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Jiang VS, Cherouveim P, Naert MN, Dimitriadis I, Souter I, Bormann CL. Live birth outcomes following single-step blastocyst warming technique - optimizing efficiency without impacting live birth rates. J Assist Reprod Genet 2024:10.1007/s10815-024-03069-x. [PMID: 38472563 DOI: 10.1007/s10815-024-03069-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
PURPOSE To evaluate the impact of a single-step (SS) warming versus standard warming (SW) protocol on the survival/expansion of vitrified blastocysts and their clinical outcomes post-frozen embryo transfer (FET). METHODS Retrospective analysis was performed on 200 vitrified/warmed research blastocysts equally divided amongst two thawing protocols utilizing the Fujifilm Warming NX kits (Fujifilm, CA). SW utilized the standard 14-minute manufacturer's guidelines. SS protocol required only a one-minute immersion in thaw solution (TS) before the embryos were transferred to culture media. A time-interrupted study was performed evaluating 752 FETs (SW: 376 FETs, SS 376 FETs) between April 2021-December 2022 at a single academic fertility clinic in Boston, Massachusetts. Embryologic, clinical pregnancy, and live birth outcomes were assessed using generalized estimated equation (GEE) models, which accounted for potential confounders. RESULTS There was 100% survival for all blastocysts (n = 952 embryos) with no differences in blastocyst re-expansion regardless of PGT status. Adjusted analysis showed no differences in implantation, clinical pregnancy, spontaneous abortion, or biochemical pregnancy rate. A higher odds of multiple gestation [AdjOR(95%CI) 1.06 (1.01, 1.11), p = 0.019] were noted, even when adjusting for number of embryos transferred [AdjOR(95%CI) 1.05 (1.01, 1.10)]. Live birth outcomes showed no differences in live birth rates or birthweight at delivery. CONCLUSIONS The study found equivalent outcomes for SS and SW in all parameters except for a slight rise in the rate of multiple gestations. The results suggest that SS warming is an efficient, viable alternative to SW, reducing thaw times without adverse effects on live birth rates or neonatal birth weights.
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Affiliation(s)
- Victoria S Jiang
- Division of Reproductive Endocrinology and Infertility, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Suite 10A, Boston, MA, 02114, USA
| | - Panagiotis Cherouveim
- Division of Reproductive Endocrinology and Infertility, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Suite 10A, Boston, MA, 02114, USA
| | - Mackenzie N Naert
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 32 Fruit Street, Suite 4F, Boston, MA, 02114, USA
| | - Irene Dimitriadis
- Division of Reproductive Endocrinology and Infertility, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Suite 10A, Boston, MA, 02114, USA
| | - Irene Souter
- Division of Reproductive Endocrinology and Infertility, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Suite 10A, Boston, MA, 02114, USA
| | - Charles L Bormann
- Division of Reproductive Endocrinology and Infertility, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Suite 10A, Boston, MA, 02114, USA.
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Cherouveim P, Mavrogianni D, Drakaki E, Potiris A, Zikopoulos A, Papamentzelopoulou M, Kouvoutsaki K, Machairiotis N, Karampitsakos T, Skentou C, Domali E, Vrachnis N, Drakakis P, Stavros S. ANRIL rs4977574 Gene Polymorphism in Women with Recurrent Pregnancy Loss. J Clin Med 2023; 12:5944. [PMID: 37762885 PMCID: PMC10531795 DOI: 10.3390/jcm12185944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND ANRIL rs4977574 gene polymorphism has been associated with arterial thrombosis and cardiovascular disease development. ANRIL rs4977574 gene polymorphism could also be associated with recurrent pregnancy loss (RPL) since there is increasing evidence in favor of a potential shared pathophysiological mechanism with cardiovascular disease, potentially through arterial thrombosis. This study's goal is to investigate the differences in ANRIL rs4977574 gene polymorphism between women with and without RPL, if any, as well as a potential association with the number of pregnancy losses. METHODS DNA was isolated from peripheral blood samples, and the sequence containing the polymorphism of interest was amplified with PCR. Results were visualized under UV light following electrophoresis in 3% agarose gel with ethidium bromide. ANRIL rs4977574 (A>G) prevalence was compared between 56 women with and 69 without RPL. Results were adjusted for women's age and BMI, while a stratified analysis was performed according to number of pregnancy losses. RESULTS Allele A was significantly more prevalent in the control group compared to RPL women [31 (44.9%) vs. 14 (25%), p = 0.021]. Although not reaching statistical significance, a gradually decreasing prevalence of allele A with an increasing number of pregnancy losses was observed [31 (44.9%) in control, eight (30.7%) with two, six (23.1%) with three, and 0 (0.0%) with four pregnancy losses, p = 0.078]. Results were also similar following adjustment. CONCLUSIONS This is the first study that demonstrates an association between RPL presence and ANRIL rs4977574 gene polymorphism (lower prevalence of allele A), while a difference according to the number of pregnancy losses cannot be excluded.
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Affiliation(s)
- Panagiotis Cherouveim
- Division of Reproductive Endocrinology and Infertility, Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA;
| | - Despoina Mavrogianni
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Medical School of the National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.M.); (E.D.); (M.P.); (K.K.); (E.D.); (P.D.)
| | - Eirini Drakaki
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Medical School of the National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.M.); (E.D.); (M.P.); (K.K.); (E.D.); (P.D.)
| | - Anastasios Potiris
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School of the National and Kapodistrian University of Athens, 12462 Athens, Greece; (N.M.); (T.K.); (N.V.); (S.S.)
| | - Athanasios Zikopoulos
- Department of Obstetrics and Gynecology, Royal Cornwall Hospital, Treliske, Truro TR1 3LQ, UK;
| | - Myrto Papamentzelopoulou
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Medical School of the National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.M.); (E.D.); (M.P.); (K.K.); (E.D.); (P.D.)
| | - Konstantina Kouvoutsaki
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Medical School of the National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.M.); (E.D.); (M.P.); (K.K.); (E.D.); (P.D.)
| | - Nikolaos Machairiotis
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School of the National and Kapodistrian University of Athens, 12462 Athens, Greece; (N.M.); (T.K.); (N.V.); (S.S.)
| | - Theodoros Karampitsakos
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School of the National and Kapodistrian University of Athens, 12462 Athens, Greece; (N.M.); (T.K.); (N.V.); (S.S.)
| | - Chara Skentou
- Department of Obstetrics and Gynecology, Medical School of the University of Ioannina, 45110 Ioannina, Greece;
| | - Ekaterini Domali
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Medical School of the National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.M.); (E.D.); (M.P.); (K.K.); (E.D.); (P.D.)
| | - Nikolaos Vrachnis
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School of the National and Kapodistrian University of Athens, 12462 Athens, Greece; (N.M.); (T.K.); (N.V.); (S.S.)
| | - Peter Drakakis
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Medical School of the National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.M.); (E.D.); (M.P.); (K.K.); (E.D.); (P.D.)
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School of the National and Kapodistrian University of Athens, 12462 Athens, Greece; (N.M.); (T.K.); (N.V.); (S.S.)
| | - Sofoklis Stavros
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School of the National and Kapodistrian University of Athens, 12462 Athens, Greece; (N.M.); (T.K.); (N.V.); (S.S.)
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Vagios S, Velmahos CS, Cherouveim P, Dimitriadis I, Bormann CL. The impact of different sperm preparation methods on clinical pregnancy and live birth rates in intrauterine insemination cycles: a retrospective single-center cohort study. Fertil Steril 2023; 120:617-625. [PMID: 37225072 DOI: 10.1016/j.fertnstert.2023.05.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To assess the impact of 2 different sperm preparation methods, density gradient centrifugation and simple wash, on clinical pregnancy and live birth rates in intrauterine insemination (IUI) cycles with and without ovulation induction. DESIGN Retrospective single-center cohort study. SETTING Academic fertility center. PATIENTS In total, 1,503 women of all diagnoses sought IUI with fresh-ejaculated sperm. EXPOSURE Cycles were divided into 2 groups on the basis of sperm preparation technique: density gradient centrifugation (n = 1,687, unexposed group) and simple wash (n = 1,691, exposed group). MAIN OUTCOME MEASURES Primary outcome measures consisted of clinical pregnancy and live birth rates. Furthermore, adjusted odds ratios and 95% confidence intervals for each outcome were calculated and compared between the 2 sperm preparation groups. RESULTS Odds ratios did not differ between density gradient centrifugation and simple wash groups for clinical pregnancy and live birth (1.10 [0.67-1.83] and 1.08 [0.85-1.37], respectively). Additionally, when cycles were stratified using ovulation induction rather than adjusted for, no differences in clinical pregnancy and live birth odds were noted between sperm preparation groups (gonadotropins: 0.93 [0.49-1.77] and 1.03 [0.75-1.41]; oral agents: 1.78 [0.68-4.61] and 1.05 [0.72-1.53]; unassisted: 0.08 [0.001-6.84] and 2.52 [0.63-10.00], respectively). Furthermore, no difference was seen in clinical pregnancy or live birth when cycles were stratified using sperm score or when the analysis was limited to first cycles only. CONCLUSION Overall, no difference was noted in clinical pregnancy or live birth rates between patients who received simple wash vs. density gradient-prepared sperm, suggesting similar clinical efficacy between the 2 techniques for IUI. Because the simple wash technique is more time-efficient and cost-effective compared with the density gradient, adoption of this technique could lead to comparable clinical pregnancy and live birth rates for IUI cycles, although optimizing teamwork flow and coordination of care.
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Affiliation(s)
- Stylianos Vagios
- Department of Obstetrics, Gynecology, and Reproductive Endocrinology and Infertility, Massachusetts General Hospital Fertility Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, Massachusetts
| | | | - Panagiotis Cherouveim
- Department of Obstetrics, Gynecology, and Reproductive Endocrinology and Infertility, Massachusetts General Hospital Fertility Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Irene Dimitriadis
- Department of Obstetrics, Gynecology, and Reproductive Endocrinology and Infertility, Massachusetts General Hospital Fertility Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Charles L Bormann
- Department of Obstetrics, Gynecology, and Reproductive Endocrinology and Infertility, Massachusetts General Hospital Fertility Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Cherouveim P, Vagios S, Hammer K, Fitz V, Jiang VS, Dimitriadis I, Sacha CR, James KE, Bormann CL, Souter I. The impact of cryopreserved sperm on intrauterine insemination outcomes: is frozen as good as fresh? Front Reprod Health 2023; 5:1181751. [PMID: 37325242 PMCID: PMC10264626 DOI: 10.3389/frph.2023.1181751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/17/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction Frozen sperm utilization might negatively impact cycle outcomes in animals, implicating cryopreservation-induced sperm damage. However, in vitro fertilization and intrauterine insemination (IUI) in human studies are inconclusive. Methods This study is a retrospective review of 5,335 IUI [± ovarian stimulation (OS)] cycles from a large academic fertility center. Cycles were stratified based on the utilization of frozen (FROZEN, n = 1,871) instead of fresh ejaculated sperm (FRESH, n = 3,464). Main outcomes included human chorionic gonadotropin (HCG) positivity, clinical pregnancy (CP), and spontaneous abortion (SAB) rates. Secondary outcome was live birth (LB) rate. Odds ratios (OR) for all outcomes were calculated utilizing logistic regression and adjusted (adjOR) for maternal age, day-3 FSH, and OS regimen. Stratified analysis was performed based on OS subtype [gonadotropins; oral medications (OM): clomiphene citrate and letrozole; and unstimulated/natural]. Time to pregnancy and cumulative pregnancy rates were also calculated. Further subanalyses were performed limited to either the first cycle only or to the partner's sperm only, after excluding female factor infertility, and after stratification by female age (<30, 30-35, and >35 years old). Results Overall, HCG positivity and CP were lower in the FROZEN compared to the FRESH group (12.2% vs. 15.6%, p < 0.001; 9.4% vs. 13.0%, p < 0.001, respectively), which persisted only among OM cycles after stratification (9.9% vs. 14.2% HCG positivity, p = 0.030; 8.1% vs. 11.8% CP, p = 0.041). Among all cycles, adjOR (95% CI) for HCG positivity and CP were 0.75 (0.56-1.02) and 0.77 (0.57-1.03), respectively, ref: FRESH. In OM cycles, adjOR (95% CI) for HCG positivity [0.55 (0.30-0.99)] and CP [0.49 (0.25-0.95), ref.: FRESH] favored the FRESH group but showed no differences among gonadotropin and natural cycles. SAB odds did not differ between groups among OM and natural cycles but were lower in the FROZEN group among gonadotropin cycles [adjOR (95% CI): 0.13 (0.02-0.98), ref.: FRESH]. There were no differences in CP and SAB in the performed subanalyses (limited to first cycles or partner's sperm only, after excluding female factors, or after stratification according to female age). Nevertheless, time to conception was slightly longer in the FROZEN compared to the FRESH group (3.84 vs. 2.58 cycles, p < 0.001). No significant differences were present in LB and cumulative pregnancy results, other than in the subgroup of natural cycles, where higher LB odds [adjOR (95% CI): 1.08 (1.05-1.12)] and higher cumulative pregnancy rate (34% vs. 15%, p = 0.002) were noted in the FROZEN compared to the FRESH group. Conclusion Overall, clinical outcomes did not differ significantly between frozen and fresh sperm IUI cycles, although specific subgroups might benefit from fresh sperm utilization.
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Affiliation(s)
- Panagiotis Cherouveim
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Stylianos Vagios
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA, United States
| | - Karissa Hammer
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Victoria Fitz
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Victoria S. Jiang
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Irene Dimitriadis
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Caitlin R. Sacha
- Division of Reproductive Endocrinology and Infertility, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Kaitlyn E. James
- Deborah Kelly Center for Outcomes Research, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Charles L. Bormann
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Irene Souter
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
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Cherouveim P, Velmahos C, Bormann CL. Artificial Intelligence (AI) for Sperm Selection - a Systematic Review. Fertil Steril 2023:S0015-0282(23)00533-2. [PMID: 37236418 DOI: 10.1016/j.fertnstert.2023.05.157] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023]
Abstract
Despite the increasing number of assisted reproductive technologies treatments being performed worldwide, there has been little improvement in fertilization and pregnancy outcomes. Male infertility is a major contributing factor, and sperm evaluation is a crucial step in diagnosis and treatment. However, embryologists face the daunting task of selecting a single sperm from millions in a sample, based on various parameters, which can be time-consuming, subjective, and may even cause damage to the sperm, deeming them unusable for fertility treatments. Artificial intelligence (AI) algorithms have revolutionized the field of medicine, particularly in image processing, due to their discerning abilities, efficacy, and reproducibility. AI algorithms have the potential to address the challenges of sperm selection with their large-data processing capabilities and high objectivity. These algorithms could provide valuable assistance to embryologists in sperm analysis and selection. Furthermore, these algorithms could continue to improve over time, as larger and more robust datasets become available for their training.
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Affiliation(s)
- Panagiotis Cherouveim
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | | | - Charles L Bormann
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Cherouveim P, Jiang VS, Kanakasabapathy MK, Thirumalaraju P, Souter I, Dimitriadis I, Bormann CL, Shafiee H. Quality assurance (QA) for monitoring the performance of assisted reproductive technology (ART) staff using artificial intelligence (AI). J Assist Reprod Genet 2023; 40:241-249. [PMID: 36374394 PMCID: PMC9935795 DOI: 10.1007/s10815-022-02649-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Deep learning neural networks have been used to predict the developmental fate and implantation potential of embryos with high accuracy. Such networks have been used as an assistive quality assurance (QA) tool to identify perturbations in the embryo culture environment which may impact clinical outcomes. The present study aimed to evaluate the utility of an AI-QA tool to consistently monitor ART staff performance (MD and embryologist) in embryo transfer (ET), embryo vitrification (EV), embryo warming (EW), and trophectoderm biopsy (TBx). METHODS Pregnancy outcomes from groups of 20 consecutive elective single day 5 blastocyst transfers were evaluated for the following procedures: MD performed ET (N = 160 transfers), embryologist performed ET (N = 160 transfers), embryologist performed EV (N = 160 vitrification procedures), embryologist performed EW (N = 160 warming procedures), and embryologist performed TBx (N = 120 biopsies). AI-generated implantation probabilities for the same embryo cohorts were estimated, as were mean AI-predicted and actual implantation rates for each provider and compared using Wilcoxon singed-rank test. RESULTS Actual implantation rates following ET performed by one MD provider: "H" was significantly lower than AI-predicted (20% vs. 61%, p = 0.001). Similar results were observed for one embryologist, "H" (30% vs. 60%, p = 0.011). Embryos thawed by embryologist "H" had lower implantation rates compared to AI prediction (25% vs. 60%, p = 0.004). There were no significant differences between actual and AI-predicted implantation rates for EV, TBx, or for the rest of the clinical staff performing ET or EW. CONCLUSIONS AI-based QA tools could provide accurate, reproducible, and efficient staff performance monitoring in an ART practice.
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Affiliation(s)
- Panagiotis Cherouveim
- Division of Reproductive Endocrinology and Infertility, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Suite 10A, Boston, MA, 02114, USA
| | - Victoria S Jiang
- Division of Reproductive Endocrinology and Infertility, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Suite 10A, Boston, MA, 02114, USA
| | - Manoj Kumar Kanakasabapathy
- Division of Engineering in Medicine, Brigham and Women's Hospital, Harvard Medical School, 65 Landsdowne Street, Cambridge, MA, 02139, USA
| | - Prudhvi Thirumalaraju
- Division of Engineering in Medicine, Brigham and Women's Hospital, Harvard Medical School, 65 Landsdowne Street, Cambridge, MA, 02139, USA
| | - Irene Souter
- Division of Reproductive Endocrinology and Infertility, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Suite 10A, Boston, MA, 02114, USA
| | - Irene Dimitriadis
- Division of Reproductive Endocrinology and Infertility, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Suite 10A, Boston, MA, 02114, USA
| | - Charles L Bormann
- Division of Reproductive Endocrinology and Infertility, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Suite 10A, Boston, MA, 02114, USA
| | - Hadi Shafiee
- Division of Engineering in Medicine, Brigham and Women's Hospital, Harvard Medical School, 65 Landsdowne Street, Cambridge, MA, 02139, USA.
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Jiang VS, Kandula H, Thirumalaraju P, Kanakasabapathy MK, Cherouveim P, Souter I, Dimitriadis I, Bormann CL, Shafiee H. The use of voting ensembles to improve the accuracy of deep neural networks as a non-invasive method to predict embryo ploidy status. J Assist Reprod Genet 2023; 40:301-308. [PMID: 36640251 PMCID: PMC9935776 DOI: 10.1007/s10815-022-02707-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/23/2022] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To determine if creating voting ensembles combining convolutional neural networks (CNN), support vector machine (SVM), and multi-layer neural networks (NN) alongside clinical parameters improves the accuracy of artificial intelligence (AI) as a non-invasive method for predicting aneuploidy. METHODS A cohort of 699 day 5 PGT-A tested blastocysts was used to train, validate, and test a CNN to classify embryos as euploid/aneuploid. All embryos were analyzed using a modified FAST-SeqS next-generation sequencing method. Patient characteristics such as maternal age, AMH level, paternal sperm quality, and total number of normally fertilized (2PN) embryos were processed using SVM and NN. To improve model performance, we created voting ensembles using CNN, SVM, and NN to combine our imaging data with clinical parameter variations. Statistical significance was evaluated with a one-sample t-test with 2 degrees of freedom. RESULTS When assessing blastocyst images alone, the CNN test accuracy was 61.2% (± 1.32% SEM, n = 3 models) in correctly classifying euploid/aneuploid embryos (n = 140 embryos). When the best CNN model was assessed as a voting ensemble, the test accuracy improved to 65.0% (AMH; p = 0.1), 66.4% (maternal age; p = 0.06), 65.7% (maternal age, AMH; p = 0.08), 66.4% (maternal age, AMH, number of 2PNs; p = 0.06), and 71.4% (maternal age, AMH, number of 2PNs, sperm quality; p = 0.02) (n = 140 embryos). CONCLUSIONS By combining CNNs with patient characteristics, voting ensembles can be created to improve the accuracy of classifying embryos as euploid/aneuploid from CNN alone, allowing for AI to serve as a potential non-invasive method to aid in karyotype screening and selection of embryos.
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Affiliation(s)
- Victoria S Jiang
- Division of Reproductive Endocrinology and Infertility, Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Suite 10A, VincentBoston, MA, 02114, USA
| | - Hemanth Kandula
- Division of Engineering in Medicine, Brigham and Women's Hospital, Harvard Medical School, 65 Landsdowne Street, Cambridge, MA, 02139, USA
| | - Prudhvi Thirumalaraju
- Division of Engineering in Medicine, Brigham and Women's Hospital, Harvard Medical School, 65 Landsdowne Street, Cambridge, MA, 02139, USA
| | - Manoj Kumar Kanakasabapathy
- Division of Engineering in Medicine, Brigham and Women's Hospital, Harvard Medical School, 65 Landsdowne Street, Cambridge, MA, 02139, USA
| | - Panagiotis Cherouveim
- Division of Reproductive Endocrinology and Infertility, Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Suite 10A, VincentBoston, MA, 02114, USA
| | - Irene Souter
- Division of Reproductive Endocrinology and Infertility, Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Suite 10A, VincentBoston, MA, 02114, USA
| | - Irene Dimitriadis
- Division of Reproductive Endocrinology and Infertility, Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Suite 10A, VincentBoston, MA, 02114, USA
| | - Charles L Bormann
- Division of Reproductive Endocrinology and Infertility, Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Suite 10A, VincentBoston, MA, 02114, USA.
| | - Hadi Shafiee
- Division of Engineering in Medicine, Brigham and Women's Hospital, Harvard Medical School, 65 Landsdowne Street, Cambridge, MA, 02139, USA.
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Cherouveim P, Mavrogianni D, Dr P, Stavros S, Drakakis P. ANRIL (ANTISENSE NON-CODING RNA IN THE INK4 LOCUS) GENE POLYMORPHISM rs4977574 IN WOMEN WITH RECURRENT PREGNANCY LOSS (RPL). Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lu Y, Cherouveim P, Jiang VS, Hammer KC, Dimitriadis I, Bormann CL, James KE, Souter I. THE EFFECTIVENESS OF INTRAUTERINE INSEMINATION (IUI) WITH OR WITHOUT OVARIAN STIMULATION (OS) IN WOMEN WITH “OVERT” OR “AT RISK” FOR TUBAL-FACTOR INFERTILITY (TFI). Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cherouveim P, Vagios S, Hammer K, Fitz V, Jiang V, James K, Dimitriadis I, Bormann C, Souter I. O-184 The impact of cryopreserved sperm on Intrauterine Insemination (IUI) outcomes: Is frozen as good as fresh? Hum Reprod 2022. [DOI: 10.1093/humrep/deac105.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Are the outcomes of IUI cycles [with or without ovarian stimulation (OS)] comparable when frozen instead of fresh-ejaculated sperm is utilized?
Summary answer
Overall, clinical outcomes did not differ significantly between frozen and fresh sperm IUI cycles, although specific subgroups might benefit from fresh sperm utilization.
What is known already
At present, data from animal studies point towards less favorable outcomes with frozen sperm utilization, implicating cryopreservation-induced damages to the cytoskeleton, DNA, and acrosome leading to adverse effects on spermatozoa’s motility, viability, and ability to fuse with the oocyte. Assisted Reproductive Technology (ART) data, mostly focusing on severe male factor infertility diagnoses, suggest no major differences between in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles utilizing frozen over fresh sperm, often surgically extracted. Nevertheless, contemporary data from IUI(±OS) cycles are still scarce.
Study design, size, duration
Data from 5335 IUI(±OS) cycles (time-period: 01/2004-12/2021) from a large academic fertility center were retrospectively reviewed. Cycles were stratified in two groups based on utilization of frozen instead of fresh-ejaculated sperm for the IUI [FROZEN (n = 1871, all infertility diagnoses), and FRESH (n = 3464, idiopathic infertility diagnosis only), respectively]. Cycle outcomes were compared between groups.
Participants/materials, setting, methods
Participants: women seeking IUI (±OS) treatments.
Outcome Measures: HCG-positivity, clinical pregnancy (CP), spontaneous abortion (SAB) rates. Initial analysis included all cycles irrespective of OS regimen. Cycles were then stratified by OS regimen into three subgroups [injectable gonadotropins, oral medications (OM): clomiphene-citrate and letrozole, and unstimulated/natural]. Odds ratios (OR) for all relevant outcomes were calculated utilizing logistic regression and adjusted for maternal age, day-3 FSH, and OS regimen. Time-to-pregnancy and first-cycle only analyses were also performed.
Main results and the role of chance
Unadjusted HCG-positivity, and CP were lower in the FROZEN compared to the FRESH group (12.2% vs. 15.6%, p < 0.001; 9.4% vs. 13.0%, p<.001, respectively), which persisted only among OM after stratification (9.9% vs. 14.2% HCG-positivity, p=.030; 8.1% vs. 11.8% CPR, p=.041, for FROZEN compared to FRESH, respectively).
Among all cycles, adjOR(95%CI) for HCG-positivity and CP were respectively: 0.75(0.56-1.02), and 0.77(0.57-1.03), ref: FRESH). Following stratification by OS regimen, adjOR(95%CI) for HCG-positivity and CP showed no difference between groups among gonadotropin and natural cycles but favored the FRESH group in OM cycles [HCG-positivity: 0.55(0.30-0.99); CP: 0.49(0.25-0.95), ref.: FRESH]. SAB odds did not differ between groups among OM and natural cycles but were lower in the FROZEN compared to FRESH group among gonadotropin cycles [adjOR(95%CI): 0.13(0.02-0.98), ref.: FRESH]. However, regarding the latter comparison, numbers were small and the 95%CI wide. When analysis was limited to first-cycles only and further stratified by OS regimen, the previously noted differences in CP and SAB odds no longer existed within the OS subgroups.
Nevetheless, time-to-conception was slightly longer in the FROZEN compared to the FRESH group (3.84 vs. 2.58 cycles, p<.001).
Limitations, reasons for caution
Study is limited by its retrospective nature. The two groups differed somewhat in age, infertility diagnosis, utilized OS regimen, and as expected in total motile sperm counts. Despite the less favorable characteristics of the FROZEN group, no detrimental effect of sperm cryopreservation on IUI outcomes was noted.
Wider implications of the findings
Our study, the largest to date, showed no significant difference in IUI outcomes between cycles utilizing frozen instead of fresh-ejaculated sperm. Although, specific subgroups might benefit from fresh sperm utilization and time-to-pregnancy might be shorter with fresh over frozen sperm, patients should be counselled about the non-inferiority of frozen sperm.
Trial registration number
Not applicable
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Affiliation(s)
- P Cherouveim
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston MA , U.S.A
| | - S Vagios
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston MA , U.S.A
| | - K Hammer
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston MA , U.S.A
| | - V Fitz
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston MA , U.S.A
| | - V Jiang
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston MA , U.S.A
| | - K James
- Deborah Kelly Center for Outcomes Research - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology , Boston MA, U.S.A
| | - I Dimitriadis
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston MA , U.S.A
| | - C Bormann
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston MA , U.S.A
| | - I Souter
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston MA , U.S.A
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Lu Y, Cherouveim P, Jiang V, Dimitriadis I, Bormann C, James K, Souter I. P-342 The impact of Clomiphene Citrate (CC) on the endometrium in comparison to gonadotropins (Gn) in intrauterine-insemination treatments (IUI): Is it thinner and does it matter? Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Utilizing patients as their own controls, does endometrial thickness (EMT) differ between CC/IUI and Gn/IUI? Does EMT differ between CC-cycles with and without associated conception?
Summary answer
Within-patient, CC resulted in thinner EMT compared to Gn. CC-cycles associated with conception compared to the ones without it, had thicker endometria.
What is known already
CC, unlike gonadotropins, may have an anti-estrogenic effect on the endometrium. Concerns exist that the thinning of the endometrium might be associated with altered endometrial development and receptivity. However, available data in CC cycles remain inconsistent, probably due to patient and protocol heterogeneity. Currently, it remains unclear whether CC treatments produce a thinner endometrium, compared to gonadotropins, in the same patient. Furthermore, it is uncertain whether such a difference, if one exists, has a consequential effect on IUI cycle outcomes.
Study design, size, duration
Design: retrospective.
Duration: 1/2004-9/2021
Cohort 1 utilized women as their own controls to evaluate CC’s impact on the endometrium and included all cycles from women who sought fertility treatments and initially underwent CC/IUI (CC1, n = 1252) followed by Gn/IUI (Gn1, n = 1307).
Cohort 2 included all cycles from women seeking fertility treatments at the same center that conceived following CC/IUI treatments (CC2, n = 686).
EMT was compared between groups (CC1 vs. Gn1, CC1 vs. CC2).
Participants/materials, setting, methods
Outcome measures:
Primary: EMT (mm).
Secondary: HCG-positivity (pos-HCGR), clinical pregnancy (CPR), and spontaneous abortion rates (SABR).
Statistics:
Regression analysis was used to calculate Odds Ratios (OR) with associated 95% confidence intervals (95%CI), adjusting for potential confounders [maternal age, Body Mass Index (BMI), prior parity, day of EMT measurement relative to trigger). Generalized estimating equations (GEE) model were utilized to account for multiple cycles per patient. P < 0.05 was considered significant.
Main results and the role of chance
In cohort 1, despite CC1 exhibiting non-inferior ovarian response compared to Gn1 (as assessed by preovulatory follicular number), EMT was significantly thinner in CC1 compared to Gn1 [Median(IQR): 7.0(5.7-8.3) vs. 8.9(7.4-10.0), p<.001]. When CC1 was compared to CC2 (CC conceiving), EMT was also thinner [Median(IQR): 7.0(5.7-8.3) vs. 7.5(6.2-9.0), for CC1 vs. CC2, respectively, p<.001]. A higher percentage of CC1 compared to Gn1 cycles resulted in EMT≤7mm (48.9% vs. 16.7% , for CC1 vs. Gn, respectively; p<.001). Most subsequent Gn cycles (82.8%), in the same women, resulted in thicker EMT compared to CC1. AdjOR, in generalized linear mixed models, suggested that CC2 when compared to CC1 cycles had thicker EMT [adjOR(95%CI): 1.81, (1.41,2.35), p<.001].
Interestingly, clinical pregnancies were observed even when EMT was ≤4mm in both CC2 and Gn1 groups and SABR did not differ between cycles with EMT≤4mm and the ones with thicker EMT (2.5% vs. 11.5%, p=.258, in CC2; 0% and 12.3%, p=.544, in Gn1; SABR EMT ≤4 vs. 4 mm, respectively). GEE models suggested an association between EMT and CPR in CC cycles (CC1&CC2), [adjOR(95%CI): 1.12(1.07,1.18), p<.001)] while in Gn1, no such association was observed.
Limitations, reasons for caution
Our study was limited by its retrospective design. Reflecting our selection criterion, in cohort 1, most CC cycles did not result in pregnancy, restricting relevant comparisons. Number of cycles resulting in EMT ≤7mm, and particularly ≤4mm, was limited, and consequently respective results should be interpreted cautiously.
Wider implications of the findings
Utilizing patients as their own controls, we showed that CC compared to gonadotropins resulted in thinner endometrium. Given comparable follicular response, and potentially estradiol levels, thinner endometrium might have resulted from CC’s anti-estrogenic effect. Furthermore, patients conceiving on CC had a thicker endometrium compared to the ones that did not.
Trial registration number
NA
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Affiliation(s)
- Y Lu
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston, Armenia
| | - P Cherouveim
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston, Armenia
| | - V Jiang
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston, Armenia
| | - I Dimitriadis
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston, Armenia
| | - C Bormann
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston, Armenia
| | - K James
- Deborah Kelly Center for Outcomes Research - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology , Boston, Armenia
| | - I Souter
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston, Armenia
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Fitz V, Cherouveim P, Hammer K, Jiang V, Sacha C, Dimitriadis I, Bormann C, James K, Roberts D, Souter I. P-434 Is there an association between pre-ovulatory estradiol levels and placental pathology of singleton livebirths conceived with gonadotropins/intrauterine insemination (Gn/IUI) treatments? Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Is pre-ovulatory estradiol level associated with placental weight (PW) and abnormality rates (PAR) in singleton livebirths resulting from gonadotropins/intrauterine insemination (Gn/IUI) treatments?
Summary answer
In Gn/IUI-conceived, singleton-livebirths with available placental pathology, an association was noted between preovulatory estradiol levels and PW, but not between estradiol and PAR.
What is known already
Data suggest an association between ART and placental-mediated pregnancy complications, as well as increased rates of placental pathology. Supraphysiologic levels of preovulatory estradiol have been implicated in abnormal placentation. Whether such an effect is noted in Gn/IUI treatments, where levels of estradiol are lower, nevertheless supraphysiologic, remains unknown.
Study design, size, duration
We retrospectively reviewed data from 560 Gn/IUI-conceived, singleton-livebirths (1/2004-1/2021) recruited from a large academic fertility center. Placental pathology information was available from 218 cycles. These cycles were stratified by pre-ovulatory estradiol levels in quartiles [Q1(lower)-Q4 (higher)]. PW [grams & percentiles (%iles)], and rates of placental abnormalities (classified as anatomic, inflammatory, infectious, and vascular/thrombotic) were compared between groups.
Participants/materials, setting, methods
Participants: Women with Gn/IUI-conceived, singleton-livebirths with available placental pathology.
Outcome Measures: PW and PAR.
Statistics: Regression analysis was utilized to estimate the association of pre-ovulatory estradiol %iles with PW and PAR, adjusting for potential confounders (PW: maternal and gestational age, BMI, infertility diagnosis, medical complications, infant gender; PAR: maternal and gestational age, BMI, race). Adjusted Odds Ratios (OR) with 95%CI were calculated for the latter.
Main results and the role of chance
Mean PW(±SD) in grams were 477.3(±124.1), 445.9(±107.4), 451.2(±113.9), and 438.9(±107.0) in Q1 through Q4 (p=.368). Small placentas (≤10thPW %ile) accounted for more than a third of the total in all estradiol quartiles (37.5%, 49.2%, 37.5%, and 42.2%, p=.539, Q1-Q4, respectively). Similarly, increasingly higher percentages of placentas ≤25th PW %ile were noted with increasing estradiol quartiles (47.9%, 57.6%, 62.5% and 64.5%, in Q1-Q4 respectively, p=.347). After adjusting for potential confounders, we noted a mean 13.7 grams decrease in PW between each subsequent estradiol quartile [ adjβ-coeff (95%CI): -13.7(-27.7-0.3), p=.055]. When estradiol levels were analyzed as a continuous variable, an inverse association with PW [ adjβ-coeff (95%CI): -0.08 (-0.16-(-0.01)), p=.026] was noted. Adjusted ORs for small placenta did not differ between estradiol quartiles or when estradiol was analyzed as a continuous variable [adjORs(95%CI): 1.73(0.74-4.07), 1.10(0.47-2.55), 1.81(0.69-4.72), for Q2-Q4, Q1 as ref.; 1.001(1.000-1.003), p=.167; respectively].
There was no significant association between placental abnormality rates (PAR) and estradiol, either before or after adjustment [adjORs(95%CI): i) Anatomic : 1.16(0.49-2.74), 1.52(0.65-3.59), and 1.17(0.45-3.02); ii) Inflammatory : 0.40(0.13-1.25), 0.79(0.28-2.17), and 1.25(0.42-3.73); iii) Infectious : 0.89(0.35-2.25), 1.67(0.68-4.13), and 0.58(0.20-1.67); iv) Vascular/thrombotic : 0.88(0.37-2.08), 1.87(0.80-4.41), and 0.95(0.36-2.49); for Q2-Q4 vs. Q1].
Limitations, reasons for caution
There are several limitations, including the retrospective design, possible selection bias resulting from the decision to obtain placental pathology. Nonetheless, birth weights did not differ between those with and without placental pathology. Estradiol levels, albeit supraphysiologic, are much lower than those in ART and differences might be masked.
Wider implications of the findings
In Gn/IUI-conceived, singleton-livebirths with available placental pathology, an association was noted between preovulatory estradiol levels and placental weight, but not between estradiol and the rate of specific placental abnormalities (PAR). Since estradiol levels are lower than those observed in ART, an association might have been missed.
Trial registration number
not applicable
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Affiliation(s)
- V Fitz
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston MA, U.S.A
| | - P Cherouveim
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston MA, U.S.A
| | - K Hammer
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston MA, U.S.A
| | - V Jiang
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston MA, U.S.A
| | - C Sacha
- University of Massachusetts Chan Medical School, Dept of OB/GYN - Division of Reproductive Endocrinology and Infertility , Worcester MA, U.S.A
| | - I Dimitriadis
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston MA, U.S.A
| | - C Bormann
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston MA, U.S.A
| | - K James
- Deborah Kelly Center for Outcomes Research - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology , Boston MA, U.S.A
| | - D Roberts
- Massachusetts General Hospital and Harvard Medical School, Department of Pathology , Boston MA, U.S.A
| | - I Souter
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston MA, U.S.A
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Velmahos C, Vagios S, Cherouveim P, Dimitriadis I, Bormann C. O-299 Analyzing the impact of simple wash versus density gradient sperm preparations on intrauterine insemination outcomes. Is the cost-effective and time-efficient option just as good? Hum Reprod 2022. [DOI: 10.1093/humrep/deac106.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
How do different sperm preparations, such as simple-wash (SW) and density-gradient (DG), impact intrauterine insemination (IUI) outcomes among women seeking fertility treatments?
Summary answer
Using a population from a large, academic medical center, this study discerned no differences in pregnancy outcomes between SW and DG sperm preparations.
What is known already
IUI with or without ovulation induction (OI) is often a first-line treatment among couples seeking fertility services. SW and DG are two common methods used to prepare sperm for IUI. In comparison to its latter counterpart, the SW technique is lesser-used, yet is more time-efficient, and cost-effective due to its utilization of only a single centrifugation step. Since the impact of sperm preparation techniques on the post-processing sperm yield and its parameters varies by the method used, the cycle outcomes might differ as well. However, limited data exists on various sperm preparations’ impact on IUI clinical outcomes.
Study design, size, duration
Data from 3378 IUI+OI cycles (from 1503 women of all diagnoses seeking IUI with fresh-ejaculated sperm) that took place at a large academic fertility center between 9/2014 and 3/2021 were retrospectively reviewed. Cycles were either unstimulated (natural) or stimulated with either oral OI agents (clomiphene-citrate & letrozole) or gonadotropins. Cycles were divided in two groups based on sperm preparation technique: SW (n = 1691) and DG (n = 1687) and outcomes were compared between them.
Participants/materials, setting, methods
Sperm preparation: SW semen were mixed in 10ml MHM (FujiFilm) and centrifuged for 10min. DG semen were layered over 45:90 gradient of Isolate (FujiFilm), centrifuged for 20min, and washed twice (10min) in 10ml MHM.
Outcome measures: hCG-positivity (posHCGR), clinical pregnancy (CPR), spontaneous abortion (SABR), and livebirth rates/cycle (LBR).
Statistics: Logistic regression with Odds Ratios (OR) adjusted for both partners’ ages, day-3 FSH, stimulation, and sperm score (poor, fair, good, excellent). Sub-analysis limited cohort to first-cycles only.
Main results and the role of chance
Groups were comparable in patient [age (maternal, paternal), BMI, day-3 FSH, infertility diagnosis], and cycle characteristics [follicular response (measured as number of preovulatory follicles), and endometrial thickness]. Preprocessing sperm parameters differed slightly with higher mean sperm concentrations and lower total motility among SW cycles (75.3 + 57.0 vs. 71.0 + 51.3 million, p = 0.02; 48.6 + 19.6 vs. 52.5 + 20.2, p < 0.001, for SW and DG, respectively). posHCGR, CPR, SABR, and LBR per cycle did not differ between groups (15.8% vs. 15.4%, p = 0.76;13.7% vs. 13.2%, p = 0.62;18.1% vs. 18.5%, p = 0.93; 9.5 vs. 8.9%, p = 0.56; for SW and DG, respectively).
Odds for posHCG, CP, SAB, or LB did not differ between groups [adjOR(95%CI): 1.05(0.87-1.26), p = 0.65; 1.10(0.67-1.83), p = 0.71; 0.98(0.60-1.60), p = 0.94; 1.08(0.85-1.37), p = 0.66, respectively]. When cycles were stratified by type of ovarian stimulation, rather than adjusted for it, no difference was seen in any of the clinical outcomes within individual strata{adjOR(95%CI): [Oral OI: 1.00(0.74-1.37), p = 0.98; 1.78(0.68-4.61), p = 0.25; 0.97(0.40-2.38), p = 0.95; 1.05(0.72-1.53), p = 0.81], [Gonadotropins: 0.99(0.78-1.28), p = 0.96; 0.93(0.49-1.77), p = 0.83; 0.97(0.52-1.80), p = 0.96; 1.03(0.75-1.41), p = 0.87], [Natural: 2.36(0.97-5.76), p = 0.06; 0.08(0.001-6.84), p = 0.26; 0.20(0.003-11.02), p = 0.43; 2.52(0.63-10.00), p = 0.19], for posHCG, CP, SAB, and LB, respectively}. Similarly, no difference was seen in any of the clinical outcomes when cycles were stratified by sperm score or when analysis was limited to first-cycles only.
Limitations, reasons for caution
LBR were calculated excluding pregnancies with no information after discharge to obstetrics (approximately 16%). Although not significant, there might be minor variations in individual provider’s practices between time frames in which these techniques were implemented.
Wider implications of the findings
SW is a much simpler, time-efficient, and cost-effective sperm processing technique for IUI compared to DG, however remains infrequently utilized. Adoption of SW, over DG, could yield comparable clinical efficacy, yet optimize teamwork flow and lower healthcare costs, due to its non-labor-intensive and inexpensive nature.
Trial registration number
not applicable
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Affiliation(s)
- C Velmahos
- University of Massachusetts Medical School, Medical School , Worcester, U.S.A
| | - S Vagios
- Tufts Medical Center, Obstetrics and Gynecology , Boston, U.S.A
| | - P Cherouveim
- Massachusetts General Hospital, Obstetrics and Gynecology , Boston, U.S.A
| | - I Dimitriadis
- Massachusetts General Hospital, Obstetrics and Gynecology , Boston, U.S.A
| | - C Bormann
- Massachusetts General Hospital, Obstetrics and Gynecology , Boston, U.S.A
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Souter I, Cherouveim P, Fitz V, Hammer K, Jiang V, Sacha C, Dimitriadis I, Bormann C, James K, Roberts D. P-426 Placental pathology following Intrauterine Insemination (IUI) with or without Ovarian Stimulation (OS). Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Do placental weight percentiles (PW %iles) and abnormality rates (PAR) differ in singleton-livebirths following IUI with or without OS [oral medications (OM), and injectable gonadotropins]?
Summary answer
Following singleton-livebirths, PW did not differ between groups, albeit over half of placentas were ≤25th%ile. Placental anatomic abnormalities were more often seen in OM cycles.
What is known already
ART data suggest a possible association between stimulation-induced supraphysiologic estradiol levels and increased risk of placental abnormalities, as well as subsequent placental-mediated pregnancy complications, such as preeclampsia. Whether there is an association between OS protocols for IUI and placental pathology remains unknown.
Study design, size, duration
Data from 975 IUI(±OS) cycles resulting in singleton livebirths at a large academic fertility center between 01/2004 and 01/2021, were retrospectively reviewed. In 386 cycles a full placental pathologic examination was available. Placentas were stratified by OS regimen into three groups: gonadotropins (n = 222), OM [Clomiphene Citrate (CC)/Letrozole (LTZ); n = 129], and unstimulated / natural (n = 35). PW and PAR were compared between groups.
Participants/materials, setting, methods
Participants: Women delivering a singleton liveborn following IUI(±OS) treatments with placental pathology available.
Outcome Measures: PW (grs & %iles), and PAR (classified as anatomic, inflammatory, infectious, and vascular/thrombotic).
Statistics: Regression analysis was utilized to compare PW and PAR between groups, adjusting for potential confounders (PW: maternal and gestational age, BMI, infertility diagnosis, medical complications, infant gender; PAR: maternal and gestational age, BMI, race). Adjusted Odds Ratios (adjOR, 95%CI) were calculated for the latter.
Main results and the role of chance
Mean(±STDEV) PW (grs) were 451.7(±113.3), 449.2(±102.4), and 481.8(±99.8), for the gonadotropins, OM, and natural groups, respectively. Interestingly, over half of the placentas in all three groups were ≤25th %ile (58.6%, 56.1%, and 52.9%, for gonadotropins, OM, and natural, respectively, p=.249), while 41.8%, 46.4%, and 38.2% were below the 10th %ile (for gonadotropins, OM, and natural, respectively, p=.598). Adjusted PW differences, and adjOR for small placenta (≤10th %ile) did not differ between groups [PW OR(95%CI): 5.6(-17.9-29.2), -28.1(-71.4-15.2), -11.7(-52.6-29.3); small placenta OR(95%CI): 1.04(0.62-1.76); 1.27(0.40-4.01), and 0.96(0.34-2.74) for OM vs. gonadotropins, OM vs. natural, and gonadotropins vs. natural, latter as ref. ].
Regarding PAR, anatomic(43.7%, 52.7%, and 40%, p=.192), inflammatory(20.7%, 27.1%, and 20%, p=.354), infectious(32.9%, 33.3%, and 31.4%, p=.978), and vascular/thrombotic(42.3%, 41.9%, and 42.9%, p=.993) abnormalities rates did not differ between gonadotropins, OM, and natural, respectively. AdjORs(95%CI) for inflammatory, infectious, and vascular/thrombotic abnormalities did not differ significantly between groups. However, anatomic abnormalities were more frequent among OM compared to gonadotropin and natural cycles [adjOR(95%CI): 1.76(1.06-2.91), p=.028, gonadotropins as ref.; 2.52(1.05-6.05), p=.038, natural as ref.].
Limitations, reasons for caution
This study is limited by its retrospective nature. Unfortunately, placental pathology was available only in conceptions clearly identified as resulting from IUI(±OS) treatments. However, birth weights did not differ between those with and without available placental pathology. Natural/IUI cycles were limited in numbers not allowing meaningful conclusions.
Wider implications of the findings
Between IUI-conceived, singleton-livebirths with available placental pathology, mean PW did not differ significantly. However, a higher-than-expected percent of placentas were below the expected %iles, suggesting that IUI(±OS) might be associated with altered placental growth. Placental anatomic abnormalities were more common among OM cycles, compared to gonadotropins, and n atural IUI cycles.
Trial registration number
Not applicable
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Affiliation(s)
- I Souter
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston MA, U.S.A
| | - P Cherouveim
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston MA, U.S.A
| | - V Fitz
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston MA, U.S.A
| | - K Hammer
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston MA, U.S.A
| | - V Jiang
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston MA, U.S.A
| | - C Sacha
- University of Massachusetts Chan Medical School, Dept of OB/GYN - Division of Reproductive Endocrinology and Infertility , Worcester MA, U.S.A
| | - I Dimitriadis
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston MA, U.S.A
| | - C Bormann
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston MA, U.S.A
| | - K James
- Deborah Kelly Center for Outcomes Research - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology , Boston MA, U.S.A
| | - D Roberts
- Massachusetts General Hospital and Harvard Medical School, Department of Pathology , Boston MA, U.S.A
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15
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Ziogas IA, Evangeliou AP, Mylonas KS, Athanasiadis DI, Cherouveim P, Geller DA, Schulick RD, Alexopoulos SP, Tsoulfas G. Economic analysis of open versus laparoscopic versus robotic hepatectomy: a systematic review and meta-analysis. Eur J Health Econ 2021; 22:585-604. [PMID: 33740153 DOI: 10.1007/s10198-021-01277-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 02/25/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Following the publication of reports from landmark international consensuses (Louisville 2008 and Morioka 2014), minimally invasive hepatectomy became widely accepted as a legitimate alternative to open surgery. We aimed to compare the operative, hospitalization, and total economic costs of open (OLR) vs. laparoscopic (LLR) vs. robotic liver resection (RLR). METHODS We performed a systematic literature review (end-of-search date: July 3, 2020) according to the PRISMA statement. Random-effects meta-analyses were conducted. Quality assessment was performed with the Cochrane Risk of Bias tool for randomized controlled trials, and the Newcastle-Ottawa Scale for non-randomized studies. RESULTS Thirty-eight studies reporting on 3847 patients (1783 OLR; 1674 LLR; 390 RLR) were included. The operative costs of LLR were significantly higher than those of OLR, while subgroup analysis also showed higher operative costs in the LLR group for major hepatectomy, but no statistically significant difference for minor hepatectomy. Hospitalization costs were significantly lower in the LLR group, with subgroup analyses indicating lower costs for LLR in both major and minor hepatectomy series. No statistically significant difference was observed regarding total costs between LLR and OLR both overall and on subgroup analyses in either major or minor hepatectomy series. Meta-analyses showed higher operative, hospitalization, and total costs for RLR vs. LLR, but no statistically significant difference regarding total costs for RLR vs. OLR. CONCLUSION LLR's higher operative costs are offset by lower hospitalization costs compared to OLR leading to no statistically significant difference in total costs, while RLR appears to be a more expensive alternative approach.
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Affiliation(s)
- Ioannis A Ziogas
- Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, 1313 21st Avenue South, Nashville, TN, 37232-4753, USA. .,Surgery Working Group, Society of Junior Doctors, Athens, Greece.
| | - Alexandros P Evangeliou
- Surgery Working Group, Society of Junior Doctors, Athens, Greece.,Aristotle University of Thessaloníki School of Medicine, Thessaloníki, Greece
| | - Konstantinos S Mylonas
- Surgery Working Group, Society of Junior Doctors, Athens, Greece.,National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Dimitrios I Athanasiadis
- Surgery Working Group, Society of Junior Doctors, Athens, Greece.,Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - David A Geller
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Richard D Schulick
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sophoclis P Alexopoulos
- Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, 1313 21st Avenue South, Nashville, TN, 37232-4753, USA
| | - Georgios Tsoulfas
- Department of Transplant Surgery, Aristotle University of Thessaloniki School of Medicine, Thessaloníki, Greece
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