To examine the degree to which paternal variables of age, body mass index (BMI), and sperm parameters affect vitrified donor oocyte IVF outcomes. Previous studies examining the impact of male partner ...characteristics on in-vitro fertilization (IVF) have found conflicting results. Concerns are rising over the potential effects of paternal factors, such as age and obesity, on pregnancy and child health. Frozen donor oocyte IVF offers an ideal model to study these effects.
Retrospective chart review.
Private fertility clinic.
Nine hundred forty-nine recipients undergoing transfer of blastocyst embryo(s) from a vitrified oocyte donor bank between 2008-2015.
None.
Implantation rate, clinical pregnancy rate, live birth rate, rate of low birth weight singleton infants (≤2500 g), and preterm deliveries (PTD) of singleton infants (<37 wk).
After adjusting for covariates known to affect oocyte donation cycle success, male age, BMI and sperm parameters were not associated with differences in IVF outcomes. There were higher PTD rates for men ≥51 years and BMI ≥35 kg/m2, however, these were not significant after adjustment. There were no differences in rates of low birth weight infants with men >35 years or BMI >25 kg/m2. Lastly, there were no differences in rates of PTD or low birth weight infants with abnormal sperm parameters.
Neither advancing male age, elevated BMI, nor poor sperm quality were associated with outcomes in frozen donor oocyte IVF cycles in this study. Intracytoplamic sperm injection and “oocyte quality” likely mitigate some of the effects of male variables on outcomes following cryopreserved oocyte donation.
Impacto de las características y los parámetros seminales del varón en los resultados de la fecundación in vitro y obstétricos en un modelo de donación de óvulos congelados
Examinar el grado en el que las variables paternas de: edad, índice de masa corporal (BMI) y parámetros seminales, afectan a los resultados de la donación de ovocitos vitrificados. Estudios previos han encontrado resultados contradictorios en el impacto de las características del varón en la fecundación in vitro (FIV). La FIV con ovocitos congelados de donante ofrece un modelo ideal para estudiar estos efectos.
Revisión retrospectiva de historias clínicas.
Clínica privada de fertilidad.
949 receptoras con transferencia de embrión(es) en fase de blastocisto procedentes de un banco de ovocitos donados vitrificados, entre 2008 y 2015.
Ninguna.
Tasa de implantación, tasa de gestación clínica, tasa de recién nacido vivo, tasa de bajo peso (≤2500 g) al nacer y parto pretérmino (PTD) (<37 sem.) en gestaciones con solo un nacido vivo.
Tras el ajuste de covariables que afectan al éxito del ciclo de donación de óvulos, la edad del varón, el BMI y los parámetros seminales no se asociaron con diferencias en los resultados de la FIV. Hubo mayores tasas de PTD en hombres ≥ 51 años y en BMI ≥ 35 kg/m2, sin embargo, estas no fueron significativas tras el ajuste. No hubo diferencias en las tasas de recién nacido vivo con bajo peso en hombres > 35 años o en BMI > 25 kg/m2. Por último, no hubo diferencias en las tasas de PTD o de recién nacido con bajo peso en parámetros seminales anormales.
En este estudio, ni la edad masculina avanzada, ni el BMI elevado ni la baja calidad seminal se asociaron con los resultados en los ciclos de FIV con ovocitos donados congelados. La inyección intracitoplasmática de espermatozoides y la “calidad ovocitaria” probablemente atenúen alguno de los efectos de las variables masculinas en los resultados de donación de ovocitos criopreservados.
To evaluate the influence of type 3 intramural fibroids on in vitro fertilization–intracytoplasmic sperm injection (IVF-ICSI) outcomes.
Retrospective cohort study.
University-based reproductive ...medicine center.
All women undergoing IVF-ICSI from January 1, 2009, to December 31, 2016, in our unit.
Each woman was matched with three separate control subjects of the same age (±1 year), number of cycles, type of infertility (primary or secondary), type of protocol used for controlled ovarian hyperstimulation (COH), and no uterine fibroids identified by transvaginal ultrasound.
Implantation, clinical pregnancy, clinical miscarriage, and live birth rates.
We included 151 patients with type 3 intramural fibroids and 453 matched control subjects who underwent IVF-ICSI. The rate of “other protocol” used in COH was significantly higher in women with type 3 fibroids than in the control subjects (P<.001). The experimental group had a significantly lower implantation rate. Type 3 fibroids also resulted in a lower frequency of live births and clinical pregnancy. There was no significant difference between the groups in the rate of clinical miscarriage. Compared with the corresponding control subjects, patients with type 3 fibroids with a single fibroid diameter (SD) or total reported fibroid diameter (TD) >2.0 cm also had significantly lower rates of live birth, clinical pregnancy, and implantation. Type 3 fibroids with SD or TD ≤2.0 cm had no significant difference in IVF-ICSI outcomes compared with corresponding control subjects.
Our results suggest that type 3 fibroids exert a negative impact on the rates of implantation, clinical pregnancy, and live birth in patients undergoing IVF-ICSI, but do not significantly increase the clinical miscarriage rate. The deleterious impact of type 3 fibroids was remarkable in women with type 3 fibroids with TD or SD >2.0 cm.
Background
In vitro methods of conception are associated with adverse perinatal outcomes. It is unclear if the risk of stillbirth is increased also.
Objective
This systematic review and meta‐analysis ...aimed to estimate the risk of stillbirth in singleton gestations following in vitro methods of conception compared to non‐in vitro conceptions.
Search strategy
A comprehensive search in PubMed, Embase, CINAHL, and Cochrane Library was undertaken from database inception to February 2021, with backward citation tracking.
Selection criteria
Eligible studies included randomized controlled trials, cohort studies, or case‐control studies that assessed stillbirth following in vitro fertilisation and/or intracytoplasmic sperm injection in comparison to non‐in vitro methods of conception, including spontaneous conceptions, intrauterine insemination, and ovarian stimulation.
Data collection and analysis
The Newcastle‐Ottawa Scale was used to assess risk of bias. A summary odds ratio (OR) for stillbirth following in vitro methods of conception compared to non‐in vitro methods was calculated using a random‐effects model for meta‐analysis.
Main results
Thirty‐three cohort studies met inclusion criteria. There was an increased risk of stillbirth with in vitro methods: OR 1.41 (95% CI 1.20–1.65); however, the crude baseline risk of stillbirth was low (4.44/1000 total births). Subgroup analysis did not demonstrate an increased risk when in vitro methods were compared to conception without in vitro methods in the context of subfertility.
Conclusions
Compared to non‐in vitro conceptions, in vitro conceptions have an increased risk of stillbirth. However, there is insufficient evidence to demonstrate whether this risk is associated with in vitro techniques or underlying subfertility.
Tweetable
This meta‐analysis found an increased risk of stillbirth in singletons from in vitro methods of conception.
Tweetable
This meta‐analysis found an increased risk of stillbirth in singletons from in vitro methods of conception.
Contemporary embryo biopsy in the United States involves the removal of several cells from a blastocyst that would become the placenta for preimplantation genetic testing. Embryos are then ...cryopreserved while patients await biopsy results, with transfers occurring in a subsequent cycle as a single frozen-thawed embryo transfer, if euploid.
We sought to determine if removal of these cells for preimplantation genetic testing was associated with adverse obstetrical or neonatal outcomes after frozen-thawed single embryo transfer.
We linked assisted reproductive technology surveillance data from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System to birth certificates and maternal and neonatal hospitalization discharge diagnoses in Massachusetts from 2014 to 2017, considering only singleton births after frozen-thawed single embryo transfers. We compared outcomes of cycles having embryo biopsy (n=585) to those having no biopsy (n=2191) using chi-square for categorical and binary variables and logistic regression for adjusted odds ratios and 95% confidence intervals, adjusting for mother’s age, race, education, parity, body mass index, birth year, insurance, and all infertility diagnoses.
Considering no biopsy as the reference, there was no difference between groups with respect to preeclampsia (adjusted odds ratio, 0.82; 95% confidence interval, 0.42–1.61; P=.5685); pregnancy-induced hypertension (adjusted odds ratio, 0.85; 95% confidence interval, 0.46–1.59; P=.6146); placental disorders, including placental abruption, placenta previa, placenta accreta, placenta increta, and placenta percreta (adjusted odds ratio, 1.16; 95% confidence interval, 0.60–2.24; P=.6675); preterm birth (adjusted odds ratio, 1.22; 95% confidence interval 0.73–2.03; P=.4418); low birthweight (adjusted odds ratio, 1.12; 95% confidence interval, 0.58–2.15; P=.7355); cesarean delivery (adjusted odds ratio, 1.04; 95% confidence interval, 0.79–1.38; P=.7762); or gestational diabetes mellitus (adjusted odds ratio, 0.83; 95% confidence interval, 0.50–1.38; P=.4734). In addition, there was no difference between the groups for prolonged hospital stay for mothers (adjusted odds ratio, 1.23; 95% confidence interval, 0.83–1.80; P=.3014) or for infants (95% confidence interval, 1.29; 95% confidence interval, 0.72–2.29; P=.3923).
Embryo biopsy for preimplantation genetic testing does not increase the odds for diagnoses related to placentation (preeclampsia, pregnancy-related hypertension, placental disorders, preterm delivery, or low birthweight), maternal conditions (gestational diabetes mellitus), or maternal or infant length of stay after delivery.
Maternal exposure to air pollution is associated with poor reproductive outcomes in in vitro fertilization (IVF). However, the susceptible time windows are still not been known clearly. In the ...present study, we linked the air pollution data with the information of 9001 women receiving 10,467 transfer cycles from August 2014 to August 2019 in The Second Hospital of Hebei Medical University, Shijiazhuang City, China. Maternal exposure was presented as individual average daily concentrations of PM2.5, PM10, NO2, SO2, CO, and O3, which were predicted by spatiotemporal kriging model based on residential addresses. Exposure windows were divided to five periods according to the process of follicular and embryonic development in IVF. Generalized estimating equation model was used to evaluate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for association between clinical pregnancy and interquartile range increased average daily concentrations of pollutants during each exposure period. The increased PM2.5 (adjusted OR = 0.95, 95% CI: 0.90, 0.99), PM10 (adjusted OR = 0.93, 95% CI: 0.89, 0.98), NO2 (adjusted OR = 0.89, 95% CI: 0.85, 0.94), SO2 (OR = 0.94, 95% CI: 0.90, 0.98), CO (adjusted OR = 0.93, 95% CI: 0.89, 0.97) whereas decreased O3 (OR = 1.08, 95% CI: 1.02, 1.14) during the duration from preantral follicles to antral follicles were the strongest association with decreased probability of clinical pregnancy among the five periods. Especially, women aged 20–29 years old were more susceptible in preantral-antral follicle transition stage. Women aged 36–47 years old were more vulnerable during post-oocyte retrieve period. Our results suggested air pollution exposure during preantral-antral follicle transition stage was a note-worthy challenge to conceive among females receiving IVF.
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•Air pollution was associated with clinical pregnancy in in vitro fertilization.•Preantral-antral follicle transition stage was critical response to air pollution.•Women aged 20–29 were more vulnerable in preantral-antral follicle transition stage.•Women aged 36–47 were more susceptible after oocyte retrieved.
Capsule: Women exposed to ambient air pollution during preantral-antral follicle transition stage was a critical time-window associated with clinical pregnancy in in vitro fertilization.
Antimüllerian hormone (AMH) levels are higher in patients with polycystic ovary syndrome (PCOS). Accumulating evidence indicates that AMH has an impact on the physiology of the female reproductive ...system.
To investigate the association of AMH levels with the risk of preterm delivery in PCOS patients.
Retrospective cohort study.
Academic fertility center.
Women who underwent in vitro fertilization between January 2017 and July 2018 (25,165 cycles).
None.
The primary outcome was preterm delivery.
Serum AMH levels were not different between the term delivery and preterm delivery groups in the entire cohort (3.8 vs. 4.1 ng/mL, P>.05). In patients diagnosed with PCOS, those with preterm delivery had higher AMH levels than were found in patients with term delivery (9.3 vs. 6.9 ng/mL, P<.01). Preterm deliveries predominated in PCOS patients with AMH levels above the 75th percentile (9.75 ng/mL) (adjusted P<.0001, adjusted odds ratio OR 4.0, 95% confidence interval CI 1.94, 8.08)) and frozen−thawed embryo transfer (FET) patients with AMH levels higher than the 90th percentile (10.10 ng/mL) (adjusted P<.05, adjusted OR 2.0, 95% CI 1.16, 3.36).
Serum AMH levels higher than 75th percentile were associated with an increased risk of preterm delivery in patients with PCOS, and serum AMH levels higher than the 90th percentile were associated with an increased risk of preterm delivery in FET patients.
Niveles altos de hormona antimulleriana están asociados con el parto pretérmino en pacientes con síndrome de ovarios poliquísticos
Los niveles de la hormona antimulleriana (AMH) son más elevados en pacientes con síndrome de ovarios poliquísticos (PCOS). La evidencia acumulada indica que la AMH tiene un impacto en la fisiología del sistema reproductivo femenino.
Investigar la asociación de los niveles de AMH con el riesgo de parto prematuro en pacientes con PCOS.
Estudio retrospectivo de cohortes.
Centro de fertilidad académico.
Mujeres que se sometieron a fecundación in vitro entre enero de 2017 y julio de 2018 (25,165 ciclos).
Ninguna.
La variable principal fue el parto pretérmino.
Los niveles séricos de AMH no fueron diferentes entre los grupos de parto a término y de parto pretérmino en toda la cohorte (3,8 vs. a 4,1 ng/ml, p>0.05). En pacientes diagnosticadas con PCOS, aquellas con parto pretérmino tenían niveles de AMH más altos que los encontrados en pacientes con parto a término (9.3 vs. 6.9 ng/mL, P<.01). Los partos pretérminos predominaron en pacientes con PCOS con niveles de AMH por encima del percentil 75 (9.75 ng/ml) (P ajustado <.0001, odds ratio ajustado OR 4.0, intervalo de confianza del 95% IC 1.94, 8.08) y transferencia de embriones congelados-descongelados (FET) con niveles de AMH superiores al percentil 90 (10.10 ng/mL) (P ajustado <.05, OR ajustado 2.0, IC 95% 1.16, 3.36).
Los niveles séricos de AMH superiores al percentil 75 se asociaron con un mayor riesgo de parto prematuro en pacientes con PCOS, y los niveles séricos de AMH superiores al percentil 90 se asociaron con un mayor riesgo de parto prematuro en pacientes con FET.
To determine if ovarian responsiveness to gonadotropin stimulation differs by race/ethnicity and whether this predicts live birth rates (LBRs) in non-White patients undergoing in vitro fertilization ...(IVF).
Retrospective cohort study.
Academic infertility center.
White, Asian, Black, and Hispanic patients undergoing ovarian stimulation for IVF.
Self-reported race and ethnicity.
The primary outcome was ovarian sensitivity index (OSI), defined as (the number of oocytes retrieved ÷ total gonadotropin dose) × 1,000 as a measure of ovarian responsiveness, adjusting for age, body mass index, infertility diagnosis, and cycle number. Secondary outcomes included live birth and clinical pregnancy after first retrievals, adjusting for age, infertility diagnosis, and history of fibroids, as well as miscarriage rate per clinical pregnancy, adjusting for age, body mass index, infertility diagnosis, duration of infertility, history of fibroids, and use of preimplantation genetic testing for aneuploidy.
The primary analysis of OSI included 3,360 (70.2%) retrievals from White patients, 704 (14.7%) retrievals from Asian patients, 553 (11.6%) retrievals from Black patients, and 168 (3.5%) retrievals from Hispanic patients. Black and Hispanic patients had higher OSIs than White patients after accounting for those with multiple retrievals and adjusting for confounders (6.08 in Black and 6.27 in Hispanic, compared with 5.25 in White). There was no difference in OSI between Asian and White patients. The pregnancy outcomes analyses included 2,299 retrievals. Despite greater ovarian responsiveness, Black and Hispanic patients had lower LBRs compared with White patients, although these differences were not statistically significant after adjusting for confounders (adjusted odds ratio, 0.83; 95% confidence interval CI, 0.63–1.09, for Black; adjusted odds ratio, 0.93; 95% CI, 0.61–1.43, for Hispanic). Ovarian sensitivity index was modestly predictive of live birth in White and Asian patients but not in Black (area under the curve, 0.51; 95% CI, 0.38–0.64) and Hispanic (area under the curve, 0.50; 95% CI, 0.37–0.63) patients.
Black and Hispanic patients have higher ovarian responsiveness to stimulation during IVF but do not experience a consequent increase in LBR. Factors beyond differences in responsiveness to ovarian stimulation need to be explored to address the racial/ethnic disparity established in prior literature.
Raza, respuesta ovárica y nacidos vivos tras fecundación in vitro
Determinar si la respuesta ovárica a la estimulación con gonadotropinas difiere en cuanto a la raza/etnia y si esto predice las tasas de nacido vivo en pacientes de raza no blanca sometidas a fecundación in vitro (FIV).
estudio de cohorte retrospectivo
Pacientes blancas, asiáticas, negras e hispanas sometidas a estimulación ovárica para FIV en una clínica académica de infertilidad.
Raza y etnia auto-declaradas.
El resultado primario fue determinar el índice de sensibilidad ovárica (ISO), definido como (el número de ovocitos punzados % dosis total de gonadotropina) x 1.000, como medida de la capacidad de respuesta ovárica, ajustado por edad, índice de masa corporal, diagnóstico de infertilidad y número de ciclos. Los resultados secundarios incluyeron nacidos vivos y embarazo clínico tras las primeras punciones, ajustado por edad, diagnóstico de infertilidad y antecedentes de fibromas, así como la tasa de abortos espontáneos por embarazo clínico, ajustado por edad, índice de masa corporal, diagnóstico de infertilidad, la duración de la infertilidad, antecedentes de fibromas y el uso de pruebas genéticas preimplantacionales para detectar aneuploidías.
El análisis primario de ISO incluyó 3.360 (70,2%) punciones de pacientes blancas, 704 (14,7%) punciones de pacientes asiáticas, 553 (11,6%) punciones de pacientes negras y 168 (3,5%) punciones de pacientes hispanas. Las pacientes negras e hispanos tenían ISOs más elevados en comparación con pacientes blancas después de tener en cuenta aquellas con múltiples punciones y ajustado por datos de confusión (6.08 en pacientes negras y 6.27 en hispanas, frente a 5.25 en las pacientes blancas). No hubo diferencias en el ISO entre las pacientes asiáticas y las blancas. Los análisis de resultados de embarazo incluyeron 2.299 punciones. A pesar de la mayor capacidad de respuesta ovárica, las pacientes negras e hispanas presentaron tasas de recién nacido inferiores en comparación con las pacientes blancas, aunque estas diferencias no fueron estadísticamente significativas tras ajustar por datos de confusión (cociente de probabilidades ajustada, 0,83; intervalo de confianza IC del 95%, 0,63-1,09, para la raza negra; cociente de probabilidades ajustada, 0,93; IC del 95%, 0,61-1,43, para la raza hispana). El índice de sensibilidad ovárica fue modestamente predictivo de nacidos vivos en las pacientes blancas y asiáticas, pero no en las pacientes negras (área bajo la curva, 0,51; IC 95%,0,38-0,64) e hispanas (área bajo la curva, 0,50; IC 95%, 0,37-0,63).
Las pacientes negras e hispanas tienen una mayor capacidad de respuesta ovárica a la estimulación durante la FIV, pero no experimentan un aumento consecuente de la tasa de recién nacido. Es necesario explorar otros factores además de las diferencias en la respuesta a la estimulación ovárica para abordar la disparidad racial/étnica establecida en la literatura previa.
Objective
To compare the intercycle variation of serum anti‐Mullerian hormone (AMH) and antral follicle count (AFC) measurements over four consecutive menstrual cycles.
Design
Observational study ...with secondary analysis using data from two previous randomized controlled trials.
Patients
Seventy‐eight women from two previous randomized trials on the effect of dehydroepiandrosterone pretreatment on ovarian response in women undergoing in vitro fertilization (IVF) treatment.
Measurements
The intraclass correlation coefficients (ICC) for AFC and AMH across the four study cycles, as well as their predictive performance on poor ovarian response, were compared.
Results
No significant difference was observed in AMH (p = .608) across the four study cycles. AFC was significantly higher at 4 weeks before ovarian stimulation compared with 0, 8 and 12 weeks before ovarian stimulation (p < .05, Conover posthoc test). Both single‐measures and average‐measures ICC were significantly higher with AMH than with AFC. The areas under the receiver operating characteristic curve of the four AFC measurements in predicting poor ovarian response (defined as three or less oocytes retrieved) in the IVF cycle ranged from 0.657 to 0.743 with no significant difference (p > .05) among the four cycles, whereas those of the four AMH measurement ranged from 0.730 to 0.780 with no significant difference (p > .05) among the four cycles.
Conclusions
Although both AFC and AMH are good predictors of ovarian response, intercycle repeatability was significantly better with serum AMH than AFC measurement. Both have no significant difference in their predictive performance on poor ovarian response when assessed within three months before IVF treatment, hence allowing pre‐IVF assessment at more flexible timing.
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