不孕症孕婦懷孕後妊娠糖尿病機率較一般孕婦高

Fertil Steril. 2016 Apr 8. pii: S0015-0282(16)61047-6. doi: 10.1016/j.fertnstert.2016.03.040. [Epub ahead of print]

Fertility problems and risk of gestational diabetes mellitus: a nationwide cohort study.

Holst S1, Kjær SK2, Jørgensen ME3, Damm P4, Jensen A5.

Author information

Abstract

OBJECTIVE:

To determine whether women with a history of fertility problems have a higher risk of gestational diabetes mellitus (GDM) than women without a history of fertility problems after adjustment for maternal factors.

DESIGN:

Nationwide population-based cohort study.

SETTING:

Not applicable.

PATIENT(S):

All live and stillbirths during 2004-2010 among women with fertility problems (n = 49,616) and women without fertility problems (n = 323,061) were identified by linkage between the Danish Medical Birth Registry and the Danish Infertility Cohort. Information on GDM was obtained from the Danish National Patient Registry.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Odds ratios and 95% confidence intervals for the association between fertility problems and risk of GDM after adjustment for potentially confounding factors, including maternal age, prepregnancy BMI, parity, parental history of diabetes, level of education, and smoking during pregnancy.

RESULT(S):

In total, 7,433 (2%) pregnant women received a diagnosis of GDM. Multivariate analysis showed that pregnant women with a history of fertility problems had a statistically significantly higher risk of GDM than pregnant women without fertility problems. In stratified analyses, the association between fertility problems and risk of GDM attenuated with increasing age and was more pronounced among primiparous women and women with polycystic ovary syndrome.

CONCLUSION(S):

Our findings suggest that pregnant women with a history of fertility problems are at increased risk of GDM.

Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

前胎剖腹產對胚胎植入懷孕率無明顯影響
但植入時間較長(30s), 出血較多

Fertil Steril. 2016 Apr 14. pii: S0015-0282(16)61052-X. doi: 10.1016/j.fertnstert.2016.03.045. [Epub ahead of print]

Impact of a prior cesarean delivery on embryo transfer: a prospective study.

Patounakis G1, Ozcan MC2, Chason RJ2, Norian JM3, Payson M4, DeCherney AH1, Yauger BJ5.

Author information

Abstract

OBJECTIVE:

To determine whether a history of prior cesarean delivery (CD) makes ET more difficult and impacts pregnancy outcomes.

DESIGN:

Prospective cohort study.

SETTING:

Infertility practice in a tertiary care military facility.

PATIENT(S):

One hundred ninety-four patients with previous delivery undergoing IVF/intracytoplasmic sperm injection (ICSI)-ET.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Live birth (primary), positive hCG, clinical pregnancy, and time to perform ET.

RESULT(S):

There was no statistically significant difference between patients with a history of only vaginal deliveries versus those with a history of CD for live birth (39% vs. 32%), positive hCG (56% vs. 53%), or clinical pregnancy (49% vs. 41%). Embryo transfers took longer in the history of CD group (157 vs. 187 seconds) and were more likely to have mucus (27% vs. 45%) or blood (8% vs. 21%) on the catheter.

CONCLUSION(S):

Embryo transfers performed on patients with a prior CD took 30 seconds longer. They were also more likely to have blood or mucus on the catheter. Despite the apparently more difficult transfers, pregnancy outcomes were not different between the two groups.

卵細胞內水分約85%可藉由冷凍液ES, VS脫出
剩餘15%水份與細胞內結構結合不會形成冰晶

脫水完全可下降冰晶形成之機率
lowering it by 3% from 23 to 20% decreases the percentage undergoing IIF from 62% to 20%. 

−70°C以下卵細胞內水分開始形成冰晶
卵細胞置於−25°C 之ethylene glycol (EG), 水分尚未形成冰晶, 可將卵細胞之水分脫出

解凍過程於 −53°C時開始形成冰晶

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2705661/

快速解凍(溫度回升速率)之重要性遠大於快速冷凍(溫度下降速率)
VS冷凍液之高張EG & DMSO雖可滲透入胚或卵細胞中(sucrose無法滲入細胞中)
但僅在1-2分鐘之VS操作過程中, 其主要目的在於脫水

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3943886/

解凍胚葉細胞反黑, 原因在於胚葉細胞內水分於解凍過程因
胚胎於未充分脫水或冷凍速度過慢胚胎內水份於冷凍過程形成冰晶
或解凍速度過慢導致玻璃化水分未直接形成液體水反而形成冰晶進而傷害胚葉細胞導致胚葉細胞反黑

於ES & VS冷凍液中胚胎皺縮狀況為一脫水過程

解凍回溫之速度比冷凍降溫之速度更關鍵

http://www.ncbi.nlm.nih.gov/pubmed/24662030

珊瑚卵冷凍實驗顯示, 卵於VS於5 °C and 26 °C比較
5 °C可下降卵代謝率減低VS對於卵細胞之傷害

玻璃化冷凍抗凍劑於冷凍過程中, 逐步提高抗凍劑濃度(ES->VS)可下降抗凍劑高張濃度對於卵子產生osmotic shock之風險

sugar無法通過細胞膜存在於VS(0.5M), TS(1M), DS(0.5M)中用於提供高張環境將卵或胚胎細胞中水份脫出防止水分子形成冰晶傷害卵或胚胎細胞

卵細胞脂肪含量越高對於冷凍耐受性越高

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4794651/

卵細胞大部存在於卵巢皮質ovarian cortical tissue
卵巢髓質ovarian medulla仍可取出少數原始卵細胞(平均11 immature oocytes)
目前原始卵細胞IVM培養效率仍極差

J Assist Reprod Genet. 2016 Mar 17. [Epub ahead of print]

Vitrification of in vitro matured oocytes collected from surplus ovarian medulla tissue resulting from fertility preservation of ovarian cortex tissue.

Yin H1,2, Jiang H1, Kristensen SG2, Andersen CY3.

Author information

Abstract

PURPOSE:

The aim of the study was to investigate the maturation rate of immature oocytes collected from ovarian medulla tissue normally discarded during preparation of ovarian cortical tissue for fertility preservation. Further we evaluated survival of derived MII oocytes following vitrification and warming.

METHODS:

36 patients aged from 8 to 41 years who had one ovary excised for fertility preservation were included. Oocytes were collected from the medulla tissue and matured in vitro 44-48 h followed by vitrification. Number of oocytes collected, the rates of maturation and post-warming survival were assessed.

RESULTS:

On average, 11 immature oocytes were collected per patient. The overall maturation rate was 29 % irrespective of whether the ovary was transported 4-5 h on ice or obtained immediately after oophorectomy. The maturation rate in patients below 20 years of age (55 %) was significantly higher than that of patients aged 20-30 years (29 %) and above 30 years (26 %). The post-warming survival rate was 64 %. No significant relationship was observed between the number of collected oocytes and the age of patients.

CONCLUSIONS:

Approximately three MII oocytes were obtained per patient following in vitro maturation (IVM) of immature oocytes collected from medulla tissue, of which two survived vitrification and warming. This approach represents an add-on method to potentially augment the fertility opportunity for cancer patients, especially in young women with cancer where transplantation of cortical tissue may pose a risk of relapse, but the IVM approach is currently too inefficient to be the only method used for fertility preservation.

大規模統計顯示PGS並無下降流產率(PGS vs non-PGS, 13.7% vs. 13.9%), 反而下降活產率(25.2% vs. 28.8%)

Fertil Steril. 2016 Mar 4. pii: S0015-0282(16)00140-0. doi: 10.1016/j.fertnstert.2016.02.026. [Epub ahead of print]

Effectiveness of in vitro fertilization with preimplantation genetic screening: a reanalysis of United States assisted reproductive technology data 2011-2012.

Kushnir VA1, Darmon SK2, Albertini DF3, Barad DH4, Gleicher N5.

Author information

Abstract

OBJECTIVE:

To assess effectiveness of preimplantation genetic screening (PGS) in fresh IVF cycles.

DESIGN:

Reanalysis of retrospective US national data.

SETTING:

Not applicable.

PATIENT(S):

A total of 5,471 fresh autologous IVF cycles with PGS and 97,069 cycles without PGS, reported in 2011-2012 to the Centers for Disease Control and Prevention.

INTERVENTION(S):

Not applicable.

MAIN OUTCOME MEASURE(S):

Cycles that reached ET, miscarriage rates, live birth rates per cycle and per transfer.

RESULT(S):

More PGS than non-PGS cycles reached ET (64.2% vs. 62.3%), suggesting favorable patient selection bias for patients using PGS. Nevertheless, live births rates per cycle start (25.2% vs. 28.8%) and per ET (39.3% vs. 46.2%) were significantly better in non-PGS cycles, whereas miscarriage rates were similar (13.7% vs. 13.9%). With a maternal age >37 years significantly more cycles in the PGS group reached ET (53.1% vs. 41.9%), suggesting a significant selection bias for more favorable patients in the PGS population. This bias rather than the PGS procedure may partially explain the observed improved live birth rate per cycle (17.7% vs. 12.7%) and lower miscarriage rate (16.8% vs. 26.0%) in the older PGS group.

CONCLUSION(S):

Overall, PGS decreased chances of live birth in association with IVF. National improvements in live birth and miscarriage rates reported with PGS in older women are likely the consequence of favorable patient selection biases.

47XXX女性
卵巢功能下降
卵巢體積較小
FSH, LH上升,
E2, inhibin下降

Fertil Steril. 2016 Mar 4. pii: S0015-0282(16)00133-3. doi: 10.1016/j.fertnstert.2016.02.019. [Epub ahead of print]

Triple X syndrome and puberty: focus on the hypothalamus-hypophysis-gonad axis.

Stagi S1, di Tommaso M2, Scalini P3, Lapi E4, Losi S5, Bencini E5, Masoni F6, Dosa L4, Becciani S3, de Martino M3.

Author information

Abstract

OBJECTIVE:

To evaluate the hypothalamus-hypophysis-gonad axis in a cohort of children and adolescents with nonmosaic triple X syndrome.

DESIGN:

Cross-sectional study with retrospective analysis.

SETTING:

University pediatric hospital.

PATIENT(S):

Fifteen prepubertal subjects (median age 9.0 years, range 6.9-11.9 years) with nonmosaic triple X syndrome and age- and pubertal-matched control group (30 girls, median age 9.1 y, range 6.9-11.6 years).

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

We evaluated FSH, LH, and E2 levels and performed an autoimmunity screening as well as a pelvic ultrasonography and an LH-releasing hormone stimulation test.

RESULT(S):

All triple X patients (with and without pubertal signs) showed a pubertal LH peak level that was significantly different from controls. Triple X patients showed increased basal and peak FSH and LH values compared with control subjects. However, the mean E2 level was significantly lower than control subjects. However, triple X patients showed reduced DHEAS levels and reduced inhibin levels compared with control subjects. Finally, triple X patients had a significantly reduced ovarian volume compared with control subjects, in both prepubertal and pubertal patients.

CONCLUSION(S):

Triple X patients showed premature activation of the GnRH pulse generator, even without puberty signs. Both basal and peak LH and FSH levels were higher than in control subjects, and E2 and inhibin levels and ovarian volume were reduced, which led to a reduced gonadal function. Other studies and a longitudinal evaluation is necessary to better understand the endocrinologic features of these subjects.

低氧培養箱(5-6% O2) vs一般氧氣培養箱(19% O2)是否提高懷孕率活產率仍具爭議(0~5% improvement??)

Fertil Steril. 2016 Mar 21. pii: S0015-0282(16)30010-3. doi: 10.1016/j.fertnstert.2016.02.037. [Epub ahead of print]

Low versus atmospheric oxygen tension for embryo culture in assisted reproduction: a systematic review and meta-analysis.

Nastri CO1, Nóbrega BN1, Teixeira DM1, Amorim J1, Diniz LM1, Barbosa MW1, Giorgi VS1, Pileggi VN1, Martins WP2.

Author information

Abstract

OBJECTIVE:

To appraise the available evidence comparing low oxygen (LowO2) and atmospheric oxygen tension (AtmO2) for embryo culture.

DESIGN:

Systematic review and meta-analysis.

SETTING:

Not applicable.

PATIENT(S):

Women undergoing assisted reproduction using embryo culture.

INTERVENTION(S):

Embryo culture using LowO2 versus AtmO2.

MAIN OUTCOME MEASURE(S):

Reproductive, laboratory, and pregnancy outcomes.

RESULT(S):

A total of 21 studies were included in this review. All used O2 concentration between 5% and 6% in the LowO2 group. Considering the studies that randomized women/couples, we observed very low quality evidence that LowO2 is better for live birth/ongoing pregnancy (relative risk [RR] = 1.1, 95% confidence interval [CI] 1.0-1.3) and clinical pregnancy (RR = 1.1, 95% CI 1.0-1.2). Considering the studies that randomized oocytes/embryos, we observed low quality evidence of no difference of fertilization (RR = 1.0, 95% CI 1.0-1.0) and cleavage rate (RR = 1.0, 95% CI 1.0-1.1), and low quality evidence that LowO2 is better for high/top morphology at the cleavage stage (RR = 1.2, 95% CI 1.1-1.3). No studies comparing pregnancy outcomes were identified. Several studies used different incubators in the groups-a new model for the LowO2 group and an old model for the AtmO2 group. The risk of detection bias for the laboratory outcomes was high as embryologists were not blinded.

CONCLUSION(S):

Although we observed a small improvement (∼5%) in live birth/ongoing pregnancy and clinical pregnancy rates (PRs), the evidence is of very low quality and the best interpretation is that we are still very uncertain about differences in this comparison. The clinical equipoise remains and more large well-conducted randomized controlled trials are needed. They should use the same incubators in both groups and the embryologists should be blinded at least when evaluating laboratory outcomes.

MC第2天 vs MC第15天開始施打誘導排卵針
卵子取出數量&懷孕率類似

Fertil Steril. 2014 Nov;102(5):1307-11. doi: 10.1016/j.fertnstert.2014.07.741. Epub 2014 Aug 22.

Comparison of starting ovarian stimulation on day 2 versus day 15 of the menstrual cycle in the same oocyte donor and pregnancy rates among the corresponding recipients of vitrified oocytes.

Martínez F1, Clua E2, Devesa M2, Rodríguez I2, Arroyo G2, González C2, Solé M2, Tur R2, Coroleu B2, Barri PN2.

Author information

Abstract

OBJECTIVE:

To assess the clinical pregnancy rate per transfer in recipients of embryos from donor oocytes obtained after ovarian stimulation initiated on day 2 (D2) or day 15 (D15) of the menstrual cycle with a secondary end point of comparing the response to stimulation.

DESIGN:

Prospective observational comparative study.

SETTING:

Private in vitro fertilization (IVF) program.

PATIENT(S):

Oocyte donors (OD) and recipients.

INTERVENTION(S):

Donors stimulated within 3 months, starting on day 2 or day 15 after bleeding, with recombinant follicle-stimulating hormone (FSH), gonadotropin-releasing hormone (GnRH) antagonist, and GnRH agonist trigger, and oocytes vitrified and later assigned to recipients, followed by routine IVF procedures one to two embryos transferred.

MAIN OUTCOME MEASURE(S):

Primary outcome pregnancy rate, and secondary outcome number of mature oocytes retrieved.

RESULT(S):

Nine D2 and nine D15 cycles were performed in nine donors. There were no differences between D2 and D15 in the number of mature oocytes obtained (14.0±6.96 vs. 16.89±7.52). To date, 20 recipients have received vitrified oocytes (8 recipients received D2 oocytes and 12 recipients received D15 oocytes). There were no differences between the groups of recipients in fertilization rate (77.3% vs. 76.5%) or number of embryos transferred (1.50±0.53 vs. 1.67±0.65). Twelve clinical pregnancies were obtained. No differences were noted in pregnancy rates (62.5% vs. 58.3%) or implantation rates (41.67% vs. 45%) between recipients of D2 oocytes and recipients of D15 oocytes.

CONCLUSION(S):

Donor oocytes obtained after ovarian stimulation initiated on day 15 of the cycle achieve good pregnancy rates. This information is useful for patients with cancer undergoing fertility preservation.

子宮鏡檢查前12 h (vs 3 h)使用cytotec 2#塞於陰道可軟化子宮頸,下降疼痛

Fertil Steril. 2016 Mar 30. pii: S0015-0282(16)30055-3. doi: 10.1016/j.fertnstert.2016.03.022. [Epub ahead of print]

Optimal timing of misoprostol administration in nulliparous women undergoing office hysteroscopy: a randomized double-blind placebo-controlled study.

Fouda UM1, Gad Allah SH2, Elshaer HS2.

Author information

Abstract

OBJECTIVE:

To determine the optimal timing of vaginal misoprostol administration in nulliparous women undergoing office hysteroscopy.

DESIGN:

Randomized double-blind placebo-controlled study.

SETTING:

University teaching hospital.

PATIENT(S):

One hundred twenty nulliparous patients were randomly allocated in a 1:1 ratio to the long-interval misoprostol group or the short-interval misoprostol group.

INTERVENTION(S):

In the long-interval misoprostol group, two misoprostol tablets (400 μg) and two placebo tablets were administered vaginally at 12 and 3 hours, respectively, before office hysteroscopy. In the short-interval misoprostol group, two placebo tablets and two misoprostol tablets (400 μg) were administered vaginally 12 and 3 hours, respectively, before office hysteroscopy.

MAIN OUTCOME MEASURE(S):

The severity of pain was assessed by the patients with the use of a 100-mm visual analog scale (VAS). The operators assessed the ease of the passage of the hysteroscope through the cervical canal with the use of a 100-mm VAS as well.

RESULT(S):

Pain scores during the procedure were significantly lower in the long-interval misoprostol group (37.98 ± 13.1 vs. 51.98 ± 20.68). In contrast, the pain scores 30 minutes after the procedure were similar between the two groups (11.92 ± 7.22 vs. 13.3 ± 6.73). Moreover, the passage of the hysteroscope through the cervical canal was easier in the long-interval misoprostol group (48.9 ± 17.79 vs. 58.28 ± 21.85).

CONCLUSION(S):

Vaginal misoprostol administration 12 hours before office hysteroscopy was more effective than vaginal misoprostol administration 3 hours before office hysteroscopy in relieving pain experienced by nulliparous patients undergoing office hysteroscopy.

陰道女性荷爾蒙補充可下降停經後女性心臟血管疾病&中風死亡率

Hum Reprod. 2016 Apr;31(4):804-9. doi: 10.1093/humrep/dew014. Epub 2016 Feb 13.

Vaginal estradiol use and the risk for cardiovascular mortality.

Mikkola TS1, Tuomikoski P2, Lyytinen H2, Korhonen P3, Hoti F3, Vattulainen P3, Gissler M4, Ylikorkala O2.

Author information

Abstract

STUDY QUESTION:

Does the use of post-menopausal vaginal estradiol (VE) affect the mortality risk for coronary heart disease (CHD) and stroke.

SUMMARY ANSWER:

The use of VE reduces the risk for cardiovascular mortality.

WHAT IS KNOWN ALREADY:

A growing number of women use VE for post-menopausal genitourinary symptoms. Although this therapy is intended to have only local effects, estrogen is absorbed into the blood circulation and thus VE use may also have systemic effects.

STUDY DESIGN, SIZE, DURATION:

We studied a nationwide cohort in Finland 1994-2009 during which post-menopausal women (n = 195 756) initiated the use of VE (age [mean ± SD] 65.7 ± 10.9 years). Follow-up data gathered 1.4 million women-years and we assessed the mortality risk due to CHD (n= 9656) or stroke (n = 4294).

PARTICIPANTS/MATERIALS, SETTING, METHODS:

The mortality risk in VE users was compared with that in the age-matched background population (standardized mortality ratio; [SMR]; 95% confidence interval) and related to various durations of exposure to VE (1 to ≤3, >3 to ≤5, >5 to ≤10 and >10 years).

MAIN RESULTS AND THE ROLE OF CHANCE:

The use of VE was accompanied by decreases in the risk for CHD and stroke death. The risk reduction for CHD death was highest for >3 to ≤5 years exposure (SMR 0.64; 0.57-0.70) and for stroke for >5 to ≤10 years exposure (SMR 0.64; 0.57-0.72). The risk reductions for both CHD and stroke mortality were detected in all age groups with the highest risk reduction being in women aged 50-59 years (SMR 0.43; 0.19-0.88 and SMR 0.21; 0.06-0.58, respectively).

玻璃冷凍造成cytoskeleton 受損包括: tubulin微管蛋白 & microtubules &microfilaments受損

卵子玻璃冷凍前使用 8 g/mL cytochalasin B 30min再冷凍可保護cytoskeleton, 提高胚胎分裂&囊胚率

Cryobiology. 2016 Mar 18. pii: S0011-2240(16)30016-5. doi: 10.1016/j.cryobiol.2016.03.005. [Epub ahead of print]

Stability of the cytoskeleton of matured buffalo oocytes pretreated with cytochalasin B prior to vitrification.

Wang CL1, Xu HY1, Xie L1, Lu YQ1, Yang XG1, Lu SS2, Lu KH3.

Author information

Abstract

Stabilizing the cytoskeleton system during vitrification can improve the post-thaw survival and development of vitrified oocytes. The cytoskeleton stabilizer cytochalasin B (CB) has been used in cryopreservation to improve the developmental competence of vitrified oocytes. To assess the effect of pretreating matured buffalo oocytes with CB before vitrification, we applied 0, 4, 8, or 12 g/mL CB for 30 min. The optimum concentration of CB treatment (8 g/ml for 30 min) was then used to evaluate the distribution of microtubules and microfilaments, the expression of the cytoskeleton proteins actin and tubulin, and the developmental potential of matured oocytes that were vitrified-warmed by the Cryotop method. Western blotting demonstrated that vitrification significantly decreased tubulin expression, but that the decrease was attenuated for oocytes pretreated with 8 g/mL CB before vitrification. After warming and intracytoplasmic sperm injection, oocytes that were pretreated with 8 g/mL CB before vitrification yielded significantly higher 8-cell and blastocyst rates than those that were vitrified without CB pretreatment. The values for the vitrified groups in all experiments were significantly lower (P < 0.01) than those of the control groups. In conclusion, pretreatment with 8 g/mL CB for 30 min significantly improves the cytoskeletal structure, expression of tubulin, and development capacity of vitrified matured buffalo oocytes.

液態氮表面存在一層蒸氣會減低冷凍下降速度
slush nitrogen 可減少vapor &下降液態氮溫度-196->-210度

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4404302/
The fast heat transfer through the thin microcapillary walls in our study was further augmented by the use of slush nitrogen, which reduced the vaporization16 at the interface between micro-capillary and the cryogenic immersion media24. 

超細超薄毛細管(內徑200 μm, 厚20 μm.)用於玻璃化冷凍癌細胞(five human epithelial cancer cell lines (PC3: prostate cancer, T24: bladder cancer, SkBr-3: breast cancer, H1650: non-small-cell lung cancer, and HepG2: liver cancer) )
===>存活率90%

冷凍保存管管壁越薄, 管徑越細保存效果越佳

使用0.75PROH 3min-->離心5min--->1.5 M PROH and 0.5 M trehalose  3min 取代7.5%->15%DMSO+EG+0.5M sucrose玻璃冷凍

http://www.ncbi.nlm.nih.gov/pubmed/25914896

Figure 1

Evaluation of a fused silica microcapillary microcapillary as a tool for vitrification. (a) Map showing the heat transfer and cyoprotectant requirements for vitrification. The line indicated the relationship between the varying dimensions of microcapillary ...

E2過高--->子宮外孕機率較高
植入胚胎較多--->子宮外孕機率較高
植入囊胚子宮外孕機率較低(compare to 植入6-8cell胚胎)
人工受精IUI打排卵針子宮外孕機率較高(compare to 不打排卵針)

Fertil Steril. 2016 Mar 18. pii: S0015-0282(16)30008-5. doi: 10.1016/j.fertnstert.2016.02.035. [Epub ahead of print]

Risk factors for ectopic pregnancy in assisted reproductive technology: a 6-year, single-center study.

Bu Z1, Xiong Y2, Wang K3, Sun Y4.

Author information

Abstract

OBJECTIVE:

To explore factors affecting the incidence of ectopic pregnancy (EP) in assisted reproductive technology (ART).

DESIGN:

A retrospective cohort study on the incidence of EPs in IVF/intracytoplasmic sperm injection (ICSI) and IUI cycles from June 2009 to August 2015. Age of patients, tubal factor infertility, type of cycle (fresh or thawed), embryo being transferred (cleavage embryo or blastocyst), and number of embryos transferred were analyzed to explore their relationship with the incidence of EP.

SETTING:

Teaching hospital.

PATIENT(S):

A total of 18,432 pregnancies resulting from ART treatment were retrospectively analyzed.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Ectopic pregnancy rate.

RESULT(S):

For IVF/ICSI cycles, the incidence of EP was different between cycles transferred with cleavage embryo and blastocyst (3.45% vs. 2.47%). In multivariate logistic regression analysis, tubal infertility was associated with EP (adjusted odds ratio 1.716, 95% confidence interval 1.444-2.039). For IUI cycles, EP was significantly higher in stimulated cycles compared with natural cycles (2.62% vs. 0.99%). The EP rate in cycles with sperm from donor and husband was 1.08% and 3.54%, respectively. However, when patients were stratified according to tubal infertility, the EP rate increased with level of peak estrogen. In thawed embryo transfer cycles, the EP rate was lower in blastocyst transfer cycles and in cycles transferred with fewer embryos.

CONCLUSION(S):

Irrespective of tubal infertility, for fresh IVF/ICSI cycles the rate of EP is positively associated with ovarian stimulation; for thawed IVF/ICSI cycles, blastocyst transfer or transfer with fewer embryos reduces the EP rate. In IUI cycles, EP is associated with sperm source.

PGD冷凍解凍囊胚植入後,  懷孕期間高血壓比例較高

Fertil Steril. 2016 Mar 19. pii: S0015-0282(16)30043-7. doi: 10.1016/j.fertnstert.2016.03.010. [Epub ahead of print]

Obstetric and neonatal outcomes in blastocyst-stage biopsy with frozen embryo transfer and cleavage-stage biopsy with fresh embryo transfer after preimplantation genetic diagnosis/screening.

Jing S1, Luo K1, He H1, Lu C1, Zhang S1, Tan Y1, Gong F1, Lu G1, Lin G2.

Author information

Abstract

OBJECTIVE:

To study whether embryo biopsy for preimplantation genetic diagnosis/preimplantation genetic screening (PGD/PGS) can influence pregnancy complications and neonatal outcomes.

DESIGN:

Retrospective analysis.

SETTING:

University-affiliated center.

PATIENT(S):

This study included data from women and their neonates born after PGD/PGS (n = 317).

MAIN OUTCOME MEASURE(S):

Questionnaires were designed to obtain information relating to pregnancy complications and neonatal outcomes.

INTERVENTION(S):

Two major strategies for PGD/PGS were evaluated. Blastocyst-stage biopsy and frozen embryo transfer (BB-FET) was carried out in 166 patients, and cleavage-stage biopsy and fresh embryo transfer (CB-ET) was carried out in 129 patients.

RESULT(S):

The incidence of gestational hypertension was significantly higher in BB-FET compared with in CB-ET (9.0% vs. 2.3%, adjusted odds ratio [OR] and 95% confidence interval [CI], 4.85 [1.34, 17.56]). In twins, the birthweight (median [range], 2.70 kg [1.55-3.60 kg] vs. 2.50 kg [1.23-3.75 kg]) was higher in BB-FET than in CB-ET and the gestational age was longer in BB-FET than in CB-ET (median [range], 36.71 weeks [31.14-39.29 weeks] vs. 35.57 weeks [30.57-38.43 weeks]). There was no difference in the incidence of singleton births between the two groups except in the incidence of preterm births (28-37 weeks; 5.3% vs. 16.5% in CB-ET and BB-FET). No significant differences were detected in the incidence of perinatal deaths, birth defects, gender of neonates, and large for gestational age in both singletons and twins, although the numbers of some events were small.

CONCLUSION(S):

BB-FET is associated with a higher incidence of gestational hypertension but better neonatal outcomes compared with CB-ET, especially in twins.