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Zhu S, Jiang W, Sun Y, Chen L, Li R, Chen X, Zheng B. Nomogram to predict the probability of clinical pregnancy in women with poor ovarian response undergoing in vitro fertilization/ intracytoplasmic sperm injection cycles. Arch Gynecol Obstet 2024:10.1007/s00404-024-07598-9. [PMID: 38913207 DOI: 10.1007/s00404-024-07598-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 06/09/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Poor ovarian response (POR) is associated with decreased clinical pregnancy rates, emphasizing the need for developing clinical prediction models. Such models can improve prognostic accuracy, personalize medical interventions, and ultimately enhance live birth rates among patients with POR. OBJECTIVE This study aims to develop and validate a prognostic model for predicting clinical pregnancy outcomes in individuals with POR undergoing in vitro fertilization/ intracytoplasmic sperm injection (IVF/ICSI) cycles. METHODS A retrospective cohort of 969 patients with POR undergoing fresh embryo transfer cycles at the Reproductive Center of Fujian Maternal and Child Health Center from January 2018 to January 2022 was included. The cohort was randomly divided into model (n = 678) and validation (n = 291) groups in a 7:3 ratio. A single-factor analysis was performed on the model group to identify variables influencing clinical pregnancy. Optimal variables were selected using LASSO regression, and a clinical prediction model was constructed using multivariate logistic regression analysis. The model's calibration and discrimination were assessed using receiver operating characteristic (ROC) and calibration curves, while the clinical utility was evaluated using decision curve analysis. RESULTS Multivariate logistic regression analysis revealed that the age of the women (odds ratio [OR] 0.936, 95% confidence interval [CI] 0.898-0.976, P = 0.002), body mass index (BMI) ≤ 24 (OR 2.748, 95% CI 1.724-4.492, P < 0.001), antral follicle count (AFC) (OR 1.232, 95% CI 1.073-1.416, P = 0.003), anti-Müllerian hormone (AMH) (OR 1.67, 95% CI 1.178-2.376, P = 0.004), number of mature oocytes (OR 1.227, 95% CI 1.075-1.403, P = 0.003), number of embryos transferred (OR 1.692, 95% CI 1.132-2.545, P = 0.011), and transfer of high-quality embryos (OR 3.452, 95% CI 1.548-8.842, P = 0.005) were independent predictors of clinical pregnancy in patients with POR. According to the receiver operating characteristic (ROC) analysis, the prediction model exhibited an area under the curve (AUC) of 0.752 (0.714, 0.789) in the model group and 0.765 (0.708, 0.821) in the validation group. The clinical decision curve demonstrated that the model held maximum clinical utility in both cohorts when the threshold probability of clinical pregnancy ranged from 6-81% to 12-82%, respectively. CONCLUSION Clinical pregnancy outcomes in patients with POR who underwent IVF/ICSI treatment were influenced by several independent factors, including the age of the women, BMI, AFC, AMH, number of mature oocytes, number of embryos transferred, and transfer of high-quality embryos. A clinical prediction model based on these factors exhibited favorable clinical predictive and applicative value. Therefore, this model can serve as a valuable tool for clinical prognosis, intervention, and facilitating personalized medical treatment.
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Affiliation(s)
- Suqin Zhu
- Center of Reproductive Medicine, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 18 Daoshan Road, Fuzhou City, 350001, Fujian Province, China
- Fujian Maternal-Fetal Clinical Medicine Research Center, Fuzhou, 350001, China
| | - Wenwen Jiang
- Center of Reproductive Medicine, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 18 Daoshan Road, Fuzhou City, 350001, Fujian Province, China
- Fujian Key Laboratory of Prenatal Diagnosis and Birth Defect, Fuzhou, 350001, China
| | - Yan Sun
- Center of Reproductive Medicine, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 18 Daoshan Road, Fuzhou City, 350001, Fujian Province, China
| | - Lili Chen
- Center of Reproductive Medicine, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 18 Daoshan Road, Fuzhou City, 350001, Fujian Province, China
| | - Rongshan Li
- Center of Reproductive Medicine, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 18 Daoshan Road, Fuzhou City, 350001, Fujian Province, China
| | - Xiaojing Chen
- Center of Reproductive Medicine, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 18 Daoshan Road, Fuzhou City, 350001, Fujian Province, China.
| | - Beihong Zheng
- Center of Reproductive Medicine, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 18 Daoshan Road, Fuzhou City, 350001, Fujian Province, China.
- Fujian Key Laboratory of Prenatal Diagnosis and Birth Defect, Fuzhou, 350001, China.
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Scheffer JB, de Carvalho RF, Scheffer BB, Aguiar APDS, Pessoa LP, Lozano DM, Fanchin R. Correlations between clinical parameters, blastocyst morphological classification and embryo euploidy. JBRA Assist Reprod 2024; 28:54-58. [PMID: 37962968 PMCID: PMC10936908 DOI: 10.5935/1518-0557.20230054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 09/21/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE The aim of the present study was to evaluate clinical and embryo parameters to predict embryo ploidy. METHODS In this retrospective analysis, we studied 838 biopsied day-5 blastocysts from 219 patients in the period from May 2021 to July 2022. All embryos were morphologically classified before biopsy and were divided into two groups according to genetic test results. Euploid embryos (299) were compared with aneuploid embryos (539) based on maternal age, anti-Mullerian hormone, antral follicle count, and embryo morphology. RESULTS Maternal age (36.2±3.0) of euploid embryos was lower than maternal age (37.1±2.5) of aneuploid embryos (p<0.0001). AMH levels were higher (3.9±1.2) in the group of euploid embryos than in the group of aneuploid embryos (3.6±1.3, p<0.0001). However, the AFC was not different in the group of euploid embryos (15.3±6.0) compared to the group of aneuploid embryos (14.5±5.9, p=0.07). The presence of aneuploidy was negatively correlated with top embryo quality (embryos 4AA and 4AB). All euploid embryos (299) were top quality versus 331 of 539 (61.49%) aneuploid embryos (p<0.0001). CONCLUSIONS We found that euploid embryos were associated with lower maternal age, higher AMH levels, and higher quality embryos.
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Affiliation(s)
| | | | - Bruno Brum Scheffer
- IBRRA - Brazilian Institute of Assisted Reproduction, Belo
Horizonte, Brazil
| | | | | | - Daniel Mendez Lozano
- School of Medicine, Tecnologico de Monterrey and Center for
Reproductive Medicine CREASIS, San Pedro Monterrey, Mexico
| | - Renato Fanchin
- Professeur des Universites- Praticien Hospitalier en Medecine de la
Reproduction, France, Hopital Foch, France
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Zhu S, Liao X, Jiang W, Sun Y, Chen X, Zheng B. Development and validation of a nomogram model for predicting clinical pregnancy in endometriosis patients undergoing fresh embryo transfer. BMC Pregnancy Childbirth 2023; 23:764. [PMID: 37907870 PMCID: PMC10617063 DOI: 10.1186/s12884-023-06082-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/21/2023] [Indexed: 11/02/2023] Open
Abstract
PURPOSE To construct and validate a nomogram model for predicting clinical pregnancy in individuals with endometriosis undergoing fersh embryo transfer (ET). METHODS A retrospective analysis was conducted on 1630 individuals with endometriosis who underwent in vitro fertilization (IVF) with fresh embryo transfer at the Reproductive Medicine Center of Fujian Maternity and Child Health Hospital from January 2018 to January 2022. The research population was sorted into two groups through random sampling, namely, the model group (n = 1141) and the validation group (n = 489), with a ratio of 7:3. Univariate analysis was utilized to determine the influencing factors for clinical pregnancy in the model group. The LASSO algorithm was utilized to select the optimal matching factors, which were then included in a multifactorial forward stepwise logistic regression to determine independent influencing factors and develop a nomogram. The discrimination, accuracy, and clinical efficacy of the prediction model were analyzed utilizing the receiver operating characteristic (ROC) curve, calibration curve, and clinical decision curve. RESULTS Through multivariate-logistic-regression analysis, these factors were identified as independent influencing factors for the clinical pregnancy in endometriosis patients undergoing fresh embryo transfer: female age (OR = 0.933, 95% CI = 0.902-0.965, P < 0.001), ASRM stage (OR = 0.384, 95% CI = 0.276-0.532, P < 0.001), postoperative to IVF duration (OR = 0.496, 95% CI = 0.356-0.688, P < 0.001), antral follicle count (AFC) (OR = 1.076, 95% CI = 1.013-1.161, P = 0.045), anti-Müllerian hormone (AMH) (OR = 1.202, 95% CI = 1.073-1.35, P = 0.002), Gonadotrophin-releasing hormone (GnRH) agonist protocol (OR = 1.536, 95% CI = 1.109-2.131, P = 0.01), number of oocytes retrieved (OR = 1.154, 95% CI = 1.067-1.249, P < 0.001), number of high-quality cleavage embryos (OR = 1.261, 95% CI = 1.164-1.369, P < 0.001), and number of embryos transferred (OR = 1.957, 95% CI = 1.435-2.679, P < 0.001). A prediction model for estimating the clinical pregnancy probability in individuals with endometriosis was constructed per these identified independent factors. The ROC showed an area under the curve (AUC) of 0.807 (95% CI = 0.782-0.832) in the model group and 0.800 (95% CI = 0.761-0.84) in the validation group. The Hosmer-Lemeshow test demonstrated no statistically significant difference between predicted and actual clinical pregnancy probabilities (P > 0.05). The clinical decision curve demonstrated that both the model and the validation groups achieved maximum net benefit at threshold probability values of 0.08-0.96 and 0.16-0.96, indicating good clinical efficacy within this range of threshold probabilities. CONCLUSION Female age, ASRM stage, postoperative to IVF duration, stimulation protocol, AFC, AMH, number of oocytes retrieved, number of high-quality cleavage embryos and number of transferred embryos are independent influencing factors for the clinical pregnancy rate in individuals with endometriosis receiving fresh embryo transfer. The nomogram model based on these factors demonstrates good clinical predictive value and efficacy, providing a basis for clinical prognosis, intervention, and individualized medical treatment planning.
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Affiliation(s)
- Suqin Zhu
- Fujian Provincial Reproductive Medicine Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 18 Daoshan Road, Fuzhou, Fujian Province, 350001, China
- Fujian Maternal-Fetal Clinical Medicine Research Center, Fuzhou, China
| | - Xiuhua Liao
- Fujian Provincial Reproductive Medicine Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 18 Daoshan Road, Fuzhou, Fujian Province, 350001, China
- Fujian Key Laboratory of Prenatal Diagnosis and Birth Defect, Fuzhou, China
| | - Wenwen Jiang
- Fujian Provincial Reproductive Medicine Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 18 Daoshan Road, Fuzhou, Fujian Province, 350001, China
| | - Yan Sun
- Fujian Provincial Reproductive Medicine Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 18 Daoshan Road, Fuzhou, Fujian Province, 350001, China
| | - Xiaojing Chen
- Fujian Provincial Reproductive Medicine Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 18 Daoshan Road, Fuzhou, Fujian Province, 350001, China.
| | - Beihong Zheng
- Fujian Provincial Reproductive Medicine Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 18 Daoshan Road, Fuzhou, Fujian Province, 350001, China.
- Fujian Key Laboratory of Prenatal Diagnosis and Birth Defect, Fuzhou, China.
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Gui J, Ni Y, Liu Q, Wang X, Xie Q. Comparison of clinical effects between early follicular prolonged GnRH agonist protocol and GnRH antagonist protocol in 3310 cycles: a retrospective study. BMC Pregnancy Childbirth 2022; 22:942. [PMID: 36522703 PMCID: PMC9756476 DOI: 10.1186/s12884-022-05295-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND It is the duty of doctors to choose a safe, simple, economic and effective controlled ovulation stimulation (COS) protocol for the patients. This study aims to compare the clinical effects of the early follicular prolonged GnRH agonist (EFPL) and GnRH antagonist (GnRH-Ant) protocols, hoping to provide some reference for clinicians when choosing COS program. METHODS A retrospective study included 3310 ovum pick up cycles undergoing assisted reproductive technology during January 2019 to May 2022 in Renmin Hospital of Wuhan University. Propensity Score Matching (PSM) and multivariable logistic regression analysis were used to improve the comparability between the two protocols. Subgroups were divided according to age, body mass index (BMI) and anti-Mullerian hormone (AMH). The live birth rate (LBR) and clinical pregnancy rate (CPR) were the primary outcomes. RESULTS After PSM, the endometrial thickness, fresh embryo transplantation rate, chemical pregnancy rate, CPR were significantly higher in EFPL group than that in GnRH-Ant group (P < 0.001). The E2, LH, P values on trigger day were significantly lower in EFPL group (P < 0.001). The cycle cancellation rate was significantly reduced in EFPL group (P < 0.001). However, the total amount of Gn and duration of Gn were significantly increased in the EFPL group (P < 0.001). Multivariable logistic regression analysis showed that the LBR was significantly higher in EFPL group after matching [OR (95%CI), 1.86 (1.13, 3.05), P = 0.02], especially for those with age < 35 years [OR (95%CI), 1.95 (1.14, 3.34), P = 0.02], BMI < 24 kg/m2 [OR (95%CI), 2.08 (1.14, 3.80), P = 0.02], AMH levels ≥ 4.5 ng/ml [OR (95%CI), 4.19 (1.53, 11.43), P < 0.01]. CONCLUSION EFPL regimen is more suitable to elicit live birth for those young patients with BMI < 24 kg/m2 and AMH ≥ 4.5 ng/ml. However, for patients with decreased ovarian reserve or advanced age, EFPL regimen has no advantage over the GnRH-Ant regimen.
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Affiliation(s)
- Juan Gui
- grid.412632.00000 0004 1758 2270Dept. of Reproductive center, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, 430060 Wuhan, China ,Assisted Reproduction and Embryogenesis Clinical Research Center of Hubei Province, Wuhan, China
| | - Yuan Ni
- grid.412632.00000 0004 1758 2270Dept. of Reproductive center, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, 430060 Wuhan, China ,Assisted Reproduction and Embryogenesis Clinical Research Center of Hubei Province, Wuhan, China
| | - Qian Liu
- grid.412632.00000 0004 1758 2270Dept. of Reproductive center, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, 430060 Wuhan, China ,Assisted Reproduction and Embryogenesis Clinical Research Center of Hubei Province, Wuhan, China
| | - Xiaochen Wang
- grid.412632.00000 0004 1758 2270Dept. of Reproductive center, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, 430060 Wuhan, China ,Assisted Reproduction and Embryogenesis Clinical Research Center of Hubei Province, Wuhan, China
| | - Qingzhen Xie
- grid.412632.00000 0004 1758 2270Dept. of Reproductive center, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, 430060 Wuhan, China ,Assisted Reproduction and Embryogenesis Clinical Research Center of Hubei Province, Wuhan, China
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Hua L, Zhe Y, Jing Y, Fujin S, Jiao C, Liu L. Prediction model of gonadotropin starting dose and its clinical application in controlled ovarian stimulation. BMC Pregnancy Childbirth 2022; 22:810. [PMID: 36333671 PMCID: PMC9635211 DOI: 10.1186/s12884-022-05152-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
Background Selecting an appropriate and personalized Gn starting dose (GSD) is an essential procedure for determining the quality and quantity of oocytes in the controlled ovarian stimulation (COS) process of the in-vitro fertilization (IVF) treatment cycle. The current approach for determining the GSD is mainly based on the experience of a clinician, lacking unified and scientific standards. This study aims to establish a prediction model of GSD, based on which good COS outcomes can be achieved with the influencing factors comprehensively evaluated quantitatively. Material and methods We collected a total of 1555 patients undergoing the first oocytes retrieving cycle and conducted correlation analysis to find the significant factors related to the GSD. Two GSD models are built based on two popular machine learning approaches, and the one with better model performance is selected as the final model. Finally, clinical application and validation were conducted to verify the effectiveness of the proposed model. Results (1) Age, duration of infertility, type of infertility, body mass index (BMI), antral follicle count (AFC), basal follicle stimulating hormone (bFSH), estradiol (E2), luteinizing hormone (LH), anti-Müllerian hormone (AMH) and COS treatment regimen were closely related to the GSD (P < 0.05). (2) The selected model has good modeling performance in terms of both root mean square error (RMSE) (29.87 ~ 34.21) and regression coefficient R (0.947 ~ 0.953). (3) A comprehensive evaluation of influencing factors for GSD is conducted and shows that the top four most significant factors are age, AMH, AFC, and BMI. (4) The proposed GSD can approximate the actual value well in the clinical application, with the mean absolute error of only 11.26 units, and the recommended results can prompt the number of oocytes retrieved (NOR) close to the optimal number. Conclusion Modeling the GSD value with machine learning approaches is feasible and effective, and the proposed model has good clinical application for determining the GSD in the IVF treatment cycle.
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Affiliation(s)
- Liang Hua
- grid.412632.00000 0004 1758 2270Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yang Zhe
- grid.412632.00000 0004 1758 2270Reproductive Medicine Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yang Jing
- grid.412632.00000 0004 1758 2270Reproductive Medicine Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shen Fujin
- grid.412632.00000 0004 1758 2270Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chen Jiao
- grid.412632.00000 0004 1758 2270Reproductive Medicine Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Liu Liu
- grid.412632.00000 0004 1758 2270Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
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Anti-müllerian hormone as a predictor for live birth among women undergoing IVF/ICSI in different age groups: an update of systematic review and meta-analysis. Arch Gynecol Obstet 2022; 308:43-61. [PMID: 35907969 DOI: 10.1007/s00404-022-06683-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 06/19/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To update the evidence of anti-müllerian hormone (AMH) as predictive factors for live birth outcome in women undergoing assisted conception and discover the modulating effect of age. METHODS PubMed, Embase, Medline, and Web of Science were searched for studies published until June 2021. We included studies that measured serum AMH levels and reported the subsequent live birth outcomes. Random effects models and hierarchical summary receiver operating characteristics (HSROC) models were used. The QUADAS-2 checklist was employed to assess the quality of the included studies. RESULTS We included 27 studies (27,029 women) investigating the relationship between AMH and live birth outcome after assisted conception. The diagnostic odds ratios (DOR) from random effects models were ruled out due to high heterogeneity. Our findings suggested that AMH was associated with live birth. The DOR was 2.21 (95% CI 1.89-2.59), and 2.49 (95% CI 1.26-4.91) for studies on women with unspecified ovarian reserve and women with low ovarian reserve, respectively. The DOR of those with advanced ages was 2.50 (95% CI 1.87-2.60). For younger women, the DOR was 1.41 (95% CI 0.99-2.02). HSROCs showed that AMH had no predictive ability towards live birth in women with diminished ovarian reserve or younger age. Exclusion of Chinese cohorts lowered the heterogeneity. CONCLUSIONS This study revealed that AMH had better prediction for live birth in advanced-age women. AMH may have implicative predictive value for assisted conception counseling of couples of advanced ages.
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Harris BS, Acharya KS, Weber JM, Truong T, Eaton JL. Can high antimüllerian hormone mitigate some of the age-related decline in live birth rates? The association between antimüllerian hormone and live birth among women over 40 undergoing in vitro fertilization. F S Rep 2021; 2:440-447. [PMID: 34934985 PMCID: PMC8655414 DOI: 10.1016/j.xfre.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To examine the association between serum antimüllerian hormone (AMH) and live birth among women aged ≥41 years undergoing in vitro fertilization (IVF). Design Retrospective cohort study using the 2012-2014 Society for Assisted Reproductive Technology Clinic Outcome Reporting System database. Setting Fertility clinics reporting to the Society for Assisted Reproductive Technology. Patients The analysis included 7,819 patients aged ≥41 years who underwent a first fresh, autologous IVF cycle during the study period. Cycles with preimplantation genetic testing were excluded. Interventions None. Main outcome measures Live birth rate. Results The empirical distribution of AMH was examined, and extreme values were observed. Therefore, the natural logarithm transformation of AMH (log-AMH) was used in all analyses. Before adjustment for covariates, a one-unit increase in log-AMH was associated with doubling of the odds of live birth up to a log-AMH of -0.34 (equivalently, AMH, 0.71 ng/mL; odds ratio [OR], 2.02; 95% confidence interval [CI], 1.66-2.46). Above an AMH level of 0.71 ng/mL, the odds of live birth increased by only 40% with each unit increase in log-AMH (OR, 1.40; 95% CI, 1.22-1.61). After adjusting for covariates, the odds of live birth increased by 91% with each unit increase in log-AMH up to -0.34 (AMH, 0.71 ng/mL; OR, 1.91; 95% CI, 1.56-2.34). Above an AMH level of 0.71 ng/mL, the odds of live birth increased by only 32% with each unit increase in log-AMH (OR, 1.32; 95% CI, 1.15-1.53). Conclusions Among women aged ≥41 years undergoing fresh, autologous IVF, the odds of live birth significantly increase with increasing serum AMH level. As the AMH level increases above 0.71 ng/mL, the association maintains statistical significance, but the effect size is diminished.
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Affiliation(s)
- Benjamin S Harris
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Kelly S Acharya
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Jeremy M Weber
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Tracy Truong
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Jennifer L Eaton
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
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Chen Y, Niu A, Feng X, Zhang Y, Li F. Prediction of pregnancy outcome in fresh in vitro fertilization/intracytoplasmic sperm injection treatment in patients with poor ovarian reserve. Aging (Albany NY) 2021; 13:18331-18339. [PMID: 34273144 PMCID: PMC8351725 DOI: 10.18632/aging.203282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/22/2021] [Indexed: 11/25/2022]
Abstract
We retrospectively analyzed the clinical data from 39,185 cycles who undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) in the First People's Hospital of Shangqiu, these poor ovarian reserve patients were further categorized into the "unexpected" group (n=3337) and the "expected" group (n=2667) based on POSEIDON classification. In "expected" group, logistic regression analysis showed that female age (OR 0.920; 95% C.I 0.902~0.939; P < 0.001), treatment cycles (OR 0.693; 95% C.I 0.560~0.859; P = 0.001), duration of Gn administered (OR 1.077; 95% C.I 1.027~1.129; P = 0.002) and transferable embryos (OR 1.377; 95% C.I 1.319~1.437; P < 0.001) is independent predictive factors of live birth. In "expected" group, logistic regression analysis showed that female age (OR 0.874; 95% C.I 0.848~0.900; P < 0.001), AFC (OR 1.285; 95% C.I 1.131~1.461; P < 0.001), total dosage of Gn administered (OR 1.001; 95% C.I 1.000~1.002; P < 0.001), duration of Gn administered (OR 0.784; 95% C.I 0.639~0.961; P = 0.019), MII number (OR 0.841; 95% C.I 0.717~0.986; P = 0.032) and transferable embryos (OR 2.057; 95% C.I 1.762~2.400; P < 0.001) is independent predictive factors of live birth. We also established a smooth curve fit to predict the probability of live birth among the POSEIDON "unexpected" and "expected" group. These independent predictive factors on the pregnancy outcome of IVF/ICSI and the successful establishment of smooth curve fit can provide valuable reference for treats poor ovarian reserve patients in clinical work.
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Affiliation(s)
- Ying Chen
- Center for Reproductive Medicine, The First People's Hospital of Shangqiu, Shangqiu College of Xuzhou Medical University, Henan, People's Republic of China
| | - AiQin Niu
- Center for Reproductive Medicine, The First People's Hospital of Shangqiu, Shangqiu College of Xuzhou Medical University, Henan, People's Republic of China
| | - XingMei Feng
- Center for Reproductive Medicine, The First People's Hospital of Shangqiu, Shangqiu College of Xuzhou Medical University, Henan, People's Republic of China
| | - YaLi Zhang
- Center for Reproductive Medicine, The First People's Hospital of Shangqiu, Shangqiu College of Xuzhou Medical University, Henan, People's Republic of China
| | - Fei Li
- Center for Reproductive Medicine, The First People's Hospital of Shangqiu, Shangqiu College of Xuzhou Medical University, Henan, People's Republic of China
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Chera-Aree P, Thanaboonyawat I, Thokha B, Laokirkkiat P. Comparison of pregnancy outcomes using a time-lapse monitoring system for embryo incubation versus a conventional incubator in in vitro fertilization: An age-stratification analysis. Clin Exp Reprod Med 2021; 48:174-183. [PMID: 34024081 PMCID: PMC8176153 DOI: 10.5653/cerm.2020.04091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/11/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare the pregnancy outcomes of in vitro fertilization with embryo transfer between embryos cultured in a time-lapse monitoring system (TLS) and those cultured in a conventional incubator (CI). METHODS The medical records of 250 fertilized embryos from 141 patients undergoing infertility treatment with assisted reproductive technology at a tertiary hospital from June 2018 to May 2020 were reviewed. The study population was divided into TLS and CI groups at a 1 to 1 ratio (125 embryos per group). The primary outcome was the live birth rate. RESULTS The TLS group had a significantly higher clinical pregnancy rate (46.4% vs. 27.2%, p=0.002), implantation rate (27.1% vs. 12.0%, p=0.004), and live birth rate (32.0% vs. 18.4%, p=0.013) than the CI group. Furthermore, subgroup analyses of the clinical pregnancy rate and live birth rate in the different age groups favored the TLS group. However, this difference only reached statistical significance in the live birth rate in women aged over 40 years and the clinical pregnancy rate in women aged 35-40 years (p=0.048 and p=0.031, respectively). The miscarriage rate, cleavage rate, and blastocyst rate were comparable. CONCLUSION TLS application improved the live birth rate, implantation rate, and clinical pregnancy rate, particularly in the advanced age group in this study, while the other reproductive outcomes were comparable. Large randomized controlled trials are needed to further explore the ramifications of these findings, especially in different age groups.
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Affiliation(s)
- Pattraporn Chera-Aree
- Infertility and Reproductive Biology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Isarin Thanaboonyawat
- Infertility and Reproductive Biology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Benjawan Thokha
- Infertility and Reproductive Biology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pitak Laokirkkiat
- Infertility and Reproductive Biology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Mizuno S, Matsumoto H, Hashimoto S, Brahmajosyula M, Ohgaki A, Tarui S, Matoba M, Satoh M, Fukuda A, Morimoto Y. A novel embryo quality scoring system to compare groups of embryos at different developmental stages. J Assist Reprod Genet 2021; 38:1123-1132. [PMID: 33646470 PMCID: PMC8190420 DOI: 10.1007/s10815-021-02117-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/15/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To construct a new embryonic quality scoring system to compare groups of embryos at different developmental stages. METHODS Based on a hypothesis that the implantation potential of any embryo in an ovum pickup (OPU) cycle remains the same at any stage of development, be it day 2, 3, or 5, a new embryo quality scoring (EQS) system was designed. It was based on the analysis of the clinical results of 1610 single embryo transfers. We validated this scoring system in the comparison of embryonic quality between groups by evaluating the mean scores calculated at day 2, day 3, and day 5 for 957 embryos (150 cycles) from 3 different groups. We then compared EQSs of patients with pregnancy favorable factors (group A) such as young age and high AMH levels, with the patients with contra features (group B). RESULTS We confirmed that each mean EQS assessed at different stages of embryonic development within the same group was similar. The mean EQSs on day 3 and day 5 in group A were significantly higher than the mean EQSs on days 2, 3, and 5 in group B. CONCLUSION The novel EQS system proposed by us enables embryonic quality comparison between groups of embryos at different developmental stages.
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Affiliation(s)
- Satoshi Mizuno
- IVF Osaka Clinic, Higashi-Osaka, Osaka, 577-0012, Japan.
| | | | - Shu Hashimoto
- IVF Namba Clinic, Osaka, 550-0015, Japan
- Graduate School of Medicine, Osaka City University, Osaka, 545-8585, Japan
| | | | - Aya Ohgaki
- IVF Osaka Clinic, Higashi-Osaka, Osaka, 577-0012, Japan
| | - Sachiyo Tarui
- IVF Osaka Clinic, Higashi-Osaka, Osaka, 577-0012, Japan
| | - Mari Matoba
- HORAC Grand Front Osaka Clinic, Osaka, 530-0011, Japan
| | | | - Aisaku Fukuda
- IVF Osaka Clinic, Higashi-Osaka, Osaka, 577-0012, Japan
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Scheffer JB, Carvalho RFD, Aguiar APDS, Machado IJM, Franca JB, Lozano DM, Fanchin R. Which ovarian reserve marker relates to embryo quality on day 3 and blastocyst; age, AFC, AMH? JBRA Assist Reprod 2021; 25:109-114. [PMID: 32960526 PMCID: PMC7863095 DOI: 10.5935/1518-0557.20200060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective: The aim of the present prospective study was to evaluate which ovarian reserve marker would be more reliable as the quality of the A + B embryos (day 3 and blastocyst). Methods: We ran a prospective study with 124 infertile women, aged 24-48 years, from 2017 to 2018. The patients were divided into 3 groups according to age and the subgroups were compared for AMH, AFC, number of A+B embryos. New division of the 3 groups was performed based on the AMH, and the subgroups were compared for age, AFC and number of A+B embryos. Finally, we divided the patients into 3 groups, based on the AFC, and we compared the subgroups for age, AMH and number of A+B embryos. P<0.05 was considered statistically significant. Results: When the 124 patients were divided according to age, we found a significant fall in an A+B embryo quality (day3; blastocyst) after 35 years (p<0.038; p<0.035), and more severely after 37 years (p<0.032; p<0.027). When the 124 patients were divided according to AMH, there was a significant fall in A+B embryo quality (day 3; blastocyst), with AMH<1ng/ml (p<0.023; p<0.021). When the 124 patients were divided according to AFC, there was a significant fall in A+B embryo quality (day 3; blastocyst) with AFC<7 (p<0.025; p<0.023). These markers had significant associations with embryo quality (p<0.005). Conclusion: Age, AFC and AMH have significant associations with A +B embryo quality on day 3 and blastocyst.
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Affiliation(s)
| | | | | | | | | | - Daniel Mendez Lozano
- School of Medicine, Tecnologico de Monterrey and Center for Reproductive Medicine CREASIS, San Pedro Monterrey, Mexico
| | - Renato Fanchin
- Professeur des Universites - Praticien Hospitalier en Medecine de la Reproduction, France; Hopital Foch, France
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Maranhão KDS, Mariz MEGDSM, Araújo EADD, Souza GRD, Taveira KVM, Morais DB. Factors related to infertility in Brazil and their relationship with success rates after assisted reproduction treatment: an integrative review. JBRA Assist Reprod 2021; 25:136-149. [PMID: 32759095 PMCID: PMC7863087 DOI: 10.5935/1518-0557.20200051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
This integrative review evaluated the most commonly diagnosed causes of infertility in men and women in Brazil, as well as the medically assisted reproduction technologies regularly employed in these cases. We searched in four electronic databases (PubMed, including Medline; Scopus; Web of Science and LILACS), and two grey literature (Google Scholar and OpenGrey), guided by the focused question: "What are the main factors responsible for male and female infertility in Brazil, and what are its relationships with success rates after assisted reproduction treatment?". We included interventional or observational studies, without limitation by language or year of publication. Our searches in the electronic indexers recovered 1,119 articles, and after analyzing the inclusion and exclusion criteria, 27 articles composed the body of analysis for this review. We grouped the studies into four themes: factors responsible for male and female infertility, assisted reproductive technologies (ART) used in the infertility treatment, assisted reproduction procedures, and clinical predictors of success rates in ART. Despite the scarcity of studies analyzing the association between infertility and assisted reproductive technologies in Brazil, it was possible to infer that the most prevalent infertility cause in women was endometriosis, while in men it was azoospermia. The most widely assisted reproductive technology applied in the country is the intracytoplasmic injection of spermatozoa (ICSI), ensuring better success rates in the treatment of infertility for men and women.
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Li F, Ye T, Kong H, Li J, Hu L, Jin H, Guo Y, Li G. Predictive Factors for Live Birth in Fresh In Vitro Fertilization/Intracytoplasmic Sperm Injection Treatment in Poor Ovarian Reserve Patients Classified by the POSEIDON Criteria. Front Endocrinol (Lausanne) 2021; 12:630832. [PMID: 33967954 PMCID: PMC8099421 DOI: 10.3389/fendo.2021.630832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/19/2021] [Indexed: 11/13/2022] Open
Abstract
The mechanisms underlying poor ovarian response (POR) in assisted reproductive technology remain unclear, there is no consensus on the management of poor responders, the POSEIDON stratification classifies infertility patients into "expected" or "unexpected" groups to provide a more nuanced picture of POR, but few researchers have discussed the independent predictive factors (smoothed plots and the threshold effect) for live birth in POR patients classified by the new criteria. We conducted a retrospective cohort study using clinical data from 6,580 POR patients classified by the POSEIDON criteria in the First Affiliated Hospital of Zhengzhou University, and explored the live birth based on the results before and after the threshold inflection point of each independent influencing factor. Among 6,580 poor ovarian reserve patients classified by the POSEIDON criteria, 1,549 (23.54%) had live births, and 5,031 (76.46%) did not have live births. Multivariate logistic regression analysis showed that female age (OR 0.901; 95% CI 0.887~0.916; P < 0.001), body mass index (OR 0.963; 95% CI 0.951~0.982; P < 0.001), antral follicle counting (OR 1.049; 95% CI 1.009~1.042; P < 0.001) and controlled ovarian hyperstimulation protocol were independent factors predicting live birth in patients with POR. The threshold effect analysis found that the inflection point of female age was 34 years old, and when age was > 34 years old, the probability of live birth in POR patients dropped sharply (OR 0.7; 95% CI 0.7~0.8; P < 0.001). The inflection point of BMI was 23.4 kg/m2, and BMI had a negative correlation with live birth (OR 0.963; 95% CI 0.951~0.982; P < 0.001). The threshold inflection point of AFC was 8n. Female age, BMI, AFC and COH protocol were independent predictive factors associated with live birth in POR patients classified by the POSEIDON criteria. The smooth curve fit and threshold effect analyses provide clinical management strategies for these patients. In addition, the early-follicular-phase long-acting GnRH-agonist long protocol seems to have a higher live birth rates than other protocols. It is worth highlighting that BMI should be considered as well in the POSEIDON criteria.
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Affiliation(s)
- Fei Li
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Center for Reproductive Medicine, The First People’s Hospital of Shangqiu, Shangqiu, China
| | - Tian Ye
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Huijuan Kong
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Li
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Linli Hu
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - HaiXia Jin
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - YiHong Guo
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Gang Li
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Gang Li,
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Scheffer JB, Scheffer BB, Carvalho RFD, Aguiar AP, Lozano DHM, Labrosse J, Grynberg M. A comparison of the effects of three luteal phase support protocols with estrogen on in vitro fertilization-embryo transfer outcomes in patients on a GnRH antagonist protocol. JBRA Assist Reprod 2019; 23:239-245. [PMID: 30875186 PMCID: PMC6724398 DOI: 10.5935/1518-0557.20190012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective: This study aimed to evaluate the effects of three different luteal phase
support protocols with estrogen on the pregnancy rates and luteal phase
hormone profiles of patients undergoing in vitro
fertilization-embryo transfer (IVF-ET) cycles. A secondary objective was to
evaluate which ovarian reserve markers correlated with pregnancy rates. Methods: This retrospective observational study was carried out at a private tertiary
reproductive medicine teaching and research center. The study enrolled 104
patients undergoing intracytoplasmic sperm injection (ICSI) on an antagonist
protocol for controlled ovarian hyperstimulation (COH). The women were
divided into three groups based on the route of administration of estrogen
(E2) for luteal phase support: oral (Primogyna); transdermal patches
(Estradott); or transdermal gel (Oestrogel Pump). The administration of
estrogen provided the equivalent to 4 mg of estradiol daily. All women
received 600mg of vaginal progesterone (P) per day (Utrogestan) for luteal
phase support. Blood samples were drawn on the day of hCG administration and
on the day of beta hCG testing to measure E2 and P levels. Clinical
pregnancy rate (PR) was the main endpoint. Results: The patients included in the three groups were comparable. No significant
differences were found in implantation rates, clinical PR, miscarriage
rates, multiple-pregnancy rates, E2 or P levels on the day of beta hCG
measurement. Concerning ovarian reserve markers, significant correlations
between testing positive for clinical pregnancy and AMH (r = 0.66,
p<0.0001) and E2 levels on beta hCG measurement day (r =
0.77; p<.0001) were observed. Conclusions: No significant differences were seen in the pregnancy rates of patients
submitted to IVF-ET cycles with GnRH antagonists given oral, transdermal
patches, or transdermal gel E2 during the luteal phase. A correlation was
found between clinical pregnancy rate and AMH and E2 levels on beta hCG
testing day.
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Affiliation(s)
| | - Bruno Brum Scheffer
- IBRRA - Brazilian Institute of Assisted Reproduction, Belo Horizonte, MG, Brazil
| | | | - Ana Paula Aguiar
- IBRRA - Brazilian Institute of Assisted Reproduction, Belo Horizonte, MG, Brazil
| | - Daniel H Mendez Lozano
- School of Medicine, Tecnológico de Monterrey and Center for Reproductive Medicine CREASIS San Pedro Monterrey, México
| | - Julie Labrosse
- Department of Reproductive Medicine, Hôpital Jean Verdier (AP-HP), University Paris XIII
| | - Michael Grynberg
- Department of Reproductive Medicine, Hôpital Jean Verdier (AP-HP), University Paris XIII.,INSERM, U782, Clamart - France
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15
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Pimentel RN, Navarro PA, Wang F, Robinson LG, Cammer M, Liang F, Kramer Y, Keefe DL. Amyloid-like substance in mice and human oocytes and embryos. J Assist Reprod Genet 2019; 36:1877-1890. [PMID: 31332596 DOI: 10.1007/s10815-019-01530-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/09/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To identify and characterize amyloid-like substance (ALS) in human and mouse oocytes and preimplantation embryos. METHODS An experimental prospective pilot study. A total of 252 mouse oocytes and preimplantation embryos and 50 immature and in vitro matured human oocytes and parthenogenetic human embryos, from 11 consenting fertility patients, ages 18-45. Fluorescence intensity from immunofluorescent staining and data from confocal microscopy were quantified. Data were compared by one-way analysis of variance, with the least square-MEANS post-test, Pearson correlation coefficients (r), and bivariate analyses (t tests). ALS morphology was verified using transmission electron microscopy. RESULTS Immunostaining for ALS appears throughout the zona pellucida, as well as in the cytoplasm and nucleus of mouse and human oocytes, polar bodies, and parthenogenetic embryos, and mouse preimplantation embryos. In mouse, 2-cell embryos exhibited the highest level of ALS (69000187.4 ± 6733098.07). Electron microscopy confirmed the presence of ALS. In humans, fresh germinal vesicle stage oocytes exhibited the highest level of ALS (4164.74088 ± 1573.46) followed by metaphase I and II stages (p = 0.008). There was a significant negative association between levels of ALS and patient body mass index, number of days of ovarian stimulation, dose of gonadotropin used, time between retrieval and fixation, and time after the hCG trigger. Significantly higher levels of ALS were found in patients with AMH between 1 and 3 ng/ml compared to < 1 ng/ml. CONCLUSION We demonstrate for the first time the presence, distribution, and change in ALS throughout some stages of mouse and human oocyte maturation and embryonic development. We also determine associations between ALS in human oocytes with clinical characteristics.
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Affiliation(s)
- Ricardo N Pimentel
- Research Scientist from the Department of Obstetrics and Gynecology, New York University School of Medicine, 550 First Avenue, NBV 9N1, New York, NY, USA.,Human Reproduction Division, Department of Obstetrics and Gynecology, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Paula A Navarro
- Human Reproduction Division, Department of Obstetrics and Gynecology, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Fang Wang
- Department of Obstetrics and Gynecology, Langone Medical Center, New York University, New York, NY, USA
| | - LeRoy G Robinson
- Department of Obstetrics and Gynecology, Langone Medical Center, New York University, New York, NY, USA
| | - Michael Cammer
- DART Microscopy Laboratory, New York University School of Medicine, New York, NY, USA
| | - Fengxia Liang
- DART Microscopy Laboratory, New York University School of Medicine, New York, NY, USA
| | - Yael Kramer
- Department of Obstetrics and Gynecology, Langone Medical Center, New York University, New York, NY, USA
| | - David Lawrence Keefe
- Department of Obstetrics and Gynecology, Langone Medical Center, New York University, New York, NY, USA.
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Use of Cumulative Live Birth Rate per Total Number of Embryos to Calculate the Success of IVF in Consecutive IVF Cycles in Women Aged ≥35 Years. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6159793. [PMID: 31346521 PMCID: PMC6617928 DOI: 10.1155/2019/6159793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/28/2019] [Accepted: 05/20/2019] [Indexed: 12/12/2022]
Abstract
Objective The use of cumulative live birth rate (CLBR) per ovarian stimulation cycle is proving to be an accurate method to calculate the success of IVF; however, the cycle outcome is closely associated with the number of embryos transferred (ET). Our aim was to report CLBR after IVF according to the number of embryos required to achieve a live birth in women aged ≥35 years, considering age, body mass index (BMI), and ethnicity. Methods We conducted a retrospective cohort study including 1344 patients who underwent IVF between January 2013 and June 2016 at the First Affiliated Hospital of Xinjiang Medical University. The cumulative probability of live birth for each couple was estimated using the Kaplan–Meier method, and survival curves were compared according to age, BMI, and ethnicity using the log-rank test. Results CLBR increased rapidly from 1 to 5 ETs, moderately from 6 to 10 ETs, and slowly thereafter. CLBR was significantly different across 4 categories based on BMI as well as across those based on age; low CLBR was significantly associated with the age of ≥42 years and obesity. Conclusion The association between CLBR and number of ET provides realistic and precise information regarding the success of IVF and can be applied to guide clinicians and patients.
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Scheffer JAB, Scheffer B, Scheffer R, Florencio F, Grynberg M, Lozano DM. Are age and anti-Müllerian hormone good predictors of ovarian reserve and response in women undergoing IVF? JBRA Assist Reprod 2018; 22:215-220. [PMID: 29949322 PMCID: PMC6106624 DOI: 10.5935/1518-0557.20180043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective Ovarian reserve evaluation has been the focus of substantial clinical
research for several years. This study aimed to examine the associations
between markers of ovarian reserve and ovarian response. Methods This prospective study included 132 infertile women aged 24-48 years
undergoing routine exploration during unstimulated cycles prior to the start
of assisted reproductive technology (ART) treatments at our center from July
2015 to January 2017. Descriptive parameters and patient characteristics
were reported as mean (SD) or median (range) values depending on the data
distribution pattern. Student’s t-test was performed for continuous
variables; the Wilcoxon and Pearson’s test were used for data not following
a normal distribution; and Fisher’s test was used for categorical variables.
p<0.05 was considered statistically significant. Results At the time of the study, the patients had a mean age of 35.7±3.84
years. On day 3 of the cycle, the mean anti-Müllerian hormone (AMH)
serum level was 2.84±1.57 ng/mL and the patients had 14.68±4.2
antral follicles (AFC). A significant correlation was observed between AMH
and age (r=-0.34 p<.01), follicle stimulating hormone
(FSH) serum levels (r=-0.32, p<.01), AFC (r=0.81,
p<.00001), total dose of medication during ovarian
stimulation (r=-0.28, p<.0003), and ongoing pregnancy
rate (p<.05). Age was significantly correlated with FSH
(r=0.46, p<.01), AFC (r=-0.34,
p<.00001), total dose of medication during ovarian
stimulation (r=0.43, p<.0003), and ongoing pregnancy
rate (p<.04). Conclusion Serum AMH and age are independent predictors of ovarian reserve and ovarian
stimulation outcome in infertile women. Age and serum AMH level may be used
to advise subfertile couples of their pregnancy prospects.
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Affiliation(s)
| | - Bruno Scheffer
- IBRRA - Brazilian Institute of Assisted Reproduction, Belo Horizonte, Brazil
| | - Rafaela Scheffer
- IBRRA - Brazilian Institute of Assisted Reproduction, Belo Horizonte, Brazil
| | - Fabio Florencio
- IBRRA - Brazilian Institute of Assisted Reproduction, Belo Horizonte, Brazil
| | - Michael Grynberg
- Department of Reproductive Medicine, Hôpital Jean Verdier (AP-HP), University Paris XIII, and INSERM, Paris, France
| | - Daniel Mendez Lozano
- School of Medicine, Tecnologico de Monterrey and Center for Reproductive Medicine CREASIS, San Pedro Monterrey, Mexico
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Zheng Z, Zhao X, Xu B, Yao N. What should we focus on before preimplantation genetic diagnosis/screening? Arch Med Sci 2018; 14:1119-1124. [PMID: 30154896 PMCID: PMC6111346 DOI: 10.5114/aoms.2018.72790] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 11/11/2017] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Preimplantation genetic diagnosis/screening (PGD/PGS) can effectively detect chromosomal abnormalities in an embryo but only if an embryo is available. However, not all couples can obtain an embryo that is available for testing. The purpose of this study was to identify factors which might affect the formation of PGD/PGS embryos to predict the possibility of obtaining embryos that could be detected. MATERIAL AND METHODS In a retrospective study, we included all couples who underwent PGD/PGS at our center from January 2015 to December 2016. We compared these patients according to the non-blastocyst group and the blastocyst group. RESULTS There were 302 couples who had blastocysts in their first PGD/PGS cycle. Fifty-seven couples had no blastocysts in their PGD/PGS cycles: 43 couples had no blastocysts in one cycle; 10 in two cycles; 4 in three cycles. The non-blastocyst group was older than the blastocyst group (32.37 vs. 30.69, p = 0.048). Anti-mullerian hormone (AMH, ng/ml) in the non-blastocyst group was significantly lower than in the blastocyst group (4.80 ±3.67 vs. 3.07 ±2.30, p = 0.00). Women whose chromosome were aneuploid (47, XXX or 45, X) had a similar AMH level compared with others, but the number of retrieved oocytes was much lower; the normal karyotype was 14.25 and aneuploidy was 5.40 (p = 0.01) in women < 30 years old. There was the same condition in women aged 30-38 years (14.60 vs. 3.44, p < 0.001). Male's different chromosome karyotype had no influence on double pronuclear number or the rate of blastocyst formation. Presence of endometriosis, polycystic ovary syndrome and tubal factor showed no difference between the blastocyst and non-blastocyst group. Nor did oligospermia and asthenospermia. CONCLUSIONS Elderly women, those with lower AMH and women with 47, XXX or 45, X have fewer ova, leading to the possibility of no blastocyst. These couples should be fully informed and weigh the advantages and disadvantages before undergoing PGD/PGS.
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Affiliation(s)
- Zhong Zheng
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Xiaoming Zhao
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Bing Xu
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Ning Yao
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
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