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Can the peak E2/follicle ratio be a quantitative indicator of pregnancy outcomes following assisted reproductive cycles? A retrospective study.

ABSTRACT: As one of the limited reference parameters for the appropriate timing of human chorionic gonadotropin (hCG) priming and embryo transfer (ET), peak serum estradiol (E2) level and related parameters have been considered to be a possible marker of in vitro fertilization (IVF) outcomes. To our knowledge, few reports have investigated the correlation between the ratio of peak serum E2 to the number of follicles ? 14 mm on the day of hCG administration (i.e., the E2/fol. ratio) and the miscarriage rate (MR) in assisted reproductive cycles. In this study, a total of 1376 cycles were examined and grouped into quartiles by E2/fol. ratio. The patient characteristics, controlled ovarian hyperstimulation (COH) performance, and IVF/ICSI results were compared between the four groups. Patients were further categorized as younger than 35 years of age or 35 years of age and older. The association between the E2/fol. ratio and the implantation rate (IR) or MR was examined using the Mantel-Haenszel test for each group. We found that the E2/fol. ratio correlated with the IR and MR for women younger than 35 years of age. There was a statistically significant increase in the IR with E2/fol. ratio between 279.83 and 552.28 pg/ml, and women with an E2/fol. ratio > 552.28 pg/ml were more likely to suffer miscarriages. Our data support a role for cryopreservation of all embryos when E2/fol. ratio exceeds 552.28 pg/ml for women younger than 35 years of age.

SUBMITTER: Hu D

PROVIDER: S-EPMC4565274 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

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Can the peak E2/follicle ratio be a quantitative indicator of pregnancy outcomes following assisted reproductive cycles? A retrospective study.

Hu Dan D Dong Xiyuan X Xiong Min M Xiong Ting T Huang Bo B Zeng Dan D Ai Jihui J Zhang Hanwang H

International journal of clinical and experimental medicine 20150715 7

As one of the limited reference parameters for the appropriate timing of human chorionic gonadotropin (hCG) priming and embryo transfer (ET), peak serum estradiol (E2) level and related parameters have been considered to be a possible marker of in vitro fertilization (IVF) outcomes. To our knowledge, few reports have investigated the correlation between the ratio of peak serum E2 to the number of follicles ≥ 14 mm on the day of hCG administration (i.e., the E2/fol. ratio) and the miscarriage rat ...[more]

PMID: 26379891

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Project description:Live-birth rates after treatment with assisted reproductive technology have traditionally been reported on a per-cycle basis. For women receiving continued treatment, cumulative success rates are a more important measure.We linked data from cycles of assisted reproductive technology in the Society for Assisted Reproductive Technology Clinic Outcome Reporting System database for the period from 2004 through 2009 to individual women in order to estimate cumulative live-birth rates. Conservative estimates assumed that women who did not return for treatment would not have a live birth; optimal estimates assumed that these women would have live-birth rates similar to those for women continuing treatment.The data were from 246,740 women, with 471,208 cycles and 140,859 live births. Live-birth rates declined with increasing maternal age and increasing cycle number with autologous, but not donor, oocytes. By the third cycle, the conservative and optimal estimates of live-birth rates with autologous oocytes had declined from 63.3% and 74.6%, respectively, for women younger than 31 years of age to 18.6% and 27.8% for those 41 or 42 years of age and to 6.6% and 11.3% for those 43 years of age or older. When donor oocytes were used, the rates were higher than 60% and 80%, respectively, for all ages. Rates were higher with blastocyst embryos (day of transfer, 5 or 6) than with cleavage embryos (day of transfer, 2 or 3). At the third cycle, the conservative and optimal estimates of cumulative live-birth rates were, respectively, 42.7% and 65.3% for transfer of cleavage embryos and 52.4% and 80.7% for transfer of blastocyst embryos when fresh autologous oocytes were used.Our results indicate that live-birth rates approaching natural fecundity can be achieved by means of assisted reproductive technology when there are favorable patient and embryo characteristics. Live-birth rates among older women are lower than those among younger women when autologous oocytes are used but are similar to the rates among young women when donor oocytes are used. (Funded by the National Institutes of Health and the Society for Assisted Reproductive Technology.).

Project description:BackgroundWe aimed to compare reproductive outcomes following ectopic pregnancy (EP) versus livebirth, miscarriage, or termination in a first pregnancy.Methods and findingsA retrospective cohort study design was used. Scottish national data on all women whose first pregnancy occurred between 1981 and 2000 were linked to records of a subsequent pregnancy. The exposed cohort comprised women with an EP in their first pregnancy. There were three unexposed cohorts: women with livebirth, miscarriage, and termination of their first pregnancies. Any differences in rates of second pregnancy, livebirth, EP, miscarriage, or terminations and complications of a second ongoing pregnancy and delivery were assessed among the different exposure groups. A total of 2,969 women had an initial EP; 667,299 had a livebirth, 39,705 women miscarried, and 78,697 terminated their first pregnancies. Women with an initial EP had an increased chance of another pregnancy within 2 years (adjusted hazard ratio (AHR) 2.76 [95% CI 2.58-2.95]) or after 6 years (AHR 1.57 [95% CI 1.29-1.91]) compared to women with a livebirth. In comparison with women with an initial miscarriage, women who had an EP had a lower chance of a second pregnancy (AHR 0.53 [95% CI 0.50-0.56]). Compared to women with an initial termination, women with an EP had an increased chance of a second pregnancy (AHR 2.38 [95% CI 2.23-2.55]) within 2 years. Women with an initial EP suffered an increased risk of another EP compared to women with a livebirth (AHR 13.0 [95% CI 11.63-16.86]), miscarriage (AHR 6.07 [95% CI 4.83-7.62]), or termination (AHR 12.84 [95% CI 10.07-16.37]). Perinatal complications in a pregnancy following EP were not significantly higher than those in primigravidae or in women with a previous miscarriage or termination.ConclusionWomen with an initial EP have a lower chance of conception than those who miscarry but an increased risk of a repeat EP in comparison with all three comparison groups. A major limitation of this study was the inability to separate women using contraception from those who were intending to conceive.

Project description:BackgroundHypertensive disorders of pregnancy (HDP) is one of the most common pregnancy complications and causes of maternal morbidity and mortality. Assisted reproductive technology (ART) has been associated with adverse pregnancy outcomes, including HDP. However, the impact of multiple pregnancies, oocyte donation, as well as fresh and frozen embryo transfer needs to be further studied. We conducted a systematic review and meta-analyses to evaluate the association between ART and HDP or preeclampsia relative to spontaneous conception (SC).MethodsWe identified studies from EMBASE, MEDLINE, and Cochrane Library (up to April 8, 2020) and manually using structured search strategies. Cohort studies that included pregnancies after in vitro fertilization (IVF) with or without intracytoplasmic sperm fertilization (ICSI) relative to SC with HDP or preeclampsia as the outcome of interest were included. The control group was women who conceived spontaneously without ART or fertility medications. The pooled results were reported in odds ratios (OR) with 95% confidence intervals based on random effects models. Numbers needed to harm (NNH) were calculated based on absolute risk differences between exposure and control groups.ResultsEighty-five studies were included after a screening of 1879 abstracts and 283 full text articles. Compared to SC, IVF/ICSI singleton pregnancies (OR 1.70; 95% CI 1.60-1.80; I2 = 80%) and multiple pregnancies (OR 1.34; 95% CI 1.20-1.50; I2 = 76%) were both associated with higher odds of HDP. Singleton pregnancies with oocyte donation had the highest odds of HDP out of all groups analyzed (OR 4.42; 95% CI 3.00-6.51; I2 = 83%). Frozen embryo transfer resulted in higher odds of HDP (OR 1.74; 95% CI 1.58-1.92; I2 = 55%) than fresh embryo transfer (OR 1.43; 95% CI 1.33-1.53; I2 = 72%). The associations between IVF/ICSI pregnancies and SC were similar for preeclampsia. Most interventions had an NNH of 40 to 100, while singleton and multiple oocyte donation pregnancies had particularly low NNH for HDP (16 and 10, respectively).ConclusionsOur meta-analysis confirmed that IVF/ICSI pregnancies are at higher odds of HDP and preeclampsia than SC, irrespective of the plurality. The odds were especially high in frozen embryo transfer and oocyte donation pregnancies.

Project description:Study questionDoes ART impact the secondary sex ratio (SSR) when compared to natural conception?Summary answerIVF and ICSI as well as the stage of embryo transfer does impact the overall SSR.What is known alreadyThe World Health Organization quotes SSR for natural conception to range between 103 and 110 males per 100 female births.Study design size durationA total of 1?376?454 ART cycles were identified, of which 1?002?698 (72.8%) cycles involved IVF or ICSI. Of these, 863?859 (85.2%) were fresh cycles and 124?654 (12.4%) were frozen cycles. Missing data were identified in 14?185 (1.4%) cycles.Participants/materials setting methodsAll cycles recorded in the anonymized UK Human Fertilisation and Embryology Authority (HFEA) registry database between 1991 and 2016 were analysed. All singleton live births were included, and multiple births were excluded to avoid duplication.Main results and the role of chanceThe overall live birth rate per cycle for all IVF and ICSI treatments was 26.2% (n =?262?961), and the singleton live birth rate per cycle was 17.1% (n =?171?399). The overall SSR for this study was 104.0 males per 100 female births (binomial exact 95% CI: 103.1-105.0) for all IVF and ICSI cycles performed in the UK recorded through the HFEA. This was comparable to the overall SSR for England and Wales at 105.3 males per 100 female births (95% CI: 105.2-105.4) from 1991 to 2016 obtained from the Office of National Statistics database. Male predominance was seen with conventional insemination in fresh IVF treatment cycles (SSR 110.0 males per 100 female births; 95% CI: 108.6-111.5) when compared to micro-injection in fresh ICSI treatment cycles (SSR 97.8 males per 100 female births; 95% CI: 96.5-99.2; odds ratio (OR) 1.16, 95% CI 1.12-1.19, P <?0.0001), as well as with blastocyst stage embryo transfers (SSR 104.8 males per 100 female births; 95% CI: 103.5-106.2) when compared to a cleavage stage embryo transfer (SSR 101.2 males per 100 female births; 95% CI: 99.3-103.1; OR 1.03, 95% CI 1.01-1.06, P =?0.011) for all fertilization methods.Limitations reasons for cautionThe quality of the data relies on the reporting system. Furthermore, success rates through ART have improved since 1991, with an increased number of blastocyst stage embryo transfers.Wider implications of the findingsThis is the largest study to date evaluating the impact of ART on SSR. The results demonstrate that, overall, ART does have an impact on the SSR when assessed according to the method of fertilization (ICSI increased female births while IVF increased males). However, given the ratio of IVF to ICSI cycles at present with 60% of cycles from IVF and 40% from ICSI, the overall SSR for ART closely reflects the population SSR for, largely, natural conceptions in England and Wales.Study funding/competing interestsThe study received no funding. C.M.B. is a member of the independent data monitoring group for a clinical endometriosis trial by ObsEva. He is on the scientific advisory board for Myovant and medical advisory board for Flo Health. He has received research grants from Bayer AG, MDNA Life Sciences, Volition Rx and Roche Diagnostics as well as from Wellbeing of Women, Medical Research Council UK, the NIH, the UK National Institute for Health Research and the European Union. He is the current Chair of the Endometriosis Guideline Development Group for ESHRE and was a co-opted member of the Endometriosis Guideline Group by the UK National Institute for Health and Care Excellence (NICE). I.G. has received research grants from Wellbeing of Women, the European Union and Finox.Trial registration numberNot applicable.

Dataset Information

Can the peak E2/follicle ratio be a quantitative indicator of pregnancy outcomes following assisted reproductive cycles? A retrospective study.

Publications

Can the peak E2/follicle ratio be a quantitative indicator of pregnancy outcomes following assisted reproductive cycles? A retrospective study.

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