Longitudinal cohort study of uterine artery Doppler in singleton pregnancies obtained by IVF/ICSI with fresh or frozen blastocyst transfers in relation to pregnancy outcomes.
新鲜或冷冻囊胚移植 IVF/ICSI 获得的单胎妊娠子宫动脉多普勒与妊娠结局关系的纵向队列研究。
- 作者列表："Cavoretto P","Farina A","Gaeta G","Sigismondi C","Spinillo S","Casiero D","Pozzoni M","Vigano P","Papaleo E","Candiani M
BACKGROUND:Pregnancies obtained by frozen blastocyst transfer (FBT) present higher gestational age and birthweight as compared to those derived by fresh blastocyst transfer (fresh). The aim of this study was to evaluate uterine artery pulsatility index (UtA-PI) during pregnancies conceived by in vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI) techniques using either fresh or cryopreserved blastocysts, in relation to pregnancy outcomes. METHODS:Prospective longitudinal study of singleton evolutive IVF/ICSI pregnancies performing serial ultrasound assessment at San Raffaele Hospital at 7-37 gestational weeks. The study groups were composed of women undergoing fresh or frozen blastocyst transfer (FBT). Miscarriages, abnormalities, twins and egg donations were excluded. Pregnant women underwent ultrasound assessments at 7-10, 11-14, 18-24, 25-32 and 33-37 weeks. Mean uterine artery PI (UtA-PI) was measured with Doppler study at each time point according to FMF criteria. Pregnancy outcomes were recorded. UtA-PI values were made Gaussian after Log10 transformation. Analysis of repeated measures with a multilevel mixed linear model (LMM) (fixed effect and random effect) was performed. The possible effect of other covariates on UtA-PI Doppler values including BMI, SGA and PE was also evaluated. RESULTS:625 observations in 367 IVF/ICSI cycles were collected and analyzed (median 2.5; range 2-4; fresh = 164 ; FBT = 203 ). The FBT group resulted in an average 14% lower UtA-PI when compared with the fresh group. In pregnancies with small-for-gestational-age (SGA) fetuses, UtA-PI resulted 18% higher irrespectively of the group. The fresh group showed significantly reduced birthweight centile (Mean (95%CI): fresh 43.4 (39.1-46.8); FBT 50.0 (46.5-53.7); p=0.007) and an increased rate of SGA (p-value=0.008), as compared to FBT. No significant differences were found for gestational age at birth, preterm-birth, preeclampsia, gestational diabetes mellitus and fetal macrosomia. CONCLUSIONS:UtA-PI and proportion of SGA are lower in pregnancies after frozen as compared to fresh blastocyst transfer. This article is protected by copyright. All rights reserved.
背景: 与新鲜囊胚移植 (fresh) 获得的妊娠相比，通过冷冻囊胚移植 (FBT) 获得的妊娠呈现更高的孕龄和出生体重。本研究旨在评估体外受精 (IVF)/卵胞浆内单精子注射 (ICSI) 妊娠期间子宫动脉搏动指数 (UtA-PI) 使用新鲜或冷冻保存囊胚的技术，与妊娠结局的关系。 方法: 在 San Raffaele 医院 7-37 孕周进行连续超声评估的单胎进化 IVF/ICSI 妊娠的前瞻性纵向研究。研究组由接受新鲜或冷冻囊胚移植 (FBT) 的女性组成。排除流产、异常、双胞胎和捐卵。孕妇在 7-10 、 11-14 、 18-24 、 25-32 和 33-37 周进行超声评估。根据 FMF 标准，在每个时间点用多普勒研究测量平均子宫动脉 PI (UtA-PI)。记录妊娠结局。Log10 变换后 UtA-PI 值为高斯。使用多级混合线性模型 (LMM) (固定效应和随机效应) 进行重复测量分析。还评估了其他协变量对包括 BMI 、 SGA 和 PE 在内的 UtA-PI 多普勒值的可能影响。 结果: 收集并分析了 625 个 IVF/ICSI 周期中的 367 个观察结果 (中位数 2.5; 范围 2-4; 新鲜 = 164; FBT = 203)。与新鲜组相比，FBT 组的 UtA-PI 平均降低 14%。在小于胎龄儿 (SGA) 的妊娠中，UtA-PI 组分别高出 18%。新鲜组显示出生体重百分位数显著降低 (平均值 (95% CI): 新鲜 43.4 (39.1-46.8); FBT 50.0 (46.5-53.7); p = 0.007) 与 FBT 相比，SGA 的发生率增加 (p 值 = 0.008)。出生胎龄、早产、子痫前期、妊娠期糖尿病、巨大儿差异无统计学意义。 结论: 与新鲜囊胚移植相比，冷冻后妊娠的 UtA-PI 和 SGA 比例较低。本文受版权保护。保留所有权利。
METHODS:BACKGROUND:Controlled ovarian stimulation (COS) has a negative effect on the endometrial receptivity compared with natural menstrual cycle. Whether it's necessary to postpone the first frozen embryo transfer (FET) following a freeze-all strategy in order to avoid any residual effect on endometrial receptivity consequent to COS was inconclusive. OBJECTIVE:The purpose of this retrospective study was to explore whether the delayed FET improve the live birth rate and neonatal outcomes stratified by COS protocols after a freeze-all strategy. METHODS:A total of 4404 patients who underwent the first FET cycle were enrolled in this study between April 2014 to December 2017, and were divided into immediate (within the first menstrual cycle following withdrawal bleeding) or delayed FET (waiting for at least one menstrual cycle and the transferred embryos were cryopreserved for less than 6 months). Furthermore, each group was further divided into two subgroups according to COS protocols, and the pregnancy and neonatal outcomes were analyzed between the immediate and delayed FET following the same COS protocol. RESULTS:When FET cycles following the same COS protocol, there was no significant difference regarding the rates of live birth, implantation, clinical pregnancy, multiple pregnancy, early miscarriage, premature birth and stillbirth between immediate and delayed FET groups. Similarly, no significant differences were found for the mean gestational age, the mean birth weight, and rates of low birth weight and very low birth weight between the immediate and delayed FET groups. The sex ratio (male/female) and the congenital anomalies rate also did not differ significantly between the two FET groups stratified by COS protocols. CONCLUSION:Regardless of COS protocols, FET could be performed immediately after a freeze-all strategy for delaying FET failed to improve reproductive and neonatal outcomes.
METHODS:OBJECTIVE:To evaluate the effect of oral diosmin on the incidence and severity of ovarian hyperstimulation syndrome (OHSS) and explore the value of diosmin in preventing and treating OHSS. METHOD:A retrospective study of women attending a reproductive center in Guangzhou, China, between September and December 2016. The inclusion criterion was previous cancellation of embryo transfer after oocyte retrieval during IVF owing to a high risk of OHSS. The women were divided into two groups depending on whether they received oral diosmin (1000 mg twice daily for 10 days) after oocyte retrieval (diosmin group) or not (control group). Apart from diosmin, both groups underwent the same treatment. Baseline information and data related to OHSS were compared. RESULTS:Overall, 146 women were included: 74 in the diosmin group and 72 in the control group. The incidence of moderate-to-severe OHSS in the diosmin and control groups was 5/74 (6.2%) and 14/72 (13.4%), respectively (P=0.027). The control group included four cases of paracentesis due to ascites; there were no cases of paracentesis or severe OHSS in the diosmin group. CONCLUSION:Oral administration of diosmin effectively reduced both the incidence of moderate-to-severe OHSS and the severity of OHSS among high-risk women.
METHODS::Recurrent implantation failure (RIF) remains a clinical dilemma. Helium-Neon (He-Ne) laser irradiation has recently become more popular under certain clinical conditions. Given the unique therapeutic effects, we were interested in determining whether pretreatment with He-Ne laser irradiation prior to frozen-thawed embryo transfer (FET) would improve the microcirculation and cause the release of growth factors and cytokines, thus improving endometrial receptivity and the clinical pregnancy rates. Patients chose for themselves whether to proceed with (n = 29) or without (n = 31) pretreatment with He-Ne laser irradiation prior to FET. The clinical pregnancy rate (37.9%) and implantation rate (20.3%) were higher in the laser-treatment group than in the control group (35.5% and 15.9%, respectively, p = .844 and .518, respectively). The live birth rate was higher in the laser-treatment group (27.6% vs. 25.8%, respectively, p = .876) and the miscarriage rate was lower in the laser-treatment group (18.2% and 27.3%, respectively, p = .611). No side effects or complications from laser irradiation were encountered in patients who received the laser treatment. We concluded that pretreatment with He-Ne laser prior to FET may be an alternative choice for RIF-affected women; however, additional well-designed prospective studies are necessary to determine the precise clinical value of this treatment.