To compare the clinical pregnancy rate (CPR) and live birth rate (LBR) of embryo transfer episodes (ETEs) performed by Reproductive Endocrinology and Infertility fellows vs. those of ETEs performed ...by faculty physicians.
Retrospective cohort analysis.
Academic reproductive endocrinology and infertility practice.
In total, 3,073 ETEs for 1,488 unique patients were performed by fellows or faculty physicians between January 2009 and January 2020.
None.
Clinical pregnancy rate and LBR.
Fifteen fellows performed 1,225 (39.9%) of 3,073 ETEs after completing 30 mock transfers. On comparing outcomes among fellowship years (FY1, FY2, and FY3), CPR (44.1% vs. 43.2% vs. 45.7%, respectively, P = .83) and LBR (39.1% vs. 38.1% vs. 38.4%, respectively, P = .97) were not significantly different. Fellowship year 1 fellows’ initial 30 ETEs vs. all the remaining FY1 ETEs had a significantly higher CPR (48.1% vs. 40.5%, respectively, P = .030) and LBR (45.4% vs. 34.3%, respectively, P = .001). There were no significant differences between faculty versus fellow ETEs in terms of CPR (43.0% vs. 45.0%, respectively, P = .30) or LBR (37.3% vs. 39.8%, respectively, P = .16), even after adjusting for patient age, body mass index, primary infertility diagnosis, autologous vs. donor oocyte, fresh vs. frozen embryo, number of embryos transferred, type of transfer catheter, and year of transfer (P = .32 for CPR, P = .22 for LBR).
Appropriately trained FY1 fellows had success rates maintained throughout all FYs. There were no significant differences in clinical outcomes between fellow- and faculty-performed transfers. These data demonstrated that allowing fellows to perform live embryo transfers is not detrimental to clinical outcomes.
Resultados de las transferencias de embriones realizadas por fellows de Endocrinología Reproductiva e Infertilidad vs médicos adjuntos: revisión retrospectiva de 11 años.
Comparar la tasa de embarazo clínico (RCP) y la tasa de nacidos vivos (LBR) de los episodios de transferencia de embriones (ETE) realizados por fellows de endocrinología reproductiva e infertilidad frente a los de ETE realizados por médicos adjuntos.
Análisis de cohorte retrospectivo.
Práctica académica de endocrinología reproductiva e infertilidad.
En total, 3.073 ETE para 1.488 pacientes fueron realizados por fellows o médicos adjuntos entre enero de 2009 y enero de 2020.
Ninguna.
Tasa de embarazo clínico y LBR.
Quince fellows realizaron 1.225 (39,9%) de los 3.073 ETE después de completar 30 transferencias simuladas. Al comparar los resultados entre años de fellowship (FY1, FY2 y FY3), RCP (44.1% vs 43.2% vs 45.7%, respectivamente, P = 0,83) y LBR (39.1% vs 38.1% vs 38.4%, respectivamente, P = 0,97) no fueron significativamente diferentes. Las 30 ETE iniciales de los fellows del año 1 de la fellowship frente a todas las ETE restantes del año 1 tenían una RCP significativamente más alta (48,1% frente a 40,5%, respectivamente, P = 0,030) y LBR (45,4% frente a 34,3%, respectivamente, P = 0,001). No hubo diferencias significativas entre ETEs del profesorado y de los fellows en términos de CPR (43,0% frente a 45,0%, respectivamente, P = 0,30) o LBR (37,3% frente a 39,8%, respectivamente, P = 0,16), incluso después de ajustar por edad del paciente, índice de masa corporal, diagnóstico de infertilidad primaria, ovocito de donante vs autólogo, embrión fresco vs congelado, número de embriones transferidos, tipo de catéter de transferencia y año de transferencia (P = 0,32 para CPR, P = 0,22 para LBR).
Los fellows debidamente capacitados del FY1 tuvieron tasas de éxito mantenidas durante todos los FY. No hubo diferencias significativas en los resultados clínicos entre transferencias realizadas por fellows y adjuntos. Estos datos demostraron que permitir a los fellows realizar las transferencias de embriones vivos no es perjudicial para los resultados clínicos.
This study assessed the quality of life (QoL) and pregnancy outcomes among infertile women undergoing in vitro fertilization (IVF) treatment to investigate the association between QoL and IVF ...pregnancy outcomes.
This study included 686 women with 1205 embryo transfers (ETs). QoL was measured using the fertility quality of life (FertiQoL) tool before ET. FertiQoL comprises two modules: a Core module (including mind/body, emotional, relational, and social domains) and a Treatment module (covering treatment environment and tolerability domains). The FertiQol total and subscale scores were computed and scored in the range of 0–100 (higher scores indicate better QoL). Multivariate generalized estimating equation analyses were carried out to assess the association between QoL and IVF pregnancy outcomes, with adjustment for time-varying factors across multiple ETs for a given person.
The lowest score in the core module was for the emotional domain (62.0), and that in the Treatment module was for the tolerability domain (59.4). QoL scores were significantly and positively associated with pregnancy outcomes (i.e., ongoing pregnancy, live birth); with a one unit increase in the emotional domain score, the probabilities of ongoing pregnancy and live birth significantly increased by 2.4% and 2.6%, respectively (p < 0.05).
This study evaluated the prospective association between QoL and IVF pregnancy outcomes among infertile women. The results highlight the importance of developing clinical strategies to improve QoL among infertile women undergoing IVF treatment, which may further improve the pregnancy rates of this population.
To assess for the first time the potential relationships of personal exposure to magnetic fields (MF) with pregnancy outcomes among a cohort of women from a fertility clinic, addressing, through ...study design, some of the primary limitations of previous studies on this topic.
Longitudinal preconception prospective cohort.
Fertility center.
Our analysis included 119 women recruited from 2012 to 2018, who underwent in vitro fertilization (IVF) (n = 163 cycles) and/or intrauterine insemination (IUI) (n = 123 cycles).
Women wore personal exposure monitors continuously for up to three consecutive 24-hour time periods separated by several weeks.
Implantation, clinical pregnancy, live birth, and pregnancy loss.
The median and maximum of the overall daily mean (daily peak) MF exposure levels were 1.10 mG (2.14 mG) and 15.54 mG (58.73 mG), respectively. MF exposure metrics were highest among women who changed environments four or more times per day. Overall, no statistically significant associations between MF exposure metrics and fertility treatment or pregnancy outcomes were observed in crude or adjusted models. Effect estimates, both positive and negative, varied by outcome and the exposure metric, including the way in which exposure was modeled.
Personal MF exposures were not associated with fertility treatment outcomes or pregnancy outcomes. Despite its limited size, strengths of the study include a longitudinal repeated-measures design, the collection of personal MF exposure data across multiple days, and carefully documented outcome and covariate information among a potentially susceptible study population.
Asociación de la exposición personal a cambios magnéticos de alta frecuencia con los resultados gestacionales entre mujeres que acuden a tratamientos de fertilidad en un estudio longitudinal de cohortes.
Evaluar por primera vez la potencial relación de la exposición personal a campos magnéticos (MF) con resultados gestacionales en una cohorte de mujeres de una clínica de fertilidad superando con el diseño del estudio algunas de las limitaciones primarias de estudios previos en este aspecto.
Cohorte prospectiva preconcepcional longitudinal.
Centro de fertilidad
Nuestro análisis incluyó 119 mujeres reclutadas desde 2012 a 2018, quienes se sometieron a fecundación in vitro (IVF) (n= 163 ciclos) y/o inseminación intrauterina (IUI) (n= 123 ciclos).
Mujeres con exposición personal a monitores de forma continua hasta tres periodos de 24 horas separados por varias semanas.
Implantación, gestación clínica, nacido vivo y pérdida gestacional.
La mediana y máxima de la media diaria total (pico diario) de los niveles de exposición a MF fueron 1.10 mG (2.14 mG) y 15.54 mG (58.73 mG), respectivamente. Las métricas de exposición a MF fueron más altas entre mujeres que cambiaron sus entornos 4 o más veces por día. En general, no se observaron asociaciones estadísticamente significativas entre las métricas de exposición a MF y los resultados de los tratamientos de fertilidad o gestacionales, tanto en los análisis en crudo como en modelos ajustados. Las estimaciones de efectos tanto positivos como negativos, variaron según el resultado y la métrica de exposición, incluyendo la vía en la que la exposición fue modelada.
Las exposiciones personales a MF no estuvieron asociadas con los resultados gestacionales o de los tratamientos de fertilidad. Pese a la limitación del tamaño, las fortalezas del estudio incluyen el diseño de mediciones repetidas longitudinales, la recolección de datos de exposición personal a MF durante múltiples días y lo cuidadosamente documentados que están los resultados e información covariable entre la población potencialmente susceptible de estudio.
Campo electromagnético, exposición personal, infertilidad, fecundación in vitro, aborto.
Two professional societies recently published opinions on the clinical management of "mosaic" results from preimplantation genetic testing for aneuploidy (PGT-A) in human blastocyst-stage embryos in ...associations with in vitro fertilization (IVF). We here point out three principal shortcomings: (i) Though a most recent societal opinion states that it should not be understood as an endorsement of the use of PGT-A, any discussion of how PGT-A should be clinically interpreted for all practical purposes does offer such an endorsement. (ii) The same guideline derived much of its opinion from a preceding guidance in favor of utilization of PGT-A that did not follow even minimal professional requirements for establishment of practice guidelines. (iii) Published guidelines on so-called "mosaic" embryos from both societies contradict basic biological characteristics of human preimplantation-stage embryos. They, furthermore, are clinically unvalidated and interpret results of a test, increasingly seen as harmful to IVF outcomes for many infertile women. Qualified professional organizations, therefore, should finally offer transparent guidelines about the utilization of PGT-A in association with IVF in general.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Single-cell genome analyses of human oocytes are important for meiosis research and preimplantation genomic screening. However, the nonuniformity of single-cell whole-genome amplification hindered ...its use. Here, we demonstrate genome analyses of single human oocytes using multiple annealing and looping-based amplification cycle (MALBAC)-based sequencing technology. By sequencing the triads of the first and second polar bodies (PB1 and PB2) and the oocyte pronuclei from same female egg donors, we phase the genomes of these donors with detected SNPs and determine the crossover maps of their oocytes. Our data exhibit an expected crossover interference and indicate a weak chromatid interference. Further, the genome of the oocyte pronucleus, including information regarding aneuploidy and SNPs in disease-associated alleles, can be accurately deduced from the genomes of PB1 and PB2. The MALBAC-based preimplantation genomic screening in in vitro fertilization (IVF) enables accurate and cost-effective selection of normal fertilized eggs for embryo transfer.
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•Whole-genome amplification and sequencing of single human oocytes using MALBAC method•First comprehensive study of crossovers and genetic interference in human oocytes•Phasing the genome of a female pronucleus by sequencing its polar bodies•Selection of a viable egg without aneuploidy or point mutations by sequencing its polar bodies
MALBAC genome amplification and high-throughput sequencing of the two polar bodies allowed inference of the health status of the oocyte, both in terms of aneuploidy and single-nucleotide variants associated with Mendelian diseases, demonstrating proof of principle for MALBAC-based preimplantation genomic screening in IVF.
This study explores the effects of endometrial thickness (EMT) before embryo transfer on newborn birth weight after in vitro fertilization-frozen embryo transfer (IVF-FET).
We collected the medical ...records related to singleton live births after IVF-FET from June 2015 to February 2019. Pregnant women were aged ≤ 42 years at delivery. Afterward, analyses were performed on outcomes related to newborns (birth weight, gestational age, delivery mode, percentage of newborns with low birth weight, and incidence of macrosomia) and pregnant women (pregnancy-induced hypertension, gestational diabetes mellitus, premature rupture of membranes, and placenta previa).
The birth weight was higher in singleton newborns delivered by patients with EMT > 12 mm before embryo transfer than those delivered by patients with a thinner endometrium. The mean birth weight was 85.107 g higher in the EMT ≥ 12 mm group and 25.942 g higher in the 8-12 mm EMT group than in the EMT < 8 mm group. Independent predictors of newborn birth weight included pregnancy-induced hypertension, premature rupture of membranes, placenta previa, newborn sex, gestational age, delivery mode, number of implanted embryos, follicle-stimulating hormone levels, estradiol levels, and pre-pregnancy body mass index.
The weight of newborn singletons is associated with EMT before embryo transfer in patients undergoing the first FET cycle. Specifically, the birth weight is lower for newborns delivered by patients with a thinner endometrium. Accordingly, it is warranted to increase EMT before embryo transfer for improving neonatal outcomes after fertility treatment.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Preimplantation genetic testing for aneuploidy (PGT-A) with trophectoderm (TE) biopsy is widely applied in in vitro fertilization (IVF) to identify aneuploid embryos. However, potential safety ...concerns regarding biopsy and restrictions to only those embryos suitable for biopsy pose limitations. In addition, embryo mosaicism gives rise to false positives and false negatives in PGT-A because the inner cell mass (ICM) cells, which give rise to the fetus, are not tested. Here, we report a critical examination of the efficacy of noninvasive preimplantation genetic testing for aneuploidy (niPGT-A) in the spent culture media of human blastocysts by analyzing the cell-free DNA, which reflects ploidy of both the TE and ICM. Fifty-two frozen donated blastocysts with TE biopsy results were thawed; each of their spent culture medium was collected after 24-h culture and analyzed by next-generation sequencing (NGS). niPGT-A and TE-biopsy PGT-A results were compared with the sequencing results of the corresponding embryos, which were taken as true results for aneuploidy reporting. With removal of all corona-cumulus cells, the false-negative rate (FNR) for niPGT-A was found to be zero. By applying an appropriate threshold for mosaicism, both the positive predictive value (PPV) and specificity for niPGT-A were much higher than TE-biopsy PGT-A. Furthermore, the concordance rates for both embryo ploidy and chromosome copy numbers were higher for niPGT-A than TE-biopsy PGT-A. These results suggest that niPGT-A is less prone to errors associated with embryo mosaicism and is more reliable than TE-biopsy PGT-A.
To determine if weight or body mass index (BMI) affects the serum progesterone level at the time of the pregnancy test in cryopreserved blastocyst transfer cycles and to determine if those serum ...progesterone levels affect live births.
Retrospective cohort study.
US academic medical center.
Six hundred thirty-three patients undergoing their first cryopreserved embryo transfer cycle.
None.
The primary outcome was the serum progesterone level on the day of the pregnancy test by patient weight and BMI. Our secondary analysis assessed the serum progesterone effect on live birth rate (LBR) in a clinic where progesterone supplementation was increased if the progesterone level was <15 ng/mL on the day of the pregnancy test.
There was a strong negative correlation between serum progesterone level and both BMI and weight, with BMI accounting for 27% and weight accounting for 29% of the variance in progesterone level. Serum progesterone level on the day of the pregnancy test was <15 ng/mL in 3% of women weighing <68 kg compared with 29% of women weighing ≥90.7 kg. Among women weighing ≥90.7 kg, live birth occurred in 47% whose serum progesterone level was <15 ng/mL on the day of the pregnancy test compared with 49% in those with serum progesterone level of 15–19 ng/mL and 44% in those with serum progesterone level of ≥20 ng/mL.
Body weight was a significant factor in serum progesterone level at the time of the pregnancy test, with nearly 30% of patients weighing ≥90.7 kg having serum progesterone level of <15 ng/mL, a value associated with lower LBRs in prior studies. However, we found no effect of low progesterone levels on LBR after cryopreserved embryo transfer cycles in a clinic where progesterone dosing was increased if serum progesterone levels were <15 ng/mL.
Advanced paternal age has been overlooked, and its effect on fertility remains controversial. Previous studies have focused mainly on intracytoplasmic sperm injection (ICSI) cycles in men with ...oligozoospermia. However, few studies have reported on men with semen parameters within reference ranges. Therefore, we conducted a retrospective cohort study analyzing the reproductive outcomes of couples with non-male-factor infertility undergoing in vitro fertilization (IVF) cycles. In total, 381 cycles included were subgrouped according to paternal age (<35-year-old, 35-39-year-old, or ≥40-year-old), and maternal age was limited to under 35 years. Data on embryo quality and clinical outcomes were analyzed. The results showed that fertilization and high-quality embryo rates were not significantly different (all P > 0.05). The pregnancy rate was not significantly different in the 35-39-year-old group (42.0%; P > 0.05), but was significantly lower in the ≥40-year-old group (26.1%; P < 0.05) than that in the <35-year-old group (40.3%). Similarly, the implantation rate significantly decreased in the ≥40-year-old group (18.8%) compared with that in the <35-year-old group (31.1%) and 35-39-year-old group (30.0%) (both P < 0.05). The live birth rate (30.6%, 21.7%, and 19.6%) was not significantly different across the paternal age subgroups (<35-year-old, 35-39-year-old, and ≥40-year-old, respectively; all P > 0.05), but showed a declining trend. The miscarriage rate significantly increased in the 35-39-year-old group (44.8%) compared with that in the <35-year-old group (21.0%; P < 0.05). No abnormality in newborn birth weight was found. The results indicated that paternal age over 40 years is a key risk factor that influences the assisted reproductive technology success rate even with good semen parameters, although it has no impact on embryo development.
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