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Liu J, Zeng SC, Wang A, Cheng HY, Zhang QJ, Lu GX. Two missense STK11 gene variations impaired LKB1/adenosine monophosphate-activated protein kinase signaling in Peutz-Jeghers syndrome. World J Gastrointest Oncol 2024; 16:1532-1546. [PMID: 38660671 PMCID: PMC11037055 DOI: 10.4251/wjgo.v16.i4.1532] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/29/2023] [Accepted: 02/03/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Peutz-Jeghers syndrome (PJS) is a rare hereditary neoplastic disorder mainly associated with serine/threonine kinase 11 (STK11/LKB1) gene mutations. Preimplantation genetic testing can protect a patient's offspring from mutated genes; however, some variations in this gene have been interpreted as variants of uncertain significance (VUS), which complicate reproductive decision-making in genetic counseling. AIM To identify the pathogenicity of two missense variants and provide clinical guidance. METHODS Whole exome gene sequencing and Sanger sequencing were performed on the peripheral blood of patients with PJS treated at the Reproductive and Genetic Hospital of Citic-Xiangya. Software was employed to predict the protein structure, conservation, and pathogenicity of the two missense variation sites in patients with PJS. Additionally, plasmids were constructed and transfected into HeLa cells to observe cell growth. The differences in signal pathway expression between the variant group and the wild-type group were compared using western blot and immunohistochemistry. Statistical analysis was performed using one-way analysis of variance. P < 0.05 was considered statistically significant. RESULTS We identified two missense STK11 gene VUS [c.889A>G (p.Arg297Gly) and c.733C>T (p.Leu245Phe)] in 9 unrelated PJS families who were seeking reproductive assistance. The two missense VUS were located in the catalytic domain of serine/threonine kinase, which is a key structure of the liver kinase B1 (LKB1) protein. In vitro experiments showed that the phosphorylation levels of adenosine monophosphate-activated protein kinase (AMPK) at Thr172 and LKB1 at Ser428 were significantly higher in transfected variation-type cells than in wild-type cells. In addition, the two missense STK11 variants promoted the proliferation of HeLa cells. Subsequent immunohistochemical analysis showed that phosphorylated-AMPK (Thr172) expression was significantly lower in gastric, colonic, and uterine polyps from PJS patients with missense variations than in non-PJS patients. Our findings indicate that these two missense STK11 variants are likely pathogenic and inactivate the STK11 gene, causing it to lose its function of regulating downstream phosphorylated-AMPK (Thr172), which may lead to the development of PJS. The identification of the pathogenic mutations in these two clinically characterized PJS patients has been helpful in guiding them toward the most appropriate mode of pregnancy assistance. CONCLUSION These two missense variants can be interpreted as likely pathogenic variants that mediated the onset of PJS in the two patients. These findings not only offer insights for clinical decision-making, but also serve as a foundation for further research and reanalysis of missense VUS in rare diseases.
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Affiliation(s)
- Jin Liu
- Hunan Guangxiu Hospital, Hunan Normal University, Changsha 410000, Hunan Province, China
- Scientific Research Department, Reproductive and Genetic Hospital of Citic-Xiangya, Changsha 410000, Hunan Province, China
| | - Si-Cong Zeng
- Hunan Guangxiu Hospital, Hunan Normal University, Changsha 410000, Hunan Province, China
- Scientific Research Department, Reproductive and Genetic Hospital of Citic-Xiangya, Changsha 410000, Hunan Province, China
| | - An Wang
- Hunan Guangxiu Hospital, Hunan Normal University, Changsha 410000, Hunan Province, China
| | - Hai-Ying Cheng
- Hunan Guangxiu Hospital, Hunan Normal University, Changsha 410000, Hunan Province, China
| | - Qian-Jun Zhang
- Hunan Guangxiu Hospital, Hunan Normal University, Changsha 410000, Hunan Province, China
| | - Guang-Xiu Lu
- Hunan Guangxiu Hospital, Hunan Normal University, Changsha 410000, Hunan Province, China
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Jwa SC, Tamaru S, Takamura M, Namba A, Kajihara T, Ishihara O, Kamei Y. Assisted reproductive technology-associated risk factors for placenta accreta spectrum after vaginal delivery. Sci Rep 2024; 14:7454. [PMID: 38548810 PMCID: PMC10978827 DOI: 10.1038/s41598-024-57988-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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 03/24/2024] [Indexed: 04/01/2024] Open
Abstract
This study aimed to investigate assisted reproductive technology (ART) factors associated with placenta accreta spectrum (PAS) after vaginal delivery. This was a registry-based retrospective cohort study using the Japanese national ART registry. Cases of live singleton infants born via vaginal delivery after single embryo transfer (ET) between 2007 and 2020 were included (n = 224,043). PAS was diagnosed in 1412 cases (0.63% of deliveries), including 1360 cases (96.3%) derived from frozen-thawed ET cycles and 52 (3.7%) following fresh ET. Among fresh ET cycles, assisted hatching (AH) (adjusted odds ratio [aOR], 2.5; 95% confidence interval [CI] 1.4-4.7) and blastocyst embryo transfer (aOR, 2.2; 95% CI 1.3-3.9) were associated with a significantly increased risk of PAS. For frozen-thawed ET cycles, hormone replacement cycles (HRCs) constituted the greatest risk factor (aOR, 11.4; 95% CI 8.7-15.0), with PAS occurring in 1.4% of all vaginal deliveries following HRC (1258/91,418 deliveries) compared with only 0.11% following natural cycles (55/47,936). AH was also associated with a significantly increased risk of PAS in frozen-thawed cycles (aOR, 1.2; 95% CI 1.02-1.3). Our findings indicate the need for additional care in the management of patients undergoing vaginal delivery following ART with HRC and AH.
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Affiliation(s)
- Seung Chik Jwa
- Department of Obstetrics and Gynecology, Saitama Medical University, 38 Morohongo, Moroyama, Saitama, 350-0495, Japan.
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan.
| | - Shunsuke Tamaru
- Department of Obstetrics and Gynecology, Saitama Medical University, 38 Morohongo, Moroyama, Saitama, 350-0495, Japan
| | - Masashi Takamura
- Department of Obstetrics and Gynecology, Saitama Medical University, 38 Morohongo, Moroyama, Saitama, 350-0495, Japan
| | - Akira Namba
- Department of Obstetrics and Gynecology, Saitama Medical University, 38 Morohongo, Moroyama, Saitama, 350-0495, Japan
| | - Takeshi Kajihara
- Department of Obstetrics and Gynecology, Saitama Medical University, 38 Morohongo, Moroyama, Saitama, 350-0495, Japan
| | - Osamu Ishihara
- Department of Obstetrics and Gynecology, Saitama Medical University, 38 Morohongo, Moroyama, Saitama, 350-0495, Japan
- Kagawa Nutrition University, Saitama, Japan
| | - Yoshimasa Kamei
- Department of Obstetrics and Gynecology, Saitama Medical University, 38 Morohongo, Moroyama, Saitama, 350-0495, Japan
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Kumar P, Mundkur A, Sai Bhavna D, Palanivel V, Adiga P, Poojari VG, Rao S, Ullagaddi R. Intrauterine Administration of Autologous Platelet-Derived Growth Factor Concentrate (aka Autologous Blood Cell Derivative) Improves the Endometrial Thickness in 'Thin' Endometrium in the Frozen Embryo Transfer Cycle. J Obstet Gynaecol India 2023; 73:108-114. [PMID: 37916017 PMCID: PMC10616002 DOI: 10.1007/s13224-022-01735-7] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 12/18/2022] [Indexed: 11/03/2023] Open
Abstract
Context Thin endometrium during the frozen embryo transfer cycles leads to cycle cancellation. The embryo transfer cycle getting deferred is an unpleasant experience for the patients and the fertility specialist. Aims The purpose of this study is to evaluate the effectiveness of Autologous Blood Cell Derivative (ABCD) growth factor concentrate to obtain an optimal thickness of endometrium for embryo transfer during IVF treatments, where rapid regeneration is crucial for the expected therapeutic outcome. Settings and Design A retrospective cohort study was conducted in Manipal Assisted Reproduction Center, a referral center in Southern India. Methods and Material Fifty-six patients with thin endometrium were administered three doses of ABCD growth factor concentrate as per the protocol after informed consent. All of them had a history of embryo transfer (ET) cancellation in frozen-thawed embryo cycles due to inadequate growth of the endometrium despite therapy with estrogens and drugs for improving uterine blood circulation. Results The endometrium thickness during the implantation window in the patients included in the study averaged 6.48 ± 1.19 mm. After the intervention, 55 out of 56 patients (98.2%) showed a considerable change in the thickness of the endometrium layer with an average thickness of 8.48 ± 1.32 mm (< 0.0001, SE 0.233, 95% CI 1.58-2.5). Out of the 55 patients, 20 got pregnant, i.e., 36.4% pregnancy rate. Till date, thirteen pregnancies had live births (65%), three pregnancies (15%) were biochemical pregnancies, 1 (5%) was ectopic, and three pregnancies (15%) had spontaneous miscarriage before eight weeks. When we compared the endometrial thickness (EMT) in the pregnant and non-pregnant groups pre- and post-ABCD instillation, (6.47 ± 1.31 mm vs 6.48 ± 1.4 mm, p = 0.98 and 8.68 ± 1.32 mm vs 8.48 ± 1.32 mm, p value 0.59) the p value was not statistically significant. Conclusions The implantation, clinical pregnancy and live birth rates were 36.4, 30 and 65%, respectively. This result is a significant improvement for patients with thin endometrium for whom we would otherwise cancel the frozen transfer. An autologous resource is a safe, readily available and inexpensive treatment modality.
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Affiliation(s)
- Pratap Kumar
- Department of Reproductive Medicine and Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka 576 104 India
| | - Anjali Mundkur
- Department of Reproductive Medicine and Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka 576 104 India
| | - D. Sai Bhavna
- Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka 576 104 India
| | - Vasanthi Palanivel
- Seragen Biotherapeutics Pvt Ltd., Bangalore Bioinnovation Centre, Helix Biotech Park Electronic City, Phase -1, Bangalore, India
| | - Prashanth Adiga
- Department of Reproductive Medicine and Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka 576 104 India
| | - Vidyashree G. Poojari
- Department of Reproductive Medicine and Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka 576 104 India
| | - Shubha Rao
- Department of Reproductive Medicine and Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka 576 104 India
| | - Rashmi Ullagaddi
- Department of Reproductive Medicine and Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka 576 104 India
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Xu B, Hou Z, Liu N, Zhao J, Li Y. Pretreatment with a long-acting GnRH agonist for frozen-thawed embryo transfer cycles: how to improve live birth? J Ovarian Res 2023; 16:197. [PMID: 37743479 PMCID: PMC10518919 DOI: 10.1186/s13048-023-01277-0] [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: 06/22/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Whether pretreatment with gonadotropin-releasing hormone agonist (GnRHa) can improve the pregnancy outcomes in frozen-thawed embryo transfer (FET) cycles is controversial. The inconsistencies in the results of different studies would be related to the characteristics of the included patients and the protocol of GnRHa use. In this study, we investigated the efficacy of pretreatment with a long-acting GnRH agonist in the early follicular phase of FET cycles and determined which population was suitable for the protocol. RESULTS We retrospectively included 630 and 1141 patients in the GnRHa FET and hormone replacement treatment (HRT) FET without GnRHa groups respectively, between October 2017 and March 2019 at a university-affiliated in vitro fertilization center. On the second or third day of menstruation, 3.75 mg of leuprorelin was administered. After 14 days, HRT was initiated for endometrial preparation. No significant differences were observed between the two groups in terms of patient characteristics. However, the GnRHa FET group showed a higher percentage of endometrium with a triple line pattern (94.8% vs 89.6%, p < 0.001) on the day of progesterone administration, with increased implantation (35.6% vs 29.8%, p = 0.005), clinical pregnancy (49.8% vs 43.3%, p = 0.008), and live birth rate (39.4% vs 33.7%, p = 0.016), than the HRT FET cycles with similar endometrial thickness, ectopic pregnancy and early miscarriage rates. Binary logistic regression analysis showed the GnRHa FET group to be associated with an increased chance of clinical pregnancy (P=0.028, odds ratio [OR] 1.32, 95% confidence interval [CI] 1.03-1.70) and live birth (P=0.013, odds ratio [OR] 1.34, 95% confidence interval [CI] 1.06-1.70) compared to the HRT FET without GnRHa group. After subgroup analysis, we found that the GnRHa FET group showed a significantly higher live birth rate in the subgroups of age < 40 years, primary infertility, with polycystic ovary syndrome (PCOS), and irregular menstruation. CONCLUSIONS Pretreatment with a long-acting GnRHa during the early follicular phase improved the live birth rate in FET cycles. Age < 40 years, primary infertility, PCOS, and irregular menstruation are effective indications for endometrial preparation with GnRHa pretreatment in FET cycles. However, further randomized controlled trials are required to verify these results.
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Affiliation(s)
- Bin Xu
- Reproductive Medicine Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha City, Hunan Province, People's Republic of China, 410008
- Clinical Research Center For Woman's Reproductive Health in Hunan Province, Changsha City, China
| | - Zhaojuan Hou
- Reproductive Medicine Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha City, Hunan Province, People's Republic of China, 410008
- Clinical Research Center For Woman's Reproductive Health in Hunan Province, Changsha City, China
| | - Nenghui Liu
- Reproductive Medicine Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha City, Hunan Province, People's Republic of China, 410008
- Clinical Research Center For Woman's Reproductive Health in Hunan Province, Changsha City, China
| | - Jing Zhao
- Reproductive Medicine Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha City, Hunan Province, People's Republic of China, 410008.
- Clinical Research Center For Woman's Reproductive Health in Hunan Province, Changsha City, China.
| | - Yanping Li
- Reproductive Medicine Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha City, Hunan Province, People's Republic of China, 410008.
- Clinical Research Center For Woman's Reproductive Health in Hunan Province, Changsha City, China.
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Pan P, Zheng L, Huang J, Chen X, Ni R, Zhang Q, Yang D, Li Y. Endocrine profiles and cycle characteristics of infertile 17α-hydroxylase/17,20-lyase Deficiency Patients undergoing assisted Reproduction Treatment: a retrospective cohort study. J Ovarian Res 2023; 16:111. [PMID: 37316894 DOI: 10.1186/s13048-023-01190-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/18/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND 17α-hydroxylase/17,20-lyase deficiency (17-OHD) is a rare form of congenital adrenal hyperplasia caused by CYP17A1 gene variants. Female patients with 17-OHD demonstrate a broad clinical spectrum, including oligomenorrhea or amenorrhea and infertility, often as the sole manifestation. However, no spontaneous pregnancies in affected women have been reported. OBJECTIVE This retrospective cohort study aimed to explore the endocrine characteristics and assisted reproductive technique (ART) performance in women with 17-OHD. METHODS Five women were referred for primary infertility in a university-affiliated hospital over an eight-year period. The endocrine profiles and cycle characteristics during a total of nine cycles of ovarian stimulation and eight cycles of frozen-thawed embryo transfer (FET) were described in details. RESULTS Three cases had homozygous variants and two cases had compound heterozygous variants, including one novel missense variant (p.Leu433Ser) in the CYP17A1 gene. Despite dual-suppression of progesterone (P) production by glucocorticoid and gonadotropin releasing hormone agonist, gradually increased P level, relatively low estradiol concentrations and thin endometrium were observed, negating fresh embryo transfer. During FET cycles, appropriate treatment resulted in low serum P levels and adequate endometrial thickness, leading to four live births. CONCLUSIONS Our findings demonstrate that continuous elevation of serum P during follicular growth impairs endometrial receptivity, the likely cause of female infertility in 17-OHD. Therefore, female infertility caused by 17-OHD is suggested as an indication for freeze-all strategy, with promising reproductive prognoses following segmented ovarian stimulation and FET treatment.
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Affiliation(s)
- Ping Pan
- Reproductive Medicine Centre, Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yan Jiang Road, Guangzhou, 510120, Guangdong, China
| | - Lingyan Zheng
- Reproductive Medicine Centre, Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yan Jiang Road, Guangzhou, 510120, Guangdong, China
| | - Jia Huang
- Reproductive Medicine Centre, Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yan Jiang Road, Guangzhou, 510120, Guangdong, China
| | - Xiaoli Chen
- Reproductive Medicine Centre, Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yan Jiang Road, Guangzhou, 510120, Guangdong, China
| | - Renmin Ni
- Department of Reproductive Medicine, Kunming Angel Women's and Children's Hospital, Kunming, Yunnan, China
| | - Qingxue Zhang
- Reproductive Medicine Centre, Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yan Jiang Road, Guangzhou, 510120, Guangdong, China
| | - Dongzi Yang
- Reproductive Medicine Centre, Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yan Jiang Road, Guangzhou, 510120, Guangdong, China.
| | - Yu Li
- Reproductive Medicine Centre, Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yan Jiang Road, Guangzhou, 510120, Guangdong, China.
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Nouiakh N, Sunyach C, Jos SL, Sari-Minodier I, Metzler-Guillemain C, Courbiere B, Bretelle F, Perrin J. Subfertile patients underestimate their risk factors of reprotoxic exposure. Basic Clin Androl 2022; 32:11. [PMID: 35787783 PMCID: PMC9254517 DOI: 10.1186/s12610-022-00161-z] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background Exposure of men and women to environmental reprotoxic agents is associated with impaired fertility and pregnancy rates after assisted reproductive treatment (ART). Nevertheless, such exposures are generally not systematically assessed in current practice before ART and subfertile men are generally less explored than women. Our objective was to study subfertile men and women’s level of knowledge about reprotoxic agents, their perception of their own risk factors and the correlation between perceived and identified circumstances of exposure. Results In our public university hospital, 390 subfertile patients (185 men and 185 women) requiring assisted reproduction technique (ART) treatment, completed a self-report questionnaire before consultation, in order to assess patients’ knowledge of reprotoxic exposures, sources of information about them and perception of their own circumstances of exposure. Then a standardized questionnaire was used by the physician during the consultation to estimate domestic, environmental and occupational risk factors of reprotoxic exposures (RFRE). We compared the patients’ perception of exposure with the estimated RFRE. The reprotoxic agents knowledge score of patients was 61%. Their main sources of information were the media (40%), the internet (22%) and gynecologists (15%). The standardized questionnaire identified RFRE in 265/390 patients (68%); risk factor was statistically more frequent in men (77%) than in women (59%) (p < 0.05). In total, 141 of the 265 patients with identified RFRE (53%) were aware of their risk factor of reprotoxic exposure. Conclusion We identified risk factors of reprotoxic exposures in the majority of subfertile patients, more frequently in men than in women, and half of patients were not aware of their exposures. Patients’ main sources of information were extra medical. Efforts should be made to inform patients, especially men, about potential reprotoxic exposure and to enhance medical training about reprotoxic agents, as recommended by international guidelines. The detection and correction of environmental exposures in subfertile men could improve their fecundity, but also their general health, which has been shown to be poorer than health of fertile men. Supplementary Information The online version contains supplementary material available at 10.1186/s12610-022-00161-z.
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Affiliation(s)
- Nadia Nouiakh
- Centre Clinico-Biologique d'AMP-CECOS, AP-HM La Conception University Hospital, 147 bd Baille, 13005, Marseille, France
| | - Claire Sunyach
- Plateforme CREER, AP-HM La Conception University Hospital, 147 bd Baille, 13005, Marseille, France
| | - Sarah-Lyne Jos
- Centre Clinico-Biologique d'AMP-CECOS, AP-HM La Conception University Hospital, 147 bd Baille, 13005, Marseille, France
| | - Irène Sari-Minodier
- Plateforme CREER, AP-HM La Conception University Hospital, 147 bd Baille, 13005, Marseille, France.,Service de Médecine et Santé au Travail, AP-HM La Timone University Hospital, 145 rue St Pierre, 13005, Marseille, France.,Aix Marseille Univ, Avignon Université, CNRS, IRD, IMBE, 27 bd J Moulin, 13385, Marseille, France
| | - Catherine Metzler-Guillemain
- Centre Clinico-Biologique d'AMP-CECOS, AP-HM La Conception University Hospital, 147 bd Baille, 13005, Marseille, France.,Aix Marseille Univ, Inserm, MMG, U1251, Marseille Medical Genetics, 27 bd J Moulin, 13385, Marseille, France
| | - Blandine Courbiere
- Centre Clinico-Biologique d'AMP-CECOS, AP-HM La Conception University Hospital, 147 bd Baille, 13005, Marseille, France.,Plateforme CREER, AP-HM La Conception University Hospital, 147 bd Baille, 13005, Marseille, France.,Aix Marseille Univ, Avignon Université, CNRS, IRD, IMBE, 27 bd J Moulin, 13385, Marseille, France
| | - Florence Bretelle
- Plateforme CREER, AP-HM La Conception University Hospital, 147 bd Baille, 13005, Marseille, France.,Aix Marseille Univ, IRD, AP-HM,MEPHI, IHU Méditerranée Infection, Marseille, France
| | - Jeanne Perrin
- Centre Clinico-Biologique d'AMP-CECOS, AP-HM La Conception University Hospital, 147 bd Baille, 13005, Marseille, France. .,Plateforme CREER, AP-HM La Conception University Hospital, 147 bd Baille, 13005, Marseille, France. .,Aix Marseille Univ, Avignon Université, CNRS, IRD, IMBE, 27 bd J Moulin, 13385, Marseille, France.
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Le Floch M, Crohin A, Duverger P, Picard A, Legendre G, Riquin E. Prevalence and phenotype of eating disorders in assisted reproduction: a systematic review. Reprod Health 2022; 19:38. [PMID: 35130918 PMCID: PMC8822730 DOI: 10.1186/s12978-022-01341-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/12/2022] [Indexed: 12/02/2022] Open
Abstract
Background Eating disorders (EDs) are common conditions that mainly affect women of reproductive age and have a major impact on fertility. Our systematic review focuses on the prevalence of EDs in patients in the process of assisted reproductive technique (ART) and describes the phenotypes of EDs identified. Methods Our systematic review is based on the PRISMA criteria. Articles were collected using the Medline/Pubmed, Web Of Science and Cochrane databases. The articles chosen had to mention the prevalence of ED in infertile patients undergoing ART and be cohort or case–control studies assessing the prevalence of ED during fertility treatment. Main findings Fifteen articles were included in this review. The prevalence of active ED varied between 0.13 and 44% depending on the types considered in each study. The main phenotypes described were EDNOS (eating disorder not otherwise specified) and binge eating disorders (BED) occurring in women with a normal body mass index (BMI) and a history of ED. Mainly subthreshold forms with cognitive distortions were described. Conclusion This review highlights a 6 times higher prevalence of EDs in infertile patients undergoing fertility treatment compared to regular pregnant women. However, diagnosing these conditions is complex. As a result, it is essential that professionals in contact with this population are alert to symptoms consistent with these conditions in order to refer them to specialized psychiatric care. Eating disorders are frequent pathologies that primarily affect women of childbearing age. Numerous articles reveal an increased risk for the mother and the child in case of an active disorder during pregnancy. We conducted a systematic review to determine the prevalence and phenotypes of eating disorders in infertile subjects undergoing fertility treatment. The results of the fifteen articles included show a prevalence six times higher than in pregnant women in the general population. Subjects with eating disorders have normal body mass indexes. The active forms are mainly characterized by episodes of binge eating disorders or other unspecified forms. Studies also describe incomplete forms characterized by the presence of dysfunctional thoughts around shape and weight without associated compensatory behavior. Professionals working in the field of reproductive medicine and providing fertility treatment have a major role to play in identifying and referring these subjects at risk to specialized care.
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Affiliation(s)
- Marine Le Floch
- Department of Child and Adolescent Psychiatry, Centre Hospitalier Universitaire d'Angers, Angers, France. .,Pediatric Psychiatry Department, University Hospital of Angers, 4, Rue Larrey, 49933, Angers Cedex 9, France.
| | - Anaïs Crohin
- Department of Child and Adolescent Psychiatry, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Philippe Duverger
- Department of Child and Adolescent Psychiatry, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Aline Picard
- Department of Perinatal Psychiatry, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Guillaume Legendre
- Department of Obstetrics and Gynecology and Medically Assisted Reproduction, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Elise Riquin
- Department of Child and Adolescent Psychiatry, Centre Hospitalier Universitaire d'Angers, Angers, France.,University of Angers, University of Nantes, LPPL, SFR Confluences, 49000, Angers, France.,University Service of the Fondation Santé des Étudiants de France, Sablé sur Sarthe Clinic, Paris, France
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Jahangirifar M, Taebi M, Nasr-Esfahani MH, Heidari-Beni M, Asgari GH. Dietary Fatty Acid Intakes and the Outcomes of Assisted Reproductive Technique in Infertile Women. J Reprod Infertil 2021; 22:173-183. [PMID: 34900638 PMCID: PMC8607876 DOI: 10.18502/jri.v22i3.6718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/02/2021] [Indexed: 11/24/2022] Open
Abstract
Background The purpose of this study was evaluating the relationship between fatty acid (FA) intakes and the Assisted Reproductive Technique (ART) outcomes in infertile women. Methods In this descriptive longitudinal study, a validated food frequency questionnaire (FFQ) was used to measure dietary intakes among 217 women with primary infertility seeking ART treatments at Isfahan Fertility and Infertility Center, Isfahan, Iran. The average number of total and metaphase II (MII) oocytes, the fertilization rate, the ratio of good and bad quality embryo and biochemical and clinical pregnancy were assessed. Analyses were performed using mean, standard deviation, Chi-square test, ANOVA, ANCOVA, logistic regression. Results A total of 140 women were finally included in the study. There was a positive relationship between the average number of total and MII oocytes and the amount of total fatty acids (TFAs), saturated fatty acids (SFAs), monounsaturated fatty acids (MUFAs), polyunsaturated fatty acids (PUFAs), linoleic acids, linolenic acids, and oleic acids intakes, while eicosapentaenoic acids (EPAs) and docosahexaenoic acids (DHAs) intakes had an inverse relationship. Consuming more amounts of TFAs, SFAs, PUFAs, MUFAs, linoleic acids, and oleic acids was associated with the lower fertilization rate, whereas the consumption of linolenic acids and EPAs increased the fertilization rate. The ratio of good quality embryo was directly affected by the amount of PUFAs intakes. Additionally, there was a negative correlation between the amount of SFAs intakes and the number of pregnant women. Conclusion TFAs, SFA, PUFA, and MUFA intakes could have both beneficial and adverse impacts on ART outcomes.
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Affiliation(s)
- Maryam Jahangirifar
- School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Mahboube Taebi
- Department of Midwifery and Reproductive Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Hossein Nasr-Esfahani
- Department of Animal Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
| | - Motahar Heidari-Beni
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholam Hossein Asgari
- Department of Community Nutrition, Isfahan University of Medical Sciences, Isfahan, Iran
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Varlı B, Şükür YE, Özmen B, Ergüder Bİ, Sönmezer M, Berker B, Atabekoğlu C, Aytaç R. Anorexigenic peptide (leptin, obestatin, nesfatin-1) levels and their impact on assisted reproductive technology treatment outcomes in patients with polycystic ovary syndrome. Clin Exp Reprod Med 2021; 48:368-373. [PMID: 34875744 PMCID: PMC8651756 DOI: 10.5653/cerm.2021.04420] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/28/2021] [Indexed: 11/09/2022] Open
Abstract
Objective In this study we aimed to assess anorexigenic peptide levels in patients with or without polycystic ovary syndrome (PCOS) and their effects on assisted reproductive treatment (ART) outcomes. Methods A prospective case-control study was conducted in a tertiary care university-based ART clinic. Eighty-three patients were included in the study. The PCOS group included 41 patients, and the non-PCOS group included 42 controls. The 2003 Rotterdam criteria were used for PCOS patient selection. The ART indications in the non-PCOS group were tubal factor or unexplained infertility. Venous blood samples were taken on the third day of the menstrual cycle to determine the serum anorexigenic peptide levels. The enzyme-linked immunosorbent assay method was used for laboratory analyses. Results In the PCOS group, serum obestatin levels were significantly lower than in the control group, but serum anorexigenic peptide levels were similar in PCOS patients with or without clinical pregnancy. Ovarian hyperstimulation syndrome (OHSS) was diagnosed only in PCOS patients, and the obestatin levels of OHSS patients were significantly lower than those of other PCOS patients. Conclusions Baseline anorexigenic peptide levels did not affect the clinical pregnancy rate in ART cycles. Obestatin may play a role in the pathophysiology of OHSS. This possibility should be confirmed in further research.
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Affiliation(s)
- Bulut Varlı
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Yavuz Emre Şükür
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Batuhan Özmen
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Berrin İmge Ergüder
- Department of Biochemistry, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Murat Sönmezer
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Bülent Berker
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Cem Atabekoğlu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ruşen Aytaç
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ankara University, Ankara, Turkey
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10
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Abstract
Assisted reproductive techniques (ARTs), such as artificial insemination, in vitro fertilization, and cryopreservation of gametes/zygotes, have been developed to improve breeding and reproduction of livestock and for the treatment of human infertility. Their widespread use has contributed to improvements in human health and welfare. However, in dogs, only artificial insemination using frozen semen is readily available as an ART to improve breeding and control genetic diversity. A recent priority in sperm cryopreservation is the development of alternatives to egg yolk, which is widely used as a component of the sperm extender. Egg yolk can vary in composition among batches and is prone to contamination by animal pathogens. The latter can be a problem for international exchange of cryopreserved semen. Low-density lipoprotein and skim milk are promising candidates for use as extenders, to ensure fertility after artificial insemination. Although not tested for its effects on fertility following artificial insemination, polyvinyl alcohol may also be a useful alternative to egg yolk as an extender. The development of cryopreservation techniques for canine embryos lags behind that for other mammals, including humans. However, given the success of non-surgical embryo transfer in 2011, studies have sought to refine this approach for practical use. Research on sperm cryopreservation has yielded satisfactory results. However, investigation of other approaches, such as cryopreservation of oocytes and gonadal tissues, remains insufficient. Techniques for the efficient induction of estrus may aid in the development of successful canine ARTs.
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Affiliation(s)
- Hiroshi Suzuki
- Obihiro University of Agriculture and Veterinary Medicine, Hokkaido 080-8555, Japan
| | - Hiroyuki Watanabe
- Obihiro University of Agriculture and Veterinary Medicine, Hokkaido 080-8555, Japan
| | - Yasuyuki Abe
- Prefectural University of Hiroshima, Hiroshima 727-0023, Japan
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11
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Somigliana E, Esposito G, Viganò P, Franchi M, Corrao G, Parazzini F. Effects of the early phase of the COVID-19 pandemic on natural and ART-mediated birth rates in Lombardy Region, Northern Italy. Reprod Biomed Online 2021; 43:765-767. [PMID: 34474979 PMCID: PMC8496890 DOI: 10.1016/j.rbmo.2021.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/17/2021] [Accepted: 07/22/2021] [Indexed: 11/25/2022]
Abstract
Research question What effects did the early phase of the COVID-19 pandemic have on natural and assisted reproductive technology (ART)-mediated birth rates? Design Regional registries were consulted with permission from the Health Authorities of Lombardy Region, Northern Italy, an area particularly affected by the early phase of the epidemic. Deliveries occurring in the area between 1 January 2019 and 31 December 2020 from women beneficiaries of the National Health System and resident in Lombardy were identified. Comparisons mainly focused on December 2020, when women who conceived after 8 March (the start of the stringent lockdown imposed by the authorities) were expected to deliver. Results When comparing the periods January to November in 2019 and 2020, a 5.1% reduction of monthly general birth rate (from 5732 in 2019 to 5438 in 2020) was observed. The contribution of ART births was similar in 2019 and 2020, being 4.4% and 4.5%, respectively. In December 2020, a notable drop in natural (–17.8%), ART-mediated (–86.6%) and overall (–21.0%) births was observed compared with December 2019. After adjusting for the expected 5.1% reduction, the inferred effect of the COVID-19 crisis corresponded to a 16.7% reduction in birth rate, of which 76% was related to natural (707 births) and 24% to ART (218 births) conceptions. Conclusions This is the first study providing population-based evidence on the effects of COVID-19 and its related stringent restrictions on birth rates. The birth rate was dramatically reduced following the critical period, and the closure of ART centres played only a marginal role (24%) in the overall detrimental effect.
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Affiliation(s)
- Edgardo Somigliana
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Department of Obstetrics, Gynecology and Neonatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Giovanna Esposito
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paola Viganò
- Department of Obstetrics, Gynecology and Neonatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Franchi
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy
| | - Giovanni Corrao
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy
| | - Fabio Parazzini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Department of Obstetrics, Gynecology and Neonatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Pan LF, Wang PH, Lin LT, Hsu S, Tsui KH. Factors that infertile couples from mainland China may take into consideration for cross-border reproductive care - A cross-sectional questionnaire study. Taiwan J Obstet Gynecol 2021; 60:24-30. [PMID: 33495003 DOI: 10.1016/j.tjog.2020.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2020] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Cross-border reproductive care (CBRC) has become popular in the world, including mainland China. We designed a questionnaire and aimed to determine the main factors that infertile couples from mainland China may consider for CBRC. MATERIALS AND METHODS In this cross-sectional questionnaire-based study, we retrospectively analyzed the data from questionnaires collected at the Reproductive Center of Beijing BaoDao Obstetrics and Gynecology Hospital from January 2018 to June 2018. The questionnaire contained 38 items that belonged to six different categories (environment and equipment, service quality, patient safety, medical quality, information acquisition channel and overseas medical services). The item scores for each factor were calculated and then weighted using principal component analysis. RESULTS A total of 297 infertile couples were identified. Most of the infertile women were aged 31-35 years, were married 1-3 years, and had a bachelor's degree. In the weighted factor analysis, "clean outpatient clinic and medical equipment" had the highest weight in the dimension of environment and equipment. The item with the highest weight in the dimension of service quality was "wait time for examination". In the dimension of patient safety, "health education on medication and surgery by counselors" had the highest weight. The item with the highest weight in the dimension of medical quality was "fee charged for ART treatment". The items with the three highest weights in the dimension of information acquisition channel were "other (seminar, exhibition, dissertation …)", "introduction from friends and relatives", and "telephone inquiry". In the dimension of overseas medical services, the two items with the highest weights were "cultural similarities" and "language similarities". CONCLUSION For CBRC, infertile couples from mainland China may take following significant factors into consideration: a high success rate and inexpensive treatment, cultural and linguistic familiarity, high-quality service and short wait time.
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Affiliation(s)
- Li-Fei Pan
- College of Finance and Banking, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taiwan
| | - Li-Te Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Biological Science, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Shuofen Hsu
- Department of Risk Management & Insurance, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan.
| | - Kuan-Hao Tsui
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Pharmacy and Master Program, College of Pharmacy and Health Care, Tajen University, Pingtung County, Taiwan.
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Ghasemian F, Esmaeilnezhad S, Mehdipour Moghaddam MJ. Staphylococcus saprophyticus and Escherichia coli: Tracking from sperm fertility potential to assisted reproductive outcomes. Clin Exp Reprod Med 2021; 48:142-149. [PMID: 34078007 PMCID: PMC8176154 DOI: 10.5653/cerm.2020.04203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/14/2021] [Indexed: 11/07/2022] Open
Abstract
Objective Bacteriospermia and urogenital infections are common problems in male infertility. This study aimed to evaluate the effects of bacteriospermia on sperm parameters and clinical outcomes in semen samples infected with two common bacteria (Staphylococcus saprophyticus and Escherichia coli) in northern Iran. Methods Microbiological tests were performed to isolate and identify organisms from 435 semen samples from infertile couples. Semen samples were assessed according to the World Health Organization criteria. The protamine status, chromatin structure, chromatin condensation, and acrosome reaction of sperm and assisted reproductive outcomes were determined in couples with different male infertility factors. Results Among the total cases, the two most prevalent pathogens were considered: S. saprophyticus (38.2%) and E. coli (52.9%). In the semen samples infected with E. coli, the spontaneous acrosome reaction and abnormal chromatin condensation were more common (p<0.05). Significant increases in abnormal chromatin condensation and deprotamination were seen in the presence of S. saprophyticus. In washed semen, tight adhesion between the sperm midpiece and S. saprophyticus was observed. There was also a significant decrease in the fertilization rate using semen samples infected with S. saprophyticus and E. coli during in vitro fertilization cycles (p<0.001). In addition, the presence of S. saprophyticus and E. coli in semen samples was associated with a lower likelihood of clinical pregnancy in couples with various factors of male infertility. Conclusion Poor results of assisted reproductive techniques may be correlated with semen samples infected with two common bacteria in northern Iran.
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Affiliation(s)
- Fatemeh Ghasemian
- Department of Biology, Faculty of Sciences, University of Guilan, Rasht, Iran
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Sparaco M, Bonavita S. The role of sex hormones in women with multiple sclerosis: From puberty to assisted reproductive techniques. Front Neuroendocrinol 2021; 60:100889. [PMID: 33189769 DOI: 10.1016/j.yfrne.2020.100889] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/02/2020] [Accepted: 11/08/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Multiple Sclerosis is a multifactorial chronic autoimmune disease, affecting predominantly females in the fertile age. Sex hormones changes during a woman's life, from puberty to menopause, including pregnancy and puerperium, may influence the onset and course of Multiple Sclerosis. The effect of estrogen levels on immune, clinical and radiological aspects of Multiple Sclerosis, also stimulated investigation on the effect of sexual hormones therapies, such as oral contraceptives and assisted reproductive technique, on the Multiple Sclerosis course. SEARCH STRATEGY AND SELECTION CRITERIA A literature search for original articles and reviews was conducted in the databases, including PubMed, Scopus, and ClinicalTrials.gov of the U.S. National Library of Medicine site from 1988 to 2020. RESULTS AND CONCLUSION This review reports the effects of the physiological and iatrogenic hormonal changes either on immune or clinical or paraclinical features in the different life stages of women affected by Multiple Sclerosis.
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Affiliation(s)
- Maddalena Sparaco
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138 Naples, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138 Naples, Italy.
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Li YX, Sun TZ, Lv MQ, Zhou L, Ge P, Li HN, Zhou DX. Is vanishing twin syndrome associated with adverse obstetric outcomes of ART singletons? A systematic review and meta-analysis. J Assist Reprod Genet 2020; 37:2783-2796. [PMID: 32840763 DOI: 10.1007/s10815-020-01928-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 05/14/2020] [Accepted: 08/17/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The objective of our meta-analysis was to estimate the effect of VTS on obstetric outcomes of ART singletons. METHODS PubMed, Embase, MEDLINE, and ClinicalTrials.gov were searched up to January 2019 to find studies reporting the obstetric outcomes of ART singletons with VTS. Dichotomous data were expressed as odds ratios (OR) with 95% confidence intervals (CI). Continuous data were expressed as weighted mean difference (WMD) with 95% CI. RESULTS A total of 17 observational studies encompassing more than 60,000 ART singletons were included in this meta-analysis. The impact of VTS on singletons was highly dependent on the definition of VTS, precisely, the vanishing timing and intrauterine growth stage. When VTS happened at or before 14 weeks, regardless of intrauterine growth stage, there were no differences in terms of gestational age (GA) [WMD = - 0.08, 95% CI = - 0.27, 0.10], preterm birth (< 37 weeks) (PTB) [OR = 1.23, 95% CI = 0.89, 1.70], and low birth weight (< 2.5 kg) (LBW) [OR = 1.56, 95% CI = 1.00, 2.43] in original singletons versus singleton with VTS. On the contrary, VTS occurred after 14 weeks was associated with significantly shorter GW and lower BW, as well as higher risks of PTB and LBW. When the sac reduced in VTS was an empty gestational sac, there would be no differences in GW, PTB, and LBW between singletons versus singletons with VTS, whereas the loss of a fetus with cardiac-activity was associated with adverse obstetric outcomes. CONCLUSIONS This meta-analysis suggests whether or not VTS is harmful to obstetric outcomes is highly dependent on the vanishing timing and intrauterine growth stage.
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Affiliation(s)
- Yi-Xin Li
- Department of Pathology, Medical School, Xi'an Jiaotong University, Xi'an, 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, 710061, China
- Institute of Genetics and Developmental Biology, Xi'an, 710061, China
| | - Tian-Ze Sun
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, 710061, China
- Institute of Genetics and Developmental Biology, Xi'an, 710061, China
- Department of Human Anatomy and Histology and Embryology, Medical School, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Mo-Qi Lv
- Department of Pathology, Medical School, Xi'an Jiaotong University, Xi'an, 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, 710061, China
- Institute of Genetics and Developmental Biology, Xi'an, 710061, China
| | - Liang Zhou
- Reproductive Medicine Center, North-West Maternal and Child Hospital, Xi'an, 710003, China
| | - Pan Ge
- Department of Pathology, Medical School, Xi'an Jiaotong University, Xi'an, 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, 710061, China
- Institute of Genetics and Developmental Biology, Xi'an, 710061, China
| | - Hao-Nan Li
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, 710061, China
- Institute of Genetics and Developmental Biology, Xi'an, 710061, China
- Department of Pathogenic Biology and Immunology, Medical School, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Dang-Xia Zhou
- Department of Pathology, Medical School, Xi'an Jiaotong University, Xi'an, 710061, China.
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, 710061, China.
- Institute of Genetics and Developmental Biology, Xi'an, 710061, China.
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Chmel R, Cekal M, Pastor Z, Chmel R, Paulasova P, Havlovicova M, Macek M, Novackova M. Assisted Reproductive Techniques and Pregnancy Results in Women with Mayer-Rokitansky-Küster-Hauser Syndrome Undergoing Uterus Transplantation: the Czech Experience. J Pediatr Adolesc Gynecol 2020; 33:410-414. [PMID: 32224249 DOI: 10.1016/j.jpag.2020.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 03/16/2020] [Accepted: 03/19/2020] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE This study aimed to evaluate the reproductive potential of patients with Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) who were candidates for uterus transplantation (UTx) before inclusion in the experimental trial, and to summarize the existing experience with posttransplantation embryo transfers in functionally successful cases. DESIGN AND SETTING A prospective study at a tertiary medical center. PARTICIPANTS Ten pre-UTx women with MRKHS and 7 successful UTx cases. INTERVENTIONS AND MAIN OUTCOME MEASURES Ovarian stimulations, frozen embryo collection, embryo transfers, and incidence of pregnancy in MRKHS women in the pre- and posttransplantation periods. RESULTS The average number of ovarian stimulations to collect the required frozen embryos was 1.9 (1-3). On average, the number of aspirated oocytes was 16.4 (7-38), 12.6 (5-26) oocytes were fertilized, and 7.0 (1-18) embryos were cryopreserved per cycle. To date, the average number of embryo transfers per recipient was 4.9 (3-8), and the embryo transfer/pregnancy rate was 8.8% (3 of 34). Three pregnancies have been achieved to date, including a missed abortion in the 8th week, a birth in the 35th week, and an ongoing pregnancy in the 30th week. CONCLUSIONS Despite the small number of UTx cases, our data indicated that women with MRKHS showed a good response to ovarian stimulation and blastocyst formation. Although the procedures for fertilization, cryopreservation, and transfer of the embryos were standardized, the success rate per embryo transfer achieved in the study group has been low to date.
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Affiliation(s)
- Roman Chmel
- Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
| | - Milos Cekal
- Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Zlatko Pastor
- Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Roman Chmel
- Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Petra Paulasova
- Department of Biology and Medical Genetics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Marketa Havlovicova
- Department of Biology and Medical Genetics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Milan Macek
- Department of Biology and Medical Genetics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Marta Novackova
- Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
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Berntsen S, Larsen EC, la Cour Freiesleben N, Pinborg A. Pregnancy outcomes following oocyte donation. Best Pract Res Clin Obstet Gynaecol 2020; 70:81-91. [PMID: 32741624 DOI: 10.1016/j.bpobgyn.2020.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 03/31/2020] [Revised: 06/18/2020] [Accepted: 07/01/2020] [Indexed: 12/17/2022]
Abstract
The use of oocyte donation (OD) has increased continuously over the last three decades, and it is now an indispensable part of assisted reproductive technology (ART). With OD, it has become possible to overcome the biological barrier of ovarian follicle pool depletion and the general age-related decline in fertility. This review contains a thorough appraisal of the safety of OD with an analysis of short-term pregnancy outcomes. Salient up-to-date evidence was evaluated, which revealed that in comparison with both IVF with autologous oocytes, and naturally conceived pregnancies, there is: (i) an increased risk of hypertensive disorders of pregnancy and preeclampsia; (ii) an increased risk of low birth weight and preterm birth and (iii) an increased risks of obstetric emergencies, following OD treatment. As a precaution, it is therefore highly encouraged to perform only single embryo transfer (SET) and to prescribe prophylactic low-dose aspirin during OD pregnancies.
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Affiliation(s)
- Sine Berntsen
- Department of Obstetrics and Gynaecology, The Fertility Clinic, Copenhagen University Hospital, Hvidovre Hospital, Kettegaard allé 30, 2650, Hvidovre, Denmark.
| | - Elisabeth Clare Larsen
- The Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Nina la Cour Freiesleben
- Department of Obstetrics and Gynaecology, The Fertility Clinic, Copenhagen University Hospital, Hvidovre Hospital, Kettegaard allé 30, 2650, Hvidovre, Denmark.
| | - Anja Pinborg
- The Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
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Tsujimoto Y, Kaneko T, Yoshida T, Kimura K, Inaba T, Sugiura K, Hatoya S. Development of feline embryos produced using freeze-dried sperm. Theriogenology 2020; 147:71-6. [PMID: 32126383 DOI: 10.1016/j.theriogenology.2020.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 02/11/2020] [Accepted: 02/16/2020] [Indexed: 11/21/2022]
Abstract
Freeze drying has been developed as a new sperm preservation method that eliminates the necessity of using liquid nitrogen. An advantage of freeze-dried sperm is that it can be stored at 4 °C and transported at room temperature. To develop assisted reproductive techniques (ARTs) for domestic cats, we evaluated the effect of the freeze-dry procedure on cat sperm DNA by analyzing DNA integrity (experiment 1) and by generating cat embryos using freeze-dried sperm that had been preserved for several months (experiment 2). In experiment 1, the rate of DNA damage to freeze-dried sperm was not significantly different than that of sperm cryopreserved with liquid nitrogen (P > 0.05). In experiment 2, the proportions of cleaved embryos, morulae, and blastocysts and the cell number of blastocysts did not differ between experimental groups in which fresh sperm and freeze-dried sperm were used (P > 0.05). In addition, we generated feline blastocysts using freeze-dried sperm stored for 1-5 months. These results support an expansion of the repertoire of ARTs that are potentially applicable to both domestic and endangered species of cats.
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Adib Moghaddam E, Kazemi A, Kheirabadi G, Ahmadi SM. A mental health intervention program for the oocyte donors: protocol for a mixed methods study. Reprod Health 2020; 17:10. [PMID: 31959209 DOI: 10.1186/s12978-020-0864-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 01/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Oocyte donation is one of the assisted reproductive techniques that can undermine the mental health of the women donor. As such, the aim of this study is to design a mental health promotion program for oocyte donors. METHODS This is an exploratory mixed methods study (qualitative-quantitative) that consists of three phases. In the first phase, a qualitative study will be conducted to identify the needs and strategies of the mental health promotion program for the women donors. In this phase, the participants will be selected using purposeful sampling method and the data will be collected through semi-structured interviews. In the second phase, the initial draft of the program is designed and validated in the panel of experts and using the classic Delphi technique and, then, the program is finalized. In the third phase, the designed program will be implemented as a quasi-experimental study in two groups of program recipients (intervention) and control, and the effectiveness of the intervention program will be evaluated. DISCUSSION In order to design a documentation-based mental health promotion program for the oocyte donors, their experience during the process of oocyte donation should be evaluated. Doing so, the program will be developed based on the specific circumstances of the target population and their social and cultural context and, hence, will have the highest impact.
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Rissanen E, Gissler M, Lehti V, Tiitinen A. The risk of psychiatric disorders among Finnish ART and spontaneously conceived children: Finnish population-based register study. Eur Child Adolesc Psychiatry 2020; 29:1155-64. [PMID: 31686240 DOI: 10.1007/s00787-019-01433-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 10/26/2019] [Indexed: 11/02/2022]
Abstract
Evidence regarding the psychiatric morbidity of children born after Assisted Reproductive Techniques (ART) is inconsistent and limited. While normal mental well-being for ART children is usually reported, concerns are still being raised. Previous studies examine only some psychiatric disorders, but not all of them, ignore the impact of multiplicity, and limit the follow-up time to childhood. We examined all psychiatric diagnoses for singletons until their young adulthood. The aim was to study whether the risk of psychiatric disorders differs between ART and spontaneously conceived (SC) singletons until young adulthood. This retrospective Finnish population-based register study includes all ART and SC live-born children born in Finland during 1990-2013 and their hospital care in 1990-2014 (n = 1,425,975 of which 1,385,956, 97.2% were singletons). After excluding multiples, the final population included 17,610 ART and 1,368,346 SC singletons in 1990-2013 from the Finnish Medical Birth Registry. These data were linked to the Finnish Hospital Discharge Registry with the child's and mother's encrypted IDs. ART singletons had fewer psychiatric diagnoses (ART 10.2%, n = 1796, SC 12.0%, n = 164,408), but they received their diagnoses earlier (mean 8.3 years old, SD 5.0) than SC singletons (mean 10.5 years old, SD 5.7). After adjusting for confounding factors, ART singletons had an increased likelihood of getting a psychiatric diagnosis until young adulthood and the results were similar for boys (adjusted hazard ratios [aHR] = 1.16, 95% confidence interval (CI) 1.10-1.24) and girls (aHR = 1.25, 95% CI 1.16-1.35). We conclude that ART children receive their psychiatric diagnoses earlier than SC children, in particular during childhood and early adolescence. After adjusting for confounding factors ART children a slightly increased likelihood of any psychiatric diagnosis compared to SC controls.
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21
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Abstract
In an age when a small quantity of sperm can lead to pregnancy through in vitro fertilization or intracytoplasmic sperm injection, selecting healthy sperm is important. Sperm DNA fragmentation (SDF) is known to be higher in infertile men. Terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling (TUNEL) and the alkaline comet test are SDF tests that directly measure DNA damage and have shown closer correlations with assisted reproduction results than indirect tools such as the sperm chromatin structure assay or the sperm chromatic dispersion test. It is difficult; however, to endorse a single test as the best test overall; instead, it is best to select a testing method based on each patient's clinical condition and goals. In a couple struggling with infertility, if the male partner has a high level of SDF, he should aim to decrease SDF through lifestyle modifications, antioxidant treatment, and ensuring an appropriate duration of abstinence, and physicians need to treat the underlying diseases of such patients. If sperm DNA damage continues despite the patient's and physician's efforts, other methods, such as micromanipulation-based sperm selection or testicular sperm extraction, should be used to select healthy sperm with nuclear DNA integrity.
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Affiliation(s)
- Gi Young Kim
- Department of Urology, Mizmedi Hospital, Seoul, Korea
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22
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Di Nisio M, Ponzano A, Tiboni GM, Guglielmi MD, Rutjes AWS, Porreca E. Effects of multiple inherited and acquired thrombophilia on outcomes of in-vitro fertilization. Thromb Res 2018; 167:26-31. [PMID: 29772490 DOI: 10.1016/j.thromres.2018.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 02/26/2018] [Revised: 04/24/2018] [Accepted: 05/06/2018] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The effects of multiple inherited and acquired thrombophilic defects on the outcome of in-vitro fertilization (IVF) remain unexplored. The aim of this study was to evaluate the association between multiple thrombophilia and clinical outcomes in a large prospective cohort of women undergoing IVF. MATERIALS AND METHODS Consecutive women scheduled for IVF were eligible. The primary study outcome was live birth. Secondary outcomes included spontaneous abortion, clinical pregnancy, and symptomatic venous thromboembolism. RESULTS 687 women with a mean age of 34.6 (±3.2) years were included. Overall, 22 women (3.2%) had two or more thrombophilic defects. The probability of live birth was not statistically significantly different between women with ≥2 thrombophilia (odds ratio [OR] 0.62; 95% confidence interval [CI], 0.18 to 2.11) or ≥1 thrombophilia (OR 0.67;95% CI, 0.41 to 1.09) and women without any thrombophilia. None of the individual inherited thrombophilia nor positivity to antiphospholipid antibodies or lupus anticoagulant were associated with live birth. Single positivity for lupus anticoagulant carried a more than threefold higher risk of abortion (OR 3.74; 95% CI, 1.30 to 10.75). There were no statistically significant associations between individual or multiple thrombophilic defects and clinical pregnancy or pregnancy test results. No woman had a history of venous thromboembolism and none developed a thrombotic event during the study. CONCLUSIONS In women undergoing IVF, the presence of two or more thrombophilic defects was rare and showed no statistically significant associations with IVF outcomes.
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Affiliation(s)
- Marcello Di Nisio
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands; Department of Medicine and Ageing Sciences, University G. D'Annunzio, Chieti-Pescara, Italy.
| | - Adalisa Ponzano
- Department of Medicine and Ageing Sciences, University G. D'Annunzio, Chieti-Pescara, Italy; Unit of Assisted Reproductive Technology, Ortona General Hospital, Ortona, Chieti, Italy
| | - Gian Mario Tiboni
- Department of Medicine and Ageing Sciences, University G. D'Annunzio, Chieti-Pescara, Italy; Unit of Assisted Reproductive Technology, Ortona General Hospital, Ortona, Chieti, Italy.
| | | | - Anne Wilhelmina Saskia Rutjes
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
| | - Ettore Porreca
- Department of Medical, Oral and Biotechnological Sciences, Gabriele D'Annunzio University, Chieti, Italy.
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Zhang SP, Lu CF, Gong F, Xie PY, Hu L, Zhang SJ, Lu GX, Lin G. Polar body transfer restores the developmental potential of oocytes to blastocyst stage in a case of repeated embryo fragmentation. J Assist Reprod Genet 2017; 34:563-571. [PMID: 28190214 DOI: 10.1007/s10815-017-0881-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 07/24/2016] [Accepted: 01/20/2017] [Indexed: 01/08/2023] Open
Abstract
PURPOSE We aimed to determine the developmental potential of human reconstructed oocytes after polar body genome transfer (PBT) and to report the case of a woman with multiple cycles of severe embryo fragmentation. METHODS Fresh and cryopreserved first polar bodies (PB1s) were transferred to enucleated metaphase II oocytes (PB1T), while fresh PB2s were removed from fertilized oocytes and used instead of the female pronucleus in donor zygotes. Reconstructed oocytes underwent intracytoplasmic sperm injection (ICSI) and were cultured to blastocyst. Biopsied trophectoderm cells of PBT-derived blastocysts were screened for chromosomes by next-generation sequencing (NGS). Then, cryopreserved PB1T was carried out in one woman with a history of several cycles of extensive embryo fragmentation, and the blastocysts derived from PB1T were screened for aneuploidy but not transferred to the patient. RESULTS There were no significant differences in the rates of normal fertilization and blastocyst formation between fresh and cryopreserved PB1T and control oocytes. Of the three fresh and three cryopreserved PB1T-derived blastocysts, two and one blastocysts exhibited normal diploidy respectively. In contrast, 17 PB2 transfers yielded 16 two pronuclei (2PN) zygotes with one normal and one small-sized pronucleus each and no blastocyst formation. In the female patient, 18 oocytes were inseminated by ICSI in the fourth cycle and the PB1s were biopsied. Although the embryos developed from the patient's own oocytes showed severe fragmentation, the oocytes reconstructed after PB1T produced three chromosomally normal blastocysts. CONCLUSIONS Normal blastocysts can develop from human reconstructed oocytes after PB1T. The application of the first PB transfers may be beneficial to patients with a history of poor embryo development and excessive fragmentation.
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Affiliation(s)
- Shuo-Ping Zhang
- Institute of Reproductive and Stem Cell Engineering, Central South University, Xiangya Road 88#, 410078, Changsha, People's Republic of China.,Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
| | - Chang-Fu Lu
- Institute of Reproductive and Stem Cell Engineering, Central South University, Xiangya Road 88#, 410078, Changsha, People's Republic of China.,Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China.,Key laboratory of Reproductive and Stem Cell Engineering, Ministry of Health, Changsha, China
| | - Fei Gong
- Institute of Reproductive and Stem Cell Engineering, Central South University, Xiangya Road 88#, 410078, Changsha, People's Republic of China.,Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China.,Key laboratory of Reproductive and Stem Cell Engineering, Ministry of Health, Changsha, China
| | - Ping-Yuan Xie
- Institute of Reproductive and Stem Cell Engineering, Central South University, Xiangya Road 88#, 410078, Changsha, People's Republic of China.,National Engineering and Research Center of Human Stem Cell, Changsha, China
| | - Liang Hu
- Institute of Reproductive and Stem Cell Engineering, Central South University, Xiangya Road 88#, 410078, Changsha, People's Republic of China.,Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China.,Key laboratory of Reproductive and Stem Cell Engineering, Ministry of Health, Changsha, China.,National Engineering and Research Center of Human Stem Cell, Changsha, China
| | - Shun-Ji Zhang
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
| | - Guang-Xiu Lu
- Institute of Reproductive and Stem Cell Engineering, Central South University, Xiangya Road 88#, 410078, Changsha, People's Republic of China.,Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China.,Key laboratory of Reproductive and Stem Cell Engineering, Ministry of Health, Changsha, China.,National Engineering and Research Center of Human Stem Cell, Changsha, China
| | - Ge Lin
- Institute of Reproductive and Stem Cell Engineering, Central South University, Xiangya Road 88#, 410078, Changsha, People's Republic of China. .,Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China. .,Key laboratory of Reproductive and Stem Cell Engineering, Ministry of Health, Changsha, China. .,National Engineering and Research Center of Human Stem Cell, Changsha, China.
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Abstract
Objective To find out the relationship of thyroid hormone profile of females with outcomes after intra cytoplasmic sperm injection (ICSI). Method It was a cross sectional study conducted in Islamabad Clinic Serving Infertile Couple from June 2013 till August 2015. T3 (triiodo thyronine), T4 (thyroxine) and TSH (thyroid stimulating hormone) of 168 consented females was estimated after they underwent the first step of treatment protocol (ovarian down regulation) for ICSI. Pregnant group had ß hCG result more than 25 IU/mL while the rest were included in the non-pregnant group. Both groups were compared by using independent sample t-test. Pearson correlation coefficient was used to associate T3 and T4 with other pregnancy variables with their significance. Results Non pregnant women had significantly higher mean values for T3 and T4 as compared to pregnant women (p <0.05, p<0.01). Difference in mean TSH value between non-pregnant and pregnant women was not significant p=0.08. It was found that T4 gave significant negative association with grading of embryo-I, blastocysts formed, thickness of endometrium and number of gestational sacs. Conclusion Disturbance in thyroid profile with raised T4 levels leads to alteration in endometrial thickness and quality of embryos required for implantation and hence conception.
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Affiliation(s)
- S Lalani
- Aga Khan University, Karachi, Pakistan
| | - I Nizami
- Aga Khan University, Karachi, Pakistan
| | | | | | - R Rehman
- Aga Khan University, Karachi, Pakistan
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Highland HN, Rishika AS, Almira SS, Kanthi PB. Ficoll-400 density gradient method as an effective sperm preparation technique for assisted reproductive techniques. J Hum Reprod Sci 2016; 9:194-199. [PMID: 27803588 PMCID: PMC5070402 DOI: 10.4103/0974-1208.192070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND: Infertility being a burning issue, the male itself contributes about 40% as a cause, as evident by statistical data. However, Assisted Reproductive Technology (ART) has emerged as a powerful tool in the management of infertility. Sperm preparation techniques govern the selection procedure to separate functional spermatozoa which can then be used in IUI, IVF, and ART and for cryopreservation. AIM: The present study was aimed at evaluation of sperm preparation techniques for reliability, performance and to determine the most effective, feasible and economical technique. MATERIALS AND METHODS: The subjects under study includes males with normal proven fertility (n=40) and the males with unexplained infertility (n=40). Four sperm separation techniques, viz., Swim-up, Swim-down, Sucrose and Ficoll-400 density gradient techniques were evaluated for their efficacy in separation of good quality fraction of spermatozoa. Sperm viability, morphology and maturation status of spermatozoa were taken as evaluation parameters following the standard methods (WHO 2010). STATISTICAL ANALYSIS: Data was analyzed using student's t-test and the four selected techniques were compared with the normal semen samples for scoring the efficiency of the techniques. RESULTS AND DISCUSSION: Out of the several techniques used, Ficoll-400 was found to be more efficient method for separation of spermatozoa. The percentage of change in each parameter was calculated and taken as the index for recovery of potent sperm from the original sperm. Ficoll-400 density gradient yielded higher percentage of live, mature, morphologically normal spermatozoa in an isolated fraction as compared to other three techniques. CONCLUSION: It was observed that a combination of Ficoll-400 gradient separation with Swim-up technique could give quality spermatozoa which in-turn would directly have an impact on the success of IVF and other ART techniques.
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Affiliation(s)
- Hyacinth N Highland
- Department of Zoology, Biomedical Technology and Human Genetics, Gujarat University, Ahmedabad, Gujarat, India
| | - A Sharma Rishika
- Department of Biochemistry, Gujarat University, Ahmedabad, Gujarat, India
| | - S Shaikh Almira
- Department of Zoology, Biomedical Technology and Human Genetics, Gujarat University, Ahmedabad, Gujarat, India
| | - P Bansal Kanthi
- IVF Center and Infertility Clinic, Safal Fertility Foundation and Bansal Hospital, Ahmedabad, Gujarat, India
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Arıoğlu Aydın Ç, Aydın S, Serdaroğlu H. Multifetal gestations with assisted reproductive technique before the single-embryo transfer legislation: obstetric, neonatal outcomes and congenital anomalies. J Matern Fetal Neonatal Med 2015; 29:2475-80. [PMID: 26414487 DOI: 10.3109/14767058.2015.1090422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare perinatal, neonatal outcome and congenital anomalies of multiple gestations conceived by means of assisted reproductive techniques with spontaneously conceived multiples before the limitation of number of embryo transfer. METHODS Cases consisted of assisted reproductive technique (ART) multifetal gestations and control group comprised of spontaneously conceived multifetal gestations delivered in the same time period. Outcomes were perinatal, neonatal outcome, long-term outcomes and congenital anomalies of multiple gestations. There were 270 multifetal pregnancies for analysis, of which 137 were achieved by ART and 133 were spontaneous in this prospective study. RESULTS Incidences of preeclampsia, gestational diabetes, deep vein thrombosis, thrombocytopenia, intrahepatic cholestasis and preterm premature rupture of membranes were similar in ART and spontaneous groups. There was no difference in fetal malformation rates between ART and control group, but higher rates of central nervous system malformation were observed (4 (1.5%) in control, 0 in ART group, p = 0.04) in spontaneous group. No difference was seen in the perinatal mortality. CONCLUSIONS Neonatal and maternal outcomes are comparable between ART and spontaneous multifetal gestations. Congenital fetal malformation rates between ART and spontaneous multifetal pregnancies were similar except central nervous system malformation that was more likely in spontaneously conceived ones.
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Affiliation(s)
- Çağrı Arıoğlu Aydın
- a Department of Obstetric and Gynecology İstanbul , Liv Hospital , Istanbul , Turkey .,b Department of Obstetrics and Gynecology Istanbul , Istanbul University School of Medicine , Istanbul , Turkey , and
| | - Serdar Aydın
- c Department of Obstetric and Gynecology İstanbul , Bezmialem Vakif University , Istanbul , Turkey
| | - Hasan Serdaroğlu
- b Department of Obstetrics and Gynecology Istanbul , Istanbul University School of Medicine , Istanbul , Turkey , and
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Agarwal A, Hamada A, Esteves SC. Engaging practicing gynecologists in the management of infertile men. J Obstet Gynaecol India 2015; 65:75-87. [PMID: 25883438 PMCID: PMC4395576 DOI: 10.1007/s13224-014-0623-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 08/22/2014] [Accepted: 09/16/2014] [Indexed: 12/01/2022] Open
Abstract
In the modern era, contemporary management of male infertility has undergone groundbreaking changes with the introduction of new concepts, advanced testing, and therapeutic interventions. As practicing gynecologists are often the first physicians who encounter an infertile couple, it is essential that these clinicians are continuously updated about the new pearls and pitfalls of male infertility management. Semen analysis is commonly ordered by gynecologists. In 2010, the WHO released new cutoff reference values for the semen parameters adopting novel methodology, which has incited much debate. Reference values have been lowered in comparison with previous standards, with a direct clinical implication in decision-making strategies. Specialized sperm-function tests, such as sperm oxidative stress and sperm chromatin integrity assessments, became clinically available, thus offering an opportunity to better understand sperm dysfunctions concealed during routine semen analysis. Furthermore, the initial counseling of azoospermic men by an andrologically well educated gynecologist may alleviate the misconception and distress surrounding the false belief of sterility, and will clarify the available options of percutaneous and microsurgical sperm-retrieval techniques and assisted conception outcome. Regarding varicocele, which is commonly seen in infertile males, it is now clear that the best treatment option for infertile men with clinical varicocele is the microsurgical vein ligation. Natural conception is significantly improved after varicocelectomy, and recent data suggest that such treatment optimizes reproductive outcome of couples undergoing ICSI or micro-TESE sperm retrieval. Lastly, new therapeutic interventions, including oral antioxidant therapy and lifestyle modifications, have gained increasing attention, as they aid in alleviating male infertility.
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Affiliation(s)
- Ashok Agarwal
- />Lerner College of Medicine, Andrology Center and Center for Reproductive Medicine, Cleveland Clinic, Mail Code X-11, 10681 Carnegie Avenue, Cleveland, OH 44195 USA
| | - Alaa Hamada
- />Department of Urology, Columbia University, New York, USA
| | - Sandro C. Esteves
- />Andrology and Human Reproduction Clinic, ANDROFERT, Av. Dr. Heitor Penteado, 1464, Campinas, SP 13075-460 Brazil
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28
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Jie Z, Yiling D, Ling Y. Association of assisted reproductive technology with adverse pregnancy outcomes. Iran J Reprod Med 2015; 13:169-80. [PMID: 26000008 PMCID: PMC4426157] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 09/18/2014] [Accepted: 10/12/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND More and more infertile patients have accepted the assisted reproductive technique (ART) therapy. Concerns have been raised over an increased risk of adverse maternal outcomes in ART populations as compared with natural conception (NC). OBJECTIVE The aim was to improve the ART in clinicial work and to reduce the incidence of pregnancy complications in ART group according to analyzing the reasons of high incidence of pregnancy complications in ART group, comparing the incidence of pregnancy complications in different controlled ovarian hyperstimulation (COH) programs and evaluating the effects of ART which attribute to adverse pregnancy outcomes. MATERIALS AND METHODS In this prospective population-based cohort study,3216 pregnant women with gestational age ≤12 weeks, regular antenatal examination,and ultrasound identification of intrauterine pregnancy were enrolled from January 2010 to June 2013. According to having ART history, the participantswere divided into two groups: ART group (contains fresh embryo transfer group or frozen-thawed embryo transfer group) and NC group. We compared the incidence of pregnancy complications between different groups and evaluated the factors which could affect the occurrence of these complications. RESULTS When compared to NC group, significantly increased rates of gestational diabetes mellitus (GDM) (p<0.01), preeclampsia (PE) (p<0.01) and intrahepatic cholestasis of pregnancy (ICP) (p˂0.01) were observed in ART group. There was no significant difference in the incidence of birth defect between the two groups (p=0.07). Multiple pregnancies and Gonadotropin (Gn) were risk factors in GDM, PE, and ICP. The exogenous progesterone treatment had no effect on GDM, PE or ICP. CONCLUSION ART increases the risk of adverse maternal complications such as GDM, PE and ICP. The dosages of Gn should be reduced to an extent and the number of embryo implantation should be controlled. Exogenous progesterone treatment is safe.
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Affiliation(s)
- Zhang Jie
- Department of Obstetrics and Gynecology , T he Second Xiangya Hospital, Central South University, Changsha, Hunan Province, People ' s Republic of China
| | - Ding Yiling
- Department of Obstetrics and Gynecology , T he Second Xiangya Hospital, Central South University, Changsha, Hunan Province, People ' s Republic of China
| | - Yu Ling
- Department of Obstetrics and Gynecology , T he Second Xiangya Hospital, Central South University, Changsha, Hunan Province, People ' s Republic of China
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Ghasemian F, Faraji R, Asgharnia M, Zahiri Z, Bahadori MH. The impact of different time intervals between hCG priming and oocyte retrieval on ART outcomes. Iran J Reprod Med 2013; 11:559-64. [PMID: 24639791 PMCID: PMC3941349] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 07/13/2012] [Accepted: 01/09/2013] [Indexed: 10/29/2022]
Abstract
BACKGROUND Abnormal oocyte morphology has been associated with the hormonal environment to which the gametes are exposed. OBJECTIVE In this study, we evaluated the oocytes morphology, fertilization rate, embryos quality, and implantation rate resulted of retrieved oocytes in different times after human chorionic gonadotrophin (HCG) administration. MATERIALS AND METHODS A total of 985 metaphase II oocytes were retrieved 35, 36, 37 and 38 h after the injection of HCG as groups 1, 2, 3, and 4 respectively. Oocyte morphology was divided into (I) normal morphology, (II) extracytoplasmic abnormalities, (III) cytoplasmic abnormalities and (IV) intracytoplasmic vacuoles and in each group, oocytes were evaluated according to this classification. RESULTS Extracytoplasmic abnormalities were encountered in 17.76% and 31.1% of these oocytes (groups 3 and 4 respectively, p=0.007) in comparison with 12.23% group 2. Cytoplasmic abnormalities in group 4 were higher than other groups. 23.88% (p=0.039) and 43.25% (p=0.089) of resulted 2PN (two pronucleus) from groups 3 and 4 showed grade Z3 respectively in comparison to group 2 (16.44%). Normal and various categories of abnormal oocytes did not differ regarding fertilization and cleavage rates (p=0.061). However, group 4 showed significant difference in the rate of embryos fragmentation (grade III and IV embryo) in comparison with group 2 (40.96% vs. 24.93%, p=0.078). The pregnancy rate was higher in G2 and G3 groups (28.5 and 24.13% respectively). CONCLUSION Oocyte retrieval time following HCG priming affected on oocyte morphology, 2PN pattern and embryos qualities subsequently. Both good quality embryo formation and pregnancy outcomes were noticeably higher when oocytes were retrieved 36 h after HCG priming in ART program.
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Affiliation(s)
- Fatemeh Ghasemian
- Biology Faculty, Kharazmi University, Tehran, Iran.,Reproductive Health Research Center, Alzahra Educational and Remedial Center, Guilan University of Medical Sciences, Rasht, Iran.
| | - Roya Faraji
- Reproductive Health Research Center, Alzahra Educational and Remedial Center, Guilan University of Medical Sciences, Rasht, Iran.
| | - Maryam Asgharnia
- Reproductive Health Research Center, Alzahra Educational and Remedial Center, Guilan University of Medical Sciences, Rasht, Iran.
| | - Ziba Zahiri
- Reproductive Health Research Center, Alzahra Educational and Remedial Center, Guilan University of Medical Sciences, Rasht, Iran.
| | - Mohammad Hadi Bahadori
- Reproductive Health Research Center, Alzahra Educational and Remedial Center, Guilan University of Medical Sciences, Rasht, Iran. ,Cellular and Molecular Research Center, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
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Mayer RB, Ebner T, Shebl O, Tews G. A new way of setting rFSH deposit: a case of severe injection error in IVF/ICSI cycle ending with live birth. J Turk Ger Gynecol Assoc 2012; 13:215-7. [PMID: 24592042 DOI: 10.5152/jtgga.2012.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/18/2011] [Accepted: 01/03/2012] [Indexed: 11/22/2022] Open
Abstract
WE PRESENT A CASE WITH A SEVERE INJECTION ERROR a 25- year old woman with secondary infertility caused by a male factor was enrolled in our IVF/ICSI-ET program. Stimulation was performed in a long- protocol and ovarian stimulation, using rFSH follitropin beta, starting on the third day of the menstrual cycle. The rFSH dose per day was 900 IU-0 IU-0 IU-0 IU. Due to normal ovarian response and follicle growth, stimulation was continued and there was no detriment in oocyte quality and no symptoms of OHSS. Following blastocyte transfer cesarean section was unpreventable at 37+5 weeks of gestation due to an impacted transverse lie. Different stimulation protocols are needed for appropriate treatment of various patients provided that the administration of treatment was done correctly. In the case of injection errors, continuing stimulation protocol seems to be achievable in certain cases considering hormone levels and the process of follicle growth.
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Affiliation(s)
| | - Thomas Ebner
- Landes- Frauen-und Kinderklinik, Kinderwunsch Zentrum, Linz, Austria
| | - Omar Shebl
- Landes- Frauen-und Kinderklinik, Kinderwunsch Zentrum, Linz, Austria
| | - Gernot Tews
- Landes- Frauen-und Kinderklinik, Kinderwunsch Zentrum, Linz, Austria
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Safdarian L, Khayatzadeh Z, Djavadi E, Mahdavi A, Aghahosseini M, Aleyasin A, Fallahi P, Khayatzadeh S, Ahmadzadeh A, Larijani MB. Prediction of assisted reproductive technique outcome in elevated early follicular phase follicle stimulating hormone with Mullerian inhibiting substance level. Iran J Reprod Med 2012; 10:201-208. [PMID: 25242994 PMCID: PMC4165962] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2010] [Revised: 05/22/2011] [Accepted: 08/07/2011] [Indexed: 06/03/2023]
Abstract
BACKGROUND Detection of best predictor of ovarian reserve in patients with temporarily or consistently elevated early follicular phase serum levels of FSH is one of the most important goals in assisted reproductive technique (ART). OBJECTIVE To evaluate whether high level of anti-mullerian hormone level is related to success of ART in patients with temporarily or consistently elevated early follicular phase serum levels of FSH. MATERIALS AND METHODS Sixty three women underwent intracytoplasmic sperm injection (ICSI) with GnRH-agonist long protocol or intrauterine insemination (IUI) in a prospective cohort study. FSH, inhibin B and anti-Mullerian hormone (AMH) levels were measured in these women whom were divided to three groups (persistently elevated FSH, variably elevated FSH and, normal FSH level). Basal characteristics, stimulation parameters, and pregnancy occurrence were evaluated. RESULTS AMH was significantly higher in women with persistently elevated early follicular phase FSH achieving pregnancy. Women with normal FSH did not have significant difference in AMH level between conceived and non conceived cycles. Women with only one elevated early follicular phase FSH achieving pregnancy did not have significant difference in AMH level with non pregnant women. Response to gonadotropin stimulation, recommendation to oocyte donation significantly differed between the groups. CONCLUSION This study has demonstrated that relatively young women with persistently or intermittently elevated day 3 FSH levels have diminished ovarian reserve and lower ART success. However, in women whose FSH levels were constantly elevated, AMH (not inhibin B) concentrations were significantly higher in ART cycles resulting in pregnancy. Therefore, AMH level is a good predictor of ART outcome in patients with elevated early follicular phase serum levels of FSH.
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Affiliation(s)
- Leili Safdarian
- Department of Obstetrics, Gynecology and Infertility, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Khayatzadeh
- Department of Obstetrics, Gynecology and Infertility, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Djavadi
- Department of Obstetrics, Gynecology and Infertility, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Atossa Mahdavi
- Department of Obstetrics, Gynecology and Infertility, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Aghahosseini
- Department of Obstetrics, Gynecology and Infertility, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ashraf Aleyasin
- Department of Obstetrics, Gynecology and Infertility, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Parvin Fallahi
- Department of Obstetrics, Gynecology and Infertility, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sima Khayatzadeh
- Department of Obstetrics, Gynecology and Infertility, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Ahmadzadeh
- Department of Obstetrics, Gynecology and Infertility, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohhamad Bagher Larijani
- Department of Obstetrics, Gynecology and Infertility, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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32
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A B, M K. Outcome of twin pregnancies conceived after assisted reproductive techniques. J Hum Reprod Sci 2011; 1:25-8. [PMID: 19562060 PMCID: PMC2700680 DOI: 10.4103/0974-1208.39593] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2007] [Revised: 03/12/2008] [Accepted: 03/13/2008] [Indexed: 11/06/2022] Open
Abstract
CONTEXT: There is a continuous controversy regarding the obstetric perinatal outcome of twin pregnancies conceived after assisted reproductive techniques (ART). There is an ongoing discussion whether theses parameters may show poorer results as compared to spontaneous conception. AIMS: To evaluate the outcome of multifetal pregnancies and to compare maternal and neonatal complications between spontaneously conceived and assisted reproductive therapy. SETTINGS AND DESIGN: Prospective case-control study. MATERIALS AND METHODS: In this prospective case-control study of 2-year duration, obstetric and perinatal outcomes were compared in 36 ART twin pregnancies (Group A) with 138 twins who conceived naturally (Group B). The outcomes were analyzed and used for a comparison between spontaneous and assisted multifetal pregnancies. STATISTICAL ANALYSIS: The continuous variables were analyzed by Student's t-test and categorical variables were analyzed with Fisher's exact test. RESULTS: Pregnancy-related complications like pregnancy-induced hypertension, antepartum hemorrhage, were similar in both groups. Incidence of cesarean section, preterm delivery, and hospital stay was significantly more in Group A vs. Group B, P < 0.001. The newborns in the assisted group had more complications than the spontaneous group; most notable were respiratory distress syndrome, newborn intensive care admission, sepsis, and longer hospital stay (4.8 days vs. 1.6 days, P < 0.001). CONCLUSIONS: Increased rates of cesarean section and preterm delivery are the main reasons for increased obstetric risk in pregnancies conceived through ART. Preterm birth and neonatal prematurity-related complications were the main cause for longer stay in hospital in ART-conceived twins.
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Affiliation(s)
- Baxi A
- Department of Obstetrics and Gynecology, Disha Fertility and Surgical Center, Indore, Madhya Pradesh, India
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