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Schottler NI, Sutcliffe AG. Children born to subfertile couples, how are they doing? Evidence from research. Arch Dis Child 2024:archdischild-2023-326023. [PMID: 38589201 DOI: 10.1136/archdischild-2023-326023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/22/2024] [Indexed: 04/10/2024]
Abstract
More than 10 million children have been born with assisted reproductive technology (ART) as we begin to enter the third generation of individuals conceived by ART. Here we summarise key messages from an enlarging body of literature regarding their health. Earlier research had pointed towards increases in perinatal, neonatal and neurological risks, such as preterm birth, low birth weight, congenital malformations and cerebral palsy. Many of these risks have continued to persist in most recent work but have shown reduction. Newer research proposes long-term cardiometabolic and endocrine concerns. Fortunately, most reports conclude there is little or no risk of increased childhood malignancy or abnormal neurodevelopment. Moving forward, new research may benefit from changes in comparator groups and a better understanding of infertility per se in ART, and the confounding role it probably plays in many of the known risk associations, to reliably scan the horizon for health threats for individuals born after ART.
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Ahlström A, Lundin K, Cimadomo D, Coticchio G, Selleskog U, Westlander G, Winerdal J, Stenfelt C, Callender S, Nyberg C, Åström M, Löfdahl K, Nolte L, Sundler M, Kitlinski M, Liljeqvist Soltic I, Bohlin T, Baumgart J, Lindgren KE, Gülen Yaldir F, Rienzi L, Lind AK, Bergh C. No major differences in perinatal and maternal outcomes between uninterrupted embryo culture in time-lapse system and conventional embryo culture. Hum Reprod 2023; 38:2400-2411. [PMID: 37879843 DOI: 10.1093/humrep/dead219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 10/06/2023] [Indexed: 10/27/2023] Open
Abstract
STUDY QUESTION Is embryo culture in a closed time-lapse system associated with any differences in perinatal and maternal outcomes in comparison to conventional culture and spontaneous conception? SUMMARY ANSWER There were no significant differences between time-lapse and conventional embryo culture in preterm birth (PTB, <37 weeks), low birth weight (LBW, >2500 g) and hypertensive disorders of pregnancy for singleton deliveries, the primary outcomes of this study. WHAT IS KNOWN ALREADY Evidence from prospective trials evaluating the safety of time-lapse incubation for clinical use show similar embryo development rates, implantation rates, and ongoing pregnancy and live birth rates when compared to conventional incubation. Few studies have investigated if uninterrupted culture can alter risks of adverse perinatal outcomes presently associated with IVF when compared to conventional culture and spontaneous conceptions. STUDY DESIGN, SIZE, DURATION This study is a Swedish population-based retrospective registry study, including 7379 singleton deliveries after fresh embryo transfer between 2013 and 2018 from selected IVF clinics. Perinatal outcomes of singletons born from time-lapse-cultured embryos were compared to singletons from embryos cultured in conventional incubators and 71 300 singletons from spontaneous conceptions. Main perinatal outcomes included PTB and LBW. Main maternal outcomes included hypertensive disorders of pregnancy (pregnancy hypertension and preeclampsia). PARTICIPANTS/MATERIALS, SETTING, METHODS From nine IVF clinics, 2683 singletons born after fresh embryo transfer in a time-lapse system were compared to 4696 singletons born after culture in a conventional incubator and 71 300 singletons born after spontaneous conception matched for year of birth, parity, and maternal age. Patient and treatment characteristics from IVF deliveries were cross-linked with the Swedish Medical Birth Register, Register of Birth Defects, National Patient Register and Statistics Sweden. Children born after sperm and oocyte donation cycles and after Preimplantation Genetic testing cycles were excluded. Odds ratio (OR) and adjusted OR were calculated, adjusting for relevant confounders. MAIN RESULTS AND THE ROLE OF CHANCE In the adjusted analyses, no significant differences were found for risk of PTB (adjusted OR 1.11, 95% CI 0.87-1.41) and LBW (adjusted OR 0.86, 95% CI 0.66-1.14) or hypertensive disorders of pregnancy; preeclampsia and hypertension (adjusted OR 0.99, 95% CI 0.67-1.45 and adjusted OR 0.98, 95% CI 0.62-1.53, respectively) between time-lapse and conventional incubation systems. A significantly increased risk of PTB (adjusted OR 1.31, 95% CI 1.08-1.60) and LBW (adjusted OR 1.36, 95% CI 1.08-1.72) was found for singletons born after time-lapse incubation compared to singletons born after spontaneous conceptions. In addition, a lower risk for pregnancy hypertension (adjusted OR 0.72 95% CI 0.53-0.99) but no significant difference for preeclampsia (adjusted OR 0.87, 95% CI 0.68-1.12) was found compared to spontaneous conceptions. Subgroup analyses showed that some risks were related to the day of embryo transfer, with more adverse outcomes after blastocyst transfer in comparison to cleavage stage transfer. LIMITATIONS, REASONS FOR CAUTION This study is retrospective in design and different clinical strategies may have been used to select specific patient groups for time-lapse versus conventional incubation. The number of patients is limited and larger datasets are required to obtain more precise estimates and adjust for possible effect of additional embryo culture variables. WIDER IMPLICATIONS OF THE FINDINGS Embryo culture in time-lapse systems is not associated with major differences in perinatal and maternal outcomes, compared to conventional embryo culture, suggesting that this technology is an acceptable alternative for embryo incubation. STUDY FUNDING/COMPETING INTEREST(S) The study was financed by a research grant from Gedeon Richter. There are no conflicts of interest for all authors to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- A Ahlström
- IVIRMA Global Research Alliance, Livio Gothenburg, Gothenburg, Sweden
| | - K Lundin
- Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - D Cimadomo
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - G Coticchio
- IVIRMA Global Research Alliance, 9.baby, Bologna, Italy
| | - U Selleskog
- IVIRMA Global Research Alliance, Livio Gothenburg, Gothenburg, Sweden
| | - G Westlander
- IVIRMA Global Research Alliance, Livio Gothenburg, Gothenburg, Sweden
| | - J Winerdal
- IVIRMA Global Research Alliance, Livio Gärdet, Stockholm, Sweden
| | - C Stenfelt
- IVIRMA Global Research Alliance, Livio Gärdet, Stockholm, Sweden
| | - S Callender
- IVIRMA Global Research Alliance, Livio Kungsholmen, Stockholm, Sweden
| | - C Nyberg
- IVIRMA Global Research Alliance, Livio Kungsholmen, Stockholm, Sweden
| | - M Åström
- IVIRMA Global Research Alliance, Livio Umeå, Umeå, Sweden
| | - K Löfdahl
- IVIRMA Global Research Alliance, Livio Umeå, Umeå, Sweden
| | - L Nolte
- IVIRMA Global Research Alliance, Livio Malmö, Malmö, Sweden
| | - M Sundler
- IVIRMA Global Research Alliance, Livio Malmö, Malmö, Sweden
| | | | | | - T Bohlin
- Örebro University Hospital, Sweden
| | | | | | | | - L Rienzi
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
- Department of Biomolecular Sciences, Carlo Bo University of Urbino, Urbino, Italy
| | - A K Lind
- IVIRMA Global Research Alliance, Livio Gothenburg, Gothenburg, Sweden
| | - C Bergh
- Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Stastna A, Waldaufova E, Fait T. The association between preterm births and assisted reproductive technologies. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2023. [PMID: 37799004 DOI: 10.5507/bp.2023.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
AIMS The aim of this study is to determine whether the risk of preterm births differs according to the conception method: with or without ART and according to the ART method used (in-vitro fertilisation (IVF) with fresh embryo transfer, frozen embryo transfer (FET) and oocyte receipt (OoR)). METHODS The research is based on individualised anonymised data on deliveries in Czechia in 2013-2018 (n=651,049) obtained from the National Health Information System. We employ the survival analysis approach applying survival functions (Life tables method) and Cox regression to model the risk of preterm births according to the conception method when controlling for a set of covariates. RESULTS The results revealed that the risk of preterm births in singleton pregnancies is higher for ART-treated women (1.56 to 2.06 depending on the ART method) than for non-ART-treated women. The proportion of preterm births differs according to the ART method; the highest proportion was observed for OoR mothers. CONCLUSIONS Overall, the differences between ART-treated mothers according to the conception method are due mainly to the structural differences between mothers. When controlling for the covariates (Cox regression model), no significant differences were observed concerning the risk of preterm births for women who underwent fresh IVF, FET and OoR.
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Affiliation(s)
- Anna Stastna
- Department of Demography and Geodemography, Faculty of Science, Charles University, Prague, Czechia
| | - Eva Waldaufova
- Department of Demography and Geodemography, Faculty of Science, Charles University, Prague, Czechia
| | - Tomas Fait
- Department of Demography and Geodemography, Faculty of Science, Charles University, Prague, Czechia
- Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University, Prague, Czechia
- Department of Health Care Studies, College of Polytechnics Jihlava, Jihlava, Czechia
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Huluta I, Wright A, Cosma LM, Dimopoulou S, Nicolaides KH, Charakida M. Fetal cardiac function at midgestation and conception by in-vitro fertilization. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:587-592. [PMID: 36971016 DOI: 10.1002/uog.26207] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVE To assess differences in cardiac morphology and function at midgestation in fetuses conceived by in-vitro fertilization (IVF), using fresh or frozen embryo transfer, compared with those conceived naturally. METHODS This was a prospective study of 5801 women with a singleton pregnancy attending for a routine ultrasound examination at 19 + 0 to 23 + 6 weeks' gestation, including 343 that conceived by IVF. Conventional and more advanced echocardiographic modalities, including speckle-tracking analysis, were used to assess fetal cardiac function in the right and left ventricles. The morphology of the fetal heart was assessed by calculating the right and left sphericity index. Placental perfusion and function were assessed by measurement of uterine artery pulsatility index (UtA-PI) and serum placental growth factor (PlGF), respectively. RESULTS Fetuses that were conceived by IVF, compared with those conceived spontaneously, had significantly lower right and left ventricular sphericity index, higher left ventricular global longitudinal strain and lower left ventricular ejection fraction. There were no significant differences in any of the cardiac indices within the IVF group between the fresh and frozen embryo transfers. In the IVF group, compared with spontaneously conceived pregnancies, UtA-PI was lower and PlGF was higher, suggesting better placental perfusion and function. CONCLUSIONS Our study demonstrates that, in IVF pregnancies, compared with those conceived spontaneously, there is evidence of fetal cardiac remodeling at midgestation, which is not related to the use of fresh or frozen embryo transfer. In the IVF group, compared with naturally conceived pregnancies, fetal heart was globular and left ventricular systolic function was mildly reduced. Whether these cardiac changes are accentuated later in pregnancy and remain in the postnatal period remains to be established. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- I Huluta
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - A Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - L M Cosma
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - S Dimopoulou
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - M Charakida
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Rubin SC, Abdulkadir M, Lewis J, Harutyunyan A, Hirani R, Grimes CL. Review of Endometrial Receptivity Array: A Personalized Approach to Embryo Transfer and Its Clinical Applications. J Pers Med 2023; 13:jpm13050749. [PMID: 37240919 DOI: 10.3390/jpm13050749] [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: 03/31/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Successful outcomes of in vitro fertilization (IVF) rely on both the formation of a chromosomally normal embryo and its implantation in a receptive endometrium. Pre-implantation genetic testing for aneuploidy (PGT-A) has been widely accepted as a tool to assess the viability of an embryo. In 2011, the endometrial receptivity array (ERA) was first published as a tool to determine when the endometrium is most receptive to an embryo, commonly referred to as the "window of implantation" (WOI). The ERA uses molecular arrays to assess proliferation and differentiation in the endometrium and screens for inflammatory markers. Unlike PGT-A, there has been dissent within the field concerning the efficacy of the ERA. Many studies that contest the success of the ERA found that it did not improve pregnancy outcomes in patients with an already-good prognosis. Alternatively, studies that utilized the ERA in patients with repeated implantation failure (RIF) and transfer of known euploid embryos demonstrated improved outcomes. This review aims to describe the ERA as a novel technique, review the various settings that the ERA may be used in, such as natural frozen embryo transfer (nFET) and hormone replacement therapy frozen embryo transfer (HRT-FET), and provide a summary of the recent clinical data for embryo transfers in patients with RIF utilizing the ERA.
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Affiliation(s)
- Sarah C Rubin
- School of Medicine, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA
| | - Mawerdi Abdulkadir
- School of Medicine, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA
| | - Joshua Lewis
- School of Medicine, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA
| | - Aleksandr Harutyunyan
- School of Medicine, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA
| | - Rahim Hirani
- School of Medicine, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA
| | - Cara L Grimes
- School of Medicine, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA
- Department of Obstetrics and Gynecology and Urology, New York Medical College, Valhalla, NY 10595, USA
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Mascarenhas M, Jeve Y, Polanski L, Sharpe A, Yasmin E, Bhandari HM. Management of recurrent implantation failure: British Fertility Society policy and practice guideline. HUM FERTIL 2022; 25:813-837. [PMID: 33820476 DOI: 10.1080/14647273.2021.1905886] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Recurrent implantation failure (RIF) is defined as the absence of a positive pregnancy test after three consecutive transfers of good quality embryos. There remains significant variation in clinical practice in the management of RIF. This British Fertility Society (BFS) Policy and Practice guideline analyses the evidence for investigations and therapies that are employed in RIF and provides recommendations for clinical practice and for further research. Evidence for investigations of sperm and egg quality, uterine and adnexal factors, immunological factors and thrombophilia, endocrine conditions and genetic factors and for associated therapies have been evaluated. This guideline has been devised to assist reproductive medicine specialists and patients in making shared decisions concerning management of RIF. Finally, suggestions for research towards improving understanding and management of RIF have also been provided.
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Affiliation(s)
- Mariano Mascarenhas
- Leeds Fertility, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Glasgow Centre for Reproductive Medicine, The Fertility Partnership, Glasgow, UK
| | - Yadava Jeve
- Birmingham Women's Fertility Centre, Birmingham Women's Hospital, Birmingham, UK
| | - Lukasz Polanski
- Assisted Conception Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Abigail Sharpe
- Leeds Fertility, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ephia Yasmin
- Department of Women's Health, University College London Hospitals, London, UK
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7
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Asthma and allergies in a cohort of adolescents conceived with assisted reproductive technologies. Reprod Biomed Online 2022; 45:1255-1265. [DOI: 10.1016/j.rbmo.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/15/2022] [Accepted: 07/12/2022] [Indexed: 11/20/2022]
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Raja EA, Bhattacharya S, Maheshwari A, McLernon DJ. Comparison of perinatal outcomes after frozen or fresh embryo transfer: separate analyses of singleton, twin, and sibling live births from a linked national in vitro fertilization registry. Fertil Steril 2022; 118:323-334. [PMID: 35717287 DOI: 10.1016/j.fertnstert.2022.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 05/04/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine whether perinatal outcomes following frozen vs. fresh embryo transfer (ET) differ within singletons, within sets of twins, and between siblings. DESIGN Population-based retrospective cohort study. SETTING Academic Medical School PATIENT(S): 200,075 live births in 151,561 women who underwent in vitro fertilization with frozen or fresh ET between 1992 and 2017. MAIN OUTCOME MEASURE(S) Gestational age at birth, birthweight, congenital anomaly, and healthy baby (≥37 weeks of gestation, birthweight 2,500-4,000 g, no congenital malformations). RESULT(S) There were 200,075 live births in 151,561 women including 132,679 singletons, 33,698 sets of twins, and 5,723 pairs of singleton siblings. In singletons, frozen ET was associated with a lower risk of very preterm birth (adjusted relative risk [aRR], 0.83; 95% confidence interval [CI], 0.73, 0.94), preterm birth (aRR, 0.93; 95% CI, 0.88, 0.97), low birthweight (<2,500 g) (aRR, 0.72; 95% CI, 0.68, 0.77), small for gestational age (aRR, 0.66; 95% CI, 0.62, 0.70) and congenital anomaly (aRR, 0.85; 95% CI, 0.78, 0.94), but higher risk of high birthweight (>4,000 g) (aRR, 1.64; 95% CI, 1.58, 1.72) and large for gestational age (aRR, 1.62; 95% CI, 1.55, 1.70) in comparison with fresh ET. In twins, frozen ET was associated with lower risk of very preterm birth (aRR, 0.84; 95% CI, 0.73, 0.97), and low birthweight (aRR, 0.72; 95% CI, 0.68, 0.77), but with a higher chance of a healthy baby (aRR, 1.11; 95% CI, 1.06, 1.16) compared to fresh ET. Singletons conceived following frozen ET had a lower risk of low birthweight (aRR, 0.56; 95% CI, 0.44, 0.74) and being small for gestational age (aRR, 0.54; 95% CI, 0.42, 0.68) than a singleton sibling born after a fresh ET. Frozen ET also was associated with higher risk of high birthweight (aRR, 1.85; 95% CI, 1.54, 2.24) and being large for gestational age (aRR, 1.81; 95% CI, 1.50, 2.20), and also were less likely to be preterm (aRR, 0.81; 95% CI, 0.67, 0.99). CONCLUSION(S) Our key finding is that singletons born following a frozen ET are less likely to be small for gestational age than a singleton sibling born following fresh ET but are more likely to be large for gestational age.
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Affiliation(s)
- Edwin-Amalraj Raja
- Institute of Applied Health Sciences, Polwarth Building, University of Aberdeen, Aberdeen, United Kingdom.
| | - Siladitya Bhattacharya
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Abha Maheshwari
- Aberdeen Fertility Centre, NHS Grampian, Aberdeen, United Kingdom
| | - David J McLernon
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
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Wijs LA, Doherty DA, Keelan JA, Burton P, Yovich JL, Beilin L, Mori TA, Huang RC, Adams LA, Olynyk JK, Ayonrinde OT, Penova-Veselinovic B, Hart RJ. Comparison of the cardiometabolic profiles of adolescents conceived through ART with those of a non-ART cohort. Hum Reprod 2022; 37:1880-1895. [PMID: 35640037 PMCID: PMC9340102 DOI: 10.1093/humrep/deac122] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/21/2022] [Indexed: 12/17/2022] Open
Abstract
STUDY QUESTION Is the cardiometabolic health of adolescents conceived through ART worse than that of their counterparts conceived without ART? SUMMARY ANSWER The majority of cardiometabolic and vascular health parameters of adolescents conceived through ART are similar or more favourable, than those of their counterparts of similar age and conceived without ART. WHAT IS KNOWN ALREADY It has been proposed that the cardiometabolic health of offspring conceived with ART may be unfavourable compared to that of their counterparts conceived without ART. The literature pertaining to cardiometabolic health of offspring conceived after ART is contradictory, but generally suggests unfavourable cardiometabolic health parameters, such as an increase in blood pressure (BP), vascular dysfunction and adiposity, as well as unfavourable glucose and lipid profiles. With over 8 million children and adults born through ART worldwide, it is important to investigate whether these early signs of adverse cardiometabolic differences persist into adolescence and beyond. STUDY DESIGN, SIZE, DURATION The Growing Up Healthy Study (GUHS) is a prospective cohort study that recruited 303 adolescents and young adults conceived after ART (aged 13-21 years) and born between 1991 and 2001 in Western Australia. Their health parameters, including cardiometabolic factors, were assessed and compared with counterparts from the Raine Study Generation 2 (Gen2). The 2868 Gen2 participants were born 1989-1992 and are representative of the Western Australian adolescent population. At ∼17 years of age (2013-2017), 163 GUHS participants replicated assessments previously completed by Gen2 at a similar age. PARTICIPANTS/MATERIALS, SETTING, METHODS Cardiometabolic parameters were compared between a total of 163 GUHS and 1457 Gen2 adolescents. Separate male (GUHS n = 81, Gen2 n = 735) and female (GUHS n = 82, Gen2 n = 722) analyses were conducted. Assessments consisted of a detailed questionnaire including health, lifestyle and demographic parameters, anthropometric assessments (height, weight, BMI, waist circumference and skinfold thickness), fasting serum biochemistry, arterial stiffness and BP (assessed using applanation tonometry). Abdominal ultrasonography was used to assess the presence and severity of hepatic steatosis, and thickness of abdominal fat compartments. Non-alcoholic fatty liver disease (NAFLD) was diagnosed if there was sonographic fatty liver in the absence of significant alcohol consumption. Chi2, Fisher's exact and Mann-Whitney U tests, performed in SPSS V25, examined cohort differences and generalized estimating equations adjusted for the following covariates: singleton vs non-singleton pregnancy, birthweight (z-score), gestational age, BMI, smoking, alcohol consumption in the past 6 months and parent cardiovascular status. Arterial stiffness measures and waist circumference were additionally adjusted for height, and female analyses were additionally adjusted for use of oral contraceptives in the preceding 6 months. MAIN RESULTS AND THE ROLE OF CHANCE In adjusted analyses, GUHS females had a lower BMI (22.1 vs 23.3 kg/m2, P = 0.014), and thinner skinfolds (triceps, subscapular, mid-abdominal; 16.9 vs 18.7 mm, P = 0.021, 13.4 vs 15.0 mm, P = 0.027, 19.7 vs 23.2 mm, P < 0.001, respectively), whereas males were not significantly different. Waist circumference was lower in GUHS adolescents (males: 78.1 vs 81.3 cm, P = 0.008, females: 76.7 vs 83.3 cm, P = 0.007). There were no significant differences between the two groups in glucose, insulin, homeostatic model assessment for insulin resistance, low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol (non-HDL-C), total cholesterol (TC), alanine aminotransferase and high-sensitivity C-reactive protein in both sexes. In females, serum triglycerides were lower in GUHS adolescents (1.0 vs 1.2 mmol/l, P = 0.029). GUHS males had higher serum HDL-C (1.1 vs 1.0 mmol/l, P = 0.004) and a lower TC/HDL-C ratio (3.2 vs 3.6, P = 0.036). There were no significant differences in the prevalence of NAFLD or steatosis severity scores between the cohorts in males and females. GUHS females had less subcutaneous adipose tissue (9.4 vs 17.9 mm, P < 0.001), whereas GUHS males had greater visceral adipose thickness (44.7 vs 36.3 mm, P < 0.001). There was no significant difference in pre-peritoneal adipose thickness. Pulse wave velocity was lower in GUHS males (5.8 vs 6.3 m/s, P < 0.001) and heart rate corrected augmentation index was lower in GUHS females (-8.4 vs -2.7%, P = 0.048). There were no significant differences in BP or heart rate in males or females between the two groups. LIMITATIONS, REASONS FOR CAUTION Despite the substantial study size and the unique study design of the ART cohort, we were unable to differentiate between different types of ART, due to the low number of ICSI cycles (e.g. IVF vs ICSI), draw definite conclusions, or relate the outcomes to the cause of infertility. Considering the differences in time points when both cohorts were studied, external factors could have changed, which could not be accounted for. Given the observational nature of this study, causation cannot be proven. WIDER IMPLICATIONS OF THE FINDINGS Contrary to our hypothesis and previous findings focussing mainly on childhood, this study reports mostly similar or favourable cardiometabolic markers in adolescents conceived with ART compared to those conceived without ART. The greater visceral adipose thickness, particularly present in males, requires further investigation. While these findings are generally reassuring, future well-designed and appropriately powered studies are required to definitively address the issue of cardiometabolic health in ART adults. STUDY FUNDING/COMPETING INTEREST(S) This project was supported by NHMRC project grant number 1042269 and R.J.H. received education grant funding support from Ferring Pharmaceuticals. R.J.H. is the Medical Director of Fertility Specialists of Western Australia and a shareholder in Western IVF. He has received educational sponsorship from MSD, Merck-Serono and Ferring Pharmaceuticals. P.B. is the Scientific Director of Concept Fertility Centre, Subiaco, Western Australia. J.L.Y. is the Medical Director of PIVET Medical Centre, Perth, Western Australia. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- L A Wijs
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, WA, Australia
| | - D A Doherty
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, WA, Australia.,Women and Infants Research Foundation, Perth, WA, Australia
| | - J A Keelan
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, WA, Australia.,Women and Infants Research Foundation, Perth, WA, Australia.,School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - P Burton
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia.,Concept Fertility Centre, Perth, WA, Australia
| | - J L Yovich
- School of Pharmacy and Biomedical Sciences, Curtin University, Perth, WA, Australia.,PIVET Medical Centre, Perth, WA, Australia
| | - L Beilin
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, WA, Australia
| | - T A Mori
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, WA, Australia
| | - R C Huang
- Centre for Child Health Research, University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - L A Adams
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, WA, Australia
| | - J K Olynyk
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia.,Department of Gastroenterology & Hepatology, Fiona Stanley Hospital, Perth, WA, Australia
| | - O T Ayonrinde
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, WA, Australia.,Department of Gastroenterology & Hepatology, Fiona Stanley Hospital, Perth, WA, Australia.,Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - B Penova-Veselinovic
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, WA, Australia
| | - R J Hart
- Fertility Specialists of Western Australia, Perth, WA, Australia
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Xu L, Gao S, Jiang J, Sun M, Sheng Y, Tang R. Outcomes of embryo vitrification at different developmental stages: Evaluation of 2412 warming cycles. Medicine (Baltimore) 2022; 101:e29233. [PMID: 35583531 PMCID: PMC9276305 DOI: 10.1097/md.0000000000029233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 03/16/2022] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Advances in cell culture media have led to a shift from cleavage stage embryo transfer to blastocyst stage transfer. Extended embryo culture to the blastocyst stage provides some theoretical advantages and disadvantages. There has been controversy. This study is sought to evaluate the clinical outcomes of vitrified-warmed cleavage-stage and blastocyst-stage embryo transfers in patients undergoing Artificial Reproductive Technique treatments. MATERIAL AND METHOD The study was performed on 2740 women undergoing frozen embryo thawing transfer. Patients' basic situation, status of frozen embryo transfer cycle, clinical pregnancy rate, early abortion rate, sex ratio of birth, and birth weight were retrospectively analyzed. We compared the main clinical results of recovery of frozen embryo on the cleavage stage and blastocyst stage. Furthermore, we evaluated the clinical outcomes of blastocyst cryopreservation on Day 5, 6, or 7 after oocyte retrieval according to the day of blastocyst expansion were evaluated. RESULTS The implantation ratio of cleavage stage embryos was 21.62% compared with 43.52% on D5 (P < .05). The D5, D6, and D7 implanting rates were statistically different. The pregnancy rates were 57.56%, 51.76%, and 35.95% versus 37.79%, respectively for embryos cryopreserved on D5, D6, D7, and D3. The ectopic pregnancy rate and early abortion rate were statistically different between D5 and D3. The sex ratio, the birth weight, and birth defect were not statistically different among the four groups. CONCLUSIONS Blastocyst transfer achieved a higher implantation rate than vitrified cleavage stage embryo and decreased ectopic pregnancy rate. With increased incubation days before expansion blastocyst formed, the implantation rate is reduced and the early abortion rate increases.
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Affiliation(s)
- Lizhen Xu
- Department of Reproductive Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200001, China
| | - Shanshan Gao
- Center for Reproductive Medicine, Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Jingjing Jiang
- Center for Reproductive Medicine, Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Mei Sun
- Center for Reproductive Medicine, Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Yan Sheng
- Center for Reproductive Medicine, Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Rong Tang
- Center for Reproductive Medicine, Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
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Xie Q, Jiang W, Ji H, Li X, Zhou Y, Zhao C, Zhang J, Lu J, Ling X. Perinatal outcomes of singletons born after blastocyst or cleavage-stage embryo transfer in FET cycles. Eur J Obstet Gynecol Reprod Biol 2022; 271:265-270. [PMID: 35259644 DOI: 10.1016/j.ejogrb.2022.03.001] [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: 04/23/2021] [Revised: 02/07/2022] [Accepted: 03/01/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE To compare perinatal outcomes of singletons after blastocyst versus cleavage-stage embryo transfer in frozen-thawed embryo transfer (FET) cycles. METHODS This was a retrospective cohort study of 4835 women who conceived after frozen-thawed embryo transfer and delivered a singleton baby from January 2015 to March 2020. The perinatal outcomes of the singletons born after blastocyst transfer (N = 3364) were compared to the singletons born after cleavage-stage transfer (N = 1471), including gestational week, birth weight, newborn gender and Apgar score. RESULTS Univariate and multivariate analysis found that infants born after blastocyst transfer had a higher risk of preterm birth (PTB) [adjusted odds ratio (aOR) 1.480; 95% confidence interval (CI) 1.213-1.807], large for gestational age (LGA) (aOR 1.329, 95%CI 1.149-1.536) and very large for gestational age (VLGA) (aOR 1.317, 95%CI 1.092-1.590) compared to infants born after cleavage-stage embryo transfer. When categorized by gestational weeks, the proportion of LGA was significantly higher for boys born after BT between GW 37 to 41 (aOR 1.301, 95%CI 1.051-1.609) and for girls born after BT between GW 32 to 41 (aOR 2.690, 95%CI 1.154-6.271, aOR 1.377, 95%CI 1.094-1.733), compared to boys and girls born after CT. CONCLUSION Our data suggested that the risk of PTB and LGA increased after blastocyst transfer versus cleavage-stage embryo transfer in FET cycles, and the risk of LGA is more apparent in the last trimester of pregnancy. Further studies are needed to confirm our findings and explored the association between the extended embryo culture and long-term outcomes of offspring.
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Affiliation(s)
- Qijun Xie
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Wei Jiang
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Hui Ji
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Xin Li
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Yuxi Zhou
- 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
| | - Junqiang Zhang
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Jing Lu
- 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.
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12
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Medically Assisted Reproduction Treatment Types and Birth Outcomes. Obstet Gynecol 2022; 139:211-222. [PMID: 34991148 PMCID: PMC8759539 DOI: 10.1097/aog.0000000000004655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/04/2021] [Indexed: 11/27/2022]
Abstract
Medically assisted reproduction treatments are associated with adverse birth outcomes; however, those risks are unlikely to be associated with the infertility treatments themselves. OBJECTIVE: To compare risks of adverse birth outcomes among pregnancies conceived with and without medically assisted reproduction treatments. METHODS: Birth certificates were used to study birth outcomes of all neonates born in Utah from 2009 through 2017. Of the 469,919 deliveries, 52.8% (N=248,013) were included in the sample, with 5.2% of the neonates conceived through medically assisted reproduction. The outcome measures included birth weight, gestational age, low birth weight (LBW, less than 2,500 g), preterm birth (less than 37 weeks of gestation), and small for gestational age (SGA, birth weight less than the 10th percentile). Linear models were estimated for the continuous outcomes (birth weight, gestational age), and linear probability models were used for the binary outcomes (LBW, preterm birth, SGA). First, we compared the birth outcomes of neonates born after medically assisted reproduction and natural conception in the overall sample (between-family analyses), before and after adjustment for parental background and neonatal characteristics. Second, we employed family fixed effect models to investigate whether the birth outcomes of neonates conceived through medically assisted reproduction differed from those of their naturally conceived siblings (within-family comparisons). RESULTS: Neonates conceived through medically assisted reproduction weighed less, were born earlier, and were more likely to be LBW, preterm, and SGA than neonates conceived naturally. More invasive treatments (assisted reproductive technology [ART] and artificial insemination [AI] or intrauterine insemination) were associated with worse birth outcomes; for example, the proportion of LBW and preterm birth was 6.1% and 7.9% among neonates conceived naturally and 25.5% and 29.8% among neonates conceived through ART, respectively. After adjustments for various neonatal and parental characteristics, the differences in birth outcomes between neonates conceived through medically assisted reproduction and naturally were attenuated yet remained statistically significant; for example, neonates conceived through ART were at 3.2 percentage points higher risk for LBW (95% CI 2.4–4.1) and 4.8 percentage points higher risk for preterm birth (95% CI 3.9–5.7). Among siblings, the differences in the frequency of adverse outcomes between neonates conceived through medically assisted reproduction and neonates conceived naturally were small and statistically insignificant for all types of treatments. CONCLUSION: Medically assisted reproduction treatments are associated with adverse birth outcomes; however, those risks are unlikely to be associated with the infertility treatments itself.
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13
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Wijs LA, Fusco MR, Doherty DA, Keelan JA, Hart RJ. Asthma and allergies in offspring conceived by ART: a systematic review and meta-analysis. Hum Reprod Update 2021; 28:132-148. [PMID: 34642743 DOI: 10.1093/humupd/dmab031] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/29/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Currently, 1 in 25 children born in Australia are conceived through ARTs such as IVF and ICSI. Worldwide over 8 million children have been born after ART. There is evidence that these children are at an increased risk of congenital malformations, preterm birth, low birth weight and neonatal morbidity. However, studies on long-term health outcomes of offspring conceived after ART are lacking. Atopic disorders, such as asthma, atopic dermatitis and various allergies are increasingly common within society, and concerns have been raised that ART increases the risk of atopy amongst offspring. OBJECTIVE AND RATIONALE The aim of this study was to systematically summarise and quantify the risk of atopic disorders in offspring conceived with ART compared to those conceived without ART. SEARCH METHODS A systematic review was conducted according to the PRISMA guidelines. Several systematic searches were performed in the following international databases: Medline, Embase, Cinahl, PsychINFO, AMED, Global Health and ISI Web of Science. Search terms utilised were all terms pertaining to ART, IVF, ICSI, asthma, atopic dermatitis and allergies. The search period was 1978-2021. Included observational studies stated a primary outcome of asthma or allergies in offspring conceived after ART, with a comparison group conceived without ART. Individual studies were scored on quality and risk of bias, using the Newcastle-Ottawa scale (NOS). OUTCOMES There were 26 studies which met the inclusion criteria; of these, 24 studies investigated asthma in offspring conceived after ART. While 10 studies, including the two largest population-based studies, reported a significantly increased risk of asthma in offspring conceived after ART (adjusted odds ratio (aOR) range: 1.20-2.38), 14 smaller cohort studies found no difference (aOR range 0.70-1.27). In the meta-analysis of the 14 highest-quality studies (NOS ≥ 7), a modest yet significantly increased risk of asthma was demonstrated in offspring conceived after ART [risk ratio (RR) 1.28 (1.08-1.51)]. Although heterogeneity in these 14 studies was high (I2 = 85%), the removal of outliers and high weight studies significantly reduced heterogeneity (I2 = 0% and I2 = 34% respectively) while still demonstrating a significantly increased risk [RR 1.19 (1.10-1.28) and RR 1.31 (1.03-1.65), respectively]. The increased asthma risk was also observed in most subgroup and sensitivity analyses. The allergy rates were not increased in offspring conceived after ART in 9 of 12 studies (aOR range 0.60-1.30). In summary, the findings of this systematic review and meta-analysis suggest a trend towards a significantly increased risk of asthma, but not allergies, in offspring conceived after ART. There was no evidence of publication bias in the asthma studies and minimal evidence of publication bias in the allergy studies (both P > 0.05). WIDER IMPLICATIONS Asthma brings considerable burden to the quality of life of individuals and to society. Hence, it is of great importance to untangle potential causal pathways. Although ART use is common, knowledge about its long-term health effects is required to provide evidence-based advice to couples considering ART, and to be vigilant for any potential adverse health effects on offspring conceived after ART.
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Affiliation(s)
- Laura A Wijs
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Western Australia, Australia
| | - Melinda R Fusco
- Department of Obstetrics and Gynaecology, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Dorota A Doherty
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Western Australia, Australia.,Women and Infants Research Foundation, Carson House, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Jeffrey A Keelan
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Western Australia, Australia.,Women and Infants Research Foundation, Carson House, King Edward Memorial Hospital, Perth, Western Australia, Australia.,School of Biomedical Sciences, Universiy of Western Australia, Crawley, Western Australia, Australia
| | - Roger J Hart
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Western Australia, Australia.,Fertility Specialists of Western Australia, Bethesda Hospital, Claremont, Western Australia, Australia
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14
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Chen H, Wang C, Zhou H, Shu J, Gan X, Xu K, Wu Z, Deng X, Huang G, Lin R. Laser-assisted selection of immotile spermatozoa has no effect on obstetric and neonatal outcomes of TESA-ICSI pregnancies. Reprod Biol Endocrinol 2021; 19:159. [PMID: 34641894 PMCID: PMC8507098 DOI: 10.1186/s12958-021-00835-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 09/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Azoospermic patients have benefited from both epididymal and testicular spermatozoa intracytoplasmic sperm injection (ICSI) treatment and lasers have been used to identify viable, immotile spermatozoa before the procedure. There are limited studies on the safety of laser-assisted selection of immotile spermatozoa. The aim of this study was to investigate the impact of laser-assisted selection of immotile spermatozoa on the obstetric and neonatal outcomes after ICSI. METHODS A retrospective comparative study was conducted on outcomes of ICSI cycles with testicular spermatozoa from June 2014 to June 2018. Of 132 cycles, 33 were allocated to the test group and oocytes were injected with immotile spermatozoa selected by laser, 99 cycles were allocated as control group. RESULTS Compared with the control group, no significant differences were found in the pregnancy, implantation, miscarriage and live birth rates in the test group in either fresh or frozen transfer cycles. The cumulative live birth rate in the test group was 69.70%, which was slightly higher than in the control group (60.61%), but this was not statistically different. There were no differences in the average gestational age, premature birth rate, neonatal birth weight, and the malformation rate between the test and control groups (P > 0.05). In addition, the obstetric outcome between the two groups were not different (P > 0.05). CONCLUSIONS No negative effect on perinatal and neonatal outcomes was seen by using laser-assisted selection of immotile spermatozoa for TESA-ICSI. This study endorses the use of laser-assisted selection of viable spermatozoa for ICSI cycles.
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Affiliation(s)
- Huanhua Chen
- Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, China
| | - Caizhu Wang
- Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, China
| | - Hong Zhou
- Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, China
| | - Jinhui Shu
- Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, China
| | - Xianyou Gan
- Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, China
| | - Kongrong Xu
- Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, China
| | - Zhulian Wu
- Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, China
| | - Xihe Deng
- Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, China
| | - Guiting Huang
- Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, China
| | - Ruoyun Lin
- Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, China.
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15
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Boutet ML, Casals G, Valenzuela-Alcaraz B, García-Otero L, Crovetto F, Cívico MS, Borrás A, Manau D, Gratacós E, Crispi F. Cardiac remodeling in fetuses conceived by ARTs: fresh versus frozen embryo transfer. Hum Reprod 2021; 36:2697-2708. [PMID: 34323946 DOI: 10.1093/humrep/deab159] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 05/19/2021] [Indexed: 01/10/2023] Open
Abstract
STUDY QUESTION Do fetuses from frozen embryo transfer (FET) present signs of cardiac remodeling and suboptimal function similar to those observed in fetuses from fresh embryo transfer (ET)? SUMMARY ANSWER Fetuses from both fresh ET and FET present signs of fetal cardiac remodeling and suboptimal function, with more pronounced changes after fresh ET as compared to FET. WHAT IS KNOWN ALREADY Our group and others have previously demonstrated that fetuses and children conceived by ARTs present cardiac remodeling and suboptimal function. These fetuses show dilated atria, more globular and thicker ventricles, reduced longitudinal motion, and impaired relaxation. Cardiac changes were already present in utero and persisted after birth. Most of the ART fetuses included in previous publications were from fresh ET. However, singletons from FET have different perinatal outcomes compared to those from fresh ET. There are no previous studies comparing cardiac morphology and function between fetuses following fresh and FET. STUDY DESIGN, SIZE, DURATION This is a prospective cohort study of 300 singleton pregnancies recruited from 2017 to 2020, including 100 spontaneously conceived (SC) pregnancies, 100 fetuses conceived by IVF with FET, and 100 fetuses conceived by IVF with fresh ET. Fetal structural and functional echocardiography was performed in all pregnancies. PARTICIPANTS/MATERIALS, SETTING, METHODS Pregnancies conceived by IVF were recruited from a single assisted reproduction center, ensuring homogeneity in IVF stimulation protocols, endometrial preparation for FET, laboratory procedures, and embryo culture conditions. SC pregnancies from fertile couples were selected from the general population and matched to IVF pregnancies by maternal age. Epidemiological and perinatal outcomes were collected in all cases. Fetal echocardiography was performed at 28-33 weeks of pregnancy to assess cardiac structure and function in all pregnancies. All echocardiographic comparisons were adjusted by maternal age, nulliparity, birthweight centile, preeclampsia, and prematurity. MAIN RESULTS AND THE ROLE OF CHANCE Parental age, ethnicity, body mass index and smoking were similar among the study groups. Median gestational age at echocardiography and estimated fetal weight were similar in all study groups. Both fresh ET and FET groups showed similar fetal echocardiographic changes, with more pronounced features in the fresh ET as compared to FET pregnancies. Fetuses conceived by IVF showed larger atria (right atria-to-heart ratio: fresh ET mean 18.1% (SD 3.2) vs FET 18.0% (3.9) vs SC 17.3% (3.2); linear tendency P-value <0.001), more globular ventricles (right ventricular sphericity index: fresh ET 1.62 (0.29) vs FET 1.61 (0.25) vs SC 1.68 (0.26); <0.001) and thicker myocardial walls (relative wall thickness: fresh ET 0.79 (0.21) vs FET 0.74 (0.22) vs SC 0.65 (0.25); <0.001) as compared to SC pregnancies. Both fresh ET and FET groups also had signs of suboptimal systolic and diastolic function, with reduced tricuspid annular systolic peak velocity (fresh ET 7.17 cm/s (1.22) vs FET 7.41 cm/s (1.19) vs SC 7.58 cm/s (1.32); <0.001) and increased left myocardial performance index (fresh ET 0.53 (0.08) vs FET 0.53 (0.08) vs SC 0.50 (0.09); <0.001) as compared to SC pregnancies. LIMITATIONS, REASONS FOR CAUTION The cardiac changes reported here are subclinical, with most cardiovascular indexes lying within normal ranges. Although echocardiographic changes are recognized as potential cardiovascular risk factors, their association with the long-term cardiovascular disease remains to be proven. The observed milder fetal cardiac features in FET fetuses cannot condition the choice of this technique and must be considered together with the global perinatal results related to these gestations. WIDER IMPLICATIONS OF THE FINDINGS The identification of cardiac remodeling in fetuses conceived by IVF with fresh ET and FET represents an opportunity for early detection. Future studies are warranted to study the potential long-term consequences of these findings. STUDY FUNDING/COMPETING INTEREST(S) This project has been partially funded with support from the Erasmus + Programme of the European Union (Framework Agreement number: 2013-0040). This publication reflects the views only of the author, and the Commission cannot be held responsible for any use, which may be made of the information contained therein. Additionally, the research leading to these results has received funding from 'la Caixa' Foundation under grant agreement LCF/PR/GN18/10310003, the Instituto de Salud Carlos III (PI15/00130, PI17/00675, PI18/00073) integrated into the Plan Nacional de I + D+I and cofinanced by ISCIII-Subdirección General de Evaluación and Fondo Europeo de Desarrollo Regional (FEDER) 'Una manera de hacer Europa', Cerebra Foundation for the Brain Injured Child (Carmarthen, Wales, UK) and AGAUR 2017 SGR grant n° 1531. The authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- M L Boutet
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - G Casals
- Assisted Reproduction Unit, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - B Valenzuela-Alcaraz
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - L García-Otero
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - F Crovetto
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - M S Cívico
- Assisted Reproduction Unit, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - A Borrás
- Assisted Reproduction Unit, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - D Manau
- Assisted Reproduction Unit, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - E Gratacós
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - F Crispi
- BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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16
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Westvik-Johari K, Romundstad LB, Lawlor DA, Bergh C, Gissler M, Henningsen AKA, Håberg SE, Wennerholm UB, Tiitinen A, Pinborg A, Opdahl S. Separating parental and treatment contributions to perinatal health after fresh and frozen embryo transfer in assisted reproduction: A cohort study with within-sibship analysis. PLoS Med 2021; 18:e1003683. [PMID: 34170923 PMCID: PMC8274923 DOI: 10.1371/journal.pmed.1003683] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 07/12/2021] [Accepted: 06/03/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Compared to naturally conceived children, adverse perinatal outcomes are more common among children born after assisted reproductive technology with fresh embryo transfer (fresh-ET) or frozen embryo transfer (frozen-ET). However, most previous studies could not adequately control for family confounding factors such as subfertility. We compared birth size and duration of pregnancy among infants born after fresh-ET or frozen-ET versus natural conception, using a within-sibship design to account for confounding by maternal factors. METHODS AND FINDINGS This registry-based cohort study with nationwide data from Denmark (1994-2014), Norway (1988-2015), and Sweden (1988-2015) consisted of 4,510,790 live-born singletons, 4,414,703 from natural conception, 78,095 from fresh-ET, and 17,990 from frozen-ET. We identified 33,056 offspring sibling groups with the same mother, conceived by at least 2 different conception methods. Outcomes were mean birthweight, small and large for gestational age, mean gestational age, preterm (<37 weeks, versus ≥37), and very preterm birth (<32 weeks, versus ≥32). Singletons born after fresh-ET had lower mean birthweight (-51 g, 95% CI -58 to -45, p < 0.001) and increased odds of small for gestational age (odds ratio [OR] 1.20, 95% CI 1.08 to 1.34, p < 0.001), while those born after frozen-ET had higher mean birthweight (82 g, 95% CI 70 to 94, p < 0.001) and increased odds of large for gestational age (OR 1.84, 95% CI 1.56 to 2.17, p < 0.001), compared to naturally conceived siblings. Conventional population analyses gave similar results. Compared to naturally conceived siblings, mean gestational age was lower after fresh-ET (-1.0 days, 95% CI -1.2 to -0.8, p < 0.001), but not after frozen-ET (0.3 days, 95% CI 0.0 to 0.6, p = 0.028). There were increased odds of preterm birth after fresh-ET (OR 1.27, 95% CI 1.17 to 1.37, p < 0.001), and in most models after frozen-ET, versus naturally conceived siblings, with somewhat stronger associations in population analyses. For very preterm birth, population analyses showed increased odds for both fresh-ET (OR 2.03, 95% CI 1.90 to 2.12, p < 0.001) and frozen-ET (OR 1.66, 95% CI 1.42 to 1.94, p < 0.001) compared with natural conception, but results were notably attenuated within siblings (OR 1.18, 95% CI 1.0 to 1.41, p = 0.059, and OR 0.92, 95% CI 0.67 to 1.27, p = 0.6, for fresh-ET and frozen-ET, respectively). Sensitivity analyses in full siblings, in siblings born within 3-year interval, by birth order, and restricting to single embryo transfers and blastocyst transfers were consistent with the main analyses. Main limitations were high proportions of missing data on maternal body mass index and smoking. CONCLUSIONS We found that infants conceived by fresh-ET had lower birthweight and increased odds of small for gestational age, and those conceived by frozen-ET had higher birthweight and increased odds of large for gestational age. Conception by either fresh-ET or frozen-ET was associated with increased odds of preterm birth. That these findings were observed within siblings, as well as in conventional multivariable population analyses, reduces the likelihood that they are explained by confounding or selection bias. TRIAL REGISTRATION ClinicalTrials.gov ISRCTN11780826.
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Affiliation(s)
- Kjersti Westvik-Johari
- Department of Fertility, Women and Children’s Centre, St. Olavs Hospital, Trondheim, Norway
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- * E-mail:
| | - Liv Bente Romundstad
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Spiren Fertility Clinic, Trondheim, Norway
| | - Deborah A. Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, Bristol, United Kingdom
- NIHR Bristol Biomedical Research Centre, Bristol, United Kingdom
| | - Christina Bergh
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mika Gissler
- Statistics and Registers Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | - Siri E. Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Ulla-Britt Wennerholm
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Aila Tiitinen
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anja Pinborg
- Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Signe Opdahl
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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Pontesilli M, Hof MH, Ravelli ACJ, van Altena AJ, Soufan AT, Mol BW, Kostelijk EH, Slappendel E, Consten D, Cantineau AEP, van der Westerlaken LAJ, van Inzen W, Dumoulin JCM, Ramos L, Baart EB, Broekmans FJM, Rijnders PM, Curfs MHJM, Mastenbroek S, Repping S, Roseboom TJ, Painter RC. Effect of parental and ART treatment characteristics on perinatal outcomes. Hum Reprod 2021; 36:1640-1665. [PMID: 33860303 PMCID: PMC8129595 DOI: 10.1093/humrep/deab008] [Citation(s) in RCA: 6] [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: 09/16/2018] [Revised: 12/14/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Do parental characteristics and treatment with ART affect perinatal outcomes in singleton pregnancies? SUMMARY ANSWER Both parental and ART treatment characteristics affect perinatal outcomes in singleton pregnancies. WHAT IS KNOWN ALREADY Previous studies have shown that singleton pregnancies resulting from ART are at risk of preterm birth. ART children are lighter at birth after correction for duration of gestation and at increased risk of congenital abnormalities compared to naturally conceived children. This association is confounded by parental characteristics that are also known to affect perinatal outcomes. It is unclear to which extent parental and ART treatment characteristics independently affect perinatal outcomes. STUDY DESIGN, SIZE, DURATION All IVF clinics in the Netherlands (n = 13) were requested to provide data on all ART treatment cycles (IVF, ICSI and frozen-thawed embryo transfers (FET)), performed between 1 January 2000, and 1 January 2011, which resulted in a pregnancy. Using probabilistic data-linkage, these data (n = 36 683) were linked to the Dutch Perinatal Registry (Perined), which includes all children born in the Netherlands in the same time period (n = 2 548 977). PARTICIPANTS/MATERIALS, SETTING, METHODS Analyses were limited to singleton pregnancies that resulted from IVF, ICSI or FET cycles. Multivariable models for linear and logistic regression were fitted including parental characteristics as well as ART treatment characteristics. Analyses were performed separately for fresh cycles and for fresh and FET cycles combined. We assessed the impact on the following perinatal outcomes: birth weight, preterm birth below 37 or 32 weeks of gestation, congenital malformations and perinatal mortality. MAIN RESULTS AND THE ROLE OF CHANCE The perinatal outcomes of 31 184 out of the 36 683 ART treatment cycles leading to a pregnancy were retrieved through linkage with the Perined (85% linkage). Of those, 23 671 concerned singleton pregnancies resulting from IVF, ICSI or FET. Birth weight was independently associated with both parental and ART treatment characteristics. Characteristics associated with lower birth weight included maternal hypertensive disease, non-Dutch maternal ethnicity, nulliparity, increasing duration of subfertility, hCG for luteal phase support (compared to progesterone), shorter embryo culture duration, increasing number of oocytes retrieved and fresh embryo transfer. The parental characteristic with the greatest effect size on birth weight was maternal diabetes (adjusted difference 283 g, 95% CI 228-338). FET was the ART treatment characteristic with the greatest effect size on birth weight (adjusted difference 100 g, 95% CI 84-117) compared to fresh embryo transfer. Preterm birth was more common among mothers of South-Asian ethnicity. Preterm birth was less common among multiparous women and women with 'male factor' as treatment indication (compared to 'tubal factor'). LIMITATIONS, REASONS FOR CAUTION Due to the retrospective nature of our study, we cannot prove causality. Further limitations of our study were the inability to adjust for mothers giving birth more than once in our dataset, missing values for several variables and limited information on parental lifestyle and general health. WIDER IMPLICATIONS OF THE FINDINGS Multiple parental and ART treatment characteristics affect perinatal outcomes, with birth weight being influenced by the widest range of factors. This highlights the importance of assessing both parental and ART treatment characteristics in studies that focus on the health of ART-offspring, with the purpose of modifying these factors where possible. Our results further support the hypothesis that the embryo is sensitive to its early environment. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by Foreest Medical School, Alkmaar, the Netherlands (grants: FIO 1307 and FIO 1505). B.W.M. reports grants from NHMRC and consultancy for ObsEva, Merck KGaA, iGenomics and Guerbet. F.B. reports research support grants from Merck Serono and personal fees from Merck Serono. A.C. reports travel support from Ferring BV. and Theramex BV. and personal fees from UpToDate (Hyperthecosis), all outside the remit of the current work. The remaining authors report no conflict of interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- M Pontesilli
- Department of Obstetrics and Gynaecology, Northwest Clinics, Alkmaar, The Netherlands
- Department of Clinical Epidemiology Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - M H Hof
- Department of Clinical Epidemiology Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - A C J Ravelli
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - A J van Altena
- Department of Clinical Epidemiology Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - A T Soufan
- Center for Reproductive Medicine, Amsterdam Reproduction & Development Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - E H Kostelijk
- Center for Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - E Slappendel
- Center for Reproductive Medicine, Nij Geertgen Clinic, Elsendorp, The Netherlands
| | - D Consten
- Center for Reproductive Medicine, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - A E P Cantineau
- Center for Reproductive Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - W van Inzen
- Center for Reproductive Medicine, IVF Center Medisch Centrum Kinderwens, Leiderdorp, The Netherlands
| | - J C M Dumoulin
- Department of Obstetrics and Gynaecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, The Netherlands
| | - L Ramos
- Center for Reproductive Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - E B Baart
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - F J M Broekmans
- Center for Reproductive Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P M Rijnders
- Center for Reproductive Medicine, Reinier de Graaf Hospital, Delft, The Netherlands
| | - M H J M Curfs
- Center for Reproductive Medicine, Isala, Zwolle, The Netherlands
| | - S Mastenbroek
- Center for Reproductive Medicine, Amsterdam Reproduction & Development Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - S Repping
- Center for Reproductive Medicine, Amsterdam Reproduction & Development Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - T J Roseboom
- Department of Clinical Epidemiology Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - R C Painter
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
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Wang CH, Hu XQ. A systematic review of clinical efficacy of frozen-thawed embryos and fresh embryos in in-vitro fertilization cycles. Cryobiology 2021; 100:19-25. [PMID: 33872610 DOI: 10.1016/j.cryobiol.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Frozen-thawed embryo (FTE) and fresh embryo (FE) transfer are two common strategies in vitro fertilization (IVF), while the results and findings still vary among studies. METHODS We searched multiple databases for relevant studies comparing the clinical effects of FTE and FE. Meta-analyses were conducted with Review Manager 5.0 to assess the efficacy among included articles. We also analyzed the risk of bias for the reports. RESULTS Nine studies eventually met the inclusion criteria from 2010 to 2018, and 11396 patients were included. The meta-analyses indicated no significant difference in biochemical pregnancy, clinical pregnancy and ongoing pregnancy rates. Meanwhile, the implantation rate and live birth rate in frozen-thawed embryos were much higher than those of fresh embryo. The birth weight in the frozen-thawed ET group was greater than that of the FE group, and the low birth weight rate in FTE was lower than FE group. CONCLUSION Our findings suggested a trend toward favouring frozen-thawed FTE might be a preferred transfer strategy for patients with IVF.
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Affiliation(s)
- Cui-Hua Wang
- Department of Gynecology and Obstetrics, Wuxi No.2 Chinese Medicine Hospital, Wuxi, China
| | - Xiao-Qing Hu
- Department of Gynecology and Obstetrics, Wuxi No.2 Chinese Medicine Hospital, Wuxi, China.
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Stern JE, Liu CL, Hwang SS, Dukhovny D, Farland LV, Diop H, Coddington CC, Cabral H. Influence of Placental Abnormalities and Pregnancy-Induced Hypertension in Prematurity Associated with Various Assisted Reproductive Technology Techniques. J Clin Med 2021; 10:1681. [PMID: 33919833 PMCID: PMC8070757 DOI: 10.3390/jcm10081681] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Assisted reproductive technology (ART)-treated women exhibit increased risk of premature delivery compared to fertile women. We evaluated whether ART treatment modalities increase prematurity and whether placental abnormalities and pregnancy-induced hypertensive (PIH) disorders mediate these risks. METHOD(S) This retrospective study of ART-treated and fertile deliveries (2004-2017) used an ART-cycle database linked to Massachusetts birth certificates and hospital discharges. Outcomes of late preterm birth (LPTB: 34-36 weeks gestation) and early preterm birth (EPTB: <34 weeks gestation) were compared with term deliveries (≥37 weeks gestation) in ART-treated (linked to the ART database) and fertile (no indicators of infertility or ART) deliveries. ART treatments with autologous oocyte, donor oocyte, fresh or frozen embryo transfer (FET), intracytoplasmic sperm injection (ICSI) and no-ICSI were separately compared to the fertile group. Adjusted odds ratios (AOR) were calculated with multivariable logistic regression: placental abnormalities or PIH were quantified in the pathway as mediators. RESULTS There were 218,320 deliveries: 204,438 fertile and 13,882 ART-treated. All treatment types increased prematurity (AOR 1.31-1.58, LPTB; AOR 1.34-1.48, EPTB). Placental abnormalities mediated in approximately 22% and 38% of the association with LPTB and EPTB, respectively. PIH mediated 25% and 33% of the association with LPTB and EPTB in FET and donor oocyte cycles, more than other treatments (<10% LPTB and <13% EPTB). CONCLUSIONS ART-treatment and all ART modalities increased LPTB and EPTB when compared with fertile deliveries. Placental abnormalities modestly mediated associations approximately equally, while PIH was a stronger mediator in FET and donor oocyte cycles. Reasons for differences require exploration.
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Affiliation(s)
- Judy E. Stern
- Department of Obstetrics & Gynecology, Dartmouth-Hitchcock, Lebanon, NH 03756, USA
| | - Chia-ling Liu
- Bureau of Family Health and Nutrition, Massachusetts Department of Public Health, Boston, MA 02108, USA;
| | - Sunah S. Hwang
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA;
| | - Dmitry Dukhovny
- Division of Neonatology, School of Medicine, Oregon Health & Science University, Portland, OR 97239, USA;
| | - Leslie V. Farland
- Epidemiology and Biostatistics Department, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA;
| | - Hafsatou Diop
- Division of Maternal and Child Health Research and Analysis, Bureau of Family Health and Nutrition Massachusetts Department of Public Health, Boston, MA 02108, USA;
| | - Charles C. Coddington
- Department of Obstetrics and Gynecology, University of North Carolina, Charlotte, NC 28204, USA;
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA;
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Cost-effectiveness of freeze-all policy - A retrospective study based upon the outcome of cumulative live births. Taiwan J Obstet Gynecol 2021; 60:125-131. [PMID: 33494984 DOI: 10.1016/j.tjog.2020.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECT We have previously reported that cumulative live birth rates (CLBRs) are higher in the freeze-all group compared with controls (64.3% vs. 45.8%, p = 0.001). Here, we aim to determine if the freeze-all policy is more cost-effective than fresh embryo transfer followed by frozen-thawed embryo transfer (FET). MATERIALS AND METHODS The analysis consisted of 704 ART (Assisted reproductive technology) cycles, which included in IVF (In vitro fertilisation) and ICSI (Intra Cytoplasmic Sperm Injection) cycles performed in Taichung Veterans General Hospital, Taiwan between January 2012 and June 2014. The freeze-all group involved 84 patients and the fresh Group 625 patients. Patients were followed up until all embryos obtained from a single controlled ovarian hyper-stimulation cycle were used up, or a live birth had been achieved. The total cost related to treatment of each patient was recorded. The incremental cost-effectiveness ratio (ICER) was based on the incremental cost per couple and the incremental live birth rate of the freeze-all strategy compared with the fresh ET strategy. Probabilistic sensitivity analysis (PSA) and a cost-effectiveness acceptability curve (CEAC) were performed. RESULTS The total treatment cost per patient was significantly higher for the freeze-all group than in the fresh group (USD 3419.93 ± 638.13 vs. $2920.59 ± 711.08 p < 0.001). However, the total treatment cost per live birth in the freeze-all group was US $5319.89, vs. US $6382.42 in the fresh group. CEAC show that the freeze-all policy was a cost-effective treatment at a threshold of US $2703.57 for one additional live birth. Considering the Willingness-to-pay threshold per live birth, the probability was 60.1% at the threshold of US $2896.5, with the freeze-all group being more cost-effective than the fresh-ET group; or 90.1% at the threshold of $4183.8. CONCLUSION The freeze-all policy is a cost-effective treatment, as long as the additional cost of US $2703.57 per additional live birth is financially acceptable for the subjects.
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21
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Townsend R, Sileo FG, Allotey J, Dodds J, Heazell A, Jorgensen L, Kim VB, Magee L, Mol B, Sandall J, Smith G, Thilaganathan B, von Dadelszen P, Thangaratinam S, Khalil A. Prediction of stillbirth: an umbrella review of evaluation of prognostic variables. BJOG 2020; 128:238-250. [PMID: 32931648 DOI: 10.1111/1471-0528.16510] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Stillbirth accounts for over 2 million deaths a year worldwide and rates remains stubbornly high. Multivariable prediction models may be key to individualised monitoring, intervention or early birth in pregnancy to prevent stillbirth. OBJECTIVES To collate and evaluate systematic reviews of factors associated with stillbirth in order to identify variables relevant to prediction model development. SEARCH STRATEGY MEDLINE, Embase, DARE and Cochrane Library databases and reference lists were searched up to November 2019. SELECTION CRITERIA We included systematic reviews of association of individual variables with stillbirth without language restriction. DATA COLLECTION AND ANALYSIS Abstract screening and data extraction were conducted in duplicate. Methodological quality was assessed using AMSTAR and QUIPS criteria. The evidence supporting association with each variable was graded. RESULTS The search identified 1198 citations. Sixty-nine systematic reviews reporting 64 variables were included. The most frequently reported were maternal age (n = 5), body mass index (n = 6) and maternal diabetes (n = 5). Uterine artery Doppler appeared to have the best performance of any single test for stillbirth. The strongest evidence of association was for nulliparity and pre-existing hypertension. CONCLUSION We have identified variables relevant to the development of prediction models for stillbirth. Age, parity and prior adverse pregnancy outcomes had a more convincing association than the best performing tests, which were PAPP-A, PlGF and UtAD. The evidence was limited by high heterogeneity and lack of data on intervention bias. TWEETABLE ABSTRACT Review shows key predictors for use in developing models predicting stillbirth include age, prior pregnancy outcome and PAPP-A, PLGF and Uterine artery Doppler.
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Affiliation(s)
- R Townsend
- Molecular and Clinical Sciences Research Institute, St George's, University of London and St George's University Hospitals NHS Foundation Trust, London, UK.,Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - F G Sileo
- Molecular and Clinical Sciences Research Institute, St George's, University of London and St George's University Hospitals NHS Foundation Trust, London, UK.,Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - J Allotey
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.,Pragmatic Clinical Trials Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - J Dodds
- Pragmatic Clinical Trials Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Centre for Women's Health, Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - A Heazell
- St Mary's Hospital, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK.,Faculty of Biology, Medicine and Health, Maternal and Fetal Health Research Centre, School of Medical Sciences, University of Manchester, Manchester, UK
| | | | - V B Kim
- The Robinson Institute, University of Adelaide, Adelaide, SA, Australia
| | - L Magee
- Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - B Mol
- Department of Obstetrics and Gynaecology, School of Medicine, Monash University, Melbourne, Vic., Australia
| | - J Sandall
- Health Service and Population Research Department, Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Women and Children's Health, Faculty of Life Sciences & Medicine, School of Life Course Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Gcs Smith
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Biomedical Research Centre, Cambridge, UK.,Department of Physiology, Development and Neuroscience, Centre for Trophoblast Research (CTR), University of Cambridge, Cambridge, UK
| | - B Thilaganathan
- Molecular and Clinical Sciences Research Institute, St George's, University of London and St George's University Hospitals NHS Foundation Trust, London, UK.,Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - P von Dadelszen
- Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - S Thangaratinam
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.,Pragmatic Clinical Trials Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - A Khalil
- Molecular and Clinical Sciences Research Institute, St George's, University of London and St George's University Hospitals NHS Foundation Trust, London, UK.,Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
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22
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Zhang X, Bai L, Ren H, Liu X, Guo S, Xu P, Zheng J, Zheng L, Tan J. Perinatal and maternal outcomes after frozen versus fresh embryo transfer cycles in women of advanced maternal age. Eur J Obstet Gynecol Reprod Biol 2020; 257:133-137. [PMID: 33131929 DOI: 10.1016/j.ejogrb.2020.09.047] [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: 11/20/2019] [Revised: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The delay of childbearing in women has become a worldwide issue in recent decades. The application of assisted reproductive technology in women of advanced maternal age (AMA) is increasing. Evidence on the safety and outcomes of frozen embryo transfer (FET) compared with fresh embryo transfer (ET) in AMA women is still lacking. Therefore, the objective of the present study was to compare perinatal and maternal outcomes after autologous FET and fresh ET cycles in women of AMA. STUDY DESIGN A retrospective study of 1663 FET and 3964 fresh ET cycles in reproductive medical centers from 2009 to 2014. Women who aged ≥35 years and had clinical pregnancies after autologous frozen or fresh ET were included. The main perinatal outcomes included birth weight, gestational age, rates of preterm birth, macrosomia, low birth weight (LBW), and very low birth weight. The main maternal outcomes included rates of hypertensive disorders of pregnancy, gestational diabetes mellitus, and preterm premature rupture of the membranes. RESULTS Women who underwent FET had an increased risk of hypertensive disorders of pregnancy [1.1 % vs. 0.4 %, adjusted OR (95 % CI): 2.76 (1.39-5.51); p = 0.004]. Singletons born after FET had significantly higher mean birth weight (3388.78 ± 538.47 vs. 3316.19 ± 549.08; p = 0.001). Furthermore, increased risk of macrosomia [13.5 % vs. 10.4 %, adjusted OR (95 % CI): 1.35 (1.07-1.71); p = 0.013] and decreased risk of LBW [3.6 % vs. 5.3 %, adjusted OR (95 % CI): 0.67 (0.45-1.00); p = 0.048] were found in singletons born after FET. CONCLUSIONS Perinatal risks of AMA patients are higher in FET than in fresh ET, including higher birth weight, risks of macrosomia in singleton births, and hypertensive disorders of pregnancy.
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Affiliation(s)
- Xinyi Zhang
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, 110022, Liaoning, China; Key Laboratory of Reproductive Dysfunction Diseases and Fertility Remodeling of Liaoning Province, Shenyang, 110022, Liaoning, China.
| | - Lina Bai
- Jinghua Hospital, Shenyang Eastern Medical Group, Shenyang, 110005, Liaoning, China.
| | - Haiqin Ren
- Jinghua Hospital, Shenyang Eastern Medical Group, Shenyang, 110005, Liaoning, China.
| | - Xinyu Liu
- Shenyang 204 Hospital, Shenyang, 110043, Liaoning, China.
| | - Shuaishuai Guo
- Reproductive Medical Center, Shenyang Women's and Children's Hospital, Shenyang, 110011, Liaoning, China..
| | - Peng Xu
- Jinghua Hospital, Shenyang Eastern Medical Group, Shenyang, 110005, Liaoning, China.
| | - Jia Zheng
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, 110004, Liaoning, China.
| | - Liqiang Zheng
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, 110004, Liaoning, China.
| | - Jichun Tan
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, 110022, Liaoning, China; Key Laboratory of Reproductive Dysfunction Diseases and Fertility Remodeling of Liaoning Province, Shenyang, 110022, Liaoning, China.
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24
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Song J, Gu L, Ren X, Liu Y, Qian K, Lan R, Wang T, Jin L, Yang J, Liu J. Prediction model for clinical pregnancy for ICSI after surgical sperm retrieval in different types of azoospermia. Hum Reprod 2020; 35:1972-1982. [PMID: 32730569 DOI: 10.1093/humrep/deaa163] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/03/2020] [Indexed: 12/13/2022] Open
Abstract
Abstract
STUDY QUESTION
Can a counselling tool be developed for couples with different types of azoospermia to predict the probability of clinical pregnancy in ICSI after surgical sperm retrieval?
SUMMARY ANSWER
A prediction model for clinical pregnancy in ICSI after surgical sperm retrieval in different types of azoospermia was created and clinical type of azoospermia, testicular size, male FSH, male LH, male testosterone, female age, female antral follicle count (AFC) and female anti-Müllerian hormone (AMH) were used as predictors.
WHAT IS KNOWN ALREADY
Prediction models are used frequently to predict treatment success in reproductive medicine; however, there are few prediction models only for azoospermia couples who intend to conceive through surgical sperm retrieval and ICSI. Furthermore, no specific clinical types of azoospermia have been reported as predictors.
STUDY DESIGN, SIZE, DURATION
A cohort study of 453 couples undergoing ICSI was conducted between 2016 and 2019 in an academic teaching hospital.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Couples undergoing ICSI with surgically retrieved sperm were included, with 302 couples included in the development set and 151 couples included in the validation set. We constructed a prediction model using multivariable logistic regression analysis. The internal validation was based on discrimination and calibration.
MAIN RESULTS AND THE ROLE OF CHANCE
We found that for male patients involved in our model, different clinical types of azoospermia are associated with different clinical pregnancy outcomes after ICSI. Considering the clinical type of azoospermia, larger testicular volume and higher levels of FSH, LH and testosterone in the body are associated with higher clinical pregnancy success rates. For women involved in our model, younger age and higher AFC and AMH levels are associated with higher clinical pregnancy success rates. In the development set, the AUC was 0.891 (95% CI 0.849–0.934), indicating that the model had good discrimination. The slope of the calibration plot was 1.020 (95% CI 0.899–1.142) and the intercept of the calibration plot was −0.015 (95% CI −0.112 to 0.082), indicating that the model was well-calibrated. From the validation set, the model had good discriminative capacity (AUC 0.866, 95% CI 0.808–0.924) and calibrated well, with a slope of 1.015 (95% CI 0.790–1.239) and an intercept of −0.014 (95% CI −0.180 to 0.152) in the calibration plot.
LIMITATIONS, REASONS FOR CAUTION
We found that BMI was not an effective indicator for predicting clinical pregnancy, which was inconsistent with some other studies. We lacked data about the predictors that reflected sperm characteristics, therefore, we included the clinical type of azoospermia instead as a predictor because it is related to sperm quality. We found that almost all patients did not have regular alcohol consumption, so we did not use alcohol consumption as a possible predictor, because of insufficient data on drinking habits. We acknowledge that our development set might not be a perfect representation of the population, although this is a common limitation that researchers often encounter when developing prediction models. The number of non-obstructive azoospermia patients that we could include in the analysis was limited due to the success rate of surgical sperm retrieval, although this did not affect the establishment and validation of our model. Finally, this prediction model was developed in a single centre. Although our model was validated in an independent dataset from our centre, validation for different clinical populations belonging to other centres is required before it can be exported.
WIDER IMPLICATIONS OF THE FINDINGS
This model enables the differentiation between couples with a low or high chance of reaching a clinical pregnancy through ICSI after surgical sperm retrieval. As such it can provide couples dealing with azoospermia a new approach to help them choose between surgical sperm retrieval with ICSI and the use of donor sperm.
STUDY FUNDING/COMPETING INTEREST(S)
This work was supported by a grant from the National Natural Science Foundations of China (81501246 and 81501020 and 81671443). The authors declare no competing interest.
TRIAL REGISTRATION NUMBER
N/A.
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Affiliation(s)
- Jingyu Song
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Longjie Gu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Xinling Ren
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Yang Liu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Kun Qian
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Ruzhu Lan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Tao Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Lei Jin
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Jun Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
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Abstract
Over the past 40 years access and effectiveness of assisted reproductive technologies (ART) have increased, and to date more than 8 million children have been conceived after ART globally. Most pregnancies resulting from ART are uncomplicated and result in the birth of healthy children. Yet, it is well known that pregnancies following ART are more likely to be affected by obstetric complications such as hypertensive disorders in pregnancy, preterm birth, and low birth weight compared with spontaneously conceived pregnancies. ART children are also at increased risk of birth defects. The majority of the problems arise as a result of multiple pregnancies and can be reduced by transferring a single embryo, thereby avoiding multiple pregnancies. New ART technologies are constantly introduced, and monitoring of the health of ART children is crucial.
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Affiliation(s)
- Ulla-Britt Wennerholm
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital East, Gothenburg, Sweden
- CONTACT Ulla-Britt Wennerholm Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital East, GothenburgSE 416 85, Sweden
| | - Christina Bergh
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Chaemsaithong P, Cuenca-Gomez D, Plana MN, Gil MM, Poon LC. Does low-dose aspirin initiated before 11 weeks' gestation reduce the rate of preeclampsia? Am J Obstet Gynecol 2020; 222:437-450. [PMID: 31494125 DOI: 10.1016/j.ajog.2019.08.047] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/23/2019] [Accepted: 08/23/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE DATA Preconception or early administration of low-dose aspirin might improve endometrial growth, placental vascularization, and organogenesis. Most studies have evaluated the potential benefit of preconception or early administration of low-dose aspirin in women with a history of recurrent pregnancy loss, women who have undergone in vitro fertilization, or women with thrombophilia or antiphospholipid syndrome. These women are at an increased risk of placenta-associated complications of pregnancy, including preeclampsia, preterm delivery, and fetal growth restriction. STUDY OUTCOMES We performed a systematic review and meta-analysis to evaluate the effect of low-dose aspirin initiated at <11 weeks' gestation on the risk of preeclampsia, gestational hypertension, or any hypertensive disorder of pregnancy. Secondary outcomes included preterm delivery at <37 weeks' gestation and fetal growth restriction. STUDY APPRAISAL AND SYNTHESIS METHODS We searched in MEDLINE via PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform from 1985 to November 2018. Entry criteria were randomized controlled trials evaluating the effect of aspirin administered at <11 weeks' gestation in preventing preeclampsia and/or hypertensive disorders in pregnancy or improving pregnancy outcomes in women with recurrent miscarriage as compared with placebo or no treatment and outcome data available or provided by authors for >85% of the study population. Relative risks with 95% confidence intervals were calculated for each study and pooled for global analysis as the effect measure. We assessed statistical heterogeneity in each meta-analysis using the χ2 statistics, I2, and Tau2. Heterogeneity was considered substantial if an I2 was greater than 50% and either the Tau2 was greater than zero or there was a low P value (<0.10) in the χ2 test for heterogeneity. Random-effects meta-analysis, weighted by the size of the studies, was performed to produce an overall summary on aspirin effect for each outcome. Sensitivity analysis by sequential omission of each individual study and by fixed-effects model was performed. Publication bias was not assessed because of the small number of included studies. Statistical analysis was performed using Stata release 14.0 (StataCorp). RESULTS The entry criteria were fulfilled by 8 randomized controlled trials on a combined total of 1426 participants. Low-dose aspirin initiated at <11 weeks' gestation was associated with a nonsignificant reduction in the risk of preeclampsia (relative risk, 0.52; 95% confidence interval, 0.23-1.17, P = .115), gestational hypertension (relative risk, 0.49; 95% confidence interval, 0.20-1.21; P = .121), and any hypertensive disorder of pregnancy (relative risk, 0.59; 95% confidence interval, 0.33-1.04, P = .067). Early administration of low-dose aspirin reduced the risk of preterm delivery (relative risk, 0.52; 95% confidence interval, 0.27-0.97, P = .040) but had no impact on the risk of fetal growth restriction (relative risk, 1.10; 95% confidence interval, 0.58-2.07, P = .775). Except for preterm delivery and any hypertensive disorder of pregnancy, sensitivity analysis demonstrated similar observations, therefore confirming the robustness of the analysis. CONCLUSION The administration of low-dose aspirin at <11 weeks' gestation in women at high risk does not decrease the risk of preeclampsia, gestational hypertension, any hypertensive disorder of pregnancy, and fetal growth restriction. However, it might reduce the risk of preterm delivery. Larger randomized controlled trials will be required to substantiate the findings.
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27
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Mizrachi Y, Weissman A, Buchnik Fater G, Torem M, Horowitz E, Schreiber L, Raziel A, Bar J, Kovo M. Placental histopathology in IVF pregnancies resulting from the transfer of frozen-thawed embryos compared with fresh embryos. J Assist Reprod Genet 2020; 37:1155-1162. [PMID: 32189181 DOI: 10.1007/s10815-020-01741-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/06/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To study whether placentas of singleton pregnancies conceived after fresh embryo transfer (ET) contain more histopathological lesions compared with placentas of singleton pregnancies conceived after frozen-thawed embryo transfer (FET). METHODS A prospective cohort study of placental histopathology in 131 women with singleton IVF pregnancies who delivered at a single medical center, between December 2017 and May 2019. The prevalence of different placental histopathology lesions was compared between women who conceived after fresh ET and FET. RESULTS Women who conceived after fresh ET (n = 74) did not differ from women who conceived after FET (n = 57) with regard to maternal age, BMI, nulliparity, or infertility diagnosis. Gestational week at delivery was lower in pregnancies conceived after fresh ET (38.5 vs. 39.2 weeks, respectively, p = 0.04), and a trend for a lower birthweight following fresh ET was noted (3040 vs. 3216 g, respectively, p = 0.053). However, placental histopathology analysis from pregnancies conceived after fresh ET was comparable to pregnancies conceived after FET, with regard to the prevalence of maternal vascular malperfusion lesions (45.9% vs. 50.9%, respectively, p = 0.57), fetal vascular malperfusion lesions (17.6% vs. 21.1, p = 0.61), acute inflammatory response lesions (28.4% vs. 28.1%, respectively, p = 0.96), and chronic inflammatory response lesions (13.5% vs. 8.8%, respectively, p = 0.48). CONCLUSION Placental histopathology did not differ between IVF pregnancies conceived after fresh and frozen ET. These results are reassuring for clinicians and patients who wish to pursue with transferring fresh embryos.
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Affiliation(s)
- Yossi Mizrachi
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, Israel. .,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Ariel Weissman
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gili Buchnik Fater
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Maya Torem
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eran Horowitz
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Letizia Schreiber
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Pathology, EdithWolfson Medical Center, Holon, Israel
| | - Arieh Raziel
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michal Kovo
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Hu S, Xu B, Long R, Jin L. Pregnancy and perinatal outcomes in pregnancies resulting from time interval between a freeze-all cycle and a subsequent frozen-thawed single blastocyst transfer. BMC Pregnancy Childbirth 2020; 20:161. [PMID: 32169044 PMCID: PMC7071692 DOI: 10.1186/s12884-020-02858-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 03/06/2020] [Indexed: 12/28/2022] Open
Abstract
Background Adverse obstetric outcomes are correlated with altered circulating hormone levels at the time implantation by the trophectoderm. What’ more, embryo freezing process may also have adverse effect on perinatal outcomes. This study aims to evaluate whether increasing interval time between a freeze-all cycle and a subsequent frozen-thawed single blastocyst transfer could have any effect on pregnancy and perinatal outcomes. Methods This was a retrospective cohort study included the first single blastocyst transfer in artificially cycles of all patients who underwent a freeze-all cycle between January 1st, 2016 and September 30th, 2018. All patients were divided into two groups according to the time interval between oocyte retrieval and the day of first frozen-thawed embryo transferred (FET): Group 1 (immediate FET cycles) and Group 2 (delayed FET cycles). Results No significant differences were reported between the two groups regarding the rates of clinical pregnancy, live birth, biochemical pregnancy and pregnancy loss even after adjusting for measured confounding. When accounting for perinatal outcomes, gestational age, birth weight, delivery mode, fetus gender, preterm birth, gestational hypertension, GDM, placenta previa, fetal malformation and low birthweight also did not vary significantly between the two groups. Only the incidence of macrosomia was more frequently in the Group 2 compared with the Group 1 (AOR 3.886, 95%CI 1.153–13.103, P = 0.029) after adjusting with a multiple logistic regression model. Conclusions We found delayed FET cycles for blastocyst transfer following freeze-all cycles may not improve the pregnancy outcomes. On the contrary, postponement of FET cycles may increase the risk of macrosomia. Therefore, FET cycles for blastocyst transfer should be done immediately to avoid adverse effects of delayed time on perinatal outcomes.
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Affiliation(s)
- Shiqiao Hu
- Department of Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 JieFang Avenue, Wuhan, 430030, People's Republic of China
| | - Bei Xu
- Department of Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 JieFang Avenue, Wuhan, 430030, People's Republic of China
| | - Rui Long
- Department of Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 JieFang Avenue, Wuhan, 430030, People's Republic of China
| | - Lei Jin
- Department of Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 JieFang Avenue, Wuhan, 430030, People's Republic of China.
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29
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Chen L, Ni X, Xu Z, Fang J, Zhang N, Li D. Effect of frozen and fresh embryo transfers on the birthweight of live-born twins. Eur J Obstet Gynecol Reprod Biol 2020; 246:50-54. [PMID: 31954368 DOI: 10.1016/j.ejogrb.2020.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 01/06/2020] [Accepted: 01/10/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To explore the influence of frozen embryo transfer (FET) and fresh embryo transfer (Fresh) on the birthweight of live-born twins. STUDY DESIGN A total of 8482 live-born twins were studied. The proportions of small for gestational age (SGA) and large for gestational age (LGA), the mean birthweight and the z score of live-born twins in the two groups were compared. Multiple linear regression analysis was used to evaluate the relationship between confounding factors and the birthweight of live-born twins. RESULTS The proportion of SGA infants significantly decreased as BMI increased (BMI < 20, 6.1 %; 20 ≤ BMI≤25, 4.1 %; BMI > 25, 3.6 %; P<0.05). The proportion of LGA infants significantly increased as BMI increased (BMI < 20, 20.5 %; 20 ≤ BMI≤25, 25.2 %; BMI > 25, 30.7 %; P<0.0001). The proportion of SGA infants was significantly lower in the FET group than in the Fresh group, whereas the proportion of LGA infants was significantly higher in the former than in the latter. The absolute mean birthweight of live-born twins was significantly higher in the FET group compared with the Fresh group (2579 ± 458 vs. 2534 ± 465, P < 0.0001). The mean z score of the FET group was also significantly higher than that of the Fresh group (0.420 vs. 0.240, P < 0.0001). Multiple linear regression analysis indicated that FET was a more significant factor than fresh embryo transfer in influencing the birthweight of live-born twins. CONCLUSION FET significantly increased the birthweight of live-born twins compared with fresh embryo transfer.
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Affiliation(s)
- Linjun Chen
- Reproductive Medical Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321#, Nanjing 210008, People's Republic of China.
| | - Xiaobei Ni
- Reproductive Medical Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321#, Nanjing 210008, People's Republic of China.
| | - Zhipeng Xu
- Reproductive Medical Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321#, Nanjing 210008, People's Republic of China.
| | - Junshun Fang
- Reproductive Medical Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321#, Nanjing 210008, People's Republic of China.
| | - Ningyuan Zhang
- Reproductive Medical Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321#, Nanjing 210008, People's Republic of China.
| | - Dong Li
- Reproductive Medical Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321#, Nanjing 210008, People's Republic of China.
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Smith ADAC, Tilling K, Lawlor DA, Nelson SM. Live birth rates and perinatal outcomes when all embryos are frozen compared with conventional fresh and frozen embryo transfer: a cohort study of 337,148 in vitro fertilisation cycles. BMC Med 2019; 17:202. [PMID: 31718643 PMCID: PMC6852977 DOI: 10.1186/s12916-019-1429-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 09/19/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND It is not known whether segmentation of an in vitro fertilisation (IVF) cycle, with freezing of all embryos prior to transfer, increases the chance of a live birth after all embryos are transferred. METHODS In a prospective study of UK Human Fertilisation and Embryology Authority data, we investigated the impact of segmentation, compared with initial fresh embryo followed by frozen embryo transfers, on live birth rate and perinatal outcomes. We used generalised linear models to assess the effect of segmentation in the whole cohort, with additional analyses within women who had experienced both segmentation and non-segmentation. We compared rates of live birth, low birthweight (LBW < 2.5 kg), preterm birth (< 37 weeks), macrosomia (> 4 kg), small for gestational age (SGA < 10th centile), and large for gestational age (LGA > 90th centile) for a given ovarian stimulation cycle accounting for all embryo transfers. RESULTS We assessed 202,968 women undergoing 337,148 ovarian stimulation cycles and 399,896 embryo transfer procedures. Live birth rates were similar in unadjusted analyses for segmented and non-segmented cycles (rate ratio 1.05, 95% CI 1.02-1.08) but lower in segmented cycles when adjusted for age, cycle number, cause of infertility, and ovarian response (rate ratio 0.80, 95% CI 0.78-0.83). Segmented cycles were associated with increased risk of macrosomia (adjusted risk ratio 1.72, 95% CI 1.55-1.92) and LGA (1.51, 1.38-1.66) but lower risk of LBW (0.71, 0.65-0.78) and SGA (0.64, 0.56-0.72). With adjustment for blastocyst/cleavage-stage embryo transfer in those with data on this (329,621 cycles), results were not notably changed. Similar results were observed comparing segmented to non-segmented within 3261 women who had both and when analyses were repeated excluding multiple embryo cycles and multiple pregnancies. When analyses were restricted to women with a single embryo transfer, the transfer of a frozen-thawed embryo in a segmented cycles was no longer associated with a lower risk of LBW (0.97, 0.71-1.33) or SGA (0.84, 0.61-1.15), but the risk of macrosomia (1.74, 1.39-2.20) and LGA (1.49, 1.20-1.86) persisted. When the analyses for perinatal outcomes were further restricted to solely frozen embryo transfers, there was no strong statistical evidence for associations. CONCLUSIONS Widespread application of segmentation and freezing of all embryos to unselected patient populations may be associated with lower cumulative live birth rates and should be restricted to those with a clinical indication.
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Affiliation(s)
- Andrew D A C Smith
- Applied Statistics Group, University of the West of England, Bristol, BS16 1QY, UK
| | - Kate Tilling
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, BS8 2BN, UK.,Population Health Science, Bristol Medical School, Bristol, UK.,NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, BS8 2BN, UK.,Population Health Science, Bristol Medical School, Bristol, UK.,NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Scott M Nelson
- NIHR Bristol Biomedical Research Centre, Bristol, UK. .,School of Medicine, New Lister Building, Glasgow Royal Infirmary, University of Glasgow, Glasgow, G31 2ER, UK.
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31
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Laval M, Garlantézec R, Guivarc'h-Levêque A. Birthweight difference of singletons conceived through in vitro fertilization with frozen versus fresh embryo transfer: An analysis of 5406 embryo transfers in a retrospective study 2013-2018. J Gynecol Obstet Hum Reprod 2019; 49:101644. [PMID: 31593781 DOI: 10.1016/j.jogoh.2019.101644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 09/24/2019] [Accepted: 09/29/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Perinatal risks after frozen embro transfer (FET) have been reassuring but some authors suggest that birthweights are higher after FET than after fresh embryo transfer (ET). The primary objective of this retrospective study, conducted in Clinique de la Sagesse, Rennes (France) from December 2013 to March 2017, was to determine whether a difference in birthweight exists between children conceived through in vitro fertilization (IVF) with frozen versus fresh ET. The secondary objective was to compare live birth rates after frozen versus fresh cycles. MATERIAL AND METHODS All couples undergoing IVF were included. Cycles with gamete donation and twin pregnancies were excluded. Hormone therapy was used in all embryo transfers. The main outcome measures were the child's birthweight, mode of delivery, gestation length and sex, maternal characteristics, and IVF characteristics. The primary endpoint was birthweight. RESULTS We studied 5406 embryo transfers and the 708 resulting singleton live births on which birthweight data were available. Mean birthweight was 3357g after frozen embryo transfer versus 3183g after fresh embryo transfer (p<0.001). After adjusting for confounding factors, the children born after frozen embryo transfer were 165.2g heavier (95%CI [92.96-237.51]). No difference was found in gestation length. Live birth was obtained after the 1.6th IVF attempt. Live birth rate was higher for fresh cycles (19% versus 12%, p<0.001), and the caesarean rate lower (16% versus 21%). DISCUSSION Birthweight was higher after frozen embryo transfer for a similar gestational age. Further research is needed to elucidate the mechanisms responsible for this difference.
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Affiliation(s)
- Maude Laval
- Reproductive Medicine, Groupe Hospitalier Bretagne Sud, 5 avenue Choiseul, 56322 Lorient, France.
| | - Ronan Garlantézec
- University of Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), 9 Avenue du Professeur Léon Bernard, 35000 Rennes, France; Centre Hospitalier Universitaire de Rennes, 2 Rue Henri le Guilloux, 35000 Rennes, France.
| | - Anne Guivarc'h-Levêque
- Reproductive Medicine, Clinique de La Sagesse, 4 Place Saint Guénolé, 35043 Rennes, France.
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Alecsandru D, Pacheco A, Guerrero-Mayo A, Fabris A, Aparicio P, Barrio A, Pellicer A, Garcia-Velasco JA. Ovarian stimulation does not influence the uterine immune environment in healthy infertile women. Reprod Biomed Online 2019; 40:113-123. [PMID: 31761720 DOI: 10.1016/j.rbmo.2019.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 07/15/2019] [Accepted: 08/14/2019] [Indexed: 10/26/2022]
Abstract
RESEARCH QUESTION There is some controversy regarding the impact of ovarian stimulation on immune cells in women undergoing IVF. The study's aim was to determine whether ovarian stimulation affected immune uterine cells in healthy women undergoing IVF. DESIGN This prospective cohort study included 28 patients undergoing IVF and 47 healthy oocyte donors. Endometrial biopsies were taken in a natural cycle and after ovarian stimulation. All participants had a normal karyotype, pelvic ultrasound and cervical cytology results and thyroid-stimulating hormone concentration, as well as normal glucose and insulin concentrations and inherited and acquired thrombophilia test results. Screening tests including human papillomavirus were normal. Immune cells were analysed using three techniques: fluorescence-activated cell sorting, immunohistochemistry and gene expression. A human leukocyte antigen (HLA)-C tetramer was used as an 'artificial embryo'. The expression of genes including those for tumour necrosis factor (TNF)-α and interleukin-10 (IL-10) was analysed. RESULTS A comparison was made of the percentage and gene expression of CD56brightCD16- uterine natural killer (uNK), CD56dimCD16+ natural killer cells, CD56-CD16+ natural killer cells and TregCD25+CD4+FoxP3+ cells, uNK binding to the HLA-C tetramer, and TNF-α and IL-10 expression. No between- or within-group differences were observed in natural versus ovarian stimulation cycles. CONCLUSIONS Ovarian stimulation does not affect the uterine immune cell population or HLA-C binding in healthy women undergoing ovarian stimulation. Further studies are underway to find out if different responses might be seen in women with previous autoimmune disorders.
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Affiliation(s)
- D Alecsandru
- Department of Immunology, IVI RMA, Madrid, Spain; Rey Juan Carlos University, Madrid, Spain; Health Research Institute La Fe, Valencia, Spain.
| | - A Pacheco
- Health Research Institute La Fe, Valencia, Spain; Department of Andrology, IVI RMA, Madrid, Spain; Alfonso X 'El Sabio' University, Madrid, Spain
| | | | - A Fabris
- Department of Reproductive Endocrinology and Infertility, IVI RMA, Madrid, Spain
| | - P Aparicio
- Department of Immunology, IVI RMA, Madrid, Spain
| | - A Barrio
- Department of Reproductive Endocrinology and Infertility, IVI RMA, Madrid, Spain
| | - A Pellicer
- Health Research Institute La Fe, Valencia, Spain; Universidad de Valencia, IVI Learning Center; Department of Reproductive Endocrinology and Infertility, IVI RMA, Roma, Italy
| | - Juan A Garcia-Velasco
- Rey Juan Carlos University, Madrid, Spain; Health Research Institute La Fe, Valencia, Spain; Universidad de Valencia, IVI Learning Center; Department of Reproductive Endocrinology and Infertility, IVI RMA, Madrid, Spain
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Li Z, Wang AY, Bowman M, Hammarberg K, Farquhar C, Johnson L, Safi N, Sullivan EA. Cumulative live birth rates following a 'freeze-all' strategy: a population-based study. Hum Reprod Open 2019; 2019:hoz004. [PMID: 30895269 PMCID: PMC6400239 DOI: 10.1093/hropen/hoz004] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 12/07/2018] [Accepted: 02/07/2019] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What is the cumulative live birth rate following a 'freeze-all' strategy compared with a 'fresh-transfer' strategy? SUMMARY ANSWER The 'freeze-all' strategy resulted in a similar cumulative live birth rate as the 'fresh-transfer' strategy among high responders (>15 oocytes retrieved) but did not benefit normal (10-15 oocytes) and suboptimal responders (<10 oocytes). WHAT IS KNOWN ALREADY Frozen-thawed embryo transfer is associated with a decreased risk of adverse obstetric and perinatal outcomes compared with fresh embryo transfer. It is unclear whether the 'freeze-all' strategy should be offered to all women undergoing ART treatment. STUDY DESIGN SIZE DURATION A population-based retrospective cohort study using data collected by the Victorian Assisted Reproductive Treatment Authority. This study included 14 331 women undergoing their first stimulated ART cycle with at least one oocyte fertilised between 1 July 2009 and 30 June 2014 in Victoria, Australia. Demographic characteristics, type of ART procedures and resulting pregnancy and birth outcomes were recorded for the stimulated cycle and associated thaw cycles until 30 June 2016, or until a live birth was achieved, or until all embryos from the stimulated cycle had been used. PARTICIPANTS/MATERIALS SETTING METHODS Women were grouped by whether they had undergone the 'freeze-all' strategy (n = 1028) where all embryos were cryopreserved for future transfer, or the 'fresh-transfer' strategy (n = 13 303) where selected embryo(s) were transferred in the stimulated cycle, and remaining embryo(s) were cryopreserved for future use. A discrete-time survival model was used to evaluate the cumulative live birth rate following 'freeze-all' and 'fresh-transfer' strategy. MAIN RESULTS AND THE ROLE OF CHANCE A total of 1028 women undergoing 'freeze-all' strategy and 13 303 women undergoing 'fresh-transfer' strategy had 1788 and 22 334 embryo transfer cycles resulting in 452 and 5126 live births, respectively. Most women (61.3%) in the 'freeze-all' group had more than 15 oocytes retrieved in the stimulated cycle compared with 18.1% of women in the 'fresh-transfer' group (P < 0.001). For high responders (>15 oocytes), the cumulative live birth rate in the 'freeze-all' group was similar to the 'fresh-transfer' group (56.8% vs. 56.2%, adjusted hazard ratio (AHR) 0.90, 95% CI 0.77-1.04). However, the likelihood of a live birth was lower in the 'freeze-all' group compared with the 'fresh-transfer' group among normal responders (10-15 oocytes) (33.2% vs. 46.3%, AHR 0.62, 95% CI 0.46-0.83) and suboptimal responders (<10 oocytes) (14.6% vs. 28.0%, AHR 0.67, 95% CI 0.14-1.01). During the minimum follow-up time of 2 years, 34.1%, 24.4% and 8.4% of suboptimal, normal and high responders, respectively, in the 'freeze-all' group did not return for any embryo transfer after the stimulated cycle, whereas all women in the 'fresh-transfer' group had at least one embryo transferred in the stimulated cycle. LIMITATIONS REASONS FOR CAUTION A limitation of this population-based study is the lack of information available on clinic-specific protocols for the 'freeze-all' strategy and the potential impact of these on outcomes. Data were not available on whether the 'freeze-all' strategy was used to prevent ovarian hyperstimulation syndrome (OHSS). WIDER IMPLICATIONS OF THE FINDINGS This study presents population-based evidence on clinical efficacy associated with a 'freeze-all' and 'fresh-transfer' strategy. The 'freeze-all' strategy may benefit some subgroups of patients, including women who are high responders and those who are at risk of OHSS, but should not be offered universally. Clinicians should consider the potential impact of electively deferring embryo transfer on treatment discontinuation in choosing the optimal embryo transfer strategy for couples undergoing ART treatment. STUDY FUNDING/COMPETING INTERESTS No specific funding was received to undertake this study. There is no conflict of interest, except that M.B. is a shareholder in Genea Ltd.
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Affiliation(s)
- Z Li
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney NSW, Australia
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney NSW, Australia
| | - A Y Wang
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney NSW, Australia
| | - M Bowman
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney NSW, Australia
| | - K Hammarberg
- Victorian Assisted Reproductive Treatment Authority, Melbourne VIC, Australia
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne VIC, Australia
| | - C Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland 1010, New Zealand
| | - L Johnson
- Victorian Assisted Reproductive Treatment Authority, Melbourne VIC, Australia
| | - N Safi
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney NSW, Australia
| | - E A Sullivan
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney NSW, Australia
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Prediction of live birth and cumulative live birth rates in freeze-all-IVF treatment of a general population. J Assist Reprod Genet 2019; 36:685-696. [PMID: 30790147 DOI: 10.1007/s10815-019-01422-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 02/12/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To investigate the cumulative live birth (cLB) rate of one complete freeze-all-IVF cycle in a general infertile population and to investigate patient and treatment variables that predict blastocyst development and live birth (LB). METHOD In a retrospective observational study, the data of all IVF cycles performed between 1 February 2015 and 31 January 2016 at a single IVF centre was investigated. In the study, patient-couples were followed up for 18 months following oocyte retrieval. After exclusions, the patient and treatment variables of 1582 patient-couples who underwent treatment were included in the analyses. RESULTS The median time interval between the oocyte retrieval attempt and the frozen embryo transfer (FET) in which LB was achieved was 38.0 (35.0-67.0) days. The variables of freeze-all-IVF cycles with single blastocyst FET selected by multiple logistic regression to predict LB significantly were female age, infertility duration, FET number (i.e. 1st, 2nd, or ≥ 3rd FET), and blastocyst quality. In a regression adjusting for female age, the number of blastocysts transferred, and oocyte number group (1-3, 4-9, 10-15, and > 15), none of the oocyte number groups were selected to predict LB of 1st FET, significantly. While the per transfer LB rates decreased linearly from the 1st (56.5%) to the 3rd (36.4%) FET, the cLB rate increased from 47.3% after the 1st FET to 55.0% after a 3rd possible FET. CONCLUSION The cLB rate of one complete freeze-all-IVF cycle of a general infertile population, with 18-month follow-up, was 55.0%. In freeze-all-IVF, ovarian reserve variables were not selected by regression models to predict LB, significantly.
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Berntsen S, Söderström-Anttila V, Wennerholm UB, Laivuori H, Loft A, Oldereid NB, Romundstad LB, Bergh C, Pinborg A. The health of children conceived by ART: ‘the chicken or the egg?’. Hum Reprod Update 2019; 25:137-158. [DOI: 10.1093/humupd/dmz001] [Citation(s) in RCA: 177] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 10/31/2018] [Accepted: 01/08/2019] [Indexed: 12/11/2022] Open
Affiliation(s)
- Sine Berntsen
- Department of Obstetrics and Gynaecology, Hvidovre Hospital, University of Copenhagen, Kettegaard Alle 30, Hvidovre, Denmark
| | - Viveca Söderström-Anttila
- Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, Helsinki, Finland
| | - Ulla-Britt Wennerholm
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital East, Gothenburg, Sweden
| | - Hannele Laivuori
- Department of Obstetrics and Gynecology, Tampere University Hospital, Teiskontie 35, Tampere, Finland
- Faculty of Medicine and Life Sciences, University of Tampere, Arvo Ylpön Katu 34, Tampere, Finland
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 8, Helsinki, Finland
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Tukhomankatu 8, Helsinki, Finland
| | - Anne Loft
- Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Nan B Oldereid
- Livio IVF-klinikken Oslo, Sørkedalsveien 10A, Oslo, Norway
| | - Liv Bente Romundstad
- Spiren Fertility Clinic, Norwegian Institute of Public Health, PO Box 222 Skøyen, Oslo, Norway
- Centre for Fertility and Health, Norwegian Institute of Public Health, PO Box 222 Skøyen, Oslo, Norway
| | - Christina Bergh
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anja Pinborg
- Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
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Twin pregnancies and perinatal outcomes: a comparison between fresh and frozen embryo transfer: a two-centre study. Reprod Biomed Online 2019; 38:241-248. [DOI: 10.1016/j.rbmo.2018.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 11/04/2018] [Accepted: 11/09/2018] [Indexed: 11/24/2022]
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Carr SV. Surrogacy and ethics in women with cancer. Best Pract Res Clin Obstet Gynaecol 2018; 55:117-127. [PMID: 30553717 DOI: 10.1016/j.bpobgyn.2018.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/02/2018] [Indexed: 10/27/2022]
Abstract
Women diagnosed with gynaecological cancer may face unwanted loss of fertility as well as all the other life-changing issues with which cancer and its treatments are associated. The decision to harvest and store gametes has to be made before commencement of treatment, and advances in these techniques have made this successful. Fertility sparing therefore must be discussed and offered at an early stage post diagnosis. Surrogacy is currently an evidence-based method of assisted reproduction, with mainly desirable outcomes for the commissioning mother, surrogate and child, without impacting on the cancer treatment and long-term survival. Surrogacy is therefore ethical as long as the autonomous rights of both the commissioning mother and gestational carrier are equally observed, they both have equal legal protection and due attention is paid to the short- and long-term welfare of any resulting offspring.
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Affiliation(s)
- Susan V Carr
- Faculty of Medicine, University of Melbourne, Parkville, Australia.
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Zhang J, Du M, Li Z, Wang L, Hu J, Zhao B, Feng Y, Chen X, Sun L. Fresh versus frozen embryo transfer for full-term singleton birth: a retrospective cohort study. J Ovarian Res 2018; 11:59. [PMID: 30012201 PMCID: PMC6048709 DOI: 10.1186/s13048-018-0432-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/05/2018] [Indexed: 12/23/2022] Open
Abstract
Background Improvements in vitrification and frozen embryo transfer (FET) technologies have rapidly increased, and some evidence suggests that FET may increase pregnancy rates and lead to more favourable perinatal outcomes. However, the outcome of interest should be offspring safety. Therefore, the primary objective of our study was to investigate whether FET was preferable to fresh embryo transfer (ET) in terms of full-term neonatal birthweight and congenital malformations. Methods This was a retrospective cohort study of patients with no pregnancy-related complications who underwent first fresh ETs (n = 2059) or FETs (n = 2053), resulting in full-term singletons births. Outcome measures were neonatal birthweight, low birthweight (LBW), small-for-gestational age (SGA), large-for-gestational age (LGA), macrosomia and congenital malformations. Additionally, we used logistic regression to adjust for baseline characteristics (age, BMI, No. of embryos transferred and embryo stage) between the two groups. Results The mean neonatal birthweight was higher for singletons born after FET than for singletons born after fresh ET (3468.7 ± 475.3 vs. 3386.7 ± 448.1; p < 0.001). The frequencies of full-term singleton LBW and SGA after FET were significantly lower than those after fresh ET (1.7% vs. 3.0 and 4.4% vs. 6.7%, respectively), with adjusted rate ratios of 0.59 (95% CI, 0.37 to 0.98; p = 0.026) and 0.73 (95% CI, 0.55 to 0.99; p = 0.041), respectively. FET resulted in higher frequencies of macrosomia and LGA (15.1% vs 10.2 and 22.8% vs. 17.5%, respectively) than fresh ET, with adjusted rate ratios of 1.43 (95% CI, 1.16 to 1.75; p = 0.001) and 1.26 (95% CI, 1.07 to 1.49; p = 0.007), respectively. Furthermore, the incidence of congenital malformations was not different between the two groups (1.2% vs. 0.9%), with a rate ratio of 0.288. Conclusions After the cycles with pregnancy-related complications were excluded and after adjustments for baseline characteristics, women undergoing FET were associated with a higher neonatal birthweight than women undergoing fresh ET cycles. Additionally, the FET protocol was associated with lower rates of LBW and SGA and higher rates of macrosomia and LGA than the fresh ET protocol. Meanwhile, no difference in the congenital malformation rate was evident between the two groups.
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Affiliation(s)
- Junwei Zhang
- The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfuqian Road, Zhengzhou, 450052, Henan, People's Republic of China
| | - Mingze Du
- The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfuqian Road, Zhengzhou, 450052, Henan, People's Republic of China
| | - Zhe Li
- The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfuqian Road, Zhengzhou, 450052, Henan, People's Republic of China
| | - Lulu Wang
- The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfuqian Road, Zhengzhou, 450052, Henan, People's Republic of China
| | - Jijun Hu
- The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfuqian Road, Zhengzhou, 450052, Henan, People's Republic of China
| | - Bei Zhao
- The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfuqian Road, Zhengzhou, 450052, Henan, People's Republic of China
| | - Yingying Feng
- The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfuqian Road, Zhengzhou, 450052, Henan, People's Republic of China
| | - Xiaolin Chen
- The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfuqian Road, Zhengzhou, 450052, Henan, People's Republic of China
| | - Lijun Sun
- The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfuqian Road, Zhengzhou, 450052, Henan, People's Republic of China.
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Chen L, Zhu L, Cai C, Yan G, Sun H. Clinical and neonatal outcomes of intrauterine insemination with frozen donor sperm. Syst Biol Reprod Med 2018; 64:240-245. [PMID: 29600727 DOI: 10.1080/19396368.2018.1453563] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Linjun Chen
- Reproductive Medical Center, Drum Tower Hospital, Nanjing University Medical College, Nanjing, People’s Republic of China
| | - Lihua Zhu
- Reproductive Medical Center, Drum Tower Hospital, Nanjing University Medical College, Nanjing, People’s Republic of China
| | - Changming Cai
- Reproductive Medical Center, Drum Tower Hospital, Nanjing University Medical College, Nanjing, People’s Republic of China
| | - Guijun Yan
- Reproductive Medical Center, Drum Tower Hospital, Nanjing University Medical College, Nanjing, People’s Republic of China
| | - Haixiang Sun
- Reproductive Medical Center, Drum Tower Hospital, Nanjing University Medical College, Nanjing, People’s Republic of China
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Abstract
PURPOSE OF REVIEW There's some preclinical evidence of an adverse effect of multifollicular growth on endometrial function in assisted reproductive technology cycles. Universal elective frozen embryo transfer (eFET) in an unstimulated cycle is being promoted as a panacea, regardless of patient, and cycle characteristics. We review the clinical evidence on the effectiveness and safety of eFETs. RECENT FINDINGS Randomized controlled trials (RCTs) comparing fresh and eFET yield contradictory results in terms of live birth rates. RCTs mainly involve women with an excessive response to ovarian stimulation. Studies including women with a normal or low ovarian response are either patient/physician preference or retrospective studies, prone to bias. Yet, they yield contradictory results as well. Overall, eFET seems to have limited potential to improve effectiveness of assisted reproductive technology, which could be limited to hyper-responders. Other suggested advantages of eFET include better obstetric and perinatal outcome. However, recent studies show that frozen embryo transfers can be associated with serious complications including hypertensive disorders during pregnancy, placenta accreta, or increased perinatal mortality. SUMMARY The evidence behind advantages of eFET is of low quality. As such, switching to a universal eFET strategy does not seem justified. New RCTs including women from different strata of ovarian response are needed.
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Margot H, Chansel-Debordeaux L, Pennamen P, Papaxanthos A, Toutain J. [Risk of confined placental mosaicism after assisted reproductive technologies]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2018; 46:57-59. [PMID: 29292097 DOI: 10.1016/j.gofs.2017.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Indexed: 06/07/2023]
Affiliation(s)
- H Margot
- Génétique médicale, CHU de Bordeaux, 33000 Bordeaux, France
| | - L Chansel-Debordeaux
- Biologie de la reproduction, CHU de Bordeaux, 33000 Bordeaux, France; University of Bordeaux, 33000 Bordeaux, France
| | - P Pennamen
- Génétique médicale, CHU de Bordeaux, 33000 Bordeaux, France; University of Bordeaux, 33000 Bordeaux, France
| | - A Papaxanthos
- Biologie de la reproduction, CHU de Bordeaux, 33000 Bordeaux, France
| | - J Toutain
- Génétique médicale, CHU de Bordeaux, 33000 Bordeaux, France.
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Haas J, Casper RF. In vitro fertilization treatments with the use of clomiphene citrate or letrozole. Fertil Steril 2017; 108:568-571. [PMID: 28965550 DOI: 10.1016/j.fertnstert.2017.08.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 08/10/2017] [Indexed: 01/30/2023]
Abstract
There has been increasing interest in combining the oral agents clomiphene citrate (CC) and letrozole with gonadotropins in IVF: for poor responders to reduce the amount of gonadotropins used, and in normal responders to reduce the incidence of ovarian hyperstimulation (OHSS). In normal responders, mild stimulation with the use of CC and gonadotropins was found to decrease the number of oocytes retrieved and result in good pregnancy rates, but in most studies the cumulative pregnancy rate was lower compared with conventional ovarian stimulation when frozen embryo transfers were considered. Coadministration of letrozole and gonadotropins has mainly been used in patients with breast cancer to prevent the massive elevation of serum E2 concentrations with the use of standard controlled ovarian hyperstimulation. CC and letrozole have both been used with gonadotropins in poor responders and have been shown to reduce the amount of gonadotropin used without reducing the pregnancy rate. Letrozole use with gonadotropins in IVF cycles may increase endometrial receptivity by increasing integrin expression in the endometrium and by lowering estrogen concentrations to more physiologic levels.
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Affiliation(s)
- Jigal Haas
- Division of Reproductive Sciences, University of Toronto; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital; and TRIO Fertility, Toronto, Ontario, Canada
| | - Robert F Casper
- Division of Reproductive Sciences, University of Toronto; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital; and TRIO Fertility, Toronto, Ontario, Canada.
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Wang X, Du M, Guan Y, Wang B, Zhang J, Liu Z. Comparative neonatal outcomes in singleton births from blastocyst transfers or cleavage-stage embryo transfers: a systematic review and meta-analysis. Reprod Biol Endocrinol 2017; 15:36. [PMID: 28472983 PMCID: PMC5418763 DOI: 10.1186/s12958-017-0255-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 04/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Comparative neonatal outcomes with respect to singleton births from blastocyst transfers or cleavage-state embryo transfers are controversial with respect to which method is superior. Many studies have yielded contradictory results. We performed a systematic review and meta-analysis for the purpose of comparing neonatal outcomes in single births following IVF/ICSI. METHODS We searched the Medline, Embase and Cochrane Central Register of Clinical Trials (CCTR) databases until October 2016. Studies and trials that contained neonatal outcomes for singleton births were included. Data were extracted in 2 × 2 tables. The analysis was performed using Rev Man 5.1 software. Risk ratios (RRs) and risk differences, with 95% confidence intervals, were calculated to assess the results of each outcome. Subgroups were applied in all outcomes. Newcastle-Ottawa scale (NOS) checklists were used to assess the quality of the referenced studies. RESULTS Twelve studies met the criteria in this meta-analysis. There was a high risk of preterm birth after blastocyst embryo transfer versus the risk after cleavage-stage transfer (RR: 1.11, 95% CI: 1.01-1.22). For the "only fresh" subgroup, the outcome was coincident (RR: 1.16, 95% CI: 1.06-1.27). For the "fresh and frozen" and "only frozen" subgroups, there were no differences. Patients who received fresh blastocyst embryo transfers had a high risk of very preterm births (RR: 1.16, 95% CI: 1.02-1.31). Finally, cleavage-stage embryo transfers were associated with a high risk of infants who were small for gestational age (0.83, 95% CI: 0.76-0.92) and a low risk of those who were large for gestation age (1.14, 95% CI: 1.04-1.25). CONCLUSIONS The risks of preterm and very preterm births increased after fresh blastocyst transfers versus the risks after fresh cleavage-stage embryo transfers. However, in frozen embryo transfers, there were no differences. Blastocyst embryo transfers resulted in high risks of infants who were large for gestational age, and cleavage-stage embryo transfers resulted in high risks of infants who were small for gestational age.
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Affiliation(s)
- Xingling Wang
- grid.412719.8The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfuqian Road, Zhengzhou, 450052 Henan People’s Republic of China
| | - Mingze Du
- grid.412719.8The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfuqian Road, Zhengzhou, 450052 Henan People’s Republic of China
| | - Yichun Guan
- grid.412719.8The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfuqian Road, Zhengzhou, 450052 Henan People’s Republic of China
| | - Bijun Wang
- grid.412719.8The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfuqian Road, Zhengzhou, 450052 Henan People’s Republic of China
| | - Junwei Zhang
- grid.412719.8The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfuqian Road, Zhengzhou, 450052 Henan People’s Republic of China
| | - Zihua Liu
- grid.412719.8The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfuqian Road, Zhengzhou, 450052 Henan People’s Republic of China
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Ghosh J, Coutifaris C, Sapienza C, Mainigi M. Global DNA methylation levels are altered by modifiable clinical manipulations in assisted reproductive technologies. Clin Epigenetics 2017; 9:14. [PMID: 28191261 PMCID: PMC5295214 DOI: 10.1186/s13148-017-0318-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 01/25/2017] [Indexed: 01/16/2023] Open
Abstract
Background We analyzed placental DNA methylation levels at repeated sequences (LINE1 elements) and all CCGG sites (the LUMA assay) to study the effect of modifiable clinical or laboratory procedures involved in in vitro fertilization. We included four potential modifiable factors: oxygen tension during embryo culture, fresh embryo transfer vs frozen embryo transfer, intracytoplasmic sperm injection (ICSI) vs conventional insemination or day 3 embryo transfer vs day 5 embryo transfer. Results Global methylation levels differed between placentas from natural conceptions compared to placentas conceived by IVF. Placentas from embryos cultured at 20% oxygen showed significant differences in LINE1 methylation compared to in vivo conceptions, while those from embryos cultured at 5% oxygen, did not have significant differences. In addition, placentas from fresh embryo transfer had significantly different LINE1 methylation compared to placentas from in vivo conceptions, while embryos resulting from frozen embryos were not significantly different from controls. On sex-stratified analysis, only males had significant methylation differences at LINE1 elements stratified for the modifiable factors. As expected, LINE1 methylation was significantly different between males and females in the control population. However, we did not observe sex-specific differences in the IVF group. We validated this sex-specific observation in an additional cohort and in opposite sex IVF twins. Conclusion We show that two clinically modifiable factors (embryo culture in 5 vs 20% oxygen tension and fresh vs frozen embryo transfer) are associated with global placental methylation differences. Interestingly, males appear more vulnerable to such treatment-related global changes in DNA methylation than do females. Electronic supplementary material The online version of this article (doi:10.1186/s13148-017-0318-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jayashri Ghosh
- Center for Research on Reproduction and Women's Health, University of Pennsylvania School of Medicine, Philadelphia, PA 19104 USA
| | - Christos Coutifaris
- Center for Research on Reproduction and Women's Health, University of Pennsylvania School of Medicine, Philadelphia, PA 19104 USA.,Department of Obstetrics & Gynecology, University of Pennsylvania School of Medicine, 3701 Market Street, 8th Floor, Philadelphia, PA 19104 USA
| | - Carmen Sapienza
- Fels Institute for Cancer Research and Molecular Biology, Temple University School of Medicine, Philadelphia, PA 19140 USA.,Department of Pathology and Laboratory Medicine, Temple University School of Medicine, Philadelphia, PA 19140 USA
| | - Monica Mainigi
- Center for Research on Reproduction and Women's Health, University of Pennsylvania School of Medicine, Philadelphia, PA 19104 USA.,Department of Obstetrics & Gynecology, University of Pennsylvania School of Medicine, 3701 Market Street, 8th Floor, Philadelphia, PA 19104 USA
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