Reproductive Technology In Women Research Articles

Prognostic factors for assisted reproductive technology in women with endometriosis-related infertility

Assisted reproductive technology is one of the therapeutic options offered for managing endometriosis-associated infertility. Yet, published data on assisted reproductive technology outcome in women affected by endometriosis are conflicting and the determinant factors for pregnancy chances unclear. We sought to evaluate assisted reproductive technology outcomes in a series of 359 endometriosis patients, to identify prognostic factors and determine if there is an impact of the endometriosis phenotype. This was a retrospective observational cohort study, including 359 consecutive endometriosis patients undergoing invitro fertilization or intracytoplasmic sperm injection, from June 2005 through February 2013 at a university hospital. Endometriotic lesions were classified into 3 phenotypes-superficial peritoneal endometriosis, endometrioma, or deep infiltrating endometriosis-based on imaging criteria (transvaginal ultrasound, magnetic resonance imaging); histological proof confirmed the diagnosis in women with a history of surgery for endometriosis. Main outcome measures were clinical pregnancy rates and live birth rates per cycle and per embryo transfer. Prognostic factors of assisted reproductive technology outcome were identified by comparing women who became pregnant and those who did not, using univariate and adjusted multiple logistic regression models. In all, 359 endometriosis patients underwent 720 assisted reproductive technology cycles. In all, 158 (44%) patients became pregnant, and 114 (31.8%) had a live birth. The clinical pregnancy rate and the live birth rate per embryo transfer were 36.4% and 22.8%, respectively. The endometriosis phenotype (superficial endometriosis, endometrioma, or deep infiltrating endometriosis) had no impact on assisted reproductive technology outcomes. After multivariate analysis, history of surgery for endometriosis (odds ratio, 0.14; 95% confidence ratio, 0.06-0.38) or past surgery for endometrioma (odds ratio, 0.39; 95% confidence ratio, 0.18-0.84) were independent factors associated with lower pregnancy rates. Anti-müllerian hormone levels <2 ng/mL (odds ratio, 0.51; 95% confidence ratio, 0.28-0.91) and antral follicle count <10 (odds ratio, 0.27; 95% confidence ratio, 0.14-0.53) were also associated with negative assisted reproductive technology outcomes. The endometriosis phenotype seems to have no impact on assisted reproductive technology results. An altered ovarian reserve and a previous surgery for endometriosis and/or endometrioma are associated with decreased pregnancy rates.

Прогнозування неефективності допоміжних репродуктивних технологій у жінок з безплідністю та патологією печінки

Прогнозування неефективності допоміжних репродуктивних технологій у жінок з безплідністю та патологією печінки

СУЧАСНИЙ ПІДХІД ЩОДО ПРОВЕДЕННЯ КОНТРОЛЬОВАНОЇ СТИМУЛЯЦІЇ ЯЄЧНИКІВ У ЦИКЛАХ ДОПОМІЖНИХ РЕПРОДУКТИВНИХ ТЕХНОЛОГІЙ У ЖІНОК ІЗ ВИСОКИМ РИЗИКОМ СИНДРОМУ ГІПЕРСТИМУЛЯЦІЇ ЯЄЧНИКІВ.

&lt;p&gt;Використання розроблених протоколів контрольованої стимуляції яєчників з антагоністом гонадотропін-рилізинг гормону з урахуванням рівня сироваткового прогестерону у програмі допоміжних репродуктивних технологій щодо жінок з високим ризиком розвитку синдрому гіперстимуляції яєчників дозволило зменшити кількість випадків середньо-тяжких форм синдрому гіперстимуляції яєчників (2,5 % проти 17,5 % у разі традиційної схеми з антагоністом гонадотропін-рилізинг-гормону; RR 0,14; 95 % ДІ 0,04–0,46), підвищити частоту настання клінічної вагітності (35,0 % проти 21,7 %; RR 1,62; 95 % ДІ 1,06–2,46)&lt;br /&gt;і пологів (33,3 % проти 16,7 %; RR 2,00; 95 % ДІ 1,25–3,21).&lt;/p&gt;

Gender Obesity Report--Influence of obesity on Reproduction and Pregnancy

Obesity influences reproduction in men and women at all ages. The increasing prevalence of obesity is associated with rising numbers of reproductive disorders in both sexes. Obesity influences menstrual cycle and ovulation irregularities, increases pregnancy complications and complication rates in assisted reproductive technologies in women and in men obesity is associated with lower semen parameters. Weight loss through lifestyle changes or bariatric surgery has positive effects on hormonal parameters and fertility in both men and women.

Second live birth after undergoing assisted reproductive technology in women operated on for endometriosis

To determine prognostic factors for a second live birth, after a first child obtained through assisted reproductive techniques (ART). Observational study from January 2004 to December 2014. Tertiary care university hospital and ART center. A total of 164 infertile patients with endometriosis, who underwent laparoscopy surgery and had a first baby obtained by ART, were included and 65 wished a second baby. No iterative surgery. Spontaneous pregnancy rate (PR) according to endometriosis fertility index. Among the cohort, 27 patients (41.5%) gave birth to a second child through spontaneous pregnancy, whereas 23 patients (35.3%) required ART to obtain a second live birth. No difference was observed between patients regarding age, endometriosis staging, complete removal of endometriosis lesions and pelvic adhesion, except for the least function score, and the endometriosis fertility index. Taking into account irrespective of both mode of conception a total of 78% of patients obtained a second child, with a median conception time of 17 months. The second live birth rate in infertile patients with endometriosis and with surgical treatment was high (78%). Spontaneous PR was 54%. Endometriosis fertility index could be considered as a predictive factor for a spontaneous second pregnancy in fertility management. Our results need to be confirmed in larger prospective studies.

Effect of sperm DNA fragmentation on the clinical outcomes for in vitro fertilization and intracytoplasmic sperm injection in women with different ovarian reserves

To investigate effect of sperm DNA fragmentation (SDF) on clinical outcomes of assisted reproductive technology in women with normal ovarian reserve (NOR) versus reduced ovarian reserve (ROR). Retrospective clinical study. University-affiliated tertiary teaching hospital. A total of 2,865 consecutive couples undergoing their first in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycle. SDF assessed using sperm chromatin dispersion in sperm samples 1-2 months before treatment. SDF, IVF, and ICSI outcomes. The grouping criteria were [1] basal follicle stimulating hormone >10 IU/L, [2] antral follicle count <6, and [3] female age ≥38 years. Women fulfilling two of the three criteria were considered to have ROR, and those not meeting any criteria were considered to have NOR. The area under the receiver operating characteristic curve was 0.594 (0.539-0.648) for the ROR group and 0.510 (0.491-0.530) for the NOR group. A cutoff value for SDF to predict the clinical pregnancy rate (CPR) in the ROR group was 27.3%. When the SDF exceeded 27.3%, the live-birth and implantation rates in the ROR group were statistically significantly decreased, but the clinical pregnancy, live-birth, and implantation rates were not affected in the NOR group. The risk of early abortion increased significantly in the NOR group when the SDF exceeded 27.3%. Sperm DNA fragmentation has a greater impact on IVF and ICSI outcomes among women with ROR, so SDF testing may be of particular clinical significance for these couples.

The development of ovarian hyperstimulation syndrome in the implementation of assisted reproductive technology in women with a background of endocrine pathology

Known factors of the development of ovarian hyperstimulation syndrome (OHSS) are not informative enough, if considered independently. This is confirmed by the absence of initial predictors in cases of severe OHSS and, in contrast, not clinically apparent manifestations in patients seemingly having high risk of this pathology. These circumstances demand investigation of additional prognostic parameters of the OHSS.Purpose: To find out additional OHSS risk factors alongside with the previously known ones in the course of implementation of assisted reproductive technologies (ART) in patients having initial metabolic and hormonal disorders.Investigation data and methods: Retrospective analysis of clinical laboratory and functional parameters of hormonal and metabolic state of 133 women suffering OHSS was held. Classification by Schenker, 1995, was used to detect the diagnosis. Control group consisted of 347 women with the unverified OHSS. Basic and control study groups were similar in age and in number of mild and long protocols of ovarian stimulation held.Results and their discussion: A significant correlation dependence was revealed between the fact of the OHSS development and some indicators of hormonal and metabolic state: HOMA index of insulin resistance; thyroid parameters: thyroid stimulating hormone (TSH), free thyroxine (fT4), thyroid peroxidase antibodies (AbTPO); and level of prolactin. The revealed correlation dependence of the OHSS development on the above parameters allows to use them for determination of the OHSS risk group and taking measures to prevent this complication of the ART.

Oocyte quality improvement using a herbal medicine comprising 7 crude drugs

Maternal age is a significant factor in infertility treatment. Ovarian function and oocyte quality decrease with age, whereas the frequency of chromosomal abnormalities increases. In this study, improvement of oocyte quality and ovarian function were attempted using a herbal medicine comprising 7 crude drugs:Angelicae radix,Rehmanniae radix,Plantaginis semen,Lonicerae flos,Carthami flos,Ginseng radix, andCucurbita moschata Duch. Thirty-one women who repeatedly failed to conceive by intracytoplasmic sperm injection took the herbal medicine before breakfast and dinner from the start of menstrual cycle in the ovum pickup cycle. Average patient age was 38.5 ± 0.7 years, and the average ovum pickup frequency on the first dosage day was 7.9 ± 1.5. To analyze the effects of herbal medicine intake, the number of recovered and mature oocytes, their morphology and physical qualities, as well as the rates of fertilization, oocyte development, and pregnancy was compared before and after intake. The recovered and mature oocyte numbers, oocyte morphology and physical qualities, and fertilization rate were not significantly different before and after drug intake. However, the oocyte development rate was significantly higher(58.0%) after herbal medicine intake than before (32.5%; p = 0.0003). Moreover, the successful pregnancy rate was significantly higher after intake than before (6.9% versus 0%; p = 0.0111). Herbal medicine may constitute a useful adjunct to assisted reproductive technology in women.

Gonadotrophin-releasing hormone antagonists for assisted reproductive technology in women with poor ovarian response. subgroup analysis of cochrane systematic review and meta-analysis

Gonadotrophin-releasing hormone antagonists for assisted reproductive technology in women with poor ovarian response. subgroup analysis of cochrane systematic review and meta-analysis

Ovarian stimulation, in vitro fertilization, and effects of culture conditions on baboon preimplantation embryo development

To evaluate the effects of ovarian stimulation and intracytoplasmic sperm injection (ICSI)-induced fertilization and efficacy of various culture systems on in vitro development of baboon embryos. In vitro study, animal model. Research laboratory. Baboons in laboratory animal research facility. Baboons received FSH (75 IU daily) for 7 to 8 days and FSH/LH (75/75 IU daily) for 3 days, followed by hCG (2,000 IU). Oocytes were retrieved laparoscopically 36 hours after hCG. Intracytoplasmic sperm injection was performed on metaphase II (MII) oocytes. Fertilized embryos were placed into different culture conditions and feeder cell coculture. Embryo development was observed through the most advanced stages, including blastocyst formation. Oocytes retrieved, fertilization rates, multicell embryo rates, and blastocyst rates. Baboon oocytes (n = 1,924, from 49 cycles) were retrieved. Significant heterogeneity was seen in ovarian response to exogenous gonadotropins and subsequent oocyte maturation. The percentage of MII oocytes showed no significant difference among individual female baboons and stimulation cycles. Nearly two thirds of MII oocytes were successfully fertilized with ICSI. Blastocyst rates varied significantly among embryos in different treatments. Coculture with feeder cells in P1/Blast, Quinn's Advantage, and Sydney IVF media generated better blastocyst rates. We tested multiple media and feeder cell combinations to optimize culture conditions in baboon embryo culture and obtained a high blastocyst rate similar to those reported for rhesus monkey embryos cultured in vitro, but still lower than with assisted reproductive technologies in women.

Hypertension in gestational diabetes mellitus: Pathophysiology and long-term consequences

Gestational hypertension and gestational diabetes mellitus are the most frequent obstetric disorders during pregnancy. The rates of both disorders are expected to increase as a result of delayed pregnancy at a later maternal age, the epidemic of obesity and the increased frequency of using assisted reproductive technology in women with infertility. Pregnancies complicated one or both of these disorders are also associated with adverse consequences for the mother and infant (both acute and long-term). The objectives of this review are to describe the association between gestational hypertension and gestational diabetes, and to discuss approaches to management and summarize long-term consequences of gestational hypertension.

Aging and infertility in women: a committee opinion

Aging and infertility in women: a committee opinion

Management of assisted reproductive technologies in women with cystic fibrosis

Management of assisted reproductive technologies in women with cystic fibrosis

Outcome of assisted reproductive technology in women over the age of 41

Objective: To analyze the results of ongoing pregnancies and deliveries after assisted reproductive technology (ART) in women aged ≥41 years, stratified by year of age. Design: Retrospective study. Setting: University hospital, IVF unit. Patient(s): A total of 431 IVF and intracytoplasmic sperm injection (ICSI) cycles were initiated in women ≥41 years of age. Intervention(s): Medical files of ART patients and pregnancy outcomes were reviewed. Main Outcome Measure(s): Oocytes retrieved, embryos developed, and clinical pregnancy and delivery rates. Result(s): Of the 431 started cycles, 376 (87%) reached the oocyte retrieval stage. The mean number of oocytes aspirated per patient was 5.4 ± 0.9 and 6.7 ± 1.2 in the IVF and ICSI cycles, respectively, and the number of embryos obtained was 2.3 ± 1.3 and 2.8 ± 1.6 in the IVF and ICSI cycles, respectively. The number of transferable embryos was 2.0 ± 1.2 and 2.5 ± 0.8. The pregnancy rate per oocyte pickup (OPU) was 12.4%; however, the delivery rate per OPU was 4.5%. The mean delivery rate per OPU among women aged 41–43 years was 2%–7%. There were no deliveries aged ≥44 years and no pregnancies at the age of 45 years. The pregnancy and delivery rates of the ICSI and IVF patients were similar after stratification by age. Conclusion(s): In our studies, ART performed with homologous oocytes, whether by IVF or ICSI, yielded no clinical pregnancies among women aged ≥45 years and no deliveries aged ≥44 years. The mean delivery rate per oocyte retrieval among women aged 41–43 years varied between 2% and 7%.

Representations of Reproductive Technology in Women's Narratives of Infertility

ABSTRACT This paper explores the ways in which the notion of reproductive technology is represented in the narratives of infertility told by a sample of Australian women. These narratives suggest that reproductive technology has been configured as the alternative instrument in realising the quest for a child. Because reproductive technology was represented in complex and changing ways in the narratives of individual women, it would have been inappropriate to divide the women into two groups as users and non-users of reproductive technology. The women were consulted at each stage of the research to ensure that what was inferred from their stories remained true to their narrative construction of themselves.

Effect of Age on Pregnancy Outcome without Assisted Reproductive Technology in Women with Elevated Early Follicular Phase Serum Follicle-Stimulating Hormone Levels

There are data suggesting that patients with elevated early follicular phase serum follicle-stimulating hormone (FSH) levels have a poor fertility outcome. This has been attributed to a high rate of aneuploidy in the oocytes. It is not clear whether the spindle defects leading to nondisjunction are related to the high FSH levels or the age of the oocyte. The study presented herein retrospectively evaluated 6-month pregnancy rates in women with elevated early follicular phase serum FSH levels according to age. Only cases without in vitro fertilization were used, since the elevated FSH levels were deemed likely to interfere with multiple egg recruitment needed for assisted reproductive technology. The 6-month clinical and ongoing pregnancy rates were significantly higher in the women <40 years of age (46.1 and 34.6%, respectively) than in those aged 40 or older (10.5 and 5.3%). These data suggest that women with elevated follicular-phase serum FSH levels have a better fertility prognosis when they are younger.

Age and fertility: results of assisted reproductive technology in women over 40 years.

Age and fertility: results of assisted reproductive technology in women over 40 years.

10 The implantation window

The implantation window is defined as that period when the uterus is receptive for implantation of the free-lying blastocyst. This period of receptivity is short and results from the programmed sequence of the action of oestrogen and progesterone on the endometrium. Implantation itself is a process that commences with apposition, continues through attachment to trophoblast outgrowth and decidualization. For maximal effectiveness of assisted reproductive technologies in women, it is important to know the optimal time for embryo transfer which implies a need to predict the period of uterine receptivity. At present there are no good markers of, or for prediction of, uterine receptivity. In cycles where endogenous hormonal activity is suppressed or absent, the optimal time for embryo transfer can be easily defined and lies between luteal days +3 to +5, where luteal day +1 is the first day of exogenous progesterone treatment. In the human, it is suggested that blastocyst apposition begins about LH day +6 and is complete by LH +10. Human embryos survive in vitro manipulation well, and the stage of development at which they are placed in the uterus seems less critical than in other species, provided they are at an earlier stage of development than that of the endometrium.