Obstetric outcome of pregnancies after the transfer of cryopreserved and fresh embryos obtained by conventional in-vitro fertilization and intracytoplasmic sperm injection.

This study reports the obstetric outcome of pregnancies obtained after the transfer of cryopreserved or fresh embryos where the initial procedure was standard in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Pregnancies obtained after frozen IVF (n = 245) or frozen ICSI (n = 177) were compared with a control group of pregnancies after fresh embryo transfer in standard IVF (n = 245) and ICSI (n = 177) cycles were selected as controls. The controls were matched according to maternal age, parity and date of embryo transfer. In the standard IVF group, the biochemical pregnancy rates in the cryopreserved and fresh groups were 18.8 and 9.8% respectively (P < 0.01). In the ICSI group, the biochemical pregnancy rates in the cryopreserved and fresh groups were 16.4 and 6.8% respectively (P < 0.01). The miscarriage rates were comparable between the cryopreserved and fresh groups. However, in the frozen ICSI group the miscarriage rate (26.0%) was significantly higher than in the frozen conventional IVF group (13.1%) (P = 0.001). The frequencies of preterm deliveries, infants with very low birthweight and intrauterine deaths were similar in the groups. The low birthweight rates in the frozen IVF (16.1%) and ICSI (12.1%) groups were significantly lower than those in the fresh IVF (32.2%) and ICSI (32.7%) groups (P < 0.001). The major malformation rates in the frozen IVF (2.4%) and ICSI (2.9%) groups were not different from the major malformation rates in the fresh IVF (4.5%) and ICSI (2.4%) groups. In conclusion, the cryopreservation process had no negative impact on the outcome of pregnancies over 20 weeks of gestation. Long-term follow-up studies are needed in order to prove the safety of the freezing-thawing process.     

Comparison between intracytoplasmic sperm injection and in-vitro fertilization (IVF) with high insemination concentration after total fertilization failure in a previous IVF attempt.

The aim of this prospective study was to evaluate whether couples with total fertilization failure in a previous in-vitro fertilization (IVF) attempt should be offered an additional IVF treatment with elevated insemination concentration or should be treated with intracytoplasmic sperm injection (ICSI). In 23 cycles 228 sibling metaphase II (MII) oocytes were randomly divided: 143 and 85 oocytes were utilized for ICSI and IVF respectively. Of the 143 injected (ICSI) oocytes, 90 (62.9%) were normally fertilized (two pronuclei), whereas 21 (14.7%) oocytes were damaged by the ICSI procedure. Of the fertilized oocytes 72 (80%) developed into transferable embryos. No fertilization at all was observed in the 85 sibling MII oocytes which were inseminated (P < 0.001). In all 23 cycles at least one embryo, obtained by ICSI, could be replaced. Eight pregnancies were achieved of which six resulted in the delivery of nine healthy children. In conclusion, for couples with no or almost no fertilization of oocytes in previous IVF attempts, ICSI appeared to be far superior to an additional IVF attempt with further elevated insemination concentrations.     

Successful twin pregnancy in a dual-transplant couple resulting from in-vitro fertilization and intracytoplasmic sperm injection: case report

There are numerous reports of successful pregnancy following liver transplantation. Little information is available regarding the incidence and management of infertility in transplant recipients, particularly the use of artificial reproductive technologies. We present a case of a successful twin pregnancy resulting from in-vitro fertilization with intracytoplasmic sperm injection (IVF/ICSI) in a liver transplant recipient, whose partner was a renal transplant recipient with severe oligozoospermia. With careful evaluation and monitoring, and the involvement of appropriate consultants, artificial reproductive technologies can be safely used in transplant recipient couples experiencing infertility.     

Fertilization and early embryology: Ongoing pregnancies and birth after intracytoplasmic sperm injection with frozen--thawed epididymal spermatozoa

In seven patients who did not become pregnant following microsurgicalepididymal sperm aspiration (MESA) and intracytoplasmic sperminjection (ICSI), a subsequent ICSI was performed using previouslycryopreserved supernumerary epididymal spermatozoa without re-operatingon the husband. During the original MESA procedure a mean spermconcentration of 12.3x10⁶/ml was achieved. The supernumeraryspermatozoa were cryopreserved for later use. After thawingfrozen epididymal spermatozoa a mean concentration of 1.9x10⁶spermatozoa/ml was obtained in straws containing a total volumeof sperm suspension of 250 µl. From 68 intact oocytesinjected with frozen—thawed epididymal spermatozoa, atwo pronuclear fertilization rate of 45% and a cleavage rateof 82% were obtained. A total of 17 embryos were replaced inthe seven patients, resulting in two ongoing singleton pregnanciesand one twin delivery. Six embryos were cryopreserved. In conclusion,it would appear mandatory to cryopreserve supernumerary spermatozoaduring a MESA in order to avoid subsequent further scrotal surgery.     

Maternal and neonatal outcomes of grand multiparity in Khartoum,Sudan

ObjectivesGrand multiparity is a major health problem that leads to adverse maternal and perinatal outcomes. We aimed to assess the maternal and perinatal outcomes of grand multiparity.MethodsA case-control study was conducted in Saad Abualila Hospital, Khartoum, Sudan from February to December 2019. The cases were grand multiparous (≥ 5 deliveries) women. The controls were women with low parity (multiparous women who delivered two to four times). Maternal and perinatal characteristics were compared between the two groups. Logistic regression analysis was performed.ResultsThere was a significant association between grand multiparity and higher maternal age (adjusted odds ratio [AOR]=1.19, 95% confidence interval [CI]=1.16–1.23), lower education level (AOR=3.38, 95% CI=2.49–5.58) and lower antenatal care attendance (AOR=1.73, 95% CI=1.02–2.92). Grand multiparous women were at increased risk for Anemia (AOR=1.48, 95% CI=1.08–2.03), diabetes mellitus (AOR=10.61, 95% CI=4.89–23.00), caesarean delivery (AOR=1.87, 95% CI=1.40–2.48), preterm birth (AOR=1.90, 95% CI=1.37–2.62) and admission to the neonatal intensive care unit (AOR=3.8, 95% CI=1.95–7.75).ConclusionsGrand multiparity was associated with poor maternal and neonatal outcomes. Development of a national health program addressing family planning, health education and improvement of antenatal, intrapartum and neonatal care are needed.     

Comparison of two recombinant follicle-stimulating hormone preparations in in-vitro fertilization: a randomized clinical study.

A randomized comparison of two recombinant human follicle-stimulating hormone (recFSH) preparations (Gonal-F and Puregon) in ovarian stimulation for in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) was carried out at the Infertility Clinic of the Family Federation of Finland. A total of 348 women (aged 22-43 years) suffering from infertility due to miscellaneous causes was recruited. Of these, 344 underwent stimulation using equal starting doses (150 IU/day: Gonal-F n = 164, Puregon n = 158 or 300 IU/day: Gonal-F n = 8, Puregon n = 14) after down-regulation with intranasal buserelin from the mid-luteal phase. Similar clinical pregnancy rates were achieved with both preparations; 33.5% per cycle and 37.4% per embryo transfer (24.5% one-embryo and 75.5% two-embryo transfers, n = 147) with Gonal-F (150 IU/day) and 32.9% per cycle and 36.4% per embryo transfer (30.1% one-embryo and 69.9% two-embryo transfers, n = 145) with Puregon (150 IU/day). The ongoing cumulative pregnancy rates after frozen-thawed embryo transfer were 35.4% with Gonal-F and 37.7% with Puregon. Six cycles were cancelled because of a low response (three in each group). Similar numbers of oocytes were obtained in both groups; 13.0 with 150 IU/day and 6.1 with 300 IU/day Gonal-F, and 12.4 with 150 IU/day and 7.1 with 300 IU/day Puregon. The fertilization and cleavage rates and the incidence of moderate or severe ovarian hyperstimulation syndrome (Gonal-F, 2.0% and Puregon, 0.7%) were also similar. Gonal-F and Puregon were equally and highly effective in stimulation for IVF and ICSI.     

A nomogram predicting clinical pregnancy in the first fresh embryo transfer for women undergoing in vitro fertilization and intracytoplasmic sperm injection (IVF/ICSI) treatments

The extent to which factors affect the probability of clinical pregnancy in the first fresh embryo transfer after assisted conception is unknown. In order to examine the predictors of clinical pregnancy, a retrospective cohort study was launched between January 1, 2013 and December 31, 2016 in four infertility clinics including 19 837 in vitro fertilization and intracytoplasmic sperm injection (IVF/ICSI) fresh cycles with known outcomes and relevant records. A multivariable logistic regression was used to select the most significant predictors in the final nomogram for predicting clinical pregnancy. Furthermore, the model was validated by an independent validation set and the performance of the model was evaluated by the receiver operating characteristic (ROC) curves along with the area under the ROC curve (AUC) and calibration plots. In a training set including 17 854 participants, we identified that female age, tubal factor, number of embryos transferred, endometrial thickness and number of good-quality embryos were independent predictors for clinical pregnancy. We developed a nomogram using these five factors and the predictive ability was 0.66 for AUC (95% CI 0.64–0.68), which was independently validated in the validation set (AUC=0.66, 95% CI 0.65–0.68). Our results show that some specific factors can be used to provide infertile couples with an accurate assessment of clinical pregnancy following assisted conception and facilitate to guide couples and clinicians.     

Andrology: Successful fertilization and establishment of pregnancies after intracytoplasmic sperm injection in patients with globozoospermia

Globozoospermia or round-headed spermatozoa is a rare type ofteratozoospermia where the acrosome is absent resulting in maleinfertility with no known therapy. A few studies have shownthat round-headed spermatozoa cannot bind to or penetrate thezona pellucida, and no normal fertilization has been observedin in-vitro fertilization (IVF) after insemination of humanoocytes with round-headed spermatozoa. In this study, the fertilizationcapacity of round-headed spermatozoa after intracytoplasmicsperm injection (ICSI) into human oocytes has been examined.In pre-clinical experiments, 45 oocytes were injected; 41 oocyteswere intact after injection, 15 oocytes were fertilized normally,and 13 of these 15 oocytes developed further in vitro. ICSIwas carried out in 11 treatment cycles of seven infertile coupleswith globozoospermia. Normal fertilization and embryo transferoccurred in four cycles (three patients). Positive serum humanchorionic gonadotrophin was observed in three cycles (two patients);one patient had a pre-clinical abortion and the other patientbecame pregnant twice: the first pregnancy was ectopic and thesecond pregnancy is a twin pregnancy which is currently at 16weeks of gestation.     

Obstetric outcome of twin pregnancies after in-vitro fertilization: a matched control study in four Dutch university hospitals

In singleton pregnancies after in-vitro fertilization (IVF), increased rates of obstetric and perinatal complications have been reported. Studies that compared IVF twin pregnancies with spontaneously conceived twins have yielded conflicting results. We compared 96 IVF twin pregnancies to 96 controls after elaborate matching. The design of our study precluded matching by zygosity. The monozygosity rate was higher in the control group and this implies that beforehand the risk for a less favourable outcome in the control group was higher than in the IVF group. However, the average birthweight of the IVF children was less than that of children in the control group (P = 0.04). This was not due to more intrauterine growth retardation in the IVF group. The mean gestational age at birth was 5 days shorter in IVF than control pregnancies, and although this difference was not significant it might explain the lower birthweight in the IVF group. The discordance rate in the IVF group was significantly increased. We found no difference in perinatal mortality and morbidity. We conclude that this study provides further evidence for a different outcome of IVF twin pregnancies in comparison with spontaneously conceived twin pregnancies.     

Ovarian cyst formation following GnRH agonist administration in IVF cycles: incidence and impact

BACKGROUND: The formation of functional ovarian cysts has been recognized as one of the side effects of GnRH agonist administration. The formation of cysts during IVF treatment may be of no clinical significance or may negatively influence its outcome. The objective of this study was to determine the incidence of ovarian cyst formation following GnRH agonist administration and to examine their effect on IVF outcome. METHODS: A prospective study of 1317 IVF patients who developed one or more functional ovarian cysts of >or=15 mm following GnRH agonist treatment was performed. Transvaginal ultrasonographic-guided cyst aspiration was carried out in 76 randomly allocated patients out of 122 patients who were found to have functional ovarian cysts before starting ovarian stimulation with gonadotropins. RESULTS: The incidence of follicular cyst formation was 9.3%. Cyst cycles in comparison with non-cyst cycles had significantly elevated day 3 basal FSH (mean+/-SD of 8.3+/-3.2 versus 5.3+/-2.6 mIU/ml, P<0.05) and required more ampoules of gonadotropins (46.3+/-16.5 versus 35+/-14.6, P<0.01). Furthermore, they showed a statistically significant decrease in the quality and number of oocytes retrieved, fertilization rate, number and quality of embryos, implantation and pregnancy rates, with a significant increase in cancellation and abortion rates. Patients with bilateral cysts had a significantly lower number of oocytes and embryos retrieved, with a lower proportion of metaphase II oocytes. They also had a higher proportion of poor quality embryos. Cyst aspiration was not associated with a significant difference in the above parameters. CONCLUSIONS: The incidence of cyst formation during GnRH agonist treatment is lower than previously reported. In such cases, the quality of oocytes and embryos were significantly compromised, with a significant increase in the cycle cancellation rate and a decrease in the implantation and pregnancy rates. Neither conservative management nor cyst aspiration improved the IVF outcome.     

Maternal ornithine transcarbamylase deficiency,a genetic condition associated with high maternal and neonatal mortality every clinician should know: A systematic review

Ornithine transcarbamylase deficiency (OTCD) is a rare X‐linked urea cycle disorder. Maternal OTCD can lead to life‐threatening hyperammonemia if untreated. We aimed to compare the outcomes of maternal OTCD when diagnosis is known prior to pregnancy to when diagnosis is made during pregnancy. We performed a systematic literature review on maternal OTCD using the databases Ovid MEDLINE and PubMed from 1982 through 2018. Studies were included if addressed maternal OTCD signs, symptoms, and detailed pregnancy outcomes. We calculated the median or the mean for continuous variables and percentages for categorical variables. Of 36 cases of maternal OTCD, 20 (55%) were diagnosed prior to pregnancy while 16 (45%) were not. In the 20 patients diagnosed prior to pregnancy, 7 (35%) had either a neurologic or psychiatric presentation during pregnancy or postpartum. Two hyperammonemic patients (11%) experienced ICU admission, dialysis, and coma with no maternal deaths. All had a favorable outcome. In the 16 patients not known to have maternal OTCD prior to pregnancy, 13 (81%) had neurologic or psychiatric presentation during pregnancy or postpartum. Four presented with hyperemesis gravidarum. Eleven (69%) hyperammonemic patients had ICU admission and coma and 7 (47%) of them had dialysis. There were 5 (31%) maternal deaths. Three patients (19%) had prolonged hospitalization course. Overall, three male neonatal deaths were reported. Three other male children had liver transplant. Maternal OTCD is associated with high maternal and neonatal morbidity and mortality when diagnosis is made during pregnancy compared to when diagnosis is known prior to pregnancy.     

Infertility: The prognosis for assisted conception treatment after unexpected failure of fertilization in vitro: a comparative study

The relative prognosis for further assisted conception treatment(without micro-injection) after initial unexpected failure offertilization in apparently favourable couples undergoing in-vitrofertilization (IVF) treatment was assessed. After their firstcycle of treatment, 481 consecutive couples were grouped accordingto their fertilization (including cleavage) rate per oocyteinto five bands. Proportions of couples proceeding to furthercycles of treatment by IVF or gamete intra-Fallopian transfer(GIFT) and resulting fertilization and pregnancy rates werecompared. Pregnancy rates in the first cycle of treatment weresignificantly related to fertilization rate. The fertilizationrate was zero in 13 couples (3%) and only 1–24% in 18(4%). There were no significant differences between these groupsin the proportions proceeding to further treatment (31, 50%)compared with others (overall 37%, including some treated byGIFT), or in their median fertilization rates (75, 60% comparedwith 67% – IVF cycles only), pregnancy rates (20, 38%of cycles compared with 37% – IVF or GIFT) or birth rates(20, 38% of cycles compared with 31% – IVF or GIFT). Amongstcouples whose initial fertilization rate was 50% there wasno fertilization in 4% of subsequent IVF cycles. We concludethat in couples with well defined favourable conditions, includingtests of sperm function for assisted conception treatment, whohave unexpected failure of fertilization, the prognosis forfurther treatment remains favourable without resort to morecomplex investigations or micro-injection methods. Such failureoccurs infrequently and generally as a random event, and shouldhave no appreciable effect on life-table calculation of cumulativepregnancy and birth rates in this group of patients.     

GnRH agonist protocol administration in the luteal phase in ICSI-ET cycles stimulated with the long GnRH agonist protocol: a randomized, controlled double blind study

BACKGROUND: GnRH agonist administration in the luteal phase was reported to beneficially affect the clinical outcome of intracytoplasmic sperm injection (ICSI) and embryo transfer (ET) cycles. This double blind, randomized, placebo controlled trial evaluates whether a single dose GnRH agonist administered 6 days after ICSI increases ongoing pregnancy rates following ET in cycles stimulated with the long GnRH agonist protocol. METHODS: Five hundred and seventy women undergoing ET following controlled ovarian stimulation with a long GnRH agonist protocol were included. In addition to routine luteal phase support with progesterone, women were randomized to receive a single 0.1 mg dose of triptorelin or placebo 6 days after ICSI. Randomization was done on the day of ET according to a computer generated randomization table. Ongoing pregnancy rate beyond 20th week of gestation was the primary outcome measure. The trial was powered to detect a 12% absolute increase from an assumed 38% ongoing pregnancy rate in the placebo group, with an alpha error level of 0.05 and a beta error level of 0.2. RESULTS: There were 89 (31.2%) ongoing pregnancies in the GnRH agonist group, and 84 (29.5%) in the control group (absolute difference +1.7%, 95% confidence interval -5.8% to +9.2%). Implantation, clinical pregnancy and multiple pregnancy rates were likewise similar in the GnRH agonist and placebo groups. CONCLUSIONS: Single 0.1 mg triptorelin administration 6 days after ICSI following ovarian stimulation with the long GnRH agonist protocol does not seem to result in an increase >or=12% in ongoing pregnancy rates.     

Maternal risk factors for low birth weight for term births in a developed region in China:a hospital-based study of 55,633 pregnancies

Low birth weight (LBW) is an important risk factor for neonatal and infant mortality and morbidity in adults..However,no large scale study on the prevalence of LBW and related maternal risk factors in China has been published.To explore the effects of maternal factors on LBW for term birth in China,we conducted a hospital-based retrospective study of 55,633 Chinese pregnancy cases between 2001 and 2008.Maternal sociodemographic data,history of infertility and contraceptive use were obtained.Their medical status and diseases during pre-pregnancy were examined by physical examination at the first antenatal care visit.Maternal medical status before childbirth and pregnancy outcomes,including body weight,infant gender,multiple pregnancy and congenital anomalies,were recorded.Univariate and multivariate logistic regression,and linear regression were used to investigate the relationship between maternal factors and term LBW.The general incidence of term LBW was 1.70% in the developed area of China.After preliminary analysis using the univariate model,low primary education,anemia,hypertensive disorders,placental previa,oligohydramnios and premature rupture of membrane were predicted as independent factors of term LBW in the multivariate model.Furthermore,the decrease in annual frquencies of these risk factors were major causes of gradual decline in the incidence of LBW (from 2.43% in 2001 to 1.21% in 2008).The study demonstrated that among maternal factors,primary education,anemia and hypertensive disorders could contribute to LBW for term birth even in the most developed area of China.     

The risk of monozygotic twins after assisted reproductive technology: a systematic review and meta-analysis

BACKGROUND: It is estimated that there is at least a 2-fold rise in theincidence of monozygotic twinning after assisted reproductivetechnology compared with natural conception. This can resultin adverse pregnancy outcomes. METHODS: We searched MEDLINE, EMBASE and SCISEARCH for studies that estimatedthe risk of monozygotic twinning and its association with anyparticular assisted reproductive technique. Monozygotic twinningwas defined by ultrasound or Weinberg criteria. A meta-analysisof the proportion of monozygotic twins was performed using bothfixed and random effects models. RESULTS: The search revealed 37 publications reporting on the incidenceof monozygotic twins after assisted reproductive techniques.Twenty-seven studies met the inclusion criteria and were includedin the meta-analysis. The summary incidence of monozygotic twinsafter assisted conception was 0.9% (0.8–0.9%). The incidenceof monozygotic twins in natural conception is 0.4%. Blastocysttransfer and intracytoplasmic sperm injection are associatedwith 4.25 and 2.25 times higher risk of monozygotic twins. CONCLUSIONS: The risk of monozygotic twins in assisted conception is 2.25times higher than the natural conceptions. Larger studies reportingon monozygotic twinning following single-embryo transfer orafter post-natal confirmation of zygosity with DNA analysisare warranted before definitive conclusions can be drawn andguidelines produced. In order to provide adequate pre-conceptionalcounselling, it is important to monitor the incidence of monozygotictwins in both natural and assisted conceptions. We suggest buildinga national multiple pregnancy database based on accurate diagnosisof zygosity.     

The histology and histomorphometry of umbilical cord cross section in preeclampsia and normal pregnancies: a comparative study

ABSTRACT

The umbilical cord is the connecting link between the mother and the fetus and its morphology is an indicator of fetal well-being. Preeclampsia is a disorder of pregnancy associated with new-onset hypertension, which occurs most often after 20 weeks of gestation. There are structural differences in the umbilical cord of normotensive and hypertensive pregnant women. This research aimed to study the histology and histomorphometry of umbilical cord areas in preeclampsia and compare the parameters with normal uncomplicated pregnancies of gestational age 37–40 weeks. A total of 70 umbilical cords were studied from preeclampsia (n = 35) and normal (n = 35) pregnancies. The parameters studied included cross-sectional areas (CSA) of umbilical cord, umbilical vein lumen, umbilical vein wall, umbilical artery lumen, umbilical artery wall, and Wharton’s jelly, including the presence of edema in the vessel walls and Wharton’s jelly and basement membrane thickening. The mean umbilical cord CSA was significantly higher in preeclampsia (p = 0.014). The mean umbilical artery lumen CSA was significantly lower than the normal pregnancy cords (p = 0.006). The mean Wharton’s jelly CSA in preeclampsia was significantly higher than the normal pregnancy cords (p = 0.004). The parameters for umbilical vein lumen CSA, umbilical vein wall CSA, and umbilical artery wall CSA did not show any significant difference. Histological findings were edema (p < 0.001) and thickened basement membranes (p < 0.0001) were considered significant.     

Rational emotive behavior therapy, cognitive therapy, and medication in the treatment of major depressive disorder: a randomized clinical trial, posttreatment outcomes, and six-month follow-up

A randomized clinical trial was undertaken to investigate the relative efficacy of rational-emotive behavior therapy (REBT), cognitive therapy (CT), and pharmacotherapy in the treatment of 170 outpatients with nonpsychotic major depressive disorder. The patients were randomly assigned to one of the following: 14 weeks of REBT, 14 weeks of CT, or 14 weeks of pharmacotherapy (fluoxetine). The outcome measures used were the Hamilton Rating Scale for Depression and the Beck Depression Inventory. No differences among treatment conditions at posttest were observed. A larger effect of REBT (significant) and CT (nonsignificant) over pharmacotherapy at 6 months follow-up was noted on the Hamilton Rating Scale for Depression only.