human safety and efficacy is warranted.
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Affiliation(s)
- Naglaa Gamil Shehab
- Pharmaceutical Sciences Department, Dubai Pharmacy College for Girls, Dubai 19099, United Arab Emirates;
- Pharmacognosy Department, Faculty of Pharmacy, Cairo University, Giza 11562, Egypt
| | - Temidayo S. Omolaoye
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai P.O. Box 505055, United Arab Emirates; (T.S.O.); (S.S.D.P.); (S.S.R.); (N.N.)
| | - Stefan S. Du Plessis
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai P.O. Box 505055, United Arab Emirates; (T.S.O.); (S.S.D.P.); (S.S.R.); (N.N.)
| | - Surendra Singh Rawat
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai P.O. Box 505055, United Arab Emirates; (T.S.O.); (S.S.D.P.); (S.S.R.); (N.N.)
| | - Nerissa Naidoo
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai P.O. Box 505055, United Arab Emirates; (T.S.O.); (S.S.D.P.); (S.S.R.); (N.N.)
| | - Kholoud Y. Abushawish
- Pharmaceutical Sciences Department, Dubai Pharmacy College for Girls, Dubai 19099, United Arab Emirates;
| | - Ayat Ahmed
- Dubai Pharmacy College for Girls, Dubai 19099, United Arab Emirates; (A.A.); (B.A.); (H.I.); (M.A.); (M.A.)
| | - Baraa Alaa
- Dubai Pharmacy College for Girls, Dubai 19099, United Arab Emirates; (A.A.); (B.A.); (H.I.); (M.A.); (M.A.)
| | - Heba Ihsan
- Dubai Pharmacy College for Girls, Dubai 19099, United Arab Emirates; (A.A.); (B.A.); (H.I.); (M.A.); (M.A.)
| | - Manar Abdelhalim
- Dubai Pharmacy College for Girls, Dubai 19099, United Arab Emirates; (A.A.); (B.A.); (H.I.); (M.A.); (M.A.)
| | - Mariam Ayman
- Dubai Pharmacy College for Girls, Dubai 19099, United Arab Emirates; (A.A.); (B.A.); (H.I.); (M.A.); (M.A.)
| | - Eslam El Nebrisi
- Department of Biomedical Sciences, Dubai Medical College for Girls, Dubai 20170, United Arab Emirates
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Weng SS, Chien LY. IVF and risk of Type 1 diabetes mellitus: a population-based nested case-control study. Hum Reprod 2024; 39:1816-1822. [PMID: 38852062 DOI: 10.1093/humrep/deae122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/15/2024] [Indexed: 06/10/2024] Open
Abstract
STUDY QUESTION Is the mode of conception (natural, subfertility and non-IVF, and IVF) associated with the risk of Type 1 diabetes mellitus among offspring? SUMMARY ANSWER The risk of Type 1 diabetes in offspring does not differ among natural, subfertility and non-IVF, and IVF conceptions. WHAT IS KNOWN ALREADY Evidence has shown that children born through IVF have an increased risk of impaired metabolic function. STUDY DESIGN, SIZE, DURATION A population-based, nested case-control study was carried out, including 769 children with and 3110 children without Type 1 diabetes mellitus within the prospective cohort of 2 228 073 eligible parent-child triads between 1 January 2004 and 31 December 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS Using registry data from Taiwan, the mode of conception was divided into three categories: natural conception, subfertility, and non-IVF (indicating infertility diagnosis but no IVF-facilitated conception), and IVF conception. The diagnosis of Type 1 diabetes mellitus was determined according to the International Classification of Diseases, 9th or 10th Revision, Clinical Modification. Each case was matched to four controls randomly selected after matching for child age and sex, residential township, and calendar date of Type 1 diabetes mellitus occurrence. MAIN RESULTS AND THE ROLE OF CHANCE Based on 14.3 million person-years of follow-up (median, 10 years), the incidence rates of Type 1 diabetes were 5.33, 5.61, and 4.74 per 100 000 person-years for natural, subfertility and non-IVF, and IVF conceptions, respectively. Compared with natural conception, no significant differences in the risk of Type 1 diabetes were observed for subfertility and non-IVF conception (adjusted odds ratio, 1.04 [95% CI, 0.85-1.27]) and IVF conception (adjusted odds ratio, 1.00 [95% CI, 0.50-2.03]). In addition, there were no significant differences in the risk of Type 1 diabetes according to infertility source (male/female/both) and embryo type (fresh/frozen). LIMITATIONS, REASONS FOR CAUTION Although the population-level data from Taiwanese registries was used, a limited number of exposed cases was included. We showed risk of Type 1 diabetes was not associated with infertility source or embryo type; however, caution with interpretation is required owing to the limited number of exposed events after the stratification. The exclusion criterion regarding parents' history of diabetes mellitus was only applicable after 1997, and this might have caused residual confounding. WIDER IMPLICATIONS OF THE FINDINGS It has been reported that children born to parents who conceived through IVF had worse metabolic profiles than those who conceived naturally. Considering the findings of the present and previous studies, poor metabolic profiles may not be sufficient to develop Type 1 diabetes mellitus during childhood. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by grants from Shin Kong Wu Ho-Su Memorial Hospital (No. 109GB006-1). The funders had no role in considering the study design or in the collection, analysis, interpretation of data, writing of the report, or decision to submit the article for publication. The authors have no competing interests to disclose. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Shiue-Shan Weng
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Li-Yin Chien
- Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei City, Taiwan
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Kupka MS, Chambers GM, Dyer S, Zegers-Hochschild F, de Mouzon J, Ishihara O, Banker M, Jwa SC, Fu B, Elgindy E, Baker V, Adamson GD. International Committee for Monitoring Assisted Reproductive Technology world report: assisted reproductive technology, 2015 and 2016. Fertil Steril 2024:S0015-0282(24)00602-2. [PMID: 38996903 DOI: 10.1016/j.fertnstert.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 07/04/2024] [Accepted: 07/05/2024] [Indexed: 07/14/2024]
Abstract
OBJECTIVE To report utilization, effectiveness, and safety of assisted reproductive technologies in 2015 and 2016. DESIGN A retrospective, cross-sectional survey of 3,103 assisted reproductive technology clinics in 74 countries in 2015 and 3,249 clinics in 79 countries in 2016 that submitted cycle and pregnancy outcome data through national and regional registries. SETTING Seventy-nine countries and >3,000 assisted reproductive technology clinics. PATIENT(S) Patients undergoing assisted reproductive technology procedures. INTERVENTION(S) Assisted reproductive technology. MAIN OUTCOME MEASURE(S) Outcomes on country, regional, and global levels. RESULT(S) Reported for 2015: 2,358,239 cycles with 548,652 infants born; for 2016: 2,807,963 cycles with 647,188 infants born. Estimated in 2015, ≥2,683,677 cycles resulted in >675,134 infants; in 2016, ≥3,100,448 cycles resulted in ≥723,026 infants. Reported cycles represent approximately 80% of global utilization. In 2015 and 2016, 27.6% and 27.8%, respectively, of women undergoing fresh autologous treatment cycles were aged ≥40 years. Frozen-thawed embryo transfer (ET) cycles accounted for 47.0% and 51.9%, respectively, of all ETs in 2015 and 2016. Oocyte donation cycles accounted for 6.7% and 7.1% of all ETs in 2015 and 2016. Intracytoplasmic sperm injection was performed in 57.7% and 56.4% of autologous aspiration cycles in 2015 and 2016, respectively. The cumulative delivery rate per aspiration cycle for fresh and frozen-thawed ET was 32.4% in 2015 and 33.1% in 2016, respectively. The average number of transferred embryos was 1.70 in 2015 and 1.69 in 2016. The proportion of single ETs in fresh autologous cycles increased from 42.1% in 2015 to 44.0% in 2016. The twin delivery rate decreased from 16.0% in 2015 to 14.7% in 2016, and the triplet rate decreased from 0.6% in 2015 to 0.4% in 2016. The proportion of single ETs in frozen-thawed ET autologous treatment cycles was 62.2% in 2015 and 64.2% in 2016, with twin and triplet rates of 10.1% and 0.3% in 2015 and 10.0% and 0.2% in 2016, respectively. CONCLUSION(S) Utilization of assisted reproductive technology treatment and births per cycle increased from 2015 to 2016, although multiple births were reduced. An increasing proportion of frozen-thawed ET cycles, continuing wide variation in use of intracytoplasmic sperm injection, and an increase in single ET rates are reported.
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Affiliation(s)
- Markus S Kupka
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany; Reproductive Medicine Center - Gynaekologicum, Hamburg, Germany.
| | - Georgina M Chambers
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Silke Dyer
- Department of Obstetrics & Gynaecology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Fernando Zegers-Hochschild
- Program of Ethics and Public Policies in Human Reproduction, Faculty of Medicine University Diego Portales, Chile and Clinica las Condes, Santiago, Chile
| | | | - Osamu Ishihara
- Nutrition Clinic Kagawa Nutrition University, Chiyoda, Sakado, Japan
| | - Manish Banker
- Banker IVF & Women's Hospital, Ahmedabad, Gujarat, India
| | | | - Bai Fu
- ART Management Department, National Center for Women and Children's Health, CDC, Beijing, People's Republic of China
| | - Eman Elgindy
- Zagazig University and Rahem Fertility Center, Cairo, Egypt
| | - Valerie Baker
- Division of Reproductive Endocrinology and Infertility, Johns Hopkins University School of Medicine, Lutherville, Maryland
| | - G David Adamson
- Equal3 Fertility, Cupertino, California; Stanford University School of Medicine, Palo Alto, California; University of California San Francisco School of Medicine, San Francisco, California
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Ma J, Xie Q, Zhang Y, Xiao Q, Liu X, Qiao C, Tian Y. Advances in microfluidic technology for sperm screening and in vitro fertilization. Anal Bioanal Chem 2024; 416:3717-3735. [PMID: 38189916 DOI: 10.1007/s00216-023-05120-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/09/2023] [Accepted: 12/19/2023] [Indexed: 01/09/2024]
Abstract
About 18% of reproductive-age adults worldwide are affected by infertility. In vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) are widely used assisted reproductive technologies (ARTs) aimed at improving clinical outcomes. Efficient and noninvasive selection and isolation of highly motile sperm with intact DNA are essential for the success of IVF and ICSI and can potentially impact the therapeutic efficacy and the health of the offspring. Compared to traditional methods, microfluidic technology offers significant advantages such as low sample consumption, high efficiency, minimal damage, high integration, similar microenvironment, and high automation, providing a new platform for ARTs. Here, we review the current situation of microfluidic technology in the field of sperm motility screening and evaluation and IVF research. First, we focus on the working principle, structural design, and screening results of sperm selection microfluidic platforms. We then highlight how the multiple steps of the IVF process can be facilitated and integrated into a microfluidic chip, including oocyte capture, sperm collection and isolation, sperm sorting, fertilization, and embryo culture. Ultimately, we summarize how microfluidics can complement and optimize current sperm sorting and IVF protocols, and challenges and possible solutions are discussed.
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Affiliation(s)
- Jingtong Ma
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, 110169, China
| | - Qianlin Xie
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, 110169, China
| | - Yusongjia Zhang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, 110169, China
| | - Qirui Xiao
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, 110169, China
| | - Xiaoyu Liu
- Department of Obstetrics and Gynaecology, General Hospital of Northern Theater Command, Shenyang, 110003, China.
| | - Chong Qiao
- Department of Obstetrics and Gynecology of Shengjing Hospital of China Medical University, Shenyang, 110022, China.
- Key Laboratory of Maternal-Fetal Medicine of Liaoning Province, Shenyang, 110022, China.
| | - Ye Tian
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, 110169, China.
- Foshan Graduate School of Innovation, Northeastern University, Foshan, 528300, China.
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Thompson JG, McLennan HJ, Heinrich SL, Inge MP, Gardner DK, Harvey AJ. A brief history of technical developments in intracytoplasmic sperm injection (ICSI). Dedicated to the memory of J.M. Cummins. Reprod Fertil Dev 2024; 36:RD24047. [PMID: 38902908 DOI: 10.1071/rd24047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/29/2024] [Indexed: 06/22/2024] Open
Abstract
Intracytoplasmic sperm injection (ICSI) is an assisted reproductive technology for treatment of severe male infertility introduced into clinical practice in 1992. This review provides a brief history of the development of ICSI by acknowledging major developments in the field. The review addresses key developments in pre-clinical and early studies, how ICSI compares with in vitro fertilisation, long-term consequences, how the mechanistic approach to ICSI has changed in both manual and semi-automated approaches, and how sperm selection procedures are integrated into ICSI. From the beginnings using animal models in the 1960-1970s, the development of ICSI is a remarkable and transformative success story. Indeed, its broad use (70% of cycles globally) exceeds the need required for treating infertile males, and this remains a controversial issue. There remain questions around the long-term health impacts of ICSI. Furthermore, advances in automation of the ICSI procedure are occurring. An estimated 6million children have been born from the ICSI procedure. With further automation of sperm selection technologies, coupled with automation of the injection procedure, it is likely that the proportion of children born from ICSI will further increase.
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Affiliation(s)
- J G Thompson
- Fertilis Pty Ltd, Frome Road, Helen Mayo South, The University of Adelaide, Adelaide, SA 5005, Australia; and Robinson Research Institute, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia; and ART Lab Solutions Pty Ltd, 10 Pulteney Street, Adelaide, SA 5005, Australia
| | - H J McLennan
- Fertilis Pty Ltd, Frome Road, Helen Mayo South, The University of Adelaide, Adelaide, SA 5005, Australia
| | - S L Heinrich
- Fertilis Pty Ltd, Frome Road, Helen Mayo South, The University of Adelaide, Adelaide, SA 5005, Australia
| | - M P Inge
- Fertilis Pty Ltd, Frome Road, Helen Mayo South, The University of Adelaide, Adelaide, SA 5005, Australia
| | - D K Gardner
- Melbourne IVF, East Melbourne, Vic 3002, Australia; and School of BioSciences, University of Melbourne, Parkville, Vic 3010, Australia
| | - A J Harvey
- Melbourne IVF, East Melbourne, Vic 3002, Australia; and School of BioSciences, University of Melbourne, Parkville, Vic 3010, Australia
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Borna MR, Sepehri MM, Maleki B. An artificial intelligence algorithm to select most viable embryos considering current process in IVF labs. Front Artif Intell 2024; 7:1375474. [PMID: 38881952 PMCID: PMC11177761 DOI: 10.3389/frai.2024.1375474] [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: 01/23/2024] [Accepted: 05/16/2024] [Indexed: 06/18/2024] Open
Abstract
Background The most common Assisted Reproductive Technology is In-Vitro Fertilization (IVF). During IVF, embryologists commonly perform a morphological assessment to evaluate embryo quality and choose the best embryo for transferring to the uterus. However, embryo selection through morphological assessment is subjective, so various embryologists obtain different conclusions. Furthermore, humans can consider only a limited number of visual parameters resulting in a poor IVF success rate. Artificial intelligence (AI) for embryo selection is objective and can include many parameters, leading to better IVF outcomes. Objectives This study sought to use AI to (1) predict pregnancy results based on embryo images, (2) assess using more than one image of the embryo in the prediction of pregnancy but based on the current process in IVF labs, and (3) compare results of AI-Based methods and embryologist experts in predicting pregnancy. Methods A data set including 252 Time-lapse Videos of embryos related to IVF performed between 2017 and 2020 was collected. Frames related to 19 ± 1, 43 ± 1, and 67 ± 1 h post-insemination were extracted. Well-Known CNN architectures with transfer learning have been applied to these images. The results have been compared with an algorithm that only uses the final image of embryos. Furthermore, the results have been compared with five experienced embryologists. Results To predict the pregnancy outcome, we applied five well-known CNN architectures (AlexNet, ResNet18, ResNet34, Inception V3, and DenseNet121). DeepEmbryo, using three images, predicts pregnancy better than the algorithm that only uses one final image. It also can predict pregnancy better than all embryologists. Different well-known architectures can successfully predict pregnancy chances with up to 75.0% accuracy using Transfer Learning. Conclusion We have developed DeepEmbryo, an AI-based tool that uses three static images to predict pregnancy. Additionally, DeepEmbryo uses images that can be obtained in the current IVF process in almost all IVF labs. AI-based tools have great potential for predicting pregnancy and can be used as a proper tool in the future.
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Affiliation(s)
- Mahdi-Reza Borna
- Department of IT Engineering, Faculty of Industrial and Systems Engineering, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Mehdi Sepehri
- Department of IT Engineering, Faculty of Industrial and Systems Engineering, Tarbiat Modares University, Tehran, Iran
| | - Behnam Maleki
- Infertility Center, Department of Obstetrics and Gynecology, Mazandaran University of Medical Sciences, Sari, Iran
- Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Kim JH, Park EA, Yoon TK, Kim MJ, Lee JH, Lee KA, Hur YJ, Choi SY, Jo EH, Kim YS. In vitro Fertilization Outcomes of Frozen-thawed Embryo Transfer with Hatched Blastocysts versus with Hatching Blastocysts. Reprod Sci 2024:10.1007/s43032-024-01499-7. [PMID: 38811454 DOI: 10.1007/s43032-024-01499-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 02/09/2024] [Indexed: 05/31/2024]
Abstract
This study aimed to elucidate the effect of hatching status on in vitro fertilization (IVF) outcomes in frozen-thawed blastocyst transfer cycles. Frozen-thawed embryo transfer (FET) cycles performed at a single fertility center between 2016 and 2021 were retrospectively assessed. Analyses were restricted to 6,821 frozen-thawed blastocyst transfers in women aged 24-47 years. For optimal comparability, double embryo transfer (ET) cycles consisting of one hatching and one hatched blastocyst were excluded. The implantation and pregnancy rates were evaluated and compared between the hatching and hatched blastocyst transfer groups based on patients' age (<38 vs. ≥38 years), blastocyst grade (good vs. bad grade), and the number of transferred embryos (single ET vs. double ET). Hatched blastocyst transfer was associated with higher implantation and clinical pregnancy rates in the single ET group (15.7% and 15.6%, respectively; p<0.001). The transfer of two hatched blastocysts had higher implantation and clinical pregnancy rates compared to the transfer of two hatching blastocysts (19.5% and 20.4%, respectively; p<0.001) in the double ET group. In the hatched blastocyst transfer group, the clinical pregnancy and implantation rates were higher, regardless of each woman's age and embryo quality. The IVF treatment outcomes were improved when the blastocysts were hatched during FET cycles. Hence, hatched blastocyst transfer in FET cycles could be considered a superior method in IVF practice.
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Affiliation(s)
- Ji Hye Kim
- CHA Fertility Center Seoul Station, CHA University, 416 Hangangdaero, Joongku, Seoul, Republic of Korea
- Department of Obstetrics and Gynecology, CHA Fertility Center Seoul Station, CHA Gangnam Medical Center, CHA University, Gyeonggi-do, Republic of Korea
| | - Eun A Park
- Fertility laboratory, CHA Fertility Center Seoul Station, Seoul, Republic of Korea
- Department of Biomedical Science, College of Life Science, CHA University, Gyeonggi-do, Republic of Korea
| | - Tae Ki Yoon
- CHA Fertility Center Seoul Station, CHA University, 416 Hangangdaero, Joongku, Seoul, Republic of Korea
- Department of Obstetrics and Gynecology, CHA Fertility Center Seoul Station, CHA Gangnam Medical Center, CHA University, Gyeonggi-do, Republic of Korea
| | - Myung Joo Kim
- CHA Fertility Center Seoul Station, CHA University, 416 Hangangdaero, Joongku, Seoul, Republic of Korea
- Department of Obstetrics and Gynecology, CHA Fertility Center Seoul Station, CHA Gangnam Medical Center, CHA University, Gyeonggi-do, Republic of Korea
| | - Jung Hyun Lee
- Fertility laboratory, CHA Fertility Center Seoul Station, Seoul, Republic of Korea
| | - Kyung-Ah Lee
- Department of Biomedical Science, College of Life Science, CHA University, Gyeonggi-do, Republic of Korea
| | - Yun Jung Hur
- CHA Fertility Center Seoul Station, CHA University, 416 Hangangdaero, Joongku, Seoul, Republic of Korea
- Department of Obstetrics and Gynecology, CHA Fertility Center Seoul Station, CHA Gangnam Medical Center, CHA University, Gyeonggi-do, Republic of Korea
| | - Seung Young Choi
- CHA Fertility Center Seoul Station, CHA University, 416 Hangangdaero, Joongku, Seoul, Republic of Korea
| | - Eun-Hye Jo
- CHA Fertility Center Seoul Station, CHA University, 416 Hangangdaero, Joongku, Seoul, Republic of Korea
| | - You Shin Kim
- CHA Fertility Center Seoul Station, CHA University, 416 Hangangdaero, Joongku, Seoul, Republic of Korea.
- Department of Obstetrics and Gynecology, CHA Fertility Center Seoul Station, CHA Gangnam Medical Center, CHA University, Gyeonggi-do, Republic of Korea.
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Tian Y, Li M, Yang J, Chen H, Lu D. Preimplantation genetic testing in the current era, a review. Arch Gynecol Obstet 2024; 309:1787-1799. [PMID: 38376520 DOI: 10.1007/s00404-024-07370-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 01/02/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Preimplantation genetic testing (PGT), also referred to as preimplantation genetic diagnosis (PGD), is an advanced reproductive technology used during in vitro fertilization (IVF) cycles to identify genetic abnormalities in embryos prior to their implantation. PGT is used to screen embryos for chromosomal abnormalities, monogenic disorders, and structural rearrangements. DEVELOPMENT OF PGT Over the past few decades, PGT has undergone tremendous development, resulting in three primary forms: PGT-A, PGT-M, and PGT-SR. PGT-A is utilized for screening embryos for aneuploidies, PGT-M is used to detect disorders caused by a single gene, and PGT-SR is used to detect chromosomal abnormalities caused by structural rearrangements in the genome. PURPOSE OF REVIEW In this review, we thoroughly summarized and reviewed PGT and discussed its pros and cons down to the minutest aspects. Additionally, recent studies that highlight the advancements of PGT in the current era, including their future perspectives, were reviewed. CONCLUSIONS This comprehensive review aims to provide new insights into the understanding of techniques used in PGT, thereby contributing to the field of reproductive genetics.
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Affiliation(s)
- Yafei Tian
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, 200438, China
- MOE Engineering Research Center of Gene Technology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200433, China
| | - Mingan Li
- Center for Reproductive Medicine, The Affiliated Shuyang Hospital of Xuzhou Medical University, Suqian, 223800, Jiangsu Province, China
| | - Jingmin Yang
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, 200438, China
- NHC Key Laboratory of Birth Defects and Reproductive Health, (Chongqing Key Laboratory of Birth Defects and Reproductive Health, Chongqing Population and Family Planning Science and Technology Research Institute), Chongqing, 400020, China
| | - Hongyan Chen
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, 200438, China
| | - Daru Lu
- MOE Engineering Research Center of Gene Technology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200433, China.
- NHC Key Laboratory of Birth Defects and Reproductive Health, (Chongqing Key Laboratory of Birth Defects and Reproductive Health, Chongqing Population and Family Planning Science and Technology Research Institute), Chongqing, 400020, China.
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Xie Q, Quan X, Lan Y, Yang X. Uterine infusion strategies for infertile patients with recurrent implantation failure: a systematic review and network meta-analysis. Reprod Biol Endocrinol 2024; 22:44. [PMID: 38627790 PMCID: PMC11020641 DOI: 10.1186/s12958-024-01221-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/10/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Intra-uterine infusion treatments were reported to be beneficial to embryo implantation and pregnancy outcomes, and considered as potential therapies for infertile patients with recurrent implantation failure (RIF). Nevertheless, their efficiencies were controversial and there lack of consensus on which intrauterine treatment is the most effective. METHODS All prospective trials (in Chinese or English) were searched in Databases PubMed, Cochrane, Web of Science, and CNKI from July 2013 to July 2023. We included studies that investigated various uterine infusions, including chorionic gonadotropin, granulocyte colony-stimulating factor, monocytes, platelet-rich plasma, etc. during IVF treatment and reported subsequent pregnancy outcomes. RESULTS We finally included 56 researches, including 40 randomized controlled trials, 14 non-randomized controlled trials, and 3 prospective cohort studies. This study included a total of 11 uterine perfusion methods: Placebo, Human Chorionic Gonadotropin (HCG), Granulocyte Colony-Stimulating Factor (G-CSF), platelet-rich plasma (PRP), Peripheral Blood Mononuclear Cell (PBMC), Growth hormone (GH), dexamethasone (DEX), Embryo culture supernatant (ESC), PRP combined with G-CSF (PRP + G-CSF), RPR combined with subcutaneous injection of G-CSF (RPR + G-CSFsc), G-CSF combined with subcutaneous injection of AXaIU (G-CSF + AXaIUsc). Intrauterine infusion of HCG, PBMC, G-CSF, and PRP significantly improves pregnancy outcomes in patients with repeated implantation failure compared with blank controls or placebo, and PRP improved the clinical pregnancy and live birth most. GH and ESC infusion might improve the pregnancy outcomes, but uterine infusion of DEX was shown with high miscarriage. The combination therapy did not show a significant advantage over the mono-therapy. CONCLUSIONS Intrauterine infusion of HCG, PBMC, G-CSF, and PRP are promising strategies for improving pregnancy outcomes for infertile patients with recurrent implantation failure. Among these treatments, PRP may be the best. More researches are required to explore the effect of drug combinations and less commonly used drugs as well. TRIAL REGISTRATION Our study was registered in PROSPERO and the ID was CRD42023467188.
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Affiliation(s)
- Qin Xie
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, The Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, 441021, P. R. China
| | - Xiaozhen Quan
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, The Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, 441021, P. R. China
| | - Yanli Lan
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, The Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, 441021, P. R. China
| | - Xuezhou Yang
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, The Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, 441021, P. R. China.
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10
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McPherson NO, Nottle M, McIlfatrick S, Saini A, Hamilton H, Bowman E, Tully CA, Pacella-Ince L, Zander-Fox D, Bakos HW. Clinical use of progesterone in human sperm preparation media for increasing IVF success. Reprod Biomed Online 2024; 48:103625. [PMID: 38402675 DOI: 10.1016/j.rbmo.2023.103625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/12/2023] [Accepted: 10/14/2023] [Indexed: 02/27/2024]
Abstract
RESEARCH QUESTION Can the addition of progesterone and neurotensin, molecular agents found in the female reproductive tract, after sperm washing increase the fertilization potential of human spermatozoa? DESIGN (i) Cohort study of 24 men. Spermatozoa selected by swim-up were incubated in either progesterone or neurotensin (0.1-100 µM) for 1-4 h, and hyperactive motility and binding to hyaluronan (0.1-100 µM) were assessed. The effect of progesterone 10 µM on sperm function was assessed in a blinded manner, including: hyperactive motility, binding to hyaluronan, tyrosine phosphorylation, acrosome reaction and oxidative DNA damage. (i) Embryo safety testing [one-cell mouse embryo assay (MEA), endotoxin and sterility counts (n = 3)] in preclinical embryo models of IVF (murine and porcine, n = 7 each model) and a small preliminary human study (n = 4) of couples undergoing standard IVF with oocytes inseminated with spermatozoa ± 10 µM progesterone. RESULTS Progesterone 10 µM increased sperm binding to hyaluronan, hyperactive motility and tyrosine phosphorylation (all P < 0.05). Neurotensin had no effect (P > 0.05). Progesterone 10 µM in human embryo culture media passed embryo safety testing (MEA, endotoxin concentration and sterility plate count). In preclinical models of IVF, the exposure of spermatozoa to progesterone 10 µM and oocytes to progesterone 1 µM was not detrimental, and increased the fertilization rate in mice and the blastocyst cell number in mice and pigs (all P ≤ 0.03). In humans, every transferred blastocyst that had been produced from spermatozoa exposed to progesterone resulted in a live birth. CONCLUSION The addition of progesterone to sperm preparation media shows promise as an adjunct to current methods for increasing fertilization potential. Randomized controlled trials are required to determine the clinical utility of progesterone for improving IVF outcomes.
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Affiliation(s)
- Nicole O McPherson
- Discipline of Reproduction and Development, School of Biomedicine, University of Adelaide, Adelaide, Australia; Freemasons Centre for Male Health and Wellbeing, University of Adelaide, Adelaide, Australia; Robinson Research Institute, University of Adelaide, Adelaide, Australia; Monash IVF Group, Clayton, Australia.
| | - Mark Nottle
- Discipline of Reproduction and Development, School of Biomedicine, University of Adelaide, Adelaide, Australia; Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Stephan McIlfatrick
- Discipline of Reproduction and Development, School of Biomedicine, University of Adelaide, Adelaide, Australia; Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Anmol Saini
- Discipline of Reproduction and Development, School of Biomedicine, University of Adelaide, Adelaide, Australia; Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | | | | | - Cathryn A Tully
- Discipline of Reproduction and Development, School of Biomedicine, University of Adelaide, Adelaide, Australia; Robinson Research Institute, University of Adelaide, Adelaide, Australia; Repromed, Dulwich, Australia
| | - Leanne Pacella-Ince
- Discipline of Reproduction and Development, School of Biomedicine, University of Adelaide, Adelaide, Australia; Robinson Research Institute, University of Adelaide, Adelaide, Australia; Repromed, Dulwich, Australia
| | - Deirdre Zander-Fox
- Discipline of Reproduction and Development, School of Biomedicine, University of Adelaide, Adelaide, Australia; Monash IVF Group, Clayton, Australia; Monash University, Clayton, Australia
| | - Hassan W Bakos
- Monash IVF Group, Clayton, Australia; University of Newcastle, Newcastle, Australia; Memphasys Ltd, Homebush, Australia
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11
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Mínguez-Alarcón L, Williams PL, Souter I, Ford JB, Hauser R, Chavarro JE. Women's preconception psychological stress and birth outcomes in a fertility clinic: the EARTH study. Front Glob Womens Health 2024; 5:1293255. [PMID: 38379838 PMCID: PMC10877713 DOI: 10.3389/fgwh.2024.1293255] [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: 10/10/2023] [Accepted: 01/19/2024] [Indexed: 02/22/2024] Open
Abstract
Background The epidemiologic literature on women's perceived stress in relation to perinatal outcomes has been inconclusive and does not consider the preconception window of exposure. Objective To evaluate whether women's preconception perceived stress is related to live birth, gestational age, and birthweight in a cohort receiving fertility treatment. Methods This observational study included women seeking fertility care at the Massachusetts General Hospital (2004-2019). During preconception, women provided information on their psychological stress using the short version of the validated Perceived Stress Scale 4 (PSS-4). We used regression models to evaluate the associations of stress with live birth (N = 768 attempting to conceive) and perinatal outcomes (N = 413 live births) while adjusting for confounders. Stratified analyses by mode of conception [natural, intrauterine insemination (IUI), and IVF (in vitro fertilization)] and selected socioeconomic factors (race, education, and income) were also conducted. Results Higher psychological stress was negatively associated with the overall probability of live birth (adjusted RR = 0.95, 95% CI: 0.92, 0.98), particularly among women conceiving using IVF. However, we found no association between women's psychological stress and gestational age and birth weight in the overall analyses and also stratified by mode of conception. Similarly, we observed no differences in women's psychological stress with any of the measured outcomes by socioeconomic factors. Discussion These results highlight the importance of considering the preconception window and mode of conception when evaluating the relationship between women's preconception stress and live birth.
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Affiliation(s)
- Lidia Mínguez-Alarcón
- Channing Division of Network Medicine, Harvard Medical School & Brigham and Women’s Hospital, Boston, MA, United States
- Departments of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Paige L. Williams
- Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Irene Souter
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Jennifer B. Ford
- Departments of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Russ Hauser
- Departments of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, United States
| | - Jorge E. Chavarro
- Channing Division of Network Medicine, Harvard Medical School & Brigham and Women’s Hospital, Boston, MA, United States
- Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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12
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Ngwenya O, Lensen SF, Vail A, Mol BWJ, Broekmans FJ, Wilkinson J. Individualised gonadotropin dose selection using markers of ovarian reserve for women undergoing in vitro fertilisation plus intracytoplasmic sperm injection (IVF/ICSI). Cochrane Database Syst Rev 2024; 1:CD012693. [PMID: 38174816 PMCID: PMC10765476 DOI: 10.1002/14651858.cd012693.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
BACKGROUND During a stimulated cycle of in vitro fertilisation or intracytoplasmic sperm injection (IVF/ICSI), women receive daily doses of gonadotropin follicle-stimulating hormone (FSH) to induce multifollicular development in the ovaries. A normal response to stimulation (e.g. retrieval of 5 to 15 oocytes) is considered desirable. Generally, the number of eggs retrieved is associated with the dose of FSH. Both hyper-response and poor response are associated with an increased chance of cycle cancellation. In hyper-response, this is due to increased risk of ovarian hyperstimulation syndrome (OHSS), while poor response cycles are cancelled because the quantity and quality of oocytes is expected to be low. Clinicians often individualise the FSH dose using patient characteristics predictive of ovarian response. Traditionally, this meant women's age, but increasingly, clinicians use various ovarian reserve tests (ORTs). These include basal FSH (bFSH), antral follicle count (AFC), and anti-Müllerian hormone (AMH). It is unclear whether individualising FSH dose improves clinical outcomes. This review updates the 2018 version. OBJECTIVES To assess the effects of individualised gonadotropin dose selection using markers of ovarian reserve in women undergoing IVF/ICSI. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility Group Specialised Register of controlled trials, CENTRAL, MEDLINE, Embase, and two trial registers in February 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared (a) different doses of FSH in women with a defined ORT profile (i.e. predicted low, normal, or high responders based on AMH, AFC, and/or bFSH) or (b) an individualised dosing strategy (based on at least one ORT measure) versus uniform dosing or a different individualised dosing algorithm. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. Primary outcomes were live birth/ongoing pregnancy and severe OHSS. MAIN RESULTS We included 26 studies, involving 8520 women (6 new studies added to 20 studies included in the previous version). We treated RCTs with multiple comparisons as separate trials for the purpose of this review. Meta-analysis was limited due to clinical heterogeneity. Evidence certainty ranged from very low to low, with the main limitations being imprecision and risk of bias associated with lack of blinding. Direct dose comparisons according to predicted response in women Due to differences in dose comparisons, caution is required when interpreting the RCTs in predicted low responders. All evidence was low or very low certainty. Effect estimates were very imprecise, and increased FSH dosing may or may not have an impact on rates of live birth/ongoing pregnancy, OHSS, and clinical pregnancy. Similarly, in predicted normal responders (10 studies, 4 comparisons), higher doses may or may not impact the probability of live birth/ongoing pregnancy (e.g. 200 versus 100 international units (IU): odds ratio (OR) 0.88, 95% confidence interval (CI) 0.57 to 1.36; I2 = 0%; 2 studies, 522 women) or clinical pregnancy. Results were imprecise, and a small benefit or harm remains possible. There were too few events for the OHSS outcome to enable inferences. In predicted high responders, lower doses may or may not affect live birth/ongoing pregnancy (OR 0.98, 95% CI 0.66 to 1.46; 1 study, 521 women), severe OHSS, and clinical pregnancy. It is also unclear whether lower doses reduce moderate or severe OHSS (Peto OR 2.31, 95% CI 0.80 to 6.67; 1 study, 521 participants). ORT-algorithm studies Eight trials compared an ORT-based algorithm to a non-ORT control group. It is unclear whether live birth/ongoing pregnancy and clinical pregnancy are increased using an ORT-based algorithm (live birth/ongoing pregnancy: OR 1.12, 95% CI 0.98 to 1.29; I2 = 30%; 7 studies, 4400 women; clinical pregnancy: OR 1.04, 95% CI 0.91 to 1.18; I2 = 18%; 7 studies, 4400 women; low-certainty evidence). However, ORT algorithms may reduce moderate or severe OHSS (Peto OR 0.60, 95% CI 0.42 to 0.84; I2 = 0%; 7 studies, 4400 women; low-certainty evidence). There was insufficient evidence to determine whether the groups differed in rates of severe OHSS (Peto OR 0.74, 95% CI 0.42 to 1.28; I2 = 0%; 5 studies, 2724 women; low-certainty evidence). Our findings suggest that if the chance of live birth with a standard starting dose is 25%, the chance with ORT-based dosing would be between 25% and 31%. If the chance of moderate or severe OHSS with a standard starting dose is 5%, the chance with ORT-based dosing would be between 2% and 5%. These results should be treated cautiously due to heterogeneity in the algorithms: some algorithms appear to be more effective than others. AUTHORS' CONCLUSIONS We did not find that tailoring the FSH dose in any particular ORT population (low, normal, high ORT) affected live birth/ongoing pregnancy rates, but we could not rule out differences, due to sample size limitations. Low-certainty evidence suggests that it is unclear if ORT-based individualisation leads to an increase in live birth/ongoing pregnancy rates compared to a policy of giving all women 150 IU. The confidence interval is consistent with an increase of up to around six percentage points with ORT-based dosing (e.g. from 25% to 31%) or a very small decrease (< 1%). A difference of this magnitude could be important to many women. It is unclear if this is driven by improved outcomes in a particular subgroup. Further, ORT algorithms reduced the incidence of OHSS compared to standard dosing of 150 IU. However, the size of the effect is also unclear. The included studies were heterogeneous in design, which limited the interpretation of pooled estimates. It is likely that different ORT algorithms differ in their effectiveness. Current evidence does not provide a clear justification for adjusting the dose of 150 IU in poor or normal responders, especially as increased dose is associated with greater total FSH dose and cost. It is unclear whether a decreased dose in predicted high responders reduces OHSS, although this would appear to be the most likely explanation for the results.
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Affiliation(s)
- Olina Ngwenya
- Centre for Biostatistics, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK
| | - Sarah F Lensen
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Andy Vail
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Frank J Broekmans
- Department of Gynecology and Reproductive Medicine, University Medical Centre, Utrecht, Heidelberglaan, Netherlands
- Centre For Fertility Care, Dijklander Hospital, Waterlandlaan, Purmerend, Netherlands
| | - Jack Wilkinson
- Centre for Biostatistics, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK
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13
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David MS, Vintejoux E, Kucharczak F, Brouillet S, Rougier N, Huberlant S. Impact of Caesarean section on pregnancy outcomes in ART after transfer of one or more frozen blastocysts. J Gynecol Obstet Hum Reprod 2024; 53:102692. [PMID: 37979690 DOI: 10.1016/j.jogoh.2023.102692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/03/2023] [Accepted: 11/15/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION The prevalence of Caesarean delivery is rising steadily worldwide, and it is important to identify its future impact on fertility. A number of articles have been published on this subject, but the impact of Caesarean section on reproductive outcomes is still under debate, and none of these articles focus exclusively on frozen blastocysts. OBJECTIVE The aim of this study was to evaluate the impact of a previous Caesarean delivery compared with a previous vaginal delivery on the chances of a live birth following the transfer of one or more frozen embryos at the blastocyst stage. METHODS This was a retrospective, bicentric study at the University Hospitals of Nîmes and Montpellier, conducted between January 1st, 2016 and February 1st, 2021. Three hundred and ninety women with a history of childbirth and a transfer of one or more frozen embryos at blastocyst stage were included in the analysis. The primary outcome was the number of live births. Secondary outcomes were: the rate of positive HCG, miscarriage, ectopic pregnancy and clinical pregnancy, as well as the live birth rate according to the presence or absence of an isthmocele. RESULTS Of the 390 patients included, 118 had a previous Caesarean delivery and 272 a vaginal delivery. No statistically significant differences were found for the primary (p = 0.9) or secondary outcomes. A trend towards lower live birth rates was observed in patients with isthmoceles, but this did not reach significance (p>0.9). On the other hand, transfers were more often described as difficult in the Caesarean delivery group (p = 0.011). CONCLUSION Our study found no effect of previous Caesarean delivery on the chances of live birth after transferring one or more frozen blastocysts. However, further prospective studies are needed to confirm these results.
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Affiliation(s)
- Marie-Sophie David
- Department of reproductive medicine, Obstetrics and Gynecology, CHU Arnaud de Villeneuve, 371 avenue du Doyen Gaston Giraud, Montpellier, France; Department of Obstetrics and Gynecology, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Emmanuelle Vintejoux
- Department of reproductive medicine, Obstetrics and Gynecology, CHU Arnaud de Villeneuve, 371 avenue du Doyen Gaston Giraud, Montpellier, France
| | - Florentin Kucharczak
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, University of Montpellier, Nîmes, France
| | - Sophie Brouillet
- Laboratory of Medically Assisted Reproduction, CHU Arnaud de Villeneuve, 371 avenue du Doyen Gaston Giraud, Montpellier, France
| | - Nathalie Rougier
- Laboratory of Medically Assisted Reproduction, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Stéphanie Huberlant
- Department of Obstetrics and Gynecology, CHU Nîmes, University of Montpellier, Nîmes, France; University of Nîmes-Montpellier, France.
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Sciorio R, Fleming SD. Intracytoplasmic sperm injection vs. in-vitro fertilization in couples in whom the male partners had a semen analysis within normal reference ranges: An open debate. Andrology 2024; 12:20-29. [PMID: 37259978 DOI: 10.1111/andr.13468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/25/2023] [Accepted: 05/25/2023] [Indexed: 06/02/2023]
Abstract
During recent decades, the application of intracytoplasmic sperm injection has increased considerably worldwide, especially in couples with non-male factor infertility. However, several studies analyzing the broad use of intracytoplasmic sperm injection, even in cases with a normal semen analysis, have collectively demonstrated no benefits compared to conventional in-vitro fertilization. Currently, there is insufficient evidence to support the intracytoplasmic sperm injection technique vs. in-vitro fertilization in cases of poor ovarian response or a low number of oocytes collected, or in patients with advanced maternal age. Since the intracytoplasmic sperm injection technique is more operator-dependent and invasive, its use should only be recommended in cases of male-factor infertility. There is some evidence showing that intracytoplasmic sperm injection is linked with an increased risk of birth defects. Albeit this evidence is limited, and currently it is not possible to draw a firm conclusion on these concerns, we do believe that these risks should be rigorously investigated. Thus, this review aims to clarify the debate on the application of the intracytoplasmic sperm injection procedure, as compared to standard in-vitro fertilization, in those assisted reproductive technology cycles without a clear male factor infertility. Furthermore, we try to clarify whether intracytoplasmic sperm injection would result in a higher live birth rate than in-vitro fertilization, in couples with non-male factor infertility.
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Affiliation(s)
- Romualdo Sciorio
- Edinburgh Assisted Conception Programme, EFREC, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Steven D Fleming
- Discipline of Anatomy & Histology, School of Medical Sciences, University of Sydney, Sydney, Australia
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Ota K, Mitsui J, Katsumata S, Takayanagi Y, Nako Y, Tajima M, Komiya A, Takahashi T, Kawai K. Seasonal Serum 25(OH) Vitamin D Level and Reproductive or Immune Markers in Reproductive-Aged Women with Infertility: A Cross-Sectional Observational Study in East Japan. Nutrients 2023; 15:5059. [PMID: 38140317 PMCID: PMC10745323 DOI: 10.3390/nu15245059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/16/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Several studies have reported that vitamin D may modify human reproductive functions; however, the results are conflicting. We aimed to comprehensively evaluate serum vitamin D levels and examine the relationship between serum vitamin D levels and ovarian reserve markers, and immune markers of implantation, in reproductive-aged Japanese women with infertility.in reproductive-aged women with infertility. This cross-sectional, single-center study included reproductive-aged women who underwent preconception screening for fertility. Serum vitamin D levels and reproductive and immune markers were measured. Standard and advanced statistical techniques were used. We observed a statistically significant difference in the seasonal and monthly 25(OH) vitamin D levels; the 25(OH) vitamin D level during winter was the lowest among all seasons. However, there was no linear correlation between 25(OH) vitamin D levels and ovarian reserve markers, such as follicle-stimulating hormone and anti-Müllerian hormone, or the Th1/Th2 cell ratio, which is used as an implantation-related immunological marker. In this large-scale study, we evaluated the serum 25(OH) vitamin D concentration in reproductive-aged women with infertility in Japan; however, there was no association between reproductive function and vitamin D levels.
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Affiliation(s)
- Kuniaki Ota
- Fukushima Medical Center for Children and Women, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan;
- Department of Obstetrics and Gynecology, Tokyo Rosai Hospital, Japan Labor Health and Safety Organization, 4-13-21 Ohmori-minami, Ohta-ku, Tokyo 143-0013, Japan
- Reproductive Medicine, Kameda IVF Clinic Makuhari, Makuhari Techno Garden D3F, 1-3 Nakase, Mihama-ku, Chiba-City 261-8501, Japan; (J.M.); (S.K.); (Y.T.); (Y.N.); (M.T.); (A.K.); (K.K.)
| | - Junichiro Mitsui
- Reproductive Medicine, Kameda IVF Clinic Makuhari, Makuhari Techno Garden D3F, 1-3 Nakase, Mihama-ku, Chiba-City 261-8501, Japan; (J.M.); (S.K.); (Y.T.); (Y.N.); (M.T.); (A.K.); (K.K.)
- Comprehensive Reproductive Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Shoko Katsumata
- Reproductive Medicine, Kameda IVF Clinic Makuhari, Makuhari Techno Garden D3F, 1-3 Nakase, Mihama-ku, Chiba-City 261-8501, Japan; (J.M.); (S.K.); (Y.T.); (Y.N.); (M.T.); (A.K.); (K.K.)
- Comprehensive Reproductive Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Yuko Takayanagi
- Reproductive Medicine, Kameda IVF Clinic Makuhari, Makuhari Techno Garden D3F, 1-3 Nakase, Mihama-ku, Chiba-City 261-8501, Japan; (J.M.); (S.K.); (Y.T.); (Y.N.); (M.T.); (A.K.); (K.K.)
| | - Yurie Nako
- Reproductive Medicine, Kameda IVF Clinic Makuhari, Makuhari Techno Garden D3F, 1-3 Nakase, Mihama-ku, Chiba-City 261-8501, Japan; (J.M.); (S.K.); (Y.T.); (Y.N.); (M.T.); (A.K.); (K.K.)
| | - Makiko Tajima
- Reproductive Medicine, Kameda IVF Clinic Makuhari, Makuhari Techno Garden D3F, 1-3 Nakase, Mihama-ku, Chiba-City 261-8501, Japan; (J.M.); (S.K.); (Y.T.); (Y.N.); (M.T.); (A.K.); (K.K.)
| | - Akira Komiya
- Reproductive Medicine, Kameda IVF Clinic Makuhari, Makuhari Techno Garden D3F, 1-3 Nakase, Mihama-ku, Chiba-City 261-8501, Japan; (J.M.); (S.K.); (Y.T.); (Y.N.); (M.T.); (A.K.); (K.K.)
| | - Toshifumi Takahashi
- Fukushima Medical Center for Children and Women, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan;
| | - Kiyotaka Kawai
- Reproductive Medicine, Kameda IVF Clinic Makuhari, Makuhari Techno Garden D3F, 1-3 Nakase, Mihama-ku, Chiba-City 261-8501, Japan; (J.M.); (S.K.); (Y.T.); (Y.N.); (M.T.); (A.K.); (K.K.)
- Comprehensive Reproductive Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
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Oppenheimer D, Caldas CP, Rego F, Nunes R. Access to infertility care in Brazil: validation of a questionnaire for a bioethical discussion. Reprod Health 2023; 20:183. [PMID: 38062511 PMCID: PMC10704618 DOI: 10.1186/s12978-023-01724-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The World Health Organization characterizes infertility as a disease since 2009; however, in many countries, reproductive health is not prioritized. Characterizing a target population and knowing the barriers to accessing reproductive care may allow for a broadening of the discussion on how to provide equal opportunities. The objective of this study was to develop and validate a questionnaire that seeks to identify socioeconomic and cultural characteristics of Brazilian infertile couples to open the discussion on the principle of fair access to health. METHODS (1) literature review in the main databases, (2) questionnaire elaboration by researchers within the areas of human reproduction and bioethics, concerned with content adequacy and comprehension, using the Google Forms online platform, (3) pilot study - the questionnaire was applied to 54 couples, over 18 years of age, that were seeking treatment for infertility and accepted to participate in the study and (4) statistical analysis - for continuous numerical variables, mean, standard deviation and 95% CI of the means were presented. For discrete numerical variables, median, interquartile range, minimum and maximum were presented. RESULTS Forty-four questionnaires were fully completed and with adequate answers. The questionnaire proved to be objective and easy to understand. It was possible to obtain information on education, race of the couple, the impact of infertility on the couple's life, socioeconomic conditions, and the main difficulties in accessing medical care for treatment of infertility. CONCLUSION The questionnaire proved to be feasible in collecting appropriate information to characterize a target population and the only limitation was that there was no academic expert evaluation prior to the pilot test.
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Affiliation(s)
- Drauzio Oppenheimer
- Faculdade de Medicina de Itajubá (FMIT), Av. Rennó Junior, 368, São Vicente, Itajubá, MG, CEP 37502-138, Brasil.
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
| | | | - Francisca Rego
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Rui Nunes
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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17
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Jiang M, Huang L, Wang Y, Wang Y, Kang Q, Chen C, Hu Y, Li J, Wang T. Yueliang Yin Ameliorates Endometrial Receptivity in Mice with Embryo Implantation Failure by Reducing Pyroptosis and Activating BDNF/TrkB Pathway. Mol Nutr Food Res 2023; 67:e2300339. [PMID: 37797178 DOI: 10.1002/mnfr.202300339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/16/2023] [Indexed: 10/07/2023]
Abstract
SCOPE Endometrial receptivity plays a vital role in embryonic implantation. Yueliang Yin is a marketed solid drink in China, also known as Bushen Cuyun Recipe (BCR), that is, assumed to have a therapeutic effect on infertility by improving endometrial receptivity. This study investigates the effects and mechanisms of BCR in protecting the endometrium. METHODS AND RESULTS Mice with mifepristone-induced embryo implantation failure that exhibited a decreased implantation sites number, thinner endometrium, reduced endometrial glands number, and poor pinopode expression levels are treated with BCR, and these mentioned conditions significantly improves afterward. Molecular docking shows that the main active components kaempferol, quercetin, and hesperetin of BCR stably bound to gasdermin D (GSDMD). Experimental results demonstrate that levels of GSDMD, cleaved caspase-1 and leucine-rich repeat, and pyrin domain-containing 3 and IL-1β levels in model mice are significantly decreased and expressions of brain-derived neurotrophic factor (BDNF) and tyrosine protein kinase B (TrkB) expression levels are significantly elevated after BCR treatments, and that the DNA damage is significantly reversed in BCR-treated mice. CONCLUSIONS BCR is potent and effective in ameliorating endometrial receptivity. The potential mechanisms of BCR on endometrial receptivity may mediate by activating BDNF/TrkB pathway activation and protecting endometrial cells' protection against pyroptosis.
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Affiliation(s)
- Mei Jiang
- Beijing Research Institute of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Ling Huang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Yuxi Wang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Yao Wang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, 100029, China
- National Key Laboratory of Efficacy and Mechanism on Chinese Medicine for Metabolic Diseases, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Qianjun Kang
- Beijing Research Institute of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Cong Chen
- Beijing Research Institute of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Yujie Hu
- Ziqiang Vocational School of Shaanxi Province, Shaanxi Province, 721000, China
| | - Jialin Li
- Beijing Research Institute of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Ting Wang
- Beijing Research Institute of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
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18
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Lustgarten Guahmich N, Borini E, Zaninovic N. Improving outcomes of assisted reproductive technologies using artificial intelligence for sperm selection. Fertil Steril 2023; 120:729-734. [PMID: 37307892 DOI: 10.1016/j.fertnstert.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/06/2023] [Indexed: 06/14/2023]
Abstract
Within the field of assisted reproductive technology, artificial intelligence has become an attractive tool for potentially improving success rates. Recently, artificial intelligence-based tools for sperm evaluation and selection during intracytoplasmic sperm injection (ICSI) have been explored, mainly to improve fertilization outcomes and decrease variability within ICSI procedures. Although significant advances have been achieved in developing algorithms that track and rank single sperm in real-time during ICSI, the clinical benefits these might have in improving pregnancy rates from a single assisted reproductive technology cycle remain to be established.
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Affiliation(s)
- Nicole Lustgarten Guahmich
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York
| | - Elena Borini
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York
| | - Nikica Zaninovic
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York.
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19
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Eisenberg ML, Esteves SC, Lamb DJ, Hotaling JM, Giwercman A, Hwang K, Cheng YS. Male infertility. Nat Rev Dis Primers 2023; 9:49. [PMID: 37709866 DOI: 10.1038/s41572-023-00459-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/16/2023]
Abstract
Clinical infertility is the inability of a couple to conceive after 12 months of trying. Male factors are estimated to contribute to 30-50% of cases of infertility. Infertility or reduced fertility can result from testicular dysfunction, endocrinopathies, lifestyle factors (such as tobacco and obesity), congenital anatomical factors, gonadotoxic exposures and ageing, among others. The evaluation of male infertility includes detailed history taking, focused physical examination and selective laboratory testing, including semen analysis. Treatments include lifestyle optimization, empirical or targeted medical therapy as well as surgical therapies that lead to measurable improvement in fertility. Although male infertility is recognized as a disease with effects on quality of life for both members of the infertile couple, fewer data exist on specific quantification and impact compared with other health-related conditions.
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Affiliation(s)
- Michael L Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Sandro C Esteves
- ANDROFERT Andrology and Human Reproduction Clinic, Campinas, Brazil
- Division of Urology, Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Dolores J Lamb
- Center for Reproductive Genomics, Weill Cornell Medical College, New York, NY, USA
- Englander Institute for Precision Medicine, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Kathleen Hwang
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yu-Sheng Cheng
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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20
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Rosa IR, Barbosa CP, Ferrandez CA, Sonoda BDB, Christofolini DM, Trevisan CM, Laganà AS, Peluso C, Bianco B. Involvement of SYCP2L and TDRD3 gene variants on ovarian reserve and reproductive outcomes: a cross-sectional study. JBRA Assist Reprod 2023; 27:428-435. [PMID: 37417852 PMCID: PMC10712833 DOI: 10.5935/1518-0557.20220074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/26/2022] [Indexed: 07/08/2023] Open
Abstract
OBJECTIVE Single nucleotide variants have been implicated in the response to fertility treatment and a pharmacogenomic approach may help to customize therapy based on patient genome. We aimed to evaluate the effect, individual and combined, of SYCP2L (rs2153157:G>A) and TDRD3 (rs4886238:G>A) variants on ovarian reserve, response to controlled ovarian stimulation (COS) and reproductive outcomes of women undergoing in vitro fertilization (IVF) treatment. METHODS This cross-sectional study included 149 normoovulatory women undergoing IVF. Genotyping was performed using the TaqMan real-time polymerase chain reaction method. Clinical parameters and reproductive outcomes were compared according to the genotypes of the variants studied. RESULTS Considering ovarian reserve, there were no significant differences among SYCP2L or TDRD3 genotypes in terms of FSH levels or AFC; however, AMH levels were significantly different in carriers of both variants. Regarding the SYCP2L rs2153157:G>A variant, lower AMH levels were observed in women carrying an AA genotype compared to women carrying a heterozygous genotype (p=0.01). Considering the TDRD3 rs4886238:G>A variant, women carrying an AA genotype presented higher AMH levels than carriers of GG and GA genotypes (p=0.025). Nevertheless, no difference was found regarding response to COS or reproductive outcomes. Considering the combined effect of the variants, women carrying the heterozygous genotype of both variants presented statistically increased AMH levels compared to SYCP2L rs2153157 AA genotype carriers and TDRD3 rs4886238 GG genotype carriers (p=0.042). CONCLUSIONS Individually and combined, the SYCP2L rs2153157 and TDRD3 rs4886238 variants have an effect on AMH level.
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Affiliation(s)
- Iasmim Ribeiro Rosa
- Discipline of Sexual and Reproductive Health and Populational
Genetics, Department of Collective Health, Faculdade de Medicina do ABC/Centro
Universitário Saúde ABC, FMABC, Santo André, São Paulo,
Brazil
| | - Caio Parente Barbosa
- Discipline of Sexual and Reproductive Health and Populational
Genetics, Department of Collective Health, Faculdade de Medicina do ABC/Centro
Universitário Saúde ABC, FMABC, Santo André, São Paulo,
Brazil
- Instituto Ideia Fértil, Santo André, Brazil
| | - Caroline Awoki Ferrandez
- Discipline of Sexual and Reproductive Health and Populational
Genetics, Department of Collective Health, Faculdade de Medicina do ABC/Centro
Universitário Saúde ABC, FMABC, Santo André, São Paulo,
Brazil
| | - Bianca Del Bel Sonoda
- Discipline of Sexual and Reproductive Health and Populational
Genetics, Department of Collective Health, Faculdade de Medicina do ABC/Centro
Universitário Saúde ABC, FMABC, Santo André, São Paulo,
Brazil
| | - Denise Maria Christofolini
- Discipline of Sexual and Reproductive Health and Populational
Genetics, Department of Collective Health, Faculdade de Medicina do ABC/Centro
Universitário Saúde ABC, FMABC, Santo André, São Paulo,
Brazil
- Instituto Ideia Fértil, Santo André, Brazil
| | - Camila Martins Trevisan
- Discipline of Sexual and Reproductive Health and Populational
Genetics, Department of Collective Health, Faculdade de Medicina do ABC/Centro
Universitário Saúde ABC, FMABC, Santo André, São Paulo,
Brazil
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico - Di Cristina -
Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal
Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Carla Peluso
- Discipline of Sexual and Reproductive Health and Populational
Genetics, Department of Collective Health, Faculdade de Medicina do ABC/Centro
Universitário Saúde ABC, FMABC, Santo André, São Paulo,
Brazil
| | - Bianca Bianco
- Discipline of Sexual and Reproductive Health and Populational
Genetics, Department of Collective Health, Faculdade de Medicina do ABC/Centro
Universitário Saúde ABC, FMABC, Santo André, São Paulo,
Brazil
- Instituto Ideia Fértil, Santo André, Brazil
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21
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Halpern G, Braga DPDAF, Morishima C, Setti AS, Setti Jr. AI, Borges Jr. E. Beetroot, watermelon and ginger juice supplementation may increase the clinical outcomes of Intracytoplasmic Sperm Injection cycles. JBRA Assist Reprod 2023; 27:490-495. [PMID: 37459441 PMCID: PMC10712821 DOI: 10.5935/1518-0557.20230012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/20/2023] [Indexed: 09/13/2023] Open
Abstract
OBJECTIVE To prove the hypothesis that beetroot, watermelon and ginger juice supplementation improves the endometrial receptivity and clinical outcomes of intracytoplasmic sperm injection (ICSI) cycles. METHODS This prospective randomized study enrolled 436 female patients undergoing ICSI cycles from January/2018 to June/2021, in a private university-affiliated IVF center. Female patients were randomized in a 1:3 ratio to either Control (n=109) or Supplementation Group (n=327). All patients received nutritional orientation before the beginning of the treatment. Participants in the Supplementation Group were instructed to intake a daily dose of homemade juice, prepared with fresh beetroot, watermelon and ginger, from the day of embryo transfer until the day of pregnancy test, while patients in Control Group did not follow the juice protocol. Generalized Linear Models, adjusted for potential confounders (female age, body mass index - BMI, endometrial thickness upon embryo transfer, and number of transferred embryos), followed by Bonferroni post hoc test for the comparison of means between groups, were used to investigate the impact of juice supplementation on the clinical outcomes of ICSI. RESULTS Patients and cycles characteristics were equally distributed among Supplementation and Control groups. Implantation rate (25.2% vs. 20.5%, p<0.001) and clinical pregnancy rate (41.0% vs. 22.0%, p=0.039) were significantly higher in the Supplementation compared to the Control group. CONCLUSIONS The use of beetroot, watermelon and ginger juice may be considered a promising strategy for improving clinical outcomes in assisted reproductive technology (ART), without any side effects.
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Affiliation(s)
- Gabriela Halpern
- Fertility Medical Group, Av. Brigadeiro Luiz Antônio, 4545.
São Paulo – SP, Brazil. Zip: 01401-002
| | - Daniela Paes de Almeida Ferreira Braga
- Fertility Medical Group, Av. Brigadeiro Luiz Antônio, 4545.
São Paulo – SP, Brazil. Zip: 01401-002
- Instituto Sapientiae – Centro de Estudos e Pesquisa em
Reprodução Assistida Rua Vieira Maciel, 62. São Paulo – SP,
Brazil. Zip: 04503-040
| | - Christina Morishima
- Instituto Sapientiae – Centro de Estudos e Pesquisa em
Reprodução Assistida Rua Vieira Maciel, 62. São Paulo – SP,
Brazil. Zip: 04503-040
| | - Amanda Souza Setti
- Fertility Medical Group, Av. Brigadeiro Luiz Antônio, 4545.
São Paulo – SP, Brazil. Zip: 01401-002
- Instituto Sapientiae – Centro de Estudos e Pesquisa em
Reprodução Assistida Rua Vieira Maciel, 62. São Paulo – SP,
Brazil. Zip: 04503-040
| | | | - Edson Borges Jr.
- Fertility Medical Group, Av. Brigadeiro Luiz Antônio, 4545.
São Paulo – SP, Brazil. Zip: 01401-002
- Instituto Sapientiae – Centro de Estudos e Pesquisa em
Reprodução Assistida Rua Vieira Maciel, 62. São Paulo – SP,
Brazil. Zip: 04503-040
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22
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Adamson GD, Zegers-Hochschild F, Dyer S. Global fertility care with assisted reproductive technology. Fertil Steril 2023; 120:473-482. [PMID: 36642305 DOI: 10.1016/j.fertnstert.2023.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
Assisted reproductive technology has progressed greatly since the birth of Louise Brown in 1978. The pregnancy rates have increased, care is safer with significantly reduced multiple pregnancy and complication rates, infants have good health, and millions of people have been able to have the families they desired. The major challenges facing assisted reproductive technology are to continue to increase the quality of care, increase utilization through more societal funding, and expand care to nontraditional and marginalized populations in all countries, especially lower- and middle-income countries where access is currently limited. Significant collaboration among professionals, organizations, the World Health Organization, and policymakers is occurring and will be necessary to achieve these goals.
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Affiliation(s)
- G David Adamson
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, ACF, Stanford University, Stanford, California.
| | - Fernando Zegers-Hochschild
- Programa de Ética y Políticas Públicas en Reproducción Humana Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
| | - Silke Dyer
- Reproductive Medicine Unit, Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa
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23
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Majangara Karaga R, Archary P, Gwet Bell E, Khrouf M, Loto O, Wada I, Dyer S. The status of ART in the public health sector in Africa: a multi-country survey. Reprod Biomed Online 2023; 47:103213. [PMID: 37236886 DOI: 10.1016/j.rbmo.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/02/2023] [Accepted: 04/06/2023] [Indexed: 05/28/2023]
Abstract
RESEARCH QUESTION What is the current availability of treatment with assisted reproductive technology (ART) in the public sector in Africa, and what are the facilitators and barriers towards its provision? DESIGN Cross-sectional quantitative and qualitative data were collected in two phases from February 2020 to October 2021. Key informants were identified from countries known to provide ART in Africa based on data from the African Network and Registry for Assisted Reproductive Technology and the 2019 Surveillance from the International Federation of Fertility Societies. Quantitative data were collected via a structured questionnaire (Phase 1); public centre-specific quantitative and qualitative data were then collected via a semi-structured questionnaire followed by a virtual interview (Phase 2). Data were analysed descriptively. RESULTS Informants from 18 countries reported the existence of 185 ART centres in 16 countries. Twenty-four centres (13.0%) in 10 of 16 countries (62.5%) were public. The majority of public centres (20/22 [90.9%]) reporting on ART performed <500 ART cycles per annum. Although public institutions covered most of the cost for ART, copayments from patients were universally required. The number of ART cycles per annum was inversely correlated to the copayment. Lack of policy and legislation, high costs and bureaucratic obstacles were identified by participants as the leading challenges in the delivery of public service ART. CONCLUSION Lack of public ART services leads to chronic and profound health inequities. Enablers of public service ART in the region are the same known to support ART services in general, namely policy and legislation, appropriate funding and good health service infrastructure. Addressing these requires the collated efforts of many stakeholders.
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Affiliation(s)
- Rumbidzai Majangara Karaga
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Paversan Archary
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; African Network and Registry for Assisted Reproductive Technology, Cape Town, South Africa
| | - Ernestine Gwet Bell
- Groupe Interafricain d'Etude, de Recherche et d'Application sur la Fertilité, Lome, Togo
| | - Mohamed Khrouf
- Groupe d'Etude de la Fertilité de la Société Tunisienne de Gynécologie Obstétrique, Tunis, Tunisia
| | - Olabisi Loto
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University, Ile-Ife, Nigeria; Association for Fertility and Reproductive Health, Lagos, Nigeria
| | - Ibrahim Wada
- Association for Fertility and Reproductive Health, Lagos, Nigeria
| | - Silke Dyer
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; African Network and Registry for Assisted Reproductive Technology, Cape Town, South Africa
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24
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Wang X, Xiao Y, Tao T, Xiong W. Influence of maternal age on the birthweight of infants delivered from frozen-thawed blastocyst transfer cycles. Front Endocrinol (Lausanne) 2023; 14:1195256. [PMID: 37497353 PMCID: PMC10368368 DOI: 10.3389/fendo.2023.1195256] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/09/2023] [Indexed: 07/28/2023] Open
Abstract
The aim of this study was to investigate whether maternal age had an effect on the birthweight of singletons delivered from frozen-thawed blastocyst transfer (FBT) cycles. A total of 1203 FBT cycles occurring between July 2011 and June 2021 at a single centre were retrospectively analysed. Based on the maternal age at FBT, the patients were divided into four groups: <30, 30-34, 35-37, and ≥38 years of age. Main outcomes measured included singleton birthweights, preterm births, large-for-gestational-age (LGA) and small-for-gestational-age (SGA) live births among the groups. There was no significant difference in birth weight among the four groups, while the highest birth weight was found in the <30 years group. The incidence of very preterm births and very low birth weights demonstrated an increasing trend with age; on the contrary, the incidence of preterm births, low birth weight (LBW), high birth weight and LGA and SGA live births gradually decreased with increasing age, but these differences were not statistically significant among groups (P>0.05, respectively). Although the proportion of females was lower than that of males, the difference was not statistically significant among the groups. After adjusting for possible confounders, maternal age was found to have no effect on adverse neonatal outcomes in the regression analyses (P>0.05). Birthweight in singleton births from FBT was not affected by maternal age.
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25
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Bolton VN, Perez MJ, Hughes G, Moodley T, Dean M, Fernandez-Ponce A, Southall-Brown G, Kasraie J. The use of ICSI in ART: evidence for practice. HUM FERTIL 2023; 26:414-432. [PMID: 37609991 DOI: 10.1080/14647273.2023.2243071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
This article reviews the evidence regarding the safety and efficacy of intra-cytoplasmic sperm injection (ICSI). It provides evidence-based clinical and laboratory guidelines and recommendations for use of ICSI within an assisted reproductive technology (ART) service. The guidelines address the evidence for the use of ICSI rather than conventional IVF (cIVF); the use of ART techniques supplementary to ICSI; and risks associated with ICSI. This article is not intended to be the only approved standard of practice or to dictate an exclusive course of treatment. Other plans of management may be appropriate, taking into account the needs and medical history of the patient, available resources, and institutional or clinical practice limitations.
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Affiliation(s)
| | | | - George Hughes
- Assisted Conception Unit, Ninewells Hospital, Dundee, UK
| | - Therishnee Moodley
- The Centre for Reproductive Medicine, St. Bartholomew's Hospital, London, UK
| | - Morven Dean
- Assisted Conception Unit, Ninewells Hospital, Dundee, UK
| | | | | | - Jason Kasraie
- University of Chester and University Centre Shrewsbury, Chester, UK
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26
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Mínguez-Alarcón L, Williams PL, Souter I, Ford JB, Hauser R, Chavarro JE. Perceived stress and markers of ovarian reserve among subfertile women. Reprod Biomed Online 2023; 46:956-964. [PMID: 37085427 PMCID: PMC10247401 DOI: 10.1016/j.rbmo.2023.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/11/2023]
Abstract
RESEARCH QUESTION Is self-reported psychological stress associated with markers of ovarian reserve among subfertile women? DESIGN Observational study of women (n = 520) seeking fertility care at the Massachusetts General Hospital who enrolled in the Environment and Reproductive Health study between 2005 and 2019. Women completed the short version of the validated PSS4, which assesses psychological stress. Ovarian reserve markers included AFC and circulating serum levels of day-3 FSH, with AMH assessed in a subset of participants (n = 185). RESULTS Higher total PSS4 scores were negatively associated with AFC and serum AMH levels. Analyses adjusted for age, BMI, race, smoking, education, physical activity and type of infertility diagnosis. Women in the second and third tertiles of stress had lower AFC (13.3, 95% CI 12.7 to 13.8; and 13.5, 95% CI 13.0 to 14.1) compared with women in the lowest tertile of psychological stress score (14.3, 95% CI 13.8 to 14.9, both P < 0.05). Women in the second and third tertiles of total PSS4 scores also had lower mean serum AMH compared with women in the lowest tertile (2.99, 95% CI 2.24 to 3.74), and (2.99 95% CI 2.22 to 3.76) versus (3.94 95% CI 3.23 to 4.64). These associations varied by several socioeconomic factors, and were observed among women who were younger, belonging to minority races, with a college degree or with annual household income less than $100,000. CONCLUSIONS Higher perceived stress was negatively associated with AFC and serum AMH levels. These associations varied by several socioeconomic factors.
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Affiliation(s)
- Lidia Mínguez-Alarcón
- Channing Division of Network Medicine, Harvard Medical School and Brigham and Women's Hospital; Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, USA.
| | - Paige L Williams
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, USA; Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, USA
| | - Irene Souter
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jennifer B Ford
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, USA
| | - Russ Hauser
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, USA; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, USA
| | - Jorge E Chavarro
- Channing Division of Network Medicine, Harvard Medical School and Brigham and Women's Hospital; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, USA; Departments of Nutrition, Harvard TH Chan School of Public Health, Boston, USA
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Vaiarelli A, Zacà C, Spadoni V, Cimadomo D, Conforti A, Alviggi C, Palermo R, Bulletti C, De Santis L, Pisaturo V, Vigiliano V, Scaravelli G, Ubaldi FM, Borini A. Clinical and laboratory key performance indicators in IVF: A consensus between the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR) and the Italian Society of Embryology, Reproduction and Research (SIERR). J Assist Reprod Genet 2023:10.1007/s10815-023-02792-1. [PMID: 37093443 DOI: 10.1007/s10815-023-02792-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/30/2023] [Indexed: 04/25/2023] Open
Abstract
PURPOSE Infertility is increasing worldwide, and many couples seek IVF. Clinical management and laboratory work are fundamental in the IVF journey. Therefore, the definition of reliable key performance indicators (KPIs) based on clinical and laboratory parameters, is essential for internal quality control (IQC). Laboratory performance indicators have been identified and a first attempt to also determine clinical ones has been recently published. However, more detailed indicators are required. METHODS An Italian group of experts in Reproductive Medicine from both public and private clinics on behalf of SIFES-MR and SIERR was established to define IVF indicators to monitor clinical performance. RESULTS The working group built a consensus on a list of KPIs, performance indicators (PIs) and recommendation indicators (RIs). When deemed necessary, the reference population was stratified by woman age, response to ovarian stimulation and adoption of preimplantation genetic testing for aneuploidies (PGT-A). Each indicator was scored with a value from 1 to 5 and a weighted average formula - considering all the suggested parameters-was defined. This formula generates a center performance score, indicating low, average, good, or excellent performance. CONCLUSION This study is intended to provide KPIs, PIs and RIs that encompass several essential aspects of a modern IVF clinic, including quality control and constant monitoring of clinical and embryological features. These indicators could be used to assess the quality of each center with the aim of improving efficacy and efficiency in IVF.
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Affiliation(s)
- Alberto Vaiarelli
- GeneraLife IVF, Clinica Valle Giulia, Via G. De Notaris, 2B, Rome, Italy.
| | | | | | - Danilo Cimadomo
- GeneraLife IVF, Clinica Valle Giulia, Via G. De Notaris, 2B, Rome, Italy
| | - Alessandro Conforti
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Carlo Alviggi
- Department of Public Health, Federico II University, Naples, Italy
| | - Roberto Palermo
- Unità Di Procreazione Medicalmente Assistita, Centro A.M.B.R.A., Palermo, Italy
| | - Carlo Bulletti
- Department of Obstetrics, Gynecology and Reproductive Science, Yale University, New Haven, CT, USA
- Scientific Partner of Incintas Therapeutics, New Haven, CT, USA
| | - Lucia De Santis
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Valerio Pisaturo
- Fondazione IRCCS, Ca' Granda, Ospedale Maggiore, Policlinico Di Milano, Milan, Italy
| | - Vincenzo Vigiliano
- ART Italian National Register, National Center for Diseases Prevention and Health Promotion, National Health Institute, Rome, Italy
| | - Giulia Scaravelli
- ART Italian National Register, National Center for Diseases Prevention and Health Promotion, National Health Institute, Rome, Italy
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Holschbach V, Kordes H, Dietrich JE, Bruckner T, Strowitzki T, Germeyer A. Patient- and cycle-specific factors affecting the outcome of frozen-thawed embryo transfers. Arch Gynecol Obstet 2023; 307:2001-2010. [PMID: 37061986 PMCID: PMC10147814 DOI: 10.1007/s00404-023-07019-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/21/2023] [Indexed: 04/17/2023]
Abstract
PURPOSE This study attempted at identifying the main parameters influencing the outcome of frozen embryo transfers. METHODS This is a single-center retrospective cohort study of 830 frozen-embryo-transfer cycles performed at a German university hospital from January 2012 to December 2016. Main outcome parameters were the clinical pregnancy and live birth rate. Twelve patient- and cycle-dependent factors were analyzed in terms of their influence on the outcome of frozen embryo transfers. Multivariate logistic regression analysis was used for the modelling of the dependency of the different parameters on outcomes. RESULTS The clinical pregnancy rate in our study was 25.5%, the live birth rate was 16.1% with an average maternal age of 34.2 years at the time of the oocyte retrieval. In the univariate analysis age, number of transferred embryos, blastocyst versus cleavage stage transfer, embryo quality and mode of endometrial preparation affected the birth rate significantly. The birth rate after artificial endometrial preparation was significantly lower than the birth rate after transfers in modified natural cycles (12.8 versus 20.6% with p = 0.031). The multivariate logistic regression analysis showed a significant independent influence of age, number of transferred embryos, culture duration and mode of endometrial preparation on the frozen embryo transfer success rates. Body mass index, nicotine abuse, a history of PCO syndrome or endometriosis and the co-transfer of a second poor-quality embryo to a good-quality embryo appeared to be irrelevant for the outcome in our collective. CONCLUSION Age, number of transferred embryos, embryo culture duration and the mode of endometrial preparation are independent predictive factors of frozen embryo transfer outcomes.
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Affiliation(s)
- Verena Holschbach
- Department of Gynecologic Endocrinology and Fertility Disorders, Heidelberg University Hospital, INF440, 69120, Heidelberg, Germany.
| | - Hannah Kordes
- Department of Gynecologic Endocrinology and Fertility Disorders, Heidelberg University Hospital, INF440, 69120, Heidelberg, Germany
| | - Jens Erik Dietrich
- Department of Gynecologic Endocrinology and Fertility Disorders, Heidelberg University Hospital, INF440, 69120, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, INF 130, 69120, Heidelberg, Germany
| | - Thomas Strowitzki
- Department of Gynecologic Endocrinology and Fertility Disorders, Heidelberg University Hospital, INF440, 69120, Heidelberg, Germany
| | - Ariane Germeyer
- Department of Gynecologic Endocrinology and Fertility Disorders, Heidelberg University Hospital, INF440, 69120, Heidelberg, Germany
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Zhang Q, Wang X, Li Z, Wang Y, Lu H, Xiao Y, Yu Y. Association between endometrial blood and clinical outcome in frozen single blastocyst transfer cycles. Front Physiol 2023; 14:1113853. [PMID: 36994421 PMCID: PMC10040739 DOI: 10.3389/fphys.2023.1113853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/02/2023] [Indexed: 03/18/2023] Open
Abstract
Background: The success of embryo transfer cycle depends mainly on the quality of embryo and endometrial receptivity. Ultrasound examination is still the most widely used non-invasive evaluation method for its advantages of convenience, non-invasiveness and repeatability. Ultrasound-measured endometrial blood flow is one of the important evaluation indicators of morphology. Aims: To investigate the effect of the number of endometrial blood flow branches on pregnancy outcome of frozen-thawed embryo transfer cycles which have undergoing hormone replacement therapy (HRT-FET). Material and methods: A retrospective cohort study was performed looking at a total of 1390 HRT-FET cycles from our reproductive medicine center between January 2017 to December 2021, which transferred one blastocyst frozen on day 5 with good quality in morphology. Associations between endometrial blood flow branches and pregnancy outcomes were evaluated with multivariable linear regression analysis. Results: The number of endometrial blood flow branches was independently associated with clinical pregnancy (OR 1.10; 95% CI 1.02-1.20). After adjusting for potential confounders, the effect size (odds ratio) was 1.09 (95% CI 1.00-1.19), and the results showed that the clinical pregnancy rate and live birth rate of T2 and T3 groups were significantly higher than those in group T1 (p < 0.05). Subgroup analysis showed that a consistent association between the endometrial blood flow branches and clinical pregnancy in all subgroups. Conclusion: Our study provided evidence for the influence of endometrial blood flow on pregnancy outcomes. There may be an independent association between the number of endometrial blood flow branches and pregnancy outcomes in frozen-thawed single blastocyst transfer cycles.
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Affiliation(s)
- Qian Zhang
- Department of Reproductive Medicine, General Hospital of Northern Theater Command, Shenyang, China
| | - Xiaolong Wang
- Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang, China
| | - Zhishu Li
- Department of Reproductive Medicine, General Hospital of Northern Theater Command, Shenyang, China
| | - Yinghua Wang
- Department of Reproductive Medicine, General Hospital of Northern Theater Command, Shenyang, China
| | - Hai’Ou Lu
- Department of Reproductive Medicine, General Hospital of Northern Theater Command, Shenyang, China
| | - Yuhong Xiao
- Department of Reproductive Medicine, General Hospital of Northern Theater Command, Shenyang, China
| | - Yuexin Yu
- Department of Reproductive Medicine, General Hospital of Northern Theater Command, Shenyang, China
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Ribas-Maynou J, Novo S, Salas-Huetos A, Rovira S, Antich M, Yeste M. Condensation and protamination of sperm chromatin affect ICSI outcomes when gametes from healthy individuals are used. Hum Reprod 2023; 38:371-386. [PMID: 36539233 DOI: 10.1093/humrep/deac261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
STUDY QUESTION Do defects in sperm chromatin protamination and condensation have an impact on ICSI outcomes? SUMMARY ANSWER Sperm protamination is related to fertilization rates in healthy donors, and the in vitro capacity of sperm to condense their chromatin is linked to blastocyst rates, both associations being more apparent in women <33 years of age. WHAT IS KNOWN ALREADY Previous data on how sperm chromatin damage affects ICSI outcomes are inconsistent. Revealing which sperm factors influence embryo development is necessary to understand the male contribution to ICSI success and to develop novel sperm selection techniques or male-based treatments. Sperm chromatin is mainly condensed in protamines, which are cross-linked through disulphide bridges. This study aimed to determine whether sperm protamination and the integrity of disulphide bonds (condensation) are related to embryo development after ICSI. STUDY DESIGN, SIZE, DURATION The design was a retrospective study with a blind analysis of sperm chromatin. Gametes were divided into two groups: double donation (DD) cohort and single donation (SD) cohort. Samples from 45 semen donors used in 55 ICSI cycles with oocyte donors (age range 19-33 years), generating 491 embryos, were included in the DD cohort. The SD cohort consisted of samples from 34 semen donors used in 41 ICSI cycles with oocytes from healthy females (single-parent families or lesbian couples, age range 20-44 years), generating a total of 378 embryos. PARTICIPANTS/MATERIALS, SETTINGS, METHODS Donor sperm samples from DD and SD cohorts were used for standard ICSI, and embryo development was observed by time-lapse imaging. The incidence of thiol reduction (dibromobimane, DBB) and the degree of chromatin protamination (chromomycin A3, CMA3, indicating non-protaminated regions) in sperm were determined by flow cytometry at 0 and 4 h post-thawing. MAIN RESULTS AND THE ROLE OF CHANCE Percentages ± standard deviation of CMA3 were 21.08 ± 9.09 and 35.01 ± 14.68 at 0 and 4 h post-thawing, respectively, in the DD cohort and 22.57 ± 9.48 and 35.79 ± 12.58, at 0 and 4 h post-thawing, respectively, in the SD cohort. Percentages of DBB+ were 16.57 ± 11.10 and 10.51 ± 8.40 at 0 and 4 h post-thawing (P < 0.0001), respectively, in the DD cohort and 17.98 ± 10.19 and 12.72 ± 8.76 at 0 and 4 h post-thawing (P < 0.0001), respectively, in the SD cohort. Female age correlated with fertilization rates, and the relation between sperm chromatin and embryo development was determined through multiple linear regression. While CMA3 was associated with fertilization rates, with no influence of female age, in the DD cohort (β1 = -1.036, P < 0.001 for CMA3; β2 = 0.667, P = 0.304 for female age), this was not observed in the SD cohort, where female age had a significant effect, masking the effects of CMA3 (β1 = -0.066, P = 0.804 for CMA3; β 2 = -1.451, P = 0.003 for female age). The in vitro capacity of sperm to condense their chromatin after 4 h of incubation was associated with blastocyst rates, independent of female age (DD cohort: β1 = -0.238, P = 0.008 for %DBB+ variation; β2 = 0.404, P = 0.638 for female age; SD cohort: β1 = -0.278, P = 0.010 for %DBB+ variation; β2 = -0.292, P = 0.594 for female age). The in vitro capacity of sperm to condense their chromatin was also related to the time required for the embryo to reach blastocyst stage in the DD cohort (P = 0.007). Finally, multiple logistic regression showed that both chromatin protamination and condensation, together with the age of the oocyte donors and the embryo recipients, had an impact on pregnancy achievement (P < 0.01) and on live birth rates (P < 0.01). LIMITATIONS, REASONS FOR CAUTION The main limitation was the restrictive selection of couples, which led to a relatively small sample size and could influence the observed outcomes. For this reason, and to reduce Type I error, the level of significance was set at P ≤ 0.01. On the other hand, the use of cryopreserved samples could also be a limitation. WIDER IMPLICATIONS OF THE FINDINGS This research demonstrated that protamination and condensation of sperm chromatin are related to embryo development after ICSI, but female age could be a confounding factor when oocytes from older females are used. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the European Union's Horizon 2020 Research and Innovation scheme under the Marie Skłodowska-Curie grant agreement No 801342 (Tecniospring INDUSTRY; TECSPR-19-1-0003); La Marató de TV3 Foundation (214/857-202039); the Ministry of Science and Innovation, Spain (IJC2019-039615-I); the Catalan Agency for Management of University and Research Grants, Regional Government of Catalonia, Spain (2017-SGR-1229); and the Catalan Institution for Research and Advanced Studies, Spain (ICREA). The authors declare no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Jordi Ribas-Maynou
- Unit of Cell Biology, Department of Biology, Faculty of Sciences, University of Girona, Girona, Spain.,Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, Girona, Spain
| | - Sergi Novo
- Fertilab-Institut Catala de Fertilitat SL, Barcelona, Spain.,Fertibank, Barcelona, Spain
| | - Albert Salas-Huetos
- Unit of Cell Biology, Department of Biology, Faculty of Sciences, University of Girona, Girona, Spain.,Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, Girona, Spain.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sergi Rovira
- Fertilab-Institut Catala de Fertilitat SL, Barcelona, Spain.,Fertibank, Barcelona, Spain
| | - Marta Antich
- Fertilab-Institut Catala de Fertilitat SL, Barcelona, Spain.,Fertibank, Barcelona, Spain
| | - Marc Yeste
- Unit of Cell Biology, Department of Biology, Faculty of Sciences, University of Girona, Girona, Spain.,Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, Girona, Spain.,Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
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Croydon S. Reluctant Rulers: Policy, Politics, and Assisted Reproduction Technology in Japan. Camb Q Healthc Ethics 2022; 32:1-11. [PMID: 36468326 DOI: 10.1017/s0963180122000603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
This article puts the spotlight on the world's largest artificial reproduction technology (ART) industry-that of Japan, seeking to explain the exceptional tardiness of the government there to install a comprehensive legal framework that regulates these practices. By relying on minutes from a conversation with an influential parliamentarian active in this area, as well as official documents, media reports, and an interview conducted with key physicians, the article reconstructs the historical trajectory leading to the enactment in December 2020 of the Assisted Reproduction Technology Act. The author contends that it is only on the background of an overview of what happened in the two decades preceding the promulgation of this Act that a sense can be made of why the latter came to be as scant and evasive as it is in terms of provisions, de facto leaving unaltered the socially and ethically undesirable situation of self-regulation in ART application by the Japanese doctors. This article adds credence to the hypothesis with regard to the issue of regulatory governance of emerging technologies more broadly that the direction of travel is toward soft, as opposed to hard, law.
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Affiliation(s)
- Silvia Croydon
- Graduate School of Human Sciences, Osaka University, Osaka, Japan
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32
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Mínguez-Alarcón L, Hammer KC, Williams PL, Souter I, Ford JB, Rexrode KM, Hauser R, Chavarro JE. Self-reported history of comorbidities and markers of ovarian reserve among subfertile women. J Assist Reprod Genet 2022; 39:2719-2728. [PMID: 36322231 PMCID: PMC9790841 DOI: 10.1007/s10815-022-02643-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/19/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To investigate whether history of comorbidities is associated with markers of ovarian reserve among subfertile women. METHODS This observational study includes 645 women seeking fertility care at the Massachusetts General Hospital who enrolled in the Environment and Reproductive Health (EARTH) study (2005-2019). Women completed a comprehensive questionnaire including medical diagnosis of comorbidities. Ovarian reserve markers including antral follicle count (AFC), assessed by transvaginal ultrasound, and circulating serum levels of day 3 FSH and AMH, are assessed by immunoassays. We fit linear regression models to evaluate the association between history of comorbidities and markers of ovarian reserve while adjusting for confounders. RESULTS Self-reported history of hypertension, cancer, and neurological disorders was negatively associated with AFC in unadjusted models and in adjusted models for age, smoking, physical activity, comorbidity count, and BMI. Adjusted mean AFC (95% CI) was lower among women with history of hypertension, compared to women with no self-reported history of hypertension (11.5 vs 15.6, p value 0.0001). In contrast, day 3 FSH levels were positively related to history of eating disorders in both unadjusted and adjusted models (10.8 vs. 7.43 IU/L, p value ≤ 0.0001). Self-reported history of other comorbidities was unrelated to AFC, day 3 FSH, and AMH levels. CONCLUSIONS History of hypertension, cancer, and neurological disorders was negatively associated with AFC, and eating disorders were positively related to day 3 FSH levels. The prevention of common comorbidities among women in reproductive age may help increase women's fertility given the declining birth rates and increasing use of assisted reproductive technologies in the past years.
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Affiliation(s)
- Lidia Mínguez-Alarcón
- Channing Division of Network Medicine, Harvard Medical School & Brigham and Women's Hospital, Boston, MA, USA.
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, MA, 02115, USA.
| | - Karissa C Hammer
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Paige L Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Irene Souter
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jennifer B Ford
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, MA, 02115, USA
| | - Kathryn M Rexrode
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, MA, 02115, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, MA, Boston, USA
| | - Jorge E Chavarro
- Channing Division of Network Medicine, Harvard Medical School & Brigham and Women's Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Martins R, Connolly MP. Valuing live births from assisted reproduction: A health economics viewpoint. Best Pract Res Clin Obstet Gynaecol 2022; 85:149-158. [PMID: 36443158 DOI: 10.1016/j.bpobgyn.2022.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 12/14/2022]
Abstract
Infertility is a medical condition that can be overcome, thanks to advances in medically assisted reproductive (MAR) therapies. Despite the ultimate measure of MAR efficacy being the birth of a new human being, there are ethical and methodological questions as to which outcome best translates the value of MAR in cost-effectiveness analyses. Many authors favour cost per life birth outcomes instead of more traditional cost per quality-adjusted life years (QALYs), which raises generalizability issues for decision-makers. Nonetheless, infertility and infertility treatments substantially differ from other health conditions and health treatments, particularly in the way they affect the quality of life of the infertile couple. Collecting quality of life measures in infertility and pregnancy is also surrounded by challenges not easily overcome. We reflect on cost-effectiveness methods applied to MAR technologies, on ethical considerations for valuing a MAR-generated life, and on its broader societal value for consideration by decision-makers.
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Affiliation(s)
- Rui Martins
- Global Market Access Solutions, Health Economics Unit, St-Prex, Switzerland; University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Mark P Connolly
- Global Market Access Solutions, Health Economics Unit, St-Prex, Switzerland; Unit of Pharmacoepidemiology & Pharmacoeconomics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands.
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Zhang L, Cai H, Li W, Tian L, Shi J. Duration of infertility and assisted reproductive outcomes in non-male factor infertility: can use of ICSI turn the tide? BMC Womens Health 2022; 22:480. [DOI: 10.1186/s12905-022-02062-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 11/10/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
Intracytoplasmic sperm injection (ICSI) is increasingly used among in vitro fertilization (IVF) cycles without male factor infertility. For couples with prolonged infertility duration, the preferred insemination method may vary across laboratories and clinics. We analyzed whether ICSI is effective for non-male factor infertility with long infertility duration.
Methods
Seventeen thousand four hundred seventy-seven IVF/ICSI cycles from women with non-male factor infertility were included, of these 4177 women with infertility duration ≥ 5 years were in the final analysis. Primary outcome was the live birth rate after first embryo transfer. Secondary outcomes were rates of clinical pregnancy and fertilization.
Results
A nonlinear relationship was observed between infertility duration and IVF fertilization rate, which decreased with infertility years up to the turning point (4.8 years). 4177 women with infertility ≥ 5 years were categorized by IVF (n = 3806) or ICSI (n = 371). Live birth rate after first embryo transfer was 43.02% in ICSI and 47.85% in IVF group (adjusted odds ratio (aOR), 0.91; 95% confidence interval (CI), 0.72–1.15). Fertilization rate per metaphaseII (aOR, 1.10; 95% CI, 0.86–1.40) and clinical pregnancy rate (aOR, 0.89; 95% CI, 0.71–1.13) were similar between the two groups. Sensitive analyses (women ≥ 35 years) did not show a benefit of ICSI over IVF.
Conclusions
Women with infertility exceeding 4.8 years had decreased incidence of IVF fertilization. The use of ICSI showed no significant improvement in fertilization and live birth rates for non-male factor couples with ≥ 5 years of infertility.
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Wu Y, Lu X, Fu Y, Zhao J, Ma L. Comparison of frozen-thawed embryo transfer strategies for the treatment of infertility in young women: a retrospective study. PeerJ 2022; 10:e14424. [PMID: 36452075 PMCID: PMC9703987 DOI: 10.7717/peerj.14424] [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: 07/01/2022] [Accepted: 10/29/2022] [Indexed: 11/27/2022] Open
Abstract
Objective To investigate transfer strategies in the frozen-thawed embryo transfer (FET) cycle. Methods The clinical data of 1,652 FET patients were divided into five groups according to the number and quality of the transferred blastocyst: high-quality single blastocyst group (group A, n = 558), high-quality plus poor-quality double blastocyst group (group B, n = 435), poor-quality double blastocyst group (group C, n = 241), high-quality double blastocyst group (group D, n = 298), and poor-quality single blastocyst group (group E, n = 120). Inter-group comparison analyses of primary conditions, pregnancy outcomes and neonatal outcomes were then performed. Results Group A had the highest embryo implantation rate (67.38%), significantly different from the implantation rates of the other four groups. The gemellary pregnancy rate (1.60%), preterm birth rate (5.58%), neonatal birth weight (3,350g [3,000g, 3,650g]), neonatal birth age (39.57 weeks [38.71, 40.34]), and incidence of low birth weight (7.02%) in group A were different from those in groups B, C, and D, but did not significantly differ from those in group E. Moreover, the proportions of male infants born in groups A (56.86%) and D (59.41%) were significantly higher than those in the other three groups. Double blastocyst transfer (0.528, 95% CI [0.410-0.680], P < 0.001) and high-quality blastocyst transfer (0.609, 95% CI [0.453-0.820], P = 0.001) were found to be protective factors for live birth. In addition, double blastocyst transfer was also the largest risk factor for pregnancy complications (3.120, 95% CI [2.323-4.190], P < 0.001) and neonatal complications (2.230, 95% CI [1.515-3.280], P < 0.001), especially for gemellary pregnancy (59.933, 95% CI [27.298-131.58], P < 0.001) and preterm birth (3.840, 95% CI [2.272-6.489], P < 0.001). Based on the ROC curves, a double blastocyst transfer could predict gemellary pregnancy reliably with a high area under the curve (AUC = 78.53%). Additionally, a double blastocyst transfer could effectively predict a high risk of pregnancy complications (AUC = 65.90%), neonatal complications (AUC = 64.80%) and preterm birth (AUC = 66.20%). Conclusion The live birth rate of frozen-thawed high-quality single blastocyst transfer is lower than that of double high-quality blastocyst transfer, which can significantly increase the embryo implantation rate. High-quality single blastocyst transfer also significantly lowers the risk of gemellary pregnancy, preterm birth, and low birth weight, and can significantly improve maternal and infant outcomes. After weighing the pros and cons of live birth with pregnancy and neonatal complications, the authors believe that high-quality single blastocyst transfer is the optimal FET strategy for young women and is worthy of further clinical application. Despite this recommendation, high-quality single blastocyst transfer can increase the risk of monozygotic twins, as well as significantly increase the proportion of male infants born.
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Affiliation(s)
- Yanhong Wu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaosheng Lu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yanghua Fu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Junzhao Zhao
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Liangliang Ma
- Department of Vascular Surgery, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Ribas-Maynou J, Barranco I, Sorolla-Segura M, Llavanera M, Delgado-Bermúdez A, Yeste M. Advanced Sperm Selection Strategies as a Treatment for Infertile Couples: A Systematic Review. Int J Mol Sci 2022; 23:ijms232213859. [PMID: 36430331 PMCID: PMC9695162 DOI: 10.3390/ijms232213859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/12/2022] Open
Abstract
Assisted reproductive technology (ART) is an essential tool to overcome infertility, and is a worldwide disease that affects millions of couples at reproductive age. Sperm selection is a crucial step in ART treatment, as it ensures the use of the highest quality sperm for fertilization, thus increasing the chances of a positive outcome. In recent years, advanced sperm selection strategies for ART have been developed with the aim of mimicking the physiological sperm selection that occurs in the female genital tract. This systematic review sought to evaluate whether advanced sperm selection techniques could improve ART outcomes and sperm quality/functionality parameters compared to traditional sperm selection methods (swim-up or density gradients) in infertile couples. According to preferred reporting items for systematic reviews and meta-analyses (PRISMA guidelines), the inclusion and exclusion criteria were defined in a PICOS (population, intervention, comparator, outcome, study) table. A systematic search of the available literature published in MEDLINE-PubMed until December 2021 was subsequently conducted. Although 4237 articles were recorded after an initial search, only 47 studies were finally included. Most reports (30/47; 63.8%) revealed an improvement in ART outcomes after conducting advanced vs. traditional sperm selection methods. Among those that also assessed sperm quality/functionality parameters (12/47), there was a consensus (10/12; 83.3%) about the beneficial effect of advanced sperm selection methods on these variables. In conclusion, the application of advanced sperm selection methods improves ART outcomes. In spite of this, as no differences in the reproductive efficiency between advanced methods has been reported, none can be pointed out as a gold standard to be conducted routinely. Further research addressing whether the efficiency of each method relies on the etiology of infertility is warranted.
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Affiliation(s)
- Jordi Ribas-Maynou
- Unit of Cell Biology, Department of Biology, Faculty of Sciences, University of Girona, 17003 Girona, Spain
- Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, 17003 Girona, Spain
- Correspondence: (J.R.-M.); (I.B.); Tel.: +34-972-419-514 (J.R.-M.); +39-051-209-7011 (I.B.); Fax: +34-972-418-150 (J.R.-M.)
| | - Isabel Barranco
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell’Emilia, 40126 Bologna, Italy
- Correspondence: (J.R.-M.); (I.B.); Tel.: +34-972-419-514 (J.R.-M.); +39-051-209-7011 (I.B.); Fax: +34-972-418-150 (J.R.-M.)
| | - Maria Sorolla-Segura
- Unit of Cell Biology, Department of Biology, Faculty of Sciences, University of Girona, 17003 Girona, Spain
- Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, 17003 Girona, Spain
| | - Marc Llavanera
- Unit of Cell Biology, Department of Biology, Faculty of Sciences, University of Girona, 17003 Girona, Spain
- Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, 17003 Girona, Spain
| | - Ariadna Delgado-Bermúdez
- Unit of Cell Biology, Department of Biology, Faculty of Sciences, University of Girona, 17003 Girona, Spain
- Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, 17003 Girona, Spain
| | - Marc Yeste
- Unit of Cell Biology, Department of Biology, Faculty of Sciences, University of Girona, 17003 Girona, Spain
- Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, 17003 Girona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), 08010 Barcelona, Spain
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De Neubourg D, Dancet EAF, Pinborg A. Single-embryo transfer implies quality of care in reproductive medicine. Reprod Biomed Online 2022; 45:899-905. [PMID: 35927209 DOI: 10.1016/j.rbmo.2022.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/22/2022] [Accepted: 04/04/2022] [Indexed: 12/24/2022]
Abstract
This review appraises evidence on the difference between single- and double-embryo transfer (SET, DET) in assisted reproductive technology (ART) regarding the four healthcare quality dimensions most important to fertility patients and doctors. Regarding safety, not only does DET create the uncontested perinatal risks of twin pregnancies, but compelling evidence has added that singleton pregnancies after a vanishing twin also have poorer perinatal outcomes. SET is as effective as DET, as shown by meta-analyses of randomized controlled trials, comparing two cycles of SET versus DET and shown by cumulative live birth rates of entire ART trajectories of up to six cycles. Proposing SET, which is safer than DET and as effective, as the gold standard is not irreconcilable with patient-centred care if patients are thoroughly informed on the reasoning behind the proposition and welcomed to challenge whether it fits their personal values. The cost-efficiency of SET is clearly higher, which has even induced certain countries to start reimbursing ART on the condition that SET is used. In conclusion, SET should be the gold standard offered to all patients. The question is not whether to apply SET but how to apply it in terms of patient selection, patient-centred counselling and coverage of treatment.
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Affiliation(s)
- Diane De Neubourg
- Center for Reproductive Medicine, Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium.
| | - Eline A F Dancet
- Leuven University Fertility Clinic - Leuven University Hospitals, Leuven, Belgium
| | - Anja Pinborg
- Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Tavousi SA, Behjati M, Milajerdi A, Mohammadi AH. Psychological assessment in infertility: A systematic review and meta-analysis. Front Psychol 2022; 13:961722. [PMID: 36389481 PMCID: PMC9650266 DOI: 10.3389/fpsyg.2022.961722] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 10/03/2022] [Indexed: 11/23/2022] Open
Abstract
Infertility is a prevalent worldwide health issue and is defined by the World Health Organization (WHO) as a global health problem. Considering the importance of the psychological dimensions of infertility, various measurement tools have been used to measure the variables involved in infertility, of which the most widely used are the following: the Symptom Checklist 90 (SCL90), the Brief Symptom Inventory (BSI), the State-Trait Anxiety Inventory Form (STAI), and the Depression Anxiety Stress Scale (DASS). Therefore, given the problems of infertile people in terms of psychological dimensions, the aim of this meta-analysis was to assess the psychological assessment score in infertility. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, we applied an online database with no time restriction. Data were gathered using a random-effect model to estimate the standard mean difference (SMD) for the evaluation of the strength of association analyses. Our data demonstrated a significant higher SCL90 score (CISCL90: 0.96, 0.34–1.57, heterogeneity: 94%, pheterogeneity < 0.001), and a non-significant higher DASS score (CIAnxiety: 0.82, -0.14 to 1.79; CIDepression: 0.8, -0.28 to 1.87; and CIStress: 0.82, -0.24 to 1.88). It is essential to seek for strategies to help infertile patients overcome their infertility-related psychological problems.
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Affiliation(s)
| | - Mohaddeseh Behjati
- Cellular, Molecular and Genetics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Milajerdi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Amir Hossein Mohammadi
- Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran
- *Correspondence: Amir Hossein Mohammadi,
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Hu KL, Yang R, Xu H, Mol BW, Li R, Wang R. Anti-Müllerian hormone in guiding the selection of a freeze-all versus a fresh embryo transfer strategy: a cohort study. J Assist Reprod Genet 2022; 39:2325-2333. [PMID: 35870096 PMCID: PMC9596674 DOI: 10.1007/s10815-022-02564-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/04/2022] [Indexed: 10/16/2022] Open
Abstract
PURPOSE To explore an interaction effect between serum anti-Müllerian hormone (AMH) levels and the relative treatment effect of a freeze-all versus a fresh embryo transfer strategy on live birth. METHODS This was a retrospective cohort study investigating couples with infertility and eligible for both freeze-all and fresh embryo transfer between 2017 and 2019. Women with an absolute indication for a freeze-all strategy were excluded. Multivariable fractional polynomial interaction analysis within a logistic regression model was used to evaluate whether the treatment effect of a freeze-all versus a fresh transfer strategy varied at different AMH levels. Non-linear interactions were also considered. The primary outcome was the live birth after the first transfer. RESULTS A total of 13,503 women underwent a fresh embryo transfer and 2247 women underwent a freeze-all strategy. Live birth rates were slightly higher in the freeze-all group compared to those in the fresh embryo transfer group (35% vs 33%). There was a non-linear interaction between baseline serum AMH levels and the relative treatment effect of a freeze-all strategy versus a fresh transfer strategy on live birth (P = 0.0161). The benefit on live birth from a freeze-all embryo transfer strategy was greatest in women with a high serum level (> 7 ng/ml). The interaction remained valid when different imputation methods were used. CONCLUSION As serum AMH level increased, there was a nonlinear increase in relative treatment effect of a freeze-only transfer versus a fresh transfer strategy on live birth, and such an effect reaches its maximum in women with high AMH levels.
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Affiliation(s)
- Kai-Lun Hu
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, No. 49 HuaYuan North Road, Haidian District, Beijing, 100191, China
| | - Rui Yang
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, No. 49 HuaYuan North Road, Haidian District, Beijing, 100191, China
| | - Huiyu Xu
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, No. 49 HuaYuan North Road, Haidian District, Beijing, 100191, China
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, 3168, Australia
| | - Rong Li
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, No. 49 HuaYuan North Road, Haidian District, Beijing, 100191, China.
| | - Rui Wang
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, 3168, Australia
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Jijo A, Cheredath A, Uppangala S, Lakshmi R. V, Joseph D, Meitei HY, Asampille G, Kumar P, Gowda G. A. N, Kalthur G, Kovacic B, Adiga SK. ICSI in non-male factor infertility patients does not alter metabolomic signature in sibling embryos as evidenced by sensitivity enhanced nuclear magnetic resonance (NMR) spectroscopy. PLoS One 2022; 17:e0273321. [PMID: 36149910 PMCID: PMC9506644 DOI: 10.1371/journal.pone.0273321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 08/06/2022] [Indexed: 11/19/2022] Open
Abstract
Intracytoplasmic sperm injection (ICSI) was developed to overcome male factor infertility, however, there recently has been an increasing trend in ICSI usage irrespective of the etiology, demonstrating an overuse of this insemination technique. There is a limited knowledge on the behaviour of ICSI derived embryos in non-male factor infertility patients. Metabolomic assessment of preimplantation embryos in conjunction with morphological evaluation can provide better understanding of embryonic behaviour. Hence, this study was undertaken to explore if there are any metabolomic differences between IVF and ICSI derived sibling day-5 blastocysts from non-male factor infertility patients. This prospective study included nineteen couples with non-male factor infertility undergoing Assisted Reproductive Technology. The sibling oocytes retrieved from each patient were randomly assigned to two groups and inseminated either by IVF or ICSI. Spent culture media (SCM) in which embryos were cultured up to day 5 were collected and investigated using sensitivity enhanced NMR based metabolite profiling utilizing high resolution (800 MHz) NMR equipped with cryogenically cooled micro-coil (1.7 mm) probe. The metabolomic signature between IVF and ICSI derived sibling blastocysts was assessed. A significant reduction in the concentrations of pyruvate, citrate, glucose and lysine were observed in both IVF and ICSI sibling embryos compared to medium control (P< 0.05-0.001). Further, histidine and valine level was found lower in ICSI embryos compared to medium control (P<0.05) during 96 hours of in vitro culture. Notably, between IVF and ICSI SCM, no significant difference in the concentration of the metabolites was found. Our results suggest that ICSI in non-male factor does not alter the SCM metabolomic signature during 96 hours of embryonic development.
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Affiliation(s)
- Ameya Jijo
- Department of Reproductive Science, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Aswathi Cheredath
- Department of Reproductive Science, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Shubhashree Uppangala
- Department of Reproductive Science, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Vani Lakshmi R.
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - David Joseph
- NMR Research Centre, Indian Institute of Science, Bangalore, India
| | - Huidrom Yaiphaba Meitei
- Department of Reproductive Science, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Gitanjali Asampille
- Department of Reproductive Science, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Pratap Kumar
- Department of Reproductive Medicine and Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Nagana Gowda G. A.
- Northwest Metabolomics Research Center, Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States of America
| | - Guruprasad Kalthur
- Department of Reproductive Science, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Borut Kovacic
- Department of Reproductive Medicine, University Medical Centre Maribor, Maribor, Slovenia
| | - Satish Kumar Adiga
- Department of Reproductive Science, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
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Zhang Q, Wang X, Zhang Y, Lu H, Yu Y. Nomogram prediction for the prediction of clinical pregnancy in Freeze-thawed Embryo Transfer. BMC Pregnancy Childbirth 2022; 22:629. [PMID: 35941542 PMCID: PMC9361510 DOI: 10.1186/s12884-022-04958-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to identify multiple endometrial receptivity related factors by applying non-invasive, repeatable multimodal ultrasound methods. Combined with basic clinical data, we further established a practical prediction model for early clinical outcomes in Freeze-thawed Embryo Transfer (FET). METHODS Retrospective analysis of clinical data of infertility patients undergoing FET cycle in our Center from January 2017 to September 2019. Receiver operating characteristic (ROC) curve and decision curve analyses were performed by 500 bootstrap resamplings to assess the determination and clinical value of the nomogram, respectively. RESULTS A total of 2457 FET cycles were included. We developed simple nomograms that predict the early clinical outcomes in FET cycles by using the parameters of age, BMI, type and number of embryos transferred, endometrial thickness, FI, RI, PI and number of endometrial and sub-endometrial blood flow. In the training cohort, the area under the ROC curve (AUC) showed statistical accuracy (AUC = 0.698), and similar results were shown in the subsequent validation cohort (AUC = 0.699). Decision curve analysis demonstrated the clinical value of this nomogram. CONCLUSIONS Our nomogram can predict clinical outcomes and it can be used as a simple, affordable and widely implementable tool to provide guidance and treatment recommendations for FET patients.
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Affiliation(s)
- Qian Zhang
- Department of Reproductive Medicine, General Hospital of Northern Theater Command, Shenhe District, No. 83, Wenhua Road, Shenyang, 110016, China
| | - Xiaolong Wang
- Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang, 110122, China
| | - Yuming Zhang
- Department of Reproductive Medicine, General Hospital of Northern Theater Command, Shenhe District, No. 83, Wenhua Road, Shenyang, 110016, China
| | - Haiou Lu
- Department of Reproductive Medicine, General Hospital of Northern Theater Command, Shenhe District, No. 83, Wenhua Road, Shenyang, 110016, China
| | - Yuexin Yu
- Department of Reproductive Medicine, General Hospital of Northern Theater Command, Shenhe District, No. 83, Wenhua Road, Shenyang, 110016, China.
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Noda A, Ishikuro M, Obara T, Murakami K, Ueno F, Matsuzaki F, Onuma T, Watanabe Z, Shiga N, Iwama N, Hirotaka H, Otsuka T, Tachibana M, Tomita H, Saito M, Sugawara J, Kure S, Yaegashi N, Kuriyama S. Association between maternal infertility treatment and child neurodevelopment: findings from the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study in Miyagi and Iwate Prefectures, Japan. BMJ Open 2022; 12:e060944. [PMID: 35672073 PMCID: PMC9174802 DOI: 10.1136/bmjopen-2022-060944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study aimed to examine the association between infertility treatment and neurodevelopment in children at 2 and 3.5 years of age. DESIGN Prospective cohort study. SETTING AND PARTICIPANTS The study population consisted of mother-child pairs who participated in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study in Miyagi and Iwate Prefectures, Japan. Pregnant women were recruited in obstetric clinics or hospitals and their children were followed up by the questionnaire. OUTCOME MEASURES The children's neurodevelopmental outcomes were assessed at 2 and 3.5 years of age using the Ages and Stages Questionnaire, third edition (ASQ-3), which consists of questions on five developmental domains. We performed a multivariate logistic regression analysis of the association between infertility treatment (including ovulation induction (OI), artificial insemination with husband's sperm (AIH) and assisted reproductive technology (ART)) and the clinical range of ASQ-3. RESULTS Of 9655 mother-child pairs, 273 (2.8%) and 487 (5.0%) were conceived through OI/AIH and ART, respectively. The odds of having developmental delays at 2 years of age were higher in children conceived through OI/AIH (OR, 1.36; 95% CI 1.00 to 1.85) and ART (OR, 1.36; 95% CI 1.07 to 1.72) than in those conceived naturally. Additionally, OI/AIH and ART were significantly associated with communication (OR, 1.93; 95% CI 1.25 to 2.98) and gross motor (OR, 1.50; 95% CI 1.08 to 2.09) delays, respectively. There were no statistically significant differences in the odds of having developmental delays at 3.5 years of age in children conceived through OI/AIH (OR, 1.13; 95% CI 0.79 to 1.61) and ART (OR, 1.03; 95% CI 0.78 to 1.37). CONCLUSION In this study, we found a significant association between infertility treatment and children's neurodevelopment at 2 years of age, whereas no statistically significant differences were found at 3.5 years of age.
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Affiliation(s)
- Aoi Noda
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Mami Ishikuro
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Taku Obara
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Keiko Murakami
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Fumihiko Ueno
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Fumiko Matsuzaki
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Tomomi Onuma
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Zen Watanabe
- Department of Obstetrics and Gynecology, Tohoku University Hospital, Sendai, Miyagi, Japan
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Naomi Shiga
- Department of Obstetrics and Gynecology, Tohoku University Hospital, Sendai, Miyagi, Japan
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Noriyuki Iwama
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
- Department of Obstetrics and Gynecology, Tohoku University Hospital, Sendai, Miyagi, Japan
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hamada Hirotaka
- Department of Obstetrics and Gynecology, Tohoku University Hospital, Sendai, Miyagi, Japan
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Tatsui Otsuka
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Psychiatry, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Masahito Tachibana
- Department of Obstetrics and Gynecology, Tohoku University Hospital, Sendai, Miyagi, Japan
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hiroaki Tomita
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Psychiatry, Tohoku University Hospital, Sendai, Miyagi, Japan
- Department of Disaster Psychiatry, International Research Institute of Disaster Science, Tohoku University, Sendai, Miyagi, Japan
| | - Masatoshi Saito
- Department of Obstetrics and Gynecology, Tohoku University Hospital, Sendai, Miyagi, Japan
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Maternal and Fetal Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Junichi Sugawara
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
- Department of Obstetrics and Gynecology, Tohoku University Hospital, Sendai, Miyagi, Japan
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shigeo Kure
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Nobuo Yaegashi
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
- Department of Obstetrics and Gynecology, Tohoku University Hospital, Sendai, Miyagi, Japan
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shinichi Kuriyama
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- International Research Institute of Disaster Science, Tohoku University, Sendai, Miyagi, Japan
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West R, Coomarasamy A, Frew L, Hutton R, Kirkman-Brown J, Lawlor M, Lewis S, Partanen R, Payne-Dwyer A, Román-Montañana C, Torabi F, Tsagdi S, Miller D. Sperm selection with hyaluronic acid improved live birth outcomes among older couples and was connected to sperm DNA quality, potentially affecting all treatment outcomes. Hum Reprod 2022; 37:1106-1125. [PMID: 35459947 PMCID: PMC9156852 DOI: 10.1093/humrep/deac058] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/13/2022] [Indexed: 11/23/2022] Open
Abstract
STUDY QUESTION What effects did treatment using hyaluronic acid (HA) binding/selection prior to ICSI have on clinical outcomes in the Hyaluronic Acid Binding sperm Selection (HABSelect) clinical trial? SUMMARY ANSWER Older women randomized to the trial's experimental arm (selection of sperm bound to immobilized (solid-state) HA) had the same live birth rates as younger women, most likely a result of better avoidance of sperm with damaged DNA. WHAT IS KNOWN ALREADY Recent randomized controlled trials (RCTs) investigating the efficacy of HA-based sperm selection prior to ICSI, including HABSelect, have consistently reported reductions in the numbers of miscarriages among couples randomized to the intervention, suggesting a pathological sperm-mediated factor mitigated by prior HA-binding/selection. The mechanism of that protection is unknown. STUDY DESIGN, SIZE, DURATION The original HABSelect Phase 3 RCT ran from 2014 to 2017 and included 2752 couples from whom sperm samples used in control (ICSI) and intervention (Physiological IntraCytoplasmic Sperm Injection; PICSI) arms of the trial were stored frozen for later assessment of DNA quality (DNAq). The trial overlapped with its mechanistic arm, running from 2016 to 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS As miscarriage reduction was a significant secondary outcome of the trial, samples (n = 1247) selected for the mechanistic analysis were deliberately enriched for miscarriage outcomes (n = 92 or 7.4%) from a total of 154 miscarriages (5.6%) among all (n = 2752) couples randomized by stratified random sampling. Values from fresh semen samples for sperm concentration (mml), percentage forward progressive motility and percentage HA-binding score (HBS) were obtained before being processed by differential density gradient centrifugation or (rarely) by swim-up on the day of treatment. Surplus sperm pellets were recovered, aliquoted and cryopreserved for later analysis of DNAq using slide-based Comet, TUNEL, acridine orange (AO) and the sperm chromatin dispersion (SCD) assays. Following their classification into normal and abnormal sample subcategories based on reference values for sperm concentration and motility, relationships with HBS and DNAq were examined by Spearman correlation, Student's t-tests, Mann Whitney U tests, and logistic regression (univariable and multivariable). Parsimonious selection enabled the development of models for exploring and explaining data trends. Potential differences in future cumulative pregnancy rates relating to embryo quality were also explored. MAIN RESULTS AND THE ROLE OF CHANCE Results from the 1247 sperm samples assayed for HBS and/or DNAq, generated data that were considered in relation to standard physiological measures of (sperm) vitality and to treatment outcomes. All measures of HBS and DNAq discriminated normal from abnormal sperm samples (P < 0.001). SCD correlated negatively with the Comet (r = -0.165; P < 0.001) and TUNEL assays (r = -0.200; P < 0.001). HBS correlated negatively with AO (r = -0.211; P < 0.001), Comet (r = -0.127; P < 0.001) and TUNEL (r = -0.214; P < 0.001) and positively with SCD (r = 0.255; P < 0.001). A model for predicting live birth (and miscarriage) rates included treatment allocation (odds ratio: OR 2.167, 95% CI 1.084-4.464, P = 0.031), female age (OR 0.301, 95% CI 0.133-0.761, P = 0.013, per decade) and the AO assay (OR 0.79, 95% CI 0.60-1. 02.761, P = 0.073, per 10 points rise). A model predicting the expected rate of biochemical pregnancy included male age (OR 0.464, 95% CI 0.314-0.674, P < 0.001, per decade) and the SCD assay (OR 1.04, 95% CI 1.007-1.075, P = 0.018, per 10 point rise). A model for conversion from biochemical to clinical pregnancy did not retain any significant patient or assay variables. A model for post-injection fertilization rates included treatment allocation (OR 0.83, 95% CI 0.75-0.91, P < 0.001) and the Comet assay (OR 0.950, 95% CI 0.91-1.00, P = 0.041). LIMITATIONS, REASONS FOR CAUTION HABSelect was a prospective RCT and the mechanistic study group was drawn from its recruitment cohort for retrospective analysis, without the full benefit of randomization. The clinical and mechanistic aspects of the study were mutually exclusive in that measures of DNAq were obtained from residual samples and not from HA-selected versus unselected sperm. Models for fitting mechanistic with baseline and other clinical data were developed to compensate for variable DNAq data quality. HABSelect used a solid-state version of PICSI and we did not assess the efficacy of any liquid-state alternatives. PICSI reduced fertilization rates and did not improve the outlook for cumulative pregnancy rates. WIDER IMPLICATIONS OF THE FINDINGS Notwithstanding the interventional effect on fertilization rates and possibly blastocyst formation (neither of which influenced pregnancy rates), poor sperm DNAq, reflected by lower HBS, probably contributed to the depression of all gestational outcomes including live births, in the HABSelect trial. The interventional avoidance of defective sperm is the best explanation for the equalization in live birth rates among older couples randomized to the trial's PICSI arm. As patients going forward for assisted conception cycles globally in future are likely to be dominated by an older demographic, HA-based selection of sperm for ICSI could be considered as part of their treatment plan. STUDY FUNDING/COMPETING INTEREST(S) The study was supported by the National Institute for Health Research (NIHR) EME (Efficacy and Mechanism Evaluation)-11-14-34. National Research Ethics Service approval 11/06/2013: 13/YH/0162. S.L. is CEO of ExamenLab Ltd (company number NI605309). TRIAL REGISTRATION NUMBER ISRCTN99214271.
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Affiliation(s)
- Robert West
- Correspondence address. Leeds Institute of Health Sciences, Room 1.27, Level 10, Worsley Building, University of Leeds, Leeds LS2 9JT, UK. E-mail: (R.W.); Centre for Human Reproductive Science, University of Birmingham, Birmingham Women’s Fertility Centre, Birmingham Women’s NHS Foundation Trust, Birmingham B15 2TG, UK. E-mail: (J.K.-B.)
| | - Arri Coomarasamy
- Centre for Human Reproductive Science, University of Birmingham, Birmingham Women’s Fertility Centre, Birmingham Women’s NHS Foundation Trust, Birmingham, UK
| | - Lorraine Frew
- Centre for Human Reproductive Science, University of Birmingham, Birmingham Women’s Fertility Centre, Birmingham Women’s NHS Foundation Trust, Birmingham, UK
| | - Rachel Hutton
- Queen’s University Belfast, Centre for Public Health, Royal Groups of Hospitals, Belfast, UK
| | - Jackson Kirkman-Brown
- Correspondence address. Leeds Institute of Health Sciences, Room 1.27, Level 10, Worsley Building, University of Leeds, Leeds LS2 9JT, UK. E-mail: (R.W.); Centre for Human Reproductive Science, University of Birmingham, Birmingham Women’s Fertility Centre, Birmingham Women’s NHS Foundation Trust, Birmingham B15 2TG, UK. E-mail: (J.K.-B.)
| | - Martin Lawlor
- Queen’s University Belfast, Centre for Public Health, Royal Groups of Hospitals, Belfast, UK
| | - Sheena Lewis
- Queen’s University Belfast, Centre for Public Health, Royal Groups of Hospitals, Belfast, UK
| | - Riitta Partanen
- Department of Discovery and Translational Science, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | - Alex Payne-Dwyer
- Department of Discovery and Translational Science, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | - Claudia Román-Montañana
- Centre for Human Reproductive Science, University of Birmingham, Birmingham Women’s Fertility Centre, Birmingham Women’s NHS Foundation Trust, Birmingham, UK
| | - Forough Torabi
- Department of Discovery and Translational Science, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | - Sofia Tsagdi
- Centre for Human Reproductive Science, University of Birmingham, Birmingham Women’s Fertility Centre, Birmingham Women’s NHS Foundation Trust, Birmingham, UK
| | - David Miller
- Department of Discovery and Translational Science, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
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Zhang CX, Xue JL, Zhao W, Wu YQ, Liu XY, Wang SW, Li LH, Gu SM, Li JQ, Zhang YY, Zhang FH, Yang YZ, Wang YM, Zhu YM, Xing LF, Qian YL, Zhang D. Embryo morphologic quality in relation to the metabolic and cognitive development of singletons conceived by in vitro fertilization and intracytoplasmic sperm injection: a matched cohort study. Am J Obstet Gynecol 2022; 227:479.e1-479.e23. [PMID: 35568190 DOI: 10.1016/j.ajog.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/27/2022] [Accepted: 05/08/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Embryos with higher morphologic quality grading may have a greater potential to achieve clinical pregnancy that leads to a live birth regardless of the type of cleavage-stage embryos or blastocysts. Few studies have investigated the impacts of embryo grading on the long-term health of the offspring. OBJECTIVE This pilot study aimed to examine the associations between embryo morphologic quality and the physical, metabolic, and cognitive development of singletons conceived by in vitro fertilization and intracytoplasmic sperm injection at preschool age. STUDY DESIGN This matched cohort study included singletons born to infertile couples who underwent fresh cleavage-stage embryo transfer cycles with good- or poor-quality embryos from 2014 to 2016 at the reproductive center of the Women's Hospital, School of Medicine, Zhejiang University. A total of 144 children, aged 4 to 6 years, participated in the follow-up assessment from 2020 to 2021, and the response rate of poor-quality embryo offspring was 39%. Singletons in the good-quality embryo group were matched with singletons in the poor-quality embryo group at a 2:1 ratio according to the fertilization method and the children's age (±1 year). We measured the offspring's height, weight, body mass index, blood pressure, thyroid hormone levels, and metabolic indicators. Neurodevelopmental assessments were performed using the Chinese version of the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition, and the Adaptive Behavior Assessment System, Second Edition. We also collected data from the medical records. A linear regression model was used to analyze the association between embryo morphologic quality and offspring health outcomes. RESULTS A total of 48 singletons conceived with poor-quality embryo transfer and 96 matched singletons conceived with good-quality embryo transfer were included in the final analysis. Age, sex, height, weight, body mass index, blood pressure, thyroid function, and metabolic indicators were comparable between the 2 groups. After adjustment for potential risk factors by linear regression model 1 and model 2, poor-quality embryo offspring exhibited a tendency toward higher free thyroxine levels than offspring of good-quality embryo transfers (beta, 0.22; 95% confidence interval, 0.09-0.90; beta, 0.22; 95% confidence interval, 0.09-0.91, respectively), but this difference was not clinically significant. Regarding neurodevelopmental assessments, there was no difference in the full-scale intelligence quotient based on the Wechsler Preschool and Primary Scale of Intelligence (109.96±12.42 vs 109.60±14.46; P=.88) or the general adaptive index based on the Adaptive Behavior Assessment System (108.26±11.70 vs 108.08±13.44; P=.94) between the 2 groups. The subindices of the 2 tests were also comparable. These findings remained after linear regression analysis. CONCLUSION At 4 to 6 years of age, singletons born from poor-quality embryo transfers have comparable metabolic and cognitive development as those born from good-quality embryo transfers using fresh cleavage-stage embryos. The results of this pilot study indicate that poor-quality embryos that can survive implantation and end in live birth are likely to have a developmental potential comparable to that of good-quality embryos.
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Weng SS, Chien LY, Huang YT, Huang YT, Chang M. Why does mode of conception affect early breastfeeding outcomes? A retrospective cohort study. PLoS One 2022; 17:e0265776. [PMID: 35303044 PMCID: PMC8932581 DOI: 10.1371/journal.pone.0265776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 03/07/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction It is uncertain whether Assisted Reproductive Technology (ART) is associated with an increased risk of poor breastfeeding outcomes and what could be possible mechanisms. This study aimed to examine the effect of mode of conception on breastfeeding outcomes during the first two months postpartum and identify the potential mediating pathways for this relationship. Methods A retrospective cohort study was conducted in a sample of 3,565 women with live births. Participants were classified by mode of conception as follows: fertile women who conceived naturally (fertile women; n = 2,857), women with infertility who conceived naturally (sub-fertile women; n = 483), and women with infertility who conceived through ART (women with infertility; n = 310). The infant-feeding patterns were assessed with four-time points before two months postpartum. Binary and multinomial logistic regression and causal mediation analyses were performed. Results The rates of breastfeeding initiation and discontinuation across modes of conception were similar. However, infertile and sub-fertile women had 37% (95% CI 1.02, 1.83) and 56% (95% CI 1.06, 2.27) increased risks of introducing formula before the first week postpartum, respectively, and 35% (95% CI 1.01, 1.82) and 52% (95% CI 1.04, 2.24) higher risks of exclusive breastfeeding for less than one week, respectively, compared to fertile women. The relationships were mainly mediated through multiple gestation and admission to neonatal/pediatric intensive care units (NICU/PICU; proportions of mediation were over 50%). The effects of mode of conception on breastfeeding outcomes became not significant in cases of singleton birth. Conclusions Sub-fertile women and women with infertility intended to breastfeed but experienced higher perinatal risks in the early postpartum period. Multiple gestation and admission to NICU/PICU forced them to introduce formula earlier than preferred, thus leading to a shorter duration of exclusive breastfeeding. Single embryo transfer policy and breastfeeding support in NICU/PICU could help those women achieve positive early breastfeeding outcomes.
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Affiliation(s)
- Shiue-Shan Weng
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Nursing, Collage of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Yin Chien
- Institute of Community Health Care, Collage of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Ting Huang
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Yen-Tsung Huang
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Min Chang
- Department of Nursing, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- * E-mail:
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Sciorio R, Esteves SC. Contemporary Use of ICSI and Epigenetic Risks to Future Generations. J Clin Med 2022; 11:jcm11082135. [PMID: 35456226 PMCID: PMC9031244 DOI: 10.3390/jcm11082135] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/30/2022] [Accepted: 04/07/2022] [Indexed: 12/19/2022] Open
Abstract
Since the birth of Louise Brown in 1978 via IVF, reproductive specialists have acquired enormous knowledge and refined several procedures, which are nowadays applied in assisted reproductive technology (ART). One of the most critical steps in this practice is the fertilization process. In the early days of IVF, a remarkable concern was the unpleasant outcomes of failed fertilization, overtaken by introducing intracytoplasmic sperm injection (ICSI), delineating a real breakthrough in modern ART. ICSI became standard practice and was soon used as the most common method to fertilize oocytes. It has been used for severe male factor infertility and non-male factors, such as unexplained infertility or advanced maternal age, without robust scientific evidence. However, applying ICSI blindly is not free of potential detrimental consequences since novel studies report possible health consequences to offspring. DNA methylation and epigenetic alterations in sperm cells of infertile men might help explain some of the adverse effects reported in ICSI studies on reproductive health in future generations. Collected data concerning the health of ICSI children over the past thirty years seems to support the notion that there might be an increased risk of epigenetic disorders, congenital malformations, chromosomal alterations, and subfertility in babies born following ICSI compared to naturally conceived children. However, it is still to be elucidated to what level these data are associated with the cause of infertility or the ICSI technique. This review provides an overview of epigenetic mechanisms and possible imprinting alterations following the use of ART, in particular ICSI. It also highlights the sperm contribution to embryo epigenetic regulation and the risks of in vitro culture conditions on epigenetic dysregulation. Lastly, it summarizes the literature concerning the possible epigenetic disorders in children born after ART.
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Affiliation(s)
- Romualdo Sciorio
- Edinburgh Assisted Conception Programme, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
- Correspondence:
| | - Sandro C. Esteves
- Androfert, Andrology and Human Reproduction Clinic, Campinas 13075-460, Brazil;
- Department of Surgery, Division of Urology, University of Campinas, Campinas 13083-970, Brazil
- Faculty of Health, Aarhus University, 8000 Aarhus, Denmark
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PTEN expression in human cumulus cells is associated with embryo development competence. ZYGOTE 2022; 30:611-618. [DOI: 10.1017/s096719942200003x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Summary
Embryo quality determines the success of in vitro fertilization and embryo transfer (IVF-ET) treatment. Biomarkers for the evaluation of embryo quality have some limitations. Apoptosis in cumulus cells (CCs) is important for ovarian function. PTEN (phosphatase and tensin homolog) is a well known tumour suppressor gene that functions as a mediator of apoptosis and is crucial for mammalian reproduction. In the present study, we analyzed the expression level of PTEN in human CCs and aimed to investigate its association with embryo developmental competence in IVF treatment cycles. The PTEN mRNA level in CCs was measured using real-time fluorescence quantitative PCR. The association of the differential expression of PTEN with embryo quality was analyzed. Our data showed that PTEN mRNA levels were significantly decreased in CCs surrounding mature oocytes compared with immature oocytes. Similar changes were found in the analysis of fertilization and blastocyst formation. The speculation that the measurement of PTEN mRNA levels in human CCs would provide a useful tool for selecting oocytes with greater chances to implant into the uterus needs to be further verified through single-embryo transfer in the future. The proapoptotic mechanism of PTEN in human reproduction needs to be further studied.
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Xiong F, Sun Q, Wang S, Yao Z, Chen P, Wan C, Zhong H, Zeng Y. A nomogram to assist blastocyst selection in vitrified‐warmed embryo transfer cycles. J Obstet Gynaecol Res 2022; 48:1816-1828. [PMID: 35373468 DOI: 10.1111/jog.15138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/14/2021] [Accepted: 12/14/2021] [Indexed: 01/21/2023]
Affiliation(s)
- Feng Xiong
- Shenzhen Key Laboratory of Reproductive Immunology for Peri‐implantation Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital Shenzhen Guangdong People's Republic of China
| | - Qing Sun
- Shenzhen Key Laboratory of Reproductive Immunology for Peri‐implantation Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital Shenzhen Guangdong People's Republic of China
| | - Sisi Wang
- Shenzhen Key Laboratory of Reproductive Immunology for Peri‐implantation Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital Shenzhen Guangdong People's Republic of China
| | - Zhihong Yao
- Shenzhen Key Laboratory of Reproductive Immunology for Peri‐implantation Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital Shenzhen Guangdong People's Republic of China
| | - Peilin Chen
- Shenzhen Key Laboratory of Reproductive Immunology for Peri‐implantation Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital Shenzhen Guangdong People's Republic of China
| | - Caiyun Wan
- Shenzhen Key Laboratory of Reproductive Immunology for Peri‐implantation Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital Shenzhen Guangdong People's Republic of China
| | - Huixian Zhong
- Shenzhen Key Laboratory of Reproductive Immunology for Peri‐implantation Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital Shenzhen Guangdong People's Republic of China
| | - Yong Zeng
- Shenzhen Key Laboratory of Reproductive Immunology for Peri‐implantation Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital Shenzhen Guangdong People's Republic of China
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Fouks Y, Yogev Y. Twinning in ART: Single embryo transfer policy. Best Pract Res Clin Obstet Gynaecol 2022; 84:88-95. [PMID: 35430161 DOI: 10.1016/j.bpobgyn.2022.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/13/2022] [Indexed: 11/16/2022]
Abstract
It is more than thirty years that perinatologists and healthcare personnel aim to reduce the morbidity associated with multiple pregnancy. In many cases, these complications stem from pregnancies achieved through artificial reproductive technologies (ART). Although dramatic measures have been taken to control those risks by increasing the proportion of single embryo transfers, the multiple pregnancy rate still remains relatively high among patient conceived through ART, carrying risks to both mothers and newborns, and is coupled with the related economic burden associated with prematurity. The aim of this review is to provide the current evidence regarding single embryo transfer to assist decision-makers and to promote patient knowledge toward an elective policy to reduce the risk of twinning. Single embryo transfer may aid in the further reduction of multiple pregnancy and, in most cases, will maintain patient autonomy and right of choice.
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Affiliation(s)
- Yuval Fouks
- Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yariv Yogev
- Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Isikoglu M, Ceviren AK, Cetin T, Avci A, Aydinuraz B, Akgul OK, Karaca M. Comparison of ICSI and conventional IVF in non-male factor patients with less than four oocytes. Arch Gynecol Obstet 2022; 306:493-499. [DOI: 10.1007/s00404-022-06471-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/16/2022] [Indexed: 12/30/2022]
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