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Bhoi NR, Chandra V, Murdia K, Kawad K. Successful Management of Triplet Heterotopic Pregnancy (Interstitial) With an Intrauterine Monochorionic Diamniotic Twin Pregnancy Through Laparoscopy: A Case Report. Cureus 2023; 15:e37249. [PMID: 37162773 PMCID: PMC10164358 DOI: 10.7759/cureus.37249] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 05/11/2023] Open
Abstract
The simultaneous occurrence of intrauterine (IU) and extrauterine pregnancies is known as heterotopic pregnancy, an uncommon clinical condition that is challenging to manage. It can be a potentially fatal illness if it remains unnoticed. This is a case report of a woman who had heterotopic triplets after transferring two embryos produced through in vitro fertilization. An ultrasound scan diagnosed live interstitial heterotopic pregnancy and an intrauterine monochorionic twin pregnancy. Laparoscopic resection of interstitial heterotopic pregnancy was done. The monochorionic twin pregnancy was closely monitored by serial ultrasound, and at 36 weeks of gestation, two healthy twins were delivered by cesarean section. The fetal growth parameters were monitored, and a dopplers study was conducted to assess fetal blood flow. Even in heterotopic pregnancy, timely diagnosis and therapeutic intervention can preserve IU pregnancy with a successful outcome. Early meticulous monitoring and early detection can lead to a favorable outcome. Even in heterotropic pregnancy, a meticulous evaluation can lead to favorable outcomes by conserving IU pregnancy, and timely intervention can prevent maternal motility.
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Affiliation(s)
- Nihar R Bhoi
- Reproductive Medicine, Indira In Vitro Fertilization (IVF) Hospital Private Limited, Udaipur, IND
| | - Vipin Chandra
- Clinical Research and Operations, Indira In Vitro Fertilization (IVF) Hospital Private Limited, Udaipur, IND
| | - Kshitiz Murdia
- Reproductive Medicine, Indira In Vitro Fertilization (IVF) Hospital Private Limited, Udaipur, IND
| | - Kishor Kawad
- Reproductive Medicine, Indira In Vitro Fertilization (IVF) Hospital Private Limited, Ahmedabad, IND
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Wang L, Wang L, Yang X, Jin P, Zhang R, Jiang Y, Zhang X. Risk factors related to early pregnancy loss in fresh IVF/ICSI: An analysis of 954 embryo transfer cycles. Medicine (Baltimore) 2022; 101:e30166. [PMID: 36042604 PMCID: PMC9410683 DOI: 10.1097/md.0000000000030166] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Early pregnancy loss (EPL) is a common complication of assisted reproductive technology treatment; however, the exact factors involved in EPL are not fully understood. This study aimed to evaluate the risk factors for EPL in fresh in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles. This retrospective cohort study was conducted on all couples who underwent clinical pregnancy in fresh IVF/ICSI cycles from January to December 2019 at a single large reproductive medical center. In total, 954 cycles were included in this study. Univariate and multivariate logistic regression analyses were performed to evaluate relevant risk factors for EPL. Curve fitting and threshold analyses were used to explore the association between risk factors and EPL. Compared with women with a normal total antral follicle count (AFC) (≥10, <15), those with a low AFC (<10) had a higher risk of EPL (odds ratio 2.97, 95% confidence interval: 1.38-6.38, P < .05). Patients with an estradiol/progesterone ratio (E2/P) ≥ 1.1 had significantly lower odds of EPL than women with E2/P < 1.1 (odds ratio 0.51, 95% confidence interval 0.28-0.91, P < .05). E2/P and serum human chorionic gonadotropin (hCG) levels negatively correlated with EPL. By using a 2-piecewise regression model, the inflection point of serum hCG level was 599.9 IU/L. Our results showed that lower AFC, E2/P, and serum hCG levels were associated with a higher EPL risk in fresh IVF/ICSI cycles.
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Affiliation(s)
- Liyan Wang
- The First Hospital of Lanzhou University, Lanzhou, China
- Key Laboratory for Reproductive Medicine and Embryo, Gansu Province, Lanzhou, China
| | - Lin Wang
- Education Examinations Authority, Gansu Province, Lanzhou, China
| | - Xia Yang
- The First Hospital of Lanzhou University, Lanzhou, China
- Key Laboratory for Reproductive Medicine and Embryo, Gansu Province, Lanzhou, China
| | - Panpan Jin
- The First Hospital of Lanzhou University, Lanzhou, China
- Key Laboratory for Reproductive Medicine and Embryo, Gansu Province, Lanzhou, China
| | - Rui Zhang
- The First Hospital of Lanzhou University, Lanzhou, China
- Key Laboratory for Reproductive Medicine and Embryo, Gansu Province, Lanzhou, China
| | - Yanbiao Jiang
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Xuehong Zhang
- The First Hospital of Lanzhou University, Lanzhou, China
- Key Laboratory for Reproductive Medicine and Embryo, Gansu Province, Lanzhou, China
- *Correspondence: Xuehong Zhang, Reproductive Medicine Center, The First Hospital of Lanzhou University, Lanzhou 730000, PR China (e-mail: )
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Jia Y, Dong YJ, Sha YL, Cai SC, Diao LH, Qiu Z, Guo YH, Huang Y, Ye HX, Liu S. Effectiveness comparison between Endometrial Receptivity Array, Immune Profiling and the combination in treating patients with multiple implantation failure. Am J Reprod Immunol 2021; 87:e13513. [PMID: 34766396 DOI: 10.1111/aji.13513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/07/2021] [Revised: 10/28/2021] [Accepted: 11/05/2021] [Indexed: 11/29/2022] Open
Abstract
PROBLEM The clinical value of endometrial receptivity array (ERA), endometrial immune profiling, or a combination of both for multiple implantation failure patients is unclear. METHOD OF STUDY One hundred and seventy-two women with a history of at least two or more consecutive implantation failures in IVF/ICSI treatment were included. According to patients' willingness, they were divided into four groups, 'no treatment', 'Immune Profiling', 'ERA' and 'ERA + Immune Profiling'. Endometrial biopsy was examined by ERA, immune profiling alone, or combination, and intention was adopted accordingly. Pregnancy outcomes were compared, and the association between ERA phases and endometrial immune profiling was also assessed. RESULTS The overall incidence rate of the displaced window of implantation (WOI) and endometrial immune dysregulations were 84.9% and 75.3%, respectively. Implantation rate was significantly higher in the 'ERA + Immune Profiling' group than the 'no treatment' group (P = 0.007). Clinical pregnancy rate was somewhat improved in the three treatment groups but with a borderline significance (P = 0.071). After controlling for other confounders, 'ERA + Immune Profiling' treatment was associated with a higher pregnancy rate [aOR (95%CI) = 3.412 (1.387-8.395), P = 0.008]. There was no association between endometrial immune profiling and ERA phases. CONCLUSIONS Our findings highlight the high incidence of displaced WOI and endometrial immune dysregulation in multiple implantation failure patients. The combination of ERA and endometrial immune profiling is more likely to have clinical value than ERA or immune profiling alone. These data suggested the unsubstitutability of ERA and endometrial immune profiling on the treatment outcome for multiple implantation failure patients. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yan Jia
- Department of Reproductive Immunology, Chengdu Xi'nan Gynecology Hospital, No. 66 Bisheng Road, Chengdu, Sichuan, PR China
| | - Ya-Jun Dong
- Department of Reproductive Immunology, Chengdu Xi'nan Gynecology Hospital, No. 66 Bisheng Road, Chengdu, Sichuan, PR China
| | - Yu-Lin Sha
- Department of Reproductive Immunology, Chengdu Xi'nan Gynecology Hospital, No. 66 Bisheng Road, Chengdu, Sichuan, PR China.,Chengdu Jinxin Research Institute of Reproductive Medicine and Genetics, No. 66 Bisheng Road, Chengdu, Sichuan, PR China
| | - Song-Chen Cai
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, PR China
| | - Liang-Hui Diao
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, PR China
| | - Zhu Qiu
- Department of Reproductive Immunology, Chengdu Xi'nan Gynecology Hospital, No. 66 Bisheng Road, Chengdu, Sichuan, PR China
| | - Yan-Hua Guo
- Department of Reproductive Immunology, Chengdu Xi'nan Gynecology Hospital, No. 66 Bisheng Road, Chengdu, Sichuan, PR China
| | - Yan Huang
- Department of Reproductive Immunology, Chengdu Xi'nan Gynecology Hospital, No. 66 Bisheng Road, Chengdu, Sichuan, PR China
| | - Hong-Xia Ye
- Department of Reproductive Immunology, Chengdu Xi'nan Gynecology Hospital, No. 66 Bisheng Road, Chengdu, Sichuan, PR China
| | - Su Liu
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, PR China
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Karabinus DS, Marazzo DP, Stern HJ, Potter DA, Opanga CI, Cole ML, Johnson LA, Schulman JD. The effectiveness of flow cytometric sorting of human sperm (MicroSort®) for influencing a child's sex. Reprod Biol Endocrinol 2014; 12:106. [PMID: 25420620 PMCID: PMC4256056 DOI: 10.1186/1477-7827-12-106] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 09/11/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Flow cytometric sorting can be used to separate sperm based on sex chromosome content. Differential fluorescence emitted by stained X- vs. Y-chromosome-bearing sperm enables sorting and collection of samples enriched in either X- or Y-bearing sperm for use to influence the likelihood that the offspring will be a particular sex. Herein we report the effectiveness of flow cytometric sorting of human sperm and its use in human ART procedures. METHODS This prospective, observational cohort study of the series of subjects treated with flow cytometrically sorted human sperm was conducted at investigational sites at two private reproductive centers. After meeting inclusion criteria, married couples (n = 4993) enrolled to reduce the likelihood of sex-linked or sex-limited disease in future children (n = 383) or to balance the sex ratio of their children (n = 4610). Fresh or frozen-thawed semen was processed and recovered sperm were stained with Hoechst 33342 and sorted by flow cytometry (n = 7718) to increase the percentage of X-bearing sperm (n = 5635) or Y-bearing sperm (n = 2083) in the sorted specimen. Sorted sperm were used for IUI (n = 4448) and IVF/ICSI (n = 2957). Measures of effectiveness were the percentage of X- and Y-bearing sperm in sorted samples, determined by fluorescence in situ hybridization, sex of babies born, IVF/ICSI fertilization- and cleavage rates, and IUI, IVF/ICSI, FET pregnancy rates and miscarriage rates. RESULTS Sorted specimens averaged 87.7 ± 5.0% X-bearing sperm after sorting for X and 74.3 ± 7.0% Y-bearing sperm after sorting for Y. Seventy-three percent of sorts were for girls. For babies born, 93.5% were females and 85.3% were males after sorting for X- and Y-bearing sperm, respectively. IUI, IVF/ICSI, and FET clinical pregnancy rates were 14.7%, 30.8%, and 32.1%, respectively; clinical miscarriage rates were 15.5%, 10.2%, and 12.7%. CONCLUSIONS Flow cytometric sorting of human sperm shifted the X:Y sperm ratio. IUI, IVF/ICSI and FET outcomes were consistent with unimpaired sperm function. Results provide evidence supporting the effectiveness of flow cytometric sorting of human sperm for use as a preconception method of influencing a baby's sex. TRIAL REGISTRATION NCT00865735 (ClinicalTrials.gov).
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Affiliation(s)
| | - Donald P Marazzo
- />Genetics & IVF Institute, 3015 Williams Dr, Fairfax, VA 22031 USA
| | - Harvey J Stern
- />Genetics & IVF Institute, 3015 Williams Dr, Fairfax, VA 22031 USA
| | - Daniel A Potter
- />Huntington Reproductive Center, 23961 Calle de la Magdalena, Suite 503, Laguna Hills, CA 92653 USA
| | - Chrispo I Opanga
- />Genetics & IVF Institute, 3015 Williams Dr, Fairfax, VA 22031 USA
| | - Marisa L Cole
- />Genetics & IVF Institute, 3015 Williams Dr, Fairfax, VA 22031 USA
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Gomes Sobrinho DB, Oliveira JBA, Petersen CG, Mauri AL, Silva LFI, Massaro FC, Baruffi RLR, Cavagna M, Franco JG. IVF/ICSI outcomes after culture of human embryos at low oxygen tension: a meta-analysis. Reprod Biol Endocrinol 2011; 9:143. [PMID: 22044493 PMCID: PMC3229451 DOI: 10.1186/1477-7827-9-143] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 11/01/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improved pregnancy, implantation, and birth rates have been reported after the use of reduced O2 concentration during embryo culture, mainly due to a reduction of the cumulative detrimental effects of reactive oxygen species. However, some studies have failed to report any positive effects. The objective of this meta-analysis was to evaluate the effect of a low-O2 environment on IVF/intracytoplasmic sperm injection (ICSI) outcomes. METHODS All available published and ongoing randomised trials that compared the effects of low (~5%; OC~5) and atmospheric (~20%; OC~20) oxygen concentrations on IVF/ICSI outcomes were included. Search strategies included online surveys of databases from 1980 to 2011. The outcomes measured were fertilisation rate, implantation rate and ongoing pregnancy rates. The fixed effects model was used to calculate the odds ratio. RESULTS Seven studies were included in this analysis. The pooled fertilisation rate did not differ significantly (P=0.54) between the group of oocytes cultured at low O2 tension and the group at atmospheric O2 tension. Concerning all cycles, the implantation (P=0.06) and ongoing pregnancy (P=0.051) rates were not significantly different between the group receiving transferred sets containing only OC~5 embryos and the group receiving transferred sets with only OC~20 embryos. In a meta-analysis performed for only those trials in which embryos were transferred on day 2/3, implantation (P=0.63) and ongoing pregnancy (P=0.19) rates were not significantly different between the groups. In contrast, when a meta-analysis was performed using only trials in which embryos were transferred on days 5 and 6 (at the blastocyst stage), the group with transferred sets of only OC~5 embryos showed a statistically significantly higher implantation rate (P=0.006) than the group receiving transferred sets with only OC~20 embryos, although the ongoing pregnancy (P=0.19) rates were not significantly different between the groups. CONCLUSIONS Despite some promising results, it seems too early to conclude that low O2 culture has an effect on IVF outcome. Additional randomised controlled trials are necessary before evidence-based recommendations can be provided. It should be emphasised that the present meta-analysis does not provide any evidence that low oxygen concentration is unnecessary.
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Affiliation(s)
- David B Gomes Sobrinho
- Department of Gynaecology and Obstetrics, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Joao Batista A Oliveira
- Department of Gynaecology and Obstetrics, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, Brazil
- Center for Human Reproduction Prof Franco Jr, Ribeirao Preto, Brazil
- Paulista Centre for Diagnosis, Research and Training, Ribeirao Preto, Brazil
| | - Claudia G Petersen
- Department of Gynaecology and Obstetrics, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, Brazil
- Center for Human Reproduction Prof Franco Jr, Ribeirao Preto, Brazil
- Paulista Centre for Diagnosis, Research and Training, Ribeirao Preto, Brazil
| | - Ana L Mauri
- Center for Human Reproduction Prof Franco Jr, Ribeirao Preto, Brazil
- Paulista Centre for Diagnosis, Research and Training, Ribeirao Preto, Brazil
| | - Liliane FI Silva
- Department of Gynaecology and Obstetrics, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, Brazil
- Center for Human Reproduction Prof Franco Jr, Ribeirao Preto, Brazil
- Paulista Centre for Diagnosis, Research and Training, Ribeirao Preto, Brazil
| | - Fabiana C Massaro
- Center for Human Reproduction Prof Franco Jr, Ribeirao Preto, Brazil
- Paulista Centre for Diagnosis, Research and Training, Ribeirao Preto, Brazil
| | - Ricardo LR Baruffi
- Center for Human Reproduction Prof Franco Jr, Ribeirao Preto, Brazil
- Paulista Centre for Diagnosis, Research and Training, Ribeirao Preto, Brazil
| | - Mario Cavagna
- Center for Human Reproduction Prof Franco Jr, Ribeirao Preto, Brazil
- Paulista Centre for Diagnosis, Research and Training, Ribeirao Preto, Brazil
- Women's Health Reference Center, Hospital Perola Byington, Sao Paulo, Brazil
| | - José G Franco
- Department of Gynaecology and Obstetrics, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, Brazil
- Center for Human Reproduction Prof Franco Jr, Ribeirao Preto, Brazil
- Paulista Centre for Diagnosis, Research and Training, Ribeirao Preto, Brazil
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