Éclosion embryonnaire assistée : évaluation des indications au CHU de Rouen

ObjectiveDespite technical progress in In Vitro Fertilisation (IVF) procedure, embryo implantation rate remains low. Assisted hatching has been proposed to facilitate natural embryo hatching and implantation.Patients and methodsOur study has evaluated whether laser assisted hatching improves implantation, pregnancy and live birth rates in different cases. We studied retrospectively 143 IVF cycles concerning more than 38 years old women, 166 IVF cycles after two previous implantation failures and 180 frozen-thawed embryo transfers.ResultsPopulation characteristics were comparable in hatched and control groups. Implantation, pregnancy and live birth rates in women more than 38 years old were comparable with or without assisted hatching. Concerning repeated implantation failures, even if implantation, pregnancy and live birth rates were higher in assisted hatching group (FIV or ICSI), the differences were not significant. After frozen-thawed embryo transfers, implantation rate was significantly better with assisted hatching (19.14% vs 8.84% [p = 0.02]).Discussion and conclusionAssisted hatching improves embryo implantation rate after frozen-thawed embryo transfer.     

Lower embryonic loss rates among twin gestations following assisted reproduction

Purpose: To determine whether maternal age and number of transferred embryos influence early pregnancy losses in twin pregnancies compared to singletons following IVF/ICSI.Methods: We compared the pregnancy loss rates in singleton (n = 549) and twin (n = 252) gestations, stratified by maternal age (≤35 and > 35 years) and the number of transferred embryos (1–3 and 4–9).Results: Loss rates of singleton pregnancies were significantly higher than that in twins (OR 3.0, 95% CI 1.9, 4.9), especially among singletons conceived after transfer of 4–9 embryos (OR 5.0, 95% CI 2.2, 11.9). Younger mothers of twins had lower loss rates (OR 0.3, 95% CI 0.1, 0.9).Conclusion: Twins have a significantly reduced spontaneous miscarriage rate compared with singletons following IVF/ICSI. Higher implantation rates per cycle (i.e., development of twins rather than one live embryo) may represent a better capacity of the uterus for early embryonic development.     

The effect of ICSI in infertility couples with non-male factor: a systematic review and meta-analysis

PurposeWe performed a systematic review and meta-analysis of available literature to investigate the efficacy of the intracytoplasmic sperm injection (ICSI) in couples with non-male factor with respect to the clinical outcomes.MethodsThe literature search was based on EMBASE, PubMed, and the Cochrane Library. All studies published after 1992 until February 2020 and written in English addressing patients in the presence of normal semen parameters subjected to ICSI and in vitro fertilization (IVF) were eligible. Reference lists of retrieved articles were hand-searched for additional studies. The primary outcomes were fertilization rate, clinical pregnancy rate, and implantation rate; the secondary outcomes were good-quality embryo rate, miscarriage rate, and live birth rate.ResultsFour RCTs and twenty-two cohort studies fulfilling the inclusion criteria were included. Collectively, a meta-analysis of the outcomes in RCTs showed that compared to IVF, ICSI has no obvious advantage in fertilization rate (RR = 1.16, 95% CI: 0.83–1.62), clinical pregnancy rate (RR = 1.04, 95% CI: 0.66–1.64), implantation rate (RR = 1.12, 95% CI: 0.67–1.86), and live birth rate (RR = 1.17, 95% CI: 0.43–3.15). Pooled results of cohort studies demonstrated a statistically significant higher fertilization rate (RR = 1.16, 95% CI: 1.03–1.31) and miscarriage rate (RR = 1.04, 95% CI: 1.01–1.06) in the ICSI group; furthermore, higher clinical pregnancy rate (RR = 0.85, 95% CI: 0.77–0.94), implantation rate (RR = 0.78, 95% CI: 0.65–0.95), and live birth rate (RR = 0.86, 95% CI: 0.79–0.94) was founded in the IVF group; no statistically significant difference was observed in good-quality embryo rate (RR = 0.98, 95% CI: 0.93–1.04).ConclusionICSI has no obvious advantage in patients with normal semen parameters. Enough information is still not available to prove the efficacy of ICSI in couples with non-male factor infertility comparing to IVF.Electronic supplementary materialThe online version of this article (10.1007/s10815-020-01970-9) contains supplementary material, which is available to authorized users.     

Does assisted hatching improve implantation rates after in vitro fertilization or intracytoplasmic sperm injection in all patients? A prospective randomized study

Purpose: Preliminary data from some research centers indicate that assisted hatching might be of value to increase embryo implantation rate in the human, at least in selected cases. It is not clear, however, whether this technique would be of benefit for all patients undergoing an embryo transfer. We therefore performed a prospective randomized study to evaluate the effect of assisted hatching on the implantation rate in our in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) program. Methods: In total, 120 couples undergoing an embryo transfer were randomized between two groups: in one group no assisted hatching was performed (AH–), whereas in the other group the embryos selected for transfer were subjected to partial zona dissection (PZD) immediately prior to the transfer (AH+). Using a computer-generated minimization procedure, patients were allocated to one of the two groups according to four preselected criteria: the number of embryos transferred, the cumulative score of transferred embryos, the age of the patient, and the use of ICSI. Results: Pregnancy and implantation rates in the AH+ and AH– groups were, respectively, 42.1 versus 38.1% and 17.9 versus 17.1%. Conclusions: From our data we conclude that assisted hatching through partial zona dissection prior to embryo transfer does not improve pregnancy and embryo implantation rates in unselected patients undergoing IVF or ICSI.Presented in part at the IXth World Congress on In Vitro Fertilization and Alternate Assisted Reproduction, Vienna, Austria, April 3–7, 1995.     

Impaired implantation in endometriosis compared with couples with male subfertility after transfer of equal quality embryos: a matched cohort study

Research questionIs implantation impaired in patients with endometriosis undergoing IVF and intracytoplasmatic sperm injection (ICSI) cycles?DesignA retrospective matched cohort study was carried out on IVF/ICSI cycles with fresh single embryo transfer at the Department of Assisted Reproductive Medicine, Ghent University Hospital, Belgium, between July 2015 and August 2017 (n = 1053). A total of 118 endometriosis cases were matched 1:1 to 118 couples diagnosed with male subfertility and stratified by embryo quality (identical ALPHA grading categories), female age (±1 year) and parity (±1 delivery). Transvaginal ultrasound, magnetic resonance imaging or laparoscopy was used to diagnosed endometriosis, and the revised American Society for Reproductive Medicine score was used to classify the endometriosis into grade I/II versus grade III/IV. Male subfertility was defined in accordance with World Health Organization criteria (fifth edition).ResultsCompared with endometriosis cases, control couples with male subfertility had significantly higher rates of positive HCG test on day 16 (P = 0.047, OR 2.077, CI 1.009 to 4.276), ongoing implantation (defined as a positive fetal heart rate on transvaginal ultrasound at a gestational age of at least 6.5–7 weeks) (P = 0.038, OR 2.265, CI 1.048 to 4.893), ongoing pregnancy (defined by a vital pregnancy at 11 weeks) (P = 0.046, OR 2.292, CI 1.016 to 5.173) and live birth (P = 0.043, OR 2.502, CI 1.029 to 6.087).ConclusionsAfter matching for embryo quality, woman's age and parity, rates of positive HCG tests, ongoing implantation, ongoing pregnancy and live birth were more than twice as high in the control group compared with the endometriosis group.     

Endometrial thickness and IVF cycle outcomes: a meta-analysis

Research questionIn this meta-analysis, the association between endometrial thickness (EMT) and cycle outcomes after IVF is explored. Associations between EMT and cycle outcomes according to study and individual characteristics were also assessed.DesignStudies evaluating associations between EMT and pregnancy, implantation, miscarriage, live birth or ongoing pregnancy and ectopic pregnancy rates in individuals after IVF were identified on PubMed, Embase and the Cochrane Library (from their inception up to December 2018). Pooled odds ratios with 95% confidence intervals, calculated using the random-effects model, were used.ResultsNine prospective and 21 retrospective studies, including a total of 88,056 cycles, were retrieved. The summary odds ratios indicated that women with lower EMT were associated with lower pregnancy rates than those with higher EMT (n = 30, OR 0.61; 95% CI 0.52 to 0.70; P < 0.001). Moreover, the implantation rate in women with lower EMT was significantly reduced (n = 9, OR 0.49; 95% CI 0.32 to 0.74; P = 0.001). Furthermore, no significant association was found between EMT and the miscarriage rate (n = 12). In addition, women with lower EMT were associated with reduced live birth or ongoing pregnancy rate (11 studies, OR 0.60; 95% CI 0.48 to 0.73; P < 0.001). Finally, the incidence of ectopic pregnancy rate between lower and higher EMT showed no statistically significant association (n = 3).ConclusionsLower EMT was associated with lower pregnancy, implantation and live birth or ongoing pregnancy rates.     

Outcome of Pregnancies Derived from Assisted Reproductive Technologies: IVF versus ICSI

Purpose: To compare the course and outcome of in vitrofertilization (IVF) and intracytoplasmic sperm injection(ICSI) pregnancies. Methods: A retrospective study was conducted in a university-affiliatedIVF unit with 200 patients who conceived in1996–1997, 100 with ICSI and 100 with IVF. Data wereretrieved from our prospectively created computerized database.In addition, all patients were interviewed by telephone,and the interviewing physician completed a detailed questionnaire.Findings for the IVF and ICSI pregnancies werecompared. The main outcome measures were maternal age,implantation rate, early pregnancy complications, clinicalabortion rate, multiple pregnancy delivery rate, gestationalage at delivery, mode of delivery, and birth weight. Results: In all, 238 children were born, including 104 singletoninfants (45 IVF, 59 ICSI), 49 twin pairs (28 IVF, 21 ICSI),and 12 triplet sets (3 IVF, 9 ICSI). Statistically significantdifferences between the ICSI and IVF groups were noted formaternal age (31.3 ± 4.4 vs. 33.4 ± 4.8, respectively, P < 0.005)and clinical abortion rate (11% vs. 24%, respectively,P < 0.05). Conclusions: ICSI pregnancies in our series were characterizedby a lower clinical abortion rate than IVF pregnancies,probably because of the mean younger age of the ICSI group.     

Fertility outcomes of IVF/ICSI after Caesarean section: a cohort study

Research questionThe study objective was to evaluate the impact of a previous Caesarean section on fertility outcomes in women undergoing IVF/intracytoplasmic sperm injection (ICSI).DesignA retrospective cohort study was designed that included 1793 women undergoing IVF/ICSI who had had a previous delivery from January 2015 to December 2016. The primary outcome was live birth. Secondary outcomes were implantation, clinical pregnancy, miscarriage, ectopic pregnancy, multiple pregnancy and perinatal complications.ResultsOf the 1793 women included, 796 had had a previous Caesarean section and 997 a previous vaginal delivery. Propensity score matching in a 1:1 ratio resulted in 538 women per group. Compared with women with a previous vaginal delivery, women with a previous Caesarean section had a lower live birth rate (30.1% versus 38.1%, odds ratio [OR] 0.70, 95% confidence interval [CI] 0.54–0.90) and a higher miscarriage rate (25.9% versus 17.5%, OR 1.65, 95% CI 1.06–2.56). Among other secondary outcomes, implantation rates were 32.9% and 37.1% (OR 0.83, 95% CI 0.69–1.01), and clinical pregnancy rates were 42.4% and 46.8% (OR 0.84, 95% CI 0.66–1.06), in the Caesarean section group and vaginal delivery group, respectively. There were no statistically significant differences in terms of ectopic pregnancy, multiple pregnancy or perinatal outcomes between the groups. Further adjustment for confounders did not change the result of the primary outcome (OR 0.64, 95% CI 0.49–0.84).ConclusionsWomen undergoing IVF/ICSI who have had a previous Caesarean section have a lower live birth rate and a higher miscarriage rate than those with a previous vaginal delivery.     

Do Lunar Phases Affect Conception Rates in Assisted Reproduction?

Objectives: To assess the effect of the phases of the moon on pregnancy rates in humans following in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatment.Design: Retrospective, observational study.Setting: Reproductive Medicine Unit, Liverpool Womens Hospital.Patient: Complete data for all women undergoing assisted conception procedures over a period of 13 years (1995–2002).Intervention: Assisted conception procedures-IVF and ICSI.Main outcome measures: Biochemical pregnancy that is positive pregnancy test result following embryo transfer.Results: There was no significant effect of any lunar phase on the incidence of biochemical pregnancy (p-value 0.71). Age of the woman significantly affects the chances of pregnancy, (OR 0.95, 95% CI 0.91, 0.998, and p-value 0.04). The chances of pregnancy rises significantly with increase in the number of embryos replaced from 1 to 2 (OR 2.97, CI 1.36, 6.48, and p-value 0.01).Conclusion: Pregnancy rates in humans, following assisted conception, appears to be independent of the effect of the lunar phase during which embryo transfer is carried out.     

In vitro fertilization in women age 40 and older: The impact of assisted hatching

Purpose To assess the impact of assisted hatching on in vitro fertilization (IVF) outcome in women age 40 and older.Methods A retrospective analysis was performed to compare 28 cycles of IVF without assisted hatching to 38 cycles of IVF with assisted hatching. All patients in both groups were age 40 or older and the mean age was similar.Results The delivery rate per oocyte retrieval was significantly higher in the assisted hatching group (18/38; 48%) compared to the nonhatched controls (3/28; 11%, P=0.0003). The implantation rate of hatched embryos (40/175; 22%) was clearly enhanced, compared to the non-hatched embryos (7/126; 6%, P<0.001). The fertilization rate, number of oocytes and the number of embryos per patient were comparable in the two groups.Conclusions Assisted hatching dramatically improves embryonic implantation and term pregnancy rates in women age 40 and older undergoing IVF.Presented at the IXth World Congress on In Vitro Fertilization and Alternate Assisted Reproduction, April 3–7, 1995, Vienna, Austria.     

Intracytoplasmic Sperm Injection Increases Embryo Fragmentation Without Affecting Clinical Outcome

Purpose: To examine the effect of intracytoplasmic sperminjection (ICSI) on embryo fragmentation and implantationrates in those embryos chosen for transfer compared toconventional in vitro fertilization (IVF). Methods: We compared 253 infertility patients (71 ICSI and182 IVF) with respect to age, semen analysis, number ofembryos transferred, embryo fragmentation, implantationrate, and pregnancy rate. Embryo fragmentation wasdetermined by one observer at the same laboratory over the entirestudy period. Results: A statistically significant difference was observedin mean embryo grade between IVF (2.2 ± 0.84) and ICSI(2.5 ± 0.77), P = 0.01. Additionally, the IVF patients hadsignificantly more nonfragmented (grade I) embryoscompared to the ICSI group, P < 0.01. Conclusions: These data suggest that ICSI, irrespective ofsemen parameters, may increase embryo fragmentation andproduce fewer nonfragmented grade I embryos while maintaining implantation and pregnancy rates similar toconventional IVF.     

Highly purified hMG achieves better pregnancy rates in IVF cycles but not ICSI cycles compared with recombinant FSH: a meta-analysis

Objective. Human menopausal gonadotropin (hMG) was demonstrated to be superior to recombinant FSH (rFSH) regarding clinical outcomes. It is not clear whether this change in the evidence was due to the introduction of highly purified (HP) hMG.

Design. Systematic review of properly randomised trials comparing HP-hMG vs. rFSH in women undergoing in vitro fertilisation (IVF) and/or intracytoplasmic sperm injection (ICSI). A meticulous search was performed using electronic databases and hand searches of the literature.

Results. Six trials (2371 participants) were included. Pooling of the trials demonstrated that the probability of clinical pregnancy following HP-hMG administration was higher than rFSH and reached borderline significance (odd ratio (O.R) = 1.21, 95% confidence interval (CI) = 1.00 to 1.45), but the ongoing pregnancy/live-birth rate was not statistically different between the two drugs, although it showed strong trends towards improvement with HP-hMG (O.R = 1.19, 95% CI = 0.98 to 1.44).

Subgroup analysis comparing both drugs in IVF cycles demonstrated a statistically significant better ongoing pregnancy/live-birth rate in favour of HP-hMG (O.R = 1.31, 95% CI = 1.02 to 1.68). On the other hand, there was almost an equal ongoing pregnancy/live-birth rate in ICSI cycles (OR = 0.98, 95% CI = 0.7 to 1.36).

Conclusions. HP-hMG should be preferred over rFSH in women undergoing assisted reproduction, especially if IVF is the intended method of fertilisation.     

The Effect of Preincubation Period of Oocytes on Nuclear Maturity, Fertilization Rate, Embryo Quality, and Pregnancy Outcome in IVF and ICSI

Purpose : To clarify the effect of preincubation of oocytes on the results of IVF and ICSI. Methods : A total of 176 IVF and 64 ICSI cycles received long protocol ovarian stimulation. The oocytes were incubated for 1–8 h before insemination or sperm injection. Metaphase II (MII) percentage was evaluated in the ICSI arm; fertilization rates, embryo quality, and pregnancy outcomes were analyzed in both IVF and ICSI arms according to the preincubation period duration of oocytes. Results : The MII percentage of the ICSI arm was significantly lower (P < 0.05) in the group with preincubation period of <2.5 h. The fertilization rates in groups with preincubation for 2.5–5.5 h were significantly higher (P < 0.001) for IVF. Embryo quality and pregnancy outcomes were not significantly different between the IVF or ICSI arm. Conclusions : The preincubation of oocytes for at least 2.5 h is beneficial to both IVF and ICSI outcomes by increasing the nuclear maturity of oocytes.     

Is Intracytoplasmic Sperm Injection Necessary for Couples Undergoing In Vitro Fertilization–Embryo Transfer with Normal Semen Analyses but Failing Hamster Egg Penetration Assays?

Purpose: Our purpose was to assess whether in vitro fertilization (IVF)–embryo transfer (ET) candidate couples with basically normal semen analyses but failing zona-free hamster egg penetration assay (HEPA) scares benefit from intracytoplasmic sperm injection (ICSI). Methods: Twenty consecutive IVF candidate couples with normal–borderline semen analyses and failing HEPA scores were recruited. Mature oocytes obtained from each woman were randomly divided between ICSI (group I; n = 126 oocytes) and standard insemination techniques (group II; 138 oocytes). Fertilization (two pronuclei) and cleavage (2–4 cells) rates were assessed for both groups. Results: There were no statistically significant differences between the two groups with respect to (mean ± standard error of the mean) fertilization (group I, 63.1 ± 7.75; group II, 77.8 ± 4.7%) or cleavage (group I, 87.3 ± 2.4%; group II, 91.2 ± 3.5%) rates. Conclusions: ICSI is not beneficial for IVF-ET when sperm samples demonstrate a failing HEPA score but have normal or minimally compromised semen analysis parameters.     

The Use of an Hydrogen Peroxide Multipurpose Isolator for Inhouse Preparation of Human Embryo Culture Media: A Unique Successful Swiss Randomized Prospective Study

Purpose: To develop inhouse made (IHM) embryo culture medium with a Multipurpose Isolator and compare the embryo development in a prospective randomized study with commercial media.Methods: Fertilization by intracytoplasmic single sperm injection (ICSI) of Metaphase II oocytes obtained after 96 controlled ovarian hyperstimulation cycles in patients not older than 37 years. Transfer of zygotes to IHM or commercial Cook Sydney IVF Cleavage medium (SIC) immediately after pronucleus observation. Evaluation of embryo cleavage and score, pregnancy, and implantation rate.Results: From 100 zygotes cultured in SIC, 61% were at the 4 cell stage 45 h after ICSI compared to 77% (78/101) in the IHM, P<0.05. The mean embryo score with IHM was 3.9±0.9 compared to 3.5±1.2 with SIC, P<0.05. The clinical pregnancy rate per transfer was 38.9% (37/95), the implantation rate was 23% (46/200), and no differences were observed between the groups.     

Association between the number of top-quality blastocysts and live births after single blastocyst transfer in the first fresh or vitrified–warmed IVF/ICSI cycle

Research questionIs there an association between the total number of top-quality blastocysts (TQB) developed in the first IVF/intracytoplasmic sperm injection cycle (ICSI) and live births after a single blastocyst transfer (SBT)?DesignPregnancy outcomes from 1336 infertile women who had undergone their first IVF/ICSI treatment and accepted a first-time embryo transfer with a single fresh or vitrified–warmed blastocyst between January 2016 and August 2018 were assessed retrospectively. The restricted cubic splines method was used to evaluate the association between the number of TQB, and ongoing pregnancies and live births.ResultsA significant non-linear functional form was found between the number of TQB and the ongoing pregnancies and live births (P < 0.05). The odds of an ongoing pregnancy or live birth were similar, at about 11% or higher for each additional TQB up to five TQB (odds ratio [OR] 1.11; 95% confidence interval [CI] 1.01–1.21). After this, pregnancy outcomes nearly plateaued, indicating that the number of TQB was not related to pregnancy when it was greater than five.ConclusionsThe quantity of TQB available for transfer or cryopreservation can provide important predictors for pregnancy and live birth after the first embryo transfer cycle with a single blastocyst. This valuable information may assist with the future application of SBT.     

Sperm DNA fragmentation index and pregnancy outcome after IVF or ICSI: a meta-analysis

PurposeThe purpose of this study was to carry out a meta-analysis for a comprehensive understanding and estimation of the association between sperm DNA Fragmentation Index (DFI) and pregnancy outcome after in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment.MethodsStudies concerning the link of DFI with pregnancy outcome were included after literature search of database PUBMED, EMBASE, MEDLINE. Related information was extracted from the eligible studies by two independent authors and a meta-analysis was conducted by using STATA 12.0 software. Pregnancy outcomes consisted of biochemical pregnancy (BP), clinical pregnancy (CP) and pregnancy loss (PL). The studies included for meta-analysis were divided into three groups according to the DFI threshold value (DFI >27 %, 15–27 %, ≤15 % group). The odds ratio (OR ) and their 95 % confidence intervals (95 % CIs) were used to evaluate the association between DFI and pregnancy outcome.ResultsTwenty articles were included in our meta-analysis. The results indicated that infertile couples were more likely to get pregnant if DFI was less than threshold value (For threshold value > 27 % and 15–27 % group, combined overall OR (95 % CI) = 1.437 (1.186–1.742), 1.639 (1.093–2.459) respectively). However, when stratified by DFI detection methods, using sperm chromatin structure assay (SCSA) as the DFI test method, the results indicated a similar CP rate between groups with a high DFI or a lower DFI value (SCSA, For threshold value >27 % and 15–27 % group, combined overall OR (95 % CI) = 1.242(0.978–1.577), 1.480(0.921–2.377) respectively). The meta-analysis based on BP (overall OR (95 % CI) = 0.952 (0.697–1.302)) and PL((For DFI >27 %, 15–27 %, ≤15 % group, OR (95 % CI) = 0.786 (0.491–1.258), 1.509 (0.655–3.476), (0.538 (0.264–1.097) respectively) outcome yielded nonsignificant results.ConclusionsThe predication value of DFI for IVF or ICSI outcome is not confirmed in our meta-analysis. Further better designed studies with larger subjects involved are needed to better address this issue.     

A Meta-Analysis of Controlled Studies Comparing Major Malformation Rates in IVF and ICSI Infants with Naturally Conceived Children

Purpose: To estimate the risk of major malformations in IVF and ICSI infants.Methods: Forty-four studies published in English since 1990 where the major malformation rate for IVF or ICSI cases was compared to an appropriate control group were reviewed. Nineteen studies met all selection criteria. In addition, a quality score was developed to assess each study based on sample size, timing of diagnosis, appropriateness of control group and other factors.Results: In 19 studies, the major malformation rates ranged from 0–9.5% for IVF; 1.1–9.7 for ICSI; and 0–6.9% in the control groups. When ICSI was compared to IVF, and multiple births compared to singleton, there were no statistically significant differences. When data from 16 studies involving 28,524 IVF infants and 2,520,988 spontaneously conceived controls and 7 studies involving 7234 ICSI infants and 978,078 controls were pooled, we found an overall odds ratio for the 19 studies of 1.29 (95% CI 1.01–1.67).Conclusions: The overall odds ratio of 1.29 was statistically significant at the 5% level. These results may be useful for counseling ART patients and properly designing the consent forms used for ART procedures. It is not clear whether this risk is due to the procedures used in ART. We found that some of these studies have design flaws. All of them lacked an appropriate control group, i.e. infertile patients conceiving spontaneously. These flaws may create biases that would in almost all instances increase the risk of major malformations in the study group. Further research with better designed studies will likely result in a better estimate of the risk of major malformations associated with IVF and ICSI.     

Maternal risks and perinatal outcome in a Danish national cohort of 1005 twin pregnancies: the role of in vitro fertilization

BACKGROUND: Twin pregnancies constitute 25% of all in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) pregnancies. There is a lack of knowledge on maternal risks and perinatal outcome of IVF/ICSI twin pregnancies. METHODS: National survey by questionnaire (n = 1769). The study population consisted of all IVF/ICSI twin mothers (n = 266) and the two control groups of all IVF/ICSI singleton mothers (n = 764) and non-IVF/ICSI twin mothers (n = 739) who delivered in Denmark in 1997. The response rate was 89% among IVF twin mothers and overall 81%. RESULTS: In terms of maternal risks and perinatal outcome no significant differences were observed between IVF/ICSI twin and non-IVF/ICSI twin pregnancies after stratification for maternal age and parity. Nevertheless, IVF/ICSI twin mothers were more frequently on sick leave (OR 2.5, 95% CI 1.5-4.0) and hospitalized (OR 1.9, 95% CI 1.3-2.8) during pregnancy. Compared with IVF/ICSI singleton pregnancies, IVF/ICSI twin pregnancies were characterized by a higher incidence of preeclampsia (OR 2.4, 95% CI 1.5-4.2) and a higher frequency of sick leave (OR 6.8, 95% CI 4.4-10.5) and hospitalizations during pregnancy (OR 3.5, (95% CI 2.5-4.9); moreover, mean birthweight (p < 0.001) and gestational age (p < 0.001) were lower. No differences were observed in the incidence of pregnancy-induced hypertension and gestational diabetes between IVF/ICSI twin and singleton pregnancies. CONCLUSION: Although this population study indicates that maternal risks in IVF/ICSI twin pregnancies are comparable with non-IVF/ICSI twin pregnancies, the IVF/ICSI twin mothers were more likely to be on sick leave or hospitalized during pregnancy. Furthermore, maternal risks were higher and obstetric outcome poorer in IVF/ICSI twin vs. IVF/ICSI singleton pregnancies.     

High placental index and poor pregnancy outcomes: a retrospective study of 18 386 pregnancies

Abstract

Introduction: Our aim was to state the correlation between placental index and pregnancy outcomes or in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) pregnancies.

Materials and methods: We included in this retrospective study all singleton births in a third level clinic during the period 2001–2011 (n?=?18?386). We divided placental index into quartiles and analyzed the differences between the groups in term of pregnancy outcomes. Then, we estimated crude and adjusted odds ratios (ORs) for placental index over the third centile of the distribution to correlate with pregnancy outcomes. We also analyzed the correlation between IVF/ICSI conceived pregnancies and placental index.

Results: Poor pregnancy outcomes were overrepresented in the highest quartile of placental index distribution. Thus, placental index was higher in pregnancies characterized by pregnancy-related hypertensive disorders (PRHDs), small for gestational age infants, newborn needing cardiopulmonary resuscitation or hospitalization in neonatal intensive care unit. These findings were independent of maternal age, length of gestation at delivery, IVF/ICSI conception and ethnicity. For IVF/ICSI pregnancies, the OR for being over the third quartile of placental index distribution was 2.01 (CI.95 1.40–2.90) after adjustment for maternal age, length of gestation, ethnicity, birth weight, parity, fetal sex, alteration of glucose metabolism in pregnancy and PRHDs.

Conclusions: We found a high placental index among pregnancies characterized by poor outcomes and conceived by IVF/ICSI.