Top-quality embryo transfer is associated with lower odds of ectopic pregnancy

Introduction The incidence of ectopic pregnancy is up to four times higher after in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) than in spontaneous pregnancies, and the risk of ectopic pregnancy is increased by tubal factor infertility and the transfer of multiple embryos. However, the effect of embryo quality on the probability of ectopic pregnancy has not been investigated until now and it is not clear whether ovarian stimulation parameters affect the incidence of ectopic pregnancy. Material and Methods An historical cohort study of 15 006 clinical pregnancies (diagnosed by ultrasound at 6-8 gestational weeks) after non-donor IVF/ICSI with fresh embryo transfer (n = 8952) or frozen-thawed embryo transfer (n = 6054). Treatments were performed during 2000-2017 in Finland. A total of 9207 (61.4%) single and 5799 (38.6%) double embryo transfers of no more than one top-quality embryo were evaluated. We analyzed the effects of multiple factors on ectopic pregnancy by logistic regression, including type of cycle (fresh vs. frozen embryo transfer), female age, number and quality of embryos transferred, tubal factor infertility and factors of ovarian response to gonadotropin stimulation. Results Ectopic pregnancy was observed in 2.3% of cycles. There was no significant difference in ectopic pregnancy rate after fresh embryo transfer and frozen embryo transfer (2.2% vs. 2.4%, p = 0.3). The ectopic pregnancy rate was lower in cycles with top-quality embryo transfer (1.9%) than of those where only non-top quality embryos were transferred (2.7%, p < 0.0001). Tubal factor infertility was diagnosed more often in ectopic pregnancy than in intrauterine pregnancies (21.2% vs. 11.0%, p < 0.0001). Logistic regression revealed lower odds for ectopic pregnancy after a top-quality embryo transfer than after transfer of a non-top quality embryo (odds ratio [OR] 0.72, 95% confidence interval [CI] 0.56-0.92, p = 0.007). Transfer of two vs. one embryo (OR 1.35, 95% CI 1.05-1.70, p = 0.02) and tubal factor infertility (OR 2.21, 95% CI 1.68-2.91, p < 0.0001) significantly increased the risk of ectopic pregnancy. Conclusions Transfer of non-top quality embryos is associated with a higher rate of ectopic pregnancy. This is particularly important to keep in mind in treatments with only non-top embryos available even in the absence of tubal factor infertility. To minimize the risk of ectopic pregnancy, the number of embryos transferred should be as low as possible.Peer reviewe

Top-quality embryo transfer is associated with lower odds of ectopic pregnancy

Introduction The incidence of ectopic pregnancy is up to four times higher after in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) than in spontaneous pregnancies, and the risk of ectopic pregnancy is increased by tubal factor infertility and the transfer of multiple embryos. However, the effect of embryo quality on the probability of ectopic pregnancy has not been investigated until now and it is not clear whether ovarian stimulation parameters affect the incidence of ectopic pregnancy. Material and Methods An historical cohort study of 15 006 clinical pregnancies (diagnosed by ultrasound at 6-8 gestational weeks) after non-donor IVF/ICSI with fresh embryo transfer (n = 8952) or frozen-thawed embryo transfer (n = 6054). Treatments were performed during 2000-2017 in Finland. A total of 9207 (61.4%) single and 5799 (38.6%) double embryo transfers of no more than one top-quality embryo were evaluated. We analyzed the effects of multiple factors on ectopic pregnancy by logistic regression, including type of cycle (fresh vs. frozen embryo transfer), female age, number and quality of embryos transferred, tubal factor infertility and factors of ovarian response to gonadotropin stimulation. Results Ectopic pregnancy was observed in 2.3% of cycles. There was no significant difference in ectopic pregnancy rate after fresh embryo transfer and frozen embryo transfer (2.2% vs. 2.4%, p = 0.3). The ectopic pregnancy rate was lower in cycles with top-quality embryo transfer (1.9%) than of those where only non-top quality embryos were transferred (2.7%, p Conclusions Transfer of non-top quality embryos is associated with a higher rate of ectopic pregnancy. This is particularly important to keep in mind in treatments with only non-top embryos available even in the absence of tubal factor infertility. To minimize the risk of ectopic pregnancy, the number of embryos transferred should be as low as possible.</p

Potilasohje CRPS-kipuoireyhtymää sairastaville

CRPS-lyhenne tulee sanoista Complex Regional Pain Syndrome, joka tarkoittaa monimuotoista paikallista kipuoireyhtymää. Tämän toiminnallisen opinnäytetyön tehtävänä oli suunnitella fysioterapeuttinen potilasohje CRPS-kipuoireyhtymää sairastaville. Opinnäytetyön toimeksiantajana oli Pohjois-Karjalan sairaanhoito- ja sosiaalipalvelujen kuntayhtymä. Potilasohjeen tavoitteena on lisätä potilaan ymmärrystä sairaudestaan, olla tukena potilaalle ja kannustaa häntä ottamaan vastuuta omasta paranemisestaan ja hoidosta. Oppaan kohderyhmänä olivat keskussairaalan fysioterapian poliklinikan CRPS-potilaat. Työ alkoi tiedonhaulla, joka toteutettiin systemaattisesti. Tiedon hakua seurasi teoreettisen viitekehyksen kirjoittaminen ja potilasohjeen suunnittelu. Potilasohjeen sisältö nojaa teoreettiseen tietoperustaan. Opinnäytetyöprosessia tukivat säännölliset tapaamiset toimeksiantajan kanssa. Valmis potilasohje on vaakamallinen ja pituudeltaan yhden kahtia taitetun A4-kokoisen paperin mittainen. Sisällön osalta potilasohjeessa on kuvattu CRPS-potilaan kannalta tärkeimmät asiat: kipuoireyhtymän määritelmä, tyypillinen oirekuva, kroonisen kivun aikaansaamia muutoksia keskushermostossa, yleiset hoitolinjaukset ja fysioterapian menetelmät. Potilasohjeen arviointi toteutettiin palautekyselylomakkeella, jonka tulokset analysoitiin laadullisesti. Potilasohje on selkeä ja johdonmukainen kokonaisuus, jossa CRPS-potilaan kannalta tärkeimmät asiat on selvitetty ymmärrettävästi potilaan kielellä. Sisällön osalta toimeksiantajan asettamat tavoitteet täyttyivät. Potilasohje on tarkoitettu käytettäväksi fysioterapeuttisen ohjauksen tukena. Asianmukainen jatkotutkimusehdotus tälle työlle olisi selvittää, millaisia kokemuksia CRPS-potilaalla on tästä potilasohjeesta. Myös CRPS-potilaiden kanssa työskentelevien fysioterapeuttien näkökulma potilasohjeen hyödynnettävyydestä ja käytettävyydestä käytännön työssä olisi tärkeää selvittää ohjeen kehittämiseksi.The purpose of this functional thesis was to design a patient education material for patients with Complex Regional Pain Syndrome (CRPS). Commission for this task came from the physiotherapy outpatient department in Joint Municipal Authority for Medical and Social Services in North Karelia. Good patient education is a significant part of the CRPS patient’s treatment and physiotherapy. The aim of this patient education material is to increase the patients’ knowledge and support them to take care of themselves. The project was carried out as follows; First, a systematic review of the subject was made and a theoretical framework was written. Then, the planning of the patient education material was started. The contents of the education material base on the theoretical framework. During the process there were meetings at regular intervals with the personnel on the physiotherapy outpatient department. The complete patient education material is horizontal and one A4 -side in length. The main goal of this education material was to explain the pain process to the patient. The education material also includes brief information about the symptoms, treatments and physiotherapy. The evaluation of this education material was done using a feedback questionnaire and the results were analyzed qualitatively. The patient education material is a clear and consistent whole. The essential issue is clarified in the patients’ language. The goals included in the commission were materialized. The aim of this patient education material is to promote physiotherapeutic guidance. An appropriate proposal for further study is to determine how the patients with CRPS experience this education material. Also the physiotherapists’ perspective about the usability of this material is helpful to find out in order to develop the patient education material

Top-quality embryo transfer is associated with lower odds of ectopic pregnancy

Abstract Introduction: The incidence of ectopic pregnancy is up to four times higher after in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) than in spontaneous pregnancies, and the risk of ectopic pregnancy is increased by tubal factor infertility and the transfer of multiple embryos. However, the effect of embryo quality on the probability of ectopic pregnancy has not been investigated until now and it is not clear whether ovarian stimulation parameters affect the incidence of ectopic pregnancy. Material and Methods: An historical cohort study of 15 006 clinical pregnancies (diagnosed by ultrasound at 6–8 gestational weeks) after non-donor IVF/ICSI with fresh embryo transfer (n = 8952) or frozen–thawed embryo transfer (n = 6054). Treatments were performed during 2000–2017 in Finland. A total of 9207 (61.4%) single and 5799 (38.6%) double embryo transfers of no more than one top-quality embryo were evaluated. We analyzed the effects of multiple factors on ectopic pregnancy by logistic regression, including type of cycle (fresh vs frozen embryo transfer), female age, number and quality of embryos transferred, tubal factor infertility and factors of ovarian response to gonadotropin stimulation. Results: Ectopic pregnancy was observed in 2.3% of cycles. There was no significant difference in ectopic pregnancy rate after fresh embryo transfer and frozen embryo transfer (2.2% vs 2.4%, p = 0.3). The ectopic pregnancy rate was lower in cycles with top-quality embryo transfer (1.9%) than of those where only non-top quality embryos were transferred (2.7%, p &lt; 0.0001). Tubal factor infertility was diagnosed more often in ectopic pregnancy than in intrauterine pregnancies (21.2% vs 11.0%, p &lt; 0.0001). Logistic regression revealed lower odds for ectopic pregnancy after a top-quality embryo transfer than after transfer of a non-top quality embryo (odds ratio [OR] 0.72, 95% confidence interval [CI] 0.56–0.92, p = 0.007). Transfer of two vs one embryo (OR 1.35, 95% CI 1.05–1.70, p = 0.02) and tubal factor infertility (OR 2.21, 95% CI 1.68–2.91, p &lt; 0.0001) significantly increased the risk of ectopic pregnancy. Conclusions: Transfer of non-top quality embryos is associated with a higher rate of ectopic pregnancy. This is particularly important to keep in mind in treatments with only non-top embryos available even in the absence of tubal factor infertility. To minimize the risk of ectopic pregnancy, the number of embryos transferred should be as low as possible