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Pourmoghadam Z, Soltani-Zangbar MS, Sheikhansari G, Azizi R, Eghbal-Fard S, Mohammadi H, Siahmansouri H, Aghebati-Maleki L, Danaii S, Mehdizadeh A, Hojjat-Farsangi M, Motavalli R, Yousefi M. Intrauterine administration of autologous hCG- activated peripheral blood mononuclear cells improves pregnancy outcomes in patients with recurrent implantation failure; A double-blind, randomized control trial study. J Reprod Immunol 2020; 142:103182. [PMID: 32781360 DOI: 10.1016/j.jri.2020.103182] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 07/18/2020] [Accepted: 07/26/2020] [Indexed: 01/30/2023]
Abstract
We aimed to investigate the effect of intrauterine administration of autologous hCG-activated PBMCs in RIF women with low Th-17/Treg cell ratio. 248 women with a history of implantation failure volunteered to receive PBMC-therapy. After immunologic consultation and doing flow cytometry analysis, 100 women with at least three IVF/ET failure who had low Th-17/Treg ratio in comparison with healthy control were enrolled in this study. These 100 patients were randomly divided into two groups as PBMC receiving (n = 50) and controls (n = 50). Then PBMCs were obtained from patients and treated with hCG for 48 h. Afterward, PBMCs were administered into the uterine cavity of the patient in the study group, two days before ET. The concentration of inflammatory cytokines was examined in the supernatant of cultured PBMCs after 2, 24, and 48 h of incubation using the ELISA method. The frequency of Th-17, Treg, and the Th-17/Treg ratio was significantly lower in RIF women than the healthy controls (P < 0.0001). The secretion of inflammatory cytokines was significantly higher after 48 h compared to 2 and 24 h (P < 0.0001). The pregnancy and live birth rate were significantly increased in women undergoing the PBMC-therapy compared to control (PBS-injecting) group (P = 0.032 and P = 0.047, respectively). The miscarriage rate was considerably lower in PBMC-therapy group (P = 0.029). Our findings suggest that intrauterine administration of autologous in vitro hCG-activated PBMCs improves pregnancy outcomes in patients with at least three IVF/ET failures.
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Affiliation(s)
- Zahra Pourmoghadam
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Golshan Sheikhansari
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ramyar Azizi
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shadi Eghbal-Fard
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamed Mohammadi
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | | | | | - Shahla Danaii
- Gynecology Department, Eastern Azerbaijan ACECR ART center, Eastern Azerbaijan branch of ACECR, Tabriz, Iran
| | - Amir Mehdizadeh
- Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Hojjat-Farsangi
- Department of Oncology-Pathology, Immune and Gene Therapy Lab, Cancer Center Karolinska (CCK), Karolinska University Hospital Solna and Karolinska Institute, Stockholm, Sweden
| | - Roza Motavalli
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Kidney Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehdi Yousefi
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Kidney Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
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Etiology and management of recurrent implantation failure: A focus on intra-uterine PBMC-therapy for RIF. J Reprod Immunol 2020; 139:103121. [DOI: 10.1016/j.jri.2020.103121] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 01/11/2023]
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Shao YH, Zhang XY, Buckett W, Ao A. Impact of in vitro fertilization-preimplantation genetic testing (IVF-PGT) funding policy on clinical outcome: An issue that stems beyond effectiveness of treatment. Eur J Obstet Gynecol Reprod Biol 2019; 235:1-5. [PMID: 30743159 DOI: 10.1016/j.ejogrb.2019.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/10/2018] [Accepted: 01/01/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVE(S) The aim of this study was to compare the patient characteristics, type of genetic disease and inheritance, volume of activity, practice patterns and pregnancy outcomes, in private versus publically funded IVF pre-implantation genetic testing (PGT) for translocation (IVF-PGT-SR) and aneuploidy (PGT-A) periods. STUDY DESIGN This study retrospectively analyzed data during both privately funded period (PRP) and publically funded period (PUP) of assisted reproductive technology (ART) for a total of 275 patients. 83 patients underwent IVF-PGT-SR and 192 patients underwent IVF-PGT-A. Given that PGT-SR is a chromosomal abnormality hereditary in nature, whereas PGT-A is sporadic in addition to the contrasting funding policies, the two cohorts were analyzed separately. To achieve the proposed objective, the two groups under analysis were grouped in accordance with their respective coverage systems for infertility. RESULTS Among translocation patients, 94 normal/balanced embryos were obtained from 47 IVF-PGT cycles in PRP whereas 145 embryos were obtained from 92 IVF-PGT cycles in PUP. The average number of embryos transferred per embryo transfer cycle was significantly lower in PUP in comparison to PRP (1.13 vs. 1.74, p < 0.0001). 13 singletons and 2 sets of twins were conceived in PRP. 14 singletons were conceived in PUP. Regardless of funding period, there were more reciprocal translocation carriers (79.4% in PRP and 76.4% in PUP) and more male carriers (82.4% in PRP and 60% in PUP), of which the majority had abnormal sperm parameters. Among aneuploidy patients, on average 2.5 embryos in PRP and 1.4 embryos in PUP were transferred per ET cycle (p = 0.05). There was a 13.3% increase in number of IVF-PGT-A attempts per patient in PRP compared to PUP. Live birth rate per IVF-PGT-A was higher in PRP (29.7% vs. 15%, P = 0.02), which consisted of 48 singletons and 18 multiparous pregnancies in PRP and 9 singletons in PUP. CONCLUSION(S) Public coverage of ART is associated with a greater utilization ART, as well as a reduced number in embryo transfer (ET) per cycle, a lower proportion of cycles resulting in successful pregnancy and a lower multiple birth rate. Our study ultimately shines light on the effect of providers' and patients' monetary conscious on pregnancy outcome.
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Affiliation(s)
- Yi-Hong Shao
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Xiao Yun Zhang
- MUHC Reproductive Centre, Department of Obstetrics and Gynecology, McGill Univeristy, Montreal, Quebec, Canada
| | - William Buckett
- MUHC Reproductive Centre, Department of Obstetrics and Gynecology, McGill Univeristy, Montreal, Quebec, Canada
| | - Asangla Ao
- MUHC Reproductive Centre, Department of Obstetrics and Gynecology, McGill Univeristy, Montreal, Quebec, Canada; Department of Human Genetics, McGill University, Montreal, Quebec, Canada.
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Tiitinen A. Single embryo transfer: Why and how to identify the embryo with the best developmental potential. Best Pract Res Clin Endocrinol Metab 2019; 33:77-88. [PMID: 31005505 DOI: 10.1016/j.beem.2019.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Multiple pregnancies with higher risk of preterm birth and the associated higher morbidity have been a major obstacle from the early days of in vitro fertilization. A good strategy to avoid multiple pregnancies is elective single embryo transfer and cryopreservation of spare embryos. Important factors in adopting this strategy are good counselling of the patients and the selection of embryos with high implantation potential. Technical advances in embryo selection have been described during recent years, time lapse monitoring and genetic assessment of the embryos being the most important achievements. With these studies we have gained new information on early embryos. However, at present, there is insufficient evidence to recommend the routine use of these new techniques. The ultimate goal of infertility treatment is a healthy baby.
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Affiliation(s)
- Aila Tiitinen
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, FI-00029 Helsinki, Finland.
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Twin pregnancies and perinatal outcomes: a comparison between fresh and frozen embryo transfer: a two-centre study. Reprod Biomed Online 2019; 38:241-248. [DOI: 10.1016/j.rbmo.2018.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 11/04/2018] [Accepted: 11/09/2018] [Indexed: 11/24/2022]
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Kovacs P, Matyas S, Forgacs V, Sajgo A, Molnar L, Pribenszky C. Non-invasive embryo evaluation and selection using time-lapse monitoring: Results of a randomized controlled study. Eur J Obstet Gynecol Reprod Biol 2018; 233:58-63. [PMID: 30580224 DOI: 10.1016/j.ejogrb.2018.12.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/31/2018] [Accepted: 12/06/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Continuous monitoring of embryos via time-lapse (TL) provides more information on embryo kinetics and morphology compared to standard daily evaluation. Embryo selection by TL could support single embryo transfer (SET). With SET multiple gestations are avoided and perinatal outcome is improved. Our primary goal was to determine whether selection of a single blastocyst based on an algorithm comprising kinetic and morphologic scores assessed through continuous TL monitoring results in superior clinical outcome compared to embryo selection based on morphology alone. A secondary goal was to assess whether a time-lapse score based on kinetic and morphologic parameters was predictive of implantation. STUDY DESIGN Randomized controlled trial performed in two private IVF centers in Hungary. Infertile couples scheduled to undergo 1st or 2nd IVF cycles were enrolled. Female age had to be under 36 years. The intervention was embryo evaluation/selection based on TL algorithm. Patients were randomized to SET with TL monitoring (TL-eSET) vs. SET with standard evaluation (control-eSET). Assuming an increase in pregnancy from 44% to 58%, a sample size of 202 per group was calculated based on the interim analysis at 10% information fraction. The primary outcome of the study was pregnancy rate. Secondary outcomes were miscarriage rates, live birth, perinatal outcome and the ability of a time-lapse score constructed based on kinetic and morphologic parameters to predict implantation. Chi-square tests, likelihood-ratio tests and exact tests were used for the analysis of categorical variables. Continuous variables were compared using independent group t-test and analysis of variance. RESULTS The study was closed after three years. Eventually 161 patients were randomized and analyzed (N = 80 TL-eSET and N = 81 control-eSET). Pregnancy rate did not significantly differ between the groups though there was a trend favoring TL selection (TL-eSET: 46.3% vs control-eSET: 34.6%, p = 0.150; OR: 1.628 (95% CI: 0.857-3.092)). The time-lapse score based on morphologic and kinetic parameters was significantly higher for blastocysts that implanted vs. those that did not (14.5 ± 1.8 vs. 12.1 ± 2.9, p = 0.0001). There were no adverse effects of the intervention. CONCLUSIONS Selection of a single blastocyst based on information derived from time-lapse monitoring can aid embryo selection for SET.
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Affiliation(s)
- Peter Kovacs
- Kaali Institute IVF Center, Istenhegyi ut 54/a, 1125, Budapest, Hungary.
| | - Szabolcs Matyas
- Kaali Institute IVF Center, Istenhegyi ut 54/a, 1125, Budapest, Hungary
| | - Vince Forgacs
- Forgacs Intezet, Kossuth Lajos utca 143, 1205, Budapest, Hungary
| | - Attila Sajgo
- Kaali Institute IVF Center, Istenhegyi ut 54/a, 1125, Budapest, Hungary
| | - Laszlo Molnar
- MediBit Foundation, Vörösmarty u. 3/B, 1201, Budapest, Hungary
| | - Csaba Pribenszky
- University of Veterinary Science, Istvan u, 2, 1078, Budapest, Hungary
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Cutting R. Single embryo transfer for all. Best Pract Res Clin Obstet Gynaecol 2018; 53:30-37. [DOI: 10.1016/j.bpobgyn.2018.07.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/28/2018] [Accepted: 07/10/2018] [Indexed: 10/28/2022]
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Schlueter R, Arnett C, Huang C, Burlingame J. Successful quintuplet pregnancy of monochorionic male quadruplets and single female after double embryo transfer: case report and review of the literature. Fertil Steril 2017; 109:284-288. [PMID: 29246561 DOI: 10.1016/j.fertnstert.2017.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/17/2017] [Accepted: 11/06/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report a rare case of quintuplets with monochorionic male quadruplets and a single female after two-blastocyst transfer. DESIGN Case report. SETTING University teaching hospital. PATIENT(S) A 37-year-old gravida 1, para 1, presenting after two-embryo IVF with monochorionic male quadruplets and a single female. INTERVENTION(S) Ultrasound examinations and cesarean delivery. MAIN OUTCOME MEASURE(S) Successful delivery of five live-born infants at 28 weeks and 6 days of gestation for preterm labor. RESULT(S) The patient was diagnosed with quintuplets consisting of monochorionic male quadruplets and a single female after the placement of two embryos in blastocyst stage. She was followed closely with ultrasound examinations and hospitalized at 23 weeks' gestation. Cesarean delivery was performed at 28 weeks and 6 days of gestation, with eventual discharge of all infants in healthy condition. CONCLUSION(S) This case represents successful assisted reproductive technology quintuplets with monochorionic quadruplets and a co-sibling. Higher-order monozygotic pregnancies with monochorionic quadruplets are exceedingly rare and a potential complication of IVF.
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Affiliation(s)
- Ryan Schlueter
- Departments of Obstetrics and Gynecology and Maternal and Fetal Medicine, University of Hawaii, Honolulu, Hawaii.
| | | | | | - Janet Burlingame
- Departments of Obstetrics and Gynecology and Maternal and Fetal Medicine, University of Hawaii, Honolulu, Hawaii
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van Loendersloot LL, Moolenaar LM, van Wely M, Repping S, Bossuyt PM, Hompes PGA, van der Veen F, Mol BWJ. Cost-effectiveness of single versus double embryo transfer in IVF in relation to female age. Eur J Obstet Gynecol Reprod Biol 2017; 214:25-30. [PMID: 28460276 DOI: 10.1016/j.ejogrb.2017.04.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 03/30/2017] [Accepted: 04/15/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of single embryo transfer followed by an additional frozen-thawed single embryo transfer, if more embryos are available, as compared to double embryo transfer in relation to female age. STUDY DESIGN We used a decision tree model to evaluate the costs from a healthcare provider perspective and the pregnancy rates of two embryo transfer policies: one fresh single embryo transfer followed by an additional frozen-thawed single embryo transfer, if more embryos are available (strategy I), and double embryo transfer (strategy II). The analysis was performed on an intention-to-treat basis. Sensitivity analyses were carried out to evaluate the robustness of our model and to identify which model parameters had the strongest impact on the results. RESULTS SET followed by an additional frozen-thawed single embryo transfer if available was dominant, less costly and more effective, over DET in women under 32 years. In women aged 32 or older DET was more effective than SET followed by an additional frozen-thawed single embryo transfer if available but also more costly. CONCLUSION SET followed by an additional frozen-thawed single embryo transfer should be the preferred strategy in women under 32 undergoing IVF. The choice for SET followed by an additional frozen-thawed single embryo transfer or DET in women aged 32 or older depends on individual patient preferences and on how much society is willing to pay for an extra child. There is a strong need for a randomized clinical trial comparing the cost and effects of SET followed by an additional frozen-thawed single embryo transfer and DET in the latter category of women.
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Affiliation(s)
| | - Lobke M Moolenaar
- Center for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands; Department of Obstetrics & Gynaecology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands; Department of Obstetrics & Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - Madelon van Wely
- Center for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Sjoerd Repping
- Center for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Patrick M Bossuyt
- Center for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Peter G A Hompes
- Department of Obstetrics & Gynaecology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | - Fulco van der Veen
- Center for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Ben Willem J Mol
- Center for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands; Department of Obstetrics & Gynaecology, University of Adelaide, Adelaide, Australia
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Chen F, Spiessens C, D'Hooghe T, Peeraer K, Carpentier S. Follicular fluid biomarkers for human in vitro fertilization outcome: Proof of principle. Proteome Sci 2016; 14:17. [PMID: 27895531 PMCID: PMC5109724 DOI: 10.1186/s12953-016-0106-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 11/01/2016] [Indexed: 01/24/2023] Open
Abstract
Background Human follicular fluid (FF) is a unique biological fluid in which the oocyte develops in vivo, and presents an optimal source for non-invasive biochemical predictors. Oocyte quality directly influences the embryo development and hence, may be used as a predictor of embryo quality. Peptide profiling of FF and its potential use as a biomarker for oocyte quality has never been reported. Methods This study screened FF for peptide biomarkers that predict the outcome of in vitro fertilization (IVF). Potential biomarkers were discovered by investigating 2 training datasets, consisting both of 17 samples and validating on an independent experiment containing 32 samples. Peptide profiles were acquired by nano-scale liquid chromatography coupled to tandem mass spectrometry (nano LC-MS/MS). Results From the training datasets 53 peptides were found as potential biomarker candidates, predicting the fertilization outcome of 24 out of the 32 validation samples blindly (81.3% sensitivity, 68.8% specificity, AUC = 0.86). Seven potential biomarker peptides were identified. They were derived from: insulin-like growth factor binding protein-5, alpha-2-antiplasmin, complement component 3, inter-alpha-trypsin inhibitor heavy chain H1, serum albumin, protein diaphanous homolog 1 and plastin-3. Conclusions The MS-based comprehensive peptidomic approach carried out in this study, established a novel panel of potential biomarkers that present a promising predictive accuracy rate in fertilization outcome, and indicates FF as an interesting biomarker resource to improve IVF clinic routine. Electronic supplementary material The online version of this article (doi:10.1186/s12953-016-0106-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fang Chen
- Leuven University Fertility Centre, UZ Leuven Campus Gasthuisberg, Herestraat 49, Leuven, Belgium
| | - Carl Spiessens
- Leuven University Fertility Centre, UZ Leuven Campus Gasthuisberg, Herestraat 49, Leuven, Belgium
| | - Thomas D'Hooghe
- Leuven University Fertility Centre, UZ Leuven Campus Gasthuisberg, Herestraat 49, Leuven, Belgium
| | - Karen Peeraer
- Leuven University Fertility Centre, UZ Leuven Campus Gasthuisberg, Herestraat 49, Leuven, Belgium
| | - Sebastien Carpentier
- Facility for Systems Biology based Mass Spectrometry (SYBIOMA), KU Leuven, Leuven, Belgium
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Hernández-Pichardo JE, Ducolomb Y, Romo S, Kjelland ME, Fierro R, Casillas F, Betancourt M. Pronuclear formation by ICSI using chemically activated ovine oocytes and zona pellucida bound sperm. J Anim Sci Biotechnol 2016; 7:65. [PMID: 27826442 PMCID: PMC5100180 DOI: 10.1186/s40104-016-0124-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 10/14/2016] [Indexed: 01/29/2023] Open
Abstract
Background In order to improve ICSI, appropiate sperm selection and oocyte activation is necessary. The objective of the present study was to determine the efficiency of fertilization using ICSI with chemically activated ovine oocytes and sperm selected by swim up (SU) or swim up + zona pellucida (SU + ZP) binding. Results Experiment 1, 4–20 replicates with total 821 in vitro matured oocytes were chemically activated with ethanol, calcium ionophore or ionomycin, to determine oocyte activation (precense of one PN). Treatments showed similar results (54, 47, 42 %, respectively) but statistically differents (P < 0.05) than mechanical activated oocytes in sham, ICSI and sham injection (13, 25, 32 %, respectively) (10–17 replicates; n = 429). Experiment 2: Twelve ejaculates and 28 straws of semen were used (11–19 replicates). Sperm were selected by SU in BSA-TCM 199-H medium. A total of 2,294 fresh sperm and 2,760 from frozen-thawed semen were analyzed after SU or SU + ZP binding. Fresh sperm selected by SU showed acrosome reaction (AR) of 59 %, the sperm selected by SU + ZP binding increased AR to 91 %. In comparison, the AR of frozen-thawed sperm using SU or SU + ZP binding was 77 and 86 %, respectively (P < 0.05). Experiment 3: fertilization in 200 mechanical activativated oocytes (17 replicates) was 4 %, but fertilization increased in ethanol activated oocytes after ICSI (12-28 %) (5–6 replicates). When fresh sperm only selected by SU were injected to 123 oocytes, a fertilization rate (28 %) was achieved; in sperm selected by SU + ZP was 25 % (73 oocytes). In comparison, in frozen-thawed sperm selected by SU, fertilization was 13 % (70 oocytes), whereas sperm from SU + ZP binding displayed 12 % (51 oocytes) (P > 0.05). Conclusions Chemical activation induces higher ovine oocyte activation than mechanical activation. Ethanol slightly displays higher oocyte activation than calcium ionophore and ionomicine. Sperm selection with SU + ZP increased AR/A and AR/D rates in comparison with SU in fresh and frozen-thawed sperm. According to this, in terms of fertilization rates, chemical activation after ICSI increased oocyte PN formation compared to mechanical activation. Also, fresh sperm treated with SU and SU + ZP were significantly different than frozen-thawed sperm, but between sperm treatments no significant differences were obtained.
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Affiliation(s)
- J E Hernández-Pichardo
- División de Ciencias Biológicas y de la Salud, Departamento de Producción Agrícola y Animal, Universidad Autónoma Metropolitana-Xochimilco, Ciudad de México, Mexico ; Doctorado en Biología Experimental, Universidad Autónoma Metropolitana-Iztapalapa, Ciudad de México, Mexico
| | - Y Ducolomb
- División de Ciencias Biológicas y de la Salud, Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, San Rafael Atlixco 186, CP 09340 Ciudad de México, Mexico
| | - S Romo
- Departamento de Ciencias Pecuarias, Facultad de Estudios Superiores Cuautitlán, UNAM, Ciudad de México, Estado de México Mexico
| | - M E Kjelland
- Conservation, Genetics & Biotech, LLC, Valley City, ND USA
| | - R Fierro
- División de Ciencias Biológicas y de la Salud, Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, San Rafael Atlixco 186, CP 09340 Ciudad de México, Mexico
| | - F Casillas
- División de Ciencias Biológicas y de la Salud, Departamento de Biología de la Reproducción, Universidad Autónoma Metropolitana-Iztapalapa, Ciudad de México, Mexico
| | - M Betancourt
- División de Ciencias Biológicas y de la Salud, Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, San Rafael Atlixco 186, CP 09340 Ciudad de México, Mexico
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Stanford JB, Simonsen SE, Baksh L. Fertility treatments and adverse perinatal outcomes in a population-based sampling of births in Florida, Maryland, and Utah: a cross-sectional study. BJOG 2015; 123:718-29. [PMID: 26148540 DOI: 10.1111/1471-0528.13510] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate perinatal outcomes associated with fertility treatments, including assisted reproductive technology (ART), intrauterine insemination with ovulation stimulation (IUI), and ovulation stimulation alone (OS). DESIGN Population-representative cross-sectional survey of women with live births, 2004-2008. SETTING Florida, Maryland, and Utah, USA. SAMPLE 21 803 women, weighted to represent 1 022 597 women. METHODS Survey and birth certificate data were analysed with logistic regression models adjusted for age, education, race, income, and parity, using separate models for singletons and all births. We used two referent groups: (1) women who never used fertility treatment and (2) subfertile women conceiving without treatment. MAIN OUTCOME MEASURES Preterm birth (<37 weeks), very preterm birth (<34 weeks), low birthweight (<2500 g), and very low birthweight (<1500 g). RESULTS Referent group 1: In singletons, ART was associated with preterm birth (OR 3.28; 95% CI 1.74, 6.20) and low birthweight (OR 2.91; 95% CI 1.99, 4.26). OS was also associated with low birthweight (OR 1.62; 95% CI 1.19, 2.19). Including all births, treatment was associated with preterm birth and low birthweight: ART (OR 6.21; 95% CI 4.21, 9.16 and OR 6.51; 95% CI 4.85, 8.73); IUI (OR 2.10; 95% CI 1.24, 3.56 and OR 2.41; 95% CI 1.54, 3.76); OS (OR 1.40; 95% CI 1.01, 1.94 and OR 2.10; 95% CI 1.60, 2.75), respectively. Referent group 2: ART was associated with both outcomes in all births, but not singletons. CONCLUSIONS Preterm birth and low birthweight associated with fertility treatments are largely attributable to multiple gestation, but are also related to underlying subfertility. TWEETABLE ABSTRACT Preterm birth is associated with subfertility, and with fertility treatments through multiple gestation.
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Affiliation(s)
- J B Stanford
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - S E Simonsen
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - L Baksh
- Utah Department of Health, Maternal and Infant Health Program, Salt Lake City, UT, USA
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Kim MS, Kim JH, Jee BC, Suh CS, Kim SH. Factors affecting occurrence of twin pregnancy after double embryo transfer on day 3. J Obstet Gynaecol Res 2015; 41:1223-8. [PMID: 25832171 DOI: 10.1111/jog.12687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 12/16/2014] [Accepted: 01/04/2015] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to identify the risk factors of twin gestation in fresh double day-3 embryo transfer cycles. MATERIAL AND METHODS Out of a total of 386 cycles of fresh double embryo transfers on day 3 between 2006 and 2013 at a single center, 72 women with single intrauterine gestational sac (GS) (single-GS group) and 32 women with double GS (double-GS group) were identified. The patients' clinical characteristics and laboratory results were extracted from electronic medical records and were compared. RESULTS The double-GS group had a significantly younger age (P = 0.012), and higher bodyweight (P = 0.033) compared with the single-GS group. The total number of blastomeres (P = 0.013) and cumulative embryo score (P = 0.012) were higher in the double-GS group. By receiver-operator curve analysis, maternal age ≤ 35 years, maternal bodyweight > 60 kg, total number of blastomeres > 14, and cumulative embryo score > 49 were the cut-off values to predict twin pregnancy. Among eight women with all four risk factors, the twin pregnancy rate was 87.5%. There was no twin pregnancy among seven women with no risk factors. CONCLUSION Younger age, higher bodyweight, and better embryo quality are all associated with a higher incidence of twin pregnancy after double embryo transfer on day 3. Single embryo transfer might be advisable for couples with risk factors for twin pregnancy.
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Affiliation(s)
- Myo Sun Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam
| | - Ji Hee Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul
| | - Byung Chul Jee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Suk Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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No specific gene expression signature in human granulosa and cumulus cells for prediction of oocyte fertilisation and embryo implantation. PLoS One 2015; 10:e0115865. [PMID: 25769026 PMCID: PMC4359149 DOI: 10.1371/journal.pone.0115865] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 11/12/2014] [Indexed: 01/01/2023] Open
Abstract
In human IVF procedures objective and reliable biomarkers of oocyte and embryo quality are needed in order to increase the use of single embryo transfer (SET) and thus prevent multiple pregnancies. During folliculogenesis there is an intense bi-directional communication between oocyte and follicular cells. For this reason gene expression profile of follicular cells could be an important indicator and biomarker of oocyte and embryo quality. The objective of this study was to identify gene expression signature(s) in human granulosa (GC) and cumulus (CC) cells predictive of successful embryo implantation and oocyte fertilization. Forty-one patients were included in the study and individual GC and CC samples were collected; oocytes were cultivated separately, allowing a correlation with IVF outcome and elective SET was performed. Gene expression analysis was performed using microarrays, followed by a quantitative real-time PCR validation. After statistical analysis of microarray data, there were no significantly differentially expressed genes (FDR<0,05) between non-fertilized and fertilized oocytes and non-implanted and implanted embryos in either of the cell type. Furthermore, the results of quantitative real-time PCR were in consent with microarray data as there were no significant differences in gene expression of genes selected for validation. In conclusion, we did not find biomarkers for prediction of oocyte fertilization and embryo implantation in IVF procedures in the present study.
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Xing LF, Qian YL, Chen LT, Zhang FH, Xu XF, Qu F, Zhu YM. Is there a difference in cognitive development between preschool singletons and twins born after intracytoplasmic sperm injection or in vitro fertilization? J Zhejiang Univ Sci B 2014; 15:51-7. [PMID: 24390744 DOI: 10.1631/jzus.b1300229] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To explore whether there exist differences in cognitive development between singletons and twins born after in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). METHODS A total of 566 children were recruited for the study, including 388 children (singletons, n=175; twins, n=213) born after IVF and 178 children (singletons, n=87; twins, n=91) born after ICSI. The cognitive development was assessed using the Chinese-Wechsler Intelligence Scale for Children (C-WISC). RESULTS For all pre-term offspring, all the intelligence quotient (IQ) items between singletons and twins showed no significant differences no matter if they were born after IVF or ICSI. There was a significant difference in the cognitive development of IVF-conceived full-term singletons and twins. The twins born after IVF obtained significantly lower scores than the singletons in verbal IQ (containing information, picture & vocabulary, arithmetic, picture completion, comprehension, and language), performance IQ (containing maze, visual analysis, object assembly, and performance), and full scale IQ (P<0.05). The cognitive development of full-term singletons and twins born after ICSI did not show any significant differences. There was no significant difference between the parents of the singletons and twins in their characteristics where data were collected, including the age of the mothers, the current employment status, the educational backgrounds, and areas of residence. There were also no consistent differences in the duration of pregnancy, sex composition of the children, age, and height between singletons and twins at the time of our study although there existed significant differences between the two groups in the sex composition of the full-term children born after ICSI (P<0.05). CONCLUSIONS Compared to the full-term singletons born after IVF, the full-term twins have lower cognitive development. The cognitive development of full-term singletons and twins born after ICSI did not show any significant differences. For all pre-term offspring, singletons and twins born after IVF or ICSI, the results of the cognitive development showed no significant differences.
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Affiliation(s)
- Lan-feng Xing
- Department of Reproductive Medicine, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310021, China
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Gerris J, Delvigne A, Dhont N, Vandekerckhove F, Madoc B, Buyle M, Neyskens J, Deschepper E, De Bacquer D, Pil L, Annemans L, Verpoest W, De Sutter P. Self-operated endovaginal telemonitoring versus traditional monitoring of ovarian stimulation in assisted reproduction: an RCT. Hum Reprod 2014; 29:1941-8. [DOI: 10.1093/humrep/deu168] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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López-Regalado ML, Clavero A, Gonzalvo MC, Serrano M, Martínez L, Mozas J, Rodríguez-Serrano F, Fontes J, Castilla JA. Randomised clinical trial comparing elective single-embryo transfer followed by single-embryo cryotransfer versus double embryo transfer. Eur J Obstet Gynecol Reprod Biol 2014; 178:192-8. [DOI: 10.1016/j.ejogrb.2014.04.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/22/2014] [Accepted: 04/08/2014] [Indexed: 11/25/2022]
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Barbosa CP, Cordts EB, Costa AC, de Oliveira R, de Mendonça MA, Christofolini DM, Bianco B. Low dose of rFSH [100 IU] in controlled ovarian hyperstimulation response: a pilot study. J Ovarian Res 2014; 7:11. [PMID: 24447686 PMCID: PMC3900938 DOI: 10.1186/1757-2215-7-11] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 01/05/2014] [Indexed: 11/23/2022] Open
Abstract
Background The initial dose of recombinant Follicle Stimulating Hormone [rFSH] to be used in assisted reproduction treatment depends on several factors, mainly the cause of the infertility and the patient’s age. For young patients [≤35 years] usually an initial dose of around 150 IU of rFSH is recommended, but there are no studies proving that this should actually be the standard initial dose. We aimed to report the experience of a low-cost Human Reproduction Center where a dose of 100 IU of rFSH was used for controlled ovarian hyperstimulation [COH]. Findings An observational prospective study was performed on 212 women aged ≤38 years old that underwent high-complexity assisted reproduction treatments. The patients’ infertility was mainly caused by tuboperitoneal, idiopathic or male factors. Controlled ovarian stimulation was performed using 100 IU of rFSH. Regarding the COH, 53.8% of the patients presented a satisfactory response, 25.9% low response, 14.2% hyper-response, and 6.1% developed ovarian hyperstimulation syndrome. Of the 55 patients with poor response, 20 started a new cycle with an initial dose of 200 IU of rFSH; 65% showed a satisfactory response, 10% a poor response, 20% a hyper-response, and 5% developed OHSS. Conclusion The initial dose of 100 IU of rFSH was considered adequate for controlled ovarian hyperstimulation, meeting the aim to reduce the costs of the assisted reproduction treatment.
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Affiliation(s)
| | | | | | | | | | | | - Bianca Bianco
- Human Reproduction and Genetics Center, Faculdade de Medicina do ABC, Santo André, SP, Brazil.
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19
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Aghajanova L, Simón C, Horcajadas JA. Are favorite molecules of endometrial receptivity still in favor? ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.3.4.487] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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20
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Lemos EV, Zhang D, Van Voorhis BJ, Hu XH. Healthcare expenses associated with multiple vs singleton pregnancies in the United States. Am J Obstet Gynecol 2013; 209:586.e1-586.e11. [PMID: 24238479 DOI: 10.1016/j.ajog.2013.10.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 08/13/2013] [Accepted: 10/02/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The purpose of this study was to document cost that is associated with multiple births vs singleton births in the United States. STUDY DESIGN This was a retrospective cohort study that used a claims database. Women 19-45 years old with live-born infants from 2005-2010 were identified. Infant deliveries were identified by International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes. The cost entailed all payment made by insurers and patients. For mothers, the cost included expenses from 27 weeks before delivery to 1 month after delivery. For infants, the cost contained all expenses until their first birthday. Adjusted cost was estimated by generalized linear models after adjustment for the potential confounding variables with a gamma distribution and a log link. RESULTS The analysis included 437,924 eligible deliveries. Of them, 97.02% were singletons; 2.85% were twins, and 0.13% was triplets or more. Women with multiple pregnancies had higher systemic and localized comorbidities compared with women with singleton pregnancies (P < .0001). Twins and triplets or more were more likely to have stayed in a neonatal intensive care unit than were singletons (P < .0001). On average, adjusted total all-cause health care cost was $21,458 (95% confidence interval [CI], $21,302-21,614) per delivery with singletons, $104,831 (95% CI, $103,402-106,280) with twins, and $407,199 (95% CI, $384,984-430,695) with triplets or more. CONCLUSION Pregnancies with the delivery of twins cost approximately 5 times as much when compared with singleton pregnancies; pregnancies with delivery of triplets or more cost nearly 20 times as much.
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van den Boogaard NM, Bensdorp AJ, Oude Rengerink K, Barnhart K, Bhattacharya S, Custers IM, Coutifaris C, Goverde AJ, Guzick DS, Hughes EC, Factor-Litvak P, Steures P, Hompes PGA, van der Veen F, Mol BWJ, Bossuyt P. Prognostic profiles and the effectiveness of assisted conception: secondary analyses of individual patient data. Hum Reprod Update 2013; 20:141-51. [PMID: 24173882 DOI: 10.1093/humupd/dmt035] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND At present, it is unclear which treatment strategy is best for couples with unexplained or mild male subfertility. We hypothesized that the prognostic profile influences the effectiveness of assisted conception. We addressed this issue by analysing individual patient data (IPD) from randomized controlled trials (RCTs). METHODS We performed an IPD analysis of published RCTs on treatment strategies for subfertile couples. Eligible studies were identified from Cochrane systematic reviews and we also searched Medline and EMBASE. The authors of RCTs that compared expectant management (EM), intracervical insemination (ICI), intrauterine insemination (IUI), all three with or without controlled ovarian stimulation (COS) and IVF in couples with unexplained or male subfertility, and had reported live birth or ongoing pregnancy as an outcome measure, were invited to share their data. For each individual patient the chance of natural conception was calculated with a validated prognostic model. We constructed prognosis-by-treatment curves and tested whether there was a significant interaction between treatment and prognosis. RESULTS We acquired data from 8 RCTs, including 2550 couples. In three studies (n = 954) the more invasive treatment strategies tended to be less effective in couples with a high chance of natural conception but this difference did not reach statistical significance (P-value for interaction between prognosis and treatment outcome were 0.71, 0.31 and 0.19). In one study (n = 932 couples) the strategies with COS (ICI and IUI) led to higher pregnancy rates than unstimulated strategies (ICI 8% versus 15%, IUI 13% versus 22%), regardless of prognosis (P-value for interaction in all comparisons >0.5), but at the expense of a high twin rate in the COS strategies (ICI 6% versus 23% and IUI 3% versus 30%, respectively). In two studies (n = 373 couples), the more invasive treatment strategies tended to be more effective in couples with a good prognosis but this difference did not reach statistical significance (P-value for interaction: 0.38 and 0.68). In one study (n = 253 couples) the differential effect of prognosis on treatment effect was limited (P-value for interaction 0.52), perhaps because prognosis was incorporated in the inclusion criteria. The only study that compared EM with IVF included 38 couples, too small for a precise estimate. CONCLUSIONS In this IPD analysis of couples with unexplained or male subfertility, we did not find a large differential effect of prognosis on the effectiveness of fertility treatment with IUI, COS or IVF.
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Affiliation(s)
- N M van den Boogaard
- Centre for Reproductive Medicine, Academic Medical Centre (AMC), Amsterdam, The Netherlands
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Chambers GM, Hoang VP, Sullivan EA, Chapman MG, Ishihara O, Zegers-Hochschild F, Nygren KG, Adamson GD. The impact of consumer affordability on access to assisted reproductive technologies and embryo transfer practices: an international analysis. Fertil Steril 2013; 101:191-198.e4. [PMID: 24156958 DOI: 10.1016/j.fertnstert.2013.09.005] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 09/04/2013] [Accepted: 09/04/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To systematically quantify the impact of consumer cost on assisted reproduction technology (ART) utilization and numbers of embryos transferred. DESIGN Ordinary least squared (OLS) regression models were constructed to measure the independent impact of ART affordability-measured as consumer cost relative to average disposable income-on ART utilization and embryo transfer practices. SETTING Not applicable. PATIENT(S) Women undergoing ART treatment. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) OLS regression coefficient for ART affordability, which estimates the independent effect of consumer cost relative to income on utilization and number of embryos transferred. RESULT(S) ART affordability was independently and positively associated with ART utilization with a mean OLS coefficient of 0.032. This indicates that, on average, a decrease in the cost of a cycle of 1 percentage point of disposable income predicts a 3.2% increase in utilization. ART affordability was independently and negatively associated with the number of embryos transferred, indicating that a decrease in the cost of a cycle of 10 percentage points of disposable income predicts a 5.1% increase in single-embryo transfer cycles. CONCLUSION(S) The relative cost that consumers pay for ART treatment predicts the level of access and number of embryos transferred. Policies that affect ART funding should be informed by these findings to ensure equitable access to treatment and clinically responsible embryo transfer practices.
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Affiliation(s)
- Georgina M Chambers
- National Perinatal Epidemiology and Statistics Unit, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
| | - Van Phuong Hoang
- National Perinatal Epidemiology and Statistics Unit, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Elizabeth A Sullivan
- National Perinatal Epidemiology and Statistics Unit, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael G Chapman
- School of Women's and Children's Health, Royal Hospital for Women, Sydney, New South Wales, Australia; IVF Australia, Sydney, New South Wales, Australia
| | - Osamu Ishihara
- Department of Obstetrics and Gynecology, Faculty of Medicine, Saitama Medical University, Moroyama, Saitama, Japan
| | - Fernando Zegers-Hochschild
- Clinica las Condes and Program of Ethics and Public Policies, University Diego Portales, Santiago, Chile
| | - Karl G Nygren
- Institute of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - G David Adamson
- Palo Alto Medical Foundation Fertility Physicians of Northern California, Palo Alto, California; Department of Gynecology and Obstetrics, Stanford University School of Medicine, Stanford, California; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
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Ajduk A, Zernicka-Goetz M. Quality control of embryo development. Mol Aspects Med 2013; 34:903-18. [DOI: 10.1016/j.mam.2013.03.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 03/05/2013] [Accepted: 03/19/2013] [Indexed: 11/28/2022]
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Manheimer E, van der Windt D, Cheng K, Stafford K, Liu J, Tierney J, Lao L, Berman BM, Langenberg P, Bouter LM. The effects of acupuncture on rates of clinical pregnancy among women undergoing in vitro fertilization: a systematic review and meta-analysis. Hum Reprod Update 2013; 19:696-713. [PMID: 23814102 DOI: 10.1093/humupd/dmt026] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Recent systematic reviews of adjuvant acupuncture for IVF have pooled heterogeneous trials, without examining variables that might explain the heterogeneity. The aims of our meta-analysis were to quantify the overall pooled effects of adjuvant acupuncture on IVF clinical pregnancy success rates, and evaluate whether study design-, treatment- and population-related factors influence effect estimates. METHODS We included randomized controlled trials that compared needle acupuncture administered within 1 day of embryo transfer, versus sham acupuncture or no adjuvant treatment. Our primary outcome was clinical pregnancy rates. We obtained from all investigators additional methodological details and outcome data not included in their original publications. We analysed sham-controlled and no adjuvant treatment-controlled trials separately, but since there were no large or significant differences between these two subsets, we pooled all trials for subgroup analyses. We prespecified 11 subgroup variables (5 clinical and 6 methodological) to investigate sources of heterogeneity, using single covariate meta-regressions. RESULTS Sixteen trials (4021 participants) were included in the meta-analyses. There was no statistically significant difference between acupuncture and controls when combining all trials [risk ratio (RR) 1.12, 95% confidence interval (CI), 0.96-1.31; I(2) = 68%; 16 trials; 4021 participants], or when restricting to sham-controlled (RR 1.02, 0.83-1.26; I(2) = 66%; 7 trials; 2044 participants) or no adjuvant treatment-controlled trials (RR 1.22, 0.97-1.52; I(2) = 67%; 9 trials; 1977 participants). The type of control used did not significantly explain the statistical heterogeneity (interaction P = 0.27). Baseline pregnancy rate, measured as the observed rate of clinical pregnancy in the control group of each trial, was a statistically significant effect modifier (interaction P < 0.001), and this covariate explained most of the heterogeneity of the effects of adjuvant acupuncture across all trials (adjusted R(2) = 93%; I(2) residual = 9%). Trials with lower control group rates of clinical pregnancy showed larger effects of adjuvant acupuncture (RR 1.53, 1.28-1.84; 7 trials; 1732 participants) than trials with higher control group rates of clinical pregnancy (RR 0.90, 0.80-1.01; 9 trials; 2289 participants). The asymmetric funnel plot showed a tendency for the intervention effects to be more beneficial in smaller trials. CONCLUSIONS We found no pooled benefit of adjuvant acupuncture for IVF. The subgroup finding of a benefit in trials with lower, but not higher, baseline pregnancy rates (the only statistically significant subgroup finding in our earlier review) has been confirmed in this update, and was not explained by any confounding variables evaluated. However, this baseline pregnancy rate subgroup finding among published trials requires further confirmation and exploration in additional studies because of the multiple subgroup tests conducted, the risk of unidentified confounders, the multiple different factors that determine baseline rates, and the possibility of publication bias.
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Affiliation(s)
- Eric Manheimer
- Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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Knez J, Kovačič B, Vlaisavljević V. Comparison of embryo transfer strategies and assisted reproduction outcome in Slovenian and cross-border patients. Reprod Biomed Online 2013; 27:310-5. [PMID: 23871362 DOI: 10.1016/j.rbmo.2013.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 03/12/2013] [Accepted: 05/22/2013] [Indexed: 10/26/2022]
Abstract
A reduction in the number of embryos transferred is the most important step in decreasing multiple gestation rates after medically assisted reproduction. Slovenia has implemented insurance company regulations that regulate single-embryo transfer in selected good-prognosis couples. The aim of the present study was to evaluate its effects on the Slovenian population compared with cross-border patients, who are not affected by the insurance company policy. Ultimately, 2403 couples undergoing IVF or intracytoplasmic sperm injection were included in the retrospective analysis. Patients were classified according to their origin. The decision about the number of embryos transferred and the treatment success were evaluated. The implementation of the policy favouring single-embryo transfer resulted in a significant decrease in the twin birth rate in Slovenian patients (24.4% before policy versus 6.7% after policy implementation, P<0.001). Although in cross-border patients twin birth rates have declined through the study period, they remained significantly higher compared with Slovenian patients (23.1% versus 6.7%, P<0.001). The data demonstrate that insurance company policies favouring single-embryo transfer are an effective tool in decreasing multiple gestation rates. Similar mechanisms should be implemented in the cross-border patient population.
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Affiliation(s)
- Jure Knez
- Department of Reproductive Medicine and Gynaecologic Endocrinology, Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, Slovenia
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Bastu E, Celik C, Keskin G, Buyru F. Evaluation of embryo transfer time (day 2 vs day 3) after imposed single embryo transfer legislation: when to transfer? J OBSTET GYNAECOL 2013; 33:387-90. [PMID: 23654322 DOI: 10.3109/01443615.2012.761186] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
To determine whether the timing of embryo transfer (day 2 or day 3) affects pregnancy outcome in IVF patients, receiving single or double embryo transfer, 380 patients were included in this retrospective study. All patients underwent GnRH antagonist protocol. When stratified by number of transferred embryos, single embryo transfer (SET) patients undergoing a day 2 embryo transfer (ET) had similar biochemical pregnancy (25% vs 20.4%; p > 0.05) and clinical pregnancy (16.6% vs 14.6%; p > 0.05) rates to SET patients that were undergoing a day 3 ET. A similar observation was again noted in double embryo transfer (DET) patients undergoing a day 2 ET, with similar biochemical pregnancy (35% vs 29.8%; p > 0.05) and clinical pregnancy (25% vs 15.5%; p > 0.05) rates to DET patients undergoing a day 3 ET. Women, despite age, number of transferred embryos and ET timing, have similar reproductive outcomes. Shortening or lengthening the duration of in vitro culture provides no obvious benefit.
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Affiliation(s)
- E Bastu
- Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey.
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van Loendersloot L, van Wely M, Goddijn M, Repping S, Bossuyt P, van der Veen F. Pregnancy and twinning rates using a tailored embryo transfer policy. Reprod Biomed Online 2013; 26:462-9. [DOI: 10.1016/j.rbmo.2013.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 01/15/2013] [Accepted: 01/16/2013] [Indexed: 10/27/2022]
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Can we improve implantation by cancellation of fresh embryo transfer? MIDDLE EAST FERTILITY SOCIETY JOURNAL 2013. [DOI: 10.1016/j.mefs.2012.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Tiitinen A. Prevention of multiple pregnancies in infertility treatment. Best Pract Res Clin Obstet Gynaecol 2012; 26:829-40. [DOI: 10.1016/j.bpobgyn.2012.05.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 04/23/2012] [Accepted: 05/13/2012] [Indexed: 11/17/2022]
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Valle M, Guimarães F, Cavagnoli M, Sampaio M, Geber S. Birth of normal infants after transfer of embryos that were twice vitrified/warmed at cleavage stages: Report of two cases. Cryobiology 2012; 65:332-4. [DOI: 10.1016/j.cryobiol.2012.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 04/30/2012] [Accepted: 05/02/2012] [Indexed: 11/28/2022]
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Schieve LA. Multiple-gestation pregnancies after assisted reproductive technology treatment: population trends and future directions. ACTA ACUST UNITED AC 2012; 3:301-7. [PMID: 19803988 DOI: 10.2217/17455057.3.3.301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Assisted reproductive technology (ART) treatments, such as in vitro fertilization, have benefited many couples worldwide. However, ART as currently practiced, with the usual transfer of at least two embryos, poses sizable risks for multiple-gestation pregnancy and accompanying serious maternal and child health sequelae. While limiting the number of embryos transferred would appear a straightforward solution, treatments with single-embryo transfer are rare. Likely reasons for this include patient and provider desires to maximize the chance for success in a single treatment given the high cost and lack of insurance coverage, the (sometimes mistaken) belief that transferring more embryos will increase the chance for pregnancy, and the preference for multiple births among some women undergoing ART. Although recent population-based data in the USA and Europe suggest the number of embryos transferred is decreasing, the ART multiple-birth rate remains high. Comprehensive patient-education efforts and continued research on the efficacy of single-embryo transfer are needed.
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Affiliation(s)
- Laura A Schieve
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Mailstop E-86, 1600 Clifton Road, Atlanta, GA 30333, USA.
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Abstract
Despite many recent advances in the field of reproductive biology and medicine, the efficiency of in vitro fertilization procedures remains relatively low. There is a need for a reliable and non-invasive method of embryo selection to ensure that only embryos with the highest developmental potential are chosen for transfer to mothers-to-be. Here, we compare various methods currently used for assessing embryonic viability, such as examination of embryonic morphology, quality of the genetic material, or metabolism. Additionally, we discuss novel procedures for embryonic assessment based on advanced time-lapse imaging techniques, which show great promise and may lead to increased in vitro fertilization efficiencies.
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Affiliation(s)
- Anna Ajduk
- University of Warsaw, Department of EmbryologyMiecznikowa 1, 02-096 WarsawPoland
| | - Magdalena Zernicka-Goetz
- University of Cambridge, The Wellcome Trust/Cancer Research Gurdon InstituteTennis Court Road, CB2 1QN, CambridgeUK
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A comparison of live birth rates and cumulative ongoing pregnancy rates between Europe and North America after ovarian stimulation with corifollitropin alfa or recombinant follicle-stimulating hormone. Fertil Steril 2012; 97:1351-8. [PMID: 22459628 DOI: 10.1016/j.fertnstert.2012.02.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 02/27/2012] [Accepted: 02/27/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare live birth rates after fresh embryo transfer (ET) and cumulative ongoing pregnancy rates after fresh ET and frozen-thawed (ET) between continents and overall after one treatment cycle with corifollitropin alfa or recombinant FSH. DESIGN Double-blind, multicenter, randomized controlled trial. SETTING Fourteen centers in North America (NA); 20 in Europe (EU). PATIENT(S) 804 NA patients and 702 EU patients. INTERVENTION(S) Patients >60 kg received a single dose of corifollitropin alfa or daily rFSH for the first 7 days of controlled ovarian stimulation. MAIN OUTCOME MEASURE(S) Live birth rates. RESULT(S) Within each continent no differences were noted between the two treatment groups; however, between continents, the cumulative ongoing pregnancy rate and live birth rate were considerably higher in NA than in EU. The live birth rate in NA was 39.2% in both treatment groups compared with 31.5% and 28.8% in EU after corifollitropin alfa and rFSH treatment, respectively. Considering the number of embryos transferred, the live birth rate per ET was still higher in NA than in EU (42.7% v.s 36.8% with corifollitropin alfa and 41.6% vs. 30.9% with rFSH). Overall live birth rates after fresh ET were 35.6% and 34.4% (estimated difference 1.1% [95% confidence interval -3.7-5.8]), and the estimated cumulative live birth rates were 43.4% and 41.3% with corifollitropin alfa and rFSH, respectively. CONCLUSION(S) Live birth rates and cumulative pregnancy rates were higher in NA than in EU after treatment with either corifollitropin alfa or daily rFSH; both treatment protocols provided equal success rates. CLINICALTRIALS.GOV IDENTIFIERS: NCT00703014 and NCT00702273.
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Nel-Themaat L, Nagy ZP. A review of the promises and pitfalls of oocyte and embryo metabolomics. Placenta 2011; 32 Suppl 3:S257-63. [PMID: 21703683 DOI: 10.1016/j.placenta.2011.05.011] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 05/26/2011] [Accepted: 05/27/2011] [Indexed: 10/18/2022]
Abstract
Embryo viability assessment is one of the most important and challenging tasks in IVF. Evaluation of embryo quality is critical when selecting the best embryo(s) to transfer or cryopreserve. Until recently, the only instrument used for embryo evaluation was the inverted light microscope, which provided information based on morphological characteristics. Developmental and morphological information gained from microscopic assessment have been positively associated with IVF outcomes, including pregnancy and implantation rates. However, based on general statistics, it is clear that IVF currently still results in relatively low pregnancy rates, while simultaneously being associated with relatively high multiple implantation rates. Only with novel embryo assessment and selection procedures would it be possible to improve these outcomes. Accordingly, it has been proposed that it is possible to test the culture environment of a developing embryo to gain valuable information regarding its viability. Different approaches have been used. These include the measurement of oxygen consumption by the embryo and testing of the soluble HLA-G in the environment, as it was proposed that secretion of HLA-G is associated with higher implantation rates. Amino acid turnover, which appears to be correlated to blastocyst development, can be measured as an indication of embryo viability. Other approaches, such as time-lapse video observation or cumulus cell gene expression analysis, may be used in the future to gain a broader understanding of embryo viability. Proteomics and metabolomics are also useful tools for assessment of embryo developmental potential. Results from recent studies on predicting embryo viability by analyzing the metabolome of different stage embryos are promising, as increases in pregnancy and implantation rates were obtained using the metabolomic profile for embryo selection. Several novel approaches are currently being developed to aid in viability assessment. These need to be evaluated in prospective clinical trials, while considering their practicality in the clinical laboratory.
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Affiliation(s)
- L Nel-Themaat
- Reproductive Biology Associates, 1150 Lake Hearn Dr., Suite 600, Atlanta, GA 30342, USA
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Mastenbroek S, van der Veen F, Aflatoonian A, Shapiro B, Bossuyt P, Repping S. Embryo selection in IVF. Hum Reprod 2011; 26:964-6. [DOI: 10.1093/humrep/der050] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Martin JR, Bromer JG, Sakkas D, Patrizio P. Insurance coverage and in vitro fertilization outcomes: a U.S. perspective. Fertil Steril 2011; 95:964-9. [DOI: 10.1016/j.fertnstert.2010.06.030] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Revised: 05/12/2010] [Accepted: 06/15/2010] [Indexed: 11/15/2022]
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Effect of the new legislation and single-embryo transfer policy in Turkey on assisted reproduction outcomes: preliminary results. Reprod Biomed Online 2011; 22:208-14. [DOI: 10.1016/j.rbmo.2010.10.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 10/15/2010] [Accepted: 10/19/2010] [Indexed: 11/19/2022]
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McLernon DJ, Harrild K, Bergh C, Davies MJ, de Neubourg D, Dumoulin JCM, Gerris J, Kremer JAM, Martikainen H, Mol BW, Norman RJ, Thurin-Kjellberg A, Tiitinen A, van Montfoort APA, van Peperstraten AM, Van Royen E, Bhattacharya S. Clinical effectiveness of elective single versus double embryo transfer: meta-analysis of individual patient data from randomised trials. BMJ 2010; 341:c6945. [PMID: 21177530 PMCID: PMC3006495 DOI: 10.1136/bmj.c6945] [Citation(s) in RCA: 228] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2010] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare the effectiveness of elective single embryo transfer versus double embryo transfer on the outcomes of live birth, multiple live birth, miscarriage, preterm birth, term singleton birth, and low birth weight after fresh embryo transfer, and on the outcomes of cumulative live birth and multiple live birth after fresh and frozen embryo transfers. DESIGN One stage meta-analysis of individual patient data. DATA SOURCES A systematic review of English and non-English articles from Medline, Embase, and the Cochrane Central Register of Controlled Trials (up to 2008). Additional studies were identified by contact with clinical experts and searches of bibliographies of all relevant primary articles. Search terms included embryo transfer, randomised controlled trial, controlled clinical trial, single embryo transfer, and double embryo transfer. Review methods Comparisons of the clinical effectiveness of cleavage stage (day 2 or 3) elective single versus double embryo transfer after fresh or frozen in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) treatments were included. Trials were included if the intervention differed only in terms of the intended number of embryos to be transferred. Trials that involved only blastocyst (day five) transfers were excluded. RESULTS Individual patient data were received for every patient recruited to all eight eligible trials (n=1367). A total of 683 and 684 women randomised to the single and double embryo transfer arms, respectively, were included in the analysis. Baseline characteristics in the two groups were comparable. The overall live birth rate in a fresh IVF cycle was lower after single (181/683, 27%) than double embryo transfer (285/683, 42%) (adjusted odds ratio 0.50, 95% confidence interval 0.39 to 0.63), as was the multiple birth rate (3/181 (2%) v 84/285 (29%)) (0.04, 0.01 to 0.12). An additional frozen single embryo transfer, however, resulted in a cumulative live birth rate not significantly lower than the rate after one fresh double embryo transfer (132/350 (38%) v 149/353 (42%) (0.85, 0.62 to 1.15), with a minimal cumulative risk of multiple birth (1/132 (1%) v 47/149 (32%)). The odds of a term singleton birth (that is, over 37 weeks) after elective single embryo transfer was almost five times higher than the odds after double embryo transfer (4.93, 2.98 to 8.18). CONCLUSIONS Elective single embryo transfer results in a higher chance of delivering a term singleton live birth compared with double embryo transfer. Although this strategy yields a lower pregnancy rate than a double embryo transfer in a fresh IVF cycle, this difference is almost completely overcome by an additional frozen single embryo transfer cycle. The multiple pregnancy rate after elective single embryo transfer is comparable with that observed in spontaneous pregnancies.
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Affiliation(s)
- D J McLernon
- Medical Statistics Team, Section of Population Health, University of Aberdeen, Aberdeen AB25 2ZD, UK.
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Clua E, Tur R, Coroleu B, Boada M, Barri PN, Veiga A. Analysis of factors associated with multiple pregnancy in an oocyte donation programme. Reprod Biomed Online 2010; 21:694-9. [DOI: 10.1016/j.rbmo.2010.06.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 06/04/2010] [Accepted: 06/08/2010] [Indexed: 11/26/2022]
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van Heesch MMJ, Bonsel GJ, Dumoulin JCM, Evers JLH, van der Hoeven MA, Severens JL, Dykgraaf RHM, van der Veen F, Tonch N, Nelen WLDM, van Zonneveld P, van Goudoever JB, Tamminga P, Steiner K, Koopman-Esseboom C, van Beijsterveldt CEM, Boomsma DI, Snellen D, Dirksen CD. Long term costs and effects of reducing the number of twin pregnancies in IVF by single embryo transfer: the TwinSing study. BMC Pediatr 2010; 10:75. [PMID: 20961411 PMCID: PMC2978208 DOI: 10.1186/1471-2431-10-75] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 10/20/2010] [Indexed: 11/24/2022] Open
Abstract
Background Pregnancies induced by in vitro fertilisation (IVF) often result in twin gestations, which are associated with both maternal and perinatal complications. An effective way to reduce the number of IVF twin pregnancies is to decrease the number of embryos transferred from two to one. The interpretation of current studies is limited because they used live birth as outcome measure and because they applied limited time horizons. So far, research on long-term outcomes of IVF twins and singletons is scarce and inconclusive. The objective of this study is to investigate the short (1-year) and long-term (5 and 18-year) costs and health outcomes of IVF singleton and twin children and to consider these in estimating the cost-effectiveness of single embryo transfer compared with double embryo transfer, from a societal and a healthcare perspective. Methods/Design A multi-centre cohort study will be performed, in which IVF singletons and IVF twin children born between 2003 and 2005 of whom parents received IVF treatment in one of the five participating Dutch IVF centres, will be compared. Data collection will focus on children at risk of health problems and children in whom health problems actually occurred. First year of life data will be collected in approximately 1,278 children (619 singletons and 659 twin children). Data up to the fifth year of life will be collected in approximately 488 children (200 singletons and 288 twin children). Outcome measures are health status, health-related quality of life and costs. Data will be obtained from hospital information systems, a parent questionnaire and existing registries. Furthermore, a prognostic model will be developed that reflects the short and long-term costs and health outcomes of IVF singleton and twin children. This model will be linked to a Markov model of the short-term cost-effectiveness of single embryo transfer strategies versus double embryo transfer strategies to enable the calculation of the long-term cost-effectiveness. Discussion This is, to our knowledge, the first study that investigates the long-term costs and health outcomes of IVF singleton and twin children and the long-term cost-effectiveness of single embryo transfer strategies versus double embryo transfer strategies.
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Affiliation(s)
- Mirjam M J van Heesch
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands.
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Assidi M, Montag M, Van der Ven K, Sirard MA. Biomarkers of human oocyte developmental competence expressed in cumulus cells before ICSI: a preliminary study. J Assist Reprod Genet 2010; 28:173-88. [PMID: 20953827 DOI: 10.1007/s10815-010-9491-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 09/28/2010] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To identify reliable genomic biomarkers expressed in cumulus cells that accurately and non-invasively predict the oocyte developmental competence and reinforce the already used morphological criteria. METHODS Eight consenting patients were selected for ovarian stimulation and ICSI procedures. Cumulus-oocyte complexes were transvaginally punctured and individually selected based on both good morphological criteria and high zona pellucida birefringence. Following ICSI, two 3-day embryos per patient were transferred. Pregnancy outcome was recorded and proven implantation was thereafter confirmed. Differential gene expression was assessed using two microarray platforms. Further real-time PCR validation, Ingenuity pathways analysis and intra-patient analysis were performed on 17 selected candidates. RESULTS Seven genes were differentially (p ≤ 0.05) associated to successful pregnancy and implantation. These biomarkers could be used to predict the oocyte developmental competence. CONCLUSIONS These genomic markers are a powerful reinforcement of morphological approaches of oocyte selection. Their large-scale validation could increase pregnancy outcome and single embryo transfer efficiency.
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Affiliation(s)
- Mourad Assidi
- Centre de recherche en biologie de la reproduction, Département des Sciences Animales, Laval University, Ste-Foy, Québec, Canada, G1K 7P4
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Lee MS, Liu CH, Lee TH, Wu HM, Huang CC, Huang LS, Chen CM, Cheng EH. Association of creatin kinase B and peroxiredoxin 2 expression with age and embryo quality in cumulus cells. J Assist Reprod Genet 2010; 27:629-39. [PMID: 20721618 DOI: 10.1007/s10815-010-9459-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Accepted: 07/21/2010] [Indexed: 11/27/2022] Open
Abstract
PURPOSE the purpose of this study was to identify age-related oocyte or embryo markers suitable for non-invasive analysis, as women over 38 years of age experience diminished pregnancy and ovulation rates. METHODS we used real-time quantitative PCR to examine the gene expression profiles in cumulus cells acquired from older and younger age groups. We selected 11 genes involved in three functions that directly affect cellular aging: cell cycle control, apoptosis, and metabolism. RESULTS CKB and PRDX2 were up-regulated in women older than 38 years, and the expression of these genes in cumulus cells was associated with embryo quality. In good-quality embryos, CKB expression was higher in the cumulus cells acquired from both older and younger age groups than in poor-quality embryos. CONCLUSIONS these potential relationships among cumulus cell gene expression, oocyte quality, and age may expand our understanding of oogenesis and embryo development. CKB and PRDX2 may serve as biomarkers or therapeutic targets for the developmental potential of oocytes.
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Affiliation(s)
- Maw-Sheng Lee
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Fauque P, Jouannet P, Davy C, Guibert J, Viallon V, Epelboin S, Kunstmann JM, Patrat C. Cumulative results including obstetrical and neonatal outcome of fresh and frozen-thawed cycles in elective single versus double fresh embryo transfers. Fertil Steril 2010; 94:927-35. [DOI: 10.1016/j.fertnstert.2009.03.105] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Revised: 03/06/2009] [Accepted: 03/30/2009] [Indexed: 10/20/2022]
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Cumulative live-birth delivery after IVF/ICSI since the progressive introduction of single-embryo transfer. Reprod Biomed Online 2010; 20:836-42. [DOI: 10.1016/j.rbmo.2010.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 09/21/2009] [Accepted: 01/22/2010] [Indexed: 11/21/2022]
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Min JK, Hughes E, Young D. [Single embryo transfer for in vitro fertilization]. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010; 32:477-494. [PMID: 20500958 DOI: 10.1016/s1701-2163(16)34503-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Elective Single Embryo Transfer Following In Vitro Fertilization. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010; 32:363-377. [DOI: 10.1016/s1701-2163(16)34482-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abate A, Nazzaro A, Salerno A, Marzano F, Pavone Cossut MR, Perino M. Efficacy of recombinant versus human derived follicle stimulating hormone on the oocyte and embryo quality in IVF-ICSI cycles: Randomised, controlled, multi-centre trial. Gynecol Endocrinol 2009; 25:479-84. [PMID: 19572228 DOI: 10.1080/09513590902770156] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The aim of this trial, comparing human follicle stimulating hormone (hFSH) and recombinant FSH (rFSH) was to evaluate the efficacy on oocyte and embryo quality in in vitro fertilisation/intracytoplasmic sperm injection cycles. Four-hundred and one women were randomised in two groups to receive or hFSH or rFSH in stimulation protocols. The primary end point of this study was the oocyte/embryo quality. No significant difference in oocyte/embryo quality was observed between the two groups. The number of oocytes retrieved was significantly higher in the hFSH group (6 +/- 2.8 in hFSH group vs. 5 +/- 2.6 in rFSH group; P = 0.003). A less amounts of gonadotropins consumed (2106 +/- 719 IU in hFSH group vs. 3536 +/- 1099 IU in rFSH group; P < 0.0001) and shorter duration of stimulation (human chorionic gonadotropin day of administration: Day 12.3 +/- 1.0 in hFSH and Day 13.3 +/- 1.2 in rFSH group, respectively; P < 0.0001) was registered in hFSH group. Fertilisation, cleavage and implantation rates, pregnancy and abortion rates were similar in both groups. However, lower clinical abortion rate (not significant) in hFSH group might be noteworthy. In our study, we demonstrated that hFSH and rFSH products are equivalent in terms of clinical efficacy.
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Affiliation(s)
- Antonino Abate
- CRU - Human Reproduction Centre, S. Camillo Hospital, Messina, Italy.
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