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Wang T, Zhu L, Yin M, Yu W, Dong J, Jin W, Lyu Q, Jin L, Long H. Sex ratio shift after frozen single blastocyst transfer in relation to blastocyst morphology parameters. Sci Rep 2024; 14:9539. [PMID: 38664459 PMCID: PMC11045847 DOI: 10.1038/s41598-024-59939-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
The sex ratio shift was observed in peoples who underwent ART treatment. Moreover, there is limited evidence on differences in sex ratio between single frozen-thawed blastocyst morphology, insemination type and transfer days. So further research is needed in this area with regard to factors possibly affecting the sex ratio. Retrospective study based on multicenter including two large assisted reproduction centers in Shanghai and Wuhan in China. A total of 6361 singleton delivery offspring after frozen-thawed blastocyst transfer. Propensity score weighting and logistic regression models were used to estimate the associations between blastocyst morphology grading and child sex ratio. The main outcome measures is singleton sex ratio. In our study, the primary outcome measure was sex ratio which was calculated as the proportion of male newborns among all live births. Higher quality blastocysts resulted in a higher sex ratio than single poor-quality frozen-thawed blastocyst transfer. Among the three blastocyst morphological parameters of trophectoderm (TE), Grade A and B were significantly associated with a higher sex ratio than Grade C. The similar trend was observed in both IVF and ICSI treated subgroups. As compared with expansion (4 + 3), expansion degree 6 achieved a higher sex ratio in overall populations and IVF treated subgroup. Transferring blastocysts of day 6 had the highest sex ratio both in IVF group and ICSI group. A 6.95% higher sex ratio in transferring blastocysts of day 5 in IVF group than those in ICSI group. No significant association between inner cell mass degree and sex ratio was observed. However, as compared with IVF treatment, all morphology parameters achieved the similar or the biased sex ratio favoring female in ICSI treated subgroup. Quality of blastocysts was positively associated with sex ratio. TE score and expansion degree rather than ICM were significantly associated with sex ratio at birth. ICSI treatment promotes the biased sex ratio favoring female.
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Affiliation(s)
- Tiantian Wang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Lixia Zhu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 300559, China
| | - Mingru Yin
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Weina Yu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Jing Dong
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Wei Jin
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Qifeng Lyu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Lei Jin
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 300559, China.
| | - Hui Long
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
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2
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Long C, Benny P, Yap J, Lee J, Huang Z. A Systematic Review of Genetics and Reproductive Health Outcomes: Asian Perspective. Reprod Sci 2024; 31:309-319. [PMID: 37524971 DOI: 10.1007/s43032-023-01311-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/14/2023] [Indexed: 08/02/2023]
Abstract
In the last four decades, advances in assisted reproductive technology (ART) have offered hope to individuals with fertility problems to conceive. However, a closer examination of the clinical outcomes of ART shows a stark contrast in Asian women compared to Caucasians, with majority of studies reporting lower reproductive success among Asian women. We performed a systematic review to elucidate the genes associated with ART clinical outcomes, with a focus on Asian ethnicities. We completed a database search to identify all studies associated with reproductive outcomes in women of different ethnic backgrounds. Following PRISMA, 128 studies were analyzed. Pathway analysis of gene sets was done using Cytoscapev3.4.0. We observed that age at menarche (AAM) was correlated with the timing of the first pregnancy, with Hawaiians having the lowest age (22.2 years) and Japanese the highest age (25.0 years). LIN28 mutations were associated with AAM and prevalent in both Chinese and American populations. FMR1 was most associated with ovarian reserve. Network analysis highlighted a close association between FMR1, FSHR, ESR1, BMP15, and INHA, through biological functions affecting menstrual cycle and hypothalamic-pituitary axis and therefore ovarian follicle development. Leveraging these findings, we propose the development of a personalized, ethnic-specific biomarker panel which would enhance patient stratification to address every woman's unique reproductive potential.
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Affiliation(s)
- Cheryl Long
- Department of Obstetrics and Gynaecology, National University Hospital, National University of Singapore, 1E Kent Ridge Rd, Level 12 NUHS Tower Block, Singapore, 119228, Singapore
| | - Paula Benny
- Department of Obstetrics and Gynaecology, National University Hospital, National University of Singapore, 1E Kent Ridge Rd, Level 12 NUHS Tower Block, Singapore, 119228, Singapore
- NUS Bia-Echo Asia Centre of Reproductive Longevity and Equality, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jeannie Yap
- Department of Obstetrics and Gynaecology, National University Hospital, National University of Singapore, 1E Kent Ridge Rd, Level 12 NUHS Tower Block, Singapore, 119228, Singapore
| | - Jovin Lee
- Department of Obstetrics and Gynaecology, National University Hospital, National University of Singapore, 1E Kent Ridge Rd, Level 12 NUHS Tower Block, Singapore, 119228, Singapore
- NUS Bia-Echo Asia Centre of Reproductive Longevity and Equality, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Zhongwei Huang
- Department of Obstetrics and Gynaecology, National University Hospital, National University of Singapore, 1E Kent Ridge Rd, Level 12 NUHS Tower Block, Singapore, 119228, Singapore.
- NUS Bia-Echo Asia Centre of Reproductive Longevity and Equality, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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3
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Ip PNP, Mak JSM, Law TSM, Ng K, Chung JPW. A reappraisal of ovarian stimulation strategies used in assisted reproductive technology. HUM FERTIL 2023; 26:824-844. [PMID: 37980170 DOI: 10.1080/14647273.2023.2261627] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/10/2023] [Indexed: 11/20/2023]
Abstract
Ovarian stimulation is a fundamental step in assisted reproductive technology (ART) with the intention of inducing ovarian follicle development prior to timed intercourse or intra-uterine insemination and facilitating the retrieval of multiple oocytes during a single in vitro fertilization (IVF) cycle. The basis of ovarian stimulation includes the administration of exogenous gonadotropins, with or without pre-treatment with oral hormonal therapy. Gonadotropin-releasing hormone agonist or antagonist is given in addition to the gonadotropins to prevent a premature rise of endogenous luteinizing hormone that would in turn lead to premature ovulation. With the advancement in technology, various stimulation protocols have been devised to cater for different patient needs. However, ovarian hyperstimulation syndrome and its serious complications may occur following ovarian stimulation. It is also evident that suboptimal ovarian stimulation strategies may have a negative impact on oogenesis, embryo quality, endometrial receptivity, and reproductive outcomes over recent years. This review describes the various forms of pre-treatment for ovarian stimulation and stimulation protocols, and aims to provide clinicians with the latest available evidence.
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Affiliation(s)
- Patricia N P Ip
- Assisted Reproductive Technology, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jennifer S M Mak
- Assisted Reproductive Technology, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tracy S M Law
- Assisted Reproductive Technology, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Karen Ng
- Assisted Reproductive Technology, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jacqueline P W Chung
- Assisted Reproductive Technology, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
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Henderson I, Lacey L, Akhtar MA, Quenby S. Ethnic group and reason for assisted reproductive technology failure: analysis of the Human Fertilisation and Embryology Authority registry data from 2017 to 2018. Fertil Steril 2023; 119:241-249. [PMID: 36370887 DOI: 10.1016/j.fertnstert.2022.11.005] [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: 06/08/2022] [Revised: 11/03/2022] [Accepted: 11/03/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To understand how the risk of different assisted reproductive technology (ART) failure types varies by ethnic group and explore the role of mediation by maternal age and suspected etiology. DESIGN An observational study of 48,750 women who undertook treatment with ART in the United Kingdom between January 2017 and December 2018. SETTING The Human Fertilisation and Embryology Authority national ART registry of the United Kingdom. PATIENT(S) Women who commenced a first cycle of ART for the purpose of primary fresh embryo transfer using their own oocytes were included. INTERVENTION(S) Maternal ethnic group. MAIN OUTCOME MEASURE(S) The ART failure types were modeled on the maternal ethnic group using the Poisson regression to produce relative risks (RRs) with 95% confidence intervals. The potential indirect effects of maternal age and etiology of subfertility were estimated, and the RRs with 95% confidence intervals were produced. RESULT(S) Black women were at greater risk of treatment failure with respect to live birth than women who were white: cycle cancellation, RR of 2.15 (1.78-2.62); failed fertilization, RR of 2.36 (1.90-2.93); unintended freeze-all, RR of 1.71 (1.43-2.05); failed implantation, RR of 1.23 (1.12-1.34); and pregnancy loss, RR of 1.38 (1.15-1.64). Women who were Asian were at moderately increased risk: RRs of 1.31 (1.17-1.47), 1.60 (1.42-1.80), 1.25 (1.14-1.38), 1.11 (1.07-1.16), and 1.13 (1.03-1.23), across the same outcomes, respectively. Inequality may have been reduced had women of all ethnicities initiated treatment at the same age. CONCLUSION(S) Black women were at greatest risk of all failure types, and women who were Asian were at intermediate risk compared with women who were white. Some of the risks among women who were black may be mediated by maternal age.
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Affiliation(s)
- Ian Henderson
- Warwick Medical School, University of Warwick, Coventry, United Kingdom.
| | - Lauren Lacey
- Warwick Medical School, University of Warwick, Coventry, United Kingdom; Department of Obstetrics and Gynaecology, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Muhammad Ahsan Akhtar
- St Mary's Hospital Manchester, Manchester University Foundation Trust, Oxford Road, Manchester, United Kingdom; Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, United Kingdom
| | - Siobhan Quenby
- Warwick Medical School, University of Warwick, Coventry, United Kingdom; Department of Obstetrics and Gynaecology, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
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Doroftei B, Ilie OD, Anton N, Marcu OA, Scripcariu IS, Ilea C. A Narrative Review Discussing the Efficiency of Personalized Dosing Algorithm of Follitropin Delta for Ovarian Stimulation and the Reproductive and Clinical Outcomes. Diagnostics (Basel) 2023; 13:177. [PMID: 36672987 PMCID: PMC9858569 DOI: 10.3390/diagnostics13020177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/24/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
Background: Follitropin delta is the third recombinant human follicle-stimulating hormone (r-hFSH) expressed in a host cell line of human fetal retinal origin that currently emphasizes that the actual tendency of administration is a personalized dosing algorithm based on the anti-Müllerian hormone (AMH) and body mass index (BMI) for ovarian stimulation. Methods: In this context, we aimed, in the present manuscript, to gather all available data published between 2018-2022 regarding the co-administration and administration of follitropin delta and the clinical outcomes reported following an in vitro fertilization (IVF). Results: Follitropin delta is non-inferior in contrast to its previously launched agents for ovarian stimulation, enhancing a similar-to-superior response reflected by both the reproductive and pregnancy outcomes in parallel with a low risk of ovarian hyperstimulation syndrome (OHSS), being well tolerated. The body weight and AMH level are factors that may influence the outcome in a patient. Despite controversy and results that refute these arguments on several occasions, follitropin delta exceeds the benefits of conventional dosing with either follitropin alfa or follitropin beta. Thus, all post hoc, derived analyses and subsets of patients that participated in subsequent studies support this statement. Conclusions: Despite the relatively limited spectrum of data in the current literature, most authors brought potent proof, supporting the subsequent use of this drug depending on the patient's profile and overcoming ethnic-related limitations. Although others contradict these observations, this topic and drug possess substantial potential, which is why additional studies are mandatory to fill the existing gaps in our knowledge and expand these experiences at a larger scale supported by the obtained reproductive and clinical outcomes that clearly indicate an overcoming of all limitations.
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Affiliation(s)
- Bogdan Doroftei
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, no 16, 700115 Iasi, Romania
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, no 34, 700038 Iasi, Romania
- Origyn Fertility Center, Palace Street, no 3C, 700032 Iasi, Romania
| | - Ovidiu-Dumitru Ilie
- Department of Biology, Faculty of Biology, “Alexandru Ioan Cuza” University, Carol I Avenue, no 20A, 700505 Iasi, Romania
| | - Nicoleta Anton
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, no 16, 700115 Iasi, Romania
| | - Olivia-Andreea Marcu
- Department of Preclinics, Faculty of Medicine and Pharmacy, University of Oradea, December 1 Market Street, no 10, 410068 Oradea, Romania
| | - Ioana-Sadyie Scripcariu
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, no 16, 700115 Iasi, Romania
| | - Ciprian Ilea
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, no 16, 700115 Iasi, Romania
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, no 34, 700038 Iasi, Romania
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Handal-Orefice RC, McHale M, Friedman AM, Politch JA, Kuohung W. Impact of race versus ethnicity on infertility diagnosis between Black American, Haitian, African, and White American women seeking infertility care: a retrospective review. F S Rep 2022; 3:22-28. [PMID: 35937451 PMCID: PMC9349228 DOI: 10.1016/j.xfre.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/21/2021] [Accepted: 11/01/2021] [Indexed: 11/24/2022] Open
Abstract
Objective To determine whether infertility diagnoses differ between Black ethnic subgroups. Design Retrospective review. Setting an urban safety-net hospital. Patient(s) Women seeking infertility care between 2005 and 2015. Intervention(s) Charts of women with infertility and polycystic ovary syndrome (International Classification of Diseases, Ninth Revision diagnoses) were reviewed to confirm diagnoses. Data were stratified by race and subsequently by ethnicity to evaluate the differences in infertility diagnoses between Black American, Black Haitian, and Black African women. White American women were used as the comparison group. Main Outcome Measure(s) Infertility diagnoses between Black ethnic subgroups and White women. Result(s) A total of 358 women met the inclusion criteria, including 99 Black American, 110 Black Haitian, 61 Black African, and 88 White American women. Anovulation/polycystic ovary syndrome was the most common diagnosis in each ethnic group, accounting for 40% of infertility among White American, 57% among Black American, 25% among Black Haitian, and 21% among Black African women. There were no significant differences in the individual infertility diagnoses between Black and White women. Between ethnic subgroups, multivariate analysis showed significantly higher odds of infertility because of anovulation/polycystic ovary syndrome in Black American women compared with Black African women (odds ratio [OR], 4.9; 95% confidence interval [CI], 1.4–17.0). Compared with Black African women, higher odds of tubal factor infertility were observed in Black American (OR, 4.7; 95% CI, 1.16–18.7) and Black Haitian women (OR, 4.0; 95% CI, 1.1–14.0). Conclusion(s) Infertility diagnoses were not homogeneous across Black ethnic groups. Studies examining infertility should specify the ethnic subgroups within a race because this may affect results.
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Affiliation(s)
- Roxane C. Handal-Orefice
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts
- Department of Obstetrics and Gynecology, Slocum Dickson Medical Group, New Hartford, New York
- Reprint requests: Roxane Handal-Orefice, M.D., M.A.-M.P.H., Department of Obstetrics and Gynecology, Slocum Dickson Medical Group, New Hartford, New York 10025.
| | - Melissa McHale
- Department of Obstetrics and Gynecology, Johns Hopkins University, Baltimore, Maryland
| | - Alexander M. Friedman
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Joseph A. Politch
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts
| | - Wendy Kuohung
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts
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7
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Jirge PR, Patil MM, Gutgutia R, Shah J, Govindarajan M, Roy VS, Kaul-Mahajan N, Sharara FI. Ovarian Stimulation in Assisted Reproductive Technology Cycles for Varied Patient Profiles: An Indian Perspective. J Hum Reprod Sci 2022; 15:112-125. [PMID: 35928474 PMCID: PMC9345274 DOI: 10.4103/jhrs.jhrs_59_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/10/2022] Open
Abstract
Controlled ovarian stimulation has been an integral part of in vitro fertilisation (IVF) treatment cycles. Availability of different gonadotropins for ovarian stimulation and gonadotropin releasing hormone (GnRH) analogues for prevention of premature rise of leutinising hormone during follicular phase offer an opportunity to utilise them for a successful outcome in women with different subsets of ovarian response. Further, use of GnRH agonist as an alternative for human chorionic gonadotropin improves safety of ovarian stimulation in hyper-responders. Mild ovarian stimulation protocols have emerged as an alternative to conventional protocols in the recent years. Individualisation plays an important role in improving safety of IVF in hyper-responders while efforts continue to improve efficacy in poor responders. Some of the follicular and peri-ovulatory phase interventions may be associated with negative impact on the luteal phase and segmentalisation of the treatment with frozen embryo transfer may be an effective strategy in such a clinical scenario. This narrative review looks at the available evidence on various aspects of ovarian stimulation strategies and their consequences. In addition, it provides a concise summary of the evidence that has emerged from India on various aspects of ovarian stimulation.
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Affiliation(s)
- Padma Rekha Jirge
- Shreyas Hospital and Sushrut Assisted Conception Clinic, Kohlhapur, India
| | | | | | - Jatin Shah
- Mumbai Fertility Clinic & IVF Centre, Mumbai, India
| | | | | | | | - Faddy I Sharara
- Virginia Center for Reproductive Medicine, Reston; Department of O&G, George Washington University, Washington, DC, USA
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8
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Current Applications of Machine Learning in Medicine: ART. Artif Intell Med 2022. [DOI: 10.1007/978-981-19-1223-8_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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9
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Ko JKY, Kan A, Leung P, Lee VCY, Li RHW, Ledger W, Ng EHY. Comparison of the number of oocytes obtained after ovarian stimulation between Chinese and Caucasian women undergoing in vitro fertilization using a standardized stimulation regime. J Ovarian Res 2021; 14:175. [PMID: 34895264 PMCID: PMC8666011 DOI: 10.1186/s13048-021-00928-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/17/2021] [Indexed: 12/02/2022] Open
Abstract
Background In vitro fertilization (IVF) is a well-established method to treat various causes of infertility. Some previous retrospective studies suggested a lower ovarian response in Asian women compared to Caucasian women. However, the ovarian stimulation regimens were not standardized, potentially confounding the findings. The objective of this study is to compare the number of oocytes obtained after ovarian stimulation between Chinese and Caucasian women undergoing IVF using a standardized stimulation regimen. Methods This is a prospective cohort study conducted in two tertiary IVF units in Hong Kong, China and Sydney, Australia from October 2016 to August 2019. A total of 192 women aged 18–42 years with a body weight > 60 kg underwent IVF with a standard ovarian stimulation regimen of 150 micrograms corifollitropin alfa (Elonva®) followed by 200 IU follitropin beta (Puregon®) per day. The number of oocytes retrieved in Chinese women treated in the Hong Kong center was compared to that of Caucasian women treated in the Australian center. Results Serum AMH levels were similar between the two groups. Although women in the Chinese cohort were older and had a higher body mass index (BMI), longer duration of infertility and lower antral follicle count (AFC) than those in the Caucasian cohort in this study, no differences in the number of oocytes retrieved [11 (8–17) vs. 11 (6–17), p=0.29], total dosage and duration of stimulation and number of follicles aspirated were noted between the two ethnic cohorts. The peak estradiol level was greater in Chinese women than in Caucasian women. After controlling for age, BMI and AFC, ethnicity was a significant independent determinant of the number of oocytes obtained. Conclusions Chinese women had a higher number of oocytes after ovarian stimulation using a standardized stimulation regimen compared with Caucasian women undergoing IVF after controlling for age, BMI, AFC and AMH despite presenting later after a longer duration of infertility. Trial registration number: NCT02748278
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Affiliation(s)
- Jennifer K Y Ko
- Department of Obstetrics and Gynecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
| | - Andrew Kan
- IVF Australia, Sydney, Australia.,Discipline of Obstetrics and Gynecology, School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Peter Leung
- IVF Australia, Sydney, Australia.,Department of Obstetrics and Gynecology, The University of Sydney, Sydney, Australia
| | - Vivian C Y Lee
- Department of Obstetrics and Gynecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.,Premier Medical Centre, Hong Kong, China
| | - Raymond H W Li
- Department of Obstetrics and Gynecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - William Ledger
- IVF Australia, Sydney, Australia.,Discipline of Obstetrics and Gynecology, School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Ernest H Y Ng
- Department of Obstetrics and Gynecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
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10
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Messinis IE, Messini CI, Anifandis GM, Daponde A, Mukhopadhyay S, Mahmood T. EBCOG position statement: Inequality in fertility treatment in people of colour. Eur J Obstet Gynecol Reprod Biol 2021; 266:74-76. [PMID: 34598026 DOI: 10.1016/j.ejogrb.2021.09.021] [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: 11/29/2022]
Abstract
Despite advances in promoting sexual and reproductive rights by the United Nations, WHO and UNFPA, inequities in the provision of health care for women exist and are influenced by the socioeconomic status and the ethnicity and the migrant status. Of late, Human Fertility and Embryology Authority (HFEA) of the United Kingdom has identified that inequities exists in quality, accessibility and outcomes of fertility services for people of colour in the UK. EBCOG calls upon the EU Commission to set up a monitoring system akin to HFEA to ensure that all citizens of Europe not only enjoy equitable access to fertility treatments but also the outcomes of interventions meet the highest standards of care.
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Affiliation(s)
- Ioannis E Messinis
- Department of Obstetrics & Gynaecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; European Board and College of Obstetrics & Gynaecology (EBCOG), Belgium
| | - Christina I Messini
- Department of Obstetrics & Gynaecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Georgios M Anifandis
- Department of Obstetrics & Gynaecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Alexandros Daponde
- Department of Obstetrics & Gynaecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Sambit Mukhopadhyay
- Department of Obstetrics and Gynaecology, Norfolk and Norwich University Hospital, Norwich, UK; European Board and College of Obstetrics & Gynaecology (EBCOG), Belgium
| | - Tahir Mahmood
- Department of Obstetrics & Gynaecology, Victoria Hospital, Kirkcaldy, Scotland, UK; European Board and College of Obstetrics & Gynaecology (EBCOG), Belgium.
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11
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Disparities in ART Live Birth and Cumulative Live Birth Outcomes for Hispanic and Asian Women Compared to White Non-Hispanic Women. J Clin Med 2021; 10:jcm10122615. [PMID: 34198545 PMCID: PMC8231797 DOI: 10.3390/jcm10122615] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND: Conflicting disparities have been seen in assisted reproductive technology (ART) outcomes for Hispanic and Asian women compared to white, non-Hispanic (WNH) women. We, therefore, sought to clarify these disparities and calculated cumulative live birth rates (CLBR) for these racial or ethnic groups using the SARTCORS database. METHODS: We performed an analysis of the 2014–2016 SARTCORS database for member clinics doing at least 50 cycles of ART each year. RESULTS: In comparison to cycles in WNH women, cycles in Hispanic and Asian patients were in older (p < 0.001), more nulliparous women, that were less likely to have a history of endometriosis compared WNH women regardless of prior ART status. ART cycles in Hispanic and Asian women, exhibited lower rates of live birth (LB) per cycle start (p < 0.001) compared to cycles in WNH women. Multivariate logistic regression demonstrated that cycles from Hispanic and Asian women were less likely to have a LB and CLBR than white women (OR 0.86; p = 0.004, OR 0.69; p < 0.001, respectively) independent of age, parity, BMI, etiology of infertility, use of ICSI or number of embryos transferred. CONCLUSIONS: Race or ethnicity continues to be an independent prognostic factor for LB and CLBR for ART. Additional analysis of trends among Hispanic and Asian women is warranted to enable addressing disparities in outcomes in ART treatment.
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12
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Racializing infertility: How South/Asian-ness has been constituted as an independent risk factor in infertility research and IVF practice. Soc Sci Med 2021; 280:114008. [PMID: 34051559 DOI: 10.1016/j.socscimed.2021.114008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/23/2022]
Abstract
Since the 1990s, scientific studies have explored possible correlations of "race/ethnicity" with ovarian aging and, by extension, the outcome of In Vitro Fertilization (IVF) procedures. Relying on a close reading of English-language scientific publications about "Asian" or "South Asian" women, corroborated by interviews with selected authors in 2018 and 2021 as well as ethnographic research in India conducted between 2010 and 2017, I analyze processes and practices of racializing infertility over time and across space. In a first step, I explore the socio-political configurations through which South/Asian race/ethnicity became a relevant variable in infertility research between the 1990s and 2010s. Further, I interrogate how South/Asian race/ethnicity has been scientifically mobilized and problematized by examining publications from the US, the UK, and India/Spain. I argue that South/Asian race/ethnicity has been constituted as an independent risk factor for ovarian aging and/or IVF outcome by invisibilizing possible alternative explanations for inequalities with regard to infertility and by establishing comparability and continuity between contexts. Inquiring why researchers actively try to make a seemingly universal notion of South/Asian race/ethnicity present in their work, I point to global scientific hierarchies and postcolonial power dynamics that characterize this body of literature. Finally, I explore the implications that the notion of South/Asian-ness as risk has in medical practice in India and illustrate how it contributes to bringing the (in)fertility of bodies racialized as "South Asian" into new realms of capital accumulation.
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Sharpe A, Mascarenhas M, Balen A. Ethnic variation in the live birth rate and perinatal outcomes following frozen embryo transfer: an analysis of the HFEA database from 2000 to 2016. HUM FERTIL 2021; 25:583-592. [PMID: 33902383 DOI: 10.1080/14647273.2021.1913291] [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: 10/21/2022]
Abstract
The literature suggests that ethnicity affects live birth rate (LBR) and preterm birth (PTB) rate after fresh but not frozen embryo transfer (FET). We analysed 64,530 FET cycles from 2000 to 2016 using the Human Fertilisation and Embryology Authority (HFEA) database. Ethnicity was recorded for 43,735 as White British, 3,034 as Indian, 1,946 as Pakistani, 1,400 as Black African, 1,090 as White Irish, 520 as Chinese, 319 as Bangladeshi and 277 as Black Caribbean women. The LBR per FET when compared with White British women (26.1%) was significantly reduced in women of White Irish (23.4%; adjusted Odds Ratio (aOR) 0.85, 95% CI 0.73 to 1.00), Indian (25.2%; aOR 0.95, 95% CI 0.91 to 0.99), Bangladeshi (21.1%; aOR 0.87, 95% CI 0.79 to 0.95) and Pakistani (25.7%; aOR 0.97, 95% CI 0.94 to 0.99) ethnicities. The PTB rate, when compared with White British women (8.4%) was significantly higher for women of Indian (11.1%; aOR 1.38, 95% CI 1.06 to 1.79), Pakistani (11.8%; aOR 1.49, 95% CI 1.09 to 2.03) and White Irish (12.3%; aOR 1.55, 95% CI 1.01 to 2.38) ethnicities. This study suggests that FET outcomes are influenced by ethnicity.
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Affiliation(s)
- Abigail Sharpe
- Leeds Fertility, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Mariano Mascarenhas
- Leeds Fertility, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Glasgow Centre for Reproductive Medicine, The Fertility Partnership, Glasgow, UK
| | - Adam Balen
- Glasgow Centre for Reproductive Medicine, The Fertility Partnership, Glasgow, UK
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Ishihara O, Arce JC. Individualized follitropin delta dosing reduces OHSS risk in Japanese IVF/ICSI patients: a randomized controlled trial. Reprod Biomed Online 2021; 42:909-918. [PMID: 33722477 DOI: 10.1016/j.rbmo.2021.01.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 01/04/2023]
Abstract
RESEARCH QUESTION This study aimed to establish the efficacy and safety of ovarian stimulation with a follitropin delta individualized fixed-dose regimen based on serum anti-Müllerian hormone (AMH) concentration and body weight versus conventional follitropin beta dosing in Japanese women. DESIGN This randomized, controlled, assessor-blind, multicentre, non-inferiority trial was conducted in 347 Japanese IVF/intracytoplasmic sperm injection patients. They were randomized to individualized follitropin delta (AMH <15 pmol/l: 12 µg/day; AMH ≥15 pmol/l: 0.10-0.19 µg/kg/day; minimum 6 µg/day; maximum 12 µg/day) or conventional follitropin beta (150 IU/day for the first 5 days, with potential subsequent dose adjustments). The primary end-point was the number of oocytes retrieved with a pre-specified non-inferiority margin (-3.0 oocytes). RESULTS The primary trial objective was met, as non-inferiority was established for number of oocytes retrieved for individualized follitropin delta dosing compared with conventional follitropin beta dosing (9.3 versus 10.5; lower boundary of 95% confidence interval -2.3). The occurrence of ovarian hyperstimulation syndrome (OHSS) was reduced to approximately half with individualized compared with conventional dosing, with an incidence of 11.2% versus 19.8% (P = 0.021) for OHSS of any grade and 7.1% versus 14.1% (P = 0.027) for moderate/severe OHSS. The live birth rate per started cycle was 23.5% for individualized dosing and 18.6% for conventional dosing. CONCLUSIONS Dosing with individualized follitropin delta in Japanese women is non-inferior to conventional dosing with follitropin beta for number of oocytes retrieved. The individualized approach shows a favourable benefit-risk profile, providing a statistically significant and clinically relevant reduction in the incidence of OHSS, without compromising live birth rates.
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Affiliation(s)
- Osamu Ishihara
- Department of Obstetrics and Gynaecology, Saitama Medical University, Moroyama, Iruma-gun, Saitama, Japan
| | - Joan-Carles Arce
- Ferring Pharmaceuticals, Reproductive Medicine & Maternal Health, Copenhagen, Denmark.
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Morris C, Rymell R, Mascarenhas M, Bhandari H. Ethnic and demographic variation in consenting for research in the context of fertility treatment. HUM FERTIL 2021; 25:575-582. [PMID: 33501856 DOI: 10.1080/14647273.2021.1876257] [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: 10/22/2022]
Abstract
A retrospective service evaluation was conducted in a tertiary fertility clinic to assess factors influencing the inclinations of individuals to consent for their information to be used for research (non-contact research) and their willingness to be contacted for future research studies (contact research). Self-reported data on ethnicity and country of birth were obtained from the HFEA registration forms of 18,384 patients undergoing fertility treatment. Socio-economic deprivation was assessed using the Index of Multiple Deprivation (IMD) determined by postcode. Analysis of data indicated that 24% were of non-white ethnicity, 32% had been born overseas and 46% resided in more deprived areas. Non-white patients were significantly less likely to consent to research than white patients (contact research: aOR 0.36, 95% CI 0.33 to 0.39; non-contact research: aOR 0.35, 95% CI 0.32 to 0.38), as were patients born overseas (contact research: aOR 0.86, 95% CI 0.79 to 0.94; non-contact research: aOR 0.89, 95% CI 0.82 to 0.97), and those living in more deprived areas (contact research: aOR 0.85, 95% CI 0.80 to 0.91; non-contact research: aOR 0.79, 95% CI 0.74 to 0.85). The findings indicate that ethnicity, country of birth and socio-economic factors are independently associated with willingness to participate in research.
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Affiliation(s)
| | - Rhean Rymell
- School of Medicine, University of Leeds, Leeds, UK
| | - Mariano Mascarenhas
- Leeds Fertility, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Glasgow Centre for Reproductive Medicine, Glasgow, UK
| | - Harish Bhandari
- School of Medicine, University of Leeds, Leeds, UK.,Leeds Fertility, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Eisenberg ML, Luke B, Cameron K, Shaw GM, Pacey AA, Sutcliffe AG, Williams C, Gardiner J, Anderson RA, Baker VL. Defining critical factors in multi-country studies of assisted reproductive technologies (ART): data from the US and UK health systems. J Assist Reprod Genet 2020; 37:2767-2775. [PMID: 32995971 PMCID: PMC7642045 DOI: 10.1007/s10815-020-01951-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/13/2020] [Indexed: 11/29/2022] Open
Abstract
As the worldwide use of assisted reproductive technologies (ART) continues to grow, there is a critical need to assess the safety of these treatment parameters and the potential adverse health effects of their use in adults and their offspring. While key elements remain similar across nations, geographic variations both in treatments and populations make generalizability challenging. We describe and compare the demographic factors between the USA and the UK related to ART use and discuss implications for research. The USA and the UK share some common elements of ART practice and in how data are collected regarding long-term outcomes. However, the monitoring of ART in these two countries each brings strengths that complement each other's limitations.
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Affiliation(s)
- Michael L Eisenberg
- Division of Male Reproductive Medicine and Surgery, Department of Urology, Stanford University School of Medicine, Palo Alto, CA, USA.
- Department of Urology, Stanford University School of Medicine, 300 Pasteur Dr., Stanford, CA, USA.
| | - Barbara Luke
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Katherine Cameron
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gary M Shaw
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Allan A Pacey
- Academic Unit of Reproductive and Developmental Medicine, University of Sheffield, Sheffield, UK
| | - Alastair G Sutcliffe
- Policy, Practice and Population Unit, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Carrie Williams
- Policy, Practice and Population Unit, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | | | - Richard A Anderson
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Valerie L Baker
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI, USA
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Lainas GT, Lainas TG, Sfontouris IA, Chatzimeletiou K, Venetis CA, Bosdou JK, Tarlatzis BC, Grimbizis GF, Kolibianakis EM. Is oocyte maturation rate associated with triptorelin dose used for triggering final oocyte maturation in patients at high risk for severe ovarian hyperstimulation syndrome? Hum Reprod 2020; 34:1770-1777. [PMID: 31384921 DOI: 10.1093/humrep/dez105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/01/2019] [Accepted: 05/28/2019] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Are oocyte maturation rates different among 0.1, 0.2 and 0.4 mg triptorelin used for triggering final oocyte maturation in patients at high risk for ovarian hyperstimulation syndrome (OHSS) undergoing ICSI? SUMMARY ANSWER A dose of 0.1 mg triptorelin results in similar oocyte maturation rates compared to higher doses of 0.2 and 0.4 mg in patients at high risk for OHSS undergoing ICSI. WHAT IS KNOWN ALREADY The GnRH agonist triptorelin is widely used instead of hCG for triggering final oocyte maturation, in order to eliminate the risk of severe OHSS in patients undergoing ovarian stimulation for IVF/ICSI. However, limited data are currently available regarding its optimal dose use for this purpose in patients at high risk for OHSS. STUDY DESIGN, SIZE, DURATION A retrospective study was performed between November 2015 and July 2017 in 131 infertile patients at high risk for severe OHSS undergoing ovarian stimulation for ICSI. High risk for severe OHSS was defined as the presence of at least 19 follicles ≥11 mm in diameter on the day of triggering final oocyte maturation. PARTICIPANTS/MATERIALS, SETTING, METHODS Ovarian stimulation was performed with recombinant FSH and GnRH antagonists. Patients received 0.1 (n = 42), 0.2 (n = 46) or 0.4 mg (n = 43) triptorelin for triggering final oocyte maturation. Hormonal evaluation of FSH, LH, estradiol (E2) and progesterone (PRG) was carried out on the day of triggering final oocyte maturation, 8 and 36 hours post triggering and 3, 5, 7, and 10 days after triptorelin administration. During this period, all patients were assessed for symptoms and signs indicative of severe OHSS development. Primary outcome measure was oocyte maturation rate, defined as the number of metaphase II (MII) oocytes divided by the number of cumulus-oocyte-complexes retrieved per patient. Results are expressed as median (interquartile range). MAIN RESULTS AND THE ROLE OF CHANCE No significant differences in patient baseline characteristics were observed among the 0.1 mg, the 0.2 mg and the 0.4 mg groups. Regarding the primary outcome measure, no differences were observed in oocyte maturation rate among the three groups compared [82.6% (17.8%) versus 83.3% (18.8%) versus 85.1% (17.2%), respectively, P = 0.686].In addition, no significant differences were present among the 0.1 mg, 0.2 mg and 0.4 mg groups, regarding the number of mature (MII) oocytes [21 (13) versus 20 (6) versus 20 (11), respectively; P = 0.582], the number of oocytes retrieved [25.5 (13) versus 24.5 (11) versus 23 (12), respectively; P = 0.452], oocyte retrieval rate [81.0% (17.7%) versus 76.5% (23.5%) versus 75.0% (22.5), respectively; P = 0.088], the number of fertilized (two pronuclei) oocytes [12.5 (9) versus 14.5 (7) versus 14.0 (8), respectively; P = 0.985], fertilization rate [71.7% (22%) versus 77.1% (19.1%) versus 76.6% (23.3%), respectively; P = 0.525] and duration of luteal phase [7 (1) versus 8 (2) versus 7 (1) days, respectively; P = 0.632]. Moreover, no significant differences were present among the three triptorelin groups regarding serum levels of LH, FSH, E2 and PRG at any of the time points assessed following triggering of final oocyte maturation. LIMITATIONS, REASONS FOR CAUTION This is a retrospective study, and although there were no differences in the baseline characteristics of the three groups compared, the presence of bias cannot be excluded. WIDER IMPLICATIONS OF THE FINDINGS Based on the results of the current study, it appears that triggering final oocyte maturation with a lower (0.1 mg) or a higher dose (0.4 mg) of triptorelin, as compared to the most commonly used dose of 0.2 mg, does not confer any benefit in terms of oocyte maturation rate in patients at high risk for severe OHSS. STUDY FUNDING/COMPETING INTEREST(S) No external funding was obtained for this study. There are no conflicts of interest.
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Affiliation(s)
- G T Lainas
- Unit of Human Reproduction, First Department of OB/Gyn, Medical School, Aristotle University, Thessaloniki, Greece.,Eugonia Unit of Assisted Reproduction, Athens, Greece
| | - T G Lainas
- Eugonia Unit of Assisted Reproduction, Athens, Greece
| | | | - K Chatzimeletiou
- Unit of Human Reproduction, First Department of OB/Gyn, Medical School, Aristotle University, Thessaloniki, Greece
| | - C A Venetis
- Centre for Big Data Research in Health and School of Women's and Children's Health UNSW Medicine, University of New South Wales, Sydney, Australia
| | - J K Bosdou
- Unit of Human Reproduction, First Department of OB/Gyn, Medical School, Aristotle University, Thessaloniki, Greece
| | - B C Tarlatzis
- Unit of Human Reproduction, First Department of OB/Gyn, Medical School, Aristotle University, Thessaloniki, Greece
| | - G F Grimbizis
- Unit of Human Reproduction, First Department of OB/Gyn, Medical School, Aristotle University, Thessaloniki, Greece
| | - E M Kolibianakis
- Unit of Human Reproduction, First Department of OB/Gyn, Medical School, Aristotle University, Thessaloniki, Greece
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Wiltshire A, Ghidei L, Brayboy LM. Infertility and assisted reproductive technology outcomes in Afro-Caribbean women. J Assist Reprod Genet 2020; 37:1553-1561. [PMID: 32462416 PMCID: PMC7376768 DOI: 10.1007/s10815-020-01826-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/13/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess the causes of infertility and artificial reproductive technology (ART) outcomes in women of African descent living in the Caribbean and Bermuda. DESIGN Cross-sectional study composed of a questionnaire administered to providers who care for women undergoing ART in the Caribbean and Bermuda. MATERIAL AND METHODS A questionnaire from the Deerfield Institute was adapted to meet the aims of our study with their permission. Eight infertility clinics in the Caribbean and Bermuda were identified. The primary physician at each site was contacted via email and invited to participate in the study. Questionnaires were completed via interview or electronically. Responses were collected in a REDCap database for statistical analysis. RESULTS There were five respondents from Barbados, Bermuda (× 2), Puerto Rico, and the Bahamas. The most commonly reported etiologies of infertility among Afro-Caribbean patients were female-male factor and uterine factor. In vitro fertilization (IVF) combined with intracytoplasmic sperm injection (ICSI) is performed more often than conventional IVF. The cumulative live birth rates (LBR) after ART for those ages ≤ 34, 35-37, 38-42, and > 42 were 52%, 40%, 22%, and 12%, respectively. The cumulative live birth rate was 31.5% for total patients. The factors reported to be most important in hindering patients from cycling were coping emotionally with poor ovarian response and cost. The biggest restraints to infertility care were costs and a lack of local IVF centers on all islands. CONCLUSION Afro-Caribbean women receiving infertility care in the Caribbean may have better ART outcomes compared to African-American women in the United States (US).
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Affiliation(s)
- Ashley Wiltshire
- Department of Obstetrics and Gynecology, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310 USA
| | - Luwam Ghidei
- Department of Obstetrics and Gynecology, Brown University Alpert Medical School, and Women & Infants Hospital, 101 Dudley Street, Providence, RI 02905 USA
| | - Lynae M Brayboy
- Division of Reproductive Endocrinology and Infertility, Women & Infants Hospital, 101 Dudley Fl 1, Providence, RI 02905 USA
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Richardson AL, Baskind NE, Karuppusami R, Balen AH. Effect of deprivation on in vitro fertilisation outcome: a cohort study. BJOG 2019; 127:458-465. [DOI: 10.1111/1471-0528.16012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2019] [Indexed: 11/30/2022]
Affiliation(s)
- AL Richardson
- Leeds Fertility Seacroft Hospital Leeds Teaching Hospitals NHS Trust Leeds UK
| | - NE Baskind
- Leeds Fertility Seacroft Hospital Leeds Teaching Hospitals NHS Trust Leeds UK
| | - R Karuppusami
- Department of Biostatistics Christian Medical College and Hospital Vellore India
| | - AH Balen
- Leeds Fertility Seacroft Hospital Leeds Teaching Hospitals NHS Trust Leeds UK
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20
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Nelson SM, Aijun S, Ling Q, Tengda X, Wei X, Yan D, Yanfang W, Zenghui T, Xinqi C, Fraser A, Clayton GL. Ethnic discordance in serum anti-Müllerian hormone in healthy women: a population study from China and Europe. Reprod Biomed Online 2019; 40:461-467. [PMID: 32094052 DOI: 10.1016/j.rbmo.2019.11.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/04/2019] [Accepted: 11/11/2019] [Indexed: 12/23/2022]
Abstract
RESEARCH QUESTION Chinese women are known to have an earlier age of natural menopause than their European counterparts, but whether they also have a lower functional ovarian reserve is unknown. This study was designed to assess whether there are ethnic differences in anti-Müllerian hormone (AMH) concentrations in women of reproductive age. DESIGN Women in China and Europe with regular menstrual cycles, not on hormonal contraception and with no medical history of note, were recruited to provide a day 2-5 early follicular phase sample. AMH concentration was determined using the Roche Elecsys assay. Decline in AMH was modelled with linear, quadratic and quadratic with interaction on age equations to assess the impact of ethnicity. RESULTS A total of 887 European and 461 Chinese women participated in the study. Despite the Chinese population being slightly younger (34.1 ± 8.4 years) than their European counterparts (34.8±8.9 years), their median AMH was lower, at 1.87 ng/ml (interquartile range [IQR] 0.28-3.64) compared with 2.11 ng/ml (IQR 0.73-3.96), with evidence of increasing discordance from age 25 years. In all regression models of the age-related decline in AMH, there was evidence of a difference between Chinese and European women. Although AMH was 28.1% (95% confidence interval [CI] 18.2-36.7%) lower in the Chinese population at age 30, this decline increased to 79.4% (95% CI 75.4- 82.9%) at age 45. CONCLUSIONS There were independent effects of age and ethnicity on serum AMH concentrations, with Chinese women having a substantially lower AMH in adult life than their European counterparts from age 25 onwards.
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Affiliation(s)
| | - Sun Aijun
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking, China
| | - Qui Ling
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking, China
| | - Xu Tengda
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking, China
| | - Xue Wei
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking, China
| | - Deng Yan
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking, China
| | - Wang Yanfang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking, China
| | - Tian Zenghui
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking, China
| | - Chen Xinqi
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking, China
| | - Abigail Fraser
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gemma L Clayton
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Mascarenhas M, Balen AH. Could ethnicity have a different effect on fresh and frozen embryo transfer outcomes: a retrospective study. Reprod Biomed Online 2019; 39:764-769. [PMID: 31615725 DOI: 10.1016/j.rbmo.2019.07.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 07/12/2019] [Accepted: 07/16/2019] [Indexed: 12/31/2022]
Abstract
RESEARCH QUESTION Does a woman's ethnicity affect her fresh and frozen embryo transfer outcomes differently? DESIGN A retrospective cohort study of the first fresh and first frozen embryo transfer per woman carried out at a single tertiary level fertility unit between 2010 and 2016 using data retrieved from an electronic database. Biochemical pregnancy, biochemical pregnancy loss, clinical pregnancy, miscarriage and live birth rates per embryo transfer were compared between 5876 white Caucasian, 1071 South Asian and 114 Black Afro-Caribbean women undergoing their first fresh embryo transfer and for 1418 Caucasian, 273 South Asian and 31 Afro-Caribbean women undergoing their first frozen embryo transfer. Logistic regression was used to adjust for age, number of oocytes retrieved, and number and stage of embryos transferred. RESULTS South Asian (26% versus 32%, adjusted OR 0.622, 95% CI 0.533 to 0.725) and Black Afro-Caribbean women (21% versus 32%, adjusted OR 0.528, 95% CI 0.332 to 0.839) had a lower live birth rate per fresh embryo transfer compared with white Caucasian women. In contrast, the live birth rates per frozen embryo transfer were not significantly different between South Asian and Caucasian women (26% versus 28%, adjusted OR 0.890, 95% CI 0.661 to 1.200) and between Afro-Caribbean and Caucasian women (29% versus 28%, adjusted OR 0.983, 95% CI 0.447 to 2.162). CONCLUSION South Asian and Black Afro-Caribbean women have a significantly lower live birth rate than white Caucasian women after fresh embryo transfer, but their frozen embryo transfer live birth rates are not significantly different.
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Affiliation(s)
- M Mascarenhas
- Leeds Fertility, Leeds Teaching Hospitals NHS Trust, Leeds LS14 6UH, UK.
| | - A H Balen
- Leeds Fertility, Leeds Teaching Hospitals NHS Trust, Leeds LS14 6UH, UK
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22
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Conception rates and contraceptive use after bariatric surgery among women with infertility: Evidence from a prospective multicenter cohort study. Surg Obes Relat Dis 2019; 15:777-785. [DOI: 10.1016/j.soard.2018.12.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/15/2018] [Accepted: 12/27/2018] [Indexed: 11/21/2022]
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Mascarenhas M, Kulkarni M, Balen A. Can the ethnic differences in IVF cycle outcome be influenced by the impact of BMI? HUM FERTIL 2019; 23:275-281. [DOI: 10.1080/14647273.2018.1563915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
| | - Mugdha Kulkarni
- Leeds Fertility, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Adam Balen
- Leeds Fertility, Leeds Teaching Hospital NHS Trust, Leeds, UK
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24
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Menke MN, King WC, White GE, Gosman GG, Courcoulas AP, Dakin GF, Flum DR, Orcutt MJ, Pomp A, Pories WJ, Purnell JQ, Steffen KJ, Wolfe BM, Yanovski SZ. Contraception and Conception After Bariatric Surgery. Obstet Gynecol 2017; 130:979-987. [PMID: 29016506 PMCID: PMC5679259 DOI: 10.1097/aog.0000000000002323] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To examine contraceptive practices and conception rates after bariatric surgery. METHODS The Longitudinal Assessment of Bariatric Surgery-2 is a multicenter, prospective cohort study of adults undergoing first-time bariatric surgery as part of routine clinical care at 10 U.S. hospitals. Recruitment occurred between 2005 and 2009. Participants completed preoperative and annual postsurgical assessments for up to 7 years until January 2015. This report was restricted to women 18-44 years old with no history of menopause, hysterectomy, or estrogen and progesterone therapy. Primary outcomes were self-reported contraceptive practices, overall conception rate, and early (less than 18 months) postsurgical conception. Contraceptive practice (no intercourse, protected intercourse, unprotected intercourse, or tried to conceive) was classified based on the preceding year. Conception rates were determined from self-reported pregnancies. RESULTS Of 740 eligible women, 710 (95.9%) completed follow-up assessment(s). Median (interquartile range) preoperative age was 34 (30-39) years. In the first postsurgical year, 12.7% (95% CI 9.4-16.0) of women had no intercourse, 40.5% (95% CI 35.6-45.4) had protected intercourse only, 41.5% (95% CI 36.4-46.6) had unprotected intercourse while not trying to conceive, and 4.3% (95% CI 2.4-6.3) tried to conceive. The prevalence of the first three groups did not significantly differ across the 7 years of follow-up (P for all >.05); however, more women tried to conceive in the second year (13.1%, 95% CI 9.3-17.0; P<.001). The conception rate was 53.8 (95% CI 40.0-71.1) per 1,000 woman-years across follow-up (median [interquartile range] 6.5 [5.9-7.0] years); 42.3 (95% CI 30.2-57.6) per 1,000 woman-years in the 18 months after surgery. Age (adjusted relative risk 0.41 [95% CI 0.19-0.89] per 10 years, P=.03), being married or living as married (adjusted relative risk 4.76 [95% CI 2.02-11.21], P<.001), and rating future pregnancy as important preoperatively (adjusted relative risk 8.50 [95% CI 2.92-24.75], P<.001) were associated with early conception. CONCLUSIONS Postsurgical contraceptive use and conception rates do not reflect recommendations for an 18-month delay in conception after bariatric surgery. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT00465829.
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Affiliation(s)
- Marie N Menke
- University of Pittsburgh School of Medicine, the University of Pittsburgh Graduate School of Public Health, and the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Weill Cornell University Medical Center, New York, New York; the University of Washington, Seattle, Washington; the Neuropsychiatric Research Institute, Fargo, North Dakota; Brody School of Medicine, East Carolina University, Greenville, North Carolina; Oregon Health & Science University, Portland, Oregon; North Dakota State University, Fargo, North Dakota; and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
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