1,720,983 research outputs found
PLACENTATION IN OOCYTE DONATION PREGNANCIES: EVALUATION OF UTERINE ARTERIES DOPPLER AND PLACENTAL HORMONES
Full text linkIntroduction and objective: The aim of our study was to investigate the hypothesis that placentation in oocyte donation pregnancies (OD) presents differences compared to pregnancies conceived naturally or through in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) technique using autologous oocytes, as a result of alteration in normal placental and fetal-maternal interaction responsible of physiological placentation, due to genetic or hormonal factor and abnormal uterine and placental perfusion.
Methods: To verify this issue we performed 2 study concurrently. We first performed a longitudinal study to measure uterine artery doppler pulsatility index (PI) at first (11-13+6 weeks), second (19-21 weeks) and third trimester (30-32 weeks) and maternal serum levels of and 17-β estradiol at 11-13+6 weeks in 55 OD pregnancies, in 48 (IVF/ICSI) pregnancies with autologous oocytes and 122 spontaneous pregnancies.
The second was a retrospective study performed in order to analyze free β-human chorionic gonadotropin (hCG), pregnancy-associated plasma protein-A (PAPP-A) and nuchal translucency in 13624 spontaneously conceived pregnancies (Controls), 171 oocyte donation pregnancies (OD IVF/ICSI) and 76 IVF pregnancies with autologous oocytes (Autologous IVF/ICSI).
Results: Mean uterine artery PI was significantly lower in OD in all trimester of pregnancy. First trimester: Controls 1,679 (DS 0,456), Autologous IVF/ICSI 1,706 (DS 0,481) and OD IVF/ICSI - oocyte recipients 1,415 (DS 0,486), showing the latter a reduced value [IC95% - p 0.001 (OD vs. Spontaneous conceived pregnancies) and p 0.007 (OD vs. Autologous IVF/ICSI)]; II trimester: Controls 0,96 (0,294), Autologous IVF/ICSI 1,15 (0,407), OD IVF/ICSI - oocyte recipients 0,80 (0,292) (p < 0.05). III trimester, only the analysis between OD and spontaneous conceived pregnancies showed the same trend (p 0.018). Free β-hCG levels were significantly higher both in OD IVF/ICSI pregnancies (1.44 ± 1.06 MoM) and Autologous IVF/ICSI (1.48 ± 1.02 MoM) compared to Controls (1.15 ± 0.84 MoM; p<0.05) and Age-matched Controls (1.18 ± 0.98 MoM; p<0.05). PAPP-A levels did not significantly differ among the four groups. Significantly lower nuchal translucency was detected in Controls (1.41 ± 0.36 mm) compared to OD IVF/ICSI (1.46 ± 0.44 mm; p<0.05), in Autologous IVF/ICSI (1.51 ± 0.34 mm; p<0.05) and Age-matched Controls (1.44 ± 0.42 mm; p<0.05).
Conclusion: Oocyte donation has a significant impact either on biophysical and biochemical markers
Detection of Hepatitis C Virus in the Semen of Infected Men and Reproductive Assistance in HCV Discordant Couples : An Overview
No full textReproductive assistance in HIV serodiscordant couples
No full textBACKGROUND Three quarters of individuals infected with human immunodeficiency virus (HIV) are in their reproductive years and may consider pregnancy planning. Techniques have been developed which can minimize the risk of HIV transmission in these couples, and the current literature on this topic is reviewed here. METHODS We reviewed the literature for the following topics: risk of HIV transmission, effects of HIV infection on fertility, reproductive assistance in industrialized and low-income countries, pre-exposure chemoprophylaxis (PrEP) and timed intercourse in HIV-discordant couples for both male and female positivity. Relevant publications were identified through searches of the EMBASE Medline and PubMed databases, the Google-indexed scientific literature and periodic specialized magazines from the on-line Library Service of the University of Milan, Italy. RESULTS In serodiscordant couples in which the man is positive, the primary method used to prevent HIV transmission is 'sperm washing', followed by IUI or IVF. Data show that sperm washing in HIV-positive men has not produced seroconversion in women or their offspring; however, the evidence is limited. Recently, increasing evidence describing PrEP for HIV prevention has been published and PrEP could be an alternative to ART for fertile couples. Usually HIV-infected women undergo self-insemination around the time of ovulation. Few studies have been published on IVF outcome in HIV-infected women. CONCLUSIONS Assisted reproduction programmes should be integrated into global public health services against HIV. For HIV serodiscordant couples with infected men, sperm washing should be the first choice. However, timed intercourse and PrEP for HIV prevention has been reported. Recent data highlight the possible impairment of fertility in HIV-infected women. Efforts to design a multicentric study should be strengthened
Maternal and fetal outcomes in oocyte donation pregnancies
No full textBACKGROUND: Since the first successful use of donated oocytes in 1984, the number of oocyte donation cycles in Europe and the USA has dramatically increased. Consequently, there has been increasing interest in the impact of oocyte donation on maternal and fetal outcomes. OBJECTIVE AND RATIONALE: The aim of this review was to summarize the literature regarding maternal and fetal outcomes from pregnancies conceived through oocyte donation. SEARCH METHODS: Identification of relevant publications was through research within the Embase Medline and PubMed databases, the Google-indexed scientific literature and periodic specialized magazines from the on-line Library Service of the University of Milan. OUTCOMES: Oocyte donation seems to be independently associated with a higher rate of pregnancy-induced hypertension and pre-eclampsia. An explanatory hypothesis is that an immunological maladaptation causes placenta-mediated disorders in oocyte donation pregnancies. The risks are even higher in twin pregnancies. Oocyte donation also seems to be associated with lower fetal birthweight. However, after adjusting for obstetric complications, most studies report less pronounced differences in birthweight or no dissimilarities. The incidence of cesarean section is increased without clear clinical indications. WIDER IMPLICATIONS: Oocyte donation pregnancies are associated with a higher rate of placental disorders of pregnancy, such as gestational hypertension and pre-eclampsia. The risk of poorer neonatal outcomes is increased in oocyte donation pregnancies compared to other in-vitro fertilization pregnancies. Poorer outcomes have been demonstrated especially for twin pregnancies and in association with previous chronic pathologies or the development of obstetrics complications
Oocyte donation pregnancies: maternal and fetal outcomes
No full textSince the first successful use of donated oocytes in 1984, the number of oocyte donation (OD) cycles in Europe and United States has dramatically increased, becoming nowadays a common treatment option, especially to overcome infertility due to advanced age. Oocyte donation pregnancies address specific issues, due to the separation between the “oocyte age” of the conceptus and the “uterine
compartment age” of the mother. Consequently, there has been increasing interest in the impact of OD on several aspects, especially maternal and fetal outcomes.
We performed a retrospective study to analyze obstetrical and neonatal outcome of singleton oocyte donation pregnancies. Data relative to pregnant women who underwent their first trimester screening for aneuploidies between January 2005 and June 2013 were collected. 158 patients with singleton oocyte donation pregnancies were eligible for the study. 60 patients were not reachable at the time of telephone interview. 98 patients were enrolled for the study and were contacted by telephone interview to collect maternal and neonatal outcomes.
Population: the mean maternal age of oocyte donation recipients was 43 years (range 30-54 years), while the mean age of oocyte donors was 26 years (range 18-36 years). Mean maternal pre-pregnancy BMI of recipients was 22.7 kg/m2 (± 3,51). 88.8% of patients were nulliparous. 40.8% of pregnant women had a Bachelor Degree. Obstetrical and neonatal outcome: 89% of women delivered by Cesarean Section and 78% of these were elective C-section by maternal request. 86.6% of patients (n= 84) delivered at term (≥37 weeks) while 13.4% of deliveries (n=13) were preterm (< 37 weeks). 1 pregnancy terminated with therapeutic abortion due to congenital malformation of genito-urinary tract of the fetus. Hypertensive disorders of pregnancies (pregnancy-induced hypertension and preeclampsia) complicated 19.3% of pregnancies. 7.1% of patients were affected by gestational diabetes. Less frequent complications reported were threatened abortion (4.1%), pPROM (3.1%), intrauterine growth restriction (1%) and post-partum hemorrhage (1%). 48 males (50%) and 48 females (50%) were born in our cohort. Mean birthweight of male neonates was 3175 g (± 490 g), with a minimum birthweight reported of 1915 g and a maximum of 4400 g (Q1= 2980 g; Q2= 3100 g; Q3= 3412 g.). Mean birthweight of female neonates was 2959 g (± 502 g), (range 1480- 3700 g; Q1= 2852 g; Q2= 3000 g; Q3= 3212 g). The birthweight of neonates from oocyte donation pregnancies resulted significantly distributed under 50° percentile of standard reference percentile curves of spontaneous pregnancies.
In our cohort, oocyte donation pregnancies are associated with a high incidence of hypertensive disorders of pregnancies. Furthermore, birthweight of neonates from oocyte donation pregnancies results significantly distributed under 50° percentile of standard reference gestation-specific curves of spontaneous pregnancies. These findings are in agreement with previous studies which also reported a higher incidence of pregnancy-induced hypertension, preeclampsia and placental pathology in oocyte donation pregnancies. In this light, the recognition of risks associated with oocyte donation pregnancies, should lead obstetricians to consider tailored clinical surveillance and, possibly, preventive strategies and appropriate screening
Hormonal milieu in singleton pregnancy during the first trimester of gestation: comparison between spontaneous, in vitro fertilization and eggs donation pregnancies
No full textIntroduction:
In pregnancies obtained by ART exogenous estrogens and progesterone need to be administered to ensure endometrial receptivity and to maintain pregnancy after embryo transfer. To our knowledge there are few data on estrogen and progesterone maternal blood levels either spontaneous and in ART pregnancies during the first trimester. The first aim of our study is to create 17β - Estradiol and Progesterone growth curves in spontaneous pregnancy and successively to compare them with those from autologous and oocyte donation pregnancies.
Methods
From November 2015 to June 2016 three groups of singleton pregnancies were studied: spontaneous, in vitro fertilization pregnancies with autologous oocytes (Autologous IVF) and oocyte donation (OD) pregnancies. Maternal hormonal venous concentrations were analyzed in our reference laboratory in 85 spontaneous, 23 homologous IVF from fresh cycles and 12 OD pregnancies between 4 and 13+6 weeks of gestations. Serum samples were processed and assayed for 17 β – estradiol and progesterone using the Electro Chemo Luminescence in Immunoassay (ECLIA – Elecsys/Cobas®) method.
Results
In spontaneous pregnancy, maternal venous 17β - estradiol and progesterone concentrations increase according to gestational age. There is a significant relation between progesterone growth and gestational age, with a concentration growths of 0.2ng/ml per day of gestation.
17β - Estradiol and progesterone are linked by a linear correlation expressed by the following formulation: Log (17β-estr) = 2,5933 + 0,0149 x progesterone and the correlation coefficient is equal 0.388.
Comparing the different mode of conception, maternal serum concentration of 17β - Estradiol appears lower in OD donation than in spontaneous and autologous IVF pregnancy in any weeks of pregnancy (fig 1), while progesterone values are higher in autologous IVF pregnancy than in spontaneous and OD pregnancies (fig2).
Conclusion
Estrogen level are lower in OD pregnancy in the first trimester of pregnancy. Low estrogen level may enhance an efficient and early invasion of spiral artery by the trophoblast.
In autologous IVF the higher progesterone concentration may suggest a revision of progesterone therapy after pick up. It is possible that the correlation between concentration of 17β – estradiol and progesterone could help in prescribing support therapy during the first weeks of pregnancy
Evaluation of uterine arteries doppler and estrogen milieu in oocyte donation pregnancies
No full textIntroduction: The number of oocyte donation (OD) cycles have dramatically increased. While OD pregnancies face increased risks of obstetrical complications, especially pregnancy-induced hypertension and pre-eclampsia (PE), little is known about the physiology and the physiopathology of placentation.
Method: We performed a prospective cohort study to analyze uterine arteries Doppler Pulsatility index (PI) and serum maternal 17 β – estradiol at 11+0-13+6 weeks’ gestation. Three groups of singleton pregnancies were studied: OD, in vitro fertilization pregnancies with autologous oocytes from fresh cycles (Autologous IVF) and spontaneous pregnancies. Outcomes were collected to include only physiological pregnancies.
Results: The analysis by weeks showed a decreased uterine arteries PI between 11 and 13+6 weeks with a similar trend in all groups, but mean uterine artery PI at 11-13+6 weeks were significantly lower in OD recipients compared to Spontaneous Pregnancies and Autologous IVF (1.415 (DS 0.486) vs. 1.679 (DS 0.456) vs. 1.706 (DS 0.481) - p < 0.05). In spontaneous pregnancies,maternal serum levels of 17 β – estradiol grows between 11 and 13+6 weeks, with mean level of 2423 pg/ml at 11.5 weeks, 2521 pg/ml at 12.5 weeks and 4654 pg/ml at 13.5 weeks. Interestingly, in the same cohort we found a higher value in female fetuses with a mean of 3204 pg/ml (DS 1634) compared to the mean value of male fetuses of 2436 pg/ml (DS 1170) with a ratio female/male of 17 β – estradiol maternal serum concentration of 1,31 (IC95%: 1.04 – 1.65). Maternal serum levels of 17 β – estradiol in OD - oocyte recipients were significantly lower than in IVF and spontaneous pregnancies (1705.33 (DS 380.61) vs. 2121.50 (DS 1387.62) vs. 2844.93 (1516,29) p < 0.05).
Conclusion: Mean uterine artery PI and 17-β estradiol at 11-13+6 weeks were significantly lower in OD recipients compared to Spontaneous Pregnancies and Autologous IVF. Oocyte donation has a significant impact on placentation in the first trimester of pregnanc
First trimester placental markers in oocyte donation pregnancies
No full textIntroduction This study investigates the hypothesis that placenta works differently in oocyte donation (OD) compared to spontaneous pregnancies. To verify this hypothesis we examine the first trimester maternal serum levels of free β-hCG and pregnancy-associated plasma protein-A (PAPP-A). Then we evaluated for potential differences of Down syndrome screening between OD pregnancies, in vitro fertilization/intracytoplasmic sperm injection pregnancies with autologous oocytes (IVF/ICSI) and spontaneous pregnancies. Methods We analyze 13624 spontaneously conceived pregnancies (Controls), 171 oocyte donation pregnancies (OD IVF/ICSI) and 76 IVF pregnancies with autologous oocytes (Autologous IVF/ICSI). Furthermore, we collect a cohort of 802 spontaneously conceived age-matched pregnancies, in order to evaluate how older uteri contribute to explain the changes in markers concentrations (Age-matched controls We compare the multiples of the median (MoM) of free β-hCG and PAPP-A and nuchal translucency. Results Free β-hCG levels are significantly higher both in OD IVF/ICSI pregnancies (1.44 ± 1.06 MoM) and Autologous IVF/ICSI (1.48 ± 1.02 MoM) compared to Controls (1.15 ± 0.84 MoM; p < 0.05) and Age-matched Controls (1.18 ± 0.98 MoM; p < 0.05). PAPP-A levels do not significantly differ among the four groups. Significantly lower nuchal translucency is detected in Controls (1.41 ± 0.36 mm) compared to OD IVF/ICSI (1.46 ± 0.44 mm; p < 0.05), in Autologous IVF/ICSI (1.51 ± 0.34 mm; p < 0.05) and Age-matched Controls (1.44 ± 0.42 mm; p < 0.05). Discussion Oocyte donation pregnancies (OD IVF/ICSI) are significantly related to altered maternal serum placenta marker levels. These alterations might be due to the IVF technique
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