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Cornelisse S, Fleischer K, van der Westerlaken L, de Bruin JP, Vergouw C, Koks C, Derhaag J, Visser J, van Echten-Arends J, Slappendel E, Arends B, van der Zanden M, van Dongen A, Brink-van der Vlugt J, de Hundt M, Curfs M, Verhoeve H, Traas-Hofmans M, Wurth Y, Manger P, Pieterse Q, Braat D, van Wely M, Ramos L, Mastenbroek S. Cumulative live birth rate of a blastocyst versus cleavage stage embryo transfer policy during in vitro fertilisation in women with a good prognosis: multicentre randomised controlled trial. BMJ 2024; 386:e080133. [PMID: 39284610 PMCID: PMC11403767 DOI: 10.1136/bmj-2024-080133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
OBJECTIVES To evaluate whether embryo transfers at blastocyst stage improve the cumulative live birth rate after oocyte retrieval, including both fresh and frozen-thawed transfers, and whether the risk of obstetric and perinatal complications is increased compared with cleavage stage embryo transfers during in vitro fertilisation (IVF) treatment. DESIGN Multicentre randomised controlled trial. SETTING 21 hospitals and clinics in the Netherlands, 18 August 2018 to 17 December 2021. PARTICIPANTS 1202 women with at least four embryos available on day 2 after oocyte retrieval were randomly assigned to either blastocyst stage embryo transfer (n=603) or cleavage stage embryo transfer (n=599). INTERVENTIONS In the blastocyst group and cleavage group, embryo transfers were performed on day 5 and day 3, respectively, after oocyte retrieval, followed by cryopreservation of surplus embryos. Analysis was on an intention-to-treat basis, with secondary analyses as per protocol. MAIN OUTCOME MEASURES The primary outcome was the cumulative live birth rate per oocyte retrieval, including results of all frozen-thawed embryo transfers within a year after randomisation. Secondary outcomes included cumulative rates of pregnancy, pregnancy loss, and live birth after fresh embryo transfer, number of embryo transfers needed, number of frozen embryos, and obstetric and perinatal outcomes. RESULTS The cumulative live birth rate did not differ between the blastocyst group and cleavage group (58.9% (355 of 603) v 58.4% (350 of 599; risk ratio 1.01, 95% confidence interval (CI) 0.84 to 1.22). The blastocyst group showed a higher live birth rate after fresh embryo transfer (1.26, 1.00 to 1.58), lower cumulative pregnancy loss rate (0.68, 0.51 to 0.89), and lower mean number of embryo transfers needed to result in a live birth (1.55 v 1.82; P<0.001). The incidence of moderate preterm birth (32 to <37 weeks) in singletons was higher in the blastocyst group (1.87, 1.05 to 3.34). CONCLUSION Blastocyst stage embryo transfers resulted in a similar cumulative live birth rate to cleavage stage embryo transfers in women with at least four embryos available during IVF treatment. TRIAL REGISTRATION International Clinical Trial Registry Platform NTR7034.
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Affiliation(s)
- Simone Cornelisse
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, Netherlands
| | | | | | - Jan-Peter de Bruin
- Department of Obstetrics and Gynaecology, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, Netherlands
| | - Carlijn Vergouw
- Amsterdam UMC location, Vrije Universiteit Amsterdam, Centre for Reproductive Medicine Amsterdam, Netherlands
| | - Carolien Koks
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, Netherlands
| | - Josien Derhaag
- Centre for Reproductive Medicine, MUMC+, Maastricht, Netherlands
| | - Jantien Visser
- Department of Obstetrics and Gynaecology, Amphia Ziekenhuis, Breda, Netherlands
| | | | - Els Slappendel
- Centre for Fertility, Nij Geertgen, Elsendorp, Netherlands
| | - Brigitte Arends
- Department of Reproductive Medicine, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Moniek van der Zanden
- Department of Obstetrics and Gynaecology, Haaglanden Medical Centre, The Hague, Netherlands
| | - Angelique van Dongen
- Department of Obstetrics and Gynaecology, Hospital Gelderse Vallei, Ede, Netherlands
| | | | - Marcella de Hundt
- Department of Obstetrics and Gynaecology, NoordWest Ziekenhuisgroep, Alkmaar, Netherlands
| | - Max Curfs
- Isala Fertility Centre, Isala Clinics, Zwolle, Netherlands
| | - Harold Verhoeve
- Department of Obstetrics and Gynaecology, OLVG Oost, Amsterdam, Netherlands
| | - Maaike Traas-Hofmans
- Department of Obstetrics and Gynaecology, Gelre Ziekenhuizen, Apeldoorn and Zutphen, Netherlands
| | - Yvonne Wurth
- IVF Centre, Elisabeth-TweeSteden Ziekenhuis, Tilburg, Netherlands
| | - Petra Manger
- Department of Obstetrics and Gynaecology, Diakonessenhuis, Utrecht, Netherlands
| | - Quirine Pieterse
- Department of Obstetrics and Gynaecology, Haga Ziekenhuis, Den Haag, Netherlands
| | - Didi Braat
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Madelon van Wely
- Amsterdam UMC, location University of Amsterdam, Centre for Reproductive Medicine, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Liliana Ramos
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Sebastiaan Mastenbroek
- Amsterdam UMC, location University of Amsterdam, Centre for Reproductive Medicine, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
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H Petersen S, Westvik-Johari K, Spangmose AL, Pinborg A, Romundstad LB, Bergh C, Åsvold BO, Gissler M, Tiitinen A, Wennerholm UB, Opdahl S. Risk of Hypertensive Disorders in Pregnancy After Fresh and Frozen Embryo Transfer in Assisted Reproduction: A Population-Based Cohort Study With Within-Sibship Analysis. Hypertension 2023; 80:e6-e16. [PMID: 36154568 DOI: 10.1161/hypertensionaha.122.19689] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Frozen embryo transfer (frozen-ET) is increasingly common because of improved cryopreservation methods and elective freezing of all embryos. Frozen-ET is associated with higher risk of hypertensive disorders in pregnancy than both natural conception and fresh embryo transfer (fresh-ET), but whether this is attributable to parental factors or treatment is unknown. METHODS Using the Medical Birth Registries of Denmark (1994-2014), Norway, and Sweden (1988-2015), linked to data from national quality registries and databases on assisted reproduction, we designed a population-based cohort study with within-sibship comparison. We included 4 426 691 naturally conceived, 78 300 fresh-ET, and 18 037 frozen-ET singleton pregnancies, of which 33 209 sibships were conceived using different conception methods. Adjusted odds ratios (aOR) of hypertensive disorders in pregnancy for fresh-ET and frozen-ET versus natural conception with 95% CI were estimated using multilevel logistic regression, where random effects provided conventional population-level estimates and fixed effects gave within-sibship estimates. Main models included adjustment for birth year, maternal age, parity, and country. RESULTS Risk of hypertensive disorders in pregnancy was higher after frozen-ET compared to natural conception, both at population-level (7.4% versus 4.3%, aOR, 1.74 [95% CI, 1.61-1.89]) and within sibships (aOR, 2.02 [95% CI, 1.72-2.39]). For fresh-ET, risk was similar to natural conception, both at population-level (aOR, 1.02 [95% CI, 0.98-1.07]) and within sibships (aOR, 0.99 [95% CI, 0.89-1.09]). CONCLUSIONS Frozen-ET was associated with substantially higher risk of hypertensive disorders in pregnancy, even after accounting for shared parental factors within sibships.
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Affiliation(s)
- Sindre H Petersen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences (S.H.P., K.W.-J., S.O.), Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjersti Westvik-Johari
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences (S.H.P., K.W.-J., S.O.), Norwegian University of Science and Technology, Trondheim, Norway.,Department of Fertility, Women and Children's Centre, St. Olavs Hospital, Trondheim, Norway (K.W.-J.)
| | - Anne Lærke Spangmose
- Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Denmark (A.L.S., A.P.)
| | - Anja Pinborg
- Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Denmark (A.L.S., A.P.)
| | - Liv Bente Romundstad
- Spiren Fertility Clinic, Trondheim, Norway (L.B.R.).,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo (L.B.R.)
| | - Christina Bergh
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Sweden (C.B., U.-B.W.)
| | - Bjørn Olav Åsvold
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences (B.O.A.), Norwegian University of Science and Technology, Trondheim, Norway.,HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Levanger (B.A.O.).,Department of Endocrinology, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Norway (B.O.A.)
| | - Mika Gissler
- THL Finnish Institute for Health and Welfare, Department of Knowledge Brokers, Helsinki, Finland (M.G.).,Karolinska Institutet, Department of Molecular Medicine and Surgery, Stockholm, Sweden (M.G.)
| | - Aila Tiitinen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Finland (A.T.)
| | - Ulla-Britt Wennerholm
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Sweden (C.B., U.-B.W.)
| | - Signe Opdahl
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences (S.H.P., K.W.-J., S.O.), Norwegian University of Science and Technology, Trondheim, Norway
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Gullo G, Scaglione M, Cucinella G, Chiantera V, Perino A, Greco ME, Laganà AS, Marinelli E, Basile G, Zaami S. Neonatal Outcomes and Long-Term Follow-Up of Children Born from Frozen Embryo, a Narrative Review of Latest Research Findings. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091218. [PMID: 36143894 PMCID: PMC9500816 DOI: 10.3390/medicina58091218] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022]
Abstract
In recent years, the growing use of ART (assisted reproductive techniques) has led to a progressive improvement of protocols; embryo freezing is certainly one of the most important innovations. This technique is selectively offered as a tailored approach to reduce the incidence of multiple pregnancies and, most importantly, to lower the risk of developing ovarian hyperstimulation syndrome when used in conjunction with an ovulation-triggering GnRH antagonist. The increase in transfer cycles with frozen embryos made it possible to study the effects of the technique in children thus conceived. Particularly noteworthy is the increase in macrosomal and LGA (large for gestational age) newborns, in addition to a decrease in SGA (small for gestational age) and LBW (low birth weight) newborns. The authors aimed to outline a broad-ranging narrative review by summarizing and elaborating on the most important evidence regarding the neonatal outcome of children born from frozen embryos and provide information on the medium and long-term follow- up of these children. However, given the relatively recent large-scale implementation of such techniques, further studies are needed to provide more conclusive evidence on outcomes and implications.
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Affiliation(s)
- Giuseppe Gullo
- IVF Unit, Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy
| | - Marco Scaglione
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences, University of Genoa, 16132 Genoa, Italy
| | - Gaspare Cucinella
- IVF Unit, Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS “Civico-Di Cristina-Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Antonino Perino
- IVF Unit, Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy
| | - Maria Elisabetta Greco
- IVF Unit, Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico-Di Cristina-Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Enrico Marinelli
- Department of Medico-Surgical Sciences and Biotechnologies, “Sapienza” University of Rome, 04100 Rome, Italy
- Correspondence:
| | | | - Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, “Sapienza” University of Rome, 00161 Rome, Italy
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Hu KL, Zheng X, Hunt S, Li X, Li R, Mol BW. Blastocyst quality and perinatal outcomes in women undergoing single blastocyst transfer in frozen cycles. Hum Reprod Open 2022; 2021:hoab036. [PMID: 35187269 PMCID: PMC8849119 DOI: 10.1093/hropen/hoab036] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/10/2021] [Indexed: 12/31/2022] Open
Abstract
STUDY QUESTION Is the morphological grading system for blastocysts associated with perinatal outcomes in women undergoing frozen-thawed single blastocyst transfer (SBT)? SUMMARY ANSWER Preferential transfer of a blastocyst based on their inner cell mass (ICM) and trophectoderm (TE) grading appears to be supported by observed differences in perinatal outcomes. WHAT IS KNOWN ALREADY The transfer of a morphologically good quality blastocyst is associated with a higher chance of implantation and pregnancy as compared to transfer of a poor quality blastocyst. However, to date, the association of the morphological parameters of the blastocyst with perinatal outcomes after blastocyst transfer remains unknown. STUDY DESIGN SIZE DURATION This retrospective cohort study started with 27 336 frozen-thawed SBT cycles from January 2013 to December 2019. PARTICIPANTS/MATERIALS SETTING METHODS There were 7469 women with singleton deliveries in Peking University Third Hospital eligible for analysis. Multivariate logistic regression was used to test the risk of factors with the expression of crude odds ratios (ORs) and adjusted OR with 95% CIs. MAIN RESULTS AND THE ROLE OF CHANCE Transfer of a blastocyst with a low overall grading was associated with a higher chance of female baby (48% vs 42%, adjusted OR = 1.26 (1.13, 1.39)) and a higher rate of caesarian section (C-section; 71% vs 68%, adjusted OR = 1.15 (1.02, 1.29)). Compared with Grade A ICM blastocyst transfer, Grade B ICM and Grade C ICM blastocyst transfers were associated with a lower chance of a female baby (adjusted OR = 0.83 (0.73, 0.95), 0.63 (0.50, 0.79), respectively) and a higher risk of large for gestational age (LGA; adjusted OR = 1.23 (1.05, 1.45), 1.47 (1.12, 1.92), respectively); Grade C ICM blastocyst transfer was also associated with an increased risk of macrosomia (adjusted OR = 1.66 (1.20, 2.30)). Compared with Grade A TE blastocyst transfer, there was an increased risk of small for gestational age with Grade C TE blastocyst transfer (adjusted OR = 1.74 (1.05, 2.88)). Both Grade B TE and Grade C TE blastocyst transfer had a higher chance of female baby (adjusted OR = 1.30 (1.11, 1.53), 1.88 (1.57, 2.26), respectively) and a lower risk of gestational diabetes mellitus (adjusted OR = 0.74 (0.59, 0.94), 0.67 (0.50, 0.88), respectively) than Grade A TE blastocyst transfer. LIMITATIONS REASONS FOR CAUTION The main limitations of this study were its retrospective nature and the relative subjectivity of blastocyst scoring. The follow-up was conducted through a phone call and some patients may not have reported their obstetrical and neonatal outcomes, leading to a relatively lower rate of several obstetrical outcomes. Due to the missing information in our dataset, we were not able to separate out iatrogenic preterm birth nor adjust for obstetric complications in previous pregnancies as a confounder in the mutivariate analysis. Because the days of blastocyst culture in total were unclear in our dataset, analysis of the association between the time to reach blastocyst expansion and perinatal outcomes was not performed. WIDER IMPLICATIONS OF THE FINDINGS Transfer of a blastocyst with a low overall grading is associated with a higher rate of C-section and a higher chance of a female baby. The association between ICM grading and LGA would suggest that Grade A ICM blastocysts should be transferred preferentially to Grade B/C ICM blastocysts. Our results support the use of current morphological systems for embryo prioritization. STUDY FUNDING/COMPETING INTERESTS This study was supported by the National Key Research and Development Program of China (2018YFC1004100 to R.L.), the National Science Fund for Distinguished Young Scholars (81925013 to R.L.) and a Zhejiang University Scholarship for Outstanding Doctoral Candidates (to K.-L.H.). All authors have read the journal's authorship agreement and policy on disclosure of potential conflicts of interest, and have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Kai-Lun Hu
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Peking University Third Hospital, Beijing, People's Republic of China.,Key Laboratory of Reproductive Genetics (Ministry of Education), Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Xiaoying Zheng
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Peking University Third Hospital, Beijing, People's Republic of China
| | - Sarah Hunt
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Xiaohong Li
- Department of Obstetrics and Gynecology, Centre for Reproductive Medicine, West China Second University Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Rong Li
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Peking University Third Hospital, Beijing, People's Republic of China
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
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Saket Z, Källén K, Lundin K, Magnusson Å, Bergh C. Cumulative live birth rate after IVF: trend over time and the impact of blastocyst culture and vitrification. Hum Reprod Open 2021; 2021:hoab021. [PMID: 34195386 PMCID: PMC8240131 DOI: 10.1093/hropen/hoab021] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 04/15/2021] [Indexed: 12/26/2022] Open
Abstract
STUDY QUESTION Has cumulative live birth rate (CLBR) improved over time and which factors are associated with such an improvement? SUMMARY ANSWER During an 11-year period, 2007–2017, CLBR per oocyte aspiration increased significantly, from 27.0% to 36.3%, in parallel with an increase in blastocyst transfer and cryopreservation by vitrification. WHAT IS KNOWN ALREADY While it has been shown that live birth rate (LBR) per embryo transfer (ET) is higher for fresh blastocyst than for fresh cleavage stage embryo transfer, CLBR per oocyte aspiration, including one fresh ET and all subsequent frozen embryo transfers (FET), does not seem to differ between the two culture strategies. STUDY DESIGN, SIZE, DURATION A national register study including all oocyte aspirations performed in Sweden from 2007 to 2017 (n = 124 700 complete IVF treatment cycles) was carried out. Oocyte donation cycles were excluded. PARTICIPANTS/MATERIALS, SETTING, METHODS Data were retrieved from the Swedish National Registry of Assisted Reproduction (Q-IVF) on all oocyte aspirations during the study period where autologous oocytes were used. CLBR was defined as the proportion of deliveries with at least one live birth per oocyte aspiration, including all fresh and/or frozen embryo transfers within 1 year, until one delivery with a live birth or until all embryos were used, whichever occurred first. The delivery of a singleton, twin, or other multiples was registered as one delivery. Cryopreservation of cleavage stage embryos was performed by slow freezing and of blastocyst by vitrification. MAIN RESULTS AND THE ROLE OF CHANCE In total, 124 700 oocyte aspirations were performed (in 61 313 women), with 65 304 aspirations in women <35 years and 59 396 in women ≥ 35 years, resulting in 38 403 deliveries with live born children. Overall, the CLBR per oocyte aspiration increased significantly during the study period, from 27.0% to 36.3% (odds ratio (OR) 1.039, 95% CI 1.035–1.043) and from 30.0% to 43.3% if at least one ET was performed (adjusted OR 1.055, 95% CI 1.050–1.059). The increase in CLBR was independent of maternal age, number of oocytes retrieved and number of previous IVF live births. The CLBR for women <35 and ≥35 years both increased significantly, following the same pattern. During the study period, a substantially increasing number of blastocyst transfers was performed, both in fresh and in FET cycles. Other important predicting factors for live birth, such as number of embryos transferred, could not explain the improvement. An increased single embryo transfer rate was observed with time. LIMITATIONS, REASONS FOR CAUTION The retrospective design implicates that other confounders of importance for CLBR cannot be ruled out. In addition, some FET cycles might be performed later than 1 year post oocyte aspiration for the last year (2017) and are, thus, not included in this study. In addition, no data on ‘dropouts’, i.e. patients that do not continue their treatment despite having cryopreserved embryos, are available, or if this drop-out rate has changed over time. WIDER IMPLICATIONS OF THE FINDINGS The results suggest that blastocyst transfer, particularly when used in FET cycles and in combination with vitrification, is an important contributor to the improved live birth rates over time. This gives a possibility for a lower number of oocyte aspirations needed to achieve a live birth and a shortened time to live birth. STUDY FUNDING/COMPETING INTERESTS The study was financed by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement (ALFGBG-70940) and by Hjalmar Svensson’s research foundation. None of the authors declares any conflict of interest.
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Affiliation(s)
- Zoha Saket
- Department of Reproductive Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Karin Källén
- Unit of Reproduction Epidemiology, Department of Obstetrics and Gynecology, Tornblad Institute, Institution of Clinical Sciences, Lund University, Lund, Sweden
| | - Kersti Lundin
- Department of Reproductive Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Åsa Magnusson
- Department of Reproductive Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Christina Bergh
- Reproductive Medicine, Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Göteborg University, Göteborg, Sweden
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Westvik-Johari K, Romundstad LB, Lawlor DA, Bergh C, Gissler M, Henningsen AKA, Håberg SE, Wennerholm UB, Tiitinen A, Pinborg A, Opdahl S. Separating parental and treatment contributions to perinatal health after fresh and frozen embryo transfer in assisted reproduction: A cohort study with within-sibship analysis. PLoS Med 2021; 18:e1003683. [PMID: 34170923 PMCID: PMC8274923 DOI: 10.1371/journal.pmed.1003683] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 07/12/2021] [Accepted: 06/03/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Compared to naturally conceived children, adverse perinatal outcomes are more common among children born after assisted reproductive technology with fresh embryo transfer (fresh-ET) or frozen embryo transfer (frozen-ET). However, most previous studies could not adequately control for family confounding factors such as subfertility. We compared birth size and duration of pregnancy among infants born after fresh-ET or frozen-ET versus natural conception, using a within-sibship design to account for confounding by maternal factors. METHODS AND FINDINGS This registry-based cohort study with nationwide data from Denmark (1994-2014), Norway (1988-2015), and Sweden (1988-2015) consisted of 4,510,790 live-born singletons, 4,414,703 from natural conception, 78,095 from fresh-ET, and 17,990 from frozen-ET. We identified 33,056 offspring sibling groups with the same mother, conceived by at least 2 different conception methods. Outcomes were mean birthweight, small and large for gestational age, mean gestational age, preterm (<37 weeks, versus ≥37), and very preterm birth (<32 weeks, versus ≥32). Singletons born after fresh-ET had lower mean birthweight (-51 g, 95% CI -58 to -45, p < 0.001) and increased odds of small for gestational age (odds ratio [OR] 1.20, 95% CI 1.08 to 1.34, p < 0.001), while those born after frozen-ET had higher mean birthweight (82 g, 95% CI 70 to 94, p < 0.001) and increased odds of large for gestational age (OR 1.84, 95% CI 1.56 to 2.17, p < 0.001), compared to naturally conceived siblings. Conventional population analyses gave similar results. Compared to naturally conceived siblings, mean gestational age was lower after fresh-ET (-1.0 days, 95% CI -1.2 to -0.8, p < 0.001), but not after frozen-ET (0.3 days, 95% CI 0.0 to 0.6, p = 0.028). There were increased odds of preterm birth after fresh-ET (OR 1.27, 95% CI 1.17 to 1.37, p < 0.001), and in most models after frozen-ET, versus naturally conceived siblings, with somewhat stronger associations in population analyses. For very preterm birth, population analyses showed increased odds for both fresh-ET (OR 2.03, 95% CI 1.90 to 2.12, p < 0.001) and frozen-ET (OR 1.66, 95% CI 1.42 to 1.94, p < 0.001) compared with natural conception, but results were notably attenuated within siblings (OR 1.18, 95% CI 1.0 to 1.41, p = 0.059, and OR 0.92, 95% CI 0.67 to 1.27, p = 0.6, for fresh-ET and frozen-ET, respectively). Sensitivity analyses in full siblings, in siblings born within 3-year interval, by birth order, and restricting to single embryo transfers and blastocyst transfers were consistent with the main analyses. Main limitations were high proportions of missing data on maternal body mass index and smoking. CONCLUSIONS We found that infants conceived by fresh-ET had lower birthweight and increased odds of small for gestational age, and those conceived by frozen-ET had higher birthweight and increased odds of large for gestational age. Conception by either fresh-ET or frozen-ET was associated with increased odds of preterm birth. That these findings were observed within siblings, as well as in conventional multivariable population analyses, reduces the likelihood that they are explained by confounding or selection bias. TRIAL REGISTRATION ClinicalTrials.gov ISRCTN11780826.
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Affiliation(s)
- Kjersti Westvik-Johari
- Department of Fertility, Women and Children’s Centre, St. Olavs Hospital, Trondheim, Norway
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- * E-mail:
| | - Liv Bente Romundstad
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Spiren Fertility Clinic, Trondheim, Norway
| | - Deborah A. Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, Bristol, United Kingdom
- NIHR Bristol Biomedical Research Centre, Bristol, United Kingdom
| | - Christina Bergh
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mika Gissler
- Statistics and Registers Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | - Siri E. Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Ulla-Britt Wennerholm
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Aila Tiitinen
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anja Pinborg
- Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Signe Opdahl
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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Cornelisse S, Ramos L, Arends B, Brink-van der Vlugt JJ, de Bruin JP, Curfs MH, Derhaag J, van Dongen A, van Echten-Arends J, Groenewoud ER, Maas JW, Pieterse Q, van Santbrink EJ, Slappendel E, Traas MA, Visser J, Vergouw CG, Verhoeve HR, van der Westerlaken LA, Wurth Y, van der Zanden M, Braat DD, van Wely M, Mastenbroek S, Fleischer K. Comparing the cumulative live birth rate of cleavage-stage versus blastocyst-stage embryo transfers between IVF cycles: a study protocol for a multicentre randomised controlled superiority trial (the ToF trial). BMJ Open 2021; 11:e042395. [PMID: 33441363 PMCID: PMC7812106 DOI: 10.1136/bmjopen-2020-042395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION In vitro fertilisation (IVF) has evolved as an intervention of choice to help couples with infertility to conceive. In the last decade, a strategy change in the day of embryo transfer has been developed. Many IVF centres choose nowadays to transfer at later stages of embryo development, for example, transferring embryos at blastocyst stage instead of cleavage stage. However, it still is not known which embryo transfer policy in IVF is more efficient in terms of cumulative live birth rate (cLBR), following a fresh and the subsequent frozen-thawed transfers after one oocyte retrieval. Furthermore, studies reporting on obstetric and neonatal outcomes from both transfer policies are limited. METHODS AND ANALYSIS We have set up a multicentre randomised superiority trial in the Netherlands, named the Three or Fivetrial. We plan to include 1200 women with an indication for IVF with at least four embryos available on day 2 after the oocyte retrieval. Women are randomly allocated to either (1) control group: embryo transfer on day 3 and cryopreservation of supernumerary good-quality embryos on day 3 or 4, or (2) intervention group: embryo transfer on day 5 and cryopreservation of supernumerary good-quality embryos on day 5 or 6. The primary outcome is the cLBR per oocyte retrieval. Secondary outcomes include LBR following fresh transfer, multiple pregnancy rate and time until pregnancy leading a live birth. We will also assess the obstetric and neonatal outcomes, costs and patients' treatment burden. ETHICS AND DISSEMINATION The study protocol has been approved by the Central Committee on Research involving Human Subjects in the Netherlands in June 2018 (CCMO NL 64060.000.18). The results of this trial will be submitted for publication in international peer-reviewed and in open access journals. TRIAL REGISTRATION NUMBER Netherlands Trial Register (NL 6857).
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Affiliation(s)
- Simone Cornelisse
- Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Liliana Ramos
- Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Brigitte Arends
- Department of Reproductive Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Jan Peter de Bruin
- Department of Obstetrics and Gynecology, Jeroen Bosch Hospital, 's-Hertogenbosch, North Brabant, The Netherlands
| | - Max Hjn Curfs
- Department of Obstetrics and Gynecology, Isala Fertility Centre, Zwolle, Overijssel, The Netherlands
| | - Josien Derhaag
- Department of Reproductive Medicine, Maastricht University Medical Centre, Maastricht, Limburg, The Netherlands
| | - Angelique van Dongen
- Department of Obstetrics and Gynaecology, Hospital Gelderse Vallei, Ede, Gelderland, The Netherlands
| | - Jannie van Echten-Arends
- Department of Obstetrics and Gynaecology, Section of Reproductive Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Eva R Groenewoud
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Northwest Hospital Group, Den Helder, North Holland, The Netherlands
| | - Jacques Wm Maas
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, North Brabant, The Netherlands
| | - Quirine Pieterse
- Department of Obstetrics and Gynaecology, Haga Hospital, the Hague, South Holland, The Netherlands
| | | | - Els Slappendel
- Fertility Clinic, Nij Geertgen, Elsendorp, North Brabant, The Netherlands
| | - Maaike Af Traas
- Department of Gynaecology, Gelre Hospital, Apeldoorn, Gelderland, The Netherlands
| | - Jantien Visser
- Department of Obstetrics and Gynaecology, Amphia Hospital, Breda, North Brabant, The Netherlands
| | - Carlijn G Vergouw
- Department of Reproductive Medicine, Amsterdam UMC Location VUmc, Amsterdam, North Holland, The Netherlands
| | - Harold R Verhoeve
- Department of Obstetrics and Gynaecology, OLVG Oost, Amsterdam, North Holland, The Netherlands
| | | | - Yvonne Wurth
- Department of Reproductive Medicine, Elisabeth-TweeSteden Hospital, Tilburg, North Brabant, The Netherlands
| | - Moniek van der Zanden
- Department of Obstetrics and Gynaecology, Haaglanden Medical Centre, the Hague, South Holland, The Netherlands
| | - Didi Dm Braat
- Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Madelon van Wely
- Centre for Reproductive Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Sebastiaan Mastenbroek
- Centre for Reproductive Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Kathrin Fleischer
- Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
- Fertility Centre, MVZ TFP-VivaNeo, Düsseldorf, Germany
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Eisenberg ML, Luke B, Cameron K, Shaw GM, Pacey AA, Sutcliffe AG, Williams C, Gardiner J, Anderson RA, Baker VL. Defining critical factors in multi-country studies of assisted reproductive technologies (ART): data from the US and UK health systems. J Assist Reprod Genet 2020; 37:2767-2775. [PMID: 32995971 PMCID: PMC7642045 DOI: 10.1007/s10815-020-01951-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/13/2020] [Indexed: 11/29/2022] Open
Abstract
As the worldwide use of assisted reproductive technologies (ART) continues to grow, there is a critical need to assess the safety of these treatment parameters and the potential adverse health effects of their use in adults and their offspring. While key elements remain similar across nations, geographic variations both in treatments and populations make generalizability challenging. We describe and compare the demographic factors between the USA and the UK related to ART use and discuss implications for research. The USA and the UK share some common elements of ART practice and in how data are collected regarding long-term outcomes. However, the monitoring of ART in these two countries each brings strengths that complement each other's limitations.
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Affiliation(s)
- Michael L Eisenberg
- Division of Male Reproductive Medicine and Surgery, Department of Urology, Stanford University School of Medicine, Palo Alto, CA, USA.
- Department of Urology, Stanford University School of Medicine, 300 Pasteur Dr., Stanford, CA, USA.
| | - Barbara Luke
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Katherine Cameron
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gary M Shaw
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Allan A Pacey
- Academic Unit of Reproductive and Developmental Medicine, University of Sheffield, Sheffield, UK
| | - Alastair G Sutcliffe
- Policy, Practice and Population Unit, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Carrie Williams
- Policy, Practice and Population Unit, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | | | - Richard A Anderson
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Valerie L Baker
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI, USA
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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.
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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
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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
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Liu Y, Wu Y. Progesterone Intramuscularly or Vaginally Administration May Not Change Live Birth Rate or Neonatal Outcomes in Artificial Frozen-Thawed Embryo Transfer Cycles. Front Endocrinol (Lausanne) 2020; 11:539427. [PMID: 33343505 PMCID: PMC7747782 DOI: 10.3389/fendo.2020.539427] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 11/02/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUNDS Previous studies suggested that singletons from frozen-thawed embryo transfer (FET) were associated with higher risk of large, post-date babies and adverse obstetrical outcomes compared to fresh transfer and natural pregnancy. No data available revealed whether the adverse perinatal outcomes were associated with aberrantly high progesterone level from different endometrium preparations in HRT-FET cycle. This study aimed to compare the impact of progesterone intramuscularly and vaginally regimens on neonatal outcomes in HRT-FET cycles. METHODS A total of 856 HRT-FET cycles from a fertility center from 2015 to 2018 were retrospectively analyzed. All patients had their first FET with two cleavage-staged embryos transferred. Endometrial preparation was performed with sequential administration of estrogen followed by progesterone intramuscularly 60 mg per day or vaginal gel Crinone 90 mg per day. Pregnancy outcomes including live birth rate, singleton birthweight, large for gestational age (LGA) rate, small for gestational age (SGA) rate, and preterm delivery rate were analyzed. Student's t test, Mann-Whitney U-test, Chi square analysis, and multivariable logistic regression were used where appropriate. Differences were considered significant if p < 0.05. RESULTS No significant difference of live birth rate was found between different progesterone regimens (Adjusted OR 1.128, 95% CI 0.842, 1.511, p = 0.420). Neonatal outcomes like singleton birthweight (p = 0.744), preterm delivery rate (Adjusted OR 1.920, 95% CI 0.603, 6.11, p = 0.269), SGA (Adjusted OR 0.227, 95% CI 0.027, 1.934, p = 0.175), and LGA rate (Adjusted OR 0.862, 95% CI 0.425, 1.749, p=0.681) were not different between two progesterone regimens. Serum P level >41.82 pmol/L at 14 day post-FET was associated with higher live birth rate than serum P level ≤41.82 pmol/L in HRT-FET cycles when progesterone was intramuscularly delivered (Adjusted OR 1.690, 95% CI 1.002, 2.849, p = 0.049). But singleton birthweight, preterm delivery rate, SGA and LGA rate were not different between these two groups. CONCLUSIONS Relatively higher serum progesterone level induced by intramuscular regimen did not change live birth rate or neonatal outcomes compared to vaginal regimen. Monitoring serum progesterone level and optimizing progesterone dose of intramuscular progesterone as needed in HRT-FET cycles has a role in improving live birth rate without impact on neonatal outcomes.
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