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Sun N, Fang X, Jiao Y, Wang Y, Wan Y, Wu Z, Jin H, Shi H, Song W. Adverse maternal and neonatal outcomes of preimplantation genetic testing with trophectoderm biopsy: a retrospective cohort study of 3373 intracytoplasmic sperm injection single frozen-thawed blastocyst transfer cycles. Arch Gynecol Obstet 2024; 309:2427-2437. [PMID: 37389643 DOI: 10.1007/s00404-023-07120-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/20/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE To investigate whether trophectoderm biopsy increases the risk of adverse maternal and neonatal outcomes in intracytoplasmic sperm injection (ICSI) single frozen-thawed blastocyst transfer cycles. METHODS This respective cohort study enrolled 3373 ICSI single frozen-thawed blastocyst transfer cycles with and without trophectoderm biopsy. Statistical methods including univariate logistic regression analysis, multivariate logistic regression analysis, and stratified analyses were performed to explore the impact of trophectoderm biopsy on adverse maternal and neonatal outcomes. RESULTS The rates of adverse maternal and neonatal outcomes were comparable between the two groups. Univariate analysis showed that the live birth rate (45.15% vs. 40.75%; P = 0.010) in the biopsied group was statistically higher than that in the unbiopsied group, and the rates of miscarriage (15.40% vs. 20.00%; P = 0.011) and birth defects (0.58% vs. 2.16%; P = 0.007) were statistically lower in the biopsied group. After adjusting for confounding factors, the rates of miscarriage (aOR = 0.74; 95% CI = 0.57-0.96; P = 0.022) and birth defects (aOR = 0.24, 95% CI = 0.08-0.70, P = 0.009) in the biopsied group were significantly lower than those in the unbiopsied group. Stratified analyses showed that the birth defects rate after biopsy was significantly reduced in the subgroups of age < 35 years old, BMI ≥ 24 kg/m2, artificial cycle with downregulation, poor-quality blastocysts, and Day 5 poor-quality blastocysts. CONCLUSION Preimplantation genetic testing (PGT) with trophectoderm biopsy does not increase the risk of adverse maternal and neonatal outcomes in ICSI single frozen-thawed blastocyst transfer cycles, and PGT can effectively reduce the rates of miscarriage and birth defects.
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Affiliation(s)
- Ning Sun
- Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Xingyu Fang
- Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Yunyun Jiao
- Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Yuan Wang
- Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Ying Wan
- Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Zhaoting Wu
- Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Haixia Jin
- Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Hao Shi
- Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Wenyan Song
- Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China.
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Liao YJ, Fang NW, Yao CS, Chang JT, Wang HP. Neonatal outcomes in infants conceived using assisted reproductive technologies: A single medical center cohort study. Pediatr Neonatol 2024:S1875-9572(24)00016-0. [PMID: 38471993 DOI: 10.1016/j.pedneo.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/28/2023] [Accepted: 01/24/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND A significant rise in the use of assisted reproductive technology (ART) has been observed, but concerns about its impact on neonatal outcomes have been considered. The aim of this retrospective cohort study is to determine the association between ART and the risk of neonatal complications and congenital anomalies within a recent time period. METHODS This retrospective study enrolled infants born after 20 weeks of gestation at a tertiary hospital in Taiwan between January 2019 and December 2021. The study population was divided into two groups: (1) ART pregnancy group and (2) natural pregnancy group. Maternal and neonatal characteristics, pregnancy complications, and neonatal outcomes were compared between the two groups. Multivariate logistic regression was used to adjust for maternal characteristics, preexisting maternal conditions, pregnancy complications, delivery methods, and infant characteristics. RESULTS This study enrolled 1770 infants comprising 289 in the ART pregnancy group and 1481 in the natural pregnancy group. The ART pregnancy group showed higher rates of multiple births, preterm births, low birth weights, and longer hospitalization periods. In the stratified analyses that were conducted on singleton births, no significant difference was observed. In the case of multiple births, lower rates of preterm birth, low birth weight, and respiratory support were observed in the ART pregnancy group. After adjusting for maternal and infant characteristics, ART was not considered a significant risk factor for adverse neonatal outcomes, including mortality, complications, and congenital anomalies. CONCLUSION Although ART pregnancies were more likely to result in multiple births and furthermore adverse outcomes, ART itself was not associated with an increased risk of poor neonatal outcomes. By implementing measures to control the number of implanted embryos, ensuring appropriate prenatal screening, and providing comprehensive postnatal care, the risks associated with increased multiple pregnancies caused by ART may be reduced.
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Affiliation(s)
- Yen-Jhih Liao
- Division of Pediatric Neonatology, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Nai-Wen Fang
- Division of Pediatric Nephrology, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Pediatrics, Pingtung Veterans General Hospital, Pingtung, Taiwan
| | - Cai-Sin Yao
- Department of Business Management, National SunYat-Sen University, No.70 Lien-hai Road, Kaohsiung, Taiwan; Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Taiwan
| | - Jenn-Tzong Chang
- Division of Pediatric Neonatology, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hsiao-Ping Wang
- Division of Pediatric Neonatology, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
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Katsani D, Paraschou N, Panagouli E, Tsarna E, Sergentanis TN, Vlahos N, Tsitsika A. Social Egg Freezing-A Trend or Modern Reality? J Clin Med 2024; 13:390. [PMID: 38256524 PMCID: PMC10816669 DOI: 10.3390/jcm13020390] [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: 11/13/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION Egg freezing for social reasons is a process in which women who want to preserve their ability to fertilize their own oocytes at an older age freeze their eggs. With the help of in vitro fertilization, the cryopreservation of oocytes for future use is achieved. The aim of this article is to study the reasons, the risks and the effectiveness of the method from a worldwide aspect. METHODS A literature search was conducted to evaluate pertinent studies, using data from the search engines PubMed, Google and UptoDate as well as the medical literature. RESULTS The reasons for delayed procreation are non-medical, with the lack of an appropriate partner for a family being first on the list. The success rate of this method differs with the age of the woman, the number of fertilized eggs and other factors. Like every medical procedure, this method carries risks that relate to the mother (being of advanced age), the embryo and the procedure of in vitro fertilization. The policies that apply in each country differ depending on respective social, economic, religious and cultural factors. Due to the high cost of the method, its selection remains a choice for only a few, reinforcing social inequality. The question of the medicalization of reproduction remains unanswered in the industry of assisted reproduction. CONCLUSIONS In conclusion, egg freezing for social reasons is gradually becoming more widely known, with the United States of America and Israel being at the top the list. Unfortunately, there is no official data registry, and consequently, no statistical results are yet available for Greece, even though it is a method that more and more women are considering. Nevertheless, there is an imperative need for a universal legal framework for all countries with respect for the needs of every woman and different social conditions. More research and data from the literature are needed in relation to the effectiveness of the method from moral and social perspectives.
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Affiliation(s)
- Dimitra Katsani
- MSc Program “Strategies of Developmental and Adolescent Health”, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.K.); (N.P.); (E.P.); (T.N.S.)
| | - Nefeli Paraschou
- MSc Program “Strategies of Developmental and Adolescent Health”, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.K.); (N.P.); (E.P.); (T.N.S.)
| | - Eleni Panagouli
- MSc Program “Strategies of Developmental and Adolescent Health”, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.K.); (N.P.); (E.P.); (T.N.S.)
| | - Ermioni Tsarna
- Second Department of Obstetrics and Gynecology, School of Medicine, ‘Aretaieion’ University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.T.); (N.V.)
| | - Theodoros N. Sergentanis
- MSc Program “Strategies of Developmental and Adolescent Health”, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.K.); (N.P.); (E.P.); (T.N.S.)
- Department of Public Health Policy, School of Public Health, University of West Attica, 12243 Aigaleo, Greece
| | - Nikolaos Vlahos
- Second Department of Obstetrics and Gynecology, School of Medicine, ‘Aretaieion’ University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.T.); (N.V.)
| | - Artemis Tsitsika
- MSc Program “Strategies of Developmental and Adolescent Health”, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.K.); (N.P.); (E.P.); (T.N.S.)
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Aponte PM, Gutierrez-Reinoso MA, Garcia-Herreros M. Bridging the Gap: Animal Models in Next-Generation Reproductive Technologies for Male Fertility Preservation. Life (Basel) 2023; 14:17. [PMID: 38276265 PMCID: PMC10820126 DOI: 10.3390/life14010017] [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: 09/05/2023] [Revised: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
This review aims to explore advanced reproductive technologies for male fertility preservation, underscoring the essential role that animal models have played in shaping these techniques through historical contexts and into modern applications. Rising infertility concerns have become more prevalent in human populations recently. The surge in male fertility issues has prompted advanced reproductive technologies, with animal models playing a pivotal role in their evolution. Historically, animal models have aided our understanding in the field, from early reproductive basic research to developing techniques like artificial insemination, multiple ovulation, and in vitro fertilization. The contemporary landscape of male fertility preservation encompasses techniques such as sperm cryopreservation, testicular sperm extraction, and intracytoplasmic sperm injection, among others. The relevance of animal models will undoubtedly bridge the gap between traditional methods and revolutionary next-generation reproductive techniques, fortifying our collective efforts in enhancing male fertility preservation strategies. While we possess extensive knowledge about spermatogenesis and its regulation, largely thanks to insights from animal models that paved the way for human infertility treatments, a pressing need remains to further understand specific infertility issues unique to humans. The primary aim of this review is to provide a comprehensive analysis of how animal models have influenced the development and refinement of advanced reproductive technologies for male fertility preservation, and to assess their future potential in bridging the gap between current practices and cutting-edge fertility techniques, particularly in addressing unique human male factor infertility.
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Affiliation(s)
- Pedro M. Aponte
- Colegio de Ciencias Biológicas y Ambientales (COCIBA), Universidad San Francisco de Quito (USFQ), Quito 170901, Ecuador
- Instituto de Investigaciones en Biomedicina “One-Health”, Universidad San Francisco de Quito (USFQ), Campus Cumbayá, Quito 170901, Ecuador
| | - Miguel A. Gutierrez-Reinoso
- Facultad de Ciencias Agropecuarias y Recursos Naturales, Carrera de Medicina Veterinaria, Universidad Técnica de Cotopaxi (UTC), Latacunga 050150, Ecuador;
- Laboratorio de Biotecnología Animal, Departamento de Ciencia Animal, Facultad de Ciencias Veterinarias, Universidad de Concepción (UdeC), Chillán 3780000, Chile
| | - Manuel Garcia-Herreros
- Instituto Nacional de Investigação Agrária e Veterinária (INIAV), 2005-048 Santarém, Portugal
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Hu Y, Zhang D, Zhang Q, Yin T, Jiang T, He S, Li M, Yue X, Luo G, Tao F, Cao Y, Ji D, Ji Y, Liang C. Serum Cu, Zn and IL-1β Levels May Predict Fetal Miscarriage Risk After IVF Cycles: A Nested Case-Control Study. Biol Trace Elem Res 2023; 201:5561-5574. [PMID: 36964416 DOI: 10.1007/s12011-023-03621-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/01/2023] [Indexed: 03/26/2023]
Abstract
To explore the association between serum-related indicators (levels of inflammatory cytokines and essential trace elements) and miscarriage risk among infertile women undergoing assisted reproductive techniques (ART) on the 14th day after embryo transfer, and to develop and establish a multivariable algorithm model that might predict pregnancy outcome. According to a nested case-control study design, a total of 100 miscarriage cases and 100 live birth controls were included in this study, and women in both groups were infertile and have underwent in vitro fertilization (IVF). Pregnancy tests were performed and serum levels of five essential trace elements (vanadium (V), copper (Cu), zinc (Zn), selenium (Se) and molybdenum (Mo)) and five inflammatory cytokines (interleukin-1β (IL-1β), IL-6, IL-8, IL-10 and tumor necrosis factor-α (TNF-α)) of the participants were measured on the 14th day after embryo transfer. The serum levels of five inflammatory cytokines were determined by multiple magnetic bead enzyme immunity analyzer; and the serum concentrations of five elements were determined simultaneously by inductively coupled plasma‒mass spectrometry (ICP ‒ MS). The logistic regression was used to evaluate the relationship between these serum indices and miscarriage risk among women undergoing ART, and a predictive model of pregnancy outcome based on these indices was established. The levels of IL-10, IL-1β and TNF-α of infertile women in the live birth group were significantly higher than those in the miscarriage group (p = 0.009, p < 0.001, p = 0.006), and the levels of V, Cu, Zn and Se of infertile women in the live birth group were also significantly higher than those in the miscarriage group (all p < 0.001). Through logistic regression analyses, we found that serum levels of IL-1β, TNF-α, V, Cu, Zn and Se were significantly and negatively associated with miscarriage risk. Different combination prediction models were generated according to the results of logistic regression analyses, and the combination of IL-1β, Cu and Zn had the best prediction performance. The area under the curve (AUC) was 0.776, the sensitivity of the model was 60% and the specificity was 84%. In conclusion, the serum-related indicators of women undergoing ART on the 14th day after embryo transfer, including the inflammatory cytokines such as IL-1β and TNF-α and the essential trace metal elements such as V, Cu, Zn and Se, were negatively correlated with miscarriage risk. A multivariate algorithm model to predict pregnancy outcome among women undergoing ART was established, which showed that IL-1β, Cu and Zn might synergistically predict pregnancy outcome.
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Affiliation(s)
- Yuan Hu
- School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Engineering Research Center of Biopreservation and Artificial Organs, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Institute of Translational Medicine, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Dongyang Zhang
- School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Engineering Research Center of Biopreservation and Artificial Organs, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Institute of Translational Medicine, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Qing Zhang
- Department of Ophthalmology, The Second Hospital of Anhui Medical University, No 678 Furong Road, Hefei, 230601, Anhui, China
| | - Tao Yin
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Engineering Research Center of Biopreservation and Artificial Organs, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Institute of Translational Medicine, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Tingting Jiang
- School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Engineering Research Center of Biopreservation and Artificial Organs, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Institute of Translational Medicine, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Shitao He
- School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Engineering Research Center of Biopreservation and Artificial Organs, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Institute of Translational Medicine, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Mengzhu Li
- School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Engineering Research Center of Biopreservation and Artificial Organs, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Institute of Translational Medicine, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Xinyu Yue
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Engineering Research Center of Biopreservation and Artificial Organs, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Institute of Translational Medicine, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Guiying Luo
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Engineering Research Center of Biopreservation and Artificial Organs, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Institute of Translational Medicine, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Fangbiao Tao
- School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Engineering Research Center of Biopreservation and Artificial Organs, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Institute of Translational Medicine, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Yunxia Cao
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, Anhui, China.
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China.
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No 81 Meishan Road, Hefei, 230032, Anhui, China.
- Anhui Province Key Laboratory of Reproductive Health and Genetics, No 81 Meishan Road, Hefei, 230032, Anhui, China.
- Anhui Provincial Engineering Research Center of Biopreservation and Artificial Organs, No 81 Meishan Road, Hefei, 230032, Anhui, China.
- Anhui Provincial Institute of Translational Medicine, No 81 Meishan Road, Hefei, 230032, Anhui, China.
| | - Dongmei Ji
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, Anhui, China.
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China.
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No 81 Meishan Road, Hefei, 230032, Anhui, China.
- Anhui Province Key Laboratory of Reproductive Health and Genetics, No 81 Meishan Road, Hefei, 230032, Anhui, China.
- Anhui Provincial Engineering Research Center of Biopreservation and Artificial Organs, No 81 Meishan Road, Hefei, 230032, Anhui, China.
- Anhui Provincial Institute of Translational Medicine, No 81 Meishan Road, Hefei, 230032, Anhui, China.
| | - Yanli Ji
- School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China.
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No 81 Meishan Road, Hefei, 230032, Anhui, China.
- Anhui Province Key Laboratory of Reproductive Health and Genetics, No 81 Meishan Road, Hefei, 230032, Anhui, China.
- Anhui Provincial Engineering Research Center of Biopreservation and Artificial Organs, No 81 Meishan Road, Hefei, 230032, Anhui, China.
- Anhui Provincial Institute of Translational Medicine, No 81 Meishan Road, Hefei, 230032, Anhui, China.
| | - Chunmei Liang
- School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, Anhui, China.
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China.
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), No 81 Meishan Road, Hefei, 230032, Anhui, China.
- Anhui Province Key Laboratory of Reproductive Health and Genetics, No 81 Meishan Road, Hefei, 230032, Anhui, China.
- Anhui Provincial Engineering Research Center of Biopreservation and Artificial Organs, No 81 Meishan Road, Hefei, 230032, Anhui, China.
- Anhui Provincial Institute of Translational Medicine, No 81 Meishan Road, Hefei, 230032, Anhui, China.
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Saunders M, Allen VM, Andreou P, Van den Hof MC. Validation of Ultrasound Dating Protocols Using Data From Twins Conceived Through In Vitro Fertilization in Nova Scotia: A Retrospective Cohort Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:102199. [PMID: 37633645 DOI: 10.1016/j.jogc.2023.102199] [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: 06/07/2023] [Revised: 08/07/2023] [Accepted: 08/07/2023] [Indexed: 08/28/2023]
Abstract
OBJECTIVES Clinical practice guidelines recommend determining gestational age (GA) for twin pregnancies using the fetal crown rump length (CRL) of the larger fetus. This study investigated whether the CRL of the larger or smaller fetus at 11-14 weeks best predicted in vitro fertilization (IVF) assigned GA. METHODS A retrospective cohort study of twin pregnancies conceived by IVF ± intracytoplasmic sperm injection, 2004-2022, generated GA estimations for each co-twin CRL at the 11-14 week ultrasound, to determine which fetus (smaller or larger) more consistently predicted IVF-assigned GA. Monoamniotic twins and twins with known structural or vascular abnormalities were excluded. Paired t tests evaluated the ability of CRL to predict GA, and logistic regression evaluated the predictive ability of each of the co-twin groups with increasing size differences. Statistical significance was set at P < 0.05. RESULTS Viewpoint 6 identified 359 eligible twin pairs. CRL was closest with the smaller fetus (0.38 days); CRL for both the smaller (95% CI 0.16-0.61) and the larger (2.25 days, 95% CI 2.04-2.46) fetus showed deviation from IVF-assigned GA. As the absolute difference between the small and large fetus increased, the ultrasound-estimated GA of the smaller fetus was still consistently closer to IVF-assigned GA. CONCLUSIONS In this selected population of twins with known GA, the CRL of the smaller fetus more accurately predicted IVF-assigned GA even with increasing differences in fetal size. These findings provide important information for appropriately dating pregnancies to facilitate adherence to national guidelines to monitor for pregnancy complications, and plan frequency and type of fetal surveillance, as well as timing of delivery.
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Affiliation(s)
- Marianna Saunders
- Department of Obstetrics and Gynaecology, Dalhousie University and IWK Health, Halifax, NS
| | - Victoria M Allen
- Department of Obstetrics and Gynaecology, Dalhousie University and IWK Health, Halifax, NS; Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS.
| | - Pantelis Andreou
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS
| | - Michiel C Van den Hof
- Department of Obstetrics and Gynaecology, Dalhousie University and IWK Health, Halifax, NS
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7
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Chen X, Li Y, Zhou J, Wei X, Ning N, Huang Q, Pang X, Yang D. Effects of the Zishen Yutai Pill compared with placebo on pregnancy outcomes among women in a fresh embryo transfer cycle: a Post Hoc subgroup analysis of a randomized controlled trial. Front Endocrinol (Lausanne) 2023; 14:1196636. [PMID: 38075073 PMCID: PMC10703301 DOI: 10.3389/fendo.2023.1196636] [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: 03/30/2023] [Accepted: 10/31/2023] [Indexed: 12/18/2023] Open
Abstract
Objective To assess whether the administration of Zishen Yutai Pill (ZYP) could improve the pregnancy outcomes in different subgroups of women undergoing fresh embryo transfer cycles. Materials and methods This is a post hoc analysis of a large scale, placebo-controlled, double blind, randomized clinical trial (RCT) regarding the use of ZYP during assisted reproductive technology (ART) treatment. The RCT was conducted at 19 in vitro fertilization (IVF) centers between April 2014 and June 2017. A total of 2265 women undergoing fresh embryo transfer cycles were randomly assigned in a 1:1 ratio to receive ZYP (n = 1131) or placebo (n = 1134). Post hoc logistic regression analyses were applied in this study to examine the between-group differences of ZYP and placebo on clinical pregnancy rate among different subgroups. Detailed analyses, both in intention-to-treat (ITT) and per-protocol population, were also conducted in specific subgroups with regards to rates of implantation, biochemical pregnancy, clinical pregnancy, live birth, pregnancy loss, as well as other neonatal indices. Results ZYP showed a significantly higher clinical pregnancy rates than placebo in the ITT population. Detailed subgroup analyses were conducted in subgroup in advanced maternal age (AMA, ≥ 35 years old) and overweight/obese patients (BMI > 24), due to the clinical importance and statistical results. In these subgroups, baseline characteristics were similar between two arms (all P > 0.05). Significantly elevated clinical pregnancy rates were observed in ZYP cohort (both P < 0.05) compared with the placebo group. Results also showed that ZYP treatment resulted in significantly higher rates of implantation, biochemical pregnancy in AMA or overweight/obese patients in ITT analysis (all P < 0.05). Conclusions The current post hoc subgroup analysis suggested that AMA and overweight/obese women could experience clinical benefits when treated with ZYP in their fresh embryo transfer cycles. The study provides references for the use of ZYP in ART practices. However, further studies in specific subgroups should be examined in more rigorous clinical trial settings. Clinical trial registration Chictr.org.cn, ChictrTRC-14004494.
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Affiliation(s)
- Xiaoli Chen
- Center for Reproductive Medicine, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yu Li
- Center for Reproductive Medicine, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jiewen Zhou
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xuemei Wei
- Guangdong Development Engineering Laboratory of Southern Chinese Herbal Drugs, Guangzhou, China
| | - Na Ning
- Guangdong Development Engineering Laboratory of Southern Chinese Herbal Drugs, Guangzhou, China
| | - Qiuling Huang
- Guangdong Development Engineering Laboratory of Southern Chinese Herbal Drugs, Guangzhou, China
| | - Xiufei Pang
- Guangdong Development Engineering Laboratory of Southern Chinese Herbal Drugs, Guangzhou, China
| | - Dongzi Yang
- Center for Reproductive Medicine, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
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8
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Silvestris E, Petracca EA, Mongelli M, Arezzo F, Loizzi V, Gaetani M, Nicolì P, Damiani GR, Cormio G. Pregnancy by Oocyte Donation: Reviewing Fetal-Maternal Risks and Complications. Int J Mol Sci 2023; 24:13945. [PMID: 37762248 PMCID: PMC10530596 DOI: 10.3390/ijms241813945] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/22/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Oocyte donation (OD) has greatly improved over the last three decades, becoming a preferred practice of assisted reproductive technology (ART) for infertile women wishing for motherhood. Through OD, indeed, it has become possible to overcome the physiological limitation due to the ovarian reserve (OR) exhaustion as well as the poor gamete reliability which parallels the increasing age of women. However, despite the great scientific contribution related to the success of OD in the field of infertility, this practice seems to be associated with a higher rate of major risky events during pregnancy as recurrent miscarriage, infections and placental diseases including gestational hypertension, pre-eclampsia and post-partum hemorrhage, as well as several maternal-fetal complications due to gametes manipulation and immune system interaction. Here, we will revisit this questioned topic since a number of studies in the medical literature focus on the successful aspects of the OD procedure in terms of pregnancy rate without, however, neglecting the risks and complications potentially linked to external manipulation or heterologous implantation.
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Affiliation(s)
- Erica Silvestris
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (E.A.P.); (V.L.); (G.C.)
| | - Easter Anna Petracca
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (E.A.P.); (V.L.); (G.C.)
| | - Michele Mongelli
- Obstetrics and Gynecology Unit, University of Bari “Aldo Moro”, 70121 Bari, Italy; (M.M.); (M.G.); (P.N.); (G.R.D.)
| | - Francesca Arezzo
- Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, 70121 Bari, Italy;
| | - Vera Loizzi
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (E.A.P.); (V.L.); (G.C.)
- Department of Precision and Regenerative Medicine—Ionian Area, University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Maria Gaetani
- Obstetrics and Gynecology Unit, University of Bari “Aldo Moro”, 70121 Bari, Italy; (M.M.); (M.G.); (P.N.); (G.R.D.)
| | - Pierpaolo Nicolì
- Obstetrics and Gynecology Unit, University of Bari “Aldo Moro”, 70121 Bari, Italy; (M.M.); (M.G.); (P.N.); (G.R.D.)
| | - Gianluca Raffaello Damiani
- Obstetrics and Gynecology Unit, University of Bari “Aldo Moro”, 70121 Bari, Italy; (M.M.); (M.G.); (P.N.); (G.R.D.)
| | - Gennaro Cormio
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (E.A.P.); (V.L.); (G.C.)
- Department of Precision and Regenerative Medicine—Ionian Area, University of Bari “Aldo Moro”, 70121 Bari, Italy
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Michalopoulos S, Tsikouras P, Varlami V, Lambrinos D, Bothou A, Nikolettos K, Papanikolopoulou S, Marinos G, Iatrakis G, Nikolettos N. Retrospective Study of the Correlation Between Twin Pregnancies and Perinatal Outcome in Association to the Impact of Preterm Birth. Mater Sociomed 2023; 35:215-221. [PMID: 37795161 PMCID: PMC10545924 DOI: 10.5455/msm.2023.35.215-221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/30/2023] [Indexed: 10/06/2023] Open
Abstract
Background Twin pregnancies make up 2% to 4% of all births. Incidence of spontaneous twin pregnancies varies around the world, with percentages ranging from 8/1000 to >17/1000 births. The variation in twin pregnancy rates is thought to be due to dizygotic pregnancies, since monozygotic pregnancies have a consistent incidence of 3.5/1000 to 4/1000 births. The incidence of twin pregnancies after the widespread use of assisted reproduction has increased significantly. Objective The purpose of the present study is to investigate factors , who contribute to improve the perinatal outcome in twin pregnancies. Support will be provided by the results of twin pregnancies by the Department of Obstetrics and Gynaecology of Demokrition University of Thrace (Alexandroupolis, Greece) in the last fifteen years. Methods From the above Department, data were collected on the number of twin pregnancies, maternal age, gestational age, mode of delivery (spontaneous delivery or caesarean section), birth weight and rate of twin pregnancies with assisted reproduction. Results The results showed the increasing trend of twin pregnancies and births. A total of 304 twin pregnancies were identified (rate 2.75%). The rate of assisted reproduction was 34.83% in our sample, while the rate of cesarean deliveries was 95.5%, showing a large increase in recent years. In ten cases, normal delivery was successfully performed. The gestational age in twin pregnancies that ended with normal delivery was 37.37 + 3 weeks and the fetuses were both cephalic presentations. The main reason for admission of newborns to the NICU Department was prematurity. Conclusion The constantly improving education of perinatalists and understanding of the pathophysiology may lead to individualization of their treatment, and improvement of their prognosis based on recent scientific data from other international centers.
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Affiliation(s)
| | | | - Vassiliki Varlami
- Neonatal Intensive Care Unit of University Hospital Alexandroupolis, Greece
| | | | - Anastasia Bothou
- Department of Obstetrics and Gynecology, Democritus Univesity of Thrace, Greece
| | | | | | - Georgios Marinos
- Georgios Marinos, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Iatrakis
- Department of Obstetrics and Gynecology, Democritus Univesity of Thrace, Greece
| | - Nikolaos Nikolettos
- Department of Obstetrics and Gynecology, Democritus Univesity of Thrace, Greece
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10
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Analyzing the Differential Impact of Semen Preparation Methods on the Outcomes of Assisted Reproductive Techniques. Biomedicines 2023; 11:biomedicines11020467. [PMID: 36831003 PMCID: PMC9953211 DOI: 10.3390/biomedicines11020467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/28/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
Sperm separation plays a critical role in assisted reproductive technology. Based on migration, density gradient centrifugation and filtration, a properly selected sperm could help in increasing assisted reproductive outcomes in teratozoospermia (TZs). The current study aimed to assess the prognostic value of four sperm selection techniques: density gradient centrifugation (DGC), swim-up (SU), DGC-SU and DGC followed by magnetic-activated cell sorting (DGC-MACS). These were evaluated using spermatozoa functional parameters. A total of 385 infertile couples underwent the procedure of intracytoplasmic sperm injection (ICSI), with an isolated teratozoospermia in the male partner. Semen samples were prepared by using one of the mentioned sperm preparation techniques. The improvements in the percentage of normal mature spermatozoa, rate of fertilization, cleavage, pregnancy and the number of live births were assessed. The normal morphology, spermatozoa DNA fragmentation (SDF) and chromatin maturity checked by using chromomycin A3 (CMA3) with DGC-MACS preparation were better compared to the other three methods. Embryo cleavage, clinical pregnancy and implantation were better improved in the DGC-MACS than in the other tested techniques. The DGC-MACS technique helped in the selection of an increased percentage of normal viable and mature sperm with intact chromatin integrity in patients with teratozoospermia.
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11
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Peeva M, Badeghiesh A, Baghlaf H, Dahan MH. Adverse obstetric outcomes in women with PCOS and multiple gestations. Reprod Biomed Online 2023; 46:379-389. [PMID: 36503681 DOI: 10.1016/j.rbmo.2022.10.009] [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: 02/22/2022] [Revised: 06/23/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022]
Abstract
RESEARCH QUESTION Does multiple gestation alter the risks for adverse obstetric outcomes in women with polycystic ovary syndrome (PCOS)? DESIGN Retrospective population-based cohort study using data from the HCUP-NIS from 2004 to 2014. A total of 14,882 women with PCOS, who delivered within that time period, were identified. The study group comprised women with PCOS who had had a multiple gestation (n = 880); the reference group was comprised of the remaining women with PCOS and singleton gestation (n = 14,002). RESULTS In women with PCOS, multiple gestation increased the risks of pregnancy complications including pregnancy-induced hypertension (adjusted odds ratio [aOR] 2.030; 95% confidence interval [CI] 1.676-2.460), pre-eclampsia (aOR 2.879; 95% CI 2.277-3.639), pre-eclampsia and eclampsia superimposed on pre-existing hypertension (aOR 1.917; 95% CI 1.266-2.903) and gestational diabetes (aOR 1.358; 95% CI 1.114-1.656). Multiple gestation increases the risk of preterm premature rupture of membranes (aOR 5.807; 95% CI 4.153-8.119), preterm delivery (aOR 8.466; 95% CI 7.071-10.135), Caesarean section (aOR 5.146; 95% CI 4.184-6.329), post-partum haemorrhage (aOR 1.540; 95% CI 1.065-2.228) and the need for transfusion (aOR 3.268; 95% CI 2.010-5.314), as well as wound complications (aOR 3.089; 95% CI 1.647-5.794). Neonates born to mothers with PCOS and having multiple gestations are more likely to be small for gestational age when compared to singleton neonates born to mothers with PCOS (aOR 4.606; 95% CI 3.480-6.095). Among PCOS women with multiple gestations, obesity increased the risks of developing pregnancy-induced hypertension (P < 0.001), pre-eclampsia (P < 0.001) and wound complications (P = 0.045). CONCLUSION These results highlight the importance of single embryo transfer and ovulation induction to develop a single follicle in women with PCOS. Obesity further increases obstetrical complications.
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Affiliation(s)
- Magdalena Peeva
- University of Ottawa, Department of Obstetrics and Gynecology, Ottawa Ontario K1H 8L6, Canada
| | - Ahmad Badeghiesh
- University of Western Ontario, Department of Obstetrics and Gynecology, London Ontario N6A 3K7, Canada
| | - Haitham Baghlaf
- University of Tabuk, Department of Obstetrics and Gynecology, Tabuk, Saudi Arabia
| | - Michael H Dahan
- McGill University, McGill University Health Center, Reproductive Center, Department of Obstetrics and Gynecology, Quebec H2L, Montreal 4S8, Canada.
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He X, Shao Z, Jing J, Wang X, Xu S, Wu M, Zhu Y. Secular trends of birth weight and its associations with obesity and hypertension among Southern Chinese children and adolescents. J Pediatr Endocrinol Metab 2022; 35:1487-1496. [PMID: 36398930 DOI: 10.1515/jpem-2021-0430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/18/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The association of low or high birth weight (L/HBW) with obesity and hypertension in childhood remains unclear. We aimed to identify the secular trend of birth weight distribution and its relationship to obesity and hypertension in Southern Chinese children and adolescents. METHODS 6,561 individuals (6-17-year-old) were enrolled by multistage cluster sampling to observed the trend of birth weight distribution and its associated factors. 1,218 were further selected by group matching to investigate the correlation between birth weight and obesity or hypertension. RESULTS Between 1997 and 2008, a significant decline in the LBW rate and no significant change in the HBW rate was found. LBW was associated with maternal BMI<18 kg/m2 (OR1.79, 95% CI 1.08-2.97) during pregnancy, while maternal BMI between 25.0 and 27.9 kg/m2 (OR1.62, 95% CI 1.04-2.52) and paternal BMI>28 kg/m2 (OR1.64, 95% CI 1.02-2.63) during pregnancy were associated with HBW. The prevalence of obesity was significantly higher with HBW than normal birth weight (NBW) or LBW (16.73, 6.25 and 5.50%, respectively). The prevalence rates of suspected hypertension were 1.62, 1.25 and 1.49% among LBW, NBW and HBW, respectively (p>0.05). LBW decreased the risks of childhood overweight (OR0.31, 95% CI 0.18-0.54), but had no effect on suspected hypertension. HBW increased the risks of childhood obesity (OR2.19, 95% CI 1.50-3.20), but decreased the risks of suspected hypertension (OR0.22, 95% CI 0.09-0.58). CONCLUSIONS HBW was positively associated with childhood obesity, and parental BMIs management might be one of the measurements to control birth weight to lessen childhood obesity.
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Affiliation(s)
- Xiaoying He
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen Global Health Institute (SGHI), Sun Yat-sen University, Guangzhou, P.R. China
| | - Zixian Shao
- Shunde Women and Children's Hospital (Maternity and Child Healthcare Hospital of Shunde Foshan), Guangdong Medical University, Foshan, P.R. China
| | - Jiajia Jing
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen Global Health Institute (SGHI), Sun Yat-sen University, Guangzhou, P.R. China
| | - Xiaotong Wang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen Global Health Institute (SGHI), Sun Yat-sen University, Guangzhou, P.R. China
| | - Suhua Xu
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen Global Health Institute (SGHI), Sun Yat-sen University, Guangzhou, P.R. China
| | - Miao Wu
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen Global Health Institute (SGHI), Sun Yat-sen University, Guangzhou, P.R. China
| | - Yanna Zhu
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen Global Health Institute (SGHI), Sun Yat-sen University, Guangzhou, P.R. China
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The Impact of Bariatric Surgery on Assisted Reproductive Technology Outcomes: A Systematic Review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:915-923. [PMID: 35526831 DOI: 10.1016/j.jogc.2022.04.010] [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: 12/28/2021] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE There is a paucity of literature on the impact of bariatric surgery on artificial reproductive technology (ART) outcomes. This topic should be examined, given that most bariatric surgery candidates are of reproductive age and those with obesity are significantly more likely to experience poor fertility outcomes. This systematic review aimed to determine if bariatric surgery impacts ART outcomes and if effects vary between females and males. DATA SOURCES MEDLINE, EMBASE, SCOPUS, and the Cochrane Central Register of Controlled Trials were searched for English studies published between January 1978 and May 2021. STUDY SELECTION Studies with participants who had had bariatric surgery and subsequently underwent ART (i.e., in vitro fertilization or intracytoplasmic sperm injection) were eligible for inclusion. Screening, data abstraction, and risk of bias assessment were conducted independently and in duplicate. DATA EXTRACTION AND SYNTHESIS Of the 279 articles screened for eligibility, 25 were sought for full text review, and 7 were included for analysis. Four studies (57%) examined ART interventions in females, while 3 (43%) examined interventions in males. Data on cumulative live birth rate (CLBR) was extracted for all 7 studies (N = 169). There were 50 live births with CLBRs ranging from 0.0% to 80.0%. Changes to female secondary outcomes were varied. Data on male secondary outcomes were contradictory: 1 study indicated improved sperm parameters following bariatric surgery, while 2 showed decreased parameters, with certain participants seeing improvements after several months. CONCLUSION Bariatric surgery prior to ART may have an impact on CLBRs; however, high-quality research is needed to delineate the direct effects of bariatric surgery on ART outcomes. Various sex-specific outcomes should be considered prior to recommending ART after bariatric surgery. Future research should determine the optimal type of bariatric surgery and timing of ART following bariatric surgery.
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Cusimano MC, Baxter NN, Sutradhar R, McArthur E, Ray JG, Garg AX, Vigod S, Simpson AN. Evaluation of Adverse Pregnancy Outcomes in Physicians Compared With Nonphysicians. JAMA Netw Open 2022; 5:e2213521. [PMID: 35604685 PMCID: PMC9127555 DOI: 10.1001/jamanetworkopen.2022.13521] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Physicians may be at risk of pregnancy complications due to prolonged work hours, overnight shifts, occupational hazards, and older maternal age at first birth compared with nonphysicians. Observational studies of physicians, including comparisons across physician specialties, are needed. OBJECTIVE To compare adverse maternal and perinatal outcomes between pregnant physicians and nonphysicians and between physicians of different specialties. DESIGN, SETTING, AND PARTICIPANTS A population-based retrospective cohort study was conducted in Ontario, Canada. Participants included physicians and nonphysician comparators residing in high-income areas who experienced a birth at 20 or more weeks' gestation from April 1, 2002, to November 26, 2018. Data analysis was performed from December 2020 to March 2022. EXPOSURES Physician occupation and physician specialty. MAIN OUTCOMES AND MEASURES Severe maternal morbidity (in pregnancy and up to 42 days' post partum) and severe neonatal morbidity (up to hospital discharge among live-born infants) were the primary outcomes. Logistic regression under a generalized estimating equations approach was used to compare outcomes between physicians and nonphysicians, accounting for potentially more than 1 pregnancy per woman. Odds ratios were adjusted (aOR) for maternal age, parity, previous preterm birth, calendar year, immigration status, comorbidities, multiple gestation, and mode of delivery. RESULTS A total of 10 489 births occurred among 6161 licensed physicians, and 298 683 births occurred among 211 191 nonphysician counterparts. Physicians were older (median [IQR] age, 34 [31-36] vs 32 [29-35] years) and more likely to be nulliparous (5049 [48.1%] vs 128 961 [43.2%]) compared with nonphysicians. Severe maternal morbidity was more likely to occur among physicians than nonphysicians (unadjusted OR, 1.21; 95% CI, 1.04-1.41) but not after adjusting for study covariates (aOR, 1.13; 95% CI, 0.97-1.32). Severe neonatal morbidity was less likely to occur among infants of physicians than infants of nonphysicians (aOR, 0.79; 95% CI, 0.72-0.87). Compared with family physicians, neither nonsurgical specialists (aOR, 1.12; 95% CI, 0.82-1.53) nor surgical specialists (aOR, 1.43; 95% CI, 0.74-2.76) were at increased risk of severe maternal morbidity. Similar findings were observed for severe neonatal morbidity (nonsurgical specialists: aOR, 0.98; 95% CI, 0.80-1.19; surgical specialists: aOR, 1.08; 95% CI, 0.68-1.71). CONCLUSIONS AND RELEVANCE The findings of this study suggest that female physicians may be at slightly higher risk of severe maternal morbidity. This association appeared to be mediated by their tendency to delay childbearing compared with nonphysicians. Newborns of physicians appear to experience less morbidity. Such differences were not observed between physician specialty groups.
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Affiliation(s)
- Maria C. Cusimano
- Department of Obstetrics & Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Nancy N. Baxter
- Melbourne School of Population & Global Health, University of Melbourne, Melbourne, Victoria, Australia
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Department of Medicine, St Michael’s Hospital/Unity Health Toronto, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Eric McArthur
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Joel G. Ray
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Department of Medicine, St Michael’s Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Medicine, Western University, London, Ontario, Canada
| | - Amit X. Garg
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Department of Medicine, Western University, London, Ontario, Canada
| | - Simone Vigod
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Department of Psychiatry, Women’s College Hospital, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrea N. Simpson
- Department of Obstetrics & Gynaecology, University of Toronto, Toronto, Ontario, Canada
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Department of Medicine, St Michael’s Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Obstetrics & Gynaecology, St Michael’s Hospital/Unity Health Toronto, Toronto, Ontario, Canada
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15
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Tai W, Hu L, Wen J. Maternal and Neonatal Outcomes After Assisted Reproductive Technology: A Retrospective Cohort Study in China. Front Med (Lausanne) 2022; 9:837762. [PMID: 35479950 PMCID: PMC9037083 DOI: 10.3389/fmed.2022.837762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background With the progress of assisted reproductive technology (ART) and the increasing number of ART pregnancy, its safety has become the focus of attention. The present study aimed to explore the associations of ART pregnancy with maternal and neonatal outcomes, as compared with naturally pregnancy. Methods This retrospective cohort study included all pregnant women who delivered at Women’s Hospital of Nanjing Medical University in 2011–2020. We compared maternal characteristics and pregnancy outcomes between group of ART pregnancy and group of naturally pregnancy using Logistic regression adjusted for confounders. Results A total of 13,604 ART pregnancies and 198,002 naturally pregnancies were included. The proportion of ART pregnancies has increased every year for the past 10 years, peaking in 2020 (9.0%). Multivariable logistic regression analysis showed that the risks of gestational diabetes, preeclampsia, moderate or severe anemia, liver-related diseases, thyroid-related diseases, preterm birth, placenta previa, postpartum hemorrhage, and cesarean section were significantly increased in ART pregnancy. For neonatal outcomes, women conceived by ART were more likely to have twins or multiples, and the risk of stillbirth or abnormal development was also significantly increased. When restriction to singletons, these risks were reduced. And the effects of ART on the risk of premature rupture of membrane, cord entanglement, intrapartum fever, cesarean section, and stillbirth or abnormal development were more pronounced in singletons pregnancies compared with that in pregnancies of twins or multiples. Conclusion Women conceived by ART were at increased risks of several adverse pregnancy outcomes compared with women conceived naturally. Multiple pregnancies could partly explain this phenomenon. For ART pregnancy, prenatal and intrapartum monitoring should be strengthened, and neonatal outcomes should be closely observed.
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Affiliation(s)
- Wen Tai
- Department of Obstetrics, Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, China
| | - Lingmin Hu
- Department of Reproduction, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| | - Juan Wen
- Nanjing Maternity and Child Health Care Institute, Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, China
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16
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Peeva M, Badeghiesh A, Baghlaf H, Dahan MH. Association between obesity in women with polycystic ovary syndrome and adverse obstetric outcomes. Evaluation of a population database. Reprod Biomed Online 2022; 45:159-167. [DOI: 10.1016/j.rbmo.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/02/2022] [Accepted: 02/10/2022] [Indexed: 10/19/2022]
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17
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Vriesen N, Carmany EP, Natoli JL. Clinical outcomes of preimplantation genetic testing for hereditary cancer syndromes: A systematic review. Prenat Diagn 2022; 42:201-211. [PMID: 34981540 DOI: 10.1002/pd.6084] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 12/09/2021] [Accepted: 12/29/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To conduct a systematic review of the published literature on clinical outcomes following preimplantation genetic testing for monogenic disorders (PGT-M) for hereditary cancer syndromes (HCS). METHODS Three electronic databases (PubMed, Cochrane, and EMBASE) were searched for publications related to PGT-M for HCS. When appropriate, weighted means were used to calculate clinical and live birth rates. RESULTS We identified 22 publications that reported on clinical and/or psychosocial outcomes of PGT-M for HCS. The weighted mean clinical pregnancy rate (CPR) per embryo was 33.5% (11 studies, 95% CI: 29.1%, 38.2%), and the CPR per cycle with embryonic transfer was 40.1% (14 studies, 95% CI: 36.1%, 44.3%). The weighted mean live birth rate (LBR) per embryo was 28.9% (11 studies, 95% CI: 24.7%, 33.4%) and the LBR per cycle with embryonic transfer was 33.2% (13 studies, 95% CI: 29.2%, 37.4%). The limited literature regarding the psychosocial outcomes of PGT-M for HCS suggests reproductive decision-making is difficult and additional support may be desired. CONCLUSION These findings suggest that CPR and LBR following PGT-M for HCS are comparable to other monogenic disorders. Heterogeneity across studies suggests the overall CPR and LBR found may not be applicable to all HCS indications and PGT-M methodologies.
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Affiliation(s)
- Natalie Vriesen
- Division of Medical Genetics, Henry Ford Health System, Detroit, Michigan, USA.,Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Erin P Carmany
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Jaime L Natoli
- Department of Clinical Analysis, Evidence-Based Medicine Services, Southern California Permanente Medical Group, Kaiser Permanente, Pasadena, California, USA
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18
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Meads C, Thorogood LR, Lindemann K, Bewley S. Why Are the Proportions of In-Vitro Fertilisation Interventions for Same Sex Female Couples Increasing? Healthcare (Basel) 2021; 9:healthcare9121657. [PMID: 34946383 PMCID: PMC8702152 DOI: 10.3390/healthcare9121657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022] Open
Abstract
Same-sex female couples who wish to become pregnant can choose donor insemination or in-vitro fertilization (IVF)-a technique intended for infertile women. In general, women in same-sex female partnerships are no more likely to be infertile than those in opposite sex partnerships. This article investigates data available from the Government Regulator of UK fertility clinics-the Human Fertilization and Embryology Authority, which is the only data available worldwide on same-sex female couples and their fertility choices. IVF is increasing both in absolute numbers and relative proportions year on year in the UK, compared to licensed donor insemination for same-sex female couples. As IVF has greater human and financial costs than donor insemination, policies should not encourage it as the first choice for fertile women requiring sperm. Commercial transactions are taking place where fertile lesbians receive cut price, and arguably unnecessary, IVF intervention in exchange for selling their eggs to be used for other infertile customers. If women are not told about the efficacy of fresh vs. frozen semen, and the risks of egg 'sharing' or intra-couple donation, exploitation becomes possible.
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Affiliation(s)
- Catherine Meads
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge CB1 1PT, UK
- Correspondence:
| | | | | | - Susan Bewley
- Department of Women and Children’s Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London SE1 7EH, UK;
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19
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Roeca C, Silva E, Barentsen C, Powell TL, Jansson T. Effects of vitrification and the superovulated environment on placental function and fetal growth in an IVF mouse model. Mol Hum Reprod 2021; 26:624-635. [PMID: 32618997 DOI: 10.1093/molehr/gaaa047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/08/2020] [Indexed: 01/15/2023] Open
Abstract
In studies of human IVF, as compared to frozen embryo transfer (ET), fresh ET is associated with smaller infants and higher risk of small for gestational age infants. Recent observations suggest that ET using vitrified embryos is associated with higher pregnancy and live birth rates compared to fresh ET, but increased rates of large for gestational age infants. The mechanisms underlying these associations are largely unknown, and available evidence suggests that the influence of IVF, vitrification and the superovulated (SO) uterine environment on placental function and fetal growth is complex. This warrants further investigation given the prevalent practice in human IVF of both fresh ET into a SO uterine environment, and vitrification with ET into a more physiologic uterine environment. Using a mouse model that closely resembles human IVF, we investigated if vitrification of IVF embryos better preserves placental function and results in better pregnancy outcomes as compared to fresh ET because of transfer into a more physiologic endometrium. We found that the SO environment, independent of vitrification status, reduced implantation rates, inhibited placental mechanistic target of rapamycin signaling and induced placental stress signaling, resulting in fetal growth restriction (1.080 ± 0.05 g estrous fresh (n = 17 litters), 1.176 ± 0.05 g estrous vitrified (n = 12), 0.771 ± 0.06 g SO fresh (n = 15), 0.895 ± 0.08 g SO vitrified (n = 10), P < 0.0001). In addition, our study suggests that vitrification impairs the developmental potential of IVF blastocysts that resulted in a significantly smaller litter size (2.6 ± 2.3 fresh estrous vs 2.5 ± 2.4 fresh SO vs 1.6 ± 1.7 estrous vitrified vs 1.7 ± 1.8 SO vitrified, P = 0.019), with no effect on fetal growth or placental function at term. Our findings suggest that vitrification may negatively impact early embryonic viability, while the SO maternal uterine environment impairs both placental development and fetal growth in IVF.
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Affiliation(s)
- C Roeca
- Department of Obstetrics & Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - E Silva
- Department of Obstetrics & Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - C Barentsen
- Department of Obstetrics & Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - T L Powell
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - T Jansson
- Department of Obstetrics & Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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20
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Chih HJ, Elias FTS, Gaudet L, Velez MP. Assisted reproductive technology and hypertensive disorders of pregnancy: systematic review and meta-analyses. BMC Pregnancy Childbirth 2021; 21:449. [PMID: 34182957 PMCID: PMC8240295 DOI: 10.1186/s12884-021-03938-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/07/2021] [Indexed: 12/17/2022] Open
Abstract
Background Hypertensive disorders of pregnancy (HDP) is one of the most common pregnancy complications and causes of maternal morbidity and mortality. Assisted reproductive technology (ART) has been associated with adverse pregnancy outcomes, including HDP. However, the impact of multiple pregnancies, oocyte donation, as well as fresh and frozen embryo transfer needs to be further studied. We conducted a systematic review and meta-analyses to evaluate the association between ART and HDP or preeclampsia relative to spontaneous conception (SC). Methods We identified studies from EMBASE, MEDLINE, and Cochrane Library (up to April 8, 2020) and manually using structured search strategies. Cohort studies that included pregnancies after in vitro fertilization (IVF) with or without intracytoplasmic sperm fertilization (ICSI) relative to SC with HDP or preeclampsia as the outcome of interest were included. The control group was women who conceived spontaneously without ART or fertility medications. The pooled results were reported in odds ratios (OR) with 95% confidence intervals based on random effects models. Numbers needed to harm (NNH) were calculated based on absolute risk differences between exposure and control groups. Results Eighty-five studies were included after a screening of 1879 abstracts and 283 full text articles. Compared to SC, IVF/ICSI singleton pregnancies (OR 1.70; 95% CI 1.60–1.80; I2 = 80%) and multiple pregnancies (OR 1.34; 95% CI 1.20–1.50; I2 = 76%) were both associated with higher odds of HDP. Singleton pregnancies with oocyte donation had the highest odds of HDP out of all groups analyzed (OR 4.42; 95% CI 3.00–6.51; I2 = 83%). Frozen embryo transfer resulted in higher odds of HDP (OR 1.74; 95% CI 1.58–1.92; I2 = 55%) than fresh embryo transfer (OR 1.43; 95% CI 1.33–1.53; I2 = 72%). The associations between IVF/ICSI pregnancies and SC were similar for preeclampsia. Most interventions had an NNH of 40 to 100, while singleton and multiple oocyte donation pregnancies had particularly low NNH for HDP (16 and 10, respectively). Conclusions Our meta-analysis confirmed that IVF/ICSI pregnancies are at higher odds of HDP and preeclampsia than SC, irrespective of the plurality. The odds were especially high in frozen embryo transfer and oocyte donation pregnancies. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03938-8.
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Affiliation(s)
- Hui Ju Chih
- Department of Obstetrics and Gynecology, Kingston General Hospital, Queen's University, Victory 4 76 Stuart St, Kingston, Ontario, K7L 2V7, Canada
| | - Flavia T S Elias
- Department of Obstetrics and Gynecology, Kingston General Hospital, Queen's University, Victory 4 76 Stuart St, Kingston, Ontario, K7L 2V7, Canada.,Health Technology Assessment Program, Oswaldo Cruz Foundation, Av. Brasil, 4365 - Manguinhos, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Laura Gaudet
- Department of Obstetrics and Gynecology, Kingston General Hospital, Queen's University, Victory 4 76 Stuart St, Kingston, Ontario, K7L 2V7, Canada
| | - Maria P Velez
- Department of Obstetrics and Gynecology, Kingston General Hospital, Queen's University, Victory 4 76 Stuart St, Kingston, Ontario, K7L 2V7, Canada. .,Department of Public Health Sciences, Queen's University, 62 Fifth Field Company Lane, Kingston, Ontario, K7L 3N6, Canada.
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21
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Portal A, Sunyach C, Loundou A, Lacroix-Paulmye O, Perrin J, Courbiere B. Nomograms for predicting adverse obstetric outcome in IVF pregnancy: A preliminary study. Birth 2021; 48:186-193. [PMID: 33529415 DOI: 10.1111/birt.12528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND In a previous study, we showed that the obstetric complication rate after in vitro fertilization (IVF) pregnancy was 40%. The main objective of our study was to determine maternal prognosis factors that influence the IVF pregnancy outcome. METHODS We conducted an observational retrospective monocentric study between January 2014 and January 2018. Pregnancy over 22 gestational weeks (GW) obtained after IVF in our infertility clinic was included. Maternal characteristics and pregnancy outcome were collected. RESULTS Data from 498 IVF pregnancies were analyzed. The most significant maternal prognosis factors for obstetric complications were maternal age above 40 years (OR 3,0 [95% IC 1,30-7,09], P = 0,010), twin pregnancies (3.8 [95% IC 1.49-9.99], P = .005), daily maternal smoking above 10 cigarettes (7.1 [95% IC 1.22-41.74], P = .029), maternal obesity (2.2 [95% IC 1.19-4.07], P = .012), endometriosis stages III and IV (6.4 [95% IC 1.52-27.04], P = .011), and history of ovarian hyperstimulation syndrome (OHSS) in early pregnancy (5.7 [95% IC 1.29-24.74], P = .021). Risk increase was independent of pregnancy type (singleton or twin) and allowed the elaboration of 2 nomograms. CONCLUSIONS Our study showed a link between some maternal factors and increase in obstetric complications after IVF. Screening of these factors during preconceptional visit is essential to identify at high-risk pregnancies and adapt their monitoring.
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Affiliation(s)
- Alice Portal
- Ecole Universitaire de Maïeutique de Marseille Méditerranée (EU3M), Aix Marseille Univ, Marseille, France.,Department of Gynecology-Obstetric and Reproductive Medicine, AP-HM, Hôpital La Conception, Marseille, France
| | - Claire Sunyach
- Department of Gynecology-Obstetric and Reproductive Medicine, AP-HM, Hôpital La Conception, Marseille, France
| | - Anderson Loundou
- Public Heath Department, Aix-Marseille Université, Assistance Publique des Hôpitaux Marseille and Aix-Marseille Univ, Marseille, France
| | - Odile Lacroix-Paulmye
- Department of Gynecology-Obstetric and Reproductive Medicine, AP-HM, Hôpital La Conception, Marseille, France
| | - Jeanne Perrin
- Department of Gynecology-Obstetric and Reproductive Medicine, AP-HM, Hôpital La Conception, Marseille, France.,CNRS, IRD, IMBE, Avignon Université, Aix Marseille Univ, Marseille, France
| | - Blandline Courbiere
- Department of Gynecology-Obstetric and Reproductive Medicine, AP-HM, Hôpital La Conception, Marseille, France.,CNRS, IRD, IMBE, Avignon Université, Aix Marseille Univ, Marseille, France
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22
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Wong K, Carson KR, Crane J. Risk of stillbirth in singleton gestations following in vitro methods of conception: a systematic review and meta-analysis. BJOG 2021; 128:1563-1572. [PMID: 33683788 DOI: 10.1111/1471-0528.16691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In vitro methods of conception are associated with adverse perinatal outcomes. It is unclear if the risk of stillbirth is increased also. OBJECTIVE This systematic review and meta-analysis aimed to estimate the risk of stillbirth in singleton gestations following in vitro methods of conception compared to non-in vitro conceptions. SEARCH STRATEGY A comprehensive search in PubMed, Embase, CINAHL, and Cochrane Library was undertaken from database inception to February 2021, with backward citation tracking. SELECTION CRITERIA Eligible studies included randomized controlled trials, cohort studies, or case-control studies that assessed stillbirth following in vitro fertilisation and/or intracytoplasmic sperm injection in comparison to non-in vitro methods of conception, including spontaneous conceptions, intrauterine insemination, and ovarian stimulation. DATA COLLECTION AND ANALYSIS The Newcastle-Ottawa Scale was used to assess risk of bias. A summary odds ratio (OR) for stillbirth following in vitro methods of conception compared to non-in vitro methods was calculated using a random-effects model for meta-analysis. MAIN RESULTS Thirty-three cohort studies met inclusion criteria. There was an increased risk of stillbirth with in vitro methods: OR 1.41 (95% CI 1.20-1.65); however, the crude baseline risk of stillbirth was low (4.44/1000 total births). Subgroup analysis did not demonstrate an increased risk when in vitro methods were compared to conception without in vitro methods in the context of subfertility. CONCLUSIONS Compared to non-in vitro conceptions, in vitro conceptions have an increased risk of stillbirth. However, there is insufficient evidence to demonstrate whether this risk is associated with in vitro techniques or underlying subfertility. TWEETABLE ABSTRACT This meta-analysis found an increased risk of stillbirth in singletons from in vitro methods of conception.
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Affiliation(s)
- Kty Wong
- Department of Obstetrics and Gynecology, Memorial University of Newfoundland, St. John's, NL, Canada
| | - K R Carson
- Department of Obstetrics and Gynecology, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Jmg Crane
- Department of Obstetrics and Gynecology, Memorial University of Newfoundland, St. John's, NL, Canada
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23
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Katagiri Y, Tamaki Y. Genetic counseling prior to assisted reproductive technology. Reprod Med Biol 2021; 20:133-143. [PMID: 33850446 PMCID: PMC8022097 DOI: 10.1002/rmb2.12361] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/30/2020] [Accepted: 12/04/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Reproductive medicine deals with fertility and is closely related to heredity. In reproductive medicine, it is necessary to provide genetic information for the patients prior to assisted reproductive technology (ART). Japan Society for Reproductive Medicine (JSRM) requires doctors involved in reproductive medicine to have standard knowledge of reproductive genetics and knowledge of reproductive medicine, which is covered in their publication, "required knowledge of reproductive medicine." METHODS With the aim of providing straightforward explanations to patients in the clinical situation at pre-ART counseling, we provide the following five topics, such as (a) risk of birth defects in children born with ART, (b) chromosomal abnormalities, (c) Y chromosome microdeletions (YCMs), (d) possible chromosomal abnormal pregnancy in oligospermatozoa requiring ICSI (intracytoplasmic sperm injection), and (e) epigenetic alterations. MAIN FINDINGS The frequency of chromosome abnormalities in infertile patients is 0.595%-0.64%. YCMs are observed in 2%-10% of severe oligospermic men. High incidence of spermatozoa with chromosomal abnormalities has been reported in advanced oligospermia and asthenozoospermia that require ICSI. Some epigenetic alterations were reported in the children born with ART. CONCLUSION Certain genetic knowledge is important for professionals involved in reproductive medicine, even if they are not genetic experts.
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Affiliation(s)
- Yukiko Katagiri
- Department of Obstetrics and GynecologyFaculty of MedicineToho UniversityTokyoJapan
- Division of Clinical GeneticsToho University Omori Medical CenterTokyoJapan
- Reproduction CenterToho University Omori Medical CenterTokyoJapan
| | - Yuko Tamaki
- Department of Obstetrics and GynecologyFaculty of MedicineToho UniversityTokyoJapan
- Division of Clinical GeneticsToho University Omori Medical CenterTokyoJapan
- Reproduction CenterToho University Omori Medical CenterTokyoJapan
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24
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Maternal Psychological and Biological Factors Associated to Gestational Complications. J Pers Med 2021; 11:jpm11030183. [PMID: 33807903 PMCID: PMC8000308 DOI: 10.3390/jpm11030183] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/18/2021] [Accepted: 03/02/2021] [Indexed: 01/07/2023] Open
Abstract
Early detection of gestational complications is a priority in obstetrics. In our social context, this is linked to maternity age. Most studies are focused on biological factors. However, pregnancy is also influenced by social and psychological factors, which have not been deeply explored. We aimed to identify biopsychosocial risk and protective factors associated with the development of maternal and fetal complications. We enrolled 182 healthy pregnant women, and plasma melatonin and cortisol levels were measured in the first trimester by chemiluminescent immunoassays. At different time points along gestation, women answered several questionnaires (positive and negative affect schedule, hospital anxiety and depression scale, pregnancy concerns scale, life orientation test, resilience scale, life satisfaction scale and life–work conflicts scale). They were followed up until delivery and categorized as normal pregnancy, maternal or fetal complications. Maternal complications were associated with low melatonin (OR = 0.99 [0.98; 1.00]; p-value = 0.08) and life satisfaction (OR = 0.64 [0.41; 0.93]; p-value = 0.03) and fetal complications were associated with high cortisol (OR = 1.06 [1.02; 1.13]; p-value = 0.04), anxiety (OR = 2.21 [1.10; 4.55]; p-value = 0.03) and life–work conflicts (OR = 1.92 [1.04; 3.75]; p-value = 0.05). We conclude that psychological factors influence pregnancy outcomes in association with melatonin and cortisol alterations. High maternal melatonin and life satisfaction levels could be potential protective factors against the development of maternal complications during pregnancy. Low anxiety and cortisol levels and reduced work–life conflicts could prevent fetal complications.
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25
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Silva R. Complicaciones obstétricas y perinatales en mujeres infértiles que se embarazan. REVISTA MÉDICA CLÍNICA LAS CONDES 2021. [DOI: 10.1016/j.rmclc.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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26
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Wang YX, Yue LF, Zhang JW, Xiong YW, Hu JJ, Wang LL, Li Z, Liu Y, Yang L, Sun LJ. Expression and DNA Methylation Status of the Imprinted Genes PEG10 and L3MBTL1 in the Umbilical Cord Blood and Placenta of the Offspring of Assisted Reproductive Technology. Reprod Sci 2021; 28:1133-1141. [PMID: 33515207 DOI: 10.1007/s43032-020-00417-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 11/25/2020] [Indexed: 11/30/2022]
Abstract
The aim of this study is to investigate the expression and DNA methylation status of the imprinted genes PEG10 and L3MBTL1 in the offspring of assisted reproductive technology (ART). The ART group consists of 30 cases of placenta and umbilical cord blood from ART full-term, uncomplicated singleton pregnancy progeny, and the normal control group consists of 30 cases of placenta and umbilical cord blood from natural full-term, uncomplicated singleton pregnancy progeny. The imprinted genes PEG10 and L3MBTL1 are analyzed, and the expression and methylation status of the two genes are detected using real-time quantitative polymerase chain reaction (QRT-PCR), immunohistochemistry (IHC), Western blotting (WB), and methylation-specific polymerase chain reaction (MSP). Compared with the normal control group, the PEG10 mRNA relative quantity (RQ) value in the placenta is 0.994 ± 0.458, with its RQ value up-regulated (P = 0.015). The PEG10 mRNA RQ value in the umbilical cord blood is 0.875 ± 0.452, with its RQ value up-regulated (P = 0.002). However, the L3MBTL1 mRNA RQ value in the placenta is 0.404 ± 0.234, with its RQ value down-regulated (P = 0.024). The L3MBTL1 mRNA RQ value in the umbilical cord blood is 0.337 ± 0.213, and there is no difference in the umbilical cord blood (P = 0.081). Compared with the normal control group, the expression of PEGl0 protein in the placenta of the ART progeny is up-regulated (P = 0.000), while the expression of L3MBTLl protein is down-regulated (P = 0.000). The methylation status of the PEGl0 promoter region in the placenta in the ART group is lower than that in the normal control group (P = 0.037), and that of the promoter region of the umbilical cord blood is lower than that of the natural pregnancy group (P = 0.032). The methylation status of the L3MBTLl promoter region is higher in the placenta than in the normal control group (P = 0.038), and there is no difference between the two groups in the umbilical cord blood (P = 0.301). In the ART group, the values of PEGl0 and L3MBTLl RQ in the placenta and the umbilical cord blood of the hypermethylated group are lower than in those of the hypomethylated group. ART may increase the risk of the abnormal expression of PEG10 and L3MBTL1 in offspring imprinted genes. The methylation of the promoter region may be the mechanism that regulates the expression of PEGl0 and L3MBTL1.
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Affiliation(s)
- Yun-Xia Wang
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Li-Fang Yue
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jun-Wei Zhang
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yi-Wen Xiong
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ji-Jun Hu
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lu-Lu Wang
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhe Li
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yang Liu
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lu Yang
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Li-Jun Sun
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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27
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Ganer Herman H, Mizrachi Y, Farhadian Y, Shevach Alon A, Gluck O, Bar J, Kovo M, Raziel A. Placental disorders of pregnancy in subsequent IVF pregnancies - a sibling cohort. Reprod Biomed Online 2020; 42:620-626. [PMID: 33468400 DOI: 10.1016/j.rbmo.2020.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/20/2020] [Accepted: 11/25/2020] [Indexed: 11/17/2022]
Abstract
RESEARCH QUESTION To assess whether the incidence of placental disorders of pregnancy decreases with increasing parity in repeat IVF pregnancies, in the same way as natural pregnancies. DESIGN This was a retrospective cohort of deliveries between November 2008 and January 2020, in a single university-affiliated medical centre. The study included women with only IVF-attained singleton pregnancies (no natural conception) with at least two deliveries, and compared the obstetric and perinatal outcomes between first, second and third deliveries. Each woman served as her own control. The primary outcome was the incidence of placental-related disorders of pregnancy, defined as small for gestational age (SGA) neonates and/or pre-eclampsia. RESULTS A total of 307 first deliveries, 307 second deliveries and 49 third deliveries by the same women were compared. A trend for a decreased rate of pre-eclampsia was noted with increased parity (P = 0.06) and a significant decrease in the rate of SGA: 11.7% for first delivery, 7.8% for second delivery and 2.0% for third (P = 0.04). This difference in SGA incidence was maintained in a matched sub-analysis of the 49 women with three deliveries (P = 0.04), and after adjustment for fresh/frozen embryo transfer (P = 0.03). Although SGA and pre-eclampsia were generally more common in IVF than natural pregnancies, their decrease with increasing parity mimicked that in natural pregnancies. CONCLUSION IVF pregnancies are associated with an increased risk of placental disorders of pregnancy. However, they exhibit a decrease in incidence with increasing parity.
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Affiliation(s)
- Hadas Ganer Herman
- In Vitro Fertilization Unit, Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yossi Mizrachi
- In Vitro Fertilization Unit, Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yasmin Farhadian
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ayala Shevach Alon
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Gluck
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arieh Raziel
- In Vitro Fertilization Unit, Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Evaluation of extracellular vesicles and gDNA from culture medium as a possible indicator of developmental competence in human embryos. ZYGOTE 2020; 29:138-149. [PMID: 33118919 DOI: 10.1017/s0967199420000593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Human embryos generated in vitro have a high incidence of chromosomal abnormalities that negatively affect pregnancy rate. Embryos generated in vitro secrete extracellular vesicles (EVs) into the culture medium that could be used potentially as indicators of embryo competence. This research aimed to evaluate the concentration and size of EVs and their gDNA content as an indicator of developmental competence in human embryos. Human embryos generated by intracytoplasmic sperm injection (ICSI) were classified morphologically as of either TOP, FAIR or POOR quality. Culture medium and developmentally arrested embryos (which were not able to be used for embryo transfer) were collected. Microvesicles, exosomes (MV/Exo) and apoptotic bodies (ABs) were isolated from culture medium. Nanoparticle tracking analysis (NTA) and array comparative genomic hybridization (aCGH) analysis were performed to evaluate EVs and their gDNA content. From NTA, the diameter (mean) of MVs/Exo from TOP quality embryos was higher (112.17 nm) compared with that of FAIR (108.02) and POOR quality embryos (102.78 nm) (P < 0.05). aCGH analysis indicated that MVs/Exo and ABs carried gDNA with the presence of 23 chromosome pairs. However, when arrested embryos were compared with their respective MVs/Exo and ABs, the latter had an increased rate of chromosomal abnormalities (24.9%) compared with embryos (8.7%) (P < 0.05). In conclusion, the size of EVs from culture medium might be an alternative for evaluating competence of human embryos, however more studies are needed to validate the use of gDNA from EVs as an indicator of embryo competence.
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Wilson RD. Antenatal Fetal Assessment: 75 Years Later (1945-2019). JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 41 Suppl 2:S276-S280. [PMID: 31785673 DOI: 10.1016/j.jogc.2019.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- R Douglas Wilson
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB
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Abstract
Donor-conceived neonates have poorer birth outcomes, including low birth weight and preterm delivery that are associated with poorer long-term health in adulthood through the developmental origins of health and disease (DOHaD) theory. The aim of this study was to conduct the first investigation of the adult health outcomes of donor-conceived people. An online health survey was completed by 272 donor sperm-conceived adults and 877 spontaneously conceived adults from around the world. Donor and spontaneously conceived groups were matched for age, sex, height, smoking, alcohol consumption, exercise, own fertility and maternal smoking. Donor sperm-conceived adults had significantly higher reports of being diagnosed with type 1 diabetes (P = 0.031), thyroid disease (P = 0.031), acute bronchitis (P = 0.008), environmental allergies (P = 0.046), sleep apnoea (P = 0.037) and having ear tubes/grommets surgically implanted (P = 0.046). This is the first study to investigate the health outcomes of adult donor sperm-conceived people. Donor sperm-conceived adults self-reported elevated frequencies of various health conditions. The outcomes are consistent with birth defect data from donor sperm treatment and are consistent with the DOHaD linking perturbed early growth and chronic disease in adulthood.
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Herman HG, Tamayev L, Feldstein O, Bustan M, Rachmiel Z, Schreiber L, Raziel A, Bar J, Kovo M. Placental-related disorders of pregnancy and IVF: does placental histological examination explain the excess risk? Reprod Biomed Online 2020; 41:81-87. [PMID: 32451302 DOI: 10.1016/j.rbmo.2020.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/25/2020] [Accepted: 04/01/2020] [Indexed: 01/04/2023]
Abstract
RESEARCH QUESTION What are the clinical characteristics of pregnancies complicated by fetal growth restriction (FGR) and preeclampsia in patients who have undergone IVF, and what is the correlation between these complications and histopathological placental findings in such pregnancies. DESIGN A retrospective cohort of patients who had delivered their babies at our institution who had been diagnosed with preeclampsia, whose babies had been diagnosed with FGR, or both. Deliveries in which the placenta was sent for histopathological examination were included. Computerized files and pathological reports were reviewed, and maternal, obstetric, neonatal outcomes and placental histopathological reports were compared between pregnancies conceived by IVF and controls. Placental lesions were classified according to the Amsterdam criteria. RESULTS Between December 2008 and December 2018, the placentas of 1114 singleton babies who had received a diagnosis of FGR, whose mothers had received a diagnosis of preeclampisa, or both, were examined. A total of 105 patients conceived with IVF and 1009 were conceived spontaneously. The IVF group was older, of lower parity and had a higher rate of diabetes and chronic hypertension. Deliveries occurred at an earlier gestational age, although birth weight was not significantly different between the groups. The rate of neonatal adverse composite outcome among IVF deliveries was significantly lower (59.0% versus 76.7%; P < 0.001). On placental examination, placental weight, maternal and fetal vascular malperfusion lesions were similar between the groups, whereas villitis of unknown etiology was significantly more common among the IVF group (16.2% versus 8.3%; P = 0.007). CONCLUSION Neonatal outcome is relatively favourable in IVF patients with placental-related diseases. Placental chronic villitis is more common in IVF patients, pointing to an additive immunological cause.
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Affiliation(s)
- Hadas Ganer Herman
- Departments of Obstetrics and Gynecology, the Edith Wolfson Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Halochamim 62, Holon, Tel Aviv, Israel, Israel.
| | - Liliya Tamayev
- Departments of Obstetrics and Gynecology, the Edith Wolfson Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Halochamim 62, Holon, Tel Aviv, Israel, Israel
| | - Ohad Feldstein
- Departments of Obstetrics and Gynecology, the Edith Wolfson Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Halochamim 62, Holon, Tel Aviv, Israel, Israel
| | - Mor Bustan
- Departments of Obstetrics and Gynecology, the Edith Wolfson Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Halochamim 62, Holon, Tel Aviv, Israel, Israel
| | - Zehavit Rachmiel
- Departments of Obstetrics and Gynecology, the Edith Wolfson Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Halochamim 62, Holon, Tel Aviv, Israel, Israel
| | - Letizia Schreiber
- Pathology, the Edith Wolfson Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Halochamim 62 Holon, Tel Aviv, Israel
| | - Arieh Raziel
- In Vitro Fertilization Unit, the Edith Wolfson Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Halochamim 62 Holon, Tel Aviv, Israel
| | - Jacob Bar
- Departments of Obstetrics and Gynecology, the Edith Wolfson Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Halochamim 62, Holon, Tel Aviv, Israel, Israel
| | - Michal Kovo
- Departments of Obstetrics and Gynecology, the Edith Wolfson Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Halochamim 62, Holon, Tel Aviv, Israel, Israel
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Ferraz Liz C, Domingues S, Guedes A, Lopes L. The impact of chorionicity and assisted reproductive therapies in obstetric and neonatal outcomes. J Matern Fetal Neonatal Med 2020; 35:1439-1444. [PMID: 32326779 DOI: 10.1080/14767058.2020.1757060] [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: 10/24/2022]
Abstract
Objective: Multiple gestations' incidence have raised worldwide in the last years, much due to assisted reproductive therapies (ART). The goal of this study was to analyze obstetric and neonatal outcomes of twin pregnancies in a level 3 maternity.Methods: A retrospective study including all twins born in a period of 12 years in a level 3 maternity was conducted. Analysis comparing spontaneous monochorionic and dichorionic twins and spontaneous and ART dichorionic twins were performed. A p value < .05 was considered statistically significant.Results: The sample included 1783 newborns from 875 mothers. Mean maternal age was 31 years, with 616 spontaneous pregnancies and 259 through ART. Prematurity occurred in 77%. Congenital malformations were found in 6%, and the mortality rate was 3%. Monochorionic twins had higher prematurity (79% vs 72%) and very low birthweight (VLBW) rate (19% vs 14%). Congenital anomalies (9% vs 6%), Respiratory Distress Syndrome (23% vs 18%), patent ductus arteriosus (7% vs 4%), anemia (11% vs 5%), periventricular hemorrhage (5% vs 3%), mechanical ventilation (16% vs 10%) and mortality (4% vs 2%) were higher in monochorionic twins. Although congenital malformations were more frequent in the ART group, the difference was not statistically significant. The effect of ART in neonatal and obstetric outcomes was related to maternal age.Conclusion: Monochorionic pregnancies were associated with worst obstetric and neonatal outcomes. Although congenital malformations were more frequent in the ART group, the difference was not statistically significant. Most obstetric and neonatal complications were related to advanced maternal age.
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Affiliation(s)
| | - Sara Domingues
- Neonatal Intensive Care Unit, Centro Materno Infantil do Norte, Porto, Portugal
| | - Ana Guedes
- Neonatal Intensive Care Unit, Centro Materno Infantil do Norte, Porto, Portugal
| | - Luísa Lopes
- Neonatal Intensive Care Unit, Centro Materno Infantil do Norte, Porto, Portugal
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Genetische Diagnostik vor assistierter Reproduktion – Empfehlungen der neuen S2k-Leitlinie 2019. GYNAKOLOGISCHE ENDOKRINOLOGIE 2020. [DOI: 10.1007/s10304-020-00317-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
ZusammenfassungGenetische Ursachen sind für etwa 10–20 % der männlichen und 5–10 % der weiblichen In- oder Subfertilität verantwortlich. Bei Männern ist die andrologische Untersuchung Voraussetzung dafür, genetische Ursachen von Spermatogenesestörungen einordnen zu können. Außer Störungen der Geschlechtschromosomen können auch balancierte Chromosomenumbauten zu einer Fertilitätsminderung führen. Eine Azoospermiefaktoranalyse in Bezug auf Y‑chromosomale Mikrodeletionen ist bei Männern mit Azoospermie indiziert, da sie über den Erfolg einer assistierten Reproduktion entscheiden kann. Bei Verdacht auf obstruktive Azoospermie soll eine Analyse des CFTR-Gens zur Diagnostik einer zystischen Fibrose erfolgen. Bei endokrinen Auffälligkeiten sind genetische Ursachen des häufigeren hypergonadotropen Hypogonadismus von denen eines seltenen kongenitalen hypogonadotropen Hypogonadismus zu unterscheiden. Algorithmen zur genetischen Diagnostik sind in der aktuellen Leitlinie im internationalen Vergleich ausgeführt.
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Kaur N, Ricciardelli R. Negotiating risk and choice in multifetal pregnancies. Soc Sci Med 2020; 252:112926. [PMID: 32197141 DOI: 10.1016/j.socscimed.2020.112926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 02/28/2020] [Accepted: 03/12/2020] [Indexed: 11/29/2022]
Abstract
Today, across all aspects of societal living, risk assessment is an ever-present exercise. Pervasiveness of technology in the everyday life has caused the world of 'risk' to change tremendously, and this is particularly true for childbearing females. The social construction of pregnancy and childbirth as, arguably, medical events that necessitate medical intervention - ever more so for multifetal pregnancies - makes it almost impossible to avoid the notions of risk that surround the events. Drawing on semi-structured interviews with 41 mothers of twins or triplets, we investigate how understandings of risk, combined with the ideology of good motherhood and information provided by physicians impact perceptions of fetal reduction or termination. We have discussed and theorized empirical findings within the framework of risk, discourses of the responsibilization of females, and the potential 'sacred child' in a context where selective reduction becomes a potentiality.
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Affiliation(s)
- Navjotpal Kaur
- Department of Sociology, Memorial University of Newfoundland and Labrador, 230 Elizabeth Avenue, St. John's, NL, A1C 5S7, Canada.
| | - Rosemary Ricciardelli
- Department of Sociology, Memorial University of Newfoundland and Labrador, 230 Elizabeth Avenue, St. John's, NL, A1C 5S7, Canada.
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Atienza-Carrasco J, Linares-Abad M, Padilla-Ruiz M, Morales-Gil IM. Experiences and outcomes following diagnosis of congenital foetal anomaly and medical termination of pregnancy: A phenomenological study. J Clin Nurs 2020; 29:1220-1237. [PMID: 31887230 DOI: 10.1111/jocn.15162] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 10/21/2019] [Accepted: 12/20/2019] [Indexed: 12/01/2022]
Abstract
AIM To determine and describe the experiences of pregnant women who receive a diagnosis of chromosomopathy and/or foetal malformation during a prenatal check-up and who decide to legally terminate the pregnancy. BACKGROUND When a pregnancy is terminated, the woman must cope with frustrated motherhood. The psychological consequences of this will largely depend on the care and support provided by health professionals. When a congenital anomaly is diagnosed, a patient-centred communication helps understanding, influences adaptation to the new situation and ensures the person concerned has sufficient (autonomy or independence or ability) to make appropriate decisions. METHODS A qualitative study, based on a phenomenological approach, was carried out through nonparticipant observation and semi-structured interviews with 27 obstetric patients. NVivo 11 software was used, and content analysis was performed. The manuscript was developed using the COREQ guidelines to inform qualitative studies. RESULTS The clinical relationship may be affected by communication problems such as patients' perceptions of scarce emotional involvement by obstetricians, by poor psychosocial support during the termination of the pregnancy and by insufficient follow-up after discharge. CONCLUSION Nurses are in a privileged position to promote the empowerment of affected women. It is necessary to improve aspects related to the privacy of patients and the awareness and training of the interdisciplinary team in interpersonal communication. Post-loss follow-up is recommended to assess individual needs, thus facilitating an optimal approach to ease the grieving process. RELEVANCE TO CLINICAL PRACTICE During the prenatal diagnosis, the existence of a fetal anomaly is emphasized, but support and follow up of the mother may be neglected; therefore, exhaustive knowledge about the obstetric history, the state of health and the expectations of patients is as important as a multidisciplinary team trained in counseling strategies and with a comprehensive care plan that covers all areas, especially those that control maternal emotions.
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Affiliation(s)
| | | | - María Padilla-Ruiz
- Research Unit, Costa del Sol Health Care Agency, Marbella, Spain.,Health Services Network for Research into Chronic Diseases (REDISSEC), Madrid, Spain
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Uysal NŞ, Gülümser Ç, Bilgin Yanık FF, Önalan G, Zeyneloğlu HB. Outcome of ICSI pregnancies with spontaneous loss of a co-twin compared with singleton ICSI pregnancies: Single center experience. J Obstet Gynaecol Res 2020; 46:445-450. [PMID: 31922328 DOI: 10.1111/jog.14177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 11/30/2019] [Indexed: 11/28/2022]
Abstract
AIM To compare the outcome of intracytoplasmic sperm injection (ICSI) pregnancies complicated by spontaneous loss of a dichorionic co-twin with that of singleton ICSI pregnancies. METHODS The study group included dichorionic ICSI pregnancies with co-twin loss (n = 33) and the control group included ICSI pregnancies with a singleton from the beginning (n = 327). Primary outcome measures were obstetric complications, including preterm delivery, newborn small for gestational age, gestational diabetes, gestational hypertensive disorders and abruptio placenta; admission to neonatal intensive care unit (NICU) and perinatal mortality observed in the study and control groups. Statistical analysis was performed using spss for Windows, version 22.0. RESULTS In the study group, there were 26 cases of first trimester (early) and 7 cases of second or third trimester (late) co-twin losses. Mean gestational age at delivery and mean birth weight were significantly lower in the whole study group compared to control (P < 0.05). Preterm delivery and NICU admission rates were significantly higher in the whole study group, compared to control (39.3% vs 14.6% and 36.36% vs 11.69% respectively, P < 0.05), but did not show significant difference between early loss subgroup and control (P > 0.05). Preterm delivery rate was significantly higher in the late loss subgroup compared to the early loss subgroup (85.71% vs 26.92% P < 0.05). CONCLUSION Loss of a co-twin in dichorionic ICSI pregnancies is associated with increased risk of preterm birth. This risk is significantly higher in cases with late loss compared to the early loss cases.
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Affiliation(s)
- Nihal Ş Uysal
- Department of Obstetrics and Gynecology, Division of Perinatology, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Çağrı Gülümser
- Department of Obstetrics and Gynecology, Division of Perinatology, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Filiz F Bilgin Yanık
- Department of Obstetrics and Gynecology, Division of Perinatology, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Göğşen Önalan
- Department of Obstetrics and Gynecology, Inferitility and Assisted Reproduction Unit, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Hulusi B Zeyneloğlu
- Department of Obstetrics and Gynecology, Inferitility and Assisted Reproduction Unit, Başkent University Faculty of Medicine, Ankara, Turkey
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Wilson RD. Évaluation fœtale prénatale : 75 ans plus tard (1945-2019). JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41 Suppl 2:S281-S286. [DOI: 10.1016/j.jogc.2019.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Second-generation preimplantation genetic testing for aneuploidy in assisted reproduction: a SWOT analysis. Reprod Biomed Online 2019; 39:905-915. [DOI: 10.1016/j.rbmo.2019.07.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 07/04/2019] [Accepted: 07/31/2019] [Indexed: 01/03/2023]
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Allen C. Health and Disease After Assisted Reproductive Technology. FERTILITY & REPRODUCTION 2019. [DOI: 10.1142/s2661318219300095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Long-term health outcomes after ART have largely focused on offspring health and perinatal parameters. Longer-term health outcomes in female patients remain difficult to fully assess. Hypothetical concerns about the effects of endocrine manipulation on hormone-sensitive conditions, e.g. breast disease, are confounded by variable factors in patients and treatments. Obstetric and perinatal factors endow an additional layer of complexity to the overall analysis and more research is required to appreciate all aspects of ART. Notwithstanding the knowledge gap, clinicians must endeavour to individualise management plans, taking into account the pros and cons of ART in the context of immediate, maternity-related and long-term health risks for their patients.This review of recent literature examines current ART practice in terms of female health and disease as we strive for best practice in an ever-changing clinical and demographic fertility landscape.
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Affiliation(s)
- Cathy Allen
- National Maternity Hospital and Merrion Fertility Clinic, Dublin, Ireland
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Xiao Y, Jiang L, Tong Y, Luo X, He J, Liu L, Gong C, Ke L, Yang L, Zhou Q, Estill J, Shen H, Chen Y. Evaluation of the quality of guidelines for assisted reproductive technology using the RIGHT checklist: A cross-sectional study. Eur J Obstet Gynecol Reprod Biol 2019; 241:42-48. [PMID: 31419695 DOI: 10.1016/j.ejogrb.2019.07.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/24/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION In recent years, assisted reproductive technology (ART) has developed rapidly, leading to an increasing number of clinical practice guidelines in this field. However, the reporting quality of current clinical practice guidelines in ART is still unknown. Objective To evaluate the reporting quality of clinical practice guidelines in the field of ART using the RIGHT checklist. METHOD Relevant guidelines were identified by electronic search of PubMed, Chinese Biomedical Literature Database (CBM), Wan Fang Database and Chinese National Knowledge Infrastructure (CNKI) from the beginning of the database to October, 2017. We also searched the websites of the guideline development organizations, including Guidelines International Network (GIN), National Guideline Clearinghouse (NGC) and the National Institute for Health and Care Excellence (NICE), as well as from two medical associations, including the European Society of Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM). We used Google Scholar to find additional clinical practice guidelines (CPGs) as well. Two investigators searched the database, selected guidelines independently based on the inclusion criteria, and extracted the relevant information. RESULT Fifteen guidelines (i.e. six developed by individual institutions and 9 by associations) were included. On average, 12.7 out of 35 items in the RIGHT standard (36.3%) were reported in each guideline. Five items were not reported by any of these guidelines. The reporting proportion of the seven domains (i.e. Basic information; Background; Evidence; Recommendations; Review and quality assurance; Funding and declaration and management of interests; Other information) were 46.7%, 40.8%, 45.3%, 29.5%, 53.3%, 10.0%, 26.7%, respectively. CONCLUSION At present, the reporting quality of guidelines for ART is poor, especially regarding the funding. In the future guideline development, more consideration should be given to reporting, dissemination and implementation.
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Affiliation(s)
- Yujie Xiao
- The Second Medical School of Lanzhou University, Lanzhou, Gansu 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou Gansu 730000, China
| | - Li Jiang
- Reproductive Medicine Center, Peking University People's Hospital, Peking 100000, China
| | - Yajing Tong
- School of Public Health of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Xufei Luo
- School of Public Health of Lanzhou University, Lanzhou, Gansu 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou Gansu 730000, China; Chinese GRADE Center, Lanzhou University, Lanzhou, Gansu 730000, China
| | - Jianghua He
- The Second Medical School of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Lian Liu
- The Second Medical School of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Chao Gong
- The Second Medical School of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Lixin Ke
- The first Medical School of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Liu Yang
- The Reproductive Medicine Special Hospital of the first hospital of Lanzhou University, Key Laboratory for Reproductive Medicine and Embryo, Lanzhou, Gansu 730000, China
| | - Qi Zhou
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou Gansu 730000, China; Chinese GRADE Center, Lanzhou University, Lanzhou, Gansu 730000, China; The first Medical School of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Janne Estill
- Institute of Global Health, University of Geneva, Switzerland; Institute of Mathematical Statistics and Actuarial Science, University of Bern, Switzerland
| | - Huan Shen
- Reproductive Medicine Center, Peking University People's Hospital, Peking 100000, China.
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou Gansu 730000, China; Chinese GRADE Center, Lanzhou University, Lanzhou, Gansu 730000, China.
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Oberg AS, VanderWeele TJ, Almqvist C, Hernandez-Diaz S. Pregnancy complications following fertility treatment-disentangling the role of multiple gestation. Int J Epidemiol 2019; 47:1333-1342. [PMID: 29939263 PMCID: PMC6124622 DOI: 10.1093/ije/dyy103] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 05/14/2018] [Indexed: 12/20/2022] Open
Abstract
Background To assess the extent to which multiple gestations mediate risk of pregnancy complications from fertility treatment and to address possible confounding by the underlying infertility. Methods From the nearly 1.8 million pregnancies recorded in the Swedish Medical Birth Register between 1996 and 2013, we selected the 9.9% (N = 174 067) that occurred to couples with known trouble conceiving (clinical infertility). Fertility treatment was identified from self-reports, medical records and procedural information from fertility clinics. We used logistic regression to estimate odds ratios (ORs) and their 95% confidence intervals (CIs), and decomposed the total effect into direct and mediated effects to estimate the proportion mediated by multiple gestations. Results Compared with pregnancies achieved without any assistance, those having received some treatment had higher odds of all studied complications except gestational diabetes. Associations with placenta previa (OR 2.17, 95% CI 1.95-2.40) and placental abruption (OR 1.77, 95% CI 1.54-2.03) were almost entirely independent of multiple gestations. In contrast, the majority of the associations with preterm birth (OR 1.69, 95% CI 1.62-1.77), caesarean delivery (RR 1.15, 95% CI 1.13-1.17) and pre-eclampsia (OR 1.17, 95% CI 1.11-1.22) were mediated by multiple gestations (87%, 62% and 91% of the effect mediated, respectively). Both direct and mediated pathways contributed to the remaining positive associations with chorioamnionitis, labour induction and postpartum haemorrhage. Results were similar when considering primi- and multi-parous women separately, and after restriction to assisted reproductive technologies only. Conclusion Multiple gestations are responsible for a large proportion of pregnancy complications associated with fertility treatment, suggesting that interventions to restrict the occurrence of multiples could reduce excess risk of pre-eclampsia, preterm birth and caesarean delivery after fertility treatment. However, the elevated risk of serious placental complications after fertility treatment appears to be largely independent of multiple gestations.
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Affiliation(s)
- Anna Sara Oberg
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Tyler J VanderWeele
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Lung and Allergy Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Sonia Hernandez-Diaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
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Jiang L, Chen Y, Wang Q, Wang X, Luo X, Chen J, Han H, Sun Y, Shen H. A Chinese practice guideline of the assisted reproductive technology strategies for women with advanced age. J Evid Based Med 2019; 12:167-184. [PMID: 31144467 DOI: 10.1111/jebm.12346] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/19/2018] [Indexed: 01/31/2023]
Abstract
More women postpone childbearing nowadays while female fertility begins to decline with advancing age. Furthermore, with the rolling out of the two-child policy, there is a huge demand for a second child for Chinese aged women. There are various assisted reproductive technology (ART) strategies applied for age-related infertility without solid evidence. On behalf of the Society of Reproductive Medicine, Chinese Medical Association, we would like to develop a Chinese guideline of ART strategies for age-related infertility. This guideline was produced following the recommendations for standard guidelines described in the 2012 WHO Handbook for guideline development. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was also followed. A protocol was formulated and a Guideline Development Group was formed with specialists of reproductive medicine, methodologists from Chinese GRADE working group, and patient representative. Questions regarding the ART strategies for aged infertility were formulated and 8 most important ones were chosen to be structured in PICO format (Population, Intervention, Comparison, Outcomes). Comprehensive search and review of the literature were performed and the quality of the evidence was assessed and rated based on certain criteria and be categorized as high, moderate, low, or very low. Twenty-five recommendations were formulated among members of the Guidelines Development Group (Delphi method) basing on the overall quality of the evidence, in addition to the balance between benefits and harms, values and preferences, and resource implications. The final recommendations were agreed on by consensus during face-to-face meetings. This is the first Chinese practice guideline in reproductive medicine developed following the standard and scientific method.
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Affiliation(s)
- Li Jiang
- Reproductive Medicine Center, Peking University People's Hospital, Beijing, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
- Chinese GRADE Center, Lanzhou, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Qi Wang
- Health Policy PhD Program, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- McMaster Health Forum, McMaster University, Hamilton, Canada
| | - Xiaoqin Wang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
- Chinese GRADE Center, Lanzhou, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Xufei Luo
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
- Chinese GRADE Center, Lanzhou, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Junqiao Chen
- Faculty of Science, University of Lisbon, Lisbon, Portugal
| | - Hongjing Han
- Reproductive Medicine Center, Peking University People's Hospital, Beijing, China
| | - Yingpu Sun
- Reproductive Medicine Center, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Huan Shen
- Reproductive Medicine Center, Peking University People's Hospital, Beijing, China
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Merino PM, Lopez P, Salinas A, Pastene C, Muñoz A, Cassorla F, Codner E. Ovarian Function in Adolescents Conceived Using Assisted Reproductive Technologies. J Pediatr Adolesc Gynecol 2019; 32:117-121. [PMID: 30502496 DOI: 10.1016/j.jpag.2018.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/04/2018] [Accepted: 11/22/2018] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE To compare ovarian function between adolescents conceived using assisted reproductive technology (AcART) and adolescents who were conceived spontaneously (AcSP). DESIGN Multicenter study of ovarian function in AcART because of male or tubal infertility. SETTING University Hospital. PARTICIPANTS We evaluated 22 AcART and 53 AcSP at 1-2 years after menarche. The participants were born at term (≥37 weeks of gestation) with normal birth weights (≥2500 g) from singleton pregnancies. INTERVENTIONS None. MAIN OUTCOME MEASURES Differences in ovulation, reproductive hormones, and ovarian morphology. RESULTS AcART had an older age of menarche than that of AcSP, even after adjusting for maternal age at menarche, gestational age, and birth weight (P = .027). AcART had lower incidence of ovulation (P = .021) and higher luteinizing hormone serum levels (P = .01) than those of AcSP. The incidence of oligomenorrhea and the cycle length were similar between AcART and AcSP. AcART had levels of anti-Müllerian hormone, inhibin B, follicle-stimulating hormone, estradiol, and androgens similar to those of AcSP. The ovarian morphology, ovarian volume, and follicle counts were similar in both groups. CONCLUSION AcART had later menarche, lower ovulation rates, and higher luteinizing hormone levels than those of AcSP. Future studies should investigate whether these findings are indicative of a risk of ovarian dysfunction later in life for AcART.
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Affiliation(s)
- Paulina M Merino
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile.
| | - Patricia Lopez
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile; Cytogenetics Laboratory, Hospital Clínico San Borja Arriarán, Santiago, Chile
| | - Abril Salinas
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Carolina Pastene
- Department of Obstetrics and Gynecology, Clinica Las Condes, Santiago, Chile
| | - Alex Muñoz
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile; Cytogenetics Laboratory, Hospital Clínico San Borja Arriarán, Santiago, Chile
| | - Fernando Cassorla
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Ethel Codner
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
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Male partners of subfertile couples in which the spouse is obese display adverse weight and lifestyle associated with reduced sperm quality. Obes Res Clin Pract 2019; 13:226-232. [PMID: 30935865 DOI: 10.1016/j.orcp.2019.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/20/2019] [Accepted: 03/01/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To assess: 1-the spousal concordance of lifestyle and anthropometric characteristics between partners of infertile couples in which the woman is obese; and 2-in men, the influence of these characteristics on their conventional seminal parameters. DESIGN Cross-sectional study. SETTING Fertility clinic of the Centre hospitalier universitaire de Sherbrooke, Canada, between January 2012 and February 2015. PATIENTS 97 infertile heterosexual couples in which women were obese and seeking fertility treatments. INTERVENTION Not applicable. MAIN OUTCOME MEASURES Weight and percentage of fat mass were evaluated using a scale with foot-to-foot bio-impedance. Abdominal obesity was estimated with waist circumference and lifestyle habits, by a self-reported questionnaire. Seminal parameters were analysed and collected according to the WHO guidelines (Kruger's strict criteria for seminal morphology). RESULTS There was a significant spousal concordance for the percentage of fat mass, leisure activities and overall nutritional quality. Accordingly, male participants displayed anthropometric and lifestyle characteristics at higher risk than Canadian men of similar age. Moreover, BMI, daily consumption of fruits & vegetables and sleeping hours in men were independently associated to the total motile sperm count. CONCLUSION This is the first study to report concordance for anthropometric and lifestyle characteristics between partners of infertile couples in which the woman is obese. These characteristics in men were more adverse than in the general population and were associated with reduced sperm quality. Altogether, our results suggest that male partners of infertile couples could benefit from participating in the lifestyle intervention that is already recommended for their spouse affected by obesity. CAPSULE Because partners of subfertile couples in which the woman is obese share adverse anthropometric and lifestyle characteristics, male partners should be implicated in lifestyle interventions already indicated for their spouse.
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Velez MP, Hamel C, Hutton B, Gaudet L, Walker M, Thuku M, Cobey KD, Pratt M, Skidmore B, Smith GN. Care plans for women pregnant using assisted reproductive technologies: a systematic review. Reprod Health 2019; 16:9. [PMID: 30696452 PMCID: PMC6352361 DOI: 10.1186/s12978-019-0667-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 01/08/2019] [Indexed: 12/28/2022] Open
Abstract
Background Between 1 and 5% of children in industrialized countries are conceived through Assisted Reproductive Technologies (ART). As infertility and the use of ART may be associated with adverse perinatal outcomes, care plans specific to these pregnancies are needed. We conducted a systematic review to examine the existing care plans specific to women pregnant following Assisted Reproductive Technologies (ART). Methods MEDLINE, Embase and the Cochrane Library were searched by a senior information specialist. The population of interest included women becoming pregnant with ART (e.g., Intra-Uterine Insemination, In Vitro Fertilization (IVF), Intracytoplasmic Sperm Injection (ICSI), and surrogacy). All proposed care plans were sought that pertained to any aspect of care during pregnancy and delivery. Only Clinical Practice Guidelines (CPGs) addressing the recommendations and plans for the care of ART pregnant women were included. The search was restricted to the publication dates 2007 to June 12, 2017 when the search was run. The search was not restricted by language, however only English and French language guidelines were considered for inclusion. Results After screening 2078 citations, a total of ten CPGs were included. The following key clinical messages were prevalent: (1) although there was no supporting evidence, antenatal care for ART pregnancies should be provided by specialist with knowledge in obstetrics; (2) high-order multiple pregnancies are the greatest risk of ART and selective reduction options should be discussed; (3) there is some evidence of increased risk of congenital abnormalities and prenatal genetic and anatomic screening is recommended, especially in IVF-ICSI pregnancies; (4) due to a lack of or conflicting evidence, treatment of venous thromboembolism, antithrombotic therapy, treatment for hypothyroidism, and women with positive thyroid antibodies is recommended to be the same as in spontaneous pregnancies; and lastly (5) since an increased level of distress is a recognized feature in these pregnancies, psychosocial care and counselling should be considered. Conclusions There is a lack of CPGs specific to ART pregnancies. While we identified a small number of recommendations for ART pregnancies, specific interventions and models of care aiming at decreasing adverse maternal and perinatal outcomes following ART should be developed, implemented, and evaluated. Electronic supplementary material The online version of this article (10.1186/s12978-019-0667-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria P Velez
- Department of Obstetrics and Gynecology, Queen's University, Kingston General Hospital, Kingston, Ontario, K7L 2V7, Canada. .,Department of Public Health Sciences, Queen's University, 62 Fifth Field Company Lane, Kingston, Ontario, K7L 3N6, Canada.
| | - Candyce Hamel
- Knowledge Synthesis Group, Ottawa Methods Centre, Ottawa Hospital Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
| | - Brian Hutton
- Knowledge Synthesis Group, Ottawa Methods Centre, Ottawa Hospital Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada
| | - Laura Gaudet
- Department of Obstetrics, Gynecology & Newborn Care, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada.,OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada
| | - Mark Walker
- Department of Obstetrics, Gynecology & Newborn Care, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada.,OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada
| | - Micere Thuku
- Knowledge Synthesis Group, Ottawa Methods Centre, Ottawa Hospital Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
| | - Kelly D Cobey
- Knowledge Synthesis Group, Ottawa Methods Centre, Ottawa Hospital Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada
| | - Misty Pratt
- Knowledge Synthesis Group, Ottawa Methods Centre, Ottawa Hospital Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
| | - Becky Skidmore
- Knowledge Synthesis Group, Ottawa Methods Centre, Ottawa Hospital Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
| | - Graeme N Smith
- Department of Obstetrics and Gynecology, Queen's University, Kingston General Hospital, Kingston, Ontario, K7L 2V7, Canada
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Palomba S, Falbo A, Daolio J, Battaglia FA, La Sala GB. Pregnancy complications in infertile patients with polycystic ovary syndrome: updated evidence. MINERVA GINECOLOGICA 2018; 70. [DOI: 10.23736/s0026-4784.18.04230-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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47
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Pregnancy outcomes from more than 1,800 in vitro fertilization cycles with the use of 24-chromosome single-nucleotide polymorphism–based preimplantation genetic testing for aneuploidy. Fertil Steril 2018; 110:113-121. [DOI: 10.1016/j.fertnstert.2018.03.026] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 03/15/2018] [Accepted: 03/19/2018] [Indexed: 11/20/2022]
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Wilson RD. Woman's Pre-Conception Evaluation: Genetic and Fetal Risk Considerations for Counselling and Informed Choice. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:935-949. [DOI: 10.1016/j.jogc.2017.07.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/26/2017] [Accepted: 07/26/2017] [Indexed: 12/30/2022]
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Assisted reproductive technologies: a hierarchy of risks for conception, pregnancy outcomes and treatment decisions. J Dev Orig Health Dis 2018; 8:443-447. [PMID: 28721836 DOI: 10.1017/s2040174417000526] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The use of assisted reproductive technologies (ART) for the treatment of infertility has grown exponentially over the last 20 years, and now accounts for 4% of all births in Australia, and over 1 m births annually around the globe. There is consistent reporting of increased risk of adverse perinatal outcomes and birth defects following infertility treatment. However, change in practice has been stymied by critical knowledge gaps with regards to (a) the relative contribution of patient and treatment factors to adverse outcomes, (b) the independent contribution of specific contemporary treatments and treatment combinations to outcomes, (c) the impact of innovations in laboratory and clinical practice on treatment success and observed risk and (d) changes over time in patient characteristics. Here we summarize key findings from the South Australian Birth Cohort, which is a whole-of-population cohort of over 300,000 births from 1986 to 2002. Relative to spontaneous conceptions, singletons from assisted conception were more likely to be stillborn [odds ratio (OR)=1.82; 95% confidence interval (CI) 1.34-2.48], while survivors as a group were comprehensively disadvantaged at birth, including lower birth weight (OR=2109 g; 95% CI 2129-289), very low birth weight (OR=2.74; 95% CI 2.19-3.43), very preterm birth (OR=2.30; 95% CI 1.82-2.90) and neonatal death (OR=2.04; 95% CI 1.27-3.26). Major birth defects, including cardiac, urogenital and musculoskeletal defects are doubled after fresh ICSI cycles, which is a particular concern as ICSI now accounts for 70% of all treatment cycles globally. Future study is needed to provide contemporary, precise evidence to inform patient and clinic decision making, and generate knowledge for future innovation in ART laboratory methods and clinical practice, thereby optimizing treatment and health outcomes while reducing adverse events.
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Neumann C, Thompson DA, Thorson H, Sidman JD, Roby BB. Assisted Reproduction is Not Associated with Increased Risk of Congenital Head and Neck Defects. Cureus 2018; 10:e2287. [PMID: 31431829 PMCID: PMC6693793 DOI: 10.7759/cureus.2287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This abstract was presented at the American Academy of Otolaryngology-Head and Neck Surgery Annual Meeting, Orlando, FL, September 2014 with the abstract published (Neumann C, Thompson D, and Sidman J; Assisted reproduction is not associated with increased risk of head and neck defects; Otolaryngology-Head and Neck Surgery; Vol 151, Issue 1, supplement, 2014). Objectives - Compare the rate of head and neck anomalies between children conceived via artificial reproductive technology (ART) versus those conceived via natural methods. - Determine the risk of congenital head and neck abnormalities associated with ART. Study design A retrospective chart review cross-sectional study from 2004-2014 of all patients admitted to the neonatal intensive care unit (NICU) at a tertiary pediatric hospital. Results A total of 14,857 charts were examined; 2,288 patients were conceived via ART, while 12,569 patients were conceived via natural methods. There were 8,022 males and 6,637 females. There were 40 patients born with defects via ART, while there were 681 patients born with defects via natural conception. The total occurrence of congenital malformations was higher for patients conceived naturally versus those conceived with artificial reproduction (5.41% vs. 1.74%). The odds ratio was 0.31 with a 95% CI of 0.23 to 0.43 and a P-value of < 0.0001; the relative risk of having any one of the head and neck defects with ART was 1.04 with a 95% CI of 1.03 to 1.05 and a P-value < 0.0001. Conclusion There appears to be no increased risk of congenital head and neck defects in children conceived via ART versus those conceived naturally.
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Affiliation(s)
- Colin Neumann
- General Surgery, Hofstra Northwell School of Medicine.,Minnesota Perinatal Physicians, Allina Health.,Otolaryngology Head and Neck Surgery, University of Minnesota.,Pediatric Ent and Facial Plastic Surgery, Children's Hospital of Minnesota, St. Paul, USA
| | | | | | - James D Sidman
- Otolaryngology Head and Neck Surgery, University of Minnesota
| | - Brianne B Roby
- Pediatric Ent and Facial Plastic Surgery, Children's Hospital of Minnesota, St. Paul, USA
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