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1.
Medicine (Baltimore) ; 98(49): e18183, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804336

RESUMO

RATIONALE: The recently increased rate of heterotopic pregnancies (HPs) has been largely attributed to the increased use of assisted reproduction technologies (ARTs). HP is a rare and potentially life-threatening condition. It is unusual in natural conception cycles, occurring in 1:10,000 to 1:50,000 pregnancies. However, with the increased use of ART such as in vitro fertilization and embryo transfer (IVF-ET), the incidence has risen to 0.5-1%. PATIENT CONCERNS: Case 1 was a 28-year-old woman who presented to our center complaining of a sudden onset of right-side lower abdominal pain with a small amount of vaginal bleeding. She had undergone IVF-ET and received a thawed embryo transfer with two embryos 23 days previously. She had a history of right salpingectomy for an ectopic pregnancy during the downregulation of her ovulatory cycle 1 year ago. Case 2 was a 25-year-old woman who presented to our center complaining of a sudden onset of right-side lower abdominal pain. She had also undergone thawed embryo transfer following IVF-ET with two embryos 35 days previously. She had a history of right salpingectomy for an ectopic pregnancy 1.5 years previously. DIAGNOSES: Both patients were diagnosed as having a heterotopic pregnancy. INTERVENTIONS: Patient 1 underwent emergency laparoscopy; patient 2 underwent emergency laparotomy and both were treated medically to prevent abortion of the intrauterine pregnancies. OUTCOMES: Patient 1 had an incomplete abortion and underwent uterine curettage on the day 10 after the operation. Patient 2 experienced no further complications during pregnancy and a healthy baby girl was born at the 38th gestational week. LESSONS: Reproductive physicians need to pay more attention to patients who have received more than one embryo at transfer, especially those with a history of salpingectomy.


Assuntos
Transferência Embrionária/efeitos adversos , Fertilização In Vitro/efeitos adversos , Gravidez Heterotópica/etiologia , Adulto , Feminino , Humanos , Gravidez , Gravidez Heterotópica/cirurgia , Salpingectomia
2.
JAMA ; 322(22): 2203-2210, 2019 12 10.
Artigo em Inglês | MEDLINE | ID: mdl-31821431

RESUMO

Importance: An increasing number of children worldwide are born after the use of fertility treatment, although it remains unclear whether the treatment affects the risk of childhood cancer and whether any associations observed are due to the use of specific drugs, the use of specific procedures, or the underlying infertility. Objective: To examine the association between different types of fertility treatments and cancer risk in children. Design, Setting, and Participants: A retrospective cohort study based on Danish population-based registry data and the Danish Infertility Cohort (individual record linkage) that included 1 085 172 children born in Denmark between January 1, 1996, and December 31, 2012, linked with parental information. There were a total of 2217 children diagnosed with cancer (follow-up occurred during 1996-2015). Exposures: Maternal fertility treatment during the index pregnancy, including the use of fertility drugs (clomiphene [n = 33 835], gonadotropins [n = 57 136], gonadotropin-releasing hormone analogs [n = 38 653], human chorionic gonadotropin [n = 68 181], progesterone [n = 41 628], and estrogen [n = 16 948]) and assisted reproductive technology (in vitro fertilization [n = 19 448], intracytoplasmic sperm injection [n = 13 417], and frozen embryo transfer [n = 3356]). Each exposure was examined separately and compared with children born to fertile women. Main Outcomes and Measures: Hazard ratios and incidence rate differences for childhood cancer. Results: After 12.2 million person-years of follow-up (mean, 11.3 years), the incidence rate of childhood cancer was 17.5 per 100 000 for children born to fertile women (n = 910 291) and 44.4 per 100 000 for children born after the use of frozen embryo transfer (n = 3356). Compared with children born to fertile women, the use of frozen embryo transfer was associated with an elevated risk of childhood cancer (14 cancer cases; hazard ratio, 2.43 [95% CI, 1.44 to 4.11]; incidence rate difference, 26.9 [95% CI, 2.8 to 51.0] per 100 000), mainly due to an increased risk of leukemia (5 cancer cases; incidence rate, 14.4 per 100 000; hazard ratio, 2.87 [95% CI, 1.19 to 6.93]; incidence rate difference, 10.1 [95% CI, -4.0 to 24.2] per 100 000) and sympathetic nervous system tumors (<5 cancer cases; hazard ratio, 7.82 [95% CI, 2.47 to 24.70]). There were no statistically significant associations with the use of the other types of fertility treatment examined. Conclusions and Relevance: Among children born in Denmark, the use of frozen embryo transfer, compared with children born to fertile women, was associated with a small but statistically significant increased risk of childhood cancer; this association was not found for the use of other types of fertility treatment examined.


Assuntos
Transferência Embrionária/efeitos adversos , Neoplasias/etiologia , Técnicas de Reprodução Assistida , Adulto , Criança , Estudos de Coortes , Dinamarca/epidemiologia , Feminino , Fármacos para a Fertilidade Feminina/efeitos adversos , Fertilização In Vitro , Humanos , Incidência , Masculino , Neoplasias/epidemiologia , Gravidez , Técnicas de Reprodução Assistida/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos , Injeções de Esperma Intracitoplásmicas
3.
Medicine (Baltimore) ; 98(48): e18182, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770271

RESUMO

RATIONALE: Rupture of an unscarred uterus after in vitro fertilization-embryo transfer (IVF-ET) in a primiparous woman is rare. Assisted reproductive technology (ART)-induced rupture of an unscarred uterus is usually attributable to increased dizygotic twinning rates. Salpingectomy can result in cornual scarring and increase the risk of uterine rupture as well as the mortality rate in a subsequent ectopic pregnancy. Here, we present the first reported case of a spontaneous, third-trimester, uterine rupture in a primiparous woman after IVF-ET due to a history of bilateral salpingectomy because of bilateral oviduct and ovarian cysts; the patient did not have an ectopic pregnancy or any cornual or other uterine scarring during this pregnancy after IVF-ET. PATIENT CONCERNS: A 24-year-old woman with a history of IVF-ET and bilateral salpingectomy was admitted to our hospital with unexplained acute upper abdominal pain during the third trimester. DIAGNOSIS: The fetal heart rate was abnormal. Abdominal ultrasonography was negative. Computed tomography revealed a small amount of abdominal and pericardial effusion. Laboratory tests revealed increased white blood cells. A diagnosis of pregnancy complicated by acute abdomen was considered. Emergent exploratory laparotomy revealed a uterine rupture at the right fundus adjacent to the right cornual area. INTERVENTIONS: The patient was successfully managed with simultaneous exploratory laparotomy and lower-segment cesarean section. The rupture site was repaired. OUTCOMES: Two live infants were uneventfully delivered. Follow-up assessments of the mother and the female baby on the 42nd postpartum day yielded normal results. The male infant was diagnosed with left hydronephrosis and required an operation. LESSONS: We conclude that the ART-associated increase in dizygotic twinning rates may be a neglected risk factor for spontaneous rupture of the unscarred uterus, especially in patients who have undergone salpingectomy. Uterine rupture should be considered in a patient with multiple pregnancy following IVF-ET who presents with acute abdominal pain and abnormal fetal heart rate. Timely exploratory laparotomy is the key to a good prognosis.


Assuntos
Dor Abdominal , Cesárea/métodos , Transferência Embrionária , Fertilização In Vitro , Frequência Cardíaca Fetal , Ruptura Espontânea , Ruptura Uterina , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Transferência Embrionária/efeitos adversos , Transferência Embrionária/métodos , Feminino , Fertilização In Vitro/efeitos adversos , Fertilização In Vitro/métodos , Monitorização Fetal/métodos , Humanos , Gravidez , Resultado da Gravidez , Terceiro Trimestre da Gravidez , Gravidez de Gêmeos , Fatores de Risco , Ruptura Espontânea/diagnóstico , Ruptura Espontânea/etiologia , Ruptura Espontânea/cirurgia , Salpingectomia/efeitos adversos , Ruptura Uterina/diagnóstico , Ruptura Uterina/etiologia , Ruptura Uterina/cirurgia , Adulto Jovem
4.
Life Sci ; 234: 116792, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31465733

RESUMO

AIMS: Assisted reproductive technologies (ART) have been widely used to treat infertility, which may impact on fetuses and offspring. This study investigated the effects of in vitro fertilization-embryo transfer (IVF-ET) on angiotensin II (AII)-mediated vasoconstrictions in umbilical cord vein, and explored possible reprogrammed methylation mechanism. MATERIALS AND METHODS: Human umbilical cords were randomly divided into ordinary pregnancy and IVF-ET pregnancy. Vascular studies with AII as well as its specific receptor antagonists losartan and PD123,319 were conducted. Real-time quantitative PCR, Western blotting, and methylation analysis by bisulfite sequencing were performed with the cord vessel samples. KEY FINDINGS: In IVF-ET group, the maximal response to AII in umbilical vessels was significantly greater than that in the ordinary pregnancy. Using losartan and PD123,319, angiotensin receptor subtype 1 (AT1R) was found mainly responsible for the enhanced contraction in the umbilical vein of IVF-ET pregnancy. Decreased mRNA expression of DNMT3A was found in umbilical vein of IVF-ET group. Hypomethylation of the AGTR1 gene (gene encoding AT1R) in the umbilical veins of the IVF group was found. The data suggested that the IVF-ET treatments altered AII-mediated vasoconstrictions in umbilical veins, which could be partially attributed to the increased expression of AT1R. SIGNIFICANCE: The hypo-methylation of the AGTR1 gene caused by IVF-ET might play important roles in altered vasoconstrictions, impacting on cardiovascular systems in the long run.


Assuntos
Angiotensina II/metabolismo , Metilação de DNA , Transferência Embrionária/métodos , Fertilização In Vitro/métodos , Receptor Tipo 1 de Angiotensina/genética , Cordão Umbilical/irrigação sanguínea , Vasoconstrição , Bloqueadores do Receptor Tipo 1 de Angiotensina II/farmacologia , Bloqueadores do Receptor Tipo 2 de Angiotensina II/farmacologia , Anti-Hipertensivos/farmacologia , Transferência Embrionária/efeitos adversos , Feminino , Fertilização In Vitro/efeitos adversos , Humanos , Imidazóis/farmacologia , Losartan/farmacologia , Gravidez , Piridinas/farmacologia , Vasoconstrição/efeitos dos fármacos , Vasoconstritores/farmacologia
5.
Fertil Steril ; 112(1): 89-97.e1, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31277770

RESUMO

OBJECTIVE: To evaluate whether intrauterine injection of hCG before embryo transfer can improve IVF-ET outcomes. DESIGN: Meta-analysis. SETTING: Not applicable. PATIENT(S): Infertile women who underwent IVF-ET and received an intrauterine injection of hCG before ET. INTERVENTION(S): Infertile women treated with or without intrauterine hCG injection before ET. MAIN OUTCOME MEASURE(S): The primary outcomes were live birth rate (LBR), ongoing pregnancy rate (OPR), and clinical pregnancy rate (CPR), and the secondary outcomes were implantation rate (IR) and miscarriage rate (MR). Odds ratios with 95% confidence intervals (CIs) and successful ET rates were pooled to determine the effects of hCG on IVF-ET outcomes. RESULT(S): Fifteen randomized controlled trials (RCTs) with a total of 2,763 participants were included. Infertile women in the experimental group (treated with intrauterine hCG injection before ET) exhibited significantly higher LBR (44.89% vs. 29.76%), OPR (48.09% vs. 33.42%), CPR (47.80% vs. 32.78%), and IR (31.64% vs. 22.52%) than those in the control group (intrauterine injection of placebo or no injection). Furthermore, MR was significantly lower (12.45% vs. 18.56%) in the experimental group than in the control group. CONCLUSION(S): The findings of this meta-analysis indicate that intrauterine injection of hCG can improve LBR, OPR, CPR, and IR after IVF-ET cycles. In addition, different timing and dosages of hCG administration may exert different effects on IVT-ET outcomes. Notably, infertile women treated with 500 IU hCG within 15 minutes before ET can achieve optimal IVF-ET outcomes.


Assuntos
Gonadotropina Coriônica/administração & dosagem , Transferência Embrionária , Fármacos para a Fertilidade Feminina/administração & dosagem , Fertilização In Vitro , Infertilidade Feminina/terapia , Gonadotropina Coriônica/efeitos adversos , Implantação do Embrião/efeitos dos fármacos , Transferência Embrionária/efeitos adversos , Feminino , Fertilidade/efeitos dos fármacos , Fármacos para a Fertilidade Feminina/efeitos adversos , Fertilização In Vitro/efeitos adversos , Humanos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/fisiopatologia , Injeções , Nascimento Vivo , Gravidez , Complicações na Gravidez/etiologia , Taxa de Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Resultado do Tratamento
6.
Taiwan J Obstet Gynecol ; 58(4): 471-476, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31307735

RESUMO

OBJECTIVE: To study the impact of stimulation duration on intracytoplasmic sperm injection (ICSI) - embryo transfer (ET) outcome in poor and normal responders during controlled ovarian stimulation using gonadotropin-releasing hormone (GnRH) antagonist protocol. MATERIALS AND METHODS: This is a retrospective cohort study. There were 1481 women undergoing ICSI-ET cycles. Women with ovum pick-up number ≤3 were defined as poor responders (n = 235), and those with a number ≥4 were normal responders (n = 1246). RESULTS: The mean stimulation duration was shorter in poor responders with pregnancy group as compared with normal responders with pregnancy group (7.8 ± 2.2 vs. 9.2 ± 1.6 days, p < 0.01). Poor responders with a shortest stimulation duration (≤6 days) appeared a higher live birth rate (≤6 days: 33.3%, 7-8 days: 20.0%, 9-10 days: 15.9%, and ≥11 days: 11.1%, p = 0.18). Normal responders with a shortest stimulation duration (≤6 days) appeared a lowest live birth rate (≤6 days: 28.6%, 7-8 days: 35.8%, 9-10 days: 33.6%, and ≥11 days: 29.3%, p = 0.61). Oocyte maturation rate was significantly lower at stimulation durations ≤6 days group (≤6 days: 67%, 7-8 days: 80%, 9-10 days: 85%, and ≥11 days: 87%, p = 0.02) in normal responders. CONCLUSION: In ICSI-ET cycles, stimulation duration appears to have different impact on oocyte maturation, clinical pregnancy rates and live birth rates in both poor and normal responders.


Assuntos
Transferência Embrionária/métodos , Hormônio Liberador de Gonadotropina/antagonistas & inibidores , Ciclo Menstrual/efeitos dos fármacos , Indução da Ovulação/métodos , Taxa de Gravidez , Adulto , Estudos de Coortes , Transferência Embrionária/efeitos adversos , Feminino , Fertilização In Vitro/efeitos adversos , Fertilização In Vitro/métodos , Seguimentos , Hormônio Liberador de Gonadotropina/administração & dosagem , Hospitais Universitários , Humanos , Ciclo Menstrual/fisiologia , Recuperação de Oócitos/métodos , Oócitos/efeitos dos fármacos , Gravidez , Valores de Referência , Estudos Retrospectivos , Medição de Risco , Taiwan , Fatores de Tempo
7.
Taiwan J Obstet Gynecol ; 58(4): 487-491, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31307738

RESUMO

OBJECTIVE: Despite the great advance of assisted reproductive technology (ART) in recent decades, many IVF patients failed to achieve a pregnancy even after multiple IVF-ET attempts. These patients are considered to have repeated implantation failure (RIF). While exhausting efforts have been devoted to the improvement of pregnancy rate in RIF patients, it is not clear whether RIF patients have aberrant obstetric or perinatal outcomes after they eventually achieved a pregnancy. MATERIALS AND METHODS: Taking advantage of a relatively large database of IVF-ET cycles at the Chang Gung Memorial Hospital, we compared obstetric and perinatal outcomes of RIF patients who have a successful pregnancy after IVF-ET treatment(s) to those of control IVF-ET patients. RESULTS: Because multiple pregnancies are associated with a high risk of obstetric complications, we restricted the analysis to patients who had singleton pregnancies. Analysis of a total of 596 control and 46 RIF cases showed the rates of almost all obstetric and perinatal outcomes investigated are not different between the two groups. However, the rate of placental abruption in the RIF group (4.35%) appeared to be significantly higher than that of controls (0.50%; OR = 8.99). This difference is still statistically significant after adjustment with the age (adjusted OR = 8.2). CONCLUSION: While the rates of a spectrum of obstetric and perinatal outcomes are normal in RIF patients, these patients could have an enhanced risk of placental abruption. However, investigations with a large sample size are needed to substantiate this inference.


Assuntos
Transferência Embrionária/efeitos adversos , Transferência Embrionária/estatística & dados numéricos , Resultado da Gravidez , Taxa de Gravidez , Falha de Tratamento , Adulto , Estudos de Coortes , Bases de Dados Factuais , Feminino , Fertilização In Vitro/efeitos adversos , Fertilização In Vitro/métodos , Humanos , Incidência , Gravidez , Retratamento , Estudos Retrospectivos , Medição de Risco , Taiwan , Adulto Jovem
8.
BMC Pregnancy Childbirth ; 19(1): 192, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31159759

RESUMO

BACKGROUND: Children born after intracytoplasmic sperm injection (ICSI) are at increased risk of specific major birth defects compared with children born after in vitro fertilization (IVF). However, whether this risk is due to the treatment itself (i.e., IVF or ICSI) or underlying male subfertility is unknown. This study investigated the associations between male subfertility and the risk of major birth defects in children born after IVF and ICSI. METHODS: We conducted a retrospective cohort study using data from the Japanese assisted reproductive technology registry between 2007 and 2014. Fresh embryo transfer cycles registered from 2007 to 2014 that resulted in singleton live births, still births, or selective terminations were included (n = 59,971). Major birth defects were defined by the US Centers for Disease Control and Prevention guidelines, excluding chromosomal abnormalities. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using generalized estimating equations adjusting for potential confounders. RESULTS: Major birth defects were reported in 626/59,971 (1.04%) cases. Among IVF cycles, male subfertility was associated with significantly greater risks of hypospadias (3/3163 [0.09%] vs 4/28,671 [0.01%], adjusted OR = 6.85, 95% CI 2.05-22.9, P = 0.002) and atrial septal defects (4/3163 [0.13%] vs 9/28,671 [0.03%], adjusted OR = 3.98, 95% CI 1.12-14.1, P = 0.03) compared with fertile men. Subgroup analysis using sperm parameters showed that oligozoospermia (i.e., sperm concentrations < 15 million/mL) was significantly associated with a greater risk of ventricular septal defects compared with normal sperm concentrations in IVF pregnancies (5/868 [0.58%] vs 60/28,090 [0.21%], adjusted OR = 2.68, 95% CI 1.15-6.27, P = 0.02), and severe oligozoospermia (i.e., sperm concentrations < 5 million/mL) was significantly associated with an increased risk of hypospadias compared with normal sperm concentrations in ICSI pregnancies (5/3136 [0.16%] vs 5/16,865 [0.03%], adjusted OR = 3.88, 95% CI 1.14-13.2, P = 0.03). CONCLUSIONS: The results of this exploratory study suggest that underlying male subfertility may play a role in the risk of major birth defects related to ICSI and IVF. Further research, including systematic reviews adjusting for confounders, is required to confirm the associations between male subfertility and major cardiac and urogenital birth defects.


Assuntos
Anormalidades Congênitas/etiologia , Transferência Embrionária/efeitos adversos , Fertilização In Vitro/efeitos adversos , Infertilidade Masculina/complicações , Injeções de Esperma Intracitoplásmicas/efeitos adversos , Adulto , Feminino , Humanos , Recém-Nascido , Masculino , Razão de Chances , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Fatores de Risco
9.
Fertil Steril ; 112(1): 82-88, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31056308

RESUMO

OBJECTIVE: To investigate whether blastocyst biopsy in preimplantation genetic testing (PGT) increases the risk of adverse neonatal outcomes. DESIGN: Retrospective cohort study. SETTING: University-affiliated center. PATIENTS: Live births after blastocyst biopsy combined with frozen ET (PGT group) and frozen blastocyst transfer after in vitro fertilization or intracytoplasmic sperm injection (control group). INTERVENTION(S): Blastocyst biopsy. MAIN OUTCOME MEASURE(S): Gestational age (GA), birth weight (BW), and rates of preterm birth (PB), very preterm birth (VPB), extreme preterm birth (EPB), low birth weight (LBW), very low birth weight (VLBW), and macrosomia. RESULT(S): No significant differences were observed in the sex ratio, GA, PB, VPB, EPB, BW, or rates of LBW, VLBW, and macrosomia between the PGT and control groups for either singletons or twins. However, the cesarean section rate of the PGT group was significantly higher than that of the control group for twins (adjusted odds ratio, 2.383 [1.079, 5.259]). Regarding fluorescence in situ hybridization-PGT neonates, neonatal outcomes, including GA, BW, and rates of PB, VPB, LBW, and VLBW, did not differ between the different groups of biopsied cells (≥10 group and <10 group) for either the grade B or grade C trophectoderm score subgroups; however, in the grade B trophectoderm score subgroup, the rate of boy babies in the ≥10 group was significantly higher than that in the <10 group (83.3% vs. 40.9%). The association between the number of biopsied cells and GA/BW was not statistically significant. CONCLUSION(S): Blastocyst biopsy may not add additional risk to neonatal outcomes when compared with a control group.


Assuntos
Blastocisto/patologia , Transferência Embrionária , Fertilização In Vitro , Testes Genéticos , Diagnóstico Pré-Implantação/métodos , Adulto , Biópsia/efeitos adversos , Peso ao Nascer , Transferência Embrionária/efeitos adversos , Feminino , Fertilização In Vitro/efeitos adversos , Idade Gestacional , Humanos , Hibridização in Situ Fluorescente , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Nascimento Vivo , Valor Preditivo dos Testes , Gravidez , Nascimento Prematuro/etiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Injeções de Esperma Intracitoplásmicas , Resultado do Tratamento
10.
Fertil Steril ; 112(1): 98-104, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31133384

RESUMO

OBJECTIVE: To compare the influence of dual suppression with the use of GnRH agonist plus aromatase inhibitor compared with suppression with the use of GnRH agonist alone or no suppression at all in patients with idiopathic recurrent implantation failure (RIF). DESIGN: Retrospective cohort study. SETTING: University-affiliated reproductive center. PATIENT(S): A total of 523 infertile women who failed two blastocyst transfers underwent a third frozen blastocyst transfer. Women with known endometriosis were excluded. INTERVENTION(S): A total of 204 subjects were not pretreated, 143 received 2 months of GnRH agonist (3.75 mg intramuscular leuprolide acetate monthly) only, and 176 received GnRH agonist and aromatase inhibitor (5 mg oral letrozole daily for 60 days). Demographic and stimulation information was collected and cycle outcomes reported. MAIN OUTCOME MEASURE(S): Clinical pregnancy rates. RESULT(S): Age, antral follicle count, basal FSH levels, duration of infertility, previous pregnancies, and full-term deliveries were similar (P>.05). Clinical pregnancy rates were higher among women who received GnRH agonist plus letrozole compared with women who received GnRH agonist only or women without pretreatment (63%, 42%, and 40%, respectively; P<.0001). Live birth rates were higher among women who received GnRH agonist plus letrozole compared with the other groups (56%, 36%, and 34%; P<.0001). No differences in pregnancy outcomes were noted between patients who did not receive pretreatment and those in the GnRH agonist only group. CONCLUSION(S): In patients with RIF, treatment with a GnRH agonist plus letrozole may improve live birth rates in subsequent cycles. We hypothesize that this improvement is due to alterations in the endometrium receptivity or treatment of undiagnosed endometriosis.


Assuntos
Inibidores da Aromatase/uso terapêutico , Implantação do Embrião/efeitos dos fármacos , Transferência Embrionária , Fármacos para a Fertilidade Feminina/uso terapêutico , Fertilização In Vitro , Hormônio Liberador de Gonadotropina/agonistas , Infertilidade Feminina/terapia , Letrozol/uso terapêutico , Leuprolida/uso terapêutico , Adulto , Inibidores da Aromatase/efeitos adversos , Quimioterapia Combinada , Transferência Embrionária/efeitos adversos , Feminino , Fertilidade/efeitos dos fármacos , Fármacos para a Fertilidade Feminina/efeitos adversos , Fertilização In Vitro/efeitos adversos , Humanos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/fisiopatologia , Letrozol/efeitos adversos , Leuprolida/efeitos adversos , Nascimento Vivo , Gravidez , Taxa de Gravidez , Estudos Retrospectivos , Fatores de Risco , Falha de Tratamento
12.
Fertil Steril ; 111(6): 1145-1150, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30955846

RESUMO

OBJECTIVE: To describe the relationship between interpregnancy interval (IPI) and perinatal outcomes in singleton live births after frozen embryo transfer (FET). DESIGN: Retrospective analysis of the Society for Assisted Reproductive Technology Clinical Outcome Reporting System cohort including patients with a history of live birth from ART who returned for an FET cycle between 2004 and 2013. SETTING: Not applicable. PATIENT(S): A total of 19,270 singleton live births from FET subsequent to a live birth. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Odds for preterm delivery (<37, <34, <28 weeks) and low birth weight (<2,500, <1,500 g) adjusted for age, body mass index, and history of prior preterm delivery. RESULT(S): Of 74,456 autologous FET cycles following an index live birth, 24,091 resulted in a repeat live birth, with 19,270 singleton live births. An IPI of <12 months occurred in 19% of cycles. Adjusted odds (aORs) for preterm delivery at <37 weeks were significantly increased for an IPI of <6 months (aOR 2.05, 95% confidence interval [CI] 1.48-2.84), 6 to <12 months (aOR 1.26, 95% CI 1.06-1.49), and 18 to <24 months (aOR 1.23, 95% CI 1.06-1.43) when compared with the reference interval of 12 to <18 months. Additionally, an IPI of <6 months was associated with increased odds for low birth weight (aOR 3.06, 95% CI 2.07-4.52) and very low birth weight (aOR 5.65, 95% CI 2.96-10.84) compared with an IPI of 12 to <18 months. CONCLUSION(S): In this nationally representative population, an interval from delivery to start of an FET cycle of <12 months is associated with increased odds for preterm delivery among singleton live births. Consistent with data for patients undergoing fresh IVF, the data support delaying FET 12 months from a live birth.


Assuntos
Criopreservação , Transferência Embrionária , Fertilização In Vitro , Infertilidade/terapia , Tempo para o Tratamento , Adulto , Peso ao Nascer , Bases de Dados Factuais , Transferência Embrionária/efeitos adversos , Feminino , Fertilidade , Fertilização In Vitro/efeitos adversos , Idade Gestacional , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Infertilidade/diagnóstico , Infertilidade/fisiopatologia , Nascimento Vivo , Paridade , Gravidez , Taxa de Gravidez , Nascimento Prematuro/etiologia , Nascimento Prematuro/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Tempo para Engravidar , Resultado do Tratamento
13.
Fertil Steril ; 111(6): 1159-1168.e1, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30982605

RESUMO

OBJECTIVE: To determine whether blastomere spatial arrangement in early human embryos is reflective of embryonic potential. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Single academic center. PATIENT(S): Patients undergoing a single blastocyst transfer. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Developmental kinetics, blastocyst quality, embryo dysmorphisms, and live birth rate. RESULT(S): A total of 716 embryos were examined in detail for cleavage plane orientation, blastomere arrangement, and morphokinetic behavior. Tetrahedral (TET) and nontetrahedral embryos (nTET) differed significantly in developmental kinetics. The frequency of dysmorphisms, multinucleation, and irregular chaotic division was higher in nTET embryos. Only 44% of nTET versus 62.9% of TET embryos were scored as top-quality blastocysts. After adjusting for age, our data indicated that having TET embryos significantly increased the odds of having a blastocyst for cryopreservation/transfer (odds ratio, 3.58; confidence interval, 2.42-5.28) when compared with nTET. A total of 164 fresh single ETs were performed with blastocyst-stage embryos. The implantation rate for TET- and nTET-derived blastocysts were similar (64.7% and 62%, respectively). The live birth rate was 55% in both groups. A meridonal first division was noted in 85% of the fresh SET blastocysts. CONCLUSION(S): Cleavage plane orientation during the first three divisions appeared to dictate final blastomere spatial arrangement. The TET formation at the four-cell stage was predictive for embryos most likely to develop into good-quality blastocysts for cryopreservation/transfer. Morphokinetic markers of embryo potential were significantly different between TET and nTET embryos.


Assuntos
Blastômeros/patologia , Criopreservação , Transferência Embrionária , Infertilidade/terapia , Microscopia de Vídeo , Imagem com Lapso de Tempo/métodos , Adulto , Transferência Embrionária/efeitos adversos , Desenvolvimento Embrionário , Feminino , Fertilidade , Humanos , Infertilidade/diagnóstico , Infertilidade/fisiopatologia , Cinética , Nascimento Vivo , Gravidez , Taxa de Gravidez , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento
14.
J Assist Reprod Genet ; 36(5): 925-933, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30924053

RESUMO

PURPOSE: This study aimed to clarify the risks of adverse pregnancy outcomes in patients and their offspring after frozen embryo transfer (FET) during an artificial cycle (AC). METHODS: We conducted a retrospective cohort study that included all FET cycles and subsequent deliveries in a single centre between August 2013 and March 2016. Pregnancy, obstetric and neonatal outcomes were compared among patients treated during an AC or a natural cycle with luteal phase support (NC-LPS). Multivariate logistic regression was performed to evaluate the relationship between endometrial preparation schemes and pregnancy, obstetric and neonatal outcomes. RESULTS: AC-FET was not a significant risk factor for clinical pregnancy rate, multiple birth rate or miscarriage rate after adjusting for potential confounders. However, AC-FET was a significant risk factor for ectopic pregnancy rate (adjusted odds ratio (AOR), 1.738; 95% confidence interval (CI), 1.086-2.781) and live birth rate (AOR, 0.709; 95% CI, 0.626-0.802). Regarding obstetric outcomes, AC-FET was found to be associated with an increased risk for hypertension disorder (AOR, 1.780; 95% CI, 1.262-2.510) and caesarean section (AOR, 1.507; 95% CI, 1.195-1.900). In multiples, birth weight (2550 g (2150-2900 g) in AC-FET vs. 2600 g (2350-2900 g) in NC-LPS; P = 0.023), gestational age (36.6 weeks (35.3-37.6 weeks) vs. 37.1 weeks (36.1-37.9 weeks); P < 0.001), and z-score (- 0.5 (- 1.1, - 0.0) vs. - 0.4 (- 1.0, 0.2); P = 0.009) were higher in the NC-LPS group than in the AC-FET group, although there were no differences in these variables among singletons. CONCLUSION: Compared with NC-LPS, AC-FET seemed to have a negative effect on obstetric outcomes.


Assuntos
Cesárea/estatística & dados numéricos , Criopreservação/métodos , Transferência Embrionária/efeitos adversos , Fertilização In Vitro/métodos , Complicações na Gravidez/etiologia , Taxa de Gravidez , Nascimento Prematuro/etiologia , Adulto , Feminino , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Estudos Retrospectivos
15.
Taiwan J Obstet Gynecol ; 58(2): 239-243, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30910146

RESUMO

OBJECTIVE: The primary objective of this study was to investigate whether preimplantation genetic testing for aneuploidy (PGT-A) of blastocysts through array comparative genomic hybridization (aCGH) improves live birth rates (LBR) in IVF cycles for patients with high prevalence of aneuploidy. MATERIALS AND METHODS: This study included 1389 blastocysts with aCGH results derived from 296 PGT-A cycles in IVF patients with advanced maternal age (AMA) (n = 87, group A), those with repeated implantation failure (RIF) (n = 82, group B), those with recurrent miscarriage (RM) (n = 82, group C), and oocyte donors (OD) (n = 45, young age, as a control group). Another 61 AMA patients without PGT-A procedures were used as a control group for group A. Vitrification was performed after blastocyst biopsy, and thawed euploid embryos were transferred in a nonstimulated cycle. RESULTS: For the AMA group, a significant increase in LBRs was found in the PGT-A group compared with the non-PGT-A group (54.1% vs. 32.8%, p = 0.018). Consistent LBRs (54.1%, 51.6%, 55.9%, and 57.1%, respectively, in group A, B, C, and young age group) were obtained for all the indications. CONCLUSIONS: LBRs can be improved using PGT-A of blastocysts with aCGH in IVF cycles for patients with a high rate of aneuploidy, especially for patients with AMA.


Assuntos
Aneuploidia , Coeficiente de Natalidade , Fertilização In Vitro/métodos , Testes Genéticos/métodos , Diagnóstico Pré-Implantação/métodos , Aborto Habitual/genética , Adulto , Estudos de Casos e Controles , Hibridização Genômica Comparativa , Transferência Embrionária/efeitos adversos , Transferência Embrionária/métodos , Transferência Embrionária/estatística & dados numéricos , Feminino , Fertilização In Vitro/estatística & dados numéricos , Humanos , Idade Materna , Gravidez , Estudos Retrospectivos , Falha de Tratamento
16.
Fertil Steril ; 111(4): 747-752, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30826114

RESUMO

OBJECTIVE: To compare the efficacy and safety of blastocyst transfer derived from small follicles (SF; ≤10 mm) and large follicles (LF; ≥11 mm). DESIGN: Retrospective cohort study. SETTING: Private clinic. PATIENT(S): Patients (n = 1,072) 30-40 years old who underwent blastocyst transfer (BT; n = 1,247) between January 2012 and December 2014. INTERVENTION(S): Oocytes retrieved during a modified natural cycle from both LF and SF were fertilized by a conventional method or intracytoplasmic sperm injection. The blastocysts were frozen, thawed, and transferred one by one in the following spontaneous ovulatory cycles or hormone replacement cycles. MAIN OUTCOME MEASURE(S): BT resulted in live births and major congenital anomalies. RESULT(S): SF-derived BTs (n = 597) yielded 55 chemical abortions (9.2%), 73 clinical abortions (12.2%), and 261 live births (43.8%), whereas LF-derived BTs (n = 650) yielded 71 chemical abortions (10.9%), 73 clinical abortions (11.2%), and 311 live births (47.9%). These incidences were not statistically different between SF- and LF-derived BTs. The incidence of abnormal karyotypes was also not statistically different between SF- and LF-derived spontaneous abortions (71% [39/55] vs. 72% [40/55], respectively). The incidence of major congenital anomalies in neonates did not differ between SF- and LF-derived pregnancies (1.5% and 1.3%, respectively; relative risk = 1.10, 95% confidence interval [0.55-3.21]). CONCLUSION(S): SF-derived BT is as efficacious and safe as LF-derived BT.


Assuntos
Transferência Embrionária/métodos , Transferência Embrionária/estatística & dados numéricos , Fertilização In Vitro/métodos , Folículo Ovariano/citologia , Resultado da Gravidez/epidemiologia , Adulto , Tamanho Celular , Anormalidades Congênitas/epidemiologia , Anormalidades Congênitas/etiologia , Transferência Embrionária/efeitos adversos , Feminino , Fertilização In Vitro/efeitos adversos , Fertilização In Vitro/estatística & dados numéricos , Humanos , Recém-Nascido , Infertilidade/epidemiologia , Infertilidade/terapia , Nascimento Vivo/epidemiologia , Ciclo Menstrual/fisiologia , Gravidez , Estudos Retrospectivos
17.
Fertil Steril ; 111(4): 714-721, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30826115

RESUMO

OBJECTIVES: To evaluate the association of fresh and frozen embryo transfer with the development of ischemic placental disease (IPD), hypothesizing that differences in implantation environment affect placentation and thus pregnancy outcomes. DESIGN: We performed a secondary analysis of a retrospective cohort study of deliveries linked to IVF cycles. SETTING: Tertiary hospital and infertility treatment center. PATIENT(S): We included all women who underwent an autologous IVF cycle and had a live-born infant or an intrauterine fetal demise (IUFD). We excluded women less than 18 years of age. INTERVENTION(S): We compared pregnancies resulting from frozen embryo transfer (frozen) cycles with those resulting from fresh embryo transfer (fresh) cycles. MAIN OUTCOME MEASURE(S): The primary outcome was a composite outcome of IPD or IUFD due to placental insufficiency. Ischemic placental disease included pre-eclampsia, placental abruption, and small for gestational age (SGA). We calculated risk ratios (RRs) and 95% confidence intervals (CIs). RESULT(S): Compared with fresh cycles, frozen cycles had a lower risk of IPD or IUFD from placental insufficiency (RR 0.75, 95% CI 0.59-0.97). Frozen cycles also conferred a lower risk of SGA than fresh cycles (RR 0.58, 95% CI 0.41-0.81). Risks of pre-eclampsia (RR 1.3, 95% CI 0.84-1.9) and abruption (RR 1.2, 95% CI 0.56-2.4) were similar. CONCLUSION(S): There was a lower risk of IPD among frozen cycles compared with fresh cycles. This association was largely driven by lower risk of SGA among frozen cycles.


Assuntos
Transferência Embrionária/métodos , Isquemia/etiologia , Doenças Placentárias/epidemiologia , Placenta/irrigação sanguínea , Adulto , Blastocisto , Criopreservação , Transferência Embrionária/efeitos adversos , Feminino , Morte Fetal/etiologia , Congelamento , Humanos , Recém-Nascido , Infertilidade/epidemiologia , Infertilidade/terapia , Isquemia/epidemiologia , Nascimento Vivo/epidemiologia , Masculino , Placenta/patologia , Doenças Placentárias/etiologia , Gravidez , Taxa de Gravidez , Estudos Retrospectivos , Fatores de Risco
18.
Yonsei Med J ; 60(3): 285-290, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30799591

RESUMO

PURPOSE: To elucidate the correlation between ovarian reserve and the incidence of ectopic pregnancy (EP) following in vitro fertilization and embryo transfer (IVF/ET) cycles. MATERIALS AND METHODS: In this observational study, 430 fresh IVF/ET cycles were examined from patient data of two university hospital infertility clinics. All included patients were positive for ß-human chorionic gonadotropin (hCG) at 2 weeks after oocyte retrieval via controlled ovarian stimulation. For each cycle, information on age, duration of infertility, basal follicle stimulating hormone (FSH), anti-Müllerian hormone (AMH), days of ovarian stimulation, numbers of retrieved oocytes and transferred embryos, and pregnancy outcomes was collected. Patients with AMH lower than 1.0 ng/dL or basal FSH higher than 10 mIU/mL were classified into the decreased ovarian reserve (DOR) group, and the remaining patients were classified into the normal ovarian reserve (NOR) group. RESULTS: In total, 355 cycles showed NOR, and 75 cycles DOR. There were no significant differences between the DOR and NOR groups regarding intrauterine (74.7% vs. 83.4%, respectively) or chemical (14.7% vs. 14.1%, respectively) pregnancies. The DOR group had a higher EP than that of NOR group [10.7% (8/75) vs. 2.5% (9/355), p=0.004]. In both univariate [odds ratio (OR) 5.6, 95% confidence interval (CI) 1.4-9.6, p=0.011] and multivariate (adjusted OR 5.1, 95 % CI 1.1-18.7, p=0.012) analysis, DOR was associated with a higher risk of EP. CONCLUSION: DOR may be associated with a higher risk of EP in IVF/ET cycles with controlled ovarian stimulation. More careful monitoring may be necessary for pregnant women with DOR.


Assuntos
Transferência Embrionária/efeitos adversos , Fertilização In Vitro/efeitos adversos , Reserva Ovariana/fisiologia , Gravidez Ectópica/epidemiologia , Gravidez Ectópica/etiologia , Adulto , Feminino , Humanos , Incidência , Modelos Logísticos , Análise Multivariada , Razão de Chances , Gravidez , Resultado da Gravidez , Taxa de Gravidez
20.
Ann Rheum Dis ; 78(3): 328-334, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30636215

RESUMO

OBJECTIVES: No studies have examined the efficacy of assisted reproductive technology (ART) treatment in women with rheumatoid arthritis. Therefore, we examined the chance of live birth after ART treatment in women with rheumatoid arthritis compared with women without rheumatoid arthritis. METHODS: Our cohort study is based on nationwide Danish health registries, comprising all women with an embryo transfer during 1 January 1994 through 30 June 2017. The cohorts comprised 1149 embryo transfers in women with rheumatoid arthritis, and 198 941 embryo transfers in women without rheumatoid arthritis. Our outcome was live birth per embryo transfer, and we controlled for multiple covariates in the analyses. In subanalyses, we examined a chance of biochemical/clinical pregnancy after ART and a possible impact of corticosteroid use prior to embryo transfer. RESULTS: The adjusted OR (aOR) for a live birth per embryo transfer in women with rheumatoid arthritis, relative to women without rheumatoid arthritis, was 0.78 (95% CI 0.65 to 0.92). The aORs for biochemical and clinical pregnancies were 0.81 (95% CI 0.68 to 0.95) and 0.82 (95% CI 0.59 to 1.15), respectively. Corticosteroid prescription prior to embryo transfer increased the OR for live birth (aOR=1.32 (95% CI 0.85 to 2.05)). CONCLUSIONS: The chance of a live birth was significantly reduced in women with rheumatoid arthritis receiving ART treatment, relative to women without rheumatoid arthritis, and our result suggested that the problem was related to an impaired chance of embryo implantation. The role of corticosteroid use prior to embryo transfer must be a subject for further research.


Assuntos
Artrite Reumatoide/complicações , Transferência Embrionária/efeitos adversos , Nascimento Vivo/epidemiologia , Complicações na Gravidez/etiologia , Técnicas de Reprodução Assistida/efeitos adversos , Adulto , Dinamarca/epidemiologia , Feminino , Humanos , Recém-Nascido , Gravidez , Sistema de Registros
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