To investigate the association between antimüllerian hormone (AMH) and preterm birth risk in a larger cohort of patients who underwent either in vitro fertilization or ovulation induction with ...intrauterine insemination at a US academic fertility center.
Retrospective cohort study.
Single academic fertility center.
Live singleton births from patients who underwent in vitro fertilization or ovulation induction between 2016 and 2020 at a single academic fertility center were included in this study. Patients were excluded if they had a missing prepregnancy AMH level, a pregnancy using donor oocytes or a gestational carrier, multiple gestations, a delivery before 20 weeks gestation, or a cerclage in place.
AMH level.
The primary outcome was the proportion of preterm delivery. Secondary outcomes included the rate of pregnancy-induced hypertension, gestational diabetes, and small for gestational age.
In the entire cohort (n = 875), 8.4% of deliveries were preterm. The mean AMH values were similar between those with term and preterm births (3.9 vs. 4.2 ng/mL). Similar proportions of patients with term and preterm deliveries had AMH levels greater than the 75th percentile (25% vs. 21%). The odds of preterm birth were similar by AMH quartile after adjusting for the history of preterm birth. Similarly, in the polycystic ovary syndrome (PCOS) cohort, there was no difference between mean AMH values of term and preterm births (n = 139, 9.6 vs. 10.0 ng/mL). The proportions of patients with PCOS with AMH levels greater than the 75th percentile were similar between those with term and preterm deliveries (25% vs. 22%). The odds of preterm birth were similar by the AMH quartile after adjusting for the history of preterm birth.
Elevated AMH levels were not associated with an increased risk of preterm birth in patients who conceived after in vitro fertilization and ovulation induction, including patients with PCOS. Although studies suggest that AMH levels may help stratify the risk of preterm birth in this population, our findings indicate that further studies are needed before clinical application.
Los niveles elevados de hormona antimülleriana no están asociados con parto pretérmino luego de fecundación in vitro o inducción de la ovulación
Investigar la asociación entre hormona antimülleriana (AMH) y riesgo de parto pretérmino en una cohorte de pacientes que se sometieron tanto a fecundación in vitro o inducción de la ovulación con inseminación intrauterina en un centro académico de fertilidad en US.
Estudio retrospectivo de cohorte.
Un centro académico de fertilidad.
Se incluyeron en este estudio nacimientos únicos vivos de pacientes que se sometieron a fecundación in vitro o inducción de la ovulación entre 2016 y 2020 en un centro académico de fertilidad. Las pacientes fueron excluidas si no tenían nivel de AMH antes del embarazo, embarazo con donante de ovocitos o gestación subrogada, embarazos múltiples, fin de las gestación antes de la semana 20, o cerclaje.
Nivel de AMH.
El resultado primario fue la proporción de partos pretérmino. Los resultados secundarios incluyeron la tasa de hipertensión inducida por el embarazo, diabetes gestacional, y pequeño para la edad gestacional.
En toda la cohorte (n=875), 8.4% de los partos fueron pretérmino. La media de valores de AMH fue similar entre aquellas con parto de término y pretérmino (3.9 vs. 4.2 ng/ml). Proporciones similares de pacientes con partos a término y pretérmino tuvieron niveles de AMH mayores que el percentilo 75 (25% vs. 21%). La probabilidad de parto pretérmino fue similar por cuartil de AMH luego de ajustar por historia de parto pretérmino. Del mismo modo, en la cohorte de síndrome de ovario poliquístico (PCOS), no hubo diferencia entre la media de valores de AMH de partos de término y pretérmino (n=139, 9.6 vs. 10.0 ng/ml). Las proporciones de pacientes con PCOS con niveles de AMH mayores que el percentilo 75 fueron similares entre aquellas con partos de término y pretérmino (25% vs. 22%). La probabilidad de parto pretérmino fue similar por cuartil de AMH luego de ajustar por historia de parto pretérmino.
Niveles elevados de AMH no se asociaron con aumento de riesgo de parto pretérmino en pacientes que concibieron luego de fecundación in vitro o inducción de la ovulación, incluyendo pacientes con PCOS. Aunque algunos estudios sugieren que los niveles de AMH podrían ayudar a estratificar el riesgo de parto pretérmino en esta población, nuestros hallazgos indican que se necesitan estudios adicionales antes de aplicación clínica.
Cryopreservation of ovarian tissue to preserve the fertility of girls and young women at high risk of sterility is now widely practiced. Pieces of cryopreserved ovarian cortex can be thawed and ...autografted to restore fertility, but because of the risks of reintroduction of the cancer, transplantation may not be possible for girls and women with blood-borne leukemias or cancers with a high risk of ovarian metastasis. Cryopreserved ovarian tissue contains mainly primordial follicles but also provides access to immature oocytes from small antral follicles, which may be matured in vitro to provide an additional source of mature oocytes. So in cases in which transplantation is contraindicated, fertility restoration could be safely achieved in the laboratory either by in vitro maturation (IVM) of oocytes aspirated from growing follicles or by the complete in vitro growth (IVG) and maturation (IVM) of primordial follicles to produce fertile metaphase II (MII) oocytes. The development of IVM and IVG methods to support all stages of oocytes available within ovarian tissue will maximize the potential for all patients undergoing fertility preservation.
To investigate the impact of controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF) on thyroid function.
Systematic review and meta-analysis.
Not applicable.
Infertile women ...undergoing conventional IVF or intracytoplasmic sperm injection.
Systematic search of PubMed, MEDLINE, Embase, Scopus, and Web of Science from inception until November 2020. Studies could be included only if they met the following criteria: subjects were classified as euthyroid or hypothyroid; serum thyroid-stimulating hormone (TSH) and/or free thyroxine (FT4) levels were evaluated before COH; and the same thyroid function test was reassessed after COH (i.e., at the time of trigger for final follicle maturation and/or at pregnancy test).
Mean difference (MD) between the serum TSH or FT4 levels assessed after COH and before COH.
In euthyroid women, the serum TSH levels assessed at the time of trigger and at the time of pregnancy test were significantly higher than those at baseline (MD: 0.69 mIU/L, 95% confidence interval CI: 0.30–1.08, I2 = 93% and MD: 0.67, 95% CI: 0.49–0.85, I2 = 72%, respectively). The serum FT4 levels did not undergo significant changes. Subanalysis confirmed an increase in the TSH level after restricting the analysis to women treated with gonadotropin-releasing hormone agonist protocols and to those who achieved pregnancy. A pronounced increase in the TSH level was observed in women treated for hypothyroidism (MD: 1.50 mIU/L, 95% CI: 1.10–1.89, I2 = 0%).
Pooling of the results showed a significant increase in serum TSH level in women undergoing COH for IVF. This change was particularly pronounced in women treated for hypothyroidism. New thyroid function screening strategies for women undergoing COH are warranted.
Modificaciones de la función tiroidea en mujeres sometidas a hiperestimulación ovárica controlada para fecundación in vitro: revisión sistemática y meta-análisis.
Investigar el impacto de la hiperestimulación ovárica controlada (COH) para fecundación in vitro (IVF) sobre la función tiroidea.
Revisión sistemática y meta-análisis.
No aplica.
Mujeres infértiles sometidas a IVF convencional o inyección intracitoplasmática de espermatozoides.
Búsqueda sistemática en PubMed, MEDLINE, Embase, Scopus y Web of Science desde su creación hasta noviembre de 2020. Se incluyeron estudios sólo si se ajustaban a los siguientes criterios: pacientes clasificados como eutiroideos o hipotiroideos, niveles séricos de hormona estimulante de la tiroides (TSH) y/o tiroxina libre (FT4) obtenidos antes de la COH, y la misma prueba de función tiroidea fue re-evaluada tras la COH (i.e. en el momento de la inducción de la maduración folicular final y/o de la prueba de embarazo).
Diferencia media (MD) entre los niveles séricos de TSH o FT4 obtenidos antes y después de la COH.
En mujeres eutiroideas, los niveles séricos de TSH evaluados en el momento de la inducción de la maduración ovocitaria y en el momento de la prueba de embarazo fueron significativamente mayores que los niveles basales (MD: 0.69 mIU/L, intervalo de confianza CI del 95%: 0.30 – 1.08, I2 = 93% y MD: 0.67, CI95%: 0.49 – 0.85, I2 = 72%, respectivamente). Los niveles séricos de FT4 no sufrieron cambios significativos. El sub-análisis de mujeres tratadas con protocolos de agonistas de hormona liberadora de gonadotropina y a aquellas que resultaron embarazadas confirmó un incremento en el nivel de TSH. Se observó un incremento pronunciado en el nivel de TSH en mujeres en tratamiento para hipotiroidismo (MD: 1.50 mIU/L, CI95%: 1.10 – 1.89, I2 = 0%).
Los resultados agregados mostraron un aumento significativo en los niveles séricos de TSH en mujeres sometidas a COH para IVF. Este cambio fue particularmente pronunciado en mujeres con tratamiento para hipotiroidismo. Son necesarias nuevas estrategias de cribado de función tiroidea en mujeres sometidas a COH.
hiperestimulación ovárica controlada, tiroxina libre, fecundación in vitro, hormona estimulante de la tiroides.
Sexually transmitted infections are of major concern to reproductive specialists. Heading the list are human immunodeficiency virus types 1 and 2 and hepatitis B and C viruses. These pathogens, which ...may cause incurable chronic infections, can be transmitted through assisted reproductive technologies and from infected mothers to the fetus or newborn. This document replaces the document of the same name, last published in 2020.
Recomendaciones para reducir el riesgo de transmisión viral durante el tratamiento de fertilidad con el uso de gametas autólogas: opinión de comité
Las infecciones de transmisión sexual son una de las mayores preocupaciones de los especialistas de la reproducción. Encabezando la lista están virus de inmunodeficiencia tipos 1 y 2 y virus de hepatitis B y C. Estos patógenos, los cuales pueden causar infecciones crónicas incurables, pueden transmitirse a través de las tecnologías de reproducción asistida y desde madres infectadas a fetos o recién nacidos. Este documento reemplaza al documento con el mismo nombre, último publicado en 2020.
To study the impact of the endometrial receptivity analysis (ERA) on live birth rates in frozen embryo transfer (FET) cycles.
Retrospective cohort study.
A single, large, university-affiliated ...infertility practice.
Autologous FET cycles between January 1, 2014, and June 30, 2019, were reviewed. Multiple covariates that impact outcomes were used for propensity score matching; 133 ERA patients were matched to 353 non-ERA patients. Patients were assigned to the ERA group if they had an ERA during treatment and underwent at least one “personalized” FET based on the ERA recommendations.
No interventions administered.
Live birth rates per cycle in the FET cycle after ERA compared with that of matched non-ERA patients.
The live birth rates for the ERA group, 49.62%, and the matched non-ERA group, 54.96%, (odds ratio 0.8074; 95% confidence interval, 0.5424–1.2018) were not significantly different, nor was a difference seen in subanalyses based on prior number of FETs or receptivity status.
The ERA identifies a patient’s putative window of implantation with the goal of improving synchrony with the embryo, thereby achieving higher live birth rates. This study used propensity score matching to control for multiple covariates in a heterogenous group of patients to compare live birth rates. There was no difference in the live birth rate in patients who underwent the ERA compared with that of those who did not.
El uso del puntaje de propensión de emparejamiento para evaluar el beneficio del análisis de receptividad endometrial en la transferencia de embriones congelados.
Estudiar el impacto del análisis de receptividad endometrial (ERA) en la tasa de recién nacido vivo en los ciclos de embriones congelados (FET).
Estudio de cohorte retrospectivo.
Una única y grande clínica de infertilidad asociada a una universidad.
Se revisaron los ciclos de FET autólogos entre el 1 de enero de 2014 y el 30 de junio de 2019. Se utilizaron múltiples covariables que impactan los resultados para el puntaje de propensión de emparejamiento; 133 pacientes con ERA fueron emparejadas con 353 pacientes sin ERA. Las pacientes fueron asignadas al grupo ERA si tuvieron un ERA durante el tratamiento y se sometieron al menos a una FET “personalizada” en base a las recomendaciones del ERA.
No se administraron intervenciones.
Tasa de recién nacido vivo por ciclo en FET después de ERA comparada con la de los pacientes emparejadas sin ERA.
Las tasas de recién nacido vivo para el grupo de ERA, 49.62%, y el grupo sin ERA emparejado, 54.96% (ratios de probabilidades 0.8074; 95% de intervalo de confianza, 0.5424 – 1.2018) no fueron significativamente diferentes, ni se vio una diferencia en los subanálisis basados en números previos de FET o el estado de la receptividad.
El ERA identifica la ventana de implantación putativa de una paciente con el objetivo de mejorar la sincronía con el embrión, logrando así mayores tasas de recién nacido vivo. Este estudio utilizó el puntaje de propensión de emparejamiento para controlar las múltiples covariables en un grupo heterogéneo de pacientes para comparar las tasas de recién nacido vivo. No hubo diferencia en la tasa de recién nacido vivo en pacientes con ERA en comparación con las que no se sometieron a un ERA.
To assess whether pregnancies achieved with trophectoderm biopsy for preimplantation genetic testing (PGT) have different risks of adverse obstetric and neonatal outcomes compared with pregnancies ...achieved with IVF without biopsy.
Observational cohort.
University-affiliated fertility center.
Pregnancies achieved via IVF with PGT (n = 177) and IVF without PGT (n = 180) that resulted in a live birth.
None.
Maternal outcomes including preeclampsia and placenta previa and neonatal outcomes including birth weight and birth defects.
There was a statistically significant increase in the risk of preeclampsia among IVF+PGT pregnancies compared with IVF without PGT pregnancies, with an incidence of 10.5% versus 4.1% (adjusted odds ratio aOR = 3.02; 95% confidence interval 95% CI, 1.10, 8.29). The incidence of placenta previa was 5.8% in IVF+PGT pregnancies versus 1.4% in IVF without PGT pregnancies (aOR = 4.56; 95% CI, 0.93, 22.44). Similar incidences of gestational diabetes, preterm premature rupture of membranes, and postpartum hemorrhage were observed. IVF+PGT and IVF without PGT neonates did not have a significantly different gestational age at delivery or rate of preterm birth, low birth weight, neonatal intensive care unit admission, neonatal morbidities, or birth defects. All trends, including the significantly increased risk of preeclampsia in IVF+PGT pregnancies, persisted upon stratification of analysis to only singleton live births.
To date, this is the largest and most extensively controlled study examining maternal and neonatal outcomes after trophectoderm biopsy. There was a statistically significant three-fold increase in the odds of preeclampsia associated with trophectoderm biopsy. Given the rise in PGT use, further investigation is warranted.
Resultados maternos y neonatales asociados con biopsia de trofectodermo
Evaluar si los embarazos logrados con la biopsia de trofoectodermo para pruebas genéticas preimplantacionales (PGT) tienen diferentes riesgos de resultados adversos obstétricos y neonatales en comparación con los embarazos logrados con la FIV sin biopsia.
Cohorte observacional.
Centro de fertilidad afiliado a la universidad.
Embarazos logrados a través de fecundación in vitro (FIV) con PGT (n = 177) y FIV sin PGT (n = 180) que resultaron en un nacido vivo.
Ninguna.
Resultados maternos que incluyen preeclampsia y placenta previa y resultados neonatales que incluyen el peso y defectos de nacimiento.
Hubo un aumento estadísticamente significativo en el riesgo de preeclampsia entre los embarazos de FIV+PGT en comparación con los embarazos de FIV sin PGT, con una incidencia de 10,5% versus 4,1% (odds ratio ajustado aOR = 3,02; intervalo de confianza del 95% 95% CI, 1,10, 8,29). La incidencia de placenta previa fue del 5,8% en los embarazos con FIV+PGT versus 1,4% en los embarazos con FIV sin PGT (aOR = 4,56; 95% CI, 0,93, 22,44). Incidencias similares de diabetes gestacional, rotura prematura de membranas prematuras y hemorragia posparto fueron observados. La FIV con PGT y la FIV sin PGT no tuvieron una edad gestacional significativamente diferente en el momento del parto o la tasa del nacimiento prematuro, bajo peso al nacer, ingreso a la unidad de cuidados intensivos neonatales, morbilidad neonatal o defectos de nacimiento. Todas las tendencias, incluyendo el aumento significativo del riesgo de preeclampsia en los embarazos de FIVPGT persistió tras la estratificación del análisis solo para recién nacidos únicos.
Hasta la fecha, este es el estudio más grande y más ampliamente controlado que examina los resultados maternos y neonatales después de la biopsia de trofectodermo. Hubo un aumento triple estadísticamente significativo en las probabilidades de preeclampsia asociada con la biopsia de trofectodermo.
Dado el aumento en el uso de PGT, se justifica una mayor investigación.
Chronic liver disease and liver transplantation (LT) can delay both timing and ability of women to conceive. With increased awareness and availability of in vitro fertilisation (IVF), the need for ...accurate counselling is paramount. To date, minimal data exist on outcomes of IVF in patients with chronic liver disease, cirrhosis, or post-LT. We report the largest experience of IVF in women with liver-related subfertility (LRSF).
A retrospective analysis was performed on 42 women with LRSF who had undergone 57 IVF cycles between 1990 and 2019.
Forty-two women with LRSF received IVF; 9 cycles in 6 women with cirrhosis, 14 cycles in 11 women post-LT, and 34 cycles in 25 women without cirrhosis. The main aetiologies of liver disease included HBV, HCV, and autoimmune hepatitis (AIH). Of 57 IVF cycles evaluated, 43 (75%) resulted in successful implantation. Eight (2 post-LT, 3 with cirrhosis, 4 without cirrhosis) resulted in miscarriage. The live birth rate (LBR) was 74% (32/43). Two of 9 (22%) patients with cirrhosis, 4/14 (29%) patients who were post-LT, and 6/34 (18%) patients without cirrhosis had unsuccessful IVF attempts. Nine of 57 (16%) IVF cycles resulted in new liver enzyme derangement during therapy, which improved after treatment completion. Six pregnancies (2 in patients who were post-LT, 4 without cirrhosis) were complicated by obstetric cholestasis (OC). Ovarian hyperstimulation syndrome (OHSS) was rare (n = 3, 7%). One patient with AIH-related cirrhosis decompensated after initiating IVF, warranting discontinuation of therapy. There were no maternal deaths. Three women developed a hypertensive disorder of pregnancy. Half the pregnancies resulted in premature deliveries (range 27–36 weeks).
In selected cases, IVF in women with LRSF can be successful. However, patients should be counselled on the potential increased risks of OHSS, OC, and prematurity.
Women with liver disease or those who have had a liver transplant can experience difficulties getting pregnant. In this study, we look at whether alternative approaches to achieve pregnancy are harmful in these women. Overall, there were no significant issues with the use of in vitro fertilisation in women with liver disease, but they need to be aware of potential risks, such as early delivery of the baby.
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•Subfertility is common in women with liver disease and can persist post-LT.•Although the complications of IVF are well described in the general population, its effects on women with liver disease are unknown.•Women with LRSF can undergo successful pregnancies with IVF therapy.•Complications are potentially greater in women with liver disease, so pre-conception counselling is important.
To determine whether the racial and ethnic distribution of sperm donors contributing to US sperm banks differs from the demographics of the US population and those of US donor sperm recipients ...undergoing treatment with in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).
Cross-sectional study.
United States donor sperm banks, US Census, and fertility clinics reporting to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System.
Sperm donors from 18 banks, men aged 18–39 years on the basis of the 2021 Census Current Population Survey, and recipients of donor sperm for IVF and ICSI treatments in clinics reporting to the Assisted Reproductive Technology Clinic Outcome Reporting System from January 1, 2018, to December 31, 2020.
None.
Proportions of sperm donors and donor sperm recipients undergoing IVF and ICSI treatments identifying as each racial and ethnic group.
Eighteen donor sperm banks were identified, encompassing 1,503 donors. Of these donors, 60.9% identified as White compared with 55.1% of the US male population and 67.7% of donor sperm recipients. Proportions of donors identifying as Asian or 2 or more races were larger than those of US men and donor sperm recipients (Asian: 18.6% vs. 6.5%, and 18.6% vs. 10.2%; 2 or more races: 11.6% vs. 2.2%, and 11.6% vs. 1.7%). In contrast, Black donors were underrepresented when compared with the US population of men and donor sperm recipients (2.8% vs. 12.9% and 2.8% vs. 13.0%). Hispanic donors were underrepresented when compared with the US population of men (6.0% vs. 22.2%). The percentages of Hispanic sperm donors and donor sperm recipients were similar (6.0% vs. 7.0%).
The racial and ethnic distribution of sperm donors differs significantly from the demographics of the US male population and donor sperm recipients undergoing IVF and ICSI treatments. These findings suggest a need for targeted recruitment efforts for Black sperm donors.
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