Thyroid Treatment Did Not Improve IVF Miscarriage Rate in Women With Thyroid Antibodies But Normal Thyroid Function

MedicalResearch.com Interview with:
Professor Tianpei Hong, MD, PhD
Of behalf of Prof. Jie Qiao and all the coauthors,
Director, Department of Endocrinology & Metabolism
Director, Department of Laboratory Medicine
Peking University Third Hospital
Beijing, China

MedicalResearch.com: What is the background for this study?

  • Ÿ           Women who test positive for thyroid autoantibodies have been reported to be at 2- to 3-fold higher risk of spontaneous miscarriage than those who test negative. However, the effect of levothyroxine on miscarriage among women with positive thyroid autoantibodies and normal thyroid function has been documented in limited studies with conflicting results.
  • Ÿ           Given the substantial difficulty achieving successful pregnancy among infertile women, identifying optimal treatment for infertile women who test positive for thyroid autoantibodies is particularly important. There are a few randomized clinical trials showing a beneficial effect of levothyroxine treatment on pregnancy outcomes among women undergoing in vitro fertilization and embryo transfer (IVF-ET). However, the sample size of those trials was rather small which may weaken the quality of the evidence.
  • Ÿ           Therefore, the Pregnancy Outcomes Study in euthyroid women with Thyroid Autoimmunity after Levothyroxine (POSTAL) study was conducted in Peking University Third Hospital to evaluate whether levothyroxine treatment initiated before IVF-ET could decrease the miscarriage rate and improve the live birth rate in infertile women who tested positive for antithyroperoxidase antibody but had normal thyroid function.

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IVF Linked To Increased Risk of Congenital Heart Defects

MedicalResearch.com Interview with:
“2010 Nobel Prize in Medicine - development of the in vitro fertilization procedure” by Solis Invicti is licensed under CC BY 2.0
Paolo Cavoretto MD PhD
San Raffaele Scientific Centre
Obstetrics and Gynaecology Department
Milan Italy

MedicalResearch.com: What is the background for this study?

Response: Congenital heart defects (CHD) are the most common forms of congenital disorders and a relevant cause of perinatal morbidity and mortality involving about 0.8% of pregnancies. IVF pregnancies are very common nowadays with increasing rates in the developed countries worldwide. There is no consensus in current practice guidelines whether IVF/ICSI conception represents an indication for performing a fetal echocardiogram according to different eminent scientific societies due to differences in the estimations of the risk for CHD in the available literature.

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Women With Health Insurance for IVF More Likely To Have Successful Live Birth

MedicalResearch.com Interview with:

Emily S. Jungheim, MD, MSCI Assistant Professor, Obstetrics and Gynecology Division of Reproductive Endocrinology and Infertility Washington University St. Louis, Missouri

Dr. Jungheim

Emily S. Jungheim, MD, MSCI
Assistant Professor, Obstetrics and Gynecology
Division of Reproductive Endocrinology and Infertility
Washington University
St. Louis, Missouri

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Many women with health insurance lack coverage for fertility treatment so they end up being self-pay for fertility treatments which can be expensive and limit access to care.

15 states have responded with mandates for employers to include fertility coverage in their employee insurance benefits, and 5 of these have comprehensive mandates that include IVF. Illinois is one of these states. Washington University is located on the border between Illinois and Missouri so our fertility center treats a number of women with coverage for fertility treatment and a large number of women who are self-pay for fertility treatment. We suspected that women requiring IVF to conceive were more likely to follow through with treatments if they had coverage so we decided to look at our data.

Ultimately we confirmed our suspicions. Women with coverage were more likely to come back for additional cycles of IVF if they didn’t conceive. Ultimately this ability to come back for additional treatment cycles led to a higher chance of live birth.

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Does IVF Raise Risk of Malignancies in Offspring?

MedicalResearch.com Interview with:
Tamar Wainstock, PhD

Department of Public Health; Faculty of Health Sciences
Ben-Gurion University of the Negev
ISRAEL

MedicalResearch.com: What is the background for this study?

Response: There is a controversy in the medical literature regarding the possible association between infertility or infertility treatments, and the long-term offspring neoplasm risk: while some studies have found such an association, others have not.
Since the number of offspring conceived following treatments are growing, and as they age, it is critical to clarify this possible association.

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Uterine Microbiome Plays Key Role in IVF Success

MedicalResearch.com Interview with:

Carlos Simón, M.D., Ph. D. Professor of Obstetrics & Gynecology. Valencia University, Spain Scientific Director, Igenomix SL. Adjunct Clinical Professor, Department of Ob/Gyn, Stanford University, CA Adjunct Professor, Department of Ob/Gyn, Baylor College of Medicine, TX

Dr. Carlos Simón

Carlos Simón, M.D., Ph. D.
Professor of Obstetrics & Gynecology. Valencia University, Spain
Scientific Director, Igenomix SL.
Adjunct Clinical Professor, Department of Ob/Gyn, Stanford University, CA
Adjunct Professor, Department of Ob/Gyn, Baylor College of Medicine, TX

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The main findings of this study reside in the concept that the uterine cavity, which has been classically considered as a sterile organ, possess its own microbiome and that the composition of this uterine microbiome have a functional impact on the reproductive outcome of IVF patients.

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National Trends and Outcomes of Embryo Donation

Jennifer F. Kawwass, MD, FACOG Assistant Professor, Emory Reproductive Center Director of Third Party Reproduction, Emory Reproductive Center

Dr. Jennifer F. Kawwass

MedicalResearch.com Interview with:
Jennifer F. Kawwass, MD, FACOG

Assistant Professor, Emory Reproductive Center
Director of Third Party Reproduction, Emory Reproductive Center

MedicalResearch.com: What is the background for this study?

Response: With the increasing use of assisted reproductive technology (ART), the number of cryopreserved embryos in storage has increased, as residual viable embryos from an in vitro fertilization (IVF) cycle may be frozen for future use. Each embryo maintains attributes reflective of the age of the female at time of the original oocyte retrieval. Embryo donation, a form of third-party reproduction, involves donation without compensation of previously formed embryos to another couple for implantation.

Limited published data exist detailing outcomes of donor embryo cycles. Patients and clinicians would benefit from information specific to donor embryo cycles to inform fertility treatment options, counselling, and clinical decision-making. We sought to quantify trends in donor embryo cycles in the United States, to characterize donor embryo recipients, and to report transfer, pregnancy, and birth outcomes of donor embryo transfers.

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New Online Fertility Calculators Predict Chance of IVF Success

MedicalResearch.com Interview with:

David McLernon PhD MPhil BSc Research Fellow in Medical Statistics Medical Statistics Team Institute of Applied Health Sciences University of Aberdeen Foresterhill Aberdeen

Dr. David McLernon

David McLernon PhD MPhil BSc
Research Fellow in Medical Statistics
Medical Statistics Team
Institute of Applied Health Sciences
University of Aberdeen
Foresterhill Aberdeen

MedicalResearch.com: What is the background for this study?

Response: Normally when a couple attend a fertility clinic to begin IVF treatment they are only informed about their chances of having a baby for the first attempt of IVF. In actual fact the first treatment is often unsuccessful and many couples will go on to have several complete cycles of the treatment– each involving the transfer of one or two fresh embryos potentially followed by one or more frozen embryo transfers. We felt that a prediction model that could calculate the chances of having a baby over the complete package of treatment would provide better information for couples.

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Gene Linked to Chromosome Abnormalities Identified

Rajiv McCoy, PhD Dept. of Genome Sciences Univ. of WashingtonMedicalResearch.com Interview with:
Rajiv McCoy, PhD

Dept. of Genome Sciences
Univ. of Washington

Medical Research: What is the background for this study? What are the main findings?

Dr. McCoy:  Aneuploidy—the inheritance of extra or missing chromosomes compared to the typical 46-chromosome set—is extremely common in human embryos. The vast majority of aneuploidies result in preclinical pregnancy loss, often before the pregnancy is even recognized by the mother. This is thought to be the primary reason why only ~30% of all conceptions result in successful live birth.

Many aneuploidies arise during egg formation, with the frequency increasing with maternal age. In addition to meiotic errors, a large proportion of aneuploidies affecting cleavage-stage embryos are mitotic in origin, arising during the initial post-fertilization cell divisions. These initial divisions are controlled by machinery contributed by the mother in the egg (before the embryo’s genome has been activated). While these mitotic errors are frequent in cleavage-stage embryos, we found that they are rare in embryos at day-5 of development (the blastocyst stage), suggesting that embryos and/or cells with extensive mitotic errors do not survive to day 5. We discovered that some women have a greater propensity to produce embryos with mitotic errors than others, and our idea was that maybe differences in the mitotic machinery could help explain this.

Using data from in vitro fertilized embryos screened by our collaborators at Natera, we found that women who have a particular version of a gene called PLK4 tend to produce more aneuploid embryos, regardless of age. This genetic variant is actually very common—more than half of people carry at least one copy—and is present in nearly all populations. PLK4 has a well-known role in ensuring the proper distribution of chromosomes. We also found that patients referred for embryo screening due to previous IVF failure had higher rates of mitotic error, which underscores the clinical importance of this form of whole-chromosome abnormality.

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IVF: Single Cell Analysis Allows Extremely Early Prediction Of Embryo Abnormalities

Shawn L. Chavez, Ph.D Assistant Scientist/Professor Oregon National Primate Research Center OHSU | Oregon Health & Science UniversityMedicalResearch.com Interview with:
Shawn L. Chavez, Ph.D
Assistant Scientist/Professor
Oregon National Primate Research Center
OHSU | Oregon Health & Science University

Medical Research: What is the background for this study?

Dr. Chavez: This study builds upon a previous study also published in Nature Communications in 2012, which demonstrated that chromosomally normal and abnormal 4-cell human embryos can be largely distinguished by combining the timing intervals of the first three cell divisions with the presence or absence of a dynamic process called cellular fragmentation. The current study further combines time-lapse imaging of embryo development and full chromosome analysis with high throughout single-cell gene expression profiling to assess the chromosomal status of human embryos up to the 8-cell stage.

Medical Research: What are the main findings?

Dr. Chavez: The key findings of this research were that by measuring the duration of the first cell division, one can identify which embryos are chromosomally normal versus abnormal even earlier in development. By examining gene expression at a single-cell level, we were able to correlate the chromosomal make-up of an embryo to a subset of 12 genes that are activated prior to the first cell division. These genes likely came from either the egg or sperm and can be used to predict whether an embryo will be chromosomally normal or abnormal within the first 30 hours of development.

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More Sunshine Linked to Better IVF Outcomes

Frank Vandekerckhove, MD, PhD Clinical Head, Centre for Reproductive Medicine University Hospital Ghent BelgiumMedicalResearch.com Interview with:
Frank Vandekerckhove, MD, PhD
Clinical Head, Centre for Reproductive Medicine
University Hospital Ghent
Belgium

Medical Research: What is the background for this study? What are the main findings?

Dr. Vandekerckhove: Several retrospective studies have evaluated seasonal variations in the outcome of IVF treatment. Some also included weather conditions, mostly temperature and hours of daylight. The results were conflicting. We focused on individual variables provided as monthly results by our national meteorological institute. We shifted the results in IVF outcome to the weather results of one month earlier, as we supposed that the selection of good quality oocytes may start in the weeks before.

Between January 2007 and December 2013, the IVF outcome of all Belgian patients treated in our university center was compared to the quarter of the year and monthly mean values of temperature, rain fall, rainy days and sunshine hours during the month when gonadotropins were started or the month before.

11494 patients started an IVF cycle and were included. Firstly bivariate correlation was performed by linear modelling between monthly weather conditions and IVF results. Secondly the same IVF outcome variables were plotted against the weather results stratified per quartile for each individual meteorological variable.

There was no relationship between IVF outcome and the quarter of the year.

When looking for a linear correlation between IVF results and the mean monthly values for the weather, the results were inconsistent.

However, when the same analysis was repeated with the weather results of 1 month earlier, there was a clear trend towards better IVF outcome with higher temperature, less rain and more sunshine hours. The live birth rate per cycle was significantly different (p 0.019) between different groups (Q=quartile) of mean number of sunshine hours (Q1=60.75, Q2=136.00, Q3=174.50).

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Decreasing Financial Burden Of IVF May Encourage Single Embryo Transfers, Reduce Multiple Births

Dmitry Kissin, MD Health scientist CDC Division of Reproductive HealthMedicalResearch.com Interview with:
Dmitry Kissin, MD
Health scientist
CDC Division of Reproductive Health

Medical Research: What is the background for this study?

Dr. Kissin: Due to the frequent transfer of more than one embryo during assisted reproductive technology (ART) treatments, such as in vitro fertilization (IVF), many ART-conceived children are born as multiples (twins, triplets and higher order). Multiple births, even twins, carry increased risk for both mothers and children. In the U.S., the practice guidelines published by the American Society for Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART) provide recommendations on how many embryos to transfer in order to balance safety with the effectiveness of assisted reproductive technology. In an effort to reduce multiple births and associated complications, it is important to evaluate embryo transfer practices that contribute to these outcomes.

Medical Research: What are the main findings?

Dr. Kissin: Using data from the CDC’s National ART Surveillance System (NASS), we found that the majority of ART-related multiple births in the U.S. resulted from assisted reproductive technology cycles practiced in accordance with ASRM/SART guidelines and involved the transfer of two embryos. Almost half of ART-related multiple births resulted from transferring two fresh blastocysts (embryos cultured for 5/6 days) to favorable- or average-prognosis patients less than 35 years and donor-egg recipients, or two frozen/thawed embryos to patients less than 35 years.

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PCOS: Inflammatory Markers May Signal Increase Risk of Pregnancy Complications

Prof. Stefano Palomba Department of Obstetrics and Gynecology University “Magna Graecia” of Catanzaro Catanzaro, ItalyMedicalResearch.com Interview with:
Prof. Stefano Palomba
Department of Obstetrics and Gynecology
University “Magna Graecia” of Catanzaro
Catanzaro, Italy

MedicalResearch: What are the main findings of the study?

Prof. Palomba: Our study demonstrates that simple markers of inflammation, commonly detectable in clinical practice with commercial kits, are significantly modified in women with PCOS during pregnancy and associated at an increased risk of complications during pregnancy in the same population with PCOS.
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IVF: No Increased Risk of Cancer in Children after In-Vitro Fertilization

Alastair Sutcliffe M.D., Ph.D. From the Institute of Child Health University College LondonMedicalResearch.com  Interview with:
Alastair Sutcliffe M.D., Ph.D.
From the Institute of Child Health
University College London

 

MedicalResearch.com: What are the main findings of the study?  

Dr. Sutcliffe: Good NEWS for couples who need assisted conception. All the births (106,000) from Great Britain over 18 years were linked to the National Childhood Cancer Registry from the Human Fertilisation and Embryology Authority (which has recorded all births sine 1991 by law.)Those children who showed up on both registries, had IVF conception and childhood cancer.

We predicted the number we would expect from the known national childhood cancer rates. We found ALMOST IDENTICAL rates 108 in our group and 109 predicted. NO INCREASED RISK OF CANCER AFTER IVF CONCEPTION IN OFFSPRING.
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