1
|
Martel RA, Lee V, Armstrong A, Demirjian M, Kwan L, Al-Safi ZA. Association between serum hormone levels in early pregnancy and risk of hypertensive diseases of pregnancy in women undergoing assisted reproduction. J Assist Reprod Genet 2024; 41:2359-2366. [PMID: 39052170 PMCID: PMC11405613 DOI: 10.1007/s10815-024-03212-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 07/18/2024] [Indexed: 07/27/2024] Open
Abstract
PURPOSE We examined the association between progesterone (P4), estradiol (E2), and human chorionic gonadotropin (hCG) levels in early pregnancy and the development of hypertensive diseases of pregnancy among women undergoing assisted reproduction. METHODS Retrospective study including patients who underwent frozen embryo transfer (FET), ovarian stimulation (OS), or unassisted conception (UC) and had a live singleton birth. The primary outcome was the development of hypertensive diseases of pregnancy (gestational hypertension, preeclampsia, HELLP, or eclampsia). Secondary outcomes were the development of fetal intrauterine growth restriction (IUGR), gestational diabetes mellitus, birth weight, and pre-term birth. Hormone levels and the development of the outcomes were correlated. RESULTS A total of 681 patients were included; 189 had FET, 193 had OS, and 299 had UC. Patients undergoing FET or OS were not more likely to develop hypertensive diseases of pregnancy compared with UC patients. While median levels of E2 and P4 were significantly different between P-FET and NC-FET patients (E2: 252 vs 317 pg/mL, P4: 64 vs 29 ng/mL, respectively; both p < 0.01), rates of hypertensive diseases of pregnancy did not significantly differ between those two groups. In the multivariate analyses, P4, E2, and hCG were not associated with the development of hypertensive diseases of pregnancy, but progesterone levels were significantly higher among those with IUGR. This remained consistent when the analysis was limited to FET patients. CONCLUSION P4, E2, and hCG levels did not correlate with the development of hypertensive diseases of pregnancy but elevated progesterone levels did correlate with the development of IUGR.
Collapse
Affiliation(s)
- Rachel A Martel
- Department of Obstetrics and Gynecology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
- Department of Obstetrics and Gynecology, UCLA David Geffen School of Medicine, 10833 Le Conte Avenue, 27-139 CHS, Los Angeles, CA, 90095-1740, USA.
| | - Victoria Lee
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Abigail Armstrong
- Department of Obstetrics and Gynecology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Maral Demirjian
- Department of Urology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Lorna Kwan
- Department of Urology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Zain A Al-Safi
- Department of Obstetrics and Gynecology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| |
Collapse
|
2
|
Salmeri N, Di Stefano G, Viganò P, Stratton P, Somigliana E, Vercellini P. Functional determinants of uterine contractility in endometriosis and adenomyosis: a systematic review and meta-analysis. Fertil Steril 2024:S0015-0282(24)00622-8. [PMID: 39067674 DOI: 10.1016/j.fertnstert.2024.07.026] [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: 06/12/2024] [Revised: 07/22/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024]
Abstract
IMPORTANCE Evidence suggests that aberrant uterine contractility in nonpregnant women with endometriosis and adenomyosis contributes to symptoms and potentially heralds their pathogenesis. However, uterine peristalsis remains understudied, inconsistently measured, and poorly understood. OBJECTIVE To summarize evidence on uterine contractility across the menstrual cycle phases in women with endometriosis and adenomyosis. DATA SOURCES PubMed/MEDLINE, Embase, and Scopus databases searched up to May 2, 2024. STUDY SELECTION AND SYNTHESIS Observational studies compared quantitative measures of uterine contractility using magnetic resonance imaging, ultrasound, electrophysiology, or direct intrauterine pressure recording across different menstrual cycle phases between women with endometriosis/adenomyosis and controls on the basis of predefined problem/population, intervention, comparison, and outcome criteria. Study quality was assessed using the Newcastle-Ottawa Scale. Pooled estimates for primary (risk ratios with 95% confidence intervals [CIs]) and secondary (mean difference [MD] with 95% CIs) outcomes were calculated using random-effects models. MAIN OUTCOMES Pooled risk of retrograde menstruation uterine contraction pattern in cases vs. controls; pooled MD in continuous measures of uterine contractility (frequency, amplitude, and velocity of contractions) across all the menstrual cycle phases in cases vs. controls. RESULTS Nine studies met the inclusion criteria; most were studies that evaluated women with endometriosis. An increased risk of retrograde uterine contractions during menstruation was observed in women with endometriosis compared with that in controls (risk ratio, 8.63; 95% CI, 3.24-22.95; I2, 0). The pooled MDs in contraction frequency between cases and controls were 0.82 (95% CI, 0.13-1.52; I2, 18.61%) in the menstrual phase and 0.52 (95% CI, 0.22-0.83; I2, 27.18%) in the luteal phase. Results for the follicular and periovulatory phases were more heterogeneous. Higher contraction amplitudes in women with endometriosis or adenomyosis were reported across all menstrual cycle phases. Because of the paucity of data, especially for adenomyosis, evidence certainty was graded as low for most comparisons. CONCLUSION AND RELEVANCE The approximately ninefold increased risk of retrograde pattern during menstruation in endometriosis supports the potential role of retrograde menstruation in its etiopathogenesis. Abnormal uterine contractility, likely not limited to the menstrual phase, may be a mechanical factor contributing to development of endometriosis and related symptoms, including menstrual pain and infertility, with limited, mostly concordant evidence for adenomyosis. CLINICAL TRIAL REGISTRATION NUMBER PROSPERO ID CRD42024512273-accepted on February 23, 2024.
Collapse
Affiliation(s)
- Noemi Salmeri
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland.
| | - Giorgia Di Stefano
- Academic Center for Research on Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università degli Studi, Milano, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Paola Viganò
- Academic Center for Research on Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università degli Studi, Milano, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Pamela Stratton
- Office of the Clinical Director, Intramural Research Program, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Edgardo Somigliana
- Academic Center for Research on Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università degli Studi, Milano, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Paolo Vercellini
- Academic Center for Research on Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università degli Studi, Milano, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| |
Collapse
|
3
|
Li X, Xie Q, Luan T, Su Y, Zhang J, Zhang J, Zhao C, Ling X. Maternal and child-health outcomes in different endometrial preparation methods for frozen-thawed embryo transfer: a retrospective study. HUM FERTIL 2023; 26:1032-1043. [PMID: 35343346 DOI: 10.1080/14647273.2022.2053593] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 01/27/2022] [Indexed: 11/04/2022]
Abstract
The purpose of this study was to analyse the obstetric outcome after frozen embryo transfer depending on the protocol used. The endometrial preparation during frozen embryo transfer (FET) was performed in the natural cycle (NC) with timing based on monitoring of the naturally occurring luteinizing hormone (LH) peak or in human chorionic gonadotropin (hCG)-triggered modified natural cycles (MNC), artificial cycle (AC) with hormone replacement therapy cycle and cycle with ovulation induction (OI). A retrospective cohort study was conducted between 2018 and 2020. Pregnancy, perinatal complications and neonatal outcomes were compared among patients treated during AC or MNC or OI protocols. After adjusting for the effect of gravidity, parity, pre-pregnancy body mass index (BMI) and number of miscarriages, the AC group had higher but not significantly different rates of gestational hypertension, preeclampsia and intrahepatic cholestasis of pregnancy (ICP) than women in OI and MNC groups. Significant differences were observed in the rates of placental adherence (15.30% in AC vs. 9.24% in MNC, p = 0.004) and postpartum haemorrhage (PPH) (24.33% in AC vs. 13.07% in OI, p = 0.003, 24.33% in AC vs. 16.24% in MNC, p = 0.002) among the three groups. In singletons, significant differences were observed in the rates of placental adherence (14.09% in AC vs. 8.57% in MNC, p = 0.002), AC and MNC groups had higher risk of PPH compared with OI group (18.36% in AC vs. 12.38% in MNC, p = 0.042 and 7.69% in OI vs. 18.36% in AC, p = 0.013). Neonatal outcomes were similar among the three groups except risk of small for date infants (0.35% in AC vs. 1.44% in MNC, p = 0.008). These findings are important in view of increasing use of frozen cycles and new policy of freeze-all cycles in in vitro fertilization (IVF). The results suggest a link between the absence of corpus luteum and adverse obstetric outcomes.
Collapse
Affiliation(s)
- Xin Li
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Qijun Xie
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Ting Luan
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Yan Su
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Juan Zhang
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - JuanJuan Zhang
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Chun Zhao
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Xiufeng Ling
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| |
Collapse
|
4
|
Dallagiovanna C, Benaglia L, Reschini M, Di Gesaro L, Li Piani L, Persico N, Vigano’ P, Somigliana E. Impact of Endometrial Preparation on the Maternal and Fetal Cardiovascular Variables of the First Trimester Combined Screening Test. J Clin Med 2023; 12:6854. [PMID: 37959319 PMCID: PMC10650935 DOI: 10.3390/jcm12216854] [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: 09/14/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
The modality of endometrial preparation for the transfer of frozen-thawed embryos may influence maternal and fetal adaptation to pregnancy and could thus impact the results of the first trimester combined screening test. We conducted a retrospective cross-sectional study on singleton pregnancies achieved by embryo transfer of a single frozen-thawed blastocyst, comparing two different endometrial preparation protocols: natural cycle (n = 174) and hormone replacement therapy (HRT) (n = 122). The primary outcome was the risk of preeclampsia at the first trimester combined screening test. Secondary endpoints included variable reflecting fetal cardiac function (nuchal translucency and fetal heart rate), maternal adaptation (median arterial blood pressure-MAP and uterine arteries pulsatility index-UtA-PI), and placentation (pregnancy associated plasma protein A and placental growth factor). The risk of early preeclampsia was comparable in the two groups (38% vs. a 28%, p = 0.12). However, women in the natural cycle group showed lower fetal heart rate (159 [155-164] vs. 164 [158-168], p = 0.002) and higher UtA-PI (0.96 [0.74-1.18] vs. 0.72 [0.58-0.90], p < 0.001). The frequency of a screening test at high risk for aneuploidies was similar. The modality of transfer of frozen-thawed embryos is associated with changes in the variables reflecting maternal and fetal cardiovascular function.
Collapse
Affiliation(s)
- Chiara Dallagiovanna
- Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (C.D.); (L.B.); (L.D.G.); (L.L.P.); (P.V.); (E.S.)
| | - Laura Benaglia
- Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (C.D.); (L.B.); (L.D.G.); (L.L.P.); (P.V.); (E.S.)
| | - Marco Reschini
- Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (C.D.); (L.B.); (L.D.G.); (L.L.P.); (P.V.); (E.S.)
| | - Luca Di Gesaro
- Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (C.D.); (L.B.); (L.D.G.); (L.L.P.); (P.V.); (E.S.)
- Department of Clinical Sciences and Community Health, Università Degli Studi di Milano, 20122 Milan, Italy;
| | - Letizia Li Piani
- Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (C.D.); (L.B.); (L.D.G.); (L.L.P.); (P.V.); (E.S.)
- Department of Clinical Sciences and Community Health, Università Degli Studi di Milano, 20122 Milan, Italy;
| | - Nicola Persico
- Department of Clinical Sciences and Community Health, Università Degli Studi di Milano, 20122 Milan, Italy;
- Fetal Medicine and Surgery Service, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Paola Vigano’
- Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (C.D.); (L.B.); (L.D.G.); (L.L.P.); (P.V.); (E.S.)
| | - Edgardo Somigliana
- Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (C.D.); (L.B.); (L.D.G.); (L.L.P.); (P.V.); (E.S.)
- Department of Clinical Sciences and Community Health, Università Degli Studi di Milano, 20122 Milan, Italy;
| |
Collapse
|
5
|
Zhao Z, Chen Y, Deng H, Huang L, Lu D, Shen X, Xu L. The influence of embryo stage on obstetric complications and perinatal outcomes following programmed compared to natural frozen-thawed embryo transfer cycles: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1186068. [PMID: 37664838 PMCID: PMC10468995 DOI: 10.3389/fendo.2023.1186068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/14/2023] [Indexed: 09/05/2023] Open
Abstract
Objective To investigate the effect of embryo stage at the time of transfer on obstetric and perinatal outcomes in programmed frozen-thawed embryo transfer (FET) versus natural FET cycles. Design Systematic review and meta-analysis. Setting Not applicable. Patients Women with programmed frozen-thawed embryo transfer (FET) and natural FET. Interventions The PubMed, MEDLINE, and EMBASE databases and the Cochrane Central Register of Controlled Trials (CCRT) were searched from 1983 to October 2022. Twenty-three observational studies were included. Primary outcome measure The primary outcomes were hypertensive disorders of pregnancy (HDPs), gestational hypertension and preeclampsia (PE). The secondary outcomes were gestational diabetes mellitus (GDM), placenta previa, postpartum haemorrhage (PPH), placental abruption, preterm premature rupture of membranes (PPROM), large for gestational age (LGA), small for gestational age (SGA), macrosomia, and preterm delivery (PTD). Results The risk of HDP (14 studies, odds ratio (OR) 2.17; 95% confidence interval (CI) 1.95-2.41; P<0.00001; I2 = 43%), gestational hypertension (11 studies, OR 1.38; 95% CI 1.15-1.66; P=0.0006; I2 = 19%), PE (12 studies, OR 2.09; 95% CI 1.88-2.32; P<0.00001; I2 = 0%), GDM (20 studies, OR 1.09; 95% CI 1.02-1.17; P=0.02; I2 = 8%), LGA (18 studies, OR 1.11; 95% CI 1.07-1.15; P<0.00001; I2 = 46%), macrosomia (12 studies, OR 1.15; 95% CI 1.07-1.24; P=0.0002; I2 = 31%), PTD (22 studies, OR 1.21; 95% CI 1.15-1.27; P<0.00001; I2 = 49%), placenta previa (17 studies, OR 1.2; 95% CI 1.02-1.41; P=0.03; I2 = 11%), PPROM (9 studies, OR 1.19; 95% CI 1.02-1.39; P=0.02; I2 = 40%), and PPH (12 studies, OR 2.27; 95% CI 2.02-2.55; P <0.00001; I2 = 55%) were increased in programmed FET cycles versus natural FET cycles with overall embryo transfer. Blastocyst transfer had a higher risk of HDP (6 studies, OR 2.48; 95% CI 2.12-2.91; P<0.00001; I2 = 39%), gestational hypertension (5 studies, OR 1.87; 95% CI 1.27-2.75; P=0.002; I2 = 25%), PE (6 studies, OR 2.23; 95% CI 1.93-2.56; P<0.00001; I2 = 0%), GDM (10 studies, OR 1.13; 95% CI 1.04-1.23; P=0.005; I2 = 39%), LGA (6 studies, OR 1.14; 95% CI 1.07-1.21; P<0.0001; I2 = 9%), macrosomia (4 studies, OR 1.15; 95% CI 1.05-1.26; P<0.002; I2 = 68%), PTD (9 studies, OR 1.43; 95% CI 1.31-1.57; P<0.00001; I2 = 22%), PPH (6 studies, OR 1.92; 95% CI 1.46-2.51; P<0.00001; I2 = 55%), and PPROM (4 studies, OR 1.45; 95% CI 1.14-1.83; P=0.002; I2 = 46%) in programmed FET cycles than in natural FET cycles. Cleavage-stage embryo transfers revealed no difference in HDPs (1 study, OR 0.81; 95% CI 0.32-2.02; P=0.65; I2 not applicable), gestational hypertension (2 studies, OR 0.85; 95% CI 0.48-1.51; P=0.59; I2 = 0%), PE (1 study, OR 1.19; 95% CI 0.58-2.42; P=0.64; I2not applicable), GDM (3 study, OR 0.79; 95% CI 0.52-1.20; P=0.27; I2 = 21%), LGA (1 study, OR 1.15; 95% CI 0.62-2.11; P=0.66; I2not applicable), macrosomia (1 study, OR 1.22; 95% CI 0.54-2.77; P=0.64; I2 not applicable), PTD (2 studies, OR 1.05; 95% CI 0.74-1.49; P=0.79; I2 = 0%), PPH (1 study, OR 1.49; 95% CI 0.85-2.62; P=0.17; I2not applicable), or PPROM (2 studies, OR 0.74; 95% CI 0.46-1.21; P=0.23; I2 = 0%) between programmed FET cycles and natural FET cycles. Conclusions The risks of HDPs, gestational hypertension, PE, GDM, LGA, macrosomia, SGA, PTD, placenta previa, PPROM, and PPH were increased in programmed FET cycles versus natural FET cycles with overall embryo transfer and blastocyst transfer, but the risks were not clear for cleavage-stage embryo transfer.
Collapse
Affiliation(s)
- Zhonghua Zhao
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Reproductive Endocrinology and Regulation Laboratory, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
- The Joint Laboratory for Reproductive Medicine of Sichuan University, The Chinese University of Hong Kong, Chengdu, China
| | - Yan Chen
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Reproductive Endocrinology and Regulation Laboratory, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
- The Joint Laboratory for Reproductive Medicine of Sichuan University, The Chinese University of Hong Kong, Chengdu, China
| | - Hongxia Deng
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Reproductive Endocrinology and Regulation Laboratory, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
- The Joint Laboratory for Reproductive Medicine of Sichuan University, The Chinese University of Hong Kong, Chengdu, China
| | - Lu Huang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Reproductive Endocrinology and Regulation Laboratory, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
- The Joint Laboratory for Reproductive Medicine of Sichuan University, The Chinese University of Hong Kong, Chengdu, China
| | - Danhua Lu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Reproductive Endocrinology and Regulation Laboratory, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
- The Joint Laboratory for Reproductive Medicine of Sichuan University, The Chinese University of Hong Kong, Chengdu, China
| | - Xiaoyang Shen
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Reproductive Endocrinology and Regulation Laboratory, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
- The Joint Laboratory for Reproductive Medicine of Sichuan University, The Chinese University of Hong Kong, Chengdu, China
| | - Liangzhi Xu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Reproductive Endocrinology and Regulation Laboratory, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
- The Joint Laboratory for Reproductive Medicine of Sichuan University, The Chinese University of Hong Kong, Chengdu, China
| |
Collapse
|
6
|
Carosso AR, Brunod N, Filippini C, Revelli A, Evangelisti B, Cosma S, Borella F, Canosa S, Benedetto C, Gennarelli G. Reproductive and Obstetric Outcomes Following a Natural Cycle vs. Artificial Endometrial Preparation for Frozen-Thawed Embryo Transfer: A Retrospective Cohort Study. J Clin Med 2023; 12:4032. [PMID: 37373725 PMCID: PMC10299226 DOI: 10.3390/jcm12124032] [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: 04/14/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
Background: The proportion of frozen embryo transfer cycles has consistently grown in recent decades. Some adverse obstetric outcomes after frozen embryo transfer could possibly be explained by different approaches in endometrial preparation. The aim of the present study was to investigate reproductive and obstetric outcomes after frozen embryo transfer, comparing different endometrial preparation strategies. Methods: This retrospective study included 317 frozen embryo transfer cycles, of which 239 had a natural or modified natural cycle and 78 underwent artificial endometrial preparation. After excluding late abortion and twin pregnancies, the outcomes of 103 pregnancies were analyzed, 75 of which were achieved after a natural cycle/modified natural cycle, and 28 were achieved after an artificial cycle. Results: The overall clinical pregnancy rate/embryo transfer was 39.7%, the miscarriage rate was 10.1%, and the live birth rate/embryo transfer was 32.8%, without significant differences in reproductive outcomes between natural/modified cycle and artificial cycle groups. The risks of pregnancy-induced hypertension and abnormal placental insertion were significantly increased in pregnancies achieved after the artificial preparation of the endometrium (p = 0.0327 and =0.0191, respectively). Conclusions: Our study encourages the use of a natural cycle or modified natural cycle for endometrial preparation for frozen embryo transfer in order to ensure the presence of a corpus luteum able to orchestrate maternal adaptation to pregnancy.
Collapse
Affiliation(s)
- Andrea Roberto Carosso
- Obstetrics and Gynecology 1U, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, Sant’Anna Hospital, University of Torino, 10124 Turin, Italy
| | - Nicole Brunod
- Obstetrics and Gynecology 1U, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, Sant’Anna Hospital, University of Torino, 10124 Turin, Italy
| | - Claudia Filippini
- Department of Surgical Sciences, Clinical Statistics, University of Torino, 10124 Turin, Italy
| | - Alberto Revelli
- Obstetrics and Gynecology 2U, Department of Surgical Sciences, Sant’Anna Hospital, University of Torino, 10124 Turin, Italy
| | - Bernadette Evangelisti
- Obstetrics and Gynecology 1U, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, Sant’Anna Hospital, University of Torino, 10124 Turin, Italy
| | - Stefano Cosma
- Obstetrics and Gynecology 1U, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, Sant’Anna Hospital, University of Torino, 10124 Turin, Italy
| | - Fulvio Borella
- Obstetrics and Gynecology 1U, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, Sant’Anna Hospital, University of Torino, 10124 Turin, Italy
| | - Stefano Canosa
- Obstetrics and Gynecology 1U, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, Sant’Anna Hospital, University of Torino, 10124 Turin, Italy
| | - Chiara Benedetto
- Obstetrics and Gynecology 1U, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, Sant’Anna Hospital, University of Torino, 10124 Turin, Italy
| | - Gianluca Gennarelli
- Obstetrics and Gynecology 1U, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, Sant’Anna Hospital, University of Torino, 10124 Turin, Italy
| |
Collapse
|
7
|
Løssl K, Spangmose AL, Asserhøj LL, Dam TV, Pinborg A. The future of frozen-thawed embryo transfer in hormone replacement therapy cycles. Curr Opin Obstet Gynecol 2023; 35:200-209. [PMID: 37185352 DOI: 10.1097/gco.0000000000000867] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
PURPOSE OF REVIEW This review focuses on the efficacy of letrozole stimulated frozen-thawed embryo transfer (FET) compared to hormone replacement therapy (HRT) FET in women with polycystic ovarian syndrome (PCOS) and/or oligo-anovulation. Further, obstetric and perinatal risks in HRT FET are summarized. RECENT FINDINGS The presence of a corpus luteum seems to reduce the risk of pregnancy-related hypertension and preeclampsia after FET. As a natural cycle (NC) FET is not an option for women with oligo-/amenorrhea these women may benefit from FET with mild stimulation compared to HRT FET. The intention of mild stimulation in anovulatory women is to induce (mono) ovulation to mimic the endocrine profiles of the natural cycle and the early pregnancy after natural conception. Mild stimulation by letrozole is patient friendly and cheap compared to gonadotropin stimulated FET and has been increasingly used in recent years. Although the quality of evidence is low, the pregnancy outcomes after letrozole FET seems similar or even better compared to HRT FET in women with PCOS and/or oligo-anovulation. SUMMARY Natural and modified NC FET should be used whenever possible to mitigate adverse obstetric and perinatal outcomes after HRT FET. For anovulatory women, whenever ovulation can be induced, we advocate the use of mild stimulation FET to create a corpus luteum awaiting results from RCTs limited to oligo-anovulatory women.
Collapse
|
8
|
Pape J, Levy J, von Wolff M. Hormone replacement cycles are associated with a higher risk of hypertensive disorders: Retrospective cohort study in singleton and twin pregnancies. BJOG 2023; 130:377-386. [PMID: 36371677 DOI: 10.1111/1471-0528.17343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/07/2022] [Accepted: 10/17/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To elaborate the associations of different cycle regimens (natural cycle [NC], stimulated cycle [SC], hormone replacement cycle [HRC]) on maternal and neonatal adverse pregnancy outcomes after frozen-thawed embryo transfers (FET). DESIGN Population-based registry study. SETTING Swiss IVF Registry. POPULATION OR SAMPLE Singleton (n = 4636) and twin (n = 544) live births after NC-FET (n = 776), SC-FET (n = 758) or HRC-FET (n = 3646) registered from 2014 to 2019. METHODS Fifteen pregnancy pathologies were modelled for singleton and twin pregnancies using mixed models adjusted for cycle regimen, delivery, fertilisation technique, chronic anovulation, age of mother and centre. MAIN OUTCOME MEASURES Maternal (vaginal bleeding, isolated arterial hypertension and pre-eclampsia) and neonatal (gestational age, birthweight, mode of delivery) adverse pregnancy outcomes. RESULTS In singleton pregnancies, the incidences of bleeding in first trimester, isolated hypertension and pre-eclampsia were highest in HRC-FET with doubled odds of bleeding in first trimester (adjusted odds ratio [aOR] 2.23; 95% CI 1.33-3.75), isolated hypertension (aOR 2.50; 95% CI 1.02-6.12) and pre-eclampsia (aOR 2.16; 95% CI 1.13-4.12) in HRC-FET vs. NC-FET and with doubled respectively sixfold odds of bleeding (aOR 2.08; 95% CI 1.03-4.21) and pre-eclampsia (6.02; 95% CI 1.38-26.24) in HRC-FET versus SC-FET. In twin pregnancies, the incidence of pre-eclampsia was highest in HRC-FET with numerically higher odds of pre-eclampsia in HRC-FET versus NC-FET and versus SC-FET. CONCLUSIONS Our data implied the highest maternal risks of hypertensive disorders in HRC-FET, therefore clinicians should prefer SC-FET or NC-FET if medically possible.
Collapse
Affiliation(s)
- Janna Pape
- Division of Endocrinology and Reproductive Medicine, Inselspital, University Women's Hospital, Bern, Switzerland
| | - Jérémy Levy
- FIVNAT Statistician, Swiss Society for Reproductive Medicine, Aarau, Switzerland
| | - Michael von Wolff
- Division of Endocrinology and Reproductive Medicine, Inselspital, University Women's Hospital, Bern, Switzerland
| |
Collapse
|
9
|
The Effect of Short-Term Aspirin Administration during Programmed Frozen-Thawed Embryo Transfer on Pregnancy Outcomes and Complications. J Clin Med 2023; 12:jcm12031064. [PMID: 36769712 PMCID: PMC9918171 DOI: 10.3390/jcm12031064] [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: 11/22/2022] [Revised: 01/13/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
Low-dose aspirin is widely used during frozen-embryo transfer (FET) cycles. Its anti-platelet property makes it a potentially useful drug for the prevention of hypertension disorders of pregnancy (HDP). However, the existing evidence about the effect of short-term aspirin administration on pregnancy outcomes is not clear. In our study, we retrospectively investigated women who had their first or second FET cycles at the Reproductive Hospital Affiliated with Shandong University from April 2017 to December 2020. A total of 4454 programmed FET cycles were recruited. According to whether aspirin was administrated in the protocols, the patients were divided into two groups: The Control group (n = 2793, 85 of them using donor sperm) and the Aspirin group (n = 1661, 35 of them using donor sperm). We analyzed the pregnancy outcomes and pregnancy complications of these cycles and observed similar live birth rates. We found that the short-term use of aspirin at a dosage of 50 mg per day for women undergoing programmed FET did not elevate the live birth rate or decrease the incidence of a series of pregnancy complications, including HDP. Based on our experience, short-term administration of low-dose aspirin may not improve the outcomes of young women undergoing frozen-thawed embryo transfer cycles.
Collapse
|
10
|
Zhang M, Li J, Fu X, Zhang Y, Zhang T, Wu B, Han X, Gao S. Endometrial thickness is an independent risk factor of hypertensive disorders of pregnancy: a retrospective study of 13,458 patients in frozen-thawed embryo transfers. Reprod Biol Endocrinol 2022; 20:93. [PMID: 35765069 PMCID: PMC9238038 DOI: 10.1186/s12958-022-00965-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/16/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) are an important cause of maternal and fetal mortality, and its potential risk factors are still being explored. Endometrial thickness (EMT), as one of the important monitoring indicators of endometrial receptivity, has been confirmed to be related to the incidence of HDP in fresh embryo transfer. Our study was designed to investigate whether endometrial thickness is associated with the risk of hypertensive disorders of pregnancy in frozen-thawed embryo transfer (FET). METHODS This respective cohort study enrolled 13,458 women who received vitrified embryo transfer and had a singleton delivery in the Reproductive Hospital affiliated to Shandong University from January 2015 to December 2019. We set strict screening criteria and obtained the information from the hospital electronic medical system. Statistical methods including logistic regression analysis, receiver operating characteristic curve and restricted cubic spline were used to evaluate the relationship between endometrial thickness and the incidence of pregnancy-induced hypertension. RESULTS The incidences of HDP in a thin endometrial thickness group (< 0.8 cm) and a thick endometrial thickness group (> 1.2 cm) were significantly greater than in a reference group (0.8 cm-1.2 cm) (7.98 and 5.24% vs 4.59%, P < 0.001). A nonlinear relationship between endometrial thickness and risk of hypertensive disorders of pregnancy was examined by restricted cubic spline (P < 0.001). The thin endometrial thickness and thick endometrial thickness groups were significantly associated with the risk of HDP after adjusting for confounding variables by stepwise logistic regression analysis. Subsequently, subgroup logistic regression analysis based on endometrial preparation regimens showed that thin endometria were still significantly associated with a higher morbidity rate in the artificial cycle group, while in the natural cycle group, thick endometria were closely associated with increased morbidity. CONCLUSION Our study manifested that both the thin and thick endometria were associated with an increased risk of hypertensive disorders of pregnancy in frozen embryo transfer cycles. Reproductive clinicians should focus on adjusting endometrial thickness in different preparation regimens; and obstetricians should be mindful of the risk of hypertension during pregnancy, when women with thin (< 0.8 cm) or excessively thicker (> 1.2 cm) endometrial thickness achieve pregnancy through frozen-thawed embryo transfer.
Collapse
Affiliation(s)
- Meng Zhang
- Center for Reproductive Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Jing Li
- Center for Reproductive Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Xiao Fu
- Center for Reproductive Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Yiting Zhang
- Center for Reproductive Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Tao Zhang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Bingjie Wu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xinyue Han
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shanshan Gao
- Center for Reproductive Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.
- Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China.
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China.
| |
Collapse
|
11
|
He M, Sun X, Wang C, Sui Y. Analysis of the risk of complications during pregnancy in pregnant women with assisted reproductive technology: a retrospective study using registry linkage from 2013 to 2018 in Shanghai, China. BMC Pregnancy Childbirth 2022; 22:526. [PMID: 35764962 PMCID: PMC9241204 DOI: 10.1186/s12884-022-04846-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 06/16/2022] [Indexed: 11/11/2022] Open
Abstract
Background To evaluate the differences in pregnancy outcomes between assisted reproductive technology (ART) patients and natural pregnant women in Shanghai, China in the past 6 years objectively. And to assess the feasibility of the research method of registry-database linkage in mainland China. Methods This retrospective study was conducted using registry-database linkage. A total of 8102 pregnancies with ART and 8096 parturients with spontaneous conception (SC) from 10 reproductive centers and 111 hospitals composed our retrospective study. The primary outcomes were the rates of obstetric complications (pregnancy-induced hypertention [PIH], gestational diabetes mellitus [GDM], placenta previa, mode of delivery, preterm birth [PTB], low birth weight [LBW], and macrosomia). The prenatal outcomes were compared between ART and SC parturients, frozen-thawed embryo transfer (FET) and fresh embryo transfer, and in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). We calculated odds ratios (ORs) and 95% confidence intervals (CIs). Results The final matching rate of the target population was 92% by using registry linkage. ART resulted in a higher rate of multiple birth, PTB, LBW, cesarean section, placenta previa and GDM compared with SC in the singleton cohort. In ART patients, pregnant women with FET had a significantly higher risk of PIH than those with fresh embryo transfer (14.1% Vs 9.3%, AOR1.528, 95% CI 1.303–1.793), but there was no difference between IVF and ICSI. FET is also related to the severity of PIH. Conclusions ART increased the rate of complications during pregnancy, the risk and severity of PIH in patients with FET was higher than that in patients with fresh embryo transfer. The registry-database linkage study is an objective and feasible research method in mainland China. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04846-1.
Collapse
Affiliation(s)
- Mulan He
- Obstetrics and Gynecology Hospital of Fudan University, 352#, Dalin Road, Shanghai, 200011, China
| | - Xiaoxi Sun
- Obstetrics and Gynecology Hospital of Fudan University, 352#, Dalin Road, Shanghai, 200011, China. .,Shanghai JiAi Genetics & IVF Institute, Shanghai, 200011, China. .,Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, China.
| | - Chunfang Wang
- Vital Statistical Department, Institute of Health Information, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Yilun Sui
- Shanghai JiAi Genetics & IVF Institute, Shanghai, 200011, China
| |
Collapse
|
12
|
Conrad KP, von Versen-Höynck F, Baker VL. Risk of preeclampsia in artificial frozen embryo transfer as a result of insufficient corpus luteum hormone levels - a response. Am J Obstet Gynecol 2022; 227:676-677. [PMID: 35718108 DOI: 10.1016/j.ajog.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/11/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Kirk P Conrad
- Department of Physiology and Functional Genomics, Department of Obstetrics and Gynecology, University of Florida College of Medicine, 1600 SW Archer Rd., M552, Gainesville, FL 32610-0274.
| | - Frauke von Versen-Höynck
- Division of Gynecologic Endocrinology and Reproductive Medicine, Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Hannover, Germany
| | - Valerie L Baker
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Lutherville, MD
| |
Collapse
|
13
|
von Versen-Höynck F, Griesinger G. Should any use of artificial cycle regimen for frozen-thawed embryo transfer in women capable of ovulation be abandoned: yes, but what's next for FET cycle practice and research? Hum Reprod 2022; 37:1697-1703. [PMID: 35640158 DOI: 10.1093/humrep/deac125] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
Over the past decade, the use of frozen-thawed embryo transfer (FET) treatment cycles has increased substantially. The artificial ('programmed') cycle regimen, which suppresses ovulation, is widely used for that purpose, also in ovulatory women or women capable of ovulation, under the assumption of equivalent efficacy in terms of pregnancy achievement as compared to a natural cycle or modified natural cycle. The advantage of the artificial cycle is the easy alignment of the time point of thawing and transferring embryos with organizational necessities of the IVF laboratory, the treating doctors and the patient. However, recent data indicate that pregnancy establishment under absence of a corpus luteum as a consequence of anovulation may cause relevant maternal and fetal risks. Herein, we argue that randomized controlled trials (RCTs) are not needed to aid in the clinical decision for or against routine artificial cycle regimen use in ovulatory women. We also argue that RCTs are unlikely to answer the most burning questions of interest in that context, mostly because of lack of power and precision in detecting rare but decisive adverse outcomes (e.g. pre-eclampsia risk or long-term neonatal health outcomes). We pinpoint that, instead, large-scale observational data are better suited for that purpose. Eventually, we propose that the existing understanding and evidence is sufficient already to discourage the use of artificial cycle regimens for FET in ovulatory women or women capable of ovulation, as these may cause a strong deviation from physiology, thereby putting patient and fetus at avoidable health risk, without any apparent health benefit.
Collapse
Affiliation(s)
| | - Georg Griesinger
- Department of Gynecological Endocrinology and Reproductive Medicine, University Hospital of Schleswig-Holstein, Lübeck, Germany
| |
Collapse
|
14
|
Yang Z, Bai X, Han Y, Zou Z, Fan Y, Wang X, Luo H, Zhang Y. Adverse obstetric and perinatal outcomes in 2333 singleton pregnancies conceived after different endometrial preparation protocols: a retrospective study in China. BMC Pregnancy Childbirth 2022; 22:378. [PMID: 35501733 PMCID: PMC9063113 DOI: 10.1186/s12884-022-04682-3] [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: 12/05/2021] [Accepted: 04/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUP Frozen-thawed embryo transfer is rising worldwide. One adverse effect of programmed frozen embryo transfer (FET) reported in some studies is an increased risk of adverse obstetric and perinatal outcomes. Meanwhile, body mass index (BMI) also has adverse effect on obstetric and perinatal outcomes. In this study, we investigated that the influence of different endometrial preparation protocols on obstetric and perinatal outcomes and the role of BMI in it. METHOD This retrospective cohort study included 2333 singleton deliveries after frozen-thaw embryo transfer at our centre between 2014 and 2021, including 550 cycles with programmed FET, 1783 cycles with true natural cycle FET (tNC-FET). In further analysis according to BMI grouped by Asian criterion, group A (18.5 kg/m2 ≤ BMI < 24.00 kg/m2) included 1257 subjects, group B (24 kg/m2 ≤ BMI < 28.00 kg/m2) included 503 subjects and group C (BMI ≥ 28 kg/m2) included 573 subjects. Baseline characteristics of the two groups were compared and analyzed. Binary logistic regression analyses were performed to explore the association between obstetric and perinatal outcomes and endometrial preparation protocols. RESULTS There were no significant differences in the placenta previa, gestational diabetes mellitus(GDM), preterm premature rupture of membranes (PPROM), cesarean section (CS) and macrosomia between the tNC-FET and programmed FET groups (P > 0.05). The programmed FET cycles were associated to a higher risk of pregnancy-induced hypertension (PIH) compared with the tNC-FET cycles (7.3% vs 4.4%, crude OR 1.71[1.16-2.54]; adjusted OR 1.845[1.03-3.30]). After dividing the patients into three groups according to the BMI, The programmed FET cycles were associated to a higher risk of PIH in group C (14.4% vs 6.2%, crude OR 2.55 [1.42-4.55]; adjusted OR 4.71 [1.77-12.55]) compared with the tNC-FET cycles. But there was no statistically significant difference in group A and group B. Programmed FET group compared with the tNC-FET group, the risk of PIH increase as the body mass index increase. CONCLUSION This study showed a tendency toward increasing risk of PIH in programmed FET cycle compared with the tNC-FET cycle, and the risk of PIH increases as BMI increases. Increased risk of preterm birth and low birth weight is linked to increased risk of PIH.
Collapse
Affiliation(s)
- Zexin Yang
- Tianjin Medical University, Tianjin, 300070, China
| | - Xuelian Bai
- Tianjin Medical University, Tianjin, 300070, China
| | - Ying Han
- Tianjin Central Hospital of Gynecology Obstetrics/Tianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin, 300100, China
| | | | - Yazhen Fan
- Tianjin Medical University, Tianjin, 300070, China
| | - Xinyan Wang
- Tianjin Central Hospital of Gynecology Obstetrics/Tianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin, 300100, China
| | - Haining Luo
- Tianjin Central Hospital of Gynecology Obstetrics/Tianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin, 300100, China
| | - Yunshan Zhang
- Tianjin Central Hospital of Gynecology Obstetrics/Tianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin, 300100, China.
| |
Collapse
|
15
|
Conrad KP, von Versen-Höynck F, Baker VL. Potential role of the corpus luteum in maternal cardiovascular adaptation to pregnancy and preeclampsia risk. Am J Obstet Gynecol 2022; 226:683-699. [PMID: 34437863 DOI: 10.1016/j.ajog.2021.08.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 11/01/2022]
Abstract
Studies in the gravid rat model revealed a key role for the corpus luteal hormone, relaxin, in the maternal circulatory changes of early pregnancy epitomized by profound systemic vasodilation and increased arterial compliance. To determine whether the corpus luteum may play a similar role in human pregnancy, women who conceived by in vitro fertilization were studied. Implementation of artificial (programmed) cycles for embryo transfers, which precluded the formation of a corpus luteum, was associated with notable attenuation of the gestational rise in cardiac output and fall in carotid-femoral pulse wave velocity (reflecting impairment of arterial dilation and increased compliance, respectively) and deficiencies in other cardiovascular changes normally observed during the first trimester. Cardiac output and carotid-femoral pulse wave velocity were restored after the first trimester of pregnancy, consistent with rescue by placental vasodilators, such as placental growth factor. In addition, a potential role of corpus luteal factors in reducing the risk of developing preeclampsia was hypothesized. In most single and multiple center, prospective and retrospective cohort (and registry) studies, the risk of developing preeclampsia and preeclampsia with severe features was increased specifically in women undergoing autologous frozen embryo transfer in artificial cycles without the formation of a corpus luteum relative to natural, modified natural, stimulated, or controlled ovarian stimulation cycles and spontaneous pregnancies-all associated with the formation of at least 1 corpus luteum. Taken together, these observational studies are sufficiently compelling to warrant randomized clinical trials comparing preeclampsia risk in autologous frozen embryo transfer in natural vs artificial cycles. Impaired endometrial function because of suboptimal hormonal administration is an alternative but not mutually exclusive explanation for increased preeclampsia risk in autologous frozen embryo transfer in artificial cycles. Potential mechanisms by which the corpus luteum may reduce the risk of developing preeclampsia and whether autologous frozen embryo transfer in artificial cycles is associated with increased risk of preterm preeclampsia, term preeclampsia, or both are discussed. Last, suggestions for future investigations are noted.
Collapse
|
16
|
Lee P, Zhou C, Li Y. Endometriosis does not seem to be an influencing factor of hypertensive disorders of pregnancy in IVF / ICSI cycles. Reprod Biol Endocrinol 2022; 20:57. [PMID: 35337338 PMCID: PMC8957116 DOI: 10.1186/s12958-022-00922-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION To evaluate whether the incidence of hypertensive disorders of pregnancy (HDP) in pregnant women was related to endometriosis (EM), ovulation and embryo vitrification technology. METHODS A retrospective cohort study was conducted on the clinical data of 3674 women who were treated with IVF / ICSI in the Reproductive Medicine Center of the First Affiliated Hospital of Sun Yat-sen University and maintained clinical pregnancy for more than 20 weeks. All pregnancies were followed up until the end of pregnancy. The follow-up consisted of recording the course of pregnancy, pregnancy complications, and basic situation of newborns. RESULTS Compared with NC-FET without EM, HRT-FET without EM was found to have a higher incidence of HDP during pregnancy (2.7% V.S. 6.1%, P<0.001); however, no significant difference was found in the incidence of HDP between NC-FET and HRT-FET combined with EM (4.0% V.S. 5.7%, P>0.05). In total frozen-thawed embryo transfer (total-FET), the incidence of HDP in the HRT cycle without ovulation (HRT-FET) was observed to be higher than that in the NC cycle with ovulation (NC-FET) (2.8% V.S. 6.1%, P<0.001). In patients with EM, no significant difference was found in the incidence of HDP between fresh ET and NC-FET (1.2% V.S. 4.0%, P>0.05). CONCLUSION EM does not seem to have an effect on the occurrence of HDP in assisted reproductive technology. During the FET cycle, the formation of the corpus luteum may play a protective role in the occurrence and development of HDP. Potential damage to the embryo caused by cryopreservation seems to have no effect on the occurrence of HDP.
Collapse
Affiliation(s)
- Pingyin Lee
- Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-sen University, Zhoushan 2 Road, Guangzhou, Guangdong, People's Republic of China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Sun Yat-sen University, Zhoushan 2 Road, Guangzhou, Guangdong, People's Republic of China
| | - Canquan Zhou
- Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-sen University, Zhoushan 2 Road, Guangzhou, Guangdong, People's Republic of China.
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Sun Yat-sen University, Zhoushan 2 Road, Guangzhou, Guangdong, People's Republic of China.
| | - Yubin Li
- Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-sen University, Zhoushan 2 Road, Guangzhou, Guangdong, People's Republic of China.
- Guangdong Provincial Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Sun Yat-sen University, Zhoushan 2 Road, Guangzhou, Guangdong, People's Republic of China.
| |
Collapse
|
17
|
Dallagiovanna C, Cappellari M, D'Ambrosi F, Reschini M, Kordas K, Li Piani L, Filippi F, Somigliana E. Endometrial preparation does not affect the risk of hypertensive disorders of pregnancy in low-risk women undergoing frozen embryo transfer. Gynecol Endocrinol 2022; 38:238-242. [PMID: 34382914 DOI: 10.1080/09513590.2021.1955342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Frozen embryo transfer (FET) is associated with a higher risk of hypertensive disorders in pregnancy. The objective of the present study is to evaluate the effect of different protocols of endometrial preparation on the risk of these disorders. METHODS We conducted a retrospective cohort study on 594 singleton pregnancies achieved by embryo transfer of single frozen-thawed blastocysts. Women with preexisting risk factors for hypertensive disorders were excluded. Women were divided into two groups according to the endometrial preparation protocol: either natural cycle (n = 495) or programming cycle with hormonal replacement therapy (n = 97). The primary outcome was the frequency of hypertensive disorders in pregnancy: specifically, gestational hypertension and preeclampsia. RESULTS No differences emerged between women following the natural cycle and those following the programming cycle in the frequency of gestational hypertension (5 vs. 4%) and preeclampsia (1.1 vs. 1.2%). No impact emerged also after multivariate analyses. CONCLUSIONS Women receiving hormonal replacement therapy have the same risk of gestational hypertension and preeclampsia as women following natural cycles when considering low-risk singleton pregnancies.
Collapse
Affiliation(s)
| | - Michela Cappellari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | | | - Marco Reschini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Karina Kordas
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Letizia Li Piani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Francesca Filippi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Edgardo Somigliana
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
18
|
Zhou R, Zhang X, Huang L, Wang S, Li L, Dong M, Zhu X, Liu F. The impact of different cycle regimens on birthweight of singletons in frozen-thawed embryo transfer cycles of ovulatory women. Fertil Steril 2022; 117:573-582. [PMID: 35120746 DOI: 10.1016/j.fertnstert.2021.09.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/27/2021] [Accepted: 09/27/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To investigate whether different endometrial preparation regimens affect neonatal outcomes after frozen-thawed embryo transfer (FET). DESIGN Retrospective cohort study. SETTING Tertiary care academic medical center. PATIENTS A total of 3,639 patients with live-born singletons were categorized into three groups on the basis of the type of endometrial preparation regimens. Of these, 1,225, 2,136, and 278 live-born singletons were conceived through natural cycle FET, artificial cycle FET, and stimulated cycle FET, respectively. INTERVENTION(S) None. MAIN OUTCOME MEASURES The main outcomes were the measures of birthweight including the absolute mean birthweight, Z-score, low birthweight, high birthweight (HBW), small for gestational age, and large for gestational age (LGA). RESULTS After controlling for a variety of covariates, singletons from the artificial cycle FET group had a higher mean birthweight and Z-score than those from the natural cycle FET group and stimulated cycle FET group. The risk of LGA infants significantly increased in the artificial cycle group (14.0%) than that in the natural cycle group (10.3%) and stimulated cycle group (7.6%). The risk of hypertensive disorders of pregnancy in the artificial cycle group (4.4%) was significantly higher than that in the natural cycle group (2.5%). The stimulated cycle FET singletons had a higher risk of low birthweight than the natural cycle FET singletons. The other perinatal outcomes, including the incidence of preterm birth, small for gestational age, and gestational diabetes mellitus, were comparable between the groups before or after adjustment for confounders. CONCLUSIONS Singletons from artificial cycle FET were associated with a higher risk of LGA infants, and natural cycle FET may be a better regimen for ovulatory women. Our results indicate a link between the absence of the corpus luteum and adverse perinatal outcomes, and further studies are needed to detect the underlying mechanism.
Collapse
Affiliation(s)
- Ruiqiong Zhou
- Center for Reproductive Medicine, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, People's Republic of China
| | - Xiqian Zhang
- Center for Reproductive Medicine, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, People's Republic of China
| | - Li Huang
- Center for Reproductive Medicine, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, People's Republic of China
| | - Songlu Wang
- Center for Reproductive Medicine, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, People's Republic of China
| | - Li Li
- Center for Reproductive Medicine, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, People's Republic of China
| | - Mei Dong
- Center for Reproductive Medicine, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, People's Republic of China
| | - Xiulan Zhu
- Center for Reproductive Medicine, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, People's Republic of China
| | - Fenghua Liu
- Center for Reproductive Medicine, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, People's Republic of China.
| |
Collapse
|
19
|
Lee JC, Badell ML, Kawwass JF. The impact of endometrial preparation for frozen embryo transfer on maternal and neonatal outcomes: a review. Reprod Biol Endocrinol 2022; 20:40. [PMID: 35227270 PMCID: PMC8883648 DOI: 10.1186/s12958-021-00869-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/29/2021] [Indexed: 12/18/2022] Open
Abstract
The use of frozen embryo transfer in assisted reproductive technology (ART) has steadily increased since development in the early 1980's. While there are many benefits to delayed frozen embryo transfer, certain adverse perinatal outcomes are noted to be more common in these transfers when compared to fresh transfers, specifically hypertensive disorders of pregnancy. Frozen embryo transfers require coordination between the embryo's developmental stage and the endometrial environment and can occur in either ovulatory or programmed cycles. Though there is no consensus on the ideal method of endometrial preparation prior to frozen embryo transfer, emerging data suggests differences in maternal and neonatal outcomes, specifically increased rates of hypertensive disorders of pregnancy in programmed cycles. Other reported differences include an increased risk of cesarean delivery, placenta accreta, postpartum hemorrhage, low birthweight, preterm birth, post term delivery, macrosomia, large for gestational age, and premature rupture of membranes in programmed cycles. The mechanism by which these differences exist could reflect inherent differences in groups selected for each type of endometrial preparation, the role of super physiologic hormone environments in programmed cycles, or the unique contributions of the corpus luteum in ovulatory cycles that are not present in programmed cycles. Given that existing studies are largely retrospective and have several key limitations, further investigation is needed. Confirmation of these findings has implications for current practice patterns and could enhance understanding of the mechanisms behind important adverse perinatal outcomes in those pursuing assisted reproduction.
Collapse
Affiliation(s)
- Jacqueline C Lee
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Emory University School of Medicine, Emory Reproductive Center, 550 Peachtree Street, 18th Floor, Atlanta, GA, 30308, USA.
| | - Martina L Badell
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Emory University School of Medicine, Emory Perinatal Center, 550 Peachtree Street, 15th floor, Atlanta, GA, 30308, USA
| | - Jennifer F Kawwass
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Emory University School of Medicine, Emory Reproductive Center, 550 Peachtree Street, 18th Floor, Atlanta, GA, 30308, USA
| |
Collapse
|
20
|
Placental Dysfunction in Assisted Reproductive Pregnancies: Perinatal, Neonatal and Adult Life Outcomes. Int J Mol Sci 2022; 23:ijms23020659. [PMID: 35054845 PMCID: PMC8775397 DOI: 10.3390/ijms23020659] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 02/06/2023] Open
Abstract
Obstetric and newborn outcomes of assisted reproductive technology (ART) pregnancies are associated with significative prevalence of maternal and neonatal adverse health conditions, such as cardiovascular and metabolic diseases. These data are interpreted as anomalies in placentation involving a dysregulation of several molecular factors and pathways. It is not clear which extent of the observed placental alterations are the result of ART and which originate from infertility itself. These two aspects probably act synergically for the final obstetric risk. Data show that mechanisms of inappropriate trophoblast invasion and consequent altered vascular remodeling sustain several clinical conditions, leading to obstetric and perinatal risks often found in ART pregnancies, such as preeclampsia, fetal growth restriction and placenta previa or accreta. The roles of factors such as VEGF, GATA3, PIGF, sFLT-1, sEndoglin, EGFL7, melatonin and of ART conditions, such as short or long embryo cultures, trophectoderm biopsy, embryo cryopreservation, and supraphysiologic endometrium preparation, are discussed. Inflammatory local conditions and epigenetic influence on embryos of ART procedures are important research topics since they may have important consequences on obstetric risk. Prevention and treatment of these conditions represent new frontiers for clinicians and biologists involved in ART, and synergic actions with researchers at molecular levels are advocated.
Collapse
|
21
|
Korkidakis A, Au J, Albert A, Havelock J. Higher blastocyst implantation in frozen versus fresh embryo transfers in good prognosis patients. Minerva Obstet Gynecol 2021; 73:776-781. [PMID: 34905881 DOI: 10.23736/s2724-606x.21.04722-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND There is emerging evidence that frozen embryo transfers provide a more favorable environment for implantation as compared to fresh embryo transfers. Our objective was to determine if there is a clinical benefit to frozen versus fresh blastocyst transfers in good prognosis patients. METHODS Subjects undergoing their first or second IVF/ICSI cycle <38 years of age in an OCP pretreated GnRH antagonist stimulation protocol with supernumerary embryos available for blastocyst cryopreservation were eligible for analysis. Primary transfer was exclusively blastocyst transfer. Exclusion criteria consisted of rescue ICSI, preimplantation genetic testing, donor oocytes, and surrogacy. The cohort was divided into two groups based on whether they underwent a fresh vs. frozen primary transfer. The implantation rates were compared using mixed-effects logistic regression. The clinical pregnancy and live birth rates were compared using logistic regression adjusted for number of oocytes retrieved and number of embryos transferred. All models included age, reason for treatment, and number of prior births as covariates. RESULTS A total of 615 subjects were included in the study. There were no differences in the two groups with respect to age, BMI, baseline ovarian reserve testing, total gonadotropin dosage, and duration of stimulation. The implantation rate was higher in the frozen-embryo group as compared to the fresh-embryo group (59% and 48% respectively; OR 1.58; 95% CI 1.02-2.44). There was a trend towards higher clinical pregnancy and live birth rates in the frozen-embryo group. These differences persisted in the adjusted analysis. CONCLUSIONS Among good prognosis patients undergoing IVF, frozen embryo transfer was associated with improved implantation rates. Consideration should be given to primary frozen blastocyst transfer in this population.
Collapse
Affiliation(s)
- Ann Korkidakis
- Division of Reproductive Endocrinology and Infertility, University of British Columbia, Vancouver, BC, Canada -
| | - Jason Au
- Pacific Center for Reproductive Medicine, Burnaby, BC, Canada
| | - Arianne Albert
- Women's Health Research Institute, BC Women's Hospital and Health Center, Vancouver, BC, Canada
| | - Jon Havelock
- Division of Reproductive Endocrinology and Infertility, University of British Columbia, Vancouver, BC, Canada.,Women's Health Research Institute, BC Women's Hospital and Health Center, Vancouver, BC, Canada
| |
Collapse
|
22
|
Waschkies F, Kroning L, Schill T, Chandra A, Schippert C, Töpfer D, Ziert Y, von Versen-Höynck F. Pregnancy Outcomes After Frozen-Thawed Embryo Transfer in the Absence of a Corpus Luteum. Front Med (Lausanne) 2021; 8:727753. [PMID: 34568385 PMCID: PMC8460906 DOI: 10.3389/fmed.2021.727753] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Nowadays, frozen-thawed embryo transfer (FET) cycles represent a high proportion of fertility treatments worldwide. Recent studies suggest differences in pregnancy outcomes depending on the FET treatment protocol used. The reason for this is still unclear, but the number of corpora lutea (CL) at conception is discussed as a possible factor. This study aims to investigate whether maternal and neonatal outcomes for pregnancies following FET lacking a CL differ from FET with one or more CL in order to explore a potential link between CL absence and adverse pregnancy outcomes. Methods: The study was designed as a retrospective, multi-center observational study with two cohorts after singleton live birth [0 CL cohort (FET in a programmed cycle, n = 114) and ≥ 1 CL cohort (FET in a natural or stimulated cycle, n = 68)]. Participants completed a questionnaire on the outcome of pregnancy and birth records were analyzed in a descriptive way. Multivariable logistic and linear regressions were performed in order to explore associations between CL absence and pregnancy outcomes. The strength of the agreement between the information in the survey and the diagnoses extracted from the files was assessed by Cohen's Kappa. Results: The risk of hypertensive disorders of pregnancy was higher after FET in the absence of a CL compared to FET with CL presence (aOR 5.56, 95% CI 1.12 – 27.72). Birthweights and birthweight percentiles were significantly higher in the 0 CL group. CL absence was a predictor of higher birthweight (adjusted coefficient B 179.74, 95% CI 13.03 – 346.44) and higher birthweight percentiles (adjusted coefficient B 10.23, 95%, 95% CI 2.28 – 18.40) particularly in female newborns of the 0 CL cohort. While the strength of the agreement between the reported information in the survey and the actual diagnoses extracted from the files was good for the majority of outcomes of interest it was fair in terms of hypertension (κ = 0.38). Conclusion: This study supports observations suggesting a potential link between a lack of CL at conception and adverse maternal and neonatal outcomes. Further investigations on causes and pathophysiological relationships are yet to be conducted.
Collapse
Affiliation(s)
- Freya Waschkies
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Luka Kroning
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Thilo Schill
- Fertility Center Langenhagen, Langenhagen, Germany
| | | | - Cordula Schippert
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Dagmar Töpfer
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Yvonne Ziert
- Institute of Biostatistics, Hannover Medical School, Hannover, Germany
| | | |
Collapse
|
23
|
Conrad KP, Taher S, Chi YY, Qiu Y, Li M, Lingis M, Williams RS, Rhoton-Vlasak A, Keller-Wood M, Segal MS. Relationships between reproductive hormones and maternal pregnancy physiology in women conceiving with or without in vitro fertilization. Am J Physiol Regul Integr Comp Physiol 2021; 321:R454-R468. [PMID: 34346723 DOI: 10.1152/ajpregu.00174.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We evaluated maternal pregnancy adaptations and their relationships with circulating hormones in women who conceived with or without in vitro fertilization (IVF). Pregnancies were grouped by corpus luteum (CL) number: 1 CL with physiological plasma relaxin concentration (PRLN; spontaneous pregnancies); 0 CL without circulating RLN (programmed cycles); >1 CL with elevated PRLN (ovarian stimulation). Major findings were that declines in plasma osmolality (Posm) and plasma sodium concentration ([Formula: see text]) were comparable in the 1 CL and 0 CL cohorts, correlated with plasma estradiol and progesterone concentrations but not PRLN; gestational declines in plasma uric acid (UA) concentration (PUA) were attenuated after IVF, especially programmed cycles, partly because of subdued increases of renal UA clearance; and PRLN and cardiac output (CO) were inversely correlated when plasma estradiol concentration was below ∼2.5 ng/mL but positively correlated above ∼2.5 ng/mL. Unexpectedly, PRLN and plasma sFLT1 (PsFLT1) were directly correlated. Although PsFLT1 and CO were not significantly associated, CO was positively correlated with plasma placental growth factor (PLGF) concentration after the first trimester, particularly in women who conceived with 0 CL. Major conclusions are that 1) circulating RLN was unnecessary for gestational falls in Posm and [Formula: see text]; 2) PRLN and CO were inversely correlated during early gestation, suggesting that PRLN in the lower range may have contributed to systemic vasodilation, whereas at higher PRLN RLN influence became self-limiting; 3) evidence for cooperativity between RLN and estradiol on gestational changes in CO was observed; and 4) after the first trimester in women who conceived without a CL, plasma PLGF concentration was associated with recovery of CO, which was impaired during the first trimester in this cohort.
Collapse
Affiliation(s)
- Kirk P Conrad
- Department of Physiology and Functional Genomics and D.H. Barron Reproductive and Perinatal Biology Research Program, grid.15276.37University of Florida, Gainesville, Florida.,Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida
| | - Shèdy Taher
- Department of Physiology and Functional Genomics and D.H. Barron Reproductive and Perinatal Biology Research Program, grid.15276.37University of Florida, Gainesville, Florida
| | - Yueh-Yun Chi
- Department of Pediatrics, University of Southern California, Los Angeles, California.,Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Yingjie Qiu
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Mingyue Li
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Melissa Lingis
- Division of Nephrology, Hypertension, and Renal Transplantation, Department of Medicine, University of Florida, Gainesville, Florida
| | - R Stan Williams
- Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida
| | - Alice Rhoton-Vlasak
- Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida
| | | | - Mark S Segal
- Division of Nephrology, Hypertension, and Renal Transplantation, Department of Medicine, University of Florida, Gainesville, Florida.,Nephrology and Hypertensive Section, Medical Service, North Florida/South Georgia Veterans Health System, Gainesville, Florida
| |
Collapse
|
24
|
Chih HJ, Elias FTS, Gaudet L, Velez MP. Assisted reproductive technology and hypertensive disorders of pregnancy: systematic review and meta-analyses. BMC Pregnancy Childbirth 2021; 21:449. [PMID: 34182957 PMCID: PMC8240295 DOI: 10.1186/s12884-021-03938-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/07/2021] [Indexed: 12/17/2022] Open
Abstract
Background Hypertensive disorders of pregnancy (HDP) is one of the most common pregnancy complications and causes of maternal morbidity and mortality. Assisted reproductive technology (ART) has been associated with adverse pregnancy outcomes, including HDP. However, the impact of multiple pregnancies, oocyte donation, as well as fresh and frozen embryo transfer needs to be further studied. We conducted a systematic review and meta-analyses to evaluate the association between ART and HDP or preeclampsia relative to spontaneous conception (SC). Methods We identified studies from EMBASE, MEDLINE, and Cochrane Library (up to April 8, 2020) and manually using structured search strategies. Cohort studies that included pregnancies after in vitro fertilization (IVF) with or without intracytoplasmic sperm fertilization (ICSI) relative to SC with HDP or preeclampsia as the outcome of interest were included. The control group was women who conceived spontaneously without ART or fertility medications. The pooled results were reported in odds ratios (OR) with 95% confidence intervals based on random effects models. Numbers needed to harm (NNH) were calculated based on absolute risk differences between exposure and control groups. Results Eighty-five studies were included after a screening of 1879 abstracts and 283 full text articles. Compared to SC, IVF/ICSI singleton pregnancies (OR 1.70; 95% CI 1.60–1.80; I2 = 80%) and multiple pregnancies (OR 1.34; 95% CI 1.20–1.50; I2 = 76%) were both associated with higher odds of HDP. Singleton pregnancies with oocyte donation had the highest odds of HDP out of all groups analyzed (OR 4.42; 95% CI 3.00–6.51; I2 = 83%). Frozen embryo transfer resulted in higher odds of HDP (OR 1.74; 95% CI 1.58–1.92; I2 = 55%) than fresh embryo transfer (OR 1.43; 95% CI 1.33–1.53; I2 = 72%). The associations between IVF/ICSI pregnancies and SC were similar for preeclampsia. Most interventions had an NNH of 40 to 100, while singleton and multiple oocyte donation pregnancies had particularly low NNH for HDP (16 and 10, respectively). Conclusions Our meta-analysis confirmed that IVF/ICSI pregnancies are at higher odds of HDP and preeclampsia than SC, irrespective of the plurality. The odds were especially high in frozen embryo transfer and oocyte donation pregnancies. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03938-8.
Collapse
Affiliation(s)
- Hui Ju Chih
- Department of Obstetrics and Gynecology, Kingston General Hospital, Queen's University, Victory 4 76 Stuart St, Kingston, Ontario, K7L 2V7, Canada
| | - Flavia T S Elias
- Department of Obstetrics and Gynecology, Kingston General Hospital, Queen's University, Victory 4 76 Stuart St, Kingston, Ontario, K7L 2V7, Canada.,Health Technology Assessment Program, Oswaldo Cruz Foundation, Av. Brasil, 4365 - Manguinhos, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Laura Gaudet
- Department of Obstetrics and Gynecology, Kingston General Hospital, Queen's University, Victory 4 76 Stuart St, Kingston, Ontario, K7L 2V7, Canada
| | - Maria P Velez
- Department of Obstetrics and Gynecology, Kingston General Hospital, Queen's University, Victory 4 76 Stuart St, Kingston, Ontario, K7L 2V7, Canada. .,Department of Public Health Sciences, Queen's University, 62 Fifth Field Company Lane, Kingston, Ontario, K7L 3N6, Canada.
| |
Collapse
|
25
|
Pereira MM, Mainigi M, Strauss JF. Secretory products of the corpus luteum and preeclampsia. Hum Reprod Update 2021; 27:651-672. [PMID: 33748839 PMCID: PMC8222764 DOI: 10.1093/humupd/dmab003] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/18/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Despite significant advances in our understanding of the pathophysiology of preeclampsia (PE), there are still many unknowns and controversies in the field. Women undergoing frozen-thawed embryo transfer (FET) to a hormonally prepared endometrium have been found to have an unexpected increased risk of PE compared to women who receive embryos in a natural FET cycle. The differences in risk have been hypothesized to be related to the absence or presence of a functioning corpus luteum (CL). OBJECTIVE AND RATIONALE To evaluate the literature on secretory products of the CL that could be essential for a healthy pregnancy and could reduce the risk of PE in the setting of FET. SEARCH METHODS For this review, pertinent studies were searched in PubMed/Medline (updated June 2020) using common keywords applied in the field of assisted reproductive technologies, CL physiology and preeclampsia. We also screened the complete list of references in recent publications in English (both animal and human studies) on the topics investigated. Given the design of this work as a narrative review, no formal criteria for study selection or appraisal were utilized. OUTCOMES The CL is a major source of multiple factors regulating reproduction. Progesterone, estradiol, relaxin and vasoactive and angiogenic substances produced by the CL have important roles in regulating its functional lifespan and are also secreted into the circulation to act remotely during early stages of pregnancy. Beyond the known actions of progesterone and estradiol on the uterus in early pregnancy, their metabolites have angiogenic properties that may optimize implantation and placentation. Serum levels of relaxin are almost undetectable in pregnant women without a CL, which precludes some maternal cardiovascular and renal adaptations to early pregnancy. We suggest that an imbalance in steroid hormones and their metabolites and polypeptides influencing early physiologic processes such as decidualization, implantation, angiogenesis and maternal haemodynamics could contribute to the increased PE risk among women undergoing programmed FET cycles. WIDER IMPLICATIONS A better understanding of the critical roles of the secretory products of the CL during early pregnancy holds the promise of improving the efficacy and safety of ART based on programmed FET cycles.
Collapse
Affiliation(s)
- María M Pereira
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Monica Mainigi
- Division of Reproductive Endocrinology and Infertility, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Centre for Research on Reproduction and Women’s Health, University of Pennsylvania, Philadelphia, PA,19104 USA
| | - Jerome F Strauss
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, 23298, USA
- Centre for Research on Reproduction and Women’s Health, University of Pennsylvania, Philadelphia, PA,19104 USA
| |
Collapse
|
26
|
Dall'Agnol H, García Velasco JA. Frozen embryo transfer and preeclampsia: where is the link? Curr Opin Obstet Gynecol 2021; 32:213-218. [PMID: 32324715 DOI: 10.1097/gco.0000000000000624] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE OF REVIEW Preeclampsia is the leading cause of maternal death and has a higher incidence in patients undergoing assisted reproduction treatments. New studies about the mechanisms by which it is more frequent in this population have emerged. The purpose of this review is to gather current information about the available results on this correlation and its possible physiopathology. RECENT FINDINGS Recent publications on the physiopathology of preeclampsia indicate that the corpus luteum is the main source of hormonal production until placental formation and that apart from the secretion of estrogen and progesterone, corpus luteum also produces important substances involved in maternal circulatory adaptation, such as relaxin.With the recent increasing number of frozen embryos transfer in natural cycles or under hormonal replacement, this adaptive circulatory process may be unbalanced and predispose this population to preeclampsia. SUMMARY This article provides a review of frozen embryo transfer and available protocols, the highest incidence of gestational hypertensive disorders presented by the infertile population and an overview of the possible impact of the absence of corpus luteum on the genesis of this disease.
Collapse
|
27
|
Kalinderis M, Kalinderi K, Srivastava G, Homburg R. When Should We Freeze Embryos? Current Data for Fresh and Frozen Embryo Replacement IVF Cycles. Reprod Sci 2021; 28:3061-3072. [PMID: 34033111 DOI: 10.1007/s43032-021-00628-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
Recent years have seen a dramatic rise in the number of frozen-thawed embryo replacement (FER) cycles. Along with the advances in embryo cryopreservation techniques, the optimization of endometrial receptivity has resulted in outcomes for FER that are similar to fresh embryo transfer. However, the question of whether the Freeze all strategy is for all is nowadays a hot topic. This review addresses this issue and describes current evidence based on randomized controlled trials and observational studies. To date, it is reasonable to perform FER in cases with a clear indication for the benefits of such strategy including impending ovarian hyperstimulation syndrome (OHSS) or preimplantation genetic testing for aneuploidy (PGT-A); however, this strategy does not fit for all. This review analyses the pros and cons of the freeze all strategy highlighting the need to follow a personalized plan in embryo transfer, avoiding a freeze all methodology for all patients in an unselected manner.
Collapse
Affiliation(s)
| | - Kallirhoe Kalinderi
- 3rd Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Roy Homburg
- Homerton Fertility Centre, Homerton University Hospital, London, UK.,Queen Mary University of London, London, UK
| |
Collapse
|
28
|
Severino AI, Póvoa AM. Frozen Embryo Transfer and Preeclampsia Risk. J Gynecol Obstet Hum Reprod 2021; 50:102167. [PMID: 34015549 DOI: 10.1016/j.jogoh.2021.102167] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/04/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
Worldwide, the use of Assisted Reproductive Technology (ART) has been steadily rising over recent years. With the continuous improvements in cryopreservation techniques and the growing practice of single embryo transfer, the proportion of frozen embryo transfer (FET) cycles has been increasing, therefore raising concern about the safety of this ART technique to both mothers and infants. This review aims to summarize the current evidence regarding the risk of preeclampsia in singleton pregnancies achieved by autologous FET compared to fresh embryo transfer, and to discuss the influence of different protocols used for endometrium preparation in frozen cycles on the risk of this obstetric complication. Several studies have reported a higher risk of hypertensive disorders, including preeclampsia, in pregnancies following FET compared with fresh embryo transfer. Recently, artificial FET cycles, which preclude the development of a corpus luteum, were shown to be associated with an increased preeclampsia risk in comparison with natural and stimulated cycles. Importantly, no difference was found between FET in a modified natural cycle and spontaneous conception. It has been proposed that the absence of the corpus luteum in artificial cycles may, at least partly, contribute to the observed increased risk of preeclampsia. Indeed, the corpus luteum secretes vasoactive hormones, such as relaxin, which are not replaced in artificial cycles, thereby compromising maternal cardiovascular adaptations to pregnancy, resulting in an increased risk of preeclampsia. If these findings are confirmed by a randomized controlled trial, natural, modified natural or stimulated cycles might be preferred over artificial cycles in eligible patients.
Collapse
Affiliation(s)
- Ana Isabel Severino
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
| | - Ana Margarida Póvoa
- Department of Gynecology, Unit of Reproductive Medicine, Universitary Hospitalar Center São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; Department of Gynecology, Obstetrics and Pediatrics, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; Institute for Investigation and Innovation in Health, University of Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
| |
Collapse
|
29
|
Trautmann C, von Versen-Höynck F. Optimales Protokoll für die Übertragung kryokonservierter Embryonen. GYNAKOLOGISCHE ENDOKRINOLOGIE 2021. [DOI: 10.1007/s10304-020-00373-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
30
|
Wu H, Zhou P, Lin X, Wang S, Zhang S. Endometrial preparation for frozen-thawed embryo transfer cycles: a systematic review and network meta-analysis. J Assist Reprod Genet 2021; 38:1913-1926. [PMID: 33829375 DOI: 10.1007/s10815-021-02125-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 02/21/2021] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To compare the effects of different endometrial preparation protocols for frozen-thawed embryo transfer (FET) cycles and present treatment hierarchy. METHODS Systematic review with meta-analysis was performed by electronic searching of MEDLINE, the Cochrane Library, Embase, ClinicalTrials.gov and Google Scholar up to Dec 26, 2020. Randomised controlled trials (RCTs) or observational studies comparing 7 treatment options (natural cycle with or without human chorionic gonadotrophin trigger (mNC or tNC), artificial cycle with or without gonadotropin-releasing hormone agonist suppression (AC+GnRH or AC), aromatase inhibitor, clomiphene citrate, gonadotropin or follicle stimulating hormone) in FET cycles were included. Meta-analyses were performed within random effects models. Primary outcome was live birth presented as odds ratio (OR) with 95% confidence intervals (CIs). RESULTS Twenty-six RCTs and 113 cohort studies were included in the meta-analyses. In a network meta-analysis, AC ranked last in effectiveness, with lower live birth rates when compared with other endometrial preparation protocols. In pairwise meta-analyses of observational studies, AC was associated with significant lower live birth rates compared with tNC (OR 0.81, 0.70 to 0.93) and mNC (OR 0.85, 0.77 to 0.93). Women who achieved pregnancy after AC were at an increased risk of pregnancy-induced hypertension (OR 1.82, 1.37 to 2.38), postpartum haemorrhage (OR 2.08, 1.61 to 2.78) and very preterm birth (OR 2.08, 1.45 to 2.94) compared with those after tNC. CONCLUSION Natural cycle treatment has a higher chance of live birth and lower risks of PIH, PPH and VPTB than AC for endometrial preparation in women receiving FET cycles.
Collapse
Affiliation(s)
- Hanglin Wu
- Department of Obstetrics and Gynaecology, Hangzhou Women's Hospital, No. 369 Kun Peng Road, Zhejiang, 310008, Hangzhou, China
| | - Ping Zhou
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 Qingchun East Road, Zhejiang, 310016, Hangzhou, China
| | - Xiaona Lin
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 Qingchun East Road, Zhejiang, 310016, Hangzhou, China
| | - Shasha Wang
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 Qingchun East Road, Zhejiang, 310016, Hangzhou, China
| | - Songying Zhang
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 Qingchun East Road, Zhejiang, 310016, Hangzhou, China.
| |
Collapse
|
31
|
Zaat T, Zagers M, Mol F, Goddijn M, van Wely M, Mastenbroek S. Fresh versus frozen embryo transfers in assisted reproduction. Cochrane Database Syst Rev 2021; 2:CD011184. [PMID: 33539543 PMCID: PMC8095009 DOI: 10.1002/14651858.cd011184.pub3] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND In vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) treatments conventionally consist of a fresh embryo transfer, possibly followed by one or more cryopreserved embryo transfers in subsequent cycles. An alternative option is to freeze all suitable embryos and transfer cryopreserved embryos in subsequent cycles only, which is known as the 'freeze all' strategy. This is the first update of the Cochrane Review on this comparison. OBJECTIVES To evaluate the effectiveness and safety of the freeze all strategy compared to the conventional IVF/ICSI strategy in women undergoing assisted reproductive technology. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility Group Trials Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, and two registers of ongoing trials from inception until 23 September 2020 for relevant studies, checked references of publications found, and contacted study authors to obtain additional data. SELECTION CRITERIA Two review authors (TZ and MZ) independently selected studies for inclusion, assessed risk of bias, and extracted study data. We included randomised controlled trials comparing a 'freeze all' strategy with a conventional IVF/ICSI strategy including a fresh embryo transfer in women undergoing IVF or ICSI treatment. DATA COLLECTION AND ANALYSIS The primary outcomes were cumulative live birth rate and ovarian hyperstimulation syndrome (OHSS). Secondary outcomes included effectiveness outcomes (including ongoing pregnancy rate and clinical pregnancy rate), time to pregnancy and obstetric, perinatal and neonatal outcomes. MAIN RESULTS We included 15 studies in the systematic review and eight studies with a total of 4712 women in the meta-analysis. The overall evidence was of moderate to low quality. We graded all the outcomes and downgraded due to serious risk of bias, serious imprecision and serious unexplained heterogeneity. Risk of bias was associated with unclear blinding of investigators for preliminary outcomes of the study during the interim analysis, unit of analysis error, and absence of adequate study termination rules. There was an absence of high-quality evidence according to GRADE assessments for our primary outcomes, which is reflected in the cautious language below. There is probably little or no difference in cumulative live birth rate between the 'freeze all' strategy and the conventional IVF/ICSI strategy (odds ratio (OR) 1.08, 95% CI 0.95 to 1.22; I2 = 0%; 8 RCTs, 4712 women; moderate-quality evidence). This suggests that for a cumulative live birth rate of 58% following the conventional strategy, the cumulative live birth rate following the 'freeze all' strategy would be between 57% and 63%. Women might develop less OHSS after the 'freeze all' strategy compared to the conventional IVF/ICSI strategy (OR 0.26, 95% CI 0.17 to 0.39; I2 = 0%; 6 RCTs, 4478 women; low-quality evidence). These data suggest that for an OHSS rate of 3% following the conventional strategy, the rate following the 'freeze all' strategy would be 1%. There is probably little or no difference between the two strategies in the cumulative ongoing pregnancy rate (OR 0.95, 95% CI 0.75 to 1.19; I2 = 31%; 4 RCTs, 1245 women; moderate-quality evidence). We could not analyse time to pregnancy; by design, time to pregnancy is shorter in the conventional strategy than in the 'freeze all' strategy when the cumulative live birth rate is comparable, as embryo transfer is delayed in a 'freeze all' strategy. We are uncertain whether the two strategies differ in cumulative miscarriage rate because the evidence is very low quality (Peto OR 1.06, 95% CI 0.72 to 1.55; I2 = 55%; 2 RCTs, 986 women; very low-quality evidence) and cumulative multiple-pregnancy rate (Peto OR 0.88, 95% CI 0.61 to 1.25; I2 = 63%; 2 RCTs, 986 women; very low-quality evidence). The risk of hypertensive disorders of pregnancy (Peto OR 2.15, 95% CI 1.42 to 3.25; I2 = 29%; 3 RCTs, 3940 women; low-quality evidence), having a large-for-gestational-age baby (Peto OR 1.96, 95% CI 1.51 to 2.55; I2 = 0%; 3 RCTs, 3940 women; low-quality evidence) and a higher birth weight of the children born (mean difference (MD) 127 g, 95% CI 77.1 to 177.8; I2 = 0%; 5 RCTs, 1607 singletons; moderate-quality evidence) may be increased following the 'freeze all' strategy. We are uncertain whether the two strategies differ in the risk of having a small-for-gestational-age baby because the evidence is low quality (Peto OR 0.82, 95% CI 0.65 to 1.05; I2 = 64%; 3 RCTs, 3940 women; low-quality evidence). AUTHORS' CONCLUSIONS We found moderate-quality evidence showing that one strategy is probably not superior to the other in terms of cumulative live birth rate and ongoing pregnancy rate. The risk of OHSS may be decreased in the 'freeze all' strategy. Based on the results of the included studies, we could not analyse time to pregnancy. It is likely to be shorter using a conventional IVF/ICSI strategy with fresh embryo transfer in the case of similar cumulative live birth rate, as embryo transfer is delayed in a 'freeze all' strategy. The risk of maternal hypertensive disorders of pregnancy, of having a large-for-gestational-age baby and a higher birth weight of the children born may be increased following the 'freeze all' strategy. We are uncertain if 'freeze all' strategy reduces the risk of miscarriage, multiple pregnancy rate or having a small-for-gestational-age baby compared to conventional IVF/ICSI.
Collapse
Affiliation(s)
- Tjitske Zaat
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, Amsterdam, Netherlands
| | - Miriam Zagers
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, Amsterdam, Netherlands
| | - Femke Mol
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, Amsterdam, Netherlands
| | - Mariëtte Goddijn
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, Amsterdam, Netherlands
| | - Madelon van Wely
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, Amsterdam, Netherlands
| | - Sebastiaan Mastenbroek
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, Amsterdam, Netherlands
| |
Collapse
|
32
|
Increased obstetric and neonatal risks in artificial cycles for frozen embryo transfers? Reprod Biomed Online 2021; 42:919-929. [PMID: 33736993 DOI: 10.1016/j.rbmo.2021.01.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/11/2021] [Accepted: 01/24/2021] [Indexed: 02/02/2023]
Abstract
RESEARCH QUESTION What are the obstetric and neonatal risks for women conceiving via frozen-thawed embryo transfer (FET) during a modified natural cycle compared with an artificial cycle method. DESIGN A follow-up study to the ANTARCTICA randomized controlled trial (RCT) (NTR 1586) conducted in the Netherlands, which showed that modified natural cycle FET (NC-FET) was non-inferior to artificial cycle FET (AC-FET) in terms of live birth rates. The current study collected data on obstetric and neonatal outcomes of 98 women who had a singleton live birth. The main outcome was birthweight; additional outcomes included hypertensive disorder of pregnancy, premature birth, gestational diabetes, obstetric haemorrhage and neonatal outcomes including Apgar scores and admission to the neonatal ward or the neonatal intensive care unit and congenital anomalies. RESULTS Data from 82 out of 98 women were analysed according to the per protocol principle. There was no significant difference in the birthweights of children born between groups (mean difference -124 g [-363 g to 114 g]; P = 0.30). Women who conceived by modified NC-FET have a decreased risk of hypertensive disorders of pregnancy compared with AC-FET (relative risk 0.27; 95% CI 0.08-0.94; P = 0.031). Other outcomes, such as rates of premature birth, gestational diabetes or obstetric haemorrhage and neonatal outcomes, were not significantly different. CONCLUSIONS The interpretation is that modified NC-FET is the preferred treatment in women with ovulatory cycles undergoing FET when the increased risk of obstetrical complications and potential neonatal complications in AC-FET are considered.
Collapse
|
33
|
Asserhøj LL, Spangmose AL, Aaris Henningsen AK, Clausen TD, Ziebe S, Jensen RB, Pinborg A. Adverse obstetric and perinatal outcomes in 1,136 singleton pregnancies conceived after programmed frozen embryo transfer (FET) compared with natural cycle FET. Fertil Steril 2021; 115:947-956. [PMID: 33461756 DOI: 10.1016/j.fertnstert.2020.10.039] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate whether obstetric and perinatal outcomes in pregnancies differ after different frozen embryo transfer (FET) protocols. DESIGN Register-based cohort study. SETTING Not applicable. PATIENT(S) All singleton deliveries after assisted reproductive technology in Denmark from 2006 to 2014. Data consisted of 1,136 deliveries after frozen in vitro fertilization. Frozen embryo transfer cycles were grouped by type of FET protocol: programmed FET (n = 357); modified natural cycle FET (n = 611); and true natural cycle FET (n = 168). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Obstetric outcomes (hypertensive disorders in pregnancy, preterm prelabor rupture of membranes, placenta previa, placental abruption, induction of labor, postpartum hemorrhage, and cesarean section) and perinatal outcomes (post-term birth, preterm birth, birth weight, small for gestational age, large for gestational age). RESULT(S) The risk of hypertensive disorders in pregnancy, postpartum hemorrhage, and cesarean section was significantly higher after programmed FET compared with natural cycle FET (modified natural cycle FET and true natural cycle FET). A higher risk of birth weight > 4,500 g was observed in the programmed FET group compared with natural cycle FET. CONCLUSION(S) This study shows that obstetric and perinatal outcomes are adversely affected in programmed FET cycles. Hence, when possible, an endometrial preparation with the creation of a corpus luteum should be considered. Properly sized randomized controlled trials of FET in programmed cycle versus natural cycle including perinatal outcomes are warranted in the future. CLINICAL TRIAL REGISTRATION NUMBER ISRCTN11780826.
Collapse
Affiliation(s)
- Louise Laub Asserhøj
- Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Anne Lærke Spangmose
- Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Søren Ziebe
- Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Rikke Beck Jensen
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anja Pinborg
- Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
34
|
Abstract
We are now in the beginning of the fifth decade of in vitro fertilization (IVF) with more than ten million children born and an annual growth rate of half a million. It was recently found that there is a sevenfold increase in the incidence of pulmonary embolism (PE) during the first trimester of an IVF pregnancy as compared to spontaneous pregnancy. PE is a major cause of maternal mortality, and it is thus of outmost importance to understand the pathophysiological mechanism. The oestrogen surge during the ovarian stimulation has been hypothesized to be the initiating pathophysiological event. A support of this is a current report showing that embryo transfer performed directly after ovarian stimulation increased the risk of PE more than eightfold, whereas no such increase was noted after delayed embryo transfer. This increased risk coincides with a persisting increased oestrogen level. Further reported cardiovascular problems are arterial thromboses, pre-eclampsia and gestational hypertension. Global haemostasis tests change in the direction of increased coagulability, but mostly within normal limits. Cell-bound haemostasis and in particular platelet activation are less studied. However, a major increase in the number of microvesicles (MVs) and markers indicating platelet activation was reported during ovarian stimulation. We now need longitudinal data concerning haemostatic variables that extends into the first trimester. A major research focus should be to identify biomarkers that could be used already before instigation of IVF. Another way to avoid risk could be to delay embryo transfer by adapting a freeze-all strategy.
Collapse
Affiliation(s)
- P Henriksson
- From the, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| |
Collapse
|
35
|
Conrad KP. Evidence for Corpus Luteal and Endometrial Origins of Adverse Pregnancy Outcomes in Women Conceiving with or Without Assisted Reproduction. Obstet Gynecol Clin North Am 2020; 47:163-181. [PMID: 32008666 DOI: 10.1016/j.ogc.2019.10.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Preeclampsia may arise from impaired decidualization in some women. Transcriptomics of mid-secretory biopsy endometrial stromal cells decidualized in vitro and of early gestation choriodecidua from women who experienced preeclampsia with severe features overlapped significantly with the classical endometrial disorders giving rise to the concept of "endometrium spectrum disorders". That is, recurrent implantation failure and miscarriage, endometriosis, normotensive intrauterine growth restriction, preeclampsia and preterm birth may all lie on a continuum of decidual dysregulation, in which phenotypic expression is determined by the specific molecular pathway(s) disrupted and severity of disruption. Women conceiving by programmed IVF protocols showed widespread dysregulation of cardiovascular function and increased rates of adverse pregnancy outcomes including preeclampsia. Programmed cycles preclude development of a corpus luteum (CL), a major regulator of endometrial function. Lack of circulating CL product(s) that are not replaced in programmed cycles (eg, relaxin) could adversely impact the maternal cardiovascular system directly and/or compromise decidualization, thereby increasing preeclampsia risk.
Collapse
Affiliation(s)
- Kirk P Conrad
- Department of Physiology and Functional Genomics, D.H. Barron Reproductive and Perinatal Biology Research Program, University of Florida College of Medicine, 1600 Southwest Archer RD, PO Box 100274, M552, Gainesville, FL 32610-0274, USA; Department of Obstetrics and Gynecology, University of Florida College of Medicine, 1600 Southwest Archer RD, PO Box 100294, N3-9, Gainesville, FL 32610-0274, USA.
| |
Collapse
|
36
|
Wiegel RE, Jan Danser AH, Steegers-Theunissen RPM, Laven JSE, Willemsen SP, Baker VL, Steegers EAP, von Versen-Höynck F. Determinants of Maternal Renin-Angiotensin-Aldosterone-System Activation in Early Pregnancy: Insights From 2 Cohorts. J Clin Endocrinol Metab 2020; 105:5898239. [PMID: 32853347 PMCID: PMC7494245 DOI: 10.1210/clinem/dgaa582] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/26/2020] [Indexed: 01/09/2023]
Abstract
CONTEXT The corpus luteum (CL) secretes prorenin, renin's inactive precursor. It may thus contribute to the renin-angiotensin-aldosterone-system (RAAS) activation that is required for maternal adaptation in pregnancy. Whether this activation is disturbed in pregnancies lacking a CL is unknown. OBJECTIVE The objective of this work is to investigate maternal RAAS determinants in early pregnancy. DESIGN AND SETTING Two observational prospective cohort studies. TOOK PLACE AT 2 tertiary referral hospitals. PATIENTS AND INTERVENTION(S) Pregnancies (n = 277) were stratified by CL number and in vitro fertilization (IVF) protocol: 0 CL (programmed cycle frozen embryo transfer [FET], n = 28), 1 CL (natural cycle FET, n = 41 and spontaneous conceptions, n = 139), and more than 1 CL (ovarian stimulation and fresh embryo transfer, n = 69). METHODS Quantification was performed for maternal prorenin, renin, and aldosterone blood levels at 5, 9, and 11 weeks of gestation. RESULTS Prorenin and renin were lower in the absence of a CL at all time points when compared to 1 CL, whereas prorenin, renin, and aldosterone were higher in the presence of more than 1 CL vs 1 CL (P < .05). Ovarian stimulation with menopausal gonadotropin resulted in higher prorenin, renin, and aldosterone concentrations during the late first trimester than recombinant follicle-stimulating hormone (P < .05). Prorenin, and to a lesser degree renin, correlated positively with serum progesterone and relaxin, but not serum estradiol. Total follicle diameter, body mass index (BMI), polycystic ovary syndrome (PCOS), and antimüllerian hormone (AMH) were additional determinants of circulating prorenin. Finally, pregnancies conceived in the absence of a CL were more disposed to develop preeclampsia. CONCLUSIONS CL number, IVF protocol, BMI, PCOS, and AMH affect maternal RAAS activation in early pregnancy, and may thus contribute to pregnancy complications.
Collapse
Affiliation(s)
- Rosalieke E Wiegel
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, CA Rotterdam, the Netherlands
| | - A H Jan Danser
- Department of Internal Medicine, Erasmus MC University Medical Center, CA Rotterdam, the Netherlands
| | - Régine P M Steegers-Theunissen
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, CA Rotterdam, the Netherlands
- Correspondence and Reprint Requests: R.P.M. Steegers-Theunissen, MD, PhD, Erasmus MC, University Medical Center Rotterdam, Department of Obstetrics and Gynecology, Room EE-2271a, PO Box 2040, 3000 CA Rotterdam, the Netherlands. E-mail:
| | - Joop S E Laven
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, CA Rotterdam, the Netherlands
| | - Sten P Willemsen
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, CA Rotterdam, the Netherlands
- Department of Biostatistics, Erasmus MC University Medical Center, CA Rotterdam, the Netherlands
| | - Valerie L Baker
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Lutherville, Maryland, USA
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, CA Rotterdam, the Netherlands
| | | |
Collapse
|
37
|
|
38
|
Li L, Hao X, Chen H, Wang L, Chen A, Song X, Hu Z, Su Y, Lin H, Fan P. Metabolomic characterization of semen from asthenozoospermic patients using ultra-high-performance liquid chromatography-tandem quadrupole time-of-flight mass spectrometry. Biomed Chromatogr 2020; 34:e4897. [PMID: 32428267 PMCID: PMC7507193 DOI: 10.1002/bmc.4897] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/09/2020] [Accepted: 05/13/2020] [Indexed: 12/15/2022]
Abstract
Asthenozoospermia (AS) is a common factor of male infertility, and its pathogenesis remains unclear. The purpose of this study was to investigate the differential seminal plasma metabolic pattern in asthenozoospermic men and to identify potential biomarkers in relation to spermatogenic dysfunction using sensitive ultra-high-performance liquid chromatography-tandem quadruple time-of-flight MS (UHPLC-Q-TOF/MS). The samples of seminal plasma from patients with AS (n = 20) and healthy controls (n = 20) were checked and differentiated by UHPLC-Q-TOF/MS. Compared with the control group, the AS group showed a total of nine significantly different metabolites, including increases in creatinine, uric acid, N6 -methyladenosine (m6 A), uridine, and taurine and decreases in carnitine, nicotinamide, N-acetylputrescine and l-palmitoylcarnitine. By analyzing the correlation among these metabolites and clinical computer-assisted semen analysis reports, we found that m6 A is significantly correlated with not only the four decreased metabolites but also with sperm count, motility, and curvilinear velocity. Furthermore, nicotinamide was shown to correlate with other identified metabolites, indicating its important role in the metabolic pathway of AS. Current results implied that sensitive untargeted seminal plasma metabolomics could identify distinct metabolic patterns of AS and would help clinicians by offering novel cues for discovering the pathogenesis of male infertility.
Collapse
Affiliation(s)
- Li Li
- Zhejiang Provincial Key Laboratory of Anesthesiology, Department of Anesthesiologythe Second Affiliated Hospital of Wenzhou Medical UniversityWenzhouZhejiangChina
| | - Xinrui Hao
- Zhejiang Provincial Key Laboratory of Anesthesiology, Department of Anesthesiologythe Second Affiliated Hospital of Wenzhou Medical UniversityWenzhouZhejiangChina
| | - Hua Chen
- Reproductive Health Centre, Department of Obstetrics and Gynecologythe Second Affiliated Hospital of Wenzhou Medical UniversityWenzhouZhejiangChina
| | - Liyuan Wang
- Reproductive Health Centre, Department of Obstetrics and Gynecologythe Second Affiliated Hospital of Wenzhou Medical UniversityWenzhouZhejiangChina
| | - Aolei Chen
- Reproductive Health Centre, Department of Obstetrics and Gynecologythe Second Affiliated Hospital of Wenzhou Medical UniversityWenzhouZhejiangChina
| | - Xiaotian Song
- Reproductive Health Centre, Department of Obstetrics and Gynecologythe Second Affiliated Hospital of Wenzhou Medical UniversityWenzhouZhejiangChina
| | - Zhiyan Hu
- Zhejiang Provincial Key Laboratory of Anesthesiology, Department of Anesthesiologythe Second Affiliated Hospital of Wenzhou Medical UniversityWenzhouZhejiangChina
| | - Ying Su
- Zhejiang Provincial Key Laboratory of Anesthesiology, Department of Anesthesiologythe Second Affiliated Hospital of Wenzhou Medical UniversityWenzhouZhejiangChina
| | - Han Lin
- Zhejiang Provincial Key Laboratory of Anesthesiology, Department of Anesthesiologythe Second Affiliated Hospital of Wenzhou Medical UniversityWenzhouZhejiangChina
| | - Pei Fan
- Zhejiang Provincial Key Laboratory of Orthopedics, Department of Orthopedicsthe Second Affiliated Hospital of Wenzhou Medical UniversityWenzhouZhejiangChina
| |
Collapse
|
39
|
Berntsen S, Larsen EC, la Cour Freiesleben N, Pinborg A. Pregnancy outcomes following oocyte donation. Best Pract Res Clin Obstet Gynaecol 2020; 70:81-91. [PMID: 32741624 DOI: 10.1016/j.bpobgyn.2020.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/18/2020] [Accepted: 07/01/2020] [Indexed: 12/17/2022]
Abstract
The use of oocyte donation (OD) has increased continuously over the last three decades, and it is now an indispensable part of assisted reproductive technology (ART). With OD, it has become possible to overcome the biological barrier of ovarian follicle pool depletion and the general age-related decline in fertility. This review contains a thorough appraisal of the safety of OD with an analysis of short-term pregnancy outcomes. Salient up-to-date evidence was evaluated, which revealed that in comparison with both IVF with autologous oocytes, and naturally conceived pregnancies, there is: (i) an increased risk of hypertensive disorders of pregnancy and preeclampsia; (ii) an increased risk of low birth weight and preterm birth and (iii) an increased risks of obstetric emergencies, following OD treatment. As a precaution, it is therefore highly encouraged to perform only single embryo transfer (SET) and to prescribe prophylactic low-dose aspirin during OD pregnancies.
Collapse
Affiliation(s)
- Sine Berntsen
- Department of Obstetrics and Gynaecology, The Fertility Clinic, Copenhagen University Hospital, Hvidovre Hospital, Kettegaard allé 30, 2650, Hvidovre, Denmark.
| | - Elisabeth Clare Larsen
- The Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Nina la Cour Freiesleben
- Department of Obstetrics and Gynaecology, The Fertility Clinic, Copenhagen University Hospital, Hvidovre Hospital, Kettegaard allé 30, 2650, Hvidovre, Denmark.
| | - Anja Pinborg
- The Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| |
Collapse
|
40
|
Wang Z, Liu H, Song H, Li X, Jiang J, Sheng Y, Shi Y. Increased Risk of Pre-eclampsia After Frozen-Thawed Embryo Transfer in Programming Cycles. Front Med (Lausanne) 2020; 7:104. [PMID: 32322584 PMCID: PMC7156607 DOI: 10.3389/fmed.2020.00104] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/09/2020] [Indexed: 11/16/2022] Open
Abstract
Objective: This study aims to investigate whether obstetric complications and perinatal outcomes after frozen embryo transfer (FET) in the programming cycles differ from that in the natural cycles. Methods: We conducted a retrospective cohort study collecting a total of 14,373 singletons born after frozen embryo transfer at the Center for Reproductive Medicine Affiliated to Shandong University from September 2013 to September 2018. The women were divided into two groups according to the regimens for endometrium preparation: either natural cycles (n = 10,211) or programming cycles (n = 4,162). The primary outcomes were the incidence of obstetric complications consisting of pre-eclampsia, gestational diabetes mellitus, placenta previa, placental abruption, and postpartum hemorrhage. The perinatal outcomes included average birthweight, low birthweight (LBW), very LBW, macrosomia, large for gestational age, and small for gestational age. Multivariable logistic regression analysis was performed to adjust for potential confounders. Results: The incidences of pre-eclampsia (8.6 vs. 3.8%) and postpartum hemorrhage (0.7 vs. 0.2%) in the programming FET cycles were significantly higher than those in the natural FET cycles. The logistic regression analysis showed that, compared to the natural FET cycles, the programming FET cycles were associated with an elevated risk of pre-eclampsia (aOR, 2.55; 95% CI, 2.06–3.16) and postpartum hemorrhage (aOR, 2.94; 95% CI, 1.44–5.99). Conclusion: The women with singleton delivery after frozen-thawed embryo transfer in the programming cycles had an elevated risk of pre-eclampsia and postpartum hemorrhage, which was speculated to be associated with the absence of the corpus luteum.
Collapse
Affiliation(s)
- Ze Wang
- Center for Reproductive Medicine, Shandong University, Jinan, China.,Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Jinan, China
| | - Hong Liu
- Center for Reproductive Medicine, Shandong University, Jinan, China.,Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Jinan, China
| | - Haixia Song
- Center for Reproductive Medicine, Shandong University, Jinan, China.,Department of Reproductive Medicine, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Xiufang Li
- Center for Reproductive Medicine, Shandong University, Jinan, China.,Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Jinan, China
| | - Jingjing Jiang
- Center for Reproductive Medicine, Shandong University, Jinan, China.,Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Jinan, China
| | - Yan Sheng
- Center for Reproductive Medicine, Shandong University, Jinan, China.,Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Jinan, China
| | - Yuhua Shi
- Center for Reproductive Medicine, Shandong University, Jinan, China.,Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Jinan, China
| |
Collapse
|
41
|
Viganò P, Alteri A, Busnelli A, Vanni VS, Somigliana E. Frozen IVF Cycles to Circumvent the Hormonal Storm on Endometrium. Trends Endocrinol Metab 2020; 31:296-307. [PMID: 32035735 DOI: 10.1016/j.tem.2020.01.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/21/2019] [Accepted: 01/09/2020] [Indexed: 01/29/2023]
Abstract
Controlled ovarian hyperstimulation (COH) determines an anticipation of endometrial maturation and a premature occurrence of the implantation window, as shown by histological, histochemical, and molecular studies and indirectly by clinical trials. There is growing agreement that in patients hyper-responding to COH and in those undergoing transfer at the blastocyst stage, deferring the transfer in a subsequent frozen cycle could increase pregnancy outcomes. For blastocysts, implantation after a fresh transfer may be limited as the implantation window is already closed while, in hyper-responders to COH, the anticipation magnitude could be more marked thus hampering implantation also for cleavage-stage embryos. Research should focus in depth on pregnancy outcomes and on the most suitable modality to prepare the endometrium for frozen transfers.
Collapse
Affiliation(s)
- Paola Viganò
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milan, Italy.
| | - Alessandra Alteri
- Centro Scienze Natalità, Obstetrics and Gynecology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Busnelli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Valeria Stella Vanni
- Centro Scienze Natalità, Obstetrics and Gynecology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Edgardo Somigliana
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
42
|
von Versen-Höynck F, Häckl S, Tierney ESS, Conrad KP, Baker VL, Winn VD. Maternal Vascular Health in Pregnancy and Postpartum After Assisted Reproduction. Hypertension 2020; 75:549-560. [PMID: 31838910 PMCID: PMC7491550 DOI: 10.1161/hypertensionaha.119.13779] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Although most pregnancies after assisted reproduction are associated with a favorable outcome for the mother and infant, reports of abnormal vascular adaptation in early pregnancy and emerging maternal and perinatal pathology warrant further investigations. Herein we extended our previous work and further examined whether perturbations of blood pressure and endothelial function during the first trimester in conceptions with nonphysiological corpus luteum (CL) numbers would persist through the third trimester of pregnancy and into the postpartum period. We investigated both maternal and perinatal outcomes. Participants were grouped according to CL number and method of conception: 0 CL (programmed autologous frozen-thawed embryo transfer, N=10-18); 1 CL (spontaneous conception [N=16] and natural cycle frozen-thawed embryo transfer [N=12]); or >3 CL associated with autologous fresh embryo transfer [N=8-12]. Augmentation index was higher during the third trimester in the absence of a CL compared to 1 CL (P=0.03) and in frozen-thawed embryo transfer in a programmed compared to a natural cycle (P=0.02). Moreover, baseline pulse-wave amplitude was higher in >3 CL conceptions at all time points (all P<0.05). The incidence of preeclampsia and preeclampsia with severe features was significantly higher in the absence of a CL compared to the presence of one or >3 CL (P=0.045 and P=0.03). Infants from conceptions with >3 CL had lower birth weights (P=0.02) and a higher rate of low birth weight offspring (P=0.008). Deficient vascular adaptation during early gestation in conceptions with nonphysiological CL numbers might predispose women to adverse pregnancy outcomes, for example, preeclampsia.
Collapse
Affiliation(s)
- Frauke von Versen-Höynck
- Stanford University Medical Center, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, 1195 West Fremont Avenue, Sunnyvale, CA 94087, United States of America
- Hannover Medical School, Department of Obstetrics and Gynecology, Lower Saxony, Germany
| | - Sebastian Häckl
- Hannover Medical School, Department of Biometry, Lower Saxony, Germany
| | - Elif Seda Selamet Tierney
- Lucile Packard Children’s Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Stanford University, Palo Alto, USA, 750 Welch Road, Suite 325, Heart Center
| | - Kirk P Conrad
- Departments of Physiology and Functional Genomics, and of Obstetrics and Gynecology, D. H. Barron Reproductive and Perinatal Biology Research Program, University of Florida College of Medicine, Gainesville, FL 32610, United States of America
| | - Valerie L. Baker
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Lutherville, MD 21093
| | - Virginia D Winn
- Stanford University Medical Center, Department of Obstetrics and Gynecology, 300 Pasteur Drive, HG332, Stanford CA 94035
| |
Collapse
|
43
|
von Versen-Höynck F, Schaub AM, Chi YY, Chiu KH, Liu J, Lingis M, Stan Williams R, Rhoton-Vlasak A, Nichols WW, Fleischmann RR, Zhang W, Winn VD, Segal MS, Conrad KP, Baker VL. Increased Preeclampsia Risk and Reduced Aortic Compliance With In Vitro Fertilization Cycles in the Absence of a Corpus Luteum. Hypertension 2019; 73:640-649. [PMID: 30636552 DOI: 10.1161/hypertensionaha.118.12043] [Citation(s) in RCA: 209] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In vitro fertilization involving frozen embryo transfer and donor oocytes increases preeclampsia risk. These in vitro fertilization protocols typically yield pregnancies without a corpus luteum (CL), which secretes vasoactive hormones. We investigated whether in vitro fertilization pregnancies without a CL disrupt maternal circulatory adaptations and increase preeclampsia risk. Women with 0 (n=26), 1 (n=23), or >1 (n=22) CL were serially evaluated before, during, and after pregnancy. Because increasing arterial compliance is a major physiological adaptation in pregnancy, we assessed carotid-femoral pulse wave velocity and transit time. In a parallel prospective cohort study, obstetric outcomes for singleton livebirths achieved with autologous oocytes were compared between groups by CL number (n=683). The expected decline in carotid-femoral pulse wave velocity and rise in carotid-femoral transit time during the first trimester were attenuated in the 0-CL compared with combined single/multiple-CL cohorts, which were similar (group-time interaction: P=0.06 and 0.03, respectively). The blunted changes of carotid-femoral pulse wave velocity and carotid-femoral transit time from prepregnancy in the 0-CL cohort were most striking at 10 to 12 weeks of gestation ( P=0.01 and 0.006, respectively, versus 1 and >1 CL). Zero CL was predictive of preeclampsia (adjusted odds ratio, 2.73; 95% CI, 1.14-6.49) and preeclampsia with severe features (6.45; 95% CI, 1.94-25.09) compared with 1 CL. Programmed frozen embryo transfer cycles (0 CL) were associated with higher rates of preeclampsia (12.8% versus 3.9%; P=0.02) and preeclampsia with severe features (9.6% versus 0.8%; P=0.002) compared with modified natural frozen embryo transfer cycles (1 CL). In common in vitro fertilization protocols, absence of the CL perturbed the maternal circulation in early pregnancy and increased the incidence of preeclampsia.
Collapse
Affiliation(s)
- Frauke von Versen-Höynck
- From the Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology (F.v.V.-H., R.R.F., W.Z., V.L.B.), Stanford University School of Medicine, Sunnyvale, CA.,Department of Obstetrics and Gynecology, Hannover Medical School, Lower Saxony, Germany (F.v.V.-H.), University of Florida, Gainesville
| | - Amelia M Schaub
- Department of Obstetrics and Gynecology (A.M.S., R.S.W., A.R.-V., K.P.C.), University of Florida, Gainesville
| | - Yueh-Yun Chi
- Department of Biostatistics (Y.-Y.C., K.-H.C., J.L.), University of Florida, Gainesville
| | - Kuei-Hsun Chiu
- Department of Biostatistics (Y.-Y.C., K.-H.C., J.L.), University of Florida, Gainesville
| | - Jing Liu
- Department of Biostatistics (Y.-Y.C., K.-H.C., J.L.), University of Florida, Gainesville
| | - Melissa Lingis
- Division of Nephrology, Hypertension, and Renal Transplantation (M.L., M.S.S.), University of Florida, Gainesville
| | - R Stan Williams
- Department of Obstetrics and Gynecology (A.M.S., R.S.W., A.R.-V., K.P.C.), University of Florida, Gainesville
| | - Alice Rhoton-Vlasak
- Department of Obstetrics and Gynecology (A.M.S., R.S.W., A.R.-V., K.P.C.), University of Florida, Gainesville
| | - Wilmer W Nichols
- Division of Cardiology (W.W.N.), University of Florida, Gainesville
| | - Raquel R Fleischmann
- From the Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology (F.v.V.-H., R.R.F., W.Z., V.L.B.), Stanford University School of Medicine, Sunnyvale, CA
| | - Wendy Zhang
- From the Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology (F.v.V.-H., R.R.F., W.Z., V.L.B.), Stanford University School of Medicine, Sunnyvale, CA
| | - Virginia D Winn
- Division of Reproductive, Stem Cell, and Perinatal Biology, Department of Obstetrics and Gynecology (V.D.W.), Stanford University School of Medicine, Sunnyvale, CA
| | - Mark S Segal
- Division of Nephrology, Hypertension, and Renal Transplantation (M.L., M.S.S.), University of Florida, Gainesville
| | - Kirk P Conrad
- Department of Obstetrics and Gynecology (A.M.S., R.S.W., A.R.-V., K.P.C.), University of Florida, Gainesville.,Department of Medicine, and Department of Physiology and Functional Genomics, D.H. Barron Reproductive and Perinatal Biology Research Program (K.P.C.), University of Florida, Gainesville
| | - Valerie L Baker
- From the Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology (F.v.V.-H., R.R.F., W.Z., V.L.B.), Stanford University School of Medicine, Sunnyvale, CA
| |
Collapse
|
44
|
Meyer R, Orvieto R, Timerman Y, Gorodesky T, Toussia-Cohen S, Kedem A, Simchen MJ, Machtinger R. Impact of the mode of conception on gestational hypertensive disorders at very advanced maternal age. Reprod Biomed Online 2019; 40:281-286. [PMID: 31870723 DOI: 10.1016/j.rbmo.2019.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/06/2019] [Accepted: 10/31/2019] [Indexed: 12/20/2022]
Abstract
RESEARCH QUESTION To study gestational hypertensive disorders in oocyte donation pregnancies compared with other modes of conception at very advanced maternal age. DESIGN A historical cohort study of all women aged 45-47 years who gave birth to singletons at a tertiary medical centre between March 2011 and May 2018, at 24 weeks' gestation or later. Pregnancy outcomes were compared between donor oocyte (IVF-OD), IVF using autologous oocytes (IVF-A) and naturally conceived pregnancies. A multivariate logistic regression was used to evaluate the association between the mode of conception and gestational hypertensive disorders. RESULTS The final analysis included 159, 68 and 73 patients in the IVF-OD, IVF-A and natural conception groups, respectively. The rate of gestational hypertensive disorders was significantly higher among those who conceived by IVF compared with those who conceived naturally but did not differ between the two IVF groups (27.0% for IVF-OD, 19.1% for IVF-A, P = 0.204; 5.5% for natural conception, P < 0.001 and P = 0.013 compared with IVF-OD and IVF-A, respectively). The results remained similar in a multivariate logistic regression analysis. The rate of Caesarean deliveries was significantly higher in the IVF-OD and IVF-A groups compared with the natural conception group (83.6%, 70.6% and 37.0%, respectively, P < 0.001), but other pregnancy outcomes did not differ between the groups. CONCLUSIONS IVF pregnancies in the late fifth decade of life were associated with significantly higher rates of gestational hypertensive disorders compared with naturally conceived pregnancies. No difference existed between the two IVF groups. These results may highlight the impact of IVF itself on gestational hypertensive disorders at very advanced maternal age.
Collapse
Affiliation(s)
- Raanan Meyer
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel.
| | - Raoul Orvieto
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Timerman
- Faculty of Medicine, St George's University of London, London, UK
| | - Tal Gorodesky
- Faculty of Medicine, St George's University of London, London, UK
| | | | - Alon Kedem
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michal J Simchen
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ronit Machtinger
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
45
|
Zhang WY, Selamet Tierney ES, Chen AC, Ling AY, Fleischmann RR, Baker VL. Vascular Health of Children Conceived via In Vitro Fertilization. J Pediatr 2019; 214:47-53. [PMID: 31443895 PMCID: PMC6815705 DOI: 10.1016/j.jpeds.2019.07.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 06/17/2019] [Accepted: 07/11/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate whether in vitro fertilization (IVF) has an effect on the cardiovascular health of offspring. STUDY DESIGN This was a cross-sectional pilot study. We performed vascular health assessment for 17 children aged 10-14 years who were conceived via IVF with autologous oocytes at Stanford University. Carotid artery ultrasound evaluated intima-media thickness and stiffness, carotid-femoral pulse wave velocity determined segmental arterial stiffness, and endothelial pulse amplitude testing assessed endothelial function. We compared IVF offspring with control adolescents assessed in the same laboratory, with all comparisons adjusted for age, sex, and race/ethnicity. RESULTS All participants had normal body mass index and blood pressure. Compared with controls, IVF children had thicker common carotid artery intima-media thickness (0.44 ± 0.03 mm vs 0.38 ± 0.03 mm; P < .01), higher elastic modulus (395.29 ± 185.33 mm Hg vs 242.79 ± 37.69 mm Hg; P = .01), higher βstiffness (2.65 ± 0.38 vs 2.28 ± 0.23; P < .01), and higher peak velocity (142.29 ± 31.62 cm/s vs 117.71 ± 32.69 cm/s; P = .04). The mean endothelial pulse amplitude testing reactive hyperemia index was not significantly different between IVF and controls. The mean pulse wave velocity was 4.69 ± 0.51 m/s compared with the controls 4.60 ± 0.57 m/s (P = .11), with 8 (47%) having abnormal values. CONCLUSION In an assessment of endothelial function and arterial properties of children conceived via IVF, we found that children conceived via IVF seem to have evidence of abnormal vascular health. Further studies with larger sample size and long-term follow-up are warranted.
Collapse
Affiliation(s)
- Wendy Y Zhang
- Stanford University School of Medicine, Stanford, CA.
| | - Elif Seda Selamet Tierney
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Angela C Chen
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Albee Y Ling
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA
| | | | - Valerie L Baker
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA; Johns Hopkins University School of Medicine, Department of Gynecology and Obstetrics, Division of Reproductive Endocrinology and Infertility, Baltimore, MD
| |
Collapse
|
46
|
Ginström Ernstad E, Wennerholm UB, Khatibi A, Petzold M, Bergh C. Neonatal and maternal outcome after frozen embryo transfer: Increased risks in programmed cycles. Am J Obstet Gynecol 2019; 221:126.e1-126.e18. [PMID: 30910545 DOI: 10.1016/j.ajog.2019.03.010] [Citation(s) in RCA: 188] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/05/2019] [Accepted: 03/18/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Frozen embryo transfer is associated with better perinatal outcome regarding preterm birth and low birthweight, yet higher risk of large for gestational age and macrosomia compared to fresh transfer. Further, higher rates of hypertensive disorders in pregnancy are noted after frozen embryo transfer. Whether these differences are due to the protocol used in frozen cycles remains unknown. OBJECTIVE To analyze the obstetric outcome after frozen embryo transfer depending on protocol used. Comparison was also made for frozen vs fresh transfer and for frozen transfer vs spontaneous conception. STUDY DESIGN A population-based retrospective registry study including all singletons born after frozen embryo transfer in Sweden from 2005 to 2015. The in vitro fertilization register was cross-linked with the Medical Birth Register, the Register of Birth Defects, the National Patient Register, the Swedish Neonatal Quality Register, and the Prescribed Drug Register. Singletons after frozen embryo transfer were compared depending on the presence of a corpus luteum in the actual cycle. All frozen transfer singletons were also compared with fresh transfer and spontaneous conception singletons. Primary outcomes were preterm birth (<37 w), low birthweight (<2500 g), hypertensive disorders in pregnancy, and postpartum hemorrhage (>1000 mL). Crude and adjusted odds ratio with 95% confidence interval were calculated and adjustment made for relevant confounders. RESULTS A total of 9726 singletons were born after frozen embryo transfer (natural cycles, n = 6297; stimulated cycles, n = 1983; programmed cycles, n = 1446), 24,365 after fresh transfer, and 1,127,566 after spontaneous conception. No significant differences were noticed for preterm birth and low birthweight between the different protocols used in frozen embryo transfer. Compared to natural and stimulated frozen cycles, programmed frozen cycles were associated with a higher risk of hypertensive disorders in pregnancy (adjusted odds ratio, 1.78; 95% confidence interval, 1.43-2.21 and adjusted odds ratio, 1.61; 95% confidence interval, 1.22-2,10, respectively) and postpartum hemorrhage (adjusted odds ratio, 2.63; 95% confidence interval, 2.20-3.13 and adjusted odds ratio, 2.87; 95% confidence interval, 2.29-2.60, respectively). Moreover, higher risks for postterm birth (adjusted odds ratio, 1.59; 95% confidence interval, 1.27-2.01 and adjusted odds ratio, 1.98; 95% confidence interval, 1.47-2.68) and macrosomia (adjusted odds ratio, 1.62; 95% confidence interval, 1.26-2.09 and adjusted odds ratio, 1.40; 95% confidence interval, 1.03-1.90) were detected. There were no significant differences in any outcomes between stimulated and natural cycles. Frozen cycles in general compared to fresh cycles and compared to spontaneous conceptions showed neonatal and maternal outcomes in agreement with earlier studies. CONCLUSION No significant difference could be seen regarding preterm birth and low birthweight between the different protocols. However, higher rates of hypertensive disorders in pregnancy, postpartum hemorrhage, postterm birth, and macrosomia were detected in programmed cycles. Stimulated cycles had outcomes similar to natural cycles. These findings are important in view of the increasing use of frozen cycles and the new policy of freeze-all cycles in in vitro fertilization. The results suggest a link between the absence of corpus luteum and adverse obstetric outcomes.
Collapse
|
47
|
Conrad KP, Petersen JW, Chi YY, Zhai X, Li M, Chiu KH, Liu J, Lingis MD, Williams RS, Rhoton-Vlasak A, Larocca JJ, Nichols WW, Segal MS. Maternal Cardiovascular Dysregulation During Early Pregnancy After In Vitro Fertilization Cycles in the Absence of a Corpus Luteum. Hypertension 2019; 74:705-715. [PMID: 31352818 DOI: 10.1161/hypertensionaha.119.13015] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Commonly used in vitro fertilization protocols produce pregnancies without a corpus luteum (CL), a major source of reproductive hormones. In vitro fertilization pregnancies without a CL showed deficient gestational increases of central (aortic) arterial compliance during the first trimester and were at increased risk for developing preeclampsia. Here, we investigated whether there was generalized impairment of cardiovascular adaptation in in vitro fertilization pregnancies without a CL compared with pregnancies conceived spontaneously or through ovarian stimulation, which lead to 1 and >1 CL, respectively (n=19-26 participants per cohort). Prototypical maternal cardiovascular adaptations of gestation were serially evaluated noninvasively, initially during the follicular phase before conception, 6× in pregnancy, and then, on average, 1.6 years post-partum. The expected increases of cardiac output, left atrial dimension, peak left ventricular filling velocity in early diastole (E wave velocity), peripheral/central arterial pulse pressure ratio, and global AC, as well as decrease in augmentation index were significantly attenuated or absent during the first trimester in women who conceived without a CL, when compared with the 1 and >1 CL cohorts, which were comparable. Thereafter, these cardiovascular measures showed recovery in the 0 CL group except for E wave velocity, which remained depressed. These results provided strong support for a critical role of CL factor(s) in the transformation of the maternal cardiovascular system in early gestation. Regimens that lead to the development of a CL or replacement of missing CL factor(s) may be indicated to improve cardiovascular function and reduce preeclampsia risk in in vitro fertilization pregnancies.
Collapse
Affiliation(s)
- Kirk P Conrad
- From the Department of Physiology and Functional Genomics and D.H. Barron Reproductive and Perinatal Biology Research Program (K.P.C.), University of Florida, Gainesville
- Department of Obstetrics and Gynecology (K.P.C., R.S.W., A.R.-V.), University of Florida, Gainesville
| | - John W Petersen
- Division of Cardiovascular Medicine, Department of Medicine (J.W.P., J.J.L., W.W.N.), University of Florida, Gainesville
| | - Yueh-Yun Chi
- Department of Biostatistics (Y.-Y.C., X.Z., M.L., K.-H.C., J.L.), University of Florida, Gainesville
| | - Xiaoman Zhai
- Department of Biostatistics (Y.-Y.C., X.Z., M.L., K.-H.C., J.L.), University of Florida, Gainesville
| | - Minjie Li
- Department of Biostatistics (Y.-Y.C., X.Z., M.L., K.-H.C., J.L.), University of Florida, Gainesville
| | - Kuei-Hsun Chiu
- Department of Biostatistics (Y.-Y.C., X.Z., M.L., K.-H.C., J.L.), University of Florida, Gainesville
| | - Jing Liu
- Department of Biostatistics (Y.-Y.C., X.Z., M.L., K.-H.C., J.L.), University of Florida, Gainesville
| | - Melissa D Lingis
- Division of Nephrology, Hypertension, and Renal Transplantation, Department of Medicine (M.D.L., M.S.S.), University of Florida, Gainesville
| | - R Stan Williams
- Department of Obstetrics and Gynecology (K.P.C., R.S.W., A.R.-V.), University of Florida, Gainesville
| | - Alice Rhoton-Vlasak
- Department of Obstetrics and Gynecology (K.P.C., R.S.W., A.R.-V.), University of Florida, Gainesville
| | - Joseph J Larocca
- Division of Cardiovascular Medicine, Department of Medicine (J.W.P., J.J.L., W.W.N.), University of Florida, Gainesville
| | - Wilmer W Nichols
- Division of Cardiovascular Medicine, Department of Medicine (J.W.P., J.J.L., W.W.N.), University of Florida, Gainesville
| | - Mark S Segal
- Division of Nephrology, Hypertension, and Renal Transplantation, Department of Medicine (M.D.L., M.S.S.), University of Florida, Gainesville
- Nephrology and Hypertensive Section, Medical Service, North Florida/South Georgia Veterans Health System, Gainesville (M.S.S.)
| |
Collapse
|
48
|
Baker VL, Iko I, Segars J. Is a frozen embryo transfer in a programmed cycle really the best option? J Assist Reprod Genet 2019; 36:935-937. [PMID: 30982144 DOI: 10.1007/s10815-019-01449-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 03/29/2019] [Indexed: 01/22/2023] Open
Affiliation(s)
- Valerie L Baker
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 10751 Falls Rd, Lutherville, MD, 21093, USA.
| | - Ijeoma Iko
- Department of Obstetrics & Gynecology, Davis Medical Center, University of California, 4860 Y St, Sacramento, CA, 95816, USA
| | - James Segars
- Division of Reproductive Sciences and Women's Health Research, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 720 Rutland Ave, Baltimore, MD, 21205, USA
| |
Collapse
|