Endometrial preparation methods for frozen-thawed embryo transfer are associated with altered risks of hypertensive disorders of pregnancy, placenta accreta, and gestational diabetes mellitus

2019 ◽  
Vol 34 (8) ◽  
pp. 1567-1575 ◽  
Author(s):  
Kazuki Saito ◽  
Akira Kuwahara ◽  
Tomonori Ishikawa ◽  
Naho Morisaki ◽  
Mami Miyado ◽  
...  
Keyword(s):  
Pregnancy Outcomes ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Placenta Accreta ◽  
Confounding Factors ◽  
Multiple Logistic Regression ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Frozen Thawed Embryo Transfer ◽  
Thawed Embryo Transfer

ABSTRACT STUDY QUESTION What were the risks with regard to the pregnancy outcomes of patients who conceived by frozen-thawed embryo transfer (FET) during a hormone replacement cycle (HRC-FET)? SUMMARY ANSWER The patients who conceived by HRC-FET had increased risks of hypertensive disorders of pregnancy (HDP) and placenta accreta and a reduced risk of gestational diabetes mellitus (GDM) in comparison to those who conceived by FET during a natural ovulatory cycle (NC-FET). WHAT IS KNOWN ALREADY Previous studies have shown that pregnancy and live-birth rates after HRC-FET and NC-FET are comparable. Little has been clarified regarding the association between endometrium preparation and other pregnancy outcomes. STUDY DESIGN, SIZE, DURATION A retrospective cohort study of patients who conceived after HRC-FET and those who conceived after NC-FET was performed based on the Japanese assisted reproductive technology registry in 2014. PARTICIPANTS/MATERIALS, SETTING, METHODS The pregnancy outcomes were compared between NC-FET (n = 29 760) and HRC-FET (n = 75 474) cycles. Multiple logistic regression analyses were performed to investigate the potential confounding factors. MAIN RESULTS AND THE ROLE OF CHANCE The pregnancy rate (32.1% vs 36.1%) and the live birth rate among pregnancies (67.1% vs 71.9%) in HRC-FET cycles were significantly lower than those in NC-FET cycles. A multiple logistic regression analysis showed that pregnancies after HRC-FET had increased odds of HDPs [adjusted odds ratio, 1.43; 95% confidence interval (CI), 1.14–1.80] and placenta accreta (adjusted odds ratio, 6.91; 95% CI, 2.87–16.66) and decreased odds for GDM (adjusted odds ratio, 0.52; 95% CI, 0.40–0.68) in comparison to pregnancies after NC-FET. LIMITATIONS, REASONS FOR CAUTION Our study was retrospective in nature, and some cases were excluded due to missing data. The implication of bias and residual confounding factors such as body mass index, alcohol consumption, and smoking habits should be considered in other observational studies. WIDER IMPLICATIONS OF THE FINDINGS Pregnancies following HRC-FET are associated with higher risks of HDPs and placenta accreta and a lower risk of GDM. The association between the endometrium preparation method and obstetrical complication merits further attention. STUDY FUNDING/COMPETING INTEREST(S) No funding was obtained for this work. The authors declare no conflicts of interest in association with the present study. TRIAL REGISTRATION NUMBER Not applicable.

scholarly journals Endometriosis Does not Seem to Be an Influencing Factor of Hypertensive Disorders of Pregnancy in IVF / ICSI Cycles

2021 ◽  
Author(s):  
Pingyin Lee ◽  
Canquan Zhou ◽  
Yubin Li
Keyword(s):  
Influencing Factor ◽  
Protective Role ◽  
Reproductive Technology ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Significant Difference ◽  
Potential Damage ◽  
Frozen Thawed Embryo Transfer ◽  
Thawed Embryo Transfer

Abstract IntroductionTo evaluate whether the incidence of hypertensive disorders of pregnancy (HDP) in pregnant women was related to endometriosis (EM), ovulation and embryo vitrification technology. MethodsA retrospective cohort study was conducted on the clinical data of 3674 women who were treated with IVF / ICSI in the Reproductive Medicine Center of the First Affiliated Hospital of Sun Yat-sen University and maintained clinical pregnancy for more than 20 weeks. All pregnancies were followed up until the end of pregnancy. The follow-up consisted of recording the course of pregnancy, pregnancy complications, and basic situation of newborns.ResultsCompared with NC-FET without EM, HRT-FET without EM was found to have a higher incidence of HDP during pregnancy (2.7% V.S. 6.1%, P<0.001); however, no significant difference was found in the incidence of HDP between NC-FET and HRT-FET combined with EM (4.0% V.S. 5.7%, P>0.05). In total frozen-thawed embryo transfer (total-FET), the incidence of HDP in the HRT cycle without ovulation (HRT-FET) was observed to be higher than that in the NC cycle with ovulation (NC-FET) (2.8% V.S. 6.1%, P<0.001). In patients with EM, no significant difference was found in the incidence of HDP between fresh ET and NC-FET (1.2% V.S. 4.0%, P>0.05). ConclusionEM does not seem to have an effect on the occurrence of HDP in assisted reproductive technology. During the FET cycle, the formation of the corpus luteum may play a protective role in the occurrence and development of HDP. Potential damage to the embryo caused by cryopreservation seems to have no effect on the occurrence of HDP.

scholarly journals Prevalence of hypertensive disorders of pregnancy and pregnancy outcomes in Sub-Saharan Africa: A systematic review and meta-analysis

2020 ◽  
Vol 16 ◽  
pp. 174550652097310
Author(s):  
Kasiye Shiferaw Gemechu ◽  
Nega Assefa ◽  
Bizatu Mengistie
Keyword(s):  
Confidence Interval ◽  
Maternal Mortality ◽  
Pregnancy Outcomes ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Sub Saharan Africa ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Pooled Prevalence ◽  
Sub Saharan

Hypertensive disorders of pregnancy are one of the leading causes of poor pregnancy outcomes and are associated with increased rates of maternal mortality, preterm birth, small for gestational age newborns, stillbirth, and neonatal death. The overall and type-specific prevalence of hypertensive disorders of pregnancy and associated pregnancy outcomes are unknown in Sub-Saharan Africa. Therefore, this review aimed to identify the prevalence of hypertensive disorders of pregnancy and associated pregnancy outcomes in Sub-Saharan Africa. A systematic review and meta-analysis were conducted on observational facility-based studies irrespective of publication status, sample size, language, and follow-up duration from 19 countries between the years 2000 and 2018 in Sub-Saharan Africa. A review of studies using PubMed, EMBASE, African Index Medicus, and African Journals Online was completed with independent extraction of studies by review authors using the predefined inclusion criteria. Quality and risk of bias of individual studies were assessed using the Joanna Briggs Institute Checklist. Random effects model was used to estimate the pooled prevalence of hypertensive disorders of pregnancy and type-specific hypertensive disorders of pregnancy. A pooled adjusted odds ratio with 95% confidence interval for each study was calculated using comprehensive meta-analysis version 2 software to estimate the association of hypertensive disorders of pregnancy and its outcomes. The existence of heterogeneity was assessed using I2 and its corresponding P value. We assessed the presence of publication bias using the Egger’s test. Subgroup analysis was performed to assess the potential effect of variables, and a sensitivity analysis was conducted to assess any undue influence from studies. The analysis included 70 studies. The pooled prevalence of hypertensive disorders of pregnancy (all types combined), chronic hypertension, gestational hypertension, preeclampsia, and eclampsia were 8% (95% confidence interval = [5, 10]), 0.9% (95% confidence interval = [0.4, 1.8]), 4.1% (95% confidence interval = [2.4, 7]), 4.1% (95% confidence interval = [3.2, 5.1]), and 1.5% (95% confidence interval = [1, 2]), respectively. Compared with normotensive pregnant or postpartum women, women with hypertensive disorders of pregnancy were associated with increased risk of maternal mortality, odds ratio = 17 (95% confidence interval = [9.6, 28.8]); cesarean section, odds ratio = 3.1 (95% confidence interval = [1.7, 5.6]); perinatal mortality, odds ratio = 8.2 (95% confidence interval = [2.8, 24]); low birth weight, odds ratio = 3.2 (95% confidence interval = [2, 5]); and preterm delivery, odds ratio = 7.8 (95% confidence interval = [2.5, 25.3]) according to this analysis. The pooled prevalence of hypertensive disorders of pregnancy was high in Sub-Saharan Africa compared to those reported from other regions. Pregnant or postpartum women with hypertensive disorders of pregnancy have increased risk of maternal mortality, cesarean section, preterm delivery, perinatal mortality, and low birth weight newborn. Therefore, creating awareness of the risks of hypertensive disorders of pregnancy is essential. Pregnant women with hypertensive disorders need due attention to manage appropriately and more importantly to have favorable outcomes in this population.

scholarly journals Effect of Individualized Progesterone Supplementation for Luteal Support in Frozen-Thawed Cycles on Pregnancy Outcomes

2021 ◽  
pp. 1-6
Author(s):  
Gülşen Doğan Durdağ ◽  
Gizem Bektaş ◽  
Esengül Türkyılmaz ◽  
Halime Göktepe ◽  
Meltem Sönmezer ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Pregnancy Outcomes ◽  
University Hospital ◽  
Serum Progesterone ◽  
Luteal Support ◽  
Significant Difference ◽  
Lower Limits ◽  
Micronized Progesterone ◽  
Frozen Thawed Embryo Transfer ◽  
Thawed Embryo Transfer

Objective: In frozen-thawed embryo transfer (FET) cycles, preparing a synchronous endometrium for the embryo is essential. Aim of this study is to provide individualized luteal support in hormonally replaced FET cycles, and to evaluate mid-luteal serum progesterone levels and pregnancy outcomes.Study Design: In this prospective cohort study, 30 patients were included in a university hospital in six month-period. Serum progesterone level on embryo transfer day was monitored, and if it was found to be below the lower limits defined by previous studies (10 ng/mL), additional 100 mg intramuscular micronized progesterone was administered once.Mid-luteal progesterone levels and pregnancy outcomes were recorded.Results: There was no significant difference between mid-luteal progesterone levels of the patients whose transfer day progesterone was above and below 10 ng/mL (p=0.481). Although clinical pregnancy rate tended to be higher in patients whose mid-luteal progesterone was above 10 ng/mL, it was also not statistically significant.Conclusion: This is the first study in which vaginal progesterone treatment was supported by intramuscular progesterone according to serum progesterone values for the purpose of individualized progesterone support. Significant difference was not found in pregnancy outcomes. However, further studies are required to optimize management and improve pregnancy rates in hormonally treated FET cycles.

scholarly journals Effect of Preconception Selenium Intake on the Risk for Gestational Diabetes: The Japan Environment and Children’s Study

Antioxidants ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 568
Author(s):  
Hyo Kyozuka ◽  
Tsuyoshi Murata ◽  
Toma Fukuda ◽  
Akiko Yamaguchi ◽  
Aya Kanno ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Preconception Care ◽  
Late Onset ◽  
Multiple Logistic Regression Analysis ◽  
Japanese Women ◽  
Multiple Logistic Regression ◽  
Logistic Regressions ◽  
Study Database

Selenium (Se) acts as a cofactor of antioxidant enzymes. Preconception care may reduce the risk of gestational diabetes mellitus (GDM). We examined the association between preconception Se intake and the risk of GDM in Japanese women. Using the Japan Environment and Children’s Study database, we identified 92,764 Japanese women recruited between January 2011 and March 2014. Participants were categorized into five groups according to preconception Se intake quintiles (Q1 and Q5 were the lowest and highest Se intake groups, respectively). GDM was categorized as early-onset (Eo-GDM) or late-onset (Lo-GDM) diagnosed before or after 24 weeks, respectively. Multiple logistic regressions were performed to identify the effect of preconception Se intake on GDM, Eo-GDM, and Lo-GDM. Using Q3 (the middle Se intake group) as the reference, a multiple logistic regression analysis showed that the highest (Q5) Se intake group demonstrated increased risks of GDM (adjusted odds ratio (aOR): 1.15, 95% confidence interval (CI): 1.01–1.30) and the lowest (Q1) Se intake group had increased risks of Lo-GDM (aOR: 1.19, 95% CI: 1.01–1.41). Thus, both high and low preconception Se intakes increase risks of glucose intolerance during pregnancy. This finding may indicate new recommendations for preconception Se intake to prevent GDM.

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