Causal relationships exist between polycystic ovary syndrome and adverse pregnancy and perinatal outcomes: a Mendelian randomization study.

Introduction: Previous observational studies have shown that polycystic ovary syndrome (PCOS) was associated with adverse pregnancy and perinatal outcomes. However, it remains controversial whether PCOS is an essential risk factor for these adverse pregnancy and perinatal outcomes. We aimed to use instrumental variables in a two-sample Mendelian randomization (MR) study to determine causality between PCOS and adverse pregnancy and perinatal outcomes. Materials and methods: Summary statistics were extracted from a recent genome-wide association study (GWAS) meta-analysis conducted in PCOS, which included 10,074 cases and 103,164 controls of European ancestry. Data on Adverse pregnancy and perinatal outcomes were summarized from the FinnGen database of European ancestry, which included more than 180,000 samples. The inverse variance weighted (IVW) method of MR was applied for the main outcome. To assess heterogeneity and pleiotropy, we conducted sensitivity analyses, including leave-one-out analysis, weighted median, MR-PRESSO (Mendelian Randomization Pleiotropy RESidual Sum and Outlier), and MR-Egger regression. Results: Two-sample MR analysis with the IVW method suggested that PCOS exerted causal effects on the risk of hypertensive disorders of pregnancy [odds ratio (OR) 1.170, 95% confidence interval (CI) 1.051-1.302, p = 0.004], in particular gestational hypertension (OR 1.083, 95% CI 1.007-1.164, p = 0.031), but not other pregnancy and perinatal diseases (all p > 0.05). Sensitivity analyses demonstrated pleiotropy only in pre-eclampsia or eclampsia (p = 0.0004), but not in other pregnancy and perinatal diseases (all p > 0.05). The results remained consistent after excluding two outliers (all p > 0.05). Conclusions: We confirmed a causal relationship between PCOS and hypertensive disorders of pregnancy, in particular gestational hypertension, but no association with any other adverse pregnancy or perinatal outcome. Therefore, we suggest that women with PCOS who are pregnant should have their blood pressure closely monitored.

Storage time does not influence pregnancy and neonatal outcomes for first single vitrified high-quality blastocyst transfer cycle.

RESEARCH QUESTION: Does blastocyst storage time have an impact on pregnancy and neonatal outcomes following the first single vitrified/warmed high-quality blastocyst transfer cycle for young women? DESIGN: Retrospective cohort study in a university-affiliated reproductive medical centre. RESULTS: A total of 2938 patients undergoing their first frozen embryo transfer (FET) cycle with a single high-quality blastocyst (Day 5: 3BB and above; Day 6: 4BB and above) transferred were divided into five groups: Group A with storage time ≤3 months (n = 1621), Group B with storage time of 4-6 months (n = 657), Group C with storage time of 7-12 months (n = 225), Group D with storage time of 13-24 months (n = 104), and Group E with storage time of 25-98 months (n = 331). After adjusting for confounding factors by multivariate logistic regression, there were no significant differences in live birth rate [Group A as reference; Group B: adjusted odds ratio (aOR) 0.954 (95% CI 0.791- 1.151); Group C: aOR 0.905 (95% CI 0.674-1.214); Group D: aOR 0.727 (95% CI 0.474-1.114); Group E: aOR 1.185 (955 CI 0.873-1.608)], ß-human-chorionic-gonadotropin-positive rate, clinical pregnancy rate and miscarriage rate between Group A and the other groups. Among all singletons born after FET, there were no significant differences with regards to gestational age, preterm birth, birthweight, low birthweight, high birthweight and macrosomia. CONCLUSION: Long-term cryostorage of human vitrified high-quality blastocysts does not affect pregnancy or neonatal outcomes.

Age at menarche and polycystic ovary syndrome: A Mendelian randomization study.

OBJECTIVE: The authors aimed to use a large two-sample Mendelian randomization (MR) study to reveal the causality between age at menarche (AAM) and polycystic ovary syndrome (PCOS) incidence. METHODS: The authors collected summary statistics from the hitherto largest genome-wide association studies conducted in AAM and PCOS in the same ancestry. MR with inverse variance weighting was conducted as the main analysis method, while weighted median and MR-Egger regression were used for comprehensive analysis. As for pleiotropy detection, inverse variance weighting, MR-Egger regression, Mendelian Randomization Pleiotropy Residual Sum and Outlier, as well as leave-one-out analysis were used to detect pleiotropy. Risk factor analysis was conducted to investigate the underlying mechanisms linking AAM to PCOS. RESULTS: Each standard deviation increment in AAM was associated with a significantly lower incidence of PCOS (odds ratio, 0.86 [95% confidence interval, 0.75-0.98]). After adjustment in horizontal pleiotropy by eliminating four outliers, this pathogenic association was still statistically detected. All pleiotropy indexes were without statistical differences, which suggested the conclusions were robust. It showed the causal association between later AAM and lower body mass index, lower fasting insulin level and insulin resistance. CONCLUSION: Our MR analysis verified that a slightly later onset age (15 to 18 years) at menarche could reduce the risk of PCOS. A more comprehensive investigation in a prospective setting is strongly advised.

Risk factors related to chromosomal mosaicism in human blastocysts.

RESEARCH QUESTION: Do factors relating to patients, ART, or both, affect the incidence of chromosomal mosaicism in human blastocysts? DESIGN: Blastocysts (n = 5718) from 1198 PGT-A cycles were biopsied between 2015 and 2021. All samples were amplified with multiple displacement amplification, and MiSeq system was used for next-generation sequencing. Mosaicism prevalence, and ART and patient factors potentially affecting mosaicism, were analysed. RESULTS: Among 5718 blastocysts detected, 1245 were mosaic (21.8%). Day-6 biopsied blastocysts yielded a statistically significantly higher mosaicism rate than day-5 blastocysts (24.5% versus 19.1%; OR 1.174; 95% CI 1.017 to 1.355, P = 0.028). Mosaicism rate increased as morphological score declined (excellent quality [13.2%], good quality [19.0%], average quality [22.0%] and poor quality [26.4%], P < 0.001). Compared with excellent-quality embryos, the OR of mosaicism was 1.490 (95% CI 1.069 to 2.078, P = 0.019) for good-quality, 1.751 (95% CI 1.274 to 2.407, P = 0.001) for average-quality, and 2.113 (95% CI 1.512 to 2.952, P < 0.001) for poor-quality embryos. Biopsy technicians were related to the incidence of mosaicism. One of the four technicians had a significantly higher mosaicism rate than the others (27.9%; 20.9%; 20.5%; 20.5%, respectively; P < 0.001). Parental ages, female BMI, history of infertility, sperm quality, antral follicular counts, ovarian stimulation protocols, stimulation length, total gonadotrophin dosage and number of retrieved oocytes, were not related to the incidence of mosaicism. CONCLUSION: Slow developing, poor-quality blastocysts are at higher risk of mosaicism. Biopsy technician may contribute to artificial mosaicism as an extrinsic factor.

Which type of chromosomal mosaicism is compatible for embryo transfer: a systematical review and meta-analysis.

PURPOSE: Chromosomal mosaicism becomes a common phenomenon in Preimplantaion genetic testing (PGT). This meta-analysis was conducted to study which feature of chromosomal mosaicism was compatible for embryo transfer. METHODS: After searching the database PubMed, Embase, CCTR and related reviews up until May 2021. Two reviewers extracted relevant information and assessed study quality by the Newcastle-Ottawa scale independently. Summary Odd Radios (OR) were calculated using fixed- or random-effects models for clinical outcomes. A network meta-analysis compared the clinical outcomes of different chromosomes. RESULTS: A total of six studies with 1,106 cycles of single mosaic embryo transferred were included. Significant results of implantation rate (IR), miscarriage rate (MR), and ongoing pregnancy/live birth rate (OP/LBR) were observed when comparing embryos with mosaicism level < 50% and ≥ 50% [OR 1.42, 95% CI (1.06, 1.89); OR 0.45, 95% CI (0.27, 0.75); OR 1.74, 95% CI (1.28, 2.37)], and embryos with mosaicism with only affecting segmental chromosome(s) and only involving whole chromosome(s) [OR 1.31, 95% CI (1.01, 1.71); OR 0.57, 95% CI (0.36, 0.93); OR 1.51, 95% CI (1.15, 2.00)]. Embryos with only mosaic gains or losses had significant higher IR and OP/LBR than complex mosaicism [Gains vs complex: OR 1.75, 95% CI (1.20, 2.54); OR 1.73, 95% CI (1.16, 2.58). Losses vs complex: OR 1.90, 95% CI (1.34, 2.71); OR 2.10, 95% CI (1.44, 3.07)]. Mosaic embryos with only one chromosome involved had significant favorable outcomes of IR and OP/LBR than with three or more chromosomes involved [OR 1.76, 95% CI (1.23, 2.52); OR 1.86, 95% CI (1.25,2.78)]. Chr. 7, Chr. 2, Chr. 1, Chr. 18, Chr. 11, Chr. X, Chr. 13, Chr. 14, Chr. 12, and Chr. 9 were considered as prioritized chromosomes of mosaic embryos for transfer. CONCLUSIONS: This analysis support the embryos with mosaicism level ≥ 50%, whole chromosome(s) involved, multiple mosaic abnormalities were associated with worse pregnancy outcomes. Mosaicism level of 50% could be used as a threshold to assess the mosaic embryos.

Impact of Luteinized Unruptured Follicles on Clinical Outcomes of Natural Cycles for Frozen/Thawed Blastocyst Transfer.

Objective: To investigate the impact of luteinized unruptured follicles (LUF) on clinical outcomes of frozen/thawed embryo transfer (FET) of blastocysts. Methods: In this retrospective cohort study, 2,192 patients who had undergone blastocyst FET treatment with natural cycles from October 2014 to September 2017 were included. Using propensity score matching, 177 patients diagnosed with LUF (LUF group) were matched with 354 ovulating patients (ovulation group). The LUF group was further stratified by the average LH peak level of 30 IU/L. Clinical pregnancy rate and live birth rate were retrospectively analyzed between the LUF and ovulation groups, as well as between LUF subgroups. Results: After propensity score matching, general characteristics were similar in the LUF and ovulation groups. Clinical pregnancy rate in the LUF group was significantly lower than that in the ovulation group (47.46 vs. 58.76%, respectively, adjusted P = 0.01, OR 0.60, 95% CI 0.42-0.87). However, no significant difference was detected in live birth rate, although it was lower in the LUF group (43.50 vs. 50.00%, adjusted P = 0.19, OR 0.76, 95% CI 0.51-1.14). In the LUF subgroup analysis, both clinical pregnancy rate (43.02 vs. 62.30%, adjusted P = 0.02, OR 0.45, 95% CI 0.23-0.87) and live birth rate (37.21 vs. 59.02%, adjusted P = 0.01, OR 0.40, 95% CI 0.20-0.78) in the LH <30 IU/L subgroup were significantly lower than those in the LH ≥30 IU/L subgroup. Conclusion: LUF negatively affected clinical outcomes of frozen/thawed embryo transfer of blastocysts, particularly when the LH surge was inadequate.

Cardia Gastric Cancer in the Gastric Pouch 5 Years after Gastric Bypass: A Case Report.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) is one of the most frequently performed bariatric procedures worldwide. Remnant gastric cancer after RYGB is a rare complication. There were about seventeen cases reported in the world. The location of the tumor in these cases occurs mainly in the gastric antrum, followed by the body, then the pylorus and linitis plastica, and the last was fundus of the stomach. To the best of our knowledge, this is the first case that gastric cancer located in the cardia of stomach after RYGB. CASE REPORT: A 68-year-old male patient had chronic esophagitis, bile reflux gastritis, and erosive antral gastritis 5 years after RYGB and now developed to aggressive carcinoma in the gastric pouch. In spite of having chemotherapy and traditional Chinese medicine therapy, the patient died of multiple organ failure after 15 months. CONCLUSIONS: This case report highlights the importance to have gastroscopy to observe the proximal small remnant stomach after RYGB in long-term follow-up. Attention must be paid when patients develop symptoms like abdominal pain or excessive weight loss after RYGB. For patients at high risk such as those who have a family history of gastric cancer or presenting abnormal levels of tumor markers should rather undergo Sleeve Gastrectomy plus Jejunojejunal Bypass (SGJB) instead of RYGB.