Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 3 de 3
Filter
1.
Fertil Steril ; 103(5): 1194-1201.e2, 2015 May.
Article in English | MEDLINE | ID: mdl-25813280

ABSTRACT

OBJECTIVE: To assess live-birth defects after a luteal-phase ovarian-stimulation regimen (LPS) for in vitro fertilization (IVF) and vitrified embryo transfer (ET) cycles. DESIGN: Retrospective cohort study. SETTING: Tertiary-care academic medical center. PATIENT(S): Infants who were born between January 1, 2013 and May 1, 2014 from IVF with intracytoplasmic sperm injection (ICSI) treatments (n = 2,060) after either LPS (n = 587), the standard gonadotropin-releasing hormone-agonist (GnRH-a) short protocol (n = 1,257), or mild ovarian stimulation (n = 216). INTERVENTION(S): The three ovarian-stimulation protocols described and assisted reproductive technology (ART) treatment (IVF or ICSI, and vitrified ET) in ordinary practice. MAIN OUTCOME MEASURE(S): The main measures were: gestational age, birth weight and length, multiple delivery, early neonatal mortality, and birth defects. Associations were assessed using logistic regression by adjusting for confounding factors. RESULT(S): The final sample included 2,060 live-born infants, corresponding to 1,622 frozen-thawed (FET) cycles, which led to: 587 live-born infants from LPS (458 FET cycles); 1,257 live-born infants from the short protocol (984 FET cycles); and 216 live-born infants from mild ovarian stimulation (180 FET cycles). Birth characteristics regarding gestational age, birth weight and length, multiple delivery, and early neonatal death were comparable in all groups. The incidence of live-birth defects among the LPS group (1.02%) and the short GnRH-a protocol group (0.64%) was slightly higher than in the mild ovarian-stimulation group (0.46%). However, none of these differences reached statistical significance. For congenital malformations, the risk significantly increased for the infertility-duration factor and multiple births; the adjusted odds ratios were 1.161 (95% confidence interval [CI]: 1.009-1.335) and 3.899 (95% CI: 1.179-12.896), respectively. No associations were found between congenital birth defects and various ovarian-stimulation regimens, maternal age, body mass index, parity, insemination method, or infant gender. CONCLUSION(S): To date, the data do not indicate an elevated rate of abnormality at birth after LPS, but further study with larger populations is needed to confirm these results. However, infertility itself poses a risk factor for congenital malformation. A higher likelihood of birth defects in multiple births may lead couples to favor elective, single ET; couples undertaking ART should be made aware of the known increased birth defects associated with a twin birth.


Subject(s)
Congenital Abnormalities/etiology , Cryopreservation , Embryo Transfer/adverse effects , Infertility/therapy , Luteal Phase/drug effects , Ovulation Induction/adverse effects , Sperm Injections, Intracytoplasmic/adverse effects , Academic Medical Centers , Adult , Birth Weight , Chi-Square Distribution , China , Congenital Abnormalities/diagnosis , Congenital Abnormalities/mortality , Embryo Transfer/mortality , Female , Gestational Age , Humans , Infant , Infant Mortality , Infertility/diagnosis , Infertility/physiopathology , Live Birth , Logistic Models , Luteal Phase/metabolism , Odds Ratio , Ovulation Induction/methods , Ovulation Induction/mortality , Pregnancy , Pregnancy Rate , Retrospective Studies , Risk Assessment , Risk Factors , Sperm Injections, Intracytoplasmic/mortality , Tertiary Care Centers , Treatment Outcome , Vitrification
2.
Fertil Steril ; 103(6): 1432-7.e1, 2015 Jun.
Article in English | MEDLINE | ID: mdl-25813286

ABSTRACT

OBJECTIVE: To evaluate the safety and efficacy of early rescue intracytoplasmic sperm injection (ICSI). DESIGN: Retrospective cohort study. SETTING: Teaching hospital. PATIENT(S): There were 13,232 ovarian stimulation cycles (IVF, n = 9,631; ICSI, n = 2,871; early rescue ICSI, n = 730) that resulted in the delivery of 5,001 babies (IVF, n = 3,670; ICSI, n = 1,095; early rescue ICSI, n = 246) from August 2008 to August 2013. INTERVENTION(S): Early rescue ICSI. MAIN OUTCOME MEASURE(S): Clinical pregnancy rates, neonatal outcomes, and congenital birth defects were analyzed. RESULT(S): The early rescue ICSI cycles did not seem to have a negative effect on the clinical pregnancy rate (43.42%) when IVF cycles (45.33%) were compared with ICSI cycles (44.39%). In the early rescue ICSI group, a total of 254 clinical pregnancies were achieved: 197 (33.67%) live births, 38 (6.49%) miscarriages, 2 (0.79%) induced abortions, 3 (1.18%) fetal deaths, and 4 pregnancies (1.57%) without completion at follow-up. Overall, the multiple gestations, the delivery method, mean gestational age, preterm deliveries, mean birth weight, and rate of congenital birth defects of the early rescue ICSI group were similar to those in the conventional IVF and ICSI groups. CONCLUSION(S): Early rescue ICSI had similar clinical pregnancy rates when compared with conventional IVF and ICSI, in addition to the delivery of healthy children. The clinical evidence from the early rescue ICSI group did not show an elevated rate of malformations. Early rescue ICSI seems to be a safe alternative method for individuals with total fertilization failure or near total fertilization failure when compared with conventional IVF treatment.


Subject(s)
Congenital Abnormalities/mortality , Fetal Mortality , Infertility, Male/mortality , Infertility, Male/therapy , Pregnancy Rate , Salvage Therapy/mortality , Sperm Injections, Intracytoplasmic/mortality , Abortion, Induced/statistics & numerical data , Abortion, Spontaneous , Adult , China/epidemiology , Cohort Studies , Female , Humans , Incidence , Longitudinal Studies , Male , Multiple Birth Offspring/statistics & numerical data , Pregnancy , Retrospective Studies , Risk Factors , Survival Rate , Treatment Outcome
3.
Am J Obstet Gynecol ; 190(6): 1766-71; discussion 1771-2, 2004 Jun.
Article in English | MEDLINE | ID: mdl-15284794

ABSTRACT

OBJECTIVE: This study was undertaken to determine whether the method of fertilization has a significant impact on survival and/or clinical pregnancy rates of cryopreserved human pronuclear (2PN) stage embryos. DESIGN: A retrospective analysis of cryosurvival and clinical pregnancy rates after thawing of 2PN stage embryos from January 2000 through December 2002 in a private Assisted Reproductive Technology (ART) center. MATERIAL AND METHODS: A total of 1408 human 2PN embryos were cryopreserved using a Planer Kryo 10 Series III freezing unit (TS Scientific, Perkasie, Pa) after dehydration/equilibration through Propanediol (Sigma Chemical, St. Louis, Mo) and sucrose. On thawing, embryos were cultured in vitro with P-1 medium with 10% Serum Substitute Supplement (Irvine Scientific, Santa Ana, Calif). Embryo transfer was performed at 40 to 48 hours from time of thaw into a recipient uterus after standard estradiol/progesterone preparation. RESULTS: In 2000, 78% of all frozen 2PN embryos survived and were transferred in 181 cycles producing a delivery rate of 26% per transfer. However, 59% of these cycles were intracytoplasmic sperm injection (ICSI), and the survival of frozen 2PN from these cycles (72%) was lower than the respective survival of frozen 2PN embryos from in vitro fertilization (IVF) (81%; P<.025). Changes to protocols for thawing frozen 2PN embryos were therefore explored and implemented during 2001, resulting in equivalent survival rates of frozen 2PN embryos from IVF and ICSI during 2001 (78% and 80%, respectively) and 2002 (73% and 74%, respectively). Coincidentally, the proportion of all cycles that were performed with ICSI increased (73% in 2001 to 78% in 2002; P<.01) and pregnancy rates after transfer of frozen/thawed 2PN embryos from ICSI increased from 15% in 2000 to 30% in 2002. CONCLUSION: 2PN stage embryo cryosurvival may be negatively affected by ICSI, possibly caused by disruption of the zona pellucida and vitelline membrane before cryopreservation, and/or because ICSI promotes fertilization of some compromised eggs (producing compromised 2PN embryos) that would not have fertilized by conventional IVF. Without close attention to embryo freezing and thawing protocols relative to outcome, lower cryosurvival of unselected ICSI-produced embryos can negatively impact pregnancy outcomes.


Subject(s)
Cryopreservation/methods , Embryo Transfer/mortality , Pregnancy Outcome , Pregnancy Rate , Sperm Injections, Intracytoplasmic/mortality , Female , Fertilization in Vitro , Fetal Death , Follow-Up Studies , Humans , Pregnancy , Retrospective Studies , Risk Factors , Survival Rate
SELECTION OF CITATIONS
SEARCH DETAIL
...