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1.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(8): 960-965, 2020 Aug 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-33053539

RESUMO

OBJECTIVES: To investigate the possible factors relevant to fertilization failure in in vitro fertilization-embryo transfer (IVF-ET). METHODS: The medical records of 4 205 infertile patients undergoing IVF-ET treatment at the Reproductive Medicine Center, Xiangya Hospital, Central South University from January 2016 to December 2017 were collected. The patients were divided into a complete fertilization failure group, a low fertilization rate group, and a control group based on fertilization rate. We examined the associations among the 3 groups in terms of female age, duration of infertility, duration of stimulation, gonadotropin (Gn) dosage, follicle-stimulating hormone (FSH) dosage, and total number of retrieved oocytes. According to theincidence factors, the patients were divided into a single female factor group, a single male factor group and a unisex factor group, and the correlation analysis of incidence factor among the 3 groups was performed. The patients were divided into a primary infertility and a secondary infertility in accordance with the type of infertility. We analyzed the correlation of infertility type among the three groups. Risk factors for complete fertilization failure and low fertilization rate in IVF-ET were obtained by stepwise multiple linear regression analysis. RESULTS: Primary infertility, long infertility duration, total number of retrieved oocytes, and unisex factor were associated with completefertilization failure and low fertilization rate in IVF-ET (P<0.05), but female age, duration of stimulation, FSH dosage as well as Gn dosage were not correlated with complete fertilization failure and low fertilization rate in IVF-ET (P>0.05). Stepwise multiple linear regression analysis showed that the incidence factor, type of infertility, and infertility duration were independent influential factors for complete fertilization failure and low fertilization rate. CONCLUSIONS: Complete fertilization failure and low fertilization rate in IVF-ET are related to duration of infertility, total number of retrieved oocytes, cause of onset, and type of infertility, but they are not relevant to female age, duration of stimulation, and Gn and FSH dosage.


Assuntos
Fertilização In Vitro , Infertilidade , Transferência Embrionária , Feminino , Humanos , Masculino , Oócitos , Injeções de Esperma Intracitoplásmicas
2.
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
3.
Medicine (Baltimore) ; 99(33): e21660, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872029

RESUMO

This study aimed to investigate the effect of the duration of embryo culture on clinical outcome in vitrified-warmed cycles.This retrospective cohort study enrolled 10,464 infertile patients, with a total of 18,843 vitrified-warmed day 3 embryos from 2012 to 2017 at a single center. The patients were divided into 2 groups: 9470 cycles in the short-term culture group (0.5-8 hours of post-thaw culture) and 994 cycles in the 48 to 72 hours culture group. The independent effect of the following variables on clinical outcomes was determined: duration of post-thaw culture, maternal age, transferred embryos, embryo quality, and endometrial thickness.We found that the pregnancy rate was positively associated with the post-thaw culture time. Ordinary least square regression analyses showed that the duration of post-thaw culture was positively associated with implantation and live birth rates overall. However, the implantation and live birth rates were not significantly associated with the post-thaw culture time in the short-term culture group. Additionally, maternal age and the number of transferred embryos were independent predictors of the implantation and live birth rates. Moreover, the duration of post-thaw culture did not affect live birth weight.These results indicated that the pregnancy rate is positively associated with the duration of post-thaw culture. Therefore, under the condition of not affecting work shifts, properly prolonging the duration of post-thaw culture to improve the outcome of frozen-thawed embryo transfer should be considered.


Assuntos
Técnicas de Cultura Embrionária/métodos , Implantação do Embrião , Transferência Embrionária/métodos , Adulto , Estudos de Casos e Controles , Criopreservação/métodos , Transferência Embrionária/estatística & dados numéricos , Feminino , Humanos , Gravidez , Taxa de Gravidez , Estudos Retrospectivos , Fatores de Tempo , Vitrificação
4.
Anim Sci J ; 91(1): e13457, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32959472

RESUMO

This study aimed to compare the efficiency of non-surgical embryo transfer (ET) using a newly developed catheter, which enables transferring embryos into a proximal site of the uterus (mostly uterine body), and surgical ET of vitrified porcine embryos. In Experiment 1, the catheter was inserted into 12 gilts, with each half of the group allocated to skilled or novice operators. The time required for insertion into the uterus did not differ between skilled and novice operators (4 min 9 s and 4 min 6 s, respectively). In Experiment 2, 12 gilts were used as recipients for non-surgical and surgical ET with vitrified embryos (n = 6, each). There was no significant difference in the rate of piglet production based on the number of transferred embryos between surgical and non-surgical ET (25.8% vs. 15.4%, p = .098). The results suggest that non-surgical ET catheter allowed for easy insertion and transfer of embryos without special training. Although the catheter is effective for deposition of embryos into the proximal site of uterus, the efficiency of piglet production is not enhanced compared with surgical ET. The ET method using this catheter, being labor-saving and less-invasive, may contribute to the improvement of ET in pigs.


Assuntos
Técnicas de Cultura Embrionária/métodos , Técnicas de Cultura Embrionária/veterinária , Transferência Embrionária/métodos , Transferência Embrionária/veterinária , Suínos/fisiologia , Útero , Vitrificação , Animais , Cateteres , Transferência Embrionária/instrumentação , Feminino , Reprodução , Fatores de Tempo
5.
Anim Sci J ; 91(1): e13453, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32926526

RESUMO

This study was performed to evaluate reproductive performance after non-surgical embryo transfer (Ns-ET) of 10-15 porcine expanded blastocysts (ExBs) that had been vitrified and warmed (V/W) using the micro volume air cooling (MVAC) method. The effect of asynchrony between the donor and recipient estrous cycle was investigated. Ns-ET was conducted in recipients whose estrous cycle was asynchronous to that of donors by a delay of 2, 1, or 0 days. In the 2-day and 1-day groups, the similar farrowing rates (27.3% and 25.0%) and survival rates to term (13.9% and 15.7%) were obtained after Ns-ET of V/W ExBs. None of the recipients in 0-day group farrowed. Artificial insemination (AI) prior to Ns-ET was then evaluated. Ten-15 V/W ExBs were transferred non-surgically to 12 recipients whose estrous cycles were asynchronous to that of donors by a 2-day delay. All of the recipients produced piglets, and all (100.0%) delivered piglets were derived from the transferred V/W ExBs. The survival rate of V/W ExBs to term was 25.2%. These results demonstrate that Ns-ET of V/W ExBs using MVAC can facilitate piglet production, even if 10-15 embryos are transferred. Moreover, piglets were obtained stably when AI was performed prior to Ns-ET.


Assuntos
Blastocisto , Sobrevivência Celular , Criopreservação/métodos , Criopreservação/veterinária , Técnicas de Cultura Embrionária/veterinária , Transferência Embrionária/métodos , Transferência Embrionária/veterinária , Inseminação Artificial/métodos , Inseminação Artificial/veterinária , Suínos/fisiologia , Vitrificação , Animais , Ciclo Estral , Feminino , Reprodução
6.
Medicine (Baltimore) ; 99(37): e22163, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925779

RESUMO

For frozen embryo transplantation patients who failed to use hormone replacement cycle (HRC) transplantation for 2 consecutive times, the third time of transplantation was divided into 2 groups: HRC and natural cycle (NC), and the pregnancy rate of the 2 groups, especially the clinical pregnancy rate, was compared.Retrospective study of 174 patients in the reproductive medicine center of an affiliated hospital of Shandong University of Traditional Chinese Medicine between January 2015 and September 2018.The 174 patients were all infertile with regular menstruation. They had undergone 2 consecutive failed cycles of endometrial preparation with hormone replacement therapy and prepare for the third frozen embryo transplantation.A third cycle of treatment was planned using either NC or HRC for endometrial preparation. All the embryos were obtained during the same oocyte retrieval cycle. Patients were divided into groups based on the method of endometrial preparation: 98 were classified as NC and 76 as HRC.The pregnancy outcomes for the 2 groups were compared. Confounding factors that may affect clinical pregnancy rates were analyzed.We found that on the day of endometrial transformation, estrogen levels and endometrial thickness in the NC group were significantly higher than those in the HRC group. There were no significant differences in the rates of biochemical pregnancy, clinical pregnancy, cumulative pregnancy, miscarriage, multiple pregnancy, ectopic pregnancy, or live birth between the 2 groups. It is concluded by binary regression analysis that the different endometrial preparation protocol have no significant effect on the CPR.NC is as effective as HRC after 2 previous cycles of HRC. Because this was a retrospective study design, selection bias is possible, although the baseline characteristics of the 2 groups of patients were matched.


Assuntos
Transferência Embrionária/métodos , Terapia de Reposição Hormonal/métodos , Resultado da Gravidez/epidemiologia , Taxa de Gravidez , Adulto , Implantação do Embrião/fisiologia , Endométrio/metabolismo , Estrogênios/sangue , Feminino , Humanos , Gravidez , Estudos Retrospectivos
7.
Cochrane Database Syst Rev ; 8: CD003416, 2020 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-32827168

RESUMO

BACKGROUND: Transfer of more than one embryo during in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) increases multiple pregnancy rates resulting in an increased risk of maternal and perinatal morbidity. Elective single embryo transfer offers a means of minimising this risk, but this potential gain needs to be balanced against the possibility of jeopardising the overall live birth rate (LBR). OBJECTIVES: To evaluate the effectiveness and safety of different policies for the number of embryos transferred in infertile couples undergoing assisted reproductive technology cycles. SEARCH METHODS: We searched the Cochrane Gynaecology and Fertility Group specialised register of controlled trials, CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform from inception to March 2020. We handsearched reference lists of articles and relevant conference proceedings. We also communicated with experts in the field regarding any additional studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing different policies for the number of embryos transferred following IVF or ICSI in infertile women. Studies of fresh or frozen and thawed transfer of one to four embryos at cleavage or blastocyst stage were eligible. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed trial eligibility and risk of bias. The primary outcomes were LBR and multiple pregnancy rate. The secondary outcomes were clinical pregnancy and miscarriage rates. We analysed data using risk ratios (RR), Peto odds ratio (Peto OR) and a fixed effect model. MAIN RESULTS: We included 17 RCTs in the review (2505 women). The main limitation was inadequate reporting of study methods and moderate to high risk of performance bias due to lack of blinding. A majority of the studies had low numbers of participants. None of the trials compared repeated single embryo transfer (SET) with multiple embryo transfer. Reported results of multiple embryo transfer below refer to double embryo transfer. Repeated single embryo transfer versus multiple embryo transfer in a single cycle Repeated SET was compared with double embryo transfer (DET) in four studies of cleavage-stage transfer. In these studies the SET group received either two cycles of fresh SET (one study) or one cycle of fresh SET followed by one frozen SET (three studies). The cumulative live birth rate after repeated SET may be little or no different from the rate after one cycle of DET (RR 0.95, 95% CI (confidence interval) 0.82 to 1.10; I² = 0%; 4 studies, 985 participants; low-quality evidence). This suggests that for a woman with a 42% chance of live birth following a single cycle of DET, the repeated SET would yield pregnancy rates between 34% and 46%. The multiple pregnancy rate associated with repeated SET is probably reduced compared to a single cycle of DET (Peto OR 0.13, 95% CI 0.08 to 0.21; I² = 0%; 4 studies, 985 participants; moderate-quality evidence). This suggests that for a woman with a 13% risk of multiple pregnancy following a single cycle of DET, the risk following repeated SET would be between 0% and 3%. The clinical pregnancy rate (RR 0.99, 95% CI 0.87 to 1.12; I² = 47%; 3 studies, 943 participants; low-quality evidence) after repeated SET may be little or no different from the rate after one cycle of DET. There may be little or no difference in the miscarriage rate between the two groups. Single versus multiple embryo transfer in a single cycle A single cycle of SET was compared with a single cycle of DET in 13 studies, 11 comparing cleavage-stage transfers and three comparing blastocyst-stage transfers.One study reported both cleavage and blastocyst stage transfers. Low-quality evidence suggests that the live birth rate per woman may be reduced in women who have SET in comparison with those who have DET (RR 0.67, 95% CI 0.59 to 0.75; I² = 0%; 12 studies, 1904 participants; low-quality evidence). Thus, for a woman with a 46% chance of live birth following a single cycle of DET, the chance following a single cycle of SET would be between 27% and 35%. The multiple pregnancy rate per woman is probably lower in those who have SET than those who have DET (Peto OR 0.16, 95% CI 0.12 to 0.22; I² = 0%; 13 studies, 1952 participants; moderate-quality evidence). This suggests that for a woman with a 15% risk of multiple pregnancy following a single cycle of DET, the risk following a single cycle of SET would be between 2% and 4%. Low-quality evidence suggests that the clinical pregnancy rate may be lower in women who have SET than in those who have DET (RR 0.70, 95% CI 0.64 to 0.77; I² = 0%; 10 studies, 1860 participants; low-quality evidence). There may be little or no difference in the miscarriage rate between the two groups. AUTHORS' CONCLUSIONS: Although DET achieves higher live birth and clinical pregnancy rates per fresh cycle, the evidence suggests that the difference in effectiveness may be substantially offset when elective SET is followed by a further transfer of a single embryo in fresh or frozen cycle, while simultaneously reducing multiple pregnancies, at least among women with a good prognosis. The quality of evidence was low to moderate primarily due to inadequate reporting of study methods and absence of masking those delivering, as well as receiving the interventions.


Assuntos
Transferência Embrionária/efeitos adversos , Transferência Embrionária/métodos , Fertilização In Vitro , Taxa de Gravidez , Aborto Espontâneo/epidemiologia , Blastocisto , Fase de Clivagem do Zigoto/transplante , Feminino , Humanos , Nascimento Vivo/epidemiologia , Gravidez , Gravidez Múltipla/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto , Transferência de Embrião Único , Injeções de Esperma Intracitoplásmicas
8.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(6): 651-656, 2020 Jun 06.
Artigo em Chinês | MEDLINE | ID: mdl-32842281

RESUMO

Objective: To investigate the association between estradiol on the day of human chorionic gonadotropin (HCG) administration and birth outcomes among singleton live births following fresh embryo transfers. Methods: Based on the clinical reproduction medicine management system of the First Affiliated Hospital of Nanjing Medical University, this retrospective cohort study collected data of fresh embryo transfer cycles during January 2013 and December 2016, including pregnant women's age, body mass index (BMI), type and cause of infertility, assisted reproductive therapy indicators (fertilization mode, ovulation stimulation protocol, estradiol levels on HCG administration day), adverse birth outcomes[small for gestational age (SGA), premature and low birth weight (LBW)], etc.. A total of 2 060 women with singleton pregnancy (2 061 fresh embryo transfer cycles) were enrolled. Multivariate logistic regression was used to analyze the association between estradiol on HCG administration day and singletons' adverse birth outcomes. Results: The age and BMI of the 2 060 pregnant women were (29.63±3.92) years old and (22.29±2.86) kg/m2. Incidences of SGA, premature and LBW were 9.8% (201/2 061), 6.9% (143/2 061) and 3.5% (73/2 061), respectively. After adjusting for confounders, the risk of LBW in 4 000-4 499 pg/ml group was significantly elevated when compared to estradiol<1 500 pg/ml group [OR (95%CI): 4.42 (1.13-17.24)]. A protective effect of premature was observed in estradiol≥4 500 pg/ml group [OR (95%CI): 0.50 (0.25-0.97)]. Conclusion: The high level of estradiol on HCG administration day might be a risk factor for LBW, but a protective factor for premature.


Assuntos
Estradiol , Fertilização In Vitro , Adulto , Gonadotropina Coriônica , Transferência Embrionária , Feminino , Humanos , Recém-Nascido , Gravidez , Estudos Retrospectivos
9.
Cochrane Database Syst Rev ; 8: CD013063, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32797689

RESUMO

BACKGROUND: Despite substantial improvements in the success of assisted reproduction techniques (ART), live birth rates may remain consistently low, and practitioners may look for innovative treatments to improve the outcomes. The injection of embryo culture supernatant in the endometrial cavity can be undertaken at various time intervals before embryo transfer. It provides an altered endometrial environment through the secretion of factors considered to facilitate implantation. It is proposed that injection of the supernatant into the endometrial cavity prior to embryo transfer will stimulate the endometrium and provide better conditions for implantation to take place. An increased implantation rate would subsequently increase rates of clinical pregnancy and live birth, but current robust evidence on the efficacy of injected embryo culture supernatant is lacking. OBJECTIVES: To evaluate the effectiveness and safety of endometrial injection of embryo culture supernatant before embryo transfer in women undergoing ART. SEARCH METHODS: Our search strategies were designed with the help of the Cochrane Gynaecology and Fertility Group Information Specialist. We sought to identify all published and unpublished randomised controlled trials (RCTs) meeting inclusion criteria. Searches were performed on 2 December 2019. We searched the Cochrane Gynaecology and Fertility Group Specialised Register of controlled trials, CENTRAL, MEDLINE, Embase, CINAHL, trials registries and grey literature. We made further searches in the UK National Institute for Health and Care Excellence (NICE) fertility assessment and treatment guidelines. We handsearched reference lists of relevant systematic reviews and RCTs, together with searches of PubMed and Google for any recent trials that have not yet been indexed in the major databases. We had no language or location restrictions. SELECTION CRITERIA: We included RCTs testing the use of endometrial injection of embryo culture supernatant before embryo transfer during an ART cycle, compared with the non-use of this intervention, the use of placebo or the use of any other similar drug. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, assessed risk of bias, extracted data from studies and attempted to contact the authors where data were missing. We pooled studies using a fixed-effect model. Our primary outcomes were live birth/ongoing pregnancy and miscarriage. We performed statistical analysis using Review Manager 5. We assessed evidence quality using GRADE methods. MAIN RESULTS: We found five RCTs suitable for inclusion in the review (526 women analysed). We made two comparisons: embryo culture supernatant use versus standard care or no intervention; and embryo culture supernatant use versus culture medium. All studies were published as full-text articles. Data derived from the reports or through direct communication with investigators were available for the final meta-analysis performed. The GRADE evidence quality of studies ranged from very low-quality to moderate-quality. Factors reducing evidence quality included high risk of bias due to lack of blinding, unclear risk of publication bias and selective outcome reporting, serious inconsistency among study outcomes, and serious imprecision due to wide confidence intervals (CIs) and low numbers of events. Comparison 1. Endometrial injection of embryo culture supernatant before embryo transfer versus standard care or no intervention: One study reported live birth only and two reported the composite outcome live birth and ongoing pregnancy. We are uncertain whether endometrial injection of embryo culture supernatant before embryo transfer during an ART cycle improves live birth/ongoing pregnancy rates compared to no intervention (odds ratio (OR) 1.11, 95% CI 0.73 to 1.70; 3 RCTs; n = 340, I2 = 84%; very low-quality evidence). Results suggest that if the chance of live birth/ongoing pregnancy following placebo or no treatment is assumed to be 42%, the chance following the endometrial injection of embryo culture supernatant before embryo transfer would vary between 22% and 81%. We are also uncertain whether the endometrial injection of embryo culture supernatant could decrease miscarriage rates, compared to no intervention (OR 0.89, 95% CI 0.44 to 1.78, 4 RCTs, n = 430, I2 = 58%, very low-quality evidence). Results suggest that if the chance of miscarriage following placebo or no treatment is assumed to be 9%, the chance following injection of embryo culture supernatant would vary between 3% and 30%. Concerning the secondary outcomes, we are uncertain whether the injection of embryo culture supernatant prior to embryo transfer could increase clinical pregnancy rates (OR 1.13, 95% CI 0.80 to 1.61; 5 RCTs; n = 526, I2 = 0%; very low-quality evidence), decrease ectopic pregnancy rates (OR 0.32, 95% CI 0.01 to 8.24; n = 250; 2 RCTs; I2 = 41%; very low-quality evidence), decrease multiple pregnancy rates (OR 0.70, 95% CI 0.26 to 1.83; 2 RCTs; n = 150; I2 = 63%; very low-quality evidence), or decrease preterm delivery rates (OR 0.63, 95% CI 0.17 to 2.42; 1 RCT; n = 90; I2 = 0%; very low-quality evidence), compared to no intervention. Finally, there may have been little or no difference in foetal abnormality rates between the two groups (OR 3.10, 95% CI 0.12 to 79.23; 1 RCT; n = 60; I2 = 0%; low-quality evidence). Comparison 2. Endometrial injection of embryo culture supernatant versus endometrial injection of culture medium before embryo transfer We are uncertain whether the use of embryo culture supernatant improves clinical pregnancy rates, compared to the use of culture medium (OR 1.09, 95% CI 0.48 to 2.46; n = 96; 1 RCT; very low-quality evidence). No study reported live birth/ongoing pregnancy, miscarriage, ectopic or multiple pregnancy, preterm delivery or foetal abnormalities. AUTHORS' CONCLUSIONS: We are uncertain whether the addition of endometrial injection of embryo culture supernatant before embryo transfer as a routine method for the treatment of women undergoing ART can improve pregnancy outcomes. This conclusion is based on current available data from five RCTs, with evidence quality ranging from very low to moderate across studies. Further large well-designed RCTs reporting on live births and adverse clinical outcomes are still required to clarify the exact role of endometrial injection of embryo culture supernatant before embryo transfer.


Assuntos
Meios de Cultura , Técnicas de Cultura Embrionária , Endométrio , Infertilidade Feminina/terapia , Técnicas de Reprodução Assistida , Aborto Espontâneo/epidemiologia , Viés , Transferência Embrionária , Feminino , Humanos , Injeções/métodos , Nascimento Vivo , Gravidez , Taxa de Gravidez , Gravidez Ectópica/epidemiologia , Gravidez Múltipla/estatística & dados numéricos , Nascimento Prematuro/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
Reprod Biomed Online ; 41(3): 361-364, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32660814

RESUMO

The COVID-19 pandemic has significantly increased mortality in many countries, with the number of infected cases increasing exponentially worldwide. One of the main determining factors of the poor prognosis in these patients is the development of coagulopathy. Moreover, it is well known that assisted reproductive technology procedures confer a risk of thromboembolic complications. This commentary analyses specific aspects coexisting between the thrombotic risk described during virus infection and that reported in the context of assisted reproduction treatments. Based on known pathophysiological aspects of virus infection and of ovarian stimulation, there are common elements that deserve to be taken into account. In the present context, any risk of hyperstimulation should be avoided. Gonadotrophin-releasing hormone agonist triggering should be mandatory in high-responder patients and/or those with COVID-19 infection. In both cases, the cycle should be segmented. A proposal is made for the use of prophylactic low molecular weight heparin not only in those cases in which oocyte retrieval has been performed, but also in those in which cancellation has been decided. In addition, endometrial preparation for frozen-thawed embryo transfers should use the transdermal route in order to minimize the higher thrombotic risk associated with the oral route.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Técnicas de Reprodução Assistida/efeitos adversos , Tromboembolia/epidemiologia , Tromboembolia/virologia , Transferência Embrionária/métodos , Feminino , Heparina de Baixo Peso Molecular/administração & dosagem , Humanos , Recuperação de Oócitos , Síndrome de Hiperestimulação Ovariana/complicações , Síndrome de Hiperestimulação Ovariana/prevenção & controle , Síndrome de Hiperestimulação Ovariana/virologia , Indução da Ovulação/efeitos adversos , Pandemias , Gravidez , Fatores de Risco , Tromboembolia/prevenção & controle
11.
PLoS One ; 15(6): e0233784, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32492024

RESUMO

Recent advances in somatic cell nuclear transfer (SCNT) in canines facilitate the production of canine transgenic models. Owing to the importance of stable and strong promoter activity in transgenic animals, we tested human elongation factor 1α (hEF1α) and cytomegalovirus (CMV) promoter sequences in SCNT transgenic dogs. After transfection, transgenic donor fibroblasts with the hEF1α-enhanced green fluorescence protein (EGFP) transgene were successfully isolated using fluorescence-activated cell sorting (FACS). We obtained four puppies, after SCNT, and identified three puppies as being transgenic using PCR analysis. Unexpectedly, EGFP regulated by hEF1α promoter was not observed at the organismal and cellular levels in these transgenic dogs. EGFP expression was rescued by the inhibition of DNA methyltransferases, implying that the hEF1α promoter is silenced by DNA methylation. Next, donor cells with CMV-EGFP transgene were successfully established and SCNT was performed. Three puppies of six born puppies were confirmed to be transgenic. Unlike hEF1α-regulated EGFP, CMV-regulated EGFP was strongly detectable at both the organismal and cellular levels in all transgenic dogs, even after 19 months. In conclusion, our study suggests that the CMV promoter is more suitable, than the hEF1α promoter, for stable transgene expression in SCNT-derived transgenic canine model.


Assuntos
Clonagem de Organismos/veterinária , Citomegalovirus/genética , Técnicas de Transferência Nuclear/veterinária , Fator 1 de Elongação de Peptídeos/genética , Regiões Promotoras Genéticas/genética , Ativação Transcricional/genética , Animais , Animais Geneticamente Modificados , Azacitidina/farmacologia , Células Cultivadas , DNA (Citosina-5-)-Metiltransferases/antagonistas & inibidores , Metilação de DNA/efeitos dos fármacos , Cães , Transferência Embrionária/veterinária , Feminino , Fibroblastos/metabolismo , Regulação da Expressão Gênica/efeitos dos fármacos , Proteínas de Fluorescência Verde/genética , Humanos , Gravidez , Transfecção , Transgenes
12.
Hum Reprod ; 35(7): 1630-1636, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32544225

RESUMO

STUDY QUESTION: Will a delay in initiating IVF treatment affect pregnancy outcomes in infertile women with diminished ovarian reserve? SUMMARY ANSWER: A delay in IVF treatment up to 180 days does not affect the live birth rate for women with diminished ovarian reserve when compared to women who initiate IVF treatment within 90 days of presentation. WHAT IS KNOWN ALREADY: In clinical practice, treatment delays can occur due to medical, logistical or financial reasons. Over a period of years, a gradual decline in ovarian reserve occurs which can result in declining outcomes in response to IVF treatment over time. There is disagreement among reproductive endocrinologists about whether delaying IVF treatment for a few months can negatively affect patient outcomes. STUDY DESIGN, SIZE, DURATION: A retrospective cohort study of infertile patients in an academic hospital setting with diminished ovarian reserve who started an IVF cycle within 180 days of their initial consultation and underwent an oocyte retrieval with planned fresh embryo transfer between 1 January 2012 and 31 December 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS: Diminished ovarian reserve was defined as an anti-Müllerian hormone (AMH) <1.1 ng/ml. In total, 1790 patients met inclusion criteria (1115 immediate and 675 delayed treatment). Each patient had one included cycle and no subsequent data from additional frozen embryo transfer cycles were included. Since all cycle outcomes evaluated were from fresh embryo transfers, no genetically tested embryos were included. Patients were grouped by whether their cycle started 1-90 days after presentation (immediate) or 91-180 days (delayed). The primary outcome was live birth (≥24 weeks of gestation). A subgroup analysis of more severe forms of diminished ovarian reserve was performed to evaluate outcomes for patients with an AMH <0.5 and for patients >40 years old with an AMH <1.1 ng/ml (Bologna criteria for diminished ovarian reserve). Logistic regression analysis, adjusted a priori for patient age, was used to estimate the odds ratio (OR) with a 95% CI. All pregnancy outcomes were additionally adjusted for the number of embryos transferred. MAIN RESULTS AND THE ROLE OF CHANCE: The mean ± SD number of days from presentation to IVF start was 50.5 ± 21.9 (immediate) and 128.8 ± 25.9 (delayed). After embryo transfer, the live birth rate was similar between groups (immediate: 23.9%; delayed: 25.6%; OR 1.08, 95% CI 0.85-1.38). Additionally, a similar live birth rate was observed in a subgroup analysis of patients with an AMH <0.5 ng/ml (immediate: 18.8%; delayed: 19.1%; OR 0.99, 95% CI 0.65-1.51) and in patients >40 years old with an AMH <1.1 ng/ml (immediate: 12.3%; delayed: 14.7%; OR 1.21, 95% CI 0.77-1.91). LIMITATIONS, REASONS FOR CAUTION: There is the potential for selection bias with regard to the patients who started their IVF cycle within 90 days compared to 91-180 days after initial consultation. In addition, we did not include patients who were seen for initial evaluation but did not progress to IVF treatment with oocyte retrieval; therefore, our results should only be applied to patients with diminished ovarian reserve who complete an IVF cycle. Finally, since we excluded patients who started their IVF cycle greater than 180 days from their first visit, it is not known how such a delay in treatment affects pregnancy outcomes in IVF cycles. WIDER IMPLICATIONS OF THE FINDINGS: A delay in initiating IVF treatment in patients with diminished ovarian reserve up to 180 days from the initial visit does not affect pregnancy outcomes. This observation remains true for patients who are in the high-risk categories for poor response to ovarian stimulation. Providers and patients should be reassured that when a short-term treatment delay is deemed necessary for medical, logistic or financial reasons, treatment outcomes will not be affected. STUDY FUNDING/COMPETING INTEREST(S): No financial support, funding or services were obtained for this study. The authors do not report any potential conflicts of interest. TRIAL REGISTRATION NUMBER: Not applicable.


Assuntos
Fertilização In Vitro/métodos , Infertilidade Feminina/terapia , Nascimento Vivo , Doenças Ovarianas/terapia , Reserva Ovariana , Tempo para o Tratamento , Adulto , Hormônio Antimülleriano/sangue , Coeficiente de Natalidade , Transferência Embrionária/métodos , Feminino , Humanos , Infertilidade Feminina/sangue , Recuperação de Oócitos/métodos , Doenças Ovarianas/sangue , Gravidez , Estudos Retrospectivos , Resultado do Tratamento
13.
PLoS One ; 15(6): e0234481, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32589634

RESUMO

BACKGROUND: Is freeze-all strategy effective in terms of cumulative live birth rates (CLBRs) in all patients? METHODS: This retrospective single-center study analyzed the CLBRs of 2523 patients undergoing fresh or electively frozen blastocyst transfer cycles. In 1047, cycles, the fresh embryo transfer (ET) strategy was applied for the 1st ET, whereas electively frozen ET (e-FET) was performed in 1476 cycles. Female age ≤ 37 and blastocysts frozen via vitrification were included. The patients in each arm were further stratified into four subgroups according to the number of oocytes retrieved as follows: Group A: 1-5, group B: 6-10, group C: 11-15 and group D: 16-25 oocytes retrieved. The primary endpoint was the CLBR. The secondary endpoints were the ovarian hyperstimulation syndrome (OHSS) rate and the live birth rates (LBRs) following fresh ETs and e-FETs for the first transfers. RESULT(S): The CLBR was similar between the fresh ET and e-FET arms in group A (35/76 (46.1%) vs 29/67 (43.3%), p = 0.74) and group B (165/275 (60%) vs 216/324 (66.7%), p = 0.091), whereas significantly higher rates were detected in favor of the e-FET arm within group C (328/460 (71.3%) vs 201/348 (57.8%), p<0.001) and group D (227/348 (65.2%), vs 446/625 (71.5%), p<0.001). The OHSS rate was also found to be higher in the fresh ET arm among group C (12/348 (3.4%) vs 0/460 (0%), p<0.001) and group D (38/348 (10.9%) vs 3/625 (0.5%), p<0.001) patients than e-FET arm. Perinatal and obstetrical outcomes were nonsignificantly different between fresh and e-FET arms. However, the birth weights were significantly lower for fresh ET, 3064 versus 3201 g for singletons (p<0.001). CONCLUSION: Compared with a fresh-transfer strategy, the e-FET strategy resulted in a higher CLBR among patients with >10 oocytes retrieved during stimulated cycles.


Assuntos
Criopreservação , Transferência Embrionária/métodos , Fertilização In Vitro/métodos , Nascimento Vivo/epidemiologia , Recuperação de Oócitos/estatística & dados numéricos , Manejo de Espécimes/métodos , Adulto , Feminino , Humanos , Síndrome de Hiperestimulação Ovariana/epidemiologia , Estudos Retrospectivos
14.
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
15.
Zhonghua Yi Xue Za Zhi ; 100(18): 1409-1413, 2020 May 12.
Artigo em Chinês | MEDLINE | ID: mdl-32392992

RESUMO

Objective: To evaluate the effect of oocyte vitrification on embryo quality and developmental potential. Methods: From January 2014 to December 2017, 30 cases of oocytes vitrification in the reproductive center of Sir Run Run Shaw hospital were collected as the frozen group, due to failure of sperm extraction or inability to obtain sufficient sperm at the ovum pick-up-day because of oligoospermia or azoospermia. 220 cases of fresh oocytes from the same period were selected as the fresh group. The fertilization rate, embryo rate, pregnancy rate, implantation rate and live birth rate of the two groups were compared retrospectively. Results: The survival rate of oocyte resuscitation was 91.4% (180/197). In the frozen group, 24 cases were transferred with 14 pregnancies, while in the fresh group, 31 cases were transferred with 18 pregnancies. The number of 2PN fertilized eggs, 2PN embryos and 2PN high-quality embryos in the frozen group was significantly lower than that in the fresh group (3.7±2.5 vs 7.3±4.8), (3.3±2.5 vs 7.2±4.8), and (1.2±1.8 vs 2.9±2.7) (all P<0.05). The fertilization rate of the frozen group was 77.2% (115/149) and the high-quality embryo rate was 36.6% (37/101), lower than that of the fresh group 77.6% (1 637/2 109) and 40.9% (651/1 591) (P>0.05).The pregnancy rate of the frozen group was 58.3% (14/24) higher than that of the fresh group 58.1% (18/31), the implantation rate of each mature oocyte and the live birth rate of each mature oocyte were 10.8% (15/138) and 10.8% (15/138), both higher than that of the fresh group 9.6% (21/218) and 8.7% (19/218) (all P>0.05). Conclusions: Vitrification cryopreservation of oocytes may lead to a decrease in embryo quality, but embryo development potential is still considerable. Higher pregnancy rate, implantation rate and live birth rate may be obtained.


Assuntos
Oócitos , Vitrificação , Criopreservação , Transferência Embrionária , Feminino , Fertilização In Vitro , Congelamento , Humanos , Masculino , Gravidez , Taxa de Gravidez , Estudos Retrospectivos
16.
Zhongguo Zhen Jiu ; 40(5): 498-502, 2020 May 12.
Artigo em Chinês | MEDLINE | ID: mdl-32394657

RESUMO

OBJECTIVE: To observe the effect of warming acupuncture on uterine blood perfusion in the patients with failed high-quality freeze-thawed embryo transfer (FET) and explore its effect mechanism on the improvement of clinical pregnancy rate after re-tranfer. METHODS: A total of 72 patients of failed high-quality FET were randomized into an observation group and a control group, 36 cases in each one. In the observation group, after the menstrual period ended, warming acupuncture started at the acupoints located on the abdomen, e.g. Qihai (CV 6), Guanyuan (CV 4), Zhongji (CV 3) and Qugu (CV 2) and those on the lumbar sacral region, e.g. Shenshu (BL 23), Mingmen (GV 4) and Yaoyangguan (GV 3), 50 min in each treatment, once daily, at the interval of 1 day after 4-day treatment. The treatment was discontinued till the patients were at the ovulatory stage. In the control group, nuangong yunzi capsules were taken orally and continuously after the end of menstrual period, 3 capsules each time, three times a day and stopped at the ovulatory stage. The treatment of one menstrual cycle was taken as one course and the treatment for 3 menstrual cycles was required. Before and after treatment, the uterine artery pulsation index (PI), endometrial thickness, endometrial type, uterine blood perfusion, the recovery time of sufficient uterine blood flow, the endomentrial receptivity (ER) during the implantation window period and the clinical pregnancy rate were observed in the two groups. RESULTS: After treatment, the endometrial thickness was increased and PI decreased obviously in the two groups (P<0.05) and PI in the observation group was lower than that in the control group (P<0.05). After treatment, the proportion of type a and type A of endometrium was increased markedly in the two groups (P<0.05) and the proportion in the observation group was higher than the control group (P<0.05). After treatment, the case proportion of sufficient uterine blood flow was increased obviously in the two groups (P<0.05) and the value in the observation group was higher than the control group [83.3% (30/36) vs 69.4% (25/36), P<0.05]. After treatment, the proportion of ER during the implantation window period was increased remarkably in the two groups (P<0.05) and the value in the observation group was higher than the control group [72.2% (26/36) vs 50.0% (18/36), P<0.05]. The recovery time of sufficient uterine blood flow in the observation group was shorter than the control group (P<0.05) and the clinical pregnancy rate was higher than the control group [47.2% (17/36) vs 33.3% (12/36), P<0.05]. CONCLUSION: Warming acupuncture enhances uterine blood perfusion and improves uterine endometrial receptivity so that the clinical pregnancy rate is increased after re-transfer in the patients with failed high-quality freeze-thawed embryo transfer.


Assuntos
Terapia por Acupuntura , Transferência Embrionária , Taxa de Gravidez , Útero/irrigação sanguínea , Pontos de Acupuntura , Endométrio , Feminino , Humanos , Gravidez
17.
Zhonghua Yi Xue Za Zhi ; 100(17): 1326-1331, 2020 May 05.
Artigo em Chinês | MEDLINE | ID: mdl-32375441

RESUMO

Objective: To investigate the effects of age and body mass index (BMI) on embryo development time kinetic parameters, embryo development potential and clinical pregnancy outcomes. Methods: A retrospective study was conducted to analyze the data of 6 294 embryos from 832 patients who underwent in vitro fertilization and embryo transfer (IVF-ET) in the Reproductive Medicine Center of the First Affiliated Hospital of Zhengzhou University from September 2016 to November 2018. According to the age, they were divided into two groups:<35-year-old group (655 cases, 5 076 embryos), ≥35-year-old group (177 cases, 1 218 embryos). According to the BMI, they were divided into three groups: low body mass group (BMI<18.5 kg/m(2), 47 cases, 355 embryos), normal body recombination (18.5-23.9 kg/m(2), 517 cases, 3 813 embryos), hyperrecombination (BMI>23.9 kg/m(2), 268 cases, 2 126 embryos). Embryo development time kinetic parameters, embryo development potential and clinical pregnancy outcomes in each group were compared. Results: Embryo development to 3 cells, 4 cells were faster in <35-year-old group than in ≥35-year-old group. The blastocyst formation rate, high-quality blastocyst formation rate, pregnancy rate, implantation rate, delivery rate, live birth rate, and abortion rate were all statistically significant (all P<0.05). There were no significant differences in normal fertilization rate, cleavage rate, embryo utilization rate, high quality embryo rate, pregnancy rate, implantation rate, abortion rate, delivery rate, live birth rate between the three BMI groups (all P>0.05). Conclusions: The age has an effect on the partial embryo development time kinetic parameters, but BMI has a little effect on it.


Assuntos
Transferência Embrionária , Desenvolvimento Embrionário , Fertilização In Vitro , Adulto , Índice de Massa Corporal , Implantação do Embrião , Feminino , Humanos , Gravidez , Taxa de Gravidez , Estudos Retrospectivos
18.
Arch Gynecol Obstet ; 302(1): 31-45, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32445067

RESUMO

PURPOSE: The use of assisted reproductive technology (ART) has increased in the last 2 decades and continuous surveillance is needed. This systematic review aims to assess the risk of adverse neonatal outcomes (preterm birth [PTB], low birth weight [LBW], small-for-gestationalage [SGA] and large for gestational-age [LGA]), in singleton pregnancies conceived by fresh or frozen embryo transfer (FET) compared to spontaneous conceptions. METHODS: Cohort studies were identified from MEDLINE, Embase, Cochrane Library (January 2019), and manual search. Meta-analyses were performed to estimate odds ratios (OR) using random effects models in RevMan 5.3 and I-squared (I2) test > 50% was considered as high heterogeneity. RESULTS: After 3142 titles and abstracts were screened, 1180 full-text articles were assessed, and 14 were eligible. For fresh embryo transfer, the pooled ORs were PTB 1.64 (95% CI 1.46, 1.84); I2 = 97%; LBW 1.67 (95% CI 1.52, 1.85); I2 = 94%; SGA 1.46 [95% CI 1.11, 1.92]; I2 = 99%, LGA 0.88 (95% CI 0.80, 0.87); I2 = 80%). For frozen, the pooled ORs were PTB 1.39 (95% CI 1.34, 1.44); I2 = 0%; LBW 1.38 (95% CI 0.91, 2.09); I2 = 98%; SGA 0.83 (95% CI 0.57, 1.19); I2 = 0%, LGA 1.57 (95% CI 1.48, 1.68); I2 = 22%). CONCLUSIONS: When compared with spontaneous pregnancies, fresh, but not frozen was associated with LBW and SGA. Both fresh and frozen were associated with PTB. Frozen was uniquely associated with LGA. Despite improvements in ART protocols in relation to pregnancy rates, attention is needed towards monitoring adverse neonatal outcomes in these pregnancies.


Assuntos
Transferência Embrionária/efeitos adversos , Transferência Embrionária/métodos , Fertilização , Retardo do Crescimento Fetal/etiologia , Infertilidade/terapia , Nascimento Prematuro/etiologia , Técnicas de Reprodução Assistida , Estudos de Coortes , Criopreservação , Feminino , Retardo do Crescimento Fetal/epidemiologia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Gravidez , Resultado da Gravidez , Taxa de Gravidez , Nascimento Prematuro/epidemiologia , Resultado do Tratamento
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