Christine C. Skiadas

Risk factors associated with pregnancies containing a monochorionic pair following assisted reproductive technologies

BACKGROUND Although several factors have been identified to predispose to an increased incidence of monozygotic twinning in assisted reproductive technologies (ART), the relative risks associated with each have yet to be fully established. Moreover, the focus has been predominantly on monozygosity, which, in the absence of monochorionicity, does not increase perinatal risk. The present objective was to undertake an analysis of the relative risks of factors associated with monochorionic pairs resulting from ART. METHODS Study cycles included the last cycle, of each patient undergoing ART at Brigham and Womens Hospital from January 1998 to December 2004, that resulted either in a pregnancy with a monochorionic pair (n = 41) or a pregnancy without a monochorionic pair at 12 weeks (n = 2460). We used multivariable logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) to identify factors significantly associated with a monochorionic pair. RESULTS Independent predictors of a monochorionic pair were assisted hatching (OR 2.23, 95% CI 1.06-4.67), ICSI (OR 2.42, 95% CI 1.22-4.83) and Day 5 embryo transfer (OR 2.48, 95% CI 1.62-3.80). The effects of ICSI and Day 5 transfer were amplified when cycles involved both interventions. CONCLUSIONS ICSI and Day 5 embryo transfer synergistically increase the risk of monochorionic placentation. Patients undergoing these procedures should be counselled regarding these increased risks.

Ovarian reserve status in young women is associated with altered gene expression in membrana granulosa cells

Diminished ovarian reserve (DOR) is a challenging diagnosis of infertility, as there are currently no tests to predict who may become affected with this condition, or at what age. We designed the present study to compare the gene expression profile of membrana granulosa cells from young women affected with DOR with those from egg donors of similar age and to determine if distinct genetic patterns could be identified to provide insight into the etiology of DOR. Young women with DOR were identified based on FSH level in conjunction with poor follicular development during an IVF cycle (n = 13). Egg donors with normal ovarian reserve (NOR) comprised the control group (n = 13). Granulosa cells were collected following retrieval, RNA was extracted and microarray analysis was conducted to evaluate genetic differences between the groups. Confirmatory studies were undertaken with quantitative RT-PCR (qRT-PCR). Multiple significant differences in gene expression were observed between the DOR patients and egg donors. Two genes linked with ovarian function, anti-Mullerian hormone (AMH) and luteinizing hormone receptor (LHCGR), were further analyzed with qRT-PCR in all patients. The average expression of AMH was significantly higher in egg donors (adjusted P-value = 0.01), and the average expression of LHCGR was significantly higher in DOR patients (adjusted P-value = 0.005). Expression levels for four additional genes, progesterone receptor membrane component 2 (PGRMC2), prostaglandin E receptor 3 (subtype EP3) (PTGER3), steroidogenic acute regulatory protein (StAR), and StAR-related lipid transfer domain containing 4 (StarD4), were validated in a group consisting of five NOR and five DOR patients. We conclude that gene expression analysis has substantial potential to determine which young women may be affected with DOR. More importantly, our analysis suggests that DOR patients fall into two distinct subgroups based on gene expression profiles, indicating that different mechanisms may be involved during development of this pathology.

Impact of selective reduction of the monochorionic pair in in vitro fertilization triplet pregnancies on gestational length

In this retrospective cohort of IVF-conceived triplets complicated by a monochorionic pair (n = 21), selective reduction of the pair to a singleton pregnancy was associated with a significantly greater likelihood of delivery at ≥34 weeks. On average, reduction of the pair was associated with 52 days longer gestation.

Does emotional support during the luteal phase decrease the stress of in vitro fertilization

OBJECTIVE To determine if phone calls between ET and pregnancy test, decrease stress levels as determined by the Perceived Stress Scale (PSS). DESIGN Randomized controlled trial. SETTING Academic medical center. PATIENT(S) Women undergoing a first fresh cycle of assisted reproductive technology using autologous oocytes with a day 2 or 3 ET. INTERVENTION(S) Phone calls from specialized social workers or standard of care. MAIN OUTCOME MEASURE(S) Primary outcome was the change in PSS score from day of ET compared with 10 days after ET; secondary outcome was perceived patient benefit. RESULT(S) A total of 131 patients were randomized to the intervention (n = 66) or control (n = 65) group. No differences were seen in the final PSS score or the change in PSS score between groups. At the completion of the study, the intervention group was more likely to report that participating in this study was helpful (65.9% vs. 21.4%), as well as to recommend emotional support during an IVF cycle (95.4% vs. 78.6%). CONCLUSION(S) Although we observed no significant change in PSS score, first-cycle IVF patients felt that increased emotional support was needed during the waiting period between ET and pregnancy test. Additional research should be conducted to determine the best interventions for this time period.