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Liao Z, Yan C, Wang J, Zhang N, Yang H, Lin C, Zhang H, Wang W, Li W. A clinical consensus-compliant deep learning approach to quantitatively evaluate human in vitro fertilization early embryonic development with optical microscope images. Artif Intell Med 2024; 149:102773. [PMID: 38462274 DOI: 10.1016/j.artmed.2024.102773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/13/2023] [Accepted: 01/14/2024] [Indexed: 03/12/2024]
Abstract
The selection of embryos is a key for the success of in vitro fertilization (IVF). However, automatic quality assessment on human IVF embryos with optical microscope images is still challenging. In this study, we developed a clinical consensus-compliant deep learning approach, named Esava (Embryo Segmentation and Viability Assessment), to quantitatively evaluate the development of IVF embryos using optical microscope images. In total 551 optical microscope images of human IVF embryos of day-2 to day-3 were collected, preprocessed, and annotated. Using the Faster R-CNN model as baseline, our Esava model was constructed, refined, trained, and validated for precise and robust blastomere detection. A novel algorithm Crowd-NMS was proposed and employed in Esava to enhance the object detection and to precisely quantify the embryonic cells and their size uniformity. Additionally, an innovative GrabCut-based unsupervised module was integrated for the segmentation of blastomeres and embryos. Independently tested on 94 embryo images for blastomere detection, Esava obtained the high rates of 0.9940, 0.9121, and 0.9531 for precision, recall, and mAP respectively, and gained significant advances compared with previous computational methods. Intraclass correlation coefficients indicated the consistency between Esava and three experienced embryologists. Another test on 51 extra images demonstrated that Esava surpassed other tools significantly, achieving the highest average precision 0.9025. Moreover, it also accurately identified the borders of blastomeres with mIoU over 0.88 on the independent testing dataset. Esava is compliant with the Istanbul clinical consensus and compatible to senior embryologists. Taken together, Esava improves the accuracy and efficiency of embryonic development assessment with optical microscope images.
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Affiliation(s)
- Zaowen Liao
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chaoyu Yan
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Jianbo Wang
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Ningfeng Zhang
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huan Yang
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China; Medical Big Data Center, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chenghao Lin
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Haiyue Zhang
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Wenjun Wang
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Weizhong Li
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China; Center for Precision Medicine, Sun Yat-sen University, Guangzhou, China; Key Laboratory of Tropical Disease Control (Ministry of Education), Sun Yat-Sen University, Guangzhou, China.
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Ma H, Mao R, Wang R, Liang Y, Jin Y, Chen H, Cheng J. Effects of inactivated COVID-19 vaccinations on the IVF/ICSI-ET live birth rate and pregnancy complication in a population of southern China: A retrospective cohort study. J Evid Based Med 2023. [PMID: 36992550 DOI: 10.1111/jebm.12528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 03/31/2023]
Affiliation(s)
- Huaqing Ma
- Reproductive Center, Gynecology and Obstetrics Department, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
| | - Ruotong Mao
- Reproductive Center, Gynecology and Obstetrics Department, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
| | - Ruina Wang
- Reproductive Center, Gynecology and Obstetrics Department, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
| | - Yingxiu Liang
- Reproductive Center, Gynecology and Obstetrics Department, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
| | - Yueqi Jin
- Reproductive Center, Gynecology and Obstetrics Department, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
| | - Hui Chen
- Faculty of Science, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jing Cheng
- Reproductive Center, Gynecology and Obstetrics Department, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
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Fang T, Yu W, Ou S, Lu J, Li R, Zhao M, Chan YL, Wang W. The impact of oocytes containing smooth endoplasmic reticulum aggregates on assisted reproductive outcomes: a cohort study. BMC Pregnancy Childbirth 2022; 22:838. [PMCID: PMC9664725 DOI: 10.1186/s12884-022-05141-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
The impact of smooth endoplasmic reticulum aggregates (SERa) on assisted reproductive technology (ART) outcomes was still controversial. Our objective is to investigate the impact of the presence of SERa on intracytoplasmic sperm injection (ICSI) outcomes.
Methods
This was a retrospective cohort study. A total of 1,090 fresh ICSI cycles from 944 patients between January 2016 and June 2020 were included. Outcomes from clinical, embryological and neonatal aspects were compared between SERa + and SERa- cycles as well as between SERa + and SERa- oocytes.
Results
The total gonadotropin (Gn) dose, number of oocytes retrieved, serum estradiol concentration and number of the available embryo were significantly higher in SERa + cycles than in SERa- cycles (P < 0.05). Comparable two pronuclei (2PN) fertilization rate and poly-pronucleus zygote rate were shown in SERa + and SERa- cycles (P > 0.05), but which were higher in SERa + oocytes than in SERa- oocytes (P < 0.05). No statistical difference in blastocyst formation rate was found in SERa + and SERa- cycles as well as in SERa + and SERa- oocytes (P > 0.05). Good-quality embryo rate was statistically higher in SERa- cycles than in SERa + cycles (P < 0.05), but the difference was comparable between SERa + and SERa- oocytes (P > 0.05). No statistical difference in clinical pregnancy rate, spontaneous abortion rate, live birth rate and premature delivery rate were found in SERa + and SERa- cycles as well as in SERa + and SERa- oocytes (P > 0.05). The implantation rate was comparable in SERa + and SERa- cycles (P > 0.05), but it is higher in the group of only SERa- embryo transfer when compared with the group of mixed SERa + and SERa- embryo transfer (P < 0.05). 159 newborns in SERa + cycles and 140 newborns in SERa- cycles were followed up. Comparable newborn malformation rate was observed between SERa + and SERa- cycles and oocytes (P > 0.05). Logistic regression analysis revealed number of oocytes and total dose of Gn were risk factors for SERa occurrence (aOR = 1.05 and 1.55, P < 0.001).
Conclusion
Oocyte's SERa is correlated with a number of oocytes retrieved and higher Gn dose, but it does not affect pregnancy outcomes and increase newborn malformation rate.
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Wang M, Yang Q, Liu J, Hu J, Li D, Ren X, Xi Q, Zhu L, Jin L. GVBD rate is an independent predictor for pregnancy in ICSI patients with surplus immature oocytes. Front Endocrinol (Lausanne) 2022; 13:1022044. [PMID: 36699025 PMCID: PMC9868552 DOI: 10.3389/fendo.2022.1022044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION It was reported that there were still up to 30% immature retrieved oocyte at germinal vesicle (GV) or metaphase I (MI) stage. Whether the spontaneous maturity competency of immature oocytes associated to the clinical outcome of in vitro fertilization (IVF) cycles remains unclear and unexplored. This study aimed to investigate how the oocyte developmental parameters in in vitro maturation (IVM) affect clinical outcomes of intracytoplasmic sperm injection (ICSI) cycles. METHODS This retrospective cohort study included couples undergoing ICSI in a university-affiliated hospital. Surplus immature oocytes during ICSI were collected and cultured in vitro. The numbers of germinal vesicle (GV) oocytes undergoing GV breakdown (GVBD) and polar body 1 extrusion within 24 h culture were recorded. The main outcome measurements were demographic baselines and oocyte developmental parameters in IVM associated with pregnancy outcomes. RESULTS A total of 191 couples were included with an overall GVBD rate of 63.7% (327/513) and oocyte maturation rate of 46.8% (240/513). 53.4% (102/191) of them had embryos transferred freshly, which originated from metaphase II oocytes that matured spontaneously in vivo, and 60.8% (62/102) got pregnant. Among factors with a P-value < 0.2 in univariate logistic regression analyses of pregnancy correlation, GVBD rate (OR 3.220, 95% CI 1.060-9.782, P=0.039) and progesterone level on human chorionic gonadotropin (HCG) day (OR 0.231, 95% CI 0.056-0.949, P=0.042) remained significant in the multivariate model. The area under the curve (AUC) of the predictive nomogram was 0.729 (95% CI 0.632-0.826) with an acceptable calibration. Moreover, decision curve analyses illustrated the superior overall net benefit of models that included the GVBD rate in clinical decisions within a wide range of threshold probabilities. CONCLUSION In conclusion, GVBD rate and progesterone level on HCG day may be associated with pregnancy outcomes in infertile couples during the regular ICSI procedure. An elevated GVBD rate within 24 h may greatly increase the likelihood of pregnancy in infertile couples during ICSI. This preliminary study may optimize clinical pregnancy prediction, which provides support in decision-making in clinical practice.
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Affiliation(s)
- Meng Wang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiyu Yang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Liu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Juan Hu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dan Li
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinling Ren
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qingsong Xi
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lixia Zhu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Jin
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Lei Jin,
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Salama S, Sharaf M, Salem SM, Rasheed MA, Salama E, Elnahas T, Lotfy R. FSH versus AMH: age-related relevance to ICSI results. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2021; 26:27. [PMID: 34421292 PMCID: PMC8369322 DOI: 10.1186/s43043-021-00071-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 07/30/2021] [Indexed: 12/04/2022] Open
Abstract
Background Women’s fecundity is known to decrease with the increase in chronologic age. Several biomarkers of the ovarian reserve, including follicle stimulating hormone (FSH), anti Müllerian hormone (AMH), have been proposed as possible predictors for the response to controlled ovarian stimulation (COS). Although there are assumptions indicating that the relationship between age and ovarian reserve is highly variable and the potential different validity of ovarian reserve markers in women in different age groups remains to be demonstrated. The purpose of our study was evaluating FSH and AMH as potential predictors of response to controlled ovarian stimulation and prediction of intracytoplasmic sperm injection (ICSI) outcome according to age. This prospective study has been carried out on 218 women having ICSI cycles. Cases were divided into two groups, group 1 (n 148), their age < 35 years, and group 2 (n 70), their age ≥ 35 years. All women received antagonist protocol during their ICSI cycles. Basal FSH and AMH were measured and correlated to the number of follicles on the day of trigger, the number of oocytes retrieved, chemical, and clinical pregnancies. Results The fertilization rate in group 1 was 68.15%, while in group 2 was 77.82% (p = 0.003) while the implantation rate (number of gestational sacs observed at 6 weeks of pregnancy divided by the number of transferred embryos) was 18.95 and 11.98% in group 1 and group 2, respectively (p = 0.041). The clinical pregnancy rate among both groups was 38.51% in group 1, while 24.29% in group 2 (p = 0.038). Women who got pregnant among those aged < 35 years had significantly lower basal FSH (p < 0.001), while women who got pregnant among those aged ≥ 35 years had significantly higher AMH levels (p value < 0.001) and higher E2 levels on the day of trigger (p = 0.007). Conclusion We found that below the age of 35 years, the chances of pregnancy are more correlated to FSH levels, while above the age of 35 years, AMH was a more relevant test.
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Affiliation(s)
- Sameh Salama
- Reproductive Health and Family Planning Department, Medical Research Division, National Research Centre, 33 Al Bohouth Street, Dokki, Giza, Egypt
| | - Marwa Sharaf
- Obstetrics and Gynaecology Department, Kasr El Eini Teaching Hospital, Cairo University, Cairo, Egypt
| | - Sondos M Salem
- Reproductive Health and Family Planning Department, Medical Research Division, National Research Centre, 33 Al Bohouth Street, Dokki, Giza, Egypt
| | - Mazen Abdel Rasheed
- Reproductive Health and Family Planning Department, Medical Research Division, National Research Centre, 33 Al Bohouth Street, Dokki, Giza, Egypt
| | - Ehab Salama
- Reproductive Health and Family Planning Department, Medical Research Division, National Research Centre, 33 Al Bohouth Street, Dokki, Giza, Egypt
| | - Tamer Elnahas
- Reproductive Health and Family Planning Department, Medical Research Division, National Research Centre, 33 Al Bohouth Street, Dokki, Giza, Egypt
| | - Rehab Lotfy
- Obstetrics and Gynaecology Department, Kasr El Eini Teaching Hospital, Cairo University, Cairo, Egypt
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Wikander I, Lundberg FE, Nilsson H, Borgström B, Rodriguez-Wallberg KA. A Prospective Study on Fertility Preservation in Prepubertal and Adolescent Girls Undergoing Hematological Stem Cell Transplantation. Front Oncol 2021; 11:692834. [PMID: 34277437 PMCID: PMC8278233 DOI: 10.3389/fonc.2021.692834] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/16/2021] [Indexed: 12/13/2022] Open
Abstract
Background Hematological stem cell transplantation (HSCT) is an established method which has markedly increased the survival rate of hematologic malignancies since its introduction in the 1980’s. The conditioning for HSCT has known gonadotoxic effects and often leads to premature loss of fertility. In this study we have prospectively followed a cohort of girls undergoing HSCT and studied the outcomes of fertility preservation treatments performed before or after HSCT, as well as the long-term reproductive outcome. Methods In this one-center prospective study, 39 girls counselled for fertility preservation prior to or after conditioning for HSCT for malignant or benign diseases at childhood or adolescence between 1990 and 2017 were included. The patients were presented with the option to undergo cryopreservation of ovarian tissue or oocytes depending on their age and the time available. Follicle counts of the ovarian tissue and number of oocytes collected before or after HSCT were compared between patients treated for benign and malignant diseases. Hormone measurements post HSCT treatment, including FSH and AMH, reproductive outcomes and overall survival until January 2021 were investigated. Results In total, 34 girls and adolescents underwent fertility preservation before or after HSCT. Before HSCT, ovarian tissue was cryopreserved in 15 patients and two patients had oocytes preserved. Thirteen patients cryopreserved ovarian tissue after HSCT and seven patients returned to cryopreserve oocytes. Follicles were present in all tissue samples collected prior to HSCT, and in more than half of the samples collected post-HSCT. Half of the patients had spontaneous menarche or resumed menstruation post HSCT. Overall, 35 patients had survived at end of follow up and 7 patients had achieved parenthood. Conclusions Since fertility loss is common following HSCT, fertility preservation should be offered to all patients. Fertility preservation treatments can be performed both before and after HSCT. Clinical Trial Registration https://clinicaltrials.gov/show/NCT04602962, identifier NTC04602962
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Affiliation(s)
- Ida Wikander
- Department of Reproductive Medicine, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm, Sweden
| | - Frida E Lundberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Nilsson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Birgit Borgström
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Kenny A Rodriguez-Wallberg
- Department of Reproductive Medicine, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm, Sweden.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
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Sahin G, Akdogan A, Aydın MH, Tekindal MA, Göker ENT, Tavmergen E. In-Vitro Fertilization Outcome Predictors in Women With High Baseline Follicle-Stimulating Hormone Levels: Analysis of Over 1000 Cycles From A Tertiary Center. JBRA Assist Reprod 2021; 25:235-241. [PMID: 33710840 PMCID: PMC8083852 DOI: 10.5935/1518-0557.20200088] [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] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 10/22/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The present study aimed to evaluate reproductive outcomes and determine the predictors of clinical pregnancy and live birth in women with elevated baseline follicle-stimulating hormone (FSH) levels, who have undergone intracytoplasmic sperm injection (ICSI) treatment. METHODS This retrospective study included 1011 ICSI cycles of women with high baseline FSH levels (> 10 IU/L), from a tertiary university IVF center between 2010 and 2015. Logistic regression analysis was performed to evaluate the prognostic factors of clinical pregnancy and live birth. RESULTS Among the 1011 ICSI cycles, the clinical pregnancy and live birth rates per oocyte retrieval were 19.5% and 14.3%, respectively. The live birth rates were 21.1% and 1.7% in women aged ≤30 years and those aged ≥40 years, respectively. In addition, the live birth rate was 1.47-fold higher in women from whom >3 oocytes were retrieved, compared to those from whom ≤3 oocytes were retrieved (p=0.047). Logistic regression analysis indicated that the age categories ≤30y, 36-39y and ≥40y, level of baseline FSH (≥20 IU/L) and the ovarian response (≤3 or >3 oocytes retrieved) were significantly associated with live birth. CONCLUSIONS Our study indicated that age, baseline FSH level, and ovarian response are independent predictive factors for clinical pregnancy and live birth among women with baseline FSH levels >10 IU/L.
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Affiliation(s)
- Gülnaz Sahin
- Ege University Family Planning and Infertility Treatment and Research Center, Ankara cad., 35100 Bornova, Izmir, Turkey
| | - Aysin Akdogan
- Ege University Family Planning and Infertility Treatment and Research Center, Ankara cad., 35100 Bornova, Izmir, Turkey
| | - Murat Hakan Aydın
- Deparment of Obstetrics and Gynecology, Ege University Faculty of Medicine, Ankara cad., 35100, Bornova, Izmir, Turkey
| | - Mustafa Agah Tekindal
- Selcuk University, Veterinary Faculty, Department of Biostatistics 42003 Selçuklu, Konya, Turkey
| | - Ege Nazan Tavmergen Göker
- Ege University Family Planning and Infertility Treatment and Research Center, Ankara cad., 35100 Bornova, Izmir, Turkey
- Deparment of Obstetrics and Gynecology, Ege University Faculty of Medicine, Ankara cad., 35100, Bornova, Izmir, Turkey
| | - Erol Tavmergen
- Ege University Family Planning and Infertility Treatment and Research Center, Ankara cad., 35100 Bornova, Izmir, Turkey
- Deparment of Obstetrics and Gynecology, Ege University Faculty of Medicine, Ankara cad., 35100, Bornova, Izmir, Turkey
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Xi Q, Yang Q, Wang M, Huang B, Zhang B, Li Z, Liu S, Yang L, Zhu L, Jin L. Individualized embryo selection strategy developed by stacking machine learning model for better in vitro fertilization outcomes: an application study. Reprod Biol Endocrinol 2021; 19:53. [PMID: 33820565 PMCID: PMC8020549 DOI: 10.1186/s12958-021-00734-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 03/23/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To minimize the rate of in vitro fertilization (IVF)- associated multiple-embryo gestation, significant efforts have been made. Previous studies related to machine learning in IVF mainly focused on selecting the top-quality embryos to improve outcomes, however, in patients with sub-optimal prognosis or with medium- or inferior-quality embryos, the selection between SET and DET could be perplexing. METHODS This was an application study including 9211 patients with 10,076 embryos treated during 2016 to 2018, in Tongji Hospital, Wuhan, China. A hierarchical model was established using the machine learning system XGBoost, to learn embryo implantation potential and the impact of double embryos transfer (DET) simultaneously. The performance of the model was evaluated with the AUC of the ROC curve. Multiple regression analyses were also conducted on the 19 selected features to demonstrate the differences between feature importance for prediction and statistical relationship with outcomes. RESULTS For a single embryo transfer (SET) pregnancy, the following variables remained significant: age, attempts at IVF, estradiol level on hCG day, and endometrial thickness. For DET pregnancy, age, attempts at IVF, endometrial thickness, and the newly added P1 + P2 remained significant. For DET twin risk, age, attempts at IVF, 2PN/ MII, and P1 × P2 remained significant. The algorithm was repeated 30 times, and averaged AUC of 0.7945, 0.8385, and 0.7229 were achieved for SET pregnancy, DET pregnancy, and DET twin risk, respectively. The trend of predictive and observed rates both in pregnancy and twin risk was basically identical. XGBoost outperformed the other two algorithms: logistic regression and classification and regression tree. CONCLUSION Artificial intelligence based on determinant-weighting analysis could offer an individualized embryo selection strategy for any given patient, and predict clinical pregnancy rate and twin risk, therefore optimizing clinical outcomes.
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Affiliation(s)
- Qingsong Xi
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Road, Wuhan, 430030, China
| | - Qiyu Yang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Road, Wuhan, 430030, China
| | - Meng Wang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Road, Wuhan, 430030, China
| | - Bo Huang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Road, Wuhan, 430030, China
| | - Bo Zhang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Road, Wuhan, 430030, China
| | - Zhou Li
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Road, Wuhan, 430030, China
| | - Shuai Liu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Road, Wuhan, 430030, China
| | - Liu Yang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Road, Wuhan, 430030, China
| | - Lixia Zhu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Road, Wuhan, 430030, China.
| | - Lei Jin
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Road, Wuhan, 430030, China.
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Fang T, Chen M, Yu W, Ma T, Su Z, Chan DYL, Zhao M, Zheng Q, Wang W. The predictive value of endometrial thickness in 3117 fresh IVF/ICSI cycles for ectopic pregnancy. J Gynecol Obstet Hum Reprod 2021; 50:102072. [PMID: 33508484 DOI: 10.1016/j.jogoh.2021.102072] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/17/2020] [Accepted: 01/14/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the predictive value of endometrial thickness (EMT) during in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles for ectopic pregnancy (EP). METHODS A total of 3068 patients with 3117 fresh IVF/ICSI cycles between January 2016 and February 2019 from the Reproductive Medicine Center of Sun Yat-Sen Memorial Hospital were included in this retrospective study. The patients were divided into an EP group (n = 92) and an intrauterine pregnancy (IUP) group (n = 3025). Multiple logistic regression analysis was conducted to evaluate the EP risk factors. Receiver operating characteristic (ROC) curves were used to evaluate the predictive value of the risk factors for EP and calculate the cutoff value of EMT for EP prediction. RESULTS The incidence rate of EP was 2.95 % (92/3117). After adjustment for other factors in the logistic regression model, the incidence of EP decreased by 55 % with an EMT > 10 mm compared with an EMT ≤ 10 mm (odds ratio 0.450, 95 % confidence interval 0.296-0.684, P < 0.001). The EMT in the EP group was significantly thinner than that in the live birth (n = 2540) and spontaneous abortion (n = 485) groups (p < 0.017). The cutoff value of EMT for EP prediction was 10.65 mm, with a sensitivity of 59 % and a specificity of 63 %. CONCLUSION A decreased risk of EP was found among the patients with an EMT > 10 mm prior to embryo transfer. A certain EMT is needed to reduce the incidence of EP.
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Affiliation(s)
- Tingfeng Fang
- Department of Obstetrics & Gynecology, Sun Yat-Sen Memorial Hospital, SunYat-Sen University, No. 107 Yanjiang Xi Road, Guangzhou, 510120, PR China
| | - Manqi Chen
- Department of Obstetrics & Gynecology, Sun Yat-Sen Memorial Hospital, SunYat-Sen University, No. 107 Yanjiang Xi Road, Guangzhou, 510120, PR China
| | - Wenchang Yu
- Department of Obstetrics & Gynecology, Sun Yat-Sen Memorial Hospital, SunYat-Sen University, No. 107 Yanjiang Xi Road, Guangzhou, 510120, PR China
| | - Tingting Ma
- Department of Obstetrics & Gynecology, Sun Yat-Sen Memorial Hospital, SunYat-Sen University, No. 107 Yanjiang Xi Road, Guangzhou, 510120, PR China
| | - Zheng Su
- Department of Plastic Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Xi Road, Guangzhou, 510120, PR China
| | - David Yiu Leung Chan
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Block E, 1F, Special Block, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, N.T., Hong Kong
| | - Mingpeng Zhao
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Block E, 1F, Special Block, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, N.T., Hong Kong
| | - Qiaolan Zheng
- Journal Center of the Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Rd, Guangzhou, 510630, PR China
| | - Wenjun Wang
- Department of Obstetrics & Gynecology, Sun Yat-Sen Memorial Hospital, SunYat-Sen University, No. 107 Yanjiang Xi Road, Guangzhou, 510120, PR China.
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Tian Z, Zhang Y, Zhang C, Wang Y, Zhu HL. Antral follicle count is reduced in the presence of endometriosis: a systematic review and meta-analysis. Reprod Biomed Online 2020; 42:237-247. [PMID: 33168492 DOI: 10.1016/j.rbmo.2020.09.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/16/2020] [Accepted: 09/08/2020] [Indexed: 12/29/2022]
Abstract
Studies suggest that the presence of endometriosis may lead to impaired ovarian reserve, while results evaluating the changes in antral follicle count (AFC) in endometriosis remain controversial. A systematic search returned 15 studies, of which nine compared AFC between patients with and without endometriosis, five articles reported differences in AFC between affected and unaffected ovaries in patients with unilateral ovarian endometriosis and one reported both of the above two situations. Overall results showed a significant decrease in AFC and anti-Müllerian hormone (AMH) and increase in serum FSH concentrations in patients with endometriosis when compared with controls. Additionally, the AFC for the ovary with the endometrioma was also significantly lower than that of the contralateral ovary in patients with unilateral ovarian endometriosis. Moreover, it appears that the AFC in patients with endometriosis where the ovaries are not affected or in early stage were not significantly different in the control group. These findings demonstrate that endometriosis is associated with reduced AFC and AMH and elevated serum concentrations of FSH, suggesting a reduction in ovarian reserve in patients with endometriosis, especially in those with ovarian endometrioma and advanced stage.
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Affiliation(s)
- Zhao Tian
- Department of Obstetrics and Gynecology, People's Hospital, Peking University, Beijing 100044, China
| | - Yang Zhang
- Department of Pediatrics, People's Hospital, Peking University, Beijing 100044, China
| | - Chen Zhang
- Department of Obstetrics and Gynecology, People's Hospital, Peking University, Beijing 100044, China
| | - Yue Wang
- Department of Obstetrics and Gynecology, People's Hospital, Peking University, Beijing 100044, China
| | - Hong-Lan Zhu
- Department of Obstetrics and Gynecology, People's Hospital, Peking University, Beijing 100044, China.
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Hormonal Effects in Reproductive Technology with Focus on Diminished Ovarian Reserve. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020. [PMID: 32406026 DOI: 10.1007/978-3-030-38474-6_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
Modern use of reproductive technologies has revolutionized the treatment of infertile couples. Strategies to improve ovarian function in cases of diminished ovarian reserve are perhaps the least understood area in this field and will be the chief focus of this chapter.
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Dai K, Xu H, Ouyang N, Li Y, Yuan P, Wang L, Zhao X, Wang W. Correlation of human telomerase reverse transcriptase single nucleotide polymorphisms with in vitro fertilisation outcomes. J Assist Reprod Genet 2018; 36:517-527. [PMID: 30535641 DOI: 10.1007/s10815-018-1379-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 11/26/2018] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To explore whether it is possible to predict the number and quality of the embryo using a few particular hTERT SNPs. METHODS We included 997 Han Chinese women who were genetically unrelated and underwent assisted reproduction using IVF from September 2014 to December 2015. DNA was genotyped by using TaqMan real-time quantitative PCR. RESULTS Among the 997 patients, individuals with the CC genotype of rs2075786 had a significantly lower number of good-quality embryos than those with the TT+TC genotypes. Compared with the CT+CC genotype carriers, patients carrying the TT genotype of rs2853677 had a significantly lower number of oocytes retrieved, mature oocytes and available embryos. Among the 750 patients aged ≤ 35 years, individuals with the AA+AG genotypes of rs2853691 had a significantly higher number of good-quality embryos than those with the GG genotype. The haplotype analysis showed that the TTTG (rs2853672/rs2853669/rs2735940/rs2736108) haplotype was more likely to lead to more than three good-quality embryos in patients aged ≤ 35 years. CONCLUSIONS Our study suggests that the hTERT SNP is associated with IVF outcomes.
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Affiliation(s)
- Kailing Dai
- Reproductive Medicine Center, Department of Obstetrics and Gynaecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No.107, Yanjiang Xi Road, Guangzhou, 510120, Guangdong, People's Republic of China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Hongmei Xu
- Reproductive Medicine Center, Department of Obstetrics and Gynaecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No.107, Yanjiang Xi Road, Guangzhou, 510120, Guangdong, People's Republic of China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, People's Republic of China
- Department of Obstetrics and Gynaecology, Fuzhou General Hospital, Fuzhou, 350001, Fujian, People's Republic of China
| | - Nengyong Ouyang
- Reproductive Medicine Center, Department of Obstetrics and Gynaecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No.107, Yanjiang Xi Road, Guangzhou, 510120, Guangdong, People's Republic of China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Ying Li
- Reproductive Medicine Center, Department of Obstetrics and Gynaecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No.107, Yanjiang Xi Road, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Ping Yuan
- Reproductive Medicine Center, Department of Obstetrics and Gynaecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No.107, Yanjiang Xi Road, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Liangan Wang
- Department of Obstetrics and Gynaecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Xiaomiao Zhao
- Reproductive Medicine Center, Department of Obstetrics and Gynaecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No.107, Yanjiang Xi Road, Guangzhou, 510120, Guangdong, People's Republic of China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Wenjun Wang
- Reproductive Medicine Center, Department of Obstetrics and Gynaecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No.107, Yanjiang Xi Road, Guangzhou, 510120, Guangdong, People's Republic of China.
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, People's Republic of China.
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Zhang J, Qiu X, Gui Y, Xu Y, Li D, Wang L. Dehydroepiandrosterone improves the ovarian reserve of women with diminished ovarian reserve and is a potential regulator of the immune response in the ovaries. Biosci Trends 2016; 9:350-9. [PMID: 26781792 DOI: 10.5582/bst.2015.01154] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Diminished ovarian reserve (DOR) has a high morbidity rate worldwide and has become a primary cause of infertility. DOR is a daunting obstacle in in vitro fertilization (IVF) and leads to poor ovarian response, high cancellation rates, poor IVF outcomes, and low pregnancy rates. Abnormal autoimmune function may also contribute to DOR. Dehydroepiandrosterone (DHEA) is a C19 androgenic steroid. DHEA is secreted mainly by the adrenal gland, and its secretion declines with age. DHEA has a pro-inflammatory immune function that opposes cortisol. The cortisol to DHEA ratio increases with age, which may lead to decreased immune function. DHEA supplementation helps improve this situation. A number of clinical case control studies and several prospective randomized clinical trials have observed a positive effect of DHEA supplementation in women with DOR. However, the underlying mechanism by which DHEA improves ovarian reserve remains unclear. DHEA functions as an immune regulator in many different tissues in mammals and may also play an important role in regulating the immune response in the ovaries. The conversion of DHEA to downstream sex steroids may allow it to regulate the immune response there. DHEA can also enhance the Th1 immune response and regulate the balance of the Th1/Th2 response. DHEA treatment can increase selective T lymphocyte infiltration in mice, resulting in a decline in the CD4+ T lymphocyte population and an upregulation of the CD8+ T lymphocyte population in ovarian tissue, thus regulating the balance of CD4+/CD8+ T cells. This review mainly focuses on how DHEA supplementation affects regulation of the immune response in the ovaries.
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Affiliation(s)
- Jiali Zhang
- Laboratory for Reproductive Immunology, Hospital & Institute of Obstetrics and Gynecology, IBS, Fudan University ShanghaiMedical College
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