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Wang YN, Zheng LW, Fu LL, Xu Y, Zhang XY. Heterotopic pregnancy after assisted reproductive techniques with favorable outcome of the intrauterine pregnancy: A case report. World J Clin Cases 2023; 11:669-676. [PMID: 36793642 PMCID: PMC9923848 DOI: 10.12998/wjcc.v11.i3.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/28/2022] [Accepted: 01/09/2023] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Heterotopic pregnancy (HP) is a rare condition in which both ectopic and intrauterine pregnancies occur. HP is uncommon after natural conception but has recently received more attention due to the widespread use of assisted reproductive techniques (ART) such as ovulation promotion therapy.
CASE SUMMARY Here, we describe a case of HP that occurred after ART with concurrent tubal and intrauterine singleton pregnancies. This was treated successfully with surgery to preserve the intrauterine pregnancy, resulting in the birth of a low-weight premature infant. This case report aims to increase awareness of the possibility of HP during routine first-trimester ultrasound examinations, especially in pregnancies resulting from ART and even if multiple intrauterine pregnancies are present.
CONCLUSION This case alerts us to the importance of comprehensive data collection during regular consultations. It is important for us to remind ourselves of the possibility of HP in all patients presenting after ART, especially in women with an established and stable intrauterine pregnancy that complain of constant abdominal discomfort and also in women with an unusually raised human chorionic gonadotropin level compared with simplex intrauterine pregnancy. This will allow symptomatic and timeous treatment of patients with better results.
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Affiliation(s)
- Ya-Nan Wang
- Department of Obstetrics and Gynecology, Reproductive Medical Center, The Second Hospital of Jilin University, Changchun 130000, Jilin Province, China
| | - Lian-Wen Zheng
- Department of Obstetrics and Gynecology, Reproductive Medical Center, The Second Hospital of Jilin University, Changchun 130000, Jilin Province, China
| | - Lu-Lu Fu
- Department of Obstetrics and Gynecology, Reproductive Medical Center, The Second Hospital of Jilin University, Changchun 130000, Jilin Province, China
| | - Ying Xu
- Department of Obstetrics and Gynecology, Reproductive Medical Center, The Second Hospital of Jilin University, Changchun 130000, Jilin Province, China
| | - Xue-Ying Zhang
- Department of Obstetrics and Gynecology, Reproductive Medical Center, The Second Hospital of Jilin University, Changchun 130000, Jilin Province, China
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Hinkson L, Schauer M, Latartara E, Alonso-Espias M, Rossetti E, Gebert P, Hinkson S, Henrich W. The Charité external cephalic version for leading twin breech without regional anesthesia and tocolysis. A prospective study on feasibility, sonographic assessment and outcomes. Eur J Obstet Gynecol Reprod Biol 2021; 268:62-67. [PMID: 34871953 DOI: 10.1016/j.ejogrb.2021.11.426] [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: 10/06/2021] [Revised: 11/14/2021] [Accepted: 11/18/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To assess the feasibility of external cephalic version (ECV) for the leading twin (twin A) in breech presentation in dichorionic and diamniotic twin pregnancies without the use of regional anesthetics and tocolysis and to characterize the sonographic parameters, maternal and neonatal outcomes. STUDY DESIGN Prospective study performed in the Charité University Hospital outpatient obstetric department in Berlin, Germany. A total of 23 women from the 35th completed week of pregnancy with confirmed dichorionic-diamniotic twin pregnancy were recruited. ECVs were performed by the lead consultant for the breech and ECV clinic. Ethical approval provided by the Charité Ethics Commission (EA2/241/18). Demographic data were recorded. Fetal sonographic parameters were assessed. The success rate of ECV, duration of the ECV, gestational age at delivery, mode of delivery for both fetuses, maternal and neonatal outcomes were analyzed. RESULTS Our main finding showed that ECV for twin A breech in dichorionic-diamniotic twins is successful in 56% (10/18) of cases without the need for regional anesthesia and without tocolysis. There is a significant increase in the spontaneous vaginal delivery rate for both twins of 95% (19/20) vs 12.5% (2/16) (p < 0.001). There is also a significant reduction in blood loss at delivery of 300 ml vs 500 ml (p = 0.034) in successful cases. CONCLUSIONS We show that ECV for twin A in breech is feasible and in 56% (10/18) successful without regional anesthesia and tocolysis. The option of ECV for twin A breech should be offered to women.
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Affiliation(s)
- Larry Hinkson
- Dept. of Obstetrics, Charité Hospital, Humboldt University, Berlin, Germany.
| | - Madeleine Schauer
- Dept. of Obstetrics, Charité Hospital, Humboldt University, Berlin, Germany
| | - Elisabetta Latartara
- Dept. of Obstetrics, Charité Hospital, Humboldt University, Berlin, Germany; Università Cattolica del Sacro Cuore Largo Francesco Vito, Roma, Italy
| | - Maria Alonso-Espias
- Dept. of Obstetrics, Charité Hospital, Humboldt University, Berlin, Germany; La Paz University Hospital, Madrid, Spain
| | - Emma Rossetti
- Dept. of Obstetrics, Charité Hospital, Humboldt University, Berlin, Germany; University of Udine, Udine, Italy
| | - Pimrapat Gebert
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany
| | - Susan Hinkson
- Department of Anesthesia, Helios Klinikum Emil von Behring, Zehlendorf, Berlin, Germany
| | - Wolfgang Henrich
- Dept. of Obstetrics, Charité Hospital, Humboldt University, Berlin, Germany
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Qu P, Zhao D, Mi Y, Dang S, Shi J, Shi W. Association between pre-pregnancy BMI and neonatal weight outcomes in twin pregnancies resulting from assisted reproductive technology: a 10-year cohort study. Eur J Clin Nutr 2021; 75:1465-1474. [PMID: 33531637 DOI: 10.1038/s41430-021-00862-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 12/17/2020] [Accepted: 01/11/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND/OBJECTIVES To examine the effect of pre-pregnancy maternal body mass index (BMI) on neonatal weight outcomes of twin infants who were conceived by assisted reproductive technology (ART). SUBJECTS/METHODS A 10-year (2006-2015) Chinese sample of 3431 mothers and their twin infants conceived by ART from a retrospective cohort were included. The effects of pre-pregnancy maternal BMI on gestational age and birth weight were assessed by generalized linear model and generalized estimating equation model. RESULTS Compared with a normal weight group, pre-pregnancy maternal underweight was associated with lower birth weight and increased risk of small for gestational age (SGA) in twins conceived by ART (birth weight: difference -59.22 g, 95% CI -93.16 to -25.27 g; SGA: RR 1.25, 95% CI 1.09 to 1.43). Pre-pregnancy maternal obesity was associated with higher birth weight and increased risk of preterm birth (birth weight: difference 65.82 g, 95% CI 10.66 to 120.99 g; preterm birth: RR 1.19, 95% CI 1.03-1.37). A nonlinear relationship between pre-pregnancy maternal BMI and SGA was observed. The risk of SGA decreased with the pre-pregnancy maternal BMI up to the turning point (BMI = 21) (RR 0.90, 95% CI 0.86-0.95). CONCLUSIONS Among mothers undergoing ART, pre-pregnancy maternal obesity is associated with higher birth weight and higher risk of preterm birth for twin pregnancy, and pre-pregnancy maternal underweight is associated with lower birth weight and higher risk of SGA. Women preparing for ART should maintain a normal BMI to lower the chances of adverse neonatal outcomes.
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Affiliation(s)
- Pengfei Qu
- Translational Medicine Center, Northwest Women's and Children's Hospital, Xi'an, 710061, Shaanxi, People's Republic of China.,Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, 710003, Shaanxi, People's Republic of China.,Departments of Pediatrics and Neonatology, Children's Hospital of Fudan University, Shanghai, People's Republic of China
| | - Doudou Zhao
- Translational Medicine Center, Northwest Women's and Children's Hospital, Xi'an, 710061, Shaanxi, People's Republic of China.,Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, 710003, Shaanxi, People's Republic of China
| | - Yang Mi
- Department of obstetrics, Northwest Women's and Children's Hospital, Xi'an, 710003, Shaanxi, People's Republic of China
| | - Shaonong Dang
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Juanzi Shi
- Translational Medicine Center, Northwest Women's and Children's Hospital, Xi'an, 710061, Shaanxi, People's Republic of China. .,Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, 710003, Shaanxi, People's Republic of China.
| | - Wenhao Shi
- Translational Medicine Center, Northwest Women's and Children's Hospital, Xi'an, 710061, Shaanxi, People's Republic of China. .,Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, 710003, Shaanxi, People's Republic of China.
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Luo X, Li Y, Zheng H, Ding L, Zhang M, Li Y, Wu Z. Thicker endometrium on hCG trigger day improves the live birth rate of fresh cleavage embryo transfer in GnRH-agonist regimen of normogonadotrophic women. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:856. [PMID: 34164490 PMCID: PMC8184494 DOI: 10.21037/atm-21-1922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Luteinizing hormone (LH) and progesterone (PROG) on human chorionic gonadotropin (hCG) trigger day are significantly correlated with assisted reproductive technology (ART) outcome. Moreover, LH and PROG are also involved in the functional preparation of the endometrium during the implantation window; however, whether they are related to endometrial thickness (EMT) is still unknown. The aim of the present study was to assess whether EMT has a positive correlation on the live birth rate following fresh embryo transfer (ET), and whether LH and PROG have an impact on EMT. Methods A total of 2,260 normogonadotrophic women were treated with a GnRH agonist for in vitro fertilization (IVF)/intracytoplasmic sperm injection. Patients with advanced age and poor ovarian reserve were excluded. The levels of LH, PROG, and EMT on the hCG trigger day were divided into binary variables, respectively, by the cutoff values, and which were obtained based on receiver operating characteristic curve analysis of live birth among LH, PROG and EMT levels on the hCG trigger day, respectively. Multivariate binary logistic regression was used to confirm the role of LH, PROG, and EMT on the live birth, and stratified analysis was used to determine whether LH and PROG have an impact on EMT. Results EMT and LH were protective factors for live births, with odds ratios (OR) of 1.11 [95% confidence interval (CI): 1.066–1.157] and 1.696 (95% CI: 1.345–2.139), respectively. However, PROG was a risk factor for live birth, with an OR of 0.635 (95% CI: 0.526–0.766). The hierarchical cross-table analysis indicated that EMT had no significant difference for live birth in the combination of low LH and high PROG group. In the other subgroups, thick EMT was associated with a higher live birth rate (P<0.05). Conclusions On hCG trigger day, EMT, LH, and PROG all were independent factors that affected the live birth of fresh ETs. Thick EMT can significantly increase the live birth rate. However, multivariate logistic regression analysis showed that EMT does not affect the live birth rate in combination of low LH and high PROG environment.
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Affiliation(s)
- Xi Luo
- Department of Reproductive Medicine, the First People's Hospital of Yunnan Province, Kunming, China.,Reproductive Medical Center of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, China.,Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China.,Medical School, Kunming University of Science and Technology, Kunming, China
| | - Yunxiu Li
- Department of Reproductive Medicine, the First People's Hospital of Yunnan Province, Kunming, China.,Reproductive Medical Center of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Haishan Zheng
- Department of Reproductive Medicine, the First People's Hospital of Yunnan Province, Kunming, China.,Reproductive Medical Center of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Lei Ding
- Department of Reproductive Medicine, the First People's Hospital of Yunnan Province, Kunming, China.,Reproductive Medical Center of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Manqin Zhang
- Department of Reproductive Medicine, the First People's Hospital of Yunnan Province, Kunming, China.,Reproductive Medical Center of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Yonggang Li
- Department of Reproductive Medicine, the First People's Hospital of Yunnan Province, Kunming, China.,Reproductive Medical Center of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Ze Wu
- Department of Reproductive Medicine, the First People's Hospital of Yunnan Province, Kunming, China.,Reproductive Medical Center of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
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Orvieto R, Venetis CA, Fatemi HM, D’Hooghe T, Fischer R, Koloda Y, Horton M, Grynberg M, Longobardi S, Esteves SC, Sunkara SK, Li Y, Alviggi C. Optimising Follicular Development, Pituitary Suppression, Triggering and Luteal Phase Support During Assisted Reproductive Technology: A Delphi Consensus. Front Endocrinol (Lausanne) 2021; 12:675670. [PMID: 34040586 PMCID: PMC8142593 DOI: 10.3389/fendo.2021.675670] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/08/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND A Delphi consensus was conducted to evaluate global expert opinions on key aspects of assisted reproductive technology (ART) treatment. METHODS Ten experts plus the Scientific Coordinator discussed and amended statements plus supporting references proposed by the Scientific Coordinator. The statements were distributed via an online survey to 35 experts, who voted on their level of agreement or disagreement with each statement. Consensus was reached if the proportion of participants agreeing or disagreeing with a statement was >66%. RESULTS Eighteen statements were developed. All statements reached consensus and the most relevant are summarised here. (1) Follicular development and stimulation with gonadotropins (n = 9 statements): Recombinant human follicle stimulating hormone (r-hFSH) alone is sufficient for follicular development in normogonadotropic patients aged <35 years. Oocyte number and live birth rate are strongly correlated; there is a positive linear correlation with cumulative live birth rate. Different r-hFSH preparations have identical polypeptide chains but different glycosylation patterns, affecting the biospecific activity of r-hFSH. r-hFSH plus recombinant human LH (r-hFSH:r-hLH) demonstrates improved pregnancy rates and cost efficacy versus human menopausal gonadotropin (hMG) in patients with severe FSH and LH deficiency. (2) Pituitary suppression (n = 2 statements): Gonadotropin releasing hormone (GnRH) antagonists are associated with lower rates of any grade ovarian hyperstimulation syndrome (OHSS) and cycle cancellation versus GnRH agonists. (3) Final oocyte maturation triggering (n=4 statements): Human chorionic gonadotropin (hCG) represents the gold standard in fresh cycles. The efficacy of hCG triggering for frozen transfers in modified natural cycles is controversial compared with LH peak monitoring. Current evidence supports significantly higher pregnancy rates with hCG + GnRH agonist versus hCG alone, but further evidence is needed. GnRH agonist trigger, in GnRH antagonist protocol, is recommended for final oocyte maturation in women at risk of OHSS. (4) Luteal-phase support (n = 3 statements): Vaginal progesterone therapy represents the gold standard for luteal-phase support. CONCLUSIONS This Delphi consensus provides a real-world clinical perspective on the specific approaches during the key steps of ART treatment from a diverse group of international experts. Additional guidance from clinicians on ART strategies could complement guidelines and policies, and may help to further improve treatment outcomes.
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Affiliation(s)
- Raoul Orvieto
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- *Correspondence: Raoul Orvieto,
| | - Christos A. Venetis
- Centre for Big Data Research in Health & School of Women’s and Children’s Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
- IVF Australia, Sydney, NSW, Australia
| | - Human M. Fatemi
- Assisted Reproductive Technology (ART), Fertility Clinics, Abu Dhabi, United Arab Emirates
| | - Thomas D’Hooghe
- Global Medical Affairs, Research and Development, Merck Healthcare KGaA, Darmstadt, Germany
- Research Group Reproductive Medicine, Department of Development and Regeneration, Organ Systems, Group Biomedical Sciences, KU Leuven (University of Leuven), Leuven, Belgium
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States
| | | | - Yulia Koloda
- Center of Reproduction “Life Line”, Moscow, Russia
- Department of Obstetrics and Gynecology, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Marcos Horton
- Pregna Medicina Reproductiva, Buenos Aires, Argentina
| | - Michael Grynberg
- Service de Médecine de la Reproduction et Préservation de la Fertilité, Hôpital Antoine Béclère, Clamart, France
| | - Salvatore Longobardi
- Global Clinical Development, Merck Serono, Italy, an Affiliate of Merck KGaA, Darmstadt, Germany
| | - Sandro C. Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Center for Male Reproduction, Campinas, Brazil
- Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Sesh K. Sunkara
- Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Yuan Li
- Medical Center for Human Reproduction, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
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6
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Conception after early IVF pregnancy loss: should we wait? Reprod Biomed Online 2020; 42:413-419. [PMID: 33303365 DOI: 10.1016/j.rbmo.2020.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/11/2020] [Accepted: 10/29/2020] [Indexed: 11/23/2022]
Abstract
RESEARCH QUESTION Is the interval length between an early pregnancy loss and the following treatment cycle a predictor for achieving clinical pregnancy among IVF patients? DESIGN This retrospective cohort study of 257 women who reinitiated treatment after first-trimester IVF pregnancy loss was conducted at a tertiary, university-affiliated medical centre between 1 January 2014 to 1 January 2018. Women aged 18-40 years, with normal uterine cavity, who experienced first-trimester pregnancy loss at less than 14 weeks after IVF, were included. Miscarriages were classified as spontaneous, biochemical, medical or surgical. RESULTS Among 257 women, interval to subsequent IVF treatment was not associated with achieving pregnancy. Patients after biochemical pregnancy (72.7 ± 56.4, median 60 days) or spontaneous miscarriage (97.7 ± 93.1, median 66 days) had shorter intervals to next cycle, compared with medical (111.9 ± 103.2, median 65 days) or surgical (123.4 ± 111.1, median 84 days) (Kaplan-Meier, P = 0.03) miscarriages. Logistic regression analysis showed that the chance of subsequent pregnancy was affected by the number of embryos transferred (P = 0.009) and the type of miscarriage. Medical (P = 0.005) and surgical (P = 0.017) miscarriages were related to lower likelihood of pregnancy compared with biochemical pregnancy (reference group). When pregnancy was achieved in the first post-miscarriage cycle, the chance of live birth increased with shorter intervals (median 57.5 days), whereas second miscarriage was related to longer intervals (median 82.5 days) between miscarriage and subsequent IVF cycle (P = 0.03). CONCLUSION On the basis of this cohort, IVF should not be postponed after pregnancy loss, as shorter intervals were associated with greater likelihood of live birth.
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Shreffler KM, Greil AL, McQuillan J. Responding to Infertility: Lessons From a Growing Body of Research and Suggested Guidelines for Practice. FAMILY RELATIONS 2017; 66:644-658. [PMID: 29422703 PMCID: PMC5798475 DOI: 10.1111/fare.12281] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Infertility is a common, yet often misunderstood, experience. Infertility is an important topic for family scientists because of its effects on families; its relevance to research in related areas, such as fertility trends and reproductive health; and its implications for practitioners who work with individuals and couples experiencing infertility. In this review, we focus on common misperceptions in knowledge and treatment of infertility and highlight insights from recent research that includes men, couples, and people with infertility who are not in treatment. The meaning of parenthood, childlessness, awareness of a fertility problem, and access to resources are particularly relevant for treatment seeking and psychosocial outcomes. On the basis of insights from family science research, we provide specific guidelines for infertility practice within broader social contexts such as trends in health care, education, employment, and relationships. Guidelines are presented across three areas of application: infertility education for individuals, families, and practitioners; steps to support the emotional well-being of those affected by infertility; and understanding of treatment approaches and their implications for individuals and couples.
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Committee Opinion No 671: Perinatal Risks Associated With Assisted Reproductive Technology. Obstet Gynecol 2016; 128:e61-8. [DOI: 10.1097/aog.0000000000001643] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Mainigi MA, Sapienza C, Butts S, Coutifaris C. A Molecular Perspective on Procedures and Outcomes with Assisted Reproductive Technologies. Cold Spring Harb Perspect Med 2016; 6:a023416. [PMID: 26747835 DOI: 10.1101/cshperspect.a023416] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The emerging association of assisted reproductive technologies with adverse perinatal outcomes has prompted the in-depth examination of clinical and laboratory protocols and procedures and their possible effects on epigenetic regulatory mechanism(s). The application of various approaches to study epigenetic regulation to problems in reproductive medicine has the potential to identify relative risk indicators for particular conditions, diagnostic biomarkers of disease state, and prognostic indicators of outcome. Moreover, when applied genome-wide, these techniques are likely to find novel pathways of disease pathogenesis and identify new targets for intervention. The analysis of DNA methylation, histone modifications, transcription factors, enhancer binding and other chromatin proteins, DNase-hypersensitivity and, micro- and other noncoding RNAs all provide overlapping and often complementary snapshots of chromatin structure and resultant "gene activity." In terms of clinical application, the predictive power and utility of epigenetic information will depend on the power of individual techniques to discriminate normal levels of interindividual variation from variation linked to a disease state. At present, quantitative analysis of DNA methylation at multiple loci seems likely to hold the greatest promise for achieving the level of precision, reproducibility, and throughput demanded in a clinical setting.
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Affiliation(s)
- Monica A Mainigi
- Department of Obstetrics and Gynecology and the Center for Research on Reproduction and Women's Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Carmen Sapienza
- Fels Institute for Cancer Research and Molecular Biology and Department of Pathology and Laboratory Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania 19140
| | - Samantha Butts
- Department of Obstetrics and Gynecology and the Center for Research on Reproduction and Women's Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Christos Coutifaris
- Department of Obstetrics and Gynecology and the Center for Research on Reproduction and Women's Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104
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Song SH, Kim DS, Yoon TK, Hong JY, Shim SH. Sexual function and stress level of male partners of infertile couples during the fertile period. BJU Int 2015; 117:173-6. [PMID: 26074135 DOI: 10.1111/bju.13201] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the sexual function and stress level during timed intercourse (TI) of male partners of infertile couples. PATIENTS AND METHODS The study included 236 male partners of couples with >1 year of infertility who sought medical care or an evaluation of couple infertility. Besides infertility evaluation, all men were asked to complete the five-item version of the International Index of Erectile Function (IIEF-5) for evaluation of sexual function, and stresses related to infertility and TI were measured using 10-division visual analogue scales (VAS). RESULTS Stress levels for sexual function were higher during fertile than non-fertile periods in109 of the 236 (46.2%) male partners, with 122 (51.7%) reporting no difference in stress during fertile and non-fertile periods. The mean (sd) VAS score of sexual relationship stress was significantly higher during fertile than non-fertile periods, at 3.4 (2.6) vs 2.1 (2.2) (P < 0.001). Of the 236 men, 21 (8.9%) reported more than mild-to-moderate erectile dysfunction (ED; IIEF-5 score ≤16) and 99 (42%) reported mild ED (IIEF-5 score 17-21). CONCLUSION Male partners of infertile couples experience significantly higher TI-related stresses during the fertile period compared with the non-fertile period. Sexual dysfunction is also common in male partners of infertile couples. Medical personnel dealing with infertile couples should be aware of these potential problems in male partners and provide appropriate counselling.
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Affiliation(s)
- Seung-Hun Song
- Department of Urology, Fertility Center, CHA Gangnam Medical Center, Seoul, Korea
| | - Dong Suk Kim
- Department of Urology, Fertility Center, CHA Gangnam Medical Center, Seoul, Korea
| | - Tae Ki Yoon
- Department of Obstetrics and Gynecology, Fertility Center, CHA Gangnam Medical Center, Seoul, Korea
| | - Jae Yup Hong
- Department of Genetics, CHA University, Seoul, Korea
| | - Sung Han Shim
- Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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11
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Adageba RK, Maya ET, Annan JJ, Damalie FJ. Setting Up and Running a Successful IVF Program in Africa: Prospects and Challenges. J Obstet Gynaecol India 2015; 65:155-7. [PMID: 26085734 DOI: 10.1007/s13224-015-0719-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 05/27/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- R K Adageba
- Ruma Fertility and Specialist Hospital, P. O. Box AY 254, Kumasi, Ghana
| | - E T Maya
- Department of Population Family and Reproductive Health, University of Ghana School of Public Health, Accra, Ghana
| | - J J Annan
- Ruma Fertility and Specialist Hospital, P. O. Box AY 254, Kumasi, Ghana
| | - F J Damalie
- Ruma Fertility and Specialist Hospital, P. O. Box AY 254, Kumasi, Ghana
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12
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Younger M, Hollins-Martin C, Choucri L. Individualised care for women with assisted conception pregnancies and midwifery practice implications: An analysis of the existing research and current practice. Midwifery 2014; 31:265-70. [PMID: 25066895 DOI: 10.1016/j.midw.2014.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 03/29/2014] [Accepted: 06/29/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE the aim is to explore the psychosocial needs of women who are pregnant after assisted conception, specifically in vitro Fertilisation and whether their needs are being addressed within the current maternity care service. DESIGN critical review of the literature using a narrative approach. FINDINGS AND KEY CONCLUSIONS 15 papers were identified. These included both qualitative and quantitative studies, literature reviews and surveys. The findings of this limited narrative review imply that women who undergo assistive reproductive techniques to achieve pregnancy have higher levels of anxiety in pregnancy and may have some difficulties in the transition to parenthood leading to perinatal morbidity. It appears that for this group of women it is important that their history in achieving pregnancy is known to the care providers, to enable the alleviation of some of the anxieties they face. Various aspects of antenatal care have been identified as possible areas which if addressed may reduce these levels of anxiety leading to a reduction in perinatal morbidity. IMPLICATIONS FOR PRACTICE currently, there is insufficient evidence to suggest that providing specialist midwifery care reduces morbidity in these women. However, maternity service providers should consider offering additional antenatal and postnatal services to meet the needs of this group in advance of further research in this area.
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Affiliation(s)
- Mimi Younger
- University of Salford, The Crescent, Salford, Lancashire M5 4WT, UK.
| | | | - Lesley Choucri
- University of Salford, The Crescent, Salford, Lancashire M5 4WT, UK.
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13
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Is the fertility treatment itself a risk factor for early pregnancy loss? Curr Opin Obstet Gynecol 2014; 26:174-80. [DOI: 10.1097/gco.0000000000000064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Boots CE, Gustofson RL, Feinberg EC. Does methotrexate administration for ectopic pregnancy after in vitro fertilization impact ovarian reserve or ovarian responsiveness? Fertil Steril 2013; 100:1590-3. [DOI: 10.1016/j.fertnstert.2013.08.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 07/27/2013] [Accepted: 08/05/2013] [Indexed: 11/25/2022]
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15
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da Silva CH, Hernandez AR, Agranonik M, Goldani MZ. Maternal age and low birth weight: a reinterpretation of their association under a demographic transition in southern Brazil. Matern Child Health J 2013; 17:539-44. [PMID: 22535218 DOI: 10.1007/s10995-012-1030-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To evaluate the relationship between changes in fecundity rates and maternal age and the impact of maternal age on low birth weight (LBW) rates in a developed region in southern Brazil. A time series study evaluating birth weight and maternal ages through the born alive information system (SINASC) in Porto Alegre from 1996 to 2008. The Chi-square test for trends was used to evaluate the trend of LBW and fecundity rates at each maternal age. Population attributed risk (PAR) was used to calculate the impact of maternal age on LBW rates. The study included 271,100 newborns. There was a significant reduction in fecundity rates in all age groups younger than 34 years, but especially in the groups between 20 and 29 years. Overall LBW increased from 9.3 to 10.7 % (P < 0.001). The PAR for LBW showed a reduction in the group from 17 to 19 years (from 1.7 % in 1996-1999 to 0.1 % in 2004-2008), and an increase in the groups from 35 to 39 years (from 2.0 % in 1996-1999 to 2.3 % in 2004-2008) and above 40 (from 1.1 % in 1996-1999 to 1.5 % in 2004-2008). There was a significant change in fecundity pattern in the last 12 years in southern Brazil. Adolescent mothers were surpassed by mothers over 30 years of age in terms of vulnerability for LBW babies. The results show a change in the maternal age distribution towards older mothers, accompanied by an increasing incidence of LBW. This demographic transition also involved a paradoxical pattern with a remarkable reduction in fecundity rates in intermediate maternal age groups with concomitant increase in their risk for LBW.
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Affiliation(s)
- C Homrich da Silva
- Núcleo de Estudos de Saúde da Saúde da Criança e do Adolescente (NESCA), Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos 2350, 10° andar (Serviço de Pediatria), Porto Alegre, Rio Grande do Sul 90035-903, Brazil.
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16
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Leeners B, Geraedts K, Imthurn B, Stiller R. The relevance of age in female human reproduction--current situation in Switzerland and pathophysiological background from a comparative perspective. Gen Comp Endocrinol 2013; 188:166-74. [PMID: 23523998 DOI: 10.1016/j.ygcen.2013.02.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Accepted: 02/21/2013] [Indexed: 11/17/2022]
Abstract
During recent years women tend to postpone childbirth to ages when fertility declines. Consequently, an increasing number of women experiences reproductive difficulties and seeks help by assisted reproductive techniques (ART). To investigate the dynamics of age-related fertility in Switzerland we evaluated data from the nationwide FIVNAT-CH statistics on ART as well as from a subsample receiving ART at the Division of Reproductive Endocrinology, University Hospital Zurich. Since 2000 the average age of women receiving ART increased from 34.9 to 36.3 years in Switzerland and since 2006 numbers of annual ART cycles augmented steadily. The percentage of women ≥40 increased from 17.2% in 2007 to 19.6% in 2011. In the Zurich cohort AMH, the number of oocytes retrieved, the number of fertilized oocytes with two pronuclei, the number of embryos with an adequate cell number, clinical pregnancy rates as well as life birth/ongoing pregnancy rates were lower in the age group ≥40 years, especially when compared to 33 year-old women. In the nationwide sample pregnancy rates decreased from about 45% at the age of 30 to less than 3% at the age of 45; delivery rates declined from about 38% to nearly 0%. In the Zurich cohort percentages of clinical pregnancies declined from 46% in women ≤34 years to 21% in women ≥40 years. In the national sample as well as in the Zurich cohort the percentage of miscarriages increased dramatically from 15.4% and 22% in women ≤34 years to 38.6% and 33% in women ≥40 years, respectively. Even in a country with high health standards such as Switzerland fertility is declining with age and ART does not succeed to improve reduced fertility. Rodent and primate models enrich our knowledge on the pathophysiological mechanisms underlying reproductive senescence. As non-infertility specialist physicians as well as the general public are not sufficiently aware of the dramatic reduction of chances for life births in women ≥40 years, medical counseling as well as schools and media should support the distribution of information future parents need for successful family planning.
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Affiliation(s)
- Brigitte Leeners
- Division of Reproductive Endocrinology, University Hospital Zurich, Switzerland.
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17
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Stadtmauer L, Silverberg KM, Ginsburg ES, Weiss H, Howard B. Progesterone vaginal ring versus vaginal gel for luteal support with in vitro fertilization: a randomized comparative study. Fertil Steril 2013; 99:1543-9. [DOI: 10.1016/j.fertnstert.2012.12.052] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 12/12/2012] [Accepted: 12/13/2012] [Indexed: 10/27/2022]
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18
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Lee SH, Kuo CP, Hsiao CY, Lu YC, Hsu MY, Kuo PC, Lee MS, Lee MC. Development of a Chinese childbearing attitude questionnaire for infertile women receiving in vitro fertilization treatment. J Transcult Nurs 2013; 24:127-33. [PMID: 23460456 DOI: 10.1177/1043659612472060] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The purpose of this study was to report the second phase of instrument development, a culturally sensitive questionnaire of childbearing attitudes to assess the psychosocial responses of infertile women. Using a nonexperimental quantitative design, we investigated 238 women who are undergoing in vitro fertilization treatment. Data collection and relevant planning occurred in two phases: in-depth interviews of women to generate items for the questionnaire and establishing the questionnaire's content and construct validity. Through factor analysis, five factors were extracted from the "attitude toward childbearing questionnaire": gender identification with self and society, insurance of marriage and inheritance, happy family life, spiritual investment, and continuing the family line and procreation. The total variance of these five factors was 64.31%. Cronbach's α and test-retest reliability were between .72 and .87 and between .60 and .76, respectively, demonstrating acceptable internal consistency and stability. The information obtained through the questionnaire could be used to provide infertile women with personal counseling and appropriate psychological support during and after assisted reproductive technology.
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Affiliation(s)
- Shu-Hsin Lee
- School of Nursing, Chung Shan Medical University, Taichung, Taiwan
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19
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Previous abortion is a positive predictor for ongoing pregnancy in the next cycle in women with repeated IVF failures. Reprod Biomed Online 2012; 25:339-44. [DOI: 10.1016/j.rbmo.2012.06.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 06/24/2012] [Accepted: 06/25/2012] [Indexed: 11/20/2022]
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20
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Risk Factors and Early Development of Children Born with an Assisted Fertilization. JOURNAL OF SPECIAL EDUCATION AND REHABILITATION 2011. [DOI: 10.2478/v10215-011-0010-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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21
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Iams JD, Berghella V. Care for women with prior preterm birth. Am J Obstet Gynecol 2010; 203:89-100. [PMID: 20417491 PMCID: PMC3648852 DOI: 10.1016/j.ajog.2010.02.004] [Citation(s) in RCA: 131] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 12/01/2009] [Accepted: 02/02/2010] [Indexed: 11/23/2022]
Abstract
Women who have delivered an infant between 16 and 36 weeks' gestation have an increased risk of preterm birth in subsequent pregnancies. The risk increases with more than 1 preterm birth and is inversely proportional to the gestational age of the previous preterm birth. African American women have rates of recurrent preterm birth that are nearly twice that of women of other backgrounds. An approximate risk of recurrent preterm birth can be estimated by a comprehensive reproductive history, with emphasis on maternal race, the number and gestational age of prior births, and the sequence of events preceding the index preterm birth. Interventions including smoking cessation, eradication of asymptomatic bacteriuria, progestational agents, and cervical cerclage can reduce the risk of recurrent preterm birth when employed appropriately.
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Affiliation(s)
- Jay D Iams
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University Medical Center, Columbus, OH
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22
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Wex-Wechowski J, Abou-Setta AM, Kildegaard Nielsen S, Kennedy R. HP-HMG versus rFSH in treatments combining fresh and frozen IVF cycles: success rates and economic evaluation. Reprod Biomed Online 2010; 21:166-78. [PMID: 20541471 DOI: 10.1016/j.rbmo.2010.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Revised: 02/18/2010] [Accepted: 05/06/2010] [Indexed: 11/30/2022]
Abstract
The economic implications of the choice of gonadotrophin influence decision making but their cost-effectiveness in frozen-embryo transfer cycles has not been adequately studied. An economic evaluation was performed comparing highly purified human menopausal gonadotrophin (HP-HMG) and recombinant FSH (rFSH) using individual patient data (n=986) from two large randomized controlled trials using a long agonist IVF protocol. The simulation model incorporated live birth data and published UK costs of IVF-related medical resources. After treatment for up-to-three cycles (one fresh and up to two subsequent fresh or frozen cycles conditional on availability of cryopreserved embryos), the cumulative live birth rate was 53.7% (95% CI 49.3-58.1%) for HP-HMG and 44.6% (40.2-49.0%) for rFSH (OR 1.44, 95% CI 1.12-1.85; P<0.005). The mean costs per IVF treatment for HP-HMG and rFSH were pound5393 ( pound5341-5449) and pound6269 ( pound6210-6324), respectively (number needed to treat to fund one additional treatment was seven; P<0.001). With maternal and neonatal costs applied, the median cost per IVF baby delivered with HP-HMG was pound11,157 ( pound11,089-11,129) and pound14,227 ( pound14,183-14,222) with rFSH (P<0.001). The cost saving using HP-HMG remained after varying model parameters in a probabilistic sensitivity analysis.
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Affiliation(s)
- Jaro Wex-Wechowski
- PharmArchitecture, Quatro House, Lyon Way, Camberley, Surrey GU167ER, UK.
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23
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Commanding the “Be Fruitful and Multiply” Directive: Reproductive Ethics, Law, and Policy in Israel. Camb Q Healthc Ethics 2010; 19:363-71. [PMID: 20507684 DOI: 10.1017/s0963180110000149] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
As of June 2009, Israel’s population was 7,424,400 people, 5,604,900 of which were Jewish, 1,502,400 were Arabs, and approximately 317,200 had no religion or are non-Arab Christians. Established in 1948, Israel is a highly urban and industrialized country. Its gross domestic product (GDP) per capita (based on exchange rate) is US$23,257, positioning it among the European developed countries. Life expectancy is 79 years for males and 82 years for females, with infant mortality rate of 4 cases per 1,000 live births. Of Israel’s GDP, 7.7% is spent on health.
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Sun LM, Walker MC, Cao HL, Yang Q, Duan T, Kingdom JCP. Assisted reproductive technology and placenta-mediated adverse pregnancy outcomes. Obstet Gynecol 2009; 114:818-824. [PMID: 19888040 DOI: 10.1097/aog.0b013e3181b76bd1] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To estimate whether the use of specific types of assisted reproductive technology (ART) is associated with an increased risk of placenta-mediated pregnancy complications, which include preeclampsia, stillbirth, small for gestational age at birth, and placental abruption. METHODS A population-based retrospective cohort study was conducted on singleton pregnancies conceived by different types of ART based on the 2004-2007 Ontario Niday Perinatal Database. Patients with fetal anomalies and maternal health problems were excluded as important confounders. Three exposed groups were created by the subtype of ART, including in vitro fertilization with or without intracytoplasmic sperm injection, intrauterine insemination, and ovulation induction. The nonexposed groups were the singleton pregnancies conceived naturally. For each exposed woman, four women from the nonexposed group were randomly matched by maternal age and parity. RESULTS There were 2,118 exposed participants and 8,420 matched nonexposed participants in the study. The sample size provided 80% power for a relative risk of 2.0 of placenta-mediated adverse pregnancy outcomes with ART. After adjustment of potential confounders, including smoking, delivery hospital level, initiating time of prenatal care, average neighborhood income, fetal sex, and previous cesarean delivery, there was no association observed between different types of ART groups and the composite of placenta-mediated pregnancy complications. Intrauterine insemination was associated with a significantly increased risk of preeclampsia (12 [2.67%] odds ratio 2.2, 95% confidence interval 1.04-5.04) compared with the corresponding control group (23 [1.29%]). CONCLUSION Assisted reproductive technology is not associated with an increased risk of the composite outcome of placenta-mediated pregnancy complications among singleton pregnancies. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Lu-Ming Sun
- From the Shanghai First Maternity and Infant Hospital, University of Tong Ji, Shanghai, China; OMNI Research Group, Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Ottawa General Hospital, University of Ottawa, Ottawa, Ontario, Canada; and Placenta Clinic, Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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25
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26
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Devroey P, Fauser BCJM, Diedrich K. Approaches to improve the diagnosis and management of infertility. Hum Reprod Update 2009; 15:391-408. [PMID: 19380415 PMCID: PMC2691653 DOI: 10.1093/humupd/dmp012] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Revised: 02/19/2009] [Accepted: 03/18/2009] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Recent advances in our understanding of the causes of infertility and of assisted reproductive technology (ART) have led to the development of complex diagnostic tools, prognostic models and treatment options. The Third Evian Annual Reproduction (EVAR) Workshop Meeting was held on 26-27 April 2008 to evaluate evidence supporting current approaches to the diagnosis and management of infertility and to identify areas for future research efforts. METHODS Specialist reproductive medicine clinicians and scientists delivered presentations based on published literature and ongoing research on patient work-up, ovarian stimulation and embryo quality assessment during ART. This report is based on the expert presentations and subsequent group discussions and was supplemented with publications from literature searches and the authors' knowledge. RESULTS It was agreed that single embryo transfer (SET) should be used with increasing frequency in cycles of ART. Continued improvements in cryopreservation techniques, which improve pregnancy rates using supernumerary frozen embryos, are expected to augment the global uptake of SET. Adaptation and personalization of fertility therapy may help to optimize efficacy and safety outcomes for individual patients. Prognostic modelling and personalized management strategies based on individual patient characteristics may prove to represent real progress towards improved treatment. However, at present, there is limited good-quality evidence to support the use of these individualized approaches. CONCLUSIONS Greater quality control and standardization of clinical and laboratory evaluations are required to optimize ART practices and improve individual patient outcomes. Well-designed, good-quality studies are required to drive improvements to the diagnosis and management of ART processes.
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Affiliation(s)
- P Devroey
- Center of Reproductive Medicine, Free University Brussels, Laarbeeklaan 101, Brussels 1090, Belgium.
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27
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Stanford JB, Mikolajczyk RT, Lynch CD, Simonsen SE. Cumulative pregnancy probabilities among couples with subfertility: effects of varying treatments. Fertil Steril 2009; 93:2175-81. [PMID: 19328479 DOI: 10.1016/j.fertnstert.2009.01.080] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 01/06/2009] [Accepted: 01/09/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To model the cumulative probability of pregnancy among couples with subfertility without a definitive diagnosis, according to different treatment strategies. DESIGN A beta distribution of fecundity was fitted that reproduced the cumulative probability of pregnancy in prospective studies of natural fertility, and this distribution was applied to simulated cohorts starting with one million couples each. Probabilities of pregnancy were generated for each cycle of each couple. SETTING Simulation study. PATIENT(S) Hypothetic subfertile population. INTERVENTION(S) After 2 or 4 years of attempting pregnancy and diagnostic evaluation to exclude anovulation, tubal obstruction, and severe male factor, simulated treatments were applied to the remaining nonpregnant couples, with treatment effects based on published literature. MAIN OUTCOME MEASURE(S) Simulated cumulative probability of pregnancy. RESULT(S) Initially, the cumulative probability of pregnancy was highest for early treatment with IVF, but over time, conservative treatment or frequent intercourse approached the same cumulative probability. CONCLUSION(S) In couples without clear indications for IVF, the main benefit of early IVF may be to shorten time to pregnancy, a benefit that must be weighed against costs and potential adverse outcomes. Couples should be encouraged to maintain regular intercourse to maximize chances of pregnancy, even after unsuccessful treatment attempts.
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Affiliation(s)
- Joseph B Stanford
- Department of Family and Preventive Medicine, Division of Public Health, University of Utah, Salt Lake City, Utah, USA
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28
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Yli-Kuha AN, Gissler M, Luoto R, Hemminki E. Success of infertility treatments in Finland in the period 1992-2005. Eur J Obstet Gynecol Reprod Biol 2009; 144:54-8. [PMID: 19268432 DOI: 10.1016/j.ejogrb.2008.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Revised: 11/25/2008] [Accepted: 12/28/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The objective was to study the success rates of infertility treatments in the period 1992-2005 in public and private clinics. STUDY DESIGN Aggregate IVF statistics (1992-2005) and nationally representative cross-sectional survey (2002). RESULTS The success rates of infertility treatments remained stable, despite a substantial increase in single-embryo transfers. In 2005, the clinical pregnancy rate was 23/100 initiated cycles and a live birth rate of 17/100 cycles. The proportions of term singletons and singletons weighing at least 2500g improved over time and both rates were 14/100 in 2005. Pregnancy rates improved most among older women during the study period. The success rate in the private sector was significantly better than that in the public sector among women younger than 35 years. CONCLUSION The single-embryo policy has not decreased pregnancy and birth rates. The proportions of term singletons per initiated cycle and singletons weighing at least 2500g per initiated cycle have improved over time. The higher success rate in the private sector may be because of different clientele.
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Affiliation(s)
- A-N Yli-Kuha
- University of Tampere, Medisiinarinkatu, Finland.
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29
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Stern JE, Goldman MB, Hatasaka H, MacKenzie TA, Racowsky C, Surrey ES. Optimizing the number of blastocyst stage embryos to transfer on day 5 or 6 in women 38 years of age and older: a Society for Assisted Reproductive Technology database study. Fertil Steril 2009; 91:157-66. [PMID: 18222441 DOI: 10.1016/j.fertnstert.2007.11.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2007] [Revised: 11/09/2007] [Accepted: 11/12/2007] [Indexed: 11/19/2022]
Affiliation(s)
- Judy E Stern
- Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
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30
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Macaluso M, Wright-Schnapp TJ, Chandra A, Johnson R, Satterwhite CL, Pulver A, Berman SM, Wang RY, Farr SL, Pollack LA. A public health focus on infertility prevention, detection, and management. Fertil Steril 2008; 93:16.e1-10. [PMID: 18992879 DOI: 10.1016/j.fertnstert.2008.09.046] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Revised: 09/08/2008] [Accepted: 09/09/2008] [Indexed: 12/31/2022]
Abstract
In 2002, 2 million American women of reproductive age were infertile. Infertility is also common among men. The Centers for Disease Control and Prevention (CDC) conducts surveillance and research on the causes of infertility, monitors the safety and efficacy of infertility treatment, and sponsors national prevention programs. A CDC-wide working group found that, despite this effort, considerable gaps and opportunities exist in surveillance, research, communication, and program and policy development. We intend to consult with other federal agencies, professional and consumer organizations, the scientific community, the health care community, industry, and other stakeholders, and participate in the development of a national public health plan for the prevention, detection, and management of infertility.
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Affiliation(s)
- Maurizio Macaluso
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Hecht JL, Allred EN, Kliman HJ, Zambrano E, Doss BJ, Husain A, Pflueger SMV, Chang CH, Livasy CA, Roberts D, Bhan I, Ross DW, Senagore PK, Leviton A. Histological characteristics of singleton placentas delivered before the 28th week of gestation. Pathology 2008; 40:372-6. [PMID: 18446627 DOI: 10.1080/00313020802035865] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIMS The placenta is a record of the fetal environment and its examination may provide information about the baby's subsequent growth and development. We describe the histological characteristics of 947 singleton placentas from infants born between 23 and 27 weeks gestation. METHODS Consent was obtained from mothers who delivered before 28 weeks (clinical estimate). We evaluated the gross and histopathological features of the placenta and assessed pair-wise correlations between variables. RESULTS Lesions of uteroplacental circulation (abruption, extensive infarction or thrombosis, marked basal or perivillous fibrin deposition, increased syncytial knots) were inversely related to those associated with inflammation of the membranes and cord. Earlier age favoured inflammatory variables, while older age favoured characteristics attributed to impaired blood flow. We observed inflammation of the chorionic plate in 43%, the cord in 19%, and of chorionic plate vessels in 30%. Of the placentas with umbilical cord inflammation, 8% had no inflammation of the chorionic plate. CONCLUSIONS This study population is unique in its size and recruitment by gestational age rather than birth weight. Inflammation occurred frequently, but not in placentas that had characteristics of vasculopathy. The prevalence of inflammation decreased with increasing gestational age, while vasculopathy increased. Funisitis need not be accompanied by chorionic inflammation.
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Affiliation(s)
- Jonathan L Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02118, USA.
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Styer AK, Wright DL, Wolkovich AM, Veiga C, Toth TL. Single-blastocyst transfer decreases twin gestation without affecting pregnancy outcome. Fertil Steril 2008; 89:1702-8. [PMID: 17644095 DOI: 10.1016/j.fertnstert.2007.05.036] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Revised: 05/24/2007] [Accepted: 05/24/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the respective pregnancy outcomes of cycles undergoing fresh elective single-blastocyst transfer (eSBT) and double-blastocyst transfer (DBT) after IVF. DESIGN Retrospective medical record review. SETTING Academic medical center. PATIENT(S) Couples undergoing fresh blastocyst transfer after IVF. INTERVENTION(S) One thousand, four hundred, ninety-nine consecutive IVF cycles from January 1, 2002 through March 31, 2006 at the Massachusetts General Hospital Fertility Center were reviewed. Patients undergoing fresh blastocyst transfer (eSBT, n = 52; DBT, n = 187) were identified. MAIN OUTCOME MEASURE(S) Respective pregnancy outcomes and the trend in twin gestations in all cycles undergoing blastocyst transfer, before and after the introduction of the eSBT program. RESULT(S) Statistically similar rates of biochemical pregnancy (76.9% vs. 77.6%), clinical pregnancy (61% vs. 63.4%), live birth (53.8% vs. 54.4%), and pregnancy loss (20% vs. 18.6%) per embryo transfer were observed for fresh eSBT and DBT cycles, respectively. Twin rates for eSBT were statistically significantly lower than for DBT cycles (3.1% vs. 51%). Fresh eSBT and DBT cryopreserved 2.8 vs. 1.7 blastocysts per cycle, respectively. Twenty-four months after the start of eSBT, the twin rate per transfer for all cycles undergoing blastocyst transfer (1, 2, or 3 blastocysts) was statistically significantly reduced from 47.2% to 22.9%, whereas the twin rate per transfer for all embryo transfers in women younger than 35 years of age was statistically significantly reduced from 28.8% to 15.6%. CONCLUSION(S) Given the promising potential of eSBT to markedly reduce the risk of twin gestation without a significant compromise to pregnancy outcomes, an active attempt should be made to consider and use eSBT in the young, favorable-prognosis patient who has good-quality embryos available for transfer and cryopreservation.
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Affiliation(s)
- Aaron K Styer
- The Fertility Center, Vincent Memorial Obstetrics and Gynecology Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
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de Melo-Martin I, Cholst IN. Researching human oocyte cryopreservation: ethical issues. Fertil Steril 2008; 89:523-8. [PMID: 17511993 DOI: 10.1016/j.fertnstert.2007.03.039] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Revised: 03/09/2007] [Accepted: 03/13/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate some ethical concerns related to the selection of participants for oocyte cryopreservation research. DESIGN Review of ethical issues related to human oocyte cryopreservation research. SETTING Academic medical center. PATIENT(S) None. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) A discussion of some ethical concerns surrounding selection of participants for oocyte cryopreservation research. RESULT(S) Human oocyte cryopreservation has the potential to expand reproductive options for infertile couples. Care needs to be taken, however, to carefully select participants in ways that maximizes benefits to them and to society and minimizes risks. Infertility programs can do so by trying to recruit women who stand to benefit the most from participating in oocyte cryopreservation protocols. CONCLUSION(S) Biomedical research is necessary to improve current medical therapies. Oocyte cryopreservation can increase the flexibility of assisted reproductive programs and offer hope to a significant number of infertile couples. Nonetheless, scientific research cannot be attentive only to the creation of new knowledge and new technologies; it also is inextricably tied to ethical considerations about the well-being of participants.
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Affiliation(s)
- Inmaculada de Melo-Martin
- Division of Medical Ethics, Department of Public Health, Weill Medical College of Cornell University, New York, New York 10021, USA.
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Hunt PA, Hassold TJ. Human female meiosis: what makes a good egg go bad? Trends Genet 2008; 24:86-93. [PMID: 18192063 DOI: 10.1016/j.tig.2007.11.010] [Citation(s) in RCA: 241] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Revised: 11/19/2007] [Accepted: 11/19/2007] [Indexed: 11/26/2022]
Abstract
Critical events of oogenesis occur during three distinct developmental stages: meiotic initiation in the fetal ovary, follicle formation in the perinatal period, and oocyte growth and maturation in the adult. Evidence from studies in humans and mice suggests that the genetic quality of the egg may be influenced by events at each of these stages. Recent experimental studies add additional complexity, suggesting that environmental influences might adversely affect all three stages. Thus, understanding the molecular control of oogenesis during these critical developmental windows will not only contribute to an understanding of human aneuploidy, but also provide a means of assessing potential effects of environmental exposures on human reproductive health.
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Affiliation(s)
- Patricia A Hunt
- School of Molecular Biosciences and Center for Reproductive Biology, Washington State University, Pullman, WA 99164-4660, USA.
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Moustafa MK, Sheded SA, El Aziz Mousta MA. Elective single embryo transfer versus double embryo transfer in assisted reproduction. Reprod Biomed Online 2008; 17:82-7. [PMID: 18616895 DOI: 10.1016/s1472-6483(10)60297-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
OBJECTIVE To evaluate the relation of a dietary pattern and other lifestyle practices to risk of ovulatory disorder infertility. METHODS We followed a cohort of 17,544 women without a history of infertility for 8 years as they tried to become pregnant or became pregnant. A dietary score based on factors previously related to lower ovulatory disorder infertility (higher consumption of monounsaturated rather than trans fats, vegetable rather than animal protein sources, low glycemic carbohydrates, high fat dairy, multivitamins, and iron from plants and supplements) and other lifestyle information was prospectively related to the incidence of infertility. RESULTS Increasing adherence to a "fertility diet" pattern was associated with a lower risk of ovulatory disorder infertility. The multivariable-adjusted relative risk of ovulatory disorder infertility comparing women in the highest with women in the lowest quintile of the "fertility diet" pattern score was 0.34 (95% confidence interval 0.23-0.48; P for trend<.001). This inverse relation was similar in subgroups defined by women's age, parity, and body weight. A combination of five or more low-risk lifestyle factors, including diet, weight control, and physical activity was associated with a 69% lower risk of ovulatory disorder infertility and an estimated population attributable risk of 66% (95% confidence interval 29-86%). CONCLUSION Following a "fertility diet" pattern may favorably influence fertility in otherwise healthy women. Further, the majority of infertility cases due to ovulation disorders may be preventable through modifications of diet and lifestyle. LEVEL OF EVIDENCE II.
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Bresee JM, Nagler HM. Is cryopreservation of sperm effective for preserving fertility in adolescents and young adults with cancer? ACTA ACUST UNITED AC 2007; 5:14-5. [DOI: 10.1038/ncpuro0967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Accepted: 10/02/2007] [Indexed: 11/09/2022]
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Ho JT, Lewis JG, O'Loughlin P, Bagley CJ, Romero R, Dekker GA, Torpy DJ. Reduced maternal corticosteroid-binding globulin and cortisol levels in pre-eclampsia and gamete recipient pregnancies. Clin Endocrinol (Oxf) 2007; 66:869-77. [PMID: 17437519 DOI: 10.1111/j.1365-2265.2007.02826.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To measure and contrast maternal cortisol and corticosteroid-binding globulin (CBG) levels in pregnancies with normal outcomes, pre-eclampsia, intrauterine growth restriction (IUGR) and in gamete recipients. STUDY DESIGN Prospective study of 93 women at high risk of pre-eclampsia, including gamete recipients (n = 22) and 33 controls. Plasma total and free cortisol and CBG were measured every 2 weeks from 16 weeks' gestation until delivery. RESULTS Forty-two per cent of the high-risk group had complications, including pre-eclampsia (n = 11), gestational hypertension (n = 16) and small-for-gestational-age (SGA) neonates (n = 12). There were no complications in the controls. In all groups, plasma CBG concentrations increased progressively across gestation (P < 0.05), in parallel to total cortisol, but fell significantly from 36 weeks' gestation onwards, with a corresponding rise in free cortisol concentrations. In pre-eclampsia and gestational hypertension, plasma CBG, and total and free cortisol concentrations were lower from 36 weeks onwards (P < 0.05). In IUGR, plasma CBG concentrations were suppressed from 28 weeks' gestation until delivery (P < 0.05), but with no significant difference in plasma total and free cortisol. Gamete recipients had significantly lower plasma CBG from 20 weeks' gestation onwards, and plasma total and free cortisol were reduced at 24 and 32 weeks onwards, respectively. CONCLUSIONS Maternal plasma CBG, total and free cortisol concentrations are reduced in pre-eclampsia/gestational hypertension, and markedly reduced in gamete recipients. Low CBG may be due to reduced synthesis or enhanced inflammation-driven degradation. Low maternal cortisol may be due to a lack of placental corticotropin-releasing hormone or reduced maternal ACTH, driving cortisol production. Low maternal cortisol may influence the foetal hypothalamic-pituitary-adrenal axis and disease patterns later in life following complicated pregnancy.
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Affiliation(s)
- Jui T Ho
- Hanson Institute, University of Adelaide, and Endocrine and Metabolic Unit of the Royal Adelaide Hospital, Adelaide, South Australia, Australia.
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Effectiveness and treatment for unexplained infertility. Fertil Steril 2007; 86:S111-4. [PMID: 17055802 DOI: 10.1016/j.fertnstert.2006.07.1475] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2006] [Revised: 07/21/2006] [Accepted: 09/05/2006] [Indexed: 10/24/2022]
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Sipe CS, Davis WA, Maifeld M, Van Voorhis BJ. A prospective randomized trial comparing anastrozole and clomiphene citrate in an ovulation induction protocol using gonadotropins. Fertil Steril 2006; 86:1676-81. [PMID: 17007849 DOI: 10.1016/j.fertnstert.2006.05.048] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2006] [Revised: 05/12/2006] [Accepted: 05/12/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare the ovarian and endometrial effects of anastrozole and clomiphene when used with gonadotropins in a combination protocol. DESIGN Prospective randomized trial. SETTING Academic infertility center. PATIENT(S) Fifty infertile women. INTERVENTIONS(S) Women were randomized to receive either 1 mg anastrozole or 100 mg clomiphene citrate for 5 days (cycle days 3-7) followed by FSH injections (days 7-11) for ovulation induction. A subset participated in a crossover arm of the study. MAIN OUTCOME MEASURE(S) Ovarian follicle number and size, E(2) levels, endometrial thickness, pregnancy, and cancellation rates. RESULT(S) On cycle day 12, anastrozole cycles were associated with fewer total follicles (1.4 vs. 3.6, P=0.01), fewer mature follicles (0.6 vs. 1.6, P<.01), lower serum E(2) (131 pg/mL vs. 613 pg/mL, P<.01,) and the same endometrial stripe thickness compared with clomiphene citrate cycles. Cycle cancellation rates were similar between the two groups. On the day of hCG administration in noncancelled cycles, anastrozole cycles were associated with fewer total follicles (1.6 vs. 3.8, P<.01), fewer mature follicles (1.3 vs. 2.1, P<.01), and an equal endometrial stripe thickness compared with clomiphene citrate cycles. Pregnancy rates were similar between clomiphene (20%) and anastrozole (12%) cycles. CONCLUSION(S) Anastrozole when used in conjunction with gonadotropins results in lower E(2) levels and fewer follicles than clomiphene citrate. A combination protocol of anastrozole and gonadotropins may be a safer protocol for patients at higher risk of hyperstimulation and multiple births after infertility treatments.
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Affiliation(s)
- Christopher S Sipe
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242-1080, USA.
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Chavez-Badiola A, Drakeley A. Optimising in vitro fertilisation (IVF) outcome in women with endometriosis. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.rigapp.2006.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Gupta S, Agarwal A, Agarwal R, Loret de Mola JR. Impact of ovarian endometrioma on assisted reproduction outcomes. Reprod Biomed Online 2006; 13:349-60. [PMID: 16984764 DOI: 10.1016/s1472-6483(10)61439-3] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The effects of ovarian endometrioma on fertility outcomes with IVF and embryo transfer have been causally related to poor outcomes. The objective of this meta-analysis was to evaluate the ovarian reserve and ovarian responsiveness to ovarian stimulation and assisted reproduction outcomes in patients with ovarian endometrioma. The odds for clinical pregnancy were not affected significantly in patients with ovarian endometrioma compared with controls, with an overall odds ratio of 1.07 from three studies [95% CI: (0.63, 1.81), P = 0.79]. The overall pregnancy rate was similar with an estimated odds ratio of 1.17 [95% CI: (0.85, 1.60), P = 0.34]. Decreased ovarian responsiveness to ovarian stimulation in patients with ovarian endometrioma may be due to a reduced number of follicles in these patients compared with controls (P = 0.002). Prospective randomized controlled trials are needed to assess whether surgical treatment versus no surgical treatment improves pregnancy outcomes in patients with ovarian endometrioma undergoing assisted reproduction cycles.
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Affiliation(s)
- Sajal Gupta
- Reproductive Research Centre, Glickman Urological Institute and the Department of Obstetrics-Gynecology, Cleveland Clinic Foundation, Cleveland, OH, USA.
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