Embryonic heart rate as a predictor of first-trimester pregnancy loss in infertility patients after in vitro fertilization

Rauch, E.R.; Schattman, Glenn; Christos, Paul J.; Chicketano, T.; Rosenwaks, Zev

doi:10.1016/j.fertnstert.2008.03.026

Cited by 24 publications

(19 citation statements)

References 16 publications

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“…Clinical pregnancy was defined as an intrauterine gestational sac containing one embryo which demonstrated cardiac action with rate ≥110/min [37], and pregnancies at ≥20 weeks of gestation were classified at on-going. Differences between groups were assessed by Chi-squared and Fisher’s exact tests.…”

Section: Methodsmentioning

confidence: 99%

Selection of single blastocysts for fresh transfer via standard morphology assessment alone and with array CGH for good prognosis IVF patients: results from a randomized pilot study

Yang¹,

Liu²,

et al. 2012

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BackgroundSingle embryo transfer (SET) remains underutilized as a strategy to reduce multiple gestation risk in IVF, and its overall lower pregnancy rate underscores the need for improved techniques to select one embryo for fresh transfer. This study explored use of comprehensive chromosomal screening by array CGH (aCGH) to provide this advantage and improve pregnancy rate from SET.MethodsFirst-time IVF patients with a good prognosis (age <35, no prior miscarriage) and normal karyotype seeking elective SET were prospectively randomized into two groups: In Group A, embryos were selected on the basis of morphology and comprehensive chromosomal screening via aCGH (from d5 trophectoderm biopsy) while Group B embryos were assessed by morphology only. All patients had a single fresh blastocyst transferred on d6. Laboratory parameters and clinical pregnancy rates were compared between the two groups.ResultsFor patients in Group A (n = 55), 425 blastocysts were biopsied and analyzed via aCGH (7.7 blastocysts/patient). Aneuploidy was detected in 191/425 (44.9%) of blastocysts in this group. For patients in Group B (n = 48), 389 blastocysts were microscopically examined (8.1 blastocysts/patient). Clinical pregnancy rate was significantly higher in the morphology + aCGH group compared to the morphology-only group (70.9 and 45.8%, respectively; p = 0.017); ongoing pregnancy rate for Groups A and B were 69.1 vs. 41.7%, respectively (p = 0.009). There were no twin pregnancies.ConclusionAlthough aCGH followed by frozen embryo transfer has been used to screen at risk embryos (e.g., known parental chromosomal translocation or history of recurrent pregnancy loss), this is the first description of aCGH fully integrated with a clinical IVF program to select single blastocysts for fresh SET in good prognosis patients. The observed aneuploidy rate (44.9%) among biopsied blastocysts highlights the inherent imprecision of SET when conventional morphology is used alone. Embryos randomized to the aCGH group implanted with greater efficiency, resulted in clinical pregnancy more often, and yielded a lower miscarriage rate than those selected without aCGH. Additional studies are needed to verify our pilot data and confirm a role for on-site, rapid aCGH for IVF patients contemplating fresh SET.

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Section: Methodsmentioning

confidence: 99%

Selection of single blastocysts for fresh transfer via standard morphology assessment alone and with array CGH for good prognosis IVF patients: results from a randomized pilot study

Yang¹,

Liu²,

et al. 2012

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“…Abnormal ultrasound findings are highly predictive of early pregnancy loss (EPL) [11][12][13][14][15]; however, whether the ultrasound findings for embryos from EPLs are related to specific chromosomal abnormalities remains unclear.…”

Section: Advanced Maternal Age (Ma) Is Associated With An Increasedmentioning

confidence: 99%

Correlation analysis between ultrasound findings and abnormal karyotypes in the embryos from early pregnancy loss after in vitro fertilization-embryo transfer

Ouyang

et al. 2016

J Assist Reprod Genet

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Purpose The purpose of the study is to evaluate the correlation between ultrasound findings and abnormal karyotypes in early pregnancy losses (EPLs) after in vitro fertilizationembryo transfer (IVF-ET). Methods This retrospective analysis assessed 2172 cases of EPL after IVF-ET occurring between January 2008 and December 2013. The cases were examined via transvaginal ultrasonography (TVS). Embryonic tissue karyotyping following miscarriage was performed using a comparative genomic hybridization (CGH) analysis with fluorescence in situ hybridization (FISH). The correlations between the ultrasound findings and the karyotypes were evaluated. Results Six categories of ultrasound findings were observed: normal ultrasound, empty sac, yolk sac only, small gestational sac, small embryonic pole, and early symmetrical arrested growth. The overall rate of abnormal karyotypes was 44.9 % (976/2172), and the rate of abnormal karyotypes associated with a normal ultrasound, empty sac, yolk sac only, small gestational sac, small embryonic pole, and early symmetrical arrested growth was 49.5 % (218/440), 28.1 % (138/491), 43.4 % (197/454), 50.0 % (43/86), 49.8 % (155/311), and 57.7 % (225/390), respectively. Compared with the other groups, the prevalence of chromosomal abnormalities was significantly higher in the early symmetrical arrested growth group but was markedly lower in the empty sac group in all cases and when cases of 46,XX were excluded (p < 0.05). Trisomy 16 was the most common chromosomal abnormality in the yolk sac only, small embryonic pole and early symmetrical arrested growth groups. In the empty sac, small gestational sac and normal ultrasound groups, monosomy X was the most frequent abnormality. Conclusions Chromosomal anomalies may be associated with specific types of ultrasound findings in EPLs after IVF-ET.

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“…Finally, a missed abortion is a pregnancy loss with an embryo present without a heart beat. If an embryo is present with a CRL greater than 5 mm a fetal heart beat is expected to be visible (Rauch et al, ). Alternatively, if a heart beat was once present but is no longer seen, a missed abortion has occurred.…”

Section: Pregnancy Scansmentioning

confidence: 99%

“…The initial EHR can be detected as early as 4 to 6 weeks gestation and should be at least 110 beats per minute (bpm). Embryonic heart rates less than 110 bpm have been associated with poor pregnancy outcomes (Rauch, Schattman, Christos, Chickentano, & Rosenwaks, 2009).…”

Section: Intrauterine Pregnancymentioning

confidence: 99%

See 1 more Smart Citation

Ultrasound for Nurses in Reproductive Medicine

Carr

2011

Journal of Obstetric, Gynecologic & Neonatal Nursing

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Embryonic heart rate as a predictor of first-trimester pregnancy loss in infertility patients after in vitro fertilization

Cited by 24 publications

References 16 publications

Selection of single blastocysts for fresh transfer via standard morphology assessment alone and with array CGH for good prognosis IVF patients: results from a randomized pilot study

Selection of single blastocysts for fresh transfer via standard morphology assessment alone and with array CGH for good prognosis IVF patients: results from a randomized pilot study

Correlation analysis between ultrasound findings and abnormal karyotypes in the embryos from early pregnancy loss after in vitro fertilization-embryo transfer

Ultrasound for Nurses in Reproductive Medicine

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