Report on the live birth rates and neonatal outcomes of ART patients at Aevitas Fertility Clinic : implications of a Frozen Embryo Transfer (FET) program

Meiring, Elizabeth (2020-03)

Thesis (MNutr)--Stellenbosch University, 2020.

Thesis

ENGLISH ABSTRACT : Background: The practice of Assisted Reproductive Technologies (ARTs) has become quite commercial in the last decade or two, since an increasing number of couple’s face fertility challenges and nevertheless remain hopeful for a family of their own. Recent refinements in ART, especially in the area of embryo cryopreservation especially vitrification, has also increased its popularity. Despite the many benefits of ART, concerns about the health of children born following ART treatment is a relevant topic of discussion. Pregnancy after infertility treatment is associated with negative neonatal and obstetric outcomes in comparison to spontaneous conceptions. Concerns about gestational age and birthweight in babies of patients of advanced maternal age have been voiced and recent evidence mentioned differences in neonatal outcomes between fresh embryo transfer (ET) cycles and frozen embryo transfer (FET) cycles. However, contradictory outcomes exist in the published literature on this subject. Some studies have hypothesized those inferior reproductive outcomes after ART may be due to parental characteristics, insemination method such as in vitro fertilization (IVF) an intracytoplasmic sperm injection (ICSI), embryo culture, cryopreservation and epigenetic modifications. It is therefore the professional responsibility of fertility specialists and scientists to be conscious of the risks of unfavourable outcomes in ART and to record and publish their results in peer reviewed publications. Aims: The primary aim was to conduct a retrospective audit of the fresh and the frozen (vitrified/warmed) embryo transfer (FET) cycle success at Aevitas Fertility Clinic for the period of 2015-2017, by calculating the LBR and evaluating neonatal outcomes. The secondary aim was to retrospectively investigate the possible effect of female age, number of ova retrieved at the time of oocyte pick up (OPU), number of embryos transferred at the time of embryo transfer (ET) and blastulation rate (BR) on the live birth rate (LBR) and neonatal outcomes in FET and fresh ET cycles. Materials and Methods: Data was acquired from the standard, routine de-identified data files of the Aevitas Fertility Clinic, using medical/laboratory records ONLY for the period of 2015-2017. Patients were included in the study after exclusion and inclusion criteria were applied. The data was submitted for statistical analysis and p-values of <0.05 were considered statistically significant. Multiple regression analyses compensated for cycle type (fresh ET/FET), female age, number of embryos transferred at the time of ET, and donor oocyte cycles. Results: The LBR (43,62% vs 45,15%), birthweight (2837,01g vs 2861,41g) and gestational age (36,29 weeks vs 36,53 weeks) of neonates were not significantly between the FET and the Fresh ET groups, respectively (p>0.05). Female age was significantly, negatively associated with the LBR (p=0.003) and neonatal birthweight (p=0.038) and oocyte donation cycles resulted in lower birthweight individuals (p=0.003). Blastulation rate was significantly different between the fresh ET and FET group (48, 18% and 65, 41%) (p=0.000). Conclusion: This retrospective study indicated similar LBRs between the fresh ET and FET groups, which is in agreement with some published works. Contrary to some reports in the literature, reporting improved outcomes on following FETs, our study showed no difference in neonatal birthweight or gestational age between the fresh ET and FET groups. This is possibly due to the compilation of the patient population. The results of the study indicate that the ART and also the blastocyst vitrification programs at Aevitas Fertility Clinic follow good clinical laboratory practices. It is very successful and in this study cohort of patients, no adverse neonatal outcomes were evident. The audit analysis could be followed up including a larger sample size, additional confounders could be added to increase the power of the findings and subgroup analysis might also give more relevant information.

AFRIKAANSE OPSOMMING : Agtergrond: Die toepassing van reproduktiewe biologie en in vitro bevrugtingsmetodes het die afgelope jare taamlik kommersieël geword, omdat 'n toenemende aantal mense uitdagings met infertiliteit moet oorkom, maar steeds hoopvol bly om hul begeertes van ouerskap te bevredig. Die toename in infertiliteitsbehandeling kan ook toegeskryf word aan verfynings in tegnologie en tegnieke in hierdie veld, veral op die gebied van die embryokriobewaring en meer spesifiek vitrifikasie. Genoegsame bewyse van suksesvolle behandeling is al gelewer. Daar is egter kommer oor die gesondheid van die kinders wat na infertiliteitsbehandeling gebore is. Swangerskappe na infertiliteitsbehandeling word geassosieer met negatiewe neonatale en verloskundige uitkomste in vergelyking met spontane swangerskappe. Vorige studies dui aan dat daar swakker resultate is met betrekking tot swangerskapouderdom en geboortegewig by neonatale individue by moeders van ‘n meer gevorderde ouderdom. Onlangse bewyse het verder verskille in uitkomste getoon tussen vars embrio-terugplasings (ET) en bevrore embrio-terugplasing. Daar bestaan egter teenstrydige uitkomste in gepubliseerde literatuur oor hierdie onderwerp. Daar word veronderstel dat swakker uitkomste na infertiliteitsbehandeling moontlik te wyte is aan ouerlike eienskappe, inseminasiemetode soos in vitro bevrugting (IVB), 'n “intracytoplasmic sperm injection” (ICSI), embriokultuur, kriobewaring en epigenetiese modifikasies. Dit is dus die professionele verantwoordelikheid van die infertiliteitsspesialiste en wetenskaplikes om bewus te wees van die risiko's van ongunstige uitkomste van infertiliteitsbehandeling en om rekord te hou van die statistiek binne die onderskeie klinieke. Publikasie van hierdie data aan betrokke rolspelers in die bedryf is van kardinale belang. Doelwitte: Die primêre doel is om 'n retrospektiewe oudit uit te voer van die sukses van die vars en bevrore embrioterugplasing-siklusse by Aevitas Infertiliteitskliniek vir die periode 2015-2017, deur die geboortesyfer te bereken en die neonatale uitkomste te evalueer. Die sekondêre doel is om die effek van vroulike ouderdom, aantal oösiete by aspirasie, die aantal embrios wat teruggeplaas is en die blastoliseringstempo, op die geboortesyfer en neonatale uitkomste in vars en bevrore ET-siklusse te assesseer. Materiale en Metodes: Data vir die projek is verkry uit die standaard, roetine, anonieme datalêers van die Aevitas Infertiliteitsskliniek, slegs van mediese/laboratoriumrekords vir die periode 2015-2017. Data is gefiltreer volgens insluit- en uitsluitingskriteria. Die data is daarna aangebied vir statistiese analise en p-waardes van <0.05 is as statisties betekenisvol beskou. Meervoudige regressie-ontledings het die tipe siklus (vars ET / FET), vroulike ouderdom, aantal embrio's wat teruggeplaas is, en die skenker-oösiet-siklusse, in ag geneem. Resultate: Die geboortesyfer (43,62% vs 45,15%), geboortegewig (2837,01g vs 2861,41g) en swangerskapsouderdom (36,29 weke vs 36,53 weke) van pasgeborenes het nie betekenisvol verskil tussen die vars en bevrore embrioterugplasings groepe nie. Die vroulike ouderdom is negatief geassosieer met die geboortesyfer (p = 0.003) en neonatale geboortegewig (p = 0.038), en die siklusse van oösietskenking het gelei tot pasgeborenes met 'n laer geboortegewig (p = 0.003). Verder, het die blastoliseringstempo het betekenisvol verskil tussen die twee groepe (48,18% en 65,41%) (p=0.000). Gevolgtrekking: Hierdie studie het soortgelyke geboortesyfers aangetoon tussen die vars en bevrore ET-groepe. Ons studie het geen verskil getoon in neonatale geboortegewig of swangerskapsouderdom tussen vars en bevrore ET-groepe nie, wat teenstrydig is met resultate in die literatuur. Hierdie bevinding is moontlik te wyte aan die samestelling van die pasiëntpopulasie. Die resultate van die studie dui aan dat Aevitas-Infertiliteitskliniek goeie kliniese praktykstandaarde volg. Die uitkomste is baie suksesvol, en binne hierdie samestelling van pasiënte is geen ongunstige uitkomste waargeneem nie. Hierdie oudit kan moontlik opgevolg word met ‘n groter steekproef, en addisionele veranderlikes kan in ag geneem word om die betekenisvolheid van die bevindings te bevorder en subgroup analises mag addisionele belangrike informasie verskaf.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/108013
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