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Alteri A, Arroyo G, Baccino G, Craciunas L, De Geyter C, Ebner T, Koleva M, Kordic K, Mcheik S, Mertes H, Pavicic Baldani D, Rodriguez-Wallberg KA, Rugescu I, Santos-Ribeiro S, Tilleman K, Woodward B, Vermeulen N, Veleva Z. ESHRE guideline: number of embryos to transfer during IVF/ICSI†. Hum Reprod 2024; 39:647-657. [PMID: 38364208 PMCID: PMC10988112 DOI: 10.1093/humrep/deae010] [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: 12/05/2023] [Indexed: 02/18/2024] Open
Abstract
STUDY QUESTION Which clinical and embryological factors should be considered to apply double embryo transfer (DET) instead of elective single embryo transfer (eSET)? SUMMARY ANSWER No clinical or embryological factor per se justifies a recommendation of DET instead of eSET in IVF/ICSI. WHAT IS KNOWN ALREADY DET is correlated with a higher rate of multiple pregnancy, leading to a subsequent increase in complications for both mother and babies. These complications include preterm birth, low birthweight, and other perinatal adverse outcomes. To mitigate the risks associated with multiple pregnancy, eSET is recommended by international and national professional organizations as the preferred approach in ART. STUDY DESIGN, SIZE, DURATION The guideline was developed according to the structured methodology for development and update of ESHRE guidelines. Literature searches were performed in PUBMED/MEDLINE and Cochrane databases, and relevant papers published up to May 2023, written in English, were included. Live birth rate, cumulative live birth rate, and multiple pregnancy rate were considered as critical outcomes. PARTICIPANTS/MATERIALS, SETTING, METHODS Based on the collected evidence, recommendations were discussed until a consensus was reached within the Guideline Development Group (GDG). A stakeholder review was organized after the guideline draft was finalized. The final version was approved by the GDG and the ESHRE Executive Committee. MAIN RESULTS AND THE ROLE OF CHANCE The guideline provides 35 recommendations on the medical and non-medical risks associated with multiple pregnancies and on the clinical and embryological factors to be considered when deciding on the number of embryos to transfer. These recommendations include 25 evidence-based recommendations, of which 24 were formulated as strong recommendations and one as conditional, and 10 good practice points. Of the evidence-based recommendations, seven (28%) were supported by moderate-quality evidence. The remaining recommendations were supported by low (three recommendations; 12%), or very low-quality evidence (15 recommendations; 60%). Owing to the lack of evidence-based research, the guideline also clearly mentions recommendations for future studies. LIMITATIONS, REASONS FOR CAUTION The guideline assessed different factors one by one based on existing evidence. However, in real life, clinicians' decisions are based on several prognostic factors related to each patient's case. Furthermore, the evidence from randomized controlled trials is too scarce to formulate high-quality evidence-based recommendations. WIDER IMPLICATIONS OF THE FINDINGS The guideline provides health professionals with clear advice on best practice in the decision-making process during IVF/ICSI, based on the best evidence currently available, and recommendations on relevant information that should be communicated to patients. In addition, a list of research recommendations is provided to stimulate further studies in the field. STUDY FUNDING/COMPETING INTEREST(S) The guideline was developed and funded by ESHRE, covering expenses associated with the guideline meetings, the literature searches, and the dissemination of the guideline. The guideline group members did not receive payment. DPB declared receiving honoraria for lectures from Merck, Ferring, and Gedeon Richter. She is a member of ESHRE EXCO, and the Mediterranean Society for reproductive medicine and the president of the Croatian Society for Gynaecological Endocrinology and Reproductive Medicine. CDG is the past Chair of the ESHRE EIM Consortium and a paid deputy member of the Editorial board of Human Reproduction. IR declared receiving reimbursement from ESHRE and EDCD for attending meetings. She holds an unpaid leadership role in OBBCSSR, ECDC Sohonet, and AER. KAR-W declared receiving grants for clinical researchers and funding provision to the institution from the Swedish Cancer Society (200170F), the Senior Clinical Investigator Award, Radiumhemmets Forskningsfonder (Dnr: 201313), Stockholm County Council FoU (FoUI-953912) and Karolinska Institutet (Dnr 2020-01963), NovoNordisk, Merck and Ferring Pharmaceuticals. She received consulting fees from the Swedish Ministry of Health and Welfare. She received honoraria from Roche, Pfizer, and Organon for chairmanship and lectures. She received support from Organon for attending meetings. She participated in advisory boards for Merck, Nordic countries, and Ferring. She declared receiving time-lapse equipment and grants with payment to institution for pre-clinical research from Merck pharmaceuticals and from Ferring. SS-R received research funding from Roche Diagnostics, Organon/MSD, Theramex, and Gedeo-Richter. He received consulting fees from Organon/MSD, Ferring Pharmaceuticals, and Merck Serono. He declared receiving honoraria for lectures from Ferring Pharmaceuticals, Besins, Organon/MSD, Theramex, and Gedeon Richter. He received support for attending Gedeon Richter meetings and participated in the Data Safety Monitoring Board of the T-TRANSPORT trial. He is the Deputy of ESHRE SQART special interest group. He holds stock options in IVI Lisboa and received equipment and other services from Roche Diagnostics and Ferring Pharmaceuticals. KT declared receiving payment for honoraria for giving lectures from Merck Serono and Organon. She is member of the safety advisory board of EDQM. She holds a leadership role in the ICCBBA board of directors. ZV received reimbursement from ESHRE for attending meetings. She also received research grants from ESHRE and Juhani Aaltonen Foundation. She is the coordinator of EHSRE SQART special interest group. The other authors have no conflicts of interest to declare. DISCLAIMER This guideline represents the views of ESHRE, which were achieved after careful consideration of the scientific evidence available at the time of preparation. In the absence of scientific evidence on certain aspects, a consensus between the relevant ESHRE stakeholders has been obtained. Adherence to these clinical practice guidelines does not guarantee a successful or specific outcome, nor does it establish a standard of care. Clinical practice guidelines do not replace the need for application of clinical judgement to each individual presentation, nor variations based on locality and facility type. ESHRE makes no warranty, express or implied, regarding the clinical practice guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose (full disclaimer available at https://www.eshre.eu/Guidelines-and-Legal).
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Affiliation(s)
| | - Alessandra Alteri
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gemma Arroyo
- Reproductive Medicine Service, Dexeus Mujer, Dexeus University Hospital, Barcelona, Spain
| | | | - Laurentiu Craciunas
- Department of Fertility Services and Gynaecology, Newcastle Fertility Centre, Newcastle upon Tyne, UK
| | - Christian De Geyter
- Reproductive Medicine and Gynaecological Endocrinology (RME), University Hospital, University of Basel, Basel, Switzerland
| | - Thomas Ebner
- Department of Gynaecology, Obstetrics and Gynaecological Endocrinology, Kepler University Hospital, Linz, Austria
| | | | - Klaudija Kordic
- Patient Representative, Executive Committee, Fertility Europe, Brussels, Belgium
| | | | - Heidi Mertes
- Department of Philosophy and Moral Sciences, Gent University, Gent, Belgium
| | - Dinka Pavicic Baldani
- Division of Reproductive Medicine and Gynaecological Endocrinology, Department of Obstetrics and Gynaecology, Clinical Hospital Centre Zagreb, and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Kenny A Rodriguez-Wallberg
- Laboratory of Translational Fertility Preservation, Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
- Division of Gynaecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Ioana Rugescu
- Cells Department, National Transplant Agency, Bucharest, Romania
| | - Samuel Santos-Ribeiro
- Department of Reproductive Medicine, Valencian Institute of Infertility in Lisbon (IVI-RMA Lisboa), Lisbon, Portugal
| | - Kelly Tilleman
- Department of Reproductive Medicine, Gent University Hospital, Gent, Belgium
| | | | | | - Zdravka Veleva
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
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Cai H, Mol B, Gordts S, Wang H, Shi J. Elective single versus double blastocyst-stage embryo transfer in women aged 36 years or older: a retrospective cohort study. HUM FERTIL 2023; 26:1185-1194. [PMID: 36719262 DOI: 10.1080/14647273.2022.2153348] [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: 09/15/2021] [Accepted: 08/29/2022] [Indexed: 02/01/2023]
Abstract
We evaluated if elective single-blastocyst transfer (eSBT) could be adopted in women aged 36 or older. In this retrospective cohort, women aged ≥36 years received IVF ovarian stimulation cycles and had ≥ two blastocysts. A total of 240 women underwent eSBT and 189 double-blastocyst transfer (DBT) in the first transfer cycle. The subsequent frozen-thawed embryo transfer cycles were a combination of single- and double- blastocyst transfers. Analysis was stratified for patients in age groups 36-37, 38-39 and ≥40, considering the quality of the blastocyst transferred. The cumulative live birth rates (cLBR) were 74.2% (178/240) versus 63.0% (119/189) after eSBT versus DBT, respectively (aOR: 1.09 (0.68, 1.75)). Time to live birth did not vary significantly between the two groups (HR: 0.85 (0.68, 1.08)). The total number of children born was 194 after eSBT (162 singletons and 16 pairs of twins) versus 154 (84 singletons and 35 twins) after DBT. The odds ratios for preterm birth (0.37 (0.21-0.64)), and low birth weight (0.31 (0.16, 0.60)) were all lower in eSBT. In women aged ≥36 years, cLBR following single- versus double- blastocyst transfer was comparable while the odds of multiple live births and adverse perinatal outcomes were reduced.
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Affiliation(s)
- He Cai
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, People's Republic of China
| | - Ben Mol
- Medicine Department, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Parkville, Victoria, Australia
- Pregnancy Research Centre, Department of Maternal-Fetal Medicine, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Stephan Gordts
- Leuven Institute for Fertility & Embryology, Leuven, Belgium
| | - Hui Wang
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, People's Republic of China
| | - Juanzi Shi
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, People's Republic of China
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Zhang H, Li Y, Wang H, Zhou W, Zheng Y, Ye D. Does sperm DNA fragmentation affect clinical outcomes during vitrified-warmed single-blastocyst transfer cycles? A retrospective analysis of 2034 vitrified-warmed single-blastocyst transfer cycles. J Assist Reprod Genet 2022; 39:1359-1366. [PMID: 35411424 DOI: 10.1007/s10815-022-02484-2] [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: 01/25/2022] [Accepted: 03/30/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Sperm DNA is essential in embryo development. The sperm DNA fragmentation index (DFI), which reflects the degree of sperm DNA fragmentation (SDF), is a crucial biomarker in evaluating the sperm quality. However, whether SDF influences the clinical outcomes after in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) remains controversial. OBJECTIVE This study aimed to investigate the relationship between sperm DNA SDF and clinical outcomes of vitrified-warmed single-blastocyst transfer cycles. MATERIALS AND METHODS A total of 2034 vitrified-warmed single-blastocyst transfer cycles (536 from ICSI and 1498 from IVF) were included in this analysis. According to the sperm DFI, all cycles were divided into two groups (DFI < 27.3% group and DFI ≥ 27.3% group). The Mann-Whitney and chi-squared tests were used to compare patient characteristics and clinical outcomes between the two groups. Furthermore, logistic regression analysis was performed to analyze the association between SDF and clinical outcomes. RESULTS The chi-squared test showed no differences in positive human chorionic gonadotropin (HCG) rate, clinical pregnancy rate, miscarriage rates, and live birth rate between the two groups. Logistic regression analysis indicated that SDF was not a prognostic predictor of positive HCG, clinical pregnancy, miscarriage, and live birth. CONCLUSION SDF was not associated with clinical outcomes either in ICSI or IVF cycles during vitrified-warmed single-blastocyst transfer cycles.
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Affiliation(s)
- Huan Zhang
- Department of Reproductive Medical Center, The First Affiliated Hospital of Wenzhou Medical University, Fuxuexiang 96#, Wenzhou, 325000, Zhejiang, China
| | - Yan Li
- Department of Reproductive Medical Center, The First Affiliated Hospital of Wenzhou Medical University, Fuxuexiang 96#, Wenzhou, 325000, Zhejiang, China
| | - Haiqing Wang
- Department of Reproductive Medical Center, The First Affiliated Hospital of Wenzhou Medical University, Fuxuexiang 96#, Wenzhou, 325000, Zhejiang, China
| | - Wei Zhou
- Department of Reproductive Medical Center, The First Affiliated Hospital of Wenzhou Medical University, Fuxuexiang 96#, Wenzhou, 325000, Zhejiang, China
| | - Yi Zheng
- Department of Reproductive Medical Center, The First Affiliated Hospital of Wenzhou Medical University, Fuxuexiang 96#, Wenzhou, 325000, Zhejiang, China
| | - Danna Ye
- Department of Reproductive Medical Center, The First Affiliated Hospital of Wenzhou Medical University, Fuxuexiang 96#, Wenzhou, 325000, Zhejiang, China.
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Metwally M, Chatters R, Pye C, Dimairo M, White D, Walters S, Cohen J, Young T, Cheong Y, Laird S, Mohiyiddeen L, Chater T, Pemberton K, Turtle C, Hall J, Taylor L, Brian K, Sizer A, Hunter H. Endometrial scratch to increase live birth rates in women undergoing first-time in vitro fertilisation: RCT and systematic review. Health Technol Assess 2022; 26:1-212. [PMID: 35129113 PMCID: PMC8859770 DOI: 10.3310/jnzt9406] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In vitro fertilisation is a widely used reproductive technique that can be undertaken with or without intracytoplasmic sperm injection. The endometrial scratch procedure is an in vitro fertilisation 'add-on' that is sometimes provided prior to the first in vitro fertilisation cycle, but there is a lack of evidence to support its use. OBJECTIVES (1) To assess the clinical effectiveness, safety and cost-effectiveness of endometrial scratch compared with treatment as usual in women undergoing their first in vitro fertilisation cycle (the 'Endometrial Scratch Trial') and (2) to undertake a systematic review to combine the results of the Endometrial Scratch Trial with those of previous trials in which endometrial scratch was provided prior to the first in vitro fertilisation cycle. DESIGN A pragmatic, multicentre, superiority, open-label, parallel-group, individually randomised controlled trial. Participants were randomised (1 : 1) via a web-based system to receive endometrial scratch or treatment as usual using stratified block randomisation. The systematic review involved searching electronic databases (undertaken in January 2020) and clinicaltrials.gov (undertaken in September 2020) for relevant trials. SETTING Sixteen UK fertility units. PARTICIPANTS Women aged 18-37 years, inclusive, undergoing their first in vitro fertilisation cycle. The exclusion criteria included severe endometriosis, body mass index ≥ 35 kg/m2 and previous trauma to the endometrium. INTERVENTIONS Endometrial scratch was undertaken in the mid-luteal phase of the menstrual cycle prior to in vitro fertilisation, and involved inserting a pipelle into the cavity of the uterus and rotating and withdrawing it three or four times. The endometrial scratch group then received usual in vitro fertilisation treatment. The treatment-as-usual group received usual in vitro fertilisation only. MAIN OUTCOME MEASURES The primary outcome was live birth after completion of 24 weeks' gestation within 10.5 months of egg collection. Secondary outcomes included implantation, pregnancy, ectopic pregnancy, miscarriage, pain and tolerability of the procedure, adverse events and treatment costs. RESULTS One thousand and forty-eight (30.3%) women were randomised to treatment as usual (n = 525) or endometrial scratch (n = 523) and were followed up between July 2016 and October 2019 and included in the intention-to-treat analysis. In the endometrial scratch group, 453 (86.6%) women received the endometrial scratch procedure. A total of 494 (94.1%) women in the treatment-as-usual group and 497 (95.0%) women in the endometrial scratch group underwent in vitro fertilisation. The live birth rate was 37.1% (195/525) in the treatment-as-usual group and 38.6% (202/523) in the endometrial scratch group: an unadjusted absolute difference of 1.5% (95% confidence interval -4.4% to 7.4%; p = 0.621). There were no statistically significant differences in secondary outcomes. Safety events were comparable across groups. No neonatal deaths were recorded. The cost per successful live birth was £11.90 per woman (95% confidence interval -£134 to £127). The pooled results of this trial and of eight similar trials found no evidence of a significant effect of endometrial scratch in increasing live birth rate (odds ratio 1.03, 95% confidence interval 0.87 to 1.22). LIMITATIONS A sham endometrial scratch procedure was not undertaken, but it is unlikely that doing so would have influenced the results, as objective fertility outcomes were used. A total of 9.2% of women randomised to receive endometrial scratch did not undergo the procedure, which may have slightly diluted the treatment effect. CONCLUSIONS We found no evidence to support the theory that performing endometrial scratch in the mid-luteal phase in women undergoing their first in vitro fertilisation cycle significantly improves live birth rate, although the procedure was well tolerated and safe. We recommend that endometrial scratch is not undertaken in this population. TRIAL REGISTRATION This trial is registered as ISRCTN23800982. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 10. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Mostafa Metwally
- Assisted Conception Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Robin Chatters
- Sheffield Clinical Trials Research Unit (CTRU), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Clare Pye
- Assisted Conception Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Munya Dimairo
- Sheffield Clinical Trials Research Unit (CTRU), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - David White
- Sheffield Clinical Trials Research Unit (CTRU), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Stephen Walters
- Design, Trials and Statistics, School of Health and Related Research (ScHARR), Sheffield, UK
| | - Judith Cohen
- Hull Health Trials Unit, University of Hull, Hull, UK
| | - Tracey Young
- Health Economic and Decision Science, School of Health and Related Research (ScHARR), Sheffield, UK
| | - Ying Cheong
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Susan Laird
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Lamiya Mohiyiddeen
- Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Tim Chater
- Sheffield Clinical Trials Research Unit (CTRU), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Kirsty Pemberton
- Sheffield Clinical Trials Research Unit (CTRU), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Chris Turtle
- Sheffield Clinical Trials Research Unit (CTRU), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Jamie Hall
- Sheffield Clinical Trials Research Unit (CTRU), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Liz Taylor
- Assisted Conception Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | | | - Helen Hunter
- Department of Reproductive Medicine, Old St Mary's Hospital, Manchester, UK
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Ma S, Peng Y, Hu L, Wang X, Xiong Y, Tang Y, Tan J, Gong F. Comparisons of benefits and risks of single embryo transfer versus double embryo transfer: a systematic review and meta-analysis. Reprod Biol Endocrinol 2022; 20:20. [PMID: 35086551 PMCID: PMC8793185 DOI: 10.1186/s12958-022-00899-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/18/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Evidence referring to the trade-offs between the benefits and risks of single embryo transfer (SET) versus double embryo transfer (DET) following assisted reproduction technology are insufficient, especially for those women with a defined embryo quality or advanced age. METHODS A systematic review and meta-analysis was conducted according to PRISMA guidelines. PubMed, EMBASE, Cochrane Library and ClinicalTrials.gov were searched based on established search strategy from inception through February 2021. Pre-specified primary outcomes were live birth rate (LBR) and multiple pregnancy rate (MPR). Odds ratio (OR) with 95% confidence interval (CI) were pooled by a random-effects model using R version 4.1.0. RESULTS Eighty-five studies (14 randomized controlled trials and 71 observational studies) were eligible. Compared with DET, SET decreased the probability of a live birth (OR = 0.78, 95% CI: 0.71-0.85, P < 0.001, n = 62), and lowered the rate of multiple pregnancy (0.05, 0.04-0.06, P < 0.001, n = 45). In the sub-analyses of age stratification, both the differences of LBR (0.87, 0.54-1.40, P = 0.565, n = 4) and MPR (0.34, 0.06-2.03, P = 0.236, n = 3) between SET and DET groups became insignificant in patients aged ≥40 years. No significant difference in LBR for single GQE versus two embryos of mixed quality [GQE + PQE (non-good quality embryo)] (0.99, 0.77-1.27, P = 0.915, n = 8), nor any difference of MPR in single PQE versus two PQEs (0.23, 0.04-1.49, P = 0.123, n = 6). Moreover, women who conceived through SET were associated with lower risks of poor outcomes, including cesarean section (0.64, 0.43-0.94), antepartum haemorrhage (0.35, 0.15-0.82), preterm birth (0.25, 0.21-0.30), low birth weight (0.20, 0.16-0.25), Apgar1 < 7 rate (0.12, 0.02-0.93) or neonatal intensive care unit admission (0.30, 0.14-0.66) than those following DET. CONCLUSIONS In women aged < 40 years or if any GQE is available, SET should be incorporated into clinical practice. While in the absence of GQEs, DET may be preferable. However, for elderly women aged ≥40 years, current evidence is not enough to recommend an appropriate number of embryo transfer. The findings need to be further confirmed.
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Affiliation(s)
- Shujuan Ma
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, No. 567, Tongzipo West Road, Yuelu District, Changsha, 410205, China
| | - Yangqin Peng
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, No. 567, Tongzipo West Road, Yuelu District, Changsha, 410205, China
| | - Liang Hu
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, No. 567, Tongzipo West Road, Yuelu District, Changsha, 410205, China
| | - Xiaojuan Wang
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, No. 567, Tongzipo West Road, Yuelu District, Changsha, 410205, China
| | - Yiquan Xiong
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, China
| | - Yi Tang
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, No. 567, Tongzipo West Road, Yuelu District, Changsha, 410205, China
| | - Jing Tan
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, China.
| | - Fei Gong
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, No. 567, Tongzipo West Road, Yuelu District, Changsha, 410205, China.
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Cirillo F, Grilli L, Ronchetti C, Paladino I, Morenghi E, Busnelli A, Levi-Setti PE. Retrospective comparison of pregnancy outcomes of fresh and frozen-warmed single blastocyst transfer: a 5-year single-center experience. J Assist Reprod Genet 2022; 39:201-209. [PMID: 34837160 PMCID: PMC8866619 DOI: 10.1007/s10815-021-02362-3] [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: 08/28/2021] [Accepted: 11/21/2021] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To assess whether live birth rates (LBR) and maternal/neonatal complications differed following single fresh and frozen-warmed blastocyst transfer. METHODS The present retrospective observational study analyzed 4,613 single embryo transfers (SET) (646 fresh and 3,967 frozen) from January 1, 2014, to December 31, 2018. Fresh embryo transfer at blastocyst stage was considered according to the age of the patient and her prognosis. In case of the risk of ovarian hyperstimulation syndrome, premature progesterone rise, non-optimal endometrial growth, or supernumerary embryos, cryopreservation with subsequent frozen embryo transfer (FET) was indicated. RESULTS No differences in LBR were recorded. Fresh embryo transfers yielded an increase both in neonatal complications OR 2.15 (95% CI 1.20-3.86, p 0.010), with a higher prevalence of singletons weighting below the 5th percentile (p 0.013) and of intrauterine growth retardation (p 0.015), as well as maternal complications, with a higher placenta previa occurrence OR 3.58 (95% CI 1.54-8.28, p 0.003), compared to FET. CONCLUSION LBR appears not to be affected by the transfer procedure preferred. Fresh embryo transfer is associated with higher risk of neonatal complications (specifically a higher prevalence of singletons weighting below the 5th percentile and of intrauterine growth retardation) and placenta previa. Reflecting on the increased practice of ART procedures, it is imperative to understand whether a transfer procedure yields less complications than the other and if it is time to switch to a "freeze-all" procedure as standard practice. TRIAL REGISTRATION Clinical Trial Registration Number: NCT04310761. Date of registration: March 17, 2020, retrospectively registered.
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Affiliation(s)
- Federico Cirillo
- grid.417728.f0000 0004 1756 8807Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089 Rozzano, Milan Italy
| | - Leonora Grilli
- grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4Pieve Emanuele, 20090 Milan, Italy
| | - Camilla Ronchetti
- grid.417728.f0000 0004 1756 8807Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089 Rozzano, Milan Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4Pieve Emanuele, 20090 Milan, Italy
| | - Ilaria Paladino
- grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4Pieve Emanuele, 20090 Milan, Italy
| | - Emanuela Morenghi
- grid.417728.f0000 0004 1756 8807Biostatistics Unit, Humanitas Research Hospital, IRCCS, 20089 Rozzano, Milan Italy
| | - Andrea Busnelli
- grid.417728.f0000 0004 1756 8807Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089 Rozzano, Milan Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4Pieve Emanuele, 20090 Milan, Italy
| | - Paolo Emanuele Levi-Setti
- grid.417728.f0000 0004 1756 8807Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089 Rozzano, Milan Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4Pieve Emanuele, 20090 Milan, Italy
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Xu Y, Qiao J. Comparison of in vitro maturation and in vitro fertilization for polycystic ovary syndrome patients: a systematic review and meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1235. [PMID: 34532372 PMCID: PMC8421970 DOI: 10.21037/atm-21-3037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/02/2021] [Indexed: 01/09/2023]
Abstract
Background There are two common treatments for polycystic ovary syndrome (PCOS): in vitro fertilization (IVF) and in vitro maturation (IVM). Our study aimed to assess the clinical effects and safety of IVM versus IVF for PCOS. Methods We searched randomized controlled trials and retrospective cohort studies comparing IVM versus IVF for PCOS. Data were extracted from eligible studies. We sought to evaluate fertilization rate, clinical pregnancy rate, live birth rate, and miscarriage. Results were expressed as risk ratio (RR) with 95% confidence intervals (CIs). Results Eight studies with a total of 1,579 patients were included in the present study. According to the heterogeneity analysis, there were no differences between the IVM group and IVF group in terms of fertilization rate, clinical pregnancy rate and miscarriage. Additionally, the IVF group had a higher live birth rate than the IVM group (overall P=0.0007). Sensitivity analysis and funnel plot showed that our study was robust and based on the funnel plot this article had low publication bias. Discussion The findings of the present study indicated that IVM had similar clinical effects compared with IVF in patients with PCOS. However, IVM might be a suitable option for PCOS in terms of cost and successful pregnancy rate.
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Affiliation(s)
- Yalan Xu
- Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.,National Clinical Research Centre for Obstetrics and Gynecology, Beijing, China.,Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China.,Research Units of Comprehensive Diagnosis and Treatment of Oocyte Maturation Arrest, Chinese Academy of Medical Sciences, Beijing, China
| | - Jie Qiao
- Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.,National Clinical Research Centre for Obstetrics and Gynecology, Beijing, China.,Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China.,Research Units of Comprehensive Diagnosis and Treatment of Oocyte Maturation Arrest, Chinese Academy of Medical Sciences, Beijing, China
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8
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Deryabin P, Domnina A, Gorelova I, Rulev M, Petrosyan M, Nikolsky N, Borodkina A. "All-In-One" Genetic Tool Assessing Endometrial Receptivity for Personalized Screening of Female Sex Steroid Hormones. Front Cell Dev Biol 2021; 9:624053. [PMID: 33659249 PMCID: PMC7917288 DOI: 10.3389/fcell.2021.624053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/08/2021] [Indexed: 12/25/2022] Open
Abstract
Endometrium is the uterine lining that undergoes hundreds of cycles of proliferation, differentiation, and desquamation throughout a woman's reproductive life. Recently, much attention is paid to the appropriate endometrial functioning, as decreased endometrial receptivity is stated to be one of the concerns heavily influencing successes of embryo implantation rates and the efficacy of in vitro fertilization (IVF) treatment. In order to acquire and maintain the desired endometrial receptivity during IVF cycles, luteal phase support by various progestagens or other hormonal combinations is generally recommended. However, today, the selection of the specific hormonal therapy during IVF seems to be empirical, mainly due to a lack of appropriate tools for personalized approach. Here, we designed the genetic tool for patient-specific optimization of hormonal supplementation schemes required for the maintenance of endometrial receptivity during luteal phase. We optimized and characterized in vitro endometrial stromal cell (ESC) decidualization model as the adequate physiological reflection of endometrial sensitivity to steroid hormones. Based on the whole transcriptome RNA sequencing and the corresponding bioinformatics, we proposed that activation of the decidual prolactin (PRL) promoter containing ancient transposons MER20 and MER39 may reflect functioning of the core decidual regulatory network. Furthermore, we cloned the sequence of decidual PRL promoter containing MER20 and part of MER39 into the expression vector to estimate the effectiveness of ESC decidual response and verified sensitivity of the designed system. We additionally confirmed specificity of the generated tool using human diploid fibroblasts and adipose-derived human mesenchymal stem cells. Finally, we demonstrated the possibility to apply our tool for personalized hormone screening by comparing the effects of natural progesterone and three synthetic analogs (medroxyprogesterone 17-acetate, 17α-hydroxyprogesterone caproate, dydrogesterone) on decidualization of six ESC lines obtained from patients planning to undergo the IVF procedure. To sum up, we developed the "all-in-one" genetic tool based on the MER20/MER39 expression cassette that provides the ability to predict the most appropriate hormonal cocktail for endometrial receptivity maintenance specifically and safely for the patient, and thus to define the personal treatment strategy prior to the IVF procedure.
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Affiliation(s)
- Pavel Deryabin
- Mechanisms of Cellular Senescence Group, Institute of Cytology of the Russian Academy of Sciences, Saint-Petersburg, Russia
| | - Alisa Domnina
- Department of Intracellular Signaling and Transport, Institute of Cytology of the Russian Academy of Sciences, Saint-Petersburg, Russia
| | - Inga Gorelova
- Department of the Assisted Reproductive Technologies, Almazov National Medical Research Centre, Saint-Petersburg, Russia
| | - Maxim Rulev
- Department of the Assisted Reproductive Technologies, Almazov National Medical Research Centre, Saint-Petersburg, Russia
| | - Mariya Petrosyan
- Pharmacology Group of D.O. Ott Institute of Obstetrics, Gynecology and Reproductology, Saint-Petersburg, Russia.,The Laboratory of Myocardial Metabolism, Almazov National Medical Research Centre, Saint-Petersburg, Russia
| | - Nikolay Nikolsky
- Department of Intracellular Signaling and Transport, Institute of Cytology of the Russian Academy of Sciences, Saint-Petersburg, Russia
| | - Aleksandra Borodkina
- Mechanisms of Cellular Senescence Group, Institute of Cytology of the Russian Academy of Sciences, Saint-Petersburg, Russia
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9
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Guo J, Zeng Z, Li M, Huang J, Peng J, Wang M, Liang X, Zeng H. Clinical outcomes after single-versus double-embryo transfers in women with adenomyosis: a retrospective study. Arch Gynecol Obstet 2021; 304:263-270. [PMID: 33386415 DOI: 10.1007/s00404-020-05924-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 11/25/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adenomyosis affects the outcomes of spontaneous fertility and assisted reproductive technology. The single blastocyst embryo transfer (SBT) policy is an effective strategy known to minimize the risk of multiple pregnancy for non-adenomyosis women. However, little is known about its applicability to women with adenomyosis. The purpose of this study is to compare pregnancy outcomes between SBT, double-blastocyst embryo transfer (DBT), single-cleavage-stage embryo transfer (SET) and double-cleavage-stage embryo transfer (DET) in the frozen-thawed embryo transfer cycles among adenomyosis patients. METHODS This retrospective study was conducted in all frozen-thawed autologous embryo transfer cycles. 393 frozen-thawed embryo transfer cycles performed in adenomyosis patients were enrolled. The major clinical outcomes were implantation rate (IR), clinical pregnancy rate (CPR), miscarriage rate (MR), multiple pregnancy rate (MPR) and live birth rate (LBR). RESULTS The SBT and DBT groups achieved higher IR (P < 0.001), CPR (P = 0.017), LBR (P = 0.040) and lower MR (P = 0.020) than the SET and DET groups. But the SBT and DBT groups achieved similar CPR and LBR. The SBT and SET groups achieved lower MPR (P < 0.001) than the DBT and DET groups. The average birth weight (BW) of SBT groups was higher than the DBT and DET groups (P = 0.016). When compared with SBT group, low-birth-weight infants were significantly higher with DBT and DET. CONCLUSIONS When performing frozen-thawed embryo transfer cycles among adenomyosis patients, the SBT group has similar IR, CPR, MR, LBR but lower MPR compared to the DBT group. Therefore, SBT might be offered as standard practice.
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Affiliation(s)
- Jiayi Guo
- Reproductive Medicine Center, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Zhi Zeng
- Reproductive Medicine Center, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Manchao Li
- Reproductive Medicine Center, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Jiana Huang
- Reproductive Medicine Center, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Jintao Peng
- Reproductive Medicine Center, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Meng Wang
- Reproductive Medicine Center, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Xiaoyan Liang
- Reproductive Medicine Center, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Haitao Zeng
- Reproductive Medicine Center, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China.
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10
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Arab S, Badegiesh A, Aldhaheri S, Son WY, Dahan MH. What Are the Live Birth and Multiple Pregnancy Rates When 1 Versus 2 Low-Quality Blastocysts Are Transferred in a Cryopreserved Cycle? a Retrospective Cohort Study, Stratified for Age, Embryo Quality, and Oocyte Donor Cycles. Reprod Sci 2020; 28:1403-1411. [PMID: 33237513 DOI: 10.1007/s43032-020-00404-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 11/16/2020] [Indexed: 11/27/2022]
Abstract
Outcomes among women who transferred only Gardner's grade BB or lower quality frozen embryos transferred (FET) are not well known. Our objective is to study whether transferring 2 versus 1 frozen low-quality blastocysts will increase the live birth rate (LBR) and the multiple pregnancy rate (MPR). This is a retrospective cohort study including 1104 FET cycles. Only day 5-6 blastocysts of grade BB or lower quality were included. Clinical pregnancy rate (CPR), MPR, and LBR per cycle were compared between single embryo transfer (SET) (n = 969) and double embryo transfer (DET) (n = 135). CPR and MPR were compared between SET and DET in grade BB, BC, CB, and CC individually. Among SET, BB blastocysts had higher CPR 34% (P = 0.0001) and a sub-significant increase in LBR 19% (P = 0.059) in comparison to other grade SET. Among all BB, MPR was significantly higher when transferring two versus one (5.9 vs. 1.9, P = 0.009). If age at egg collection ≥ 40 years (n = 97), no difference was found in CPR (11.1 vs. 11.7, P = 0.9), MPR (0 vs. 0), and LBR (6.3 vs. 0,P = 0.13) when SET or DET was performed. If age was < 40 years (n = 818), the MPR was significantly higher in DET than SET (6.7 vs. 1.63, P = 0.004). In egg donor cycles (n = 189), there was no difference in CPR, MPR, and LBR between SET and DET. Single embryo transfer should be offered even in women ≥ 40 years of age or transferring lower quality embryos since transferring more did not increase outcomes in this group, and SET is likely the safest path.
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Affiliation(s)
- Suha Arab
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility Center, McGill University, 888 Boulevard de Maisonneuve East, suit # 200, Montreal, Quebec, H2l 4S8, Canada.
| | - Ahmad Badegiesh
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
| | - Sarah Aldhaheri
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
| | - Weon-Young Son
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility Center, McGill University, 888 Boulevard de Maisonneuve East, suit # 200, Montreal, Quebec, H2l 4S8, Canada
| | - Michael H Dahan
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility Center, McGill University, 888 Boulevard de Maisonneuve East, suit # 200, Montreal, Quebec, H2l 4S8, Canada
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11
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Sayed S, Reigstad MM, Petersen BM, Schwennicke A, Wegner Hausken J, Storeng R. Time-lapse imaging derived morphokinetic variables reveal association with implantation and live birth following in vitro fertilization: A retrospective study using data from transferred human embryos. PLoS One 2020; 15:e0242377. [PMID: 33211770 PMCID: PMC7676704 DOI: 10.1371/journal.pone.0242377] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 11/01/2020] [Indexed: 01/03/2023] Open
Abstract
The purpose of this retrospective time-lapse data analysis from transferred preimplantation human embryos was to identify early morphokinetic cleavage variables that are related to implantation and live birth following in vitro fertilization (IVF). All embryos were monitored from fertilization check until embryo transfer for a minimum of 44 hours. The study was designed to assess the association between day 2 embryo morphokinetic variables with implantation and live birth based on Known Implantation Data (KID). The kinetic variables were subjected to quartile-based analysis. The predictive ability for implantation and live birth was studied using receiver operator characteristic (ROC) curves. Three morphokinetic variables, time to 2-cells (t2), duration of second cell cycle (cc2) below one threshold and cc2 above another threshold had the highest predictive value with regards to implantation and live birth following IVF treatment. The predictive pre-transfer information has little divergence between fetal heartbeat and live birth data and therefore, at least for early morphokinetic variables up to the four-cell stage (t4), conclusions and models based on fetal heartbeat data can be expected to be valid for live birth datasets as well. The three above mentioned variables (t2, cc2 below one threshold and cc2 above another threshold) may supplement morphological evaluation in embryo selection and thereby improve the outcome of in vitro fertilization treatments.
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Affiliation(s)
- Shabana Sayed
- Klinikk Hausken, IVF and Gynecology, Haugesund, Norway
| | - Marte Myhre Reigstad
- Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway
| | | | | | | | - Ritsa Storeng
- Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway
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12
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Demirel C, Goksever Celik H, Tulek F, Tuysuz G, Donmez E, Ergin T, Buyru F, Bastu E. The impact of a poor quality embryo on the implantation chance of a good quality one when transferred together: A study on double blastocyst transfers. J Gynecol Obstet Hum Reprod 2020; 50:101967. [PMID: 33161131 DOI: 10.1016/j.jogoh.2020.101967] [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: 07/12/2020] [Accepted: 10/28/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Embryo quality assessment with morphological evaluation remains the first-line method of assessment to select the best embryo for transfer. We aimed to determine if an effect of poor quality embryos on good quality ones exists, whether by a paracrine effect or an adverse endometrial influence, when they are transferred together. MATERIALS AND METHODS We included 412 couples, who underwent intracytoplasmic sperm injection (ICSI) cycles in a tertiary IVF center. Single embryo transfer with a good quality embryo and double embryo transfers with a good + poor quality embryo were evaluated. Overall pregnancy (PR) and live birth rates (LBR) were our main outcome measures. RESULTS When PR and LBR are compared, there was no statistical significance between single embryo transfer (SET) and double embryo transfer (DET) groups (51.7 % vs 53.7 %, p = 0.620 and 47 % vs 43.1 %, p = 0.117). When the PR and LBRs were compared between SET from poor cohort and DET group, the outcomes were better in DET group (22.1 % vs 53.7 %, p < 0.001 and 22.1 % vs 43.1 %, p < 0.001). The PR and LBRs of SET from good cohort were significantly better than those of DET (64.4 % vs 53.7 %, p < 0.001 and 57.7 % vs 43.1, p < 0.001). When the PR and LBRs of SET from good cohort and SET from poor cohort were compared, better results were obtained in SET from good cohort. CONCLUSION The addition of poor quality embryo even is of benefit to the LBR, in the setting of when there is only one good quality blastocyst available for the transfer.
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Affiliation(s)
- Cem Demirel
- Ataşehir Memorial IVF Center, Department of Obstetrics and Gynecology, Istanbul, Turkey; Bilgi University, Faculty of Health Sciences, Istanbul, Turkey.
| | - Hale Goksever Celik
- Saglik Bilimleri University Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
| | - Firat Tulek
- Ataşehir Memorial IVF Center, Department of Obstetrics and Gynecology, Istanbul, Turkey.
| | - Gulsum Tuysuz
- Ataşehir Memorial IVF Center, Department of Embryology, Istanbul, Turkey.
| | - Ersan Donmez
- Ataşehir Memorial IVF Center, Department of Embryology, Istanbul, Turkey.
| | - Tolga Ergin
- Ataşehir Memorial IVF Center, Department of Obstetrics and Gynecology, Istanbul, Turkey; Bilgi University, Faculty of Health Sciences, Istanbul, Turkey.
| | - Faruk Buyru
- Acıbadem Mehmet Ali Aydinlar University, Department of Obstetrics and Gynecology, Istanbul, Turkey.
| | - Ercan Bastu
- Acıbadem Mehmet Ali Aydinlar University, Department of Obstetrics and Gynecology, Istanbul, Turkey.
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13
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Yang M, Lin L, Sha C, Li T, Gao W, Chen L, Wu Y, Ma Y, Zhu X. Which is better for mothers and babies: fresh or frozen-thawed blastocyst transfer? BMC Pregnancy Childbirth 2020; 20:559. [PMID: 32967652 PMCID: PMC7513314 DOI: 10.1186/s12884-020-03248-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 09/14/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In recent years, there have been many reports on the pregnancy outcomes of fresh blastocyst transfer (BT) and frozen-thawed BT, but the conclusions are controversial and incomplete. To compare the pregnancy outcomes, maternal complications and neonatal outcomes of fresh and frozen-thawed BT in the context of in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) cycles, we conducted a meta-analysis. METHODS A meta-analysis was conducted by searching the PubMed, Embase, and Cochrane Library databases through May 2020. Data were extracted independently by two authors. RESULTS Fifty-four studies, including 12 randomized controlled trials (RCTs), met the inclusion criteria. Fresh BT was associated with a lower implantation rate, pregnancy rate, ongoing pregnancy rate, and clinical pregnancy rate and higher ectopic pregnancy rate than frozen-thawed BT according to the results of the RCTs. The risks of moderate or severe ovarian hyperstimulation syndrome, placental abruption, placenta previa and preterm delivery were higher for fresh BT than for frozen-thawed BT. The risk of pregnancy-induced hypertension and pre-eclampsia was lower for fresh BT; however, no significant differences in risks for gestational diabetes mellitus and preterm rupture of membrane were found between the two groups. Compared with frozen-thawed BT, fresh BT appears to be associated with small for gestational age and low birth weight. No differences in the incidences of neonatal mortality or neonatal malformation were observed between fresh and frozen-thawed BT. CONCLUSIONS At present there is an overall slight preponderance of risks in fresh cycles against frozen, however individualization is required and current knowledge does not permit to address a defintive response.
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Affiliation(s)
- Meiling Yang
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Obstetrics and Gynecology, Nantong City No 1 People's Hospital and Second Affiliated Hospital of Nantong University, Nantong, 226000, China
| | - Li Lin
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Chunli Sha
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Taoqiong Li
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Wujiang Gao
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Lu Chen
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Ying Wu
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Yanping Ma
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Xiaolan Zhu
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China.
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China.
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14
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Kamath MS, Mascarenhas M, Kirubakaran R, Bhattacharya S. Number of embryos for transfer following in vitro fertilisation or intra-cytoplasmic sperm injection. Cochrane Database Syst Rev 2020; 8:CD003416. [PMID: 32827168 PMCID: PMC8094586 DOI: 10.1002/14651858.cd003416.pub5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Transfer of more than one embryo during in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) increases multiple pregnancy rates resulting in an increased risk of maternal and perinatal morbidity. Elective single embryo transfer offers a means of minimising this risk, but this potential gain needs to be balanced against the possibility of jeopardising the overall live birth rate (LBR). OBJECTIVES To evaluate the effectiveness and safety of different policies for the number of embryos transferred in infertile couples undergoing assisted reproductive technology cycles. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility Group specialised register of controlled trials, CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform from inception to March 2020. We handsearched reference lists of articles and relevant conference proceedings. We also communicated with experts in the field regarding any additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing different policies for the number of embryos transferred following IVF or ICSI in infertile women. Studies of fresh or frozen and thawed transfer of one to four embryos at cleavage or blastocyst stage were eligible. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed trial eligibility and risk of bias. The primary outcomes were LBR and multiple pregnancy rate. The secondary outcomes were clinical pregnancy and miscarriage rates. We analysed data using risk ratios (RR), Peto odds ratio (Peto OR) and a fixed effect model. MAIN RESULTS We included 17 RCTs in the review (2505 women). The main limitation was inadequate reporting of study methods and moderate to high risk of performance bias due to lack of blinding. A majority of the studies had low numbers of participants. None of the trials compared repeated single embryo transfer (SET) with multiple embryo transfer. Reported results of multiple embryo transfer below refer to double embryo transfer. Repeated single embryo transfer versus multiple embryo transfer in a single cycle Repeated SET was compared with double embryo transfer (DET) in four studies of cleavage-stage transfer. In these studies the SET group received either two cycles of fresh SET (one study) or one cycle of fresh SET followed by one frozen SET (three studies). The cumulative live birth rate after repeated SET may be little or no different from the rate after one cycle of DET (RR 0.95, 95% CI (confidence interval) 0.82 to 1.10; I² = 0%; 4 studies, 985 participants; low-quality evidence). This suggests that for a woman with a 42% chance of live birth following a single cycle of DET, the repeated SET would yield pregnancy rates between 34% and 46%. The multiple pregnancy rate associated with repeated SET is probably reduced compared to a single cycle of DET (Peto OR 0.13, 95% CI 0.08 to 0.21; I² = 0%; 4 studies, 985 participants; moderate-quality evidence). This suggests that for a woman with a 13% risk of multiple pregnancy following a single cycle of DET, the risk following repeated SET would be between 0% and 3%. The clinical pregnancy rate (RR 0.99, 95% CI 0.87 to 1.12; I² = 47%; 3 studies, 943 participants; low-quality evidence) after repeated SET may be little or no different from the rate after one cycle of DET. There may be little or no difference in the miscarriage rate between the two groups. Single versus multiple embryo transfer in a single cycle A single cycle of SET was compared with a single cycle of DET in 13 studies, 11 comparing cleavage-stage transfers and three comparing blastocyst-stage transfers.One study reported both cleavage and blastocyst stage transfers. Low-quality evidence suggests that the live birth rate per woman may be reduced in women who have SET in comparison with those who have DET (RR 0.67, 95% CI 0.59 to 0.75; I² = 0%; 12 studies, 1904 participants; low-quality evidence). Thus, for a woman with a 46% chance of live birth following a single cycle of DET, the chance following a single cycle of SET would be between 27% and 35%. The multiple pregnancy rate per woman is probably lower in those who have SET than those who have DET (Peto OR 0.16, 95% CI 0.12 to 0.22; I² = 0%; 13 studies, 1952 participants; moderate-quality evidence). This suggests that for a woman with a 15% risk of multiple pregnancy following a single cycle of DET, the risk following a single cycle of SET would be between 2% and 4%. Low-quality evidence suggests that the clinical pregnancy rate may be lower in women who have SET than in those who have DET (RR 0.70, 95% CI 0.64 to 0.77; I² = 0%; 10 studies, 1860 participants; low-quality evidence). There may be little or no difference in the miscarriage rate between the two groups. AUTHORS' CONCLUSIONS Although DET achieves higher live birth and clinical pregnancy rates per fresh cycle, the evidence suggests that the difference in effectiveness may be substantially offset when elective SET is followed by a further transfer of a single embryo in fresh or frozen cycle, while simultaneously reducing multiple pregnancies, at least among women with a good prognosis. The quality of evidence was low to moderate primarily due to inadequate reporting of study methods and absence of masking those delivering, as well as receiving the interventions.
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Affiliation(s)
- Mohan S Kamath
- Department of Reproductive Medicine, Christian Medical College, Vellore, India
| | - Mariano Mascarenhas
- Leeds Fertility, The Leeds Centre for Reproductive Medicine, Seacroft Hospital, Leeds, UK
| | - Richard Kirubakaran
- Cochrane South Asia, Prof. BV Moses Centre for Evidence-Informed Healthcare and Health Policy, Christian Medical College, Vellore, India
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15
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Bergh C, Kamath MS, Wang R, Lensen S. Strategies to reduce multiple pregnancies during medically assisted reproduction. Fertil Steril 2020; 114:673-679. [PMID: 32826048 DOI: 10.1016/j.fertnstert.2020.07.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 02/07/2023]
Abstract
Multiple birth rates after fertility treatment are still high in many countries. Multiple births are associated with increased rates of preterm birth and low birth weight babies, in turn increasing the risk of severe morbidity for the children. The multiple birth rates vary in different countries between 2% and 3% and up to 30% in some settings. Elective single-embryo transfer, particularly in combination with frozen-embryo transfer and milder stimulation in ovulation induction/intrauterine insemination, to avoid multifollicular development is an effective strategy to decrease the multiple birth rates while still achieving acceptable live-birth rates. Although this procedure is used successfully in many countries, it ought to be implemented broadly to improve the health of the children. One at a time should be the normal routine.
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Affiliation(s)
- Christina Bergh
- Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, Gothenburg University, Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Mohan S Kamath
- Department of Reproductive Medicine, Christian Medical College, Vellore, India
| | - Rui Wang
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Sarah Lensen
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
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Levi Setti PE, Cirillo F, De Cesare R, Morenghi E, Canevisio V, Ronchetti C, Baggiani A, Smeraldi A, Albani E, Patrizio P. Seven Years of Vitrified Blastocyst Transfers: Comparison of 3 Preparation Protocols at a Single ART Center. Front Endocrinol (Lausanne) 2020; 11:346. [PMID: 32547496 PMCID: PMC7272701 DOI: 10.3389/fendo.2020.00346] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/04/2020] [Indexed: 01/08/2023] Open
Abstract
Introduction: Frozen-thawed embryo transfers (FET) have become a standard practice to increase cumulative pregnancy rates, however, the choice of the best preparation protocol remains a matter of debate. Design: Retrospective analysis of clinical pregnancy (CPR) and live birth rate (LBR) of FET in natural cycles (NC-FET), modified natural cycles with hCG-triggered ovulation (mNC-FET), and hormonal artificial replacement (AR-FET). Materials and Methods: For natural cycles, patients were monitored by ultrasound to evaluate the dominant follicle and by urinary LH kits (NC-FET). When the endometrial thickness reached at least 7 mm and the dominant follicle 16-20 mm, hCG was administered in absence of urinary LH surge (mNC-FET). Embryo thawing and transfer was planned 7 days after LH surge or hCG administration. For the AR-FET, oral estradiol valerate was administered from day 2 of menstrual cycle until endometrial thickness reached at least 7 mm and transfer was planned after 5 days of vaginal progesterone start. Only single vitrified blastocyst transfers were included. Results: In total 2,895 transfers were performed of which 561 (19.4%) carried out with NC-FET, 1,749 (60.4%) with mNC-FET and 585 (20.2%) with AR-FET. CPRs were 32.62, 43.05, and 37.26%, respectively. LBR were 24.06, 33.56, and 25.81%, respectively. A statistically significant (p < 0.001) higher LBR for mNC-FET vs. NC-FET (OR 0.49-0.78) and AR-FET (OR 0.47-0.74) was observed. A higher ectopic pregnancy rate (p = 0.002) was observed in NC-FET (3.28%) than in AR-FET (1.83%) and mNC-FET (0.40%). A higher abortion rate (p = 0.031) in pregnancies <12 weeks was observed in AR-FET (27.52%) than in NC-FET (19.67%) and in mNC-FET (19.39%). At Post hoc analysis only female age (OR 0.91-0.95), antimullerian hormone (AMH) (OR 1.01-1.07) and mNC-FET (OR 1.39-1.98) were statically significant prognostic factors for LBRs. Conclusions: These results demonstrate a superior CPR and LBR following FET in hCG-triggered ovulation cycles compared to NC and AR-FET, a higher ectopic pregnancy rate in NC-FET and a higher abortion rate in pregnancies <12 weeks in AR-FET. However, these data need to be confirmed in randomized and prospective studies before definitive conclusions can be drawn. Clinicaltrials.gov ID: NCT03581422.
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Affiliation(s)
- Paolo Emanuele Levi Setti
- Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Humanitas Clinical and Research Center (IRCCS), Milan, Italy
- *Correspondence: Paolo Emanuele Levi Setti
| | - Federico Cirillo
- Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Humanitas Clinical and Research Center (IRCCS), Milan, Italy
| | - Raffaella De Cesare
- Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Humanitas Clinical and Research Center (IRCCS), Milan, Italy
| | - Emanuela Morenghi
- Biostatistics Unit, Humanitas Clinical and Research Center (IRCCS), Milan, Italy
| | - Valentina Canevisio
- Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Humanitas Clinical and Research Center (IRCCS), Milan, Italy
| | - Camilla Ronchetti
- Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Humanitas Clinical and Research Center (IRCCS), Milan, Italy
| | - Annamaria Baggiani
- Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Humanitas Clinical and Research Center (IRCCS), Milan, Italy
| | - Antonella Smeraldi
- Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Humanitas Clinical and Research Center (IRCCS), Milan, Italy
| | - Elena Albani
- Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Humanitas Clinical and Research Center (IRCCS), Milan, Italy
| | - Pasquale Patrizio
- Yale University Fertility Center, New Haven, CT, USA
- Yale University Fertility Center, New Haven, CT, United States
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Lee MS, Hsu W, Huang HY, Tseng HY, Lee CT, Hsu CY, Shieh YC, Wang SH, Yao DJ, Liu CH. Simultaneous detection of two growth factors from human single-embryo culture medium by a bead-based digital microfluidic chip. Biosens Bioelectron 2019; 150:111851. [PMID: 31740257 DOI: 10.1016/j.bios.2019.111851] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/31/2019] [Accepted: 11/05/2019] [Indexed: 12/30/2022]
Abstract
The measurement of growth factors released in a culture medium is considered to be an attractive non-invasive approach, apart from the embryo morphology, to identify the condition of an embryo development after fertilization in vitro (IVF), but the available embryo culture medium in the current method is only a few microlitres. This small sample volume, also of small concentration, makes difficult the application of a conventional detection method, such as an enzyme-linked immunosorbent assay (ELISA). A reliable detection of the growth factor from each embryo culture medium of such a small concentration hence remains a challenge. Here for the first time we report the results of measurement of not just one, but two, growth factors, human IL-1β and human TNF-α, from an individual droplet of embryo culture medium with a bead-based digital microfluidic chip. The required sample volume for a single measurement is only 520 nL; the total duration of the on-chip process is less than 40 min. Using the culture media of human embryos with normal morphologic features, we found that the concentrations of TNF-α change little from day 3 to day 5-6, but the concentrations of IL-1β for some embryos might double from day 3 to day 5-6. For other embryos even with similar normal morphologic features, some growth factors, such as IL-1β, might exhibit different expressions during the culture period. Those growth factors could serve to distinguish the development conditions of each embryo, not merely from an observation of embryo morphology.
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Affiliation(s)
- Meng-Shiue Lee
- Department of Mechanical Engineering, National Chiao Tung University, Hsinchu, Taiwan
| | - Wensyang Hsu
- Department of Mechanical Engineering, National Chiao Tung University, Hsinchu, Taiwan.
| | - Hong-Yuan Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan; Department of Obstetrics and Gynecology, Chang Gung University College of Medicine, Tao-Yuan, Taiwan.
| | - Hsueh-Yang Tseng
- Department of Mechanical Engineering, National Chiao Tung University, Hsinchu, Taiwan
| | - Chia-Tung Lee
- Department of Mechanical Engineering, National Chiao Tung University, Hsinchu, Taiwan
| | - Chung-Yu Hsu
- Department of Mechanical Engineering, National Chiao Tung University, Hsinchu, Taiwan
| | - Yi-Chueh Shieh
- Department of Mechanical Engineering, National Chiao Tung University, Hsinchu, Taiwan
| | - Shih-Hung Wang
- Department of Mechanical Engineering, National Chiao Tung University, Hsinchu, Taiwan
| | - Da-Jeng Yao
- Institute of Nanoengineering and Microsystem, National Tsing Hua University, Hsinchu, Taiwan; Department of Power Mechanical Engineering, National Tsing Hua University, Hsinchu, Taiwan
| | - Cheng-Hsien Liu
- Department of Power Mechanical Engineering, National Tsing Hua University, Hsinchu, Taiwan
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Brännström M. Nordic light in assisted reproduction - let it keep shining. Acta Obstet Gynecol Scand 2019; 98:273-274. [PMID: 30801667 DOI: 10.1111/aogs.13554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Mats Brännström
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Stockholm IVF-EUGIN, Stockholm, Sweden
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Dobson SJA, Lao MT, Michael E, Varghese AC, Jayaprakasan K. Effect of transfer of a poor quality embryo along with a top quality embryo on the outcome during fresh and frozen in vitro fertilization cycles. Fertil Steril 2019; 110:655-660. [PMID: 30196962 DOI: 10.1016/j.fertnstert.2018.05.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 04/29/2018] [Accepted: 05/10/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate the impact of a poor quality embryo (PQE) during double ET (DET) with a top quality embryo (TQE) on IVF outcome. DESIGN A review of prospectively collected data. SETTING Tertiary level fertility clinic. PATIENT(S) All patients undergoing blastocyst transfers as part of fresh IVF (n = 939) and frozen ET (n = 1,009) cycles performed between 2010 and 2016. INTERVENTION(S) Single ET (SET) with TQE (group 1) was set as control and compared with outcomes for SET with PQE (group 2), DET with 2 TQEs (group 3), PQE plus TQE (group 4), and 2 PQE (group 5). MAIN OUTCOME MEASURE(S) Live births and multiple births. RESULT(S) The live birth rates for group 4 were statistically similar to group 1 during fresh IVF (26.5% vs. 33.7%; odds ratio [OR], 0.95; 95% confidence interval [CI] 0.53-1.7) and frozen ET (24.2% vs. 32.7%; OR, 0.75; 95% CI 0.48-1.2), although there was a trend for lower success. Conversely, multiple births were higher in group 4 for fresh IVF (19% vs. 4.7%; OR, 2.9; 95% CI 1.3-6.6) and frozen ET (10.3% vs. 2.6%; OR, 2.4; 95% CI 1.2-4.9). The live birth rates for group 2 (12.2% for fresh IVF and 14.6% for frozen ET) and group 5 (21.2% for fresh IVF and 14% for frozen ET) were lower and for group 3 were higher (40.8% for fresh IVF and 40.3% for frozen ET) when compared with group 1. Multiple births were significantly higher with DET. CONCLUSION(S) This study does not support DET with one PQE along with a TQE, when there is only one TQE and one or more PQEs available for fresh IVF or frozen ET.
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Affiliation(s)
| | | | - Essam Michael
- ASTRA Fertility Clinic, Mississauga, Ontario, Canada
| | | | - Kannamannadiar Jayaprakasan
- Department of Obstetrics and Gynaecology, Royal Derby Hospital, Derby, United Kingdom; Division of Obstetrics and Gynaecology, University of Nottingham, Nottingham, United Kingdom.
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Tiitinen A. Single embryo transfer: Why and how to identify the embryo with the best developmental potential. Best Pract Res Clin Endocrinol Metab 2019; 33:77-88. [PMID: 31005505 DOI: 10.1016/j.beem.2019.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Multiple pregnancies with higher risk of preterm birth and the associated higher morbidity have been a major obstacle from the early days of in vitro fertilization. A good strategy to avoid multiple pregnancies is elective single embryo transfer and cryopreservation of spare embryos. Important factors in adopting this strategy are good counselling of the patients and the selection of embryos with high implantation potential. Technical advances in embryo selection have been described during recent years, time lapse monitoring and genetic assessment of the embryos being the most important achievements. With these studies we have gained new information on early embryos. However, at present, there is insufficient evidence to recommend the routine use of these new techniques. The ultimate goal of infertility treatment is a healthy baby.
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Affiliation(s)
- Aila Tiitinen
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, FI-00029 Helsinki, Finland.
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22
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Berkhout RP, Vergouw CG, van Wely M, de Melker AA, Schats R, Repping S, Hamer G, Mastenbroek S, Lambalk CB. The addition of a low-quality embryo as part of a fresh day 3 double embryo transfer does not improve ongoing pregnancy rates. Hum Reprod Open 2017; 2017:hox020. [PMID: 30895234 PMCID: PMC6276645 DOI: 10.1093/hropen/hox020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/14/2017] [Accepted: 10/17/2017] [Indexed: 01/19/2023] Open
Abstract
STUDY QUESTION Does the addition of a low-quality embryo in fresh Day 3 double embryo transfer (DET) affect the ongoing pregnancy rate (OPR) and multiple gestation rate in patients with only one or no high-quality embryos available? SUMMARY ANSWER In patients with only one- or no high-quality embryo available, the addition of a low-quality embryo in fresh Day 3 DET does not improve the OPR but increases multiple gestation rates in fresh DET. WHAT IS KNOWN ALREADY Pregnancy rates after DET are considered to be higher compared to single embryo transfer (SET) when analyzed per first embryo transfer only. However, these conclusions are based on RCTs in which mostly patients with two or more high-quality embryos were included, and can therefore not be applied to patients with only one or no high-quality embryo available. This is particularly relevant since it has been suggested that low-quality embryos could impair the implantation of simultaneously transferred embryos by paracrine signaling. Hence, we investigated in patients with only one or no high-quality embryo available whether the addition of a low-quality embryo in DET affects the OPR, multiple gestation rate and miscarriage rate. STUDY DESIGN SIZE DURATION This was a retrospective cohort study of 5050 patients receiving 7252 fresh embryo transfers on Day 3 after fertilization in IVF/ICSI cycles from 2012 to 2015 in two academic hospitals. PARTICIPANTS/MATERIALS SETTING METHODS We included all women that received fresh SET or DET with any combination of high-quality embryos (7, 8 or 9 blastomeres, with equal to or <20% fragmentation) or low-quality embryos (all other embryos). Outcomes were OPR (primary outcome, defined as a positive fetal heartbeat by transvaginal ultrasound at least 10 weeks after oocyte retrieval), miscarriage rate and multiple gestation rate. We used a generalized estimating equations model adjusting for maternal age, number of oocytes retrieved, center of treatment and the interaction between maternal age and number of oocytes retrieved. Other baseline characteristics, including infertility diagnosis, fertilization method and the number of consecutive fresh embryo transfers per patient, did not contribute significantly to the GEE model and were therefore excluded, and not adjusted for. MAIN RESULTS AND THE ROLE OF CHANCE Compared to SET with one high-quality embryo, DET with two high-quality embryos resulted in a higher OPR (adjusted odds ratio (OR) 1.38, 95% CI 1.14-1.67), while DET with one high- and one low-quality embryo resulted in a lower OPR (adjusted OR 0.65, 95% CI 0.49-0.90). However, SET in patients with only one high-quality embryo available resulted in a lower OPR compared to SET in patients with two or more high-quality embryos available (adjusted OR 0.52, 95% CI 0.39-0.70). After adjusting for this confounding factor, we found that both DET with two high-quality embryos (adjusted OR 0.99, 95% CI 0.74-1.31) and DET with one high- and one low-quality embryo (adjusted OR 0.78, 95% CI 0.47-1.27) resulted in a not significantly different OPR compared to SET with one high-quality embryo. If only low-quality embryos were available, DET did not increase the OPR as compared to SET with one low-quality embryo (adjusted OR 0.84, 95% CI 0.55-1.28). Multiple gestation rates were higher in all DET groups compared to SET (DET with ≥1 high-quality embryo(s) compared to SET with one high-quality embryo; DET with two low-quality embryos compared to SET with one low-quality embryo; all comparisons P < 0.001). Miscarriage rates were not different in all DET groups compared to SET (DET with ≥1 high-quality embryo(s) compared to SET with one high-quality embryo; DET with two low-quality embryos compared to SET with one low-quality embryo; all comparisons P > 0.05). LIMITATIONS REASONS FOR CAUTION Limitations to this study include the retrospective design and possible bias between study groups related to embryo transfer policies between 2012 and 2015. Consequently, we may have underestimated pregnancy chances in all DET groups. Furthermore, the OPR was calculated as a percentage of the number of fresh embryo transfers in each study group, and not the total number of started IVF/ICSI cycles. Therefore, the reported pregnancy outcomes may not truly reflect the pregnancy chances of couples at the start of treatment. A possible confounding effect of maternal age in our study is acknowledged but we could not compare clinical outcomes in different age groups separately owing to small sample sizes. Analysis of pregnancy outcomes in lower prognosis patients (higher maternal age, fewer oocytes retrieved) separately is an avenue for future research. WIDER IMPLICATIONS OF THE FINDINGS The decision to perform DET rather than SET in order to increase the OPR per fresh embryo transfer seems not to be justified for those patients with only one or no high-quality embryo(s) available. However, owing to the limitations of this study, prospective RCTs are needed that specifically investigate pregnancy outcomes in patients with only one or no high-quality embryo(s) available in SET and DET. STUDY FUNDING/COMPETING INTERESTS This study was funded by a grant from the joint Amsterdam Reproduction & Development Institute of the Academic Medical Center and VU University Medical Center (www.amsterdam-reproduction-and-development.org). The authors have no conflicts of interest to declare.
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Affiliation(s)
- R P Berkhout
- Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, VU University Medical Center, 1081 HV Amsterdam, The Netherlands
| | - C G Vergouw
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, VU University Medical Center, 1081 HV Amsterdam, The Netherlands
| | - M van Wely
- Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - A A de Melker
- Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - R Schats
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, VU University Medical Center, 1081 HV Amsterdam, The Netherlands
| | - S Repping
- Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - G Hamer
- Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - S Mastenbroek
- Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - C B Lambalk
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, VU University Medical Center, 1081 HV Amsterdam, The Netherlands
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Omani Samani R, Almasi-Hashiani A, Vesali S, Shokri F, Cheraghi R, Torkestani F, Sepidarkish M. Tehran Survey of Potential Risk Factors for Multiple Births. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2017; 11:220-225. [PMID: 28868845 PMCID: PMC5582151 DOI: 10.22074/ijfs.2017.4700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 10/17/2016] [Indexed: 11/04/2022]
Abstract
Background The multiple pregnancy incidence is increasing worldwide. This increased incidence is concerning to the health care system. This study aims to determine the frequency of multiple pregnancy and identify factors that affect this frequency in Tehran, Iran. MATERIALS AND METHODS This cross-sectional study included 5170 mothers in labor between July 6-21, 2015 from 103 hospitals with Obstetrics and Gynecology Wards. The questionnaire used in this study consisted of five parts: demographic characteristics; information related to pregnancy; information related to the infant; information regarding the multiple pregnancy; and information associated with infertility. We recruited 103 trained midwives to collect data related to the questionnaire from eligible participants through an interview and medical records review. Frequencies and odds ratios (OR) for the association between multiple pregnancy and the selected characteristics (maternal age, economic status, history of multiple pregnancy in first-degree relatives, and reproductive history) were computed by multiple logistic regression. Stata software, version 13 (Stata Corp, College Station, TX, USA) was used for all statistical analyses. RESULTS Multiple pregnancy had a prevalence of 1.48% [95% confidence interval (CI): 1.19-1.85]. After controlling for confounding variables, we observed a significant association between frequency of multiple pregnancy and mother's age (OR=1.04, 95% CI: 1.001-1.09, P=0.044), assisted reproductive technique (ART, OR=6.11, 95% CI: 1.7- 21.97, P=0.006), and history of multiple pregnancy in the mother's family (OR=5.49, 95% CI: 3.55-9.93, P=0.001). CONCLUSION The frequency of multiple pregnancy approximated results reported in previous studies in Iran. Based on the results, we observed significantly greater frequency of multiple pregnancy in older women, those with a history of ART, and a history of multiple pregnancy in the mother's family compared to the other variables.
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Affiliation(s)
- Reza Omani Samani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Samira Vesali
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Fatemeh Shokri
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Rezvaneh Cheraghi
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Farahnaz Torkestani
- Department of Obstetrics and Gynecology, Shahed University of Medical Sciences, Tehran, Iran
| | - Mahdi Sepidarkish
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.
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Sundhararaj UM, Madne MV, Biliangady R, Gurunath S, Swamy AG, Gopal IS. Single Blastocyst Transfer: The Key to Reduce Multiple Pregnancy Rates Without Compromising the Live Birth Rate. J Hum Reprod Sci 2017; 10:201-207. [PMID: 29142449 PMCID: PMC5672726 DOI: 10.4103/jhrs.jhrs_130_16] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Historically, to achieve higher pregnancy rates, multiple embryos were transferred after an in-vitro fertilisation (IVF). However, this practice is being reassessed, because it leads to multiple pregnancies that is known to cause adverse maternal and fetal outcomes. AIM To compare the pregnancy outcomes in fresh IVF or intracytoplasmic sperm injection (ICSI) cycles among women undergoing elective single blastocyst transfer (eSBT) vs. those undergoing double blastocyst transfer (DBT). SETTINGS AND DESIGN It is a retrospective data analysis of 582 patients undergoing fresh IVF/ICSI cycles performed from January 2012 to June 2015. MATERIALS AND METHODS Patients, who underwent IVF/ICSI and developed more than one blastocyst, were included in the study. Donor cycles were excluded from the study. All the embryos were cultured to blastocyst stage in sequential media followed by transfer of two blastocysts (DBT) or eSBT and cryopreservation of the remaining. STATISTICAL ANALYSIS Statistical analysis was performed using chi square test. RESULTS Out of 582 patients, in 149 patients one blastocyst was transferred and in 433 patients two blastocysts were transferred. There was no statistical difference in the biochemical pregnancy rate, clinical pregnancy rate and live birth rate in both the groups. Statistics demonstrated a significant drop in miscarriage rate in eSBT group. There was no incidence of twins in eSBT group, whereas twin birth rate per clinical pregnancy was 29.02% in DBT group. CONCLUSION Single blastocyst transfer is an effective method to reduce the risk of multiple births without compromising the pregnancy outcomes. Given the promising potential of vitrification; the remaining blastocyst can be cryopreserved.
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Affiliation(s)
| | - Monali V. Madne
- Fertility Unit, Cloudnine Hospitals, Bangalore, Karnataka, India
| | - Reeta Biliangady
- Fertility Unit, Cloudnine Hospitals, Bangalore, Karnataka, India
| | - Sumana Gurunath
- Fertility Unit, Cloudnine Hospitals, Bangalore, Karnataka, India
| | - Ambika G. Swamy
- Fertility Unit, Cloudnine Hospitals, Bangalore, Karnataka, India
| | - Indu S.T. Gopal
- Fertility Unit, Cloudnine Hospitals, Bangalore, Karnataka, India
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Stamenov GS, Parvanov DA, Chaushev TA. Mixed double-embryo transfer: A promising approach for patients with repeated implantation failure. Clin Exp Reprod Med 2017; 44:105-110. [PMID: 28795050 PMCID: PMC5545218 DOI: 10.5653/cerm.2017.44.2.105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 04/08/2017] [Accepted: 05/17/2017] [Indexed: 11/11/2022] Open
Abstract
Objective The purpose of this study was to evaluate the efficacy of frozen mixed double-embryo transfer (MDET; the simultaneous transfer of day 3 and day 5 embryos) in comparison with frozen blastocyst double-embryo transfer (BDET; transfer of two day 5 blastocysts) in patients with repeated implantation failure (RIF). Methods A total of 104 women with RIF who underwent frozen MDET (n=48) or BDET (n=56) with excellent-quality embryos were included in this retrospective analysis. All frozen embryo transfers were performed in natural cycles. The main outcome measures were the implantation rate, clinical pregnancy rate, multiple pregnancy rate, and miscarriage rate. These measures were compared between the patients who underwent MDET or BDET using the chi-square test or the Fisher exact test, as appropriate. Results The implantation and clinical pregnancy rates were significantly higher in patients who underwent MDET than in those who underwent BDET (60.4% vs. 39.3%, p=0.03 and 52.1% vs. 30.4%, p=0.05, respectively). A significantly lower miscarriage rate was observed in the MDET group (6.9% vs. 10.7%, p=0.05). In addition, the multiple pregnancy rate was slightly, but not significantly, higher in the MDET group (27.1% vs. 25.0%). Conclusion MDET was found to be significantly superior to double blastocyst transfer. It could be regarded as an appropriate approach to improve in vitro fertilization success rates in RIF patients.
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Gatimel N, Ladj M, Teston C, Lesourd F, Fajau C, Cohade C, Parinaud J, Léandri RD. How many embryos should be transferred? A validated score to predict ongoing implantation rate. Eur J Obstet Gynecol Reprod Biol 2017; 212:30-36. [DOI: 10.1016/j.ejogrb.2017.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 11/23/2016] [Accepted: 03/07/2017] [Indexed: 10/20/2022]
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Kushnir VA, Barad DH, Albertini DF, Darmon SK, Gleicher N. Systematic review of worldwide trends in assisted reproductive technology 2004-2013. Reprod Biol Endocrinol 2017; 15:6. [PMID: 28069012 PMCID: PMC5223447 DOI: 10.1186/s12958-016-0225-2] [Citation(s) in RCA: 188] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 12/21/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Assisted Reproductive Technology (ART) has undergone considerable changes over the last decade, with consequences on ART outcomes in different regions of the world being unknown. METHODS We conducted a systematic review of published national and regional ART registry data to assess how changes in clinical practice between 2004 and 2013 have impacted outcomes in Australia and New Zealand, Canada, Continental Europe, the United Kingdom (U.K.), Japan, Latin America, and the United States (U.S.). The data reflect 7,079,145 total ART cycles utilizing both fresh and previously cryopreserved embryos from autologous oocytes that resulted in 1,454,724 live births. This review focused on the following measures: ART cycle volume, use of cryopreserved embryos, single embryo transfer (SET), live birth rates in fresh and frozen-thawed cycles, and perinatal outcomes in recent years. RESULTS SETs and utilization of frozen-thawed embryos increased worldwide over the study period. In 2012 SET utilization in all ART cycles was highest in Japan and Australia/New Zealand (82.6% and 76.3% respectively) and lowest in Latin America (16.0%). While gradual improvements in live birth rates were observed in most regions, some demonstrated declines. By 2012-2013, fresh cycle live birth rates were highest in the U.S. (29%) and lowest in Japan (5%). In Japan, the observed decline in fresh cycle live birth rate coincided with transition to minimal stimulation protocols, transfer of frozen-thawed rather than fresh embryos, and implementation of an SET policy. Similarly, implementation of an SET policy in parts of Canada was followed by a decline in fresh cycle live birth rate. Increasing live birth rates in frozen-thawed embryo cycles, seen all over the world, partially compensated for declines in fresh ART cycles. During 2012-2013 Australia/New Zealand and Japan reported the lowest multiple delivery rates of 5.6 and 4% respectively while the US had the highest of 27%. In recent years, preterm delivery rates in all regions ranged between 9.0 to 16.6% for singletons, 53.9 to 67.3% for twins, and 91.4 to 100% for triplets and higher order multiples. Inconsistencies in the way perinatal outcome data are presented by various registries, made comparison between regions difficult. CONCLUSIONS ART practices are characterized by outcome differences between regions. International consensus on the definition of ART success, which accounts for perinatal outcomes, may help to standardize worldwide ART practice and improve outcomes. TRIAL REGISTRATION PROSPERO ( CRD42016033011 ).
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Affiliation(s)
- Vitaly A. Kushnir
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- Wake Forest School of Medicine, Winston-Salem, NC USA
| | - David H. Barad
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- Foundation for Reproductive Medicine, New York, NY USA
| | - David F. Albertini
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- University of Kansas Medical Center, Kansas City, KS USA
- The Rockefeller University, New York, NY USA
| | - Sarah K. Darmon
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
| | - Norbert Gleicher
- The Center for Human Reproduction, 21 East 69th Street, New York, NY 10021 USA
- Foundation for Reproductive Medicine, New York, NY USA
- University of Vienna School of Medicine, Vienna, Austria
- The Rockefeller University, New York, NY USA
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Márton V, Zádori J, Kozinszky Z, Keresztúri A. Prevalences and pregnancy outcome of vanishing twin pregnancies achieved by in vitro fertilization versus natural conception. Fertil Steril 2016; 106:1399-1406. [PMID: 27565251 DOI: 10.1016/j.fertnstert.2016.07.1098] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/07/2016] [Accepted: 07/18/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate whether vanishing twin (VT) pregnancies achieved by in vitro fertilization and intracytoplasmic sperm injection (IVF-ICSI) had a more adverse perinatal outcome than those after natural conception. DESIGN Longitudinal, retrospective cohort study. SETTING Tertiary university hospital. PATIENT(S) Three hundred and six (78 after IVF-ICSI and 228 after natural conception) VT pregnancies over a 22-year period, with VT cases matched to primarily singleton controls. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Obstetric and neonatal outcome data. RESULT(S) The incidence of VT was statistically significantly higher after natural conception (18.2% of twins) than after IVF-ICSI (12.6% of twins). The odds of VT in pregnancies complicated with pregestational or gestational diabetes were disproportionally higher in IVF-ICSI cases than in spontaneously conceived VT pregnancies (adjusted odds ratio [AOR]: 0.80 vs. 3.10 and 1.00 vs. 1.07, respectively). Previous induced abortion (AOR 1.34) or second-trimester fetal loss (AOR 3.3) increased the risk of VT pregnancies after spontaneous conception. Gestational diabetes mellitus in both the previous (AOR 5.41) and the present (AOR 2.3) pregnancy as well as chronic maternal diseases (AOR 3.5) and placentation anomalies all represented independent risk factors for VT after IVF-ICSI. CONCLUSION(S) Vanishing twin pregnancies had a lower prevalence and a worse perinatal outcome after IVF-ICSI as compared with those of their spontaneously conceived counterparts.
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Affiliation(s)
- Virág Márton
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary.
| | - János Zádori
- Center for Assisted Reproduction, Kaáli Institute, University of Szeged, Szeged, Hungary
| | - Zoltan Kozinszky
- Department of Obstetrics and Gynecology, Blekinge Hospital, Karlskrona, Sweden
| | - Attila Keresztúri
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary
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Zhang T, He Y, Wang Y, Zhu Q, Yang J, Zhao X, Sun Y. The role of three-dimensional power Doppler ultrasound parameters measured on hCG day in the prediction of pregnancy during in vitro fertilization treatment. Eur J Obstet Gynecol Reprod Biol 2016; 203:66-71. [DOI: 10.1016/j.ejogrb.2016.05.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/10/2016] [Accepted: 05/13/2016] [Indexed: 11/25/2022]
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Lee AM, Connell MT, Csokmay JM, Styer AK. Elective single embryo transfer- the power of one. Contracept Reprod Med 2016; 1:11. [PMID: 29201400 PMCID: PMC5693485 DOI: 10.1186/s40834-016-0023-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 05/11/2016] [Indexed: 11/15/2022] Open
Abstract
Despite the highest historical live birth success rates for couples undergoing in vitro fertilization (IVF), there has been an epidemic of iatrogenic twin and higher order gestation conceived from this treatment. Continued improvement in cryopreservation techniques have allowed preservation of supernumerary embryos for use in future cycles, and refinements in culture systems and embryo selection have resulted in the transfer of fewer embryos while maintaining favorable pregnancy rates. The voluntary transfer of a single high quality embryo, elective single embryo transfer (eSET), has significantly reduced multiple gestation rates and maximized the rate of singleton pregnancy without compromising overall success rates. Although eSET is the standard of care in several developed countries, utilization in the United States has been slow. States with mandated IVF insurance have seen decreases in preterm birth rates yielding down stream health care savings. Herein, the evolution and future applications of this practice to reduce the risk of iatrogenic twins is reviewed.
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Affiliation(s)
- Amy M Lee
- Massachusetts General Hospital Fertility Center, Vincent Memorial Obstetrics and Gynecology Service and Harvard Medical School, Boston, MA 02114 USA.,Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA 02114 USA
| | - Matthew T Connell
- Walter Reed Army Medical Center, Washington, DC USA.,Program in Reproductive and Adult Endocrinology, NICHD, National Institutes of Health, Bethesda, MD USA
| | - John M Csokmay
- Walter Reed Army Medical Center, Washington, DC USA.,Program in Reproductive and Adult Endocrinology, NICHD, National Institutes of Health, Bethesda, MD USA
| | - Aaron K Styer
- Massachusetts General Hospital Fertility Center, Vincent Memorial Obstetrics and Gynecology Service and Harvard Medical School, Boston, MA 02114 USA.,Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA 02114 USA.,Vincent Reproductive Medicine and IVF, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Yaw 10A, 55 Fruit Street, Boston, MA 02114 USA
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Letrozole versus artificial hormonal endometrial preparation for vitrified–warmed embryos transfer cycles. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2016. [DOI: 10.1016/j.mefs.2015.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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The effect on pregnancy and multiples of transferring 1-3 embryos in women at least 40 years old. J Assist Reprod Genet 2016; 33:1195-202. [PMID: 27245848 DOI: 10.1007/s10815-016-0749-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 05/23/2016] [Indexed: 12/16/2022] Open
Abstract
UNLABELLED PURPOSE "CAPSULE" IS MANDATORY. PLEASE PROVIDE.SINGLE EMRBYO TRANSFER (SET) IN WOMEN ≥40 YEARS OLD APPEARS TO LOWER THE CHANCE OF A PREGNANCY. HOWEVER, IT MINIMIZES THE RISK OF MULTIPLE PREGNANCIES EVEN IN WOMEN OF ADVANCED MATERNAL AGE. THEREFORE, WOMEN 40 YEARS OF AGE OR OLDER SHOULD BE OFFERED (SET).: This study was performed to investigate the multiple pregnancies and live birth rates when 1-3 embryos are transferred at this age in women at least 40 years of age. METHOD A retrospective analysis of data which included 631 women aged 40 to 46 years, who underwent 901 cycles of IVF, from August 2010 to June 2012 was undertaken. These women underwent embryo transfer of 1-3 non-donor fresh embryo(s). RESULTS Results suggested that the average pregnancy rate when up to three embryos were transferred was 25 % for women 40 years old, 20 % for women 41 years old, 16 % for women 42 years old, 17 % for women 43 years old, 8 % for women 44 years old, 6 % for women 45 years old, and 0 % for women 46 years old. No live births occurred in women treated after their 44th birthday, and only patients younger than 42 years of age receiving double embryo transfer had a live birth of twins. Live birth rates increased as more embryos were transferred for 40- and 42-year-old subjects (p = 0.01 and 0.05, respectively). CONCLUSIONS From these results, it was concluded that SET in women ≥40 years old appears to lower the chance of a pregnancy. However, it minimizes the risk of multiple pregnancies even in women of advanced maternal age. Women 40 years of age or older should be offered single-embryo transfer. Further studies are needed to determine risk of multiple pregnancies in women 42 years of age or older when few embryos are transferred. Decisions on the number of embryos to transfer should be on a case by case basis, in discussion with the patient.
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Sahraravand M, Laitinen P, Järvelä I, Ryynänen M. First-trimester maternal serum ADAM12-s and PAPP-A levels are altered in pregnancies conceived after assisted reproduction techniques (ART). Prenat Diagn 2016; 36:163-9. [DOI: 10.1002/pd.4764] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 12/02/2015] [Accepted: 12/19/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Maarit Sahraravand
- Department of Obstetrics and Gynecology; Oulu University Hospital; Oulu Finland
| | - Päivi Laitinen
- Clinical Chemistry and Haematology; HUSLAB, Helsinki University Hospital; Helsinki Finland
| | - Ilkka Järvelä
- Department of Obstetrics and Gynecology; Oulu University Hospital; Oulu Finland
| | - Markku Ryynänen
- Department of Obstetrics and Gynecology; Oulu University Hospital; Oulu Finland
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Griesinger G. Beware of the 'implantation rate'! Why the outcome parameter 'implantation rate' should be abandoned from infertility research. Hum Reprod 2016; 31:249-51. [PMID: 26724801 DOI: 10.1093/humrep/dev322] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 11/27/2015] [Indexed: 11/14/2022] Open
Affiliation(s)
- G Griesinger
- Department of Reproductive Medicine and Gynecological Endocrinology, University Clinic of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
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Vaidya A, Stafinski T, Nardelli A, Motan T, Menon D. Assisted Reproductive Technologies in Alberta: An Economic Analysis to Inform Policy Decision-Making. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:1122-30. [PMID: 26637087 DOI: 10.1016/s1701-2163(16)30080-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Regulation and public funding of assisted reproductive technologies (ARTs) vary across the Canadian provinces. In Alberta, neither of these exists. We conducted this study to evaluate the cost effectiveness and budget impact of providing ARTs in Alberta under three different policy scenarios (a "restrictive" policy, a policy based on Quebec's model, and a "permissive" policy) in comparison with the status quo. METHODS To predict the cost effectiveness and budget impact of three policy options for publicly funded ARTs in Alberta, we developed an economic model by combining a state transition Markov model and a decision tree. The primary outcome was cost per healthy singleton. Probabilistic and one-way sensitivity analyses were conducted. RESULTS The restrictive policy was the most cost effective option for two subgroups of age (< 35 years and 35 to 39 years), while the Quebec policy option was most cost-effective for the ≥ 40 years subgroup. Budget impact analysis extending up to the age of 18 years for the children in the model showed the cost savings of $8.33 million for the restrictive policy for the < 35 years subgroup. For the ≥ 40 years subgroup, the Quebec policy option resulted in total cost savings of $3.75 million. Sensitivity analyses showed that the model results were robust. CONCLUSION This economic modelling study shows that publicly funded and scientifically regulated ARTs could provide treatment access and save health care expenditures for the province.
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Affiliation(s)
- Anil Vaidya
- Health Technology and Policy Unit, School of Public Health, University of Alberta, Edmonton AB
| | - Tania Stafinski
- Health Technology and Policy Unit, School of Public Health, University of Alberta, Edmonton AB
| | - Alexa Nardelli
- Health Technology and Policy Unit, School of Public Health, University of Alberta, Edmonton AB
| | - Tarek Motan
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Alberta, Edmonton AB
| | - Devidas Menon
- Health Technology and Policy Unit, School of Public Health, University of Alberta, Edmonton AB
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Dupont C, Hafhouf E, Sermondade N, Sellam O, Herbemont C, Boujenah J, Faure C, Levy R, Poncelet C, Hugues J, Cedrin-Durnerin I, Sonigo C, Grynberg M, Sifer C. Delivery rates after elective single cryopreserved embryo transfer related to embryo survival. Eur J Obstet Gynecol Reprod Biol 2015; 188:6-11. [DOI: 10.1016/j.ejogrb.2015.02.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 12/31/2014] [Accepted: 02/19/2015] [Indexed: 10/23/2022]
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Cumulative live birth rate after two single frozen embryo transfers (eSFET) versus a double frozen embryo transfer (DFET) with cleavage stage embryos: a retrospective cohort study. J Assist Reprod Genet 2014; 31:1621-7. [PMID: 25267163 DOI: 10.1007/s10815-014-0346-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 09/09/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE According to the latest ART report for Europe, about 13% of pregnancies after frozen embryo transfer are multiple. Our objective was to analyse the impact on the multiple pregnancy rate of two eSFET (elective single frozen embryo transfers) versus a DFET (double frozen embryo transfer) in women aged under 38 years, who had not achieved pregnancy in their fresh transfer and who had at least two vitrified embryos of A/B quality. METHODS This study was conducted from January 2010 to June 2013 at a public hospital. The couples were divided into three groups. Group DFET: the first cryotransfer of two embryos (105 women); cSFET group: the only cryotransfer of a single vitrified embryo (60 women); eSFET group, individually vitrified embryos: 20 patients included in a clinical trial of single-embryo fresh and frozen transfer and 21 patients who chose to receive eSFET. RESULTS The clinical pregnancy rate was 38.1% in the DET group and the cumulative clinical pregnancy rate was 43.3% in the eSFET group. There were no significant differences between the DFET and eSFET groups (30.0 vs 34.1%) in cumulative live birth delivery rate. The rate of multiple pregnancies varied significantly between the DFET and eSFET groups (32.5 vs 0%, p < 0.05). CONCLUSIONS For good-prognosis women aged under 38 years, taking embryo quality as a criterion for inclusion, an eSFET policy can be applied, achieving acceptable cumulative clinical pregnancy and live birth rates and reducing multiple pregnancy rates.
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Jarvela IY, Pelkonen S, Uimari O, Makikallio K, Puukka K, Ruokonen A, Tekay A, Martikainen H. Controlled ovarian hyperstimulation leads to high progesterone and estradiol levels during early pregnancy. Hum Reprod 2014; 29:2393-401. [DOI: 10.1093/humrep/deu223] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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López-Regalado ML, Clavero A, Gonzalvo MC, Serrano M, Martínez L, Mozas J, Rodríguez-Serrano F, Fontes J, Castilla JA. Randomised clinical trial comparing elective single-embryo transfer followed by single-embryo cryotransfer versus double embryo transfer. Eur J Obstet Gynecol Reprod Biol 2014; 178:192-8. [DOI: 10.1016/j.ejogrb.2014.04.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/22/2014] [Accepted: 04/08/2014] [Indexed: 11/25/2022]
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Shuai HL, Ye Q, Huang YH, Xie BG. Comparison of conventionalin vitrofertilisation and intracytoplasmic sperm injection outcomes in patients with moderate oligoasthenozoospermia. Andrologia 2014; 47:499-504. [PMID: 24811903 DOI: 10.1111/and.12291] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2014] [Indexed: 11/26/2022] Open
Affiliation(s)
- H.-L. Shuai
- Department of Obstetrics and Gynecology; the First Affiliated Hospital of Jinan University; Guangzhou China
| | - Q. Ye
- Department of Obstetrics and Gynecology; Pingxiang People's Hospital; Pingxiang China
| | - Y.-H. Huang
- Reproductive Medicine Center; the Affiliated Hospital of Hainan Medical College; Haikou China
| | - B.-G. Xie
- Reproductive Medicine Center; the Affiliated Hospital of Hainan Medical College; Haikou China
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Peeraer K, Debrock S, Laenen A, De Loecker P, Spiessens C, De Neubourg D, D'Hooghe TM. The impact of legally restricted embryo transfer and reimbursement policy on cumulative delivery rate after treatment with assisted reproduction technology. Hum Reprod 2013; 29:267-75. [PMID: 24282120 DOI: 10.1093/humrep/det405] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What is the impact of the Belgian legislation (1 July 2003), coupling reimbursement of six assisted reproduction technology (ART) cycles per patient to restricted embryo transfer policy, on cumulative delivery rate (CDR) per patient? SUMMARY ANSWER The introduction of Belgian legislation in ART had no negative impact on the CDR per patient based on realistic estimates within six cycles or 36 months. WHAT IS KNOWN ALREADY The introduction of Belgian legislation limiting the number of embryos for transfer resulted in a reduction of the multiple pregnancy rate (MPR) per cycle by 50%. STUDY DESIGN, SIZE, DURATION A retrospective cohort study with a study group after implementation of the new ART legislation (July 2003 to June 2006) and the control group, before legislation (July 1999 to June 2002). PARTICIPANTS/MATERIALS, SETTING, METHODS CDR was compared in an academic tertiary setting between a study group after legislation (n = 795 patients, 1927 fresh and 383 frozen-thawed embryo transfer (FET) cycles) and a control group before legislation (n = 463 patients, 876 fresh and 185 FET cycles) within six cycles or 36 months, delivery or discontinuation of treatment. The CDR was estimated using life table analysis considering pessimistic, optimistic and realistic scenarios and compared after adjustment for confounding variables. In the realistic scenario we included information on embryo quality to define the prognosis of each patient discontinuing treatment. MAIN RESULTS AND THE ROLE OF CHANCE In the realistic scenario, CDR within 36 months was comparable (all ages, P = 0.221) in study group (60.8%) and control group (65.6%), as well as in different age groups (<36 years, P = 0.242; 36-39 years, P = 0.851; 40-42 years, P = 0.840). In the realistic scenario applied to six cycles, we found lower CDRs in the study group than in the control group within the two first cycles (all ages, P = 0.009; <36 years, P = 0.007) but no difference in CDRs between the two groups within the four subsequent cycles (all ages P = 0.232; <36 years, P = 0.198). The CDR within six cycles was 60 and 65.3% for study group and control group, respectively, for all ages, and 65.8 and 70.4%, respectively, in the subgroup younger than 36 years. In women ≥36 years, CDR within six cycles was comparable in both groups (36-39 years, 43% in study versus 44.4% in control group, P = 0.730; 40-42 years, 21% in study versus 23% in control group, P = 0.786). LIMITATIONS, REASONS FOR CAUTION A retrospective cohort study design was the only way to study the impact of legislation on CDR. Owing to the retrospective nature of this analysis over a long period of time, our data are potentially influenced by improvements in techniques and therefore improved success rates in ART over time. WIDER IMPLICATIONS OF THE FINDINGS This 'Belgian model' can now be considered for application worldwide in countries with the aim to reduce the main ART side effect (high MPR) and its associated costs without a negative effect on the main intended effect (high CDR). STUDY FUNDING/COMPETING INTEREST(S) The authors have no conflict of interest to declare. No funding was obtained for this study.
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Affiliation(s)
- K Peeraer
- Leuven University Fertility Center, UZ Leuven Campus Gasthuisberg, 3000 Leuven, Belgium and
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Xie BG, Huang YH, Zhu WJ, Jin S. Comparison of the Outcome of Conventional in vitro Fertilization and Intracytoplasmic Sperm Injection in Moderate Male Infertility from Ejaculate. Urol Int 2013; 94:111-6. [DOI: 10.1159/000353975] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 06/25/2013] [Indexed: 11/19/2022]
Abstract
Objective: To evaluate whether couples with moderate male infertility should be treated with conventional in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Patients and Methods: A total of 249 couples with moderate male infertility undergoing their first IVF/ICSI cycle were enrolled in the study. The couples were divided into two groups according to the results of semen analysis: moderate oligozoospermia (O group) and moderate oligoasthenozoospermia (OA group). Sibling oocytes were randomized into groups to be inseminated either by conventional IVF or ICSI. Fertilization rate, embryo quality, implantation rate, and clinical pregnancy rate were examined. Results: There was no difference in the fertilization, implantation, and pregnancy rates between conventional IVF and ICSI in either the O group or OA group (p > 0.05). Additionally, in the OA group, the good quality embryo rate was similar after IVF or ICSI (p > 0.05). However, in the O group, the good quality embryo rate was significantly higher after ICSI than after IVF (p < 0.05). Conclusions: Couples with moderate oligozoospermia or moderate oligoasthenozoospermia did not influence the major indices of IVF. Because of the uncertainties concerning the safety of ICSI, couples with moderate oligozoospermia or moderate oligoasthenozoospermia need not be subjected to this procedure.
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Van den Abbeel E, Balaban B, Ziebe S, Lundin K, Cuesta MJG, Klein BM, Helmgaard L, Arce JC. Association between blastocyst morphology and outcome of single-blastocyst transfer. Reprod Biomed Online 2013; 27:353-61. [DOI: 10.1016/j.rbmo.2013.07.006] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 07/05/2013] [Accepted: 07/09/2013] [Indexed: 11/15/2022]
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Umranikar A, Parmar D, Davies S, Fountain S. Multiple births following in vitro fertilization treatment: redefining success. Eur J Obstet Gynecol Reprod Biol 2013; 170:299-304. [DOI: 10.1016/j.ejogrb.2013.06.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 03/13/2013] [Accepted: 06/24/2013] [Indexed: 11/29/2022]
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Pandian Z, Marjoribanks J, Ozturk O, Serour G, Bhattacharya S. Number of embryos for transfer following in vitro fertilisation or intra-cytoplasmic sperm injection. Cochrane Database Syst Rev 2013; 2013:CD003416. [PMID: 23897513 PMCID: PMC6991461 DOI: 10.1002/14651858.cd003416.pub4] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Multiple embryo transfer during in vitro fertilisation (IVF) increases multiple pregnancy rates causing maternal and perinatal morbidity. Single embryo transfer is now being seriously considered as a means of minimising the risk of multiple pregnancy. However, this needs to be balanced against the risk of jeopardising the overall live birth rate. OBJECTIVES To evaluate the effectiveness and safety of different policies for the number of embryos transferred in couples who undergo assisted reproductive technology (ART). SEARCH METHODS We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE, from inception to July 2013. We handsearched reference lists of articles, trial registers and relevant conference proceedings and contacted researchers in the field. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing different policies for the number of embryos transferred following IVF or intra-cytoplasmic sperm injection (ICSI) in subfertile women. Studies of fresh or frozen and thawed transfer of one, two, three or four embryos at cleavage or blastocyst stage were eligible. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility and risk of bias and extracted the data. The overall quality of the evidence was graded in a summary of findings table. MAIN RESULTS Fourteen RCTs were included in the review (2165 women). Thirteen compared cleavage-stage transfers (2017 women) and two compared blastocyst transfers (148 women): one study compared both. No studies compared repeated multiple versus repeated single embryo transfer (SET). DET versus repeated SETDET was compared with repeated SET in three studies of cleavage-stage transfer. In these studies the SET group received either two cycles of fresh SET (one study) or one cycle of fresh SET followed by one frozen SET in a natural or hormone-stimulated cycle (two studies). When these three studies were pooled, the cumulative live birth rate after one cycle of DET was not significantly different from the rate after repeated SET (OR 1.22, 95% CI 0.92 to 1.62, three studies, n=811, I(2)=0%, low quality evidence). This suggests that for a woman with a 40% chance of live birth following a single cycle of DET, the chance following repeated SET would be between 30% and 42%. The multiple pregnancy rate was significantly higher in the DET group (OR 30.54, 95% CI 7.46 to 124.95, three RCTs, n = 811, I(2) = 23%, low quality evidence), suggesting that for a woman with a 15% risk of multiple pregnancy following a single cycle of DET, the risk following repeated SET would be between 0% and 2%. Single-cycle DET versus single-cycle SETA single cycle of DET was compared with a single cycle of SET in 10 studies, nine comparing cleavage-stage transfers and two comparing blastocyst-stage transfers. When all studies were pooled the live birth rate was significantly higher in the DET group (OR 2.07, 95% CI 1.68 to 2.57, nine studies, n = 1564, I(2) = 0%, high quality evidence). This suggests that for a woman with a 40% chance of live birth following a single cycle of DET, the chance following a single cycle of SET would be between 22% and 30%. The multiple pregnancy rate was also significantly higher in the DET group (OR 8.47, 95% CI 4.97 to 14.43, 10 studies, n = 1612, I(2) = 45%, high quality evidence), suggesting that for a woman with a 15% risk of multiple pregnancy following a single cycle of DET, the risk following a single cycle of SET would be between 1% and 4%. The heterogeneity for this analysis was attributable to a study with a high rate of cross-over between treatment arms. Other comparisons Other fresh cycle comparisons were evaluated in three studies which compared DET versus transfer of three or four embryos. Live birth rates did not differ significantly between the groups for any comparison, but there was a significantly lower multiple pregnancy rate in the DET group than in the three embryo transfer (TET) group (OR 0.36, 95% CI 0.13 to 0.99, two studies, n = 343, I(2) = 0%). AUTHORS' CONCLUSIONS In a single fresh IVF cycle, single embryo transfer is associated with a lower live birth rate than double embryo transfer. However, there is no evidence of a significant difference in the cumulative live birth rate when a single cycle of double embryo transfer is compared with repeated SET (either two cycles of fresh SET or one cycle of fresh SET followed by one frozen SET in a natural or hormone-stimulated cycle). Single embryo transfer is associated with much lower rates of multiple pregnancy than other embryo transfer policies. A policy of repeated SET may minimise the risk of multiple pregnancy in couples undergoing ART without substantially reducing the likelihood of achieving a live birth. Most of the evidence currently available concerns younger women with a good prognosis.
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Affiliation(s)
- Zabeena Pandian
- Obstetrics and Gynaecology, Aberdeen Maternity Hospital, Aberdeen, UK.
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Crosignani PG. The need for new methods of ovarian stimulation. Reprod Biomed Online 2013; 5 Suppl 1:57-60. [PMID: 12537783 DOI: 10.1016/s1472-6483(11)60218-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
It is easy to diagnose sterility but much harder to diagnose subfertility, because minor defects are not necessarily associated with consistent impairment of fertility. Correct evaluation of the background fertility can avoid needless treatment of couples. Ovarian stimulation is a powerful strategy frequently used to re-establish or improve fertility in infertile couples, but it is often the cause of twin pregnancy. The risks and costs of multiple gestation are important factors that must be taken into full account in the pro-fertility decision. To avoid twins, inseminations should preferably be done in unstimulated cycles or in association with induced mono-ovulatory cycles. For the same reason, it is probably time to follow the policy of favouring single embryo transfer in young women undergoing IVF and intracytoplasmic sperm injection programmes. In addition, there is an urgent need to avoid an invasive multiple transfer policy in women over 38 and to select new strategies to improve the well-known age-related lower implantation rate.
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Affiliation(s)
- Pier Giorgio Crosignani
- First Department of Obstetrics and Gynecology, University of Milano, Via della Commenda 12, 20122 Milano, Italy.
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Veleva Z, Orava M, Nuojua-Huttunen S, Tapanainen JS, Martikainen H. Factors affecting the outcome of frozen-thawed embryo transfer. Hum Reprod 2013; 28:2425-31. [DOI: 10.1093/humrep/det251] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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[Reduction of multiple pregnancies in ART with large SET procedures over the period 2001-2010]. ACTA ACUST UNITED AC 2013; 41:20-6. [PMID: 23291055 DOI: 10.1016/j.gyobfe.2012.09.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 09/19/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate delivery rate and multiple pregnancy rates in ART (assisted reproductive techniques) following introduction of an elective single embryo tranfer (eSET) policy. This strategy was started in 2002 including transfer of one embryo for women less than 35 years with a least two good quality embryo during their first or second attempts. PATIENTS AND METHODS Retrospective study including all IVF cycles performed in the IVF centre of Clermont-Ferrand University Hospital from 01/01/2001 to 31/12/2010. Main outcome measures were number of embryos transferred, cumulative delivery and multiple pregnancy rates (including fresh and frozen embryo transfers). A subgroup analysis including patients' age was done. RESULTS Cumulative delivery rate reached 27,3% in 2010 with a significant drop in multiple pregnancy rate: from 30% in 2001 to 7,9% in 2010. The average number of transferred embryo decreased from 2.29 to 1.55 in the same period. In our centre, eSET was performed in 85% of first IVF attempt and in 34,4% of second attempts for women less than 35 years. CONCLUSION The implementation of an eSET policy does not change the delivery rate but significantly decrease the number of multiple pregnancies compared to double embryo transfer. eSET should be carried out during the 1st and 2nd attempts in patients under 35 years when at least two good quality embryos were obtained.
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Tiitinen A. Prevention of multiple pregnancies in infertility treatment. Best Pract Res Clin Obstet Gynaecol 2012; 26:829-40. [DOI: 10.1016/j.bpobgyn.2012.05.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 04/23/2012] [Accepted: 05/13/2012] [Indexed: 11/17/2022]
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Niinimäki M, Suikkari AM, Mäkinen S, Söderström-Anttila V, Martikainen H. Elective single-embryo transfer in women aged 40-44 years. Hum Reprod 2012; 28:331-5. [PMID: 23175499 DOI: 10.1093/humrep/des399] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY QUESTION Is an elective single-embryo transfer (eSET) policy feasible for women aged 40 or older? SUMMARY ANSWER For older women (aged 40-44 years) with a good prognosis, an eSET policy can be applied with acceptable cumulative clinical pregnancy rates and live birth rates. WHAT IS KNOWN ALREADY Various studies have shown the effectiveness of eSET in women aged <35 years with high cumulative pregnancy rates and low rates of multiple births. STUDY DESIGN, SIZE, DURATION This retrospective cohort study included 628 women treated between 2000 and 2009. PARTICIPANTS, SETTING, METHODS Women aged 40-44 years underwent a fresh cycle of IVF or ICSI treatment with eSET (n = 264) or double-embryo transfer (DET) (n = 364). In the subsequent frozen-thawed embryo transfer cycles, SET/DET was performed in both groups according to the number of embryos available and the opinion of the couple. The study was performed at the Family Federation of Finland Helsinki Fertility Clinic. MAIN RESULTS AND THE ROLE OF CHANCE In the fresh cycles, the clinical pregnancy rates were 23.5 and 19.5% in the eSET and DET groups, respectively, and live birth rates were 13.6 and 11.0%, respectively. In the fresh cycles with eSET, there were no twin pregnancies, but in the DET group, there were three sets of twins (7.5%). The cumulative clinical pregnancy rates per oocyte retrieval were 37.1 and 24.2% in the eSET and DET groups, respectively (P < 0.001), and the cumulative live birth rates were 22.7 and 13.2%, respectively (P = 0.002). Cumulative twin rates were 6.7% (n = 4) in the eSET group and 8.3% (n = 4) in the DET group (P = 0.726). All of the twin pregnancies in the eSET group resulted from frozen and thawed DET embryo transfer cycles. LIMITATIONS The characteristics of the two patients groups are not comparable because the suitability of eSET was individually assessed by a clinician based on both clinical prognostic factors and the outcome of IVF or ICSI, i.e. the number and quality of embryos. WIDER IMPLICATIONS OF THE FINDINGS This study may be generalized to IVF units having experience in eSET and cryopreservation.
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Affiliation(s)
- M Niinimäki
- Department of Obstetrics and Gynecology, University Hospital of Oulu, Oulu, Finland.
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