Predictors of live birth in women with a history of biochemical pregnancies after assisted reproduction treatment.
- 作者列表："Tarín JJ","Pascual E","Gómez R","García-Pérez MA","Cano A
OBJECTIVES:To ascertain whether women with a history of biochemical pregnancies (BPs) in in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment cycles have decreased chances of live birth (LB); and (2) to build a predictive model for LB in this particular population of infertile women. METHODS:In order to achieve the first objective, data from 1536 women that had a LB using autologous fresh or frozen embryos, or dropped out of further IVF/ICSI treatments after completing one to three unsuccessful treatment cycles were retrospectively analyzed. A subpopulation of 90 women that experienced one or more BPs in our assisted reproduction unit were selected to build a predictive logistic regression model for LB. RESULTS:LB percentages significantly decreased from a value of 55.3 % in women with no history of previous BPs to 30.9 % and 11.1 % in women that displayed a history of one or more than one BP, respectively. Three out of 35 selected potential predictors were finally included into the model: "number of the last embryo transfer cycle resulting in a BP", "women's age", and "oligo-, astheno-, and/or teratozoospermia". The value of the c-statistic was 0.819 (asymptotic 95 % CI: 0.724-0.913). The model adequately fitted the data with no significant over or underestimation of predictor effects. CONCLUSION:(1) A history of BPs is negatively associated with later chance of LB in women undergoing a series of IVF/ICSI treatment cycles; and (2) LB probability of women with a history of BPs can be predicted using a model with excellent discriminatory capacity.
目的: 确定在体外受精 (IVF)/卵胞浆内单精子注射 (ICSI) 中是否有生化妊娠 (BPs) 史的妇女治疗周期降低了活产 (LB) 的机会; (2) 在这一特定不孕妇女人群中建立 LB 的预测模型。 方法: 为了实现第一个目标，数据来自 1536 名使用自体新鲜或冷冻胚胎进行 LB 的女性,回顾性分析在完成一至三个不成功的治疗周期后或退出进一步的 IVF/ICSI 治疗。选择在我们的辅助生殖单元中经历过一次或多次 BPs 的 90 例女性亚群，构建 LB 的预测 logistic 回归模型。 结果: LB 百分比显著降低，从既往无 BPs 病史的女性的 55.3% 降至显示一个或多个 BP 病史的女性的 30.9% 和 11.1%。35 个选定的潜在预测因子中有 3 个最终被纳入模型: “最后一个胚胎移植周期导致 BP 的数量” 、 “女性年龄” 和 “oligo-,弱精子症-和/或畸形精子症”。C 统计量值为 0.819 (渐近 95% CI: 0.724-0.913)。该模型充分拟合了数据，没有显著的预测效应过度或低估。 结论 :( 1) BPs 病史与接受一系列 IVF/ICSI 治疗周期的女性日后发生 LB 的几率呈负相关; (2) 具有 BPs 病史的女性的 LB 概率可以使用具有优秀区分能力的模型进行预测。
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.