1
|
Marinaro J, Goldstein M. Microsurgical Management of Male Infertility: Compelling Evidence That Collaboration with Qualified Male Reproductive Urologists Enhances Assisted Reproductive Technology (ART) Outcomes. J Clin Med 2022; 11:jcm11154593. [PMID: 35956208 PMCID: PMC9369943 DOI: 10.3390/jcm11154593] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022] Open
Abstract
A male factor plays a significant role in a couple's reproductive success. Today, advances in reproductive technology, such as intracytoplasmic sperm injection (ICSI), have allowed it to be possible for just a single sperm to fertilize an egg, thus, overcoming many of the traditional barriers to male fertility, such as a low sperm count, impaired motility, and abnormal morphology. Given these advances in reproductive technology, it has been questioned whether a reproductive urologist is needed for the evaluation and treatment of infertile and subfertile men. In this review, we aim to provide compelling evidence that collaboration between reproductive endocrinologists and reproductive urologists is essential for optimizing a couple's fertility outcomes, as well as for improving the health of infertile men and providing cost-effective care.
Collapse
Affiliation(s)
- Jessica Marinaro
- Department of Urology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Marc Goldstein
- Center for Male Reproductive Medicine and Microsurgery, Weill Cornell Medicine, 525 East 68th St., Starr Pavilion, 9th Floor (Starr 900), New York, NY 10065, USA
- Correspondence:
| |
Collapse
|
2
|
Godines-Enriquez MS, Miranda-Velásquez S, Enríquez-Pérez MM, Arce-Sánchez L, Martínez-Cruz N, Flores-Robles CM, Aguayo-González P, Morales-Hernández FV, Villarreal-Barranca A, Suárez-Rico BV, Montoya-Estrada A, Romo-Yáñez J, Reyes-Muñoz E. Prevalence of Thyroid Autoimmunity in Women with Recurrent Pregnancy Loss. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:96. [PMID: 33499017 PMCID: PMC7912215 DOI: 10.3390/medicina57020096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/16/2021] [Accepted: 01/19/2021] [Indexed: 11/17/2022]
Abstract
Background and objectives: Thyroid autoimmunity (TAI) has been associated with a significantly increased risk of miscarriage in women with recurrent pregnancy loss (RPL). The aim of this study was to determine the prevalence of TAI in women with RPL and compare the clinical characteristics of positive and negative TAI women. Materials and Methods: This is a retrospective cross-sectional study; 203 women with RPL were included. Thyroid profile, anti-thyroid peroxidase (TPO-Ab), and anti-thyroglobulin (TG-Ab) antibodies were measured in all participants. Clinical characteristics and causes of RPL were compared between positive and negative TAI. Results: Prevalence of TAI was 14.8%; prevalence of positive TPO-Ab and TG-Ab was 12.3% and 4.9%, respectively. Women with TAI had significantly higher concentrations of thyrotropin (TSH) compared to women without TAI (4.8 ± 3.8 versus 3.1 ± 1.1, p = 0.001). There was no significant difference in age, the number of gestations, miscarriages, state of antiphospholipid antibodies (aPL), or causes of RPL between women that were TAI-positive versus TAI-negative. Prevalence of positive TAI by cause of RPL was: endocrine 7/25 (28%), genetic 1/5 (20%), autoimmune 1/5 (20%), anatomic 8/55 (14.5%), and unexplained cause 13/112 (11.6%). Conclusions: The prevalence of TAI in women with RPL is 14.8%. Women with an endocrine cause have the highest prevalence of TAI.
Collapse
Affiliation(s)
| | - Silvia Miranda-Velásquez
- Reproductive Gynecology Department, National Institute of Perinatology, Ministry of Health, Mexico City 11000, Mexico; (S.M.-V.); (P.A.-G.); (F.V.M.-H.)
| | | | - Lidia Arce-Sánchez
- Department of Endocrinology, National Institute of Perinatology, Ministry of Health, Mexico City 11000, Mexico; (L.A.-S.); (N.M.-C.); (C.M.F.-R.)
| | - Nayeli Martínez-Cruz
- Department of Endocrinology, National Institute of Perinatology, Ministry of Health, Mexico City 11000, Mexico; (L.A.-S.); (N.M.-C.); (C.M.F.-R.)
| | - Claudia Montserrat Flores-Robles
- Department of Endocrinology, National Institute of Perinatology, Ministry of Health, Mexico City 11000, Mexico; (L.A.-S.); (N.M.-C.); (C.M.F.-R.)
| | - Patricia Aguayo-González
- Reproductive Gynecology Department, National Institute of Perinatology, Ministry of Health, Mexico City 11000, Mexico; (S.M.-V.); (P.A.-G.); (F.V.M.-H.)
| | - Fela Vanessa Morales-Hernández
- Reproductive Gynecology Department, National Institute of Perinatology, Ministry of Health, Mexico City 11000, Mexico; (S.M.-V.); (P.A.-G.); (F.V.M.-H.)
| | - Alma Villarreal-Barranca
- Coordination of Education and Research, Hospital de la Mujer, Ministry of Health, Mexico City 11340, Mexico;
| | - Blanca Vianey Suárez-Rico
- Direction of Research, National Institute of Perinatology, Ministry of Health, Mexico City 11000, Mexico;
| | - Araceli Montoya-Estrada
- Coordination of Gynecological and Perinatal Endocrinology, National Institute of Perinatology, Ministry of Health, Mexico City 11000, Mexico; (A.M.-E.); (J.R.-Y.)
| | - José Romo-Yáñez
- Coordination of Gynecological and Perinatal Endocrinology, National Institute of Perinatology, Ministry of Health, Mexico City 11000, Mexico; (A.M.-E.); (J.R.-Y.)
| | - Enrique Reyes-Muñoz
- Coordination of Gynecological and Perinatal Endocrinology, National Institute of Perinatology, Ministry of Health, Mexico City 11000, Mexico; (A.M.-E.); (J.R.-Y.)
| |
Collapse
|
3
|
Schaller MA, Griesinger G, Banz-Jansen C. Women show a higher level of anxiety during IVF treatment than men and hold different concerns: a cohort study. Arch Gynecol Obstet 2016; 293:1137-45. [PMID: 26884350 DOI: 10.1007/s00404-016-4033-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 01/29/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of the present study was to determine levels of anxiety during the course of IVF treatment and gender differences in treatment anxiety. METHODS This was a prospective cohort study set in a university affiliated, tertiary care IVF program. 119 women and 82 men entering the clinic to undergo IVF treatment filled out questionnaires containing the Spielberger state-trait-anxiety-inventory (STAI) as well as further items on specific stress triggers. RESULTS Women and men undergoing IVF have higher levels of anxiety than the average population in Germany. Overall, female patients show significantly higher values (mean ± SD) for state and trait anxiety (47.4 ± 11.0 and 40.1 ± 9.85) than their male partners (41.4 ± 9.66 and 35.3 ± 8.57, p < 0.01). Over the course of several IVF cycles, average STAI scores increased for both genders. When asked about specific stress factors on a 4-point scale from 'not at all' to 'very much so', women report as their main anxiety the failure to achieve a successful pregnancy, scoring significantly higher on questions like 'obtaining a negative pregnancy test' (3.24 ± 0.82, p < 0.01) and 'disclosure of infertility' (3.02 ± 1.10, p < 0.001). Their male partners are more concerned about the health risks the women have to take such as 'side effects of ovarian stimulation' (2.55 ± 0.77, p = 0.002) and 'bleeding or infection after the oocyte aspiration' (2.58 ± 0.84, p = 0.007). Both genders indicated to be very little worried about multiple pregnancies after IVF. CONCLUSIONS Women show a higher level of anxiety during IVF treatment and hold different concerns. Neither of the sexes appears to be familiar with the risks associated with multiple pregnancies, a matter that should better be addressed.
Collapse
Affiliation(s)
- Martin Alexander Schaller
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
| | - Georg Griesinger
- Department of Reproductive Medicine and Gynecological Endocrinology, University Hospital of Schleswig-Holstein, 23538, Luebeck, Germany
| | - Constanze Banz-Jansen
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| |
Collapse
|
4
|
De Brucker M, Camus M, Haentjens P, Francotte J, Verheyen G, Tournaye H. Cumulative delivery rates after ICSI with donor spermatozoa in different age groups. Reprod Biomed Online 2014; 28:599-605. [DOI: 10.1016/j.rbmo.2014.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 01/17/2014] [Accepted: 01/21/2014] [Indexed: 11/25/2022]
|
5
|
Assisted reproduction counseling in women aged 40 and above: a cohort study. J Assist Reprod Genet 2013; 30:1431-8. [PMID: 23982590 DOI: 10.1007/s10815-013-0085-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 08/13/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE Fertility treatment in women aged ≥40 year old remains difficult and controversial. All available studies in older women report results of one specific method of ART, i.e. IUI, IVF/ICSI or oocyte donation, and success rates are always published per attempt but never per patient. Randomized studies are not available because of the obvious heterogeneity in patient populations and treatment options. This prospective observational study aimed at analyzing the outcome in a consecutive cohort of patients above 40 undergoing various methods of ART. METHODS A total number of 909 women older than 40 attended our fertility centre during a 3 years period. A flowchart showing the consecutive ART treatments with their respective outcome was constructed. Any delivery after 22 weeks gestation (or 500 g.) was taken as primary endpoint. Crude cumulative delivery rates (CDRs) and binomial exact 95 % confidence limits (95 % CLs) were calculated for each group of interest. RESULTS ART treatment could be proposed to 737 patients (81 %) and eventually 585 patients (64 %) started ART treatment: 111 patients started IUI, 439 patients started IVF/ICSI and 35 patients started oocyte donation as a primary approach ART. Ten patients got pregnant spontaneously and delivered before starting any treatment. In the 909 patients consulting for infertility, 111 deliveries were achieved after ART, i.e. a crude CDR of 12.2 % (95 % CL 10.1 % to 14.5 %). CONCLUSION Only 10 % of patients aged 40 and above could achieve delivery of their genetically-own child, while 1 % conceived spontaneously. More than one third of patients consulting never started any treatment for different reasons, i.e. anticipated poor prognosis, financial restrictions, illness or spontaneous pregnancy.
Collapse
|
6
|
De Brucker M, Camus M, Haentjens P, Verheyen G, Collins J, Tournaye H. Assisted reproduction using donor spermatozoa in women aged 40 and above: the high road or the low road? Reprod Biomed Online 2013; 26:577-85. [DOI: 10.1016/j.rbmo.2013.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 02/01/2013] [Accepted: 02/12/2013] [Indexed: 10/27/2022]
|
7
|
|
8
|
Abstract
For years, the management and treatment of male factor infertility has been 'experience' and not 'evidence' based. Although not evidence-based, current clinical practice involves extensive use of assisted reproductive techniques (ART). Where specific treatments are not indicated or have failed, ART have become popular adjunctive treatments for alleviating male factor infertility. According to the limited evidence available, intrauterine insemination (IUI) may be considered as a first-line treatment in a couple in which the female partner has a normal fertility status and at least 1×10(6) progressively motile spermatozoa are recovered after sperm preparation. If no pregnancy is achieved after 3-6 cycles of IUI, optimized in vitro fertilization (IVF) can be proposed. When less than 0.5×10(6) progressively motile spermatozoa are obtained after seminal fluid processing or sperm are recovered surgically from the testis or epididymis, intracytoplasmic sperm injection (ICSI) should be performed. Although the outcome of no other ART has ever been scrutinized as much before, no large-scale 'macroproblems' have as yet been observed after ICSI. Yet, ICSI candidates should be rigorously screened before embarking on IVF or ICSI, and thoroughly informed of the limitations of our knowledge on the hereditary aspects of male infertility and the safety aspects of ART.
Collapse
Affiliation(s)
- Herman Tournaye
- Centre for Reproductive Medicine, University Hospital of the Dutch-speaking Brussels Free University, Belgium.
| |
Collapse
|
9
|
Assisted reproductive technologies: a systematic review of safety and effectiveness to inform disinvestment policy. Health Policy 2011; 102:200-13. [PMID: 21868120 DOI: 10.1016/j.healthpol.2011.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 06/09/2011] [Accepted: 07/21/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Health policy relating to assisted reproductive technologies (ART) has been variably informed by clinical evidence, social values, political and fiscal considerations. This systematic review examined key factors associated with specific benefits and harms of ART to inform the development of a model for generating policy recommendations within an Australian disinvestment research agenda. METHODS Six databases were searched from 1994 to 2009. Included articles contained data on safety and/or effectiveness of in vitro fertilisation (IVF) or IVF with intracytoplasmic sperm injection with reference to female age, male age or cycle rank. Narrative descriptions of key outcomes (live birth, miscarriage) were constructed alongside tabular summaries. RESULTS Sixty-eight studies and one registry report were included. There was substantial heterogeneity present within the evidence-base which limited the strength and scope of conclusions that could be drawn. However, this review does affirm the differential effectiveness associated with the ageing of ART patients with regard to live birth and miscarriage. CONCLUSION From the available evidence, it was not possible to determine an explicit age or cycle rank that could be used to formulate defensible policy responsive to identified differential effectiveness. Stakeholder interpretation of this evidence-base may assist in developing policy that can incorporate uncertainty and reflect social values.
Collapse
|
10
|
Abstract
Via its interaction in several pathways, normal thyroid function is important to maintain normal reproduction. In both genders, changes in SHBG and sex steroids are a consistent feature associated with hyper- and hypothyroidism and were already reported many years ago. Male reproduction is adversely affected by both thyrotoxicosis and hypothyroidism. Erectile abnormalities have been reported. Thyrotoxicosis induces abnormalities in sperm motility, whereas hypothyroidism is associated with abnormalities in sperm morphology; the latter normalize when euthyroidism is reached. In females, thyrotoxicosis and hypothyroidism can cause menstrual disturbances. Thyrotoxicosis is associated mainly with hypomenorrhea and polymenorrhea, whereas hypothyroidism is associated mainly with oligomenorrhea. Thyroid dysfunction has also been linked to reduced fertility. Controlled ovarian hyperstimulation leads to important increases in estradiol, which in turn may have an adverse effect on thyroid hormones and TSH. When autoimmune thyroid disease is present, the impact of controlled ovarian hyperstimulation may become more severe, depending on preexisting thyroid abnormalities. Autoimmune thyroid disease is present in 5-20% of unselected pregnant women. Isolated hypothyroxinemia has been described in approximately 2% of pregnancies, without serum TSH elevation and in the absence of thyroid autoantibodies. Overt hypothyroidism has been associated with increased rates of spontaneous abortion, premature delivery and/or low birth weight, fetal distress in labor, and perhaps gestation-induced hypertension and placental abruption. The links between such obstetrical complications and subclinical hypothyroidism are less evident. Thyrotoxicosis during pregnancy is due to Graves' disease and gestational transient thyrotoxicosis. All antithyroid drugs cross the placenta and may potentially affect fetal thyroid function.
Collapse
Affiliation(s)
- G E Krassas
- Department of Endocrinology, Diabetes, and Metabolism, Panagia General Hospital, N. Plastira 22, N. Krini, 55132 Thessaloniki, Greece.
| | | | | |
Collapse
|
11
|
The reproductive outcome of female patients with myotonic dystrophy type 1 (DM1) undergoing PGD is not affected by the size of the expanded CTG repeat tract. J Assist Reprod Genet 2010; 27:327-33. [PMID: 20221684 DOI: 10.1007/s10815-010-9392-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Accepted: 01/14/2010] [Indexed: 10/19/2022] Open
Abstract
PURPOSE This study aims to analyze the relationship between trinucleotide repeat length and reproductive outcome in a large cohort of DM1 patients undergoing ICSI and PGD. METHODS Prospective cohort study. The effect of trinucleotide repeat length on reproductive outcome per patient was analyzed using bivariate analysis (T-test) and multivariate analysis using Kaplan-Meier and Cox regression analysis. RESULTS Between 1995 and 2005, 205 cycles of ICSI and PGD were carried out for DM1 in 78 couples. The number of trinucleotide repeats does not have an influence on reproductive outcome when adjusted for age, BMI, basal FSH values, parity, infertility status and male or female affected. Cox regression analysis indicates that cumulative live birth rate is not influenced by the number of trinucleotide repeats. The only factor with a significant effect is age (p < 0.05). CONCLUSION There is no evidence of an effect of trinucleotide repeat length on reproductive outcome in patients undergoing ICSI and PGD.
Collapse
|
12
|
De Brucker M, Haentjens P, Evenepoel J, Devroey P, Collins J, Tournaye H. Cumulative delivery rates in different age groups after artificial insemination with donor sperm. Hum Reprod 2009; 24:1891-9. [DOI: 10.1093/humrep/dep085] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
13
|
The role of thyroid autoimmunity in fertility and pregnancy. ACTA ACUST UNITED AC 2008; 4:394-405. [PMID: 18506157 DOI: 10.1038/ncpendmet0846] [Citation(s) in RCA: 188] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 04/09/2008] [Indexed: 01/25/2023]
Abstract
The thyroid gland and gonadal axes interact continuously before and during pregnancy. Hypothyroidism influences ovarian function by decreasing levels of sex-hormone-binding globulin and increasing the secretion of prolactin. In women of reproductive age, hypothyroidism can be reversed by thyroxine therapy to improve fertility and avoid the need for use of assisted reproduction technologies. For infertile women, preparation for medically assisted pregnancy comprises controlled ovarian hyperstimulation that substantially increase circulating estrogen concentrations, which in turn can severely impair thyroid function. In women without thyroid autoimmunity these changes are transient, but in those with thyroid autoimmunity estrogen stimulation might lead to abnormal thyroid function throughout the remaining pregnancy period. Prevalence of thyroid autoimmunity is significantly higher among infertile women than among fertile women, especially among those whose infertility is caused by endometriosis or ovarian dysfunction. Presence of thyroid autoimmunity does not interfere with normal embryo implantation, but the risk of early miscarriage is substantially raised. Subclinical and overt forms of hypothyroidism are associated with increased risk of pregnancy-related morbidity, for which thyroxine therapy can be beneficial. Systematic screening for thyroid disorders in pregnant women remains controversial but might be advantageous in women at high risk, particularly infertile women.
Collapse
|
14
|
Abstract
Thyroid autoimmunity (TAI), infertility and miscarriage are currently issues of extreme interest that have attracted the attention of many investigators. Several papers have been published, focusing on women of childbearing age that include healthy women, women with recurrent miscarriage and those undergoing assisted conception. Most of these studies show a significant association between the presence of thyroid autoantibodies, infertility and a higher miscarriage rate. The underlying pathogenetic mechanisms, which might explain the association between TAI and infertility, remain speculative given the scarce information from animal models and from in vitro data addressing the potential effects of TAI on fertility. Adequate levels of circulating thyroid hormones are of primary importance for normal reproductive function and inadequate delivery of triiodothyronine to granulosa and stromal cells may disrupt normal female reproductive function. With regards to the association between TAI and miscarriage, a close relationship has been largely confirmed in recent studies. The aim of this review is to present the relevant information published so far in the literature regarding TAI and miscarriage in euthyroid female individuals.
Collapse
Affiliation(s)
- Gerasimos E Krassas
- a Department of Endocrinology, Diabetes and Metabolism, Panagia General Hospital, N. Plastira 22, Thessaloniki, 551 32 Greece.
| | - Petros Perros
- b Endocrine Unit, Freeman Hospital High Heaton, Newcastle Upon Tyne, Tyne and Wear, NE7 7DN, UK
| | - Athina Kaprara
- c Department of Endocrinology, Diabetes and Metabolism, Panagia General Hospital, N. Plastira 22, Thessaloniki, 551 32 Greece
| |
Collapse
|
15
|
Gleicher N, Weghofer A, Barad D. Too old for IVF: are we discriminating against older women? J Assist Reprod Genet 2007; 24:639-44. [PMID: 18064561 DOI: 10.1007/s10815-007-9182-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Accepted: 11/05/2007] [Indexed: 11/25/2022] Open
Abstract
In vitro fertilization (IVF) in women of advanced age (>42 years) represents only 5%, a comparatively minute part, of the national IVF experience in the United States (US). In view of evolving population dynamics, it, however, also represents proportionally a rather quickly expanding patient need. Because of access restrictions at many IVF programs, this market does not live up to its potential. As best demonstrated by the 2004 US National Summary and Fertility Clinic Report, which for the first time reported pregnancies and births above age 45 year, IVF in women of advanced reproductive age represents a cutting edge area of interest for improving current IVF outcomes. Access to IVF should, therefore, not be withheld based on female age and/or baseline FSH levels. Instead, a definition of acceptable minimal pregnancy and life birth rates could be used to define the limits of offered access to IVF, independent of age and/or baseline FSH levels.
Collapse
Affiliation(s)
- Norbert Gleicher
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | | | | |
Collapse
|
16
|
Abstract
The menstrual pattern is influenced by thyroid hormones directly through impact on the ovaries and indirectly through impact on SHBG, PRL and GnRH secretion and coagulation factors. Treating thyroid dysfunction can reverse menstrual abnormalities and thus improve fertility. In infertile women, the prevalence of autoimmune thyroid disease (AITD) is significantly higher compared to parous age-matched women. This is especially the case in women with endometriosis and polycystic ovarian syndrome (PCOS). AITD does not interfere with normal foetal implantation and comparable pregnancy rates have been observed after assisted reproductive technology (ART) in women with and without AITD. During the first trimester, however, pregnant women with AITD carry a significantly increased risk for miscarriage compared to women without AITD, even when euthyroidism was present before pregnancy. It has also been demonstrated that controlled ovarian hyperstimulation (COH) in preparation for ART has a significant impact on thyroid function, particularly in women with AITD. It is therefore advisable to measure thyroid function and detect AITD in infertile women before ART, and to follow-up these parameters after COH and during pregnancy when AITD was initially present. Women with thyroid dysfunction at early gestation stages should be treated with l-thyroxine to avoid pregnancy complications. Whether thyroid hormones should be given prior to or during pregnancy in euthyroid women with AITD remains controversial. To date, there is a lack of well-designed randomized clinical trials to elucidate this controversy.
Collapse
Affiliation(s)
- Kris Poppe
- Department of Endocrinology, Vrije Universiteit Brussel (AZ-VUB), Brussels, Belgium.
| | | | | |
Collapse
|
17
|
Ciray HN, Ulug U, Tosun S, Erden HF, Bahceci M. Outcome of 1114 ICSI and embryo transfer cycles of women 40 years of age and over. Reprod Biomed Online 2006; 13:516-22. [PMID: 17007672 DOI: 10.1016/s1472-6483(10)60639-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to contribute to the development of strategies to obtain acceptable outcomes in assisted reproduction treatments in women over 40 years of age. A retrospective study was carried out on the database of the German Hospital in Istanbul using data from the years 1997 to 2004. A total of 1114 embryo transfer cycles were assessed. The pregnancy, implantation and delivery rates of the assessed population were 18.2, 8.3 and 10.9% respectively. The results showed that the demographics and outcome of cycles of women at 40 years differed significantly from those over 40. Cycles in which six or more oocytes were retrieved displayed better characteristics and outcome than those with five or fewer. The clinical pregnancy and delivery rates after transfer of three embryos were similar to four or more. Therefore, women over 40 years with a good ovarian response and at least three embryos available for transfer have an acceptable pregnancy and delivery rate with a low multiple pregnancy risk.
Collapse
Affiliation(s)
- H Nadir Ciray
- Bahçeci Women's Health Care Centre, and German Hospital in Istanbul, Istanbul, Turkey
| | | | | | | | | |
Collapse
|
18
|
Witsenburg C, Dieben S, Van der Westerlaken L, Verburg H, Naaktgeboren N. Cumulative live birth rates in cohorts of patients treated with in vitro fertilization or intracytoplasmic sperm injection. Fertil Steril 2005; 84:99-107. [PMID: 16009164 DOI: 10.1016/j.fertnstert.2005.02.013] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2004] [Revised: 02/22/2005] [Accepted: 02/22/2005] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Follow-up of IVF/intracytoplasmic sperm injection (ICSI) patients to obtain accurate information concerning chances of live birth as well as early treatment dropout. Comparison of the cumulative pregnancy rates, established in cohorts, with those estimated with life table analysis to determine which method provides the most accurate data without overestimation. DESIGN Retrospective longitudinal cohort study. SETTING Academic medical IVF center. PATIENT(S) All 750 patients from the Leiden IVF center and another 706 patients from cooperating clinics starting IVF/ICSI treatment in the period 1996-2000. INTERVENTION(S) All observations were part of standard IVF/ICSI and cryopreservation protocols. MAIN OUTCOME MEASURE(S) Endpoints of this study were a first live birth or termination of treatment. Treatment cycles were followed until the end of 2002, pregnancy follow-up through September 2003. RESULT(S) The cumulative live birth rate for the Leiden cohort was 59.1%. In yearly cohorts this varied from 54.8% to 67.1%. Cumulative live birth rates were 61.8%-63.2% for unexplained infertility (n = 229), endometriosis (n = 19), and andrologic indication (n = 223). For tubal (n = 129) and hormonal (n = 46) indications the rates were 55.8% and 45.7%, respectively. The group of egg donation or surrogacy (n = 10) reached 40.0%, and patients with two or more indications (n = 84) 56.0%. For women < or = 35 years of age the cumulative live birth rate was 64.6%, for women 36-39 years of age it was 48.7%, and for women 40-42 years of age 31.0%. CONCLUSION(S) In contrast to estimation of expected cumulative pregnancy rates the cohort measurement does not overestimate success rates. It accurately reflects chances of both live birth as well as early treatment dropout. The cumulative live birth rate was 59.1%. Over time results improved and the contribution of cryopreservation increased.
Collapse
|
19
|
Vernaeve V, Festré V, Baetens P, Devroey P, Van Steirteghem A, Tournaye H. Reproductive decisions by couples undergoing artificial insemination with donor sperm for severe male infertility: implications for medical counselling. ACTA ACUST UNITED AC 2005; 28:22-6. [PMID: 15679617 DOI: 10.1111/j.1365-2605.2004.00501.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Since 1992, ICSI has been introduced as a successful treatment for male infertility, including azoospermia. The present study is aimed at evaluating the practice of insemination with donor sperm (AID) in infertile couples who may benefit from the new developments that ICSI has brought in the last decade. AID was performed in 440 heterosexual couples. Twelve couples were lost for follow-up (3%). In 128 (29.9%) and 229 (53.5%) of the couples the husband was either oligozoospermic (OAT) or azoospermic. In 60 couples (14.0%) the man had a transmissible genetic trait. In 11 couples (2.6%) there were other indications for performing AID. In the OAT group 36 couples never had ICSI treatment (28.1%) because they had already an AID child born before the introduction of ICSI (n = 16), the burden of ICSI treatment was too high (n = 9) or they considered that ICSI success rate was too low (n = 7). Ninety-two couples tried ICSI treatment before opting for AID (71.9%), mainly because ICSI failed (n = 43). In 229 couples the husband had azoospermia (53.5%). In 112 couples (49%) no sperm or too few testicular sperm were found at testicular biopsy (TESE) and 15 couples (6.5%) had more than three failed ICSI-TESE attempts. Eighty-one azoospermic men refused TESE (35.4%) because of an anticipated low success rate (n = 28) or the burden of this approach (n = 23). Although a majority of patients could opt for ICSI, our results show that AID is still an option for many couples for whom these techniques were either not feasible or not successful. A substantial proportion of patients (33%) did not even opt for these advanced fertility treatments.
Collapse
Affiliation(s)
- V Vernaeve
- Centre For Reproductive Medicine, University Hospital, Dutch-speaking Brussels Free University (Vrije Universiteit Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium.
| | | | | | | | | | | |
Collapse
|
20
|
Daya S. Life table (survival) analysis to generate cumulative pregnancy rates in assisted reproduction: are we overestimating our success rates? Hum Reprod 2005; 20:1135-43. [PMID: 15790603 DOI: 10.1093/humrep/deh889] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The variability in the numbers of treatment cycles couples may undertake with assisted reproductive technology (ART) and the length of time they may have to wait between successive cycles of treatment make the evaluation of treatment efficacy and prognosis complicated. The cumulative pregnancy rate using the life table method of analysis is being used more frequently to estimate the effectiveness of treatment. Although this approach is valid in some areas of infertility research, its use in ART is not appropriate, because the factors necessary for the analysis (particularly the scale for measuring the passage of time and lack of informative censoring) are not satisfied. Consequently, an overestimation of the effect of treatment is produced that may lead to biased decision making. Although there is no easy solution to this problem, several options for summarizing the outcome data are offered: pregnancy rate per cycle, time-limited analysis using proportions, conservative cycle-based cumulative pregnancy rate and real-time-based cumulative pregnancy rate. In this manner, more realistic information can be generated to counsel patients, evaluate the efficacy of treatments, compare rates among centres and guide the formulation of policies for infertility management and resource allocation.
Collapse
Affiliation(s)
- Salim Daya
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton, Ontario, Canada.
| |
Collapse
|
21
|
Bahceci M, Ulug U. Does underlying infertility aetiology impact on first trimester miscarriage rate following ICSI? A preliminary report from 1244 singleton gestations. Hum Reprod 2004; 20:717-21. [PMID: 15608032 DOI: 10.1093/humrep/deh681] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We evaluated the impact of using ICSI for assisted fertilization on first trimester survival rates of singleton gestations among an unselected infertile population. METHODS The 1244 singleton gestations achieved by ICSI were segregated according to underlying infertility aetiology, with 55.0% having male factor, 3.6% endometriosis, 4.3% polycystic ovarian disease, 9.1% tubal factor, 24.3% unexplained and 3.3% other. None of the patients had coexisting infertility factor. RESULTS The survival rate of all ICSI singleton gestations during the first trimester was 72.2%. There were no differences in early pregnancy loss (EPL) rate by infertility factor. Among patients undergoing ICSI because of male factor, there were no differences in EPL using ejaculated or non-ejaculated sperm. Regardless of aetiology, women aged >40 years had significantly higher EPL (42.1%). CONCLUSION Our preliminary results demonstrate that first trimester miscarriage rates of ICSI gestations are not affected by underlying infertility aetiology but are affected by maternal age.
Collapse
Affiliation(s)
- Mustafa Bahceci
- Bahceci Women Health Care Center and German Hospital in Istanbul and Yeditepe University School of Medicine, Istanbul, Turkey.
| | | |
Collapse
|
22
|
Pasqualotto FF, Lucon AM, Sobreiro BP, Pasqualotto EB, Arap S. The best infertility treatment for vasectomized men: assisted reproduction or vasectomy reversal? ACTA ACUST UNITED AC 2004; 59:312-5. [PMID: 15543406 DOI: 10.1590/s0041-87812004000500016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In men with prior vasectomy, microsurgical reconstruction of the reproductive tract is more cost-effective than sperm retrieval with in vitro fertilization and intracytoplasmic sperm injection if the obstructive interval is less than 15 years and no female fertility risk factors are present. If epididymal obstruction is detected or advanced female age is present, the decision to use either microsurgical reconstruction or sperm retrieval with in vitro fertilization and intracytoplasmic sperm injection should be individualized. Sperm retrieval with in vitro fertilization and intracytoplasmic sperm injection is preferred to surgical treatment when female factors requiring in vitro fertilization are present or when the chance for success with sperm retrieval and intracytoplasmic sperm injection exceeds the chance for success with surgical treatment.
Collapse
Affiliation(s)
- Fábio Firmbach Pasqualotto
- Department of Urology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo - São Paulo/SP, Brazil.
| | | | | | | | | |
Collapse
|
23
|
Osmanagaoglu K, Kolibianakis E, Tournaye H, Camus M, Van Steirteghem A, Devroey P. Cumulative live birth rates after transfer of cryopreserved ICSI embryos. Reprod Biomed Online 2004; 8:344-8. [PMID: 15038902 DOI: 10.1016/s1472-6483(10)60915-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A cohort follow-up study was designed to assess the efficacy of an intracytoplasmic sperm injection cryopreservation programme through analysis of cumulative live birth rates in successive frozen-thawed cycles in a tertiary referral centre. There were 2013 patients and they underwent 2680 frozen-thawed embryo transfer cycles. The follow-up period was between 1992 and 2001. Only frozen-thawed embryo transfer cycles up to the fourth trial were included. Crude cumulative live birth rates were calculated in five age subgroups, i.e. <30, 30-34, 35-37, 38-39 and >/=40 years old and in surgically or non-surgically retrieved sperm subgroups. Expected cumulative live birth rates were calculated only for the total number of patients. Outcome measure was a live birth occurring after 25 weeks of gestation. Overall, the expected cumulative live birth rate was as high as 26.7% after four cycles while the crude cumulative delivery rate was 10.5%. Multiple cryopreserved embryo transfer cycles increase the chance of a couple to achieve a live birth.
Collapse
Affiliation(s)
- Kaan Osmanagaoglu
- Centre for Reproductive Medicine, Dutch-speaking Brussels Free University, Laarbeeklaan 101, B 1090 Brussels, Belgium.
| | | | | | | | | | | |
Collapse
|
24
|
Schröder AK, Katalinic A, Diedrich K, Ludwig M. Cumulative pregnancy rates and drop-out rates in a German IVF programme: 4102 cycles in 2130 patients. Reprod Biomed Online 2004; 8:600-6. [PMID: 15151731 DOI: 10.1016/s1472-6483(10)61110-8] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cumulative pregnancy rates are useful in counselling couples on their chance of conceiving during infertility treatment. Patients also have to be counselled about the physical and psychological stress of infertility treatment. Beside the pregnancy rates, drop-out rates are a direct, and may be the most important, marker of physician quality in an IVF programme. Data from 4102 IVF cycles in 2130 patients in Germany were analysed retrospectively. Data were analysed using descriptive statistics as well as the Kaplan-Meier procedure. A real cumulative pregnancy rate of 31.2% was achieved after four cycles with an expected cumulative pregnancy rate (ECPR) of 53.3%. Age was a significant factor regarding pregnancy rates (ECPR after four cycles: 57.1% <35 years, 44.8% > or =35 years, 35.4% > or =40 years). The drop-out rate of non-pregnant patients increased from 39.9% after the first cycle to 62.2% after the fourth cycle, indicating the enormous stress and frustration that increased during the course of treatment. The drop-out rate should be used as an important marker of quality control. The presented data give, for the first time, a good basis for this counselling procedure in Germany.
Collapse
Affiliation(s)
- A K Schröder
- Department of Gynaecology and Obstetrics, University Clinic Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
| | | | | | | |
Collapse
|
25
|
Kolettis PN, Sabanegh ES, Nalesnik JG, D'Amico AM, Box LC, Burns JR. Pregnancy outcomes after vasectomy reversal for female partners 35 years old or older. J Urol 2003; 169:2250-2. [PMID: 12771762 DOI: 10.1097/01.ju.0000063780.74931.d6] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE We review the outcomes after vasectomy reversal for couples with female partners 35 years old or older. MATERIALS AND METHODS A retrospective review of experience at 2 institutions was performed. Patency was defined as the presence of motile sperm. Patients with less than 6 months of followup were excluded from the patency rate analysis unless they had sperm in the semen. Similarly, patients with less than 12 months of followup or no ongoing interest in establishing conception were excluded from the pregnancy rate analysis unless they had established a pregnancy or they were azoospermic with sufficient followup. RESULTS A total of 46 men with partners 35 years old or older underwent vasectomy reversal at 2 institutions. Mean partner age was 37 +/- 2 years, and median obstructive interval was 10 years. Bilateral vasovasostomy was performed in 43 men, unilateral vasovasostomy in 2 and vasovasostomy/vasoepididymostomy in 1. Of the 46 men 27 had followup semen analyses with a patency rate of 81% (22). Transient patency occurred in 2 cases (7%). Pregnancy occurred in 35% of the couples (14 of 40 patients) with sufficient followup. The ongoing/live delivery rate was 33% (13 of 40 cases). The pregnancy and ongoing/delivery rates were 46% (12 of 26 patients) and 46% (12 of 26) for female partners 35 to 39 years old, and 14% (2 of 14) and 7% (1 of 14) for female partners older than 40, respectively. CONCLUSIONS Vasectomy reversal offers reasonable chance for success when the female partner is 35 years old or older. The chance for success is similar to that of a single cycle of in vitro fertilization with intracytoplasmic sperm injection. These couples should not be eliminated from consideration for reversal simply because the female partner is 35 years old or older.
Collapse
Affiliation(s)
- Peter N Kolettis
- Division of Urology, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | | | | | | |
Collapse
|
26
|
Rossi-Ferragut LM, Iaconelli A, Aoki T, Rocha CC, dos Santos DR, Pasqualotto FF, Borges E. Pronuclear and morphological features as a cumulative score to select embryos in ICSI (intracytoplasmic sperm injection) cycles according to sperm origin. J Assist Reprod Genet 2003; 20:1-7. [PMID: 12656060 PMCID: PMC3455800 DOI: 10.1023/a:1021286119979] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To analyze best parameter to select embryos according to sperm origin in ICSI cycles. METHODS One hundred seventy-two ICSI cycles were divided among three different groups: A (ejaculated spermatozoa from nonmale factor infertility), B (ejaculated spermatozoa from oligospermia), and C (spermatozoa from azoospermia). Embryos were divided on Day 1 into two patterns: S0 (pronuclei (PN) aligned and close with normal arrangement of nucleoli) and S1 (when these characteristics were absent) and also on transfer day according to morphological features. RESULTS Relationships of PN patterns related to sperm origin were noted. More S0 embryos were detected with better sperm quality. Higher number of good quality embryos was obtained when male factor was absent. Ejaculated and epididymal spermatozoa provide better quality embryos than do testicular spermatozoa. CONCLUSIONS PN classification associated with transfer day morphology is valuable additional noninvasive criterion for elective embryo transfer, mainly in the cases with severe male factor.
Collapse
|