Obstetric outcome after single embryo transfer

Obstetric outcome after single embryo transfer Department of Obstetrics and Gynecology, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, SE-413 45 Gothenburg, Sweden. Background: Children born after IVF have a poorer neonatal outcome than children born after spontaneous conception, even after adjustment for confounders. In Sweden, since 2003 an increasing amount of IVF cycles are single embryo transfers (SET). This gives the opportunity to investigate and compare the outcome after SET and double embryo transfers (DET). Aim: To assess the neonatal and maternal outcomes after IVF, particularly after SET. Methods: Paper I: All IVF children born in Sweden after IVF treatment during the years 2002-2006 and their mothers were included (n=13 544 children) and compared with all children in the general population born during the same time period and their mothers (n=587 009 children) concerning neonatal and maternal outcomes. Paper II: All IVF singletons born after fresh IVF cycles and own oocytes were included (n= 8941) and cross-linked with the Swedish Medical Birth Registry. Four major outcomes were investigated: very preterm birth (<32 weeks), small for gestational age (SGA), placenta previa and placental abruption. Maternal characteristics (age, parity, BMI, smoking and years of infertility) and treatment-related variables (number of oocytes retrieved, number of embryo culture days, number of transferred and cryopreserved embryos and “vanishing twin”) were investigated for independent association with the four selected outcomes. Paper III: All singletons after cryopreserved (n=2348) and fresh IVF cycles (n=8944) were included and compared with all singletons born after spontaneous conception (n=571 914). Paper IV: Outcomes for women (n=921) undergoing two IVF pregnancies with singletons (n=1842) were compared with women (n=991) undergoing one IVF pregnancy with twins (n=1982). Results: Paper I: Children born after IVF had a poorer neonatal outcome than children in the general population. Comparing IVF singletons, irrespective of the number of embryos transferred, with singletons in the general population, significantly higher rates of preterm birth (4500g) were higher for singletons after cryopreservation cycles than for singletons in the general population and for singletons after fresh cycles. Higher rates of preeclampsia were noted for pregnancies after cryopreservation cycles versus general population and fresh cycles. Paper IV: Preterm birth, very preterm birth, LBW, VLBW and SGA were dramatically increased for IVF twins as compared with two IVF singletons with the same mother with adjusted odds ratios between 4 and 16. Significantly higher rates of respiratory complications, sepsis and jaundice were detected among the IVF twins. Significantly higher rates of preeclampsia, preterm premature rupture of the membranes and Cesarean section were observed for IVF twin pregnancies. Conclusions: Children born after IVF, also singletons and irrespective of the number of embryos transferred, had a poorer neonatal outcome than singletons in the general population. In singletons born after fresh IVF, certain maternal characteristics and the number of embryos transferred, when there was a ‘vanishing twin’, affected the neonatal outcome negatively. Singletons born after cryopreservation as compared with fresh IVF cycles had a better neonatal outcome as regards LBW. An increased rate of placenta previa was observed after blastocyst transfer. Maternal and neonatal outcomes were dramatically better for women who had two IVF singleton pregnancies than for those with one IVF twin pregnancy. The finding of an increased rate of LGA and macrosomia after cryopreservation needs further studies. The results support SET as the main transfer strategy

Neonatal and maternal outcomes comparing women undergoing two in vitro fertilization (IVF) singleton pregnancies and women undergoing one IVF twin pregnancy

Objective: To compare outcomes for women undergoing two in vitro fertilization (IVF) pregnancies with singletons and women undergoing one IVF twin pregnancy. The concept of single-embryo transfer in IVF has reduced the risks of both maternal and neonatal complications, but there is still a discussion of whether or not twins are a desired outcome of IVF. Design: Registry study. Setting: Not applicable. Patient(s): All reported twins after IVF with double-embryo transfer (n = 1,982) and their mothers (n = 991) and all mothers (n = 921) who gave birth to two IVF singletons (n = 1,842). Intervention(s): None. Main Outcome Measure(s): Maternal and neonatal outcomes including severe neonatal morbidity. Result(s): Preterm birth, very preterm birth, low birth weight, very low birth weight, and small for gestational age were dramatically increased for IVF twins compared with two IVF singletons with the same mother, with adjusted odds ratios from 4 to 16. Significantly higher rates of respiratory complications, sepsis, and jaundice were detected among the IVF twins. Significantly higher rates of pre-eclampsia, preterm premature rupture of the membranes, and cesarean section were observed for IVF twin pregnancies. Conclusion(s): The neonatal and maternal outcomes were dramatically better for women undergoing two IVF singleton pregnancies compared with one IVF twin pregnancy after double-embryo transfer. These results support single-embryo transfer to minimize the risks associated with twin pregnancies. (Fertil Steril (R) 2013; 99: 731-7. (C) 2013 by American Society for Reproductive Medicine.

Obstetric outcome in singletons after in vitro fertilization with cryopreserved/thawed embryos

There is increasing use of cryopreservation in IVF. This study compared singletons born after cryopreservation with singletons born after fresh IVF cycles and singletons born to women in the general population. Data were collected for Swedish IVF treatments during the years 20022006. All singletons from single embryo transfer (SET) and double embryo transfer (DET) after cryopreserved (n 2348) and fresh cycles (n 8944) were included and cross-linked with the Swedish Medical Birth Registry and compared with all singletons born after spontaneous conception (n 571 914). Main outcomes were preterm and very preterm birth and low and very low birthweight (VLBW). Other outcomes were small for gestational age, large for gestational age (LGA), perinatal mortality and maternal outcomes. Singletons from cryopreserved SET/DET or cryopreserved SET had increased rates of extreme preterm birth compared with singletons from the general population. A lower rate of LBW was found for cryopreserved SET/DET singletons compared with singletons from fresh cycles; however, a higher rate of perinatal mortality was detected. The rates of LGA and macrosomia were increased for cryopreserved SET/DET singletons when compared with those from fresh cycles and the general population. For maternal outcomes, a higher rate of pre-eclampsia was noted for pregnancies from cryopreserved cycles compared with those from fresh cycles or the general population, but the rate of placenta praevia was lower in pregnancies from cryopreserved cycles compared with those from fresh cycles. The obstetric outcome of singletons after cryopreservation was slightly poorer when compared with the general population. In comparison with fresh cycles, the outcome varied. The finding of an increased rate of LGA after cryopreservation requires further study

Factors affecting obstetric outcome of singletons born after IVF

BACKGROUND: Singletons born after IVF have an adverse perinatal outcome when compared with singletons in the general population. This study investigates maternal characteristics and IVF-treatment-related variables, for a possible influence on obstetric outcomes. METHODS: Data from all IVF clinics in Sweden, including all IVF singletons born after fresh treatment cycles and own oocytes during 2002-2006, were included (n = 8941) and cross-linked with the Swedish Medical Birth Registry. Four major outcomes were investigated: very preterm birth (<32 weeks), small for gestational age (SGA), placenta previa and placental abruption. Maternal characteristics (age, parity, BMI, smoking and years of infertility) and treatment-related variables (number of oocytes retrieved, number of embryo culture days, number of transferred and cryopreserved embryos, 'vanishing twin') were investigated for independent association with the four selected outcomes. Adjusted odds ratios (AORs) were calculated by logistic regression. RESULTS: Primiparity, smoking, BMI and 'vanishing twin' were associated with an increased risk of very preterm birth. Maternal age, primiparity, smoking, BMI and years of infertility were associated with an increased risk of SGA. Maternal age and blastocyst transfer were associated with an increased risk, and primiparity with a decreased risk, of placenta previa. Smoking was significantly associated with placental abruption. CONCLUSIONS: In singletons born after fresh IVF, certain maternal characteristics and the number of embryos transferred, when there was a 'vanishing twin' affected the obstetric outcome negatively. An increased rate of placenta previa was observed after blastocyst transfer. The results support the use of single embryo transfer and indicate that lifestyle factors are important for obstetric outcome

Obstetric outcome after in vitro fertilization with single or double embryo transfer

BACKGROUND: IVF children, including singletons, are known to have a poorer obstetric outcome than children born after spontaneous conception. With a broad introduction of single embryo transfer (SET), this scenario might change. This study compares the obstetric outcome after IVF with SET, elective SET (eSET), non elective SET (non-eSET) and double embryo transfer (DET) with outcomes in the general population. METHODS: All IVF children born in Sweden after IVF treatment during the years 2002-2006 (n = 13 544 children) were included and compared with all non-IVF children born during the same time period (n 587 009 children). Data were collected from all 16 Swedish IVF clinics and cross-linked with the Swedish Medical Birth Registry. Main outcomes were preterm birth (< 28, < 32 and < 37 w), very-low-birthweight (VLBW) and low-birthweight (LBW). Adjusted odds ratios were calculated. RESULTS: In total, 7763 children were born after SET and 5724 children after DET. Comparing all SET children, irrespective of multiplicity, with all children in the general population, significantly higher rates of,28 w was found for the IVF children. Comparing IVF singletons, irrespective of SET and DET with non-IVF singletons from the general population, significantly higher rates of < 28 w, < 37 w, LBW and VLBW were found. eSET singletons, compared with singletons in the general population, had a significantly higher rate of < 37 w and non-eSET singletons had significantly higher rates of < 28 w and < 2500 g births. CONCLUSIONS: Children born after IVF had a poorer obstetric outcome compared with children from the general population. Singletons, when analysed as one group, irrespective of whether the children were born after eSET, non-eSET or DET, also had a poorer obstetric outcome with higher rates of preterm and LBW compared with singletons in the general population

Autonomic nervous system activation mediates the increase in whole-body glucose uptake in response to electroacupuncture

A single bout of low-frequency electroacupuncture (EA) causing muscle contractions increases whole-body glucose uptake in insulin-resistant rats. We explored the underlying mechanism of this finding and whether it can be translated into clinical settings. Changes in glucose infusion rate (GIR) were measured by euglycemic-hyperinsulinemic clamp during and after 45 min of low-frequency EA in 21 overweight/obese women with polycystic ovary syndrome (PCOS) and 21 controls matched for age, weight, and body mass index (experiment 1) and in rats receiving autonomic receptor blockers (experiment 2). GIR was higher after EA in controls and women with PCOS. Plasma serotonin levels and homovanillic acid, markers of vagal activity, decreased in both controls and patients with PCOS. Adipose tissue expression of pro-nerve growth factor (proNGF) decreased, and the mature NGF/proNGF ratio increased after EA in PCOS, but not in controls, suggesting increased sympathetic-driven adipose tissue metabolism. Administration of α-/β-adrenergic receptor blockers in rats blocked the increase in GIR in response to EA. Muscarinic and dopamine receptor antagonist also blocked the response but with slower onset. In conclusion, a single bout of EA increases whole-body glucose uptake by activation of the sympathetic and partly the parasympathetic nervous systems, which could have important clinical implications for the treatment of insulin resistance.-Benrick, A., Kokosar, M., Hu, M., Larsson, M., Maliqueo, M., Marcondes, R. R., Soligo, M., Protto, V., Jerlhag, E., Sazonova, A., Behre, C. J., Højlund, K., Thorén, P., Stener-Victorin, E. Autonomic nervous system activation mediates the increase in whole-body glucose uptake in response to electroacupuncture