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Capalbo A, de Wert G, Mertes H, Klausner L, Coonen E, Spinella F, Van de Velde H, Viville S, Sermon K, Vermeulen N, Lencz T, Carmi S. Screening embryos for polygenic disease risk: a review of epidemiological, clinical, and ethical considerations. Hum Reprod Update 2024; 30:529-557. [PMID: 38805697 PMCID: PMC11369226 DOI: 10.1093/humupd/dmae012] [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: 01/10/2024] [Revised: 03/25/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND The genetic composition of embryos generated by in vitro fertilization (IVF) can be examined with preimplantation genetic testing (PGT). Until recently, PGT was limited to detecting single-gene, high-risk pathogenic variants, large structural variants, and aneuploidy. Recent advances have made genome-wide genotyping of IVF embryos feasible and affordable, raising the possibility of screening embryos for their risk of polygenic diseases such as breast cancer, hypertension, diabetes, or schizophrenia. Despite a heated debate around this new technology, called polygenic embryo screening (PES; also PGT-P), it is already available to IVF patients in some countries. Several articles have studied epidemiological, clinical, and ethical perspectives on PES; however, a comprehensive, principled review of this emerging field is missing. OBJECTIVE AND RATIONALE This review has four main goals. First, given the interdisciplinary nature of PES studies, we aim to provide a self-contained educational background about PES to reproductive specialists interested in the subject. Second, we provide a comprehensive and critical review of arguments for and against the introduction of PES, crystallizing and prioritizing the key issues. We also cover the attitudes of IVF patients, clinicians, and the public towards PES. Third, we distinguish between possible future groups of PES patients, highlighting the benefits and harms pertaining to each group. Finally, our review, which is supported by ESHRE, is intended to aid healthcare professionals and policymakers in decision-making regarding whether to introduce PES in the clinic, and if so, how, and to whom. SEARCH METHODS We searched for PubMed-indexed articles published between 1/1/2003 and 1/3/2024 using the terms 'polygenic embryo screening', 'polygenic preimplantation', and 'PGT-P'. We limited the review to primary research papers in English whose main focus was PES for medical conditions. We also included papers that did not appear in the search but were deemed relevant. OUTCOMES The main theoretical benefit of PES is a reduction in lifetime polygenic disease risk for children born after screening. The magnitude of the risk reduction has been predicted based on statistical modelling, simulations, and sibling pair analyses. Results based on all methods suggest that under the best-case scenario, large relative risk reductions are possible for one or more diseases. However, as these models abstract several practical limitations, the realized benefits may be smaller, particularly due to a limited number of embryos and unclear future accuracy of the risk estimates. PES may negatively impact patients and their future children, as well as society. The main personal harms are an unindicated IVF treatment, a possible reduction in IVF success rates, and patient confusion, incomplete counselling, and choice overload. The main possible societal harms include discarded embryos, an increasing demand for 'designer babies', overemphasis of the genetic determinants of disease, unequal access, and lower utility in people of non-European ancestries. Benefits and harms will vary across the main potential patient groups, comprising patients already requiring IVF, fertile people with a history of a severe polygenic disease, and fertile healthy people. In the United States, the attitudes of IVF patients and the public towards PES seem positive, while healthcare professionals are cautious, sceptical about clinical utility, and concerned about patient counselling. WIDER IMPLICATIONS The theoretical potential of PES to reduce risk across multiple polygenic diseases requires further research into its benefits and harms. Given the large number of practical limitations and possible harms, particularly unnecessary IVF treatments and discarded viable embryos, PES should be offered only within a research context before further clarity is achieved regarding its balance of benefits and harms. The gap in attitudes between healthcare professionals and the public needs to be narrowed by expanding public and patient education and providing resources for informative and unbiased genetic counselling.
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Affiliation(s)
- Antonio Capalbo
- Juno Genetics, Department of Reproductive Genetics, Rome, Italy
- Center for Advanced Studies and Technology (CAST), Department of Medical Genetics, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Guido de Wert
- Department of Health, Ethics & Society, CAPHRI-School for Public Health and Primary Care and GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Heidi Mertes
- Department of Philosophy and Moral Sciences, Ghent University, Ghent, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Liraz Klausner
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Edith Coonen
- Departments of Clinical Genetics and Reproductive Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- School for Oncology and Developmental Biology, GROW, Maastricht University, Maastricht, The Netherlands
| | - Francesca Spinella
- Eurofins GENOMA Group Srl, Molecular Genetics Laboratories, Department of Scientific Communication, Rome, Italy
| | - Hilde Van de Velde
- Research Group Genetics Reproduction and Development (GRAD), Vrije Universiteit Brussel, Brussel, Belgium
- Brussels IVF, UZ Brussel, Brussel, Belgium
| | - Stephane Viville
- Laboratoire de Génétique Médicale LGM, Institut de Génétique Médicale d’Alsace IGMA, INSERM UMR 1112, Université de Strasbourg, France
- Laboratoire de Diagnostic Génétique, Unité de Génétique de l’infertilité (UF3472), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Karen Sermon
- Research Group Genetics Reproduction and Development (GRAD), Vrije Universiteit Brussel, Brussel, Belgium
| | | | - Todd Lencz
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Departments of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Shai Carmi
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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Shi S, Zhao B, Hu Z, Shi Q. The impact of blastocyst grade on singleton birth weight in fresh IVF‒ET cycles in ART: a retrospective study. BMC Pregnancy Childbirth 2024; 24:588. [PMID: 39244568 PMCID: PMC11380778 DOI: 10.1186/s12884-024-06794-4] [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: 05/25/2024] [Accepted: 08/29/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND The positive correlation between embryo quality and pregnancy outcomes has been confirmed in many studies, but there are few on the impact of embryo quality on neonatal weight, especially among neonates from fresh IVF‒ET cycles in ART. Therefore, this study aimed to compare the birth weights of infants from different blastocyst grades in fresh IVF-ET cycles and explore related factors affecting birth weight. METHODS The main outcome measure was singleton birth weight. A total of 1301 fresh cycles of single blastocyst transplantation and single live birth profiles were retrospectively analyzed and divided into four groups according to blastocyst quality: the excellent group (grade AA), which included 170 cycles; the good group (grade AB/BA), which included 312 cycles; the average group (grade BB/CA/AC), which included 559 cycles; and the poor group (grade BC/CB), which included 260 cycles. The relationships among cystic cavity expansion, endocytic cell mass, ectodermal trophoblast cell grade, and birth weight were studied. Multiple linear regression analysis was performed to investigate the relationship between blastocyst quality and neonatal birth weight and logistic regression for the risk factors for low birth weight newborns. RESULTS With decreases in the blastocyst quality, including ICM, TE quality, and embryo expansion stage, birth weight declined, and Z scores correspondingly decreased. After adjusting for confounders, the average and poor groups (P = 0.01 and P = 0.001, respectively) and blastocysts with TE grade C (P = 0.022) resulted in singletons with lower birth weight. Additionally, the poor group and blastocysts with Grade C TEs had a greater chance of leading to low birth weight infants compared with the other groups. CONCLUSION Our findings indicated that excellent and good-grade blastocyst transplantation could achieve better pregnancy outcomes and that average and poor-grade blastocyst transplantation, especially with grade C TEs, were associated with single birth weight loss. No association was found between the embryo expansion stage or ICM quality and neonatal birth weight.
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Affiliation(s)
- Senlin Shi
- Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, Henan Province, 450052, People's Republic of China.
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
- Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
| | - Boya Zhao
- Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, Henan Province, 450052, People's Republic of China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
- Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Zhan Hu
- Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, Henan Province, 450052, People's Republic of China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
- Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Qiongyao Shi
- Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, Henan Province, 450052, People's Republic of China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
- Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
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Ma X, Wang J, Shi Y, Tan J, Guan Y, Sun Y, Zhang B, Zhao J, Liu J, Cao Y, Li H, Zhang C, Chen F, Yi H, Wang Z, Xin X, Kong P, Lu Y, Huang L, Yuan Y, Liu H, Li C, Mol BWJ, Hu Z, Zhang H, Chen ZJ, Liu J. Effect of single blastocyst-stage versus single cleavage-stage embryo transfer on cumulative live births in women with good prognosis undergoing in vitro fertilization: Multicenter Randomized Controlled Trial. Nat Commun 2024; 15:7747. [PMID: 39237545 PMCID: PMC11377718 DOI: 10.1038/s41467-024-52008-y] [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: 08/31/2023] [Accepted: 08/20/2024] [Indexed: 09/07/2024] Open
Abstract
In this multicenter, non-inferiority, randomized trial, we randomly assigned 992 women undergoing in-vitro fertilization (IVF) with a good prognosis (aged 20-40, ≥3 transferrable cleavage-stage embryos) to strategies of blastocyst-stage (n = 497) or cleavage-stage (n = 495) single embryo transfer. Primary outcome was cumulative live-birth rate after up to three transfers. Secondary outcomes were cumulative live-births after all embryo transfers within 1 year of randomization, pregnancy outcomes, obstetric-perinatal complications, and livebirths outcomes. Live-birth rates were 74.8% in blastocyst-stage group versus 66.3% in cleavage-stage group (relative risk 1.13, 95%CI:1.04-1.22; Pnon-inferiority < 0.001, Psuperiority = 0.003) (1-year cumulative live birth rates of 75.7% versus 68.9%). Blastocyst transfer increased the risk of spontaneous preterm birth (4.6% vs 2.0%; P = 0.02) and neonatal hospitalization >3 days. Among good prognosis women, a strategy of single blastocyst transfer increases cumulative live-birth rates over single cleavage-stage transfer. Blastocyst transfer resulted in higher preterm birth rates. This information should be used to counsel patients on their choice between cleavage-stage and blastocyst-stage transfer (NCT03152643, https://clinicaltrials.gov/study/NCT03152643 ).
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Affiliation(s)
- Xiang Ma
- State Key Laboratory of Reproductive Medicine and Offspring Health, Center for Clinical Reproductive Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jing Wang
- State Key Laboratory of Reproductive Medicine and Offspring Health, Center for Clinical Reproductive Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yuhua Shi
- State Key Laboratory of Reproductive Medicine and Offspring Health, Center for Reproductive Medicine, Institute of Women, Children and Reproductive Health, Shandong University, Jinan, China
| | - Jichun Tan
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
- Key Laboratory of Reproductive Dysfunction Disease and Fertility Remodeling of Liaoning Province, Shenyang, China
| | - Yichun Guan
- Reproductive Medicine Center, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yun Sun
- Department of Reproductive Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Bo Zhang
- Department of Reproductive Medicine Center, Maternal and Child Health Hospital in Guang Xi, Guangxi, China
| | - Junli Zhao
- Reproductive Medicine Center, General Hospital of Ningxia Medical University, Ningxia, China
| | - Jianqiao Liu
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, the Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yunxia Cao
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), Hefei, China
| | - Hong Li
- Suzhou Municipal Hospital, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Cuilian Zhang
- Reproductive Medical Center, Henan Provincial People's Hospital, Zhengzhou, China
| | - Feng Chen
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Honggang Yi
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Ze Wang
- State Key Laboratory of Reproductive Medicine and Offspring Health, Center for Reproductive Medicine, Institute of Women, Children and Reproductive Health, Shandong University, Jinan, China
| | - Xing Xin
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
- Key Laboratory of Reproductive Dysfunction Disease and Fertility Remodeling of Liaoning Province, Shenyang, China
| | - Pingping Kong
- Reproductive Medicine Center, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yao Lu
- Department of Reproductive Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Ling Huang
- Department of Reproductive Medicine Center, Maternal and Child Health Hospital in Guang Xi, Guangxi, China
| | - Yingying Yuan
- Reproductive Medicine Center, General Hospital of Ningxia Medical University, Ningxia, China
| | - Haiying Liu
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, the Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Caihua Li
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), Hefei, China
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, The Ritchie Center, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Monash Health, Melbourne, VIC, Australia
| | - Zhibin Hu
- State Key Laboratory of Reproductive Medicine and Offspring Health, Center for Clinical Reproductive Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- State Key Laboratory of Reproductive Medicine (Suzhou Center), the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Heping Zhang
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA
| | - Zi-Jiang Chen
- State Key Laboratory of Reproductive Medicine and Offspring Health, Center for Reproductive Medicine, Institute of Women, Children and Reproductive Health, Shandong University, Jinan, China.
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China.
| | - Jiayin Liu
- State Key Laboratory of Reproductive Medicine and Offspring Health, Center for Clinical Reproductive Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Shavit T, Hasson J, Hyman JH, Tsafrir A. Trends in patient age at planned oocyte cryopreservation. J Assist Reprod Genet 2024:10.1007/s10815-024-03237-z. [PMID: 39235517 DOI: 10.1007/s10815-024-03237-z] [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: 05/28/2024] [Accepted: 08/19/2024] [Indexed: 09/06/2024] Open
Abstract
PURPOSE The outcome of planned oocyte cryopreservation (POC) is inversely related to the age at the time of oocyte cryopreservation commencing in the mid-30 s. We sought to evaluate whether the age of women undergoing POC has changed over the last decade. METHODS The study employed a retrospective, observational multicenter design. It included all women who had at least one POC cycle in two large private IVF units belonging to the same medical organization in Israel. The main outcome measure was age at the first cycle. Data on the total number of women each year and their age at the first cycle were recorded. RESULTS Between 2011 and the end of 2023, 4488 women underwent POC. The average age at the first retrieval was 36.2 years (± 2.4). In 2011, the average age was 38.3 years (± 2.6), which decreased to 35.4 years (± 2.5) in 2023. The trendline indicates a decline in the average age of 3.0 months per year (β = - 0.252, F = 301.8, p < 0.001). The proportion of women aged < 36 at their first POC cycle increased from 14% in 2011 to 54% in 2023. CONCLUSIONS The age at the time of POC has significantly declined over the past decade. This trend may potentially lead to higher overall birth rates from POC, though further research is needed to confirm this hypothesis.
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Affiliation(s)
- Tal Shavit
- Faculty of Health Sciences, IVF Unit, Assuta Medical Centers, Ben-Gurion University, Be'er Sheva, Israel
| | - Joseph Hasson
- Faculty of Health Sciences, IVF Unit, Assuta Medical Centers, Ben-Gurion University, Be'er Sheva, Israel
| | - Jordana Hadassah Hyman
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Obstetrics and Gynecology, IVF Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Avi Tsafrir
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
- Department of Obstetrics and Gynecology, IVF Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
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Wischmann T. Psychological aspects of infertility. MED GENET-BERLIN 2024; 36:171-177. [PMID: 39263650 PMCID: PMC11388721 DOI: 10.1515/medgen-2024-2029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
The unfulfilled desire for children is a significant problem worldwide. The psychological effects of this development are usually underestimated, while the myth of "psychogenic infertility" stubbornly persists. This article first provides an overview of the basic facts on the subject before highlighting the psychological effects of both the diagnosis of infertility and the therapeutic options. Psychological aspects of "third-party" reproduction and further developments after childbirth or without a child are discussed, followed by a brief outline of the general and specific subject matter addressed in infertility counselling. The article concludes with reflections on the possible psychological consequences of further medical developments in this area.
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Affiliation(s)
- Tewes Wischmann
- Heidelberg University Hospital Institute of Medical Psychology Bergheimer Str. 20 69115 Heidelberg Germany
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Baroutis D, Kalampokas T, Katsianou E, Psarris A, Daskalakis G, Panoulis K, Eleftheriades M. The Role of the Mediterranean Diet in Assisted Reproduction: A Literature Review. Nutrients 2024; 16:2807. [PMID: 39203942 PMCID: PMC11356935 DOI: 10.3390/nu16162807] [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: 06/26/2024] [Revised: 07/25/2024] [Accepted: 08/20/2024] [Indexed: 09/03/2024] Open
Abstract
The Mediterranean Diet, characterized by high consumption of plant-based foods, olive oil, moderate intake of fish and poultry, and low consumption of red meat and processed foods, has been suggested to improve assisted reproductive technology (ART) outcomes. This narrative review aimed to summarize and synthesize the evidence from observational studies on the associations between preconception adherence to the Mediterranean Diet and ART outcomes. PubMed/MEDLINE, Embase, ScienceDirect, Google Scholar, and Web of Science databases were searched to identify relevant studies. Seven observational studies (n = 2321 women undergoing ART) were included. Adherence to the Mediterranean Diet was assessed using food frequency questionnaires with 6-195 items. Three studies found that higher Mediterranean Diet scores were associated with improved clinical pregnancy rates (OR 1.4, 95% CI 1.0-1.9; RR 1.98, 95% CI 1.05-3.78) or live birth rates (RR 2.64, 95% CI 1.37-5.07). Two studies showed a positive effect on embryo yield (p = 0.028) and ovarian response. However, two studies reported no significant associations with ultimate ART success, and four studies found no effects on oocyte and embryo number or quality. The heterogeneity in study designs, Mediterranean Diet assessment methods, and ART protocols limited the strength of conclusions. Evidence for the effects of greater adherence to the Mediterranean Diet on ART outcomes is limited but promising. Future research should focus on conducting randomized controlled trials with standardized Mediterranean Diet assessment methods to establish causal relationships between Mediterranean Diet adherence and ART outcomes, and to elucidate potential mechanisms of action.
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Affiliation(s)
- Dimitris Baroutis
- Aretaieio Hospital, 2nd Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, 11528 Athens, Greece
- Alexandra Hospital, 1st Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Theodoros Kalampokas
- Aretaieio Hospital, 2nd Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Eleni Katsianou
- Aretaieio Hospital, 2nd Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Alexandros Psarris
- Alexandra Hospital, 1st Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - George Daskalakis
- Alexandra Hospital, 1st Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Konstantinos Panoulis
- Aretaieio Hospital, 2nd Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Makarios Eleftheriades
- Aretaieio Hospital, 2nd Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, 11528 Athens, Greece
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Bui BN, Kukushkina V, Meltsov A, Olsen C, van Hoogenhuijze N, Altmäe S, Mol F, Teklenburg G, de Bruin J, Besselink D, Stevens Brentjens L, Obukhova D, Zamani Esteki M, van Golde R, Romano A, Laisk T, Steba G, Mackens S, Salumets A, Broekmans F. The endometrial transcriptome of infertile women with and without implantation failure. Acta Obstet Gynecol Scand 2024; 103:1348-1365. [PMID: 38520066 PMCID: PMC11168281 DOI: 10.1111/aogs.14822] [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: 04/21/2023] [Revised: 01/26/2024] [Accepted: 02/16/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION Implantation failure after transferring morphologically "good-quality" embryos in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) may be explained by impaired endometrial receptivity. Analyzing the endometrial transcriptome analysis may reveal the underlying processes and could help in guiding prognosis and using targeted interventions for infertility. This exploratory study investigated whether the endometrial transcriptome profile was associated with short-term or long-term implantation outcomes (ie success or failure). MATERIAL AND METHODS Mid-luteal phase endometrial biopsies of 107 infertile women with one full failed IVF/ICSI cycle, obtained within an endometrial scratching trial, were subjected to RNA-sequencing and differentially expressed genes analysis with covariate adjustment (age, body mass index, luteinizing hormone [LH]-day). Endometrial transcriptomes were compared between implantation failure and success groups in the short term (after the second fresh IVF/ICSI cycle) and long term (including all fresh and frozen cycles within 12 months). The short-term analysis included 85/107 women (33 ongoing pregnancy vs 52 no pregnancy), excluding 22/107 women. The long-term analysis included 46/107 women (23 'fertile' group, ie infertile women with a live birth after ≤3 embryos transferred vs 23 recurrent implantation failure group, ie no live birth after ≥3 good quality embryos transferred), excluding 61/107 women not fitting these categories. As both analyses drew from the same pool of 107 samples, there was some sample overlap. Additionally, cell type enrichment scores and endometrial receptivity were analyzed, and an endometrial development pseudo-timeline was constructed to estimate transcriptomic deviations from the optimum receptivity day (LH + 7), denoted as ΔWOI (window of implantation). RESULTS There were no significantly differentially expressed genes between implantation failure and success groups in either the short-term or long-term analyses. Principal component analysis initially showed two clusters in the long-term analysis, unrelated to clinical phenotype and no longer distinct following covariate adjustment. Cell type enrichment scores did not differ significantly between groups in both analyses. However, endometrial receptivity analysis demonstrated a potentially significant displacement of the WOI in the non-pregnant group compared with the ongoing pregnant group in the short-term analysis. CONCLUSIONS No distinct endometrial transcriptome profile was associated with either implantation failure or success in infertile women. However, there may be differences in the extent to which the WOI is displaced.
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Affiliation(s)
- Bich Ngoc Bui
- Department of Gynecology and Reproductive MedicineUniversity Medical Center UtrechtUtrechtThe Netherlands
| | | | - Alvin Meltsov
- Competence Center on Health TechnologiesTartuEstonia
- Department of Obstetrics and Gynecology, GROW, School for Oncology and ReproductionMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Catharina Olsen
- Center for Medical Genetics, Research Group Reproduction and GeneticsVrije Universiteit BrusselBrusselsBelgium
- Brussels Interuniversity Genomics High Throughput Core (BRIGHTcore)VUB‐ULBBrusselsBelgium
- Interuniversity Institute of Bioinformatics in Brussels (IB)BrusselsBelgium
| | - Nienke van Hoogenhuijze
- Department of Gynecology and Reproductive MedicineUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Signe Altmäe
- Department of Biochemistry and Molecular Biology, Faculty of SciencesUniversity of GranadaGranadaSpain
- Instituto de Investigación Biosanitaria, ibs.GRANADAGranadaSpain
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology (CLINTEC)Karolinska Institute and Karolinska University HospitalStockholmSweden
| | - Femke Mol
- Center for Reproductive Medicine, Reproduction and Development, Amsterdam University Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
| | | | - Jan‐Peter de Bruin
- Department of Obstetrics and GynecologyJeroen Bosch Hospital‘s‐HertogenboschThe Netherlands
| | - Dagmar Besselink
- Department of Obstetrics and GynecologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Linda Stevens Brentjens
- Department of Obstetrics and Gynecology, GROW, School for Oncology and ReproductionMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Darina Obukhova
- Department of Clinical GeneticsMaastricht University Medical CenterMaastrichtThe Netherlands
- Department of Genetics and Cell Biology, GROW School for Oncology and ReproductionMaastricht UniversityMaastrichtThe Netherlands
| | - Masoud Zamani Esteki
- Department of Clinical GeneticsMaastricht University Medical CenterMaastrichtThe Netherlands
- Department of Genetics and Cell Biology, GROW School for Oncology and ReproductionMaastricht UniversityMaastrichtThe Netherlands
| | - Ron van Golde
- Department of Obstetrics and Gynecology, GROW, School for Oncology and ReproductionMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Andrea Romano
- Department of Obstetrics and Gynecology, GROW, School for Oncology and ReproductionMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Triin Laisk
- Estonian Genome Center, Institute of GenomicsUniversity of TartuTartuEstonia
| | - Gaby Steba
- Department of Gynecology and Reproductive MedicineUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Shari Mackens
- Brussels IVFUniversitair Ziekenhuis Brussel, Vrije Universiteit BrusselBrusselsBelgium
| | - Andres Salumets
- Competence Center on Health TechnologiesTartuEstonia
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology (CLINTEC)Karolinska Institute and Karolinska University HospitalStockholmSweden
- Department of Obstetrics and Gynecology, Institute of Clinical MedicineUniversity of TartuTartuEstonia
| | - Frank Broekmans
- Department of Gynecology and Reproductive MedicineUniversity Medical Center UtrechtUtrechtThe Netherlands
- Center for Infertility Care, Dijklander HospitalPurmerendThe Netherlands
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Cutting ER, Abdallah KS, Mol BW. Is there a treatable cause of repeated implantation failure, or is it simply treatment failure by chance? Reprod Biomed Online 2024; 48:103845. [PMID: 38636349 DOI: 10.1016/j.rbmo.2024.103845] [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: 09/05/2023] [Revised: 12/03/2023] [Accepted: 01/17/2024] [Indexed: 04/20/2024]
Abstract
RESEARCH QUESTION Does repeated implantation failure (RIF) sometimes have a cause, or is it simply treatment failure by chance? DESIGN A hypothetical model of a cohort of 1000 women undergoing four repeated IVF attempts was constructed. A proportion of women with RIF carried an underlying risk factor negatively affecting implantation, compared with women without the factor. In strategy A, women had standard IVF without additional treatment; in strategy B, the women received standard IVF plus an additional treatment. The sensitivity analysis varied the prevalence of the underlying risk factor from 5% to 50%. The model was compared with literature studies where a treatment strategy had been applied. RESULTS With strategy A, the clinical pregnancy rate decreased with subsequent IVF attempts (31% in the first transfer with a risk factor prevalence of 5%, to 8% in the fourth transfer with a risk factor prevalence of 50%). As the prevalence increased, the clinical pregnancy rate was higher with strategy A. For strategy B, the clinical pregnancy rates for the modelled cohort decreased with each subsequent IVF attempt. Regardless of the prevalence of the risk factor, the decline in clinical pregnancy rate was less strong (from 32% in the first transfer with a prevalence of 5%, to 25% in the fourth transfer with a prevalence of 50%). When applying the model to the literature studies, the trends expected for strategy B (decreasing clinical pregnancy rates) were not expressed. CONCLUSIONS RIF might therefore be of iatrogenic origin due to the low success rate of IVF and might be triggered by the increasing female age associated with higher numbers of RIF.
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Affiliation(s)
- E R Cutting
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.
| | - K S Abdallah
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia; Department of Obstetrics and Gynaecology, Assiut University, Assiut, Egypt
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia; Womens and Children's Program Monash Health, Clayton, Melbourne, Victoria, Australia; Aberdeen Centre for Women's Health Research, School of Medicine, University of Aberdeen, Aberdeen, UK
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9
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Wang SF, Seifer DB. Assessment of a Decade of Change in U.S. Assisted Reproductive Technology Cumulative Live-Birth Rates: 2004-2009 Compared With 2014-2020. Obstet Gynecol 2024; 143:839-848. [PMID: 38696814 DOI: 10.1097/aog.0000000000005598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 03/29/2024] [Indexed: 05/04/2024]
Abstract
OBJECTIVE To assess the effects of demographic shifts, changes in contemporaneous clinical practices, and technologic innovation on assisted reproductive technology (ART) success rates by conducting an analysis of cumulative live-birth rates across different time periods, age groups, and infertility diagnoses. METHODS We conducted a retrospective cohort study of autologous linked cycles comparing cumulative live-birth rates over successive cycles from patients undergoing their first retrieval between 2014 and 2019 in the SART CORS (Society for Assisted Reproductive Technology Clinic Outcome Reporting System) database. All cycles reported for these individuals up to 2020 were included for analysis. We compared cumulative live-birth rates stratified by age and infertility cause with published data from the 2004-2009 SART CORS database. RESULTS From 2014 to 2019, 447,042 patients underwent their first autologous index retrieval, resulting in 1,007,374 cycles and 252,215 live births over the period of 2014 to 2020. In contrast, between 2004 and 2008, 246,740 patients underwent 471,208 cycles, resulting in 140,859 births by 2009. Noteworthy shifts in demographics were observed, with an increase in people of color seeking reproductive technology (57.9% vs 51.7%, P <.001). There was also an increase in patients with diminished ovarian reserve and ovulatory disorders and a decrease in endometriosis, tubal, and male factor infertility ( P <.001). Previously associated with decreased odds of live birth, frozen embryo transfer and preimplantation genetic testing showed increased odds in 2014-2020. Preimplantation genetic testing rose from 3.4% to 36.0% and was associated with a lower cumulative live-birth rate for those younger than age 35 years ( P <.001) but a higher cumulative live-birth rate for those aged 35 years or older ( P <.001). Comparing 2014-2020 with 2004-2009 shows that the overall cumulative live-birth rate improved for patients aged 35 years or older and for all infertility diagnoses except ovulatory disorders ( P <.001). CONCLUSION This analysis provides insights into the changing landscape of ART treatments in the United States over the past two decades. The observed shifts in demographics, clinical practices, and technology highlight the dynamic nature of an evolving field of reproductive medicine. These findings may offer insight for clinicians to consider in counseling patients and to inform future research endeavors in the field of ART.
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Affiliation(s)
- Sarah F Wang
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
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10
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Tran HP, Nguyen NN, Ho NT, Tran TTT, Ly LT, Hoang TTD, Le DTP, Tzeng CR, Vo VT, Tran LG. The impacts of telemedicine on assisted reproduction: a systematic review and meta-analysis. Reprod Biomed Online 2024; 48:103752. [PMID: 38489925 DOI: 10.1016/j.rbmo.2023.103752] [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: 05/26/2023] [Revised: 10/14/2023] [Accepted: 10/24/2023] [Indexed: 03/17/2024]
Abstract
Telemedicine is being applied in assisted reproduction technology (ART) to provide remote consultations, monitoring and support for patients. This study aimed to evaluate the potential advantages of telemedicine in ART treatment in the form of virtual consultations. Studies in which patients were using telemedicine during ART treatment were identified from four scientific databases (PudMed, EMBASE, Scopus, Web of Science). The success of fertility treatments was compared between telemedicine and in-office care, and patient satisfaction with ART through telemedicine was assessed. Eleven studies, comprising 4697 patients, were identified. Quality assessment (Joanna Briggs Institute Critical Appraisal and revised Cochrane risk-of-bias tools) revealed an acceptable risk of bias for both randomized controlled trials and observational studies. Using a fixed-effects model, telemedicine was comparable to in-person care regarding the pregnancy rate achieved (odds ratio 1.02, 95% confidence intervals 0.83-1.26, P = 0.83). A Q-test suggested that all the included studies were homogeneous. Patients who received telemedicine during fertility treatment reported a high level of satisfaction (91%, 95% confidence intervals 80-96%). Egger's test confirmed that no publication bias was found. Telemedicine could serve as a complementary tool during fertility treatment to facilitate patients' satisfaction and overcome some practical problems without compromising treatment outcomes. Future studies should continue exploring the potential applications of telemedicine in assisted reproduction.
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Affiliation(s)
- Huy Phuong Tran
- Infertility Department, Hung Vuong Hospital, Ho Chi Minh City, Vietnam
| | - Nam Nhat Nguyen
- College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Nguyen-Tuong Ho
- College of Medicine, Taipei Medical University, Taipei, Taiwan.; Taipei Fertility Center, Taipei, Taiwan
| | | | - Loc Thai Ly
- Infertility Department, Hung Vuong Hospital, Ho Chi Minh City, Vietnam
| | | | | | - Chii-Ruey Tzeng
- College of Medicine, Taipei Medical University, Taipei, Taiwan.; Taipei Fertility Center, Taipei, Taiwan
| | - Van Toi Vo
- School of Biomedical Engineering, International University, Vietnam National University HCMC, Ho Chi Minh City, Vietnam
| | - Le-Giang Tran
- School of Biomedical Engineering, International University, Vietnam National University HCMC, Ho Chi Minh City, Vietnam..
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11
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Zhang Y, Gong X, Zhang M, Zhu Y, Wang P, Wang Z, Liu C, La X, Ding J. Establishment and validation of a nomogram for subsequent first-cycle live births in patients diagnosed with recurrent implantation failure: a population-based analysis. Front Endocrinol (Lausanne) 2024; 15:1334599. [PMID: 38505751 PMCID: PMC10950066 DOI: 10.3389/fendo.2024.1334599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/14/2024] [Indexed: 03/21/2024] Open
Abstract
Background The inability of patients with recurrent implantation failure (RIF) to achieve pregnancy and a live birth after multiple high-quality embryo transfer treatments has been recognized as a major obstacle to successful application of artificial reproductive technologies. The objective of this study was to establish and validate a nomogram for prediction of subsequent first-cycle live births to guide clinical practice in patients diagnosed with RIF. Methods A total of 538 patients who underwent in vitro fertilization/intracytoplasmic sperm injection treatment and were first diagnosed with RIF at the Reproductive Center of the First Affiliated Hospital of Xinjiang Medical University between January 2017 and December 2020 were enrolled. The patients were randomly divided into a training cohort (n=408) and a validation set (n=175) in a ratio of 7:3. A nomogram model was constructed using the training set based on the results of univariate and multivariate logistic regression analyses and validated in the validation set. Results Age, body mass index, duration of RIF, endometrial thickness, type of embryo transferred, and number of previous biochemical pregnancies were included in the nomogram for prediction of subsequent first-cycle live births in patients diagnosed with RIF. Analysis of the area under the receiver-operating characteristic curve, calibration plots, and decision curve analysis showed that our predictive model for live births had excellent performance. Conclusion We have developed and validated a novel predictive model that estimates a woman's chances of having a live birth after a diagnosis of RIF and provides clinicians with a personalized clinical decision-making tool.
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Affiliation(s)
- Yunian Zhang
- Department of Immunology, School of Basic Medical Sciences, Xinjiang Medical University, Urumqi, China
- Center for Reproductive Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Xinjiang Clinical Research Centre for Reproductive Immunology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiaoyun Gong
- Center for Reproductive Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Manli Zhang
- Center for Reproductive Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yuejie Zhu
- Center for Reproductive Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Peng Wang
- Center for Reproductive Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Zhihui Wang
- Center for Reproductive Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Chen Liu
- Center for Reproductive Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiaolin La
- Center for Reproductive Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Xinjiang Clinical Research Centre for Reproductive Immunology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jianbing Ding
- Department of Immunology, School of Basic Medical Sciences, Xinjiang Medical University, Urumqi, China
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Chien CW, Tang YA, Jeng SL, Pan HA, Sun HS. Blastocyst telomere length predicts successful implantation after frozen-thawed embryo transfer. Hum Reprod Open 2024; 2024:hoae012. [PMID: 38515829 PMCID: PMC10955253 DOI: 10.1093/hropen/hoae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 02/04/2024] [Indexed: 03/23/2024] Open
Abstract
STUDY QUESTION Do embryos with longer telomere length (TL) at the blastocyst stage have a higher capacity to survive after frozen-thawed embryo transfer (FET)? SUMMARY ANSWER Digitally estimated TL using low-pass whole genome sequencing (WGS) data from the preimplantation genetic testing for aneuploidy (PGT-A) process demonstrates that blastocyst TL is the most essential factor associated with likelihood of implantation. WHAT IS KNOWN ALREADY The lifetime TL is established in the early cleavage cycles following fertilization through a recombination-based lengthening mechanism and starts erosion beyond the blastocyst stage. In addition, a telomerase-mediated slow erosion of TL in human fetuses has been observed from a gestational age of 6-11 weeks. Finally, an abnormal shortening of telomeres is likely involved in embryo loss during early development. STUDY DESIGN SIZE DURATION Blastocyst samples were obtained from patients who underwent PGT-A and FET in an IVF center from March 2015 to May 2018. Digitally estimated mitochondrial copy number (mtCN) and TL were used to study associations with the implantation potential of each embryo. PARTICIPANTS/MATERIALS SETTING AND METHODS In total, 965 blastocysts from 232 cycles (164 patients) were available to investigate the biological and clinical relevance of TL. A WGS-based workflow was applied to determine the ploidy of each embryo. Data from low-pass WGS-PGT-A were used to estimate the mtCN and TL for each embryo. Single-variant and multi-variant logistic regression, decision tree, and random forest models were applied to study various factors in association with the implantation potential of each embryo. MAIN RESULTS AND THE ROLE OF CHANCE Of the 965 blastocysts originally available, only 216 underwent FET. While mtCN from the transferred embryos is significantly associated with the ploidy call of each embryo, mtCN has no role in impacting IVF outcomes after an embryo transfer in these women. The results indicate that mtCN is a marker of embryo aneuploidy. On the other hand, digitally estimated TL is the most prominent univariant factor and showed a significant positive association with pregnancy outcomes (P < 0.01, odds ratio 79.1). We combined several maternal and embryo parameters to study the joint effects on successful implantation. The machine learning models, namely decision tree and random forest, were trained and yielded classification accuracy of 0.82 and 0.91, respectively. Taken together, these results support the vital role of TL in governing implantation potential, perhaps through the ability to control embryo survival after transfer. LIMITATIONS REASONS FOR CAUTION The small sample size limits our study as only 216 blastocysts were transferred. The number was further reduced to 153 blastocysts, where pregnancy outcomes could be accurately traced. The other limitation of this study is that all data were collected from a single IVF center. The uniform and controlled operation of IVF cycles in a single center may cause selection bias. WIDER IMPLICATIONS OF THE FINDINGS We present novel findings to show that digitally estimated TL at the blastocyst stage is a predictor of pregnancy capacity after a FET cycle. As elective single-embryo transfer has become the mainstream direction in reproductive medicine, prioritizing embryos based on their implantation potential is crucial for clinical infertility treatment in order to reduce twin pregnancy rate and the time to pregnancy in an IVF center. The AI-powered, random forest prediction model established in this study thus provides a way to improve clinical practice and optimize the chances for people with fertility problems to achieve parenthood. STUDY FUNDING/COMPETING INTERESTS This study was supported by a grant from the National Science and Technology Council, Taiwan (MOST 108-2321-B-006-013 -). There were no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Chun-Wei Chien
- Center for Genomic Medicine, Innovation Headquarters, National Cheng Kung University, Tainan, Taiwan
| | - Yen-An Tang
- Center for Genomic Medicine, Innovation Headquarters, National Cheng Kung University, Tainan, Taiwan
- Institute of Molecular Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shuen-Lin Jeng
- Department of Statistics, Institute of Data Science, National Cheng Kung University, Tainan, Taiwan
- Center for Innovative FinTech Business Models, National Cheng Kung University, Tainan, Taiwan
| | - Hsien-An Pan
- IVF center, An-An Women and Children Clinic, Tainan, Taiwan
- Department of Obstetrics and Gynecology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - H Sunny Sun
- Center for Genomic Medicine, Innovation Headquarters, National Cheng Kung University, Tainan, Taiwan
- Institute of Molecular Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Bui BN, Ardisasmita AI, Kuijk E, Altmäe S, Steba G, Mackens S, Fuchs S, Broekmans F, Nieuwenhuis E. An unbiased approach of molecular characterization of the endometrium: toward defining endometrial-based infertility. Hum Reprod 2024; 39:275-281. [PMID: 38099857 PMCID: PMC10833067 DOI: 10.1093/humrep/dead257] [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: 07/14/2023] [Revised: 10/01/2023] [Indexed: 02/02/2024] Open
Abstract
Infertility is a complex condition affecting millions of couples worldwide. The current definition of infertility, based on clinical criteria, fails to account for the molecular and cellular changes that may occur during the development of infertility. Recent advancements in sequencing technology and single-cell analysis offer new opportunities to gain a deeper understanding of these changes. The endometrium has a potential role in infertility and has been extensively studied to identify gene expression profiles associated with (impaired) endometrial receptivity. However, limited overlap among studies hampers the identification of relevant downstream pathways that could play a role in the development of endometrial-related infertility. To address these challenges, we propose sequencing the endometrial transcriptome of healthy and infertile women at the single-cell level to consistently identify molecular signatures. Establishing consensus on physiological patterns in endometrial samples can aid in identifying deviations in infertile patients. A similar strategy has been used with great success in cancer research. However, large collaborative initiatives, international uniform protocols of sample collection and processing are crucial to ensure reliability and reproducibility. Overall, the proposed approach holds promise for an objective and accurate classification of endometrial-based infertility and has the potential to improve diagnosis and treatment outcomes.
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Affiliation(s)
- Bich Ngoc Bui
- Department of Gynaecology and Reproductive Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Ewart Kuijk
- Department of Pediatric Gastroenterology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Signe Altmäe
- Department of Biochemistry and Molecular Biology, Faculty of Sciences, University of Granada, Granada, Spain
| | - Gaby Steba
- Department of Gynaecology and Reproductive Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Shari Mackens
- Brussels IVF, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sabine Fuchs
- Department of Metabolic Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank Broekmans
- Department of Gynaecology and Reproductive Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
- Centre for Infertility Care, Dijklander Ziekenhuis, Purmerend, The Netherlands
| | - Edward Nieuwenhuis
- Department of Pediatric Gastroenterology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Science, University College Roosevelt, Middelburg, The Netherlands
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14
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Zhang WB, Li J, Li Q, Lu X, Chen JL, Li L, Chen H, Fu W, Chen JC, Lu BJ, Wu H, Sun XX. Endometrial transcriptome profiling of patients with recurrent implantation failure during hormone replacement therapy cycles. Front Endocrinol (Lausanne) 2024; 14:1292723. [PMID: 38352249 PMCID: PMC10863671 DOI: 10.3389/fendo.2023.1292723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/28/2023] [Indexed: 02/16/2024] Open
Abstract
Background The molecular mechanisms underlying window of implantation (WOI) displacement in patients with recurrent implantation failure (RIF) remain unclear. This study aims to explore the transcriptomic signatures of endometrium with normal and displaced WOIs and to identify the causes of endometrial receptivity (ER) abnormalities and WOI displacement in RIF patients. Methods In this study, 40 RIF patients were recruited and underwent personalized embryo transfer (pET) guided by the predicted results of endometrial receptivity diagnosis (ERD) model. Transcriptome analysis of endometrium from patients with clinical pregnancies after pET was performed to identify differentially expressed genes (DEGs) associated with WOI displacement. Gene expression data from HRT and natural cycle endometrium were compared to identify specific gene expression patterns of ER-related genes during WOI. Results The ERD results indicated that 67.5% of RIF patients (27/40) were non-receptive in the conventional WOI (P+5) of the HRT cycle. The clinical pregnancy rate in RIF patients improved to 65% (26/40) after ERD-guided pET, indicating the effectiveness of transcriptome-based WOI prediction. Among the 26 patients with clinical pregnancy, the gene expression profiles of P+5 endometrium from advanced (n=6), normal (n=10) and delayed (n=10) WOI groups were significantly different from each other. Furthermore, 10 DEGs identified among P+5 endometrium of 3 groups were involved in immunomodulation, transmembrane transport and tissue regeneration, which could accurately classify the endometrium with different WOIs. Additionally, a large number of ER-related genes showed significant correlation and similar gene expression patterns in P+3, P+5, and P+7 endometrium from HRT cycles and LH+5, LH+7, and LH+9 endometrium from natural cycles. Conclusion Our study shows that ER-related genes share similar gene expression patterns during WOI in both natural and HRT cycles, and their aberrant expression is associated with WOI displacements. The improvement of pregnancy outcomes in RIF patients by adjusting ET timing according to ERD results demonstrates the importance of transcriptome-based endometrial receptivity assessment and the clinical efficiency of ERD model.
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Affiliation(s)
- Wen-bi Zhang
- Shanghai Ji Ai Genetics and In vitro Fertilization and Embryo Transfer (IVF-ET) Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Jue Li
- Unimed Biotech (Shanghai) Co., Ltd., Shanghai, China
| | - Qing Li
- Unimed Biotech (Shanghai) Co., Ltd., Shanghai, China
| | - Xiang Lu
- Shanghai Ji Ai Genetics and In vitro Fertilization and Embryo Transfer (IVF-ET) Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Jun-ling Chen
- Shanghai Ji Ai Genetics and In vitro Fertilization and Embryo Transfer (IVF-ET) Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Lu Li
- Shanghai Ji Ai Genetics and In vitro Fertilization and Embryo Transfer (IVF-ET) Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Hua Chen
- Shanghai Ji Ai Genetics and In vitro Fertilization and Embryo Transfer (IVF-ET) Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Wei Fu
- Shanghai Ji Ai Genetics and In vitro Fertilization and Embryo Transfer (IVF-ET) Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | | | - Bing-jie Lu
- Unimed Biotech (Shanghai) Co., Ltd., Shanghai, China
| | - Han Wu
- Unimed Biotech (Shanghai) Co., Ltd., Shanghai, China
| | - Xiao-xi Sun
- Shanghai Ji Ai Genetics and In vitro Fertilization and Embryo Transfer (IVF-ET) Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Key Laboratory of Female Reproductive Endocrine-Related Diseases, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
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Ben Messaoud K, Bouyer J, Guibert J, de La Rochebrochard E. The burden of very early dropout in infertility care: a nationwide population-based cohort study. Hum Reprod 2024; 39:102-107. [PMID: 37898958 PMCID: PMC10767936 DOI: 10.1093/humrep/dead226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/11/2023] [Indexed: 10/31/2023] Open
Abstract
STUDY QUESTION What is the frequency and the associated factors of very early dropout following unsuccessful clomiphene citrate (CC)/gonadotropin treatment in the context of full coverage of treatment cost. SUMMARY ANSWER Despite free treatment, almost one in four women had a very early dropout following unsuccessful CC/gonadotropin treatment, with patients below the poverty line being more likely to drop out early. WHAT IS KNOWN ALREADY Success of infertility care is tarnished by very high dropout rates. Infertility care dropout has been considered as resulting principally from financial barriers because of the high cost of treatment. Nearly all previous work addressed dropout following IVF/ICSI. Factors associated with dropout following CC/gonadotropins may be different and also need to be investigated. STUDY DESIGN, SIZE, DURATION Nationwide population-based cohort study. PARTICIPANTS/MATERIALS, SETTING, METHODS Using the French national health insurance and hospital databases, we included in the cohort 27 416 women aged 18-49 years unsuccessfully treated with CC/gonadotropins in 2017. The main outcome was very early dropout, defined as discontinuation of all infertility treatment after unsuccessful treatment for 1-3 months. Very early treatment dropout was analysed by multivariate logistic regression. MAIN RESULTS AND THE ROLE OF CHANCE Among women unsuccessfully treated with CC/gonadotropins, 22% dropped out of infertility care within 3 months. In multivariate analysis, higher early dropout following unsuccessful CC/gonadotropin treatment was associated with older and younger ages (≥35 and <25 years), being below the poverty line, being treated with CC prescribed by a general practitioner and lack of infertility tests or monitoring. LIMITATIONS, REASONS FOR CAUTION This study is based on health administrative data that do not include reasons for dropout and record only a limited amount of information. It is thus not possible to analyse the reason for early dropout. WIDER IMPLICATIONS OF THE FINDINGS Despite full coverage of all infertility treatment, women under the poverty line have a higher risk of very early dropout following unsuccessful CC/gonadotropin treatment. Better understanding is needed of the non-financial barriers and difficulties faced by these patients. To address disparities in infertility treatment, practitioner training could be reinforced to adapt to patients from different social and cultural backgrounds. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the ANR StimHo project, grant ANR-17-CE36-0011-01 from the French Agence Nationale de la Recherche. The authors have no conflict of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Khaoula Ben Messaoud
- Institut National d’Etudes Démographiques, Ined, Sexual and Reproductive Health and Rights Unit—UR14, Aubervilliers, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Villejuif, France
| | - Jean Bouyer
- Institut National d’Etudes Démographiques, Ined, Sexual and Reproductive Health and Rights Unit—UR14, Aubervilliers, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Villejuif, France
| | - Juliette Guibert
- Centre Médico-Chirurgical de la Baie de Morlaix, rond-point de la Vierge Noire, Morlaix, France
| | - Elise de La Rochebrochard
- Institut National d’Etudes Démographiques, Ined, Sexual and Reproductive Health and Rights Unit—UR14, Aubervilliers, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Villejuif, France
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Väinämö S, Saqib S, Kalliala I, Kervinen K, Luiro K, Niinimäki M, Halttunen-Nieminen M, Virtanen S, Nieminen P, Salonen A, Holster T. Longitudinal analysis of vaginal microbiota during IVF fresh embryo transfer and in early pregnancy. Microbiol Spectr 2023; 11:e0165023. [PMID: 37882794 PMCID: PMC10715154 DOI: 10.1128/spectrum.01650-23] [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: 05/09/2023] [Accepted: 09/08/2023] [Indexed: 10/27/2023] Open
Abstract
IMPORTANCE Infertility is a global public health issue which leads many couples to seek fertility treatments, of which in vitro fertilization (IVF) is considered to be the most effective. Still, only about one-third of the women achieve live birth after the first IVF embryo transfer (IVF-ET). Factors affecting embryo implantation are poorly known, but the female reproductive tract microbiota may play a key role. Our study confirms the beneficial role of vaginal lactobacilli, especially Lactobacillus crispatus, in the probability of achieving clinical pregnancy and live birth following IVF-ET. Our findings regarding the intra-individual shift of vaginal microbiota between non-pregnancy and pregnancy states are novel and provide new information about the dynamics of microbiota in the early steps of human reproduction. These findings may help clinicians in their attempts to optimize the conditions for ET by microbiota screening or modulation and timing the ET when the microbiota is the most favorable.
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Affiliation(s)
- Sofia Väinämö
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Schahzad Saqib
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Ilkka Kalliala
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Kaisa Kervinen
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kaisu Luiro
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maarit Niinimäki
- Department of Obstetrics and Gynaecology, Oulu University Hospital, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Mervi Halttunen-Nieminen
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Seppo Virtanen
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Pekka Nieminen
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anne Salonen
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tiina Holster
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Redelmeier DA, Zipursky JS. A Dose of Reality About Dose-Response Relationships. J Gen Intern Med 2023; 38:3604-3609. [PMID: 37783979 PMCID: PMC10713937 DOI: 10.1007/s11606-023-08395-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/24/2023] [Indexed: 10/04/2023]
Abstract
Observational research can be strengthened by examining potential dose-response relationships that correlate a clinical intervention with a patient outcome. Despite being a classic criterion for establishing causality, dose-response testing can be difficult to interpret in clinical medicine due to multiple diverse pitfalls. This review introduces a cautionary framework for investigators considering dose-response relationships in observational research to support evidence-based medicine. Each pitfall is illustrated with a specific example relevant when analyzing a dose-response relationship. Several pitfalls stem from faulty interpretation including confounding by indication and fallible range selection. Additional pitfalls relate to improper analysis including fitting a nonlinear model and misclassification error. Further pitfalls arise in special situations including subjective self-report and artifacts from survival bias. These caveats are common sources of misunderstanding in analyses that examine the link between varying exposures and the intensity of clinical outcomes. Awareness of specific pitfalls, we suggest, might help advance the conduct, application, and translation of dose-response relationships in observational research to inform evidence-based medical care.
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Affiliation(s)
- Donald A Redelmeier
- Department of Medicine, University of Toronto, Toronto, Canada.
- Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Toronto, Canada.
- Institute for Clinical Evaluative Sciences, Toronto, Canada.
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada.
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
| | - Jonathan S Zipursky
- Department of Medicine, University of Toronto, Toronto, Canada
- Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
- Division of Clinical Pharmacology & Toxicology, University of Toronto, Toronto, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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18
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Seifer DB, Wang SF, Frankfurter D. Cumulative live birth rates with autologous oocytes plateau with fewer number of cycles for each year of age > 42. Reprod Biol Endocrinol 2023; 21:94. [PMID: 37872609 PMCID: PMC10591412 DOI: 10.1186/s12958-023-01144-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 09/22/2023] [Indexed: 10/25/2023] Open
Abstract
OBJECTIVE To disaggregate the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) age category of " > 42" and compare age-stratified cumulative live birth rates (CLBR) > 42 years old. DESIGN Retrospective cohort study of autologous linked ART cycles. SETTING United States (US) National ART Database. PATIENT(S) Women > 42 years old without a history of prior ART cycles who underwent ART between 2014-2020 as reported to the SART CORS database. INTERVENTION(S) Disaggregate the SART CORS age category of " > 42" into age-stratified cumulative live birth rates (CLBR). MAIN OUTCOME MEASURE(S) Age-stratified cumulative live birth rates (CLBR) for women ≥ 43 years old. RESULTS Between 2014-2020, 24,650 women > 42 years old without history of prior ART underwent 58,132 cycles, resulting in 1,982 live births. Women ages 43, 44, 45, 46, 47, 48, 49, ≥ 50 achieved maximal CLBR of 9.7%, 8.6%, 5.0%, 3.6%, 2.5%, 1.5%, 2.7%, 1.3%, respectively. CLBR for women between 43-45 were significantly higher compared to those 46 and older (p < 0.05). Among women 46 and older, CLBR were not significantly different. Women ages 43 and 44 did not exhibit a significant increase in CLBR beyond the 5th cycle. Age 45 and 46 reached CLBR plateau by the 3rd cycle. Age ≥ 47 CLBR plateaued after the first cycle. After adjusting for age, race/ethnicity, BMI, nulliparity, etiology of infertility, number of oocytes retrieved, embryos transferred, blastocyst transfer, use of ICSI, PGT, and ART treatment cycle number, there was no association between markers of ovarian reserve (day 3 FSH and random AMH levels) and live birth for women > 42. CONCLUSIONS While CLBR of autologous cycles from women 42 or younger generally plateau by cycle number 5, age-stratified cycles from women > 42 plateau after fewer cycles to maximize CLBR. Patient and physician expectations for maximum CLBR beyond 42 may be practically based on fewer planned cycles before reaching an age-specific CLBR plateau than may have been previously expected.
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Affiliation(s)
- David B Seifer
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, Yale Fertility Center 200 West Campus Drive Orange, Orange, CT, USA.
| | - Sarah F Wang
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, Yale Fertility Center 200 West Campus Drive Orange, Orange, CT, USA
| | - David Frankfurter
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, Yale Fertility Center 200 West Campus Drive Orange, Orange, CT, USA
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19
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Fang Y, Jingjing F, Tiantain C, Huanhuan X, Qiaohua H. Impact of the number of previous embryo implantation failures on IVF/ICSI-ET pregnancy outcomes in patients younger than 40 years: a retrospective cohort study. Front Endocrinol (Lausanne) 2023; 14:1243402. [PMID: 37842291 PMCID: PMC10571131 DOI: 10.3389/fendo.2023.1243402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/31/2023] [Indexed: 10/17/2023] Open
Abstract
Objective The objective of this study was to examine the influence of repeated embryo implantation failures on pregnancy outcomes among patients under 40 years of age undergoing in vitro fertilization/intracytoplasmic sperm injection embryo transfer (IVF/ICSI-ET). Materials and methods A retrospective analysis was conducted on the clinical data of 13,172 patients who underwent 16,975 IVF/ICSI-ET treatment cycles at Henan Reproductive Hospital between January 1, 2015, and December 31, 2018. Patients were categorized into four groups based on the number of previous embryo implantation failure cycles: Group A=no implantation failure, Group B= 1 implantation failure, Group C=2 implantation failures, Group D=≥3 implantation failures. Baseline characteristics and pregnancy outcomes were compared among the four groups. The impact of the number of previous embryo implantation failures on pregnancy outcomes among IVF/ICSI-ET patients was investigated using univariate and multiple regression analyses. Results Univariate logistic regression analysis demonstrated that factors such as the number of previous embryo implantation failures, female age, basal follicle count, endometrial thickness, total number of oocytes retrieved, type of cycle, number of high-quality embryos transferred, and stage of embryo development significantly affected implantation rate, clinical pregnancy rate, early spontaneous abortion rate, and live birth rate (all P < 0.05). The duration of infertility and anti-Mullerian hormone (AMH) levels were also found to influence implantation rate, clinical pregnancy rate, and live birth rate (all P < 0.05). Upon conducting multivariate logistic regression analysis and adjusting for confounding factors such as age, AMH levels, basal follicle count, endometrial thickness, total number of oocytes obtained, cycle type, number of high-quality embryos transferred, ovarian stimulation protocol, and stage of embryo development, it was revealed that, compared to Group A, Groups B, C, and D exhibited significantly lower implantation and live birth rates, as well as a significantly higher risk of early spontaneous abortion (all P < 0.05). Conclusions The number of previous embryo implantation failures is an independent factor affecting implantation rate, clinical pregnancy rate, spontaneous abortion rate and live birth rate of patients underwent IVF/ICSI-ET. With the increase of the number of previous embryo implantation failures, the implantation rate, clinical pregnancy rate and live birth rate of patients underwent IVF/ICSI-ET decreased significantly, and the rate of early spontaneous abortion gradually increased.
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Affiliation(s)
- Yuan Fang
- Reproductive Medicine Center, Henan Provincial People's Hospital, Zhengzhou, China
- People's Hospital of Henan University, Zhengzhou, China
| | - Fan Jingjing
- Reproductive Medicine Center, Henan Provincial People's Hospital, Zhengzhou, China
- People's Hospital of Henan University, Zhengzhou, China
| | - Cheng Tiantain
- Reproductive Medicine Center, Henan Provincial People's Hospital, Zhengzhou, China
- People's Hospital of Henan University, Zhengzhou, China
| | - Xie Huanhuan
- Reproductive Medicine Center, Henan Provincial People's Hospital, Zhengzhou, China
- People's Hospital of Henan University, Zhengzhou, China
| | - He Qiaohua
- Reproductive Medicine Center, Henan Provincial People's Hospital, Zhengzhou, China
- People's Hospital of Henan University, People's Hospital of Zhengzhou University, Zhengzhou, China
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20
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Esposito G, Viganò P, Filippi F, Franchi M, Corrao G, Parazzini F, Somigliana E. The modest impact of assisted reproductive technology on the second birth: insights from a population-based study in Lombardy, Northern Italy. Eur J Obstet Gynecol Reprod Biol 2023; 288:56-60. [PMID: 37429199 DOI: 10.1016/j.ejogrb.2023.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND In the field of assisted reproductive technology (ART), family rate is a neglected but emerging issue. The aim of the study was to investigate the epidemiological impact of ART on the second birth during the period 2007-2020 in Lombardy, Northern Italy. METHODS We conducted a population-based study using administrative data from regional healthcare databases of Lombardy including first and second births occurred from 2007 to 2020. The proportion of deliveries after ART was calculated separately among first and second births. The probability of undergoing ART to achieve second birth compared to first one was estimated computing odds ratio (OR), crude and adjusted for maternal age, education, and nationality. We also assessed changes with age and calendar period. RESULTS We obtained a cohort including 553,190 first births and 317,976 second births. The proportion of ART babies among first and second births was 4.3% and 1.0% respectively (p < 0.001). The probability of undergoing ART to achieve second birth compared to first one, adjusted for age, education, and nationality, was 0.14 (95%CI: 0.13-0.15). The proportion of deliveries after ART increased with maternal age and along the calendar period but remained always markedly higher among first births rather than among second births. CONCLUSION ART played a significantly lower role in the determinism of the conception of a second birth in comparison to the conception of a first one.
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Affiliation(s)
- Giovanna Esposito
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Paola Viganò
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Filippi
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Franchi
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy
| | - Giovanni Corrao
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy
| | - Fabio Parazzini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Edgardo Somigliana
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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21
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Stein LJ, Rösner S, Lo Giudice A, Ditzen B, Wischmann T. Analysing medical predictors for the outcome of infertility treatment: a 5-year follow-up survey. Arch Gynecol Obstet 2023; 308:1007-1014. [PMID: 37347283 PMCID: PMC10348950 DOI: 10.1007/s00404-023-07097-3] [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: 01/12/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE For many couples, bearing children is a common life goal; however it cannot always be fulfilled. Undergoing infertility treatment does not always guarantee pregnancies and live births. Couples experience miscarriages and even discontinue infertility treatment. Significant medical predictors for the outcome of infertility treatment have yet to be fully identified. METHODS To further our understanding, a cross-sectional 5-year follow-up survey was undertaken, in which 95 women and 82 men that have been treated at the Women's Hospital of Heidelberg University participated. Binary logistic regressions, parametric and non-parametric methods were used for our sample to determine the relevance of biological (infertility diagnoses, maternal and paternal age) and lifestyle factors (smoking, drinking, over- and underweight) on the outcome of infertility treatment (clinical pregnancy, live birth, miscarriage, dropout rate). In addition, chi-square tests were used to examine differences in the outcome depending on the number of risk factors being present. RESULTS In the binary logistic regression models for clinical pregnancies, live births and drop outs were statistically significant only for the maternal age, whereas the maternal and paternal BMI, smoking, infertility diagnoses and infections showed no significant predicting effect on any of the outcome variables. A correlation between the number of risk factors and the outcome of infertility treatment could not be excluded. CONCLUSION The results confirm that maternal age has an effect on infertility treatment, whereas the relevance of other possible medical predictors remains unclear. Further large-scale studies should be considered to increase our knowledge on their predictive power.
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Affiliation(s)
- Lea Joana Stein
- Institute of Medical Psychology, Heidelberg University Hospital, Bergheimer Str. 20, 69115, Heidelberg, Germany.
| | - Sabine Rösner
- Department of Gynaecological Endocrinology and Fertility Disorders, Women's Hospital of Heidelberg University, Heidelberg, Germany
| | - Alessandra Lo Giudice
- Institute of Medical Psychology, Heidelberg University Hospital, Bergheimer Str. 20, 69115, Heidelberg, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Heidelberg University Hospital, Bergheimer Str. 20, 69115, Heidelberg, Germany
| | - Tewes Wischmann
- Institute of Medical Psychology, Heidelberg University Hospital, Bergheimer Str. 20, 69115, Heidelberg, Germany
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22
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Salih M, Austin C, Warty RR, Tiktin C, Rolnik DL, Momeni M, Rezatofighi H, Reddy S, Smith V, Vollenhoven B, Horta F. Embryo selection through artificial intelligence versus embryologists: a systematic review. Hum Reprod Open 2023; 2023:hoad031. [PMID: 37588797 PMCID: PMC10426717 DOI: 10.1093/hropen/hoad031] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/17/2023] [Indexed: 08/18/2023] Open
Abstract
STUDY QUESTION What is the present performance of artificial intelligence (AI) decision support during embryo selection compared to the standard embryo selection by embryologists? SUMMARY ANSWER AI consistently outperformed the clinical teams in all the studies focused on embryo morphology and clinical outcome prediction during embryo selection assessment. WHAT IS KNOWN ALREADY The ART success rate is ∼30%, with a worrying trend of increasing female age correlating with considerably worse results. As such, there have been ongoing efforts to address this low success rate through the development of new technologies. With the advent of AI, there is potential for machine learning to be applied in such a manner that areas limited by human subjectivity, such as embryo selection, can be enhanced through increased objectivity. Given the potential of AI to improve IVF success rates, it remains crucial to review the performance between AI and embryologists during embryo selection. STUDY DESIGN SIZE DURATION The search was done across PubMed, EMBASE, Ovid Medline, and IEEE Xplore from 1 June 2005 up to and including 7 January 2022. Included articles were also restricted to those written in English. Search terms utilized across all databases for the study were: ('Artificial intelligence' OR 'Machine Learning' OR 'Deep learning' OR 'Neural network') AND ('IVF' OR 'in vitro fertili*' OR 'assisted reproductive techn*' OR 'embryo'), where the character '*' refers the search engine to include any auto completion of the search term. PARTICIPANTS/MATERIALS SETTING METHODS A literature search was conducted for literature relating to AI applications to IVF. Primary outcomes of interest were accuracy, sensitivity, and specificity of the embryo morphology grade assessments and the likelihood of clinical outcomes, such as clinical pregnancy after IVF treatments. Risk of bias was assessed using the Modified Down and Black Checklist. MAIN RESULTS AND THE ROLE OF CHANCE Twenty articles were included in this review. There was no specific embryo assessment day across the studies-Day 1 until Day 5/6 of embryo development was investigated. The types of input for training AI algorithms were images and time-lapse (10/20), clinical information (6/20), and both images and clinical information (4/20). Each AI model demonstrated promise when compared to an embryologist's visual assessment. On average, the models predicted the likelihood of successful clinical pregnancy with greater accuracy than clinical embryologists, signifying greater reliability when compared to human prediction. The AI models performed at a median accuracy of 75.5% (range 59-94%) on predicting embryo morphology grade. The correct prediction (Ground Truth) was defined through the use of embryo images according to post embryologists' assessment following local respective guidelines. Using blind test datasets, the embryologists' accuracy prediction was 65.4% (range 47-75%) with the same ground truth provided by the original local respective assessment. Similarly, AI models had a median accuracy of 77.8% (range 68-90%) in predicting clinical pregnancy through the use of patient clinical treatment information compared to 64% (range 58-76%) when performed by embryologists. When both images/time-lapse and clinical information inputs were combined, the median accuracy by the AI models was higher at 81.5% (range 67-98%), while clinical embryologists had a median accuracy of 51% (range 43-59%). LIMITATIONS REASONS FOR CAUTION The findings of this review are based on studies that have not been prospectively evaluated in a clinical setting. Additionally, a fair comparison of all the studies were deemed unfeasible owing to the heterogeneity of the studies, development of the AI models, database employed and the study design and quality. WIDER IMPLICATIONS OF THE FINDINGS AI provides considerable promise to the IVF field and embryo selection. However, there needs to be a shift in developers' perception of the clinical outcome from successful implantation towards ongoing pregnancy or live birth. Additionally, existing models focus on locally generated databases and many lack external validation. STUDY FUNDING/COMPETING INTERESTS This study was funded by Monash Data Future Institute. All authors have no conflicts of interest to declare. REGISTRATION NUMBER CRD42021256333.
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Affiliation(s)
- M Salih
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Department of Data Science and Artificial Intelligence, Faculty of Information Technology, Monash University, Clayton, Victoria, Australia
| | - C Austin
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Department of Data Science and Artificial Intelligence, Faculty of Information Technology, Monash University, Clayton, Victoria, Australia
| | - R R Warty
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - C Tiktin
- School of Engineering, RMIT University, Melbourne, Victoria, Australia
| | - D L Rolnik
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Women’s and Newborn Program, Monash Health, Melbourne, Victoria, Australia
| | - M Momeni
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - H Rezatofighi
- Department of Data Science and Artificial Intelligence, Faculty of Information Technology, Monash University, Clayton, Victoria, Australia
- Monash Data Future Institute, Monash University, Clayton, Victoria, Australia
| | - S Reddy
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - V Smith
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - B Vollenhoven
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Women’s and Newborn Program, Monash Health, Melbourne, Victoria, Australia
- Monash IVF, Melbourne, Victoria, Australia
| | - F Horta
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Monash Data Future Institute, Monash University, Clayton, Victoria, Australia
- City Fertility, Melbourne, Victoria, Australia
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23
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Maignien C, Hachem RE, Bourdon M, Marcellin L, Chalas C, Patrat C, Gonzàlez-Foruria I, Chapron C, Santulli P. Oocyte donation outcomes in endometriosis patients with multiple IVF failures. Reprod Biomed Online 2023; 47:103236. [PMID: 37390602 DOI: 10.1016/j.rbmo.2023.05.008] [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: 02/03/2023] [Revised: 05/05/2023] [Accepted: 05/17/2023] [Indexed: 07/02/2023]
Abstract
RESEARCH QUESTION What are the reproductive outcomes and the prognostic factors of live birth rates in patients with endometriosis referred to oocyte donation after multiple IVF failures? DESIGN Observational cohort study including all women with endometriosis-related infertility and two or more failed IVF/intracytoplasmic sperm injection (ICSI) cycles referred to oocyte donation between January 2013 and June 2022. Endometriosis was diagnosed based on published imaging criteria, and was confirmed histologically in women who had a history of surgery for endometriosis. The main outcome measured was the cumulative live birth rate (CLBR). The characteristics of women who had a live birth were compared with those who did not using univariate and multivariate analysis to identify determinant factors of fertility outcome. RESULTS Fifty-seven patients underwent 90 oocyte donation cycles after 244 failed autologous IVF cycles. The mean ± SD age of the population was 36.8 ± 3.3 years, with a mean duration of infertility of 3.6 ± 2.2 years, and a mean number of autologous IVF/ICSI cycles of 4.4 ± 2.3 cycles per patient. Three patients (5.3%) had superficial peritoneal endometriosis, two patients (3.5%) had ovarian endometriomas, and 52 patients (91.2%) had deep infiltrating endometriosis, among which 30 patients (57.7%) had bowel lesions. Thirty patients (52.6%) had associated adenomyosis. Overall, CLBR per patient was 36/57 (63.2%). After multivariate analysis, only being nulligravida (P=0.002) remained an independent negative predictive factor of the live birth rate. Previous surgery did not impact reproductive outcomes. CONCLUSION This study suggests that oocyte donation appears to be a viable option to optimize the live birth rate in women with endometriosis-related infertility and recurrent IVF failures.
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Affiliation(s)
- Chloé Maignien
- Université Paris Cité, Faculté de Santé, 12 Rue de l'Ecole de Médecine, 75006 Paris, France; Department of Gynaecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, 123 Boulevard de Port Royal, 75014 Paris, France
| | - Rami El Hachem
- Université Paris Cité, Faculté de Santé, 12 Rue de l'Ecole de Médecine, 75006 Paris, France; Department of Gynaecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, 123 Boulevard de Port Royal, 75014 Paris, France
| | - Mathilde Bourdon
- Université Paris Cité, Faculté de Santé, 12 Rue de l'Ecole de Médecine, 75006 Paris, France; Department of Gynaecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, 123 Boulevard de Port Royal, 75014 Paris, France; Department of Development, Reproduction and Cancer, Cochin Institute, INSERM U1016, Paris, France
| | - Louis Marcellin
- Université Paris Cité, Faculté de Santé, 12 Rue de l'Ecole de Médecine, 75006 Paris, France; Department of Gynaecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, 123 Boulevard de Port Royal, 75014 Paris, France; Department of Development, Reproduction and Cancer, Cochin Institute, INSERM U1016, Paris, France
| | - Céline Chalas
- Université Paris Cité, Faculté de Santé, 12 Rue de l'Ecole de Médecine, 75006 Paris, France; Department of Histology and Reproductive Biology, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, 123 Boulevard de Port Royal, 75014 Paris, France
| | - Catherine Patrat
- Université Paris Cité, Faculté de Santé, 12 Rue de l'Ecole de Médecine, 75006 Paris, France; Department of Histology and Reproductive Biology, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, 123 Boulevard de Port Royal, 75014 Paris, France
| | - Iñaki Gonzàlez-Foruria
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Dexeus Mujer - Dexeus University Hospital, 08028 Barcelona, Spain; NatuVitro, Travessera de les Corts, 322, 08029 Barcelona, Spain
| | - Charles Chapron
- Université Paris Cité, Faculté de Santé, 12 Rue de l'Ecole de Médecine, 75006 Paris, France; Department of Gynaecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, 123 Boulevard de Port Royal, 75014 Paris, France; Department of Development, Reproduction and Cancer, Cochin Institute, INSERM U1016, Paris, France
| | - Pietro Santulli
- Université Paris Cité, Faculté de Santé, 12 Rue de l'Ecole de Médecine, 75006 Paris, France; Department of Gynaecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, 123 Boulevard de Port Royal, 75014 Paris, France; Department of Development, Reproduction and Cancer, Cochin Institute, INSERM U1016, Paris, France.
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Salas-Huetos A, Mitsunami M, Wang S, Mínguez-Alarcón L, Ribas-Maynou J, Yeste M, Souter I, Chavarro JE. Women's Adherence to Healthy Dietary Patterns and Outcomes of Infertility Treatment. JAMA Netw Open 2023; 6:e2329982. [PMID: 37594758 PMCID: PMC10439476 DOI: 10.1001/jamanetworkopen.2023.29982] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/28/2023] [Indexed: 08/19/2023] Open
Abstract
Importance Increasing evidence suggests that specific foods and nutrients may improve infertility treatment outcomes in women. However, less is known about the role of dietary patterns. Objective To investigate whether women's adherence to a priori-defined dietary patterns promoted for the prevention of chronic conditions is associated with outcomes of infertility treatment. Design, Setting, and Participants This prospective cohort study was conducted at a fertility center at an academic medical center in Boston, Massachusetts. Women undergoing infertility treatment cycles, including intrauterine insemination cycles and in vitro fertilization with or without intracytoplasmic sperm injection were included. Data were collected from January 2007 to October 2019, and data were analyzed from February to December 2022. Exposures Women's pretreatment diet was assessed with a validated food frequency questionnaire from which 8 a priori-defined scores were calculated (higher score indicates greater adherence): (1) Trichopoulou Mediterranean diet, (2) alternate Mediterranean diet, (3) Panagiotakos Mediterranean diet, (4) Healthy Eating Index, (5) Alternate Healthy Eating Index, (6) American Heart Association (AHA) index, (7) Dietary Approaches to Stop Hypertension index, and (8) plant-based diet. Main Outcomes and Measures The adjusted probability of clinically relevant outcomes (live birth as a primary outcome and clinical pregnancy and pregnancy loss as secondary outcomes) was evaluated across quartiles of adherence to each dietary pattern using multivariable generalized linear mixed models to account for repeated cycles. Results This analysis included 612 women with a median (IQR) age of 35.0 (32.0-38.0) years. There was no association between women's adherence to the 8 a priori dietary patterns and probability of clinical pregnancy or live birth following in vitro fertilization or intrauterine insemination. However, an inverse association was found between adherence to AHA dietary pattern and risks of total and clinical pregnancy loss. Among women who became pregnant during the course of infertility treatment, the adjusted probabilities of pregnancy loss in the lowest and highest quartile of the AHA dietary pattern were 0.41 (95% CI, 0.33-0.50) and 0.28 (95% CI, 0.21-0.36), respectively (P for trend = .02). The corresponding adjusted probabilities of clinical pregnancy loss were 0.30 (95% CI, 0.22-0.39) and 0.15 (95% CI, 0.10-0.23) (P for trend = .007). A similar pattern was observed for all other dietary patterns, with the exception of the plant-based diet pattern. Conclusions and Relevance Findings of this cohort study suggest that preconception adherence to the AHA diet may be associated with a lower likelihood of pregnancy loss during the course of infertility treatment.
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Affiliation(s)
- Albert Salas-Huetos
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Unit of Preventive Medicine and Public Health, Alimentació, Nutrició, Desenvolupament i Salut Mental, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
- Consorcio Centro de Investigación Biomédica en Red, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Makiko Mitsunami
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Siwen Wang
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Lidia Mínguez-Alarcón
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Jordi Ribas-Maynou
- Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, Girona, Spain
- Unit of Cell Biology, Faculty of Sciences, Department of Biology, University of Girona, Girona, Spain
| | - Marc Yeste
- Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, Girona, Spain
- Unit of Cell Biology, Faculty of Sciences, Department of Biology, University of Girona, Girona, Spain
| | - Irene Souter
- Massachusetts General Hospital Fertility Center and Harvard Medical School, Boston
| | - Jorge E. Chavarro
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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25
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Oluwayiose OA, Houle E, Whitcomb BW, Suvorov A, Rahil T, Sites CK, Krawetz SA, Visconti PE, Pilsner JR. Non-coding RNAs from seminal plasma extracellular vesicles and success of live birth among couples undergoing fertility treatment. Front Cell Dev Biol 2023; 11:1174211. [PMID: 37427387 PMCID: PMC10323426 DOI: 10.3389/fcell.2023.1174211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/12/2023] [Indexed: 07/11/2023] Open
Abstract
Background: Infertility remains a global health problem with male-factor infertility accounting for around 50% of cases. Understanding the molecular markers for the male contribution of live birth success has been limited. Here, we evaluated the expression levels of seminal plasma extracellular vesicle (spEV) non-coding RNAs (ncRNAs) in men of couples in relation with those with and without a successful live birth after infertility treatment. Method: Sperm-free spEV small RNA profiles were generated from 91 semen samples collected from male participants of couples undergoing assisted reproductive technology (ART) treatment. Couples were classified into two groups based on successful live birth (yes, n = 28) and (no, n = 63). Mapping of reads to human transcriptomes followed the order: miRNA > tRNA > piRNA > rRNA> "other" RNA > circRNA > lncRNA. Differential expression analysis of biotype-specific normalized read counts between groups were assessed using EdgeR (FDR<0.05). Result: We found a total of 12 differentially expressed spEV ncRNAs which included 10 circRNAs and two piRNAs between the live birth groups. Most (n = 8) of the identified circRNAs were downregulated in the no live birth group and targeted genes related to ontology terms such as negative reproductive system and head development, tissue morphogenesis, embryo development ending in birth or egg hatching, and vesicle-mediated transport. The differentially upregulated piRNAs overlapped with genomic regions including coding PID1 genes previously known to play a role in mitochondrion morphogenesis, signal transduction and cellular proliferation. Conclusion: This study identified novel ncRNAs profiles of spEVs differentiating men of couples with and without live birth and emphasizes the role of the male partner for ART success.
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Affiliation(s)
- Oladele A. Oluwayiose
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Emily Houle
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Brian W. Whitcomb
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, United States
| | - Alexander Suvorov
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, United States
| | - Tayyab Rahil
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Springfield, MA, United States
| | - Cynthia K. Sites
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Springfield, MA, United States
| | - Stephen A. Krawetz
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, School of Medicine, Wayne State University, Detroit, MI, United States
- Center for Molecular Medicine and Genetics, Wayne State School of Medicine, Detroit, MI, United States
| | - Pablo E. Visconti
- Department of Veterinary and Animal Sciences, University of Massachusetts Amherst, Amherst, MA, United States
| | - J. Richard Pilsner
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, School of Medicine, Wayne State University, Detroit, MI, United States
- Institute of Environmental Health Sciences, Wayne State University, Detroit, MI, United States
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Abstract
Embryo implantation in humans is interstitial, meaning the entire conceptus embeds in the endometrium before the placental trophoblast invades beyond the uterine mucosa into the underlying inner myometrium. Once implanted, embryo survival pivots on the transformation of the endometrium into an anti-inflammatory placental bed, termed decidua, under homeostatic control of uterine natural killer cells. Here, we examine the evolutionary context of embryo implantation and elaborate on uterine remodelling before and after conception in humans. We also discuss the interactions between the embryo and the decidualising endometrium that regulate interstitial implantation and determine embryo fitness. Together, this Review highlights the precarious but adaptable nature of the implantation process.
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Affiliation(s)
- Joanne Muter
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, CV2 2DX, UK
- Tommy's National Centre for Miscarriage Research, University Hospitals Coventry & Warwickshire NHS Trust, Warwick Medical School, University of Warwick, Coventry, CV2 2DX, UK
| | - Vincent J. Lynch
- Department of Biological Sciences, University at Buffalo, Buffalo, NY 14260-4610, USA
| | - Rajiv C. McCoy
- Department of Biology, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Jan J. Brosens
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, CV2 2DX, UK
- Tommy's National Centre for Miscarriage Research, University Hospitals Coventry & Warwickshire NHS Trust, Warwick Medical School, University of Warwick, Coventry, CV2 2DX, UK
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27
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Sun Y, Cui L, Lu Y, Tan J, Dong X, Ni T, Yan J, Guan Y, Hao G, Liu JY, Zhang B, Wei D, Hong Y, He Y, Qi J, Xu B, Lu J, Zhang Q, Zhao S, Ji X, Du X, Zhang J, Liu J, Wang J, Huang Y, Huang D, Du Y, Vankelecom H, Zhang H, Chen ZJ. Prednisone vs Placebo and Live Birth in Patients With Recurrent Implantation Failure Undergoing In Vitro Fertilization: A Randomized Clinical Trial. JAMA 2023; 329:1460-1468. [PMID: 37129654 PMCID: PMC10155063 DOI: 10.1001/jama.2023.5302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/18/2023] [Indexed: 05/03/2023]
Abstract
Importance Implantation failure remains a critical barrier to in vitro fertilization. Prednisone, as an immune-regulatory agent, is widely used to improve the probability of implantation and pregnancy, although the evidence for efficacy is inadequate. Objective To determine the efficacy of 10 mg of prednisone compared with placebo on live birth among women with recurrent implantation failure. Design, Setting, and Participants A double-blind, placebo-controlled, randomized clinical trial conducted at 8 fertility centers in China. Eligible women who had a history of 2 or more unsuccessful embryo transfer cycles, were younger than 38 years when oocytes were retrieved, and were planning to undergo frozen-thawed embryo transfer with the availability of good-quality embryos were enrolled from November 2018 to August 2020 (final follow-up August 2021). Interventions Participants were randomized (1:1) to receive oral pills containing either 10 mg of prednisone (n = 357) or matching placebo (n = 358) once daily, from the day at which they started endometrial preparation for frozen-thawed embryo transfer through early pregnancy. Main Outcomes and Measures The primary outcome was live birth, defined as the delivery of any number of neonates born at 28 or more weeks' gestation with signs of life. Results Among 715 women randomized (mean age, 32 years), 714 (99.9%) had data available on live birth outcomes and were included in the primary analysis. Live birth occurred among 37.8% of women (135 of 357) in the prednisone group vs 38.8% of women (139 of 358) in the placebo group (absolute difference, -1.0% [95% CI, -8.1% to 6.1%]; relative ratio [RR], 0.97 [95% CI, 0.81 to 1.17]; P = .78). The rates of biochemical pregnancy loss were 17.3% in the prednisone group and 9.9% in the placebo group (absolute difference, 7.5% [95% CI, 0.6% to 14.3%]; RR, 1.75 [95% CI, 1.03 to 2.99]; P = .04). Of those in the prednisone group, preterm delivery occurred among 11.8% and of those in the placebo group, 5.5% of pregnancies (absolute difference, 6.3% [95% CI, 0.2% to 12.4%]; RR, 2.14 [95% CI, 1.00 to 4.58]; P = .04). There were no statistically significant between-group differences in the rates of biochemical pregnancy, clinical pregnancy, implantation, neonatal complications, congenital anomalies, other adverse events, or mean birthweights. Conclusions and Relevance Among patients with recurrent implantation failure, treatment with prednisone did not improve live birth rate compared with placebo. Data suggested that the use of prednisone may increase the risk of preterm delivery and biochemical pregnancy loss. Our results challenge the value of prednisone use in clinical practice for the treatment of recurrent implantation failure. Trial Registration Chinese Clinical Trial Registry Identifier: ChiCTR1800018783.
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Affiliation(s)
- Yun Sun
- 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
| | - Linlin Cui
- Center for Reproductive Medicine, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Yao Lu
- 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
| | - Jichun Tan
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
- Key Laboratory of Reproductive Dysfunction Diseases and Fertility Remodeling of Liaoning Province, Shenyang, China
| | - Xi Dong
- Reproductive Medicine Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tianxiang Ni
- Center for Reproductive Medicine, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Junhao Yan
- Center for Reproductive Medicine, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Yichun Guan
- Reproductive Medicine Center, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guimin Hao
- Department of Reproductive Medicine, the Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jia-Yin Liu
- Department of Reproductive Medicine, the First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital, Nanjing, China
| | - Bo Zhang
- Center for Reproductive Medicine, Maternal and Child Health Hospital/Obstetrics and Gynecology Hospital of Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Daimin Wei
- Center for Reproductive Medicine, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Yan Hong
- 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
| | - Yaqiong He
- 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
| | - Jia Qi
- 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
| | - Juanjuan Lu
- Center for Reproductive Medicine, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Qian Zhang
- Center for Reproductive Medicine, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Shanshan Zhao
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
- Key Laboratory of Reproductive Dysfunction Diseases and Fertility Remodeling of Liaoning Province, Shenyang, China
| | - Xiaowei Ji
- Reproductive Medicine Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaofang Du
- Reproductive Medicine Center, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jie Zhang
- Department of Reproductive Medicine, the Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jinyong Liu
- Department of Reproductive Medicine, the First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital, Nanjing, China
| | - Jing Wang
- Department of Reproductive Medicine, the First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital, Nanjing, China
| | - Yingqin Huang
- Center for Reproductive Medicine, Maternal and Child Health Hospital/Obstetrics and Gynecology Hospital of Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Dongmei Huang
- Center for Reproductive Medicine, Maternal and Child Health Hospital/Obstetrics and Gynecology Hospital of Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Yanzhi Du
- 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
| | - Hugo Vankelecom
- Laboratory of Tissue Plasticity in Health and Disease, Cluster of Stem Cell and Developmental Biology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Heping Zhang
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut
| | - Zi-jiang Chen
- 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
- Center for Reproductive Medicine, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
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Ha M, Drees A, Myers M, Finkelstein ER, Dandulakis M, Reindorf M, Roque DM, Beall SA, Slezak S, Rasko YM. In vitro fertilization: a cross-sectional analysis of 58 US insurance companies. J Assist Reprod Genet 2023; 40:581-587. [PMID: 36542313 PMCID: PMC10033791 DOI: 10.1007/s10815-022-02697-5] [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: 09/07/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Infertility affects one in eight women in the USA. In vitro fertilization (IVF) is an effective but costly treatment that lacks uniform insurance coverage. We evaluated the current insurance coverage landscape for IVF in America. METHODS We conducted a cross-sectional analysis of 58 insurance companies with the greatest state enrollment and market share, calculated to represent the majority of Americans with health insurance. Individual companies were evaluated for a publicly available policy on IVF services by web-based search, telephone interview, or email to the insurer. Coverage status, required criteria, qualifying risk factors, and contraindications to coverage were extracted from available policies. RESULTS Fifty-one (88%) of the fifty-eight companies had a policy for IVF services. Thirty-five (69%) of these policies extended coverage. Case-by-case coverage was stated in seven policies (14%), while coverage was denied in the remaining nine (18%). The most common criterion to receive coverage was a documented diagnosis of infertility (n = 23, 66%), followed by care from a reproductive endocrinologist (n = 9, 26%). Twenty-three (45%) of the companies with a policy had at least one contraindication to coverage. Three companies (6%) limited the number of IVF cycles to be covered, capping payments after 3-4 lifetime cycles. CONCLUSION Most Americans with health insurance are provided a public policy regarding IVF. However, there is great variation in coverage and requirements to receive coverage between insurers. Coupled with inconsistencies in state-level mandates and available choices for employer-sponsored plans, this may limit coverage of IVF services and, therefore, access to infertility treatment.
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Affiliation(s)
- Michael Ha
- Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Abigail Drees
- Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Madalyn Myers
- Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Emily R Finkelstein
- Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
- Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Mary Dandulakis
- Department of Obstetrics and Gynecology, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Dana M Roque
- Division of Gynecologic Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Stephanie A Beall
- Department of Obstetrics and Gynecology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sheri Slezak
- Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Yvonne M Rasko
- Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
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Guan F, Zhang S, Fan L, Sun Y, Ma Y, Cao C, Zhang Y, He M, Du H. Kunling Wan improves oocyte quality by regulating the PKC/Keap1/Nrf2 pathway to inhibit oxidative damage caused by repeated controlled ovarian hyperstimulation. JOURNAL OF ETHNOPHARMACOLOGY 2023; 301:115777. [PMID: 36191663 DOI: 10.1016/j.jep.2022.115777] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/05/2022] [Accepted: 09/27/2022] [Indexed: 05/19/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Kunling Wan (KW) is a traditional Chinese medicine that is principally used for kidney deficiency, qi stagnation, and blood stasis, which are basic syndromes of infertility in China. KW can improve ovarian follicular development, ovarian function, and endometrial receptivity, which lead to improving pregnancy outcomes. Repeated controlled ovarian hyperstimulation (COH) reduces oocyte quality and results in a lower pregnancy rate. Whether KW has the potential to improve oocyte quality reduced by repeated COH has yet to be determined. AIMS OF THE STUDY The aim of this study wwas to evaluate the effect of KW on oocyte quality after damage due to repeated COH, and to investigate the mechanism(s) underlying the antioxidative protection of oocytes by mitochondria. MATERIALS AND METHODS Female Kunming mice were randomly divided into four groups: normal group, model (repeated COH) group, KW group, and N-acetylcysteine (NAC) group. We observed the morphology and quality of mitochondria, level of reactive oxygen species (ROS), and antioxidant enzymes activity of each group. Oocytes were treated with H2O2 and KW-containing serum, and we determined the antioxidant effects of KW on H2O2-treated oocytes and the mechanism involved in the regulation of Nrf2 in reducing oxidative damage. RESULTS Our results revealed that repeated COH caused oxidative damage and impaired oocyte mitochondrial function and structure, resulting in poor oocyte quality. KW pretreatment reduced oxidative damage by inhibiting ROS production and improving mitochondrial structure and function, thereby enhancing overall oocyte quality. In response to H2O2, KW activated the PKC/Keap1/Nrf2-signaling pathway and promoted the translocation of Nrf2 from the cytoplasm to the nucleus, which activated the expression of SOD and GSH-Px, and removed the excess ROS that caused the initial mitochondrial damage. CONCLUSIONS KW improved oocyte quality perturbed by repeated COH via reducing oxidative effects and improving mitochondrial function. The mechanism may be related to regulation of the PKC/Keap1/Nrf2 pathway in removing excess ROS.
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Affiliation(s)
- Fengli Guan
- Hebei Key Laboratory of Integrative Medicine on Liver-Kidney Patterns, Institute of Integrative Medicine, College of Integrative Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, 050200, China
| | - Shuancheng Zhang
- Hebei Key Laboratory of Integrative Medicine on Liver-Kidney Patterns, Institute of Integrative Medicine, College of Integrative Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, 050200, China
| | - Lijie Fan
- Hebei Key Laboratory of Integrative Medicine on Liver-Kidney Patterns, Institute of Integrative Medicine, College of Integrative Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, 050200, China
| | - Ying Sun
- Hebei Key Laboratory of Integrative Medicine on Liver-Kidney Patterns, Institute of Integrative Medicine, College of Integrative Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, 050200, China
| | - Yucong Ma
- Hebei Key Laboratory of Integrative Medicine on Liver-Kidney Patterns, Institute of Integrative Medicine, College of Integrative Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, 050200, China
| | - Can Cao
- Hebei Key Laboratory of Integrative Medicine on Liver-Kidney Patterns, Institute of Integrative Medicine, College of Integrative Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, 050200, China
| | - Yu Zhang
- Hebei Key Laboratory of Integrative Medicine on Liver-Kidney Patterns, Institute of Integrative Medicine, College of Integrative Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, 050200, China
| | - Ming He
- Hebei Key Laboratory of Integrative Medicine on Liver-Kidney Patterns, Institute of Integrative Medicine, College of Integrative Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, 050200, China.
| | - Hulan Du
- Hebei Key Laboratory of Integrative Medicine on Liver-Kidney Patterns, Institute of Integrative Medicine, College of Integrative Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, 050200, China.
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Akashi K, Yamada M, Jwa SC, Utsuno H, Kamijo S, Hirota Y, Tanaka M, Osuga Y, Kuji N. Artificial oocyte activation using Ca 2+ ionophores following intracytoplasmic sperm injection for low fertilization rate. Front Endocrinol (Lausanne) 2023; 14:1131808. [PMID: 36967799 PMCID: PMC10034378 DOI: 10.3389/fendo.2023.1131808] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/27/2023] [Indexed: 03/29/2023] Open
Abstract
This large multi-center retrospective study examined whether artificial oocyte activation (AOA) using Ca2+ ionophore following ICSI improves the live birth rate for couples with previous ICSI cycles of unexplained low fertilization rate. In this large-scale multi-center retrospective study conducted in Japan, data were collected from Keio University and 17 collaborating institutions of the Japanese Institution for Standardizing Assisted Reproductive Technology. Between January 2015 and December 2019, 198 couples were included in this study. Oocytes for both the intervention and control groups were procured from the same pool of couples. Oocytes obtained from ICSI cycles with no or low fertilization rate (<50%) with unknown causes were included in the control (conventional ICSI) group while oocytes procured from ICSI cycles followed by performing AOA were assigned to the intervention (ICSI-AOA) group. Those fertilized with surgically retrieved sperm were excluded. ICSI-AOA efficacy and safety were evaluated by comparing these two groups. Live birth rate was the primary outcome. The ICSI-AOA group (2,920 oocytes) showed a significantly higher live birth per embryo transfer rate (18.0% [57/316]) compared to that of the conventional ICSI group with no or low fertilization rate (1,973 oocytes; 4.7% [4/85]) (odds ratio 4.5, 95% confidence interval 1.6-12.6; P<0.05). A higher live birth rate was observed in younger patients without a history of oocyte retrieval. Miscarriage, preterm delivery, and fetal congenital malformation rates were similar between the two groups. ICSI-AOA may reduce fertilization failure without increasing risks during the perinatal period. AOA may be offered to couples with an ICSI fertilization rate < 50%.
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Affiliation(s)
- Kazuhiro Akashi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Mitsutoshi Yamada
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
- *Correspondence: Mitsutoshi Yamada,
| | - Seung Chik Jwa
- Department of Obstetrics and Gynecology, Saitama Medical University, Saitama, Japan
| | - Hiroki Utsuno
- Clinical Laboratory, Keio University Hospital, Tokyo, Japan
| | - Shintaro Kamijo
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Yasushi Hirota
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Mamoru Tanaka
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Naoaki Kuji
- Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo, Japan
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Tepla O, Topurko Z, Jirsova S, Moosova M, Fajmonova E, Cabela R, Komrskova K, Kratochvilova I, Masata J. Timing of ICSI with Respect to Meiotic Spindle Status. Int J Mol Sci 2022; 24:ijms24010105. [PMID: 36613547 PMCID: PMC9820079 DOI: 10.3390/ijms24010105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/11/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
The aim of this study was to evaluate the efficiency of using meiotic spindle (MS) visibility and relative position to the polar body (PB) as indicators of oocyte maturation in order to optimize intracytoplasmic sperm injection (ICSI) timing. This was a cohort study of patients younger than 40 years with planned ICSI, the timing of which was determined by MS status, compared with those without MS evaluation. The angle between PB and MS and MS visibility were evaluated by optical microscope with polarizing filter. Oocytes with MS evaluation were fertilized according to MS status either 5-6 h after ovum pick-up (OPU) or 7-8 h after OPU. Oocytes without MS evaluation were all fertilized 5-6 h after OPU. For patients over 35 years visualization of MS influenced pregnancy rate (PR): 182 patients with MS visualization had 32% PR (58/182); while 195 patients without MS visualization had 24% PR (47/195). For patients under 35 years, visualization of MS did not influence PR: 140 patients with MS visualization had 41% PR (58/140), while 162 patients without MS visualization had 41% PR (66/162). Visualization of MS therefore appears to be a useful parameter for assessment of oocyte maturity and ICSI timing for patients older than 35.
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Affiliation(s)
- Olga Tepla
- Department of Obstetrics and Gynaecology First Faculty of Medicine, Charles University and General University Hospital in Prague, Apolinarska 18, 128 08 Prague, Czech Republic
| | - Zinovij Topurko
- Department of Obstetrics and Gynaecology First Faculty of Medicine, Charles University and General University Hospital in Prague, Apolinarska 18, 128 08 Prague, Czech Republic
| | - Simona Jirsova
- Department of Obstetrics and Gynaecology First Faculty of Medicine, Charles University and General University Hospital in Prague, Apolinarska 18, 128 08 Prague, Czech Republic
| | - Martina Moosova
- Department of Obstetrics and Gynaecology First Faculty of Medicine, Charles University and General University Hospital in Prague, Apolinarska 18, 128 08 Prague, Czech Republic
| | - Eva Fajmonova
- Department of Obstetrics and Gynaecology First Faculty of Medicine, Charles University and General University Hospital in Prague, Apolinarska 18, 128 08 Prague, Czech Republic
| | - Radek Cabela
- Department of Obstetrics and Gynaecology First Faculty of Medicine, Charles University and General University Hospital in Prague, Apolinarska 18, 128 08 Prague, Czech Republic
| | - Katerina Komrskova
- Laboratory of Reproductive Biology, Institute of Biotechnology of the Czech Academy of Sciences, BIOCEV, Prumyslova 595, 252 50 Vestec, Czech Republic
- Department of Zoology, Faculty of Science, Charles University, Vinicna 7, 128 44 Prague, Czech Republic
| | - Irena Kratochvilova
- Institute of Physics of the Czech Academy of Sciences, Na Slovance 2, 182 21 Prague, Czech Republic
| | - Jaromir Masata
- Department of Obstetrics and Gynaecology First Faculty of Medicine, Charles University and General University Hospital in Prague, Apolinarska 18, 128 08 Prague, Czech Republic
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Vuong VVH, Tran TH, Nguyen PD, Thi NN, Le Thi P, Minh Nguyet DT, Nguyen MH, Bui TH, Ta TV, Tran VK. Feasibility of combining short tandem repeats (STRs) haplotyping with preimplantation genetic diagnosis (PGD) in screening for beta thalassemia. PLoS One 2022; 17:e0278539. [PMID: 36476827 PMCID: PMC9728894 DOI: 10.1371/journal.pone.0278539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
β-thalassemia is an autosomal recessive disease with the reduction or absence in the production of β-globin chain in the hemoglobin, which is caused by mutations in the Hemoglobin subunit beta (HBB) gene. In Vietnam, the number of β-thalassemia carriers range from 1.5 to 25.0%, depending on ethnic and geographical areas, which is much higher than WHO's data worldwide (1.5%). Hence, preimplantation genetic diagnosis (PGD) plays a crucial role in reducing the rate of β-thalassemia affected patients/carriers. In this research, we report the feasibility and reliability of conducting PGD in combination with the use of short tandem repeat (STR) markers in facilitating the birth of healthy children. Six STRs, which were reported to closely linked with the HBB gene, were used on 15 couples of β-thalassemia carriers. With 231 embryos, 168 blastocysts were formed (formation rate of 72.73%), and 88 were biopsied and examined with STRs haplotyping and pedigree analysis. Thus, the results were verified by Sanger sequencing, as a definitive diagnosis. Consequently, 11 over 15 couples have achieved pregnancy of healthy or at least asymptomatic offspring. Only three couples failed to detect any signs of pregnancy such as increased Human Chorionic Gonadotropin (HCG) level, foetal sac, or heart; and one couple has not reached embryo transfer as they were proposed to continue with HLA-matching to screen for a potential umbilical cord blood donor sibling. Thus, these results have indicated that the combination of PGD with STRs analysis confirmed by Sanger sequencing has demonstrated to be a well-grounded and practical clinical strategy to improve the detection of β-thalassemia in the pregnancies of couples at-risk before embryo transfer, thus reducing β-thalassemia rate in the population.
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Affiliation(s)
- Vu Viet Ha Vuong
- Center for Gene and Protein Research, Hanoi Medical University, Hanoi, Vietnam
- Hospital of Post and Telecommunications, Hanoi, Vietnam
| | - Thinh Huy Tran
- Center for Gene and Protein Research, Hanoi Medical University, Hanoi, Vietnam
- Biochemistry Department, Hanoi Medical University, Hanoi, Vietnam
- Hanoi Medical University Hospital, Hanoi Medical University, Hanoi, Vietnam
| | - Phuoc-Dung Nguyen
- Center for Gene and Protein Research, Hanoi Medical University, Hanoi, Vietnam
| | | | - Phuong Le Thi
- Center for Gene and Protein Research, Hanoi Medical University, Hanoi, Vietnam
| | | | - Manh-Ha Nguyen
- Hanoi Medical University Hospital, Hanoi Medical University, Hanoi, Vietnam
| | - The-Hung Bui
- Center for Gene and Protein Research, Hanoi Medical University, Hanoi, Vietnam
- Center for Molecular Medicine, Clinical Genetics Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Thanh Van Ta
- Center for Gene and Protein Research, Hanoi Medical University, Hanoi, Vietnam
- Biochemistry Department, Hanoi Medical University, Hanoi, Vietnam
- Hanoi Medical University Hospital, Hanoi Medical University, Hanoi, Vietnam
| | - Van-Khanh Tran
- Center for Gene and Protein Research, Hanoi Medical University, Hanoi, Vietnam
- * E-mail:
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Fragoulakis V, Mantis A, Christoforidis N, Dovas D, Deftereos S, Lainas T, Mantoudis E, Paraschos T, Sakellariou D, Makrakis E. Follitropin Alpha for assisted reproduction: an analysis based on a non-interventional study in Greece. Curr Med Res Opin 2022; 38:2227-2235. [PMID: 36193626 DOI: 10.1080/03007995.2022.2131303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To conduct an economic evaluation estimating the cost per live birth after controlled ovarian stimulation (COS) using Follitropin Alpha (Gonal-F), in the Greek National Health System setting. A secondary objective was to predict the live birth rateof the In Vitro Fertilization (IVF) procedure. METHODS A single arm, multi-center, prospective, non-interventional study was conducted on which economic, efficacy and safety data were collected by six of the largest IVF centers. The participants were 350 female patients. Three statistical methods were employed for the analysis of the study outcomes, namely (a) Generalized Linear Modeling for the estimation of the costs of IVF treatment, (b) multivariable logistic regression and (c) an Artificial Neural Network (ANN) model for live birth prediction. RESULTS The mean total cost of IVF therapy per patient was estimated at €3728 (95% CI: €3679-€3780), while the total cost per live birth was €14,872 (95% CI: €12,441-€17,951). The live birth rate after 3 complete IVF cycles was estimated at 22.9%, while the percentage of those suffering from OHSS was limited at 0.57%. In logistic regression, the Ovarian Sensitivity Index (OSI) was a factor found to be positively associated with live birth (OR 7.39, 95% CI: 1.84-29.71). For the ANN, important predictors included number of gestational sacs and the duration of infertility. CONCLUSION The present study constitutes the largest single-arm study based on real data in Greece to date. The cost of IVF treatment and the cost per live birth are not insignificant in this NHS setting. The live birth rate, cost per oocyte, and the cost per live birth are in line with literature. OSI was a main contributing factor to the accurate prediction of the live birth rate, while age and BMI were found to be negatively correlated.
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Affiliation(s)
| | - Andreas Mantis
- School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | | | | | | | - Tryfwnas Lainas
- Eugonia - Assisted Reproduction Unit Konstantinou Ventiri 7 (HILTON), Athens, Greece
| | - Evripidis Mantoudis
- Medically Assisted Reproduction Unit and Cryopreservation Bank, "Gennima", Athens, Greece
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Li J, Lyu S, Lyu S, Gao M. Pregnancy Outcomes in Double Stimulation versus Two Consecutive Mild Stimulations for IVF in Poor Ovarian Responders. J Clin Med 2022; 11:jcm11226780. [PMID: 36431256 PMCID: PMC9699477 DOI: 10.3390/jcm11226780] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/06/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022] Open
Abstract
To compare pregnancy outcomes between double stimulation (DouStim) and two consecutive mild stimulations in poor ovarian responders, this study retrospectively analyzed 281 patients diagnosed as having poor ovarian response (POR) who underwent oocytes retrieval for in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) from January 2018 to December 2020. They were divided into two groups: the DouStim group (n = 89) and the two consecutive mild stimulations group (n = 192). The results illustrated that there were no significant differences in the number of oocytes and 2PNs between the two groups. The number of frozen embryos [1 (0, 2) versus 1(0, 2)] was significantly lower and the proportion of patients without frozen embryos (39.3% versus 26.0%) was significantly higher in the DouStim group than in the two consecutive mild stimulations group (p < 0.05). There were no significant differences in the clinical pregnancy rate (CPR) and the cumulative live birth rate (CLBR) between the two groups (p > 0.05). The intra-subgroup comparison showed that in young POR patients under 35 years old, there were no significant differences in clinical indicators and pregnancy outcomes (p > 0.05). In elderly POR patients aged 35 years and above, the number of frozen embryos [1 (0, 1.5) versus 1 (0.25, 2)] (p < 0.01) was significantly lower in the DouStim group than in the two consecutive mild stimulations group, but the pregnancy outcomes were not significantly different (p > 0.05). In conclusion, the DouStim protocol is inferior to the two consecutive mild stimulations protocol in terms of the number of frozen embryos, which mainly occurs in elderly patients, but there is no difference in pregnancy outcomes between the two protocols.
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Tsafrir A, Ben-Ami I, Eldar-Geva T, Gal M, Dekel N, Levi H, Schonberger O, Srebnik N, Weintraub A, Goldberg D, Hyman J. Clinical outcome of planned oocyte cryopreservation at advanced age. J Assist Reprod Genet 2022; 39:2625-2633. [PMID: 36264444 PMCID: PMC9723084 DOI: 10.1007/s10815-022-02633-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/30/2022] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To report outcome of planned oocyte cryopreservation (POC) in the first 8 years of this treatment in our center. METHODS A retrospective study in a university-affiliated medical center. RESULTS A total of 446 women underwent POC during 2011-2018. Fifty-seven (13%) women presented to use these oocytes during the study period (until June 2021). POC was performed at a mean age of 37.9 ± 2.0 (range 33-41). Age at thawing was 43.3 ± 2.1 (range 38-49). A total of 34 (60%) women transferred their oocytes for thawing at other units. Oocyte survival after thawing was significantly higher at our center than following shipping to ancillary sites (78 vs. 63%, p = 0.047). Forty-nine women completed their treatment, either depleting their cryopreserved oocytes without conceiving (36) or attaining a live birth (13)-27% live birth rate per woman. Only one of eleven women who cryopreserved oocytes aged 40 and older had a live birth using thawed oocytes. CONCLUSION Women should be advised to complete planned oocyte cryopreservation before age 40, given low success rates in women who underwent cryopreservation at advanced reproductive age. In this study, oocyte shipping was associated with lower survival rate. These findings may be relevant for women considering POC and utilization of cryopreserved oocytes.
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Affiliation(s)
- Avi Tsafrir
- IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Shmu'el Bait St 12, 9103102, Jerusalem, Israel.
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Ido Ben-Ami
- IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Shmu'el Bait St 12, 9103102, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Talia Eldar-Geva
- IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Shmu'el Bait St 12, 9103102, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael Gal
- IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Shmu'el Bait St 12, 9103102, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nava Dekel
- IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Shmu'el Bait St 12, 9103102, Jerusalem, Israel
| | - Hadassah Levi
- IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Shmu'el Bait St 12, 9103102, Jerusalem, Israel
| | - Oshrat Schonberger
- IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Shmu'el Bait St 12, 9103102, Jerusalem, Israel
| | - Naama Srebnik
- IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Shmu'el Bait St 12, 9103102, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amir Weintraub
- IVF Unit, Laniado Medical Center and the Rappaport Faculty of Medicine-Technion, Netanya, Israel
| | - Doron Goldberg
- Clalit Health Services, Fertility clinic, Modi'in Illit, Israel
| | - Jordana Hyman
- IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Shmu'el Bait St 12, 9103102, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Learning from Online Video Education (LOVE) improves confidence in fertility treatments: a randomized controlled trial. NPJ Digit Med 2022; 5:128. [PMID: 36038614 PMCID: PMC9424217 DOI: 10.1038/s41746-022-00673-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
Fertility treatments like in vitro fertilization (IVF) or oocyte cryopreservation (OC) require the daily use of injectable gonadotropins and has been associated with treatment burden and attrition from fertility treatment. We conducted a randomized clinical trial to determine (1) whether educational videos about fertility medications improved infertility self-efficacy scale (ISES), fertility quality of life treatment (FertiQoL-T), and Perceived stress scale (PSS) scores and (2) if such videos improved confidence and reduced medication errors during a first ovarian stimulation cycle. Participants were given access to an online portal with randomized access to either placebo control videos focused on an orientation to IVF or experimental videos that reviewed the preparation and administration of medications used during ovarian stimulation in addition to the placebo videos. Participants completed pre and post-treatment questionnaires. 368 patients enrolled and 257 participants completed the study. There were no differences in ISES, FertiQoL-T or PSS scores between the two groups in an intention-to-treat (p = 0.18, 0.72, and 0.92, respectively) or per-protocol analysis (p = 0.11, 0.38, and 0.37, respectively). In the per protocol analysis, participants who watched experimental videos were four-fold more likely to report confidence administering medications OR 4.70 (95% CI: 2.10, 11.1; p < 0.01) and were 63% less likely to make medication errors OR 0.37 (95% CI: 0.14, 0.90; p = 0.03). Participants had similar likelihoods of rating videos as helpful and recommending videos to others (p = 0.06 and 0.3, respectively). Educational videos about fertility medications may not influence psychological well-being but might improve confidence in medication administration and reduce medication errors. Trial registration number: NCT02979990.
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Gao X, Sun S, Xie L, Lu S. Effects of donor sperm on perinatal and neonatal outcomes resulting from in vitro fertilization-intracytoplasmic sperm injection and embryo transfer cycles: a retrospective cohort study. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:819. [PMID: 36034991 PMCID: PMC9403916 DOI: 10.21037/atm-21-5492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 06/24/2022] [Indexed: 12/02/2022]
Abstract
Background The impact of donor sperm on pregnancy outcomes is controversial. The aim of this study was to investigate whether donor sperm in in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment could reduce the rate of live births or increase the incidence of adverse pregnancy outcomes and birth defects in neonates. Methods This single-centre, retrospective cohort study included 1,559 patients with infertility who received donor sperm at our hospital from 2015 to 2019. All the patients received fresh embryos and underwent first-cycle transfer. After propensity score matching, 4,677 controls who received their partners’ sperm were matched at 1:3. Clinical pregnancy, perinatal, and neonatal outcomes were compared between the donor sperm and partner sperm groups. Results The embryo development was better in the donor sperm group than in the partner sperm group. The high-quality embryo and available embryo rates were significantly higher in the donor sperm group (P<0.05 for both groups). The rate of high-quality embryos transferred from the donor sperm group was higher than that from the partner sperm group (P<0.05). The clinical pregnancy (62.99% vs. 59.65%; P=0.02) and live birth (54.65% vs. 51.59%; P=0.036) rates were higher in the donor sperm group. After adjusting for confounding factors, no significant difference in live birth rates was observed between the two groups (adjusted P=0.057). The low birthweight (18.21% vs. 21.39%; P=0.023) and small for gestational age (SGA) (7.60% vs. 11.97%; P<0.001) rates were lower in the donor sperm group. To exclude the effect of multiple pregnancies, we evaluated neonatal outcomes of singleton pregnancies. No significant differences were noted in preterm and very preterm birth, SGA, mean birthweight, high birthweight, and low birth weight (LBW) and very low birth weight (VLBW) rates (P>0.05 for both groups). Further, no significant between group differences were observed in the ectopic pregnancy rate, early and late spontaneous abortion rates, gestational age, rate of large for gestational age (LGA), and neonatal defects. Conclusions Compared with partner sperm, donor sperm did not reduce live birth rate and did not increase neonatal LBW or low birth defects.
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Affiliation(s)
- Xinyan Gao
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China.,Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, China
| | - Shihu Sun
- Tengzhou Maternal and Child Health Hospital, Zaozhuang, China
| | - Lei Xie
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China.,Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, China
| | - Shaoming Lu
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China.,Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, China
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Wu XW, Liu PP, Zou Y, Xu DF, Zhang ZQ, Cao LY, Lu-Fan, Xia LZ, Huang JL, Chen J, Xin CL, Huang ZH, Tan J, Wu QF, Li ZM. A novel heterozygous variant in PANX1 is associated with oocyte death and female infertility. J Assist Reprod Genet 2022; 39:1901-1908. [PMID: 35834089 PMCID: PMC9428072 DOI: 10.1007/s10815-022-02566-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 07/04/2022] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Oocyte death is a severe clinical phenotype that causes female infertility and recurrent in vitro fertilization and intracytoplasmic sperm injection failure. We aimed to identify pathogenic variants in a female infertility patient with oocyte death phenotype. METHODS Sanger sequencing was performed to screen PANX1 variants in the affected patient. Western blot analysis was used to check the effect of the variant on PANX1 glycosylation pattern in vitro. RESULTS We identified a novel PANX1 variant (NM_015368.4 c.86G > A, (p. Arg29Gln)) associated with the phenotype of oocyte death in a non-consanguineous family. This variant displayed an autosomal dominant inheritance pattern with reduced penetrance. Western blot analysis confirmed that the missense mutation of PANX1 (c.86G > A) altered the glycosylation pattern in HeLa cells. Moreover, the mutation effects on the function of PANX1 were weaker than recently reported variants. CONCLUSION Our findings expand the inheritance pattern of PANX1 variants to an autosomal dominant mode with reduced penetrance and enrich the variational spectrum of PANX1. These results help us to better understand the genetic basis of female infertility with oocyte death.
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Affiliation(s)
- Xing-Wu Wu
- Reproductive Medicine Center, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi 330006 People’s Republic of China
| | - Pei-Pei Liu
- Reproductive Medicine Center, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi 330006 People’s Republic of China ,JXHC Key Laboratory of Fertility Preservation, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi 330006 People’s Republic of China
| | - Yang Zou
- JXHC Key Laboratory of Fertility Preservation, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi 330006 People’s Republic of China ,Central Laboratory, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi 330006 People’s Republic of China
| | - Ding-Fei Xu
- Reproductive Medicine Center, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi 330006 People’s Republic of China
| | - Zhi-Qin Zhang
- Reproductive Medicine Center, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi 330006 People’s Republic of China
| | - Li-Yun Cao
- Reproductive Medicine Center, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi 330006 People’s Republic of China ,JXHC Key Laboratory of Fertility Preservation, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi 330006 People’s Republic of China
| | - Lu-Fan
- Reproductive Medicine Center, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi 330006 People’s Republic of China ,JXHC Key Laboratory of Fertility Preservation, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi 330006 People’s Republic of China
| | - Lei-Zhen Xia
- Reproductive Medicine Center, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi 330006 People’s Republic of China
| | - Jia-lv Huang
- Reproductive Medicine Center, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi 330006 People’s Republic of China
| | - Jia Chen
- Reproductive Medicine Center, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi 330006 People’s Republic of China
| | - Cai-Lin Xin
- Reproductive Medicine Center, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi 330006 People’s Republic of China
| | - Zhi-Hui Huang
- Reproductive Medicine Center, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi 330006 People’s Republic of China
| | - Jun Tan
- Reproductive Medicine Center, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi 330006 People’s Republic of China ,JXHC Key Laboratory of Fertility Preservation, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi 330006 People’s Republic of China
| | - Qiong-Fang Wu
- Reproductive Medicine Center, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi 330006 People’s Republic of China
| | - Zeng-Ming Li
- JXHC Key Laboratory of Fertility Preservation, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi 330006 People’s Republic of China
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Zhang X, Guan Q, Yu Q, Xiao W, Chen Z, Dong C, Deng S, Zhuang Y, Xia Y. Estimating the effects of policies on infertility prevalence worldwide. BMC Public Health 2022; 22:1378. [PMID: 35854262 PMCID: PMC9295370 DOI: 10.1186/s12889-022-13802-9] [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: 11/24/2021] [Accepted: 07/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Infertility has troubled millions of people worldwide while always being an ignored issue. The high cost of treatment or lack of services placed a barrier to the alleviation of infertility status. Governments play a significant role to promote infertility-related policies for better access to infertility services and comprehensive supports for infertile people. Methods Data of infertility status indicators and infertility-related policies in ten representative countries were collected. An infertility-related policy system was established, then classification and quantification were processed according to specific criteria, and different policy implementation patterns were identified. The effectiveness of specific infertility-related policy and various patterns on infertility prevalence relief between 1990 and 2017 were evaluated via generalized linear models and analyses of covariance for the first time. Results Economic support policies would be less prioritized compared with social security policies, while economic support policy had a significant positive role in the decline of female infertility prevalence (β = -2·16, p = 0·042). In detail, insurance coverage and economic reward policies were crucial (β = -3·31, p = 0·031; β = -4·10, p = 0·025) with adjusted with covariates. The effect of economic support-oriented pattern was relatively better than other patterns for both male and female infertility prevalence relief. Nevertheless, the effectiveness of gradual-promotion pattern seemed preferable for male infertility prevalence relief while was similar with simultaneous-promotion pattern for females. Conclusions Our data-driven analysis revealed that insurance coverage and economic reward policies played the pivotal role in moderation of female infertility status. Economic support-oriented pattern and gradual-promotion pattern were preferable when promoting infertility-related policies. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13802-9.
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Affiliation(s)
- Xiaochen Zhang
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, No.101 Longmian Road, Nanjing, 211166, China.,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Quanquan Guan
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, No.101 Longmian Road, Nanjing, 211166, China.,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Qiurun Yu
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, No.101 Longmian Road, Nanjing, 211166, China.,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Wenwen Xiao
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, No.101 Longmian Road, Nanjing, 211166, China.,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Ziyu Chen
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, No.101 Longmian Road, Nanjing, 211166, China.,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Chao Dong
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, No.101 Longmian Road, Nanjing, 211166, China.,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Siting Deng
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, No.101 Longmian Road, Nanjing, 211166, China.,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Yin Zhuang
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, No.101 Longmian Road, Nanjing, 211166, China.,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Yankai Xia
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, No.101 Longmian Road, Nanjing, 211166, China. .,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
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Elhakeem A, Taylor AE, Inskip HM, Huang J, Tafflet M, Vinther JL, Asta F, Erkamp JS, Gagliardi L, Guerlich K, Halliday J, Harskamp-van Ginkel MW, He JR, Jaddoe VWV, Lewis S, Maher GM, Manios Y, Mansell T, McCarthy FP, McDonald SW, Medda E, Nisticò L, de Moira AP, Popovic M, Reiss IKM, Rodrigues C, Salika T, Smith A, Stazi MA, Walker C, Wu M, Åsvold BO, Barros H, Brescianini S, Burgner D, Chan JKY, Charles MA, Eriksson JG, Gaillard R, Grote V, Håberg SE, Heude B, Koletzko B, Morton S, Moschonis G, Murray D, O’Mahony D, Porta D, Qiu X, Richiardi L, Rusconi F, Saffery R, Tough SC, Vrijkotte TGM, Nelson SM, Nybo Andersen AM, Magnus MC, Lawlor DA. Association of Assisted Reproductive Technology With Offspring Growth and Adiposity From Infancy to Early Adulthood. JAMA Netw Open 2022; 5:e2222106. [PMID: 35881399 PMCID: PMC9327583 DOI: 10.1001/jamanetworkopen.2022.22106] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/13/2022] [Indexed: 11/14/2022] Open
Abstract
Importance People conceived using assisted reproductive technology (ART) make up an increasing proportion of the world's population. Objective To investigate the association of ART conception with offspring growth and adiposity from infancy to early adulthood in a large multicohort study. Design, Setting, and Participants This cohort study used a prespecified coordinated analysis across 26 European, Asia-Pacific, and North American population-based cohort studies that included people born between 1984 and 2018, with mean ages at assessment of growth and adiposity outcomes from 0.6 months to 27.4 years. Data were analyzed between November 2019 and February 2022. Exposures Conception by ART (mostly in vitro fertilization, intracytoplasmic sperm injection, and embryo transfer) vs natural conception (NC; without any medically assisted reproduction). Main Outcomes and Measures The main outcomes were length / height, weight, and body mass index (BMI; calculated as weight in kilograms divided by height in meters squared). Each cohort was analyzed separately with adjustment for maternal BMI, age, smoking, education, parity, and ethnicity and offspring sex and age. Results were combined in random effects meta-analysis for 13 age groups. Results Up to 158 066 offspring (4329 conceived by ART) were included in each age-group meta-analysis, with between 47.6% to 60.6% females in each cohort. Compared with offspring who were NC, offspring conceived via ART were shorter, lighter, and thinner from infancy to early adolescence, with differences largest at the youngest ages and attenuating with older child age. For example, adjusted mean differences in offspring weight were -0.27 (95% CI, -0.39 to -0.16) SD units at age younger than 3 months, -0.16 (95% CI, -0.22 to -0.09) SD units at age 17 to 23 months, -0.07 (95% CI, -0.10 to -0.04) SD units at age 6 to 9 years, and -0.02 (95% CI, -0.15 to 0.12) SD units at age 14 to 17 years. Smaller offspring size was limited to individuals conceived by fresh but not frozen embryo transfer compared with those who were NC (eg, difference in weight at age 4 to 5 years was -0.14 [95% CI, -0.20 to -0.07] SD units for fresh embryo transfer vs NC and 0.00 [95% CI, -0.15 to 0.15] SD units for frozen embryo transfer vs NC). More marked differences were seen for body fat measurements, and there was imprecise evidence that offspring conceived by ART developed greater adiposity by early adulthood (eg, ART vs NC difference in fat mass index at age older than 17 years: 0.23 [95% CI, -0.04 to 0.50] SD units). Conclusions and Relevance These findings suggest that people conceiving or conceived by ART can be reassured that differences in early growth and adiposity are small and no longer evident by late adolescence.
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Affiliation(s)
- Ahmed Elhakeem
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Amy E. Taylor
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol, United Kingdom
| | - Hazel M. Inskip
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
| | - Jonathan Huang
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore
- Academic Clinical Program in Obstetrics and Gynaecology, Duke-NUS Medical School, Singapore
| | - Muriel Tafflet
- Université de Paris, National Institute for Health and Medical Research, National Research Institute for Agriculture, Food and Environment, Centre for Research in Epidemiology and Statistics, Paris, France
| | - Johan L. Vinther
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Federica Asta
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Jan S. Erkamp
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
- Department of Paediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Luigi Gagliardi
- Department of Mother and Child Health, Ospedale Versilia, Viareggio, Azienda Usl Toscana Nord Ovest, Pisa, Italy
| | - Kathrin Guerlich
- Division of Metabolic and Nutritional Medicine, Department of Pediatrics, Dr von Hauner Children’s Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Jane Halliday
- Murdoch Children’s Research Institute, Parkville, Australia
- University of Melbourne, Parkville, Australia
| | - Margreet W. Harskamp-van Ginkel
- Amsterdam University Medical Centers, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Jian-Rong He
- Division of Birth Cohort Study, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Vincent W. V. Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
- Department of Paediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Sharon Lewis
- Murdoch Children’s Research Institute, Parkville, Australia
- University of Melbourne, Parkville, Australia
| | - Gillian M. Maher
- School of Public Health, University College Cork, Cork, Ireland
- The Irish Centre for Maternal and Child Health Research, University College Cork, Cork, Ireland
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
- Institute of Agri-Food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece
| | - Toby Mansell
- Murdoch Children’s Research Institute, Parkville, Australia
- University of Melbourne, Parkville, Australia
| | - Fergus P. McCarthy
- The Irish Centre for Maternal and Child Health Research, University College Cork, Cork, Ireland
- Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Sheila W. McDonald
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Emanuela Medda
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | - Lorenza Nisticò
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | - Angela Pinot de Moira
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Maja Popovic
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Reference Centre for Epidemiology and Cancer Prevention Piemonte, Turin, Italy
| | - Irwin K. M. Reiss
- Department of Paediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Carina Rodrigues
- Epidemiology Research Unit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional, Porto, Portugal
| | - Theodosia Salika
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Ash Smith
- Centre for Longitudinal Research, He Ara ki Mua, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Maria A. Stazi
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | - Caroline Walker
- Centre for Longitudinal Research, He Ara ki Mua, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Muci Wu
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Bjørn O. Åsvold
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Levanger, Norway
- Department of Endocrinology, Clinic of Medicine, St. Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Henrique Barros
- Epidemiology Research Unit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional, Porto, Portugal
| | - Sonia Brescianini
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | - David Burgner
- Murdoch Children’s Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Department of Paediatrics, Monash University, Clayton, Australia
| | - Jerry K. Y. Chan
- Academic Clinical Program in Obstetrics and Gynaecology, Duke-NUS Medical School, Singapore
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, Singapore
| | - Marie-Aline Charles
- Université de Paris, National Institute for Health and Medical Research, National Research Institute for Agriculture, Food and Environment, Centre for Research in Epidemiology and Statistics, Paris, France
- National Institute for Demographic Studies, National Institute for Health and Medical Research, National Blood Service Joint Unit Elfe, Paris, France
| | - Johan G. Eriksson
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Romy Gaillard
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
- Department of Paediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Veit Grote
- Division of Metabolic and Nutritional Medicine, Department of Pediatrics, Dr von Hauner Children’s Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Siri E. Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Barbara Heude
- Université de Paris, National Institute for Health and Medical Research, National Research Institute for Agriculture, Food and Environment, Centre for Research in Epidemiology and Statistics, Paris, France
| | - Berthold Koletzko
- Division of Metabolic and Nutritional Medicine, Department of Pediatrics, Dr von Hauner Children’s Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Susan Morton
- Centre for Longitudinal Research, He Ara ki Mua, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - George Moschonis
- Department of Food, Nutrition and Dietetics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Deirdre Murray
- The Irish Centre for Maternal and Child Health Research, University College Cork, Cork, Ireland
- Department of Pediatrics and Child Health, University College Cork, Cork, Ireland
| | - Desmond O’Mahony
- National Longitudinal Study of Children in Ireland, Economic and Social Research Institute, Dublin, Ireland
| | - Daniela Porta
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Xiu Qiu
- Division of Birth Cohort Study, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Reference Centre for Epidemiology and Cancer Prevention Piemonte, Turin, Italy
| | - Franca Rusconi
- Department of Mother and Child Health, Ospedale Versilia, Viareggio, Azienda Usl Toscana Nord Ovest, Pisa, Italy
| | - Richard Saffery
- Murdoch Children’s Research Institute, Parkville, Australia
- University of Melbourne, Parkville, Australia
| | - Suzanne C. Tough
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Tanja G. M. Vrijkotte
- Amsterdam University Medical Centers, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Scott M. Nelson
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol, United Kingdom
- School of Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Maria C. Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Deborah A. Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol, United Kingdom
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Fan L, Guan F, Ma Y, Zhang Y, Li L, Sun Y, Cao C, Du H, He M. N-Acetylcysteine improves oocyte quality through modulating the Nrf2 signaling pathway to ameliorate oxidative stress caused by repeated controlled ovarian hyperstimulation. Reprod Fertil Dev 2022; 34:736-750. [PMID: 35513370 DOI: 10.1071/rd22020] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/14/2022] [Indexed: 01/02/2023] Open
Abstract
CONTEXT N -acetyl-cysteine (NAC) is a potent antioxidant that can be used for many gynecological diseases such as polycystic ovary syndrome and endometriosis. Controlled ovarian hyperstimulation (COH) is a critical step in infertility treatment. Our previous clinical studies have shown that repeated COH led to oxidative stress in follicle fluid and ovarian granulosa cells. AIMS In this study, we investigated whether NAC could inhibit oxidative stress in mice caused by repeated COH and improve the mitochondrial function of oocytes. METHODS Female Institute of Cancer Research (ICR) mice were randomly assigned into three groups: normal group, model (repeated COH) group, NAC group. We examined the morphology, number and quality of mitochondria. The mechanism of regulation of nuclear factor erythroid 2-related factor 2 (Nrf2) by NAC to ameliorate oxidative stress was also investigated. KEY RESULTS Repeated COH caused oxidative damage in ovaries and oocytes and decreased oocyte quality, while NAC prevented oxidative damage and increased oocyte mitochondrial function. In in vitro experiments, it was verified that NAC can promote the nuclear translocation of Nrf2, which transcriptionally activates the expression of superoxide dismutase and glutathione peroxidase, which removed excessive reactive oxygen species that causes mitochondria damage. CONCLUSIONS The results suggest that NAC raises mitochondrial function in oocytes and improves oocyte quality through decreasing oxidative stress in mice with repeated COH. The underlying mechanism is related to the regulation of the Nrf2 signaling pathway. IMPLICATION This study provides a meaningful foundation for the future clinical application of NAC during repeated COH.
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Affiliation(s)
- Lijie Fan
- College of Integrative Medicine, Hebei Medical University, Shijiazhuang, Hebei 050017, China; and Hebei Key Laboratory of Integrative Medicine on Liver-Kidney Patterns, Institute of Integrative Medicine, College of Integrative Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei 050091, China
| | - Fengli Guan
- Hebei Key Laboratory of Integrative Medicine on Liver-Kidney Patterns, Institute of Integrative Medicine, College of Integrative Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei 050091, China
| | - Yucong Ma
- Hebei Key Laboratory of Integrative Medicine on Liver-Kidney Patterns, Institute of Integrative Medicine, College of Integrative Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei 050091, China
| | - Yu Zhang
- Hebei Key Laboratory of Integrative Medicine on Liver-Kidney Patterns, Institute of Integrative Medicine, College of Integrative Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei 050091, China
| | - Li Li
- Reproductive Medicine Center, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Ying Sun
- Hebei Key Laboratory of Integrative Medicine on Liver-Kidney Patterns, Institute of Integrative Medicine, College of Integrative Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei 050091, China
| | - Can Cao
- Hebei Key Laboratory of Integrative Medicine on Liver-Kidney Patterns, Institute of Integrative Medicine, College of Integrative Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei 050091, China
| | - Huilan Du
- College of Integrative Medicine, Hebei Medical University, Shijiazhuang, Hebei 050017, China; and Hebei Key Laboratory of Integrative Medicine on Liver-Kidney Patterns, Institute of Integrative Medicine, College of Integrative Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei 050091, China
| | - Ming He
- Hebei Key Laboratory of Integrative Medicine on Liver-Kidney Patterns, Institute of Integrative Medicine, College of Integrative Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei 050091, China
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Chen H, Sun ZL, Chen MX, Yang Y, Teng XM, Wang Y, Wu YY. Predicting the probability of a live birth after a freeze-all based in vitro fertilization-embryo transfer (IVF-ET) treatment strategy. Transl Pediatr 2022; 11:797-812. [PMID: 35800265 PMCID: PMC9253936 DOI: 10.21037/tp-21-589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 04/02/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The predictors for live birth rate (LBR) following one episode of in vitro fertilization (IVF) cycle for patients using a "freeze-all" strategy are not entirely clear. METHODS A retrospective cohort study utilizing a prediction model was developed to assess the relationship to the LBR. Women undergoing IVF with a freeze-all strategy were screened. Univariate models were first fitted for female age at oocytes retrieval/frozen-thawed embryo transfer (FET), body mass index (BMI), duration and etiology of infertility, previous IVF failures, total dose and duration of gonadotrophin, ovarian sensitivity index (OSI), number of oocytes collected, method of fertilization, number of embryos created, number and stage of embryos frozen, type and number of FET cycles, endometrial thickness (EMT)/pattern, hormone level on transplantation day, storage duration, number of embryos thawed and damaged thawed embryos, number and stage of embryos transferred and number of different quality embryos transferred. Variables with P<0.05 in the univariate model were selected for further analysis of the final multivariate discrete-time logistic regression model. RESULTS A total of 7,602 women undergoing one ovarian stimulation resulted in 9,964 FETs, of whom 3,066 (40.33%) had a live-birth after their first FET and 3,929 (51.68%) after total FETs. The EMT and woman's age at oocyte retrieval were the most important predictors. In the first FET, the LBR of women with an EMT ≤8 mm [27.40%; 95% confidence interval (CI): (21.60-33.81%)] was significantly lower than that of women with EMT between 9 and 11 mm [36.51%; 95% CI: (34.25-38.81%)] and thicker than 12 mm [44.23%; 95% CI: (42.22-46.25%)] (P<0.05). The optimistic and conservative cumulative LBRs of women younger than 31 years [87.5%; 95% CI: (86.32-88.61%) and 63.04%; 95% CI: (61.36-64.69%)] were significantly decreased in women aged 31-35, 36-40 and >40 (P<0.001). CONCLUSIONS Our study provides an effective prediction model for a woman's chance of having a baby after a "freeze-all" policy. The use of EMT and female age as tools to identify LBR are shown to be justified, and repeated FETs cannot reverse the age-dependent decline in fertility.
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Affiliation(s)
- Hong Chen
- Department of Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zi-Li Sun
- Department of Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Miao-Xin Chen
- Department of Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yang Yang
- Department of Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiao-Ming Teng
- Department of Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yun Wang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan-Yuan Wu
- Department of Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
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Reschini M, Cristina M, Ferrari S, Filippi F, Somigliana E, Rossi FG, Boeri L, Onida F, Baldini L, Vigano' P. Natural and assisted conceptions in male cancer recipients of hematopoietic cell transplantation who stored their semen for fertility preservation. Bone Marrow Transplant 2022; 57:1327-1328. [PMID: 35585188 DOI: 10.1038/s41409-022-01712-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Marco Reschini
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Marco Cristina
- Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefania Ferrari
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Filippi
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Edgardo Somigliana
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Università degli Studi di Milano, Milan, Italy
| | - Francesca Gaia Rossi
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Boeri
- Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Università degli Studi di Milano, Milan, Italy
| | - Francesco Onida
- Università degli Studi di Milano, Milan, Italy.,Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Baldini
- Università degli Studi di Milano, Milan, Italy.,Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Vigano'
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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44
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Vastis V, Hussaini S, Neal M, Karnis M, Taerk E, Amin S, Deniz S, Faghih M. Impact of Protocol Adjustments due to the COVID-19 Pandemic on Infertility Treatment Outcomes. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:1006-1010. [PMID: 35526833 PMCID: PMC9069974 DOI: 10.1016/j.jogc.2022.03.021] [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] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 11/20/2022]
Abstract
As a result of the COVID-19 pandemic, our centre made adjustments that reduced the number of patient visits, ultrasound scans, laboratory investigations, and face-to face instructions. The objective of this study was to evaluate whether these changes had any effect on the pregnancy rate for patients undergoing infertility treatment. The primary outcome was clinical pregnancy rates from intrauterine insemination and frozen embryo transfer. Clinical pregnancy rates were not statistically different between patients who underwent either procedure before and after the protocols were put in place. It is reassuring to know our pandemic protocol adjustments did not have a negative impact on infertility treatment outcomes.
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Affiliation(s)
- Vasilia Vastis
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON
| | - Sofia Hussaini
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON; Division of Reproductive Endocrinology and Infertility, McMaster University, Hamilton, ON
| | | | - Megan Karnis
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON; Division of Reproductive Endocrinology and Infertility, McMaster University, Hamilton, ON; ONE Fertility, Burlington, ON
| | - Evan Taerk
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON; Division of Reproductive Endocrinology and Infertility, McMaster University, Hamilton, ON; ONE Fertility, Burlington, ON
| | - Shilpa Amin
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON; Division of Reproductive Endocrinology and Infertility, McMaster University, Hamilton, ON; ONE Fertility, Burlington, ON
| | - Stacy Deniz
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON; Division of Reproductive Endocrinology and Infertility, McMaster University, Hamilton, ON; ONE Fertility, Burlington, ON
| | - Mehrnoosh Faghih
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON; Division of Reproductive Endocrinology and Infertility, McMaster University, Hamilton, ON; ONE Fertility, Burlington, ON.
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45
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Anti-Müllerian hormone is a predictor of medium-term cumulative live birth following in vitro fertilization/intracytoplasmic sperm injection: A retrospective study. Eur J Obstet Gynecol Reprod Biol 2022; 272:220-225. [PMID: 35395615 DOI: 10.1016/j.ejogrb.2022.03.043] [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: 07/09/2021] [Revised: 03/07/2022] [Accepted: 03/28/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study aims to examine the capacity of anti-Müllerian hormone (AMH) to predict cumulative live birth rate (CLBR) following IVF/ICSI within 36 months since start of treatment. STUDY DESIGN This is a cohort study of women seeking IVF/ICSI fertility treatment in a private Australian IVF clinic in a single calendar year. Live births were monitored over three years following start date of IVF/ICSI. The impact of serum AMH level on the CLBR was assessed using Cox's proportional hazard models, and its incremental values in the prediction of CLBR were evaluated. RESULTS The CLBRs were significantly higher in women with AMH levels in the highest (>44.5 pmol/L; 87.0%, 95% CI 79.2% - 95.1%) and in the middle two quartiles (between 11.5 and 44.5 pmol/L; 81.0%, 95% CI 74.2% - 87.6%), compared with AMH levels below the 25th percentile (≤11.5 pmol/L; 63.2%, 95% CI 53.2% - 74.5%). Approximately half of the women with AMH in the lowest quartile conceived a live birth within 12 months of starting IVF compared with two-thirds of the women in the upper three quartiles. After adjusting for confounders, AMH remained a significant, albeit slight predictor of CLBR with a fall of 3 pmol/L equating to an 1% decrease in CLBR. The AMH's added values into the prediction of live birth were slight, indicated by a net reclassification improvement of 13.8%. The value is lower than that of maternal age (35.1%). CONCLUSIONS Serum AMH level was a significant slight predictor of CLBR following IVF/ICSI. AMH should not be used to exclude women from IVF/ICSI however, women with low AMH should be counselled on the likelihood of taking longer to achieve a live birth than individuals with normal AMH levels.
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46
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Persevering in Fertility Treatments Despite Failures: Unrealistic Optimism and the Reality of a Pronatalist Culture. Int J Behav Med 2022; 29:209-219. [PMID: 34008158 DOI: 10.1007/s12529-021-10001-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Fertility treatment discontinuation is difficult as it entails accepting childlessness. In most countries, financial limitations provide sufficient justification to terminate treatment. In Israel, unlimited funding enables women to undergo multiple treatment cycles, even when the odds of success are poor, thus providing a context for studying the psychological mechanisms involved when financial constraints are set aside. The study aimed to investigate the contribution of unrealistic optimism to Israeli women's willingness to continue fertility treatments even after repeated failures and to their psychological adjustment, comparing age groups. METHODS A longitudinal study of 100 women (ages 31-45) undergoing in vitro fertilization (IVF) treatment (1-22 previous cycles), who filled in questionnaires assessing their estimates of treatment success (theirs/for same-age patient), estimates received from the physician, intentions to continue treatment, and psychological adjustment. Follow-up was conducted 17(± 4) months later, by phone (n = 71) and/or medical records (n = 90). RESULTS Most women (57%) reported that they will continue as long as needed till they have a child, 13% did not know, and 25% mentioned a specific plan; 5 did not reply. Women's estimates of treatment success showed vast unrealistic optimism, which was unrelated to their age, history of unsuccessful treatment cycles, or intentions for treatment continuation, yet was related to better psychological adjustment. At follow-up, almost all women who did not conceive were found to have continued treatments. CONCLUSIONS Unrealistic optimism helps women maintain hope and well-being along the demanding journey to (biological) parenthood, where childlessness is highly stigmatized, and contributes to perseverance in treatment, regardless of objective factors.
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Black–White Inequality in Outcomes of In Vitro Fertilization: a Systematic Review and Meta-analysis. Reprod Sci 2022; 29:1974-1982. [DOI: 10.1007/s43032-022-00928-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/17/2022] [Indexed: 10/18/2022]
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48
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Mounce G, Allan HT, Carey N. 'Just have some IVF!': A longitudinal ethnographic study of couples' experiences of seeking fertility treatment. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:308-327. [PMID: 35076088 PMCID: PMC9303759 DOI: 10.1111/1467-9566.13429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 11/18/2021] [Accepted: 11/25/2021] [Indexed: 06/14/2023]
Abstract
We present findings from a longitudinal ethnographic study of infertile couples seeking treatment following initial GP referral to specialist fertility services. Repeated observations and interviews were undertaken with the same 14 heterosexual participants over an 18-month period. Heterosexual, non-donor couples comprise the majority of fertility clinic patients; however, research interest in this group has dwindled over time as IVF cycles have increased. In the United Kingdom, IVF is presented as a logical response to involuntary childlessness, and as an entirely predictable, and linear, course of action. The market is well-developed and often patients' first experience of privatised health care in the NHS. Our couples were challenged by this, and while they felt expected to move on to IVF, some wished to explore other options. While IVF is ubiquitous, the discomfort and challenge around fertility treatments remain; experiences are prolonged and characterised by recursive narratives and expressions of disequilibrium, which are rarely acknowledged and reflected in ongoing clinic-patient interactions. Our findings develop understanding of the process of 'mazing' (Image - The Journal of Nursing Scholarship, 1989, 21, 220), the pursuit of parenthood, by showing that the routine and normative status of IVF, at least in the current health care context, is at odds with the lived experiences of individuals.
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Affiliation(s)
- Ginny Mounce
- School of Nursing and MidwiferyOxford Brookes University/University of OxfordOxfordUK
| | - Helen T Allan
- Department of Nursing, Midwifery and Child HealthMiddlesex UniversityMiddlesexUK
| | - Nicola Carey
- Department of Nursing and MidwiferyUniversity of the Highlands and IslandsInvernessUK
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When ART fails: figures, experiences, interventions and a plea for the 'plan B'. J Assist Reprod Genet 2022; 39:195-199. [PMID: 34984598 PMCID: PMC8866578 DOI: 10.1007/s10815-021-02388-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/21/2021] [Indexed: 11/05/2022] Open
Abstract
Infertility is perceived by many of those affected by it as one of the most stressful episodes in life. Assisted reproduction can help only some of the people with a desire for children to experience the birth of a biological child. Most people who remain involuntarily childless eventually come to terms with the situation; their psychological well-being is not lastingly affected. However, they should envisage a ‘plan B’ as early as possible. The prospect of permanent childlessness should not be an unmentionable topic, neither for couples themselves nor for the doctors treating them.
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50
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Somigliana E, Busnelli A, Kalafat E, Viganò P, Ata B. Recurrent Implantation Failure: A plea for a widely adopted rational definition. Reprod Biomed Online 2022; 45:183-185. [DOI: 10.1016/j.rbmo.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 01/18/2022] [Indexed: 10/19/2022]
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