To investigate the predictive value of endometrial thickness (EMT) for live birth when a lower threshold of EMT is not employed for embryo transfer (ET).
Retrospective study
Academic assisted ...reproduction center
All women who underwent fresh or frozen-thawed ET at the Koç University Hospital Assisted Reproduction Unit between October 2016 and August 2019
After ruling out endometrial pathology, blastocyst transfer was planned regardless of the EMT in the absence of increased serum progesterone level on the trigger day in fresh embryo transfer cycles or before commencing progesterone treatment in artificially prepared frozen-thawed ET cycles.
The primary outcome was live birth. Live birth and miscarriage rates per ET were stratified according to fresh and frozen-thawed ET cycles for each millimeter of endometrial thickness. Receiver operator characteristic curve analyses were performed to evaluate the predictive value of EMT for live birth.
A total of 560 ET cycles, 273 fresh and 287 frozen-thawed, were included in the study. Relevant patient characteristics as well as EMTs were similar between women who achieved a live birth and those who did not after fresh or frozen-thawed ET. There was no linear association between EMT and live birth or miscarriage rates. Area under the curve values for EMT to predict live birth after fresh, frozen-thawed, and all ETs were 0.56, 0.47, and 0.52, respectively.
Our results showed that the EMT was not predictive for live birth in either fresh or frozen-thawed ET cycles. Once intracavitary pathology and inadvertent progesterone exposure were excluded, women with thinner EMTs should not be denied their potential for live birth because it is comparable to that of those with thicker EMT.
El grosor endometrial no es predictivo para nacido vivo después de transferencia embrionaria, incluso sin valor de corte.
Investigar el valor predictivo del grosor endometrial (EMT) para nacido vivo cuando no se aplica un valor de corte inferior para transferencia embrionaria (ET).
Estudio retrospectivo.
Centro universitario de reproducción asistida.
Todas las mujeres que realizaron ET en fresco o criotransferencia en la Unidad de Reproducción Asistida del Hospital Universitario Koc entre Octubre de 2016 y Agosto de 2019.
Tras descartar patología endometrial, se planificó la transferencia de blastocisto independientemente del EMT en ausencia de incremento del nivel sérico de progesterona en el día de la inducción en ciclos de transferencia embrionaria en fresco o antes de iniciar el tratamiento con progesterona en ciclos de ET sustituidos.
El resultado principal fue nacido vivo. Las tasas de nacido vivo y de abortos por ET se estratificaron según los ciclos de ET en fresco o de embriones criopreservados para cada milímetro de grosor endometrial. Se realizaron análisis de curvas ROC para evaluar el valor predictivo del EMT para nacidos vivos.
Se incluyeron en el estudio un total de 560 ciclos de ET, 273 en fresco y 287 de embriones criopreservados. Las características relevantes de los pacientes así como los EMTs fueron similares entre las mujeres que lograron un nacido vivo y aquellas que no lo lograron después de ET en fresco o de embriones criopreservados. No hubo asociación lineal entre EMT y nacido vivo o tasas de aborto. Los valores del área bajo la curva para el EMT para predecir nacido vivo después de transferencia en fresco o de congelados y todas las ETs fueron de 0.56, 0.47 y 0.52 respectivamente.
Nuestros resultados demuestran que el EMT no fue predictivo para nacido vivo ni en ET en fresco ni en ciclos de transferencia de congelados. Una vez descartada la existencia de patología intracavitaria y la exposición inadvertida a progesterona, las mujeres con endometrio más fino no deberían ser descartadas para ET por su probabilidad de nacido vivo porque es comparable al de aquellas con EMT más grueso.
Grosor endometrial, nacido vivo, transferencia embrionaria en fresco, transferencia embrionaria de congelados, fecundación in vitro.
To develop and validate a practical model for quality control monitoring of dichotomous in vitro fertilization (IVF) outcomes such as pregnancy resulting from the transfer of euploid blastocysts.
We ...designed and validated a model for quality control monitoring of dichotomous IVF outcomes. We demonstrate use of this model for assessment of euploid blastocyst transfer quality control based on fetal heartbeat rate per embryo. The model uses 3 weighted moving averages with window sizes of 21, 51, and 101 embryo transfers to detect short and long-term shifts in success rates. The quality warning limit was set to have a 2-sided type I error rate of 0.30 per 100 embryo transfers and the control limit was set to have a type I error rate of 0.05 per 100 embryo transfers. Simulation studies were performed to validate the model through assessment of type I and type II errors using custom computer programs.
Not applicable.
Patients undergoing IVF.
None.
Type I and type II error rates and statistical power analysis.
Validated quality warning and control limits are presented for a range of expected outcome rates. The power to detect a 20% decrease from an expected fetal heartbeat rate of 50%, when the decrease persisted for 50 embryo transfers, was 86% for the warning limit and 57% for the control limit.
This model can be used for continuous quality control assessment of dichotomous IVF outcomes such as pregnancy rates.
Diseño y validación de un modelo de monitorización de control de calidad de resultados dicotómicos en fecundación in vitro.
Desarrollar y validar un modelo práctico de control de calidad para la monitorización de resultados dicotómicos en fecundación in vitro (IVF) como es: gestación resultante de transferencias de blastocistos euploides.
Diseñamos y validamos un modelo para la monitorización del control de calidad de los resultados dicotómicos de IVF. Demostramos el uso de este modelo para evaluar la transferencia de blastocistos euploides basado en la tasa de latido cardíaco fetal por embrión. El modelo utiliza 3 medias móviles ponderadas con tamaños de ventana de 21, 51 y 101 transferencias de embriones, para detectar desplazamientos de las tasas de éxito a corto y largo plazo. El límite de alarma de calidad se puso para tener una tasa de error tipo I de 2 colas de 0.30 por cada 100 transferencias de embriones. Se realizaron estudios de simulación para validar el modelo a través de la valoración de los errores tipo I y tipo II utilizando programas de ordenador a medida.
No aplica.
Pacientes en tratamiento de IVF.
Ninguna.
tasas de errores tipo I y tipo II y análisis de la potencia estadística.
Se presentan unos límites validados de calidad, de alarma y de control, para un rango de tasa de resultados esperado. La potencia para detectar una disminución de un 20% de una tasa esperada de latido cardiaco fetal del 50%, cuando la disminución persistió más allá de 50 transferencias embrionarias, fue del 86% para el límite de alarma y del 57% para el límite de control.
Este modelo puede utilizarse para la evaluación del control de calidad continua de resultados dicotómicos de IVF tales como la tasa de gestación.
To develop an interpretable machine learning model for optimizing the day of trigger in terms of mature oocytes (MII), fertilized oocytes (2PNs), and usable blastocysts.
Retrospective study.
A group ...of three assisted reproductive technology centers in the United States.
Patients undergoing autologous in vitro fertilization cycles from 2014 to 2020 (n = 30,278).
None.
Average number of MII oocytes, 2PNs, and usable blastocysts.
A set of interpretable machine learning models were developed using linear regression with follicle counts and estradiol levels. When using the model to make day-by-day predictions of trigger or continuing stimulation, possible early and late triggers were identified in 48.7% and 13.8% of cycles, respectively. After propensity score matching, patients with early triggers had on average 2.3 fewer MII oocytes, 1.8 fewer 2PNs, and 1.0 fewer usable blastocysts compared with matched patients with on-time triggers, and patients with late triggers had on average 2.7 fewer MII oocytes, 2.0 fewer 2PNs, and 0.7 fewer usable blastocysts compared with matched patients with on-time triggers.
This study demonstrates that it is possible to develop an interpretable machine learning model for optimizing the day of trigger. Using our model has the potential to improve outcomes for many in vitro fertilization patients.
Un modelo de aprendizaje automático interpretable para predecir el día óptimo de trigger durante la estimulación ovárica.
Desarrollar un modelo de aprendizaje automático interpretable para optimizar el día de trigger en términos de ovocitos maduros (MII), ovocitos fertilizados (2PN) y blastocistos utilizables
Estudio retrospectivo.
Un grupo de tres centros de reproducción asistida en los Estados Unidos.
Pacientes que se sometieron a ciclos de fertilización in vitro autóloga de 2014 a 2020 (n = 30.278).
Ninguna.
Número promedio de ovocitos MII, 2PN y blastocistos utilizables
se desarrolló un conjunto de modelos de aprendizaje automático interpretables mediante regresión lineal con recuentos de folículos y niveles de
Cuando se usa el modelo para hacer predicciones día a día de trigger o para continuar la estimulación, se identificaron posibles activaciones tempranas y tardías en el 48,7% y el 13,8% de los ciclos, respectivamente. Después de emparejar la punuación de propensión, los pacientes con trigger temprano tenían en promedio de 2.3 menos ovocitos MII, 1.8 menos 2PN y 1.0 menos blastocistos utilizables en comparación con pacientes emparejados con trigger a tiempo, y las pacientes con trigger tardíos tenían en promedio 2,7 menos ovocitos MII, 2,0 menos 2PN y 0,7 menos blastocistos utilizables en comparación con pacientes emparejados por trigger a tiempo.
Este estudio demuestra que es posible desarrollar un modelo de aprendizaje automático interpretable para optimizar el día de trigger. El uso de nuestro modelo tiene el potencial de mejorar los resultados para muchas pacientes de fertilización in vitro.
The human microbiome project has shown a remarkable diversity of microbial ecology within the human body. The vaginal microbiota is unique in that in many women it is most often dominated by ...Lactobacillus species. However, in some women it lacks Lactobacillus spp. and is comprised of a wide array of strict and facultative anaerobes, a state that broadly correlates with increased risk for infection, disease, and poor reproductive and obstetric outcomes. Interestingly, the level of protection against infection can also vary by species and strains of Lactobacillus, and some species although dominant are not always optimal. This factors into the risk of contracting sexually transmitted infections and possibly influences the occurrence of resultant adverse reproductive outcomes such as tubal factor infertility. The composition and function of the vaginal microbiota appear to play an important role in pregnancy and fertility treatment outcomes and future research in this field will shed further translational mechanistic understanding onto the interplay of the vaginal microbiota with women's health and reproduction.
To provide an updated comparison of pregnancy-related complications and adverse perinatal outcomes of pregnancies conceived after frozen embryo transfer (FET) versus fresh embryo transfer (fresh ET).
...Meta-analysis.
University.
Pregnancies resulting from FET versus fresh ET.
Pubmed, Embase, Cochrane Library, Google Scholar, and Chinese databases, including the China National Knowledge Infrastructure Database, Wanfang, and Chinese Scientific Journals Full-Text Database were searched by two independent reviewers from January 1980 to September 2017. The results were expressed as risk ratios with 95% confidence intervals.
Pregnancy-related complications and perinatal outcomes.
Our search retrieved 1,397 articles, of which 31 studies were included. Pregnancies resulting from FET were associated with lower relative risks of placenta previa, placental abruption, low birth weight, very low birth weight, very preterm birth, small for gestational age, and perinatal mortality compared with fresh ET. Pregnancies occurring from FET were associated with increased risks of pregnancy-induced hypertension, postpartum hemorrhage, and large for gestational age compared with fresh ET. The risks of gestational diabetes mellitus, preterm premature rupture of the membranes, and preterm birth (PTB) showed no differences between the two groups.
Our analysis demonstrated that FET results in lower risks of placenta previa, placental abruption, low birth weight, very low birth weight, very preterm birth, small for gestational age, and perinatal mortality than fresh ET, some differences that are attributed to the increased risks of pregnancy-induced hypertension, large for gestational age, and postpartum hemorrhage. Although cryotechnology keeps improving, for comprehensive consideration, individual approaches remain appropriate to balance the options of FET or fresh ET at present.
Diet and fertility: a review Gaskins, Audrey J.; Chavarro, Jorge E.
American journal of obstetrics and gynecology,
04/2018, Letnik:
218, Številka:
4
Journal Article
Recenzirano
Odprti dostop
The literature on the relationship between diet and human fertility has greatly expanded over the last decade, resulting in the identification of a few clear patterns. Intake of supplemental folic ...acid, particularly at doses higher than those recommended for the prevention of neural tube defects, has been consistently related to lower frequency of infertility, lower risk of pregnancy loss, and greater success in infertility treatment. On the other hand and despite promising evidence from animal models, vitamin D does not appear to exert an important role in human fertility in the absence of deficiency. Antioxidant supplementation does not appear to offer any benefits to women undergoing infertility treatment, but it appears to be beneficial when it is the male partner who is supplemented. However, the available evidence does not allow discerning which specific antioxidants, or at which doses, are responsible for this benefit. Long-chain omega-3 fatty acids appear to improve female fertility, although it remains unclear to what extent contamination of shared food sources, such as fish with high levels of environmental toxicants, can dampen this benefit. Lastly, adherence to healthy diets favoring seafood, poultry, whole grains, fruits, and vegetables are related to better fertility in women and better semen quality in men. The cumulative evidence has also piled against popular hypotheses. Dairy and soy, once proposed as reproductive toxicants, have not been consistently related to poor fertility. In fact, soy and soy supplements appear to exert a beneficial effect among women undergoing infertility treatment. Similarly, because data from large, high-quality studies continue to accumulate, the evidence of a potentially deleterious effect of moderate alcohol and caffeine intake on the ability to become pregnant seems less solid than it once did. While a complete picture of the role of nutrition on fertility is far from complete, much progress has been made. The most salient gaps in the current evidence include jointly considering female and male diets and testing the most consistent findings in randomized trials.
: To investigate the impact of recryopreservation on embryo viability and the outcomes of in vitro fertilization (IVF) by comparison with single cryopreservation. There is a lack of consensus and ...reliable evidence regarding the impact of recryopreservation techniques on human embryos, particularly with respect to embryo viability and IVF outcomes.
Systematic review and meta-analysis.
Not applicable.
Various databases such as PubMed, Embase, Cochrane Library, and Scopus were searched until October 10, 2022. All comparative studies comparing embryonic and IVF outcomes between repeated and single cryopreservation of embryos were included. The random-effect and fixed-effect meta-analysis models were used to pool the odds ratio (OR) and corresponding 95% confidence intervals (CIs). A subgroup analysis was performed based on different methods of cryopreservation and different times of embryo cryopreservation or transfer.
Outcomes referring to embryo surviva l, IVF outcomes (including clinical pregnancy rate, embryo implantation rate, miscarriage rate, and live birth rate), and neonatal outcomes (including low birth weight rate and preterm birth rate) were evaluated.
Fourteen studies were eligible for the present meta-analysis, involving 4,525 embryo transfer cycles in total (3,270 cycles with single cryopreservation control group and 1,255 with recryopreservation experimental group). Decreased embryo survival (OR, 0.51; 95% CI, 0.27–0.96) and clinical pregnancy rates (OR, 0.47; 95% CI, 0.23–0.96) were found in embryos that were recryopreserved by slow freezing. The live birth rate of revitrified embryos was also notably affected (OR, 0.60; 95% CI, 0.38–0.94). Overall, recryopreservation resulted in a decreased live birth rate (OR, 0.67; 95% CI, 0.50–0.90) and an increased miscarriage rate (OR, 1.52; 95% CI, 1.16–1.98) compared with single cryopreservation. No significant difference was found in neonatal outcomes. When embryos were cryopreserved and transferred at the blastocyst stage, both the embryo implantation rate (OR, 0.59; 95% CI, 0.39–0.89) and live birth rate (OR, 0.60; 95% CI, 0.37–0.96) were significantly different between the 2 groups.
The present meta-analysis suggested that recryopreservation, compared with single cryopreservation, can lead to impaired embryo viability and a lower rate of IVF success, with no affected neonatal outcomes. Clinicians and embryologists should retain a cautious attitude toward recryopreservation strategies.
CRD42022359456
Efecto de la re-criopreservación en la viabilidad embrionaria y los resultados en fecundación in vitro: revisión sistemática y metaanálisis
Investigar el impacto de la recriopreservación sobre la viabilidad embrionaria y los resultados de la fecundación in vitro (FIV) en comparación con la criopreservación única. Existe una falta de consenso y de pruebas fiables sobre el impacto de las técnicas de re-criopreservación en embriones humanos, especialmente en lo que respecta a la viabilidad embrionaria y los resultados en FIV.
Revisión sistemática y meta-análisis.
No aplicable.
Se realizaron búsquedas en diversas bases de datos como PubMed, Embase, Cochrane Library y Scopus hasta el 10 de octubre de 2022.
Se incluyeron todos los estudios que compararon los resultados embrionarios y de FIV entre la criopreservación repetida y única de embriones.
Se utilizaron los modelos de metanálisis de efectos aleatorios y de efectos fijos para agrupar las odds ratio (OR) y los correspondientes intervalos de confianza (IC) del 95%. Se realizó un análisis de subgrupos basado en diferentes métodos de crioconservación y diferentes tiempos de crioconservación o transferencia de embriones.
Se evaluaron los resultados relativos a la supervivencia embrionaria, los resultados de la FIV (incluida la tasa de embarazo clínico, la tasa de implantación embrionaria, tasa de abortos espontáneos y tasa de nacidos vivos) y resultados neonatales (tasa de bajo peso al nacer y tasa de nacimientos prematuros).
Catorce estudios fueron elegibles para el presente meta-análisis, con 4.525 ciclos de transferencia de embriones en total (3.270 ciclos con criopreservación única grupo de control y 1.255 con re-criopreservación grupo experimental). Disminución de la supervivencia embrionaria (OR,0,51; IC del 95%, 0,27-0,96) y las tasas de embarazo clínico (OR, 0,47; IC del 95%, 0,23-0,96) en los embriones re-crioconservados mediante congelación lenta. La tasa de nacidos vivos de los embriones re-vitrificados también se vio notablemente afectada (OR, 0,60; IC del 95%, 0,38-0,94). En general, la re-criopreservación provocó una disminución de la tasa de nacidos vivos (OR, 0,67; IC 95%, 0,50-0,90) y un aumento de la tasa de abortos espontáneos (OR, 1,52; IC 95%, 1,16-1,98) en comparación con la criopreservación única. No se encontraron diferencias significativas en los resultados neonatales. Cuando se criopreservaron embriones y se transfirieron en la fase de blastocisto, tanto la tasa de implantación embrionaria (OR, 0,59; IC 95%, 0,39- 0,89) como la tasa de nacidos vivos (OR, 0,60; IC 95%, 0,37-0,96) fueron significativamente diferentes entre los 2 grupos.
El presente metaanálisis sugiere que la re-criopreservación, en comparación con la criopreservación única, puede conducir a una viabilidad embrionaria alterada y a una menor tasa de éxito de la FIV, sin que se vean afectados los resultados neonatales. Los clínicos y los embriólogos deben mantener una actitud cautelosa ante las estrategias de re-criopreservación.
PDF
