Fertility and sterility最新文献

Objective: To study the timing of the effect of linzagolix, an oral GnRH antagonist, on significant reduction in heavy menstrual bleeding (HMB) in women with uterine fibroids.

Design: The study used pooled data from PRIMROSE1 and PRIMROSE2, two double-blind, similar placebo-controlled trials of linzagolix in US and Europe, respectively. Eligible participants were randomized equally across four treatment arms (linzagolix 100mg and 200mg, with and without concomitant hormonal add-back therapy [ABT] consisting of 1 mg estradiol and 0.5 mg norethisterone acetate) and one placebo arm. The cumulative incidence of achieving clinically significant HMB reduction and maintaining it to week 24 was compared between the linzagolix arms and the placebo arm using Kaplan-Meier plots adjusted for confounding by race and study (PRIMROSE1 vs PRIMROSE2).

Subjects: The PRIMROSE trials randomized 1,012 women aged ≥18 years with ultrasound-confirmed uterine fibroids and HMB.

Intervention: Linzagolix (100mg and 200mg, with and without hormonal add-back therapy) versus placebo.

Main outcome measures: The main outcome of this analysis was the time to achievement of clinically significant HMB reduction and its maintenance up to week 24.

Results: The onset of action in achieving and maintaining clinically significant HMB reduction was significantly more rapid for the linzagolix treatment arms than for the placebo arm, with a median time of <4 weeks for most linzagolix doses (except 100mg alone). The fastest onset was seen with linzagolix 200mg with or without ABT doses, with a median time of only 3 days. The cumulative incidence of achieving clinically significant HMB reduction by week 4 and maintaining it to week 24 was also significantly higher for the linzagolix treatment arms than the placebo arm. Specifically, across the four linzagolix treatment arms, 23.2% to 68.1% achieved clinically significant HMB reduction by week 4 and maintained it to week 24 versus 7.8% for placebo arm.

Conclusion: Linzagolix was associated with a quick effect on reducing clinically significant HMB compared to placebo. Linzagolix thus offers a novel non-invasive treatment approach for the rapid management of HMB symptoms in patients with uterine fibroids.

Objective: To assess the relationship between endometrial thickness and live birth rates in fresh embryo transfer and frozen embryo transfer with and without preimplantation genetic testing.

Design: Retrospective cohort study using the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS).

Subjects: Autologous IVF fresh and frozen embryo transfer cycles initiated in 2019-2020.

Exposure: Endometrial thickness measured in millimeters.

Main outcome measure: Live birth rate.

Results: A total of 244,001 embryo transfer cycles met inclusion criteria (100,419 frozen embryo transfer (FET) cycles with preimplantation genetic testing (PGT), 96,249 FET cycles without PGT, and 47,333 fresh embryo transfer cycles). An increase in endometrial thickness was associated with an increase in live birth rate among all cycle types until a threshold of 9mm, after which there was minimal increase in live birth rate. Prior to 9mm, each 1mm increase in endometrial thickness was associated with a relative increase in the odds of live birth by 19% for frozen embryo transfer with PGT (aOR: 1.19, 95% CI: 1.66-1.22), 13% for frozen embryo transfer without PGT (aOR: 1.13, 95% CI: 1.09-1.16), and 15% for fresh embryo transfer (aOR: 1.15, 95% CI: 1.09-1.20).

Conclusion: Live birth rate increased with an increase in endometrial thickness for fresh and frozen transfer with or without PGT until a threshold of 9mm, beyond which the live birth rate plateaued. There was no thickness above 9mm associated with a decrease in live birth.

Objective: To study the association between sperm deoxyribonucleic acid fragmentation index (DFI) and the odds of preeclampsia and other adverse perinatal outcomes after in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatment.

Design: A prospective cohort study including infertile couples undergoing conventional IVF or ICSI treatment and their children. Data regarding preeclampsia and perinatal outcomes were derived from the Swedish National Birth Register.

Patient(s): A total of 1,594 infertile couples undergoing IVF or ICSI treatment and their 1,660 children conceived by assisted reproduction.

Exposure: Sperm DFI measured by Sperm Chromatin Structure Assay.

Main outcome measure(s): The primary outcome was preeclampsia. The secondary outcomes were preterm birth (PTB), low birth weight, low Apgar score, and small for gestational age.

Result(s): With a DFI level of <20% as a reference, the odds ratio (OR) of preeclampsia statistically significantly increased in the group with a DFI level of ≥20% when IVF was used as the fertilization method (OR, 2.2; 95% confidence interval, 1.1-4.4). Already at the DFI levels of ≥10%, in IVF pregnancies, the OR of preeclampsia increased in a dose-response manner, from a prevalence of 3.1% in the reference group to >10% among those with a DFI level of ≥30%. The DFI was not associated with the OR of preeclampsia in the ICSI group. In the entire cohort, a DFI level of ≥20% was associated with an increased OR of PTB (OR, 1.4; 95% confidence interval, 1.0-2.0).

Conclusion(s): High DFI level was associated with increased odds of PTB and, in IVF pregnancies, also increased odds of preeclampsia.

Objective: To examine the association between preovulation body mass index and pregnancy outcomes after frozen embryo transfer in patients with polycystic ovary syndrome with insulin resistance.

Design: This was a single-center, retrospective cohort study.

Patient(s): Women with infertility, diagnosed with polycystic ovary syndrome and insulin resistance, and treated at the Reproductive Medicine Center, Second People's Hospital of Nanning, China, between January 2020 and August 2023, were included.

Exposure: Patients were divided into four groups according to their body mass index (BMI): slim (<18.5 kg/m²), normal (18.5≤ BMI <24 kg/m²), overweight (24≤ BMI <28 kg/m²), or obese (≥28 kg/m²).

Main outcome measure(s): The main pregnancy outcomes included rates of embryo implantation, biochemical pregnancy, clinical pregnancy, and ongoing pregnancy.

Result(s): In total, 282 eligible patients were included. A linear association was observed between the BMI and clinical pregnancy outcomes of the first frozen embryo transfer. After accounting for all potential variables, each 1 kg/m² increase in BMI was linked to a 2% decrease in the embryo implantation rate, 11% decrease in the frequency of biochemical pregnancy, and 9% decrease in the both clinical and ongoing pregnancy rates.

Conclusion(s): In patients with polycystic ovary syndrome and insulin resistance, a higher BMI was associated with lower rates of embryo implantation, biochemical pregnancy, clinical pregnancy, and ongoing pregnancy.

Objective: To investigate first, the association between endometriosis and preterm birth; second, the associations between endometriosis and preeclampsia, placenta previa, postpartum hemorrhage, stillbirth, and small-for-gestational-age infants (assessed by birthweight); and third, the risk of these adverse pregnancy outcomes with and without the use of medically assisted reproduction.

Design: Multicenter retrospective cohort study.

Patients: Deliveries by 368,935 women (377,338 infants) from 1999 through 2016.

Exposure: Endometriosis, defined as a single disease entity (endometriosis and/or ademyosis) MAIN OUTCOMES MEASURES: The main outcome was the preterm birth rate (both <37 and <33 weeks). The secondary outcomes were rates of preeclampsia, placenta previa, postpartum hemorrhage, stillbirth, and small-for-gestational-age neonates.

Results: Women in the endometriosis group had more frequent histories of infertility before the included pregnancy (34.7 vs. 5.0%), more hospitalizations during the pregnancy (27.4 vs. 19.8%), and more planned cesarean sections (14.0 vs. 8.7); they more often were nulliparous (51.7 vs. 43.4%). The prevalence of preterm birth at <37 weeks was 11.1% in the endometriosis group and 7.7% in the unexposed group, and for <33 weeks, it was 3.1% and 2.2%, respectively. The adjusted relative risk for confounding factors was higher in the endometriosis than the unexposed group for preterm delivery <37 weeks (1.40, 95% confidence interval, 1.18-1.67) or <33 weeks (1.53, 95% confidence interval, 1.08-2.16). For the secondary outcomes, the adjusted risk ratios for preeclampsia, placenta previa, postpartum hemorrhage, and small-for-gestational-age status of <10th and <5th percentiles were higher in the endometriosis group. The adjusted risk ratios for stillbirth and small-for-gestational-age status of <3rd percentile did not differ between the two groups, and those after stratification by medically assisted reproduction for preterm birth at <37 and <33 weeks did not differ statistically significantly between them, for the secondary outcomes, only the risk of placenta previa was higher in the medically assisted reproduction and non-medically assisted reproduction subgroups.

Conclusion: Pregnant women with endometriosis had higher risks of preterm birth and other poor pregnancy outcomes than women without endometriosis.