1
|
Li X, Du Y, Han X, Wang H, Sheng Y, Lian F, Lian Q. Efficacy of atosiban for repeated implantation failure in frozen embryo transfer cycles. Sci Rep 2023; 13:9277. [PMID: 37286752 DOI: 10.1038/s41598-023-36286-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 05/31/2023] [Indexed: 06/09/2023] Open
Abstract
Atosiban was commonly added to improve pregnancy outcomes of patients with repeated embryo implantation failure (RIF). In this study, we aimed to investigate the effect of atosiban before transferring the frozen-thawed embryo to RIF patients. This retrospective study was conducted in the Hospital for Reproductive Medicine affiliated to Shandong University from August 2017 to June 2021. A total of 1774 women with a history of RIF undergoing frozen embryo transfer (FET) were included in this study. All the participants were classified into atosiban or control group: Group A included 677 patients who were administered atosiban intravenously 30 min prior to FET with a dose of 37.5 mg; Group B included 1097 patients who received no atosiban before the transfer. There were no significant differences observed in the live birth rate (LBR) (39.73% vs. 39.02%, P = 0.928) between the two groups. Other secondary outcomes including biochemical pregnancy rate, clinical pregnancy rate, implantation rate, clinical miscarriage rate and preterm birth rate were similar between the two groups (all P > 0.05). However, subgroup analysis demonstrated significantly higher preterm birth rates in the control group compared with the atosiban group (0 versus 3.0%, P = 0.024) in the natural FET cycles. Atosiban may not improve pregnancy outcomes of RIF patients in FET cycles. However, the effects of Atosiban on pregnancy outcomes should be assessed in clinical trials with larger sample sizes.
Collapse
Affiliation(s)
- Xiufang Li
- Center for Reproductive Medicine, Shandong University, Jinan, 250021, China
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, 250014, China
| | - Yanbo Du
- Center for Reproductive Medicine, Shandong University, Jinan, 250021, China
| | - Xu Han
- Center for Reproductive Medicine, Shandong University, Jinan, 250021, China
| | - Huidan Wang
- Center for Reproductive Medicine, Shandong University, Jinan, 250021, China
| | - Yan Sheng
- Center for Reproductive Medicine, Shandong University, Jinan, 250021, China
| | - Fang Lian
- Reproductive and Genetic Center of Integtated Traditional and Western Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250011, China.
| | - Qingfeng Lian
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China.
| |
Collapse
|
2
|
Nataj Majd M, Moini A, Samimi Sadeh S, Bastanhagh E. The effect of Nifedipine on embryo transfer outcomes: A randomized clinical trial. Int J Reprod Biomed 2023; 20:1013-1018. [PMID: 36819210 PMCID: PMC9928978 DOI: 10.18502/ijrm.v20i12.12562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/18/2021] [Accepted: 06/20/2022] [Indexed: 01/11/2023] Open
Abstract
Background Endometrial receptivity is crucial for embryo implantation, and excessive uterine contraction reduces success. Nifedipine which is a calcium channel blocker, could decrease uterine contraction and improve pregnancy outcomes. Objective This study aimed to assess the effect of Nifedipine before embryo transfer on the pregnancy outcome in women undergoing in vitro fertilization (IVF) in a tertiary center in Iran. Materials and Methods 150 women who were candidates for IVF were randomly assigned into 2 groups: group 1 received 20 mg Nifedipine 30 min before embryo transfer, and group 2 received no intervention. Blood pressure of the participants was monitored every 10 min for 1 hr under the supervision of an anesthesiologist. Finally, implantation rate and chemical and clinical pregnancy rates were compared between groups. Results At the end of the study, 140 participants were included in the final analyses. No significant difference was observed in clinical pregnancy rates between groups (20% vs. 22%, p = 0.51). Conclusion Nifedipine administration before embryo transfer does not improve the implantation and clinical pregnancy rates in women undergoing IVF.
Collapse
Affiliation(s)
- Masoomeh Nataj Majd
- Department of Anesthesiology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ashraf Moini
- Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Breast Disease Research Center (BDRC), Tehran University of Medical Sciences, Tehran, Iran.,Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Saghar Samimi Sadeh
- Department of Anesthesiology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Bastanhagh
- Department of Anesthesiology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
3
|
Tang CL, Li QY, Chen FL, Cai CT, Dong YY, Wu YY, Yang JZ, Zhao M, Chi FL, Hong L, Ai A, Chen MX, Li KM, Teng XM, Chen ZQ. A randomized double blind comparison of atosiban in patients with recurrent implantation failure undergoing IVF treatment. Reprod Biol Endocrinol 2022; 20:124. [PMID: 35986323 PMCID: PMC9389813 DOI: 10.1186/s12958-022-00999-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/03/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Patients with recurrent implantation failure (RIF) may have more uterine contractions. Several observational studies suggested that atosiban administration around embryo transfer resulted in higher pregnancy rates in RIF patients. This study aimed to evaluate the effect of atosiban given before fresh embryo transfer on pregnancy outcomes of women with RIF. METHODS A prospective, randomized, double-blind controlled clinical trial was performed in IVF center of Shanghai First Maternity and Infant Hospital. According to a computer-generated randomization list, 194 infertile women with RIF received fresh embryo transfer between July 2017 and December 2019 were randomly allocated into the atosiban (n = 97) and the placebo (n = 97) groups. Women in the treatment group received atosiban intravenously about 30 min before embryo transfer with a bolus dose of 6.75 mg over one minute. Those in the placebo group received only normal saline infusion for the same duration. RESULTS There was no significant difference in the live birth rate between the atosiban and placebo groups (42.3% vs 35.1%, P = 0.302, RR = 1.206 (0.844-1.723)). No significant differences were found between the two groups in the positive pregnancy test, clinical pregnancy, ongoing pregnancy, miscarriage, multiple pregnancy, ectopic pregnancy and implantation rates. Similar results were found when stratified by the number of embryos previously transferred, number of previous failed embryo transfers, frequency of endometrial peristalsis on embryo transfer day (≥ 3 waves/min) or serum estradiol (E2) on the day of hCG above the median level. And, there was no correlation between the serum E2 level on the day of hCG and the frequency of endometrial peristalsis on embryo transfer day. The frequency of endometrial peristalsis on embryo transfer day, total FSH/HMG dosage and duration were the significant factors which independently predicted the likelihood of a live birth. CONCLUSIONS These results suggested that atosiban treatment before fresh embryo transfer might not improve the live birth rate in RIF patients. TRIAL REGISTRATION The study had been approved by the Institutional Review Board of the hospital (2017 ethics No.43) and was registered under Clinicaltrials.gov with an identifier NCT02893722.
Collapse
Affiliation(s)
- Chuan Ling Tang
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
| | - Qi Yue Li
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Feng Lian Chen
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Chen Ting Cai
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Yue Yan Dong
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Yuan Yuan Wu
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Jian Zhi Yang
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Mei Zhao
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Feng Li Chi
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Ling Hong
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Ai Ai
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Miao Xin Chen
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Kun Ming Li
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Xiao Ming Teng
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Zhi Qin Chen
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
| |
Collapse
|
4
|
Craciunas L, Tsampras N, Kollmann M, Raine-Fenning N, Choudhary M. Oxytocin antagonists for assisted reproduction. Cochrane Database Syst Rev 2021; 9:CD012375. [PMID: 34467530 PMCID: PMC8408576 DOI: 10.1002/14651858.cd012375.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Embryo transfer (ET) is a crucial step of in vitro fertilisation (IVF) treatment, and involves placing the embryo(s) in the woman's uterus. There is a negative association between endometrial wave-like activity (contractile activities) at the time of ET and clinical pregnancy, but no specific treatment is currently used in clinical practice to counteract their effects. Oxytocin is a hormone produced by the hypothalamus and released by the posterior pituitary. Its main role involves generating uterine contractions during and after childbirth. Atosiban is the best known oxytocin antagonist (and is also a vasopressin antagonist), and it is commonly used to delay premature labour by halting uterine contractions. Other oxytocin antagonists include barusiban, nolasiban, epelsiban, and retosiban. Administration of oxytocin antagonists around the time of ET has been proposed as a means to reduce uterine contractions that may interfere with embryo implantation. The intervention involves administering the medication before, during, or after the ET (or a combination). OBJECTIVES To evaluate the effectiveness and safety of oxytocin antagonists around the time of ET in women undergoing assisted reproduction. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility (CGF) Group trials register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, and two trials registers in March 2021; and checked references and contacted study authors and experts in the field to identify additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) of the use of oxytocin antagonists for women undergoing ET, compared with the non-use of this intervention, the use of placebo, or the use of another similar drug. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. Primary review outcomes were live birth and miscarriage; secondary outcomes were clinical pregnancy and other adverse events. MAIN RESULTS We included nine studies (including one comprising three separate trials, 3733 women analysed in total) investigating the role of three different oxytocin antagonists administered intravenously (atosiban), subcutaneously (barusiban), or orally (nolasiban). We found very low- to high-certainty evidence: the main limitations were serious risk of bias due to poor reporting of study methods, and serious or very serious imprecision. Intravenous atosiban versus normal saline or no intervention We are uncertain of the effect of intravenous atosiban on live birth rate (risk ratio (RR) 1.05, 95% confidence interval (CI) 0.88 to 1.24; 1 RCT, N = 800; low-certainty evidence). In a clinic with a live birth rate of 38% per cycle, the use of intravenous atosiban would be associated with a live birth rate ranging from 33.4% to 47.1%. We are uncertain whether intravenous atosiban influences miscarriage rate (RR 1.08, 95% CI 0.75 to 1.56; 5 RCTs, N = 1424; I² = 0%; very low-certainty evidence). In a clinic with a miscarriage rate of 7.2% per cycle, the use of intravenous atosiban would be associated with a miscarriage rate ranging from 5.4% to 11.2%. Intravenous atosiban may increase clinical pregnancy rate (RR 1.50, 95% CI 1.18 to 1.89; 7 RCTs, N = 1646; I² = 69%; low-certainty evidence), and we are uncertain whether multiple or ectopic pregnancy and other complication rates were influenced by the use of intravenous atosiban (very low-certainty evidence). Subcutaneous barusiban versus placebo One study investigated barusiban, but did not report on live birth or miscarriage. We are uncertain whether subcutaneous barusiban influences clinical pregnancy rate (RR 0.96, 95% CI 0.69 to 1.35; 1 RCT, N = 255; very low-certainty evidence). Trialists reported more mild to moderate injection site reactions with barusiban than with placebo, but there was no difference in severe reactions. They reported no serious drug reactions; and comparable neonatal outcome between groups. Oral nolasiban versus placebo Nolasiban does not increase live birth rate (RR 1.13, 95% CI 0.99 to 1.28; 3 RCTs, N = 1832; I² = 0%; high-certainty evidence). In a clinic with a live birth rate of 33% per cycle, the use of oral nolasiban would be associated with a live birth rate ranging from 32.7% to 42.2%. We are uncertain of the effect of oral nolasiban on miscarriage rate (RR 1.45, 95% CI 0.73 to 2.88; 3 RCTs, N = 1832; I² = 0%; low-certainty evidence). In a clinic with a miscarriage rate of 1.5% per cycle, the use of oral nolasiban would be associated with a miscarriage rate ranging from 1.1% to 4.3%. Oral nolasiban improves clinical pregnancy rate (RR 1.15, 95% CI 1.02 to 1.30; 3 RCTs, N = 1832; I² = 0%; high-certainty evidence), and probably does not increase multiple or ectopic pregnancy, or other complication rates (moderate-certainty evidence). AUTHORS' CONCLUSIONS We are uncertain whether intravenous atosiban improves pregnancy outcomes for women undergoing assisted reproductive technology. This conclusion is based on currently available data from seven RCTs, which provided very low- to low-certainty evidence across studies. We could draw no clear conclusions about subcutaneous barusiban, based on limited data from one RCT. Further large well-designed RCTs reporting on live births and adverse clinical outcomes are still required to clarify the exact role of atosiban and barusiban before ET. Oral nolasiban appears to improve clinical pregnancy rate but not live birth rate, with an uncertain effect on miscarriage and adverse events. This conclusion is based on a phased study comprising three trials that provided low- to high-certainty evidence. Further large, well-designed RCTs, reporting on live births and adverse clinical outcomes, should focus on identifying the subgroups of women who are likely to benefit from this intervention.
Collapse
Affiliation(s)
- Laurentiu Craciunas
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nikolaos Tsampras
- Reproductive Medicine, St Marys Hospital, Central Manchester University Hospital NHS Trust, Manchester, UK
| | - Martina Kollmann
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Nick Raine-Fenning
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
| | | |
Collapse
|
5
|
Pierzyński P, Pohl O, Marchand L, Mackens S, Lorch U, Gotteland JP, Blockeel C. The mechanism of action of oxytocin antagonist nolasiban in ART in healthy female volunteers. Reprod Biomed Online 2021; 43:184-192. [PMID: 34167897 DOI: 10.1016/j.rbmo.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/16/2020] [Accepted: 01/11/2021] [Indexed: 11/19/2022]
Abstract
RESEARCH QUESTION What are the effects of the oxytocin receptor (OTR) antagonist nolasiban on uterine contractions, endometrial perfusion and endometrial mRNA expression? DESIGN Randomized, double-blind, parallel-group, mechanism-of-action study with nolasiban. Forty-five healthy, pre-menopausal women were treated with placebo, 900 mg or 1800 mg nolasiban on the day corresponding to blastocyst transfer. Ultrasonographic uterine contraction frequency and endometrial perfusion were assessed, and endometrial biopsies analysed by next-generation sequencing. RESULTS Both doses of nolasiban showed decreased contraction frequency and increased endometrial perfusion depending on the time point assessed. At 1800 mg, 10 endometrial genes (DPP4, CNTNAP3, CNTN4, CXCL12, TNXB, CTSE, OLFM4, KRT5, KRT6A, IDO2) were significantly differentially expressed (adjusted P < 0.05). Of these, OLFM4, DPP4 and CXCL12 were regulated in the same direction as genes involved in implantation during the window of implantation. In addition, three genes (DPP4, CXCL12 and IDO2) were associated with decidualization and endometrial receptivity. CONCLUSIONS These data expand our knowledge of the mechanism of action of nolasiban in increasing pregnancy rates after embryo transfer. The results suggest more marked effects of nolasiban 1800 mg compared with the 900 mg dose, supporting testing at higher doses in IVF patients.
Collapse
Affiliation(s)
- Piotr Pierzyński
- Oviklinika Warszawa Fertility Centre, Połczyńska 31, Warszawa 01-377, Poland
| | - Oliver Pohl
- ObsEva SA, Chemin des Aulx 12, 1228 Plan-les-Ouates, Geneva, Switzerland
| | - Line Marchand
- ObsEva SA, Chemin des Aulx 12, 1228 Plan-les-Ouates, Geneva, Switzerland
| | - Shari Mackens
- Universitair Ziekenhuis Brussel, Centre for Reproductive Medicine, Laarbeeklaan 101, Brussel 1090, Belgium
| | - Ulrike Lorch
- Richmond Pharmacology Ltd, St George's University of London, Cranmer Terrace, Tooting, London SW17 0RE, UK
| | | | - Christophe Blockeel
- Universitair Ziekenhuis Brussel, Centre for Reproductive Medicine, Laarbeeklaan 101, Brussel 1090, Belgium
| |
Collapse
|
6
|
Sztachelska M, Ponikwicka-Tyszko D, Sokolowska G, Anisimowicz S, Czerniecki J, Lebiedzinska W, Zbucka-Kretowska M, Zygmunt M, Wołczynski S, Pierzynski P. Oxytocin antagonism reverses the effects of high oestrogen levels and oxytocin on decidualization and cyclooxygenase activity in endometrial tissues. Reprod Biomed Online 2019; 39:737-744. [PMID: 31548121 DOI: 10.1016/j.rbmo.2019.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/30/2019] [Accepted: 06/04/2019] [Indexed: 11/27/2022]
Abstract
RESEARCH QUESTION What is the in-vitro effect of oxytocin receptor (OTR) antagonism on parameters of receptivity in human endometrial explants and endometrial stromal cell lines cultured in oestradiol-rich conditions mimicking ovarian stimulation? DESIGN Experimental in-vitro study on endometrial tissue explants collected by aspiration biopsy from 30 women undergoing fertility treatment and cultured endometrial tHESC cell line. The study examined the effects of high oestradiol, oxytocin and OTR antagonist on parameters of decidualization (cell viability and prolactin secretion) as well as cyclooxygenase-1/2 (COX-1/2) activity and prostaglandin F2α (PGF2α) secretion. Changes in expression of OXTR and COX-2 genes were examined using quantitative polymerase chain reaction (qPCR). RESULTS In experiments on cultured endometrial cell line, high oestradiol and oxytocin similarly limited the viability of cells. In cultured endometrial explants both also decreased the secretion of prolactin (a marker of decidualization) and augmented endometrial COX-2 activity and formation of PGF2α. Oxytocin antagonist atosiban was confirmed to reverse the above effects, both in the endometrial line and endometrial explants. Addition of atosiban to cultures acted analogously in experiments employing both oxytocin and high oestradiol. CONCLUSIONS Oxytocin antagonist reversed the effects of high oestradiol and oxytocin on parameters related to endometrial receptivity in conditions mimicking ovarian stimulation. This might point to a novel, endometrium-related mechanism to support embryo implantation achieved by the application of oxytocin antagonist prior to embryo transfer.
Collapse
Affiliation(s)
- Maria Sztachelska
- Department of Biology and Pathology of Human Reproduction, Białystok, Institute of Animal Reproduction and Food Research of Polish Academy of Sciences, Tuwima 10, Olsztyn 10-748, Poland
| | - Donata Ponikwicka-Tyszko
- Department of Biology and Pathology of Human Reproduction, Białystok, Institute of Animal Reproduction and Food Research of Polish Academy of Sciences, Tuwima 10, Olsztyn 10-748, Poland
| | - Gabriela Sokolowska
- Department of Reproduction and Gynecological Endocrinology, Medical University of Białystok, M. Sklodowskiej-Curie 24a, Białystok 15-276, Poland
| | | | - Jan Czerniecki
- Department of Biology and Pathology of Human Reproduction, Białystok, Institute of Animal Reproduction and Food Research of Polish Academy of Sciences, Tuwima 10, Olsztyn 10-748, Poland
| | - Weronika Lebiedzinska
- Department of Reproduction and Gynecological Endocrinology, Medical University of Białystok, M. Sklodowskiej-Curie 24a, Białystok 15-276, Poland
| | - Monika Zbucka-Kretowska
- Department of Reproduction and Gynecological Endocrinology, Medical University of Białystok, M. Sklodowskiej-Curie 24a, Białystok 15-276, Poland
| | - Marek Zygmunt
- Department of Obstetrics and Gynecology, University of Greifswald, Ferdinand-Sauerbruchstrasse, Greifswald D-17489, Germany
| | - Slawomir Wołczynski
- Department of Reproduction and Gynecological Endocrinology, Medical University of Białystok, M. Sklodowskiej-Curie 24a, Białystok 15-276, Poland
| | - Piotr Pierzynski
- Department of Reproduction and Gynecological Endocrinology, Medical University of Białystok, M. Sklodowskiej-Curie 24a, Białystok 15-276, Poland.
| |
Collapse
|
7
|
Saravelos SH, Li TC. Embryo transfer techniques. Best Pract Res Clin Obstet Gynaecol 2019; 59:77-88. [PMID: 30711373 DOI: 10.1016/j.bpobgyn.2019.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/03/2019] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
Embryo transfer is the final and rate-limiting step of the assisted reproductive technique. Few advances have occurred in the last few decades with regard to this procedure. Studies conducted thus far have focused on factors and interventions taking place before, during and after this procedure. These factors are highly varied and range from methods to improve the psychological state of the patients to methods aimed at reducing uterine contractility and methods aimed at optimising the precise transfer of the embryo. The key question is which factors and interventions have thus far been proven to increase pregnancy rates and live birth rates. This paper aims to review the evidence relating to embryo transfer techniques in a systematic manner with a view to provide practical recommendations to practitioners involved in the procedure.
Collapse
Affiliation(s)
| | - Tin-Chiu Li
- Assisted Reproductive Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
| |
Collapse
|
8
|
Ng KKL, Rozen G, Stewart T, Agresta F, Polyakov A. Does nifedipine improve outcomes of embryo transfer?: Interim analysis of a randomized, double blinded, placebo-controlled trial. Medicine (Baltimore) 2019; 98:e14251. [PMID: 30681617 PMCID: PMC6358362 DOI: 10.1097/md.0000000000014251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/22/2018] [Accepted: 01/03/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Implantation failure is the main factor affecting the success rate of in vitro fertilization (IVF) procedures. Studies have reported that uterine contractions (UC) at the time of embryo transfer (ET) were inversely related to implantation and pregnancy rate, hence reducing the success of IVF treatments. Various pharmacological agents, with the exception of calcium channel blockers, have been investigated to improve ET outcomes by reducing UC. Thus, a double-blinded randomized, placebo-controlled trial was conducted to determine whether nifedipine, a calcium channel blocker with potent smooth muscle relaxing activity and an excellent safety profile, can improve the outcome of patients undergoing ET treatments. METHODS Ninety-three infertile women were recruited into 1 of 2 groups: placebo (n = 47) or nifedipine 20 mg (n = 46). Study participants were admitted 30 minutes prior to ET and given either tablet after their baseline vital signs were recorded. They then underwent ET and were observed for adverse events for another 30 minutes post-ET. Follow up of the participants' outcomes was conducted via electronic medical records. The primary outcomes are implantation and clinical pregnancy rates. Secondary outcomes include any maternal or fetal adverse events, miscarriage, pregnancy, live births, and neonatal outcomes. Resulting data were then analyzed using t test, Pearson chi-square test, and Fisher exact test to compare outcomes between the 2 groups. RESULTS No statistical differences in the implantation rate (42.6% vs 39.1%, P = .737, rate ratio 0.868, 95% confidence interval [CI]: 0.379-1.986) and the clinical pregnancy rate (23.4% vs 26.1%, P = .764, rate ratio 1.155, 95% CI: 0.450-2.966) were detected between the placebo and the treatment groups. In addition, no statistical significance between the placebo and the treatment groups for any secondary outcomes were detected. CONCLUSIONS This double blinded, randomized, and placebo-controlled trial demonstrated that the single use of 20 mg nifedipine given 30 minutes before embryo transfer did not improve the implantation rate or the clinical pregnancy rate of the infertility treatment. Further studies are required to demonstrate the clinical benefits and risks of nifedipine usage in embryo transfer.
Collapse
Affiliation(s)
| | - Genia Rozen
- Royal Women's Hospital, Parkville
- Melbourne IVF, East Melbourne, Victoria, Australia
| | | | - Franca Agresta
- Royal Women's Hospital, Parkville
- Melbourne IVF, East Melbourne, Victoria, Australia
| | - Alex Polyakov
- Royal Women's Hospital, Parkville
- Melbourne IVF, East Melbourne, Victoria, Australia
| |
Collapse
|
9
|
Xia T, Liu Q, Ye Q, Xing W, Wang D, Li J, Zang ZJ. Serum oxytocin profiles in patients with repeated implantation failure during IVF cycles. Gynecol Endocrinol 2018; 34:1048-1052. [PMID: 29909692 DOI: 10.1080/09513590.2018.1480715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE The objective of this study is to investigate the association between oxytocin (OT) levels and repeated implantation failure (RIF) during in vitro fertilization-embryo transfer (IVF-ET) cycles. METHODS Blood samples were collected from 108 women undergoing IVF-ET treatment at the following time points: gonadotrophin (Gn) administration day (Gn Day 0), hCG administration day (hCG Day 0), ET administration day (ET Day 0), and 5 d after ET (ET Day 5). Serum OT and steroid profiles were measured and compared among three groups: Group A included 38 women with a history of RIF, Group B included 41 women who became pregnant following the first fresh ET, and Group C included 29 women who did not become pregnant following the first fresh ET. RESULTS The OT levels of the three groups at different time points were not significantly different. Serum OT levels were significantly higher on hCG Day 0, ET Day 0, and ET Day 5 than on Gn Day 0, and they were significantly correlated with the estradiol concentration on ET Day 0. CONCLUSIONS RIF patients do not have elevated serum OT levels during IVF-ET cycles.
Collapse
Affiliation(s)
- Tingting Xia
- a Department of Infertility and Sexual Medicine , The Third Affiliated Hospital, Sun Yat-sen University , Guangzhou , China
- b Reproductive Medical Center, Reproductive Medical Center , The First Affiliated Hospital, Sun Yat-sen University , Guangzhou , China
| | - Qiuli Liu
- c Cell-gene Therapy Translational Medicine Research Center , The Third Affiliated Hospital, Sun Yat-sen University , Guangzhou , China
| | - Qingjian Ye
- d Department of Gynecology , The Third Affiliated Hospital, Sun Yat-sen University , Guangzhou , China
| | - Weijie Xing
- a Department of Infertility and Sexual Medicine , The Third Affiliated Hospital, Sun Yat-sen University , Guangzhou , China
| | - Dong Wang
- e Department of Immunology , The First Affiliated Hospital, Sun Yat-sen University , Guangzhou , China
| | - Jie Li
- b Reproductive Medical Center, Reproductive Medical Center , The First Affiliated Hospital, Sun Yat-sen University , Guangzhou , China
| | - Zhi-Jun Zang
- a Department of Infertility and Sexual Medicine , The Third Affiliated Hospital, Sun Yat-sen University , Guangzhou , China
| |
Collapse
|
10
|
Ng KKL, Rozen G, Stewart T, Agresta F, Polyakov A. A double-blinded, randomized, placebo-controlled trial assessing the effects of nifedipine on embryo transfer: Study protocol. Medicine (Baltimore) 2017; 96:e9194. [PMID: 29390463 PMCID: PMC5758165 DOI: 10.1097/md.0000000000009194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 11/20/2017] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Implantation failure is the main factor affecting the success rate of in vitro fertilization (IVF) procedures. Studies have reported that uterine contractions (UCs) at the time of embryo transfer (ET) were inversely related to implantation and pregnancy rate, hence reducing the success of IVF treatment. Various pharmacological agents, with the exception of calcium channel blocker (CCB), have been investigated to reduce UC. In this regard, we are presenting a proposal for a double-blind randomized placebo-controlled trial. The trial aims to determine whether nifedipine, a CCB with potent smooth muscle relaxing activity and an excellent safety profile, can improve the outcome of ET. METHODS AND ANALYSES We will recruit 100 infertile women into one of 2 groups: placebo (n = 50) and nifedipine 20 mg (n = 50). Study participants will be admitted 30 minutes prior to ET and given either tablet after their baseline vital signs have been recorded. They will then undergo ET and be observed for adverse events for another 30 minutes post-ET. The primary outcome will be implantation rate and clinical pregnancy rate. Secondary outcomes include adverse events, miscarriage and pregnancy, and neonatal outcomes. Resulting data will then be analyzed using t test, Chi-square test, and multivariate test to compare outcomes between the 2 groups for any statistical significance. This protocol has been designed in accordance with the SPIRIT 2013 Guidelines.
Collapse
Affiliation(s)
- Kelvin KL Ng
- Melbourne Medical School, University of Melbourne
| | - Genia Rozen
- Department of Reproductive Services, Royal Women's Hospital, Parkville
- Melbourne IVF, East Melbourne, Victoria, Australia
| | - Tanya Stewart
- Department of Reproductive Services, Royal Women's Hospital, Parkville
- Melbourne IVF, East Melbourne, Victoria, Australia
| | - Franca Agresta
- Department of Reproductive Services, Royal Women's Hospital, Parkville
- Melbourne IVF, East Melbourne, Victoria, Australia
| | - Alex Polyakov
- Department of Reproductive Services, Royal Women's Hospital, Parkville
- Melbourne IVF, East Melbourne, Victoria, Australia
| |
Collapse
|