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Peyser A, Gulersen M, Krantz D, Li X, Bornstein E, Rochelson B, Mullin C, Goldman R. The impact of fresh versus frozen-thawed embryos on maternal serum analyte levels in IVF singleton and twin pregnancies. J Assist Reprod Genet 2024; 41:473-481. [PMID: 38133878 PMCID: PMC10894779 DOI: 10.1007/s10815-023-03007-3] [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: 08/23/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE To determine whether embryo cryopreservation is associated with a difference in maternal serum analyte levels in singleton and twin pregnancies conceived via in vitro fertilization (IVF). METHODS This was a retrospective cohort study of singleton and twin pregnancies conceived via IVF from a university health system from 01/2014 to 09/2019. Patients with available first and second trimester serum analyte data were included and analyzed separately. Multiple of the median (MoM) values for free β-human chorionic gonadotropin (β-hCG), pregnancy-associated plasma protein A, alpha-fetoprotein (AFP), Inhibin A, and unconjugated estriol (uE3) were compared between two groups: pregnancies conceived after the transfer of fresh embryos versus pregnancies conceived after the transfer of frozen-thawed embryos. Multiple linear regression of log MoM values with F test was performed to adjust for potential confounders. RESULTS For singletons, fresh embryos were associated with a lower median first trimester free β-hCG (1.00 MoM vs. 1.14 MoM; parameter estimate [PE] 0.90, 95% CI 0.82-0.99, p = .03) compared to frozen-thawed embryos. Fresh embryos were also associated with a lower median second trimester uE3 (0.93 MoM vs. 1.05 MoM; PE 0.88, CI 0.83-0.95, p = .0004) and AFP (1.02 MoM vs. 1.19 MoM; PE 0.91, CI 0.84-0.99, p = .02) compared to frozen-thawed embryos in singletons. There were no significant differences between median first and second trimester serum analytes in twin pregnancies compared between the two groups. CONCLUSION Singleton pregnancies derived from fresh embryos had lower first (free β-hCG) and second (uE3 and AFP) trimester analytes compared to frozen-thawed embryos. Twin pregnancies demonstrated no difference between the groups.
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Affiliation(s)
- Alexandra Peyser
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, North Shore University Hospital - Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY, 11030, USA.
| | - Moti Gulersen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - David Krantz
- Prenatal Screening Lab, Northwell Health Laboratories, Lake Success, NY, USA
| | - Xueying Li
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Eran Bornstein
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital - Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Burton Rochelson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North Shore University Hospital - Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Christine Mullin
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, North Shore University Hospital - Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY, 11030, USA
| | - Randi Goldman
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, North Shore University Hospital - Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY, 11030, USA
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Alonso-Mayo C, Kohls G, Santos-Ribeiro S, Soares SR, Garcia-Velasco JA. Modified natural cycle allows a window of 7 days for frozen embryo transfer planning. Reprod Biomed Online 2023:103774. [PMID: 38609793 DOI: 10.1016/j.rbmo.2023.103774] [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: 09/29/2023] [Revised: 11/18/2023] [Accepted: 11/23/2023] [Indexed: 04/14/2024]
Abstract
RESEARCH QUESTION Should ovulation be triggered in a modified natural cycle (mNC) with recombinant human chorionic gonadotrophin (rHCG) as soon as a mean follicle diameter of 17 mm is visible, or is more flexible planning possible? DESIGN This multicentre, retrospective, observational study of 3087 single frozen blastocyst transfers in mNC was carried out between January 2020 and September 2022. The inclusion criteria included endometrial thickness ≥7 mm and serum progesterone <1.5 ng/ml. The main outcome was ongoing pregnancy rate. Secondary end-points were pregnancy rate, implantation rate, clinical pregnancy rate and miscarriage rate. The mean follicle size at triggering was stratified into three groups (13.0-15.9, 16.0-18.9 and 19.0-22 mm). RESULTS The baseline characteristics between the groups did not vary significantly for age, body mass index and the donor's age for egg donation. No differences were found in pregnancy rate (64.5%, 60.2% and 57.4%; P = 0.19), clinical pregnancy rate (60.5%, 52.8% and 50.6%; P = 0.10), implantation rate (62.10%, 52.9% and 51.0%; P = 0.05) or miscarriage rate (15.0%, 22.2%; and 25.0%; P = 0.11). Although ongoing pregnancy rate (54.9%, 46.8% and 43.1%; P = 0.02) varied significantly in the univariable analysis, it was no longer significant after adjustment for the use of preimplantation genetic testing for aneuploidies and egg donation. CONCLUSIONS The findings showed rHCG could be flexibly administered with a mean follicle size between 13 and 22 mm as long as adequate endometrial characteristics are met, and serum progesterone is <1.5 ng/ml. Considering the follicular growth rate of 1-1.5 mm/day, this approach could allow a flexibility for FET scheduling of 6-7 days, simplifying mNC FET planning in clinical practice.
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Affiliation(s)
| | - Graciela Kohls
- IVIRMA Global Research Alliance, IVIRMA Madrid, Madrid, Spain
| | | | | | - Juan A Garcia-Velasco
- IVIRMA Global Research Alliance, IVIRMA Madrid, Madrid, Spain; IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigación Sanitaria La Fe, Valencia, Spain; Rey Juan Carlos University, Madrid Spain
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Fan J, Zhang J, Xu S, Liu H, Lv W, Bi X, Liu Y, Shi W, Zhang Y, Wu X. The predictive value of uterine artery Doppler in the success rate of pregnancy from the first frozen embryo transfer during the implantation window. BMC Pregnancy Childbirth 2023; 23:825. [PMID: 38037011 PMCID: PMC10688035 DOI: 10.1186/s12884-023-06150-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Worldwide, frozen embryo transfer (FET) has become a new strategy for the treatment of infertility. The success of FET is closely related to endometrial receptivity. Does uterine artery Doppler during the implantation window predict pregnancy outcome from the first FET? METHODS A total of 115 retrospectively collected cycles were included in the study, with 64 cycles of clinical pregnancy and 51 cycles of nonclinical pregnancy; There were 99 nonabsent end-diastolic flow (NAEDF) cycles and 16 absent end-diastolic flow (AEDF) cycles. The differences in uterine artery Doppler findings between different pregnancy outcomes were investigated. The clinical pregnancy rate and spontaneous abortion rate in the NAEDF and AEDF groups were compared. The predictive value of uterine artery Doppler during the implantation window in the success rate of pregnancy from the first FET was also investigated. RESULTS Between the clinical pregnancy group and the nonclinical pregnancy group, there were no significant differences in the mean resistance index (mRI) (Z = -1.065, p = 0.287), mean pulsatility index (mPI) (Z = -0.340, p = 0.734), and mean peak systolic/end-diastolic velocity(mS/D) (Z = -0.953, p = 0.341); there were significant differences in the mean peak systolic velocity (mPSV) (Z = -1.982, p = 0.048) and mean end-diastolic velocity (mEDV) (Z = -2.767, p = 0.006). Between the NAEDF and AEDF groups, there was no significant difference in the clinical pregnancy rate (χ2 = 0.003, p = 0.959), and there was a significant difference in the spontaneous abortion rate (χ2 = 3.465, p = 0.019). Compared with uterine artery Doppler alone, its combination with artificial abortion history, waist-to-hip ratio, LH (Luteinizing hormone) of P (Progesterone) administration day, mPSV and mEDV had a higher predictive value regarding clinical pregnancy from the first FET [ROC-AUC 0.782, 95% CI (0.680-0.883) vs. 0.692, 95% CI (0.587-0.797)]. CONCLUSIONS Uterine artery Doppler, particularly mPSV and mEDV during the implantation window, was useful for predicting clinical pregnancy, and AEDF was related to spontaneous abortion in the first trimester. Uterine artery Doppler combined with artificial abortion history, waist-to-hip ratio, LH of P administration day, mPSV and mEDV have a higher predictive value than uterine artery Doppler alone regarding the pregnancy from the first FET.
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Affiliation(s)
- Junmei Fan
- Department of Reproductive Medicine Center, Children's Hospital of Shanxi and Women Health Center of Shanxi, Affiliated of Shanxi Medical University, Taiyuan, Shanxi, China.
| | - Junkun Zhang
- Department of Intensive Care Unit, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, Shanxi, China
| | - Suming Xu
- Department of Reproductive Medicine Center, Children's Hospital of Shanxi and Women Health Center of Shanxi, Affiliated of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Huiping Liu
- Department of Reproductive Medicine Center, Children's Hospital of Shanxi and Women Health Center of Shanxi, Affiliated of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Weigang Lv
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xingyu Bi
- Department of Reproductive Medicine Center, Children's Hospital of Shanxi and Women Health Center of Shanxi, Affiliated of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yanling Liu
- Department of Reproductive Medicine Center, Children's Hospital of Shanxi and Women Health Center of Shanxi, Affiliated of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Wenjing Shi
- Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yuxia Zhang
- Department of Reproductive Medicine Center, Children's Hospital of Shanxi and Women Health Center of Shanxi, Affiliated of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xueqing Wu
- Department of Reproductive Medicine Center, Children's Hospital of Shanxi and Women Health Center of Shanxi, Affiliated of Shanxi Medical University, Taiyuan, Shanxi, China.
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Maman E, Adashi EY, Baum M, Hourvitz A. Prediction of ovulation: new insight into an old challenge. Sci Rep 2023; 13:20003. [PMID: 37968377 PMCID: PMC10651856 DOI: 10.1038/s41598-023-47241-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 11/10/2023] [Indexed: 11/17/2023] Open
Abstract
Ultrasound monitoring and hormonal blood testing are considered by many as an accurate method to predict ovulation time. However, uniform and validated algorithms for predicting ovulation have yet to be defined. Daily hormonal tests and transvaginal ultrasounds were recorded to develop an algorithm for ovulation prediction. The rupture of the leading ovarian follicle was a marker for ovulation day. The model was validated retrospectively on natural cycles frozen embryo transfer cycles with documented ovulation. Circulating levels of LH or its relative variation failed, by themselves, to reliably predict ovulation. Any decrease in estrogen was 100% associated with ovulation emergence the same day or the next day. Progesterone levels > 2 nmol/L had low specificity to predict ovulation the next day (62.7%), yet its sensitivity was high (91.5%). A model for ovulation prediction, combining the three hormone levels and ultrasound was created with an accuracy of 95% to 100% depending on the combination of the hormone levels. Model validation showed correct ovulation prediction in 97% of these cycles. We present an accurate ovulation prediction algorithm. The algorithm is simple and user-friendly so both reproductive endocrinologists and general practitioners can use it to benefit their patients.
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Affiliation(s)
- Ettie Maman
- Sheba Medical Center In Vitro Fertilization Unit, Department of Obstetrics and Gynecology. Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.
- Herzliya Medical Center, In Vitro Fertilization Unit, Herzliya, Israel.
| | - Eli Y Adashi
- Departments of Medical Science and Obstetrics and Gynecology, the Warren Alpert Medical School, Brown University, Providence, RI, 02906, USA
| | - Micha Baum
- Sheba Medical Center In Vitro Fertilization Unit, Department of Obstetrics and Gynecology. Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- Herzliya Medical Center, In Vitro Fertilization Unit, Herzliya, Israel
| | - Ariel Hourvitz
- Shamir Medical Center In Vitro Fertilization Unit, Department of Obstetrics and Gynecology. Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
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Violette CJ, Mandelbaum RS, Matsuzaki S, Ouzounian JG, Paulson RJ, Matsuo K. Assessment of abnormal placentation in pregnancies conceived with assisted reproductive technology. Int J Gynaecol Obstet 2023; 163:555-562. [PMID: 37183534 DOI: 10.1002/ijgo.14850] [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: 02/02/2023] [Revised: 04/14/2023] [Accepted: 04/21/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To examine the association between assisted reproductive technology (ART) and abnormal placentation. METHODS This is a retrospective cohort study querying the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample. The study population included 14, 970, 064 deliveries for national estimates from January 2012 to September 2015. The exposure was 48, 240 pregnancies after ART. The main outcome measure encompassed three abnormal placentation pathologies (placenta previa [PP], placenta accreta spectrum [PAS], and vasa previa [VP]). Propensity score matching was performed to assess the exposure-outcome association. RESULTS Pregnancy after ART was more likely to have a diagnosis of PAS (2.8 vs 1.0 per 1000 deliveries; adjusted odds ratio [aOR], 2.06 [95% confidence interval (CI), 1.44-2.93]), PP (24.5 vs 8.6 per 1000; aOR, 2.98 [95% CI, 2.64-3.35]), and VP (2.3 vs <0.3 per 1000; aOR, 11.3 [95% CI, 5.86-21.8]) compared with pregnancy without ART. Similarly, pregnancy after ART was associated with an increased likelihood of having multiple types of abnormal placentation, including VP with PP (aOR, 15.4 [95% CI, 6.15-38.4]) and PAS with PP (aOR, 2.80 [95% CI, 1.32-5.92]) compared with non-ART pregnancy. CONCLUSIONS This national-level analysis suggests that pregnancy after ART is associated with a significantly increased risk of abnormal placentation, including PAS, PP, and VP.
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Affiliation(s)
- Caroline J Violette
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Rachel S Mandelbaum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Shinya Matsuzaki
- Department of Gynecology, Osaka International Cancer Institute, Osaka, Japan
| | - Joseph G Ouzounian
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Richard J Paulson
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
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Mumusoglu S, Erden M, Ozbek IY, Ince O, Esteves SC, Humaidan P, Yarali H. The true natural cycle frozen embryo transfer - impact of patient and follicular phase characteristics on serum progesterone levels one day prior to warmed blastocyst transfer. Reprod Biol Endocrinol 2023; 21:86. [PMID: 37723581 PMCID: PMC10506193 DOI: 10.1186/s12958-023-01136-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/10/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND In a true-natural cycle (t-NC), optimal progesterone (P4) output from the corpus luteum is crucial for establishing and maintaining an intrauterine pregnancy. In a previous retrospective study, low P4 levels (< 10 ng/mL) measured one day before warmed blastocyst transfer in t-NC were associated with significantly lower live-birth rates. In the current study, we aim to examine the relationship between patient, follicular-phase endocrine and ultrasonographic characteristics, and serum P4 levels one day prior to warmed blastocyst transfer in t-NC. METHOD 178 consecutive women undergoing their first t-NC frozen embryo transfer (FET) between July 2017-August 2022 were included. Following serial ultrasonographic and endocrine monitoring, ovulation was documented by follicular collapse. Luteinized unruptured follicle (LUF) was diagnosed when there was no follicular collapse despite luteinizing-hormone surge (> 17 IU/L) and increased serum P4 (> 1.5 ng/mL). FET was scheduled on follicular collapse + 5 or LH surge + 6 in LUF cycles. Primary outcome was serum P4 on FET - 1. RESULTS Among the 178 patients, 86% (n = 153) experienced follicular collapse, while 14% (n = 25) had LUF. On FET-1, the median serum luteal P4 level was 12.9 ng/mL (IQR: 9.3-17.2), ranging from 1.8 to 34.4 ng/mL. Linear stepwise regression revealed a negative correlation between body mass index (BMI) and LUF, and a positive correlation between follicular phase peak-E2 and peak-P4 levels with P4 levels on FET-1. The ROC curve analyses to predict < 9.3 ng/mL (< 25th percentile) P4 levels on FET-1 day showed AUC of 0.70 (95%CI 0.61-0.79) for BMI (cut-off: 23.85 kg/m2), 0.71 (95%CI 0.61-0.80) for follicular phase peak-P4 levels (cut-off: 0.87 ng/mL), and 0.68 (95%CI 0.59-0.77) for follicular phase peak-E2 levels (cut-off: 290.5 pg/mL). Combining all four independent parameters yielded an AUC of 0.80 (95%CI 0.72-0.88). The adjusted-odds ratio for having < 9.3 ng/mL P4 levels on FET-1 day for patients with LUF compared to those with follicle collapse was 4.97 (95%CI 1.66-14.94). CONCLUSION The BMI, LUF, peak-E2, and peak-P4 levels are independent predictors of low serum P4 levels on FET-1 (< 25th percentile; <9.3 ng/ml) in t-NC FET cycles. Recognition of risk factors for low serum P4 on FET-1 may permit a personalized approach for LPS in t-NC FET to maximize reproductive outcomes.
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Affiliation(s)
- Sezcan Mumusoglu
- Department of Obstetrics and Gynecology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Murat Erden
- Department of Obstetrics and Gynecology, Hacettepe University School of Medicine, Ankara, Turkey
| | | | - Onur Ince
- Department of Obstetrics and Gynecology, Kutahya Health Sciences University, Kutahya, Turkey
- Faculty of Arts and Science, Department of Statistics, Middle East Technical University, Ankara, Turkey
| | - Sandro C Esteves
- Androfert, Andrology, and Human Reproduction Clinic, Referral Center for Male Reproduction, Campinas, SP, Brazil
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Peter Humaidan
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- The Fertility Clinic, Skive Regional Hospital, Resenvej 25, Skive, Denmark
| | - Hakan Yarali
- Department of Obstetrics and Gynecology, Hacettepe University School of Medicine, Ankara, Turkey.
- Anatolia IVF and Women Health Centre, Ankara, Turkey.
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Kavrut M, Sagir FG, Atayurt Z. Large-scale retrospective analysis of methodological factors affecting pregnancy rates after embryo transfer for in vitro fertilization. Medicine (Baltimore) 2023; 102:e35146. [PMID: 37682170 PMCID: PMC10489353 DOI: 10.1097/md.0000000000035146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/18/2023] [Indexed: 09/09/2023] Open
Abstract
This study aimed to investigate the impact of methodological factors on pregnancy rates after embryo transfer (ET) for in vitro fertilization. This retrospective cross-sectional study was conducted between September 2020 and April 2022. A total of 2048 patients who underwent ultrasonography-guided first frozen embryo transfer (FET) or a fresh ET cycle due to infertility were included in the study. The effects of age, ET protocol (frozen or fresh), preimplantation genetic testing, number of embryos transferred (NET), and embryo fundus distance on pregnancy rate were investigated. The mean age of pregnant patients (31.51 ± 5.28) was significantly lower than that of non-pregnant patients (35.34 ± 6.39) (P < .001). Multiple regression analysis showed that women with lower age (P < .001), higher NET (P < .001), higher embryo fundus distance (P < .001), FET (P < .001), and preimplantation genetic testing (P = .012) had a significantly higher likelihood of pregnancy. Appropriate transfer depth, younger age, euploid embryo transfer, FET, and a higher NET can increase the likelihood of pregnancy. However, multiple factors must be considered when deciding the best protocol for a particular patient, including patient preference, costs and timing.
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Affiliation(s)
| | - Fulya Gokdagli Sagir
- Kolan International Hospital Gynecology, Obstetrics and IVF Center, Istanbul, Turkey
| | - Zafer Atayurt
- Sisli Kolan International Hospital, IVF Center, Istanbul, Turkey
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Yarali H, Mumusoglu S, Polat M, Erden M, Ozbek IY, Esteves SC, Humaidan P. Comparison of the efficacy of subcutaneous versus vaginal progesterone using a rescue protocol in vitrified blastocyst transfer cycles. Reprod Biomed Online 2023; 47:103233. [PMID: 37400318 DOI: 10.1016/j.rbmo.2023.05.005] [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: 01/12/2023] [Revised: 05/07/2023] [Accepted: 05/10/2023] [Indexed: 07/05/2023]
Abstract
RESEARCH QUESTION Does administration of subcutaneous (s.c.) progesterone support ongoing pregnancy rates (OPR) similar to vaginal progesterone using a rescue protocol in hormone replacement therapy frozen embryo transfer cycles? DESIGN Retrospective cohort study. Two sequential cohorts - vaginal progesterone gel (December 2019-October 2021; n=474) and s.c. progesterone (November 2021-November 2022; n=249) -were compared. Following oestrogen priming, s.c. progesterone 25 mg twice daily (b.d.) or vaginal progesterone gel 90 mg b.d. was administered. Serum progesterone was measured 1 day prior to warmed blastocyst transfer (i.e. day 5 of progesterone administration). In patients with serum progesterone concentrations <8.75 ng/ml, additional s.c. progesterone (rescue protocol; 25 mg) was provided. RESULTS In the vaginal progesterone gel group, 15.8% of patients had serum progesterone <8.75 ng/ml and received the rescue protocol, whereas no patients in the s.c. progesterone group received the rescue protocol. OPR, along with positive pregnancy and clinical pregnancy rates, were comparable between the s.c. progesterone group without the rescue protocol and the vaginal progesterone gel group with the rescue protocol. After the rescue protocol, the route of progesterone administration was not a significant predictor of ongoing pregnancy. The impact of different serum progesterone concentrations on reproductive outcomes was evaluated by percentile (<10th, 10-49th, 50-90th and >90th percentiles), taking the >90th percentile as the reference subgroup. In both the vaginal progesterone gel group and the s.c. progesterone group, all serum progesterone percentile subgroups had similar OPR. CONCLUSIONS Subcutaneous progesterone 25 mg b.d. secures serum progesterone >8.75 ng/ml, whereas additional exogenous progesterone (rescue protocol) was needed in 15.8% of patients who received vaginal progesterone. The s.c. and vaginal progesterone routes, with the rescue protocol if needed, yield comparable OPR.
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Affiliation(s)
- Hakan Yarali
- Hacettepe University School of Medicine, Department of Obstetrics and Gynaecology, Ankara, Turkey; Anatolia IVF and Women Health Centre, Ankara, Turkey.
| | - Sezcan Mumusoglu
- Hacettepe University School of Medicine, Department of Obstetrics and Gynaecology, Ankara, Turkey
| | - Mehtap Polat
- Anatolia IVF and Women Health Centre, Ankara, Turkey; Atılım University Vocational School of Health Services, Department of Medical Services and Techniques, First and Emergency Aid Programme, Ankara, Turkey
| | - Murat Erden
- Hacettepe University School of Medicine, Department of Obstetrics and Gynaecology, Ankara, Turkey
| | | | - Sandro C Esteves
- Androfert, Andrology and Human Reproduction Clinic, Referral Centre for Male Reproduction, Campinas, São Paolo, Brazil; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Peter Humaidan
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; The Fertility Clinic, Skive Regional Hospital, Skive, Denmark
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Almohammadi A, Raveendran A, Black M, Maheshwari A. The optimal route of progesterone administration for luteal phase support in a frozen embryo transfer: a systematic review. Arch Gynecol Obstet 2023; 308:341-350. [PMID: 35943567 PMCID: PMC10293378 DOI: 10.1007/s00404-022-06674-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 06/14/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To investigate the optimal route of progesterone administration for luteal phase support in a frozen embryo transfer. DESIGN Systematic review. PATIENTS Women undergoing frozen embryo transfer (FET). INTERVENTIONS We conducted an extensive database search of Medline (PubMed), Embase, Web of Science, and Cochrane Trials Register using relevant keywords and their combinations to find randomized controlled trials (RCTs) comparing the routes (i.e., oral, vaginal, intramuscular) of progesterone administration for luteal phase support (LPS) in artificial FET. MAIN OUTCOME MEASURES Clinical pregnancy, live birth, miscarriage. RESULTS Four RCTs with 3245 participants undergoing artificial endometrial preparation (EP) cycles during FET were found to be eligible. Four trials compared vaginal progesterone with intramuscular progesterone and two trials compared vaginal progesterone with oral progesterone. One study favored of vaginal versus oral progesterone for clinical pregnancy rates (RR 0.45, 95% CI 0.22-0.92) and other study favored intramuscular versus vaginal progesterone for clinical pregnancy rates (RR 1.46, 95% CI 1.21-1.76) and live birth rates (RR 1.62, 95% CI 1.28-2.05). Tabulation of overall evidence strength assessment showed low-quality evidence on the basis that for each outcome-comparison pair, there were deficiencies in either directness of outcome measurement or study quality. CONCLUSION There was little consensus and evidence was heterogeneous on the optimal route of administration of progesterone for LPS during FET in artificial EP cycles. This warrants more trials, indirect comparisons, and network meta-analyses. PROPERO NO CRD42021251017.
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Affiliation(s)
| | - Ainharan Raveendran
- Department of Obstetrics and Gynaecology, Aberdeen Royal Infirmary, Aberdeen Maternity Hospital, Aberdeen, UK
| | - Mairead Black
- University of Aberdeen, Aberdeen Maternity Hospital, Aberdeen Centre for Women's Health Research, Aberdeen, UK
| | - Abha Maheshwari
- Aberdeen Fertility Centre, Aberdeen Maternity Hospital, Reproductive Medicine, Aberdeen, UK
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Aydin T, Koroglu N, Albayrak N, Insel MA. Serial progesterone levels more accurately predict the time of ovulation in subfertile women: a prospective cohort study. J Assist Reprod Genet 2023:10.1007/s10815-023-02864-2. [PMID: 37351803 PMCID: PMC10371972 DOI: 10.1007/s10815-023-02864-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/15/2023] [Indexed: 06/24/2023] Open
Abstract
PURPOSE To predict ovulation in subfertile women using serial follicular growth (FG) and serum hormone measures (estradiol (E2), luteinizing hormone (LH), and progesterone (P) levels) in mathematical models. METHODS This was a prospective observational study of 116 subfertile women aged between 18 and 40 years. FG was assessed by serial transvaginal ultrasonography starting from cycle days 8-12, depending on cycle length. Once the dominant follicle reached 15-16 mm, hormone levels were assessed daily. The primary outcome measure was ovulation (Ov), with a serum LH level ≥15 IU/l defining the start of the LH surge (the day prior to ovulation) and a serum P level >1 μg/ml concurrent with a drop in serum E2 levels indicating Ov. To determine Ov, mathematical models were generated using FG, LH, E2, and P measurements. RESULTS A mathematical model was constructed using exponential regression to relate days until and after ovulation with P levels. The Ov(P) model was found to be superior to the Ov(LH) model in the prediction of Ov, with high R2 and low RMSE values of 0.9983 and 0.2454, respectively. In the range of [-2, 2] days, the net accuracy of the Ov(P) model was 63.0%, while with an allowed one-day error, the accuracy was 99.6%. CONCLUSION Serum P levels display a highly predictable linear curve in natural cycles, which enables the prediction of ovulation. The Ov(P) model can be independently used to schedule embryo transfer in natural frozen-thaw cycles and could therefore replace the Ov(LH) model in clinical practice.
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Affiliation(s)
- Turgut Aydin
- Department of Obstetrics and Gynecology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Nadiye Koroglu
- Department of Obstetrics and Gynecology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.
| | - Nazli Albayrak
- Department of Obstetrics and Gynecology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Mert Akin Insel
- Department of Chemical Engineering, Yildiz Technical University, Istanbul, Turkey
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Lawrenz B, Melado L, Fatemi HM. Frozen embryo transfers in a natural cycle: how to do it right. Curr Opin Obstet Gynecol 2023; 35:224-229. [PMID: 36924405 DOI: 10.1097/gco.0000000000000862] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
PURPOSE OF REVIEW Assisted reproductive technology treatment has seen a significant shift from fresh to frozen embryo transfers (FET). Endometrial receptivity in the FET cycle can be achieved through a hormonal replacement cycle or a natural cycle, and the preparation approach has important implications on the pregnancy itself. In the natural cycle approach, planning of the embryo transfer timing might be challenging due to the need to identify ovulation correctly. RECENT FINDINGS Ovulation in a natural cycle is characterized by a luteinizing hormone surge, followed by the rise in progesterone (P4) levels, inducing secretory transformation. However, the luteinizing hormone surge can vary widely in its pattern, amplitude and duration and might not even result in the formation of a corpus luteum and P4 production. Monitoring of the luteinizing hormone surge using urinary luteinizing hormone kits might be a convenient approach, however, it is deemed unreliable and should be considered inadequate for securing the best outcome of a FET cycle. SUMMARY Endometrial receptivity depends on the duration of progesterone exposure to the adequately estrogenized endometrium. In a natural cycle endometrial preparation approach, correct planning for the embryo transfer timing should include the measurement of luteinizing hormone, estradiol and P4.
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Melado L, Lawrenz B, Nogueira D, Raberi A, Patel R, Bayram A, Elkhatib I, Fatemi H. Features of chromosomal abnormalities in relation to consanguinity: analysis of 10,556 blastocysts from IVF/ICSI cycles with PGT-A from consanguineous and non-consanguineous couples. Sci Rep 2023; 13:8857. [PMID: 37258645 DOI: 10.1038/s41598-023-36014-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 05/27/2023] [Indexed: 06/02/2023] Open
Abstract
Consanguineous marriage is defined as marriage between first or second-degree cousins, with high prevalence in many cultures and societies. Descendants from consanguineous unions have an increased risk for genetic diseases. Additionally, in consanguineous couples, chromosomal disjunction during embryogenesis could also be affected, increasing the risk of chromosomal errors. Nowadays, genomic testing allows to identify new genetic syndromes and variants related to copy-number variations (CNV), including whole chromosome, segmental and micro-segmental errors. This is the first study evaluating chromosomal ploidy status on blastocysts formed from consanguineous couples during IVF/ICSI treatments with Preimplantation Genetic Testing for Aneuploidies (PGT-A), compared to non-consanguineous couples. Although consanguine couples were significantly younger, no differences were observed between groups for fertilisation rate, blastulation rate and euploidy rate, once adjusted by age. Nevertheless, the number of blastocysts biopsied on day 5 was lower for consanguine couples. Segmental errors, and aneuploidies of chromosomes 13 and 14 were the most prominent abnormalities in relation to consanguinity, together with errors in chromosome 16 and sex chromosomes when the female partner was younger than 35. Once euploid blastocysts were considered for subsequent frozen embryo transfer, pregnancy outcomes were similar in both groups. The current findings point toward the fact that in consanguine unions, not only the risk of having a child with genetic disorders is increased, but also the risk of specific chromosomal abnormalities seems to be increased. Premarital counselling and tailored reproductive treatments should be offered to these couples.
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Affiliation(s)
- Laura Melado
- Medical Department, ART Fertility Clinics, Marina Village Villa B22 - 23, PO Box 60202, Abu Dhabi, UAE.
| | - Barbara Lawrenz
- Medical Department, ART Fertility Clinics, Marina Village Villa B22 - 23, PO Box 60202, Abu Dhabi, UAE
| | - Daniela Nogueira
- Medical Department, ART Fertility Clinics, Marina Village Villa B22 - 23, PO Box 60202, Abu Dhabi, UAE
- ART Fertility Clinics, Gurgaon, India
| | - Araz Raberi
- Medical Department, ART Fertility Clinics, Marina Village Villa B22 - 23, PO Box 60202, Abu Dhabi, UAE
| | | | - Asina Bayram
- Medical Department, ART Fertility Clinics, Marina Village Villa B22 - 23, PO Box 60202, Abu Dhabi, UAE
| | - Ibrahim Elkhatib
- Medical Department, ART Fertility Clinics, Marina Village Villa B22 - 23, PO Box 60202, Abu Dhabi, UAE
| | - Human Fatemi
- Medical Department, ART Fertility Clinics, Marina Village Villa B22 - 23, PO Box 60202, Abu Dhabi, UAE
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Wiegratz I, Bordignon N, Jung-Hoffmann C, Bahlmann F, Santen R, Meyer G. Kinderwunschbehandlung nach Kraniopharyngeom in der Kindheit. GYNAKOLOGISCHE ENDOKRINOLOGIE 2023. [DOI: 10.1007/s10304-023-00499-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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14
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Melado L, Lawrenz B, Vitorino RL, Patel R, Ruiz F, Marques LM, Bayram A, Elkhatib I, Fatemi H. Clinical and laboratory parameters associated with pregnancy outcomes in patients undergoing frozen euploid blastocyst transfer. Reprod Biomed Online 2023:S1472-6483(23)00153-0. [PMID: 37062636 DOI: 10.1016/j.rbmo.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 01/03/2023] [Accepted: 02/27/2023] [Indexed: 03/09/2023]
Abstract
RESEARCH QUESTION Which factors impact on clinical pregnancy rate (CPR) and live birth rates (LBR) in euploid frozen embryo transfer (eFET) cycles? DESIGN Retrospective observational study including 1660 eFET cycles with 2439 euploid blastocysts, from November 2016 to December 2020. The impact of clinical and laboratory parameters on CPR, biochemical miscarriage rate (BMR), clinical miscarriage rate (CMR) and LBR was evaluated. RESULTS CPR per transfer was 63.4%, LBR per transfer 51.6%. CPR and LBR were significantly higher when double embryo transfer (DET) was performed (71.6% versus 57.7%, P < 0.001; 55.2% versus 49.1%, P = 0.016, respectively). However, pregnancy loss was significantly higher in the DET group (28.8% versus 22.8%, P = 0.02). When patients were classified by body mass index (BMI), no differences were observed for CPR, but CMR was lower (P < 0.001) and LBR higher (p = 0.031) for the normal BMI group. The natural cycle protocol revealed lower CMR (P < 0.001) and lower pregnancy loss (P < 0.001); subsequently, higher LBR (57.6%, 48.8%, 45.0%, P = 0.001) compared with hormonal replacement protocol and stimulated cycle. Day of trophectoderm biopsy affected CPR (P < 0.001) and LBR (P < 0.001), yet no differences were observed for BMR, CMR or pregnancy loss. The multivariate analysis showed that day 6/7 embryos had lower probabilities for pregnancy; overweight and obesity had a negative impact on LBR, and natural cycle improved LBR (adjusted odds ratio 1.445, 95% confidence interval 0.519-0.806). CONCLUSIONS Day of biopsy affected CPR, while BMI and endometrial preparation protocol were associated with LBR in eFET. DET should be discouraged as it will increase the risk of pregnancy loss. Women with higher BMI should be aware of the higher risk of pregnancy loss and lower LBR even though a euploid blastocyst is transferred.
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Tang H, Yang M, Yi H, Lin M. Risk Factors of Preterm Birth and Low Birth Weight in Singletons Conceived Through Frozen Embryo Transfer: A Retrospective Study. Int J Gen Med 2022; 15:8693-8704. [PMID: 36575734 PMCID: PMC9790167 DOI: 10.2147/ijgm.s394231] [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: 10/20/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Background The risks of adverse perinatal outcomes in offspring conceived following frozen-thawed embryo transfer (FET) assisted reproductive technology (ART) are inconsistent. The aim of this study was to analyze the risk factors for preterm birth and low birth weight in singletons after FET. Methods 386 FET cycles was conducted at the Reproductive Medicine Center of Meizhou People's Hospital. The relationship between clinical characteristics and outcomes (term birth and preterm birth, normal birth weight and low birth weight) was analyzed. Results The rate of primary infertility, basal FSH and T levels, gestational age, birth weight, and proportion of male fetuses were significantly different in the preterm and full-term groups. Logistic regression analysis showed that high maternal age (≥35 years) (OR 3.652, 95% CI: 1.683-7.925, P=0.001), primary infertility (OR 2.869, 95% CI: 1.461-5.632, P=0.002), low FSH level (<6.215 mIU/mL) (OR 3.272, 95% CI: 1.743-6.144, P<0.001), and hormone replacement therapy (HRT) method (OR 2.780, 95% CI: 1.088-7.100, P=0.033) may increase risk of preterm birth after FET. Gestational age and birth weight were significantly different in fetuses with low birth weight (<2500g, n=38) and normal birth weight (≥2500g and <4000g, n=333). Logistic regression analysis showed that low basal FSH level (<6.215 mIU/mL) (OR 0.425, 95% CI: 0.209-0.865, P=0.018), and HRT method of endometrial preparation for FET (OR 0.272, 95% CI: 0.079-0.934, P=0.039) may reduce the risk of low birth weight after FET. Conclusion High maternal age, primary infertility, low FSH level, HRT method of endometrial preparation for FET, and male fetus may increase risk of preterm birth after FET. In addition, primary infertility, low basal FSH level, and HRT method of endometrial preparation may reduce the risk of low birth weight after FET.
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Affiliation(s)
- Haiyu Tang
- Reproductive Medicine Center, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China,Correspondence: Haiyu Tang, Reproductive Medicine Center, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, No. 63 Huang tang Road, Meijiang District, Meizhou, People’s Republic of China, Tel +86 753-2131-883, Email
| | - Man Yang
- Reproductive Medicine Center, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China
| | - Honggan Yi
- Reproductive Medicine Center, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China
| | - Mei Lin
- Reproductive Medicine Center, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China
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Li L, Liu L, Kou Z, Huo M, An J, Zhang X. GnRH agonist treatment regulates IL-6 and IL-11 expression in endometrial stromal cells for patients with HRT regiment in frozen embryo transfer cycles. Reprod Biol 2022; 22:100608. [DOI: 10.1016/j.repbio.2022.100608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 12/13/2022]
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Kadour-Peero E, Feferkorn I, Bellemare V, Arab S, Buckett W. A comparison of frozen-thawed embryo transfer protocols in 2920 single-blastocyst transfers. Arch Gynecol Obstet 2022; 306:887-892. [PMID: 35543740 DOI: 10.1007/s00404-022-06588-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/17/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the effect of frozen-thawed embryo transfer (FET) protocol on live-birth rate (LBR) and clinical pregnancy rate (CPR), in single-vitrified-blastocyst transfer MATERIALS AND METHODS: Retrospective cohort study with FET of a single-blastocyst embryos (n = 2920 cycles) thawed 2013-2018. FET protocols were natural cycles (NC-FET) (n = 147), artificial hormone replacement treatment cycles (HRT-FET) (n = 2645), and modified NC (mNC) with hCG triggering (n = 128). Primary outcome was LBR. Adjustment for age, embryo grade, year of freezing\thawing, infertility cause, and endometrial thickness was performed. RESULTS There were no significant differences between the groups with regard to female age, embryo grade, and endometrial thickness. LBR was higher in the mNC compared to HRT-FET cycles (38.3% vs. 20.9% P < 0.0001), and in the NC compared to HRT-FET cycles (34.7% vs. 20.9%, P = 0.0002). CPR was higher in the mNC compared to HRT-FET cycles (46.1% vs. 33.3% P = 0.0003), and in the NC compared to HRT-FET cycles (45.9% vs. 33.3%, P = 0.002). There was no significant difference in LBR or CPR between NC-FET and mNC-FET. Higher LBR with NC-FET and mNC-FET remained significant after adjusting for confounders (aOR 2.42, 95%CI 1.53-3.66, P < 0.0001). CONCLUSION The use of the convenient artificial HRT-FET cycles must be cautiously reconsidered in light of the potential negative effect on LBR when compared with natural cycle FET.
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Affiliation(s)
- Einav Kadour-Peero
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montreal, QC, Canada.
| | - Ido Feferkorn
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montreal, QC, Canada
| | - Veronique Bellemare
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montreal, QC, Canada
| | - Suha Arab
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montreal, QC, Canada
| | - William Buckett
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montreal, QC, Canada
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Timing of warmed blastocyst transfer related to luteinizing hormone surge in the true natural cycle and its impact on ongoing pregnancy rates. Reprod Biomed Online 2022; 45:440-447. [DOI: 10.1016/j.rbmo.2022.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/06/2022] [Accepted: 04/26/2022] [Indexed: 11/22/2022]
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Gan J, Rozen G, Polyakov A. Treatment outcomes of blastocysts thaw cycles, comparing the presence and absence of a corpus luteum: a systematic review and meta-analysis. BMJ Open 2022; 12:e051489. [PMID: 35473741 PMCID: PMC9045106 DOI: 10.1136/bmjopen-2021-051489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
PURPOSE This study aims to review the literature and perform a meta-analysis to determine if the presence of a corpus luteum has an impact on treatment outcomes in thaw cycles, where blastocyst embryos are transferred. METHOD PUBMED, EMBASE, CENTRAL and CINAHL were searched for papers published between January 2017 and 27 July 2020. Additional articles were selected from the reference list of the results and previous reviews. Three reviewers independently reviewed and extracted data. The meta-analysis was conducted though RevMan V.5.4.1. Studies were quality assessed with the Cochrane risk of bias tool and the Newcastle-Ottawa Scale. RESULTS Nine publications were included for data extraction and subsequent meta-analysis. Two studies were randomised controlled trials, and seven were cohort studies. Subgroup analysis of the different study designs was performed. While the rates of positive human chorionic gonadotropin results (relative risk, RR 1.0, 95% CI 0.95 to 1.05) and clinical pregnancies (RR 1.06, 95% CI 0.96 to 1.18) were comparable between the two groups, the rates of live births were higher in thaw cycles with a corpus luteum (RR 1.14, 95% CI 1.06 to 1.22). Analysis of pregnancy losses demonstrated that both biochemical pregnancy (early miscarriage) (RR 0.71, 95% CI 0.62 to 0.82) and miscarriages (RR 0.72, 95% CI 0.62 to 0.83) were increased in cycles without a corpus luteum. CONCLUSION Where clinically appropriate, the use of cycle types that have a functional corpus luteum should be favoured. There were several limitations to this study, including the quality of studies and the inherent bias of retrospective cohort studies. Further, high-quality research, particularly randomised controlled trials with blastocysts embryos, is required to further explore these findings. PROSPERO REGISTRATION NUMBER CRD42020209583.
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Affiliation(s)
- Joscelyn Gan
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Genia Rozen
- Reproductive Services, Royal Women's Hospital, Parkville, Victoria, Australia
- Melbourne IVF, East Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alex Polyakov
- Reproductive Services, Royal Women's Hospital, Parkville, Victoria, Australia
- Melbourne IVF, East Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
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Sethi A, Singh N, Patel G. RE: The effects of hysteroscopic morcellation of endometrial polyps on frozen embryo transfer outcomes. Eur J Obstet Gynecol Reprod Biol 2022; 271:281. [PMID: 35246334 DOI: 10.1016/j.ejogrb.2022.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/18/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Ankita Sethi
- DM Reproductive Medicine Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India.
| | - Neeta Singh
- DM Reproductive Medicine Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Garima Patel
- DM Reproductive Medicine Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
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Li J, Sun Q, Zhang M, Fu X, Zhang Y, Gao S, Ma J. Natural cycles achieve better pregnancy outcomes than artificial cycles in non-PCOS women undergoing vitrified single-blastocyst transfer: a retrospective cohort study of 6840 cycles. J Assist Reprod Genet 2022; 39:639-646. [PMID: 35122175 PMCID: PMC8995231 DOI: 10.1007/s10815-022-02424-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/31/2022] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To identify the optimal method for endometrial preparation in vitrified single-blastocyst transfer (VSBT) cycles. METHODS This was a retrospective cohort study for non-PCOS patients who underwent VSBT cycles from March 2015 to November 2019 in an academic reproductive medical center. A total of 6840 VSBT cycles were enrolled and classified into two groups according to different endometrial preparation methods. RESULTS The non-PCOS patients who underwent VSBT showed a significantly higher clinical pregnancy rate (61.96% vs 56.85%, p < 0.001) and live birth rate (49.09% vs 39.86%, p < 0.001), as well as a statistically lower early miscarriage rate (12.02% vs 18.08%, p < 0.001) in the natural cycle (NC) group compared with the artificial cycle (AC) group. Multivariable analysis further confirmed that NC was associated with an increased likelihood of clinical pregnancy (adjusted odds ratio (aOR) 0.852, 95% confidence interval (CI) 0.765-0.949, p = 0.004) and live birth (aOR 0.746, 95% CI 0.669-0.832, p < 0 .001), but decreased early miscarriage occurrence (aOR 1.447, 95% CI 1.215-1.724, p < 0.001) compared to AC. CONCLUSIONS Our study demonstrated that non-PCOS patients could benefit from NC in vitrified blastocyst transfer. Increased clinical pregnancy rate and decreased early miscarriage rate led to a significantly higher live birth rate in NC patients compared with AC with our present protocol.
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Affiliation(s)
- Jing Li
- grid.27255.370000 0004 1761 1174Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012 China ,grid.27255.370000 0004 1761 1174Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong 250012 China ,grid.27255.370000 0004 1761 1174Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong 250012 China ,Shandong Provincial Clinical Research Center for Reproductive Technology and Reproductive Genetics, Jinan, Shandong 250012 China ,grid.27255.370000 0004 1761 1174National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong 250012 China
| | - Qian Sun
- grid.27255.370000 0004 1761 1174Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012 China ,grid.27255.370000 0004 1761 1174Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong 250012 China ,grid.27255.370000 0004 1761 1174Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong 250012 China ,Shandong Provincial Clinical Research Center for Reproductive Technology and Reproductive Genetics, Jinan, Shandong 250012 China ,grid.27255.370000 0004 1761 1174National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong 250012 China
| | - Meng Zhang
- grid.27255.370000 0004 1761 1174Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012 China ,grid.27255.370000 0004 1761 1174Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong 250012 China ,grid.27255.370000 0004 1761 1174Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong 250012 China ,Shandong Provincial Clinical Research Center for Reproductive Technology and Reproductive Genetics, Jinan, Shandong 250012 China ,grid.27255.370000 0004 1761 1174National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong 250012 China
| | - Xiao Fu
- grid.27255.370000 0004 1761 1174Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012 China ,grid.27255.370000 0004 1761 1174Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong 250012 China ,grid.27255.370000 0004 1761 1174Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong 250012 China ,Shandong Provincial Clinical Research Center for Reproductive Technology and Reproductive Genetics, Jinan, Shandong 250012 China ,grid.27255.370000 0004 1761 1174National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong 250012 China
| | - Yiting Zhang
- grid.27255.370000 0004 1761 1174Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012 China ,grid.27255.370000 0004 1761 1174Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong 250012 China ,grid.27255.370000 0004 1761 1174Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong 250012 China ,Shandong Provincial Clinical Research Center for Reproductive Technology and Reproductive Genetics, Jinan, Shandong 250012 China ,grid.27255.370000 0004 1761 1174National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong 250012 China
| | - Shanshan Gao
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China. .,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, 250012, China. .,Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, 250012, China. .,Shandong Provincial Clinical Research Center for Reproductive Technology and Reproductive Genetics, Jinan, Shandong, 250012, China. .,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, 250012, China. .,Center for Reproductive Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China.
| | - Jinlong Ma
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China. .,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, 250012, China. .,Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, 250012, China. .,Shandong Provincial Clinical Research Center for Reproductive Technology and Reproductive Genetics, Jinan, Shandong, 250012, China. .,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, 250012, China.
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Khoury S, Kadour-Peero E, Calderon I. The effect of LH rise during artificial frozen-thawed embryo transfer (FET) cycles. REPRODUCTION AND FERTILITY 2022; 2:231-235. [PMID: 35118393 PMCID: PMC8801030 DOI: 10.1530/raf-21-0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 08/23/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose To evaluate the association between a rise in serum luteinizing hormone (LH) levels during artificial frozen–thawed embryo transfer (FET) cycles and clinical pregnancy rate. Methods A retrospective cohort study of women undergoing artificial FET cycles. We compared cycles in which LH double itself from the early follicular phase and further (group A) to cycles without a rise in LH (group B). Endometrium preparation was achieved by administration of 2 mg three times per day estradiol valerate tablets. Embryo transfer (ET) was conducted after achieving endometrial thickness > 7 mm and vaginal progesterone was added according to the embryo’s age. A beta-hCG was measured 13–14 days after ET. Clinical pregnancy was diagnosed on transvaginal ultrasound. Results Data from 984-FET cycles were retrieved. LH, exogenous estradiol (E2), progesterone values, endometrial thickness, and pregnancy outcomes were available in all patients. From 984-FET cycles, 629 (63.9%) had a doubling, and 355 (36.07%) had no rise in LH. Patients mean age was 30 years, similar in both groups. A multivariable logistic regression analysis was calculated to assess the effect of LH rise and pregnancy outcomes, after adjusting for confounders including a rise in E2 level and endometrial thickness. In this model, there was no association between doubling LH values and pregnancy rates (adjusted odds ratio: 1.06, 95% CI: 0.75–1.5, P = 0.74). Conclusion LH rise during artificial FET cycles does not alter pregnancy rates. Apparently, hormonal monitoring of LH levels may not yield useful information in the artificial FET cycle and may be omitted. Lay summary Supplementation of estradiol, a hormone produced by the ovaries, starting at the beginning of the menstrual cycle of an artificially frozen embryo transfer (FET) can lead to a rise in luteinizing hormone (LH), the hormone that induces ovulation. Such a rise in LH may interfere with embryo implantation, the process where the embryo attaches to the inner lining of the uterus and, therefore, could affect the chances of pregnancy. The current study is the first to assess the effect of a dynamic rise in LH levels during FET cycles on pregnancy rates. This study found no difference in pregnancy rates between FET cycles where the LH doubled compared to cycles without such a rise in LH. Larger, prospective studies should be conducted to assess the impact of LH elevation on pregnancy outcomes.
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Affiliation(s)
- Samer Khoury
- Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel.,Technion-Israel Institute of Technology, The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Einav Kadour-Peero
- Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel.,Technion-Israel Institute of Technology, The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Ilan Calderon
- Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel.,Technion-Israel Institute of Technology, The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
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Abdala A, Elkhatib I, Bayram A, Arnanz A, El-Damen A, Melado L, Lawrenz B, Fatemi HM, De Munck N. Day 5 vs day 6 single euploid blastocyst frozen embryo transfers: which variables do have an impact on the clinical pregnancy rates? J Assist Reprod Genet 2022; 39:379-388. [PMID: 35064434 PMCID: PMC8956773 DOI: 10.1007/s10815-021-02380-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/13/2021] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To determine which variables affect most the clinical pregnancy rate with positive fetal heartbeat (CPR FHB+) when frozen embryo transfer (FET) cycles are performed with day 5 (D5) or day 6 (D6) euploid blastocysts. Design and method A single center retrospective study was performed from March 2017 till February 2021 including all single FET cycles with euploid D5 or D6 blastocysts and transferred in natural cycles (NC) or hormone replacement therapy (HRT) cycles. Trophectoderm (TE) and inner cell mass (ICM) qualities were recorded before biopsy. RESULTS A total of 1102 FET cycles were included, 678 with D5 and 424 with D6 blastocysts. Pregnancy rate (PR), clinical PR (CPR), and CPR FHB+ were significantly higher with D5 blastocysts (PR: 70.7% vs 62.0%, OR = 0.68 [0.53-0.89], p = 0.004; CPR: 63.7% vs 54.2%, OR = 0.68 [0.52-0.96], p = 0.002 and CPR FHB+: 57.8% vs 49.8%, OR = 0.72 [0.53-0.96], p = 0.011). However, miscarriage rate (12.5% vs 11.4%, OR = 0.78 [0.48-1.26], p = 0.311) did not differ. From a multivariate logistic regression model, endometrial thickness (OR = 1.11 [1.01-1.22], p = 0.028), patient's age (OR = 1.03 [1.00-1.05], p = 0.021), BMI (OR = 0.97 [0.94-0.99], p = 0.023), and ICM grade C (OR = 0.23 [0.13-0.43], p < 0.001) were significant in predicting CPR FHB+. CONCLUSION Although clinical outcomes are higher with D5 blastocysts, CPR FHB+ is more affected by endometrial thickness, patient age, BMI, and ICM grade C rather than biopsy day or endometrial preparation protocol.
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Affiliation(s)
- Andrea Abdala
- ART Fertility Clinics, Al Ain, Abu Dhabi, United Arab Emirates
| | | | - Aşina Bayram
- ART Fertility Clinics, Al Ain, Abu Dhabi, United Arab Emirates
| | - Ana Arnanz
- ART Fertility Clinics, Al Ain, Abu Dhabi, United Arab Emirates ,Biomedicine and Biotechnology Department, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Ahmed El-Damen
- ART Fertility Clinics, Al Ain, Abu Dhabi, United Arab Emirates
| | - Laura Melado
- ART Fertility Clinics, Al Ain, Abu Dhabi, United Arab Emirates
| | - Barbara Lawrenz
- ART Fertility Clinics, Al Ain, Abu Dhabi, United Arab Emirates ,Obstetrical Department, Women’s University Hospital Tuebingen, Tuebingen, Germany
| | - Human M. Fatemi
- ART Fertility Clinics, Al Ain, Abu Dhabi, United Arab Emirates
| | - Neelke De Munck
- ART Fertility Clinics, Al Ain, Abu Dhabi, United Arab Emirates
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24
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OUP accepted manuscript. Hum Reprod Update 2022; 28:717-732. [DOI: 10.1093/humupd/dmac012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/05/2022] [Indexed: 11/14/2022] Open
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25
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Blastocyst development rate influences singleton gestational age of similarly graded blastocysts after vitrified–warmed single embryo transfer cycles. Reprod Biomed Online 2021; 44:449-458. [DOI: 10.1016/j.rbmo.2021.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 11/03/2021] [Accepted: 11/19/2021] [Indexed: 11/22/2022]
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26
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Waschkies F, Kroning L, Schill T, Chandra A, Schippert C, Töpfer D, Ziert Y, von Versen-Höynck F. Pregnancy Outcomes After Frozen-Thawed Embryo Transfer in the Absence of a Corpus Luteum. Front Med (Lausanne) 2021; 8:727753. [PMID: 34568385 PMCID: PMC8460906 DOI: 10.3389/fmed.2021.727753] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Nowadays, frozen-thawed embryo transfer (FET) cycles represent a high proportion of fertility treatments worldwide. Recent studies suggest differences in pregnancy outcomes depending on the FET treatment protocol used. The reason for this is still unclear, but the number of corpora lutea (CL) at conception is discussed as a possible factor. This study aims to investigate whether maternal and neonatal outcomes for pregnancies following FET lacking a CL differ from FET with one or more CL in order to explore a potential link between CL absence and adverse pregnancy outcomes. Methods: The study was designed as a retrospective, multi-center observational study with two cohorts after singleton live birth [0 CL cohort (FET in a programmed cycle, n = 114) and ≥ 1 CL cohort (FET in a natural or stimulated cycle, n = 68)]. Participants completed a questionnaire on the outcome of pregnancy and birth records were analyzed in a descriptive way. Multivariable logistic and linear regressions were performed in order to explore associations between CL absence and pregnancy outcomes. The strength of the agreement between the information in the survey and the diagnoses extracted from the files was assessed by Cohen's Kappa. Results: The risk of hypertensive disorders of pregnancy was higher after FET in the absence of a CL compared to FET with CL presence (aOR 5.56, 95% CI 1.12 – 27.72). Birthweights and birthweight percentiles were significantly higher in the 0 CL group. CL absence was a predictor of higher birthweight (adjusted coefficient B 179.74, 95% CI 13.03 – 346.44) and higher birthweight percentiles (adjusted coefficient B 10.23, 95%, 95% CI 2.28 – 18.40) particularly in female newborns of the 0 CL cohort. While the strength of the agreement between the reported information in the survey and the actual diagnoses extracted from the files was good for the majority of outcomes of interest it was fair in terms of hypertension (κ = 0.38). Conclusion: This study supports observations suggesting a potential link between a lack of CL at conception and adverse maternal and neonatal outcomes. Further investigations on causes and pathophysiological relationships are yet to be conducted.
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Affiliation(s)
- Freya Waschkies
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Luka Kroning
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Thilo Schill
- Fertility Center Langenhagen, Langenhagen, Germany
| | | | - Cordula Schippert
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Dagmar Töpfer
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Yvonne Ziert
- Institute of Biostatistics, Hannover Medical School, Hannover, Germany
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27
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Mumusoglu S, Polat M, Ozbek IY, Bozdag G, Papanikolaou EG, Esteves SC, Humaidan P, Yarali H. Preparation of the Endometrium for Frozen Embryo Transfer: A Systematic Review. Front Endocrinol (Lausanne) 2021; 12:688237. [PMID: 34305815 PMCID: PMC8299049 DOI: 10.3389/fendo.2021.688237] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/23/2021] [Indexed: 11/13/2022] Open
Abstract
Despite the worldwide increase in frozen embryo transfer, the search for the best protocol to prime endometrium continues. Well-designed trials comparing various frozen embryo transfer protocols in terms of live birth rates, maternal, obstetric and neonatal outcome are urgently required. Currently, low-quality evidence indicates that, natural cycle, either true natural cycle or modified natural cycle, is superior to hormone replacement treatment protocol. Regarding warmed blastocyst transfer and frozen embryo transfer timing, the evidence suggests the 6th day of progesterone start, LH surge+6 day and hCG+7 day in hormone replacement treatment, true natural cycle and modified natural cycle protocols, respectively. Time corrections, due to inter-personal differences in the window of implantation or day of vitrification (day 5 or 6), should be explored further. Recently available evidence clearly indicates that, in hormone replacement treatment and natural cycles, there might be marked inter-personal variation in serum progesterone levels with an impact on reproductive outcomes, despite the use of the same dose and route of progesterone administration. The place of progesterone rescue protocols in patients with low serum progesterone levels one day prior to warmed blastocyst transfer in hormone replacement treatment and natural cycles is likely to be intensively explored in near future.
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Affiliation(s)
- Sezcan Mumusoglu
- Department of Obstetrics and Gynecology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Mehtap Polat
- Anatolia IVF and Women Health Centre, Ankara, Turkey
| | | | - Gurkan Bozdag
- Department of Obstetrics and Gynecology, Hacettepe University School of Medicine, Ankara, Turkey
| | | | - Sandro C. Esteves
- Androfert, Andrology and Human Reproduction Clinic, Referral Center for Male Reproduction, Campinas, Brazil
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Peter Humaidan
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- The Fertility Clinic, Skive Regional Hospital Resenvej 25, Skive, Denmark
| | - Hakan Yarali
- Department of Obstetrics and Gynecology, Hacettepe University School of Medicine, Ankara, Turkey
- Anatolia IVF and Women Health Centre, Ankara, Turkey
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28
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Severino AI, Póvoa AM. Frozen Embryo Transfer and Preeclampsia Risk. J Gynecol Obstet Hum Reprod 2021; 50:102167. [PMID: 34015549 DOI: 10.1016/j.jogoh.2021.102167] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/04/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
Worldwide, the use of Assisted Reproductive Technology (ART) has been steadily rising over recent years. With the continuous improvements in cryopreservation techniques and the growing practice of single embryo transfer, the proportion of frozen embryo transfer (FET) cycles has been increasing, therefore raising concern about the safety of this ART technique to both mothers and infants. This review aims to summarize the current evidence regarding the risk of preeclampsia in singleton pregnancies achieved by autologous FET compared to fresh embryo transfer, and to discuss the influence of different protocols used for endometrium preparation in frozen cycles on the risk of this obstetric complication. Several studies have reported a higher risk of hypertensive disorders, including preeclampsia, in pregnancies following FET compared with fresh embryo transfer. Recently, artificial FET cycles, which preclude the development of a corpus luteum, were shown to be associated with an increased preeclampsia risk in comparison with natural and stimulated cycles. Importantly, no difference was found between FET in a modified natural cycle and spontaneous conception. It has been proposed that the absence of the corpus luteum in artificial cycles may, at least partly, contribute to the observed increased risk of preeclampsia. Indeed, the corpus luteum secretes vasoactive hormones, such as relaxin, which are not replaced in artificial cycles, thereby compromising maternal cardiovascular adaptations to pregnancy, resulting in an increased risk of preeclampsia. If these findings are confirmed by a randomized controlled trial, natural, modified natural or stimulated cycles might be preferred over artificial cycles in eligible patients.
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Affiliation(s)
- Ana Isabel Severino
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
| | - Ana Margarida Póvoa
- Department of Gynecology, Unit of Reproductive Medicine, Universitary Hospitalar Center São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; Department of Gynecology, Obstetrics and Pediatrics, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; Institute for Investigation and Innovation in Health, University of Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
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29
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Matorras R, Pijoan JI, Perez‐Ruiz I, Lainz L, Malaina I, Borjaba S. Meta-analysis of the embryo freezing transfer interval. Reprod Med Biol 2021; 20:144-158. [PMID: 33850447 PMCID: PMC8022104 DOI: 10.1002/rmb2.12363] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/18/2020] [Accepted: 12/12/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The decision of whether frozen embryo transfer (FET) should be performed in the cycle immediately after OPU or at least one cycle later is controversial. FET could improve pregnancy rates in IVF; however, how much time is needed for the endometrium to return to optimal receptivity after ovarian stimulation is not known. METHODS Electronic search in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials to identify studies providing data on the influence of the interval between embryo freezing (or OPU) and FET in FET cycles published between January 1, 2007, and February 1, 2020. MAIN FINDINGS Data analyzed indicated that in the immediate FET cycles, there was a trend to an increased biochemical pregnancy rate (RR = 1.08; CI = 1.00-1.18), whereas the clinical pregnancy rate was somewhat higher, but without reaching statistical significance (RR = 1.07; CI = 0.99-1.15). The live birth rate was similar in the two groups (RR = 1.05; CI = 0.95-1.15), as was the implantation rate (RR = 0.98; CI = 0.83-1.16). Stratifying by embryo stage or FET type (freeze-all or FET after failed fresh transfer) showed no differences. CONCLUSION Systematically delaying FET does not offer benefits to IVF outcomes. In addition, immediate transfer is associated with a nonsignificant trend to better clinical pregnancy rate and it also avoids the psychological effects of prolonging the stress on prospective parents.
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Affiliation(s)
- Roberto Matorras
- Reproduction UnitCruces HospitalBiocruces Health Research InstituteBIOEFVizcayaSpain
- Department of Gynecology and ObstetricsFaculty of Medicine and NursingUniversity of the Basque CountryVizcayaSpain
- IVI BilbaoVizcayaSpain
| | - Jose Ignacio Pijoan
- Clinical Epidemiological UnitCruces HospitalBiocruces Health Research InstituteBIOEFVizcayaSpain
| | - Irantzu Perez‐Ruiz
- Reproduction UnitCruces HospitalBiocruces Health Research InstituteBIOEFVizcayaSpain
| | - Lucía Lainz
- Reproduction UnitCruces HospitalBiocruces Health Research InstituteBIOEFVizcayaSpain
| | - Iker Malaina
- Clinical Epidemiological UnitCruces HospitalBiocruces Health Research InstituteBIOEFVizcayaSpain
- Department of MathematicsFaculty of Science and TechnologyUniversity of the Basque CountryVizcayaSpain
| | - Sonia Borjaba
- Reproduction UnitCruces HospitalBiocruces Health Research InstituteBIOEFVizcayaSpain
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Moreno-Sepulveda J, Espinós JJ, Checa MA. Lower risk of adverse perinatal outcomes in natural versus artificial frozen-thawed embryo transfer cycles: a systematic review and meta-analysis. Reprod Biomed Online 2021; 42:1131-1145. [PMID: 33903031 DOI: 10.1016/j.rbmo.2021.03.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/23/2021] [Accepted: 03/01/2021] [Indexed: 12/28/2022]
Abstract
This systematic review of literature and meta-analysis of observational studies reports on perinatal outcomes after frozen embryo transfer (FET). The aim was to determine whether natural cycle frozen embryo transfer (NC-FET) in singleton pregnancies conceived after IVF decreased the risk of adverse perinatal outcomes compared with artificial cycle frozen embryo transfer (AC-FET). Thirteen cohort studies, including 93,201 cycles, met the inclusion criteria. NC-FET was associated with a lower risk of hypertensive disorders in pregnancy (HDP) (RR 0.61, 95% CI 0.50 to 0.73), preeclampsia (RR 0.47, 95% CI 0.42 to 0.53), large for gestational age (LGA) (RR 0.93, 95% CI 0.90 to 0.96) and macrosomia (RR 0.82, 95% CI 0.69 to 0.97) compared with AC-FET. No significant difference was found in the risk of gestational hypertension and small for gestational age. Secondary outcomes assessed were the risk of preterm birth (RR 0.83, 95% CI 0.79 to 0.88); post-term birth (RR 0.48, 95% CI 0.29 to 0.80); low birth weight (RR 0.84, 95% CI 0.80 to 0.89); caesarean section (RR 0.84, 95% CI 0.77 to 0.91); postpartum haemorrhage (RR 0.39, 95% CI 0.35 to 0.45); placental abruption (RR 0.61, 95% CI 0.38 to 0.98); and placenta accreta (RR 0.18, 95% CI 0.10 to 0.33). All were significantly lower with NC-FET compared with AC-FET. In assessing safety, NC-FET significantly decreased the risk of HDP, preeclampsia, LGA, macrosomia, preterm birth, post-term birth, low birth weight, caesarean section, postpartum haemorrhage, placental abruption and placenta accreta. Further randomized controlled trials addressing the effect of NC-FET and AC-FET on maternal and perinatal outcomes are warranted. Clinicians should carefully monitor pregnancies achieved by FET in artificial cycles prenatally, during labour and postnatally.
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Affiliation(s)
- José Moreno-Sepulveda
- Obstetrics and Gynecology Department, Universitat Autònoma de Barcelona, Campus Universitario UAB, Bellaterra Cerdanyola del Vallès 08193, Spain; Clínica de la Mujer Medicina Reproductiva, Alejandro Navarrete 2606, Viña del Mar, Chile.
| | - Juan Jose Espinós
- Obstetrics and Gynecology Department, Universitat Autònoma de Barcelona, Campus Universitario UAB, Bellaterra Cerdanyola del Vallès 08193, Spain; Fertty International, Carrer d'Ausiàs Marc, 25, Barcelona 08010, Spain; Department of Obstetrics and Gynaecology, Hospital de la Santa Creu i Sant Pau, Carrer de Sant Quintí, 89 Barcelona 08041, Spain
| | - Miguel Angel Checa
- Obstetrics and Gynecology Department, Universitat Autònoma de Barcelona, Campus Universitario UAB, Bellaterra Cerdanyola del Vallès 08193, Spain; Fertty International, Carrer d'Ausiàs Marc, 25, Barcelona 08010, Spain; GRI-BCN, Barcelona Infertility Research Group, IMIM, Institut Hospital del Mar d'Investigacions Mèdiques, Carrer del Dr. Aiguader, 88, Barcelona 08003, Spain
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Ota K, Shiraishi S, Takahashi T. Relationship between temporal changes of endometrial blood flow impedance during natural and hormone replacement cycles and prediction of pregnancy during vitrified-warmed embryo transfer. J Obstet Gynaecol Res 2021; 47:1052-1063. [PMID: 33395733 DOI: 10.1111/jog.14637] [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: 08/14/2020] [Revised: 11/20/2020] [Accepted: 12/17/2020] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to examine the relationship between the temporal changes in endometrial blood flow impedance during natural and hormone replacement therapy (HRT) cycles and clinical outcomes of vitrified-warmed embryo transfer (ET). METHODS This retrospective observational cohort study included 60 women, 28 with natural, and 32 with HRT cycles, who underwent vitrified-warmed ET. Uterine radial artery resistance index (RA-RI) was measured during the natural and HRT cycles at the following time points: early follicular phase, day of the human chorionic gonadotropin injection during a natural cycle or day of progesterone administration during an HRT cycle, and day of ET. RESULTS The clinical pregnancy rates of the natural and HRT cycles were 32.1% and 34.4%, respectively. The RA-RI at the early follicular phase was significantly lower in the pregnant group than in the nonpregnant group with natural but not HRT cycles (p = 0.04). The odds ratio for pregnancy was 0.70 (95% confidence interval [CI], 0.52-0.95) when the RA-RI value at the early follicular phase was increased by 0.01 in the natural cycle. With the natural cycle, the area under the receiver-operating characteristic curves for the RA-RI at the early follicular phase with a threshold of 0.68 was 0.75 (95% CI, 0.57-0.93), and the positive and negative predictive values were 0.53 (95% CI, 0.37-0.59) and 0.92 (0.74-0.99), respectively. CONCLUSION RA-RI at the early follicular phase might be an effective and useful tool for deciding between natural or HRT cycles for vitrified-warmed ET.
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Affiliation(s)
- Kuniaki Ota
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
| | - Satoru Shiraishi
- Department of Obstetrics and Gynecology, Nasu Red Cross Hospital, Tochigi, Japan
| | - Toshifumi Takahashi
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
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