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1.
Medicine (Baltimore) ; 99(40): e22558, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019467

RESUMO

RATIONALE: During ultrasound prenatal screening, absence of the fetal nasal bone is used as a marker for common aneuploidies in singleton pregnancies. However, its application in multiple pregnancies is less sensitive and more challenging owing to difficulties in obtaining adequate views of the fetal face. PATIENT CONCERNS: A 38-year-old woman with dichorionic-diamniotic (DCDA) pregnancy and a history of in vitro fertilization and embryo transfer was referred to our hospital with the absence of the nasal bone noted on ultrasound images obtained during the second trimester in 1 fetus. DIAGNOSIS: Prenatal sonographic examination revealed the absence of the nasal bone in 1 fetus in the DCDA gestation. Amniocentesis performed on the dual amniotic sacs revealed normal karyotypes for each twin. The absence of the nasal bone was confirmed on a radiograph obtained postnatally in 1 infant. INTERVENTIONS: The mother underwent routine outpatient care according to the gestational age and successfully delivered following lower-segment cesarean section. OUTCOMES: Two live infants were uneventfully delivered. Radiography confirmed the absence of the nasal bone in 1 of the newborns on postnatal day 3. The infants were followed up until 2 years and 9 months of age, which revealed normal appearance and eating and breathing functions. LESSONS: Prenatal diagnosis of the absence of nasal bone in 1 fetus of DCDA pregnancy has rarely been reported. Although a fetus with the absence of the nasal bone in DCDA gestation poses a significant risk of aneuploidy, it is acceptable when the defect is an isolated anomaly after ruling out genetic abnormalities. Appropriate consultation should be provided for these patients.


Assuntos
Fertilização In Vitro/efeitos adversos , Osso Nasal/anormalidades , Diagnóstico Pré-Natal/métodos , Adulto , Amniocentese/métodos , Cesárea/métodos , Transferência Embrionária , Feminino , Feto , Humanos , Osso Nasal/diagnóstico por imagem , Gravidez , Segundo Trimestre da Gravidez , Gravidez Múltipla , Radiografia , Gêmeos Dizigóticos , Ultrassonografia Pré-Natal/métodos
2.
Int J Gynaecol Obstet ; 150(1): 34-40, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32524593

RESUMO

The 10% rate of preterm birth rate worldwide has not been proved amenable to reduction. Avoiding multiple embryo transfer in assisted reproductive technologies (ART) using in vitro fertilization is one unassailable method. Preimplantation genetic testing (PGT) to select only a single euploid embryo for transfer is one unequivocal way, maintaining 50%-60% pregnancy rates while avoiding twins. Contemporary methodology entails trophectoderm biopsy of a 5-6-day blastocyst, and cryopreservation of biopsied embryos while awaiting analysis by next generation sequencing. Embryo biopsy is safe, analytic validity for chromosomal analysis high, and global access to PGT high.


Assuntos
Testes Genéticos/métodos , Diagnóstico Pré-Implantação/métodos , Nascimento Prematuro/prevenção & controle , Transferência Embrionária/efeitos adversos , Transferência Embrionária/métodos , Feminino , Fertilização In Vitro/efeitos adversos , Fertilização In Vitro/métodos , Humanos , Gravidez
3.
PLoS One ; 15(4): e0232323, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32348371

RESUMO

Uterine transplantation (UTx) associated with IVF restores fertility in women affected by absolute uterine factor infertility (AUFI). Pregnancies achieved both in women undergoing any solid organ transplantation and following IVF are associated with an increased risk of maternal and neonatal complications. This systematic review evaluated this risk in UTx-IVF treated women focusing on the safety and efficacy features of the treatment. Twenty-two studies and three press releases reporting on 52 UTx-IVF treatments were identified. Regarding the safety of treatment, 38/52 (73,1%) of surgical procedures led to the restoration of uterine function in recipients, 12/52 (23,1%) of recipients experienced post-operative complications requiring hysterectomy, and 2/52 (3,8%) of procedures failed before uterine recipients' surgery due to intra-operative complications. Regarding the efficacy of treatment, results focused on transplanted patients showing full recovery of organ functioning: 16/38 (42,1%) of patients achieved a pregnancy, including two women who gave births twice. UTx-IVF pregnancies led to 16 deliveries and all new-borns were healthy. Six out of 16 (37,5%) UTx pregnancies faced major complications during gestation. Preterm births occurred in 10/16 (62,5%) UTx deliveries. Our data indicates that the risk of gestational and delivery complications deserves important consideration in AUFI women receiving UTx-IVF treatments. However, these observations are preliminary and need to be revised after larger series of data are published.


Assuntos
Fertilização In Vitro/métodos , Infertilidade Feminina/terapia , Útero/transplante , Feminino , Fertilização In Vitro/efeitos adversos , Humanos , Histerectomia , Infertilidade Feminina/etiologia , Transplante de Órgãos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Gravidez , Complicações na Gravidez/etiologia , Resultado da Gravidez , Resultado do Tratamento
4.
PLoS One ; 15(4): e0231028, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32298277

RESUMO

OBJECTIVE: Whether the use of assisted reproductive technologies (ART) affects the outcome of twin pregnancies is still a matter of debate. Previous studies have evaluated the association between birth weight and ART, without a clear distinction between fetal growth restriction (FGR), a condition at higher risk of adverse outcome, and constitutionally small for gestational age (SGA) fetuses. The aim of this study was to determine whether dichorionic (DC) twin pregnancies obtained by ART have a greater risk of developing FGR, defined by accurate ultrasound criteria, than those spontaneously conceived (SC), and to compare the severity of ultrasound features in the growth restricted fetuses. METHODS: A retrospective study was conducted on DC twin pregnancies delivered between 2010 to 2018 at a tertiary hospital. Twin pregnancies conceived spontaneously were compared with those obtained via in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI), after exclusion of cases with major fetal or uterine malformations. The primary outcome was the incidence of FGR. Secondary outcome was the rate of SGA neonates, defined by a birth weight less than the 10th percentile. The ultrasound characteristics of the growth restricted fetuses in the two groups were also compared. The groups were compared using univariate and multivariate analyses. RESULTS: Six hundred and seventy-eight DC twin pregnancies were identified. Of these, 367 (54.1%) conceived via IVF/ICSI and 311 (45.9%) conceived spontaneously. The incidence of FGR was not significantly different between the ART and the SC groups (7.9% vs 8.4% respectively, p = 0.76, adjusted OR 0.84, 95% CI 0.53-1.32). Growth restricted fetuses of the two groups showed similar occurrence of an estimated fetal weight less than the 3rd percentile, similar abnormalities in Doppler studies and similar gestational age at diagnosis. There was no difference in the incidence of delivery of an SGA neonate (p = 0.47) or in the rate of maternal complications and preterm delivery between the groups. CONCLUSIONS: Twin pregnancies conceived by assisted reproductive technologies do not have a higher risk of ultrasound-diagnosed FGR than spontaneously conceived twin pregnancies, and fetuses diagnosed with growth restriction in the two groups show similar severity of the ultrasound findings.


Assuntos
Retardo do Crescimento Fetal/etiologia , Gravidez de Gêmeos , Técnicas de Reprodução Assistida/efeitos adversos , Adulto , Feminino , Fertilização In Vitro/efeitos adversos , Retardo do Crescimento Fetal/diagnóstico , Retardo do Crescimento Fetal/diagnóstico por imagem , Retardo do Crescimento Fetal/epidemiologia , Humanos , Incidência , Recém-Nascido Pequeno para a Idade Gestacional , Gravidez , Resultado da Gravidez , Fatores de Risco , Injeções de Esperma Intracitoplásmicas/efeitos adversos , Ultrassonografia Pré-Natal
5.
Urol Clin North Am ; 47(2): 257-270, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32272997

RESUMO

The male contribution to infertility has traditionally been overlooked, or at best oversimplified. In recent years efforts have been made to optimize diagnostic and therapeutic techniques to maximize fertility outcomes. A renewed focus on the male partner has resulted in an increased understanding of both genetic and epigenetic changes within the male germline. Furthermore, single-nucleotide polymorphisms, copy-number variants, DNA damage, sperm cryopreservation, obesity, and paternal age have recently been recognized as important factors that play a role in male fertility. Developing a deeper knowledge of these issues could potentially lead to improved success with assisted reproductive technology.


Assuntos
Epigênese Genética/genética , Fertilização In Vitro/tendências , Infertilidade Masculina/genética , Infertilidade Masculina/terapia , Obesidade/genética , Herança Paterna/genética , Fatores Etários , Criopreservação , Dano ao DNA/genética , Feminino , Fertilização In Vitro/efeitos adversos , Fertilização In Vitro/métodos , Previsões , Humanos , Infertilidade Masculina/etiologia , Masculino , Mutação , Obesidade/complicações , Polimorfismo Genético/genética , Técnicas de Reprodução Assistida/efeitos adversos , Técnicas de Reprodução Assistida/tendências
6.
Fertil Steril ; 113(4): 745-752, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32147172

RESUMO

OBJECTIVE: To investigate whether endometrial thickness (EMT) is associated with adverse obstetric and neonatal outcomes in fresh in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) cycles. DESIGN: Retrospective cohort study. SETTING: University-based reproductive medical center. PATIENT(S): Women under the age of 42 years who underwent IVF/ICSI treatment and received fresh ET in our unit from January 2017 to December 2018, resulting in a live singleton birth. INTERVENTION(S): Controlled ovarian hyperstimulation and IVF/ICSI; fresh ET. MAIN OUTCOME MEASURE(S): Birth weight, gestational age, small for gestational age (SGA), large for gestational age (LGA), placenta previa, placental abruption, hypertensive disorders, and gestational diabetes mellitus. RESULT(S): The risk of being born SGA was statistically significantly increased in the EMT ≤7.5 mm group compared with those from the EMT >12 mm group (adjusted odds ratio [aOR] 2.391; 95% confidence interval [CI], 1.155-4.950). Moreover, maternal body mass index, secondary infertility, preterm delivery, and hypertensive disorders were all independent predictors for SGA. The mean birth weights of singletons in women with EMT ≤7.5 mm were lower than in the groups with EMT >7.5-12 mm and EMT >12 mm (3.25 ± 0.56 kg vs. 3.38 ± 0.51 kg and 3.39 ± 0.53 kg, respectively). CONCLUSION(S): After fresh IVF/ICSI-ET, the risk of SGA was increased twofold in women with EMT ≤7.5 mm compared with women with EMT >12 mm. We suggest that women with a thin EMT after obtaining a pregnancy by IVF should receive improved prenatal care to reduce the risk of delivering a SGA infant.


Assuntos
Transferência Embrionária/efeitos adversos , Endométrio/diagnóstico por imagem , Recém-Nascido Pequeno para a Idade Gestacional/fisiologia , Nascimento Vivo/epidemiologia , Injeções de Esperma Intracitoplásmicas/tendências , Adulto , Peso ao Nascer/fisiologia , Estudos de Coortes , Transferência Embrionária/tendências , Endométrio/patologia , Feminino , Fertilização In Vitro/efeitos adversos , Fertilização In Vitro/tendências , Humanos , Recém-Nascido , Masculino , Tamanho do Órgão , Estudos Retrospectivos , Injeções de Esperma Intracitoplásmicas/efeitos adversos
7.
J Ovarian Res ; 13(1): 25, 2020 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-32138790

RESUMO

BACKGROUND: Ovarian hyperstimulation syndrome (OHSS) is a rare, yet severe, iatrogenic complication of ovulation induction therapy during assisted reproductive procedures. Our group previously detected atypical cells in the ascitic fluid of OHSS patients, although no malignancy developed during follow up. Here, the aim was to perform a comparative analysis of the cytokines present in the abdominal fluid of patients affected by OHSS versus patients with advanced ovarian cancer, a benign adnexal mass, or ovarian endometriosis. METHODS: This prospective, non-randomized study was conducted at the Clinical Center of the University of Pecs Department of Obstetrics and Gynecology/Reproductive Center between October 2016 and March 2018. Abdominal fluid samples were obtained from 76 patients and subjected to Luminex analysis. The samples were collected from patients with OHSS (OHSS; n = 16), advanced ovarian cancer (OC; n = 22), a benign adnexal mass (BAM; n = 21), or ovarian endometriosis (EM; n = 17). Data were subjected to the non-parametric Kruskal-Wallis test and Spearman's rank correlation coefficient to identify statistical differences between the four study groups. RESULTS: Leukocytosis and hemoconcentration were detected in the peripheral blood of OHSS patients. Abdominal fluid analysis further revealed significantly higher levels of interleukin (IL)-6, IL-8, IL-10, and transforming growth factor (TGF)-ß in both the OHSS and OC groups compared to the BAM and EM groups. The highest concentration of vascular endothelial growth factor (VEGF) was detected in the OC group, while a significantly lower level was detected in the OHSS group. Moreover, VEGF levels in OC and OHSS groups were significantly elevated compared to the levels in the BAM and EM groups. CONCLUSIONS: Vasoactive and hematogenic cytokines were present at higher levels in both the OHSS and OC abdominal fluid samples compared to the fluid samples obtained from the peritoneal cavity of the BAM patients. It is possible that these cytokines play an important role in the formation of ascites.


Assuntos
Ascite/metabolismo , Líquido Ascítico/metabolismo , Citocinas/metabolismo , Síndrome de Hiperestimulação Ovariana/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Citocinas/sangue , Feminino , Fertilização In Vitro/efeitos adversos , Humanos , Pessoa de Meia-Idade , Síndrome de Hiperestimulação Ovariana/sangue , Síndrome de Hiperestimulação Ovariana/etiologia , Indução da Ovulação
8.
Arch Gynecol Obstet ; 301(2): 491-498, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32025846

RESUMO

PURPOSE: To evaluate whether vanishing twin (VT) pregnancies following spontaneous conception have a more adverse perinatal outcome than those conceived after assisted reproduction techniques. METHODS: The retrospective cohort study consisted of 316 VT pregnancies derived from a hospital database between January 1994 and January 2016 (81 after IVF/ICSI and 235 after spontaneous conception). RESULTS: VT was significantly more prevalent after spontaneous conception (in 22.0% of twins) than after IVF/ICSI (in 14.5% of twins). VT pregnancies were significantly more associated with pre-gestational and gestational diabetes mellitus (GDM) in IVF/ICSI pregnancies compared to those spontaneously conceived [adjusted odds ratio (AOR): 4.12 and 11.1, respectively]. IVF-related placental insertion abnormalities were significantly higher in VT pregnancies. A high risk for VT was recorded in the spontaneous group for those who had previously undergone an induced abortion (AOR 0.56) or second-trimester fetal loss (AOR 0.67). The VT phenomenon was a major prognosticator of intrauterine growth retardation (IUGR) for the remaining fetus in IVF pregnancies (AOR 5.12). After controlling for covariates conjointly, advanced age (AOR 1.3), GDM (AOR 2.1), hypertensive disorders (AOR 3.5), primiparity (AOR 3.8), and placentation anomalies all represented independent risk factors for VT in IVF pregnancies. CONCLUSIONS: IVF/ICSI poses a higher risk for an adverse perinatal outcome following VT pregnancies as compared with those spontaneously conceived.


Assuntos
Aborto Espontâneo/genética , Fertilização In Vitro/efeitos adversos , Gravidez de Gêmeos/genética , Adulto , Feminino , Humanos , Recém-Nascido , Gravidez , Estudos Retrospectivos , Fatores de Risco
9.
Fertil Steril ; 113(2): 241-247, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32106970

RESUMO

Cryopreservation has become a central pillar in assisted reproduction, reflected in the exponential increase of "freeze all" cycles in the past few years. Vitrification makes it possible to cool and warm human eggs and embryos with far less cryo-damage than 'slow-freeze' and allows nearly intact survival of embryos with very high survival rates for eggs as well. This has resulted in a complete transformation how we manage treatment for in vitro fertilization patients. Fresh transfers can be avoided without compromising outcomes, and in fact, cumulative pregnancy/delivery rates may be improved by performing sequential elective "frozen" single embryo transfers. Some recent evidence suggests that previously vitrified embryos give better perinatal outcomes than fresh embryo transfers. Frozen embryo transfer, especially when coupled with preimplantation genetic testing allows for highly efficient single embryo transfers that translate to more singleton and therefore safer pregnancies, as well as healthier babies. Additionally, vitrification has also opened new options for patients, most notably fertility preservation (through oocyte cryopreservation), and donor egg banking.


Assuntos
Fertilização In Vitro/métodos , Vitrificação , Biópsia , Criopreservação , Transferência Embrionária , Feminino , Fertilização In Vitro/efeitos adversos , Humanos , Nascimento Vivo , Gravidez , Taxa de Gravidez
10.
Fertil Steril ; 113(2): 344-353.e2, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32106988

RESUMO

OBJECTIVE: To study the association between prepregnancy subnormal body weight and obstetrical outcomes after autologous in vitro fertilization (IVF) cycles. DESIGN: Systematic review and meta-analysis. SETTING: Not applicable. PATIENT(S): Women with prepregnancy subnormal body weight (body mass index <18.5 kg/m2) and normal body weight (body mass index 18.5-25 kg/m2) after assisted reproductive treatment. INTERVENTIONS(S): None. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate (CPR), live birth rate (LBR), and miscarriage rate. CPR and LBR were calculated at per-woman and per-cycle levels. RESULT(S): A total of 38 cohort studies with low risk of bias were included. Meta-analyses showed that, compared with normal-weight women, those underweight before pregnancy had a lower CPR at per-woman and per-cycle levels. Compared with normal weight, underweight before pregnancy had little impact on LBR at both per-woman and per-cycle levels, nor on miscarriage rate. CONCLUSION(S): Compared with women of normal weight, women who were underweight before pregnancy had modest association with a lower CPR, but underweight did not seem to affect LBR or miscarriage after IVF.


Assuntos
Peso Corporal , Fertilidade , Fertilização In Vitro , Infertilidade/terapia , Saúde Materna , Magreza/fisiopatologia , Aborto Espontâneo/epidemiologia , Adulto , Índice de Massa Corporal , Feminino , Fertilização In Vitro/efeitos adversos , Humanos , Infertilidade/diagnóstico , Infertilidade/epidemiologia , Infertilidade/fisiopatologia , Nascimento Vivo , Pessoa de Meia-Idade , Gravidez , Taxa de Gravidez , Medição de Risco , Fatores de Risco , Magreza/diagnóstico , Magreza/epidemiologia , Resultado do Tratamento , Adulto Jovem
11.
Fertil Steril ; 113(2): 354-363.e1, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32106989

RESUMO

OBJECTIVE: To evaluate the effectiveness of intracytoplasmic sperm injection (ICSI) in improving fertilization rates compared to conventional in vitro fertilization rates (IVF) among women aged ≥38 years with a non-male factor diagnosis. DESIGN: Systematic review and meta-analysis. SETTING: Not applicable. PATIENT(S): Women aged ≥38 years with a non-male factor diagnosis receiving IVF or ICSI. INTERVENTION(S): A systematic review of databases including PubMed and Embase was performed. Study protocol was registered at the International Prospective Register of Systematic Reviews. Studies were selected if they compared fertilization rates from ICSI with those from conventional IVF among women aged ≥38 years with a non-male factor infertility diagnosis. A random effects model was used. Meta-analysis of Observational Studies in Epidemiology guidelines were applied. MAIN OUTCOME MEASURE(S): Fertilization rate. RESULTS: Seven studies including 8796 retrieved oocytes (ICSI: 4,369; IVF: 4,427) with mean female age ≥38 years met the inclusion criteria. There was no significant difference in fertilization rates between ICSI and conventional IVF (relative risk [RR] 0.99, 95% confidence interval [CI] 0.93-1.06; P = .8). Heterogeneity was observed between studies (I2 = 58.2; P < .05). Heterogeneity was significant (I2 = 57.1; P < .05) when cycles with prior fertilization failure were excluded; however, when analysis was restricted to poor responders (RR 1.01, 95% CI 0.97-1.05; P = .6), heterogeneity was no longer significant (I2 = 0.0; P = .5). CONCLUSIONS: No difference was found in fertilization rates between conventional IVF and ICSI. Further studies are needed to assess the impact of ICSI in this population, controlling for other indications such as preimplantation genetic testing.


Assuntos
Fertilidade , Fertilização In Vitro , Fertilização , Infertilidade Feminina/terapia , Injeções de Esperma Intracitoplásmicas , Adulto , Feminino , Fertilização In Vitro/efeitos adversos , Humanos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/fisiopatologia , Masculino , Idade Materna , Pessoa de Meia-Idade , Gravidez , Injeções de Esperma Intracitoplásmicas/efeitos adversos , Resultado do Tratamento
12.
Annu Rev Anim Biosci ; 8: 395-413, 2020 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-32069434

RESUMO

Development of assisted reproductive technologies has been driven by the goals of reducing the incidence of infertility, increasing the number of offspring from genetically elite animals, facilitating genetic manipulation, aiding preservation and long-distance movement of germplasm, and generating research material. Superovulation is associated with reduced fertilization rate and alterations in endometrial function. In vitro production of embryos can have a variety of consequences. Most embryos produced in vitro are capable of establishing pregnancy and developing into healthy neonatal animals. However, in vitro production is associated with reduced ability to develop to the blastocyst stage, increased incidence of failure to establish pregnancy, placental dysfunction, and altered fetal development. Changes in the developmental program mean that some consequences of being produced in vitro can extend into adult life. Reduced competence of the embryo produced in vitro to develop to the blastocyst stage is caused largely by disruption of events during oocyte maturation and fertilization. Conditions during embryo culture can affect embryo freezability and competence to establish pregnancy after transfer. Culture conditions, including actions of embryokines, can also affect the postnatal phenotype of the resultant progeny.


Assuntos
Desenvolvimento Embrionário , Resultado da Gravidez , Técnicas de Reprodução Assistida/efeitos adversos , Animais , Criopreservação , Transferência Embrionária , Embrião de Mamíferos , Feminino , Fertilização In Vitro/efeitos adversos , Humanos , Masculino , Mamíferos , Gravidez , Técnicas de Reprodução Assistida/veterinária
13.
Acta Obstet Gynecol Scand ; 99(8): 1014-1021, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32072616

RESUMO

INTRODUCTION: The incidence of Swedish stillbirths has varied little in the past 40 years, with a reported frequency of 400-450 stillbirths/y (approximately 4‰), despite increased information about fetal movement in the media and awareness among healthcare providers. The objectives of this project were to describe the outcome of pregnancies with reduced fetal movement in a Swedish context and to investigate factors associated with poor neonatal outcome in this group. MATERIAL AND METHODS: A retrospective cohort study was performed at Soder Hospital, Stockholm, Sweden. All single pregnancies at the hospital from January 2016 to December 2017 presenting with reduced fetal movement after 22 gestational weeks were included in the study. A composite neonatal outcome was constructed: 5-minute Apgar score ≤7, arterial pH in the umbilical cord ≤7.10, transfer to neonatal care unit for further care or intrauterine fetal death. RESULTS: For women seeking care for reduced fetal movement, the occurrence of composite poor neonatal outcome ranged from 6.2% to 18.4% within different groups. The highest risk for poor neonatal outcome (18.4%) was found in the group of women with a small-for-gestational-age fetus. Another high-risk group (12.8%) was the one comprising women with normal birthweight/large-for-gestational-age fetuses with an in vitro fertilization pregnancy. CONCLUSIONS: The highest incidence of poor neonatal outcome among women with reduced fetal movement was found in the groups with small-for-gestational-age fetuses in nulliparous and multiparous women. A routine ultrasound assessment for fetal growth in third trimester is supposedly most efficient to identify undiagnosed small for gestational age.


Assuntos
Morte Fetal , Retardo do Crescimento Fetal/epidemiologia , Movimento Fetal , Recém-Nascido Pequeno para a Idade Gestacional , Resultado da Gravidez , Adulto , Feminino , Fertilização In Vitro/efeitos adversos , Humanos , Recém-Nascido , Gravidez , Estudos Retrospectivos , Fatores de Risco , Suécia/epidemiologia
14.
Sci Rep ; 10(1): 2286, 2020 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-32042061

RESUMO

Sperm preparation in IVF cycles using density gradient centrifugation (DGC) in combination with swim-up (SU) has been widely adopted in reproductive centres worldwide. It is a fact that the sperm recovery rate following one DGC from poor semen samples (showing liquefaction defects/containing too many unresolvable clots or rare sperm) is relatively low. Our results showed that double DGC (DDGC) is effective at increasing the sperm recovery rate from poor semen samples. However, DDGC may increase the mechanical stress of sperm, thereby potentially impairing embryo development. Therefore, it is necessary to evaluate the safety of using sperm prepared by DDGC/SU for IVF cycles. In this study, we retrospectively analysed the data generated from a total of 529 IVF cycles (from June 2017 to June 2018), and these IVF cycles contributed 622 transfer cycles (from June 2017 to December 2018) in Changzhou Maternal and Child Health Care Hospital. Of them, 306 IVF cycles and the related 355 transfer cycles (normal semen samples prepared by DGC/SU) were set as the normal group, while 223 IVF cycles and the related 267 transfer cycles (poor semen prepared by DDGC/SU) were set as the observation group. The main outcome measures, including the normal fertilization rate, top D3 embryo formation rate, blastocyte formation rate, clinical pregnancy rate and live birth rate, birth weight and duration of pregnancy, were compared between the two groups. Compared to semen in the DGC/SU group, semen in the DDGC/SU group showed increased levels of the DNA fragmentation index (DFI) and reduced sperm concentration, percentage of progressive motility (PR) sperm, and percentage of normal morphology sperm. The indicators reflecting in vitro embryo development and clinical outcomes were similar in the DGC/SU group and DDGC/SU group, including the normal fertilization rate, top D3 embryo formation rate, blastocyte formation rate, pregnancy rate, implantation rate, spontaneous abortion rate, live birth rate, birth weight and duration of pregnancy. Furthermore, we found that the 1PN zygote formation rate was significantly lower in the DDGC/SU group than that in the DGC/SU group. We concluded that oocytes fertilized by sperm from poor semen samples separated by DDGC/SU achieved the same outcomes as oocytes fertilized by sperm from normal semen separated by DGC/SU, suggesting that DDGC/SU is an effective and safe method of sperm enrichment for poor semen samples in IVF. The main contribution of the present study is the verification of the effectiveness of DDGC/SU in improving sperm recovery from poor semen samples and the safety of using sperm prepared by DDGC/SU for IVF.


Assuntos
Fertilização In Vitro/métodos , Infertilidade/terapia , Oócitos/fisiologia , Sêmen/fisiologia , Motilidade Espermática/fisiologia , Espermatozoides/fisiologia , Adulto , Centrifugação com Gradiente de Concentração/métodos , Feminino , Fertilização In Vitro/efeitos adversos , Humanos , Nascimento Vivo , Masculino , Gravidez , Taxa de Gravidez , Estudos Retrospectivos , Sêmen/citologia , Resultado do Tratamento
15.
Fertil Steril ; 113(2): 408-416, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31973902

RESUMO

OBJECTIVE: To investigate the use of preimplantation genetic testing for aneuploidy (PGT-A) among patients pursuing embryo banking (EB) for medically indicated fertility preservation (FP). DESIGN: Retrospective cohort. SETTING: University-affiliated fertility center. PATIENTS: All patients who underwent in vitro fertilization with or without PGT-A for medically indicated FP between January 2014 and April 2018. INTERVENTIONS: None MAIN OUTCOME MEASURES: EB cycle characteristics, subsequent cycle pursuit/outcomes, and frozen embryo transfer (FET) outcomes. RESULTS: A total of 58 medical EB cycles were compared; 34 cycles used PGT-A. Of the EB patients with breast cancer, 67% used PGT-A; other indications were evenly divided between PGT-A (FP/PGT-A) and no PGT-A (FP). PGT-A use increased over the study period. Groups were similar in age, days of stimulation, and days from initial FP consultation to treatment initiation. Number of oocytes (14.5 [2-63] FP vs. 17.5 [1-64] FP/PGT-A), 2PN zygotes (7 [1-38] FP vs. 9 [0-36] FP/PGT-A), and blastocysts (5.5 [0-22] FP vs. 5 [0-18] FP/PGT-A) cryopreserved were similar between groups. Equal numbers cryopreserved both oocytes and embryos (5 vs. 3). Five FP/PGT-A patients underwent a second EB cycle. Among FP/PGT-A patients, an average of 6.7 ± 5 blastocysts underwent PGT-A, with 3.5 ± 3 (48.2%) euploid embryos cryopreserved for future FET compared to an average of 7.2 ± 7 untested embryos in the FP group. CONCLUSION: PGT-A in medical EB cycles increased over time and did not limit the use of other FP methods such as oocyte cryopreservation. In some cases, poor PGT-A results informed patients to pursue a second EB cycle. When counseling patients, the prognostic benefits of PGT-A must be weighed against the financial costs and potential for "terminal" fertility diagnosis.


Assuntos
Aneuploidia , Blastocisto/patologia , Preservação da Fertilidade , Fertilização In Vitro , Doenças Genéticas Inatas/diagnóstico , Testes Genéticos , Diagnóstico Pré-Implantação , Adulto , Criopreservação , Transferência Embrionária , Feminino , Preservação da Fertilidade/efeitos adversos , Fertilização In Vitro/efeitos adversos , Aconselhamento Genético , Doenças Genéticas Inatas/genética , Humanos , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento
16.
Fertil Steril ; 113(2): 444-452.e1, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31973904

RESUMO

CONTEXT: Antimüllerian hormone (AMH) levels are higher in patients with polycystic ovary syndrome (PCOS). Accumulating evidence indicates that AMH has an impact on the physiology of the female reproductive system. OBJECTIVE: To investigate the association of AMH levels with the risk of preterm delivery in PCOS patients. DESIGN: Retrospective cohort study. SETTING: Academic fertility center. PATIENTS: Women who underwent in vitro fertilization between January 2017 and July 2018 (25,165 cycles). INTERVENTIONS: None. MAIN OUTCOME MEASURES: The primary outcome was preterm delivery. RESULTS: Serum AMH levels were not different between the term delivery and preterm delivery groups in the entire cohort (3.8 vs. 4.1 ng/mL, P>.05). In patients diagnosed with PCOS, those with preterm delivery had higher AMH levels than were found in patients with term delivery (9.3 vs. 6.9 ng/mL, P<.01). Preterm deliveries predominated in PCOS patients with AMH levels above the 75th percentile (9.75 ng/mL) (adjusted P<.0001, adjusted odds ratio [OR] 4.0, 95% confidence interval [CI] 1.94, 8.08)) and frozen-thawed embryo transfer (FET) patients with AMH levels higher than the 90th percentile (10.10 ng/mL) (adjusted P<.05, adjusted OR 2.0, 95% CI 1.16, 3.36). CONCLUSION: Serum AMH levels higher than 75th percentile were associated with an increased risk of preterm delivery in patients with PCOS, and serum AMH levels higher than the 90th percentile were associated with an increased risk of preterm delivery in FET patients.


Assuntos
Hormônio Antimülleriano/sangue , Fertilização In Vitro/efeitos adversos , Infertilidade Feminina/terapia , Síndrome do Ovário Policístico/terapia , Nascimento Prematuro/etiologia , Adulto , Biomarcadores/sangue , Feminino , Humanos , Infertilidade Feminina/sangue , Infertilidade Feminina/etiologia , Infertilidade Feminina/fisiopatologia , Síndrome do Ovário Policístico/sangue , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/fisiopatologia , Gravidez , Nascimento Prematuro/sangue , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Regulação para Cima
17.
BMJ Case Rep ; 13(1)2020 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-31988058

RESUMO

Severe early-onset ovarian hyperstimulation syndrome (OHSS) with deranged liver function tests is an entity that cannot be eliminated wholly even after gonadotropin-releasing hormone (GnRH) agonist trigger without any luteal human chorionic gonadotropin (hCG) rescue in a GnRH antagonist protocol with the freeze-all approach. We describe a case of young polycystic ovary syndrome patient with prior history of severe early-onset OHSS in her last in vitro fertilisation cycle in which she received antagonist protocol followed by blastocyst transfer. Given her history, she was planned for agonist trigger and freeze all approach during the present cycle. Despite segmentation of the cycle without any luteal rescue hCG, she developed early-onset severe OHSS with markedly deranged liver function tests for which she underwent ascitic tapping and remained hospitalised for 8 days. Her symptoms improved with conservative management, and she was discharged satisfactorily. She underwent letrozole based frozen-thawed embryo transfer cycle after 4 months. One good quality blastocyst was transferred, and she conceived in the same cycle.


Assuntos
Fertilização In Vitro/efeitos adversos , Hepatopatias/complicações , Síndrome de Hiperestimulação Ovariana/complicações , Adulto , Contagem de Células Sanguíneas , Feminino , Hormônio Liberador de Gonadotropina/antagonistas & inibidores , Humanos , Ultrassonografia
18.
Anesth Analg ; 130(2): 436-444, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-30829674

RESUMO

BACKGROUND: The use of in vitro fertilization is increasing. The incidence of adverse outcomes is greater for women who undergo in vitro fertilization, potentially leading to intensive care unit admission. This study aimed to assess the etiology and course of intensive care unit admission in women who underwent in vitro fertilization compared to those who did not, with specific focus on intensive care unit admission due to postpartum hemorrhage. METHODS: In this retrospective study, medical records of patients admitted to the intensive care unit during pregnancy or the peripartum period at 2 medical centers (2005-2016 at Mount Sinai Hospital, New York, NY, and 2005-2013 at Shaare Zedek Medical Center, Jerusalem, Israel) were analyzed. Demographic, past medical and obstetric history, and details regarding delivery and intensive care unit stay were collected, as was information regarding mode of conception (in vitro fertilization versus non-in vitro fertilization) for the current pregnancy. The primary outcome measure was difference in etiology of intensive care unit admission between in vitro fertilization and non-in vitro fertilization groups. Secondary outcome measures included differences in prepregnancy characteristics, incidence, severity, and management of postpartum hemorrhage, as well as incidence of other clinical major morbidity events and delivery-related complications. Multivariable logistic regression was performed to study the relationship between in vitro fertilization and the odds of having been admitted to the intensive care unit due to hemorrhage. RESULTS: During the study period, there were nearly 192,000 deliveries, with 428 pregnant and peripartum women admitted to the intensive care unit. Of the 409 cases analyzed, 60 had conceived following in vitro fertilization and 349 had conceived without in vitro fertilization. The non-in vitro fertilization group was more likely to have multiple medical comorbidities, and the in vitro fertilization group was more likely to have multiple gestations. The groups also differed in etiology of intensive care unit admission; more women in the in vitro fertilization group were admitted due to a pregnancy-related complication. Intensive care unit admission for postpartum hemorrhage was more frequent in the in vitro fertilization group (60.0% vs 43.1%, P = .014), with a 2-fold increase in the incidence of hemorrhagic shock. Logistic regression analysis revealed a 2-fold increase in the odds that intensive care unit admission was due to hemorrhage in women undergoing in vitro fertilization, a finding that was not statistically significant when multiple gestation was added to the model. CONCLUSIONS: Among patients admitted to the intensive care unit, patients with different modes of conception had dissimilar etiologies for intensive care unit admission with intensive care unit admission due to hemorrhage greater in those with in vitro fertilization. Higher rates of multiple gestation pregnancies may explain this difference. Differences in pregnancies conceived via in vitro fertilization versus without in vitro fertilization may affect the obstetric intensive care unit case mix.


Assuntos
Fertilização In Vitro/tendências , Unidades de Terapia Intensiva/tendências , Complicações do Trabalho de Parto/etiologia , Admissão do Paciente/tendências , Complicações na Gravidez/etiologia , Adulto , Estudos de Coortes , Feminino , Fertilização In Vitro/efeitos adversos , Humanos , Complicações do Trabalho de Parto/diagnóstico , Complicações do Trabalho de Parto/terapia , Hemorragia Pós-Parto/diagnóstico , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/terapia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/terapia , Estudos Retrospectivos
19.
Hum Reprod Update ; 26(1): 118-135, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31867625

RESUMO

BACKGROUND: Freeze-all IVF cycles are becoming increasingly prevalent for a variety of clinical indications. However, the actual treatment objectives and preferred treatment regimens for freeze-all cycles have not been clearly established. OBJECTIVE AND RATIONALE: We aimed to conduct a systematic review of all aspects of ovarian stimulation for freeze-all cycles. SEARCH METHODS: A comprehensive search in Medline, Embase and The Cochrane Library was performed. The search strategy included keywords related to freeze-all, cycle segmentation, cumulative live birth rate, preimplantation genetic diagnosis, preimplantation genetic testing for aneuploidy, fertility preservation, oocyte donation and frozen-thawed embryo transfer. We included relevant studies published in English from 2000 to 2018. OUTCOMES: Our search generated 3292 records. Overall, 69 articles were included in the final review. Good-quality evidence indicates that in freeze-all cycles the cumulative live birth rate increases as the number of oocytes retrieved increases. Although the risk of severe ovarian hyperstimulation syndrome (OHSS) is virtually eliminated in freeze-all cycles, there are certain risks associated with retrieval of large oocyte cohorts. Therefore, ovarian stimulation should be planned to yield between 15 and 20 oocytes. The early follicular phase is currently the preferred starting point for ovarian stimulation, although luteal phase stimulation can be used if necessary. The improved safety associated with the GnRH antagonist regimen makes it the regimen of choice for ovarian stimulation in freeze-all cycles. Ovulation triggering with a GnRH agonist almost completely eliminates the risk of OHSS without affecting oocyte and embryo quality and is therefore the trigger of choice. The addition of low-dose hCG in a dual trigger has been suggested to improve oocyte and embryo quality, but further research in freeze-all cycles is required. Moderate-quality evidence indicates that in freeze-all cycles, a moderate delay of 2-3 days in ovulation triggering may result in the retrieval of an increased number of mature oocytes without impairing the pregnancy rate. There are no high-quality studies evaluating the effects of sustained supraphysiological estradiol (E2) levels on the safety and efficacy of freeze-all cycles. However, no significant adverse effects have been described. There is conflicting evidence regarding the effect of late follicular progesterone elevation in freeze-all cycles. WIDER IMPLICATIONS: Ovarian stimulation for freeze-all cycles is different in many aspects from conventional stimulation for fresh IVF cycles. Optimisation of ovarian stimulation for freeze-all cycles should result in enhanced treatment safety along with improved cumulative live birth rates and should become the focus of future studies.


Assuntos
Criopreservação/métodos , Transferência Embrionária/métodos , Fertilização In Vitro/métodos , Oócitos/transplante , Indução da Ovulação/métodos , Coeficiente de Natalidade , Embrião de Mamíferos/embriologia , Feminino , Fertilização In Vitro/efeitos adversos , Congelamento , Testes Genéticos/métodos , Hormônio Liberador de Gonadotropina/antagonistas & inibidores , Antagonistas de Hormônios , Humanos , Doação de Oócitos , Oócitos/fisiologia , Síndrome de Hiperestimulação Ovariana/etiologia , Síndrome de Hiperestimulação Ovariana/patologia , Indução da Ovulação/efeitos adversos , Gravidez , Taxa de Gravidez , Diagnóstico Pré-Implantação/métodos
20.
J Matern Fetal Neonatal Med ; 33(2): 322-333, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30189770

RESUMO

Background: Assisted reproductive technologies (ARTs) have made great progress. However, whether tube baby born after ART were at an increased risk of birth defects is not clear.Objective: To assess whether the ART increases the risk of birth defects in children born after ART.Search strategy: Medline, Google Scholar, and the Cochrane Library were searched.Selection criteria: Clinical trials that evaluate the risk of birth defect in children born after in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) and natural conceptions (NC) were included. The primary outcome was the prevalence of birth defects.Data collection and analysis: The relative risk was used as the summary measure with random effects model. We assessed heterogeneity between studies using the I2 index.Main results: Totally 46 studies were included. The pooled relative risk (RR) estimated suggested there was an increased risk of birth defects in ART compared with the NC group (RR: 1.40; 95% CI 1.31-1.49). Twenty and fifteen studies were included to compare the risk of birth defects between NC and IVF/ICSI, respectively. The results indicated that both IVF and ICSI increase the risk of birth defects (IVF: RR 1.25; 95% CI 1.12-1.40; ICSI: RR 1.29; 95% CI 1.14-1.45). When subgroup according to plurality, 22 studies assessed the risk of birth defects after ART or NC in singletons and 15 studies evaluated the risk of birth defects in twins. The pooled RRs were 1.41 (95% CI 1.30-1.52) and 1.18 (95% CI 0.98-1.42), respectively.Conclusions: Children born after ART were at an increased risk of birth defects compared with NC. There was no difference in birth defects risk between ART twins and NC twins.


Assuntos
Anormalidades Congênitas/epidemiologia , Fertilização In Vitro/efeitos adversos , Pré-Escolar , Anormalidades Congênitas/etiologia , Feminino , Fertilização In Vitro/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Razão de Chances , Gravidez , Fatores de Risco , Injeções de Esperma Intracitoplásmicas/efeitos adversos , Injeções de Esperma Intracitoplásmicas/estatística & dados numéricos
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