1
|
Bar-El L, Lenchner E, Gulersen M, Gobioff S, Yeshua A, Eliner Y, Grünebaum A, Chervenak FA, Bornstein E. Comprehensive appraisal of pregnancy and neonatal outcomes in singleton pregnancies conceived via in vitro fertilization in the USA (2016-2021). J Perinat Med 2024; 52:343-350. [PMID: 38126220 DOI: 10.1515/jpm-2023-0409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/11/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES We set out to compare adverse pregnancy and neonatal outcomes in singleton gestations conceived via in vitro fertilization (IVF) to those conceived spontaneously. METHODS Retrospective, population-based cohort using the CDC Natality Live Birth database (2016-2021). All singleton births were stratified into two groups: those conceived via IVF, and those conceived spontaneously. The incidence of several adverse pregnancy and neonatal outcomes was compared between the two groups using Pearson's chi-square test with Bonferroni adjustments. Multivariate logistic regression was used to adjust outcomes for potential confounders. RESULTS Singleton live births conceived by IVF comprised 0.86 % of the cohort (179,987 of 20,930,668). Baseline characteristics varied significantly between the groups. After adjusting for confounding variables, pregnancies conceived via IVF were associated with an increased risk of several adverse pregnancy and neonatal outcomes compared to those conceived spontaneously. The maternal adverse outcomes with the highest risk in IVF pregnancies included maternal transfusion, unplanned hysterectomy, and maternal intensive care unit admission. Increased rates of hypertensive disorder of pregnancy, preterm birth (delivery <37 weeks of gestation), and cesarean delivery were also noted. The highest risk neonatal adverse outcomes associated with IVF included immediate and prolonged ventilation, neonatal seizures, and neonatal intensive care unit admissions, among others. CONCLUSIONS Based on this large contemporary United States cohort, the risk of several adverse pregnancy and neonatal outcomes is increased in singleton pregnancies conceived via IVF compared to those conceived spontaneously. Obstetricians should be conscious of these associations while caring for and counseling pregnancies conceived via IVF.
Collapse
Affiliation(s)
- Liron Bar-El
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital - Northwell Health/Zucker School of Medicine, New York, NY, USA
| | - Erez Lenchner
- Biostatistics and Data Management, New York University Rory Meyers College of Nursing, New York, NY, USA
| | - Moti Gulersen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Samantha Gobioff
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital - Northwell Health/Zucker School of Medicine, New York, NY, USA
| | - Arielle Yeshua
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital - Northwell Health/Zucker School of Medicine, New York, NY, USA
| | - Yael Eliner
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital - Northwell Health/Zucker School of Medicine, New York, NY, USA
| | - Amos Grünebaum
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital - Northwell Health/Zucker School of Medicine, New York, NY, USA
| | - Frank A Chervenak
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital - Northwell Health/Zucker School of Medicine, New York, NY, USA
| | - Eran Bornstein
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital - Northwell Health/Zucker School of Medicine, New York, NY, USA
| |
Collapse
|
2
|
Li M, Han J, Yang N, Li X, Wu X. Transcriptome profiling reveals superovulation with the gonadotropin-releasing hormone agonist trigger impaired embryo implantation in mice. Front Endocrinol (Lausanne) 2024; 15:1354435. [PMID: 38469140 PMCID: PMC10925639 DOI: 10.3389/fendo.2024.1354435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/29/2024] [Indexed: 03/13/2024] Open
Abstract
Introduction Superovulation is a critical step in assisted reproductive technology, but the use of human chorionic gonadotropin (hCG) as a trigger for superovulation can result in ovarian hyperstimulation. Thus, the use of Gonadotropin-releasing hormone agonist (GnRHa) trigger has been increasingly adopted, although it has been associated with a higher rate of pregnancy failure compared to natural cycles. This study aimed to investigate the effect of GnRHa trigger on embryo implantation in a mouse model. Methods Mice in the superovulation (PG) group were administered 7.5 IU of PMSG, followed by the injection of 3.5 μg of GnRHa (Leuprorelin) 48 h later, while mice in the control group (CTR) mated naturally. We compared the number of oocytes, blastocysts, and corpus luteum between the two groups and the implantation sites after the transfer of natural blastocysts. Ovaries, uterus, and serum 2 and 4 days after mating were collected for qRT-PCR, transcriptome sequencing, and hormone assays. Results The PG group had more oocytes, blastocysts, and corpus luteum after superovulation than the CTR group. However, the mRNA expression of leukemia inhibitory factor (Lif) and the number of implantation sites were reduced in the PG group. The ELISA assay revealed that superovulation increased ovarian estrogen secretion. The transcriptome analysis showed that superphysiological estrogen led to a response of the uterus to a high estrogen signal, resulting in abnormal endometrium and extracellular matrix remodeling and up-regulation of ion transport and inflammation-related genes. Conclusion Our findings suggest that a combination of PMSG and GnRHa trigger impaired embryo implantation in mice, as the excessive uterine response to superphysiological estrogen levels can lead to the change of gene expression related to endometrial remodeling, abnormal expression of uterine ion transport genes and excessive immune-related genes.
Collapse
Affiliation(s)
- Meng Li
- College of Animal Science and Technology, Hebei Technology Innovation Center of Cattle and Sheep Embryo, Hebei Agricultural University, Baoding, China
| | - Jingmei Han
- College of Veterinary Medicine, Hebei Agricultural University, Baoding, China
| | - Nana Yang
- College of Animal Science and Technology, Hebei Technology Innovation Center of Cattle and Sheep Embryo, Hebei Agricultural University, Baoding, China
| | - Xiangyun Li
- College of Animal Science and Technology, Hebei Technology Innovation Center of Cattle and Sheep Embryo, Hebei Agricultural University, Baoding, China
| | - Xinglong Wu
- College of Animal Science and Technology, Hebei Technology Innovation Center of Cattle and Sheep Embryo, Hebei Agricultural University, Baoding, China
| |
Collapse
|
3
|
Gök K, Ozden S. Decreased fetal thymus size in pregnancies after assisted reproductive technologies. J Matern Fetal Neonatal Med 2023; 36:2166401. [PMID: 36636015 DOI: 10.1080/14767058.2023.2166401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To compare the size of the fetal thymus, using both fetal thymic-thoracic ratio and fetal thymus transverse diameter values in Assisted reproductive technologies (ART) or naturally conceived pregnancies. METHODS In this retrospective study, fetal thymic-thoracic ratio and fetal thymus transverse diameter were evaluated in 204 pregnant women. Patients were examined in two groups. The study included 58 Intracytoplasmic sperm injection (ICSI) patients (study group) and 146 healthy pregnant women (control group). RESULTS Fetal thymic-thoracic ratio in ART pregnancies were found to be statistically significantly lower than that of the control group (p = .001). Also, the fetal thymus transverse diameter value was found to be statistically significantly lower in ART pregnancies compared to that of the control group (p = .001). CONCLUSIONS The size of the fetal thymus, manifested with a decrease in both fetal thymic-thoracic ratio and thymus transverse diameter values, decreased in ART pregnancies.
Collapse
Affiliation(s)
- Koray Gök
- Department of Obstetrics and Gynecology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Selçuk Ozden
- Department of Obstetrics and Gynecology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| |
Collapse
|
4
|
Kornfield MS, Gurley SB, Vrooman LA. Increased Risk of Preeclampsia with Assisted Reproductive Technologies. Curr Hypertens Rep 2023; 25:251-261. [PMID: 37303020 DOI: 10.1007/s11906-023-01250-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE OF REVIEW We summarized recent available data to assess the association between assisted reproductive technology (ART) and risk for preeclampsia. RECENT FINDINGS The majority of clinical studies supporting the association of preeclampsia and ART are retrospective. Published data from both clinical and pre-clinical studies suggest specific ART procedures may contribute to the increased risk, including in vitro embryo handling and development, hormone stimulation, transfer cycle types, and use of donor oocytes/embryos. Potential mechanisms include epigenetic aberrations leading to abnormal placentation, absence of factors secreted by the corpus luteum, and immunologic responses to allogenic gametes. There is an increased risk of preeclampsia following ART. Treatment plans that favor reduced preeclampsia risk should be considered for ART pregnancies. To make ART pregnancies safer, additional clinical and animal model studies are needed to elucidate the underpinnings of this risk association.
Collapse
Affiliation(s)
- Molly S Kornfield
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Susan B Gurley
- Division of Nephrology & Hypertension, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Lisa A Vrooman
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, 505 NW 185th Ave, Beaverton, OR, USA.
| |
Collapse
|
5
|
Sundrani DP, Joshi SR. Assisted reproductive technology (ART) and epigenetic modifications in the placenta. HUM FERTIL 2023; 26:665-677. [PMID: 34706609 DOI: 10.1080/14647273.2021.1995901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 04/19/2021] [Indexed: 10/20/2022]
Abstract
Assisted reproductive technology (ART) has become common amongst couples with infertility issues. ART is known to be successful, but epidemiological data indicates that ART is associated with placental disorders. Additionally, reports show increased risks of short- and long-term complications in children born to mothers undergoing ART. However, the mechanisms responsible for these events are obscure. The placenta is considered as a key organ for programming of diseases and ART procedures are suggested to alter the placental function and intrauterine growth trajectories. Epigenetic changes in maternal and foetal tissues are suggested to be the underlying mechanisms for these outcomes. Epigenetic regulation is known to evolve following fertilisation and before implantation and subsequently across gestation. During these critical periods of epigenetic 'programming', DNA methylation and chromatin remodelling influence the placental structure and function by regulating the expression of various genes. ART treatment coinciding with epigenetic 'programming' events during gametogenesis and early embryo development may alter the programming phases leading to long-term consequences. Thus, disruptions in placental development observed in ART pregnancies could be associated with altered epigenetic regulation of vital genes in the placenta. The review summarises available literature on the influence of ART procedures on epigenetic changes in the placenta.
Collapse
Affiliation(s)
- Deepali P Sundrani
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Sadhana R Joshi
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune, India
| |
Collapse
|
6
|
Khan S, Jamal MA, Khan IM, Ullah I, Jabbar A, Khan NM, Liu Y. Factors affecting superovulation induction in goats ( Capra hericus): An analysis of various approaches. Front Vet Sci 2023; 10:1152103. [PMID: 37035816 PMCID: PMC10079885 DOI: 10.3389/fvets.2023.1152103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/24/2023] [Indexed: 04/11/2023] Open
Abstract
Goats are generally called a "poor man's cow" because they not only provide meat and milk but also other assistance to their owners, including skins for leather production and their waste, which can be used as compost for fertilizer. Multiple ovulation and embryo transfer (MOET) is an important process in embryo biotechnology, as it increases the contribution of superior female goats to breeding operations. The field of assisted reproductive biotechnologies has seen notable progress. However, unlike in cattle, the standard use of superovulation and other reproductive biotechnologies has not been widely implemented for goats. Multiple intrinsic and extrinsic factors can alter the superovulatory response, significantly restricting the practicability of MOET technology. The use of techniques to induce superovulation is a crucial step in embryo transfer (ET), as it accelerates the propagation of animals with superior genetics for desirable traits. Furthermore, the conventional superovulation techniques based on numerous injections are not appropriate for animals and are labor-intensive as well as expensive. Different approaches and alternatives have been applied to obtain the maximum ovarian response, including immunization against inhibin and the day-0 protocol for the synchronization of the first follicular wave. While there are several studies available in the literature on superovulation in cattle, research on simplified superovulation in goats is limited; only a few studies have been conducted on this topic. This review describes the various treatments with gonadotropin that are used for inducing superovulation in various dairy goat breeds worldwide. The outcomes of these treatments, in terms of ovulation rate and recovery of transferrable embryos, are also discussed. Furthermore, this review also covers the recovery of oocytes through repeated superovulation from the same female goat that is used for somatic cell nuclear transfer (SCNT).
Collapse
Affiliation(s)
- Samiullah Khan
- Anhui Province Key Laboratory of Embryo Development and Reproduction Regulation, Anhui Province Key Laboratory of Environmental Hormone and Reproduction, School of Biological and Food Engineering, Fuyang Normal University, Fuyang, China
- The Scientific Observing and Experimental Station of Crop Pest in Guiyang, Ministry of Agriculture, Institute of Entomology, Guizhou University, Guiyang, China
| | | | - Ibrar Muhammad Khan
- Anhui Province Key Laboratory of Embryo Development and Reproduction Regulation, Anhui Province Key Laboratory of Environmental Hormone and Reproduction, School of Biological and Food Engineering, Fuyang Normal University, Fuyang, China
| | - Irfan Ullah
- College of Biotechnology, Jiangsu University of Science and Technology, Zhenjiang, Jiangsu, China
| | - Abdul Jabbar
- Faculty of Veterinary and Animal Sciences, University of Poonch, Rawalakot, Pakistan
| | - Nazir Muhammad Khan
- Department of Zoology, University of Science and Technology, Bannu, Pakistan
| | - Yong Liu
- Anhui Province Key Laboratory of Embryo Development and Reproduction Regulation, Anhui Province Key Laboratory of Environmental Hormone and Reproduction, School of Biological and Food Engineering, Fuyang Normal University, Fuyang, China
| |
Collapse
|
7
|
Ma R, Jin N, Lei H, Dong J, Xiong Y, Qian C, Chen S, Wang X. Ovarian Stimulation in Mice Resulted in Abnormal Placentation through Its Effects on Proliferation and Cytokine Production of Uterine NK Cells. Int J Mol Sci 2023; 24:ijms24065907. [PMID: 36982985 PMCID: PMC10054838 DOI: 10.3390/ijms24065907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
Ovarian stimulation is associated with an increased incidence of abnormal placentation. Uterine natural killer (uNK) cells are the major subpopulation of decidual immune cells, which are crucial for placentation. In a previous study, we found that ovarian stimulation impairs uNK cell density on gestation day (GD) 8.5 in mice. However, it was not clear how ovarian stimulation led to a reduction in the density of uNK cells. In this study, we constructed two mouse models, an in vitro mouse embryo transfer model and an estrogen-stimulated mouse model. We used HE and PAS glycogen staining, immunohistochemical techniques, q-PCR, Western blot, and flow cytometry to analyze the mouse decidua and placenta, and the results showed that SO resulted in a fetal weight reduction, abnormal placental morphology, decreased placental vascular density, and abnormal density and function of uNK cells. Our results suggest that ovarian stimulation resulted in aberrant estrogen signaling and may contribute to the disorder of uNK cells caused by ovarian stimulation. Together, these results provide new insights into the mechanisms of aberrant maternal endocrine environments and abnormal placentation.
Collapse
Affiliation(s)
- Rong Ma
- Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Medical University, Xi'an 710038, China
| | - Ni Jin
- Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Medical University, Xi'an 710038, China
| | - Hui Lei
- Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Medical University, Xi'an 710038, China
| | - Jie Dong
- Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Medical University, Xi'an 710038, China
| | - Yujing Xiong
- Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Medical University, Xi'an 710038, China
| | - Chenxi Qian
- Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Medical University, Xi'an 710038, China
| | - Shuqiang Chen
- Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Medical University, Xi'an 710038, China
| | - Xiaohong Wang
- Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Medical University, Xi'an 710038, China
| |
Collapse
|
8
|
Liu Y, Li R, Wang Y. Clinical outcomes and placental pathological characteristics after fresh embryo transfer and frozen-thawed embryo transfer with different endometrial preparation protocols. Placenta 2023; 131:65-70. [PMID: 36493625 DOI: 10.1016/j.placenta.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/24/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Yuanying Liu
- National Clinical Research Center for Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
| | - Rong Li
- National Clinical Research Center for Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China; Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology and Key Laboratory of Assisted Reproduction, Ministry of Education, Center for Reproductive Medicine, Peking University Third Hospital, Beijing, 100191, China.
| | - Yongqing Wang
- National Clinical Research Center for Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China.
| |
Collapse
|
9
|
Wu J, Zhang H, Wang X. E2 level > 2950 pg/ml on hCG trigger day is an independent predictor for birthweight loss of full-term singletons born after fresh embryo transfers in non-PCOS patients. Reprod Biol Endocrinol 2022; 20:162. [PMID: 36411437 PMCID: PMC9677889 DOI: 10.1186/s12958-022-01027-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 10/26/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Previous studies have demonstrated that the supraphysiological E2 level is negatively correlated with birthweight. However, the cut-off value of E2 level that significantly affects birthweight is unknown, and there is no definite conclusion regarding this level. Our study aimed to explore the threshold of the effect of E2 levels on birthweight. DESIGN A retrospective cohort study of 1846 samples was performed. All patients ≤42-years-old underwent autologous IVF cycles between August 1st, 2016 and April 30th, 2020. We categorized our data into four groups according to the E2 level: Group 1: ≤2000 pg/mL; Group 2: 2001-3000 pg/mL; Group 3: 3001-4000 pg/mL; and Group 4: > 4000 pg/mL. RESULTS The results of the multivariate regression analyses showed that when the E2 level was 3001-4000 pg/mL (adjusted β: - 89.64, 95% [CI]: - 180.29 to - 6.01; P = 0.0336) and greater than 4000 pg/mL (adjusted β: - 138.10, 95% [CI]: - 272.87 to - 10.33; P = 0.0181), weight loss was significant. Furthermore, the odds of full-term SGA were 1.40 times higher with E2 levels of 3001-4000 pg/mL (adjusted OR: 1.40, 95% [CI]: 1.090 to 3.18; P = 0.0256) and 2.55 times higher with E2 > 4000 pg/mL (adjusted OR: 2.55, 95% [CI]: 1.84 to 3.86; P = 0.0063) compared to the reference group. It can also be seen from the adjusted curves and the threshold effects that when the E2 level > 2950 pg/mL and > 3121 pg/mL, the incidence of SGA increased and the birthweight decreased, respectively. CONCLUSIONS Our data suggest that E2 levels > 2950 pg/mL is an independent predictor for greater odds of full-term SGA singletons born after fresh embryo transfer.
Collapse
Affiliation(s)
- Jing Wu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Tang Du Hospital, The Air Force Military medical University, 1 Xinsi Rd, Xi'an, 710038, Baqiao District, China
| | - Hengde Zhang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Tang Du Hospital, The Air Force Military medical University, 1 Xinsi Rd, Xi'an, 710038, Baqiao District, China
| | - Xiaohong Wang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Tang Du Hospital, The Air Force Military medical University, 1 Xinsi Rd, Xi'an, 710038, Baqiao District, China.
| |
Collapse
|
10
|
Gulersen M, Eliner Y, Grunebaum A, Lenchner E, Bar-El L, Chervenak FA, Bornstein E. Adverse outcomes associated with twin pregnancies conceived via in vitro fertilization. J Matern Fetal Neonatal Med 2022; 35:10213-10219. [PMID: 36100265 DOI: 10.1080/14767058.2022.2122806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To compare adverse pregnancy and neonatal outcomes in twin pregnancies conceived by in vitro fertilization (IVF) to those conceived spontaneously. METHODS Retrospective analysis of the Centers for Disease Control and Prevention, Natality Live Birth database for the years 2016-2019. All twin live births were included and stratified into two groups: those from pregnancies conceived via IVF and those from pregnancies conceived spontaneously. The incidence of several adverse pregnancy and neonatal outcomes were compared between the two groups. Statistical analysis included multivariable logistic regression to adjust for the following potential confounders: maternal age, race/ethnicity, body mass index, education level, type of medical insurance, chronic hypertension, pregestational diabetes, and prior preterm birth. Data were presented as adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS Twin live births from pregnancies conceived via IVF comprised 9.5% of the study cohort (39,356 of 415,560). Baseline characteristics varied significantly between IVF and spontaneously conceived twins. After adjusting for these variables, IVF in twins was associated with an increased risk of multiple adverse outcomes including gestational diabetes (aOR = 1.35, 95% CI = 1.30-1.39), hypertensive disorders of pregnancy (aOR = 1.70, 95% CI = 1.65-1.75), preterm birth prior to 28 weeks (aOR = 1.53, 95% CI = 1.43-1.63), maternal intensive care unit admission (aOR = 2.03, 95% CI = 1.79-2.31), maternal blood transfusion (aOR = 2.97, 95% CI = 2.75-3.20), unplanned hysterectomy (aOR = 3.37, 95% CI = 2.73-4.16), and prolonged ventilation in newborns (aOR = 1.76, 95% CI = 1.69-1.82), compared to spontaneously conceived twin pregnancies. CONCLUSIONS Based on this large United States population-based cohort, twin pregnancies conceived via IVF represent a subgroup of twins that have an increased risk for several adverse pregnancy and neonatal outcomes, compared to those conceived spontaneously. With increased contemporary utilization of IVF, obstetricians should consider these risks while caring for patients with twin pregnancies conceived via IVF.
Collapse
Affiliation(s)
- Moti Gulersen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North Shore University Hospital - Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Yael Eliner
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital - Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Amos Grunebaum
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital - Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Erez Lenchner
- Biostatistics and Data Management, New York University Rory Meyers College of Nursing, New York, NY, USA
| | - Liron Bar-El
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital - Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Frank A Chervenak
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital - Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Eran Bornstein
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital - Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| |
Collapse
|
11
|
Mitter VR, Grädel F, Kohl Schwartz AS, von Wolff M. Gonadotropin Stimulation Reduces the Implantation and Live Birth Rate but Not the Miscarriage Rate of Embryos Transferred When Compared to Unstimulated In Vitro Fertilization. Reprod Sci 2022; 30:283-290. [PMID: 35768691 PMCID: PMC9810560 DOI: 10.1007/s43032-022-01016-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/14/2022] [Indexed: 01/07/2023]
Abstract
Research suggests that gonadotropin stimulation in in vitro fertilization (IVF) treatment affects embryo quality and the endometrium that might influence embryo implantation, placentation and establishment of a viable pregnancy. We assessed the impact of gonadotropin stimulation on implantation, live birth and miscarriage rates per transferred embryo by comparing stimulated and unstimulated IVF treatment. In a cohort of 728 couples, 1310 IVF cycles with successful embryo transfer were analysed; 857 cycles were stimulated with gonadotropins > 75 IU/day (333 poor responder < 4 oocytes; 524 normal responders), and 453 were unstimulated. In total, 1913 fresh cleavage-stage embryos were transferred. Zygote but no embryo selection was performed, and supernumerous zygotes were vitrified. The implantation rate was defined as number of sonographically detected amniotic sacs; live birth rate as number of children born per transferred embryo. Modified mixed effect Poisson regression was used to account for the dependency of cycles and embryos within the same women and the same transfer cycle. Adjustments were made for maternal age, parity, primary or secondary infertility and indication for IVF. Per transferred embryo, implantation rates (rate ratio (RR) 1.37; 95% CI 1.04-1.81; p = 0.028; aRR 1.42; 95% CI 1.10-1.84; p = 0.008) and live birth rates (RR 1.33; 95% CI 0.95-1.86; p = 0.093; aRR 1.38; 95% CI 1.01-1.88; p = 0.044) were higher in NC-IVF compared to cIVF normal responders. Miscarriage did not differ (RR 0.99; 95% CI 0.59-1.65; p = 0.965; aRR 0.90; 95% CI 0.52-1.53 p = 0.698). Similar results were obtained in poor responders. The study suggests an impact of gonadotropin stimulation on the implantation potential of embryos.
Collapse
Affiliation(s)
- Vera Ruth Mitter
- Division of Gynecological Endocrinology and Reproductive Medicine, Bern University Hospital, Inselspital Bern, University of Bern, Friedbühlstrasse 19, 3010, Bern, Switzerland. .,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.
| | - Flavia Grädel
- Division of Gynecological Endocrinology and Reproductive Medicine, Bern University Hospital, Inselspital Bern, University of Bern, Friedbühlstrasse 19, 3010 Bern, Switzerland ,Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Alexandra Sabrina Kohl Schwartz
- Division of Gynecological Endocrinology and Reproductive Medicine, Bern University Hospital, Inselspital Bern, University of Bern, Friedbühlstrasse 19, 3010 Bern, Switzerland ,Division of Reproductive Medicine and Gynaecological Endocrinology, Cantonal Hospital Lucerne, Women’s Hospital, Lucerne, Switzerland
| | - Michael von Wolff
- Division of Gynecological Endocrinology and Reproductive Medicine, Bern University Hospital, Inselspital Bern, University of Bern, Friedbühlstrasse 19, 3010 Bern, Switzerland
| |
Collapse
|
12
|
A microphysiological model of human trophoblast invasion during implantation. Nat Commun 2022; 13:1252. [PMID: 35292627 PMCID: PMC8924260 DOI: 10.1038/s41467-022-28663-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/01/2022] [Indexed: 12/12/2022] Open
Abstract
Successful establishment of pregnancy requires adhesion of an embryo to the endometrium and subsequent invasion into the maternal tissue. Abnormalities in this critical process of implantation and placentation lead to many pregnancy complications. Here we present a microenigneered system to model a complex sequence of orchestrated multicellular events that plays an essential role in early pregnancy. Our implantation-on-a-chip is capable of reconstructing the three-dimensional structural organization of the maternal-fetal interface to model the invasion of specialized fetal extravillous trophoblasts into the maternal uterus. Using primary human cells isolated from clinical specimens, we demonstrate in vivo-like directional migration of extravillous trophoblasts towards a microengineered maternal vessel and their interactions with the endothelium necessary for vascular remodeling. Through parametric variation of the cellular microenvironment and proteomic analysis of microengineered tissues, we show the important role of decidualized stromal cells as a regulator of extravillous trophoblast migration. Furthermore, our study reveals previously unknown effects of pre-implantation maternal immune cells on extravillous trophoblast invasion. This work represents a significant advance in our ability to model early human pregnancy, and may enable the development of advanced in vitro platforms for basic and clinical research of human reproduction. Normal and abnormal pregnancy is challenging to study and involves complex interactions between maternal and fetal cells. Here the authors present an implantation-on-a-chip device capable of modeling trophoblast invasion, a process critical to the establishment of pregnancy.
Collapse
|
13
|
Zhang Y, Shen L, Yin X, Chen W. Live-Birth Prediction of Natural-Cycle In Vitro Fertilization Using 57,558 Linked Cycle Records: A Machine Learning Perspective. Front Endocrinol (Lausanne) 2022; 13:838087. [PMID: 35527994 PMCID: PMC9072737 DOI: 10.3389/fendo.2022.838087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/07/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Natural-cycle in vitro fertilization (NC-IVF) is an in vitro fertilization (IVF) cycle without gonadotropins or any other stimulation of follicular growth. Previous studies on live-birth prediction of NC-IVF were very few; the sample size was very limited. This study aims to construct a machine learning model to predict live-birth occurrence of NC-IVF using 57,558 linked cycle records and help clinicians develop treatment strategies. DESIGN AND METHODS The dataset contained 57,558 anonymized register patient records undergoing NC-IVF cycles from 2005 to 2016 filtered from 7bsp;60,732 records in the Human Fertilisation and Embryology Authority (HFEA) data. We selected matching records and features through data filtering and feature selection methods. Two groups of twelve machine learning models were trained and tested. Eight metrics, e.g., F1 score, Matthews correlation coefficient (MCC), the area under the receiver operating characteristic curve (AUC), etc., were computed to evaluate the performance of each model. RESULTS Two groups of twelve models were trained and tested. The artificial neural network (ANN) model performed the best in the machine learning group (F1 score, 70.87%; MCC, 50.37%; and AUC score, 0.7939). The LogitBoost model obtained the best scores in the ensemble learning group (F1 score, 70.57%; MCC, 50.75%; and AUC score, 0.7907). After the comparison between the two models, the LogitBoost model was recognized as an optimal one. CONCLUSION In this study, NC-IVF-related datasets were extracted from the HFEA data, and a machine learning-based prediction model was successfully constructed through this largest NC-IVF dataset currently. This model is universal and stable, which can help clinicians predict the live-birth success rate of NC-IVF in advance before developing IVF treatment strategies and then choose the best benefit treatment strategy according to the patients' wishes. As "use less stimulation and back to natural condition" becomes more and more popular, this model is more meaningful in the decision-making assistance system for IVF.
Collapse
Affiliation(s)
- Yanran Zhang
- Medical School of Nanjing University, Nanjing, China
- *Correspondence: Yanran Zhang,
| | - Lei Shen
- College of Computer and Information, Hohai University, Nanjing, China
- Nanjing Marine Radar Institute, Nanjing, China
| | - Xinghui Yin
- College of Computer and Information, Hohai University, Nanjing, China
| | | |
Collapse
|
14
|
Taher L, Israel S, Drexler HCA, Makalowski W, Suzuki Y, Fuellen G, Boiani M. The proteome, not the transcriptome, predicts that oocyte superovulation affects embryonic phenotypes in mice. Sci Rep 2021; 11:23731. [PMID: 34887460 PMCID: PMC8660899 DOI: 10.1038/s41598-021-03054-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/26/2021] [Indexed: 11/18/2022] Open
Abstract
Superovulation is the epitome for generating oocytes for molecular embryology in mice, and it is used to model medically assisted reproduction in humans. However, whether a superovulated oocyte is normal, is an open question. This study establishes for the first time that superovulation is associated with proteome changes that affect phenotypic traits in mice, whereas the transcriptome is far less predictive. The proteins that were differentially expressed in superovulated mouse oocytes and embryos compared to their naturally ovulated counterparts were enriched in ontology terms describing abnormal mammalian phenotypes: a thinner zona pellucida, a smaller oocyte diameter, increased frequency of cleavage arrest, and defective blastocyst formation, which could all be verified functionally. Moreover, our findings indicate that embryos with such abnormalities are negatively selected during preimplantation, and ascribe these abnormalities to incomplete ovarian maturation during the time of the conventional superovulation, since they could be corrected upon postponement of the ovulatory stimulus by 24 h. Our data place constraints on the common view that superovulated oocytes are suitable for drawing general conclusions about developmental processes, and underscore the importance of including the proteins in a modern molecular definition of oocyte quality.
Collapse
Affiliation(s)
- Leila Taher
- Institute of Biomedical Informatics, Graz University of Technology, Stremayrgasse 16/I, 8010, Graz, Austria.
| | - Steffen Israel
- Max Planck Institute for Molecular Biomedicine, Roentgenstrasse 20, 48149, Muenster, Germany
| | - Hannes C A Drexler
- Max Planck Institute for Molecular Biomedicine, Roentgenstrasse 20, 48149, Muenster, Germany
| | - Wojciech Makalowski
- Institute of Bioinformatics, Faculty of Medicine, University of Münster, Niels Stensen Str. 14, 48149, Münster, Germany
| | - Yutaka Suzuki
- Department of Medical Genome Sciences, Graduate School of Frontier Sciences, University of Tokyo, Kashiwa, Chiba, 277-8562, Japan
| | - Georg Fuellen
- Institute for Biostatistics and Informatics in Medicine and Aging Research (IBIMA), Rostock University Medical Center, Ernst-Heydemann-Strasse 8, 18057, Rostock, Germany.
| | - Michele Boiani
- Max Planck Institute for Molecular Biomedicine, Roentgenstrasse 20, 48149, Muenster, Germany.
| |
Collapse
|
15
|
Sánchez Soler MJ, López-González V, Ballesta-Martínez MJ, Gálvez-Pradillo J, Nicolás-Arnao M, Gómez-Sánchez E, Pérez-Fernández V, Guillén Navarro E. Risk of mayor and minor birth defects in children conceived by assisted reproductive technology (IVF/ICSI): A prospective controlled cohort study. An Pediatr (Barc) 2021; 95:448-458. [PMID: 34857501 DOI: 10.1016/j.anpede.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/14/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION About 0.2-6.1% of newborns in the developed world have been conceived by assisted reproductive techniques (ART). Higher rate of major and minor malformations have been described in this population, but the multiple possible confounders associated make it difficult to establish a direct causal relationship and the specific factors involved. MATERIAL AND METHODS To determine the risk of these malformations in our population, a collaborative prospective controlled cohort study was designed. We collected the specific ART-data related to the clinical gestation of women treated in a period of 2 years in the Reproduction Unit from a Spanish public tertiary-level hospital. 231 out of 267 newborns of these gestation (88%) participated in the study and were assessed by a pediatrician with expertise in Clinical Genetics and Dysmorphology at 12-20 and 26-40 months of age. At the same time a controlled group of children naturally conceived (NC) was selected according to the following criteria: the next NC newborn belonging to the same group of maternal and gestational age, and type of gestation (single or multiple). 230 controls were chosen and 208 participated in the study (90%). RESULTS Major malformations were presented in 7.8% of the ART-children and 7.2% of the controls, without founding statistically differences between groups. However, differences were found in the risk of some minor malformations such as capillary malformations and pigmentary lesions, higher in the ART-group. A recurrent pattern of craneofacial anomalies was also unexpectedly detected. CONCLUSIONS In spite of the high rate of major congenital malformations detected, there were no differences between groups. Thus, our results suggest that ART may affect the normal embryonic development but in a milder way than other confounding factors do. The facial phenotype identified has not previously been described, either the higher risk of capillary malformations and pigmentary lesions. More studies are needed to confirm this association.
Collapse
Affiliation(s)
- María José Sánchez Soler
- Genética Médica, Servicio de Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain.
| | - Vanesa López-González
- Genética Médica, Servicio de Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
| | | | - Jorge Gálvez-Pradillo
- Unidad de Reproducción, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | | | | | - Encarna Guillén Navarro
- Genética Médica, Servicio de Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
| |
Collapse
|
16
|
Segal TR, Amini P, Wang J, Peters G, Skomorovska-Prokvolit Y, Mainigi MA, Goldfarb JM, Mesiano S, Weinerman R. Superovulation with human chorionic gonadotropin (hCG) trigger and gonadotropin releasing hormone agonist (GnRHa) trigger differentially alter essential angiogenic factors in the endometrium in a mouse ART model†. Biol Reprod 2021; 102:1122-1133. [PMID: 31995151 DOI: 10.1093/biolre/ioaa014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/18/2019] [Accepted: 01/28/2020] [Indexed: 12/11/2022] Open
Abstract
Gonadotropin-releasing hormone agonists (GnRHa) are used as an alternative to human chorionic gonadotropin (hCG) to trigger ovulation and decrease the risk of ovarian hyperstimulation syndrome. GnRHa is less potent at inducing ovarian vascular endothelial growth factor (VEGF), but may also affect endometrial angiogenesis and early placental development. In this study, we explore the effect of superovulation on endometrial angiogenesis during critical periods of gestation in a mouse model. We assigned female mice to three groups: natural mating or mating following injection with equine chorionic gonadotropin and trigger with GnRHa or hCG trigger. Females were killed prior to implantation (E3.5), post-implantation (E7.5), and at midgestation (E10.5), and maternal serum, uterus, and ovaries were collected. During peri-implantation, endometrial Vegfr1 and Vegfr2 mRNA were significantly increased in the GnRHa trigger group (P < 0.02) relative to the hCG group. Vegfr1 is highly expressed in the endometrial lining and secretory glands immediately prior to implantation. At E7.5, the ectoplacental cone expression of Vegfa and its receptor, Vegfr2, was significantly higher in the hCG trigger group compared to the GnRHa group (P < 0.05). Soluble VEGFR1 and free VEGFA were much higher in the serum of mice exposed to the hCG trigger compared to GnRHa group. At midgestation, there was significantly more local Vegfa expression in the placenta of mice triggered with hCG. GnRHa and hCG triggers differentially disrupt the endometrial expression of key angiogenic factors during critical periods of mouse gestation. These results may have significant implications for placental development and neonatal outcomes following human in vitro fertilization.
Collapse
Affiliation(s)
- Thalia R Segal
- Division of Reproductive Endocrinology and Infertility, University of California, San Francisco, CA, USA.,Department of Reproductive Biology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Peyvand Amini
- Department of Reproductive Biology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Junye Wang
- Department of Reproductive Biology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Gregory Peters
- Department of Reproductive Biology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Monica A Mainigi
- Department of Reproductive Endocrinology and Infertility, University of Pennsylvania, Philadelphia, PA, USA
| | - James M Goldfarb
- Division of Reproductive Endocrinology and Infertility, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sam Mesiano
- Department of Reproductive Biology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Rachel Weinerman
- Department of Reproductive Biology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Division of Reproductive Endocrinology and Infertility, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| |
Collapse
|
17
|
Sánchez Soler MJ, López-González V, Ballesta-Martínez MJ, Gálvez-Pradillo J, Nicolás-Arnao M, Gómez-Sánchez E, Pérez-Fernández V, Guillén Navarro E. [Risk of mayor and minor birth defects in children conceived by assisted reproductive technology (IVF/ICSI): A prospective controlled cohort study]. An Pediatr (Barc) 2021; 95:S1695-4033(21)00220-4. [PMID: 34315688 DOI: 10.1016/j.anpedi.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/03/2021] [Accepted: 06/14/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION About 0.2-6.1% of newborns in the developed world have been conceived by assisted reproductive techniques (ART). Higher rate of major and minor malformations have been described in this population, but the multiple possible confounders associated, make it difficult to establish a direct causal relationship, and the specific factors involved. MATERIAL AND METHODS To determine the risk of these malformations in our population, a collaborative prospective controlled cohort study was designed. We collected the specific ART-data related to the clinical gestation of women treated in a period of 2 years in the Reproduction Unit from a Spanish public tertiary-level hospital. 231 out of 267 newborns of these gestation (88%) were exhausted assessed by a Clinical Geneticist expertise in Dysmorphology at 12-20 and 26-40 months of age. At the same time a controlled group of children naturally conceived (NC) was selected according to the following criteria: the next NC newborn belonging to the same group of maternal and gestational age, and type of gestation (single or multiple). 230 controls were chosen and 208 participated in the study (90%). RESULTS Major malformations were presented in 7.8% of the ART-children and 7.2% of the controls, without founding statistically differences between groups. However, differences were found in the risk of some minor malformations such as capillary malformations and pigmentary lesions, higher in the ART-group. A recurrent pattern of craneofacial anomalies was also unexpectedly detected. CONCLUSIONS In spite of the high rate of major congenital malformations detected, there were no differences between groups. Thus, our results suggest that ART may affect the normal embryonic development but in a milder way than other confounding factors do. The facial phenotype identified has not previously, either the higher risk of capillary malformations and pigmentary lesions. More studies are needed to confirm this association.
Collapse
Affiliation(s)
- María José Sánchez Soler
- Genética Médica, Servicio de Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca. IMIB-Arrixaca, Murcia, España.
| | - Vanesa López-González
- Genética Médica, Servicio de Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca. IMIB-Arrixaca, Murcia, España
| | | | - Jorge Gálvez-Pradillo
- Unidad de Reproducción, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | | | | | | | - Encarna Guillén Navarro
- Genética Médica, Servicio de Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca. IMIB-Arrixaca, Murcia, España
| |
Collapse
|
18
|
Talebi T, Mohsen-Pour N, Hesami M, Maleki M, Kalayinia S. The association between in vitro fertilization and intracytoplasmic sperm injection treatment and the risk of congenital heart defects. J Matern Fetal Neonatal Med 2021; 35:7471-7485. [PMID: 34233556 DOI: 10.1080/14767058.2021.1949705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Assisted reproductive technology (ART), an effective treatment modality for infertility, is associated with a higher prevalence of congenital anomalies such as congenital heart defects (CHDs). The present study aimed to evaluate data linking CHDs in infants to pregnancies resulting from in vitro fertilization (IVF) and/or intracytoplasmic sperm injection (ICSI). METHODS In this study, we conducted a systematic literature search on CHDs in infants following IVF/ICSI in Google Scholar, Embase, Scopus, MEDLINE, and PubMed databases from inception to February 2020. The search strategy used combinations of search keywords that included assisted reproductive technology/ART, in vitro fertilization/IVF, intracytoplasmic sperm injection/ICSI, birth defect, congenital malformation, and congenital heart defects. RESULTS Fifty-six studies fulfilled the inclusion criteria and were selected in the current systematic review, which assessed the association between ART and the risk of CHDs. CONCLUSION Children conceived by IVF/ICSI manifested an increased risk of CHDs compared with spontaneously conceived children. Further studies are needed to assess the long-term cardiovascular safety of these techniques, which is important for the counseling of patients before the use of ART.
Collapse
Affiliation(s)
- Taravat Talebi
- Department of Genetics and Molecular Medicine, School of Medicine, Zanjan University of Medical Sciences (ZUMS), Zanjan, Iran
| | - Neda Mohsen-Pour
- Department of Genetics and Molecular Medicine, School of Medicine, Zanjan University of Medical Sciences (ZUMS), Zanjan, Iran
| | - Mahshid Hesami
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Maleki
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Samira Kalayinia
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
19
|
Neonatal and maternal outcomes among twin pregnancies stratified by mode of conception in the United States. Fertil Steril 2021; 116:514-521. [PMID: 33975727 DOI: 10.1016/j.fertnstert.2021.03.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare neonatal and maternal outcomes among twin pregnancies conceived as a result of different types of fertility treatments with those of spontaneously conceived twin pregnancies. DESIGN Retrospective Cohort. SETTING Population-based analysis. PATIENT(S) Population-based analysis of twin pregnancies in the United States based on their mode of conception using the natality data from the National Center for Health Statistics from the Centers for Disease Control and Prevention (from January 2015 through December 2017). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Adverse neonatal and maternal outcomes. RESULT(S) The overall prevalence of early adverse maternal outcomes and medical complications and obstetric complications including the risk of unplanned hysterectomy, intensive care unit admission, maternal blood transfusion, and perineal laceration were significantly higher in the fertility treatment group (including both ovulation induction/intrauterine insemination and assisted reproductive technology groups) compared with those of the spontaneous conception group, even after adjusting for several potential confounders. The risk of adverse composite neonatal outcomes was slightly lower in the spontaneous conception live twin birth group even after adjustment for several potential confounders. CONCLUSION(S) The rate of maternal and neonatal morbidity in twins conceived via different fertility treatments was slightly increased compared with those of twins conceived spontaneously. Because the absolute risks of maternal and neonatal morbidity were low, overall reassurance regarding these outcomes can be provided to the patients undergoing all types of fertility treatments.
Collapse
|
20
|
Libby VR, Wilson R, Kresak A, Cameron C, Redline R, Mesiano S, Weinerman R. Superovulation with gonadotropin-releasing hormone agonist or chorionic gonadotropin for ovulation trigger differentially affects leukocyte populations in the peri-implantation mouse uterus. F&S SCIENCE 2021; 2:198-206. [PMID: 35559753 DOI: 10.1016/j.xfss.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To investigate the effect of superovulation with human chorionic gonadotropin (hCG) or gonadotropin-releasing hormone agonist (GnRHa) trigger on leukocyte density and expression of leukocyte-specific genes in the peri-implantation period in the mouse uterus. DESIGN Laboratory research. SETTING University laboratory facility. INTERVENTIONS Female mice were mated to fertile male mice in one of three protocols: (1) natural mating or mating following injection with pregnant mare serum gonadotropin followed by trigger with (2) GnRHa or (3) hCG. Female mice were killed prior to implantation, 3 days after ovulation (E3.5), and the ovaries and uterine tissue were collected. Total RNA was isolated and assayed using quantitative reverse transcription polymerase chain reaction, and the uterine tissue was stained for histologic analysis of immune cell markers. MAIN OUTCOME MEASURES Endometrial leukocyte (CD45) and vessel density (CD31) by immunohistochemical staining; expression of leukocyte markers CD11b, CD335, and CD22, by quantitative reverse transcription polymerase chain reaction in the whole uterine tissue. RESULTS Superovulation decreased (compared with controls) the endometrial leukocyte density, based on the number of cells staining for CD45, and endometrial vessel density, based on the number of cells staining for CD31. Leukocyte density was additionally decreased in the GnRHa trigger group compared with that in the hCG trigger group. Superovulation with hCG and GnRHa triggers decreased the uterine expression of the B-cell marker CD22 compared with controls. The expression of the natural killer cell marker CD11b was decreased by the hCG trigger but not by the GnRHa. Abundance of mRNA encoding the CD335 natural killer cell marker was not affected by superovulation or trigger agent. CONCLUSIONS In mice, superovulation with the GnRHa trigger compared with that with the hCG trigger differentially alters key immunologic factors in the uterine peri-implantation. These altered immunologic factors have roles in angiogenesis that may assist in elucidating the effects of assisted reproductive technologies on implantation efficiency and fetal growth and development.
Collapse
Affiliation(s)
- Valerie R Libby
- Division of Reproductive Endocrinology and Infertility, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Rachel Wilson
- Department of Reproductive Biology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Adam Kresak
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Cheryl Cameron
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Raymond Redline
- Department of Reproductive Biology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Sam Mesiano
- Department of Reproductive Biology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Rachel Weinerman
- Division of Reproductive Endocrinology and Infertility, University Hospitals Cleveland Medical Center, Cleveland, Ohio; Department of Reproductive Biology, Case Western Reserve University School of Medicine, Cleveland, Ohio.
| |
Collapse
|
21
|
Wang CH, Hu XQ. A systematic review of clinical efficacy of frozen-thawed embryos and fresh embryos in in-vitro fertilization cycles. Cryobiology 2021; 100:19-25. [PMID: 33872610 DOI: 10.1016/j.cryobiol.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Frozen-thawed embryo (FTE) and fresh embryo (FE) transfer are two common strategies in vitro fertilization (IVF), while the results and findings still vary among studies. METHODS We searched multiple databases for relevant studies comparing the clinical effects of FTE and FE. Meta-analyses were conducted with Review Manager 5.0 to assess the efficacy among included articles. We also analyzed the risk of bias for the reports. RESULTS Nine studies eventually met the inclusion criteria from 2010 to 2018, and 11396 patients were included. The meta-analyses indicated no significant difference in biochemical pregnancy, clinical pregnancy and ongoing pregnancy rates. Meanwhile, the implantation rate and live birth rate in frozen-thawed embryos were much higher than those of fresh embryo. The birth weight in the frozen-thawed ET group was greater than that of the FE group, and the low birth weight rate in FTE was lower than FE group. CONCLUSION Our findings suggested a trend toward favouring frozen-thawed FTE might be a preferred transfer strategy for patients with IVF.
Collapse
Affiliation(s)
- Cui-Hua Wang
- Department of Gynecology and Obstetrics, Wuxi No.2 Chinese Medicine Hospital, Wuxi, China
| | - Xiao-Qing Hu
- Department of Gynecology and Obstetrics, Wuxi No.2 Chinese Medicine Hospital, Wuxi, China.
| |
Collapse
|
22
|
Huang X, Fu J. Association Between Assisted Reproductive Technology and White Matter Injury in Premature Infants: A Case-Control Study. Front Pediatr 2021; 9:686670. [PMID: 34513759 PMCID: PMC8429486 DOI: 10.3389/fped.2021.686670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 08/02/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives: Whether there is a link between assisted reproductive technology (ART) and brain damage in premature infants remains unclear. The aim of this study was to determine whether premature infants conceived by ART are at a greater risk of developing white matter injury (WMI), as detected by magnetic resonance imaging (MRI) or diffusion-weighted imaging (DWI) within 14 days, than those naturally conceived (NC). Methods: A retrospective case-control study was conducted on singleton premature infants with a gestational age of ≥28 weeks and <34 weeks delivered between 2017 and 2019 at Shengjing Hospital, China Medical University. This study included 638 live births that were stratified into case group (n = 218) and control group (n = 420), depending on the presence or absence of WMI. The exposure proportion of ART was compared between the case and control groups, and a logistic regression model was used to identify whether ART was an independent risk factor for WMI. Results: In the univariate analysis, the exposure proportion of ART conception was higher in cases than in controls (12.84 vs. 7.38%, p = 0.024). According to the multivariable analysis, after adjustment for other variables, the association between ART and WMI remained significant (1.82; 95% confidence interval, 1.04-3.21; P = 0.038). Conclusions: Singleton premature infants conceived by ART have a higher risk of WMI than NC infants. Given that ART is an independent risk factor for WMI in premature infants, more attention should be paid to neurodevelopmental outcomes in this group.
Collapse
Affiliation(s)
- Xuejiao Huang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - JianHua Fu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| |
Collapse
|
23
|
Maternal Docosahexaenoic Acid Status during Pregnancy and Its Impact on Infant Neurodevelopment. Nutrients 2020; 12:nu12123615. [PMID: 33255561 PMCID: PMC7759779 DOI: 10.3390/nu12123615] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 12/15/2022] Open
Abstract
Dietary components are essential for the structural and functional development of the brain. Among these, docosahexaenoic acid, 22:6n-3 (DHA), is critically necessary for the structure and development of the growing fetal brain in utero. DHA is the major n-3 long-chain polyunsaturated fatty acid in brain gray matter representing about 15% of all fatty acids in the human frontal cortex. DHA affects neurogenesis, neurotransmitter, synaptic plasticity and transmission, and signal transduction in the brain. Data from human and animal studies suggest that adequate levels of DHA in neural membranes are required for maturation of cortical astrocyte, neurovascular coupling, and glucose uptake and metabolism. Besides, some metabolites of DHA protect from oxidative tissue injury and stress in the brain. A low DHA level in the brain results in behavioral changes and is associated with learning difficulties and dementia. In humans, the third trimester-placental supply of maternal DHA to the growing fetus is critically important as the growing brain obligatory requires DHA during this window period. Besides, DHA is also involved in the early placentation process, essential for placental development. This underscores the importance of maternal intake of DHA for the structural and functional development of the brain. This review describes DHA’s multiple roles during gestation, lactation, and the consequences of its lower intake during pregnancy and postnatally on the 2019 brain development and function.
Collapse
|
24
|
Conforti A, Picarelli S, Carbone L, La Marca A, Venturella R, Vaiarelli A, Cimadomo D, Zullo F, Rienzi L, Ubaldi FM, Alviggi C. Perinatal and obstetric outcomes in singleton pregnancies following fresh versus cryopreserved blastocyst transfer: a meta-analysis. Reprod Biomed Online 2020; 42:401-412. [PMID: 33234401 DOI: 10.1016/j.rbmo.2020.09.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/12/2020] [Accepted: 09/28/2020] [Indexed: 11/30/2022]
Abstract
The transfer of cryopreserved blastocysts is increasing in IVF centres. However, little is known about the perinatal and obstetric outcomes of this procedure. In an attempt to further elucidate these issues, a systematic review and meta-analysis was conducted to compare cryopreserved transfer with fresh blastocyst embryo transfer. The results show that the risk of both preterm (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.80-0.99, P = 0.04) and low birthweight births (OR 0.82, 95% CI 0.68-0.99, P = 0.04) was significantly lower after cryopreserved blastocyst transfer than after fresh blastocyst transfer. The rate of large for gestational age births was significantly higher (OR 1.68, 95% CI 1.55-1.82, P < 0.00001) and the rate of small for gestational age births significantly lower (OR 0.59, 95% CI 0.54-0.65, P < 0.00001) after cryopreserved blastocyst transfer. The transfer of cryopreserved blastocysts was associated with a significantly lower risk of placental abruption (OR 0.58, 95% CI 0.40-0.83, P = 0.003) but a significantly higher risk of Caesarean section (OR 1.21, 95% CI 1.01-1.43, P = 0.03). In conclusion, the perinatal and obstetric outcomes associated with the transfer of cryopreserved blastocysts differ from those associated with fresh blastocyst transfer.
Collapse
Affiliation(s)
- Alessandro Conforti
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy.
| | - Silvia Picarelli
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Luigi Carbone
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Antonio La Marca
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberta Venturella
- Unit of Obstetrics and Gynaecology, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Alberto Vaiarelli
- GENERA Centre for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
| | - Danilo Cimadomo
- GENERA Centre for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
| | - Fulvio Zullo
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Laura Rienzi
- GENERA Centre for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
| | | | - Carlo Alviggi
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| |
Collapse
|
25
|
Siqueira LG, Silva MVG, Panetto JC, Viana JH. Consequences of assisted reproductive technologies for offspring function in cattle. Reprod Fertil Dev 2020; 32:82-97. [PMID: 32188560 DOI: 10.1071/rd19278] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Abnormal fetuses, neonates and adult offspring derived by assisted reproductive technologies (ART) have been reported in humans, rodents and domestic animals. The use of ART has also been associated with an increased likelihood of certain adult diseases. These abnormalities may arise as a result of an excess of or missing maternally derived molecules during invitro culture, because the invitro environment is artificial and suboptimal for embryo development. Nonetheless, the success of ART in overcoming infertility or improving livestock genetics is undeniable. Limitations of invitro embryo production (IVEP) in cattle include lower rates of the establishment and maintenance of pregnancy and an increased incidence of neonatal morbidity and mortality. Moreover, recent studies demonstrated long-term effects of IVEP in cattle, including increased postnatal mortality, altered growth and a slight reduction in the performance of adult dairy cows. This review addresses the effects of an altered preimplantation environment on embryo and fetal programming and offspring development. We discuss cellular and molecular responses of the embryo to the maternal environment, how ART may disturb programming, the possible role of epigenetic effects as a mechanism for altered phenotypes and long-term effects of ART that manifest in postnatal life.
Collapse
Affiliation(s)
- Luiz G Siqueira
- Embrapa Gado de Leite, Juiz de Fora, MG, Brazil 36038-330; and Corresponding author.
| | | | - João C Panetto
- Embrapa Gado de Leite, Juiz de Fora, MG, Brazil 36038-330
| | - João H Viana
- Embrapa Recursos Genéticos e Biotecnologia, Brasília, DF, Brazil 70770-917
| |
Collapse
|
26
|
Abstract
Development of assisted reproductive technologies has been driven by the goals of reducing the incidence of infertility, increasing the number of offspring from genetically elite animals, facilitating genetic manipulation, aiding preservation and long-distance movement of germplasm, and generating research material. Superovulation is associated with reduced fertilization rate and alterations in endometrial function. In vitro production of embryos can have a variety of consequences. Most embryos produced in vitro are capable of establishing pregnancy and developing into healthy neonatal animals. However, in vitro production is associated with reduced ability to develop to the blastocyst stage, increased incidence of failure to establish pregnancy, placental dysfunction, and altered fetal development. Changes in the developmental program mean that some consequences of being produced in vitro can extend into adult life. Reduced competence of the embryo produced in vitro to develop to the blastocyst stage is caused largely by disruption of events during oocyte maturation and fertilization. Conditions during embryo culture can affect embryo freezability and competence to establish pregnancy after transfer. Culture conditions, including actions of embryokines, can also affect the postnatal phenotype of the resultant progeny.
Collapse
Affiliation(s)
- Peter J Hansen
- Department of Animal Sciences, D.H. Barron Reproductive and Perinatal Biology Research Program and Genetics Institute, University of Florida, Gainesville, Florida 32611-0910, USA;
| |
Collapse
|
27
|
Sullivan-Pyke C, Mani S, Rhon-Calderon EA, Ord T, Coutifaris C, Bartolomei MS, Mainigi M. Timing of exposure to gonadotropins has differential effects on the conceptus: evidence from a mouse model†. Biol Reprod 2020; 103:854-865. [PMID: 32584398 DOI: 10.1093/biolre/ioaa109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/23/2020] [Accepted: 06/19/2020] [Indexed: 11/13/2022] Open
Abstract
Superovulation with gonadotropins alters the hormonal milieu during early embryo development and placentation, and may be responsible for fetal and placental changes observed after in vitro fertilization (IVF). We hypothesized that superovulation has differential effects depending on timing of exposure. To test our hypothesis, we isolated the effect of superovulation on pre- and peri-implantation mouse embryos. Blastocysts were obtained from either natural mating or following superovulation and mating, and were transferred into naturally mated or superovulated pseudopregnant recipient mice. Fetal weight was significantly lower after peri-implantation exposure to superovulation, regardless of preimplantation exposure (p = 0.006). Placentas derived from blastocysts exposed to superovulation pre- and peri-implantation were larger than placentas derived from natural blastocysts that are transferred into a natural or superovulated environment (p < 0.05). Fetal-to-placental weight ratio decreased following superovulation during the pre- or peri-implantation period (p = 0.05, 0.01, respectively) and these effects were additive. Peg3 DNA methylation levels were decreased in placentas derived from exposure to superovulation both pre- and peri-implantation compared with unexposed embryos and exposure of the preimplantation embryo only. Through RNA sequencing on placental tissue, changes were identified in genes involved in immune system regulation, specifically interferon signaling, which has been previously implicated in implantation and maintenance of early pregnancy in mice. Overall, we found that the timing of exposure to gonadotropin stimulation can have differential effects on fetal and placental growth. These findings could impact clinical practice and underscores the importance of dissecting the role of procedures utilized during IVF on pregnancy complications.
Collapse
Affiliation(s)
| | - Sneha Mani
- Division of Reproductive Endocrinology and Infertility, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Eric A Rhon-Calderon
- Department of Cell and Developmental Biology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Teri Ord
- Division of Reproductive Endocrinology and Infertility, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Christos Coutifaris
- Division of Reproductive Endocrinology and Infertility, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Marisa S Bartolomei
- Department of Cell and Developmental Biology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Monica Mainigi
- Division of Reproductive Endocrinology and Infertility, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| |
Collapse
|
28
|
Vrooman LA, Rhon-Calderon EA, Chao OY, Nguyen DK, Narapareddy L, Dahiya AK, Putt ME, Schultz RM, Bartolomei MS. Assisted reproductive technologies induce temporally specific placental defects and the preeclampsia risk marker sFLT1 in mouse. Development 2020; 147:147/11/dev186551. [PMID: 32471820 DOI: 10.1242/dev.186551] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 04/18/2020] [Indexed: 12/11/2022]
Abstract
Although widely used, assisted reproductive technologies (ARTs) are associated with adverse perinatal outcomes. To elucidate their underlying causes, we have conducted a longitudinal analysis of placental development and fetal growth using a mouse model to investigate the effects of individual ART procedures: hormone stimulation, in vitro fertilization (IVF), embryo culture and embryo transfer. We demonstrate that transfer of blastocysts naturally conceived without hormone stimulation and developed in vivo prior to transfer can impair early placentation and fetal growth, but this effect normalizes by term. In contrast, embryos cultured in vitro before transfer do not exhibit this compensation but rather display placental overgrowth, reduced fetal weight, reduced placental DNA methylation and increased levels of sFLT1, an anti-angiogenic protein implicated in causing the maternal symptoms of preeclampsia in humans. Increases in sFLT1 observed in this study suggest that IVF procedures could increase the risk for preeclampsia. Moreover, our results indicate that embryo culture is the major factor contributing to most placental abnormalities and should therefore be targeted for optimization.
Collapse
Affiliation(s)
- Lisa A Vrooman
- Epigenetics Institute, Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Eric A Rhon-Calderon
- Epigenetics Institute, Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Olivia Y Chao
- Epigenetics Institute, Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Duy K Nguyen
- Epigenetics Institute, Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Laren Narapareddy
- Epigenetics Institute, Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.,Department of Family and Community Health, Claire M. Fagin School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Asha K Dahiya
- Epigenetics Institute, Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Mary E Putt
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Richard M Schultz
- Department of Biology, School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Marisa S Bartolomei
- Epigenetics Institute, Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| |
Collapse
|
29
|
Begum S, Perlman BE, Valero-Pacheco N, O'Besso V, Wu T, Morelli SS, Beaulieu AM, Douglas NC. Dynamic Expression of Interleukin-33 and ST2 in the Mouse Reproductive Tract Is Influenced by Superovulation. J Histochem Cytochem 2020; 68:253-267. [PMID: 32108542 DOI: 10.1369/0022155420911049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Interleukin-33 (IL-33) is an IL-1 family cytokine with pleiotropic effects on diverse cell types. Dysregulated IL-33 signaling has been implicated in pregnancy-related disorders, including preeclampsia and recurrent pregnancy loss, and in ovarian function in women undergoing controlled ovarian stimulation for in vitro fertilization. To date, expression of IL-33 and its receptor subunit, ST2, in the female reproductive tract remains poorly characterized. We identify IL-33-expressing oocytes surrounded by ST2-expressing granulosa cells at all stages of follicular development, in addition to IL-33+ and ST2+ non-endothelial cells in the ovarian stroma and theca layer in ovaries from adult mice. These expression patterns are similar in estrus- and diestrus-stage adults and in pubescent mice, suggesting a role for IL-33 signaling in ovarian function throughout development and in the estrous cycle. In the uterus, we find expression of IL-33 and ST2 in glandular and luminal epithelia during estrus and at the initiation of pregnancy. Uterine IL-33 expression was modulated by the estrous cycle and was reduced in pubescent females. Last, superovulation increases transcripts for IL-33 and the soluble form of ST2 (sST2) in ovaries, and for IL-33 in uteri. Collectively, our findings lay the foundation for studies identifying cell type-specific requirements for IL-33/ST2 signaling in the establishment and maintenance of mouse pregnancy.
Collapse
Affiliation(s)
- Salma Begum
- Department of Obstetrics, Gynecology and Women's Health, Rutgers Biomedical and Health Sciences, Newark, NJ
| | - Barry E Perlman
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Women's Health, Rutgers Biomedical and Health Sciences, Newark, NJ
| | - Nuriban Valero-Pacheco
- Department of Microbiology, Biochemistry, and Molecular Genetics, Rutgers Biomedical and Health Sciences, Newark, NJ
| | - Valerie O'Besso
- Department of Obstetrics, Gynecology and Women's Health, Rutgers Biomedical and Health Sciences, Newark, NJ
| | - Tracy Wu
- Department of Obstetrics, Gynecology and Women's Health, Rutgers Biomedical and Health Sciences, Newark, NJ
| | - Sara S Morelli
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Women's Health, Rutgers Biomedical and Health Sciences, Newark, NJ
| | - Aimee M Beaulieu
- Department of Microbiology, Biochemistry, and Molecular Genetics, Rutgers Biomedical and Health Sciences, Newark, NJ.,Center for Immunity and Inflammation, Rutgers Biomedical and Health Sciences, Newark, NJ
| | - Nataki C Douglas
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Women's Health, Rutgers Biomedical and Health Sciences, Newark, NJ.,Center for Immunity and Inflammation, Rutgers Biomedical and Health Sciences, Newark, NJ
| |
Collapse
|
30
|
Bourdon M, Ouazana M, Maignien C, Pocate-Cheriet K, Patrat C, Marcellin L, Chapron C, Santulli P. Impact of Supraphysiological Estradiol Serum Levels on Birth Weight in Singletons Born After Fresh Embryo Transfer. Reprod Sci 2020; 27:1770-1777. [DOI: 10.1007/s43032-020-00174-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 01/21/2020] [Indexed: 01/09/2023]
|
31
|
Zhang WY, Selamet Tierney ES, Chen AC, Ling AY, Fleischmann RR, Baker VL. Vascular Health of Children Conceived via In Vitro Fertilization. J Pediatr 2019; 214:47-53. [PMID: 31443895 PMCID: PMC6815705 DOI: 10.1016/j.jpeds.2019.07.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 06/17/2019] [Accepted: 07/11/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate whether in vitro fertilization (IVF) has an effect on the cardiovascular health of offspring. STUDY DESIGN This was a cross-sectional pilot study. We performed vascular health assessment for 17 children aged 10-14 years who were conceived via IVF with autologous oocytes at Stanford University. Carotid artery ultrasound evaluated intima-media thickness and stiffness, carotid-femoral pulse wave velocity determined segmental arterial stiffness, and endothelial pulse amplitude testing assessed endothelial function. We compared IVF offspring with control adolescents assessed in the same laboratory, with all comparisons adjusted for age, sex, and race/ethnicity. RESULTS All participants had normal body mass index and blood pressure. Compared with controls, IVF children had thicker common carotid artery intima-media thickness (0.44 ± 0.03 mm vs 0.38 ± 0.03 mm; P < .01), higher elastic modulus (395.29 ± 185.33 mm Hg vs 242.79 ± 37.69 mm Hg; P = .01), higher βstiffness (2.65 ± 0.38 vs 2.28 ± 0.23; P < .01), and higher peak velocity (142.29 ± 31.62 cm/s vs 117.71 ± 32.69 cm/s; P = .04). The mean endothelial pulse amplitude testing reactive hyperemia index was not significantly different between IVF and controls. The mean pulse wave velocity was 4.69 ± 0.51 m/s compared with the controls 4.60 ± 0.57 m/s (P = .11), with 8 (47%) having abnormal values. CONCLUSION In an assessment of endothelial function and arterial properties of children conceived via IVF, we found that children conceived via IVF seem to have evidence of abnormal vascular health. Further studies with larger sample size and long-term follow-up are warranted.
Collapse
Affiliation(s)
- Wendy Y Zhang
- Stanford University School of Medicine, Stanford, CA.
| | - Elif Seda Selamet Tierney
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Angela C Chen
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Albee Y Ling
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA
| | | | - Valerie L Baker
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA; Johns Hopkins University School of Medicine, Department of Gynecology and Obstetrics, Division of Reproductive Endocrinology and Infertility, Baltimore, MD
| |
Collapse
|
32
|
Jin HX, Lv AX, Wu ZT, Wen S, Zhang XY, Jin DC, Sun YP. Comparative study on the pregnancy outcomes of in vitro fertilization-embryo transfer between patients with different ovarian responses (a STROBE-compliant article). Medicine (Baltimore) 2019; 98:e16191. [PMID: 31277126 PMCID: PMC6635258 DOI: 10.1097/md.0000000000016191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
There have been few studies on large-sample data of cleavage-stage embryo and blastocyst transfers. We compared the pregnancy outcomes of patients with different ovarian responses after the transfer of different numbers of embryos in different developmental stages.Patients were divided into 3 groups including low response group, medium response group, and high response group according to different ovarian responses. Patients in each group were further divided into 4 subgroups including group A: transfer of 1 D3 embryo, group B: transfer of 2 D3 embryos; group C: transfer of 1 D5 blastocyst; and group D: transfer of 2 D5 blastocysts.In low ovarian responders, the implantation rate, clinical pregnancy rate and live birth rate were significantly lower in the group A than in the groups B and C. In medium ovarian responders, the implantation rate was significantly higher, but the multiple pregnancy rate was significantly lower in the group C than in the group B. The multiple pregnancy rate was significantly higher in the group D than in the group C. In high ovarian responders, the implantation rate was significantly lower, but the multiple pregnancy rate was significantly higher in the group B than in group C.Based on the above results, the single blastocyst transfer is preferable for the patients with different ovarian responses.
Collapse
Affiliation(s)
- Hai-Xia Jin
- Center for Reproductive Medicine of The First Affiliated Hospital of Zhengzhou University
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ai-Xiang Lv
- Center for Reproductive Medicine of The First Affiliated Hospital of Zhengzhou University
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhao-Ting Wu
- Center for Reproductive Medicine of The First Affiliated Hospital of Zhengzhou University
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuang Wen
- Center for Reproductive Medicine of The First Affiliated Hospital of Zhengzhou University
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiang-Yang Zhang
- Center for Reproductive Medicine of The First Affiliated Hospital of Zhengzhou University
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Da-Chuan Jin
- Center for Reproductive Medicine of The First Affiliated Hospital of Zhengzhou University
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying-Pu Sun
- Center for Reproductive Medicine of The First Affiliated Hospital of Zhengzhou University
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
33
|
Côté A, Maheux-Lacroix S, Sabr Y, Gasse C, Bujold E, Boutin A. Association between fertility treatments and early placentation markers. Placenta 2019; 82:35-41. [PMID: 31174624 DOI: 10.1016/j.placenta.2019.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/16/2019] [Accepted: 05/17/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Pregnancies resulting from fertility treatments are at higher risk of placenta-mediated complications. Hence, we aimed to estimate the association between fertility treatment and levels of first-trimester markers of placentation. METHODS We conducted a cohort study in an academic center from 03/2011 to 12/2014. Adult nulliparous women with singleton pregnancies were recruited between 11 + 0 and 13 + 6 weeks of gestation. Data on maternal characteristics, medical history, and pregnancies conceived through fertility treatments (whether ovulation agents, insemination or assisted reproductive technologies) were collected. Maternal serum concentrations of PlGF, sFlt-1, PAPP-A, AFP, and free β-hCG were obtained, and notches and UtA-PI were measured using Doppler ultrasound. Mean Multiple of the Medians (MoM) and frequencies were computed to estimate the mean differences (MD) or risk ratios (RR) comparing fertility treatment to spontaneous pregnancies. RESULTS 427 (9%) pregnancies out of 4815 were conceived through fertility treatments, using ovulation agents (n = 233, 5%), insemination (n = 174, 4%) and/or assisted reproductive technologies (n = 85, 2%). The latter were associated with significantly lower log10PAPP-A MoM (adjusted MD: -0.02, 95%CI: -0.04 to -0.01), lower log10PlGF MoM (adjusted MD: -0.04, 95%CI: -0.06 to -0.01) and higher log10free β-hCG MoM (adjusted MD: 0.05, 95%CI: 0.01 to 0.09) compared to spontaneous pregnancies. Ovulation agents and insemination were associated with the presence of notches (adjusted RR: 1.24, 95%CI: 1.14 to 1.35; and 1.27, 95%CI: 1.15 to 1.42, respectively) and higher log10UtA-PI MoM (adjusted MD: 0.16, 95%CI: 0.08 to 0.24; and 0.17, 95%CI: 0.07 to 0.27, respectively) than spontaneous pregnancies. CONCLUSION Fertility treatments are associated with significant variations in markers of placentation.
Collapse
Affiliation(s)
- Alexandra Côté
- CHU de Québec - Université Laval Research Center, Quebec City, QC, G1V 4G2, Canada
| | - Sarah Maheux-Lacroix
- CHU de Québec - Université Laval Research Center, Quebec City, QC, G1V 4G2, Canada; Department of Gynecology, Obstetrics and Reproduction, Université Laval, Quebec City, QC, G1V 0A6, Canada
| | - Yasser Sabr
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC, V6H 2N9, Canada; Department of Obstetrics & Gynaecology, College of Medicine, King Saud University, Riyadh, 11633, Saudi Arabia
| | - Cédric Gasse
- CHU de Québec - Université Laval Research Center, Quebec City, QC, G1V 4G2, Canada; Department of Social and Preventive Medicine, Université Laval, Quebec City, QC, G1V 0A6, Canada
| | - Emmanuel Bujold
- CHU de Québec - Université Laval Research Center, Quebec City, QC, G1V 4G2, Canada; Department of Gynecology, Obstetrics and Reproduction, Université Laval, Quebec City, QC, G1V 0A6, Canada
| | - Amélie Boutin
- CHU de Québec - Université Laval Research Center, Quebec City, QC, G1V 4G2, Canada; Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC, V6H 2N9, Canada.
| |
Collapse
|
34
|
Kamai EM, McElrath TF, Ferguson KK. Fetal growth in environmental epidemiology: mechanisms, limitations, and a review of associations with biomarkers of non-persistent chemical exposures during pregnancy. Environ Health 2019; 18:43. [PMID: 31068204 PMCID: PMC6505101 DOI: 10.1186/s12940-019-0480-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 04/16/2019] [Indexed: 05/18/2023]
Abstract
BACKGROUND Non-persistent chemicals, such as phthalates, environmental phenols, organophosphate pesticides, and others, are challenging to study because of their ubiquity in the environment, diverse exposure routes, and high temporal variability of biomarkers. Nonetheless, there is interest in understanding how gestational exposure to these chemicals may affect fetal growth, as perturbations to normal fetal growth are related to a plethora of adverse health outcomes in childhood and adulthood. METHODS The purpose of this review is to describe the state of the science on this topic. We searched PubMed for studies that included both 1) biomarkers of non-persistent chemicals collected during pregnancy and 2) fetal growth outcomes measured at birth (e.g., birth weight) or by ultrasound in utero (e.g., estimated fetal weight). RESULTS The bulk of the literature we found uses biomarkers measured at a single time point in pregnancy and birth weight as the primary measure of fetal growth. There is a small, but growing, body of research that uses ultrasound measures to assess fetal growth during pregnancy. In addition to summarizing the findings of the publications we identified, we describe inconsistencies in methodology, areas for improvement, and gaps in existing knowledge that can be targeted for improvement in future work. This literature is characterized by variability in methodology, likely contributing to the inconsistency of results reported. We further discuss maternal, placental, and fetal pathways by which these classes of chemicals may affect fetal growth. CONCLUSIONS To improve understanding of how everyday chemical exposures affect fetal growth, and ultimately lifelong health outcomes, mechanisms of toxicant action should be considered alongside improved study designs for future hypothesis-driven research.
Collapse
Affiliation(s)
- Elizabeth M. Kamai
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599 USA
| | - Thomas F. McElrath
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Kelly K. Ferguson
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, 111 TW Alexander Drive, Research Triangle Park, NC 27709 USA
| |
Collapse
|
35
|
Patil AS, Nguyen C, Groff K, Wu J, Elliott J, Gunatilake RP. Severity of congenital heart defects associated with assisted reproductive technologies: Case series and review of the literature. Birth Defects Res 2019; 110:654-661. [PMID: 29714054 DOI: 10.1002/bdr2.1228] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 03/05/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Assisted reproductive technology (ART) has been associated with a higher incidence of congenital anomalies, including a specific increase in the rate of congenital heart defects (CHD). In this study, the rate of CHD in pregnancies resulting from ART at a single high-risk pregnancy referral center are compared to the published literature. METHODS Pregnancies were screened by fetal echocardiography for the indication of ART over a 2-year period. CHD were classified as either mild or severe based on the need for postnatal surgical intervention. Results were compared to findings from a literature review of studies examining CHD in pregnancies resulting from ART since 1980. RESULTS Over the course of two years, 363 fetuses in 264 pregnancies from our cohort were screened for CHD. The incidence of mild CHD in fetuses from ART pregnancies was 2.75% (10 out of 363 fetuses). None of the affected fetuses had severe CHD. Review of the literature yielded 20 studies since 1980 that examined CHD in pregnancies resulting from ART. Composite data from the studies was described based on characterization of severity of the CHD anomalies. The incidence of mild CHD in ART pregnancies was 2.2%, compared to 1% in non-ART pregnancies (out of 332,157 infants). The incidence of severe CHD in ART pregnancies and naturally conceived pregnancies was 1.4% and 1.2%, respectively (out of 661,455 infants). The incidence of unspecified CHD in ART pregnancies was 1.8%, compared to 1% in naturally conceived pregnancies (out of 1,593,277 infants). CONCLUSION The greatest increase in risk appears to be for mild CHD (nonsurgical), which may inform counseling of patients prior to use of assisted reproductive technologies.
Collapse
Affiliation(s)
- Avinash S Patil
- Center for Personalized Obstetric Medicine, Valley Perinatal Services, Phoenix, Arizona
| | - Cynthia Nguyen
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, Arizona
| | - Katie Groff
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, Arizona
| | - Jonathan Wu
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, Arizona
| | - John Elliott
- Center for Personalized Obstetric Medicine, Valley Perinatal Services, Phoenix, Arizona
| | - Ravindu P Gunatilake
- Center for Personalized Obstetric Medicine, Valley Perinatal Services, Phoenix, Arizona
| |
Collapse
|
36
|
The role of progesterone elevation in IVF. Reprod Biol 2019; 19:1-5. [DOI: 10.1016/j.repbio.2019.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/04/2019] [Accepted: 02/07/2019] [Indexed: 11/24/2022]
|
37
|
Abstract
Natural Cycle IVF (NC-IVF) with and without modifications is being increasingly performed. NC-IVF and conventional gonadotropin-stimulated IVF (cIVF) should not be understood as competing treatments, but as complementary treatments with different target groups and to some extent other indications. NC-IVF is particularly interesting for couples who wish to save money, wish a treatment with as few risks as possible and for women who would like to avoid selection and cryopreservation of embryos. NC-IVF therefore contributes to the concept of individualized and patient-oriented therapy. The time to pregnancy is slightly longer than with conventional IVF. NC-IVF is particularly suitable for younger women and for women with a very low ovarian reserve. In this article, the principles of NC-IVF, i.e. monofollicular IVF without gonadotropin stimulation, are described and the technical differences to cIVF, advantages and disadvantages, perinatal outcome and indications for NC-IVF are highlightened.
Collapse
Affiliation(s)
- Michael von Wolff
- University Women's Hospital, Division of Gynaecological Endocrinology and Reproductive Medicine, Inselspital, University Hospital, Berne, Switzerland.
| |
Collapse
|
38
|
Senapati S, Wang F, Ord T, Coutifaris C, Feng R, Mainigi M. Superovulation alters the expression of endometrial genes critical to tissue remodeling and placentation. J Assist Reprod Genet 2018; 35:1799-1808. [PMID: 29959621 PMCID: PMC6150905 DOI: 10.1007/s10815-018-1244-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 06/14/2018] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Epidemiologic data suggest that in vitro fertilization (IVF) is associated with an increased risk of disorders of placentation including preeclampsia and fetal growth restriction. Specifically, studies have demonstrated that singleton pregnancies conceived following a fresh embryo transfer are at an increased risk of delivering an infant with low birth weight compared to those conceived following a frozen embryo transfer. The mechanism responsible for this association remains unclear. Procedures utilized in IVF have also been linked with epigenetic changes and gene expression changes in both fetal and maternal tissues. Data suggest that modifications in the maternal endometrium can lead to disordered trophoblast invasion and placentation. This study examines the effect of ovarian stimulation on endometrial gene expression and DNA methylation during the window of implantation to examine potential pathways playing a role in the adverse outcomes associated with IVF. METHODS Endometrial biopsies were obtained from oocyte donors and age-matched naturally cycling women 11 days following oocyte retrieval in donors or 12 days following luteinizing hormone (LH) surge in naturally cycling women. Global gene expression was analyzed via Affymetrix Human Gene 1.1 ST array and confirmed with RT-qPCR. DNA methylation was assessed with the Infinium DNA methylation 450 K BeadChip. RESULTS Analysis of endometrial gene expression from 23 women (11 oocyte donors and 12 controls) demonstrated 165 genes with a greater than twofold change in expression between donors and controls. While there were 785 genes with significant differential methylation in the endometrium of donors when compared with control subjects, none of the genes with altered expression showed significant changes in DNA methylation. Analysis of the differentially expressed genes showed enrichment for genes involved in endometrial remodeling including PLAT, HSPE2, MMP2, and TIMP1. Validation studies using RT-qPCR found a 73% reduction in expression of heparanase 2 (HSPE2) an enzyme associated with both angiogenesis and cell invasion, a greater than twofold increase in tissue-type plasminogen activator (PLAT), a serine protease participating in matrix degradation, and a 70% increase in MMP2, a gelatinase involved in collagen and fibronectin breakdown. CONCLUSIONS Superovulation alters expression of genes critical to endometrial remodeling during early implantation. Such changes could lead to altered trophoblast migration and impaired endovascular invasion. These findings offer a potential mechanism for the adverse perinatal outcomes observed following embryo transfer during fresh IVF cycles.
Collapse
Affiliation(s)
- Suneeta Senapati
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology & Infertility, University of Pennsylvania Perelman School of Medicine, 3701 Market Street Suite 800, Philadelphia, PA, 19104, USA
| | - Fan Wang
- Department of Molecular Cardiology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Teri Ord
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology & Infertility, University of Pennsylvania Perelman School of Medicine, 3701 Market Street Suite 800, Philadelphia, PA, 19104, USA
| | - Christos Coutifaris
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology & Infertility, University of Pennsylvania Perelman School of Medicine, 3701 Market Street Suite 800, Philadelphia, PA, 19104, USA
| | - Rui Feng
- Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Monica Mainigi
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology & Infertility, University of Pennsylvania Perelman School of Medicine, 3701 Market Street Suite 800, Philadelphia, PA, 19104, USA.
| |
Collapse
|
39
|
Weinerman R, Ord T, Bartolomei MS, Coutifaris C, Mainigi M. The superovulated environment, independent of embryo vitrification, results in low birthweight in a mouse model. Biol Reprod 2018; 97:133-142. [PMID: 28859279 DOI: 10.1093/biolre/iox067] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/27/2017] [Indexed: 12/23/2022] Open
Abstract
Epidemiological studies suggest that babies born following in vitro fertilization (IVF) and fresh embryo transfer are of lower birthweight than babies born following frozen embryo transfer, although the mechanism responsible for this phenotype is not known. We developed a novel mouse model that isolates the independent effects of embryo freezing and the superovulated environment, which cannot be performed in humans. We transferred blastocysts that had been vitrified and warmed, mixed with with fresh blastocysts, into individual pseudopregnant recipients produced by either natural mating or mating following injection with equine chorionic gonadotropin and human chorionic gonadotropin and hCG (superovulation). We found that superovulation of the recipient dams led to significantly lower fetal weight at term while blastocyst vitrification had no significant effect on fetal weight (1.43 ± 0.24 g fresh-natural, 1.30 ± 0.28 g vitrified-natural vs. 1.09 ± 0.20 fresh-superovulated, 0.93 ± 0.23 g vitrified-superovulated, P < 0.0001). Doppler ultrasound revealed increased median umbilical artery resistance in the placentae of near-term dams exposed to superovulation compared to naturally mated dams (0.927 vs 0.904, P = 0.02). Additionally, placental microvascular density was lower in superovulated compared to naturally mated dams (1.24 × 10-3 vessel/micron vs 1.46 × 10-3 vessels/micron, P = 0.046). Gene expression profiling suggested alterations in fetal genes involved in glucorticoid regulation. These results suggest a potential mechanism for altered birthweight following superovulation in our model and may have implications for human IVF.
Collapse
Affiliation(s)
- Rachel Weinerman
- Division of Reproductive Endocrinology and Infertility, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Reproductive Endocrinology and Infertility, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Teri Ord
- Division of Reproductive Endocrinology and Infertility, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Marisa S Bartolomei
- Epigenetics Program, Department of Cell and Developmental Biology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christos Coutifaris
- Division of Reproductive Endocrinology and Infertility, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Monica Mainigi
- Division of Reproductive Endocrinology and Infertility, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
40
|
Wang X, Wu H, He X, Jiang H, Wu L, Xu Y, Zhou P, Wei Z, Cao Y. Retrospective Study to Compare Frozen-Thawed Embryo Transfer with Fresh Embryo Transfer on Pregnancy Outcome Following Intracytoplasmic Sperm Injection for Male Infertility. Med Sci Monit 2018; 24:2668-2674. [PMID: 29708103 PMCID: PMC5946740 DOI: 10.12659/msm.907229] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND With the development of assisted reproductive technology, there is increasing evidence that frozen-thawed (FT) embryo transfer achieves a better outcome when compared with fresh embryo transfer in different types of infertile individuals. This aim of this study was to investigate the effect of FT embryo transfer for intracytoplasmic sperm injection (ICSI) on pregnancy outcome in assisted reproductive technology for male infertility. MATERIAL AND METHODS A total of 516 embryo transfer cycles (286 fresh embryo transfer cycles and 230 FT embryo transfer cycles) were studied, in which ICSI treatment was performed for the first time because of male infertility. The women in the study were normal or had Fallopian tube abnormalities. The clinical data and pregnancy outcomes of these two study groups were compared. RESULTS The implantation rate, pregnancy rate, and multiple birth rate of the FT embryo transfer group were similar when compared with the fresh embryo transfer group. The live birth rate of the FT embryo transfer group was significantly greater when compared with the fresh embryo transfer group (P<0.05). The rate of miscarriage of the FT embryo transfer group was 6.52%, which was significantly less than that of the fresh embryo transfer group (14.01%) (P<0.05). The gestational age and neonatal birth weight were not significantly different between the two groups (P>0.05). CONCLUSIONS FT embryo transfer was an effective and safe treatment for patients undergoing ICSI, which improved the live birth rate and reduced the rate of miscarriage.
Collapse
Affiliation(s)
- Xue Wang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland).,Institute of Reproductive Genetics, Anhui Medical University, Hefei, Anhui, China (mainland).,Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, Anhui, China (mainland)
| | - Huan Wu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland).,Institute of Reproductive Genetics, Anhui Medical University, Hefei, Anhui, China (mainland).,Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, Anhui, China (mainland)
| | - Xiaojin He
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland).,Institute of Reproductive Genetics, Anhui Medical University, Hefei, Anhui, China (mainland).,Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, Anhui, China (mainland)
| | - Huanhuan Jiang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland).,Institute of Reproductive Genetics, Anhui Medical University, Hefei, Anhui, China (mainland).,Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, Anhui, China (mainland)
| | - Longmei Wu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland).,Institute of Reproductive Genetics, Anhui Medical University, Hefei, Anhui, China (mainland).,Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, Anhui, China (mainland)
| | - Yuping Xu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland).,Institute of Reproductive Genetics, Anhui Medical University, Hefei, Anhui, China (mainland).,Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, Anhui, China (mainland)
| | - Ping Zhou
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland).,Institute of Reproductive Genetics, Anhui Medical University, Hefei, Anhui, China (mainland).,Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, Anhui, China (mainland)
| | - Zhaolian Wei
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland).,Institute of Reproductive Genetics, Anhui Medical University, Hefei, Anhui, China (mainland).,Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, Anhui, China (mainland)
| | - Yunxia Cao
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland).,Institute of Reproductive Genetics, Anhui Medical University, Hefei, Anhui, China (mainland).,Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, Anhui, China (mainland)
| |
Collapse
|
41
|
Duranthon V, Chavatte-Palmer P. Long term effects of ART: What do animals tell us? Mol Reprod Dev 2018; 85:348-368. [DOI: 10.1002/mrd.22970] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 02/09/2018] [Indexed: 01/01/2023]
|
42
|
Marshall KL, Rivera RM. The effects of superovulation and reproductive aging on the epigenome of the oocyte and embryo. Mol Reprod Dev 2018; 85:90-105. [PMID: 29280527 DOI: 10.1002/mrd.22951] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 12/14/2017] [Accepted: 12/19/2017] [Indexed: 12/26/2022]
Abstract
A societal preference of delaying maternal age at first childbirth has increased reliance on assisted reproductive technologies/therapies (ART) to conceive a child. Oocytes that have undergone physiologic aging (≥35 years for humans) are now commonly used for ART, yet evidence is building that suboptimal reproductive environments associated with aging negatively affect oocyte competence and embryo development-although the mechanisms underlying these relationship are not yet well understood. Epigenetic programming of the oocyte occurs during its growth within a follicle, so the ovarian stimulation protocols that administer exogenous hormones, as part of the first step for all ART procedures, may prevent the gamete from establishing an appropriate epigenetic state. Therefore, understanding how oocyte. Therefore, understanding how hormone stimulation and oocyte physiologic age independently and synergistically physiologic age independently and synergistically affect the epigenetic programming of these gametes, and how this may affect their developmental competence, are crucial to improved ART outcomes. Here, we review studies that measured the developmental outcomes affected by superovulation and aging, focusing on how the epigenome (i.e., global and imprinted DNA methylation, histone modifications, and epigenetic modifiers) of gametes and embryos acquired from females undergoing physiologic aging and exogenous ovarian stimulation is affected.
Collapse
Affiliation(s)
- Kira L Marshall
- Division of Animal Sciences, University of Missouri, Columbia, Missouri
| | | |
Collapse
|
43
|
Kamath MS, Kirubakaran R, Mascarenhas M, Sunkara SK. Perinatal outcomes after stimulated versus natural cycle IVF: a systematic review and meta-analysis. Reprod Biomed Online 2018; 36:94-101. [DOI: 10.1016/j.rbmo.2017.09.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/21/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
|
44
|
Abstract
Most IVF-conceived children are healthy, but IVF has also been associated with adverse obstetric and perinatal outcomes as well as congenital anomalies. There is also literature suggesting an association between IVF and neurodevelopmental disorders as well as potentially long-term metabolic outcomes. The main driver for adverse outcomes is the higher risk of multiple gestations in IVF, but as the field moves toward single embryo transfer, the rate of multiple gestations is decreasing. Studies have shown that singleton IVF pregnancies still have a higher incidence of adverse outcomes compared to unassisted singleton pregnancies. Infertility itself may be an independent risk factor. Animal models suggest that epigenetic changes in genes involved in growth and development are altered in IVF during the hormonal stimulation and embryo culture. Further animal research and prospective human data are needed to elucidate the mechanisms by which IVF may contribute to adverse outcomes and to decrease risks.
Collapse
Affiliation(s)
- Chantae S Sullivan-Pyke
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, 3701 Market St, Suite 810, Philadelphia, PA 19104
| | - Suneeta Senapati
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, 3701 Market St, Suite 810, Philadelphia, PA 19104.
| | - Monica A Mainigi
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, 3701 Market St, Suite 810, Philadelphia, PA 19104
| | - Kurt T Barnhart
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, 3701 Market St, Suite 810, Philadelphia, PA 19104
| |
Collapse
|
45
|
Frozen embryo transfer can be performed in the cycle immediately following the freeze-all cycle. J Assist Reprod Genet 2017; 35:135-142. [PMID: 28939988 DOI: 10.1007/s10815-017-1048-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE In this study, we investigated whether the time interval between oocyte retrieval and frozen embryo transfer (FET) affected the live birth (LB) rates of human segmented-IVF cycles. METHOD A total of 1338 ICSI freeze-all cycles were performed between February 2015 and January 2016, with 1121 FET cycles being retrospectively analyzed. All vitrified-warmed blastocyst transfers were performed in artificial FET cycles, using gonadotropin-releasing hormone (GnRH) agonist downregulation and oral estrogen endometrial preparation. The primary outcome measure was LB. Cycles were investigated in oocyte retrieval-to-FET interval groups of 32-46, 47-61, 62-76, 77-91, and ≥ 92 days, with the 47-61-day group used as the reference group. RESULTS There were no significant differences in LB rates between the groups in the overall analysis, as well as, in sub-analyses investigating LB in terms of single blastocyst transfer (SBT), trigger type (GnRH agonist, triggers including hCG), oocyte number (≤ 5 and ≥ 15), and maternal age (> 35 years). CONCLUSION The present study showed that it is feasible to perform transfers 36 days after oocyte retrieval and that delaying FET in freeze-all beyond the cycle immediately following oocyte retrieval does not increase LB rates.
Collapse
|
46
|
|
47
|
Siqueira LG, Dikmen S, Ortega MS, Hansen PJ. Postnatal phenotype of dairy cows is altered by in vitro embryo production using reverse X-sorted semen. J Dairy Sci 2017; 100:5899-5908. [DOI: 10.3168/jds.2016-12539] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 03/06/2017] [Indexed: 12/31/2022]
|
48
|
Kalisch-Smith JI, Simmons DG, Pantaleon M, Moritz KM. Sex differences in rat placental development: from pre-implantation to late gestation. Biol Sex Differ 2017; 8:17. [PMID: 28523122 PMCID: PMC5434533 DOI: 10.1186/s13293-017-0138-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 05/08/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND A male fetus is suggested to be more susceptible to in utero and birth complications. This may be due in part to altered morphology or function of the XY placenta. We hypothesised that sexual dimorphism begins at the blastocyst stage with sex differences in the progenitor trophectoderm (TE) and its derived trophoblast lineages, as these cells populate the majority of cell types within the placenta. We investigated sex-specific differences in cell allocation in the pre-implantation embryo and further characterised growth and gene expression of the placental compartments from the early stages of the definitive placenta through to late gestation. METHODS Naturally mated Sprague Dawley dams were used to collect blastocysts at embryonic day (E) 5 to characterise cell allocation; total, TE, and inner cell mass (ICM), and differentiation to downstream trophoblast cell types. Placental tissues were collected at E13, E15, and E20 to characterise volumes of placental compartments, and sex-specific gene expression profiles. RESULTS Pre-implantation embryos showed no sex differences in cell allocation (total, TE and ICM) or early trophoblast differentiation, assessed by outgrowth area, number and ploidy of trophoblasts and P-TGCs, and expression of markers of trophoblast stem cell state or differentiation. Whilst no changes in placental structures were found in the immature E13 placenta, the definitive E15 placenta from female fetuses had reduced labyrinthine volume, fetal and maternal blood space volume, as well as fetal blood space surface area, when compared to placentas from males. No differences between the sexes in labyrinth trophoblast volume or interhaemal membrane thickness were found. By E20 these sex-specific placental differences were no longer present, but female fetuses weighed less than their male counterparts. Coupled with expression profiles from E13 and E15 placental samples may suggest a developmental delay in placental differentiation. CONCLUSIONS Although there were no overt differences in blastocyst cell number or early placental development, reduced growth of the female labyrinth in mid gestation is likely to contribute to lower fetal weight in females at E20. These data suggest sex differences in fetal growth trajectories are due at least in part, to differences in placenta growth.
Collapse
Affiliation(s)
- J I Kalisch-Smith
- School of Biomedical Sciences, The University of Queensland, St Lucia, QLD 4072 Australia
| | - D G Simmons
- School of Biomedical Sciences, The University of Queensland, St Lucia, QLD 4072 Australia
| | - M Pantaleon
- School of Biomedical Sciences, The University of Queensland, St Lucia, QLD 4072 Australia
| | - K M Moritz
- School of Biomedical Sciences, The University of Queensland, St Lucia, QLD 4072 Australia.,Centre for Child Health Research, The University of Queensland, South Brisbane, QLD 4101 Australia
| |
Collapse
|
49
|
Roque M, Valle M, Kostolias A, Sampaio M, Geber S. Freeze-all cycle in reproductive medicine: current perspectives. JBRA Assist Reprod 2017; 21:49-53. [PMID: 28333033 PMCID: PMC5365201 DOI: 10.5935/1518-0557.20170012] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The freeze-all strategy has emerged as an alternative to fresh embryo transfer
(ET) during in vitro fertilization (IVF) cycles. Although fresh
ET is the norm during assisted reproductive therapies (ART), there are many
concerns about the possible adverse effects of controlled ovarian stimulation
(COS) over the endometrium. The supra-physiologic hormonal levels that occur
during a conventional COS are associated with modifications in the
peri-implantation endometrium, which may be related to a decrease in pregnancy
rates and poorer obstetric and perinatal outcomes when comparing fresh to
frozen-thawed embryo transfers. The main objective of this study was to assess
the available literature regarding the freeze-all strategy in IVF cycles, in
regards to effectiveness and safety. Although there are many potential
advantages in performing a freeze-all cycle over a fresh ET, it seems that the
freeze-all strategy is not designed for all IVF patients. There is a need to
develop a non-invasive clinical tool to evaluate the endometrial receptivity
during a fresh cycle, which enables the selection of patients that would benefit
from this strategy. Today, it is reasonable to perform elective cryopreservation
of all oocytes/embryos in cases with a risk of OHSS development, and in patients
with supra-physiologic hormonal levels during the follicular phase of COS. It is
not clear if all normal responders and poor responders may benefit from this
strategy.
Collapse
Affiliation(s)
- Matheus Roque
- ORIGEN - Center for Reproductive Medicine, Rio de Janeiro, Brazil.,UFMG, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Marcello Valle
- ORIGEN - Center for Reproductive Medicine, Rio de Janeiro, Brazil
| | | | - Marcos Sampaio
- ORIGEN - Center for Reproductive Medicine, Belo Horizonte, Brazil
| | - Selmo Geber
- UFMG, Federal University of Minas Gerais, Belo Horizonte, Brazil.,ORIGEN - Center for Reproductive Medicine, Belo Horizonte, Brazil
| |
Collapse
|
50
|
Berkkanoglu M, Coetzee K, Bulut H, Ozgur K. Optimal embryo transfer strategy in poor response may include freeze-all. J Assist Reprod Genet 2016; 34:79-87. [PMID: 27832397 DOI: 10.1007/s10815-016-0825-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 09/30/2016] [Indexed: 12/17/2022] Open
Abstract
PURPOSE In this retrospective cohort study, we investigated the best embryo transfer strategy in ICSI cycles with ≤4 oocytes collected at oocyte retrieval. METHODS Women who underwent antagonist co-treatment COS for ICSI treatment between January 2010 and December 2015 at a private ART clinic (N = 2263). Eight hundred seventy-nine women (group 1) had ≤4 oocytes collected at oocyte retrieval, of whom 645 (group A) had cleavage stage embryo transfer (ET), and 234 (group B) had blastocyst ET. One thousand three hundred eighty-four women (group 2) had 10-15 oocytes collected at oocyte retrieval, of whom 676 (group C) had cleavage stage ET, and 708 women (group D) had blastocyst ET. Blastocyst vitrification was performed using the Cryotop method and FET using artificial cycles. RESULTS In group 1, the cancellation rate was significantly lower in group A (25.2 vs 38 %). The pregnancy rate (PR), clinical PR, implantation rate (IR), and live birth rate (LBR) per ET and per oocyte retrieval were all lower in group A. The clinical PR, IR, and LBR per ET of vitrified-warmed blastocyst ET were significantly the highest. In group 2, the cycle cancellation rate was significantly lower in group C (3.5 vs 13.4 %). The PR, clinical PR, and IR per ET and per oocyte retrieval were all lower in group C. The LBR per ET was significantly lower, but the LBR per oocyte retrieval was not significantly lower in group C. Again, the PR, clinical PR, and IR per ET of vitrified-warmed blastocyst ET were significantly the highest. CONCLUSIONS Day 5 ET strategy has been reserved for normal or high responders. The improved pregnancy outcomes from blastocyst culture and cryopreservation may challenge ART to extend this benefit to poor responders.
Collapse
Affiliation(s)
- Murat Berkkanoglu
- Antalya IVF, Halide Edip Cd. No: 7, Kanal Mh, Antalya, 07080, Turkey.
| | - Kevin Coetzee
- Antalya IVF, Halide Edip Cd. No: 7, Kanal Mh, Antalya, 07080, Turkey
| | - Hasan Bulut
- Antalya IVF, Halide Edip Cd. No: 7, Kanal Mh, Antalya, 07080, Turkey
| | - Kemal Ozgur
- Antalya IVF, Halide Edip Cd. No: 7, Kanal Mh, Antalya, 07080, Turkey
| |
Collapse
|