The aging of the human ovary and the depletion of the oocyte pool have traditionally been the mar... more The aging of the human ovary and the depletion of the oocyte pool have traditionally been the marker of the ending fecundity. The availability of assisted reproduction and the associated technologies such as cryopreservation and egg donation has significantly extended the possibility to conceive quite far beyond the natural human fecundity. Such pregnancies in women of advanced age raise serious medical and ethical concerns regarding the welfare of both the mother and child. The adverse effect of advanced maternal age (AMA) on offspring health has been studied extensively and is currently well recognized. Here we will describe the dilemmas for setting up an age limit for conception attempts, how to screen the candidates in the narrow path of safety, and how to manage these pregnancies.
BackgroundIntra‐uterine insemination is an essential component in the treatment of infertility. S... more BackgroundIntra‐uterine insemination is an essential component in the treatment of infertility. Success rates are dependent on clinical factors of the female partner, sperm quality, and preparation technique. The effect of the time interval between the end of sperm preparation in the lab, and its injection into the uterine cavity (lab‐to‐uterus time) is yet to be determined.AimTo investigate the association between the lab‐to‐uterus time and the pregnancy rate.Materials and methodsPartner and donor spermatozoa intra‐uterine insemination cycles were included. Preparation for intra‐uterine insemination of partners’ fresh ejaculate or donor thawed spermatozoa was identical. The time interval from the completion of this stage to the actual intra‐uterine injection was recorded. The lab‐to‐uterus intervals were divided into groups A (0–29 min), B (30–59 min), C (60–89 min), and D (90–180 min). Pregnancy was defined as two adequate consecutive doubling levels of hCG and the pregnancy rates...
The association between fresh embryo transfer (ET) outcome and the subsequent frozen-thawed (FET)... more The association between fresh embryo transfer (ET) outcome and the subsequent frozen-thawed (FET) cycles that follow is not clear, mainly because of incomplete embryo cohort utilization. The aim of this study was to determine if the outcome of a fresh ET affects the frozen cumulative clinical pregnancy (CP) and live birth (LB) rates resulting from the utilization of all surplus embryos from sibling oocytes. Outcome measures were the FET cumulative CP and LB rates. Multivariate logistic regression was performed for the frozen cumulative CP rate and adjusted for age, the number of oocytes, fresh ET outcome and other confounders. A total of 1313 cycles met the inclusion criteria. The FET cumulative CP and LB rates were not affected by the outcome of the fresh ET. The FET cumulative CP rate increased with the number of oocytes collected regardless of whether a pregnancy was achieved in the fresh cycle or not. In multivariate analysis, age (OR = 0.96, 95% CI 0.94-0.98), protocol (OR = 0.13, 95% CI 0.03-0.57) and the number of oocytes (OR = 1.05, 95% CI 1.02-1.07) were associated with the frozen cumulative CP rate. It is concluded that fresh ET does not impact the outcome of the vitrified-thawed embryos from the same oocyte cohort.
Third stage of labor complications are more prevalent following singleton vaginal deliveries of g... more Third stage of labor complications are more prevalent following singleton vaginal deliveries of gestations conceived through in vitro fertilization (IVF) and fresh embryo transfer. This study aimed to evaluate these complications in pregnancies conceived through frozen-thawed embryo transfer (FET), in which endometrial preparation differs from fresh cycles. A cohort study of all singleton pregnancies conceived through IVF-FET who delivered vaginally at a tertiary medical center during 2007–2017. The study group consisted of 88 IVF-FET gestations (cases) that were matched to 176 spontaneous pregnancies based on age, gravidity, parity and gestational week at delivery (controls). The association between mode of conception and third stage of labor complication rate was examined. Baseline characteristics were similar between groups, except for a lower prevalence of induction of labor in the control group (23.3% vs. 36.3%, p = 0.03). The rate of post-partum hemorrhage (PPH), manual lysis and revision of the uterine cavity were all higher in pregnancies conceived through IVF-FET versus spontaneously (13.6% vs. 5.7%, p = 0.018; 17% vs. 2.3%, p < 0.001; and 21.6% vs. 6.8%, p < 0.001, respectively). Multivariate analysis adjusting for age, previous cesarean section, induction of labor, neonatal weight and use of analgesia demonstrated that deliveries following IVF-FET were independently associated with an increased risk for third stage of labor complications (estimated OR = 3.45, p = 0.0002). IVF-FET is an independent risk factor for PPH, need for manual lysis and revision of the uterine cavity. Precautionary measures should be undertaken in the third stage in deliveries following IVF-FET, even if no other risk factors are present.
The aging of the human ovary and the depletion of the oocyte pool have traditionally been the mar... more The aging of the human ovary and the depletion of the oocyte pool have traditionally been the marker of the ending fecundity. The availability of assisted reproduction and the associated technologies such as cryopreservation and egg donation has significantly extended the possibility to conceive quite far beyond the natural human fecundity. Such pregnancies in women of advanced age raise serious medical and ethical concerns regarding the welfare of both the mother and child. The adverse effect of advanced maternal age (AMA) on offspring health has been studied extensively and is currently well recognized. Here we will describe the dilemmas for setting up an age limit for conception attempts, how to screen the candidates in the narrow path of safety, and how to manage these pregnancies.
BackgroundIntra‐uterine insemination is an essential component in the treatment of infertility. S... more BackgroundIntra‐uterine insemination is an essential component in the treatment of infertility. Success rates are dependent on clinical factors of the female partner, sperm quality, and preparation technique. The effect of the time interval between the end of sperm preparation in the lab, and its injection into the uterine cavity (lab‐to‐uterus time) is yet to be determined.AimTo investigate the association between the lab‐to‐uterus time and the pregnancy rate.Materials and methodsPartner and donor spermatozoa intra‐uterine insemination cycles were included. Preparation for intra‐uterine insemination of partners’ fresh ejaculate or donor thawed spermatozoa was identical. The time interval from the completion of this stage to the actual intra‐uterine injection was recorded. The lab‐to‐uterus intervals were divided into groups A (0–29 min), B (30–59 min), C (60–89 min), and D (90–180 min). Pregnancy was defined as two adequate consecutive doubling levels of hCG and the pregnancy rates...
The association between fresh embryo transfer (ET) outcome and the subsequent frozen-thawed (FET)... more The association between fresh embryo transfer (ET) outcome and the subsequent frozen-thawed (FET) cycles that follow is not clear, mainly because of incomplete embryo cohort utilization. The aim of this study was to determine if the outcome of a fresh ET affects the frozen cumulative clinical pregnancy (CP) and live birth (LB) rates resulting from the utilization of all surplus embryos from sibling oocytes. Outcome measures were the FET cumulative CP and LB rates. Multivariate logistic regression was performed for the frozen cumulative CP rate and adjusted for age, the number of oocytes, fresh ET outcome and other confounders. A total of 1313 cycles met the inclusion criteria. The FET cumulative CP and LB rates were not affected by the outcome of the fresh ET. The FET cumulative CP rate increased with the number of oocytes collected regardless of whether a pregnancy was achieved in the fresh cycle or not. In multivariate analysis, age (OR = 0.96, 95% CI 0.94-0.98), protocol (OR = 0.13, 95% CI 0.03-0.57) and the number of oocytes (OR = 1.05, 95% CI 1.02-1.07) were associated with the frozen cumulative CP rate. It is concluded that fresh ET does not impact the outcome of the vitrified-thawed embryos from the same oocyte cohort.
Third stage of labor complications are more prevalent following singleton vaginal deliveries of g... more Third stage of labor complications are more prevalent following singleton vaginal deliveries of gestations conceived through in vitro fertilization (IVF) and fresh embryo transfer. This study aimed to evaluate these complications in pregnancies conceived through frozen-thawed embryo transfer (FET), in which endometrial preparation differs from fresh cycles. A cohort study of all singleton pregnancies conceived through IVF-FET who delivered vaginally at a tertiary medical center during 2007–2017. The study group consisted of 88 IVF-FET gestations (cases) that were matched to 176 spontaneous pregnancies based on age, gravidity, parity and gestational week at delivery (controls). The association between mode of conception and third stage of labor complication rate was examined. Baseline characteristics were similar between groups, except for a lower prevalence of induction of labor in the control group (23.3% vs. 36.3%, p = 0.03). The rate of post-partum hemorrhage (PPH), manual lysis and revision of the uterine cavity were all higher in pregnancies conceived through IVF-FET versus spontaneously (13.6% vs. 5.7%, p = 0.018; 17% vs. 2.3%, p < 0.001; and 21.6% vs. 6.8%, p < 0.001, respectively). Multivariate analysis adjusting for age, previous cesarean section, induction of labor, neonatal weight and use of analgesia demonstrated that deliveries following IVF-FET were independently associated with an increased risk for third stage of labor complications (estimated OR = 3.45, p = 0.0002). IVF-FET is an independent risk factor for PPH, need for manual lysis and revision of the uterine cavity. Precautionary measures should be undertaken in the third stage in deliveries following IVF-FET, even if no other risk factors are present.
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