The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Ben Willem J Mol - One of the best experts on this subject based on the ideXlab platform.
-
live birth after In Vitro maturation versus standard In Vitro Fertilisation for women with polycystic ovary syndrome protocol for a non Inferiority randomised clInical trial
BMJ Open, 2020Co-Authors: Xiaoying Zheng, Ben Willem J Mol, Wei Guo, Lin Zeng, Danni Zheng, Shuo Yang, Lina Wang, Rui Wang, Jie QiaoAbstract:Introduction Polycystic ovary syndrome (PCOS) is the first common cause of anovulatory Infertility. Currently, In Vitro Fertilisation (IVF) is recommended when conventional attempts have failed. In Vitro maturation (IVM) of human oocytes is an emergIng treatment option In Infertile women with PCOS. It is a patient-friendly Intervention, avoidIng the risk of ovarian hyperstimulation syndrome, which is a serious complication of controlled ovarian stimulation In the standard IVF procedure. We plan a randomised controlled trial (RCT) to evaluate whether IVM is non-Inferior to the standard IVF for live birth In women with PCOS. Methods and analysis This is a sIngle-centre, open-label, non-Inferiority RCT performed In a large reproductive medicIne centre In ChIna. Infertile women with PCOS will be randomised to receive either IVM or standard IVF In a 1:1 treatment ratio after Informed consent. IVF procedures used In our study are all standard treatments and other standard-assisted reproductive technologies will be similar between the two groups. The primary outcome is ongoIng pregnancy leadIng to live birth withIn 6 months of the first oocyte retrieval cycle after randomisation. Pregnancy outcome, maternal safety and obstetric and perInatal complications will be secondary outcomes. The planned sample size is 350 (175 per group). Ethics and dissemInation Ethical permission was acquired from the Ethics Committee of PekIng University Third Hospital. The results will be issued to publications through scientific journals and conference reports. Trial registration number NCT03463772.
-
effectiveness and safety of In Vitro maturation of oocytes versus In Vitro Fertilisation In women with high antral follicle count study protocol for a randomised controlled trial
BMJ Open, 2018Co-Authors: Lan N Vuong, Robert J Norman, Rui Wang, Vinh Quang Dang, Tuan H Phung, Nhu H Giang, Toan D Pham, Johan Smitz, Robert B Gilchrist, Ben Willem J MolAbstract:Introduction In Vitro maturation (IVM) is a potential alternative to conventional In Vitro Fertilisation (IVF) to avoid ovarian hyperstimulation syndrome (OHSS). This is particularly relevant In women with a high antral follicle count (AFC) and/or polycystic ovary syndrome (PCOS), who are at Increased risk for OHSS. However, no randomised controlled trials of IVM versus IVF In women with high AFC have reported both pregnancy and OHSS rates. The aim of this study is to compare the effectiveness and safety of one IVM cycle and one IVF with segmentation cycle withIn women with PCOS or high AFC-related subfertility. Methods and analysis This randomised controlled trial will be conducted at a specialist IVF centre In Vietnam. Eligible subfertile women with PCOS and/or high AFC will be randomised to undergo either IVM or IVF. The primary outcome is live birth after the first embryo transfer of the started treatment cycle. Cycles In which no embryo is available for transfer will be considered as failures. The study has a non-Inferiority design, with a maximal acceptable between-group difference of 5%. Rates of OHSS will also be reported. Ethics and dissemInation Ethical approval was obtaIned from the participatIng centre, and Informed patient consent was obtaIned before study enrolment. Results of the study will be submitted for publication In a peer-reviewed journal. Trial registration number NCT03405701; Pre-results.
-
can we identify subfertile couples that benefit from immediate In Vitro Fertilisation over IntrauterIne InsemInation
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2016Co-Authors: R I Tjonkonfat, Patrick M M Bossuyt, Inge M Custers, Parvin Tajik, Fulco Van Der Veen, Madelon Van Wely, Ben Willem J Mol, Mohammad Hadi ZafarmandAbstract:Abstract Objective Available treatment options In couples with unexplaIned or mild male subfertility are IntrauterIne InsemInation with controlled ovarian hyperstimulation (IUI-COH) and In Vitro Fertilisation (IVF). IUI-COH is a less Invasive treatment that is often used before proceedIng with IVF. Yet as the IVF success rates might be higher and time to pregnancy shorter, expedited access to IVF might be the preferred option. To identify couples that could benefit from immediate IVF over IUI-COH, we assessed whether female age, duration of subfertility or prewash total motile count (TMC) can help to identify couples that would benefit from IVF over IUI-COH. Study design We performed a secondary data-analysis of a multicentre open-label randomised controlled trial In three university and six teachIng hospitals In the Netherlands. 116 couples with unexplaIned or mild male subfertility were randomised to one cycle of IVF with elective sIngle embryo transfer with subsequent frozen-thawed embryo transfers or 3 cycles of IUI-COH. The primary outcome was an ongoIng pregnancy withIn 4 months after randomisation. Our aim was to explore a possible differential effect of specific markers on the effectiveness of treatment. We chose to therefore assess female age, duration of subfertility and TMC as these have previously been identified as predictors. For each prognostic factor we developed a logistic regression model to predict ongoIng pregnancy with that prognostic factor, treatment and a factor-by-treatment Interaction term. Results Female age and duration of subfertility were not associated with better ongoIng pregnancy chances after IVF compared to IUI-COH ( p -value for Interaction=0.65 and 0.26, respectively). Only when TMC was lower than 110 (×10 6 spermatozoa/mL), the probability of ongoIng pregnancy was higher In women allocated to IVF ( p -value for Interaction=0.06). Conclusion In couples with unexplaIned or mild male subfertility, a low TMC might lead to higher pregnancy rates after IVF than after IUI-COH. This fIndIng needs to be validated In a larger trial before it can be applied In clInical practice.
William S.b. Yeung - One of the best experts on this subject based on the ideXlab platform.
-
Cumulative live-birth rate In women with polycystic ovary syndrome or isolated polycystic ovaries undergoIng In-Vitro Fertilisation treatment
Journal of Assisted Reproduction and Genetics, 2013Co-Authors: Vivian Chi Yan Lee, Estella Y L Lau, William S.b. YeungAbstract:Purpose This retrospective cohort study evaluated the cumulative live birth rate In women with polycystic ovary syndrome (PCOS) and isolated polycystic ovaries (PCO) undergoIng In-Vitro Fertilisation (IVF) treatment.
-
role of baselIne antral follicle count and anti mullerian hormone In prediction of cumulative live birth In the first In Vitro Fertilisation cycle a retrospective cohort analysis
PLOS ONE, 2013Co-Authors: Vivian Chi Yan Lee, Estella Y L Lau, William S.b. YeungAbstract:Objective This retrospective study determIned for the first time the role of baselIne antral follicle count (AFC) and serum anti-Mullerian hormone (AMH) level In the first In-Vitro Fertilisation (IVF) cycle In predictIng cumulative live birth from one stimulation cycle.
Siladitya Bhattacharya - One of the best experts on this subject based on the ideXlab platform.
-
e freeze a randomised controlled trial evaluatIng the clInical and cost effectiveness of a policy of freezIng embryos followed by thawed frozen embryo transfer compared with a policy of fresh embryo transfer In women undergoIng In Vitro Fertilisation
Trials, 2020Co-Authors: Jennifer L Bell, Siladitya Bhattacharya, Pollyanna Hardy, Melanie Greenland, Edmund Juszczak, Christina Cole, Abha Maheshwari, Louise LinsellAbstract:The E-Freeze trial is a multi-centre randomised controlled trial of fresh versus frozen embryo transfer for women undergoIng In Vitro Fertilisation. This paper describes the statistical analysis plan for the E-Freeze trial. E-Freeze is a two-arm parallel-group, multi-centre, Individually randomised controlled trial to determIne if a policy of freezIng embryos, followed by thawed frozen embryo transfer, results In a higher healthy baby rate when compared with the current policy of transferrIng fresh embryos. Couples undergoIng their first, second or third cycle of In Vitro Fertilisation at fertility centres In the UK were randomised to either fresh or frozen embryo transfer. The primary outcome is a healthy baby, defIned as a live sIngleton baby born at term with an appropriate weight for gestation. This paper describes the statistical analysis plan for the trial, IncludIng the analysis prInciples, defInitions of outcomes, methods for primary analysis, pre-specified subgroup analysis and sensitivity analysis. This plan was fInalised prior to completion of recruitment to the trial. ISRCTN registry: ISRCTN61225414 . Registered on 29 December 2015.
-
an improvement In the method used to assess discrimInatory ability when predictIng the chances of a live birth after one or more complete cycles of In Vitro Fertilisation
BMJ, 2018Co-Authors: David J Mclernon, Ewout W Steyerberg, Egbert Te R Velde, Amanda J Lee, Siladitya BhattacharyaAbstract:Our paper presents two clInical prediction models that estimate the chance of havIng a baby over multiple complete cycles of In Vitro Fertilisation (IVF)—that is, cumulative live birth.1 The pretreatment model predicts the chance of cumulative live birth before treatment starts, and the post-treatment model predicts the chance of cumulative live birth just after the first embryo transfer. Through a collaboration with researchers from the University of Utrecht, who have externally validated these models, we have decided to revise the method used to assess the discrimInatory ability of our models In the origInal study. In time to event models, such as ours, discrimInation Indicates the proportion of all pairs of women who can be ordered such that the woman with the lower predicted chance of live birth is the one who either did not have a live birth or had more complete cycles of IVF to have a live …
-
In Vitro Fertilisation for unexplaIned subfertility
Cochrane Database of Systematic Reviews, 2015Co-Authors: Zabeena Pandian, Ahmed Gibreel, Siladitya BhattacharyaAbstract:Background One‐third of subfertile couples have no identifiable cause for their Inability to conceive. In Vitro Fertilisation (IVF) is a widely accepted treatment for this condition; however, this treatment is Invasive and expensive and is associated with risks. Objectives To evaluate the effectiveness and safety of IVF compared with expectant management, unstimulated IntrauterIne InsemInation (IUI) or IntrauterIne InsemInation along with ovarian stimulation with gonadotropIns (IUI + gonadotropIns) or clomiphene (IUI + CC) or letrozole (IUI + letrozole) In improvIng pregnancy outcomes. Search methods This review has drawn on the search strategy developed by the Cochrane Menstrual Disorders and Subfertility Group. We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (searched May 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, first quarter), MEDLInE (1946 to May 2015), EMBASE (1985 to May 2015), the Cumulative Index to NursIng and Allied Health Literature (CInAHL) (May 2015) and reference lists of articles. We searched the followIng trial registries: clInicaltrials.gov (http://www.clInicaltrials.gov) and the World Health Organization International Trials Registry Platform search portal (http://www.who.Int/trialsearch/Default.aspx). We searched the Web of Science (http://wokInfo.com/) as another source of trials and conference abstracts, OpenGrey (http://www.opengrey.eu/) for unpublished literature from Europe and the LatIn American Caribbean Health Sciences Literature (LILACS) database (http://regional.bvsalud.org/php/Index.php?lang=en). Moreover, we handsearched relevant conference proceedIngs and contacted study authors to ask about additional publications. Two review authors Independently assessed trial eligibility, extracted data and assessed risk of bias. The primary review outcome was cumulative live birth rate. Multiple pregnancy and other adverse effects were secondary outcomes. We combIned data to calculate pooled risk ratios (RRs) and 95% confidence Intervals (CIs). We assessed statistical heterogeneity by usIng the I2 statistic. We assessed the overall quality of evidence for the maIn comparisons usIng Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methods. Selection criteria We Included randomised controlled trials (RCTs) In which the effectiveness of IVF In couples with unexplaIned subfertility was compared with that of other treatments, IncludIng expectant management, unstimulated IUI and stimulated IUI usIng gonadotropIns or clomiphene or letrozole. Live birth rate (LBR) per woman was the primary outcome. Data collection and analysis Two review authors Independently assessed the eligibility and quality of trials and evaluated the quality of the evidence by usIng GRADE criteria. MaIn results IVF versus expectant management (two RCTs): Live birth rate per woman was higher with IVF than with expectant management (odds ratio (OR) 22.00, 95% confidence Interval (CI) 2.56 to 189.37, one RCT, 51 women, very low quality evidence). Multiple pregnancy rates (MPRs), ovarian hyperstimulation syndrome (OHSS) and miscarriage were not reported. IVF versus unstimulated IUI (two RCTs): Live birth rate was higher with IVF than with unstimulated IUI (OR 2.47, 95% CI 1.19 to 5.12, two RCTs, 156 women, I2 = 60%, low quality evidence). There was no evidence of a difference between the groups In multiple pregnancy rates (OR 1.03, 95% CI 0.04 to 27.29, one RCT, 43 women, very low quality evidence) IVF versus IUI + ovarian stimulation with gonadotropIns (three RCTs) or clomiphene (one RCT) or letrozole (no RCTs): Data from these trials could not be pooled because of high statistical heterogeneity (I2 = 93.3%). Heterogeneity was elimInated when studies were stratified by pretreatment status. In trials comparIng IVF versus IUI + gonadotropIns among treatment‐naive women, there was no conclusive evidence of a difference between the groups In live birth rates (OR 1.27, 95% CI 0.94 to 1.73, four RCTs, 745 women, I2 = 8.0%, moderate‐quality evidence). In women pretreated with IUI + clomiphene, a higher live birth rate was reported among those who underwent IVF than those given IUI + gonadotropIns (OR 3.90, 95% CI 2.32 to 6.57, one RCT, 280 women, moderate‐quality evidence).There was no conclusive evidence of a difference In live birth rates between IVF and IUI + CC In treatment‐naive women (OR 2.51, 95% CI 0.96 to 6.55, one RCT, 103 women, low quality evidence). In treatment‐naive women, there was no evidence of a difference In rates of multiple pregnancy between women who underwent IVF and those who received IUI + gonadotropIns (OR 0.79, 95% CI 0.45 to 1.39, four RCTs, 745 women, I2 = 0%, moderate quality evidence). There was no evidence of a difference In MPRs between women who underwent IVF compared with those given IUI + CC (OR 1.02, 95% CI 0.20 to 5.31, one RCT, 103 women, low‐quality evidence). There was no evidence of a difference In ovarian hyperstimulation syndrome rate between treatment‐naive women who underwent IVF and those given IUI + gonadotropIns (OR 1.23, 95% CI 0.36 to 4.14, two RCTs, 221 women, low quality evidence). There was no evidence of a difference In OHSS rates between groups receivIng IVF versus those receivIng IUI + CC (OR 1.02, 95% CI 0.20 to 5.31, one RCT, 103 women, low‐quality evidence). In treatment naive women, there was no evidence of a difference In miscarriage rates between IVF and IUI + CC (OR 1.16, 95% CI 0.44 to 3.02, one RCT, 103 women, low‐quality evidence), nor between women treated with IVF versus those receivIng IUI+ gonadotropIns (OR 1.16, 95% CI 0.44 to 3.02, one RCT, 103 women). No studies compared IVF with IUI + letrozole. The quality of the evidence ranged from very low to moderate. The maIn limitation was serious imprecision resultIng from small study numbers and low event rates. Authors' conclusions IVF may be associated with higher live birth rates than expectant management, but there is Insufficient evidence to draw firm conclusions. IVF may also be associated with higher live birth rates than unstimulated IUI. In women pretreated with clomiphene + IUI, IVF appears to be associated with higher birth rates than IUI + gonadotropIns. However In women who are treatment‐naive there is no conclusive evidence of a difference In live birth rates between IVF and IUI + gonadotropIns or between IVF and IUI + clomiphene. Adverse events associated with these Interventions could not be adequately assessed owIng to lack of evidence.
-
the prognostic profile of subfertile couples and treatment outcome after expectant management IntrauterIne InsemInation and In Vitro Fertilisation a study protocol for the meta analysis of Individual patient data
British Journal of Obstetrics and Gynaecology, 2012Co-Authors: N M Van Den Boogaard, Siladitya Bhattacharya, P G A Hompes, Kurt T Barnhart, Inge M Custers, Christos Coutifaris, A J Goverde, David S Guzick, P F Litvak, Pieternel SteuresAbstract:Please cite this paper as: Boogaard N van den, Hompes P, Barnhart K, Bhattacharya S, Custers I, Coutifaris C, Goverde A, Guzick D, Litvak P, Steures P, Veen F van der, Bossuyt P, Mol B. The prognostic profile of subfertile couples and treatment outcome after expectant management, IntrauterIne InsemInation and In Vitro Fertilisation: a study protocol for the meta-analysis of Individual patient data. BJOG 2012;119:953–957. Objective The current evidence concernIng the best treatment option for couples with unexplaIned and male subfertility is Inconclusive. Most studies that have evaluated the effectiveness of treatment options, such as expectant management (EM), IntrauterIne InsemInation (IUI), with or without controlled ovarian stimulation (COS), and In Vitro Fertilisation (IVF), have not taken the couples’ prognosis Into account. It is very likely that the Individual prognosis of the couple Influences the effect of treatment. Individual patient data analyses allow us to take these prognostic factors Into account, and to evaluate their effect on treatment outcome. This study aims to use anonymised data from relevant published trials to perform an Individual patient data meta-analysis, evaluatIng the effect of couples’ prognosis on the effectiveness of EM, IUI, with or without COS, and IVF. Methods Based on earlier systematic reviews and an updated search, randomised controlled trials will be considered for Inclusion. Untreated subfertile couples with unexplaIned or male subfertility Included In trials comparIng EM, IUI, with or without COS, and IVF are Included. Authors of the Included studies will be Invited to share their origInal anonymised data. The data will be assessed on validity, quality and completeness. The prognosis of the Individual couple will be calculated with existIng prognostic models. The effect of the prognosis on treatment outcome will be analysed with marker-by-treatment predictiveness curves, illustratIng the effect of prognosis on treatment outcome. This study is registered In PROSPERO (registration number CRD42011001832). Conclusion Ultimately, this study may help to select the appropriate fertility treatment, tailored to the needs of an Individual couple.
-
mInimisIng twIns In In Vitro Fertilisation a modellIng study assessIng the costs consequences and cost utility of elective sIngle versus double embryo transfer over a 20 year time horizon
British Journal of Obstetrics and Gynaecology, 2011Co-Authors: Graham Scotland, Paul Mcnamee, David J Mclernon, Jennifer J Kurinczuk, Kirsten Harrild, H Lyall, M Rajkhowa, Mark Hamilton, Siladitya BhattacharyaAbstract:Please cite this paper as: Scotland G, McLernon D, KurInczuk J, McNamee P, Harrild K, Lyall H, Rajkhowa M, Hamilton M, Bhattacharya S. MInimisIng twIns In In Vitro Fertilisation: a modellIng study assessIng the costs, consequences and cost–utility of elective sIngle versus double embryo transfer over a 20-year time horizon. BJOG 2011;118:1073–1083. Objectives To assess the cumulative costs and consequences of double embryo transfer (DET) or elective sIngle embryo transfer (eSET) In women commencIng In Vitro Fertilisation (IVF) treatment aged 32, 36 and 39 years. Design Microsimulation model. SettIng Three assisted reproduction centres In Scotland. Sample A total of 6153 women undergoIng treatment at one of three Scottish IVF clInics, between January 1997 and June 2007. Methods A microsimulation model, populated usIng data Inputs derived from a large clInical data set and published literature, was developed to compare the costs and consequences of usIng eSET or DET over multiple treatment cycles. MaIn outcome measures Disability-free live births; twIn pregnancy rate; women’s quality-adjusted life-years (QALYs); health service costs. Results Not only did DET produce a higher cumulative live birth rate compared with eSET for women of all three ages, but also a higher twIn pregnancy rate. Compared with eSET, DET ranged from costIng an additional £27 356 per extra live birth In women commencIng treatment aged 32 years, to costIng £15 539 per extra live birth In 39-year-old women. DET cost ∼£28 300 and ∼£20 300 per additional QALY In women commencIng treatment aged 32 and 39 years, respectively. Conclusions ConsiderIng the high twIn pregnancy rate associated with DET, coupled with uncertaInty surroundIng QALY gaIns, eSET is likely to be the preferred option for most women aged ≤36 years. The cost-effectiveness of DET improves with age, and may be considered cost-effective In some groups of older women. The decision may best be considered on a case-by-case basis for women aged 37–39 years.
Rui Wang - One of the best experts on this subject based on the ideXlab platform.
-
live birth after In Vitro maturation versus standard In Vitro Fertilisation for women with polycystic ovary syndrome protocol for a non Inferiority randomised clInical trial
BMJ Open, 2020Co-Authors: Xiaoying Zheng, Ben Willem J Mol, Wei Guo, Lin Zeng, Danni Zheng, Shuo Yang, Lina Wang, Rui Wang, Jie QiaoAbstract:Introduction Polycystic ovary syndrome (PCOS) is the first common cause of anovulatory Infertility. Currently, In Vitro Fertilisation (IVF) is recommended when conventional attempts have failed. In Vitro maturation (IVM) of human oocytes is an emergIng treatment option In Infertile women with PCOS. It is a patient-friendly Intervention, avoidIng the risk of ovarian hyperstimulation syndrome, which is a serious complication of controlled ovarian stimulation In the standard IVF procedure. We plan a randomised controlled trial (RCT) to evaluate whether IVM is non-Inferior to the standard IVF for live birth In women with PCOS. Methods and analysis This is a sIngle-centre, open-label, non-Inferiority RCT performed In a large reproductive medicIne centre In ChIna. Infertile women with PCOS will be randomised to receive either IVM or standard IVF In a 1:1 treatment ratio after Informed consent. IVF procedures used In our study are all standard treatments and other standard-assisted reproductive technologies will be similar between the two groups. The primary outcome is ongoIng pregnancy leadIng to live birth withIn 6 months of the first oocyte retrieval cycle after randomisation. Pregnancy outcome, maternal safety and obstetric and perInatal complications will be secondary outcomes. The planned sample size is 350 (175 per group). Ethics and dissemInation Ethical permission was acquired from the Ethics Committee of PekIng University Third Hospital. The results will be issued to publications through scientific journals and conference reports. Trial registration number NCT03463772.
-
effectiveness and safety of In Vitro maturation of oocytes versus In Vitro Fertilisation In women with high antral follicle count study protocol for a randomised controlled trial
BMJ Open, 2018Co-Authors: Lan N Vuong, Robert J Norman, Rui Wang, Vinh Quang Dang, Tuan H Phung, Nhu H Giang, Toan D Pham, Johan Smitz, Robert B Gilchrist, Ben Willem J MolAbstract:Introduction In Vitro maturation (IVM) is a potential alternative to conventional In Vitro Fertilisation (IVF) to avoid ovarian hyperstimulation syndrome (OHSS). This is particularly relevant In women with a high antral follicle count (AFC) and/or polycystic ovary syndrome (PCOS), who are at Increased risk for OHSS. However, no randomised controlled trials of IVM versus IVF In women with high AFC have reported both pregnancy and OHSS rates. The aim of this study is to compare the effectiveness and safety of one IVM cycle and one IVF with segmentation cycle withIn women with PCOS or high AFC-related subfertility. Methods and analysis This randomised controlled trial will be conducted at a specialist IVF centre In Vietnam. Eligible subfertile women with PCOS and/or high AFC will be randomised to undergo either IVM or IVF. The primary outcome is live birth after the first embryo transfer of the started treatment cycle. Cycles In which no embryo is available for transfer will be considered as failures. The study has a non-Inferiority design, with a maximal acceptable between-group difference of 5%. Rates of OHSS will also be reported. Ethics and dissemInation Ethical approval was obtaIned from the participatIng centre, and Informed patient consent was obtaIned before study enrolment. Results of the study will be submitted for publication In a peer-reviewed journal. Trial registration number NCT03405701; Pre-results.
Michael A Heneghan - One of the best experts on this subject based on the ideXlab platform.
-
safety and efficacy of In Vitro Fertilisation In patients with chronic liver disease and liver transplantation recipients
Journal of Hepatology, 2021Co-Authors: Mussarat N Rahim, Eleni Theocharidou, Katherine Gar Yen Lau, Refah Ahmed, Flevin Marattukalam, Lisa Long, Mary Cannon, Michael A HeneghanAbstract:Background & Aims Chronic liver disease and liver transplantation (LT) can delay both timIng and ability of women to conceive. With Increased awareness and availability of In Vitro Fertilisation (IVF), the need for accurate counsellIng is paramount. To date, mInimal data exist on outcomes of IVF In patients with chronic liver disease, cirrhosis, or post-LT. We report the largest experience of IVF In women with liver-related subfertility (LRSF). Methods A retrospective analysis was performed on 42 women with LRSF who had undergone 57 IVF cycles between 1990 and 2019. Results Forty-two women with LRSF received IVF; 9 cycles In 6 women with cirrhosis, 14 cycles In 11 women post-LT, and 34 cycles In 25 women without cirrhosis. The maIn aetiologies of liver disease Included HBV, HCV, and autoimmune hepatitis (AIH). Of 57 IVF cycles evaluated, 43 (75%) resulted In successful implantation. Eight (2 post-LT, 3 with cirrhosis, 4 without cirrhosis) resulted In miscarriage. The live birth rate (LBR) was 74% (32/43). Two of 9 (22%) patients with cirrhosis, 4/14 (29%) patients who were post-LT, and 6/34 (18%) patients without cirrhosis had unsuccessful IVF attempts. NIne of 57 (16%) IVF cycles resulted In new liver enzyme derangement durIng therapy, which improved after treatment completion. Six pregnancies (2 In patients who were post-LT, 4 without cirrhosis) were complicated by obstetric cholestasis (OC). Ovarian hyperstimulation syndrome (OHSS) was rare (n = 3, 7%). One patient with AIH-related cirrhosis decompensated after InitiatIng IVF, warrantIng discontInuation of therapy. There were no maternal deaths. Three women developed a hypertensive disorder of pregnancy. Half the pregnancies resulted In premature deliveries (range 27–36 weeks). Conclusions In selected cases, IVF In women with LRSF can be successful. However, patients should be counselled on the potential Increased risks of OHSS, OC, and prematurity. Lay summary Women with liver disease or those who have had a liver transplant can experience difficulties gettIng pregnant. In this study, we look at whether alternative approaches to achieve pregnancy are harmful In these women. Overall, there were no significant issues with the use of In Vitro Fertilisation In women with liver disease, but they need to be aware of potential risks, such as early delivery of the baby.
-
safety and efficacy of In Vitro Fertilisation In patients with chronic liver disease and liver transplantation recipients
Journal of Hepatology, 2021Co-Authors: Mussarat N Rahim, Eleni Theocharidou, Katherine Gar Yen Lau, Refah Ahmed, Flevin Marattukalam, Lisa Long, Mary Cannon, Michael A HeneghanAbstract:Abstract Background Chronic liver disease and liver transplantation (LT) can delay both timIng and ability of women to conceive. With Increased awareness and availability of In Vitro Fertilisation (IVF), the need for accurate counsellIng is paramount. To date, mInimal data exists to Inform outcomes of IVF In patients with chronic liver disease, cirrhosis or post-LT. We report the largest experience of IVF In women with liver related subfertility (LRSF). Methods A retrospective analysis was performed on 42 women with LRSF who had undergone 57 IVF cycles between 1990-2019. Results 42 women with LRSF received IVF; 9 cycles In 6 women with cirrhosis, 14 cycles In 11 women post-LT and 34 cycles In 25 women without cirrhosis. MaIn aetiologies of liver disease Included hepatitis B virus (HBV), hepatitis C virus (HCV) and autoimmune hepatitis (AIH). Of 57 IVF cycles evaluated, 43 (75%) resulted In successful implantation. Eight (2 post-LT, 3 cirrhotic, 4 non-cirrhotic) resulted In miscarriage. Live birth rate (LBR) was 74% (32/43). 2/9 (22%) cirrhotics, 4/14 (29%) post-LT and 6/34 (18%) non-cirrhotics had unsuccessful IVF attempts. 9/57 (16%) IVF cycles resulted In new liver enzyme derangement durIng therapy, which improved after treatment completion. Six pregnancies (2 LT, 4 non-cirrhotic) were complicated by obstetric cholestasis (OC). Ovarian hyperstimulation syndrome (OHSS) was rare (n=3, 7%). One patient with AIH-related cirrhosis decompensated after InitiatIng IVF, warrantIng discontInuation of therapy. There were no maternal deaths. Three women developed a hypertensive disorder of pregnancy. Half the pregnancies resulted In premature deliveries (range 27-36 weeks). Conclusion ln selected cases, IVF In women with LRSF can be successful. However, patients should be counselled on the potential Increased risks of OHSS, OC and prematurity.
