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

Pingyin Lee ◽  
Canquan Zhou ◽  
Yubin Li

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.

2019 ◽  
Vol 34 (8) ◽  
pp. 1567-1575 ◽  
Kazuki Saito ◽  
Akira Kuwahara ◽  
Tomonori Ishikawa ◽  
Naho Morisaki ◽  
Mami Miyado ◽  

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.

Gülşen Doğan Durdağ ◽  
Gizem Bektaş ◽  
Esengül Türkyılmaz ◽  
Halime Göktepe ◽  
Meltem Sönmezer ◽  

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.

Hypertension ◽  
2020 ◽  
Vol 76 (5) ◽  
pp. 1506-1513 ◽  
Michael C. Honigberg ◽  
Hilde Kristin Refvik Riise ◽  
Anne Kjersti Daltveit ◽  
Grethe S. Tell ◽  
Gerhard Sulo ◽  

Hypertensive disorders of pregnancy (HDP) have been associated with heart failure (HF). It is unknown whether concurrent pregnancy complications (small-for-gestational-age or preterm delivery) or recurrent HDP modify HDP-associated HF risk. In this cohort study, we included Norwegian women with a first birth between 1980 and 2004. Follow-up occurred through 2009. Cox models examined gestational hypertension and preeclampsia in the first pregnancy as predictors of a composite of HF-related hospitalization or HF-related death, with assessment of effect modification by concurrent small-for-gestational-age or preterm delivery. Additional models were stratified by final parity (1 versus ≥2 births) and tested associations with recurrent HDP. Among 508 422 women, 565 experienced incident HF over a median 11.8 years of follow-up. After multivariable adjustment, gestational hypertension in the first birth was not significantly associated with HF (hazard ratio, 1.41 [95% CI, 0.84–2.35], P =0.19), whereas preeclampsia was associated with a hazard ratio of 2.00 (95% CI, 1.50–2.68, P <0.001). Among women with HDP, risks were not modified by concurrent small-for-gestational-age or preterm delivery ( P interaction =0.42). Largest hazards of HF were observed in women whose only lifetime birth was complicated by preeclampsia and women with recurrent preeclampsia. HF risks were similar after excluding women with coronary artery disease. In summary, women with preeclampsia, especially those with one lifetime birth and those with recurrent preeclampsia, experienced increased HF risk compared to women without HDP. Further research is needed to clarify causal mechanisms.

2014 ◽  
pp. 33-38
Gabriel Braga Diégues Serva ◽  
Leonardo Santos Calvacanti Guerra ◽  
Vilneide Maria Santos Braga Diégues Serva ◽  
Waldmiro Antônio Diégues Serva ◽  
Marcela Patrícia Macêdo Belo ◽  

Objectives: To identify if the presence of migraine before pregnancy predisposes to hypertensive disorders of pregnancy. Methods: Observational study undertaken from a database of a follow-up study, composed of women consecutively assisted, at the first postnatal week, at IMIP. Its objective was to evaluate the course of migraine during pregnancy and postpartum in women with migraine before pregnancy. The Fisher exact test was used considering the significance level of less than 5%. Results: Of the 686 women, 38.8% were migraine sufferers before pregnancy. 14.3% referred hypertensive disorders of pregnancy. The presence of migraine before pregnancy and to have been submitted to a cesarean section (p<0.001) were factors associated with the presence of hypertensive disorders in pregnancy. Conclusion: Migraine before pregnancy is an associated factor to hypertensive disorders of pregnancy. The diagnosis of migraine should always be taken into consideration during antenatal care, for the prevention of complications.

2020 ◽  
Hua Lou ◽  
Na Li ◽  
Yichun Guan ◽  
Yuchao Zhang ◽  
Dayong Hao ◽  

Abstract Objective: To determine the association between the morphologic grading and implantation rate of euploid blastocysts in single frozen-thawed embryo transfer (SET) cycles.Design: Retrospective cohort study.Setting: Single university-based fertility centerPatient(s): Women aged 20–40 years undergoing euploid SET from January 2017 to December 2019 were identified. Main Outcomes Measure(s): Implantation rate (IR) Result(s): A total of 271 euploid SET cycles were included. The cycles were divided into three groups based on their morphologic grading before cryopreservation: good-quality (n = 58), average-quality (n = 88) and poor-quality blastocysts (n = 125). Good-quality blastocysts yielded statistically significantly higher implantation rates than poor-quality embryos (79.31% vs. 48%; P<0.001). Planned subgroup analyses by age and the day of TE biopsy were conducted. Logistic regression analyses that adjusted for these variables identified higher implantation rates (adjusted odds ratio(aOR)= 4.083, 95% confidence interval (CI):1.836–9.082, P<0.001) for the good-quality blastocysts than for those that underwent poor-quality cycles in women aged <35 years, but not in women aged ≥35 years (aOR=6.074, 95%CI: 0.456-80.919, P=0.172). The implantation rates were higher among women with good-quality blastocysts on both Day 5 and Day 6 of TE biopsy than among those with poor-quality blastocysts (Day 5, aOR=3.294, 95%CI:1.260-8.616, P = 0.015; Day 6, aOR=4.179, 95%CI:1.004~17.399, P=0.049). Day 5 euploid blastocysts had no significant difference in implantation potential and early spontaneous abortion rate compared with similarly graded Day 6 euploid blastocysts.Conclusions: Blastocyst morphologic grading was associated with implantation rate for euploid embryo transfers after adjustment for potential confounders. These findings suggest that evaluating blastocyst morphology is critical when selecting the best euploid blastocyst.

2021 ◽  
Hui Ju Chih ◽  
Flavia Elias ◽  
Laura Gaudet ◽  
Maria Velez

Abstract BackgroundHypertensive disorders of pregnancy (HDP) is one of the most common pregnancy complications and causes of maternal morbidity and mortality. Many cohort studies were conducted to study adverse pregnancy outcomes associated with pregnancies from assisted reproductive technology. We aimed to comprehensively review all available evidence to date to compare the odds of HDP and preeclampsia between pregnancies achieved by in vitro fertilization (IVF) and spontaneous pregnancies.MethodsWe conducted a systematic review and meta-analysis based on cohort studies identified from EMBASE, MEDLINE, and Cochrane Library (up to 2020) and manually using a structured search strategy. Cohort studies that compared pregnancies after IVF with or without intracytoplasmic sperm fertilization (ICSI) and 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. Studies published in English, French, Chinese, and Portuguese were reviewed. Eligibility and quality of studies were evaluated by two reviewers independently. Quality assessment was conducted using the Newcastle Ottawa Scale (NOS) for Cohort Studies. The pooled results were reported in odds ratios (OR) with 95% confidence intervals based on random effects models. I-squared (I2) test was used to evaluate heterogeneity and publication bias was assessed using funnel plots.ResultsSeventy-eight studies were included after a screening of 1,879 abstracts and 275 full text articles. Compared to SC, IVF/ICSI singleton pregnancies (OR 1.63; 95% CI 1.54-1.74; I2 = 79%) and multiple pregnancies (OR 1.31; 95% CI 1.18-1.47; I2 = 73%) 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 4.11; 95% CI 2.75-6.16; I2 = 85%). 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%). Similar findings for preeclampsia were also reported.ConclusionsOur meta-analysis confirmed that IVF/ICSI pregnancies are at high odds of HDP and preeclampsia than SC, irrespective of the plurality. The odds were especially high in frozen embryo transfer and oocyte donation pregnancies.

Jourdie Triebwasser ◽  
Elizabeth S. Langen ◽  
Jennifer Lewey ◽  
Jourdie Triebwasser

Background: The American College of Obstetricians and Gynecologists and the American Heart Association recommend that women with hypertensive disorders of pregnancy be counseled on lifelong cardiovascular risks and transitioned to primary care for ongoing screening and management. Objective: To assess frequency and content of postpartum counseling regarding cardiovascular risk and follow-up among women with hypertensive disorders of pregnancy. Study Design: A secondary analysis of a randomized trial of women with hypertensive disorders of pregnancy, excluding chronic hypertension, performed at a single tertiary care academic hospital. We abstracted documented counseling on hypertensive disorders from the discharge summary and postpartum visit note in the electronic medical record. We defined counseling as documentation of any one of the following: 1) recommending aspirin in a future pregnancy, 2) follow-up with primary care, or 3) lifelong risk of cardiovascular disease. We used logistic regression models to estimate adjusted odds for receiving counseling. Results: Seventy-four women enrolled in the study. A hypertensive diagnosis was documented for 71 women (96.0%) in the discharge summary, but only 11 (14.9%) had any documented counseling in the discharge summary or postpartum visit note. Of the 11 women counseled, 5 (6.7%) were counseled on taking aspirin in a future pregnancy, 5 (6.7%) were counseled on follow-up with primary care, and only 3 (4.1%) were counseled on the lifelong cardiovascular risk associated with hypertension in pregnancy. Two women (2.7%) were counseled on follow-up with primary care and lifelong cardiovascular risk. There were no participants counseled on all three components. Later gestational age at delivery was associated with lower odds of counseling (adjusted OR 0.49, 95% CI 0.27-0.89). Conclusion: Despite consistent evidence on long-term risks of hypertensive disorders of pregnancy, counseling about those risks is suboptimal. Improved communication of risks is the first step towards improving maternal health in the “fourth trimester” and beyond.

Pteridines ◽  
1993 ◽  
Vol 4 (3) ◽  
pp. 144-148
H. Schröcksnadel ◽  
D. Fuchs ◽  
M. Herold ◽  
H. Wachter ◽  
O. Dapunt

SummaryNeopterin (serum. urine) and other markers of macrophage activation (lL-1 IL-6, TNF alpha) were compared in preeclamptic patients and healthy pregnant controls. The prepartal urine neopterin median in preeclampsia (337 μmol/mol creat.) was 33% higher than that of healthy pregnant controls (253 μmol/mol creat.). There was no statistically significant difference between the groups (p = 0.08). In plasma there were no statistically significant differences in cytokine concentrations between healthy pregnant and nonpregnant controls with the exception of neopterin. that showed higher values in pregnant women (p = O.OO4). Elevated levels of IL-6. TNF-alpha and neopterin were observed in hypertensive women. Differences to healthy pregnant controls were statistically significant for IL-6 (p = 0.008). TNF-alpha (p = 0.009) and neopterin (p=0.04) and were more pronounced in severe forms of the disease. These three parameters of monocytic origin showed positive significant correlations amongst each other. A participation of macrophages in the pathomechanism of hypertensive disorders of pregnancy can thus be assumed.

Sign in / Sign up

Export Citation Format

Share Document