1
|
Pier BD, Roshong A, Santoro N, Sammel MD. Association of duration of embryo culture with risk of large for gestational age delivery in cryopreserved embryo transfer cycles. Fertil Steril 2024; 121:814-823. [PMID: 38185197 DOI: 10.1016/j.fertnstert.2024.01.002] [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: 10/14/2023] [Revised: 12/31/2023] [Accepted: 01/02/2024] [Indexed: 01/09/2024]
Abstract
OBJECTIVE To examine the relationship between the day of embryo cryopreservation and large for gestational age (LGA) infants in women undergoing frozen embryo transfers (FETs) after cryopreservation on days 2-7 after fertilization and to compare the risk of the day of embryo cryopreservation to other possible risk factors of LGA after FET cycles. DESIGN Retrospective cohort study. SETTING Society of Assisted Reproduction Clinical Outcomes Reporting System. PATIENTS Women undergoing FET cycles. INTERVENTION Day of cryopreservation. MAIN OUTCOME MEASURE Singleton LGA infant. RESULTS A total of 33,030 (18.2%) FET cycles in the study group (n = 181,592) resulted in LGA infants during the study period of 2014-2019. There was an increase in LGA risk when cryopreservation was performed from day 2 (13.7%) to days 3-7 (14.4%, 15.0%, 18.2%, 18.5%, and 18.9%). In the log-binomial model, the risk increased compared with days 2-3 combined when cryopreservation was performed on days 5-7 (adjusted relative risk [aRR] 1.32, 95% confidence interval [CI] 1.22-1.44 for day 5, aRR 1.34, 95% CI 1.23-1.46 for day 6, and aRR 1.42, 95% CI 1.25-1.61 for day 7). Other factors most associated with LGA risk in the log-binomial model were preterm parity of >3 compared with 0 (aRR 1.82, 95% CI 1.24-2.69) and body mass index (BMI) of >35 kg/m2 compared with normal weight (aRR 1.94, 95% CI 1.88-2.01). Increasing gravity, parity, BMI, number of oocytes, and embryo grade were also associated with LGA in this model. Asian, Black, Hispanic, and combined Hawaiian and Pacific Islander were protective factors in the model compared with White patients. Low BMI (<18.5 kg/m2) was also considered a protective factor in the model compared with normal BMI. CONCLUSION Duration of embryo culture was associated with an increased risk of LGA in this study cohort when controlling for known confounders such as maternal BMI and parity. This study sheds new light on the possible link between FET and LGA infants.
Collapse
Affiliation(s)
- Bruce D Pier
- Department of Gynecologic Surgery and Obstetrics, Womack Army Medical Center, Fort Liberty, North Carolina.
| | - Anne Roshong
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Texas at San Antonio, San Antonio, Texas
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
| | - Mary D Sammel
- Department of Biostatistics, School of Public Health, University of Colorado School of Medicine, Aurora, Colorado
| |
Collapse
|
2
|
Hesters L, Sermondade N, Lambert C, Pouly JL, Pereira B, Lucas C, Levy R, Brugnon F. Is large for gestational age in singletons born after frozen embryo transfer associated with freezing technique or endometrial preparation protocol? A longitudinal national French study. Hum Reprod 2024; 39:724-732. [PMID: 38384249 DOI: 10.1093/humrep/deae027] [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: 05/10/2023] [Revised: 01/28/2024] [Indexed: 02/23/2024] Open
Abstract
STUDY QUESTION Is large for gestational age (LGA) observed in babies born after frozen embryo transfer (FET) associated with either the freezing technique or the endometrial preparation protocol? SUMMARY ANSWER Artificial cycles are associated with a higher risk of LGA, with no difference in rate between the two freezing techniques (vitrification versus slow freezing) or embryo stage (cleaved embryo versus blastocyst). WHAT IS KNOWN ALREADY Several studies have compared neonatal outcomes after fresh embryo transfer (ET) and FET and shown that FET is associated with improved neonatal outcomes, including reduced risks of preterm birth, low birthweight, and small for gestational age (SGA), when compared with fresh ET. However, these studies also revealed an increased risk of LGA after FET. The underlying pathophysiology of this increased risk remains unclear; parental infertility, laboratory procedures (including embryo culture conditions and freezing-thawing processes), and endometrial preparation treatments might be involved. STUDY DESIGN, SIZE, DURATION A multicentre epidemiological data study was performed through a retrospective analysis of the standardized individual clinical records of the French national register of IVF from 2014 to 2018, including single deliveries resulting from fresh ET or FET that were prospectively collected in fertility centres. Complementary data were collected from the participating fertility centres and included the vitrification media and devices, and the endometrial preparation protocols. PARTICIPANTS/MATERIALS, SETTING, METHODS Data were collected from 35 French ART centres, leading to the inclusion of a total of 72 789 fresh ET, 10 602 slow-freezing FET, and 39 062 vitrification FET. Main clinical outcomes were presented according to origin of the transferred embryos (fresh, slow frozen, or vitrified embryos) and endometrial preparations for FET (ovulatory or artificial cycles), comparing five different groups (fresh, slow freezing-ovulatory cycle, slow freezing-artificial cycle, vitrification-ovulatory cycle, and vitrification-artificial cycle). Foetal growth disorders were defined in live-born singletons according to gestational age and sex-specific weight percentile distribution: SGA and LGA if <10th and ≥90th percentiles, respectively. Analyses were performed using linear mixed models with the ART centres as random effect. MAIN RESULTS AND THE ROLE OF CHANCE Transfers led to, respectively, 19 006, 1798, and 9195 deliveries corresponding to delivery rates per transfer of 26.1%, 17.0%, and 23.5% after fresh ET, slow-freezing FET, and vitrification FET, respectively. FET cycles were performed in either ovulatory cycles (n = 21 704) or artificial cycles (n = 34 237), leading to 5910 and 10 322 pregnancies, respectively, and corresponding to pregnancy rates per transfer of 31.6% and 33.3%. A significantly higher rate of spontaneous miscarriage was observed in artificial cycles when compared with ovulatory cycles (33.3% versus 21.4%, P < 0.001, in slow freezing groups and 31.6% versus 21.8%, P < 0.001 in vitrification groups). Consequently, a lower delivery rate per transfer was observed in artificial cycles compared with ovulatory cycles both in slow freezing and vitrification groups (15.5% versus 18.9%, P < 0.001 and 22.8% versus 24.9%, P < 0.001, respectively). Among a total of 26 585 live-born singletons, 16 413 babies were born from fresh ET, 1644 from slow-freezing FET, and 8528 from vitrification FET. Birthweight was significantly higher in the FET groups than in the fresh ET group, with no difference between the two freezing techniques. Likewise, LGA rates were higher and SGA rates were lower in the FET groups compared with the fresh ET group whatever the method used for embryo freezing. In a multivariable analysis, the risk of LGA following FET was significantly increased in artificial compared with ovulatory cycles. In contrast, the risk of LGA was not associated with either the freezing procedure (vitrification versus slow freezing) or the embryo stage (cleaved embryo versus blastocyst) at freezing. Regarding the vitrification method, the risk of LGA was not associated with either the vitrification medium used or the embryo stage. LIMITATIONS, REASONS FOR CAUTION No data were available on maternal context, such as parity, BMI, infertility cause, or maternal comorbidities, in the French national database. In particular, we cannot exclude that the increased risk of LGA observed following FET with artificial cycles may, at least partially, be associated with a confounding effect of some maternal factors. No information about embryo culture and incubation conditions was available. Most of the vitrification techniques were performed using the same device and with two main vitrification media, limiting the validity of a comparison of risk for LGA according to the device or vitrification media used. WIDER IMPLICATIONS OF THE FINDINGS Our results seem reassuring, since no potential foetal growth disorders following embryo vitrification in comparison with slow freezing were observed. Even if other factors are involved, the endometrial preparation treatment seems to have the greatest impact on LGA risk following FET. FET during ovulatory cycles could minimize the risk for foetal growth disorders. STUDY FUNDING/COMPETING INTEREST(S) This work has received funding from the French Biomedicine Agency (Grant number: 19AMP002). None of the authors has any conflict of interest to declare. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- Laetitia Hesters
- Department of Reproductive Biology CECOS, Hôpital Antoine Béclère, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Clamart, France
| | - Nathalie Sermondade
- Department of Reproductive Biology CECOS, Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Céline Lambert
- Biostatistics Unit, Department of Clinical Research and Innovation, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Clermont-Ferrand, France
| | - Jean-Luc Pouly
- Department of Reproductive Biology CECOS, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit, Department of Clinical Research and Innovation, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Clermont-Ferrand, France
| | - Cécily Lucas
- Department of Reproductive Biology CECOS, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Clermont-Ferrand, France
| | - Rachel Levy
- Department of Reproductive Biology CECOS, Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Florence Brugnon
- Department of Reproductive Biology CECOS, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Clermont-Ferrand, France
- University of Clermont Auvergne, IMoST, INSERM 1240, Faculté de Médecine, Clermont-Ferrand, France
| |
Collapse
|
3
|
Galanti F, Riccio S, Giannini A, D'Oria O, Buzzaccarini G, Scudo M, Muzii L, Battaglia FA. Placentation and complications of ART pregnancy. An update on the different possible etiopathogenic mechanisms involved in the development of obstetric complications. J Reprod Immunol 2024; 162:104191. [PMID: 38219630 DOI: 10.1016/j.jri.2023.104191] [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: 08/07/2023] [Revised: 11/25/2023] [Accepted: 12/29/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Infertile couples' percentage is increasing all over the world, especially in Italy, with high number of children born in our country through assisted reproductive techniques (ART). However, pregnancies obtained by ART have increased potential obstetrical risks which could be caused by fetus-placenta unit development, most of all due to placentation's evolution. These can be reassumed into miscarriage, chromosomal abnormalities, preterm delivery, multiple pregnancy, IUGR, placenta previa, abruptio placentae, preeclampsia and hypertensive disorders, postpartum hemorrhage. METHODS The aim of this article is to evaluate hypothetic mechanism involved in placentation process and in the etiopathology of ART pregnancies disorders, giving an updating overview of different etiopathogenetic pathways and features. On this scenario, we create an updated review about the etiopathogenesis of abnormal placentation in ART pregnancies. RESULTS Several features and different etiopathogenetic characteristic might impact differently such as advanced maternal age, poor ovarian reserve, oocyte quality and causes of subfertility themselves, and the ART techniques itself, as hormonal medical treatments and laboratory techniques such as gamete and embryo laboratory culture, cryopreservation versus fresh ET, number of embryos transferred. CONCLUSION To further explore the molecular mechanisms behind placentation in ART pregnancies, further studies are necessary to gain a better understanding of the various aspects involved, particularly those which are not fully comprehended. This could prove beneficial to clinicians in both ART care and obstetric care, as it could help to stratify obstetrical risk and decrease complications in women undergoing ART, as well as perinatal disorders in their children. Correct placentation is essential for a successful pregnancy for both mother and baby.
Collapse
Affiliation(s)
- Francesco Galanti
- Obstetrics and Gynecology Unit, Santa Maria Goretti Hospital, Latina, Italy.
| | - Serena Riccio
- Obstetrics and Gynecology Unit, Santa Maria Goretti Hospital, Latina, Italy.
| | - Andrea Giannini
- Department of Maternal Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy.
| | - Ottavia D'Oria
- Department of Maternal Child Health and Urologic Sciences, Umberto I Hospital, Sapienza University, Rome, Italy.
| | - Giovanni Buzzaccarini
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
| | - Maria Scudo
- Obstetrics and Gynecology Unit, Santa Maria Goretti Hospital, Latina, Italy.
| | - Ludovico Muzii
- Obstetrics and Gynecology Unit, Santa Maria Goretti Hospital, Latina, Italy.
| | | |
Collapse
|
4
|
Casciani V, Monseur B, Cimadomo D, Alvero R, Rienzi L. Oocyte and embryo cryopreservation in assisted reproductive technology: past achievements and current challenges. Fertil Steril 2023; 120:506-520. [PMID: 37290552 DOI: 10.1016/j.fertnstert.2023.06.005] [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: 02/09/2023] [Revised: 05/27/2023] [Accepted: 06/01/2023] [Indexed: 06/10/2023]
Abstract
Cryopreservation has revolutionized the treatment of infertility and fertility preservation. This review summarizes the milestones that paved the way to the current routinary clinical implementation of this game-changing practice in assisted reproductive technology. Still, evidence to support "the best practice" in cryopreservation is controversial and several protocol adaptations exist that were described and compared here, such as cumulus-intact vs. cumulus-free oocyte cryopreservation, artificial collapse, assisted hatching, closed vs. open carriers, and others. A last matter of concern is whether cryostorage duration may impact oocyte/embryo competence, but the current body of evidence in this regard is reassuring. From social and clinical perspectives, oocyte and embryo cryopreservation has evolved from an afterthought when assisted reproduction was intended for immediate pregnancy with supernumerary embryos of secondary interest to its current purpose, which primarily is to preserve fertility long-term and more comprehensively allow for family planning. However, the initial consenting process, which still is geared to short-term fertility care, may no longer be relevant when the individuals that initially preserved the tissues have completed their reproductive journey. A more encompassing counseling model is required to address changing patient values over time.
Collapse
Affiliation(s)
- Valentina Casciani
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - Brent Monseur
- Stanford Fertility and Reproductive Health, Stanford University, Sunnyvale, California
| | - Danilo Cimadomo
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - Ruben Alvero
- Stanford Fertility and Reproductive Health, Stanford University, Sunnyvale, California
| | - Laura Rienzi
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy; Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Urbino, Italy.
| |
Collapse
|
5
|
Yan G, Yao Y, Yang W, Lu L, Wang L, Zhao D, Zhao S. An all-37 °C thawing method improves the clinical outcomes of vitrified frozen-thawed embryo transfer: a retrospective study using a case-control matching analysis. Arch Gynecol Obstet 2023; 307:1991-1999. [PMID: 37041370 DOI: 10.1007/s00404-023-07029-1] [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: 10/04/2022] [Accepted: 03/27/2023] [Indexed: 04/13/2023]
Abstract
PURPOSE The purpose of this study is to assess the impact of different temperatures and incubation times on the clinical outcomes of FET cycles during the thawing procedure and to select a better thawing method to improve clinical outcomes. METHODS This retrospective study included 1734 FET cycles from January 1, 2020, to January 30, 2022. Embryos vitrified using a KITAZATO Vitrification Kit were thawed at 37 °C in all steps (the case group, denoted the "all-37 °C" group) or at 37 °C and then at room temperature (RT; the control group, denoted the "37 °C-RT" group), according to the kit instructions. The groups were matched 1:1 to avoid confounding. RESULTS After case-control matching, 366 all-37 °C cycles and 366 37 °C-RT cycles were included. The baseline characteristics were similar (all P > 0.05) between the two groups after matching. FET of the all-37 °C group yielded a higher clinical pregnancy rate (CPR; P = 0.009) and implantation rate (IR; P = 0.019) than FET of the 37 °C-RT group. For blastocyst transfers, the CPR (P = 0.019) and IR (P = 0.025) were significantly higher in the all-37 °C group than in the 37 °C-RT group. For D3-embryo transfers, the CPR and IR were non-significantly higher in the all-37 °C group than in the 37 °C-RT group (P > 0.05). CONCLUSIONS Thawing vitrified embryos at 37 °C in all steps with shortening wash time can enhance CPR and IR in FET cycles. Well-designed prospective studies are warranted to further evaluate the efficacy and safety of the all-37 °C thawing method.
Collapse
Affiliation(s)
- Gaofeng Yan
- Department of Reproduction and Genetics, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - Youlin Yao
- Department of Reproduction and Genetics, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - Wenjuan Yang
- Department of Reproduction and Genetics, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - Ling Lu
- Department of Reproduction and Genetics, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - Longda Wang
- Department of Reproduction and Genetics, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - Di Zhao
- Department of Reproduction and Genetics, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - Shuhua Zhao
- Department of Reproduction and Genetics, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China.
| |
Collapse
|
6
|
Trobo D, García C, Martínez M, Rodríguez I, Rojo M, Moreno S, Nozaleda G, Solís A, Pérez L, Caballero M, Ceballos E, Navarro MT, Pérez-Milán FM. Impact of Embryo Cryopreservation on Large for Gestational Age Babies Born by Embryo Transfer: Cohort Retrospective Study. Reprod Sci 2023; 30:1257-1265. [PMID: 36068375 DOI: 10.1007/s43032-022-01075-x] [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: 11/15/2021] [Accepted: 08/24/2022] [Indexed: 11/28/2022]
Abstract
The transfer of frozen-thawed embryos has been associated with an increased risk of large for gestational age at birth. Our objective is to assess its impact on the risk of large for gestational age (LGA) in order to improve the bias control in relation with the available studies. Retrospective cohort study on cumulative sample of 801 single live births of 32 weeks or longer of gestation, resulting from pregnancies obtained by cryopreserved or fresh embryo transfer which are not affected by disorders that could impair fetal growth and carried out at Hospital General Universitario Gregorio Marañón, in Madrid, during the period 2005-2017. The relative risk (RR) of LGA has been estimated with its confidence interval (CI) at 95%. Multivariate analysis using logistic regression was applied to adjust the crude effect. LGA was more frequent in babies born after cryotransfer in comparison with the reference group (20.9% vs. 6.0%; p < 0.001), as well as macrosomia (8.2% vs. 0.9%; p < 0.001). Frequencies of weight > 4500 g were similar (0.7% vs. 0.1%; p > 0.05). Nulliparity was associated to a higher risk of LGA (RR: 3.8; CI95%: 2.0-7.0; p < 0.005), as well as cleaving embryo transfer (RR: 2; CI95%: 1.07-3.8; p < 0.05). According to the multivariate analysis, the exposure variable was the only one independently associated with LGA (OR: 3.5; CI95%: 2.0-6.1; p < 0.001). Frozen-thawed embryo transfer significantly increases the risk of LGA, regardless of the influence of factors relating to the patient's condition, the embryos transferred, or the fetal sex.
Collapse
Affiliation(s)
- Duna Trobo
- Department of Obstetrics and Gynaecology and Reproductive Medicine, Hospital General Universitario Gregorio Marañón, c/ O'Donnell 48, 28009, Madrid, Spain.
| | - Cecilia García
- Department of Obstetrics and Gynaecology and Reproductive Medicine, Hospital General Universitario Gregorio Marañón, c/ O'Donnell 48, 28009, Madrid, Spain
| | - Marta Martínez
- Department of Obstetrics and Gynaecology and Reproductive Medicine, Hospital General Universitario Gregorio Marañón, c/ O'Donnell 48, 28009, Madrid, Spain
| | - Inés Rodríguez
- Department of Obstetrics and Gynaecology and Reproductive Medicine, Hospital General Universitario Gregorio Marañón, c/ O'Donnell 48, 28009, Madrid, Spain
| | - María Rojo
- Department of Obstetrics and Gynaecology and Reproductive Medicine, Hospital General Universitario Gregorio Marañón, c/ O'Donnell 48, 28009, Madrid, Spain
| | - Sonsoles Moreno
- Department of Obstetrics and Gynaecology and Reproductive Medicine, Hospital General Universitario Gregorio Marañón, c/ O'Donnell 48, 28009, Madrid, Spain
| | - Gonzalo Nozaleda
- Department of Obstetrics and Gynaecology and Reproductive Medicine, Hospital General Universitario Gregorio Marañón, c/ O'Donnell 48, 28009, Madrid, Spain
| | - Ana Solís
- Department of Obstetrics and Gynaecology, Hospital Fundación Jove, Avenida Eduardo de Castro 161, 33290, Gijon, Asturias, Spain
| | - Laura Pérez
- Department of Obstetrics and Gynaecology and Reproductive Medicine, Hospital General Universitario Gregorio Marañón, c/ O'Donnell 48, 28009, Madrid, Spain
| | - Miguel Caballero
- Department of Obstetrics and Gynaecology and Reproductive Medicine, Hospital General Universitario Gregorio Marañón, c/ O'Donnell 48, 28009, Madrid, Spain
| | - Elena Ceballos
- Department of Obstetrics and Gynaecology and Reproductive Medicine, Hospital General Universitario Gregorio Marañón, c/ O'Donnell 48, 28009, Madrid, Spain
| | - María T Navarro
- Department of Obstetrics and Gynaecology and Reproductive Medicine, Hospital General Universitario Gregorio Marañón, c/ O'Donnell 48, 28009, Madrid, Spain
| | - Federico Mariano Pérez-Milán
- Department of Obstetrics and Gynaecology and Reproductive Medicine, Hospital General Universitario Gregorio Marañón, c/ O'Donnell 48, 28009, Madrid, Spain
| |
Collapse
|
7
|
Zheng Q, Mo M, Zhang H, Xu S, Xu F, Wang S, Zeng Y. Prolong cryopreservation duration negatively affects pregnancy outcomes of vitrified-warmed blastocyst transfers using an open-device system: A retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2023; 281:68-75. [PMID: 36566684 DOI: 10.1016/j.ejogrb.2022.12.012] [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: 05/07/2022] [Revised: 11/20/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate the impact of cryopreservation (CP) duration on pregnancy outcomes of vitrified-warmed blastocysts transfers using an open-device liquid-nitrogen (LN2) system. METHODS This retrospective cohort study was conducted on 6327 first vitrified-warmed single blastocyst transfer cycles with autologous oocytes from January 2015 to December 2020. The CP duration was initially divided into six groups: Group I: 0-3 months (n = 4309); Group II: 4-6 months (n = 1061); Group III: 7-12 months (n = 304); Group IV: 13-24 months (n = 113); Group V: 25-72 months (n = 466); Group VI: 73-120 months (n = 74). Multivariate logistic regression was performed to evaluate the independent effect of CP duration on pregnancy outcomes. To further examine the time limit of vitrification, propensity score matching (PSM) was applied to compare pregnancy outcome of patients with storage duration of 25-120 months to those of 0-24 months. After that, pregnancy outcomes were compared among the subgroups of Group I': 0-24 months, Group II': 25-48 months, Group III': 49-72 months, Group IV': 73-120 months. Stratification analysis based on embryo quality was also performed. Primary outcomes were clinical pregnancy rate and live birth rate. Secondary outcomes were implantation, biochemical pregnancy rate, ongoing pregnancy rate and early miscarriage rate. RESULTS Logistic regression demonstrated that the odds of pregnancy outcomes were similar across Group I to IV. However, the implantation rate, chances of biochemical pregnancy, clinical pregnancy, ongoing pregnancy, and live birth significantly decreased as the storage duration increased up to 25 months, while miscarriage rate did not significantly differ between groups. Subgroup analysis confirmed a dramatical decrease of clinical pregnancy and live birth rate when cryopreserved for more than 24 months. After that, the slope was relatively steady between 25 and 72 months, then steeply decreased again as CP reached 73-120 months. In addition, there was a more remarkable decline of pregnancy outcomes in the average quality embryo transfers than in the high quality embryo transfers as cryopreservation storage increased. CONCLUSION Prolonged cryopreservation of vitrified blastocysts in an open-device LN2 system up to 24 months might negatively affect pregnancy outcomes. This negative impact progresses as storage duration increases, especially when exceeds 72 months. Average quality embryo appears to be less sustainable with long-term cryo-storage.
Collapse
Affiliation(s)
- Qizhen Zheng
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen 518045, Guangdong, People's Republic of China
| | - Meilan Mo
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen 518045, Guangdong, People's Republic of China
| | - Hongzhan Zhang
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen 518045, Guangdong, People's Republic of China
| | - Shiru Xu
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen 518045, Guangdong, People's Republic of China
| | - Fen Xu
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen 518045, 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 518045, 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 518045, Guangdong, People's Republic of China.
| |
Collapse
|
8
|
Sermondade N, Hesters L, De Mouzon J, Devaux A, Epelboin S, Fauque P, Gervoise-Boyer MJ, Labrosse J, Viot G, Bergère M, Devienne C, Jonveaux P, Levy R, Pessione F. Fetal growth disorders following medically assisted reproduction: due to maternal context or techniques? A national French cohort study. Reprod Biomed Online 2023; 46:739-749. [PMID: 36906455 DOI: 10.1016/j.rbmo.2023.01.006] [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: 09/01/2022] [Revised: 12/08/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Abstract
RESEARCH QUESTION What part do maternal context and medically assisted reproduction (MAR) techniques play in the risk of fetal growth disorders? DESIGN This retrospective nationwide cohort study uses data available in the French National Health System database and focuses on the period from 2013 to 2017. Fetal growth disorders were divided into four groups according to the origin of pregnancy: fresh embryo transfer (n = 45,201), frozen embryo transfer (FET, n = 18,845), intrauterine insemination (IUI, n = 20,179) and natural conceptions (n = 3,412,868). Fetal growth disorders were defined from the percentiles of the weight distribution according to gestational age and sex: small and large for gestational age (SGA and LGA) if <10th and >90th percentiles, respectively. Analyses were performed using univariate and multivariate logistic models. RESULTS Compared with births following natural conception, multivariate analysis showed that the risk of SGA was higher for births following fresh embryo transfer and IUI (adjusted odds ratio [aOR] 1.26 [1.22-1.29] and 1.08 [1.03-1.12], respectively) and significantly lower following FET (aOR 0.79 [0.75-0.83]). The risk of LGA was higher for births following FET (aOR 1.32 [1.27-1.38]), especially in artificial cycles when compared with ovulatory cycles (aOR 1.25 [1.15-1.36]). In the subgroup of births without any obstetrical or neonatal morbidity, the same increased risk of SGA and LGA were observed following fresh embryo transfer or IUI and FET (aOR 1.23 [1.19-1.27] or 1.06 [1.01-1.11] and aOR 1.36 [1.30-1.43], respectively). CONCLUSIONS An effect of MAR techniques on the risks for SGA and LGA is suggested independently from maternal context and obstetrical or neonatal morbidities. Pathophysiological mechanisms remain poorly understood and should be further evaluated, as well as the influence of embryonic stage and freezing techniques.
Collapse
Affiliation(s)
- Nathalie Sermondade
- Department of Reproductive Biology, Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Laetitia Hesters
- Department of Reproductive Biology, Hôpital Antoine Béclère, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Clamart, France
| | | | - Aviva Devaux
- Department of Reproductive Biology, Centre Hospitalier Universitaire, Amiens, France
| | - Sylvie Epelboin
- Department of Reproductive Medicine, Gynecology and Obstetrics, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris Nord, Université de Paris, Paris, France
| | - Patricia Fauque
- Université Bourgogne Franche-Comté-INSERM UMR1231, Dijon, France
| | | | - Julie Labrosse
- Department of Reproductive Medicine, Gynecology and Obstetrics, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris Nord, Université de Paris, Paris, France
| | | | | | | | | | - Rachel Levy
- Department of Reproductive Biology, Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | |
Collapse
|
9
|
Chen D, Mao X, Zhang J, Wu L. The impact of maternal ABO blood type on obstetric and perinatal outcomes after frozen embryo transfer. Reprod Biomed Online 2023; 46:767-777. [PMID: 36868884 DOI: 10.1016/j.rbmo.2023.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023]
Abstract
RESEARCH QUESTION Does the maternal ABO blood type affect obstetric and perinatal outcomes following frozen embryo transfer (FET)? DESIGN A retrospective study was performed at a university-affiliated fertility centre, involving women with singleton and twin deliveries conceived by FET. Subjects were divided into four groups based on ABO blood type. The primary end-points were obstetric and perinatal outcomes. RESULTS A total of 20,981 women were involved, with 15,830 having singletons and 5151 delivering twins. In singleton pregnancies, women with blood group B had a slight but significantly increased risk of gestational diabetes mellitus compared to women with blood group O (adjusted odds ratio [aOR] 1.16; 95% confidence interval [CI] 1.01-1.34). Furthermore, singletons born to women with the B antigen (blood type B or AB) were more likely to be large for gestational age (LGA) and with macrosomia. In twin pregnancies, blood type AB was related to a decreased risk of hypertensive diseases of pregnancy (aOR 0.58; 95% CI 0.37-0.92), while blood type A was associated with a higher risk of placenta praevia (aOR 2.04; 95% CI 1.15-3.60). When compared with the O blood group, twins from the AB blood group had a lower risk of low birthweight (aOR 0.83; 95% CI 0.71-0.98) but a higher risk of LGA (aOR 1.26; 95% CI 1.05-1.52). CONCLUSIONS This study demonstrates that the ABO blood group may influence the obstetric and perinatal outcomes for both singletons and twins. These findings emphasize that patient characteristics could be, at least partly, responsible for adverse maternal and birth outcomes following IVF.
Collapse
Affiliation(s)
- Di Chen
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China
| | - Xiaoyan Mao
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China
| | - Jie Zhang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China.
| | - Ling Wu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China.
| |
Collapse
|
10
|
Association of infertility cause with perinatal outcomes in a freeze-all policy: an analysis including 10,151 singleton newborns. AJOG GLOBAL REPORTS 2022; 3:100098. [DOI: 10.1016/j.xagr.2022.100098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
11
|
De Croo I, Colman R, De Sutter P, Stoop D, Tilleman K. No difference in cumulative live birth rates between cleavage versus blastocyst transfer in patients with four or fewer zygotes: results from a retrospective study. Hum Reprod Open 2022; 2022:hoac031. [PMID: 35919767 PMCID: PMC9341301 DOI: 10.1093/hropen/hoac031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Is the cumulative live birth rate (CLBR) per oocyte collection cycle (OCC) comparable after cleavage-stage or blastocyst-stage transfer in combination with supernumerary blastocyst vitrification on Day 5 (D5) in patients with four or fewer zygotes on Day 1? SUMMARY ANSWER The CLBR in a fresh blastocyst-transfer or cleavage-stage transfer policy followed by vitrification on D5 is comparable in patients with four or fewer zygotes. WHAT IS KNOWN ALREADY Blastocyst transfer enhances the self-selection of the embryo and shortens the time to pregnancy in patients with normal or high ovarian response. Whether these advantages are also present in patients with a low ovarian response and/or a limited number of available zygotes is a continuous debate. STUDY DESIGN, SIZE, DURATION This was a retrospective, observational cohort study of 2359 consecutive OCCs between January 2014 and December 2018. According to a shift in transfer policy in our center, 571 OCCs had been scheduled for a fresh transfer on Day 3 (D3) and 1788 on D5. The D5 group was matched to the D3 group by propensity score (PS) matching according to multiple maternal baseline covariates. After PS matching, there were 571 OCCs in each group. PARTICIPANTS/MATERIALS, SETTING, METHODS OCCs scheduled for a D3 transfer (n = 571) or for a D5 transfer (n = 1788) were matched by PS matching in a 1:1 ratio accounting for potential confounding factors associated with CLBR. The model included patient characteristics, such as maternal age and cycle rank, as well as treatment characteristics such as GnRH analog regimen and ovarian response. Embryological variables included the number of zygotes and the number of 6- to 7- and 8-cell embryos on D3. The delivery outcomes of the fresh treatment cycle and the consecutive vitrified-warmed embryo transfers were analyzed up to the first live birth. The primary endpoint of this study was CLBR per OCC. Secondary outcomes were live birth rate per fresh transfer and embryo implantation rate per transferred embryo. MAIN RESULTS AND THE ROLE OF CHANCE The CLBR per OCC was comparable between the D5 and D3 groups (16.8% versus 17.7%, respectively, P = 0.600). Live birth rates per OCC did not differ between a cleavage-stage transfer and blastocyst-stage transfer policy (15.2% versus 12.4%, respectively, P = 0.160). In the D5 group, 201 cycles did not result in a blastocyst to perform an embryo transfer or cryopreservation; in the D3 group, only 59 cycles did not have an embryo transfer because of poor embryo quality (35.2% versus 10.3%, respectively; P < 0.001). A significantly higher number of fresh double embryo transfers were performed in the D3 group compared to D5 (23.8% versus 7.0%, respectively, P < 0.001). LIMITATIONS, REASONS FOR CAUTION Although adjusted for important confounders in the PS matching, BMI and embryo quality of the transferred embryo(s) were not taken into account. This study is limited by its retrospective design and is a single-center study, which may limit the generalizability of our findings. WIDER IMPLICATIONS OF THE FINDINGS The CLBR in a fresh blastocyst-transfer or cleavage-stage transfer policy followed by vitrification on D5 is comparable. A fresh embryo transfer on D3 can still be considered in patients with a poor ovarian response and/or limited number of zygotes when combined with blastocyst vitrification without impacting the overall CLBR of the cycle. STUDY FUNDING/COMPETING INTEREST(S) No external funding was obtained for this study. There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER This retrospective study was approved by the local ethical committee at Ghent University Hospital (B 670201731234).
Collapse
Affiliation(s)
- I De Croo
- Ghent University Hospital Department of Reproductive Medicine, , Ghent, Belgium
| | - R Colman
- Ghent University Hospital Biostatistics Unit, , Ghent, Belgium
| | - P De Sutter
- Ghent University Hospital Department of Reproductive Medicine, , Ghent, Belgium
| | - D Stoop
- Ghent University Hospital Department of Reproductive Medicine, , Ghent, Belgium
| | - K Tilleman
- Ghent University Hospital Department of Reproductive Medicine, , Ghent, Belgium
| |
Collapse
|
12
|
The impact of a previous tubal ectopic pregnancy on subsequent live birth and perinatal outcomes mostly resulting from cleavage-stage embryo transfers in frozen-thawed cycles: a retrospective cohort study using propensity score analysis. Reprod Biomed Online 2022; 45:1266-1273. [DOI: 10.1016/j.rbmo.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/05/2022] [Accepted: 07/25/2022] [Indexed: 11/19/2022]
|
13
|
Tang X, Yu Y, Ding Q, Liu H, Niu Y, Li Y, Zhao S, Wei D, Chen ZJ. The sex-specific difference in singleton birth weight after frozen embryo transfer compared with fresh embryo transfer: a secondary analysis of 3 randomized trials. Fertil Steril 2022; 117:1004-1012. [PMID: 35216834 DOI: 10.1016/j.fertnstert.2022.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess whether the between-group difference in singleton birth weight following frozen vs. fresh embryo transfer varied with infant sex. DESIGN A post hoc exploratory secondary analysis of data from three multicenter randomized trials compared the live birth rates between freeze-only vs. fresh embryo transfer. SETTING Academic fertility centers. PATIENT(S) A total of 1,886 women who achieved singleton live birth after a frozen or fresh embryo transfer during these trials were included. INTERVENTION(S) Women underwent either a frozen or fresh embryo transfer. MAIN OUTCOME MEASURE(S) Mean birth weight, large for gestational age (LGA), and small for gestational age (SGA). RESULT(S) There was an interaction between the types of embryo transfer and infant sex on the birth weight and on the incidences of LGA and SGA. Among male infants, compared with singletons following fresh embryo transfer, singletons following frozen embryo transfer had higher mean birth weights (3,520.6 ± 526.1 vs. 3,345.1 ± 524.9 g), a higher risk of being LGA (25.2% vs. 15.7%), and a lower risk of being SGA (3.3% vs. 6.1%). However, among the female infants, no statistically significant difference was found in the mean birth weight (3,336.5 ± 514.8 vs. 3,299.5 ± 485.0 g) or the risks of being LGA (18.8% vs. 15.7%) or SGA (5.2% vs. 6.0%) between frozen and fresh embryo transfer. CONCLUSION(S) Male singletons born after frozen embryo transfer were more likely to have a higher birth weight than those born after fresh embryo transfer.
Collapse
Affiliation(s)
- Xiaoqian Tang
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China; The Key Laboratory of Reproductive Endocrinology of Ministry of Education, Jinan, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China
| | - Yunhai Yu
- Department of Obstetrics and Gynecology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qiaoqiao Ding
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China; The Key Laboratory of Reproductive Endocrinology of Ministry of Education, Jinan, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China
| | - Hong Liu
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China; The Key Laboratory of Reproductive Endocrinology of Ministry of Education, Jinan, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China
| | - Yue Niu
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China; The Key Laboratory of Reproductive Endocrinology of Ministry of Education, Jinan, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China
| | - Yan Li
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China; The Key Laboratory of Reproductive Endocrinology of Ministry of Education, Jinan, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China
| | - Shigang Zhao
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China; The Key Laboratory of Reproductive Endocrinology of Ministry of Education, Jinan, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China
| | - Daimin Wei
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China; The Key Laboratory of Reproductive Endocrinology of Ministry of Education, Jinan, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China.
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China; The Key Laboratory of Reproductive Endocrinology of Ministry of Education, Jinan, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China
| |
Collapse
|
14
|
Alteri A, Campo G, Pagliardini L, Privitera L, Cavoretto P, Candiani M, Papaleo E, Viganò P. The impact of vitrified-warmed blastocyst transfer on postnatal growth: A 1-year follow-up questionnaire study. Reprod Biomed Online 2022; 44:907-914. [DOI: 10.1016/j.rbmo.2021.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 12/01/2021] [Accepted: 12/27/2021] [Indexed: 11/16/2022]
|
15
|
van Duijn L, Rousian M, Reijnders IF, Willemsen SP, Baart EB, Laven JSE, Steegers-Theunissen RPM. The influence of frozen-thawed and fresh embryo transfer on utero-placental (vascular) development: the Rotterdam Periconception cohort. Hum Reprod 2021; 36:2091-2100. [PMID: 33974704 PMCID: PMC8289318 DOI: 10.1093/humrep/deab070] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/28/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Does frozen-thawed or fresh embryo transfer (ET) influence utero-placental (vascular) development, when studied using three-dimensional (3D) ultrasound and virtual reality imaging techniques? SUMMARY ANSWER In the first trimester, placental developmental parameters, that is, placental volume (PV) and utero-placental vascular volume (uPVV), were comparable between pregnancies resulting from frozen-thawed ET, fresh ET and natural conception; and in the second and the third trimester, uterine artery Doppler indices were lower in pregnancies after frozen-thawed ET compared to pregnancies after fresh ET and natural conception. WHAT IS KNOWN ALREADY Pregnancies after frozen-thawed ET are at risk of developing placenta-related pregnancy complications. There is strong evidence that impaired first-trimester spiral artery remodelling is involved in the pathophysiology of these complications. Studies on longitudinal placental development in pregnancies with different modes of conception, that is, after frozen-thawed ET, fresh ET or natural conception, are lacking. STUDY, DESIGN, SIZE, DURATION Women with singleton pregnancies were included before 10 weeks of gestation, between January 2017 and July 2018, as a subcohort of the ongoing Rotterdam Periconception cohort. Results were partially validated in 722 women from the total cohort, which was conducted from November 2010 onwards. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 214 women, of whom 32 conceived after frozen-thawed ET, 56 conceived after fresh ET and 126 conceived naturally, were selected. PV and uPVV measurements were obtained at 7, 9 and 11 weeks of gestation by transvaginal 3D (power Doppler) ultrasound. The uterine artery pulsatility index (UtA-PI) and resistance index (UtA-RI) were measured transvaginally at 7, 9, 11 and 13 weeks and abdominally at 22 and 32 weeks of gestation by pulsed wave Doppler ultrasound. In the validation cohort, the PV was measured in 722 women. Associations between mode of conception and placental development were studied using linear mixed models. MAIN RESULTS AND THE ROLE OF CHANCE First-trimester parameters of placental development, that is, PV, uPVV, UtA-PI and UtA-RI, were comparable between pregnancies after frozen-thawed and fresh ET and naturally conceived pregnancies. In our validation cohort, comparable results were found for PV. However, the second- and third-trimester UtA-PI and UtA-RI in pregnancies after frozen-thawed ET were significantly lower than in pregnancies after fresh ET (βUtA-PI −0.158 (95% CI: −0.268, −0.048), P = 0.005; βUtA-RI −0.052 (95% CI: −0.089, −0.015), P = 0.006). The second- and third-trimester uterine artery indices in pregnancies after fresh ET were comparable to those in pregnancies after natural conception. LIMITATIONS, REASONS FOR CAUTION The main limitation of this study is the lack of power to optimally detect differences in placental development and placenta-related pregnancy outcomes between pregnancies after different modes of conception. Moreover, our population was selected from a tertiary hospital and included a relatively limited number of pregnancies. Therefore, external validity of the results should be confirmed in a larger sample size. WIDER IMPLICATIONS OF THE FINDINGS These findings indicate no significant impact of conception mode on early placental development and a beneficial impact for frozen-thawed ET on the second- and third-trimester Doppler indices. This suggests that frozen-thawed ET may not be as detrimental for placental perfusion as previous research has demonstrated. As the number of clinics applying the ‘freeze-all strategy’ increases, future research should focus on establishing the optimal uterine environment, with regards to hormonal preparation, prior to ET to reduce placental-related pregnancy complications after frozen-thawed ET. STUDY FUNDING/COMPETING INTEREST(S) This research was funded by the Erasmus MC Medical Research Advisor Committee’s ‘Health Care Efficiency Research’ program and the department of Obstetrics and Gynaecology of the Erasmus MC, University Medical Center, Rotterdam, The Netherlands. JSEL reports grants and personal fees from Ferring, personal fees from Titus Healthcare, grants and personal fees from Ansh Labs, grants from NIH, grants from Dutch Heart Association and grants from ZonMW outside the submitted work. None of the other authors have a conflict of interest. TRIAL REGISTRATION NUMBER Registered at the Dutch Trial Register (NTR6684).
Collapse
Affiliation(s)
- Linette van Duijn
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Melek Rousian
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Igna F Reijnders
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Sten P Willemsen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Biostatistics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Esther B Baart
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Developmental Biology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | |
Collapse
|
16
|
Zhang J, Wei M, Bian X, Wu L, Zhang S, Mao X, Wang B. Letrozole-induced frozen embryo transfer cycles are associated with a lower risk of hypertensive disorders of pregnancy among women with polycystic ovary syndrome. Am J Obstet Gynecol 2021; 225:59.e1-59.e9. [PMID: 33529574 DOI: 10.1016/j.ajog.2021.01.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/10/2021] [Accepted: 01/21/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Observational retrospective data suggest that an artificial cycle frozen embryo transfer may be associated with a higher risk of hypertensive disorder of pregnancy than a natural cycle frozen embryo transfer among women with regular ovulatory cycles. The corpus luteum, which is not present in the artificial frozen cycles, is at least partly responsible for this poor obstetrical outcome. However, an artificial cycle is the most frequently used regimen for women with polycystic ovary syndrome undergoing frozen embryo transfer. Whether the risk of hypertensive disorder of pregnancy could be mitigated by employing physiological frozen embryo transfer protocols that lead to the development of a corpus luteum in patients with polycystic ovary syndrome remains unknown. OBJECTIVE This study aimed to investigate the impact of letrozole use during frozen embryo transfer cycles on obstetrical and perinatal outcomes of singleton and twin pregnancies compared with artificial frozen cycles among women with polycystic ovary syndrome. STUDY DESIGN This retrospective cohort study involved women with polycystic ovary syndrome who had undergone artificial frozen cycles or letrozole-stimulated frozen cycles during the period from 2010 to 2018 at a tertiary care center. The primary outcome was the incidence of hypertensive disorder of pregnancy. A multivariable logistic regression analysis was performed to control for the relevant confounders. RESULTS A total of 2427 women with polycystic ovary syndrome were included in the final analysis. Of these women, 1168 underwent artificial cycles and 1259 underwent letrozole treatment, of which 25% of women treated with letrozole alone and 75% of women receiving letrozole combined with gonadotropins. After controlling for maternal characteristics and treatment variables, no significant difference was noticed regarding gestational diabetes mellitus, abnormal placentation, and preterm premature rupture of membranes between groups in both singleton and twin pregnancies. For birth outcomes, the prevalence rates of preterm birth, perinatal death, and birthweight outcomes were all comparable between groups in both singletons and twins. However, singleton pregnancies resulting from letrozole-stimulated cycles had a lower risk of hypertensive disorder of pregnancy than those conceived by artificial cycles (adjusted odds ratio, 0.63; 95% confidence interval, 0.40-0.98). Furthermore, a decreased risk of hypertensive disorder of pregnancy was seen among women with twin deliveries resulting from letrozole-stimulated cycles vs artificial cycles (adjusted odds ratio, 0.52; 95% confidence interval, 0.30-0.87). In addition, the cesarean delivery rate was significantly lower for singletons but not for twins in the letrozole group compared with pregnancies from the artificial cycle group (adjusted odds ratio, 0.63; 95% confidence interval, 0.50-0.78, and adjusted odds ratio, 1.20; 95% confidence interval, 0.65-2.23, respectively). CONCLUSION In women with polycystic ovary syndrome undergoing frozen embryo transfer, letrozole use for endometrial preparation was associated with a lower risk of hypertensive disorder of pregnancy than artificial cycles for endometrial preparation. Our findings provided a foundation that the increased risk of hypertensive disorder of pregnancy associated with frozen embryo transfer might be mitigated by utilizing physiological endometrial preparation protocols that lead to the development of a corpus luteum, such as a mild ovarian stimulation cycle for oligo- or anovulatory women.
Collapse
Affiliation(s)
- Jie Zhang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Mengjie Wei
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuejiao Bian
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ling Wu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuo Zhang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyan Mao
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bian Wang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
17
|
Tirgar P, Sarmadi F, Najafi M, Kazemi P, AzizMohseni S, Fayazi S, Zandi G, Ziaie N, Shoushtari Zadeh Naseri A, Ehrlicher A, Dashtizad M. Toward embryo cryopreservation-on-a-chip: A standalone microfluidic platform for gradual loading of cryoprotectants to minimize cryoinjuries. BIOMICROFLUIDICS 2021; 15:034104. [PMID: 34025896 PMCID: PMC8133792 DOI: 10.1063/5.0047185] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/08/2021] [Indexed: 05/31/2023]
Abstract
Embryo vitrification is a fundamental practice in assisted reproduction and fertility preservation. A key step of this process is replacing the internal water with cryoprotectants (CPAs) by transferring embryos from an isotonic to a hypertonic solution of CPAs. However, this applies an abrupt osmotic shock to embryos, resulting in molecular damages that have long been a source of concern. In this study, we introduce a standalone microfluidic system to automate the manual process and minimize the osmotic shock applied to embryos. This device provides the same final CPA concentrations as the manual method but with a gradual increase over time instead of sudden increases. Our system allows the introduction of the dehydrating non-permeating CPA, sucrose, from the onset of CPA-water exchange, which in turn reduced the required time of CPA loading for successful vitrification without compromising its outcomes. We compared the efficacy of our device and the conventional manual procedure by studying vitrified-warmed mouse blastocysts based on their re-expansion and hatching rates and transcription pattern of selected genes involved in endoplasmic reticulum stress, oxidative stress, heat shock, and apoptosis. While both groups of embryos showed comparable re-expansion and hatching rates, on-chip loading reduced the detrimental gene expression of cryopreservation. The device developed here allowed us to automate the CPA loading process and push the boundaries of cryopreservation by minimizing its osmotic stress, shortening the overall process, and reducing its molecular footprint.
Collapse
Affiliation(s)
| | | | - Mojgan Najafi
- Embryo Biotechnology Laboratory (EmBio Lab), Department of Animal Biotechnology, National Institute of Genetic Engineering and Biotechnology (NIGEB), Tehran 1497716316, Iran
| | | | | | - Samaneh Fayazi
- Embryo Biotechnology Laboratory (EmBio Lab), Department of Animal Biotechnology, National Institute of Genetic Engineering and Biotechnology (NIGEB), Tehran 1497716316, Iran
| | - Ghazaleh Zandi
- Embryo Biotechnology Laboratory (EmBio Lab), Department of Animal Biotechnology, National Institute of Genetic Engineering and Biotechnology (NIGEB), Tehran 1497716316, Iran
| | - Nikta Ziaie
- Embryo Biotechnology Laboratory (EmBio Lab), Department of Animal Biotechnology, National Institute of Genetic Engineering and Biotechnology (NIGEB), Tehran 1497716316, Iran
| | - Aida Shoushtari Zadeh Naseri
- Embryo Biotechnology Laboratory (EmBio Lab), Department of Animal Biotechnology, National Institute of Genetic Engineering and Biotechnology (NIGEB), Tehran 1497716316, Iran
| | - Allen Ehrlicher
- Department of Bioengineering, McGill University, Montreal, Quebec H3A0B9, Canada
| | - Mojtaba Dashtizad
- Embryo Biotechnology Laboratory (EmBio Lab), Department of Animal Biotechnology, National Institute of Genetic Engineering and Biotechnology (NIGEB), Tehran 1497716316, Iran
| |
Collapse
|
18
|
Bergin K, Eliner Y, Duvall DW, Roger S, Elguero S, Penzias AS, Sakkas D, Vaughan DA. The use of propensity score matching to assess the benefit of the endometrial receptivity analysis in frozen embryo transfers. Fertil Steril 2021; 116:396-403. [PMID: 33926718 DOI: 10.1016/j.fertnstert.2021.03.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To study the impact of the endometrial receptivity analysis (ERA) on live birth rates in frozen embryo transfer (FET) cycles. DESIGN Retrospective cohort study. SETTING A single, large, university-affiliated infertility practice. PATIENT(S) Autologous FET cycles between January 1, 2014, and June 30, 2019, were reviewed. Multiple covariates that impact outcomes were used for propensity score matching; 133 ERA patients were matched to 353 non-ERA patients. Patients were assigned to the ERA group if they had an ERA during treatment and underwent at least one "personalized" FET based on the ERA recommendations. INTERVENTION(S) No interventions administered. MAIN OUTCOME MEASURE(S) Live birth rates per cycle in the FET cycle after ERA compared with that of matched non-ERA patients. RESULT(S) The live birth rates for the ERA group, 49.62%, and the matched non-ERA group, 54.96%, (odds ratio 0.8074; 95% confidence interval, 0.5424-1.2018) were not significantly different, nor was a difference seen in subanalyses based on prior number of FETs or receptivity status. CONCLUSION(S) The ERA identifies a patient's putative window of implantation with the goal of improving synchrony with the embryo, thereby achieving higher live birth rates. This study used propensity score matching to control for multiple covariates in a heterogenous group of patients to compare live birth rates. There was no difference in the live birth rate in patients who underwent the ERA compared with that of those who did not.
Collapse
Affiliation(s)
| | - Yael Eliner
- Boston University School of Public Health, Boston, Massachusetts
| | | | | | | | - Alan S Penzias
- Boston In-Vitro Fertilization, Waltham, Massachusetts; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | - Denny Sakkas
- Boston In-Vitro Fertilization, Waltham, Massachusetts
| | - Denis A Vaughan
- Boston In-Vitro Fertilization, Waltham, Massachusetts; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
19
|
van Duijn L, Hoek J, Rousian M, Baart EB, Willemsen SP, Laven JSE, Steegers-Theunissen RPM, Schoenmakers S. Prenatal growth trajectories and birth outcomes after frozen-thawed extended culture embryo transfer and fresh embryo transfer: the Rotterdam Periconception Cohort. Reprod Biomed Online 2021; 43:279-287. [PMID: 34092521 DOI: 10.1016/j.rbmo.2021.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 11/30/2022]
Abstract
RESEARCH QUESTION Are there differences in prenatal growth trajectories and birth outcomes between singleton pregnancies conceived after IVF treatment with frozen-thawed extended culture embryo transfer at day 5, fresh embryo transfer at day 3 or naturally conceived pregnancies? DESIGN From a prospective hospital-based cohort, 859 singleton pregnancies were selected, including 133 conceived after IVF with frozen-thawed embryo transfer, 276 after fresh embryo transfer, and 450 naturally conceived pregnancies. Longitudinal 3D ultrasound scans were performed at 7, 9 and 11 weeks of gestation for offline crown-rump length (CRL) and embryonic volume measurements. Second trimester estimated fetal weight was based on growth parameters obtained during the routine fetal anomaly scan at 20 weeks of gestation. Birth outcome data were collected from medical records. RESULTS No differences regarding embryonic growth trajectories were observed between frozen-thawed and fresh embryo transfer. Birthweight percentiles after fresh embryo transfer were lower than after frozen-thawed embryo transfer (38.0 versus 48.0; P = 0.046, respectively). The prevalence of non-iatrogenic preterm birth (PTB) was significantly lower in pregnancies resulting from fresh embryo transfer compared with frozen-thawed embryo transfer (4.7% versus 10.9%; P = 0.026, respectively). Compared with naturally conceived pregnancies, birthweight percentiles and percentage of non-iatrogenic PTB were significantly lower in pregnancies after fresh embryo transfer and gestational age at birth was significantly higher. CONCLUSIONS This study shows that embryonic growth is comparable between singleton pregnancies conceived after fresh and frozen-thawed embryo transfer. The lower relative birthweight and PTB rate in pregnancies after fresh embryo transfer than after frozen-thawed embryo transfer and naturally conceived pregnancies warrants further investigation.
Collapse
Affiliation(s)
- Linette van Duijn
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Jeffrey Hoek
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Melek Rousian
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Esther B Baart
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Sten P Willemsen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Biostatistics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | | | - Sam Schoenmakers
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
20
|
Qiu J, Matsukawa K, Koshimoto C, Edashige K. Equilibrium vitrification of mouse embryos at various developmental stages using low concentrations of cryoprotectants. J Reprod Dev 2021; 67:109-114. [PMID: 33563870 PMCID: PMC8075728 DOI: 10.1262/jrd.2020-152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We previously developed a new vitrification method (equilibrium vitrification) by which two-cell mouse embryos can be vitrified in liquid nitrogen in a highly dehydrated/concentrated state using low concentrations of cryoprotectants. In the present study, we examined whether this method is effective for mouse embryos at multiple developmental stages. Four-cell embryos, eight-cell embryos, morulae, and blastocysts were vitrified with EDFS10/10a, 10% (v/v) ethylene glycol and 10% (v/v) DMSO in FSa solution. The FSa solution was PB1 medium containing 30% (w/v) Ficoll PM-70 plus 0.5 M sucrose. The state of dehydration/concentration was assessed by examining the survival of vitrified embryos after storage at -80°C. When four-cell embryos and eight-cell embryos were vitrified with EDFS10/10a in liquid nitrogen and then stored at -80°C, the survival rate was high, even after 28 days, with relatively high developmental ability. On the other hand, the survival of morulae and blastocysts vitrified in liquid nitrogen and stored at -80°C for four days was low. Therefore, morulae and blastocysts cannot be vitrified in a highly dehydrated/concentrated state using the same method as with two-cell embryos. However, when blastocysts were shrunken artificially before vitrification, survival was high after storage at -80°C for four days with high developmental ability. In conclusion, the equilibrium vitrification method using low concentrations of cryoprotectants, which is effective for two-cell mouse embryos, is also useful for embryos at multiple stages. This method enables the convenient transportation of vitrified embryos using dry ice.
Collapse
Affiliation(s)
- Juan Qiu
- Laboratory of Animal Science, College of Agriculture, Kochi University, Kochi 783-8502, Japan
| | - Kazutsugu Matsukawa
- Laboratory of Animal Science, College of Agriculture, Kochi University, Kochi 783-8502, Japan
| | - Chihiro Koshimoto
- Frontier Science Research Center, Miyazaki University, Miyazaki 889-1692, Japan
| | - Keisuke Edashige
- Laboratory of Animal Science, College of Agriculture, Kochi University, Kochi 783-8502, Japan
| |
Collapse
|
21
|
Shah JS, Vaughan DA, Leung A, Korkidakis A, Figueras F, Garcia D, Penzias AS, Sakkas D. Perinatal outcomes in singleton pregnancies after in vitro fertilization cycles over 24 years. Fertil Steril 2021; 116:27-35. [PMID: 33810846 DOI: 10.1016/j.fertnstert.2021.01.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine how a shift in clinical practice along with laboratory changes has impacted singleton perinatal outcomes after autologous in vitro fertilization (IVF) cycles. DESIGN Retrospective cohort. SETTING Single academic fertility clinic. PATIENT(S) Singleton live births resulting from all IVF cycles (n = 14,424) from August 1, 1995 to October 31, 2019. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Live birth weight, large for gestational age (GA), small for GA, and preterm birth. RESULT(S) The entire cohort consisted of 9,280 fresh and 5,144 frozen IVF cycles. Maternal age, parity, body mass index, neonatal sex, and GA at delivery were similar in both groups. There was a decrease in adjusted birth weight per year over the study period for the entire cohort of IVF cycles (-4.42g, 95% confidence interval [CI]: -6.63g to -2.22g). Rates of large for GA newborns decreased by 1.7% (95% CI: 2.9% to 0.6%) annually across the entire cohort of IVF cycles. Furthermore, there was a decrease in annual rates of preterm birth before 32 weeks by 3.2% (95% CI: 5.9% to 0.5%) across the entire cohort of IVF cycles. Trends were also seen in annual reduction of rates of preterm birth before 37 and 28 weeks. CONCLUSION(S) With the gradual evolution of clinical and IVF laboratory practices, there has been a decrease in birth weight over 24 years for the entire cohort of IVF cycles. Concurrently, noteworthy practice changes have resulted in an improvement in IVF outcomes with decreased rates of large for GA newborns and preterm birth before 32 weeks for the entire cohort of IVF cycles.
Collapse
Affiliation(s)
- Jaimin S Shah
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachussetts; Boston IVF, Waltham, Massachussetts
| | - Denis A Vaughan
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachussetts; Boston IVF, Waltham, Massachussetts
| | - Angela Leung
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachussetts; Boston IVF, Waltham, Massachussetts
| | - Ann Korkidakis
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachussetts; Boston IVF, Waltham, Massachussetts
| | - Francesc Figueras
- Department of Maternal-Fetal Medicine, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, Universitat de BarcelonaBarcelona, Spain; Institut de Recerca August Pi Sunyer, Barcelona, Spain; Center for Biomedical Network Research on Rare Diseases, Instituto de Salud Carlos III, Barcelona, Spain
| | | | - Alan S Penzias
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachussetts; Boston IVF, Waltham, Massachussetts
| | | |
Collapse
|
22
|
Qin N, Zhou Z, Zhao W, Zou K, Shi W, Yu C, Liu X, Dong Z, Mao Y, Liu X, Sheng J, Ding G, Wu Y, Huang H. Abnormal Glucose Metabolism in Male Mice Offspring Conceived by in vitro Fertilization and Frozen-Thawed Embryo Transfer. Front Cell Dev Biol 2021; 9:637781. [PMID: 33634140 PMCID: PMC7900417 DOI: 10.3389/fcell.2021.637781] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/20/2021] [Indexed: 12/16/2022] Open
Abstract
Frozen and thawed embryo transfer (FET) is currently widely applied in routine assisted reproductive technology (ART) procedure. It is of great necessity to assess the safety of FET and investigate the long-term effect including glucose metabolism on FET-conceived offspring. The mouse model is a highly efficient method to figure out the relationship between the process of FET and offspring health. In this study, we obtained mouse offspring of natural conception (NC), in vitro fertilization (IVF), and FET. Glucose and insulin tolerance test (GTT/ITT) were performed on both chow fed or high fat diet (HFD) fed offspring to examine the glucose metabolism status. We detected hepatic PI3K/AKT pathway by western blotting and transcriptome status by RNA-sequencing. Impaired glucose tolerance (IGT) and decreased insulin tolerance were occurred in FET conceived male offspring. After challenged with the HFD-fed, male offspring in FET group performed earlier and severer IGT than IVF group. Furthermore, higher HOMA-IR index and higher serum insulin level post glucose injected in FET-chow group suggested the insulin resistance status. The PI3K/AKT signaling pathway, the major pathway of insulin in the liver, were also disrupted in FET group. Transcriptomics of the liver reveals significantly downregulated in glucose metabolic process and insulin resistance in the FET-chow group. In our study, FET-conceived male mouse offspring presented glucose metabolism dysfunction mainly manifesting insulin resistance. The hepatic insulin signaling pathway were in concordance with reduced glycogen synthesis, increased glycolysis and enhanced gluconeogenesis status in FET-conceived male offspring.
Collapse
Affiliation(s)
- Ningxin Qin
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University, Shanghai, China
| | - Zhiyang Zhou
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University, Shanghai, China
| | - Wenlong Zhao
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University, Shanghai, China
| | - Kexin Zou
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University, Shanghai, China
| | - Weihui Shi
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University, Shanghai, China
| | - Chuanjin Yu
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University, Shanghai, China
| | - Xia Liu
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University, Shanghai, China
| | - Zehan Dong
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University, Shanghai, China
| | - Yiting Mao
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University, Shanghai, China
| | - Xinmei Liu
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University, Shanghai, China.,Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Jianzhong Sheng
- Department of Pathology and Pathophysiology, School of Medicine, Zhejiang University, Hangzhou, China
| | - Guolian Ding
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University, Shanghai, China.,Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Yanting Wu
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University, Shanghai, China.,Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Hefeng Huang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University, Shanghai, China.,Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China.,The Key Laboratory of Reproductive Genetics, Ministry of Education, School of Medicine, Zhejiang University, Hangzhou, China
| |
Collapse
|
23
|
Qiu J, Hasegawa A, Mochida K, Ogura A, Koshimoto C, Matsukawa K, Edashige K. Equilibrium vitrification of mouse embryos using low concentrations of cryoprotectants. Cryobiology 2020; 98:127-133. [PMID: 33285110 DOI: 10.1016/j.cryobiol.2020.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/02/2020] [Accepted: 11/16/2020] [Indexed: 11/15/2022]
Abstract
Previously, we developed a method for vitrification of mouse embryos in a near-equilibrium state using EFS35c, PB1 medium containing 35% (v/v) ethylene glycol, and 0.98 M sucrose. This method has advantages in both slow freezing and vitrification. However, since the vitrification solution in this method contains high concentrations of cryoprotectants and thus has high osmolality, the solution would injure oocytes and embryos with high sensitivity to chemical toxicity and high osmolality. In this study, we examined whether embryos could be vitrified in a near-equilibrium state using a solution containing low concentrations of cryoprotectants and thus with low osmolality. To investigate whether embryos were vitrified in a near-equilibrium state, 2-cell mouse embryos were vitrified with EDFS10/10a, PB1 medium containing 10% (v/v) ethylene glycol, 10% (v/v) DMSO, and 0.4 M sucrose, in liquid nitrogen, stored at -80 °C for 4-28 days, and warmed in water at 25 °C. The viability of the embryos was evaluated by the appearance of embryos after warming and developmental ability. When embryos were vitrified in liquid nitrogen using EDFS10/10a, the survival and developmental ability into blastocysts after storage at -80 °C for 7 days were high, indicating that embryos were vitrified in a near-equilibrium state. A high proportion of embryos vitrified with EDFS10/10a developed to term after transportation with dry ice, re-cooling in liquid nitrogen, and transfer to recipients. Therefore, new equilibrium vitrification developed in this study may be useful for oocytes and embryos that are highly sensitive to the toxicity of cryoprotectants and high osmolality.
Collapse
Affiliation(s)
- Juan Qiu
- Laboratory of Animal Science, College of Agriculture, Kochi University, Nankoku, Kochi, Japan
| | - Ayumi Hasegawa
- RIKEN BioResource Center, Tsukuba, Ibaraki, 305-0074, Japan
| | - Keiji Mochida
- RIKEN BioResource Center, Tsukuba, Ibaraki, 305-0074, Japan
| | - Atsuo Ogura
- RIKEN BioResource Center, Tsukuba, Ibaraki, 305-0074, Japan
| | - Chihiro Koshimoto
- Frontier Science Research Center, University of Miyazaki, Miyazaki, 889-1692, Japan
| | - Kazutsugu Matsukawa
- Laboratory of Animal Science, College of Agriculture, Kochi University, Nankoku, Kochi, Japan
| | - Keisuke Edashige
- Laboratory of Animal Science, College of Agriculture, Kochi University, Nankoku, Kochi, Japan.
| |
Collapse
|
24
|
|
25
|
de Mouzon J, Chambers GM, Zegers-Hochschild F, Mansour R, Ishihara O, Banker M, Dyer S, Kupka M, Adamson GD. International Committee for Monitoring Assisted Reproductive Technologies world report: assisted reproductive technology 2012†. Hum Reprod 2020; 35:1900-1913. [DOI: 10.1093/humrep/deaa090] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
STUDY QUESTION
What was the utilization, effectiveness and safety of practices in ART globally in 2012 and what global trends could be observed?
SUMMARY ANSWER
The total number of ART cycles increased by almost 20% since 2011 and the main trends were an increase in frozen embryo transfers (FET), oocyte donation, preimplantation genetic testing and single embryo transfers (SET), whereas pregnancy and delivery rates (PR, DR) remained stable, and multiple deliveries decreased.
WHAT IS KNOWN ALREADY
ART is widely practiced throughout the world, but continues to be characterized by significant disparities in utilization, availability, practice, effectiveness and safety. The International Committee for Monitoring Assisted Reproductive Technologies (ICMART) annual world report provides a major tool for tracking trends in ART treatment for over 25 years and gives important data to ART professionals, public health authorities, patients and the general public.
STUDY DESIGN, SIZE, DURATION
A retrospective, cross-sectional survey on the utilization, effectiveness and safety of ART procedures performed globally during 2012 was carried out.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Sixty-nine countries and 2600 ART clinics submitted data on ART cycles performed during the year 2012, and their pregnancy outcome, through national and regional ART registries. ART cycles and outcomes are described at country, regional and global levels. Aggregate country data were processed and analyzed based on methods developed by ICMART.
MAIN RESULTS AND ROLE OF CHANCE
A total of 1 149 817 ART cycles were reported for the treatment year 2012. After imputing data for missing values and non-reporting clinics in reporting countries, 1 948 898 cycles (an increase of 18.6% from 2011) resulted in >465 286 babies (+17.9%) in reporting countries. China did not report and is not included in this estimate. The best estimate of global utilization including China is ∼2.8 million cycles and 0.9 million babies. From 2011 to 2012, the number of reported aspirations and FET cycles increased by 6.9% and 16.0%, respectively. The proportion of women aged 40 years or older undergoing non-donor ART increased from 24.0% in 2011 to 25.2% in 2012. ICSI, as a percentage of non-donor aspiration cycles, increased from 66.5% in 2011 to 68.9% in 2012. The IVF/ICSI combined delivery rates per fresh aspiration and FET cycles were 19.8% and 22.1%, respectively. In fresh non-donor cycles, SET increased from 31.4% in 2011 to 33.7% in 2012, while the average number of transferred embryos decreased from 1.91 to 1.88, respectively—but with wide country variation. The rates of twin deliveries following fresh non-donor transfers decreased from 19.6% in 2011 to 18.0% in 2012, and the triplet rate decreased from 0.9% to 0.8%. In FET non-donor cycles, SET was 54.8%, with an average of 1.54 embryos transferred and twin and triplet rates of 11.1% and 0.4%, respectively. The cumulative DR per aspiration increased from 28.0% in 2011 to 28.9% in 2012. The overall perinatal mortality rate per 1000 births was 21.4 following fresh IVF/ICSI and 15.9 per 1000 following FET.
LIMITATIONS, REASONS FOR CAUTION
The data presented depend on the quality and completeness of data submitted by individual countries to ICMART directly or through regional registries. This report covers approximately two-thirds of` world ART activity, with a major missing country, China. Continued efforts to improve the quality and consistency of reporting ART data by registries are still needed, including the use of internationally agreed standard definitions (International Glossary of Infertility and Fertility Care).
WIDER IMPLICATIONS OF THE FINDINGS
The ICMART world reports provide the most comprehensive global statistical census and review of ART utilization, effectiveness, safety and quality. While ART treatment continues to increase globally, the wide disparities in access to treatment, procedures performed and embryo transfer practices warrant attention by clinicians and policy makers. With the increasing practice of SET and of freeze all and resulting increased proportion of FET cycles, it is clear that PR and DR per aspiration in fresh cycles do not give an overall accurate estimation of ART efficiency. It is time to use cumulative live birth rate per aspiration, combining the outcomes of FET cycles with the associated fresh cycle from which the embryos were obtained, and to obtain global consensus on this approach.
STUDY FUNDING/COMPETING INTEREST(S)
The authors declare no conflict of interest and no specific support from any organizations in relation to this manuscript. ICMART gratefully acknowledges financial support from the following organizations: American Society for Reproductive Medicine; European Society for Human Reproduction and Embryology; Fertility Society of Australia; Japan Society for Reproductive Medicine; Japan Society of Fertilization and Implantation; Red Latinoamericana de Reproduccion Asistida; Society for Assisted Reproductive Technology; Ferring Pharmaceuticals and Abbott (both providing ICMART unrestricted grants unrelated to world reports).
TRIAL REGISTRATION NUMBER
NA.
Collapse
Affiliation(s)
| | - Georgina M Chambers
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health, School of Women’s and Children’s Health, University of New South Wales, Sydney, Australia
| | - Fernando Zegers-Hochschild
- Clinica las Condes and Program of Ethics and Public Policies in Human Reproduction, University Diego Portales, Santiago, Chile
| | | | - Osamu Ishihara
- Department of Obstetrics and Gynaecology, Saitama Medical University, Moroyama, Japan
| | | | - Silke Dyer
- Department of Obstetrics & Gynaecology, Groote Schuur Hospital, South Africa
- Faculty of Health Sciences, University of Cape Town, South Africa
| | - Markus Kupka
- Fertility Centre, Gynaecologikum Hamburg, Germany
| | - G David Adamson
- Equal3 Fertility, Cupertino, CA, USA
- Stanford University School of Medicine, Palo Alto, CA, USA
- University of California School of Medicine, San Francisco, CA, USA
| |
Collapse
|
26
|
Abstract
Over the past 40 years access and effectiveness of assisted reproductive technologies (ART) have increased, and to date more than 8 million children have been conceived after ART globally. Most pregnancies resulting from ART are uncomplicated and result in the birth of healthy children. Yet, it is well known that pregnancies following ART are more likely to be affected by obstetric complications such as hypertensive disorders in pregnancy, preterm birth, and low birth weight compared with spontaneously conceived pregnancies. ART children are also at increased risk of birth defects. The majority of the problems arise as a result of multiple pregnancies and can be reduced by transferring a single embryo, thereby avoiding multiple pregnancies. New ART technologies are constantly introduced, and monitoring of the health of ART children is crucial.
Collapse
Affiliation(s)
- Ulla-Britt Wennerholm
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital East, Gothenburg, Sweden
- CONTACT Ulla-Britt Wennerholm Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital East, GothenburgSE 416 85, Sweden
| | - Christina Bergh
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
27
|
Wenquan L, Yuhua L, Jianxin C, Hongqing X, Kecheng Z, Jiyang L, Yunhe G, Yi L, Wang Z, Shaoqing L, Yixun L, Shen Q, Wanguo X, Zhi Q, Lin C. Tumor deposit serves as a prognostic marker in gastric cancer: A propensity score-matched analysis comparing survival outcomes. Cancer Med 2020; 9:3268-3277. [PMID: 32163670 PMCID: PMC7221304 DOI: 10.1002/cam4.2963] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 02/01/2020] [Accepted: 02/19/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Gastric cancer (GC) treatment is determined by accurate tumor staging. The value of tumor deposit (TD) in prognostic prediction staging system is not yet determined. METHODS We retrospectively analyzed clinical information on GC patients who underwent gastrectomy at the Department of General Surgery of the Chinese PLA General Hospital from July 2014 to June 2016. Propensity score matching (PSM) was performed to reduce the possibility of selection bias according to the presence of TD. RESULTS Of the 1034 GC patients, 240 (23.21%) presented with TD, which was associated with younger age and larger tumor size (all P < .05). TD-positive patients had a worse survival than TD-negative patients before (P < .001) and after (P = .017) matching. Multivariable analysis showed that mortality risk of patients with TD increased by 58%, 62%, 37%, and 40% in the crude (HR = 1.58, 95% CI 1.32-1.89, P < .001), adjusted I (HR = 1.62, 95% CI 1.35-1.94, P < .001), adjusted II (HR = 1.37, 95% CI 1.13-1.66, P = .001), and adjusted III (HR = 1.40, 95% CI 1.16-1.68, P < .001) models before matching. Similarly, in the PSM cohort patients with TD had worse prognosis in the crude (HR = 1.32, 95% CI 1.07-1.63, P = .011), adjusted I (HR = 1.35, 95% CI 1.09-1.67, P = .005), adjusted II (HR = 1.26, 95% CI 1.00-1.58, P = .049), and adjusted III (HR = 1.33, 95% CI 1.07-1.65, P = .010) models. TD had a similar value range between N1 and N2 stages among different models. CONCLUSIONS Among GC patients, TD is associated with survival and may have a role in the staging of patients.
Collapse
Affiliation(s)
- Liang Wenquan
- Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China
| | - Liu Yuhua
- Institute of Army Hospital Management, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Cui Jianxin
- Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital, Beijing, China
| | - Xi Hongqing
- Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital, Beijing, China
| | - Zhang Kecheng
- Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital, Beijing, China
| | - Li Jiyang
- Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital, Beijing, China
| | - Gao Yunhe
- Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China
| | - Liu Yi
- Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China
| | - Zhang Wang
- Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China
| | - Li Shaoqing
- Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China
| | - Lu Yixun
- Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China
| | - Qiao Shen
- Medical Big Data Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xue Wanguo
- Medical Big Data Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Qiao Zhi
- Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital, Beijing, China
| | - Chen Lin
- Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
28
|
Neonatal outcome after fresh versus frozen embryo transfer in normogonadotropic healthy young women undergoing IVF. GINECOLOGIA.RO 2020. [DOI: 10.26416/gine.28.2.2020.3182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|