Professional Documents
Culture Documents
preeclampsia
Uterine malformations
Previous scar/ fibroids - eSET
Complications
____________________________________________________________________
OHSS
Perinatal morbidity PE, SGA, IUGR, LBW
Ectopic pregnancies
Preeclampsia
Multiple pregnancies - DT & monozygotic twins
Birth Defects
Complications following OR
Clinical Presentation
Mild
Moderate
Severe
Critical
Level of evidence
Decreasing exposure to
gonadotropins
GnRH antagonist
1a
2a
Approximately half the risk of OHSS with P for LPS vs. hCG
1a
IVM
Insulin-sensitizing agents
1a, 2a
Level of evidence
Cycle cancellation
Coasting
1a
1b
Recombinant human LH
1b
Cryopreservation of all
embryos
1a
Antagonist salvage
1b
Level of evidence
Albumin
1a
Hydroxyethyl starch
1b
Follicular aspiration
1a
Aromatase inhibitors
Dopamine agonists
1b
Glucocorticoids
2a
To investigate the association between oocyte number and the rates of ovarian
hyperstimulation syndrome (OHSS) and live birth (LB) in fresh autologous in vitro
fertilization (IVF) cycles.
Main
Outcome
Measure
Rates of OHSS and LB were calculated fir each group. A generalized estimating equation
(GEE) was used to assess differences in OHSS and LB between groups. Receiver
operating characteristic (ROC) curves were used to evaluate oocyte number as predictor
of OHSS and LB.
Result
The LB rate increased up to 15 oocytes, then plateaued (0-5:17%, 6-10:31.7%; 1115:39.3%, 16-20:42.7%; 21-25:43.8%; and >25 oocytes: 41.8%). However, the rate of
OHSS became much more clinically significant after 15 oocytes (0-5:0.09%; 6-10:0.37%;
11-15:0.93%; 16-20:1.67%; 21-25:3.03% and >25 oocytes: 6.34%).
Conclusion
Ryan G. Steward, MD
Fertil Steril 2014:101:967-73
Nested case-control
Result(s): Of 6,223 gestations, 131 MZTs were diagnosed (2.1% incidence, 2% in autologous and 2.7%
in donor IVF cycles), 10 were dichorionic and 121 were monochorionic. Controlling for all
risk factors, young oocyte age, extended culture (noncleavage embryos transferred
on/after day 4) , and year of IVF treatment cycle were significantly associated with MZT.
When assessing factors associated with specific MZT placentation,d day 3 assisted hatching
correlated more with dichrorionic MZT, whereas extended culture and advanced day 5
embryonic stage correlated with monochorionic MZT.
Conclusion
After IVF the incidence of MZT is high, with young oocyte age, year of
treatment and extended culture conferring greatest risk. ART procedures may
influence the timing of enbryonic splitting (i.e. may be influenced by ZP
manipulation whereas later splitting may occur during delayed implantation).
Jaime M. Knopman
Fertility and Sterility Vol. 102, No. 1 July 2015
To conduct a meta-analysis of studies assessing the effect of IVF and intracytoplasmic sperm
injection (ICSI) on birth defects.
Patient(s):
Result(s):
Of 925 studies reviewed of eligibility, 802 were excluded after screening titles and abstracts,
67 were excluded for duplicated data, data un-available, or inappropriate control group, 56
were included in the final analysis. Among the 56 studies, 46 studies had data on birth
defects in children conceived by IVF and/or ICSI (124,468) compared with spontaneously
conceived children. These studies provided a pooled risk estimation of 1.37 (95% confidence
interval [CI]; 1.26-1.48), which is also evident in subgroup analysis. In addition, 24 studies
had data on birth defects in children conceived by IVF (46,890) compared with those by ICSI
(27,754), which provided an overall no risk difference.
Conclusion
FIGURE 2
Individual risk ratio estimates and pooled ratio estimates from the studies relating IVF and ICSI children compared with spon taneously conceived
children. Abbreviations as in Fig. 1. *Weight from random effects analysis.
Wen. ART and the risk of birth defects: a meta-analysis. Fertil Steril 2012.
FIGURE 3
Individual risk ratio estimates and pooled risk ratio estimates from studies relating birth defects in children conceived by IVF compared with ICSI.
Abbreviations as in Fig. 1. *Weight form random effects analysis.
Wen. ART and the risk of birth defects: a meta-analysis. Fertil Steril 2012.
Congenital Abnormalities
1. Subfertility (Time-to-Pregnancy > 1 Year) HR1.29 to 1.01
7. FET No difference.
(a) Slow freezing
(b) Vitrification
Anja Pinborg, M.D.
Fertility and Sterility Vol . 99, No.2 February 2013
To study the association of perinatal outcome and IVF transfer type in group of
infertility patients with standardized treatment and similar prognosis.
Result(s):
The final sample included 340 pregnancies: 218 fresh and 122 frozen ETs. Singleton
pregnancy was less likely after transfer of fresh embryos (odds ratio [OR} 0.39, 95%
confidence interval [CI] 0.23-0.67), and pregnancies after fresh ET were more likely to
end in first-trimester (OR 1.82, 95% CI 1.05-3.13). Composite adverse outcome after
transfer of fresh (44.0%) versus frozen (32.6%) emrbyos are higher (OR 1.52, 95% CI
0.90-2.56) and was strongly associated with twin gestation (OR 23.82, 95% CI 11.1650.82).
Conclusion(s):
Result(s):
Conclusion(s):
Multiple mechanisms have been proposed as potential etiologies for low birth weight (LBW) in assisted
reproductive technology (ART). Ovarian stimulation, maternal characteristics, and subfertility may act through an
impairment of the embryo or endometrial quality. The impairment in the endometrial quality may result in
placental associated defects. The culture medium and the stage of embryo development at transfer may act via the
embryo quality. The number of embryos transferred may act through the vanishing twin hypothesis causing
suboptimal implantation. The impairment of the embryo quality can result in either an insult to its implantation
potential or its development potential.