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Mourad A, Antaki R, Rowen M, Lévesque É, Lapensée L. The POPI-Plus tool: prediction model of outcome of pregnancy in in vitro fertilization from a large retrospective cohort. Fertil Steril 2024; 121:489-496. [PMID: 38043845 DOI: 10.1016/j.fertnstert.2023.11.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE To create a tool that accurately predicts live birth chances after a positive pregnancy test after elective single embryo transfer (ET). DESIGN Retrospective cohort. SETTING CHUM hospital and Ovo clinic in Montreal, Canada. PATIENT(S) Patients with a positive pregnancy test result who underwent their first single ET after in vitro fertilization (IVF) at the CHUM hospital and Ovo clinic in Montreal, Canada, from 2012 to 2016 were selected. A total of 1,995 patients were included in this study. INTERVENTION(S) The data from both centers were combined and divided into training (70%, n = 1,398) and validation (30%, n = 597) sets. The predictive model was developed using backward selection method for the following variables: age of patient at egg retrieval; log β-human chorionic gonadotropin (β-hCG) (β-hCG) 1; log β-hCG 2; and IVF treatment type. Moreover, the classification tree, random forest, and neural network models were generated. MAIN OUTCOME MEASURE(S) The measured outcomes were live birth (live fetus ≥24 weeks of gestation) and nonviable pregnancies. The performance of all models was evaluated by area under the receiver operating characteristic curve (AUC). RESULT(S) Advancing age was negatively correlated with live birth. The odds ratio (OR) of age of patient at the time of egg retrieval was 0.95 (95% confidence interval [CI], 0.91-0.99). The log β-hCG 1 and log β-hCG 2 were positively correlated with live birth in the univariate analysis (OR, 4.15 [95% CI, 3.19-5.39], and OR, 3.84 [95% CI, 2.99-4.93], respectively). The β-hCG 1 level needed for a successful pregnancy was lower in frozen ET and modified natural IVF than in simulated IVF (OR, 0.55 [95% CI, 0.34-0.91], and OR, 0.49 [95% CI, 0.26-0.95], respectively). The best performance in terms of the AUC was the updated logistic model: POPI-Plus. The AUC values were 0.76 (95% CI, 0.73-0.79) and 0.78 (95% CI, 0.74-0.82) for the training and validation data, respectively. The other models (classification tree, random forest, and neural network) also performed adequately, with an AUC of ≥0.7, but remained below POPI-Plus. An open-access calculator was generated and can be found on the website of the University of Montreal on the following link: https://deptobsgyn.umontreal.ca/departement/divisions/medecine-et-biologie-de-la-reproduction/the-popi-plus-tool/. CONCLUSION(S) The POPI-Plus tool offers individualized counseling for patients after an initial positive β-hCG test result. Future studies will assess its impact on patient anxiety while awaiting viability ultrasound and perform prospective validation on new patients.
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Affiliation(s)
- Ali Mourad
- Department of Obstetrics and Gynecology, Western University, London, Ontario, Canada
| | - Roland Antaki
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada; Reproductive Endocrinology and Infertility, Ovo Fertility Clinic, Montreal, Quebec, Canada
| | - Mélanie Rowen
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada
| | - Étienne Lévesque
- Faculty of Public Health, University of Montreal, Montreal, Quebec, Canada
| | - Louise Lapensée
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada; Reproductive Endocrinology and Infertility, Ovo Fertility Clinic, Montreal, Quebec, Canada.
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Sfakianoudis K, Maziotis E, Trypidi A, Grigoriadis S, Vaxevanoglou T, Angeli I, Rapani A, Kotsifaki A, Pistola K, Pantou A, Dafopoulos K, Pantos K, Simopoulou M. Embryo Transfer Procedural Parameters Do Not Predict IVF Cycle Outcome. J Clin Med 2024; 13:1312. [PMID: 38592155 PMCID: PMC10931750 DOI: 10.3390/jcm13051312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/01/2024] [Accepted: 02/07/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND this study aims to assess the effect of embryo transfer (ET) performance parameters of a technical nature on IVF outcome. METHODS A total of 1417 ETs from a single IVF center were included in this prospective observational study. The parameters investigated were as follows: the presence of cervical mucus post catheter withdrawal, the presence of blood, catheter reload, the employment of a tenaculum and stylet, catheter resistance as experienced by the physician and patient discomfort. RESULTS When ET performance parameters were associated with clinical outcomes on a singular level, none of the ET parameters presented with any statistical significance. The evaluation of covariates indicated that the number and the quality of transferred embryos, as well as maternal age, exerted a statistically significant effect on clinical outcomes. In a multivariate analysis, only the presence of mucus along with significant catheter resistance presented with statistical significance; however, when adjusting for covariates, this combination showed no statistically significant effect on clinical outcomes. CONCLUSIONS the results indicate that the time-consuming process of recording and analyzing ET performance parameters fails to offer any additional value in predicting the cycle's outcome, while factors like embryo quality and number, as well as maternal age, seem to be the sole robust predictive factors of an IVF cycle.
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Affiliation(s)
| | - Evangelos Maziotis
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Anna Trypidi
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Sokratis Grigoriadis
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | | - Irene Angeli
- Genesis Athens Clinic, Centre for Human Reproduction, Papanikoli, 15232 Athens, Greece
| | - Anna Rapani
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Amalia Kotsifaki
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Kalliopi Pistola
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Agni Pantou
- Genesis Athens Clinic, Centre for Human Reproduction, Papanikoli, 15232 Athens, Greece
| | - Konstantinos Dafopoulos
- Department of Obstetrics and Gynecology, School of Health Sciences, Faculty of Medicine, University of Thessaly, 41500 Larisa, Greece;
| | - Konstantinos Pantos
- Genesis Athens Clinic, Centre for Human Reproduction, Papanikoli, 15232 Athens, Greece
| | - Mara Simopoulou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Cai J, Jiang X, Liu L, Liu Z, Chen J, Chen K, Yang X, Ren J. Pretreatment prediction for IVF outcomes: generalized applicable model or centre-specific model? Hum Reprod 2024; 39:364-373. [PMID: 37995380 PMCID: PMC10833083 DOI: 10.1093/humrep/dead242] [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: 06/06/2023] [Revised: 11/03/2023] [Indexed: 11/25/2023] Open
Abstract
STUDY QUESTION What was the performance of different pretreatment prediction models for IVF, which were developed based on UK/US population (McLernon 2016 model, Luke model, Dhillon model, and McLernon 2022 model), in wider populations? SUMMARY ANSWER For a patient in China, the published pretreatment prediction models based on the UK/US population provide similar discriminatory power with reasonable AUCs and underestimated predictions. WHAT IS KNOWN ALREADY Several pretreatment prediction models for IVF allow patients and clinicians to estimate the cumulative probability of live birth in a cycle before the treatment, but they are mostly based on the population of Europe or the USA, and their performance and applicability in the countries and regions beyond these regions are largely unknown. STUDY DESIGN, SIZE, DURATION A total of 26 382 Chinese patients underwent oocyte pick-up cycles between January 2013 and December 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS UK/US model performance was externally validated according to the coefficients and intercepts they provided. Centre-specific models were established with XGboost, Lasso, and generalized linear model algorithms. Discriminatory power and calibration of the models were compared as the forms of the AUC of the Receiver Operator Characteristic and calibration curves. MAIN RESULTS AND THE ROLE OF CHANCE The AUCs for McLernon 2016 model, Luke model, Dhillon model, and McLernon 2022 model were 0.69 (95% CI 0.68-0.69), 0.67 (95% CI 0.67-0.68), 0.69 (95% CI 0.68-0.69), and 0.67 (95% CI 0.67-0.68), respectively. The centre-specific yielded an AUC of 0.71 (95% CI 0.71-0.72) with key predictors including age, duration of infertility, and endocrine parameters. All external models suggested underestimation. Among the external models, the rescaled McLernon 2022 model demonstrated the best calibration (Slope 1.12, intercept 0.06). LIMITATIONS, REASONS FOR CAUTION The study is limited by its single-centre design and may not be representative elsewhere. Only per-complete cycle validation was carried out to provide a similar framework to compare different models in the sample population. Newer predictors, such as AMH, were not used. WIDER IMPLICATIONS OF THE FINDINGS Existing pretreatment prediction models for IVF may be used to provide useful discriminatory power in populations different from those on which they were developed. However, models based on newer more relevant datasets may provide better calibrations. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the National Natural Science Foundation of China [grant number 22176159], the Xiamen Medical Advantage Subspecialty Construction Project [grant number 2018296], and the Special Fund for Clinical and Scientific Research of Chinese Medical Association [grant number 18010360765]. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Jiali Cai
- Reproductive Medicine Centre, The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China
- School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Xiaoming Jiang
- Reproductive Medicine Centre, The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China
- School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Lanlan Liu
- Reproductive Medicine Centre, The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China
- School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Zhenfang Liu
- Reproductive Medicine Centre, The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China
| | - Jinghua Chen
- Reproductive Medicine Centre, The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China
| | - Kaijie Chen
- Reproductive Medicine Centre, The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China
| | - Xiaolian Yang
- Reproductive Medicine Centre, The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China
| | - Jianzhi Ren
- Reproductive Medicine Centre, The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China
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Hu F, Wang X, Ren H, Lv Y, Li H, Liu S, Zhou W. Ovarian sensitivity index can be used as a more sensitive indicator than follicular output rate to predict IVF/ICSI outcomes in patients of normal expected ovarian response stimulated with GnRH antagonist protocol. HUM FERTIL 2023; 26:1264-1270. [PMID: 36650952 DOI: 10.1080/14647273.2023.2164869] [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: 09/27/2021] [Accepted: 09/27/2022] [Indexed: 01/19/2023]
Abstract
This retrospective study was performed to investigate the predictive power of the Ovarian Sensitivity Index (OSI) for IVF/ICSI outcomes in infertile patients who were of normal expected ovarian response. A total of 912 infertile patients who underwent GnRH antagonist protocol between January 2017 to August 2019 at the Medical Center for Human Reproduction, Beijing Chao-Yang Hospital were included. All patients completed the full oocyte retrieval cycle and either had a live birth or had no embryos left. OSI was significantly lower in patients with a live birth (196.0 ± 120.4 in the live birth group vs 276.4 ± 235.7 in the non-live birth group, p < 0.001) while follicular output rate (FORT, defined as the ratio of pre-ovulatory follicle count on hCG day x 100/small antral follicle count at baseline) showed no significant difference. Patients were divided into low, average and high OSI groups and analysed in tertiles. From the low to the high OSI group, the cumulative live birth rate (CLBR) decreased dramatically (72.7 vs 67.2 vs 54.8%, p < 0.001). Multivariate regression analysis showed that OSI was an independent factor affecting CLBR (OR: 0.996, 95%CI: 0.995-0.998, p < 0.001) in our study population. In conclusion, OSI can be used as an independent indicator to distinguish fecundity in infertile patients with normal expected ovarian response and is probably more sensitive than FORT.
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Affiliation(s)
- Fen Hu
- Medical Center for Human Reproduction, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Center of Reproductive Medicine, Children's Hospital of Shanxi and Women Health Center of Shanxi, Taiyuan, China
| | - Xiaocheng Wang
- Department of Medical Record and Statistics, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Haiying Ren
- Medical Center for Human Reproduction, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yasu Lv
- Medical Center for Human Reproduction, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Huanhuan Li
- Medical Center for Human Reproduction, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shan Liu
- Medical Center for Human Reproduction, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Wenhui Zhou
- Medical Center for Human Reproduction, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Wei J, Luo Z, Dong X, Jin H, Zhu L, Ai J. Cut-off point of mature oocyte for routine clinical application of rescue IVM: a retrospective cohort study. J Ovarian Res 2023; 16:226. [PMID: 37993915 PMCID: PMC10664607 DOI: 10.1186/s13048-023-01294-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/02/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND The rescue in vitro mature(Rescue IVM) technique allows the use of immature oocytes collected in conventional COH to obtain more mature oocytes for fertilization through in vitro maturation. Some studies have shown that Rescue IVM could improve clinical outcomes in patients undergoing IVF/ICSI, but the effectiveness and the indications for the clinical application of this technique remain controversial. It remains to be studied whether Rescue IVM should be universally applied in all conventional IVF/ICSI cycles. METHOD This is a large retrospective cohort study that included a total of 22,135 female patients undergoing their first IVF treatment cycles. The effect of the number of mature oocytes(metaphaseII[MII]) on the cumulative live birth rate was investigated in a population with routine IVF/ICSI first. The receiver operating characteristic curve(ROC) analysis was used to explore the cut-off point of the number of MII affecting CLBR. Secondly, Patients undergoing ICSI with Rescue IVM were included in the analysis with those who underwent ICSI only during the same period, grouped according to the MII cut-off values. Multi-factor binary logistic regression and inverse probability weighting (IPW) were used to investigate whether Rescue IVM influenced the final cumulative live birth rate(CLBR). RESULTS The CLBR increased with the number of MIIoocytes (P < 0.001). The ROC analysis showed the cut-off point for the number of MIIoocytes to have a significant effect on CLBR was 9 (sensitivity 0.715, specificity 0.656). Furthermore, 912 patients who underwent ICSI with Rescue IVM were included and compared to those who underwent ICSI only during the same period, and found Rescue IVM significantly increased the number of available MIIoocytes. For patients with MII numbers < 9, Rescue IVM significantly improves their clinical pregnancy rate(55.6% vs. 46.7%, P = 0.001) and CLBR(65.4% vs. 48.1%, P < 0.001), but not for those patients with MII numbers ≥ 9. CONCLUSION This study further clarifies the candidates for the application of Rescue IVM technique: patients with an MII oocytes < 9 in a conventional IVF/ICSI cycle. In contrast, it is not necessary for patients who already have sufficient mature oocytes(≥ 9), to avoid over-medication.
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Affiliation(s)
- Jianbo Wei
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 JieFang Avenue, Wuhan, 430030, People's Republic of China
| | - Zhongyu Luo
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiyuan Dong
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 JieFang Avenue, Wuhan, 430030, People's Republic of China
| | - Huizi Jin
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases; Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology; Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
- Key Laboratory for Reproductive Medicine of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Lixia Zhu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 JieFang Avenue, Wuhan, 430030, People's Republic of China.
| | - Jihui Ai
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 JieFang Avenue, Wuhan, 430030, People's Republic of China.
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Meng S, Shi C, Jia Y, Fu M, Zhang T, Wu N, Han H, Shen H. A combined clinical and specific genes' model to predict live birth for in vitro fertilization and embryo transfer patients. BMC Pregnancy Childbirth 2023; 23:702. [PMID: 37777726 PMCID: PMC10541716 DOI: 10.1186/s12884-023-05988-6] [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: 11/23/2022] [Accepted: 09/10/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND We aimed to develop an accurate model to predict live birth for patients receiving in vitro fertilization and embryo transfer (IVF-ET) treatment. METHODS This is a prospective nested case-control study. Women aged between 18 and 38 years, whose body mass index (BMI) were between the range of 18.5-24 kg/m2, who had an endometrium of ≥ 8 mm at the thickest were enrolled from 2018/9 to 2020/8. All patients received IVF-ET treatment and were followed up until Jan. 2022 when they had reproductive outcomes. Endometrial samples during the window of implantation (LH + 6 to 9 days) were subjected to analyze specific endometrial receptivity genes' expression using real-time PCR (RT-PCR). Patients were divided into live birth group and non-live birth group based on IVF-ET outcomes. Clinical signatures relevant to live birth were collected, analyzed, and used to establish a predictive model for live birth by univariate analysis (clinical model). Specific endometrial receptivity genes' expression was analyzed, selected, and used to construct a predictive model for live birth by The Least Absolute Shrinkage and Selection Operator (LASSO) analysis (gene model). Finally, significant clinical factors and genes were used to construct a combined model for predicting live birth using multivariate logistical regression (combined model). Different models' Area Under Curve (AUC) were compared to identify the most predictive model. RESULTS Thirty-nine patients were enrolled in the study, twenty-four patients had live births, fifteen did not. In univariate analysis, the odds of live birth for women with ovulation dysfunction was 4 times higher than that for women with other IVF-ET indications (OR = 4.0, 95% CI: 1.125 - 8.910, P = 0.018). Age, body mass index, duration of infertility, primary infertility, repeated implantation failure, antral follicle counting, ovarian sensitivity index, anti-Mullerian hormone, controlled ovarian hyperstimulation protocol and duration, total dose of FSH/hMG, number of oocytes retrieved, regiment of endometrial preparation, endometrium thickness before embryo transfer, type of embryo transferred were not associated with live birth (P > 0.05). Only ovulation dysfunction was used to construct the clinical model and its AUC was 0.688. In lasso analysis, GAST, GPX3, THBS2 were found to promote the risk of live birth. AUCs for GAST, GPX3, THBS2 reached to 0.736, 0.672, and 0.678, respectively. The gene model was established based on these three genes and its AUC was 0.772. Ovulation dysfunction, GAST, GPX3, and THBS2 were finally used to construct the combined model, reaching the highest AUC (AUC = 0.842). CONCLUSIONS Compared to the single model, the combined model of clinical (Ovulation dysfunction) and specific genes (GAST, GPX3, THBS2) was more accurate to predict live birth for IVF-ET patients.
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Affiliation(s)
- Shihui Meng
- Department of Obstetrics and Gynecology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University People's Hospital, Peking University, Beijing, 100044, China
| | - Cheng Shi
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University People's Hospital, Peking University, Beijing, 100044, China
| | - Yingying Jia
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University People's Hospital, Peking University, Beijing, 100044, China
| | - Min Fu
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University People's Hospital, Peking University, Beijing, 100044, China
| | - Tianzhen Zhang
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University People's Hospital, Peking University, Beijing, 100044, China
| | - Na Wu
- Department of Central Laboratory and Institute of Clinical Molecular Biology, Peking University People's Hospital, Beijing, China
| | - Hongjing Han
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University People's Hospital, Peking University, Beijing, 100044, China.
| | - Huan Shen
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University People's Hospital, Peking University, Beijing, 100044, China.
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Li M, Duan X, Zhang N, Ding F, Wang Y, Liu P, Li R. Development and validation of a conventional in vitro total fertilization failure prediction model. J Assist Reprod Genet 2023:10.1007/s10815-023-02851-7. [PMID: 37382786 PMCID: PMC10371948 DOI: 10.1007/s10815-023-02851-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/01/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Conventional total fertilization failure (TFF) is a challenging problem for clinicians. The predictive model developed in this study aims to predict the individual probability of conventional in vitro total fertilization failure. METHODS The prediction model was developed based on 1635 patients who underwent first-attempt in vitro fertilization (IVF) cycles from January 2018 to January 2020. Total fertilization failure and normal fertilization occurred in 218 and 1417 cycles, respectively. Multivariate logistic regression analyses were used to develop the prediction model. Performance of our model was evaluated using calibration (Hosmer-Lemeshow test) and discrimination (area under the receiver operating characteristic curve [AUC]). RESULTS Thirteen risk factors for TFF were included in the prediction model, as follows: female age; female body mass index; infertility duration; number of oocytes retrieved; stimulation protocol; infertility etiology; infertility diagnosis; male age; sperm concentration; total sperm motility; normal sperm morphology percentage; swim-up sperm motility; and swim-up sperm concentration. The AUC of our model was 0.815 (95% CI: 0.783-0.846), indicating satisfactory discrimination performance. CONCLUSION Considering female and male factors (especially sperm parameters), we established a model that predicts the probability of TFF in conventional IVF procedures that will be helpful in the laboratory supporting IVF to facilitate physicians in determining optimal treatment.
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Affiliation(s)
- Ming Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive, Technology, Beijing, 100191, China
| | - Xiangyue Duan
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive, Technology, Beijing, 100191, China
| | - Nan Zhang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive, Technology, Beijing, 100191, China
| | - Feng Ding
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive, Technology, Beijing, 100191, China
| | - Yuanyuan Wang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive, Technology, Beijing, 100191, China
| | - Ping Liu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive, Technology, Beijing, 100191, China
| | - Rong Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, China.
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China.
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive, Technology, Beijing, 100191, China.
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Jin W, Lin J, Wang P, Yang H, Jin C. Screening the predictors for live birth failure in women after the first frozen embryo transfer based on the Lasso algorithm: a retrospective study. ZYGOTE 2023:1-9. [PMID: 37183670 DOI: 10.1017/s0967199423000217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This study aimed to screen factors related to live birth outcomes of women with first frozen embryo transfer (FET). The enrolled women were divided into training and validation cohorts. The least absolute shrinkage and selection operator (Lasso) regression algorithm of machine learning and the multiple regression model were then used to screen factors relevant to live birth failure (LBF) for the training dataset. A nomogram risk prediction model was established on the basis of the screened factors, and the consistency index (C-index) and calibration curve were derived for evaluating the model. The validation cohort was utilized to validate the nomogram model further. In total, 2083 women who accepted the first FET in our hospital were included and 44 factors were initially screened in this study. On the basis of the training cohort, the screened risk factors via multiple regression analysis with odds ratio (OR) values were female age (OR: 3.092, 95%CI: 1.065-4.852), body mass index (BMI; OR: 1.106, 95%CI: 1.015-1.546), caesarean section (OR: 1.909, 95%CI: 1.318-2.814), number of high-quality embryos (OR: 0.698, 95%CI: 0.599-0.812), and endometrial thickness (OR: 0.957, CI: 0.904-0.980). The nomogram model was generated based on five predictors. Furthermore, favourable results with C-indexes and calibration curves close to ideal curves indicated the accurate predictive ability of the nomogram. Female age, BMI, caesarean section, number of high-quality embryos, and endometrial thickness were independent predictors for LBF. The five factors of the risk assessment model may help to identify LBF with high accuracy in women who accept FET.
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Affiliation(s)
- Wumin Jin
- Department of Reproductive Medicine Centre, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jia Lin
- Department of Reproductive Medicine Centre, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Peiyu Wang
- Department of Reproductive Medicine Centre, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haiyan Yang
- Department of Reproductive Medicine Centre, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Congcong Jin
- Department of Reproductive Medicine Centre, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Vaiarelli A, Zacà C, Spadoni V, Cimadomo D, Conforti A, Alviggi C, Palermo R, Bulletti C, De Santis L, Pisaturo V, Vigiliano V, Scaravelli G, Ubaldi FM, Borini A. Clinical and laboratory key performance indicators in IVF: A consensus between the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR) and the Italian Society of Embryology, Reproduction and Research (SIERR). J Assist Reprod Genet 2023:10.1007/s10815-023-02792-1. [PMID: 37093443 DOI: 10.1007/s10815-023-02792-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/30/2023] [Indexed: 04/25/2023] Open
Abstract
PURPOSE Infertility is increasing worldwide, and many couples seek IVF. Clinical management and laboratory work are fundamental in the IVF journey. Therefore, the definition of reliable key performance indicators (KPIs) based on clinical and laboratory parameters, is essential for internal quality control (IQC). Laboratory performance indicators have been identified and a first attempt to also determine clinical ones has been recently published. However, more detailed indicators are required. METHODS An Italian group of experts in Reproductive Medicine from both public and private clinics on behalf of SIFES-MR and SIERR was established to define IVF indicators to monitor clinical performance. RESULTS The working group built a consensus on a list of KPIs, performance indicators (PIs) and recommendation indicators (RIs). When deemed necessary, the reference population was stratified by woman age, response to ovarian stimulation and adoption of preimplantation genetic testing for aneuploidies (PGT-A). Each indicator was scored with a value from 1 to 5 and a weighted average formula - considering all the suggested parameters-was defined. This formula generates a center performance score, indicating low, average, good, or excellent performance. CONCLUSION This study is intended to provide KPIs, PIs and RIs that encompass several essential aspects of a modern IVF clinic, including quality control and constant monitoring of clinical and embryological features. These indicators could be used to assess the quality of each center with the aim of improving efficacy and efficiency in IVF.
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Affiliation(s)
- Alberto Vaiarelli
- GeneraLife IVF, Clinica Valle Giulia, Via G. De Notaris, 2B, Rome, Italy.
| | | | | | - Danilo Cimadomo
- GeneraLife IVF, Clinica Valle Giulia, Via G. De Notaris, 2B, Rome, Italy
| | - Alessandro Conforti
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Carlo Alviggi
- Department of Public Health, Federico II University, Naples, Italy
| | - Roberto Palermo
- Unità Di Procreazione Medicalmente Assistita, Centro A.M.B.R.A., Palermo, Italy
| | - Carlo Bulletti
- Department of Obstetrics, Gynecology and Reproductive Science, Yale University, New Haven, CT, USA
- Scientific Partner of Incintas Therapeutics, New Haven, CT, USA
| | - Lucia De Santis
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Valerio Pisaturo
- Fondazione IRCCS, Ca' Granda, Ospedale Maggiore, Policlinico Di Milano, Milan, Italy
| | - Vincenzo Vigiliano
- ART Italian National Register, National Center for Diseases Prevention and Health Promotion, National Health Institute, Rome, Italy
| | - Giulia Scaravelli
- ART Italian National Register, National Center for Diseases Prevention and Health Promotion, National Health Institute, Rome, Italy
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Houri O, Gil Y, Danieli-Gruber S, Shufaro Y, Sapir O, Hochberg A, Ben-Haroush A, Wertheimer A. Prediction of oocyte maturation rate in the GnRH antagonist flexible IVF protocol using a novel machine learning algorithm - A retrospective study. Eur J Obstet Gynecol Reprod Biol 2023; 284:100-104. [PMID: 36965213 DOI: 10.1016/j.ejogrb.2023.03.022] [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: 07/08/2022] [Revised: 01/17/2023] [Accepted: 03/18/2023] [Indexed: 03/27/2023]
Abstract
Oocyte maturation is affected by various patient and cycle parameters and has a key effect on treatment outcome. A prediction model for oocyte maturation rate formulated by using machine learning and neural network algorithms has not yet been described. A retrospective cohort study that included all women aged ≤ 38 years who underwent their first IVF treatment using a flexible GnRH antagonist protocol in a single tertiary hospital between 2010 and 2015. 462 patients met the inclusion criteria. Median maturation rate was approximately 80%. Baseline characteristics and treatment parameters of cycles with high oocyte maturation rate (≥80%, n = 236) were compared to cycles with low oocyte maturation rate (<80%, n = 226). We used an XGBoost algorithm that fits the training data using decision trees and rates factors according to their influence on the prediction. For the machine training phase, 80% of the cohort was randomly selected, while rest of the samples were used to evaluate our model's accuracy. We demonstrated an accuracy rate of 75% in predicting high oocyte maturation rate in GnRH antagonist cycles. Our model showed an operating characteristic curve with AUC of 0.78 (95% CI 0.73-0.82). The most predictive parameters were peak estradiol level on trigger day, estradiol level on antagonist initiation day, average dose of gonadotropins per day and progesterone level on trigger day. A state-of-the-art machine learning algorithm presented promising ability to predict oocyte maturation rate in the first GnRH antagonist flexible protocol using simple parameters before final trigger for ovulation. A prospective study to evaluate this model is needed.
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Affiliation(s)
- Ohad Houri
- IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva, 4941492, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6901128, Israel.
| | - Yotam Gil
- IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva, 4941492, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6901128, Israel
| | - Shir Danieli-Gruber
- IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva, 4941492, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6901128, Israel
| | - Yoel Shufaro
- IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva, 4941492, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6901128, Israel
| | - Onit Sapir
- IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva, 4941492, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6901128, Israel
| | - Alyssa Hochberg
- IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva, 4941492, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6901128, Israel
| | - Avi Ben-Haroush
- IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva, 4941492, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6901128, Israel
| | - Avital Wertheimer
- IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva, 4941492, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6901128, Israel
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Wang CW, Kuo CY, Chen CH, Hsieh YH, Su ECY. Predicting clinical pregnancy using clinical features and machine learning algorithms in in vitro fertilization. PLoS One 2022; 17:e0267554. [PMID: 35675328 PMCID: PMC9176781 DOI: 10.1371/journal.pone.0267554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 04/12/2022] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Assisted reproductive technology has been proposed for women with infertility. Moreover, in vitro fertilization (IVF) cycles are increasing. Factors contributing to successful pregnancy have been widely explored. In this study, we used machine learning algorithms to construct prediction models for clinical pregnancies in IVF. MATERIALS AND METHODS A total of 24,730 patients entered IVF and intracytoplasmic sperm injection cycles with clinical pregnancy outcomes at Taipei Medical University Hospital. Data used included patient characteristics and treatment. We used machine learning methods to develop prediction models for clinical pregnancy and explored how each variable affects the outcome of interest using partial dependence plots. RESULTS Experimental results showed that the random forest algorithm outperforms logistic regression in terms of areas under the receiver operating characteristics curve. The ovarian stimulation protocol is the most important factor affecting pregnancy outcomes. Long and ultra-long protocols have shown positive effects on clinical pregnancy among all protocols. Furthermore, total frozen and transferred embryos are positive for a clinical pregnancy, but female age and duration of infertility have negative effects on clinical pregnancy. CONCLUSION Our findings show the importance of variables and propensity of each variable by random forest algorithm for clinical pregnancy in the assisted reproductive technology cycle. This study provides a ranking of variables affecting clinical pregnancy and explores the effects of each treatment on successful pregnancy. Our study has the potential to help clinicians evaluate the success of IVF in patients.
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Affiliation(s)
- Cheng-Wei Wang
- Division of Reproduction Medicine, Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chao-Yang Kuo
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- Smart Healthcare Interdisciplinary College, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chi-Huang Chen
- Division of Reproduction Medicine, Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Hui Hsieh
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Emily Chia-Yu Su
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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12
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Majeed HH, Mukheef MA, Jabbar HS. Comparing the ICSI outcome between different causes of subfertility and estimate the role of IL-1β in predicting ICSI outcome. THE JOURNAL OF MEDICAL INVESTIGATION 2022; 69:180-184. [DOI: 10.2152/jmi.69.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Hind Hadi Majeed
- Assistant lecturer at Jabir ibn hayyan medical university/ college of medicine/ department of human anatomy, Najaf, Iraq
| | - Maher Abbood Mukheef
- University of Warith Al-Anbiyaa/ College of Medicine/ Department of biochemistry, Kerbala, Iraq
| | - Hiba Sattar Jabbar
- Assistant lecturer at Al-Muthanna University/ college of medicine/ department of human anatomy, Al-Muthanna, Iraq
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Elbardisi H, Arafa M, Singh N, Betts B, Agrawal A, Henkel R, Al-Hadi AA, Burjaq H, Alattar A, Khalafalla K, Majzoub A. The effect of paternal age on intracytoplasmic sperm injection outcome in unexplained infertility. Arab J Urol 2021; 19:274-280. [PMID: 34552779 PMCID: PMC8451663 DOI: 10.1080/2090598x.2021.1955553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Objective : To examine the effect of paternal age on intracytoplasmic sperm injection (ICSI) outcomes in unexplained infertility. Subjects and Methods : This retrospective study, done at the Hamad Medical Corporation, Doha, Qatar screened infertile couples who underwent ICSI between 2014 and 2019 for the inclusion and exclusion criteria defining 'unexplained infertility'. Couples recruited were allocated into two groups: Group A (paternal age <35 years) and Group B (paternal age ≥35 years). Baseline characteristics, investigations including semen and advanced sperm function tests and ICSI records were compared for primary outcomes such as fertilisation, cleavage, clinical pregnancy, miscarriage and live birth; and secondary outcomes such as semen parameters and advanced sperm functions (DNA fragmentation index and oxidation reduction potential). Results : We found that final pregnancy outcomes including clinical pregnancy rate (P = 0.231), live-birth rate (P = 0.143), and miscarriage rates (P = 0.466) were not significantly different between the two age groups. Normal fertilisation (P = 0.01) and cleavage rate after ICSI (P = 0.001) were statistically significant when the age groups were compared. Also, normal sperm morphology was found to be significantly different (P = 0.041). Conclusions : Advanced paternal age affects sperm morphology, fertilisation and embryo cleavage in ICSI but does not appear to affect clinical pregnancy, miscarriage or live-birth rates. ICSI appears to be a valid fertility treatment option in advancing paternal age.
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Affiliation(s)
- Haitham Elbardisi
- Urology Department, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine-Qatar, Education City, Qatar
| | - Mohamed Arafa
- Urology Department, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine-Qatar, Education City, Qatar.,Andrology Department, Cairo University, Cairo, Egypt.,American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Neha Singh
- Obstetric & Genecology department King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Bridget Betts
- School of Pharmacy, University of Mississippi, Mississippi, USA
| | - Ashok Agrawal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.,Department of Metabolism, Digestion and Reproduction, Imperial College London, LondonUK.,Department of Medical Bioscience, University of Western Cape, Bellville, South Africa
| | - Alia A Al-Hadi
- Department of Reproductive Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Hasan Burjaq
- Department of Reproductive Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Alia Alattar
- Urology Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Ahmad Majzoub
- Urology Department, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine-Qatar, Education City, Qatar
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14
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Nomogram to predict pregnancy outcomes of emergency oocyte freeze-thaw cycles. Chin Med J (Engl) 2021; 134:2306-2315. [PMID: 34561337 PMCID: PMC8509984 DOI: 10.1097/cm9.0000000000001731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Existing clinical prediction models for in vitro fertilization are based on the fresh oocyte cycle, and there is no prediction model to evaluate the probability of successful thawing of cryopreserved mature oocytes. This research aims to identify and study the characteristics of pre-oocyte-retrieval patients that can affect the pregnancy outcomes of emergency oocyte freeze-thaw cycles. Methods: Data were collected from the Reproductive Center, Peking University Third Hospital of China. Multivariable logistic regression model was used to derive the nomogram. Nomogram model performance was assessed by examining the discrimination and calibration in the development and validation cohorts. Discriminatory ability was assessed using the area under the receiver operating characteristic curve (AUC), and calibration was assessed using the Hosmer–Lemeshow goodness-of-fit test and calibration plots. Results: The predictors in the model of “no transferable embryo cycles” are female age (odds ratio [OR] = 1.099, 95% confidence interval [CI] = 1.003–1.205, P = 0.0440), duration of infertility (OR = 1.140, 95% CI = 1.018–1.276, P = 0.0240), basal follicle-stimulating hormone (FSH) level (OR = 1.205, 95% CI = 1.051–1.382, P = 0.0084), basal estradiol (E2) level (OR = 1.006, 95% CI = 1.001–1.010, P = 0.0120), and sperm from microdissection testicular sperm extraction (MESA) (OR = 7.741, 95% CI = 2.905–20.632, P < 0.0010). Upon assessing predictive ability, the AUC for the “no transferable embryo cycles” model was 0.799 (95% CI: 0.722–0.875, P < 0.0010). The Hosmer–Lemeshow test (P = 0.7210) and calibration curve showed good calibration for the prediction of no transferable embryo cycles. The predictors in the cumulative live birth were the number of follicles on the day of human chorionic gonadotropin (hCG) administration (OR = 1.088, 95% CI = 1.030–1.149, P = 0.0020) and endometriosis (OR = 0.172, 95% CI = 0.035–0.853, P = 0.0310). The AUC for the “cumulative live birth” model was 0.724 (95% CI: 0.647–0.801, P < 0.0010). The Hosmer–Lemeshow test (P = 0.5620) and calibration curve showed good calibration for the prediction of cumulative live birth. Conclusions: The predictors in the final multivariate logistic regression models found to be significantly associated with poor pregnancy outcomes were increasing female age, duration of infertility, high basal FSH and E2 level, endometriosis, sperm from MESA, and low number of follicles with a diameter >10 mm on the day of hCG administration.
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Zhang X, Guo F, Wang Q, Bai W, Zhao A. Low-dose aspirin improves blood perfusion of endometrium of unexplained recurrent biochemical pregnancy loss. Int J Gynaecol Obstet 2021; 157:418-423. [PMID: 34314517 DOI: 10.1002/ijgo.13838] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/22/2021] [Accepted: 07/21/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the differences in Doppler parameters of endometrial receptivity in unexplained recurrent biochemical pregnancy loss (URBPL) and the therapeutic effect of low-dose aspirin (LDA). METHODS A retrospective study was conducted at Ren Ji Hospital, Shanghai, PR China, from January 2017 to January 2019. Doppler parameters of endometrium and uterus were recorded as the evaluation of the endometrial receptivity. Receiver operating characteristic (ROC) curve was managed to predict the risk of URBPL. Ultrasonography tests were repeated after 2 months of treatment with LDA. RESULTS Biochemical pregnancies did not correlate with maternal age. The resistance of endometrial perfusion (pulsatility index, resistive index, and systolic-to-diastolic ratio) was significantly higher in URBPLs (P < 0.001) and had predictive values (0.739, 0.779, and 0.760, respectively). Endometrial thickness and impedance to uterine blood flow showed no statistically significant difference (P > 0.05). After treatment with LDA, patients with URBPL improved the blood perfusion of endometrium significantly (P < 0.01). CONCLUSION There was no relation between BPL and maternal age. Patients with URBPL had inappropriate endometrial blood velocity. Doppler indices are capable of predicting the risk of URBPL. LDA exerts the therapeutic effect on improving blood perfusion of endometrium in URBPL.
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Affiliation(s)
- Xiaoxin Zhang
- Department of Obstetrics and Gynecology, School of Medicine, Ren Ji Hospital, Shanghai JiaoTong University, Shanghai, PR China.,Shanghai Key Laboratory of Gynecologic Oncology, Shanghai, PR China
| | - Feng Guo
- Department of Obstetrics and Gynecology, School of Medicine, Ren Ji Hospital, Shanghai JiaoTong University, Shanghai, PR China
| | - Qiaohong Wang
- Department of Obstetrics and Gynecology, School of Medicine, Ren Ji Hospital, Shanghai JiaoTong University, Shanghai, PR China
| | - Wenxin Bai
- Department of Obstetrics and Gynecology, School of Medicine, Ren Ji Hospital, Shanghai JiaoTong University, Shanghai, PR China
| | - Aimin Zhao
- Department of Obstetrics and Gynecology, School of Medicine, Ren Ji Hospital, Shanghai JiaoTong University, Shanghai, PR China.,Shanghai Key Laboratory of Gynecologic Oncology, Shanghai, PR China
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16
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Scaravelli G, Zacà C, Levi Setti PE, Livi C, Ubaldi FM, Villani MT, Greco E, Coccia ME, Revelli A, Ricci G, Fusi F, Vigiliano V, De Luca R, Bolli S, Borini A. Fertilization rate as a novel indicator for cumulative live birth rate: a multicenter retrospective cohort study of 9,394 complete in vitro fertilization cycles. Fertil Steril 2021; 116:766-773. [PMID: 33972085 DOI: 10.1016/j.fertnstert.2021.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To appraise the fertilization rate as a predictive factor for cumulative live birth rate (CLBR). DESIGN Multicenter retrospective cohort study. SETTING Ten in vitro fertilization clinics, whose data were collected and processed by the assisted reproductive technology (ART) Italian National Registry. PATIENT(S) 7,968 couples undergoing 9,394 complete intracytoplasmic sperm injection cycles. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The primary outcome measure was the CLBR in association with the fertilization rate intervals (<65%-group 1; 65%-80%-group 2; and >80%-group 3). Further data stratification was performed on the basis of maternal age (<34, 35-38, and 39-42 years) and number of retrieved oocytes (5-7, 8-10, and > 10 oocytes). RESULT(S) The CLBR was progressively higher in relation to the fertilization rate in groups 1, 2, and 3 (20.1%, 34.7%, and 41.3%, respectively). The number of recovered oocytes, embryo number per cycle, and cumulative pregnancy rate followed the same trend. The decrease in CLBR with increasing maternal age was significantly correlated with the fertilization rate and CLBR in all 3 maternal age groups. Multivariate logistic regression analysis showed fertilization rate as a factor independently associated with CLBR. CONCLUSION(S) The present data indicated a positive association between the fertilization rate and the CLBR, suggesting the predictive clinical relevance of this parameter and its adoption as a key performance indicator.
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Affiliation(s)
- Giulia Scaravelli
- ART Italian National Register, National Centre for Diseases Prevention and Health Promotion, National Health Institute, Rome, Italy
| | - Carlotta Zacà
- 9.Baby, Family and Fertility Center, Tecnobios Procreazione, Bologna, Italy
| | - Paolo Emanuele Levi Setti
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Humanitas Fertility Center. Humanitas Clinical and Research Center (IRCCS), Rozzano (Milan), Italy
| | - Claudia Livi
- Demetra Assisted Reproductive Center, Florence, Italy
| | | | - Maria Teresa Villani
- Department of Obstetrics and Gynecology, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, Emilia, Italy
| | - Ermanno Greco
- Center for Reproductive Medicine, European Hospital, Rome, Italy
| | | | - Alberto Revelli
- Gynecology and Obstetrics 1U, Physiopathology of Reproduction and IVF Unit, Sant'Anna Hospital, University of Torino, Italy
| | - Giuseppe Ricci
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy; Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Francesco Fusi
- Department of Maternal Fetal and Pediatric Medicine, ASST, Papa Giovanni XXIII, Bergamo, Italy
| | - Vincenzo Vigiliano
- ART Italian National Register, National Centre for Diseases Prevention and Health Promotion, National Health Institute, Rome, Italy
| | - Roberto De Luca
- ART Italian National Register, National Centre for Diseases Prevention and Health Promotion, National Health Institute, Rome, Italy
| | - Simone Bolli
- ART Italian National Register, National Centre for Diseases Prevention and Health Promotion, National Health Institute, Rome, Italy
| | - Andrea Borini
- 9.Baby, Family and Fertility Center, Tecnobios Procreazione, Bologna, Italy.
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17
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Ratna MB, Bhattacharya S, Abdulrahim B, McLernon DJ. A systematic review of the quality of clinical prediction models in in vitro fertilisation. Hum Reprod 2021; 35:100-116. [PMID: 31960915 DOI: 10.1093/humrep/dez258] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 11/01/2019] [Indexed: 12/20/2022] Open
Abstract
STUDY QUESTION What are the best-quality clinical prediction models in IVF (including ICSI) treatment to inform clinicians and their patients of their chance of success? SUMMARY ANSWER The review recommends the McLernon post-treatment model for predicting the cumulative chance of live birth over and up to six complete cycles of IVF. WHAT IS KNOWN ALREADY Prediction models in IVF have not found widespread use in routine clinical practice. This could be due to their limited predictive accuracy and clinical utility. A previous systematic review of IVF prediction models, published a decade ago and which has never been updated, did not assess the methodological quality of existing models nor provided recommendations for the best-quality models for use in clinical practice. STUDY DESIGN, SIZE, DURATION The electronic databases OVID MEDLINE, OVID EMBASE and Cochrane library were searched systematically for primary articles published from 1978 to January 2019 using search terms on the development and/or validation (internal and external) of models in predicting pregnancy or live birth. No language or any other restrictions were applied. PARTICIPANTS/MATERIALS, SETTING, METHODS The PRISMA flowchart was used for the inclusion of studies after screening. All studies reporting on the development and/or validation of IVF prediction models were included. Articles reporting on women who had any treatment elements involving donor eggs or sperm and surrogacy were excluded. The CHARMS checklist was used to extract and critically appraise the methodological quality of the included articles. We evaluated models' performance by assessing their c-statistics and plots of calibration in studies and assessed correct reporting by calculating the percentage of the TRIPOD 22 checklist items met in each study. MAIN RESULTS AND THE ROLE OF CHANCE We identified 33 publications reporting on 35 prediction models. Seventeen articles had been published since the last systematic review. The quality of models has improved over time with regard to clinical relevance, methodological rigour and utility. The percentage of TRIPOD score for all included studies ranged from 29 to 95%, and the c-statistics of all externally validated studies ranged between 0.55 and 0.77. Most of the models predicted the chance of pregnancy/live birth for a single fresh cycle. Six models aimed to predict the chance of pregnancy/live birth per individual treatment cycle, and three predicted more clinically relevant outcomes such as cumulative pregnancy/live birth. The McLernon (pre- and post-treatment) models predict the cumulative chance of live birth over multiple complete cycles of IVF per woman where a complete cycle includes all fresh and frozen embryo transfers from the same episode of ovarian stimulation. McLernon models were developed using national UK data and had the highest TRIPOD score, and the post-treatment model performed best on external validation. LIMITATIONS, REASONS FOR CAUTION To assess the reporting quality of all included studies, we used the TRIPOD checklist, but many of the earlier IVF prediction models were developed and validated before the formal TRIPOD reporting was published in 2015. It should also be noted that two of the authors of this systematic review are authors of the McLernon model article. However, we feel we have conducted our review and made our recommendations using a fair and transparent systematic approach. WIDER IMPLICATIONS OF THE FINDINGS This study provides a comprehensive picture of the evolving quality of IVF prediction models. Clinicians should use the most appropriate model to suit their patients' needs. We recommend the McLernon post-treatment model as a counselling tool to inform couples of their predicted chance of success over and up to six complete cycles. However, it requires further external validation to assess applicability in countries with different IVF practices and policies. STUDY FUNDING/COMPETING INTEREST(S) The study was funded by the Elphinstone Scholarship Scheme and the Assisted Reproduction Unit, University of Aberdeen. Both D.J.M. and S.B. are authors of the McLernon model article and S.B. is Editor in Chief of Human Reproduction Open. They have completed and submitted the ICMJE forms for Disclosure of potential Conflicts of Interest. The other co-authors have no conflicts of interest to declare. REGISTRATION NUMBER N/A.
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Affiliation(s)
- M B Ratna
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - S Bhattacharya
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - B Abdulrahim
- NHS Grampian, Aberdeen Fertility Centre, Aberdeen, UK
| | - D J McLernon
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, UK
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Li F, Lu R, Zeng C, Li X, Xue Q. Development and Validation of a Clinical Pregnancy Failure Prediction Model for Poor Ovarian Responders During IVF/ICSI. Front Endocrinol (Lausanne) 2021; 12:717288. [PMID: 34497586 PMCID: PMC8419272 DOI: 10.3389/fendo.2021.717288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUNDS Despite the great advances in assisted reproductive technology (ART), poor ovarian response (POR) is still one of the most challenging tasks in reproductive medicine. This predictive model we developed aims to predict the individual probability of clinical pregnancy failure for poor ovarian responders (PORs) under in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). METHODS The nomogram was developed in 281 patients with POR according to the Bologna criteria from January 2016 to December 2019, with 179 in the training group and 102 in the validation group. Univariate and multivariate logistic regression analyses were used to identify characteristics that were associated with clinical pregnancy failure. The nomogram was constructed based on regression coefficients. Performance was evaluated using both calibration and discrimination. RESULTS Age >35 years, body mass index (BMI) >24 kg/m2, basic follicle-stimulating hormone (FSH) >10 mIU/ml, basic E2 >60 pg/ml, type B or C of endometrium on human chorionic gonadotropin (hCG) day, and the number of high-quality embryos <2 were associated with pregnancy failure of POR patients. The area under the receiver operating characteristic curve (AUC) of the training set is 0.786 (95% confidence interval (CI): 0.710-0.861), and AUC in the validation set is 0.748 (95% CI: 0.668-0.827), showing a satisfactory goodness of fit and discrimination ability in this nomogram. CONCLUSION Our nomogram can predict the probability of clinical pregnancy failure in PORs before embryo transfer in IVF/ICSI procedure, to help practitioners make appropriate clinical decisions and to help infertile couples manage their expectations.
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Merviel P, Menard M, Cabry R, Scheffler F, Lourdel E, Le Martelot MT, Roche S, Chabaud JJ, Copin H, Drapier H, Benkhalifa M, Beauvillard D. Can Ratios Between Prognostic Factors Predict the Clinical Pregnancy Rate in an IVF/ICSI Program with a GnRH Agonist-FSH/hMG Protocol? An Assessment of 2421 Embryo Transfers, and a Review of the Literature. Reprod Sci 2020; 28:495-509. [PMID: 32886340 DOI: 10.1007/s43032-020-00307-2] [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: 05/28/2020] [Accepted: 08/25/2020] [Indexed: 11/30/2022]
Abstract
None of the models developed in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) is sufficiently good predictors of pregnancy. The aim of this study was to determine whether ratios between prognostic factors could predict the clinical pregnancy rate in IVF/ICSI. We analyzed IVF/ICSI cycles (based on long GnRH agonist-FSH protocols) at two ART centers (the second to validate externally the data). The ratios studied were (i) the total FSH dose divided by the serum estradiol level on the hCG trigger day, (ii) the total FSH dose divided by the number of mature oocytes, (iii) the serum estradiol level on the trigger day divided by the number of mature oocytes, (iv) the serum estradiol level on the trigger day divided by the endometrial thickness on the trigger day, (v) the serum estradiol level on the trigger day divided by the number of mature oocytes and then by the number of grade 1 or 2 embryos obtained, and (vi) the serum estradiol level on the trigger day divided by the endometrial thickness on the trigger day and then by the number of grade 1 or 2 embryos obtained. The analysis covered 2421 IVF/ICSI cycles with an embryo transfer, leading to 753 clinical pregnancies (31.1% per transfer). Four ratios were significantly predictive in both centers; their discriminant power remained moderate (area under the receiver operating characteristic curve between 0.574 and 0.610). In contrast, the models' calibration was excellent (coefficients: 0.943-0.978; p < 0.001). Our ratios were no better than existing models in IVF/ICSI programs. In fact, a strongly discriminant predictive model will be probably never be obtained, given the many factors that influence the occurrence of a pregnancy.
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Affiliation(s)
- Philippe Merviel
- ART Center, Brest University Hospital, 2 avenue Foch, 29200, Brest, France. .,Department of Gynecology, Obstetrics and Reproductive Medicine, Brest University Hospital, 2 avenue Foch, F-29200, Brest, France.
| | - Michel Menard
- ART Center, Brest University Hospital, 2 avenue Foch, 29200, Brest, France
| | - Rosalie Cabry
- ART Center, Amiens University Hospital, 1 rond-point du professeur Christian Cabrol, 80054, Amiens, France
| | - Florence Scheffler
- ART Center, Amiens University Hospital, 1 rond-point du professeur Christian Cabrol, 80054, Amiens, France
| | - Emmanuelle Lourdel
- ART Center, Amiens University Hospital, 1 rond-point du professeur Christian Cabrol, 80054, Amiens, France
| | | | - Sylvie Roche
- ART Center, Brest University Hospital, 2 avenue Foch, 29200, Brest, France
| | | | - Henri Copin
- ART Center, Amiens University Hospital, 1 rond-point du professeur Christian Cabrol, 80054, Amiens, France
| | - Hortense Drapier
- ART Center, Brest University Hospital, 2 avenue Foch, 29200, Brest, France
| | - Moncef Benkhalifa
- ART Center, Amiens University Hospital, 1 rond-point du professeur Christian Cabrol, 80054, Amiens, France
| | - Damien Beauvillard
- ART Center, Brest University Hospital, 2 avenue Foch, 29200, Brest, France
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20
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The predicted probability of live birth in In Vitro Fertilization varies during important stages throughout the treatment: analysis of 114,882 first cycles. J Gynecol Obstet Hum Reprod 2020; 50:101878. [PMID: 32747217 DOI: 10.1016/j.jogoh.2020.101878] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 11/21/2022]
Abstract
RESEARCH QUESTION How much the variability in patients' response during in vitro fertilization (IVF) may add to the initial predicted prognosis based only on patients' basal characteristics? DESIGN Anonymous data were obtained from the Human Fertilization and Embryology Authority (HFEA). Data involving 114,882 stimulated fresh IVF cycles were retrospectively analyzed. Logistic regression was used to develop the models. RESULTS Prediction of live birth was feasible with moderate accuracy in all of the three models; discrimination of the model based only on basal patients' characteristics (AUROC 0.61) was markedly improved adding information of number of embryos (AUROC 0.65) and, mostly, number of oocytes (AUROC 0.66). CONCLUSIONS The addition to prediction models of parameters such as the number of embryos obtained and especially the number of oocytes retrieved can statistically significantly improve the overall prediction of live birth probabilities when based on only basal patients' characteristics. This seems to be particularly true for women after the first IVF cycle. Since ovarian response affects the probability of live birth in IVF, it is highly recommended to add markers of ovarian response to models based on basal characteristics to increase their predictive ability.
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21
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Shim YJ, Hong YH, Kim SK, Jee BC. Optimal numbers of mature oocytes to produce at least one or multiple top-quality day-3 embryos in normal responders. Clin Exp Reprod Med 2020; 47:221-226. [PMID: 32689758 PMCID: PMC7482947 DOI: 10.5653/cerm.2019.03377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 02/20/2020] [Indexed: 12/04/2022] Open
Abstract
Objective We attempted to identify the optimal cutoff numbers of mature oocytes that would produce at least one or multiple top-quality (grade A) day-3 embryos in normal responders undergoing stimulated in vitro fertilization (IVF) cycles. Methods We selected 210 fresh IVF cycles performed in 170 infertile women at a single center from January 2014 to November 2019. Four to 14 (total) oocytes were obtained in all cycles after conventional ovarian stimulation. A receiver operating characteristic curve analysis was performed to find the moderate and extreme cutoff numbers of mature oocytes that would produce ≥ 1, ≥ 2, ≥ 3, ≥ 4, and ≥ 5 top-quality embryos. Results The cutoff number of mature oocytes was significantly correlated with the number of top-quality embryos (r = 0.467, p= 0.000). The moderate cutoff number of mature oocytes was ≥ 3, ≥ 5, ≥ 5, ≥ 6, and ≥ 6 for obtaining ≥ 1, ≥ 2, ≥ 3, ≥ 4, and ≥ 5 top-quality embryos, respectively. The extreme cutoff number of mature oocytes was ≥ 9, ≥ 9, ≥ 10, ≥ 10, and ≥ 11 for obtaining ≥ 1, ≥ 2, ≥ 3, ≥ 4, and ≥ 5 top-quality embryos, respectively. Conclusion We present the optimal cutoff numbers of mature oocytes that would yield ≥ 1, ≥ 2, ≥ 3, ≥ 4, and ≥ 5 top-quality embryos with 95% specificity. Our findings could help infertility clinicians to set target mature oocyte numbers in women undergoing stimulated IVF cycles.
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Affiliation(s)
- Yoo Jin Shim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Yeon Hee Hong
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Byung Chul Jee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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22
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Ovarian reserve as a predictor of cumulative live birth. Eur J Obstet Gynecol Reprod Biol 2020; 252:273-277. [PMID: 32645642 DOI: 10.1016/j.ejogrb.2020.06.063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Develop an up to date prediction model using recent cycle data and key pre-treatment predictor variables to estimate a couple's individualised probability of a cumulative live birth after one cycle of ovarian stimulation and transfer of all frozen embryos, before the first embryo transfer. STUDY DESIGN This was a retrospective cohort study. To estimate the cumulative live birth rate we only included couples who had used all embryos from their initial stimulation or achieved a live birth. We constructed a logistic regression model using live birth as a dependent variable and age group, duration of infertility, primary vs. secondary infertility, insemination method, cause of infertility, Anti-Mullerian Hormone (AMH), Follicle Stimulating Hormone (FSH) and antral follicle count (AFC) as our independent variables and used a backward elimination method to create the best fitting regression models to predict the probability of a cumulative live birth (p < 0.05 for elimination). RESULTS There were 516 complete cycles of ovarian stimulation resulting in 357 livebirths giving a cumulative livebirth rate of 69.2 % (95 % CI 66.0-74.0). Women with a live birth had significantly lower median age (34 years [IQR 31-37] vs. 36 years [IQR 33-39], p = 0.01) and FSH (6.7 iu/L [IQR 5.8-7.9] vs. 7.4 iu/L [IQR 6.2-8.6] and a significantly higher median AMH (22.1 pmol/L [IQR 12.1-30.9] vs. 10.5 pmol/L [IQR 7.3-20.7], p = 0.01) and AFC (18 [IQR 12-26] vs. 12 [IQR 9-19], p = 0.01). The backward conditional logistic regression model retained age category, FSH category and AMH category as significant independent predictors. The area under the curve for this model was 0.68 (95 % CI 0.63 - 0.73). CONCLUSION Our prediction model estimates a couple's individualised probability of achieving a live birth after their first complete cycle of IVF using all known pre-treatment predictors. LIMITATIONS, REASONS FOR CAUTION The study population were only those eligible for NHS funded IVF treatment which have strict ovarian reserve criteria. Exclusion of those with very low egg reserve is likely to influence the predictive capacity of out model. Furthermore, our model was developed using cycle data from one unit and thus its predictive capacity has not been assessed on an independent cohort of women. We therefore welcome external geographical validation of our model prior to its use in clinical practice.
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Xu B, Liu C, Qian L, Qu Y, Su W, Xu J, Zhao J. Statistical Modelling Outcome of In Vitro Fertilization and Intracytoplasmic Sperm Injection: A Single Centre Study. Comb Chem High Throughput Screen 2020; 22:225-231. [PMID: 30947663 DOI: 10.2174/1386207322666190404145448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/19/2018] [Accepted: 01/02/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Assisted reproductive techniques (ART) have been extensively used to treat infertility. Inaccurate prediction of a couple's fertility often leads to lowered self-esteem for patients seeking ART treatment and causes fertility distress. OBJECTIVE This prospective study aimed to statistically analyze patient data from a single reproductive medical center over a period of 18 months, and to establish mathematical models that might facilitate accurate prediction of successful pregnancy when ART are used. METHODS In the present study, we analyzed clinical data prospectively collected from 760 infertile patients visiting the second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University between June 1, 2016 and December 31, 2017. Various advanced statistical methods, including broken-line regression, were employed to analyze the data. RESULTS Age remained the most important factor affecting the outcome of IVF/ICSI. Using the broken-line regression model, the fastest clinical pregnancy declining age was between 25 and 32. Female infertility type was found to be a key predictor for the number of good-quality embryos and successful pregnancy, along with the antral follicle count (AFC), total number of embryos, recombinant follicle stimulating hormones (rFSH) dosage, estradiol (E2) on the trigger day, and total number of oocytes retrieved. rFSH dosage was also significantly associated with the number of oocytes retrieved and the number of frozen embryos. CONCLUSION The fastest clinical pregnancy declining age is ranged between 25 and 32, and female infertility type is evidenced as another key predictive factor for the cumulative outcome of ART.
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Affiliation(s)
- Boyun Xu
- Reproductive Medicine Center, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou University, Wenzhou 325000, China
| | - Chang Liu
- Reproductive Medicine Center, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou University, Wenzhou 325000, China
| | - Lianfen Qian
- Department of Mathematical Sciences, Florida Atlantic University, Boca Raton, FL 33431, United States
| | - Yue Qu
- Wenzhou Medical University-Monash Biomedicine Discovery Institute Alliance in Clinical Experimental Biomedicine, Wenzhou 325027, China.,Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, VIC 3800, Australia
| | - Weijue Su
- Reproductive Medicine Center, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou University, Wenzhou 325000, China
| | - Jialing Xu
- Reproductive Medicine Center, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou University, Wenzhou 325000, China
| | - Junzhao Zhao
- Reproductive Medicine Center, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou University, Wenzhou 325000, China
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24
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Pan Y, Hao G, Wang Q, Liu H, Wang Z, Jiang Q, Shi Y, Chen ZJ. Major Factors Affecting the Live Birth Rate After Frozen Embryo Transfer Among Young Women. Front Med (Lausanne) 2020; 7:94. [PMID: 32266278 PMCID: PMC7105776 DOI: 10.3389/fmed.2020.00094] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/04/2020] [Indexed: 12/19/2022] Open
Abstract
In recent years, the freeze-all strategy has been widely adopted and applied. However, with the exception of age, the factors that affect the outcomes of frozen embryo transfer are still unclear. Therefore, the identification and mitigation of factors that influence the live birth rate after frozen embryo transfer is a good way to increase the "take-home-baby" rate of frozen embryo transfer. The objective of this study was to identify factors affecting the live birth rate after cleavage-stage frozen embryo transfer in young ovulatory women. This was a secondary analysis from a previously published multicenter randomized controlled trial (ChiCTR-IOR-14005406) that was originally designed to compare the live birth rate and perinatal complications after fresh embryo transfer to those after frozen embryo transfer among ovulatory women. This study was carried out using a portion of the data from the original randomized controlled trial, which included 917 young women who underwent cleavage-stage frozen embryo transfer. The 16 clinical candidate variables potentially affecting the live birth rate after frozen embryo transfer were analyzed. Univariable analysis and multivariable analysis were performed to assess the relationship between predictive factors and outcomes, with the aim of identifying independent predictors of live birth after frozen embryo transfer. In this study, the live birth rate was 53.0% (486/917). Three independent predictors were ultimately identified as the main factors affecting the live birth rate of ovulatory young women. Infertility duration [odds ratio (OR): 0.933, 95% confidence interval (CI): 0.876-0.995, p = 0.033], endometrial thickness before frozen embryo transfer (OR: 3.375, 95% CI: 1.556-7.321 p = 0.002), and the number of embryos transferred (OR: 2.653, 95% CI:1.226-5,743, p = 0.013) were the major factors contributing to the live birth rate after cleavage-stage frozen embryo transfer among young women. The cut-off point for infertility duration was 4.5 years, and the cut-off point for endometrial thickness was 0.89 cm. Infertility duration, endometrial thickness and number of embryos transferred might affect the live birth rate after frozen embryo transfer among young women. This result could help inform clinical decisions and counseling to increase the live birth rate after frozen embryo transfer among young women.
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Affiliation(s)
- Ye Pan
- Center for Reproductive Medicine, Shandong University, Jinan, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China.,Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, China
| | - Guimin Hao
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qiumin Wang
- Center for Reproductive Medicine, Shandong University, Jinan, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China.,Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, China
| | - Hong Liu
- Center for Reproductive Medicine, Shandong University, Jinan, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China.,Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, China
| | - Ze Wang
- Center for Reproductive Medicine, Shandong University, Jinan, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China.,Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, China
| | - Qi Jiang
- Center for Reproductive Medicine, Shandong University, Jinan, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China.,Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, China
| | - Yuhua Shi
- Center for Reproductive Medicine, Shandong University, Jinan, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China.,Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, China
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Shandong University, Jinan, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China.,Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, China
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25
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The effect of platelet-rich plasma on the achievement of pregnancy during frozen embryo transfer in women with a history of failed implantation. Heliyon 2020; 6:e03577. [PMID: 32195397 PMCID: PMC7075971 DOI: 10.1016/j.heliyon.2020.e03577] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 11/13/2019] [Accepted: 03/09/2020] [Indexed: 12/23/2022] Open
Abstract
Objective The aim of this study was to evaluate the effect of platelet-rich plasma (PRP) on the rate of implantation and pregnancy in women with repeated failed implantation during frozen embryo transfer. Methods This study was conducted on 50 infertile women candidates (who were referred to the Infertility Treatment Center of Besat Hospital in Sanandaj) with a history of failed implantation for the purpose of frozen embryo transfer. The participants were randomly divided into two groups (n = 25). In the first group (control), the intrauterine infusion of 0.5 ml of Ringer serum was done 48 h before embryo transfer. In the second group (treatment), the intrauterine infusion of 0.5 ml of PRP was performed 48 h before embryo transfer. Results In this study, there was no significant difference between the two groups in the rate of chemical and clinical pregnancy. The rate of chemical pregnancy was 28% in the treatment group and 36% in the control group, while the rate of clinical pregnancy was 28% in the treatment group and 24% in the control group. Conclusion The intrauterine infusion of PRP before frozen embryo transfer in infertile women with a history of failed implantation will not make any significant effect on the result of pregnancy.
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26
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Aghajanzadeh F, Esmaeilzadeh S, Basirat Z, Mahouti T, Heidari FN, Golsorkhtabaramiri M. Using autologous intrauterine platelet-rich plasma to improve the reproductive outcomes of women with recurrent implantation failure. JBRA Assist Reprod 2020; 24:30-33. [PMID: 31689042 PMCID: PMC6993157 DOI: 10.5935/1518-0557.20190055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective: Reproductive clinics are often faced with cases of repeated implantation failure (RIF). This study evaluated whether platelet-rich plasma (PRP) might improve the implantation outcomes of patients suffering from RIF. Methods: Thirty women with RIF submitted to frozen-thawed embryo transfers were included in the study. Intrauterine infusions of autologous purified platelet preparations were administered 48 hours prior to embryo transfer. Differences in implantation, clinical pregnancy, and miscarriage rates of cycles with and without PRP infusions were analyzed. Results: The implantation rate seen in the PRP group was 6.7%. No significant difference was found the between the implantation, clinical pregnancy, ongoing pregnancy, and miscarriage rates of frozen-thawed embryo transfers with and without PRP infusion. However, the effect size of PRP infusion (Cohen's d=0.39) on implantation rates revealed a relationship in medium strength. Conclusion: Platelet-rich plasma might potentially yield beneficial effects as a safe therapeutic option offered alongside other treatments designed to improve the reproductive outcomes of women with repeated implantation failure.
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Affiliation(s)
- Fateme Aghajanzadeh
- Fatemezahra Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Science, Iran, Middle East
| | - Sedighe Esmaeilzadeh
- Fatemezahra Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Science, Iran, Middle East
| | - Zahra Basirat
- Fatemezahra Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Science, Iran, Middle East
| | - Treza Mahouti
- Fatemezahra Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Science, Iran, Middle East
| | - Fateme Nadi Heidari
- Fatemezahra Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Science, Iran, Middle East
| | - Masoumeh Golsorkhtabaramiri
- Fatemezahra Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Science, Iran, Middle East
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Richardson AL, Baskind NE, Karuppusami R, Balen AH. Effect of deprivation on in vitro fertilisation outcome: a cohort study. BJOG 2019; 127:458-465. [DOI: 10.1111/1471-0528.16012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2019] [Indexed: 11/30/2022]
Affiliation(s)
- AL Richardson
- Leeds Fertility Seacroft Hospital Leeds Teaching Hospitals NHS Trust Leeds UK
| | - NE Baskind
- Leeds Fertility Seacroft Hospital Leeds Teaching Hospitals NHS Trust Leeds UK
| | - R Karuppusami
- Department of Biostatistics Christian Medical College and Hospital Vellore India
| | - AH Balen
- Leeds Fertility Seacroft Hospital Leeds Teaching Hospitals NHS Trust Leeds UK
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28
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Gu YE, Zhang X, Zhang Q, Dai MC, Wu Y, Zhou Y, Qu F. The effects of acupuncture on pregnancy outcomes of in vitro fertilization with embryo transfer: An interdisciplinary systematic review. J Gynecol Obstet Hum Reprod 2019; 48:677-684. [PMID: 31276842 DOI: 10.1016/j.jogoh.2019.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/25/2019] [Accepted: 07/01/2019] [Indexed: 12/14/2022]
Abstract
The present systematic review is designed to summarize the evidence concerning the effect of acupuncture on pregnancy outcomes in vitro fertilization with embryo transfer (IVF-ET). We searched MEDLINE, the Wanfang Database, the China Academic Journal Electronic Full-text Database in the China National Knowledge Infrastructure, and the Index to Chinese Periodical Literature. Randomized controlled trials with intervention groups using acupuncture and control groups consisting of no acupuncture or sham (placebo) acupuncture in IVF-ET treatment were selected. Study characteristics were examined from these studies and an intention-to-treat approach was used to extract outcome data from each study. In total, 31 articles including 4450 women passed our selection criteria. The legitimacy, characteristics, and IVF outcomes of the included trials were summarized. Additional Traditional Chinese Medicine (TCM) theory-based, standardized, large-size, randomized, and multicenter trials are necessary prior to any conclusions being drawn on whether TCM can improve IVF outcomes.
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Affiliation(s)
- Ying-Er Gu
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xian Zhang
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qing Zhang
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Min-Chen Dai
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yan Wu
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yong Zhou
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fan Qu
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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29
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Vaegter KK, Berglund L, Tilly J, Hadziosmanovic N, Brodin T, Holte J. Construction and validation of a prediction model to minimize twin rates at preserved high live birth rates after IVF. Reprod Biomed Online 2019; 38:22-29. [DOI: 10.1016/j.rbmo.2018.09.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 10/27/2022]
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30
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Zhang W, Wang M, Wang S, Bao H, Qu Q, Zhang N, Hao C. Luteal phase ovarian stimulation for poor ovarian responders. JBRA Assist Reprod 2018; 22:193-198. [PMID: 29931967 PMCID: PMC6106630 DOI: 10.5935/1518-0557.20180045] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective To compare the clinical outcomes of follicular versus luteal phase ovarian
stimulation in women with poor ovarian response (Bologna criteria)
undergoing IVF. Methods This retrospective study investigated 446 patients submitted to 507 cycles in
three groups. First, the two larger cohorts were examined: 154 patients
treated with luteal phase ovarian stimulation (Group Lu); and 231 patients
administered follicular phase ovarian stimulation (Group Fo). Then the
clinical outcomes of 61 patients submitted to double ovarian stimulation
were analyzed. Clinical outcomes included number of retrieved oocytes,
fertilization rate, cleavage rate, top-quality embryo rate, clinical
pregnancy rate (CPR), and live birth rate (LBR). Results Longer stimulation, higher dosages of HMG, and higher MII oocyte rates were
achieved in Group Lu (p<0.001). There were no
significant differences in CPR and LBR between the two groups offered
frozen-thawed embryo transfer (28.4% vs. 33.0%, p=0.484;
22.9% vs. 25.5%, p=0.666). In the double ovarian
stimulation group, the number of oocytes retrieved in the luteal phase
stimulation protocol was higher (p=0.035), although luteal
phase stimulation yielded a lower rate of MII oocytes
(p=0.031). CPR and LBR were not statistically different
(13.8% vs. 21.4%, p=0.525; 10.3% vs. 14.3%,
p=0.706). Conclusion Luteal phase ovarian stimulation may be a promising protocol to treat women
with POR, particularly for patients unable to yield enough viable embryos
through follicular phase ovarian stimulation or other protocols.
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Affiliation(s)
- Wei Zhang
- Yantai Yuhuangding Hospital of Qingdao University - Yantai - China
| | - Meimei Wang
- Yantai Yuhuangding Hospital of Qingdao University - Yantai - China
| | - Shuang Wang
- Yantai Yuhuangding Hospital of Qingdao University - Yantai - China
| | - Hongchu Bao
- Yantai Yuhuangding Hospital of Qingdao University - Yantai - China
| | - Qinglan Qu
- Yantai Yuhuangding Hospital of Qingdao University - Yantai - China
| | - Ning Zhang
- Yantai Yuhuangding Hospital of Qingdao University - Yantai - China
| | - Cuifang Hao
- Yantai Yuhuangding Hospital of Qingdao University - Yantai - China
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31
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Xue Y, Tong X, Zhu H, Li K, Zhang S. Freeze-all embryo strategy in poor ovarian responders undergoing ovarian stimulation for in vitro fertilization. Gynecol Endocrinol 2018; 34:680-683. [PMID: 29465272 DOI: 10.1080/09513590.2018.1427715] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
This retrospective study determined the efficacy of the 'freeze-all' embryo strategy in poor ovarian responders undergoing ovarian stimulation for in vitro fertilization (IVF). A total of 559 poor responders who met Bologna criteria between January 2012 and December 2014 were included in this study: 256 in the fresh embryo transfer group and 303 in the freeze-all group. Vitrification and warming of day 3 embryos were performed using the Cryotop method. The poor responders treated with fresh embryo transfer and those treated with freeze-all strategy showed similar live birth rates per cycle (12.1% vs. 16.2%, p = .172) and per transfer (15.9% vs. 20.9%, p = .182). Multivariate logistic regression analysis showed that maternal age at retrieval (odds ratio, 0.919; 95% confidence interval, 0.865-0.977; p = .006) and number of good-quality embryos transferred (odds ratio, 1.953; 95% confidence interval, 1.346-2.835; p < .001) were significantly associated with the live birth rate. Freeze-all cycle is an acceptable treatment in poor ovarian responders, and it should be suggested by physicians as an alternative to cycle cancelation in case in which a fresh transfer would not be advantageous.
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Affiliation(s)
- Yamei Xue
- a Reproductive Medicine Center, Department of Obstetrics and Gynecology , Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University , Hangzhou , Zhejiang , China
| | - Xiaomei Tong
- a Reproductive Medicine Center, Department of Obstetrics and Gynecology , Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University , Hangzhou , Zhejiang , China
| | - Haiyan Zhu
- a Reproductive Medicine Center, Department of Obstetrics and Gynecology , Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University , Hangzhou , Zhejiang , China
| | - Kun Li
- b Department of Reproductive Physiology , Zhejiang Academy of Medical Sciences , Hangzhou , Zhejiang , China
| | - Songying Zhang
- a Reproductive Medicine Center, Department of Obstetrics and Gynecology , Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University , Hangzhou , Zhejiang , China
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32
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Bos-Mikich A, de Oliveira R, Frantz N. Platelet-rich plasma therapy and reproductive medicine. J Assist Reprod Genet 2018; 35:753-756. [PMID: 29564738 DOI: 10.1007/s10815-018-1159-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 03/13/2018] [Indexed: 12/22/2022] Open
Abstract
Reports on clinical uses of platelet-rich plasma (PRP) have dramatically increased in the last decade. Indications for PRP therapy range from muscle and skeletal injuries to hair re-growth. More recently evidences have shown its positive effects in promoting endometrial and follicular growth and gestation in assisted reproduction cycles. We discuss the putative role of PRP on endometrial receptivity, with a brief history of its applications in research and clinical therapies. Despite its widespread uses in medicine, the mechanisms through which PRP exerts its regenerative effects are only postulated, not based on scientific data. There is an unmet need for advanced research to corroborate present findings in the clinical scenario.
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Affiliation(s)
| | | | - Nilo Frantz
- Nilo Frantz Human Reproduction Center, Porto Alegre, Brazil
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Murugappan G, Farland LV, Missmer SA, Correia KF, Anchan RM, Ginsburg ES. Gestational carrier in assisted reproductive technology. Fertil Steril 2018; 109:420-428. [PMID: 29428314 DOI: 10.1016/j.fertnstert.2017.11.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/08/2017] [Accepted: 11/09/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To compare clinical outcomes of in vitro fertilization (IVF) cycles with the use of gestational carriers (GCs) with non-GC IVF cycles. DESIGN Retrospective cohort study of assisted reproductive technology (ART) cycles performed with (24,269) and without (1,313,452) the use of a GC. SETTING ART centers. PATIENT(S) Infertile patients seeking IVF with or without use of a GC. INTERVENTIONS(S) Autologous and donor oocyte cycles, fresh and cryopreserved embryo transfer cycles. MAIN OUTCOME MEASURE(S) Live birth rate (LBR), twin and high-order multiple birth rates. RESULT(S) Approximately 2% of embryo transfers used a GC. Per embryo transfer, GCs had greater pregnancy rate and LBR across all IVF types compared with non-GC cycles in crude models and models adjusted a priori for potential confounders. For women with uterine-factor infertility, embryo transfer with the use of a GC resulted in a higher odds of live birth for autologous fresh embryos and for cryopreserved embryos compared with patients with non-uterine-factor infertility diagnoses. CONCLUSION(S) GC benefits LBRs for some patients seeking ART. The highest LBRs occurred when the indication for GC was uterine-factor infertility.
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Affiliation(s)
- Gayathree Murugappan
- Department of Reproductive Endocrinology and Infertility, Stanford University School of Medicine, Stanford, California.
| | - Leslie V Farland
- Division of Reproductive Medicine, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Stacey A Missmer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Division of Adolescent and Young Adult Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, Michigan
| | - Katharine F Correia
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Raymond M Anchan
- Division of Reproductive Medicine, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elizabeth S Ginsburg
- Division of Reproductive Medicine, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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34
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Marchiani S, Tamburrino L, Benini F, Fanfani L, Dolce R, Rastrelli G, Maggi M, Pellegrini S, Baldi E. Chromatin Protamination and Catsper Expression in Spermatozoa Predict Clinical Outcomes after Assisted Reproduction Programs. Sci Rep 2017; 7:15122. [PMID: 29123209 PMCID: PMC5680250 DOI: 10.1038/s41598-017-15351-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 10/19/2017] [Indexed: 01/19/2023] Open
Abstract
Identification of parameters predicting assisted reproductive technologies (ARTs) success is a major goal of research in reproduction. Quality of gametes is essential to achieve good quality embryos and increase the success of ARTs. We evaluated two sperm parameters, chromatin maturity and expression of the sperm specific calcium channel CATSPER, in relation to ART outcomes in 206 couples undergoing ARTs. Chromatin maturity was evaluated by Chromomycin A3 (CMA3) for protamination and Aniline Blue (AB) for histone persistence and CATSPER expression by a flow cytometric method. CMA3 positivity and CATSPER expression significantly predicted the attainment of good quality embryos with an OR of 6.6 and 14.3 respectively, whereas AB staining was correlated with fertilization rate. In the subgroup of couples with women ≤35 years, CATSPER also predicted achievement of clinical pregnancy (OR = 4.4). Including CMA3, CATSPER and other parameters affecting ART outcomes (female age, female factor and number of MII oocytes), a model that resulted able to predict good embryo quality with high accuracy was developed. CMA3 staining and CATSPER expression may be considered two applicable tools to predict ART success and useful for couple counseling. This is the first study demonstrating a role of CATSPER expression in embryo development after ARTs programs.
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Affiliation(s)
- S Marchiani
- Dept. of Experimental and Clinical Medicine, Center of Excellence DeNothe, University of Florence, Florence, Italy.
| | - L Tamburrino
- Dept. of Experimental and Clinical Medicine, Center of Excellence DeNothe, University of Florence, Florence, Italy
| | - F Benini
- Centro Procreazione Assistita "Demetra", Florence, Italy
| | - L Fanfani
- Centro Procreazione Assistita "Demetra", Florence, Italy
| | - R Dolce
- Dept. of Experimental and Clinical Medicine, Center of Excellence DeNothe, University of Florence, Florence, Italy
| | - G Rastrelli
- Dept. of Experimental and Clinical Biomedical Sciences "Mario Serio", Center of Excellence DeNothe, University of Florence, Florence, Italy
| | - M Maggi
- Dept. of Experimental and Clinical Biomedical Sciences "Mario Serio", Center of Excellence DeNothe, University of Florence, Florence, Italy
| | - S Pellegrini
- Centro Procreazione Assistita "Demetra", Florence, Italy
| | - E Baldi
- Dept. of Experimental and Clinical Medicine, Center of Excellence DeNothe, University of Florence, Florence, Italy.
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Yavas Y. Curvilinear relationship between age and assisted reproduction technique success: retrospective analyses of US National ART Surveillance System data from 2010-2014. Reprod Biomed Online 2017; 35:657-668. [PMID: 28865756 DOI: 10.1016/j.rbmo.2017.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 11/26/2022]
Abstract
In assisted reproduction technique cycles using fresh autologous embryos, the pattern by which outcomes per started cycle (live birth and clinical pregnancy) and per clinical pregnancy (live birth and miscarriage) change with age was determined. A dataset was created with 488,351 cycles. Success rates changed with age following well-fitted, ∩-shaped curvilinear (quadratic, cubic, quartic) regressions. These rates increased steadily from age <24-28 years (P = 0.001; P = 0.02; P = 0.04; respectively) with positive slopes (P ≤ 0.03); live birth and pregnancy rates per cycle were lower in women aged <25 years versus women aged 25-28 years (P = 0.0002; P = 0.01, respectively), and declined steadily thereafter with negative slopes (P < 0.0001). The initial increase occurred at decreasing rates; subsequent decline occurred at increasing rates. Women aged <29 years with successful outcomes were older than those who were unsuccessful (P = 0.001; P = 0.04; P = 0.001; respectively); those with successful outcomes were younger in other age groups (P < 0.0001). Miscarriage followed similar but reverse ∪-shaped curvilinear regressions. Age-driven decline in success rates begins <30 years and occurs at increasing rates, suggesting that women >30 years old with infertility should not delay assisted reproduction, if it is their only option.
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Affiliation(s)
- Yalcin Yavas
- Stats of the ART, 1202 NW 180th Ave, Pembroke Pines, FL 33029, USA; Palm Beach Fertility Center, 7015 Beracasa Way, Suite 201, Boca Raton, FL 33433, USA.
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Bracewell-Milnes T, Saso S, Abdalla H, Nikolau D, Norman-Taylor J, Johnson M, Holmes E, Thum MY. Metabolomics as a tool to identify biomarkers to predict and improve outcomes in reproductive medicine: a systematic review. Hum Reprod Update 2017; 23:723-736. [DOI: 10.1093/humupd/dmx023] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 07/05/2017] [Indexed: 12/30/2022] Open
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Vanni VS, Somigliana E, Reschini M, Pagliardini L, Marotta E, Faulisi S, Paffoni A, Vigano’ P, Vegetti W, Candiani M, Papaleo E. Top quality blastocyst formation rates in relation to progesterone levels on the day of oocyte maturation in GnRH antagonist IVF/ICSI cycles. PLoS One 2017; 12:e0176482. [PMID: 28520729 PMCID: PMC5435161 DOI: 10.1371/journal.pone.0176482] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 04/11/2017] [Indexed: 02/05/2023] Open
Abstract
Cycles with progesterone elevation during controlled ovarian stimulation (COS) for IVF/ICSI are commonly managed with a "freeze-all" strategy, due to a well-recognized detrimental effect of high progesterone levels on endometrial receptivity. However, also a detrimental effect of elevated progesterone on day-3 embryo quality has recently been found with regards to top quality embryo formation rate. Because blastocyst culture and cryopreservation are largely adopted, we deemed relevant to determine whether this detrimental effect is also seen on blastocyst quality on day 5-6. This issue was investigated through a large two-center retrospective study including 986 GnRH antagonist IVF/ICSI cycles and using top quality blastocyst formation rate as the main outcome. Results showed that on multivariate analysis sperm motility (p<0.01) and progesterone levels at ovulation triggering (p = 0.01) were the only two variables that significantly predicted top quality blastocyst formation rate after adjusting for relevant factors including female age, BMI, basal AMH and total dose of FSH used for COS. More specifically, progesterone levels at induction showed an inverse relation with top quality blastocyst formation (correlation coefficient B = -1.08, 95% CI -1.9 to -0.02) and ROC curve analysis identified P level >1.49 ng/ml as the best cut-off for identification of patients at risk for the absence of top quality blastocysts (AUC 0.55, p<0.01). Our study is the first to investigate the top quality blastocyst formation rate in relation to progesterone levels in IVF/ICSI cycles, showing that increasing progesterone is associated with lower rates of top quality blastocyst. Hence, the advantages of prolonging COS to maximize the number of collected oocytes might eventually be hindered by a decrease in top quality blastocysts available for transfer, if increasing progesterone levels are observed. This observation extends the results of two recent studies focused on day-3 embryos and deserves further research.
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Affiliation(s)
- V. S. Vanni
- Centro Scienze Natalità, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - E. Somigliana
- Fondazione IRCCS Ca’Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Università degli Studi di Milano, Milan, Italy
| | - M. Reschini
- Fondazione IRCCS Ca’Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - L. Pagliardini
- Centro Scienze Natalità, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - E. Marotta
- Centro Scienze Natalità, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - S. Faulisi
- Centro Scienze Natalità, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - A. Paffoni
- Fondazione IRCCS Ca’Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - P. Vigano’
- Centro Scienze Natalità, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- * E-mail:
| | - W. Vegetti
- Fondazione IRCCS Ca’Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - M. Candiani
- Università Vita-Salute San Raffaele, Milan, Italy
| | - E. Papaleo
- Centro Scienze Natalità, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Heitmann RJ, Hill MJ, Csokmay JM, Pilgrim J, DeCherney AH, Deering S. Embryo transfer simulation improves pregnancy rates and decreases time to proficiency in Reproductive Endocrinology and Infertility fellow embryo transfers. Fertil Steril 2017; 107:1166-1172.e1. [PMID: 28292614 DOI: 10.1016/j.fertnstert.2017.01.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 12/22/2016] [Accepted: 01/19/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To design and evaluate an ET simulator to train Reproductive Endocrinology and Infertility (REI) fellows' techniques of ET. DESIGN Simulation model development and retrospective cohort analysis. SETTING Not applicable. PATIENT(S) Patients undergoing IVF. INTERVENTION(S) Simulation model evaluation and implementation of ET simulation training. MAIN OUTCOME MEASURE(S) Pregnancy rates. RESULT(S) The REI fellow and faculty evaluation responses (n = 19/21 [90%]) of the model demonstrated realistic characteristics, with evaluators concluding the model was suitable for training in almost all evaluated areas. A total of 12 REI fellows who performed ET were analyzed: 6 before ET trainer and 6 after ET trainer. Pregnancy rates were 31% in the initial 10 ETs per fellow before simulator vs. 46% after simulator. One of six pre-ET trainer fellows (17%) had pregnancy rates ≥40% in their first 10 ETs; whereas four of six post-ET trainer fellows had pregnancy rates ≥40% in their first 10 ETs. The average number of ETs to obtain >40% pregnancy efficiency was 27 ETs before trainer vs. 15 ETs after trainer. Pregnancy rates were similar in the two groups after 20 ETs, and collective terminal pregnancy rates were >50% after 40 ETs. CONCLUSION(S) Embryo transfer simulation improved REI fellow pregnancy rates in their first 10 transfers and led to a more rapid ET proficiency. These data suggest potential value in adopting ET simulation, even in programs with a robust history of live ET in fellowship training.
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Affiliation(s)
- Ryan J Heitmann
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, Washington.
| | - Micah J Hill
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - John M Csokmay
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Justin Pilgrim
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Alan H DeCherney
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Shad Deering
- Department of Obstetrics and Gynecology, Uniformed University of the Health Sciences, Bethesda, Maryland
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Vaegter KK, Lakic TG, Olovsson M, Berglund L, Brodin T, Holte J. Which factors are most predictive for live birth after in vitro fertilization and intracytoplasmic sperm injection (IVF/ICSI) treatments? Analysis of 100 prospectively recorded variables in 8,400 IVF/ICSI single-embryo transfers. Fertil Steril 2017; 107:641-648.e2. [DOI: 10.1016/j.fertnstert.2016.12.005] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/09/2016] [Accepted: 12/06/2016] [Indexed: 10/20/2022]
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40
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Garcia-Velasco JA, Acevedo B, Alvarez C, Alvarez M, Bellver J, Fontes J, Landeras J, Manau D, Martinez F, Muñoz E, Robles A, Rodriguez-Tabernero L. Response: in reference to 'Strategies to manage refractory endometrium: state of the art 2016'. Reprod Biomed Online 2016; 33:605. [PMID: 27575342 DOI: 10.1016/j.rbmo.2016.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 08/18/2016] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | | | | | - Juan Fontes
- Hospital Virgen, de las Nieves, Granada, Spain
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41
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Tigges J, Godehardt E, Soepenberg T, Maxrath B, Friol K, Gnoth C. Determinants of cumulative ART live-birth rates in a single-center study: age, fertilization modality, and first-cycle outcome. Arch Gynecol Obstet 2016; 294:1081-1089. [DOI: 10.1007/s00404-016-4162-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 07/27/2016] [Indexed: 10/21/2022]
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42
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Strategies to manage refractory endometrium: state of the art in 2016. Reprod Biomed Online 2016; 32:474-89. [DOI: 10.1016/j.rbmo.2016.02.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 02/07/2016] [Accepted: 02/09/2016] [Indexed: 01/01/2023]
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43
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Does Unilateral Oocyte Retrieval due to Transvaginally Inaccessible Ovaries, Contrary to Common Beliefs, Affect IVF/ICSI Treatment Outcomes That Much? BIOMED RESEARCH INTERNATIONAL 2016; 2016:3687483. [PMID: 27123444 PMCID: PMC4829687 DOI: 10.1155/2016/3687483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/21/2016] [Indexed: 11/28/2022]
Abstract
Objective. To investigate in vitro fertilization (IVF) treatment outcomes of unilateral oocyte retrieval in patients with transvaginally inaccessible ovaries. Study Design. Ninety-two women who underwent unilateral oocyte retrieval were retrospectively matched for age, antral follicle count, and body mass index with 184 women who underwent bilateral oocyte retrieval. Each patient in bilateral oocyte retrieval group had the same number of cumulus oophorus complexes (COCs) from single ovary and had comparable number of follicles (±2) on contralateral site where follicular aspiration was performed. Results. The number of COCs, metaphase-2 oocytes, 2-pronuclei, and top-quality embryos was significantly lower in unilateral oocyte retrieval group. However, proportion of patients with an embryo transfer of at least one top-quality embryo was found to be comparable between unilateral and bilateral oocyte retrieval. Subsequently, clinical pregnancy and live birth rates were found to be similar between the groups. The ROC curve analysis revealed (AUC = 0.74, 95% CI 0.63–0.86, p = 0.001) that retrieved COCs ≥ 5 from single ovary had sensitivity of 76.0% and specificity of 64.2% for occurrence of a clinical pregnancy. Conclusion. The patients with unilateral oocyte retrieval have reasonable chance of success with IVF. The retrieval of ≥5 COCs from accessible ovary might result in better treatment outcomes among these patients.
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Antsiferova YS, Sotnikova NY. Apoptosis and endometrial receptivity: Relationship with in vitro fertilization treatment outcome. World J Obstet Gynecol 2016; 5:87-96. [DOI: 10.5317/wjog.v5.i1.87] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 09/28/2015] [Accepted: 12/02/2015] [Indexed: 02/05/2023] Open
Abstract
Apoptosis is an important process in the reconstruction of endometrium within the menstrual cycle. The balance between cell proliferation and apoptosis regulates the periodic repair and shedding of endometrial cells and leads to the menstruation or prepare the mucosal layer of endometrium for the implantation of the embryo. Many factors with pro- and antiapoptotic action, such as B cell lymphoma/leukemia-2 and inhibitors apoptosis proteins families, caspases, tumor necrosis factor receptors, phosphatase and tensin homolog, proliferator-activated receptor gamma, microRNAs and others are differently expressed in the endometrial tissue at phases of menstrual cycle. Receptivity of the endometrium at the period of “window of implantation” is associated with the significant increase of apoptosis in endometrium to allow the embryo to be successfully implanted. The impairment of apoptosis regulation in the endometrium at this period often is observed in infertile women with endometriosis, tubal factor, polycystic ovary syndrome, etc.. In many cases the impairment of apoptosis regulation in the endometrium is the main cause of in vitro fertilization (IVF) treatment failure in these patients. As of today, the exact mechanisms and factors mediating the apoptotic process in normal endometrium and in infertile women are not fully understood. Herein, the literature data concerning the endometrial apoptosis regulation in general, and in light of the influence of apoptosis upon IVF treatment outcome are reviewed. The possibility to use some parameters of endometrial apoptosis for prediction of the successful pregnancy achievement in women participating in IVF protocols also is discussed.
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The influence of female age on the cumulative live-birth rate of fresh cycles and subsequent frozen cycles using vitrified blastocysts in hyper-responders. Taiwan J Obstet Gynecol 2015; 54:567-71. [DOI: 10.1016/j.tjog.2015.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 06/16/2015] [Indexed: 11/23/2022] Open
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Chen YH, Xu XH, Wang Q, Zhang SD, Jiang LL, Zhang CL, Ge ZJ. Optimum oocyte retrieved and transfer strategy in young women with normal ovarian reserve undergoing a long treatment protocol: a retrospective cohort study. J Assist Reprod Genet 2015; 32:1459-67. [PMID: 26384107 DOI: 10.1007/s10815-015-0571-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 09/07/2015] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This study aimed to investigate the relationship between the number of oocytes retrieved and clinical outcomes in young women with normal ovarian reserve who were undergoing their first in vitro fertilization and embryo transfer (IVF-ET) cycle. The transfer strategy based on yielded oocytes was also discussed in this article. METHODS A total of 1567 patients who underwent first long protocol of IVF treatment in our reproductive medical center between January 2010 and June 2014 were categorized into five groups based on the retrieved oocyte number, namely, 4∼6, 7∼9, 10∼12, 13∼15, and ≥16. Baseline parameters were similar among the groups. Primary outcome was defined as the cumulative live birth rate (CLBR), and secondary outcomes included the rate of patients with high risks for ovarian hyperstimulation syndrome (OHSS). RESULTS It was found that the CLBR increased with the number of oocytes, as well as the rate for high risks of OHSS. In fresh cycles, 10∼12 oocyte group demonstrated the highest implantation rate (53.32 %), clinical pregnancy rate (CPR) (73.13 %), and live birth rate (LBR) (61.14 %), with no significant differences. Moreover, both cumulative CPR (CCPR) and CLBR became significantly higher in the 10∼12 oocyte group, compared with 4∼6 and 7∼9 groups. However, when the retrieved oocytes increased to 13∼15 or ≥16, the cumulative results did not have a significant increase. Also, the high risk rate of OHSS was much lower in the 10∼12 group (11.53 %) than that in the 13∼15 group (29.97 %) and ≥16 group (77.30 %). Unconditional multivariate logistic regression analysis showed that when ≥10 oocytes were retrieved, the CLBR increased significantly (P < 0.01). When oocyte number exceeded 16, the CPR of frozen embryo transfer cycle was much higher than that of fresh cycle (P < 0.05). CONCLUSIONS For young women with normal ovarian reserve, retrieving 10∼12 oocytes might result in optimized pregnancy outcomes in a fresh cycle with low OHSS risk and would not compromise cumulative outcomes. When ≥16 oocytes were retrieved, a "freeze-all" embryo strategy might be preferable.
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Affiliation(s)
- Yuan-hui Chen
- Reproductive Medical Center, People's Hospital of Zhengzhou University, 450003, Weiwu Road, Zhengzhou, Henan Province, People's Republic of China. .,Reproductive Medical Center, Henan Provincial People's Hospital, 450003, Weiwu Road, Zhengzhou, Henan Province, People's Republic of China.
| | - Xiao-hang Xu
- Reproductive Medical Center, People's Hospital of Zhengzhou University, 450003, Weiwu Road, Zhengzhou, Henan Province, People's Republic of China. .,Reproductive Medical Center, Henan Provincial People's Hospital, 450003, Weiwu Road, Zhengzhou, Henan Province, People's Republic of China.
| | - Qian Wang
- Reproductive Medical Center, People's Hospital of Zhengzhou University, 450003, Weiwu Road, Zhengzhou, Henan Province, People's Republic of China. .,Reproductive Medical Center, Henan Provincial People's Hospital, 450003, Weiwu Road, Zhengzhou, Henan Province, People's Republic of China.
| | - Shao-di Zhang
- Reproductive Medical Center, Henan Provincial People's Hospital, 450003, Weiwu Road, Zhengzhou, Henan Province, People's Republic of China.
| | - Li-le Jiang
- Reproductive Medical Center, People's Hospital of Zhengzhou University, 450003, Weiwu Road, Zhengzhou, Henan Province, People's Republic of China. .,Reproductive Medical Center, Henan Provincial People's Hospital, 450003, Weiwu Road, Zhengzhou, Henan Province, People's Republic of China.
| | - Cui-lian Zhang
- Reproductive Medical Center, Henan Provincial People's Hospital, 450003, Weiwu Road, Zhengzhou, Henan Province, People's Republic of China.
| | - Zhao-jia Ge
- Reproductive Medical Center, Henan Provincial People's Hospital, 450003, Weiwu Road, Zhengzhou, Henan Province, People's Republic of China.
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Predictors of in vitro fertilization outcomes in women with highest follicle-stimulating hormone levels ≥ 12 IU/L: a prospective cohort study. PLoS One 2015; 10:e0124789. [PMID: 25867175 PMCID: PMC4395083 DOI: 10.1371/journal.pone.0124789] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/11/2015] [Indexed: 11/19/2022] Open
Abstract
Objective The purpose of this study is to evaluate factors predictive of outcomes in women with highest follicle-stimulating hormone (FSH) levels ≥12 IU/L on basal testing, undergoing in vitro fertilization (IVF). Methods A prospective cohort study was conducted at Stanford University Hospital in the Reproductive Endocrinology and Infertility Center for 12 months. Women age 21 to 43 undergoing IVF with highest FSH levels on baseline testing were included. Donor/Recipient and frozen embryo cycles were excluded from this study. Prognostic factors evaluated in association with clinical pregnancy rates were type of infertility diagnosis and IVF stimulation parameters. Results The current study found that factors associated with clinical pregnancy were: increased number of mature follicles on the day of triggering, number of oocytes retrieved, number of Metaphase II oocytes if intracytoplasmic sperm injection was done, and number of embryos developed 24 hours after retrieval. Conclusions Our findings suggest that it would be beneficial for women with increased FSH levels to attempt a cycle of IVF. Results of ovarian stimulation, especially embryo quantity appear to be the best predictors of IVF outcomes and those can only be obtained from a cycle of IVF. Therefore, increased basal FSH levels should not discourage women from attempting a cycle of IVF.
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Hessel M, de Vries M, D'Hauwers KWM, Fleischer K, Hulsbergen-van de Kaa CA, Braat DDM, Ramos L. Cytological evaluation of spermatogenesis: a novel and simple diagnostic method to assess spermatogenesis in non-obstructive azoospermia using testicular sperm extraction specimens. Andrology 2015; 3:481-90. [DOI: 10.1111/andr.12023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 12/15/2014] [Accepted: 02/04/2015] [Indexed: 11/29/2022]
Affiliation(s)
- M. Hessel
- Department of Obstetrics and Gynaecology; Radboud University Medical Centre; Nijmegen the Netherlands
| | - M. de Vries
- Department of Obstetrics and Gynaecology; Radboud University Medical Centre; Nijmegen the Netherlands
| | - K. W. M. D'Hauwers
- Department of Urology; Radboud University Medical Centre; Nijmegen the Netherlands
| | - K. Fleischer
- Department of Obstetrics and Gynaecology; Radboud University Medical Centre; Nijmegen the Netherlands
| | | | - D. D. M. Braat
- Department of Obstetrics and Gynaecology; Radboud University Medical Centre; Nijmegen the Netherlands
| | - L. Ramos
- Department of Obstetrics and Gynaecology; Radboud University Medical Centre; Nijmegen the Netherlands
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Liao C, Huang R, Scherer RW, Liang XY. Prognostic factors associated with clinical pregnancy in in vitro fertilization using pituitary down-regulation with depot and daily low-dose luteal phase gonadotropin releasing hormone agonists: A single center's experience. J Hum Reprod Sci 2015; 8:30-6. [PMID: 25838746 PMCID: PMC4381380 DOI: 10.4103/0974-1208.153124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 01/15/2015] [Accepted: 02/27/2015] [Indexed: 11/29/2022] Open
Abstract
AIM: To review the experience on depot-dose, and daily low-dose gonadotropin releasing hormone agonist (GnRHa) long protocols and identify prognostic factors. SETTING AND DESIGN: A chart review was conducted on 2106 depot and 1299 daily low-dose cycles at a university hospital. METHODS: Clinical parameters were summarized, and prognostic factors of clinical pregnancy for each protocol were identified by logistic regressions. Missing data were imputed using multiple imputations (MI) and the regression models were rerun after MI. RESULTS: Clinical pregnancy rate was 57.5% and 46.9% in the depot and daily low-dose groups, respectively. Logistic regressions with MI identified age (odds ratio [OR]: 0.95, 95% confidence interval [CI]: 0.92–0.98), serum progesterone (OR: 0.62, 95% CI: 0.45–0.84) and endometrial thickness (OR: 1.06, 95% CI: 1.02–1.12) on human chorionic gonadotropin (hCG) day, number of oocytes retrieved (OR: 1.04, 95% CI: 1.01–1.06), fertilization rate (OR: 2.66, 95% CI: 1.46–4.87) and ratio of good-quality D3 embryos (OR: 4.31, 95% CI: 2.79–6.67) as prognostic factors in the depot group. Age (OR: 0.95, 95% CI: 0.92–0.98), endometrial thickness on hCG day (OR: 1.09, 95% CI: 1.03–1.15), ratio of good quality D3 embryos (OR: 2.56, 95% CI: 1.59–4.13) and the number of cryopreserved embryos (OR: 1.07, 95% CI: 1.003–1.15) are prognostic for the daily low-dose protocol. Some regression coefficients that are significant under model-wise deletion become nonsignificant after MI. CONCLUSIONS: Age, embryo quality and endometrial thickness on hCG day are important prognostic factors for both 1.0/1.3 mg depot and 0.05/0.1 mg daily low-dose luteal phase GnRHa long protocols. MI is a valuable tool to gauge and address bias caused by missing data in reproductive medicine.
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Affiliation(s)
- Caiyun Liao
- Reproductive Medicine Research Center of the Sixth Affiliated Hospital, Sun Yat Sen University, Tianhe District, Guangzhou, Guangdong 510620, China
| | - Rui Huang
- Reproductive Medicine Research Center of the Sixth Affiliated Hospital, Sun Yat Sen University, Tianhe District, Guangzhou, Guangdong 510620, China
| | - Roberta W Scherer
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland 21205, USA
| | - Xiao-Yan Liang
- Reproductive Medicine Research Center of the Sixth Affiliated Hospital, Sun Yat Sen University, Tianhe District, Guangzhou, Guangdong 510620, China
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Yang R, Yang S, Li R, Chen X, Wang H, Ma C, Liu P, Qiao J. Biochemical pregnancy and spontaneous abortion in first IVF cycles are negative predictors for subsequent cycles: an over 10,000 cases cohort study. Arch Gynecol Obstet 2015; 292:453-8. [PMID: 25663163 DOI: 10.1007/s00404-015-3639-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 01/27/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE To identify whether biochemical pregnancy (BP) and spontaneous abortion (SA) cases have the same clinical characteristics in assisted reproductive therapy (ART), and to assess its predictive value for the subsequent cycles. METHODS Retrospectively reviewed 12,174 cycles in the first in vitro fertilization and embryo transfer (IVF-ET) cycle from January 2009 to December 2012 of Peking University Third Hospital Reproductive Medical Center. Besides those patients who reached ongoing pregnancy stage, 7,598 cases were divided into three groups: group 1, lack of pregnancy (n = 6,651); group 2, BP (n = 520); and group 3, SA (n = 427). We compared the basic status of patients of the three groups, including ages, body mass index, basic hormone levels, controlled ovarian hyperstimulation protocols, amount of gonadotropin use, and endometrium thickness. The reproductive outcome of the next embryo transfer cycles of the three groups was analyzed. RESULTS 520 patients ended as BP, and 427 patients ended as SA. The age, primary infertility proportion, body mass index, basic FSH level and basic E2 level were similar among groups. Endometrial thickness, controlled ovarian hyperstimulation protocol, Gn dosage, average oocyte retrieval and ET numbers were also similar. Multivariate analysis showed that only the age (P = 0.037, OR 1.060, 95 % CI 1.001-1.120) and endometrium thickness on hCG administration day (P = 0.029, OR 1.136, 95 % CI 1.013-1.275) may result in the differences between BP and SA groups. In the subsequent ET cycles, the total BP rate was 4.37 %, clinical pregnancy rate was 37.28 %, and miscarriage rate was 8.18 %. The clinical pregnancy rates were similar among groups. However, BP group still had the highest BP rate (P < 0.05, 7.97 vs. 4.01 % and 5.28 %), BP and SA group had higher miscarriage rate (P < 0.05, 11.76 % and 14.75 vs. 7.41 %). CONCLUSION BP and SA in first IVF cycles had negative predictive value for subsequent ART outcomes.
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Affiliation(s)
- Rui Yang
- Department of Obstetrics and Gynecology, Reproductive Medical Center, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, China
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