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Recurrent pregnancy loss
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Christine E. Ryan, Danny J. Schust
Much research has been devoted to possible therapeutic options for couples with unexplained RPL. Two recent studies have evaluated the role of preimplantation genetic screening for couples with idiopathic RPL. They have yielded conflicting results. Munne et al. studied 58 couples with unexplained RPL among whom the female partner was 35 years of age and older. The authors performed PGS for chromosomes X, Y, 13, 15, 16, 17, 18, 21, and 22 and transferred up to four embryos (euploid for these particular chromosomes). The subsequent miscarriage rate after identification of a gestational sac was 15.7%, which was lower than expected. They also found the “take-home” baby rate per retrieval to be 36% (146). Work by Platteau and colleagues (147) included 49 women with idiopathic RPL in a prospective cohort study. Their embryos were tested for abnormalities in chromosomes X, Y, 13, 16, 18, 21, and 22. For women less than age 37, the pregnancy rate per cycle initiated was 23%, whereas for women at or beyond 37 years of age, the rate dropped drastically to 3%, with 44% and 67% aneuploidy rates, respectively. Like Shahine and colleagues (38), these researchers concluded that no therapeutic evidence currently exists to support the use of in vitro fertilization with or without PGS for idiopathic RPL patients. Oocyte donation may be effective (148). Randomized controlled trials are needed.
Multiple pregnancy and infertility
Published in Janetta Bensouilah, Pregnancy Loss, 2021
Polycystic ovarian syndrome (PCOS) accounts for around 75% of anovulatory cases of infertility. Women with PCOS are at increased risk of spontaneous miscarriage. Although the exact pathophysiological mechanism is unclear, the elevated luteinising hormone (LH) level that characterises the syndrome has in the past been thought to be responsible, although recent research suggests this is unlikely. Instead, hyperandrogenaemia, obesity and hyper-insulinaemia have been identified as more probable contributory factors.8 Clomifene citrate has traditionally been the first-line treatment for women with anovulatory PCOS who wish to conceive. In cases that are resistant to clomifene, and in women who fail to conceive, gonadotrophins may be given. Women with PCOS who are treated with gonadotrophins have a multiple pregnancy rate of 36%. In recent years the use of metformin in PCOS has become increasingly widespread, and there is some evidence to suggest that this may have a number of protective effects in pregnancy by reducing complications such as gestational diabetes and early pregnancy loss.9
Transvaginal Sonography in the Management of Infertility
Published in Asim Kurjak, Ultrasound and Infertility, 2020
Ilan E. Timor-Tritsch, Shraga Rottem
Clearly, the success of an infertility clinic is measured by its pregnancy rate. Therefore, the early diagnosis of a pregnancy is not only a matter of subjective concern for the patient and the entire team providing the care, but it has other important implications that relate to outcome statistics. The rate of spontaneous abortions, ectopic gestations, and multiple pregnancies, which are higher as a result of this treatment, must be carefully tabulated. It is important, therefore, that reliable and earliest possible detection of the pregnancy be made.
Socioeconomic status and fertility treatment outcomes in high-income countries: a review of the current literature
Published in Human Fertility, 2023
Rachel Imrie, Srirupa Ghosh, Nitish Narvekar, Kugajeevan Vigneswaran, Yanzhong Wang, Mike Savvas
The study by Smith et al. (2011) also looked at income as a measure of SES. They noted that women with household incomes of >$150,000 per year were more likely to use higher levels of fertility treatments such as IUI (RR 2.4, CI 1.0–5.9) and IVF (RR 5.2, CI 2.4–11.3) compared to those with a household income <$100,000. Those in the highest income households were more likely to have more 1-5+ treatment cycles compared to 0 cycles. They observed a threshold point of fertility treatment expenditure above which there were significant increases in pregnancy rates (constant increase in pregnancy rates after an expenditure of $2,500 up to $45,000 expenditure on fertility treatment after which a decline was noted), even though there was no direct correlation between treatment expenditure and outcome. Only a slight non-statistically significant increase in pregnancy rates was seen in those with higher household incomes.
Factors affecting clinical pregnancy in controlled ovarian hyperstimulation with GnRH-a long protocol: a retrospective cross-sectional study
Published in Journal of Obstetrics and Gynaecology, 2022
Yanli Fan, Yi-Fei Sun, Yue-Ming Xu, Zi-Yu Cao, Zhuo-Ye Luo, Yong Sun, Zhi-Ming Zhao, Gui-Min Hao, Bu-Lang Gao
The Chinese expert consensus on the number of embryos transferred (Sun Yi-Juan et al. 2018) recommended that regardless of age or number of transfer cycles, the number of embryos transferred per cycle should not exceed two. Based on this, the patients were further divided into two groups according to the number of embryos transferred: one embryo group and two embryo groups (Supplemental Table 1). The clinical pregnancy rate (63.1 vs. 22.4%, p < .05) and live birth rate (53.8 vs. 14.5%, p < .05) were significantly higher in the two embryo group than those in the one embryo group, and the miscarriage rate (12.5 vs. 35.3%, p < .05) was significantly lower in the two embryo group than that in the one embryo group. The rate of ectopic pregnancy (2.1 vs. 0%, p > .05) and multiple pregnancies (35.5 vs. 0%, p > .05) was higher in the two embryo group than that in the one embryo group without significantly.
Strictly selected Mono- and non-pronuclear blastocysts could result in appreciable clinical outcomes in IVF cycles
Published in Human Fertility, 2022
Lei Fu, Dapeng Chu, Wenhui Zhou, Yuan Li
Various cycle and outcome parameters were evaluated as: (i) occurrence (%) = number of cycles containing at least one given embryo/total number of cycles × 100%; (ii) cleavage rate (%) = number of cleaved embryos/number of given zygotes × 100%; (iii) blastulation rate (%) = number of blastocysts/number of cultured embryos × 100%; (iv) available embryo rate (%) = number of transferred or cryopreserved embryos/number of cleaved zygotes × 100%; (v) clinical pregnancy rate (%) = number of patients with clinical pregnancy/number of transferred patients × 100%; (vi) implantation rate (%) = number of implanted embryos/number of transferred embryos × 100%; (vii) multiple pregnancy rate (%) = number of multiple pregnancies/number of clinical pregnancies × 100%; (viii) live birth rate (%) = number of live birth cycles/number of transfer cycles × 100%; (ix) spontaneous abortion rate (%) = number of spontaneous abortion cycles/number of clinical pregnancy cycles × 100%; (x) premature birth rate (%) = number of premature birth/number of live birth × 100%; (xi) gender (males/females) = number of boys/number of girls; and (xii) malformation rate (%) = number of babies with birth defects/total number of babies × 100%. Statistical analysis was performed with χ2 test and one-way ANOVA. Fisher’s exact test was used when n < 40 or a value of <5 was expected. Significance was set at p < 0.05. Our main outcome measures were clinical pregnancy rate and live birth rate.