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Jwa SC, Takahashi H, Tamaru S, Takamura M, Namba A, Kajihara T, Ishihara O, Kamei Y. Assisted reproductive technology-associated risk factors for retained products of conception. Fertil Steril 2024; 121:470-479. [PMID: 38036239 DOI: 10.1016/j.fertnstert.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To evaluate assisted reproductive technology-associated risk factors for retained products of conception among live births. DESIGN Registry-based retrospective cohort study. SETTING Not applicable. PATIENT(S) Cycle-specific data for a total of 369,608 singleton live births after fresh and frozen-thawed embryo transfers (FETs) between 2007 and 2017 were obtained from the Japanese assisted reproductive technology registry. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Retained products of conception after delivery. Odds ratios and 95% confidence intervals for risk factors associated with retained products of conception during fresh and frozen cycles. RESULT(S) In total, 132 deliveries (0.04% of eligible assisted reproductive technology registry deliveries) had retained products of conception; 122 (92.4%) of these deliveries occurred after FET transfer cycles. Cases with retained products of conception were significantly more likely to have undergone vaginal delivery than cases without retained products of conception (78.0% vs. 61.1%); they were also more likely to have been complicated with the placenta accreta spectrum (24.2% vs. 0.45%). Among patients undergoing FETs, factors associated with a significantly increased risk of retained products of conception were embryo stage at transfer, use of hormone replacement cycles, and assisted hatching. Use of hormone replacement cycles represented the largest risk factor (adjusted odds ratio, 4.9; 95% confidence interval, 2.0-12.4), such that retained products of conception occurred in 0.05% (51 of 97,958) of deliveries after hormone replacement cycles but only 0.01% (5 of 47,079) of deliveries after natural cycles. Subgroup analysis showed that hormone replacement cycles and assisted hatching remained significant risk factors for retained products of conception in cases without polycystic ovary syndrome and anovulation and cases with vaginal delivery, but not cases with cesarean section. Among fresh embryo transfers, an increased number of retrieved oocytes was the only significant risk factor for retained products of conception. CONCLUSION(S) Our analyses demonstrated that most of the cases involving retained products of conception were derived from FETs, and we identified the use of hormone replacement cycles as the largest risk factor for retained products of conception within this group.
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Affiliation(s)
- Seung Chik Jwa
- Department of Obstetrics and Gynecology, Saitama Medical University, Saitama, Japan; Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan.
| | - Hironori Takahashi
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
| | - Shunsuke Tamaru
- Department of Obstetrics and Gynecology, Saitama Medical University, Saitama, Japan
| | - Masashi Takamura
- Department of Obstetrics and Gynecology, Saitama Medical University, Saitama, Japan
| | - Akira Namba
- Department of Obstetrics and Gynecology, Saitama Medical University, Saitama, Japan
| | - Takeshi Kajihara
- Department of Obstetrics and Gynecology, Saitama Medical University, Saitama, Japan
| | - Osamu Ishihara
- Department of Obstetrics and Gynecology, Saitama Medical University, Saitama, Japan; Clinical Medicine, Kagawa Nutrition University, Saitama, Japan
| | - Yoshimasa Kamei
- Department of Obstetrics and Gynecology, Saitama Medical University, Saitama, Japan
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Xu Y, Song JY, Sun ZG. Editorial: Exploring the optimal endometrial preparation protocol for frozen-thawed embryo transfer. Front Endocrinol (Lausanne) 2024; 15:1377488. [PMID: 38455647 PMCID: PMC10918688 DOI: 10.3389/fendo.2024.1377488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 02/02/2024] [Indexed: 03/09/2024] Open
Affiliation(s)
- Ying Xu
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jing-Yan Song
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zhen-Gao Sun
- Reproductive Center of Integrated Medicine, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
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Xin X, Dong L, Guan L, Wang Y, Li J, Lian F. Effect of human chorionic gonadotropin injection before frozen-thawed embryo transfer: A retrospective cohort study. Medicine (Baltimore) 2023; 102:e35658. [PMID: 38050223 PMCID: PMC10695501 DOI: 10.1097/md.0000000000035658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/25/2023] [Indexed: 12/06/2023] Open
Abstract
The aim of this study is to investigate the effect of human chorionic gonadotropin (hCG) in hormone replacement regimen for frozen-thawed embryos. We performed a retrospective cohort study and included patients who underwent frozen embryo transfer (FET) between January 1, 2020 and May 31, 2022. According to the protocols for the FET cycle, the patients were divided into control (n = 238) and hCG groups (n = 216). The clinical pregnancy rate, live birth rate, early abortion rate, late abortion rate, and ectopic pregnancy rate were compared between the 2 groups. There was a significant difference in clinical pregnancy rate between the hCG and control groups (55.1% vs 45.8%, P = .048). The ectopic pregnancy rate decreased (5.0% vs 6.4%, P = .654), while the live birth rate increased (36.1% vs 29.0%, P = .105) in the hCG group. However, these differences were not statistically significant. The administration of hCG injection in HRT-FET cycles alone was also found to be associated with clinical pregnancy by logistic regressive analysis. HCG injection in the hormone replacement regimen for FET increased the clinical pregnancy rate.
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Affiliation(s)
- Xin Xin
- Shandong University of Traditional Chinese Medicine, Jinan City, Shandong Province, China
| | - Li Dong
- Shandong University of Traditional Chinese Medicine, Jinan City, Shandong Province, China
| | - Lu Guan
- Shandong University of Traditional Chinese Medicine, Jinan City, Shandong Province, China
| | - Yixuan Wang
- Shandong University of Traditional Chinese Medicine, Jinan City, Shandong Province, China
| | - Jiaxi Li
- Shandong University of Traditional Chinese Medicine, Jinan City, Shandong Province, China
| | - Fang Lian
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan City, Shandong Province, China
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Li L, Gao DD, Zhang Y, Song JY, Sun ZG. Comparison of Stimulated Cycles with Low Dose r-FSH versus Hormone Replacement Cycles for Endometrial Preparation Prior to Frozen-Thawed Embryo Transfer in Young Women with Polycystic Ovarian Syndrome: A Single-Center Retrospective Cohort Study from China. Drug Des Devel Ther 2021; 15:2805-2813. [PMID: 34234412 PMCID: PMC8253980 DOI: 10.2147/dddt.s317545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/11/2021] [Indexed: 12/15/2022]
Abstract
Objective The principal purpose of this study was to compare reproductive outcomes for stimulated cycles (STC) and hormone replacement cycles (HRC) for endometrial preparation before frozen-thawed embryo transfer (FET) in young women with polycystic ovary syndrome (PCOS). Methods We conducted a retrospective study of 1434 FET cycles from January, 2017 to March, 2020 in our reproductive center, in which stimulated and hormone replacement cycles were used for endometrial preparation. Pregnancy outcomes of couples undergoing routine STC-FET or HRC-FET were analyzed by propensity score matching (PSM) and multivariable logistic regression analyses. Results Data on 1234 HRC protocols (86% of the total) and 200 STC protocols (14%) were collected. After PSM, 199 patients were included in both groups, respectively. There was no significant difference in positive pregnancy rate (52.7% vs 54.8%, p=0.763), clinical pregnancy rate (51.8% vs 52.8%, p=0.841), live birth rate (45.2% vs 43.7%, p=0.762), pregnancy loss rate (9.7% vs 16.2%, p=0.164) and ectopic pregnancy rate (1.5% vs 0.5%, p=0.615) between STC and HRC protocols. Subsequent multivariate logistic regression analysis also yielded similar results. Conclusion STC for endometrial preparation had similar pregnancy outcomes compared with HRC protocols. Evidence is available which shows that for young women with PCOS in preparation for FET, HRC could be a reasonable choice for patients who are unwilling to accept injections. However, STC may reduce unnecessary anxiety and operational costs and offer more flexibility for patients. Eventually, we must embrace the concepts of individualization, securitization, and optimization in the clinic.
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Affiliation(s)
- Li Li
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, 250014, People's Republic of China
| | - Dan-Dan Gao
- The College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, People's Republic of China
| | - Yi Zhang
- The College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, People's Republic of China
| | - Jing-Yan Song
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, 250014, People's Republic of China
| | - Zhen-Gao Sun
- Reproductive and Genetic Center of Integrated Medicine, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250011, People's Republic of China
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Ogawa T, Kasai T, Ogi M, Fukushima J, Hirata S. Effect of transdermal estrogen dose regimen for endometrial preparation of frozen-thawed embryo transfer on reproductive and obstetric outcomes. Reprod Med Biol 2021; 20:208-214. [PMID: 33850454 PMCID: PMC8022087 DOI: 10.1002/rmb2.12370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/08/2021] [Accepted: 01/25/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Previous studies have reported different methods of estrogen administration during endometrial preparation for frozen-thawed embryo transfer (FET). This study aimed to investigate a beneficial regimen of transdermal estrogen administration for FET. METHODS We investigated the reproductive and obstetric outcomes of FET by comparing the increasing dose (ID) group that mimics changes in serum estradiol during the menstrual cycle and the constant dose (CD) group. Transdermal patches were used for estrogen administration in both groups. In our hospital, we targeted 315 cycles of the ID group in which FET was performed in 2017 and 324 cycles of the CD group in which FET was performed in 2018. In all cases, single embryo transfer was performed. RESULTS All were singleton pregnancies. There was no difference in clinical pregnancy rate (28.9% vs 28.2%, P =.837) and live birth rate (17.3% vs 21.4%, P =.201) between the ID and CD groups. Spontaneous abortion rate was significantly lower in the CD group than in the ID group (37.2% vs 23.0%, P =.041). There was no difference in obstetrical outcomes. CONCLUSIONS It was considered that the simple CD regimen may be more beneficial than the complicated ID regimen.
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Affiliation(s)
- Tatsuyuki Ogawa
- Department of Obstetrics and GynecologyFaculty of MedicineUniversity of YamanashiChuoJapan
| | - Tsuyoshi Kasai
- Department of Obstetrics and GynecologyFaculty of MedicineUniversity of YamanashiChuoJapan
- Konohana ClinicKaiJapan
| | - Maki Ogi
- Department of Obstetrics and GynecologyFaculty of MedicineUniversity of YamanashiChuoJapan
| | - Jiro Fukushima
- Department of Obstetrics and GynecologyFaculty of MedicineUniversity of YamanashiChuoJapan
| | - Shuji Hirata
- Department of Obstetrics and GynecologyFaculty of MedicineUniversity of YamanashiChuoJapan
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Liu R, Bai S, Jiang X, Luo L, Tong X, Zheng S, Wang Y, Xu B. Multifactor Prediction of Embryo Transfer Outcomes Based on a Machine Learning Algorithm. Front Endocrinol (Lausanne) 2021; 12:745039. [PMID: 34795639 PMCID: PMC8593232 DOI: 10.3389/fendo.2021.745039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/15/2021] [Indexed: 11/17/2022] Open
Abstract
In vitro fertilization-embryo transfer (IVF-ET) technology make it possible for infertile couples to conceive a baby successfully. Nevertheless, IVF-ET does not guarantee success. Frozen embryo transfer (FET) is an important supplement to IVF-ET. Many factors are correlated with the outcome of FET which is unpredictable. Machine learning is a field of study that predict various outcomes by defining data attributes and using relevant data and calculation algorithms. Machine learning algorithm has been widely used in clinical research. The present study focuses on making predictions of early pregnancy outcomes in FET through clinical characters, including age, body mass index (BMI), endometrial thickness (EMT) on the day of progesterone treatment, good-quality embryo rate (GQR), and type of infertility (primary or secondary), serum estradiol level (E2) on the day of embryo transfer, and serum progesterone level (P) on the day of embryo transfer. We applied four representative machine learning algorithms, including logistic regression (LR), conditional inference tree, random forest (RF) and support vector machine (SVM) to build prediction models and identify the predictive factors. We found no significant difference among the models in the sensitivity, specificity, positive predictive rate, negative predictive rate or accuracy in predicting the pregnancy outcome of FET. For example, the positive/negative predictive rate of the SVM (gamma = 1, cost = 100, 10-fold cross validation) is 0.56 and 0.55. This approach could provide a reference for couples considering FET. The prediction accuracy of the present study is limited, which suggests that there may be some other more effective predictors to be developed in future work.
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Affiliation(s)
- Ran Liu
- Reproductive and Genetic Hospital, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Shun Bai
- Reproductive and Genetic Hospital, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xiaohua Jiang
- Reproductive and Genetic Hospital, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Lihua Luo
- Reproductive and Genetic Hospital, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xianhong Tong
- Reproductive and Genetic Hospital, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Shengxia Zheng
- Reproductive and Genetic Hospital, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Ying Wang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- *Correspondence: Ying Wang, ; Bo Xu,
| | - Bo Xu
- Reproductive and Genetic Hospital, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- *Correspondence: Ying Wang, ; Bo Xu,
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Saito K, Kuwahara A, Ishikawa T, Morisaki N, Miyado M, Miyado K, Fukami M, Miyasaka N, Ishihara O, Irahara M, Saito H. Endometrial preparation methods for frozen-thawed embryo transfer are associated with altered risks of hypertensive disorders of pregnancy, placenta accreta, and gestational diabetes mellitus. Hum Reprod 2020; 34:1567-1575. [PMID: 31299081 DOI: 10.1093/humrep/dez079] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 04/24/2019] [Indexed: 12/18/2022] Open
Abstract
STUDY QUESTION What were the risks with regard to the pregnancy outcomes of patients who conceived by frozen-thawed embryo transfer (FET) during a hormone replacement cycle (HRC-FET)? SUMMARY ANSWER The patients who conceived by HRC-FET had increased risks of hypertensive disorders of pregnancy (HDP) and placenta accreta and a reduced risk of gestational diabetes mellitus (GDM) in comparison to those who conceived by FET during a natural ovulatory cycle (NC-FET). WHAT IS KNOWN ALREADY Previous studies have shown that pregnancy and live-birth rates after HRC-FET and NC-FET are comparable. Little has been clarified regarding the association between endometrium preparation and other pregnancy outcomes. STUDY DESIGN, SIZE, DURATION A retrospective cohort study of patients who conceived after HRC-FET and those who conceived after NC-FET was performed based on the Japanese assisted reproductive technology registry in 2014. PARTICIPANTS/MATERIALS, SETTING, METHODS The pregnancy outcomes were compared between NC-FET (n = 29 760) and HRC-FET (n = 75 474) cycles. Multiple logistic regression analyses were performed to investigate the potential confounding factors. MAIN RESULTS AND THE ROLE OF CHANCE The pregnancy rate (32.1% vs 36.1%) and the live birth rate among pregnancies (67.1% vs 71.9%) in HRC-FET cycles were significantly lower than those in NC-FET cycles. A multiple logistic regression analysis showed that pregnancies after HRC-FET had increased odds of HDPs [adjusted odds ratio, 1.43; 95% confidence interval (CI), 1.14-1.80] and placenta accreta (adjusted odds ratio, 6.91; 95% CI, 2.87-16.66) and decreased odds for GDM (adjusted odds ratio, 0.52; 95% CI, 0.40-0.68) in comparison to pregnancies after NC-FET. LIMITATIONS, REASONS FOR CAUTION Our study was retrospective in nature, and some cases were excluded due to missing data. The implication of bias and residual confounding factors such as body mass index, alcohol consumption, and smoking habits should be considered in other observational studies. WIDER IMPLICATIONS OF THE FINDINGS Pregnancies following HRC-FET are associated with higher risks of HDPs and placenta accreta and a lower risk of GDM. The association between the endometrium preparation method and obstetrical complication merits further attention. STUDY FUNDING/COMPETING INTEREST(S) No funding was obtained for this work. The authors declare no conflicts of interest in association with the present study. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Kazuki Saito
- Department of Perinatal Medicine and Maternal Care, National Center for Child Health and Development, Tokyo 157-8535, Japan.,Department of Comprehensive Reproductive Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo 113-8510, Japan.,Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo 157-8535, Japan
| | - Akira Kuwahara
- Department of Obstetrics and Gynecology, The University of Tokushima Graduate School, Institute of Health Biosciences, Tokushima 770-8503, Japan
| | - Tomonori Ishikawa
- Department of Comprehensive Reproductive Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Naho Morisaki
- Department of Social Medicine, National Center for Child Health and Development, Tokyo 157-8535, Japan
| | - Mami Miyado
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo 157-8535, Japan
| | - Kenji Miyado
- Department of Reproductive Biology, National Research Institute for Child Health and Development, Tokyo 157-8535, Japan
| | - Maki Fukami
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo 157-8535, Japan
| | - Naoyuki Miyasaka
- Department of Comprehensive Reproductive Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Osamu Ishihara
- Department of Obstetrics and Gynecology, Saitama Medical University, Saitama 350-0495, Japan
| | - Minoru Irahara
- Department of Obstetrics and Gynecology, The University of Tokushima Graduate School, Institute of Health Biosciences, Tokushima 770-8503, Japan
| | - Hidekazu Saito
- Department of Perinatal Medicine and Maternal Care, National Center for Child Health and Development, Tokyo 157-8535, Japan
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Abstract
The implementation of cryopreservation-techniques in the IVF laboratory and the improved survival rates of oocytes, cleavage and blastocyst stage embryos have led to a significant increase in the number of frozen-thawed embryo transfer cycles (FET). FETs can be planned either in a 'pure' natural cycle, a modified natural cycle, a stimulated cycle or a hormonal replacement therapy cycle and the optimal means to prepare the endometrium for frozen embryo transfer is a topic of ongoing controversy. Recent findings report an increased risk of hypertensive disorders if pregnancy is achieved in a frozen embryo transfer cycle without an existing corpus luteum. Therefore, the question of how to prepare the endometrium has gained even more importance and taken on a new dimension as it should not simply be reduced to the basic question of 'which approach will result in superior pregnancy rates?' but instead 'which approach will result in the best pregnancy rates and the safest outcome for mother and baby?'. The aim of this review is to summarize and critically appraise the existing data on the different approaches of endometrial preparation for frozen embryo transfer with a special focus on the 'pure' natural cycle.
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Affiliation(s)
- Barbara Lawrenz
- IVF Department, IVIRMA Middle-East Fertility Clinic, Abu Dhabi, United Arab Emirates
- Obstetrical Department, Women´s university hospital Tuebingen, Tuebingen, Germany
| | - Carol Coughlan
- IVF Department, IVIRMA Middle-East Fertility Clinic, Abu Dhabi, United Arab Emirates
| | - Laura Melado
- IVF Department, IVIRMA Middle-East Fertility Clinic, Abu Dhabi, United Arab Emirates
| | - Human M Fatemi
- IVF Department, IVIRMA Middle-East Fertility Clinic, Abu Dhabi, United Arab Emirates
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Jin XY, Zhao LJ, Luo DH, Liu L, Dai YD, Hu XX, Wang YY, Lin X, Hong F, Li TC, Zhang SY. Pinopode score around the time of implantation is predictive of successful implantation following frozen embryo transfer in hormone replacement cycles. Hum Reprod 2018; 32:2394-2403. [PMID: 29040606 DOI: 10.1093/humrep/dex312] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 09/27/2017] [Indexed: 01/05/2023] Open
Abstract
STUDY QUESTION Is pinopode measurement of any prognostic value? SUMMARY ANSWER Pinopode expression was significantly associated with the occurrence of pregnancy after frozen embryo transfer. WHAT IS KNOWN ALREADY Pinopodes are expressed in the endometrium during the implantation period. Pinopode measurement has been proposed as a marker of endometrial receptivity. STUDY DESIGN, SIZE, DURATION A prospective cohort study was conducted at the Center of Reproductive Medicine, Sir Run Run Shaw Hospital, between 2014 and 2016, recruiting 172 women with infertility and undergoing frozen embryo transfer following IVF treatment. Among 172 participants, 46 women took part in the first study to quantify the daily changing pattern of pinopodes 3-7 days after the initiation of progesterone therapy in the hormone replacement cycles and the remaining 126 women with infertility participated in a study to examine the relationship between pinopode count and pregnancy outcome following frozen embryo transfer in hormone replacement cycles. PARTICIPANTS/MATERIALS, SETTING, METHODS The mean age of participants was 29 years old. All participants received an artificial hormone replacement protocol capable of supporting successful implantation. Endometrial biopsies from 46 women were obtained 3, 4, 5, 6 and 7 days after the initiation of progesterone therapy (P + 3, n = 6; P + 4, n = 6; P + 5, n = 11; P + 6, n = 13; P + 7, n = 10, respectively). Another 126 endometrial biopsies were obtained precisely 6 days after the initiation of progesterone. Scanning electron microscopy was used to capture the pinopode images, followed by use of the image J program to quantify the count and subtype of the pinopodes. MAIN RESULTS AND THE ROLE OF CHANCE We found that at least 60 microscopic fields were necessary to achieve a reproducible result. An intra-observer variability study showed good agreement between two measurements regarding the developing pinopode (DP) subtype (r = 0.95) and the fully developed pinopode (FDP) subtype (r = 0.86) but not for the regressing (RP) pinopode subtype (r = 0.39). The proportion of DP/total pinopodes (TP) declined rapidly form day P + 4 to a minimum on day P + 6. The percentage of FDP/TP increased rapidly from day P + 4 to reach a peak on day P + 6. On the other hand, the percentage of RP/TP reached a peak on day P + 7. Participants who conceived had a significantly (P = 0.011) higher percentage of FDP/TP on day P + 6 and significantly (P = 0.005) lower percentage of DP/TP on the same day compared with participants who did not become pregnant. Using a scoring system incorporating the percentages of DP and FDP, it was found that the pregnancy rate and the embryo implantation rate of women with a high pinopode score (82.3%; 63.0%) was significantly (P = 0.001; P = 0.046) higher than that of women with a low pinopode score (53.3%; 46.7%), respectively. There remains a possibility that the observations could have arisen due to chance. LIMITATIONS, REASONS FOR CAUTION This study examined pinopode count and subtype in the HRT cycles, and it is uncertain whether the same observations apply to in natural cycles. WIDER IMPLICATIONS OF THE FNDINGS Pinopodes have been questioned as a potential marker of endometrial receptivity for many years. Our results suggested that pinopode measurement may be of value in predicting pregnancy. STUDY FUNDING/COMPETING INTEREST(S) The study was supported by the grants from the general project of medicine and health in Zhejiang Province of China (2015KYA142; 2018KY106), the Key Research and Development Program of Zhejiang Province (2017C03022) and the National Natural Science Foundation of China (81701514).The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript. We have no competing interests to declare. TRIAL REGISTRATION NUMBER ISRCTN26300668.
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Affiliation(s)
- X Y Jin
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou 310016, PR China
| | - L J Zhao
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou 310016, PR China
| | - D H Luo
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou 310016, PR China
| | - L Liu
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou 310016, PR China
| | - Y D Dai
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou 310016, PR China
| | - X X Hu
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou 310016, PR China
| | - Y Y Wang
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou 310016, PR China
| | - X Lin
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou 310016, PR China
| | - F Hong
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou 310016, PR China
| | - T C Li
- Department of Obstetrics & Gynecology, Chinese University of Hong Kong, Shatin, Hong Kong, PR China
| | - S Y Zhang
- Department of Obstetrics and Gynecology, Assisted Reproduction Unit, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou 310016, PR China
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Tsuji Y, Otsuki J, Iwasaki T, Furuhashi K, Matsumoto Y, Kokeguchi S, Shiotani M. Retrospective comparative study of the factors affecting birthweights in frozen-thawed embryo transfer, compared to fresh embryo transfer. Reprod Med Biol 2017; 16:283-289. [PMID: 29259479 PMCID: PMC5715888 DOI: 10.1002/rmb2.12038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 04/22/2017] [Indexed: 12/26/2022] Open
Abstract
Aim Several studies have indicated that the cause of the increased birthweight of frozen‐thawed embryos was associated with assisted reproductive technology (ART) procedures, such as cryopreservation. In the present study, the mean birthweight of singletons was compared between the ovulatory and hormone replacement therapy (HRT) cycles in order to investigate the primary factor that leads to higher birthweights from frozen‐thawed embryo transfer (FET). Methods This retrospective study was carried out from January 2011 to December 2014 on 2738 singletons who were born at 37‐41 weeks’ gestation, following ART in a single facility. The mean birthweight of the singletons who were born after a fresh embryo transfer (ET) was compared to the mean birthweight of the singletons who were born after a FET. In the FET cycles, the mean birthweight of the singletons was compared between the ovulatory and HRT cycles. Results The mean birthweight of the singletons who were born after a FET was significantly higher than that of the singletons who were born after a fresh ET. In the FET cycles, the birthweight from the HRT cycles was significantly higher than that from the ovulatory cycles. Among the HRT cycles, there was no difference between the birthweight of the singleton who were born from a blastocyst transfer and those who were born from a cleavage‐stage ET. Conclusion The primary factor to affect the birthweight of singletons might be the pre/postET hormonal environment of the endometrium and not the stage of the transferred embryo nor the frozen‐thawed procedure itself.
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Shiotani M, Matsumoto Y, Okamoto E, Yamada S, Mizusawa Y, Furuhashi K, Ogata H, Ogata S, Kokeguchi S. Is human chorionic gonadotropin supplementation beneficial for frozen and thawed embryo transfer in estrogen/progesterone replacement cycles?: A randomized clinical trial. Reprod Med Biol 2017; 16:166-169. [PMID: 29259465 PMCID: PMC5661815 DOI: 10.1002/rmb2.12023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/07/2017] [Indexed: 11/10/2022] Open
Abstract
Aim Human chorionic gonadotropin (hCG) is used frequently for luteal support in fresh in vitro fertilization cycles as it induces progesterone secretion from the ovaries after oocyte retrieval and modulates the endometrium for implantation in fresh cycles. In contrast, hCG is not usually used for the transfer of cryopreserved-thawed embryos in estrogen/progesterone replacement cycles because ovulation is suppressed. However, several studies have shown that luteinizing hormone and hCG receptors are present in the human endometrium and that hCG can directly induce the decidualization of endometrial stromal cells in vitro. Thus, this study evaluated whether hCG supplementation can be beneficial for cryopreserved-thawed embryo transfer in estrogen/progesterone replacement cycles. Methods One-hundred-and seventy-three cryopreserved-thawed embryo transfer cycles with estrogen/progesterone replacement were divided randomly into two groups. Transdermal oestradiol was used in combination with vaginal progesterone suppositories for HR. The embryo transfer was performed on day 17 and/or day 20 of the HR therapy cycle in both groups. In Group A, 3000 IU of hCG was administered on days 17, 20, and 23. In Group B, hCG was not used. Results There was no significant difference in the average age of the patients, the average number of previous assisted reproductive technology cycles, or the average number of embryo transfers between the two groups. The rates of pregnancy and implantation per embryo were 37.2% and 25.3%, respectively, in Group A and 35.6% and 21.7%, respectively, in Group B. The pregnancy and implantation rates were similar in both groups. Conclusion Supplementation with hCG is not beneficial for cryopreserved-thawed embryo transfer in estrogen/progesterone replacement cycles.
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