The effect of first trimester subchorionic hematoma on pregnancy outcomes in patients underwent IVF/ICSI treatment

Objective: The aim of this retrospective cohort study was to assess the effect of subchorionic hematoma (SCH) on pregnancy outcomes in IVF/ICSI patients.

Methods: We retrospectively analyzed 1097 pregnancies achieved by in vitro fertilization and embryo transfer (IVF-ET) or frozen-thawed embryo transfers (FETs) between January 2013 and June 2013 at the IVF center of Nanjing Drum Tower Hospital. The prevalence of SCH was 12.1% in this group (133/1097). We compared the pregnancy outcomes between the SCH group and non-SCH group, while the risk factors for SCH were also evaluated.

Results: There was no significant difference between SCH group and non-SCH group with regard to patients’ age, spouse’s age, endometrial thickness, miscarriage rate (5.6% versus 6.2%, p?>?0.05), second trimester fetus loss rate (5.6% versus 7.7%, p?>?0.05) or live birth rate (89.5% versus 86.1%, p?>?0.05). While the birth weight in singleton pregnancy in SCH group was significant lower (3207.8?±?595.7?g versus 3349.2?±?59.7?g, p =?0.03). SCH was more common in fresh embryo transfer patients than that in FET patients (16.6% versus 5.1%, p?Conclusion: We concluded that SCH was associated with lower birth weight in singleton pregnancy, but SCH did not increase pregnancy loss rate in IVF/ICSI patients, and fresh embryo transfer may contribute to SCH onset.     

Early pregnancy loss in in vitro fertilization (IVF) is a positive predictor of subsequent IVF success

OBJECTIVE: To determine the significance of biochemical pregnancy losses and clinical spontaneous abortion (SAB) on outcomes of future IVF cycles. DESIGN: Retrospective cohort study. SETTING: Academic IVF program. PATIENT(S): Women with a history of unsuccessful IVF attempts undergoing IVF. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate. RESULT(S): Patients with an early pregnancy loss had a greater ongoing clinical pregnancy rate in the immediate next cycle when compared with those women who had a negative pregnancy test (37.3% vs. 27.3%). Patients with a history of a biochemical pregnancy or a clinical spontaneous abortion had an ongoing clinical pregnancy rate in the next cycle of 38.4% and 42.3%, respectively, compared with 27.3% in women who had a history of a negative pregnancy test. The cumulative pregnancy rate after the first IVF attempt was 54.1% in patients with a previous biochemical pregnancy loss, 61.4% in those with a previous clinical SAB, and 46.5% in women with a previous negative pregnancy test. CONCLUSION(S): Women who experience an early pregnancy loss after IVF have a greater likelihood of success in subsequent IVF cycles when compared with patients who fail to conceive.     

Serum estradiol and progesterone in the mid-luteal phase predict clinical pregnancy outcome in IVF/ICSI cycles

Abstract

In this prospective study, we tested the hypothesis if E2 and P serum levels significantly differ during the luteal phase following in vitro-fertilization/intracytoplasmic sperm injection (IVF/ICSI) therapy in conception (CC) versus non-conception (NC) cycles, and their potential in the prediction of pregnancy at the earliest point in time. Serum was sampled from the day of embryo transfer (ET) and throughout the luteal phase until ET?+?14 from patients consecutively enrolling for IVF/ICSI therapy. The luteal phase was supported by vaginal P suppositories only, clinical pregnancies were detected by ultrasound and followed up until the 20th week. Overall pregnancy rate was 30.9% constituting the two study groups of CC (n?=?22) and NC cycles (n?=?49). Significantly, higher E2 (3326?±?804 versus 1072?±?233?pmol/l, p?=?0.014) and P (244?±?68 versus 73?±?10?nmol/l, p?=?0.023) were present in CC versus NC from as early as ET?+?7. In the CC group, patients with ongoing pregnancies (CC-OG) as compared with miscarriages (CC-MC) had significantly higher E2 and P from ET?+?7, predicting ongoing pregnancy in receiver operator characteristics analysis.     

肌壁间子宫肌瘤对体外受精-胚胎移植临床结局的影响

目的:探讨宫腔形态无改变的肌壁间子宫肌瘤对体外受精/卵胞质内单精子注射-胚胎移植(in vitro fertilization/intracytoplasmic sperm injection-embryo transfer,IVF/ICSI-ET)临床结局的影响。方法:选择行IVF/ICSI-ET治疗伴单发或多发肌壁间子宫肌瘤且宫腔形态正常的93例不孕症患者作为研究对象,共行胚胎移植104个周期(研究组);按对照组与研究组1:3比例随机抽取同期行IVF/ICSI-ET且无子宫肌瘤的308例患者作为对照组,共行IVF/ICSI-ET周期312个,分析控制性超促排卵(COH)、体外受精参数和妊娠结局。结果:研究组患者的年龄、不孕年限显著高于对照组(P0.05),促性腺激素(Gn)使用天数、获卵数显著低于对照组(P0.05);体质量指数(BMI)、Gn用量、双原核(2PN)率、卵裂率、优质胚胎率、临床妊娠率、着床率、异位妊娠率、早期流产率、晚期流产率、活产率、单胎活产率、双胎活产率、早产率、低体质量儿率、出生缺陷率组间均无统计学差异(P0.05)。结论:宫腔形态无改变的肌壁间子宫肌瘤对IVF-ET的临床结局无明显不良影响。     

The effect of endometrial thickness on the day of hCG administration on pregnancy outcome in the first fresh IVF/ICSI cycle

The aim of this study was to investigate the effect of endometrial thickness (EMT) on human chorionic gonadotropin (hCG) day on in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcome. A retrospective study was conducted on the clinical data of 756 patients in their first fresh IVF/ICSI cycle at the Wuxi Maternity and Child Health Hospital. Compared with the pregnancy failure group, the clinical pregnancy group had more transferable embryos and good-quality embryos and had a thicker endometrium (p?<?0.05). The endometrial pattern was not significantly different between the two groups. EMT was found to be an independent prognostic factor for clinical pregnancy (adjusted OR?=?1.25, 95% CI: 1.15–1.36, p?<?0.01). Seven hundred and fifty-six cycles were categorized into three groups upon EMT on the hCG day: group 1 (EMT??14?mm). Group1 had significantly lower clinical pregnancy, embryo implantation and live birth rates compared with group 2 and 3 (p?<?0.01), while there was no significant difference in either spontaneous abortion or multiple-birth rate among these three groups. It was concluded that EMT on the hCG day was associated with pregnancy outcome in the first fresh IVF/ICSI cycle. A higher clinical pregnancy rate could be achieved when EMT?≥?8?mm, and no adverse pregnancy outcome was observed when EMT?>?14?mm.     

Impact of a restriction in the number of embryos transferred on the multiple pregnancy rate

OBJECTIVE: To study the impact of the introduction of reimbursement of in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) laboratory costs in Belgium which is linked to an embryo transfer strategy leading to prevention of multiple pregnancies. The impact on the incidence of multiple and twin pregnancy rate as well as on ongoing pregnancy rate in our centre is calculated. STUDY DESIGN: Observational cohort study of all patients in the first year (July 1, 2003-June 30, 2004) since the implementation of the law and comparison of ongoing pregnancy rate and multiple pregnancy rate of our centre with Belgian data. RESULTS: Our results of one year of IVF/ICSI since reimbursement of laboratory costs show a total conception rate of 42.2% with 29.7% ongoing pregnancies beyond 25 weeks amenorrhea. The multiple pregnancy rate was 8.5% including five monozygotic twin pregnancies. These data show an important decline of multiple pregnancy rate when compared to Belgian data (2002) with 24.4% multiple pregnancy rate in the year prior to reimbursement. CONCLUSION: The introduction of reimbursement of IVF/ICSI laboratory costs coupled to a restriction in the number of embryos for transfer has reached the goal of halving the multiple pregnancy rate since its introduction while maintaining an optimal ongoing pregnancy rate.     

Recurrent heterotopic pregnancy after bilateral salpingectomy in an IVF patient: Case report

Purpose: To report a rare clinical case of recurrent heterotopic pregnancy in the same patient following bilateral salpingectomy and in-vitro fertilization (IVF) treatments. Methods: A 35 year-old woman, suffering from mechanical infertility, was treated by IVF, resulting in two episodes of heterotopic pregnancies within 2 years. The first episode ended in bilateral salpingectomy due to unilateral tubal pregnancy and contralateral severely damaged tube. The intrauterine pregnancy ended in early missed abortion. The second heterotopic pregnancy presented as bleeding cornual pregnancy, managed by laparoscopic resection of the tubal stump, and ended in a term singleton delivery. Conclusion: The possibility of cornual heterotopic pregnancy following bilateral salpingectomy, though very rare, should be considered by every gynecologist treating IVF patient.     

ABO血型、ABO血型抗体与IVF/ICSI-ET妊娠结局的关系

目的:探讨ABO血型、ABO血型抗体对IVF/ICSI-ET妊娠结局的影响.方法:回顾性分析2015年1月至2018年1月于山东大学附属生殖医院接受IVF/ICSI-ET的5370例不孕症患者的临床资料.根据女性血型分为O组、A组、B组、AB组,比较各组的妊娠结局,并进一步将O型血女性按血型抗体分组,比较其妊娠结局.结...     

Low follicular fluid IL-6 levels in IVF patients are associated with increased likelihood of clinical pregnancy

Purpose  

Relationships between follicular fluid levels of IL-6 with ovarian response and clinical pregnancy were evaluated in IVF-ET cycles.     

Predictive value of basal androgen levels on ongoing pregnancy rates during in vitro fertilization cycles

We aimed to evaluate the impact of elevated basal androgen levels on the endometrial receptivity. This study retrospectively enrolled 5278 fresh in vitro fertilization (IVF) cycles and sought to determine whether increased basal androgen levels are associated with adverse outcomes in regard to ongoing pregnancy rates. The results showed that the average age of our sample was 29.31 years. Almost 61.6% of all embryo transfers were with Day 3 embryos and the remaining 38.4% were with Day 5 embryos. The ongoing pregnancy rate was 56.4%. The ongoing pregnancy rates according to the various ordinal serum androgen intervals (<10.00, 10.00–19.99, 20.00–29.99, 30.00–39.99, and ≥40.00?ng/dL) were 60.12, 56.62, 58.64, 55.48, and 50.17%, respectively. The ongoing pregnancy rates were significantly lower in patients with high basal androgen levels (e40?ng/dL) (p?<?.05). Multivariate regression analysis showed that age, BMI, and endometrial thickness were inversely associated with basal androgen levels (p?相似文献   

Association of p53 polymorphism with ICSI/IVF failure and recurrent pregnancy loss

Background: The p53 tumour suppressor gene is a well-known factor regulating apoptosis in a wide variety of cells. Alterations in the p53 gene are among the most common genetic changes in human cancers. Several polymorphisms of the p53 tumour suppressor gene have been associated with recurrent pregnancy loss (RPL).
Aims: To evaluate the association of polymorphisms p53 codon 72 with the response to in vitro fertilisation (IVF) treatment and occurrence of repeated miscarriages.
Methods: The homozygous and heterozygous genotypes and allelic frequencies of Arg and Pro p53 at codon 72 were identified by using polymerase chain reaction–restriction fragment length polymorphism technique in 70 infertile women with more than two IVF failures. Each comparison was made with 97 women experiencing RPL and 32 fertile women each with at least two healthy children as the control group.
Results: The frequency of homozygous Pro/Pro genotypes was found significantly higher among the women with RPL than the other two groups ( P  = 0.041). Whereas, Arg/Arg genotype was significantly different in the recurrent implantation failure (RIF) group ( P  = 0.005).
Conclusion: It is concluded that p53 codon 72 polymorphism may serve as a susceptible factor affecting the chances of RPL and RIF.     

Construction and validation of a prediction model to minimize twin rates at preserved high live birth rates after IVF

Research question

Elective single-embryo transfer (eSET) at blastocyst stage is widely used to reduce the frequency of multiple pregnancies after IVF. There are, however, concerns about increased risks for the offspring with prolonged embryo culture. Is it possible to select embryos for transfer at the early cleavage stage and still achieve low twin rates at preserved high live birth rates?

Selective single blastocyst transfer reduces the multiple pregnancy rate and increases pregnancy rates: a pre- and postintervention study

Objective  To examine the clinical pregnancy rate (CPR) and multiple pregnancy rate (MPR) in a large in vitro fertilisation (IVF) programme before and after the introduction of single blastocyst transfer (SBT) strategy in a selected group of women.
Design  A 3-year pre- and postintervention study.
Setting  A tertiary reproductive medicine and assisted conception unit in a London teaching hospital.
Population  Two thousand four hundred and fifty-one fresh IVF cycles performed between July 2004 and June 2007 at the Assisted Conception Unit at Guy's and St Thomas' Hospital NHS Foundation Trust were included in the study.
Methods  In January 2006, we implemented a multidisciplinary intervention involving the introduction of a selective day 5 SBT service together with an educational programme on the risks of multiple pregnancy and potential advantages of blastocyst transfer aimed at couples at high risk of multiple pregnancy.
Main outcome measures  The CPR per cycle started and MPR per clinical pregnancy achieved.
Results  A statistically significant increase in the CPR from 27% (324/1198) to 32% (395/1253) (risk difference [RD] 5%, risk ratio [RR] 1.17, 95% CI 1.03–1.32, P = 0.015) and reduction in the MPR per clinical pregnancy from 32% (103/272) to 17% (69/395) (RD 15%, RR 0.46, 95% CI 0.35–0.60, P < 0.001) were observed after introduction of the SBT service.
Conclusion  Selective SBT in women with good prognosis can reduce the MPR after IVF while maintaining the overall success rate of the IVF programme.     

Live birth following IVF/ICSI using oocytes from donor who was conceived via IVF: a case report

Purpose

The purpose of the study was to report a case of live birth following donor oocyte in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) in which the oocyte donor herself was conceived via IVF. To our knowledge, such a case has not been previously reported.

Methods

Retrospective chart review; this case is reported after chart review of a successful outcome.

Results

A 42 year-old woman, with diminished ovarian reserve, and her husband desired to conceive. She underwent a fresh IVF/ICSI cycle with her own oocytes, which unfortunately was not fruitful in terms of pregnancy or cryopreserved embryos. The couple was counseled regarding the option of donor oocytes, and they elected to proceed with a fresh cycle of donor oocyte IVF/ICSI. The couple selected an anonymous oocyte donor from a donor agency who was a first-time oocyte donor and, interestingly, was conceived via IVF herself. The fresh donor oocyte/IVF/ICSI cycle did not result in pregnancy; however, two supernumerary blastocysts were cryopreserved for future cycles. The recipient’s subsequent frozen-thawed embryo transfer (FET) resulted in a singleton gestation and live birth.

Conclusions

An oocyte donor who was conceived via IVF had good ovarian response to stimulation, a good number of oocytes retrieved, and the formation and cryopreservation of blastocysts which, in a subsequent FET cycle, resulted in pregnancy and live birth for a recipient couple. To our knowledge, this is the first case reported of live birth with the use of donor oocytes from an oocyte donor who herself was conceived via IVF.     

二甲双胍对体外受精/卵胞质内单精子显微注射中多囊卵巢综合征患者妊娠结局有效性的系统评价

目的:系统性评价二甲双胍对常规体外受精/卵胞质内单精子显微注射(IVF/ICSI)中多囊卵巢综合征(PCOS)患者妊娠结局的有效性,旨在为助孕前的干预措施提供理论依据。方法:计算机检索中国学术期刊全文数据库(CNKI)、万方数据库、维普数据库、Pub Med、Medline、Embase有关二甲双胍对IVF/ICSI中PCOS患者妊娠结局的临床随机对照试验(RCT)。按Cochrane系统评价方法,首先对纳入的文献进行质量评价和资料提取后,采用Rev Man5.2软件进行Meta分析。结果:纳入11个RCT研究,共1 310例患者,其中二甲双胍组713例,对照组597例。Meta分析结果显示:与对照组相比较,二甲双胍组的临床妊娠率(OR=1.60,95%CI:1.26~2.04,P=0.000 2)较高,卵巢过度刺激综合征(OHSS)发生率较低(OR=0.45,95%CI:0.31~0.64,P=0.000 1)。而活产率(OR=1.38,95%CI:0.98~1.94,P=0.06)和流产率(OR=0.72,95%CI:0.51~1.02,P=0.07)组间无统计学差异。结论:二甲双胍可提高IVF/ICSI中PCOS患者的妊娠率、降低OHSS发生率,但不能提高活产率及降低流产率。     

Efficacy of IVF following conservative management of endometrial cancer

Five cases of conservative management of early stage uterine carcinoma were reported. All patients successfully underwent in vitro fertilization (IVF). Role of conservative treatment, IVF and prophylactic surgery followed competition of parity was discussed.     

Effect of ICSI on subsequent blastocyst development and pregnancy rates

Purpose: To investigate whether ICSI (intracytoplasmic sperm injection)results in decreased blastocyst formation and pregnancy compared to IVF (in vitro fertilization). Methods: We performed a retrospective analysis of blastocyst transfer (BT)offered routinely to patients under age 40 with three 8-cell embryos on day 3 and compared IVF to ICSI cycles. Sequential media were used with P1 until day 3, then Blastocyst Medium until day 5/6. Results: There were 131 IVF and 75 ICSI cycles. There was no difference in age, number of oocytes, zygotes, 8-cell embryos, blastocysts on days 5 and 6, or embryos transferred. Progression to blastocyst was similar (78% for IVF and 73% for ICSI) as was the viable pregnancy rate (51.4% for IVF and 55% for ICSI). No cycles failed to form blastocysts. Conclusions: The progression to blastocyst and the likelihood of conceiving aviable pregnancy were unaltered by ICSI. Thus it seems appropriate for programs to offer BT to patients undergoing ICSI using the same inclusion criteria applied to their IVF patients.     

Ovarian abscess and heterotopic triplet pregnancy: two complications after IVF in one patient

A patient is reported, who suffered from ovarian abscess after ovarian puncture of a functional ovarian cyst. The cyst has developed after administration of a GnRH agonist depot preparation in the preceeding luteal phase. She was planned to be stimulated for IVF according to the long luteal protocol. The abscess was removed by laparoscopy, and stimulation started two months later after administration of two further GnRH against depot preparations. The patient got pregnant after embryo transfer of three embryos, and a heterotopic triplet pregnancy, with intrauterine twins and a tubal singleton was established. Bilateral salpingectomy was performed, because of bilateral haematosalpinx and previously described bilateral tubal occlusion. The further pregnancy was uncomplicated. Accepted: 27 March 1999     

Interval double transfer improves treatment success in patients with repeated IVF/ET failures

Purpose  To examine whether double transfer of embryos on day 2–3 and on day 5 after ovum pick-up (OPU) improves IVF/ET success rates in patients with multiple consecutive IVF failures Methods  Consecutive IVF failures patients (7.6 ± 0.5) undergoing IVF/ET cycles were treated with interval double transfer on day 2–3 and on day 5 after OPU. Matched patients, that had embryos transferred only once on day 2 or 3 served as controls. Results  Baseline and cycle characteristics were similar in the study group and controls. The total pregnancy rate was 44.6% in the study group and 24.2% in the controls (p = 0.001), and the clinical pregnancy rates were 38.5% and 19.6%, respectively (p = 0.001). Conclusions  Patients with multiple consecutive IVF/ET failures, treated with the interval double transfer approach had significantly improved cycle success rates compared with regular day 2 or 3 embryo transfer protocol. Capsule Patients with consecutive repeated IVF/ET failures, treated with the interval double transfer had significantly improved cycle success rates compared with regular day 3 embryo transfer.     

Effects of general anaesthesia vs. sedation on fertilization, cleavage and pregnancy rates in an IVF program

Anaesthetic management for oocyte retrieval may interfere with the results and success rate of an in vitro fertilization (IVF) program. This study was conducted to compare the effects of two different anaesthetic techniques (general anaesthesia versus sedation) used for oocyte retrieval on IVF outcome. For general anaesthesia we used a combination of remifentanil (Ultiva^TM) with either propofol or isoflurane in hypnotic concentrations. For sedation the protocol included midazolam, diazepam or propofol according to clinical needs. In total, 202 women were enrolled in the study. 96 women opted for sedation and 106 for general anaesthesia. The number of collected oocytes was significantly higher with general anaesthesia (10.54±5.43 [mean±SD]) than with sedation (6.25±3.65, p<0.0001), whereas the number of fertilized oocytes was not different (4.70±3.57 vs. 4.23±2.90). There were no significant differences in cleavage and pregnancy rates. We therefore believe that remifentanil-based general anaesthesia without nitrous oxide is a suitable alternative to sedation and may be recommended for IVF oocyte retrieval if general anaesthesia is requested. Received: 26 October 1998 / Accepted: 20 January 1999