Fertility Impact of Initial Operation Type for Female Ulcerative Colitis Patients

Abstract Background Ileal pouch–anal anastomosis (IPAA) is the mainstay of surgical treatment for patients with ulcerative colitis (UC) but is associated with an increased risk of infertility. We developed a simulation model examining the impact of initial surgical procedure on quality-adjusted life-years (QALYs) and fertility end points. Methods A patient-level state transition model was used to analyze outcomes by surgical approach strategy for females of childbearing age. Initial surgical options included IPAA, rectal-sparing colectomy with end ileostomy (RCEI), and ileorectal anastomosis (IRA). The primary outcome examined was QALYs, whereas secondary outcomes included UC and fertility-associated end points. Results IPAA resulted in higher QALYs for patients aged 20–30 years, as compared with RCEI. For patients aged 35 years, RCEI resulted in higher QALYs (7.54 RCEI vs 7.53 IPAA) and was associated with a 28% higher rate of childbirth, a 14-month decrease in time to childbirth, and a 77% reduction in in vitro fertilization utilization. When accounting for the decreased infertility risk associated with laparoscopic IPAA, IPAA resulted in higher QALYs (7.57) even for patients aged 35 years. Conclusions Despite an increased risk of infertility, our model results suggest that IPAA may be the optimal surgical strategy for female UC patients aged 20–30 years who desire children. For patients aged 35 years, RCEI should additionally be considered, as QALYs for RCEI and IPAA were similar. These quantitative data can be used by patients and providers to help develop an individualized approach to surgical management choice.

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SUN-715 IIM May Influence Matured Oocytes’ DNA Methylation of PCOS Patients

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1031 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Congru Li ◽

Yang Yu

Keyword(s):

Dna Methylation ◽

In Vitro Fertilization ◽

Embryonic Development ◽

Embryo Transfer ◽

Cpg Island ◽

Reproductive Technologies ◽

Childbearing Age ◽

Vitro Fertilization ◽

The Impact

Abstract Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of childbearing age and is the main cause of anovulatory infertility. To increase the number of oocytes obtained, controlled ovarian stimulation (COS) has become a routine choice for in vitro fertilization-embryo transfer (IVF-ET), which is one of the common assisted reproductive technologies for PCOS patients. However, for these patients, there is a high risk of ovarian hyperstimulation syndrome (OHSS). Obtaining in vitro maturation (IVM) of immature oocytes, and then in vitro fertilization and embryo transfer of mature oocytes provides a possible way for people to solve the above problems. Since the IVM technology will expose oocytes to in vitro conditions for a longer period of time, theoretically increasing the risk of the oocytes being affected by the culture environment, further research and explorations are needed for study in gene programming, epigenetics, etc. Therefore, to explore the impact of IVM operation on embryonic development is of great significance for further clarifying assisted reproductive safety and improving IVM operation conditions. Here we focused on DNA methylation reprogramming process which was essential for embryonic development. We tested the DNA methylation of sperm, IVM oocytes and IVM generated early stage embryos including pronucleus, 4cell, 8cell, morula, inner cell mass, trophoectoderm (TE) as well as six-week embryos by Nimble Gen Human DNA Methylation 3x729K CpG Island Plus RefSeq Promoter Array and compared the data with our published genome-wide DNA methylomes of human gametes and early embryos generated from in vivo maturation oocytes. We showed that IVM embryos show abnormal DNA methylation reprogramming pattern. By analyzing the abnormally reprogrammed promoters, we further found that IVM may affect the functions of demethylation related genes. Oocytes from IVM manipulation were tested with higher DNA methylation levels, and their abnormal methylated promoters mainly enriched in immune and metabolism pathways. Furthermore, we investigated the DNA methylation of TE, which was directly related with implantation process and revealed the abnormal methylated promoters were related with metabolism pathway too. Our data support that IVM may influence the DNA methylome of oocytes, which in turn affects the methylome of their embryos. However, due to the limited number of samples and the inability of the chip to cover all CpG sites, the results of this study require further research and validation.

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The Impact of Endocrine-Disrupting Chemicals on Female Fertility

Revista de Chimie ◽

10.37358/rc.20.6.8194 ◽

2020 ◽

Vol 71 (6) ◽

pp. 286-294

Author(s):

Aida Petca ◽

Nicoleta Maru ◽

Mihai Cristian Dumitrascu ◽

Madalina Sighencea ◽

Florica Sandru ◽

...

Keyword(s):

In Vitro Fertilization ◽

Polycystic Ovary ◽

Endocrine Disrupting Chemicals ◽

Antral Follicle ◽

Lower Probability ◽

Vitro Fertilization ◽

Increased Risk ◽

Endocrine Disrupting ◽

The Impact

Nowadays, infertility is a prevalent problem among couples. Exposure to endocrine-disrupting chemicals (EDCs) may influence the female reproductive outcomes through multiple mechanisms, being one of the important causes of infertility. These compounds may interfere with some fertility and fecundity markers, leading to increased time to pregnancy, increased risk of spontaneous abortion, shorter menstrual cycles, early age at menopause, anovulation or delayed ovulation, smaller preovulatory follicles, increased serum FSH, decreased synthesis of estradiol and progesterone, low plasma levels of anti-Mullerian hormone and decreased antral follicle count. Endocrine-disrupting chemicals may also impair in vitro fertilization outcomes, being responsible for: a lower probability of implantation, reduced fertilization rates, diminished probability of clinical pregnancy, and near term pregnancies after in vitro fertilization. Another mechanism of altering the female reproductive function is through the disorders induced by EDCs, such as polycystic ovary syndrome, uterine fibroids, and endometriosis. Those conditions may finally lead to infertility.

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Reproductive Technologies and the Risk of Birth Defects

50 Studies Every Obstetrician-Gynecologist Should Know ◽

10.1093/med/9780190947088.003.0046 ◽

2021 ◽

pp. 251-256

Author(s):

Caitlin Sacha ◽

John Petrozza

Keyword(s):

Birth Defects ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Reproductive Technologies ◽

Adverse Outcomes ◽

Vitro Fertilization ◽

Increased Risk ◽

The Impact ◽

Fertile Women

Understanding the risks of adverse outcomes such as birth defects after the use of assisted reproductive technology (ART) is crucial for both OB/GYN physicians and patients suffering from infertility. In a South Australian population cohort study of 308,974 spontaneous and assisted pregnancies between 1986 and 2002 in women over age 20, assisted conceptions were associated with an increased risk of birth defects, including cerebral palsy, compared to spontaneous conceptions in fertile women (adjusted odds ratio 1.28, 95% confidence interval 1.16–1.41). However, when examining in vitro fertilization and intracytoplasmic sperm injection (ICSI) pregnancies, only ICSI with fresh transfer remained associated with an increased risk of birth defects compared to spontaneous conceptions in fertile women in adjusted models. These findings suggest that while patients should be counseled regarding the potential increased risk of birth defects with ART procedures such as ICSI, more research is needed regarding the impact of infertility itself and specific ART interventions on neonatal outcomes.

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Exploring the Relationship between Biologics and Postoperative Surgical Morbidity in Ulcerative Colitis: A Review

Journal of Clinical Medicine ◽

10.3390/jcm10040710 ◽

2021 ◽

Vol 10 (4) ◽

pp. 710

Author(s):

Abel Botelho Quaresma ◽

Fernanda da Silva Barbosa Baraúna ◽

Fábio Vieira Teixeira ◽

Rogério Saad-Hossne ◽

Paulo Gustavo Kotze

Keyword(s):

Ulcerative Colitis ◽

Postoperative Complications ◽

Meta Analysis ◽

Qualitative Evaluation ◽

Complication Rates ◽

Surgical Morbidity ◽

Randomized Studies ◽

Pubmed Database ◽

Increased Risk ◽

The Impact

Background: With the paradigm shift related to the overspread use of biological agents in the treatment of inflammatory bowel diseases (IBD), several questions emerged from the surgical perspective. Whether the use of biologicals would be associated with higher rates of postoperative complications in ulcerative colitis (UC) patients still remains controversial. Aims: We aimed to analyze the literature, searching for studies that correlated postoperative complications and preoperative exposure to biologics in UC patients, and synthesize these data qualitatively in order to check the possible impact of biologics on postoperative surgical morbidity in this population. Methods: Included studies were identified by electronic search in the PUBMED database according to the PRISMA (Preferred Items of Reports for Systematic Reviews and Meta-Analysis) guidelines. The quality and bias assessments were performed by MINORS (methodological index for non-randomized studies) criteria for non-randomized studies. Results: 608 studies were initially identified, 22 of which were selected for qualitative evaluation. From those, 19 studies (17 retrospective and two prospective) included preoperative anti-TNF. Seven described an increased risk of postoperative complications, and 12 showed no significant increase postoperative morbidity. Only three studies included surgical UC patients with previous use of vedolizumab, two retrospective and one prospective, all with no significant correlation between the drug and an increase in postoperative complication rates. Conclusions: Despite conflicting results, most studies have not shown increased complication rates after abdominal surgical procedures in patients with UC with preoperative exposure to biologics. Further prospective studies are needed to better establish the impact of preoperative biologics and surgical complications in UC.

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Prevalence of pathogenic copy number variants among children conceived by donor oocyte

Scientific Reports ◽

10.1038/s41598-021-86242-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Sandra Monfort ◽

Carmen Orellana ◽

Silvestre Oltra ◽

Mónica Rosello ◽

Alfonso Caro-Llopis ◽

...

Keyword(s):

In Vitro Fertilization ◽

Copy Number ◽

Assisted Reproductive Technologies ◽

Copy Number Variants ◽

Reproductive Technologies ◽

Significant Excess ◽

Vitro Fertilization ◽

Donor Oocyte ◽

Increased Risk

AbstractDevelopment of assisted reproductive technologies to address infertility has favored the birth of many children in the last years. The majority of children born with these treatments are healthy, but some concerns remain on the safety of these medical procedures. We have retrospectively analyzed both the fertilization method and the microarray results in all those children born between 2010 and 2019 with multiple congenital anomalies, developmental delay and/or autistic spectrum disorder (n = 486) referred for array study in our center. This analysis showed a significant excess of pathogenic copy number variants among those patients conceived after in vitro fertilization with donor oocyte with respect to those patients conceived by natural fertilization (p = 0.0001). On the other hand, no significant excess of pathogenic copy number variants was observed among patients born by autologous oocyte in vitro fertilization. Further studies are necessary to confirm these results and in order to identify the factors that may contribute to an increased risk of genomic rearrangements, as well as consider the screening for genomic alterations after oocyte donation in prenatal diagnosis.

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Individualized embryo selection strategy developed by stacking machine learning model for better in vitro fertilization outcomes: an application study

Reproductive Biology and Endocrinology ◽

10.1186/s12958-021-00734-z ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Qingsong Xi ◽

Qiyu Yang ◽

Meng Wang ◽

Bo Huang ◽

Bo Zhang ◽

...

Keyword(s):

Machine Learning ◽

In Vitro Fertilization ◽

Endometrial Thickness ◽

Learning System ◽

Embryo Selection ◽

Selection Strategy ◽

Application Study ◽

Vitro Fertilization ◽

The Impact

Abstract Background To minimize the rate of in vitro fertilization (IVF)- associated multiple-embryo gestation, significant efforts have been made. Previous studies related to machine learning in IVF mainly focused on selecting the top-quality embryos to improve outcomes, however, in patients with sub-optimal prognosis or with medium- or inferior-quality embryos, the selection between SET and DET could be perplexing. Methods This was an application study including 9211 patients with 10,076 embryos treated during 2016 to 2018, in Tongji Hospital, Wuhan, China. A hierarchical model was established using the machine learning system XGBoost, to learn embryo implantation potential and the impact of double embryos transfer (DET) simultaneously. The performance of the model was evaluated with the AUC of the ROC curve. Multiple regression analyses were also conducted on the 19 selected features to demonstrate the differences between feature importance for prediction and statistical relationship with outcomes. Results For a single embryo transfer (SET) pregnancy, the following variables remained significant: age, attempts at IVF, estradiol level on hCG day, and endometrial thickness. For DET pregnancy, age, attempts at IVF, endometrial thickness, and the newly added P1 + P2 remained significant. For DET twin risk, age, attempts at IVF, 2PN/ MII, and P1 × P2 remained significant. The algorithm was repeated 30 times, and averaged AUC of 0.7945, 0.8385, and 0.7229 were achieved for SET pregnancy, DET pregnancy, and DET twin risk, respectively. The trend of predictive and observed rates both in pregnancy and twin risk was basically identical. XGBoost outperformed the other two algorithms: logistic regression and classification and regression tree. Conclusion Artificial intelligence based on determinant-weighting analysis could offer an individualized embryo selection strategy for any given patient, and predict clinical pregnancy rate and twin risk, therefore optimizing clinical outcomes.

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The Effect of Stress, Anxiety and Depression on In Vitro Fertilization Outcome in Kazakhstani Public Clinical Setting: A Cross-Sectional Study

Journal of Clinical Medicine ◽

10.3390/jcm10050937 ◽

2021 ◽

Vol 10 (5) ◽

pp. 937

Author(s):

Gauri Bapayeva ◽

Gulzhanat Aimagambetova ◽

Alpamys Issanov ◽

Sanja Terzic ◽

Talshyn Ukybassova ◽

...

Keyword(s):

In Vitro Fertilization ◽

Depressed Mood ◽

Depression Scale ◽

Anxiety Scale ◽

Clinical Depression ◽

Cross Sectional ◽

Vitro Fertilization ◽

Scale Scores ◽

The Impact

Although it is clear that infertility leads to heightened stress for patients, the impact of depressed mood and anxiety on treatment outcome is inconsistently reported. The aim of this study was to evaluate the effect of stress, depression and anxiety on in vitro fertilization (IVF) outcomes in Kazakhstani public assisted reproductive technology (ART) clinics. The prospective cohort study was performed between June 2019 and September 2020 using questionnaires to assess psychological stress, depressed mood and anxiety in women referred to IVF clinics in two public clinical centers in Kazakhstan, Nur-Sultan and Aktobe. Our study sample comprised 142 women with the average age of 33.9 ± 4.9 years, and infertility duration 6.0 ± 3.5 years. More than half of respondents had Center for Epidemiological Studies Depression Scale (CES-D) scores higher than 16, indicating their risk of developing clinical depression. Ninety-one percent of women from Aktobe city were at risk for clinical depression (p < 0.001). Aktobe city respondents had higher stress subscale scores and anxiety scale scores (p < 0.001) than Nur-Sultan respondents. Statistical analysis showed that IVF outcome was not significantly associated with depression and stress, while the higher anxiety scale scores were negatively associated with clinical pregnancy after IVF.

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Impact of anion exchange adsorbents on regional citrate anticoagulation

The International Journal of Artificial Organs ◽

10.1177/0391398820947733 ◽

2020 ◽

pp. 039139882094773

Author(s):

Karin Strobl ◽

Stephan Harm ◽

Ute Fichtinger ◽

Claudia Schildböck ◽

Jens Hartmann

Keyword(s):

Anion Exchange ◽

Regional Citrate Anticoagulation ◽

Liver Support ◽

Anion Exchange Resins ◽

Increased Risk ◽

Extracorporeal Liver Support ◽

Target Molecules ◽

Exchange Resins ◽

The Impact

Introduction: Heparin and citrate are commonly used anticoagulants in membrane/adsorption based extracorporeal liver support systems. However, anion exchange resins employed for the removal of negatively charged target molecules including bilirubin may also deplete these anticoagulants due to their negative charge. The aim of this study was to evaluate the adsorption of citrate by anion exchange resins and the impact on extracorporeal Ca2+ concentrations. Methods: Liver support treatments were simulated in vitro. Citrate and Ca2+ concentrations were measured pre and post albumin filter as well as pre and post adsorbents. In addition, batch experiments were performed to quantify citrate adsorption. Results: Pre albumin filter target Ca2+ concentrations were reached well with only minor deviations. Citrate was adsorbed by anion exchange resins, resulting in a higher Ca2+ concentration downstream of the adsorbent cartridges during the first hour of treatment. Conclusions: The anion exchange resin depletes citrate, leading to an increased Ca2+ concentration in the extracorporeal circuit, which may cause an increased risk of clotting during the first hour of treatment. An increase of citrate infusion during the first hour of treatment should therefore be considered to compensate for the adsorption of citrate.

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DEFINING ELIGIBILITY CRITERIA FOR FUNDING POLICIES AROUND IN VITRO FERTILIZATION

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462315000628 ◽

2015 ◽

Vol 31 (6) ◽

pp. 426-433 ◽

Cited By ~ 1

Author(s):

Devidas Menon ◽

Alexa A. Nardelli ◽

Tarek Motan ◽

Kristin Klein ◽

Tania Stafinski

Keyword(s):

Maternal Age ◽

Smoking Status ◽

Cochrane Collaboration ◽

Assessment Tools ◽

Paternal Age ◽

Eligibility Criteria ◽

Vitro Fertilization ◽

Funding Policies ◽

The Impact

Objectives: This review aims to assess the state of the science around the potential impact of certain patient characteristics on the safety and effectiveness of in vitro fertilization (IVF).Methods: Following Cochrane Collaboration guidelines and the PRISMA statement, a comprehensive systematic review of reviews and recent primary studies examining the impact of paternal age and maternal age, smoking, and body mass index (BMI) on the safety and effectiveness of IVF was performed. Papers, published between January 2007 and June 2014, were independently reviewed and critically appraised by two researchers using published quality assessment tools for reviews and primary studies. Due to heterogeneity across papers (different study designs and patient selection criteria), a qualitative analysis of extracted information was performed.Results: Seventeen papers (ten systematic reviews and seven primary studies) were included. They comprised evidence from retrospective observational studies in which maternal age, BMI, and smoking status were explored as part of secondary analyses of larger studies. The majority of papers found that the likelihood of achieving a pregnancy was lower among women who were >40 years, had a BMI ≥ 25 and smoked. Advanced maternal age and BMI were also associated with higher rates of preterm birth and low birth weight.Conclusions: Based on available evidence, it may be appropriate to consider “maternal age” and “morbid obesity” in public funding policies that aim to maximize the effectiveness of IVF. However, given inconsistencies in the effect of smoking across different pregnancy-related outcomes, support for incorporating it into funding conditions appears weak.

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