Collection of pregnancy outcome records following infertility—challenges and possible solutions

Floyd, Erin; Versen‐Höynck, Frauke von; Liu, Jing; Yun, Yueh; Fleischmann, Raquel R.; Baker, Valerie L.

doi:10.1007/s10815-016-0733-1

Cited by 6 publications

(6 citation statements)

References 21 publications

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“…Participants were part of the Stanford Pregnancy Outcomes Following Infertility (POFI) Study (19). After approval of the study by the institutional review board at Stanford University, 878 infertile patients undergoing treatment at the Stanford Division of Reproductive Endocrinology and Infertility with sonographically confirmed viable pregnancy were recruited at 8 weeks' gestation between October 2011 and March 2014.…”

Section: Stanford Pregnancy Outcomes Following Infertility Studymentioning

confidence: 99%

“…Accordingly, the first aim of this study was to investigate maternal RAAS determinants in early pregnancy. To address this question, we used 2 large periconception cohorts, the Stanford Pregnancy Outcomes Following Infertility (POFI) Study and the Rotterdam Periconceptional Cohort (Predict) Study (19,20). Importantly, von Versen-Höynck et al have shown in the POFI Study that an abnormal CL number associates with increased preeclampsia risk (14).…”

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confidence: 99%

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Determinants of Maternal Renin-Angiotensin-Aldosterone-System Activation in Early Pregnancy: Insights From 2 Cohorts

Wiegel

Danser

Steegers‐Theunissen

et al. 2020

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context The corpus luteum (CL) secretes prorenin, renin’s inactive precursor. It may thus contribute to the renin-angiotensin-aldosterone-system (RAAS) activation that is required for maternal adaptation in pregnancy. Whether this activation is disturbed in pregnancies lacking a CL is unknown. Objective The objective of this work is to investigate maternal RAAS determinants in early pregnancy. Design and Setting Two observational prospective cohort studies took place at 2 tertiary referral hospitals. Patients and Intervention(s) Pregnancies (n = 277) were stratified by CL number and in vitro fertilization (IVF) protocol: 0 CL (programmed cycle frozen embryo transfer [FET], n = 28), 1 CL (natural cycle FET, n = 41 and spontaneous conceptions, n = 139), and more than 1 CL (ovarian stimulation and fresh embryo transfer, n = 69). Methods Quantification was performed for maternal prorenin, renin, and aldosterone blood levels at 5, 9, and 11 weeks of gestation. Results Prorenin and renin were lower in the absence of a CL at all time points when compared to 1 CL, whereas prorenin, renin, and aldosterone were higher in the presence of more than 1 CL vs 1 CL (P < .05). Ovarian stimulation with menopausal gonadotropin resulted in higher prorenin, renin, and aldosterone concentrations during the late first trimester than recombinant follicle-stimulating hormone (P < .05). Prorenin, and to a lesser degree renin, correlated positively with serum progesterone and relaxin, but not serum estradiol. Total follicle diameter, body mass index (BMI), polycystic ovary syndrome (PCOS), and antimüllerian hormone (AMH) were additional determinants of circulating prorenin. Finally, pregnancies conceived in the absence of a CL were more disposed to develop preeclampsia. Conclusions CL number, IVF protocol, BMI, PCOS, and AMH affect maternal RAAS activation in early pregnancy, and may thus contribute to pregnancy complications.

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Section: Stanford Pregnancy Outcomes Following Infertility Studymentioning

confidence: 99%

mentioning

confidence: 99%

Determinants of Maternal Renin-Angiotensin-Aldosterone-System Activation in Early Pregnancy: Insights From 2 Cohorts

Wiegel

Danser

Steegers‐Theunissen

et al. 2020

The Journal of Clinical Endocrinology &Amp; Metabolism

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“…Finally, our study may face challenges in the retrieval of medical records for outcome ascertainment. Acceptance of medical release forms, timeliness of delivery, responsiveness of obstetrical offices, and receiving hospitals are a few of the anticipated problems [ 36 ]. Through trimester contacts, we hope to supplement medical record data and decrease loss to follow-up by gathering clinical data through structured questionnaires.…”

Section: Discussionmentioning

confidence: 99%

Natural vs. programmed cycles for frozen embryo transfer: study protocol for an investigator-initiated, randomized, controlled, multicenter clinical trial

Baksh

Casper

Christianson

et al. 2021

Trials

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Background Randomized trials of assisted reproductive technology (ART) have been designed for outcomes of clinical pregnancy or live birth and have not been powered for obstetric outcomes such as preeclampsia, critical for maternal and fetal health. ART increasingly involves frozen embryo transfer (FET). Although there are advantages of FET, multiple studies have shown that risk of preeclampsia is increased with FET compared with fresh embryo transfer, and the reason for this difference is not clear. NatPro will compare the proportion of preeclampsia between two commonly used protocols for FET,modified natural and programmed cycle. Methods In this two-arm, parallel-group, multi-center randomized trial, NatPro will randomize 788 women to either modified natural or programmed FET and follow them for up to three FET cycles. Primary outcome will be the proportion of preeclampsia in women with a viable pregnancy assigned to a modified natural cycle FET (corpus luteum present) protocol compared to the proportion of preeclampsia in pregnant women assigned to a programmed FET (corpus luteum absent) protocol. Secondary outcomes will compare the proportion of live births and the proportion of preeclampsia with severe features between the protocols. Conclusion This study has a potential significant impact on millions of women who pursue ART to build their families. NatPro is designed to provide clinically relevant guidance to inform patients and clinicians regarding maternal risk with programmed and modified natural cycle FET protocols. This study will also provide accurate point estimates regarding the likelihood of live birth with programmed and modified natural cycle FET. Trial registration ClinicalTrials.govNCT04551807. Registered on September 16, 2020

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“…As evident in the supplemental analysis, the study was potentially underpowered to detect significant differences in outcomes such as clinical pregnancy rates until the “Low E2” sample size increased with a higher E2 cutoff. The lack of a unified medical record system in the United States poses a significant challenge to accessing detailed pregnancy and neonatal medical records for a larger cohort of women who have undergone LTZ-FETs ( 57 ). Most of the patients in our cohort were Asian and Caucasian, potentially limiting the generalizability to other ethnic groups.…”

Section: Discussionmentioning

confidence: 99%

The impact of estradiol on pregnancy outcomes in letrozole-stimulated frozen embryo transfer cycles

et al. 2021

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Objective: To assess the impact of low estradiol (E2) levels in letrozole-stimulated frozen embryo transfer (FET) cycles on pregnancy and neonatal outcomes. Design: Retrospective cohort. Setting: University-affiliated fertility center. Patient(s): All patients who underwent letrozole-stimulated FET cycles from January 2017 to April 2020 (n ¼ 217). The ''Low E2'' group was defined as those with E2 serum levels on the day of trigger <10th percentile level (E2 <91.16 pg/mL, n ¼ 22) and the ''Normal E2'' group was defined as those with E2 serum levels R10th percentile level (E2 R91.16 pg/mL, n ¼ 195). Intervention(s): None. Main Outcome Measure(s): Pregnancy outcomes including rates of clinical pregnancy, clinical miscarriage, and live birth. Neonatal outcomes including gestational age at delivery, birth weight, and Apgar score. Result(s): The mean AE SD estradiol level was 66.8 AE 14.8 pg/mL for the ''Low E2'' group compared with 366.3 AE 322.1 pg/mL for the ''Normal E2'' group. There were otherwise no substantial differences in cycle characteristics such as endometrial thickness on the day of ovulation trigger and progesterone levels in early pregnancy. The ''Low E2'' group had a significantly higher clinical miscarriage rate (36.4% vs. 8.8%, adjusted odds ratio 8.06) and lower live birth rate (31.8% vs. 57.9%, adjusted odds ratio 0.28). Neonatal outcomes such as gestational age at delivery, mean birth weight, Apgar scores, and incidence of newborn complications were not clinically different between the groups. Conclusion: Low E2 levels were associated with a significantly higher miscarriage rate and lower live birth rate, suggesting that E2 levels in the follicular phase may have an effect on cycle outcomes. Given the rise in use of FET, further studies are needed to confirm our findings and understand the mechanisms.

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Collection of pregnancy outcome records following infertility—challenges and possible solutions

Cited by 6 publications

References 21 publications

Determinants of Maternal Renin-Angiotensin-Aldosterone-System Activation in Early Pregnancy: Insights From 2 Cohorts

Determinants of Maternal Renin-Angiotensin-Aldosterone-System Activation in Early Pregnancy: Insights From 2 Cohorts

Natural vs. programmed cycles for frozen embryo transfer: study protocol for an investigator-initiated, randomized, controlled, multicenter clinical trial

The impact of estradiol on pregnancy outcomes in letrozole-stimulated frozen embryo transfer cycles

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